HomeMy WebLinkAbout09-10-13 xI �
J 1505610105
REV-1500 EX(02-intFI'
PA Department of Revenue Pennsylvania OFFICIAL USE ONLY
Bureau of individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN
Harrisburg,PA 17128-o6o% RESIDENT DECEDENT a _
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDOYYYY Date of Birth MMDDYYYY
.1212112012 0610911918
Decedent's Last Name SU%IX Decedent's First Name MI
Neumann Hannah rS
(If Applicable)Enter Sumlving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
CND 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12.13-82)
O d.Limited Estate O 4a.Future Interest Compromise(date of O S. Federal Estate Tax Return Required
death after 12.12-82)
COD 8.Decedent Died Testate O 7.Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A)
Between 12-31.91 and 1-1.95) (Attach Schedule O) OD
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX IN "MATiON SHOULD.BE DIRECTEi1 TO:
Name DayCtmejelephoneNumbdrl O
'Andrew C. Sheely, Esquire 717ofiI;i�7L0.5p --I i
rn.z
r`RElnstEp OF ILLS USE ONLY
2 th
O C) O
First Lino of Address O C '�1 M
127 South Market Street O
W Tt
Second Line of Address
P.O. Box 95
City or Post Office State ZIP Code DATE FILED
Mechanicsburg CFW 17055
Correspondent's e-mail address;andreWC.Sheely@verizon.net
Under perrafties of perjury,t declare that I have examined this ream,Including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete.Declaration of preparer other than the Personal representative Is based on all information of which preparer has any Wawledge.
SIGNATU E OF PERSON RESPONSIB OR FILING RETURN
An _ 1afni r,e -13
Janice E. Baer, Execu 'x, 3 1 Minerva Lake Road, Columbus, Ohio 43231 F
SIG RE P A T R AN REPRESENTATIVE VT
� -
/
oeec
Andrew C. Sheely, Esquir , 127 South Market Street, P.O. Box 95, Mechanicsburg, PA 17055
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610105 1505610105
1505610205
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name: Neumann, Hannah S. (
RECAPITULATION
1. Real Estate(Schedule A). . .. . ... . ... . .... . . . .. . . .. . . ... . . . .. . . . ... . . . 1.
2. Stocks and Bonds(Schedule B) .. . . .. . .. . . . .. .. . . ... . ... . .... . . . .... . . 2. 668.75
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) . .. . . 3.
4. Mortgages and Notes Receivable(Schedule D) . . . . . . ... . . .. . . . . . . . . . .... . 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). . .. . . . 5. 591,975.80
6. Jointly Owned Property(Schedule F) O Separate Billing Requested . . . . . . . 6. 203,497.01
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property 101,278.83
(Schedule G) O Separate Billing Requested.. .. . . . . 7.
8. Total Gross Assets total Lines 1 through 7 897 420.39
9, Funeral Expenses and Administrative Costs(Schedule H). .. . . . .... . .. . . .. .. 9. 15,491.02
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1). . ... . . .. . . .. .. 10. 4,238.13
11, Total Deductions(total Lines 9 and 10). . . . . . . .. . . . . ... . . .. . . . . .. . . . ._. 11. 19,729.15
12. Net Value of Estate(Line 8 minus Line 11) .. . . .. . . . . ... . . . . . . . .... . . . ... 12. 877,691.24
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) . . . ... . . .... . .... . . . ... . 13. 56,000.00
14. Net Value Subject to Tax(Line 12 minus Line 13) . . . ... . . ... . . . ... . . ... .. 14. 821,691.24
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers and-,sec.9116
(a)(1.2)X .0 15.
16. Amount of Line 14 t-able
at lineal rate x .o45 801,691.24 16 36,076.10
17. Amount of Line 14 taxable
at sibling rate X.12 17.
18. Amount of Line 14 taxable 20,000.00 3,000.00
at collateral rate X.15 18.
19. TAX DUE . . . . .. . .. . . . . . . .. . .... . .... . .... . ... . . . ... . . ... . . . ... . . . . 19.
39,076.10
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT COD
Side 2
1505610205 1505610205
REV-1500 EX(Fl) Page 3 File Number
Decedent's Complete Address: o;z / " /oZ
DECEDENT'S NAME
Hannah S. Neumann
RTRFFT AnnRFSS -- —
736 Oak Oval
STATE
Me ZIP
Mechanicsburg
VA � 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 39,076.10
2. CreditsfPayments
A.Prior Payments 38,500.00
B.Discount 2,026.25_
3. Interest Total Credits(A+B) (2) 40,526.25
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (3) -
Fill in oval on Page 2,Line 20 to request a refund. (4) 1,450.15
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
I. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred.......................................................................................... ❑ 0
b. retain the light to designate who shall use the property transferred or its income ............................................ ❑ 0
c. retain a reversionary interest .............................................................................................................................. ❑ ■
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 adequate consideration?.............................................................................................................. ❑ N
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ N
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 ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1,1994,and before Jan. 1.1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(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 dales of death on or after July 1,2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S. §9116(a)(1.3)].A sibling is defined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
3081 Minerva Lake Road
Columbus OH 43231
3/15/2013
In regards to: File Number 2012-01333
Glenda Famer Strasbaugh
Register for the Probate of Wills
1 Courthouse Square
Room 102
Carlisle, PA 17013
Dear.Ms. Strasbaugh,
Enclosed please find a check payable to"Glenda Famer Strasbaugh, Register of Wills"in
the amount of$38,500.00 for prepayment of inheritance tax from the estate of Hannah S.
Neumann. Enclosed is a SASE for return of receipt or other correspondence.
Respect5illy,
Janice E Baer
Executrix H. S.Neumann Estate
cc: Andrew C. Sheely, Attorney at Law
REY-gb}E%a(7-v) .
. ;i pennsylvania SCHEDULE B
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hannah S. Neumann 21-12-1333
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
I' US Savings Bond-face value$500,accrued interest$168.75 $668.75
TOTAL(Also enter on Line 2, Recapitulation) $ $668.75
If more space is needed,insert additional sheets of the same size -
PD F 5314
Department of the Treasury
Bureau of the Public Debt
(Revised January 2007)
SAVINGS BOND REDEMPTION CHECK
The enclosed check represents payment for the redemption of series HH or H bonds. If
you also requested payment for the redemption of series EE, E, or I bonds or the issue of
new bonds, you will receive them separately.
Any deferred,interest recorded on the redeemed bonds is interest earned on savings bonds
and/or notes used in purchasing the series HH or H bonds. Deferred interest must be
re orted as taxable income the year of redemption or final maturity whichever is earlier.
We will file this information with the Internal Revenue Service and provide a 1099-INT form
at year end, if appropriate.
Please direct questions concerning this check or the deferred interest on the bond(s) you
redeemed to the Bureau of the Public Debt at (304) 480-7711.
PN )CBANK
070
11ORTHINGTON (068)
6900 North High Street
Worthington OH 43085
Cashbox 06 AM
* Deposit Check
09:48 JUL 9 2013
Account Number XXXXXX9469
Tran Amount $500.00
Check Amount 1: $500.00
W/S ID WPJS07096 Sequence Number 00015
This deposit or payhent is accepted subject to
verification and to the rules and regulations of
this bank. Deposits nay not be available for
mediate eithdraual. Receipt should be held
until verified uith your stateaent.
• REV-15o8 EX+(11-1D)
pennsylvania SCHEDULE E
DEPARTMENT OF R EVE NUE CASH, BANK DEPOSITS & MISC.
INHERrrANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Hannah S. Neumann 21-12-1333
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Central Penn Auto Club refund $51.00
2. Messiah Village meal plan refund $320.44
3. Erie Insurance refund $371.25
4. Decedent's 2008 Chevy Malibu,fair condition $9,000.00
5. PNC Checking Acct.#5005059469,date of death value$58,022.50,accrued interest$.06 $58,022,56
6. Janney Montgomery Scott-Investment Acct.#6214-0661 $518,278.62
7. Decedent's personal property-Decedent was a resident of Messiah Village at the time of her death. $750.00
8. Comcast refund $22.29
9. RiverSource Long Term Nursing Care refund $219.64
10. Messiah Village refund $4,940.00
TOTAL(Also enter on Line 5, Recapitulation) $ 591,975.80
If more space is needed, use additional sheets of paper of the same size.
NO:- C T
-409935 MEMBERSHIP REFUND - '8510240 851,00
DECEASED MEMBER
ID TO: HANNAH S NEUMANN ESTATE TOTAL DISTB. 8*******51.00
ESTATE OF HANNAH NEUMANN Vendor Code: 004412 Vendor Code 004412
invoice No. - Description Date Amount Discount Withheld Net Amount
012113 . 01/21/2013 320.44 ,0.00 0.00 320.44
fVA
,
CheckDate: 101/25/20131 Check O:' 0000124954 1 Totals: 320.4A 0.00 1 0.00 320.44
Messiah Wine-MessiahVilepe-MMiahV"-Memiah wage-MMsien VRpe•MessiM village-Mess[ V&w-MaseiMr Vlape.Messiah Wne-Mmsieh Vnape-Messi�V'lape-MessiahMHa -i
NOTICE OF PREMIUM REFUND
DATE
Erie 02 111 1 2013
Insurancer REFUNDAMOUNT $314.00
100 Erie Ins.R. • Eft.PA 16570 POLICY/ACCOUNT NO. 0101506125
AGENT NO. AA7373
AGENT NAME J P WOLFE INSURANCE INC
CHECK NO. 2000833589
REFUND REASON PRO RATE CANCELLATION
000 0003037 00007000 001 001 03037 INS:0 0
AA7373 NON-NEGOTIABLE
ESTATE OF HANNAH S NEUMANN
C/O JANICE BAER EXECUTRIX
3081 MINERVA LAKE RD
COLUMBUS, OH 43231
THIS REFUND CHECK HAS BEEN ISSUED TO YOU AS A RESULT OF
A PREMIUM CREDIT BALANCE REMAINING ON THE CANCELLED
POLICY/ACCOUNT INDICATED ON THE BELOW CHECK.
IF YOUR RECORDS DO NOT AGREE, PLEASE NOTIFY YOUR AGENT.
— — DATE
MO. DAY YR.
Erie 02 111 1 2013
!4304 Insurance REFUND AMOUNT $20.00
too Erie im.m - Erie,PA 16570 POLICYIACCOUNT NO. 0341550201
AGENT NO. AA7373
AGENT NAME J P WOLFE INSURANCE INC
CHECK NO. 2000829804
REFUND REASON ENDORSEMENT CREDIT
000 000146100000000 001 001 01466 INS:0 0
ESTATE OF HANNAH S NEUMANN AA7373 NON-NEGOTIABLE
C/O JANICE BAER EXECUTRIX
3081 MINERVA LAKE RD
COLUMBUS,OH 43231
THIS REFUND CHECK HAS BEEN ISSUED TO YOU AS A RESULT OF
AN ENDORSEMENT CREDIT APPLIED TO THE POLICY/ACCOUNT
INDICATED ON THE BELOW CHECK.
IF YOUR RECORDS DO NOT AGREE, PLEASE NOTIFY YOUR AGENT.
011751 vep 665011
'tvv 1 tv� vt r 1�uvnvwl nu vIw
DATE
A MO. DAY YR.
Erie o$ I is 1 2013
�\ Insurance'
REFUND AMOUNT $3
100 Ede:m.M. - Eft PA 16530 4155
POLICYIACCOUNT NO. 0341550201
AGENT NO. AA7373
AGENT NAME J P WOLFE INSURANCE INC
CHECK NO. 2001051058
REFUND REASON OTHER REASONS
000 0000011 00000000 001 001 00011 INS:0 0
ESTATE OF HANNAH S NEUMANN AA7373 NON-NEGOTIABLE
C/O JANICE BAER EXECUTRIX
3081 MINERVA LAKE RD
COLUMBUS,OH 43231
THIS REFUND CHECK HAS BEEN ISSUED TO YOU AS A RESULT OF
A PREMIUM OVERPAYMENT AGAINST THE POLICY/ACCOUNT
INDICATED ON THE BELOW CHECK.
IF YOUR RECORDS DO NOT AGREE, PLEASE NOTIFY YOUR AGENT.
1 1x d i §Ma. ° r ri gan►orAmenc' NCuome rCO metlion 641278 '�
. ar. x : �n,.
unbz`7. .1 0'. 'S: 11'
InsUr�ncer 2QnTE fi :ate C}iECKNO?ZOOIU$1058'. kff
100 H2Im PI .Eel PA 16530'.'' �
_ MO DAY
PAY EXACTLY THIRTY SEVE�7`D06LARS AND 2$CENTS'''; 05' I29' 2013
1
TO THE ORDER OF: ESTATE OF HANNAH S NEUMANN $37.25 8
C/O JANICE BAER EXECUTRIX
8
REFUND REASON POLICY/ACCOVNf NO a7�t } H x
OTHER REASONS.' Q341550201 AA7373 •i a 'rs ! n� 4
' , 07or1z�dSlgnatilre ; +,,
- x -
11' 200105105811' 1:06 L11271381: 329 999 651411'
Dec. 28. 2012 9:24AM PNC No. 3437 P. 2
P
December 28,2012
Andy Sheely
Attorney at Law
127 S Market St
Mechanicsburg PA 17055
RE: Hannah S Neumann
SSN: 188-03-8848
DOD: 12/21/2012
Dear Sir/Madam:
In response to your request for Date of Death(DOD)balances for the customer noted above, our
records show the following:
Checking Account
Account#5005059469 Established: 05/01/2009
HANNAH S NEUNLkNN
DOD balance: $58,022.50+0.06 accrued interest
Savings Account
Aa.oust#5112781297 Established: 07/08/2010
HANNAH S NEUMANN ITF
JANICE E BAER
JOYCE E PRINTZ
DUIN balance: $7,229.58+0.05 accrued interest
Ple se note that this office provides date of death balances for deposit accounts(11 As,CDs,Checking and
Savings). We do not process any financial transactions or provide statements. If you need assistance with
any of these items,please call 1-888-PNC-BANK(1-888-762-2265)or stop byyour local PNC Bank branch
office.
Sincerely,
National Financial Services Center
PNC Bank,N.A.
Member FDIC
Page 1 of 2
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400'd TTWULTL SYIP 63:9T ZTOZ-L3-03Q
COMCAST
1555 SUZY STREET
ATTN: LEBANON SUPPORT SERVICES
LEBANON, PA 17046
comcast,
HANNAH NEUMAN 29399 0088-28-49-3DG
736 OAK OVAL
MECHANICSBURG, PA 17055-8408
,II�I�IIT�I'�I'�I�"11"���111,�'I��I1��11,�I1111�1111111111111�,
PAYMENT SUMMARY
CHECK NO: 0010418409
ACCOUNT NO: 09547-43871401 CHECK DATE: 02/20/13
Dear HANNAH NEUMAN,
The attached check represents a refund for account number 09547-43871401 in the amount of
$22.29.
If you are a Comcast %FINITY customer and have questions regarding your refund check, you
can write us at the address above, call Comcast's toll free customer service number at
1-888-COMCAST (1-888-266-2278), or chat with us at www.comcast.com/chat. Our
representatives are available to assist you 24 hours a day, 7 days a week.
If you are a Comcast Spotlight client or agency, please contact your local Spotlight
office.
OETACHAND RETAIN THIS STATEMENT
THE ATTACHEO CHECK IS IN PAYMENT OF ITEMS DESCRIBED ABOVE.
IF NOT CORRECT PLEASE NOTIFY US PROMPTLY NO RECEIPT OESRED
COMCASTW,INANCIALAGENCY CORPORA710N 60-160/433
ACOMCASTCABLE COMMUNICATIONS'GROUP COMPANY
�' - .. ACCOUNT NUMBER CHECK DATE . ' CHECICNUMBER
- - 09547-43871401 02/20/2013 0010418409
VALID FOR 180 DAYS
f E 71 `HANNAH NEUMAN $********22.29
THE 736 •,' OAK OVAL .
i ORDER: `MECHANICSBURG, PA`17055-8408
OF:. . .
i
THE BANK OF.NEW YORK MELLON
.... - PITTSBURGH,- PENNSYLVANIA '
i1'OOL04LB40911' 1:0433016011: L13n, 713 3Lot
RiverSource Life Insurance Company
70100 Amenprise Financial Center
Minneapolis, MN 55474
An Ameriprise Financial Company
January 22, 2013
Claim Number: 517018
��'�III�I�I�II"I'I'��'IIII�I'II"I"II'll�r�I.I�I.�.IrII1.Il1l�l Policy Number: 9100-2953638
HANNAH S NEUMANN
o ESTATE OF HANAH S NEUMANN
g 736 OAK OVAL
N MECHANICSBURG PA 17055-8408
-._-.,Dear-ESTATEOFHANAH.S.NEUMANN: .
Please accept our condolences.
The attached check for $219.64 represents the death benefits due you under this contract.
Premium: —__._$219.64
Total Payment: $219.64
If you have questions, please contact us Monday through Friday from 8 a.m. to 5 p.m. Central time. Thank you.
RiverSource Life Claims
(888) 320-8741
Inaulymw and annu ies arc issued by RiverSource Life Insurance Compar"("RiverSource Life-I an dmen ct
pbse Financial company.RiverSource Life also as as principal in
the sale and distribution of its variable annuity contracts and variable life insurance policies.Other Information regarding execution of the transaction including the time of the
Vansaction will be provided upon written request.
r
MESSIAH
Lfeways
Life. Embraced.
June 14,2013
Janice Baer
3081 Minerva Lake Rd.
Columbus,OH 43231
Dear Ms. Baer:
Enclosed please find a check in the amount of$4,940.00. This is the amount of the refund for
the apartment occupied by Hannah Neumann at 736 Oak Oval,Messiah Village. If you have any
questions regarding the refund,please call me at(717) 591-7204.
1Sincerely,
&Own
Michele Maglich BrovJA
Director of Financial Operations
Encl.
Allen.100 Wit. Drive, •r
Life Coaching En.ichment Opportunities I Community Support J Messiah Village 1 Mount Joy Country Homes
REV-J509 EX+(01-10)
pennsylvania SCHEDULE F
r� DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN IOINTLY-OWNED PROPERTY
RESIDENT DECEDENT
ESTATE OF: _ FILE NUMBER:
Hannah S. Neumann 21-12-1333
If an asset became jointly owned within one year of the decedent's date of death,It must be reported on Schedule G.
SURVMNG JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A.Janide E. Baer 3081 Minerva Lake Road,Columbus,OH 43231 Daughter
8-Joyce E. Printz 2185 Franklin Hill Road, Hallstead, PA 18822 Daughter
C.
JOINTLY OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
• ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENTS VALUE OF
NUMBER TENANT )DINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST
1. A. 5101109 PNC Bank A.Savings Acct#5112781297, Jointly owned with Janice E. $7,229.63 331/3 $2,409.87
Baer&Joyce E.Printz. Date of death value:$7,229.58,interest$.05
2. A 10123/09 Janney Montgomery Scott—Acct.#8830-5973,Jointly owned with Janice 201,087.14 50 $100.543.57
E.Baer. Date of death value:$201,087.14
3. B 10/09/09 Janney Montgomery Scott—Acct.#7801-4335,Jointly owned with Joyce $201,087.14 50 $100,543.57
E.Printz. Date of death value:$201,087.14
TOTAL (Also enter on Line 6, Recapitulation) $ 203,497.01
If more space is needed,use additional sheets of paper of the same size.
DEC-27-2012 e:= i 7177314411 mo
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REV-110 EX+(08-09)
gjJpennsylvania SCHEDULE G
!i7 DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TM RENRN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hannah S. Neumann 21-12-1333
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM DESCRIPTION OF PROPERTY
INCLUDE THE WE OF THE TRANSFEREE,THEIR REIATOA'SHIP TD DECEDENT AND DATE OF DEATH % DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OFTRAISFOL ATTACH A COPT Of THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IFAPRICAPIEI VALUE
I. Thrivent Annuity Agreement#4877132 101,278.83 100% 101,278.83
TOTAL(Also enter on Line 7, Recapitulation] $
101,278.83
If more space is needed,use additional sheets of paper of the same size.
WThrivent Financial for Lutherans-
' 4321 N.Ballard Road,Appleton,WI 54919-0001
Thrivent.com•800-THRN'ENT(800-847.4836)
January 23, 2013
Attorney Andrew C Sheely
PO Box 95
Mechanicsburg, PA 17055
Claim: Hannah S Neumann
Dear Mr Sheely,
Our insured, Hannah Neumann, was the owner of the following contract(s).
Contract Date of Death Value as of December 21, 2012
Life insurance contract 349207 $ 7,483.05
Fixed Period settlement agreement 4877132 $ 101,278.83
Life insurance contract 71904 $ 2,018.26
If we can be of further assistance, let us know.
Sincerely,
Darla Kratzke,ALHC
Claims Examiner, Death Claims
Claims Operations, Member Interactions
Hannah S Neumann CIF 506703017
REV-1511 EX,+(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hannah S. Neumann 21-12-1333
Decedent's debts must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. K.M. Knight Funeral Home $8,923.00
2. St.John's Church-funeral meal $145.25
3. Gingrich Memorials $165.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: $0.00
Name(s)of Personal Representative(s)�Janice E. Baer
Street Address 3081 Minerva Lake Road
city Columbus —State OH ZID43231
Years)Commission Paid:.
$3,500.00
2. Attorney Fees:
3. Family Exemption: (if decedent's address is not the same as claimant's,attach explanation.)
Claimant - -
Street Address_
city_ _State ZIP
Relationship of Claimant to Decedent_
$528.50
4. Probate Fees:
5. Accountant Fees: $341.25
6. Tax Return Preparer Fees:
7. Postage for certified mail and correspondence $85.28
B. Reimbursement to Executors for travel and related administrative espenseslcosts $1,187.74
9. Filing Fee $15.00
10. Reserves to conclude Estate administration,final accountings $600.00
TOTAL(Also enter on Line 9, Recapitulation) $ 15,491.02
If more space is needed,use additional sheets of paper of the same size.
R.:ffl. Rttigbt iunerat jlOme
31 Second Street • Highspire, PA 17034
Phone 717-939-5602
D. Duke Cuckovic,'Jr., Owner
Janice E. Baer
3081 Minerva Lake Road
Columbus,Ohio 43231
Date January 30, 2013
Funeral Expenses for—Hannah S.(Baer)Neumann
Professional Services
Services of Funeral Director.. ............ ......... 1,990.00
Embalming...(Regular)...........................................795.00
Dress,Casketing...................................................250.00
Sub-Total Professional Services.................... ............................$ 31035.00
Facilities and Services
Funeral Service and Staff......................................390.00
Ptep-Room and Supplies........................................250.00
Sub-Total Facilities and Equipment....... ....... ......... .......S 640.00
Automotive Equipment
Removal to Funeral Home... ?..................200.00.
Hearse.............................................................300.00
UtilityVan............................................-.....................175.00
Sub-Total Automotive Equipment..............................................$ 675.00
Charge For Merchandise Selected
20 Gauge Jupiter-Bronzetone..............:.................1,690.00
Guardian Concrete Vaul t.......:..........:............ ....1,150.00
Register Book, Folders, Thank you cards...................100.00
Sub-Total of Merchandise........ .......... .............. ........... 2,940.00
Cash Advance
Newspaper(Harrisburg Patriot)............'.....................248.00
Certified Copies of Death Certificates....`.......................50.00
Grave opening regular—St.John's Cemetery................700.00
Minister.......................................:.....................150.00
Organist....................................... .....................150.00
Vault Service Charge.......................'........................275.00
Hair Dresser.................................!...,...................50.00
Sub-Total of Cash Advanced...................... ..............................$ 1,633.00
Total Funeral Expenses............................. .............................$ 8,923.00
x:
e`
CHARGE SALES INVOICE
OBAhold {�I . VI,VIS7
USA
Store# Please pay*om this invoice..
"'Date TERMS : NET10DAYS '
F . Payments accompanied by remittance copy
` otthis invoice should be mailed to: Customer'
Ahold Financial Services Account No,
3213 Paysphere Circle Ytiicleone: Profit N
}1
Chicago , IL 60674 Tax Exempt#
P.O. No.
' Address
.. Street (City) State Code
a
Shopper,s Name ePrinted 0 , C
Customer's Signature i L w::^n r'. TOTAL 1.
Retain Store Copy for 1 period - Form#1467
Shred upon completion of retention period.. -� - .Revised 0411311:
h� ..
White—General office copy Yellow-Store'Copy Pink—Remittance-Co PY' Gold—custoiner Copy
Gingrich Memorials
568 N. Union Sheet
Middletown, PA 17057
(717) 944-34 1
Janice Baer-McCreary invoice 3/14/2013
3081 Minerva Lake Rd
Columbus, OH 43231
Contract# Contract Date Name Salesman
11-11533 1/3112013 Hanna Baer Nathan Gingrich
I Cemetery Inscription
916mijou,,your memorldor cemetery Order Total: $165.00
inscription isfilds&d Payments: $0.00
Balance Due; $165M
Please include contract 9 with your payment
A finance charge of IY2%per month(18%annuidly) w91 be added after 30 days
..........11 ...... - I - - � .. ... ..
PLEASE TEAR THIS PORTION OFF AND RETURN WITH PAYMENT
Ginarich Memorials Family: Baer
569 N. Union Street Contract#: 11-11533
Middletown, PA 17057
Balance Due: 4)165.00 Amount Paid:
i
RECEIPT FOR 1AYMENT
GLENDA FARNER STRASBAUGH Receipt Date : 12/27/2012
Cumberland County —Register Of Wills Receipt, Time : 10 :4708
One Courthouse Square Receipt No. : 1072508
Carlisle, PA 17013
I
NEUMANN HANNAH S
Estate File•No. : 2012-01333
Paid By Remarks : ANDREW C SHEELY j
HEA
--------- ---- - -- -------- Receipt Dist ibution ---------------=------
Fee/Tax Description Payment Amoun� Payee Name '
PETITION LTRS TEST 460 . 00 CUMBERLAND �COUNTY GENERAL FUN
WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 20 . 00 CUMBERLANDICOUNTY GENERAL FUN
JCS FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D
AUTOMATION FEE 5 . 00 CUMBERLANDICOUNTY GENERAL FUN
RENUNCIATION 5 . 00 CUMBERLAND COUNTY GENERAL FUN
-------------= -
Check# 4096 $528 .50
Total Received. .. . . . . . . $528 . 50
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HAMILTON & MUSoM, PC, CPAs
176 Cumberland Parkway
Mechanicsburg,IPA 17055
717-697-3888
April 4,2013
CONFIDENTIAL
HANNAH NEUMANN
3081 MINERVA LAKE RD
COLUMBUS,OH 43231
For professional services rendered in connection with the preparation of your 2012 individual tax
return:
ReturnSummary.............................................................................................$ No Charge
2 Yr Comparison Report.................................. .............................................. No Charge
Tax Return History Report............................... .............................................. No Charge
Form 1040-V Voucher(Payment Voucher)..... .............................................. No Charge
Form 1040(Individual Income Tax Return)................................................... 140.50
Schedule A(Itemized Deductions}..................1.............................................. 73.00
Schedule D(Capital Gains and Losses)........... .............................................. 35.50
Form 8949(Sales&Disp of Capital Assets)....I.............................................. 25.75
Form 8948(Preparer Explanation Not ELF).... .............................................. 11.50
General Sales Tax Worksheet.......................... ................................I............. No Charge
Social Security Worksheets.........................I.... .............................................. 1.75
Carryover Reports............................................1..............................................
7.75.
Pension/Annuity Report...................................1.
SSA-1099 Documents..................................... ............................................... No Charge
............. No Charge
3 1099-R Documents......................................... . g
PASummary Report........................................L.............................................. No Charge
PA Two Year Comparison Report...................I..........................................:.... No Charge
28.75
PA Form PA-40(Income Tax Return)............................................................ No Char e .
PA Schedule W2S (Wage Statement Summary)............................................. g
PA Schedule AB(Interest and Dividend Income)......................................... No Charge
PA Schedule D(Sale of Pro .............................................. No Charge
Property)..
PA Form PA-V(Payment Voucher)...............I............................................... No Charge
PAIncome Worksheet.................................... ............................................... No Charge
Amount due $ 341.25
INTERVIEWER:RICHELLE L.HAMBERGER,CPA
PREPARER:RICHELLE L HAMBERGER.CPA
CLIENT ID:NEUMANN
f
• MESSIAH Fqm PB
W
l!fewa s•
at MESSIAH VILLAGE f
I
100 MT.ALLEN DRIVE,MECHANICSBURG,PA 17055 I RESIDENT# I UNIT I STMT. DATE
20916 736 02/28/2013
RESIDENT(S)
JANICE BAER Mrs. HANNAH NEUMANN
3081 MINERVA LAKE ROAD
COLUMBUS, OH 43231 I TOTAL AMOUNT DUE $360.00
DATE DUE 03/31/2013
DG NOT PAY Total amount due will be electronically withdrawn from your bank account. DO NOT PAY
DATE DESCRIPTt6N i RATE Units CHARGES° CREDITS BALANCE
Balance Forward 1,114.00
02/20/2013 PAYMENT RECEIVED-THANK YOUI I I 1,114.00 0.00
02/02/2013 GUEST ROOM-APARTMENT 60.00 6.00 360.00 360.00
GUEST APARTMENT 1/27-2/2/13 I
I
I
RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE
20916 360.00 0.00 0.00 0.00 0.00 $360.00
RESIDENT NAME Mrs. HANNAH NEUMANN NIA P841
?lease make check payable to Messiah Lifeways at Messiah Village.
k I%finance charge may be assessed on accounts for which payment has not been received by the due date. Thank you!
If you have any questions or concerns about your bill,please address them directly to Fiscal Services at 790-8220. Thank You!
GLENGARY POST OFFICE
WESTERVILLE, Ohio
430819996
3817950586 -0099
. 11/05/2013 (800)275-8777 11:29:21 AN
Sales Receipt
rroduct, Sale Unit Final
Iescription Qty Price Price
i
IARRISBURG PA 17106 $0.45
:one-4 First-Class
.otter G
O.80roz. Y/4i+�iCa�
Issue PVI:
:ARLISLE PA 17013 $0.45
:one-4 First-Class
.otter .. ¢¢
0.40 oz. Voter
Issue PVI: V c1;07
Forever) 1 $9.00 $9.00
our Flags
rouble Sided
.kit/20
otal: $9.90
raid by:
:ash $10.00
:hanse Due: 40.10
1rder.stamps.at usps.com/shop or call
.2800-Stamp24. Go to usps.com/clicknship
.o -print.shipping labels with postage. For
.ther information call 1-800-ASR-USPS.
wwaaaaww»RaiwaaaKaKww»waw«wKKaKKwwww»Rw
RR wa K»#R#M»K+wwaKK+w#ww Ya#xiKaK»»#»»»w» ,
let your mail when and where you want it ;
,ith a secure Post Office Box, Sign up for
box online at usps.coa/poboxes.
rwwwwwwK#wwwawwwwww+wRwwwwRawaww K+wwaKa
ww wwaaKKMwMMw Rwa»wwxwwwx#Mx w»wKMRM»a MMR I -
f
:il1N: 1000100368629
:lerk: 10
All sales final on stamps and postage
Refunds for guaranteed services only
Thank you for your business
r»KKK#w»w##wwwKx»ww»M#www waKKxwK xw+»x K»K
r#RK+xw»w»Kwww w»Rwww#KM##Ra»RMwwx»MR#»Kw . .
HELP US SERVE YOU BETTER
Go to: https://postalexperience.com/Pos
TELL US ABOUT YOUR RECENT
POSTAL EXPERIENCE
YOUR OPINION COUNTS
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.w ww wwKK»RwwRwwwwww»wwwwwwwwwraRKww»KKww
Customer Copy
I
i
REV-1512 EX+ (12-08) - i
T pennsylvania SCHEDULE I
DEPARTMENT of REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF - FILE NUMBER .-
Hannah S.-Neumann 21-12-1333
Report debts incurred by the decedent prior to death that remained unpaidat the date of death,including unreimbursed medical expenses..
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PPL-final bill $81.68
2. Verizon-final bill $91.60
3. Erie Insurance-final bill $20.25
4. Alert Pharmacy-final bill i $35.31
5. Holy Spirit-final bill $375.00
6. Guideposts subscription-final bill $27.97
7. Messiah Lifeways-monthly rent $1,114.00
8. Messiah Lifeways-monthly rent,mist.expenses $1,180.00
9. Messiah Homecare $578.08
10. Decedent's 2012 Federal Income Tax due $336.00
I
11. Decedent's 2012 PA Income Tax due $83.00
i
12. Checking account imaging fee $18.00
13. Repairs/maintenance to Decedent's Chevy Malibu prior to sale $297.24
TOTAL(Also enter on Line 10, Recapitulation) $ 4,238.13
If more space is needed,Insert additional sheets of the same size.
1 Insured C<
EriEF Insurance
VVV -'' 0 3 Exchange Mail Date: 02105/201
M mber Erie Insurance G=P
100 Erle Im.R. • ele,PA 16530
Premium Invoice
Named Insured
ESTATE OF HANNAH Policyholder: ESTATE OF HANNAF
S NEUMANN C/O JANICE BAER EXEC Policy Number: Q50261038,1
3081 MINERVA LAKE RD Policy Type: - Home Protecto
COLUMBUS OH 43231-4864
Policy Period: 02/26/2013 - 021261201r
025931793
AA7373 Previous Minimum Due: $0.00
Payment: $0.00
Net Adjustments: $0.00
Past Due Amount: $0.00
Current Installment: $81.00
ERIE Agent Billing Fees Due: �� $0.00
Agent Number AA7373 To pay in full: $81._
J P WOLFE INSURANCE INCMlu' �1
23 W MAIN ST
SHIREMANSTOWN, PA 17011-6327 Thank you for choosing Erie Insurance for your
(717)737-4981
insurance needs!
I r
Want to pay this-bill online? Go to www.erieir5surance:com, Pay My Bill and make a convenient, secure online payment.
Other bill paying options are also available on our Web site.IContact your Agent with questions or coverage changes.
Fees Will be added for any returned payments and included on future invoices.
Keep top portion for your records/Return bottom portion with your payment
0emch here PCOO Detach mm
ESTATE OF HANNAH Agent Number: AA7373
S NEUMANN C/O JANICE BAER Agency Name: J P WOLFE INSURANCE INC Mail Date 02/05/201:
3081 MINERVA LAKE RD Agency Phone: (717)737-0981: Due Date 02126/201:
COLUMBUS, OH 43231 -4864 Policy Number. 0502610385 .
Policy Type: Home Protector MINIMUM DUE $81.01
Please Write Your Policy Number On
Your Check and Make Payable to: TO PAY IN FULL: $81.01
Address Change:
ERIE INSURANCE GROUP Amount You Are Paying: $
❑PERMANENT ❑TEMPORARY 100 Erie Insurance Place Payment Plan: --A— .
Erie, PA 16530 Change pay plan to A<en f� a.7
(See Reverse side for Vay plan options)
PLEASE DO NOT WRITE BELOW THIS LINE 9 IJ4/fP -
PHONE �)
ALEkT A FINANCE CHARGE OF 1.50 % PER MONTH
i tnRnfACVSmvtC�.m, 219 North Baltimore Ave (AN ANNUAL PERCENTAGE RATE OF 18.0$) OR A
Mt Holly Springs, PA 17065
Responsive. Innovative. Reliable. 800-266-9954 (717)486-860CMINIMUM SERVICE CHARGE OF $ 1:00 WILL BE CHARGED
ivw Aler(Pharmacgcom ON ALL AMOUNTS 30 DAYS OR MORE PAST DUE
STATEMENT OF ACCOUNT IF YOU RECEIVE A NEW INSURANCE CARD,FOR YOUR
PRESCRIPTIONS BE SURE TO SUPPLY US WITH A COPY.
Date 11/30/2012
PMT DUE. . 12 27/12
NEUMANN, HANNAH NEUMH
MESSIAH VILLAGE GRP-7I
736 OAK OVAL PAGE 1
MECHANICSBURG PA 17055 Amount Paid
PLEASE DETACH AND RETURN TOP PORTION WITH YOUR PAYMENT
ALERT PHARMACY SERV. INC.219 NORTH BALTIMORE AVE. MT HOLLY SPGS, PA 17065
DPT.1,j MED. AMOUNT SALES TAX ITEM TOTAL
k* ACTIVITY FOR NEUMANN, HANNAH -NEUMH -
11/01/12 16045018'45 ZSOSORBIB_* - O1 --S.a-6 - - ---00 "-5:-0c--
11/08/12 16036863 30 CEROVITE SILVER 01 * 3.46 .00 3.46
11/08/12 16042358 30 *KAON-CL IOMEQ TA 01 5.00 .00 5.00c
11/16/12 16045175 20 ONDANSETRON ODT 14.99
11/16/12 1 **Rcpt # 00080298 14.99
11/19/12 1 GNP BEST FIB * 9.27
11/19/12 1 **Rcpt # 00080372 8.34
11/29/12 Payment-Thank You 73.64- .00 73.64-
ACH
11/29/12 16039837 30 VITAMIN D 1,000 U 01 3.08 .00 3.08
11/29/12 16043508 30 *DIGITEK 125MCG T 01 5.00 .00 5.00C
.11/29/12 16045018 45 ISOSORBIDE *MN* 3 01. 5.00 .00 5.00c
11/30/12 1 EFFERDENT TB *. 3.09
11/30/12 1 **Rcpt # 00080959 2.78
DO NOT SEND PAYMENT
The amount due will automatically be
deducted from your account.as requested
J
. 00
34.99 18 .90
LEGEND' NON-LEGEND TOTAL TAX
FOR MONTH FOR MONTH
Previous Balatiee Ch eis thta math Finance Charge - TOW P"mone a Cr¢Eir• AMOUNT DUE
50 .31 + 52 . 65 + . 00 = 102 . 96 - 73 .64 29 . 32
FOR ALL PHARMACY RELATED INQUIRES PLEASE CALL Alert Pharmacy Services,Inc at 1.80 -268.9954
Statement Terminology on reverse
eH(OLY
HOSAL 4Ikr<I /icn0. 17x, �c J. C.
lame: t tr ,.t dr Lf' C�
Finnnca[Counselor
- 50313ordi 21st-Street camp 011.2288 ''.,',,, y
hone:
V A3
t4. `
4 ,
Account# 41.4 rl I;k-1 453
_.
Eomated Total Out cif-Pocket-Patient Responsibility
As part.of yo>x(stay here at Holy Spirit Hospital,the insurance you provided,was verified
with the.insiu'ance.tompany aiid we were_advis0 what the total estimated out of pocket
cost will be foz yotz? stay.. :.
Holy Spirit Ilpspital has several ophops tp help you with this.out of pocket:
Pay attune of,disclu-- or within 5 days of disghFge holy Spirit lHospital offers
a25 otui6.0,f,service,tl scowit.
pay wrthm 3Q days of receiving your first statement Holy Spirit Hospital offers a
liv 15°lo discount „. <-.
fo setup a payment plan contactheTulancial Caitiisgloi$at 71 7 763 2885.
Discuss.our iriancial Assisiasiae Program call 717-M-75Sd.
.-._. .___. ---�>-our'estIDi3tezl'ait'cif�a7kist�ss�ifp�'i�at�m`"e of seryice�c"-�f3as#"olIows: " ._._
Ca Insurance Amount 'with 25%discount
Deductible mount+ _ with 25a o dl8epurlt
Copay Apqunt X000° _ with 25%discount 3
S
EsiYmate £otal Out of Packet . 60 ,
Yonrsavmmgsx#pfud,aineofseyice�
Total amount 11,25% $g0ligt,_��
We adept cash,decks,debit or re3it,cards farpaynkesat. We accept Visa,MastekGard
American,Expregs and piscgver cards. '..
If you have arty questions,please contact the Financial Counselor-fisted below.,
Thank you,
f
I
V4MESSIAH . _ ! i$.,et , 4.
i
few;;\/s
FormP"l
,.
at MESSIAH VILLAGE
100 MT.ALLEN DRIVE,MECHANICSBURG,PA 17055 RESIDENT# I —UNIT I STMT. DATE
20916 736 1 01/31/2013.
RESIDENT(S) .
JANICE BAER Mrs. HANNAH NEUMANN
3081 MINERVA LAKE ROAD
COLUMBUS,OR 43231 TOTAL AMOUNT DUE $1,114.00
DATEIDUE 02/28/2013
•i NOT • • due will be electronically withdrawn from • bank account. •i NOT
DATE DESCRIPTION RATE ' Days/ CHARGES CREDITS BALANCE
Balance Forward I,180.00
01122/2013 PAYMENT RECEIVED-THANK YOU+.! 11180.00 0.00
*** Residential Living ***
01/012013 MNTHLY CHG LEHIGH 01/01-01/31 1,114.00 1.00 11114.00 1,114.00
.,,
RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE
20916 1,114.00 0.00 0.00 0.00 0,00 $1,114.00
RESIDENT NAME Mrs.HANNAH NEUMANN Form P& I
WA
Please make check payable to Messiah Lifeways at Messiah Village..
A 1%finance charge may be assessed on accounts for which payment has not been received by the due date. Thank you!
It you have any questions or concerns about your bill,please address them directly to Fiscal Services at 790-8220. Thank You!
Pa_ �
MESSIAH rnm.w. _
v4
LifF 0,
ewa sr
at MESSIAH VILLAGE
100 MT.ALLEN DRIVE,MECHANICSBURG,PA 17055 RESIDENT# UNIT STMT. DATE
20916 736 12/31/2012
RESIDENT(S)
JANICE BAER Mrs.HANNAH NEUMANN
3081 MINERVA LAKE ROAD
COLUMBUS,OH 43231 TOTAL AMOUNT DUE $1,180.00
DATE DUE 01131/2013
DO NOT PAY Total amount due will be electronically withdrawn from your bank account. DO.NOT PAY
i
DATE DESCRIPTION RATE Units CHARGES CREDITS BALANCE
Balance Forward 1,239.00
12/20/2012 PAYMENT RECEIVED-THANK YOU!!! 1,239.00 0.00
***Residential Living ***
12/0112012 NINTHLY CHG LEHIGH 12/01-12131 1,114.00 1.00 1,114.00 1,114.00
12/10!2012 BARBER/BEAUTY SHOP 16.00 1.00 16.00 1,130.00
SET/STYLE
12/20/2012 NURSES HOUSE CALL(5) 50.00 1.00 50.00 1,180.00
COTTAGE CALL -
RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE
20916 1,180.00 0.00 0.00 0.00 0.00 $1,180.00
RESIDENT NAME Mrs.HANNAH NEUMANN NIA"
Please make check payable to Messiah Lifeways at Messiah Village.
A 1%finance charge may be assessed on accounts for which payment has not been received by the due date. Thank you!
If you have any questions or concerns about your bill,please address them directly to Fiscal Services at 790-8220. Thank You!
MESSIAH
v4 rifeways-
AT F.PB-0t
HOME J
QUESTIONS?CALL: 717)790-8220
100 MT.ALLEN DR.,MECHANICSBURG,PA 17055 RESIDENT# UNIT STMT. DATE
20916 1 736 12/31/2012
RESIDENT(S)
JANICE BAER Mrs.HANNAH NEUMANN
3081 MINERVA LAKE ROAD
COLUMBUS,OH 43231 TOTAL AMOUNT DUE $578.08
DATE DUE 01/31/2013
DONOTPAY* Total amount due will be electronically withdrawn from your bank account. * DONOTPA
DATE DESCRIPTION RATE Unl61 CHARGES CREDITS BALANCE
Balance Forward 1,005.61
12/20/12 PAYMENT RECEIVED-THANK YOU!!! 1,005.61 0.00
***Nursing Care ***
12/10/12 Home Care Assistant 20.95 3.50 73.33 73.33
12/12/12 Home Care Assistant 20.95 1.00 20.95 94.28
***Residential Living ***
12/03/12 Home Care Assistant 20.95 4.00 83.80 178.08
12/04/12 Home Care Assistant 20.95 3.00 62.85 240.93
12/05/12 Home Care Assistant 20.95 3.25 68.09 309.02
12/17/12 Home Care Assistant 11,20.95 3.75 78.56 387.58
12117112 Mileage Charge(car) 0.65 3.00 1.95 389.53
12402 Home Care Assistant 20.95 3.00 62.85 452.38
12/19/12 Home Care Assistant 20.95 3.00 62.85 515.23
12/20/12 Home Care Assistant 20.95 1.00 20.95 536.18
12/24/12 Home Care Assistant 20.95 2.00 41.90 578.08
RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE
20916 578.08 0.00 0.00 0.00 0.00 $578.08
RESIDENT NAME Mrs. HANNAH NEUMANN Fa Pea,
Please make check payable to Messiah Lifeways Community Support Services.
A 1%finance charge may be assessed on accounts for which payment has not been received by the due date. Thank you!
If you have any questions or concerns about your bill,please address them directly to Fiscal Services at(717)790-8220. Thank You!
Filing Instructions
Form 1040 US Individual Income Tax Return
With
Form 1040-V Payment Voucher
Taxable Year Ended December 31, 2012
Name: HANNAH NEUMANN
Date Due: April 15,2013
Remittance: A check in the amount of$336 should be made payable to the United States
Treasury and included with the voucher. Write "S.S.N. 188-03-8848,2012 Form
1040" and your daytime phone number on the check.
Mail To: Internal Revenue Service
P.O.Box 802501
Cincinnati,OH 45280-2501
Signature: You should sign and date the return on Page 2.
Other: Initial and date the copy of the return,and retain for your records.
Do not attach your payment or Form 1040-V to your return or to each other.
Instead place them loose in the envelope.
Filing Instructions
Form PA-40 - PA Individual Income Tax Return
Taxable Year Ended December 31, 2012
Name: HANNAH NEUMANN
Date Due: April 15,200
Remittance: A check in the amount of$83 should be made payable to the Pennsylvania
Department of Revenue. Write the last four digits of your S.S.N., "2012 Form
PA-V"and your daytime telephone number on the check.
Mail To: Include Form PA-V with your check.
PA Dept of Revenue
Payment Enclosed
1 Revenue Place
Harrisburg,PA 17129-0001
Signature: Sign and date the return on Page 2.
Other: Initial and date the copy of Form PA-40,and retain it for your records.
i
REV-1513 EX+(01-10)
]pennsylvania SCHEDULE
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Hannah S. Neumann PAGE 1 21-12-1333
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY KL of Not list T ustee(s)N I anuOF ESTATE arse
I TAXABLE DISTRIBUTIONS rinclude outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. Elizabeth Rebl,104 Kilamey Road,Summerville,SC 29483 Step-Niece $10,000.00
2.. John Drury, 181 West 13th Street,Jim Thorpe,PA 18229 Step-Nephew $10,000.00
3. David Printz,238 Stone Head Road,Dillsburg,PA 17019 Grandson $10,000.00
4. Linette Printz, 238 Stone Head Road,Dillsburg,PA 17019 Granddaughter $10,000.00
5. Joyce E.Printz,2185 Franklin Hill Road, Hallstead,PA 18822 Daughter 50% of rest. residue &
remainder of Estate
6. Janice E. Baer,3081 Minerva Lake Road,Columbus,OH 43231 Daughter 50% of rest, residue &
remainder of Estate
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II 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. St.John's Lutheran Church,Go David Smith,Council President,44 West Main St,Shiremanstown,PA
17011 $30,000.00
2. Zion Lutheran Church,do Vicki E.Delp,Council President,2730 BOOser Avenue,Harrisburg,PA 17103 $20,000.00
3. The Salvation Army,Richard D.Allen,Secretary,West Nyack Rd.,P.O.Box C-635,West Nyack,NY $1,000.00
10994-1739
4. Smile Train, Inc.,Go Gilbert Domfeh,Vice-President,41 Madison Ave,28th Floor,New York,NY 10010 $1,000.00
5. New Hope Ministries,Molly Helmstetter,Director of Development,P.O. Box 448,Dillsburg,PA 17019 $1,000.00
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
REV-f513 Ex+(01-30)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Hannah S. Neumann PAGE 2 21-12-1333
KtIAI1UN5H1P IU UtCLULNI AMUUNI UK�INAKt
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include outright Spousal distributions and transfers under
Sec.9116(a)(1.2).)
1.
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES IS THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II 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' Central Pennsylvania Food Bank,Joseph Arthur,Ex.Director,3908 Corey Rd.,Harrisburg,PA 17109 $1,000.00
7. American Bible Society,Peter Rathbun,General Counsel, 1865 Broadway,New York,NY 10023-7503 $1,000.00
8. Keystone Area Coundl, Boy Scouts of America,Jeffrey D. Spencer,Director of Development, $1,000.00
One Baden Powell Lane. Mechanicsbura. PA 17050
TOTAL OF PART 13 — ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 56,000.00
If more space is needed,use additional sheets of paper of the same size. .
LAST WILL AND TESTAMENT
OF
HANNAH S. NEUMANN
I, HANNAH S. NEUMANN, of 316 West Green Street,
Shiremanstown, (Borough of Shiremanstown), Cumberland County,
Pennsylvania, make, publish and declare this as and for my Last Will and
Testament, hereby revoking all other Wills and Codicils heretofore made by me.
FIRST: I direct that all inheritance, estate, transfer, succession and
death taxes, as well as my just debts and funeral expenses, of any kind
whatsoever, which may be payable by reason of my death, shall be paid out of the
residual of my estate as the same can conveniently be done.
SECOND: I specifically give and bequeath the following cash gifts
to the charitable organizations named herein:
(a) I specifically give and bequeath the sum of Thirty Thousand
Dollars ($30,000.00) to ST. JOHN'S LUTHERAN CHURCH, of Shiremanstown..
Pennsylvania, to be used for general church purposes; and
(b) I specifically give and bequeath the sum of Twenty Thousand
Dollars ($20,000.00) to ZION LUTHERAN CHURCH, of Penbrook,
Pennsylvania, to be used for general church purposes; and
(c) I specifically give and bequeath the sum of One Thousand Dollars
($1,000.00) to THE SALVATION ARMY, of Carlisle, Pennsylvania, to be used
for general purposes; and
(d) I specifically give and bequeath the sum of One Thousand Dollars
($1,000.00) to THE SMILE TRAIN, of New York, New York, to be used for
general purposes; and
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(e) I specifically give and bequeath the sum of One Thousand Dollars
($1,000.00) to NEW HOPE MINISTRIES, of Dillsburg, Pennsylvania, to be used
for general purposes; and
(f) I specifically give and bequeath the sum of One Thousand Dollars
($1,000.00) to CENTRAL PENNSYLVANIA FOOD BANK, of Harrisburg,
Pennsylvania, to be used for general purposes; and
(g) I specifically give and bequeath the sum of One Thousand Dollars
($1,000.00) to AMERICAN BIBLE SOCIETY, of New York, New York, to be
used for general purposes; and
(h) I specifically give and bequeath the sum of One Thousand Dollars
($1,000.00) to KEYSTONE AREA COUNCIL, NO. 515, BOY SCOUTS OF '
AMERICA, of Mechanicsburg, Pennsylvania, to be used for general purposes.
THIRD: I specifically give and bequeath the following cash gifts:
(a) I specifically give and bequeath the sum of Ten Thousand Dollars
($10,000.00) to my step-niece, ELIZABETH REBL, of Summerville, South
Carolina; and
(b) I specifically give and bequeath the sum of Ten Thousand Dollars
($10,000.00) to my step-nephew, JOHN DRURY, of Jim Thorpe, Pennsylvania;
and
(c) I specifically give and bequeath the sum of Ten Thousand Dollars
($10,000.00) to my grandson, DAVID PRINTZ, of Dillsburg, Pennsylvania; and
(d) I specifically give and bequeath the sum of Ten Thousand Dollars
($10,000.00) to LINEITE PRINTZ, of Dillsburg, Pennsylvania.
FOURTH: I give, devise and bequeath all the rest, residue and
remainder of my estate of whatever nature and wherever situate, including any
property over which I hold power of appointment and together with any insurance
policies thereon, as follows:
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(a) Fifty percent (50%) thereof unto my daughter, JOYCE E.
PRENTZ, ofHallstead, Pennsylvania, provided that should JOYCE E. PREM
predecease me, I give and bequeath her share unto her issue, share and share
alike; and
(b) Fifty percent (50%) thereof unto my daughter, JANICE E.
BAER, of Columbus, Ohio, provided that should JANICE E. BAER predecease
me, I give and bequeath her share unto her issue, share and share alike.
FIFTH: In addition to all powers granted to them by law and by
other provisions of this Will, I give the fiduciaries acting hereunder the following
powers, applicable to all property, exercisable without court approval and
effective until actual distribution of all property:
(A) To sell at public or private sale, or to lease, for any period of time,
any real or personal property and to give options for sales, exchanges or leases, •far
such prices and upon such terms (including credit, with or without security) or
conditions as are deemed proper. This includes the power to give legally sufficient
instruments for transfer of the property and to receive the proceeds of any disposition.
(B) To partition, subdivide, or improve real estate and to enter into
agreements concerning the partition, subdivision, improvement, zoning or management
of real estate and to impose or extinguish restrictions on real estate.
(C) To compromise any claim or controversy and to abandon any
property which is of little or no value.
(D) To invest in all forms of property, including stocks, common trust
funds and mortgage investment funds, without restriction to investments authorized for
Pennsylvania fiduciaries, as are deemed proper, without regard to any principle of
diversification, risk or productivity.
(E) To exercise any option, right or privilege granted in insurance policies
or in other investments.
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(F) To exercise any election or privilege given by the Federal and other
tax laws, including, but not necessarily being limited to, personal income, gift and
estate or inheritance tax laws.
(G) To make distributions to my herein named beneficiaries in cash or in
kind or partly in each.
(H) To borrow money from themselves or others in order to pay debts,
taxes, or estate or trust administration expenses, to protect or improve any property
held under my will, and for investment purposes.
(I) To select a mode of payment under any qualified retirement plan
(pension plan, profit sharing plan, employee stock ownership plan, or any other type of
qualified plan) to the extent provided for by the plan or the law.
SIXTH: I nominate and appoint JOYCE E. PRINTZ and JANICE E.
BAER, Co-Executors, of this, my Last Will and Testament. I direct that my Co-
Executors and their successor shall not be required to post security or a bond for the
performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this_, my
Last Will and Testament, this ,Z) t'- day of August, 2008.
T�z �. ,sc � ��'..�-�✓ (SEAL)
HANNAH S. NEUMANN
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Signed, sealed, published and declared by the above-named Testatrix as and for
her Last Will and Testament in ounpresence, who, at her request, in her presence and
in the presence of each other, have hereunto subscribed our names as attesting
witnesses'.
Address t ?a S Name
I {J'KI"it• l%J
Address ' t 1c i5 Name
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