HomeMy WebLinkAbout10-25-13 _� .__��
J 1506610105
REV-f 500�`{°'-°,��>d�
OFFICIAL U$E ONLY
PA Department of Revenue Pennsytvania Counry Gode Year Fle Number
8ureau oi Individual Taxes °"�`�`°""`�°"`
Pa sox asoeoi �NHERITANCE TAX RETURN � �1 �p� �� �
Herrisburq,AA Y7u8-o6oi RESlDENT DECEDENT EtJ1� ' ! �� s ' Q"�p� 1
ENTER DECEDENT INfORMATION BELOW
Social Security Number Date of Death Mh106YVYY 6ate of Birth MMDDVYYY
_ . .. ...... . ,.-. _. . __..._ .___-__. ....... ..
� i �01t11t241$ i11113t1939 �
_ ___ _____._._ _ _. _. _ _ . __„__
DecedenYs Last Name Su�z � DecadenYS Pirst Name MI
. . __..___... .. .__...._. _ ...__..__.__. ...__ .
i Walter i 1 i Michael 'W �
tif AppBcabie)Enter Surviving$Pouee's Informatlon Below ...... .., . _ __... , � _..._... ... .....�
Spousa'a Last Name S�x Spouse's Firs#Mame Mt
.__.._. .._. . ...__.___._�.. . . .._ ..._......_, ..._.
. .... y ,__... , �_. ..... _ . ._. ��. .,_..�.
I ( i i
_......_ ....... . . . ____ _ ..._. .__ . ... a ._ ._. i L_""__....
Spouse's Social Securiry Number ., . � � ���� ����
� FHIS RETURN MUST BE Ft�ED IN DUPUCATE WITH THE
_ __..
' REGISTER OF WILLS
R��IN APPROPRIA7E OVAtS BEtOW
� 1.Original Return p Z.Suppiemerttal Rafum p 3. Remainder ReNm(Date of Death
� � Pnorto 72-73-82) �
p 4.Limited Estate p 4s.Future Interest Compromise(date ot O 5. Fedef�Estate Taz Retwn Raquired
desth a8er 12•12-82)
p 6. Dacedent Died Testate O t.�ecedent MafMained a Uving Trust _ &. Toisi Number of Sate E}eposd Boxes
(Attach Copy of Witi} (Attach Gopy of Trust.)
C7 9.Litigation Proceeds ReceNed p t0.Spousaf Poverty Credlt(Dete of Death p ft. Election to Tax under Sec,91t3(A)
Between 12-31-91 and t-i-95) (Attach Schadule O)
CORRESPON4ENT-TMiS SECTWtt MUST 8E CQM4LE7ED,A1L GINtRESPONDENCE AtID CONFiDENTIAI TAX MFQRMATION SNtMtLO 8f�CTE6 TO•.�
Name . . .......__ .___.. Dayhme�lliephoneNurr� � rn
r_ __ __ __ _ --__.._. ,c _rn_
Peter J. Russo j(717)�1�'55 =' � �
c� — �' i
_ . _ _ _ _�.�- -_��t _ <t>-�u—.
REj� OP'WILI�B,yISE�Y(Y1
A � :�7 � � �
First Line of Address � � '� -^p � "�rt
5006 E. Trindie Road -- _ . __. _ , � a � � TM- �
, o � .� r>
,___ _. __.._ __ ---. . � r_ rn
Second�ine of Address � ' � r— �
..._.......... ..... ............__.....�....._._,.__.....___......_._4 � � �
�Suite 2Q3 s' c,a '�
��� ....___. . _..__... _ ......._. __ _.._.. DATEFILED
City or Post Office �� �� Stata ZIP Cade
. .. . ._.._ .__ . . _... ._. . .. ..._ ... . .._... .... ... . .
�Mechanicsburg ' � PA j '1705� '
. __ _ _. �^'''�
CorrespondeM's e-maG adereae:pn,ls9p(o3pjtlaw.COm��/ G�y�',�,�/C./�
� Under penalties of perjury,I tleclare that I have sxaml�ed this retum,inGudhg accompeny6g schedules antl etetements,and to the Dest of my k+�owlsdge and Celief.
t d is we,corzect an�m�r�piete.OeciaraUon of preparer aiher than the pereonei representative is based on eli intorma5ion of which preparer hes arry knowletlge.
iSIGNATURE OF GERSbN RESPONS�BLE FOR FILING RETURN DA7E { ` iq
� 1� �1� i1J
' ADDRESS
'� SIGNATURE OF pREPARER OTHER THAN REPRESENFATIVE OATE
A�DRESS
� - PLRASL° US@ ORlCi11iA�FORM ONLY � �
Slde 'I
� 15D561�105 150561a105 � J
�
_ _ _ _ _ .
J 1505610205
REV-1500 EX(FI)
Decedent's Social Secunty Number
oa�ee�rs Nama: Michael William Walter �
RECAPITULATION
1. Real Esfate(Schedule A). . . ..... .. . . . ... ... . . . . . .... . . . ........ . . . . . . 1. � . .. _.....-(
2. Stocks and Bonds(Schedule B) . . . . . ..... . . . �� �� �� �� �,
..... . . . ... .. . . . . . 2. �
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ... . 3 �� � ����i
. ,_ .... .....__.. .. ... . .., . '
�....._.. .. .
4. Mortgages and Notes Receivable(Schedule D) . . . . , , , . .,,.,,, q, . �i
. . . . .... t._______.._...�..�. _. . _._....__ ...._.. ..
� 5. Cash, Bank Deposits and Miscellaneous Personal Propetly(SChedule E). ... .. . S. � 10,f>75.SJ �
�...�..._...�..� .__..___. ...�.
6. Jointly Owned Property(Schedule F) O Separete Billing Requested ... . . . . 6, � ���
7. IntervVivosTrensfersBMiscellaneousNon-ProbateProperty ����-- �-��--- �---- � -
(Schedule G) O Separete Billing Requested.. . .. ... 7. �, �
��.�_.�...___..._._......_._..._ ...._..
6. Fotal Gross Asaets(total Lines 1 through 7). . . ..... . . . ...�. . .. . . . .. ..... . 8. , 1 Q675.59 '
9. Funeral Ezpenses and Administretive Costs(Schedule H). .... . . . . . . .. . .... . 9. �: 14,155.28 (
�..___.. ___,._.__...._ _..._._ . _._'
10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I)... . . . . .... . . . 10. � 4$,178.11 �
�.� �..._..__._ ._... . . _ .. ....
� 11. Total Deductions(total Lines 9 and 10). .... . . . .. . . . . . . ... 11. 62,333.39 '
,�_._._...._.,........._. __... . . •
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . ..... 12 � -51,F)b7.8���'�.
13. Charitable and Govemmental Bequests/Sec 9113 Tmsts for which �-'""�"'°��'�"" �--- -�- � � �- - ��
an election to tax has not been made(SChedule J) . . ..... . . . ..... . . . . . .... 13. , (
•�-..._.,�.. _._._ .. , . . . . .
� 14. Net Value SubjecS to Tax(Line 12 minus Line 13) . .. . .. .... . . .. ..... 14. � 51 657.$0 )
TAX CALCUTATION SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rete,or
transfersunderSec. 9116 (� ������ �������--��--�- � -
_ __- --- �
�a)�7.2)X.0- ' 15 i ,
16. AmountofLinel4taxable �" �������� ���""""""'"" --�- - .. --���-
at lineal rate X.0_ ; 16 """'���'�- �����-��-_._.�,_,,,�
17. Amount of Line 14 taxable �� � �� �`��`����""-�� `- ��
. _... ...._...._._.. _...._._._..��.,.�
atsiblingrate X.12 � -S�,6S7.8Q ; 17 0.00 ���
18. Amount of Line 14 taxable ���� ���"v���� "-" ��� --
_....___.,. _......�_._.__.,�
at collateral rete X .15 ' ': 18 �
._ ___.... ._..
.. . ..._ ,.._. ...... _.._.....__..........__._..._..._�_..____�
19. TAX DUE . .. .. . . . . . . ... . . . . ... . . . . ... .. 19 , 0.00 �
� 20. FILL IN THE OVAL IF YOU ARE REqUESTING A REFUND OF AN OVERPAYMENT �
Side 2
L, 1505610205 1505610205 �
� I��
ftEV-15W EX{R) Pagg 3 FIb Number
Decedent's Camplete Address:
DECEDENT'S NAME
Michael William Watter
STREETADDRESS J._i��—����.�—.— ���--^
528 Humme!Avenue,Apt 1A
CI7Y � �STATE � ZIP
lemayne PA 17043
Tax Payments and Credits:
1. Tax Dne(Page 2,�ine 19} (i} O.Op
2. Credits/Payments
A.Pfior Payments �
$.Discaunt
� Total Credits(A+B) (2) 0.00
3. tnterest
(3) 0.00
4. !f Line 2 is greater than Line 1+�ine 3,en�r the differ�nce. This is Yhe OYERPAYMENT.
Fill in pval on Page 2,Line 20 to request a refund. (4) 0.00
5. If Line 1 +Line 3 is greater than Line 2,enter the differenoe.This is the TAX DUE. (5) O.OQ
Make check payabie to: REGISTER OF WII.LS,AGENT.
PLEASE ANSWER THE FOILOWING QUESTIONS BY PLACING AN "X" IN 7HE APPROPRIATE BLOCKS
1. Did decedent make a trans(er and: Yes No
a. retain the use a income of the�xopeRy transferred......................................................................_.............._.. 0 �
b. reNain the right to designate who shall use the property transferred or its income ............................................ ❑ �
c. retain a reversionary interest.............................................................................................................................. 0 �
d. receive the promise for tlfe of either paymenls,benefits or rare?........................_.................,.._................._... � �
2. if deaM occurted aHer Dec. 12,1982,did decedeni trensfer property within one year o(death
wiNout receiving adequate considerati�n?............................................................................................................_ � �
3. Did decedem own an"in truet for"pr payable-upon•death bank accoum or security at his or her death?.....,.,...._ � �
4. 6id decedeM ow�an individuai rstirement accrourtt,annuiry or other non-prabate property,which
contains a beneficiary designation? ..._..................__..................._................................ ❑ �
........................................
IF THE ANSWER T4 ANY OF TNE ABOYE QUESTIONS IS YES,YOU MOST COMPLETE SCHEDUL6 6 AND EI�E!T AS PART OF THE RET!lRN.
For datas of�ath on a afEer July 1,1994,and t�fae Ja�.1,1995,the tax rate imposed on the net vaitre of hansfers to or for the use of ttie surviviru�spouse
is 3 perceM(72 P.S.§9116(a)(1.1)(i)].
For dates of death on or afler Jan. 1, 1895, the tax rate imposed an ihe net value of irans(ers to or far the use of the surviving spouse is 0 percenk
(/2 PS.§9116(a}(1.1){ii�].The stat�te does rwt ezempt a trensfer ta a surviving spouse hom tax,amJ the statutwy requirements for disdosure af assets and
firng a fax retum are skiii app�icable even if the survn+ing spouse is the onI y beneficiary.
For dates of death on or aftar Juty 1,2�t3:
' + The tax rate imposed on the net value of transfers trom a deceased child 21 years ot age or you�er at death ta or for the use of a naSUral parant,an
adoptive parent or a stepparent af tha chiW is 0 percent(72 P.S.§9116(a)(12)1.
• The haz rate imposed an the�et value of trar�sfers to or for tl�e use of the decedent's line�6enefiaaries is 4.5 percEnt,exc�t as rwted in(!2 P.S.§9116(e}(1}].
. The tax rate imposed on the net va4ue of transfers to or for the use o(the decedeM's sibfings is 12 percent[7?P.S.§9116{a){t.3}].A s�aling is defir�d,
under Section 9102,as an individual who has at least ane pareni in common wifh ihe decedent,whether by binod or edoption,
REV-�5o8 EX+(�yio)
�i pennsylvania / SCNEpNL� E
Y� �EPANTMENTOF qEVENUE y�ySH� BANK DEPOSITS 8� MISC.
ESID NT o cT e�R" PERSONAL PROPERTY
ESTATE OF:
FILE NUMBER:
Michael William Walter 2013-00581
Include the proceeds of IiNgation and the date the proceeds were received by the estate,
All property�o1Mly owned wlth Hght of survivorshlp must be disNOSed on Scheduk F.
]TEM
NUMBER DESCRIPTfON VALUE AT DATE
oF oenrri
�. Members 1st Savings Acct-Acd No.42379-00 25.12
2, Members tst Savings Acct-Acct No.42379-11 10,447.69
3. Comcast
12229
q, Cumbetland County Ret
80.48
5, Members 1st Dividends
0.01
6.
7.
8
TOTAL(Also enter on Line S, Recapitulation) � 10,675.59
[f more space is needed,use additional sheets of paper of the same size.
St
.
MEMBERS 1'�
PEDBRAL CRHDR UMON
REGULAR SAVMIGS ACCOUNT:
Account Number/Suffix 42379-00
D-ate Account Eatablished 10/03/1984
Principal Balance at Date of Death $25.12
Accrued Interest to Date of Death $.00
Total Principal and Aa:rued Interest $25.12 _.--:
Name of Joint Owner None
CHECKING ACCOUNT:
Account NumbedSuffix 42379-11
D-ate Account Estabiished 09/19/1990
Principal Baiance at Date of Death $10,447.54
Accrued Interest to Date of Death $.15
Total Principal and Accrued Interest $10,447.69
Name of Joint Owner None
ERS 1�FEDE AL�f�IT UNION
V.J�2� �,►SL(�
Danie e A. Kline
Lending Insurance Support Specialist
July 17, 2013
Estate of: MICHAEL W WALTER
Date of Death: 01l71/2013
Social Security Number: 187-30-1372
5000 I.ouise Drive • P.O. Box 40 • Mechanicsburg,Pennsylvania 17055 • (800) 283-2328 • www.memberslst.oxg
CO�AST
isss susx srass� '
a�= �Saxa� svero� ssxvxcss
LBBAiION, PA 17846
�omcast.
i�o� �an 27ses aosz-si-a7-s�
� DILtBBtlR!fi, 8A 17019-9334
i�I�id���tiIP�1�1iI�Mr�IJl�lid��Iqilpi�(�ll���i6d(���dll
PAYMENT SUMMA.RY
���: Q010333$94
��: 04547-18467344 ot�ox cra7�: 42186113
Dear I�C87�L wALTER,
Tfie attacLed ch�ck representa a refund #or acecunt number 09547-18067306 in the amnunt of
$iaz.zs.
If pon are a Cotroast ZFF1127.R ausLOUer and Lare questions regardisg your refnnd aLeck, yau
aaa wrfte na at t§e address above� aell Coaaast's toll fzee cuolomer earviae aumber at
1-888-COMCABT (1-888-266-2278)� or oLat pith us at vnra.comaasb.comlahat. Our
reprosantativea are arai2able ta sss3et pou 24 hanr� a day, 7 daps a rKek.
If pau are a Comaasb Spotlight clieat or agency, glease caatact your loca2 6pot2igbt
affiae.
aEr�rwo p�rwi tws sr�r�tNr
THE ATTACI�OG�If IS NMYMBif OF RHA60l5CNIB@OA90VE.
�tbT Wt�ECi;PL6ASEN6fIFY USPROWTI.Y.N4REC9PT O�.
COMCAS't'1�IXNiCL1LAGYTtCY CBRPOBA'R4N ,
AGfl�ICA�'�'�CABLECOMMUNICATI(INSGROUPCOMPAIVX •60-160/433 �
. .. . ., . .. accouNi'NUM�n � � 61�OK nATE . ' Cf�{9k NUM�H �
i 89547-1l1667304 62/96/i61! 0010333644 j
! �
� . , .. _, . VIILID FOS 280 DAYS
� � M�Ct]KEL WALTER .', r+�••*••2z2,zs
nre 1#d `�3R�°'B11MK RO ' . �
a� bILL58URG, PA 17U19=9334 `
, oF: { .
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. � �
„ 1� 8ljIFiC-oF.:11&It YoA$ �LL6N ' . .. .
� ._ . . ., . PITTSBIIRCfB'',' PSMNSYLVAHIA '
��•ODi0333$94n' +:04330L60i�: LL3��� 7834iP — � I
Ct�lDERLAND CTY RET - QPERATE aCC
STATEMENT OF bYSTRIBUTION - TAX YEAR 2013
----------------------------^----°______
DISTRIDUTFQN DETAIt TA% DE7A2!
------^---��------- --^------`
TOTAL VALUE OF PAYMENT 0 100.60 9RD55 AMOUNT 6 100.60
ROI,LOVER AMOUNT 0 0.00 TAkAiLE AMOUNT 8 lOQ.6Q
EED TAX $ 2U,12 NOk TAXAl1.E 4 O.Op
EF� AF7£R FAX COttTR2E # 0.00
NET UNREALI2ED APPREC 8 O.Qp
tQTAL ROLLOVER MIFlUNT B O.qO
VALUE OF SHARES GISTRIE B 0.00
NET PAY#�NT AlIOUN7 $ 80.48 COST Qf SNARES IIZSTRIB 6 U.QO
. IR5 F�M 1699-R IS ISSUED !Y JANUARY 31ST OF THE YEAR FOLLOWINB TNE DISTRI6UTIDN
OR IN THE CASE OF A REISSUED CHECK, IN THE YEpR FOLLOWINB THE ORIBINAL DISTRIBUTfON.
TNE DIS7RISU7IOH CODE THA7 MIL1. APPEAR IN DOX 7 IS 4 -DEATH
4UESTIONS R£9ARDIt� TiiE TAXASIIITY OF TNiS BISTRI$UTION SHOUtD iE pIRECTEt! TO YOUR
TA% ADVISOR. PLEASE NO7IFY YOUR PLAN SpONSOR OF ANV CHANQES IN YOUR ADDRESS.
IF YOU DECIQE TO R4LL QVER THE ELI�IB�E PQRTIpN Of YINlR DISTRIW720M, FE1tERAt TAX
lAM REQUIRES iHAT YQU MA10E TNE DEPOSIT iiITNIN 60 DAYS AFTER YOU RECEIYE TNIS
PAYMENT.
&bTH COlITRIB. DATE;
ESTATE OF MICHAEL M WA6TER DATE: U4/29l2913
52E l�NM�C AYE PAY �P: 383t�62721.
: iST FL CHEqC #a OpIli02463
� lEMOYNE pp i�2a�
�FNC �11:2019�'i1; ���:�
F«eT�E. sssa4az�ii
npre: aaix9i2oia
; _ ; �n�eoa�,er� cut�s�Rta�a<�rr ���` , �e�ar� ncc .
� �_ : �
:> 3 ` PMC'$a�k�r�Np�Aa��ion
a�
°:� A'EI�'Y flOLLARS � 48/100 .; , . VOID AFTER 1 YR
PAY TO 7NE
��R� 1 �� . ' � �,�*: ��
x < �' = ESTATE^"OF MICHAEL W Wp4TER � " �a '�
,�`M g . ' S28 'HUl�L AVE n ;' M1, `
ri+cs.et �: : lST Fk; "
p i�pA LEMOYNE PA 1?243 -,� :
AUTXORIZED 816NATURE
� �'00 L i 20 i96 in* �:043000096�: QO i i i730 i i+�'
�Ii
E .. _�
REV-1511 EX+(10-09)
pennsylvarria SCHEDULE H
..... _ DEPARTMENT OFREVENUE FUNERAL EXPENSES AND
INHHIRANCETA%REIURN ADMINISTRATIVE COSTS
RESIOEM DKEOENT
ESTATE Of
FILE NUMBER
Michael William Walter 2013-00581
DecedenPs debts muet he reported on Schedule i.
ITEM
��R DESCRIPTION
A• FUNERAL EXPENSES: aMOUNi
�' Myers 8uhrig Funeral Home
12,313.00
B. A6MINISTRATIVE COSTS:
1• Personal Representntive Commissions:
Name(s)of ve�wnal RepresenWHve(s) 533.78
. Stree[Address
� � S[ate_ZIP
Year(s)Commission Paid:
Z• Attomey Fees: 925.00
. 3• Family Ezemption:(If decedent's address Is not the ume as claNnaM's,aUach explanaUon.)
Claimant
Street Address
. City Sta[e_21P
ReWttonsMp of Claimant to Decedent
4. Probate Fees:
383.50
5• Accountantfees .
6• Taz Retum Preparer Fees:
7.
TOTAL(Also enter on Line 9, Recapitulation) # 14,15528
If more space is needed,use additional sheets of paper of the ume size.
,
aY M1 •y.,�
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� �'S ���+���{V
a�„�y�o,zot3
C*aTy Reibart �J���
I50 Ore Bsnk Raad
Dillsburg,PA 17019
Dear Gary:
Tisanlc you for allowing us the privilege of serving you anci yow family. We apprc�iate Your PaYment
of$1,10Q.Q0 using check#5323;I�wcver,the ctuek was rcturned to us by Mr,mbers 1�Federai
Credit Union. The reason for ita renun ie that tbe bank account tho check was written�om has heen
6vzen by the credit union. You can save$858.04 with oar t�ms discount if the diacounted halau�ce
of$1,944.81 ia paid ia full by m latu than Fehruary i2,2023. If paid aft�Febntary 12,ZOT3,the
balance due ie$Z,bQ2.87,as the Teims Discount will have expired. Below is aa accowrting for yraur
records:
Stateme�t of Goals&Services $ 12,3i3.04
Plus: Limrnusine 217.00
Plus•CaskcF Pelsonaliaation 65.f�1
Lcsa:A ' t to New OtriWaries i FS.QO
L,eas:Pa from NGL Insixrance Ca 8,544.13
Less:Pa t fimn famil 1,700_00
L�s:PcencEd Quarantce Sa ' 1,383.00
Plus:Roturned Chock#5323 1,700.00
Pius:Raturned Check Fee 50.00
Bsie�e. $2 6U2.8?
I,esa:Terms Discounk,if 'd b Fe 12,2013 858.00
Hala�e Due,if ' b F 12,2(l13 $ 1,T44.87
Please calC us at anytime ttat we may be pf service.
With 1�Varm Itegards,
`"/ ► l�c..Ci�.,e+U{., '�� (1
;
Michelle Buhrig
tf'atkJleg with T7eose in Grief
RObert°Bob"L.Buhrig,dA:,tv,Syrorviwr�W1WYn1"BIII*L.CNrlDtophOr,FD
. Phona (in17663421 � Fax: pi��745J241 • 37 Eaat Main Suect • Mechanicxburg,PA 17055 • www.Mye�s-Buhrig.com • DireclorsQMyera•Buhrig.com
RECEIPT FOR PAYMENT
GLENDA FARNER STRASBAUGH Receipt Date : 5/22/2013
Cumberland County - Register Of Wills Receipt Time: 12 : 01 :32
One Courthouse Square Receipt No. : 1074262
Carlisle, PA 17613
WALTER MICHAEL WILLIAM
Estate File No. : 2013-00581 ---
Paid By Remarks : GARY REIHART
DMB
------------------------ Receipt Diatribution ----------------- _______
FeejTax Description Payment Amount Payee Name
RENUNCIATION 5 . 00 CUMBERLAND COUNTY GENERAL FUN
PETITION LTRS ADM 20 . 00 CUMBERLAND COUNTY GENERAL FUN
_ SHORT CERTIFICATE 25 . 00 CUMBERLAND COUNTY GENERAL FUN
INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN
INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN
JCS FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D
AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN
----------------
Check# 528 $108 .50
Total Received. . . . . . . . . $108 .50
.�'�.- ..��.� �'� ��� �� � _
✓(P�--�-�-����-•�-� ,c�-s�z-�L ��� c�e�C, �`ia a �-��d�'� o
�.,�¢-�-- ✓1�.�-r..�/v�e.� �rr� �rn.�-.�`� �/v 8: sz,
/VG��� " "
�o,��.�o L. /.J,� �(� .
COtvIMISSIONS: PERSQATAL REPRESEN7"A'PIVE
� (M}.4I to $ I�.00O.OQ 5% $ S,OOd.� (S 5,0�.�)
$ 100,000.01 to $ 200,000.00 4% $ 4,OOU.dO ($ 9,000.00)
$ 200,OOO.p1 to $1,OOO,pp0.00 3% a24,000.00 ($33,000.00)
$1>400>04Q.01 to $2,OOQ>000.04 2°to $20,Q00.00 ($53,000.�)
$2,(100,OQ0A1 to $3,dd0,040.00 I'!z°!o $IS,OOp.00 ($68,000.04)
$3,000,000.01 to $4,OOQOQ0.00 1% $10,000.00 ($78,000.00)
$4,4QQ,QOOA1 to $5,044>000.00 'lxto $ S,OOO.OQ ($83,OOOAQ}
1%Joint accounts
1°lo PA.D.Bond�
1"/o Trust funds
I%Real Estate speoific devise
3°!o Reat Estate c�nverted witts the aid of a broker
5%Rea(Estate:non-comerted
$ 00.01 to $ 25,000.00 7% $ 1,750.OQ ($ 1,750.Oq)
$ 25,OOOAI to $ SO,i�0.00 6°l0 $ 1,5{H}.00 {S 3,250.{Kt)
$ 54,Ud0.01 to $ IOd,Od0.00 5% $ 2,500.(30 ($ 5,750.Q0j
$ 100,000.01 to $ 200,000.00 4% $ 4,000.00 ($ 9,750,00)
$ 244,000.41 ' to $I,QOO,QOQ.OQ 3°!a $24,flQ0.OQ {$33,75fl,0(?}
$1,004,OOd.01 to $2,400,000.0t} 2% $20,004.00 ($53,750.00)
$2,000,000.01 to $3,000,000.00 1%z% $15,00(1.q0 ($6&,750.00)
$3>t100,40Q.Q2 ` to $4,OU4,040.Q6 1% $1Q,OOQ.t�t} ($?8,750.OQ}
$4,004,000.ai ' to $5,004,OQ0,00 'Is°fo $ S,Od0.00 ($83,750.00}
,
�^�rm�w snoizo
I
aev-is�z ex+�iz-oe7
�pennsytvania SCHEDULf I
OEPANTMENTOFREVENUE DEBTS OP DECEDENT,
INMERRANCE TAX RETURN MdR7GAGE LIABIf.iTIES$c I.IENS
RES[oENT pECE6ENT
ESTATE OF fILE NUM6ER
Michael Willi�m Waker 2013-00581
Re�wrt dabts iecurred Dy the decadent prbr to d,ath that remaimbd mryaid at Mt date of deatA,ineiuding unraimbureed mMkal expanses.
ITEM VALUE AT pATE
NUM9ER DE5CRlPTlON OF DEATN
1� US Bank-losn 0000-0513-03&278 15,916.23
2. West Shore EMS 157.74
3. Chase Bank Acct 3108(DCM Services) 31,104.14
a. Harrisburg Brethren in Ghurch in Christ(Deposited Aiter pate of 6eaith) 1,000.00
5.
6.
7.
8.
9.
10.
9 t.
12.
TOTAL{NSa enter on Une 10, Rerapitulation} ; 4&,178.11
If more space is needetl,insert addkianai sheeks of the same size.
�. ����I
��►ank.
LOAN SfATEMENT PQ�Q � °f 2
--- u.s. s:arv� osoo
PIITSBURGH INDIRECT ; A�C�l�qt $tltM�f!'1� �
— P4 B4X 740179 ��; �A't�-2Q43 :
��_�_.�
ST. LOUIS MO 63179-0179 Account Numbet: 0040-0513-�3b-278
_ Mafuriiy Date: Qct. p9, 2046
Prineipal Batance;' $95,49623
Totnf Mlnimum Amt. Due: $2,184.72
��i�i�lililll°�I�Ipill�bl��'ll11i111��9�'�lil�d��iqld�i�� Paylneflf DUe Dclte: May 9. 2013
f Y�+�a f ihe TofaJ Mmu ar t e ky ihe
� 06Q068856 1 A8 0.38d fQ8d81p864(1098d P o�snt�e�is.Yau maX ur��lo�o�s cM1aigei
MICNAEL W WALJER �vh c P��I�+ppe�r on r �+»�M/ssment. amount.
52$ MUMMEL AV FkR t am�f z�our8o�o"�'f-a00-�r°s�Nt�c°Xor payon
LEMOVNE PA l70A3-1826
_ . . . :/k :,�_: � . >'':.. . . _ %. .. . ... >: ... , .. . >:. . . . ... >: .. ... .. . ..... ... . .: . ... .. :.: .... :
If1you I�a�vZs^�q�sti4rn cQn���g��ar��ae apntact U.3. Bank 24Hour Banking toll free at 1•600.USBANKS
( -ow�a oa7). f0f'ND 111
Far wrM� af US.Ban P.O,g 2188,Oshkaeh WIgql03-2188.Waass nofe lhat cal us wNl notprvpeervm
namo, �'an�d ast four d h�om��rpy k�f maliar��u{yau wNlt ot�af�df�s.ai�e saW a�rfotiaa wtllt yoex
ig your aociai aecur�numba ta US.8ank,P.O.Box'1800 St Paal MN 55701.
':f. . _. . . . . . _ . . . . . . . .. . .. . ... . . .. . . . . . . . .. . . .. ... , .. . . .. . ..
49�64;44f;4�i;1�f0�4i4 44 i1+��t� 4 14 ♦ 4 444i0 ♦i14�9440949444094p
. us oam • s roa I�g �ouro�
e ENmin s your ppper clulfnr wHtt oMlfte statsm+�Ms. a
� w i n ce iinm cr H orr8 . a
. �p�O°aay cn us .aom� 4
04�44i04494i4t9�N49909l94140444i40040049144Ad440494044994�4i894044d�t44
Intarast paid in 201� S44o.07
� you�wAci IYo�n racssiv��annoHlclal 0�9�tarm��ani�+as a caurtecy.if yow accouM ii�es for 1098
In tM t�above and fhe cfctua!amour�t cn tho 1048��anount i�atl�ahatld�rswlonsid�a�d�anncs
aaHmate ot iMsrast and tmros pald.
PAi�a uss fhs �pqy at tlx boft�chat the tksf poye wh+rn yar Yaw paymsnt vri��the ctnre»t
mum amou�}pdruosq.as8��� hme you a on�,o asne��pqrw�al ehe�thb paym�t��
Coupon. upaa i���za us to tt fhat c»ckP��bs •M��p� yo���unt.Y oAee accouyn�t wmiNqbys debit+md
iw�Mrr�ir.�oae.U S.�Ba��Yt d�iaaking aoaaN ousfomers mW aMe mdca PWma�s�W o Rw nueifrrr I�od�fbva.
PaymaMs rse�ived S�t3 p.m.Central Ttmm at a�r Paym�et Pra�esi CeMar veill be a1r�iied#o your taxount aftsdive
iha same buekieAe day, ayments roceWed aHer the cufott Nme,ar on wee�Cends or lognl hond�ys,wIN be applled to yaur
Statstr�errf Cartfnass ar Nexf Fage V 6cpraf Nou#rrp Lender
i � �""'��ko Fteas�detacb co++Pan and se»d wMh PW+na+�t SYa�em�n Ddte:Apc 1��3278
�'��'� M�MAEL W WALFER
Address Cha�?t+W�b�eh,oaq 3�4�F1our
BcnkNg af 1•B�USBANKS.or v1aM www.u�bank.eom p�gpt DUe Date May 9,2043
' send pavmeni�o addrora de�ow: MINIMUM AMOUNT pUE $2,189.72
U.S. BANK 0300 Ameunt Enoletad $
PIT786UR6Fi lNDERfC7
p0 BOX 790179 To meke raaawnai psymenm or p�lnepa�paymenb,ploase raed the
3T. �OUfS MO 63179-4l79 �mpa�amas.uapassau+anrorbwtn+eaons,
1'���IIU��I��p��dm�lllql�l�d�u�u�li��nllll'1�I�1��l��II
�ODOOR 5$Q56�5740[I�Q0513[1362784S1fl0��2189721
�
EMERGENCY MEBICAL SERVECFS 265 Grnndview Ave.,Suste 21I Camp Hill,PA t701 t-170$ (7t7}7G3-2t62
♦ � �Y� l�I�1M1 ,
EsT��aF: riuc��,wnr,�x
CAI.L PT(TMBER: 23693SW
fio Whom it May Cancem:
Please accept aur canda2�csn yotu zece�tt loss. We realize that tlris is a difficult tima for you,
and we wiIl do our best to help you with this prpcedure.
To assiat with the procesatng of#�e abave clxlm,piease conu�ptete tLe fallowin$sbeps:
� "n V 1`�.a � •Y /� ��M1 .
2. Bstate is beiug handled by:
(Please inolude fiill
3. Thera is np estate(circle)
'I"hank you for yaur atte�#ian#o this matter. Please contact our office if yau have any qt�tions.
Billing Office
W�t Share EMS f��/��r�.�'] �
�r,, � I
� �� �-� ' �
.�
� �� � �
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��� � WEST SH4R8 EMS - BLS o�scovER �
205 GRANDVIEW AVE SUITE 211
CAMP HILL, PA 17017-1708 ON REVERSESIDE
WESI'SHORE EMS P6ane#: {800} 367-4512 Federai Taac ID: 23-2463402
�tWtY3HAR HFt.ITN SYSi@A �
PATIENT NAME: (y�tCHAEL WALTER �NSURAN�E: NQVlTAS SOLUTiCtFJS,iNC. ES'fqTE
A
CALL NUMBER: ,136�5gW DATE dF CALL• 01/OS/2013
FROM: GOLDEN llVING
T8: 115 MUMPER LN
ACCOUNTSUMMARY
MiCHAE�WALTER
CIO ATTQRNEY PETER RUSSO ToTAL CHAHtiiES: i88.74
5006 E TRINDLE RD SUITE 203 PAYMENTS/AD.IUSTMENTS: O.pp
MECHANICSBUR(3,PA 1TOS0-3651 PL�E PAY THIS AMOUNT: 1$$,7¢
DETACHALONO PERFlDRATION AND RETURN STUB WITH PAYMENT
_ . . . . , .. ..... .
. _. . . . . . . . . . ... . . . . . . ... . . . . . �
� . t1ESGRIP710N£�Ct1AEiflE� � . � QilI1NTITY . UP717'PfttGE AdNOtlPIT
STRETCHER VAN-1 Way Transport T2005 1.0 108.75 108.75
Trensport Van M(feage S0209 13.1 3.74 48.99
$AD GHECK CFiARGE 1.4 31.40 31.Od
Total Charges �88.74
� H OF PAYMENF RECElAS PAYMENT DATE � RMOUNT� .
P�ivate Payment/Check 5324 02/02l2013 -157.74
Private Payment t Gheck 5324 01123t2013 i 57.14
T�aI Credks O.dO
PLEASE PAY THiS AMOUNT–INVC/ICE DUE UPOlJ RECEIPT —► �188:T4
RETttFiNED CHECK FEE–�31.�
PA7IEMTNkME WALTER, MICHAEI. cAt.l.NU[�16ERt 2$$955W AMOCIKEPNO:
OB728t2013
IMPORTANT MESSAGES: WE ARE AWARE TNAT THE PATIENT iS DEGEASED AND YOUR OffiGE IS
HAND�ING TFtE fSTATE. PlEASE FORWARD PAYi�AENT TO ABOVE
ADDRESS AS SOON AS POS3IBLE.
WES7 SMORE EMS -BLS 205 GRANDVIEW AVE SUITE 211 CAMP HILL, PA 7 7 011-1 70 8
May 07 2013 3:17PM Dan Services 6122438490 pege Z
�
sarvfces
7641 PeaN AvE 8,�iutTR IR600
MtNNe�tnous.Mnw�ptA a5423-5�4
TE�EpFioME 612-243-8620 Nours(ci); 7:on em-7;otl pm M-�
FAX 877-326-8784 ]:00 em—S:Od pm F
Ta��-Fae� 8Blf-234-1138
May 6, 2813
Re: E9tat8 of: MICHAEI.W WALTER
Our Ctiertt: Chase Bank USA N.fl.
AccOetpt Mo: *****x******9108
Unpaid Balance: �3110A.14
Reference No: 8991701
Dear Slr or Madam:
`f'his letter conflrrns a� unptUd balence oP$312Q4.24 an the above listed acoourrt raqarding tfie
EstaCe of MICHAEt W NlALTER. We are not hoFdlnq you personally nexpansiWe for kfie batance. We
are s�eeking payment from the assets af the decedant"s eatata,
Tf you need to make payrrrent arrangemenks or to make payment over the phone, call us toll free
st i-BSS-234-1135.
CordieliY,
pCM Services, LLC
This compeny €s a debt collectar. We are attempting to caliect a debt and any irrtormatlon obtalned
wili be uroci for ttrat purpase. Caiis may be monitored ar r�orded far quality assurance purposes.
NOTIC£: SL°E N�XT PAQC FOR IMPORTANT IliRORMATIO�N - Psge ! ot 2-
t+»betsch tawer Partlon arx!Ratum wtth naymmk•••
1 8 9917 0 1-7104-6.6.2013 t RltefEnCC#►: 899i.702 Clier�IDt 7AMCi1
��,� u� Ba�a�ce: $ssxoa.ta
7ftf1 FatKt 1Nns S,�ite ik63D Checks PayeWe to: O�;Mi ServFCes. lLC
lMnnerpothe, MN 55�423-5004
ADDRESS SERVICE REQUESTED Amount Encbsed: �`"i�
�.��___.....
� May 6, 2013
The E�tate of MICHAEL W WAtTfR: bCM Senrie�es/Chase na
Aip�: PETER RUSSd PO BoX 1478
5006 E TRINDLE RD 57E 203 Minneapolis, MN 5S44d-1473
t«�CHANIC'SBUR6, PA 37050
- 69°M17DS 31015
., wm
May Q7 2Q13 3:l7PM Dcm Snrv�ces 61224384� pege 3
Paya 2 0!2
*=MpORTAMT IWFORM/l7`xdN�'
Under the iaw we are required to notify you oF the foliowing informadon. Thts Iist does not Include a
complete Ilst of rights consumers have under State and Federal Laws.
NdTTCE ASOUT El.ECT�MIC CHECK iANYlRSiON
When you pravtde a check as payment,yau sutharize us efthar ta use infarmaHOn from your cfieck
to make a one-Nme �I�onic fund transfer fram your aarourrt or ta procass the payment as a
check trart�actbn. When we use informatfort from your chetic to make an eiectronlc lund transter,
funds may be withdrawn from your account as soon as the same day we racelve your peyment,
and yau wtil nat recetve your check back from yaur flnancia! tnstltutlon.
POR CCLORADQ RlSIDlM7'S
Colorada Offlce InCormat{an: Colarada Mana�er Inc. 80 �rc7an Center, Suite 3, BroamfTeld, CO
8002Q, (3Q3) 420-4763.
lwdR MASSACHtiS!'TTS RES=DENTS
NOTICE OF IMpORTANT ttIGHTS
YOU HAVE THE RIGHT TO MAKE A WRTREN OR ORAL REQUEST THAT TELEPN4NE CALlS
REGARDING YOUft DEBT NQT BE MADE TO YOU AT YOUR PtACE Of EMPLOYMtEA!`t. ANY
SUCH �RAL REQUEST WIIL 8E YALID FOR ONIY 7'EN QAYS UNkESS YOU RRtJVIDE
WRITTEN CQPiFIRMA'IIf?N OF TNE REQUE5T PQS3'MARKEp OR DEUVERED WITHIN SEVEN
DAXS OP SUCH REQUEST. YpU MAY TERMINA7E 7HT5 REQUfST BY WRITING T8 THE I�EB?
ca��ecroa.
FOR MINNE8�ITA RESIDENTS
This Catiec#io� Agency is tkensed by the Minnesote Department of Cornmerca.
FOR NEW YQRK CiTY R�IDENTS
New Yark Gty Depertment of Consumer Affafrs Ucense Number; 1239504
To dlscuss thls aa.aunt, please call aur to11 free number ta speak wtth Amanda Kodelka. A
reprasentaklv+e will be able to assist you during our narma) busfnes�s hours.
POR NbRTH CAROLINA RESIDENTS
tVarth Garalina Permit Number: d44d
FOR TENNES$'EE RESIbEMTB
Thts Coliedton Agency is licensed by the Collectian Servlce Barard of the Department oP
Commerce and Insurance.
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�pennsytvarria SCHEDULE 7
OEP�iRTMdiT OF 0.EVEAt/E
,�,���„ seN�eFxcau►RtEs
PEBIUEM DECEDEI/f
ESTATE OF: PIlE NUMBER:
Michael William WaNer 2013-Q0581
RELATlONSHIP TO DECEOENT AMOUM QR 5HARE
NINABER NAME AND AQORE55�PERSON(Sj RECEtV€NG PROPEN,TY Do NM iirt Trustea(sj OF ESYATE
I TAXABLE DlSfR18UTI�dS{lndude uutrfghf spousal diStHbut�ns�iransfers w�dlr .
� Sec.911b(a)(1.2J.]
._._. _.__._ __..__.-_.__.._ __ _.__.. ....._.�---- ` _. ._,.__. _ ,._ ......_ . ...., ... ..
1. Ronald L.Walter �Srother 50 -
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2 Cadyn L.Williams .. . ;Sister 50
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II p�7-iA%ABLE D1STRt6UitONS
A SPWSAL DISTRSO4ITIONS UNDER SECTiON 4113 FOR WHICN AN ELECTION TO TAX IS NOT TAKEM:
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TBTAt OP PAlt7 Ii—ENiER T6TAL NON-TAXABtE DISTRiBUT10N5 ON LINE 13 OF REV-1500 COVER SHEEf, $',I � �
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