HomeMy WebLinkAbout10-24-13 (2) � g� 150S61U1H3
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PA Dapartmertt of Revenue psnnayivqnia cwmy oa vs.r F��
Bureau af IndWidual7axes °°�*d�
aoBax.2eoso� INHERITANCETAXRETURN 21 13 0796
kamspurg.Qa 4�iab-�o� RESIDENT OECEDENT
ENTER[SEGE�NT 1!}FQRMATtON BELOYY
Social Security Number Date of Death Date of Birth
O6 22 2013 07 19 1925
C1eCedenPs tsst Nama SUfH�c DecedenPS FiBt Name MI
SERNHARD 3USANNE C
(M Appiieabie}E�r SurviW�8pouss's Inforrnatlun Bslaw
Spsuse's LaaC Name SuMx Spbuse's Firet Name MI '�..
Spouse's Socisi Security Number -
THIS RETURN MU3T BE Ff1.8D IN a1JPtICATE WITH THE
REGISTER OF WILLS
Fl�l�i APPRG1PItIJ1TE i7VAi.3 SEI.OW
� 7. OrlpinetRetum � 2. SupplementafRetum � 3. �R�ntler13eWm(daleotEeath
� 4. LimitedESta� � 4e.{�at�duri2�i2�? ❑ 5. FederalEStete7axReNmReGUitetl
� 8' (A�CwY�WflaNele � �, ���a LIWro iiust _ B. Total Numbar W 5afe DeP�i 8oxes
� S. LNig9�Proc9HA!Recaived � !Q.�i�����} � (� 11.{AUach Sch.4}utMer Sec.9113(A)
CQRRESPQNDENT•THI$SECTION MUST BE CQMpLETED.ALL CORRESP4NDENCH AND CONFWENTIAI.TAX INFORAAKf�OH BHOULD BE DIRECTED TO:
Name Daytime Telephaip t�umbar
�3A3�T M WILEY 71t'T 492 Q�66-m �
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RF�01871ROF WIL'L�.4 Ub�Q�Y .
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. Clfy w Posk OtNce State ZIP Cods DA'f'E PA�D
DxLLSHURC PA 17019
carrssaa,d�nn's s-mae aamess: lanmwiisy�comcastnet
u wa :a°' ° �`�a:r�ma,a a�on,�r n�,f°�""a',a�p��or�"$i nn�i"r�o�is n�'"�u �'a�wa�a'�r no,oy"�01�8�oeiim,
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3 PI.8altlmae St►eat,Di�bur�.PA 17019 ��31 !�`�'l � 3
87C�NA7VREOFFREPAREROINER�P(tEBEMATNE ATE
/"��
Jan M Wiley
s
r
.Baldmore St.�Dilisburg,PA
Side 1
� 1505610143 150561�b43 �,,,�
��
__
� 1505610243
REV-1500 EX
De�denPa Soclal Security Number
�'•� Bernhard, Susanne C
RECAPITULATION
1. Real Eatate(Schedule A)....................................................................................... t.
2. scodcs and sonds(scneduia s>............................................................................. z. 112,2 8 6.2 5
3. Cloaely Held Coryoration,Partrrerahip or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgeges 6 NMes Receivable(Schedub D)........................................................ 4.
5. Cash,Benk Deposita 8 Miscellaneous Penonai Property(Schedule E)............... 5. 187,355 . 39
8. Jointry Ovmed Property(Schedule F) ❑ Separate BilHng Requested............ 6. 34 , 653 . 67
7. IMer-VNos Transfers 8 Miscellaneous Hoq Probate Property
(Schedub G) LJ Seperete Billing Repuested............ 7,
8. Total Gross Aaseb(total Lines 1-7)..................................................................... 8. 334,295 . 31
9. Funaral E�enses&AdministraHve Costs(Schedule H)....................................... 9. 41 � 771 . 73
10. Debta of Decadent,MoRgage LiabilRiea,8 Liens(Schedub I).............................. 70.
7 7. Tofal DeducUona(total Lines 8 8 70)................................................................... 11. 41� 771 . 73
12. Net Value of Estats(Lirre 8 minua line 11).......................................................... 12. 2 92 ,523 . 58
13. Charitabb and Govemmental Bequests/Sec 9113 Trusts for which
an ebction to tax has not bean made(Schedule J)............................................... 13.
14. Net Value SubJectto Tax(Line 12 minus Lirre 13)............................................... 14. 292 ,523 . 58
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. AmouM of Li�re 74 taxable
8�tllQ SPOU681 t8)(fe�e,Of
tranafeB undar Sec.9116 �5 0 . ��
(a)(12)X.00
78. Amount of Lina 14 tezable 2 g2 , 523 . 58 ts. 13 , 163 . 56
at lineal rete X .045
17. Amount W Line 14 taxable
at siDling rate X.12 0 . 00 n. 0 . 00
18. Amount of Line 14 taxable
accone�ereireux.�s 0 . 00 �e. 0 . 00
is. raxoue.................................................................................................................. �9. 13,163 . 56
20. FILL IN THE OVAL IF YOU ARE REQUESTINO A REFUND OF AN OVERPAYMENT. �
Side 2
L 150561�243 15U561�243 J
REV-15�EX Page 3 Pile Number 21-13-079B
Decadant's Compl�Adde�s:
DECEDENTSNAME
B•rnlu�rd,Susanne C
STRHETADD1tES3
4805 E.THndM Road
GITY STATE ZIP
Mschanicsbur� PA 17066
Tax Psymeerts and Credits:
1. Te�Due(Page 2,Llne 19) (1) 13,183.56
2. Credpa7PaymerNS ..
A. Prior Payments 10,90$.4S
8. Qiacount 574.13
TotaiCr�ita{A +g} (2} ii,+f82.62
3. 3ntetest (3)
4. �t Lirre 2 ts 9roadar Man Line i+Line 3,enter the differonce. 7his is the OVERPAYMENT. (4)
Chsck box on Pags 2 Lina 20 ta roquest a rofund '
s. n u�s���s��reaee��,�,��2,em�me a�e�. rns��ne�r�oue. ta) 1,680.94
Make Check Pa bie to: 1tEGi3SER OF WlL,LS At3ENT.
PLEASE ANSWER tHE FOLLOWING t1UE8TION3 BY PLACINi3 AN °7C" IN THE APPROPRIATE B60CKS
t. D'W Aecedant make a trattsfer end: Yp No
a. retaln the use or Mcome M the proPerty transferredl...............................................................................
b. retefn Me ripht to dmaignate who shall sme the Qroperty transTerted or its income:............................._...
o. Eeta'a�a rsversibnary Interpst;or...............................................................................................................
d. reoake ths promlee for Itk otedher PaYmeMs�beneNb or caro?............................................................
2, It death oaurted aRer December 12, 1982,dW decedant trenater propdAy within qne year of death witMiout
receNing adequate conakbretion?.................................................................................................................... ❑ �
3. Dicf deaedont am an°in tnret fot or payablr upon Ceetli b&nk aaount or secu�ity ak h�or her�afh?...,... ❑ Q
4. dW dece4enR own an IndNidual Retirement Account,ennuiry,or oMer non-probate property whieh
coMainna benaflaary slesignatbn7...........................:...................................................................................... � ❑
IF THE ANSWER TQ ANY OF 7HE ABqYE QUESTIONS 13 YEB.YOSI MU$t C4MP6ETE SCHEDUtE 6 ANQ FN.E iT A8 PART OF THE R@TURN.
For daEes of deadl on or attor Juy 1, 1944 end before Jan. 1, 199B,the lax rate impoaed on the net value of hansfxs to or for the use af the survlving
spaupe b 3 per�,pM(72 P.S.§9178{a}{1.1)(i}j, �
Fcr d8bs of�th on a ef�Jat�uary t,f99�.s,tlre tax rate anpaaed on the nM vakte M trans#ers M or tor tha use of�aurviving apot�e�0 percant
[72 R.B.$9118(a)(1.1)(ip]. Yhe aletute d4es not exempt a tranater to a survWi�g apouw from tax,and Ne statutory requlrements for discloauro of
aaaets aM fllinp a tax retum an stlll applfcabb evan H tM surviving spoux fs the onty beneficiary.
Fw de�s ot�eth on a srter duy t.z060:
• Tha tax rebnimposed on Me net vaiue M tre�fers from e doceased chiM 2tye ars of age ar younger at death to or fw the use of a naturaf paront,an
eSloptNe pa nf,or a atepparoM of the child is 0 peroeM[72 P.S.§9116(e)(1.2)1•
.The tax rate Nnpqsod an tlwe net velue W transfero to a Wr tlie use of the decedenPd lineal beneNciaries is 4.8 percent,erccept ea noted in
1s Ps.���6 12�gz P.s.§af�6{a}t�)b
.Tha tax rabe impo�ed on the net vahm of tranefiers to or fa tha use of tM decedent's eibNngs is 92 perceM[72 P.S.§9118{a}(7.3). A
a�ling ia deflmfd under Sedion 9102,an an individusl who has at least one perent in common wqh tM decetlnnt,wtbther by b or adoptlon.
rsw.�ew ez.�e.b�
� scN�nu�e s
STOCKS & BONDS
cauMOHV�xn�aFr�ev�vuar,
�ra�rnxnenaw
�eioeiroECme'r
ESTATE OF FILE NUNIBER
Bernhard Susanne C 21-13-0786
�wawnrla�r�*•a wroi np�e m wwrmixa mw�e.a.eb..a on senau•F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
7 PNC Inves6nents 112.286.25
TOTAL 1Alao e�r on Line 2, RecapMulatlon) 112.288.25
pf more spece ia needed,adAttbna�pepas oi the seme aize)
CopyripM(c)2002 torm soRwara ony The Lackner Group, Int. Form PA-7800 Schedule B(Rev.6-98)
N�v-tl08 E%t(!-W)
� SCMEDULE E
CASH, BANK DEPOSIYS, 8 MISC.
PERSONAL PROPERTY
cou�oNV�u.TMaFVeaanvuu�
N6NMMCETNf Rl1VRN
IWBICHITGlCl�FJlf
ESTATE OF FILE NUIII�ER
Bemhard,Suaanne C 21-13-0796
� Maw.m. mr .bubmum.aow.a.».re�.wn.a u�e«W..
All P�b �MnownW tlN AYM o/wMVOnNP mu��W M�ChWuN F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Allstats Insura�e(�GA18600840) 99.852.02
2 Altstate Insurance(fIGA20882400) 60,000.00
3 MetLits(9200609464) 27,503.37
TOTAL(aso enter on Line 5,Rsupitulatlon) 187.355.39
(H mae cpace la neetla4 etlditlonel ppes of tlie�ame ei=e)
Copyright(c)2002 tortn aoftware onty The Leckner Group,In¢ Fo�m PA•1800 Schetlub E(Rev.6�98)
. _
�,,.,�.�.��� �
SCHEDULE F
cwra�wrKtnoFV�snvu�H JOINTLYAWNED PROPERTY
�»�..�,.��
��
ESTATE OP FILE NUMBER
Bemhard Susanne C 21-13-0798
x.o....�.r m.a.laM�nm on.r.v a m.a.o.a.m�.a.0 m a..m,i�mwe w r.poma m.�n.aw o.
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
A.
B.
C.
JOINTIV OWNED PROPERTY:
DESCRIPTION OF PROPERTY e�� ppr�oF pEpTM
��M LETIER DATE pICLUDE NNAE OF FINANCIAL M18TINTIOfi AND BANK ACCWNT DATE OF DEATH �(�'p'S pECEDEHf'S qffERE3T
NUA�RER FOR JOI MADE N�MBEp pp gIMIIAR IDENTIFVINO MMABER.A17ACH DEED FOR qLUE OF ASSE ��REST
TENANT JOINT JOIN7LV-HELD REPL EBTATE.
1 PNC Checking Account(5740467:i5E) 33,556.35 50.00076 16.778.18
2 PNC Checking AccouM(3140480052) 14,048.10 50.000% 7,024.05
3 PNC Savinga Account(5780403105) 21,702.87 50.000% 10,861.44
TOTAL(Also erMSr on lina 6,RecapiWladon) 34,853.67
(M mora epeca la needeA.atltlXbnal pepea of the eeme cize)
Copyripht(c)2002 firm soRwara onty The Leckner Group,Ina Fortn PM1600 Schedub F(Rev.698)
nev-net ez,��a.a� � I
scHeou� H
c �+� FUiMERAL EJCPEN$ES &
ADMIMSTRATIVE COSTS
ESTATE OF FILE NUMBER
Barnhsrd,Sus�nne C 21-15-0796
Debffi of deeedent must be reported on Schedule I.
1TEM DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
See contlnuation schedule(s)attaahed 1 t,314.25
B. ApMIN13TRATIVE C09T3:
1. � Petaonal Reproee�tative's Commissfons
NBme of PetEOna(Repr988ntstiva{s}
Jan M WNey
Saeet,nddrses 3 N.Bai�more Street
Cny DNl�burg stero PA zio 77019
Year{s)Commfssian t�aid 15,0OO.OQ
2, nnomevs Fees 7he Wiley Ciroup,PC �s,oDp.pO
g, Famity Exemptbn: (If decedenYs address is not the sama ws daimant's,atfach e�lanation}
Claimant
Sheet Address
Cfly Stata Zip
Relationshic of GlaimaM to Decedent
4. Probate Feea 163.50
5. A.ccounteM'a Feea
6. TAx Rawm Propsreta Feas
7. Otl�er Adminishatiue Costs 308.58
Sse carrtinuatlan schedufie(s}attached
rorat�,aso emer on iine s,�tecaRnutsaa�� a�,���.ta
CopyrigM(c)2pp9 fortn soRwero only Tha Ledcner Group,Inc. Form PA-76W SchetluW H(Rav. 1Q-O6)
scN�ou�� H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUNfBER
8emhard Susanne C 21-13-0788
� DESCRIPTION AMOUNT
NUAABER
�
7 Cxklin's Funeral Home 11,314.25
H-A 71.314.25
Otl�er AdmfnietraWe Costs
2 The Dlllaburg Banrrer-Advertising 93.20
3 TM Sendnel-AdverUsing 270.78
H-B7 303.88
Copyripht(c)2002 fortn soRwaro ony The Ladcner Group,Ina Fortn PA-1600 Schedule H(Rev.E98)
REV.1617 EXt(11�) �
scNEau�E �
c �Y""'" BENEFICIARIES
E8TATE OP FILE NUMBER
Bemhard,Susanne C 21-13-07�
NAME AND ADDRESS OF RELATIONSHIP TO SMARE OF ESTATE OUNT OF ESTATE
NUMBER PERSONfS1 RECEIVING PROPERTY DECEDENT (yyoMs) ($u)
I� TAXABLE DISTRIBUTIONS [inGude outripht spousal
distnbut�ons,and tranafers
under Sec.9178 a 1.2
Mark L Bemhard Son
PSC 486
Box 45
Fpo,AP 96695
Jan M Wiley Estate
3 N.Baltimore Street
Dillaburg,PA 17018
Total
E�er dolhr amamts for diatrWutions shown sbove on Ik�ea 15 Nro h 18 on Rev 1500 caror shsel a
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOT PART II-ENTER TOTAL NON-T LE DISTRIBUTION6 ON LINE 13 OF REV-1500 COVER 3
Cop�Mght(c)2008 Mrtn sollwara o�ty The Lackner Group,Ina Fortn PM1S00 Sdntlule J(Rev. 11-08)
r-�
�1; � 2C,�. � �J'N. F��1�; �a�ii� No. � »f�
�����
�F.;0.Fii��,ThlEY�Ff1Y
August R, ?Ol�
.Tan n1 1�'ile� Esq
Tl1e «'ila) �iii;up
3 N Raltunore St
I�illsbiug, FA 17019
RE: Susannc C Bernhard
SSN: �10-16-59�2
pOn: 06-22?013
Dear Su/Madam:
In zesponse tu your request for Date uf beath(17C>L�)balanccs for the enstomer nc,tec�a6���e; ciuz
recor�s �o�c the Yollovciag_
Checkiug Account
Au�unt# 5]404>7>58 Established: 05-31-1959
MART�LEWTS BERI�i?,R17
SiJSANNE BERNH.4RD
L)UD balance: a 33,556.15 + Q�2 accrued i.nterest
Tnterest pai� U1-01-2013 thni 06-22-2013 $ 1.10 �'TD
Actoiuit# 5140460052 Established: 12-07-1985
SITSANNE C B�RNf�A�
MARK L BERNHARb
DOD balance: � 14A�7.97+0.13 accrued intezesti
Tnterest paid O1-01-2013 thn� 06-22-2013 $ 0.54 Y'PD
Sa�'in�s Accuunt
Account# 51�040�105 Established: 03-22-1985
SL7SANIv'E C BE,RNF�ART�
MARK L BERNHARD
llOD balance: $21,702.55 +Oa2 accrued interest
Tnterzst paid pl-01-201� thru 06-22-?1113 � 3.03 YTI>
Page 1 oY 2
�
til:z . ��:,�� � �:�,:�e"I �1i, _ ;",ti °i��:. �ii:5 !. [� C
Yl�as'e note that tlus c�fYtce procidrs dxTe of'dcatli balau:e::ti:�r deposrt scepunts (iRA,,CDs,Gheckang ancl
Savings 1. W e do not process any financial h•nnsactiuns or provide stxtements. If yon nc�d usistance���ith
an� vf tbese items,plesse call 1-FR(�-YNGR�L�v-Y:{1-i+RS-iti2-�^6�j�r stop b} yo��:lucal PI3C Aanl:hrxnch
pfficc-
Sincerel�_
Natioual Financial Services Cen[er
YNC Rai�1:.:ti.A.
Membcr Fll1C
This n�assa.�*e is ir�teraied,f�r rhr ��sc c��th� in�fvi�ual or �nrrty to which rt is adc�r�ssed and may
ebrttain ir�fornt�itinn tF�ut is prfi zlt��eil. ccn fc�erarinl imcl exen�pt fi•am disclosvire under¢pplicable 1v�-
If the vk�uc�er pf tliis me.ssage is rrot Ilie ir�[�nded reci�ient or t{ie employee ur ugeret responsible fi�r
detiverirz�thia rr�ecsage ro t1it� irtrelided rec�pierit; y(iu ase lierebt�riotifie��Thar r�rr} dis.serninattor�.
c�istrrbr�rinrr or cc��yir�g c?f this cumni�rriication,c is sirictly prohihited. If yoz�hcn'e received this
communicarion in error, pledse nutin'me immediarely bl ra�l��or by telephone at 800-?62-1'i5 an��
tmmectlarel} �7�an•ny this fr��d duc7xrne�zt.
Page 2 of 2
�� Allstate �if0 insur2Y�c� CompBny 7elephone: i-H00-755-52'IS
PO Box 660i91 Fax: 7-868-628-140s
A��`��'�� pallas, TX 75266-0197
JunO 3, 2�t3
SUSANNE C BERN HARD ���.���� '
4305 E TRIPtDtE DR APT 1033 �
MECHANICSBURG PA 77050-3643
CHARLES E LITTLE
PNC INS SERVICES LLC
2EMAIN57
MECHANICSBURG PA 17055-3857
(717)000-Of100
A{istate Pure Advantage
Annuity #GA20852400
As yau cequested, we heve processed the foilowing withdrewal. Your withdrawal has been electronically tre�sferred
according to yaur fnstn�ckions.
W ithd rawal I nfo rmatf o n:
Totai Anrruity Value as of 06/03/i3 $60,160.56
Grass WiFhdrawai Amount $160.56 $i60.56
Eiectranic Transfer Amount $16Q.56
Remaining Tatal Annufty Yalue as of OB1U3/13 $60,000_00
As required, the ta�cabie amount of this distributian wili be reported to the tnternai Revenue Service on Form 1099R.
You will receive a capy of this form for yaur recards by January 31 of the next year. please retain thfs informatipn for
yaur ftnancial and tax records.
Additional information on this transactinn is provided on your confirmation statement.
We value our relationship wiih you and look forward to helping you achieve your lo�g•term financiaf gaafs.
.;.'+:_ i At78K9PEO.N6t
� Nrmmu.K.vcoww.ro.EOOO�
IN15fiv
�� Ailstate Life Insurance Company Telepnone: i-s0oas5�52�5
�� �X ���j Fax: i-$66-62H�1005
�'i��'�` Daltas,TX75266-0191
May 3t, 2013
SUSANNE C BERNHARD Y4ttr RO{fl'@se»tetlVe
4945 E TR}t*1D�E fiD APT Y033
MECHANlCS$l1RG PA 7�050-3843
CNARLES E LITTLE
PNC INS SERVICES LLC
2 E MAIN S7
MECHANtCSBURG PR 17055-3851
(717}000-0000
Atistate�Advantage Pius #GA16600640
As you requested, we have processed the following withdrawal. Your withdrawal has been electronicaliy transferred
accarding to your insiructions.
Withdrawal information:
Grcrss Annuity Value as of 45t31118 $10b,020.SO
Gross Withdrawal Amaunt Q'� 8.08 168.Q8
Electronic Transfer Amount $168.08
Remaining Annuity Value as of 05/31M3 $99,852A2
As required, the taxabie amount af Ehis disiribution wiit be reparted to ihe Internal Revenue Senrice on Farm 1099R. A
copy o4 this form wili be maifed to you by January 3i of the next year. Ptease retain this information for yaur financial
and tax records.
If you have any questians about this fransacfion, please contact your representative, or caI{ 1-&170-755-5275. We vaiue
our relation5hip with you and lac7k forward to continuing to heip you achieve your long-term financiaf goals.
j X26K8ZSM.hf41
� .ummxi.xzs«xner.r,r cez
1%151M1
Page 1 of 1 Confirmation Statement
MetLife� ---�-T-
i�s,�a�e= � . � _ �u,�.u_ � _�_
MetLife Investors USA tnsurance Company 72/37/03 Premier Select II
P.O.Box 10366 Overnight Address �p�e�;j�p�p� , : � ": , '(CQpy�"�'ypp� "` `��'�' �'�:
Des Moines,IA 50306-0366 4700 Westown Parkway, Suite 200 gp00609464 '�. Non-�ualified
1(800)709-2906 West Des Moines,IA 50266-2266 - —�-
� www.metlifeinvestors.eom .: �K$} rn
SUSANNE C BERNHARD
. _ .. . ��) .. .
SUSANNECBERNHARD
m SUSANNE C BERNHARD — ---- —— --- —
—� COUNTRY MEADOWS RETIREMENT HM
=� 4905 E TRINDLE RD APT 1033 � -'�itbr��"Q T'
�e MECHANICSBURG, PA 17050-3643 Chades�ittle
Account Summary
Account Balance on June 3,2013 $27,503.37
Current Accumuiation Period 1 year(s)—
Current Interest Rate 1.50%�
Transaetion I Trensaetlon Doller Amount �
Date Desaipdon of Transae[ion �
6/t/13 Monthry Interest Payment $34.80 �
1 Vear Guarantee Periotl $34.80 �
Payee Name:PNC BANK �
�
lesseges: �
�
larket Value Adjustmerrts may apply to this conVact on certain distributions in excess of Me Free Withdrawal Amount.Account Value is reduced �
�partial amourts�,nthdrawr.from the ccMrac!. Penattiee,a�;ueL^eer.ts ar.d evitt:holCings are applieC to the partial amouM;ivithdrawn artd reflected �
�.ihe net amount payAble. Piease review this confirmatlon carefully antl notify us ot any evors.If we are rwt notified of an evor within 30 days aNer �
�ceipt of this ffiatemertt,ihe correction will be made at Me rete on the date we receive notificatioa o
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Cocklin Funeral Home, Inc. Acct: Contract # 194
MEMORANDUM OF SERVICE
SERVICES OF: Susanne C. Bernhard DATE: 7/3/2013
(A) Services:
Traditional Service Package $3,925.00
Heirloom Pewter-Crepe $2,765.00
Monticello $1,440.00
Marker $1,469.80
Total (A) S9,5s9.80
(B) Cash Advance Items:
Certified Copies $120.00
Clergy Honorarium $150.00
Opening and Closing Grave $],085.00
Newspaper Notice-Harrisburg $179.45
Newspaper Notice-Banner $35.00
Organist $75.00
Canter $50.00
Alter Helpers $20.00
TOt81 (B) 51,714.45
Total Amount �11,314.25
Less Amount Paid �0.00
Due $11,314.25
_
The Sentinel T1�E WILEY GROUP AD NUMBER PAGE N0.
w.�.w.c�m b e r I I n k.c o m 3 N.BALTIMORE STREET 423666 1 Of 1
/}� DILLSBURG,PA 1T019
���Q Pi 7172_9� BILL DATE SALESPERSON
cAxe�:[ v+^R„se�n6 PEauvmu�rv
08I22H3 wolfc
START DATE STOP DATE
OSI08/13 08/22N3
AD NUMEER AD DESCRIPTION CLASS LINES
423666 EXECUTOR NOTICE ESTATE OF SUSANNE 10 PUBLIC NOTlCES 38 ' 2 cols
Publication Insertions Rate Net Amount Gross Amount
3 THE SENTINEL-LEGAL 3 LGL $201.78
TOTAL AD CHARGE $Zp��g
3 MOBILE SITE MOB2 $2.00
3 PROOF OF PUBLICATION 01 PRF $7.00
���� Est. S.Bemhard PAY THI3 AMOUNT $210.78 $252.94'
'AFTER 09h6/t3
Lee Enterprises no bnger accepts credR card payments sent via e-mail.
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THE SENTINEL ❑ Check# ❑Credit Card Ad Number ��
clo LEE NEWSPAPERS ❑ � ❑ � ❑ �, ❑ - gilling Date 08/2YH3
PO BOX 510
WATERLOO IA 50794-0540 �� Amount Due $ 270.78
E�y.Date:m m
Neme on cretlit wM a � I O i�
3�preMe
. v�eesa meice checks peysNe to: THE SENTINEI
��*� THE SENTINEL
' THE WILEY GROUP rJo LEE NEWSPAPERS
. 3 N.BALTIMORE STREET PO 60X 1425A8
DILLSBURG,PA 17019 . CINCINNATI OH 45274-2518
���n�����n�����u����n�u�������n�u��u�u�n��n���u���
21540200UOU0042366600000UOOODU000025294000002b0786
Bargain Sheet & Dillsburg Banner Invoice
��M � 31 5. Baltimore Street
Dilisburg PA 17019
432-3456 DATE INVOICE NO.
08/22/13 125629
BILL TO
Jan M. Wiley, Esquire
3 N BALTIMORE ST
Dillsburg PA 17019
TERMS DUE DATE
Net 30 09/21/13
ITEM DESCRIPTION �TY RATE AMOUNT
6 Legal Susan Bernhard estate, ran Aug. 1 3 9.80 29.40
6 Legal Susan Bernhard estate, ran Aug. 8 3 9.80 29.40
6 Legal Susan Bernhard estate, ran Aug. 3 9.80 29.40
15
66 Notary 5.00 5.00
Total $93.20
RECEIPT FOR PAYMENT
GLENDA FARNER STRASBAUGH Receipt Date : 7/22/2013
Cumberland County - Register Of Wills Receipt Time : 10 :46 :15
One Courthouse Square Receipt No . : 1074932
Carlisle, PA 17Q13
BERNHARD SUSANNE C
Estate File No . : 2013-00796
Paid By Remarks : THE WILEY GROUP PC
HMW
-- --- - - -- -- - - - - ---- Receipt Distribution - -- -------- -
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST 45 . 00 CUMBERLAND COUNTY GENERAL FUN
WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 30 . 00 CUMBERLAND COUNTY GENERAL FUN
JCS FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D
AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN
INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN
INH TAX 32ETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN
REN[TNCIATION 5 . 00 CUMBERLAND COUNTY GENERAL F[JN
------------
Check# 1257 $153 . 50
Total Received. . . . . . . . . $153 . 50
COMMONWEAITN OF PENNSYWANIA REV-11$2 EX{i i-S8�
DEPAPTMEM OF REVENl1E
BUREAU OF IND�VIpUAL TAXES
OEPT.2$0641
HARAISBURG,FR TlY28-6601
PENNSYLVANfA
iECEIVED FROM: INNERITANCE AND ESTATE TAX
OFFICtAL REGEIPT
N0. CD 018'E 63
WfLEY JAN M
THE WILEY GROUP
3 N BALTIMORE AVERit1E
DIE.LSBURG, PA 17019
ACIV
ASSESSMERIT AMOUNT
CONTFiOL
NUMBER
- - ro��
--...-- ------
101 � $10,908.49
ESTATE iNFORMATtQN: ssN: 2t0-is-as3z �
FI�E nlUMBER: 2113-0796 J
oECEpENf rvAME: BERNNARD SUSANNE C �
DAT� (?F PAYMENT: QS/ZC}/2013 �
POSTMARK DATE: 09/19/2013 (
C4UNTY: Cl1MBERLAIUD �
DATE pFDEATH: 06/Z�/201� I
�
TOTAL AMOUNT PA1Q: $14,908.49
REMARICS:
CHECK# 1002
(NITIALS: DMB
sea� RECEIVED BY: GLENClA FARNER STRASBAUGH
REGISTER OF WILLS
TAXPAVER
j i
i
�
�
�,��st ���f�l ttrtd L���xttrrtrnt �
OF
SUSANNE C.BERNH.aKD
BE 1T REMEMAERCD.that 1.SUSANNE C.I3�RNHARD,bf 4I l�'umngton
Rnad. Dillsburg, York C�ouniv. Pennsylvania, hcin, ul� sound mind, memnn und
� undcr�mndi�g.do make.�ublish and dedare this as und for my Last Will a�d'lcstumcm,
i
� hrrehp revoki�g and makin�null and void any and ull �k'ills and Testamems and writin@s
in the namre thereof made b� ine at any time heretuforc.
ITEM 1: I direct that all myjust debts and funeral expenses be paid as soon
nttrr my demise as may be convenient.
ITEM2: Alltherest,residueandremainderofmyestate,ofwhatscevernanve
ond �vheresoever si Wate, eahether it be real, personal or mixed, iocluding property over
��hich 1 h�ve a power of appointment,I give,devise and bequeath unto my son,MARK L.
BERNHARD.
1TEM 3: Should my son,MARK L. BERNHARD,predecease me fail to
survive me for a period of thirty(30)days,or should we die simultaneous]y, 1 then give,
devise and bequea[h my entire residuary estate unto my daughter-in-Iaw, RACHEL
GRAVADOR.
ITEM 4: Should my daughter-in-law,RACHEL GRAVADOR,predecease
me,fail to survive me for a period of thirty(30)days,or should we die simultaneously,1
then give,devise and bequeath my entire residuary estate as follows:
� (a.) ]giveone-third(Ys)thereoftoSAINTELIZABETHAlY1VSETON
CHURCH.
(b.) ] give one-third ('/a) thereof to THE AMERICAN CANCER
SOC1E7'Y.
(c.) ] give the remaining one-third ('/s)thereof to THE MULTIPLE
SCLEROSIS SOCIETY. �
ITEM 5: 1 direct my hereinafier named Executor ro pay all inheritance,estate,
succession and legacy taxes of whatsoever nature and kind; to which my estate or the
_ __ __ - --�- _ .
� �
i
I i
trans�er nl any property passine hereunder or otherwise p,35sing b��reuson of my drmi.e. � �
m�c br subject and�o cl�arge such tases against my residuun estate_i� being mp imonion �
thet none of the aforesaid taacs eitl�er Tederal or state on any property requimd to bc i
indudai in my gross es[ale. und��r thc provisions of anc;cvc nr fedaral law no�� h; 1„rrr �
� or herenfiec enacted_shall be prnroted nmong ihe persons imerested in m�-estate io m�iiom �
� such propem is or may be transferred or to whom ariy benclit accrucs.
I
� ITEM 6: 1 appoint nry son,MARK L.BERNHAKD,as F.,xecutorofihi=rtn�
Last Will and Testement. Shuuld my sou predecease me. fail �o qu¢lify,cease to aci or
renounce probate,1 then appoin.IAN M.WILEY,ESQUIRF,as alternate Executur of
Ihis ms Last Will and Tesinment.
� 1_I'EM 7: 7 direci iha�my Exeemor or his successor shall not be reqoiced to
Igive 6und fur ihe ft�ithful performance oftheir duties in any jurisdiction.
� IN W ITNESS WHF:REOF,I have hereunto set my hand and seal ihis UY�day
of----L�%�(�,2007_
TNESS:
�_ "'t �� �LQoi�.�Qw (4�q�.S�AL)
SUSANNE C.BERNHARD
���.�C�/�.��/�(1*.-�
-2.
I
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� COMMONWEAL'PH OF PENNSYLVANIA . �I
:SS �
COI-�7l-OF)'ORK
���r_SUSA'NNE C BERN}IARD,JAN M.W1LE:1, I;SQU7RE xnd MAHCI �
iR.RI�.I�IHAW, the Testatrix �nd [hc witnesses respectiveJ�, •.cnusc names are signed ir j
ihe su,�ched or foregomg instrumcm_ being first duly swoni. Jo he�eby declaze to th<- I
under_.i pned c�uihori p�Ihat the Teaatri.e signed and executed�hr i nstrument as her Last Wl i i
and l-esttiment an�ttmt she had signed willingly(or willingl}�direcied another to sign ibr
her); and th�t she executed it as her free and voluntary nci for the purposes therein
expressed. and that each of the witnesses, in ihe presence :uid hearin� of the Testatris,
signed this Last W ill and Testament as wimess and that to the best of their knowledge the
. Tes�atri�was ai the time eightecn(t R)years of age or older.of sound mind and u�der no
constraint or undue inl7uence.
-��-� ��
SUSANNE G RERNHARD
� �
I — SS _. _�
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WITNES—�/ —
Swom to and subscribed
before me this (p�ay of
,2007.
s
NO"IARY PUBLIC
MY COMMISSION EXPTRES:
�OM,NEA1�H OF PENNSVLVANIA
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llV.4RNING: It is illegal 4o dupficate fh'ss co;�y Psy �xh�tostat or photograph.
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�i�p,�SN OFpEy� ����-z1dy cop�ed fiom an o�i�_mal Certificate of Deat
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