HomeMy WebLinkAbout01-13-14 (2)_ __ .�.-.. �-,
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-� 1505610105
REV-1500 IX�oz-ii)(FI)�
OFFICIAL USE ONLY
PA Department of Revenue P�^SY���a Couniy Code Year File Number
DE►ANTMENT��NHERITANCE TAX RETURN
Bureau of Individual Taxes �� � � �--�
Po Box z8o6o1 RESIDENT DECEDENT
Harrisbur PA i 128-o6os ---
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
�____.--- `.____��____� �—____.____—___-_�
'~ � 06/17/2013 ! 10/09/1948 �
�
! 1 ---� ��_ _-----__J
� __�...� �_��__ _.m . ..----_—___._..._.__ �_.._,
�_._____—.__—._ __�__
Dec:edent's Last Name Suffix Decedent's First Name
--__--.___ —_—_------------_---_-----; --
�____ _. __�^_____�_�------ �
LAMANCUSA � � ' TINER � �
_._._�__� �.__.---____.� i ___ _.
� _�__.__.__-------- � ._____. ____________---_e_��.
---------
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
� —_..__.---_._._.___.._.._.----_..-- _
---_�._____,� � _____�______.___._____.__---.--, —
LAMANCUSA � � N-� M
� �_____________� � __�.
_ _____________�___.��__----�
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
318-42-8283 Y- ,_^--—--�
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1.Original Return O 2.Supplemental Retum O 3. Remainder Return(Date of Death
Prior to 12-13-82)
p 4.Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
� 6.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)
CORRESPONDENT-TH13 SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIA�TAX INFORNIATION SHOULD BE DIRECTED T0:
Name Dayfime Tele�hbne Number
___�_-_______________________ ___---._--.-------------
____ �______- _�_�.__�
�(71 761-4646� � � 1
DAVID ENGLEHART j `_ _;��_ --� �t ____,
� ---._ ---- ----- ------__ --.
_��_____�_. ____ ---______ _____
TER OF�hL3 U C�ILY
� � C? � � �
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First Line of Address � �
_----__ __..- - -__._ __.___.__ _. ___ __--_.__ __ _ .;
—_ - � � � ?C � �
704 LISBURN RD STE 102 � � c3 � � '�`� �
_.._____________ ______ ._____ ___
--- — �_ __ _�� � �n
_ c� �
Second Line of Address ;� � �
__ -- ___ _ ---- _ ,
----_______�___ _�______ .--- � � � � �
; %
____. _._
_.__ ___ -- --- _�_ _ --- �•-------_DA ED
City or Post Office State ZIP Code
___________ ____. _ ___.
_ __. __l k _— - , ---- _ __ �
CAMP HILL I ! PA ! �17011 '
� _ __�__! �_.---�_..i � _---,—-.-_____.__.__- --_-- - -------�__,
�
Correspondent�s e-maii aaaress:denglehart profinadvinc.com _
Under penatti�es of perjury,I dedare that I have examined this retum,including acoompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete.Dedaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
E OF PERSON RESP NS FOR FILING RETURN DATE
`��� �-vr�a�,,ti-C. � � 1
An ss .
1 5 NORTHAMPTON LANE NEW CUMBERLAND PA 17070
SIG T F P PA R OT ER T N REPRESENTATIVE DATE
�— S —�
ADDRESS
704 LISBURN RD STE 102 CAMP HILL PA 17011
PLEASE U8E ORIGINAL FORM ONLY
Side 1
�
1505610105 1505610105 �
W
� i
� 1505610205
REV 1500 EX(FI) Decedent's Social Security Number
oecedent's Name: TINER J LAMANCUSA 210-40-2709
RECAPITULATION __ �
1. Real Estate(Schedule A). .......... .................................. 1.
2. Stocks and Bonds(Schedule B) ....................................... 2.
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3.
4. Mortgages and Notes Receivable(Schedule D)........................... 4.
5. Cash,Bank Deposits and Miscelianeous Personal Property(Schedule E)....... 5. 1,043.00
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. 132,537.00
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property 054.00
(Schedule G) O Separate Billing Requested........ 7. 163,
8. Total Grosa Assets(total Lines 1 through 7)............................. 8. 296,634•00
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 4,336.00
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)........ ....... 10.
11. Total Deductions(total Lines 9 and 10)................................. 11. 4,336.00
12. Net Value of Estate(Line 8 minus Line 11) .............................. 12. 292,298.00
13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) ........................ 13.
14. Net Value Sub'ect to Tax Line 12 minus Line 13 ••••••••••••• �4• 292'298'00
J � ) ...........
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or _
transfers under Sec.9116 �-- � 132,537.00 15 0.00
(a)(1.2)X.0 0
16. Amount of Line 14 taxabie 7,189.25
at Iineai rate x.0 45 159,761.00 �s.
17. Amount of Line 14 taxabie �
at sibling rate X.12 17.
18. Amount of Line 14 taxable
at collateral rate X.15 �8•
_�__�._ __ _.._
19. TAX DUE ................................................:........ 19 _- _.__- _--_�__._.�__ .
7,189
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
Side 2
�
1505610205 1505610205 J
� 2 \
REV 1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENTS NAME
TINER J LAMANCUSA
STREET ADDRESS
1435 NORTHAMPTON LN
CITY STATE Z�P
NEW CUMBERLAND PA 17070
Tax Payments and Credits: -
1. Tax Due(Page 2,Line 19) (1) 7,189.25
2. Credits/Payments
A.Prior Payments 0.00
B.Discount 0.00
Total Credits(A+B) (2) 0.00
3. Interest �g) 0.00
4. If Line 2 is greater than Line 1+Line 3,enter the difference. This is the OVERPAYMENT. �4� 0.00
Fill in oval on Page 2,Line 20 to request a refund.
5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 7,189.25
Make check payable to: REGISTER OF WILLS,AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred.......................................................................................... ❑ �
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ �
c. retain a reversionary interest.............................................................................................................................. ❑ �
d. receive the promise for life of either payments,benefits or care?...................................................................... � �
2. If death oc:curred after Dec.12,1982,did decedent transfer property within one year of death ■
without receiving adequate consideration?.............................................................................................................. ❑
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ �
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
oontainsa beneficiary designation? ........................................................................................................................ � ❑
IF THE ANSYVER 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 disdosure of assets and
filing a tax retum are still applicable even if the suroiving spouse is the only beneficiary.
For dates 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
adopave 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,exoept 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.
r �
REV-15o8 EX+(o8-i2)
enns lvania SCNEp1�LE E
�PARTMEN7'OF REVENUE CASH� BANK DEPOSITS �MISC.
INHERITANCE TAX RETURN pERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
TINER J LAMANCUSA
Include the proceeds of litigation and the date the proceeds were received by the estate.
Aii property jointly owned with right of survivorship must be discbsed on Schedule F.
�M VALUE AT DATE
NUMBER DESCRIP'TION OF DEATH
�,; Americhoice FCU Acct#36711 Savings : 28.00
2;�, Americhace FCU Acct#36711 Money Market 635.00
3' Susquehanna Valley FCU Acct#13514 � 380.00
. .. . . � . . �� . . . p,'. .. .
+i
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� . . . . . .. . .. . ... . .. ... ��" �Sx... e�,u.�`tr.i¢'� }.i3
� . . . . . . . . . "� ;A , .
Y '
. . . . . . . .� 'h•r .
' 1,043.00 .
TOTAL(Also enter on Line 5, Recapitulation) $
If more space is needed,use additional sheets of paper of the same size.
� �
REV-t5og EX+(oi-io)
� pennsylvania SC�IEp1�LE F
DEPARTMENT OF iiEVENUE �OINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
TINER J LAMANCUSA
if an asset became joiMly owned within one year of the decedent's date of death,it must be reported on Schedule G.
SURVIVING]OINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A�JEAN M LAMANCUSA 1435 NORTHAMPTON LN SPOUSE
NEW CUMBERLAND PA 17070
B.
C.
]OINTLY OWNED PROPERTY:
� pq� DESCRIPTION OF PROPERTY °ND� ����'TM
ITEM FpR�pINT MApE INCLUDE NAME OF FINANCIAL INSTIRITION AND BANK AOCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENTS VAWE OF
NUMBER TENANT ]OINT IDENTIFYING NUMBER.ATTAQi DEED POR JOINTLY HELD REAL ESTATE. VALUE OF ASSEf INTEREST DECEDEM"5 INTEREST
i. A. Residence-1435 Northampton Ln New Cumberland PA 249,300.00 50 124,650.00
2 A PSECU Acxount#8225663544 2,418.00 50 1,209.00
3 A PSECU Account#8335734839 2,935.00 50 1,468.00
4 A Members 1st FCU Ac:oount#252955 10,419.00 50 5,210.00
TOTAL(Also enter on Line 6, Recapitulation) $ 132,537.00
If more space is needed,use additional sheets of paper of the same size.
E y
REV-1510 EX+(08-09)
� pennsylvania SCH EDU LE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX REfURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FII.E NUMBER
TINER J LAMANCUSA
This schedule must be completed and filed if the answer to any of questions i through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
ITEM IIrCLUDE THE NAhE OF THE TRA�ff,T}fIR RBATIONSFffP TO DEC�HVT AND
NUMBER n�a►�oF�ws�.nnAa a rnw aF nie o�wk�u Esra�. VALUE OF ASSET INTEREST (ff a�tcns�> VALUE
1• Putnam Hartford IRA,Acxt#710782226 57,247.00 100 57,247.00
Philip Lamancusa,son,beneficiary
2 Americhace IRA,Acct#711 105,807.00 100 105,807.00
Philip Lamancusa,son,beneficiary
TOTAL(Also enter on Line 7, Recapitulation) � 163,054.00
If more space is needed,use additional sheets of paper of the same size.
, ,
REV-1511 EX+(08-13)
� pennsylvania SCHEDULE H
� DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DKEDENT
ESTATE OF FILE NUMBER
TINER J LAMANCUSA
Decedent's debts must be reported on Schedule i.
�M AMOUNT
NUMBER DESCRIPTION
A. FUNERAL EXPENSES:
i' Parthemore Funeral&Cremation Services 1303 Bridge St New Cumberland PA 17070 3,064.00
Rolling Green Cemetary 720.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
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
4. Probate Fees:
5. Accountant Fees:
6. Tax Return Preparer Fees: 3Q0.00
�• Medical expenses
252.00
TOTAL(Also enter on Line 9, Recapitulation) $ 4,336.00
If more space is needed,use additional sheets of paper of the same size.
� ,
REV-1513 EX+(01-10)
pennsylvania SCH E DU LE �
DEPARTMENT OFREVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
TINER J LAMANCUSA
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECENING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. PHILIP LAMANCUSA 5055 Stacey Dr#1608 Harrisburg PA 17111 SON 100%
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.
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.
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OF
TINER J.LAMANCUSA
I,TINER J.L�►�VIANCUSA,of New Cumberland,Cumberland County,Pennsylvania,
declare this to be my Last Will and Testament,and revoke any and all Wills and Codicils
' previously made by me.
IT M I: I direct that a11 my just debts,fwneral expenses and last medical expenses �
3
;
sha11 be paid from the assets of my estate as soon as practicable after my decease. �
3
ITEM II: All federal state and other death taxes payable because of my death with �
� �
;
respect to the property form.i.ng my gross estate for tax purposes,whether or not passing under 4
�
this Will,including any interest or penalty imposed in connection with such tax,shall be �
�
�
�
considered a part of the expense of the administration of my estate and sha11 be paid out of the ;
i
1
�
principal of my estate,without apportionment or right of reimbursement. ;
F
. �
ITEM III: Should my wife,Jean Mary Lamancusa,predecease me,or should we die =
�
;
� in a common accident or disaster,I leave one-half of the fair market value of our joint held real �
estate located at 1435 Northampton Lane,New Cumberland,Pennsylvania,or any subsec}uent
home we may purchase,to my wife's two children, Stephen David Drehoble and Mary Dee
Bottoms,or their issue,per stirpes. �
;
�
ITEM IV: I give,devise and bequeath the balance of my entire Estate of every name �.
�
and nature and wheresoever situate to my son,Philip Michael Lamancusa,or his issue,per �
,
s ' es. Should my son,Philip Michael Lamancusa,predecease me leaving no issue,I give, f
�
. �
- ;
.
� ' h �
devise and bequeath my entire Estate of every�narne and nature and wheresoever situate to my
fifteen(15)nieces and nephews,in equal shares,or to their issue,per stirpes.
ITEM V: I appoint my wife,Jean M.Lamancusa,Executrix of this my Last Will and :
Testament. Should Jean M. Lamancusa predecease me,fail to qualify or cease to act as
Executrix,I appoint Elizabeth Poselli,as the Executrix of this my Last Will and Testament.
ITEM VI: I direct that my personal representative,and her successors,sha11 not be ;
uired to give bond for the faithful performance of their duties in any jurisdiction•
�
liEOF I have hereunt hand and seal this ��.da� of�
IN WITNESS `'VHE �
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�e p�Ceding instrument, consisting of this and one other typewritten Page was� on the.
date thereof, signed, published and declared�by Tiner J. Lstmancnsa, the Testator therein
natned,as and for his Last Will,in the presence of us,who,at lus request,in his presence, and in
the presence of each other,have subscribed our names as witnesses hereto. �
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We,Tiner J.Lamancusa, a•nd
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l.� . �%��`l� ��lZ the Testator and the �i��:-�.';
se names are si ed to the attached or foregoing u��� �� �rst du�`' ;
respect�vely, who �
b declare to the undersigned authority that the�'es�or stg������:'
sworn, do here y
�
his iast Will and that�e had sign�d��in�� t��+e��c�+d �t����:�'
instrument as �
lun act for the urposes therein expressed, and that each of the�itaesses, in t�e�r�'� ;
vo taYy P
e Tes#ator si ed the Will as witnesses and that to the best of the�r kno�led�e. ;
and hearu�.g of th , �
r was at that time eighteen years of age or older, of sound mind and under � :
the Testato
constraint or undue influence.
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Witness
Subscribed, sworn to and acknowiedged before{�e,by Tiner .Laman�usa,the
• to before me b c1�
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Testator,and subscn and sworn Y
' witnessed,ttus f 1 day of �
and �'la�c � ��y�r<
2009.
. �
Notary Public _ _._
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:.;.. ;; ;Statement of Accounts
saso«�arrza�e vrrve .... ...:_ . �� ._...._ .�_ __.__ ...... _ _ . . ,
SUSQUEHANNA ��,PA f70i1-7809 .......'. - ���
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F t D[R A L C 1t E O 1 T Y N 1 O N wrvw.svkx,org 1..�514 .... :.0��'2�13,::; . _'1 .. ..
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TINER J LAMANCUSA ����
� 1435 NORTHHAMPTON LANE
NEW CUMBERLAND PA 17070-2236
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04/O1 Type: 00 - REGULAR SHARES - 00 PREVIOUS BALANCE 5.00
Joi nt wi th:
06/3a NEW BALANCE 5.00
04/O1 Type: 40 - SHARE DRAFT - 40 PREYIOUS BALANCE 374.86 �
Joint with: �
06/30 NEW BALANCE 374.86 ��
�
Member Year-to-Date Totals
YTD Dividends: 0.00 =
YTO Interest: 0.00 -
��
YTD Charges: 0.00 �
�
IMPORTANT NOTICE: Effective May 15, 2013. fee amounts for some SYFCU services will _
change. This includes but is not limited to Non-Sufficient Funds Checks and Late Payment �'�
Fees. SVFCU's Schedule of Fees/Charges may be viewed and printed here: www.svfcu.org/fees.
page 1 of 2 For 24-t�our automated telephone service P�ease c�lll us at(800)948-1454 or visit our web site at www.svfcu.com
� Send Inquires to:
��� Statemerrt of Accounts
Po.6ox� .
� M�chaniasbur0.PA 17066 . •
�"�"�"•�""'b"��'tiO''�+ � Jul 01,2013 thru Jul 31,2013
M"m�'"�cr'b°'r�a: n�n s�-��s�°r�8°°�2�"�s Acoount Number. 252955
EZ Call: (7171 NT 1372 or(a00)?83-�372
� TDD: (71n 887-6312 or(s00)233-232a�xt 6812
MEIVIB�RS 1� TN�Branch: f11n 796-6048 or(8001237 72a8 681anCe8 at a GlanCe:
FIDE�►LC3�nrr uNtoN Chedcing: 708.30
TINER J LA�AANCUSA Savings: g.648•25
JEAN M I.AMANCUSA Certificates: �•�
C/O JEAN LAMANCUSA Loans: �.�
1435 NORTHAMPTON LANE
NEW CUMBERLAND PA 17070 Money Managemerrt: 0•�
Swipe 5 YTD Reward: 0.00
Page: 1 of Z
Your aggregate balance as of July 1 is
;158,562.66. An aggregate balance of 52,500•QO and
having 3 products wili place you in the Sllver MLR
level.
Go paperles.s and sign up for eStatements today! See the enclosed insert for more detaiis.
CHECKING ACCOUNTS
0011-CHECKING .
Da�e Trar�n D�cri�ton Additlons �Subtractions 9alance
JW 01 8�Forward S�T71.87
Jul 01 Chedc OQ1007 T1'a0er 0000231640 3,063.57- 708.80
JW 31 EnaN»g Ba/ance 708.50
CHECK SUMMARY
CI►eck#� Amount Dare ���� Check# •Amount Date
001007 3.063.57 .ki101
!Checka C/s+�red for;3,063.:f7
SAVINGS ACCOUNTS
0000-RE(3ULAR SAViNGS
� T� ���n Addidons Subtractlons Bsiance
JW 01 Balsnce Forw�enal 6,64T.40
Jul 31 Deposit Dividend 0.15096 0.85 6,648.25
qnn�a/P�4rge y1ek16arned 0.130N+fi'+�»7H/7�18!h►�t�gh 7/3!%2015
JW 31 Eitd�B�e _ 6,648.25
rro suMMAR1ES
TOTAI..aVIDENDS PAID
0000 REGULAR SAVINGS $2.80
0011 CHECKING $1.45
Total Year to Date Dividends Paid 4.35
NOTE:Total indudes dosed sha�s
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Pennsylvania State Emptoyees Credit Union
P.O. Box 67013 Hanisburg, PA 17106-7013 �ember Number: 8225*"'***
800.237.7328
��•COm Ststemsnt Period: 07/01/13 to 07/31/13
���t inqui�s rega�djng preauthonzed� Page Number: Regular 1 of 2
t�sfer or acoount emors to the above address.
Account Balances at a Giance
Total Shares: $2,441.95
Totai Certiflcates: $0.00
TINER J LAMANCUSA Total Loans: $0.00
1435 NORTHHAMPTON LN
NEW CUMBERLAND�PA 17070-2236 �] I � f a O � 3 a'-��`�• g�
t
ANNUAL FEE
INACTIYITY FEE
A P R* BAtANCE TRANSFER FEE
•ANNUAI���CENTAd[IIATE �u�C�'/�� \f���I
YEAR TO DATE INFORMATION
�s�P� M�ount
Total Dividends Year to Date $3.62
SHARES
PosNng Eft�sctive Transaction New
Date Ds�e T�ansaction Dsscription Amount Balance
��u�swe►r�s !D 01
Additi�onal Joint Owne�(s):
JEAN M LAMANCUSA
07/01 Beginning Balance 1 pg,
O7/24 Paymertt:�000unt Adjustment: 23.76 128.81
07I24 J08-CORRECT TRANSFER
07/31 Payment:Dividend 0.15096 0.01 129.82
Annual Peroentage Yield Eamed 0.11096 from 07/01/13 through 07/31 h 3
Based on Average Daily Balance of 112.18
0T/31 Ending Balanoe 129.82
Dividend YTD: Year to Date 0.07
CHECKING ID 04
Additional Joint Owne�(s):
JEAN M LAMANCUSA
07/01 Beginning Balance 80 .01
07/31 Payment:Dividend 0.100°16 0.07 .08
Annual Per+centage Yield Eamed 0.10096 from 07/01 h 3 through 07/31/13
Based on Average Daily Balanoe of 802.01
07/31 Ending Balanoe 802.08
Dividend YTD: Year to Date 0.16
*' �
Pennsylvania State Employees Credit Union -
s P.O. Box 67013 Hanisburg, PA 17106-7013 Member Nurnber• 8335***"'**
800.237.7328 '
psecu.com Statement Period: 07/01/13 to 07/31/13
� D�ect inquiries reganlin9 PreautFw�ized electronic
transfer or aocau�t emors to the ab�re addr�ess. Page Number: Regular 1 of 2
Account Balances at a Glance
Total Shares: $1,577.38
Total Csrtificates: $0.04
68204 1 AV 0.360 00.582 00.056 T220 P1 180 Total Losns: $0.0�
JEAN M LAMANCUSA
1435 NORTHHAMPTON LN
NEW CUMBERLAND,PA 17070-2236
,��ii��ii���iii��i��l��li�lli�i�iii��ll�lliii���i����i��i�ii�ii�i �� � I ��� 3 - ��°)3S� ► �
000869 08 01 T568 001 D S2 SAP:1.2,3,4
ANNUALfEE
- � INACTIYITY FEE
A P R� BALANCE TRANSFER FEE
M AMNYAL/tRCENTA6E•ATE ��C«n/�� �f�11)US�
YEAR TO DATE INFORMATION
DsscripNon Amount
Totai Dividends Year to Date $1.95
SHARES
Posting Effsctive Transaction Nsw
Dabe Date Transaction Description Anaunt Balance
...__... _ . ...._ .. . -- - --� - -
REGIlLAR SHARE ID 01
A�litional Joint Owner(s):
TINER J LAMANCUSA
O7/01 Beginning Balanoe 1 0 29
07/06 Withdrawal via Home Banking Transfer To Share 04 -1,030.00 13.29
07/31 Paymen�Dividend 0.15096 0.02 13.31
Annuel Peroentage Yield Eamed 0.1309`from 07/01/13 through 07/31/13
Based on Average Daily Batance of 179.42
07/31 Ending Balanoe 13.31
Dividend YTD: Year to Date 0.79
CHECKING ID 04
Additional Joint Owner(s):
TINER J LAMANCUSA
07/01 Beginning Balanoe 1,891.8
O7/02 Withdrawal Direct Deposit PAWC -41.66 , 0.20
07/02 TYPE:PAYMENT ID: 1008096660 CO:PAWC
O7/05 Chedc 001888 -98.00 1�752.20
O7/06 Payment:via Home Bank�ng Transfer From Share 01 1�030.00 2�782.20
07/06 Payment:via Home Banking Transfer 900.00 3,682.20
07/� From LAMANCUSA,JEAN M XXXXXXXXXX Share 07
07/10 Payment:Transfer 800.00 4�482.20
07/10 From LAMANCUSA,JEAN M XXXXXXXXXX Share 07
O7/10 Automatic Share Transfer
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PARTH EM(�RE � Fune r ' '
& C ematlon Services, Inc.
Mrs.Jean M. � � � 6/21/2013
� 1435 Northa�nptou �►
New Cumberland,PA
For the Secvices of Tiner J.Lamancusa
1303 Bridge Street
P.O Box 431
IVew Cumberland,PA 17070 We��ly appre�ate the confidence you hava placed in us and will continue to assist you ia evtry way
we c�n. Pleasc foel free to c:ontact us if you have any questions in regard to dus statanen� The�Following
PH:(717)7747721 is an iteanized statement of the services,facilities,automotive equipment and m�chandise that you selected
FX:(717)7745546 wh�making the funeral aRangements.
www.parthemore.com �
� Terms Due Date Account#
. . Net 30 7/Z 1/2013 6629.1
u.�.�k:.:>wn_�:,.w,..�:;�-::�.:�}.�,Y�:..,-�--��,���,:..,.-_ Description Amou�t
SERVICES&MERCHANDISE O.pp �
Direct Crernation 2,475.00
Gilbert W.Parthemore Premium Wood veteran�s Stationery Set 195.00
Founder
Total Savices and Merchandise 2,670.04
Gilbert J.Parthemore CASH ADVANCE TTEMS p,pp .
Supervisor Death Notic�e,Hairisburg Patriot 321.57
"'� 7 C�ed Copies of Death Certificate 42.00
. �hen K.Parthemore Dauphin County Coroner Fee,Cremation Authorization 30.00
President,CFSP
Total Cash Advances � 393.57
Bruce R.Parthemore - �
Pre-Need Coordinator,CPC
_�..��.�::x4.._...._,.�...�_.�.�.��w.�.,�...z,
Professional Memberships: ;
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- Order o��he `
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_� Golden Rule .
,m
� TO'�1� 53,063.57
'1� _ Payments/Credits -s3,o�3.s�
��a� r � � Balance Due $o.�
r .. . .- `
k�::: Rq.�f,.3L. ��'«`',�t.' . .�g..�����:• ... , �f3�' �f Y��IM� �rAlr������� ��� . . ..
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Contract � -
. File Foldcr Namc/Number � �
. CEM�TERY INTERMENT RIGHTS,MERCHANDISE,AND SERVICES PURCHASE/S'�CURITY AGREEMENT
1'HIS AGI�EMENT PROYIDES FOR�PERPETUAL/�A�DOWIVIENT CARE.
TLe rinderd�ncd,re[ere+ed�o as�Pnreti�er',het'eb7 a�to P�e the Intermmt Rights,M�chaodise aad SenIas d�cribed 6ereio,sn4jeet to�coeptan�e and a
. ppenval oi
the above aamed c�,6a�a[ter ref'enYd b as�Sdkr'. �
��:�rr�: �_ �}-�1�4 (�i G�3�.5� i i i i i i i i i ��`t`'I ti�.�R i i i i i i r i I Middk:`i� i i i i i i
Telepho�• i� �C�._����- SSN: . - - . . DOB: __� '/. Fanail: � . . � �
nddress: ��,�.'�1?I L �D Q�"tt i��t�►i��"I�NI I �..fR 11i�1 I �'h'' ��LJl �Sil���.n i�!l���ce: � 7.ip: ��j�
Co-Pnrchascr:Last Narne: 1 I I I I 1 I I 1 I I I I I 1 I I I F"�' I 1 I 1 1. I ..l I ! 1 I I I I �'�k: I I I I 1 I I
7'e�ephoee:� . _ SSN: _ DOB: _1_1 Bmail:
A`�"�: I I I I I 1 I I I I I 1 i I I 1 I I I I I I f I I 1 �'' I I I I I I {. i I I. I I I S�: ��.�'p:
n��a:��Ns�: ��R �-t.�4 n1 I:.;1)1�,�1- � � � � � � � � � ��: t .� � � � � � � � � � t �` � M�a�: � � � � � � �
noB: 1 C� t�f t���' non: �� I� �.��t 3 s��a n�: �-1 v�: � .
Description or Intecn�t.Ri�6ts co be nscdi L._.���J,''t,..�t C'��+.,1 �}►C�.-� �� `1`i- M�on Ri�6ts: :
, . : _..... ..::•:... . .
... _. . . __... ,
issue Certificate of Interma�t Rights to: . _
Addreas: City: State: � Zip:
INTERMENT � MERCHANDISE&SEKVICES '
� Iaterment Ri�6ts S —° • Urn --
(Includes Perpetual/Eadowment Care of S ) Supplier � . .
• Interment and RecordiHg Fees . ""' TypelColor
• Outer Bnrfal Coutainer � """ � Desiga/Size .
Supptier . • AdminJProcessing Fee. � �o�t� .�
ModelEDesign�� . • Ot6er�"E?c i�t�:�rr s� i_ _� ,rs`�o.�ta� ��'f�. �}
� MateriaUColor - . - , Other. �k S�- 1��.0� �. . c�I S1 ��
•�Outer Buriai Conta�nner InstallaEion "� • Ot6e�. . .""'`
MEMORIALIZATION . • �Ot�er � --
• Memorial .�. • pti,e�. . „�
Supplier • Other � .-.
�YP�/Color TOTALS, ALLOWANCES&TAXES .
.., _ . ... _... ....__---.,_._ _,_ ,.__ _ :._ __ _ . _ _ _
._..._ ._�_.- . ..,.._ ._._,
..� ..: ..,_. __ ,_, . ...... . ....._
Design/Siu . • In�nent Righta...... ......... ................... ......... ........ ( - ._--:� -- -
. �
•.Memorial Basc . ..' Resson
. .
:,_
Supplier
. - • M,et�handisefSa'vice.......... ....... .....»..........:. ....... ;( )
TYPe/C�or 'Rcgsoa
Desiga/Siu. . . � - _ APP1Y�o
• Memorial t Care ° • MercfisndiselSa�vice..:.........:.......... .......... "" )
....... ... (
• Meuwria!I�on Fee Reason
• Memorial Inspic�ion.Fee. �-- Apply to
' .Name.p�te/Scro�l � . . _ . $nb Total � ,
� I.ettering ` Tofa�Taz$ble _..�:
_
. Fla�reT Vase "' - Sales�az(if aPPtica6le�'.:.--------•.............:.....:.................' "„'
Supplier TOTAL CASH PRICE'$` ����'_ �
_ _ , .
'TYPc/Color. Legs: Dowa Paymeat �?��. , �. -..
Design/Siu {)t6er
� v�� . _ : Total Down Payq�ent ( r:.,� �t:).
S�z�Matenai �- — -- — -- � ���,,;��������,� ,
:. - -:r <: <
'
• �L
k� a 4 �,.d °'�'^a�' 9�`
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. �::. . .� ...: -.-�, ..: .�� ., .:: =: .. ' . .
` Not�s:&�rrt�dc�d�(r�he;e�pplicabie).
TERMS
The Total Cash Price is due�nd payaWe as of the datc of this Agreement A deti�uency charge of percent witl be assessed monthly on any balance notpaid within
30 days of the date of thia Agreemeat. If less than full payment is recxiv�ed,Seller shall ckduct the accrued delinquancy charge from the amouat ra:eiv�ed and cndit the
cemainder of tl�payment to dte Unpaid Bals�Kx.
T • � �
MenlberS �`
1Q06 Roiling Green Cemetery 90.00
1�7 Parthemore Funerat Home 3063.57
CC Roiling Green Cemetery 630.00
1015 Pinnacle Health Med Svcs 44.75
PSECtJ
1885 Pinnacle Heaith Hospital 127.57
1886 Pinnacie Heatth Hospitai 19.39
1887 Pinnacle Health Hospita{ 40.00
P�,►�r.a.�C�. ��ea.��. �-D. o v
w1.�.a� Svc-
TOTAL 40�„5,28
_ ■ . .
eriChoice
� FEDERAL CREDIT UNl�N .
Building Relafionships For Life
September 18,2013
Jean Lamancusa
1435 Northhampton Lane
New Cumberland,PA 17070-2236
Re: Accownt of Tiner J Lamancusa
Jean,
The decedent had one member number,3671 l;titled Tiner J Lamancusa.This was an individual
account.
Account 36711
Regular Savings(suffix 0001)—opened 10/22/2004
Money Market(suffix 0018)—opened O1/OS/2010
IRA Share(suffix 20)—opened 11/OS/2009
Date of death balaaces are as follows:
Balance Dividends earned from 1/1/13 to DOD
�
0001 -$27.90 $0.00
. 0018-$635.45 $0.00
0020-$ 105,806.51 $ 183.95
Mr. Lamancusa did not have a safe deposit box with AmeriChoice.Philip Lamancusa is the
beaeficiary on the IR.A.All documentation has been filed with Ascensus and we are waiting for a
.__�___._.. __r�sponse-�i�e b�a�fici�. — -- -- _ - ---- —- ---
Please feel free to contact me directly with any questions you may have.
Sincerely,
. ��
• Bonnie R Seagraves
Qperations Specialist
Phone(717) 591-1282 �
Fax(71'�697-3713
Email bseagravesCa_�americhoice.org
Main Office:2175 Bumble Bee Hollow Road �Mechanicsburg, PA 17055 •Phone:(717)697-3474 •Fax:(717)697-3713
Website:www americhoice.org
� :
� LENGE •rius�•s
L N R �T��s
�. • ! � '� .
v}i
THE
HARTFORD
September 27,2013
Philip Lamancusa
1435 Northhampton Lane
New Cumberland,PA 17070
—_ ----- --- - -
-- -- -- Re e�rence: --�The Hartford Annuity 710782226 — -- .
Tiner J Lamancusa,Decedent
Dear Mr.Lamancusa,
Thank you for your correspondence regardin�the above annuity contract
The death benefrt payable under this contract is not considered"life insurance"reportable on IRS Form 712,(life
insurance statement).Please find the below information in response to your request.
Contract Number 710782226
Owner Tiner J Lamancusa
Decedent Tiner J Lamancusa
, Soe��i.Security Number XX-XX-2709
Date of Deati�used for values June 17,2013
Cash Value on the date of death $15,885.86
Death Benefit Value on the date of death $57,246.89
3The Ik�th 8�ne5t Value o�the d�e of death di�layed above may inclu�a Death Benefit Adjustment ffi outlined in d�e Annuity Contrad.This figune is being
providcd f+or illustramion p�uposes�d is na�equivaknt to the final death beneftt.The dea�bene5t will be calcule�ed oo all o�tracts�socia�ed with this client
the day we�cxiva d�pmof of dceth.Oncx the ckath benefit is celcula�cd,the baicfit amount remains invcsted�d is subject to market fluch�tion until
compleLe se�t instrucba�s are raxived.
Please con�ac�our Investment Professional or one of our Annuity Specialists with any questions or concerns.You
may reach The H�arlford by calling 1-800-862-6668,Monday through Thursday from 8 a.m.to 7 p.m.and Friday
from 9:15 a.m.to 6 p.m.,Eastern Time.
Thank you for th�opportunity to help provide for your financial needs.
Sincerely,
IIlV6Sb11e1'lt P1'OdUCt$e1'V1C.eS The Hsrtiord Weatth M�ager�t—Global Annuities
ICS Annuity Benefit Services Team 745 WestNew Circla Road
Hartford Life and Annuity Insurance Company ��2a°'ist Fioor
gton,KY 40511
Mailing Address:
PO Baoc 14Z93
Lexington,KY 40512-4293
miline.hartfordli&.com
- - -- - _ __ _ -- _