HomeMy WebLinkAbout04-10-14 (2) � 1505610105
REV-1500 EX(oz-ii)(FI)=;�!�
!i7 OFFICIAL USE ONLY
PA Department of Revenue pennsylvania Coun Code Year File Number
Bureau of Individual Taxes �""pT"`�' `"`°`"°` ty/ �� �� �
PO BOX z8o6oi � INHERITANCE TAX RETURN
Harrisburs,PA 1'7128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW '^
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
Suffix DecedenYs First Name MI
Maffett Dorothy
(If Applicable)Enter Surviving 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
� 1.Original Return p 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compromise(date of p 5. Federal Estate Tax Return Required
death after 12-12-82)
O 6. Decedent Died Testate O 7.Decedent Maintained a Living Trust � 8. Totai 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 und�ec.9113(Q�
Between 12-31-91 and 1-1-95) (Att Schedule O� � �„
CORRESPONDENT- THIS SECTION MUST BE COMPIETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATIB�S LD BE DI$EtTED� � '"'F
Name Daytime T�pK�e�lumb� ���:, �'
Marjorie J. Morrison �° a r"� t-� ���. �
D � � � ��� *
RE(�TER`O ILLS.�SE O� �..�
c7 � -�ry � "�
First Line of Address � � � � �
4 Caven Crossing �„ t,,� c� �
�
Second Line of Address
City or Post Office State ZIP Code DATE FILED
Enola PA 17025
Correspondent's e-mail address:
Under penalties of perjury,I declare that I have examined this return,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 knowledge.
SIG TURE OF pERSON RESP NSIBLE FOR FILING RETURN ,pq�^ �
(2.cJ� D�R ��'` y l
ADDRESS
I�V �1205Si�'t , L`�'�C���-- �`��7�a
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
D /�- ZD�x
ADDRESS
l.3 ��b L.��i t t� CG�� f , l��h�,v�„, , t//jl 2 0/�7 /
PLEAS USE ORIGINAL FORM ONLY
Side 1
� 1505610105 1505610105 J
� 1505610205
REV-1500 EX(FI)
DecedenYs Social Security Number
oecedent's rvame: Do�Othy MBffett
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 Miscellaneous Personal Property(Schedule E)... . ... 5. 91,832.96
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ... . ... 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested..... . .. 7. 64,193.22
8. Total Gross Assets(total Lines 1 through 7)..... . .... . .... ... . .... . .... . 8. 156,026.18
9. Funeral Expenses and Administrative Costs(Schedule H). ... .... ..... . .... . 9. 4,781.58
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I). .... . .... . .... 10. 3,012.99
11. Total Deductions(total Lines 9 and 10). ..... ..... . .. ..... ..... ..... . ... 11. 7,794.57
12. Net Value of Estate(Line 8 minus Line 11) . .. .... ..... ........ ..... .. ... 12. 148,231.61
13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) .. ....... ...... ..... .... 13.
14. Net Value Subject to Tax(Line 12 minus Line 13) ..... .......... ..... . ... 14. 148,231.61
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X.0_ 15.
16. Amount of Line 14 taxable
at�inea�rate x.0 45 135,392.97 16. 6,092.68
17. Amount of Line 14 taxable
at sibling rate X.12 17.
18. Amount of Line 14 taxable 12,838.64 1,925.80
at collateral rate X.15 18.
19. TAX DUE . .... . ..... .. . .... . .... . ..... ..... .. . ..... ..... ..... ..... 19. 8,�18.48
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
L 1505610205 1505610205 J
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
Dorothy Maffett
STREET ADDRESS
4837 East Trindle Road
Building 3 Room 88
CITY STATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 8,018.48
2. CreditslPayments
A.Prior Payments
B.Discount
Total Credits(A+B) (2)
3. Interest
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)
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 8,018.48
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 occurred 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
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 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
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 decedenYs 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 decedenYs 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.
REV-i5o8 EX+(o8-i�)
� pennsylvania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Dorothy Maffett
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. Members First Credit Union,Mechanicsburg,PA,Estate Account as of 12/20/2013 87,910.36
2,' 'Cumberland County Register of Wills,02/10/2014 100.00
3, 'Country Meadows,Mechanicsburg,PA,for a refund for nursing home rent on 01/24//2014 1,576.60
4. Erie Insurance Exchange, Erie,PA,for renter's insurance refund on 16.00
5, IRS for Federal tax refund 2,230.00
Note: For the last eighteen months of Dorothy Maffett's life,she lived in room 88 at the Country
Meadows assisted living facility with virtually no personal belonging except lots of cloths, two old
recliner chairs,family photos,a TV,and a small radio,tape and CD player. The clothing that was in either
good or new condition was donated to the Salvation Army in Camp Hill,and the small boom box was
donated to Rachel Carson Middle School,Herndon,VA 20171.
TOTAL(Also enter on Line 5, Recapitulation) $ 91,832.96
If more space is needed,use additional sheets of paper of the same size.
REV-isio�x+�os-oy7
N� SCHEDULE G
� � pennsylvania
�_' DEPARTMENTOFREVENUE INTER-VIVOS TRANSFERS AND
� INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Dorothy Maffett
This schedule must be compieted 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 DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
INCLUDE THE NAME OF THE TRANSFEREE,THEIR RE1A710NSHID TO DECEDEM AND
NUMBER THE DATE OFTRANSFER.ATfACH A COPY OF 7HE DEED FOR REAL ESTAlE. VALUE OF ASSET INTEREST IF APPLICABLE VALUE
1• Lincoln Financial Group Annunity: Non-qualified,with non-probate 64,193.22 100' 64,193.22''
beneficiaries:
Robert S Maffett-son=40%or$25,677.29;therefore,inheritance tax @ '
4.5%_$1155.46 '
Marjorie J Mornson-daughter=40%or$25,677.29;therefore,inheritance
tax @ 4.5%_$1155.46
James L Hoover-friend=20%or$12,838.64;therefore,inheritance tax @ '
15%_$1925.80
TOTAL(Also enter on Line 7, Recapitulation) $ 64,193.22
If more space is needed,use additional sheets of paper of the same size.
��v-isri ex+ (os-is)
� pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Dorothy Maffett
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES,
1' Neill Funeral Home, Inc., Camp Hill, Pa,17011 3,740.46
2. Pastor's Honorarium for Memorial and grave site services 200.00
3.' Giant Foods,Enola,PA„for food trays 99�95
B. ADMINISTRATIVE COSTS,
1. Personal Representative Commissions: '
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
250.00
2. Attorney Fees:
3. Family Exemption, (If decedent's address is not the same as claimant's,attach explanation.)
Claimant
StreetAddress _..--._........___..........__................__........_...__ _......
City_..__..._........___......_....___...._._......._................._._......._......._._........_._........._........__...___..........----_......_.__......_._..__._..._State__..............._..ZIP._............_.................._..............._.._
Relationshipof Claimant to Decedent._....._._.........._..._...__._...___...............__.._...........__.._.....__....__..._.__.__.._..........._............._._...._.............__.............._.............._................__.
4. Probate Fees: 303.00
5. Accountant Fees:
6. Tax Return Preparer Fees 160.00
�• Members First Credit Union, Enola,PA.,for blank estate account checks 2.00 '
s. ,Postage for mailing Fed and PA income tax retums AND ammended Fed and PA tax returns 26.17 '
TOTAL(Also enter on Line 9, Recapitulation) $ 4,781.58
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-12)
� pennsylvania SCHEDULE I
DEPARTMENTOFREVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Dorothy Maffett
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1� Country Meadows Home,Mechanicsburg,PA,for private duty nursing 2,205.00
2. Diamond Pharmacy,Indiana PA,PA 15701,for medications 19.73
3.' Camp Hill Fire Co.,Camp Hill,PA.,for ambulance service on 05/30/2012 711.26 '
4. Pennsylvania State Income tax for the ammended return on 03/19/2014 17.00
5. US Treasury for ammended return on 03/19/2014 60.00
TOTAL(Also enter on Line 10, Recapitulation) $ 3,012.99
If more space is needed,insert additional sheets of the same size,
REV-1513 EX+(OS-10)
� <��
� "; pennsylvania SCHEDULE �
� DEPARTMENT OFREVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Dorothy Maffett
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
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• Robert S.Maffett, 13400 Whaley Court,Herndon,VA 20171 son 30%
2. Marjorie J.Morrison,4 Caven Crossing,Enola,PA 17025 daughter 30%
3. Lora L.St.Angelo,807 E.Pittsburg McKeesport Boulevard,
North Versailles,PA 15137 ' granddaughter 10% ''
4. Carrie A.Barnes,35 Country Club Place West,Camp Hill,PA 17011 granddaughter 10%
5. Alissa N.Cornell,341 Virginia Avenue,Winchester,VA 22601 granddaughter 10%
6. David T.Maffett, 14614 Lufthansa Circle,Chantilly VA 20151 grandson 10%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OP 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;
L
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.
L.?�S`I� 1�%I E.l� :��v'1� `�I�S 3,rsllt??v7,
O;
��RQT���1 B. 1�1�?=;+�Ti
I, Dorotl�_y �. Matfett, of 45�7 Easi �I'rindIe- �Roa�i; Ei?ildluc 3 RooT?� 88, Couni,; of
Cumberlat�d: 1`�iecllanicsbur�; PA 170��, �ueiii� of sound mind and men7c�ry, do Izereby make,
publish and declare this to be my Last �a�1i11 and Tes�am�nt.
FIR�S`�: X hereby revoke all VJills and Cod:cils t1,1e�-e#o by ine at any time
heretofore made.
��C�N�}: I direct tl�at all my Ie�al deE�ts; zny fiineral expe��ses and tY�e costs of
��dn7irlistration of rriy estate b� paid as soon as pract'icable after iz1}� death. T dii-ect that my
�xecutor or Execut7 ix pay out of my estate; «s a gez;eral char��e thereon, all inneritance, estate,
succession and otll�r ta�cs, iogether with any interest or pen�Ity �l�ereon assessed by re�son of
i�z�� deatl7 tivith regard to all properties an�l ass�ts subject io such taxes; �vl�e.il-ier or 1�ot suc11
property aud assets pass under this ;��ill.
�:H��Z�: I eive; devise and bequeat�l all of my estate, real, persona, or ��iixcd;
tangible or intanbible�, of whatsoever kind al�cl ��heresoever situated, to�eiher ���i.th any property
to ��-hich I nza_y har�e any po�ver oi dis��ositioil or appointineiit and wnether acquired duri3��� or
afler mv ]ifetime as fo11o���s_
1. To my son; Rol�ei�t S. Maifett of 1�4U0 ��%hale-,� Cou,-t, Oak Ilill, VA ?f�171 — �0°�a
pro�ided he survive� me for a period of?� da�,s. S,�ottld my son; Roberi S. �iarzett,
��red�.cease me, his share shall bz issucd equall;� bet�tiee.n hi� children_
%. 10 lTlj C�3U��lI?I�; !�%l��I�70Ii� T. i�1017'?SOii Of �. La`:'z?1 `�.IUS�117��, �-I1013; p,'=1 1 �l)�� — i��°,��,
provided s'l_e survive� me to�� a p�1io�3 of 3U d�ys. �'r�o�,zld ;��v dau�hter; :;�Iui,�cri;:. �i.
iV101��15=`:]. ��TCi7�.�:,'<;; ?ii�, ii�.t ��_��3�� ti}�<+.;i }?c' 1S�L!Zi �Qli:���'r JC'L�','G�Il�2GI' C�ll���i'it;L.
�. � '� 1;1F �l�:Ilil:jdU�'_fliC1, Z��)!ti :�. �i. _=•II 1G O� �i)7 C�. ;"�]tlS['lii�`?Il 1�'�i:�_cL;•�`l�Il
�3��u].e��ar�i;A�orth�,%crsailles; i�: 1�i��%— 1G°.'o, provided s}�e survi��es me for a period
ot 30 dati�s.
4. T� my eranddaughter, C:ln�ie A. BG�i�e's of 35 Cuuntl:% C)u� 1'1«ce; Camp H�II, Pl-1
170]1 — I O%, provided sii� sur�,nve�� n1� ior a period of ��.) da}'s. S1-�ould Carrie
predecezse me,lier shall �ie issued to ]�er c�aughier, AJexia}3arnes.
�. 1'o rtly erai�dd2ught�r, :�lissa N. Corllell of 341 Vir�iliia Avenue, �Vinchestez�, �tA
2?bUl — 10°ro, pzo��ided sl_1e survives ��7� fcr a period of 30 d�titi�s.
6. �Co rny �,�razidson; David T. i��laffett oi i 4614 Lufthansa Circle, Cl�antilly VA 2U151 —
10`;0, provided he sur�,�ives mc for a period oi�30 davs.
If�any ot n�y grandchildrel� as listed abo���� art decease�d at the time of rny de��th or do not
�
sui��i��� izle zor a p�riod of�� da�;'s_ but a�e repres���ied t�_v livin� isstie; ,ucl� issue shall i�•ak�; p�r
stii��es, th� le�oa�y tu whicl� l�is or h�z�parent��ould ��l�lve been F�n1.it1_ed if t}�en livin�.
At the� sole disct-etion of�i�y �xecutor or Eaecutrix; thc sllare oi any minor child slialJ be
selected and h�ld by �ny Executor or �xecutri� for delivery to such uhild at termination of
ininority; or in t11e soie �iscretio« oi�ii��;- �;;:ecu�tor oi� E�ecu�ri?�:, ma;� be delivered either to the
7ninor or to another to h�ld for tl�z 1�ii�loi- iiuri,nc r�inc�,�itv, and the receipi �1-the mino� or slteh
other person shall operation as conlplete discl�ar�Ye of my Etizcut�r or ��ecutri�.
FE�iU32T�-�: �'Iy Execuior or Executri;l; sl�all have. tiie follo�:�in�� po;���rs in addition to
ihose ���ested in tLz111 bv la�,.� and b,,� oiher �,r�,visions ��i m}- Last ���,'ill anc� Tesiamenl, app;icablz
l0 GII �IOL?z'.I�l\', \'/]iLt�liI' L�I�l?1�1C�£il O� IiiCOI:1C, ]:?C.ILi�j:il� �TQ�=�t'lV ��Z�C] i01 11i:P.0i�. C;i�?'C:1S�?�;;C
\'Jii}1CLil C011?"i a�?;_ii�'J<il <_Ii'1 LTfcGil'•!C L1i1Lli '�.:til�t� �'�iStitriL1t10i: pT :ill }iIO�',CF.;
< .... . _., . -�c:... .._.<� ., ,� -, 1 �— . . , . . . ... .. .
.. � �;liCGL I(Icl`t ;[1\ 1"'\CC;ULC)t U1 :', i1i.i1'�. ".li�] j1:S 11_I JllC..�.S�rl:, �:Id_1 f1Ut D :C��ll1'i�,u
t�, ��i�-e bo�=d tor t11c faithtui uel�fo!Inance oi-his/�-�er dut,e�in an�;' iurisdiction_
%. `Ji�,- E�e.curor or Execuiri:� s�iall rece�ve coi7�pensatioli ior thc periorin�nce. of
iiis!ner ;unetions 1-ieretn�der in a�cordance ����iih tl�e Pennst,-lvazlia Esiates �?ractice
standard scli�dtll� of fe�s in e;rfect Frolli tim�� to time. cl�_iring th� perioci over :�✓hicl�
the services are per�Forrncd_
3. To allocate receipts and expenses to principal or income 1:0 �7�c;,tga;;c oz� pledge
any c�r �ll real or personal propei�}� as Izly Eaecutot- or �,�ecu�ri�: ii1 his/h�,r sole
discretion shall c},loose, ti��iith��«t re�;ard for �he dispositive provisi;�ns of this
insirume�lt.
�',_ 1�o bon������v li�lone-y froln any pe��so�1 or institution and ro mortcage or�lcc�l�e any �r
�il z�al or p�.rsonal prvr�e.riy as n�;� �xecutc;r or Lxee.ut��ix ;u his!her- sole cliseretion
;ilall choos�, ��.-ithot�t regarcl�li�om th:: uispositive pz-ovisions of This instrument.
�. To co�a:�}�rumise any clain� or controversv.
6. To make ciistribt�tion in cash or in kinci, or ��arty in c�sh and partly in kind; and in
such rrian��er as he%sh� m��y deic-rli�ine; and at valuations fnlally t�� be fixed by
iliin!her.
7. �Z,o vest in ��JI foi���s o�I�prope.rty (i�lcludin; stock or other securities and com��ion
trust funds ���ld mortaa�e iinrestn�e�;t funds;; «�ithout re�stz�iction to inve�tments
auihorized for Penns�-lvania tiduci��rie-s, as he,/she deen�s proper, ��vithout re�ard to
aii:� P=i��cil�le� ai di-:-ersiiicaTion or risk,.
��. �O �c� �it �,llii!1� VC UIl\cir�� ��a.�C, ii? �. �i1,_il'; . _ 2J 1��:SC TO? ui;� j.li!0�7 O� iilil��,
�I:`, T��tl O7 �i,TSOIld� PIC))C?`li '�;ii� t0 '�?Il� O��L1UP_S IOl" S21(;S; G�C11':trl`-?cj O1' 1�aSc.�,
f�ur such prices and upo» -such tei�i�7s or cotidit;ons as helsl?� deeiz�s proper.
9. To e>,_ezcise anv Ia��;-given o�tion �u treat adzlia�i�trative. e;<penscs either as
1�]COT11�; t�.`� Or 35 C'.Std�� t�iX C�i:�LICI1C11�; '�i'v�iLli I"e�?aiCl t0 \�'�leL�lel" tl1C ;;X�i��IlSFS �•i�.0
oaid fro�n principal_ or inconie.
10. All shal�es of princip�l and inco��z�� hereby given shall be f�ree fiom anticipatiorl,
assi�i;znent, r,ltd��e or obli�ati�rE oi ihe ben�ficiaries al�d any of t�lem shall �loi be-
�uoje�c'i 10 �ir,�v txecution, attacl�meilt, levy o� sequestratic�n or oiher clail;�s oi ihe
�r�iiitor� oi�:;aid beneficiaries or any oi ti;ei��.
��iFT'�i: I �o hereby niake, constitute �and app�:�ii�t m;r dau�i�ter, �'iarjorie J. ivlorrison,
�1r�d i7�y son, Robcrt 5. i�.�laftett as Go-�.�e.c�ltors oI t;?�s ;_��� Last ��%ill ard T�sta��iezzt. S1iould
r
�:riler�ail tc� qualliy or cease to act; I appoini n�y �on-in-la���, lhon�<�s ��'Iorri�on; as my �.ectztor
uz this m��LaSt \Uill and"f e5zamer�t.
IN I�JETN�,�SS ��'�lE�2E€��', I Dorothy B. 1�lazfett, Testatrix aboee name, hati-e het�eunto
subscribed my zxazlle and atfixed my seal this_;���'�of_�ovcznber 20>>.
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pre�ence and in the presence of ea�_n other; ha��e here�lr:CO s�_ib�cr}��ed theiz rames as ��°�t1z��s:;s
the�eiu tlie. day and ;�ear last ti�,7itterl above.
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fiee and voluniary act for the purposes there�in e;�pressed.
S�,vorn to or aftiri�led ��ltld ackno�ti�ie�a�ed befa=:; �i7��e l�_r� Duroihy �. Maffett, tl�ie "IL��atrix,
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tllis f�°f`�Noverl�ber 2013_ _—,...�r�- .
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C)li this i _ day oi I�Tnveznber 2013; be,'o�e Ine, ihe ui�ciersiUned c�fficer; Perso��aily
appe��re;1 ���Jilliain R. Balaban; Attorl�ey i. D. 1`;o. 19667, kno�vn �o me (or satisiac.toril�,� pro�.�en)
to bc a me,niber oi the. bar oi the highest crtu�t ot�aid stat�, and cel�tified that 11e ��;as personall��
pleseni �vlien Dor�thy B. I��ffett, bein� of sULU-�d ;nir�d anc'i lne;noiy execuied tl�e tore��oin�
i�istrumellt ior the pu�iposes thez�eizi coz�tained by sinniii��1-�er nan�e.
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DECEASED: DOROTHY MAFFETT 12/14/13
1040 Department of the Treasury—Internal Revenue Service (99)
Form U.S. Individual income Tax Return 2013 OMB No.1545-0074 IRS Use Only—Do not write or staple in this space.
For the yzar Jan 1 -Dec 31,2013,or other tax year beginning ,2013,ending ,20 See separate instructions.
Your first name and initial Last name Your social security number
DOROTHY MAFFETT 054—01-9978
If a joint retum,spouse's first name and initial La�tire�e Spouse's social security number
i!
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Home address(number and street).If you have a P.O.box,see insiructions. '-„} _�� 4� .r ; Apartment no. . Make sure the SSN(s) above
,. s ;{
MARJORIE MORRISON 4 CAVAN CROSSING and on line 6c are correct.
City,town or post office,state,and ZIP code.It you have a foreign address,also complete spaces below(see instructions). PreSld@fit18� E�2CtiOfl C8t11polgtl
ENOLA, PA 17 0 2 5 Check here if you,or your spouse if filing
Foreign country name Foreign province/stalefcounty Foreign postal code lointly,want$3 to go to this fund?Checking
a box below will not change your tax or
refund. YOU SpOUSe
Fllitlg StatuS � X Single q � Head of household (with qualifying person). (See
instructions.) If the qualifying person is a child
2 8 Married filing jointiy(even if oniy one had income) but not your dependent, enter this chiid's
Check oniy 3 Married filing separately.Enter spouse's SSN above&full name here.. �
one box. name here...! 5 ❑ Qualifying widow(er) with dependent child
Exemptions 6a X Yourself. If someone can claim you as a dependent, do not check box F8 ....... ... . Boxes checked
on 6a and 66.. 1
b Spouse........ ........... ............................ ...... .. . No.of children
2 De endenYs f on 6c who:
( ) p (3)Dependent's �4)
c Dependents: cn�id u�de� •Iived
social security relationship a e» w;cn yo�.....
number to you quali ing for
(1)First name Last name chil tax cr • did not
(see instrs) live with you
due to divorce
or separation
If more than four (see instrs)...
dependents, see Dependents
instructions and on 6c not
check here... �� entered above.
Add numbers
on lines �
d Total number of exemptions claimed.............................. ....... .................. abo�e..... 1
7 Wages, salaries, tips, etc. Attach Form(s)W-2.............. .......... ................. 7
Income 8a Taxable interest. Attach Schedule B if required........................... .............. 8a
b Tax-exempt interest. Do not include on line 8a............. 8b ' '
�`a
Attach Form(s) 9a Ordinary dividends. Attach Schedule B if required.................. .................... 9a
W-2 here.Also b Qualified dividends....................................... 9 b �� �:
attach Forms 10 Taxable refunds, credits, or offsets of state and local income taxes.... .................. 10 v
W-2G antl 1099-R
if tax was withheld. 11 Alimony received................................................... ..... ........... .. 11
12 Business income or (loss). Attach Schedule C or C-EZ............. .................... 12
if you did not 13 Capital gain or(loss).Att Sch D if reqd.If not reqd,ck here........................ ► ❑ 13
get a W-2,
see instructions. 14 Other gains or (losses). Attach Form 4797........................ ... .. .... ....... ..... 14
15a IRA distributions.. ......... 15a bTaxabie amount..... ...... .. 15b
16a Pensions and annuities..... 16a bTaxable amount ............. 16b 22, 200 .
17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E. 17
18 Farm income or (loss). Attach Schedule F................... ...... ....... ............. 18
19 Unemployment compensation................................. .... .................... 19
20a Sociai security benefits.......... � 20a� 3, 839. �b Taxable amount............. 20b 0 .
21 Otherincome ------------------------------------- 21
22 Combine the amounts in the far right column for lines 7 through 21.This is your totai income............. � 22 22, 2 00 .
23 Educator expenses........................ . 23 . :
Adjusted 24 Certain business expenses of reservists,performing artists,and fee basis f ;
GYOSS government officials.Attach Form 2106 or 2106-EZ... 24 =` `
.. > ,.
InCOme 25 Heaith savings account deduction. Attach Form 8889....... 25 �= '
th. �,':`�.
' ..
26 Moving expenses. Attach Form 3903....................... 26 ; :=
27 Deductible part of self-employment tax.Attach Schedule SE........ ..... 27 E.' 4 ;
.
28 Self-employed SEP, SIMPLE, and qualified plans.......... 28 4 ?,
s
29 Self-employed health insurance tleduction................. 29 ,,:?;:,,;,
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30 Penalty on early withdrawal of savings...... ............... 30 ,,,�,,�,;;
,, ,.:
31 a Alimony paid b Recipien't's SSN.... ' 31 a � x�;
; ,
32 IRA deduction........................... ................. 32 _"�..;:.:
33 Studentloan interest deduction ........................... 33
�
34 Tuition and fees. Attach Form 8917........................ 34 �«,,„,.
35 Domestic production activities deduction.Attach Form 8903............. 35 = ;,�
__.:�::.:
36 Addlines 23through 35....... .................................... ............. ........... 36 0.
37 Subtract line 36 from line 22. This is your adjusted gross income.... .. ............... � 37 22, 200 .
BAA For Disciosure, Privacy Act,and Paperwork Reduction Act Notice,see separate instructions. F�iaot�2� 08/05/13 Form 1040 (2013)
Form 1040 (2013) DOROTHY MAFFETT 054–01-9978 Page 2
Tax and 38 Amount from line 37 (adjusted gross income).................. ................... 38 22, 200 .
Credits 39a Check X You were born before January 2, 1949, Blind. Total boxes �''�'
�s�Y�.;
if: Spouse was born before January 2, 1949, 8 Blind. checked ► 39a 1
°� .
Standard b If your spouse itemizes on a separate return or you were a dual�status alizn,check here..... .... � 39 b `
Deduction qp Itemized deductions(from Schedule A)or your standard deduction(see left margin)... ... .. ............. 40 12, 520 .
for— —
41 Sublract iine 40 from line 38................... q�
• Peopie who 9 680 .
check any box 42 Exemptions. If line 38 is$150,000 or less,multiply$3,°�0 by the number on line 6d.Otherwise,see instrs. .. ... 42 3, 90 0.
on line 39a or 43 Taxable income. Subtract line 42 from line 41.
39b or who can If line 42 is more than line 41,enter-0....... ................................... .. .. ........... 43 5, 7 8 0.
be claimed as a qq Tax(see instrs). Check if any from: a �Form(s) 8814 c ❑
dependent, see
instructions. b Form 4972.............. 44 5']g .
....
• All others: 45 Alternative minimum tax(see instructions}. Attach Form 6251 .......................... 45 p_
Single or 46 Add lines 44 and 45........................ ....... ....... ....... � 46 5 7 8 .
Marned filing 47 Foreign tax credit. Attach Form 1116 if required. 47 -
; :
separately, 48 Credit(or child and dependent care expenses.Attach Form 2441... ........ 48 `��--:
$6,100 qg Education credits from Form 8863, line 19....... . 49 '' `
Married flling � ����� � ;
jointly or 50 Retirement savings contributions credit. Attach Form 8880... 50 y -
� :
Quali in �= =
fY 9 51 Child tax credit. Attach Schedule 8812, if required. .......... 51
$1�2�200r) 52 Residential energy credits. Attach Form 5695............... 52 ���:; =
�a1 :
Head of $3 Other crs from Form: a � 3800 b � ggp� c � 53
�::_..:
household, 54 Add lines 47 through 53. These are your totai credits.......... 54
$8�950
55 Subtract line 54 from line 46. If line 54 is more than line 46, enter -0-................. � 55 578 ,
OtheY 56 Self-employment tax.Attach Schedule SE............. 56
....................
Taxes 57 Unreported sociai security and Medicare taz from Form: a �4137 b � gg)g................... . . 57
58 Additional tax on IRAs,other qualifietl retirement plans,etc.Attach Form 5329 if required... ............... . 58
59a Household empioyment taxes from Schedule H....................................... . 59a
b First-time homebuyer credit re ayment. Attach Form 5405 if required............. ...... . 59 b
60 Taxes from: a a Form 8959 b � Form 8960 c � Instrs;enter code(s)____________ 60
61 Add lines 55-60.This is your total tax..... ............................. .. .................. � 61 578 .
Pa mentS 62 Federai income tax withheld from Forms W-2 and 1099... 62 2, $p8 ' ��!
If you have a 63 2013 estimated tax payments and amount applied from 2012 return.. . . 63 '�-X .v
` ,_
qualifying 64a Earned income credit(EIC)........... �- �',
child, attach — � ........... ..... 64a ����.
Schedule EIC. b Nontaxable combat pay election..... 64b �,g ,�.�
�Tw�._ �� r�.
65 Additional child tax credit. Attach Schedule 8812............ 65 "� '
66 American opportunity credit from Form 8863, line 8......... 66 �� `�
} �.
67 Reserved............................ .................... . 67 �� ,r'� . " _, `� ����;
-: .M �
� _...,h; z,
68 Amount paid with request for extension to file............... 68 ""'LL
��;
69 Excess social security and tier 1 RRTA tax withheld......... 69 F�' >:
70 Credit for fetleral tax on fuels. Attach Form 4136............ 70 '� �
71 Credits from Form: a�2439 b�Reserved c�8885 d � 71 �'� ?
�.,�: ...._
72 Add Ins 62,63,64a,&65-71.These are your total pmts......................................... � 72 2, 8 p g ,
Refund 73 if line 12 is more than line 61,subtract line 61 from line 72.This is the amount you overpaid... 73 2, 230 .
74a Amount of line 73 you want refunded to you. If Form 8888 is attached, check here. ' � 74a 2, 230.
► b Routing number........ XXXXXXXXXX ► c Type: Checking � Savings `x�;;
Direct deposit? . d Account number,....... XXXXXXXXXXXXXXXXXXXXX?iXX ''`"'��
See instructions. 75 Amount of line 73 you want applied to your 2014 estimated tax........ ' 75 ��� �
'zw���•:����::
Amourlt 76 Amount you owe.Subtract line 72 from line 61.For details on how to pay see instructions................ � 76
You OWe 77 Estimated tax enalt (see instructions) " `: ` `
..... 77 -�> _
:.:.
rr, , �.,- � �,.,,
Third Party Do you want to allow another person to discuss this return with the IRS(see instructions)?........ .. � Yes.Complete below. �No
Designee oame�ee's .KEITH R HUNTZINGER, CPA Pnone Personal identification
�o. ' 717-580-2463 number(PIN) ' 81694
Sign Under penalties of perjury,I declare thai I have ezamined this retum and accompanyinq schedules and statements,and to ihe best of my knowledge and
belief,they are true,correcl,and compfete.Declaration of preparer(other(han taxpayer)is based on all information of which preparer has any knowledge.
Here Your signature Date Your occupation Daytime phone number
Joint return?
See instructions. 1 RETIRED
Keep a copy Spouse'S signature.If a join�retum,both must sign. Date Spouse's occupation If[he IRS sent you an Identity Pro-
for your records. � tection PIN,enler
it here(see insVs)
PrinUType preparer's name Prepar�r's signature Date Check if PTI
7 /'
�` /'� i �
Paid �"'�'v �;'�� �1' � � self employed �� �^t�j' �
Preparer Firm'sname � KEI H NTZINGER� CPA
Use Only Firm's address► 277 SCHOOLHOUSE RD Firm's EtN► 27-3011964
MIDDLETOWN, PA 17057 Pno�e�o (717) 580-2463
Form 1040 (2013)
FDIA0112L OS/OS/13
:. �. .
SCHEDULE A Itemized Deductions OMBNo.1545-0074
(Form 1040) 2013
Department of the Treasury ' Information a6out Schedule A and its separate instructions is at www.irs.gov/schedulea. Attacnment
Internal Revenue Service (99) � AttaCh t0 FOYm 1040. Sequence No. �7
Name(s)shown on Form 104D Your social sewrity number
DOROTHY MAFFETT 054-01-9978
Medical Caution.Do not include expenses reimbursed or paid by others.
and � Medical and dental expenses(see instructions)....... .................. � 13, 866 :"y =
Expenses 2 Enter amount from Form 1040,line 38..... � 2 I 22, 20 0 . ' ::
� .
3 Multiply line 2 by 10%(.10).But if either of you or your spouse was bom before `� w_
January 2,1949,multiply line 2 by 7.5°/o(.075)instead 3 1, 6 65.
4 Subtract line 3 from line 1. If line 3 is more than line l, enter -0-. ........ ......... ........ . 4 12 201 .
axes ou 5 State and local (check oniy one box):
, �;:
Paid a Income taxes, or 319 � _
... 5 s;F
b BX General sales taxes '
6 Real estate taxes see instructions ��'; Y
( ).. .............. ........... 6
7 Personal property taxes.................... .. ................ 7 °`"'
8 Other taxes. List type and amount � � �� � ��
— -------------------- $ �E�,,
— — ---
.�: _..
9 Add lines 5 through 8................... .......... .................. .................... 9 3 1 9.
Interest 10 Home mtg interest and points reported to you on Form 1098................ 10 � ;�,, ^!
You Paid 11 Home mortgage interest not reported to you on Form 1098.If paitl to the person ��„ �;�'�;�M-
from whom you bought the home,see instructions and show that person's name, ��` � �t�e!
identifying number,and address ► ��'��! ''���`r;
��� �:r�t.
Note. �'��< rk '.
Yourmortgage — -------------------------- �^� A:�'
s ,� - t;
interest ��' � � `
----- ---------------------- xr� �, g ;- `
deduction may ��� � ��_�,;
belimited(see -------- '" ' ``
------------------ �:; �
instructions). 1� �`�'�
--------------------- -- � �
12 Points not reported to you on Form 1098.See instrs for spcl rules......... .. 12 ��y`''
:, ;
13 Mortgage insurance premiums (see instructions)....... ........ 13 � �
14 investment interest. Attach Form 4952 if required. �� �
(See instrs. '`� `
).... ............................... ............ ... 14 :�,._
��..,,;
15 Add lines 10 through 14..... .............................. ............ .... .............. 15 0 .
Gifts to 16 Gifts by cash or check. If you made any gift of$250 or . `;� :;;
u:~ - ,
Charity more, see instrs............................................. 16 �X `��
Y ��; ���
If you made a » Other than by cash or check. If any gift of$250 or ��,?�, ,,� ,�
gift and got a more, see instructions. You must attach Form 8283 if _ti3, ;'�„�^;
benefit for it, over$500.................... '_ �
. 17 L'�-.,
see instruchons. �;�w
18 Carryover from prior year................................... . 18 ,.,M;�:,..,.;
19 Add lines 16 through 18....................... ................ .......................... l9 0 .
Casualty and
Theft Losses 20 Casuaity or theft loss(es). Attach Form 4684. (See instructions.)........................... 20 0.
Job Expenses 21 Unreimbursed employee expenses —job travel, union dues, " „ �
and Certain job education, etc. Attach Form 2106 or 2106-EZ if i =
Miscellaneous required. (See instructions.) � ��',� �� �,
Deductions --------------- �s �:: � ¢;
21 `"�r
----- ------ -- ------ --- s�#..
22 Tax preparation fees.. ..... ... .. 22 ;, ,,.
23 Other expenses — investment, safe deposit box, etc. List ;:vt ;
type and amount � x; �;� t <
____________________....z.x..., :::F.�!.
----------------------------- 23
— :- "'
24 Add lines 21 through 23...................................... 24 - �''
25 Enter amount from Form 1040,iine 38..... � 25 I _.; �: s
_._..._.. _
,; .1
26 Multiply line 25 by 2% (A2).......... ......................... 26 �. ;
_..�,:._.
27 Subtract line 26 from line 24. If line 26 is more than line 24, enter -0-.................... .. 27 p
Other 28 Other — from list in instructions. List type and amount �
Miscelianeous --------------- `
Deductions ------------------------- `
----------------- -:2$<._ 0
Total 29 Is Form 1040,line 38,over�150,000?
Itemized �No.Your deduction is not limited.Add the amounts in the far right column
Deductions for lines 4 tnrough 28.Also,enter this amount on Form 1040,line 40.
�Yes.Your deduction may be limited.See the Itemized Deductions Worksheet 29 12 520 .
in the instructions to figure the amount to enter. :� 3���,� �� �
30 If you elect to itemize deduc'tions even though they are less thar your standard ' � j �-� �
deduction,checkhere.......................................................... .. ...... ► ❑ � -
a 4 �,�, ;
�
BAA For Paperwork Reduction Act Notice,see Form 1040 instructions. Foiaosoi� 08f28l2013 Schedule A (Form 1040) 2013
. .__ � ._ ._�. � � �
� , �_
6251 OMB No. 1545-0074
Form Alternative Minimum Tax — Individuals 2�� 3
�Information about Form 6251 and its separate instructions is at www.irs.gov/form6251.
Departrnent of the Treasury At[achment
�ntema�Revenue Service(99) � AttaCh to Form 1040 or Form 1040NR. sequence No. 32
Name(s)shown on Form 1040 or Form 7C40NR Your social security number
DOROTHY MAFFETT 054-01-9978
Rart I �>' Alternative Minimum Taxable Income See instructions for how to com lete each line.
l If filing Schedule A (Form 1040), enter the amount from Form 1040, line 41, and go to line 2. Otherwise,
enter the amount from Form 1040, line 38, and go to line 7. (If less than zero, enter as a negative amount.). 1 9, 680 .
2 Medical and dental. If you or your spouse was 65 or older, enter the smaller of Schedule A (Form 1040),
line 4 or 2.5% (.025) of Form 1040, line 38. If zero or less, enter -0. ........................ ............. 2 555.
3 Taxes from Schedule A (Form 1040), line 9................................................. ............ 3 319.
4 Enter the home mortgage interest adjustment,if any,from line 6 of the worksheet in th2 instructions for this line...... . ........... . 4
5 Miscellaneous deductions from Schedule A (Form 1040), line 27..............:..... ...... ................ 5
6 If Form 1040, line 38, is $150,000 or less, enter -0-. Otherwise, see instructions............ ... ............ 6
7 Tax refund from Form 1040, 1ine 10 orline 21............................ ................. .............. 7
8 Investment interest expense (difference between regular tax and AMI�.. ...................... ........... g
9 Depletion (difference between regular tax and AM�.................................. ................... 9
10 Net operating loss deduction from Form 1040, line 21. Enter as a positive amount......................... 10
11 Alternative tax net operating loss deduction.......................................... ......... .......... 11
12 Interest from specified private activity bonds exempt from the regular tax.............. ...... ...... ....... 12
13 Qualified small business stock (7% of gain excluded under section 1202� .................... . . .... ....... 13
14 Exercise of incentive stock options (excess of AMT income over regular tax income). .. ............ ...... . 14
15 Estates and trusts (amount from Schedule K-1 (Form 1041), box 12, code A).... ....... .............. ..... l5
16 Electing large partnerships (amount from Schedule K-1 (Form 1065-B), box 6)...... ...................... 16
17 Disposition ot property (difference between AMT and regular tax gain or loss)............................. 17
18 Depreciation on assets placed in service after 1986 (difference between regular tax and AMI�....... ....... 18
19 Passive activities (tlifference between AMT and regular tax income or loss)............................... 19
20 Loss limitations (difference between AMT and regular tax income or loss).............. ....... ............ 20
21 Circu�ation costs (difference between regular tax and AM� .................................... .......... 21
22 Long-term contracts (difference between AMT and regular tax income).......................... .......... 22
23 Mining costs (difference between regular tax and AMl)........................ .......................... 23
24 Research and experimental costs (difference between regular tax and AM�............ ................... 24
25 Income from certain installment sales before January 1, 1987............................ .. ... ........... 25
26 Intangible drilling costs preference...... ................................................................ 26
27 Other adjustments, including income-based related adjustments.......................................... 27
28 Alternative minimum taxable income.Combine lines 1 through 27. (If married filing
separately and line 28 is more than $238,550, see instructions.).............................. ............ 28 10, 554.
-Part II �;� Alternative Minimum Tax(AMT)
29 Exemption. (If you were under age 24 at the end of 2013, see instructions.) ;= ka,?
IF your filing status is.... AND Iine 28 is not over.... THEN enter on line 29.... � ;
Single or head of household......... ...... $115,400.. .. ............. $51,900 '�5�'
,; a�<.
Married filing jointly or qualifying widow(er) 153,900................ . 80,800 =
Married filing separately.......... ........ 76,950................. 40,400 """
If line 28 is over the amount shown above for your filing status, see instructions. ^29 � 51, 900.
30 Subtract line 29 from line 28. If more than zero, go to line 31. If zero or less,
enter -0- here and on lines 31, 33, and 35, and go to line 34............................................. 30 p,
31 •If you are filing Form 2555 or 2555-EZ, see instructions for the amount to enter.
•If you reported capital gain distributions directly on Form 1040,line 13;you reported qualified dividends on Form
,,=k,.''
)040,line 9b;or you hatl a gain on both lines 15 and 16 of Schedule D(Form 1040)(as refigured for the AMT,if °'=� ""
necessary),complete Part III on page 2 and enter the amount from line 60 here. g� �
•All others: If line 30 is $179,500 or less ($89,750 or less if married filing separately), >
multiply line 30 by 26% (.26). Otherwise, multiply line 30 by 28% (.28) and subtract $3,590 �: ,
($1,795 if married filing separately) from the result.
.,,:;
32 Alternative minimum tax foreign tax credit (see instructions)......................................... 32
33 Tentative minimum tax. Subtract line 32 from line 31 ................... ................................. 33 p,
34 Tax from Form 1040, line 44 (minus any tax from Form 4972 and any foreign tax credit from Form 1040,
Iine 47). If you used Schedule J to figure your tax, the amount from line 44 of Form 1040 must be refigured
without using Schedule J (see instructions).... ......................... ....... .......................... 3q 5�g
35 AMT.Subtract line 34 from line 33. If zero or less, enter -0-. Enter here and on Form 1040, line 45. ........ 35 p_
BAA For Paperwork Reduction Act Notice,see your tax return instructions. F�tA53iz� 12/04/13 Form 6251 (2013)
__ �� .,� �. .,
Form 1310 Statement of Person Claiming oMBNo. ,545-00�4
(RevNOVember2005) Refund Due a Deceased Taxpayer
Departmenl of the Treasury
Internal Revenue Service � $e2 If1StYlJCt10l15. Seque ce No. �7
Tax year decedent was due a refund:
Calendar year 2013 , or other tax year beginning , and ending
Name of decedent Date of death Decedent's social security number
DOROTHY MAFFETT 12/14/13 054-01-9978
Name of person daiming refund Your social security number
Please MARJORIE MORRISON
print 169-44-3169
Or Home address(number and street).It you have a P.O.box,see instructions Apartment number
type 4 CAVAN CROSSING
City,lown or post office.If you have a foreign address,see instructions State ZIP code
ENOLA, PA 17025
Part I .; `- Check the box that applies to you. Check only one box. Be sure to complete Part III below.
A Surviving spouse requesting reissuance of a refund check (see instructions).
B �X Court-appointetl or certified personal representative (see instructions).Attach a court certificate showing your appointment, unless
previously filed (see instructions).
C � Person,other than A or B, claiming refund for the decede�t's estate(see instructions). Also, complete Part II.
Part II'.=:`"i Complete this part only if you checked the box on line C above.
Yes No
1 Did the decedentleave a will?.............................
..............
2 a Has a court appointed a personal representative for the estate of the decedent?. ..... ............. .......... . . .. .. .....
blf you answered 'No' to 2a, will one be appointed?...... ................ ....... ..................................
If you answered'Yes'to 2a or 2b, the personai representative must file for the refund. ,
� � �c�,� :;
��,�� ,� , ;
3 As the person claiming the refund for the decedent's estate, will you pay out the retund according to the �aws of the state �"� ��'s
_.;..:
where the decedent was a legal resident?............................................................................ .
If you answered'No'to 3, a refund cannot be made until you submit a court certificate showing your appointment as
personal representative or other evidence that you are entitled under state law to receive the refund.
Part II1,:�:_-; Signature and verification. All filers must complete this part.
I request a refund of taxes overpaid by or on behalf of the decedent. Under penalties of perjury, I declare that I have examined this claim,
and to the best of my knowledge and belief, it is true, correct, antl complete.
Signature of person claiming refund ► Date ►
BAA For Privacy Act and Paperwork Reduction Act Notice,see separate instructions. Form 1310 (Rev 11-2005)
FDIA2001L 11l08f05
�. . ,
8Q�x OMB No 1545�2200
Form ✓ v Preparer Explanation for Not Filing Electronically
(Rev Seplember 2012) ► Attach to taxpayer's Form 1040,1040A,1040EZ,or Form 1041
Depar�ment of the Treasury � At[achment
Intemal Revenue Service Information about Form 8948 and its instruction is available at www.irs.gov/form8948. seq�e�ce rvo. 173
Name(s)on tax return Tax year of return Taxpayer's identifying number
DOROTHY MAFFETT 2013 054-01-9978
Preparer's name Preparer's Tax Identificalion Number(PTIN)
Three out of four taxpayers;now use[RS e f�le�Go to www�ars gov/efile for details on using I:RS e f�te The benef�ts of electron�cfilipg}" f �� .;,�
x a a� �'�rr t�` t � -t . ,, t. , '4=�, � 5 i �. ���. s .r .t`-,� 3
includethefollowing,��,� 'x���,„��';��'�'�°�.��� r�� � K`a4x��€� , z £x'; � G �J �,��� � x 7�T�-�.:������ ,sa .r �` � ��.�'
.. d. . V"�a t.x �.'�^� a. �� n:�t �a `�•ia�� .S�a �+ �'ae;i �a3i?x '$i2� ,��`. y'e4�*"`'�,z� 's '-x ��ro' ��s�-.�:.:=
• �aster refunds , ;y:t�`��� z�� �• Secure tra�sm�ssions E � xr �-�r d�!�E payment�options,L ;, y-:, �,�� ,
y .,,� �,,; ��- "'�� 4��y.��.� r ; p 3. v ea � � �.A .�^"�',„. ' '`. �z+ s .d ,-�r�,:,%
•;;More accurate reCurns, ,�,` �. Eas,ier flling mefhod,_,_,. ,_`. �_ __,.;�, , _ , : ,! Rece�,pt,�acknowledged , '
. __�:� _,m..�, ._. ..__�_ , .. � s�,... _._
Check the applicable box to indicate the reason this return is not being filetl electronically. Do not check more than one box.
1 �X Taxpayer chose to file this return on paper.
2 �The preparer received a waiver from the requirement to electronically file the tax return.
Waiver Reference Number Approval Letter Date
3 �The preparer is a member of a recognized religious group that is conscientiously opposed to filing electronically.
4 �This return was rejected by IRS e-file and the reject condition could not be resolved.
Reject code: Number of attempts to resolve reject:
5 �The preparer's e-file software package does not support Form or Schedule
attached to this return.
6 Check the box that applies and provide additional information if requested.
a �The preparer is ineligible to file electronically because IRS e-file does not accept foreign preparers without social security
numbers who live and work abroad.
b �The preparer is ineligible to participate in IRS e-file
c �Other: Describe below the circumstances that prevented the preparer from filing this return electronically.
BAA For Paperwork Reduction Act Notice,see instructions. F�iza�oi� 09/19/72 Form 8948(9-2012)
s. :, , ,: <. , � < _
����� ���
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COMMONWEALTH OF PENNSYLVANIA SHORT CERTIFICATE
COUNTY OF CUMBERLAND
� S
; ;�
�
I, GLENDA FARNER STRASBAUGH
Register for the Probate of Wi11s and Granting
Letters of Administration in and for
CUMBERLAND County, do herehy certify that on
the 20th day of December, Two Thousand and
�, Thirteen,
��
Letters TESTAMENTARY
in common form were grar�ted by the Register of
said County, on the
estate of DOROTHYMAFFETT , late of HAMPDEN TOWNSH/P
/Fiist,Middle,Lasr)
in said county, deceased, to MARJORIEJMORRISON and
lFirst,Middle,Lastl
ROBERT S MAFFETT
(Firsf,Middle,Lasq
and that same has not since been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the
seal of said office at CARLISLE, PENNSYLVANIA, this 20th day of December
Two Thousand and Thirteen.
Fi1e No. 2013- 01327
PA Fi1e No. 2�- 13- 1327
Date of Death 92/�4/2013
S. S. #
'� i % , . i _ ,- / � 'i
' ��' � � 1 1 ��� � � ,
, �_��� � �, - � t� t '1�;r ��� �����. ( ,,
,_
Register O�WiIIs
i
� j. � _ ..
(� � � i /
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_ �I � � �..1 _ 1;-( � �` —, t' ,
`Depui'
--,1
NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL
_. ,.,, ,,:.. � �. .,r � ,. _- , , .
� 1,�a�1,1,3681, �
PA-40 — 2013
Pennsylvania lncome Tax Return
ENTER ONE LETTER OR NUMBER IN EACH BOX
N Extension. N Amended Return.
�54�1,9978
R Residency Status.
�l A F F E T T PA Resident/NonresidentlPart-Year Resident
from to
D 0 R 0 T H Y Occupation R E T I R E D S Single/Married, Filing Jointly/Married,
Filing Separately/Finai Return
Occupation
Y Deceased
Y Taxpayer Date of Death 1,21,41,3
N Spouse Date of Death
4 CAVAN CROSSING
N Farmers.
ENOLA PA 1,7025 SchoolDistrictName EAST PENNSBOR
2125�
1 a Gross Compensation. Do not include exempt income, such as combat 1,a �
zone pay and qualifying retirement benefits. See the instructions.
1 b Unreimbursed Employee Business Expenses. 1,b 0
1 c Net Compensation. Subtract Line 1 b from Line 1 a. L C �
2 Interest Income. Complete PA Schedule A if required. 2 �
3 Divldend and Capital Gains Distributions Income.Complete PA Schedule B if required. 3 �
4 Net Income or Loss from the Operation of a Business, Profession or Farm. 4 0
5 Net Gain or Loss from the Sale, Exchange or Disposition of Property. 5 0
6 Net Income or l.oss from Rents, Royalties, Patents or Copyrights. 6 �
7 Estate or Trust income. Complete and submit PA Schedule J. 7 D
8 Gambling and Lottery Winnings. Complete and submit PA Schedule T. 8 0
9 Totai PATaxable Income.Adtl only the positive income amounts from Lines lc, 9 �
2, 3, 4, 5, 6, 7 and 8. DO NOT ADD any losses reported on Lines 4, 5 or 6.
10 Other Deductions.Enter the appropriate code for the type of deduction. N y 0 �
See the instructions for additional information.
11 Adjusted PA Taxable Income.Subtract Line 10 from Line 9. �� 0
PAIA0412� 10130113
EC Page 1 of 2 FC
� 1,3001,1,3681, � m 1,���1,7,3681, �
.:� a �._.: ..., _, _ �... _ . .,.: , ., .. �
1,3��21,3697
� PA-40 — 2013 L�.�
Social Security Number
05401,9978 Name(s) �1AFFETT , DOROTI-�Y
.�.�..
12 PA Tax Liability.Multiply Line 11 by 3.07 percent(0.0307). L 2 �
13 Total PA Tax Withheld. See the instructions. ],3 �
14 Credit from your 2012 PA Income Tax return. 1 4 Q
15 2013 Estimated installment Payments. REV-459B included. N 1,5 �
16 2013 Extension Payment. ],6 �
17 Nonresident Tax Withheld from your PA Schedule(s)NRK-l.(Nonresidents only) 1,7 �
18 Total Estimated Payments and Credits.Add Lines 14, 15, 16 and 17. 1 8 0
Tax Forgiveness Credit.Submit PA Schedule SP.
19 a Filing Status: Ol Unmarried or Separated 02 Married 03 Deceased L 9 a ��
19 b Dependents, Part B, Line 2, PA Schedule SP 1,9 b 0�
20 Total Eligibility Income from Part C, Line 11, PA Schedule SP. 2� 0
21 Tax Forgiveness Credit from Part D, Line 16, PA Schedule SP. 2 1, Q
22 Resident Credit. Submit your PA Schedule(s)G-R with your
PA Schedule(s)G-S,G-L andlor RK-1. 2 2 �
23 Total Other Credits. Submit your PA Schedule OC. 2 � 0
24 TOTAL PAYMENTS and CREDfTS.Add Lines 13, 18, 21, 22 and 23. 2 4 �
25 USE TAX.Add amount. See instructions. 2 5 �
26 TAX DUE. If the total of Line 12 and Line 25 is more than Line 24, enter the difference here. 2 6 0
27 Penalties and Interest. See the instructions. Enter code: 2 7 �
If including form REV-1630/REV-1630A, mark the box. N
28 TOTAL PAYMENT DUE.See the instructions. 2 8 0
29 OVERPAYMENT.if Line 24 is more than the total of Line 12, Line 25 and Line 27, enter 2 9 0
the difference here.
The total of Lines 30 through 36 must equal Line 29.
30 Refund—Amount of Line 29 you want as a check mailed to you. Refund 3� �
31 Credit—Amount of Line 29 you want as a credit to your 2014 estimated account. 3 1 �
32 Amount of Line 29 you want to donate to the PA Breast Cancer Coalition's Breast 3 2 �
and Cervical Cancer Research Fund.
33 Amount of Line 29 you want to donate to the Wild Resource Conservation Fund. 3� �
34 Amount of Line 29 you want to donate to the Military Family Relief Assistance Program. � 4 �
35 Amount of Line 29 you want to donate to the Governor Robert P.Casey Memoriai 3 5 0
Organ and Tissue Donation Awareness Trust Fund.
36 Amount of Line 29 you want to donate to the Juvenile(Type 1)Diabetes Cure Research Fund. 3 6 0
Signature(s).Under penatties of perjury,I(we)declare that I(we)have examined ihis return,incfuding all
accompanying schedules and slatements,and to the besi of my(our)belief,they are true,correcl,and complzte.
Your Signature Spouse's Signature,if filing jointly
Preparer's PJame and T2lephone Number �"]17� 5 8 0–2 4 6 3 Date pt Out Y
E-File O
KEITH HUNTZINGER, CPA ��'L �'����, t.��{ FiRM FeiN 2 7 3 01,1,9 6 4
Preparer's PTIN ��� (�/� ,�
� f
� 1,30�21,3697 Pa�qe2of2 1,3pp21,3697 �
PAIA04 2L 10/30f13
. ,: . � .�.., „ ,
� � m �� �,,.._
�'
COMMONWEALTH OF PENNSYLVANfA SHORT CERTIFICATE
��
COUNTY OF CUMBERLAND
-�
, �,. -
1, - _ �
-_ j: ��
+"c"F
I, GLENDA FARNER STRASBAUGH
Reqzster for the Probate of Wi11s and Granting
Letters of Administration in and for
CUMBERLAND County, do hereby certify that on
� the 20th day of December, Two Thousand and
��`� Thirteen,
� Letters TESTAMENTARY
in common form were granted by the Register of
said County, on the
estate of DOROTHYMAFFETT , late of HAMPDEN TOWNSH/P
lFrrsf,Middle,LasU
in said county, deceased, to MARJORIEJMORRISON and
lFrrst,Middle,Lasrl
ROBERT S MAFFETT
/Fiist,Middle,Lasl1
and that same has not since been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the
seal of said office at CARLISLE, PENNSYLVANIA, this 20th day of December
Two Thousand and Thirteen.
Fi 1 e No. 2013- 01327
PA Fi1e No. 2�- 13- 1327
Date of Death 12/�4/2093
S. S. #
� ..
� l / � ,'' � � � � 1 _ / i
r`,.i '�. � :, � --��� I'ie� L: F `�J I..�.� . �/f��'�,/( �i.'�1
l �
RegisYer O�"Wi!ls
1
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/'(_ :
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' `DepuY
r
NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL
DECEASED (DOROTHY MAFFETT) 12/14/13
1040XDepartment of the Treasury—Intemal Revenue Service
F°`r" Amended U.S. Individual Income Tax Return OMBNo.7545-0074
(Rev December 2013)
► Information about Form 1040X and its separate instructions is at www.irs.gov/form1040X.
This return is for calendar year X 2013 2012 2011 2010
Other year.Enter one: calendar year or fiscal year (month and year ended):
Your first name MI Last name Your social security number
DOROTHY MAFFETT
If a joint return,spouse's first name MI Last name Spouse's social security number
Home address(number and street).If you have a P.O.box,see instructions. i �; T,,,., ���� Apt no. Your phone number
4 CAVAN CROSSING #{ � � s� �`"' �'�
City,town or post office.If you have a foreign address,also complete spaces below(see'insfruclions). State ZIP code
ENOLA, PA 17025
Foreign country name Foreign provinceistate/county Foreign postal code
Amended return filing status.You must check one box even if you are not changing your filing status.
Caution. You cannot change your filing status from joint to separate returns after the due date.
BX Single Married filing jointly �Married filing separately
Qualifying widow(er) BHead of househoid (if the qualifying person is a child but not your dependent, see instructions.)
A Original B Net change— C Correct
Use Part III on page 2 to expiain any changes amount amount of amount
or as previously increase or
adjusted (see (decrease) —
Income and Deductions instructions) explain in Part III
1 Adjusted gross income. If net operating loss (NOL) carryback is
included, check here............................ ................... ► � 1 22,200. 556 . 22, 756.
2 Itemized deductions or standard deduction................... . .. ... ..... 2 12,520. —42 . 12, 478 .
3 Subtract line 2 from line 1... .............. ............................... 3 9, 680. 598. 10, 278 .
4 Exemptions. If changing,complete Part I on page 2 and enter the amount
from line 28............................................................. 4 3, 9 0 0. 3, 9 0 0 .
5 Taxable income. Subtract line 4 from line 3............................... 5 5, 780. 598 . 6, 378.
Tax Liability
6 Tax. Enter method used to figure tax (see instructions):
TABLE 6 578. 60 . 638 .
7 Credits. If general business credit carryback is included, check here. ►� 7
8 Subtract line 7 from line 6. If the result is zero or less, enter -0-............ 8 578. 60 . 638 .
9 Othertaxes............................................................. 9
10 Total tax. Add lines 8 and 9.............................................. 10 578. 60. 638 .
Payments
11 Federal income tax withheld and excess social security and tier 1 RRTA tax
withheld (if changing, see instructions)............................. ...... 11 2, 808. 2, 808 .
12 Estimated tax payments, including amount applied from
prior year's return.. .................................. ................... 12
13 Earned income credit (EIC)................................. ......... ... 13
14 Refundable credits from Schedule(s) �8812 or �M or Form(s} 2439
� 4136 �5405 �8801 � 8812 (2010-2011) � 8839 8 8863
8885 or �other (specify): 14
15 Total amount paid with request for extension of time to file,tax paid with originai return, and additional tax
paid after return was filetl................................................................................. 15
16 Total payments. Add lines 11 through 15......................... ......................... ................. 16 2, 808 .
f�efUtld Of A1710Ut1t YOU �We (Note.Allow 8-12 weeks to process Form 1040X.)
17 Overpayment, if any, as shown on original return or as previously adjusted by the IRS........................ 17 2, 230 .
18 Subtract line 17 from line 16 (if less than zero, see instructions)..... ............ ................. .... ...... . 18 578 .
19 Amount you owe. If line 10, column C, is more than line 18, enter the difference............................. 19 60 .
20 If line 10, column C, is less than line 18, enter the difference. This is the amount overpaid on this retum...... 20
21 Amount of line 20 you want refunded to you ............................................................. . 21
22 Amount of line 20 you want applied to your(enter year): estimated tax. 22 -
� Complete and sign this form on�Page 2.
BAA For Paperwork Reduction Act Notice,see instructions. F�iaisiz� nioin3 Form 1040X(Rev 12-2013)
Form 1040X (Rev 12-2013) DOROTHY MAFFETT Page 2
Part i`" Exemptions
Complete this part only if you are increasing or decreasing the number of exemptions(personal and dependents) claimed on line 6d of
the return you are amending.
A Original number of B Net change C Correct number
See Form 1040 or Form 1040A instructrons and Form 1040X insrructions. exemptions or amount or amount
reported or.as
previously ad�usted
23 Yourself and spouse. Caution. If someone can claim you as a dependent,
you cannot claim an exemption for yourself........ ..... .... ............. 23
24 Your dependent children who lived with you............................... 24
25 Your dependent children who did not live with you due to divorce or separation. ............. 25
26 Olher dependents................. .................................. .... 26
27 Total number of exemptions. Add lines 23 through 26........ .......... .... 27
28 Multiply the number of exemptions claimed on line 27 by the exemption
amount shown in the instructions for line 28 for the year you are amending.
Enter the resuit here and on line 4 on page 1 of this form.................. 28
29 List ALL dependents (children and others) ciaimed on this amended return. If more than 4 dependents, see instructions.
(b)Depentlent's (c)Dependent's (d)Check box if qualifying
(a)First name Last name social security relationship to child for child tax credit
number you (see instructions)
Part II.,`? Presidential Election Cam ai n Fund
Checking below wiii not increase your tax or reduce your refund.
Check here if you did not previously want$3 to go to the fund, bu't now do.
Check here if this is a joint return and your spouse did not previously want$3 to go to the fund, but now does.
Part lll;< Explanation of changes. In the space provided below, tell us why you are filing Form 1040X.
► Attach any supporting documents and new or changed forms antl schedules.
SUBSEQUENT TO THE FILING OF THE ORIGINAL TEX RETURN, A 1099-INT FORM WAS RECEIVED
FROM MEMBERS 1ST FEDERAL CREDIT UNION IN THE AMOUNT OF $556. THIS AMENDED RETURN
IS BEING FILED TO REPORT THE ADDITIONAL INCOME.
Sign Here
Remember to keep a copy of this form for your records.
Under penaities of perjury, I declare that I have filed an original return and that I have examined this amended return, including accompanying
schedules and statements, and to the best of my knowiedge and belief, this amended return is true, correct, and complete. Declaration ot
preparer (other than taxpayer) is based on all information about which the preparer has any knowledge.
/ /
Your signature Date Spouse's signature.If a joint return,both must sign Daie
Paid Preparer Use Only
� / / !\ �s�1`� KEITH HUNTZINGER, CPA
�r!.� /� ��J/� —�Z,/e�'��(f�g Firm's name(or yours if seif�employed)
� gf� � ) tLT
P�ePa«�'s siGnat�re oate 2�7 SCHOOLHOUSE RD
���.�� � ���L-��`�,�; -U�- , � '� MIDDLETOWN, PA 17057
PrinUtype preparer's name Firm's address,and ZIP code
���_ j�' f�, �ff �`Checkifself-employed (717) 580-2463 27-3011964
PTI �E �� Phone number EIN
For forms and publications, visit IRS.gov. Form 1040X(Rev 12-2013)
FDIA1812L 17/01l13
� 1300113681 �
PA-40 — 2013
Pennsylvania income Tax Return
ENTER ONE LETTER OR NUMBER IN EACH BOX
N Extension. Y Amended Return.
054�19978
R Residency Status.
�1 A F F E T T PA Resident/Nonresident/Part-Year Resident
from to
D 0 R 0 T H Y Occupation R E T I R E D S Single/Married, Filing JointlylMarried,
Filing Separately/Final Return
Occupation
Y Deceased
Y Taxpayer Date of Death 1,21,41,3
N Spouse Date of Death
4 CAVAN CROSSING
N Farmers.
ENOLA PA 1,7025 SchoolDistrictName EAST PENNSBOR
21,250
��
1 a Gross Compensation. Do not include exempt income, such as combat 1 a �
zone pay and qualifying retirement benefits. See the instructions.
1 b Unreimbursed Employee Business Expenses. �b �
1 c Net Compensation. Subtract Line 1 b from Line 1 a. �� �
2 Interest income. Complete PA Schedule A if required. 2 5 5 6
3 Dividend and Capital Gains Distributions Income.Complete PA Schedule B if required. 3 �
4 Net Income or Loss from the Operation of a Business, Profession or Farm. 4 �
5 Net Gain or Loss from the Sale, Exchange or Disposition of Property. 5 0
6 Net Income or Loss from Rents, Royalties, Patents or Copyrights. 6 �
7 Estate or Trust income. Complete and submit PA Schedule J. 7 �
8 Gambling and Lottery Winnings. Complete and submit PA Schedule T. 8 �
9 Total PA Taxabie Income.Add only the positive income amounts from Lines 1 c, 9 5 5 6
2, 3, 4, 5, 6, 7 and 8. DO NOT ADD any losses reported on Lines 4, 5 or 6.
10 Other Deductions.Enter the appropriate code for the type of deduction. N 1� 0
See the Instructlons for atlditional information.
11 Adjusted PA Taxabie Income.Subtract Line 10 from Line 9. L L 5 5 6
PAIA0412L 10l30I13
EC Page 1 of 2 FC
� 1,�001,1,3681, � m 1,3�01,1,�681, �
� 1300213697 �
PA-40 — 2013
Social Security Number
�5401,9978 Name(s) hIAFFETT , DOROTHY
12 PA Tax Liability.Multiply Line 11 by 3.07 percent(0.030�. 1 2 17
13 Total PA Tax Withheld. See the instructions. �3 �
l4 Credit from your 2012 PA Income Tax return. � 4 �
15 2013 Estimated Instaliment Payments. REV-459B includetl. N 1 5 D
16 2013 Extension Payment. �6 �
17 Nonresident Tax Withheld from your PA Schedule(s)NRK•1. (Nonresidents only) 1 7 �
18 Total Estimated Payments and Credits.Add Lines 14, 15, 16 and 17. �8 0
Tax Forgiveness Credit.Submit PA Schedule SP.
19 a Filing Status: Ol Unmarried or Separated 02 Married 03 Deceased �, 9 8 0�
19 b Dependents, Part B, Line 2, PA Schedu�e SP 1 9 b ��
20 Total Eligibility Income from Part C, Line 11, PA Schedule SP. 2� �
21 Tax Forgiveness Credit from Part D, Line 16, PA Schedule SP. 2 1 �
22 Resident Credit. Submit your PA Schedule(s)G-R with your
PA Schedule(s)G-S,G-L and/or RK-1. 2 2 �
23 Total Other Credits. Submit your PA Schedule OC. 2 3 �
24 TOTAL PAYMENTS and CREDITS.Add Lines 13, 18, 21, 22 and 23. 2 4 �
25 USE TAX.Add amount. See instructions. 2 5 �
26 TAX DUE.If the total of Line 12 and Line 25 is more than Line 24, enter ihe difference here. 2 6 1,7
27 Penalties and Interest. See the instructions. Enter code: 2 7 �
If including form REV-1630/REV-1630A, mark the box. N
28 TOTAL PAYMENT DUE.See the instructions. 2 8 �7
29 OVERPAYMENT. if Line 24 is more than the total of Line 12, Line 25 and Line 27, enter 2 9 0
the difference here.
The totai of Lines 30 through 36 must equal �ine 29.
30 Refund—Amount of Line 29 you want as a check mailed to you. Refund 3� �
31 Credit—Amount of Line 29 you want as a credit to your 2014 estimated account. 3 1 �
32 Amount of Line 29 you want to donate to the PA Breast Cancer Coalition's Breast 3 2 0
and Cervical Cancer Research Fund.
33 Amount of Line 29 you want to donate to the Wild Resource Conservation Fund. 3� �
34 Amount of Line 29 you want to donate to the Military family Relief Assistance Program. 3 4 �
35 Amount of Line 29 you want to donate to the Governor Robert P.Casey Memorial 3 5 Q
Organ and Tissue Donation Awareness Trust Fund.
36 Amount of Line 29 you want to donate to the Juvenile(Type 1)Diabetes Cure Research Fund. �6 0
Signature(s).Under penalties of perjury,I(we)declare that I(we)have examined ihis relurn,including all
accompanying schedules and statements,and to the best of my(our)belief,they are Irue,correct,and complete.
Your Signature Spouse's Signature,if filing jolntiy
Preparer'sNameandTelephoneNumber �717� 580-2463 Date E-FileOptOul Y
KEITH HUNTZINGER, CPA !`�'G'1, J���C��—�'�- FIRMFEIN 273D1,1,964
Preparer's PTIN �/u�r�y%C�L�/
E � l t7 �
� 1,30�21,3697 Pa�qe2of2 1,30�21,3697 �
PAIA04 2l 10/30It3
��005�1686
� SCHEDULE PA-40X �
Amended PA Personal Income Tax
Schedufe PA-40X(06-13)
PA Department of Revenue 2��3
MAFFETT DOROTHY 054D1,9978
CAUTION: This schedule must be filed with a PA-40, Pennsylvania Personal Income Tax Return, indicating it is an amended
return.An amended return is not filed until the department receives both the amended PA-40 and the Schedule PA-40X.
PART I A. Oriyinal B. Net change-amount of C. Correct amount
amount or as increase or(decrease)
previously Explain in Part III
amended
INCOME
Line 1 a Gross Compensation � � �
Line 1 b Unreimbursed Employee Business Expenses 0 � �
Line lc Net Compensation. Subtract �ine lb from Line la. � 0 �
Line 2 Interest Income 0 5 5 6 5 5 6
Line 3 Dividentl and Capital Gains Distributions Income 0 � �
Line 4 Net Income or Loss from the Operation of a Business,Profession or Farm � � �
Line 5 Net Gain or Loss from the Sales,Exchange or Disposition of Property � � 0
Line 6 Net Income or Loss from Rents, Royalties, Patents or Copyrights � 0 �
Line 7 Estate or Trust Income 0 0 �
Line 8 Gambling and Lottery Winnings � � 0
Line 9 Total PA Taxable Income.For Columns A and C, add only the
positive income amounts from Lines 1 c through 8. � 5 5 6 5 5 6
Line 10 Other Deductions. 0 N � 0
Enter the appropriate code for the type of deduction.
Line 11 Adjust PA Taxable Income. For Columns A and C, subtract Line 10
from Line 9. O 556 556
Line 12 PA Tax Liability. For Columns A and C, multiply Line 11 by 3.07
percent (.0307) � ],7 L 7
WITHHOLDINGS,PAYMENTS,CREDITS AND
USE TAX, PENALTIES AND INTEREST
Line 13 Total PA Tax Withheld 0 � �
Line 14 Credit from your 2012 PA Income Tax return 0 � �
Line 15 2013 Estimated Instailment Payments � � �
Line 16 Extension Payment � � �
Line 17 Nonresident Taz Withheld from PA Schedule(s)NRK-1 (Nonresident only) � D �
Line 18 Total Withholdings&Payments.Add Lines 13 through 17 for
Column A and C. � � 0
�ine 21 Tax Forgiveness Credit.Complete Lines 19 and 20 on Amended PA-40 � � �
Line 22 Resident Credit. (Based on instructions for PA-40, Line 22) � 0 0
Line 23 Other Credits (Based on the instructions for PA-40, Line 23) 0 � �
Line 24 Total Payments and Credits.Add Lines 18,21,22 and 23 for Columns A znd C. � � 0
Line 25 Use Tax � � �
Line 27 Penalties and Interest � 0 �
Page 1 of 2
� 1,�0051,1,686 PAIA0512L 10/09/13 1,30�51,1,686 �
_ _ _ _
.� , .., ,;. � � < � ..�. ,�,� ���� � .,�...,.x,,�,,, � _ �. _
1,30061,1,692 �
� SCHEDULE PA-40X
Amended PA Personal Income Tax
Schedule PA-40X(08-13)
PA Department of Revenue 20�3
�1AFFETT DOROTHY 05401,997B
PART II CALCULATION OF REFUND OR PAYMENT DUE WITH AMENDED PA-40
A. Enter the amount of your amended PA tax �iability from �ine 12, Column C of Page 1. 1�
B. Enter the amount of your amended total payments and credits from Line 24, Column C of Page 1. �
C. Subtract Line B from Line A. ],7
D. Enter the amount of the overpayment(refund,carry over credit and donations)from your original return or any
previously amended returns. See the instructions. Do not report this amount on your amended PA-40.* �
E. Enter the amount of your amended use tax from Line 25, Column C ot Page 1. �
F. Enter the amount of your amended penalties from Line 27, Column C of Page 1. �
G. Add the amounts on Lines C, D, E and F. �,7
H. Enter the amount of all payments made with your original return and all previously amended PA-40 retums. Indude any
penalties and interest paid with those returns or after the filing of those returns. Do not report this amount on your
amended PA-40.* �
I. Subtract Line H from Line G.if the result is positive,this is the amount you owe with your amended return. Please
foilow the instructions for Payment Options found in the PA-401N booklet to make a payment with your amended PA-40.
If the result is negative, this is the amount of your overpayment.
Use Lines 30 through 36 on your amendetl PA-40 to notify the department how to disperse your overpayment. �7
Do not report this amount on Line 28 or Line 29 of your amended PA-40.*
" The department will automatically calculate your amended tax liability or overpayment. Including the amounts previously
paid or refunded on your amended PA-40 return will delay processing and could result in avoidabie correspondence from
the department.
PART III DESCRIPTION OR EXPLANATION OF CHANGES
Provide a description or expianation for each change to amounts reported on the original or most recent amended return. Also include
an explanation for any change to filing status or residency status if changed from the original or most recent amended return. Include
supporting amended schedules and documentation as required. See the instructions.
SUBSEQUENT TO THE FILING OF THE ORIGINAL TAX RETURN, A ],099—INT FORhI WAS RECEIVED FROf1
f1Ef18ER5 1ST FEDERAL CREDIT UNION IN THE AMOUNT OF $556• THIS A�tENDED RETURN IS BEIN6
FILED TO REPORT THE ADDITIONAL INCOME.
Page 2 of 2
�,�,.,,,,,.,,. 1,���61,1,6 9 2 PAIA0512L 10/09/13 1,3��61,1,6 9� �
� CORRECT�D (if checkeci)
PAYER'S name,street address,city,state,ZIP cod?znd tzlephone numFxr Pay�r's RT�d(a;itionzl) OM�PJo.1545-0112
MEMBERS 1ST F�uERAL CP,EDIT UNION I
5000 LOUISE DRI�l� P.O. oOX 40 - �
�
MECHANICSSURG, PA 17055 I �� ,� � ��,���,���
(S00)233-232a Form'�v�S-��:� ������
P.4YER'�Federal!denti:`ication niim'oer I F,'ECIP;EiJTS identifcaiion number t Ini.r�st incon��a Ca�y 8 �or
,;.�, z�-isoo�os xxx-xx-�s�a �� �ss.a� 2ec'spien�
t�;�;
�� RECIPIEtdT'S name,zddr�ss;including apt no.;,city,state znd�I°code 2 Early�:�i'h^rzr:a!p�naRy 3 Iniere;t on U.S.
c� This is im ortant
Sz':�ings 2onds�ncl �
Treas.obligations iax info'rrnation and
*"` is bein rurnished
$ 0.00 � ��'� to t�'ne Internai
�
DOROTHY Nll�FFETi ;:��� !a ;ederalincometax �5 Irnestmente.�penszs R°V2f1U�SeIVICZ.
49d5 EAST TRINGLE RD APT 3088 � '^^�n�e��' li you are reyuired
MECHANICSBURG, PA 170$0 io file a return,a
$ 0.00 � 0.00 negiigence;�enalty ,
or u�ner sanction '
6 Foreign ta:t paid 7 Foreiyn country or ���a�D2 imposed �
U.S.possession �
on you if this II
$ 0.00 incorne is taxable ',
_� and ihe IRS j
Taz-ezempt intere;i 9 Specified privatz I i0 Tax-exempt bond rU51F no. I GPTP(Cn!tl2S thHt It ��
Account numb�r rsee instruc5onc) activity bond inter�st � (see instructions) ha5 f10I 620I1
v
XXXXX702 $ 0.00 $ 0.00 � reported.
�����ta�P 12 StatF identificatirn no. � 13 Siate tax wiithheld j
�
� 0.00 I
Form ���7-��� Substitute Form (Keep for your reecrds.) Deparimen�cf ihe Treasury-Internal P,evenue Seriice
v✓�:n,v.irs.go�dform 1099int
Ir�s�����t6�s�� ���° �����e�:��
Recipient's identificaYion number. For your protection, this 2ox 5.Any amour�t shown is your share of investment expenses
form may show oniy the last four digits of your social security or'a single-class RtIV11C. If you file Form 1040, you may deduct
number(SSN), indivicivai faxpayer identification number these expenses on ihe "Other expenses" line of Schedule A
(ITIN), or adoptlon taxpayer idertification number(ATIN). (Form 104Q) subject±o the 2% limit. This amount is included in
However, the issuer has reported yo!ir cornplete identification box �.
number'to the IRS and,where appiicable, to stai�and/or 8ox 6. Shows foreign tax paid. You may be abie to claim this tax
local governments. as a decluction or a credit on your Form 1040. See your�orm
1040 instructions.
Account number. May show an account or oiher unique 8ox 7_Shows the country or U.S. possession to wPiich the foreign
number the payer assign2d to distinguisi�your account. iax was paid.
Box 8. Shows tax-exempt interest paid io you during ihe calendar
Sox 1. Shows taxable interest paid to you during ihe year by the payer. Report this amount on line 8b oi Form 1040 or
calendar year by the payer. This does not include interest Form 1040,4. This amount may be subject to backup�:aitiihoiding.
shown in box 3. May also show ihe 'totai amount of the See box 4.
credits from clean rene�Jvable energy bonds, quali ied iorestry Box a. Shows tax-exempt interest subject fo ihe al'ternative
conservation bonds, nevv clean renewable energy bonds, minimum tax. i his arnount is included in box 3. See 'the
yualified energy conservation bonds, qualified zone academy !r.struc,ic^s for;crm 6251.
bonds, qualified school construction �onds, and build Sox 10. Shows CUSIP number(s)for tax-exempi bond(s) on
America bonds that must be included in your interesi income. which tax-exempt in�erest was paid to you during±he c;lendar
These amounts were 'treated as paid to you during 2013 on year and reported in box 8. If blank, no CUSIP number�,vas
the credit allowanc2 dates(March 15, June 15, September issued for the bond(s).
15, and December 15). For more informaiion, see Form 8oxas 11-13. State ±ax�.vithheld reporting boxes.
3912, Cr2dif to Hoiders cf Tax Cr2dit °onds.
3ox 2. Sho��is interest or principal forfeiTGd because of early °Jorr,inees. li this icr�� includes amounts belonging io anuther
withdra�val of time sa��ings. You may deduci!his amoun!io person(s), yeu are considered a nominee recipien±. Compl2ie a
figure your adjusted yross income on your income tax return. Fon; 1099-INT ror each of the other owners showing the incom�
See the instruc�ions*"cr Fonr� 10^-.0 to see�:vhere to take the allocabie to each. �ile Copy A of the;oiir�vi?h;he IRS. Fu;nisf�
deduction. i:opy E to each o,�mer. i ist ya.�rs21f as i'�2 "payer" and ?�a c;n�;
8ox ?. Sho�:vs in'teres;c�n U.S. Savings 8onds; Treasur� ov�rner!s) as the°recipieni." File Form(s) i099-il,iT v;�iii� �o!r�;
biils, �reasury bonds, and I reasury no�es.This may or!�ay 1096�,�,�iih ;he ir?emai P.evenue Servic� Cen�er r`or you,ar��=;. On
not all be taxabi2. See °ub. 550. This interest�s exemp;irom Form ?^v9E list yourseif as the "riler"� hu;hai;d o;�vi;� ;s;,��;
state and locai !IlCvl-t':P±axes. This inter2st IS tlflt IIIC�U�Ed I!l f2�U!i2� �O i!�E� nOt?lifl°2 f2iUfil t0 Sh0`:��;�r�OUiIIS ^\�Vil�•'� �`/ i�"Ir
box 1. ather. �
Box�. Shows backup�•:ai'thholding. G2nerally, a pa;%er must
backup vviihhoid if you did noi �un�ish your taxpayer ;utur� c�e�✓eiop;rz,,Ys. For the latesi informa?ion abr!ii
identifir.ation number(T!�.I) or you did not iurnisn the correc� dee-elocmenis re!a;ed to �crm 1099-INT and iis instruc�iors. such
TIN tc ihe payer. See Form in/-O InduJe this amoun!on your as legislat(on enact�d aft�r tiiey were publisheo, go io
income tax retum as iax v✓iihhclCl. 61NV'vV.f�S,yOV�rOl;rn i0°9inr.
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`n � ` �' Sales Receipt
�.:�ti IFU : _.. � �a�~"_-! �?y
ru ~ f Product Sale Unit Final
o ! -_ � Description Qty Price Price
� �t w�r R: iH � J.� ..�_ . #,.L l`��__.' u4 'uriarl;
(ERd r„Et1�i�t'r�F� -r
° ' � � F�`�Y NORTH VER5AILLES PA 15137 Zone-3 $2.32
Re tr ciC��I I� — __ �t,�,i_iii ��
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n ______. . ' 1.40 oz.
� ,.: � �,;:. , � 7 �f.�4 �' �l? ri+?,:ii; Expected Delivery: Thu 0?_/13/14
" - _.._.___ --_.___._._: PID #:
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"�' _ °- - - - - -- - ,- -.. ., ___ .._._° HARRISBURG PA 17129 Zone-1 $0.49
� ? First-Class Mail Letter
;�� ;-.t. ' 0.80 oz.
6 '� " ' ���r� Expected Del i very: Wed 02/12/14
a s Return Rcpt (Green Card) $2.70
a� Certified $3.30
m i � � . USPS Certified Mail #: ��jy,
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c���r�e�r-�� � y Expected Del i very: Fri 02/14/14
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Rt�rum� i i Fee __.__ �a�tmar4;
� (Enda;seme�t n cj�red� ! � He.t, L(� Cert i f i ed $3.3p
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POSTAL EXPERIENCE
_ " YOUR OPIIJION COUNTS
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Customer Copy
Keith R. Huntzinger, CPA, CPP, CSEP, MST
277 Schoolhouse Road
Middletown, PA 17057
Estate of Dorothy Maffett
c/o Marjie Morrison
4 Cavan Crossing
Enola, PA 17025
February 8, 2014
Professional Services Rendered:
Preparation of 2012 Federal and Pennsylvania income tax returns
Amount due $ 160.00
f �. �
WILL.IAM BAI_.ABA�N &ASSOCIATES, LLC
Attorneys&Counselors At Law
Govcrnoi-s' Ro���
Z7 NorCh I'ront Slrccl
Harrisburg,PA 17101-1606
Yl�o�ic: 717-(�95-2901 ��Villian� R. 13alaban, l�squirc
l�acsimilc: 717-695-791�1� I',inail: W13alabanC�l3alabanlli�d�lssociatcs.coin
December 18, 2013
Marjorie J. Morrison
4 Caven Crossing
Enola, PA 17025
RE: Last Will and Testament of Dorothy B. Maffett
Dear Marjorie:
Per our telephone call from earlier today, enclosed please find the following:
1. Original (and a copy) of your mother's November 14, 2013 Last Will &
Testament;
2. The Lincoln National Life Insurance Company Change of Beneficiary Form
and Addendum; and
.,, ,' -
����_ � ,.. �+'�_ �
3. Our Statement in the amount of$250.00. V� � ���-.���� �`� `"�U ��°:�> �"�
I was happy to have been of assistance to your and your brother, Robb in this matter.
When i visited with you mother and Robb on Tuesday October 29, 2013 at Country Meadows,
she was in great health and she shared many wonderful thoughts and memories about your
family and mine growing up together in Camp Hill. I enjoyed hearing those stories and was
happy to be able to share them with my mother, Margaret.
Do not hesitate to contact me if you have any questions on the attached and/or if I can be
of any assistance to you and Robb as you probate your mother's estate. I ani more than happy to
assist you as a courtesy with no charge to the estate.
� �������.13alabaiill»dllssocialcs.com
7 , .
Cauntry►�/�eadows qt Home
PO Box 3060
Hershey, pq 17033 srAr�MENT
Phone:(ggg) 754_2220 AZ`
Fax: c�LNrRY
����)520-4760 h1E�n��
� www.countrymeadowsathorr�e.co►r� �"Gf.'
Date: PP7"�S'onut Care Sera-'
—� 12/17/2013 �ces
Client Name:Maffett, Dorothy
Dorothy Maffett Account#: '
�_ , ,
02845
�`:Date .. ; Page# �
12/03/2013 "/ � " ,.Transaa#ion
,
12/11/2013 Balance forward �" �� � '" ` �� �
. ,
12/15/2013 PMT#1177. qmount. ,.- '
N1. Morrison
INV#21864. �Balance �> �'
4,119.00- 4,119.00
2,205.00
2,205.00
GRRENT �-30 DAYS
PAST DUE 31-60 pqys
PAST DUE 61-�DAYS
2,205.00 PAST DUE �VER 90 DAYS
Tens: Due ���� PAST DUE
�thin 14 Days Of �.00 AMOUNT DUE
_ s://countr meadows.bi��i� Receipt. you �.00
doc.net or b may pay bY VISq, Mastercard, �•00
y phone tolf free 1-g55-532-7103 American Express $2�205.00
oi� Discover On �ine at
I". �� � <G R�TI ��.
I,r il`#D r'r_ ;1 �r,R
- , �; �`'i;JiT}t YOUfi r�:+,�,;,��,;. ,
, � ,
Marjorie J. Morrison
December 18, 2013
Page 2
Once again, my sincerest condolences and prayers to you and your family on the death of
your mother, Dorothy B. Maffett.
Respectfully yours,
WILLIAM BALABAN & ASSOCIATES, LLC
By: ! .>t,�
William R. Balaban, Esquire
Enclosures
cc: Robert S. Maffett (w/Enclosures)
�
�111COI11
Financial Group� Annuity
PO Box 2348 Con fi r��a tion
Fort Wayne IN 46801-2348 12/24/13
000515 21135902
DOROTHY MAFEETT Owner: DOROTHY MAFFETT
4905 E TRINDLE RD Annuitant: DOROTHY MAFFETT
APT 3088 Assu.rance (C Sha.re) : 92-4U132U1
MECHANICSBURG PA 17050-3653 Contra.ct effective da.te: 6/2/OS
Plan type: Non-Qualified
Represe.ntative: T.AMERA J MOSIER HERRELI.
Broker/Dealer: QUESTAR CAPIT.AL CORP
If you have questions regaxding this
statement, please call Lincoln Life at
SSS-868-2583.
3
N
*
N
W
U�
`° Activity
0
0
° Date Tyj�e uf nctivity Urcit vnlue 1Vumbrr u f units Amuurct
�
0
0 12/24/13 Death cla.in� $25,677.29
° Net withdrawal 25,677.29
x Cl��inz yaid to Rvbert S.Maj�'ett
3
3
� Fxom:
FT Tnc Sec 14.666349 - 1396.2U3U - 2U,477.2U
PIMCO Commodty 12.25U219 -424.4896 - 5,2UU.U9
12/24/13 Death claim $ 12,838.64
Net withdrawal 12,838.64
Clainr yaid to Janres L.Nvvver
From:
FT Inc Sec 14.666349 - 698.1U15 - 1U,238.60
PIMCO Commodty 12.25U219 - 212.2444 - 2,6UU.U4
= 12/24/13 Death claim $ 25,677.29
� Net withdrawal 25,677.29
Clnirrz yaid tv Marjvrfe J.Nlvrrisvn
From:
� FT Inc Sec 14.666349 - 1396.2027 - 2U,477.2U
� PIMCO Comzuodty 12.25U219 -424.4892 - 5,2U0.U9
� 12/24/13 Contract option change $ �'��
�
�
O 2013 Tlte Lincotn 1Vational Lije Irisurarice Conryany Cvnti�tued vtr b�zek
Lirzevin FinaneialGrvtty is the nrarketing nan�e JvrLi�icvlri lVational Coryorati�n�zrtd iis ajtili��tes.
AJ'j7liates nre seyarately resyorisible ror t�ieir v�ti�t Jinarxeial ari��evntraetrr�il vblig�ztivns.
r .
L111COI11
Financial Group� Annuity
POBox2348 Beneficiary Acknowled�er��ent
FortWaynelN 46801-2348 11/2S/13
015783 21133004
DOROTHY MAFEETT Owner: DOROTHY MAFFET"T
4905 E TRINDLE RD Annuita.nt: DORnTHY MAFFETT
APT 3088 Assu.rance (C Share) : 92-4U132U1
MECHANICSBURG PA 17050-3653 Contract effective clate: 6/2/US
Plan type: Non-Qualified
Repxesentative: TAMERA J MOSTER HERRELL
Bxoker/Dealer: QUESTAR CAPITAL CORP
If you have questions rega.rding this
statenlent,please cail Linc�li�Life at
888-868-2583.
3
N
#
W
� Beneficiary The following beneficiary designation for yaur contract has been recorded by Lincoln
° Information Life.
w BENEFICIARY NAME(S) RELATIONSHIP PCT/DESG
0
o --- PRIMARY---
0
0
° ROBERT S MAFFETT Child As Named IN Written Design
ti
3 MARJONE J MORRISON Child As Named IN Written Design
N JAMES L HOOVER Friend As Named IN Written Desigr
Please Jile this acknv�ti�ledgenzent�a�ith yvur contrnct inJornzation Jor Jittitre retererrce.
Corrections If the beneficiary information is not correct, please contact us at the phone number
above.
Of Interest to You
� Help us help you! By signing up for eDelivery you help us increase our efficiency and better the
� environment while at the sa.me tinte increasing the speed in which you receive critical information
� about you.r a.nnuity. Go to www.LincolnFina.ncial.com a.nd select 'Register naw' to n�ake a difference.
�
�
�
�
�
�
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�
�
�O ZUI3 Tlle L1)ICUItl NAIIUlItII LIJQ IYIS1lPel)ICQ CUYiIYtItIy Continued vn b��ek
Litzevin Finarieial Groi�V is the nzarketiny nanze/or Lir��coln Nationa!Coryvrativn and its aJ/ih�ztes.
rljJiliates arz seynrately resyvrrsible jvr tl�eir viani/itz��ric<<�!ezn�t coritmctital obhgativrrs.
��
Lincoln . . SM
Financia! Grou�� ��n���� ��Q��eP,(,lS
'The l:incoln Na(ional Life Insurance t�empany :�iIIil1l1L1'(�ifl3i'[eT�1�sCAteIill'Rr
�o B<,�2;j? 4ti�Quarter 2(i13
Fu�1�4a�ne.1\<1��tit}I-=;-�i
�
ti00-�S2b-(:i4S
1`aur_�r.cti�►a�[InCoitatati€>n j'«ur_��annil�'f,onla�l Inturrnaliun
t'ontrac[[)svner: D(.1R(7I�I�-�I�11 F�€T�1' Cuntrect��emi�er: 9^-7t>1��t)1 Rc��reseutefi��: T.4�fL:RA T i��t)SiL:R HERItF'LL
Annuitrnl: DORC?TH� VI.�PFi I 3 Pr��u�[..��ssma3nce(C Sh�rel Brnker�3eelerc QULSTAR t'AI'I7't\I.C{')RP
Plan Ty��e_ Non-Qualiliaci Ifyou have;me yuzst.ions re�ardins this statamert;
Contr:�c!Fttecii�e Dulc: 6,'2;�Q0� plaase centact us.�t tha phone number above oz cisit
e;ur ueh.it.e at t«uz��.Li ncc>l nFinancial_eorn.�Co
contact,cour r����.�ntative ciiract.ly,pleasz cali
-i4-d��_?{>i)f i.
1'our il'dlll'IjV_'�l'CITIILI Vxiuc
Value 9131i11:� �'e(.�ctivity GriY�lLass Vahtc 12;3U'13
_— ----
-- -- __ --- -------_
Sb2,<'�F_4G (`�:4,14.;�?) v 1?)f,4�6 �0.0(1
Nit I,isim�13caoe�!l�calnm
.11ic3n_L�oalit feature has net b �n alected tiary�uurc<>ntract alt.hough somz pr<x3ucis do not a3ioic ih�s�Jaatui<s. Yl�as;ui��taci v�.jar Keps�:aniatia��t�ith
an��yuesi.iu�ts.
S`burPun�l Sainman
.�s ol 9:3i),'"(3 _A.uf 72{31113
___ _ ---- __--- -------
� itiautlicr _ Numbcr
I�`�md Name I;nii Valae of[lnits �%alae Net_�ctii�iiv (:aaulL+rss ltnil Vslne oi�tluits V�loc �
_ --- . __-- -- -- —-- - ------- ------- �
1��I�inc Sec I 1 i)-{fit)�l'� i,=}�iO�t1,� 4�9,t?�.SS (5�1,193.00} `�2.1&�.01 I-}_7(�;{)ti(1 f.1.0(,l{)i) $-QO
PI1Y1tY)('enxnudi� 1'-.�i�i�O 1_{�51 ��?= 4:l:,196.1; {SYi,O00?2! (579ti?�i 1^.106<19j i).(N)O1.) $.00 �
Ynur F►arterlv#ccdnnt,tc[itiih� �
Dale acii�ity i��rnd\ame �nao»nt iinit Valne NamberofiJuits
�2;?-i;(i Death cl:iim jy^_�6^-�c� � �
FI'tncSec !�?t),�T;.�01 i4.655i�t) (1,i9(?Q;O) �
PII�IC'C1Cnmrnuc7ty {tii.20��_r.><�) l�-=�(i�l) (42-�.�89G)
12'24;'I± D�athdatitn {'ti72.�iS.ti41
FT Ioc Sec f$lQ,2;�3.60 t 14.6b6i49 (693_1015)
PII��CO(�ommo�lty {`�2,fi0p.O�1 I'??•O219 (2122�4-�)
t�%?�'1 i ll�aih claim iv?�,�y-7_'q}
I�T Inc Sec (S?i),�"?.�Q 1 1=}(�6fi i�9 ((,i96.2027)
PI�-If"C?(_'rxtunodt.� {4�^Q9_(?t>) {�?>f)214 {�24_4fi92)
� 1'nnr Pioti6cations arsd Disclos�ire. � � � � �
•Acce�;tu cour contract inforrnatic�n is a�-=�iiaihte oniine. R�e�stLrat 1�?���.I.incc�InPinvncial.com t�x3ay. This i3ocurnznt and inan}�oti���s can ix read onliue by
signin��up t'or�I)tii��erc. Halp make a posiirvz e��.��renmental impuct l�y si�ning i�p tcxiav.
•I'his conlinnation is prepa�zd l��°The Lincc�ln:tia[inn;il I_ife In;urance t�ompany or one vi it,Life Insurnnce cempany atliliate�punuant tr,�t�_agr-�n�ien3.itiith
tha piincipal underu�ni.�r t�ft:he insui:�nce seu�rRies descdbeci herein.li�r th�b:nefit of the>�lfin�z lxok r d�aler.
•�utilg Lincciin premptly if inforn7ation u�ntainzd ia this doeuniant is not accurate Pl�a�e i��l 1�r�t��r�-coiiiinn an�i�ral communication in tivriting to lintlier
pic�t.�ct pour iiz}tis.
•1nt���si ie�te,:�nd crulitin�tr,aihc li li._,witl(r pro�;d�t31<�yni�u��n r�c�ue;t an�7 fieaofcha�_z.
I,inci?In Financial Group is the rtaarkeEin�nam�ior 1_ircoln tiaiii?nal Cotporation and it:alfilis�t�:ti.
�?(.11_i Th�I.incoin�iati«nal Life Insuranca Gornpaoy.
9�-4U1;2O1 I?OROTHY'1�1:�.FF£T'I' (-ontiriued on back
i)(�(?i)(}i)r) �(ilTt,)N , ;-1;' �it?S:I:RFII=RKI:LI.. F.3\hfK.�I �"S77'P_\
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�� Members ]st Federal Credit Union 12/20/2013 12/31l2d13 1 of 2 XXXXXXX818
�000 Louise Drive
Y.O.Bo�40
Mechaincsbtu�PA 170��-0040
� � (800)237-7258
MEMBERS 1s� (717j 697-�312(Hearing Impairedi
rmeRa�,car:mrunio� «����.inemberslsLor`
`,*'�',
20
DOROTNY MAFFETT ESTATE
4 CAVAN CROSSING �:;�
ENOLA PA 17025 C"'
47453
�ng,9-I.N�s are not �includedin this state,me�nt. If you ear�iedat Ceast�lo.00 �i.n diviclends on yoz�r
accotitnt for�oi3, you�viCCreceive your togg-I:N�'in a sepa.rate rn.a.iling in.�anuary �or�.
, � : , , . .
CHECKING 554.57
SAVI NGS 81,001.54
CERTIFICATES 0.00
LOANS 0.00
e1
BEGINNING BALANCE: $0.00
Eff. Post
Date Date Description Deposits Withdrawals Balance
12/27 12/27 Deposit Transfer From Share 0000 6,500.00 6,5�0.00
12/30 12/30 Check 000051 Tracer 0000336441 3,740.46 2,759.54
12/31 12/31 Check 000052 Tracer 0000176142 2,205.00 554.54
12/31 12/31 Deposit Dividend 0.050% 0.03 554.57
Annual Percentage Yield Earned 0.050%from 12/27/13 through
12/31/13
ENDING BALANCE: $554.57
Check# Date Amount Check# Date Amount Check# Date Amount
51 12I30 3,740.46 52 12l31 2,205.00
* Indicates check out of sequence 2 Checks Cleared for 5,945.46
Total Deposits 6,500.03 Average Daily Balance 4,562.82
Totai Withdrawals 5,945.46
� - � 1 i t 1
BEGINNING BALANCE: $0.00
Eff. Post
Date Date Description Deposits Withdrawals Balance
12/20 12/20 Deposit Transfer 87,910.36 87,910.36
From MAFFETT,DOROTHY XXXXXXXXXX Share 0000
12l20 12/20 Withdrawal Transfer 303.00 87,607.36
� S� „
�y � �• � . . • � � • �
MEMBERS 1S� 12/20/2013 12/31/2013 2 of 2 XXXXXXX818
dPEDERALCREUfC UN10N
Eff. Post
Date Date Description Depnsits Withdrawais Balance
To MORRISON,THOMRS XXXXXXXXXX Share 0011
12/27 12/27 Withdrawal TransferTo Share Q011 6,500.00 81,107.36
12/27 12/27 Withdrawai 150.00 80,957.36
,�,,, 12/31 12l31 Deposit 40.00 80,997.36
� 12/31 12/31 Deposit Dividend 0.150% 4.18 81,001.54
Annual Percentage Yieid Earned 0.150%from 12/20/13 through
12/31/13
ENDING BALANCE: $81,001.54
Total Deposits 87,954.54 Total Withdrawals 6,953.00
r , '
TOTAL DIVIDENDS PAID
0000 REGULAR SAVINGS 4.18
0011 CHECKING 0.03
Total Year to Date Dividends Paid (Includes Closed Shares) 4.21
,:�� .. _:.� �� . ,: . s..- � �., ��-� _ _ _
Page 1 c
�
1M1�11'1���� �St
�FEDfi�L CitEDIT UIvION
�ccount Statement
)OROTHY MAFFETT ESTATE For Account: 0000537818
ZOBERT MAFFETT
JIARJORIE MORRISON
G CAVAN CROSSING
=NOLA, PA 17025
Reporting Period: 1/O1/2014 to 2/28/2014
000� REGuLAR SAVINGS
'ost Date Transaction Description Amount New Balance
I/24/14 Deposit Check $ 1,576.60 $82,578.14
Check Received 1,576.60
I/31/14 Dividends:0.150o�a $ 10.37 $82,588.51
?/10/14 Withdrawal Transfer:To Share 0011 $750.00- $81,838.51
!/18/14 Withdrawal of Cash $ 13.00- $81,825.51
?/28/14 Dividends:0.100% $6.30 $81,831.81
0011 CHECKING
�ost Date Transaction Description Amount New Balance
I/02/14 Draft: 000053 $ 11.87- $542.70
I/02/14 Draft:000055 $200.00- $342.70
I/06l14 Draft: 000054 $250.00- $92�70
I/28/14 Draft: 000056 $7.86- $84.84
'./08/14 Fee:Temp Checks $2.00- $82.84
?/10/14 Deposit Check $ 100.00 $ 182.84
Check Received '!00.00
?/10/14 Deposit Transfer: From Share 0000 $750.00 $932.84
?/12/14 Draft: 000058 $ 160.00- $772.84
!/14/14 Draft:000057 $711.26- $61.58
4/3/2
,�.�� �.. � �� s. ���.�,. v� ,., _ � - .� . _
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Page 1 0
S�
����.G.C�.� ��� . . . .
n FFDERAL CREI�IT UNIt}1'�
ccount Statement
)ROTHY MAFFETT ESTATE For Account: 0000537818
)BERT MAFFETT
�RJORIE MORRISON
:AVAN CROSSING
lOLA, PA 17025
Reporting Period: 3/O1/2014 to 4/07/2014
0000 REGULAR SAVINGS
�st Date Transaction Description Amount New Balance
I 8/14 Deposit Check $ 16.00 $81,847.81
Check Received 16.00
19/14 Withdrawal Transfer:To Share 0011 $ 150.00- $81,697.81
?0/14 Withdrawal of Cash $ 12.98- $81,684.83
?7/14 Deposit Check $2,230.00 $83,914.83
Check Received 2,230.00
31/14 Dividends:0.100% $6.98 $83,921.81
)3/14 Deposit $90.00 $84,011.81
TAX FILING REFUND
0011 CHECKING
>st Date Transaction Description Amount New Balance
19/14 Deposit Transfer: From Share 0000 $ 150.00 $211.58
24/14 Draft: 000063 $90.00- $ 121.58
25/14 Draft: 000065 $ 17.00- $ 104.58
26/14 Draft: 000064 $60.00- $44.58
4/7/20
Service Corporation International
PRINT SINGLE CASH RECEIPT �a� �ti2�rzo�a
Page 1 of 1
Batch#: 100530567 Batch date: 12/27/2013
3
#of Trans: 1 Batch Amt: $3,740.46
Location: 7411 -Neill Funeral Home, Inc. Cesh Reoeipt dafie: 12/27/2013 9:50:00 AM
Address: 3401 Market Street Cash Reoelpt#: 741 1 1 3967879
Camp Hilf PA 170114428 Cash ReoeiptAmt 3740.46
Payment Check Payer. Marjorie Morrison Ref aqt; 0051
Type:
Contract# Purchaser Amt
741101000456 Morrison,Marjorie 3740.46
GL Axount DesaJP�� Mit
Total: 3740.46
Trans ID -
Neill Funeral Home,Inc. �
3401 Market Street
Camp Hill,PA 170114428
(717)737-8726
Supervisor:Kevin J.Shillabeer
The following is a deRailed bill ior the professional seivices andlor merchandise arrenped for
�,y u�eu
pate of Service:December 30,2013
�M p� December 27,2013
Marjorie Morrison 741101000456
4 Cavan Crossing, Contracx Number
Enola,PA 17025
qrranger Name Kevin J Shillabeer
INtlal Seledion Flnal Selectlon Difference
Pad�ge Of6edngs
Dired Crematlon $2,255.00 $2,255.00 —
Basic Professional Service Fee
Incl Incl --
Refigeration
Incl Incl --
Transfer of Remains to Funeral Home
Incl Incl ---
Transfer to or From Crematory
Incl Incl –'
Service Vehicie
Ind Incl "'
Total Padce9e Offe�ings S2�•� 3�.255.00 —
Use of Fadlides and Re�eted Serwoes
Chapel Funeral Ceremony $395.00 $395.00 "'"
Total Use of Fadiities and Related Setvioes �395.00 $395.00 —
Otl�er Goods and SeMces
Cremation Fee $395.00 $395.00 "-
$175.00 ; $175.00 --
Flowers
To�si Other Goods and Setvioes 5570.00 5570.00 —
Merchandise __
Moonlight Blue Vase Full Size Brass
$195.00 $195.00
Totsl Merchendi.ae $195.00 $195.00 —
Cash Advanoe --
Certified Copies of the Death Certificate
$36.00 $36.00
Newspaper Notice $259.46 $259.46 �'
$30.00 $30.00 –"
Permit
�
INtlal Selectbn Flnal Selecdon p�re�
T�al Cash Advanoe $325.46 $325.46 _
Total Servloes.Merchandi�and Cash Advance $3.740.46 $3.740.46 _
Total Charges(Total Servioes+/_qp��+Taxes) $3.740.46 $3,740.46 _
���R� (33,740.46)
Unpeid Balanoe Due $O.p�
Pape 2 of 2
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Statement Date: 01/15/14 Diamond Pharmacy
645 Kolter Drive
Customer Number: 55350 Indiana, PA 15701
Facility ID: CMWS2
(800)882-6337 phone
CustomerGroup: P151 (724)349-1111 toll-free
Balance Forward
$11.87
Payments
Check Date Check Number Amount
12l31/13 53 ($11.87)
New Activity
Date Rx No Drug Name Qty Price Ins.Pay Amt. Pat. Pay Amt.
Invoice-IN00041610
MAFFETT,DOROTH
12/01l13 459004 OTC-ACETAMINOPHEN 650MG SUPP 12 $5.97 $0.00 $5.97
12/09/13 467818 OTC-BISACODYL SUP 10MG 10 $1.89 $0.00 $1.89
IN000416107 Totals =___________ _____________ _____________
, Total Legend-IN000416107 $0.00 $6.00 , $0.00
Total OTC-IN000416107 $7.86 $0.00 $7.86
Total-IN000416107 $7.86 $0.00 $7.86
Statement Totals _____________ _____________ ____________-
Total Legend-Statement $0.00 $0.00 $0.00
Total OTC-Statement $7.86 $0.00 $7.86
Total-Statement $7.86 $0.00 $7.86
Page 1 Salan;.e cue:$7.86
1-30 Days O/Due 31-60 Days OfDue 61-90 Days O/Due Over 90 Days O/Due
$7.86 $0.00 $0.00 $0.00
Payment Due Upon Receipt. Please pay Balance Due. To pay using your MasterCard or Visa, please call
(800)882-6337. Pharmacv Hours:Mondav-Fridav 9 a.m.-5 p.m.&Saturdav 9 a.m.-2 p.m.
Please Remit Payment To: � �_ � _ ,� _ � •
Camp Hill Fire Company fvo 1
Billing Office 12-151186 2/2/2014 $711.26
PO Box 726
New Cumberland, PA 17070-0726 � l � ,.._ �
QUESTIONS ABOUT THIS BILL? Phone: 577-214-6018 Espanol: 866-�24-4114 Fax: 717-214-6020 Email: info@ambulancebillingoffice.com
Date of Service: 5/27/2012 09:43 Please visit our website to provide insurance or make payment, and
Patient Name: MAFFEI-i�, DOROTHY for additional payment options and frequently asked questions:
From: RESID�NCE �wena.arnb�aBancebiiiingoffice.com
To: Holy Spirit Hospital
� . .
We billed this claim to your insurance; however, they have denied the claim. This balance is now your responsibility. You ma}
contact your insurance carrier regarding the denial. Please remit payment for the balance. Thank you.
t
5/27/12 BLS Emergency Transport A0429 1.0 1,045.00 1,045.00
5/27/12 Mileage A0425 2.0 32.50 65.00
6/22/12 Payment -398_74
Total 1,110.00 0.00 -398.74
DETACN AND RETURN BOITOM PORTION WITH YOUR PAYMENT.
�y� � ��.� vr rr-�C�v��UIVI KtFUND
DqTE
'� Erie
MO. DAY YR.
� Insurance° oa ,o I 2014
100 Erie Ins.PI. • Erie,PA 16530 REFUND AMOUNT
POLICYlACCOUNT NO. Q521512991
AGENT NO. AA7685
��• AGENT NAME STROCK INSURANCE AGENCY
CHECK NO. 2001653313
REFUND REASON PRO RATE CANCELLATION
000 0000044 00000000 001 0p1 00044 INS:0 0
AA7685
DOROTHY MAFFETT C/O MARJORIE J NON-NEGOTIABLE
MORRISON
4 CAVAN CROSSING
ENOLA, PA 17025
ERIE INSURANCE EXCHANGE
�� Erie° Insurance P.O. BOX 1699 ERIE, PA 16530 NAMED INSURED COPY
� Exchange CANCELLATION NOTICE
Member • Erie Insurance Group
100 Erie Ins.PI. • Erie,PA 16530
MAIL DATE 03/10/14 CANCELLATION EFFECTIVE
POLICY NUMBER Q52 1512991 H 12/20/13 12.01 AM
POLICY EFFECTIVE DATE 04/15/13
HOMEPROTECTOR POLICY STANDARD TIME
NAMED INSURED
DOROTHY MAFFETT
C/0 MARJORIE J MORRISON AA7685
4 CAVAN CROSSING
ENOLA PA 17025
Insured Copy
�� Erie Insurance
�\ Exchange Mail Date: 03/10/2014
Member • Eiie Insurance Group
100 Erie Ins.PI. • Erie,PA 16530
Final Statement o�� Policy Balance
Named Insured
DOROTHY MAFFETT C/O
MARJORIE .1 MORRISON - Policyholder Name: DOROTHY MAFFETT C/�
�,:.��
4 CAVAN CROSSING � :��,.',ar}.� Policy Number: Q52151299
ENOLA PA 17025-1841 �"'�'`�'� Policy Type: Home Protectc
59846665 Final Balance: $16.00 C
AA7685 �„,,,,,„+ n��o• * ��F nn r
STATEMENT
Country Meadows West Shore 3
4905 East Trindle Road Statement Date: 01/O1/2014
Mechanicsburg, PA 17050
Telephone: (717) 975-3434
Amount Enclosed $
Amount Due: $ -1,576.60
Account #: 94353
RE: Dorothy MafFett
Marjie Morrison
4 Cavon Crossing
Enola, PA 17025
Please detach and return top portion with payment.
Da s
Date Descri tion y
p Quant Rate Charges Payments
Balance B/F 3,749.00
12/05/13 MORRISON,M
12/05/13 MORRISON,M 97.00
12/01/13- 12/31/13AL Private Studio 31 3,652.00
12/O1/13 - 12/13/13AL Private Studio -3,652.00
12/O1/13 Monthly Pendant Fee 13 1,560.85
12/14/13 - 12/20/13AL Private Studio -1 15.00 -15.00
� 529.55
Country Meadows Associates 217900
Pay to: ESTATE OF DOROTHY MAFFE� Date: 01/16/2014 Amt: $1,576.60""'
MEFqO INV.DATE INV.NUMBER INV.AMOUNT DiSCOUNT NET AMOUNT
RESIDENT REFUND 12/21/2013 MAFFETT, D 1, 576.60 1, 576. 60
DOROTHY MAFFETT
9043/94353
ESTATE OF DOROTHY MAFFETT
C/0 MARJIE MORRISON
9 CAVON CROSSING �
ENOLA, PA 17025
----- ��..v�.vv � .VV .UV -1�`J�6.6U
Thank you for choosing Country Meadows of West Shore 3!
Please include the top portion of this bill with your payment by the
15th using the enclosed envelope. Make your check payabie to Country Statement Date: 01/O1/2014
Meadows Associates.
Dorothy Maffett- Account #: 94353
Country Meadows West Shore 3
� 4905 East Trindle Road
Mechanicsburg, PA 17050
Telephone: (717) 975-3434
� - Y
-` Country Meadows At Home STATEMENT `�t n1E�ows
PO Box 3060 0�,yl e
Hershey. PA'17033
Phone: (888)754-2220 Personcd Care Sera:ices
Fax: (717) 520-4760
www.countrymeadowsathome.com Date: 12/17/2013
Client Name:Maffett, Dorothy •
Account#: 02845
Dorothy Maffett
Page#: �
� � � ,: , - � �
�-�`�Date ...�.. ;� �-
, ;.
' ' .. .Transacflon ; ; ` '' °- , Amount :"; ', Balance
12/03/2013 Balancefonvard 4,119.00
12/11/2013 PMT#1177. M. Morrison 4,119.00-
12/15/2013 INV#21864. 2,205.00 2,205.00
1-30 DAYS 31-60 DAYS 61-90 DAYS OVER 90 DAYS
C9RRENT PAST DUE PAST DUE PAST DUE PAST DUE AMOUNT DUE
2,205.00 0.00 0.00 0.00 0.00 $2,205.00
Terns: Due Within 14 Days Of Receipt. You may pay by VISA, Mastercard, American Express or Discover On Line at
htps://countrymeadows.billinqdoc.net or by phone toll free 1-855-532-1103
r' ,a���:C `,Cr?p,^.0�,cTUI'i + -��''`�,�1`,I JB U11TN YOUF r' 1 D,1�(��-� �
� . . Y . .�� ��: , ,,. ,
m,�. �
�..."►.� : ._ :
� :
�t COUNTRY
MEAD0IUS
�'���� INVOICE DATE: 12/15/2013
INVOICE#: 21864
Per;snnc�l Care Sera�ices
PO Box 3060 PAYER: Morrison, Majorie
Phone:(888)754-2220
Hershey, PA 17033 Fax:(717)520-4760 CLIENT: Maffett, Dorothy
www.countrymeadowsathome.com ACCOUNT#: 02845
Majorie Morrison
Date Start-End Time Description Care Giver Unit
QTY Rate Amount
12/02/2013 7:OOAM 10:OOAM HCA-Hourly(over 2 hrs) Templin, Samantha HOURS 3.00 21.00 63.00
12/02/2013 11:30AM 2:30PM HCA-Hour�y(over 2 hrs) Templin, Samantha HOURS 3.00 21.00 63.00
12/02/2013 6:OOPM 9:OOPM HCA-Hourly(over 2 hrs) Schreiner, Stephanie HOURS 3.00 21.00 63.00
12/03/2013 7:OOAM 10:OOAM HCA-Hourly(over 2 hrs) Schreiner, Stephanie HOURS 3.00 21.00 63.00
12/03/2013 11:30AM 2:30PM HCA-Hourly(over 2 hrs) Schreiner,Stephanie HOURS 3.00 21.00 63.00
12/03l2013 6:OOPM 9:OOPM HCA-Hourly(over 2 hrs) Karnes,Aurora
12/04/2013 7:OOAM 10:OOAM HCA-Hourly(over 2 hrs) Schreiner, Ste hanie HOURS 3.00 21.00 63.00
12/04/2013 o r i p HOURS 3.00 21.00 63.00
11:30AM 2:3G, ti� H„P.-Hourly�over 2 hrs) Schroinor creYnu�;P Hp�I�G 3.
12/04l2013 6:OOPM 9:OOPM HCA-Hourly(over 2 hrs) Ps ck, Johanna �� 21.00 63.00
12/05/2013 7:OOAM 10:OOAM HCA-Hourly(over 2 hrs) Schreiner, Stephanie HOURS 3.00 21.00 63.00
12/05/2013 11:30AM 2:30PM HCA-Hourly(over 2 hrs) Schreiner, Stephanie HOURS 3.00 21.00 63.00
12/05/2013 6:OOPM 9:OOPM HCA-Hourly(over 2 hrs) Flinn,Amy HOURS 3.00 21.00 63.00
12/06/2013 7:O�AM 10:OOAM HCA-Hourly(over 2 hrs) Karnes,Aurora
12/06/2013 11:45AM 2:45PM HCA-Hourly(over 2 hrs) Karnes,Aurora HOURS 3.00 21.00 63.00
12/06/2013 6:OOPM 9:OOPM HCA-Hourly(over 2 hrs) Dickinson, Rosalind HOURS 3.00 21.00 63.00
12/07/2013 7:OOAM 10:OOAM HCA-Hourly(over 2 hrs) Schreiner, Ste hanie HOURS 3.00 21.00 63.00
12/07/2013 11:30AM 2:30PM HCA-Hourly(over 2 hrs) Schreiner, Stephanie HOURS 3.00 21.00 63.00
12/07/2013 6:OOPM 9:30PM HCA-Hourly(over 2 hrs) Karnes,Aurora HOURS 3.00 21.00 63.00
12/08/2013 7:30AM 10:OOAM HCA-Hourly(over 2 hrs) Good, Christal HOURS 3.50 21.00 73.50
12/08/2013 11:30AM 2:30PM HCA-Hourly(over 2 hrs) Good, Christaf HOURS 2.50 21.00 52.50
12/08/2013 6:OOPM 9:OOPM HCA-Hourly(over 2 hrs) Schreiner, Ste hanie HOURS 3.00 21.00 63.00
12/09/2013 7:OOAM 10:OOAM HCA-Hourly(over 2 hrs) Tem lin, Samantha HOURS 3.00 21.00 63.00
12/09/2013 11:30AM 2:30PM HCA-Hourly(over 2 hrs) Trost�le, Bernadette HOURS 3.00 21.00 63.00
12/09/2013 6:OOPM 9:OOPM HCA-Hourly(over 2 hrs) Dickinson, Rosalind HOURS 3.00 21.00 63.00
12/10/2013 7:OOAM 10:OOAM HCA-Hourly(over 2 hrs) Tem lin, Samantha HOURS 3.00 21.00 63.00
12/10/2013 11:30AM 2:30PM HCA-Hourly(over 2 hrs) TemPlin, Samantha HOURS 3.00 21.00 63.00
p HOURS 3.00 21.00 63.00
12/10/2013 6:OOPM 9:OOPM HCA-Hourly(over 2 hrs) Dickinson, Rosalind HOURS 3.00 21.00 63.00
12/11/2013 7:OOAM 10:OOAM HCA-Hourly(over 2 hrs) Good, Christal HOURS 3.00 21.00 63.00
12/11/2013 6:OOPM 9:OOPM HCA-Hourly(over 2 hrs) Dickinson, Rosalind HOURS 3.00 21.00 63.00
12/12/2013 7:OOAM 10:OOAM HCA-Nourly(over 2 hrs) Templin, Samantha HOURS 3.00 21.00 63.00
12/12/2013 11:30AM 2:30PM HCA-Hourly(over 2 hrs) Forney, Kim HOURS 3.00 21.00 63.00
12/12/2013 6:OOPM 9:OOPM HCA-Hourly(over 2 hrs) Psyck, Johanna HOURS 3.00 21.00 63.00
12/13/2013 7:OOAM 10:OOAM HCA-Hourly(over 2 hrs) Good, Christal HOURS 3.00 21.00 63.00
12/13/2013 11:30AM 2:30PM HCA-Hourly(over 2 hrs) Forney, Kim HOURS 3.00 21.00 63.00
12/13/2013 6:OOPM 9:OOPM HCA-Hourly(over 2 hrs) Dickinson, Rosalind HOURS 3.00 21.00 63.00
Terms: Due Within 14 Days Of Receipt. You may pay by VISA,Mastercard.American Express or
Discover On Line at https://countrymeadoWS billinqdoc net or by phone toll free 1-866-965-8610 TOTAL: 105.00(Hours) $2,205.00
Pana�nf� Arrni int#• fl�Rdri C;ni intni AAaarin�nrs Ratiramant C�nmmi initiac
: _ y. n. ��,� �:..�
RECEIPT FOR PAYMENT
GLENDA FARNER STRASBAUGH Receipt Date : 12/20/2013
Cumberland County - Register Of Wills Receipt Time : 11 : 18 : 42
One Courthouse Square Receipt No . : 1076540
Carlisle, PA 17613
MAFFETT DOROTHY
Estate File No. : 2013-01327
Paid By Remarks : MARJORIE MORRISON
CJ
-- --- -- ----- ----- -- - Receipt Distribution --- -- ------ -- ---- ---
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST 210 . 00 CUMBERLAND COUNTY GENERAL FUN
WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 20 . 00 CUMBERLAND COUNTY GENERAL FUN
JCS FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D
AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN
INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN
INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN
-------------- --
Check# 3749 $303 . 50
Total Received. . . . . . . . . $303 . 50
REORDEN i5C5•V.S,Pql tRl`NO.553&29G,55755u'fi,i541187,Si3w'o3.'_.33u-�6a,iif.
999022921 MARJORIE MORRISON CHECKNUMBER 890435 DATE 02/07/14
INVOICE NUMBER DATE DESCRIPTION GROSS AMT. DISCOUNT NET AMOUNT
12414VA Ol/24/14 D. Maffett - Bu 100.00 0.00 100.00
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