HomeMy WebLinkAbout06-18-14 (2) J 1505610105
REV-1500 EX(02-11)(FI)
PA Department of Revenue pennsylvania OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 28o6o1 INHERITANCE TAX RETURN
Harrisburg,PA 19128-o601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
06/05/2005 05/1211922
Decedent's Last Name Suffix Decedent's First Name MI
JUMPER THELMA M
(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
C@D 1.Original Return O 2.Supplemental Return C=:) 3. Remainder Return(Date of Death
Prior to 12-13-82)
C= 4. Limited Estate C=) 4a. Future Interest Compromise(date of C=:) 5. Federal Estate Tax Return Required
death after 12-12-82)
( D 6.Decedent Died Testate C=:) 7.Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
C=) 9. Litigation Proceeds Received C=:) 10. Spousal Poverty Credit(Date of Death C=) 11. Election to Tax under Sec. 9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name _ Daytime Telephone Number
JANE M ALEXANDER, ESQ (717)432-4514 v
REGJ13Ti4t OF WILLS USE ONL-�
-O
First Line of Address
_... ....... ... . . .... ...... .,,,
148 S. BALTIMORE STREET 2: Fn r; n,
Second Line of Address - - - J C) 'Z7 T
C:11 C7
k-+
City or Post Office State ZIP Code -O DATE F O T
..... _ ...... ..... ...... .._. ... .... l--+ TI
DILLSBURG PA 1701.19 l
Correspondent's e-mail address: �I yy) ,Ie XANI�/.!' ILL 4� accn ClCSI
Under enalties of
p 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.
SIGNATURE RF PERSON.REESPONSI LE O FILING RETURN DATE
�U C1� oS • J P AA
ADDRESS —�
8 CEDAR AVENUE, MECHANICSBURG, PA 17055
SIGNATURE O PREPARER OT7 THAN REP ES A IVE DATE
ADDRESS
148 S. TIMORE STREET, DILLSBURG, PA 17019
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610105 1505610105 J (�
i
J 1505610205
REV-1500 EX(FI)
RECAPITULATION
1. Real Estate(schedule A). ...... ...... .. ...... ..... ... .. _.. .......... . ..__._..79,000.00
2. Stocks and Bonds(Schedule B) ... .. ............. ... .................. 2. ! 8,902.12
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) . .... 1 .._....._..�,...._2.~� � ^ `
4. Mortgages and Notes Receivable Schedule D
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E), .. . .. . 5. 29,454.52
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. ! 767.17
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested_. ... . . 7. ' 21,905.53
8. Total Gross Assets(total Lines 1 through 7). . 140,029.34
9. Funeral Expenses and Administrative Costs(Schedule H). . . . .. . . .. . . .. . .. . . 9. 14,611.23
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. 12,24&.40
__.,..._. N__..
11. Total Deductions(total Lines 9 and 10). ... .. . ... . . . . .. . .. . ... . . .. . .. . .. 11. ! 26,859.63
12. Net Value of Estate(Line 8 minus Line 11).............................. 12. ! 113,169.71
13. Charitable and Governmental BequestslSec 9113 Trusts for which .._..._.__.._._:
an election to tax has not been made(Schedule J) . .. . ... . .. .. . ... . .. . .. . 13. ! 500.00
14. Net Value Subject to Tax(Line 12 minus Line 13) ........................ 14. 112,669.71
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_
16. Amount of Line 14 taxable .__.._.._,.�.... .._...,...,,,._... _,.,..,...._... �.,._.....,' .»,.....,.-._,_.�....,_.-._.__...._d..,�_....�._.,.. !
at lineal rate x.0 45 63,535.73 16. 2,85911
17. Amount of Line 14 taxable
at sibling rate X .12 37,721.96 17, 4,526.64
18. Amount of Line 14 taxable .. .__.__.,,.,..... ._._...�,,._.-, ...,...__.._ -.�.�. _,..____,_....._.,..,...__....................._.�___
at collateral rate X.15 11,412-02 ; 1$ ' 1 711.80
19. TAX DUE . .. . .. . .. ... ... .. . .. . .. . ... ... . .. . . . .. . ... ... . .. . . ... .. . . 19. ' 9,097.55
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Call
Side 2
1505610205 1505610205
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
THELMA M. JUMPER
STREET ADDRESS —�
2109 CEDAR RUN DRIVE UNIT 203
CITY STATE ZIP
CAMP HILL PA 17019
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 9,097.55
2. Credits/Payments
A.Prior Payments 4,000.00
S.Discount
Total Credits(A+e) (2) 4,000.00
3. Interest
(3) 3,7$8.12
4. if Line 2 is greater than Line 1+Line 3.enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 28 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) 8,885.67
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?.,....... N ❑
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation? ..........................................-........._.........-..._..._..._..._..._......._...-..._.......... (♦ ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN,
For dates of death on or after July 1, 1994,and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent[72 P.S.§9116(a)(11)(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
172 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 decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S. §9116(a)(1.3)].A sibling is defined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
®f
fjeUtta A_Iwnper
I,Thelma M.Jumper,of the Township of Lower Allen,County of Cumberland and
Commonwealth of Pennsylvania,being of sound mind,memory and understanding,do herewith
publish and declare this to be my Last Will and Testament,hereby revoking and declaring null and
void any and all Wills and Codicils heretofore written by me.
ITEM I. 1 direct that all my just debts and funeral expenses be paid as soon after my
demise as may be convenient to the proper administration of my estate.
ITEM IL I give,devise,and bequeath the sum of Five Hundred(%500.00)Dollars to The
Mechanicsburg Church of the Brethren,or its successor,to become a pan of its General Operating
Fund.
ITEM ID. I give,devise,and bequeath the following items of personal property to the
named individual:
a) The automobile which I may own at the time of my death unto my
grandson,David Metzger.
b) My diamond ring to Julie Metzger.
ITEM IV. I direct that the following named individuals shall each be entitled to select one
of my pieces ofjewelry as a remembrance of me.
a) Connie Fetterman;
b) Dolores L.Hertzler and her daughters,Michele and Jane;
c) Nancy Sanger and her daughter,Sherri Focht;
d) Deb Shook;
e) Linda Moll;
t) Lenore Ritter;
g) Jo Ann Bowles;
h) Andrea Metzger;
Page I of 3
i} Susie Kirkland;
1} Rose Hrisicak;and
k) Ernie Kepner.
ITEM V. I order and direct my hereinafter named ExectrtrixlExecutor to convert the
remainder of my estate,into cash at either public.or private sale,whenever in her/his di sanction it may
be most expedient for the proper administration of my estate. In the event orsuch conversion,I
authorize my said Exeoutrix/Executor to execute a good and sufficient Warranty Deed to the purchaser
of any rest estate of which I may dire seized,in the same manner and capacity as I could if living.
ITEM VI. I direct that all inheritance and estate taxes be paid on the proceeds of the above
conversion and on all the rest residue and remainder of my estate from the residue of my estate prior to
further distribution.
ITEM VII. I then direct that the net proceeds from the sale of my home shall be divided
equally between my sister,Dolores L.Hensler and my grandson,David Metzger. The proceeds of
the sale of the furniture and furnishings shall be given to my daughter,Andrea Metzger,as well as all
the rest,residue and remainder of my estate.
If my said daughter should predecease me the proceeds of the sale of my
furniture and furnishing as well as the entire residue of my estate shall be divided equally between my
sister,Dolores L.Herrzler,and my grandson,David Metzger,per capita and not per shapes.
ITEM VIH. I nominate,czmatitute and appoint my sister,Dolores L.Hensler,as Executrix
of this my Last Will and Testament, Should my sister predecease me or be unable or unwilling to
serve I then nominate,constitute and appoint my grandson,David Metzger,as Executor in her place
and stead. I direct that my Exectruo E-sax for shall not be required to post bond other than herthis
personal assurance for her/his duties as Execvtrix/Excrutor.
IN WITNESS WHEREOF,1,Thelma M.Jumper,have hereunto subscribed my hand to this
my Last Will and Testament,this_'Z 0 day of av9-x �200d.
.4
The7umper
Page 2 of
SIGNED,PUBLISHED and DECLARED by the above-named,Thelma M.Jumper,as and
for her Last Will and Testament in the presence of us,who at her request and in her presence and in the
presence of each other,have signed our names as attesting witnesses hereto.
ding at
i
I
7,
sidin
g ° 1 PA 17uIR
Page 3 of 3
REV-1502 EX+(11-08)
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF
THELMA M. JUMPER FILE NUMBER
21-05-0532
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts.
Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. ffVAEA
NUMBER
DESCRIPTION
1' ALL THAT CERTAIN PARCEL OF REAL PROPERTY SITUATE IN LOWER ALLEN
TOWNSHIP,CUMBERLAND COUNTY, PENNSYLVANIA, UNIT NO. 203,CEDAR RUN
APARTMENT BUILDING 2109 A CONDOMINIUM. Sold to Aaron S. Drunsic Febryary 20
2007.
TOTAL (Also enter on Line 1, Recapitulation.) $ 79,000.00
IF more space is needed, insert additional sheets of the same size.
REV-1503 EX+(6-98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
THELMA M. JUMPER FILE NUMBER
21-05-0532
ITEM All property jointly-owned with right of survivorship must he disclosed on Schedule F.
NUMBER DESCRIPTION VALUE AT DATE
20-$100.00 U.S. SAVINGS BONDS SERIES E OF DEATH
8,902,12
SEE EXHIBIT ATTACHED
TOTAL(Also enter on line 2, Recapitulation) $ 8,902.12
(if more space is needed,insert additional sheets of the same size)
REV-1508 EX+(11-1o)
� = pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
RESIDENTDECEDER�T PERSONAL PROPERTY
E57A:F OF:
THELMA M. JUMPER FILE NUMBER:
21-05-0532
Include the proceeds of litigation and the date the proceeds were received by the estate.
REM All property jointly owned with right of survivorship must be disclosed on Schedule F.
NUMBER DESCRIPTION VALUE AT DATE
1. Sovereign Bank checking account no. 1051075718 OF DEATH
6,877.75
2. Harris Savings Bank-savings account no. 574108049
4,805.98
3. Little"IKE"Eichelberger-net proceeds from sale of items of-personalty 5/18/06 1,920A5
4, Funds received from sale of furniture at private sale 3/23/2006
840.00
5. 2000 Honda Civic Sedan-VIN#2HGEJ6616YH576772
6,830.00
6, Diamond Ring appraised by Joseph James Jewelry 5/31/2007 650.00
7. Sovereign Bank-Certificate of Deposit no. 358011872
1,485.01
8. Sovereign Bank-Certificate of Deposit no. 1058121524 5,169.69
9. Sovereign Bank-Certificate of Deposit no. 358010320
95.63
10. Fund received from sale of jewelry at private sale 22.00
11. Jewelry chosen by heirs from specific bequest 320.00
12. Funds deposited after date of death to Sovereign Bank checking account no. 1051075718
99.00
13. Pinnacle Health System, Inc. Pension-Trust No. 1501012128 175.35
14. Prudential Financial-refund on overpayment
163.66
TOTAL (Also enter on Line 5, Recapitulation) $ 29,454.52
If more space is needed, use additional sheets of paper of the same size.
REV-1509 E%+(oi-io)
= 3 pennsylvania
SCHEDULE F
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY
RESIDENT DECEDENT
ESTATE OF:
Thelma M. Jumper FILE NUMBER:
21-05-0532
If an asset became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G.
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS
RELATIONSHIP TO DECEDENT
A.Geraldine E. Gasswint 8 Cedar Avenue, Mechanicsburg, PA 17055
Sister
B.
C.
JOINTLY OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S DATE VALUE OEFTH
NUMBER TENANT JOINT IDENTIFYING NUMBER,ATTACH DEED FOR JOINTLY HELD REAL ESTATE, VALUE OF ASSET INTEREST DECEOENT'S INTEREST
I.
A. 06/18/91 M&T Bank checking account no.57697418
1,534.35 50 767.17
TOTAL(Also enter on Line 6, Recapitulation) $ 767.17
If more space is needed,use additional sheets of paper of the same size.
REV-1510 EX+ (08-09)
Pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
RESIDENT ED RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE Of
Thelma M. Jumper FILE NUMBER
21-05-0532
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM DESCRIPTION OF PROPERTY
NUMBER INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % DECD'S EXCLUSION TAXABLE
THE DATE OF TRAHSHIR. ATTACH A Coal Of THE DIE)FOR REAL ESTATE. VALUE OF ASSET INTEREST
(IF APPLICABLE) VALUE
1 Morgan Stanley-IRA Rollover Accout No.410033634024
(Beneficiary: Ernie Kepner,friend) 9,755.69 100 9,755.69
2 Sovereign Bank Trust account no.0575133707
(Beneficiary:David Metzger,son) 12,149.84 100 12,14984
TOTAL (Also enter on Line 7, Recapitulation) $ 21,905.53
If more space is needed, use additional sheets of paper of the same size.
REV-1511 Ext (10-09)
'"
r � $ pennsylvania SCHEDULE H
ta
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN
RESIDENT DECE ADMINISTRATIVE COSTS
DENT
ESTATE OF
THELMA M. JUMPER FILE NUMBER
21-05-0532
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A• FUNERAL EXPENSES:1.
James R. Gingrich Memorials-stone grave marker and lettering
1,575.00
Cocklin Funeral Home-balance on funeral bill 194.68
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s) DOr012S L. Hertzler 4,500.00
Street Address 8 Cedar Avenue
city,-Mechanicsburg--_--- --- —- —- --- --- -state PA -17055
Year(s)Commission Paid: 2014
2. Attorney Fees: 6,900.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.)
Claimant None claimed
Street Address
City --_- __State ZIP
Relationship of Claimant to Decedent
4. Probate Fees:
290.00
5. Accountant Fees:
700.00
6. Tax Return Preparer Fees:
7 Cumberland County Law Journal-advertising grant of letters 75.00
B. The Sentinel Legal-advertising grant of letters 151.55
e. Register of Wills-filing Inheritance tax return and Inventory 30.00
to Notary fees 143.00
Narumol Alexander-witness fee 25.00
Total from the attached sheet 27.00
TOTAL (Also enter on Line 9, Recapitulation) $ 14,611.23
If more space is needed,use additional sheets of paper of the same size.
SCHEDULE H (Continued)
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
Estate of Thelma M. Jumper
File No. 21-05-0532
Item No. Description Amount
12. Register of Wills-short certificates
$22.00
13. Clerk of Orphans' Court- reserved for filing release
$5.00
Total this page 1 $27.00
REV-1512 EX+ (12-08)
� ,, Pennsylvania
SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN
RESIDENT DECEDENT MORTGAGE LIABILITIES & LIENS
ESTATE OF
THELMA M. JUMPER FILE NUMBER
2105-0532
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreim-053 medical expenses.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
DF DEATH
1'
r st Cable account no.09547 224795-01-8-debt of decedent 19.59
2. lectric account no.47090-78002-debt of decedent 358.64
3. Erie Insurance-Homeowner insurance policy no. Q53 2804132-debt of decedent 110.00
4. Verizon account no. 717763966417625Y-phone service-debt of decedent 10.89
5. 2109 Cedar Run Condo Assn(2005-02120/2007)-debt of decedent 3,030.03
6. Ralph Greiman-real estate market analysis fee 300.00
7. Gannett Fleming Inc:health insurance-debt of decedent 260.69
8. Joseph James Jewelers-appraisal fee 63.60
9. Bonnie K.Miller,Tax Collector-2005 Coutny and Township real estate tax 559.87
10. Bonnie K.Miller,Tax Collector-2006 Coutny and Township real estate tax 249.43
11. Bonnie K.Miller,Tax Collector-2005-06 School real estate tax 436.63
12. Bonnie K.Miller,Tax Collector-2007 Coutny and Township real estate tax 34.86
13. Monaghan Fire Department-rental fee for sale for auction 5/18/2006 225.00
14. Dolores L.Hertzler-packing supplies 88.15
15. Clark American-estate checks
31.02
16. C21-Walak Associates-Broker's Commission 4,740.00
17. Recorder of Deeds-1%realty transfer tax 790.00
18. 2109 Cedar Run Condo Assn-resale cerfificate fee
25.00
19. 2109 Cedar Run Condo Assn-initiation fee 790.00
20. Walak/Waltz-transaction fee for sale of real estate 125.00
TOTAL(Also enter on Line 10, Recapitulation) $ 12,248.40
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+(01-10)
1,
ll
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Thelma M. Jumper 21-05-0532
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
72ConniMe AME AND ADDRESS OF PERSONS)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
RIBUTIONS(Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).3
er-800 York Road,Lot 40,Dover,PA 17315 Daughter Diamond Ring: $650
erman-1508 Spring Garden Drive,Mid dletown,PA 17057 Friend Jewelry: $3.00
1 Michele Blash-419 Thames Street,Hagerstown,MD 21740-6769 Niece Jewelry: $15.00
4. Jane L. Hertzler-8 Cedar Avenue, Mechanicsburg, PA 17055-4701 Niece Jewelry: $10,00
5. Nancy Sanger-820 Lisbum Road,Apt.511 Mallard Run, Friend Jewelry: $45.00
Camp Hill,PA 17011 Jewelry: $45.00
6. Sherri Focht-331 Bracburn Drive,Etters,PA 17319 Friend Jewelry: $8.00
7. Deb Shook-201 Martel Circle,Dillsburg,PA 17019 Friend Jewelry: $20.00
8. Linda Moll-426 Prowell Drive, Camp Hill,PA 17011.1469 Friend Jewelry: $5.00
(Continued on attached sheet)
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE,
TI NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN:
1 NONE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
The Mechanicsburg Church of the Brethren 50U0
I
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 500.00
If more space is needed,use additional sheets of paper of the same size.
SCHEDULE (Continued)
BENEFICIARIES
Estate of Thelma M.Jumper File No. 21-05-0532
RELATIONSHIPTO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSONS)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
9. Lenore Ritter Friend Jewelry value $7.00
2100 Cedar Run Drive, Unit 307
10. Jo Ann Bowles Friend Jewelry value$25.00
133 Sasafras Street, Harrisburg, PA 17102
11. Andrea Metzger Daughter Jewelry value $25.00
12 Talbot Street, Ocean City, MD 21842-4144 and net proceeds
of the sale of the
furniture and
furnishing and
100%of residue
12. Susie Kirkland Friend Jewelry value $75.00
11 Dishley Drive, Mechanicsburg, PA 17055-4867
13. Rose Hrisicak Jewelry value$7.00
4834 East Trindle Road, Mechanicsburg, PA 17050 Friend
14. Ernie Kepner
233 Bows Street, Harrisburg, PA 17102 Friend Jewelry value$65.00
15. Dolores L. Hertzler Sister Jewelry value $10.00
8 Cedar Avenue, Mechanicsburg, PA 17055-4701 50%of proceeds of
David Metzger the sale of home
800 York Road, Lot 40, Dover, PA 17315
16. David Metzger Grandson Automobile value
800 York Road, Lot 40, Dover, PA 17315 $6,830.00 and
50%of proceeds of
the sale of home
Total this page
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D.NAME OF BORROWER: AARON S.DRUNSIC T
ADDRESS: 442 N.Park Dr.,Arlington VA 22203 _
E,NAME OF SELLER: THE ESTATE OF THELMA J.JUMPER
ADDRESS:
F,NAME OF LENDER: PENNSYLVANIA STATE BANK ISAOA i
ADDRESS: _ P.Q-BOX 36,EAST PETERSBURG,PA 17520
G,PROPERTY ADDRESS: 2109 CEDAR RUN DRIVE,LOWER ALLEN TOWNSHIP,CAMP HILL,PA 17011
H.SETTLEMENT AGENT: HomeSale Settlement Services,Inc.,717-671.9876 FAX 711671-9676
PLACE OF SETTLEMENT: COLDWELL BANKER HOMESALE 3435 MARKET STREET.CAMP HILL PA 17011
I.SETTLEMENT DATE: 02120/2007 _
J.su fimARY OF BORROWER'S_RAN A TIO K-SUMMARY aF BELLE 'S TRA SACTION:
100,GROSS AMOUNT DUE FROM BORROWER 400-GROSS AMOUNT DUE TO SELLER
101. Contract sales mice 1 79.0 0.00 401. Contract sales price 79 000.00
102. Personal Propene 402_Personal Ropeny_�, „_
103. Settlement charges to borrower time 1400 5706.27 403.
104. 404,
105, _ 405.
usimenis for items paid by salter in advance _ Adjustments for items Paid by seller in advance
108. School Taxes 021201071o06130107 211.44 408. School Taxes 02120f07to06i30i07 211.44
109. Assoc dues 02120107toO2128107 44.97 409, Assoc.dues 0220107m02128107 i�44.97
110. 410.
111. _ 4%
112. 412.
120.GROSS AMOUNT DUE FROM BORROWER 84 962.68 420.GROSS AMOUNT DUE TO SELLER 79 2`5841
200.AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500.REDUCTIONS IN AMOUNT DUE TO SELLER
201. DepositoreamesimonDr 1 2000.00 501. Excess Deposit(see insWClionst
202. Principal amount of new loans 63t200.00 502. Settlement cha_roes to seller line 1400 6,63400
203. Exist Wants}taken subject to 503. Existin loan s taken subject to ^,
204. _ 504. Payoff of Fust MmIgage Loan
205. _ _.. 505.
206. 506.
207. A IicalioT fde credit_ 350.00 507.
20lL _ 5081
209. i ", 509. _
Adjustments for items unpaid by setter _ Adjustments for Items unpaid b seller _
211. Count taxes 01101107to02/20107 34.86 511. Count4laxes 01101107to02120107, ^34,06
213. 513.
214 514.
216. _ 516.
217. 517.
218 518,
219. 519. _
220.TOTAL PAID BYIFOR BORROWER 65,58t86 520-TOTAL REDUCTION AMOUNT DUE SELLER 6 666.86
300.CASH AT SETTLEMENT FROM OR TO BORROWER 600,CASH AT SETTLEMENT TO OR FROM SELLER
301 Gross amount due from borrower line 120 84,962.681 601. Gross amount due to seller line 420 79 256,41
302. Less amounts pa id bj rborrow 58,k861 602. Less reduction amount due seller Ilne 520 6666.86
303.,CASH FROM BORROWER
'19.377.821 603.CASH TO SELLER _,^72 589.55
0UBST0iFUTTE FORM IM SELLER STATEMENT TM NO-Um emleinea Mrein is impalaallse Framalim aM b Georg NuOtanaJ b1ne,MaMi R.SeNca Cyvu era(ep:4�ttl fit¢irNUm,
Mlw dOi Mwre W�ieNNRea Pe Crowm[mee�°aG N�Vdns�aGb�2���mrellot'9mpxW eM(Iro rRS defNmime POY%fiOa,WtbeOnrapnrlaa. fieCrvNaG aahe%iu tle¢rnIRE On
SCLLER INSTRUCTIONS'.tt Pia 11.1 o¢IMe wu ytur pnrmipal rO5i0p1Ce,rile Fdm 2118,Gel¢w ErcM,paor Pnrclpal NesitleMb,for enV gain,wile your Inavnelm rOWm,laoHwr Va,1¢aCWN
fgmpMle Pe ePG�Sb pen,d Farm pi UT,Fern I1Z520M/M SEneM4O(Fw?9 t990)
You ere rerywreU OV Mw.pestle Pa..0..a0em(Q1ae.Tay lO NU'. IwuNyaafwrtwy tarpelet MnNNCVtwrmmber.HIrM Mprovge pwcarydr6Cpyer id nL mhon
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nN. l� SELLER(9)SIONXMRE(S)- I
$(LLER(sjNEW MAKINGAODRESB'__ `^__,_ „_ ___
HW.ti +`aiNmeWeK 4301
FINAL PnGE2
_ File Number.07'177 Print¢d0211812007 at 1546-R --
FROM
T rtt 5 stem PAID FROM
TilleEx aaa SetUame _ SELL£R'S
---------"_ BORROWER'S FUNDS AT
a®vt�s WWn )FppP1m FUNDS AT
0.S.DEPARTME-NT OFATEMEAND UR6AN DEVELOP �_-j70J00____---� _ SERLEMENT SETTLEMENT
ENT STATEMENT
SETTLE__�.-.-- Gis ,,$79 000.00'
SETTLEMENT COMMISSION based_.�-- - 00
7_00.TOTAL SA ES„_IBROKE.------'- -- --� -t
n Gne 700 xa fold ssoelates_s -_ _.1...--�-
DivisianotcommK SWat-"ak�s Grou Inu.
701.3_-- 5.00 to Goo-m=-sale Se��--_._
--_-_ -- er LR 1264.00
702.�-- ada� t¢�Seitlemant P.O.C. 632.00 B _
Canmisvon WRYi LO AI 87ATE BANK tSAQAR 300.60
703--EMS PAYABLE iN CDNNE NSYLVANtA STATE BANKiSAOA 31.00
-806 _- 1.000 _-.-_ LR 350.00
nation Fee 2,000%PENN Is I �'ons -.---- LR --- -"
loan isatm 150,.0
gp2. Lean 01 In_-_ to Mort a eSy___e_r!ice--s----"_OA - ---_- LR 5.00 --
803, sisal Fee - to EgL�ft a pYE BANKISA .---�- LR 31.00
806. Credfl Re w PE�VAN t�.. LR
for Bean it.W -- -'
006. Bank Adm+msVatla+fee to T ock F�i�es in,.,-�•_,-- LR 73.00
305. Adminiieee F eof to BtueR
------"'�FederatNices tine
Uric f f_ to
�9 0, ht Ex less fee - to Blue Rock F��rviG ��2
a R Gam to Pirst_Ame °a Reai Es �'9- - LR -_----
ee s
810. Ta* " PAID 1N ADVAN ECEC
�-�E 9,_4361
at 1.--.-_ Y LENDER 11200 or -- -
900.ITEMS REQUIRE Q012001 to 0310O.C.t 166 00 _
---- -_ tom- `'-
961. interest Firse premium to ----
902. �ance -._
d Insurance Premium for to
903_-Hazar�---
906.
905. ES DEPOSITED WI LEND 13.831-_ -
RESERJ 42.42
1000. _..- ro. �nb-- LR -491.00
LR D.OD
1001 HezarainsIns _ .84.89
1002 m eNSUrance - `..5�.3 2_-121-imo��-" LR,.._
Pro
Taxes 2 mo t�a 49,i01mo---- -- -.------
1003.CA Taxes 10 mo. _,004,count ATE BA �--
1005 sob a'tTaxes ent jo PENNSYLVAN
ate Anal eas Ady� `--
i009'A CHARGES
110 LE .n�_ -_-_----�"_-
enlor doss -- - -'-'��10.00
1101.Se
ttlem --------'�_��.- 25.U0
tale search _
ttp2.Abstract a _P -'-
._.-ance b'nd.er to
1104.iitienNn aratron t�Gas�_ 725.42 -...----'-
1105 DonumeniR _
1108.Noi fees��-
110t,AO=m 'a i -'-
includes above Hems No'. -to Nom _--e --Rate 235.00
1101,1162
1108.idle lnsur -
indudesaooveltemsNo' 63100.042 ---
---�'---- _------""_79000.00 _------_'_• es
1109.t.ertdetsPd ---- silt M5emc _
1t10.OSnn�s Poli 18 OOV+na+ HomeSat
i1t1.End t00 End 300 --- -- �..--
790.00 _--7g0.00
ttt2.:.------ -IRA SFER CHARGES- .- -
1513. MENT RECGROIN� n -Rd¢-as-�.�---__- 27.00
1200,GOB 80.50 ..--+.- Mort ---_" �_ -"
1 Fees Deed --."D�s�79000
1205.R�
790. _ ----.---------'i.-' ���
00
VD Cl l"T x to Raccor�D-=���_-�
1203.Scale Taxtsia _._------"'�--
R¢cadASS nmenl -.- -
1204. __ ��_.�----
1265_-ZONAL SETTLEMENT - 25.00 _
1300.AODR �--..--- 25.00
1301.SUrv�_"__----- Iement Sarvic_ ¢.-.-_?..--`
Ion omesale 5efl Inc.
5302.Perms __� t om¢saie Sett _--mentte Sarv;ce. ��_-- -02 40
350.00 1092.60
5303.Wse Fas to Nomesa�e BeN Groot' - ""-
1304.intemetDa�re-p,.. --wale SaNices
1305.ExMess Wandil F� to CB tiort! d _--.---- 5706.27
1300.Transa -"'""��J�Amegcart HOm - _-
1301.HOmoDrsemeti1s1520 - and and 5025ection ,NS msaew5mr eawFlwwmn
1308.Q1her fines J03 six d,ure�rols me ci'wn.m
elan y4y�e stBiemaN
TAL SETTLEMENT C� Hu�A"pN OF ern
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US COGF SECTION WE t WI ANO SECTIO
w.mam.emori.ere aewaie _
U.S.DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT ��^^nuo r tyesnei eameoou aaosx
SETTLEMENT STATEMENT File Number 07.177 FINAL PAGE 3
TitleEx ress Sediemenl S stem Pdntetl 01/16/2507 at 15:49 KR
ITEMIZATION OF HUD LINE 1308
1500.SCHEDULE OF DISBURSEMENTS
BUYER SELLER
1501.Initiation lee l0 2109 Condominium Association
790.00
1502,Februa Dues to 2109 Condominium Association
152.00
1503, Resale Cem to 2109 Condominium Association
1504.Transadion/M mi Fee to WalaklWaltz 25.00
125.00
1505. Escrow 2007 Co 8 Tw .tax to CPSS Escrow Holding Account
350.00
1506.2006 School lax aid to in the amount of$648.07
1507.
1506.
1509.
1510.
1511.
1512.
1513.
1514.
1515,
1516.
1517.
1518.
1519.
1520.TOTAL HUD LINE 1308 EXPENSE,
350.00 1 092.00
96218
Date: 02/16/07 Amount: 72,589.55
File Number: 07-177
Check H: 96218
Pay To: THE ESTATE OF THELMA J. JUMPER
Buyer: AARON S. DRUNSIC
Seller: THE ESTATE OF THELMA J. JUMPER
Property: 2109 CEDAR RUN DRIVE, LOWER ALLEN TOWNSHIP, CAMP HILL, PA 17011
72,589.55 Cash from Closing
96218
HOMESALE SETTLEMENT SERVICES, INC. MtmBank
ESCROW SETTLEMENT ACCOUNT d�-.d 10 07-177
4309 LINGLESTOWN ROAD w-14v313
HARRISBURG.PA 17112 96218
02/16/07 **$72,589.55**
DATE AMOUNT
Tt] Sum SEVENTY TWO THOUSAND FIVE HUNDRED EIGHTY NINE DOLLARS and 55/100
TO THE S
ORDER THE ESTATE OF THELMA J. JUMPER
OF
E
Cash.__f_r_nm_I.� g
11'O96218fi 1 03 130 14 2 21. 3219 Si69211'
Tax Parcel No. 13-23-0549-234 U-203-7
Address: 2109 Cedar Run Drive
Cedar Run Apartments Unit 203
T41 Ntk� Camp Hill,PA 17011
Made the x 0 day of in the year of our Lord two thousand seven (2007)
BYAND BETWEEN DOLORES L. HERTZLER, Executrix under the Last Will and
Testament of Thelma M. Jumper a/k/a Thelma J. Jumper, deceased, late of the Township of
Lower Allen, County of Cumberland, Commonwealth of Pennsylvania,
GRANTOR
AND AARON S. DRUNSIC, of Arlington, State of Virginia,
GRANTEE
WHEREAS, the said Thelma M. Jumper aWa Thelma J. Jumper was vested in her lifetime with
title to premises hereinafter described, situate in the Township of Lower Allen, County of
Cumberland, Commonwealth of Pennsylvania; and
WHEREAS, the said Thelma M. Jumper a/k/a Thelma J. Jumper died testate on June 5, 2005 and
her Last Will and Testament was duly probated in the Register of Wills Office in the County of
Cumberland; and is of record to no. 21-05-0532; and
WHEREAS, the said real estate hereinafter_described was not_s�ecif calls devised,-and_ the said
0 ores L. Hertzler qualihed as Executrix of e Last Will and I estament; an
NOW THEREFORE, This Indenture Witnesseth that the said Dolores L. Hertzler, Executrix as
aforesaid, for and in consideration of the sum of Seventy-nine thousand and no one-hundredths
($79,000.00)Dollars, lawfully money of the United States to the Estate of Thelma M. Jumper
a/k/a Thelma J.Jumper in hand paid by the said Aaron S. Drunsie at and before the ensealing and
delivery hereof,the receipt whereof is hereby acknowledged,has granted,bargained, sold,
aliened, released and confirmed, and by these presents,by virtue of the power and authority in
her vested by the Probate, Estates and Fiduciaries Code of the Commonwealth of Pennsylvania,
does grant, bargain, sell, alien, release and confirm unto the said Aaron S. Drunsic, his heirs and
assigns,
F AT CERTAIN parcel of real property situate in Lower Allen Township, Cumberland
ennsylvania being UNIT NO. 203 CEDAR RUN APARTMENTS, BUILDING 2109,
OMINIUM, as established and described in the Declaration executed by the Grantor,
ed in the Cumberland County Recorder's Office February 19, 1981, in Miscellaneous
, Page 937, and an amendment thereto recorded in Miscellaneous Book Page
ting a plan recorded in Plan Book 39, Page 119, the same being a two-bedroom unit
divided interest of 4.609375% in the common elements, TOGETHER with the rights
eges, and SUBJECT to the obligations, as set forth in the said Declaration.
BEGINNING the same premises that Louise D. Altland, widow, by her deed dated May 27,
1993 and recorded in the Office of the Recorder of Deeds in Cumberland County on June 1,
1993 in Deed Book H, Vol. 36, Page 964 granted and conveyed unto Thelma J. Jumper. The
said Thelma J. Jumper having died on June 5, 2005 testate, Letters Testamentary were granted
June 14, 2005 to Dolores L. HertzIer,Executrix and Grantor herein.
TO73AVEAND TO HOLD the said messuage or tenement and tract of land, hereditaments and
premises hereby granted and released, or mentioned and intended so to be, with the
appurtenances, unto the said Grantee, his heirs and assigns, to and for the only proper use and
behoof of the Grantee, his heirs and assigns forever.
AND the said grantor, executors, as aforesaid, his heirs, executors and administrators do
covenant, promise and agree to and with the said Grantee, his heirs and assigns, by these
presents,that the grantor has not done, committed any act, matter or thing whatsoever whereby
the premises hereby the premises hereby granted, or any part thereof, is, are, shalt or may be
impeached, charged or encumbered in title, or otherwise howsoever.
IN WITNESS WHEREOF, the said Executrix of the Estate of Thelma M. Jumper a/k/a Thelma
J. Jumper, deceased, Grantor herein,has hereunto set her hand and seal the-day and year first
Signed, Sealed and Delivered
In the Presence of Estate of Thelma M. Jumper a/k/a
Thelma J. Jumper by:
(Seat)
Dolores L. Iertzler,E �
(Seal)
FCOUNTY LTH OF PENNSYLVANIA
SS
n s, he da y of 2007,before me a Notary
Public in and for said County and Commonwealth,the undersigned officer, personally appeared
Dolores L. Hertzler, Executrix of the Estate of Thelma M. Jumper a/k/a Thelma J. Jumper,
known to me (or satisfactorily proven) to be the person whose name is subscribed to the within
instrument, and acknowledged that she executed the same for the purpose therein contained.
IN 07TNESS WHEREOF, I have hereunto set my hand and notarial seal.
Notary Public
My Commission Expires:
Certificate of Residence
I hereby certify that the precise address of the Grantee herein is as follows:
Attorney for Grantee
Prepare by:
Jane M A[ezarder,Esquire
148 S.Baltimore Street
Dillsburg,PA 17019
r711j 432-4514
Calculated Value of Your Paper Savings Bonds)
Calculator Results for Redemption Date 06/2005
Total Price Total Value Total Interest YTD Interest
$1,500.00 $8,902.12 $7,402.12 $171.76
Bonds: 1-20 of 20
Issue Next Final Issue Interest
Serial # Series Denosn Date Accrual Maturity Price Interest Rate Value Note
C2058377543E E $100 04/1978 10/2005 04/2008 $75.00 $314.16 3,32% $389.16
C2058378720E E $100 05/1978 11/2005 05/2008 $75.00 $303.88 4.00% $378.88
C2065766484E E $100 06/1978 12/2005 06/2008 $75.00 $304.84 4.00% $379.84
C2071965484E E $100 07/1978 07/2005 07/2008 $75.00 $297.48 4.00% $372.48
C2071966749E E $100 08/1978 08/2005 08/2008 $75.00 $297.48 4.00% $372.48
C2071968356E E $100 09/1978 09/2005 09/2008 $75.00 $297.48 4.00% $372.48
C2071969613E E $100 10/1978 10/2005 10/2008 $75.00 $297.48 4.00% $372.48
C2068651952E E $100 11/1978 11/2005 11/2008 $75.00 $301.00 4.00% $376.00
C2068653452E E $100 12/1978 12/2008 12/2008 $75.00 $302.04 4.00% $377.04
C2037862858E E $100 03/1977 09/2005 03/2007 $75.00 $435.12 4.00% $510.12
C2041067271E E $100 04(1977 10/2005 04/2007 $75.00 $435.12 4.00% $510.12
C2027275537E E $100 05/1977 11/2005 05(2007 $75.00 $440.16 4X0% $515.16
C2042501047E E $100,06/1977 12/2005 06/2007 $75.00 $441.24 4.00% $516.24
C2027275839E E $100 07/1977 07/2005 07/2007 $75.00 $431.04 4.00% $506.04
C2048049695E E $100 08/1977 08/2005 08(2007 $75.00 $431.04 4.00% $506.04
C2048054669E E $100 09(1977 09/2005 09/2007 $75.00 $431.04 4.00% $506.04
C2048055878E E $100 09/1977 09/2005 09/2007 $75.00 $431.04 4.00010 $506.04
C2051317181E E $100 10/1977 10/2005 10/2007 $75.00 $431.04 4.00% $506.04
C2050979250E E $100 11/1977 11/2005 11/2007 $75.00 $389.08 4.00% $464.08
C2051300696E E $100 12(1977 12/2005 12/2007 $75.00 $390.36 4.00% $465.36
Totals for 20 Bonds $1,500.00 $7,402.12 $8,902.12
Notes
NI Notlssued
NE Not eligible for payment
05 includes 3 month interest penalty
MA Matured and not earning interest
http://www.treasurydirect.gov/BC/SBCPrice 5/14/2010
Sovereign Bmk STATEMENT OF ACCOUNTS
.f 1-877-76$-1143 www.sovereignbank.com Milestone Sanking7+relnfer options
Statement LEGACY CHECKING o• 0 06/14/05
THELMAIUMPER Accourft#'1651075718
Former ACCo"Unt 11'6o6o33157
,Balances
g� i lari e $ J 2:09
Deposits/Credits r +$1,678.04 Average Daily Balance $6;013.74
Interest —_
Pa Pe:3. _ 2 22 i• e ;r i =Ease o —_
,.Earned this Period $722 Paid Last Year $0:00 _
'The interest earned and the interest paid may differ depending on when interest is credited to your account.
mm
Checks Pasted <
check# Date Paid Amount Reference-# Check# -Dat6l aid Amount`.z'Reference#
} T1 05 7 $25x00 n 1:09 4;7<6f3 l , 2
, 7 $ x 5 q
m _-
872 45127 .. $24.33 610331450 674 105(31 $25 83 ;6 4241'667o
4 Check(s) Posted=$11.1.16 —
An asterisk (')indicates a-skip in sequential check numbers.
Account Activity. ,
. - .. �bapavw±•Y .
Date Description Additions -Subtractions "ia' lance
05-16 Beginni9y8alance $5;412.09
-` :tl9
"05-27 CyHECW '872 " $24.33 $5;362.76
F491 MET
05-31 CHECK '874 $25,83 $5,;300.93
;011, P `A' tti-"LTs ' NS $
06-01 _ PRU ANNTY PYMT 163.66 $5;747.75
JUN;05
015875
N3' US TREASU ( , tr 0 ..H �' �..
1
page 3 of 5 1051075718
1-877-768-1143 wWW.Sovereignbank.com Milestone Banking Prernfer Options
Account Activity (Cont. for Acct# 1051075718)
Date Description Additions Subtractions Balance
06-14 DEPOSIT $99.00 $6,976.75
E D 22Zp,���,,A4�
1, g Balance IN
U0�14 C"U
$6,978.97
Page 4 of 5
1051075718
Sovereign Bank �D-1-KFEMENT cal' AocoUNTS
1.877-SOV-BANK(1.877-768-2265) www.sovereignbank.Com STATEMENT SAVINGS ACCOUNT
STAT EMENT SAVINGS ACCOUNT Statement Period 04/01/05 - 06/30/n
-TNELMA 3uMFER Account # $74108049
Former Account S 500092292
Balances
i"'R^;J.{�`S; _,�""y;vt.�a�a.tt A���,'„"��m°�xt»�^�. ,x•svn.. '�, "wR"�v'F...w�„� k.C. �'•'^ --
Be�rnrnn =8 ( nc=' 5�-�- -,j,.�-$4 798.7 sr:> _, C5jrent��a�A`nCe •�:= W � $4 805 98��:
Deposits/Credits + $7.21 Average Daily Balance $4,798.77
1/Vithdr�`'w I5%C a its OR 'r` Q 00 � : i4*-*,, ��l._ —
"-" pAS. ..:c `zi��aratRc�a�01 Ems'.—K.F3"
Interest,
Earned this Period .,$7.21-- Paid Last Year . $0.00 —
Ta�
'The interest ea tried and the interest paid may differ depending on when interest is credited to your account.
Account Activity —_
Date Description Additions Subtractions Balance _
04-01 Beginning Balance. $4,798.77 .—
6TOi MINTR Si'fCRE11 -
06-30 Ending Balance. $4,805.98
page 3 of 574108044
1
Little IKE Eichelberger, Auctioneer
Dillsburg, PA 17019
Phone Number(717) 432-0006
Pa License #AU. 001954-1
Statement of Public Sale Held For: 77--
EXPENSES '
Advertising..........................................................
Insurance.............................................................
Auctioneer's Commission..1. W........... .. . 4 119 o -:3!�
Real Estate Commission..........................
Clerk's Commission.....�Guc��co p' _
............
Runner's Pay..........Q... ..:.................. ( M,UO
Portpotty............................................................
.S=/7-v6
Miscellaneous Expenses....aa-gi. . d' C4� X00
p...a. .....Q:........ _
TotalExpenses......................................................
RECEIPTS
GrossSal e............................................................ 36 (4� �s
Less Expenses............................... 1 / `f�'• 9 6
..............
Less Uncollected Amount.........................................
TotalNet Sale. .t................................................... ( �a0 • S
I received $ C I ao•�Sn from proceeds of the listed sale on
Signature YX :B_ �
Date_
ri`x+ Sk.
Little IKE Eichelberger Auctioneer
150 Mount Top Rd.
Dillsburg,PA. 17019 PH: 432-0006
Appraisal done Thursday March 23, 2006 for the Estate of Thema Jumper 2109 Cedar Run
Dr. Camp Hill PA.
Items that were appraised:
3 pc. dark color spool bedroom suite
Pedestal round table w/4 bow back chairs $250.00
6 drawer high chest of drawers $200.00
Maple 4 drawer hutch $100.00
2-Hitchcock half spindle back chairs pr. $75.00
Entertainment center $50.00
Lady's head vase w/hand up to face $50.00
Lady's head vase large trimmed in pink w/flowers (missing earring) $50.00
Lady's head vase w/poinsettia g) $40.00
$25.00
Total $840.00
total from page $840.00
Little IRE Eichelberger Auctioneer
' Mp.MHP.R UR
pENNSV.v..ny
�elley4 lue Book - Trade-In Pricing Report - Honda, Civic
t, Page I of
Kehl' Blue Book Close Window
Wy
THE TRUSTED RESOURCE
gr
2000 Honda Civic VP Sedan 4D
BLUE BOOK'a TRADE-IN VALUE advertisement
Condition Value
Excellent $7,350
Good o $6,830
(Selected)
Fair $5,925
Vehicle Details advertisement
Engine: 4-Cyl. 1,6 Liter
Transmission: Automatic
Drivetram: FWD
Mileage: 31,400
Selected Standard Equipment
Air Conditioning Tilt Wheel Single Compact Disc
Power Steering AM/FM Stereo Dual Front Air Bags
Power Door Locks
Blue Book Trade-In Value
Trade-in Value is what consumers can expect to receive from a dealer for a
trade-in vehicle assuming an accurate appraisal of condition.This value will
likely be less than the Private Party Value because the reselling dealer incurs
the cost of safety inspections, reconditioning and other costs of doing
business.
Vehicle Condition Ratings
Excellent
JUDOM $7,350
"Excellent" condition means that the vehicle looks new, is in excellent
mechanical condition and needs no reconditioning. This vehicle has
never had any paint or body work and is free of rust.The vehicle has a "J,
clean title history and will pass a smog and safety inspection. The
engine compartment is clean, with no fluid leaks and is free of any wear
or visible defects. The vehicle also has complete and verifiable service
records. Less than 5%of all used vehicles fall into this category.
Good (Selected)
$6,830
"Good"condition means that the vehicle is free of any major defects.
This vehicle has a clean title history, the paint, body and interior have
only minor(if any) blemishes, and there are no major mechanical
problems. There should be little or no rust on this vehicle. The tires
match and have substantial tread wear left. A "good' vehicle will need
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JOSEp JAMES JEWELERS
TO WHOM IT MAY CONCERN:
Tammeo ccnily thatweared andddcribe jewelry business,appraising diamonds,watches,jewelry and precious stones trait descriptions. Wehamwiacertifythmwehave this day carefully
examined the following listed and described win lot the property of.
NAME: Estate of Thelma Jumper
ADDRESS: c/o Julie Metzger
800 York Road
I,or 940
Dover PA 17315
We estimate the value az listed for insurance or other puryoses at the torten[renil value,excluding Federal and other taxes. In making this Apprasal we DO NOT
the articles.
. agrm to purchase or replace
The following item was appraised for estate purposes:
DESCRIPTION
Lady's 14K yellow gold diamond ring. The largest round brilliant cut diamond
measures approximately 5.25mm x 5.28mm and 3.1 mm deep. This diamond weighs .57ct. The clarity is VSz. The
color is H. The table is approximately 62.0°/x. The depth is approximately 58.8%. This is framed with one,
4.80mm —4.81 mm, round old European cut diamonds, approximately .46ctw. The clarity of this diamond is VS'.
The color is J. Each crown is 14K white gold with four prongs. The shank contains five, l.Omm - 2.Omm round
brilliant cut diamonds and six. 1.7mm — 2.Inun single cut diamonds. Eleven diamonds totaling approximately
crown . The clarity is VS-SP. The color is H-J. This is constructed from a one piece casting with two die struck
crowns.
Value: $650.00
A D. Avts P.G. L MU 31 2007
The foregoing Appraisal is made with the understanding that the Appraiser assumes no liability with respect to any action that may be taken on the basis ofthis Appraisal.
301 East Main Street • Mechanicsburg, PA 17055 . (7171795-9224
If Sovereign Bank INDIVIDUAL RETIREMENT ACCOUNT
P.O.Box 12646-Rending,PA 19612(877)768-2265 Social Security Number 203-14-4334
Retirement ID 1203104334
Bank FIN 23-1237295
Statement Date 12-31-05
Begin Statement Period 01-01-05
End Statement Period 12-31-05
THELMA JUMPER Page 1 of 2
8 CEDAR AVE 9
MECHANICSBURG PA 17055-4701
,,I,111111,11„I I„0 I111,,,,,1111,,i„I,,,I,n 5143.32.1
CERTIFICATE Account Number:400000358010320
1. Prior Balance 95.62 Maturity 08-25-05 Rate Fool
Description Date Amount Balance
INTEREST 02.28.05 0.01 95.63
INTEREST 03-31-05 0.00 95.63
INTEREST 04-30-05 0.00 95.63
INTEREST 05-31-05 0.00 95.63
INTEREST 06-30-05 0.00 95.63
INTEREST 07-31-05 0.00 95.63
DEATH WITHDRAWAL 08.17-05 -95.63 0.00
CERTIFICATE Account Number: 000000358011872
Prior Balance 1 1,456.12 Maturi 08-06-06 Rate 2.200
Description Date Amount Balance
INTEREST 02-06-05 10.69 1,466.81
INTEREST 08-31-05 18.20 1,485.01
CURRENT YEAR CONTRIBUTION 12-27-05 71.02 1,556.03
CURRENT YEAR CONTRIBUTION 12-27-05 639.24 2,195.27
CERTIFICATE 'a- c r k ;'r Accx o u:n t,;:Numts er:'0b:0,.0
0. 1z 0 5a.8h7x 2 124.
,.
Pnar Blance 4
Description Date Amount Balance
INTEREST 01-31-05 21.95 5,062.07
INTEREST 02-28.05 19.92 5,081.99
INTEREST 03-31-05 22.14 5,104.13
INTEREST 04-30-05 21.52 5,125.65
INTEREST 05-31.05 22.33 5,147.98
INTEREST 06-30-05 2111 5,169.69
INTEREST 07-31.05 22.52 5,192.21
INTEREST 08-31-05 22.62 5,214.83
INTEREST 09-30-05 21.99 5,236.82
INTEREST 10-31-05 22.82 5,259.64
INTEREST 11-30-05 22.18 5,281.82
°' SOVereign Bank INDIVIDUAL RETIREMENT ACCOUNT
P.O.Box 12646-Reading,PA 19612(877)768-2265 Social SecuritV Number 1 203-10-4334
Retirement ID 1203104334
THELMA JUMPER Page 2 of 2
CERTIFICATE continued Account Number: 000001058121524
Prior Balance 5,Q40.12 Maturit 04-03-07 Rate 5,130
Description Date Amount Balance
INTEREST 12-31-05 23.01 5,304.83
SUMMARY
Prior Cash Balance 6,591.86 Disbursements 85.53
Pius Credits 710.26 Federal Tax Withheld �____ 0.00
Plus Interest 293.61 State lax Withheld 0.00
Less Debits 95.63
CONTRIBUTIONS SINCE 01-01-05
New Cash Balance 7,SOO.iO P004 0.00
Total Plan Value 7,500.10 2005 710.26
Rollovers 0.00
FAIR MARKET VALUE OF PLAN AT THE END OF 2005 7,500.10
THE FAIR MARKET VALUE INFORMATION IS BEING FURNISHED TO THE
INTERNAL REVENUE SERVICE.
Thelma M.Jumper Estate
List of name, description of jewelry, and appraised value for the
Beneficiaries named in paragraph ITEM III of will
Name Description of Jewelry
Appraised Value
Connie Fetterman Black,white and yellow gold tone circle earrings
$3.00
Michele Blash Sapphire with diamond silver bracelet
$15.00
Jane L. Hertzler White pearl necklace with brown and black stone accents
$10.00
Nancy Sanger Gold ruby solitaire ring
$45.00
Sherri Focht Silver and Peridot oval flower ring
$8.00
Deb Shook Yellow gold with diamond bezels oval bracelet
$20.00
Linda Moll Silver two-strand rope bracelet
$5.00
Lenore Ritter Silver round bracelet
$7.00
Jo Ann Bowles Silver chain necklace with pink marbled charm
$25.00
Andrea Metzger Gold horse with diamond horseshoe ring
$25.00
Susie Kirkland Green, diamond, red, dark blue (black)stone pendant
$75.00
Rose Hrisicak Yellow gold watch-band style bracelet
$7.00
Ernie Kepner Gold a w uamarine triangle ring w/ q g g-missing a diamond
$65.00
Dolores L. Hertzler Silver diamond and sapphire Hamilton watch
10.00
Total S320.0
COMMONWEALTH OF PENNSYLVANIA
' DEPARTMENT OF REVENUE INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AND FILE ND. 21 05-0532
DEPT. 280601
HARRISBURG, PA 17128-0601 TAXPAYER RESPONSE ACN 06113539
DATE 03-21-2006
REV-MS EX W(L9-001
TYPE OF ACCOUNT
EST. OF THELMA M JUMPER ❑ SAVINGS
S.S. NO. 203-10-4334 ® CHECKING
DATE OF DEATH 06-05-2005 ❑ TRUST
COUNTY CUMBERLAND ❑CERTIF.
REMIT PAYMENT AND FORMS TO:
GERALDINE E GASSWINT REGISTER OF WILLS
8 CEDAR AVE CUMBERLAND CO COURT HOUSE
MECHANICSBURG PA 17055 CARLISLE, PA 17013
H & T BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decadent,, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. questions may be answered by calling (717) 787-8327.
COMPLETE PART I BELOW iEii x SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 57697418 Date 06-18-1991 To insure
proper credit to your account, two
Established (2) copies of this notice must accompany your
Account Balance 1,534.35 payebl to the Register of Willa. Rake check
payable to: "Register of Wills, Agent°.
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax 767.18 (3) months of the decedent's date of dean,
Tax Rate X .15 you may deduct a SX discount of the tax due.
Potential Tax Due 115.08 Any inheritance tax due will become dalinquent
nine (9) months after the date of death.
PART TAXPAYER RESPONSE
.
A. The above information and tax due is correct. '
1. You mmy choose to remit payment to the Register of Wills with two copies of this notice to obtain.
CHECK a discount or avoid interest, or you may check box ^A^ and return this notion to the Register of
ONE Wills erns an official assessment will be issued by the PA Department of Revenue.
BLOCK B. F1 The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
ONLY to bs filed by the decedent's representative.
C. El The above information I. incorrect snorer debts and deductions were paid by you.
You must complete PART O and/or PART 0 below.
PART If you indicate a different tax rate, please state your N
relationship to decadent: { ; i & ,1� `�"Ty •13' }
TAX RETURN - COMPUTATION OF TAX ON JOINT,'TRUST ACCOUNTSs =
rig
LINE 1. Date Established 1 ! d -
S
2. Account Balance 2
3. Percent Taxable 3 X a! !' :-! F !I +K #_.!IRS
F
4. Amount Subject to Tax 4
k T
S. Debts and Deductions 5
6. Amount Taxable 6 3 rl s
mod! .,
7. Tax Rate 7 X ` ;r'- ' " ' --' -k
S. Tax Due $ Pli y,0 r v " '
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTI,ON _ AMOUNT PAID
TOTAL (Enter on Line S of Tax Computation) B
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of my knowledge and belief. HOME ( 1
WORK ( )
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Morgan Stanley IRA Designat n o Ii1k01 � i�
410-033634 IRB
Awoum r~lumbtt f'
_ �7 IFORIcheckonel! ItITcadidonalIRA 0SIMPLft 0Roth IRA
participants Name ii Paridpan2,Social Se,rny Number
N Ai . Flu - lO-
t hereby dcalgnam the following person(.)v primary and eoadngent bete cf.des;(arment,oklmonal sheets if netereary)
Additional sheets arc D arc on,mnclud. Number of5heesa
primary&nefivary Cond%vnt Ilsencfidary
[A- A) - cPAI
Relaliumhip Soda)Security Number RetadonsNp Security a`lumber
P-ICAJ 6 / 3&- 6 a`o
Address - Ad+hw
3 &X S 9T
Gry State 'Lip Code Cry State Zip Gale
Wr4,e t W G T2)4,
I undenaand rbar upon my death my interest in the Morgan Stanley Individunt atonement Pha(the*IRA")dcscrihed drove"become the peoperey of the
primary lat"Iidsry,if her or she rurvivcs me,and if no primary henefidary mrvivcs me,shm of the contingent hcnefidary,and if no condngrot henef+dory
.-ves me,or the Custodian cannot locate the bcnefidnry•,then the Custodian shag distribute the amounts payable to my spoor,if he or she survives me,and,if
morr,to my children in equal Shaer,..or(no children survive me,to my emus.
I reserve the right to revoke or change this bcarfit ary doignadon. All prior dnigardons(if any)ofp simary m eunungsntlsenetkiadu for die MA docdbcd
shave,are hereby ovokrd and rephced by this Deanputu n of Beneficiary.
Signature of participant Oaae
Wh rn non-spouse beneficiary it named,spouse consent Is required in community propcoy sots,oteluding but not canned to:AZ CA,ID,LA.NV,NK'M
WA,lCq, t hereby agree and consent m the beneficiary xt ford+above,an,l along with my agre{mgm Pori eunKns,du hereby wmmux w my aiwaae ell my
community ,pruperry intera a m the IRA described above that]may have. t acknoadedge my dghi to one half community pmperry in thr Amount and voluntarily
ekee m rrlfnquish my dgMS+o the rommu+dry popery bravest in ehe Aceeum.
5iga wxtofPer&ip;me,5ponx Date
Dh,.g,.anuo of a beneftstwy may have eigtdhcanr Ina and Inheritance{onscquenas(o,the pmempants estate and the bemfimary{o d{asgnaseti,end the participant
should consult We or her anmney or not advisor with regard to this destgnadon.
Notc:This Designation of Beneficiary form is only valid for the above referenced Morgan Stanley IRA
lnveuments and service,Pre Mred thnn%h Murgms Stmdey DW lne,mmnbe,SIPC.
ID 2081 Morgan Stanley DW lose. ,
CIF#37402 - Rev OB(02 Morgan .t
COMMONWEALTH OF PENN}QYLVANIA
DEPARTMENT OF RE'YENUE
BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX
INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
PO BOX 2BD601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON
HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS REV-1548 EX AFP (06-OS)
DATE 07-31-2006
ESTATE OF JUMPER THELMA M
DATE OF DEATH 06-05-2005
FILE NUMBER 21 05-0532
COUNTY CUMBERLAND
DAVID A METZGER SSN/DC 203-10-4334
ACN 05142462
800 YORK RD TR 40 APPEAL DATE: 09-29-2006
DOVER PA 17315 (See reverse side under Objections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS +—
____^----^---^---- ^-------------^----------------------------------------------------`
REV-1548 EX AFP CO3-05)
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 07-31-2006
ESTATE OF JUMPER THELMA M DATE OF DEATH 06-05-2005 COUNTY CUMBERLAND
FILE NO. 21 05-0532 S.S/D.C, NO. 203-10-4334 ACN 05142462
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: SOVEREIGN BANK ACCOUNT NO. 0575133707
TYPE OF ACCOUNT: C )SAVINGS C ) CHECKING 0OTRUST ( )TIME CERTIFICATE
DATE ESTABLISHED 07-09-1981
Account Balance 12,149.84 NOTE: TO INSURE PROPER CREDIT TO
Percent Taxable X 1.000 YOUR ACCOUNT, SUBMIT THE
Amount Subject to Tax 12,149.84 UPPER FORTICH OF THIS NOTICE
Debts and Deductions .00 WITH YOUR TAX PAYMENT TO THE
Taxable Amount 12,149.84 REGISTER OF WILLS AT THE
Tax Rate X .15 ABOVE ADDRESS. MAKE CHECK
Tax Due 1,822.48 OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
INTEREST IS CHARGED THROUGH 08-08-2006 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 1,822.48
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 54.59
TOTAL DUE 1,877.07
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ■
t IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT- i CR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THI$_FORM FOR INSTRUCTIONS. ) _
Cocklin Funeral Home , Inc.
P.O. Box 424
Dillsburg, PA 17019
(717)432-5312
August 22, 2005
Mrs. Dolores L. Hertzler
8 Cedar Ave.
Mechanicsburg, PA 17055-
The Funeral Service for Mrs. Thelma M. Jumper
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES,AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
I.Professional Services
Funeral Director&Staff
FUNERAL HOME SERVICE CHARGES _ • . ' ' • • $2880.00
SELECTED MERCHANDISE: . . ' 10880An
Tigereye, _ •
THE COST OFOURS.ER.VICES,EQUIPMENT,AND MERCHANDISE $3195.00
THAT YOU HAVE SELECTED _
Cash Advances • ' ' • • . $6075.00
Cemetery Charges. •
Newspaper Notice• ' . . • . • ' • • • • • . . . . $995.00
Certified Copies . • _ • . • ' ' • . • • . • . . , $159.00
Clergy Honorarium . . . . $72.00
Flowers. . . . . . . . . . . . . $75.00
TOTAL CASH ADVANCES AND SPECIAL CHARGES . . $135.68
T .
otal
• � � $1436.68
Total Cost
. . . . . . . . . . . . . $7511.68
SUB-TOTAL $7511.68
INITIAL PAYMENT/DISCOUNT/CREDITS
7317.00
TOTAL AMOUNT DUE $194.68
unpaid balance over 0 days is subjected to a 0.50%service charge per month-6.0000%per annum.
Mrs. Thelma M. Jumper
Page 1
ORDER FORM
No. 2-20276
ingrie Foundation By t red M dyne
❑ Carved Lettered Supplier lL�l W S
❑ Drawing Required Ack. #
MEMORIALS Since 1921 ❑ Drafter Date Recd
5243 Simpson Ferry Road, Mechanicsburg, PA 17050
(717) 766-5622 • Fax (717) 766-8007 ❑ Sandblast By Found. Ordered form i
"� w .gingrichmemorials.com Manufacturer �7 Position Verified
SOLD TO: (t�ht Estot tSf �,A^o- 1 1. l� 1LT Date of Order
C/'0 lJn �vYQ.S L. �2r�ZICY' Cemetery !6w-�
O CCrinr ftV`2 Location Bloc�C K - S2C� t1S G -� C{
1 _y_Ar% tint/ 5 burr, PA 11 65s Center Over_� Graves Lot #
Phone (H)—n C C.- 1 146 (W) Approx. Date of Completion n oyro y. W11.1mid {Y-
Lettering
vase,
�S Per M.a�he"�s
p�rauj 16
T" ELMH M . AUMPER
1 .�L1 �pelling and dates have been approved.
Type of Memorial bCOA-Le Stv+gp� Material M�-ftOW3 Q7"fjn ROSS
Size -,ZLC X L « X Finish I .1,.
Size��X_._X-�_ Finish �-010V,( Yl7� (^ ray - VI Vt Alra y t
Misc.
Design
Location
❑ Vase ❑ Corner Posts -
Agreement:A 50%deposit is required to commencement of work. Price $ 1 ,] { J .
Agree to pay stated balance upon erection regardless of labor troubles or shipments or any other good reasons.This order or contact
cannot be cancelled by customer unless agreed by both parties.The article herein mentioned shall remain the properly of James R. Foundation $ ac)C).
Gingrich Memorials until paid in full and they reserve the right to remove the same is not paid as stated. $
1 agree to carefully proofread all names and dates for accuracy and accept full responsibility for any errors or omissions.THERE
WILL BE AN ADDITIONAL CHARGE FOR ANY LETTERING ADDED TO THIS MEMORIAL AFTER ERECTED ON THE $
CEMETERY. TOTAL
I further agree to pay the balance staled for the work performed under this contract within thirty(30)days of receipt of the final invoice _
and further agree that interest shall accrue at the rate of one and one-half percent(t ur%)per month on the unpaid balance owed to DEPOSIT $
James R.Gingrich Memorials not paid within thirty(30)days of the invoice date.In addition thereto.I agree if it becomes necessary
for James R.Gingrich to institute legal proceeding to collect any funds due from me for my account being past due thirty(30)days, Balance Due
to pay all court costs and attorneys fees incurred by James R.Gingrich Memorials to collect the same,
/�,� /, �J Upon Completion $
Dealer �h'Y\ Customef�l �L.--L-r�./ Z d. & '(_-V c
v
(I further agree that the above na , spelling, and dates are correct)
WHITE-Office YELLOW-Production PINK-Customer GOLDENROD-Branch
µ k yy
nn g ttn U7, 6WA6 tit ,err CCallwantl
245 W. Si &I r i bur PA 17019
Chartered April 1962 � VOL. � Emergency - 911
Non-Emergency - 697.8012
SOCIAL HALL RENTAL AGREEMENT
The undersigned agrees to rent the Monaghan Township Fire Company Social Hall for auction(s)on
DATE:_Mlq .t? )— TIME:_ AUCTIONEER:
The rental fee is$225.00 per day for auctions held on Monday through Thursday and$300.00 per day for auctions held on Friday
through Sunday. If kitchen service is desired,it will be staffed and run by Fire Company personnel.
A deposit of$100.00 is required when you rant the building and'/of your deposit will be returned if you cancel at least 90 days in
advance of the event date.
The undersigned agrees to:
Vacate the building if anyone becomes destructive to the building or disruptive to the neighborhood.
Absolve the Monaghan Township Fire Company from any liability resulting from the serving of food or alcoholic beverages or
resulting from any damage and/or theft of property belonging to or under the control of the renting party or group.
Regardless if event starts after 6:00 p.m.,it must end at midnight, 12:00 a.m.,and complete clean up by 1:00 a.m.
Helium balloons are allowed as long as fans are not used.
Approval must be received from the Fire Company before any decorations can be put up. Do not push up the ceiling the to decorate.
DO NOT HANG DECORATIONS FROM THE FANS.
Pay full cost of rental,plus deposit prior to the event. The deposit will be returned,provided all conditions of this contract are met and
the hall is left in the shape you found it in upon arrival. You will receive a check after the first Thursday night of the month following
your function.
NO PETS ALLOWED IN THE FIRE HALL!!!1
No smoking in the building.
We request that prior to leaving the building you:
Clean up all spills and messes that were made.
Remove all decorations from walls and ceiling.
Place all trash in the dumpster out back.
Wipe off all tables and chairs,and return them to their original positions,9 rows of 4 tables each,and 6 chairs per table.
Please sign and return this contract and your$100.00 deposit within 15 days to confirm your reservation. If the form is not returned
within this time frame,the building may he rented to someone else. Please make all check payable to:The Monaghan Township
Volunteer Fire Company. Please return one copy of signed contract to the Fire Company.
PURCHASER p MONAGHAN FIRE COMPANY
Signature:_
d. Signature: : "/X1'17 i"t 7T(i
Print Name: aCor� S �. I$PPtlt r Print Name: /?0& f C. Jk-'a } ot!
Street Address: �C'�3a r Street Address:245 W Siddonsburg Road
City State Zip: ee,j: ;¢ H :c5 b vr< f'n, j 7 ah City,State,Zip: Dillsburg,PA 17019
Telephone: /7 7!'fL yci Telephone: (717)697-8012
Date:_ 1�_/ O to Date:--q/f-/ 0(f
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