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Home My WebLink About06-27-14 (2) � 1505610105 REV-1500 Ex�oz_��,�F�, .�;; OFFICIAL USE ONIY PA Department of Revenue pennsylvania ;,.�.R,„E„.o,H,�,��, County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN . '` PO BOX 280601 ,� � l 3 f(,Yp � Harrisburq PA 1�i28-o6oi RESIDENT DECEDENT � ENTER DECEDENT INFORMATION B�LOW Social Security Number Date of Death MMDDYYYY Oate of Birth MMDDYYYY ' 09/27/2013 11/04/1932 DecedenYs Last Name Suffix DecedenPs First Name MI Parsons Elizabeth ' {� '' (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!N APPROPRIATE OVALS BELOW � 1.Originai Return O 2.Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) p 4. Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) ,-.�, O 9. Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election t6'Tax under Sec:�l13(A� � Between 12-31-91 and 1-1-95) (Attach S6�e�O) ,;.� rT� CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHWL(� E DIRECTf�fO: .::"� � Name _ Daytime Telephni�e l�un46er '� ''� r�� _ _ ., � N , ,_, 717-697-7050 = °'' ' , :� Andrew C. Sheely, Esquire - � ; `�' r� - _ _ _ _ . ;;. , �.� _ _ _ _ _ _ :. � ;� =r7 REGISTE�O�1�IILU:S US NLY _,� � � _� � t,��7 �— f„� . n _ � N � � First Line of Address � � �y p _ '" �1 ' 127 South Market Street `� Second Line of Address P.O. Box 95 ' City or Post Office _ _ State ZIP Code DATE FILED Mechanicsburg ' PA , '17055 , Correspondent°s e-maii address:andrewc.sheely@verizon.net Unde ies f p rjury,I clare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it i rue rre a compl e.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. IGN O RESPONSIBLE FOR FILING RETURN j � DA l �' T '✓ ADGRESS Richard M. Parsons,Administrator, 2232 Canterbury Drive, Mechanicsburg, PA 17055 SIGN RE OF PREPAR TH AN REPRESENTATIVE ��A� ��/ D RESS Andrew C. Sheely, Esquire, 12 South Market Street, P.O. 8ox 95, Mechanicsburg, PA 17055 PLEASE USE ORIGINAL FORN! ONLY Side 1 � 15056101�5 1505610105 J h _ °__ .. :._,...��. . �mm.<.�.�,_..,a�, �.,, ��,�A�.��.��,�._ J 1505610205 REV-1500 EX(FI) DecedenYs Social Security Number DecedenYs Name: PBfSOf1S, ElizBbeth P. RECAPITULATION 1. Real Estate(Schedule A). . .. .. ... . . . ... .. .. .. .. .. . .. . .. ... . .. .. .. . ... 1. ', 233,576.00 ' 2. Stocks and Bonds(Schedule B) . .. ... . .. ... . . . . .. .. .. .. ... .. . .. .. . .. . . 2. $7,507.60. 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . . . . . 3. 4. Mortgages and Notes Receivable(Schedule D). . .. .. .. .. ... .. . . .. .. . .. .. . 4. ' 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). .. . . .. 5. 6,074.00 6. Jointly Owned Property{Schedule F) O Separate Billing Requested .. .. .. . 6. ' 33,799.29 7. inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested.. .. . . . . 7, ; 171,437.77 8. Total Gross Assets(total Lines 1 through 7). . .. .. .. ... .. .. . . .. . .. .. . .. .. 8. , 452,394.66 9. Funeral Expenses and Administrative Costs(Schedule H). . . . .. . .. .. .. .. .. . . 9. ', 6,944.47 ' 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I}. . . ... .... ... .. 1Q 22,553.19 11. Totai Deductions(total Lines 9 and 10). . .. .. .. .. .. .. . .. . ... .. . .. .. ... .. 11. 29,497.66 12. Net Value of Estate(Line 8 minus Line 11) .. ...... .. .. .. . .. .. .. ... ... .. . 12. ' 42L,897.00 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which - an election to tax has not been made(Schedule J) .. .. .. . .. . ... .. ... ... .. . 13. ' 14. Net Value Subject to Tax(Line 12 minus Line 13) .. . . . ... . .. .. . .. .. ... .. . 14. ' 422,897.00 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 _ _ _ _ �a)�1.2)X.0- 15. _ 16. Amount of Line 14 taxable _. _ _ at lineal rate X.0 45 : 422,897.00 16. 19,030.36 17. Amount of Line 14 taxable . . . _ at sibling rate X.12 ', 17. ' 18. Amount of Line 14 taxable ' . _ ' at collateral rate X.15 ' �$ ' 19. TAX DUE .. . .. .... ..... .. . . . .. ... .. .. . .. .. . .. .. . . ... ... .. . . .. ..... 19. ' _. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Side 2 � 1505610205 1505610205 � REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: � t - / 3 ��d� � DECEDENT'S NAME Elizabeth P. Parsons _. _ _.. STREETADDRESS - _.... .._ _...... .. _...... _..... .... _..... __ _.......__. 700 Cocklin Street -_— _....... .. _ - _.... __..... _... _ __ CITY _.--... _... _.....-__ _ PA_ __ ZIP _.. STATE _ - echanicsburg 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) 2. Credits/Payments ��7 19,030.36 A.Prior Payments _.__ _....__.. -- _.... .... _.....__.. B.Discount 3. interest Total Credits(A+B) (2) 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) 19,030.36 Make �heck 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 shail 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 sec!�rity at his or her death?.............. ❑ � 4. �id decedent own an individual retirement account,annuity cr 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. � � �.,, , , . � , � _ �� .. � , - F 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 tlecedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)J. • 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-1502 EX+(11-08) � pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REA� ESTpTE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Elizabeth P. Parsons 21-13-1061 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 seil,both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be discfosed 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. VALUE AT DATE NUMBER OF DEATH . DESCRIPTION 1• DecedenYs real estate located at 700 Cock�in Street,Mechanicsburg,Cumberland County,PA $233,576.00 17055.Tax Parcel No. 17-24-0789-195.Assessed value$240,800.00 X CLR .97=233,576.00 TOTAL(Also enter on !ine i, Recapitulation.) $ $233,576.00 If more space is needed,insert additional sheecs of the same size. 'ropertyMapper-Cumberland County,PA 6/19/14 2:07 PM � tittp://gis.ccpa.net/PropertyMapper/ Page 1 of 1 ' REV-1$03 EX+(�-ii) � pennsylvania SCHEDYLE B DEPARTMENT OP REVENUE INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMSER Elizabeth P. Parsons 21-13-1061 Aii property jointty owned with right of survivorship must be disclosed on Schedule F. ITENi VALUE AT DATE NUMBER DESCRIPTION OF DEATH i• 40 shares of IBM stock.Account C0005434505(Richard D.Parsons)-date of death value $7,507.60 TOTAL(Also enter on Line 2, Recapitulation} $ $7,507.60 If more space is needed,insert additional sheets of the same size lnternatioqal Business Machines Corp.,IBM Historical Quote-(NYSE)IBM,Iniernational Busir�ess Machines Corp.Stock Price-BigCharts.com 6/26/14,2:38 PM ! ° ` � , � � � � Enter Symbois or Keywords aFfir�£'H ( i • �M��s � � Ci�ar�s �� CAPITA�.Jt�t�RHAL� ,b� P�.IT�5�N P�RSAECTIYE • � � ��LL�',��L. I?�aamic eoverage oj'Pdttics�,rtatio►u�Z saurit�tmd pdic�. , ,a;; „.. � I�J�7) Basic Chart Advanced Chart Interactive Chart , _..._ _.. __._...._ _,.._ ....... _........, .. . i Home Quotes ; News Industries :; Mar9cets yfs�r`,CBI�csAtgg '; BigReports � _._ This Histaical Quotes tool allows you to look up a securitys exaG Uosing prica. Simply type in the�symbol and a histoncai date ro wew a quote antl mini chart for tha?secunty. ��, � r? «�� N: ' Enter Symbol: :ibm Enter Date: g/z7/13 . �r�: �3i$@i'313$lRli��Yii3:;i�^:?r8�r'e,C�313'�f:S�:03'i,:, ..� ... t'ii"; i:lOSfnfj Pr;GB. i8b,92 <.�;;r>r.: 1 g�.$? r�g>.' S�$.$4 t.�:rr. i$�S�l5 �'J!i�ltri< J.e�I.��.�aj'� ��v�*�:i�i�J `3��Ql�f 4��.�¢ ` , t!%�• �,� l�,'� I � C; /x,c� Too 5 Stocks To Buv 2014 Crossover SUVs �Y, �'�� D Bank Rates 2014 Luxurv Sedans Top Stocks To Invest $tocks To Trade Hioh Yield Savinas Account ?on MBA Schools 10 Stocks To Own Dividend Stocks To Buv Get started with a broker � t ��: � �r �� Trade free for 60 days+ get up ro 5600!Open an accounttoday Home�About;JoD Opportunities;ContaC Us i FeeCback�Help Copyn9M 2014 MarkeiWatch,Ine.WI rights reservetl. By using this sfte.you apree!o the Tercns of Usa.Privacy Policy,and Cookie Policy. Imraday Data provitled by SIX Financial Informalion and subject to tertns of use. http://bigchaRS.marketwatch.com/historical/default.asp?symb=ibm&closeDate=9%2F27%2F13&x=35&y=27 Page 1 of 2 ' REV'iso8 EX+(ii-so) � pennsylvania SCNEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERT1( RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Elizabeth P. Parsons 21-13-1061 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 NUMBER VALUE AT DATE DESCRIPTION OF DEATH � IRS 2013 income tax refund $1,874.00 2 1994 Lexus ES3000,poor condition $1,000.00 3 DecedenYs personal property $3,200.00 TOTAL(Also enter on Line 5, Recapitulation) $ 6,074.00 If more space is needed,use additional sheets of paper of the same size. . �� ,� � �5'S� P 488,985,340 �� ,. 5l `�k �.�'. � O�� . �;�. . "�'°f :-� ` Chxk No. .��:, _� :; :<. x�' ; "� - � 09 27 13 2009Q8Q0- KANSAS C:IT.X, MO - 40.�,4 00728835 �, �- ` 0001b75g2116 4034 00728835 I ` �QQ02013'26_2081 Pa9� '�I�I�IIIIIf�111�i�i�I�I1�lllr�„��,�„�,:�,i,,�in�,,f,.y,,r,�t,: _ - -xhearda'of ELIZABETH P PARSOC�lS ' , - ` �`• 700 COCKLIN ST �. MfCHANICSBURG PA 17055 6b14 ' $*�*18?�+*Q0 ;. �, r � ; YOID AfTER ONE YEAR v xeo�.��rvotrieex �'��,.,,.� _ � . rst ' �2lliku -�- �� ,�� . - �. . � . �y'.!ti,.1�—t'� ��1 Tt ti�' r Ix1kFtS ANI30VE 12/2012 TAX REfUND 30 , �" �� ,, * �i �-'L.�a� � f �_ , ��r �.�"��-��:.� _ .. , ^.\ 'Y. l � . .. �. . �. . .... . . . �-� l., �� '"'1a,w>� � . .. . . . ' � . �" '��' >��QD'0000 5 i8�: 00 7 288 3 58+i' 0409 L 3 �' �. ,� : �`�`� E;��s � >_ .. -. . REV-i$o9 EX+(oi-io) � pennsylvania SCNEDULE F DEPARTMENT OP REVENUE INHERITANCETAXRENRN �OINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Elizabeth P. Parsons 21-13-1061 If an asset became jointry 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 q,Richard Parsons 2232 Canterbury Drive, Mechanicsburg, PA 17055 Son B. C. ]OINTLY OWNED PROPERTY: LEffER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR lOINT MADE INCLUDE NAME OF FtNANUAL INSTITUTION AND 3ANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF NUMBER TENANT )OINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE Of ASSET INTEREST DECEDENT'S INTEREST 1. A. 07/06/2007 Members 1 st Savings Acct.309366-00,Jt.acct with son,Richard Parsons Principal balance$11,962.43, accrued interest$1.28 $11,963.71 50% $5,981.85 2. A 07/0612007 Members 1st Checking Acct.309366-11,Jt.acct with son,Richard Parson Principal balance$11,443.68, accrued interest$.20 $11,443.68 50% $5,721.84 3. A 06/23/2010 Members 1 st Investment Savings Acct.309366-08,Jt.acct with son, Richard Parsons,Principal balance$44,182.01,accrued interest$9.19 $44,191.20 50% $22,095.60 TOTAL(Also enter on Line 6, Recapitulation) $ 33,799.29 If more space is needed,use additional sheets of paper of the same size. St m MEMBERS 1� FEDERAL CREDTT LTNION REGULAR SAVINGS ACCOUNT: Account Number/Suffix 309366-00 D-ate Account Established 07/06/2007 Principal Balance at Date of Death $11,962.43 Accrued Interest to Date of Death $�•28 Total Principal and Accrued Interest $11,963.71 � Name of Joint Owner Richard Parsons Date Joint Ownership Established 07/06/2007 CHECKING ACCOUNT: Account Number/Suffix 309366-11 D-ate Account Estabiished 07/09/2007 Princioal Balance at Date of Death $11,443.48 Accrued Interest to Date of Death $0.20 . Total Principal and Accruad Interest $11,443.68 Name of Joint Owner Richard Parsons Date Joint Ownership Established 07/06/2007 iNVESTMENT SAVINGS ACCOUNT: Account Number/Suffix 309366-05 Date Account Established 06/23/2010 Principal Balance at Date of Death $44,182.01 Accrued Interest to Date of Death $9•�9 Total Principal and Accrued Interest $44,191.20 Name of Joint Owner � Richard Parsons Date Joint Ownership Established 06/23/2010 ViSA ACCOUNT: Account Number/Suffix 4672090000511980 D-ate Account Established 07/10/2007 � Principal Balance at Date of Death 0.00 Name of Joint Owner Cardhoider None MEMBERS 1ST FEDERAL CREDIT UNION �..C�c��C.17�-' Tessa L Klugh Lending Insurance Support Specialist Oetober 9, 2013 Estate of: Elizabeth Parsons Date of Death: 09/27/2013 Social Security Number: 168-26-3684 5000 Louise Drive • P.O.Box 40 • Mechanicsbwrg,Pennsplvania 17055 • (800) 283-2328 • wwwmei;nnberslst.org RE�.'-1510 EX+(OS-09) � pennsylvania SCHEDULE G - DEPARTMENTOFREVENUE INTER-VIVOS TRANSPERS AND 1NNERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Elizabeth P. Parsons 21-13-1061 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. DESCRIPiTON OF PROPERTY �M ;NCLUDE 7HE NAME OF 1HE TRANSFEREE,7HEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OF DECD�S EXCLUSION TAXABLE NUMBER TfiE DAiE OF TRA�dSFER. ATfACFI A COPY OF THE DEED fOR REAL ESTA7E. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1 Raymond James IRAAccount#71355987.Beneficiaries:Richard M.Parsons, Son,2232 Canterbury Drive,Mechanicsburg,PA 17055,Michae�K.Parsons, 171437.77 100 171437.77 Son,206 Lewisberry Road,New Cumberland,PA 17070,Elizabeth A. Parsons,Daughter,433 Stonehedge Lane,Mechanicsburg,PA 17055 TOTAL(Also enter on Line 7, Recapitulation) $ 171437.77 If more space is needed,use additional sheets of paper of the same size. 06/2412014 15:45 17324945841 EAGLE PLANS INC PAGE 02/02 � m�� c�� mw � t� aQ '" Wy � G71GVIV �� {mva �'''� e � j °' 5 � �+' caaaa� G' ^� .irvm�, o s� �, � e��' �' � �ti °' o°or� �� WANtDOcDI�►�'O �' ec ,�~,.�$ m �.a�.�.� � vc ��., ow° � wrw '" � °-: °, � m��$Q a� � �a wwn+ ctim -,, � � �w° � OGC7v ..• �r•- m ��Z�,o �� Q�a�, m �' e�p � n.m 0 m � m� l��p 7��C 4�y � �� + � �A�� :b a � . b�� m� Q.r4 y� �� ..r�� 7�Q� fA � s �� h >iX �x �� Q � � `�2� m �. �� m ��q�� v y�� •� `� 01 O 'Tl N A~1 I�V N CTI �� CS� � S � b� �� s� +� � a -i -1 ^p �pri-� wC.� ww .i �� hm' w � � zOom � '� a� � �* �'��Q �d �m °��° °z� ��°�� m �y .. �'��' oy��`°�� m � aQm�'�aZ �� n�io 0 �? ro� �`�' �� w�� „r,� �� az � nC�cm � C �� m �� ' � � ° � ooa��' �v�, m :~ � � ' � �frima � Q �Q�� 5�-b � b�� Q��Z a ,.y�',� S� � �� e �oC CZ � � a `I n w w � Q _ ,� G� QA�-{ �,b � �� G � �? 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DEPARTMENT OFREVENUE FU N E RAL EXPE NSES AN D 1NHERITANCE TAX RETURN AD NII NISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Elizabeth P. Parsons 21-13-1061 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AM4UNT A. FUNERAL EXPENSES: 1' Hollinger Funerai Home, inc. $4,141.07 2. Funeral Luncheon $550.00 3. The Nancy Painter Home for Mothers and Children, Inc.-memorial donation $50.00 $0.00 e. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personai Representative(s) RiChBrd M. PBrsons Street Address 2232 Canterbu rr�Drive __ �;�y Mechanicsburg _ _ __ _______state_ PA ZIP,17055__ Year(s)Commission Paid: Z• Attorney Fees: 1.200.00 3• Family Exemption: (If decedent's address is not the same as claimant's,attach,explanation.) Claimant Street Address City _.....____State__ZIP-----.--.--_ Relationship of Claimant to Decedent 4• Probate Fees; $398.50 5• Accountant Fees: 6• Tax Return Preparer Fees: �. Misc.postage $4.90 a. Reserves to conclude Estate administration,final accountings $600.00 TOTAL(Also enter on Line 9, Recapitulation) $ 6,944.47 If more space is needed,use additional sheets of paper of the same size. , 06-24-'14 11 :17 FRO�- Hollinger FH 717-486-3433 T-456 P0002/0002 F-916 �� • qr �i �� A. . . Holiinger F�ne�al Home&Crennatorq, Inc. Eric L.Ho[Iin�er.Superalsor January 29,2d14 Marc Parsons Z232 Canterbury Dr. Mechanicsbur�, Pa 17055 � The Funeral Service for Efizabeth Parsons: We sincerely appreciate the confidence you have placed in us and wii!continue to assist you in every way we can. Please fee!fsee to cantact us if you ha�e any questions in regard to this statemenC. THE FOLLOWfNG fS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITfES,AUT�MC?TIVE EQUIPMENT, AND M�RCHANDISE THAT YOU S�LECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. Professional Service Cremation Package C—Memorial/Graveside Servites $3045.00 Merchandis� Memorial Pkg.-register book,falders,acknowle�dgements 1�5.00 AT THE TIME FUNERAL ARRANGEM�NTS WERE MADE,WE ADVANCED CERTAIN PAYMENTS TO QTHERS AS AN ACCOMMORATI�N. THE FOI.I.OWING IS AN ACCOUNTING �OR THOSE CHARGES. Cash Advances Certified Copies of Death Certificate(20 Q$6j 120.00 Cumberland County Coroner's Authorization 30.00 Patriot 468.07 Clergy-2 priests Z75,pp Organist 75.00 Fiowers—2 alter�ases w/tax 53.U0 Totai Charges $4141.07 . �y 501 NQRT�I B�AI.TIMQRE A17ENllE � MdUNT HtaLLY SPAIi�TGS.PE1�tNSYLVANIA 1T065 • (717)4$6-3�33 • PAX(7.17)488-�Q15 Ww�.hqlIfngerfuneralhome.cam . REV-1512 EX+(12-08) � pennsylvania SCHEDUI.E I DEPAHTMENT OF REVENUE DEBTS OF DECEDENT, 1NHERITANCE TAX REfURN MORTGAGE LIABILITIES & LIENS RES:DENT DECEDENT ESTATE OF FILE NUMBER Elizabeth P. Parsons 21-13-1061 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• Verizon-final bill for 700 Cocklin Street $1,309.86 2. PPL-final bill for 700 Cocklin Street $1,021.42 3. United Water-final bill for 700 Cocklin Street $218.26 4. Misc.bank fees for estate checking acxount $48.85 5. Buchanan&Erb Hea6ng Oil-final bill for for 700 Cocklin Street $4,286.91 6. Cumberland County tax claim for delinquent 2013 taxes $1,310.98 7. Borough of Mechanicsburg-sewer and trash bills for 700 Cocklin Street $277.20 8. Pinnacle Health-final medical bill for decedent $50.00 9. Holy Spirit Hospital-final hospital bill for decedent $60.00 10. William Goodling,Contractor-misc.repairs to secure/maintain decedent's residence prior to sale $6,713.00 11. Lester Vogelsong,painter-painting repairs to 700 Cocklin Street $3,321.00 12. Walgreen Pharmacy-decedent's final pharmaceutical bill $300.00 13. West Shore EMS-final bill-decedent's ambulance seroice $50.00 14. John Rowe Lawn Service for decedenYs residence at 700 Cocklin Street $856.00 15. Mike Stoner,snow removal for decedenYs residence at 700 Cocklin Street $110.00 16. TruGreen Lawn Service-final bill $106.97 17. Visiting Angels and misc.caregiver fees through date of death $855.50 18. Chase credit card-decedent's final credit card statement $1,657.24 TOTAL(Also enter on Line 10, Recapitulation) $ 22,553.19 If more space is needed,insert additional sheets of the same size. REV-1513 EX+(01-10) � pennsylvania SCHEDULE � DEPARTMENT OF REVENUE INHERITANCE TAX RETURN IBENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Elizabeth P. Parsons 21-13-1061 NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY RE o NotSL st Trustee(S�NT AMOOF ESOTATE ARE I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec.9116(a)(1.2).) 1. Richard M.Parsons,2232 Canterbury Drive,Mechanicsburg,PA 17055 Son 33.33% 2. Michael K.Parsons,206 Lewisberry Road,New Cumberland,PA 17070 Son 33.33% 3. Elizabeth A.Parsons,433 Stonehedge Lane,Mechanicsburg,PA 17055 Daughter 33.33% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 151"HROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A, SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II— ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size.