HomeMy WebLinkAbout07-23-14 (2) � 1505610105
REV-1500°``�-""�''�
oF�cuu.uae oN�r
PA DepartmeM of Revenue �� ;o�Code Year File Nwnba
Bureau of Indtvtduat Taxes INHERITANCE TAX RETURN ��/ � // /�
Po aox s8o6oi
HaMsbu�,PA s�i28-o6oi RESIDENT DECEDENT / CO�J
�
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date oi Bkth MA�DDYYYY
' 10/24/2013 12/07/1921
DecedenYs Last Name Suffix DecedeM's Fkst Name MI
___ _-_ _ __ _
' MURTOFF RUTH K
(If Applfcabl�)EMer Surviviny 8pouse's Information Below
Spouse's Last Name Suifix 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 Retum O 2.Supplemental Retum O 3. Remainder Retum(Date oi Death
Priorto 12-13-82)
p 4.Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Retum Required
deaM atter 12-12-82)
� 6.Decedent Died Testate O 7.Decedent MaiMained a Uving Trust 0 8. Total Number of Safe Deposit Boxes
(��PY of Will) (Attach Copy of TrustJ
O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Sd�edule O)
CORRESPONDENT-THIS SECTION IIUST BE COMPLETED.ALL CORRESPONDENCE AND CONFlDENTIAL TAX INFORMATION SFIOULD BE DNlECTED TO:
Name Daytime Teleplwne Number
Robert G Murtoff (717)258-3768
,
, >-:_� _
REGIST �F`�INILLS 113�ONLY ��
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rJt7'�j i-° i- -�
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Firat Line of Address '
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PO Box 274 ��`' w �
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Sec�ond Line of Address ��:^ '� - - ?��;
_ _ ..,_ _ ,._..
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,.. -�-"'_I :. r . .
City or Post OIBoe State ZIP Code ����� �'`� ~ �
____.
'Boiling Springs PA 17007
Comspond�M's amail addr�ss:robmurt@aol.com
Under penaltisa d perjury.I dedare tliat I have examined thfs retum�kiduding acoortiDe�sd�edubs ard sta�MS.and b the best oT my Imowlstlpe and belief,
k ic true.oorrect and comPle�.Dsclarallon ot preparer other tlian the PB►sona�nD►eeenfatlre k bassd on ap kitortnatbn d which preparer has arry krwwledge.
SIGNAT O PER� SPONSI � IN� G RET�RN 7^�3 — ?�/� DATE
ADDRESS
PO Box 274, Boiling Springs PA 17007
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEAEE U8E ORIGINAL FORM ONLY
Side 1
L 1505610105 1505610105 J
�
� 1505610205
REV 1500 EX(FI)
DecedenYs Social Security Number
_
oecedenrs Nair�e: RUTH K MURTOFF
RECAPITULATION
1. Real Estate(Schedule A). ............................................ 1. :
2. Stocks and Bonds(Schedule B) ....................................... 2. '
3. Cbsely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3.
4. Mortgages and Notes Reoeivable(Schedule D)........................... 4. ;
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. ' 117,243.58 ,
6. Jandy Owned Property(Schedule F) O Separate Billing Requested ....... 6.
7. Inter-�vos Transfers 8 Miscellaneous Non-Probate Property - -- - _ __
(Schedule G) O Separate Billing Requested........ 7. 'i
8. Total Gross Assets(total Lines 1 through 7)............................. 8. 117,243.58 !
9. Funeral Expenses and Adminishative Costs(Schedule H)................... 9. '' 6,045.61 I
10. Debis of Decedent,Mortgage Liabilitles and Liens(Schedule I)............... 10. : 36,624.92 "
11. Total Deductions(total Lines 9 and 10)................................. 1L ' 42,670.53
12. Net Value of Estata(Line 8 minus Une 11).............................. 12. 74,573.05 ;
13. Charitable and Govemmental Bequests/Sec 9113 Tnists for which _ _. _
an election to tax has not been made(Schedule J) ....................•••. 13. ;
_ _ _. .
14. Net Valus Subjoct to Tax(line 12 minus Line 13) ........................ 14. ! 74,573.05
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Lir►e 14 taxable
at the spousal tax rate,or
transfers u�der Sec.9116
(a)(1.2)X.0_ 15.
16. Amount of Line 14 taxable . _ . .. _ _ . _, .__ ,__ _. , ..
at uneel rate x.0 45 ' 74,573.05 ! �g, 3,355.79
__ _ _ __ _ __ _ __._ . _._ - -__
17. Amount of Line 14 taxable
at siWing rate X.12 ', 17.
18. Amount of Line 14 taxable _ _ .
at oollateral rate X.15 ' 18.
19. TAX DUE ......................................................... 19. 3,355.79 i
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) Paye 3 FIM Numb�r
Decedent's Complete Address:
oeNrs w►r�
RUTH K MURTOFF
S7REETADDRESS
801 N Hanover St
CITY STATE ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 3,355.79
2. CreditslPayments
A.Prior Payments 2,700.00
B.Discount 142.10
Total Credits(A+B) (2) 2,842.10
3. Interest
(3)
4. If Line 2 is greater than Line 1+Line 3,ent�the diflerence. This�s the OVERPAYMENT.
Fill in oval on Pape 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) 513.69
Make check payable to: REGISTER OF WILLS,AGENT.
� e^s.'°� ,,.,�G� �`+ s• -ia .��- �ztt' y; e.saa�'a,"� �'+,,� `€ � �-�.r v`�`�:�". %�.�.: �.SS""�'��. ,'�,�x� �`+ „aS"'�w`a*<.'"�, ?,,;Y..
,�.�., .` .. . .��-��.,-��sa� �..�,�'�:'::>..�n ..,a_.�.. :0 5. ., � ...�:., .w�.��-�- �_-.:�����-=`s' .U��., . ..�':.��'�Ua�'.. �_....'v�°-��
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�e property transfemed.......................................................................................... ❑ �
b. retain the right to designate who shall use the property transferred or its incon�e ............................................ ❑ �
c. �etain a reversion�y in�e�est.............................................................................................................................. ❑ �
d. reoeive tl�e promise for 1'rfe of either payrtients,benefils or ca�e?...................................................................... ❑ �
2. If death oxurred ai�er Dec.12,1982,did decedent trar�sfer propeAy within or►e year of death
without reoeiving adequa�oonsideradon?.............................................................................................................. ❑ �
3. Did decedent own an"in bust ta"or payable-upon�death bank account or securiry at his or her death?.............. ❑ �
4. Did decedent own an individual retiremeM acaount,armuity or other rwn-probate properiy,which
contains a benefic�ary designatia�? ........................................................................................................................ ❑ �
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETURN.
�� �� �, � ,
. � ;��,.� � _� �������- _ � �5� � �
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For dates of deaih on a after July 1,1994,and before Jan.1,1995,the tax rate imposed on tl�e net value of transfers to or for the use of the surviving spouse
is 3 percent[72 P.S.§9116(a)(1.1)(i)j.
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to a for the use of the survnring spouse is 0 perceM
[72 P.S.§9116(a)(1.1)(ri)].The statute does not exempt a Uansfer to a sun�iving spouse irom tax,and tlie statutay requiremenls for disdosu�of assets and
filing a tax retum are still applicable even ff tlie surviving spouse is the ony benefiaary.
For dates of death on a after Juhr 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 a a stepparent of tl�e chiid is 0 percent[72 P.S.§9116(a)(1.2)j.
. The tax rate imposed on tl�e net value of transfers to a for the use of the deoedenfs 6neal benefiaaries is 4.5 percent,except as no�ed�[l2 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 Sec6on 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
REV-i5o8 EX+(o8-u)
�pennsylvania SCI�IEDULE E
r�� DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
RUTH K MURTOFF 2013-01163
Include the proceeds of litigafion 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 1st Federal Credit Union,5000 Louise Drive,P.O.Box 40,Mechaniscburg,PA 17055
account#271431-00;Regular Savings 5.19
2. Members 1 st FCU(see address above);account#271431-05;Investment Savings 82,241.19
3. Members 1st FCU(see address above);account#271431-11;Checking 2g�ggg,5�
4, Orrstown Bank,Operations Center,2695 Philadelphia Ave.,Chambersburg,PA 17201
account#106003069;Checking 458.32
5, 2005 Hyundai Elantra(selling price) 4,500.00
g, Church of God Home;refund of overpayment 1,039.37
TOTAL(Also enter on Line 5, Recapitulation) $ 117,243.58
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(08-13)
�� pennsylvania SCHEDULE H
��+���uE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
RUTH K MURTOFF 2013-01163
Deadent's debts mud be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' First Lutheran Church,21 S Bedford St,Carlisle PA 17013;funeral reception 259.56
2. Baughman Memorial,41 S Bedford St,Carlisle PA 17013;grave marker 1,081.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: 2,000.00
Name(s)of Personal Representative(s) Robert G. Murtoff
Street Address PO Box 274
�;�, Boiling Springs state PA ZIP 17007
Year(s)Commission Paid: 2014
2,000.00
2. Attomey Fees:
3. Family Exemption:(If decedent's address is not the same as claimanYs,attach euplanadon.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. probate�ees: 353.50
5. Accountant fees:
6. Tax Retum Preparer Fees: 290.00
�• Certified postage 35.55
s. 2012 and 2013 PA income tax due 26•00
25
TOTAL(Also enter on Line 9, Recapitulation) ; 6,045.61
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
RUTH K MURTOFF 2013-01163
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,inciuding unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1• PA Department of Pubiic Welfare;Reimbursement of inedical assistance 36,570.40
2. Alert Pharmacy,219 N Naltimore Ave,Mt Holly Springs PA 17065;medications 54.52
TOTAL(Also enter on Line 10, Recapitulation) � 36,624.92
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
�pennsylvania SCHEDULE �
DE►ARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
RUTH K MURTOFF 2013-01163
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).J
1. Ruth M.Osbome,9 E.Linden Dr,Carlisle PA 17015 daughter 25%
2. Wiiliam A.Murtoff,9A Worcester Ave,Hudson MA 01749 son 25°�
3. Anne L.Hawbaker,509 N.Walnut St,Mt.Holly Springs PA 17065 daughter 25%
4. Robert G.Murtoff,PO Box 274,Boiling Springs PA 17007 son 25%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A, SPOUSAL DISTRIBUTIONS UNDER SECfION 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.
._ _ _ _ _ __ _ _ . _
�
s
MEMBERS 1'�
������
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix 271431-00
Date Account Established 09/13/2005
Principal Balance at Date of Death $5.19
Accrued Interest to Date of Death $0.00
Totaf Principal and Accrued Interes# �5.19
Name of Joint Owner None
INVESTMENT SAVINGS ACCOUNT:
Account NumberlSuffix 271431-05
Date Account Established 03/04/2006
Principal Balance at Date of Death �82,22$•2h
Accrued Interest t�Date of Death $12.95
Total P�ncipal and Accrued Interest $82,241.19
Name of Joint Owner None
CHECKING ACCOUNT:
Acx�ount NumbedSuffix 279431-11
Date Account Established 09/13/20U5
Principal 6alance at Date of Death $28,��•s�
Aocrued Interest fio Date of Death $0.91
Total Principai and Accrued Interest $28,999.51
Name of Joint Owner None
MEMBERS 1sT FEDERAL CREDIT UNION
� —
Tessa L Klugh
Lending Insurance Support Specialist
July 10, 2014
Estate of: RUTH K MURTOFF
Date of Death: 90124l2013
Sociai SecuMty Number. 182-18-1458
�—
Printmail Group
ORRSTOWN gqNK Date 11/08/13 Page 1 - �
OPERA7'jONS CENTER Primary Account 106003069
2695 PHILADELPHIA AVENU� Enclosures
CHAMBERSBURG, PA 17201
Ruth K Murtoff
AlbertJ Murtoff�--(�dtcc�.sc� °1��1� ZOaS,
PO Box 334
Boiling Springs PA 17007-0334
CHECKING ACCOUNTS
Account Title Ruth K Murtoff
Albert J Murtoff
50+ Interest Checking Chedc Safekeeping
Account Number 106003069 Statement Dates 10/11/13 thru 11/11/13
Previous Balance 458.32 Days In The Statement Period 32
1 Deposits/Credits 363.00 Average Ledger 583.10
Chedcs/Debits .00 Average Collected 583.10
Service Fee .00
Interest Paid .00
Current Balance 821.32 2013 Interest Paid .27
Deposits and Additions
Date Description Amount
li/Ol XXSOC SEC SSA TREAS 310 363.00
PPD
Daily Balance Information
Date Balance Date Balance
10/11 458.32 11/O1 821.32 .
Interest Rate Summary
li/O1 0.010000%
THANK YOU FOR BANIQNG WITH ORRSTOWN BANK '
.� BALANCE AS OF DATE OF DEATH 10/24/13 idAS $458•32 (SEE ATrACHdENT)
Printed li/8/2013
' , i0/14 Deposit Iaquiry 15:13:28
,. K Murtoff Account aumber: 106003069
„losed Messages 1 of 1
Last stmt balance: . 00 Last stmt date: 12/10/13
Curreat balaace: .00 Statemeat cycle: 10
1=View 6=priat T=Tset Control: From To
Posted Check No S T/C Debit Credit Salance
8/11/13 151 .01000000� 4,732.26
9/03/13 C 163 363 . 00 5,095.26
9/10/13 160 .04 5,095.30
9/10/13 151 .01000000� 5,095.30
9/25/13 450 P 091 5,000.00 95.30
9/25/13 151 .00000000� 95.30
10/03J13 C 163 363.00 458.30
10/10/13. 160 .02 '�' 458.32
11/O1/13 C 163 363.00 821.32
11/O1/13 151 .01000000� 821.32
11/il/13 151 .01000000� 821.32
12/02/13 N 135 363.00 458.32
12/02/13 N 053 458.32 .00
12/02/13 151 .00000000� .00
Bottom
�'4=Redsply F6=Bal Iaq F7=Scan iPwd F8=Scan Bkwd F11=Prior bal F15=$FT F'16=Sort
E'17=Top F18=Bottom F19=EDI F20=IInfold F22=T/C F23=Checks
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244
CHRISTOPHER WARNER AUTOMOTIVE
P.O.BOX 220
8 FRONT STHEET F&AA TRUST
BOIUNG SPRWGS,PA 17007 �
p»j 2sa-s�a2 7/14/2014
PAY TO THE
OADER OF RUTH K MURTOFF ESTATE • �
$*4,�00.00
r n fiv Hund and 00/900
ouAc
RUTH K MURTOFF ESTATE
PD BOX 334
BOIUNG SPRINGS, PA 17007
�
MEt�o 2005 HYUfdDAi SDN KMHDN46D55U953903 �_ "'��
�������� ���' - -------�------
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CH OF GOD HOME, INC -
801 N.HANOVER STREET ����-o,
CARLISLE, PA 17013
RESIDENT# UNIT STMT. DATE
2125 H213A 03l31/2014
RESIDENT S
r - ROBERT MURTOFF ��`' � � Ruth K. Murtoff
.J u PO BOX 274 �G�,-�� �1-� ,
BOILING SPRGS, PA 17007 TOTALAMOUNT DUE -$1 039.37
DETACH AND RETURN TH1S PORTION WI
TH YOUR REMITTANCE $ �� ��`� �
AMOUNT REMITTED
DATE DESCRIPTION �a�� CHARGES CREDITS BALANCE
Units
Balance Forward 7,249.43
06/20/2012 Shampoo &Blow Dry 1 166.80 7,082.63
Ol/31/2013 Security Deposit-Nursin� 1 8,122.00 -1,039.37
Please call the billing office at 717-8b6-3256 with any statement questions.
All checks should be made payable to Church of God Home. Please use the enclosed envelope
to mail your payment.
RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 T OUNT D
2125 -1,039.3? 0.00 0.00 0.00 0.00 -$1,039.37
RESIDENT NAME Ruth K. Murtoff �°""�'01
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E:tTRA R�Y��RDS SA111NG� � pp 6.3q
TOTAL SAV�M65 ° ^ , . '�r ;.j:i;t��� f'ili►17.. ,
, � � , •.� ,�z ';i,pfn�;:.
� .��•r� f���:trP�� -i ,: 1 .R i r,•
�x�■x�rx RrWARD°� PGI��":: $111'NRjI<�l C N:re
E"<srn Ru�leew . _ F_t, .,r:�•u.0 �!•,
- -- l� .Ci9 i 1 :3 �3 c� 'r,� � � ,
3i�
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, :,yr�xs•. ;k:ix:,.FY�'�• - • _....... ,. „ _ '�'�'�{�./� . . . .
(``�
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. . d � �Price � � ���'�. , '' �T,
-�, ..�� � �,'''�?` ��`�, ° 1 �� �� ��.�
� _..
�81�20y"'ZCII�O�'k.f�Inc. °�sz:� -�"� '�.�i.C���.> r € , ��,
� 23-25 South Main Street � 10 First Avenue �G%�j� ���'�
Dover, PA 17315 Red Lion, PA 17356
Telephone (717) 292-2621 Telephone (717j 244-i 828
Fax (717}292-7936 Fax (71� 417-5263
E-mail in#oC�baughmanmemorials.com E-mail lori@baughmanmemorials.com Totat rice { �t° �} �- ��'
,. p �
Date x .f �% �`�
� . �� : - �°
For ' s � ° '� —
-,;, _r
Address �' � ;`" , ;,f� ��L�- . r;'�.�:� ;! x � b e Y fP�..��:
�`
Design No.
Material ,r;� _..,...j y;�, ,,.�
��
Die
Base
Markers � `'^ � ��`�° � ';'�
Posts
Vases
, �. �_
Price j `' '` �,;� ' Tax ,�..�..�..�.
Deposit
Balance Due
Style of Letters _ ��
Foundation to be furnished by ��`'`a ;`�>����`�y�'�
Material to be best selected monumental grade and to be free from imperfections and first class in every way.Work to be finished in a workmanlike
manner. ° �:'
This memorial to be erected in �.-'�'�"`f ��'%+#�` '� ��'�� Cemetery in or near
during the month of ��.- 3�°���`'' �'.�y°�'"��'+ '�''�� unless unavoidably delayed by labor
troubles and other contingencies beyond our control and then as soon as possible.Additional lettering and other work on this memorial in the future is
not included in the Contract Price.
Title and right of possession and removal of said stone,monument or appurtenances shall remain for all purposes in Baughman Memoria!Works,
Inc.until work and materials ordered are fully paid by purchaser or purchasers.ln consideration of the acceptance by Baughman Memorial Works,Inc.
of this order,the undersigned(hereinafter known as tne purchaser)agrees to pay Baughman Memorial Works,Inc.
f 'a '4
/ ;,` �' � . u�' :„=• Dollars on or before the 15th day following
the billing of the work or job upon compleiion thereof by Baughman Memorial Works,Inc.Thirty(30)days from date of invoice a 1-1/2%finance charge
will be added to the unpaid balance. Said billing to be notice of completion thereof,this order shall become a contract between the purchaser and
Baughman Memorial Works,Inc.upon acceptance thereof in the space below by a duly authorized representative of said Baughman Memorial Worlcs,
Inc.It being understood that this instrument upon such acceptance covers all of the agreement between the purchaser and Baughman Memorial Worics,
Inc. and that no agent or representative of Baughman Memorial Works, Inc. has rUade any statements or agreements,verbal or written, modified or
adding to the terms and conditions herein set forth.
It is further understaod that upon the acceptance of this order the contract so made cannot be cancelled,altered,or modified by the purchaser or
by any agent of Baughman Memorial Works,Inc.in any manner except by agreement in writing between the purchaser and Baughman Memorial Works,
Inc.and it is hereby understood and agreed by all parties involved that in case of default by purchaser or purchasers,twenry-five per cent of the total
original cost of the work or work and materials ordered,as the case may be,shall be a specified correct sum as liquidated damages which purchaser
shatl owe Baughman Memorial Works,Inc.less any payment on account made prior to such defauli,this specification of damages to be due regardless
of removal and taking possession of stone,monument or materials from purchaser or purch�sejs by Bau�hman I�mo��o s, Inc.upon following
such defauk. t:� '� ,'��'�,��.�_.--'� i�l�`s�''` t �...�_� (SEAL)
� _.. ,�f: ..
T�: v 20� � (SEAL)
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o,...,.�....,,., �e,...,,,.,,.i�ni...�� i..� n...,..,.,�i [2�� :�"'''.. . . � a#; e�=,`c= :d.:,a (SEAL)
4 ' �
RECEIPT FOR PAYMENT
GLENDA FARNER STRASBAUGH Receipt Date: 11/O1/2013
Cumberland County - Register Of Wills Receipt Time: 13 : 10 :27
One Courthouse S uare Receipt No. : 1076099
Carlisle, PA 17�13
MURTOFF RUTH K ��
��
Estate File No. : 2013-01163
Paid By Remarks : ROBERT MURTOFF
DBl
------------------------ Receipt Distribution ------------------------
Fee/Tax Description Payment Amount Payee �ame
PETITION LTRS TEST 90 . 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
INVENTORY 15 . 00 CUMBERLAND COUNTY GENER.AL FUN
INH TAX RETURN . - CUMBERLAND COUNTY GENERAL FUN
---- -----------
Check# 2644 $183 .50
Total Received. . . . . . . . . $183 . 50
. t
R�CEIP� ��R PAYIKENT
LISA M. GR.AYSON, ESQ. Receipt Date: 7/21/2014
Cumberland County - Register Of Wills Keceipt Time : 09:38 :47
One Courthouse S quare Receipt No. : 1078595
Carlisle, PA 176Z3
MURTOFF RUTH K
Estate File Na. : 2013-01163
Paid By Rema�ks : ROBERT MURTOFF
DMB
------------------------ Receipt Distribution ------------------------
Fee/Tax Description Payment Amount Payee Name
AF3D PROBATE' FEE 1"7 0 . 0 Q eL7MBERL,�l'�TD et3fi.T1�TT� GEhTER.P;L FUN
----------------
Cheek# 004Q933750 $170.04
Total Received. . . . . . . . . $170 . 00
� ,� ,
�;---
! .,�E� ��IoP�.�' z� zr l� No. �
_ �_, DATE� ��
RECEIVED F M "� �"' �
__� _ _ DOLLARS
QFOR RENT Z� .� �� �C.7�I � ���
��- �i�L
ACGOUNT O CASH �L�
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PRYMENT �CHECK FROM TO �O
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BAL DUE OCREDIT
CARD � 8Y
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SWOPE TAX SERVICE
182 FAITH CIR
CARLISLE, PA 17013-8870
(717) 24Q-0823
swopetaxservice@comcast.net
June 24, 2014
RUTH K. MURTOFF
P.O.BOX 334
BOILINGS SPRINGS,PA 17007
Statement of Charges for Services Rendered:
Per Form Charges:
See forms listed below-Federal 110.00
Miscellaneous Fees and Adjustments:
PRICE INCLUDES COPYING AND ACCOUNTING FEES 0.00
Total fee $ 110.00
Summary of Federal Form Charges:
Description Charge per Form Count Charge
Form 1040 Individual Income Tax 80.00 1 80.00
Medical Expenses Worksheet 5.00 1 S.OQ
Schedule D Capital Gains&Losses 15.00 1 15.00
Form 8949 Sales/Disp of Cap Assets 10.00 1 10.00
_ _ _ _
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SWOPE TAX SERVICE
182 FAITH CIR
CARLISLE, PA 17013-8870
(717) 240-0823
swopetaxservice@comcast.net
June 24, 2014
RUTH K. MURTOFF
P.O.BOX 334
BOILINGS SPRINGS, PA 17007
Statement of Charges for Services Rendered:
Per Form Charges:
See forms listed below-Federal 90.00
Miscellaneous Fees and Adjustments:
PRICE INCLUDES COPYING AND ACCOUNTING FEES 0.00
Total fee $ 90.00
Summary of Federal Form Charges:
Description Charge per Form Count Charge
Form 1040 Individual Income Tax 80.00 1 80.00
Medical Expenses Worksheet 5.00 1 5.00
Schedule D Capital Gains &Losses 5.00 1 5.00
,�,�� y.,..�.. �.. ..�„�"° . �� - _ .
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SWOPE TAX SERV 1�,�
182 FAITH CIR
CARLISLE, PA 17013-8870
(717) 240-0823
swopetaxservice@comcast.net
June 24, 2014
RUTH K. MURTOFF
P.O.BOX 334
BOILINGS SPRINGS, PA 17007
Statement of Charges for Services Rendered:
Per Form Charges:
See forms listed below-Federal 90.00
Miscellaneous Fees and Adjustments:
PRICE INCLUDES COPYING AND ACCOUNTING FEES 0.00
Total fee $ 90.00
Summary of Federal Form Charges:
Description Charge per Form Count Charge
Form 1040 Individual Income Tax 80.00 1 80.00
Medical Expenses Worksheet 5.00 1 5.00
Schedule D Capital Gains &Losses 5.00 1 5.00
_ .�
twtun� rnl� CARLISLE MPO .
BOILIi� SPRING , ernsyivania
�"" , � 17���8 GARLISLE, Pennsylvania
4134870U07 -0097 170139998
12/10/2013 t717)258-6668 03:46:02 PM 4134870013 -0098
07/21/2014 (800?275-8777 10:01:32 lU4
Sales Receipt �—
Product Sale Unirt Final Sales Receipt
Description Qty Frice Price Product Sale Unit Finat
Description Rty Price Price
HARRISBURG PA 17105 Zone-1 $0.46
First-Ctass Mail Letter HARRISBURG PA 17105-8486 Zone-1 $0.49
0.30 oz. First-Class Nait Letter
Scheduled Oelivery Day: Wed 12/11/13 0.40 oz.
Return Rcpt (Green Card) $2.55 Expected Delivery: Tue 07/22/14 2-70
99 CerYified $3.10 Return Rcpt (Green Card) �3.30
Labei #: 70123050000�28434054 (+p Certified
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Issue PUI: � - 70140510000237510512
� _____�_�
� Issue Posta9e: $6'49 , .�
Total: � $6.� �
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Change D�: -$13.89 paid by:
Gash $10.00
Q9 For tracking or inquiries go to Change Due: -53.51
USPS.com or call 1-800-222-1811.
Orde►^ st�s at usps.com/shop or call t+0 Por tracking or inquiries 9a to
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Go to: https://postalexperience.com/Pos
Bill#: 1000205990301
TELI US ABOUT YOUR RECENT Cierk: 07
POSTAL EXPERIENCE
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yOUR OPIWION COUNTS Refunds for guaranteed services only
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,�— BOILING SPRIN�S, PennsYlvania
170079998
4134870007 -�99
07/07/2014 (717)258-6668 02:54:57 PM �
Sales Receipt
Product Sale Unit Finai
Description Qty Price Price
HARRISBURG PA 17129-0�02 Zone-1 $0.49
First-Class Mail Letter
1.00 oz.
Expected Delivery: Tue 07/08/14
� Certified $3.30
USPS Certified Mail #:
��JJ�) ��� �O S'�} <r �! 70123050�00028445197 `_ ________
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Issue PVI: $3.79
KANSAS CITY MO 64999 Zone-5 $0.70
/�61 ��x ��fjQ,�,i S - First-Class Mail Letter
� l Expected Delivery: Thu 07/10/14
Q� Certifled $3.30
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Issue PVI: $4.00
KANSAS CITV MO 64999 Zaie-5 $0.49
First-Ciass Mail letter
1.00 oz.
Expected Delivery: Thu 07/10/14
Q�I Certifiied $3.30
USPS Certified Mail #:
• 7012�028445210 _r___�
Issue PVI: $3 79
, KANSAS CITY ht0 64999 Zone-5 $0.49
First-Class Mail Letter
0.90 oz.
Expected Delivery: Thu 07/10/14
�i Certified $3.30
t1SPS Certified Mail #:
7012305000002&145227 '�^�--
� Issue PVI: $3.79
HAf�2ISBUR� PA 17129-0001 Zone-1 �0.49
First-Class Maii Letter
0.90 oz.
Expected Deliv�y: Tue 07/08l14
/� Certified $3.30
USPS Certified Mail �:
� 70123050000028445234 ^—/
Issue PVI: r $3 79
• HARRISBURG PA 17129-0001 Zene-1 $0.49
F1rst-Class Mail Letter
0.90 oz.
Expected Delivery: Tue 07/08/14
�G1 Certified $3.30
USPS C�tified Mail #:
76123050000028445241 `
Is�sue PYI: . --$3.79
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182-18-1458 MU 120091U055
PAYMENT AMOUNT
MURTOFF
RUTH K 717-258-3768
9 .00
PO BOX 334
B O I L I N G S P R G S Mske d�k°r"'°'�ey°�de�
P A DE P A RTMENT US E ONLY �b�e to ti►e F+e�osy�+ran�a
17 U�7 � �e�M°f Revenue
L _J
� PRIMARY SSN CHECK DIGIT SPOUSE'S SSN �
1 8 2 1 8 1 4 5 8 M U 13D0910D54
u►sr r�e �asr ruMe MI PAYMENT AMOUNT
URTOFF RUTH K
SPOUSE' UST NA E RST NAME MI
PIRST LINE OF ADDRESS 1 7 O �
0 BOX 334
SECOND LINE OF ADDRESS
CITY STATE ZIP PHONE NUMBER Make check or money orde�
OILING SPRIN PA 17�D7 7b?-258-3768 PaYabietothePennsylvania
Department of Revenue
DEPARTMENT USE ONLY
� � , � �
� COMMONWEALTH OF PENNSYLVANIA �
BUREAU OF PROGRAM INTEGRITY
DIVISION OF THIRD PARTY LL461LITY '
RECOVERY SECTION
- PO BOX 8486
HARRISBURG,PA 17105-8486
December 18,2013
STATEMENT OF CLAIM SUMMARY
NAME Estate of MURTOFF,RUTH
ID 930 310 183
MEDICAL CLASS 3 CLASS 5.1 TOTAL
INPATIENT .00 .00 .00
OUTPATIENT _00 _00 .00
LONG TERM CARE _00 36,570.40 36,570.40
DRUG .00 .00 .00
REIMBURSEMENT TO DPW .00 36,570.40 36,570.40
_ _ _ __
COMMONWEAITH OF PENNSYLVANlA
DEPARTMENT OF PUBLIC WELFARE
E!N- 23-6003113
_ ___..
- �����"�':�'�1,:_.�2�°��1�" �`f��4�[_:_��'�'t�d�`� ��. -'�'--��i3t�`���5-;-"��,-�i$`b�- --- --- --------
, . . . . '' , ; . .
.
�* ACTIVITY FOR MURTOFF, RUTH K -MURTR3 - -803056
10/04/13 9035932 45 dS-CAL SUO+D CHEW O1 * 4 :55- - --- - - ,-pp �;59_
10/04/13 9035932 60 OS-CAL 500+D CHEW O1 * 8.35 .00 8.35
10/13/13 9125128 5 ATROPINE 1% EYE 5 01 30.42 .00 30.42
t���
�� �- o��-, ��-�51� DUE
. o0
30.42 3 . 80 i
LEGEND NON-LEGEND F ToTA�Tax !
FOR MONTH FOR MONTH
�evious Balance Charges this month Finance Cha e Tom�rayme�e s creatts AMOUNT 1
20.30 +; 38 . 77 + . 00 = 59. 07 - 4 . 55 - 54 . 52
'OR ALL PHARMACY RELATED INQUiRES PLEASE CALL Alert Pharmacy Services, Inc at 1-800-266-9954
Statement Terminology on reverse
----�.
�NWEALTH OF PENNSYLVANIA i�EV-1 762 EX{11-96)
DEPARTMEP(T OP REVENUE .
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRI58URG,PA 17128-0601 �
PENNSYLVANIA
�ECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT NO. CD 018690
MURTOFF ROBERT G
PO BOX 274
BOILING SPRINGS, PA 17007
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
--'—" (old
"""_"_ """"_
101 � S 2,700.00
ESTATE INFORMATION: ssrv: �
F��E tvunnBER: 2113-1 163 (
DECEDENT NAME: MURTOFF RUTH K I
DATE OF PAYMENT: 01/23/2014 �
POSTMARK DATE: 01/23/2014 �
couNTY: CUMBERLAND �
DATE OF DEATH: 10/24/2013 �
�
TOTAL AMOUNT PAID: 52,700.00
REMARKS:
CHECK# 53
INITIALS: CJ
SEAL RECEIVED BY: LISA M. GRAYSON, ESQ.
REGISTER OF WILLS
TAXPAYER
I�.
U
LAa?' WILL AND TESTAN�EN'T
OF
RUTH K. 1VIURTOFF
I, RUTH K. MURTOFF, of the Borough of Carlisie, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do make,
publish and declare this as and for my Last Will and Testament, hereby revoking and
making void any and all former Wills, Codicils, or writings in the nature thereof, by me at
any time heretofore made.
FIRST: I hereby order and direct my Executor, hereinafter named, to
pay all my just debts, funeral expenses, testamentary expenses and all Inheritance,
Estate, Transfer and Succession Taxes, as soon as may be conveniently done after my
death, out of my residuary estate.
SECOND: I give to my niece, MIMI ANN DEVENNEY, of East Street,
Carlisle, Pennsylvania, the sum of One Thousand ($1,000.00) Dollars.
THIRD: I give, devise and bequeath my residuary estate to my
husband, ALBERT J. MURTOFF, provided he survives me by thirty (30) days. .
FOURTH: A. Should my husband, ALBERT J. MURTOFF,
predecease me, I give, devise and bequeath our tall case clock to my son, ROBERT G.
MURTOFF.
B. I reserve the right to leave a list of personal property
which I may wish various of my children to have with this Will, and request that my
Executor honor that list of personal property, and distribute the property in accordance
with that list.
C. I give, devise and bequeath ail the rest, residue and
rernainder of my estate, real, personal or mixed, whatsoever and wheresoever situate, to
my children, RUTH A. OSBORNE, of Carlisle, Pennsylvania, ANNE L. HAWBAKER, of
Mt. Holly Springs, Pennsylvania, ROBERT G. MURTOFF, of Boiling Springs,
Pennsylvania, and WILLIAM A. MURTOFF, of Boston, Massachusetts, per stirpes. In
dividing said equal shares, my Executor shall take into account the value of the personal
property distributed above, except for our tall case clock, which I have left to my son,
ROBERT G. MURTOFF, on the understanding that he will not sell the clock, but pass it
down to another member of the family. I direct that his residuary share not be reduced by
the value of said tall case clock.
LASTLY: I nominate, constitute and appoint my son, ROBERT G.
MURTOFF, to be the Executor of this my Last Will and Testament. Should ROBERT G.
MURTOFF be my Executor, he shall receive as his compensation the sum of Two
Thousand ($2,000.00) Dollars. No Executor shall be required to file bond in this or any
other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
;�- �'�fay of , 2005.
� ��, ,
Ruth K. Murtoff.
SIGNED, SEALED, PUBLISHED and
DECLARED in the presence of:
�
�
2
.
COMMONWEALTH OF PENNSYLVANIA :
: ss
COUNTY OF CUMBERLAND :
I, RUTH K. MURTOFF, Testatrix, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will; that I signed it
willingly; and that I signed it as my free and voluntary act for the purposes therein
expressed.
Sworn or affirmed to and acknowledged efore me, by RUTH K.
MURTOFF, the Testatrix, this o1.L���-- day of 0 ,
2005.
�L�'�i� �
Ruth K. Murto , Testatrix
N ry Public
NOTARIAL SEAL
MERLENE J.MARHEVKA,NOTARY PUBUC
CARLISLE,CUMBERLAND COUNTY,PA
MY COMMISSION EXPIRES JUNE B,20�
�
�
Y
COMMONWEALTH OF PENNSYLVANIA :
: ss
COUNTY OF CUMBERLAND :
We, �3�..e� nd '
the witness whose names are signed t he attached or regoing instrument, being
duly qualified according to law, do depose and say that we were present and saw
Testatrix sign and execute the instrument as her Last Will; that she signed willingly and
that she executed it as her free and voluntary act for the purposes therein expressed; that
each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that
to the best of our knowledge the Testatrix was at that time 18 or more years of age, of
sound mind and under no constraint or undue influence.
Sworn or affirmed to and subscribed to before me b ��� � ..
and � = L�L.( this ���" day of �
2005.
U-� �
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Witness
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i
• itness
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No Public -
NOTARIAL SEAL
MERLENE J.MARHEVKA,NOTARY PUBLIC
CARLISLE,CUMBERLAND COUNTY,PA
MY COMMISSIOM EXPIRES JUNE 8,2008
4