HomeMy WebLinkAbout07-23-14 (4) � 15�561�105
REV-1500��oz_s�,�F�>, .�w
PA Department of Revenue P��yLv8n18 OFFICIAL USE ONLY
OEMAMEMlOFPEYBIYF
ureau of Individual Taxes County Code Year File Number
POBOXz8o6o1 INHERITANCE TAX RETURN �/ /� %
Harrisbur PA 1��2�pgp1 RESIDENT DECEDENT
ENTER DEGEDENT INFORMATfdN BEL4W
Social Security Number Date of Death MMODYYYY Date of Birth MMDDYYYY
184-38-1841 12/16/2013 08/11/1944 '
Last Name Suffix DecedenYs First Name
MI
Alleman Roxanne .
R
(IfAppiicable)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 DUPLIGATE WITH THE
_ REGISTER 4F WlLLS
FILL IN APPROPRIATE OVALS BELOW
� 1.Original Retum O 2.Supplementai Retum O 3. Remainder Retum(Date of Death
Prior to 12-13-82)
O 4.Limited Estate p 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Retum Required
death after 12-12-82)
O 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust _ 8. Totai Number of Safe Qeposit Boxes
(Attach Copy of Will} (Attadt Copy of Trust.)
O 9.Litigation Proceeds Received p 10.Spousai Poverty{kedit(Date of Death O 11. Election to Tax under Sea 9113(A)
Behrveen 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIUENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name
_ Daytime Telephone Number
Shauna R Garcia (717}329-3961
REGISTER OF WILLS USE OMt�,�
� �
w . _ �
First Line ofAddress �--�
�� � c� '"'
, } ,
219 Gold Finch dr �s��, r � r
��i� r`�a r A-'. r�
Second Line of Address ���-, ,� 4J �.`-
��, c_ - :-�l
C?C � � rm;
City or Post O�ce r'J' C- '_ C:
State ZIP Code DATE F. O� fi..� :T+
Palmyra PA 17078 D � �n�
CorrespondenYs e-mail address:ShaUfl8fOX8f1f1@ mail.com
UrxSer penalties of perjury,I declare that I have examined fhis retum,including accomparyying schedutes and stateme�s,a�d to the best of my Imowledge and belief,
it is true,correct and complete.Declaration of preparer ott�er than the personal representative is based on all infortnation of whidi preparer has any knowledge,
SI TU E F P�R ESPONSIBLE FOR FIUNG RETUR DATE 't
ADDRES � L Z ZQ J"T
2-1 � � � �L � 1�1� 7�YY� � �- I 7 G'� �
SIGNATURE OF PREPARER 07HEF2 THAN REPRESENTATtVE DATE
AQDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 150561D105 1505610105 J
��
J 1505610205
REV-1500 EX(Fl�
DecedenYs Social Security Number
DecedenYS Name: Roxanne Aqemen
RECAPITULATION
1. Real Estate(ScheduleA). ....... . .. .. ... .. ................. ........ .. 1. ' 133,000.00
2. Stocks and Bonds(Schedule B) ... .. .. . .. .. ... . . .. . .. ......... . . . .. ... 2.
3. Closely Held Corporation,Partnersfiip or Sole-Proprietorship(Scheduie C) . .. .. 3.
4. Mortgages and Notes Receivable(Schedule D)..... .. .. ... .... . .. .. ... .. . 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property{Schedule E)....... 5. 13,000.00
6. JoinNy Qwned Property(Schedule F) O Separate Billing Requested . .. .... 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Scheduie G) O Separate BiNiag Requested........ 7.
8. Total Gross Assets(total Lines 1 through 7).. .. .. . .. .. . .. .. ... . . .. ..... . 8. 146,000.00
9. Funeral Expenses and Administrative Costs(Schedule H).......... . .. ... .. . 9. 9,646.00
10. Debts of Decedent,Mo�tgage Liabilities and Liens{Schedule I).... .. ...... ... 10. 94,591.00
11. Total Deductions(total Lines 9 and 1Q).... ..... .. ..... ..... ......... .. . 11. 104,237.00
12. Net Value of Estate(Line 8 minus Line 11) ... .... ........... ....... .. .. . 12. 41,763.00
13. Charitable and Govemmental BequestslSec 9113 Trusts for which
an election to tau has not been made(Schedule J) .. ............ .. .. ..... . 13.
14. Net Yalue Subject to Ta�c(Line 12 minus Line 13) .. ................. ..... 14. 41,763.00
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amaunt of Line 14 taxabte
at the spousal tax rate,or
transfers under Sec.9116
{ax1.2)X.0� 15.
16. Amount of Line 14 taxabie
at lineal rate X.0 45 41,763.00 16, 1,879.00
17. Amount of Line 14 taxable _ _ _ _ _
at sibling rate X.12 ' ��
18. Amount of Line 14 taxaMe _ _ _
at collateral rate X.15 �$
19. TAX DUE . . .. ... ................ . .. .. ... .. .. ... ....... ....... ..... 19. 1,879.00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
Side 2
L 1505610205 1505610205 J
_
REV-1500 EX(FI) Page 3
File Number
Decedent's Complete Address:
DECEDENTS NAME
Roxanne Allemen
STREETADDRESS --- _
1083 West Trindle rd --
cirr -- ---- --
Mechanicsburg STATE - Z�p
PA 17055
Tax Payments and Credits:
1. Tau Due{Page 2,Line 19)
2. Credits/Payments t�� 1,879.00
A.Prior Payments _
B.Discount
3. Interest Total Credits(A+g) (2)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. {3)
Fill in ovai 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) 1,879.00
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 fiansfer 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 far 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 cansideration?...............
............................................................................................... ❑ �
3. Did decedent awn an'�n trusf far"or paya6le-upon-death bank account or security at his or her death?.............. ❑ �
4. Did decedent own an individual retirement account,annuify or other non-probate property,which
contains a beneficiary designa6on? .......................
................................................................................................. ❑ �
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS 1S 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 t�fore Jan. 1, 1995,the tax rale imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent[72 P.S.§9i16(a)(1.1}()).
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 statutary raquirements for disclosure of assets and
filing a tax retum are s611 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 valere af fransfers from a deceased child 21 years of age or younger at death ta or for the use of a natural parent,an
adoptive parent or a stepparent of the child is d percent(72 P.S.§9118(a){1.2)j.
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefiaaries 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 ar for the use of the decedenPs 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+(12-12)
�pennsylvania SCHEDULE A
�EPARTMENT OF REVENUE
INHERI7ANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF:
FILE NUMBER:
Ail real property awned 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.
Reai property that is joinUy-owned with right of survivorship must be disclosed an Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Incfude a copy of the deed showing decedent's interest if owned as tenant in common.
NUMBER VALUE AT DATE
DESCRIPTION OF DEATH
1' Property-1083 West Trindle Rd Mechanicsburg PA 17055
133,000.00
(see settlement sheet)
TOTAL(Also enter on Line 1, Recapitulation.) $ 133,000.00
If more space is needed,use additional sheets of paper of the same size.
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HUD CERTIPICA°ltON OF BUYCR AMD$ELLER
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BErnEYEN7 Af�IT oaTE
WARNING:IT IS A CRIME TD KIYOWIN4LY MAKE PALSE BTATEMENT9 TO THE UNITED STATE9 ON TMB OR ANY 91M1qlAR�ORM.PEMALTEB UPON
CONVICTION CAN II�IUbE A FII�AND IMPRIBONA�NT.FOR OETAllB 8EE TTLE 1B;U.S.CODE 8ECTIOM 1001 AND 8ECT10N 7010.
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� REV-i5e>8 EX+(o8-iz)
�pennsylvania SCNEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENi DECEDENT
EST E OF: FILE NUMBER:
�o�en ne h
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.
IfEM
NUMBER DESCRIPTION VALUE AT DATE
� 2008 Toyota camry oF oEaTH
13,000.00
All personal items were either disposed of or donated to Salvation Army.Most items were unsalvagable
TOTAL(Also enter on Line 5, Recapitulation) $ 13,OQ0.00
If more space is needed, use additional sheets of paper of the same size.
. _ ___ _ _ _ _
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REV-1511 EX+(p8-13)
�
� � pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCE TAX REfURN ADMINISTRATIYE COSTS
RESIDENT DECEDENT
EST TE OF
��/Qn�. � ' �n� FILE NUMBfR
l.K � � M.
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
p• FUNERAL EXPENSES: aMOUNT
1.
Myers Buhrig Funeral Home
9,388.00
B. ADMINISTRATIVE COSTS:
1, Personal Representative Commissions:
Name(s}of Personai Representative(s}
Street Address
City_ ___State ZIP
Year(s)Commission Paid:
2• Attomey Fees:
3• Family Exemption: (If decedenYs address is not the same as claimant`s,attach explanation.)
Claimant
Street Address
City _ _____State__ZIP
Relationship of Claimant to Decedent
4• Probate Fees:
5� Accountant Fees
6� Tax Return Preparer Fees:
7.
TOTAL(Also enter an Line 9, Recapitulation) $ 9,388.00
If more space is needed, use additional sheets of paper of the same size,
_ .���Sp-� °- �-f}�Gwwn.Q.
� .
� r �
.�f�������' � �.
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Gu��Oma,r:
� Shauna Garcia
� 219 Goki Finch Drive '
� Palmyra, PA 17078 Invoice Number: 11018
� Invo�e Date: Dec 17,2013
I
�- -- Page: �
Natr���l�,�a�; I�att!�of C�►th ` p�,�r�srr�t Terms . Fct►t+air�.=�JC�ar;
L_ Ro�nne K.Alieman ( December 16,2013 f iVet 30 Days � WilNam L Christopher i
J�� ttet��1ur�ihier - �ia�it�. ' � ; : t�scri�a#�on �i�Pri�e A�urrt .
PS Professional Services $ 4,729.00
J FSE ; Faci6ties, Staff and Equipment I
� i $ 2,150.00 I
+ V � f Vehides i I $ 550.Q4
I M � � Merchandise � ' �
; i $ 545.00
I M I � Merchandise Ad�astment � $ 49.00
� CA Cash Advances � $ 1,340.00 1
: CA Cash Advances Adjustments r $ 25.00
I
' i
� Terms Discount of$743.00 has been app�ed_ �
�
�
�
�
�
i
�
� I
� '
i I
� � , �
� �
ank ou for allowi us to serve ou and our famil .
Subtotal � $ _ g,388.00
We gladly accept the following forms o#payment Sn�AP�n9 $ 0.00
Cash, Check, Ysa, MasierCard,Discover,American E�ress � Sales Tax __ � $ 0.00
Kindly make your check payable to: �Total Invoice Amount _� $ 9,388.00
Myers-Buhrig Funeral Home and Crematory �r P — --------
ayment/Cre��t Appl�ed $ 9,3E8.00
Past due accounts are subject to interest charges of 1.5%per month. Tt�TAk�C?t1�:` � �r�p
Wadking with Those in Grief
Robert"Bob"L.Buhrig,.IG�Fp,Supen isor•William"Bill"L.Christapher,Fo
Phone: �7i��7663421 • Fax: �7t1>795.7291 • 37 East Main Sueet • Mechanicsbu a,FA 17055 • H�ww�.Myers-Buhrig.com • DirectorsnMyers-Buhrig.com
' REV-1512 EX+(12-12)
s
� pennsylvania SCHEQULE I
°�'"�"��� DEBTS OF DECEDENT,
INMERITANCE TAX RE71fltM MORTGAGE �IABILITIES SF LIENS
RES[DENT DE(fDEM
ESTATE OF FILE NUMBER
Roxanne Alleman
Report debts i�curred by tl�e deadent prior to death that remained unpaid at tl�e date of deaNy indud'eng�axeimbursed medical expenses.
�M YAWE AT DATE
NUMBER DESCRiPTION OF DEATH
2.
��Eie� ss2.ss
Penn Waste 96.08
ATE�T 92.73
Verizon 108.53
Bank of America 56,767.53
PSECU HELOC 10,000.00
PSECU Ysa 4,800.�0
Toyota 2,937.69
Holy S�rit Hospitai 232.61
Se#bement fees for sale of twme{see settlement sheet) 21,563.40
TOTAI(Also enter on Line 10,Recapitulation) � 97,591.43
If more space is needed,insert addRional sheets oF ihe same s¢e.
, - PO Box 1259, Dept. 106410
,Oaks, PA 19456 ,
� � 'lll����������������������ll������ �
SPEEDPAY'
�n�il�ii��llwl���.i�����u���hu��hirl��ull�n(i�,�li��i�l ,�217��
SHAUNA GARCIA
� ��'^,� 299 GOLD F1NCH DR
" PALMYRA PA 1707&9010
January Q6, 2014
This is your Westem Union�t SpeedpayCgl service money transfer receipt. On 01/03/14, you authorized a one time payment
from your credit/debit card account to your Toyota Financial Services*("TFS") account ending in *****"'*3867 as follows:
Confirmation Number: 0027195256
Sender Name: Shauna Garcia
Card Number. +�•*'"�*�***�•�g92
Receiver Name and Address: Toyota Financiai Services
P.O. Box 9490
Cedar Rapids, lA 42409-9490
Payment Amount: $2,937.69
Western Union Transfer Fee; $p,pp
Total Payment Amount: ZZ,937.69
Westem Union will charge the Tatai Payment Amount to your crediUdebit card account and send payment to Toyota
Financial Services to make your payment as requested. The Total Payment Amount is the addition of your vehicle account
payment and the transfer fee, if applicab{e. Typically, Toyota Financial Services will effective date the payment ta your TFS
account based on the Scheduled Payment Date unless the payment is retumed by your bank or card issuer.
If you have any questions regarding this transac#ion, or wish to make corrections to the information listed above, please
contact Wes#em Union at the add�ess or call the telephone number listed at the bottom o#the reverse side of this page.
Please contact Toyota Financial Services at 8Q0-8748822 if you have questions conceming amounts posted to your TFS
account.
"Toyota Financiat Services is a service mark used by Toyota Matar Credit Carporatian.
,o�,
���
100217-TU-683
• COMPUTER CREDIT, ( NC .
, CLAfM DEPT 082515 . 64p West Fourth Street. Post Office Bax 523&. Winston-Salem,NC. 27113-523$ . 336-761-1538
May 12, 2014
� • - • •
Holy Spirit Hospital
053 SH1HS 259 075b1567$?
Roxanne AAeman Attention: Patient Financiai Services
For: Alleman, Roxanne R 1'elepho�e:(717)763-2138
219 Goid Finch Dr
Palmyra, PA 17078-9010 Pay Online: www.hsh.org
�If,lll��ll'�t�lll�ul�l�i�llhl�lt�'��1�'i�l"'��'t��tl�i��lill� Account# 46437224 O
Date of Service: 1 Q-29-13
PAST DUE AMOUNT: $232.61
PLEASE SEE lMPORTANT NOTICE ON BACK
Dear Raxai�ne A�feman:
Your overdue balance with Holy Spirit Hospi#al has been re#erred to Computer Credit, Inc. (also re#erred to in this letter as
CCI)for collection. Our records indicate that this debt is your responsibili#y. This letter wil!serve to inform you that your
account remains unpaid and we expect resolution of your obligation to the hospital. Computer Credit, Inc. is a debt collector
and a member of ACA International,the Assoc+ation of Credit and Collection Professionats.
This communication is an attempt to collect a debt and any information obtained will be used for that purpose. Unless you
not'rfy our office that you dispute the validity of this debt or any portion thereof within 3Q days of receiving this letter,we will
assume that the debt is vafid and expect it to be paid.
Pay the amount due to prevent further collection activity by Computer Credit, Inc. We appreciate your attention to this
matter.
c���
Hofy Spirit Hea/th System provides frnanciat counseling assistance to a!t patienfs
C. Jordan �a may have difficulty meeting their financial responsibility.Piease call the credifor
ai the�umber above to conlact one of their firrancial counselors.
Director of Operations
� To pay securely aR �,, Tolt free: 1-855-SELFPAY Reference Number
� www.informationcci.cam tt-s5�-�as-s�2s� 7561 5678 Q515
Return this portion wifh your payment
� � '"� • •
�� �� �� ❑�� GUARAN70R Roxanne Alleman
CARD NUMBER EXP DATE PATIENT Alleman,Roxanne R
SECURIN CODE ACCOUNT# 46437224 O
AMOUNT AMOUNT DUE
$232.61
SIGNATURE
You ntay make check payabte to:
PRINT CARDHOLDER'S tdAME
ILUN A DR SS BILLING ZIP CODE Holy Spfrit Hosp�tal
P.O. Box 822183
Philadelphia, PA 19182-2183
Computer Credit, Inc. «,� Z.�, n9
CCI KEY: 0756156787 1""11'1�'ll��l��ll+u���ll��l�n��ll��'�1�11"I'�u��l�ll���l��
`�'*°'s`r m Questions?Pfease � Vislt us online at
4�iMBbd{q�y..
� �p �r�- contact us by Apr 28, pa�p 2
f i-800-DIAL-PPL pp�electric.com
4A e''
, ���� `_. a (1-800-342-5775) � • • . ,
M-F:8am to 5pm 3fi850-82001 Apr 28, 2014 $gg2,gg
Your Eiectric Usa_ e Profile
Service to: -- g���.� �ummary (Biliing detatls on 6ack)
ROXANNE R ALLEMAN-ESTATE 8alance as af Apr 7,2pi4
1083 W TRINDLE RD Charges: 5789.24
MECHANICSBURG, PA 17055 Total PPL Electric Utilities Charges
Meter:94068254 5203.62
Your next meter reading is on or about May 7,2014. T�al Charges^`, _ v
`���.�..� $992.86
�Amount�gy qpr�8s 201�..�_.__ __
This section heips you understand your year-to-year Account 8alance � -`"° V--`������$�
electrlc use by month. Meter readings are actual uniess � -_�-W������
otherwise noted. $g9z,g6
PPL Electric Utillties'prlce to compare for your rate is$0.08754 per kWh.
��3 �2014 This changes the 1st uf Mar,Jun,Sept,and Dec. Visit papowerswitch.com
� ____._i____, or wwry,o�,�tate,pa.us for suppller offers.
� � y� Your Messa e Center
g --'---- • Budget Summary:
a 45 �N8�}���8d y0U
30 ►ncluding this biil,you used `�4��
� After this payment,your budget is ahead
d ls and$S2.88 remains from las�year`s Budget Plan $$5�92
o � settlement.
� F nn a nn > > a s o N p j ' �ejrt month your budget amount wiil change to '�
Monms $17Q.(�. �
� rhe��89,24 balance includes$24.4U in prior late g
• � payment charges.
' '• • : � s information about appliance energy use and tips on
Apr 2014 ' saving energy are avallable throu h the Energy Library
32 7Z5 23 40F on our We�site,ppielectric,comf e-power
Apr2p13 30 1651 55
39F
• � :
. Ap� � Actual e78039 P8 ment Methods �
Mar 6 Oniine at .:..
Actuai 77314 � Pp�electrtc.com (��Y Phone:1•8pp-342.5775 �
32 Days kWh Bflled or call BiIlMatrix serv(ce fee app�fes) �
725 at 1-8Q0-672.241�to pay using Vlsa, �
•. • MasterCard, Dlscover or debit card.
May 2013-Apr 2014 16677 � � BY Mail' Correspondence shouid be sent to: �
1390 � 2 North 9th Street Customer Servlces �
May 2012-Apr 2013 gg�gg CPC-GENN1 827 Hausman Road a
1516 Allentown, PA 18101-1115 AIlentown, PA 18104-g392
.r
Other important fnformation on the back of this btli-� �
'y�4i98p�� .
♦a.}sAby9 fp*,
s,.- � Retum this part in the envelope `°
pRl :�. N
.0�� provided with a check payabie " � ' a • �. - .
r�,,�w,,,� ° ° to PPL Electric Utiiities. � ° �
3fi85Q-$2001 Apr 28, 2Q14 $992.$6
AB 01 001617 00795 8 g E Amount Enclosed:
IJII�II���ilr�il��1�11��1�'I��'�lull��n+�ll�illl"1����"����� �
ROXANNE R ALLEMAN-ESTATE ❑
C/0 ❑
SHAU �
NA G ❑
ARCI �
219 GOLDFINCH DRA PPL ELECTRIC UTILITIES
PALMYRp,pA 17�78-9Q1p 2 NORTH 9TH S7REET CPC-GENN1
ALLENTQWl�, pA Tg���-1175
il��llr����l��rl��ilffl���tlr�nrE��l�u����1�liEl�r�i���iry�����
1 680QOQ9928680�00992869 3685Cl820�y
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CUMBERLAND LAW JOURNAL
32 SOUTH BEDFORD STREET
CARLISLE, PA 17013
Tete: (717)249-3166 Fax:(71�249-2663
January 3'i, 2014
Cumberland Law Joumai is published every Friday by the Cumberland County
Bar Ass�ciation and is designated by the Court of Common PieaS as the officia! legal
publication for Cumberland County and the legal newspaper for publication of legal
notices.
TO: Shauna R. Garcia
RE: Roxanne R. .Alleman Estate
Legal advertisements must be received by Friday Noon. All legal advertising
must be paid in advance. Make all checks payable to: Cumberland Law Journal.
Advertisement inserted on foflowing dates:
January 17, January 24, and January 31, 2014
Advertising Cost $ 75.00
Proof of Publication $ 0.00
Second Proof Request $ 0.00
Payment received $ 75.00
Tota1 Amount Due $� 0,00
Becky H. Morgenthal, Executive Director ,
, ' ' RECEIPT FOR PAYMENT
�
-------------------
-------------------
GLENDA FARNER STRASBAUGH Receipt Date : 12/20/2013
Cumberland County - Register Of Wills Receipt Time : 12 : 55 : 59
One Courthouse S quare Receipt No. : 1076543
Carlisle, PA 17613
ALLEMAN ROXANNE ROSALYN
Estate File No. : 2013-01330
Paid By Remarks : SHAUNA GARCIA
HMW
------------------------ Receipt Distribution ------------------------
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS ADM 135 . 00 CUMBERLAND COUNTY GENERAL FUN
RENUNCIATION 15 . 00 CUMBERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 50 . 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 GENERAL FUN
INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN
----------------
Cash $258 . 50
Total Received. . . . . . . . . $258 . 50
A�M Number Amour�t Due
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ROXANNE ALLEMAN Page: 3 of 3
�+�;A 10$3 W TRlNDLE RD Bilt Cycie Daie: 12I21�13-01/20I14
M�"�� MECHANlCSBURG, PA 17055-4515 � \� AccounL- Q6AOfl97689Lt6
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Total Amount Due $92,73 � an AT&T store
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717 979-9323 514,16 2 2 State Gross Receipts Surcharge 0.26
TOt81 N8w ChBt`ge5 519.74 Governmerrt Fees and Taxes
3. PA State 5ates Tax 0.32
Tota!Qthec Charges &Credits 5.58
TotaE Account Charges 5.58
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Nation 45Q w8h Rottover- lnctudes 450 Anytime Minutes
with Roliover, Nationwide Long Distance & Roaming, Unlimited
Mobite to Mobite calling toJfrom other AT&T Mobiies, 5,000
HoW t0 C01Yt�Ct US: Night{gpm-6am) &Weekend Minutes,Call forward Feature, `
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� ' � �;� INVOICE
Invoice Number: 0002576119
� ^ Penn Waste, �11C. r�} r L,� t� �Page Number: 1 of 1
P O B ox 3 0 6 6 �l" U� Date: 11/30/2013
� York,PA 17d02 '� �4� °'°� �-^� � Account Number: RS731839
� � � www.pennwaste.com � �� ' Site Number. 0000
� _ Phone(71T�767-4456 ���� � Reference:
V ToltFree 1-(866}575-87
� Fax(T17)T67-4285 Invoice Totai: $45.75
� ,,.� Total Due: $45.75
� �
� f.
L • http://pennwaste.biiltruat.com
� eV � SRS MPP MPG
8752 1 AV 0.360 E0185X 10194 0830236092 P1709850 OOU1:0001 \
"���'1'I�11'�I"I���1'I'1�111""�11�1"1���11�I11"���'�II'��I� , � ' , Online Billing NowAvailabie!
� ROXANNE ALLEMAN l ♦ / Receive your invoices faster
1083 W TRINDLE RD � '. '� '. and heip save the environment by
MECHANICSBURG PA 17055-4515 ��� t re enrolling in our free oNine seroice.
� See enrollment details above!
���1 .
Code Description Dabe Reference Quantity Amount
(Q001)
Roxanne Alleman
1083 Trindie Rd W Mechanicsburg,PA
31 Curbside Trash w/Cart&Rec 11/30/13 1.00 45.75
96.00GA
1i�d3.��A-3/3112014
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Please visit our website at www.pennwaste.com Current 30-so Days si-90 Days over 90 Days
for holiday schedules and coilection information. $45.75 $0.00 $0.00 $0.00
PLEASE DETACH AND RETURN BOTTOM PORTION WITH PAYMfiNT
----------------------------------------------------------------------------------°---------------°----------------------°-----------------------------------------------------------°
PAYMENT COUPON
Make Checks Payab(e To:Penn Waste,Inc. Invoice Number: 0002576119
Page Number. 1 of 1
Payment For Current Charges is due by 12/30/2013 Date: 11/30/2013
All past due balances are due i.ffiediately. Account Number: RS731839
AFTER THIS DATE A LATE FEE UP TO 10� WZI.I� BE ASSESSED Site Number: 0000
Reference:
A service charge up to $50.00 xill be assessed on sll
returned checks. Remitiance Amount: 45.75
Please Do Not Enclose Check Number:
Any Writtan Co�nunication
S�ith Your Bill
Please Contact Cuatomer Service At (717) 767-4456 _
REMiTTANCE ADDRESS
i��{�I���II��I�I�II���t��1�1��tt�IF����liti��„��NII���11���1
Penn Waste Inc.,
c/o M&T Bank
P.O. Box 64910
8altimore, MD 21264-4910
?31839000�D0025761190000004575
000�:000i
� � = i /� Questions?Piease � Visit us oniine at Page i
, _ <tt,
���' °����"'r��`" `dJ corrtact us by Feb 26. pplelectric.cam
A � 1-800-DIAL-PPL • '
`� �„ (1-80C)-342-5775} 36$50-82�1 Feb 26, 01 ���
w�,.�,.�u�uu� M-F:8am to 5pm ��
Your Electric Usa e Profiie Bitii Summa pit ils on back)
5�rvice to: nce as of Feb 5,2013 .00
ROXANNE R ALLEMAN h es:
1083 W TRINDLE RD I L ectric Utilities Char e $173.�
MECHANICSBURG,PA 17055 _
Meter:94068254 Totai Cha g $173.�
You�n�xt meter reading is on or abo 3 �,�,��
,
This section helps you understand your year- � ���ce $173.00
electric use by month. Meter readings are a ua u le pp ectric UtiHties' c ta com are for our rate is$ 0
otherwise noted. p y per kWh.
' changes the 1st ar,Jun,Sept,and De�,a pr���slt switch.com
!2012 �2013 WyYW,pq, .pa s fo�suppiier aff��'� i+ j
� ;� Your Mes Centerr�.�� � �'��
� � • suaget summary: �;�� . �
�' We biiled you $i73.f�
S 45 including this biii,you u5ed 5222.32�
a 30 After this payment,your budget is behind $49.32 ����
a° 1�'�
is �.
o • With paperiess biliing,you can rece�ve and pay your d��� �
PPL ftectric Utilities biils online.The process►s free, �
J F M A M J i A 5 O N D .�
quick,conveni�nt and secure.70 learn more or slgn up,� � o
nno►�cns visit pplelectric.com. ���
• Informatian about apptiance energy use and tips on
' saving energy are available through the Energy Library
on our Web site,ppielectric.cam.
Feb 2013 29 1945 67 31F
Feb 2012 31 2076 67 35F
�
Payment Methods =
Feb 5 Actual 57891 � Oniine at: �By phone:i-800-342-5775 S
Jan 7 Actua{ 55g46 pR�e�ectric.com or call BiliMatrEx(service fee appiies) =
at 1-800-672-2413 to pay using�sa, =
29 Days kWh Billed 1945 MasterCard,Discover or debit card. =
. � � By Mail: Correspondence should be sent ta: =
Mar 2012-Feb 2013 17788 14g2 2����Street Customer Servkes =
CPC-GENN1 827 Nausman Road =
Mar 2011-Feb 2012 18796 1566 Alfentown, PA 18101-1175 Ailerrtown, PA 181Q4-9392 =
_ _ ___a___�..__. _ Other important infc►r .�i ,n on th��a��f t.�.„�b;u�,_,_—
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'0*`���¢b��- � Retum this part in the envebpe , � x '
�=d-
�p �L;t_ Provided with a chedc payable � -
u to PPL Electric Utilities. 36850-82001 Feb 26, 2013 $173.00
wc�.�s�e►�c uwe�►
Amount Endosed:
AV 01 010926 fl9799B 41 A`�5D6T
I�N(��Il���rlhi�ih�itll��ilil�lil��,�r�ll�l�ti��f����I�illi� �a�❑❑,❑�
ROXANNE R ALLEMAN ,�,�°�;,�� PPL ELECTRIC llTILtT1ES
1083 W TRINDLE RD '`�"'�;°" 2 NORTH 9TH STREET CPC-GENN1
MECHANICSBURG,PA 17a5b-4515 ' ALLENTOWN, PA't81{}1-1175
,
°�,
s��''� '� Illlfll��.�i"{�Pl�ii�E��tlf�'{I'����i`��I����t�lll�l�ltl��ill{�
1 21�OOQ173QD10000173DQ9 3685082001
, � • Holv Spiri# Mospitat ��
, ' , 503 North 21a`Street • Camp Hill,PA 17011 • (800)Sy�
Febraary 26,?0,
Your Acconnt With: Ho1y Spirit Hospital
Accaunt#: 46437224
For: Roxanne Alleman
Admission Date: 14/29i13
To#al Due: $232.61
Dear Roxanne Alleman:
Perhaps you overiooked our recent conespondence in which we notified you that the above referenced account is
still outsta.nding.
We are wit}ing to work with you ta resolve this account. Payment in full is preferred, but if you are unable ta
remit the entire balance due,our representatives are prepared to work with you to reach a mutually acceptable
payment schedule. Our representatives are available Monday thraugh Friday,from 8:OU a.m.to 5:00 p.m.,and
can be reached at 1-800-596-9997.
Once again,thank you for choosing Holy Spirit Hospital and for resoiving this outstanding balance. ff you feel
you are unable to pay the amount due,even over an extended period of time,you are encouraged to contact the
Hospital's fmancial assistance counselor at 717-972-7556.
To assure proper application of your payment,please attach the bottom portion of 's letter to it. If you wish to
pay by credit card,please complete the required information on the reverse side th etter. If you have
insurance that may pay al}or a portion of this debt,please eamplete the inform o e reverse side of this
letter and return the entire letter. Payment can also be made oniine at s
Sincerely,
Holy Spirit Hospital
IONFIRT10792
tss I.ower Portion With Payment*••
Account#: 46437224
Totai Due: $232.61
ONFIRII O �
PO Box 1022 � � �
Wixom MI 48393-1022
.�
February 26,2014
Roly Spirit Hoapital
PO Box 822183
@@@ 253064544 Philadeiphia PA 19182-2i83
�i1��1����1�1�11�1�',�'��'���I�1'��'���'�'�II��"���������ny�ll 1���111�1„���III��L��1�1��l�I��i11L�I��Fll�l��l�nll��l��1)
Roxanne Aiteman
1083 W Trindle Rd
Mechanicsburg PA 17a55-4515
�000464372240010�DQ0023261001��73500�00[]Q11308
REV-1523 DC+(01-f0}
� pe�r�rEvarna SCHEDULE ]
����� BENEFICiARIES
INHERITANCE TAX RERIRN
RESLDE7Pf OECEDENT
ESTATE OF: FILE NUMBER:
Roxanne Alleman �e�28
RFEATIQI�.SHFP TU OECEDENT AM�ilNF�t SNARE
NUMBER (�AME AND ADQRESS OF PERSt}N{S}REC�MNG PRC�FER7Y Do Mot t�t Tr�e(s) OF E5TATE
L TAXABLE OISiRIBUR�[Inchde adright spos�al6stn�d�a�rd hansfiers un��
Sec.9t26(a)(1.2).j
i. Sha�C�cia daugh� i 0,44Q.OQ
Mlan�e McAdams da�tgt�r 10,440.00
Ri�rd t� son 1 Q,440.OU
Rob�m Reed daught� 1Q,440Af?
ENTfR DOLLAR AMWNTS t�OR QISTRISUTIONS�iQWN I180VE ON i1NES 15 71iR0UfH 18 OF RfiF-15�CQ1/fR StiEET,AS APPROPRUUE.
� NON TRXABLE DISTRIBUFIOMS
A. SPOUSAL DISTRIBIITIONS UN�t SECTItM!91f3�t 4YHICti Ati B�CTIO!!TO TA3f IS I�T7AKB�:
1.
B. CHARTfABIE AND GOYE�RNMEIYTAL DISTRIBU7IONS:
1.
TOTAL OF PART II—ENTER T4TAL NON TAXASEF dIS'fRIBUTf�ON UNE 13 Of itEV-1504 COVER SHEEi: �
�Ip�SQdC��Ei�2QR t��Itl�1315�5 Of��f�Of th2 53R12�.