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HomeMy WebLinkAbout08-01-14 (2) J 1505610143 REV-1500 EX�°2_1,, ,m PA Department of Revenue OFFICIAL USE ONLY pennsylvania County Code Year File Number Bureau of individual Taxes ��TMENTOFREVENUE Po Boxzsoso� INHERITANCE TAX RETURN 21 13 1282 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth Suffix DecedenYs First Name KILHOFER MI RUTH A (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name KILHOFER M� RICHARD A Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW X❑ 1. Original Return � 2. Supplementai Return � 3, Remainder Retum(Date of Death Priorto 12-13-82) � 4. Limited Estate � qa Future Interest Compromise) � 5. Federal Estate Tax Retum Required (date of death after 12-12-82 � g Decedent Died Testate � Decedent Maintained a Living Trust 1 (Anach Copy of wiil) ❑ (Anach Copy of Trust) 8. Total Number of Safe Deposit Boxes � 9. Litigation Proceeds Received � �p.Spousal Povert Credic�Date of Death ��.Election to tax under Sec.9113 A between 1231�31 and -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 JESSICA FISHER GREENE 717 697 3223 REGISTEF�F WILLS US�:ONLY� � �� x� �.,.� First Line ofAddress �-� . � �:,._:�!� 555 GETTYSBURG PIKE ���' � i=-� �=,�=: �'`:. -_ -^ -- ���". Second Line of Address r,,,- �. � �: �,:_ ..7 _, ,,- STE C100 ��' � := ='= �� r �-, ir', City or Post Office D E�ILED � �. p State ZIP Code MECHANICSBURG PA 17055 � CorrespondenYs e-mail address: jessica(a�keystoneelderlaw.com Under penalti perjury,I cl that I have exammed this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,cor d com laration of preparer other than the personal representative is based on all information of which pre arer has any knowledge. SIGNATU ERSO E FILING RETURN �TE / Gregory C. Gnatt ADDRESS 8 Naraqansett Drive, Mechanicsburq PA 17050 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE /� � � C� DATE w�1��.t,C� �• ''��Q ,� Jessica Fisher Greene � � � �y AL�RESS 555 Gettysburg Pike Ste C100, Mechanicsburg, PA � Side 1 � 1505610143 1505610143 � J 1505610243 REV-1500 EX DecedenYs Social Security Number oe�ede�rsName: KilhOfe�� Ruth A. RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 2. Stocks and Bonds(Schedule B)............................................................................. 2. 16,384 .24 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3. 4. Mortgages&Notes Receivable(Schedule D)........................................................ 4. 5. Cash,Bank Deposits 8�Miscellaneous Personal Property(Schedule E)............... 5. 2 94, 18 9. 5 6 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 0 . �0 7. Inter-Vivos Transfers&Miscellaneous -Probate Property (Schedule G) � Separate Billing Requested............ 7. 8. Total Gross Assets(total Lines 1 through 7)........................................................ g. 3].O ,573 . $� 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 15,4 67 . 77 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. 4 ,24 9. 6� 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 19, 717 . 37 12. Net Value of Estate(Line 8 minus Line 11)............................. ........................... �2_ 2 9O, 85 6. 43 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)............................................... �4. 2 9O , 85 6. 43 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(�.2)x.00 98,362 . 00 �5. 0 . 00 16. Amount of Line 14 taxable at lineal rate x .045 192, 4 94 . 43 1s. 8, 662 .25 17. Amount of Line 14 taxable at sibling rate X.12 0 . 0 0 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X.15 0 . 0 0 18. 0 . 0 0 19. TAX DUE................................................................................................................ 19. S, 662 . 25 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. � Side 2 � 1505610243 1505610243 J REV-1500 EX Page 3 File Number 21-13-1282 Decedent's Complete Address: DECEDENT'S NAME Kilhofer, Ruth A. STREETADDRESS 8 Naragansett Drive CITY STATE Z�p Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 8,662.25 2. Credits/Payments A. Prior Payments 8,409.93 B. Discount 433.11 Total Credits(A +g) (2) 8,843.04 3. interest �3� 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 180.79 Check box on Page 2,Line 20 to request a refund 5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. �5� Make Check Pa able 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;or.............................................. . ............................................................. x d. receive the promise for life of either payments,benefits or care?............... . � � ................................ . .... ....... . I death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without ❑ ❑ receiving adequate consideration?.................................................................................................................... x 3. Did decedent own an"in trust for' or payable upon death bank account or security at his or her death?....... ❑ � 4. Did decedent own an individual retirement account,annuity,or other non-probate property which contains a beneficiary designation?....................................................................... ❑ � . .......................................... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994 and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after January 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)). The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent,or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedenYs lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)]. . The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent[72 P.S.§9116(a)(1.3)j. 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-1503 EX+(6-98) SCHEDULE B STOCKS & BONDS COMMONWEALTHOFPENNSYLVANIA INHERITANCE TAX RETURN RESIDENTDECEDENT ESTATE OF FILE NUMBER Kilhofer, Ruth A. 21-13-1282 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM CUSIP NUMBER NUMBER DESCRIPTION VALUE AT DATE UNIT VALUE OF DEATH 1 744320102 72 shares of Prudential Financial Inc-Com 88.g7 6,384.24 2 United States Treasury HH Bonds 10,000.00 TOTAL(Also enter on Line 2, Recapitulation) 16,384.24 (If more space is needed,additional pages of the same size) Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B(Rev.6-98) Rev-1508 EX+(11-10) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Kilhofer, Ruth A. 21-13-1282 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Citizens Bank Checking Account xxxxxx5067 497.90 2 Citizens Bank Money Market xxxxxx5390 255,535.22 3 Citizens Bank Savings xxxxxx2084 33,251.32 4 Alert Pharmacy Prescription Refund 8.11 5 Claremont Nursing 8�Rehab Center: Health Care Refund 4,320.00 6 Country Meadows West Shore: Personal Care Home Refund 396.89 7 Hershey Medical Center Refund 10.00 8 Hershey Medical Center Refund 10.00 9 John Hancock Life Insurance Company: Long Term Care Premium Refund 90.15 10 Patient First -Overpayment �58 11 State Farm Mutual Auto Insurance Company Refund from Canceling policy 524 6390-A16 62.39 -38R TOTAL(Also enter on Line 5, Recapitulation) 294,189.56 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev. 11-10) Rev-7509 EX+(Ot-10) pennsylvania SCHEDULE F DEPARTMENTOFREVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Kilhofer, Ruth A. 21-13-1282 If an asset was made joint within one year of the decedent's date of death,it must be reported on schedule G. SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT A. Richard A. Kilhofer 8 Naragansett Drive Spouse Mechanicsburg, PA 17050 B. C. JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE Of DEATH ITEM FOR JOINT MADE �NCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD�S VALUE OF NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR ALUE OF ASSE DECEDENT'S INTEREST JOINTLY-HELD REAL ESTATE. INTEREST � Citizens Bank Safe Deposit Box Jointly 0.00 50.000% 0.00 Owned with Husband, no contents in box at date of death-had no value ' TOTAL(Also enter on Line 6, Recapitulation) 0.00 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule F(Rev.01-10) REV-7511 EX+(�0-09) pennsylvania SCHEDULE H DEPARTMENTOFREVENUE FUNERAL EXPENSES AND INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Kilhofer, Ruth A. 21-13-1282 Decedent's debts must be reported on Schedule I. ITEM N MBE DESCRIPTION AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s)attached 1,241.35 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(s)Commission Paid Waived 2. Attorney's Fees Keystone Elder Law P.C. 13,067.00 3. Family Exemption: (If decedenYs address is not the same as claimant's,attach explanation) Claimant Street Address ��� State Zip Relationshin of Claimant to Decedent 4. Probate Fees 458.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 700.92 See continuation schedule(s)attached TOTAL(Also enter on line 9, Recapitulation) 15,467.77 Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev. 10-09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Kilhofer, Ruth A. 21-13-1282 ITEM NUMBER DESCRIPTION AMOUNT Funeral Ex enses 1 Dollar Tree Store:Tableware for Funeral Service 15.90 2 Giant Foods: Food For Funeral Service 199.51 3 Heintzelman Funeral Home 821 � 4 Royer's Flowers: Funeral Arrangement 79.50 5 St. Patrick Church: Fee for holding Funeral Service 125.00 H-A 1,241.35 Other Administrative Costs 6 Citizens Bank Service Charge 2.00 7 Citizens Bank Service Charge 2.00 8 Citizens Bank Service Charge 2.00 9 Citizens Bank Service Charge 2.00 10 Citizens Bank Service Charge 2.00 11 Citizens Bank Service Charge 2.00 12 Citizens Bank Service Charge 2.00 13 Cumberland Bar Journal Publication Notice 75.00 Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Kilhofer, Ruth A. 21-13-1282 ITEM NUMBER DESCRIPTION AMOUNT 14 Returning November's State Employees' Retirement System Pension Payment to State 433.00 Employees' Retirement System 15 Sentinel letters Testamentary publication Notice 178.92 H-B7 700.92 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-1512 EX+(�y-08) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCETAXRETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Kilhofer, Ruth A. 21-13-1282 Report debts incurred by tl�e decedent prior to death tF�at remained unpaid at the date of death,including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 PA Dept of Revenue-2013 PA State Personai Income Tax 4,159.00 2 Patient First: Urgent Care Office Visit from 10/6/2013 40.60 3 Pinnacle Health Hospitals medical bill for services on 9/17/2013 50.00 TOTAL(Also enter on Line 10, Recapitulation) 4,249.60 (If more space is needed,additional pages of the same size) Copyright(c)2008 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev. 12-08) REV-1573 EX*(Ot-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Kilhofer, Ruth A. 21-13-1282 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (�/ords) ($$$� i t s I� TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116 a 1.2 Mary Jane K.Gnatt Daughter 2/3 of residue of 196,656.85 8 Naragansett Drive estate Mechanicsburg, PA 17050 Richard A. Kilhofer Spouse 1/3 of estate 98,362.00 8 Naragansett Drive Mechanicsburg, PA 17050 Total 295,018.85 Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet,as a ro riate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10) i , LASTWILLANDTESTAMENT REGpRpEp 0��10E 4F oF �EGISTER 4F ��iE_LS RUTH A. KILHOFER ��!i3 CEC S �C� Z �6i i, RUTH A. KlLHOFER, currently residing at 4833 Trindle Road, A�Q.L�K�Q�chanicsburg, Cumberland County, Pennsylvania, 17050, declare that this is my Wili ar(j�g�r���1(��7pi��s and Codicils that I have made. CUMB�ERLA�D CO., PA ARTICLE I: FAMILY 1.01. iDENTiFICATION OF MY FAMILY 1 declare that I am married to Richard A. Kilhofer, and that I have one (1) child, Mary Jane K. Gnatt. 1.02. DEFINITION OF FAMILY TERMS As used in this Will, the term "my spouse" shall mean only Richard A. Kilhofer. As used in this Will, the term "my children" refers only to the above-referenced chitdren set forth in Paragraph 1.01. The term "my children" excludes all other persons. Far purposes of inheritance from me, the "children" of an individual shall be interpreted to include persons who have been legally adopted by the individual but shall exclude stepchildren who have not been legally adopted. ARTICLE 2: PAYMENT OF DEBTS AND TAXES 2.01. PAYMENT OF DEBTS AND EXPENSES I direct that all my vafid debts and the expenses of my last iltness and funeral be paid from my estate as soon as practicable after my death. 2•�2• PAYMENT OF TAXES I direct my Personal Representative(s) to pay out of the principal of my residuary estate all inheritance, transfer, estate, and similar taxes (including interest and penalties), assessed or payable by reason of my death, on any property or interest in property that is included in my estate for the purpose of computing such taxes. My Personal Representative(s) shall not require any recipient of such property or interest in such property to reimburse my estate for taxes paid under this paragraph. ARTICLE 3: DISTRIBUTION OF ESTATE TO BENEFICIARIES 3.01. SPECIFIC BEQUEST TO SUPPORT TRUST FOR SPOUSE If my spouse survives me by one hundred seventy (170) days and is declared to be a Supplemental Needs Person as defined below, I give, devise, and bequeath to my Trustee, hereinafter named, for the benefit and support of my spouse, cash, securities, or other property of my estate, including, without limitation, personal property and effects, having a value equal to the amount, if any, that my spouse would be entitled to receive if my spouse exercised my spouse's elective share rights as set forth in section 2201, et seq. of the Pennsylvania Probate, Estates, and Fiduciaries Code (the"PEF Code"); provided that the amount of this bequest shall be reduced to the extent my spouse has waived the right to elect under PEF Code Section 2207 or forfeited the right to elect under PEF Code Section 2208. In determining the amount of this bequest, my spouse shall be deemed to have elected, pursuant to PEF Code Section 2204(c), to retain all beneficial interests in property that my spouse would otherwise be required to disclaim if my spouse exercised my spouse's elective share rights. Contingent upon my spouse sunriving me by said one hundred seventy (170) days, it is my intention that, as a result of my death, my spouse shall receive property having a value 1 equal to (but not more than) that which my spouse would receive if my spouse were to exercise my spouse's elective share rights. My Personal Representative(s) shall have the sole and exclusive discretion to select the assets that shall fund this bequest. if my spouse does not survive me by one hundred seventy (170) days, this bequest shali be distributed as part of the residuary estate. This bequest to my spouse shall be distributed, in trust, to my hereinafter-named Trustee to be held, administered, and distributed as follows: a. During the term of the trust, the Trustee shall pay to or apply for my spouse's benefit all of the net income and principal of the trust estate. In addition, upon request of my spouse, the Trustee shall terminate the trust and distribute all of the trust principal and accumulated income of the trust estate to my spouse. In the event that my spouse is incapacitated, the Trustee shall make all of the income and principal of the trust estate available to my spouse to provide for the support, maintenance, and health of my spouse. b. All principat and any accumulated income that remains in the trust estate upon the death of my spouse shall be paid as an addition to the shares of the beneficiaries of my residuary estate in proportion to their interests in my residuary estate. c. The purpose of this trust is to provide for investment and management of that portion of my estate that is distributed to my spouse due to my belief that my spouse may need the Trustee's assistance with said investment and management. 3.02. DISPOSITION OF RESIDUARY ESTATE All of the rest, residue, and remainder of the property that I own at the time of my death, both real and personal, of every kind and description, wherever situated, to which I may be legally or equitably entitled at the time of my death (my "residuary estate"), I give to my to my child, MARY JANE K. GNATT, per stirpes. ` 3.03. TRANSFERS TO TRUST FOR BENEFICIARIES UNDER THE AGE OF TWENTY-FIVE (25)YEARS Should any beneficiary of mine be under the age of twenty-five (25) years, my Personal Representative shall hold such beneficiary's share of my estate, as Trustee, IN TRUST and shall invest, reinvest and distribute the principal and net income of such beneficiary's share as follows: a. Until such beneficiary attains the age of twenty-five(25} years, my Trustee, in my Trustee's sole but reasonable discretion, may pay or apply the income and any or all of the principal of such beneficiary's share for the health, maintenance, support and education of such beneficiary considering all other sources of income availabte to such beneficiary and known to my Trustee. Upon such beneficiary attaining the age,of twenty-five (25) years, my Trustee shall distribute the balance of the principal and accumulated income, if any,of each such beneficiary's share to such beneficiary. b. Should the principal of the Trust Estate, in the sole opinion of my Trustee, be or become too small to warrant placing or continuing of such fund in trust or should its administration be or become impractical for any other reason, my Trustee, in the exercise of their sole discretion, may pay such share absolutely to the person maintaining such beneficiary or may place such shares in the beneficiary's name in an interest-bearing deposit in any bank, bank and trust company or national banking association of his choosing, payable to the beneflciary at majority, or if said beneflciary has reached his or her majority, then to him or her directly. c. All shares of principal and income hereby given shall be free from anticipation, assignment, pledge or obligati�n of my beneficiary(s),and shall not be subject to any execution or attachment. 2 ARTICLE 4: FIDUCIARIES 4.01. EXECUTOR or PERSONAL REPRESENTATIVE(S) I appoint my daughter, MARY JANE K. GNATT, and son-in-law, GREGORY C. GNATT, to be Personal Representative(s)of my Will. 4.02. TRUSTEE I appoint my duly appointed Personal Representative(s) Trustee(s) of the Trusts(s) created pursuant to Sections 3.01, and 3.03. Under no circumstances shafl my spouse serve as Trustee of the trust created pursuant to Section 3.01. 4.03. WAIVER OF BOND None of the Personat Representatives, Guardians, or other Fiduciaries named in this Will shall be required to furnish bond for the faithful performance of his or her duties. 4.04. CREDITOR PROTECTIQPI No gift or beneficial interest shall be subject to anticipation, assignment, pledge, obligation, or alienation of my beneficiary(s), whether voluntary or involuntary, and the income and principal thereof shall not be subject to any execution or attachment. 4.05. NO CONTEST CLAUSE If any beneficiary, person or entity in any manner, directly or indirectly, cantests or attacks this WII or any of its provisions,or objects to the accounts or actions of my fiduciaries,withouf probable cause, such beneficiary, person or entity shall pay all costs, including but not limited to attomeys' fees, arising in connection with such contest, attack or objection incurred by my estate, such trust or such fiduciary personally. In the event that such beneficiary, person or entity does not prevait in such action, any share or interest in my estate or such trust which would othervvise pass to such beneficiary, person, entity or remainderman under this Will shall be revoked and the property consisting of such share shall be disposed of in the manner provided herein as if that contesting person or entity had predeceased me without surviving issue. ARTICLE 5: SUCCESSOR TRUSTEES 5.01. RESIGNATION OF TRUSTEE Any Trustee may resign by giving written notice, specifying the effective date of the resignation, to the beneficiaries then entitled to the trust income. 5.02. APPOINTMENT OF SUCCESSOR TRUSTEE If all Trustees named in this instrument are unable or refuse to act, a successor Trustee may be appointed as Trustee by a written instrument delivered to the successor Trustee and signed Personal Representative(s), or the survivor of them. No successor Trustee shall be liable for acts, defaults, or omissions of any prior Trustee. Any successor Trustee with the written approval of the persons appointing the successor Trustee shall accept as correct without examination the accounts rendered by the prior Trustees and property delivered by the prior Trustees without incurring any liability. Nothing in this paragraph shall be construed as requiring the naming of a successor Trustee as long as any Trustee named in this instrument shall continue to act as Trustee hereunder. 5.03. POWERS f�F SUCCESSOR TRUSTEE Any successor Trustee shall have the title, duties, powers, and discretion as the Trustee succeeded without the necessity of conveyance or transfer. 3 ARTICLE 6: POWERS OF ADMINISTRATION 6.01. My Executor or other Personal Representative, my Trustees, and Guardians (a(I of whom are hereafter sometimes referred to as my"Fiduciaries°) in regard to the administra6on of my estate, the administration of the trust and trust shares created under this Will, and such other actions as may be taken by my Fiduciaries, shall have the powers and authority set forth in this Article. These powers may be exercised by my Fiduciaries in the Fiduciary's sole and absolute discretion, without the permission or order of any court. These powers shall be supplementary to the pawers conferred by law, including but not limited to those set forth in Title 20, Chapter 33, of the Pennsylvania Consolidated Statutes. 6.02. If a Fiduciary is at any time required to make payments of principal or income to or for the benefit of any beneficiary who is a minor, or is an incompetent or incapacitated person, or is a person whom the Fiduciary in his or her sole discretion deems unable to handle funds properly or wisely if paid directly to the beneficiary, the Fiduciary in his or her sole discretion and without court approval may make payments in any one or more of the following ways: a. Directly to the beneficiary; b. To the natural Guardian or legally appointed Guardian of the Person or Estate of the beneficiary; c. By making expenditures directly for the care, support, maintenance, or education af the beneficiary; d. To any person or organization furnishing care, support, maintenance, or education for the beneficiary; '� e. To any custodial parent of a minor beneficiary; f. Directly to creditors in payment of the debts and expenses of the beneficiary; g. To a Custodian for the beneficiary under any law related to gifts or transfers to minors, including to my Executor or Personal Representative in that capaciry; h. To an Attomey-in-Fact authorized to act for the beneficiary pursuant to a Durable Power of Attorney. The Fiduciary shall not be required to see to the application of any funds paid or applied in any of the aforementioned ways and the receipt of the payee shall be full acquittance. The decision of the Fiduciary with regard to the setection of which of the aforementioned methods should be used in making payments shall be conclusive and binding on all parties concerned. 6.03. My Fiduciaries shall have the power to invest in, accept and retain any real or personal property, inctuding stock, savings, checking, and other accounts of a corporate Fiduciary or its holding company, without restriction to legal investments. 6.04. My Fiduciaries shall have the power to sell, exchange, partition, or lease for any period of time any reaf or personal property and to give opfions therefor for cash or credit, with or without security. 4 6.05. My Fiduciaries shall have the power to borrow money for any estate purpose from any person including any Fiduciary acting hereunder and t�mortgage or pledge any real or personai property. 6.06. My Fiduciaries shall have the power to hold shares of stock or other securities in nominee registration form, including that of a clearing corporation or depository, or in book entry form or unregistered or in such other form as witl pass by delivery. 6.07. My Fiduciaries shall have the power to engage in litigation and compromise, arbitrate, or abandon claims. 6.0$. My Fiduciaries shall have the power to make distributions in cash or in kind at current values, or part(y in each, allocating speci�c assets to particular distributees on a non-pro rata basis and for such purposes to make reasonable determinations of current values, 6.09. My Fiduciaries shall have the power to make elections, decisions, cancessions, and settlements in connection with all income, estate, inheritance, gift or other tax returns and the payment of such taxes, without obligation to adjust the distributive share of income or principal of any person affected thereby. . 6.10. My Fiduciaries shall have the power to retain uninvested cash, in such amounts and for such period of time as the Fiduciaries shall deem advisable for the proper administration of the property. 6.11. My Fiduciaries shall have the power to manage, control, improve, and repair real and personal property belonging to the estate. 6.12. My Fiduciaries shall have the power to employ an accountant, attorney, investment adviser, broker, tax specialist, or any other Agent deemed appropriate in the discretion of the Fiduciaries, including persons associated with or employed by any Fiduciaries, and to pay from the estate reasonable compensation for all services pertormed by any of them. 6.13. My Fiduciaries shall have the power to borrow money for any estate purpose from any person, firm, or corporation, including one acting as a Fiduciaries hereunder, on the terms and conditions deemed appropriate by the Fiduciaries and to obligate estate and trust assets for repayment; to encumber the estate or any trust or any property thereof by mortgage, deed of trust or otherwise, using whatever procedures to consummate the transaction deemed advisable by the Fiduciaries; and to replace, renew, and extend any encumbrance and to pay any loans or other obligations of the estate deemed advisable by the Fiduciaries. 5 6.14. Notwithstanding any provision of law to the contrary, my Fiduciaries shall be authorized to invest in all forms of real and personal property of every kind, without restriction to investments authorized for Fiduciaries and without regard to any principle of diversification or risk, as the Fiduciary shall determine to be appropriate in the Fiduciary's sole and exclusive discretion. ARTICLE 7 MISCELLANEOUS PROVISIONS 7.01. As long as any income or principal to which any beneficiary under my Will may be entitled remains in the possession of the Fiduciary and is not actually distributed to the beneficiary, such income or principal shalt not be subject to anticipation or alienation by the beneficiary, by assignment, or by any other means (except as specifically authorized herein), and it shall be free and clear of the bene�iciary's debts and obligations and shall not.be taken, seized, or attached by any process whatsoever_ 7.02. Whenever appropriate in this Will, the singular shall be deemed to include the plural and vice versa; and the masculine shall be deemed to include the feminine, and vice versa, and each of them to include the neuter, and vice versa. 7.03. For all purposes hereunder, the word "properky" shall be deemed to include real and personal property and any interest of any kind in any real or personal property; and the word "give" shall be taken to include the words "devise" and "bequeath" wherever appropriate in order to effectuate the testamentary transfer of real or personal property. 7.04. For all purposes hereunder, the terms "Executors," "Trustees," "Guardians," "Personal Representatives" and "Fiduciaries," and the singulars thereof, shall apply, respectively, to those who are then entitled and qualified to act as such, whether originally appointed, remaining, substituted, or succeeding. 7.05. No individual Trustee appointed under this Will shall at any time be held liable for any act'ton or defautt of himself or his Agent or of any other person in connection with the administration of the trust estate, unless caused by his own gross negligence or by the willful commission by him of an act of breach of trust. 7.06. The Trustee shail receive reasonable fees for the ordinary and extraordinary services rendered by the Trustee. 7.07. Should any of the provisions of my Will be for any reason declared invalid, such invalidity shall not affect any of the other provisions of this Will and all invalid provisions shall be wholly disregarded in interpreting this Will. 6 7.08. For all purposes hereunder, the term "Supplemental Needs Person" means a person who: (i) is disabled; or (ii) is receiving, or is eligible to receive, assistance or other benefits under a means-based government program (such as Medicaid or Supptemental Security Income}. As used above, the term "disabled" means disabled as defined in United States Code Title 42, Section 1382c(a)(3), or under Pennsyfvania law related to means-based government programs. As used above, the term"assistance" means assistance or medical assistance as defined in United States Code Title 42, Section 1396d(a), or under Pennsylvania {aw related to means-based government programs. ARTICLE 8: MERGER,CONSOLIDATION,AND DIVISION 8.01. For convenience of administration or investment, the Trustee of any trusts created hereunder may: a. Invest the assets of multiple trusts in a single fund, assigning them undivided interests in such common fund, dividing the income proportionately and accounting for them separately; b. Merge or consolidate any trust created hereunder together with any other trusts having the same Trustee and substantially the same dispositive provisions; and c. Divide any trust created hereunder into two (2) or more separate trusts, each such trust to contain a fractional share of the assets of the trust before such division. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 18th day of October, 2013. (� G"r , -- RUTH A. KIL OFER SIGNED, SEALED, PUBLISHED AND DECLARED BY RUTH A. KILHOFER, the above named Testatrix, 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 hereunto subscribed our names as witnesses. , f 4Y i � � ��.�� �' �i�n�a r� 0 . Witness Wit ss " _�_��� ��i`��i u� ��I� S - Address � ��-- � Address 7 ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA • COUNTY OF CUMBERLAND :SS: I, RUTH A. KILHOFER, the Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowiedge that I signed and executed the instrument as my Last Will, and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. � � . / UTH A. 1L OFER — Sworn to or affirmed and acknowledged before me, by RUTH A. KILHOFER,the Testatrix,on October 18,2013. ��i '�'�;�'C'` �'%'tLQ.A�.� ae�tl�fie-er P7�Attorney 8 AFFIDAVlT COMMONWEALTH OF PENNSYLVANIA • COUNTY OF CUMBERLANO � SS: �� �� � , a witness whose name is signed to the attached or foregoing instrument,—�dut worn and ua ified accordin to I g aw, do depose and say that I was present and saw the Testatrix sign and execute the instrument as her Last Will; that she had signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix, signed the Will as Witness; and that to the best of my knowledge the Testatrix was at that time eighteen (18)years of age or older, of sound mind and under no constraints or undue influence. r I � Witness � Sworn to or affirmed and acknowledged before me, by ��� � �rv����Witness on October 18,2013. � '�/noon v PA Attorney 9 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA � COUNTY OF CUMBERLAND : SS: i, Jessica Fisher Greene, Esquire, a witness whose name is signed to the attached or foregoing instrument, being duly sworn and qualified according to law, do depose and say that I was present and saw the Testatrix sign and execute the instrument as her Last Will; that she had signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix, signed the Will as Witness; and that to the best of my knowledge the Testatrix was at that time eighteen (18) years of age or older, of sound mind and under no constraints or undue influence. �_o�. -f".C�� �n o o.+�f� ess Swom to or affirmed and acknowledged before me, by Jessica Fisher Greene, Esquire, a Witness on October 18,2013. ���u�r.� __�?�� �'2-�..�G�-�. Notary Public r�i��� NOTARIAL SEAL CERTIFICATION MARCIA M NESBIT Notary Pub1(c COMMONWEALTH OF PENNSYLVANIA � UPPER A�I.EN TWP.,CUMBERLAND COUNTY : SS: My Commission Expfres Jun 4,2014 COUNTY OF CUMBERLAND � On October 18, 2013, before me, the undersigned officer, personally appeared Jessica Fisher Greene, Esquire (Pennsylvania Supreme Court ID No. 310018), known to me or satisfactorily proven to be a member of the bar of the highest c�urt of Pennsylvania and certified that she was personatly present when the foregoing acknowledgement and a�davit(s)were signed by the Testatrix and witnesses. IN WITNESS WHEREOF, I hereunto set me hand and official seal. �/A I �OO � / l.�C..+fY7itil'^� Notary Public �� NOTARIAI SEAL MARCIA M NES81T Notary Public UPPER Al.LEN TWP.,CUMBERLAMD COUNTY My Commiss(on Expires Jun 4,2014 10 PRU I3istorical Prices �Prudential Financial, Inc. Comm Stock-Yahoo! 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PflCef Date Open High Low Close Vopima Adj Cbse• ' Dec 13,2013 88.48 86.98 87.87 88.19 1.533.300 87.08 Dec 12,2013 88.28 86.12 87.86 88.33 2�607,800 $7.20 Dec 11,2013 8$.84 89.91 87.88 88.06 2�523,900 88.BA Dec 10,2013 88.75 88.28 87.91 BB.00i 1,b13,200 87.89 Dec 9,2013 88.94 86.82 88.85 88.98 2,069,90D 87.84 Deo 8,2013 88.98 88.70 88.83 88.91 2,202�700 87.77 Dec 5,2019 87.58 88.� 87.09 87.70 2,4?8,000 gg,sg Dec 4,2Q13 87.73 88.89 88.85 87.78 2,052�40D 88.64 Dec 3,2013 89.22 88.87 87.51 87.76 3,380,300 ge.gq Deo 2,2(313 88.03 80.53 88.70 89.48 2.738,800 88.32 Nov 29,2p13 89.49 89.87 88,73 88.78 1,246,400 g7.g3 Nov 27�Z013 90.38 9D.� 88.94 �.28 1,528,400 8&14 ��,�3 �.St 9D.24 �.16 �.74 1,998,800 gg,$g Nw 25.2013 80.i4 80.20 89.11 8823 1�Q97,400 8d08 Nov 22,2013 �.50 90.12 89.40 90.07 1,888,800 88.92 Nov 22,2013 0.53 Dividend Nov 21�2013 88.35 8D.84 �.24 90.20 2,740,400 88.53 Nw 20,2018 �.23 �.53 88.53 88.� 1,844,200 87.24 Nw 18,T013 88.60 �.53 88.43 88.98 1.883,100 87.33 Nov 18,2013 88.98 88.98 88,43 88.85 3,126,800 87.00 Pbv 15,2013 88.41 88.00 87.H0 88.82 2,501.400 88.87 Nw 14,2019 88.33 88.37 88.A2 �.OS 2,D47,300 87.40 Nov 13,2013 8A.29 87.87 8Q12 87.83 2,439,100 gg,pp �p�P��1luabd for dvidenOc end�Nts. � First�Previous�Next�last 1�SDownload to Spr�dsheet Cu�rency in USD. 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D���1 � ��nt 8�j �en ���� __._�.w._� ..._..�.�W,�..--�. _ ��°� � _„-,.�°,....�°'--�-Y"�.,..e'..---�--��.,— ���� � 8��, i�'��,t�C��; s ��.� � �,>��::�?�as• : 4x{��Q �.$C15���t� a �. ` '!� �t9'����b� �A3�Slt� C IfiY,. t�� ��„��'�3't�'��C}C1'� „ . �� �,� � .. �t��:t� ������+�tD � y ;. , �p�1?`f�b+�?#��8 , � � �'"�� #����.` ��c'�t���,t'�$�'� ` � R� .1� d� '��L� �'���,fi� � � ��',�� ��4���AN���'fi ����i��i.v�r► ,. ti��s���.����������� �'���,���C�'B��!� , � 3 ���[�t� 5'�;A�`�� ,�:. ,.. �• ti � � > ��: ��f����' � ' m��� ; , ���� rt: ���3����t3 ��* � � � � �� ' ;° �`�������+�'"` �.C�Q�1Dg�5 �� �. ..; ' �.��� .: x . � �` - ��� - One Citizens Drive ROP112 Riverside, RI 02915 December 24,20I3 Keystone Elder Law PC Attn Becki Starr 555 Gettysburg Pike Ste G-100 Mechanicsburg PA 17055 Estate of RUTH KILHOFER Date of Death:Nov 14, 2013 SSN: 170-26-2568 Dear Sir/Madam: In accordance with your request,the attached information sheet has been provided in the above decedent's name as of his/her date of death. The decedent did have a safe d�osit box jointly owned at the Mechanicsburg Branch located at 2 West Main St in Mechanicsburg, PA 17055. Please contact them at 1-717-766-4743 with any questions you may about the box. For all otha�inquiries,please call 1-877-579-2667. � Sinc el , �. Badger Decedent Account cessing REF#: 620815 � i � ������ ��' '� ... .. Account Number 6234445067 Account Title Ruth A Kilhofer Date Opened � 10/10/2012 Account Type Checking Princi al Balance as of DOD $497.73 Interest from Last Posting to DOD �_1� Account Balance as of DOD $497.90 YTD Interest to DOD $.63 ������� _ � : :;� Account Number 6300515390 Account Title Ruth A Kilhofer Date Opened 10/30/2013 Account Type Checking Princi al Balance as of DOD $255461.49 Interest from Last Posting to DOD $73.73 Account Balance as of DOD $255535.22 YTD Interest to DOD $ .00 � . ����� , Account Number 6140052084 Account Title Ruth A Kilhofer Date Opened 1/26/1981 Account Type Savings Princi al Balance as of DOD $33251.16 Interest from Last Posting to DOD $ .16 Account Balance as ofDOD $33251.32 " YTD Interest to DOD $� 76 � „, ;: .. , �,��� ,,. � :2t+�2v�urth�trim ,. � �$N�I�E G�i€A�if.,k: QF`. 7..5E1 � ��:�au�e�€�u:�aa�:r�. . �a+� ���t `M�Y3+�'�'�I ,wir}#u� ,��n�E.�A 3�tt#� {� ,i�L�TLI,A2, P�C�1�'I'A£� Rk�iTE t}� ,?�8.4��3' �� A 1'�es�}��tSiV�: ti�la�va�iv�,°t����b��. 8t���9��� , �?l�?���Ckp� w�rr�.-�t�t�`��t^��rr� �'I2�IMt�t ��"�F�'��, ��T,A32�� t3�' S �.'€�� 'V��,L B� C�IARGED C3PT X�,� A�'ipL7�s1T� 3� �?AS�S 4�S i�0�� �",'�`� �3[I$ �E�i �'�Ti��� �[' liRS��rV��T � ``'" _`` '�- �-- f '�.�^� �� �cfi'���� Y����� � �'�'f •5�k,�.,�` -.1 0. 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We thank yau far having given us an opportunity ta �rovide thi� insurance. �o,os ��uai �i��a-iota IoRson��a �r�,.,«+ � � � �;�aoAtc3+xr+cki��wc,►+A �� � �s•i�, � 1�I 5t�te Farm Mutual Au#otr�nbflie�lnsurance Cqmpahy ��'A ���'°Q°°0 l"'"”`1�o�►c�a�oa Pa�s�as 11�4446�4P ►� _ BFi + P(J�K:Y NUMBER 524 B390-A16°38R OATE DEC 26 2013 gs�_S_� , : � 8 � ki#A! !� � o PAYTU THE 6895 1 54'1 62.38 ='-' . � o�o�po� KI�MOFER, RUTH A -�-s°crvnv°A"°s�n°°°°ua�g�� • � 4833 E TR�NDLE RD APT 552 � � z M�CNANICSBURG PA 17050-3b54 �'���»+"�Q� � p CWAIRMAN. z ' N z �_S:J I�-�i,..,,,.�C._ U iREABWR&R ► .•,.. �.«� ..�.... _- ::�.. • � � ��i � ... -�• � n .� . .. � ... ,, � . . ►�' L3 i3444694��• �:044 L i5443�: 777 L4�,9 ?3�►' ° ,� +�_)Y'�;��'�� �,, � r �..,, i, �;t;� !' ,, ;�i�l �t�.:; i,;. � � � �tii ; I E, �-,� I�OI�AR TI2EE �iTpRf� INC. , � '� �� t�'� :� t f.'lerk�t: ti� tLTi�HtT1{ '�;1Gj':"i.!� ; Storeh 9C18 (717i �43-2237 �t�ij!'l:ir�i.�:�1i1f1; ��8�+1! k�:i, �i ±;.-,�..... 254 {�estmiras�.er� Dr. �•= '�1° Ga.�lisie PA 17G13-31�7 -:=_===_=_;:.___��_______=_ _�_:�=_:--_:-,._ FUNF.kki. 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Gard 7ype: MasttrrCatrd Carr!tVl�nyber:�XXX-X7(X?f-XXXX-6�57 *Receip#►n�be presenied at time of pFticeep s «S�ftt a IVaw Orader t Prtet�ia pe� � ---- � .....-. Yrint[M,irwa+e fa your n[ortls. Ta oYr eustamwre.wfth[md slllr¢i�: .. PledsB be ndWSed d�ttr!ixUrkKRs pupared in Wr(Wd p�aparstton a�s mbY centNn cu ttibse ante irt tmM�[f:Ytt!:pmrnutsr tre.t nut�,ao!"beswa.nNMc.e4'M.+wka�f./IsM er sMN�. �2613 Giant food Siores,llC.dd Aiqhts Qesc.vert�orwxy ve,r+ey FoNow us on: . .,i�Ga�.%i>oa�b VMr�,.. �. _ .:i4!wr.n'v,�:�'!��t.tl5 Fnl low https:/lwww.�i�ncfoori�tores.com//shareddev/greatent/index.btrn(2sbt=3 l 1!18/2013 LYiark D. Heintzelrnan Funeral and Cremation Services 103�$en�cr Pike 226 S.P�nnsvlvania��venuc 5tate Co)lege.PA !G$O! Gentrc Hall,PA Ib$28 1an Jcfferson.Supervispr ;�1ark D.Neintzefman.5u}xrvisor 1'ei.!i I•t-?3�-U332 `i'cl.K1^4-3b�-1412 STAT�MENT C3F FUNERAL GOODS AND S6RVIC6S SELECTED CdNYfiACT�r:'i t1'.��;'% ; Gharges are onty for those items th�t you selecNSd or;huf are required.If we are rec�ired by law or by a cemetory M erematory ro uab eny items,we win axplain the reasons in writinQ befow. Arcangements for:...�=:,;:�1 ':t r •.1<-{" ------- ------ Date ot Arrartgement.------ .�, as;i_ _. Date of Death ;--t- ;Y<;,� BERYICEB,FACiLIT1E3,AU701ttOB1LE,OTNEp EpUtPMENT MERCHANDiSE: AND ClTHFR SERYlC85: CasKer �nizad Geifarel PHos ust: Bas�Protassiarta�Sarv�ces of !7UT8t BUl{�I C!MlAt�Rr' Fur�ni Diroctor antl Statt: � ._. Other Cara of the Daceased: Gremallon Um• '� Emhalming --- Cremation Container. San�tary Ceve ot Ute �, �r e: Unembelmed Remaina __Lc.sr��ii�• � c� r+'s`+' �... Dfessi�9,CaskeG CMthing as Sefeoted rg,and Cosmetob�y P�t Autopsy CarelPOSt Osqan Rqnetion _..____..._ Grare Markrx: �toraUon Charge ppt�r�;,��pent Cards as SeHected � Ga�B Si+tl Cu��ody Whrle Shellemtg H�mains MemaAal Reptster �Ottier CBre ot the Daceased: Memnrial Fe1Anr5/Prgyer('.,�rCfs t:pmpmplrpr+ghippin�Un1VA�r I r�Y — __... Total Care ol the Deceased � __....�_ Total Merchandies ; �. i :....� bin;Ctlytg ot Sarv�ces and Uat 01 Facitjfka: CASli ADVANCE6: Yisik�tlOrY _.__.._._ 601es Tiax: g Funetal CeremonY _.__.___. Cemetery: �` Memaiai Ceremcjny DeaM Certif�cates(No.±.�t�'$�_`_'_� __..� Gravssltta Permlt DfspositlonlBurial ParmH .,. SpetNal Nrs.Chsr�n Mudicai @xamlr�r's CharQe � :-�' Monorarium: Iuh�siCtAng,NpcdHSf� Patal Dlrocfing of 5orvicas and ,�ir or Uthe�r Trarnport: Use oI FacGilies S � Out oF Town Funerai Homas: Automotiva,Otfior EqWp.,Qthrr sarvices NewsPei�er Noticss:`.;�?( 6?,tr � •4 t,�it '1'I and Qther Chsrgps� Motor Escon: Tr�e�ar ol Remams to Funersl Hame - - -- HeacsNGaach and Drivar --.__...... UmawinalOther Passe ---- --- ngar Vetdde t�d Drrver ------ Satety/Lead VeAicle 3ntl Drivar ToW�Ca91i AdvancOm b ft2� Flo�nrer Van and Driver Utiliry Vehide and Drivar We enarpe you tar seMCes�oDta�ning. Cemetery tent and grave eqvipment . . My Cesh AAVanC2 ttemR markert Additional Trenspnrtation Char�es: wim an Agt�1'1 __ - _ — — SUMMARY: ' —� Basic Prof.Servico5 of FD&Siett S _ Tota�Auto.Other Equipment and 8ervices S Ot�er Cere of the Deceased � Di�etting Services and Use of F��7litles AnU/Ui AutomoCive,Othgr EquiR.and 3ervicss � arxuor - Pecsonsll�d Sacvles Prx�gram Pacluge PBrsataN28tf Survice Proqram Padcage ���ebn a�epadr�nwYae� Other Services �"y '�-`— �dls br Ehe G�er�PMaa tkr provichd J,wl� 7bta1 Servloe Charqos w1tN _ S � Personslizad Reck�ges i ,�t.;S:'��,;`•' Mardtantlls8 �._�w,��.c Othlr Sirvi�ff [Sash AidrAt4G9S }�'��i,i�e{ SseGer�ers�PliceLbY/orcor�p/eled�ap�'+nn 7olalChAtgts S '3i�ii ��'� Immadate Buriai � (Creditsj Io Account Di�ea CreR,a�ioo w�mou�a Se,�ce S ���:�'��� Paymems[cash,check,or credit card� --- fawarQn9 flanarx bMoMiar Funeraf i-bn�a S +.x r1s r `ti.c... i f� tz '. — -��` �}3,.it St-��' �-1�t7 `,i�. �LMTA R9RWi14 6U(TI f111DIF1E'�FU11BP81 E'{ORtB S r�''L'. {�Wrr..: i 1 �� � rl � :��.�;p• ------ � _... .,k+ ,s� rr� .�:�.;r<� � Totei Servicv�Charges wt�h ,;`<,��; � Baianca tlue atter creifits V g �� Peryor181izuJ Pack9pes 5 ^�`} .�1�, . 9 ..���,.(-.� � _Y�.�v_4.iJ1 �l{..... .. � 5�.� .......l,e....�..1.......�•,.,..���i}i� ��� � .�._— - �r,-_ 4 Pogt t ot 2} ..........C. ,,t,� .. ... . 1'biARI�D►. 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