HomeMy WebLinkAbout09-16-14 1505610105
REV-1500 EX(02-11)(FI)I� OFFICIAL USE ONLY
PA Department of Revenue pennsylvania
County Code Year File Number
Bureau of Individual.Taxes INHERITANCE TAX RETURN ........ ...............
PO BOX 28o6o1
Harrisburg,PA 17128-o6oi RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
12/10/2013 !
03/04/1928
....... ............
Decedent's Last Name Suffix Decedent's First Name MI
....... ........-.......... ...............
HussonMary ; M
... ....... ..... ...............................
............
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name Mi
..........
.......... ............- . ........... .... ...............
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
QO 1.Original Return r—n 2.Supplemental Return C=D 3. Remainder Return(Date of Death
Prior to 12-13-82)
C=:) 4. Limited Estate O 4a. Future Interest Compromise(date of C=:) 5. Federal Estate Tax Return Required
death after 12-12-82)
6. Decedent Died Testate C=D 7.Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
C=:) 9. Litigation Proceeds Received C=:) 10.Spousal Poverty Credit(Date of Death C=:) 11. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule 0)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
............... ................. .............. ............- ......
,Andrew C. Sheely, Esquire 717-697-7050
C=
............................ .......... ............ . ................ ......- ...... -.1.1-1 Cl> ___11"_'_t�__= ":;b
REGIST6 RMVILLS USUNLY 1-n C-
G-)
t3 7J-) 77
First Line of Address
rrl.......... ................ ............ . .........
rn
127 South Market Street J
....................... ...................... ........
SecondI Line-o.f-Address
P.O. Box 95
�7
City or Post Office State ZIP Code -!ATE FILED
..........- .......... ................
'
Mechanicsburg PA 117055
............ ..................... ............. .... .......... ........... .... .........- ..........
Correspondent's e-mail address:andrewc.sheely@verizon.net
Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNA E OF P ON E ONSI E FOR FILING RETURN DATE
U1 Ir
79"IREfS
Ma .11� YJ I
Mary
alp, Executrix, 3020Larket Street,Apartment 1, Camp Hill, PA 17011
SIGN RE/OFP R T ER THAN REPRESENTATIVE
A(5DRLSS
Andrew C. Sheely, Esquire, 127 South Market Street, P.O. Box 95, Mechanicsburg, PA 17055
PLEASE USE ORIGINAL FORM ONLY
Side I
1505610105 1505610105
1505610205
REV-1500 EX(FI)
Decedent's Social Security Number
........ .
Decedent's Name: HUsson, Mary M.
RECAPITULATION
1. Real Estate(Schedule A). ............................. .............. 1. ' $11$,000M
2. Stocks and Bonds(Schedule B) . ... ... ... ..... ........................ 2, 3$,7$9,$3
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . ... . 3.
4. Mortgages and Notes Receivable(Schedule D).. ... .... . ... ... .... ....... 4. ! f
5, Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). ... .. 5 $12,379.24 r
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ..... .. 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property(Schedule G)G) CY Separate Billing Requested... ,. ... 7.
8, Total Gross Assets(total Lines 1 through 7). ... . .... .... ... .. . ........ .. $. $169,169.07
9. Funeral Expenses and Administrative Costs(Schedule H). .. .. ... ... 9. 17,470.60
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1).... 10 41,75$.73
11. Total Deductions(total Lines 9 and 10)...................... ........... 11. 59,229.33
12. Net Value of Estate(Line 8 minus Line 11) . . .... ... . ... . ... ... .... .... .. 12. ! 109,939.74
13, Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made Schedule J 1
( ) .. .. . .. ... .. ... ... ..... . 13. `
_....
14. Net Value Subject to Tax(Line 12 minus Line 13) .. . ... ,... . . ...... ... .. 14. 109,939.74 y
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
_..
(a)(1,2)X.0 0.
15.
16, Amount of Line 14 taxable
at lineal rate X.0 45
109,939.74 16. 4,947.2$
�r
17, Amount of Line 14 taxable
at sibling rate X.12 17.
_y . ,.m,
18. Amount of Line 14 taxable .... ,.at collateral rate X.15 18
19. TAX DUE . . . .. . . ... ....... . ... ....... ... .. ... .... ... . .... .. ....... 19. 4,947.2$
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505610205 1505610205
NEV-1500 FAX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME_
Mary M. Husson
STREETAIDDRESS
149 West Vine Street
............. ......... ........ ............... ........ .............. ........
..................___....................... ..................... ................ . .......................
CITY STATE ZIP
Shiremanstown PA 17011
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 4,947.28
2. Credits/Payments
A.Prior Payments ........—------ $5,000.00
B.Discount 263.15
Total Credits(A+B) (2) 5,263.15
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4) $315.87
5. If Line I +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5)
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred .......................................................................................... El E
b. retain the right to designate who shall use the property transferred or its income ............................................ 0 N
c. retain a reversionary interest .............................................................................................................................. F-1 0
d. receive the promise for life of either payments,benefits or care?..................................................................... ❑
2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death
without receiving adequate consideration?............................................................................................................. ID 0
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. El 0
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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an
adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S. §9116(a)(1.3)].A sibling is defined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
1
BUF&AU OF INDIVIDUAL TAXES
DEPT.280601 .
HARRISBURG,PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
N0. CD 018861
WALP MARY V
127 SOUTH MARKET ST
CAMP HILL, PA 17011
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- fold
101 $5,000.00
ESTATE INFORMATION: SSN:
FILE NUMBER: 2113-1324
DECEDENT NAME: HUSSON MARY M
DATE OF PAYMENT: 03/07/2014
POSTMARK DATE: 03/07/2014
COUNTY: CUMBERLAND
DATE OF DEATH: 12/10/2013
TOTAL AMOUNT PAID: $5,000.00
REMARKS: RECEIPT TO ATTY
CHECK#{ 1016
INITIALS: DMB
SEAL RECEIVED BY: LISA M. GRAYSON, ESQ.
REGISTER OF WILLS
TAXPAYER
REV-1502 EX+(11-08)
e
pennsylvania SCHEDULE A
f ,DEPARTMENT OF REVENUE
~ 'INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Mary M. Husson 21-13-1324
All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts.
Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1 Decedent's real estate located at 149 West Vine Street,Shiremanstown,Cumberland County,
PA, 17011. Tax Parcel#37-23-0557-168L.See attached settlement sheet. $118,000.00
TOTAL(Also enter on Line 1, Recapitulation.) $ $118,000.00
If more space Is needed,insert additional sheets of the same•size.
PtMEN7OR OMB Approval No.2502-0265
' 1 a* I *GGt
HUD-1
oG �II Q�� A. Settlement Statement (HUD 1)
9BfN O1 VENO Page 1 of 3
B.Type of Loan
1.❑FHA 2. RHS 3. Conv.Unins. 6.File Number: 7.Loan Number: 8.Mortgage Insurance Case Number:
4.0X VA 5. Conv.Ins. 401402612-SK 7131930567
C.NOTE: This form is furnished to give you a statement of actual settlement costs.Amounts paid to and by the settlement agent are shown.
Items marked"(p.o.c.)"were paid outside the closing;they are shown here for informational purposes and are not included in the
totals.
D.Name and Address of Borrower E.Name and Address of Seller F.Name and Address of Lender
TAMMY J.WILBURN MARY V.WALP,EXECUTOR OF ESTATE OF ERA HOME LOANS
4512 FLORENCE AVENUE MARY M.HUSSON 1 MORTGAGE WAY,
MECHANICSBURG,PA 17055 149 WEST VINE STREET MOUNT LAUREL,NJ 08054
SHIREMANSTOWN,PA 17011
G.Property Location H.Settlement Agent
SECURED LAND TRANSFERS,LLC
149 WEST VINE STREET, 485 ST.JOHNS CHURCH ROAD,
SHIREMANSTOWN,PA 17011 SHIREMANSTOWN,PA 17011
Phone:(717)901-8342
COUNTY:CUMBERLAND
PARCEL ID:37-23-0557-168L Place of Settlement 1.Settlement Date 09/12/2014
TOWNSHIP:SHIREMANSTOWN BOROUGH 3915 MARKET ST Disbursement Date 09/12/2014
CAMP HILL,PA 17011
J.Summary of Borrower's Transaction K.Summary of Seller's Transaction
100.Gross Amount Due from Borrower 400.Gross Amount Due to Seller
101. Contract Sales Price $iiB4O00.00 401. Contract Sales Price $118,000.00
102. Personal Property 402. Personal Property
103. Settlement charges to borrower line 1400 $5,549.89 403.
104. 404.
105. 405.
Adjustment for items paid by seller in advance Adjustment for items paid by seller in advance
106. CI own Taxes 406. Ci own Taxes
107. County Taxes 632.15 r9/12/2014 to 1/1/2015 $192.24 407. County Taxes 632.15/yr 912 2014 to 1/1/2015 192.24
108. Assessments 408. Assessments
109. School Taxes 1,743.76/yr 9/12/2014 to 7/1/2015 $1,395.01 409. School Taxes 1,743.76/yr 9/12/2014 to 7/1/2015 $1,395.01
110. HOA monthly due for Sept 92.75/mo for 9/12/2014 $58.74 410. HOA monthly due for Sept 92.75/mo for 9/12/2014 $58.74
to 10 1/2014 to 10/1/2014
111. Sewer 70.00/qtr for 9/12/2014 to 10/1/2014 $14.46, 411. Sewer 70.00/qtr for 9/12/2014 to 10/1/2014 14.46
112. MOA Credit 15.38 412. HOA Credit 15.38
120.Gross Amount Due from Borrower 1$125,225.72 420.Gross Amount Due to Seller 1$119,675.831
200.Amounts Paid by or in Behalf of Borrower 500.Reductions In Amount Due to Seller
201. Deposit or earnest move $1,000.00 501. Excess Deposits
202. Principal Loan Amount from ERA Home loans $120,500.00 502. Settlement Charges to Seller 14 004.13
203. Existing loans taken subject to 503. Existing loans taken subject to
204. 504.
205. 505.
206. 506.
207. 507.
208. 508.
209. 509.
Adjustments for items unpaid by seller Adjustments for items unpaid by seller
210. Ci own Taxes 510. Ci own Taxes
211. County Taxes 511. County Taxes
212. Assessments 512. Assessments
213. Seller Paid Closing Costs $2,745.00 513. Seller Paid Closing Costs $2,745.00
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220.Total Paid b for Borrower 124 245.00 520.Total Reduction Amount Due Seller 16 749.13
300.Cash at Settlement from/to Borrower 600.Cash at Settlement to/from Seller
301. Gross amount due from borrower line 120 125 225.72 601. Gross amount due to seller line 420 $119,675.83
302. Less amounts paid by/for borrower line 220 124 245.00 602. Less reductions in amount due seller line 520 $16,749.13
303.Cash X From To Borrower 1 $980.72 603.Cash I X rToIFrom Seller 102,926.70
The Public Reporting Burden for this collection of information is estimated at 35 minutes per response for collecting,reviewing,and reporting the data.This agency may not
collect this information,and you are not required to complete this form,unless it displays a currently valid OMB control number.No confidentiality is assured;this disclosure
is mandatory.This Is designed to provide the parties to a RESPA covered transaction with information during the settlement process. /}
Initials��
401402612-SK HUD-1 Page 2 of 3
L.Settlement Charges
700.Total Real Estate Broker Fees$7475.00
Paid From Paid From
Division of Commission line 700 as follows:
Borrower's Funds Seller's Funds
701. $3935.00 to Re Max Realty Associates 3540+395 At Settlement At Settlement
702. $3540.00 to ERA-NRT LLC
703. Commission paid at settlement $7,475.00
704.
800.Items Payable in Connection with Loan
801. Our origination charge $498.00 from GFE#1
802.Your credit or charge(points)for the specific interest rate chosen -$2,105.00 from GFE#2
803.Your adjusted origination charges from GFE A -$1,607.00
804.Appraisal Fee to STARS from GFE#3 375.00
805.Credit report to CBC Innovis Inc. from GFE#3 7.76
806.Tax Service from GFE#3
807. Flood Cert.Fee from GFE#3
808. Lenders Inspection Fee to STARS $100.00
809. Mtg Svcs Doc Prep Fee $85.00
810.Application Fee/Conversion Fee $395.00
811.Automated Scoring Fee $18.00 from GFE#3
900.Items Required by Lender to Be Paid in Advance
901. Daily interest charges from 9/12/2014 to 10/1/2014 @ 14.03/day ERA (from GFE#10) $266.57
Home Loans
902.VA FUNDING FEE TO:SECRETARY OF VA from GFE#3 $2,537.00
903. 1 year Homeowner's Insurance Allstate Vehicle and Property Insurance (from GFE#11) $410.18
Company
904.
1000.Reserves Deposited with Lender
1001.Initial deposit for your escrow account from GFE#9 $717.88
1002.Hazard Ins.Reserve 3 Months @ 34.18 per Months ERA Home Loans $102.54
1003.City Property Taxes 8 Months @ 52.68 per Months ERA Home Loans $421.44
1004.School Taxes 4 Months @ 152.42 per Months ERA Home Loans $609.68
1005.Aggregate Accountin Ad ustment to ERA Home Loans -$415.78
F006.
07.
1100.Title Charges
1301.Title services and lender's title insurance to Secured Land TransfersLLC from GFE#4 $1,330.00 $40.00
1102.Settlement or closing fee
1103.Owner's title insurance from GFE#5
1104.Lender's title insurance to Secured Land Transfers LLC $1,205.00
1105.Lender's title policy limit 120 500.00
1106.Owner's title policy limit $120,500.00
1107.Agent's portion of the total title insurance premium to Secured Land $1,084.50
TransfersLLC
1108.Underwriter's portion of the total title insurance premium to TRGC $120.50
1109.Insured Closing Protection Letter to TRGC $125.00
1200.Government Recording and Transfer Charges
1201.Government recording charges from GFE#7 $213.00
1202.Deed 79.00 Mortgage 27 Pages) 134.00 Releases
1203.Transfer taxes from GFE#8 $1,180.00
1204.Ci /Coun tax stam s Deed$1180.00 Mort a e
1205.State tax/stamps Deed 1180.00 Mortgage $1,180.00
1206.
1300.Additional Settlement Charges
1301.Required services that you can shop for from GFE#6 $19.50
1302.FLOOD CERTIFICATION TO:STARS $19.50
1303,ESCROW FOR INHERITANCE TAXES to Secured Land Transfers $2,965.00
Mechanicsbur
1304.2014/15 School Taxes-Beth A Moni han Tax Collector $1,743.76
1305.Home Inspection and Radon Cert to Mike Sheely Home Inspections POC
380.00
1306.Resale Cert to PMI $150.00
1307.Wood Cert to POC$45.11
1308.Sewer to Lower Allen Twp Sewer Authority 7/8/9 plus penalty $77.00
1309.HOA dues to Shireman Gardens HOA $97.37
1310.Duplicate Bill fee-Beth A.Moni hanTax Collector 1.00
1311.Invoice to Mike Sheely Home Inspections 275.00
1400.Total Settlement Charges(enter on lines 103,Section 3 and 502,Section K) $5,549.891 $14,004.13
If you have any questions about the settlement charges and loan terms listed on this form,please contact your lender.Settlement agent is not responsible for content of
lenders assessments on HUD.
The sellers and borrowers signatures hereon acknowledge their approval and signify their understanding that tax and insurance proration and reserves are based on
figures for the preceding year or supplied by others or estimated for the current year,and in the event of any change for the current year,all necessary adjustments will be
made between borrower and seller directly.Any deficit delinquent taxes or mortgage payoffs will be promptly reimbursed to the settlement agent by the seller.
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief,it is true and accurate statement of all receipts and disbursements
made on my aby me in this t nsadion.I further certify that I have received a copy of the HUD-1 Settlement Statement.
�� SELLERS
Estate otM.Hu�.
Tamy J.iYlbum
i
By:Mary65,
p,ExecutorThe HUD-1 Settlement Statem t which I have prepared is a true and accurate account of thision.I have caused or will use the funds to be disbursed in
accordan it this stateme
Settlement nt Date
09/12/2014
*Any items marked"POC"were paid outside closing by:Borrower POC(B),Lender POC(L),Mortgage Broker POC(M),Seller POC(S),Real Estate Agent POC(R),or
Other POC(0).
HUD-1 Addendum
File Number: 401402612-SK Settlement Agent/Place of
Settlement:
Property Address: 149 WEST VINE STREET, Secured Land Transfers,LLC
SHIREMANSTOWN,PA 17011 485 ST.JOHNS CHURCH ROAD,
SHIREMANSTOWN,PA 17011
COUNTY:CUMBERLAND Phone:(717)901-8342
PARCEL ID:37-23-0557-168L
TOWNSHIP:SHIREMANSTOWN BOROUGH
Seller(s): MARY V.WALP,EXECUTOR OF ESTATE OF MARY M.HUSSON
Buyer(s): TAMMY J.WILBURN Settlement Date: 9/12/2014 1:00:00
PM
Disbursement Date:9/12/2014
Loan Number: Lender:ERA Home Loans Mortgage Broker:
7131930567
Buyer Charges seller Charges
New Loan Fees:
Loan Discount Fee%to ERA Home Loans ($2,105.00)
Mtg Svcs Doc Prep Fee $85.00
Application Fee/Conversion Fee $395.00
Automated Scoring Fee $18.00
Line 803 Total: ($1,607.00) $0.00
Appraisal Fee to STARS $375.00
Credit report to CBC Innovis,Inc. $7.76
Lenders Inspection Fee to STARS $100.00
Additional Settlement Charges:
FLOOD CERTIFICATION TO:STARS $19.50
Line 1301 Total:1 $19.501 $0.00
Title and Escrow Charges:
Notary fee to Secured Land Transfers,LLC $30.00
Seller Notary Fee to Secured Land Transfers,LLC $10.00
Lender's Coverage to Secured Land Transfers,LLC $1,005.00
PA 100 No Violation of Restrictions-Existing Construction to Secured Land Transfers,LLC $50.00
PA 300 Survey-Loan Policy to Secured Land Transfers,LLC $50.00
PA 900 Environmental to Secured Land Transfers,LLC $50.00
PA 820 Condo-Land(PUG)to Secured Land Transfers,LLC $50.00
Insured Closing Protection Letter to TRGC $125.00
Line 1101 Total: $1,330.00 $40.00
AUG=19-2014 11:27AM FROM- T-162 P•004/006 F-676
r«w tb Sts-�LtD rRor w -•—J+—..Y.^Y__,,,n '
tl i �4MTJLK w4
F I .
Y r
Q{f t t4r �'``! der of Al l�'f.�"�"1 A.D.one thouwad afiu
h°ndeod and Seventy-five (1975) betwa a the Cap m;es W the man e
nyk and tide of XAUETMM ENTERPRISES, INC., a Pennsylvania corporation
Grantor, party •� I �
i
C ' of ch.one para and �1
i MARY M. >!iUSSON, Bingle weman,
t of County d I
6 the State of Pennsylvania, Grantee, party of the ether part ETu[Pmt#
That the std Kauffman Knterprisea, Inc. foe and in tea•
1 t,dorati..of the awn of TWELVE In=SAND
- -�- Defray.la.fvl mom,of the United St.&4.to it in hand paid by the aid -
party of the second part,
at the time of the mcaCm,hereof.the teceipt whereof 4 IKteby adtmwiedtc4 Ms paerr& barptoed, acid.
a6n4 eefteQtd,aa1c"d and tnnfumrd,and by than pmmta dna snot,hvS4%M*144m.tafaes,eckate and t
confirm unto t&aaW Grantee, her heirs
sad aa94031
so that eern;tt ptao of pard of land,tituatc in the Borough of shiremanstown,
Cumberland County, Pennsylvania, more particularly bounded and
described as follows, to wit:
BEGINNnM at a point which is the southwest corner of Lot 3-D on the
hereinafter mentioned Plan of Lots,- which point is on the dividing
line between Lots 3-c anct 3-D on maid Pian; thenre along said dividing
line north 11 degrees 26 minutes west 62.67 feet to a point on the f
dividing lino between the within described Lot and certain common areas
Z as shown on said Plan; thence along said last mentioned dividing line �I
1 north 78 degrees 34 minutes east 20.30 feet to a point at the dividing
I . . . line between 7,ots 3-D and 3-E on said Plan; thence along said last
f I mentionc8 dividing line south 11 degrees 26 minutes east 62.67 feet i
to a point at the dividing line bMieen the within described lot and
other common area as appears on said Plan; thence along said .last
mentioned dividing line south 78 degrees 34 minutes west 20.30 feet
to a point the Place of BEG123N M.
fBEING tot-No. 3-D on the Revised.Plan of Section•1 of shiireman Gardens,
which Pian is recorded in the office of the Recorder-of Deeds in and
I for cwmberland'County-in Plan Book 2 6 Volume-_.- page
uAv=G thereon erected a townbovse,)mown and ntmtbered as 144 Vine Street.
BEnM part of the same premises which Leonard Levin,-et al by deed
dated July 19, 1971 and recorded in Ctumberland county in Deed Book
''E", Volume 24, page 226, granted and conveyed unto Kauffman Enterprises,
Inc., Grantor herein.
THIS COI11/mANCE is made under and subject to a Declaration of covenants
and easements dated November 1, 1974 and recorded in Cumberland County .
i Misc.'noek 211, page 898.
I• .
I 'The Grantee herein, her heirs and assigns shall'have an easement for tho
continued maintenance of the party walls of the Townhouse erected on the
within described property to the extent that the same encroach upon r
adjoining rots 3-C and 3-•E. sim£liarly this conveyance is =ado subject
I to the rights of the owners of the townhouses erected on adjoining
bots 3-C and.3-Z to continue to maintain the party walls to the extemt
that the sa=e may ermoroacb upon the premises described heiein.
60ti6 PAGE 990
AUG-!9-2014 11:27AM FROM- T-162 P•005/006 F-676
Comb.Co.... .. � `' xe>!GG: COMMONWEAM OF 4 M MAltlU►
p school Dist.Camh,Co„P.. ISAM 4EtMT OF REVENUE
,iz t.9i feia�+traetr-F!o ' '
.ZG 4-1fat-t.Tw4r 4. •.at REMY
Ar 2jP ,..: !/� — its
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In the presence of .�^�
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AUG-19-2014 11:27AM FROM- T-162 P-006/006 F-676
State of Pennsylvania }
R Cwoq of Dauphin
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REV-1503'EX+(7-11)
Pennsylvania SCHEDULE B
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Mary M. Husson 21-13-1324
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Comcast common stock- 27.395 shares @$49.34/share at date of death $1,351.66
2 Verizon common stock-281.189209 shares @$49.17/share at date of death $13,826.07
3 AT&T common stock-681.445988 shares @$34.65/share at date of death $23,612.10
TOTAL (Also enter on Line 2, Recapitulation) $ 38,789.83
If more space is needed,insert additional sheets of the same size
AT&T Inc.,T Historical Quote-(NYSE)T,AT&T Inc.Stock Price-BigCharts.com 8/26/14, 12:00 PM
enter Symbols or Keywords SEARCH
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r—
Enter Symbol: IT................................ Enter Date: 112/10/13
• 34.40
34.79
34.91
Lw. 34.39
18,389.575
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Verizon Communications Inc.,VZ Historical Quote-(NYSE)VZ,Verizon Communications Inc.Stock Price-BigCharts.com 8/26/14, 11:56 AM
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k. Enter Symbol: :... Enter Date: 12/10/13
Verizon Communications Inc.
C!o-rro F=rca. 49.05
Open: 49.49
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Ittp:!/bigcharts.marketwatch.com/historical/default.asp?symb=vz&closeDate=12%2F10%2F13&x=33&y=21 Page 1 of 2
Comcast Corp.Cl A,CMCSA Historical Quote-(NASDAQ)CMCSA,Comcast Corp.Cl A Stock Price-BigCharts.com 8/26/14, 11:52 AM
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This Historical Quotes tool allows you to look up a security's exact closing price.
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n Enter Symbol: 'cmcsa Enter Date `12/10/13
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Intraday Data provided by SIX Financial Information and subject to terms of use.
Ittp://bigcharts.marketwatch.com/historical/default.asp?symb=cmcsa&close bate=1.2%2F10%2F13&x=24&y=24 Page 1 of 2
REV-i5o8 EX+(ii-io)
0-A"
pennsytvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Mary M. Husson 21-13-1324
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PSECU Savings Account#0197200112 $502.27
2. PSECU Checking Account#0197200112 $2,395.57
3. PSECU Certificate of Deposit#0197200112 $778.53
4. Decedenfs 2004 Volkswagon,VIN WVWPD63894P143271,fair condition $4,000.00
5. Comcast refund $167.26
6. MT&T Bank Checking Account#88232446 $1,505.23
7. The Estate Sale Company-Sale of Decedent's personal property $1,657.15
8. QLT Consumer Lease Services-refund $58.80
9. Sale of misc.personal items $300.00
10. American Water refund $28.37
11. Westfield Insurance refund $192.06
12. Decedent's 2013 Federal Income tax refund $794.00
TOTAL(Also enter on Line 5, Recapitulation) $ $12,379.24
If more space is needed, use additional sheets of paper of the same size.
PSECO
02/10/2014
Andrew C.Sheely
Attorney at Law
P.O.Box 95
Mechanicsburg,PA 17055
Re:MARY'HUSSON,Deceased.
PSECU Reference#4896344731800
Dear Attorney Sheely:
The above referenced person has an account with PSECU which was opened on
February 15, 1978.The Share accounts were individually held by MARY HUSSON.The Visa,Auto
and Real Estate Equity loans were individually held.
The following are the Date of Death Balances for MARY HUSSON's account with PSECU:
Account Date of Death Balances Interest—December 1-10
Shares:
(S1)Savings $502.27 $0.02
(S4)Checking $2,395.57 $0.07
(S52)Certificate $778.53 $0.10
Loans:
(L9)Visa Loan $3,104.92
(LIO)Auto Loan $6,621.44
(L53)Real Estate Equity Loan $12,105.99
If the Estate has sufficient funds to pay off the decedent's Visa loan,please contact us for the payoff
amount. If there are not sufficient funds to pay off this loan,please submit a letter of insolvency along
with supporting documentation such as a final inheritance tax return and financial accounting.
The Auto loan balance must be satisfied by the Estate unless the Administrator does not wish to keep
the vehicle. If that is his decision you may contact the Credit Union and make the necessary
arrangements to return the vehicle to PSECU.
The Real Estate Equity Loan must be satisfied by the Estate before this account can be closed.
If you have any questions,please contact our department toll-free at(800)237-7328,press 6,extension
3120 or email accountservices(d�asecu.com.
Sincerely,
Sand
.. . Y Fa gile Y
Member Service Representative
P. O. BOX 67013 HARRISBURG, PA 1 71 06-701 3 800.237.7358 >>psecu.com
THIS CREDIT UNION IS FEDERALLY INSURED BY THE NATIONAL CREDIT UNION ADMINISTRATION.EQUAL OPPORTUNITY LENDER.
i
CERTIFICATE OF TITLE-FORA VEHICLE•. '
wi '•
-14
x VEHICLE�IOENT1 CATION NUMBER i •YEAR MAKE OF VEHICLE
. xAt r�� jj r� •� [t -�j
l}P,f DJ, 7D � b24� _
:BODY TYPE .1 OUP„ SEAT CAP VPRIOR TITLE STATE ODM PROCD.DATE.,, LOOM MILES; -_DOOM STATUS c,r •,ry
DATE PA TRIED DATE OF ISSUE ( UNLADEN WEIGHT GVWR` .. GCWR • TtTLE BAAND5
" ODOMETER STU ATUS ;`
. 0•a ACTUAL MiLEA �:• '•p=�'+
'.•
UMrrS
_ ' i=MILEAGE IXt�EDs THE tAECftAtBQAL"�'�
2=NOT THE ACTUAL MILEAGE '' r F'• _
"��,�• - a-NOT THE ACTUAL MILE7IGE-000M
TAMPMe-RING'.VERIFIE6
�A 4:EXEMPT FROih OOOMESEfl OISCtA£UR^c
REGISTEREDOWNER(S)'. . !6iCSr "`�!r""'+�''•1 TITLE BRANDS
A.MftIOUE�VEHICIE ,
C:Ct.ASS1C•YEHKh.$�
�P1'q;?a'tT+"Qt,ti#•o�"£F'F+c d .8 LKIUECTF23LE YF#(1CT£ k�.R"
C0UXW.
•� ti !,�
YIN
-! T' �k xy"- ._....� ('"nt, Y - -,..•.�. G=ORIGUNALLY MFGO.FOR NON•t1.$5'
r r .fl'[g YF •'Y I NE .S T -,. X,���,..�,-. - .F-V,�`'r DISTRIBUTION t ,
lTy }!
r„ =AGRXXiLTURAI VEtitCLE}p '.G -.
kiREMANttO N PA- Ii7all - L =LG»�,GYEHOLE:
P=ISWAS.A POUCE VEHICLE
.RC-CONSSTFSEETTRUCTED" rid•°'>.'�„'�,
R00 •.
• _Yn _ , "r TRECOV�AED TtiEF,T-VEtiiCFf;. v
'•� Y .VEHICLEOORiTAiN9;t -ViN� ,
.• - •
IN FLOOO VEHICLE
FIRST LIEN FAVOR OF " " ORLIEN FAVOR O 'X='ISAVASA TAXI Yt
tp - *r•'
_ - It a swond-RonhoWer is 31sted 4m aRUsladrorf tf the
^ - •:den der must farward this Tide to the Swasu d FAota Votildey whtl.the,
FIRST LIEN RELEASED "eppTopdale tam and tae .• ?11. y�r�,,�
DATE
BY SECOND LIEN RELEASED .z
AUTHORIZED REPRESENTATIVE DATE -
'MAIUNG ADDRESSr;;'•-
. BY
• AUTHORIZED REPRESENTATfVE} '
MARY M. HUSSON
149 W VINE ST =t .
SHIREMAN.STOWN PA 17011 • .. ���
pennsylvania 2
DEPARTMENT.OF"ANSPORTATION
w
• , p CyOV t [��tn Lt �t ,
• .I cer*as of me date of issue,"the otT"rewrds of the Pennsylvania Departnent. - ZAR'R s J .•i S CHOC I.1-.`„-,r!:`..-f`-
.mfleLt b bi rwm,0(SL o,axImay-omr*0 hma.t;,the W&— ownor - � '+.'.• ;�:,�.
of tha said Vehicle. - ,. �- Secretaryof Transportatiau,
APPLICATIONTo RE commereo By PuAcHAsER WHEN VEHICLE IS-SOLD AND THE
i' TITLE AND-LIENINFORMATION-
RIB ED If a co-purchaser other than your spouse is listed and YOU wartt fhe titie:to•'
TO BEFOR MAND SWORN 31e listed as'Joint Tenants With Right of Survivarship'.(Orr deaitl_of.one..,
«ro'.:: AY Yaw. owner,ttle.goes to surviving owner)CHECK HERE 31,oche :se;.,ifle�fte,
iwill be issuod as'Tenants in Common'(On death of one>owner rnfere';ta, '•
.;deceasBdowmer'goesto'his/herheirsonesrate),
AC%WVrERM OATH
r I IF NO LIEN.CHECKQ IS THIS AN ELT?(IF YES FIN REWIREOS 'A:
.. • j IST UENHOLDEFE'FIN AL INSTITUTION NUMBER^ -” i 4"�'•" -
1
SST UENHOfDER NAME
• .STREETCil
CT) CITY STATE,.,,.
IF NO 2ND LIEN,CHECK 0 IS THIS AN ELT?OF REFINWIRED MOO
'The mftai od_bmby-maw amkagt+ fa OVOWlf a T48 m ft vtltiGe dm2"
Coa4ow.+ub}cc w Er«rdmt .vc ra mreer kgsl ciwrs sn was,tw.. .� ,;+2.. t',�
W
I.2ND UENHOLDER FINANCIAL INSTITUTION NUMB�ij 1 ''Sy ,
N2ND UENHCLDER NAME X yam'
LJ ..SIGNATURE OF APPLICANT OR AUTHORLZEO SIGNER -
� STREET .
SIGNATURE Of COAMPUGANV7TTtE OF AUSfpRZEO SIGNER. CITY STATE 'ZIP' • :.i',?:
-----------------
(G
.:COMCAS
1555 SUZY STREET
ATTN: LEBANON SUPPORT SERVICES
LEBANON, PA 17046
Ccomcast
M HUSSON 19598 0127-38-85-3DG
3020 MARKET ST APT1
CAMP HILL, PA 17011-4542
PAYMENT SZI OL48Y _
K NO: 0012352779
ACCO
CHECKUNTT NO: 09547-22520701 CHECK DATE: 01/07/14
Dear M HUSSON,
The attached check represents a refund for account number 09547-22520701 in the amount of
$167.26.
If you are a Comcast %FINITY customer and have questions regarding your refund check, you
can-write us at the address above, call Comcast's toll free customer service number at
1-888-COMCAST (1-8.88-266-2278), or chat with us at www.comcast.com/chat. Our
representatives are available to assist you 24 hours a day, 7 days a week.
if you are a Comcast Spotlight client or agency, please contact your local Spotlight
office.
DETACH AND RETAIN THIS STATEMENT
THE ATTACHED CHECK IS IN PAYMENT OF ITEMS DESCRIBED ABOVE.
IF NOT CORRECT PLEASE NOTIFY US PROMPTLY NO RECEIPT DESIRED.
co FIN-ANCIALAGENCY CORPORATION
ACOMC:?1ST� 3LE COiVIMU 1L Afi ON ::DROIT,COWA WV' `•'- 60=160 f 43 3 z'
f CHECK'D
BER`
ACCOU1itT`.iJ;ilM$.Et�'` ATE +:5."H
:
:r
--09547-42520701 . 01/07/20#`4"% F 0012352779
{ ) 1 Li
,'. VALID,FOR .1$9. DAYS:
'� 1'I Q
:..
1�S$ 67
To � .�
: .
T T P
`3 �� �tARKE S A 1`
. THE
ORDER:ti'4 "CAfiP H 1 LL, PA 17011 x:542
OF:
:E}
�z
j -•
N
ftR yD ON
THE MELL
PITTSB TRG .PENNSYLVANiA
N
11'0012352779118 {:04330L60III: L1113811783411,
®M&1Bank
............ .... . ..... .. ....... . . ....... .
..........
... ................... ...... ...... ......
...... ........ ..
;CCOUNT. . .. ....
. ............ ............. ..
..................................:...... ..:.:.:.;::. :.:..:::::•:. ::::..............:....::.......
...........................
88232446 CLASSIC CHECKING NOV.16-DEC.13,2013 I OF 1
00 0 06117M NM 017
47784
MARY M HUSSON
149 W VINE ST
CAMP HILL PA 17011-6347
INTEREST EARNED FOR STATEMENT PERIOD 0.00 MECHANICSBURG
ACCOUNT SUMMARY
...... ..................... ......... ....
....................... ..
........... ...........
.. . T. '...:CURRENT.':. ..... .... .
........ .............
........................... ................ ............ .............................................. . ..... ... ........ .
..... ............................... ...... .................... ........... ...... . . ............... ....::::::*........ .... .. ... ............... ::.::•::.::::::.::::. ::::::•:.
S.YM. 'T 10
T'
....... . .. ......... .... �RA.o I
NO. AMOUNT NO. AMOUNT NO. AMOUNT
272.68 1 1,232.55 0 1 0.00 0 0.00 0.00 1,505.23
ACCOUNT ACTIVITY
.... ...... .
...... :;ii::::>:>:::.::::::. : .............. Epo
........T4f:6j4§:: :::" ..........
...............
OTHEA::4ADDI . SUBTRACTT
11-16-13 BEGINNING BALANCE $212.68
12-05-13 DEPOSIT 1,232.55 1,505.23
IENDING BALANCE $1,505.23
SAVE MONEY ON GIFTS AND MORE AT MAJOR RETAILERS THIS HOLIDAY SEASON. FIND OUT
HOW TO GET ADDITIONAL SAVINGS BY USING YOUR M&T VISA DEBIT CARD OR M&T VISA
CREDIT CARD AT MORE THAN 50 RETAILERS WHEN YOU VISIT MTB.COM/SHOPPING.
FOR CUSTOMER SERVICE QUESTIONS, PLEASE CALL 1-800-724-2440. MEMBER FDIC.
The Estate Sale Company
213 S York St.
Mechanicsburg,PA 17055
717-979-9213
EstateSa lesPA@aol.com
Dear Mary,
Thank you for choosing the Estate Sale Company to facilitate your transition. The following is a summary of your
sale. We appreciate your business.
Jocine Alessandrini&Alida Mason
Sale:149 W Vine St. Shiremanstown,PA
Dates: April 10,11,12 2014
Labor:
Clean Out-140
Tagging-21
Sale—105
Advertising:
Ads in The Guide:April 1 and April 8-$240.00
Listed on Craigslist.com
Ad with Pictures EstateSales.net-$50.00
Received 993 hits
Sale-
Pre-Sale- $231.00
Thursday-$1028.25
Friday-$544.75
Saturday-$846.20
Total-$2549.45
35%Commission-$892.30
65%Proceeds-$1657.15
a
Statement Date: May 13,2014
PO Box 506 Account Number: 717-761-4661
Cedar Knolls,NJ 07927-0506 Credit Balance: $58.80 cr
146QLT Refund Check will be Issued
%qu Commer Lease Servkes Please allow 4 weeks for your refund to be processed.
7282004575 PRESORT 45751 MB 0A35 PIC26<4>
EST OF MARY M HUSSON
149 W VINE ST
SHIREMANSTOWN PA 17011-6347
Service 149 W Vine St DO NOT PAY To Contact Us:
Address: Shiremanstown, PA 17011 Credit 1 (800)555-8111 %%% QLT
----Balance www.QLTCLS.com %111 C.—iiir Lose S-'i
es
Summary of Account May 13,2014 Important Messages---
Statement Date: 717761-4661 We are sorry for your loss. We
-
Account Number: $58.80 cr know you have many things to
Credit Balance: handle during this difficult time
and we want to make taking care
Previous Amount Billed $38.91 of this account and the lease
Less Payments Applied Thru May 13 .00 product as easy as possible for you.
Previous Balance $38.91
Credit For Leased Equipment Services Dec 10-Jul 26 If you have not yet discussed the
Traditional Touchtone Phone 44.82 cr disposition of the.leased products
Traditional Touchtone Phone 44.82 cr with us, please call 1 (800) 555-8111
2.69 cr or contact us through.our web site
Federal Taxes 5.38 cr at www.qltcls.com/contact. We will
State And Local Taxes $97.71 cr be happy to explain the process for
Total Current Charges returning the leased product/s.
Total Credit- Refund Check hi111e Issue
58.8 cr
Once the disposition of the productlis
is complete, a revised.final statement
Please Allow 4 Weeks For Your Refund To Be Processed.
will be issued and mailed.
* * * FINAL BILL' If we can be of further assistance,
please do not hesitate to call us.
Representatives are available 8 am
to 7 pm ET, Monday- Friday. Of
course,you can send us a message
at any time through our web site.
We will respond within 24 business
hours.
Thank you for your attention to this
matter. And please accept our
condolences on your loss.
aa&^ rAvo_r_qA for irinnortant information—
Filing Instructions
Electronically Filed
Form 1040 US Individual Income Tax Return
With
Form 8879 IRS a-file Signature Authorization
Taxable Year Ended December 31, 2013
Name: Mary M Husson
Date Due: April 15,2014
Remittance: None is required. The return shows a total overpayment of$794,which is to be
refunded in its entirety.
Signature: Form 8879 IRS a-file Signature Authorization authorizes your electronically
fled return to be signed with a Personal Identification Number(PIN)and
certifies that Part I amounts are from your tax return. Review and sign the Form
8879 IRS a-file Signature Authorization and mail it as soon as possible to:
Boreman&Babb,CPA's
710 Bridge St
New Cumberland,PA 17070-1934
Important: Your return will not be filed with the IRS until the signed Form
8879 IRS e-file Signature Authorization has been received by this office.
Other: Initial and date the copy of the Form 1040, and retain it for your records.
Retain a copy of the signed and dated Form 8879 for your records.
Your return is being filed electronically with the IRS and is not required to be
mailed. If you mail a paper copy of Form 1040 to the IRS it will delay
processing of your return.
REV-1511 EX+(1G-U9)
" Pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Mary M. Husson 21-13-1324
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT _
A. FUNERAL EXPENSES:
1. The Groffs Family Funeral Services $7,901.52
2. Funeral Luncheon $247.88
3. Gingrich Memorials $1.084.80
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: $3,500.00
Name(s)of Personal Representative(s) Mary V. Walp, Executrix
Street address_._3020 Market Street,Apartment 1
City Camp Hill—...---- --- — ---..._._.....__-----------State PA ZIP 17011
Year(s)Commission Paid:._.__...._
2. Attorney fees: $3,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.)
Claimant
Street Address
City_........ State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: $358.50
5. Accountant Fees: $230.00
6. Tax Return Preparer Fees:
7. Misc.postage and certified mail $47.90
8. Reserves to conclude estate administration,final accountings $600.00
TOTAL(Also enter on Line 9, Recapitulation) $ 17,470.60
If more space is needed,use additional sheets of paper of the same size.
e Groffs Family
Funeral Services
Mary Walp January 08,2014
3020 Market Street,Apt. 4
Camp Hill,PA 17011
For the Funeral Services of: Mary M.Husson
Date of Death: December 10,2013
Professional Services
Basic Services of Funeral Director and Staff $ 2,195.00
Subtotal of Professional Services $ 2,195.00
Other Staff and Related Facilities
Use of Facilities and Staff for visitation at Funeral Home or Other location $ 445.00
Staff for Graveside Committal $ 445.00
Use of Facilities and Staff for Memorial Service at Funeral Home or Other Location $ 645.00
Subtotal of Other Staff and Related Facilities $ 1,535.00
Transportation
Transfer of Remains to Funeral Home $ 425.00
Lead/clergy/errand Car $ 225.00
Subtotal of Transportation $ 650.00
Merchandise
Alterative Container $ 150.00
Urn: Safari Green $ 425.00
Register Book $ 50.00
Memorial Folders $ 100.00
Subtotal of Merchandise $ 725.00
Cash Advances
Cemetery Opening $ 935.00
Local Newspaper Notice $ 418.60
Out of Town Newspaper-Patriot News-Harrisburg $ 380.72
Clergy Offering $ 300.00
15 Death Certificates $ 90.00
Cremation Fee $ 290.00
Coroner authorization $ 25.00
Organist $ 125.00
Sexton $ 75.00
Flowers $ 157.20
Subtotal of Cash Advances $ 2,796.52
TOTAL CHARGES $ 7,901.52
BALANCE DUE: $ 7,901.52
528 West Orange Street■ Lancaster, PA 17603■ P:717-394-5300 o F:717-945-6406 s www.thegroffs.com
The Groffs Family Funeral&Cremation Services Inc.,B&beth M.Groff,Ucensed Supervisor
Sep US 14 12: 08p Gingrich Mertioirials 717-766-8007 p. 2
L2nyric 2-02196
MEMORIALS Since 1921 Drawing t� Drawing Sent to Cust. +� Approved
5243 Simpson Ferry Road, Mechanicsburg,PA 17050 Found. By Found. Ordered
(717)766-5622•Fax(717)766-8007 Vendor Ack.#
www.gingrichmemorials.com Grave Position Verified Cremation
SOLD TO: 01
! !�-12 1W W 4-1-
30 2 a MA-9k.6-T :5'+Z6f-T' Date of Order_ �y
- Cemetery _05647 W5 {--W+ e t
Cemetery Location 6AU-SAI+Ar` - LA-AVICA5.E,X . PfF
Phone ) �f�3- g/r19 Center Over .t Graves Sec.l Lot#
Email Approx. Date of Completion
Lettering
Nlf�-(Ly MJGK�,.JTH�9-c.�2
H �assG�
/j9".q, 112 6 t),--C &)j AN-3
Type 1--,,I-'I" Material l e&'g-tJ ,nAi7o 4^)l Additional Lettering:
Size Z't% X I—o X 0_q Top 14j% Finish O Back ❑ Base
Size X X Finish
Description
Location on Cemetery
0 Vase ❑ Photo ❑ Other
Agreement:A 50%deposit is required to commencement of work. COSTS: �G1
Agree to pay stated balance upon erection regardless of labor troubles or shipments or any other good reasons.This order or Memorial $
contract cannot be cancelled by customer unless agreed by both parties.The article herein mentioned shall remain the property of
James R.Gingrich Memorials until paid in fun and they reserve the right to remove Yre same is not paid as stated. Foundation $ Z
I agree to carefully proofread all names and dates for accuracy and accept full responsibility for any errors or omissions.THERE Cemetery Fees $
WILL BE AN ADDITIONAL CHARGE FOR ANY LETTERING ADDED TO THIS MEMORIAL AFTER ERECTED ON THE
CEMETERY. $
I further agree to pay the balance stated for the work performed under this contract within thirty(30)days of receipt of the final
invoice and further agree that interest shall accrue at the rate of one and one-haft percent(t'h%)per month on the unpaid balance $
owed to James R.Gingrich Memorlals not paid within thirty(30)days of the invoice date.to addition thereto.I agree if it becomes
necessary for James R.Gingrich to institute legal proceeding to collect any funds due from me for my account being past due thirty $
(30)days,to pay all V
costs and attorneys fees in unEd by J roes R.Gingrich Memorials to collect a same. TOTAL $
MemorialisDEPOSITeX4 $ 10_h6('
Customer /0600
Balance Due $
I er agree that the U..na ,spelling,and dates are correct) a Upon Completion
RECEIPT FOR PAYMENT
-------------------
-------------------
GLENDA FARNER STRASBAUGH Receipt Date: 12/19/2013
Cumberland County - Register Of Wills Receipt Time : 09 : 53 :22
One Courthouse Square Receipt No. : 1076523
Carlisle, PA 17613
HUSSON MARY M
Estate File No. : 2013-01324
Paid By Remarks : ANDREW C SHEELY
DB1
------------------------ Receipt Distribution ----------------- --------
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST 45 . 00 CUMBERLAND COUNTY GENERAL FUN
WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 25 . 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
----------------
Check# 3994 $143 . 50
Total Received. . . . . . . . . $143 . 50
710 Bridge Street
New Cumberland, PA 17070
Phone: (717) 774-8129
Boreman & Babb
CERTmEDPuBLicAccouNTAws
EW010E
BILL TO DATE -INVOICE#
Andrew C. Sheely 4/17/2014 1402080
Attorney At Law
127 South Market Street
Mechanicsburg, PA 17055
TERMS
Net 30
DESCRIPTION QTY RATE AMOUNT
2013 FEDERAL INCOME TAX RETURN- 195.00 195.00
HUSSON
Schedule B -Interest and Dividends 25.00 25.00
Schedule D - Capital Gains and Losses
15.00 15.00
Statement of Person Claiming Refund Due 10.00 10.00
PA 40 -PENNSYLVANIA STATE RETURN 40.00 i 40.00
PA Schedule SP - Special Tax Forgiveness 10.00 10.00
Property Tax or Rent Rebate Program 35.00 35.00
Fee Reduction - PER DWB I
-100.00 I -100.00
Total $230.00
REV-1512 EX+(12-08)
- SCHEDULE I
pennsylvania
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Mary M. Husson 21-13-1324
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Computershare trading fees for the liquidation of the AT&T and Verizon stock. $126.88
2. Shareowner Services service fee and commission for the liquidation of the Comcast stock $23.84
3. PSECU Loan#10-car loan payoff $6,249.90
4. UGI-final bill $581.65
5. QLT Consumer Lease Services $38.91
6. Advanced Disposal-final bill $126.73
7. Pennsylvania American Water-final bill $271.02
8. Community Life Team-Golden Living $51.60
9. PSECU Loan#9-VISA credit card payoff $3,298.44
10. PPL-final bill $857.77
11. Pinnacle Health Medical Group $20.00
12. Lower Allen Township Authority-sewer,final bill $152.54
13. Westfield Auto and Home Insurance-final bill $640.06
14. Property Management Inc.,-monthly homeowner fees $1,054.25
15. Judy Prowell,tax collector-county and borough taxes $439.91
16. Verizon -final bill $14.27
17. Settlement costs from sale of 149 West Vine Street,Shiremanstown, Pennsylvania. $9,218.37
18. PSECU Loan#53-real estate payoff $11,637.26
19. Harries Painting-painting interior of home $1,510.00
20. Greg Fuller-carpeting replacement $3,029.00
21. Reimbursement for misc.electric and gas repairs $377.58
22. 2014-2015 School taxes to date of settlement $348.75
23. Joseph J. Christoldi,Electrician -electrical repairs to 149 West Vine Street,Shiremanstown, PA $1,690.00
TOTAL(Also enter on Line 10, Recapitulation) $ 41,758.73
If more space is needed, insert additional sheets of the same size.
'Please Remit Payment Tor' • - •- • _ • • .
Community LifeTeam Inc
Billing Office 13.241923 1/5/2014 $51.60
PO Box 726
New Cumberland, PA 17070-0726
QUESTIONS ABOUT THIS BILL? Phone: 877-214-6018 Espanol: 866-724-4114 Fax: 717-214-6020 Email: info@ambulancebillingoffice.com
Date of Service: 1113012013 11:10 Please visit our website to provide insurance or make payment, and
Patient Name: HUSSON, MARY for additional payment options and frequently asked questions:
From: PinnacleHealth Hospitals www.ambulancebillingoffice.com
To: GOLDEN LIVING CENTER-WEST SHORE
IMPORTANT
**Final Notice** If we do not receive payment within 10 days, your account may-be referred to collection :Contact.our office .
to make payment arrangements This service is not covered by most insurance carriers
11/30/13 Wheelchair Van Trans-One Wa, A0130 1.0 45.00 45.00
11130113 Mileage(loaded) 50209 3.3 2.00 6.60
Total 51.60 0.00 0.00
Y
DETACH AND RETURN BOTTOM PORTION WITH YOUR PAYMENT.
i
J
F—
Important Message
Due to the recent integration of multiple
#° billing systems,you may receive several
F' PIN NAC LE H EALT H statements for services you've received at --
� ' Medical Group Pinnacle Health System.Each statement
f could represent a different encounter or date
of service. Balance(s)for all services,
regardless of the statement received,are
due upon receipt,Thank you.
MARY E_ HUSSON For account information Please call(717)
B241343 2 231-8960 or(800)565-6229 for Out of Area
770 POPLAR CHURCH RD Calls.
CAMP HILL PA 97011-2302 See details on the back of this statement.
If payment has been sent, please disregard.-'
Payment can be made online at:
haps:Ilbi##pgY inpa #eheaith.rarta or make
Check payable W. PINNACLE HEALTH
MEDIGA#.GROUP
Ac6ount Summary- Financial Summary ,
Responsible Party: Mary E. Husson Total Charges: 5307.00
Account ID: 20222 Payments and Adjustments:
Bili bate: 02/05/14
Bill Number 6213$39 Please Pay This Amt; $20.00
Contact
Aetna Medi HMO PPO For questions,call Customer Service at:
717-231-8960 for local calls or
1-800-565-6229 for Out of Area
Customer Service Hours:
Mon-Wed-Fri 8:00 AM to 4:30 PM
40 Tues-Thurs 8:00 AM to 6:00 PM
N
i
i
U
5 .
May. 9. 201412:20PM No. 2068 P. 1
nE(O
(717)697-7065
May 9,2014
Attorney AAdrew Sheely
To Whom It May Concern:
Re: Mary Husson
Account Number 0197200112-Loan Number�53
Joan secured by property located at
149 West Vine Street,Shiresmanstown,PA
The following is the payoff for the above Real+Estate loan:
Principal Due $11,554.75
Interest Due $27.01
Late Fees Due $0.00
Collection Fees Due $0.00
Escrow Balance Due $0.00
Satisfaction Fee X55.54
Total $11,637.26
This payoff total applies as of May 19,2014. Additional interest of$1.51 per day will apply to
payoff received after May 19,2,014 and before the beginning of the next month. if?SICU has m of
received payment in fait by the end of the month for which issuA.this payoff will be aull and
void.
There is no penalty for pre-payment However,we may require final verification of these figures,
reserve the right to adjust them,and refuse foods that are insufficient to pay the loan in full.
We will deposit any excess payoff amount into our members Regular Share(Savings). Make checks
payable to PSECU and mail to ATTN: PAYMENTS 1500 Ehnerton Avenue,Harrisburg,P.A.
17110-2990(use this address for ovemigbt n*il only)DO NOT N A,l L TO THE UNDERSIGNED.
PSECU STAFF IS NOTAY E WEEKENDS for receipt of payoff's.
I
Questions may be directed To the Real Estate`Servicing Depan meat at 800-237-7328 nationwide. If
you bave a touch-tone phone,enter 6 at the Options Menu,when asked ether extension 3885.
Sincerely _
Mechelle Lemelle
Real Estate Servicing
P. 0. BOX 67013 HARRISBURG,] PA 17106-7013 800.237.7328 -psecu.com
THIS CREDIT UNION I5 FEDERALLY INSURED BYTHE NATIONAL CREDIT UNION ADMINISTRATION,EQUAL
OPPORTUNITY LENDER.
4 i .
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® �..rc . ��,,...: Vit,.��>= H
1
LOWES HOME C ?.Ir^ERS,
MBP 2223
Improving Home improveme W 5500 CARLISLE P T KF
MECHANICSBU (s Ptak
Please check file merchandise you are purchasing'to ensure all items are rcecived as iG.oa'c's cannot he respom4hle fill-;homage, after you Ica%c Lowe',trarchou.c.Yom:.igtx hurt arks+,•.,brie;
deliver}'and your receipt the date set firth below of all items of merchandise.weep(tho e items noted as being for Feer dolircry[c.g..I L(nk e's DOiver,:Ill. Pick-ill.I.iter.SOS yl,criu!()1,t
of-WH-%Varchouse or back ofstore pick-up].Not signikL acknowledgement orreecipt.however.docs not utcan that such merchandise(t'as trot delivcred.-111 claitm,nul return tmrclrttidi.v'vit..
he aecoinpinied by this Invoice and made within 30 days of delivey for credit or refund.This docunxnt may alio evidence if relum of merchandise de.a'ibed helo,c it"kcl(nn"is I'llmrd a till lt'
to an ifetn. In such instance you will be given credit or cash as described ami your sigoatuvc reprcxtits your
ickno,vledgtnent of the accuracy of the terms and conditions of the retum.SFF BELOW FOR i I i PAYMENT TERMS
AN[)CONDI't IONS FOR CERTAIN PLJRCHASI-S AND f2a WARRAN'T'Y INFORMA FION AND AGREEMI:N P.S.
DO NOT SiCiN TIIIS INVOICE IINTIL COMPLETE AND YOIJ HAVi: RECEIVED AND A('('EPTFD Till:
MER('HANDISF CLIRREN'rix BEING DELIVERED TO YOU AND YOti HAVE. Ri•'At) }HIS LN)CLiMEN'l.
YOUR S((iNA'i URb:C'(iNS'i'IT[I'1'T?S Y'OUK AC,RF.[:I(4}:N'1 Lt'I f}!API'L.l(''::BLL`I'ROVISH)!�S LIS"Clic)BFl.O>:t. "
Y011;ARE ENTiTITT) •O A COPY OF THE INt%nICF.
PURCHASER SIGNATURE
TRANSACTION CUSTOMER DATE PAGE INVOICE NUMBER
R SALE MARY WALP 0$121114 2 775$6 : 's4
VISA
If 1,011DW LOAD QTY/DMT ITEM # DESCRIPTION UNIT PRICE EXT: PRICE
f 'Zo3 1 EA 39032 20SP 20CIR 100—AMP INDOOR M/B V/P 55.00 55 .00
PL MODEL NUMBER: HOMVP5
2 EA 13538 AMP CIR BRK 8.25 16.50
PL MODEL NUMBER: HOM2330CP
�i 1 EA 13317 HOM 2—POLE 20—AMP CIR BRK 8.25 8.25
!� PL MODEL NUMBER: HOM220CP
9 EA 9011 HOM 1P 15—AMP CIR BREAKER 3 .48 31 .32
PL MODEL NUMBER: HOM].15CP
5 EA 12811 HOM 1 POLE 20—AMP CIR BRK 3.48 '17.40
PL MODEL NUMBER: HOM120CP
_ 3 1 EA 158883 3CT 15A 125V WHITE GFCT_ 28.71
PL MODEL NUMBER: 1595—W3PKCC4
1 EA ,75637 3/8—IN NM CONNECTOR 10—BAG 3.36 3, :36
PL MODEL NUMBER: 45650
t 1 EA 45695.2—IN NM/S;EU CONN 4.25 4.1-15
all PL MODEL NUMBER: 44676
P4TRC8ASE OSMER REF. NO. BUTER CODE SALES PERSON OTL
08/21/14 CUS JNTT—NTJTEDA ,
I':11"t4GN'I'TGR\4S,\ND CONDITIONS:Thr frllraine turns and conditions apph to[!}I3winec'('barge:\aoum purrh:car_;(but a uhrm tintirng el- g d,,:a,mpktc tcrnc,�❑.!r•"::dr+,"•..•!'.uta!t,r,a,r:.{!:,+�;,i.,.;•�e
r rchasts not paid florin full at timtrf purchase.and ?)any purchase im'ohinga purchaceordcrorrtha Joeumcntlunless tttetcnns andconditions nfsuchhnce Iv:—,roc I arr;m r;l i;=:,;iritic b)1•,e,;',1 tat
credit veal account uea;lab!r front rr through Lots(incluJinc Lewes Recoh•ing Crcdit Asrement and Lou c'.Busing,Retolving Credit Account Agrc`ement Its not suh;ett! Iha e t+.q n:aa!,;,,:.xtd ca+„in:,::..t=•,:
pa,tacttt tams and tt+nditirns ofsvch flet„utit.Lmrc's rc2ular hieing dais is the 25Th ot'carh mrnrh•with the balance fine and pa}able net Mthe ithh oftitc trikm'ing mt+nih.if}r,;r l3„sin,•,s(':vrer ace:•un!l,ni.;oo;.•r;•:::,!::`
b)the ithh orihe mmrrtfi nest folio vims billing or the purchase of merchandise,respectivek.onh the NF7 A1,401=XI'ofthe billing alai-mcni or purchase.r•.tpmti^, ,:ill he m,:+hi,itlt.=;pa,t!^;:m t!w%!hr,:,;,.•,:r._•.
topaz for the purchase ispast dicaudindcfcult.and ALATE CHARGE ORSERVICE CHARGEMAYBE MADLINTiIFAN10t'\i't)Ft!:°°PERM()\T'H{jRl�,,:l\tit'.tlF.l.t:•1S(!i.'itf}3tt\Hit,
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an nioliv:!)F:-'"°mombf,._d°..annu .
LIMIA.D WARRANTY:Phis consumer prMkqawty is applicable to products used f'or personal.Inmily or houwhold purposes.it is not applicable it commercial imnsaction>or on+,lucis purclt,:ic:i ii,r p,u!t+sec.t rr.:dc,
Love s,t ill re!tairm rephtce defeai , ria M.ms .for imety(901da,s from purchase..ALi.EXPRESS AND SMI'Lt1i1)W',\RRAN'1IF:SI\(•t.FUIKGI'XPRFSS UARRA\I il'�ttl IT I\I i> NnY 11\FII
PURPOSE ANUiMPUEUI\'AR Y 0 'TABILITY;RELi11ITF•U-FOR'I'M E SA11F+)0 !pU, SomcscataJrnura!Inu limitation onhowlone:1ainn•hrd::;ur.:m,
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This u'artanty givci,,ru specfit teal rights an )'� race other rights which t art fn,m stifle to ai:tl In e,91l rf del'cct of hnhe,'inti+mi:dors regarding sere^ (+,:'{.n'ainth•.t`k.,s-.-ton;.;,'F\.+rte l.s'.s!!•'::e
or Lcx,-c's C"onrpanies,Inc..Custorna R c 11!i.\ret)Wilkesboro.NC'�fr?{r.'Ttk•phnnr(?=(+(fi. -*991. '
WARRAN1 Y FOR COMMERCIAL PIiRPOS "icc+nititutes tfieagreement between Purchaser nainedo ,Ince 10006- he li,lien uti.,j,. :" pp!,.::,a,vd:>;au,t(n:;i'o•^:-:.,,.,.'. .
of the fare htrcof it't'urchaca arc -tar c`±13disc.
i.Purchater auras ohm it's aai,,i Sclla shrill be for rcpnir rr replacement ofam defer +rtded herein. Purchaser,er is;hitt tto olh:r;oncdt. in::u,lm:hul root
constqurntial c!mnages for Ion}. a r,;niul to person or property or an,other incidental or mnscqucnrial loss.chill Ir a,ailahle m i'urch:t cr. �I his,� 'nth shah hn�iN i h't'of,,„t;,r,•�,,.,rron:;,, ..
iac!uding hot not limited!o ANY IMPLIED WARRAN I'Z OE.)WCHANTABILITY OR FIT7NF S FOR PAR-I ICULAR PURPOIT. �
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after notification in Purch<•cter of an) M-1 substit trnfotming merchandise either tn�vepl-elneoi ofsuch non-c in n !K with nvtii+nning rtcrt•hsuutisr of l+3 e!'I'q uu;h•rnn or,::!iva,:;rm,
mcrdtandia•.Mrir1��3�1ll�lust be acerin a' e rricinal in,'oicc M proof of porch or rrplacancnt.This shatl inJudr the repair o.
the c,eat nrn•co, mm�c merchandise cannot rrniinc or co in_merehandise tanner be forms u inn thereof.tht nen-confrnninv m Yehnndisc ma,iv:raurnc,!i,t rite Pu::h:isrr to<vl!r:.�;;•... :
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' $t'!`.t'73.1RGliti3N("t'RRi'E) `
=. F.\�m uh n Purrhasa has the righi to return n this ri,_ht is venting•tit a +ti artier to tidla,at:c
tx +sed ruurt.!hi.n•aka:fill•,.a!:,.•rna•,u:a Pin;.,:•!:. -:
:don_with a des-ription of'u hat nierchandist i o+r reiumed. It s r. resch ilgt'eC,i II1:II SCII<r Ilia\dtrhne u,p,.•nnit um at oon-ern!:a,ntrretr iso xnd d'srcrt,ah,•r,hyn•im.a::v,t:;m.,,•s,a±+d+,.;;,,f>t,::•-;;
J.Srllds hahility fin'non"a,n!i+nning mercha I •^ o ton`rnt:ng tiny JClicliar or nion•c•onf+nu nln!nti:tp;mnrband;sr:n�cifr!'s clr:!•.'r ',„ .,bhc,t„.;;E:;.::.;::.
non-tonfonnine ni•rchandise shall terminate nin•ty T purchasers receipt of the narc t. ` �'
:.1 he ahmc remediu••,are eip—N agreed it,be the sole mrd t\ctutive retnedic;atailat,lc h+Purcha I a; I s Jon the face he rn+f and oat h•l,rrt(v't.•t wdem:ut, I'nt.:;.:.,:;.
u;a)v irh respect to the valve or markef price c-
6,
h, Aar action h)-Purchaser insiitined agaimt StII el-am hmcfi rtihis agrrtmtnt mtut n,crd within ane 3 ver!}roti the acom+ai ni cause ol'aa' tc tams mtJ ronJitionv al this❑urcu,rn!sit,dl t•c•?::,rear:!!_:
North Carolina. `
7.This"W'ARRANTY FOR COMMERCI.At.P{1K . eagret+ntm i,ttn'cu-,a tiM Pan IIIIn�M� .cyCc+' _ tent t,ill,r,.;1Ye1 fl-melirr:,e u!:!ird iliefd't !In<i,
IS BINDING li)'O\T'HE SPC(ISS0RS AND ASSIGNS OF THE PART1Eti.1'HERE M:R'BF W MOUil7c'A'i '<"' ,.CGP!Hl'\t'RI!
��� IE\I\+c!Rl`\,Ir\I tit{,\F.t3 In
1. CA'l FHA,r'r AGRiAkf;O DELIVERY.
ELIV RY4.0\t`E'S RI-N1`L.= 1'1=S NFGI.1(:I-NCI:OR N(t!, 1011WI \\I)ok Mill` ,f
t.{)CA'i F.'1)A'T fH}.PL:\C'1={SF'DEL(\'EKl'.
9.Lou is is a supplier ofinerchandise onh.Lot,e"does not"itime in the practiceofciuzi:rring.architc,•torc err_,mrrai c otrnautg. mean,responsthiiit)tis,ksicn.en_•wcn:•,.�rvr;,m+ten:•..;, ;:q..
choice of materials!lora ecncrai or spccifit usc:for quantities orsizing of materials:for the use or instali;uion r°maarials or rite
S � PRO('RAM:Lraesha.tFmhlishcdaerluntan(”onsmntrAwarrne,sPrrgr:uncarld•tm c
lo.it., nalh, nnc4n_ierner dsttahnmJair",larlci amov+kltmict:+:nSold
p.b)'tr!:tdiau'iRlii nfultoorheith-Ikcsemanufaeturu5shouldsuppi)Lowes,cith -c:.n:,.::,.ix^xw:,i.„'s.i.+n•
information concerning the chemim!s in the pn,,3ta^..the xtt:use rfm,id ptc4tim,and medirai trca!n!en:tnf,nn.r,:,.�, in;,..:••.,;:.; =ihrs
bc•ohrainc^d from.our local i roves Store Manager. :
.11-tv'ClIce
LOWE'S HOME CENTERS, LLC
MBP 2223
e Improvement" 5500 CARLISLE !"ll"IFF
y
ECHANICSBiG
I TR ?:_; �k
merchandise you are purchasing to enure all iteins are received as Isco,c s cannot Ill,IvsIx,lisible for,hollagcs allcr;ou IvnVI:I oxkc�oarcholl"'.Y.mf ign.litilc
your receipi the date set forth below or all iteins of merchandise.except those items nmetl as being fiv latertilcliNen.I e.g..I.D1 Lowe's Delilem.1°I. Ilick-til,I IS Sl,c,:41i t
archouse or back of store pick-upj.Not signini;acknowledgement of'receipt-however.doe:tint mean that such inerchaudise wa.,not delivered.All claimantl return iner,:Ij;oi-jie`.I! 11
panW hy ilihs finoice and made within 30 day,of delivery for credit or refund,This document may also evidence a muni of merchandise described hcloa,it' pro oof 1,nh Lesko,-ti,
hen). In such instance you will be g;vcn credit or cash as described and your signature represents )our
.n"ledginew ofthe accuracy 01,111c tenns and conditions ofilte return.SEE BELOW FOR I I I PAYMENT TERKII,
D C'ONDIT'IONS FOR CERTAIN P1 J RC'I fASES AND[21 WARRANTY INFORMATION ANI)AG RET M i:N I S.
NOT SIGN IHISINVOICE UNTILCOMPLIETE AND YOU HAVE RECEIVED AND ACCEPTED THE
MERCHANDISE ('tJRRI'-.N'I*I.Y BEING DFLIVERED TO YOU AND YOU HAVE READ PHIS DOCLIMFN 1.
YOOR SIONA ICI IRE CONsTrruTE-.S YOUR AOREEMENT WITH APPLACAFILE PROVISIONS HSI ED B110W,
YOU ARFFNTITLED TO A COPY OF THE INVOICE
PURCHASER SIGNATURE
TRANSACTION CUSTOMER DATE PAGE INVOICE NUMBER
R SALE MARY WALP 08/21/14 2 77586 1'14
VISA
LOAD QTY/tMIT ITEM # DESCRIPTION MIT PRICE: EXT. PRICE
] 1 EA 113199 CEILING BOX COVER FLAT BLANK 0.66 0.66
PL MODEL NUMBER: 54 C I
PLI1 EA 70185 ROUND COVER 3-1/2-IN KO 0-98 0-98 i4
MODEL NUMBER: 24 C 6
1 EA 71002 4-IN PVC ROUND COVER- 11 .09 1 .09
PL - MODEL NUMBER: EZYKLR )2- )3
SUBTOTAL 1.67.52
TAX 10.06
PvNCMSS ORDER I". NO. BU=CODE SALES PERSON TOTAL
08/21/14 CUS 177.S8
15:06:13 VISA 177.58 L
SALES #: 000113174 MORGAN
PAY NIFN I'TERMS AND CONDI1 IONS:the folh ing tmiis and conditions apply to I I I ausiness(*hinge Account purchases[bill without limitiagoraeuming,the co,uplci,1"..,!"I 1".,6 iln"n,"t 6
purchases not paidfv in full it tine:of purchase.and[`]any purchase invoking a purchascorder or other docum=I-less illviemns:cod conditions ol'sucil bloc Ixm,c\rrcs,,I-. opm-wd I,I Ao
cre-dit card accounzaolulable from or through Loue's[inchuling Louts Re,-ol\ing Credil Agreement and Loo,*,littsm,Re,ole int.( cdix l ccnu i.-*,,trcc,,,,nt I is`o: "`I�jco io'he ivomcnl u,-:,,I I..';i
In nkat rents and conditions M',uchaccmint,Lowe's rceular billing date is the?5th of each month.with the hakowc due and Ila,altv nest h,the Kith 11-u,Itil'in", zlcc,•Uoi
h,the loth ofthc month nem following hilliq or the purchascofmcwhandise. theNt:I billing micoxin or purchase.rolpecti\cl}.�,ol IV 11 lot 1.\ it,lith,'lei w�,mn
to pa} tiff the iturcha,;',is pist'jilcand'in default.and A LA FE CHARGE OR SER\'ICE(ItAfC(;F MAY Kh-.14ADI,IN I IIEA.�TOINI OF 1 1-2'.PER MONI It OR .\NNI
NIONI-ii ONIIli:BAIANCI: AS orrflE 25111 DAI'FOF 1'HI'PRFN?I0tN' MONIH I),,,pnynicivand credit,to-id Kilonce I CN 111 VAVVt'Nl IN II'Ll IS M MDI I'll I I RIA I �l K\I(I 1 11\RGI 1\\H'l It \171
PURCHASE'S IN ME FOLLOWING SlA'11
armullIN;DE-Z*,mor%thl,'.241.annaltill,_ S:AR AND mollD
rui\. 10'�annvally�M -I°.mouths)-,12'°aotivall.\:PA %IS-I owndfl.'. IE 1 1 -,"Joi, "I
L UMITI�D WARRANT Y:Thisconsuinerproduct warranty ill applicable to products used for Personal.fatniK orlwvwhold purposus.It is not opT.licabictocotruncre.al Iran:activ,I luo,pureh"'l;!,1'.0 1",--.1,!,
I "c",till repair or rellacedclecthe products.uitere nccevan.for ninet\[00]da-from purchase.AL.I.I.XI'RFSS AND IMPLIED WARRANT IFS INCLI'DING TAMINS\\AKRAN:1 11 S i W 1 11.slo\ I OR 11\It 1 ff I I
Pt;RPOSF AND I Nfill.I ED WARRAN'ry oF.MERCHANIABfLI1'Y ARE UNIIIED I-OR*('HE SAME 00 DAY PERIOD.Sonic stat"Jon"i allot\limitation on hr-1,,n,, an impfcdjrj,n\ ],,j, <ue!l lin tau,n
"t 11-1.;!
11hcrc shall be no remedy other than rerhiko,m)lacernem ofillep,oduct.INCIDENTAL OR CONSFQUI'N'IIAI
OR(-O\I,FQIIEN'I'tAf.D.-\MA(;CSARI li,X<'LLI-DEDFRO,\4-IliE\V,I,RRANn'.I;mncstate,dal.,Iallow,-xe:tL,;Nl-ii,,Iit.,iti+,.i,fi.ti,k,i,t.],xco,,,,xlmvii;,;,L,,,,.g,,,,,,.,.eh... lo-Is.
This -arrunt,gives van sivok ,an Fmmstate lostale. {untie, mlonnatio.rc;;ardinft,arcane
or Loom's Companies.Inc..Cusionicr Relations.Bo.x I I I(.North Wilkesboro.NC2&65&1'ekpli.nc J.'.(,l OjR-4011,,
WARRANT Y WR COMMERCIAL PURKISLiS:this constitutes the agreement heloveen Purchase named on ill,lace herc,'I'mid I rue's I al",roerred I,,it,Sella 1,l he 6,11 inl.!............>of,pk n.'o..'11......ldin,
"I tile face her,,ofif Ilurchmwr accepts deliver ofinerchandise.
1, VtocNiser agrev's that it's,ole and exclusive remedy against Seller sJullf be for repair or rplaccinem,•l an} dctectie invrclininfist a,pro\i&,J herein.Purchaser agrees that Ill. ren,,!, Eonnol lil'ti"A :1%,
consequential damages for lost profits.sada:labor.ir�jury to person orproperTy oranx other incidental or cons*cquentiol loss.shall Iv mailahic it)Purchaser. I'his uarnult%5h.111 he IN I tf4 (IC
includims but no, niited to ANY IMPLIFI)WARRAN I Y OFNII:R�CHA NTABILITY OR h11 NESS FOR PAR 1-10 A
4R Pt:RPOSI:
I
-, II rtcmofefillptitc.it'Purchaser either properK and lawfully m1cos merchandise which does not corobrut to v,_,rceinetii or I)rcfvdh and tau tilt rookes acarfanee of sorb InvChond"C' SO;"'11AI 11:1; .1 Jim.
after nofificz
looll I"Purchaser oranN problenas or defects ill substitute conforming inerchandisc either h\mTliceinY1i ofstich nontmftnninp illevilindis4 U hit confPmime murchamfise 11 eiteouiv rv:,4 jdm-1o,eIv 1,•=1ta i:I
Inruchandisc.Merchandise to IV returned must be accompanied by the original moiccorproofofmrchzw twilic original Purchaser for refund orrepliccolcm.IN.,shall iviclu&the
rhe-ern non-confomine inerchandise cannot he made confommit orconjomerchandise cannot tk-furnished in substitution fh.rc,-I;ihcnon-conlonninu merchuodi,e
to
Purchaser.I*HE LIAMI-11 Y OF SELLER IN THIS EV'EN'T .IS
ILIMICED TO ACCEPTANCE OF RFl URNED NON-CONFORMING XIERCHADISE A\D RFRND OF'111 RCI iASk III00 C IR 10(:R I f 01 1 !1: 1.
PRIC17TO PURCHASWS,BI"IINFSS CHARGE.ACCOt,:NTOR BALANCE OWING 10 SELLER.PLL IS A PROPORrIONA1 1:AMOUN I OF ANY FINANCE('11AROJES 1\(*t KKI
E, n u hen fTurrhas r fit\ the light to return tton eonf ansae me chandise,this ht s contingent upon notice loSelkmal 1=11 tell aler,Seki :1wiint-;Q
hiseNpressly agrectd t3lnt Sciter msn latae to tomtit rqurnilii.onconf ill,mcwhindise and diruiother di,j,,,,il,,n
e'lIcn.w.
4,Selleesliobilit, shall he limited eitherto co.fommenr rTlacu,_.Jetccti,eo, \\iil,c movilandisc.11
shall trnninatcnincty[901days after purchawesreceipt of the merchandise.
5.1 hcabovere'nedies are expnssl,luareed to be the sole and ensclusoe remedies available in Purchaser.'I his I,molml pmhaserr with rsfxil u,the merchandise fi,icd—I),,face
ma,with rcstlect!o tile,Ilu<or;n.�rkit price of the merchandise or with respect to the intended use or consequences of an,furnkten ,,famish hi.g n�int to to third Persim,b, 11 11
: 1,
6, An%action In Ilurchoser instituted agaimaSeller foran) breach of this agreement ni.st IV commoVed uhhinI c"odni "11t. o d 11,
Nonh Carolina.
I his"WARRANTY FOR CONIMEPCIAl.PURPOSES'contains the totality of the ulreetnelo bd"ee:,the rwl I",and is intcodcl:L,the final expression ol'ihc o vvcnlon ,;flI,esf1 w :,,,0,"i!Is,;e11. MIN VIVIIMI
ISHINDIN(iL;PON-'IHESL.'('C"ES.IORS.\NL)ASSIGNS OF'I'HEPAftTIES.tHEPE,\IAYBF.NO3IODIFICi\110NORRL*S('l",Slo!OFTtil';A(iRF.FMFNfFX(-I-PI 81 \i iwootet fill
x. Pt*IRCHASER AGREES TO INDEMNIFY IDNVE'S OF AND FROM ANY AND ALI.DA\4A(;FWHICIJ X'lAYOCCUR.Will:.11117k ARESFIXOF
L O('ATUD A I*THF PLACI-.'0F DELIVER,',
I e'.,is a supplieroflnerch.ndisconly.kmv's does engage fit the practice or conin"ning. Laurt\dies not assume am rsisnsibilia Ii,r afc,i_n,ru_m,.,; ••:;,c,.uncaon. a,•:alae:: ✓::..,
os.::for quantities to S"Zing of materials;for the use or installation of materials or for compliance whin any balding cock or standard
CONSUMER AWARENESS PR(X;RAM:Us is has established a voluntary Consumer Aullrencz program for its customer,,'the kttd-at,•ocemment has de(enninrd ohm some product,said i+,rea:d:r.mat ha, Prmi:.d.:•S.h:i.r,,
Could III,huralf.1 w your health."=manufactures should supp(%
rroducl,,.and medical trva!mcni
IV ohmined Iron,,our local Loves Store Manint r.
Joseph J. Christaldi Invoice
13o Ironmaster Road
Lebanon, PA 17042-9030
Invoice#2014-1
Date:September.12,2014
To: Mary M.Musson Estate For:
DESCRIPTION HOURS AMOUNT
Rewired Electric Lamp Post 1 90.00
Repaired/replaced copper piping for multiple water leaks in basement 3 300.00
Replaced and resupported iron gas pipe for gas stove 3 300.00
Replaced&rewired electrical panel box;Fed Pacific was fire hazard.
Metal covers on open junction boxes;replaced GFCI outlets 5 1000.00
TOTAL $1,690.00
Make all checks payable to: Joseph J.Christaldi
Total due in 15 days.Overdue accounts subject to a service charge of 1%per month.
Thank you for your business!
REV-1513 EX+(01-10)
pennsylvania SCHEDULE
_< DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Mary M. Husson 21-13-1324
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).]
I. Mary V.Walp,3020 Market Street,Apt.1,Camp Hill,PA 17011 Daughter 331/3%
2. Barbara L.Husson,4524 Linden Avenue,Mechanicsburg,PA 17055 Daughter 331/3%
3. Scott J. Husson,224 Westwood Drive, Mandeville,LA 70471 Son 331/3%
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 SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B: CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS;
1.
TOTAL OF PART II—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional;sheets of paper of the same size.
i
M
LAST WILL AND TESTAMENT
OF
MARY M: HUSSON
I, MARY M. HUSSON, of 149 West Vine Street, Shiremanstown,
(Borough of Shiremanstown), Cumberland County, Pennsylvania, make, publish
and declare this as and for my Last Will and Testament, hereby revoking all other
Wills and Codicils heretofore made by me.
FIRST: I direct that all inheritance, estate, transfer, succession and
death taxes, as well as my just debts and funeral expenses, of any kind
whatsoever, which may be payable by reason of my death, shall be paid out of the
principal of my estate as the same can conveniently be done.
SECOND: I give, devise and bequeath all the rest, residue and
remainder of my estate of whatever nature and wherever situate, including any
property over which I hold power of appointment and together with any insurance
policies thereon, as follows:
(a) Thirty-three and one-third percent (33 1/3%) thereof unto my
daughter, BARBARA L. HUSSON; of Mechanicsburg, Pennsylvania, provided that .
should BARBARA L. HUSSON predecease me, I give and bequeath her share unto
my son, SCOTT J. HUSSON, of Mandeville, Louisiana, and my daughter, MARY V.
WALP, of Camp Hill, Pennsylvania, share and share alike; and
(b) Thirty-three and one-third percent (33 1/3%) thereof unto SCOTT J.
HUSSON, provided that should SCOTT J. HUSSON predecease me, I give and
bequeath his share unto his issue, share and share alike; and
(c) Thirty-three and one-third percent (33 1/3%) thereof unto MARY V.
WALP, provided that should MARY V. WALP predecease me, I give and bequeath
her share unto her issue, share and share alike.
THIRD: I acknowledge no bequests are made to the issue of my deceased
son, ARTHUR R. HUSSON, as appropriate distributions have been made to them
during my lifetime.
FO In addition to all powers granted to them by law and by other
provisions of this Will, I give the fiduciaries acting hereunder the following powers,
applicable to all property, exercisable without court approval and effective until actual
distribution of all property:
(A) To sell at public or private sale, or to lease, for any period of time,
any real or personal property and to give options for sales, exchanges or leases, for
such prices and upon such terms (including credit, with or without security) or
conditions as are deemed proper. This includes the power to give legally sufficient
instruments for transfer of the property and to receive the proceeds of any disposition.
(B) To partition, subdivide, or improve real estate and to enter into
agreements concerning the partition, subdivision, improvement, zoning or management
of real estate and to impose or extinguish,restrictions on real estate.
(C) To compromise any claim or controversy and to abandon any
property which is of little or no value.
(D) To invest in all forms of property, including stocks, common trust
funds and mortgage investment funds, without restriction to investments authorized for
Pennsylvania fiduciaries, as are deemed proper, without regard to any principle of
diversification, risk or productivity.
(E) To exercise any option, right or privilege granted in insurance policies
or in other investments.
(F) To exercise any election or privilege given by the Federal and other
tax laws, including, but not necessarily being limited to, personal income, gift and
�k estate or inheritance tax laws.
2
(G) To make distributions to my herein named beneficiaries in cash or in
kind or partly in each.
(H) To borrow money from themselves or others in order to pay debts,
taxes, or estate or trust administration expenses, to protect or improve any property
held under my will, and for investment purposes.
(I) To select a mode of payment under any qualified retirement plan
(pension plan, profit sharing plan, employee stock ownership plan, or any other type of
qualified plan) to the extent provided for,by the plan or the law.
FIFM: I direct that any and all inheritance, estate, transfer, succession
and similar death taxes shall be paid out of the principal of my residual estate.
SIXTH: I nominate and appoint MARY V. WALP, Executrix, of this,
my Last Will and Testament. In the event of the death, resignation or inability to serve
for any reason whatsoever of MARY V. WALP, I nominate and appoint BARBARA
L. HUSSON and SCOTT J. HUSSON Co-Executors, of this, my Last Will and
Testament. I direct that my Executrix or Co-Executors, as the case may be, shall not
be required to post security or a bond for the performance of their duties in any
jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my
Last Will and Testament, this /e day of November, 2011.
i
(SEAL)
MARY k. HUSSON
k
Signed, sealed, published and declared by the above-named Testatrix as and for
her Last Will and Testament in our presence, who, at her request, in her presence and
in the presence of each other, have hereunto subscribed our names as attesting
4
witnesses. '
T
C - k
Addressame
Address l 7 Name
4
4 :