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HomeMy WebLinkAbout09-25-14 (2) 1505610149 REV-1500 Ex{02.11}Pennsylvania OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of 280 Individual 1 Taxes INHERITANCE TAX RETURN �j �( � . PO BOX 280641 `�' Harrisburg.PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 06 24 2014 01 05 1918 Decedent's Last Name Suffix Decedent's First Name MI Albert Josephine D (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 1.Original Return O 2. Supplemental Return O 3, Remainder Return(Date of Death Prior to 1243-82) O 4,Limited Estate O 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12.12.82) !♦ 6.Decedent Died Testate O 7. Decedent Maintained a Living Trust 0 S. Total Number of Sate Deposit Boxes (Attach Copy of Wig) (Attach Copy of Trust.) O 9.Litigation Proceeds Received O 10. Spousal Poverty Credit(Date of Death p 11. Election to Tax under Sec.9113(A) Between 12-31.91 and 1-1-95) (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Robert R . Church, Esq . 717 255 8059 g w rm REGISTER OF060L�^USE ONLj d n _O � First Line of Address Z M cart � rn C7 Keefer Wood Allen 8 Rahal , LLP cn � o 0 a -n In Second Line of Address n Cam.., ) 4 22 P . O . Box 11963 - m r- rn r.3 DATETILEOi co City or Post Office State ZIP Code CV n Harrisburg PA 17108-1963 Correspondent's e-mail address: rchurch @keeferw00d.COm 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.Dedaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNLtT)1R OF PERSON RRSPO�IOR FILING RETURN F/ DATE ADD/RESS...._ I 9a X ll a� SIGNATURE OF P A R W AN REPRkSENTAT —� „QATE/` ADDRESS P.O. box 11963 Harrisburg, PA 17108-1963 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610149 1505610149 I 1505610249 J REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: Josephine hine D Albert - RECAPITULATION 1. Real Estate(Schedule A).. . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 0 . 00 2. Stocks and Bonds Schedule B 2. 0 . 00 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) . . . .. 3. 0 - 00 4. Mortgages and Notes Receivable(Schedule D) 0 - 00 5. Cash, Bank Deposits and Miscellaneous Personal Properly(Schedule E) . . . . . . 5. 0 - 00 6. Jointly Owned Property(Schedule F) p Separate Billing Requested . . . . 6. 104 ,004 • 12 7. Inter-Vivos Transfers& Miscellaneous Non-Probate Property 0 . 00 (Schedule G) O Separate Billing Requested . . . . 7. 8. Total Gross Assets(total Lines 1 through 7) . . .. . .. . .. . .. . . . . .. . . . . . . . . 8. 104 ,004 . 12 9. Funeral Expenses and Administrative Costs Schedule H) 9, $ , 14 5 • 61 10. Debts of Decedent.Mortgage Liabilities and Liens(Schedule 1) . . . .. . . . . . . . . . 10. 0 - 00 11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . .. . .. . . . . . . . . . . . . . 11. 51145 - 61 12. Net Value of Estate(Line 8 minus Line 11) 12. 981858 • 51 . . . . . . . . . . . . . . . . . . . .. . . . . . . . 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) . . . . . . . . . . . . . . . . . . . . . .. 13. 0 • 00 14. Net Value Subject to Tax Line 12 minus Line 13 14. 98,858 • 51 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 0 . 00 15. 0 . 00 16. Amount of Line 14 taxable at lineal rate X.0 45 981858 . 51 16. 41448 . 63 17. Amount of Line 14 taxable at sibling rate X.12 0 . 00 17. 0 . 00 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18. 0 . 00 19. TAX DUE 19, 4 ,448 - 63 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610249 1505610249 REV-1500 EX(Fb Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Josephine D. Albert STREET ADDRESS 4833 Trindle Road Apt. 527, Country Meadows CITY STATE ZIP Mechanicsburg PA 17050-3677 Tax Payments and Credits: 1. Tax Due(Page 2. Line 19) (1) 4,448.63 2. Credils!Payments A.Prior Payments 4,226.20 S.Discount 222.43 Total Credits(A+B) f21 4,448.63 3. Interest (3) 0.00 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) 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a 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 . . . . . . . . . . . . . .. . .. . .. . . . . .. . .. . . . . . . . . . . . . . . . . . . . ❑ I] d. receive the promise for life of either payments, benefits or care? . . . . . . . . . . . . . . . . . . . . ❑ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . .. . . . . . . . . . . .. . .. . . . . . . . . . . . . . . . . . ❑ 3. Did decedent own an"in trust for"or payable-upon-death bank account or 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 172 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 172 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 F2 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 172 P.S.§9116(a)(1.3)].A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent.whether by blood or adoption. REV-1509 EX+ (01-10) T pPenEnsylvama SCHEDULE F INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Josephine D. Albert If an asset became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. Helen A. Bickett 909 Bayberry Court Daughter Williamstown, NJ 08094 B. C. JOINTLY OWNED PROPERTY: REM LETTER DATE DECSRIPTION OF PROPERTY DATE OF DEATH %OF DATE OF DEATH NUMBER FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR VALUE OF ASSET ECEDENTS VALUE OF TENANT JOINT SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL E STATE INTEREST DECEDENTS INTEREST 1 A The following seven (7) items were held in 0.00 50.00OC 0.00 Edward Jones Account#25209667. These funds were held jointly with the Decedent's daughter, Helen A. Bickett for more than one year prior to the date of death. 2 A 1842.228 shares of AIM Counselor Ser Tr Inv 20,614.53 50.00OC 10,307.27 Egty&Incm A Mutual Fund @$11.19 3 A 409.382 shares of AIM Growth Ser Inv Us 5,121.37 50.00OC 2,560.69 Mortage A Mutual Fund @$12.51 A Accrued Dividend on above 16.54 50.00OC 8.27 4 A 3912.219 shares of AIM Counselor Ser Tr Inv 63,808.29 50.0000 31,904.15 PA Tfx Inc A Mutual Fund @$16.31 A Accrued Dividend on above 152.05 50.0000 76.03 5 A 1575.184 shares of Lord Abbett Invt Tr Core Fx 17,327.02 50.0000 8,663.51 Incm A Mutual Fund @ $11.00 A Accrued Dividend on above 25.84 50.00010 12.92 6 A 2122.085 shares of Lord Abbett Invt Tr Mltast 27,587.11 50.00010 13,793.56 Bal Opp A Mutual Fund @ $13.00 Total from continuation Schedule(s) 36,677.72 TOTAL (Also enter on Line 6, Recapitulation) 104,004.12 If more space is needed, use additional sheets of paper of the same size. J Page 2 Estate of: Josephine D. Albert Schedule F - Jointly-Owned Property Letter Date %of Date of Death Item for Joint Made Date of Death Deed's Value of Num. Tenant Joint Description of Property Value of Asset Interest Decedent's Interest 7 A 2106.837 shares of Lord Abbett Invt Tr Mltast 40,893.71 50.0000 20,446.86 Grwth A Mutual Fund @ $19.41 8 A 3053.692 shares of Lord Abbett Invt Tr Total 32,399.67 50.0000 16,199.84 Return A Mutual Fund @ $10.61 A Accrued Dividend on above 62.04 50.0000 31.02 TOTAL. (Carry forward to main schedule) . . . . . . 36,677.72 REV-1511 EX+ (08-13) ipennsylvania SCHEDULE H DEVARI UnOFREV NUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN RESIDENT DECEDENT ADM I NSTRATIVE COSTS ESTATE OF FILE NUMBER Josephine D. Albert Decedent's debts must be reported on Sdiedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See schedule attached 3,695.61 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: 2. Attorney Fees: 1,450.00 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: 5. Accountant Fees: 6. Tax Return Preparer Fees: TOTAL (Also enter on Line 9, Recapitulation) 5,145.61 If more space is needed, use additional sheets of paper of the same size. Page 2 Estate of: Josephine D. Albert Schedule H, Part A - Funeral Expenses Item Number Description Amount 1 Auer Cremation Services 2,211.37 2 Plainfield Cemetary 350.00 3 Wingate Hotel 6/24/14, 6/25/14 253.10 4 Wingate Hotel 7/20/14 135.16 5 Wingate Hotel 8/14/14 135.16 6 Snappers Restaurant 7/21/14 37.66 7 McDonalds 7/20/14 12.91 8 Arby's 7/20/14 11,83 9 Boiling Springs Tavern 8/14/14 84.61 10 Memorial Service 8/15/14- Minister 100.00 11 Memorial Service 8/15/14- Organist 75.00 12 Memorial Service 8/15/14 - Luncheon 63.33 13 Memorial Service 8/15/14 - Flowers 84.61 14 Memorial Service 8/15/14 - Picture Display Frames 84.47 15 Bridge Tolls 6/24/14, 7/20/14, 8/14/14 15.00 16 Turnpike Tolls -three round trips 41.40 TOTAL. (Carry forward to main schedule) . . . . . . 3,695.61 REV-1513 EX+ (01-10) '.' pennsylvania SCHEDULE J INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Josephine D. Albert NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Tmstee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec. 9116(a)(1.2).] 1 Helen A. Bickett Daughter 98,858.51 909 Bayberry Court Williamstown, NJ 08094 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: B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 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. Thomas Kimmett Edwart. Jones Financial Advisor St Johns Place 4401 Carlisle Pike Suite E Camp Hill, PA 17011 thomas.kimmett@edwardjones.com Important. For your security, please do not disclose account numbers, passwords or other sensitive information in e-mail messages. Fax Sheet (Broker/Dealer Use Only) Sep 8, 2014 Kristi Foster, Keefer Wood Alien & Rahai 255-8042 DATE TO FAX NUMBER 2 Sandra L Downey (888) 527.7385 NUMBER OF PAGES FROM FAX NUMBER Induding cover sheet COMMENTS: Krlstl, Here is a copy of the Death Certificate for Josephine Albert. Please note the reference in Section 43. Amendments, "Item #3 should read..." When we originally received a copy of the certificate, I noted the social security number shown in Section 3 was Incorrect. This was then presented to the Local Registrar who amended the record with the notation In Section 43 showing the correct number. If we can be of any other assistance, please don't hesitate to contact us. Sandra Downey Branch Office Administrator for Thomas Kimmott Please call our office with any questions. Phone: (717) 763-7669 For Broker/Dealer Use Only The information contained in this facsimile message is intended only for the use of the individual or entity to which it is addressed and may contain information that is legally privileged and/or confidential. If the reader of this message is not the Intended recipient or the employee or agent responsible for delivering the message to the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication is strictly prohibited. if you have received this communication in error, please notify us Immediately by telephone. Thank You. Estate valuation Date o* Death: 06/24/2014 Estate of: Josephine D. Albert Valuation Date: 06/24/2014 Account: $62964 Processing Date: 09/09/2014 Report Type: Date of Death Number of Securities: 7 File ID: Estate Valuation Shares Security Mean and/or Div and int Security or eaY Description High/Ash. Low/Bid Adjustments Accruals Value 1) 1842.228 AIM COUNSELOR SER TR (921139102; ACEIX) INV EQTY&INCM A Mutual Fund (as quoted by NASDAQ) 06/24/2014 11.19000 Mkt 11.190000 20,614.53 2) 409.382 AIM GROWTH SER (00888W619; VKMGX.) INV US MORTAGE A Mutual Fund (as quoted by NASDAQ) 06/24/2014 12.51000 Mkt 12.510000 5,121.37 Daily Div. Accrual as of 06/24/2014 16.54 3) 3912.219 ATM COUNSELOR SER TR (00142J255; VKMPX) INV PA TFX INC A Mutual Fund (as quoted by NASDAQ) 06/24/2014 16.31000 Mkt 16.310000 63,808.29 Daily Div. Accrual as of 06/24/2014 152.05 4) 1575.184 LORD ABBETT INVT TR (543916878; LCRAX) CORE FX INCM A Mutual Fund (as quoted by NASDAQ) 06/29/2014 11.00000 Mkt 11.000000 17,327.02 Daily Div. Accrual as of 06/24/2014 25.84 5) 2122.085 LORD ABBETT INVT TR (543916209; LABFX.) MLTAST SAL OPP A Mutual Fund (as quoted by NASDAQ) 06/24/2014 13.00000 Mkt 13.000000 27,567.11 6) 2106.837 LORD ABBETT INVT TR (543916613; LWSAX) MLTAST GRWTH A Mutual Fund (as quoted by NASDAQ) 06/24/2014 19.41000 Mkt 19.910000 40,893.71 7) 3053.692 LORD ABBETT INVT TR (543916845; LTRAX) TOTAL RETURN A Mutual Fund (as quoted by NASDAQ) 06/24/2014 10.61000 Mkt 10.610000 32,399.67 Daily Div. Accrual as of 06/24/2014 62.04 Total Value: $207,751.70 Total Accrual: $256.47 Total: $206,008.17 Page 1 This report was produced with Estateval, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.4.0) nD , c = m m0 > � ( ¥ 0 > = a co oee ER = R » « mm \ g 2 « . ! . z . a . ! = , mE > $ E2 } = E \ [ \ G m @ § _ ` I @ \ = = 0 G [ 9 ( \ \ § t \ F % \ , CD 0 ! y ! ® _ ) \ \ ! E _ - ( ( ) Go 0. . \ G & j ( # _W ID \ \ \ ) } \ ) ` > \ � � \ < \ j j ) \ - - _ , \ \ ® ; / r - - / % } _ .. 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E \ \ \ / \ \ \ \ \ ( \ \ \ \ ( } \ \ \� CD © - _ - ® , , E ® - _ } _ - \ G } } / a = F 0- 2 F CD\ ! & w s , ( E W } 2 \ § E / - : _ / . ■ c ` - ƒ - - _ \ Q , § \ \ 2 CD 0 \ .. / CD o \ ( - G CL } / ) } \( CL E � ° C ` k = a . . ¢ ( L \\ o > - 0 — K � \ \ CL CD CD 0 w \ CD}\ k \ \ < / (D \ \ \ \ CD CD \� �_\ _ ® \ CD CD ' FD CL / . . o CL $ 0 � � Funeral Expenses for Josephine Albert Auer Cremation Services $2,211.37 Plainfield Cemetary $ 350.00 Wingate Hotel 6/24/14, 6/25/14 $ 253.10 Wingate Hotel 7/20/14 $ 135.16 Wingate Hotel 8/14/14 $ 135.16 Snappers Restaurant 7/21/14 $ 37.66 McDonalds 7/20/14 $ 12.91 Arby's 7/20/14 $ 11.83 Boiling Springs Tavern 8/14/14 $ 84.61 Memorial Service 8/15/14 Minister $ 100.00 Organist $ 75.00 Luncheon $ 63.33 Flowers $ 84.61 Picture Display Frames $ 84.47 Bridge Tolls 6/24/14, 2/20/14, 8/14/14 $ 15.00 Turnpike Tolls 3 round trips $ 41.40 Total $ 3,695.24 �RFMAT[ON SERy C AUER CREMATION SERVICES OF PENNSYLVANIA, INC. •Op �G• 4100 Jonestown Road • Harrisburg, PA 17109 • 1-500-720-8221 • Fax 717-541-9943 • Shawn E. Carper;Supervisor pENNST1vk%tN'� V _ J 140663 MO-5 Jun 24 , 2014 Mrs . Helen Bickett 909 Bayberry Court Williamstown, NJ 08094 Josephine D. Albert - Deceased SPECIAL CHARGES X Direct Cremation $1 , 795 .00 Nationwide Guarantee Program Worldwide Travel Protection Program TOTAL SPECIAL CHARGES $1 , 795 . 00 PROFESSIONAL SERVICES X Services of Funeral Director & Staff Included Bathing and Disinfection .of Deceased . Facilities & Staff for Memorial Service Staff & Equipment for Memorial Service Private ID Family Viewing Witnessing the Cremation Packaging/Forwarding of Cremated Remains Personal Delivery of Cremated Remains Scattering of Cremated Remains TOTAL PROFESSIONAL SERVICES $0 . 00 AUTOMOTIVE EQUIPMENT X Removal Vehicle Included Lead Car/Clergy Car Family Car Service Vehicle TOTAL AUTOMOTIVE EQUIPMENT $0 . 00 -- - --°- -- �-�, 1455 PHILIP J. BICKETT C' 14 5 5 3t2 S HELEN A. BICKETT 909 BAYBERRY CT DATE - / 2 Shield°' WILLIAMSTOWN,NJ 080994�4 PAPER THEE /L?'I ORDER OF ^----D6 LABS LJ N ewfield 49 National Bank �//�// � l ZEWFIEID,NJ 08344 A— !Ce �/. ��f-i ___-- MEMO�j UP x:031 05340 : is 25 Sall m77-81I' i455 1 GIAIVT Oaai y.Setwaian.Savings Ewry Day. l 6560 CARLISLE G x Jl MECHANICSBURG, PA PIKE Store Telephone: (717) 796-6555 Pharmacy Telephone: (717) 796-0444 OlIlea Bargain Outlet Store #6005 08/15/14 09:34am 717-766-6364 Eating saveSisnatureImase ITEM FL LAYS LT SLID 4.29 F Description QTY Item Total BONUSBUY SAVINGS 0.79-F - --- -------- PRICE YOU PAY 3.50 892761 LUNCH NAPKIN 1 $0,79 WEGE PRETZL 120Z 2.49 F 892761 LUNCH NAPKIN 1 PARTY TRAY 34.99 F 892763 DESSERT PLATE 1 $0 79 DUTCH SALAD 6.99 F $0. 79 MACARONI SALAD 6.99 F 892763 DESSERT PLATE i $0 7y 892763- DESSERT PLATE 1 $0.79 Your l Savings Savings 500.7f9 892763 DESSERT PLATE 1 $0,79 Total After Savings 54.96 892762 DINNER PLATE 1 $0,79 TAX. 0.00 892762 DINNER PLATE 1 10 79 *+ BALANCE _. 4.96 892762 DINNER PLATE 1 892762 DINNER PLATE 1 $0.79 (*E $0.79 Payment Type: M D 00 Sub Total 17,90 Payment Amt: $5 Tax 40 47 BALANCE: $ Total 18.37 AUTHh 06229Z 09:35 Debit Total $8,37 MASTERCARD 54.96 Purch amt $8.37 CHANGE 0.00 Cash Back $0.00 r * +� * * SAVINGS SUMMARY *a* *x*a Card Savings: 0.79 Your Total Savings: 0.79 ***ltaae**■11ft■#3kMiFM%IFkiFkiFeXilkltiilxN**M■x PEN14SYLVANIA STATE TAH 08/15/14 09:36am 6005 7 33 138 $0.47 Sales Associate: Margaret A Sign up for email and save UJlies Army q with exclusive digital offers. : 00000000 visit giantfoodstores.con/register Thank guu for shopping 2014 BONUSCARD SAVINGS 187.20 011ies Bargain Outlet Miss a da.. . . . .miss a deal! ! Visit us at www olliesbargainoullet.com Trn:05297 Str 3 Rey 05-24 8/13/14 19:72 Iillill 111111 IIIII II 1111111 IIIII Ilill III IIIIIIII III IIIII Illii Ili�I IIII *ELKZAFHVTRARD* C-M !' ORE I i� �MRA- iE ARTS & CRAFTS ARTS & CRAFTS Turnersville Cross Keys Plaza Turnersviiie Sewell, RJ 08012 Cross Keys Plaza Telephone: (636) 97-r-09561 Sewell, NJ 08012 Telephone: (856) 875-9550 i SALZ_ SALE Customer Name: And et 81C4: T Customer Name: Customer Number: 999001212121 Andrew BICKETT Loyalty Type: Loyalty Meabe;s Customer Number: 999001212121 Loyalty Points: 1845 Loyalty Type: Loyalty Members The above balance may not reflect Loyalty Points: 430 transactions posted in the last 48 hours. The above balance may not reflect transactions posted in the last 48 hours. Salesperson: Kathleen No. 2045542 Salesperson: Cynthia No. 2052638 3148955734698 19x25 MI-TEINT PAPER $2°9T You 634524082480 GLUE DOTS REMOVABLE 20$3.99T E 31489557734698 19x25 MI-TLZiri PATE? 52$997 Promotional Price: 2.50 SAVINGS: ($1.49) You Paid: $2.54 You Paid: $2.50 ***50% off axle ***55% off one REG item*** 642828163477 11x14 08s :P M EDGES17.99T 642828163453 11x14 REVERSE SLANT 5r17.99T You Paid: 57.66 You Paid: $8.10 50% off one REG t`.r:5SP:, (�_M} �T1 55% Off one REG item YYou SAYED: ($9.89) COUPON: 5550 BA COUPON: 55508020955 ****** 642828163477 11x14 05L RAiSH).EDGE-B A 030674039555 19x25 MI-TEINT PAPER #$2.99T 3 x $17.99 $53i97T You Paid: $2.99 You Paid: $45.86 Subtotal $13.59 Subtotal 5 State Tax 7.0000% $0.95 15% Teacher Dismit T' #413:+4) Total $14.54 State Tax 7.0000% $4.10 You Saved $11.38 Total 562.70 Cash $20.00 You Saved $19.34 Cash Change $5.46 Visa $62.70 Card Store: 00143 Reg: 04 Tran: 105121 Auth.NNo.X03158DXXXXXi629 <S> Date 8/2/2014 2:59:38 PM Assoc: 2062838 14/07/27 - 12:34:38 Item(s) Sold: 3 Purchase----------------------$ 62.70----- Item(s) Returned: 0 ------------------------------------------ -• APPROVED Please Retain for Your Records ni_ BY WYNDH'I'M Wingate by Wyndham Mechanicsburg 385 Cumberland Parkway Mechanicsburg, PA 17055 Tel: (717)766-2710 Fax:(717) 766-9735 06-26-14 Philip Bickett Folio No. Room No. 117 909 Bayberry Court AIR Number Arrival 06-24-14 Williamstown NJ 08094 Group Code Departure 06-26-14 US DESCRIPTION Company P Y Conf. No. 36235869 Wyndham Rewards : Rate Code ' SSR Invoice No. Page No. 1 of 1 Date I Description Charges I Credits 06-24-14 -Room 116.10 06-24-14 Sales Tax 6.97 06-24-14 Occupancy Tax 34B 06-25-14 Room 116.10 06-25-14 Sales Tax 6 97 06-25-14 Occupancy Tax 3.48 06-26-14 Visa 253.10 Wyndham Rewards members earn valuable points on qualifying stays at nearly 7,000 hotels Total 253.10 253.10 around the world.If you are not already a member,join the next time you check4n,visit us at www.wyndhamrewards.com or call 1.866.996-7937. Balance 0.00 Guest Signature: Please contact the Manager about and issues with your stay. Wingate or affiliates may contact you about goods and services unless you call 877-222-3297 or write to Wyndham Worldwide Hotels,Inc. 1 Sylvan Way, Parsippany,NJ 07054 to opt out. View our Wingate website about privacy. Thank you for staying with us. It was our pleasure to serve you. Wingate by Wyndham Mechanicsburg 385 Cumberland Parkway Mechanicsburg, PA 17055 Tel: (717) 766-2710 Fax: (717) 766-9735 07-21-14 Philip Bickett Folio No. Room No. 217 909 Bayberry Court A/R Number Arrival 07-20-14 Williamstown NJ 08094 Group Code Departure 07-21-14 US DESCRIPTION Company a Conf. No. 48645203 Wyndham Rewards : 143323482B Rate Code RACK Invoice No. Page No. 1 of 1 Date Description I Charges Credits 07-20-14 Room 124.00 07-20-14 Sales Tax 7.44 07-20-14 Occupancy Tax 3.72 07-21-14 Visa 135.16 Wyndham Rewards members earn valuable points on qualifying stays at nearly 7,000 hotels Total 135.16 135.16 around the world.If you are not already a member,join the next time you check-in,visit us at www.wyndhamrewards.com or call 1.866.996.7937. Balance 0.00 Guest Signature: Please contact the Manager about and issues with your stay. Wingate or affiliates may contact you about goods and services unless you call 877-222-3297 or write to Wyndham Worldwide Hotels,Inc.1 Sylvan Way, Parsippany,NJ 07054 to opt out. View our Wingate website about privacy. Thank you for staying with us. It was our pleasure to serve you. Wingate by Wyndham Mechanicsburg 385 Cumberland Parkway Mechanicsburg, PA 17055 Tel: (717) 766-2710 Fax: (717)766-9735 07-21-14 Philip Bickett Folio No. Room No. 217 909 Bayberry Court AIR Number Arrival 07-20.14 Williamstown NJ 08094 Group Code Departure 07-21-14 US DESCRIPTION Company Conf. No. 48645203 Wyndham Rewards : 143323482B Rate Code : RACK Invoice No. Page No. : 1 of 1 Date 1 Description i Charges 1 Credits 07-20-14 Room 124.00 07-20-14 Sales Tax 744 07-20-14 Occupancy Tax 3.72 07-21-14 Visa 135.16 Wyndham Rewards members earn valuable points on qualifying stays at nearly 7,000 hotels Total 135.16 135.16 around the world.If you are not already a member,join the next time you check-in,visit us at www.wyndhamrewards.com or call 1.866.996-7937. Balance 0.00 Guest Signature: Please contact the Manager about and issues with your stay. Wingate or affiliates may contact you about goods and services unless you call 877-222-3297 or write to Wyndham Worldwide Hotels, Inc.1 Sylvan Way, Parsippany,NJ 07054 to opt out. View our Wingate website about privacy. Thank you for staying with us. It was our pleasure to serve you. -- - 0037 --_ Ser'rer: GEORGIA r 07/20:'14 wi�;er1 7: 996 Term: 21 ######################################## 3 snapper's DP,TE 126 -"' Alien Street h1ID 000007773636 TIMF (717)697-5475 7:56:46PM MERCHANT : 000007773636 BOILING SPRINGS TAVERN VISA TVPE ACCOUNT NUMBER Front vlsA First Str:e,fs (Jame: PiiILIP BICKXX"XXXX%XXX1629 Boiling Springs, PA UU TP,ANSACIION APPROVED 17007 AUTHORIZATION k: 04235D 717-258- Refrrenoe: 0720010000037 HANK YOU!PLEASE36OME i RAWS TYPE: Q"edit Card SALE F*#####*##,#*##########A*###a. .. CI-IEC{� : M##### TTP E5 ALTH p9581D XXXXXXXXxXXX1625 PRE-RUTH in 38 CHECK 262563 TOTAL : Gi0in9 Room GAIL 49. APIDUNT- - - - --- TAk 80.75 X 3.72 SUBTOTAL ---------------- 84 . 4; PHONE: ( Tip CAR NiL�Ep WANT PAY CARD ISSUER ABOVE TOTA L AMOUNT $. . . . . . . . . .. . .. . Sign One Rop,, CARDHOLDER AGREEMENT Your V. � K' eep a Copy for —�--- Record's CUSTOMER COPY _ W. fl { t ti I - - LL u O w w "U Ohl ONE FREL UlUkRILK VOUNDLR tai In m W!"EESE OR EGG MYUFFIN - w N mww ncrtroice.-nom within 'r dav�c a• .. T ' u5 ab'1Jt Y71ir V1si- — y Jaii__non 'Code:_ LL 6xUires Al days after recc-.iPt date. LL Valid at participatir4 US McDonald's- Unit# 1172 7%"21/2014 w 905 WALNUT BOTTOM RD Cashier: Jeanie 1 :12:34 PM LL CARL.s1a PA F 17013 1i-j m ! THANK MU ! ! ! PTR TEt.p 717 249 0695 Stored 1021 2 $3.99 14F Sand or 111rap 7.98 Mki Frsh CB Reuben ----- --- --- - 2 Sul Pepsi 3.16 w Jul .''%0'1? (Sun) 11 :36 SubTotal 11.16 0 Tax i0.67 MFY S.1-DE i ;i'1/; Order 63 Total 1� UJl l Y ITE ; TOTAL 1 Grl Ckn Bacrar• Salad 1.89 Cash 20.85 m w 1 Ranch Dressing r' m 1 S Diet Coke 1 .00 Change J,O2 dwa 1 Clua,ter libnRch Meal 6.29 it 1 I Cake LL LL 0 Subtotal 12.18 LL Tax p.73 Order Number 114708 c1 x Eat- .1 to[al 12.91 a m w ,ash 'endered 20.01 'hanye 7.10 McOonaid's Restaurant