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HomeMy WebLinkAbout11-12-14 1505610105 REV-1500 DC(02-11)(FI)�J!j ern�sytvania OFFICIAL USE ONLY Bu Department d Revenue P Yt County Code Year File Number cv�mnem a nevem¢ Bureau ofIo6oidualTaxes INHERITANCE TAX RET URN �` 1 In PO BOX 280601 J Harrisburg,PA 17128-o6ol RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYW 03/08/2011 04/19/1915 Decedent's Last Name _ Suffix Decedent's First Name _ MI Burtner � �•� Raymond � H� (If Applicable)Enter Surviving Spouse's Information Below LJ Spouse's Last Name Suffix Spouse's First Name MI 1 Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW CD 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) O 4.Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) M 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 1 William S. Daniels 1 (717)243-3831 REGISTkR OIDMLLS UE�ONLYr1l r 67) c3 r'1 n C First Line of Address :^ r— ,_, -d CD r rrt He st High Street =p Second Line of Address Suite 205 7 r rn City or Post Office State ZIP Code DATE FILED r_ } Carlisle PA 17013 . . i Correspondent's e-mail address:humeranddaniels@outlook.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:Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGN TURE OF PE SON ESPON$IBLE FOR FILING RETURN DA E ADDRESS Ann B. Tra is,66 Rolling Dr., Carlisle, PA 17013 SIPNATURE OF PREPARER OTHERT EPRESENTATIVE DAT A&2RE8S William S. Daniels,'Mq., 1 W. High St., Suite 206, Carlisle, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 J O✓J yi 1505610205 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: Raymond H. BUrtner RECAPITULATION I. Real Estate(Schedule A). ............................................ 1.: 181,576.00 2. Stocks and Bonds(Schedule B) ....................................... 2. 0.00 3. Closely Held Corporation,Partnership or Sale-Proprietorship(Schedule C) ..... 3. 0.00 4. Mortgages and Notes Receivable(Schedule D)........................... 4. 0.00 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).....,. 5, 8,870.00 6. Jointly Owned Property(Schedule F) C) Separate Billing Requested ....... 6. ; 11,061.59 ` 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) C) Separate Billing Requested........ 7. 0.00 8. Total Gross Assets(total Lines 1 through 7)............................. 8. : 201,507.59 9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. ` 20,787.55 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. 14,303,85 11. Total Deductions(total Lines 9 and 10)................................. 11. 35,091.40 12. Net Value of Estate(Line 8 minus Line 11) .............................. 12. 166,416.19 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., 166,416.19 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- 15. 0.00 16. Amount of Line 14 taxable at lineal rate X.0 45 166,416.19 16, 7,488.73 17. Amount of Line 14 taxable at sibling rate X.12 17. 18. .Amount of Line 14 taxable at collateral rate X,15 18, 19. TAX DUE................ .......................,............ 19. 7,488-73 ' 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610205 1505610205 I REV-1502 EX+(12-12) r 17�10-'-7 pennsyLvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Raymond H. Burtner 21-11-0385 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. 66 Rolling Drive,Carlisle,PA 17013 157,300.00 2. Potter County Cabin and Property(2.55 CLR x$9520 Assessed Value=FMV) 24,27 6.00 TOTAL(Also enter on Line 1, Recapitulation.) 181,576.00 If more space is needed,use additional sheets of paper of the same size. Cumberland County Board of Assessment Appeals ArAA.l=il�lt� Old Courthouse, First Floor One Courthouse Square t Carlisle, PA 17013 ° 04001926-2A-3343 m. s isotliL��llhnmllullululul�llutl�lnLllutllttltlttl � 7576 BURTITER, RAYMOND H & RITA H x21 P1 66 ROLLING DRIVE CARLISLE, PA 17013-4274 Deadline for Scheduling an Informal Review Appointment: Tune 14, 2010 For details, please see the reverse side. NOTiCE OF OF The Cumberland County Board of Assessment Appeals is providing you with notice of the value on this property, determined as a result of the Cumberland County countywide reassessment completed this year. The countywide reassessment values each property at current Fair Market Value, as of ,January 1, 2010, equalizing and establishing a uniform tax base so that properties of like characteristics and the same actual Fair Market Value will be taxed the same. VALUE • • FORMAL APPEAL DEADLINE: June 14, 2010 MAILING DATE: may 3, 2010 Parcel Identifier: MUaiC.: 04 - CARLISLE BORO 3RD WRD 04-23-0600-209 . School: 3 - CARLISLE AREA SD Location: 2010 Base Year Assessed Value Old Assessed Value 66 ROLLING DRIVE Fair Market Value (2010 Market x 100%) (2004 Market) LOT 5 Land 57,600 57,600 50,000 Buildings 140,500 140,500 79,660 t c 9- SQ Pt' A-- TOTAL 198,100 198,100 129,660 Taxable Property 2010 Clean and Green Values UnitlLot ID: L-o0o5 Land NOT NOT NOT Land Size: ,62 acres Buildings APPLICABLE: APPLICABLE APPLICABLE Property Type: R TOTAL Residential(Vader 10 Acres) Clean and Green values apply to qualified farm and forest land and become effective only upon application and approval. Clean and Green applications must be received Homestead Approved by the Assessment Office no.later, than 4:30 p.m: on October 15,-2010. Those previously approved for Clean and Green do not need to re apply. ESTIMATED TAX IMPACT 57. 3 = The ESTIMATED impact statement printed below is our best estimate of change, based on 2010 COUNTY tax figures. THIS ESTIMATE DOES NOT INCLUDE ANY BOROUGH,TOWNSHIP, OR SCHOOL DISTRICT IMPACT. Current 2010 County mills - 2.579 Adjusted 2010 County mills - 2.074 $ 334 . 2010 COUNTY Tax BEFORE Reassessment. 4 411 s 2010 COUNTY Tax AFTER Reassessment. (see reverse side) Cumberland County Board of Assessment Appeals JRROPERTY OWNER INFORMAL REVIEW ACCEPTANCE OR REJECTION FORM. Is As of (date), !/we have requested an appeal of our assessment. 0 As 01 the above date, I/we have met With an offici Property assessment in question, al assessment representative to discuss mylour 0 The parcel/account number of the subject property is a. Pero The current el/Account Number market Value of thi The current Cl s Property is S L man and green Appral-Ser-.9 Re on value (if aP)Dlicable) of this j0roPerfy is$ COMMendation: Pro *rty Owner,. De cison: E? ti we eccept the recom "ommendation , f, 'enclattion appeal will be 0 C QS9 't the review bsern considerrnal aPPeal hea PPraiser an uncleent and a red to be ring will n,) d un 't,2nd that if the Withd t be Go understand that if th rawn. Ch �Gduleod and any Previous I 11,,rd scheduled. h . raw Of that ecking this box constitute," 9 nard,d. at appeal by rn / - us app os not anDr,04 the Y our -P requyr for-roves the h a r,9 c(a)m0c L appeal of iRformal cOOftherecor"nendatOur for a f0jectthe recommend noation, an 'In reML �a1 he, ation of the "DiVal heallng ' "we further scedu . nng by the review Will be thea deadline, 'vaPPraiser and understa P stated,onth,,,t,,,' ndthat it, roperry owne'r4l Si notice, an appeal Ywe have filed healing will request be ft9vie W AppraiserS Sig� A atUre-- L I/We acknowledge rece- Pt of a duplicate te signed copy Of this�ton'n_ CertificatiOn dumber_..`'--- 0111 No: 40 2011 Statement of Real Estate Taxes Control No: 230-011442 Bill Date: 3101/2011 Assessed Land irkorovement mineral Total AYABI_Et values 2.5201 7,000 0 9,520_ COUNTY OF POTMR,PENNSYLVANIA Discount Face PensItT_ JACQUELYN REEDER-FLICKINGER Rates .01355000 01355000 27 10% 10 LACKAWANNA AVE PO BOX 333 COUNTY R/E 126.42 129.00 141.90 GROSS FORK PA 17729-0333 STEWARDSON TOWNSHIP Rates .00250000 .00250000 2% 10% MONK. R 23.32 23.80 26.18 MAP NO: 230-001 -034 67 CHESTNUT ST TAX AMOUNT DUE $149.74 $152.80 ACRES 1.050 DEED 0183 /1087 1 RT 144 if Paid on or After 3/01/201 5/01/2011 7/01/2011 If Paid On or Before 4/3 2011 613012011 12 31 2021 SEASONAL DWELLING NO APPTS APRIL 24-30,2011 MAIL PAYMENTS ONLY. BURTNER RAYMOND H MUST BE POSTMARKED BEFORE APRIL 30,2011 FOR DISCOUNT. %YER 6 ROL,�IPG DR 8A PA 17013 THANK You mcr: MAIL PAYMENT OR CALL FOR APPT. cuss: TELEPHONE 570-923-2246 RETURNED CHECK FEE$35.00 BOOKS CLOSE DECEMBER 312011 Return Bill with Payment.For a Receipt, Date Pala Amount Paid Enclose a self-addressed stamped envelop! HAROLD L.'TRAVIS 607772M/23t3 ANN.B.'TRAVIS 4158 CARLISLE ROAD PH.117-486-3816 GARDNERS,PA 17324 A/ drdeco{ LAO _L 0 Sovereign Bank PART OF THE SANTANDER GROUPCS 1: 2 3 13 7 269 la: 289 10 to 5386118099 2 cl't' Le (_O�elr 83 REV-15o8 EX+(o8-12) SCHEDULE • pennsytvania DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Raymond H. Burtner 21-11-0385 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. Personal Property,66 Rolling Drive,Carlisle,Appraisal attached 1,712.00 2. 2002 Chrysler 200M-V6 Sedan 4D,Average Trade-In Value 4,525.00 3. Cash in Pocket 327.00 4. Income Tax Refund,2011 2,306.00 TOTAL(Also enter on Line 5, Recapitulation) 8,870.00 If more space is needed,use additional sheets of paper of the same size. M0,05 R wo, N W-1 Mop pill PROM AW-1 5001, Tgo' �. i 'OR i .. Igor i .� / � �..� � � � .!.ice -/ - - •�� // ✓ / - i wArlo -9y; ./ i VIA / - II " I F FUN .+� i r.Ml-_.:;-,ffl�,R r M�W I-mo -_me-, jowl' fM�W" 4` y�ti t • �G� t •- � j f r" • �T 411 ' 10VJ oo r Y 4O o y 1 — /fz4"� - 730.00+ _ �._..--- 75.00+ .413-00+ ' ._.---194.00+ 1 7712• SoR RU j CUSTOMER #: 4863815 137430 = •-� - UNIT## T2110 *INVOICE* DILLSBURG,PA HAROLD L TRAVIS P.O. BOX 446 - 700 NORTH US ROUTE 1-5.: 4158 CARLISLE RD DILLSBURG, PA. 17019 GARDNERS, PA 17324-8903 PAGE 1 1717 17171 766) 766-9614 HOME:717-4 8 6-3 815 CONT:N f A -2009 TIiTc• CELL: SERVICE ADVISOR: 7886 JEREMY Summary With NADA Values NADA Used Car Guide Friday,April 15,2011 Guide Edition: Eastern Used Car Guide-April 2011 Vehicle Description: 2002 CHRYSLER 300M-V6 Sedan 4D VIN: 2C3AE66G42H142559 Weight: 3581 Stock#: MSRP: $28.340 Rough Avg. Clean Clean Glean NADA Trade-In Trade,in Trade-In Loan Retail Base Values $1,900 $2,775 $3,500 $3,150 $5,62 Mileage: 56122 $1,750 $1,750 $1,750 $1,750 $1,750 Accessories $0 $0 $0 $0 $0 NADA Adjusted Values $3,650 $4,525 $5,250 $4,900 $7,375 Appraiser $0 $0 $0 $0 $0 Adjustment Adjusted Values $3,650 $4,525. $5,250 $4,900 $7,375 Accessories: Trade Loan Retail REV-15oq EX+(oi-io) Jpennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Raymond H. Burtner 21-11-0385 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 X Ann B.Travis 66 Rolling Drive,Carlisle Daughter B. C, JOINTLY OWNED PROPERTY: LEPER DATE DESCRIPTION OF PROPERTY % DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENTS VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. M&T Select with Interest,Checking Account#v=6236 11,670.69 50 5,835.35 2. A. Members 1st Credit Union 7,216.71 50 3,60836 3. A. WachoviaMelis Fargo 3,235.75 50 1,617.88 TOTAL(Also enter on Line 6, Recapitulation) $ 11,061.59 If more space is needed,use additional sheets of paper of the same size. M&T Bank Account History Spring Garden ****6236 1-800-724-2440 M &T Select With Interest Siinit Posting. tr�dic #or Hate Description Witfidrawais: ©epossts" 8aiance 0510212011 SAFE BOX DEBITS SAFE BOX $18.85 { $10,056.22 05/0112011 INTEREST PAYMENT $.09 $10,07$.07 04/20!2011 PPL EU ELEC SVC $75.05 $10,074.98 04/14/2011 Centuryl-ink Telecom $37.75 $10,150.03 04/13/2011 REVERSE DIRECT DEPOSIT $843.95 $10,187.78 * 04/13/2011 REVERSE DIRECT DEPOSIT $3,386.85 $11 t031.73 * 04/01/2011 INTEREST PAYMENT $•09 $14,418.58 * 04/01/2011 OFAS-CLEVELAND RET NET $843.95 $14,418.49 * 04/01/2011 US TREASURY 312 XXCIV SERV $3.386.85 $13,574.54 * 03/30/2011 TRI-COUNTY REG ACH PAYMNT $20.52 510,187.69 03/24/2011 CHECK NUMBER 1772 $8.08 $10,208.21 03/23!2011 CHECK NUMBER 1771 $82-80 $10.216.29 03/2212011 PPI_EU ELEC SVC $112.60 $10,299.09 * 03121/21011 CHECK NUMBER 1768 $93.50 $10,411.69 03115/2.011 Centuryl.ink Telecom $36.78 $10,505.19 03/15!2-011 CHECK NUMBER 1769 $91.84 $10,541.97 03114/2011 TAMPA ELECTRIC PAYMENTS $223.40 $10,633.81 * 03/11/2011 CHECK NUMBER 1766 $223.40 $10,85721 03/09/2011 CHECK NUMBER 1767 6590.08 $11,080.61 03/08/2011 CHECK NUMBER 1765 $140.94 $11,670.69 tom' 03/07/2011 CHECK NUMBER 1762 $50.00 $11,811.63 * 03/07/2011 COMCAST CENTRAL CENTRAL PA $71.54 $11,861.63 03/02/2011 TRI-COUNTY REG ACH PAYMNT $20.36 311,933.17 r 03/01/2011 INTEREST PAYMENT $.31 $11,953.53 " PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE NO. 21 PO BOX 280601 TAXPAYER RESPONSE ACN 11118378 HARRISBURG PA 17128-0601 4$ DATE 03-18-2011 Rev-1545 Ex AFP(0e-001) TYPE OF ACCOUNT EST, OF RAYMOND BURTNER © SAVINGS SSN 199-07-6918 ❑ CHECKING DATE OF DEATH 03=08-2011 ❑ TRUST COUNTY CUMBERLAND ❑ CERTIF. REMIT PAYMENT AND FORMS TO: ANN B TRAVIS REGISTER OF WILLS 4158 CARLISLE ROAD 1 COURTHOUSE SQUARE GARDNERS PA 17324 CARLISLE PA 17013 MEMBERS 1ST FCU provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account, If You feel the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of Pennsylvania. Please call (717) 787-8327 with questions. CbIMPLETE PART'i_ BEfC J * SEE vREVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 4949-00 Date 10-28-1959 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance 7,216.71 payment to the Register of Wills. Make check payable to 'Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax yt, 3,608.36 months of the decedent's date of death, Tax Rate X .045 deduct a 5 Percent discount on the tax due. Potential Tax Due cy� 162.38 Any Inheritance Tax due will become delinquent nine months after the date of death. PART TAXPAYER RESPONSE FAILUF2E: TO -itESPOND WILL RESULT 'IN AN OFF ICIALTAX. ASSESSMENT A. ❑ The above information and tax due is correct. Remit Payment to the Register of Wills with two copies of this notice to obtain CCHE C K a discount or avoid interest, or check box "A" and return this notice to the Register of H ONE E Wills and an official assessment will be issued by the PA Department of Revenue. BLOCK B. ❑ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ONLY to be filed by the estate representative. C. ❑The above Information is incorrect and/or debts and deductions were paid. Complete PART 2l and/or PART 3❑ below. PART If indicating a different tax rate, please state C)FFTCIAL• USE. ONLY. - AAF M relationship to decedent: c' ❑ + PA.-:DEPARTMENT OF. REVENUE . .: v TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD 3 'LINE, 1;—Date'Establ'ished 1 2. Account Balance 2 $ 2 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ 4 ' J 5. Debts and Deductions 5 6. Amount Taxable 6 6 _ -ti-„ 7. Tax Rate 7 X ? 8. Tax Due 8 8 PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) S Under penalties of perjury, I declare that'the facts I have reported above are true, correct and complete to the best of my knowledge„add belief- HOME C WORK c Raymond Burtner Estate-Value 6/43/11 ' 66 Rolling Drive $157,300.00 Potter Co $39,000 Florida $17,000 Florida Contents $17220.00 : 2002 Chrysler $4525.00 r M&T Bank -Date of Death $11670.69 1/3 ownership � �' `rZ Inpocket-Date of Death $327.00 Members 1" CU $7,216.71 '/2 own.ershi Wachovia/Wells Faro $3,235.75 '/2 ownershi ? REV-1511 EX+ (08-13) 11 ,7 Pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Dugans Funeral Home 8,228.65 2. Mt.Zion Lutheran Church,Reception 200.00 3. Allen Dugan,Death Certificates 19.00 B. ADMINISTRATIVE COSTS: L Personal Representative Commissions: 0.00 Name(s)of Personal Representative(s) Ann B. Travis Street Address 66 Rolling Drive City Carlisle State PA ZIP 17013 Year(s)Commission Paid: N/A 2. Attorney Fees: 10,142.23 3• Family Exemption:(If decedent's address is not the same as claimant's,attach explanation.) 0.00 Claimant N/A Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 71.50 5. Accountant Fees- 0.00 6. Tax Return Preparer Fees: 248.00 7. Property Appraisal(contents 70 and auto 93.17) 163.17 8. Short Certificates 12.00 9. Advertising,Cumberland Law Journal(75)and Sentinel(275) 375.00 10. Recorder of Wills,Filing 30.00 11. Death Certificates 99.00 Continued on Page 2(Page 2 subtotal shown on Page 2;Total shown below) TOTAL(Also enter on Line 9, Recapitulation) $ 20,787.55 If more space is needed,use additional sheets of paper of the same size. Page 2 - Schedule H, Continued ESTATE OF RAYMOND H. BURTNER FILE NO. 21-11-0385 Item Number Description Amount 11. Additional Probate 240.00 12. Cumberland County Recorder of Deeds,Two Deed Transfers 125.00 13. Potter County Recorder of Deeds,Two Deed Transfers 84.00 14. Reserve 750.00 Subtotal to be added to Page 1 1,199.00 TOTAL (Entered on Page I of Schedule H) 20,787.55 o 4 113 Forge Rd., Boiling Springs, PA 17407 PF C In Account With 6� ROY D. GOTTSHALL, AUCTIONEER r t .....• .... .raw HAROLD L.TRAVIS tea: `�� so;enaix�ls ... 1 8.5 3 — i AN B. TRAVIS-- SLE RAVIS ='_' ` • �:.' 4158 CARLISLE RDTPH: -f 64 GARDNERS, PA 173 4,89Q3 `_ 1s' •; r. } TV- w. 76 St Mi7MEM P 9 PAI — . •www.membmtaaq, .� .y— IL 1: 2313822t. D 004153-L1. 50n' L853 �� RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Receipt Date: 3/24/2011 Cumberland County - Register Of Wills Receipt Time: 14 :00 : 09 One Courthouse Square Receipt No. : 1064910 Carlisle, PA 17013 BURTNER RAYMOND H Estate File No. : 2011-00385 Paid By Remarks: WILLIAM S DANIELS HMW ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 20 . 00 CUMBERLAND COUNTY GENERAL FUN WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 8 . 00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 23 .50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5. 00 CUMBERLAND COUNTY GENERAL FUN ---------------- - Check# 1060 $71. 50 Total Received. . . . . . . . . $71 .50 '` POTTER COUNTY REGISTER AND RECORDER RECEIPT Gary E.Kelsey Register and Recorder Potter County Courthouse I North Main St-Suite 101 Coudersport,PA 16915 814-274-8370 Inv Number: 38294 Invoice Date: 011141201310:28:08 AM RECEIPT Reg/Drw ID- 0201 Customer: Last Change: By: SMR HUMER&DANIELS I IN HIGH STREET SUITE 205 CARLISLE,PA 17013 ATTN:WILLIAM S DANIELS ESQUIRE Chg# Charge/Payment I Fee Description Amount Inst#I Inst Date Municipality I DEED $42.00 201300113 STEWARDSON Grantor-BURTNER,RAYMOND H EST 0111411310:28:38 AM TOWNSHIP Grantee-TRAVIS,ANN B Total Pages.5 Consideration- $0.00 Tax Basis- $0.00 Return Via-ENVELOPE PARCEL IDENTIFICATION NUMBER 230-001-034 Fee Detail: COUNTY RECORDING FEE $13.00 IMPROVEMENT FEE-COUNTY $2.00 IMPROVEMENT FEE-RECORDER $3.00 JCS/ATJ/CJEA FEE $23.50 STATE WRIT FEE $0.50 Inst Info:1.05 ACRES 2 DEED $42.00 201300114 STEWARDSON Grantor-TRAVIS,ANN 8 01114113 10:55:42 AM TOWNSHIP Grantee-TRAVIS,ANN B Total Pages:4 Consideration- $1.00 Tax Basis- $0.00 Return Via-ENVELOPE PARCEL IDENTIFICATION NUMBER 230-001-034 Fee Detail: COUNTY RECORDING FEE $13.00 IMPROVEMENT FEE-COUNTY $2.00 IMPROVEMENTFEE-RECORDER $3.00 JCS I ATJ/CJEA FEE $23.50 STATE WRIT FEE $0.50 Inst Info:1.05 ACRES TOTAL CHARGES $84.00 PAYMENTS CHECK.,1114-HUMER&DANIELS $84.00 TOTAL PAYMENTS $84.00 AMOUNT DUE $84.00 PAYMENT ON INVOICE ($84.00) BALANCE DUE $0.00 Date:Jan 14,201310:59:37 AM Page CUMBERLAND COUNTY RECORDER OF DEEDS RECEIPT Inv Number: 117817 Invoice Date: 0912012012 4:02:49 PM RECEIPT Reg/DrwID: 0101 Customer: Last Change: Receipt By:COUNTER By: SW DANIELS Chg# Charge I Payment I Fee Description Amount Inst#I Inst Date Municipality 1 DEED $63.00 201228937 CARLISLE BOROUGH- Grantor-BURTNER,RAYMOND H 09/20/12 4:02:57 PM 3RD WARD Grantee-TRAVIS,ANN B Total Pages:6 Consideration- $157,300.00 Tax Basis- $0.00 Return Via-PICKUP PARCEL IDENTIFICATION NUMBER 04-23-0800-209- Fee Detail:, AFFORDABLE HOUSING FEE $11.50 COUNTY RECORDING FEE $11.50 IMPROVEMENT FEE-COUNTY $2.00 IMPROVEMENT FEE-RECORDER $3.00 JCS/ATJ/CJEA FEE $23.50 PARCELS FEE $10.00 STATEMENT OF VALUE FEE $1.00 STATE WRIT FEE $0.50 CARLISLE-3RD MUNICIPAL REALTY TAX FEE $0.00 SCHOOL DISTRICT REALTY TAX $0.00 2 DEED $62.00 201228938 CARLISLE BOROUGH- Grantor-TRAVIS,ANN B 09120/12 4:06:48 PM 3RD WARD Grantee-TRAVIS,ANN B Total Pages:4 Consideration- $1.00 Tax Basis- $0.00 Return Via-PICKUP PARCEL IDENTIFICATION NUMBER 04-23-0600-209- Fee Detail: AFFORDABLE HOUSING FEE $11.50 COUNTY RECORDING FEE $11.50 IMPROVEMENTIFEE-COUNTY $2.00 IMPROVEMENT FEE-RECORDER $3.00 JCS/ATJ/CJEA FEE $23.50 PARCELS FEE $10.00 STATE WRIT FEE $0.50 CARLISLE-3RD MUNICIPAL REALTY TAX FEE $0.00 SCHOOL DISTRICT REALTY TAX $0.00 TOTAL CHARGES $125.00 PAYMENTS CHECK:1104 $125.00 TOTAL PAYMENTS $125.00 AMOUNT DUE $125.00 PAYMENT ON INVOICE ($125,00) BALANCE DUE $0,00 Date:Sep 20,2012 4:07:47 PM Page Miscellaneous Expenses for Raymond.Surtner Estate March 08, 2011 through September 18, 2012 Expense Description Amount Date Cabelas invoice 234.17 3/10/1 Dugans Funeral Home 8228.65 4/05/11 Groups Tax Service(2011 taxes) 145.00 4/13/11 Mt.Zion Lutheran Church-Luncheon -,Z 200.00 3/21/11 Death Certificates 99:00 3/16/11 Kris Kessel Chi ,sler repair and appraisal 93.17 3/27.11 Cumberland County—short certificates _;'_ 12.00 6101/11 H&R Block(2012 Income Taxes) 248.00 4102/12 M &T Lock Box-2011 1885 4/20/11 M&T Lock Box-2012 19.00 4130/12 Allen Dugan-Death Certificates ✓ R 19.00 8/05111 Home Depot-Repairs 173.55 Stab total 8526.89 Estimated Inheritance Taxes 9500.00 6/03/11 Page total 19,026.89 REV-1512 EX+(12-12) pennsylvania SCHEDULE DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES &LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Raymond H. Burtner 21-11-0385 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 Safe Deposit Box Rental 37.85 Z Credit Card Debt(Cabelas) 234.17 3. Utilities,66 Rolling Drive,Carlisle,PA 2,712.38 4. Electricity and Expenses,Potter County Cabin 3,100.90 5. Groups Tax Service,2010 Income Tax Preparation on 4/13111 145.00 6, Property Taxes,Real Estate 2011 786.64 7, Personal Tax 2011 4.90 8. School Tax 2011 1,763.95 9. Property Insurance 889.00 10. Cumberland Goodwill Fire and Rescue,Charitable Donation 82.80 11, Tree Removal Due to Storm Damage 2,365.00 12. Landscape Repair Due to Tree Removal 1,980.00 13, Miscellaneous Property Repair 201.26 TOTAL(Also enter on Line 10, Recapitulation) $ 14,303.85 If more space is needed,insert additional sheets of the same size. Q Miscellaneous Expenses for-Potter-County Cabin f / 67 Chestnut St. , Cross Fork, PA March OB,2011 through September 18,0.1-2 Expense Description � Amount Local Taxes 2011 Date Local Taxes .2012 149.74 4/29/11 162.32 Total- 312.06 6128!12 School Taxes 2011 �,. School Taxes 2012 360.31 8/15/11_, Total 348.$1 9!14/12 709.12 Property Insurance 8/03f- 1 -8/03/12 291 Pro erty Insurance 8/03112— 10103/127!25/11 $0'50 - 9104112 Total 371.50 Watershed Asso.Fee 00 25, Tree removal {fallen-property damage) 25.0:50 5/02/11 7, Trash fee—annual.a sessment 2011 10!08!-11 ( f ,f Trash fee- annual assessment 2012 100 611511.1 -� Ambulance assoc fees 2011 1 7/03/12 X. Ambulance assoc fees 2012 155 15 :-Z 6115111 Sewa e s Total 1,255:50 stem re air/r lacemeut Perk test 900 System replacement 10104/11 8450 -5/13/12-5000 Tree removal for----tic-replacement14-00 6/27/12-3450 Backhoe use for pert test 150 5/14/12 Total 101900 Kettle Creek Hose Co—annual fee 25 3!0,8/11 Tri County Electric 2011 Total 25.00 Tri Coun Electric 20.52 3/30/11 Tri Coun Electric 23S7 5/02/41 Tri County Electric 20.66 5/31/11 Tri County Electric 24.76 6/3011.1 Tri County Electric 25-97 8/0111.1 Tri C67 ounty Electric 19 00 8130/1.1 Tri County Electric 19.97 00 9/3.0/1.1 Tri County Electric 22.33 1013I1.1 1 Tri County Electric 22 33 11130/11 Tri County Electric 201.2 19.00 12/30/1,1 Tri Coun Electric 22.48 1/30/12 Tri County Electric 27.62 3101112 Tri County Electric 20'85 3/30/12 Tri County Electric 22`08 -4/30%12 Tri County Electric 24.08 5!30!12 Tri County Electric 23.93 7102112 Tri County Electric 23.01 7/30112 Tri County Electric due 10/01 27.78 8130/12 31.16 Service 8/01-9/01 Total 457.34 Page total 14,030.52 Utility Expenses for 66 Rolling ve, Carlisle,PA 17013 March 08,2011 through September 17, 2012 ` Expense Description Amount Date PPL Electric 2,011 112.60 3/22/11 PPL Electric- 75.05 4/22/11 PPL Electric 69.89 5/20/11 PPL Electric 106.71 6/21/1.1 PPL Electric 189.47 7/20/11 PPL Electric 209.04 8/19.11 PPL Electric 170.84 9/19/11 _ PPL Electric 133.92 10/20/11 PPL Electric 105.88 11/18/11 PPL Electric 97.78 12/22/11 PPL Electric 2012 93.45 1/19/12 PPL Electric 119.90 2/21/12 PPL Electric 66.45 3/21/12 PPL Electric 56.23 4/19/12 PPL Electric 59.51 5/21%12 PPL Electric 42.01 6/20/12 PPL Electric 67.43 7/19/12 Total 1776.66 Carlisle Borough-water and sewer 72.90 6/22/1.1 Carlisle Borough water and sewer 72.90 3/15/11 Carlisle Borough-water and sewer 72.90 8/21/11 Carlisle Borough-water and sewer 72.90 3/05/12 Carlisle Borough-water and sewer 72.90 6/22/12 Carlisle Borough-water and sewer 72.90 8/28/12 Total 437.40 Cf Aero Energy-Fuel Oil 316.51 3/29/11 ' Aero Energy-Fuel Oil 220.22 11%07/11 Aero Energy-Fuel Oil 259.86 12/15/11 Aero Energy-Fuel Oil 283.44 1/31/12 Aero Energy-Fuel Oil 333.73 4/18/12 Total 1413.86 Century Link-Phone 36.78 3/13/1.1 Century Link-Phone 37.75 4/13/11 Century Link-Phone 32.78 5/13/11 Century Link-Phone 32.78 6/13.11 Century Link-Phone 32.78 7/13/11 Century Link-Phone 32.61 8/22/11 Century Link-Phone 32.78 9/20/11 '}' Century Link-Phone 32.78 10/24/11 )0 Century Link-Phone 132.82 11/18/11 Century Link-Phone 136.85 12/21/11 Miscellaneous Kzpenses for RayxnondBurtver.Estate March 08,2411 through September 18, 2012 Expense Description Amount Date Cabelas invoice 234.17 3/10/1j Dugans Funeral Home 8218.65 4/05/11 Groups Tax Service(2011 taxes) 145.00 4/13/11 Mt. Zion Lutheran Church-Luncheon V 200.00 3/21/IJ Death Certificates 4, 99.-00 3/1611 1 Kris Kessel Chrysler j9pairand a . raisal 93.17 3/27.11 Cumberland County—short certificates V 12.00 6/01/11 H&R Block(2012 Income'Taxes) ty, j 248.00 4102/12 M& T Lock Box-2011 ✓ 18.85 4/20/11 M&T Lock Box-2012 19.00 4/30/12 Allen Dugan-Death Certificates ✓ 19.00 8/05111 Home Depot-Re airs 171I.55 Sub total 9526.89 Estimated Inheritance Taxes 9500.00 6/03/11 Pap total 19,026.-89 M&TBwAL'& Manufacturers and Traders Trust Company Member FDIC SAFE DEPOSIT BOX RENTAL INVOICE z RAYMOND H BURTNER t RITA H BURTNER 66 ROLLING DR CARLISLE PA - 170134274. { SEND PAYMENT TO: I M & T BANK HIGH STREET-CARLISLE! 0004319 P. 0. BOX 62301 BOX NO: 0003256. BALTIMORE MARYLAND 21264-2301 YOUR CHECKING ACCOUNT 000000000406236 WILL BE CHARGED FOR NET RENTAL AMOUNT RENTAL PERIOD: 04/30/11 TO 04/29/12 NOTICE DATE 04/20/11 RENTAL RATE: 29.00 TOT DISCS 10.15- BALANCE DUE: 18.85 25% DISC A$10.00 late charge will be assessed if the balance due (shown above) is not received on or before 5/30/11 STATEMENT OF AUTOMATIC DEBIT ONLY. DO NOT PAY. MM&TBm* MturOrs an[ITratlers crust ComDaoY MemberemberFOIC SAFE DEPOSIT SOX RENTAL INVOICE { i SEND PAYMENT TO: M & T BANK HIGH STREET-CARLISLE! 0004319 P. 0_ BOX 62301 BOX NO: 0003256 BALTIMORE MARYLAND YOUR CHECKING ACCOUNT 000000000406236 21264-2301 WILL .BE CHARGED FOR NET RENTAL AMOUNT RENTAL PERIOD: 04/30/11 TO 04/29/12 NOTICE DATE : 04/20/11 RENTAL RATE: 29.00 TOT DISCS 10.15- RAYMOND H BURTNER RITA H BURTNER ! 66 ROLLING DR CARLISLE PA - 170134274 BALANCE DUE: 18.8$ 25% DISC 000431900032SLOO18AS 1.031(MI Miscellaneous Expenses for 66 Rolling Drive, Carlisle, PA 17013 March 08,2011 through September 18,2012 Expense Description Amount Date Z_ Borough Taxes 2011 personal-201 1 4.90 4/28/11 V Borough Taxes 2011 786.64 .4/28/11. Borough Taxes, 2012 -802.-69 6/27/12 Total 1594.23 School Taxes -2011 1763.95 8/15/11 School Taxes 2012 -802.69 -8/23/12 Total 3543.87 Property Insurance 8/03/11-8A03/12 889.00 7/15/11 Property Insurance 8/03/12-10/03/12 236.75 9/04/12 Total 1-125.76 Tree Removal (Stonndamage4) 2365.00 7 4 , 4/05/11 . Landscape repair (Jon Daniels) 1200.D0 4/06/11 Landscape repair (Jon Daniels) 780.00 6/21/11 j Total -4345.-00 Property Appraisal-(Roy Gottshall) 70.00 V' � 6/03/11 Cumberland Goodwill Fire and Rescue 82.80 3/17/11 Miscellaneous property repair 201.26 4/01/11 Total 354.06 Basement water damage-mold-and mildew repair 25,550- 3/12/2012 (Old Town Homes) Total 25,550 -Page total 36512.912