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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG, PA 17128-0601
REV-1500
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
BATES, ISABELLE C.
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
12-22-2000 05-24-1912
(IF APPLICABLE) SURVIVING SPOUSE'S N~ME (LAST, fiRST, AND MIDDLE INITIAL)
OFFICIAL USE ONLY
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[!] 1. Original Return
o 4. Limited Estate
[j 6. Decedent Died Testate (Alt<lch copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (dale 01 death after 12-12-62)
o 7. Decedent Maintained a Living Trust (Alt<lch copy of Trust)
o 10. Spousal Poverty Cred(t(dat6o(t.iea.(!lbeiwl;",~ 12-31-91 <l1Itl 1-1-%}
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FILE NUMBER
L l - ~ -'-- Jl..!L Jl.. ~ ~
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
177 - 16
- 0774
THIS RETURN MUST BE fiLED IN DUPUCATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (date ofdealh prior to 12.13-821
o 5. Federal Estate Tax Return Required
1 8. Total Number of Safe Deposit Boxes
D i1. Election to tax under Sec. 9113(A) (Mac/1 &:h 0)
COMPLETE MAILING ADDRESS
Andrew C. Sheely, Esquire
127 South Market Street
P.O. Box 95
Mechanicsburg, PA 17055
OFFICIAL USE ONLY
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NAME
FIRM NAME (II Applicable)
TElEPHONE NUMBER
717-697-7050
(8)
374,942.77
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
(1)
(2)
(3)
(4)
(5)
26,014.66
29,615.62
319,312.49
(11)
(12)
(13)
21,023.82
353,918.95
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4. Mortgages & Notes Recei....able (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
g. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule f)
11, Total Deductions (total Lines 9 & 10)
(9)
(10)
14,505.19
6,518.63
(14)
15,926.35
15,926.35
(6)
(7)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE fOR APPLICABLE RATES
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15. Amount of line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
x.O_ (15)
x .D45- (16)
x .12 (17)
x .15 (18)
(19)
16. Amount of line 14 taxable at lineal rale
353,918.95
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Complete Address:
STREET ADDRESS
Messiah Villa e
GITY
STATE
PA
Mechlmicsbur
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
15,926.35
15,110.00
795.24
Total Credits (A + 8 + C ) (2)
15,905.24
3. InteresVPenal1y if applicable
D. Interest
E. Penalty
TotallnteresVPenalty ( D + E ) (3)
4. If Line 2 is 9reater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 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)
A. Enter the interest on the tax due.
(SA)
8. Enter the total of Line 5 + 5A. This is the 8ALANCE DUE.
21.11
(58)
Make Check Payable to: REGISTER OF WILLS, AGENT
IllIlt.r..IIl____.-_r~- IIIElIlur- w_-.- .-.~~.i_.l:c,JI!!l ~_
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred;....
b. retain the right to designate who shall use the property transferred or its income; .... .
c. retain a reversionary interest; or... ....................
d. receive the promise for life of either payments, benefits or care?.. ..
2. If death occurred after December 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? ................
No
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G ANO FILE IT AS PART OF THE RETURN.
Yes
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R. Mira lia
DATE
7/23/01
Under penalties of perjury, r declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct
ar"ld complete.
Declaration of preparer other than the personal represer"ltative is based Or"l all informatior"l of which preparerhas ar"lY knowledge
Road, Camp Hill, PA 17011
REPRESENTATIVE
Andrew C. Shee
DATE
7/23/01
ADDRESS
127 South Market Street, P.O. Box 95, Mechanicsburg, PA 17055
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For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
172 P.S. S9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. S9116 (a) (1.1) (i1)].
The statute does not exemDI 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 twenty-one 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% [72 P.S. s9116(a)(1.2)].
The tax rate imposed on Ihe net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. S9116(1.2) [72 P.S. s9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. s9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has al least one parent in common with the decedent, whether by blood or adoption.
. ISABELLE C BATES 127
MARTHA MIRAGLIA
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REV-15~7 EX+ (1-97) '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
ESTATE OF
ISABELLE C. BATES
FILE NUMBER
21-01-0042
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
,.
NOTES RECEIV ABLE: LOAN TO MARTHA MIRAGLIA AND
CHARLES J. MIRAGLIA
PRINCIPAL DUE AT DATE OF DEATH
$26,014.66
TOTAL (Also enter on line 4, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
$26,014.66
AMORTIZATION SUMMARY
JUN 3, 1993
denison
Original loan amount
$60,000.00
Interest Rate
6.000%
P & I payment
$599.93
Total Interest
$23,389.72
Payments
138 @
1 @
$599.93
$599.38
First payment
Sun AUG 1, 1993
last payment
Tue FER 1, 2005
JUN 3, ~'993 AMORT! ZA T! ON SCHEDULE PAGE
PMT INTEREST PRINCIPAL ADDITIONAL REMAINING
# DATE PAYMENT PAYMENT PAYMENT BALANCE
1 AUG 1 300.00 Z99.93 0.00 59,700.07
2 SEP 1 298.50 301.43 0.00 59,398.64
3 OCT , 296.99 302.94 0.00 59,095.70
4 NOV 1 295.48 304.45 0.00 58,791.25
5 OEC 1 293.96 305.97 0.00 58,485.28
1993 1,484.93 1,514.72 0.00
6 JAN 1 292.43 307.50 0.00 58,177.78
7 FEB 1 290.89 309.04 0.00 57,868.74
8 MAR 1 289.34 310.59 0.00 57,558.15
9 APR 1 287.79 312.14 0.00 57,246.01
10 MAY 1 286.23 313.70 0.00 56,932.31
11 JUN 1 284.66 315.27 0.00 56,617.04
12 JUL 1 283.09 316.84 0.00 56,300.20
13 AUG 1 281.50 318.43 0.00 55,981.77
14 SEP 1 279.91 320.02 0.00 55,661. 75
15 OCT 1 278.31 321.62 0.00 55,340.13
16 NOV 1 276.70 323.23 0.00 55,016.90
17 OEC 1 275.08 324.85 0.00 54,692.05
1994 3,405.93 3,793.23 0.00
18 JAN 1 273.46 326.47 0.00 54,365.58
19 FEB 1 271.83 328.10 0.00 54,037.48
20 MAR 1 270.19 329.74 0.00 53,707.74
21 APR 1 268.54 331.39 0.00 53,376.35
22 MAY 1 266.88 333.05 0.00 53,043.30
23 JUN 1 265.22 334.71 0.00 52,708.59
24 JUL 1 263.54 336.39 0.00 52,3n.20
25 AUG 1 261.86 338.07 0.00 52,034.13
26 SEP 1 260.17 339.76 0.00 51,694.37
27 OCT 1 258.47 341. 46 0.00 51,352.91
28 NOV 1 256.76 343.17 0.00 51,009.74
29 OEC 1 255.05 344.88 0.00 50,664.86
1995 3,171.97 4,027.19 0.00
30 JAN 1 253.32 346.61 0.00 50,318.25
31 FEB 1 251.59 348.34 0.00 49,969.91
32 MAR 1 249.85 350.08 0.00 49,619.83
33 APR 1 248.10 351.83 0.00 49,268.00
34 MAY 1 246.34 353.59 0.00 48,914.41
35 JUN 1 244.57 355.36 0.00 48,559.05
36 JUL 1 242.80 357.13 0.00 48,201.92
37 AUG 1 241.01 358.92 0.00 47,843.00
38 SEP 1 239.22 360.71 0.00 47,482.29
39 OCT 1 237.41 362.52 0.00 47,119.77
40 NOV 1 235.60 364.33 0.00 46,755.44
41 OEC 1 233.78 366.15 0.00 46,389.29
1996 2.<-923.59 4,275.57 0.00
JUN 3, 4993 AMORT! ZA T I ON SCHEDULE PAGE 2
PMT INTEREST PRINCIPAL ADDITIONAL REMAINING
# DATE PAYMENT PAYMENT PAYMENT 8ALANCE
42 JAN , 231.95 367.98 0.00 46,021.31
43 FE8 1 230.11 369.82 0.00 45,651.49
44 MAR 1 228.26 371.67 0.00 45,279.82
45 APR 1 226.40 373.53 0.00 44,906.29
46 MAY 1 224.53 375.40 0.00 44,530.89
47 JUN 1 222.65 377.28 0.00 44,153.61
48 JUL 1 220.77 379.16 0.00 43,774.45
49 AUG 1 218.87 381.06 0.00 43,393.39
50 SEP 1 216.97 382.96 0.00 43,010.43
51 OCT 1 215.05 384.88 0.00 42,625.55
52 NOV 1 213.13 386.80 0.00 42,238.75
53 DEC 1 211.19 388.74 0.00 41,850.01
1997 2.659.88 4,539.28 0.00
54 JAN 1 209.25 390.68 0.00 41,459.33
55 FE8 1 207.30 392.63 0.00 41,066.70
56 MAR 1 205.33 394.60 0.00 40,672.10
57 APR 1 203.36 396.57 0.00 40,275.53
58 MAY 1 201.38 398.55 0.00 39,876.98
59 JUN 1 199.38 400.55 0.00 39,476.43
60 JUL , 197.38 402.55 0.00 39,073.88
61 AUG 1 195.37 404.56 0.00 38,669.32
62 SEP , 193.35 406.58 0.00 38,262.74
63 OCT 1 191.31 408.62 0.00 37,854.12
64 NOV 1 189.27 410.66 0.00 37,443.46
65 DEC , 187.22 412.71 0.00 37,030.75
1998 2,379.90 4,819.26 0.00
66 JAN 1 185.15 414.78 0.00 36,615.97
67 FEB , 183.08 416.85 0.00 36,199.12
68 MAR , 181.00 418.93 0.00 35,780.19
69 APR 1 178.90 421.03 0.00 35,359.16
70 MAY 1 176.80 423.13 0.00 34,936.03
71 JUN , 174.68 425.25 0.00 34,510.78
72 JUL 1 172.55 427.38 0.00 34,083.40
73 AUG 1 170.42 429.51 0.00 33,653.89
74 SEP 1 168.27 431.66 0.00 33,222.23
75 OCT 1 166.11 433.82 0.00 32,788.41
76 NOV 1 163.94 435.99 0.00 32,352.42
77 DEC 1 161.76 438.17 0.00 31,914.25
1999 2,082.66 5,116.50 0.00
-
78 JAN 1 159.57 440.36 0.00 31,473.89
79 FEB 1 157.37 442.56 0.00 31,031.33
80 MAR , 155.16 444.77 0.00 30,586.56
81 APR 1 152.93 447.00 0.00 30,139.56
82 MAY 1 150.70 449.23 0.00 29,690.33
83 JUN 1 148.45 451.48 0.00 29,238.85
84 JUL 1 146.19 453.74 0.00 28,785.11
85 AUG 1 143.93 456.00 0.00 28,329.11
86 SEP 1 141.65 458.28 0.00 27,870.83
87 OCT 1 139.35 460.58 0.00 27,410.25
88 NOV 1 137.05 462.88 0.00 26,947.37
89 DEC 1 134.74 465.19 0.00 26,482.18
2000 1,767.09 5,432.07 0.00
JUN 3, ,993 AMORTIZATION SCHEDULE PAGE 3
PMT INTEREST PRINCIPAL ADDITIONAL REMAINING
# DATE PAYMENT PAYMENT PAYMENT BAlANCE
90 JAN 1 132.41 467.52 0.00 26,014.66
91 FEB 1 130.07 469.86 0.00 25,544.80
92 MAR 1 127.72 472.21 0.00 25,072.59
93 APR 1 125.36 474.57 0.00 24,598.02
94 MAY 1 122.99 476.94 0.00 24,121.08
95 JUN 1 120.61 479.32 0.00 23,641. 76
96 JUL 1 118.21 481. 72 0.00 23,160.04
97 AUG 1 115.80 484.13 0.00 22,675.91
98 SEP 1 113.38 486.55 0.00 22,189.36
99 OCT 1 110.95 488.98 0.00 21,700.38
100 NOV 1 108.50 491.43 0.00 21,208.95
101 DEC 1 106.04 493.89 0.00 20,715.06
2001 1,432.04 5,767.12 0.00
102 JAN 1 103.58 496.35 0.00 20,218.71
103 FEB 1 101.09 498.84 0.00 19,719.87
104 MAR 1 98.60 501.33 0.00 19,218.54
105 APR 1 96.09 503.84 0.00 18,714.70
106 MAY 1 93.57 506.36 0.00 18,208.34
107 JUN 1 91.04 508.89 0.00 17,699.45
108 JUL 1 88.50 . 511.43 0.00 17,188.02
109 AUG 1 85.94 513.99 0.00 16,674.03
110 SEP 1 83.37 516.56 0.00 16,157.47
111 OCT 1 80.79 519.14 0.00 15,638.33
112 NOV 1 78.19 521.74 0.00 15,116.59
113 DEC 1 75.58 524.35 0.00 14,592.24
2002 1,076.34 6,122.82 0.00
114 JAN 1 72.96 526.97 0.00 14,065.27
115 FEB 1 70.33 529.60 0.00 13,535.67
116 MAR 1 67.68 532.25 0.00 13,003.42
117 APR 1 65.02 534.91 0.00 12,468.51
1\8 MAY 1 62.34 537.59 0.00 11,930.92
119 JUN 1 59.65 540.28 0.00 11,390.64
120 JUL 1 56.95 542.98 0.00 10,847.66
121 AUG 1 54.24 545.69 0.00 10,301.97
122 SEP 1 51.51 548.42 0.00 9,753.55
123 OCT 1 48.77 551.16 0.00 9,202.39
124 NOV 1 46.01 553.92 0.00 8,648.47
125 OEC 1 43.24 556.69 0.00 8,091. 78
2003 698.70 6,500.46 0.00
126 JAN 1 40.46 559.47 0.00 7,532.31
127 FEB 1 37.66 562.27 0.00 1>,970.04
128 MAR 1 34.85 565.08 0.00 1>,404.96
129 APR 1 32.02 567.91 0.00 5,837.05
130 MAY 1 29.19 570.74 0.00 5,266.31
131 JUN 1 26.33 573.60 0.00 4,692.71
132 JUL 1 23.46 576.47 0.00 4,116.24
133 AUG 1 20.58 579.35 0.00 3,536.89
134 SEP 1 17.68 582.25 0.00 2,954.64
135 OCT 1 14.77 585.16 0.00 2,369.48
136 NOV 1 11.85 588.08 0.00 1,781.40
137 DEC 1 8.91 591.02 0.00 1,190.38
2004 297.76 6,901.40 0.00
JUN 3, ]993 AMORTIZATION SCHEDULE PAGE 4
P~T INTEREST PRINCIPAL ADDITIONAL REMAINING
# DATE PAYMENT PAYMENT PAYMENT BALANCE
138 JAN , 5.95 593.9B 0.00 596.40
139 FEB 1 2.98 596.40 0.00 0.00
2005 8.93 1,190.38 0.00
,REV.'",,,",'.9"W
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ISABELLE C. BATES
FILE NUMBER
21-01-0042
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointry.owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
2.
3.
4.
5.
DESCRIPTION
VERIZON REFUND
PERSONAL PROPERTY AT MESSIAH VILLAGE
ADULT CARE PER BRICKER APPRAISAL
VALUE AT DATE
OF DEATH
$ 8.81
$ 395.00
EVERm CASH MUTUAL INSURANCE CO. REFUND
$ 18.00
RESIDUARY SHARE OF THE ESTATE OF VIRGINIA C. MURRAY
<DATE OF DEATH 8/8/00)
$ 9,851.81
MEMBERS FIRST FEDERAL CREDIT UNION
SAVINGS ACCOUNT NUMBER
DATE ACCOUNT OPENED
PRINCIPAL BALANCE AT DATE OF DEATH
ACCRUED INTEREST
DATE OF DEATH VALUE
6.
MEMBERS FIRST FEDERAL CREDIT UNION
ACCOUNT NUMBER
DATE CERTIFICATE PURCHASED
PRINCIPAL BALANCE AT DATE OF DEATH
ACCRUED INTEREST
DATE OF DEATH VALUE
129186-00
10/13/1992
$849.13
1.40
$ 850.53
CD
129186-46
4/7/1998
$18,427.36
61.92
$18,489.28
$
2.19
7.
QUANTUM IMAGING REFUND
ACCOUNT #329730
TOTAL (Also enter on line 5, Recapitulation) $29,615.62
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APPRAISAL
Personal Property of ISAf5t!LLr c, 8/}Tt'"S c:5T4'TE
Appraised by Chuck E. Bricker AU094.L Date a.., - S - 0
ITEM VALUE ITEM VALUE
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WILL
OF
VIRGINIA C. MURRAY
I, VIRGINIA C. MURRAY, of 102 South Potomac Street, Waynesboro,
Franklin County, Pennsylvania, being of sound and disposing mind, memory and
understanding, revoke any prior wills and codicils and declare this to be my wilL
ITEM I. EXPENSES AND TAXES. I direct that as soon as may be
convenient after my decease there be paid from my estate all of my just debts,
expenses incident to my illness, my funeral expenses and, from the principal of the
residue of my estate, all of my state and federal inheritance and estate taxes.
ITEM II. SPECIFIC BEQUESTS. I give all of the tangible personal
property contents of my residence room at Hearthstone in Waynesboro, P A, to such
of my sisters who survive me, to be divided among them as they shall determine.
My living sisters are Elizabeth C. Bitner, Isabelle C. Bates, and Louisa C.
Decker.
ITEM III. RESIDUARY DISPOSITION. All the rest and residue of my
estate I give, devise and bequeath in equal shares to my sisters, Elizabeth C.
Bitner, Isabelle C. Bates and Louisa C. Decker, or their lineal issue per stirpes. In
'~1f?~ C. h.vVt1-tkj
: VirginIa C. Murray - C
the event any of said beneficiaries shall predecease me without leaving issue to
survive, the share of such beneficiary shall be distributed ratably among the other
beneficiaries.
ITEM IV. DESIGNATION OF FIDUCIARY. I appoint Financial Trust
Services Company, Waynesboro, PA, Personal Representative of this my last will
and testament.
ITEM V. NO BOND. I direct that no fiduciary appointed hereunder shall
be required to post bond in this or any other jurisdiction.
IN WITNESS WHEREOF, I, VIRGINIA C. MURRAY, the Testatrix,
hereby execute on d:JciUb-eY<. L, 1997, this my will, typewritten upon two (2)
sheets of paper.
~;;;f~"AL- e, 1-t.-vvu-t'f:fjl~)
v: 'nia C. Murray r
In our presence VIRGINIA C. MURRAY signed this and declared it to be
her will and now at her request, in her presence and in the presence of each other,
we sign as witnesses.
~~~"POQ
----
~-~ /;iz1J
- 2 -
VIRGINIA C. MURRAV ESTATE 108
I MARTHA R. MIRAGLIA EXEC.
.~ SUSAN BOTTINI EXEC. Date Aplf.II. zr; ),oaJ 60-2951::;
~ 1PBrt::fT.,n\-~n~. c. gt>fes FrTq-feJ I $~85J.'?{
! NiMlhclA..C(l,wl. 8~,",-r +/unberl r;tt~':t,e ~Y\J X-Dollars m::=:
I K~sto!1e~'
I ~~~~:3' /)J,ztu:-d&v K ~
For eM _i').,:.~~ coe.'r1~;l, * * "0" "-!nlll.lR~~PlRJ.!ZL.;eI}~:If;;':';Jr47i/v-e-M
,:03*302'i551: C C1::J U.oB"
Metnbersl."
FEDERAL CREDIT UNION
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Opened
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
25209 -00
09/15/1980
$3,461.29
$5.69
$3,466.98
Martha R. Miraglia
CERTIFICATES OF DEPOSIT:
Account Number/Suffix
Date Certificate Purchased
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Maturity Date
Name of Joint Owner
25209 -63 18 MO
03/2212000
$20,000.00
$72.61
$10,072.61
09/2012001
Martha R. Miraglia
CERTIFICATES OF DEPOSIT:
Account Number/Suffix
Date Certificate Purchased
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Maturity Date
Name of Joint Owner
25209 -64 2 YR
11/1312000
$53,159.47
$204.77
$53,364.24
11/1312002
Martha R. Miraglia
tNSURANCE DEPARTMENT
5000 LOUISE DRIVE
P. O. BOX 40
MECHANICSBURG, PA 17055
1 -&00..2&3-232& or (7\7) 697-\\61
129186-00
10/13/1992
$849,13
$1.40
$850.53
None
129186 --46 18 MO
0410711998
$18,427,36
$61.92
$18,489.28
04/051200 I
None
February 13, 2001
Estate of: ISABELLE C. GATES
Date of Death: 12/22/2000
Social Security Number: 177-16-0774
REV.'''EX:I'." '*
COMMONWEALTH OF PENNSYLVANIA
\NHERltANCE TAX RETURN -
RESIDENT DECEDENT
SCHEDULE F
JOINTL Y~OWNED PROPERTY
ESTATE OF
ISABELLE C. BATES
FILE NUMBE~ 1-01-0042
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
. . OH
A.
Martha R. Miraglia
64 Old Federal Road
Camp Hill, PA
Daughter
17011
s.
c
JOINTL y-oWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %0' DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank a:::count number or similar identifying number, Attach DATEQFDEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed forjointly-hald reafestate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. /29/82 Mellon Bank
162-132-4456
Date of Death Balance $ 4,275.25
Accrued Interest $ 1.04
Date of Death Value $ 4,276.29 50% $ 2,138.15
Isabelle C. Bates/Martha R. Miraglia, Jt. Ten.
2. A. . 2/07/00 Mellon Bank
00977862
Date of Death Balance $ 13,000.00
Accrued Interest $ 31.17
Date of Death Value $ 13,031.17 50% $ 6,515.59
Isabelle C. Bates/Martha R. Miraglia, n. Ten.
3. A. Y25/99 Fulton Bank CD
223-0062935
Date of Death Balance $ 32,943.59
Accrued Interest $ 151.42
Date of Death Value $ 33,095.01 . 50% $16,547.51
Isabelle C. Bates/Martha R. Miraglia, Jt. Ten.
4. A. 9/11/00 Fulton Bank CD
328-0114992
Date of Death Balance $65,000.00
Accrued Interest $ 1,222.81
Date of Death Value $66,222.81 50% ~33, 111.41
Isabelle C. Bates/Martha R. Miraglia, Jt. Ten.
TOTAL (Also enter on line 6, Recapitulation) $ CONTINUED
-
(If more space is needed, insert additional sheets of the same size)
M ExDlanation: This account was opened with
joint funds owned by decedent and Martha R.
Miraglia, fUnds derived from Mellon Bank
certificate of deposit, Account Number
00876624 in the amount of $40,000.00
which matured on September 3, 2000
and funds derived from a PNC Bank
certificate of deposit, Account Number
31800060934, in the amount of $25,000.00
which matured on September 3,2000.
The Fulton Bank CD originated from previous
Joint fUnds from the accounts listed above.
5. A. 9/09/99 Waypoint Bank CD
1800012945
Date of Death Balance $ 99,659.60
Accrued Interest $ 2,847.49
Date of Death Value $102,507.09 50% $51,253.55
Isabelle C. Bates/Martha R. Miraglia, Jt. Ten.
6. A. 1103/95 Waypoint Bank CD
8000008683
Date of Death Balance $ 30,000.00
Accrued Interest $ 11 0,68
Date of Death Value $ 30,110.68 50% $15,055.34
Isabelle C. Bates/Martha R. Miraglia, Jt. Ten.
7. A 1104/95 Waypoint Bank CD
8000008686
Date of Death Balance $ 10,000.00
Accrued Interest $ 36.89
Date of Death Value $ 10,036.89 50% $ 5,018.45
Isabelle C. Bates/Martha R. Miraglia, Jt. Ten.
8. A. 1118/95 Waypoint Bank CD
8000009946
Date ofDeath Balance $ 20,000.00
Accrued Interest $ 73.79
Date of Death Value $ 20,073.79 50% $10,036.90
Isabelle C. Bates/Martha R. Miraglia, Jt. Ten.
9. A. 5/04/96 Waypoint Bank CD
8000019286
Date of Death Balance $ 16,175.31
Accrued Interest $ 44.46
Date of Death Value $ 16,219.77 50% $ 8,109.89
Isabelle C. Bates/Martha R. Miraglia, Jt. Ten.
10. A.
6/27/00
11. A.
10/10/96
12. A.
6/27/00
PNC Bank
31900191075
Date of Death Balance
Accrued Interest
Date of Death Value
Isabelle C. Bates/Martha R. Miraglia, Jt. Ten.
to Exolanatlon: This account was opened with
joint funds owned by decedent and Martha R.
Miraglia, funds derived 1i'om PNC Bank
checking account. See PNC Bank statement attached.
PNC Bank
5000000951
Date of Death Balance
No Accrued Interest
Date of Death Value
Isabelle C. Bates/Martha R. Miraglia, Jt. Ten.
PNC Bank Money Market Account
5080032071
Date of Death Balance
Accrued Interest
Date of Death Value
Isabelle C. Bates/Martha R. Miraglia, Jt. Ten.
$ 15,000.00
$ 78.03
$ 15,078.03 50% $ 7,539.02
$ 516.34
$ 0.00
$ 516.34
50% $258.17
$ 55,587.48
$ 109.30
$ 55,696.78
50% $27,848.39
.. Exolanation: This account was opened with
joint funds owned by decedent and Martha R.
Miraglia, funds derived from PNC Bank
cheCking account. See PNC Bank statement attached.
13. A. 5/05/99 Allfirst Bank CD
80000002174170
Date of DeatllBalance $32,289.16
Accrued Interest $ 221.52
Date olOeatll Value $32,510.68 50% $16,255.34
Isabelle C. Bates/Martha R. Miraglia, Jt. Ten.
14. A. 9/09/99 Allfirst Bank CD
8000ooo2174254
Date of Death Balance $26,812.67
Accrued Interest $ 70.30
Date of Death Value $26,882.97 50% $13,441.49
Isabelle C. Bates/Martha R. Miraglia, Jt. Ten.
CONTINUED
15. A. 8/14/00 AIlfirst Bank CD
8000ooo2114554
Date of Death Balance $45,000.00
Accrued Interest $ 100.90
Date of Death Value $45,100.90 50% $22,550.45
Isabelle C. Bates/Martha R. Miraglia, Jt. Ten.
.. Exolanation: This account was opened with
joint funds owned by decedent and Martha R.
Miraglia, fUnds derived fi"Om PNC Bank
certificate of deposit, Account Number
31000167818 in the amount of $35,000.00
which matured on August 2, 2000
and funds derived from a York Federal
certificate of deposit, Account Number
105549, in the amount of $10,000.00
which matured on August 10,2000.
The A1IFirst CD originated fi"Om
joint funds from the accounts listed above,
created more than one year from December
22, 2000.
16. A. 9/15/80 Members First Federal Credit Union
Savings Account #25209-00
Date ofDeath Balance $3,461.29
Accrued Interest $ 5.69
Date of Death Value $3,466.98 50% $1,733.49
Isabelle C. Bates/Martha R. Miraglia, Jt. Ten.
17. A. 3122100 Members First Federal Credit Union CD
25209-63 18 month
Date of Death Balance $20,000.00
Accrued Interest $ 72.61
Date ofDeath Value $20,072.61 50% $10,036.31
Isabelle C. Bates/Martha R. Miraglia, Jt. Ten.
.. Exolanation: This account was opened with
joint funds owned by decedent and Martha R.
Miraglia, funds derived fi"Om Members 1st
certificate of deposit, Account Number
25209-53 In the amount of $1 0,000.00
which matured on March 18, 2000
and funds derived from a Members 1st
certificate of deposit, Account Number
25208-61 rollover account, in the amount
of$10,000.OOwhich matured on March 19,
2000. The Members 1st CD originated from
Joint funds from the accounts listed above, all
of which were created prior to December
22, 1GGG. CONTINUED
18. A.
11/13/00
Members First Federal Credit Union CD - Add on Certificate
25209-64 24 month
Date of Death Balance
Accrued Interest
Date of Death Value
Isabelle C. Bates/Martha R. Miraglia, Jt. Ten.
$53,159.47
$ 204.77
$53,364.24
50% $26,682.12
.. ExDlanation: This account was opened with
joint funds owned by decedent and Martha R.
Miraglia, funds derived from Members 1st
certificate of deposit, Account Number
25209-562 in the amount of $45,000.00
which matured on November 3,2000
and funds derived from a Members 1st
Account Number 25209-60 rollover account,
in the amount of $10,000.00 which matured
on December 6,2000, and an amount of $158.30
which was a transfer from a Members First Account.
The Members 1st CD originated from
Joint funds from the accounts listed above, all of
which were created prior December 22, 1999.
Iii Low AVQ.
19. A.
Waypoint(230shares) 10.31 10.00 10.160
Cusip 94675610 3
Isabelle C. Bates/Martha R. Miraglia, Jt. Ten.
$2,336.80
50% $1,168.40
ExDlanation: Decedent and Martha J. Miraglia
were joint owners of Harris Savings Bank
stock when Harris Savings Bank merged
with Waypoint. The 230 shares constitute the
aggregate number of shares from Harris Savings
Bank Certificate HFI63, issued November 18, 1997
and Harris Saving Bank Certificate 472 issued
January 25, 1994.
20. A.
NorthropGrumman 75.63 74.00 74.820 $26,935.20 50% $13,467.60
360 shares/ Cusip 666807 10 2
Isabelle C. Bates/Martha R. Miraglia, Jt. Ten.
Issue Date: November 5, 1980, November 27, 1980 and October 16, 1984.
CONTINUED
21. A.
22. A.
McKesson (200 shares) 33.66 32.90 33.280 $ 6,656.00
Cuslp581557105
Isabelle C. Bates/Martha R. Miraglia. Jt. Ten.
Issue Date: october 1, 1986, November 13, 19BO,Januilrf7, 1998
The st. Paul Companies 52.38 51.69 52.040
1046 shares/Cuslp 792860 10
Isabelle C. Bates/Martha R. Miraglia, Jt. Ten.
Issue Date: May 29, 1998
$54,433.84
50% $ 3,328.00
50% $27,216.92
$319,312.49
@ Mellon Bank
Wednesday, January 10,2001
Account
Number Account Title
Isabelle C Bates
Martha R Miraglia
162-132-4456
Date Opened: 04/29/1982
Principal Sal Int from Last
as of 000 Posting to 000
$4,275.25 $1.04
Date Opened: 12/07/1999
Principal Sal Int from Last
as of 000 Posting to 000
$13,000.00 $31.17
00977862
Isabelle C Bates Or
Martha R Miraglia
Account Type: DO
Account Sal YTD Int to
as of 000 000
$4,276.29 $71.89
Account Type: TO
Account Sal YTD Int to
as of 000 ODD
$13,031.17 $761.46
\
Page 2 of 2
F\J.lton Bank
P.O. BOX 4887 . LANCASTER, PA 17604
People dedicated to your success. ~
(717)291-2589
WWW.FULTONBANK.COM
]-800-FULTON-4
January 5, 2001
Andrew C. Sheely
127 South Market St.
Mechanicsburg, P A 17055
Dear Mr. Sheely:
RE: Isabelle C. Bates, deceased
December 22, 2000
In response to your recent inquiry concerning the accounts maintained in the name of
the decedent, please be advised that the following accounts were open at the date of death:
CD #223-0062935, open 2/25/99, matures 8/25/01, balance
$32,943.59 and accmed interest $151.42; paying 6.2%, joint
with Martha R. Miraglia.
CD #328-0114992, open 9/11/00, matures 3/11/02, balance
$65,000 and accmed interest $1,222.81; paying 6.67%, joint
Martha R. Miraglia.
If you have any further questions, please do not hesitate to contact me,
G:~'~~
Christine Putt Smith
Credit Confirmation Processor
CON Fi OENTLL\L
. 1,... .,.qnr n: \~ ' "'~;.'~ , ~,.
IS Information is furrliel",' c'.' " 10,. ",:: "
.- ;'"~,,." " :~" ,:.; ~,' \' '", ,,".. ,. - . ,I \
"f1swerto YOll' :,-".0\, , . ..." "I' i'.
a . . ,,' " ", ~( 1.'11 .,-h;" '\lil (l,1 I ,c. ,..~ .
) re;;p, onsibill\Y \: ",,:ur""d:J U,. 'l'b~:le"i.HO'ciWnn(' Vlii.hout
. ! . ,:.. ':'l"'r\r{~{'Se' IS S1.. .'.....t l,' ::' '
iv ootnlOn nCl(;iP \:.;\!~ ,..,"),
"J\
1'" WaYRoint
BANK
LOOK FOR US. WEU GET YOU THERE.
JANUARY 8, 200 I
ANDREW C SHEELY
126 S MARKET ST
MECHANICSBURG P A 17055
The information which you requested on the ISABELLE C BATES DECEASED
(Social Security Number 177-16-0774) is as follows.
Account Number(s) 1800012945 8000008683 &000008bKIo
Class of AccOlll1t CERTIFICATE CERTIFICATE CERTIFICATE
Date Opened 090999 010395 010495
Principal Balance 99659.60 30000.00 10000.00
Accrued Interest 2847.49 110.68 36.89
Balance at Date of Death 102507.09 30110.68 10036.89
Account Ownership JTO JTO JTO
Name of Joint Owner, if any MARTHA MIRAbl.Jt:\ MARTHA MIRAGUfiMARTHA MIRAGJ..IR
Date Ownership Was Established 090999 010395 010495
Additional Information Requested PLEASE COMPLETE W-9
PO. Box 1711. HARRISB!J~r, PI=NNl::;V!\"."IIA .7lne ''''711
V1Way~qint
LOOK FOR US. WE'LL GET YOU THERE.
Account N wnber( s)
Accrued Interest
8000009946 8000019286
CERTIFICATE CERTIFICATE
011895 050496
20000.00 16175.31
73.79 44.46
20073. 79 16219.77
JTO JTO
Class of Account
Date Opened
Principal Balance
Balance at Date of Death
Account Ownership
Name of Joint Owner, if any
MARTHA M1RA&LlI\ MARTHA MIRAGLIA
Date Ownership Was Established 011895
050496
Additional Information Requested PLEASE COMPLETE W-9
Sirrerely,
Halo/I. rt1
KathyL.i:.rg
::enicr f'eJ:vices Rep.
P.O. Box 1711. HARRISBURG. PENNSYLVANIA /7/05-1711
Toll FrEE 1-866-WAYPOINT (1-866-929-7646) . www.waypointbank.com
JA~j-2S-20dl is: 18
P.01/1212
~PNCBAN<
Decedent Reportine
Firstside Center
P7.PFSC-4-F
500 First Avenue
Pittllburgh, P A 15219-3128
/SCP
January 29,2001
Andrew C. Sheely
127 South Market Street
P.O. Box 95
M~hanicsburg, PAl 7055
RE: Estate of Isabelle C. Bates, Deceased
SSN: 177-16-0774
000: 12/22/2000
Dear Mr. Sheely:
Plea:le find the date of death balances you h,~ve req:lcsted listed below.
C'ERTIFICA TE OF DEPOSIT
#31900191075 Established 005/27/2000
ISABELLE C BATE;
MARTHA. R MIRAGUA
DOD Balance: $15,000.00 + $78.03 a~'(:1'\led int\:rnt
CBII:CKlNG ACCOUNT
#50000009S1 EstablishedlO/J 0/1996
ISABELLE C BATE:; OR
MARTHA R MIRAGLIA
DOD Balance: $516.34 + $0 00 ae<:ru<<1 intE:rest
Page I oi2
A mt!mbc:r uf 'l'h~ ~C fin.nci,r Servi~5 GI'(jUP
PN(: 8<ll1k N.A. PittSburgh P~nn~wrvunjG 5265
" ' -, ,.. ;jl ,
PNCBANK
Total' Banking Statement
PNC Bank
Primary account nllmber: 50-0000+0951
Page 1 of 2
M
f... the period O1ll21f2000 to 07f20f2000
Number of enclosures: 0
ISABELLE C BATES OR
MARTHA R MIRAGLIA
233 MESSIAH VLG
PO BOX 2015
MECHANICSBURG PA 17055-2015
l
...::;. .
Relationship Overview
Bank Deposit Accounts
Description
Interest Checking
Certificate-(s) Of Deposit.
Total Deposits
11' For 24-hour customer service or
current rates: Call1+888-PNC.BANK
~ Write to: Customer Service
PO Box 609
Pittsburgh PI'. 15230-9738
Q Visit us at www.pncbank.com
Ii1 TDDterminal: 1-800-531-1648
For hearing impaired elienls only
-
Account Number
Deposit Balance
2,690.40
134,280.32
136,970.72
50-0000-0951
Total of 5
Could you use some extra cash? Tell us your story.
-D1C roof is leaking. So is the bathtuh_ Your credit c.ards are at their limit. It mar be time for a Home Equity Line of Credit from
PNC Bank. Come in and teU us your story today, and we'll help you decide what type of loan is best for you. TI1en you c,'\n just
write a check to the repairman, the plumber. the home improvement store. Only you know it's a loan. and you only pay interest.
on th~. amount that you borrow. Best of an, the interest n1ay be tax d{~ductible (consult your tax advisor). Stop in to ten us your
story or apply by calling 1-888-PNC-BANK or by ,isiting us on the web at www.pncbank.com.
Isabelle C Bates Or
Martha R Miraglia
Premium Plan
Interest Checking Account Summary
Account number: 50-0000+0951 Account Link ~ number: 0177160774
Balance Summary
Please see the Activity Detail section for
addittonal information.
Beginning
balance
32,440.31
3
DepOSits and Checks and other Ending
other additions deductions balance
8.09 29,758.00 2,690.40
Average monthly Charges
balance and fees
11,012.91 .00
Bank card/POS Account Information Teller
tr;1nsactions assistance calls transactions
0 0 0
PNC Bank MAC other MAC A TM other ATM
ATM transactions transactions transactions
0 0 0
Number of days Awrage collected Interest Earned
In interest period balance for APYE this period
30 11,012.91 8.09
As of 07/20, a total of $37.09 in interest was
earned this year.
Transaction Summary
Checks paid/
withdrawals
Total ATM
transactfons
Interest Summary
Annual Percentage
Yield Earned (APVE)
0.90"/.
o
.Total Banking Statement
PNCBANK
Al..-count number: 50MOOOO-0951 ~ continued
For tho poriod 0612112000 to 0712012000
ISABELLE C BAfES OR
Primary account number: 50~OOOO-0951
Page 2 of 2
tt For 24~"our customer service:
Call: '-888-PNC-BANK
Activity Detail
Deposits and Other Add"dions
Date
07/20
Amount Description
B.09 lntel:esl Ilayment
There was 1 Deposit or Other Addition
totaling $8.09.
Check.
Check
number
:J05
306
Amount
4,750.00
25,000.00
Date
paid
07/12
06/27
Reference
number
Check
number
:J07
Amount
8.00
Date
paid
07/11
Reference
number
022374532
027510181
022120490
* Gap in check sequence
There were 3 checks listed totaling
$29,758.00.
Daily Balance Detail
rl:!tl"
B;)'anc~
32,440.31
7,440.31
Di'lte
07/ II
07/12
8alance
7,432.3\
2,682.31
Oat~
07/20
Balfll'1~e
2,690.40
06/21
06/27
Leave Your Checkbook At Home
.lust carry yonr PNC Bank Check Card and you won't need cash or checks. It's the easiest way to pay for everything. . . groceries.
clothing, books, event tickets and more. TIlere's no hassle. No cash to carry, no check to write, or check-;tpproval wait. Just
present your PNC Bank Check Card, sign the receipt and you're ready to go, with the amount of your purchase deducted right
from your checking account. . . jnst like a check.
Certificates of Deposit
Isabelle C Batos
Martha R MirClglia
Investment Description Maturity date Interest Origln<1lor Current
number rate renewal value value
31000167848" 9 Mouth(s) Fi.~ed Rate 08/02/2000 5.66 % 35,066.00 35,158.22
31800060934. 17 Mnnth(s) fixed Rale 09/10/2000 4.90% 25,000.00 25,030.09
31000]56567 " 17 Mnnlh(s) fixed lUlle 11/17/2000 5.J.l% 35,00000 37,013.97
31900193334 ,/ 4 Month(s) Fi.~ed Rate 11/17/2000 7.7.( % 22,000 00 22,013.95
3190tl191075 13 Monlh(s) Fixed Rale 07/27/2001 6.80% 15,000,00 15,064.09
Total current value 134,280.32
JA'<-29-202l1 15: 18
P. 02/1212
~PNCBAN<
SAVINGS ACCOUNT
#S08OO32071 Established 06/27/2000
ISABELLE C BATES
MARTHA M;:R.o\GlIA
DOD Balance: $55,587.48 + $109.30 accmed intuest
SAFE DEPOSIT BOX #137
Located:
Messiah Vilkge Uralch
VILLAGE COMMONS. 100 MT. ALLE'< DRIVE
MECHANICSBlJRG PA 17055
717-691-4090
OUI' office only provides dale of deatl~ balances for IRA's, CD's,Checkillg and
Sa'\lings accounts. We do!:iQ Financid "ransa.ctions or Statemellt OrdEn. For
FU.rther information please call1-80(l-4-HANKJI:Il~ or l'onr locall'NC Branc.h and
ask to speak with a Finlll1cial Services Reprel,e~ltati'\le.
Sinc;erely,
8acA^~ ~J.l)
Rachelle Sciullo
1-800-762-1775
Page 201'2
A lt1t'm~1' of Th~ PNC Fi".1Ir'I~ial krvi~C'~ r.Jvoup
PNC earl\( NA T"iasb1Jfgn ?tnnsylv,tnl.<t 15265
TmAL F'.02
Thanh you fhr !Janhin/!;
wilh IlS.
* 230 DEP MU
5080032071 LTl/MIX 83
0400000004613 14:38
02 0000019
PNCRANlK.
Wlwrf I'rr!ormal/a CouI/ls
$10,000.00
27JUN2000
$0.00
This deposit or payment is' . .
may not be available for im~~~~F:~d:i~~{f;~~olverific.ation and [0 the rule-'
a . Receipt should be held u S ~Ind ~egulations of this bank D .
ntl venfied with yo . eposlts
ur statement.
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MembersJ
FEDERAL CREDIT UNION
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Opened
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
25209 -00
09/15/1980
$3,461.29
$5.69
$3,466.98
Martha R. Miraglia
CERTIFICATES OF DEPOSIT:
Account Number/Suffix
Date CertiflCate Purchased
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Maturity Date
Name of Joint Owner
25209 -63 18 MO
03/2212000
$20,000.00
$72.61
$10,072.61
09/2012001
Martha R. Miraglia
CERTIFICATES OF DEPOSIT:
Account Number/Suffix
Date Certificate Purchased
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Maturity Date
Name of Joint Owner
25209 -64 2 YR
1111312000
$53,159.47
$204.77
$53,364.24
11/13/2002
Martha R. Miraglia
INSURANCE DEPARTMENT
5000 WUISE DRIVE
P. O. BOX 40
MECHANlCSBURG. PA 17055
1 -800-283-2328 or (717) 697-1161
129186 -00
1O/131l992
$849.13
$1.40
$850.53
None
129186 -46 18 MO
04/07/1998
$18,427.36
$61.92
$18,489.28
04/0512001
None
February 13,2001
Estate of: ISABELLE C. GATES
Date of Death: 12/22/2000
Social Security Number: 177-16-0774
)r,;c:r~ral
3008 0006
38 Y
101 S. George Street. York. PA 17401
717.846.877 or 1.800.222. YFED
ACCOUNT NUMBER
800-0005549
POSTING DATE
JULY 6, 2000
ISABELLE CRAIG BATES (JT/WROSJ
MARTHA R MIRAGLIA
233 MESSIAH VILLAGE
PO BOX 2015
MECHANICSBURG PA 17055-2015
TAXPAYER ID
177-16-0774
RENEWAL NOTICE
36 MONTH VARIABLE CD
PRINCIPAL VALUE... $10,000.00 ISSUE DATE............ AUGUST 10, 1997
GRACE DAyS........ 7 MATURITY DATE......... AUGUST 10, 2000
RENEWAL MATURITY DATE. AUGUST 10, 2003
RENEWAL INSTRUCTIONS: RENEW PRINCIPAL ONLY, INTEREST PAID MONTHLY
DEAR CUSTOMER:
YOUR ACCOUNT, 800-0005549, WILL AUTOMATICALLY RENEW ON AUGUST 10, 2000, FOR AN
ADDITIONAL TERM OF 36 MONTHS.
THE INTEREST RATE AND ANNUAL PERCENTAGE YIELD FOR THE NEW TERM HAVE NOT YET
BEEN DETERMINED. RATE AND YIELD INFORMATION WILL BE AVAILABLE ON THE MATURITY
DATE OF YOUR ACCOUNT AND CAN BE OBTAINED BY CALLING US AT THE TELEPHONE NUMBER
SHOWN BELOW.
IF NO CHANGES ARE MADE, THE VALUE OF YOUR ACCOUNT AT RENEWAL WILL BE
$10,000.00.
YOU WILL HAVE 7 CALENDAR DAYS AFTER THE MATURITY DATE TO WITHDRAW FUNDS
WITHOUT PENALTY. INTEREST WILL BE PAID ON FUNDS WITHDRAWN DURING THE GRACE
PERIOD.
YOU DO NOT NEED TO DO ANYTHING IF YOU WISH TO RENEW YOUR ACCOUNT FOR AN
ADDITIONAL TERM.
THANK YOU FOR BANKING WITH US.
DIRECT
INQUIRIES TO:
TELEPHONE:
YORK FEDERAL SAVINGS AND LOAN
101 S GEORGE ST POBOX 15068
YORK PA 17405-7068
( 7 1 7) 84 90i..a 'l>>,()" thA intHrnAr :,<t www \/nrkIArl rnm
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.ST A TEMENT
SE:.ND DIRECT INQUIRIES TO:
25209
4~:I}~~49~j
mL62 "~~~:~Jm
.........L.5.2m .m6.6.9.....7.9.u
1. 63 671. 42
.mm.m..3L.24.. .]0.2..66..
28.33 730.99
.....m.....19.4....54 .. ....925..5.3..
34.58 960. 11
MemberslST
FEDERAL CREDIT UNION www.members1st.org
Ma.in Switchboard: 1717) 697.1161 or (800) 283-2328
Call-24: 7171697.4372 or (800) 283-4372
Dlal-A-Loan: 717 795-6053 or (800) 723-4352
Loan Center: i717 795-6040 or (800) 283-2328 ex1. 6040
TeleBranch: 717) 795-6049 or (800) 237-7288
TOO
tor ttlElHearing Impaired: (717) 697-5312 or 1800) 283-2328 ext. 5312
Personal Branch: i7l7) 795-6050 or BBB} 466-3265
Mortgage Dept: 717) 795-6026 or 800) 283-2328 ex!. 6026
PO Box 40
Mechanlcsburg, PA 17055
# 17 (3 -.1)- 60)
'll, { IS+-
l'U:>l~r--,
..---~"-" .'. ~
ISABELLE C BATES
233 MESSIAH VILLAGE
PO BOX 2015
MECHANICSBURG PA 17055-2015
1",111",111""1,1"1,1",1,111",,,,11,1,1,,,,11,1,1,1,,1,1
1f- ~s~c9 -53
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DIVIDEND
DIVIDEND....
DIVIDEND
IfR..EROM..5HARES.....
TFR FROM SHARES
IfR..EROM...SHARES....
TFR FROM SHARES
....2.5.2.09:::52u...
25209-6.0
....2.520.9:::.62......
252.09-63
JoijijfoWNERS, MARTHA R MIRAGLIA
"m ......Y:::T:::.O....OIVIDENO.S;m...
....... TRUTH ..IN..5AV.INGS.INfO.RMAllON...
u...4...7.7...
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0.2290 DIVIDEND
m .022.9.0. CERL.O.IVIDENOu...
0.33~0 DIVIDEND
... .o33J,0 IfR..TO..S.HARES.
u . JOINT..OWNERS.
......~...
31.24
............:-.3.1...24
29.22
........ m...:-2.9u..22
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. .. I ..... ....
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........OuiSSLJEDATE:0.ii498 MATURITY DATE, 071406mLIV RATE,
....25.20.9:::.0.0.....
..MARIHA..MIRAGLIA...
Y-T-D
DivIDENDS:"
TRUTH IN SAVINGS INFORMATION
..._~ ..,... ANNUAL ..P1~-RCEhfA.~iE...'{IELD l '-'6~'3'i-%
. ANNUAL ..P.ERCEN.TAGE...YIEL.O....EARNED u.u/ ......6.,..2.7%...
....0131.0
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... .oalaO
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..... . m....II5....95
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......4.2...98
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CONFIDENTIAL
I~\: ':::}t~~8\U
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. ~.QUU ..oI'II:IE.I'\?:. MARTHA 13 MIRAGLIA
................................'FFoDiVtlJENDS:
Ti4:f3nFDREtfUREs:
.._.__.,..u'_..m.____._......__...
nL ANNUAl:
.. ANt-NIIL
UfRUfH TNsAVTNGStNFORMAttoN ..
PERCENfAGEyrELo ..... /6:50%
PERi::I;NTAGEYIELPEARNEDu I ...5,5:311,
; ....~
6tssUEoAtE:03Ta06t:1AtURtTYbAfE,09160T ..tvRAfE, ......6.3100
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033fo fi'iCtosHARES "'25209"'00
28.33
nn""21i:'33 .
26.51
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28.33
.. .. ""'2ii:33 .
... JoiNt OWNERS: uMARfHARMtRAGLIA
... .Y:::T~PQIYJPENP~:. .......u9:3...J?
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... ANNUAL PERCENfAGEYIHoEARNEO / u5:68%
"]"""~;
. .
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of310
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DtVlbENDuunun
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'45:95"
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-42.98
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.
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.... ANNUAL PERCENTAGEuvTELo' .n; "'6:50%u
.... AI:INI,IAL PERi::ENIAGEYIELPnEARNEP/n5,5:311,
---:--'-
.................0...tSSUE....DATE:03T900 .t:1ATUiHTV 'bAfE':09'1701' ...tV"'RAfE:" "6:3100'
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JotNT uOWNERS: nM'ARfHARMtRAilLA
uun nunnuY~I~P uPlYJPENPS:n uu56~.~2J:QREJII,JBES:
..____.n....._........_....
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--:--i_
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-------------------------------------------------------- ----------
SUFFIX:63 18 MONTH .C.ER.I.tfICA.I.E... .00
sHARE.OEP6sIt.........u.. . "'20000:00' ..20600:00.....
032~0
... .'.....:.---..
0052U'M 'MM-XXX-OI>02
,
>
8T A. TEMENT
SEND DIRECT INQUIRIES TO:
129186
CONFIDENTIAL
03-31-00
PAGE
MemberslST
FEDERAL CREDIT UNION www.members1st.org
Main Switchboard: (717) 697-1161 or (800) 28;3-2328
Call~24: (717) 697-4372 or (800) 283-4372
Dial-A-loan: (717) 795-6053 or (800) 723-4352
Loan Center: (717) 795-6040 or (ROO) 28;3-2328 ext. 6040
TeleBranch: (717) 795-6049 or (800) 237-7288
TOD
tor the Haaring lmpalred: (717) 697-5312 or (800) 283-2328 ext. 5312
Personal Branch: (717) 795-6050 or (B88) 466-3265
Mortgage Dept: (717) 795-6026 or (800) 283-2328 ext. 6026
PO Box 40
Mechanlcsburg, PA 17056
CERTIFICATE RATES AS HIGH AS
7.00%. CALL OUR TELEBRANCH
DEPARTMENT AT (800) 237-7288 OR
(717)795-6049 OR VISIT OUR
~EB SITE AT ~~~.MEMBERSlST.ORG.
ISABELLE C BATES
233 MESSIAH VILLAGE
PO BOX 2015
MECHANICSBURG PA 17055-2015
1",111",111""1,1"1,1",1,111",,,,11,1,1,,,,11,1,1,1,,1,1
~IM~:;TVRI DE$cRIPTION OF TRANSAOTlON
... ,', "1~lfl*6~::~:~1:' ,,: ::::',:;;;:,::::''"'"
....._f.-...
ANNUAL PERCENTAGE YIELD
AMOlIllT
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0~3~0
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.SU.FEIX,A6.
DIVIDEND
DIVID.END,
DIVIDEND
IfR..T.O...SHARES......
u"ul,.29...9.5...
.,91.4l121.35
n.....n._....___,....
I
---------------------------------~-~~~~~:~--------------~~~~~-~~~J~-~~
...1...182.51.12 .
90.53 18342.25
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91.40 18518.76
....u..~.9 LAO, ...18.4.2.L3.6 "'j
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I,
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... .129186.:::00 ..
.... ANNUAL
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PERCENIAGLYl.ELO.,u.J. ..,.6.0.0%...
PERCENTAGE YIELD EARNED / 5.97%
ERLNOL
uOISSU.E"D.AIE.:I0.06.9.9.MAT.UR l.I V ..OAT.E..:.OAQ.5.01. ..IVuRAT.E..:..
5..8.400.u
-~-
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-------------------------------------------------------- ----------
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....n...;a>.i.~ 04'"
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.
1
012240'~ -MM-XXX~OOOI
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FEDERAL CREDIT UNION
TELEPHONE NUMBER: 717-795-6049
LONG DISTANCE: 1-800-283-2328
f,-,-',c"
'.:r .,
C W R [)fJ~'[J';'h-.'ii. I :,,'.L
DO NOT WRITE ABOVE LINE
i\~
CERTIFICATE WITHDRAWAL REQUEST
Please Print
MEMBERS NAME: :L $CLb-t IJe
'Ra. kS.
ACCOUNT
NUMBER: J2.. -:;,;( 0 ?
ADDRESS:
CITY:
HOME PHONE
NUMBER:
STATE:
ZIP CODE:
WORK
NUMBER:
_ 00 5,-. Lj_o $ LI7 000, oc)
I HEREBY APPLY TO REDEEM MY CERTIFICATE AND:
\ ,- Ii /} C'" -11 ,J 11f""l:"
CHOOSE Me-MIJ,er '-"a"~ 0'-. yl" .u v"C 1'\
ONE: I" \
w~\C \f_ "'.,-,t- f::O ;;< yr.
. DEPOSIT TO SAVINGS ACCOUNT-
. DEPOSIT TO CHECKING ACCOUNT -
- DEPOSIT TO INVESTMENT SAVINGS ACCOUNT -
. APPLY TO LOAN ACCOUNT -
- RECEIVE A CHECK.
. I l .u - r" .,1 . i , ",\,,, e\" \~d'; ,. d..k 'IS II.. 3
L. I. fl-')' ",liS OP"<\JlQ to ref <<<'" Q.kO<;NJ -... T""'-.' I
}-\oA!Jt:'l'!V\ (\C.~ 01"'\ )
MEMBERSSIGNATURE~)t7:;lII(i' f)</; vi?-t11;/~i; DATE: li-13,~q
A penalty will be Imposed for early withdrawal, for furU<~r details refer to the certificate disclosure you
received when you purchased the certificate.
DATE CERTIFICATE
ISSUED:
CERTIFICATE NO.:
CERTIFICATE CERTIFICATE CODE
RATE TYPE
&.1 I~M <1
CERTIFICATE BALANCE
Vd..
WITHDRAWAL DATE
MATURITY DATE
MBRS 1: 58-21
Rev. 3/96
Office Use Only
Amount 01
Penalty
$ -6--
Amount
Disbursed
$
'I?
000 , 0"
ACCOUNT NUMBER
:MemberslST
f'l-::DERAL CREDIT UNION
Your ."";,,>:'100....111. i'L'>Ul',tl Lv ~\UU.<l1l\I
P.O. Box 40 . Mechanicsburg, PA 17055-0040
(717) 697-1161
TOLL FREE (800) 283-2328
www.members1st.org
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STATEMENT ORDER. 0 [WEN DATE. 15/86/99 RDLLDVER DATE' 11/03/00
YTD DIVIDENDS' 1924.34 DIU PAID TO. 11/03/00 CENTS DilYS. 2570900000
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MemberslST
FEDERAL CltEDn UNION
P.O. Box 40 . Mechanicsburg, PA 17055-0040
(717) 697-1161
TOLL FREE (800) 283-2328
www.members1st.org
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ISHBELLE C BiHES
233 MESSIAH VILLRGE
PO BOX ;:~f.'):L ~:.:.i
MECHRNICBBURG PH 17053-2015
SIGNATURE
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P.O. Box 40 . Mechanicsburg, PA 17055,0040
Telephone Number: 7174795-6049 Long Distance 1.800.283-2328
Hearing Impaired: 717-697-5312 -
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I CeRTIFICATE RENEWAL NtlTlCE T
ACCOUNT NO. NOTICE DATE
25209'-62 I [ 11/0'3/00
Your certifjcat,eha~,,~ee.r~ ren~we? in the na~t;fjisted
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please call the number iisteqabol/il. .
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lSlABk'LL$C BATES
;,:;:33 MESSIAH VILLAGE
PO BOX. 2015
MECHANICSBURG PA 17055-2015
MATURITY DATE"
05/04/02
This Renewal Notice informs you of the renewal of your certificate of deposit account with Members 1st Feu.
,REV.,51,"'."'.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
ISABELLE C.BATES
FILE NUMBER
21-01-0042
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
11.- MYERS FUNERAL HOME $8,240.00
2. RICE MEMORIAL WORKS - HEADSTONE 75.00
3. PEALER'S FLOWER8 164.25
4. MEAL FOLLOWING SERVICE 383.94
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) MARXBA 1IIKAtlt.IA, EXr;e:UYllIX
Social Security Numbe~s) I EIN Number of Personal Represenlalivels) $ 0.00
Street Address 64 OLD FEDERAL ROAD
CAMP RILL PA 17011
City Slale Zip
Year(s) Commission Paid:
2. Attorney Fees ANDREW C. SHEELY, ESQUIRE, PER AGREEMENT $4,750.00
3. Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation)
Claimant
Street Address
City Slate Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. CUMBERLAND COUNTY REGISTER OF WILLS $ 334.00
FILING FEES FOR INHERITANCE TAX RETURNS 15.00
MISC. POSTAGE AND MAILINGS - SEE POSTAGE BILL 43.00
Reserves to conclude administration of Estate, 500.00
Accounting Fees, taxes, preparation/mailing and
copy charges of necessary Fiduciary Returns
TOTAL (Also enter on line 9, Recapitulation) $ $14,505.19
(If more space is needed, insert additional sheets of the same size)
Myers Funeral Home, Inc.
37 East Main Street
Mechanicsburg, Pa. 17055
Boyd L. Myers Jr., Supervisor
(717) 766-3421
A STANDARD OF EXCELLENCE SINCE 1910
January 17, 2001
Mrs. Martha R. Miraglia
64 Old Federal Road
Camp Hill, Pa. 17011
Dear Mrs. Miraglia,
You have the right to pay the entire amount due at any time to avoid future interest charges.
Services for: Isabelle C. Bates
BALANCE
Payment Received
$8,240.00
01/17101
BALANCE AFTER PAYMENT $8,240.00
I nterest Added
Late Charge Added
NEW BALANCE 14
PAYMENT AMOUNT DUE $8,240.00 r - Let /I
DATE PAYMENT DUE . ~ I 2f,
MONTHS REMAINING 1
Credits Granted: $1,095.0 Package Price Discount 1/22.../ Z.oo I
Interest at the rate of 1 % per month ( 12 % per annum) will be added to balance after 30 days.
(A late payment fee of $20.00 will be assessed if not paid by the due date)
~~~Yflmw, Jnc.
37 EAST MAIN STREET
MECHANICSBURG. PENNSYLVANtA 17055
(717) 766-3421
......
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Received From ~~TH,4 ;1/Jrv!.A r....L.~ A- $ 82 Lje). 00
Z~i/..+ Th.ov~N~ 1,-,-,", l.'_IAA-".Q ~~ ~ D:;:~
For Funeral Expenses of --:L- f"rr~e:LL-tZ C'.. J?ArEr
o Cash 0 M.O.
01
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Received By
Rice Memorial Works
RD. 2 BOX GA-9
WEST MAIN STREET
NEW BLOOMFIELD PA 17068
6/27/2001
MARTHA MIRAGLIA
64 OLD FEDERAL ROAD
CAMP HILL
PA. 17011
Item
Description
ITEM SUMMARY
Qty.
Price Each
Total
Inscription work for: BATES
75.00
75.00
f-
f-
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Total 75.00
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Lettering was done on: 6/27/2001 ~ 1;)0 I
Please call us with any questions at (717) 582-2512JZ~~ 5
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cut along dotted line
INSCRIPTION ORDER FORM
RICE MEMORIAL WORKS
ORDER NO.
a diuision of I
J.m.. R {l,ingrich
GI- MEMORIALS
134855
R.D. 2, Box GA-9, West Main Street, New Bloomfield, PA 17068 . (717) 582-2512
(3/4 mile west of the square)
...... ,
CEMETERY i ,!) h n :;
NAME OF DECEASED ..J <
LETTERING REQUIRED
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UPON EXAMINING THE ABOVE INSCRIPTIONS, I/WE THE UNDli'RSIGNED, FIND THE SPELLING AND DATES TO BE
CORRECT. THE WORK WILL BE COMPLETED. AS IT IS ACCUMULATED. NO SPECIFIC COMPLETION DATE IS
GUARANTEED.
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PRICE
DEPOSIT
BALANCE DUE
$
$
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SOLD BY
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(' Ie BRANCH
rJ...-
DATE ENTERED
PEALERS FLllERS - TRINIU RlllD
Telephone No: 137-4506
Order No : 741~ Operator: 000
Taken At I Il:2B ~
Register ,52 Clerk: 217
Order Date: 12/ZZ/OO Sile Type : CA
Del Date ,11I17/oo
Sold To ,MARTHA MlRAli.lA
1 CIlSXET SPRAV XMAS TIDE $150.00
MIXED 6tIEENS HOI.L Y WHITE SPlDE
RED CARNS
THIS IS FOR A CLll5ED CASlIET
SubTotal :
Deli very Charge I
Service/Relay Charge ,
Tax AIIount :
Total llMount I
$150.00
$4.95
$.00
$9.30
-..-...---
$164.25
llMount Tl!IIdered: $164.25
Change , $.00
Deliver To: ISAllELI.E IlATES
Attn:
Address: MYERS FUNERAL IOE
City, 5h IECHAliICSllURll PIl
Visit Us Online At
..........pealel"s.com!
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RESTAURANT & CATERING
CAMP HiLL~ PA 17011 761-7539
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i GUESTS ANGELA SM.IR lE-
I GINGERALE 1.50
1 CUrri' ~::;i< 3. 95
1 A8SOLUT 3" 95
1 QUA 1 L f'tE~LOT" /:;L ""C
/'.~_ Mol ,j~--,IJ
1 Uf~DF: HEF.tOT GL 4 ~ 75
1 G If.H,EFiiLE 1. 50
nsoup OF DA\'
S~JP i 3.50
5 ttCRA8 8ISQUE 19.75
3 tMOZZ CHEESE 13.50
1 SALAD Wi ENTREE 1.95
EUU CHEESE .50
2 CR ALJlOHD CHiC i5.00
1 EU::: PF RIB 8."50
1 BU< PI? f?:IB :::.50
1 BLK PP PIE: ;.:~, 50
1 BU::: PF e.50
2 SALNOH FILET i7~ 90
i ::;ALNON FILET 8.95
i ~:G CPf~8 CHI<E ;::.35
1 3M FUDGE SUNDAE 2.75
1 CliCK li/TOPP I fiG 4. 90
1 CHOC DU .JOUR 3.75
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8.30
1 E.q, '" ~:5
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RESTAURANT & CATERING
CAt1P HII.L, PA 17011 161-753',:
13CKft 82
10 GUESTS -JOANNE SR!..W 15
1 ABSOLUT 3.95
i GIN 3.95
2 SHIPLEY TEP1PLE 3.00
1 LG JUICE 2.75
1 BLOODY t't~R\' 4.75
3 itCRAB 8ISQUE 11.85
i *i3NAPPER SOUP 3.75
2 riON S~JP 7.50
HSOUP OF DAY
SOUP 1 3.50
i 8LOOD \' i'tAPY - 4. 75
? RG CRAB CAKE 62.65
1 :3AlI'10Ii FILE, :,:.95
1 8LK PP RIB 8.50
1 CR liLNONP CHIC 7.50
1 GlHGEF.:HLE 1.50
1 ICE CREAN 2.50
i BREAD PUDDING 2.50
1 PIE ALA MODE 3.90
3M FUDGE SUNDAE 2.75
1 LG FUDGE SUNDAE 3.75
1 PIE 2.95
2 COFFEE/TEA 3.00
i 3M FUDGE SUtIDAE 2.75
1 ICE CREAM 2.50
1 CHEESECAKE 3.95
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CSHR DA\' OPEN 13:40
2355 15:16 ~Ol DEC,27~~J REGGOe?
RECEIPT FOR PAYMENT
-------------------
-------------------
Cumberland County - Reqister Of Wills
Hanover and Hiqh StreeE
Carlisle, PA 17013
Receipt Date
Receipt Time
Receipt No.
1/09/2001
13:48:58
1024251
BATES ISABELLE C
File Number 2001-00042
Remarks MARTHA R MIRAGLIA
AC
Transaction Description
PETITION FOR PROBA
EXTRA PAGES
SHORT CERTIFICATE
JCP FEE
Distribution Of Receipt ------------------------
Payment Amount Payee Name
305.00
9.00
15.00
5.00
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
BUREAU OF RECEIPTS & CNTR M.D
Check# 2189
Total Received.........
$334.00
$334.00
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MEC~ANICSBURG MPO
MECHANICSBURG, Pennsylvenia
170553459
03/13/2001 (717)697-4641 01:01:01 PM
Salas Receipt
Sal e Unit
Qty Prl ce
Product
Description
Final
Price
JERSEY CITY NJ 07303
Flrst-Cless
Return Receipt
Reelstered
Insured Value
Article Value:
Label Serial H:
$0.55
$1. 50
$9.75
$1. 089.00
$1. 089.00
RR339282813US
Issue PVI:
$11. 80
$0.55
$1.50
$8.25
$134.00
$134.00
RR339282827US
JERSEY CITY NJ 07303
First-Class
Return Receipt
Reelstered
Insured Value
Article Value:
Label Serial H:
Issue PVI: $10.30
JERSEY CITY NJ 07303 $0.55
First-Class
Return Receipt $1.50
Reelstered $9.00
Insured Velue $539.00
Article Value: $539.00
Label Serial H: RR339282835US
Issue PVI: $11.05
CRANFORD NJ 07016 $0.55
First-Class
Return Recei pt $1. 50
Reel stered $7.50
Insured Value $47.00
Article Value: $47.00
Label Serial H: RR339282844US
Issue PVI:
$9.55
Total:
Paid by:
Cash
Chanee Due:
$42.70
$43.00
-$0.30
8illH: 1000300266300
Clerk: 13
----- Thank yOU for your business -----
''''''''''I.''''''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF
ISABELLE C. BATES
FilE NUMBER
21-01-0042
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
DESCRIPTION
AMOUNT
IRS - TAXES FOR 2000 TAX YEAR
$2,139.00
PA DEPT. OF REVENUE FOR 2000 STATE INCOME TAXES
289.92
FINAL NURSING CARE BILL
3,689.00
HAULING - TRUCK RENTAL - FURNITURE REMOV AL
55.39
BRICKER APPRAISAL FEE
30.00
MESSIAH VILLAGE FINAL BILL, 1-1-01 TO 1-2-01
238.00
WEST SHORE EMS
37.53
WEST SHORE EMS
39.79
TOTAL (Also enter on line 10, Recapitulation) $ 6,518.63
(If more space is needed, insert additional sheets of the same size)
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PA.40 . 2000 (09-00)
Pennsylvania Income Tax Retum
PA Department of Revenue, Harrisburg, PA 17129-0006 OFFICIAl. U':;E ONLY
PLEASE PRINT IN BLACK INK. ENTER ONE LETTER OR NUMBER IN EACH BOX. FILL IN OVALS COMPLETELY.
Your Social Security Number Spouse's Social Number c:::::> Extension. See instructions.
- ~ . "X'-".' .f I
'"-'<t.,,:: ;'jli/ "
, .!
W r;-~~'~''''':''''__'''''':::''-C.''~''
ffi I 177-16-0774 SA
:I:~
~i BATES ISABELLE C
-' I, 563 DOGWOOD DR
~! MESSIAH VIL BOX 2015
:)! MECHANICSBURG, PA 17055-6176
~I
wI
01
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---1
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First line of address - P.O. Box; Apartment
RR No. - if
Second line of address. Street Address
,J~"J.,~~,'L.l~i,j,~~I"']~J~:]J
State ZIP Gode
j
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;.",~",~~..............~,,,,;,,,..."..;';._"-" ...
School Code Daytime Telephone Number
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CJ
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~a. Gross Compensation, from PA Schedule._W.~?S, Q!jI'9ur For~ W-2, or other stateme~
h b. Unreimbursed Emplovee Business Expenses, from PA Schedule:1I[l. .
~ Compensation. SubtractTIiie) ~J!om~rri'e~ . . . . . . .
~resfTncome. Complete a-ncrenCf6se-P~chedule A, if over$UO]J ..
~iaerldlnCome:compJeteancrenclDSePA Schedule B, lfOVe~500l . . . . . . .
4. Net Income or Loss from the Operation of a Business, Profession, or Farm. . . .
5. Net Gain or Loss from the Sale, Exchange, or Disposition of Property. ...... . . .
6. Net Income or Loss from Rents, Royalties, Patents, or Copyrights. .
7. Estate or Trust Income. Complete and enclose PA Schedule J. ...
8. Gambling and Lottery Winnings.
c:::> Amended Return. FiB in this oval jf
you are amending your 2000 PA return.
c::::> Fiscal Year Fliers. Fill in this oval.
FY beginning ---1 _/00 & ending ---1_1_
Residency Status. Fill in only one oval.
-. R Resident
t:::) N Nonresident
c::::> P Part-Year Resident from -1-100
to ---1---100.
Type Flier. Fill in only one oval.
= S Single
t:::) J Married, Filing Jointly
c:::> M Married, Filing Separately
c:::> F Final Return. Indicate reason:
~ D Deceased. Date of death ;;J!.bt/60
Identification Label Change.
c:::> Fill in this oval if the label you received with this
booklet is not completely correct, or if you did not
file a 1999 PA tax return. Do not make corrections
on the label - DISCARD IT.
Municipality where you lived on 12/31/00.
u.. ,....1" 1'1 "'>-" -rIM ;
LOSS
=
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=
5.
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=
6.
7.
8.
~otal PA Taxable Income. Add only the positive Income amounts from Unes 1'0;2,3. 4, 5. 6. 7, andBl
DO NOT ADD any losses reported on Lines 4, 5, or 6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10. Contributions To Your Medical Savings Account. See the instructions.
11. Adjusted PA Taxable Income. Subtract Line 10 from Line 9. . . . . . . .
n:Cl>ATaxuaDITi~Multlply Line 11 by 2.8%(0.028). Also enter on Cine 13, SlCe2:]
Side 1
OFFICIAL USE ONLY
L
0000110015
9.
10.
11.
12.
0000110015
---1
....J
I
Your Name T< 'iI f../I(' C::, d5ri f~~
~PJffaiTlabfl1!iJ=iiter"vourTaxllii!?TITfv from Line 12 on Side 11. . . . . . . . . . . . . ... . . . . .. 13.
OFFICIAL USE ONLY
PA.40 . 2000
Social Security Number
0000220012
~TOI:arP-Alax..wTffihelcrrr6mPA-ScneaUle-W:2S or vour Form(s) W-2 or offl9i=Sfafernenfs.
14.
9 "
15. Credit from your 1999 PA Income Tax Return.
15.
16. 2000 Estimated Installment Payments.
15.
17. 2000 Extension Payment.
17.
18. Nonresident Tax Withheld on your PA Schedule(s) NRK-1. . .
18.
19. Total Estimated Payments and Credits. Add Lines 15. 16, 17, and 1 B.
Tax Forgiveness Credit. Complete Lines 208, 20b, 21, and 22. Read instructions.
20a. Filing Status: <::::) Unmarried or c::> Married ~ Deceased
Separated
19.
20b Dependents, Part B, Line 2, PA Schedule SP.
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~i-:-foiarEl;QT6i1Tiy Income from Part"C,UnelT, PA Schedule-S!'j ..1 ^ I I A I I 1TI
- - -
g2:iaXYJ!rgNemeSS Credlfrrom Part D, lIne 1~ASche~ .............. ............. 22.
. ..
23. Total Credit forTaxes Paid to Other States or Countries. Enclose your PA Schedule G or RK~1. ... 23.
.. ..
24. PA Employment Incentive Payments Credit. Enclose your PA Schedule W, RK-1 or NRK-1. ...... 24.
.. .
25. PA Jobs Creation Tax Credit, from enclosed certificate or PA Schedule RK-1 or NRK-1. . . . . . . . . . 25.
- -
26. PA Waste 11re Recycling Investment Tax Credit, from enclosed certificate or PA Schedule RK-1 or NRK-1. ... 26.
- -
2,7. PA Research and Development Tax Credit, from enclosed certificate or PA Schedule RK-1 or NRK-1. .... 27.
~~ -
12!CTOJATPAVMENTSiiiidCll-enliS~ Add Lines 14, f9, and 22 throuon21l . . . . . .............. 2B. .:
I l29-:-rAl(JLOE;:[f]Jfi~-1;'}'l.criQr~jDjl.n 1:ifie~8, "enter the difference here.1 ...... ....... ... ... 29. 7 L/ 9 ;;.
~Q,~3~.v.~~p~y"~EJ~!.JL~,i~~~~8 is~moreth~n Line 13; ~nterthe difference here~ ....... .......... 30.
c::::n1i'~totalofDnes:31 thiQYQEi37 must eaual Line 30. I .. ...
~T-Reliinir=-:-Am-o-unrofUne--3(:rvciu'waiif~i's-'a..cflecKmafJed to vOUJ ................. Refund 31.
IiIIIlI ...
~2:-Credlr=-AmourirofUne 30 yOU want as a crectlno vour2~6()Teslrmated taX" accoun1l ..... .... 32. }
t==__~~~I~~~~~:6.u~~6~~~~~~,~~.~~l~~~~~~t~ .t~ .t~~ ~I,I~ ,~~~~~r.c~. ~~~~~~~t~l. . . . . . . . ... ....
33W ,
, ... -
[l'Co-onallc:in n Amount of One 30 ou want to donate to the lJiilied States Olvm~ 34. '
L_C.omi!1!!!ee. PAJllvtslon, .... ........................... .. .......... ::t:ttJ
E1::~~~ -~.. ~~.o~~~ ~~ ~i.n.e. ~-~ ~~~~~~~t. t~ ~~~~~t~ .t~ ~~~ ~a.n. ~~~~~ .~~~~~~s,s. :~~ . . . . . . 35.
~-oonatlo~ -- Amount ofITne-'30y0u wannocfonate tOTheKOre87Vfe'tnam Memorlallnc.~ ....... 36. ,
t17-:-0oriatlon-.-=-A'mount of Tine-3Cfvo"llwanflodOnalefOlneBreaSt aria~ervlcarCance~ 37.
I,
..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,....,. .. ...................
Under penalties of perjury, I (we) declare that I (we) have examined this return, IncludIng all accompanying schedules and statements, and to the best of my (our)
belief the are true, correct, and com lete.
urSignature:
p"
'/c..<"
&~'uh;x
Dale: Your Occupation:
.;t-J3-al
Date: Spouse's Occupation:
Spouse's Signature, if filing jointly:
Preparer or Company Name. other than taxpayer(s)
Preparer or Company Name (Please Print):
Date;
Signature 01 the Preparar(Optional):
L
0000220012
PLEASE DO NOT CALlABOlIT YOUR REFUND UNTIL 8 WEEKS AFTER YOU ALE.
Side 2
0000220012
....J
-Fdrm
1040A
Label
(See page 20.)
Use the
IRS label.
Otherwise,
please print
or type.
Presidential
Elecllon Campaign
(See page 21.)
Filing
status
Check only
one box.
Exemptions
tfmore than
seven
dependents,
see page 23.
Income
Attach
Form(s) W-2
here. Also
attach
Form(s)
1099-R if tax
was withheld.
If you did not
get a W~2, see
page 26.
Enclose, but do
not attach, any
payment.
Adjusted
gross
income
o.P",*",lIlIt '" l/lS T_ry-Im,mallle.en.o Se,NIce " . , , ,,',
U.S.:lndivldLiallncom.:"iReturn" r,s;;':2000; ','
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II'lI'1I4111 828
# lSABELLE C BATES 76
'II 563 DOGWOOD DR HESS1AH VlLLAGE
# 563 DOGWOOD DR # ME8S1AH
'II HECHANICSBURG PA 17055-6:176
CI.{ ."., '..' .
.;...~mportantl ..
, .: I' YOI/. mUllt enter your
, c.. .,/lSN(s) abQve.
4
L
(1) Rill! n8me .'
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15 Add ~~es7 throu h14p (far riht Column). This iI>' r totalincome. .
16'" I dedUQtion sea a Il 31 . 16 '
17' '. Student loan interest deduction' Illla a e 31 . 17.
18 . dines 16 and 17. These are our. total ad u$tm$ntll.
19 s'ubtraotlj~e 18 from line 15. This is our adjusted follll incom~;; '.... 111 ,
For aeclosure, Privacy Aqt, and Pap_Q~ Reduction Act Notice, 8lKI page ~ Cat NQ. 11327A'
Form 1040A (2000)
Taxable 20 ~ntertheamount frOm line 19. ... ....
income 21a' ~eci(T~~.:r~: ~~ ~~~~der g~::~~ } ~:~':~ ~~:~~~ :
b If you are married filing separately ane! your spouse itemizes
.deductions,seepaQe33andcheckhere.. . .... ... .. 21b 0
22 Enter the standard deduction for your filing status. B.ut see page 33 It
youcheqkedany box on line 21a or21b or if someon<;>.can claim you
a~a dependent.
. $ingl6=$4,400 . Married fili!1\1 jointly or gWllifying \iVidow(<;>r)::--$7,?59.
. Head at household-$6,450 . Married filin separatel --$3;675
SlIbtract line 22 from line 20. It line 22Js more than line 20 enter ,0,.
Multi f $2,800 b the totainumberofexem tions claimed onHne6d.
$uqtract line 24.tromline 23. It line 24 is more than line 23, enter +.
This is our taxable income. Ii"-
Tax: see a e34.
Credit for child and dePendent care expenses.
Attach Schedule 2.
Credit for the elderly.orthedis(ilqled.Att<!ch
Schedule 3. 28
Education credits. Attach Forni 886 29
Child tax credit . see a e 37 . 30
Ado lion credit. Attach Form 8839. 31
Add Jines27throu h31. These are our total credits.
subtract line 32 tromllne 26. It Iin~32 is more than line 26, enter ,0,.
Advance earnepincome credit a ments frOm Form s W-2.
Add Jines 3a ane! 34. This is your tot.!itax.
Federal income tax withheld trom Forms W-2
and 1 099.
37 2000estimat<;>d tax paym<;>nts and amou.nt
a lied from 1999 r<;>turn.
38a Earned income credit Ele.
b Nontaxable earned income:
amollnt .. and type ..
Additional child tax credit. Att<!ch Form 8812; 39
Add lines 6 37 38a and 39. These are our t tal a nt
Ifline 4015 more than line 35. s.uotractflne35.from Iinei40;
This is the amount you over aid.
42a Amount of line 41 ou want refunded to you.
.. b ~~~~lr DIIJIIIII", 9.Type;q(:)h(jckilli0"P.~vit1li~
.. d Account
number
43 Amount Of line 41 youwMtapplied to your
2001 estimatlld tl!x. 43
44 It line 35 is more than.line 40, suotract line 4Q trom line 35. Thisisthe
amount ouoWe.FQrdetalls on how to a see a e49,
45. Estimated tax . anal see a e 49 45
UnderpenaltiasQf WWrYitqectere 'thatl r.ave&xamlned ihlllf~turrr~mi:taccompanyln.g'schlll(fu[es a(ld$t$tehl~rrt$.and to the best Of my
knowJedgeand beJief,theY aretrlJe,correot, and accuratelyllstall amounts an9 sourc:esQflnOOmeJI'$~ived~l.j!il1g!netaxYear, DSl;::laration
of preparer {oth.Elrt/lanthlll t~paYer}i~,baseQonalllnformatfoll of which the preparElrhas~flyknpwll:K:\ge., ',.,
Your :~nature A I Date Your occupation Daytime phone number
~ 4Y..~ /:tl;:;" 260~ 6 - S2-
. ~ou..'s si'fatu. reo If a j.oi~t ret. urn, bot7rnust sign. Spouse's occupation May the IRS discuss this return with the preparer
" "Yi: aAJ:..luC' If." n {~t:-","'" (.-(';wt, . shawn halew (see page 50}1 0 Yes 0 No
P . ~ V ~ecu.,-frt.>( Date Preparer's SSN or PTIN
reparers
signature
Firm's name (or ~
yours jf self-employed),
address, and ZIP code
Tax,
credits,
and 28
payments
29
30
31
32
33
34
35
36
If you have
a. qualifying
child, attach
Schedule
EIC.
Refund
Have it
directly
deposited!
See page 48
and fill in
42b. 42c.
and 42d.
Amount
you owe
Sign
here
Joint return?
See page 21.
Keep a copy
for your
records.
Paid
preparer's
use only
l ',..
-+_ ....---c-,
,.~" .'
/-/
21aUJ
23
24
25
26
2.7
27
Ii"-
36
37
38a
6t.OO
39
40
41
..
40
41
42a
. - Page 2
:z- -
22
23
24
-
25
26
3
-
32
33
34
35
's?
.$< oC
Phone no.
)
Form 1040A (2000)
. Schedule 1
(Form 1040A)
Name(s) shown on Form 1040A
Department of the Treasu~lntemal Revenue S~ryice
Interest and Ordinary Dividends
for Form 1040A Filers (s)
c, !I-d:e- '>
2000'
OMS No. 1545-0065
-r' ".
~>",-,\,
Part I
Note. If you receiveq ~ Form 1099.INT, Form 1099-010, or B\.Ibstitute statement from a
brokerage firm, enter the firm's name and the totafinterest shown on that form.
Interest
(See page
62 and the
instructions
for Form
1040A,
line Sa.)
1
Ust name of payer. If any Interest Is from a seller-finanoed
mortgage and the buyer ul;led the property es a personal .
residenoe, see palle 62 and list this Intanilst first. Also, show,that :" .
btlYer's soolall'ecuriJy number ~nd addnilsl!. .' " .' . (:' f .'
\,,"',
"
2
3
4'
dS1ssued,a!ler1,96e . ',' ,
,',"':",;),,,' ""_'''':':P''_V'"'j',,_,,. '
2
~
Part II
: Note. If you reCE/tlred' a 'Form
firm's name ,and Ina'o, td
, ',"- '",,' - ,'-.
Q ".' l,.lst,name of payer.lncl'lqi!only,
,,~lvE/d an)!; oapitalnalll cllstrib
., 'Form 1040A:' line 10.'" '. " .'
do~ Form 1040A;'
" ".'4 3/S"'7J -
Ordinary
dividends
',',' ',' ,',,-;"""',1/:-':',>0.,'< '" ',:- ': " " ,
'SUbstitute statement fram' a brokerage firm, enter the
, shown on that forlT!" ". .',. .
ends. If you
ons" see the Instructions for,
,-' -",>"""" ." ',,, ','. --.- ,
(See page
Amount
62 and the 5
instructions <;1 2) '"" I ~/I 9 -
for Form h. ~+-J. J-,~ .~) ./"n"'71.
1040A, -
line 9.) I.fCi , , " t-.
, ..~ -
h-1~ /1'"',... < .<.:?h 4'%
6 ~dd the amounts on line 5. Enter the total here and on Form 104M, /'?/f(
line 9. '" ,6 ,-
For Paperworl< Reduction Act NOI'ce, see form 1040A In~rucllons.
c.t. No, 12070R
Sch~dule 1 (form 1040A) 2000
PAN (09-00)
177-16-0774 SA
BATES ISABELLE C
563 DOGWOOD DR
MESSIAH VIL BOX 2015
MECHANICSBURG, PA 17055-6176
PA PAYMENT VOUCHER
For use with your 2000 PA-40 Tax Return.
000914 ENTER THE AMOUNT OF YOUR PAYMENT.
DO NOT USE CENTS. ENTER WHOLE DOLLARS.
2000 PA.V
Commonwealth of PA
Department of Revenue
$
7'1-'12--
Make check or money order payable to the PA Dept. of Revenue
DO NOT WRITE IN THIS SPACE
L
30018117716077400021200012310000000000000002
MESSIAH VILLAGE
. .
100 Mt. Allen Drive
P.O. Box 2015
Mechanicsburg, PA 170552015
(717) 697-4666
Resident: ISABELLE C BATES
B
I ISABELLE BATES
L 233 MESSIAH VILLAGE
L P.O. BOX2015
T MECHANICSBURG. PA 17055-2015
o
Date
Description
Beginning Balance
12/01/2000
PC - SUSQUEHANNA SINGLE
21 DAYS AT 119.00 PER DAY
PAYMENT RECEIVED - THANK YOU!
PC - SUSQUEHANNA SINGLE
/0 7J1l13 fI"f' /lq.oo fe'te.. 1:> 7
12/12/2000
12/22/2000
Current
Past
Due
61-90 Days
91-120 Days
31-60 Days
2,499.00
1,190.00
0.00
0.00
1% FINANCE CHARGE AFTER JANUARY 31. 2001
STATEMENT
Resident Number Date
000068208 12/31/2000
Page Amount Due
1 3,689.00
Chan:ies Credits Total l
3,570.00
2,499.00 6,069.00
-3,570.00 2,499.00
1,190.00 3,689.00
c, '\t~,
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Over 120
I PENSKE'
Truck leasing
PENSKE TRUCK LEASING CO., L.P.
("Penske")
L;<5~j
1-'i;::i",
i. ',''l};,~j
,"'j ! ;,"1
."
I'll:
TRUCK
RENTAL AGREEMENT
EMERGENCY SERVICE 1-800-526-0798
LOCATION
NUMBER
I ,,:;,. '^I
RENTAL AGREEMENT NUMBER
Please snow lhis number on
all correspondence
l!l'"iJ/ "":"!':j~,I';
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he/she elects to relurn Vehicle with less fuel than when rented, he/she will pay Penske's refueling service charge.
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MESSIAH VILLAGE STATEMENT
. .
100 Mt. Allen Drive
P.O. Box 2015
Mechanicsburg, PA 170552015
(717) 697-4666
Resident Number Date
000068208 01/31/2001
Page Amount Due
1 238.00
Resident ISABEllE C BATES
B
I MARTHA MIRAGLIA
L 64 OLD FEDERAL ROAD
L CAMP Hill. PA 17011
T
o
Date
Description
CharQes
Credits
Total
-3,689.00
3,689.00
3,927.00
238.00
Be9inning Balance
01/01/2001
01/16/2001
PC - SUSQUEHANNA SINGLE
PAYMENT RECEIVED - THANK YOU!
238.00
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Current Past 31-60 Days 61-90 Days 91-120 Days Over 120 Total Due....~. -.. ISABELLE C
I Due r- 238.00 jTES
0.00 0.00 238.00 0.00
ANCE CHARGE AFTER FEBRUARY 28. 2001 "---------
1%F1N
fA
WEST SHORE
E~1ERGENCY MEDICAL SERVICES
503 North 2\st Street. Camp Hill, PA 170\1-2204
(717) 761-1038 . 1-800-367-0512 (PA Only)
FEDERAL 10 # 23~2463002
INVOICE
INVOICE #: ( 9052::::4.3B )
DATE: (
1 1 /06/0(~
[lOB:
PATIENT:
OS/24/12 SSN: 177-16-0774
B!-\TES ., I E,(.iBEL.LE
100 MT ALLEN DR-MESSIAH
PI.] BClX 201~.)
MECHANICSBURG, PA 17055
BILL TO:
ISABELLE B(.\ TES
100 IVI"]" !-\LLEN DR--11ESE, H\H
PO BOX 201'5
MECHAN1CSBURG, PA 17<YS5
POLICY NAME:
INS. #:
INS. #:
ACCOUNT#: :::::J600
TRlP#: 9 <Y:52BLI.3B
DATE OF SERVICE: 11/06/00
PATIENT PICKED UP: MESS I AH V I L.L,':\GE
PATIENT TAKEN TO: HClL Y ~,PHn"]" HCI~,PITAL.
DESCRIPTION OF ILLNESS/INJURY:
4.~5'" .. 0 HEMCmm.IAGE
379..91 P?\ I 1\1 EYE
DESCRIPTION UNIT COST QTY. AMOUNT DUE
?\mbul ance Ba~5E~ Chi"~qe --. ElU, :~~?2 ,,2~: 1 2'::/:2 .. 2~5
t1 i 1 f~a9(~ Ch,::\f"'~~(~ ... BLS ~S. 7'~: '- :3 4~. . ~:.;O
'..'
COMMENTS: .lHHI. l"!(?c!'c c:ar'(~ h.:~~~i p,,'i cI tl-l(?'i I'"" PO\.....t 'j ell") Cl SUBTOTAL :3:~::6 .. 7~~5
*** bc.<l.).::'Inc:e ;-=5 t.h(~ CO'--PA Y r.~nd lor'" DEDUCTABL.E .:3.rnour
.)f-'M..JI' l'"'f!CjU 'i 1.....(~1E1 W(2 IJ 'j '1 '1 to YClU.. Y(JUf""' pl"ompt. p.;3.YlTl(-:~n' CREDIT 2::::9,,22
THANK YOU TOTAL :::'::7 .. ~5::~:
-~ =.._"
,1I.i'~"~~'!1r Ma,<;terCard and l..VfSA J Visa Accepted
, it..::""'IIIo>.:J
~
WEST SHORE
E~lLRGENCY MEDICAL SER VICES
503 North 21st Street. Camp Hill, PA 17011-2204
(717) 761-1038.1-800-367-0512 (PA Only)
FEDERAllD # 23-2463002
INVOICE
INVOICE #:
( ':;-}()~'~:'994.B'
. . ....... -
)
DATE: (
11/(>7/()()
[lOB:
PATIENT:
OS/21\/12 ,;SN' 177'-16-07"74.
BI-HI::!:i., I Sl-iBELLI::
100 MT ALLEN DR-MESSIAH
PO BOX ::'01~'j
MECHAN I CSBURG, PA 1JO~5"5
BILL TO:
ISr-)BELLE BATES
:l 00 I'IT 1-\1..1..1::1\1 DRnIVIl~!:iS I AH
PO BOX 201.~5
~ECHAI\IICSBURG, PA 17055
POLICY NAME:
INS. #;
INS. #:
ACCOUNT#: :::::3600
TRIP#: ')!y:,;Z'::":;'4B
DATE OF SERVICE: :l :l/07 100
PATIENT PICKED UP: MESSH.)H \lILLACE
PATIENT TAKEN TO: !-l1-\F(R1SBURG Hm:iPITI-\L
DESCRIPTION OF ILLNESS/INJURY:
900.9 Head Injury
~'5~:,::3" ') ))1 (.\HPHEI-\
DESCRIPTION UNIT COST QTY. AMOUNT DUE
Ambu '{ i:\nC(:.~ Ba'ir,8 Chi.r'\;j(? ... ElI..E, :;::,)2,,2~' :l 2':)2" 2C"5
Mi leaqe Chi~t-'ge .- BLS ~5 . .,. 9 ~ij, . 7~5
".
COMMENTS: .~{..~I"~I' l"'IE~d'i c:alP'oe hl"S pi.iel tl1E~'i ,,.... PDI"'t i on C). SUBTOTAL ::?.l~4 ..00
*~.* ba 1 .;;i\nCE' i (~ t.h(~ CO'-F'A Y and/or DEDUCTABL.E amour
-'!.\>.}\-.~\. I~'P-qu -j 1"'(~~3 1.A.1(-?, bi 1 1 t" YCHJ" yDUl.... I:ll-(Jmpt pi~vmellt CREDIT :304,,2:l
THANK YOU TOTAL ::~19" 79
,~" MasterCard and E~l Visa Accepted
''''''''''''''''.9".
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
ISABELLE C. BATES
FILE NUMB~1_00_0042
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)
1. !lAUGHTER 100% of
MARTHA R. MIRAGLIA
64 Old Federal Road Rest, residue
Camp Hill, P A 17011 & remainder of
estate
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
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, insert additional sheets of the same size)
~
LAST WILL AND TESTAMENT
OF
ISABELLE C. BATES
I, ISABELLE C. BATES, of 233 Messiah Village,
Mechanicsburg, (Upper Allen Township), 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, unto my daughter,
MARTHA R. MIRAGLIA, of Camp Hill, Pennsylvania.
THIRD: Should my daughter, MARTHA R. MIRAGLIA,
predecease me, 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. Fifty percent (50%) thereof to my son-in-law, CHARLES
J. MIRAGLIA of Camp Hill, Pennsylvania; and
B. Twenty-five percent thereof (25%) thereof to my sister,
EliZABETH C. BITNER, of Mechanicsburg, Pennsylvania, provided
that should EliZABETH C. BITNER predecease me, I give, devise and
bequeath her share as provided for in this subparagraph B unto her issue,
share and share alike; and
C. Twenty-five percent (25%) thereof to my sister,
LOUISE C. DECKER, of Waynesboro, Pennsylvania, provided that
should LOUISE C. DECKER predecease me, I give, devise and bequeath
her share as provided for in this subparagraph C to my son-in-law,
CHARLES J. MIRAGLIA of Camp Hill, Pennsylvania.
FOURTH: 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
. ~
1 j 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,
d 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
i\~.
,~ property and to receive the proceeds of any disposition.
(B) To partition, subdivide, or improve real estate and to
tI
2
enter into agreements concerning the partition, subdivision, improvement,
zoning or management of real estate and to impose or extinguish restric-
tions 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 pro-
ductivity.
(E) To exercise any option, right or privilege granted in
J
~
~
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, per-
sonal income, gift and estate or inheritance tax laws.
(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.
(1) To select a mode of payment under any qualified retire-
ment plan (pension plan, profit sharing plan, employee stock ownership
plan, or any other type of qualified plan) to the extent authorized by the
3
plan or the law.
FIFTH: I nominate and appoint my daughter, MARTHA R.
MIRAGLIA, Executrix, of this, my Last Will and Testament. In the
event of the death, resignation or inability to serve for any reason whatso-
ever of MARTHA R. MIRAGLIA, I nominate and appoint my son-in-
law, CHARLES J. MIRAGLIA, Executor, of this, my Last Will and
Testament. I direct that my Executrix or Executor, as the case may be,
shall not be required to post security or a bond for the performance of his
or her duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and
seal to this, my Last Will and Testament, this I &rt day of November,
2000.
~~/ E/" cz.:;~
ISABELLE C. BATES
(SEAL)
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 witnesses.
~ 1/ I /7.". ,II ()
I/vj 3>tlt.5L(~'~."H,il. p,'!- 17lJ( / 1JfJlU L J j"...X
Address Name 0
%7 b;tI'3t.M~ Mechantrs/1/J'j, A /7055 (Z.....flJi~ctfCa.~ .
Address Name
4
PETITION FOR PROBATE and GRANT OF LETTERS
No.
To:
Register of Wills for the
, Deceased. County of Cumberland in the
Social Security No. 177-16-0774 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner~), who is/are 18 years of age or older an the executrix
in the last will of the above decedent, dated November 10
and codicil(s) dated
21-01-42
Estate of Isabelle C. Bates
also known as
named
--2.0..0..0
(state relevant circnmstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in ~nmhprl ::lInif
h er last family or principal residence at 7~~ MPRRi ::lIh
TTpppr Allpn Township, ppnnsylvania
(list street, number and muncipality)
County, Pennsylvania, with
Vill::l19P, Mpl"'h::llnil"'Rhnrg,
Decendent, th~n. RR years of age, died December. 22 , 2000.,
at Holy Sp~r1t Hosp1tal, East Pennsboro Townsh1p, Pennsylvan1?
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in P:::.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
$ 300, DCO, 4:'0
$
$
$
WHEREFORE, petitioner61) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters testamentary
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
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en
Martha R. Miraglia
64 Old Federal Road
Camp Hill. PA 17011
'1J7~dj<, ::7),+
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA I ss
COUNTY OF C~JMBERLAND J
The petitioner~) above-nCl.med swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(30 and that as personal represen-
tative(~ of the above decedent petitionerl.X) will well and truly administer the estate according to law.
Sworn 10 0' aff"med aile subsc,;bed t/}nprd1A.< t. /)}1."7)2 ~ ;"
before me this 9th day of .' ~
: JANUARY I )lr.L001_ ~
>>:P/LI/rz,~u~ ' ~
/ Register ~
/6--c:20/- ~
No. :n-Ul-4L
Estate of
ISABELLE C. BATES
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW JANUARY 9, ~2001 , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated November 10, 2000
described therein be admitted to probate and filed of record as the last will of
Isabelle C. Bates
and Letters Testamentary
are hereby granted to Martha R. Miraglia
'--,~/) ~ \ ~ I /7 ~
/(L./t2:lc.r <Jr?-?Ut~/2flU .Il..!.tj ~.u6//
/ ~egister of Wills II
FEES
Probate, Letters, Etc. .........
Short Certificates( )..........
~-pag~s
KefluIfclation ................
JCP
$
$
$
$ 5.00
TOTAL _ $ 334.00
.. .. ;r.~~~~~. ?... .~~9.1. . .. . .. .. .. . .
305.00
15.00
9.UU
Andrew C. SheelY 62469
12 7 A TTOI<NEY (Sup. ~l. LD. No.)
S. Market Street, P.O.
Mechanicsburg, FA 17055
ADDRESS
Box 95
717-697-7050
Filed
PHONE
<. _._.~
. .
21-00-42
REGISTER OF WILLS OF CUMBERLAND COUNTY
OATH OF SUBSCRIBING WITNESS
Andrew C. Sheely and Ann W. Martin
(each) a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that they were present and saw
Isabelle C. Bates
the testatr ix, sign the same and that the y signed as a witness at the
request of testat--Lix.... in IE r presence and (in the presence of each other)
Sworn to or affirmed. a~d subscribed before
me this g-t;7 day of
,~~'Ia~L404-
~ '-
NOTARIAL SEAL
KATHLEEN A. SrIEELY, Notary Public
Mechanicsburg Boro, Cumberlond County
My Commission Expires Auguzt 25, 2003
/!v,)J C &~
.
I \'1.- N, -3 O~ S._AN(f~4J Ife--N / (4 710 I (
(LJ%~~JI
(Name)
C}{)7IJJnrzy !.JJJL /f}ecl1cUI/c:::/)Wq A /7&55
- rAddress) J
REGISTER OF WILLS OF COUNTY
OATH OF NON-SUBSCRIBING WITNESS
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
familiar with the signature of
codicil
will
that
testat_ of (one of the subscribing witnesses to) the
presented herewith and
codicil
believes the signature on the will is in the handwriting of
to the best of
knowledge and belief.
Sworn to or affirmed and subscribed before
me this day of
19_
Register
(Name)
(Address)
(Name)
(Address)
:\.
Jut the information here given is correctly copied from an original certificate of death dIlly filed with me as
!Ie original certificate will be forwarded to the State Vital Records Office for permanent 'filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
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liff'._ . :6\...
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COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
TYPEiPRINT
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PERMANENT
BLACK INK
srAJff'lfMiMftER
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Mechanicsburg, Pa.
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NAME AND ADDRESS OF FACiliTY
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lICENSE NUMBER
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UCENSE NUMBER DATE SklNED
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
09-03-2001
BATES
12-22-2000
21 01-0042
CUMBERLAND
101
ANDREW C SHEELY
127 S MARKET ST
PO BOX 95
MECHANICSBURG
ESQ
PA 17,055
Amount Remitted
REY-1547 EX AFP el2-00l
ISABELLE
C
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV=i54-;-EX-AFP-(i"~f=ooT-NOTicE--OF-INHEifi;:AN-CE-TAjtAPPRJfiSEMENT-:--AL'LOWANCE-oi-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BATES ISABELLE C FILE NO. 21 01-0042 ACN 101 DATE 09-03-2001
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
TAX RETURN WAS: (X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
I~ an assessment was issued previously, lines
re~lect ~igures that include the total o~ ~
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate
16. Amount of Line 14 taxable at Lineal/Class A rate
17. Amount of Line 14 at Sibling rate
18. Amount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
PAYMENT
DATE
03-13-2001
07-25-2001
NOTE:
RECEIPT
NUMBER
AA478149
CD000083
DISCOUNT (+)
INTEREST/PEN PAID (-)
795.26
.00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
CHANGED
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
26,014.66
29,615.62
319,312.49
.00
(8)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
374,942.77
21.023 82
353,918.95
.00
353,918.95
14, 15 and/or 1&, 17, 18 and 19 will
returns assessed to date.
.00
15,926.35
.00
.00
15,926.35
15,926.37
.02CR
.00
.02CR
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
(9)
(10)
14,505.19
6,518.63
(1)
(2)
(13)
(14)
(5)
(16)
(17)
(18)
.00 X 00 =
353,918.95 X 045 =
.00 X 12 =
.00 X 15 =
(19)=
AMOUNT PAID
15,110.00
21. 11
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
RESERVATION: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S.
Section 9140).
Detach the top portion of this Notice and submit with your pay.ent to the Register of Wills printed on the reverse side.
--Make check or money order payable to: REGISTER OF MILLS, AGENT
A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office
of the Register of Wills, any of the 23 Revenue District Offices, or by calling the special 24-hour
answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-3020 (TT only).
Any party in interest not satisfied with the appraise.ent, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5Z) discount of
the tax paid is allowed.
The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax a.nesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which beca.e delinquent before January 1, 1982 bear interest at the rate of
six (6Z) percent per annum calculated at a daily rate of .000164. All taxes which beca.e delinquent on and after
January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2001 are:
Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor
1982 20Z .000548 1992 9Z .000247
1983 16Z .000438 1993-1994 ]X .000192
1984 HZ .000301 1995-1998 9Z .000247
1985 13Z .000356 1999 ]X .000192
1986 10Z .000274 2000 8Z .000219
1987 9Z .000247 2001 9Z .000247
1988-1991 HZ .000301
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If pay.ent is made after the interest computation date shown on the
Notice, additional interest must be calculated.
t::-
---
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
NAME OF DECEDENT:
Isabelle C. Bates
Date of Death:
December 22, 2000
Will No: 21-01-0042
To the Register:
I hereby certify that Notice of Beneficial Interest required by Rule
5.6(a) of the Orphans Court Rules was served or mailed to the following
beneficiaries of the above-captioned Estate on January 10, 2001.
Martha R. Miraglia
Daughter
64 Old Federal Road
Camp Hill, PA 17011
Notice has now been given to all persons entitled thereto under Rule
5.6(a) except: NONE
Andrew C. Sheely,
PA ID NO 62469
P.O. Box 95
1 27 S. Market Street
Mechanicsburg, PA 17055
717-697-7050
Counsel for Personal Representative,
Martha R. Miraglia, Executrix
DATE: January 10, 2001
fhAJ (J
__'~l
ANDREW C. SHEELY
ATIORNEY AT LAW
Telephone: (717) 697-7050
127 South Market Street
P.O. Box 95
Mechanicsburg, Pennsylvania 17055
Fax: (717) 697-7065
March 13, 2001
Register of Wills
Cumberland County Courthouse
Carlisle, PA 17103
ft
RE: The Estate of Isabelle C. Bates
No. 21-01-0042
Date of Death: December 22, 2000
Dear Register of wills:
I represent the Estate of Isabelle C. Bates. Enclosed is a
check made payable to the Register of Wills in the amount of
$15,110.00, same constituting a prepayment on account of
pennsylvania inheritance taxes in the above-captioned estate.
Your time and consideration in this matter is greatly
appreciated. Please forward a receipt on account of this payment
to me as is your standard custom.
vp~~
ANDREW C. SHEELY
ACS/bmk
Enclosure
c: Martha R. Miraglia, Executrix
C"'
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DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128,0601
RECEIVED FROM:
ANDREW C SHEELY ESQUIRE
127 S MARKET STREET
POBOX 95
MECHANICSBURG, PA 17055
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OFFICIAL RECEIPT
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NO. CD 000083
ANDREW C. SHEELY
ATTORNEY AT LAW
Telephone: (717) 697-7050
127 South Market Street
P.O. Box 95
Mechanicsburg, Pennsylvania 17055
Fax: (717) 697-7065
July 23, 2001
Register of wills
Cumberland County Courthouse
Carlisle, PA 17013
RE: The Estate of Isabelle C. Bates
No. 21-of-00042
Date of Death: December 22, 2000
Dear Register of Wills Lewis:
I represent the Estate of Isabelle C. Bates. Enclosed for
filing please find an original and one copy of the Pennsylvania
Inheritance Tax Return for the above-referenced Estate. In
addition, I am enclosing two (2) checks. One check is in the
amount of $15.00 and constitutes the fee for filing the return.
The second check is in the amount of $21.11 and is made payable to
the Register of Wills, Agent, same constituting the remaining
pennsylvania inheritance taxes due in the above-captioned estate.
A prepayment in the amount of $15,110.00 was previously made.
Please provide me with the appropriate receipts in this
matter.
Your time and consideration in this matter is greatly
appreciated.
v~rJQ3tt~
ANDREW C. SHEELY
ACS/bmk
Enclosures
c: Martha R. Miraglia, Executrix
~
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Isabelle C. Bates
Date of Death: December 22, 2000
Will No.
Admin. No .21-01-0042
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes X No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No y:.
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes X No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
4uCO~
~ignature
Date:
f()J/J / f) I
I I
Andrew C. Sheely, Esquire
Name (Please type or print)
PO Box 95, 127 South Market Street
Mechanicsburq, PA 17055
Address
( 717) 697-7050
Tel. No.
Capacity:
Personal Representative
X
Counsel for personal
representative
(MAH:rmf/AM3)