HomeMy WebLinkAbout06-22-15 J �i:�Pennsy�vania 15 0 5 61410 5
� °E"�"r"�'T°`�v�"�E EX(03-14)(FI)
REV���OO I�FFICIAL USE ONLY
Bureau of Individual Taxes �ounty Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN A1� I I� ��U
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
01112015 11211953
DecedenYs Last Name Suffix DecedenYs First Name MI
HALE CATHERINE L
(If Applicable)Enter Surviving Spouse's Informatlon Below
Spouse's Last Name Suffix Spouse's First�Jame MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH 7HE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1.Original Retum p 2.Supplemental Retum Cp 3. Remainder Retum(date of death
priorto 12-13-82)
p 4.Agriculture Exemption(date of p 5. Future Interest Compromise(date of � 6. Federal Estate Tax Retum Required
death on or after 7-1-2012) death after 12-12-82)
p 7. Decedent Died Testate p 8.Decedent Maintained a Living Trust _,_ 9. Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
p 10. Litigation Proceeds Received p 11.Non-Probate Transferee Retum (� 12. Deferral/Election of Spousal Trusts -
(Schedule F and G Assets Only)
O 13. Business Assets O 14.Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX IMFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
KATHLEEN K. SHAULIS (717)243-6655
First Line of Address
P.O. BOX 1229
Second Line of Address
City or Post Office State ZIP Code
CARLISLE PA 17015
,
CorrespondenYs emaii aadress: Jrs037carliste@sprintmaiLcom �=_' � �
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REGISTER QF S USE NL'Y '.�.? C:..
�-� -^, ,�., ,.;'�i ::�,
REGISTER OF WIILS USE ONLY _ ' � '
DATE FfLED MMDDYYYY �� � �
. , �
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. ; ; '' '.:_ '�
_,� ,
�' ~� _. ;:�
DATE FILED$TAMP �U ` �
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C.G) . �
PLEASE USE ORIGINAL FORM ONLY
Side 1
� i iiiiii iiiii iiiii���������������iiiii iiiii iiii iiii 15 0 5 61410 5 J
��N
� 15�5614205
REV-1500 EX{FI}
DecedenYs Social Security Number
oPoeaenr,N�m�:: Catherine L. Hale ',
RECAPITULATION __
1. Real Estate(Schedule A). . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . 1. 0.00 ',
2. 5tocks and Bonds(Schedule B) z. 0.00 '
3. Closefy Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . . . . . 3. ', 0.00 '
4. Mort a es and Notes Receivable(Schedule D 4. �.00 d
9 9 } . . . .. . . . . . . . . . .. . . . . . . . . . . .
5. Cash, Bank Depasits and Misceilaneous Personal Property{Schedule E). . . . . . . `�. 1,584.10 '
_
6. Jointly Owned Property(Schedule F) C� Separate Billing Requested . . . . . . . 6. 0.00 '
?. inter-Vivos Transfers&Miscellaneous Non-Probat�:Properfy
{Schedule G) O Separate Billiny Requested.. . . . . . . 7. O.00 ',
8. Total Gross Assets totai Unes 1 thrau h 7 g. ' 1,584.10 ;
� 9 ). . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. Funeral Expenses and Administralive Costs(Scheduie H}. . .. .. . . . . . . . . .. . . . 9. ' 3,41�.�� i
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule i). . . . . . . . . . . . . . . 1O. ', 568.15 '.
11. Total Qeductions(total Lines 9 and 10). . . . . . . . . . . . . . . . . . .. . . . . . . . . . .. . . 11. ' 3,979.15
12. Net Value of Estate(Line 8 minus Line 11) . .. . . . . . .. . . . . . . .. .. . . . . . . . . . . 12. -3,395.05 `
13. Charitable and Govemmental Bequests/Sec.9113 Trusts for which
an election to tax has not been made(Schedule J) . .. . . . . . . . . .. . . . . . . . . . . . 1;i. 0.00 '
14. Net Value Subject to Tax(Line 12 rrunus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. ' -3,395.05
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 _
(a){1.2)X .0_ ' ', 15. '
_ _ _
16. Amount of Line 14 taxable '
at lineal rate X.0_ ' ��� ',
17. Amount of Line 14 taxable
at sibling rate X .12 ', ' 1 T• '
_ .__.._ _
1$. Amount of Line 14 taxable ' '
at collateral rate X.15 ' �8• ' '
19. TAX DUE . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . .. . .. . . . . . . . . . . . . . . . . . 19. D.U�
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND QF AN OVERPAYMENT O
Under penalties o(perjury, I declare I have examined this retum,including accompanyiny schedules and statemr;nts,and to the best of my knowledge and belief.
it is true, correct and complete. Declaration of preparer other than the person responsible for filing the retum is based on all information of which preparer has
any knowledge.
SIGNATURE OF PERSUN RESPONS BLE FOR FILING RETURN DATE
„�i t i y-�'{`L��-. `.�_�C�/.�'/y,� L=-�-'►"'c',�-. �si _//�/J
ADDRFSS
Dorothy Hockenberry, sister, 299 N. Locust Point Road, New Kingstown, �'A 17072
SIGN RE F REPARE QTf Thi PERSON SPONSIBL FQR FILING THE RETURN Df1TE
� aa- � s"
ApDR SS
Kat leen K. Shaulis, Esq. P.O. Box 1229, Carlisle, PA 17013
� I 1"�'�I�I'I�II�)�l�II'lII"���I II�II�����I������I�I�������I Side 2 �
1505614205 1505614205
REV-1508 EX+ (02-15)
i �� pennsylvan�a SCI�IEDULE E
`� DEPARTMENTOFREVENUE CASH, BANK DEPOSITS &MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT .
ESTATE OF: FILE NUMBER:
Catherine L. Hale
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disciosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION _ OF DEATH
�� Checking account-#9838682665,M+T Bank 5219 Simpson Ferry Road,Mechanicsbur,PA 17055 1,584.10
TOTAL(Also enter on Line 5, Recapitulation) � 1,584.10
If more space is needed,use additional sheets of paper of the saane size.
REV-1511 EX+ (02-15)
i 4� pennsylvania SCHEDULE H
�� DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CATHERINE L. HALE
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION _ AMOUNT
A. FUNERAL EXPENSES:
1' NEIL FUNERAL HOME INC.3401 MARKET STREET CAMP HILL, PA 1701 3,411.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions;
Name(s)of Personal Representative(s) _______
Street Address
Ciry State_____._"1_IP
Year(s)Commission Paid:
2. Attorney Fees:
3. Family Exemption: (If decedent's address is not the same as ciaimant's,attach explanation.)
Claimant
Street Address
City State____._7_IP
Relationship of Claimant to Decedent
4, Probate Fees:
5. Accountant Fees:
6. Tax Return Preparer Fees:
7.
TOTAL(Also enter on Line 9, Recapitulation) ; 3,411.00
lf more space is needed,use additional sheets of paper of the same size.
REV-i512 EX+ (02-15)
�i ��� pennsylvania SCHEDULE I
� DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES 8e LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CATHERINE L. HALE
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VpLUE AT DATE
NUMBER DESCRIPTION OF DEATH
1• CAPITAL BLUE CROSS 169.09
2 PPL 281.50
3 COMCAST 27.55
4 VERIZON 90.01
TOTAL(Also enter on Line lq, Recapitulation) � 568.15
If more space is needed,insert additional sheets of the same size.
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Section 3101 - Title 20 - DECEDENTS, ESTATES AND FIDUCIARIE5 Page 1 of 3
CHAPTER 31
DISPOSITIONS INDEPENDENT OF LETTERS;
FAMILY EXEMPTION; PROBATE OF WILLS
AND GRANT OF LETTERS
Subchapter
A. Dispositions Independent of Letters
B. Family Exemption
C. Probate
D. Grant of Letters
E. Personal Representative; Bond
F. Personal Representative; Revocation of Letters; Removal and
Discharge
Enactment. Chapter 31 was added June 30, 1972, P.L.508,
No. 164, effective July 1, 1972.
SUBCFiAPTER A
DISPOSITIONS INDEPENDENT OF LETTERS
Sec.
3101. Payments to family and funeral directors.
3102. Settlement of small estates on petition.
Cross References. Subchapter A is referred to in section 3126
of this title.
� 3101. Payments to family and funeral directors.
(a) Wages, salary or employee benefits.--Any employer of a
person dying domiciled in this Commonwealth at any time after the
death of the employee, whether or not a personal representative
has been appointed, may pay wages, salary or any employee benefits
due the deceased in an amount not exceeding $5, 000 to the spouse,
any child, the father or mother, or any sister or brother
(preference being given in the order named) of the deceased
employee. Any employer making such a payment shall be released to
the same extent as if payment had been made to a duly appointed
personal representative of the decedent and he shall not be
required to see to the application thereof. Any person to whom
payment is made shall be answerable therefor to anyone prejudiced
bndaloan association, building and loan assoc uw1i N�..`�m,~~y�.���:~*'eg'..
b) D@posit aecouat.--Any bank, savings association, savin s�
iat' on, credit union
or other savings organization, at any time after the death of a
depositor, member or certificate holder, shall pay the amount on
deposit or represented by the certificate, when the total standing
to the credit of the decedent in that institution does not exceed
$10, 000, to the spouse, any child, the father or mother or any
sister or brother (preference being given in the order named) of
the deceased depositor, member or certificate holder, provided
that a receipted funeral bill or an affidavit, executed by a
licensed funeral director which sets forth that satisfactory
arrangements for payment of funeral services have been made, is
presented. Any bank, association, credit union or other savings
organization making such a payment shall be released to the same
extent as if payment had been made to a duly appointed personal
representative of the decedent and it shall not be required to see
to the application thereof. Any person to whom payment is made
shall be answerable therefor to anyone prejudiced by an improper
' stribution.
�n�"`==fnTh'e n'�fie"�'"cl e c e"'�'4� ,,,,...
recipient of inedical assistance from the Department of Public
http://www.legis.state.pa.us//WU01/LI/LI/CT/HTM/20/00.031.001.0OO..HTM?72 6/11/2015 ,
`q
Section 3102 - Title 20 - DECEDENTS, ESTATES AND FIDUCIARIES Page 1 of 1
� 3102. Settlement of small estates on petition.
When any person dies domiciled in the Commonwealth owning
property (exclusive of real estate and of ro erty a able under
s ction 310 relating to payments to ami y and funeral
i o , but including personal property claimed as the family
exemption) of a gross value not exceeding $50, 000, the orphans '
court division of the county wherein the decedent was domiciled at
the time of his death, upon petition of any party in interest, in
its discretion, with or without appraisement, and with such notice
as the court shall direct, and whether or not letters have been
issued or a will probated, may direct distribution of the property
(including property not paid under section 3101) to the parties
entitled thereto. The authority of the court to award distribution
of personal property under this section shall not be restricted
because of the decedent's ownership of real estate, regardless of
its value. The decree of distribution so made shall constitute
sufficient authority to all transfer agents, registrars and others
dealing with the property of the estate to recognize the persons
named therein as entitled to receive the property to be
distributed without administration, and shall in all respects have
the same effect as a decree of distribution after an accounting by
a personal representative. Within one year after such a decree of
distribution has been made, any party in interest may file a
petition to revoke it because an improper distribution has been
ordered. If the court shall find that an improper distribution has
been ordered, it shall revoke the decree and shall direct
restitution as equity and justice shall require.
(Dec. 10, 1974, P.L.867, No.293, eff. imd. ; July 11, 1980,
P.L.565, No. 118, eff. 60 days; Dec. l, 1994, P.L. 655, No. 102, eff.
60 days; July 2, 2013, P.L. 199, No.35, eff. 60 days)
2013 Amendment. Section 2 of Act 35 provided that the
amendment of section 3102 shall apply to estates of decedents
dying on or after the effective date of section 2 .
1994 Amendment. Section 10 of Act 102 provided that the
amendment of section 3102 shall apply to estates of decedents
dying on or after the effective date of Act 102.
http://www.legis.state.pa.us//WU01/LI/LI/CT/HTM/20/00.031.002.0OO..HTM?73 6/11/2015
ler: Neill Funeral Home,Inc. Contract.#- 741101000551
3401 Mazket Streei 3501 Derrv Stzeet
Camn Hill.PA 170114428 Harrisbur�.PA 17111 Case.#-35116�645
(717)737-8726 717-564-2633
Kevin J.Shillabeer,Supervisor Stephen J.Wilsbach,Supervisor
Part One of Three Parts'
Statement of Funeral Goods and Services Selected/Purchase Agreement
ite of Death O1/11/2015 Date of Service O1/17/2015
me of Deceased C3thet'llle H31e Date of Birth 11/21/1953
ceased's Last Address 1057 Allendale Rd,AUt.G ��tY Mechanicsburg State�_Zip Code1'7055-4459___
rchasei s Name Dorothv Hockenberrv Phone Number (717)697-7538
rchaser's Home Address 299 N Locust Point Rd �ity New Kin�stown State pp Zip Code 17072
-Purc6aser's Name Phone Number
-Purchaser's Home Address City State Zip Code
this Agreement the words you and your refer to the Purchaser and the Co-Purchaser,if any,signing this Agreement.The words we,us and our refer to the Funeral Provider or
ller whose oame and address appeaz above.For good and valuable coasideratioq which each pazty acknowledges receiving,you agree to buy the goods and services described
low.You authorize us to prepaze and caze for the body of the decedent named in this Agreement and to conduct the funeral and services and incur the chazges listed in said
;reement.We have the right to collect the total amounts due under this Agreement from any person who signs this Agreement as Purchaser or Co-Purchaser.(N/A indicates
ms ofservice and/or merchandise that are not Drovided) —
�arges are only for those items that you selected or that are required.If we are requ�red by law or by a cemetery or crematory to use any�tems,we will ezplain the
asons in writing below.If you selected a funeral that may requireembalming,such as a funeral with viewing,you may 6ave to pay for embalming_You do not have to
y for embalming you did not approve if you selected arrangements such as a direct cremation or immediate burial.If we charged for embalming,we will esplain why
low.
:CTION I -SERVICES AND MERCHANDISE MERCHANDISE
INERAL DIRECTOR AND STAFF SERVICES Casket or Altemative Container:
iasic Professional Service Fee $ Incl Manufacturer/Supplier
�CKAGE OFFERINGS � 2,355.00 ModelName/Number
)irect Cremation Material
mmediate Burial � "�a Species of Wuod
'orwarding Remains $ �a Type of Metal
;eceiving Remains $ �a WeighUGaugP
$ '�a Interior
� �a Exterior Color � �d
Outer Bwial Container:
1RE AND PREPARA710N OF REMAlNS Manufacturer/Supplier
imbalmin � �a
Model Name/Nurnber
)ther Preparation(specify) � n/a
Material
RPfTigPration $ 170� Urn: '
a �a Manufacturer/Suppiier
b $ �a Model Name/�Iumber
$ �a Material $ �a
$ n/a $ n/a
3E OF FACILITIES AND RELATED SERVICES $ '�a
lisitation $ n�a $ �a
�uneral Ceremony �w 395.00 TOTAL SECTION I_ $ 3,145.00
�Iemorial Service $ "�a
SECTION II-CHARGES TO BE INCURRED BY US ON
3raveside Service $ "�a YOUR BEHALF(Cerfain charges may be estimated='e"means
�ther(specify): esfimated.)
� �a We charge you for our services in obtaining those items marked with an'X'
Cemeterv $ �a
$ n/a — $ n/a
2ANSPORTATION $ �a
Cransferring Remains to Funeral Home $ Incl Musicians or Singers $ �a
�uneral Vehicle/Hearse $ �a Certified Copies $ 36.00
i�/a-
�ther(specify}: Newspaper Notices 2p0.00 ''-
,T'ransf*r��*F*�**�rrematorv � Tncl �a
Servi e Vehicle $ Tncl
� e� n/a
S n!a n/a
_ __: n/a
$ n/a pey�t 30.00
5 n/a � n/a
$ n/a
THER GOODS AND SERVICES $ �/a
Memorial Booklet $ �a S n/a
Service Folders � �a $ n/a
b �a ----____._..,., ..t,N..� �
� n/a Model Name/Number
� n/a Material $ �a
SE OF FACILITIES AND RELATED SERVICES $ n/a
Visitation $ � n/a
n/a $ /a
Funeral Ceremony $ 95 nn
�femorial Service $ TOTAL SECTION I $ 3 145 00
3raveside Service $ n�a SECTION II-CHARGES TO BE INCURRED BY US ON
Jther(specify): YOUR BEHALF(Certain charges may be estimated='e"means
$ �a estimated.)
$ �a We charge you for our services in obtaining those items marked with an'X'
� n/a Cemete � �a
:ANSPORTATION $ �a
'ransferring Remains to Funeral Home $ ��PT� $ n/a
°� Musicians or Singers _� �y
uneral Vehicle/Hearse $ �a
ther(specify); Certified Copies $ 36.00
Transfer to nr Frnm('rem^torv $ Newspaper Notices $ �a
Serv�ce Vehicle $ T� � 200.00
$ n/a
g �a n/a
$ �a n/a
n/a
30.00
$ n/a
1ER GOODS AND SERVICES $ �a
:morial Booklet $ �a $ r�/a
rvice Folders $ g �a
n/a
ryer Cards $ g �a
know(edgement Cards $ �a 3 n/a
morial Package $ �a $ n/a
°mation Fee
$ 395.00 $ �a
$ $ n/a
$ n/a
$ TOTAL SECTION II $ 266.00
$ n/a
$ TOTAL SECTION 1 CHARGES- S '�145 nn
$
� $ TOTAL SECTION II CHARGES $ 266 00
n/a
$ �a TOTAL SECTION I AND SECTI N 11 CHARGES $ 3 411.00
$ n/a
$ �a � /����� ' � /���/SS
� a
� PURCHASER'S INITIAT,S AND DATE ' WI'IN S'INITIALS AND ATE
n/a
$ . a ;::
— -- --- - __ _. _ _ . _
_ . _ __
S
INDIANTOWN GAP NATIONAL CEMETERY
The monument will be inscribed as shown. It will be si�ty days before the permanent headstone is
received. If we do not hear from you by the below date with corrections or additions,we will consider
this inscription correct.
REPLYBYNOON
JAN 26 2015
AUDIE E HALE
PFC US ARMY WWII
SEP 27 1915 MAY 28 2007
CATHERINE HALE
NOV 21 1953 JAN 11 2015
OPTIONAL INSCRIPTION
.:,
THE INFORMATION ABOVE WILL BE INSCRIBED ON THE MONUlV�NT AND IS
CONSIDERED TO BE CORRECT Ur1LESS YOU CONTACT THE CEMETERY BY THE ABOVE
DATE WITH CORRECTIONS.
OPTIONAL INSCRIPTIONS ARE AVAILABLE AT NO COST.THE INSCRIPTION WILL CONSIST
OF ONE (1) LINE NOT TO EXCEED 22 CHARACTERS iNCLUDING SPACES.
� � � ",� � � �- � �
, 1 �ti � � 5 � �, �
CEMETERY OFFICE HOURS
MONDAY-FRIDAY(EXCEPT HOLIDAYS)
8 A.M.TO 4:30 P.M.
PHONE: (71'n 865-5254
FAX: (71'n 865-5256
Capital BLUe �•��
8_�1
Individual Billing Invoice Date: O1/30/2015
' Subscriber ID: 801149083 Current Premium: $169.09
Invoice Number: 150300000314 Retroactive Adjustment: $0.00
Payment Due Date: 03/O1/2015 Adjustment: $-338.18
SuUscriber Name: Catherine L Hale Past Due Premium: $0.00
Contract Type: Subscriber Only Total Premium Due: $-169.09
Plan ID: Security F Coverage Period: O1/O1/2015 -O1/31/2015
This is your billing invoice from Capital B1ueCross If you have any questions regarding this invoice, contact us by
calling the Customer Service telephone number located on the back of your identification card Payments are due on
or before the due date to ensure prompt clauns service
Thank you for choosing Capital B1ueCross as your health insurance carriec
If you have children under the age of 19,they may be eligible for free or lo�cost coverage through the Children's
Health Insurance Program(CHIP).Call 1-800-KIDS-101 (1-800-543-7101)for more information.
PLEASE PAY THE AMOUNT INDICATED ABOVE FOR"TOTAL PREMNM DUE." MAKE
CHECK PAYABLE TO CAPITAL BLUE CROSS AND INCLUDE YOUR SUBSCRIBER ID
ON YOUR CHECK.
IF YOU ARE 1NTERESTED IN ELECTROIVIC PAYMENT OPTIONS,PLEASE VISIT US ON THE WEB AT
www.mycapbluecross.com AND CLICK THE"PAY MY PREMIUM"LINK,OR CALL 1-877-889-7282 TO MAKE A
PAYMENT OVER THE PHONE.
TO ENSURE PROPER CREDIT,DETACH THE BOTTOM PORTION OF THIS INVOICE
AND RETURN WITH YOUR PAYMENT IN THE ENCLOSED ENVELOPE TO:
CAPITAL BLUE CROSS `"
PO BOX 779515
IIARRISBURG,PA 17177-9515
���� � � �o
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_. .. m _.,,..�.,.._�,.. . . , � _ . _ .� ,_. _. � DO�NOTFOLDOR�STAPLE
;
Subscriber ID Covera e Period Pa ment Due Date Notice Concernin Chan es Amount Due :
Check here for name,address and �
801149083 O1/O1/2015 -O1/31/2015 03/O1/2015 � °�1z�°�°a� $-169.09
see back eor;nstn,ctioas. .
Invoice No: 150300000314 16909
; : _ _
RETURN THIS PORTION WITH YOUR PAYMENT TO:
��Iln�l����l��l�l�l��������ll��ll�l���l�ll���l�������l��l���l��� �A�ITAL BLUE cRoss
CATT�RINE L HALE PO BOX 779515
1057 ALLENDALE RD APT G a-ol �-I�,RRISBURG,PA 17177-9515
MECHANICSBURG,PA 17055-4459
1300900�100��050801149�83001011562�1506200�0��169�933
SG�4�t���. �
� Questions?Please Visit us online at Fin�f Bill Page 1
.'�;;,,�,.
�'��"''�;;_ � contact us by Feb 25. pplelectric.com ,
p� . 1-804�DIAL-PPL � � � ,,
:=�� (1-800-342-5775� �80390-89086 Feb 25,2015 '��� �'`,�2�'��d�''';i ;�
��,,,��,,,tl.. � M-F:8am to 5pm
Your Electric Usage Profile Biliing Summary (Biuin�de�aiis on back)
Service to: Balance as of Feb 4,2015 $�r0.99
CATHERINE L HALE - Charges:
1057 ALLENDALE RD APT G Total PPL Electric Utilities Charges -$29•49
MECHANICSBURG, PA 17055
Meter:55723960 Total Charges $28].50
rtw� 1��yC L,�}�y. �yC , ` ���.;��i'
'. �ryr���,7r��},,1?��I�[,Y,pc,�.lk�Y�a� ���i t.�� ' ) r)lr f � i < ��� '� i � �i��� i� l i�
.�., u r, Iw .n(�G �iL.m_ <1�� I,� ,.,t�
This section helps you understand your year-to-year Account Balance $281.50
electric use by month. Meter readings are actual unless pp�Electric Utilities' price#o compare for your rate is$0.09318 per kWh.
otherwise noted. This changes the ist of Mar,Jun,Sept,and Dec.Visit papowerswitch.com
�2o�a �20�5 or www.oca.state.pa.us for supplier offers.
54 Your Message Center
Y4s . Budget Settlement Summary after 12 months:
36 We billed you $234.51
0 27 Including this bill,you used $234.51
� ia • We have subtracted $60.92 from this bili to settle your
a 9 Budget Billing Plan. ^
o • The$310.99 balance includes$2J6 in prior late �
� F M A M > > a s o N � payment charges. �
Months • Information about appliance energy use and tips on
saving energy are available through the Energy Library
� � , on our Web site, ppleledric.c�m/e-power
� � �
Feb 2015 . 7 Zzg 33 24F
Feb 2014- 30 1301 43 27F _
• • Payment Methods =
, Feb 3 Actual 85274 `f� Online at: �By phone:1-800-342-5775 _
- U pplelectric.com or cali BiIlMatrix(service fee applies)
Jan 27 Adual 85046 at 1-800-672-2413 to pay using Visa, -
7 Days kWh Billed 228 MasterCard, Discover or debit card. _-_
� � � � . . , � By Mail: Correspondence should be sent to:
Mar 2014-Feb 2015 5490 458 Z North 9th Street �� Customer Services _
CPC-GENN1 827 Hausman Road =-
Mar 2013-Feb 2014 8071 673 Allentown, PA 181�1-1175 Allentown, PA 181049392 _
Other important information on the back of this bill�
r
comcastm , Account Number 09547 238626-04-3
C Biliin Date 01/21/15
9
� Unpaid Balance $27.55-Due Now
Totai Amount Due $27.55
Page 1 of 2
ContaCt us: Q www.comcast.com� 1-800-XFINITY
CATHRINE HALE � � '�� ■-�
Previous Balance 27.55 '
For service at: Payments- received by 01/21/15 0.00 �.
1057 ALLENDALE RD APT G
MECHANICSBURG PA 17055-4459 Unpaid Balance - Due Now : 27.55 ;
Totai Amount Due $27.55 '
News from Comcast ,.� : . ,. .. ; , _
�e, ,•. �i« �.� �.�' r s' ��� ����Ca� ����.
We regret losing you as one of our subscribers. Our records � � ,i'i����" ' ' ' ' , .
indicate that the final balance shown above is now due.Your � ��': � �,j� ;���I'��I��,i�� �-���,� . +
prompt payment is appreciated.Any outstanding equipment �`��`` - �� F���-�` _�-��-��'�� ��
must be returned to our office within 7 days. Please call us at � _
1-800-COMCAST any time should you wish to reconnect your
m
service. N
0
Hearing/Speech Impalred Call 711
•�;•�:
�•,�.:
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r
i CATHERINE HALE GET ANSWERS FAST
Primary Phone: 717-766-2646
' Account Number: 717 766-2646 211 29Y • Click to chat at verizon.comlliveagent
• Call 1.800.VERIZON(1.600.837.4966)
� • Customers with disabilities call
�, Bill Date: January 19,2015 1.800.974.6006(Voice or TTY)
: �Account Summary ��, WHATCHANGED?
..
•Previous Balance 100.15 • You made changes to your services. ,
No Payment Received .00 Details on page 3. li
� Overdue-Please Pay Now 5100.15
�OFFERS d�BENEFITS
�
Your One-Time Activities 2•79 Before You Move... '
' Requested Change in Service -10.20 1/15- 1/18 Call 1-888-416-9691 and we'll help set i
' Fees 8 Other Charges -2�73 up your Intemet, TV and phone for your
Current Charges -510.14 new home. You can be up and running ?:
in no time! DON'T WAIT!And be sure i
Total Due - Please Pay Now $9�.�1 to ask if Verizon FiOS is available in
Your account has been disconnected. Any other charges or credits your area. Service availability varies. �
wi11 appear on your next bill. Overdue balances are subject to 1Ne Value You
' collection action. Pay your overdue charges today at �
venzon.com/paybill. We appreciate your business 8�want to
deliver the very best entertainment to
you. Call us at 1-888-456-0039 to find '
out about the new ways Verizon can
save you money. We enjoy being your �
provider, and we would like to keep you '
with us longer by improving your '
Verizon experience. ,
� � . � �
Never be late again! Auto Pay at verizon.com j '
myverizon and yau're atways on time,or use: �
• MY FiOS app ',
• Pay by phone at 1.800.837.4966
•verizon.com/paymentlocations to pay in person ��
• Mail(use the stub below)
— _.,,,.,,7.,---- ---- — ---- __ _ _ .v,---. _ - _ -- --- — -
Subtotal -52J3
Current Charges -�10.14
Total Due 590.01
Reference ID AZOICVA766
Page 3 of 5
HIUS.gpi REV r01111
LOCAL REGISTRAR'S CERTIFICAl'I�t����°�p OF DEATH
WARNING: It is illegal to duplicate this copy by phatcas�t.alt ��r photograph.
Fee for this certificate, $6.00 ,,����""""��-,-. �7'hi���, is to certify that the information here given is
�''d�P`�H�F PF�" c�o�-rc,„tl co ied from an ori inal Certificate of Death
,�� �. N,y= ' Y P �
,,�`o���`r�; ilu�l, filed with me as L�cai Registrar. The original
�c�/ �`, � �z, ��,it��icat�e will be forwarded to the State Vital
IvI y� �a� f e� ��r�ls Office for permanent filing.
'*� �'*,
_-�- �
�
a�' �� ���-�- I �_
P 21402356 -�`��q9rME E��~�''� ` � i�� .�Y
� � _��y�=
Certification Number ,,,,,,,,,,,����� l:,o,c��.l Registrar Dafe Issued
COMMONWEALTM OF PENNSYIVANIP•DEPRRTMEN�Of NEAItH•VITAI PECORDS
� CERTIFICATE OF DEATH S,a,eF;�eN�mm�:
z,se. 3.sonai x����ry N�mee. !.Date of OeatM1(MolDay/Vr��Speli Mo)
DecedmPs I.ega�Wme(Flrst,Middle,l�st,SuKx) Felnale 191-46- 1 Jan� 11. 2015
Catherine Hale
.Age-last Birthday�Vrs� Sb.UMer i Year Sc.Untler l0a 6.Dah of Birth�Mo/Day/Year�(Spell MonM� ]a.8irth��iS��State atr�f7o,relyn Countryl
Months Oay Hours Minu[es .
61 NOvember 21� 1953 �e.e�nnd•=<1cW�n�
�.PesiEeMe(SOh or forelgn Couneryl Bb.Pesiderice�Sheet and Number�InduEe Ap[No.) &.Did D��n1 ee^Tow hi�Lp1_ �1�- `W�
Penns lvania 1057 Allendale Rd �r•�, �E'�L
i.n<:ia��a�eo��cr) ❑ryo,deadent IHed wlNin Ilmi[s of__�_. cify/boro.
1 ee.ae:iaence lae code) � m r.:�mar.iaa�l
Ever in US Armed Forcesl 10.Marital5utus at Tlme af Deat� ❑Marn d �
Wldowed 11.SuniWngSpouse'sName�Ilwile,[�+enameprior
]Yes [�No ❑Unknown ❑Divorced ❑Never Marrled ❑Unkro�'13.Moth<r s Name Prlor[o Flrst Marrl�ge(Fint,M'iddk,l�f[)
i.Fa[her'sName�First,MidCle,l�s[,Sufflv) r�ry ��
bbses Dietrich . y�a,e n coae
Ca.ln(ormant'.cName 16b.Fela[ionshlpto0ecetlent 14 Informant'sMallingAEdress(StreetandNumber,Ciry,. . V I
Doroth Hock Sister 299 N. Ivcust Point New Kin stown PA 17072
Sa.P att o Oeath Chec e j]DeceCene's Nome
DeathOccurtedlnaHospttal: �Inpa[knl ill0ea[hOccu�red5omewhere0[herThanaHospital: ❑Mosplttianllty
�eadonArrrval � ON�rsingHame/long�lermGrefaclliry ❑��r�5pecily�___._
❑lmer6ency0.00m/Outpatien[ ❑ 15dCounlyo�DeatM1
Sb.iacilityNsme�ltmtins[Hution,B�itree[aiMnumber) ISc.CINarTown,Sn��TME'iDCode ���rland
,.,Y;fiill, PA 17011
Hol Spirit Hospital `"` ��� � r,�,�ma v �
6a.MethaE ot OlsposlHon ❑Burial �CremaHon 16b.Dah of DisOosi[ian 16c.Place of Dis tbn Name of cemeter rory,or other latt
❑w.mo�,in,ms�.�e ❑o�^=�b^ 1/14/15 E.Vans Crsnation Service
❑Ot�er�Speclly� n in CharBe ot Inrerm¢nt t'Ib.License Number
15tl.Locnbn af Disposition(Cih or Towq Sbro,and ZI0) »'.s'e""`°� "'�� ` [�'p Ol 3239 L
L,eola, PA 17540
VcNameandCom0leteAEtlressolfunenlFadliry 3401 Mark St. Hill PA 17011
1 al Home Inc
l8.DeceJeM's EducaHon-Check the bo�that best descrlbes[he 19.Decetlene al Nispanic Orlgin�Check[he ]0.DecedenYs Nace-ChP�k ONE Olt MORE races ro intlkafe w at
nlgheit deOree ar level ol xhaol wmpleKd a1 the time of death. baM that best describes whet�er the deceeent the W„'[���<<onsitleretl M1lmsell or�e����Korean
❑aone�ae<o�ie:. iz50aNsh/HlsOank/Latlno.Chec4the"No" � viemamese
❑Natlipbma,9M�13lhgrade boxitEecetlentlsnot5pan�sNHisOank/Wuna. �BlackorAfncanAmerican [7
No,iwt5panish/HisOanic/la�ino ❑AmencanlndianorAiaskaNa[Ive ❑O[M1erRsian
$�NighuhoolgraCwteoiGEDcompkttd � Me�ican,Mee�c�nAmerican,Chlcano ❑Asianlndlan ❑NatNeHaw�iian
❑Some<aNeB«<�����utnatleeree ���s' ❑Chineu ❑GuamanianorChamono
❑Assoclah Eeyree�e.6�Ap•A5) ❑�ei,Vu<rto Rican ❑Samoan
❑Yes.Cuban ❑Fllipina
❑BxhaloisEegrce�e.g.9R,AB,BS) MBA' �Yes,otherSpanish/Nlspan�c/Latlrw ❑lapanese ❑aherPacificlslantler
❑Mastefs Jyrx�e g.MA,M5,MEng,MEd,MSW, ❑p�her(Specily�__._.___
❑Dacroratt�e.6�Ph�,EdD�orProlessionaldegree ISpeciM) �
..MD,�DS DVM LLB ID �WO*
i1.Decedent's5ingleNace3elt-Designation-CheckONIYONEtolnAlca[ewhatthedeceCeniconsideredhimsellor�ersel/to�e. tlonetlurin{mos`t'ofjw`knRll(e.nDONIOTtUSFNETIRED.
Q White ❑lapa^ese ❑Samoan
❑BWckorAfncanAmerkan ❑Korean ❑OH�erPacificlslander Hp��k.PS
❑Ame�IranlMlanorAlaskaNative ❑��etnamese ❑Don'tNnow/NotS�re ZTb.Nindoleusiness/Industry �
❑AilanlnElan ❑OtherAsian ❑Refusetl
❑CM�u ❑NatNeHawallan ❑OMer�SpeciNl � H�e
❑Filipino ❑GuamanianorChamono
RfMS]3a-33dMU5TBECOMVLETED 13a.0a[eVror�auncedOeaE�MODaY/Y�)e�13b.5ignatureofFersonVronountlngDeath�OnN�'henapplicable� 23�l�censeNumbe�
BY YERSON WHO PRONOUN[ES OR S�rl U�C r '1 �\] Ja�,��T,�11���-�/�"�� N Z���$I�
CEtttIFlES DGTX ��lrld••
23d.0ate5igned�Mo/OaY/'��) 34.TIm o�Death � �ilEvdmir�e�orCo�One�Conbchdl ❑ Yes �No
SQf11.��Q � O� C �.� 25.Was e i
CAUSE OF DEA � Avvro*�m•�•
mcenai:
zs.varti.e�c«m.�n-�ore���--m:..+�:,mw���:,o��ompu�ano�:-ena�e�.e�erv=•�:eemeeeam.oor+ore��e��e�minl'e�qeaaaamo�a n�+s��e�.::arv. � o�:.�mo.=m
respraroryartlSl,otvenMcubrllOrilla[ianw o�[s�winythee'Iog�oNOTA VIATE.En[eron � r�eO^a - --- i
O��� i
IMMEDIPTECAl/5E -----�-�--'-'' '� �
�FinaldiseaseormndHion / /Ouem�ora ��afl- �
B I
resukingindea[h� / U� ` � -..-�-�--
sequennanr�isem�aino�s, b o��wle�a.am�ua� «aFl� i
il anV.�e�dl�ro[he cause __--- �
listttlonliriea.En[erthe � Du<[o�orasaconsequencea�: �
UNDEPlY1NG GUSE �
�disease or Inlury Nat ..-_.-----
iniHahEcheeventsrcsulHng d� Dueto�orasaconseduencea�'
In Eeath�IATT.
ying cause g ?].W as an auropsy performed7
26.Vart ll.Enter other' I� 4�� ��b tl to 0eath but not rcsulting in[�e untlerl Iven In Part l. ❑yes
Ig.W ere auro05y IlMmts availabk
to comPlete the ca�se of deathl
❑Yes `�No
30.�id Tobacco Use ConVibu[e to Death? 31.Manner ol Dea[N
39.IIFeS ale: ❑Yes ❑ProbabN ❑'�^������ ❑Homicide
$r+o�nrea�amwnn�ovanvar �,R p u�k�ow„ ❑ncnaem ❑a.oemem�ae�ea�m�
❑Vregnan[atHmeolEeath �Suicide �CouldnotbetletermineE
�Not pregiunt,ht pregnant wilhin 03 days ol tleath 5 II Monlh�
❑Notpreem^4�utpegnant�3dayslolyearbeloredeath 3].Dattollnlury�Mo/Oay/Yrll Pe 33.Timeotlnjury
❑UnkiwwnitO�egnanlwithlnthepaslVe��
34.Vlace of InI��Y I��B�home;c0�itrvction si4;f2�m;SCh001) 35.Location ol lnj�ry IStreel and NumEer,Ciry,Courly,State.Llp cod<)
portat 38.Describe How Inlury Octu�re0'.
36.InIuryalWa�k 3].IfTrans Ionlnlurv.50eciN'.
❑Yes ❑Oriver/Operalor ❑Petlestrfan
❑No ❑Vassenger ❑an�rlsv��ryl -
39a.Ce d�er-ahnmia�.cemneeo�� wa�no��.,m�m�aie..m��e�/ro�o�e�i�ne�wa^amdn�e.:u�ea.
�rtllying only-TO[�e besl owleEge,aeaM occurred due to Ne cause�s� ue to the cause�s�antl mannei staletl.
❑V�anoundng&Certifying th st of my knowledge,dealn occurred at the tlme,date.and plac ed F1�e tlme,Oate,an0 place,and due tn ihe c us r statetl
❑MetlkNExaminer/Coro er 0 hebaslsofeaa '+��onaiM/orinvestlgation,Inmyopi^ion.dea /i'A, seNumber'
titkoimnlfier ���N
Sqnalure of rtifler: en 39c.Date Ign Da �I�"-
3� ��tl mqetin ea[h te 1 ]
az.n - r v�ie o7�e�Mo oay/rd ' '
.pegis ral5�I Ict Num 41.Registrar'sSignatu�e � I�s['� +�
7�1��,i x 14�il1,?2 �
al.Amenamem:
I//'�i j nN105�,C3'
K�
_ __ . �
LAW OFFICE OF
THOMAS D. GOULD �
� ATTORNEY AT LAW
+ 2 EAST MAIN STREET • SH�REMANSTOWN, PA 17071
717-737-1461
__ _._.___ __�-----_____.-----_ __�..._
THOMAS D. GOULD, ESQUIRE
2 EAST MAIN STREET
gHIREMANSTOWN, PA 17011
(717) 731-1461
L1�S T T�TI LL AND TE S TAN�NT
OF
CATHERINE L . HALE
I, CATHERINE L. HALE, a Pennsylvania resident with a
current address of 1067-I Allendale Road, Mechanicsburg,
Pennsylvania 17055 being of sound mind, memory and understanding do
hereby make and publish this my Last Will and Testament hereby
revoking all previous Wills and Codicils made by me .
Item I . I order and direct that all of my just debts,
funeral expenses and inheritance taxes may be paid as soon as
conveniently possible immediately after my death.
Item II . I may leave a written list, which will be dated and
i:�
either in my own handwriting or signed by me, that sets forth my
wishes regarding distribution of specific persorlal property. The
list may include proceeds from any insurance policies . It is my
hope that those entitled to share in my estate will informally
respect my wishes .
Item III . All of the rest, residual, and remainder of my
estate, real, personal and mixed of whatever kind and wheresoever
situated, I give arid bequeath to my sister, DOROTHY I. HOCKENBERRY.
�l� ��k�d n +�d
�
�
Item N, I hereby nominate and appoint DOROTHY I. HOCKENBERRY
to be the Personal Representative of my estate .
Item V. I direct that no Personal Representative appointed
under this Will be required to post any bond or provide any
security to serve in that capacity.
Item VI . I confer on my Personal Representative, in addition
to those powers granted by law, the following powers to be
exercised in a prudent manner and applicable to all property
constituting a part of my estate: �
,
A. To retain and to invest in all forms of real and '
. ;
,
�
personal property, without being confined to '
investments authorized by a statutory list, without
being required to diversify and regardless of any
principal of law limiting delegation of investment
responsibilities by executors or t:rustees; x
J
3,�
B. To compromise claims and to abandon any property �
�
whiCh, in my Personal Representati.ve ' s opinion, is '
�
of little or no value;
C. To sell at private or public sale, to exchange or
�
to lease for any period of time, any real or i
i
�
personal property, and to give options for sales or
leases;
;
;`
i
�
2 �
t
!
�
�
r J
�0 � I
1 ,
cJ2ct"'� �. ..,...��,I ,
— ---_
Personal Representative hereunder, and to pledge
property as security for repayment of the funds
borrowed;
E. To join in any merger, reorganization, voting-trust
plan or other concerted action of security holders,
and to delegate related discretioriary duties;
F. To employ and to rely upon the advice given by
investment counsel, to deleqate discretionary
authority to make changes in investments to
investment counsel, and to pay investment counsel
reasonable compensation in addition to any fees
otherwise paid to my Personal Representative;
G. To employ a custodian, to hold property
unregistered or in the name of a nominee (including
the nominee of any institution employed as
custodian) , and to pay reasonable }compensation to
the custodian in addition to any fees otherwise
payable to my Personal Representative;
H. To procure and carry at the expense of my estate
insurance of kinds, forms and amounts deemed
advisable by my Personal Representative to protect
my estate and my Personal Representative against
any hazard;
3
I . To commence or defend at the expense of my estate
any litigation affecting my estate deemed advisable
by my Personal Representative;
J. To conduct alone or with others any business in
which I am engaged or in which I have any interest
at my death, with all the powers of any owner with
respect thereto, including the power to delegate
discretionary duties to others, to invest other
property held hereunder in such business and to
organize a partnership or corporation to carry out
such business; and
K. To distribute in cash or in kind.
IN WITNESS WHEREOF, I, CATHERINE L. HALE, have to this my Last
JS�
Will And Testimony hereunto set my hand and seal this / day
��
of � C�� , 2010 .
� :��_
.�� �
CATHERINE L. HALE
4
. LL ;. .. . � � �.,. . , _..� �__.�_
, , , ,.
, ..;......_.
_ . . . �..o ..�. _
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named
Testatrix, CATHERINE L. HALE, as and for her Will, in the presence
of us who, at her request, in her presence, and in the presence of
each other, all being present at the same time, have hereto set our
hand as witnesses :
NAME / 1I��'!A'1" � • �j0� RESIDING AT �,''� �i�rs✓�3T /��..! �T�'{�
J^�'l�"�";Mmr4����✓r�� �.J�
� �n//
NAME RESIDING AT �� ! ��r�+'l �.1
,��be.m��A ���� 3�
��7
5
-STATE OF PENNSYLVANIA •
� . SS .
COUNTY OF CUMBERLAND -
I, CATflERINE L. HALE, having been duly qualified
according to law, acknowledge that I signed the foregoing
instrument as my Will, and that I signed it as my free and
voluntary act for the purposes therein expressed.
�
1 0�+ ��_��t� .
CATHERINE L. HAT.�
We, having been duly qualified according to law, depose
and say that we were present and saw CATHERINE L. HALE sign the
foregoing instrument as her Will; that she signed it as her free
and voluntary act for the purposes therein expressed; that each of
us in her sight and hearing and at her request signed the Will as
witnesses; and that to the best of our knowledge she was at the
time 18 years or more of age, of sound mind, and under no
constraint or unciue ir.f luence .
-%�.a��► :J . ��'
Witness
�
itness
,x�
Subscribed, sworn to, or affirmed, and acknowledged
before me by the above-nam�� testatrix and l�y�(e witnesses whose
names appear, on this _�_ day of �G ,h
, 2010 .
Notary Public
COfWMOi�WEAIi'H OF PENNSYLVANIA
Nota�ial Seal
Leola M.Gou1d,Notary Public
Lower Allen 7wp.,Cumberland County
My Commisslon Expires April 28,2012
Member,Pannsylvania AimoClation Of Notaries
6