HomeMy WebLinkAbout05-04-05
REV-l5DDEX(6-00)
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
. COMMONWEALTHOF
PENNSYLVANIA
. DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
FILE NUMBER
21 05
cOUNTY CODE YEAR
0226
-----
NUMBER
SOCIAL SECURITY NUMBER
552-38-5464
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DECEDENT'S N/lME (LAST, FIRST, AND MIDDLE INITIAL)
AZIZE, HELENE
DATE OF DEATH (MM.DD-YEAR)
0310112005
THIS RETURN MUST BE ALED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
DATE OF BIRTH (MM-DD-YEAR)
01/2711906
(IF APPlICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIOOLE INITIAl)
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I!J 1. OrlginalRetum D2.suPPlementa'Retum D 3. Remainder Retum (dale 01 d8a1ll pdorlO 12-13-8:21
o 4. Limited Estate 0 48. FutLlre lnierest Compromlse (dOl of deelh elter 12.12-82) 0 5. Federal Estate Tax Return Required
[!] 6. Dec&SeoI Died Testate (ArIIIctl cq>y ofWll) 0 7. Decedent Maintained a LIvIng Trust (AtI8d1 copyofTnlst) 8. Total Number of Safe Deposit Boxes
o 9. Litigation Proceeds Received o 10. Spousal Poverty Credit {d8i!ofdealhblltween 12.J1-91 and 1-1-95) o 11.EleClIonlotaxunderSec.9113(A)(AIlIchSdlO)
TNIS SI(mON MUST.n COMPI.ITID. ALL CORRESPONDENCE' D 011 lIX IN' :rION' IlOlJtD 8E DI C TO:
NAME COMPlETE MAlUNG ADDRESS
ROBERT H, BARTOLO 1711 Sherwood Road, New Cumberland, PA 17070
FIRM NAME ,,_,
TELEPHONE NUMBER
(717) 770-0558
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Ill:
(1)
(2)
(3)
(4)
(5) 10,941,09
(6) 62,829.26
(7)
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,. Real Estate (Schedule A)
2. Sl:lckS and Bonds (Schedula B)
3. CIosaly _ COIjlOmlion, Partne",h~ or SoIe-Propriatorshlp
4. Mortgages & Notes Recelvab~ (Schadu~ 0)
5. Cash, Bank Deposits & Miscelaneous Personal Property
(Schedule E)
6. Jo/nUy ewr..o Property (Schedule F)
o Saparate Billing Raquestad
7. Inter-VIVOS Transfers & Miscellaneous Non-Probate Property
(Schedule G or l)
8. Total G_ _ (total Lines 1.7)
9. Funeml Expanses & Admlnistrallve Cosls (Schadula H) (9)
10. Debts of De<:adant, Mortgaga liablllttes, & Liens (Schaduis I) (10)
11. T olaI DocIucIIons (total Lines 9 & 10)
12. NelValue 01 E_(Llne 6 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an electbn to tax has not been
.- (Schedule J)
73,770.35
(B)
8,263.78
162.80
(11)
(12)
(13)
8,426.58
65,343.77
2,000.00
14. Net Value SUbtectto Tax (Line 12 minus Line 13}
(14)
63,343.77
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SEE INSTRUCTIONS ON REVERSE SIDE FOR APl'l.ICASlE RATES
15. Amount of line 14 taxable atlha spousal tax
mis, or IIllnsfars undar Sec. 9116 (a)(1.2)
,,0_ (15)
'.0_ (16)
.._~...._..._......~, .12 (17)
16. Amoorrt of Line 14 taxab~ at lineal mta
17. Amount of Line 14 taxable at sibling rate
19. Tax Due
63.343,77 '.15 (18)
(19)
9.501.51
9,501.51
18. Amount of Uoe 14 taxable at collateral ra~
20.0
CHECK HERE IF yOU ARE REDUESTING A REFUND OF AN OVERPAYMENT
> > n SUItE n) ~ ALL QllI!8tIONltGM'RMlI8ltllllllE.,.ao.oIlllCHl!ClK IillATHe'.
~
Decedent's Complete Address:
AD
The WOODS at CEDAR RUN
824 L1SBURN ROAD
CITY CAMP HILL
STATEpA
ZIP 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
9,501.57
475.08
TotaICrndits(A+B+C) (2)
475.08
3. IntarasUPanaIty if applicable
D.lnterest
E. Penalty
TotaIlnteresttPenalty ( 0 + E ) (3)
4. "Line 2 is greater Ihan Line 1 + Line 3, enter the difference. This is Ihe OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater then Line 2. enter the differenoo. This is the TAX DUE. (5)
A. Enter Ihe interest on the tax due. (5A)
0.00
B. Enter Ihe total of Line 5 + SA. This is the BAlANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
9,026.49
0.00
9,026.49
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a tllmstar and: Ves No
a. retain the use or income of the property lransfenred;.......................................................................................... 0 [KJ
b. retain the right to designalll who shall use the property transfenred or its income; ............................................ 0 IKJ
c. retain a reversionary interest; or.......................................................................................................................... 0 [KJ
d. receve the promise for 1"- of ailher payments, benefits or care? ...................................................................... 0 IKJ
2. If death occunred afier December 12. 1982. did decedent transfer property within one year of dealh
without receiving adequate consideration? .............................................................................................................. 0 [KJ
3. Did decedent own an 'n trust fof or payabie upon dealh bank account or security at his or her dealh? .............. 0 IKJ
4. Did decedent own an Individual Retirement Account, aMuity, or olher non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0 [KJ
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES. YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN,
Under penalties of pe~ury, I dedare lhall have examined Ihis return, Including acoompanylng sdledules and statements, and 10 the best of my knowledge 8fId belief, It is Irue. correct
and complete.
Declaralionofpreparerotnerlh I representative i based all Ictl prepal1lr has any knowllldge.
SIGNATURE OF PER SI F ETU
~ATE /
. . 00 ~[-
ADDRESS
1711 Sherwoow Road, New Cumberland. PA 17070
SIGNATURE OF PRE PARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
",-,.,
For detes of dealh on or after July 1. 1994 end before January 1. 1995, the lax rate imposed on !he net value of transfers to or for the use of the surviving spouse is 3%
[12 P.S. ~9116 (a) (1.1) (i)).
For dates of dealh on or afier Ja"",ry 1, 1995, the lax rate Imposed on !he net value of transfers to or for the use of the surviving spouse is 0%. [72 P.S. ~9116 (a) (1.1) (;)1.
The statute does not examot a tnmater to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are stili applicable even ~
Ihe surviving spouse Is the only beneficiary.
For dates of dealh on or after July 1, 2000:
The lax rata imposed on the net value of transfers from a deceased child twenty-one years of ego or younger at death to or for !he use of a natural paren~ an adoptive parent,
or a stepparent of the child is 0% [72 P.S. ~116(a)(1.2)).
The tax rate imposed on Ihe net value of transfers to or for Ihe use of the decedenfs 1in9lllbene~ciaries is 4.5%. except aSI1qi!>d in 72 P.S.: ~9116(1.2) [72 P.S. ~~116(a)(1)1.
The tax rate Imposed on the net value of transfers to or for the use of the dectidenfs siblings Is 12% [72 P.S. ~9116(a)(1.3)]. A sibling is defirled. under Silction 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-150ft EX_ (6-98) '*
COMMONWEAlTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULI I
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
HENENE AZIZE
FILE NUMBER
21-05-0226
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property Jointly-owned with right of IUNtvorshlp must be dllCloltd on Schedul. F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1 M&T BANK checking account # 950821013, DOD value including accrued interest to DOD (03-01-05)-
SOCIAL SECURITY for the month of February 2005 received on 03-03-05
INTEREST ACCRUED for checking account # 950821013 to 03-04-05
INTEREST ACCRUED at the closing of checking account # 950821013 on 03-10-05
3,074.82
772.00
0.03
0.05
2 PERSONAL PROPERTY (will be given to Charity)
Wearing apparel ( estimated )
Cosmetic jeweriy ( estimated )
$ 100.00
$ 30.00
$130.00
130.00
TOTAL
3 Refund of Capital Blue Cross premium
118.49
4 FUNERAL PRE PLANNED
THE PRE PLAN ($2,920.00 plus accrued interest to DOD)- $ 3,072.70
SecurCOICE TM
$ 3,773.00
TOTAL- $ 6,845.70
6,845.70
TOTAL (Also enter on line 5, Recapftulalion) $
(tf more space is needed, insert addlUonal sheets of the same size)
10,941.09
HELENE AZIZE ESTATE
Date of Death 03-01-2005
Age at death 99
Date of Birth 01-27-1906
SS# 552-38-5464
SCHEDULE E
ATTACHMENT FOR
Item Number 1,2,3&4
ITEM - 1
HELENE AZIZE ESTATE
Date of Death 03-01-2005
Age at death 99
Date of Birth 01-27-1906
SS# 552-38-5464
CHECKING ACCOUNT
M&T BANK
Highland Park
344 South 10th Street
Lemoyne. PA 17043
Checking Account Name: Robert H. Bartolo Representative for Helene Azlze
Account No. 950821013
Balance as of date of death 03/01/051lncludes accrued Interest) -$3,074.82
3/3/05 Deposit Soc. Sec. for February 2005--- n2.00
$3,846.82
3/4105 Interest Payment-------------------------------------__________ 0.03
$3,845.85
0.05
$3.846.90
3/10/05 Interest payment-
Balance @Close 3/10/05
On 3/10/05 opened an interest-bearing Checking Account for
The Estate of: HELENE AZIZE
Robert Bartolo Executor
Account!\Jo.9836670688
3/10/05
$3,846.90
rl;1 M&r~.
ACCOUNT NO, ACCOUNT TYPE
STATEMENT PERIOO
PAGE
950821013 MIT CLASSIC CHECKING W/INTEREST
HAR.05-APR.06,200S
1 OF 1
00 0 06113M NM 017
16789
HELENE AZIZE
BY ROBERT H BARTOLO, REP PAYEE
1711 SHERWOOD RD
NEW CUMBERLAND PA 17070-1455
INTEREST PAID YEAR TO DATE
0.90
NIGHLAND PARK
ACCOUNT SUMMARY
GIIIIlItIll
BALANCE
3,846.85
OslTS&
()THER.ADD!tlONs
NO. AMOUNT
o 0.00
CHECKS PAID
NO. AMOUIfT
o 0.00
OTHER
SU8TRAClIONS
NO. AMOUNT
1 ,846.90
CURRENT
INTEREST>PD
ENDING
BALANCE
0.05
0.00
ACCOUNT
CHECK .OTHER
sU8TRACTIONs
OAI Y
llALANcE
PDST till
DnE
TRANSACTION.. DESCRIPTIoN
03-05-05 BEGINNING BALANCE
03-10-05 INTEREST PAYMENT
03-10-05 CLOSEOUT
&3,B46.85
0.05
3,846.90
0.00
ENDING BALANCE
&0.00
ANNUAL PERCENTAGE YIELD EARNED = 0.09 %
M&T CHOICEQOITY, THE FLEXIBILITY TO CHODSE FIXEO RATE LOANS OR A LINE OF CREDIT
ANYTIME. APPLY AT ANY MIT BANK BRANCH OR CALL THE M&T TELEPHONE BANKING CENTER
AT 1-800-724-3222. EQUAL HOUSING LENDER.
lOOSA (1103)
New Account. 03/10/05
MANUFACTURERS ^.'lD TRADERS TRUST COMPANY
CONSUMEH DEPOSI'I ACCOUNT OPENING RE UEST
ACCOUNT TITLE AND /. ; JDRESS OFFICE OF ACCOUNT
ESTATE OF HELENE AZllE 6113 Highland Park
ROBERT H BARTOLO, EXEC
1711 SHERWOOD RD
NEW CUMBERLAND PA 170701455
ACCOUNT NUMBER
9836670688
ACCOUNT TYPE
M & T Classic Checking With I
CUST 1 PHONE #
717-770-0558
CUST I SSN:
CUST 2 SSN:
552385,164
BIRTHDATE
BIRTIIDATE
01/27/1906
06/08/1935
079300'114
By s'gnlng below, I (we) (l) request that M&l Bank open in my (our) names the deposit account Te~'Jested
below with the features requested. and (2) acknowledge receipt of, and agree to all provisions of, the General
Deposit Account Agreement, Availability Disclo~qre for Consumer Deposit Accounts, the Specific Features and
Terms containing information aboul the account, !he applicable fee schedule and, if the account is a Jumbo
Certificate of Deposit, the Agreemcllt for Teleph01lc Instructions. By Ilgolng below, I (we) acknowledge and
agree that if the account is opened in the names or two or more individuals, unless the account is a fiduciary or
custodial accollnt, it will be a Tenancy By The Entireties Account With Right of Survivorship if the sole
individuals in whose name the 8Cc~unt is opened. are husband and wife, and, in a11 other cases, a Joint Account
With Right of Survivorship.
Cutlficatlun. Under pen.I"" of perjury, I (customer 1) certify: (1) that the number shown 011 this form
Is my correct Taxpayer Identification Number (tlr I am waiting for a number to be Issued to me), and (2)
tbat I am not subject to backup wlthholdhtg bec:\U1e (a) I am eumpt from backup withholdIng; of (b) t
have not been notified by the Internal Revenue Service (IRS) that I am lIubJect to backup withholding 8'
. result of a failure to report aU Interest or dividends, or (c) the IRS has notified me that I am no louger
.nbJectto backop withholding; and (3) lhat I a'" a US person (Inclndlng aU,S, re.ldent alien),
Certification 'nstructlons - You must cross oul Item (2) above If you have been notlned by the IRS that
you are currently 11\bJee! to bacl\up wlthholdb1q: becadse of underreportlng Interest or dividends on your
tax return. (Also see Part III - Certlncatlou ulltler Speclnc Instructions on the separate W-9 form.)
The IRS does not require your onsent to any provbion of this document other thaD the certlncatl",n
re ulred to avoid b8d,'~, with dl I I /?
SIGNATURECUSTI . ~ DATE
SIGNATURE CUST 2
DATE
SIGNATURE CUST 3
DATE
SIGNATURE CUST 4
IDENTIFICATION:
CUST 10TH KK
CUST2 OTH K K
CUST J
CUST 4
DATE
,OTH KK
OTH KK
OPENING AMOUNT $3800.00
ACCI IUNT SPECIfiCS
DATE 03/10/05
CHECKING:
Relationship P3ckage
Transfer Interest to Account
Safecheck? YES
SAVINGS:
Interest Rate
PR
Interest Rate 0.100
PR
00 funding Account
Trnnsfl"t Interest to Account
CLUB:
Transfer to Account
TIME DEPOSIT:
Initial Tenn
Automatically Renewabl,'?
Interest Rate
Interest Check?
Basis Points
PR Approval
Promotional Code Servk' Char e Waive Code
Original- Account SeT\'ices Copy. Branch
WPAOOl (03104)
Interest Rate
lnil' al Maturil)' Date
fill II Maturity Date
Tm.\sfer Interest to Account
In., 'est Cycle
PR
S2X
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HELENE AZIZE ESTATE
Date of Death 03-01-2005
Age at death 99
Date of Birth 01-27-1906
SS# 552-38-5464
ITEM - 2
The decedent, Helene Azize, lived frugally in an assisted living furnished apartment.
Her wearing apparel and cosmetic jewelry will be donated to Charity
WEARING APPAREL
NO.
DESCRIPTION
ESTMATED
VALEU
3
6
1
8
1
2
1
5
2
4
2
1
8
12
6
1
2
3
Dress
Jackets (knit and Mat.)
2 piece dress suit
Skirts
2 piece Blouse and Trouser
Rob
Sweat suit
Trousers
Knitwear
Pajama
Shawls
Knit Set (two pieces)
Sweaters
Blouses
Petticoats
Rain Coat
Coats
Hand Bags
Misc. Items-Hair nets, Bras, Pantyhose,
8
2
4
Old Pairs of Shoes
Old Pairs of Slippers
Handbags
Sub Total ----$100.00
COSMETIC JEWELRY
3
2
11
7
1
2
Rings
Bracelets
Necklace
Earrings
Brooch
Watches
Sub Total----$ 30.00
TOTAL- 5130.00
.
~
03/31105
Capital BlueCross
Capital Advantage Insurance Company'
Independent Licensees of the Blue Cross and Blue Shield Association
HELENEAZIZE
ClOTHE ESTATE OF HELENEAZIZE
1711 SHERWOOD RD
NEW CUMBERLAND, PA 17070-1455
... Explanation Of Refund ...
Refund Reason: Subscriber Deceased-Helene Azize-197070949
LrEH ;j- .3
CHECK NUMBER:
30005370
GROUP I SUBGROUP ID:
00900001 -
Total Refund Amount:
$118.49
ITEM - 4
HELENE AZIZE ESTATE
. Date of Death 03-01-2005
Age at death 99
Date of Birth 01-27-1906
SS# 552-38-5464
PREPAID FUNERAL ACCOUNT
1. Pre Plan (Brooklyn, NY - Final Resting Place)--- $3,072.70
2. SecurChoice TM(New Cumberland starting Place)--- $3.773.00
TOTAL $6,845.70
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IYSFDA PREPLAN TRUST FUND
10 fUNERAL DIRECTOR SUPPORT SERVICES, INC.
Funeral Director Supporl Servlces,lnc.
P.O.BOX 5288
ALBANY, NY 12205-0286
From the Prepaid Revocable Funeral Trust for the benefit of Helene A-DlJ?J
COBBLE HILL CHAPELS
171 Court Street
Brooklyn, NY 11201
74897
'.
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DisbulSemen\ for contract number 70121140
03/21/2005
$ '-H3,072.70
>.._,ji':.r"(.'>7:':I!C'~.1\i'
MY THREE THOUSANl1$!;VE~tv''Mb AND 70 1100 DOLLARS
,
TO THE
ORDER OF
COBBLI: HilL cl-tAPels
171 Court St~ill .
Brooklyn, Ny 11201
DATE 'I"
. A~OU~T
$ ........a.ot2.10
03/21/2005,
"- '
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S ecu rChoicerM
7441 Allenlown Blvd. . Harrisburg, PA 17112
September 29, 2003
Ms. Helene Azize
c/o Mr. Robert Bartollo
1711 Sherwood Road
New Cumberland, PA 17070
Re: SecurChoice - Pre-Need and
Individual Trust Agreement
Dear Ms. Azize:
PNC Bank, N.A. has received and accepted the Pre-Need
and Individual Trust Agreement for Helene Azize, Account
36154. This Irrevocable Trust, funded with $3,773.00, is a
participant in the Master Pre-Need Trust of Parthemore
Funeral Home and Cremation.
If you have any questions, please consult with your
funeral director.
Very truly yours,
~ti-. CaMM~
Ruth A. Carrera
SecurChoice
Trust Admin. Asst.
Enclosure
cc: Mr. Gilbert J. Parthemore
Parthemore Funeral Home and Cremation
POBox 431
1303 Bridge Street
New Cumberland PA 17070-0431
OFFICE:
. (717) 545-7215. FAx (717) 545-7360
PRE-NEED INSURANCE OFFICE:
1-800-627-1526.(717) 540-1303. FAX (717) 540-1496
Webslte: www.pCda.org
SeculC:hoice TM
q t:J&-o3 3
3C>IS:!
PART I
Pre-Need and Individual Trust Agreement
("The Agreement")
~ This Agreement Is made this q I ~ ~ I 0..3
rl I . DATE
Funeral Home 41-TJj~t10/2..t- I-rrq.,L..S.. 'I,.:Jc-
Address~~. NltJ ~~(!.~_eLAJp PA-
I I BUSINEljil ADDRESS .
an1J the Purchaser ----1:T~ /...ff..-N E. It z iz.ti. 1- .l1 - O~
(hereinafter "YoU") 11 J. NAME _ I fJ ~ /:. .. DID'}' I .
~,)..T u.s~-l&1 ~It() ~p ttl'-'-
. ADDRESS
by and between
17070
S"~.t - .J~. S:-</bf
/J SOCIAL SECURITY II
rA-- , 7 f) If
(M) (ED
for ihe Benefit of
(if Beneficiary is
different from
the Purchaser)
NAME
0/0/8
SOCIAL SECURITY /I
(M) (F)
ADDRESS
nIl .s.~o RoAp
~~~ Ih
I lei!,
D
ANNUAL FINANCE Amount Financed Total of Payments
PERCENTAGE CHARGE The amount of credit ' The amount You will have paId alter
RATE The dollar amount the provided 10 You or on You have made all payments as
credit wlll cost You. Your behall. scheduled.
The cosl 01 Your credU
as a yearly rale. er
0.00% $0.00 $ $ 1,.773. ,-
Total Sale Price
The tolal cost of Your purchase
on credit, Il1cludln It.{fown-......
payment 01 ~-'"____ ,
5:.773
\
II not paid In full, Your Payment Schedule will be:
No. of 8 ments Amount of Pa ments When Pa men Is Are Due
".-- $ Monthly beginning MO.' ~ ~
ItemIzation of Amount Financed
Cash Price
See reverse side IOf any addlllonal Information about
nonpayment and default.
$ :111~. ~
Total Down~imenI3{ 73. --
Unpaid Balance of Cas~ Price & Amount
Financed - $ ft'
You hereby agree 10 buy and the Funeral Home hereby agrees to sell the funerel goods ("Merchendlse") end funeral services ("Services")
which are described In Iteml~ lilt attached aa Exhibit A for a Total Sala Price of $ .3 -, 7~ ,... .
Arrangament Fee: $ f:,i:ir.' This fee Is saparete and distinct from the Total Sale Price and will be deposited In the Trust.
After payment of the Total Sale Price and all other payments required to be made, the Funeral Home will render, upon the death of the Beneficiary,
all the Merchandise and Services described on attached Exhibit A. This Agreement Is subject to the terms and conditions shown above and
on the reverse side of this page. which You have fead and accepted.
YOJ,Hlereby elect that this Agreement shall be:
[!(lrrevocable upon payment In full of the Total Sale Price 0 Revocable by You at Your option at all limes
YOlJ.-'lnd the Funerel Home egree that the prices shown on Exhibit A sre:
'i/'Guaranteed by the Funeral Home upon timely payment of the Total Sale Price 0 Not guaranteed by the Funeral Home
EXcLUSION OF WARRANTIES: THE FUNERAL HOME IS NOT PROVIDING TO YOU ANY WARRANTY OF MERCHANTABILITY OR
WARRANTY OF FITNESS FOR A PARTICULAR PURPOSE FOR THE MERCHANDISE. The only warrentles You ere receiving lor the
Merchandise are the expresa written warrantlea, If eny, which srs provided by the manulscturars of the Merchandise sold to You under
thla Agreament. Only the manufacturer shell heva eny liability to YoU under such werrentles. .
You end the Funerel Home have signed this Agreement on the day and yesr written above and Intend to be legally bound. By signing this
Agreement, the Funerel Home, sa sgent for the Purchaser, hereby agrees to establish en Individual trust with the Trustee under the Master
p~ed Trust Agreement (the "Master Trust") between the Funersl Home end the s (the" r ).
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REV-I509 EX. t6-...
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLy-oWNED PROPERTY
ESTATE Of
HELENE AZIZE
FILE NUMBER
21-05-0226
If an ..... was mad. Joint wHhln one year of the dlced.nt'. date of d.ath, " must be reported on Schedule G.
ADDRESS
RELATIONSHIP TO DECEDENT
SURVIVING JOINT TENANT{S) NAME
A. Robert H. Bartolo
1711 Sherwood Road, New Cumberland, PA 17070
Nephew
B.
C.
JOINTLY.owNED PROPERTY:
lmER DATE DESCRIPTION OF PRoPERTY 'OF DATE OF DEATH
iTEM FORJOIHT MADE INCLUDE NAME OF FINANCIAllNsrtTUTlONAND BANK ACCOUNT NUM8EROR SIU\lNl. O"TE OF 0Eo\11-l. DECO'S VALUE Of
NUMBER TENANf JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTlY-HELO REAL ESTATE. VALUE OF ASSET INTEREST OECEDENT'S INTEREST
1. A. 08101/03 Janney Montgomery Scott LLC Account # HB3213781893 125,658.52 50 62,829.26
!
TOTAL (Also enter on line 6, Recep~ulallon) $ 62,829.26
(If mOfe space Is needed, Insert additional sheets of lhe 8sme size)
HELENE AZIZE ESTATE
Date of Death 03-01-2005
Age at death 99
Date of Birth 01-27-1906
SS# 552-38-5464
SCHEDULE F
ATTACHMENT FOR
Item Number 1
For Inheritance Tax Return ofthe Estate of Helene Azize
a}?:~8ley
iT&{-~
Janney Mon tgomery Scott LLC
T
March 21, 2005
Robert H. Bartolo
1711 Sherwood Rd
New Cumberland P A 17070
RE: Robert H. Bartolo & Helene Azize Jt- Ten
Mr. Bartolo:
Please find enclosed a summary of the assets held in the above referenced account on
Mrs. Azize's date of death with closing values as of the end of business on February 28,
2005.
The account was transferred to Janney Montgomery Scott LLC in August 2003, and was
originally established as a joint tenancy account. No changes to the registration of the
account have ever occurred.
Should you require additional assistance or information regarding this matter, please do
not hesitate to contact me at 731-4400.
Sincerely,
in~'{~
Kiisty J. Lehman
Registered Sales Assistant
. ,
~ r','
:!O Er/"onl Road, Suitt. :H5.1.(-'llloYIl('. PA 17o,tQ L09 . 717.n1.4400 . lilX: 717.7:H.4411 . wwwjmsolllillC.COlll
l'vlernhn New York S1<wk Ex<:hange, JilL and othe!" princip;d exchanges
I\.lclllher Securili('s Illveslor I'nllcctioll (:orporalioll
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REV-15ll EX. 112'99).
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
HELENE AZIZE
FILE NUMBER
21-05-0226
Debts of decedent mUlt be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
,.
FUNERAL EXPENSES:
PARTHEMORE FH&CS, INC, (New Cumberland, PAl-See Attachment
COBBLE HILL CHAPELS (Brooklyn, N.Y}-See Attachment
JAMES WEIR FLORAL Co.
FOOD & REFRESHMENT
ENTERPRISE (Rent-a-car)
Gas for rented car
3,773.00
3,205.00
150.00
185.00
71.20
REV-1511 EX+ (12-99)
..
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HELENE AZtZE
RLE NUMBER
21-05-0226
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
AMOUNT
B.
1.
4.
5.
6.
7.
DESCRIPTION
1.
FUNERAL EXPENSES:
PARTHEMORE FH&CS, INC, (New Cumberland, PAl-See Attachment
COBBLE HILL CHAPELS (Brooklyn, N.Y.)-See Attachment
JAMES WEIR FLORAL Co.
FOOD & REFRESHMENT
ENTERPRISE (Rent-a-car)
Gas for rented car
To Inscribe The Decedent's Name on Existing Monument
ADMINISTRATIVE COSTS:
3,773.00
3,205.00
150.00
185.00
71.20
30.00
520.00
Personal Representative's Commissions
N.meofP.rsonaIR.presentallvo(s) Robert H. Bartolo
Sode' Seal"'Y Number(s)/EIN Number of P.rsonal Repmsenl.Uve(s)
StreelAddm.. 1711 Sherwood Road
0.00
City New Cumberland
51.1. PA Zip 17070
Year(s) Commission PaId;
2.
Attorney Fees
0.00
3.
Family Exemption: (If decedent's address Is not the same as claimant's, attach explanallon)
Claimant
0.00
StreelAddress
City
Stale
,Zip
Relationship of Claimant 10 Decedent
Probate Fees
72.00
Accoonlant's Fees
0.00
Tal( Return Preparer's Fees
0.00
B
THE SENTINEL - LEGAL (Executor's notice LETTERS of TESTA)
CUMBERLAND LAW JOURNAL (Executo(s Notice Adver. )
Estimated final closing costs of administration of estate
82.58
75.00
100.00
9
Note: attachments for the above claims are included in this retum
8,263.78
TOTAL (Also enter on line 9, Recapiluialion) $
(If more space Is needed, insert additional sheets of the same sIze)
HELENE AZIZE ESTATE
Date of Death 03-01-2005
Age at death 99
Date of Birth 01-27-1906
SS# 552-38-5464
SCHEDULE H
ATTACHMENT FOR
Item Number A-I
B-4,7&8
ITEM-A 1
HELENE AZIZE ESTATE
Date of Death 03-01-2005
Age at death 99
Date of Birth 01-27-1906
SS# 552-38-5464
FUNERAL AND BURIAL EXPENSES
PARTHEMORE FH&CS, INC
P.O. Box 431 New Cumberland PA 17070
--$3,773.00
COBBLE HILL CHAPELS ------
171 Court Street, Brooklyn, NY 11201
---$3,205.00
JAMES WEIR FLORAL Co.
160 Montague Street, Brooklyn, NY 11201
----$ 150.00
FOOD & REFRESHMENT (Approx.) ----
$ 185.00
ENTERPRISE (Rent-a-Car) --------------
Transportation for Nephew, Robert H. Bartolo &
Nice, Jeanine Loe
New CumberlandlBrooklynlNew Cumberland
-$ 71.20
Gas for Rented car
---$ 30.00
To inscribe the decedent's Name on the existing Monument.
Estimate cost from S1. Charles Memorials & Holy Family Monuments,
New York-$365 ($265+$100) plus tax, Cemetery fees-$80 plus tax and round trip
fare for myself- New Cumberland I New York (same day) to see exactly what is on
the existing monument and finalize arrangement with St. Charles Memorials &
Holy Family Monuments.
Total Estimate--$ 520.00
SeculChoice TM
q -d&-03 .3
3vlSf
PART I
Pre-Need and Individual Trust Agreement
("The Agreement")
~ This Agreement Is made this q I d ~ I 0..3 by and between
~J I. DATE
Funeral Home -M:En:!~MO/2.t- t-rr~W. TNC-.
Address~i 43.(, Nw CZ~(1f"~eLAJp PA-
I I BUSINE~ ADDRESS .
antJ the Purchaser -LT~ l-~'" E. It z. iz.~ / - .l, - O~
(hereinafter "You") J . NAME _ I n _ /"'. .. 0/0,! I .
e,;)..q. tA.s~~&1 ~It() ~p t:J1f-L
. ADDRESS
17070
.5'"~.l.-.J~' s:-rlbf
/J SOCIAL SECURITY N
rA- 17 off
(M) (ED
for ihe Benefit of
(If Beneficiary Is
different from
the Purchaser)
NAME
0/0/8
SOCIAL SECURITY II
(M) (F)
ADDRESS
n " s.~O RoAp
~~~ fA
I lcilr
o
ANNUAL FINANCE Amount Rnanced Total of Payments
PERCENTAGE CHARGE The amount 01 credll . The amount You will have paid after
RATE The dollar amount the provIded 10 You or on You have made all payments 8S
credit will cost You. Your behalf. scheduled.
The cosl of Your credit
as a yearly rate. er
0.00% $0.00 $ $ 1,.773. ..-
Total Sale Price
The lolal cosl of Your purchase
on credlt, Includ!n r own-_
payment 0
:?-773
\
If not paid In full, Your Payment Schedule will be:
No. of 8 ments Amount of Pe. ments When Pa ments Are Due
,..-- $ Monthly beginning MO.~~ YE;i.i;-
itemization of Amount Financed
Cash Price
See reverse side for any addItional Information about
nonpayment and default.
$ 2.11~.-
Total Down~iment3{ 73. --
Unpaid Balance of Caab Price & Amount
Financed .. $ fr
You hereby agree to buy and the Funeral Home hereby agrees to aell the funeral goods ("Merchandise") snd funeral services ("Services")
which ate described In ltemlzJlP .!ilIt attached as Exhibit A for a Total Sale Price of $ .317~ ... .
Arra~gement Fee: $ ~.. Thla fee Is separate and dlatlnct from the Total Sale Price and will be deposited In the Trust.
After payment of the Total Sale Price and all other payments required to be made, the Funeral Home will render, upon the death of the Benellclary,
all the Merchandise and Services described on attached Exhibit A. This Agreement Is subJect to the terms and conditions shown above and
on the reverse side of this page. which You have read and accepted.
YoJl-hereby eleclthat this Agreemenl shall be:
[!(Irrevocable upon payment In full of the Total Sale Price 0 Revocable by You at Your option at all times
YO'Y"nd the Funeral Home agree that the prices shown on Exhibit A are:
VGuaranteed by the Funeral Home upon timely payment of the Total Sale Price 0 Not guaranteed by the Funeral Home
EXcLUSION OF WARRANTIES: THE FUNERAL HOME IS NOT PROVIDING TO YOU ANY WARRANTY OF MERCHANTABILITY OR
WARRANTY OF FITNESS FOR A PARTICULAR PURPOSE FOR THE MERCHANDISE. The only warrantlee You are receiving for the
Marchandlse are tha axprees written warranties, II any, which ate provided by tha manufscturers oftha Merchsndlse sold to You under
this Agreement. Only the manufacturer shall have any liability to YoU under such werrantles. .
You and the Funeral Home have signed this Agreement on the day and year written above and Intend to be legally bound. By signing this
Agreement, the Funeral Home, as agenl for the Purchaser, hereby agreea to eatabllsh an Individual trust with the Trustee under the Master
P~.d Trust Agreement (the "Master Trust") between the Funeral Home and t~"t' 5thj7?)' / . j!
JA-fL~O~<l-C5 )(.~~4
. 'n/'> ('YNERAL HOME NAME _ ~'scn . .
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718-875-1640
fax 718"875-0310
I.,'" ' .1 i
;" / II' t'" /It-( '".. '"
lIo66Ce lIifrllnapeCs
MARCH 231 2005
MR. ROBERT B~RTOLO
1711 SHERWOob ROAD
NEW CUMBERLAND, PA. 17070
FUNERAL EXPENSES FOR HELENE AZIZE
DATE OF DEATH: MARCH 1, 2005
FUNERAL ARRANGEMENTS
SUPERVISION OF FUNERAL
HEARSE
LIMOUSINE
CEMI!:TERY
MASS OFFERING
6 PALLBEARERS @ $40.00
GRATUITIES, CHURCH & CEMETERY
$ 500.00
250,00
295.00
290.00
1300.00
300,00
240.00
. . 30,00
$ 3205.00
-3072.10
$ 132.30
RECEIVED FROM PRE PL~N
BALANCE DUE
THANK YOU FOR YOUR TRUST,
~ jpo-- .
. .. GRE ORY. . OHN . .
. COBBLE HILL CHAPELS
. 171 Court Street - Brooklyn, NY 11201
718-815-7429
www.cobblehillchapels.com
.'
IYSFDA PREPLAN TRUST FUND
'0 ~lJN~rlAL OIRECTOR SUPPORT SERVICES. INC.
74897
Funeral Director Support Services, Inc.
P.DBOX 5286
ALBANY, NY 12205-0286
From the Prepaid Revocable Funellll Trust lor the benefit of Helene Azlze
COBBLE HILL CHAPELS
171 Court Stlllet
Brooklyn, NY 11201
DisbulSemenl for conlract number 70121140
03/21/2005
$ 'H'H3,072.70
-~... -+;~--------......,........----- - --
. ,J" , :l!olll" /"1 ", 1- ,
\ ~ Y " Ill' .tH fl!l '~""'j I,
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'.iJl1iiYili( tllliio f SUpport Services, toc.
T~ !O 1 ~1 561,;11' ;r' ,
:"1:' A1b1liy, t!W'lbrk 1221i-24S6
,,-,' "":\'.'.:' ';
,
':!l
,
MY THREETHOU$ANO SEVE~-TWAN070 /100 DOLLARS
,
u'071,8l:j711'
fa
1
J
J
--------------------.. j
I: 2 2lo:1 B '18 'II: 7 Sr,l, 2 278 'lOr, SII'
---..---.-..------.----------- -"-
DATE
'r'l
"j.
AMOUNT
TO THE
ORDER OF
03/21/2005
$ ......3.072:10
COBBLE HILL CHAPELS
171 Cour! Street
Brooklyn. NY 11201
UNTS OVER $50.000
.
"
".<1
HELENE AZIZE ESTATE
Date of Death 03-01-2005
Age at death 99
Date of Birth 01-27-1906
SS# 552-38-5464
Requested a friend of the family (Mrs. Inaam Katra) in Blooklyn to pay for
us the flowers required to be placed on the Coffin. On the day of the funeral,
I did reimbursed $150 in cash.
(,;UtiIUMI:;Kt,;UPV
PAGE 1 of 111
, S79~AFALL004
"'t,r.:<,~~'p". 'r"'.."'~
IN E11814318112M13/.41/
.'t1tItf:Il~~OF~JID{r~~tmNSALlIlJGHtlltOENTERPrlIS!.~S.li!D~~I'''''"''''''''4''''>;:;'''~'R~.
'St.~~&
?loltf?~ ~
/ 'ill. 11 8/1 - I
Corner of New Highway & Route 109
Exit 34 Southern State Parkway
at foot of
St. Charles Cemetery
By J. Auricchio
P.O. Box 59. F^RMINGO^lE, NEW YORK 11735
TEl: (631) 694-4830
,1)
TO INSCRIBE ADDITIONAL NAMES ON EXISTING MONUMENTS
Dear Valued Customer:
Please Note: Below is information and prices regarding the addition of a name to your
monument:
If you have an existing monument and care to have an additional name inscribed on it,
please return this form to us at your earliest convenience.
However, before you mail it, will you please fill in the name and dates of the deceased
and other information at the bottom.
We thank you for your patronage and assure you of pleasant service and excellent
workmanship. if you do not as yet have a monument, upon your request, we will send you
informative literature and prices.
Year
of Birth
<91/z..7/,'1()C.
Year
of Death
OS{ot/ o~;
The charge for adding one additional name to your monument i
the first name, middle initial, year of birth and year of death.
1st Name
fl/ll.-rI. tJ t7~
Middle
Initial
Terms of endearments as follows may also be inscribed along with names and dates for an additional
o Beloved Father
o Beloved Mother
o Beloved Husband and Father
o Beloved Husband
o In God's Care
o Beloved Mother and Father
o Beloved Wife and Mother
o Beloved Wife
o Rest In Peace
o Always in Our Hearts
Note: Other endearments call be arrallged upon request.
Purchaser's Name
Address
Telephone
Name of Cemetery
(If this correspondence is misdirected, kindly disregard)
-Z7"[ 1111- 4
RECEIPT FOR PAYMENT
-------------------
-------------------
GLENDA FARNER STRASBAUGH
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17G13
Recetpt Date:
Recelpt Time:
Receipt No. :
3/10/2005
10:34:05
1039883
AZIZIE HELENE
Estate File No. :
Paid By Remarks:
2005-00226
ROBERT H BARTOLO
JA
------------------------ Receipt Distribution ------------------------
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST
WILL
AUTOMATION FEE
SHORT CERTIFICATE
JCP FEE
Check# 1198
Total Received..... ....
30.00
15.00
5.00
12.00
10.00
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
BUREAU OF RECEIPTS & CNTR M.D
$72.00
$72.00
RETAIN THIS PORTION FOR YOUR RECORDS
REMITT A~CE A~~'i'l? I BILL TO
THE ENTI L - LEGAL ROBERT BARTOLO
P.o. BOX 130. CARLISLE, PA 17013
AD NUMBER I CLASS SALESPERSON BILLING DArt LINES
283373 10 PUBLlC NOTICES 29 04/20/05 26 * 2
AD DESCRIPTION START DATE STOP DA TE
EXECUTOR'S NOTICE LETTERS OF TESTA 03/31/05 04/14/05
PUBLICA liON INSERTIONS RATE NET AMoUNT GROSS AMOUNT
3 THE SENTINEL - LEGAL 3 LGL
FLAT CHARGE FC 76.23
TOTAL AD CHARGE 76.23
3 PROOF OF PUBLICATION 01PRF 6.35
PREVIOUSLY PAID -82.58
DAYS RUN
PURCHASE ORDER PAY THIS AMOUNT .00 .00*
Est.He1eheAzize
. AFTER OS/20/05
MESSAGE:
Thank you for advertising with The Sentinel.
Deadlines for in-column legal advertisements: Monday is Friday at
11 a.m.; Tuesday is Friday at 4 p.m.; Wednesday is Monday at 12 Noon;
Thursday is Tuesday at 12 Noon; Friday is Wednesday at 12 Noon; Sunday
is Thursday at 12 Noon.
If you have any questions regarding your Legal bill please call
Tammy Shoemaker 243-2611, ext 203.
Fax your legals to 243-3754, attention Tammy Shoemaker
You can also EMAIL yourlegaltoC1assifiedads:classified@cumberlink.com
Please send a cover letter including your name and address as an attachment
DETACH AND RETURN THIS PORTION WITH YOUR PAYMENT
THE SENTINEL. LEGAL Est. HeleneAzize
POBOX 130 CARLISLE PA 17013
. .
AD NUMBER CLASSO START DATE STOP DATE
283373 PUBLIC NOTICES 03/31/05 04/14/05
AD DESCRIPTION BilLING DATE TElEPHONE NUMBER
EXECUTOR'S NOTICE LETTERS OF TESTA 04/20/05 717-770-0558
\'...
~
~
~
N
GROSS AMOUNT OF
.00
DUE AFTER OS/20/05
TOTAL AMOUNT DUE
ENTER AMOUNT ENCLOSED
ROBERT BARTOLO
1711 SHERWOOD RD
NEW CUMBERLAND, PA
17070
*170705*
20200000002833730000000000000000000000000000005
.00
---
Z/~tf ~8
CUMBERLAND LAW JOURNAL
32 SOUTH BEDFORD STREET
CARLISLE, P A 17013
April 22, 2005
Cumberland Law Journal is published every Friday by the Cumberland County Bar
Association and is designated by the Court of Common Pleas as the official legal publication for
Cumberland County and the legal newspaper for publication of legal notices.
TO:
Robert H. Bartalo, ESQUIRE
RE:
Helene Azize, ESTATE
Legal advertisements must be received by Friday Noon. All legal advertising must be
paid in advance. Make all checks payable to: Cumberland Law Joumal.
---------------------------------------------
-------------------------------------------------
Advertisement inserted on following dates:
AprilS, 15,22,2005
Advertising Cost
$ 75.00
$ 0.00
Proof of Publication
Second Proof Request
$ 0.00
Payment Received
$ 75.00
Total Amount Due
$ 0.00
----
-------
Payment received Avril 5. 2005
by Beckv H. Morgenthal/Executive Director
. REV.1512EX'112-03) ..
COMMONWEALTIi OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS Of DECEDENT,
MORTGAGE LIABILITIES, & LIENS
'2
!
ESTATE OF
HELENE AZIZE
FILE NUMBER
21-05-0226
Report debts Incurred by the deced.nt prior to death whfch remained unpaklas of the date of death, Including unrelmbursed m.dlcal.xpen....
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
GRIFFIE & ASSOCIATES Attorney Professional Services
3
BONNIE K MILLER TREASURER -Township of Lower Allen 2005 Personal Tax
125.00
28.00
9.80
2
HCR ManorCare
Note: attachments for all of the above claims are included in this return
TOTAL (Also antar on IIna 10, Recapitulation) S
(If more space Is needed, insert adclillonal sheets of the same sIze)
162.80
HELENE AZIZE ESTATE
Date of Death 03-01-2005
Age at death 99
Date of Birth 01-27-1906
SS# 552-38-5464
SCHEDULE I
ATTACHMENT FOR
Item Number 1,2&3
r~ 4eL,t'lB34'lO(p8,6
1
;;'.f..41'n. stit< ~.vC,-D.!i~'I>
f?!/tv!.k. tI;b /,J *- ,4Hev":>l
..,.(: if I ~r--(.D -:> FI> R -rtf'S
I tJJOIC "- td 3//4 i14
fA"{YI,e.-.,...>-1 I t-l ~ U L.~
f-> I'i I t-JT 0 V I-....J
1.AJ1t-'-
v-J ~..... '/ OV 'l .s-'"-,~v' I ~ tv.!.
flll- "- (LA-I!? v J ,l li--JI
12;/.6
if/ {Ioj'
.I~tf /I: I
GRIFFIE & ASSOCIATES
200 North Hanover Street
Carlisle, PA 17013
Invoice submitted to:
Helene Azize
c/o Robert H. Bartolo
1711 Sherwood Drive
New Cumberland PA 17070
.'
March 1, 2005
In Reference To:Estate Planning
Invoice # 34494
Professional services
Hours
Amount
02/01/05 Receipt and Review of Correspondence
and document from POA; Correspondence
to POA
0.10
25.00
02/23/05 Telecon with Marsh at Manorcare;
Correspondence to POA
0.40
100.00
For professional services rendered
0.50
$125.00
$75.00
-$75.00
Previous balance
02/11/05 Payment - thank you
Balance due
$125.00
THIS STATEMENT REFLECTS ALL SERVICES RENDERED AND PAYMENTS RECEIVED
AS OF JANUARY 31, 2005.
We accept Visa, Mastercard and Discover.
.
HCR.ManorCare
""",,", Cr4'~}])
r '--'.~'-"'~~"
F'AYAllLE
W
DESC
TA~ES
'"'
^"
PAYABLE
FROM
,^'
,,)<,
OHlCE
\l0\1f1~
MANORCARE CARLISLE 372
9~0 WALNUT BOTTOM ROAD
CARLISLE, PA 17013
(711) 2~9-(J085
ROBERT BARTOLO
EO!! HLl. ENE AZIZL
1711 SHERWOOD ROAD
NEW CUMBERLAND, PA
MEDICI,RE A
PRIVATE
ROOI'I 100 --A
17070
Pte;~se nnlutn This Portion
With Yow l-'8.yrwHlI
AlliE, HELENE [
- .- .-. - -- - ~ - - -- -.- ._-
_~2L03/0_~
______"'?/2f3J0',
2~069
DATE or
:_:;H1VICE
[ --J-- -~- ----
CODE
__________ __n____ ___ ....._._
SERVICE I1ENDEf1ED
_~_I__~~~;~F;~-ES___]==~~~~-;~~f:-~__ -I
18.00
02/01/05
02/09/05
02/10/05
02/22/05
02/22/05
BALANCE FORI~ARD
PAYMENT
11100 WASH AND SET
11100 WASH AND SET
11100 HAIR CUT
18.00
( QIY
( QIY
( QTY
I )
I )
1 )
10.50
9.00
8.5'1
PAYMENT DUE UPON RECEIPT
I ..J~! #,1l
)!11 V .J-l 0) ~ i\
! rl'\.~\1C t\~ ~t; .I\~
L 'y\ 'fX')V
?~
I 28. 0(~
_.6.M()llI\lT,n1 n::
256
*:.::.. ,>;.>:,/~;;,.';j:1:. '"
** TAXPAY~R 'J)(lP'V;}'~:;
>j-
BILL DATE
3/01/2005
et%~ 55
COLL 12/29/05
/.
BONNIE K_ MILLER. TREASURER ~
1993 HUMMEL AVENUE R'CD \UJ\\I
CAMP HILL. PA 170~~~~ '~\'
JOB TITLE PJ.
FULL Y RETI RED ,~1t) 1 B
CTL 13 19942 ,~
SSN OOO-OO-OOCJeOO . ,;A~~\<..~\l:~;:oJ:i
,~ eJebtO'/lell\\le~
s:>~
AZ IZE. HELENE 1'10 j)
% ROBERT BARTOLO~
1711 SHERWOOD ROAD
NEW CUMBERLAND PA 17011
2005 PERSONAL TAX NOTICE
COUNTY OF CUMBERLAND
TOWNSHIP OF LOWER ALLEN
BONNIE MILLER@LOWER-ALLEN.PA.US
UNPAID-rAXES SUBMITTED TO DELINQUENT
VALUE
o
fig!'
, , .
CNTY PIC
MUN PIC
5.00000
5.00000
4.90
4.90
5.50
5.50
TOTAL TAX PAYABLE ~
CNTY pic
MUN pic
2.0% 10.0%-
2.0% 10.0%
MON TUES & THURS 9-4 OR BY APPT
4/25-4/29 9-4~ SAT 4/30 9-12NOON
CLOSED WEDS. rRI & HOLIDAYS
PHnNF (717) Q7S-7,7S FXT 17nl
DEADLINE TO APPEAL O~ CHANGE JOB TITLE IS 90 DAYS FROM ~ILt bATE
'4n-~~~~ OR ~q~_nl7' ~y~ ~l~~ OR ~l?_7?R~ F.Y~ ~l~~
REV-1513EX'{>OO) ..
COMMON'WEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
HELENE AZIZE
FILE NUMBER
21-05-0226
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSDN(S) RECEIVING PROPERTY Do Not List Trusteels) OF ESTATE
I TAXABLE DiSTRIBUTIONS ~ndude outright spousal distributions, and transfers under
Sec. 9116 (al (1.2))
1 Robert H. Bartolo Nephew
514.51
2 Robert H. Bartolo Nephew
62,829.26
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, 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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1 Our LADY of LEBANON ROMAN CATHOLIC CATHtDRAL 1,000.00
2 The CONFRATERNITY of the IMMACULATE CONCEPTION of Our LADY of LE8ANON
ROMAN CATHOLIC CA THIDRAL 1,000.00
TOTAL OF PART 11- ENTER TOTAL NON.TAXABLE DISTRIBUTIONS ON LINE 13 OF REV.1500 COVER SHEET S 2,000.00
(If more space is needed, Insert additional sheets of the same size)
HELENE AZIZE ESTATE
Date of Death 03-01-2005
Age at death 99
Date of Birth 01-27-1906
SS# 552-38-5464
SCHEDULE J
ATTACHMENT FOR
Item Number ll-1&2
NUMBER n-B
HELENE AZIZE ESTATE
Date of Death 03-01-2005
Age at death 99
Date of Birth 01-27-1906
SS# 552-38-5464
From interest-bearing Checking Account # 9836670688 for the Estate of Helene Azize
3/17/05 CK. # 94 Our LADY of LEBANON ROMAN
CATHOLIC CATHIDRAL (WILL) --1.000.00
3/17/05 CK. # 95 the CONFRATERNITY of the
IMMACULATE CONCEPTION of
LADY of LEBANON ROMAN
CATHOLIC CATHIDRAL (WILL) -------1.000.00
NUMBER II - 1
OUR LADY OF LEBANON
ROMAN CATHOLIC CATHEDRAL
113 Remson Street,
Brooklyn, NY 11201
Robert H. Bartolo
1711 Sherwood Road
New Cumberland
PA 17070
March 17, 2005
Dear MSG Sadek:
I am the Executor of the Estate of the late Helene Azize (my Aunt).
The late Mrs. Helene Azize stated in her Will the following:
"1 give and bequeath to the building and maintenance fund
Of OUR LADY OF LEBANON RONAM CATHOLIC
CATHEDRAL, 113 Remson Street, New York the sum of
ONE THOUSAND ($1000.00) DOLLARS. I would request
that some Masses be offered for the repose of my soul and the
soul of my husband, JAMES AZIZE, the number of which shall
be in the sole discretion of the Pastor."
So according my Aunt's request, 1 am enclosing a check # 94 in the amount of One
Thousand Dollars and hope you will see that her request is achieved.
Yours truly,
Robert H. Bartolo. Executor
NUMBER II - 2
THE CONFRATERNITY OF THE
IMMACULATE CONCEPTION OF
OUR LADY OF LEBANON
113 Remson Street,
Brooklyn, NY 11201
Robert H. Bartolo
1711 Sherwood Road
New Cumberland
PA 17070
March 17,2005
Dear LADIES:
1 am the Executor of the Estate of the late Helene Azize (my Aunt).
The late Mrs. Helene Azize stated in her Will the following:
"I give and bequeath the sum of ONE THOUSAND ($1000.00)
DOLLARS to THE CONFRATERNITY OF THE IMMACULATE
CONCEPTION OF OUR LADY OF LEBANON CATHEDRAL,
for its general uses and purpose."
So according my Aunt's request, 1 am enclosing a check # 95 in the amount of One
Thousand Dollars.
Yours truly,
Robert H. Bartolo. Executor