HomeMy WebLinkAbout07-29-05
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG, PA 17128-0601
REV-1162 EXI11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 005629
BOMGARDNER WILBERT D
2556 HOPE DRIVE
ERIE, PA 00000
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
n_~____ fold
101
$22,238.00
ESTATE INFORMATION: SSN: 160-16-7121
FILE NUMBER: 2105 - 0500
DECEDENT NAME: MCCANN HELEN A
DATE OF PAYMENT: 07/28/2005
POSTMARK DATE: 07/28/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 05/31/2005
TOTAL AMOUNT PAID:
$22,238.00
REMARKS:
CHECK# 1013
SEAL
INITIALS: CCP
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
FIEY-1600 EX (8-00)
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'* COMMONWEALTH OF
PENNSYlVANIA
. DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDlE INITIAL)
HELEN A. McCANN
FILE NUMBER.
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COOlllY cooe 'IEIIl.
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SOCIAL SECURITY NUMBER
160-16-7121
DATE OF DEATH (MM.DO-YEAR)
05/31/2005
DATE OF BIRTH (MIA-DO-YEAR)
08/0811920
THIS RETURN MUST BE FILED IN DUPUCATE W1111111E
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(IF APPUCABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
I!J 1. Original Retum
o 4. Limited Estate
~ 6. Decedent Died Testate (__of\Wl
o 9. Litigation Proceeds Recalvad
o 2. Supplemental Relurn
o 40. Futura Interasl Compromise (dal' ofd"""'allo< 12.12-8>\
o 7. Decedent Maintained e Living Trust (""'';' "'l'yofT.wI)
o 10. Spousal PO'Ierty Cmdit (d'" of d,"" b_ 12."-91 and 1-1-95)
03. Remainder Retum (da''ofdo''''pri<T1012.13~
o 5. Federal Estate Tax Relum Requimd
~ 8. Total Number of Safe Depostt BOX9<>
o 11. EJection to tax under Sec. 9113(A) (,Allact> Sd> 01
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation. Partnership or SoIlH'ropri6torship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash. Bank Daposits & Miscellanaous Pernonal Property
(Schedule E)
6. JoI~ Owned Property (Schedule F)
o Separete BiDing Requested
7. Inter-Vivos Transfers & MisoeIlanoous Non-Probate Property
(Schedule G Of L)
8. TollIl G...... Assets (lolal Lines 1-7)
9. Funeral Expenses & Administmtiva Costs (Schedule H)
10. Debts of [)eceden~ Mortgage Liabilities, 8. Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Val... 01 Estate (Une 8 minus Line 11)
13. Charitable and Governmental BequesfslSec 9113 Trusts for which an election to lax has not been
made (Schedule J)
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TELEPHONE NUMBE
(814) 825-6945
COMPLETE MAILING ADDRESS
2556 HOPE DR. APT 2
ERIE, PA16510
(1)
(2)
(3)
(4)
(5)
0.00
1,971.00
0.00
0.00
192,063.00
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14. Net Value Subject 10 Tax (Une 12 minus Line 13)
(6)
0.00
(7)
0.00
(9)
(10)
{8}
17,901.00
11,868.00
(11)
(12)
(13)
194,035.00
29,769.00
164,266.00
0.00
(14)
164,266.00
SEE INSTRUCTlOHS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 iIDIlble at Ille spousal tax
rate. or transfers under Sea. 9116 (a)(1.2)
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16. Amount of Line 14 iIDIlbJe at lineal rata
0.00 x.o _ (15)
0.00 x.O _ (16)
17. Amount of Line 14 taxable at sibling rate 41,067.00 x .12 (17) 4,928.00
18. Amount of Line 14laxable atoollaterel rale 123,199.00 x .15 (18) 18.480.00
19. Till< Due {19} 23,408.00
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
. Dec,dent's Complete Address:
STREET ADDRE~ _
113 MAT DR. APT,l
CllY CAMP Hill, "._-~ .- j STATE I ZIP
PA 17011
Tax Payments and Credits:
1. Tax Due (Page 1 line 19)
2. CreditslPayments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
23,408.00
1,170.00
Total Credits ( A + 8 + C ) (2)
1,170.00
3. Interest/Penally if applicable
D. Interest
E. PenaKy
ToIaIlnteresllPenally (0 + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Che<:k box on Page 1 Line 20 to request a refund (4)
A. Enter the interest on the laX due.
(5)
(5A)
22,238.00
5. If Une 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
22,238.00
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Old decedent make a lransfer and: Yes No
a. retain the use or income of the property transferred; .......................................................................................... 0 IiI
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 IiI
c. retain a reversionary interest; or.......................................................................................................................... 0 IiI
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 IiI
2. If death occurred after December 12, 1962, did de<;edent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0 IiI
3. Did decedent own an 'in trust for" or payable upon death bank account or security at rus or her death? """"'''''' 0 00
4. Did decedent own an Individual ReUrement Account, annuity, or other non-probate property which
contains a benefidary designation? ........................................................................................................................ 0 IiI
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND ALE IT AS PART OF TWE RETURN.
Under penallles of perjury, I dedar9 Ihat I hav9 axallinod ttisl1l1u'n. incIulIng accompanying sd1e~1es WId siatsmonls, and 101110 beSt of my krJJI\iQ1ge and bllliot. it is tnJe, ctmlct and canplete.
Oo<:Iellll;oo of prtpOfII_ \!>an \he ~ r~ Is based on all i/fOrmalion of_ prep.....h.. fIllY knowledge.
SIGNATURE OF R RSON RESPONSIBLE FOR FILING RE N
W'
ADDRESS
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
For dates of death on 01 after July 1. 1994 and before January 1, 1995, the laX rate imposed on the net value of transfers 10 or forthe use of the surviving spouse Is 3%
[72 P,S. ~9116 (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. ~9116 (a) (1.1) (iill.
T~ staMe does not exempt a transfer \0 a surviving spouse from lax. and the statutory requirements for disclosure of assets and flllng a tax return WlI stili applicable lIVl1n W
the surviving spouse is the only benefidary.
For dates of death on 01 after July 1,2000:
The laX ralll imposlld on the net value of transfers from a deceased child twenly-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stsppamnt of the child is 0% [72 P.S. 99116(8)(1.2)).
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineel beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(12) [72 PS. 99116(s)(1)].
The lax rate imposed on the nel 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 SecUon 9102, as an
Individual who has at least one parent In common with the decedent. whether by blood 01 adoption.
,
WILL
OF
HELEN A. MCCANN
I, HELEN A. MCCANN, 6f the Borough of Camp Hill, Cumberland County,
Pennsylvania, declare this to be my last will and revoke any will previously
made by me.
Item I. I devise and bequeath all of my estate of every nature and
wherever situate to my sister, MARGARET CALVERT, of Camp Hill, Pennsylvania.
Item II. Should my sister, Margaret Calvert, predecease me, I devise
and bequeath all of my estate of every nature and wherever situate to my brothel
WILBERT D. BOMGARDNER, of Erie, Pennsylvania.
Item III. It is my wish that at the time of death my body be released
to the Anatomical Board of the State of Pennsylvania by my nearest of kin or
the executor of my estate for delivery to one of the medical schools of the
State of Pennsylvania. for studies in the promotion of scientific medicine and
ultimate cremation with others, and burial of the ashes with others, in the
burial plot of the Anatomical Board.
Item IV. I appoint my sister, MARGARET CALVERT, executrix of this my
last will. Should my sister, Margaret Calvert, fail to qualify or cease to act
as executrix, I appoint my brother, WILBERT D. BOMGARDNER, executor of this my
last will.
Item V. I direct that my personal representative shall not be required
to give bond for the faithful performance of their duties in
~1
, 1967.
hereunto set my hand this
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any jurisdiction.
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day of
IN WITNESS WHEREOF, I have
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The preceding instrument, consisting of this and one other typewritten
page, each identified by the signature of the testatrix, was on the date
thereof signed, published and declared by HELEN A. MCCANN, the testatrix
therein named, as and for her last will, in the presence of us, who, at her
request, in her presence, and in the presence of each other, have subscribed
our names as witnesses hereto.
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OOMMCJMo\EALTH OF PENNSYLVANIA
INHERITl\NCE TAX RETURN
RESIDENT DECEDENT
SCHIDUU .
STOCKS & BONDS
ESTAtE OF
HELEN A. McCANN
FILE ~eR
AM pIIIIIlMtr lalnllJ ".Iled wtlII dtIll '" IUI'IIWOIahlp" be chcIoIId Dl\ ........ f.
ITEM
VALUE AT DATE
OF llEA'Il-I
1.
40 Shlnll S<MhIm CornpaIy COIYITlllll etook 034.2218 per share CUSIP #842587107
Me! Life o.mulualizBlicln cnh 1DIf.5190898
Met Life Oemu~ stack 10#5190699
1,366.00
14.00
592.00
2.
3.
TOTAL (Also enw on line 2, Recapilulallon) $
(It_S/IlICllIs~. II-' addIIDnIlWollaol1he__l
1,972.00
Enr.TKJ In St'rr". lou,- U'}'m}d"
\"IueSllons ( OVU-;>;)'/-/tl..!tl
Fax 404-506-0945
Email stockholders@southerncompany.com
Account Statement 06/30/05
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COMPANY
1",111",111"'11,11",1111",1
WILBERT D BOMGARDNER EXEC
ESTATE HELEN A MCCANN
113 MAY DR APT 1
CAMP HILL PA 17011
CUSIP 8<\2587107
Ticker SO
Record Date 05/02/05
Payment Date 06/06/05
Dividend Rate $0.372.5
Record Date Shares 0.0000
Online Account http://investor.southerncompanY.con
Security Code Last 4 digits of SSN
Please review Ihls slatement In ils entirely and notify us Immediately at 800-554-7826 If you find any errors or omissions.
2/31/0'"
,,/110/05
&/17/05
BALANCE FORWARD
PLAN SHARES TRANSfERRED
PLAN SHARES SOLD
1.366....7
3....2218
40.0000
"'0.0000-
0.0001
/'to.0001
O.OOOt
. " SALE, price per share includes $.02 broker commission and $.04 service fee paid by stockholder (seller).
. " PURCHASE, price per share includes $.02 broker commission paid by company.
4S"~r.~'r:,..';';,' 'ec;rti~eatj;SharM~':::;;....;"'Dlreet'R;9i~i,.at'qrt;~~riij'. .;:.:........P!a~..~ha'fjs.wm....mt.<::rQ'fl\{~:~~~~.:illmmi~~iiili~ijy,~..~~c~~Jiilliiiii~mii.m.i~~;~gW::
./30/05 0 0.0000 0.0000 0.0000 $34.6700 to.OO
)'.~:': :';+'!.G~~'oj1f$"lfald . ...........OrosSDlV$..R.i.Mst*d:.... ..;.........ii'~erlll..'t'...ic.Wi~if'.mmmf .:iiti.;mn%iI!li~~~cln;:~~i(!::wj~i!~~~lliililf*wm~'~_
./30/05 $0.00 $0.00 $0.00 $0.00 SO.OO
The Southern Compan
ACCOUNT NUMBER
l]ij()()7::;], 98l
PLEASE ADDRESS ANY INQUIRIES CONCERNING
THIS CHECK TO:
TAXPAYER I.D. NUMBER
~=~1-6127547
NUMBER SHARES SOLD
110.0000
STOCKHOLDER SERVICES
SOUTHERN COMPANY SERVICES, INC.
P.O. BOX 54250
ATLANTA, GEORGIA 30308-0250
SETTLEMENT DATE
Cfi/22,'(!:.
PRICE PER SHARE
3,~ " 2 2. .~ ;~:
FEDERAL TAX WITHHELD
'=1.00
OR TELEPHONE;
1-800-554-7626
NET PROCEEDS
366.47
KPRICE PER SHARE INCL~DES S.O:
SHOLER COM~':IS~:;ION J\ND :::~. (li+ :~:EP\7T(~_':C
~EE PAI~ BY STOC"l:HOLDER !SE~~ER~.
.
Commonwealth of Pennsylvania
Treasury Department
Bureau of Unclaimed Property
Robert p, Casey, Jr.
State Treasurer
STATE OF ~~ COUNTYOF (eh.-vJ,~~
BEING first duly sworn, L{): I tud n. 150o'l'l('1 ALcWl:f:..("Claimant(S)") deposes and repr~nts as follows:
THAT Claimant(s) resides at II ~ Y>1 /\'1 t&h, If fl: -J (Y ~~J:.. f6..-. /7 0 II
THAT Claimant(s) has made a claim for unclaimed property held by the Treasury Department;
CLAIM NUMBER
99602652
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AFFIDAVIT AND INDEMNIFICATION AGREEMENT
THAT Claimant(s) is unable to present to the Treasury Department, as proof of entitlement to the Unclaimed Property, the
following original property information:
Property 10 Property Description Cash Claimed Shares Issue Name Holder
5190698 Demutualization Cash $14.28 0.00 METLlFE INC DEMUTUALIZAl
5190699 Demutualization Stock $590.75 0.00 METLlFE INC DEMU METlIFE INC DEMUTUALlZAl
because such property described above has been lost, stolen, destroyed, misplaced, or never received and
Claimant, hislher heirs, assigns or successors have not received or enjoyed any benefit from the property or proceeds
therefrom;
THAT Claimant(s), in exchange for payment by the Treasury Department of said claim, agrees to at all times indemnify, save,
defend, and keep harmless the Treasury Department, its employes and representatives, from and against any and all claims,
demands, actions, or suits against them, whether groundless or otherwise, and any and all losses, damages, liabilities, costs
and fees arising out of or in any way connected with the payment of the claim, particularly by reason of a claim for payment to
any third person claiming an ownership interest therein or who may hereafter come into possession of the original security,
regardless of whether such claims, actions, losses, damages, suits or liability arise in whole or in part from the gross
negligence or willful misconduct of the Treasury Department;
THAT Claimant(s) agrees that this Affidavit and Indemnification Agreement shall be construed in accordance with the laws of ,
the Commonwealth of Pennsylvania; and
THAT Claimant(s) acknowledges and understands that any information and/or documentation supplied with the
claim, if false, will subject Claimant to prosecution under 18 Pa. C.S.S4904, relating to unsworn falsification to
authorities; the conviction of which could subject Claimant to a prison tenn of up to two years and a fine of up to $5,
000. I- .: j I ..JL, (0) i:? /)
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Signature of CI i antis)
BEFORE ME. the undersigned authority, on this day ~rsq(lallnppeared L~) II ( r- ]) b7M 4 "den r
known tome (orintroduced tome by NLtf(..{y\ +-1- .f.....ViIN\ l,tobethepe n whose name is
subscribed to the foregoing instrument, and acknowledged so helshe executed the sa e for the purposes and
consideration therein expressed and SUBSCRIBED AND SWORN TO ME thi the . it day of
~tAY\e A.D.20~. j... (d
Notary Signature~ liLt ~ ;' r------ '-
PrintedNameofNotary:~{(/qY7 H' PIA..r/ /{ '\
s--~ 2~ ,2J)OZ
My Commission Expires:
NOTARY STAMP
~Seal /''''';;----'----
Nr8l H: Parikh, Notao/ Pubiic J', 1:,.'
lrMer AII8n Twp., ~ County .
My~ Elipires May 28, 2006 I
Mlmber, Penns)1variIa AasodaIiOn or :'-IolllrilJt
REV 150B EX+ (6-98) ~.
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
REclDE:N'!' fJECE;DEN r
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
HELEN A. McCANN
FILE NUMBER
Include the pracMds of litigation and the date the proceeds weill r40Iived by the e8lll1ll.
All fIIOpeJty jointly-owlled witIl rigIIt of survlvonhip mast be ....ed 011 .....uIe F,
ITEM
NUMBER
DESCRIPTION
VAl.UE AT DATE
OF DEATH
1. Sovereign Bank checking account # 571120385
3556 Getty\lburg Rd
Camp Hm, Pa 17011
2. Sovereign Bank CD #710000088O
3. Wearing appalel Donated b Salvation Arrrrf 11 bags
4. Jewelryhfatcheslrin~chainslcostume
5. Household goods /donated to family/ see appraisal
6. Household goods FMV/AUCTION
7. 1995 Buick
175,616.00
11,79500
311,00
1,400.00
1,075.00
49200
8. 06106I2OO5 MNBA cl8dit card rebate
700,00
700
9. 0610&'2005 Met life dividend
10. 07/0Sl2005ladies Home Journal rebate
41.00
13 071ll5f2OO5 Tv Guide rebate
24.00
24900
315.00
3800
11. 0105I2OO5 Highmark Health Ins rebate
12. 0710512OO5 Erie Ins. rebate
-
TOTAL (Also enter on line 5, Recapitulation) $
Of molll 5fl'IC8 ;5 needed, In.ert additional sneets of the same siza}
192,003.00
Date
O~: 7/24/2000 Tenn: 20 MONTHS
Certificate of Deposit
Tu
10:
160-16-7121 Number:
,Account Number:
710000088
Amouator ,
Deposit: ten tl:lousand CIo11ars and no cents
This Tbne Deposit la, Issued to:
Issuer:
$ 10,000.00
NEST SHORE PLAZA BR. HARRIS SAVINGS
1200 MARKET STREET
LEMOYNE PA 17043
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HELEN A MCCANN
5 COUNTRY CLUB PL
CAMP HILL PA 17011-0000
Not Negotiable. Not Traosferable. Adclitlonal tenus are below.
Milestone Banking
Grow. Ac1deve. Thrive.
Ask for details. caJll-877-SOV-8ANK (1-877-768-22651. or visit sovervignbanll.com,
. Sovereign Bank
ClJSTOMER RECEIPT
Milestone Banking
Grow. Achieve Thri
k for delails. call 1-877-SOV-8ANK (J-877-7~:5) , , .
,Dr~sttsov~~banlCDm,
*' Sovereign Bank
CUSTOMER RECEIPT
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T~ Wth Date 06/06/05 10:13 Tl~
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I THE ~ALVATIO. ABlVIY"
II ADULT REHABILITATION CENTER
3650 Vartan Way. Harrisburg, PA 17110
I Phone: (717) 541-0203
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t)E' 11 f~'("'~ E~~5~5C
2555 HOPE I)R AP-r 2
!~=PTF: pn tr:.:,511f.')
Commission d.t 40.000~
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EPIE Pf-:j 16510
Item
Descr'iption
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Amount:
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Commission at 40.000~
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Less adjustments:
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Net due to seller:
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TV GUIDE
P.O. Box 350
Radnor, PA 19088
t"'ayee'1f
46799975
. --...-.. ,..,. ...---...-
113 MAY DR APT 1
CAMP HILL, PA 17011-5024
Refund Type Check Number Check Date Check Amount
Rate and/or Term Adjusted 8779 June 27, 2005 *******$38.22
SUBSCRIPTION REFUND
Record Dat(>
T..(' ,',:,".';j',,:.t'-. ','~,i/,.~.~r;y
.37250000
40.0000
00002b0710
. ..-
! 1l5/02/05
Ob/Ob/05
}I
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t,.' ~::-: \. . l~. '
jr:~YI:' l';l{','~'> ; ;'\~~,:\-. ,~,:,:! -',.i; ;'.::,,"';
DIvIdend Rate
. .
14.9~_____ .~OD
" ,- ~, .( f ~'.
. .
; HELEN A MCCANN
HAY DRIVE *1
'HILL PA 17011-0000
., " ,.- .' ~ ~ /.
'1\, ~.:" \.
1-800-554-7626
let Account Access at Web Address above. Internet Security Code i. equal to the last four digits of the Account's Tax ID.
~J II (-. I J t\ "' '\1" I /
IJI"IIV,/ \.',
Date: 06/14/2005
This Month
Gross payment amount
Net payment amount
249.00
249.00
", , " , i' " (,
:.,.' _.._i.. ,~) .) t.~~ J
-
-
-
.....+
leredith Publishing
dies Home Journal
0343100
lATE
DESCRIPTION
Refund for HELEN MCCANN
on a subscription or unavailable single-issues.
LHJ 046452651-6
51
AMOUNT
$24.05
)6/15/05
~
I
426429628201202
CPV INVOICE
UMBER NUMBER
0505061200
77-Credi Balance R
15742919
~~T ~PWT'"
6.67
..
..
Enclosed you wil find a check w ich represen s a credit balance refund from yo r MBNA America
account.
.r
If you have furth r questions. pi se cantaOl 0 r Customer Safis Olion Departm nt at
1-800441-997 We appreciat this oppoltu to be of servic to you.
. Any adjustme ts will be posted to
~
~
~
Remember that I credit balen
your account.
6.67
o
6.67
1ffi'1I~
~ ERIE INSURANCE GROUP
~ 100 Ene Ins PI . Ene. PA '6530
FRIEl!)
DATE
MO.j DAVIVA
06 20 05
1,"111",111"",,1111,1111",1
ESTATE OF MISS HELEN A MC CANN
113 MAY DR APT 1
CAMP HILL PA 17011
REFUND AMOUNT $185.00
POUCYNUMBER QI0 0104487 H
AGENT NO AA7636
AGENT'S NAME WE I TZEL INS. AGY.,
REASON 1
REF NO W004277
CHECK NO. 23004277
AA7636
NON-NEGOTIABLE
I. -
I
. ERIEINSUAANCE GROUP
~ .00 Erie Ins. PI . Ene. PA 16530
FRIEl!)
NOTICE OF PREMIUM REFUND
DP164G HI
DATE
MO.!DAVIVR
06 20 05
I II ,III II ,III "'"' II '" 1111",1
ESTATE OF HELEN A MC CANN
113 MAY DR APT 1
CAMP HILL PA 17011
REFUND AMOUNT $130.00
POUCYNUMBER Q53 1607781 H
AGENT NO. AA7636
AGENT'S NAME WEITZEL INS. AGY.,
REASON 1
REF NO. W004626
CHECK NO. 23004626
AA7636
NON-NEGOTIABLE
.- ...-....-- ,.... . ...............-... - ....-. .........t"1
FROM
U.S. DEPARTMENT OF THE TREASURY
FINANCIAL MANAGEMENT SERVICE
PHILADELPHIA FINANCIAL CENTER
POST OFFICE BOX 51321
PHilADELPHIA, PA 19115-6321
_ECTRONIC FUNDS TRANSFER
:DERAL RECURRING PAYMENTS
NOTICE OF RECLAMATION
linin IIIII1 ~III M~III.IIUIIUIIIIIIIIIIIIIIII
*3816700260X*
DATE
07/01/05
9224692
~IPIENT AND/OR BENEFICIARY NAME
HELEN A MCCANN
CLAIM NUMBER
160-16-7121 A
DATE OF DEATH
05-31-05
06-03-05
AGENCY
~
PAYMENT
RSISSA
1'RACE
NU!A8ER
TYPE OF
ACCOUNT
DEPOSITOR
ACCOUNT NUMBER
AMOUNT
DAlE OF
PAYMENT
03173601 2212837
C
0571120385
1048.00
~~~4nd5~.'
-
~
OUTSTANDING TOTAL
1048.00
TICE TO ACCOUNT OWNERS FROM THE GOVERNMENT
~ Government has received information that person named on this notice is deceased. The purpose of this notice
o inform you that by law entitlement to Government benefits for this person ended at death. Therefore, the
vernment must recover all payments made after the date of death. If there has been an error and this person is not
:eased, or if the date of death is wrong, this notice explains how to correct the mistake. If you do not understand
; notice, please get help either your financial institution or the Government agency that was making payments.
YMENTS TO THIS PERSON HAVE BEEN STOPPED
Jr financial institution has been asked to return the payments shown on this notice to the Government because
'f were issued in error. The Government has asked your financial institution to send this notice to you, the account
nero Your financial institution must notify you if it has taken action to recover these funds from the account.
ntact your financial institution immediately if you do not undersflttfctitsactions. If t~e qOYlffrrnent is unal?le to r
lect from the financial institution the fUllamot.!nt Qf the payments made aft~,. cflfafff: YtSi.t may be contacted by the
mcy which made the payments
rHE PERSON IS NOT DECEASED
If the person is not deceased, immediately contact both your financial institution and the agency that made the
ments to correct the error. The Government regrets any inconvenience this error may cause. Your financial institu-
I can correct the collection action if it is given satisfactory proof that the person is alive. NOT~: YOU MUST
NTACT THE AGENCY THAT MADE THE PAYMENTS BECAUSE THIS ERROR HAS STOPPED FURTHER
YMENTS. ONLY THE AGENCY CAN RESTART THE PAYMENTS.
r~~
~'
. c. Sovereign Bank
v
July 06, 2005
Estate of Helen McCann
113 May Dr- Apt 1
Camp Hill, PA 17011-5024
Subject: Death Certificate Notification
Return of Deposit Request
On July 052005, we received a copy of the short certificate with instructions to
return a Federal payment deposited to the account of Helen McCann.
The certificate advises us that Ms. McCann's date of death was 05/31/05 and that
all payments made after that date must be returned to the Treasury. Please be
advised that the following amount has been debited from the account listed below
and the payment was returned on the date shown.
Date:
Account debited:
Amount debited:
07106/05
571120385
$1,048.00
If you have any questions regarding this reclamation or need any additional
information, please call our customer service center toll free at 1-877-768-2265.
Thank you.
Sincerely,
jeamtte C
ACH Department
Enclosure
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COMWClNWEAlTH OF PENNSYLVANIA
INHeRrr~l!. TAX f\lm}l'Il'I
RESIDENT DECEOENT
SCIIIDULI H
FUNEAAL EXPENSES &
ADMINISTRAJIVE COStS
ESTATE OF
HELEN A. McCANN
RLE NUMIlIlR
\WItt of .....1lUIt... ........ 0lI1c1Mc1l11t J.
AMOUNT
ITEM
NUM5E
A.
1.
FUNERAl.I;XPEHSES:
AUER MEMORIAl. HOME AND CREMATION
4100 JONESTOWN RO
HARRISBURG, PA 17109
B. ADMlHISTRATtVE COSTS:
,. PlnonaI R/Jp-*lMl's CcmrniIWns 15,000.00
NameofPenlon8l~s) WILBERT D. BOMGARDNER EXEC.
SoclII SealllIy NucNlella)aH Number 01 PIItIon&I RspreSlllUlMl(.) 204-26-8279 ._
Sl/8etAddftlllS 2256 HOPE DR APT 2
CilyERIE. ,SfIIllIPA np 16510
YearW~ !'aId: 1
2. AllDmey "- 100.00
3. Farrily Exemption; (If decedlInt'. addrws IS 11011118 _Ill cIIIIm8nt'&. aIllIch uplenIIIoo)
CI8Im8nt
SbwtAclcl_
ClIy Slalll . Zip
RlUllar1s11ip ri Claimant tJ !leoIldIW
4. ProOa1e F_ 310.00
6. Aaloonlant's f_
6. Tax Relllm Prepa/8r's f_
7. DORIS K BROTHERS SS # 292.26-0274 4305 Carney Ave Erie. Pa 16510 1,000.00
(diBpo8aIliIId meinlIIing propeI1y June 4-.Nne 18.20051100 1lclur&@10.oo pw hour)
8. P8Irial: News (TESTAMENTARY NOTICE) 181.56
9. APPRAISAL FEE (far darIfild hauIehokI goods) 25.00
10. REGISTER OF WillS ~a1 filinllll) 45.00
11. Ollice Mall (SCANNER FOR ADMIN. USE FilliNG OUT FOAMS)
TOTAL (Alto entBr online 9, R8cllpilulallon)' 17 I 90 1 .00
(N more lIpICll is neIded. lnNrt addIionIlsIIMII 011'" _ size)
~
Account Inqujries
{j :;=~;rvice:
W D BOMGARDNER
Account Number: 5423618370637669
Closing Date: 06/24/05
Credit Limit: $5,000 Available Credit: $3,820
A.c.~o\lnt $~JMlary
Previous Balance
Page 1 of 1
-
ERIE FEDERAL CREDIT UNION
Please Direct Written Inquiries to:
CUSTOMER SERVICE
PO BOX 30495
TAMPA, Fl33630
Payment tnforma~n
I.~ Total Minimum Payment Due
~ Payment Due Date
Mail Payments to: MASTERCARD PO BOX n044
. \mportant.NeW;S
'-'1.
~
Purchases +
Cash +
Credits
Payments
Insurance +
Other Debits +
Finance Charges +
NEW BALANCE $
$ 0.00
1180.00
0.00
0.00
0.00
0.00
0.00
0.00
1,180.00
$36.00
07/19/05
MADISON WI 53707-1044
TO REPORT A CARD LOSTISTOLEN, PLEASE CALL (866) 604-0381 OR (727) 571J..4881.
.." *.......
MANAGE YOUR CARD ACCOUNT ONLINE. IT'S FREEl IT'S EASYI
SIMPL Y GO TO WWW.EZCARDlNFO.COM AND ENROLL IN OUR ONLINE SERVICE. YOU CAN
REVIEW ACCOUNT INFORMATION, TRACK SPENDING, SET ALERT NOTIFICATIONS,
DOWNLOAD FILES, AND MUCH MORE. MANAGING YOUR ACCOUNT IS FAST. SECURE AND
EASY WITH EZCARDlNFO. ENROLL TODA YI
IDENTITY THEFT STRIKES M/WONS OF PEOPLE EVERY YEARH' DON'T LET IT HAPPEN
TO YOU! NOW YOU CAN FIGHT BACK WITH EASY, AFFORDABLE EQUIFAX CREDIT WATCH
WITH IDENTlTYPROTECT. GO TO WWW./DENTlTYPROTECT.COMlCSCUANDSIGNUPTODAY.
OR CALL 1-800-437-4919 TO RECEIVE IT BY MAIL.
r
I'purchases
Cash
Fees/Finance Charge
Total
Account Activity Summary
_HJ:~;:::~ I
$ 0.00
0.00
PeriOlic .--1' Correspondng
)~~te Annual Per~ R&!e
0.9917% 11.90%
0.9917% 11.90%
New
Balance
See reverse side for explanation of Finance Charge Method Credit Purchases: E
$ 1,180.00
Days In Billing Cycle: 30
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PHONE: (717) 737-1300
.L:aw Dfflau of
DEBRA K. WALLET
24 N. 32nd STREET
CAMP HILL, PA 17011-2917
Email: Walletdeb@aol.com
June 28, 2005
Estate of Helen A. McCann
c/o Mr. Wilbert D. Bomgardner
2556 Hope Drive
E!"ie, PA 16510-3922
RE: Helen A. McCann
FAX: (717) 761-5319
Telephone conferences with Melissa Zeiger and Wilbert Bomgardner;
Travel to and from Hershey Medical Center
BALANCE DUE
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RECEIPT FOR PAYMENT
-------------------
-------------------
mDA FARNER STRASBAUGH
ilierland County - Register Of wills
~ Courthouse Square
~lisle, PA 17IT13
Receipt Date:
Receipt Time:
Receipt No. :
6/03/2005
12:08:50
1040856
MCCANN HELEN A
:ate File No.:
.d By Remarks:
2005-00500
WILBERT BOMGARDNER
RSK
.--------------------- Receipt Distribution ------------------------
!/Tax Description Payment Amount Payee Name
'ITION LTRS TEST
,L
lRT CERTIFICATE
J FEE
~OMAT
260.00
15.00
20.00
10.00
5.00
----------------
$310.00
$310.00
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
BUREAU OF RECEIPTS & CNTR M.D
CUMBERLAND COUNTY GENERAL FUN
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Now you know
Order Confirmation
Customer
WILBERT D. BOMGARDNER, EXECUTOR
Orderer Account Number
89138
Paver
Paver Account Number
89138
Ad Order
~
Order Taker
Order Source
0001329277
rholton
rholton
~
Camp Hill PA 17011 USA
SDecial Pricing
PO Number
Ordered Bv
Customer Fax
ESTATE OF MCCANN
WILBERT
WILBERT D. BOMGARDNER, EXECUTOR
113 MAY DR. APT 1
Customer EMail
Customer Phone 717-761-3859
Paver Phone 717-761-3859
Tear Sheets
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Promo Tvpe
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Invoice Text
Payment Amount
$0.00
Payment Method
~
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Materials
Total Ad Cost
$181.56
Amount Due
$181.56
Ad Number Ad Type
0001329277-0' Legal Liners
Ad Size
: 1.0X 14 Li
Color
<NONE>
Production Method Production Notes
Ad Booker
Product Information
Classification
# Inserts
Run Dates
PNCO: :Full Run
806-Estate Notices
3
6115/2005,6/22/2005,6/29/2005
Run Schedule Invoice Text
ESTATE NOTICELetters Testamentary for the estate of Helen A. McC~nn
6/29/2005 8:32: 13AM
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,REV-1512 EX' (12-03)
*'
SCHEDULE I
DE8TS OF DECEDENT,
MORTGAGE UA8IUTlES, & UENS
COMMONWEALTH OF PENNSVLVANIA
INHERITANCE TAX RETURN
RESIDEN1 DECEDENT
ESTATE OF
HELENA McCANN
Report debtslllCll",1I by the del:edtnt prior to lIatlt which remained unpaid aa of tha data of daath, IncludiAV UIInlimbursed madk:al upenaas.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
FILE NUMBER
1. Check #2973 Paid by POA OS/2812005lnot cleared by date of death
2 Check tfJ.974 Paid BY POA 05l2812005lnot cleared by date of death
3. Check #2972 Paid by POA 05l2812OO5Inol cleared by date of death
Check #2975 Paid by POA 0512812005 nol cleared by dele of death
Check #2971 Paid by POA 05l25/2005Inot cleared by date of date
(See attached slatement)
10_
TOTAL (Also enter on line 10, Recapilulallon)
(If more space is needed, insert addnional sI1aels oltha sa"", sile)
W: ::\ u vr; i'U1i";n I) cud\
1-877-S0V-BANK (1-877-768-2265) www.sovereignbank.com
THE ONE CHECKINC
THE ONE CHECKINC Statement Period 05/16/05 - 06/14/05
HELEN A MCCANN
MELISSA ZEIGER A TTY IFF
Account H 571120385
Former Account H 500006949
Balances
Beginning Balance
Deposits/Credits
Withdrawals/Debits
$175,885.61
+ $1,248.21
- $172,933.61
Current Balance
Average Daily Balance
$4,200.21
$123,025.91
Interest
Paid this Period *
Earned this Period
Paid Year-To-Date
$ 200.21
$ 200.21
$1,414.60
Annual Percentage Yield Earned
Paid Last Year
2.00%
$0.00
"The interest earned and the interest paid may differ depending on when interest is credited to your account.
Checks Posted
Check # Date Paid Amount Reference # Check # Date Paid Amount Reference #
2965 05/18 $33.02 645913100 2971 06102 $37.92 617798610
2966 05/17 $65.00 611738410 2972 06103 $797.00 610756710
2967 05/19 $44.00 616604230 2973 06102 $100.00 617717420
2968 OS/26 $100.00 617655770 2974 06/02 $8,744.40 617646150
2969 OS/27 $15.24 610332290 2975 06106 $2,000.00 641948760
2970 05/31 $12.05 642278970
11 Check(s) Posted = $11,948.63
An asterisk (*) indicates a skip in sequential check numbers.
Account Activity
Date Description
Additions
Subtractions
Balance
05-16
05-17
05-18
05-19
---
05-26
05-27
~31
06-02
Beginning Balance
CHECK 2966
CHECK 2965
CHECK 2967
CHECK 2968
CHECK 2969
CHECK 2970
CHECK 2974
$65.00
$33.02
$44.00
$100])0
$15.24
$12.05
$8,744.40
$175,885.61
$175,820.61
$175,787.59
$175,743.59
$175,643.59
$175,628.3~ J
$~ 75,616.30.
$166,871.90
1-877-S0V-BANK (1-877-768-2265) www.sovereignbank.com THE ONE CHECKINC
Account Activity (Cont. for Acct# 571120385)
Date Description Additions Subtractions Balance
06-02 CHECK 2973 $100.00 $166,771.90
06-02 CHECK 2971 $37.92 $166,733.98
06-03 US TREASURY 303 $1,048.00 $167,781.98
sac SEC 060305
ASSA
06-03 CHECK 2972 $797.00 $166,984.98
06-06 WTHDRWL $160,984.98 $6,000.00
06-06 CHECK 2975 $2,000.00 .. $4,000.00
06-14 INTEREST CREDIT $200.21 $4,200.2T
06-14 Ending Balance $4,200.21
We never stop workIng for you.
l-.o'lIl11lH LJClIc;. v. """'''''' r c1~'t;: ) VI U
Telephone Number: 717761 3859
Account: 717761 385954582 Y
How to Reach Us: See page 2
~
ve~'ZSLn
HELEN MC CANN
Account Summary
Previous Charges
Payments Received thru Jut 5
$33.19
-33.19
$.00
Past Due Charges
New Charges
Ver/zon (page 3)
Ver/zon Long Distance (page 6)
Total New Charges
$1.94
5.81
$7.75
Total Due {pas. Due , New)
$7.75
),
Mall payments to:
Verizon. PO Box 28000. Lehigh Vly PA 18002-8000
~
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C~nge of billing address?
Go to verizon.comlb/llingaddress or see page 2_
~-;..-:.;:;.;-.:-:. _._.:-_::".-:::. _._ _ _ _ _ _ _ _ _ _ _ _ _ ~D.!'I~h2':!!tu.!.nE.ay!"e!!t~ip1"j!!:!y~uc..ch2"~p.1'.y~l~o'ye.!:!z,!,._ _ _
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We never stop working for you.
HELEN MC CANN
Account Summary
Previous Charges
Payments Received thru May 26
Past Due Charges
$33.02
-33.02
$.00
New Charges
Verizon (page 3)
Verizon Long Distance (page 5)
Total New Charges due Jun 21
$29.44
3.75
$33.19
Total Due (past Due + New)
$33.19
05/01/05
05/16/05
05/03/05
BALANCE FORWARD
PAYMENT CHECK # 2966
11100 BEAUTY AND BARBER
T~i~ph~~~-N~;'b~r:-717 76t 3859 *\
Account: 717761 385954582 Y J
_toRe'~ U'q~2 ~
sOSL Le\ \ ~
New News from Verizon Online DSL ~
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but kept the price the same' Just $29.95
a month when you sign up for a year
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or call 1-877-668-5375.
Se1vice not available on aI/lines.
Subject to nnal venficatlDn by
Vemon. Other res!J;cl/ons apply.
eo
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m
65.00
( QTY
65
1
12.00
PAYMENT DUE UPON RECEIPT
12.
....
PPL Electric
Utilities
Page 1
y<>ilt iIIACCllUi.fN~""
ppl
00480-74077
For:
MISS HELEN A MCCANN
113 MAY DR APT I
CAMP HILL PA nOli
Summary Page
Balance as of Jun 20, 2005
Char~s:
TotafPPL ELECTRIC UTILITIES Charges
S 27.63
Electric
Service
Final BID
$ 23.04
$ 50.67
ACCOlUlt Balance
QuestioDs about
tliis bill'? Please
contact us by Jul JJ
,,-.....,
corn ea st,
~
ACCOUNT
NUMBER
DATE
DUE
TOTAL
AMOUNT DUE
Visil us on the web at www.comcasl.C..om
09547 184855-08-5
Due Now
WILBERT BOMGARDNER
How to reach us...
How to reach us:
4830 Carlisle Pike, Suite 0-14
Mechanicsburg, Pa 17055
(717)540-8900
Telephone Customer Service
24 hours a day. seven days a week
For service at:
113 MAY DR APT 1
CAMP HILL PA 17011-5024
Summary of Charges
Billed from 06/09/05 to 07/08/05
~!.~vJgu_s Balanc:;~._____ ___.____ _____,_ _______Q.90_
PaYll1ent,~_1!nch,JQ~s paYlTlents!.~iv~!?y 06/2~/O_~L____ _ _... __9.00
Montllly~ervices _ ___ .___m._ __ ____ ______ ____ 42.29__.
Insla/latiol]Gharges __ _ .__._____._________.__,_ _g.!)~__
Taxes. Surl;;harges, &. Fee~__. ____. ;J.!l!l.,
5'''- y3 n /J
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News from Corneas. q- 1f, 7~
Thank you tOl choosing CorneasH We are very pleased to be able to provide you
with the lalest in enlertainment and technology. We hope thaI you are enjoying your
service. " you have any questions. please feel free to conlact us at the phone
number listed in the upper right corner ot your bill.
$56.43
Detail of Charges on baek
UPN and Phillies now in High Definition! Watch Phillies home games and more in
HD on WL YH channel 236. For informalion about enlertainment packa~i1h /
Comcas! HDTV. please call1'800-COMCAS~ t~ 10 () :; "" /0')
",'
,:.I.U
SUITE 300 B
7825 BAYMEADOWS WAY
JACKSONVILLE. FL 32256
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001-518-3501-11
37.92
6/23/2005
7/11/2005
35.02
l.ulII...III.... ..1I...1I.1.1.llulIIl.I.I..III... ...11I..1.1
HELEN MCCANN
113 MAY DR APT 1
CAMP HILL. PA 17011.5024
D
FOR QUESTIONS REGAROING YOUR
ACCOUNT, PLEASE CALL
1-866-737-4943 OR 904-807-3777
WEBSITE - WWW.ISTA-~.COM
MON-FRI 8:00AM - 5:00PM EST
0lIClClM6\ 461
MONITORED HEAT SERV
HOT WATER HEATING
BASE ENERGY
2
5.95
17.72
11.35
FOR YOUR CONVENIENCE, YOU CAN Access YOUR ACCOUNT INFORMATION AND MAKE
PAYMENTS ONlINE AT WWW.ISTA-NA.COM. PAYMENTS CAN BE MADE OIIllINE
WITH A CHECK. CREDIT/DEBIT CARD OR BY PHONE. BY CALLING OUR BILINGUAL
CUSTOMER SERVICE TOLL FREE NUMBER.
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MOVING OUT? DO I\K)T CALL ISTA WITH YOUR MOVE OUT INFORMATION. ISTA ONLY
ACCEPTS MOVE OUT INfORMATION FROM YOUR PROPERTY MANAGEMENT_
TO ENSURE FASTER PAYMENT PROCESSING. PLEASE WRITE YOUR ACCOUNT NUMBER ON
YOUR CHECK OR MONEY ORDER Alii) ENCLOSE WITH THE REMITTANCE COUPON. PLEASE
DO JIllT STAPLE OR CLIP YOUR CHECK TO THE COUPON. PLEASE DO I\K)T SEI\K) CASH.
A LAn! FEE MAY 815 ASSESSED ON ANV UNPAID BAl.ANCE THAT IS NOT RECEIVED BY TIlE DUE DATE
RI!TAIN THIS PORTION FOR YOUR ReCORDS. NOT1!: Thl. bill I. NOT from your lOCal utility.
~.." .~.~ _. ~ ~.-
,,"-V-1~1SW(9~Q) ..
COMMONWEALTH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESloeNT DECEDENT
SCHIDULE ,
BENEFIOARIES
ESTATE OF
HELEN McCANN
FIlE NUMBER
NUMBER NAMEANO AOORESS OF PERSON(S) RECEIVING PROPERTY
I TAXA8LE OISTRlBUnOtlS [include outright spousal dislJiblJtions, and Ir8nsfl1rs IIIld8r
Sec. 9116 (a) (1.2)J
1. WILBERT D. BOMGARDNER
RElATIONSHIP TO DECEDENT
Do Not Usl TNRl I
AMOUNT OR SHARE
Of eSTATE
BROTHER
41067.00
2556 Hope Dr. Apt 2 Erie, Pa. 1651Q
3.
Pam ZimrnermM
Gr. niece
41067.00
2.
Peggy Rodenhaber
Gr. Niece
303 Redwood 5t Harrisburg. Pa 17109
41067.00
3202 Hoffman 5t Harrisburg, Pa 17110
4. PIOicia A. Flemisler
1640 Market St. Harrisburg, Pa 17103
Gr. Niece
41067.00
ENTER OOLLARAMOUNTSF<lR DISTRIBUTIONS SHOWNASOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, Otl REV-l5CO COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A SPOUSAL QlSlRl8UTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
8. CHARITABLE ANO GOVERNMENTAL DISTRIBUTIONS
TOTAl OF PART 11- ENTER TOTAL NOH-TAXABLE DISTRIBUTIONS ON UNE 13 OF REV-1500 COVER SHEET
(If _ space is needed, ineert addlllonalllleelS of II1e l8_sizlo)