HomeMy WebLinkAbout08-10-05
Rev .1NO l!lt .1.401
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
,~"....,"
, 21 05"
QQJ.Lfill'l;QOE ViOJ\R
SOCIAL SECURITY NUMBER
COMMONWEAlTH OF PENNSYLVANIA
OEPARTMENT OF ~EVENUE
DEPT. 2aoeo1
HAARISBUR13, P/4. 171~8-OS01 l
-]DECEDENTS NAME (LAST. FIRST. AND MIDDLE INITIAL)
DeMarco, Michael J.
O~/~
NUMBER
205-09-4816
i DATE OF DEATH (MM-DD-YEAR)
I 09/29/2004
CP~'C:::~:U::~: SPOUSE'S NAME (LA: FI:ST :u:::::~;N~::~:n
i 0 4, Limited Estate 0 4a. Future Interest Compromise (dale 01 death afler
! 12-12-82)
181 6. Decedent Died Teslate (Attach copy 0 7. Decedent Maintained a Living Trust (Mach
of Will) copy of Trust)
, 0 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (date 01 dealh belween 0 11. Election to taK under Sec. 9113(A) IAnach Scf1 0)
I . . 12-31-91 .]'d1.~Hlil_ .
!THIS SECTION MUST BE COMPlETED' ALL CORRESPONDENCE ANtlCONFlDENTlAL TAX INFORMATJONCSHOULO BE DIRECTED TO:
t'!AME ICOMPlETE MAIUNG ADDRESS
: Stephen L. Bloom
~IAMN-AME(lt- applicable)
Stephen L. Bloom, Esquire
rELEPHONE-NUMBEA
717/249-7717
1
>-
z
W
Q
W
lil
Q
I DATE OF BIRTH (MM-OO-YEAR)
! 06/24/l9 17
THIS RETURN MUST BE FILED IN OUPUCATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
~
,,~~
:;l"'g
X~.J
0...01
~
,
I
-n- 3. Remainder Retum (date ot death prior to 12-13-82)
o 5. Federa( Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
th>-
~~
02
o~
2100 Longs Gap Road
Carlisle, PA 17013
1. Real Estate (SchBdule A) (1) None
2. Stocks and Bonds (Schedule B) (2) None
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None
4. Mortgages & Notes Receivable (Schedule D) (4) None
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) None
(Schedule E)
6. Jointly Owned Property (Schedule F) (6) 7,015,67
z o Separate Billing Requested
0
~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None
j:? (Schedule G or L)
~ 8. Total Gross Assets (total Lines 1-7)
w 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 13,341.79
'"
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 574.90
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 6 minus Line 11)
C,2 OH'ICiAI.. ~1..JNl_ y
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(8)
7,015,67
(11)
13,916.69
(12)
insolvent
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13)
made (SchBdule J)
14. Net VBlue Subject to Tax (Line 12 minus Line 13) (14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15.Amount of Line 14 taKable at the spousal tax rate, K .00 (15)
or transfers under Sec. 9116(a}(1.2}
z .045 (16)
0 16, Amount of Line 14 taxable at lineal rate x
F
g
... 17. Amount of Line 14 taxable at sibling rate .12 (17)
:0 x
0
0
~ 18. Amount of Line 14 taxable at collateral rate K .15 (18)
19. Tax Due (19)
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
/"
_.._._._ ...>~_BE.'S_lJl:'lEr()'~~S~.~ QUESTiOtfS.5>:N_R-'SveRS!~I!?~'AN"'~~CHe9~f(/~Tlf~<
Copyright 2000 form software only The Lackner Group, Inc.
Form REV.1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
150 Hickory town Road
CITY
Carlisle
I STATE PA
IZIP 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
Total Credits (A + B + C)
(2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total [nteresVPenalty (0 + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3) 0.00
(4)
(5) 0.00
(5A)
(5B) 0.00
Make Check Payable to: REGISTER OF WILLS, AGENT
ii\iIII~.I_~~$lilJ.__lli~11l1.1.1..n ~1\~ii'.I"'lIHln Ir 11l.1~~I[[miF BlJ'fi.~~*,)1li\f~Y
PLEASE ANSWER THE FOllOWING QUEST[ONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
y~ I
1. Did decedent make a transfer and:
a. retain the use or Income of the property transferred;..................................................................................
b. retain the right to designate who shall use the property transferred or its income;....................................
c. retain a reversionary interest; or..................................................................................................... .... ...... ...
d. receive the promise for life of either payments, benefits or care?.............................................................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?......,.......................................................................................................... .....
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.........
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?.............,............................................................... ....................,...................
o
o
o
~
~
~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND F[LE [T AS PART OF THE RETURN.
Under penalties of pefj\Jry, I deelare that I have exsmined this retum, Induding accompanying schedules and statements, and to the best of my knO'Nledge and belief, it is true, correct and complete. Declaration of
flrtJparer Ol!1ttr ~a~l~~,~_r~onal r~erese~t8ti\le is ba~f:Ki on an i~~rmatio_~ o! w!1icl1_ pr~parer h8l.\~~y_~~~edge.
SIGNATURE Of PERSON RESPONSIBLE fOR fiLING RETURN ADDRESS DATE
CharlesW. DeMarco 'I) _" . tJ j).., j71~, 150 Hickorvtown Road 7/.P-VO s-
YI.t rCM./ Carlisle, P A 17013 '/.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
ADDRESS
DATE
ADDRESS
DATE
2100 Lon~s Gap Road
Carlisle, P'A 17013
7/;)<-1/05
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)J.
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) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death 10 or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116
1.2) [72 P.S. !i9116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116 (a) (1.3)]. A sibling is defined.
under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
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SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
I FILE NUMBER
_'- 2\ - -
If an asset was made Joint within one year of the decedent's date of death. It must be reported on schedule G.
DeMarco, Michael J.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A Charles W. DeMarco
150 Hickory town Road
Carlisle, PA 17013
Son
JOINTLY OWNED PROPERTY:
ITEM Ii LETTER I DATE
NUMBER FOR JOINT I MADE
. TENANT, JOINT
A 2002
1-~c~~~rra~~~~~;:~;~~~;Jf:;j~~~~?~;~~J:~rrl~~1TE OtF Dfs'1Tt-r 1.[,Jli~TIDEc::~~~~i~;;EST
estate. .
, ,\ ,
M&T Bank Checking Account - 28065085 14,031.331 50%1 7,015.67
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TOTAL (Also enter on line 6, Recapitulation)
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T
7,015.67
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SCHEDUlE H
FlN:RAL. EXPENSES &
ADlWNSlRAllVE COSTS
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
REaIDEH'T OeCeDeNl
ESTATE OF
DeMarco, Michael J.
FilE NUMBER
21 - -
Debts of decedent must be reported on Schedule I.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
Marker Installation - Office of Catholic Cemeteries
200.00
2
Funeral Service - Wiedeman Funeral Home
8,635.67
B. I ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State _ Zip
Year(s) Commission paid
Attorney's Fees Stephen L. Bloom, Attorney and Counsellor at Law
2.
3.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Charles W. DeMarco
Street Address ISO Hickory town Road
City Carlisle State PA Zip 17013
Relationship of Claim anI 10 Decedent Son
1,006.12
3,500.00
4. Probate Fees
5. Accountant's Fees
6. Tax Relurn Preparer's Fees
7. Other Adminislrative Costs
I
TOTAL (Also enter on line 9, Recapitulation)
13,341.79
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SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYL Vo\NlA
INHERITANCE TAX REnJRN
RESIDENT DECEDENT
ESTATE OF .
DeMarco, Michael 1.
i FILE NUMBER
2 I - .
Include unreimbursed medical expenses.
ITEM
NUMBER
1
DESCRIPTION
AMOUNT
Ambulance Services - Cumberland-Goodwill Fire Rescue
498.00
2
Hospital Services - Holy Spirit Hospital
76.90
TOTAL (Also enter on Line 10, Recapitulation)
574.90
",..I ..__~...__ -----_.._u ~_...
-
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.. r -I' .
MICHAEL f" DeMARCO
I. MICHAEL J. DeMARCO, of ~teelton, Dauphin County,
Pennsylvania. being of sound mird and disposing memory,
rGolizing tho uncertainty of th 5 life, hut with confidenc8
t~ justify me nnd give me etern 1 life. do hereby make,
the cross, and rose a88,in
in God and trust in His Son,
Lord and Savior, Jesus
Chris~, who died for my sins
publish and decl~re this to be
and s~.clfic811y revoking my w
Last Will and Testament,
of December 19, 1978,
hereby will G~d dispose of all the property which I own at my
death in the folJnwing manner:
FIRST:
~DMINISTRATIVE PR VISION - I direct the payment
of my debts and expenses of my last illness and funeral from
my egtate a~ soon nfter my dc~ h as may conveniently be done.
If there be no c:(~metery lot OlV ilable far my interment o~ned
by me at the time of my death, I authorize my Executor, to be
hereinafter named, to purchaso such cemetery lot with a
Poge Onc of Six Pagos
I
~
MICHAEL j~DeMARCO
contract for perpetual care, usinS therefore funds from my
.,
estate in such amount as he shal consider necessary and
Further, in ~his connection I Quthori~e my Executor to
vested in such
desirable. end 1 au~horize my Ex cutor to cause title to or
o~ncrship of such lot to purchas
person as my Executor shall desi
expend funds from my estate, in uch amount as my Executor
shall consider noccssary and des rable, for the purchase,
erection and insc~iption of a su table marker for my grave.
SEqOND:
DISPOSITIVE PROVISI N - I give, devise and
bequeath my automobiles, jewelry clothing, household furniture
cnd futnishin~s, and other taniit18 property, toaether with ~he
insurance pol1cies on such prop. ty as well as the rest, reS1-
cue an4 remainder of my estate, real. personal or mixed of
whacsoever natur~ and WhereSOever situate to my sons, MICHA!L J.
DeMARCO, CHARLBS W. DeMARCO and ~ILLIAM~. DeM~RCO, in equal
one-third (1/3) sh~res per stri us.
Pese T~o of Six Pages
MI CHAEt-.r:-De~IARCO
THIRD:
SPENDTHRIFT PROVISI N - No interest in income
or principal shall bo assignable by or available to anyone
having a claim against a benefic1iary before actual payment to
~he bcncfic~ory. I
FOURTH: POWERS OF FIDUGIA~IES - In addition to the
authority conf~rr~d upon fiduci ri~B by law, ! authorize my
~xecuLors to ret"ln any propert pending distribution here-
r sell any real or personal
-lnder, Lo compron::.se claims \Ji~ out Court approval. to lease
"ithout limitation 'as to term,
property at publiC or private s Ie for such prices and upon
such terms as to cash and credi as far as real estate is
concerned without liability ont ho part of the purchasers to
sec to the application of the p rchose money. also to invQs~
in all forms of property wi thou
I
authorized by fiyuci8ric~ and ~t
I
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j
I
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I
-........-
I
I
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rQstrictiDn to investments
distribute in cash or in kind.
Page Three of Six Pages
MICHAEL J. DeMARCO
FIFTH: APPOINTMENT OF EXE UTOR - I nominate,
conSl::Ltute ana a,)pOil't my $on, Hl\RLES IV. D<!IIARCO, as Executor
of this my Last ~ill and Testam nt. In the event that he fails
to qualify or ceases to act, I ubstitute and appoint my son,
\J1LLIAM ~. De~1^RCO, as Alternat Executor. In thQ event that
he fails to qualify or ceases t act, I substitute and appoint
DAUPllItl DEPOSIT BANK as Altern<1~e Executor. I direet that no
bood 0r other security shall bel required of my' ElCecuto~s, any
law or rule of Co~rt to the con~rary notwithstanding.
I
FIFTH: DISPOSITIVE PROVIS ON - I Bille, devise a.nd
bequeath my residence located a 410 Orchard Drive, SW8tara
Township, Steclton. Pennsylvani Michael J. DeMarco. Jr.
shall have a life estate in the property for his natural life.
The said Trust fo~ Michael shull maintain the property ~ithout
!
payment of rQnC to my other so~s.
Page Four of Six PaBcs
,
I
-'-1---- ~IICH^EL J. DeHiRCO
I
\,..~ ...u....
..-.. --,/ ...
- - - - .. ,-- _.. t.r.("
-
~~~ ~n~~D~O";. ~ha~ T
-=;nn,a.,t ..... _.
Upon Michael's death or u on his failure to live In the
residence. the property sholl c sold ond the proee~ds
divided equally between my the livinS children.
Pase Five of Si.x Pages
I~ MICHAEL J. DeMARCO
!
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I, MICHAeL J. DeMARCO, cas
th0 foregoing instrument, havin
~Q la~. do hereby acknowledge t
in$trume~t as my Lost Will and
~y free and voluntary act for t
atar, whose name is signed to
been duly qualified according
at I signed and executed the
estament: that I signed it a.
e purposes cherein expressed.
I
S~orn to and subs:ribed before te
testator, thie day of I
-,-
MICHAEL J. DeMARCO
by Michael J. DeMarco,
, 1987.
NOTARY PUBLIC
We, . and
, the witn sses whose names are 5igned to
the foregoing instrument, b~in8 duly qualified according to lev,
do depose and say that ~e were rosentond saw testator s18n and
execute this 88 his Last Will a d Testament: that Hichael J.
DeHarco signed willingly ~nd th t Michael J. DeMarco executed it
as his free and voluntary act f r the purposos therein expressed;
that all of us in the hearing n d sight of the testator signed
the Will DS witnesses; and thatteo the best of our kno~lu4le
eh~ t~st8tor ~as at that time 1 or morG years of age. of sound
mind and under no constraint of undue influence.
-- .. I
Witness ! Witness
:
I
\~ i t.n e s s
this
to and !ubscribed before
and
e by
51..."rn
day '0(-'-
,
, 1987.
,
witBesses,
NOTARY PUBLIC
Page Six of Six Pngcs
-.--.--+-.
I
InCHAEL rDa1fARCO
"""",~,~~,~,",,,",__--,,",,.,,,,,,,,,,,,,,,,-.,c~,,,~,,,,,.,,",_".".~,....,w,.".... .
m1 M&fBank
ACCOUNT NO. ACCOUNT TYPE
28065085 RELATIONSHIP CHECKING WITH INTEREST
STATEMENT PERIOD
PAGE
SEP.25-0CT.26,2004
1 OF 3
00 0 06654H NH 117
63
CHARLES W DEMARCO
MICHAEL J DEMARCO
150 HICKORVTOWN RD
CARLISLE PA 17013-9732
INTEREST PAID YEAR TO DAiE
15.43
PENNSYLVANIA PRIVATE BANKING
ACCOUNT SUMMARV
14,031. 33
DEPOSITS I
OTHE ADDITIONS
NO. AHOUNT
4 4,455.68
CHECKS PAID
NO . AMOUNT
4 1,655.00
OTHER
SUBTRACTIONS
NO . AHOUNT
5 4,460.68
CUR ENT
INTEREST PD
1.18
ENDING
BALANCE
GINNING
BALANCE
12,372 .51
POSTING
DATE
ACCOUNT ACTIVITY
DEPOSITS,INT EST
TRANSACT ON DESCRIPTION I OTHER ADDITIONS
CHECKS & THER
SUBTRACT ONS
17,838.17
17,833.17
17,303.17
09-25-04 BEGINNING BALANCE
09-30-04 PA TREASURY DEPT ANNUITANT
10-01-04 US TREASURY 312 CIVIL SERV
10-01-04 US TREASURY 303 sac SEC
10-05-04 CHECK NUHBER 7387
10-06-04 CHECK NUMBER 7391
10-19-04 REVERSE DEBIT OF 10/19/04
10-19-04 REVERSE DIRECT DEPOSIT
10-19-04 REVERSE DIRECT DEPOSIT
10-20-04 REVERSE DIRECT DEPOSIT
10-20-04 NOD,PA TREASURY ANNUITANT,MICHAEL DEMARCO,9/301
10-20-04 COVENANT HOUSE DDNATIDN
10-21-04 CHECK NUMBER 7392
10-25-04 CHECK NUMBER 7393
10-26-04 INTEREST PAYMENT
648.84
2,357.00
801.00
5.00
530.00
648.84
801.00
648.84
2,357.00
648.84
5.00
1,000.00
120.00
16,502.17
1.18
13,491.33
12,491.33
12,371. 33
12,372.51
ENDING BALANCE
$12,372.51
CHECKS PAID SUHHARY
7387 10- 05- 04
7393 10-25-04
5.00
120.00
7391* 10-06-04
530.00
7392 10-21-04
1,000.00
ANNUAL PERCENTAGE YIELD EARNED = 0.09 %
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, ',~. '?<i1;~>~t_7 ~.~ '., '" '1I"ilil'I"I!lii'
~ 'r,".,. ,..,1' !""",. "",I I ~"I'I
.,[<,','" "(>>'.~';"',';p;:f;!'r,-i'~':,.T ,_ i ,I. iil
111111.11'111111111
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f J !)!)7/oy
CJ~ t1 7 'i):;
~ Office of Catholic Cemeteries
Dloce_ of Harrisburg
PO Box 3651
Harrisburg, Pennsylvania 17105
Phone (717) 657-4804
Invoice No. C1-9002
INVOICE ~
Customer
'\
Date 12/17/2004
Order No. C1-9002
Rep RESURRECTION
Terms 90 DAYS
Name
Address
City
Phone
CHARLES W DEMARCO
150 HICKORYTOWN ROAD
CARLISLE State PA
ZIP 17013
Date I Description TOTAL
12/20/04 VA MARKER INSTALLATION FOR MICHAEL DEMARCO SR 5-317-3 $200.00
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SubTotal $200.00
$0.00
TOTAL $200.00
Please return one copy of this invoice along with your payment. If not paid
within 90 days from the date of this invoice, a finance charge of 6% will be
added.
Of l i e d e ma n
f/VF'U NE RAL H O'M E
Dennis L, Wiedeman, r,o, - Supervisor
James W, TaUan, F,O,
William A. Siben, F,O,
October 25, 2004
Mr. CharlesW.DeMarco
150 Hickorytown Road
Carlisle. PA 17013
.
STATEMENT
OF ACCOUNT
357 South Second Street
Steelton,PA, 17113
Phone: 717,939.2344
Fax: 717.939.1999
email: wiedemanfh@comcast.net
www.wiedemanfuneralhome.com
The Funeral Service of:
Mr. Michael J. DeMarco, Sr.
1 _' rr_w '" ,;;.. .... ~/ :.. ~~," .~,,~ ( ~(... .....'" "':+~ ~~ f" ,...t
b f; t~I;o""..,,'.1,"i)<'G,1,: ~'J?I,<"" ,I......, .j~.I,::<~1~?i~.p "
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i:<, \:~): f} ~,=~ C1i:', :t'},~ 1 ,Vi ":4 '{~1;: -:~\I~~i'.) ~i .;k"r~_!;(~t1{l)~~}I~?; ,
1. PROFESSIONAL SERVJe"ES s
2. FACILlTIES/SERVICESIEQUIPMENT:$
3. AUTOMOTIVE EQUIPMENT: $
(A) TOTAL OF PROFESSIONAL SERVICES. $
FACILITIES AND AUTOMOTIVE
Casket. . , . . . . , . . . 'C' . . . . . . . . . . . ..,,, ...$
(Description) 18 Ga. Steel Gaskeled
Outer Receptacle. . . . . . . . . . . . . .. . . . . . .. $
(Description) Standard Concrete Steel Reinforced
Outer burial container. ... .. .. .. . . . .. . . .. $
(Descrilltloi1)
Acknowledgement Cards. .. . ". .. . .. . .. . $
Register Book(s)... .. .. . .. .. .. .. . .. .... $
Memory Folders... . . . . . . . .... ..... . '" $
Prayer Cards. .... .... . . . . . .. ... . . .. .. $
Temporary grave marker................ $
Burial Clothing........................ $
OtherCloll\fng;... .....................$
Cu8toni'GrapliiO"Otlsign'll<:F.'lInti~'.;;-;;-:- ,.",.,.$ ....
FlowenLPAA~~!~P~):',:".:rl!~... ",....... $
MA...he of FInwA", + TAX ' $
$
Cremation Um . . . , . . . . . . . . . . . . . . . . . . . . . $
Interior & Exterior Crucifixes. . . . . .. ...... $
Refrigeration. . . . . . . . . . . . . . . . . . . . . .. . .. $
. (8) TC)'rAL MERCHANDISE' SELECTED
(" ':.I'" - ';1 I ,,. -.'" ""' , ." . ..,
" ......1.......1\"-.,'.~" "",j " iI...1lI ,(.C'i ~ ...j, .1
2210..00
Forwardlng'of remains 10
$
-o~
815.00
655.00
3140.00
$
.0-
(Funeral Home)
Immediate Burial
Direct Cremation'
$ -0-
$ -0-
. $ .Q;.' .
,SUB'T01Af6iSPECIAL:C.~(JES<..... .,.....C, $:
..., . ....... f'" ... .
2150.00
835.00
j" ..Gt . " " " . -.,.,' .. ". ,
.!~;,!! '''''';V.~!i.!t'Ji,,~~ Cb~'!..:... "...' ..,......;,;:1.:
i'< ~ ~ .~."'-- . , ~
'~Opeiling':,Grave~';~'i:~:~";:~.4' ~~~{,~;i;'~.;\~' ;~j~;~ f:$4
CerTieterfEqlllpme'J\t.;::.:~;~~,;.";J,,'.',..'$'
',: . ',' ,"- :~ "~ ,.', .. .: ':, ,~',)"-:::-..: - ,.
Newsllape"NOti~;;.Loca'I';"";':>';I:' ,;!. ...l. .
.NeWSpa'P8rNotiCes-:~;Ou.t:-pf;toWn.(.:"::'/ '$'
Telephone&Tel6grams".:,./.-..:... ,$
Airfare.,.......;.....,................ $
Clergy Honorarium . . .. . . . . . . .. .. . . . $
Pallbearers. .. . .. .. .. . . . . . . . . .. . . . $
Certified Copies of Death Certificate... $
CrematorY Charges.. .. ... .... . '" . I $
Organist........... ..'.... ........... $
~~""~.,~Sploiet".~~~,_~.Jt..~~*:~-t:\'"
.... _. . 011\81'" .~ ""-..,.. "-'.S
$
$
SUB-TOTAL OF CASH ADVANCES . . . . .. . .P$
.-0-
.0-
-0-
-0-
-0-
-0-
.0-
~().o
~-::,:;. --0:--0:
265.00
19.50
-0-
-0.
50.00
-0.
1516.17
$
3379.50
FIlID' IN . FULL
RECEIVED 10129/2004
.~:;~..
. . ;~/#--.
Fa m i,1 y 0 w n e d an d 0 per ate d .. . . We Car e
STEPHEN L. BLOOM
A TTORNEY AND COUNSELLOR AT LAW
WWW.PRACTICALCOUNSEL.COM
2100 LONGsGt\pRoAIJ
C,\RLISLE. PFNNSYLVANlt\ 17013
TELEPHONE 717-249-7717
Ft\CSIMILF 717-249-7757
TOLLFREE 877-548-9602
S B LOll M@P R t\ cr I C t\ u: () II N S E L. COM
Invoice submitted to:
Estate of Michael J. DeMarco, Sr.
c/o Charles W. DeMarco
150 Hickory town Road
Carlisle PA 17013
July 28, 2005
In Reference To: Estate Administration
Invoice #1613
Professional Services
2/7/2005 Telephone consultation with client
Hrs/Rate Amount
0.08 16.67
200.00/hr
0.12 23.06
200.00/hr
0.09 17.28
200.00/hr
1.82 364.28
200.00/hr
1.50 300.00
200.00/hr
3/4/2005 Review correspondence and documents from Executor
6/29/2005 Administrative matters; Review and evaluation of asset and deductible
expense information in preparation for Inheritance Tax Return
7/28/2005 Administrative and estate matters; Preparation and Assembly of
Pennsylvania Inheritance Tax Return, Schedules and Exhibits; Tax
Calculation; Estate Information Document
Reserve for final matters of administration: Consultation with client for
review and execution of Inheritance Tax Return; Appearance at Office
of Register of Wills for filing of same; Review and file correspondence
from Pennsylvania Department of Revenue; Final correspondence with
client and close file
For professional services rendered
3.61
$721.29
$284.83
($284.83)
($284.83)
Previous balance
2/10/2005 Payment - thank you
Total payments and adjustments
PRACTICAL COUNSEL + CHRISTIAN PERSPECTIVE
Estate of Michael J. DeMarco, Sr.
Page 2
Amount
Balance due
$721.29
PAYABLE UPON RECEIPT - THANK YOU
PRACTICAL COUNSEL + CHRISTIAN PERSPECTIVE
STEPHEN L. BLOOM
ATTORNEY AND COUNSELLOR AT LAW
WWW.PRACTlCAl.COUNSEL.COM
2 1 0 0 L () N (; S G i\ I' R () i\ 0
CARLISLE, PENNSYl.VANIA 17011
TELEPII(lNI ~ 1 ~ 249 ~~ 1-
f',CSIMILE 717-249-~-5~
TOLLFREr. 87~-548-9602
SI1LOOM@PHALTICALCOUNSEL COM
Invoice submitted to:
Estate of Michael J. DeMarco, Sr.
clo Charles W. DeMarco
150 Hickorytown Road
Carlisle PA 17013
February 04, 2005
In Reference To: Estate Administration
Invoice #1530
Professional Services
HrslRate
Amount
10/28/2004 Review decedent's Last Will and Death Certificate; Prepare for
consultation with Executor; Conference with Executor and preliminary
assessment of estate administration
1.00 200.00
200.00/hr
2/4/2005 Review and evaluation of status of administration; Correspondence with
Executor
0.42 84.83
200.00/hr
For professional services rendered
1.42 $284.83
Balance due
$284.83
PAYABLE UPON RECEIPT - THANK YOU
PRACTICAL COUNSEL'" CHRISTIAN PERSPECTIVE
r
/} J 10 (HICl 'i
eth# 731~
Phone #:
Cumberland-Goodwill Fire Rescu
% WAYPOINT BANK
PO BOX 8511
HARRISBURG, PA 17105
(800) 367-0512 INV6~' Tax 10: 23-2298422
PATIENT NAME: MICHAEL DEMARCO
INSURANCE: MEDICARE B
PEBTF
205094616A
205094616
PATIENT NUMBER:
CALL NUMBER:
DATE OF CALL:
TIME OF CALL:
CALLER:
FROM:
TO:
3672
CG0402800
09/07/2004
NSOF
NONE
CG0402800
Police/Fire/911
150 HICKORYTOWN RD
CARLISLE REGIONAL MEDICAL CTR
MICHAEL DEMARCO
150 HICKORYTOWN RD
CARLISLE, PA 17013
REASON(S)
FOR
TRANSPORT
Generalized Weakness
NAUSEA ALONE
DESCRIPTION OF CHARGE QUANTITY UNIT PRICE AMOUNT
BLS EMERGENCY BASE RATE A0429 1.0 350.00 350.00 i
OXYGEN A0422 1.0 50.00 50.00
MILEAGE CHARGE A0425 14.0 7.00 98.00
!
Total Charges 498.00 j
DESCRIPTION OF PAYMENT
RECEIPT
PAYMENT DATE
AMOUNT
Total Credits
0.00
PLEASE PAY THIS AMOUNT _
$498.00
~HOLY
~
The Spirit of Carillg
111.!lI1 ~ l_'_'_'~__'''''
Holy Spirit Hospital
flet P/IJjoy
. tU 1/ 71.f){
503 N 21ST STREET
CAMP HILL PA 17011
#
717-763-2141
................................--..- ..-..-.....,....,................ ....
.._ d...... ,.. ,.........,.. ........... . ..,.. __.. .., .... ,",'" .... _...............
, d'''''' _.... ...... ............_ ....._............,....", _,_
.......D.. ...E..l\1.A....a..c.. ..O.....;NJ..... .{..o" .11... .A...E"L. ....J..........................
...'..... ." -,'",", ',-.-.... '. . ',',' . ....... .......'....,-.._-.-.-.-..,.....-.-_.........,
. . . ., ..... . - . - . ... ,."...-.....-....
s~6kib~n~t~*>u~i6~id~<
..............- ..'..-...-...,......,-.,.... "...,.,.......--.. ......"...........,.-..,..
~:~~~#~~~~=;~in~t~i~:)i~)ri4
........'A.~CqWt~Nj):...'..,2:J~:'4$80t......,.....,.,. .
For Account Information, Please Call 717-763-2141
Transaction Date
09/10/04
09/29104
09/30/04
10/12104
1-0/15/04
10/15/04
10/15/04
10/22/04
10/22/04
11/04/04
PREVIOUS BALANCE
SWALLOW EVALUATION
MED CIA HOSP-IP M90 MEDICARE lIP
OTHER PATIENT NON CO M90 MEDICARE liP
MEDI LATE CHRG ADJ I M90 MEDICARE lIP
MED-I PYMT-HOSP If' - M9{J MEDICARE I/-P
MEDI CIA HOSP-IP M90 MEDICARE lIP
MED CIA HOSP-IP M90 MEDICARE lIP
MEDI PART B PYMT-IP M90 MEDICARE liP
MEDI PART B C/A-IP M90 MEDICARE lIP
PEBTF PAYMENT B86 PEBTF
28,852.95
189.00
20,495.71-
9.60-
189.00-
7,439.90-
20,101.75-
20,495.71
116.81-
231. 99-
876.00-
Estimated Insurance Due:
.00
Total Patient Credits:
Account Balance:
76.90
M90 MEDICARE liP .00 B86 PEBTF .00
PLEASE DISREGARD THIS STATEMENT IF YOU HAVE PAID.