Loading...
HomeMy WebLinkAbout08-09-05 f!EV.l500EXj&{XI) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OfFICiAL USE OIRY w ,.., '::t,:!tn 0."" wll.O ",00 011:'" 11.11I a. " FILE NUMBER 21 05 0498 -NER--- COUNTY CODE YEAR I- Z W C W o W C DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Skin nell, Helen DATE OF DEATH (MM-DD-YEAR) 04/23/2005 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER SOCIAL SECURITY NUMBER 198-20-7027 DATE OF BIRTH (MM-DD-YEAR) 11/12/1928 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ~ 1. Original Return o 4. limited Estate o 6. Decedent Died Testate {f\.ltaclI 00\l~ cl Will} o 9. litigation Proceeds Received o 2. Supplemental Return o 4a. Future IntereSI Compromise (dale of deatl1 after 12.12-82) o 1. Decedent Maintained a Living Trust (Attach copy of Trust) o 10. Spousal Poverty Credit ldale of death balwaen 12-31.91 and 1-1-95) o 3. Remainder Return (dale of death priorto 12-13-82) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Election to tax undefSec. 9113{A) (M\achSchO) ,.., Z w o z ~ .. w II: II: o u NAME Thomas E, Flower, Esq. FIRM NAME (If Ajlplicable) Saidis, Shuff, Flower & Lindsay TELEPHONE NUMBER (717) 737-3405 COMPLETE MAILING ADDRESS 2109 Market Street Camp Hill, PA 17011 z o ~ :::l l- ii: <( o W 0:: 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corpofatiol'l, Partl'lerstlipor Sole-Proprietorship 4. Mortgages & Notes Receivable {Schedule OJ 5. Cash. Bank Deposils & Miscelfaneous Personal Property (Schedule E) 6. Jointly Owned Property (ScI1edule F) o Separate Billing Requested 1. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (IOlal lines 1-7) 9. Funeral Expenses & Administrative Cosls {Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (1) (2) (3) (4) (5) OFFiCIA~E ONCy . o " -.ill C~-C) >...-.1 r~ . 'c' c': >s :-~ m o (-:> r-. c') l I"J,) - -...;>,,- (::J - , .,.. C~ r.n )(j ~rl 88,336_06 .;~-" (6) ~~""l _r::- rv (7) 17 ,499.57 105,835.63 (9) (10) (8) 13,586.96 1,804.74 (11) (12) (13) 15,391.70 90,443_93 11. Total Deductions (total lines 9 & 10) 12. Net Value of Estate (line 8 minus line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (line 12 minus Line 13) (14) 90,443.93 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o !;( I-' :::l a.. == o o ~ 15, Amount of Line 14 taxable at the spousal tax x.O_ (15) rale, or transfers under See. 9116 (a)(1.2) 16. Amount of line 14 taxable at lineal rate 90,443.93 x.o 45 (16) 4,069_98 17. Amount of Line 14 taxable at sibling rale x .12 (17) 18. Amount of Une 14 taxable al conateral rate x .15 (lB) 19. Tax Due (19) 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT . Decedent's Complete Address: STREHtDI~:'ri I Ct 1 51 rial . CITYC r J I STATEpA r ZIP 17013 arise Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 4,069.98 Total Credits (A + B + C ) (2) 3. InteresVPenalty if applicable D.lnterest E. Penalty TotallnteresUPenalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enler Ihe difference. This is the OVERPAYMENT. Check box on Page 1 Line ZO to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) 4,069.98 Make Check Payable to: REGISTER OF WILLS, AGENT !~;'_..I "IT LJIIlIIlIIIIi_ ""';;-iIl/IIII.i~~ .__._0_ n PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Ves No a. retain the use or income oflhe property transferred;.......................................................................................... 0 [iJ b. retain the right to designate who shall use the property transferred or its inoome; ............................................ 0 [iJ c. retain a reversionary interest; or.......................................................................................................................... 0 [iJ d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [Xl 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate oonsideration? ........................m................................................................................... 0 [iJ 3. Did decedent own an 'in trust fo~ or payable upon death bank account or security at his or her death? .............. [iJ 0 4. Did decedenl own an Individual Relirement Acoounl, annuity, or other non-probate property which oontains a beneficiary designation? ........................................................................................................................ [iJ 0 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 penallies of peTjury, \ declare 1ha\ I have examined !his return, 'Including acoompanying schedules and sUilements. and to the best of my knowledge and belef, ij is true, correct and cornplete. Declaration ofpreparer other than the personal represenlativeis based on all informationofwhich preparer has any knowledge. SIGNATURE OF PERSON RESPON R Fl ING URN ADDRESS 8 Pleasant Hill Ct., Dillsburg, PA 17019 SIG E OF PREPARER 0 R T. PRESENTATIVE DATE - '3 -O~ ADDRESS Saidis, Shuff, Flower & Lindsay, 2109 Market St., Camp Hill, PA 17011 ~_!W_< I ~_.t" _ "l.1l'i~ ~ For dates of death on or after July 1, 1 994 and betore January 1. 1995, the tax rate imposed on the net value of transfers to or for the use of the sUNiving spouse is 3% 172 P.S. 99116 (a) (1.1) (i)]. For dates of death on or after January 1, 19l15, the tax rate imposed on the net value of transfers to or for the use of the SUNNing spouse is 0% 172 P.S. 99116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax., and the statutory requirements for disclosure of asse1s and filing a tax. return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% (72 P.S. !j9116(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. 99116(1.2) [72 P.S. 99116(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. 99116(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. REV-1508EX_(._98) .. COMMONVllEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Helen Skinnell FILE NUMBER 21-05-0498 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Stilel, Nicolaus & Co., Inc. - investment account (itemized valuation attached) 74,443.01 9,870.80 97.25 2. Stilel, Nicolaus & Co., Inc. -IRA account (itemized valuation attached) 3. MeUlle, final life annuity payment 4. 1999 Ford Focus automobile, 37,668 miles 3,925.00 TOTAL (Also enter on line 5, Recapttulation) S (If more space is needed. insert additional sheets of the same size) 88,336.06 REV-"'0 EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Helen Skinneli FILE NUMBER 21-05-0498 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1SQO COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INClUDE THE NAME OF THE TRANSFEREE. THEIR RElAllONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IIFAPPI.JCAIlLEl VAlUE ,. Edward Jones security accoint with T.O.D. beneficiary designaUons, see 17,499.57 100 17,499.57 attached REV-1543A information noUces TOTAL (Also enter on line 7 Recapo"lation) $ 17,499.57 (If more space is needed, insert additional sheets of the same size) REV.1511 EX. 112'991. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALlH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Helen Skinnell FilE NUMBER 21-05-0498 ITEM NUMBER A. Debts of decedent must be reported on Schedule I. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: ROSSI BROS. FUNERAL HOME, professional services, casket, etc. (bill not itemized): FOREST LAWN MEMORIAL PARK, grave opening and intennent Father George, Clergy Honorarium Holiday Inn, funeral banquet DERAMO'S ROSE PETAL FLORIST, funeral flowers CHURCH OF HOLY ASCENSION, funeral service 7,572.00 625.00 750.00 994.50 266.25 100.00 2. 3. 4. 5. 6. B. ADMINISTRATIVE COSTS: 1 . Personal Representative's Commissions 2. Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal RepresentaUve(s) Street Address City . Stale Zip Year{s) Commission Paid: Attorney Fees 2,500.00 3. Family Exemption; (If decedent's address is not the same as claimant's, attach explanation) 4. Claimant Street Address City State .Zip Relationship of Claimant to Decedent Probate Fees 241.00 5. Accountant's Fees 7. 6. Tax Return Pre parer's Fees 10 8 Published Estate Notices: (a) Cumberland law Joumal- 75.00 (b) Sentinei - 180.59 Stifel, Nicolaus - Account Tennination Commission/Fee PNC Bank - Check Printing Fee Death Certificates 255.59 134.12 28.50 120.00 9 TOTAL (Also enter on line 9, Recapitulation) $' (If more space is needed, insert additional sheets of the same size) 13,586.96 REV.1512 EX. (12.03) .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESlOENT O~CEOENl SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Helen Skinnell FILE NUMBER 21-05-0496 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death. including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 2 R. C. Hodgson. Misc. Bills PPL - Eiectric 6i11s 3 Carlisle Oigestive Oisease Associates - Medical Bills 222.03 133.32 106.40 4 North Middleton Authority - Water/Sewer Bill 5 UGI - Gas Bills 79.90 60.51 6 Stoken Opthamology 339.55 17.90 7 Spring Road Family Practice - Medical Bill 6 Carlisle Regional Medical Center - Medical Bills 765.66 9 Velizon - Phone Bill 59.47 TOTAL (Also enter on line 10. Recapil lation) $ 1,604.74 (If more space is needed, insert additional sheats of the same size) REV-151"X'19-001 .. COMMONlNEAlTH OF PENNSYlVANlA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Helen Skinnell FILE NUMBER 21-05-0498 RELATIONSHIP TO ~; :EDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trus (s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9118 (a) (1.2)] 1_ Robert C. Skinnell, II son 0.50 2. Rebecca Hodgson daughter 0.50 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIAT ,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 I TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER S iEET $ 0.00 (If more space IS needed, Insert additional sheets of the same sIze) Stifel, Nicolaus & Company, Incorporated July 18, 2005 970 Windham Court Suite 9 Youngstown, Ohio 44512 330-965-6929 Fax: 330-965-6939 Toll-free: 877-562-0019 Thomas E. Flower, Attorney Saidis, Shuff, Flower & Lindsay 2109 Market Street Camp Hill, P A 17011 RE: The Estate of Helen Skinnell, Deceased Dear Sir or Madam: The following is the inventory of Helen Skinneii's holdings as of her date of death. By now you should have received her proceeds from the liqui4ation of her Individual Retirement Account and the Transfer on Death account ha~ already been paid to her beneficiaries. ! ! Please don't hesitate to contact me with any questions you may have. Helen Skinnell, TOO Account ! I Quantitv Name DOD Value i I 114 AT&T Corp. New $ 2,142.44 I 4 Agere Systems Class A $ 4.68 ! 105 Agere Systems Class B $ 123.90 . 32 Avaya Inc. $ 270.45 184 Comcast Corp. Class A New $ 5,898.12 4 Walt Disney Company $ 109.08 525 Duquesne Light Holdings Inc. $ 9,377.38 2666.041 Federated Strategic Income $ 23,061.25 25 General Electric Co. $ 904.54 105 Harley Davidson Inc. $ 4,923.45 385 Lucent Technologies Inc. $ 974.69 200 HAlT Investment Ser. B Pfd. $ 5,07fifi7 200 Royal Bk of Scotland 7.875 Pfd. $ 5,228.67 554 SBC Communications Inc. $ 12,872.19 102 Verizon Communications $ 3,476.50 Cash $ Total Value $ 74,443.01 Helen Skin nell, IRA Account 300 Time Warner Inc. New Cash Total Value $ $ $ 5,219.80 4,651.00 9,870.80 The summaries/prlces/quotes/statistics contained herein have been obtained from sources bel eyed to be reliable but are not ne~~SSariIY complete and c~nnot(Wj:parante~d. They ar(-p;?Vided for inf mational purposes only. OJ;Ml~j.tm~m/ Q/m"l)f.Cej. C7t:'lCe f ,90 MEMBER SIPC AND MEMBERS, NEW YORK STOCK EXCHANGE, INC., CHICAGO, AND AMERICAN STOCK EXCHANGES Page 2 Skinnell July 18, 2005 :ed ~,"...."erelY' '. ~ . //Jjd~J)~ neida Duncan \ IRegistered Sales Assista~t I I }~ COMMONWEALTH OF PENNSVlVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 05500261 06-01-2005 REV-15~3A AFP a-DDl EST. OF HELEN S INNELL 5.5. NO. 198-20-7027 DATE OF DEATH 04-23-2005 COUNTY CUMB RLAND TYPE OF ACCOUNT o SECURITY IX] SEC ACCT o STOCK o BONDS ROBERT C SKINNELL 8 PLEASANT HILL CT DILLSBURG PA 17019 EMIT PAYMENT AND FORMS TO: REGIS ER OF WILLS CUMBE LAND CO COURT HOUSE CARLI LE, PA 17013 EDWARD JONES has provided the Departlllent with the information listed b low which has been used in calculating the potential tax dUe. Their records indicate that at the death of the above decedent, yoU were a beneficiary of this asset. If YOU feel this information is incorrect, pleillse obtain written correction from the transfer agen " attach a copy to this forlll and return it to the above address. This account is taxable in accordance with the Inheritance Tax La s of the Co.monwealth of Pennsylvania. QUBstion~ .ay be answerad by calling !?l7) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE Account No. 880198106 FOR FILING AND P YMENT INSTRUCTIONS PART ill 17,499.57 50.000 8,749.79 .045 393.74 TAXPAYER RESPONSE .",,~~~~!I~lmlml~~~llill~~~llm~~lml~~lmDliill1!~~~l~.iii~l.llli~".' ", ODD Valuation Percent Taxable Amount Subject to Tax Rate Potential Tax Due x To insure P oper credit to your account, two (2) copies f this notice must accompany your payment to he Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If x payments are made within three (3) months f the decedent's date of death, you .ay ded ct a 57. discount of the tax due. Any inheri nce tax due will become delinquent nine (9) 11I0 ths after the date of death. Tax ii"ii iim~~~li1iii.ill.~ilii.~l.mi' [CHECK ] ONE BLOCK ONLY A. D The above information and tax due is correct. 1. Vou nay choose to remit paYllent to the Register of Wills with tw copies of this notice to obtain a discount or avoid interest, or yoU may check box "An and retur this notice to the Register of Wills and an official assessment will be issued by the PA Depart ent of Revenue. B. ro<'The above asset has been or will be reported and tax paid with the P nnsylvania Inheritance Tax return ~ ~o be filed by the decedent's representative. C. 0 The above information is incorrect and/or debts and deductions were aid by you. You lIust complete PART 0 and/or PART ~ below. PART @] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PART ~ TAX RETURN - COMPUTATION If you indicate a different tax ratB~ please state your relationship to decedent: LINE 1. DOD Valuation 2. Percent Taxable 3. Amount Subject to Tax 4. Debts and Deductions 5. Amount Taxable o. Tax Rate 7. Tax Due OF TAX ON ABOVE ASSETCSJ 1 2 X 3 4 5 6 X 7 PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computatio ) $ Under penalties of perjury~ I declars that the facts I have reported abo ear. true} correct and cOlllp1ete to the best of lIy knowledge and belief. HOME ( ) WORK C J I COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES OEPT. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO.21 05500262 06-01-2005 REU-1543AAFPC]_nOJ EST. OF HELEN SK NNELL 5.5. NO. 198- 0-7027 DATE OF DEATH 0 -23-2005 COUNTY CUMB RLAND TYPE OF ACCOUNT o SECURITY IX] SEC ACCT o STOCK o BONOS REBECCA C HODGSON III SCHOOLFIELD RD CARLISLE PA 17013 EMIT PAYMENT AND FORMS TO: REGIS ER OF WILLS CUMBE LAND CO COURT HOUSE CARLI LE, PA 17013 EDWARD JONES has provided the Department with the inf'ormation listed be ow which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, ou were a beneficiary of this asset. If YOU feel this information is incorrect, please obtain written correction from the transfer agent attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Law of the Commonwealth of Pennsylvania. Questions aay bE answered by calling (717) 787-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND P YMENT INSTRUCTIONS Account No. 880198106 PART [!] 17,499.57 50.000 8,749.79 .045 393.74 TAXPAYER RESPONSE mm~g~~~1ii~1I!iiiiiWl~~Al!1mi~~~~mii~~Ii~'iiii~~'ii~~imiA~~~~~mjmlt~~Jij!!iIl~", ..,-.-,-,-,-.-.-.-...-.......-..-,-.-,-.-.-.-.-........,...,.,-,-,-.-.-......,.,.,.,.,-.-.-..,."'.,.,.,..",-,-.-.-.-.....,, .,-,..-,-.-.-.-..., ,.,.,.,-,..-.-,-....,., '.",.,"-'- .-....,........-.-............--.-...................-.-..........-...-.-.-...............-.-.-..... DOD Valuation Percent Taxable Amount Subject to Tax Rate Potential Tax Due x To insure p oper credit to your account, two (2) copies f this notice must accompany your payment to he Register of Wills. Make check payable to: "Register of Willsl Agantn. x NOTE: If x payments are made within three (3) months f the decedent's date of death I you may ded ct a 5% discount of the tax due. Any inheri nce tRX due will become delinquent nine (9) mo ths after the date of death. m~~m'~~mi~~~!!i~~~1il~~1i'j' Tax [CHECK ] ONE BLOCK ONLY A. 0 The above information and tax due is correct. 1. You may choose to rerlit payment to the Register of Wills with tw copies of this notice to obtain a discount or avoid interest, or yoU may check box "An and retur this notice to the Register of Wills and an official assessment will be issued by the PA Depart Bnt of Revenue. B. ~The above asset has been Dr will be reported and tax paid with the P nnsylvania Inheritance Tax return to be filed by the decedent's representative. C. 0 The above information is incorrect and/or debts and deductions were You must cOllplete PART 0 and/or PART 0 below. PART @] DATE PAID DEBTS AND DEDUCTIONS CLAIMED If you indicate a different tax ratB~ please state your relationship to decedent: PART ~ TAX RETURN - COMPUTATION LINE 1. DOD Valuation 2. Percent Taxable 3. Amount Subject to Tax 4. Debts and Deductions 5. Amount Taxable 6. Tax Rais 7. Tax Due OF TAX ON ABOVE ASSETCS) 1 2 3 4 5 6 7 x x PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation $ Under penalties of perjury, I declare that the facts I have reported abo are true, correct and complete to the best of my knowledge and belief. HOME ( ) WORK C ) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 PENNSYLVANIA INHERITANCE AND ESTAT OFFICIAL RECEIPT RECEIVED FROM: FLOWER THOMAS E 2109 MARKET STREET CAMP HILL, PA 17011 _nn~~_ fold ESTATE INFORMATION: SSN: 198.20.7027 FILE NUMBER: 2105-0498 DECEDENT NAME: SKINNELL HELEN DATE OF PAYMENT: 08/09/2005 POSTMARK DATE: 08/09/2005 COUNTY: CUMBERLAND DATE OF DEATH: 04/23/2005 TOTAL AMOUNT P REMARKS: THOMAS E FLOWER, ESQ CHECK# 006 SEAL INITIALS: RSK RECEIVED BY: REGISTER OF WILLS REV-1162 EX{11-961 E TAX NO. CD 005667 ACN SSESSMENT AMOUNT CONTROL NUMBER _d_n__ 101 I $4,069.98 I I I I I I I I AID: $4,069.98 GLENDA F} R NER STRASBAUGH REGISTER F WILLS A ..il{;l~~~t~..~~ -,!If-;';; l~'l "'I ,~. 1>- ljt l"~ I.' C: 10! '\ "-I P.~L.~~~,,,. till ilt...,.,y...;,......o i. :11'/"''''(;';<.< ~-., .~' :,' ,_, . r ~ f. ':~]:5~~~ f~~) I \~. '. ~ ./Q, !.l-\:~. ... J " ,:!-",- d ~ ~ ""i; )/ V> '$,.q r ~ ,- 4. <1 iY " I': ,., '#~-1 ~ j1;1~1 { J. ti ~ ~ ~ J ~ ~ -ti ,; ~ 'W 11- go, >- "' '" "0 C :::; c/l ~ ~ Q)-~ .....;:(1)0 Q)OQ)"'" ~ - .b...... OU-Ul<i iI:t::Q5Q.. . ~..::.:::_- w..cm= ",Ul",,:!: m uic:. a. E '5 '" E 0.-.,0 ttI ..cro~() !-(I)N I \ "jICE OF ,~ 1.11'1 ('I \...1;- -,/ tLJ ':;:; -9 ",'J ": 1:2 v HI", CLEf" ORPH' Cl"'" ". '" ~ '+-2: o OJ .... => ~g(V) "a' Q) C; Q)"'r-- !l::=>...... Q),g<( :5tn. '+- => _ o 0 Q) Q) () .!!? OQ)-,:: .- OJ 88() " ~ - - . :: ..,. ': :; J N o o () {Il III I 1'1 I'l 1'1 1'1 .... 1'1 .. o t- ..