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Home My WebLink About08-11-05 ~ ii !il ; ::;a m < I ....Ii. (II o o i ~ ;:a ~ rg ~"O8 c:~~m~ ;:a-gmz~ p,-i~~~ ~~!il~~ ~~~i~ i ~ !il _ m - z ::a::E: mm cn::a 6=4 m> ZZ -10 em m-l 0> m>< e::a mm z-I -Ie: ::a z ~~~ ~r ~ I Ii ~p g: I~ Ie> i!;~ ~I~ I~ I~ l::;l'" Ng J,.j!: f1I'" 0lP:: Ole: 01"" o:';! z e: 3: '" m "" DECEDENT ~ ~ ~ I ~~i~ ~ ~ 0 i - III m 3: a- ~ - ~ ~ s:: ~ :!C ' "" - ~ ~ c 31: g In z =i ~ '" :i! g in ~ ~ gl ;:a ~ "" mil: :';! (j) 51 z -... e: CIl.... lJl 3: m '" m... ~ ;:a r;: oeo ,,2 i~ ~g ~ ~ ~~ Om WO - .., ....'" <0- ~~ ~ ~ j Oil I '" e: ~ < Z Q '" ~ e: '" "l '" ~ m ~ :-< .., ~ :-< ~ c 31: ;:; c hi z :3 ~ CHECK APPROPRIATE BLOCKS CORRESPONDENT ii.~ i ggg~ H pPt Ii ' I ! i f .. ~ "" i r! ~oooo i i i i ?I~II ! . n f f ~ l- t Sl. 6 :I:<o~e i f1 i Dl W ~!II. Sl. Jl-olli I "'[Ji:~ il j ! >0 ~ ;;; Sl. ~ < - ~ ~ ~1Il~ (!It! O=Q - ~~ 8 i1 ~ ;:a ~ )C ~!:l191;:-g9 in i .., "" ~~i~~, ~~cIJ I 5' ~ !Ii' ~ or ~ ~ "" S< S!. ~ 6~g>il'3 itiit""i HI ~ j ~ Sl. Ii ~ a l I ill .sol 8' E, I ~~~ii~ l! ! ~ ~ ~ ~ 3~ ~; ~m w~ <031: ....:;ll ......"" RECAPITULATION ..... ..... ........................ ?' ~ ~~~?!DPO :--I P'" ~~~~:-" : I !! i. ! i i I i ~! OJ I J J i i I is!. t ~I t i Sl. ~ i~ Ii' ltf I 'J; ! i s-i ... ~ ~i i. t I i I ~i ~!!!i ll" it B' - c':lRl~fi- !i-C~jJ ~fl!i !! I i I! ~ i i.t: ill" I t""-i I~ i " i ~ :: if ~ l! I!' '" !;. . i ! J .!!l '" i-Ii ll" It. - ~ t i i ;- s f i ~ ;J) -0 i \l' -f I ~ 1! ~ ! i I I s 1 i-! i~ ! ! . i ! '" , !!l !: I- ~- :s - ----- i . .ss .s .!!!~~~.::: g i '" if .. ~ r .... .... '".!>. C11 ~I~ I~I~I~ ~.Id ~IW ~1l0l ~, \ T', "'1\1 \ i{' ('\30' 1(\0-V ' j\) jJ\:jjV \j I bJJJd ;Ii:) \ \-,1'1,"1.\ ,~,Jj-'\ 30 .L,-Il ~\J...J 'Ill 0 ,2(' '::..:']\" ->1) )',,-,:::I.oJ 9~ :2\ o is o o o .... .... '".!>. ~ N w .... ...... -:-:::-:::""'<00; ~.!::!=N<O- ~ ~I ...... C11 C11 0 .... ~CD ........ ...... ,f>. .... !=' ~ 9' o <0 N o OIl (It .; .... ~ .... '" 00 TAX COMPUTATION .. b - .!!! ~.... ~ .... 19 .. <=> ~ .$ ...... OIl ~ <0 1$ I Q, c iil .: I !!l. i ~ .. .. u; ~ ~ .:; :::: I Q, i .: I !!l. ~ 6 i :t -0 ~ I Sl. i .: I !ll. I i s iO a eo i ~ o n I m n ;>; I iT ;() m 01 -< ~ >> ;() m ;() m o c n UJ -; Z C> >> ;U m 01 c Z o o 01 J> z o < m JJ 'U J> -< S m z -; y y III ; a I ~ I i I I ~ CI R i I ^ ^ , .. , 6il 00 ~ Ib /JvY f A~~c1 ~ , Decedent's Complete Address: STREET ADDRESS 000 W re Haith and Rehab 770 Po lar Church Road CITY Camp Hill Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2, CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount Mailing: (1) 78.39 0.00 0.00 0.00 Total Credits (A + B + C) (2) 0.00 3. InterestlPenalty if applicable D. Interest E. Penalty TotallnterestJPenalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This Is the OVERPAYMENT. Check box on Page 1 Une 20 to request a refund (4) 0.00 0.00 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 0.00 78.39 0.00 78.39 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) PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... 0 [i] b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 lil c. retain a reversionary interest; or.......................................................................................................................... 0 lil d. receive the promise lor life of either payments, benefits or care? ...................................................................... 0 lil 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................,......................... 0 lil 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 [iI 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 [i] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. lM*",- d plIljIIy, I __ that I have eurrined this return, Induding 8CXXlInporIyilllllChecllMlend _menIs. end to tho _ '" my IcnowIedgo end _,I is true, CUf8d end compIeIo. 0ecIIIlIIi0n "'__ then... poIIOIIlII ,...._ is baled on" inIonrBUI 01_ _.... any knoWledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ~ ~3 Powells Valley Road Halifax, PA 17032 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE l d'6JOf O~ DATE ADDRESS 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 lor the use of the surviving spouse is 3% [72 P.S. ~116 (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 lor the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1,1) (iij]. The stalute does not exemot a transfer 10 a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum 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. ~g116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedenfs lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~116(aXl)]. The tax rate imposed on the net value of transfers to or for the use of the decedenfs 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. "?D.'"~. '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER ,. DESCRIPTION VALUE AT DATE OF DEATH ~~ h k -I-- -~N\'\V\UM~ ~t'~ .'V~ c.-,,{~i ~~~Vlqoq -~ f\~~ ~5~ I~l{~ 't>~~dD\v- poor ~f\dlhbn I(), ~'57, I- 3 <too.oo TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) $ II, 451 :~3 , COmmunit\!Banks Caro~ M George 93 Powe~~s Va~~ey Road Ba~ifax PA 17032 Free Checking Account Number Previous Balance 1>o~ &,\Q.NJL 2 Deposits/Credits 5 Checks/Debits Service Fee Interest Paid Ending Balance 1402717909 1,223.43 5,660.24 2,317.39 .00 .00 4,566.28 Primary Account: 1402]17909 Statement Period: 05/06/05 Number of Images - 06/05/05 4 Page 1 6/05/05 31 1,472.99 1,472.99 . DeDOsits and Additions Date Description 5/12 Deposit 5/19 Deposit . Debits and Withdrawals Date Description 5/09 DBT DR BESS 38309 BAlUUSBURG PA . Checks (In Number Order) DlIte Serial 5/25 3040 5/24 3042* * Denotes missing check number . DailY Balance Information Date' Balance 5/06 1,223.43 5/09 1,188.92 5/12 1,922.92 Amount 61.17 1,011.10 Date 5/19 5/23 5/24 Statement Dates 5/06/05 thru Days in the Statement Period Average Balance Average Collected Amount 734.00 4,926.24 Amount 34.51 Date 5/26 5/23 Serial 3043 3044 Balance 6,849.16 6,349.16 5,338.06 Date 5/25 5/26 Balance 5,276.89 4,566.28 Thank you for banking with CommunityBanks. Amount 710.61 500,00 CO Claim 10 HPASO 103687 Payee 10 ??oo54638 Number 00701459 Explanation of Benefits Check Date: OS/23/2005 HIGHMARK. LIFE INSURANCE CO One Riverfront Plaza Westbrook, ME 04092-9700 E;state Of Carol George 93 Powells Valley Rd Halifax, PA 17032 Survivor Benefit Payment Adjustment 05/06/05 - 05/06/05 05/06/05 - 05/06/05 Total 3,574.95 198.61 Taxable Non-Taxable 3,574,95 198.61 Taxable Non-Taxable 3,574.95 198.61 Offset Offset Period 'i Net Benefits 3,773.56 3,773.56 3,773,56 Taxes/Deductions l=Tax Withholding 2=PreTax 3=PostTax Current YTD , I Total Net Payment 3,773.56 Notes IF YOU HAVE ANY QUESTIONS, PLEASE CALL 999-999-9999 Administrated by Disability RMS REV.1511 EX+ (12,99) , '*' t .... '" I COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule J, ITEM NUMBER A. 1. DESCRIPTION ~~XP~~~\ ~omes ~ lll-lDq~- 3:l'l'S f\lI~V\t.t6 ~ ~M~ to ~()JyWt"Ct\ hoVl---l- ~ A.H'o.theJ b~\I , ~\\~~lU~ tJ\OY\l,tt'!"trrl- ~mraYt^f -'l1 Gro.vt 90he AMOUNT 411//43.50 ilL:- -JOO.O 6 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative( s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State _ Zip Year(s) Commission Paid: 2. AtlorneyFees .-~obtrt ROllrtot\ \:R.utjh - ~~rt b()'(~... a\'l.l-l.f.\'I'(("~\\-\1 f-A I't\VenlurlJ -\ "'"" ('to!>']... () Family Exemption: (If decedent's address is not the same as ciaimant's. attach explanation) Claimant i 50..QO 3. Sfreet Address City State _ Zip Relationship of Claimant to Decedent 4, Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ II q q 3 . 50 (If more space IS needed. Insert additional sheets of the same size) ~ Hoover Funeral Homes, Inc. 118 South Market Street MilIersburg, PA 17061 (717) 692-3298 Bradley S. Boyer, Supervisor fax 692-4599 or 362-9845 Forethought Funeral Planning Nathan C. Minnich, FD www.hooverfuneralhomes.com Monday, June 6, 2005 Melissa McGruther 93 Powells Valley Road Halifax, PA 17032 103 West Main Street Elizabethville, PAl 7023 (717) 362-8522 Robert M, Stianche, Ir. Supervisor Dear Melissa, Thank you for selecting our funeral home to provide services for your family during your time of bereavement. I hope that you found our services. so tar. to be of the highest standards that we always try to achieve. The following is a summary of the service charges as previously explained and provided in written form on the services for: CAROL M. GEORGE L PROFESSIONAL SERVICES Basic service offuneral director & staff Embalming Other Preparation of Deceased Equipment & Staff for Service at Other Location Transfer remains to funeral home Hearse Utility Car Use of Equipment & Staff for viewing At church $ 1300 $ 500 $ 200 $ 400 $ 200 $ 250 $ 50 $400 TOTAL PROFESSIONAL SERVICES MERCHANDISE Casket: Primrose Outer Burial Container Con-a-Lite Register book Memorial Folders Temporary marker $3,300.00 $2,200.00 $875.00 $ 25 $ 25 $ 25 TOTAL FUNERAL MERCHANDISE $3,150.00 CASH ADVANCES Certified Copies of Death Certificate Musician I Organist Paid Newspaper Notice Patriot-News Cemetery Charges Flowers & P A sales tax $ 72.00 $ 25 $ 112,50 $ 625 $ ]59 CASH ADVANCE TOTAL TOTAL OF SERVICES --$7.443.56 $993.50 BALANCE DUE $7,443.50 If there are any questions or concerns that remain unanswered. please call me. Sincerely, Bradley S, Boyer Pres.! Supervisor ~ , ~1V-l~12 EX" (1-i,7} SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF /' ~_ teu-ot (Y\ ~r-r Include unreimbursed medical expenses. ITEM NUMBER FiLE NUMBER DESCRIPTION I.. AMOUNT d.-", Wt..*" ShOt<:... ~lth. ~ ~ha.h -P r\r\o.hud N('tt'St~ "oM... b\ \\ . ?\i)..'("t'\'It~lCt'. - flMllud pklh~ bl \I ~I,oll. (0 1. i ~ ID. CoI TOTAL (Also enter on line 10, Recapitulation) $ I I 71../. 75 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT,280601 HARRIS8URG. PA 17128-0601 REV-1162 EX("-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT MCGRUTHER MELISSA MICHELE 93 POWELLS V ALLEY ROAD HALIFAX, PA 17032 -------- fold ESTATE INFORMATION: SSN: 202-46-6660 FILE NUMBER: 2105-0436 DECEDENT NAME: GEORGE CAROL MAXINE DATE OF PAYMENT: 08/11/2005 POSTMARK DATE: 08/11/2005 COUNTY: CUMBERLAND DATE OF DEATH: 05/06/2005 NO. CD 005678 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $78.39 I I I I I I I I TOTAL AMOUNT PAID: $78.39 REMARKS: MELISSA MCGURTHER CHECK# 1219 SEAL INITIALS: SK RECEIVED BY: REGISTER OF WILLS GLENDAFARNERSTRASBAUGH REGISTER OF WILLS I'tt:>r-ll~~r- '\:, fuK\ls \jQl~ fJ - t\Q\\~OJ<. PF\ 110 ~2... '" L ,.Lf 3 , oz.""v :J ~' ~~7' ~~ 'if,-o'!' Pg,~ ~o~~~-o N ~. -,''':lrJ, N- ...-\ ..Nt:") ~ $-. 5'. ~ ~ cnJ...4L ~ ~ J..ul""II1I"I...II..II",II...II""I.ft~III_IiI.....~ . ~\\ \\\\\~,,\\\\\\\\ \\\\\\\\\\\\\\\1... J - 7004 2890 0001 7094 210 ~ ' ~n'\bedo..r\d. 6>\.Ln,h.\ l~M ~t+.6L ,j ,~')~\.u'\ht)\tCJ1... ~ Lt(Ue.. 'J~,j~\\.Jt P-A, Il6l3- 3~~7 I b..,\\1\" ~~\S~ eX 'N\\\s 9 :21 Wd II sn~ SQUL ,"_. . ; -i' i Jr\~J_\(\ n=I""'~l(\i '!'_~,I j .J.Jd_jU "-JJ.....1U\_d..../_IL ~, 17': 13+3323-'39 C002 -"-'~" ....._...,~,..~ _~C,,",_~ -' -. --.'. - ~-- -. ---.--. - . \