HomeMy WebLinkAbout08-18-05
REV-1500 EX (6-00\
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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REV-1500
FILE NUMBER
21_ ~5_
COUNTY CODE YEAR
INHERITANCE TAX RETURN
RESIDENT DECEDENT
--.-9360 _ _ _
NUMBER
SOCIAL SECURITY NUMBER
201 16 -2981
DATE OF BIRTH (MM-DD- YEAR)
11/23/2004 08/10/1925
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
N/A
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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[KJ 1. Original Return
o 4. limited Estate
[X] 6. Decedent Died Testate (Attach copy of Will)
o 9. litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future In1erest Compromise (date of death after 12-12-82)
o 7. Deceden1 Maintained a Living Trust (Attach copy of Trusl)
o 10_ Spousal Poverty Credit (dale of death between 12-31.91 and 1-1-95)
o 3. Remainder Return (dale of death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
~ 8. Total Number of Safe Deposit Boxes
o 11 Election to tax under Sec. 9113(A) (Attach Soh 0)
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NAME COMPLETE MAILING ADDRESS
JAMES D. CAMEROO, ESQ.
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FIRM NAME (IfAppliceble)
TELEPHONE NUMBER
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Propnetorship
4. Mortgages & Notes Receivable (Schedule OJ
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I)
11. Total Deductions Itotal Lines 9 & 10)
1 325 NORTH FRrnI' STREET
HARRISBURG, PA 17102
(1) 120,120.00
(2) -0-
(3) -0-
(4) -0-
(5) 59,110.51
(6) 20,560.00
(7) -0
(8)
(9) 18,756.91
(10) 1,255.77
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199,790.51
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)
(11) 20,012.68
(12) 179.777.83
(13) -0-
(14) 179,777.83
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rale
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
-0-
x.O_ (15)
45 (16)
x .0_
x 12 (17)
x .15 (18)
(19)
8,090 00
179,777.83
8,090.00
-0-
-0-
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
20.0
Decedent's Complete Address:
STREET ADDRESS
106 West Vine Street
CITY Shiremanstown I STATE PA I ZIP 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A SpDusal PDverty Credit
8. Prior Payments
C. DiscDunt
(1)
8,090.00
-0-
-0-
-0-
TDtal Credits (A + 8 + C ) (2)
-0-
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Totallnteresi!Penalty ( D + 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
(3) -0-
(4) -0-
(5) R,OQO 00
(SA) -0-
(58) 8,090.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A Enter the interest Dn the tax due.
B. Enter the tDtal Df Line 5 + SA. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes ND
a. retain the use or incDme Dfthe property transferred;......... ........................................................................ . 0 []
b. retain the right tD designate whD shall use the property transferred or its incDme; ..... .............................. 0 KJ
c. retain a reversionary interest; Dr.................. ........................ .................... ....................... ................... 0 []
d. receive the prDmise for life of either payments, benefits or care? ...... .................... ...................... ................. 0 []
2. If death occurred after December 12, 1982, did decedent transfer prDperty within one year of death
without receiving adequate consideration? .... .. ........................... .. .................... ................ .. ....................... 0 RJ
3 Did decedent Dwn an "in trust for" or payable upDn death bank account Dr security at his or her death? ............. 0 KJ
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ..... . ................... ....................... ..................... ................... .............. 0 KJ
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete,
Declaration of preparer other than the personal represenlative IS based on all information of which preparer has any knowledge.
oS
Street, ShiremanstoWl1, PA 17011
TH REPRESENTATIVE
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ADDRESS
1
Harrisburg, PA 17102
For dates of death on Dr after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or fDr the 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) (Ii)].
The statute does not exemDt 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 tile 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 Df age or younger at death to or for the use Df a natural parent, an adDptive parent,
or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)J.
The tax rate imposed on the net value of transfers to or fDr the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. ~9116(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 PS. 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 Dr adDptiDn.
LAST WILL AND TESTAI1ENT OF HARlE L. IffiUHSIEI\:
I, HARlE L. KRUHSIEK, of the Borough of Shiremanstovm,
County of Cumberland and State of Pennsylvania, being of sound
and disposing mind, memory and understanding, do make, publish
and declare this my Last Will and Testament, hereby revoking and
making void any and all prior vTills by me at any time heretofore
made.
1.
I direotthe payment of all my just debts and funeral
expenses as soon after my decease as the same can be conveniently
done.
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I give, deviss,and bequeath all the rest, residue ~np
remainder of my est~te. real, personal and mixed, whatsbever.:-
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and wheresoever the 'same may be situate, to my daughter, BAi{BARA'~ ~~;
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ANN KRUMSIEK-WILL~~,\,absolutely and unconditionally.
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(a) In t~~>~:i~;~~~~that my daughter, BARBARA ANN KHUMSIEK-
WILLIAI1S, shouldp .",eease me, or should she die ,.ithin thirty
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e:of my death, then in either of such
(30) days
events, I
ath my entire estate, of whatsoever
he same may be situate, to my grandson,
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JAMES KURTIS 'l-JILLIAlvIS, with the direction in such event, that
should my said grandson be under the age or eighteen (18) years
at the time or my decease, my personal representative shall
liquidate my estate and convert it into cash and shall deposit
the same in an interest bearing account with a local banking
institution or other accredited financial institution, with the
instructions that the same shall remain on deposit and be invested
until such time as my grandson attains the age or eighteen (18)
years, at which time the same shall be paid over to him, absolutely
and unconditionally, free and clear or all further restrictions.
LASTLY, I nominate, constitute and appoint my daughter,
BARBARA ANN IffiUMSIEK-WILLIAMS, Executrix or this my Last Will and
Testament, and in the event that my said daughter should predecease
me, or should she be unable or unwilling to serve in such capacity
ror any reason, then in such event, I nominate, constitute and
appoint my cousin, B. ROSALIA GEIGER, Executrix or this my Last
Will and Testament, in her place and stead.
IN WITNESS .WHEREOF, I have hereunto set my hand and seal
this 2'1 day of May, A. D., 1999.
JJ&Ali, ~ ;.%?J-'~
Marie L. Krumsiek
(SEAL)
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Signed, sealed, p1;~~':' . lled and declared by the above
named, MARIE L. IffimWIE:?:, '.8 and for her Last Hill and Testament,
in the presence of ml, iI. llB.Ve subscribed our names hereto as
witnesses, at the reque31 If said testatrix, in her presence and
in the presenoe of eEloh ". ';:'ler.
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UMMONWEALTII OF PENNSYLVANIA )
55.
UUNTY OF CUMBERLAND
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I, HlillIE L. IffiUHSIEK , the testat rix
llose name is signed to the attached or foregoing instrument, having
pen duly qualified according to law, do hereby acknowledge that I
igned and executed the instrument as my Last Will and Testament;
hat I signed it willingly; and that I signed it as my free and volun-
3ry act and deed, for the purposes therein contained.
HARTE
:>.y of
Sworn and affirmed to and acknowledged before me~bYL-/ ~
To. KmIT,1STF.K , the testat rix ,this c... L
HR}T , A. D., 1999.
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Notary Public
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Notarial Seal P blle
Mari!y" E. WiHiamS,~:~nd' County
MechaO,cSburllsloBnor~:.Sres Nov. 6, 2001
My commls..... ,
Member, Pennsylvania Association 01 Notariel
i)MMONWEALTH OF PENNSYLVANIA
)
OUNTY OF CUMBERLAND
)
, '
We, the undersigned, J. ROBERT STAUFFER
'l1d SUSAN A. HeCOY '" , the witnesses whose names are
igned to the attachedor~foregoing instrument, being duly qualified
-t">
iccording to law, depose 'and 'say that we were present and saw the
estat rix ,>l1ARIE/l~L: IffiUHSIEIC , sign and eXe-
ute the instrument,~s.~her,Last Will and Testament; that the
aid testatrix ,;MARIE'j:L. KRUI>1SIEK , executed it as
'~/her free and voluntarylitactfor the purposes therein expressed;
i hat each of us, in"ith'e)ihEi'taring{and sight of the testatriX , signed
he Will a~ witnesse~;\l~n'i~~:t~'to the best of our knowledge, the
estat rix was, at~:th ,f!., e,', eighteen (18) or more years of age,
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f Round mind, and'unde onstraint, duress or undue influence.
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
FILE NUMBER
MARIE L. KRUMSIEK, DECEASED 21-05-0360
All reel properly owned solely or as a lenanlln common must ba reported at fair merkel value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled 10 buy or sell, both having reasonable knowledge of Ihe relevanl facts.
Real properly which Is jolnlly-owned wllh right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
Real estate situate at 106 West Vine street, Shiremanstown
Cumberland County, Pennsylvania, more particularly
described in CUmberland County Deed Book "0", Volume 32,
Page 647
(assessed value)
$120,120.00
TOTAL (Also enter on line 1, Recapitulation) $ 120, 120.00
(If more space is needed. insert additional sheets of the same size)
DATE
JULY 1 2005
A55ESSMENT---aiii..' NO.- C 2. "
TAX VEAR
2005-06 REAL ESTATE TAX NOTICE ** SCHOOL **
~~~~R~~MICSBURG AREA SCHOOL DISTRICT
JUDY C. PROWELL
211 E. CHESTNUT STREET
SHIREMANSTOWN PA 17011
PHONE: (717) 737-2193
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ACCT NO 37-23-0557-172
KRUMSIEK, MARIE L
106 WEST VINE STREET
SHIREMANSTOWN PA 17011
I F-n:-X~E"~~"AlftE'..'i.;~nE;'~'~~~~W~ ;"I."i~rR.W;:~'~-
THIS BILL TO YOUR MORTGAGE COMPANY
120,120
300
I. 7/1 TO 9/1 TUES & THURS 7PM - 9PM
ALSO THURS 1-3PM & WED AUG 31 7-9PM
SEPT & OCT 7-9PM ON THURSDAY ONLY
AFTER NOV 1 BY APPOINTMENT ONLY
%P
M
M DURING THIS PERIOD
PAY THIS AMOUNT
%P
106 W VINE STREET
CLEPPER FARMS
LOT 6 SEC A PB 19 PG 38
Residential Building
IF UNPAID BY 12/15/05 TAXES WILL BE
TURNED OVER TO CUMBERLAND CO.
TAX CLAIM BUREAU.
$1.00 FEE FOR ADD'L RECEIPTS REQUESTED
- '.. LllClr. are ~5t funded by State
Return Bill with Payment. 1"01 " n"~"",, . ~"_'_n -
........~
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A{V.15OI"(.I:.I'''n
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
MARIE L. KRUMSIEK, DECEASED
FILE NUMBER
21-05-0360
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
1.
4
5
6
7
8
DESCRIPTION
VALUE AT DATE
OF DEATH
Commerce Bank
100 Senate Avenue
Camp Hill, PA 17011
Checking account number 0513154815
7,771.27
2
Commerce Bank
100 Senate Avenue
Camp Hill, PA 17011
Accrued interest, checking account number 0513154815
.03
3
Commerce Bank
100 Senate Avenue
Camp Hill, PA 17011
Money market account number 0032062028
40, 1 41 . 13
Commerce Bank
100 Senate Avenue
Camp Hill, PA 17011
Accrued interest, money market account number 0032062028
8.29
Commerce Bank
100 Senate Avenue
Camp Hill, PA 17011
Certificate of deposit number 801067
10,215.19
Commerce Bank
100 Senate Avenue
Camp Hill, PA 17011
Accrued interest, certificate of deposit number 801067
14.60
American Express Travelers Checks
'.460.00
500.00
1984 Pontiac station wagon VIN 2G2AL35HXE9709810
TOTAL (Also enter on line 5, Recapitulation) $ 59,110.51
(If more space is needed, insert additional sheets of the same size)
Commerce
"Bank
June 25, 2005
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James Duryea Cameron
Attorney At Law
1325 N Front St
Harrisburg, PA 17102
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RE:
Estate of: Marie L Krumsiek
Social Security #: 201-16-2981
Date of Death: November 11, 2004
Dear Sirs:
In reference to the letter regarding the above mentioned
Estate, we would like to inform you of the information that
we have researched and found.
Type: Checking
Account #: 032062028
Date Opened: 4/5/96
Primary Owner: Marie L Krumsiek
Date of Death Balance: $40,141.13
Accrued Interest: $8.29
Principal Balance: $40,132.84
Type: Checking
Account #: 513154815
Date Opened: 10/28/99
Primary Owner: Marie L Krumsiek
Date of Death Balance: $7,771.27
Accrued Interest: $.03
Principal Balance: $7,771.24
Both above mentioned accounts are set to be closed.
Commerce Bank I Harrisburg, NA
P.O. Box 8599
100 Senate Avenue
Camp Hill, Pennsylvania 17001-8599
Commerce
"Bank
Type: Time Deposit
Account #: 801067
Date Opened: 10/25/03
Primary Owner: Marie L Krumsiek
Date of Death Balance: $10,215.19
Accrued Interest: $14.60
Principal Balance: $10,200.59
If there are any questions or additional information that
is needed, please feel free to contact me at (717) 795-7118
ext. 3151.
Sincerely,
~ch~~~
Wanda J Morris
eIF Team Leader
Commerce Bank / Harrisburg, NA
P.O. Box 8599
100 Senate Avenue
Camp Hill, Pennsylvania 17001-8599
Rtv.1509 EX+ (1-9r)
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
MARIE L. KRUMSIEK, DECEASED
FILE NUMBER
21-05-0360
If an asset was made joint wnhin one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. Barbara Ann Williams
106 West Vine street, Shiremanstown PA 17011
child
B.
c.
JOINTLY.OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES
1. A. 1996 Miscellaneous tangible personal property $5,000.00 50% $2,500.00
2 A 11/04 2004 Kia sedan, VIN KNADC125946347334 $8,060.00 100% $8,060.00
3 A 06/96 Cash at residence $20,000.00 50% $10,000.00
TOTAL (Also enter on line 6, Recapitulation) $ 20,560.00
(If more space IS needed, insert additional sheets of the same size)
Kelley Blue Book - Private Party Pricing Report - Kia, Rio
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Pennsylvania. August 10, 2005
2004 Kia Rio Sedan 40
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Air Conditioning
Power Steering
AM/FM Stereo
Cassette
Single Compact Disc
Dual Front Air Bags
Engine: 4-Cyl. 1.6 Liter
Trans: Automatic
Drive: FWD
Mileage: 9,800
Equipment
Consumer Rated Condition: Good
"Good" condition means that the vehicle is free of any major defects. This vehicle has a clean title hi.!;torv ,
the paint, body and interior have only minor (if any) blemishes, and there are no major mechanical
problems. There should be little or no rust on this vehicle. The tires match and have substantial tread wear
left. A "good" vehicle will need some reconditioning to be sold at retail. Most consumer owned vehicles fall
into this category.
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
21-05-0360
MARIE L. KRUMSIEK, DECEASED
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Malpezzi Funeral Home 2,081.00
2 Chestnut Hill Cemetery 775.00
(grave opening/closing)
B. ADMINISTRATIVE COSTS:
1- Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s) N/A
Street Address
City State _ Zip
Year(s) Commission Paid:
2. Attorney Fees James D. Cameron, Esq. 8,961.53
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Barbara A. Williams
Street Address 106 West Vine street
City . Shiremanstown State -EA- Zip 17011
Relationship of Claimant to Decedent child 3,500.00
4. Probate Fees
Register of wills of CUmber land County 302.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. PPL Electric utilities (West Vine Street) 76.34
8 PA American Water (West Vine Street) 36.69
9 PPL Electric utilities (West Vine Street) 78.88
(Please see attached for continuation)
TOTAL (Also enter on line g, Recapitulation) $18,756.91
(If more space is needed, insert additional sheets of the same size)
SCHEDULE H (cant I d)
Marie L. Krumsiek, deceased
No. 21-05-0360
10. Pennsylvania American Water Company 42.02
(water service; 106 West Vine street)
11. PPL Electric utilities 66.98
(electric service; 106 West Vine street)
12. Pennsylvania American Water Company 39.11
(water service: 106 West Vine street)
13. The Sentinel 144.29
(legal advertising)
14. Cumberland Law Journal 75.00
(legal advertising)
15. Lower Allen Township 59.40
(sewer and refuse: 106 West Vine street)
16. PPL Electric utilities 65.99
(electric service: 106 West Vine street)
17. pennsylvania American Water Company 41.43
(water service: 106 West Vine street)
18. Judy C. Prowell, Tax Collector 510.82
(2005 Borough/County real estate tax)
19. Judy C. Prowell, Tax Collector 1,510.32
(2005-2006 school real estate tax)
20. Lower Allen Township 30.00
(sewer and refuse: 106 West Vine street)
21. pennsylvania American Water Company 74.73
(water service~ 106 West Vine street)
22. PPL Electric utilities 255.38
(electric service; 106 West vine street)
23. Register of Wills of Cumberland County 30.00
(filing fees--Inventory and Inheritance
Tax Return)
Malpezzi Funeral Home
8 Market Plaza Way
Mechanicsburg, P A 17055
(717)697 -4696
Dcccmbcr 9,2004
Barbara Williams
lOG Wcst Vinc Street
Shircmanstown, P A 17011
Olllc Funcral Service for Marie L. Krumsiek
We sinccrcly apprcciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feci frce to contact us if you have any questions in regard to this statement.
TilE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCIIANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
I. PROFESSIONAL SERVICES
Services of Funeral Director/Staff
$1895.00
$t895.00
FUNERAL 1I0ME SERVICE CHARGES
SELECTED I\IERCIIANUlSE:
Casket. . . . . . . 0 . . . . . . . . . . . . . . . . 0
Grave Liner
. . . . a a 0 . . . . . . . . . . . . . . . . . . .
$895.00
$640.00
TilE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
TIIAT YOU IIA VE SELECTED . . . . . . . . . . . . . $3430.00
AT TilE TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTS TO
OTIIERS AS AN ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES.
CAS II ADVANCES
Cel1l~tery E~uipl1lent. . . . . . . . . . . . . . . .
Cerlifie~ Copi~s of the Deat!1 C~rti!ic~te. . . . . . . . . .
TOTAL CASII ADVANCES AND SPECIAL CHARGES.
CONTRACT PRICE . . . . . . . . . . . .
IIISTORY
11/2~/2~04 .Co!1lP~ssi.on~le ~is~OU!11 -. Tr~d ~II s.erv!ce~
11/2~/2~04 .Pa:(m~nl. . . . .
I2IO~/2~04 .P8:(m~nt. . . . .
TOTAL AMOUNT DUE
$75.00
$6.00
$81.00
$3511.00
$-1430.00
$-400.00
$-600.00
$1081.00
CHESTNUT HILL CEMETERY
Robert J. Wolf, Supt., Sec., Treas.
579 Brighton Place
Mechanicsburg, P A 17055
717-766-6244
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Please re~d accompanying Prescribing Information.
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SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEAL TH OF PENNSYLVANIA
INHE RIT ANCE TAX RETURN
RESIOENT DECEDENT
ESTATE OF
MARIE L. KRUMSIEK, DECEASED
FILE NUMBER
21-05-0360
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION AMOUNT
1.
54.56
2
3
4
5
6
West Shore EMS-BLS
(medical expense not covered by insurance)
Holy Spirit Hospital
(medical expense not covered by insurance)
40.34
Bureau of Account management for Pinnacle Health Hospitals
(medical expense not covered by insurance)
939.99
Quantum Imaging & Therapeutic
(medical expense not covered by insurance)
24.39
Susquehanna Internal Medicine
(medical expense not covered by insurance)
112.70
Hershey Kidney Speciailists
(medical expense not covered by insurance)
83.79
TOTAL (Also enter on line 10, Recapitulation) $ 1,255.77
(If more space is needed, insert additional sheets of the same size)
> REV.151} EX. 19'00.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
MARIE L. KRUMSIEK, DECEASED
FILE NUMBER
21-05-0360
1.
RELATIONSHIP TO DECEDENT
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Truslee(s)
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
Barbara Ann Krumsiek-williarns child
106 West Vine street
Shiremanstown, PA 17011
AMOUNT OR SHARE
OF ESTATE
NUMBER
I
100% residue
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1S00 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
JAMES DURYEA CAMERON
ATTORNEY- AT-LAW
I32rJ NORTH FRONT STREET
HARRISBURG, PENNSYLVANIA 17102
LICENSED IN BOTH PENNSYLVANIA
AND MARYLAND
Office of the Register of Wills
CUMBERLAND COUNTY COURTHOUSE
1 Courthouse Square
Carlisle, PA 17013
Re: Estate of Marie L. Krumsiek
No. 2005-00360
To Whom It May Concern:
;~,
You will find enclosed the original and one copy of an
Inventory, and the original and two copies of the Pennsylvania
Inheritance Tax Return, for the above-referenced Estate.
Also enclosed are the Estate's checks, numbers 1020 and
1022, payable to "Register of Wills" and "Register of Wills,
Agent", in the amounts of $30.00 and $8,090.00, respectively, in
payment of the filing fees and the tax due.
Kindly file the original documents and return the time-
stamped copies to us in the envelope provided.
Please contact my office if you have any questions. Thank
you.
TELEPHONE: (717) 236-3755
FACSIMILE (717) 236-3655
August 17, 2005
.,-- -.
Sincerely -... ,
`,
. ~_~-
Jam s D. Cameron
JDC/sg
Enclosures
cc: Barbara A. Krumsiek-Williams, Executrix
REV-1162 EX111-96)
COMMONWEAL (H OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
KRUMSIEK-WILLIAMS BARBARA ANN
106 WEST VINE STREET
SHIREMANSTOWN, PA 17011
ACN
ASSESSMENT
CONTROL
NUMBER
-------- told
ESTATE INFORMATION:
FILE NUMBER:
DECEDENT NAME:
DATE OF PAYMENT:
POSTMARK DATE:
COUNTY:
DATE OF DEATH:
SSN: 201-16-2981
2105-0360
KRUMSIEK MARIE L
08/18/2005
08/17/2005
CUMBERLAND
11/23/2004
TOTAL AMOUNT PAID:
REMARKS:
SEAL
CHECK# 1022
INITIALS: CCP
RECEIVED BY:
NO. CD 005709
AMOUNT
$8,090.00
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
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