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ETZWEILER AND ASSOCIATES
ATTORNEYS-AT-LAW
105 NORTH FRONT STREET
HARRISBURG, PA 17101-1436
Office hours: Mon.-Fri. 8:00 a.m.-5:00 p.m.
(717) 234-5600
Earl Richard Etzweiler, Esquire
Christian S. Daghir, Esquire
HALIFAX LINE
(717) 896-3737
Fax Line: (717) 234-5610
Email Address:retzweilerlalcomcast.net
2 West Main Street
Elizabethville, P A 17023
(717) 362-8395
Office hours: Thurs. 7:00 p.m.-9:00 p.m.
225 Market Street
Millersburg, PA 17061
(717) 692-2519
Office hours: Tues. and Fri. 4:00 p.m.-8:00 p.m.
Sat. 10:00 a.m.-J2:00 noon
August 30, 2005
Register of Wills Office
Cumberland County Courthouse
Hanover and High Streets
Carlisle, P A 17013
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RE: ESTATE OF REBA W. GARMAN
FILE NO. 2005-00609
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Dear Sir or Madam:
Please find enclosed for processing the following:
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1. The original and one copy of the Inheritance Tax Return;
2. The original Inventory;
3. A copy ofthe face sheet ofthe Inheritance Tax Return and Inventory to be time-stamped
and returned to our office in the self-addressed, stamped envelope included with this
mailing;
4. Our check in the amount of $80.00 representing your fees for processing the same.
(This amount includes the additional probate fee of$50.00, as well as the $30.00 to file
the Inheritance Tax Return and Inventory); and
5. Our check in the amount of$6,695.14, which represents the Inheritance Tax Due.
Thank you for your assistance in this regard.
Sincerely yours,
,~h~
Earl Richard Etzwei1er
ERE:haf
Enclosure
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OFFICIAL USE ONLY
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT,280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
.li 05
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
0609
NUMBER
D 2, Supplemental Return
D 4a. Future Interest Compromise (date 01 death
after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach
copy 01 Trust)
D 10 Spousal Povert~ Credit (date 01 death between
. 12-31-91 and 1-1-95)
.TH'$$$(!:'tJ9NMl.l$"'ig~MP4$t$WA~g(;E:l~~~j#qNl?lEji@$ANP.~NfIP$NtIAA:MKlNj!iQFWAt@ij$J.l{:ll.lgl?~$pi~lEqt~pt{:lr>.....'."""
NAME COMPLETE MAILING ADDRESS
Earl Richard Etzweiler
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- ! DECEDENTS NAME (LAST, FIRST. AND MIDDLE INITIAL)
Garman, Reba W.
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
184-26-5167
THIS RETURN MUST BE FIL.ED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL. SECURITY NUMBER
D
D
3. Remainder Return (date 01 death prior to 12-13-82)
5. Federal Estate Tax Return Required
06-25-2005
09-17-1921
8. Total Number of Safe Deposit Boxes
D 11.Election to tax under Sec. 9113(A) (Attach Sch 0)
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDL.E INITIAL)
[!] 1. Original Return
D 4. Limited Estate
[!] 6. Decedent Died Testate (Attach
copy 01 Will)
D 9. Litigation Proceeds Received
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FIRM NAME (II applicable)
Etzweiler and Associates
105 North Front Street
Harrisburg, PA 17101
TELEPHONE NUMBER
(717) 234-5600
1 . Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
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5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L) D Separate Billing Requested
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 (total Lines 9 & 10)
12 Net Value of Estate (Line 8 minus Line 11)
(1 )
(2)
(3)
(4)
(5)
(6)
(7)
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None
84,398.62
None
None
69,219.75
None
14,514.00
(8)
168,132.37
(9)
(10)
11,028.58
492.31
(11 )
11,520.89
(12)
156,611.48
0.00
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)
(13)
(14)
156,611.48
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
J 20. ~
0.00
7,047.52
0.00
0.00
7,047.52
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
. .~ ...>..>~M~g~Q~li;tqAN~W~ijMkqQ$$tj{:lN$9N~~~$~~Q$.WJpij~(!:HlEqk;MAtl-l@..U.~.?>..""'"
Copyright 2002 form software only The Lackner Group, Inc.
15. Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15)
z or transfers under Sec. 9116(a)(1.2)
0
~ 16. Amount of Line 14 taxable at lineal rate 156,611.48 x .045 (16)
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Q. 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17)
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0
u 18. Amount of Line 14 taxable at collateral rate 0.00 .15 (18)
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~ 19. Tax Due
(19)
Form REV-1500 EX (Rev. 6-00)
.' Dec.edent's Complete Address:
STREET ADDRESS
4905 E. Trindle Road, Apt. #92
I STATE PA
TZ'P 17050
CITY Mechanicsburg
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
7,047.52
6,695.14
352.38
Total Credits (A + B + C)
(2)
7,047.52
3. Interest/Penalty if applicable
D. Interest
E. Penalty
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4)
(5) 0.00
(5A)
(58) 0.00
Total Interest/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
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Yes No
D 0
D 0
D ~
D ~
o 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.............. 0 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?........ ............ ........ ............... ....... ... ... ....... ........................................................ 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 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 representative is baserl on al\ information of which prepare' has any knowledge.
ADDRESS
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?............................................................................................................... ..........
DATE
1126 Baldwin street
Mechanicsburg, PA 17055
B~6-0S
SIG
ADDRESS
DATE
DATE
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS
grl Ric~Jar5.Y:~zw~r /~}. _ .' /) 105 North Front Street
~~~l ~ Harrisburg, PA 17101
)tr\}:j~r:jjtt)j~\\?tt(~U/\rr\fjr(}}t((J}(~j::::::.:.::::fj(lt?\\j(t~{}}{fj{f}t1~j~j~1t ....... ."...... .',.. .. .... .........:.:...:.:.......:...:}:~:~:~:~{::.......... .. ...... .::::=::::::::::;:;:::::;:::::...... . ':::::. ~'~':'~':'~':'~'~':::.. .... ..,. . ......
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)].
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 exempt 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 to or for the use of a
natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116 (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. ~9116 (a) (1 )].
g; 30/ cy-
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.
"
"
LAST WILL AND TESTAMENT OF
REBA W. GARMAN
I, REBA W. GARMAN, a resident of Halifax Township, Dauphin County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make,
publish and declare this instrument to be my Last Will and Testanient, hereby revoking any and all
wills by me at any time heretofore made.
ITEM I: I direct my hereinafter named Executor to pay all my just debts, funeral
expenses, administration expenses and inheritance, estate, succession or excise taxes, which I owe
or may become due on account of my death, as soon as may be convenient after my decease.
ITEM II: All the rest, residue and remainder of my estate, be it real, personal or .
mixed, ofwhatever nature and wheresoever situate which I may own or have the right to dispose of
at the time of my decease, I give, devise and bequeath to my husband, Eugene M. Garman, of 415
West Fourth Street, Halifax, Pennsylvania.
ITEM III: If my said husband should predecease me or die simultaneously with me,
then I give, devise and bequeath to my granddaughter, Ashlyn A. Rehm, of 1126 Baldwin Street,
Mechanicsburg, P A 17055, all my furniture, household articles and all tangible personal property
which I might own at the time of my decease.
A. If my said granddaughter should predecease me or die simultaneously with me,
then her share shall lapse and become a part of the residue of my estate.
"\J\..:'t....,.,.\ \1 \. ..'\....... t-<-v'v--~.---.J
Reba W. Garman
(SEAL)
"
"
ITEM IV: If my said husband should predecease me, then I give, devise and
bequeath the sum of Five Thousand Dollars ($5,000.00) to each of my following two (2) great
grandchildren, provided they have attained 21 years of age:
1. Emilee Lauren Rehm, of 1126 Baldwin Street, Mechanicsburg, P A 17055
2. Jacob Norman Rehm, of 1126 Baldwin Street, Mechanicsburg, PA 17055.
A. If either of my said great grandchildren have not attained 21 years of age
at the time of my decease, then I nominate, constitute and appoint my granddaughter, Ashlyn A.
Rehm, Guardian and/or Trustee of the Estate of my said great grandchildren without being required
to file bond for the performance of her duties, with discretion to invest such share or shares in any
manner she may deem appropriate, and to hold such share until said great grandchild have attained
21 years of age, with the exception that my said Guardian and/or Trustee may use such portion of
the income and principal as she may deem appropriate for educational purposes only for said great
grandchildren prior to attaining 21 years of age.
ITEM V: If my said husband should predecease me, or die simultaneously with me,
then I give, devise and bequeath all the rest, residue and remainder of my estate, be it real, personal
or mixed, of whatever nature and wheresoever situate which I may own or have the right to dispose
of at the time of my decease to be equally divided between my following two sons, per stirpes:
A. John D. Garman, of Route 447, Box 295, Pine Knob Inn,
Canadensis, P A 18325
B. George E. Garman, of 7968 Somerset Street,
Hummelstown, P A 17036
-_\ ~~ \ >-r \ ~. \ _ __~~."'~~" ~ ,,,-,,-JSEAL)
Reba W. Garman
. .
ITEM VI: I hereby nominate, constitute and appoint my husband, Eugene M.
Garman, Executor of this my Last Will and Testament, with full power in his discretion to do any
and all things necessary for the complete administration of my estate, without being required to file
bond for the performance of his duties, with full power to sell at public or private sale and without
order of court any real or personal property belonging to my estate, and to compound, compromise
or otherwise settle or adjust any and all claims, charges, debts and demands whatsoever against or
in favor of my estate as fully as I could if living.
A. If my said husband should predecease me, die simultaneously with me or be
unable or unavailable to serve or complete his duties, then I nominate, constitute and appoint my two
sons, John D. Garman and George E. Garman, and my granddaughter, Ashlyn A. Rehm, Executors,
with the same power and authority as given my said husband.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last .
Will and Testament this 2nd day of July, 2002.
\.~~ L.:.. \ \...~\. ~~ ~"/"-.J-"".JJ (SEAL)
Reba W. Garman
Signed, sealed, published and
declared by the above-named
Reba W. Garman as and for
her Last Will and Testament, in
the presence of us, who at her
request, in her presence and
in the presence of each other,
we believing her to be of
sound and disposing mind,
memory and understanding,
have hereunto subscribed our
names as witnesses this 2nd
day of July, 2002.
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Rev,1tl03 EX+ (6;!lS)
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SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSVLVANIA
INHERITANCE TAX RE'TlJRN
RESIDENT DECEDENT
ESTATE OF
Garman, Reba W.
FILE NUMBER
21-05-0609
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 Oppenheimer Funds - Account No. 330-3301434468 52,836.71
2 91 shares of PPL Common 59.53 5.417.23
3 392 shares of Rite Aid 4.11 1,611.12
4 98 U.S. Savings Bonds 24.533.56
'.
TOTAL (Also enter on Line 2, Recapitulation) 84.398.62
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule B (Rev. 6-98)
$,'
. OppenheimerFunds~
The Right Way to Invest
Account Statement
Statement Period: January 01, 2005 . June 30, 2005
Page 1 of 1
EUGENE M GARMAN &
REBA W GARMAN
JT TEN WROS NOT Te
4:15 N4TH.ST
HALIFAX PA t703Z-9408.
Your' Financial Advisor.
HOUSE
OPPENHEIMERFUNDS DISTRIBUTOR
INC
. PO BOX 5270
DENVER. CO 80217-5270
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.': Or partial account balance} from. lift! fiim(ac:coont Into:another:ftmltaccauntonce ill any 3O'-day'cafendar period. Yw Wilt find more Information on this new '"
exchange policy in your Funcfs prospectu&and-orHltlF.websimat.www.oppenheimerfunds.com.. - '. '. ," ~
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Rev-1508 EX+ (6.98)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMON\NEAl TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Garman, Reba W.
FILE NUMBER
21-05-0609
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
1 Halifax National Bank - CD Account No. 101433130
VALUE AT DATE
OF DEATH
69,209.05
2 The Patriot News - refund
10.70
TOTAL (Also enter on Line 5, Recapitulation)
69.219.75
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
Earl Richard Etzweiler, Esquire
Christian S. Daghir, Esquire
ETZWEILER AND ASSOCIATES
ATTORNEYS-AT-LA W
105 NORTH FRONT STREET
HARRISBURG, PA 17101-1436
Office hours: Mon.-Fri. 8:00 a.m.-5:00 p.m.
(717) 234-5600
HALIFAX LINE
(717) 896-3737
Fax Line: (717) 234-5610
Email Address:retzweiler@comcast.net
225 Market Street
MilIersburg, P A 17061
(717) 692-25 19
Office hours: Tues. and Fri. 4:00 p.m.-8:00 p.m.
Sat. 10:00 a.m.-12:00 noon
HALIFAX NATIONAL BANK
Third and Market Streets
Halifax, PA 17032
2 West Main Street
Elizabethville, P A 17023
(717) 362-8395
Office hours: Thurs. 7:00 p.m.-9:00 p.m.
July 12, 2005
This office represents the Reba W. Garman who died on June 25, 2005, a resident of the Hampden
Township, Cumberland County, Pennsylvania, and whose Social Security Number is 184-26-5167.
Would you please complete the bottom portion of this letter for all accounts in which the decedent
had an interest in as of the date of death showing the balance in said account(s) at date of death
and have the same signed by the appropriate officer or employee of your financial institution.
ERE:hf
Account Number(s)
Type of Account
Date Opened
Accrued Interest posted calendar
year up to date of death
Principal Balance
as of Decedent's Death
Accrued Interest
not disbursed as of
Decedent's Death
Maturity Date
Account Ownership
Name of Joint Owner
Date Joint Ownership
was Established
sincep~
Ead:fuch~rd Etzweiler
101433130
CD
12/03/1997
949.02
69,209.05
114.72
1 ?/n"3/?OOfi
REBA GARMAN
NONE
CASHED IN 7/13/05
If a joint account is dated within one year of the date of death of decedent, could that account be
traced to a prior joint account in existence over one year prior to the death of decedent.
Rev-1510 EX+ (6-98)
*'
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RElURN
RESIDENT DECEDENT
ESTATE OF
Garman, Reba W.
FILE NUMBER
21-05-0609
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV -1500 COVER SHEET is yes.
ITEM
NUMBER
DESCRIPTION OF PROPERTY
INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE.
American Express Financial - Account No.
0010-1008-7273-7 -002
14,514.00
DATE OF DEATH % OF DECO'S EXCLUSION
VALUE OF ASSET INTEREST (IF APPLICABLE)
1
Named Beneficiaries were son, John D.
Garman, son, George E. Garman and
granddaughter, Ashlyn A. Rehm.
TOTAL (Also enter on Line 7, Recapitulation)
(If more space is needed, additional pages of the same size)
Copyright (C) 2002 form software only The Lackner Group, Inc.
TAXABLE
VALUE
14,514.00
14,514.00
Form PA-1500 Schedule G (Rev. 6-98)
Ben L Mcdonougtl
Sent by; Bert L
Mcdonough
To: Michael G Papson/FieldlWH/AEFA@AMEX
cc:
Subject: 18466795 4001
REBA W GARMAN - DEATH SETTLEMENT REQUIREMENTS-
PLEASE DO NOT DELETE
08/25/2006 10:40 AM
IDS Life Insurance Company
American Express Funds
Amerlprlse Certificate Company
Amerlprlse Brokerage
'70100 AmeripriSlll Financial Center
Minneapolis, MN 55474
August 25, 2005
JOHN PAUL GROVE
4661 TRINDLE RD
CAMP HILL, PA 17011-5603
***Account was distributed to named beneficiaries
being, son, John Garman, son, George Garman and
grand daughter, Ashlyn Rehm
Dear JOHN PAUL GROVE:
Thank: you for your recent inquiry regarding REBA W GARMAN's accountS. These are the values of the accounts
as of 06/25/2005.
Mutual Funds
Ac90unt Number
01010059807 6 002
010100872737002
0]0101319084002
Total Value
$291.26
$7564.63
$6658.11
# of shares
56.998
324.523
1302.956
A!'i~ Value Per Share
5.110
23.310
5.110
The dare of death value..~ provided are for estate tax pwposes and are not a value to be paid. Accounts may be
sui:l,icct to market fluctuation as govemed by each product. Please note that the values indicated fOf any Life
Insurance product(s) reflect the gross death benefIt at date of death, not the cash value. V slues for any proprietary
mutual funds include accrued dividends as applicable.
We appreciate the opportunity to be of service to you. Please contact US if you have any questions.
Sincerely,
Bert McDonough
Death Settlements Processing Team
70100 Ameriprise Financial Center
Minneapolis, MN 55474
1-800-862-7919, Option ~,1
.. ........
cd Wd9~:c1 S00C Sc .6n~
17661 19L L 1L
.ON 3NOHd S~OSIna~ .NI~ SS3~dX3 N~JI~3W~
WO~~
REV-1161 EX+ (12-~9)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Garman, Reba W.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-05-0609
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 2,813.95
B. 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
2. Attorney's Fees Earl Richard Etzweiler 7,435.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 325.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 454.63
TOTAL (Also enter on line 9, Recapitulation) 11,028.58
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev-te02 EX+ (6-9a)
'.
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONl/\lEALTH OF PENNSYLVANIA
INHERITANCE TAX RE11JRN
RESIDENT DECEDENT
ESTATE OF
Garman, Reba W.
FILE NUMBER
21-05-0609
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Ashlyn Rehm - reimbursement for Funeral Dinner ($286.53) and dinner supplies
Walmart ($15.43)
301.96
2
Flowers on Locust - funeral flowers
96.99
3
Hoover Funeral Home - funeral services
2,000.00
Subtotal
2,398.95
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
~~/L8IL~~8 L~:L1
(1 (b':lL48'::l'::l
Hoover Funeral Homes, Inc.
118 South Mar1<et Street . 10:3 West Main Street
MlIlersburg. M 17061 fax 692-4599 or 362-9845 ElixllbQthvillll. PA 17023
(717) 69:<1-3298 Forethought Funeral Planning (717) 362-8522
6lG1ell~y S. Boyer, $l,Ipervlsor Roben M. Stianche. Jr. Supervisor
Nalhan Corl Minnich, FD
www.hoovl!!rfunerafhomes.com
No. 5167
SERVICES FOR: Reba W. Garman
DATE OF DEATH June 25, 2005
PLACE OF DEATH 1126 Baldwin St.
DATE OF STATEMENT June 27,2005
DATE OF SERVICE July 3. 2005
SERVICES, FACILITIES & TRANSPORTATION
Basic SelVices of Funeral Director and Staff $
~~~~ $
Other Preparation of Body $
Use of Facilities & Staff for Viewing I Visitation $
Use of Facilities & Staff for Funeral Ceremony $
Use of Facilities & Staff for Memorial Service $
Use of Equipm~nt & Staff for Graves/de Service $
Use of Equipment & Staff for Church Service $
Transfer of Remains to Funeral Home $
Hearse $
Sedan $
Service (Utility vehicle S
$
$
$
TOTAL SERVICE CHARGE $
200.00
MERCHANDISE
Casket (or alternative container)
Name I No.
Material
Color
Outer Burlal Container
Name ( No.
Ml'lteriel
Clothing
$
$
$
$
$
$
$
:5
$
$
$ 285
$
$
$ 285.00
Acknowledgment Cards
Register 600k
Memorial Folders
Prayer Cards
Cremation Urn
TOTAL OF MERCHANDISE
SPECIAL SERVICES
Forwarding remains to:
~eceiving Remains from:
Immediate Burial
Direct Cremation
$
S
$
$
S
$
$
1300
TOTAL OF SPECIAl.. CHARGE
TOTAL FUNERAL HOME CHARGES
(This lotal does 1'101 Include cash advances)
EMBALMING REQUIREMENT AND DISCLOSURES
If any law, cemetery or crematory requirements have requir~ an embalming or the
PVrCf1l;l$O;! Of $ny item$, the law Ot the requirement is explained \)eJow.
1,300.00
1,785.00
HUUV~~ ~UN~~AL HUM~~
I-'A(;i~ ~L
stATEMENT OF FUNERAL GOODS lU'
AND SERVICES SEI.ECTED
-/!~~"
.~ Jl1:; ;
~.J:
Charges are only for those ilems you selecled or that are required. If
we !!re required by law or by a cematllry or cremlltory fo use any
item. we wilr explain reaSQns In writing below.
If you selected a funeral that may require all embalming, sucl'la$ a
funeral with vi4Wlng, you may' tlave to pay for embalming Ycu dO
1'10t have to pay for embalming you did not approve if you selected
arrsngements SUCh as dIrect cremation or immediele burial. If we
charge for embalming. we wUl explain whY below.
CASH ADVANCES
Certified Copies Death Certificate # 15
Clergy Rev. George W. Barto. III
Musician . - .
Paid Notices Patriot-News
Other Notices
Cemetery
Coroner
Monument inscription
TOTAL CASH ADVANCES
.i$
1$
I 1$
I _$
I $
I i$
I 1$
-. 1$
1$
i 1$
1$
$
630.00
90,00
150
140
100
25
125
200
We Chal'9O you for our st!Nice& in Oblflining l!ems mBrked with an .X.
SUMMARY OF EXPENSES
Total All Aoove Items $
Sales Tax (ir App) @ % $
GRAND TOTAL $
Less Credits and Payments
Payment Made
2,415.00
0.00
2,415.00
Balance due
$
$
$
2,415.00
July 3.2005
BILLING TO; Ashlyn Rehm
1128 Baldwin SI. MeChanicsburg. PA 17055
ACKNOWLEDGMENT AND AGREEMENT
I hereby acknowledge that I htIve tile right to arrange the final service
for the person named above, snd I authorize this funenal
establishment to perform services, furnish goods. and inC1.lr
OUl$ide charges specified in this Statement. I acknowledge that a
Casket Price List and a Outer Burial Container Price List were made
aVllllablp to me and that a copy of the Generai Price Lisf was given 10
me prior to rrYf making financial arrangements.
TERMS OF PAYMENT
Full payment is due no lalarthan July 3, 2005
If any payment i$ not paid when due, an unenticipstecl LATE::
CHARGE: of 1.5% per month (ANNUAL PERCENTAGE RATE 18%)
will be added to the unpaid balance. I agree 10 pay th. Balance due
IIst8d on this statement. plus anX Late Charge. In the event I default in
payment to thiS funeral estabhshmen~ I agree to pay reasonable
attorney iees and elt court costs In addition to any L.ate C1'I8rge
app!i.cable. I Undel'9tlilnd lInd Ilgrclll that r :1m assuming personrill
liabIlity for afl the e/'lal'ges set IOrth In this statement, and that is in
addition to the lIabill1y ImpO$ed by law upon lhe estate of the
deceased. By my si911ature below. I hereby agree to all of the above
and acknowledge receipt of ill signlld copy of this Statement.
Addilional terms of payment are:
DISCLAIMER OF WARRANTIES
Our tunenal home makes no representations or warranties regarding
caskets or outer burtal conlainers. The only w.....rranlies, expressed or
Implied, grante(j in connection wittl goods sold with tl'1e funere!
service are lhe express written warrantiell. if /lny, extended by the
manuf:lcturer thereof. No other warranties inCluding the implied
warranties of merchanlability or fitness for particular purpose are
extended by the seller.
.
SiCll'lO<l
SeolOI Socullty N""'~er
Ju n 27, :1005
Cl.w~
, Jun 27. 2005
51l)11~ DOlled
ACCEI">I~TANCE Our funl!!rar hom~ agrees to provide ail the services,
mercha e and cas'i, adv"JIlces indicated on this statement
By .1 r. IJ ~.A.J f=. ~
. fl .;;;;;;r.. ~ .-
V U
Rev-15()2 EX+ (6-96l
,'.
SCHEDULE H-B4
PROBATE FEES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Garman, Reba W.
FILE NUMBER
21-05-0609
ESTATE OF
ITEM
NUMBER DESCRIPTION
1 Register of Wills - additional probate fee
AMOUNT
50.00
2 Register of Wills - Dauphin County (out of county oath)
15.00
3 Register of Wills - Letters Testamentary
260.00
Subtotal
325.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B4 (Rev. 6-98)
Rev-1Sg2 EX+ (6-9~)
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Garman, Reba W.
FILE NUMBER
21-05-0609
ESTATE OF
ITEM
NUMBER DESCRIPTION
1 Cumberland County Law Journal - advertise Letters Testamentary
AMOUNT
75.00
2
Etzweiler and Associates - photocopies, notary, postage and long distance telephone
calls.
125.00
3
Karen L. Paul - witness will
15.00
4
Register of Wills - fee to file estate papers
30.00
5
The Sentinel - advertise Letters Testamentary
209.63
Subtotal
454.63
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
ReV:1.~12 EX+ (~-.981
*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAA RE'TURN
RESIDENT DECEDENT
ESTATE OF
Garman, Reba W.
FILE NUMBER
21-05-0609
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
VALUE AT DATE
OF DEATH
1 Metro Med Services - medical services provided
86.25
2 The Meadows Assoc. - balance due nursing home care
406.06
TOTAL (Also enter on Line 10, Recapitulation)
492.31
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule I (Rev. 6-98)
REV '513 EX"'l'".oO)
*'
.- -
.
. . I SCHEDULE .J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Garman, Reba W. 21-05-0609
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do Not List Trustee/51
I. TAXABLE DISTRIBUTIONS [include outright sfrousal
distributions, and ransfers
under Sec. 9116(a)(1 .2)]
George E Garman Son 50% residue
7968 Somerset Street
Hummelstown, PA 17036
John D. Garman Son 50% residue
Route 447 Box 295
PA 18325
Emileee L Rehm Granddaughter 5,000.00
1126 Baldwin Street
Mechanicsburg, PA 17050
Jacob Rehm Grandson 5,000.00
1126 Baldwin Street
Mechanicsburg, PA 17050
Total 10,000.00
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, 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
TOTAL OF PART" - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J (Rev. 6-98)
}
Register of Wills, Cumberland County, Pennsylvania
INVENTORY
Estate of
Reba W. Garman
No.
2005-00609
also known as
Date of Death 06/25/2005
, Deceased
Social Security No. 184-26-5167
Ashlyn A. Rehm
The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory
include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of
Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as
of the date of the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of
Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements
made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the
penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities.
Attorney:
Earl Richard Etzweiler
Signature:
.f1L-
I.D. No.:
06398
Signature:
Signature:
Firm: Etzweiler and Associates
Address: 105 North Front Street
Harrisburg, PA 17101
Telephone: (717) 234-5600
Address: 1126 Baldwin Street
Mechanicsburg, PA 17055
Telephone:
Dated:
B -&-b-o S
Personal Propertv
Cas h....................................................................................................
Pe rso n a I Pro perty .............................................................................
Stocks/Listed.....................................................................................
Stoc ks/C losely He I d............................................. ......... ............ .......
Bonds.................................................................................................
Partnerships and Sole Proprietorships ........................................
Mortgages and Notes Receivable..................................................
All Othe r Pro pe rty .............................................................................
69,219.75
59,865.06
: (-')
24,533.51)~
CJ-)
c.)
":0
[.} ;"TI
:<~~
,l J
~i~
~)
c.,
- ..I"r
:c:'S
:"T1
....J
T ota I Personal Property...........................................
153,618.37
CO:)
-<:-
T ota I Real Property...... .............................................
Total Personal and Real Property........................... ly>153;61~.371
Total Out-ot-State Real Property............................
J ·
Register of Wills, Cumberland County, Pennsylvania
INVENTORY
, Deceased
No.
Date of Death
Social Security No.
2005-00609
06/25/2005
184-26-5167
Estate of Reba W. Garman
also known as
Cash
Halifax National Bank - CD Account No. 101433130
69,209.05
10.70
The Patriot News - refund
Total Cash
69,219.75
Stock I Listed
share Oppenheimer Funds - Account No. 330-3301434468
91.0000 shares PPL Common
52,836.71
5.417.23
392.0000 shares Rite Aid
1,611.12
Total Stock I Listed
59,865.06
Bond
98 u.s. Savings Bonds
Total Bond
24.533.56
24,533.56
(Attach additional sheets if necessary)
Total Personal Property and Real Estate
153.618.37