HomeMy WebLinkAbout09-13-05
.REV.'~ex ~ (6-00) REV-1500 OFFICIAL USE ONLY
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER
DEPT. 280601
HARRISBURG, PA 17128<>601 RESIDENT DECEDENT 21 -0 5 004 1
""'CciUNTvCO'DE ---YEAR- - - tMiBeR--
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
I-
Z VOGL FLORA G. 0 9 0- 2 2 - 7 6 1 4
W DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
0
W 12/11/2004 10/16/1930 REGISTER OF WILLS
U
W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
0
- -
w [R] 1. Original Retum o 2. Supplemental Retum o 3. Remainder Return (date ofdeath prior to 12.13-82)
I-
,,~"' o 4. limited Estate D 4a. Future Interest Compromise (dateofde<ih aIIer 12.12-82) o 5. Fe<leral Estate Tax Retum Requirad
u"'''
wG.u
,,00 [R] 6. Decedent Died Testate (AttacIl copy of Wi) D 7. Decedent Maintained a living Trust (Allacll copy ofTrustj
olf~ _ 8. Total Number of Safe Deposit Boxes
G. o 9. Litigation Proceeds Receive<l D 10. Spousal Poverty Credit (dati! of death between 12-31-91 and 1-1-95)
.. o 11. Election to tax under Sec. 9113(A) 1_'8<'0)
I-
z NAME COMPLETE MAILING ADDRESS
w
0 R. MARK THOMAS ESQ. 101 S. MARKET STREET
z
~ FIRM NAME (If Applicable)
"'
w
'"
'" TELEPHONE NUMBER
0
u 717-796-2100 MECHANICSBURG ...sA 17055
1. Real Estate (Sct1e<1ule A) (1) -j'-:-:> OFFIGrAL USE-~~
--, u') :-i,C")
. , r." C,'}C)
2. Stocks and Bonds (Sche<lule B) (2) eJ " C') .",:"J
,. ~~~ - ~ C::J
;'1 :"T1
3. Close~ Held Corporation, Pannership or Sole-Proprietorship (3) i .' W :=J 1.:::J
, ......""
4. Mortgages & Notes Receivable (Sct1e<1ule D) (4) ~.) ..." )0
;l'--j-j
'-,-1 :::;.: --n
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 12,430.41 . :.~'1 w . - (:5
__ rTl
Z (Sct1e<1uleE) - :--,') ,~"'.'::)
"';'1
0 6. Jointly Owne<l Property (Sche<lule F) (6) \.D
j:: o Separate Biliing Requested
:5
:J 7. Inter~Vivos Transfers & Miscellaneous Non-Probate Property (7) 17,901.99 ...~----
I- (Sct1e<1ule G or L)
ii: 30,332.40
04: 8. Total Gross Assets (total Lines 1-7) (8)
U 4,001.00
w 9. Funeral Expenses & Administrative Costs (Schedule H) (9)
0::
10. Debls of Dece<lent Mortgage Liabilities, & Liens (Sche<lule I) (10) 13,286.33
11. Total Deductions (total Lines 9 & 10) (11) 17,287.33
12. Net Value of Estate (Line 8 minus Line 11) (12) 13,045.07
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13)
made (Sct1e<1ule J)
14. Net Value Subjeclto Tax (Line 12 minus Line 13) (14) 13,045.07
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
Z 15. Amount of Line 14 taxable at the spousal tax
0 rate, or transfers under Sec. 9116 (a)(1.2) 0.00 X _ (15) 0.00
S 16. Amount of Line 14 taxable at lineal rate (X1I.4 FwuIs) 13,045.07 X .045 (16) 587.03
:J 0.00 X .12 0.00
0.. 17. Amount of Line 14 taxable at sibling rate (17)
:::E
0 18. Amount of line 14 taxable at collateral rate 0.00 X .15 (18) 0.00
U
~ 19. Tax Due (19) 587.03
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's ComDlete Address:
STREET ADDRESS 35 EAST GATE DRIVE, APT. 304
CITY I STATE I ZIP
CARLISLE PA 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Une 1 g) (1) 587.03
2 Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B +C) (2) 0.00
3. InteresUPenalty if applicable
D. Interest
E. Penalty 0.00
TotallnteresUPenalty (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 Line 20 to request a refund (4) 0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 587.03
A. Enter the interest on the tax due. (5A)
B. Enter the total 01 Line 5 + 5A. This is the BALANCE DUE. (5B) 587.03
Make Check 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: Ves No
a. retain the use or income of the property transferre<l; ........................................................................... 0 00
b. retain the right to designate who shall use the property translerred or its income; ........................................ 0 00
c. retain a reversionary interest; or ...................................................................................................... 0 00
d. receive the promise lor lile 01 either payments, benefits or care? ............................................................. 0 00
2. II death occurred after December 12,1982, did decedent transfer property within one year 01 death
without receiving adequate consideration?.............................................................................................. 0 00
3. Did decedent own an 'in trust lo~ or payable upon death bank account or security at his or her death? ................. 0 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 00 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.
q
PA
ATIVE
ADDRESS 101 S. MARKET ST.
For dates of death on or after July 1,1994 and before January 1, 1995. the tax rate imposed on the net value 01 transfers to or lor 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 lor disclosure of assets and filing a tax retum are still applicable even il
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 01 transfers from a deceased child twenty-one years of age or younger at death to or lor the use of a naturai parent, an adoptive parent,
or a stepparent 01 the child is 0% [72 P.S. ~9116(a)(1.2)).
The tax rate imposed on the net value 01 transfers to or for the use 01 the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)).
The tax rate imposed on the net value 01 transfers to or for the use 01 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.
. REV-l5OB EX + (6-98)
* SCHEDULE E
COMMONWEALTH OF PENNSYlVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
VOGL FlORA G :>1 05 0041
Indude the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned _ rioht of survIYolShio must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. BELCO Community Credit Union 7,337.75
403 N. 2nd St., PO Box 82, Harrisburg, PA 17108
Savings Acet. #188910
2. BELCO Community Credit Union 752.95
Checking Acet. #188910
3. Apartment furnishings 250.00
4. Cash 75.65
5. Safe deposit box contents 130.00
Gold jewelry - 100.00; Costume jewelry - 10.00; Eisenhower silver dollars - 8.00;
Tiny gold piece - 10.00; Stamps - 2.00
6. 2004 Federal tax refund 12.00
7. Apartment security deposit 679.88
8. State Farm Insurance Refund 66.60
9. Mutual of Omaha Refund 12.30
10. 2000 Oldsmobile Alero 3,095.00
11. Capital Tax Collection Bureau refund 18.28
TOTAL (Also enter on line 5, Recapitulation) $ 12430.41
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (6-98)
* SCHEDULE G
INTER.VIVOS TRANSFERS &
COMMONWEALTH OF PENNSYLVANIA MISC. NON-PROBATE PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
VOGL FLORA G 21 05 0041
Th~ schedule most be completed and filed ~ Itle answerto any of Questions 1 through 4 on Itle reverse side of Itle REV-1500 COVER SHEET ~ yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OFTHIO TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER w,EOA1EQfTIl.I\M$FER ...n~"'OOf"l'CFT\'\EDEEDFQRl'EJo1.Ea"'ifE VALUE OF ASSET INTEREST VALUE
(IF APPliCABlE)
1. BELCO Community Credit Union 17,901.99 100. 17,901.99
403 N. 2nd St., PO Box 82
Harrisburg, PA 17108
TOTAL (Also enter on line 7 Recaoilolation) $ 17901.99
(If more space Is needed, insert additional sheets of the same size)
. REV-1511 EX + (12-99)
* SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAl( RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
VOGL FlORA G 21 05 0041
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Croley Funeral Home 1,441.00
2. Memorial service 125.00
3. Funeral meal 200.00
B. ADMINISTRATIVE COSTS:
,. Personat Representative's Commissions
Name of Personal Representative (s) Brian VOQI 1,000.00
Social Security Numbe~sYEIN Number of Personal Represenlative{s) 191-46-3096
Street Address 307 E. Elmwood Ave.
City MechanicsburQ State PA Zip 17055
Yea~s) Commission Paid: 2005
2. Attomey Fees R. Mark Thomas 1,100.00
3. Family Exemption: (If decedents address is not the same as claimants, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant 10 Dece<lent
4. Probate Fees 135.00
5. Accountants Fees
6. Tax Return Prepare(s Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ 4,001.00
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX. (6-98)
* SCHEDULE'
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
EST ATE OF FILE NUMBER
VOGL FLORA G 21 05 0041
Include unreimbursed medical expense..
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Bosler Public Library - Late fee 8.00
2. CDmcast Cable 30.05
3. Sprint (phone bill) 42.53
4. IDT Corp. (long distance phone service) 22.84
5. Publisher's Clearing House 8.86
6. Publisher's Clearing House 6.73
7. Publisher's Clearing House 6.73
8. Pathology Assoc. of Central PA 2.40
9. BELCO 1 Visa card 1,452.31
Acm.#4108420000089113
10. Chase Visa 935.70
Ace\. #4366163032364909
11. Chase Visa 4,793.63
Acc\.#4305876840095514
12. Silkies 14.92
13. The Literary Guild Select 51.65
14. Waypoint Bank - Balance on vehicle loan 5,909.98
TOTAL (Also enteron line 10, Recapitulation) $ 13286.33
(If more space is needed, insert additional sheets of the same size)
'REV.1513 EX < I'. SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIOENT OECEOENT
ESTATE OF FILE NUMBER
\/()l::1 ~ ()RA l:: ?1 n<; nnLl1
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Ust Trustee{sl OF ESTATE
I. TAXABLE DISTRIBUTIONS [indude outright S~US" d~tJibutions, and transfers under
Sec. 9116 (.)(1. Il
1. Brian J. Vogl Lineal
307 E. Elmwood Ave.
Mechanicsburg, PA 17055
2. Sharon L. Bloss Lineal
4414 Alta Vista Dr.
Fairfax, VA 222030
3. Gregory D. Vogl Lineal
1840 Park Forest Blvd.
Ml. Dera, FL 32757
4. Mark R. Vogl Lineal
7082 FM 1795
Big Sandy, TX 75755
5. Kevin R. Vogl Lineal
11790 NW 1st Cl.
Coral Springs, FL 33071
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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - 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)
. e .
~
LAS T W ILL
- - -- - - --
AND
- --
TESTAMENT
---------
o F
FLORA G. VOGL
I, FLORA G. VaGI" residing at Freeport,Nassau County,
New York, being of sound and disposing mind and memory, do hereby
make, publish and deolare this as and for my Last Will and Testa-
ment, hereby expressly revoking all other Wills and Codioils by
me at any time heretofore made.
FIRST: I direot that all my just debts, funeral and
testamentary expenses be paid by my Exeoutor and Exeoutrix, here-
inai'tel' named, as soon after my deoease as may be praotioal.
SECOND: I give, devise and bequeath all the rest,
residue and remainder of my estate, both real and personal prop-
erty, of whatsoever kind and nature and wheresoever the same may
be situate, u~to my Trusteees, IN 'rRUSrr NEVERTHELESS, for the
benefit of my children surviving me who have not then attained the
age of twenty-one (21 ) years, to invest and reinvest the same and
to pay to or apply for the benefit of each of them the net income
and such portion of the prinoipal of said trust as my Trustees
shall deem proper 1'or their support, maintenanoe, education and
r~eneral welfare for so lomg during the life of each of my said
children as he 01' she shall remain under the age 0 f twenty-one
(21 ) years and upon the last of said children to survive and reach
the age of twenty-one (21) years to terminate said trust and to
.
pay over, transfer or distribute to all the ohildren of mine then
living the principal of said tI'ust fund and accumulated interest
._-
.....' ,',---,~~-. -
in equal shares, absolutely and forever.
i3HIRD I nominate, constitute and appoint my aunt,
THELMA r,iOWHY, of Harrisburg, Pa. and my uncle, HOBERT WJNRY, of'
Harrisburg, Pa. the Executrix and Executor and 'l'rustees of' this
ly Last Will and Testament and r provide that they shall not be
required to furnish bond Or other security, in any jurisdiction,
for the faithful performance of their duties.
In the event that either of them shall pre-
decease me or shall fail to qualify or resign, the remaining
person is hereby designated and appointed as SU~1 Executor and
'rrustee.
I nominate, constitute and appoint my uncle,
Robert Mowry, and my aunt, THELMA MOWRY, the Guardians of the
person and estate of any of n~ children that have not reached
their majorit;y at the time of my death until such time as they
reach their majority.
FOURTH: I authorize and empower my Executor and
Executrix and Trustees, in each capacity, to take possession of,
collect the rents and income from and to manage all of the real
estate of which I may die selzed and possessed, to sell and
dispose of any or all of my real or personal estate, at public or
private sale. at such time and upon such terms and conditions
deemed expedient; and also to lease or mortgage any part or whole
of my said property, real or personal, in such an~untand upon
such terms and conditions as deemed expedient; to make distribu-
tion in kind or in cash or partly in kind and partly in cash at
valuations determined by them; to retain any of my estate in the
-2-
_.
.-.- ..
same rorm as they exist at the time or my death; and to execute
and deliver any and all instruments rrom time to time necessary
and pl'oper in connection with the exercise or any and all or the
aforesaid powers.
IN WI TNESS WHEREOF, I have hereunto set my name and
--
arfixed my seal this,j{.3 day of August, Nineteen Hundred Sixty-
Flour.
/r~~A2/~
Flora G.Vogl /
The foregoinc; instrument was subscribed, sealed,
published and declared by IeLORA G. VOGL, as and for her Last Will
and Testament, in our presence and in the presence of each of us,
and we, at the same time, at her request and in her presence and
in the presence of each other, hereunto subscribed our names and
residences as attesting witnesses, this~ day of August, 1964.
~il~~CGresiding at (/y'fJ~U L
7i:~'~ ' Y ,
/ u
,11 ifL 'f 11 l(l.~{""i " residing at b ,1-/ fiHp jr
~n/~/H'~ IV. Y.
...
,
c" / page.-1_ of "
. .. / ~
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
{t) Cash: Report total only.
( (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be
designated by nam~ of company, certificate number, date of certificate, name in which stock is registered, and
number of shares s'1d class of stock.
(3) Obligations of U.S - Government: Number of items, date of issue, face value, names in which registered and
type of ownership, I e., join\ly held, payable on death, etc.
(4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds)
(5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in bo' I"
name of bank and tranch, and balance.
(S) Jewelry, Coins, 5t, mps, Manuscripts, etc: List and describe as fully as possible.
(7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: list and describe as full..
as possible.
(8) All other contents.
ITEM ITEM DESCRIPTION
NO.
tt:: 0 - m~-JL \loy
'~~ fJrlXJd. - ~P/l/U
lI<:6:/;:~~cJ-, - ~~
~'r~d,f~(f
--;> -,=S
~
VVJ9-
PR NT NAME
~n~ V"", I
PRINT TITLE
Coor~ /-22-05 ~ExecuIOr(triX) 0 Adminislrator{trixl
ES!Bte Represanlalive 0 Joint OWfler cI safe depos'ilhox
NOTE: Attach addiUona:18'/1" x 11 'sheet(s) if necessary or use duplicates of this page of form.
Page l- of -1
SAFE DEPOSIT BOX INVENTORY -
INSTRUCTIONS ,
(1) Cash: Report total ( nly.
(2) Stocks: list in deta I every common or preferred certificate. warrant or other rights found in box. Stocks are to be
designated by namE of company, certificate number, date-of certificate, name in which stock is registered, and
number of shares a Id class of stock.
(3) Obligations of U.S Government: Number of items, date of issue, face value, names in which registered and
type of ownership, i.., jointly held, payable on death, etc.
(4) Bonds: Designate l y name, amount, serial number, or other designation. (Bearer Bonds)
(5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in beel',
name of bank and branch, and balance.
(6) Jewelry, Coins, Stamps, Manuscripts, etc: list and describe 85 fully as possible.
(7) Deeds, Mortgages, Current Insurance Policies or other evidences of Indebtedness: List and describe as full--
as possible.
(8) All other contents.
'1'ENI ITEM DESCRIPTION
NO.
d. -
~h;rd Ioox-
T
~~
10 -f
..
p~
I CERTIFY UNCER PENALTY OF PER~' JRY THAT THE ABOVE R ORC IS PERSON RECEIVING COPY OF
CORRECT AND COMPLETE TO THE E =5T OF MY KNOWLEDGE AND BELIEF. SAFE DEPOSIT BOX INVENTORY:
~UR' ,~URE
NAME Y&Jl ~)cl.
-:>
J)('lC, - ,
PRINT TITLE
CDor-J"rv'--Dv- 1-2l-oS
~
NOTE: Attach additional 81lz" 11" sheet(s) if necessary or use duplicates of this page of form.
Page 3 of 3-
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
(1) Cash: Report total only.
(2) Stocks: List in detail every common or preferred certificate. warrant or other rights found in box. Stocks are to be
designated by name of company, certificate number, dale of certificate, name in which stock is registered, and
number of shares and class of stock.
(3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and
type of ownership, i.e., jointly held, payable on death, etc.
(4) Bonds: Designate by name,' amount, serial number, or other designation. (Bearer Bonds)
(5) Bank and Savings and Loan Passbooks: State name of depositor, number of book. last date appearing in book.
name of bank and branch, and balance.
(6) Jewelry, Coins, Stamps, Manuscripts, etc: list and describe as fully as possible.
(7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as full'l
as possible.
(8) All other contents.
ITEM DESCRIPTION
.
.
(J l ."
\J",/~ PPROPRIATE BOX BELOW
",-, '""-
PRINT TITLE DATE CHECKAPPROPR~TE OX
~rcl, n dt:v- '-2'--OS ~ Exec:utOl'~rixJ 0 Adminislrator(lrix)
o Estate Representative 0 Joint OWner of sare deposit box
NOTE: Attach additional 8'/2" x 11" sheet(s) if necessary or use duplicates of this page of form.
Mf'UMM~S
'jUATet-r.'1 clto'Cc:
34 WEST MAIN STREET
MECHANICSBURG, PA 17055
APPRAISAL Phone: 766-9422 APPRAISAL
~- :'1- or
Appraisal For: (/-F
fs iCtte F /Ph{ G. V~J
Gold ~ewelrJ - #;(}O~
-
&blume Jewery flf). p{2
1//0 c)"O
-
.
This appraisal constitutes OUf carefully studied opinion of
o the retail replacement cost through our facilities
ftthe distress sales nature valve
of the artlcle(s) described above insofar as the mounting(s) have permitted
observation. We assume no liability with respect to any action that may be
taken on the basis of this appraisal.
~Q]~~ppraiser
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lW.~2. fI STATEMENT OF ACCOUNT Page
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L getting you there
MAIN OFACE:
403 N. 2nd S1not
P.O. Box 82
HaTisbl.og. PA 17108
JOINT OWNERS
FLORA G. VOGL ***
0101 PREVIOUS BALANCE ~ ~ SAVINGS 7343 7
0122 TRANSFER WITHIN SAME ACCO 764141
0122 WITHDRAWAL 4800
0131 DIVIDEND 5224
THE ANNUAL PERCENTAGE RATE IS 1.00
THE ANNUAL PERCENTAGE YIELD IS 1.00
THE ANNUAL PERCENTAGE YIELD EARNED IS 1. 0
0131 NEW BALANCE 5224
0101 PREVIOUS BALANCE ~ ~ CHECKING 451 ..
0107 PREAUTHORIZED WITHDRAWAL 1731128555 -12 2 0 297 4
UNITED AMERICAN INS. PREM
0107 REFUND NSF FEE 2 322 4
UNITED AMERICAN INS PREHV173112BSSS
0116 * NON SUFFICIENT FUNDS FEE 1251720585 -2 297 4
WAYPDINT BANK LOAN PYMT
0122 TRANSFER WITHIN SAME ACCO -29 44 00
0131 NEW BALANCE 00
0101 PREVIOUS BALANCE ~ ~ YAR BAIf IRA 17901 9
0131 DIVIDEND 1 01 1792100
THE ANNUAL PERCENTAGE RATE IS 1.25
THE ANNUAL PERCENTAGE YIELD IS 1.26
THE ANNUAL PERCENTAGE YIELD EARNED IS 1. 6
0131 NEW BALANCE 1792100
<IRA ARNIN S YEAR-TO-DATE: 19.01>
TOTAL DIVIDEND YEAR- TD-DATE 4.24 TOTAL ANANCE CHARGE YEAR-TO-DATE 11.86
tar II savings oxcopt IRA. lor II Iuans.
Dividond. shown, ij $10 or lIYW. wi be
~d to tho IntomaI _ SoMeo NOTICE: See rover.. side tar inportant intarmalion.
lorllisc__. 0711018
'INOICATES EFFECTIVE DATE
CROLEY FUNERAL HOME
401 North Center, P.O. Box 706 305 West Uarrison, P.O. Box 835
Gladewater, Texas 75647 Gilmer, Texas 75644
Phone (903) 845-2155 Phone (903) 843-2555
FUNERAL PURCHASE AGREEMENT
Name of Deceased F \ 0 I 0. 1.0. () 0 '0 \ Last Address '10 ('<,) i' 'Iv', -;"1",':) DateofDeath \:l. II' 0,1
Charge to \II C. t \<. UO-8' Telephone' };)5. ~\-.,r.:.> DateofService I,) 1:;1 0'\
Buye(s Home Address 10~J. \ V"" Cy,1.S City \SI,) S,",,,!ld State \'1 ZiPCodej':","/S'S
Charges are only for those items that you have selected or that are required. If we are required by law or by cemetery or by
crematory to use any items, we will explain the reasons in writing below. "you selected a funeral that may require embalming, such
as a luneral with viewing, you may have to pay lor embalming. You do not have to pay lor embalming you did not approve il you
selected arrangements such as a direct cremation or immediate burial. " we charged lor embalming, we will explain why below.
PROFESSIONAL SERVICES SELECTED G. SPECIAL SERVICES
A. SERVICES OF FUNERAL DIRECTOR AND STAFF 1. Forwarding remains to another luneral home
$ $
B. EMBALMING $ 2. Receiving remains from another funeral home
Reason for embalming $
C. OTHER PREPARATION OF THE BODY 3. Immediate burial $
$ 4. Direct cremations $ 1395.00
$ Additional charges for staff services and/or use of facilities $
$ Descrl>e:
$ Cemetery or crematory requirements if any
D. USE OF FACILITIES, STAFF SERVICES AND EQUIPMENT
1. Viewing per day $ TOTAL OF SPECIAL SERVICES SELECTED $J ?:ft5. ,)<.,
2. Funeral Service $ H. CASH ADVANCES
3. Memorial Service $
- 4. Graveside Service and equipment $ o 1. Cemetery charges $
5. Relrigeration 01 unembalmed remains $ o 2. Crematory charges $
E. TRANSPORTATION 03. Transportation $
o 4. Clergy honorarium $
1. Transler 01 remains to luneral home $ o 5. Musicians honorarium $
2. Automotive Equipmenl o 6. Flowers $
A. Hearse $ 07. Obituaries $
B. Hearse at other location $ o 8. Certified copies 01 death certificates $ LII.oOD
C. Family car $ Number of copies \0
D. Limousine $- 09. Police Escort $
E. Clergy car $ o 10. Other $
F. Other Automotive Equipment $ We charge you for our service in obtaining those items marked with
G.Addl.Mileage_@ (per mile) $ an IXI. $ ((lu.oo
TOTAL OF PROFESSIONAL SERVICES SELECTEO TOTAL OF CASH ADVANCES
$ SUMMARY OF CHARGES
F. MERCHANDISE PROFESSIONAL SERVICES $
1. Casket $ MERCHANDISE SELECTED $
2. Alternative Container $ SPECIAL SERVICES $ 13'15.00
3. Outer Burial Container $ CASH ADVANCES $ <./(" 00
4. Urn $ TOTAL OF ALL CHARGES (Balance Due) $ Ili<lI.oi:'l
5. Stationery
Acknowledgment Cards METHOD OF PAYMENT:
@$ (per 25) $ Less: o Cash Received on Account $
Re9isler Book (5) $ o Sums consisting of my assignment to you of the proceeds of
Memory Folders 1 Prayer Cards $
6. Burial Clothing $
7. Other $
TOTAL OF MERCHANDISE SELECTED (type of benefit assigned)
$ - which I am making this day in a separate instrument $
WARRANTIES: The only warranties, expressed or implied, granted in UNPAID BALANCE $
connection with goods sold with this funeral service are the
express wriUen warranties, if any, extended by the manufacturers \ ;). IL\ , 04.
thereof. No other warranties and no warranties of merchantability UNPAID BALANCE DUE BY
or fitness for a particular purpose are extended by seller.
1 agree that any monies assigned above shall be paid to you within 60 days of the date of this contract. Upon your giving me at least five (5) days prior wrillen
notice that any monies due under the assignmenl(s) described above have not been paid to you as promised, you can require that any such unpaid amount(s)
previously credited to my account be paid by me at once.
Charges are made only for those items that are used. "the type of luneral selected requires extra ilems, we win explain the reasons in writing on this contract.
In the event I wish to complain or question any area of your service, I may conlact you at my convenience. If any complaints cannot be resotved, I may also
contact the Texas Funeral Service Commission, P.O. Box 12217, Austin, Texas 78711. Telephone Number: (888) 667-4881, Fax Number: (512) 479-5064.
TERMS: The Unpaid Balance set out above win be due and payable on the Due Date set out above. A FINANCE CHARGE of 1 %% per month (ANNUAL
PERCENTAGE RATE 18%) will be added 10 all past due amounts not paid on or before the Due Date set out above. If this agreement is placed in the hands of
an attorney anellor agency lor collection, I (we) agree to pay reasonable attorney's fees anellor collection costs. .
By his (her) signature. buyer(s) in addilion to authorizing seller to conduct the funeral, perform the service, furnish the materials. and incur the charges
specified within this agreement. on the terms and conditions set forth, acknowledges that prior to the execution of this agreement, a printed or typewritten list
of retail price of the funeral services and funeral merchandise offered by seller was made available to buyer(s).
\ d. Iclr- f' P<. E:'V\A~~\. , ,;100<(
Executed this day 01 \
Signature of Provisional Licensee Assislant )
ACCEPTED FOR SELLER: vZ,;/.tlc f'
s;<):L fYI, c.-'~\'-'~ I (,"'1'( I Signature (1)
Boy,,, """
Signature (2)
]!~2.11 Page
VISA'Statement of Account 1
L getting you there ~
.. 1",11I...111......11..11..11..1.1....1.1...111."11,1,,,1,,11 IF PAYING BY MAIL PLEASE DETACI!
FLORA G. VOGL IE IE IE AND RETURN TOP PORTION TO:
35 EASTGATE DR #304 BELCO COMMUNITY CREDIT UNION
CARLISLE PA 17013-6921 PO BOX B2
HARRISBURG. PA 1 71 DB
TD REPORT A LOST OR STDLEN CAIlD CAlL: 232-3526 MONDAY THRDUGH FRIDAY DETACH HERE t
B:30 AM - 5:00 PM: AFTER HOURS. HOLIDAYS AND WEEKENDS CAlL: '-B88-800-0031
USE THE VISA WITH BUYING POWER! BELCO HAS THE
SAME LOW RATE FOR PURCHASES AND CASH ADVANCES. NO
ANNUAL FEE OR TEASER RATES!
0.00
OVER 1,452.31
OFFICE OF PROBATE STATE Pennsylvania COUNTY Cumberland
PROBATE COURT DEPARTMENT
IN MATTER OF PROBATE )
,. ) DOCKET NUMBER: 2005 00041
COUNTY CLERK/PROBATE )
COURT NO. ) STYLE OF
NUMBER OBTAINED FROM ) ESTATE: Flora G. Vogl
RESIDENT COUNTY, Cumberland ) Deceased
SWORN STATEMENT SUPPORTING CLAIM AGAINST ESTATE
.1, Diana Olivas , hereinafter called Affiant, do solemnly swear that the foregoing and attached Claim
against the above-numbered and served Estate, amounting to the sum of
Four Thousand Seven Hundred Ninety Three and Sixty Three/1 00 Dollars ($4,793.63) is a just claim, and that all legal
offsets, payments and credits known to Affiant have been allowed and that the sum herein claimed justify due. Chase
Account Number(s)
43058768 4009 5514
Account(s) islare revolving, unsecured iine(s) of credit.
(i) PEGGY J. RUSSELL p~~
Notary Public. Arlzono Affiant - Representaliv for Cha~an Bank USA, NA
. . Maricopa County P.O. Box 52188
, _ M Comm. Ex Ires Mar 19. 2007 Phoenix, AZ. 85072-2188
(800) 352-3234
NOTARY PUBLIC'S SIGNATURE AND SEAL
sw~n to and subsc 'bed ~~e ,2005
PROOF OF SERVICE
The undersigned has this day delivered or mailed a true copy of this claim (_Lby U.S. Mail or _by registered mail,
return receipt attached) together with a true copy of each written instrument upon which the claim is predicated to the legal
representative of the estate and the attorney of record, Brian Vogl clo R. Mark Thomas,Attorney at law, 101 S. Market
Stret, Mechancisburg, PA 17055 ~j/$~4fl#o
Dated March M2005
, ClaimanVAffiant
APPROVAL OR DENIAL OF CLAIM
The within Claim for $ was presented to me on ,
20 , and was denied I allowed on , 2005 as a claim against the above-
numbered and styled Estate.
Title
NOTARY PUBLIC'S SIGNATURE AND SEAL
Sworn to and subscribed before
me on ,2005
COMMONWEALTH OF PENNSYLVANIA COURT OF COMMON PLEAS
.- OF CUMBERLAND COUNTY
ORPHANS' COURT DIVISION
NOTICE OF CLAIM
In Re: The Estate of: Court File No: 210541
FLORA G VOGL
Deceased
TO: THE CLERK OF THE ORPHANS' COURT DIVISION Notice of claim by
creditor, Pursuant to Section 3532(b)(2) of the Probate, Estates, and Fiduciaries
Code, 20 PA.C.S.A. ~3532(b)(2).
1) Claimant's name: CHASE AS SUCCESSOR TO BANK ONE
clo NCO Financial Systems, Inc
2) Claimant's address: Probate Department,#450
1804 Washington Boulevard
Baltimore, MD 21230
(443)263-3300, ext 3304
3) Creditor listed below is the owner and holder of a claim in the amount of
$935.70 Acct# 4366163032364909
4) The facts upon which this claim is based is a credit agreement between
Creditor and Decedent, identified as account number which is evidenced by
the attached affidavit of account stated.
5) Decedent's address: 35 EAST GATE DRIVE APT 304, CARLISLE PA 17013-6921
6) Date of Death: 12/11104
7) That the claim arose prior to the death of the decedent on or about
B) That the claim is secured by
On behalf of the claimant, I do solemnly declare
perhury that they Information and representatio
to t e best of my knowledge, information and
Dated: April 19, 2005 AGENT
Claimant R13422
Written notice of claim was given to Personal Representative and/or his/her counsel
as stated below:
BRIAN VOGL
Name.
307 E. ELMWOOD AVE
Address
MECHANICSBURG P A 17055
City/State/Zip
APRIL 19, 2005
Date notice mailed