HomeMy WebLinkAbout10-20-05 (2)
RIiV-1500 EX (EI-OO)
R~G.l~'6e.. GP.f
OFFICIAL USE ONLY
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
~L
COUNTY CODE
~L 0372 ___
YEAR NUMBER
I-
Z
W
C
w
()
w
C
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Newcomer Kathleen
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
SOCIAL SECURITY NUMBER
209-42-7185
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
A
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
7/20/2004
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Newcomer, Daniel D.
[X] 1. Original Return
D 4. Limited Estate
D 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
W
I-
~~(/)
oll::~
wa.O
:z:OO
Oll::..J
a. 10
a.
<I:
D 2. Supplemental Return D 3. Remainder Return (date of death 'prior to 12-13-82)
D 4a. Future Interest Compromise (date of death after 12-12-62) D 5. Federal Estate Tax Return Requil-ed
D 7. Decedent Maintained a Living Trust (Attach copy of Trust) L 8. Total Number of Safe Deposit Bbxes
D 10. Spousal Poverty Credit (dale of death between 12-3'.9' and 1.,.95) D 11. Election to tax under Sec. 911i3(A)(Attach SchO)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: i
NAME COMPLETE MAILING ADDRESS
I-
Z
W
o
z
o
D..
U)
~
o
lJ
Bradford Dorrance, Es .
FIRM NAME (If Applicable)
Keefer Wood Allen & Rahal LLP
TELEPHONE NUMBER
PO Box 11963
Harrisburg, PA 17108-1963
717-255-8014
1. Real Estate (Schedule A)
o
o
o
o
322,816
o
-1;:1
:t:
(1)
,OFFICIAl USE O~
" en
c-j-:)
" !)
~--~i
-.OJ
'"I i /"1
; :;5
J
, 'J
"t I~ ,=1
;: :;
2. Stocks and Bonds (Schedule B)
(2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
,,- )
r~~.)
o
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E) (5)
z
o
i=
:5
:>
l-
ii:
<(
()
w
0::
6. Jointly Owned Property (Schedule F) (6)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
CD
\.lfJ
o
322,816
8. Total Gross Assets (total Lines 1-7)
(8)
25,007
648
(11)
(12)
(13)
(14)
~97,161
9, Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
I 25,655
297,161
o
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subjectto Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax 297,161 L(15)
Z rate, or transfers under Sec. 9116 (a){1.2) x.O
0
j:: 16. Amount of Line 14 taxable at lineal rate 0 x .0 45 (16)
<I:
I-
::> 0
a. 17. Amou nt of Line 14 taxable at sibling rate x .12 (17)
::E
0 0
0 18. Amount of Line 14 taxable at collateral rate x .15 (18)
><
<I: Tax Due
I- 19. (19)
o
o
o
o
o
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
v
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
3W4645 1.000
II
Decedent's Complete Address:
STREET ADDRESS
1016 Kent Drive
Cumberland County
ellY I STATE I ZIP
Mechanicsbura PA 170$0-
Yes
D
D
D
D
without receiving adequate consideration? '" . . . . . . . . . . . . . . . . . . . . . . . .. D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D [jI
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RElTURN.
Under penalties of perjury, I declare that I ha"" examined this retum, including accompanying schedules and statements, and to the best of my knowledge and bel;.,f, it is true, correct and C011I>plete.
Declaration of preparer other than the personal representati"" is based on all inf ation of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
Daniel D. Newcomer, Administrator
ADDRESS
1016 Kent Drive, Mechanicsburg,PA 17050
SIGNA'TURE OF PREPARER OTHER THAN REPRESENTATIVE ~
Bradford Dorrance, Esq. g",.O_ ~~
ADDRESS
Keefer Wood Allen & Rahal PO Bpx 11963, Harrisburg, PA 17108-19El3
I
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.13 9916 (a) (1.1) (ill.
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8, Prior Payments
C. Discount
(1 )
o
o
o
Total Credits (A + 8 + C) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
o
o
Total Interest/Penalty (0 + 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)
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)
8. Enter the total of Line 5 + SA. This is the BALANCE DUE.
Make Check Payable to: REGISTEROFWlLLS,AGENT
(58)
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
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
For dates of death on or after January 1, 1995, the tax rate imposed on the net value ottransters to or tor the
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for dis,
the surviving spouse is the only beneficiary.
1\J (\Pb
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
or a stepparent of the child is 0% [72 P.S. S 9116(a)(1.2)].
The lax rate imposed on the net value oltranslers to or lor the use of the decedent's lineal beneficiaries is 4.5~
~ ' ~-d-~
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. 13
individual who has at least one parent in common with the decedent, whether by blood or adoption.
3W46461.000
o
o
o
o
o
o
o
II
No
~
~
og
og
~
og
DATE
d .- 2.l{) c) 5-
DATE
l (a) (1: 1) (i1)]
llicable even if
:!optive parent,
,. 13 911!6(a)(1 )].
n 9102" as an
11
.
REV-150B EX + (6-9B)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Kathleen A. Newcomer
FILE NUMBER
21 05 0372
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
1 Estate of Linda V. Wetterau,
Deceased, (Dauphin County Estate #
22-03-1007), Daniel D. Newcomer,
Administrator dbn. This amount
represents the decedent's
anticipated inheritance from the
probate estate of her late sister,
Linda V. Wetterau, administration
of which is continuing. The amount
reported here is the same as
reported on the Pennsylvania
Inheritance Tax Return for Linda
V. Wetterau, deceased and
comprises 100% of the PA taxable
value of said estate.
322,816
:
3W46AD 1.000
TOTAL (Also enter on line 5 Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
322,816
REV-1511 EX + (12-99)
, '
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kathleen A. Newcomer
ITEM
NUMBER
A.
B.
3W46AG 1.000
Debts of decedent must be reported on Schedule I.
DESCRIPTION
1.
FUNERAL EXPENSES:
Holiday Inn
funeral luncheon
Total from continuation schedules .
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) Daniel D. Newcomer
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address 1016 Kent Drive
City Mechanicsburg
Zip 17050
State PA
Year(s) Commission Paid:
2.
Attorney Fees
3.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Daniel D. Newcomer
Street Address 1016 Kent Drive
City Mechanicsburg
Zip 17050
State PA
Relationship of Claimant to Decedent SURVIVING SPOUSE
4.
Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
1
Keefer Wood Allen & Rahal
Legal fees
2
Reserve for Administrative
Expenses
FILE NUMBER
21 05 0372
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$
AMOUNT
\ \
848
12,220
7,500
3,500
434
5
500
25 007
11
Estate of: Kathleen A. Newcomer
Item
No.
2
3
4
5
209-42-7185
Schedule H Part 1 (Page 2)
Description
Amount
Malpezzi Funeral Home
8,638
Office of Catholic Cemeteries
Purchase Burial Lot
1,162
Office of Catholic Cemeteries
Purchase bronze memorial
1,450
Office of Catholic Cemeteries
granite bench at grave
970
Total (Carry forward to main schedule)
12,220
REV-1512 EX + (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kathleen A. Newcomer
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
21 05 0372
\ I
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER
1.
3W46AH 2.000
.
Capital One
credit card debt
2
Orchard Bank
Credit Card debt
DESCRIPTION
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
VALUE AT DATE
OF DEA l[H
324
324
.
,
648
1 T
REV-1513 EX+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kathleen A Newcomer
FILE NUMBER
21 05 0372
NUMBER
I
1
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
underSe~ 9116~)(1.2~
Daniel D. Newcomer
1016 Kent Drive
Mechanicsburg, PA 17050
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
AMOUNT OR SHARE
OF ESTATE
100% Residue: 297,161
Surviving Spouse
297,161
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
/I 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 II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
$
o
3W46A11.000
(If more space IS needed, Insert additional sheets of the same size)
~
11
Michael J. Malpezzi, Owner · Jeremy J. Shartzer, Funer1' Director
8 Market Plaza Way · Mechanicsburg, PA 17055 · Pho'rze: (717) 697-4696
August 17, 2004
Daniel D. Newcomer
1016 Kent Drive
Mechanicsburg, P A 17050
The Funeral Service for Kathleen Ann Newcomer
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
1. PROFESSIONAL SERVICES
Services of Funeral Director/Staff
FUNERAL HOME SERVICE CHARGES
SELECTED MERCHANDISE:
Steel Gasketed Casket
Sentinel
Register, Memorial Cards, Ackn.
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED
A T THE TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADV ANCED CERTAIN PAYMENTS TO OTHERS AS AN
ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES.
CASH ADVANCES
Opening Grave
Cemetery Equipment
Newspaper Notices - Local 2 Days
Newspaper Notices - Out-of-town
C]ergylMass Offering
Organist
Certified Copies of the Death Certificate
Flowers
Cantor / Soloist
Altar Servers
TOTAL CASH ADVANCES AND SPECIAL CHARGES
can. Please
$3545.00
$3545.00
$2395.00
$955.00
$45.00
$6940.00
$750.00
$105.00
$273.]8
$50.00
$100.00
$75.00
$10.00
$265.00
$50.00
$20.00
$1698.18
SUB-TOTAL
INITIAL PAYMENT / DISCOUNT / CREDITS
TOTAL AMOUNT DUE
. $8638.] 8
I
---~-----------
I $8638.18
I
I
I
I
,
www.malpezzijuneralhome.com
.
--_._---._~-~ _._-~_..._-
i.'! *~ ~~
5401 Carlisle Pike
Mechanicsburg, PA 17055
Telephone: (717) 697-0321
FAX: (717) 697-5917
BANQUET OR FUNCTION
PERSON IN CHARGE: DATE: ,-
"
ORGANIZATION: " ",. J ,';.;'
: J" " ,:~ : ,,"':; ! ., "
ADDRESS: BILLING:
DESCRIPTION AMOUNT
"-l? i, i/ l '/ . :.".. " :,' i' /: :: 17 '/ :::
: ..-
,.,.-,. 'C';:: ..' /,' t/r,,,,r
" , ;/,:/ / (
,/'
.
METHOD OF PAYMENT I FOOD { .( 'J ,./j~:,'
ROOM I BEVERAGE
GRATIJITY / r/ Z i(,C.:,.
AUDIO/VISUAL
X MISC. .d' c.
SIGNATURE OF APPROVAL
ROOM RENTAL
acc TAX
F&B TAX ;:' ..~){" {", ?",,::
.9krnk 1/otP./W-1/OtU'- ~ TOTAL DUE ~~. l,,,~' t7 'I ';;
,<'
INDEPENDENTLY OwNED BY MECHANICSBURG OF INVESTORS, OPERATED BY: CENTRAL PA HOSPITALITY, INC.
L
GUEST
'I
--!
~'~""'_~~_''''i__~''''_''''-'''''''''..'",_.,_,_~.,.",.,."".,"",;"___,,,>.
t1r)Office of Cotholic Cemetenes
CEMETER Y
SALESMAN NO.
EASEMENl NO.
NAME
FAMILY PROTECTION
PH0NE(
./,~5';{1
",!
"'.
ADDRESS
CITY
,.>J.;,<",',
~TATE
.+.04-
" /'-,' e!',>
ZIP CODE
,- i ",.! ~ ,
1. Price. . . . . . . . . . . . . . . . . . . . . . . . . . . ., $
i --, -.'
IntermentSpaces . .-'. . . . @
Bronze Memorials . . . . . . @
$
2. Down Payment . . . . . . . . . . . . . . . . . . . . . .
3. Unpaid Balance (1-2) . . . . . . . . . . . . . . . . . .
4. Finance Charge. . . . . . . . . . . . . . . . . . . . . .
5. Deferred Paymlln Amount (3+4) . . . . . . . . . .
6. Total Price (1+4) . . . . . . . . . . . . . . . . . . . . .
Size
Foundations. . . . . . . . . . . . @
$
Burial Vaults . . . . . . . . . @
$
7. Approximate Monthly Payment. . . . . . . . . . .
8. Number of Monthly Payments . . . . . . . . . . . .
9. First Monthly Payment Due .............
10. Annual Percentage Rate
Crypt Spaces . . . . . . . . . @
$
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Section
c,'e' G rave( s) _, ,:t.,_;;<
Terms:
Cash
Lot
Block
Crypt( s)
90 Days
Selection must be made within 30 days or cemetery will make choice.
Installment
11
NO.
A/N ~ PIN ......:..-
AIR!
I ." ".~"
t,{ 'c. '
I ' ,,' ..
c/''''/ .//(.'~:~,.-./.t". ,i,d)..." -,
I. !'.:J... . i of
I "
_ The payment is due on the date stated above and the remaining payments on the same day of each succeeding mont
Buyer may prepay in advance the full amount due without penalty and will be entitled to a proportionate refund f the unearned
finance charge.
Upon default in the payment of any installment due hereunder for a period in excess of one hundred twenty (1 0) days. Seller
may. at its option, void this agreement and retain all payments made by Buyer as liquidated damages.
Buyer hereby acknowledges receipt of an exact executed copy of this agreement at the time of execution hereof.
Before any burial is permitted in this lot, or any memorial placed on this lot, the price of the grave and memori I must be paid
in full.
_ The Purchaser(s) agree(s) to abide by all rules and regulations of the cemetery now in force as well as any rules nd regul ations
which may hereafter be adopted. Said rules and regulations may be seen upon request at the Seller's office.
Upon fulfillment of the conditions of this agreement and receipt of all the above described payments, Seller agrees nd binds itself
to convey to the Buyer, by its cemetery easement, for interment purposes only, the above mentioned number of site.
YOU, THE PURCHASER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT 0 THE THIRD
BUSINESS DAY AFTER DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR
AN EXPLANATIGN OF THIS RIGHT.
BY
, ;,
.~
","--",-
\ _,c ",....:c:.J '.;
(Authorized Representative)
(Purchaser's Signature)
NOTICE: See other side for additional information.
(Co-purchaser's Signature)
<~_....,..~_.~....~-.,.--....''''''''''''''''~
BPI 5900
~-. ""'Y-,}'" "'/-
~ "",,-~,."""'_ ",".~Y_!'l.':.'':'.q.,!!,,_,__''i''''''. 'If'..." ""~"':"""'''''_'_'' '.;"> .,":
, ">:' ',~,'---"" 't' ,-
!"'I-l';:'iA
,""I',k
tm Office of Catholic Cemeteries
Diocese of Harrisburg
PO Box 3651
Harrisburg, Pennsylvania 17105
Phone (717) 657-4804
SALES CONTRACT
DATE:V'~('~)';/' 0
,
CEMETERY 61li': 'j' "/;!?,ir/tkc't/CEMETERY# .:.::::.'
..
ZIP CODE 1/1?J2)
1. Price. . . . .. . . . . . . . . . .. $At"{~li;:t'l:"!
I <
2. Down Paymenf(i,f><:,!~:r.r~i~..-:L; --J/"r<S':>i.,t()
I
I
.,,"
J'\,
PIN
PHONE (
AIN
.
NAME lJr//;/J.E/.. ':ZJ, ,/~,~ttk''''>C''l/)C;''~
ADDRESS
)/
,.' <? l;~ >~_ __; f--'--
, < .. &: ,.e;,,\/7
,..
U'"~e
CITY
,I'~"" ,
_"^"/~~r_ I ,.f),' ,:j f i./JJ.(;' (-"t'~> ,,/'-/ ",t"^'.,t"''''>
.' .. 'l.., ",-"".-_ _ J'L ,,_
:7~~:;i
STATE
/
Interment Spaces. . . . . . . @
.......@
Bronze Memorials. . . . . . . @
Size ;:I1/X J2.It~'t\'i
Granite Foundation. . . . . . @
Burial Vaults. . . . . . . . . . . @
$
$
$ )2,~). .t,()
$. "V/' ;u. I
L,~-"'t,-.... .".''it...
3. Unpaid Balance(1-2) . . . . .
Crypt Spaces. . . . . . . . . . @
Niche Spaces . . . . . . . . . . @
Other
$
$
$
$
4. Finance Charge. . . . . . . . .
5. Deferred Payment (3+4) . .
6. Total Price (1+4) . . . . . . . .
7. Approx. Monthly Payment
8. Number of Payments. . . .
9. First Monthly Payment Due
10. Annual Percentage Rate
Section
:z
Lot 2~rave(s) (.,;;;" ~
Building
Side
Crypt or Niche
Selection must be made within 30 days or cemetery will make choice.
AIR
~;;.Y;".'~ P"-;=~,..,"''').::., :l:.-"-- ,.~')'!
/ ......,........., c..."/ (j ..."
=
I
~,
4'; )/'; ri.1
.' '- cP . (.'1."
!
,.-"",>iF
I ...,,/
I /'
.i
,_1 <
" I
,
I
I
The payment is due on the date stated above and the remaining payments on the same day of each sucCerding month.
Buyer may prepay in advance the full amount due without penalty and will be entitled to a proportionate ~fund of the
unearned finance charge. I
!
Upon default in the payment of any installment due hereunder for a period in excess of one hundred twen~ (120) days,
Seller may, at its option, void this agreement and retain all payments made by Buyer as liquidated damage~.
Buyer hereby acknowledges receipt 01 an exact executed copy 01 this agreement at the ~me 01 execu~ontereol.
Before any burial is permitted in this lot, or any memorial placed on this lot, the price of the grave and merlnorial must be
paid in full. I
I
!
The Purchaser(s) agree(s) to abide by all rules and regulations of the cemetery now in force as well as any ~ules and
regulations which may hereafter be adopted. Said rules and regulations may be seen upon request at the ~eller's office.
I
Upon fulfillment of the conditions of this agreement and receipt of all the above described payments, sellelr agrees and
binds itself to convey to the Buyer, by its cemetery easement, for interment purposes only, the above men~ioned number c
sites. :
I
YOU, THE PURCHASER, MAY CANCEL THIS TRANSACTION BY WRITTEN NOTICE AT ANY TIME PRIORI TO MIDNIGHT
OF THEJ.8IRE> BUJ!NESS ~_AY AFTER THE DATE OF THIS TRANS~~~ION. ,I
BY /c::;iijlf"j.~/~--~~' (~-~;! ,- . ."', ': - l ,,'
. (Authoriled Represenlative>'--bwurCh:',.; s;~~a~rel>" . v
,
I
I
I
!
I
The payment is due on the date stated above and the remaining payments on the same day of each sucCeedirg month.
Buyer may prepay in advance the full amount due without penalty and will be entitled to a proportionate ref~nd of the
unearned finance charge. I
Upon default in the payment of any installment due hereunder for a period in excess of one hundred twenty l120) days,
Seller may, at its option, void this agreement and retain all payments made by Buyer as liquidated damages. I
Buyer hereby acknowledges receipt of an exact executed copy of this agreement at the time of execution herjOf'
Before any burial is permitted in this lot, or any memorial placed on this lot, the pike of the grave and memo ial must be
paid in full.
The Purchaser(s) agree(s) to abide by all rules and regulations of the cemetery now in force as well as any rUIJs and
regulations which may hereafter be adopted. Said rules and regulations may be seen upon request at the sell,r's office.
Upon fulfillment of the conditions of this agreement and receipt of all the above described payments, Seller af'rees and
binds itself to convey to the Buyer, by its cemetery easement, for interment purposes only, the above mention d number of
sites.
YOU, THE PURCHASER, MAY CANCEL THIS TRANSACTION BY WRITTEN NOTICE AT ANY TIME PRIOR Td MIDNIGHT
OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.
(t Office of Catholic Cemeteries
Diocese of Harrisburg
PO Box 3651
Harrisburg, Pennsylvania 17105
Phone (717) 657-4804
SALES CONTRACT
, , / -'"
DATE " " .'<:"';:,',t.",~.'>,.>' , < ":/ 7 ,
, " />~.:;"~' ~
CEMETERY.'/ l;'f:" /',/l/jt..c
i'
AIN
PIN
PHONE (
NAME
/~.l':~/:.' ."
otli...."" ",..-"
-~'>.~\ f I',
A:;'" ../ ~t..'.."
/'.it:'t / C".,,,,,,.
,It.t:'t,.r,
<:::,.,.,-;"F"':-",,,," '.
ADDRESS ,/. /' r>'/"'C_/i . " '.f' ,
CITY
'/.:;' E' J-f',.,;",;./.",i ,,,"{" ,"5,,'\~:'~",dF/ '~>..
~;
.,r'.',L',/
ZIP CODE
STATE
Interment Spaces. . . . . . . @
.......@
Bronze Memorials. . . . . . . @
Size
Granite Foundation. . . . . . @
$
$
$
2. Down Payment. .... '. ::~:
1. Price. . . . . . . . . . . . . . . . .
\"..""
$
$
$
$
3. Unpaid Balance(1-2) . . . . .
4. Finance Charge. . . . . . . . .
5. Deferred Payment (3+4) . .
6. Total Price (1+4)........
7. Approx. Monthly Payment
8. Number of Payments. . . .
Burial Vaults. . . . . . . . . . . @
Crypt Spaces . . . . . . . . . . @
Niche Spaces. . . . . . . . . . @
Other /i ( ".i~(/1' }<.;~:. (/i
$ ~~7/' . /'
, ,-"',./; ;f.,t.)
Section
'r' ., .1
Lot.:"vC", Grave(s)
r.:.';.A'~',
Building
Side
Crypt or Niche
9. First Monthly Payment Due
Selection must be made within 30 days or cemetery will make choice,
10. Annual Percentage Rate
BY
~ . ;
j .;>'/ ,r ~,,'
',""
(Authorized Represe~_!~!lJe)
(Purchaser's Signature)
NOTICE: See other side for additional information.
r, .4
W'
I ,",'
"-, CEMETElRY#
AIR
~/:':~.;t
,+,,/~. :l'" ,17
,
,.>
,':/7;.j.
L_cf.r ,y
~r/
i
C;I./h'1 ,.
L-L:1"i. ?"(.,..)
i
I
I ",/
i.
1/
(Co-purchaser's Signature)