HomeMy WebLinkAbout12-27-05
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX( 11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
BIDDLE JANICE M
14 WESTFIELDS DRIVE
MECHANICSBURG, PA 17050
-------- fold
ESTATE INFORMATION: SSN: 196-14-2190
FILE NUMBER: 2105-0650
DECEDENT NAME: BAKER VIOLA MAE
DATE OF PAYMENT: 12/27/2005
POSTMARK DATE: 12/27/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 06/25/2005
NO. CD 006144
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $13,954.78
I
I
I
I
I
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TOTAL AMOUNT PAID:
$13,954.78
REMARKS: VIOLA MAW BAKER ESTATE
JANICE M BIDDLE
CHECK# 113
SEAL
INITIALS: LKG
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
Estate of
Baker, Viola Mae
, Deceased
No. 21 - 05 - 00650
Date of Death 6/2512005
Social Security No. 196-14-2190
also known as
Janice M. Biddle
__.u~_.. __.._...____,,_.__ ____.____,__.
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:
S~epheE L~lootl1._
Personal Repre~stive ~..
_ Signature: _(fYL '1;3 A.....,Lr,JJ.-;-._
Ja ice M. Biddle
Signature:
1.0. No.:
49811
Signature:
Address:
2100 Longs Gap Road
Carlisle, PA 17013
Address: 14 Westfields Drive
Mechanicsburg, P A 17050
Telephone: 717/249-7717
Telephone: 717-766-1236
Dated:
/~JJ6/0)
f '
Personal Property
BELCO Community Credit Union - Savings Account #69400
31,838.22
Wachovia Bank N.A. - Checking Account #1000653649480
7S,6,03.21
Personal Property - Actual Sale Price - Bricker's Auction
:.335.00
Refund - AARP
18.00
Refund - Comcast Cable
"'18.82
Refund - Erie Insurance
f"~)
,19.00
Refund - Patriot-News Subscription
60.40
Refund - Springwood Real Estate - Apartment Fees
105.16
Refund - Verizon Insurance (Medical)
32.29
Total Personal Property
4:108030,10
(Attach additional sheets if necessary)
Total Personal Property and Real Estate
$108,030.10
~~
REV. 1500 EX + ($.00)
REV-1500
COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN FILE NUMBER
:A~R~:~~fr~~6~~~::'-n _1_~ RESID_~~T DECEDENT _----1 COUN~y1CODE Y~;R_~_ ~~~B~~_~
---r6ECE-oENTS-NA-ME-(LAST,-FIR.SU-N()MID-OLElNITIAL)- ------ .-- --- - -----------~-,_sOCIAL SECUR!TY- NUMBER-.------~
I- I Baker, Viola Mae __I ~96-14-21~__n~______
I ~;;~~;.;;.~''''^;il----I ~':~~:'~;;;.~~>EA" 1". ~.~~~;~~:;~:o:~:: ~ '"
o )(IFAPPLlCABLE) suFiViVINGSPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) I. SOCIAL SECURITY NUMBER ---._--~----
---- ~ OriginalR;;t~~------~-- 02. Supple~ental Return 0 3. Remainder Retum (date of death priort~12-13-8~-
w
" ~o:: ~ I 0 4. Limited Estate 0 4a. Future Interest Compromise (date 01 death after 0 5. Federal Estate Tax Return Required
01>.0 12-12-82)
~ ~ 9 1181 6. Decedent Died Testate (Attach copy 0 7. Decedent Maintained a Living Trust (Attach 0 8. Total Number of Safe Deposit Boxes
o I>. III of Will) copy of Trust)
~ 0 0
9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death between
1
*'
'I-
lI)z
Ww
0::0
O::z
00
01>.
THIS SECTION MUST BE COMPLETED. ALL CORR
AME
t~;~~t'~~:~'E~",': - - -- --,' .
TELEPHONE NUMBER
717/249-7717
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
COMPLETE MAILING ADDRESS
2100 Longs Gap Road
Carlisle, PA 17013
L
1. Real Estate (Schedule A)
(1 )
(2)
(3)
(4)
None
~,.~s[: l)t;l v
2. Stocks and Bonds (Schedule B)
None
3. Closely Held Corporation, Partnership or Sole-Proprietorship
None
4. Mortgages & Notes Receivable (Schedule D)
None
z
o
>=
:3
:::>
l-
ii:
<(
o
w
0::
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)
(5) 108,030.10
(~ None
(7) None
...--.......:
(8) 108,030.10
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
(9) 13,635.53
(10) 1,362.69
11. Total Deductions (total Lines 9 & 10)
(11 )
14,998.22
12. Net Value of Estate (Line 8 minus Line 11)
(12)
93,031.88
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)
93,031.88
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15.Amount of Line 14 taxable at the spousal tax rate, x .00 (15)
or transfers under Sec. 9116(a)(1.2)
z .045 (16)
0 16.Amount of Line 14 taxable at lineal rate x
>=
<(
I-
:::>
I>. 17. Amount of Line 14 taxable at sibling rate x .12 (17)
::E
0
0
~ 18. Amount of Line 14 taxable at collateral rate 93,031.88 x .15 (18)
I-
---
19. Tax Due (19)
13,954.78
! 20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
13,954.78
>> BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH<<
Copyright 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
c~
Decedent's Complete Address:
STREET ADDRESS
39 Ashburg Drive, Suite 7
c-----
CITY
--.~----.--..~.-IsTA~---------I~--.---- -.
I STATE PA ZIP 17050
Mechanicsburg
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
13,954.78
Total Credits (A + 8 + C)
(2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
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.
A. Enter the interest on the tax due.
8. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(3)
(4)
(5)
(SA)
(58)
0.00
13,954.78
13,954.78
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:
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?............ ................ .................................. .......................................... ..............
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?........
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?............. .............................. .................... ......................................................
Yes No
~ I
D ~
D ~
D ~
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 retum, including accompanying schedules and statements, and to the best of my knowledge and belief. it is true, correct and complele. Declaralion of
1".ep"rer oth~r-'l1a_n the.l"''!Onal rep~e_s~ntative_;,; based on ali information of which preparer has any knowiedge. _._.____~______________
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE
01 M. B_:~le. _ fJ1L~ )j3~iJJ-_
RE OF PERSON RESPONSIBLE FOR FILING RETURN
ADDRESS
14 Westfields Drive
___~echanicsburg, y A 170~
I:J!I{,(OS/
-- ---
DATE
-'0':' - --"',,,,,
DATE
21 00 Lo~s Gap Road
Carlisle,.ITA 17013
1<'2-/u';or
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. S9116 (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 forthe use of the surviving spouse is 0%
[72 P.S. S9116 (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. S9116 (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. S9116 (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 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.
I
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SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PE.NNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I FILE NUMBER- --- -- -- ----
21_- 05-00650 ______
ESTATE OF
Baker, Viola Mae
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 BELCO Community Credit Union - Savings Account #69400
VALUE AT DATE OF
DEATH
-------'-------- -----_._-,~_._.-------
31,838.22
DESCRIPTION
2
Wachovia Bank N.A. - Checking Account #1000653649480
75,603.21
3
Personal Property - Actual Sale Price - Bricker's Auction
335.00
4
Refund - AARP
18.00
5
Refund - Comcast Cable
18.82
6
Refund - Erie Insurance
19.00
7
Refund - Patriot-News Subscription
60.40
8
Refund - Springwood Real Estate - Apartment Fees
105.16
9
Refund - Verizon Insurance (Medical)
32.29
TOTAL (Also enter on Line 5, Recapitulation)
108,030.10
SCHEDULE H
FUNERAL EXPENSES &
ADNINIS1RA11VE COSlS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Baker, Viola Mae
.--.---..----- --~-- ---- ---. .-- -.-
---------IF!LE NUMBER-----------
I 21 - 05 - 0065~_
Debts of decedent must be reported on Schedule I.
---.IT-EM!
_!\JLJM~E_~ ________~______
A. I FUNERAL EXPENSES:
1 I Wiedeman Funeral Home, Inc.
I
--+
I
AMOUNT
DESCRIPTION
B.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
1.
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City
Year(s) Commission paid
State _ Zip
2.
Attorney's Fees
Stephen L. Bloom, Esquire
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
4.
Probate Fees
Cumberland County - Register of Wills (Initial Probate)
Cumberland County - Register of Wills (Inventory)
Cumberland County - Register of Wills (Add' I Probate)
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
I
Other Administrative Costs
Publication of Legal Notices - Cumberland Law Journal
2
Publication of Legal Notices - The Sentinel
I
I
._--+--- ..
I
TOTAL (Also enter on line 9, Recapitulation)
9,094.50
4,000.00
189.00
15.00
125.00
75.00
137.03
13,635.53
*'
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
-
-_.-._----.--
'I FILE NUMBER
21 - 05 - 0_0650 _____
ESTATE OF
Baker, Viola Mae
Include unreimbursed medical expenses.
ITEM
NUMBER
-- --------- -----.------
1 BELCO Community Credit Union - Unsecured Loan
DESCRIPTION
2
West Shore EMS - Ambulance Services
3
Smith Radiology - Medical Services
TOTAL (Also enter on Line 10, Recapitulation)
AMOUNT
110.99
1,249.86
1.84
1,362.69
.
REV-1513 EX+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
-~_.~~-----^---_.~--^..~.. --------..---
~~-~-~~---~..~_.---~---~--~-- ~~-
-- -- - - - - -----~---- --
---- ..----- .._--_.._--~-
I ---r-:;;XABLE DISTRIBUTIONS (include outright spousal distributions)
.
I Janice M. Biddle
14 Westfields Drive
Mechanicsburg, P A 17050
I FILE NUMBER
.~~- 05- OO~O________
L R:L~;~i:~_ AM~~~~~:A~~ARE _
Niece I 50%
ESTATE OF
Baker, Viola Mae
NUMBER I
I
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
2
Donna K. Streibich
25 Lexington Circle
Marlton, NJ 08053
I Niece
50%
i i
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet I
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
i i
. I
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI
- ------- -...
STEPHEN L. BLOOM
ATTORNEY AND COUNSELLOR AT LAW
2100 LONGS GAP ROAD
CARLISLE, PENNSYLVANIA 17013
717-249-7717
@@{P)~
LAST WILL AND TESTAMENT
I, VIOLA MAE BAKER, of Swatara Township, Dauphin County, Pennsylvania, being of
sound and disposing mind and memory, do hereby make, publish and declare this to be my Last Will
and Testament, hereby revoking any and all former Wills or Codicils by me made.
1.
I direct that all my legally enforceable debts, funeral expenses, testamentary expenses and all
inheritance taxes (whether such taxes may be payable by my estate or by any recipient of any
property) shall be paid from my residuary estate as soon as practicable after my decease and as part
of the administration of my estate. My personal representative shall have no duty or obligation to
obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other
property not passing under this Will.
2.
I give, devise and bequeath such items of personal property as are itemized in a certain list, if
any, attached hereto to the persons named thereon, which list is signed and dated by me at the end
thereof.
3.
I give, devise and bequeath all the rest, residue and remainder of my estate, both real and
personal property, in equal shares, unto my nieces, JANICE M. BIDDLE and DONNA K.
STREIBICH, absolutely.
Page 1 of 4 Pages
i/)1/3
V.M.B.
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_,..,-'t" "-;";J,. "l, :..~ \. \-
, ,< ,v . '\ '
~:~\ \\ ~l .;:.....-:/
'.'~"\\'~/: ....",
-- ------.-
~._~
4.
I nominate, constitute and appoint my niece, JANICE M. BIDDLE, as Executrix of my estate.
In the event she shall be unable or unwilling to serve in such capacity, then I appoint my niece,
DONNA K. STREIBICH, to act in such capacity.
5.
I direct that my personal representative shall not be required to file a bond to secure the
faithful performance of her duties in any jurisdiction.
6.
I authorize and empower my personal representative, in her sole and absolute discretion, to
purchase or otherwise acquire and retain any investments of which I die seized or any real or
personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or
grant options in regard to any or all property of any kind forming a part of my estate for such terms
and such prices as she may deem advisable; to borrow money for any purposes connected with the
protection and preservation of my estate; to mortgage or pledge any real or personal property forming
a part of my estate or to join in or secure the partition of same; to compromise any claims or
demands of my estate against others or of others against my estate; to make distribution in kind and
to cause any share to be composed of cash, property or undivided fractional shares in property
different in kind from any other share; to employ agents, attorneys and proxies and to delegate to
them such power as my personal representative considers desirable and to pay reasonable
compensation for such services as may be rendered by such agents, attorneys and proxies; and to
execute and deliver such instruments as may be necessary to carry out any of these powers. In
addition, I direct that my personal representative shall have the power to conduct an inventory of any
safe deposit box necessary to the administration of my estate.
Page 2 of 4 Pages
t/M/3
V.M.B.
IN WITNESS WHEREOF I have hereunto set my hand and seal this 7th day of May, 2002.
:l/__~l ~ ,9t'OR __ J3~~SEAL)
Viola Mae Baker
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix, as and
for her Last Will and Testament, in the presence of us, who at her request, have hereunto subscribed
our names as witnesses thereto, in the presence of the said Testatrix and of each other.
-~~
._.-fYl~T /.!d~/YtLio7'/~--,
,
Page 3 of 4 Pages
BELCO
&I
Community Credit Union
L gelling JOlt Ilren?
www.belco.org
December 7. 2005
Stephen L Bloom
Atty and Counsellor at Law
2 I 00 Longs Gap Rd
Carlisle Pa 17013
Re: Estate of Viola Baker
S.S. 196-14-2190
Dear Stephen.
Here is the information for the above referenced account. I f you need any further
information. please call me at 717-720-6234.
r I Masten
Electronic Services
--~,
)
Belco Community Credit Union
403 N. 2nd Street, P.O. Box 82
Harrisburg, PA 17108
717 -232-3526 in Harrisburg area; 717-393-1116 in Lancaster area
800-642-4487 olll~irlp. of rnllinn nrp.n
BELCO COMMUNITY CREDIT UNION
DECEDENT ESTATE INFORMATION
1. Name(s) in which the account was held:
VIOLA M BAKER
2. Account number: 69400
3. Balance as of date of death: 6/25/2005
Balance Accrued Dividends YTD Dividends
For 6/25/2005
Regular Savings: $ $31,663.31 $ $130.66 $174.91
Christmas Club: $ $ $
Whatever Club: $ $ $
Checking: $ $ $
Money Market: $ $ $
Certificates: Balance Accrued Dividends YTD Dividends Certificate Number
For
$
$
$
$
$
$
$
$
$
$
4. Date the account was initiated:
5/24/1973
5. Name(s) in which Safe Deposit Box was held: N/A
6. Date the box was initially rented: N/A
7. Branch address at which the box is located:
8. Loan Information:
B. Secured Loans:
Balance Accrued Interest Per Diem Int
109.91 1.08
$ $ $
$ $
$ $ $
$ $ $
$ $ $
A. Unsecured Loans:
C. Mortgage Loans:
Miscellaneous:
II!
P':~
WACHOVIA
Relerence ID: 1400821
Wachovia Bank N.A.
Balance Confirmation Services
POBox 40028
Roanoke, VA 24022-73 13
October 3\, 2005
STEPHEN L BLOOM
ATTORNEY AT LAW
2\ 00 LONGS GAP ROAD
CARLISLE, PA \70\3
SUBJECT: Verification / Confirmation of Account and Balance Information provided for:
Customer: VIOLA M BAKER (SSN# 196-14-2190)
Date of Death: June 25, 2005
Deposit Account Information
Account
Typc
Account
Number
Datc of Dcath
Balance
A vcrage
Balancc.
Date
Opened
Maturity
Datc
Interest Accrued YTD Date
Rate Interest Interest Paid Closed
CHECKING 1000653649480
LEGAL TITLE: VIOLA M BAKER
JANICE M BIDDLE POA
DONNA K STREIBICH POA
$75,603.21
2/6/1978
· Duc to system limitations, we can only provide a twelve month average balance on depository accounts.
No Sate Deposit Box fOlmd fl)r cuslomcr.
· Date of death balance does not include accrued inlerest.
· If date of death occurrs on a weekend or a holiday, date of death balance does not include any transactions that were
made during that time period.
~~ubShvm
Servicenter Associate
Phone: (540)563-7323
abs; js
BRICKERS AUCTION
Complete Auction Service
Auction - Wednesday Evenings
766-5785
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~-~\)
L/ 8 1/)t,
~t.
) u-?>
Chuck Bricker, Auctioneer
TOTAL SALE
COMM.
CLEAR.
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Of} i e d e man
rV FUN ERA L H 0 M E
Dennis L. Wiedeman. F .0. - Supervisor
JamesW. TaUan. F.D.
William A. Sibert. F.D.
STATEMENT
July 14, 2005
Mrs. Janice M. Biddle
14 Westfields Dr.
Mechanicsburg, PA 17050
The Funeral Service of: Miss Viola M. Baker
~A. CHARGE FOR SERVICES SELECTED: I
1. PROFESSIONAL SERVICES $ 2485.00
2. FACILlTIES/SERVICES/EQUIPMENT:$
670.00
3. AUTOMOTIVE EQUIPMENT:
$
695.00
(A) TOTAL OF PROFESSIONAL SERVICES. $ 3850.00
FACILITIES AND AUTOMOTIVE
lB. CHARGE FOR MERCHANDISE SELECTED: I
Casket. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $ 2995.00
(Description) Solid Pecan
Outer Receptacle . . . . . . . . . . . . . . . . . . . . . . $
(Description) Standard Concrete Steel Reinforced
875.00
Outer burial container. . . . . . . . . . . . . . . . . .. $
(Description)
Acknowledgement Cards ...............
Register Book(s). . . . . . . . . . . . . . . . . . . . . . .
Memory Folders . . . . . . . . . . . . . . . . . . . . . . .
Prayer Cards . . .. .....................
Temporary grave marker. . . . . . . . . . . . . . . .
Burial Clothing ......... . . . . . . . . . . . . . . .
Other Clothing . . .. . . . . . . . . . . . . . . . . . . . . .
Custom Graphic Design & Printing ........
Flowers .GC/~k,e.t .spr~Y .+. TI1)( . . . . . . . . . . . . .
-0-
$
$
$
$
$
$
$
$
$
$
$
Cremation Urn . . . . . . . . . . . . . . . . . . . . . . . . . $
Interior & Exterior Crucifixes ...... . . . . . .. $
Refrigeration. . . . . . . . . . . . . . . . . . . . . . . . .. $
-0-
-0-
-0-
-0-
-0-
121.00
-0-
-0-
159.00
26.50
-0-
-0-
-0-
-0-
Rmp Pillow + TI1X
(B) TOTAL MERCHANDISE SELECTED
$
4176.50
Family Owned and
.
357 South Second Street
Steelton. PA. 17113
Phone: 717.939.2344
Fax: 717.939.1999
email: wiedemanfh@comcast.net
www.wledemanfuneralhome.com
OF
ACCOUNT
t C" SPECIAL CHARGES:
Forwarding of remains to
(Funeral Home)
Receiving of remains from
(Funeral Home)
Immediate Burial
Direct Cremation
SUB-TOTAL OF SPECIAL CHARGES.... ......
I D. CASH ADVANCES:
Opening Grave. . . . . . . . . . . . . . . . . . .. $
Cemetery Equipment. . . . . . . . . . . . . . . . $
Newspaper Notices - Local . . . . . . . . .. $
Newspaper Notices - Out-of-town. .,. $
Telephone & Telegrams. . . . . . . . . . . . . $
Airfare . . . . . . . . . . . . . . . . . . . . . . . . .. $
Clergy Honorarium . . . . . . . . . . . . . . . . . $
Pallbearers . . . . . . . . . . . . . . . . . . . . . . . $
Certified Copies of Death Certificate . .. $
Crematory Charges. . . . . . . . . . . . . . . . . $
Organist. . . . . . . . . . . . . . . . . . . . . . . . . $
SoioiOlt . .. . . . . . . . . . . . . . . . . . . . . . . . . ~
Other
Other
Other
SUB-TOTAL OF CASH ADVANCES
SUMMARY OF CHARGES:
A. Professional Services, Facilities and
Equipment and Automotive
Equipment. . . . . . . . . . . . . . . . . . . . . . . S
B. Merchandise..................... S
C. Special Charges. . . . . . . . . . . . . . . . .. s
D. Cash Advances. . . . . . . . . .. . . . . .. $
t
$
-0-
$
$
S
$
-0-
-0-
-0-
-0-
C$
-0-
t
700.00
110.00
98.00
-0-
-0-
-0-
100.00
-0-
60.00
-0-
-0-
-G-
-0-
-0-
-0-
$
$
$
........0$
1068.00
3850.00
4176.50
-0-
1068.00
TOTAL OF ALL SELECTIONS ................. $
9094.50
LESS PAYMENTS.RECBVEn ..... . . . . . . .... .. $
BALANCE DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
are
0.00
9094.50
STEPHEN L. BLOOM
A T TOR N E Y t\ N D C 0 U N S ELL 0 RAT L 1\ W
w W W I'R" C TIC" I. C (} 1/ N S ,; I. C () M
2 1 0 0 L () N (; S G t\ I' R ( ) :\ 1)
C ;\ 1\ LIS L F, PEN '-: S Y L V t\ N 1:\ 1 7 0 1 J
T Fl. F I' 1 f ( ) N I' 7 1 7 - 2 -I I) - 7 7 1 7
F :\ C S I \ I I L ,. 7 I 7 - 2 -I <) - 7 7 S 7
T ( ) I. I r H I: I' S 7 7 - .~ -I X - ') (, 0 2
S 1\ I. (l (l :VI @ I' 1\ ,\ C TIC ,\ I. c: Ol ' '" SF I. c: 0 \1
Invoice submitted to:
Estate of Viola Mae Baker
c/o Janice M. Biddle, Executrix
14 Westfields Drive
Mechanicsburg, PA 17050
December 15, 2005
In Reference To: Estate Administration - Billing Statement
Invoice #1679
Professional Services
7/14/2005 Preliminary administrative and estate matters; Preparation of Petition for Grant of Letters
Testamentary, Oath of Personal Representative, Proposed Decree of Probate, Estate Information
Document and Exhibits; Preparation and filing of IRS Form SS-4 and review correspondence from
IRS re same; Office consultation with Executrix; Correspondence
7/26/2005 Administrative and estate matters
7/27/2005 Administrative and estate matters
9/6/2005 Review Certificate of Grant of Letters and Short Certificates; Administrative matters
10/25/2005 Administrative and estate matters; Research re banking information and correspondence with
same (Wachovia Bank NA and BELCO Credit Union); Correspondence with Department of Public
Welfare, Estate Recovery Section; Preparation of required Notice of Beneficial Interest in Estate
and Certification of Notice Under Rule 5.6(A); Appearance at Register of Wills for filing of same;
Preparation of required Legal Notices for publication and correspondence with the Cumberland Law
Journal and the Sentinel re same; Correspondence with Fiduciary
10/27/2005 Administrative and estate matters
10/28/2005 Administrative and estate matters; Appearance at Register of Wills re Certification of Notice
12/8/2005 Administrative and estate accounting matters; Review asset valuation information documents;
Review correspondence from DPW Estate Recovery Section; Review Proof of Publication of
required Legal Notice (The Sentinel); Telephone conferences with Deputy Register of Wills and
Executrix
12/15/2005 Administrative and estate accounting matters; Review correspondence and information from
BELCO; Preparation of Pennsylvania Inheritance Tax Return, Schedules and Exhibits; Tax
Calculation; Preparation of required Inventory; Preparation of Release, Reciept and Refunding
Agreements; Conference with Executrix for review and execution of documents; Appearance at
Register of Wills for filing of Inheritance Tax Return and Inventory; Official Reciept; Review and
PRACTICAL COUNSEl. + CHRISTIAN PERSPECTIVE
Estate of Viola Mae Baker
Page
2
filing of Notice of Appraisement from Department of Revenue; Preparation of Final Notice of Status
of Administration; Appearance at Register of Wills for filing of same; Telephone conferences and
miscellaneous final correspondence; Life Insurance Matters; Reserve for final matters of
Administration
For professional services rendered
Amount
$4,000.01
($2,000.00)
($2,000.00)
7/30/2005 Payment - thank you
Total payments and adjustments
Balance due
$2,000.01
, ' \l~
, \'J.-\ \ b
QJ
PAYABLE UPON RECEIPT - THANK YOU
PRACTICAL COUNSEL + CIIRISTIAN PERSPECTIVE
RECEIPT FOR PAYMENT
GLENDA FARNER STRASBAUGH
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17G13
Recetpt Date:
Rece+pt Time:
Recelpt No.:
7/21/2005
13:05:06
1041359
BAKER VIOLA MAE
Estate File No. :
Paid By Remarks:
2005-00650
SK
------------------------ Receipt Distribution ------------------------
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST
SHORT CERTIFICATE
WILL
JCP FEE
AUTOMATION FEE
Check# 1857
Total Received.........
135.00
24.00
15.00
10.00
5.00
----------------
$189.00
$189.00
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
BUREAU OF RECEIPTS & CNTR M.D
CUMBERLAND COUNTY GENERAL FUN
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RETAIN THIS PORTION FOR YOUR RECORDS
REMITTANCE ADDRESS I Bill TO
THE SENTINEL - LEGAL ATTORNEY AT LAW STEPHEN L. BLO :).
P.o. BOX 130, CARLISLE, PA 17013
AD NUMBER I CLASS SALESPERSON BilLING DATE LINES
296552 10 PUBLIC NOTICES wolfc 11/23/05 36 * 2
AD DESCRIPTION START DATE STOP DATE
NOTICE LETTERS TESTAMENTARY ON THE 11/05/05 11/19/05
PUBLICATION INSERTIONS RATE NET AMOUNT GROSS AMOUNT
3 THE SENTINEL - LEGAL 3 LGL 130.68
TOTAL AD CHARGE 130.68
3 PROOF OF PUBLICATION 01PRF 6.35
DAYS RUN
PURCHASE ORDER PAY THIS AMOUNT 137.03 164.44*
Est.ViolaBaker
M
. AFTER 12/23/05
MESSAGE:
Thank you for advertising with The Sentinel.
Deadlines for in-column legal advertisements: Monday is Friday at
11 a.m.; Tuesday is Friday at 4 p.m.; Wednesday is Monday at 12 Noon;
Thursday is Tuesday at 12 Noon; Friday is Wednesday at 12 Noon; Sunday
is Thursday at 12 Noon.
If you have any questions regarding your Legal bill please call
Tammy Shoemaker 243-2611, ext 203.
Fax your legals to 243-3754, attention Tammy Shoemaker
You can also EMAIL yourlegaltoClassifiedads:classified@cumberlink.com
Please send a cover letter including your name and address as an attachment
BELCO COMMUNITY CREDIT UNION
1. Name(s) in which the account was held:
VIOLA M BAKER
DECEDENT ESTATE INFORMATION
2. Account number: 69400
3. Balance as of date of death: 6/25/2005
Regular Savings:
Christmas Club:
Whatever Club:
Checking:
Money Market:
Certificates:
Balance
Accrued Dividends
For 6/25/2005
$ $31,663.31
$
$
$
$
Balance
$
$
$
4. Date the account was initiated:
5/24/1973
N/A
5. Name(s) in which Safe Deposit Box was held:
$ $130.66
$
$
$
$
Accrued Dividends
For
$
$
$
YTD Dividends
YTD Dividends
$
$
$
$
Certificate Number
6. Date the box was initially rented:
7. Branch address at which the box is located:
8. Loan Information:
fA
B.
Miscellaneous:
N/A -
---
Balance
109.91
$ $
$
.~ $
$ $
$ $
-----------
------ ~,
C;~C"red Loans:
Se~lired-L-oans:
C.
Mortgage Loans:
Accrued Interest
Per Diem Int
1.08
-~
$
$
-
wu.."'. ~nv~~ CIVI;:) - l,AKLI::>L~
205 GRANOVIEW AVE
SUITE 211
CAMP HILL, PA 17011
Phone #: (800) 367-0512 Federal Tax 10: 23-2463002
~
/ I \
<( r
WEST SHORE
PATIENT NAME: VIOLA BAKER
INSURANCE:
MEDICARE B
UNITED HEAL THCARE
196142190A
861802329
PATIENT NUMBER:
CALL NUMBER:
DATE OF CALL:
TIME OF CALL:
CALLER:
FROM:
TO:
39831
3045487
06/11/2005
MDEN
B
3045487
39 ASHBURY DR APT 7
CARLISLE REGIONAL MEDICAL eTR
VIOLA BAKER
39 ASHBURY DR APT 7
MECHANICSBURG, PA 17050
REASON(S)
FOR
TRANSPORT
DYSPNEA
INVOICE
DESCRIPTION OF CHARGE QUANTITY UNIT PRICE AMOUNT
PARAMEDIC INTERCEPT A0999 1.0 512.49 512.49
EKG ELECTRODES A0396 1.0 4.23 4.23
PROVENTIL A0394 1.0 1.60 1.60
Total Charges 518.32
DESCRIPTION OF PAYMENT RECEIPT PAYMENT DATE AMOUNT
Total Credits 0.00
PLEASE PAY THIS AMOUNT _ $518.32
DETACH ALONG PERFORMATION AND RETURN STUB WITH PAYMENT
AMOUNT DUE
ATIENT NAME: BAKER, VIOLA CALL NUMBER 3045487 AMOUNT $
ATIENT NUMBER: 39831 BILLING DATE: 08/03/2005 ENCLOSED
518.32
THIS ACCOUNT IS NOW 40 DAYS PAST DUE!l Please send your
payment now. PROTECT YOUR CREDIT!
VISA
VISA
'.t~~.
1Mliii"J
WEST SHORE EMS - CARLISLE 205 GRANDVIEW AVE
AND
MASTER CARD
ACCEPTED
CAMP HILL, PA 17011
WESTSHUK~~M~-O~~
205 GRANDVIEW AVE
SUITE 211
CAMP HILL, PA 17011
Phone #: (800) 367-0512 Federal Tax 10: 23-2463002
PATIENT NAME: VIOLA BAKER
PATIENT NUMBER:
CALL NUMBER:
DATE OF CALL:
TIME OF CALL:
CALLER:
FROM:
TO:
INSURANCE: MEDICARE B
UNITED HEAL THCARE
196142190A
861802329
132141W
VIOLA BAKER
39 ASH BURY DR APT 7
MECHANICSBURG, PA 17050
REASON(S)
FOR
TRANSPORT
INVOICE
/a2.~\
/...._'
,~~
WEST SHOl-tE
39831 WCS
132141W 8
06/21/2005
03:45 PM
HOl Y SPIRIT HOSPITAL
HOLY SPIRIT HOSPITAL
HEAL THSOUTH REGIONAL SPEC HO
C.O.P.O.
DESCRIPTION OF CHARGE QUANTITY UNIT PRICE AMOUNT
Stretcher One Way Transport A0999 1.0 79.03 79.03
Transport Van Mileage A0999 5.0 1.51 7.55
Oxygen Administration A0422 1.0 50.93 50.93
Total Charges 137.51
DESCRIPTION OF PAYMENT RECEIPT PAYMENT DATE AMOUNT
Total Credits 0.00
PLEASE PAY THIS AMOUNT _ $137.51
PATIENT NAME: BAKER, VIOLA
PATIENT NUMBER: 39831
CALL NUMBER
BILLING DATE:
132141W
08/03/2005
DETACH ALONG PERFORMATION AND RETURN STUB WITH PAYMENT
AMOUNT DUE
AMOUNT $
ENCLOSED
137.51
This account is now PAST DUEl! Payment must be received
WITHIN 10 DAYS. Collection process will begin.
WEST SHORE EMS - BLS 205 GRANDVIEW AVE
..
M2'i<lo.
VISA
, VISA
\H
AND
MASTER CARD
ACCEPTED
CAMP HILL, PA 17011
VVt:.~ I ~nuru: E:IVI;;) - 1'\L.;J
205 GRANDVIEW AVE
SUITE 211
CAMP HILL, PA 17011
Phone #: (800) 367-0512 Federal Tax 10: 23-2463002
INSURANCE: MEDICARE B
UNITED HEAL THCARE
196142190A
861802329
PATIENT NUMBER:
CALL NUMBER:
DATE OF CALL:
TIME OF CALL:
CALLER:
FROM:
TO:
39831
3046222A
06/23/2005
MOEN
C
PATIENT NAME: VIOLA BAKER
3046222A
HEAL THSOUTH REGIONAL SPEC HO
HOLY SPIRIT HOSPITAL
VIOLA BAKER
14 WESTFIELDS DR
MECHANICSBURG, PA 17050-7910
REASON(S)
FOR
TRANSPORT
Hypotension
Pulmonary Edema
INVOICE
DESCRIPTION OF CHARGE QUANTITY UNIT PRICE AMOUNT
PARAMEDIC INTERCEPT A0999 1.0 512.49 512.49
10GTT TUBING A0394 1.0 7.96 7.96
ANGIOCATH (14-24) A0394 1.0 4.99 4.99
DOPAMINE 400MG A0399 1.0 55.91 55.91
EKG ELECTRODES A0396 1.0 4.23 4.23
NITROPASTE A0999 1.0 0.76 0.76
NORMAL SALINE 500ce A0394 1.0 2.99 2.99
OP SITE A0394 1.0 4.70 4.70
Total Charges 594.03
DESCRIPTION OF PAYMENT RECEIPT PAYMENT DATE AMOUNT
Total Credits 0.00
PLEASE PAY THIS AMOUNT _ $594.03
PATIENT NAME:
PATIENT NUMBER:
BAKER, VIOLA M
39831
DETACH ALONG PERFORMATION AND RETURN STUB WITH PAYMENT
AMOUNT DUE
AMOUNT $
ENCLOSED
594.03
CALL NUMBER
BILLING DATE:
3046222A
09/06/2005
This account is now PAST DUEl! Payment must be received
WITHIN 10 DAYS. Collection process will begin.
WEST SHORE EMS - ALS 205 GRANDVIEW AVE
"I VISA
VISA
t. . 1 AND
MASTER CARD
ACCEPTED
CAMP HILL, PA 17011
~~
l.iI'
-.J
) SlJ .l 1_. I J "; <:::\\.J .L l...' J. U Lj '_" .1. \ I '.
DATE
PROCEDURE
CODE
DESCRIPTION
DR.
PATIENT
PREVIOUS BALANCE--)
0&/23/05 nc2 Viola M 74000a
\!.ID" :':;0" l~::'.,
1,:1.":. v.L' i,~::.
Abdomen 1 Ii
Plan Payment:.
Ad.J '.\ s t rn e n t
[>1 e d 1 I,':: a)" e
Bill Balance--}
.NQUIR1ES MUST BE MADE BY THE
"I::~,j' PE ,; H I r:'Ai~1 F<EGULAT IONS
Medicare has paid its
share of your bill.
This statement is for the
amount payable
directly by you to us.
Please remit.
')-.~ '{ ''''1 f..:.
PAY THIS AMOUNT ~
[,,- 1'10 T Rf=:et= I I,' ED .1
'('1 ,.I'i' '~)ER!. ICE C!{Ar~C3E: l.JILL. f',f ADDED
'I. I,' 1"11, l'If\HI:.
AMOUNT
0. 1;11il
l 1:.11/'
1 .
l.. ~::~,'-J
1 . Lj