HomeMy WebLinkAbout01-31-06
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REV.1500 EX 16-00)
REV-1500
'*' COMMONWEALTH OF
PENNSYLVANIA
. . DEPARTMENT OF REVENUE
DEPl 280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
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COUNTY CODE YEAR
QJ.lCLC\S
NUMBER
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Casterline, Lucy
DATE OF DEATH (MM-DD-YEAR)
04/30/2005
SOCIAL SECURITY NUMBER
189-38-3860
DATE OF BIRTH (MM-DD-YEAR)
08/18/1908
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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~ 1. Original Retum
o 4. Limited Estate
~ 6. Decedent Died Testate (Attach copy ofWiI)
o 9. Litigation Proceeds Received
o 2. Supplemental Retum
o 4a. Future Interest Compromise (date of dealh after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copyofTlUsl)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
o 3. Remainder Retum (dale of death pliorto 12-13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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COMPLETE MAILING ADDRESS
1205 Manor Drive, Suite 200
Mechanicsburg, PA 17055
NAME
Wayne M. Pecht, Esquire
FIRM NAME (If Applicable)
Pecht & Associates, PC
TELEPHONE NUMBER
(717) 691-9808
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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)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
(1)
(2)
(3)
(4)
(5)
0.00
0.00
0.00
0.00
130,532.67
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(6)
14,087.57
(7)
0.00
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
(9)
(10)
(8)
13,444.30
0.00
144,620.24
(11)
(12)
(13)
13,444.30
131,175.94
0.00
13. Charitable and Govemmental 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)
(14)
131,175.94
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
x .0
(15)
16. Amount of Line 14 taxable at lineal rate 131,175.94 x .O~ (16) 5,902.91
.
17. Amount of Line 14 taxable at sibling rate x .12 (17)
18. Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due (19)
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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Decedent's Complete Address:
STREET ADDRESS
Lucv Casterline
132 Pleasant Grove Road
CITY M h . b I STATE I ZIP 17050
ec amcs urg PA
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
5,902.91
Total Credits (A + B + C) (2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( 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
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(SA)
(5B)
0.00
0.00
0.00
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.
5,902.91
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOllOWING' QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
No
[KJ
[KJ
[K]
[K]
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;.......................................................................................... 0
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0
c. retain a reversionary interest; or.......................................................................................................................... 0
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0
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DATE
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17050
DATE
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ADDRESS
Pecht & Associates, PC, 1205 Manor Drive, Suite 200, Mechanicsburg, PA 17055-4894
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. 99116 (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. 99116,(a) (1.1) (ii)].
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum 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. 99116(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. 99116(1.2) [72 P.S. 99116(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. 99116(a)(1.3)J. 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-1508 EX+ (6-98) '*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
VALUE AT DATE
OF DEATH
ITEM
NUMBER
DESCRIPTION
Certificate of Deposit (Sovereign Bank #1858286528)
of Deposit (Sovereign Bank #1858286529)
of Deposit (Sovereign Bank #1858286530)
Property (PA Treasurey Department - Claim #99594018)
5 Pre-paid Funeral Insurance (Fore Thought)
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
130,532.67
_ Sovereign Bank'.
6017 0168
1,365 Y
ACCOUNT NUMBER
1685211748
POSTING DATE
001365-0001 050812
AUGUST 11, 2005
LUCY CASTERLINE TTEE
WILLIAM CASTERLINE
132 PLEASANT GROVE RD
MECHANICSBURG PA 17050-1528
RENEWAL NOTICE
18-23 MONTH CD
PRINCIPAL VALUE... $39,867.01
GRACE DAYS. ....... 7
ISSUE DATE... ......... JANUARY 6, 2004
MATURITY DATE..... .... SEPTEMBER 6, 2005
RENEWAL MATURITY DATE. MAY 6, 2007
RENEWAL INSTRUCTIONS: RENEW PRINCIPAL AND INTEREST, INTEREST CREDITED MONTHLY
DEAR CUSTOMER:
YOUR ACCOUNT, 1685211748, WILL AUTOMATICALLY RENEW ON SEPTEMBER 6, 2005, FOR
AN ADDITIONAL TERM OF 20 MONTHS.
THE INTEREST RATE AND ANNUAL PERCENTAGE YIELD FOR THE NEW TERM HAVE NOT YET
BEEN DETERMINED. RATE AND YIELD INFORMATION WILL BE AVAILABLE ON THE MATURITY
DATE OF YOUR ACCOUNT AND CAN BE OBTAINED BY CALLING US AT THE TELEPHONE NUMBER
SHOWN BELOW.
IF NO CHANGES ARE MADE, THE VALUE OF YOUR ACCOUNT AT RENEWAL WILL BE
$39,867.01 WHICH INCLUDES A MATURITY INTEREST PAYMENT OF $11.08 THAT WILL BE
ADDED TO YOUR PRINCIPAL VALUE AT MATURITY.
YOU WILL HAVE 7 CALENDAR DAYS AFTER THE MATURITY DATE TO WITHDRAW FUNDS
WITHOUT PENALTY. INTEREST WILL NOT BE PAID ON FUNDS WITHDRAWN DURING THE
GRACE PERIOD.
YOU DO NOT NEED TO DO ANYTHING IF YOU WISH TO RENEW YOUR ACCOUNT FOR AN
ADDITIONAL TERM.
THANK YOU FOR BANKING WITH us.
DIRECT
INQUIRIES TO:
TELEPHONE:
SOVEREIGN BANK
PO BOX 12646
READING PA 19612-2646
(800) 683-4663
. Sovereign Banle
6017 0168
1,367 Y
ACCOUNT NUMBER
1685211763
POSTING DATE
001367-0001 050812
AUGUST 11, 2005
LUCY CASTERLINE TTEE
MARVIN E CASTERLINE BENEF
132 PLEASANT GROVE RD
MECHANICSBURG PA 17050-1528
RENEWAL NOTICE
18-23 MONTH CD
PRINCIPAL VALUE... $39,867.01
GRACE DAyS........ 7
ISSUE DATE..... ....... JANUARY 6, 2004
MATURITY DATE.. ....... SEPTEMBER 6, 2005
RENEWAL MATURITY DATE. MAY 6, 2007
RENEWAL INSTRUCTIONS: RENEW PRINCIPAL AND INTEREST, INTEREST CREDITED MONTHLY
DEAR CUSTOMER:
YOUR ACCOUNT, 1685211763, WILL AUTOMATICALLY RENEW ON SEPTEMBER 6, 2005, FOR
AN ADDITIONAL TERM OF 20 MONTHS.
THE INTEREST RATE AND ANNUAL PERCENTAGE YIELD FOR THE NEW TERM HAVE NOT YET
BEEN DETERMINED. RATE AND YIELD INFORMATION WILL BE AVAILABLE ON THE MATURITY
DATE OF YOUR ACCOUNT AND CAN BE OBTAINED BY CALLING US AT THE TELEPHONE NUMBER
SHOWN BELOW.
IF NO CHANGES ARE MADE, THE VALUE OF YOUR ACCOUNT AT RENEWAL WILL BE
$39,867.01 WHICH INCLUDES A MATURITY INTEREST PAYMENT OF $11.08 THAT WILL BE
ADDED TO YOUR PRINCIPAL VALUE AT MATURITY.
YOU WILL HAVE 7 CALENDAR DAYS AFTER THE MATURITY DATE TO WITHDRAW FUNDS
WITHOUT PENALTY. INTEREST WILL NOT BE PAID ON FUNDS WITHDRAWN DURING THE
GRACE PERIOD.
YOU DO NOT NEED TO DO ANYTHING IF YOU WISH TO RENEW YOUR ACCOUNT FOR AN
ADDITIONAL TERM.
THANK YOU FOR BANKING WITH US.
TELEPHONE:
SOVEREIGN BANK
PO BOX 12646
READING PA 19612-2646
(800) 683-4663
DIRECT
INQUIRIES TO:
_ Sovereign Banli'"
6017 Ol68
l,366 Y
ACCOUNT NUMBE:R
l6852ll755
POSTING DATE
001366-0001 050812
AUGUST ll, 2005
LUCY CASTERLINE TTEE
MARY LOUISE PIERCE-MCLAIN BENE
l32 PLEASANT GROVE RD
MECHANICSBURG PA l7050-l528
RENEWAL NOTICE
18-23 MONTH CD
PRINCIPAL VALUE... $39,867.01
GRACE DAYS. ....... 7
ISSUE DATE... ...... ... JANUARY 6, 2004
MATURITY DATE... ...... SEPTEMBER 6, 2005
RENEWAL MATURITY DATE. MAY 6, 2007
RENEWAL INSTRUCTIONS: RENEW PRINCIPAL AND INTEREST, INTEREST CREDITED MONTHLY
DEAR CUSTOMER:
YOUR ACCOUNT, l6852l1755, WILL AUTOMATICALLY RENEW ON SEPTEMBER 6, 2005, FOR
AN ADDITIONAL TERM OF 20 MONTHS.
THE INTEREST RATE AND ANNUAL PERCENTAGE YIELD FOR THE NEW TERM HAVE NOT YET
BEEN DETERMINED. RATE AND YIELD INFORMATION WILL BE AVAILABLE ON THE MATURITY
DATE OF YOUR ACCOUNT AND CAN BE OBTAINED BY CALLING US AT THE TELEPHONE NUMBER
SHOWN BELOW.
IF NO CHANGES ARE MADE, THE VALUE OF YOUR ACCOUNT AT RENEWAL WILL BE
$39,867.01 WHICH INCLUDES A MATURITY INTEREST PAYMENT OF $11.08 THAT WILL BE
ADDED TO YOUR PRINCIPAL VALUE AT MATURITY.
YOU WILL HAVE 7 CALENDAR DAYS AFTER THE MATURITY DATE TO WITHDRAW FUNDS
WITHOUT PENALTY. INTEREST WILL NOT BE PAID ON FUNDS WITHDRAWN DURING THE
GRACE PERIOD.
YOU DO NOT NEED TO DO ANYTHING IF YOU WISH TO RENEW YOUR ACCOUNT FOR AN
ADDITIONAL TERM.
THANK YOU FOR BANKING WITH US.
TELEPHONE:
SOVEREIGN BANK
PO BOX l2646
READING PA 19612-2646
(800) 683-4663
DIRECT
INQUIRIES TO:
Commonwealth of Pennsylvania
Treasury Department
Bureau of Unclaimed Property
I111111111111111111111111111I111111111111111111111
99594018
(8) Original Owner's Address as Reported
681/2 N WELLES AVE KINGSTON PA 18704-5106
(A) Original Owner's Name
CASTERLINE LUCY
(C) Holder Reporting Funds
PRUDENTIAL FINANCIAL INC DEMUTE KI
(E) Holder Address and Contact
(D) Last Transaction Date
01/25/2002
150 ROYALL STREET
CANTON NJ 02021
(F) Type of Funds Reported
230210107271912
(G) Certificate, Policy or Check Number
Demutualization Cash
(H) Amount Reported
$483.48
CASTERLINE LUCY
(8) Original Owner's Address as Reported
681 2 N WILLES AVE KINGSTON PA 18704-0000
(A) Original Owner's Name
(C) Holder Reporting Funds
PRUDENTIAL FINANCIAL INC DEMUTE KI
(E) Holder Address and Contact
(D) Last Transaction Date
01/25/2002
150 ROYALL STREET
CANTON NJ 02021
(F) Type of Funds Reported
230210113580764
(G) Certificate, Policy or Check Number
Demutualization Cash
(H) Amount Reported
Total Shares Claimed
0.0000
Total Cash Claimed
$398.16
$881.64
RETURN CLAIM FORM AND DOCUMENTATION TO:
Bureau of Unclaimed Property P.O. Box 1837, Harrisburg, PA 17105-1837
99594018
Linda Blackburn
Demutualization
. F0RE
THE>UGHT@
GROUP INSURANCE ENROLLMENT FORM 6429293
FORETHOUGHT lIFE INSURANCE COMPANY · FORfTHOUGHT CENTER · BATESVlllE, INDIANA 47006 Please Print
o 3 yr. Pay
o 5 yr. Pay
o 10 yr. Pay
o Flex
o Other
o Monthly 0 Annual 0 Semi 0 Quarterly
o Coupon Book 0 AP A *-Automatic Payment Authorization
* Attach completed authorization form and voided
check if APA is selected.
Make check payable to Forethought Life Insurance
Company and write certificate number on check.
To secure the Funeral Firm guarantees stated in the Funeral Planning
Agreement, proceeds are to be paid to the Funeral Firmin an amount
not to exceed the retailt>rice of the funeral provided. These directions
may be changed any tIme before the funeral is provided by giving
written notice to Forethought Life Insurance Company.
Any remaining proceeds are to be paid to the Beneficiary which is the
estate of the insured. If another Beneficiary is desired, provide the
information below. (Beneficiary should..be other than the funeral home.)
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First Name I Middle'Initial1 Last Name' . .
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Please answer each question to the best of YO":7. knowledge and belief
1. Are you currently confined to a hospital, hospice, nursing home
(including custodial care) or other such facility; or, within the past
twelve months, have you been told by a medical. practitioner that
you should be confined but have chosen not to follow that
instruction?
DYes 0 No
2. During the last five years have you been diagnosed as having, or
have you received active treatment from a medical practitioner
for any of the following:
DYes 0 No
AIDS/ARC
Blood Disorder
Brain Disorder
Cancer
Circulatory Disorder
Heart Disorder
Kidney Disorder
Liver Disorder
Lung Disorder
If the answer to both health questions is "No," a certificate which
provides full coverage will be issued. If either answer is "yes," or if
the Proposed Insured is physically or mentally unable to answer the
questions, a certificate with limited death benefits during the fIrst one
or two years (depending on age and plan) will be issued.
AUTHORfZA TfON By completing the Health Questions and signing
this Enrollment Form, any medical practitioner or facility, or other
person is authorized to give Forethought Life records or information
regarding the Proposed Insured's health. This authorization is limited
to matters related to the Health Questions. This authorization is
effective for a period of two years and six months.
@ 1999 Forethought
0399
IMPORT ANT: Both sections of form must be completed.
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Name of Insured
Number of Policy/Certificate/Annuity
I hereby irrevocably assign ownership of the Forethought Life insurance policy/certificate or annuity to the Funeral
Firm identified below in return for the promise to deliver funeral services and merchandise, and for the promise of
the Funeral Firm to immediately transfer ownership of the policy/certificate/annuity to The Forethought Trust on
my behalf.
By assigning ownership of the polic~/certificate/annuity to the Funeral Firm, it is understood:
1. This is permanent and irrevocable, and except as stated below, I renounce my power to control the policy/
certificate/annuity; and
2. Ownership of the policy/certificate/annuity will subsequently be transferred by the Funeral Firm to The
Forethought Trust which shall assure payment to the Funeral Firm, or any subsequently designated funeral
firm, for the provision of funeral services and merchandise; and
3. I waive all rights under the policy/certificate/annuity to surrender it for cash and to obtain a loan against the
policy/certificate/annuity. I do not assign these rights to any other person; and
4. I understand that it is my personal obligation to pay all premiums due on the policy/certificate/annuity
identified above; that I retain the right to change the designated funeral firm; and that I retain the right to
change the named beneficiary.
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Signatu/..e of Owner
Date
On behalf of the Funeral Firm, I accept the above assignment, and hereby transfer ownership of the policy/certificate/
annuity to The Forethought Trust. I understand that any right to receive payment of the proceeds is contingent upon
delivery of funeral services and merchandise. .
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Name of Funeral Firm (please Print Name)
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Sfgnature of Authorized. Representative
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'NHITE - Forethought
YELLOW - Funeral Home
PINK - Family
@ 1996 Forethought
0696
REV-1509 EX+ (6-98*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTlY-OWNED PROPERTY
ESTATE OF
FILE NUMBER
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A Mary Lou Pierce McLain
132 Pleasant Gave Rd.
Mechanicsburg, PA 17050
Daughter
c.
B.
JOINTLY-OWNED PROPERTY:
LETTER DATE
ITEM FOR JOINT MADE
NUMBER TENANT JOINT
1. A.
2 B
DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTlTUTION AND BANK ACCOUNT NUM8ER OR SIMILAR
IDENTiFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE.
Certificate of Deposit (PNC Bank #31700244358)
Bank Account (Citizens Bank Acct #610070-454-8
TOTAL (Also enter on line 6, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
14,087.57
CertIficate of Deposit
Account Verification
Page 1 of 2 ~ ?"
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PNC Bank National Association
LUCY CASTERLI NE
MARY LOU PIERCE MCCLAIN
132 PLEASANT GROVE RD
MECHANICSBURG
Certificate Number
31700244358
Reference Number
3700093094
Purchase Date
08/20/2004
M04/20Dl2006
Purchase Amount
. $ 12 . 098. 60
Term
20 MONTHS
PA 17050-1528
Annual Percentage Yield
2.5400
Renewal Type
AUTOMATIC
Product Description
FIXED RATE CD
For Information, Call
1-877-BANK-PNC
Interest Rate
Effective Until
2.516
04/20/2006
040
Plp,,~p ~pp rp"pr~p ~;np for A r('Ol1nt A arp.pmpnt
Member
FDIC
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~''citizen's Bank
1-888-910..4100
CaU Citizens' PhoneBank anytime for accollntinformation,
current rates and answers to your questions.
U5259 BR292
7
1
LUCY CASTERLINE
132 P~EA5ANT GROVE RD
MECHANICSBURG PA 17050-1528
Citizens Circle
Account Statement
o OF 3
Beginning April 12, 2005
through May 10, 2005
Contents
Summary
Checking
Check Images
Page 1
Page 2
Page 3
Citizens Circle Summary
Account
Account Number
Balance
This Statement
Balan ce
Last Statement
DEPOSIT BALANCE
Checking
Citizens Circle Checking
610070-454-8
Monthly combined balance to waive monthly fee is
Your monthly combined balance this statement period is
f\ember FDIC @ Equal Hous; n9 Lender
See reverse side for important informaUon
7,184.96
5,000.00
5,403.58
1,988.97
LUCY CASTERLINE
MARY LOUISE PIERCE MCLAIN
Citizens Circle Checking
610070-454-8
o
Total Deposit Balance
1,988.97
o
Total RelationshIp Balance
1,988.97
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REV-1511 EX+ (12-99)W
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Lucy Casterline, Deceased
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Funeral and related services
Additional flowers
Catering
Notice in Patriot News
8,370.00
53.00
591.30
180.00
2.
3
4
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
. State
Zip
Year(s) Commission Paid:
2.
Attorney Fees
750.00
3.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Mary Louise Pierce McLain
Street Address 132 Pleasant Grove Road
3,500.00
City Mechanicsburg
Relationship of Claimant to Decedent Daughter
State PAZip 17050
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
13,444.30
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FGrty Fort, Pennsy!vanrr:: 18704
Te15phone (57.0) ~~86;~SS.41
f"Ucha.c! V\F.. Harrison} Supervfsor
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DATE OF DEATH
PLACE OF DEATH
DATE OF STATEMENT
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A. CHARGE FOR SERVICES SELECTED
1. Professional Services:
Basic Services of Funeral Director & Staff. . . . .
Embalming. . . . . . . . . . . . . . . . . . . . . . . . . . .
Other preparation of body. . . . . . . . . . . . . . . . . .
2. Facilities, Equipment & Staff:
Use of Facilities & Staff for Viewing I Visitation . . .
Use of Facilities & Staff for Funeral Ceremony. . .
Use of Facilities & Staff for Memorial Service. . . .
Use of Equipment & Staff for Graveside Service ...
Use of Equipment & Staff for Church Service. . . .
3. Transportation:
Transfer of Remains to Funeral Home ...... . .
Hearse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Limousine. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sedan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Service I Utility Vehicle . . . . . . . . . . . . . . . . . . . .
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4. .Other Services I Facilities I Equipment:
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TOTAL OF SERVICES SELECTED. . . . . . . . . . . . . . . . . . . . ..$ ;}!./ {;' [,.0
STATEMENT OF
FUNERAL GOODS AND SERVICES SELECTED
Charges are only for those items that you selected or that are
required. If we are required by law or by a cemetery or crematory
to use any items, we will explain the reasons in writing below.
If you selected a funeral that may require embalming, such as a
funeral with viewing, you may have to pay for embalming. You
do not have to pay for embalming you did not approve If you
selected arrangements such as a direct cremation or immediate
burial. If we charged for embalming, we will explain why below.
CASH ADVANCES
Certified Copies of Death Certificate
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TOTAL CASH ADVANCES $ f c: ::: C f"'jf'i
We charge you for our services in obtaining: (specify cash advance items).
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SUMMARY
Total Funeral Home Charges. . . . . . . . . . . . . . . . . $
Local Sales Tax (if applicable) ........... .... $
State Sales Tax (if applicable). . . . . . . . . . . . , . . . . $
Total Cash Advances . . . . . . . . . . . . . . . . . . . . . . . $
GRAND TOTAL $
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Less Credits and Payments
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Total Credits. . . . . . . . . . . . . . . . . . . . . . . .$
BALANCE DUE {!
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Billing To
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DISCLOSURES
Reason for embalming r (f:: G' !d;. '/-' ') 11 ',n}
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.j . . APR-~e-e' SA" ee, 44 pR. WES. HUCCEH
/r(i) ! EI:Us Mark.et Cate,ri.n,g
I ~~~ BOEfELLls' . 824-6437'-
P//~ Call Us For All Your Catering Ne..,eds!
~;, n 11;;1 r ~~o"s . Choice Of Three Entrees 1:.S~/1I1.
I \ Y O(.c.~.. Fried Chicken · Breaded Pork Chops ~t TUrk~ 'eNll
,/, i1 1 /;t/' . . . Barbecue Chicken .. Smoked Pork Chops .. Sausage & PePP~r~
~'Y'~; l' /' r.~... ...... ...... ..I.t alian Chl~ken .. Barbecue Pork Chops.. Piggies ~e/' ,.'.... .
Y^ / ~.to.. .' < .,.Baked Chicken ~al<ed HarU::s · Meatloa1 Home.,rm
,....//'/ . U' f ~ ~ '.Yeais':' ;,.' Cajun Chicken · Roast Pork .. Ziti Lasagna Food/:
. 1 '.Experle.l:e'.. Buffalo Style Chicken · Roast Beef .. Meatballs
?j'\ (j. -{ d ';. .. Scampi Style Chicken · Ham Barbecue .. Bar are ribs
~II O~ .Il / .rertyaki Chicken · Pori< Bart>ecU& · Baked Haddock
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Choice Of TVv'O Sides
.. Cole Slaw
· Potato.salad
.. Macaroni Salad
· Italian Pasta Salad ·
· Pasta Salad · Halusld .
. Scallop Potatoe$ ~. ~~c - .Bake~rpotatoes
as 0 00 .. Maeeroni & Cheese
e your choice) · Parsley Potatoes
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Choice Of Two Sides
· Cheese & Pepperoni Tray .. Veggle Tray ", ~.
· Smoked Kielbasa Tray H Deli Tray
· Sea Legs with Cocktail Sauce *" These Choices Available for
· Rigatoni & MUShroom ~auce PartIes of 30 or more Guests Only
· Tossed Salad ._-.
· Homemade Stuffing
· AmericanPierogie
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NEED A HOSTESS?
Call Doriset
696-3438
$9.9-5
.p To: &: Delivery Charge
L..c., DeliWq $1"'& OutIyiq """.. $20
ALL PAAT!laS u./Oluol PIOLLS" IIUTftiR, W.lJIlIolEll$/SfT Up AND
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WE CATER ALL
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Weddings. Private Parties
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WE ACCEPT MASTERCAIlD & VISA.
ANY QUESTIONS? NEED A MENU CALI. 824-5437
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Hugh B. Hughes & Son, Inc., Funeral Home
1044 Wyoming Avenue
Forty Fort, Pennsylvania
Phone 570-288-9341
Faz 570-1970
Michael W. Harrison, Supervisor
Tuesday, May 3, 2005
Estate of Mrs. Lucy Casterline
Side arrangement of flowers
$ 53.00
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Q5/01 0001304664
893-Death Notices, Lucy D. CasterlineLucy Darragh Caster
SU PennLive.com, Start Date: 05/01/05
893-Death Notices, Lucy D. CasterlineLucy Darragh Caster
SU Patriot News, Start Date: 05/01/05
1.00 x 56 Li
56CL
1.00 x 56 Li
56CL
Amount to Pay:
1
0.00
0.0000
'05/01 0001304664
180.00
3.2143
$180.00
STATEMENT OF ACCOUNT AGING OF PAST DUE AMOUNTS
. .
30 DAYS
60 DAYS
OVER 90 DAYS
.. .
. . . .
$ 180.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 180.00
([be patriot-News
Now you know
All Billing Inquires (717) 255-8213
Fed. ID # 23-1304402
]sarMI
* UNAPPLIED AMOUNTS ARE INCLUDED IN TOTAL AMOUNT
.
05/01/2005 - 05/31/2005
0000151991
1M
~bt patriot-News
Now you know
.. .. ..
. . -
05/01/2005 - 05/31/2005
Hughes Funeral Home
. . . .
.. .
. '.
$ 180.00
Net 30 Days
. .
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ADVERTISING INVOICE / STATEMENT # :
$ 180.00
$ 0.00
$ 0.00
$ 0.00
0000151991
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1
05/31/2005.
Hughes Funeral Home
1044 Wyoming Avenue
Kingston, PA "704 USA
THE PATRIOT-NEWS
P. O. BOX 2066
MECHANICSBURG PA 17055-0996
. .
84790
. . -
84790
o Address changes on back
o Credit Card Payment on back
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
NO. CD 006264
MARY LOUISE PIERCE MCLAIN
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
_nnu_ fold
101 I $5,902.91
ESTATE INFORMATION: SSN: 000-00-0000 I
FILE NUMBER: 2106-0095 I
DECEDENT NAME: CASTERLINE LUCY I
DA TE OF PAYMENT: 01/31/2006 I
POSTMARK DATE: 01/31/2006 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 04/30/2005 I
I
TOTAL AMOUNT PAID: $5,902.91
REMARKS:
CHECK# 1975
INITIALS: LKG
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS