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15056051058
REV-1500 EX (01_05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
170-10-0348
OFFICIAL USE ONLY
~o~~tyCode Year
INHERITANCE TAX RETURN
RESIDENT DECEDENT
File Number
0101
Date of Birth
12/13/1917
Haladay
Decedent's First Name
MI
Decedent's Last Name
Anna
(If Applicable) Enter Surviving Spouse's Informa ion Below
Spouse's Last Name Suffix
Spou.se's..First..~ame
MI
IN/A
Spouse's Social
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
<:a:l 1. Original Retum
c:::J
4. Limited Estate
c:::J
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
c:::J
. Supplemental Return
c:::J
c::>
c:::J 4. Future Interest Compromise (date of
death after 12-12-82)
. Decedent Maintained a Living Trust
(Attach Copy of Trust)
r...)
. Spousal Poverty Credit (date of death c::> 11. Election t9.tllx under Sec/9~13(A)
between 12-31-91 and 1-1-95} (Attach SCh,' OJ...,
CORRESPONDENT - THIS SECTION MUST BE COMPL TED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATlONSHQ~LD BE D1~CiTED TO:
Name [)~ytiJne Tele e~u.~tjer
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
c::;:)
8. Total Number of Safe Deposit Boxes
<:a'>
c::;:)
REGISTER
Andrew H. Shaw, Esquire
Firm Name
First line of address
City or Post Office
State
ZIP Code
61 West Louther Street
Second line of address
, Carlisle
17013
Correspondent's e-mail address:
Under penalties of perjury, I declare that I have examined this tum, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other han the personal representative is based on all information of which prei>arer has any IthOWledge:' . .
I ATURE OF PERSON RESPONSIBLE FOR FILING R URN DATE
L-\. / \ \J()b
T
i 'ng Springs, PA 17007
OTHER THAN REPRESENTAIJ"IVE
DATE
L/-- //v 0 r;,
RESS
61 West Louther St., Carlisle, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
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15056051058
15056051058
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15056052059
REV-1500 EX
Decedent's Social
Number
Decedent's Name:
Anna
Haladay
170-10-0348
RECAPITULATION
0.00
0.00
1. Real estate (Schedule A). .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1.
2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2.
0.00
0.00
0.00
35.109.98
0.00
35,109.98
13,792.95
838.36
14,361.31
20,748.67
0.00
20,748.67
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3.
4. Mortgages & Notes Receivable (Schedule D). . . . . . . . . . . . . . . . . . . . . . . . . . . ., 4.
5. Cash. Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . ., 5.
6. Jointly Owned Property (Schedule F) C::::>'. Separate Billing Requested . . . . . ., 6.
7. Inter-Vivos Transfers & Miscellaneous Non-frobate Property
(Schedule G) c::::>! Separate Billing Requested.. . . . . .. 7.
8. Total Gross Assets (total Lines 1-7). . . . .. ............................. 8.
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). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.
12. Net Value of Estate (Line 8 minus Line 11) f . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.
13. Charitable and Governmental Bequests/See 19113 Trusts for which
an election to tax has not been made (Sche~ule J) . . . . . . . . . . . . . . . . . . . . . . . . 13.
14. Net Value Subject to Tax (Line 12 minus Li e 13) . . . . . . . . . . . . . . . . . . . . . . . . 14.
TAX COMPUTATION - SEE INSTRUCTIONS F
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0_
16. Amount of Line 14 taxable
at lineal rate X.O 45
17. Amount of Line 14 taxable
at sibling rate X. 12
18. Amount of Line 14 taxable
at collateral rate X. 15
APPLICABLE RATES
0.00
20,748.67
0.00
0.00
0.00
933.69
0.00
0.00
933.69
15.
16.
17.
18.
19. TAX DUE. .. ... . . . .. . . . .. . .. . . . ., .. .. ............................ 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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15056052059
Side 2
15056052059
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REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENTS NAME
Anna Haladay
STREET ADDRESS
307 Glenn Ave.
,E!l!Nym\:l-!L.".".,
DECEDENTS SOCIAL SECURITY NUMBER
170-10-0348
CITY
Boiling Springs
STATE
PA
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
ZIP
17007
933.69
0.00
0.00
0.00
Total Credits (A + B + C ) (2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
0.00
0.00
Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. this is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a tefund. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. ~his is the TAX DUE. (5)
A. Enter the interest on the tax due.
(5A)
(5B)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
0.00
0.00
933.69
0.00
933.69
Make Check P able 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: Yes
a. retain the use or income of the property transferred;.......................................................................................... 0
b. retain the right to designate who shall use lhe property transferred or its income; ............................................ 0
c. retain a reversionary interest; or................+........................................................................................................ 0
d. receive the promise for life of either paym~nts, benefits or care? ...................................................................... 0
2. If death occurred after December 12, 1982, di~ decedent transfer property within one year of death
without receiving adequate consideration? .....1........................................................................................................ 0
3. Did decedent own an "in trust for" or payable ~pon death bank account or security at his or her death? .............. 0
4. Did decedent own an Individual Retirement A~count, annuity, or other non-probate property which
contains a beneficiary designation? ...............J........................................................................................................ 0
No
[iJ
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[i]
[iJ
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
[iJ
For dates of death on or after July 1, 1994 and before January t, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent [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 zero (0) percent
[72 P.S. 99116 (a) (1.1) (iill. The statute does not exemot a tra~sfer 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 lis 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 decellsed 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 zero (0) percent [12 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 four and one-half (4.5) percent, except as noted in
72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)].
The tax rate imposed on the net value oftransfers to or for the us~ of the decedent's siblings is twelve (12) percent [72 P.S. 99116(a)(1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in co~mon with the decedent, whether by blood or adoption.
\ .
REV-1509 EX+ (6-98*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
ANNA HALADA Y
FILE NUMBER
21-06-0101
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. ANNE LASKOWSKI
307 GLENN AVE.
BOILING SPRINGS, PA 17007
DAUGHTER
B.
C.
JOINTLY.OWNED PROPERTY;
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTlY.HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 04/1711986 Residential Property -111 Pond Street, Taylor, PA 18518 19,593.96 50% 9,796.98
2. A. 04/01/1983 Members 1st Savings Account 10733300 5,564.72 50% 2,782.36
3. A. 04/01/1983 Members 1st Certificate Account 10733341 1,230.50 50% 615.25
4. A. 04/01/1983 Members 1st Certificate Account 10733342 14,236.10 50% 7,118.05
5. A. 04/01/1983 Van Kampen Investments US Mortgage Fund Class A 40/244673 4,129.89 50% 2,064.95
6. A. 04/01/1983 Wachovia Money Market Account 1010071445007 12,866.19 50% 6,433.10
7. A. 04/01/1983 Wachovia Checking Account 1014159413096 12,598.58 50% 6,299.29
TOTAL (Also enter on line 6, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
35,109.98
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Send Inquires to:
5000 Louise Drive
PO Box 40
Mechanicsburg, PA 17055
www.members1st.org
Main Switchboard: (717) 697-1161 or (800) 283-2328
EZ Call: (717) 697-4372 or (800) 283-4372
TOO: (717) 697"5312 or (BOO) 283-2328 ext. 5312
TeJeBranch: (717) 795-6049 or (800) 237-7288
MEMBERS 1st
FEDERAL CREDIT UNION
37829 1 AS 0.301 91036-37829
1".111"1"1,1,,,,111,,,1...11.1..1...111.1.,...11. ~.II...III
ANNA HALADAY
111 N POND ST
TAYLOR PA 18517-1419
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Statement of Accounts
Oct 01, 2005 thru Dec 31, 2005
Account Number:
107333
Account Balances at a Glance:
Checking: 0.00
Savings: 5 I 564 . 72
Certificates: 15,581.73
Loans: 0.00
Money Management: 0.00
Page: 1 of 2
Your current! Member Loyalty Reward level is Gold
2005 1099-INT and/or IRA! Fair Market Value information is provided with this
statement. No separab~ tax mailing will be made for the tax information
provided. This informatior1 is being furnished to the Internal Revenue Service.
Please retain this statement for your tax records.
SA VINGSACCOUNTS
00 - REGULAR SAVINGS
Date Transaction Descriotion
Oct 01 Balance Forward
Joint Owner : ANNE LASKOWSKI
Oct 31 Deposit Dividend .1.0000/0
Annual Percentage yteld~amed 1. (J{)(J% from 10'101/2005 through 10/31/2005
Nov 30 Deposit Dividend 1.000% I
Annual Percentage Yl8ld Eamed 1.01C1'hfrom 11101/2005 through 11/30/2005
Dee 31 Deposit. Dividend 1.000% :
Annual Percentage Yield Eamed 1. (J{)(J% from 12,01/2005 through 12/31/2005
Dee 31 Ending Balance
Additions
Subtractions
Balance
5,550.72
5,555.43
5,560.00
5,564.72
5,564.72
4.71
4.57
4.72
CERTIFICATE ACCOUNTS
41 -12 MONTH CERTIFICATE Maturity Date - Oct 23,2006
Date Transaction Descri tion
Oct 01 Balance Forward
Joint Owner: ANNE LASKOWSKI
Oct 23 Deposit Dividend 1 .880010
AnnualPercentage Yteld Eamed 1.890% from 10((J1/2005 through 10/22/2005
Renewed at 3.010%to matUre 10/23/06
Oct 31 . Deposit Dividend 3.010010 ....... .. ..'
Annual Percentage Yl8ld .Eamed 3. 06C1'h frOI7JJO/~/2fJ05thrOugh10/31/2005
Nov .30 Deposit Dividend 3.010%
Annual Percenta(J8 Yteld Eamed 3.05l1% from . 11/(J1/2005 through .11/30/2005
Dec 31 . Deposit Dividend. 3.0100/0
Annual Percentage Yteld Eamed 3. OSCl'h from 12/01/2005 through 12/31/2005
Dee 31 Ending Balance .
Additions Subtractions Balance
1,222.04
1.38 1,223.42
0.91 1,224.33
3.03 1,227.36
3.14 1.230.50
1,230.50
M1ST01
- - - Continued on following page - --
tv 1st
MEMBERS 1"
""'"""'..".-
PI037-37112P
Oct 01. 2005 thru Dee 31, 2005
Account Number: 107333
Page: 2 of 2
42 - 11 MONTH CERT Maturity Date - Feb 21, 2006
'" ;;;;;;;;;;;;;;;
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Date Transaction Description
Oct 01 Balance Forward
Joint Owner: ANNE LASKOWSKI
Oct 31 Deposit Dividend 3.200010
Annual Percentage Yield Eamed 3.25fJJ6 from 10/01/2005 through 10/31/2005
Nov 30 Deposit Dividend 3.200%
Annual Percentage YJ8Id Eamed 3.25QJ6 from 11/01/2005 through 11/30/2005
Dec 31 Deposit Dividend 3.200%
Annual Percentage Yield Eamed 3.25fJJ6 from 12/01/2005 through 12/31/2005
Dee 31 Ending Balance
Additions
Subtractions
Balance -
14,236.10
14,274.79 -
38.69
37.54
14,312.33
14.351.23
14,351.23
38.90
YTD SUMMARIES
TOTAL DNlDENDS PAID
00 REGULAR SAVINGS
41 12 MONTH CERTIFICATE
42 11 MONTH CERT
45.25
25.52
351.23
Total Year To Date Dividends Paid
NOTE: Total includes closed shares
422.00
M1ST02
VAN KAMPEN
INVESTMENTS
Generations of ExperienceSM
HIOI780986 12/31/05-17.03.22
Investment Report
January 1,2005 - December 31, 2005
ANN HALAOAY
ANNE LASKOWSKi JTTEN
111 N POND ST
TAYLOR PA 18517-1419
004b12
1'11111111111.1111111I11I111I11 .111111111I.11111I11 11I11 11111 1
~~t1itaj'P4ft(Qt<<fVal"
$4,129.89
;~oflid' " 'alii.." Sum"
Beginning Value
Investments/Contributions
Withdrawals/Red e m ptions
Dividends/Cap Gains
Change in Portfolio Value
Total Portfolio Value
Quarterly Activity
$4,163.22
$0.00
$0.00
$57.48
($33.33)
$4,129.89
$22,948.78
$0.00
($18,778.69)
$274.45
($18,818.891
$4,129.89
Vear-to-Date Activity
Change in Portfolio Value is the difference between the Total Portfolio
Value ( closing value) and the Beginning Value.
;;~iflltfcEgIJ"
Page 1 of 3
G Financial
Advisor
GEORGE A SNEED
WY31
FIRST CLEARING LLC
WACHOVIA SECURITIES INC
3 LEMOYNE DR
LEMOYNE PA 17043
~
~
Access
Your Account
On the Web
(800) 847-2424
vankampen.com
Purchases and new account applications
should be mailed to the addresses on their
respective forms. If you need to send
your purchase or new account application
via overnight courier, please ship to:
Van Kampen Investments
816 Wyandotte Station
Kansas City, MO 64105
Dream. Build. Achieve. Plan for a child's
future - and enjoy potential tax
benefits - with the Higher Education 529
Frmd. To learn more, visit vankampen. com.
r--
..,.
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C\l
ill
Percent Asset Category
Total Value
0.00% Growth
0.00% Growth & Income
0.00% Global/International
100.00% Income
0.00% Senior Loan
0.00% Tax Free
0.00% Capital Preservation
100.00% Total
$0.00
$0.00
$0.00
$4 , 129. 89
$0.00
$0.00
$0.00
$4,129.89
..-12100-.091B185O\6.13834 131D4.CNSACS01.INVMAG __...ACS.......DD118otB6
Set Up Your Online Transaction Privileges.
If you haven't established your online
purchase and redemption privileges,
don't worry-now you can enroll
online. Visit vankampen. com
to learn more.
r
1-001780986 12/31105-17.03.22
VAN KAMPEN
INVESTMENTS
Generations of ExperienceSM
Investment Report
January 1, 2005 - December 31, 2005
Page 2 of 3
ic!Ac&ounfSumm :;
Fund Name/Symbol
flInd/Account Number
Beginning Value
as of 1/0112005
Investments!
Contributions
Withdrawals!
Redemptions
Dividends!
Cap Gains
Change
in Value
Closing Valua
asof 12131J2G05
Non-Retirement
US Mortgage Fund Class A (VKMGX)
401244673 $22,948.78
$22.948.78
$274.45
($18,818.89)
($18.818.89)
$4,129.89
$4,129.89
Total All Accounts
$0.00
($18,778.69)
1$18.718.69)
$274.45
$0.00
Change in Portfolio Value is the difference between the Total Portfolio Value (closing value) and. the ~ginni~ Value.
[~.'ctoiiQi'lfil1i$ilpiIQ'..
U S Mortgage Fund Class A (VKMGX)
Fund/AccauntNumber 40/244673
Account Owner Ann Haladay
Anne Laskowski]tten
Trade Transaction
Date Description
Year-ta-Date Dividends $274 .45
Year-to-Date Capital Gains $0.00
Dividends are Paid in Cash
Capital Gains are Reinvested
Dollar Shara Shares This Total
Amount Price = Transaction Shares
$22,948.78 $13.94 1,646.254
$74.97 $0.00 0.000 1,646.254
($18,778.69) $13.98 (1,343.254) 303.000
$33.45 SO.OO 0.000 303.000
$13.69 $0.00 0.000 303.000
$15.85 $0.00 0.000 303.000
$15.77 $0.00 0.000 303.000
$15.86 $0.00 0.000 303.000
$15.76 $0.00 0.000 303.000
$15.17 $0.00 0.000 303.000
$15.85 $0.00 0.000 303.000
$15.76 $0.00 0.000 303.000
$15.85 $0.00 0.000 303.000
$9.48 $0.00 0.000 303.000
$16.39 $0.00 0.000 303.000
$4.129.89 $13.63 303.000
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Beginning Value as of 1101/2005
01/31/2005 Income Oiv Cash
02/09/2005 Shares Redeemed
02/28/2005 Income Oiv Cash
03/31/2005 Income Oiv Cash
04/29/2005 Income Oiv Cash
05/31/2005 Income Div Cash
06/30/2005 Income Oiv Cash
07/29/2005 Income Oiv Cash
08/31/2005 Income Oiv Cash
09/30/2005 Income Oiv Cash
10/31/2005 Income Oiv Cash
11/30/2005 Income Oiv Cash
12/29/2005 Special Income Cash Oiv
12/30/2005 Income Oiv Cash
Ending Value 8S of 12f.i112005
Effective September 26, 2005. a 2% redemption fee will be assessed on the proceeds of fund shares that are
redeemed - either by sale or exchange - within 7 or 30 days of purchase, depending on the fund. For more
information. please read the fund's prospectus au-efully before investing.
Your fund's dividend may have increased. H.ease read your statement carefully.
Vtsit vankampen.com/vksite/news/announcements/index.asp for more information.
Thank you for choosing Van Kampen Investments. Your satisfaction is important to us. If you
notice any inaccuracies on your statement, please contact us within 60 days of receiving thiS
statement.
.-12201)ol.D91I88SO 11. 1383S.1313S.CNSACSO 1.INVMAG........At$.......OO 1780,.6
- I
.
..~~
High Performance Money Market
01 1010071445007 752 30 0 9 55.615
WACHOVIA.
0001652401 AV 0.27801 5DGS 51
1...111., I, ,I, 1,1111111111", II, I" 1",11111111111111.11111111
ANNA HALADAY
ANNE LASKOWSKI
111 N POND ST
TAYLOR PA 185171419
PI
High Performance Money Market
11/16/2005 thru 12/14/2005
Account number:
Account owner(s):
1010071445007
ANNA HALADA Y
ANNE LASKOWSKI
Account Summary
Opening balance 11/16
Interest paid
Closing balance 12/14
$12,849.95
16.24 +
$12,866.19 r\-- \ 0
... <,
:') -
~.q \'-\ .
\~ ~f):J. .~ _
\..-\. ~~ ~
-\ (,Iv
Deposits and Other Credits
Date Amount Description
12/14 16.24 INTEREST FROM 11/16/2005 THROUGH 12/14/2005
Total $16.24
~
Interest
Number of days this statement period
Annual percentage yield earned
Interest earned this statement period
Interest paid this statement period
Interest paid this year
29
1.60%
$16.24
$16.24
$174.62
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INTRODUCING PERSONAL CHECKING AND SAVINGS STATEMENTS IN SPANISHI
Banking at Wachovia just got easier! Trust Wachovia to offer you and your family an
easy way to manage your money. To receive your next statement in Spanish, stop
by your local Financial Center or call us at 800-WACHOVIA (922-4684) and select
option 7 for assistance in Spanish.
IPRESENTAMOS LOS ESTADOS DE CUENTA EN ESPANOL PARA CUENTAS
CORRIENTES Y DE AHORROS PERSONALES!
jAhora realizar sus transacciones bancarias con Wachovia es mucho mas faci!! Contie en que
Wachovia Ie ofrecera a usted y a su familia una manera facil de administrar su dinero. Para
recibir su proximo estado de cuenta en espanol, visite su centro financiero local 0 lIamenos al
800-WACHOVIA (922-4684) Y oprima 7 para recibir asistencia en espana!.
NACHOVIA BANK, N.A., TAYLOR
page 1 of 2
.
~~,.....
Custom Checking
01 1014159413096 752 40
16 11.3
34,030
--
WACHOVIA
1.,.111.,1,,1,1. .,.11'".1,. .11,1. .1. .,11",.".,11",1",,11,
ANNA HALADAY
ANNELASKOWSKl
III N POND ST
TAYLOR PA 185171419
-
-
PB
-
CustomCbecking
1.1/221200S.fhru 12120/2005
Account number:
Account owner(s):
1014159413096
ANNA HALADAY
ANNE LASKOWSKI
Account Summary
Opening balance 11/22
Deposits and othercredits
Checks
Closing balance 12/20
$12,739.07
1 ,086.00 +
1,226.49 -
512,598.58
Deposits and Other Credits
Date
Amount Description
12/02 1,086.00 AUTOMATED CREDIT'USTREASURY303 SOC SEC
CO. ID. 3031036030051202 ppD
Total $1,086.00
Checks
Number
1860
1886*
1887
1888
1889
1890
Amount Date Number Amount Date Number Amount Date
22.00 12/06 1891 148.59 11/23 1897 400.00 12/13
18.00 1.1/23 1892 2.00 12/05 1898 150.00 12/14
100.00 12/02 1893 135.00 12/06 1899 31.04 12/16
25.00 11/25 1894 36.00 12/06 1900 31.33 12/20
2.00 11/28 1895 15.53 12/02 Total $1 ,226.49
10.00 11/29 1896 100.00 12/13
"'Indicates a break in check number sequence
INTRODUCING PERSONAL CHECKING AND SAVINGS STATEMENTS IN SPANISHI
Banking at Wachovia just got easier! Trust Wachovia to offer you and your family an
easy way to manage your money. To receive your next statement in Spanish. stop
by your local Financial Center or call us at 800-WACHOVIA (922-4684) and select
option 7 for assistance in Spanish.
WACHOVIA BANK, N.A., DUPONT
page 1 of 3
.
~~~~
Custom Checking
01 1014159413096 752 40
7 113
35,610
--
WACHOVIA
-
1...11 1..1..1.1....111...1...11.1..1...111.1"'1.111'111...1II
ANNA HALADAY
ANNE LASKOWSKI
III NPOND ST
TAYLOR PA 185171419
--
PI
-
Custom Checking
12/21/2005 thru 1/23/2006
Account number:
Account owner(s):
1014159413096
ANNA HALADA Y
ANNE LASKOWSKI
Account Summary
OpeningbaJance 12/21
Deposits and other credits
Checks
Other withdrawals and service fees
Closing balance 1/23
~ $12,598.58
14,004.74 +
9,703.14 -
1 ,122.00 -
: $15,778.18
Deposits and Other Credits
Date Amount Description
1/03 1,122.00 AUTOMATED CREDIT US TREASURY 303 SOC SEC
CO. 10.3031036030060103 PPD
1/12 12,882.74 TRANSFER FROM 1010071445007
Total $14,004.74
Checks
1901
1902
1903
Amount Date Number Amount Date Number Amount Date
148.59 12/29 1904 31.18 1/18 1907 20.46 1/17
349.80 1/18 1905 150.00 1/17 Total $9,703.14
8,985.00 1/18 1906 18.11 1/17
Number
Other Withdrawals and Service Fees
Date Amount Description
1/06 1,122.00 ACH RETURN
REASON: GOVT. DEPOSIT PER DEATH NOTIFICATION
ORIGINATOR: SSA
FOR DATE OF: 1/3/2006
Total $1,122.00
WACHOVIA BANK, N.A., DUPONT
page 1 of 3
REV-1511 EX+ (12-99*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Anna Haladay
FilE NUMBER
21-06-0101
ITEM
NUMBER
A.
B.
1.
2.
3.
4.
5.
6.
7.
Debts of decedent must be reported on Schedule I.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Tom Linson Floral-Funeral Flowers
Semian Funeral Home - Funeral Services
St. George's Orthodox Center - Service
Mounument Service - Headstone
349.80
8,985.00
1,021.15
2,879.00
0.00
0.00
0.00
2.
3.
4.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) Anne Laskowski
Social Security Number(s)/EIN Number ()f Personal Representative(s) 170-10-0348
Street Address 307 Glenn Ave.
0.00
City Boiling Springs
Year(s) Commission Paid: . N/A
State PA Zip 17007
Attomey Fees
500.00
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant N/A
0.00
Street Address
City
State
. Zip
Relationship of Claimant to Decedent
Probate Fees
58.00
Accountant's Fees
0.00
Tax Retum Preparer's Fees
0.00
0.00
0.00
0.00
0.00
0.00
0.00
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
13,792.95
I .
!1> T -1 <lX Deductible
,/ FEE
DEPOSIT
AI10UNT
~
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RECEIPT FOR PAYMENT
-------------------
-------------------
GLENDA FARNER STRASBAUGH
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Receipt Date:
Rece~pt Time:
Rece1.pt No.:
2/01/2006
12:08:09
1043236
HALADAY ANNA
Estate File No. :
Paid By Remarks:
2006-00101
ANNE LASKOWSKI
CMM
------------------------ Receipt Distribution ------------------------
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST
WILL
SHORT CERTIFICATE
AUTOMATION FEE
JCP FEE
Check# 1909
Total Received.. .......
20.00
15.00
8.00
5.00
10.00
----------------
$58.00
$58.00
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
BUREAU OF RECEIPTS & CNTR M.D
REV-1512 EX+ (12'{)3)
.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE UABIUTIES, & UENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Anna Haladay
FILE NUMBER
21-06-0101
Report debts Incurred by the decedent prior to de~th which remained unpaid as of the date of death, Including unrelmbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
3.
Mel Phone Bill 61.16
PPL Electric Bill 64.81
Gas Bill 450.00
Water Bill 75.40
Sewage Bill 37.50
Real Estate Taxes 149.49
2.
4.
5.
6.
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
838.36
:= >':,..A'.!:.:-:',::"I::c ::"h:':?Cd: ::: .-:l~&.':'.'..!'.':";::::'~!;: F2.:'!",~\=;-;', C /:..-:--[.'i:f€~;~:' t',::h:",,: :: S<>C,~t,~.~ C=r=: r..;:: "T'.T2,;< :::"ed!..!':!~b(~ C .~-~'-~'=:l::'r':.;;~-= -(i~rd='
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REV-1513 EX+ (9-00)
'*
SCHEDULE J
BENEFICIARIES
COMMONWEAlTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
NUMBER
I
NAME AND ADDRESS OF PERSON(S)! RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spous,1 distributions, and transfers under
Sec. 9116 (al (1.2)]
FILE NUMBER
21-06-0101
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
ESTATE OF
Anna Haladay
1.
Anne Laskowski
Daughter
20,748.67
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS ,SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBurrlONS
TOTAL OF PART 11- ENTER TOTAL NON-TAX~BLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
0.00