HomeMy WebLinkAbout04-26-06 (2)
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15056051058
REV-1500 EX (06-05)
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
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
County Code Year
File Number
21 05
0728
Date of Birth
171-261627
08/05/2005
09/25/1933
Decedent's Last Name
Suffix
Decedent's First Name
MI
Kurtz
Ann Marie
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
Kurtz J~
Clyde
R
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
. 1. Original Return
4. Limited Estate
2. Supplemental Return 3. Remainder Return (date of death
prior to 12-13-82)
4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required
death after 12-12-82)
7. Decedent Maintained a Living Trust 0 8, Total Number of Safe Deposit Boxes
(Attach Copy of Trust)
10, Spousal Poverty Credit (date of death 11, Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch, 0)
. 6. Decedent Died Testate
(Attach Copy of Will)
9, Litigation Proceeds Received
CORRESPONDENT - THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
Craig A. Doll, Esquire
Firm Name (If Applicable)
(717) 566-9000
f""--..-..')
REGISTER QFYVILLS USE ONd
. ) ,
1
First line of address
,---.
25 West Second Street
, ,
Second line of address
--:-'
I'
P.O. Box 403
City or Post Office
State
ZIP Code
DAFEFll~D
Hummelstown
PA
17036-0403
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c.}
Correspondent's e-mail address:CDoI176342@aol.com
Under penalties of perjury, I declare that I have examined this return, includin9 accompanyin9 schedules and statements, and to the best of my knowledge and belief.
it is true, correct and complete. Declaration of prepare! other than the personal representative is based on all information of which preparer has any knowledge.
d:~J~ (f 2~_~E~ON~:;r.O~G RE:~RN ____._ _ ___. ___.__ __ __ __j. ~)'%;(____ _ _
ADDRESS .~;-..... \' /
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-- -- - -- -~~ . ~--- - ----- --- -- ----- --
SIG,r>J1\fURE OF?,REPA~7R ,00:~ER THAN REPRESENTATIVE I DATE;
L-"A~ Ii. .{rW-(' :j cl.. Ie (-
ADD~ESs'/ , I ' " ' f J' ). -;-,
f,('v /5{!X )1(/~..j, )- LJ/Ylm" sn.:;", FA j 7Li3 Ii.
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056051058
15056051058
--1
-.J
15056052059
REV-1500 EX
Decedent's Name:
Ann Marie
Kurtz
RECAPITULATION
1. Real estate (Schedule A).
2. Slocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)
4. Mortgages & Notes Receivable (Schedule D) . . . . . .
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . .
6. Jointly Owned Property (Schedule F) Separate Billing Requested . .
7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) Separate Billing Requested.. .
8. Total Gross Assets (total Lines 1-7). .
9. Funeral Expenses & Administrative Costs (Schedule H). . . . .
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .
2.
...10.
11. Total Deductions (total Lines 9 & 10).. ..
. . . . . . . .. 11.
.12.
12. Net Value of Estate (Line 8 minus Line 11) . .
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.
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) XO~ 190,278.23 15.
16. Amount of Line 14 taxable
at lineal rate X.O 45 6,522.68 16.
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15
19. TAX DUE . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
15056052059
Side 2
L
Decedent's Social Security Number
1.
3.
4.
5.
6
7.
8.
9.
171-26-1627
~~
~
.'i
~~
It
~J)
15056052059
148,275.00
0.00
0.00
0.00
47,227.82
0.00
6,522.68
202,025.50
5,224.59
0.00
5,224.59
196,800.91
0.00
196,800.91
0.00
293.52
293.52
.-J
Kt: V-l :,UU t:X Page 3
File Number
Decedent's Complete Address:
DECEDENTS NAME
Ann Marie
--. ~--~_._- -""----
STREET ADDRESS
19 Hendel Loop
21
05
0728
Kurtz
DECEDENT'S SOCIAL SECURITY NUMBER
171-26-1627
CITY
Carlisle
ST^TE
PA
ZIP
17013
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
293.52
3. lr1terestlPer1alty if applicable
D. Interest
E. Penalty
Total Credits ( A + B + C ) (2)
0.00
------~ --------- Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater thar1 Lir1e 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
B. Er1ter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(5B)
293.52
0.00
293.52
A. Enter the interest on the tax due.
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: Yes No
a. retain the use or income of the property transferred;......................................................................................... 0 [K]
b. retair1 the right to desigr1ate who shall use the property transferred or its income; ........................................ 0 [K]
c. retain a reversionary interest; or........................................................................................................ 0 [iJ
d. receive the promise for life of either payments, benefits or care? ............................................................... 0 [iJ
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ............................................................................................................. 0 [iJ
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?............. 0 [K]
4. Did decedent own an Individual Retirement Account, annuity, or other r1on-probate property which
cOr1tair1s a ber1eficiary designation? ........................................................................................................................ ~ 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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 three (3) percent [72 P.S. 39116 (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. 39116 (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 zero (0) percent [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 four and one-half (4.5) percent, except as noted in
72 P.S. 39116(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 twelve (12) percent [72 P.S. 39116(a)(1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1502 EX+ (6-98)
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ann Marie Kurtz
FILE NUMBER
21-05-0728
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell. both having re~~nnable knowledge of the relevant facts.
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F
ITEM
NUMBER
DESCRIPTION
Cottage 19, Hendel Loop, Cumberland Crossings Retirement Community
VA.LUE AT DATE
OF DEATH
148,275.00
1 Longsdorf Way, Carlisle, PA 17013
See attached letter of date of death valuation from Cumberland Crossings Retirement
Community. Property is subject to "buy-back" provision in purchase documents.
TOTAL (Also enter on line 1, Recapitulation) $
148,275.00
(If more space is needed, insert additional sheets of the same size)
Kt:V-1508 EX+ (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISe.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ann Marie Kurtz
FILE NUMBER
21-05-0728
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
ITI::M
NUMBER
DESCRIPTION
Community Bank Checking Account (Number 115015390)
VALUE AT DATE
OF DEATH
4,169.85
2 Community Bank Checking Account (Number 1512727509)
11,59317
3 United States Treasury Bond CUSIP # 912795VMO
20,710.80
4 Unused Travelers Checks
500.00
5 Miscellaneous Cash
54.00
6 2003 Buick La Saber (Blue Book Value)
7,900.00
7 Clothing (donated)
800.00
8 Household goods and furnishings
1,50000
TOTAL (Also enter on line 5, Recapitulation) $
47,227.82
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX+ (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISe. NON-PROBATE PROPERTY
FILE NUMBER
21-05-0728
ESTATE OF
Ann Marie Kurtz
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION or PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IF .'\PPUCA81....[j VALUE
1. Community Bank - IRA Account 6,522,68 100
6,52268
Son, Arthur Kurtz was named as beneficiary
I
I
I
I
I
TOTAL (Also enter on line 7 Recapitulation) $ 6,522.68
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Ann Marie Kurtz
FILE NUMBER
21-05-0728
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Patriot News - Obituary
Post service meal - Oinninni Foods
146.00
752.60
2
B. ADMINISTRATIVE COSTS:
1.
Personal Representative's Commissions
0.00
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
2,44000
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4 Probate Fees 307.00
5. Accountant's Fees 0.00
6 Tax Return Preparer's Fees 0.00
7. Met-Ed - Utilities on Property 86.05
8. Cumberland Crossing - Monthly maintenance fee 145.20
9. Cumberland Crossing - monthly common fee 1,232.00
10 Sprint - Last telephone bill 16.94
11 Advertising of letters 98.80
TOTAL (Also enter on line 9, Recapitulation) S
5,22459
(If more space is needed, insert additional sheets of the same size)
REV-15 ~ 3 EX + 19-00)
~k
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERiTANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ann Marie Kurtz
FILE NUMBER
21-05-0728
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)1
1 . Clyde R. Kurtz, Jr., Cumberland Crossing Retiirement Community Husband 190,278.23
1 Langsdorf Way, Carlisle, PA 17013
2. Arthur Kurtz, 28 Community Road, Newport, PA 17074 6,522.68
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-15DD COVER SHEET
" 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 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-150D COVER SHEET $ 000
(If more space is needed, insert additional sheets of the same size)
0' 6;( y
"_ [J~~.~.
LAST lVILL AND TESTAMENT
OF
ANN MARIE KURTZ
I, Ann Marie Kurtz, presently residing and domiciled in the
Borough of Dauphin, Dauphin County, Pennsylvania, being of sound
mind and disposing memory and not under the restraint or undue
influence of any person, do make, publish and declare this to be
my Last will and Testament, hereby revoking all former wills and
codicils executed by me.
ITEM I: I hereby direct that all my just debts, including
unpaid charitable pledges whether or not the same are legally
enforceable obligations of my estate, the expenses of my last
illness, funeral and burial, and the cost of a suitable marker at
my grave, and the taxes or other expenses in connection with the
probate of this will and administering my estate, shall be paid
by my Executor, hereinafter named, from my residuary estate as
part of the expense of administration of my estate.
ITEM II: I hereby nominate and appoint my husband Clyde R.
Kurtz, Jr., as the Executor of my estate. In case of his death,
C:\WP51\CO\Ann.wil
'M..-......_.......'h.__ 0 ,OQIt
either before or after mine, or if he should resign or be
disqualified or unable to act, or be removed, then and in such.
event I nominate and appoint my son Michael Kurtz of Dauphin,
Pennsylvania and my daughter Joyce Kurtz of Newport,
Pennsylvania, as Co-Executors~ and confer upon them in such
capacity all of the rights, privileges, and powers which I have
given unto my husband as Executor.
ITEM III:
I devise, bequeath and appoint to my husband,
Clyde R. Kurtz, all of my property, or every nature and wherever
situate, providing he shall survive me by sixty days.
IT~~ IV:
Should my husband predecease me or die on or
before the sixtieth day following my death, I devise and bequeath
my estate of every nature and wherever situate to my children,
Gary Kurtz, Michael Kurtz, Arthur Kurtz, and Joyce Kurtz or those
of their issue who survive me on the sixty-first day following my
death in equal shares, share and share alike. However, as my
sons Gary and Michael and my daughter Joyce have jointly
purchased a parcel of land comprised of ten (10) acres more or
less, currently held in the name of Gary Kurtz, and as one of
them may wish to purchase the interests of my other children
named above but have insufficient funds to do so, I direct that
the funds necessary to buyout the remaining equitable owners at
the fair market value of their interest be paid from my estate
with a corresponding reduction in the share to which he or she
C:\WPS1\CD\Ann.wil
November 8, 1994
2
may be entitled pursuant to this paragraph.
Should they so
desire, and if municipal ordinances permit, they shall have the
option to subdivide the land into proportionate shares.
In such
event, the conditions expressed in this paragraph shall not be
operative, and my children shall be entitled to share in my
estate on an equal basis with no reduction.
ITEM V: If any beneficiary hereunder should die within
sixty (60) days after my death, he shall be deemed to have
predeceased me for all purposes hereunder.
ITEM VI: My personal representatives, trustees, and
guardian of any minor children, shall have the following powers
in addition to those vested in them by law and by other
provisions of my Will, applicable to all property, including
property held for minors, whether principal or income,
exercisable without court approval, and effective until actual
distribution of all property:
A. To retain any or all of the assets of my estate,
real or personal, without regard to any principle of
diversification, risk or productivity.
B. To invest in all forms of property without
restriction to investments authorized for Pennsylvania
fiduciaries, as they deem proper, without regard to any principle
of diversification, risk, or productivity.
C:\WP51\CD\Ann.wil
November 8, 1994
3
c. To sell at public or private sale, to exchange or
to lease, for any period of time, any real or personal property
and to give options for sales, exchanges or leases, for such
prices and upon such terms or GonditionR ~s they deem proper.
D. To allocate receipts and expenses to principal or
income or partly to each as they deem proper at their sole
discretion.
E. To borrow money from any person or institution,
including any Executor or Trustee and to mortgage or pledge any
or all real or personal property as my executors and trustees in
their sole discretion shall choose.
F. To compromise any claim or controversy.
G. To exercise any option, right or privilege granted
in insurance policies or in other investments.
H. To repair, alter or improve any real or personal
property.
I. To distribute in cash or in kind or partly in each
at valuations fixed by the Trustee.
J. To purchase investments at premiums and to charge
premiums to income or principal or partly to each.
K. To subscribe for or to exercise options for
stocks, bonds or other investments; to join in any plan of lease,
mortgage, merger, consolidation, reorganization, foreclosure, or
voting trust and to deposit securities thereunder; and to
generally exercise all the rights of security holders or
employees of any corporation.
C:\WP51\CO\Ann.wil
November 8, 1994
4
L. To register securities in the name of a nominee or
in such manner that title shall pass by delivery.
M. To assume continuance of the status of any
beneficiary with reference to death, marriage, divorce I illness,
incapacity, or other change in the absence of information deemed
reliable, without liability for disbursements made on such
assumption.
N. To add to the principal of any trust created by
this instrument any real or personal property received from any
person by Deed, will or in any other manner.
o. To exercise all power, authority and discretion
given by this instrument after the termination of any trust
created herein until the same is fully distributed.
P. To employ attorneys, accountants, engineers and
such other persons, professional or otherwise, as may be
necessary for the proper administration of this estate and to pay
their compensation from such funds.
Q. I authorize my personal representatives to pay an
amount which they shall determine as proper and reasonable to
compensate the guardian of the person of any minor beneficiary.
It is my desire that whoever should assume the responsibility of
raising minor children should be properly compensated from my
estate or any Trust created herein.
ITEM VII: If my husband and I shall die under such
circumstances that the order of our deaths cannot be established,
C:\WP51\CD\Ann.wil
November 8. 1994
5
it shall be conclusively presumed for all purposes of this Will
that I survived my husband.
ITEM VIII: I direct that my personal representatives,
trustees, and guardians, as well as their successors, shall not
be required to give bond for the faithful performance of their
duties in any jurisdiction.
ITEM IX: I direct that as soon as practicable after my
death, and before embalming, my body be placed in the hands of
the Humanity Gifts Registry of the state of Pennsylvania or the
nearest medical school in the event death occurs outside of
Pennsylvania.
Such institution shall use my eyes and other
appropriate body parts for restorative purposes in living persons
and shall store any tissue that can be preserved for subsequent
restorative purposes in living persons. In accordance with this
paragraph, I, Ann Marie Kurtz, have executed a Uniform Donor
Card.
COMMONWEALTH OF PENNSYLVANIA:
ss
COUNTY OF \:'::)J\\)r \--\ \ I-.\.
We,
\(. \ \- f-\
fY\ ,
\..0 Y'5,.,o~ i-, \
-4D\.s.r-.\..\\ WY~ock..\
, ,
and Ann Marie Kurtz the testator and the witnesses, whose names
are signed to the attached or foregoing instrument, being first
duly sworn and qualified according to law, do hereby declare to
the undersigned authority that we were present and saw the
testatrix sign and execute the instrument as her Will, and that
C:\WP51\CD\Ann.wil
November 8, 1994
6
.,
she executed it as her free and voluntary act for the purposes
therein expressed, and that each of the witnesses in the presence
and hearing of the testatrix signed the will as witnesses and
that to the best of their knowledge the testatrix was at that
time eighteen years of age or older, of sound mine and under no
constraint or undue influence; and If the said testatrix, do
hereby acknowledge that I signed and executed the instrument as
my Last Will, that I signed it willingly, and I signed it as my
free and voluntary act for the purposes therein expressed.
~~k<k';& ~
Testatrix
;+ OJ, )j/;~d./
ltness
~~j~[j~~~~"
Wltn
Sworn and subscribed to before me
this \'"L\~ day of ~P.hl 1995".
Nolarial So...al
John A. Reichard, Jr., Notary Putk
Dauphin Boro, Dauphin County
t.fiy Commission Expires March 23. 1997
ML'fliS-3f, PerulSytvaniaAss-."Cia1ion ot Notaries
C:\WP51\CD\Ann.wil
November 8, 1994
7
CUMBERLAND CROSSINGS
RETIREMENT COMMUNITY
DJakon Lutheran Social Ministries
December 27,2005
Mr. Craig A. Doll, Esquire
25 West Second Street
Hummelstown, P A 17036-0403
Dear Mr. Doll,
I received your letter dated December 13, 2005 concerning the Estate of Ann Marie Kurtz
and the refund due on Cottage 19, Hendel Loop.
\Ve hereby acknowledge that, pursuant to the contract executed by Mrs. Kmiz, vvhen a new
resident pays a residency fee for, and takes possession of, Mrs. Kurtz's cottage, a refund in
the amount of$148,275.00 \vill be payable to Ann Marie Kurtz's estate.
If you have any questions, pI ease do not hesitate to call me at 717-240-6012. Thank you.
Sincerely,
C',~.-l '._
Jan Bigelow
Executive Director
".w," rl i;; k on ora
II I
August 30,2005
Craig A Doll
25 \\7 2nd 8t
PO Box 403
HummelstowLl PA 17036
RE: Estate of Ann Marie Kurtz, deceased
Enclosed you will find the information requested on the above referenced individual's
accounts. Unless othenvise noted, the information furnished is as of date of death.
Please feel free to contact me at 717-354-3590 ifJ can be or further assistance.
Sincerely,
Deborah K Lorah
Deposit Services/Research Manager
P.O. Box 350 . Millersburg, PA 17061 . Phone 1-866-255-2580
CommunityBanks
Decedent's Name
AlLD Marie Kurtz
Social Security Number
171-26-1627
August 5, 2005
Date of Death
Account Number 115015390 1512727509
Account Type Checking Checkin a
'"
Date Opened 417 /05 11/14/02
Principal Balance S4,}69.85 S11,579.55
Accrued Interest at Date of Death S.OO S13.62
Balance at Date of Death $4,169.85 S11,593.17
.\faturity Date
Account O\ynership Single Single
Names of Joint Owners, if any
Date Joint 0vmership was
Established
Interest Rate .20% 1.59%
Additional Information Closed 8/22/05
,/'"""-,
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;, ~,,-~,__,"'~~
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"
Da'e
CommunitvBanks
Decedent's Name Ann Marie Kurtz
Social Security Number 171-26-1627
Date of Death August 5,2005
Account Number 645000520
Account Type IR>\ Certificate of Deposit
Date Opened 2/24/04
Principal Balance
S6.515.00
s
Accrued [nterest at Date of Death
S7.68
s
Balance at Date of Death
S6,522.68
s
l\Iaturity Date
8/24/06
Account Ownership
Single
Names of Joint Ovmers, if any
Date Joint Ownership was
Established
Interest Rate
2.87%
~/o
Additional Information
\,~,. \!' ~"-,
'-"'-<' \ \:~ . "',--\ .c-____. \
ADtho~jzed Signature D?1P
~D F 5181 (Ap,il 2:>05) OMB No. 1535.0069
Departr'lent of the Treasury
Burea:J of the Public Debt
P.o. Box 1254
Parkers::lJrg, V\'V 25105.1254
TreasuryDirect
P Mailing Number: 00800~
STATEMENT DATE: 06/28/2005
ANN MARIE KURTZ
19 HENDEL LOOP
CARLISLE PA 17013
The amount of your maturing security is $ 2 0) 000.00.
You can reinvest 24 hours a day, 7 days a week. To reinvest call 1-800-722-2678 by 08/0712005.
Live outside US? Dial 1-304-480-6464. If you don't want to reinvest, disregard this form.
Have this form and a pen or pencil ready when you telephone. You will be prompted to enter the following information:
1. Enter your TreasuryDirect Account Number 1800-028-8986 j
2. Enter the CUSIP ( 912795VMO I which matures on 08118/2005,
3. Enter the Validation Number I 20000202 ,
When using the telephone,
if your CUSIP contains the...
~~l~
letter Q
letter Z
press 7
press 9
press
Zero
4. Select the appropriate security term offered.
\'\},L:.;i:.\.J.$
:>u
5. Select the appropriate number of reinvestments,
Confirmations are not mailed. Listen carefully to verify the information you entered.
For your records, write your Confirmation Number here: I TN --r- N 0 f' .~ \.l \ 1- \ ~ 1
number or
letter 0
'To request partial reinvestments use PD F 5180 "Reinvestment Request" or contact your Treasury Retail Securities Site at:
1-800-722-2678
You can also reinvest by visiting our web site at WWW.PublicdebUreas.gov/sec/sectdes.htm
If you have a change of address, or questions, please contact your Treasury Retail Securities Site.
Please see the back of this form for important information about Treasury securities.
, /
~ I ; ; : '~J
If vou can't use our Electronic SeNices to reinvest, complete this form and return it to the address on the oack. Don't make ,n01es on this form or
attaoh correspondence.
VALlDATIONNUMBER:20000202 CUSIP: 912795VMO ACCOUNT NUMBER: 1800-028-8986
SECURiTY NUMBER 0;:: RcINVE:STME:NTS
TERM (SE:LECT ON:': BOX SE:LOW)
1 2 3 4 5 6 7 8
ANN MARIE KURTZ 13 WEEK S [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ]
19 HENDEL LOOP
CARLISLE PA 17013 26 WEEKS [ ] [ ] [ ] [ ]
If more than one box is marked, one reinvestment will be scheduled for the shortest term selected.
If no box is marked, one reinvestment.will be s?heduled for the sh~rt~st term available. Return By: 07/29/2005
The security terms shown are the only available options. Please do not write In other security terms.
AMOUNT: $20,000.00
~":~::~.')~;;T~ES - 3.H..LS ~J\D !-,1QTES
"-'.-" :.-.'~"""~.-..,:. :....~ ,..-.-~-....--,
.~. . ~ -".... -~.-. '.
":1~~;::~'~~~~']r{~;;~~r.~:~:~~~ir~~'~::~~i:~S~!~~:~~~::':~ :~~~~r~~~~;~~~~(~-:~~E,:;:~'~:~;ti~~~l~=~~i~~~c~~~:r:<j
:~>2 r:'j~tli"'(:Y 02.te Df YDUr secur1ty does r1:)t ca:r-;cicls \\1\1\1 the jSSL!S d2tS .:]1 the :iSV/ S~::;:J;-f~\' t~::=- ps: =~"!":l-:j'Jnt js ~/~i~~::j i:-
~~:;:;.~<:;:~: -:~>:' 2. period n'Jt to 8Y.ceed f~V8 (5) Gays"
":;,,_: ~;?y ~<,J7 :-'.:::;:..-:.:.s"i :~,),...,~:)::'~p:::<~tj\.'2 is!nVsstrnen: ::--;':0 3.:,,:y :erm of a se.~u;-~ty ilst'3d on the fiont if yc:u ars 2JSG bidding c.~Dr'1petitive\y in ths S2.;-ns
,J::'(::.:-:,' -::-:~s:'.:: :"",.::"~ S'"3"''!S:--:;",: ;-:~.jcEti:::-:2.! i8stricti:::;i;S to ;j:)ncompetitiv9 bidders that are provided in par3gr21.ph 356.12 (b) (2) 8f Trs2SU:--Y Circu:s.f No. t .'.'j.j
r"~~'-'. :~,~-._' '_'-':" :>3.;"':: 3~,3.34 provjdes. for 2SS'3Ssr-,-1snt e;f 3 D3rt2.ity of I ~/o of the pai o.mcunt of se::>~J;iti3s 2w&:ded i~: S:\ 2u::iG:: if ths bi::<;::;: ;Sl;S
. ... :::;~,
e. 'in;;s:\, iT!s.'ner.
~ ~..:._ ' --c",
:<;::.~; ~~ -;-~:-'::::,S~;:-'i" :~<jis 2.n::i notes 2.iS s.:dd bV 2u:ti::;--L T~ie P[-[-::::3 is dete~l:\\ns::i 2.f'\8: t~-\e. 3.U'::~\Cli;,.
/:-,8 3. '..}:;n':'):----i:!~tt\'v:; bij:j::r. '(0U: J:"ice
:--,8
,::Q:::.'''"
<. ,:.~
. ;'~0\::l 2,G'~sDtSj frDm ths C:CF-n;:!'3tit~vs jids.
-:
-"." \"~<.i ~~2~;; ?2Y'"08r";7 :=\~~) 1'..:::.:;82 jf thE: :\Sh' 3S.:::U;'";ty 32!]2 i3.i: 2. P:-S:-71!U:7i =..nd/JI if 5::::.ru-sd itlt-=;i~sl :::) UU3, i"i ; -~-"::.o;".~
_ -X;:;sss ~;~.cd Y:J'Jf P2YGsrr:: pro'T:p~\y. It'2 j~9 upon re2-2j~:. \'o'J iT"i:.Jst pay 2.::y tJ;-ss:!Jji~ s.nd/:;;- 2c-:r'Jed i;:tS;-S3~j~;S ~::e1':::"s '.;'2-
- ~ _, - ..-...._..i
-::;",- v~'
",e ,"'::O-~,:: f:): :-(::;.:s. t-an the par 2mou~t (i'i' t;-lS prics per So; DO is S"i D2"7871 for inst::.nce) the:--i i'JU mi.~.ht ,']\\"'3 2. pre~I\'Jrrl.
'.r---y.""c.~-
,-.--."..-
,'>"~';-' ,~:: >;~'_~"?~'"> ::-: .;.,~",; e:-:"';-~ u:-;t of interest a security GainS beTore ifs actually :ssued. A security starts earning interest on W:121'S ':3.:\.2,j the. f'ds.ts:
:=:.3__~:-,7" :~f {;';s: ::~~,.~s.":::,';j~h.?:; ::2'.7'3 ~'J~" iss'Jing that security. t--Jormslly, the dcted date :s the sarne as the issue dste, but /0:.1 17"!ight ov/s 2.:c:r'Jsd inte:83~
_" :2. ;. _'~o:,:,:ii;-;; ("-.i.nd/or If the neVJ SS':;Uf\ty'S datsd dote is a no:r-8usiness day.
.-;31:-TJ~::;t:;iS:lt option shown on the f[.::'}i"'\t 8f th~s torr:" rr,3.)' be a feo;:>en\ng. /"\ reoj)8:1\ng is \NhsTi \NS auction 3 prei:o'Jsly iSS'..J2:l
;-~;s ~?~~;':G :i:3.t.1:-:ry' d2ts and interest f2tS as the oriQhal, DlJt ",";'ith 2 diffsrent issue date (\vhich creates a 3nc:n:'2r :Jvera[\ t2:-1;;) a;-;:t,
?::.;-r-~',:;;,~~;~': ;'._\;-:':;'1233 prics. VVhile most 2.re p:ann,=~d, Treasury o::c2s1onal!y has a "suiprlss" r80peiling if, 3.t auction, a se::Jr:t)-' ssHs &t ~:-12
/_ __ :-'; c'7"10 th3 SSiT\S \n.ter-:;st pei\.~d 2.5 e.. p;-~;\(i.ClUS\j a.uc.t\o-f'1ed sec\JTity. \n titS C3se, Treasury' Tn2}' iec.:,sn t'~le Gri?lnai, :y)~ 2uc:tiry~ 2.
,.....; ::::_'\' 2 D-~.'(;;;?J nc.te in t\~2)!.!n J!J:l2, the U.S. Treasury reopens thaJ "1 C)-year ;l.Jte wj~h the same :T';2.~'Jr;'~y date and t:ltersst rate--}:...:s:~ 8.
,..-... <..'_.' ;;:nc;thsi ~ C-ye2.: note in June, ConsequentlY, the security }'ou bJIJQht in Iv';ay and ti-ie~ne )'O~ bO'Jg~t In June ars b~Sj::2Py t;.;;:.~
_._"~r ~-.-.' ". ~".;.-._-~:>:cs::;t T2L the ter~r'1 3.:'ld the J'JrGh~se 'Jric:e. The G\f'\erences: (1) you bought your 3sGond ss.:::urity O;l9 month after the :xigi~laL S:!
'.:C>J:' ;::::;.:-::::;-<. ~'..'""" r~t~f~; tS-;O:-:i :s 9 years 2nd 11 1"no;:ths instes.d of an even 10 years; and (2) YDU ni3Y pay more D; isss f.:J! t~!e sscan: sS'2urity,
~;-/;;; tis :'s':;g~:.-ej at the sec:::;ld 2uct!Cn, if ifs higher the.n par, )'0u'ii owe 2 p~5mjum pillS the acCrl~]'3j i~terest f8f the first :nJ:!t~:
-. =',-.;:::: 1'::"':"
-,.< ; """.... , _ in ..iU:iS v-..:as :;;-igrn3.lJy issus:lln k~3Y, but :lelJ bought it in J~ne, 8-0 it already sa.rne:i 2. r7::Jnth of int9~est since [\I;sy_ '{c.u'r"e
~:~?ct :];-lS rtnnth's intsj"est =:~r;:-:),.Jnt S',] \"/8 (:00 pa.y you a full six-mo:ith li,tef3st 2rncun: DTi ~hs Tiist SSr,'l.i3.:-; '-EJ3,! j;;t3:"SS.~
i';C.:'.:S~::<3f (;-;:J: =)s~/:;'~:;3t").
"4-';
;'::T~'-'~~.~~S;;.i~S:S D~J' - .fj, f'slnvest::l'3nt Q~tion shown on the T;-'Jnt ()f this form may h9ve a:ietsd ja~s t::2t .j08S nc.;t ~3.!I 0;-;
'<~".,:,,",:.::::,- -~~~" j.? ::L:e jf 3. se:u:-ity beghs S2::Jin;; int9rest on a ilan-bus!n'~ss day (v.'8skend or he;![jay).
.::: ~~ ,:::-;,.,:JCC'::
_. ~,~~".~.~-,
HG"Tj;:::: U';'{~):::R THE ?rT~~VAC\f AND PA?cR\\'ORK R~DUCTiO~ hC73
----".-r:.-:::.':'-,'-i "C):- t>;~~ 1:-:rn t:~ 2.ss:s"t JS in p:-~S9ss'!n; ycur se:ur"ities li2r'133.::ticln ,equest.s, QUi 2L.it~Oiity :;.':)mes ;;-J:T: 3-; U.2.C. '::::;::. 31 '~"/li:.:h 2JJt~~,::.~i:es 1!-;s
~. _ -,I :_;:.;:;?r~~;':3:-:'~ t:; to~~:)~:..' ;":lcns/ tG pay the ;Jubii.::; dabt -)f the :j;-:i:e,j Sta.tes. A!so, 25 U.S,C. 5"'1 [19 requi~2s us to use YGUi S.S!\! ':IL ce:-tEii:i \G~r:s \'Ihen \-'F2 ~2:::':;:-~ i:S::21C;i::-;
";~,,,;,,~, :?,3. it's ".';;L.FY~2~Y th2.~ ;.'.:)':..' ::::~O'.lj:i9 ttiB ii:quested inTO~inst!.:::;n, b~t \':ithout it, Vie r.l2Y not be abie to process your Iisfisa:tiJi: iSqL.JSS::S. jnf-or:r;3i:!C;~i c2~::einjn;: Y.):'1:
~~~~:~,;':.~:,:)~)Cc:~;:~~::J~2c"~:~~~~,~:;~2t~St~~';~:::Je:'~~2 c~;~~~~t~: ~~~~~; ':;:~;: ~~;U~~~~~Sc~r~ ~~~ ~:i~ ~~~~:;;gl~~:er;~~i{CI':c~~~,~;~~,::r ~;i~!~~i!~J\~I:~; ~'~~::~~e~S~~ of ::11S
'>;-:~:-ns:-;~., :;~!;:;:-,.:;i~.;;s:>:-;':',;:::;',~:g j\s:;\;):;u:s 2.~'r)rJ\'ed C:);I:PUle-:- ~ms'nss) dstermining siigi':Jj)jty f::. benefits, findjn;J DeiS-O:--;S 'Ne've !'Js': :C;:l~a:::t v.,'ith, or hs!:);:!:; L'S c:;:
.';'':;~.,::';, C:,;;3:"'::"::s:: '::.;' ~:-,\".::.'~X0E,ti::::'::2, :;:' ::;::;:..;;-ts, .::::ounssl, 2nd cths~s Tor litigation an::! other pr'::::esdi;iQS; 2. CO:i2rs;:.si:J:,3.i ofn~;e a.ski~g 0;\ \'2Ur t3~\3(f: a::: 2S
-::C'';::-:.-;:r'',']s,? ::::;_..;:~--:.~;,::-.::.~::::~ ;E.\~r.
:::::;7::~: --
~=::,~~:, .~'::.-,:...: 2::::'l.t e:::: ;:';;n-:.1:95 t:J cc.n;:;';ete tills ;::1;'":1,. ~Jv/S-\Je:-, Y:JU arl2 i'l:lt iSQu!r2: i~) ;:;rovde infc~m3ti:J;i le~'.]sst~:j u::isss :1 \'2\ij 0:--/::: .~"";:;i:~!"Ji n',!;;iJe, is
. CQ;-;'l::"19nts J;- suggestions '"sgardlng this l::>:-rn shouiG be S9nt to the 9urs31J of the Public De~L rOi~S i'v~?-:',?'J~~-~~;~"_ '2~~:,:?~ ;>a~~ s,:;':YJ~~
~:)~:"2::: ':o:IT'; i':l th\s address; :nsts?c; S2il::;0 the c:a:-;-e:i :::cidress Sh-:;'l;T, b~!o\"!.
D=F',L.~~T\/:=\\jT ::)i:: T'~I:= ihE..ASL\R"{
2.URE,L.U O~ 1f--~~ PU3L~C D=2.T
PC) BOX Ai 25~.
?!\~~i<=RS3U?\G '}'{./ 26~ D3 -1254
BOX 1 Gross distribution .
BOX 2a Taxable amount.
BOX 2b Taxable amount not determined (If checked)
BOX 20 Total distribution (If checked)
BOX 3 Capital gain (included in box 2a) .
BOX 4 Federal income tax withheld. - . . . . . . . . . . . .
BOX 5 Employee contributions or insurance premiums
BOX 6 Net unrealized appreciation in employer's securities..
BOX 7 Distribution code.
IR~/SEP/SIMPLE distribution (If checked)
BOX 8 Other. .
BOX 9a Your percentage of total distribution
BOX 9b Total employee contributions.
BOX 10 State tax withheld.
CommunityBanks Inc
750 East Park Drive
Harrisburg PA 17111
1-866-255-2580
Payer's
Fed I.D. No.
23-0962860
Arthur Kurtz
Beneficiary of Ann Marie Kurtz's IR
C/O Sam Mcelwee
731 Sam Hills Lane
Dauphin PA 17018
Recipient's
Tax I.D. No.
189-52-9214
Account Information
*------------------------*
6450005201 K009094 IRA
BOX 11 State/Payer's state
BOX 12 State distribution.
BOX 13 Local tax withheld.
BOX 14 Name of locality.
BOX 15 Local distribution.
~"
.LL"-' .
OMB No. 1545-0119
Distributions From
Pensions, Annuities,
Retirement or Profit-
Sharing Plans, IRAs,
Insurance Contracts,
etc.
Form 1099-R
Copy C
For Recipient's
Records
For year 2005
6,046.53
6,046.53
XXX
604.65
4
XXX
This information is being furnished to the Internal Revenue Service
(KEEP FOR YOUR RECORDS.)
CRtUG A. DOLL
ATTORNEY AT LAW
25 WEST S:=COND STREET
P.O. SOX 403
HU,'.'1rviELS,OWN, PENNSYLVANIA 17036
TELEPriONE (717) 556-9000
Sstate of Ann Kurtz
c/o Michael ? Kurtz
405 Mountainview Lane
DauDhin PA 17013
AprL. 22, 2006
:=D~ ::JR,JFESS!:=)NL~ 3=RVI=~S ~r:~~:J~OEJ
Hours
11/2/05 Meecing with Executors
2.00
12/13/05 Letter to Cumberland Crossing regarding
date of death value of home; Letters
for advertising; Rule 5.6 Notices and
1 ~ n
_.~v
?ilin;s
1/12/06 Review Cumberland Crossings Retiremenc
Community documents regarding
disposition of home; Federal
Inheritance Lax issues.
2.50
?/~? Inr
~ -" "I" ';)
?repare Preliminary Inheritance Tax
Report; Discussions with CUIT~erland
Crossings regarding repurchase
agreement on cottage at retirement
communicy; Reivew contract and
3 .30
repu~cnase agreement.
4/12/06 ?repare Inheritance l~X reDort
1.60
4/13/06 ?repare Estate Income Tax Forms
0.30
For Drofessional serVlces rendered
Amaun t
400.00
300.00
500.00
760.JO
32D.CJD
160.CD
12.20 $2,440.0D
(Y'J::::::J',)= A~'='JLH<7S V\'iLL 8E:HARG::D A LAT:: F~~ OF iCJ, p:,::?, ~/IOhrT1-": (l29'o ANNUAi..-LYj 0",1 ,~U_ ACCO',)NTS PAST DU=
THE PAXTON HERALD
~;''-J']I'.j',~\'m''t7.._'rF''::L.!~
Tkwl Pn"'\OTl Hertlld' 49'0 End DrM,Harr;sb.Jrg, PA 17112. ~..Q540
East Shore
(717) 545-9540
(717) 545-8762
Fax
(717) 657-3523
Office & Plant - (PO Box 631 0) 101 Lincoln Street
Harrisburg, PA 17112
ACCOlillT STATEMENT/I~0JOICE
09/28/2005
CRF.IG DOLL ATTORNEY AT LAW
hCCO'J.D-C No:
2560
?hone Ho:
2.7) 23 -9355
25 WEST SECOND ST
HLi1VJIVjELSTOWN PA 17036
Tea~ S'z-leet: N
A~te~tion: C~~IG DOLL
EET~J?J0 TO? P'JRTIDN 02 S'TJ..TEM2NT KITH ?.L.yrv;SXT
----------- ~._--~-------~--~_.~------
_"A.ccoun'.:. ~Jo 2560 .4:5. ?g & Ad Disc Disc CO:l~ ?enaley Bill Ser-v
:::at'2 =>esc~i?~io:1 S~z'::: Se::: Cos'c Ame 'tI.~ 1 .25% Cbayge
lOOS/09/07 EN] h. KURTZ 1. 00 P06S1 .00 .00
lOOS/09/14 EN] A. KURTZ 1. 00 P07S1 .00 .00
2005/09/21 EN: A. KURTZ 1. 00 P07S1 38.00 .00
Net
Adjustmen:.
~;::.l
Cost
c.~ ~'ayme:1t
l)ue
3alance ?o::::-....ia~d:
.00 .00
.00 .00
38.00 38.00
PAY THIS AMOu~T 38.0C
WHEN PAYING YOUR BILL -
PLEASE PUT YOUR ACCOUNT lillMBER ON YOUR CHECK
. OR REFERRING TO YOUR ACCOm~T. . PLEASE USE YOUR ACCOul~T Im~BE
LATE CHG: 1.25% added to Bal. Due after 30 days
3ILLING SERVICE CHARGE: $3.50 added to Bal. Due for each additional billing for unDaid balar
90'82:/0, 83.L:iV *
08'09 INnOIAl'U SIHl A. 'Ud Z:j..::rn)IUWf':j.s8
~96'ZL 83080 3S\lf-
Nntl ,
SC 9 dCId10 NO 1.1';[;) I 1:8:Dd dO dOOCId
Sv'vS 8DCI"i;i}D ffi[ 1:V.10.1
SV'VS 1:D1: t: 1:';[831: - 1:8NI.1N3:S 3:H.1
.1NnOVW ssmm .1NnOI^J\I l.3N 3.1 \18 SNOl.1tl3SNI NOI.1 \lJlll
SO/Z'G/60 SO/80/60 o Q3.1NVCID N838: 3:A"iH SCI3J,.13:'1 3;) I J,(
3.1 VO dO.1S :HVO 18V.1S NOI.1dll:DS~O
1 S1 SO/8C:/60 OJlOM S3:;)I.10N ;)I'18:Dd 01 I t:lc:t:6'G
S3NIl 3.1 VO 9NIlll8 NOS83dS3lVS SSVlJ 838I^JnN
''11:0Q 'V DIVCI;) MV1: \ nOLt 'id ' 3:'1 S I'1cr'i::l 'on xos: '0
.1 -\i 'X.1J,V '1Vf):!I'1 - '1:!INI.LNHS :!IE
O.1lll8 SS3800V 3:JNV.1.1W,
SGClOJ3Cl ClnOA ClO:l NOI1ClOd SIHl NI\f13Cl
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
RECEIVED FROM:
KURTZ MICHAEL P
405 MOUNTAIN VIEW lANE
DAUPHIN, PA 17018
__n_n fold
ESTATE INFORMATION: SSN: 171-26-1627
FILE NUMBER: 2105-0728
DECEDENT NAME: KURTZ ANN M
DATE OF PAYMENT: 04/25/2006
POSTMARK DATE: 04/26/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 08/05/2005
NO. CD 006607
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $293.52
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK#1013
SEAL
INITIALS: MG
RECEIVED BY:
REGISTER OF WILLS
$293.52
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
LUMMUNWtALI H Ur- f-ltNN::iYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
HtV-ll bL' tX(11-96)
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
RECEIVED FROM:
NO. CD 006607
DUPLICA TE
KURTZ MICHAEL P
405 MOUNTAIN VIEW lANE
DAUPHIN, PA 17018
__nn~~ fold
ESTATE INFORMATION: SSN: 171-26-1627
FILE NUMBER: 2105-0728
DECEDENT NAME: KURTZ ANN M
DATE OF PAYMENT: 04/26/2006
POSTMARK DATE: 04/26/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 08/05/2005
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $293.52
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK#1013
SEAL
INITIALS: MG
RECEIVED BY:
J-\hl\~~V (~~2ulCLT[D ~rt
'0-: D,A~ r--l L N-r
/}- llcl
REGISTER OF WILLS
$293.52
GLENDA FARNER STRASBAUGH
REGISTER OF WillS