The URL can be used to link to this page

Home My WebLink About10-30-06 . , . , --.J 15056051058 REV-1500 EX (06-05) PA Department of Revenue *. Bureau of Individual Taxes . ;.. ~. PO BOX 280601 . .' . ~" Harrisburg, PA 17128.()601 .... . -' ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year Fie Number 21 06 0074/' Date of Birth 176-32-2941 08/17/2006 07/11/1915 Decedenfs Last Name Suffix Decedenfs First Name MI Lamey Anne c (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW . 1. Original Retum 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return f~eQuired 4. Limited Estate 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (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) CORRESPONDENT - THIS SECTION MUST BE COMPlETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received o 8. Total Number of Safe Deposit Boxes Florence H Galbraith (717) 697-0529 Firm Name (If Applicable) Mechanicsburg PA 17055 REGISTER OF WILLS USE Q~LY ~~ .~g "'_~::;'O c:r", :TJ C) n C:l ;Tp --I iT] G) ~5? C) )C) ,~_) un .DA~FILED _.t.. ':.;---1 ''\:1 ~-~ ,) First line of address 936 Emily Dr Second line of address City or Post Office State ZIP Code -r_.rl (~) Correspondenfs e-mail address:jg936@aol.com Under penalties of perjury, I declare that I have examined this return, Induding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. :;Z~;:;~;:';-JL?i:t"j'?:r;.<!X--__ _ DATI'R/le/-" t ~36 Emil~Qr:~ Mechanicsburg, PA 17055 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY L 15056051058 Side 1 15056051058 -.J ..J 15056052059 REV-1500 EX Decedenfs Name: Anne C Lamey RECAPITULATION 1. Real estate (Schedule A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 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) Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 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) .. . .. . . . . . . . . . . . .. .. . . . . . . . . . . 12. 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) .. . . . . . . . . . . . . . . . . . . . . .. 13. 14. Net Value Subjectto Tax (line 12 minus line 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)X .0_ 16. Amount of Line 14 taxable at lineal rate X.O_ 17. Amount of line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 16,581.96 15. 16. 17. 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 176-32-2941 Decedenfs Social Security Number 15056052059 24,021.99 24,021.99 5,957.16 1,,482.87 7,,440.03 16,581.96 16,581.96 2,487.30 2,487.30 ...J , , REV-1508 EX+ (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Anne C Larney FILE NUMBER 21-06-0074 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. ITEM NUMBER DESCRIPTION The WDods at Cedar Run; 824 Lisburn Rd;Camp Hill, PA 17011 for Apt. 606 & Room 232 VALUE AT DATE OF DEATH a) Refund Meal Credit 175.00 b) Interest Earned on Deposit 76.99 c) Deposit Refund 2,305.58 2 Marsh Affinity Home Care Insurance - Policy Premium Refund 59.95 3 Verizon Telephone - Acct Refund 0.20 4 USAA - Renters Policy Refund 10.87 5 USAA Credit Card Savings Acct - #5420396006028867 1,306.30 6 USAA Savings Acct 12,538.49 7 M & T Checking Acct - #54377617 7,548.61 :VI..; ~~ ~.-'- ~ fl-/ ~ r~' t ~ ~ r!Lu.d. TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 24,021.99 , , SEP-0S-2006 12:10 PM THE WOODS AT CEDAR RUN The Woods at Cedar Run \ GCCC 824 Lisbum Road Camp Hill, P A 17011 CUSTOMER Anne Lamey 82<1 Li!burn RDIId Apt. If. 232 Camp Hill. PA 1'7()11 DESCRIPTION "'==--=.l I Tcoml Sec:urtty DepO!iit 3 claY' pro-lIICd 8/29 - 1131/06 - Bmokvi_ SuitOl Aaiatcd Llvin. Mall CredIt. Brookvlew Suiles Auilted Livina - 7125 -1121106 717 737 3490 P.01 Credit Memo [_n_~~Ai~-~-~~~I~ ~.~~~ 113112006 I .. 114414 -- ... . ,..._~._._---_._.._,. . (j) __p,o :' .1___~ROJECT QTY RATE AMOUNT -2,0'3.00 -252.58 -1".00 'M._'_..__.~_ ____._._. .,~ 2,053.00 -] 14.19355 -35 5.00 .. .....M....____,_.... I Total .. -......._.___L__..... '. , .L___.__ I .. ..1 S-2.480.~8j . , THE WOODS AT CEDAR RUN/GCCC 824 L1SBURN RD. CAMP Hill, PA 17011 DEBTOR IN POSSESION CASE # 1-06-00-914 M & T BANK NYC COMMERCIAL BANKING MANUFACTURERS AND TRADERS TRUST COMPANY 60-295-313 (jJ 9/7/2006 PAY TO THE ORDER OF' Anne Larney $ ** 175.00 One Hundred Seventy-Five and 00/ 100*** * * ******** * ** ***** **** * ******* ************************************** ************* DOLLAR: Anne Lamey 824 Lisburn Road Apt. # 232 Camp Hill, PA 17011 11.0 . 5 ~ 2 '7 II. I: 0 ~ . ~ 0 2 g 5 5 I: --~---~- -_._------._-~ MEMO Refund Meal Credit THE WOODS AT CEDAR RUN/GCCC 1~J:'" 153 THE WOODS AT CEDAR RUN/GCCC 824 L1SBURN RD. CAMP Hill, PA 17011 DEBTOR IN POSSES!ON CASE # 1-06-00-914 M & T BANK NYC COMMERCIAL BANKING MANUFACTURERS AND TRADERS TRUST COMPANY 8/23/2006 60-295-313 **76 99 PAY TO THE Anne Larney $ . ORDER OF' * ** ** * * ** ** * * * * * * * * ** * * ** * *** ** ** *** * ** * ** * *** * * * ** ** * * * * * * * * **** S. d 99/100******************************** DOLLJ Seventy- IX an Anne Larney 824 Lisburn Road Apt# 232 Camp Hill, PA 17011 ~~---~-- MEMO Interest earned 611/05 - 8/31/06 II. 0 . 5 ~ 0 '7 III I: 0 ~ . ~ 0 2 g 5 5 I: 8 8 g 2 58 5 2 7 '7 II. _.___.,.^~__.._~____~___~M________'_ 154 THE WOODS AT CEDAR RUN/GCCC 824 L1SBURN RD. CAMP Hill, PA 17011 DEBTOR IN POSSESION CASE # 1-06-00-914 M & T BANK NYC COMMERCIAL BANKING MANUFACTURERS AND TRADERS TRUST COMP~\NY 8/31/2006 60-295-313 PAY TO THE ORDER OF' . d 58/100***************************************************************************** Two Thousand Three Hundred Five an Anne Larney $ **2,305.58 DOLU Anne Lamey 824 Lisburn Road Apt. # 232 Camp Hill, PA 17011 f2 <I tri~ __ -_.~--~-~._--_.__.__._-------------- MEMO 1110 * 5.... * 5 III I: 0 ~ * :1 0 2 g 5 51: 88 Ii 2 58 5 2 7 7 III Marsh Affinity Practice a service of Seabury & Smith, Inc. ....-------..~ ~/--. o 1776 West Lakes Parkway/West Des I\'loines, Iowa 5039 /515-243-1776 \! '-- -- ,-~--,~--_." ~:K NUMBER L- 836810 CERT NUMBER NAME CHECK DATE BATCH REQUESTOR DATE APPLIED REFUND AMOUNT - 040800004432 - LARNEY,ANNE C - 08/30/2006 60830PRF048 - CR-2240 - 08/30/2006 - ****59.95 / ~~p II11II11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 ~- , ." d~_I~i1._\;_~~e.l.;;1Ii__~_I~~'l'.~.;.~ h'~ ~~_II_.t!th'~~.'_~~~J,.lh~.:,l_ =i'ri_~V:~~:~ci:I.81~ I~ ,I ~,:~e:\J1.~:~_:_I~a:i!j_:f'~.~_.~ ;IJ: .. i ~1~:.".':_~"'(e_I_~lt~.J ~'~_~Sli!~'\)' w'~*~'~.~L?~_.~l~!~i~If~~,~~~l_~#'~:~_~,~":~'~~f:i~u::'_~[~:~_~:1i.9~:i:.1 ,~'ir~_~ g .- ". ,..,'- ....- ,'-- '," .--- --. '" ..-, ,-. .- - -- .... ". M~rsh Affinity practice a service i:lf SeabiJry& Smith, Inc, 1776WEST LAKES PARKWAY WEST DES r.,.10INES. .IOWA 50398 836819 ","' ._ ,.___ ',".,', d.-.- _ ,'.-,-.._ .d ".- '-', - .".-.,. ,',',-.-.' --,'- -- .-.- --.. .-' . ---,. '"'' ,-- ---, .. -- --- .-..-. ....... ,- -- --. -... .. - - -- ., ---- '," ,-- .., - -. .--. .. ". --.-.., :" '- :-".-',' .:-:.- -:- .:--" . - ,.-,' .- - --', . . ---- ~ c.. '-.--, .'- ...-..,... - ''''-,",- ." ... __ .. __ ____ ___ d_ _ _. _" . ___ .", ." - ... d'_,' ,",._.'-" . - - .", . ----- -,.._- ......'. ',"-'-' -- .-' .- .--- -- ---- ','----" -'-' . The Chase, Manhattan Bank, N.A. .' . . Syracus~, New York . .-.'.','--.,' ".-.,', -'-. >:.:..--,,:;::.. : :>::: ":: .----- --- ------... .... *:~***59.95 "CHECK AMOUNT ",.- -- --- - .:. ',.--:. -. .' - .;... . FIFTY NINE AND 95/l00 DOLLARS PAY to THE ORDER OF ESTATE OF ANNE LARNEY 824 LISBURN RD :jf606 CAMP HILL PA _^~htJ,L~ ~ ---~~~~_._~-----~~~~ -~---~- - --~~- ~ --- --.- ..._--~--- -----~------- ---~---,-~-------~--~------- . DATE 09/12/06 CREDIT BALANCE REFUND TELEPHONE NUMBER 717 612-9660 TOTAL REFUND $.20 (}) PA ;,';'" ~/~. ......,...... . . ~ USM@ STATEMENT 9800 Fredericksburg Road San Antonio, Texas 78288 Visit us at usaa.com 2138 110 NE-1 I 2138 LJSAA NUMBER 00039 35 88 - = EST OF ANNE C LARNEY C/O FLORENCE GALBRAITH LTC USA RET 936 EMILY DR MECHANICSBURG PA 17055-5749 TO UPDATE POLICIES GO TO USAA.COM OR CALL 1-800-531-8111 FOR BILLING AND PAYMENT INQUIRIES GO TO USAA.COM OR CALL 1-800-531-6095 TO REPORT A CLAIM, CALL 1-800-531-8222 MONTHLY ACTIVITY BALANCE ON LAST STATEMENT REFUND CHECK ISSUED USAA RENTERS POLICY REN 001 POLICY CANCELLATION CREDIT POLICY CANCELLATION CREDIT RENEWAL PREMIUM ACCOUNT BALANCE AS OF 09-18-2006 POLICIES. BEING BILLED EFFECTIVE.DATE 09-26-2006 USAA RENTERS POLICY REN 001 TOTALS YOUR REFUND CHECK IS ATTACHED. -- - - = $ .00 09-18-2006 10.87 08-18-2006 10.87CR 09-26-2006 101.70CR 09-26-2006 101.70 $ .00 PAYMENT PLAN OPTIONS BALANCE REGULAR PLAN EXTENDED PLAN $ $ .00 $ $ .00 $ .00 .00 .00 $ .00 NOW YOU CAN CHOOSE THE PAYMENT PLAN THAT FITS YOUR NEEDS AT NO EXTRA COST. WE NO LONGER ASSESS A SERVICE CHARGE WHEN YOU PAY YOUR pac INSURANCE BILL ON THE EXTENDED PAYMENT PLAN. SEE THE REVERSE SIDE OF THIS BILL FOR MORE INFORMATION ABOUT AVAILABLE PAYMENT PLAN OPTIONS, OR VISIT USAA.COM. DM4462 18433-0704 PAY ***TEN AND.871100 DOLLARS TO FROST NATIONAL BANK SAN ANTONIO, TEXAS II- REFUND CHECK # 13069431 ~ ~~ USMC"' STATEMENT NE-1 I 1218 110 (j) USAAbd NUMBER D ~ 00039 3S 88 9 9800 Fredericksburg Road San Antonio, Texas 78288 Visit us at usaa,com = 1218 110 TO UPDATE POLICIES GO TO USAA.COM OR CALL 1-800-531-8111 FOR BILLING AND PAYMENT INQUIRIES GO TO USAA.COM OR CALL 1-800-531-6095 TO REPORT A CLAIM, CALL 1-800-531-8222 = = EST OF ANNE C LARNEY C/O FLORENCE GALBRAITH LTC USA RET 936 EMILY DR MECHANICSBURG PA 17055-5749 = - MONTHLY ACTIVITY BALANCE ON LAST STATEMENT SUBSCRIBER SAVINGS ACCOUNT REFUND CHECK ISSUED 09-19-2006 10-17-2006 $ .00 1,306.30CR 1,306.30 ACCOUNT BALANCE AS OF 10-17-2006 $ .00 POLICIES BEING BILLED PAYMENT PLAN OPTIONS BALANCE REGULAR PLAN EXTENDED PLAN EFFECTIVE DATE TOTALS $ ,00 $ .00 $ .00 YOUR REFUND CHECK IS ATTACHED. NOW YOU CAN CHOOSE THE PAYMENT PLAN THAT FITS YOUR NEEDS AT NO EXTRA COST. WE NO LONGER ASSESS A SERVICE CHARGE WHEN YOU PAY YOUR P&C INSURANCE BILL ON THE EXTENDED PAYMENT PLAN. SEE THE REVERSE SIDE OF THIS BILL FOR MORE INFORMATION ABOUT AVAILABLE PAYMENT PLAN OPTIONS, OR VISIT USAA.COM. DM4462 REFUND CHECK # 13117930 18433-0704 ~ USAA@ ,; ~I ~F"""'~'n",,,,~. '~--<""'T"""''''''~~-Gc~fff~~}t II; :l,'Ui[lC'l~lInlil J';I~\'i"IU. . \11 . ,. f ;.t:1o. :,'\y'''~{~'TtTi"b'{li~~iU. :":;'~>:'~:'IJ:~)';\V,'u;:;~ft:f"h"~~i\-1I:~~rt}""_' P. ...t~~ ",'~ :':". ; ~"in. . -~1.iI".i '.~.U()i"~ j - ,- ",~'&'6~;;o.:~....'.<.;,'ttiC"'$:<-,~ii':-" _""~k__",";;s~.,j"_;;""'''li\;,.,~.:.._~""''J<'-"~'''"_~~,,,,,, _ ~,,__ti1.. 13117930 9800 Fredericksburg Road San Antonio, Texas 78288 DATE 10-17-2006 USAA NUMBER 00039 35 88 PAY ***ONE THOUSAND THREE HUNDRED SIX AND 30/100 DOLLARS TO THE ORDER OF EST OF ANNE C LARNEY ~****1,30~ FROST NATIONAL BANK SAN ANTONIO, TEXAS ~/~ II- 0 0 . :1 . . 7 g :1 0 II- I:.. L. 0 0 DOg :11: O. 0 28 5 2 8 5 II- ~~ USAA FEDEHAl SAVINGS I31<NK ~ ~ 10750 MCDERMOTT f'Wy SAN MJTONIO. TX 78288-0544 U$,AJ\@ Payee: ESTATE OF ANNE LARNEY FLORENCE GALBRAITH, ADMIN FBO: FLORENCE GALBRAITH, ESTATE ADMINISTRATOR FLORENCE GALBRAITH 936 EMILY DRIVE MECHANICSBURG PA 17055 HOLD DOCUMENT UPTO THE. LIGHT TO VIEW TRUE WATERMARK ~~ ~ U$AA@ USAA FEDERAL SAVINGS BANK 10750 MCDERMOTT FW'I SAN ANTONIO. TX 78288-0544 @ OFFICIAL CHECK -- Receipt 400622631 Regu/2r Mail NOTICE TO PURCHASER As a conditiun to this institution's issuance of this check. Purchaser agrees to provide an inde,nnity bond prior to the refund or repJace.llent of this chsck in the event it ;s lost, rnisplaced, or stolen 09/12/2006 Check NrJ. 400622631 Amount: S12,53849 Reason: Close Account PURCHASER'S COpy NON-NEGOTIABLE 499156243803499157 REV3 05/05 8510026370 10-ili1220 PAY TVyELVE THOUSAND FIVE HUNDRED THIRTY EIGHT DOLLARS AND 49 CENT 538 49 FIVE TH!lU EIGHT PER FDUR 'tINE TO THE ORDER OF ESTATE OF ANNE LARNEY FLORENCE GALBRAITH, ADMIN FBO: FLORENCE GALBRAITH, EST ATE.ADMINISTRA TOR I DHMer':USAA Federal Savings Bank Void if over $12,538.49 '...1........,., ^............"....t Issued by Integrated Payment Syst~ms IlIe.. Englewood, Colorado Tu Cilillank, :-; "-, Oullillo, NY 0.. I m'llIIi II:D '1 "'~~.'''''.lUl.'I.~..,1ll'l ~7<'J ")lllS'K- ""'~!.I\.o 1.....,-p.....~IIIPII ~7tI" .------J y () , t-~ LU l__ . JJj~"' I Fealues AMOUNTS INEXCES~~,,!-^-,,:O"O_~.E?UIRE.~O S:G~!Jl..~=:n;.hU.Jl f D':::'; 00 -' ~~ USAA FEDEHAl SAVINGS I3ANK ~ ~ 10750 MCDERMOTT FWv SAN MITONIO. TX 78288-0544 U$AA@ Payee: ESTATE OF ANNE LARNEY FLORENCE GALBRAITH, ADMIN FBO: FLORENCE GALBRAITH, ESTATE ADMINISTRATOR FLORENCE GALBRAITH 936 EMILY DRIVE MECHANICSBURG PA 17055 OFFICIAL CHECK -- Receipt 400622631 ReguI2r Mail NOTICE TO PURCHASER As a conditiun to this institution's issuance of this check. Purchaser agrees to provide an inde,nnity bond prior to the refund or replac:e.'llent of this ch'3ck in the event it is lost, misplaced, or stolen 09/12/2006 Check NrJ. 400622631 Amount S 12,538.49 Reason: Close AccC'lInt ~c;".~ PURCHASER'S COpy NON-NEGOTIABLE 0~(11/2006 10:27 302-934-2136 M AND T BANK RECORDS PAGE 01/01 499 Mitchell Road Millsboro. Delaware 19966 1-888-502-4349 (302) 934-2955 fax ~ M&TBank Fax To: Jennie Weikel From: Charlene Warrington Fax: (717) 691-3197 Pages: 1 Phone: Date: 9/11/2006 Re; Anne Lamey-Date of Death 08/17/06 o Urgent o :For Review o Please Comment a Please Reply D Please Recycle . Comments: Please fmd below the date of death balance you had requested for the above named decedent. L Account 1ype.... ....................... Checking Account Account Number.......... ...... ....... 54377617 Ownership (Names of).............. Anne C. Lamey Opening Date......, ...... .......... ....06/28/74 Balance on Date OfDeath......"u.$7,574.26 Accrued 1nterest $ 0.95 TotaL...... ............................ ....$7,575.21 rL ~ A ---- LA~.~ /' ,,r--- / i4i\;!iloI:MJOCOMEN1>UI?,TQirHE;LlGH:r;"TO"VtEW,IBUEWATEBM I ~~Com,"OY~~ BUFFALO, N,Y, 14240 I " ,i HOLlJ DOCUMENT UP TO THE,UGHT TO VtEW TRUEWATEBMARK"t.: ~cr 424658372-{4] :l 23-97/1020 REMITTER DATE 10/16/2006 7,548.61 tD SOW"" Features Datallson "'" \ ( Florence H Galbraith ~YTO THE ORDER OF Florence H Galbraith I $ ~~SEVE"~ THOUSAND FIVE HUHDREb FORTY EIGHT and' 61 11 oo***uSDollars TWO AUTHORIZED ~c:--- "ru'~ '~'fSI 7iL:O~~' 0': I H IZED SIGNATURE ~WER: M & T BANK led by Integrated Payment Systems Inc" Englewood, Colorado ~organ Chase Bank, NA, Denver, Color~_ M> ===--==_ AUTHORIZED SIGNATURE II- :\ I... 2 5 :\ 2 II- I: .0 2000 g ? gl: b BOO I... 2 I... b 5 B 3 ? 2 1...11- . -'. - -- - '" -'.- ;,..----'" ---, '.-.- ,,-' ',. " . . ,,-'- --, - " >,-, .. OFJ;~ltli\L CHECK (iJ . ,': I "- ORIGINATING CIiEEJ,'", " EMPLOYEE NUMBER COST I".' UIiILEIJ CENTER !,!!';' I / i " ! Ii ,: ~'-:. , 1 t I SUB PRODUCT DEBIT:;WIP TRA~SAGT,ION AUTHORIZATION !:,"'"-?, '" I. ,( J ~ :' '. - .-. GF-269 (5/98) DATE i ""T"'./!.~ f (- ~ ",;. . -....,"" ~ DESCRIPTION r" :' "'7' Original - Processing Work Copy 1 - Central Balancing Copy 2 - Branch/Dept. I, G/L NO, POSTING COST CTR, ~~ CUSTOMER SIGNATURE ORIGINATING I ~'~IIAN r~_E, I ' TST TNTr ',' I __ -' ~ " i ; ..' _-- 5IJ~~Q,~O :T ,-, _', i ;- LLLLC1:LLLLJ .' ," "~_- J "t, , . REV-1513 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Anne C Lamey FILE NUMBER 21-06-0074 AMOUNT OR SHARE OF ESTATE NUMBER I RELATIONSHIP TO DECEDENT Do Not List Trustee(s) NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Florence H Galbraith; 936 Emily Dr; Mechanicsburg, PA 17055 ~ \ e c.e.... 100.00% 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 N/A B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS N/A (If more space is needed, insert additional sheets of the same size) TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 ," '. REV-1512 EX+ (12-03) '* SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Anne C Lamey FILE NUMBER 21-06-0074 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unrelmbursed medical expenses, ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1, Messiah Village 50.00 2 Patriot News - Legal Notice 98.13 3 Commissioned Officers' Club - Funeral Luncheon 631.89 4 Classic Printing 61.48 5 Talbots 276.00 6 Postage 39.00 7 UPS 26.37 8 Estimate for Preparation of State and federal 2006 Tax Retums 300.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1,482.87 , . REV-1511 EX+ (12-99) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Anne C Lamey FILE NUMBER 21-06-0074 ITEM NUMBER A, Debts of decedent must be reported on Schedule I. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Neill Funeral Home, Inc,; 3401 Market St; Camp Hill, PA 17011 - Statement Attached 5,797.16 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 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Florence H Galbraith Street Address 936 Emily Drive City Mechanicsburg State PA .Zip 17055 Relationship of Claimant to Decedent Niece 4. Probate Fees 160.00 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) 5,957.16 - NEILL Funeral Home Inc. Mrs. Florence Galbraith 936 Emily Drive Mechanicsburg, PA 17055 Services For: Anne C. Larney Services of Funeral Director and Staff . . . . . . . . . . . . . . . . ., $ Embalming ...................................... Dressing Casketing and Cosmetology . . . . . . . , . . . . . . . . . . Visitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Funeral Service .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Transfer of Remains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hearse/Coach and Driver . . . . . . . . . . . . . . . . . . . . . . . . . . . Safety/Lead Vehicle and Driver . . . . . . . . . . . . . . . . . . . . . . . Flower Van and Driver . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . Veterans - Box set . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Death Certificates .... . . . . . . . . . . . . . . . . . . . . . . . , . . . . . Hairdresser . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Vera Lee Garment Co. 479 CR BL 60 . . . . . . . . . . . . . . . . . . Patriot News Obituary . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . Huntington Daily News Obituary . . . . . . . . . . . . . . . . . . . . . . Package Savings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rev. Rothan '" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dauphin County Honor Guard '" . . . . . . . . . . . . . . . . . . . . . Blooms by Vickrey / Floral . . . . . . . . . . . . . . . . . . . . . . . . . . . Valley News Dispatch Obituary . . . . . . . . . . . . . . . . . . . . . . . Total Funeral Charges Adjustments (Payments) 3401 Market Str('('1 Camp Hill, PA - 17011-4428 t('1 717 7)7-8726 fax 717 737-1859 Rebecca J Donahue, Supervisor Balance Due on Al:icblmtv tfime date: 08/22/2006) Harrisburg. PA - 17] ] j -181 7 tel 71 7 564-2633 fax 717 561-9918 Stephen]. \Vilsbach. Supervisor September 5,2006 Ref No.: 1003345 I C06 067 $ $ 1,935.00 515.00 205.00 315.00 515.00 415.00 315.00 205.00 1 00.00 190.00 90.00 85.00 155.00 360.80 35.00 (370.00) 125.00 50.00 471.70 84.66 $5,797.16 0.00 $ $5,797.16 tv1f:'fllhc[ of ALDERWOODS eRell;!'