HomeMy WebLinkAbout11-13-06
.-J
15056041046
REV-1500 EX (05-04)
PA Department of Revenue
Bureau of Individual Taxes
Dept. 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Number Date of Death
OFFICIAL USE ONLY
County Code Year
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
~ I 0 (p
00 '7Q '7
Date of Birth
I '1 9
o 0
o
10
o
lo
C"J
C, Ig l Y
Decedent's Last Name
Suffix
Decedent's First Name
MI
o
Cqrr/E~
G-
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
Spouse's Social
Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
_ 1. Original Return
c:::>
4. Limited Estate
c::::>
3 Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
c:::>
2. Supplemental Return
c:::>
c:::>
c:::> 4a. Future Interest Compromise (date of
death after 12-12-82)
c:::> 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
c:::> 10. Spousal Poverty Credit (date of death c:::> 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 Daytilme Telephone Number
8. Total Number of Safe Deposit Boxes
c:::>
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
.01 a r
I yrJ
Hurley
-7 11 J, L4 3 3 q 7S
Firm Name (If Applicable)
REGISTER OF WILLS U~NLY
f ~;:-)-
c.;>
t..;....-'
'-'"iT
-=~
c.)
First line of address
C"J
I '10
'W Q
o
Y'lU
Second line of address
r~-)
-,'1
FILED CO
City or Post Office
State
ZIP Code
.)>
(, a r- I
5 I c
A
I, 0 13
-.J
Correspondent's e-mail address: \
Under penalties of perjury, I declare that I have examin this return, including 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.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN nATF
~{;:~:~:~,,~::~~;~\Qe~ "'Q,"<>-~~"'\,~oO~
SIGNcr.:.m.:RE~E~~:t~N REPRESENTATIVE
ADDRESS \ \ J
-3 ). \ ~ C--c C,J J ..('r. / N C:: 'vJ L-i.,.. f\, 10 (;y 1 G"
~ATE
J [- j-QlP
fit
17070
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056041046
15056041046
---.J
..-I
15056042047
REV-1500 EX
Decedent's Social Security Number
Decedent's Name:
I (9 ocr
0..0 I
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.
8.
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-Probate Property
(Schedule G) C) Separate Billing Requested.. . 7.
9. Funeral Expenses & Administrative Costs (Schedule H). . .
.. ... .. .. 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .
. . 10.
9
\<3
34
11. Total Deductions (total Lines 9 & 10). . . . . . .
11.
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) .
. 12.
. . . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13)
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_
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
. 14.
~ .~. <6 <6 \ ...~ 34
15.
16.
17.
18.
19 TAX DUE. . . . .
. . . . . 19.
lo
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
C)
Side 2
L
15056042047
1,5056042047
-1
REV-1500 EX Page 3
File Number
Decedent's Complete Address:
DECEDENT'S NAME
LQrrlC':
G-
Gro.ss
AV(
STREET ADDRESS
i ;2, 0
\;.k, I tOt0
CITY
c...- (,1' II J It
STATE P f~
ZIP
) ", 0/3
Tax Payments and Credits:
1, Tax Due (Page 2 Line 19)
2, Credits/Payment?
A, Spousal Poverty Credit
8, Prior Payments
C, Discount
(1)
I 0 d. q .. (o~
51.4~
Total Credits ( A + 8 + C ) (2)
.5\ol4~
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.
Fill in oval on Page 2, Line 20 to request a refund. (4)
8, Enter the total of Line 5 + 5A, This is the BALANCE DUE.
(5)
(5A)
(58)
Cjj'6.lg
5, If Line 1 + Line 3 is greater than Line 2, enter the difference This is the TAX DUE.
A, Enter the interest on the tax due,
9/'6~ 1<6
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 ~
b, retain the right to designate who shall use the property transferred or its income; "'''','''' "" ,,"" " ,,,"" '''' 0 r8'.!
c, retain a reversionary interest; or"""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,",""'''' 0 ~
d, receive the promise for life of either payments, benefits or care? ''','''''' "" """ " " "" ,,""" ,,"""''','''' ",,"" 0 g]
2, If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? "'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' ,,""""',," 0 fZJ
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
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, S9116 (a) (1,1) (i)],
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent
[72 P,S. S9116 (a) (1,1) (ii)], The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary,
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is 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 PS. S9116(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 PS, s9116(a)(1 ,3)], A sibling is defined, under
Sp.r.tion 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
RE\i-I503 Ex + (1-97)
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
CCrrl(
G
G- r05.5.
FILE NUMBER
;11 - O(p. 00 t] 9 7
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
J..
LI S _ $avi1J:i> BCi-IJ
(, J,5. F';:L (.
SC"'YJt./ t- G J). S D 3'7 q J. ~ 3 E
J9f6.'l;
J ql.o,;9
1.
US. 5avi).)J s f>c;.;<l
<$),,5. f.;".
Se-r;t. / 11 Q J;;Z Si ).. Co 5 { 3 J'-l E
3~
(, '1 .s h "..t! .)
f'rle:t Lite- J:nL.,
3/~Lj..50
TOTAL (Also enter on line 2, Recapitulation) $ q 13 9" i <.0
(If more space is needed, insert additional sheets of the same size)
REV:':'l8 EX . (1-97)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Corrl(;
G-
GrosS
FILE NUMBER
;21- b& - DO 79-/
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
iY\ ".J i i6CiI'l/L. - c'hjJthlt:..1 C 1i4 b r;c..v" NJ S {jL(.iPvt
(tut -:I::- ~ 50 D Lj q ?. 0 I 0 '7 J. 91
VALUE AT DATE
OF DEATH
.5 5 01o~..L..
.~.
I q ql c.. hry 5 lc; (' C.OI\CO") S(;JON
V:r IV - ;). c. 3 H 0 5 ~ F L4 V H 10 S i 1./ ;).
1050.00
TOTAL (Also enter on line 5, Recapitulation) $ i ~ 00. y)..
(If more space is needed, insert additional sheets of the same size)
Qt'.' .~.:"';; r::x + (1-97)
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNS, LVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Co('ri~
G-
G-ro.5S
FILE NUMBER
;;1ll - b{,,- () 0 '79 7
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 fYlu(/IYJJ S, HLArley
1),0 wo/ta,.; Ave,}
e. c. r I JJ it
Pit J701J
DauJ ~Tt:f
B.
c.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY '10 OF DATE OF DEATh
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OIF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERE
1. A. '-3i-05 M liJ 1- 8 C;}1/<" - C- kd,.I'wy /tc (.()I.'''' C1"74.lJli SOla 4 'if '7.. 0
A at-it 5S 9~)' Y
i 8'^,,~- SC"" Aij fJe:. c..,,-,,,t - 1Y) 1\1\ .4c..:.;;......t 4 3(.,,~".7~ 509,; ;), I SL.l, 37
B 1-31-05 rY\ (,,, J
(tcc,tif: 15004 ~oo131S91
TOTAL (Also enter on line 6, Recapitulation) $ J..<07/~31
,~ 'r
-,;
o
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
CarrIe:
G-
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
GrosS
FILE NUMBER
;( 1-0&'- 0079'7
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 COliER SHEET is yes.
DESCRIPTION OF PROPERTY %OF
ITEM iNCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
ATTACH A COPY OF THE DEED FOR REAL ESTATE.
NUMBER VALUE OF ASSET INTEREST IF APPLICABLE)
1. fT) (d LI ~<= f1 f) 'lud-y
11J.~.tll 100$'" - J '7J.1.01
ftu.t1 ooo~9 O,;q 3 p., 5
D. - d- ~yo~, 5(p
)~ A116tl-tT0 A ny\l.il t-y ~~y O~.':;L, IOo7v
(tLd1t A c... 100 Sf :.2.54
TOTAL (Also enter on line 7, Recapitulation) $ d-Y> j 30. 5'7
. .
(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
Gro5S
ITEM
NUMBER
A.
C orr IE
FILE NUMBER
J.l -- 0(" - 0 0 ~7 q 7
G-
Debts of decedent must be reported on Schedule I
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
i~otffr\c.;J - A.orL. Fi.-l/1U..i HtJi'-lt; JilL-
sr. t'r\c;ttht\J S U c...c.. - Li-tflC~(c,J 1::-~"IiWIJl/J pl,,~(r,;/
g 1'-1/..)0
J 500 00
RILe: MC:MDUc/ ~/o,-I<.s ,-
H (: c ~l .s t." (. )\,t, k I N~ j
JJ...5" 00
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
2. Attorney Fees
Year(s) Commission Paid:
3.
4.
Family Exemption: (If decedent's address is not the same as claimant's. attach explanation)
Claimant fhCi rt I r AJ s, t-I {,; 1'1 (; Y
Street Address I ~ 0 W Ct/n: iJ five:..,
City c..OrtIStC; State~Zip )70lJ
Relationship of Claimant to Decedent OCH".J ~t(,'r
Probate Fees ,- t l..t ",b '-7 tt:.J t.(;~;iJ ty
3500. 00
~J... 00
5. Accountant's Fees
6.
7.
I 0 5., 0 0
Tax Return Preparer's Fees - It N l fl.'.,: ,!,'(:fI/I<'C ]:nG
N6tvry KC:J ,~..( TItle jr""J kl" /-c::c~ of- V (:~I(,1 &
1;;(1.50
TOTAL (Also enter on line 9, Recapitulation) $ i 3 d.. II., ). 0
(If more space IS needed. insert additional sheets of the same size)
REV-1512 EX+ (12-03)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
FILE NUMBER
G GroSS ~1-Olo'O()r)C11
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, includin!~ unreimbursed medical expenses
C arr;(
-
VALUE AT DATE
OF DEATH
ITEM
NUMBER
DESCRIPTION
t\...OfNwutJ }JOM\G-~ UJJIh.'-(:1 thl(.L, OJ. (h//Jt H(Jr-,C-j
3/5..00
-d.,
(rcd; t CD rJJ - Tkc fJon - ion
t7 3" 9~
YLi<6"q~
TOTAL (Also enter on line 1 0, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV:1513 EX+ (9-00) _
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
CarriG
G-
G-ro!'~
FILE NUMBER
J. ) - 0 (p '- 0 0 '7 9 7
ESTATE OF
1.
RELATIONSHIP TO DECEDENT
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not ListTrustee(s)
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
t'Y\ardYAJ S. HiAl' /€Y OCtj,.~~hV'
, J.. 0 \IJ (, IIOJJ It t/t:.
c.. C.t' II J Ie: p !} I 7 0 I J
AMOUNT OR SHARE
OF ESTATE
NUMBER
I
5o~o
~.
Ju. Mt-j It G-ro..d~ S DN
J <6 '-11 stC:1' r(ttJ Ge-V A V(;.
(,orl/Jl6 fit 1'70/3
l.'
SO/v
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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
,.-...,.,.,
CARRIE G. GROSS
MARILYN S. HURLEY
PH. 717-243-3975
120 WALTON AVE.
CARLISLE, PA 17013
DATE 'S::..~ 5 C.l('{,
~4335
313
3303
PAYTOTHIt:"\ -..<'\ It..~, ... - n' ...... "'-.l. \ \
ORDEROF ,)""'.V\9--,......~e.~'S ~.c..'-'. ~,\1\ti::.~S , '1'\.',3t'-'\,O.~
C'C
('1\..,("" "-n \>. '" c\."'\7e6 <::;, '-~ ,....... o.'C\~ \.0(\
r:!MaTB~ " '-
~ andT~ TruslCanpany
North Middleton Office
$ co
\50 -\crt
DOLLARS 6:J
MsaSc-h:t:m
(... .
MEMO" U 'n e ~ClL'-- \ u"-nC,,", ~0 -""'
~~ ~ '!;~_ M'
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I 1:0].]0 2 q S SI:
~
~..
-----.----.--
... ,..... .. ...........,,",. .".,.,...
CARRIE G. GROSS
MARILYN S. HURLEY
PH. 717-243-3975
120 WALTON AVE.
CARLISLE, PA 17013
~433';
313 '
3309
DATE S~ \:~ !;).. \ 0 (:,
----.J $ \co ~
~~~J~ ci':'E ~ \=\ ~ ~D,,- '" <Y'~\
. ~0
S \ 'k" ~ "f>-n~ ~'nt-.- lOt> ..-
~~~
North Middteton 0Ifice
- DOLLARS {D ~!::.,
MsaSc-h:t:m
MEMO ')(~ "I... >:: \( ~ -:I 'i. v.... 0 ~ 0
1:0] .]0 2qSSI:
~~s~~_ M'
S Sqb-2~:~ ]Clq =-~OOOOOO ~-~~
--;-_.~
...-. :.m
I
!
60-295 '1335
313
3310
CARRIE G. GROSS
MARILYN S. HURLEY
PH. 717-243-3975
120 WALTON AVE.
CARLISLE, PA 17013
DATE 5f.~ [(\ 0 <e
I $ 5"l \~
I ~
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1200 Your Account Stated to Date - If Error is Found, Return at Once
HofIman-Roth Funeral Home, Inc.
219 North Hanover Street
Carlisle, P A 17013
(717)243-4511
September 15,2006
Marilyn S. Hurley
120 Walton Ave.
Carlisle, P A 17013-
The Funeral Service for Carrie G. Gross
14835-156
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
OUR SERVICE:
Traditional Funeral Service Package . . . . . .
FUNERAL HOME SERVICE CHARGES
$3890.00
$3890.00
SELECTED MERCHANDISE:
Mansfield-Stainless Casket. " . . . . " " . . . . . . . . . . .
Monticello Interment Receptacle. . . " . . . . . . . . . . " . .
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THATYOUHAVESELECTED " " . . . . . . . " . . .
$2865.00
$1190.00
$7945.00
Cash Advances
Opening Grave. . " . . " . . .
Newspaper Obituary Notice-Sentinel. .
Newspaper Obituary Notice-Patriot News.
Clergy Offering . " . . . . "
Certified Copies of Death Certificates"
Flowers
Hairdresser.
Organist. .
$500.00
$133.40
$236.80
$100.00
$30.00
$132.50
$30.00
$40.00
TOTAL CASH ADVANCES AND SPECIAL CHARGES .
$1202.70
Total
Total Cost .
$9147.70
TOTAL AMOUNT DUE
$9147.70
"his statement is net and payable in full within 30 days of receipt.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - - - - - - - - --
Please return this portion with your Remittance
$
Amount Enclosed
Service 10 # 14835"156
Carrie G. Gross
Statement
united Church of Christ Homes
Thornwald Home
442 Walnut Bottom Road
Carlisle, PA 17013
Statement Date: 09/01/2006
Marilyn Hurley
120 Walton Ave
Carlisle, PA 17013
Due Date: 09/25/2006
Re: Carrie G Gross
Account Nr: 600
--------------------------------------------------------------------------------
Date
Description
Days
Quant
Rate
Charges
Payments
Balance
--------------------------------------------------------------------------------
165.00
165.00
.00
375.00
BALANCE FORWARD
08/18/06 PAYMENT
08/31/06 Private Room Differ
165.00
25.00
15.00
375.00
RECEl.l?'l' FO.R. l'AYMEN'l'
GLENDA FARNER STRASBAUGH
Cumberland County - Register Of wills
One Courthouse Square
Carlisle, PA 17G13
Receipt Date:
Rece=!-pt Time:
Recelpt No.:
9/12/2006
16:08:57
1045644
GROSS CARRIE GABEL
Estate File No. :
Paid By Remarks:
2006-00797
GROSS CARRIE G HURLEY MARILYN
AJW
------------------------ Receipt Distribution ------------------------
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST
WILL
SHORT CERTIFICATE
JCP FEE
AUTOMATION FEE
Check# 3307
Total Received........ .
20.00
15.00
12.00
10.00
5.00
----------------
$62.00
$62.00
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
BUREAU OF RECEIPTS & CNTR M.D
CUMBERLAND COUNTY GENERAL FUN
Rice Memorial Works
417 W. Main Street
New Bloomfield, PA 17068
(717) 582-2512
Marilyn Hurley
120 Walton Avenue
Invoice
1 0/20/2006
Carlisle, P A 17013
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13-30117 9/13/2006 Carrie Gross Ann Shull
1 Cemetery Inscription
~ cvtde4 f-04 a tnenWJtial Oft
iIM CJdptUut i6 fWW ccunpfete_
Order Total: $125.00
PaymEmts: $0.00
----"--_.._--_.,._-~-
Balance Due: $125.00
A finance charge of 11f2% per month (18% annually) will be added after 30 days
PLEASE TEAR THIS PORTION OFF AND RETURN WITH PAYMENT
Rice Memorial Works
417 W. Main Street
New Bloomfield, PA 17068
Family: Gross
Contract#': 13-30117
Balance Due: $125.00 Amount Paid: i :6.5___"
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1022575 0002597
~AUstate@
September 28, 2006
RE: Allstate@ Performance Plus
# AC1008725A
The check amount of $12,880.47 represents the net proceeds of your annuity as of 09/28/06.
Gross Annuity Value as of 09/28/06
$13,204.28
$13,204.28
Gross Withdrawal Amount
Less Federal Income Tax Withholding
Check Amount
$13,204.28
$323.81
$12,880.47
$13,204.28
Remaining Annuity Value as of 09/28/06
$0.00
As required, the taxable amount of this distribution will be reported to the Internal Revenue Service on
Form 1099R. A copy of this form will be mailed to you by January 31 of the next year.
If you have any questions, please contact your representative or call Allstate LifEl Insurance Company
at 1-800-755-5275. If we can be of any service in the future, we would again wl31come the opportunity
to assist you in reaching your long-term financial goals.
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C88YWRAO.N01
NYLR24.1 A
MetLife
Metropolitan Life Insurance Company
If you have questions about your payments, call:
1-800-635-7775
ANNT 10: 000690213RB
ALL INQUIRIES SHOULD BE DIRECTED TO:
METLIFE
P.O. BOX 10359
DES MOINES IA 50306-0359
DATE OF CHECK
GROSS PAYMENT
FEDERAL TAX
STATE TAX
NET PAYMENT
SEP
$
$
$
$
21 06
1,722.01
.00
.00
1,722.01
#BWNMDRP * * VCHK1
#DQPHZQSMC////FA8#
MARILYN SHURLEY
120 WALTON AVE
CARLISLE, PA 17013-1240
To Request a Change of Address, Contact Us at 1-800-635-7775 or Mail Your Request to
the Address Listed Above. For Written Requests, Please Include Your Name, Signature,
Contract Number and Full Address (Street, City, State and Zip Code).
J54BVP,SCRE (OG/oll
Detach stub before cashing
STEP AHEAD AUTO WORLD, INC.
1080 Harrisburg Pike, Carlisle, PA 17013
1995 Spring Road, Carlisle, PA 17013
Phone: (717) 258-1150
Fax: (717) 258-0914
PLEASE ENTER MY ORDER FOR THE FO~ING
USED [J AS ISl8
DRIVER L1C. #
STREET
CITY
STATE
ZIP
PHONE
RES.
PHONE
BUS.
YR.
MAKE
. .
MODEL
cJ"q:;/{
COLOR
RIM
VIN
TITLE NO.
ADDRESS
POLICY NUMBER
COLLISION DEDUCTIBLE
INSURANCE CO.
SPOKE WITH
EFFECTIVE DATE
EXP. DATE
VERIFIED BY
o USED CAR WARRANTY - Used caris covered by a limited warranty detailed in a separate document
o AS IS - This motor vehicle is sold "AS IS" without any warranty either expressed or implied. The purchaser
will bear the entire expense of repairing or correcting any defect that presently exists or that may occur TOTAL CASH PRICE
in the vehicle.
PURCHASER'S ALLOWANCE FOR TRADE IN
SIGNATURE X
If you cancel this purchase agreement or refuse to take delivery of the vehicle ordered, BALANCE
excepted as permitted by law, you shall, at our option forfeit as damages
the amount of $ SALES TAX
PURCHASER'S
SIGNATURE X
TEMP. TAG
ENCUMBRANCE FEE
TITLE
REGISTRATION
TRANSFER
INCREASE FEE
Purchaser hereby acknowledges to the above clause
DOCUMENTARY FEES
ENCUMBRANCE ON TRADE
OWED TO
TOTAL BALANCE DUE
GOOD THROUGH
USED CAR CONTRACTUAL DISCLOSURE STATEMENT
The information you see on the window form for this vehicle is part of this contract.
Information on the window form overrides any contrary provisions in this contract of sales.
Purchaser agrees that this order includes all of the terms and conditions on both the face
and reverse side hereof, that this order cancels and supersedes any prior agreement and
as of the date hereof comprises the complete and exclusive statement of the terms of
agreement relating to the subject matters covered hereby. This order shall not become
bindinq until accepted bv the dealer or his authorized representative. You the buyer may
cancel this contract and receive a full refund any time before receipt of a COpy of this
contract siqned bY an authorized dealer representative by qivinq written notice of cancella-
tion to the dealer. Purchaser by his execution of this order acknowledges that he has read
its terms and conditions and has received a true copy of this order.
DEPOSIT
SERVICE CONTRACT
BALANCE DUE AT DELIVERY
ADDITIONS OR DELETIONS
PURCHASER'S
SIGNATURE X
DATE
NEW BALANCE
TAX
TOTAL
ffl' !\ If ~T B' ",,_1,{'"
~; }~(J.()(l. . ,i::U..1Il-
STATEMENT,PERlOD
AUG.04-SEP.Ol}2006
2 OF 2
CARRIE G GROSS
MARILYN SHURLEY
ANNUAL PERCENTAGE YIELD EARNED
0.10 %
M&T MARKET ADVANTAGE
CARRIE G GROSS
MARILYN SHURLEY
ACCOUNT NO. 15004200934592
INTEREST EARNED FOR STATEMENT PERIOD
NORTH MIDDLETON
1.46
BEGINNING DEPOSITS' & WITHDRAWALS & OTHER ... CURRENT ENDING
BALANCE OTHER ADDITIONS ' .. SUBTRACTIONS INTEREST PAID BALANCE ..
NO. T AMOUNT NO. I AMOUNT
4}368.74 01 0.00 21 4}370.19 1.45 0.00
ACCOUNT SUMMARY
POSTING
DATE
TRANSACTION
ACTIVITY
DEpOSITS,INTEREST W/DRAWALS & OTHER
& OTHER ADDITIONS SUBTRACTIONS
DAILY
BALANCE
08-04-06 BEGINNING BALANCE
08-28-06 CUSTOMER WITHDRAWAL
09-01-06 INTEREST PAYMENT
09-01-06 CLOSEOUT
4}000.00
1.45
370.19
0.00
ENDING BALANCE
$0.00
ANNUAL PERCENTAGE YIELD EARNED
0.50 %
** END OF STATEMENT **
L008A 11/03)
fl3 M&TBank
ACCOUNT.NO.
ACCOUNT TYPE
559628
M&T SELECT WITH INTEREST
SEP.02-0CT.03,2006
00 7 04335M M 021
CARRIE G GROSS
MARILYN SHURLEY
120 WALTON AVE
CARLISLE PA 17013
INTEREST PAID YEAR TO DATE
3.19
533
HORTH MIDllLETON
974.00
POSTING
DATE
09-02-06 BEGINNING BALANCE
09-05-06 DEPOSIT
09-07-06 DEPOSIT
09-11-06 CHECK NUMBER 3306 1'0j''\
09-13-06 DEPOSIT
09-13-06 MBNA/IBS CHECK PYMT 000000000003304
09-14-06 CHECK NUMBER 3307 - \."
09-15-06 ATG MONTHLY DDA TO SAV
09-18-06 CHECK NUMBER 3305
09-19-06 CHECK NUMBER 3308
09-22-06 DEPOSIT
09-26-06 CHECK NUMBER 3310.
09-26-06 CHECK NUMBER 3309
09-29-06 CHECK NUMBER 3303
10-02-06 DEPOSIT
10-03-06 INTEREST PAYMENT
ENDING BALANCE
OTHER
SUBTRACTIONS
AMOUNT
77.00
0.36
ACTIVITY
DEPOSITS, INTEREST
& OTHER ADDITIONS
CHECKS & OTHER
SUBTRACTIONS
PAGE
1 OF 2
ENDING
BALANCE
8,967.87
DAILY
BALANCE
~
1,344.19
4,271.39
4,266.39
4,389.39
4,327.39
4,277.39
3,821. 99
3,446.99
7,191.49
7,117.51
6,967.51
8,967.51
8,967.87
$8,967.87
370.19
2,927.20
5.00
150.00
27.00
62.00
50.00
455.40
375.00
3,744.50
57.18
16.80
150.00
2,000.00
0.36
CHECKS. PAID SUMMARY
3303
3307
3310
09-29-06
09-14-06
09-26-06
150.00
62.00
57.18
330511 09-18-06
3308 09-19-06
5.00
16.80
455.40
375.00
3306
3309
09-11-06
09-26-06
ANNUAL PERCENTAGE YIELD EARNED
0.10 %
L008A (1/03)
m1oMg~
Septem ber 8, 2006
~\w l3\1\\~ ~l ~ >
5019
CARRIE G GROSS
120 WALTON AVE
CARLISLE PA 17013
Re: Club Account Maturity Notice
Dear Carrie G Gross,
Your Automatically Renewable Club account will mature as shown below:
Account Number:
Maturity Date:
Renewal Date:
Balance as of 09/08/06:
25004920107297
10/13/06
10113/06
~
The proceeds of your Automatically Renewable Club account will be paid to you by
check issued on the first business day following the maturity date listed above.
On the renewal date, we will automatically renew your account and the maturity date
will be 10/12/07. This means that your account will remain open after we pay its
balance to you. Therefore, you can continue to make deposits to the account for the next
cIu b year.
The interest rate and annual percentage yield that will be in effect on the renewal date
for your account have not yet been determined. These rates will be determined on the
renewal date. If you have any questions or would like to obtain the interest rate and
annual percentage yield for the new term of your account, please call the M&T
Telephone Banking Center at 716-626-1900 or 1-800-724-2440.
Thank you for banking with M&T Bank.
Sincerely,
Michele Cole-Hectoh
Michele Cole- Hector
Customer Service Manager
SMACCL CMRVPl
Calculated Value of Your Paper Savings Bond(s)
Page 1 of 1
Calculated Value of Your Paper Savings Bond(s)
HOW TO SAVE YOUR INVENTORY
Calculator Results for Redemption Date 09/2006
Total Price
$37.50
Total Value
$394.66
Total Interest
$357.16
YTD Interest
$0.00
Bonds: 1-2 of 2
Serial
#
NA
NA
. Issue
Senes Denom Date
E $25 11/1956
E $25 09/1956
Next
Accrual
Final
Matu rity
11/1996
09/1996
Issue
Price
$18.75
$18.75
I t tInterest
n eres Rate
$179.72
$177.44
I
Value Notel
I
$198.47 MA II
$196.19 MA
htto:llwww. treasurydirect.gov/BC/SBCPrice
9/7 /2006