HomeMy WebLinkAbout11-22-06
REV.l500 EX + (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
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KILLINGER
DATE OF DEATH (MM-DD-Year)
DOROTHY W.
DATE OF BIRTH (MM-DD-Year)
1 78- 1 6 - 6 834
THIS RETURN MUST BE FILED IN DUPUCA TE WITH THE
REGISTER OF WILLS
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICiAl USE ONLY
FILE NUMBER
2 1 -0 6 0 8 1 4
coUN''r';COoE ---y"'EAR- - - 'NuMiiER- -
SOC~SECURITYNUMBER
08/27/2006 08/23/1918
(IF APPUCABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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[Xl 1. Original Return
D 4. Limited Estate
[Xl 6. Decedent Died Testate (AIIach copy of WdQ
D 9. Litigation Proceeds Received
SOCIAL SECURITY NUMBER
D 2. Supplemental Return
D 4a. Future Interest Compromise (dale of death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy of Trust)
D 10. Spousal Poverty Credit (dale of death between 12-31.91 and 1-1.95)
D 3. Remainder Retum (dale of death prior to 12.13-82)
D 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (AIIach Sch 0)
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule 0) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. JoinUy Owned Property (Schedule F) (6)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
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)
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)
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NAME
ROGER B. IRWIN ESQUIRE
FIRM NAME (If Applicable)
IRWIN & McKNIGHT
TELEPHONE NUMBER
717 249-2353
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COMPLETE MAILING ADDRESS
60 WEST POMFRET STREET
CARLISLE
100,000.00
8.728.04
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(8)
108,728.04
34,283.09
237.85
(11)
(12)
(13)
34.520.94
74,207.10
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
(14)
74,207.10
0.00 X _(15) 0.00
74.207.10 X .045 (16) 3,339.32
0.00 X .12 (17) 0.00
0.00 X .15 (18) 0.00
(19) 3,339.32
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Complete Address:
STREETADDRE55
STATE PA ZIP 17241
Irv NEWVILLE
Tax Payments and Credits:
t. lax Due (Page 1 Llne 19)
2. Credits/Payments
A. Spousal Poverty Credit _
8. Prior Payments
C. Discount
3. InteresUPenalty if applicable
D. Interest
E. Penalty
166.97
Total Credits (A + B + C) (2) 166.97
Total InteresUPenalty (D + E )
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
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.
(3) 0.00
(4)
0.00
(5) 3.172.35
(5A)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5g) 3,172.35
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 : ........................................................................... ^ ^X
b. retain the right to designate who shall use the property transferred or its income : ........................................ ^ ^X
c. retain a reversionary interest; or ...................................................................................................... ^
d. receive the promise for life of either payments, benefits or care? ............................................................. ^ ^X
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ............................................................................................... ^ ^X
3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ................. ^ ^X
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN
Under penalties of perjury, I declare that I have examined 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 mfonnation of which preparer has any knowkdge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN j -y~ DATE
7525 WERTZVI LE ROAD
(1) 3,339.32
1650 NEWVILLE
SIGNATURE OF PREQQRER OTHER KHAN REPRESENTATIVE DATE
ADDRESS 60 WE8T MFRET STREET
tiAtia.tSLt I PA 17013
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the nef value of tral .e is 0% [72 P.S. §9116 (a) (1.1) (ii)].
The statute does not exemat a transfer to a surviving spouse from tax, and the statutory rec a tax return are still applicable even ii
the surviving spouse is the only beneficiary. ~ ~ A Q ]~
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 ~' a ~~~ . pC~ ~ ~i a natural parent, an adoptive parent,
or d stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. = C
1
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal I ~ °~ l~ '.S. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's sibling ~~ ~~) ~ L ~ ~ ~ defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or a
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REV-1502 EX + (6-98r
" '*
,. COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
KILLINGER DOROTHY W. 21 06 0814
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 reasonable knowledge of the relevant facts.
Real proDertv which is iointlv-owned with riaht of survivorshiD must be disclosed on Schedule F.
SCHEDULE A
REAL ESTATE
ITEM
NUMBER
1.
DESCRIPTION
2327 RITNER HIGHWAY, CARLISLE, PENNSYLVANIA
VALUE AT DATE
OF DEATH
100,000.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
100.000.00
REV-1508 EX + (6-gs,
'. .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
KILLINGER
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
DOROTHY W. 21 06
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.
0814
ITEM
NUMBER
1.
2.
3.
DESCRIPTION
Personal Property - Appraisal Attached
Orrstown Bank - Checking Account #106001818
Cash on Hand
VALUE AT DATE
OF DEATH
2,066.00
6,402.04
260.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
8.728.04
REV-1511 EX + (12-99)
'. .
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
'. COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
KILLINGER
DOROTHY
W
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
FUNERAL EXPENSES:
Hoffman-Roth Funeral Home
Westminster Cemetery
1.
2.
B.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
1.
City
State
Year(s) Commission Paid:
2.
3.
Attomey Fees Irwin & McKnight
Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant Esther E. Boldosser
Street Address 48 Fairfield Street
City Newville State P A
Relationship of Claimant to Decedent DauQhter
4.
Probate Fees Register of Wills
5.
Accountanfs Fees
6.
Tax Retum Preparer's Fees Patricia A. Rosendale, CPA
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
Register of Wills, Filing Fee
Cumberland Law Journal
Roy D. Gottshall, Appraisal on Personal property
Max Killinger, Repairs and Labor
Notary Fees
The Sentinel - Legal
Closing Costs on Sale of Real Estate
J.F. McGraw Co. - Water Test and Shock Treatment
About - Bugs, Inc. - Pest Inspection
J.F. McGraw Co. Installation of UV Light
FILE NUMBER
21
06
0814
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
Zip
Zip 17241
AMOUNT
7,077.96
1,150.00
6,100.00
3,500.00
244.00
350.00
30.00
75.00
65.00
299.64
45.00
144.29
13,787.00
175.00
657.20
583.00
34.283.09
REV-1512 EX + (6-98)
'.
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SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
KILLINGER DOROTHY
w.
FILE NUMBER
21 06
0814
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. Dauphin Oil Company
VALUE AT DATE
OF DEATH
237.85
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
237.85
REV'''''EX~.(*
SCHEDULE J
BENEFICIARIES
, 'COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
1.(11 I ...- .-
NUMBER
1.
1.
2.
3.
4.
5.
6.
7.
I U 11-011 lTHY
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FILE NUMBER
21 Of;
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Lineal
Lineal
OR1A.
AMOUNT OR SHARE
OF ESTATE
1/8th Remainder
1/8th Remainder
Lineal
1/8th Remainder
Lineal
1/8th Remainder
Lineal
1/8th Remainder
Lineal
1/8th Remainder
Lineal
1/8th Remainder
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV.1500 COVER SHEET
n. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
Max B. Killinger
1650 Newville Road
Carlisle, P A 17013
Irene K. Myers
7525 Wertzville Road
Carlisle, PA 17013
Joanne E. Rickards
126 Wesley Drive
Mechanicsburg, PA 17055
Esther E. Boldosser
48 Fairfield Street
Newville, PA 17241
Kathy Brooks
108 1/2 Third Street
Boiling Springs, PA 17007
Sherry A. Mowery
60 Wise Lane
Boiling Springs, PA 17007
Gayle E. Unger
609 Charles Street
Shippensburg, PA 17247
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)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
, .
KILLINGER
Decedent's Name
DOROTHY
w.
Page 1
21 06 0814
File Number
Schedule J - Beneficiaries - 1
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)
Heirs of John E. Killinger
1/8th Remainder
8. Jesse Killinger Lineal
945 E. High Street
Carlisle, P A 17013
9. Pam Raudabaugh Lineal
733 Bloserville Road
Newville, PA 17241
10. John E. Killinger, Jr. Lineal
41 Yorwick Road
Carlisle, PA 17013
..
lUaat 'JWTHl Ctuh 'Q}tatmtt~ut
or
OOROTHY If. KILLINGER
I, DOROTHY W. KILLINGER, of the Township of West Pennsboro,
County of Cumberland, and state of Pennsylvania, b~ing of sound
and disposing mind, memory and understanding, do hereby make, .
publish and declare this my Last will and Testament, hereby
revoking and making void any and all prior wills by me a~ any
time heretofore made.
1.
I direct the payment of all my just debts and funeral
expenses as soon after my decease as the same can conveniently be
done.
2.
I give and bequeath my entire estate, of whatsoever nature
and wheresoever the same may be situate, to my children, share
and share alike, per stirpes.
3.
For the purpose of facili tating the settlement and
distribution of my,estate, I authorize and empower my Executors,
hereinafter named, to sell any and all real estate which I may
own at the time of my decease, as well as my personal property,
at either public or private sale or sales, including also the
- 1 -
. .
liquidation and conversion to cash of any and all securities,
bank accounts and/or deposits which I may own at that time.
LASTLY, I nominate, constitute and appoint my following
named children, to wit, JOHN E. KILLINGER, IRENE K. HYERS and
MAX B. KILLINGER, Co-Executors of this my Last will and Testament
and direct that they be excused from posting bond or other
security for the faithful performance of their duties in any
jurisdiction.
IN WITNESS WHEREOF, I' have hereunto set my hand and
seal this ~ day of October, 1997.
CD~ k' .t~9-L"~/ (SEAL)
~othY w. Killjbger
Signed, sealed, published and declared by the above-named
DOROTHY W. KILLINGER, as and for her Last will and Testament, in
the presence of us who have subscribed our names hereto as
witnesses, at her request, in her presence and in the presence of
each other.
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COIDIONWEALTH OF PENNSYLVANIA
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COOllTY OF
I, DOROTHY W. KILLINGER, the testatrix, whose name is signed
to the attached or foregoing instrument, having been duly
qualified according to law, do hereby acknowledge that I signed
and executed the same instrument as my Last Will and Testament;
that I signed it willingly, and that I signed it as my free and
voluntary act and deed, for th~ purposes therein expressed.
/7"J~, 1
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othy w. Killinger
(SEAL)
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
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We, the undersigned, J. ROBERT STAUFFER and SUSAN A. McCOY,
the witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, depose and say
that we were present and saw the testatrix, DOROTHY W. KILLINGER,
siqn and execute the instrument as her Last will and Testament;
that the said testatrix executed it as her free and voluntary act
for the purposes therein expressed; that each of us, in the
hearing and sight of the testatrix, signed the will as witnesses;
and that, to the best of our knowledge, the testatrix was, at the
time, eighteen ( 18 ) or more years of age, of sound mind, and
under no constraint, duress or und,,!:.e .~inf lu~nce .
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Sworn and SUbscr~.' ~ to
before me this J'
day of October, 1997.
r1CU-:jL;<- ,d;:;;L
Notary 'Publicl
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MertJnr.at. ~~~~~
1iDIItlI~1)cI!O, cu<<,bG III 19i1
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~Pr1MOUI edtions are otJsot.te
10"" HUD.1 13186) rei HanaboOK 4305.2
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A. Settlement Statement
U.S. Oepanment of Housing and Urban Development
A. ~. ~..n ,,_ "'Ot'''''''''''' fexoires 01"101'>00""
1. DFHA 2. DFmHA 3. ilConv. Unins. I 6. File Number I 7. Loan Number I 8. Mortgage Insurance Case Number
.4 nVA ~ nrMU ,~. P~1111 'J010061141QQ6
C.Note: Thil form is furniShed Ic> givo yc>u a statamont of actual SO<<lemont coata. Amount. pald,tc> and by !lie .ollle_nt "4lonl are Shc>Wh. I TideExpress Settlement System
n.ms marked -(p.o.c.l- were ~ outside the cloeing; they are shown her. lor Informabon purposes and ~r. nol1ncluded, in the lolall.
WARNING: II i~ a crims Ic> knowmgiy make falle "~a,!!"ents to u~~ un,,~, Slat.. on Ihll or any oltulr Similar form. PenallleS upon
D. NAME OF BORROWER; Jonathan D. Rothenberger
..nn.."<:<:. 11'i rh"rlottP Wrlt 301 Fnolrl PA 17025
E. NAME OF SELLER: Dorothy W. Killinger. Estate
AnnD"<:<:.
F. NAME OF LENDER; Decision One Mortgage Company, LLC
..nnDJ:<:". 1021 H~Rr W~' l<~.. u;1I ~r ;971 'i
G. PROPERTY ADDRESS: 2327 Ritner Highway. Carlisle PA 17015-9398
ron~l.Apl~n~ Countv. West P"nn"horn Tnwn"rnn
H. SETI'LEMENT AGENT: Primary Settlement Services, Inc., Telephone: 717-898-7110 Fax: 717-898-7433
Dr .,...,nt::<:1'TTI FMFNT' Trwin Jir . fiO ~ . ~ 17013
1 1112 11200fi
.J. ~UMMARY OF BORROWER'S TRANSACTION: K. SUMMARY ()F .C::l=lII=R'S TRANSACTION:
100. .............. 'UI"\II...T 4M I":!onc:c: nlJl-
101 ' "';"a 100 000.00 .4n. 100 000.00
102_ "_nn~1 """""'" ..M
'03. 6 392.14 ..m
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f", ,...me n"in 'n ..riv..n"",
,nil An..
'''7 An'7
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109. Ana
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120. 1':>01"\"'''' III:: I"~()~ 106 392 .14 d?n r.~m~!': A~()IINT nlll:: T() !':F=I I F=~ 100 000.00
200. AUI"\I'.'T'" CAII"\ RV ()R ()N nr-" AI .;nn ' ,... A..nll.,T
701. 1 000.00 on,
202- 100 000.00 CM 7 787.00
203. ' ....an ..."'..... 'n om
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717 ~I.... 0'" ~chnnl tax
71~ 0"
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71S. . 0'.
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717 on
719 0'.
71!l 010
"0 Tt"\TAI 107 000.00 ,,?n TOTA' o!:'" . nl'!: !':F=I I 1"1'1 13 787.00
~OO. CASH ..nn CASH AT !':F=TTlFMFN T[ I OR FRO~ SF=II 1"1
~n. 106.392.14 RO, 100 000.00
~n7 107.000.00 OM ."'~_.~, 13 787.00
~m CASH 607.A6 ..n~ CASH Tn C:I'" I 1"0 86 213.00
SUBSTITUTE FORM '099 SELl.ER STATEMENT: Tha infonnali<>n contained herein i.lmportant tax Infonnatlon and is baing fumished to the Internal Revenue SOlVice. K you.re required to tile a .-turn.
:.~~ ~sc:~~ ~C:~~=,im~t=~~iS item i. required to ba rapo~ed and the IRS dotannlna. that K has not been rep<>~ed. The Contract Sala. Pnce doscnbad on
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TlN:_"_ '_'_' _ '_ SELLER(S)SIGNATURE($):
SELlER(S) NEW MAILING ADDRESS:
SELlER(S) PHONE NUMBERS: (HI
[WI
Previous edillonl are oblol8le
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
File Number: PSl133
torm HUD-, (3186) reI Handbook 4305.2
PAGE 2
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. . ,Inll""",' FUNDS AT FUNDS AT
'7n. .. 2.815.00 tn ReMax Rea1tv Assoc.1ates SETTLEMENT SETTLEMENT
'70<> .. 2 165.00 In Centurv 21 P.1sc.1oneri
'70" . "a"'''''''ant 5 580.00
'7""- tn Centurv 21 Pisc.1oneri 195.00
Ann ITr::U~ P4V4~1 J:
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an? 2.000 OJ.Decision One Monoaoe Comnanv. LI.C LR 2 000.00
aM 4~'..' I'aa
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Ana In primarv LendinlY Services 495.00
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"n<> .- tn primarv Settlement Services Inc. 50.00
11M In FedEx 15.00
11,.. T~_ ,,~~ "Aft In DAhnrab W. Pi"""r 2.00
11 no; In Primarv Settlement Services Inc.
11Nl "'-n, "a_ In Garv Gutshall 40.00 10.00
11n'7
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11nA In Primarv Settlement Services Inc. 858.75
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.11n 100.000.00 - 858.15
11 11 "'..... nn "'.....,nn I'nrI ann In primarv Settlement Services Inc. 150.00
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111.. In primarv Settlement Services Inc. 35.00
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..,n'O T'_M"M". tn ReMax Realtv Associates 195.00
i'U\ol '__11 IO" ,^~ ,~ In J.Ii'. McGraw Co. IP.O.C.l 583.00 S..lleX'
. 'On" ".......__.^ tn J.Ii'. McGraw Co. IP.O.C.l 175.00 Seller
''O'''' tn About - BuolS Inc IP.O.C.l 657.20 Seller
unn TnTAI ~FTTI J:MF=NT r.~AI'lr,F=!': C!~.; 'oi <;11') ".....tlnn 1(\ 6 392.14 7 787.00
HUD CERTIFICATION OF BUYER ArID SELLER
I h.... .,.-uIIy r.._ the HUD-1 Seltl8m8nt Slalement and 10 tho boot of my knowledge and belle!, ~ II a\OJo and accurate slatomon, 01 all rocoiptl and dlsbursoments mado an my account or
~ _In litis transaction. llurthercertlfy thall hoYe r8C8IVod a copy 01 tho HUD-, S.nlemont Statement
Jo.-an D. Rothenberger
Oorot/Iy W. Killinger, Estato
The HUD-l Setll8menl SlatllfT18nl which I hayo propared is 0 IOJO and
accunde account of this transaction. I have caused or w~1 cause the
_ \0 be dlsbutsod in accordanco wllh Ihll slaloment.
WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE
UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION
CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAilS SEE TITLE 18:
U.S. CODE SECTION 1001 AND SECTION 1010.
SETTLEMENT AG~NI
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ORRSTO'WN BANK
tSC1"ltl
~tP 2 2 ;.. ,; ~
IRWIN' & l'vlcKNIGHT
September 20,2006
TO: Irwin & McKnight
60 VV. Pomfret Street
Carlisle, PA 17013
FROM: Carrie McGee
22 S. Hanover Street
Carlisle, PA 17013
RE: ESTATE OF Dorothy W. Killinger
DATE OF DEATH: August 27,2006
IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD, ON THE
ABOVE DATE, THE FOllOWING ACCOUNTS WITH ORRSTOWN BANK:
CHECKING ACCOUNTS
ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED BALANCE & ACCRUED INTEREST
106001818 50+ Interest Checking 12/5/00 $6395.79 $6.25
P.O. BOX 250
SHIPPENSBURG, PA 17257
TEL. (717) 532-6114
~
Hoffman-Roth Funeral Home, Inc.
219 North Hanover Street
Carlisle, P A 17013
(717)243-4511
September 22, 2006
Irwin & McKnight
60 West Pomfret St.
Carlisle, PAl 70 13
The Funeral Service for Dorothy W. Killinger
r&~~~wltl
,-,i...l~ .;? ~,.>j'l'<!l
IRWIN & !vlcKNIGH1
14837-158
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
SELECTED MERCHANDISE:
. Christian II Casket. . . . . . . . . . . . . ., ......
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THAT YOU HAVE SELECTED . . .. ....
. Casb Advances
. Newspaper Obituary Notice-Sentinel .
. Newspaper Obituary Notice-Patriot News.
Clergy Offering . . . . . . .
Certified Copies of Death Certificates.
Flowers. . . . . . . . . .
Hairdresser. . . . . . . . .
. .
TOTAL CASH ADVANCES AND SPECIAL CHARGES .
Total
Total Cost.
TOTAL AMOUNT DUE .
This statement is net and payable in full within 30 days of receipt.
$3890.00
$3890.00
$2330.00
$6220.00
$158.60
$241.00
$150.00
$60.00
$218.36
$30.00
$857.96
$7077.96
$7077.96
Please return this portion with your Remittance
. - - - - - - -. - -. -. - - -.. - - - - - - - - -.... - --- -. -. - - - - - - - - -.... - -. - - - - - - - - --
$
Amount Enclosed
Service 10 # 14837-158
Dorothy W. Killinger
I
08/28/2006 13:41
717-24'3-'3365
WESTMINSTER CEMETERY
Buri,I No.
CONTRAcr NO,
Westminster Cemetery
1159 New~lIIe Road · Carlisle, PA 17013
717-149-1019
lNTiRMENTfENTOMBMENT AUTHORIZ....TION AND lNDEMNmCATION
- PATA ON DECEASED.
Propelt)' Occd No.
90
Thda)'"s Oal~;
1'- rtJ6
MAJUTAl. STATtJS
NO
//a#WA-y
101
. DATA ON NEXT OF KIN OR REPRESENTATIVE .
I ~.A"q, k!:. L- lllEl.ATlONSHlP: SOt! T'~m: 'J4J1 ~ z--I
A"~::~ ~~~;;~ L.2.on a,L;('~~ Pd /70'_~ ..? -
. O.(TA ON PROPERTY 0 NEll-
I ::~~ L. ( ~~ #//~~J(;;c.e I OILAn"",~ I p~ I
. tNTERMENTIENTOMBMENTIlNURNMENT DATA.
- MA.USOLEUM -
TEMP: _II\ofAIJSO~ IIIAMI:: I SECTIOI'I 1'10, LI!VliL ~O. I ClI.YrT 1N1CHE /110. I ~G: CIl.YPT PLATE
PBIlM: YES , NO
INCtSlNO/!CIlOU. Of AT II DAn ....SOID: YI.$ I NO ~IGIOllS AFF1UAT10HJO~~:
- BUJUAL -
CIIA1!L S&JMCIi
PN MEMOJUAL INSTALl.ED:
ICJtOu DEATH DATelEN(ilAvrHG HQiDeJ>'
z
. CURRENT CHARGES AND PREPAlD INFORMATION -
DATE NUM.~R SELLING PRICE
~MO"I'lT DVE
"'~5:ED CONTRACT;
O'EtI1JIIOICLosn-ro
VAUlTNAULT INSTALl..
C"sx.~T
MAIUtElll8ASE
P.O~
OTMEfl
AMOUNT om TO IE ucaVD ",OMl
PAGE
01
~
~ ;1J ,0 ~
~~. ~~l
~ l {?
TOTAL OUE.:
The WldersiJllcd Ilcrcby cc"iO" they have Ihe fulllqalaullumty 10 di~I !he IrllelTrlClll, Enlombment, Dr Inummem oflhe rell18il\5 of IIlC ._ed. t.n4 hereby IUtltor-
Ite the CCI'M1ery ID make dispoUlio\1 of lhe rC'l11lilU ot tM dtccued as indiclled. The-undeT1iB1ltd here"" f'IInller eenllY and rcpreseTlllhallIMy lire Q_r(~) or IUlhor-
ized rellrncn..dvcC.) or Itlcl owna{s) of ,he Ibqve d~cn"bcd Inlcll\1ent Ri.hlllnd hereby authvrize UJe lJf SAid I"lemmenl Riahli of tItc Inll:nnall. EnlomblMnl. or
Inummenl of lhe mYWns of \he 1lcreIn OItmc4 dettucd. 1M cemetery is ~by direcled 10 supcnoise InJlallllion or ill.llAlI Ul)' oulB burial cOI\II;n"", to Ihe elllcnl
,equired by IIW, purehb..s in cOl1neclion wilh .hi. IntCnnenl and the Intmncnl Rilhla described lwei".
"(be undefSi.,.cd hereby IJI"IlC 10 indtmni(y U1d hold Iwrmlen d\e r:emclC1Y. III 'Icnla and emplO)'RS fn:lm any IIId all LIABILIty, lncludhlt _nablc lftOmey's
ree.. IlId I"IM any losa it or du!y mIIY sunam ;11 conM~ 'lII'Ith the IntemllWI\L EnIMnbmenI. or InUT11mC1l1 luthorltcd hcrcWll:lcr. 1lIe cemetery \Pes erear CG'C II)
.vOid 0ITCIfJ. Inn m die eV""I'" iMdvct1clll CTTOr doe. OO:C\R', the cemetl!T)' shall hive the tilhllO C_CI any m-ar in lhe Inlenll.""," &llOmbmmt or Inummcnl, 11114
0- cllpCIlfe, withOllIIl/l)' li.bOi'Y for such error.
NOTfS:
c--&,~
Sill'lNR 0 mil)' Senrice Counselor
gmCE USE ONLY
/
Inlllmlml
CIlcdc
PI_er. wll/ be 'IlIlOv. 2 dI7' from burial.
~?r~~
\I. . . Si"'."'11! of Lot o-erl A.uthori~ed . 'athle
. A UDlT A1tD RlCORDkEErlNG-
(lllltlal after web)Up b I.'Ompleted)
MEAMENT ORDI!R CH8CK2D
INTERMENT CARD C'OMJ'l.~ /t.M) P1t.SO
MA,,"~1l CAN) \JPIM,'T1D
'LAr /tOOk AND LOT MAl'SUPDATED
llVlUA1..1'PlI4TT IlECElV~ A/'It) ftl.eD
OTHER
WhII. . Ad""""lrtlllon . ClII&IY' Aclrnrnlslr.otion . PII\ll. a.lll"'_
S'''CE VUmCATlON
F.,"II, Vrrlnedl
Sq,.."ylCd By,
Cb,..,kd By!
"'lIII 8101
COMMONWEALTH OF PENNSYLVANIA
: SS
COUNTY OF CUMBERLAND
Max B. Killinl!er and Irene K. Mvers
, late of West Pennsboro Townshio
, being duly sworn according to law, deposes and says that they are the Co-Executors of
the Estate of
Dorothv W. Killinl!er
, Cumberland County,
Pennsylvania, deceased and that the within is an inventory made by Max B. Killinl!er and Irene K. Mvers, the said Co-Executors
of the entire estate of said decedent, consisting of all the personal property and real estate, except real estate outside the Commonwealth
of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death.
Sworn and subscribed before me,
this~ day of
~~
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A
1650 Newville Road
Carlisle. PA 17013
\" . iI~
,,,.,;!../l.... c.. /1.-<-- ~ L fig
Irene K. Myers, Co- xecutor
Notarial Seal
Karen S. Noel, Notary Public.
C.mle Boro, Cumberland County
My Commission Expires Dec. 8, 2007
7525 Wertzville Road
.....,
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Carlisle. P A 17013
Date of Death
27
Day
08
Month
INSTRUCTIONS
1. An inventory must be filed within three months after appointment of personal representative.
2. A supplement inventory must be filed within thirty days of discovery of additional assets.
3. Additional sheets may be attached as to personalty or realty.
4. See Article IV, Fiduciaries Act of 1949.
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