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HomeMy WebLinkAbout11-28-06 AEV-I500 EX.. (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-Q601 DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL I- Z w C W (J W C HUSLER JEANETTE DATE OF DEATH (MM-DD-Year) --------, REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 2 1 -0 6 0 8 6 4 ""CciUNlYCOOE ---vEAR- - - NUMaER-- SOCIAL SECURITY NUMBER E. DATE OF BIRTH (MM-DD-Year) 2 35- 1 8 - 7 047 THIS RETURN MUST BE FILED IN DUPUCATE WITH THE REGISTER OF WILLS 09/22/2006 11/30/1920 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, F RST, AND MIDDLE INITIAL) 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or.Sole- rop!ietorship 4. Mortgages & Notes Receivable (SchedulE! D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Bimng Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Pro ate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Sche ule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) W I- ~ :!U) oa:~ w~8 :c a: oJ o ~CD c( [X] 1. Original Return D 4. Limited Estate [X] 6. Decedent Died Testate (AIlach copy 01 w~) D 9. Litigation Proceeds Received I- Z w Q Z o Q, en w a: a: o o il:kTHlSSECTlO.fjUfiBE:CiMilmo~i NAME ROGER B. IRWIN ESQUIRE FIRM NAME (If Applicable) IRWIN & McKNIGHT TELEPHONE NUMBER 717 249-2353 z o ~ ~ I- a: c( (J w a: SOCIAL SECURITY NUMBER D 2. Supplemental Return D 4a. Future Interest Compromise (date of death after 12-12-82) D 7. Decedent Maintained a Living Trust (AltachcopyofTrust) D 10. Spousal Poverty Credit (dale 01 death between 12.31.91 and 1+95) D 3. Remainder Return (date of death prior to 12-13-82) D 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes D 11. Ejection to tax under Sec. 9113(A) (Attach Sch 0) . 'L1;CORBESPoNsEttCeAINatcONFtOe~iiAliIN.al~TtON.s"'o"'fZo'lefjBEml!fde'.;\Wi COMPLETE MAILING ADDRESS 60 WEST POMFRET STREET CARLISLE PA 17013 (1 ) (2) (3) (4) (5) OFFJ9IAL USE ONLY c.:-,.:> = c.... -:.t~ o ....::: N co lJ c. I: ) o .- ("T'''j :=J] ~.- .....--~, 129.362.~_~ 3 ~~ c~.- -0 ....... w o (6) 50.~ -;--\ (7) (8) 129,412.06 (9) (10) 22,835.72 33.91 (11 ) (12) (13) 22.869.63 106,542.43 14. Net Value Subject to Tax (Line 12 minus Line 13) SeE INSTRUCTIONS ON REVERSE SID FOR APPLICABLE RATES z o t= c( I- ~ Q. :s o (J >< c( I- 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) 106,542.43 0.00 X _(15) 0.00 106,542.43 X .045 (16) 4,794.41 0.00 X .12 (17) 0.00 0.00 X .15 (18) 0.00 (19) 4,794.41 ;\':";'?1:,N:'_.:d::. -..-,," '/'-:\/,':>:: :<',~\'::;.:-tx :g,:;:,:~_:,}~./ CHECK HERE IF YOU ARE REClUESTlNG A REFUND OF AN OVERPAYMENT ?:..:-::A2~:~;;.i:::::}: /i.KW:.:::,:}.{::::.;:) 20. D ;; tt:~t:1J:StlONsrONiREVEFlS - )SIDEiAND-FleCHECI(:M4TH'{~<<';i,.jlf;f:h..;i;rf;];\j:.fii\fe o d I C Add ece ents amp' ete ress: STREET ADDRESS 409 MEADOWBROOK ROAD CITY I STATE I ZIP CARLISLE PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 4,794.41 Total Credits (A + B + C) (2) 239.72 3. InteresVPenalty if applicable D. Interest E. Penalty 0.00 T otallnteresVPenalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the diff rence. This is the OVERPAYMENT. Check box on Page 1 Line 20 to uest a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the diff rence. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) (58) to: REGISTER OF AGENT 0.00 4,554.69 4,554.69 PLEASE ANSWER THE FOLLOWI G 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 pro erty transferred; ....................................:...................................... 0 IX] b. retain the right to designate who s all use the property transferred or its income; ........................................ 0 IX] c. retain' a reversionary interest; or .. ....................................................................... ............................. 0 IX] d. receive the promise for life of eithet payments, benefits or care? .............................................................. 0 IX] 2. If death occurred aft~r December 12, 1 ~82, did decedent transfer property within one year of d~ath . without receiving adequate consideratipn?...... ........ ............... .............................. ..... ...:.............. ....... ...... 0 IX] 3. Did decedent own an 'in trust for" or p~yable upon death bank account or security at his or her death? ................. 0 IX] 4. Did decedent own an Individual Retiretent Account, annuity, or other non-probate property which . contains a berieficiary designation? ...~........................................................ ................;................. ......... 0 IX] IF THE ANSWER TO ANY OF THE ABOVE CUES IONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of pe~ury, I declare that I have examined this retum, includ ~ 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 II Information of which preparer has any knowledge. . SIGNATURE OF PERSO RE NSIBLE FOR FILING ETU N DATE ,- ;J7/-t:J ADDRESS PA 17015 ATE (t !-1,' Ob ADDRESS PA 17013 For dates of death on or after July 1, 1994 and before Jan ary 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. 99116 (a)(1.1)(i)]. , For dates of death on or after January 1, 1995, the tax rat~ imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)). The statute does not exemot a transfer to a surviving spo~se 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. I For dates of death on or after July 1, 2000: I The tax rate imposed on the net value of transfers from a jeceased 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 0% [72 P.S. ~9116(a)(1.2)]. The tax rate-imposed on the net value of transfers to or fo. the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P .S. 99116(1.2) [72 P .S. 99116(a)(1)]. The tax rate imposed. on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P .S. 99116(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-1508 EX + (6-118) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ITEM NUMBER 1. 2. 3. 4. 5. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER e proceeds of litigation and the date the proceeds were received by the estate. jointly-owned with right of survivorship must be disclosed on Schedule F. DESCRIPTION Personal Property - Appr isal Attached M& T Bank - Checking Ac~ount #713708 M& T Bank - Savings Account #015004210920086 M&T Bank - Certificate of peposit #031003912277661 Cash on Hand TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 4 VALUE AT DATE OF DEATH 1,269.00 22,814.37 3,914.60 100,974.16 389.93 129362.06 --- . -, REV-1509 EX + (6.98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER If an asset was mad~ 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. Clement L. Husler 409 Meadowbrook Road Carlisle, P A 17015 Son B c JOINTL y-oWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING N1iJMBER. ATTACH DEED FOR JOINTlY-HELD REAL ESTATE. VAlUE OF ASSET INTEREST DECEDENTS INTEREST t. A. 4/17/06 American Home Bank 100.00 50. . '50.00 I TOTAL (Also enter on line 6, Recapitulation) $ 50.00 (If more space is needed, insert additional sheets of the same size) REV-'.11 EX + I'. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS HUSLER ITEM NUMBER A. 1. 2. 3. 4. 5. B. . 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. FILE NUMBER JEANETTE E. 06 21 Oebts of decedent must be reported on Schedule I. DESCRIPTION FUNERAL EXPENSES: Hoffman-Roth Funeral Home Carlisle Memorials Reverend Iva L. O'Brien Sunnyside Restaurant - F~neral Reception Westminster Cemetery, ULC - Final Interment ADMINISTRATIVE COSTS: Personal Representative's Com~issions Name of Personal Represflntative (s) Social Security Number(s)YEIN Number of Personal Representative(s) Street Address City State Zip Year{s) Commission Paid: Attorney Fees Irwin & McKnight Family Exemption: (If decedenfs a~dress is not the same as claimanfs, attach explanation) Claimant Clement L. Husler Street Address 409 Meadowbrook Road City Carlisle State P A Relationship of Claimant to Decedent Son Zip 17013 Probate Fees Register of Wills Accountanfs Fees Tax Return Preparer's Fees Patricia A. Rosendale, CPA Register of Wills, Filing Fee Notary Fees Cumberland Law Journ~:lI, Estate Notice The Sentinel- Legal, EMate Notice Roy D. Gottshall, Apprc: isal on Personal Property I I TOTAL (Also enteron line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0864 AMOUNT 8,684.13 221.00 150.00 1 ,304.56 1,150.00 6,925.00 3,500.00 244.00 350.00 30.00 10.00 75.00 137.03 55.00 22.835.72 . REV-1512 EX T (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF HUSLER JEANETTE SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS E. Include unreimbursed medical expenses. FILE NUMBER 21 06 0864 ITEM NUMBER DESCRIPTION 1. AT&T Credit Card j I (If more space is needed, insert additional sheets of the same size) TOTAL (Also enteron line 10, Recapitulation) $ VALUE AT DATE OF DEATH 33.91 33.91 REV.1513~+"* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF HlI~1 FR SCHEDULE J BENEFICIARIES I r"" . - Ilr E NUMBER I. NAME AND ADDRESS OF PEF SON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outr ght spousal distributions. and transfers under Sec. 9116 (1) (1.2)] 1. Clement L. Husler 409 Meadowbrook Road Carlisle, PA 17015 . . FILE NUMBER ?1 06 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Lineal ORAA AMOUNT OR SHARE OF ESTATE 100% Remainder ENT~R DOLLAR AMOUNTS FOR DIS~ RIBUTIONS SHOWN ABOVE ON LINES .15 THROUGH 18, AS APPROPRIATE, ON REV.1500 COVER SHEET ll. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDEF SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENT~L DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOT~L NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV.1500 COVER SHEET $ Of more space is needed, insert additional sheets of the same size) ---r Last Will and Testament Of Jeanette E. Husler I, JEANETTE E. HUSLER, of Lower Frankford Township, Cumberland County, Pennsylvania, declare th s instrument to be my Last Will and Testament, hereby expressly revoking all Wills and Co icils heretofore made by ~e. I 1. I direct fY personal representative to pay ail of my debts, funeral and administrative expenses a~ soon. as may be done conveniently after my decease. 2. I authorize and .empower my personal rep~esentative to sell any realty owned by me at my death, and not pecifically devised herein, at either public or private sale, and to give good and sufficient deeds therefor, in fee simple, as I coul~ do if living. 3. I give, dev se and bequeath all of my estate of every nature and wherever situate to my son, CLEMENT L. H SLER, provided he shall survive me by sixty days. 4. Should th gift in paragraph 3 not take effect, I give, devise and bequeath all of my estate of every nature d wherever situate as follows: (a) the sum 0 $10,000.00 to the WEST HILL UNITED METHODIST CHURCH, Newville oad, Carlisle, Pennsylvania; (b) all the res, residual and remainder to the UNITED METHODIST CHURCH of Leesburg, umberland County, Pennsylvania and the WEST HILL UNITED METHO 1ST CHURCH, Newville Road, Carlisle, Pennsylvania, share and 5. I nominat and appoint CLEMENT L. HUSLER to be the Executor of this my Last Will and Testame t; he is to serve as such without bond. Should he die before my death, renounce or refuse to sfrve for any reason, or die leaving any of my estate unadministered, I nominate and appoint ~OGER B. IRWIN, MARCUS A. McKNIGHT, ill and DOUqLAS G. MILLER, as substitute fxecutors, also to serve as such without bond, with the same powers as are given herein to my ohginal Executor. I here~y suggest that my personal representative retain the services of Irwin & rCKnight, as attorneys iri the settlement of my estate. IN WITNESS WHERE.OF, r have hereunto set my hand and seal this 3/JT day of March, 2004. ~tl'A(tr;: 1,0 /~~~A_ if . JEANETTE E. HUSLER (SEAL) I Signed, sealed, p~blished and declared by the above-named person as and for a Last Will I and Testament, in our pr~sence, who at said person's request, in said person's presence and in the I presence of each other h ve hereunto set our names as subscribing witnesses. 2 AC OWLEDG~IENT AND AFFIDAVIT WE, JEANETT E. HUSLER, CHERYL L. CLELAND and l\IARTHA L. NOEL, the testatrix and witness s respectively, whose names are signed to the foregoing instrument. being first duly sworn, d hereby declare to the undersigned authority that the testatrix signed and executed the instrument s her Last Will, and that she had signed willingly, and that she executed it as her free and volunt act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as a witness and that to the best of their knowledge the testatrix as, at that time, eighteen years of age or older, of sound mind and under no constraint or undue in COMMONWEAL TH F PENNSYLVANIA COUNTY OF C~IBE LAND S8 Subscribed, swo to and acknowledged before me by JEANETTE E. HUSLER the testatrix herein and sub cribed and sworn to before me by CHERYL L. CLELAND and MARTHA L. NOEL, w toesses, this Lday of March, 2004. ~.~ ry Public larial Seal Roger B. Irwin. Notary Public Carlisle Born, Cumberland County My Commission Expires Oct. 3. 2004 Member, PennsylVania AJaociatIon of Notaries ;; ~ (" -'- /" /,"" II ~ /If) ~..s;.I ;;'=/#.;,. '" , ..:-I'~'2 ~ tZ-~~ ", "', J7 )~,;-~ /( ,,! ,,1 " ..(,/>,.~.'"'<- . f-"'~'" /) . ~ /i~/~G^"' r-,~ :.A::! .?~~1-t,<!-L4!!.- j'li.A/ -., ~ /7' " " , { ~/ / -:7 ~d~~~"(i.. .t:'",~,e /~f:? -' / .- ..., ~ -,.'?-" -~ '".' ~ <::::~...aJ~..,.:'" ~,-,., I . ,'/ -" '/. ~ ,/" /" ~.~ ',.77 _ . ,\ --" ...-- -~ p ....,.-'~ " '--6"'/C/., ~;;C?:"~T.I.4.;/ ~'J..I;:~/::.~:.,//~ t::E-L-~-'-e:.-~.'-, /i/' /-- Yr"''''' ,9-~: /;1;1./;'_ /lL/Y;~Z<2/--;[ . /;!~i , "j /:;'.1/ ..,& .~ ----~.-6. -_.~ ~~~-~;~'G d~~7 /~'v /~~~?~.J ~'?:~~: ::r ' /~ ,... J ./7 ~'~ .1 :.4.- ~ ..,<;.... ,~,", " C;:;:~'~~L;~".~a ~,~ ,~~.:/.;~ I r~~~,...4t.,l4L",.bU ~?Jz ~d--t/' ~_"t C? :"uJ~.4{~c~~:e. Tv ~J?:~' :///".... --:.' ~ -'~::"~" .,l ,/.-1 I ~."..,----.. ~..2 ".;,.. ",.J /...-;; ~~,.' ~ ~_~,-.,"",- ~/ '-' ,.. __..'1C,.... 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't!t,/r~~;;7$~jz \ g"CiL ~v } /LI ~j\ L ......,. r ___ 185-00 + ji___ 484"00: . ~ 0.* r!:1M&f 499 Mitchell Road, Millsboro, DE 1996 Mail Code DE-MB-12 Phone (888)502-4349 Fax (302) 934-2955 October 4, 2006 Law Offices Irwin & McKnight West Pomfret Profession 60 West Pomfret Street Carlisle, Pennsylvania 17 13-3222 Re: Estate ~~CtiUWli~ r>("r. . 6 100 \J\-. 0 . (; 6 :~ 'R ,vrr'" ... 1 1/" r T....... .HT '? . y' .. i'~~ i'" i \ 'l" \.. ~ ii, +. .., 1~ ~ '"''- "''''_'''' ."\...1 'l1,,-1.:. Dear Sir or Madam: Per your inquiry dated September 29, 2006, please be advised that at the time of death, the above-named decedent had on deposit with this bank the followin: ' 1. Type of Account Checking Account Account Number 7/3708 Ownership (Names of) Jeanette Husler * Opening Date 02/01/71 Balance on Date of De th $22,8/3.68 Accrued Interest '$ 0.69 Total $22,8/4.37 2. Type of Account Account Number Ownership (Names of) Opening Date Balance on Date of De h Accrued Interest Total Savings Account 0/5004210920086 Jeanette Husler ,.. /1//7/04 $3,9/4./1 $ 0.49 $3,9/4.60 3. Type of Account Certificate of Deposit Account Number 031003912277661 Ownership (Names oj) Jeanette Husler * Opening Date 07/17/06 Balance on Date of De th $100,000.00 Accrued Interest $ 974.16 Total $100,974.16 Please be advised, there was no sa e deposit box found for the above decedent. * For further account informa on, regarding ownership, closures and/or reimbursement of funds, etc~ please call the Stonehedge Office # 717-24 524. Sincerely, ~~ce7~ Nancy Clagett Records Management PI,,,: ~ ;\.1 ~ ;. ,c. '..," . ,,"', ",\11 I ~~~!UW[~ \.1\.. ( .J't (UUb Irwin & McKn ght Law Offices 60 West Pomfr t 8t Carlisle Penns lvania 17013 IR'rvn'<[ & lVlcKNIGHT Re: Estate of Janette Edna Husler Dear Mr. Irwin iry American Home Bank did have an account for the late Mrs; Husler. There as a deposit of $1 00 made on April 17, 2006 and there has been. no activity sinc . Therefore the balance remains at $100. At the time the ccount was opened, Mr. Clement L. Husler was also named on the account. T at has not changed. No other deposit accounts, loans, or safe" deposit boxes e ist in her name. 417 Village Drive / Carlisle, PA 17013-6929 . Phone 717/218-6635 . www.bankahb.com \.... ~ e ~.~ .g -0'6 ~ '5-- ~ p... -0 e ~ ~ 0. ~'6' U ~ -e~~ ""~ c: ;::; ~ 0 .g ~ ""C,I 'S .... .P -0 ~ ~~.~ g.~ .S ~ -0 G) ~ ~"'5~ ~.... .s:..~';i 00.. ....'"3 00 o.U "'3 1'\~% "0 .% ~ .tj, G) ~ ~%O!-:? ~ ~~.g0~ ~ 9",&'tj, c: ..c r.n ~'" -0.0- ~ lG.,..:: ~'a .... u :';: 0',' ~ ~ -!: t ~~ ~ ~ ~ .p ''i r: ff'J ~ " -0 ~~ OU .,., ~ 'a.1() eO ~ 'E u u u ~ oS ~ o(:l "'6b ~ .g ~ _ . ~ c: '. e %'0 !:"".tj, ts '" .2tlOO%~ ~iC ~~ u l'i ~_/ ," ~ oS ';i", ~ ~ ,e., ., ~ c: 00 "i\ '" ~ '.' .~" 0 0 1;.... p::. ......:€~ v 0... ~ g. G) G) ~ ;t( tl' p.g. 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S ~ ~~ ~,~ 00 .,e ?ii ;..,.I ti ~ -0 6i ";to a 0 6i 6i ~ ~ 0- N ~ P 'en '5 CO U ~ tj;) .'---~ 850 N Hanover Street Carlisle, PA 17013 Phone: (717) 243-5712 Fax: (717) 243-8399 YNIW.sunnysiderestaurant.com CLBND'r BUSLER / lfmmRAL 409 HEODOWBROOlt BD CARLISLE, PA. 17015 09/27/06 GUEST CHECKS CHK# AMOUNT TOTAL GUEST CHECKS TAX INCLUDED - PRE-QRDERlOTHER T Y A!I;IILE CHARGES LUNCHEON I 1 @ $12 95 PO PERSON t.o ~ SALAD - RANCH AND V~NGRETTE VEGETABLE - MED MIX CHOICE OF: CHICKEN ALFREDO, BIj:EF TENDERLOIN MARSALA BR. CRAB CAKE " . . ~"'" 7){P""; ,-,,- DESSERT - 1/2 CBDi~ECAD 1/2 CHEF CAD @ $2. 75 PER PERSON J ~"',~ TOTAL PRE-ORDERIOTC I ()sb J.. em SALES TAX 6% l.. )"J I TOTAL GUEST CHECKS. PRE-ORDER, TAX- J/~;b7 BAR AND NON TAXABI..E ITEMS TOTAL BAR * SUBTC TAL GUEST CHECKS, PRE-ORDER, TAX, BAR /,'oJ15,(J I GRA TU/TV - ~~ ..".,~ ...J,- OTHER- DESCRIPTION & COST c:k' ,~ lO t ,'i. .., ~ PAID $100.00 DEPOSIT -$100.00 ~ -/001/"4 rJ TOTAL OTHER * PREPARED BY: TOTAL* * l~lotr~~~ ------. * /2J7A/ (OST'J30'/S07r I . / 41 Sou h Bedford St. Carlisle, P A 17013 Ph De: 717-243-5480 Fax: 717-243-5687 DATE: FOR: ADDRESS: CEMETERY: L.OCATION OF CEME SECTION: r:- L LOCATION OF LOT: CEMETERY LETTERING OR REPAIR WORK ~ t.JLJ- 511 S ~ / . LETTERING: ;./'" REPAIR: (,'/1 J;V'~ ~ Lf, OTHER INFO: NAME OF DECEASE TYPE OF BURIAL: GULA ~ CREMATION: LETTERING REQUI D: . '- ):t- eL '~'. ~(;, LOCATIONOFINSC PTION: ~/<;~Zlo A.fKv..~ STYLE OF LETTERI G: oj? ~~ S~ I 1 I MATERIAL: OTHER NAMES ON DATE COMPLETED: COST: ;::;; ~ fl. ~s f- . ~. ~ ~.- ) - - t9D -T /~ ~ W41t~ ~_t J.2 I, ~ ~. DESCRIPTION OF W RK: SIGNATURE: SALESMAN SIGNATURE: COMMONWEALTH OF PENNSYLVANIA : SS COUNTY OF CUMBERLAND Clement L. Husler , being duly sworn according to law, deposes and says that he is the Executor of the Estate of Jeanette E. Husler , late of Lower Frankford Townshio , Cumberland County, Pennsylvania, deceased and that the within is an inventory made by Clement L. Husler, the said Executor 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 d.~ay of November , 2006. ~U\~ l ~ } . COMMONWEALTH OF PENNSYl ~"ANlA Notarial Seal I ~n S. Noel, Notary Public Carhile Boro, Cumberland County My Commission Expires Dec. 8, 2007 22 Day Date of Death (ijJ~;;L ~ Clement L. Husler, Executor 409 Meadowbrook Road . Carlisle. P A 17015 Address 09 Month 2006 Year 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. ~ 00 o ~ I .- N o Z ~ o E-4 Z ~ > Z ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ (I) Cl ~ Z g: < ~ ~ ell ~ u.i c.a ~ i15 ~ :E r.IJ c: ~ o ~ "'lj l-< <E ..:..: c: Cd l-< u.. l-< ~ ~ ~ -,;j Q) ~ II.) u Q) Cl ci .a Cd > >. r.IJ c: s:: Q) l:l.. >. e ::l o U -g Cd "i: II.) e ::l U "'lj ~ ~ ..:..: o o a:l Q) ~ t:l. I 00't ~ o ~ ....l d) 1-0 'S '" ~>- .S Q) ~ e 1-0 0 -t:l ~< ~ o o ~ Inventory of the real and personal estate of JEANETTE E. BUSLER . deceased 1. Personal property $1,269.00 2. M&T Bank - Checking Account #713708 $22,814.37 3. M&T Bank - Savings Account #015004210920086 $3,914.60 4. M&T Bank - Certificate of Deposit #031003912277661 $100,974.16 5. Cash on Band $389.93 TOTAL .. " ,'" i '\" :l:r'lnf'\ " r ...., ! I, ", ""'!.J ,,, v Vd \JJ \-.:I\(: >~-" " \ unr\,' C:,' \\'.,Hd'dO ..LU \U~J Uf: ~ ' I I If') \\l,J::r'\f'\ j\_ ll;,.j.-i J d nz ~\O' 'I'.l QuOZ \ 0 : S \f! 0 I' '~) $129,362.06 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT IRWIN ROGER B ESQ 60 W POMFRET ST CARLISLE, PA 17013 nn_n_ fold ESTATE INFORMATION: SSN: 235-18-7047 FILE NUMBER: 2106-0864 DECEDENT NAME: HUSLER JEANETTE E DATE OF PAYMENT: 11/28/2006 POSTMARK DATE: 11/28/2006 COUNTY: CUMBERLAND DATE OF DEATH: 09/22/2006 NO. CD 007486 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $4,554.69 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 023647 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $4,554.69 GLENDA FARNER STRASBAUGH REGISTER OF WILLS