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Home My WebLink About01-03-07 --.J 15056041114 REV -1500 EX (06-05) OFFICIAL USE ONLY County Code Year File Number PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT ~\ blo cPHLP Date of Birth 162-22-2712 10012006 05061925 Decedent's Last Name Suffix Decedent's First Name MI SEBURN (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix MARY E 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 W 1. Original Return D 2. Supplemental Return D 4. Limited Estate D 4a. Future Interest Compromise (date of death after 12-12-82) W 6. Decedent Died Testate (Attach Copy of Will) D 9. Litigation Proceeds Received D D 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) D D o 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIfU::9TED TO: Name Daytime Teleph<?n'1 ~mber ~ __ . (.- ~ ~~,.. -.:-;u FREY c::) ROBERT G. Firm Name (If Applicable) FREY & TILEY First line of address 5 SOUTH HANOVER STREET _./Jr) '''h Second line of address co City or Post Office State ZIP Code DATE FILED CARLISLE PA 17013 RFREY@FREYTILEY.COM LDO(, ~ DATE "'^"\.--,~ "2(.) "L<.'lOG PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041114 15056041114 --.J~ --.J 15056042115 REV-1500 EX Decedent's Name: MARY ESE BURN RECAPITULATION 1. Real estate (Schedule A) . . . . . . . 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . 162-22-2712 Decedent's Social Security Number 1. NONE 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. NONE 2. NONE 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. NONE 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) DSeparate Billing Requested. . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) DSeparate Billing Requested. . . . . . . . 7. 8. Total Gross Assets (total Lines 1-7) . . . . . . . . . . . . . . . . . . . NONE 8. 7334.00 4202.00 11536.00 7462.00 9. Funeral Expenses & Administrative Costs (Schedule H) . . 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 Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to 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.O L 16. Amount of Line 14 taxable at lineal rate X .0 ~ 17. Amount of Line 14 taxable at sibling rate X . 12 18. Amount of Line 14 taxable at collateral rate X . 15 3826.00 16. 19. TAX DUE. . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056042115 9. 15. 17. 18. 15056042115 248.00 7710.00 3826.00 0.00 3826.00 0.00 172.00 0.00 0.00 172.00 D --.J REV-1500EX Page 3 162-22-2712 Decedent's ComDlete Address: DECEDENT'S NAME MARY E SEBURN STREET ADDRESS 445 KERRSVILLE ROAD File Number 21-06-996 CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 172.00 164.00 8.00 Total Credits ( A + B + C) (2) 172.00 3. InteresUPenalty if applicable D. Interest E. Penalty TotallnteresUPenalty ( 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) 0.00 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 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: a. retain the use or income of the property transferred; . . . . . . . . . Yes D D D D D D D b. retain the right to designate who shall use the property transferred or its income; . . . . . . . . . . . . . . . . c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d. receive the promise for life of either payments, benefits or care? . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? . 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No o o o o o D o 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. 99116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P .S. s9116(a}(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. 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 P.S. ~9116(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. 217 REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MARY E SEBURN SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21-06-996 Include the proceeds of litigation and the date the proceeds were received by the estate. All Drooertv iointlv-owned with riaht of survivorshio must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1 M&T Bank Account no. 25004920107966 2 M&T Bank Account no. 25004920109045 3 M&T Bank Account no. 1062662 4 Miscellaneous personal property VALUE AT DATE OF DEATH 601 601 4,724 1 ,408 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 7,334 217 REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER MARY E SEBURN 21-06-996 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. Doris Reeder 121 Stonehouse Road, Carlisle, PA 17013 Daughter B. C. JOINTLY-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 JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET NUMBER TENANT INTEREST DECEDENT'S INTEREST 1. A. 4/24/86 Members 1 st account no. 49734-00 1,385 50.00% 693 2. A 4/25/86 Members 1st account no. 49734-11 2,015 50.00% 1,008 3. A M&T Bank Account no. 1500420930938 5,001 50.00% 2,501 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL (Also enter on line 6 Recapitulation' $ 4202 (If more space is needed, insert additional sheets of the same size) 217 REV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER MARY E SEBURN 21-06-996 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Ewing Brothers Funeral Home 6,123 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 750 3. Family Exemption: (If decedent's address is not the same as claimant's. attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Auctioneer expenses 589 8. TOTAL (Also enter on line 9 Recapitulation) $ 7462 (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 ESTATE OF MARY E SEBURN SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-06-996 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Final rent owed 100 2. PPI Electric bill 111 3. AT&T Telephone Bill 12 4. Sprint telephone bill 25 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 248 217 REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER MARY E SEBURN 21-06-996 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Doris J. Reeder Daughter 25% 2 James H. Sebum Son 25% 3 Connie L. Losinger Daughter 25% 4 Audrey M. Sebum Daughter 25% 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0 (If more space is needed, insert additional sheets of the same size) "\.' .~. ,:<J~:"'<. LAST WILL AND TEST AMENT OF MARY E. SEBURN I, MARY E. SEBURN, widow, of West Pennsboro Township (mailing address: 445 Kerrsville Road, Carlisle, Pennsylvania 17013), Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all Wills by me at any time heretofore made. 1. I direct my hereinafter named Executors to pay all of my just debts and funeral expenses as soon after my death as may be found convenient to do so. I further direct that all inheritance, transfer, succession, estate and death taxes which may be payable on account of my death, shall be paid from the residue of my estate regardless of whether the assets on which such taxes are based are included in my probate estate. I further direct that my body be interred on my burial lot located in Westminster Cemetery in North Middleton Township, near the Borough of Carlisle, Pennsylvania. 2. All of the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever the same may be situate, I give, devise and bequeath in equal shares to my four (4) children, their heirs and assigns, they being Doris J. Reeder, James H. Sebum, Audrey M. Stone, and Connie L. Losinger, provided each of my said children shall survive me by a period of ninety (90) days, but should any of them fail to so survive me then the share such deceased child of mine would have received shall pass to such of his or her issue, their heirs and assigns, as shall survive me by a period of ninety (90) days, per stirpes, and if there be no such issue the same shall lapse and be added to the shares of my other children. i I I I ! ~:.; .:......... ,.{t--l . "~ ! . i 3. I hereby nominate, constitute and appoint my said four (4) children, Doris J. Reeder, James H. Sebum, Audrey M. Stone, and Connie L. Losinger, or any of them, as co- Executors of this my Last Will and Testament, and I further direct that none of them shall be required to post any bond to secure the faithful performance of his or her duties in the Commonwealth of Pennsylvania or in any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament written on one (1) page, this 21st day of July, 1994. 'Jri <<;, 1# (), Mary E. Se m ~? ~ ~ 1 A /) .I(SEAL) Sign~d, sealed, published and declared by MARY E. SEBURN, the Testatrix above named, as and for her Last Will and Testament, in our presence, who, in her presence, at her request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. ~~. 1>.( Jf~'~' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 171Z8-0601 * INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 ACN 06157516 DATE 11-22-2006 REV-1545 EX AFP 109-00> EST. OF MARY E SEBURN S.S. NO. 162-22-2712 DATE OF DEATH 10-01-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT IiJ SAVINGS o CHECKING o TRUST o CERTIF. DORIS REEDER 121 STONEHOUSE RD CARLISLE PA 17015 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling (717) 787-83Z7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 49734-00 Date 04-24-1986 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 1,385 . 11 50.000 692.56 .045 31.17 TAXPAYER RESPONSE To insure proper credit to your account, two (Z) copies of this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax payments are made within three (3) months of the decedent's date of death, yoU may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. Tax PART [I] A. [ CHECK ] ONE BLOCK B. ONLY c. [] The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. [] The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED If you indicate a different tax rate, please state your relationship to decedent: PART @] TAX RETURN - COMPUTATION OF LINE 1. Date Established 1 2. Account Balance 2 3, Percent Taxable 3 4. Amount Subject to Tax 4 5, Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 8. Tax Due 8 TAX ON JOINT/TRUST ACCOUNTS x x PAYEE DESCRIPTION AMOUNT PAID I $ TOTAL (Enter on Line 5 of Tax Computation) Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME ( ) WORK ( ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 ACN 06157517 DATE 11-22-2006 REY-15~3 EX AFP 109-00> EST. OF MARY E SEBURN S.S. NO. 162-22-2712 DATE OF DEATH 10-01-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS Ii] CHECKING o TRUST o CERTIF . DORIS REEDER 121 STONEHOUSE RD CARLISLE PA 17015 REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 HEHBERS 1ST FCU has prDvided the Department with the infDrlllatiDn listed belDw which has been used in calculating the pDtential tax due. Their recDrds indicate that at the death Df the abDve decedent, YDU were a jDint Dwner/beneficiary Df this aCCDunt. If YDU feel this infDrlllatiDn is incDrrect, please Dbtain written cDrrectiDn frDIII the financial institutiDn, attach a CDPY tD this fDrm and return it tD the abDve address. This accDunt is taxable in accDrdance with the Inheritance Tax Laws Df the CDmlllDnwealth Df Pennsylvania. QuestiDns mey be answered by ceIling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 49734-11 Date 04-25-1986 Established x 2,014.98 50.000 1,007.49 .045 45.34 TAXPAYER RESPONSE TD insure prDper credit tD YDUr accDunt, tWD (2) cDpies Df this nDtice must accDlllpany YDur payment tD the Register Df Wills. Make check payable tD: "Register Df Wills, Agent". Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x Tax NOTE: If tax paYlllents are made within three (3) mDnths Df the decedent.s date Df death, YDU may deduct a 57. discDunt Df the tax due. Any inheritance tax due will becDme delinquent nine (9) mDnths after the date Df death. PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. [] The abDve infDrmatiDn and tax due is cDrrect. 1. YDU may chDDse tD remit payment tD the Register Df Wills with tWD cDpies Df this nDtice tD Dbtain a discDunt Dr aVDid interest, Dr YDU may check bDX "A" and return this nDtice tD the Register Df Wills and an Dfficial assesslllent will be issued by the PA Department Df Revenue. [] The abDve asset has been Dr will be repDrted and tax paid with the Pennsylvania Inheritance Tax return tD be filed by the decedent's representative. [] The abDve infDrmatiDn is incDrrect and/Dr debts and deductiDns were paid by YDU. YDU lIIust cDmplete PART ~ and/Dr PART ~ belDw. PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED If you indicate a different tax rate, please state your relationship to decedent: PART ~ TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF 1 2 3 4 5 6 7 8 x TAX ON JOINT/TRUST ACCOUNTS x PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME ( ) WORK ( ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE . Page 2 November 22, 2006 , / 3. Account Type.................... .......Checking Account Account Number. . .. . ..... .... .. . .. . .. .1062662 Ownership (Names oj)...............Mary Sebum Opening Date. ........................ ..04/05/90 (account closed 11/13/06) Balance on Date ofDeath..........$4,724.47 Accrued Interest $ 0.00 TotaL.................................... ..$4,724.4 7 4. Account Type........................ ...Savings Account Account Number..................... ..1500420930938 Ownership (Names oj)...............Mary Sebum, Doris Reeder Opening Date..... .................... ..03/01/76 (account closed 11/13/06) Balance on Date ofDeath..........$4,999.65 Accrued Interest $ 1.00 TotaL................................. ....$5,000.65 The above named decedent did not have a safe deposit box. For any additional information on the above accounts, including ownership, statements and closures please contact our Stonehedge branch at 717-240-4524. Sincerely, . ~11~ Charlene Warrington, Records Management 1-888-502-4349 ~ m1M&fBank 499 Mitchell Street, Millsboro, DE 19966 November 22, 2006 Frey & Tiley Attorneys At Law 5 South Hanover Street Carlisle, PA 17013 RE: Estate of Mary E. Sebum Date of Death: October 1, 2006 Social Security No.: 162-22-2712 Dear Mr. Frey: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the following accounts. 1. Account Type................. ..........Savings Account Account Number.... .................. .25004920 107966 Ownership (Names of}..... ........ ..Mary Sebum Opening Date. . ... .. . .. . . . . .. . .. . .. . .. . .10/04/83 Balance on Date of De at h..... .....$600.76 Accrued Interest $ 0.00 Total. . .. . .. . .. . .. . .. .. . . .. . .. . .. . . . . .. . .. .. $600.76 2. Account Type....................... ....Savings Account Account Number..................... ..25004920 109045 Ownership (Names oj}.............. . Mary Sebum Opening Date.... . .. . .. . . .. .. . .. . . .. .. . . 10 /04/83 Balance on Date of Death........ ..$600.76 Accrued Interest $ 0.00 TotaL................................... ..$600.76 Ewing Brothers Funeral Home, Inc. 630 South Hanover Street Carlisle, PA 17013- (717)243-2421 October 6, 2006 Doris Reeder 121 Stonehouse Rd. Carlisle, PA 17015 The Funeral Service for Mary E. Sebum 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. 1. PROFESSIONAL SERVICES Services of Funeral Director/Staff. . . . . . . FUNERAL HOME SERVICE CHARGES $3695.00 $3695.00 SELECTED MERCHANDISE: 20G Jupiter Gold Casket Gasketed. . . . . . . . . . . . . . . . . THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED . . . . . . . . . . . . . $1995.00 $5690.00 Cash Advances Clergy/Mass Offering. . . . . . . Certitied Copies of the Death Certificate . Flowers. . Hairdresser. . . . . . . . . . Sentinel obit . . . . . . . . . TOTAL CASH ADVANCES AND SPECIAL CHARGES. $75.00 $72.00 $ I 32.50 $35.00 $118.40 $432.90 Total Total Cost $6122.90 SUB-TOTAL INITIAL PAYMENT / DISCOUNT / CREDITS TOTAL AMOUNT DUE $6122.90 0.00 $6122.90 The unpaid balance over 45 days is subjected to a 1.00 % service charge per month - 12.0000 % per annum. -I ~.;/ Il~ --J ~tJ . Jd()f,.1 ~ J/~ (j.ft , / J J,t--, !/'1Jl- /J/ Y!--- [JQiJ tP if' L~ 1J/ ~,~. . / J 'Z- '10, ,,;) () : &1 tp . ~;;p{l ~ Member of National Funeral Directors Association j)C1te./5 ;eJ:7:LJEI< I J-i 5 TO ;V/:'- tIoos IF .R b C&,( L/Jpj Pit 17cJ/5- ,. , , / ,...; ...,." l../ u SElLER NAME ADDRESS l..I' ~ ' ". ~...' '(_..... , < ."., ".-",' '.-/ L:.d I """- ~~ PO IlOlC 4lU!!FFlJNIIURGo PA 17844 . PHONE lllllOl32&-74lM FINAL SETTLEMENT DATE OF SALE dZsHOU c:) ~ PHONE 77(;,.- ?5-LfLf ZIP AUCTIONEER r; 1-1- -IVAI NFlu I/,~)..L-- /:=-';;/e GKcJ('/pd..s ~,tet2y 77~-71/3 LOCATION OF SALE .wrS.;~~~~SI:;S~:') PROFESSIONAL FEES AUCTIONEER CLERK CASHIER OTHER EXPENSES.J C J( :ff' /3LJ>'- J<,.&'J.I r 5"'703 /<uNII/:,-j! S c flS It IlIEZvS CH&p,-o~- -I1-Jv {;&/~t"- - /9-.JV PHONE (,ijfi;lO"'"""'R'e""ElbTcC"3:,., ''.. ") ~~u...".. r!.,U<\'.i~l~;;~;i $ $ $ ~~ ..!?!3- 3-.r)alcV~4 "';Vir.' TO ~ ~c:l:7)El2. o~ 17 CASH $ S; g $ 116:;"', ~ CHECKS OTHER RECEIPTS $ $ ;La? ~ $ $ St'..~ $ $ %~ $ $ AIle $ $ $ $ $ $ $ $ $ $ TOTAL RECEIPTS $ J'it51. 32- $ LESS TOTAL EXPENSES $ .s-S'?; so I (or we), the seller, accept this settlement and acknowledge receipt of the above specified net proceeds from the auction of my goods and property sold on the above date. I accept all responsibility for providing merchantable title to all goods, and property sold, and for delivery of title to the purchaser. ~r~tu uctioneer or as Jer signa re ...d. -4' Date (Seller's Signature)