HomeMy WebLinkAbout03-05-08 (2)
~
15056051047
REV-1500 EX (06-05)
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
OFFICIAL USE ONLY
County Code Year
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
~I () <6
o \ d--,3.
Date of Birth
/90095f21./
0./ 2. C> Z- (!) 0 f
o
'.9 I 7
Decedent's Last Name Suffix
Decedent's First Name
1<. D .5 .5 L I?.
IAn?
MI
Ie.
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
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:::::>
2. Supplemental Return
c:::::> 3. Remainder Return (date of death
prior to 12-13-82)
c:::::> 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
c:::::> 4. Limited Estate c:::::>
., 6. Decedent Died Testate c:::::>
(Attach Copy of Will)
c:::::> 9. Litigation Proceeds Received c:::::>
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
c:::::> 11. Election to tax under Sec. 9113(A)
(Attach Sch. 0)
-
CORRESPONDENT - THI~TION MUs:':. BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name '., Daytime Telephone Number
K A(T f(
E€^ .AJ'
rA
N. e.N13 11 U /']
7 ' 7 721 9 I a ~
Firm Name (If Applicable)
REGISTER OF WILLS U$I: ONLY
()
:::-:;0
-::':6
L,lr' ,
First line of address
:':;:,:l'l"
;;0;"1
, "'--.
.
.
Ul
t, / I L'I
-5 0 t77I>7ER. TD;J
))~
Second line of address
City or Post Office
State
ZIP Code
-:!.
.:._~' :::::) ... ()
-P-A-rE FILED --
/Yl E (! ;.( A Ai I c S 1.3 v 1\ G
/',4
(", )
17a SO
Correspondent's e-mail address:
k.aii 3/ @ t!.-6/71(i/lJ! /Iff
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 information of which preparer has any knowledge.
DATE
J);- (t!zO/?/t'.:]hll?
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056051047
15056051047
~
.-.J
15056052048
REV-1500 EX
Decedent's Name:
Decedent's Social Security Number
/ q{) () 9 :;ffZLf
RECAPITULATION
1. Real estate (Schedule A).
2. Stocks and Bonds (Schedule B) . .
1.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 3.
........ . . ... 2.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . .
4 Mortgages & Notes Receivable (Schedule D). . . . 4.
5.
6. Jointly Owned Property (Schedule F) c::> Separate Billing Requested .
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) c::> Separate Billing Requested.
8 Total Gross Assets (total Lines 1-7).
9. Funeral Expenses & Administrative Costs (Schedule 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 Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J) . . . . . . . . . .
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) X .0_
16. Amount of Line 14 taxable
at lineal rate X.O - 9(j I; Zit.,
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15 ·
19. TAX DUE. . . . .
6.
7.
8.
9.
. . 10.
... 11.
. . . 12.
. . . . 13.
. . . . . 14.
15.
.3 16.
17.
18.
. . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L
15056052048
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9
D 0
Z 0 9 20
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15056052048
.-.J
REV-1500 EX Page 3
File Number
Decedent's Complete Address:
DECEDENT'S NAME
tul~'-I"'f71 ^ ;(u~~i....E/?.
STREET ADDRESS
JJ~
" 110
..5r)IY)n7E ,em;.)
CITY
STATE
/7}~ (i H/-1/J,'fS/3~/(~
14
IlLI So
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount (, oS 24- :'$ )
3. Interest/Penalty if applicable
D. Interest
E. Penalty
(1 )
Total Credits ( A + B + C ) (2)
2. 3 2, I ~
TotallnterestJPenalty ( 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)
ZIP
~ ~ II. If
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
~ I 7 q. () z..
A. Enter the interest on the tax due.
(5)
(5A)
(5B)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
~ 179. 02-
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
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
c. retain a reversionary interest; or.......................................................................................................................... 0
d. receive the promise for life of either payments, benefits or care? .................................................................... 0
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ................................................................................................... 0
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 wr.ich
contains a beneficiary designation? ............................................................................................................. 0
No
Dr
55
~
[Z
~
~
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. ~9116 (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. ~9116 (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 PS. ~9116(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. ~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 siblings is twelve (12) percent [72 P.S. s9116(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-1503 EX+ (6-98*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
WtLLIAfJ?' f(
FILE NUMBER
liOS$ L €'II!:.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
A ,I ~ -,r, __/IV
t../-1iZ16"" €
E{I/~.R.l; y
:3.tf;''}llJ.9/
2.
Ii bE t.11't.
'POI/J ,Ad
7~ ["'73- ,:r
TOTAL (Also enter on line 2, Recapitulation)
(If more space is needed, Insert addllional sheets of the same size)
$/01.7 f1,5'7
'J
REV-150B EX + (1-97)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
tJ li.liAfI] X j{os:st.E,{
FILE NUMBER
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
VALUE AT DATE
OF DEATH
9 % s: tt.;:
/t)fj/
el!t>rd..
TOTAL (Also enter on line 5, Recapitulation) $ 9 ~~ ~J
(If more space is needed, insert additional sheets of the same size)
REV.I509 EX. (1.97)
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
/)) I J..~/..q I?? ;f
K();J~ uae.
FILE NUMBER
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
RELA TIONSHIP TO DECEDENT
A. k/-lrE (KATl-li..[;E'tJ)
'-rA AfN€'tJ~4LJn'}
/"'/10 .5{)r)?m~R ToJ
rrh e HI-1/J J{!~ BtJRG,
iJ<
/?-1
b/JU6Hr~t(
J 70S?J
s,
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 OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate, VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. l/e3 hr5f N/)hct?t1( 1S'i11 k.. o'{ t17a rjS y, I Ie..
~ hit! k'i:5 Ace-l .Jr 437247 4/&,3'1 ..s; 1'2 20q.;?D
c ,;.
TOTAL (Also enter on line 6, Recapitulation) $
"
(If more space IS needed, Insert additional sheets of the same size)
REV-1511 EX+ (10-06).
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
WJ ILL /il1J1. R ~(JS5 L- 'lFr<.-
Debts of decedent must be reported on Schedule I.
FILE NUMBER
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
fY}()rh{~;#t1,ni5 Gpill'Srt.
I'7Ul1iCJtfJ,tf 5eYV/bl. 1?er;L~ltmin6
2;3!t),. &')
J 2S: ItrJ
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative( s)
Street Address
City
State _Zip
Year(s) Commission Paid:
2. Attorney Fees
3.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant !<aJt. -7'4. 'lt1l'l1J/ha u.i?1
Street Address 1..;10 SommeItbifl br.
City t1UJfN!AntlfJf1hU~ .
Relationship of Claimant to Decedent ~M.el.tleJ'
J
~5~D.M
State ~Zip 17()$l)_~
4.
Probate Fees IJ""~. ..k~) rI~r':J
r~brJite AiL
Accountant's Fees
276..70
5.
6. Tax Return Preparer's Fees
7.
Jf1 oJ "
21.:..33
2,117
TOTAL (Also enter on line 9, Recapitulation) $ ~,z 1 (). 9()
(If more space is needed, insert additional sheets of the same size)
REV.1512 EX+ (12.03)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
\J 'Lt-1A IY}\'t. K~$5 J..€~
FILE NUMBER
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.
.A Ut?3h"-n:lo [ylR.t'~l~ FeltYIACL
5'{tl. it(
2.
h 'I:S.CDVt{ tauL
~ qg; <17
.~
~(.Il>1 , Y)(h)m\e--r~ .., ~d,i': ,rrJ
1'4 ~.,{Jf)
4.
zPDl l^e~~€-'1 ~~ - S+-c...fe cr:f p~
23g.o-fjI
5' ~tJ~~ 9fl, J4~,
jJb,:;;tJ
~ G~ >>()P.L~Ctml~ Ph~S,C;lJ~~
35.~
TOTAL (Also enter on line 10, Recapitulation) $
~111~ bk
(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
ESTATE OF
FILE NUMBER
Wi J..)..JlUY/ 1: i!,(j$~ LEi?
RELATIONSHIP TO DECEDENT
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not LlstTrustee(s)
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1, u.~4. '1An l'\el1,hau.mrr 3(iQnddAA?J~I--l('
J{JDZ, (atJ (hJj.t}J<d. M. ' 7210
P jrvO'BrU'L A z. gSo32.
]. A /eJl'7d n n 21l ~lU7\
l:" ilb 56 ijYlrY'\efkn Dr d
yi)echll1) I t1 bt.l~PA IlDSD g}rttrl .... ..f;qr)
'3'Jh.c;mt\SKe~\ll
('3 5klj \ul 'p(. Ar\,~
@rk5ptu tA tlt! it~1 ~t!l1
~:th}un ra.n Ill'Q,f)baU fY\
19lto S~m m~t+l>T\ 'bi.
Mt.ehA,tH~hLt'3 fA n 0Sf)
4
da~ h-~u-
AMOUNT OR SHARE
OF ESTATE
f,DOD.-
J
l tybO
I
(N1)'\\f.lt t1lf\~ S'of; v
yem{tinl~ sotelo
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,
1.
B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
OUf l.4J~ c{ Gnttt.. e-hu..trl\..
rvlt. P:'Rt4.~ '1Ztl
G re.J..(\~h~~ 'PA t5'l:Dl
'Z
Sf 'tht(f~ C-h'~'fCh...
J-/ f 31 arl~IY)(nd-A /?'/-r&t.
(I hi .;A jJuJt.h YA _)
t:X3 3d J
~, t)~(;),
~Il &t!)0
(If more space is needed, insert additional sheets of the same size)
TOTAL OF PART II - ENTER TOTAL NON.TAXABLE DISTRIBUTIONS ON LINE 13 OF REV.1500 COVER SHEET $ 7-DD tJ
-.. -
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REGISTER OF WILLS
CUMBERLAND COUNTY
PENNSYLVANIA
CERTIFICATE OF
GRANT OF LETTERS
No. 2008-00122 PA No. 21-08-0122
Es ta te Of: WILLIAM R KaSSLER
IFirst, Middle, Last!
Late Of:
HAMPDEN TOWNSHIP
CUMBERLAND COUNTY
Deceased
Social Securi ty No: 190-09-5824
WHEREASr on the 4th day of February 2008 an instrument dated
August 29th 2003 was admitted to probate as the last will of
WILLIAM R KaSSLER
(First. Middle, Last)
la te of HAMPDEN TOWNSHIP, CUMBERLAND County,
who died on the 20th day of January 2008 and,
WHEREAS, a true copy of the will as probated ~s annexed hereto.
THEREFORE, I, GLENDA FARNER STRASBAUGH Register of Wills in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARY to:
KA THLEEN KOSSLER TANNENBAUM
who has duly qualified as EXECUTOR(RIXj
and has agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 4th day of February 2008.
()jJ.Q,ftcrit
lJp.i~.~'f L:,-
''-, puty
* *NOTE* *
ALL Nll.MP..C: .ll pnTl]:;' ZI DDr?71 D f...-rnnm
(-:) '"-i')
_.,-)
\-'".-
LAST Will AND TESTAMENT
OF
WilliAM R. KOSSlER
...-'-",
"/"1
::.-1
'-.;,.")
c.:.
KNOW All MEN BY THESE PRESENTS, That I, WilLIAM R. KOSSlER, of the
township of Hampden, County of Cumberland, and Commonwealth of Pennsylvania, do
make, publish, and declare this instrument to be my Last Will and Testament, hereby
revoking and making void any and all former Wills by me at any time heretofore made.
FIRST: I direct the Executor hereof to pay all my just debts, funeral expenses and
costs of administration as soon as conveniently may be done after my death. I further direct
the Executor hereof to pay all inheritance, estate, transfer and succession taxes which may
be levied or assessed upon any property which is included as part of my gross estate for the
purpose of any such tax.
SECOND: I give and bequeath unto the following individuals and corporations as
follows:
A. ST. THERESA CHURCH of Chesapeake, Virginia, the sum of $1 ,000.00.
B. OUR LADY OF GRACE CHURCH of Greensburg, Pennsylvania, the sum of
$1,000.00.
C. ALEX TANNENBAUM, the sum of $1,000.00.
D. LAURA TANNENBAUM, the sum of $1 ,000.00.
f4/"tZ.J\
- 1 -
THIRD: I divide the rest, residue and remainder of my estate, realty and
personalty, howsoever designated whosesoever situate into equal shares and I then
give, devise and bequeath one equal share unto each of my children, my daughter
KATHLEEN J. TANNENBAUM, and my son THOMAS R. KOSSlER as follows:
a.) In the-event my daughter, KATHLEEN J. TANNENBAUM, does not survive
me by thirty (30) days, then in that event I give, devise and bequeath her share
of my estate that she would have received to my son-in-law, HARVE A.
TANNENBAUM, per stirpes.
b.) In the event my son, THOMAS R. KOSSlER, does not survive me by thirty
(30) days, then in that event I give, devise and bequeath the share of my estate
that he would have received to my daughter, KATHLEEN J. TANNENBAUM,
and in the event that my daughter KATHLEEN J. TANNENBAUM does not
survive me by thirty (30) days, then in that event I give, devise and bequeath her
share of my estate set forth in this subparagraph that she would have received to
my son-in-law, HARVE A. TANNENBAUM, per stirpes.
FOURTH: I appoint my son, THOMAS R. KOSSlER, to be Executor of this my
Last Will and Testament. I do hereby give to the Executor hereof full power, discretion and
authority at any time or times to sell, at private or public sale, mortgage, lease, pledge,
exchange or otherwise deal with or dispose of the property comprising my estate as deemed
best, to settle and compound any and all claims in favor of or against my estate as deemed
best and, for any of the foregoing purposes, to make, execute and deliver any and all deeds,
mortgages, contracts, leases, bills of sale or other instruments necessary or desirable
therefor.
ftI/1)~
- 2 -
1/] 1'::;,'\1\_" H [.S
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Certification Number
,,'I'IJI"fI'7;,~.;
,\\,'\t~~jJff{,i------"-
/~ ....~~"-
t'~_Va. ..~... L\~\
!~ ~i . .. .. \'!':.~
(~,_,_~ -a" 1,"'-"',
\~S\-ft1- )~~
\\*" ..~... .. ;*$)
\\~~.c ''''-' .. /~l/
~~~ /~.,
--,-!11MENl ~{~\\\\\\'\
-'J;'-"'-""unUliJ1tj!J!-11
This is to certit\ that the informuti,\n hcre given i
correctly copied from an original Certificate of Deati
duly filed with me as Locul Rc.'!i'Mar. The origina
certificate will be forwarded to the Swte Vitu
Records Office lor pcrmanent filing.
Fec for this certi ficate. 56.00
P 14125145
~~t3 tl-cL~~
1 / J.:J.1 (] 't
Dute Issued
Local Registrar
Hl05143REV 1112006
TYPE /PRJNT IN
PERMANENT
BlACK lNK
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse) STATE FilE NUMBER
,,,
6 OM. ct M. Momh, Qa .
7, Birth Cit .m....orlDr
190- 09 -5824
a. PIp! of De. Chri.
Hospil_
D_ DER'o".._ DOOA DN~.","",,,
g, WNc.c.dIntdHiapal'licO"igin? gNo
(u...._c"""'.
Muican,Puer\o~,~)
.. D_ofOulh{McnIh,~,.,..-)
January 20, 2008
t Narnt 01 Dec:.denl {Fi'st, middle. IISI. 5\lffix)
William R. Kassler
5 ~ (lISt BnhdIYI
11. o.o.o.nl'sUll.IllQa::u lion Kinddw.:ri:.doM moI1c1wa\m 'fleCCJnotPd,tti(<<t
Kind d wort. I(ind~ SusiMs,sl \ndI.lUy
land Consultant Electric Com
. 16 OecederIl'sMaiIillqAda'"flIss(StrMt,cil:yfWM\,st..zipcode)
6110 Sommerton Drive
Mechanicsburg, PA 17050
13. ~l'a E6.qtjon (Spoc:ity only hictliIIt.,.* oomplUd)
Ellmlllla'y' Second.-y (l).. 12) eoaeg. ('" <If 5+)
2
14.MaitIISLltu':~.Nev.M<<ried,
WicioMd, Oi.tt<<~ (Specitfl
Widowed
D_.s""",,
10 RIce: AmericIr1IndiIfl, 8Id., 'Mh, *'
1-
90
September 4,1917
ad, F.aityNMM(lfnolinstitu1ion,givellr_ll"Idrnl~)
Bb. CountyolDealtl
Cumberland
6110 Sommerton Drive
White
17b Counly
PA
Cumberland
""-
Uw.irI.
Township?
17C,lJ. Y~,CecedentUvedin
17dO~~~Vedwilhin
Hampden
Top
171. Stale
City/Bao
18 Fat/llll'" Nam. (hSl, middle, lasl, suffix)
19 MoltIfIr'sNarne{Firstmiddle,mIidenSl.rnImeI
Minnie Roberts
Joseph Kossler
Kate Tannenbaum
20h ll'lformlllfs Mliling Atlaeu IS...... city I lawn, at.., lip code)
6110 Sommerton Drive Mechanicsburg, PA 17050
201 Infam.r\l'aN~ {1"y~/Pnnt}
21c, Piece of Disposition (Nam. of ~IMy, 17emlfory or oil. pI.ace\
21d. LOCJtiontC4y/lowwn,"N, zipcoo.)
Conolite Crematory
SChaefferstown, Pa. 17088
22c, Name IIld .A.dCi'.ss of FIci~ty
Myers Funeral Home, Inc. 37 East Main Street Mechanlcsburg. PA 17055
23b Lit:enM Numw
%
W
"
W
o
"
~
Appomnaie in\wval. P'/W1 II: Enl8l' othiIr sionilicllll COI1ditions cooribulillQ 10 death
CkI$&I.laOealh but nlll resulling in the undMiying C&lsegiven in plft I
28 Did ToblCCO Use ConG'1bilM to Dealh?
o Yea 0 Proo.bty
lS(No D U"known
29 "Fernq
ONol.fX~NI\Wl\Junpa~lye.
o Plegnll'l\'-bmtt01 Oealh
o <<i.1l.p"egnll1t,b\llp'lIl9"ant IMIhi/l 42 days
oIdellh
ONOl,pregr,anl,bI.ltp"~atl\4JdaystolY(UJ1
"'do'"
DuoknOMi!/IX890aotlMlhiolhtlPlStYli.
32c P~oflnj\l~.Hom.,F.m,SIr_,Factay,
~ 8uDIg, e1c (5f*i1y)
. I~s 24.26 must be completed liy ptll'$OO
....tlop-oolllJncesdulh
24 TimeotDe,lh 'I
. lei
() r.,
26 W.CIWRAfilf{ltdlaf.Wca4E",amif,.JCOl'ClnIrkleReI$OOOlhwlh.-. amallonaDonalioo?
D ,.. !'tN.
IMMEDIATE CAUSE {f1Oa\ dl~ase a-
lXlOdItionrtlsultingifldealh) -.
I~~C k~
Sequeoll&llylistcoodlIlOl'ls,i1&r1Y
Ielding to cauUl bted on jne a
Ent. ltI. UNDERlVING CMJS-E
(diseaseorinjurylhatinillatedlhe
. e~enli resultlnllln dealh ) LAST.
Due to(IU'" IcooS8qutlnC;1Il 0.0
Due to (or...(;onuqtlenc;e 00:
D'...~o
OVoIS DNo
31 Manner 01 Dulh
~Nalurill 0 Homiode
O-'cclOel1t DPlndlnglnv.s~lI.llOn
o SUIClOO 0 CI;lUId Not b6 Dellll'mined
;Ud, Tim.oIlnjury
329 Loca\tOI\ 01 ~ (S"lf\, CIot11 \OMl, It.te)
30e Wu Il1lwtOl)s1
Perlormed7
30b W.I A\J\opsy Findings
AvailablePriatQCQffipl61loo
otCIUSIOjDtiath?
M
331, Certifi...jctledo: Ol1I~onl)
~;:l~:,~~~~~~~;:;: d=:~~:;: :ju~: 1h~:U:~~)::1'::.~~,~=~C~ ~~ ~~ ~~~ ~1:n_2~ _ .. _ _ _ _ _ _ _ _ __ _ .. _ _ _ _ _ _ Jg: ~
i:o~:ubn::t:: ~~~~:,h:::~t(::~:: =u::::n:n~;~(;:=Z~:gt: =::~:r~d m&nnlr., ,tat~.. _ .. _ _ _.. _ _ __ _.. _ _ _ _.. _ .D
~~:b~~~~~~;fn~':. Illg I or InvnUQIUon, in n1V- opinion, death oc<;uu.d it \ha tlma, d"t1, Vld pl"(;I, Ing dill to till t.u..(allnd mannII' la ,tiltld. _ _ .D
~
~lt.
11- 11 1)..1,1, 1'1.
--
Disposition Permit No
PROOF OF PUBLICATION
State of Pennsylvania, County of Cumberland
Troy Whitesel, Classified Advertising Manager, of The Sentinel, of the
County and State aforesaid, being duly sworn, deposes and says that THE SENTINEL,
a newspaper of general circulation in the Borough of Carlisle, County and State
aforesaid, was established December 13th, 1881, since which date THE SENTINEL has
been regularly issued in said County, and that the printed notice or publication
attached hereto is exactly the same as was printed and published in the regular editions
and issues of THE SENTINEL on the following day(s):
February 9, 16, 23, 2008
COPY OF NOTICE OF PUBLICATION
EXECUTRIX NOTICE
Letters Testamentary on the Estate of WilliAM R.
KOSSlER, lat9.of the Township of Hampden,
Cumberland County, Pennsylvania, deceased,
have been granted to the undersigned.
All persons knowing themselves t9 be indebted to said
Est~te will make, payments immediate)y,andthose
havlngclalm~wlll presentthem for settlement. "
Kat~leen Tannenbaum
Executrix
61.1Cl Sommerton Drive
Mechanicsburg; PA 176S()'
Affiant further deposes that he/ she is not
interested in the subject matter of the
aforesaid notice or advertisement, and that
all allegations in the foregoing statement
as to time, place and character of
publication are true.
~~~.~..
<...........::... '. .-'
Sworn to and subscribed before me this
25th day of February, 2008.
C>ItL~);. :J1a.J ';fn{) ~
Notary PU~
My commission expires: Of /1/0{
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Christina L. Wdfe, Notary Public
Car1is1e Bora, CUmbel1and County
My Commission Expires Sepl1. 2008
Member, Pennsylvania Association Of Notaries
Please Note: Your Sale Proceeds Check is Attached
,..
BNY MELLON
SHAREOWNER SERVICES
P/~b}.
:::Y:iJ-'j'irijl:fit:with:::eas~::!:(:: .... ......... ....... ................:.::........:.'.............':.':'........... .....
Login to
Investor ServiceDirect@ at
www.bnymellon.com/shareowner/isd
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SHAREHOLDER OF
DESCRIPTION
/NVESTOR /D
124842647906
SHARES/UNITS SOLD
667.9986
GROSS PROCEEDS
$34,925.91
NET PROCEEDS
$34,910.91
ALLEGHENY ENERGY, INC.
CUSIP ACCOUNT KEY
001 75001736110 KOSSLER..WILLROFOO
PRICE PER SHARE ($)
52.2844090
CHECK NUMBER
6551348
TRADING FEES PAID BY
SHAREHOLDER
$80.16
COMPANY
$0.00
TAX WITHHELD
COMPANY
$0.00
$0.00
SHARES HELD BY PLAN
0.??oo
c ~,t LL
o:~
C. 1 / ctlfvV f)
~
CHECK AMOUNT
$34,910.91
SERVICE FEES PAID BY
SHAREHOLDER
$15.00
Please Note: Your Sale Proceeds Check is Attached
~~
~
BNY MELLON
SHAREOWNER SERVICES
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-
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;.;.:.:-:.:.:.:.:.:.:.:.:.:.:.;.:.;.:
. . . . . . . , . . . . .. ..
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_.____.~__~R________________________------------------------------------~-----------------------------------.------------.-----.--------.
RETAIN
........'..... 'I:j:':j:jj),:):),j:'ij:':'::I)m'j:m:,)m:I:::I::""'m"'::::::):;:m:':::::'::::):j'::)m:tI@:j,jjj:j:j';::':::j::':'::"?j:::;I:j:'):II;:::jj,j:jj:j:;?::;j:jm:):::)'jIIjMN$A<<tt:QNj~j,f.AjI;:j:::,:j:jj:):j:{I:,i)I,,:jjjj:':';):::,j):::::::Iji:)jiji)i:j:j,;):):::::::@{::):)::,),,:::,j::j::::)),;:,:::):,j),),@::;,::::::,:::::::,@):),)::): .. .... .... ..
....". :;:;:;:;:;:;:;:;:;:;:;:::::::.::::.;.;.;.:.;.;.:......
SHAREHOLDER OF DESCRIPTION
ALLEGHENY ENERGY, INC. SHARES SOLD
INVESTOR ID I CUSIP I ACCOUNT KEY CHECK NUMBER I CHECK DATE I CHECK AMOUNT
124842647906 001 750 01 7361 10 KOSSLER-WILLROFOO 6551348 02/19/2008 $34.91 0.91
SHARES/UNITS SOLD PRICE PER SHARE ($) TRADING FEES PAID BY SERVICE FEES PAID BY
667.9986 52.2844090
GROSS PROCEEDS TAX WITHHELD COMPANY I SHAREHOLDER COMPANY I SHAREHOLDER
$34,925.91 $0.00 $0.00 $80.16 $0.00 $15.00
NET PROCEEDS SHARES HELD BY PLAN
$34,910.91 0.0000
PLEASE DETACH BELOW- CHECK NUMBeR: 6551348
_:I.II::Ir.1:1::f...I:II.I.loi.h'II::I~I..:r.~"JI:l.~~I{.lti:'.1:1:.a:t.'..I:la.:'=-:'.lot;..la.:II:w.I.lotlli'II::I~I.e{.I~.'.ml-...mr"a'lalljr""'l'l',.:t:Ii'lr":I:":I'IIII.Jt:".lmr"~leill=lli'.a'JI~
60-160
CHECK DATE CHECK NUMBER 433
ALLEGHENY ENERGY, INC. 02119/2008 6551348
PO BOX 358014
PITTSBURGH, PA 15252.8014
PAYABLE AT MELLON BANK N.A. PITTSBURGH, PA.
IN U.S. DOLLARS
100271001 MB 0.360 -AUTO T9 0 603617050.7305101 DOMOOOOO101
11111111111111111111111111111111111111111111111111111111111111 .
PAY TO THE
ORDER OF:
KATHLEEN TANNENBAUM EKUW
WILLIAM R KOSSLER
6110 SOMMERTON DR
MECHANICSBURGPA 17050-7305
I PAV....................$34, 91 0.911
?!~
t AUTHORIZED SIGNATURE
II. 0 b 5 5 I. 3 ~ a II. I: 0 ~ 3 3 0 I. bOLl:
o I. 1.11'001,011.
~ ,;~~]~1;re~'}::r~'r~"~~~!~i~iiCFfC"~'~77'CC~?~1;Ti~
, , BROKERAGE SERVICES L..LC
; "/;'
./ "-'% ,(~/'.':', "~.,~.;v-:<'
,-:.:
':. "
62-35131.1
.PA Y <'Seventv Two Thousand Eight Hundred Seventv Three Dollars
arid 68 Gents
Febrciary 25; 2008
I EXACTLY.
*$72.873.68 *
TO
THE
ORDER
OF
0000912
KATHLEEN TANNENBAUM EX
EtO WILLIAM R KOSSLER
6110 SOMMERTON DR
MECHANICSBURG PA 17050-7305
Not Valid After 90 Days
National Financial Services LLC
~. ~~
AUTHORIZED GNATURES
II- '1 ~ I. 5 ~ ~ 2 ~ 1.11- 1:0:l ~ ~00:15 ~I: 11-0 :l00 '1? I. 20 ~II-
THE ORIGINAL DOCUMENT HAS AWHITE REFLECTIVE WATERMARK ONTHE BACK. HOLD AT AN ANGLE TO SEE THE MARK WHEN CHECKING THE ENDORSEMENTS.
Fidelity Brokerage Services LLC
P. 1- o-t ;r
VOUCHER
NO.914511214
........ .
:-:-:-:-:.;;;. ,-,.. . . ....,.~;.;..'....;............ ;;;.;.;::-:,:;:-:-:-:,;,;':'
.B~t~:j::: ;:::m~~~~~"]~::8~~P:~1:~~)8~:::::::..:j::j:::jj:j;::::::j:j:
02/25 CREDIT BALANCE
72,873.68
ACCOUNT NO. X179103091
DETACH THIS PORTION BEFORE CASHING CHECK
p..q
~., Kelley Blue Book
~ THE TRUSTED RESOURCE
. !ebb .tom
. """'. Send to Printer
advertisement
1991 Honda Accord OX Sedan 4D
advertisement
BUE BOOK IRADf.IN VALL:
Condition
Value
Excellent
$1,600
Good
$1,375
~
~
(Selected)
$985
Average Consumer Rating (148 Reviews)
Read Reviews
4.6 out of 5
Review This Vehicle
Vehicle Highlights
Mileage:
Engine:
Transmission:
Drivetrain:
95,000
4-Cyl. 2.2 Liter
Automatic
FWD
Selected Equipment
Standard
Air Conditioning
Optional
Power Windows
Power Door Locks
Power Steering
AM/FM Stereo
Tilt Wheel
Cruise Control
Cassette
Close Window
Blue Book Trade-In Value
Trade-in Value Is what consumers can expect to receive from a dealer for a trade-In
vehicle assuming an accurate appraisal of condition. This value will likely be less
than the Private Party Value because the reselling dealer incurs the cost of safety
inspections, reconditioning and other costs of doing business.
Vehicle Condition Ratings
lof2
2/14120086:53 PM
Excellent
$1,600
· Looks new, is in excellent mechanical condition and needs no
reconditioning.
· Never had any pilint or body work and is free of rust.
· Clean title history and will pass a smog and safety inspection.
. Engine compartment is clean, with no fluid leaks and is free of any
wear or visible defects.
· Complete and verifiable service records.
Less than 5% of all used vehicles fall into this category.
Good
$1,375
· Free of any major defects.
. Clean title history, the paints, body, and interior have only minor (if
any) blemishes, Ind there Ire no major mechanical problems.
· Uttle or no rust on this vehicle.
· Tires match and have substantial tread wear left.
· A "good" vehicle will need some reconditioning to be sold at retail.
Most consumer owned vehicles fall into this category.
../' Fair (Selected)
$985
· Some mechanical or cosmetic defects and n..ds servicing but is still
in reasonable running condition.
· Clean title history, the paint, body and/or interior need work
performed by a professional.
. Tires may need to be replaced.
· There may be some repairable rust damage.
Poor
NfA
. Severe mechanical and/or cosmetic defects and is in poor running
condition.
· May have problems that cannot be readily fixed such as a damaged
frame or a rusted-through body.
· Branded title (salvage, flood, etc.) or unsubstantiated mileage.
Kelley Blue Book does not attempt to report a value on a "poor" vehicle
because the value of these vehicles varies greatly. A vehicle in poor condition
may require an independent appraisal to determine its value.
* Pennsylvlnia 2/14/2008
2of2
2/14/20086:53 PM
t
ational
of Marysville
To: Kate Tannenbaum, Executrix for the Estate of
William R Kossler
RE: Date of Death Balance for checking account #437247
Account owners: William R Kossler and Kate Tannenbaum,
Joint owners with rights of survivorship
Date of Death Balance is $418.39 with all checkS; having cleared
Free checking account, with no interest.
First National Bank of Marysville
683
1...111...111....1.1.11...1...1..11.11....1.111111111111111111
WILLIAM R KOSSLER
6110 SOMMERTON DR
MECHANICSBURG PA 17050-7305
BE INFORMED: Protect your Medicare
number as you would a credit card number.
CUSTOMER SERVICE INFORMATION
Your Medicare Number: XXX-XX-5824A
If you have questions, write or call:
Highmark Medicare Services (#00865)
P.O. Box 890413
Camp Hill, PAl 7089-04 13
Call: 1-800-MEDICARE (1-800-633-4227)
Ask for Doctor Services
TTY Users Only Should Call 1-877-486-204~
Business Hours: M-F; 9:00 - 4:30 EST.
This is a summary of claims processed from 12/11/2007 through 02/04/2008.
PART B MEDICAL INSURANCE - ASSIGNED CLAIMS
Dates Medicare You See
of Amount Medicare Paid May Be Notes
Service Services Provided Charged Approved Provider Billed Section
Claim number 11-07340-809-610
Dailey Eye Associates PC, 1857 Center Street, a
Camp Hill, PA 17011-1703
Dr. Harvey, Todd J. M.D.
12/05/07 1 Eye exam & treatment (92014) $95.00 $86.04 $68.83 $17.21 r'
12/05/07 1 Visual field examination(s) (92083) 90.00 67.67 54 . 14 13.53
12/05/07 1 Opthalmic dx imaging (92135-RT) 70.00 39.Ll1 31.53 7.88
12/05/07 1 Opthalmic dx imaging (92135-L T) 70.00 39.41 31.53 7.88
Claim Total $325.00 $232.53 $186.03 $Q6.50
-r,;:(~~'~';;'.~~-;~';;'~>f-~;',:';;.,~;;:&,;;! ;;-;;:;--~';;;';~~-~~;~~;~;-~'!!f,'~~'~-;;.:;~;;'';i-~-~~!-~;;;;;.;~~.;*-~-~?;;;';~'~-;;;:~~!-;-~';i-;~;i-~-e.';';~'Y.i~~~~;'~~';;:r:~~';::'~,*.;'it:;:'~!';~::~i'~:~'~~'~'~,~!;;;::;;;';'~.~;';,'M"~o!:~:;'~~}r.,;~';'~~'~~;:r;;.~;~~~i;';=::':~f.';' M.:~~~~',~i::~ ~~~'e',~~'~';";;;,~i--~~;';H::::~::,;~ ~~'.: ~;,,~:~~;'~~;;;' ~~';,''i-:;'~i:; '~~<'~~
Claim number 18-07340-519-690
Heritage Medical Group LLP, POBox 12942,
Philadelphia, PA 1917~0942
Referred by: Dr. Harm Jr, Kenneth R., M.D.
Dr. Sangillo, Cathleen M.D.
11/30/07 1 Office/outpatient visit, est (99213)
11/30/07 1 Decis mkr/advncd plan doc'd (l080F)
Claim Total
......,'..",',"",'--,'.'".,..,'.'
=' ,~'" "~', ,~~,. ':",',0< "",,'~~ ">
a
$75.00
0.00
$75.00
$56.68
0.00
$56.68
pd. 1.0\
$11.3lt.A
0.00 b
$11.3Q
$45.34
0.00
$Q5.3Q
THIS IS NOT A BILL - Keep this notice for your records.
000222965
Your Medicare Number: XXX-XX-5824A
PART B MEDICAL INSURANCE - ASSIGNED CLAIMS (continued)
Dates
or
Service
Services Provided
Claim number 19-08022-198-910
Heritage Medical Group LLP, POBox 12942,
Philadelphia, PA 19176-0942
Dr. Harm Jr, Kenneth R. M.D.
01/15/08 1 Office/outpatient visit, est (99214)
01jI5/08 1 Urinalysis, auto w/scope (81001)
01jI5/08 1 Office servIce (l123F)
01/15/08 1 Office servIce (4040F)
01/15/08 1 Tobacco use, smoking, assess (1000F)
01/15/08 1 Office servIce (1 036F)
Claim Total
Amount
Charged
$105.00-
12.00....
0.00
0.00
0.00
0.00
$117.00
Medicare
Approved
$86.30
4.Lt3
0.00
0.00
0.00
0.00
$90.73
Medicare
Paid
Provider
$0.00
tt.tt3
0.00
0.00
0.00
0.00
$lf.lf3
4]217268
Page 2 of 4
February 26, 2008
You
May Be
Billed
See
Notes
Section
a
$86.30 c
0.00 d
0.00 b
0.00 b
0.00 b pd-
0.00 b
$86.30
'.;;,~~',~'~;- ~~;;?~; ,; ii:,~~ ~~-==ii: ;;~ ~~: :;:, .:;;: :g:;,~~,~';;'~'~~?,-~~;5;'~:,~~,~'?"~:: ,;-;,~,,~;.;-;;;~:-.~~; t~~ ~E-,~2;-~i';;;r::~'ii-~-,,;;:~;;::;-;;-~_~.~.~.~~-;:~,~i.~?;;ii.~.;;?: ~~.:;i:;:.;~-:;.~~;;:;':Y.~~';.;,-io~;;.>;~: ~r,-;~;:;.~~; ;:,:;:-~~>;:'~~;.~'~~_:;~,~~';;;,~ :~!.;-;P;',~~ ;,;:;:,~,:.;:~; ~;,;-~::-~',,;-;;.;~-~;-.;'t~~--~~:;::;,~; ,: ,;;;' ~~';:.;;:,~;; ;,;~:;:: ,~~::;; :;:~~~; ;:;: ~~:.;:;: :;;i." ::,/ ~~:: :,-:. ::;: ; :::~; :;.:;~:~~~ ~"
Claim number 11-07332-478-210
Urology or Central P A Inc, POBox 4963,
Lancaster, PA 17604-0000
Referred by: Dr. Harm Jr, Kenneth R., M.D.
Dr. Dowling, Keith J. M.D.
11/27/07 1 Office/outpatient visit, est (99212)
$60.00
$3tt.56
$27.65
a
pd.
'~3 -D ~
$6.91
Notes Section:
a This information is being sent to your private insurer. They will review it to see if
additional benefits can be paid. Send any questions regarding your supplemental benefits
to them. Your private insurer is HIGHMARK INC.
b This code is for informational/reporting purposes only. You should not be charged for
this code. If there is a charge, you do not have to pay the amount.
c This approved amount has been applied toward your deductible.
d This service is paid at 100% of the Medicare approved amount.
i17.6D
I l
24.27
"i.tt3
51.3D
35.vv
-
111.00
Four Generations..,
.~fi~nQ
ST A TEMENT OF FUNERAL GOODS AND SERVICES SELECTED
Charges are only for those items that you selected or that are required, If we are required by law or by a cemetery or crematory to use any items, we will
explain in writing below,
If you selected a funeral that may require embalming, such as a funeral with viewing, you may have to pay for embalming, You do not have to pay for embalming
you did not approve if YOji s~lectJd arrani\ellle~~uch as a direl'cremation O~medja~ burial, If we charged for embalming, we w' ~ e!Q.lain ,~h~~?w, ,
For the Service of VL/ ICL, of'l}'Vl A, le.ss (",~,< Date of D ath ZO :.-d ~
t'lTIE' ~ iJ <'r./ ,.... c:'ll () .JO ~;1-hN 1?1'S,-o
Name Address City
BOYD L. MYERS, JR., Supervisor
37 E. MAIN STREET
MECHANICSBURG, PA 17055
(717) 766-3421
Charge to:
A. CHARGE FOR SERVICES SELECTED:
I, PROFESSIONAL SERVICES
Services of Funeral Director/Staff
Embalming , , , '
Other preparation of body
Other clothing
, , ;CvJ-
SUB-TOTAL OF PROFESSIONAL SERVICES,
2. FACILITIES AND SERVICES
Use of facilities and services for
viewing (Visitation/Wake),
Use of facilities and services
for funeral ceremony ,
Use of facilities and services for
Memorial Service
Use of equipment and services
for graveside service,
Other use of ,facilities
Al~
S
$
-L
(~eeS~~~~~n~rn, i'tL:.4" i9' S~
OTHER $
S
S
'''~
"" $~
" " B 5*
$ ..-/
TOT AL MERCHANDISE SELECTED,
C. SPECIAL CHARGES:
Forwarding of remains to
$ ./
(Funeral Home)
Receiving of remains from
s
$ ..,.-
(Funeral Home)
Immediate Burial, ' ,
Direct Cremation,
s
s7~
s
209~~
C$_,
$~
$~
SUB-TOTAL OF FACILITIES/EQUIPMENT, '
, A2 ;t:f,a,L
SUB.TOTAL OF SPECIAL CHARGES
D. CASH ADVANCED
Opening Grave
Cemetery Equipment, , '
lot and Deed, , ' , . , , . , , '
Newspaper Notices-local
Newspaper Notices-Out-of-town , ,
Telephone & Telegrams
Airfare .
Clergy/Mass Offering,
Pallbearers . ,
Certified Copies of t~~l:at~
Certificate,. ,'S". ,~',..
Police Escort
Flowers
Vault Service Charge. . . , , . .
$
S
S
$~
S
S
S
S
$
3. AUTOMOTIVE EQUIPMENT
~~~i;~ie lOlransfer re~ains to Funeral H~~
Hearse (Casket Coach)
Local,
limousine
local
Family car
Local.
Flower car or floral disposition
Local,
Leadcar/c~gy car . I'!') .1'"" uL.,.....
Local ,CI\(.\.., .,. ("ft-I r J,~ , , ~
Car for pallbearers
Local
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SUB-TOTAL OF AUTOMOTIVE EQUIPMENT. , '
TOTAL OF PROFESSIONAL SERVICES,
FACILITIES AND AUTOMOTIVE
EQUIPMENT
SUB.TOTAL OF ADVANCES...
A3~
We charge you for our services in obtaining:
(specify cash advances that are marked-up)
^ 0-~
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Outer burial container,
$-
SUMMARY OF CHARGES
A, Professional Services, Facilities and
Equipment, and Automotive
Equipment,
B. Merchandise, ,
C. Special Charges
D, Cash Advances. , , '
TOTAL OF ALL SECTIONS, , , . , .
PAID AT TIME OF OR PRIOR TO
D;..t L
~
$ ----2!s: ~
09
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B. CHARGE FOR MERCHANDISE SELECTED:
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RECEIPT FOR PAYMENT
-------------------
-------------------
GLENDA FARNER STRASBAUGH
Cumberland County - Register Of wills
One Courthouse Square
Carlisle, PA 17013
Receipt Date:
Recetpt Time:
Recelpt No. :
2/04/2008
09:14:28
1051445
KOSSLER WILLIAM R
Estate File No. :
Paid By Remarks:
2008-00122
AJW
------------------------ Receipt Distribution ------------------------
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST
WILL
RENUNCIATION
SHORT CERTIFICATE
JCP FEE
AUTOMATION FEE
Check# UNNUMBERED
Total Received.........
60.00
15.00
5.00
40.00
10.00
5.00
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
BUREAU OF RECEIPTS & CNTR M.D
CUMBERLAND COUNTY GENERAL FUN
$135.00
$135.00
REMITTANCE ADDRESS I BILL TO
THE SENTINEL - LEGAL KATE TANNENBAUM
P.O. BOX 130, CARLISLE, PA 17013
AD NUMBER I CLASS SALESPERSON BILLING DATE LINES
343694 10 PUBLIC NOTICES shoet 02/25/08 30 * 2
AD DESCRIPTION START DATE STOP DATE
EXECUTRIX NOTICE LETTERS TESTAMENT 02/09/08 02/23/08
PUBLICATION INSERTIONS RATE NET AMOUNT GROSS AMOUNT
3 THE SENTINEL - LEGAL 3 LGL 119.70
TOTAL AD CHARGE 119.70
3 PROOF OF PUBLICATION 01PRF 7.00
PREVIOUSLY PAID -126.70
DA YS RUN
PURCHASE ORDER PAY THIS AMOUNT
william Kossler .00 .00*
R.
* AFTER 03/26/08
MESSAGE:
Thank you for advertising with The Sentinel.
Deadlines for in-column legal advertisements: Monday is Friday at
11 a.m.; Tuesday is Friday at 4 p.m.; wednesday is Monday at 12 Noon;
Thursday is Tuesday at 12 Noon; Friday is Wednesday at 12 Noon; Sunday
is Thursday at 12 Noon.
If you have any questions regarding your Legal bill please call
Tammy Shoemaker 717-240-7176
Fax your legals to 717-243-3754 attention Tammy Shoemaker
You can also EMAIL yourlegaltoClassifiedads:classified@cumberlink.com
Please send a cover letter including your name and address as an attachment
DETACH AND RETURN THIS PORTION WITH YOUR PAYMENT
THE SENTINEL - LEGAL .
POBOX 130 CARLISLE PA 17013 Wllliam R. Kossler
. .
AD NUMBER CLASSO START DATE STOP DATE
343694 PUBLIC NOTICES 02/09/08 02/23/08
AD DESCRIPTION BILLING DATE TELEPHONE NUMBER
EXECUTRIX NOTICE LETTERS TESTAMENT 02/25/08 717-514-6941
GROSS AMOUNT OF
.00
DUE AFTER 03/26/08
TOTAL AMOUNT DUE
.00
ENTER AMOUNT ENCLOSED
KATE TANNENBAUM
6110 SOMMERTON DRIVE
MECHANICSBURG, PA
1,,1111111111,1111.111111I1,1111
17050
20200000003436940000000000000000000000000000002
THE SENTINEL - LEGAL
Printed on 02/15/2008 at 10:26 by shoet
A01t jlljb~q
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Last changed by shoet
02/08/2008 09:42
(717) 514-6941 Acct* 77207
KATE TANNENBAUM
6110 SOMMERTON DRIVE
Given by KATE TANNENBAUM PO# William R. Kassler
Start 02/09/2008 Stop 02/23/2008
Transient Bill Expir.
Class 10 PUBLIC NOTICES
Index: EXECUTRIX NOTICE LETTERS TESTAMENT
Co1s 2 Lines 15 Inches 1.51 Words 59 Box? N
MECHANICSBURG, PA 17050
Subscr? N
Comments:
pd check over the phone. tam
Mail Info:
Type Mail Sched Copies Sunday Comment
Affid N L 1 William R. Kossler
Pb* Code Rate Base-Charge Addl-Charge Total-Cost Ins Start Stop SMTWTFS
OlPRF 7.00
3 LGL 119.70 7.00 126.70 3 02/09/2008 02/23/2008 0000001
TOTAL AD COST 126.70 lla 'th ~2>rd(
-r-
EXECUTRIX NOTICE
letters Testamentary on the Estate of WILLIAM R.
KaSSLER, late of the Township of Hampden,
Cumberland County, Pennsylvania, deceased,
have been granted to the undersigned.
All persons knowing themselves to be indebted to said
Estate will make payments immediately, and those
having claims will present them for settlement.
Kathleen Tannenbaum
Executrix
6110 Sommerton Drive
Mechanicsburg, PA 17050
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CARLISLE - 717-243-3887
01/23/2008 12:54 PM
RECEIPT EXPIRES ON 04/22/08
1111111111111111111111111111111111111
081060076 4CT ENVELOPE T
081020593 2CT SHARPIE T
SUBTOTAL
T = PA TAX 6.0000% on 3.19
TOTAL
CASH PAYMENT
CHANGE DUE
1.47
1.72
3.19
0.20
3.39
5,00
1.61
RECEIPT 10# 2-8023-2099-0078-5765-3
VCD# 750-288-851 TM#~~~~9261
Win a
$5000
GiftCard
Tell us about your last Shopping experience
at Target for a chance to win
a $5000 Target GlftCardl
Locate tha Gift Registry
Kiosk and select GUEST SURVEY.
Or at home. log onto:
M.J.ocget. cOlI/survey
User ID: 7197 6790 1992
Password: 142 347
Cuentanos acerca de tu ultima expariencia
de compra en Target y tendras la oportunidad
de ganar una tarjeta de regale Target
GlftCard por valor de $5000.
En el kiosco del reglstro da regal os,
selecclona "Guest Survey" 0 visita
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1a contrasena y NO de usuarlo de arrIba.
Normas disponibles en "Servlcio al huesped"
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Guests must be 18 or older to enter.
Sweepstakes runs from
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Complete rules at Guest
Service Desk and Target. com/sur'
(Target team and family not a"
l;~ol'
\0\1"
02/05/2008
USPS. ENOLA
ENOLA. Pennsylvania'
170259998
4134870025 -0097
(800) 275-8777
11:01:23 AM
Sales Receipt
Product Sa 1 e Un i t F j na 1
Description Qty Price ,Price
SOUTH HACKENSACK NJ $0.97
07606 Zone-2
First-Class Large Env
1.50 oz.
Return Rcpt (Green Card) $2 15
Certified $2:65
Label #: 70072680000106582574
========
Issue PVI:
$5.77
Total:
Paid by:
Visa
Account #:
Approval #:
Transaction #:
23 903110047
$5.77
$5.71
XXXXXXXXXXXX9509
221545
540
Order stamps at USPS.com/shop or call
1-800~Stamp~4.. Go to USPS.com/clicknship
to prlnt shlPPlng labels with postage.
For other information call 1-800-ASK-USPS.
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xxxxxxxxxxxxxxxxxxxxxx~~~xxxxxxxxxxxxxxx
"LET US DARE TO READ. THINK.
SPEAK AND WRITE. "
. -JOHN ADAMS. 1765
www.poweroftheletter.com
*~***************************x********w*
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx~xxx
Blll#: 1000302435242
Clerk: 01
All sales final on stamps and postage.
Refunds for guaranteed services only.
Thank you for your business.
****************************************
wwwxwxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
HELP US SERVE YOU BETTER
Go to: http://gx.gal1up.com/pos
TELL US ABOUT YOUR RECENT
POSTAL EXPERIENCE
YOUR OPINION COUNTS
wwxxxxxxxx~xxxxxxxxxx~xxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
Customer Copy
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Mechanlcsburg Main Post Office
MECHANICSBURG. Pennsylvania
170553459
4134870055 -0098
(800)275-8777 01:16:53 PM
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01/23/2008
Sales Receipt
Sale Unit
Qty Price
Final
PrIce
Product
Description
CARLISLE PA 17013
Zone-1 First-Class
Large Env
0.70 02.
Return Rcpt (Green Card)
Certified
Label #:
$0.80
Issue PVI:
$2.15
$2.65
70070710000387174990
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$5.60
Total:
$5.60
Paid by:
Cash
Change Due:
Order stamps at USPS.com/shop or call
1-800-Stamp24. Go to USPS.com/c1icknship
to print shipping labels with postage.
For other information call 1-800-ASK-USPS.
$6.00
-$0.40
Bl11#: 1000203074983
Clerk: 16
All sales final on stamps and postage.
Refunds for guaranteed services only.
Thank you for your business.
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
HELP US SERVE YOU BETTER
Go to: http://gx.gallup.com/pos
TELL US ABOUT YOUR RECENT
POSTAL EXPERIENCE
YOUR OPINION COUNTS
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx.xxx
.x.xx..xxx.x..x.xx.x..xxxxxxx..xxxxxXXXx
Customer Copy
/'
2 Old 30 Plaza / Greensburg, PA 15601-8320
Tel: (724) 830-5984 or (888) 462-2328 / Fax: (724) 830-5129
E-mail: AECU@comcast net / Web Site: www AEFCU.coop
Allegheny Energy
FEDERAL CREDIT UNION
February 8, 2008
Kate K Tannenbaum
Executor for the Estate of William R Kossler
6110 Sommerton Drive
Mechanicsburg, PA 17050
Dear Ms. Tannerbaum,
This letter is to verify that the AEFCU Visa credit card account number
4148-8600-00025769 has been paid in full and closed in the amount of
$570.19 as of 2/8/2008 by a transfer from AEFCU's share account number
0000000323.
If I could be of any further assistance to you, please contact our office at the
above number. Thank you!
Sincerely,
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Member Service Rep.
Allegheny Energy FCU
No
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o PLATE TO BE ISSUED BY
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11. GRAND TOTAL
(ADD 9 & 10)
REASON FOR REPLACMENT
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PURCHASER FURTHER CERTIFIES THAT HE/SHE IS AUTHORIZED TO CLAIM THIS EXEMPTION. I/WE ACKNOWLEDGE THAT I/WE MAY LOSE MY/OUR OPERATING PRIVILEGES(S) OR VEHICLE
REGISTRATION(S) FOR FAILURE TO MAINTAIN FINANCIAL RESPONSIBILITY ON THE CURRENTLY REGISTERED VEHICLE FOR THE PERIOD OF REGISTRATION. I/WE ACKNOWLEDGE THAT I/WE MAY
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TITLE GOES TO SURVIVING OWNER) CHECK HERE O. OTHERWISE. THE TITLE WILL BE ISSUED AS:TENANTS IN COMMON" (ON DEATH OF ONE OWNER. INTEREST OF DECEASED OWNER
GOES TO HIS/HER HEIRS OR ESTATE.)
NOTE: IF THE VEHICLE IS TO BE USED AS A DAILY RENTAL OR LEASED VEHICLE. CHECK THIS BLOCK O. IF BLOCK IS CHECKED, COMPLETE AND ATTACH FORM MV-1L.
MESSENGER NUMBER:
3, APPLICANT'S COPY I TEMPORARY REGISTRATION (VALID FOR 90 DAYS)
I
L
DAilEY HARVEY EYE ASSOCIATES
1857 CENTER STREET
CAMP HILL, PA 17011-1703
(717) 761-3011
STATEMENT DATE
illiliil
WILLIAM R. KOSSLER
6110 SOMMERTON DRIVE
MECHANICSBURG PA 17050
~
27495.0(1)
DATE i DESCRIPTION I CHARGE I CREDIT
I I
12/05/07
01/02/08
01/02/08
01/16/08
12/05/07
01/02/08
01/02/08
01/16/08
WILLIAM R. KaSSLER (2749 .0)
EYE, ESTABLISHED PATIENT, 95.00
Ins Pmt-MEDICARE
BAL TO SECOND INSURANCE
Adjustment
Reject-HIGHMARK PA BLUE SHIELD
PT OWES COPAY
VISUAL FIELD, EXTENDED 90.00
Ins Pmt-MEDICARE
BAL TO SECOND INSURANCE
Adjustment
Reject-HIGHMARK PA BLUE SHIELD
PT OWES BALANCE
68.83
8.96
0.00
54.14
22.33
0.00
12/05/07
01/02/08
01/02/08
01/16/08
12/05/07
01/02/08
01/02/08
01/16/08
HRT 70.00
Ins Pmt-MEDICARE
BAL TO SECOND INSU~~~CE
Adjustment
Reject-HIGHMARK PA BLUE SHIELD
PT OWES BALANCE
HRT 70 . 00
Ins Pmt-MEDICARE
BAL TO SECOND INSURANCE
Adjustment
Reject-HIGHMARK PA BLUE SHIELD
PT OWES BALANCE
TOTAL FOR WILLIAM R.
01/15/2008
01/15/2008
01/15/2008
01/15/2008
01/15/2008
01/15/2008
02/07/2008
02/07/2008
02/20/2008
02/20/2008
WILLIAM R KOSSLER ESTATE 10# 110670/KENNETH R HARM JR MD
OFFICE / OUTPATIENT VISIT ESTABLISHED PATIENT DETAILED
URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBI
ADVANCE CARE PLANNING DISCUSSED AND DOCUMENTED; ADVANCE
PNEUMOCOCCAL VACCINE ADMINISTERED OR PREVIOUSLY RECEIVE
TOBACCO USE ASSESSED (CAD, CAP, COPD, PV)l (DM)4
CURRENT TOBACCO NON-USER (CAD, CAP, COPD, PV)l (DM)4
SYSTEM CONTRACTUAL ADJUSTMENT FROM MEDICARE
PAYMENT FROM MEDICARE
PAYMENT FROM BLUE SHIELD
PATIENT RESPONSIBILITY - THE BALANCE IS YOUR COPAY WHICH IS NOT COVERED
--> BY YOUR INSURANCE.
105.00 105.00 0.00
12.00 12.00 0.00
0.00 0.00 0.00
0.00 0.00 0.00
0.00 0.00 0.00
0.00 0.00 0.00
-26.27 0.00
-4.43 0.00
-51.30 0.00
-35.00 35.00
.00 35.00
BALANCE TICKET #GHFP125242
Make Checks
Payable To:
35.00
.00
35.00
HERITAGE MEDICAL GROUP, LLP
For Billing Questions Call
(717)-732-8877
EG2651-32
PLEASE DO NOT SEND CASH THROUGH THE MAIL
PAGE 1 OF 1
01 2498
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