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HomeMy WebLinkAbout09-24-0815056051058 REV-1500 Ex (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po Box 2eosot 21 08 0769 Hartisburg, PA 17t28-060t RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Soaal Security Number Oate of Death Date of Birth 200-16-0652 07/19/2008 03/17/1926 Decedents Last Name Suffix Decedent's First Name MI Kase Norman P (If Applicable) Enter Surviving Spouse's Information Below Spouse's last Name Suffix 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 • 1. Original Retum 2. Supplemental Retum 3. Remainder Retum (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Retum Required death after 12-12-82) • 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUIL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Deborah K Fenstermacher Firm Name (If Applicable) First line of address 8 N. Clearview Dr. Second line of address City or Post Office Palmyra (717) 838-6945 P ~? ~ ~~ C.- REGISTER-.D~IIILLS US~LY _C' r r1 -r - ~~} ,~ '_ ~ r J ~- ~" = ~ -' ~. - > - ~; ~~.__ ~:., ~. State ZIP Code j DATE FILED O PA 17078 Corcespondent's a-mail address: tOlefent~COmCBSt.net Under penalties of perjury, 1 deGare that I have examined this return, irx:luding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Dedaretion of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERS RESPONSIBLE FOR FILING RETURN DATE ADDRESS ~ N G PcLn v i eta ~ . PRQ >Y, ~ ~.. ~ ~ 17 ~ ~ g SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE OR161NAL FORM ONLY Side 1 15056051058 15056051058 f ~, ~ 15056052059 REV-1500 EX Decedent's Social Security Number Norman P Kase 200-16-0652 oecedenrs Name: RECAPITULATION 1. Real estate (Schedule A) . ........ . . . . ............................ .... 1. 2. Stocks and Bonds (Schedule B) ................................... .... 2. 80,325.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . .... 3. 4. Mortgages 8 Notes Receivable (Schedule D) ......................... .... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .... .... 5. 9,747.00 6. Jointly Owned Property (Schedule F) Separate Billing Requested ... .. - . 6. 7. IntervVivos Transfers & Miscellaneous Non-Probate Property 7 00 34 031 (Schedule G) Separate Billing Requested.... . .... , . 8. Total Gross Assets {total Lines 1-7) ................................ .... e. 124,103.00 9. Funeral Expenses 8 Administrative Costs (Schedule H) ................. .... 9. 5,607.00 10. Debts of Der dent, Mortgage Liabilities, & Liens (Schedule I) ............ .... 10. 6,273.00 11. Total Deductions (total Lines 9 & 10) .............................. ..... 11. 11,880.00 12. Net Value of Estate (Line 8 minus Line 11) .......................... .... 12. 112,223.00 13. Charitable and Governmental Bequests/Sec 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. 112,223.00 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^ 15. 16. Amount of Line 14 taxable at lineal rate x .0 45 112,223.00 16• 5,050.00 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18- 19. TAX DUE .................................................... ..... 19. 5,050.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 npr_rarlant's Cemnlete Address: File Number 21 08 0769 DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER Norman P Kase __ 200-16-0652 - - -- _ STREETADDRESS 222 Messiah Circle _ _ _ _- CITY -- -- -- STATE ZIP Mechanicsburg ~~ 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 5,050.00 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 253.00 Total Credits (A + B + C) (2) 253.00 3. Interest/Penalty if applicable D. Interest _ E. Penalty Total InterestlPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the drfference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. ff Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 4,797.00 A. Enter the interest on the tax due. (~) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 4,797.00_ Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property Vansfen-ed :......................................................................................... . ^ b. retain the right to designate who shalt use the property transferred or its income : ........................................... . ^ c. retain a reversanary interest; or ......................................................................................................................... . ^ d. receive the promise for life of either payments, benefits or care? ..................................................................... . ^ 2. If death occurred after December 12,19ti2, 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 Aarount, annuity, or other non-probate property which contains a benefiaary designation? ....................................................................................................................... . ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefiaaries 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. §9116(a)(1.3)]. Asibling 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) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Norman Paul Kase 21-08-0769 All property jointly-owned with right of survivorship must be disclosed on Schedub F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~ ~ 873 shares American High Income Fund -CUSIP 026547208 9,660.00 2. 2926 shares Eaton Vance Spl Invt Large Cap Growth Fund -CUSIP 277905675 42,050.00 3. 2667 shares MFS Tr III High Income Fund --CUSIP 552984205 9,120.00 4. 6 shares Fairpoint Communications Stock -CUSIP 30556010 45.00 5. 73 shares MetLife, Inc. Stock -CUSIP 59156R10 3,768.00 6. 154 shares Comcast Corporation Common Stock -CUSIP 20030N101 3,117.00 7. 352 shares Verizon Communications Common Stock -CUSIP 92343V104 12,414.00 8. 4 shares Verizon Communications Common Stock -- Dividend 151.00 TOTAL (Also enter on line 2, Recapitulation) I s 80,325.00 (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Norman Paul Kase 21-08-0769 Indude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule f. (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FlLE NUMBER Norman Paul Kase 21-08-0769 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (~ APPLICABLE) TAXABLE VALUE ~ • TIAA Annuity -Contract #'s ID510112, ID510120 1,262.00 100 1,262.00 2. CREF Stock Annuity -- Certificate # OT70827 4,457.00 100 4,457.00 3. Hartford Annuity -- Contract # 990981353 28,312.00 100 28,312.00 Beneficiaries of all Annuities are Deborah Fenstermacher and Pamela Ryan-Daughters TOTAL (Also enter on line 7 Recapitulation) S ~ 34,031.00 REV-1511 EX+ (12-99) SC1~IEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8e INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Norman Paul Kase 21-08-0769 Debts of decsderd must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 ~ Malpezzi Funeral Home -- Professional services, merchandise, and various cash advances 4,547.00 2. Royer Flowers -Flowers 171.00 3. Messiah Village Dining Services -Funeral meal 318.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) _ SVeet Address City .State rp Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as daimant's, attach explanation) Claimant Street Address City State . Zrp Relationship of Claimant to Decedent 4. Probate Fees 205.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Publishing Fees for Estate Notice -Cumberland Law Journal and Patriot News 366.00 TOTAL (Also enter on line 9, Recapitulation) I S 5,607.00 (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 SCNEp1~LE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Norman Paul Kase 21-OS-0769 Rennet debts Incurred by the decedent prior to death which remained unpaid a: Of the date Ot death, including unreimburasd ntedlcal expenses. (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (g.p0) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE ~ BENEFICIARIES ESTATE OF FILE NUMBER Norman Paul Kase 21-08-0769 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECENING PROPERTY Do Not List Trustee(s) OF ESTATE t TAXABLE DISTRIBUTIONS [ndude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 • Pamela Ryan 4 E. Summit Ave. Haddonfield, NJ 08033 Daughter 50% 2• Deborah Fensterrnacher 8 N. Clearview Dr. Palmyra, PA 17078 Daughter 50% 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 II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I; (If more space is needed, insert additional sheets of the same size) REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE OF GRANT OF LETTERS No . 2008- 00769 PA No . 21- OS- 0769 Estate Of : NORMAN PAUL KASE (First, Middle, Last) Late Of : UPPER ALLEN TOWNSHIP CUMBERLAND COUNTY Deceased Social Security No: 200-76-0652 WHEREAS, on the 22nd day of July 2008 an instrument dated February 4th 1986 was admitted to probate as the Last will of NORMAN PAUL KASE (First, Middle, Last) late of UPPER ALLEN TOWNSH/P, CUMBERLAND County, who died on the 19th day of July 2008 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wi 11 s in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: DEBORAH K FENSTERMACHER who has duly qualified as EXECUTOR(R/X) 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 mV hand and affixed the seal of my office on the 22nd day of July 2008. **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) r--> nl~ ~.'. V '.,;17 ~~ ~ L- -ri L~: ill-P~i i ~ ' ~ ~~ ~ ~ r -~ ~ ? ~ N 1 ~ -i ~ i l i ~ V i ` ~ll :; :; l NORMAN P. KASE -i ,J ~ ' BE IT REMEMBERED that I, NORMAN P. KASE, of Upper Allen Township, County ~ of Cumberland, Commonwealth of Pennsylvania, being of sound mind and understanding, do make, publish and declare this as and for my Last Wi11 and Testament, hereby revoking and making null and void any and all Wills and Testaments and writings in the nature thereof by me at any time heretofore made. ITEM 1: I direct that all my just debts and funeral expenses be paid as soon after my demise as may be convenient. ITEM 2: All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, whether it be real, personal or mixed, including property over which I have a power of appointment, I give, devise, and bequeath unto my beloved wife, EVELYN K. KASE, absolutely provided she survives me. ITEM 3: Should my wife, EVELYN K. KASE, predecease me, fail to survive me, or should we die simultaneously, I then give, devise and bequeath my entire residuary estate as follows, to wit: A. Fifty percent (50%) to my daughter, Pamela Jean Kase of Mechanicsburg, Pennsylvania. B. Fifty percent (50%) to my daughter, Deborah Anne Fenstermacher of ftershey, Pennsylvania. ITEM 4: I nominate, constitute and appoint my said wife, EVELYN K. KASE, as Executrix of this my Last Will and Testament. If my said wife should predecease me or otherwise be unable or unwilling to serve, then I nominate, constitute and appoint my daughter, Deborah Anne Fenstermacher as Alternate Executrix of this my Last Will and Testament. ITEM 5: I direct that my above-named Executors pay all inheritance, estate, succession and legacy taxes of whatsoever nature and kind, to which my Estate or the transfer of any property passing hereunder or. otherwise pasing by reason of my demise, may be subject, and to charge such taxes against my residuary estate, it being my intention that none of the aforesaid taxes, either federal or state, or any property required to be included in my gross estate, under the provisions of any state or federal law now in force or hereafter enacted, shall be prorated among the persons interested in my Estate to whom such property is or may be transferred or to whom any benefit accrues. ITEM 6: I direct that my Executrix shall not be required to give bond for the faithful performance of her duties in any jurisdiction. ITEM 7: I may have items of personal property that I would like to bequeath to specific individuals. In that event I shall attach a memorandum to this my Last Will and Testament, addressed to my Executrix, detailing any such specific bequests. I request my Executrix to make any such distributions prior to distribution of my estate per Item 2 of this my Last Will and Testament. IN -WITNESS WIIEREOF, I have hereunto set my hand and seal this ~,~ day of ~G~.~a 1986. WITNESS: -~ ~ G ~ _ / ~jl~ h~?2 ;,J `':L_.- (SEAL) NORMAN P. KASE COr410NWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND ~~ ~ I "~~ ~~ We, NORMAN P. KASE, , and _~~.,.:~ ~>,~~ ~n-,k:~,1~~A..~ nd the witnesse-~tively whose names are signed to the the Testator a attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament and that he had signed willingly (or willingly directed another to sign for him), and that he executed it, as his free and voluntary act for the purpose therein expressed, and that each of the witnesses, in the presence and hearing of the Testator signed this Last Will and Testament as witness and that to the best of their knowledge, the Testator was at the time, eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. NORMAN P. KASE WITNE WITNESS Sworn to and subscribed to before me this ~(~ day of }, 2~,' , 1986. NOTARY PUBLIC My Commission Expires.:. , ` °t` ` ,,, ,~, ,:. ,: .,, REV-485 EX + (3-04) ~ - r COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 PA 171 SAFE DEPOSIT BOX INVENTORY Please Print or nnl ICT r2C f^f1nnD1 CTCf1 RV RCPGFCFNTATIVG (1F FIAIAAICIAI wcnTl ITinN wHFRF SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE ADDRESS COUNTY CODE FILE NUMBER SOCIAL SECURITY (Required) OR DEATH CERTIFlCATE NUMBER (only if SSN is unknown) aoo --t b - o ~5~ DECEDENT'S NAME (LAST, FIRST, MIDDLE) . s~ ~'oc~~i/ P DATE OF DEATH ~-iq-Og • ADDRESS OF DECEDE T (STREET) ~ ~ a N~ `~ S S ifl N C~c Ke L~ (CITY) ~ ~G("~l ~1/U i ~S B ~ P~ (STATE) ~ {ZIP CODE) l 7n 5 ~ NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX AME) ~c,f~o ~R K t~NN~ FS/VS' ~ ~~vt~ct+"Lt~ (STREET ADDRESS) (CITY) (STATE) (ZI~DO : NAME ,ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PERSON(S) PRESENT AT THE BOX OPENING a. (NAME) (RELATIONSHIP) (STREET NAME) (CITY) (STATE) (ZIP CODE) b. (NAME) (RELATIONSHIP) (STREET NAME) (CITY) {STATE) {ZIP CODE) c. (NAME) (RELATIONSHIP) (STREET NAME) (CITY) (STATE) (ZIP CODE) • NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED (NAME) /)/~ ~~ „ // (STREET NAME) ~ C~ f} ~ 01/ft ~- (CITY) /ct ~ ~,9N ~ cs~ ~>~ (STATE) ~i4- (ZIP CODE) -7 o s s ~ NAME OF PERSON MAKING LAST ENTRY P~rgc~~a~N 1~~~~ F `rN`~~~ ~~N ~ DATE AND TIME OF LAST ENTRY DATE OF CONTRACT TO RENT BOX a 3-- t l -o f NUMBER OF BOX /o J . TITLE UNDER WHICH BOX IS REQUESTED 1Vo N l~ ~ S~ NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX a. (NAME) b. (NAME) (STREET ADDRESSI (STREET ADDRESS) (CITY) (STATE) (ZIP CODE) (CITY) (STATE) IZIP CODE) • NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY ~©~~ V! s ~S~ WAS A WILL IN THE BOX? ~ YES ^ NO If yes, a. Date of will: b. Name and address of personal representative, if named in the v~nll (NAME) ~ ~~ P./~~l A-K'Nz FANS ~ 4~Lj~~~ (STREET ADDRESS) ~ N C~~p~Ui~ D~ ~ (CITY) HLM('Il?f~ STATE) ~/4 (ZIP CODE) r7a ~~ c. Name and address of attorney, if any (NAME) (STREET ADDRESS) (CITY) (STATE) (ZIP CODE) EFORM125600 SAFE DEPOSIT BOX INVENTORY Page __L_ of INSTRUCTIONS The Department is authorized under federal law, 42 U.S.C. § 405(c}, to use the decedent's Social Security number in administering this state tax law. The department uses Social Security numbers to establish a decedent's identity and ensure proper credit for tax payments. (1) Cash: Report total only. (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by name of company, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stock. (3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and type of ownership, i.e., jointly held, payable on death, etc. (4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank and branch, and balance. (6} Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible. (7) Deeds Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible. (8) All other contents. ITEM NO. ITEM DESCRIPTION 1 P/t GtiK o ~' D t S T R t ~ vT l v ~/ ~ t= 5 7o C1G s ~ 15-'~-E ~ 8 7~ ~ `l i~ i t~-( 6 r ~ zy'. ~ ~ ~~ ~ rl Z ~-7 ~.! F~ ~ N S U,t;4~ ~ #~ Sao X76 A ~-~ ~ -t y-S3' ~Sooo ~rSte !NS 3 N~T(a L S 6~1L`c Z-lF ~V ss oo -,~~ ~ b~' ~~r~p 7 ~~`-`fb ~~l ~F ~'`~T ~/S AFFf}1~S (3~ni~FrctA-~ 7 ~St~~1ATio~fi'~V$Soo `IZ ~~ ~ ~ ~}~ ~S~ F r,~/S ~~ M~~~ yZ I b ~-M ~L~ ~ S~' ,~/ I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. PERSON RECEIVING COPY OF SAFE DEPOSIT BOX INVENTORY: SIGNATURE SIGN,,A~T,,U~-R~E,~ /n" PRINT NAME PRINT TITLE DATE ~' ?-30_0 //~~ ~~ // c~ ~~ ~j(~~ ~"S~µ~ ~ L ~W ~ C'~ !~~'v ~ PRINT NAME AND CHECK APPROPRIATE BOX BELOW: CHECK APPROPRIATE BOX: ~ Executor(trix) ^ Administrator(trix) ^ Estate Representative ^ Joint owner of safe deposit box rvv ~ r: witacn additional S'/z" x 71 " sheet(s) if necessary or use duplicates of this page of form. AUG/U~/1UU~/'1'Uh U3:'J.~ Y1V1 Batate Valuation Date of Death: 07/19/2008 Valuation Date: 07/19/2008 I prpcee8lpg Date: 08/05/2008 I '~ ~ Shares Security ' oz Far DeacriBCion Ij~gh/Ask Low/Bid 1) .872.6 AMIBRICAN BxGN IDICOMH TR (026547208) ~ CL B SI[S Estate of: NORMAN P. $A8H AccounC: 4622-5329 Report Type: Date o! Death Number o~ Securities: 4 Pile Ib: KAS&,NORMAN bean and/or Div anfl Int 6ecurity Adjuatmetit6 Accruals Value Mutual FVnd (as quoted by NABDAQ) 07/18/coos il.o7oao MOct 11.070000 i2) 2926:261:8ATON VANCS 6FL INV'P TR (277905675) ' Y,i4 CAP GwTH C ~ Mutual Pund (ae quoted by NASDAQ) 07/18/2008 14.37000 Mkt 11.370000 ~3) 2666;-667 M$S S8R TR III (5,52984205) ~ !iI Y2iCOlSE CL 8 .Mutual bVUd,(es quoted by NASDAQ) d ~ 07/18/2008 3.42000 MOct '4) 6549.94 HLACBROC$ FD3 (091927701) MONEY MIX INV A Mutual Bund (as quoted by NASDAR) i 07/19/2008 1.00000 1.00000 i total value: To~a1 Accruals :I ~ Total: $67,3?9.99 I I 3.420000 9,659.68 !2,050_]7 9,120.00 1.000000 6,549.94 $67,379.99 60.00 I i gage 1 Tbie report,wae produced with PstateVal, a product of ~etate Valuatioae & Writing SyaCeas, Yac_ If you have questions, i please contact 8Vp Systems at (818);313-6300 or www.evpsys.com. (&evieiem 7.0.4) i BNY Mellon Shareowner Services P.O. Box 358333 Pittsburgh, PA 15252-8333 August 9, 2008 DEBORAH K FENSTERMACHER 8 N CLEARVIEW DR PALMYRA PA 17078 Dear Investor: B1VY M~`t~i.O1~I SHAREQYVNER S~ERVYGES '~'! Company FAIRPOINT '' 'Name 'COMMUNICATIONS, '~ INC. ;Account ~ KASE-----NORMP0000 Key Control 200808040008666 Number _ Telephone 877-295-8608 _ ~ Number 3 a Thank you for your inquiry requesting information for this account. Unfortunately, we are unable to provide the date of death value as of July 19, 2008. It was not a business trading day. Listed below is the account balance as of July 18, 2008. Div. Reinv. Balance: 6.1953 Total Shares: 6.1953 Per share value: $7.31 ~' ~ / Total value: Per share value X Total shares ~ We hope that this information has been helpful. If you have additional questions, please call our Customer Service Center at the number listed above. Sincerely, Natasha Anderson BNY Mellon Shareowner Services BNY Mellon Shareowner Services P.O. Box 358333 Pittsburgh, PA 15252-8333 July 24, 2008 DEBORAH FENSTERMACHER 8 N CLEARVIEW DRIVE PALMYRA PA 17078 RE: NORMAN P KASE Dear Sir or Madam: BNY' M1iI.~.ON 5FIAREO'WhiER SERVIt.E3 Company METLIFE, INC. Name ~ Account Key ~ __ ~ KASE----- ~ NO RMP0000 I _ _ ~ , _ Investor ID # 806580421366 Control 200807240003372 Number ' j Thank you for contacting BNY Mellon Shareowner Services regarding the above referenced MetLife, Inc. common stock account. Please be advised that 07/19/2008, was a non business day, hence we are unable to provide you with the closing price for the same. However, we are able to provide you with the closing price for the dates referenced below: The closing price as on 07/18/2008 ,was $51.5700 per share. ~~~- The closing price as on 07/21/2008 ,was $51.6400 per share. S/~ bl Also, be informed that the number of shares as on 07/19/2008 were 73. If you have any additional questions or concerns, please call our Customer Service Center at 1-800-649- 3593. Sincerely, BNY Mellon Shareowner Services ~omputershare Computershare Investor Services 250 Royall Street Canton Massachusetts 02021 www.computershare.com DEBORAH FENSTERMACHER 8 N CLEARVIEW DR PALMYRA PA 17078 August 7, 2008 Company: Registration: Holder Account Number: Our Reference: COMCAST CORPORATION NORMAN P KASE 03004266080 CMCS/0002844561/8/66140 Dear Sir/Madam: Thank you for contacting Computershare, the transfer agent for COMCAST CORPORATION. We appreciate the opportunity to be of service to you. On July 19, 2008, account number 03004266080 held 154 shares. On that date, the closing price was $20.24 per share. Should you have other account related questions, please call us at 888-883-8903 during regular business hours. Sincerely, i~f 6~/N%W Service Representative Enclosure: None OOD09D NORMAN P KASE 222 MESSIAH CIRCLE 402 MECHANICSBURG PA 17055 inriiinriiinniriairilininiinnriiirinniriniririnii Page 1 of 2 ~pmputershare Computershare Trust Company, N.A. PO Box 43076 Providence, RI 02940-3078 Nfrthin the US, Canada 6 Puerto Rico 800 631 2355 Outside the US, Canada 6 Puerto Rico 761 575 3994 www.computershare.com/verizon Holder Aaount Number imm~nmi SSrUTNI Certllbd Symbol Yes VZ OOIC50006 RPS.EML.VZN.112Q55_21B99/000090/D(10a93/i Verizon Communications Direct Invest Statement k is important b retain this strternent for talc reporting purpoaet, and for tree ~ a reference when you access your account online at our website a when contacting Computerahare. Holder Account Number: 00001366751 eTree®Progrem- By receiving links to shareholder materials online, you can help reduce the amount of materials we print and mail. As a thank you we will plant a Uee on your behaB. You can sign up at www.etree.com/vt:rizon orcall800-631-2355 or 781-575-3994. - ACCOUNT SUMMARY As of close of stock market on 07 Aug 2008 Stock Class Certificated Shared Direct Regilstratlon Investment Plan F Description I Units Held by You I Book SharesNnks I Book SharedUnits ~~61~ ~ ' DSPP - Camrtan SkxdC 0.000000 0.000000 0.000000 0.000000 33.700000 0.00 Transaction History Fran: 01 Jan 2008 To: OT Aug 2008 This section penains only to bookentry shareslunks. Date I Transaction I Trensadion I Deduction I Deduction I Net Price Per Transaction Total Book Description Amount (;) Description Amount (;) I Amolatt (;) ( I SharelUnk (;) SharaslUnks SharttslUnits Plan Transactions DSPP -Common Sock 01 Jan 2006 Balance Forward 344.511042 01 Feb 2008 Dividend Reinvestment 148.14 Transaction Fee 2.11 146.03 38.337590 3.809055 348.320097 01 May 2008 Dividarrd Reimrestrnem 149.78 TransaLtan Fee 2.12 147.66 38.101843 3.675403 352.195500 01 Aug 2008 Dividend ReirnestrneM 151.44 Transaction Fee 2.13 149.31 34.145637 4.372740 356.568240 07 Aug 20011 Transfer -356.568240 0.000000 OOTPPA 194UDR VZN '+ Y~r -. , ~ , ~ .~ aaae "n°.~id" ~a'"1'"°r`f°rr~, Stock Cbs Daaiption - A description d the stock class kt which you hold stlares, e.g. Common stack CatlBated SharesAlrYts Held By You -You relived a stock rib for these shams. Bookfi9ook~EMry Shores -Shares Computershare maintains for you in an electronic aoceurlL a stock certiRCab was rat blued for tllese shares. All Direct Regbtratlar Shares and investment plan ('PIanO shags are held bbook-entry form. Direct Repistralbn Book ShareslUrrils (DRS) - Book~rltry shares that are not part of the Plan. IrwostmeM Plan Book ShanslUdb - Bookentry shares that are part d either a dividerd mimeshrant plan (DRP) a diced stack purchase plan (DSPP}. Total SharesA)nils -The sun d aN certiraated and Ixx* shares held in tlris aaorxrt as d the dab specified. Clostrlg Prke - The closrg market Price as d the account sunmary date. Market Yalua - The doter value d the total shares held in tlms axant as d the data specfed. Dedrrcaon Descripllon -A description d arty amourlb withheld ixdudirg trarlsadion fees. Nel Aarourrt - The trial amount trareaded far you. equal b the trarlsac~n amount less arty applicable dedlrctiarls. Price Per SharelUM -The market price per share purchased a sold under the Plan for thb trareaction. Transw6on ShareWnrb -The nurlber d shares pundtased or sold Mrough Me Plan for This uansatAorr. Total Book ShradUnhs -The sum d all book-entry shares, indud'mg botll DRS and invesbrred plan shares, as d the date specified. SSNrrIN CanNbd - U you acCald b rat certified, as ildicebd b! the word NO appearing udder the SSNlfIN titles the top rigta seldton d 1tNs form, You must complete a Farm W-9 (US resident} or Fonn w-BBEN (norH1S residerd) ar faxes will be w4tldleld ficm arty dNiderds a sales proceeds per Interval Revenue Service requiremerds. Ei6rerlam b avaiable thragh the'DOWNLCADABLE FORMS'section d olr websib. Faxed bms are trot accepbble. Computershare -Shareholder Services -Price at bate Price Graph Price History Price at Date Tinker Symbol or Company Name bolding VERIZON COMMUNICATIONS INC. DSPP -COMMON STOCK Price at Date VERIZON COMMUNICATIONS INC. (D,' Class: Date: Doge Close 18 Jul 2008 US$35.4500 News and Profiles rz~ J iPP -COMMON STOCK} DSPP -COMMON STOCK 18 July 2008 High Low US$35.5400 US$34.9800 ~J Volume 6,047,000 c~ Reuters Limited. Click for Restrictions. ?nc,rs«~•~ ~n~! ~*-^s - - - - Co ri c 20 Co rsh e Limited Il ri h_t~s~e rued. Reproduction in whole or in part in any f~ e 1 Of 1 COII-l~~~~wi{~}~~~~~r~~f'~dutershare Limited is prohibited. Please view o ~ Terms and Conditions and Privacy policy. Price Graph Price History Price at Date TicFser Symbol or Company Name holding VERIZON COMMUNICATIONS INC. DSPP -COMMON STOCK News and Profiles Price at Date VERIZON COMMUNICATIONS INC. (DSPP -COMMON STOCK) Class: DSPP -COMMON STOCK Doge: 21 July 2008 Date Close High Low 21 Jul 2008 US$35.1500 US$35.5500 US$35.0000 `~ Reuters Limited. Click for Restrictions. Volume 1,782,900 J J Copyright c 2008 Computershare Limited. All rights reserved. Reproduction in whole or in part in any form or medium without express written permission of Compukershare Limited is prohibited. Please view our Terms and Conditions and Privacy policy. ~e,~ir~: Premium Plan Account Statement 'NC Baal: R For the period 07/17/2008 to 08/15/2008 EST NORMAN P KASE DECD DEBORAH A FENSTERMACHER EXTRX C/0 DEBORAH A FENSTERMACHER 8 N CLEARVIEW DR PALMYRA PA 17078-9330 PNCBANK Primary account number: 50-7006-8521 Page 1 of 3 Number of enclosures: 0 For 24-hour banking, and transaction or ~- -4 interest rate information, sign on to 'Q' PNC Bank Online Banking at pnc.com. For customer service call 1-888-PNC-BANK between the hours of 6 AM and Midnight ET. Para servicio en espariol, 1-866-HOLA-PNC MovingT Please contact us at 1-888-PNC-BANK ® Write to: Customer Service PO Box 609 Pittsbtlrgll PA 15230-9738 [~ Visit us at pnc.corn TDD terminal: 1-800-531-1648 For hear ink impaired rlienrs only )Vl~it])1L-~I''}' PRO"1'1:C"LION for your PNC Ranh checking account if you haven't allnady done so, stop into your local PNC Rank brmtch today to open and etuoll your PNC' I3anh Select Rewards Visa Platillutn '.ord. N/hat could be better than the solely and comlorl of knowing you'ln protected'? it:ttlllg a SOUltd 1nVCStlIIellt course Inquires expct1isc, empathy and eyperience. PNC' Illvesttnents glades thew clients toward Inal-world olutions designed to help them meet their goals. Pon more inlonnation stop by a PNC Branch or visit pnc.com lot. FDIC Insured * 1~Iav Lose Valise * No I3ank Guaraulee mportant Investor Information: Securities and brokel;lge sclvices are plbvided by PNC Investments LLC, memherFINRr1 and SIPC. tnmlities and other insurance products are ol7ered by }'N(' Insurance Services, LLC' a licensed vlsurance agency. 'senior Premium Plan Est Norman P Kase Decd nterest Checking Account Summary Deborah A Fenstermacher Extrx account number: 50-7006-8521 ~alanee Summary Please see the Activity Detail section for additional information. Beginning Deposits and Checks and other Ending balance other additions deductions balance „???.IO 71,G1L5r1 til7.~i9 73,~1ti.10 Average monthly Charges balance and fees ~7,3~i3.09 .O0 transaction Summary Checks paid/ Check Card POS Check Card/Bankcard withdrawals signed transactions POS PIN transactions :, 0 0 Total ATM PNC Bank Other Bank transactions ATM transactions ATM transactions 0 l) 0 nterest Summary As of 08/15, a total of $6.313 in interest was paid this year. Annual Percentage Number of days Average collected Interest Paid Yield Earned (APYE) in interest period balance for APYE this period O. Lis 3c) `,7,1 10.16 1.3`~ FORM953R-1005 Senior Premium Plan Account Statement ~ ~ ~ For the period 07/17/2008 to 08/15/2008 ~; For 24-hour information, sign on to PNC Bank Online Banking EST NORMAN P KASE DECD ~---ton pnacom. Primary account number: 50-7006-8521 Account number: 50-7006-$52l -continued Page 2 of 3 Activity Detail Deposits and Other Additions Date Amount Description 07,%.i0 9.63 llirect Deposit - Dca1De0307 Gomcast Corpot~t C:LcYSSi6030Cuus 03,/0.1 ~i0,500.00 llirect Deposit -Brokerage Bill 1~lmover :i22791'L 03% 03 17,353.~i0 llirect lleposit - Broket:~e Hill blmover 322'79'44` 03i 12 3,744.14 lleposit Reference No 0`~ 175 13%ri 08j' 1 ri 4.32 Interest Pa~~ment Checks and Substitute Checks Check Date Reference number Amount paid number .li(r8 75.43 07;'17 0370f5ii~i 4 5ti9 91.50 07.'~ 13 ii8is5i31ii 45%0 7Ci,0U 08-11 035?77105 " Gap in check sequence Daily Balance Detail Date Balance 07 / l ~ i.67 C-0!13 `~ Uri~i 17~ 1 07,"30 2,06-.30 Date Balance 03 %04 52,561.30 Os '03 69,913.30 08;! 11 69,8°13.30 Check number 1571 157, Date Balance 03,' 12 73,537.14 08:! 1-4 73,`~ 11.73 03, 15 73,216.10 There were 5 Deposits and Other Additions totaling $71,611.59. Date Reference Amount paid number `?05.00 O3,!l~l (1v7161~1?a6 1 /l). (i:J (11 ); 1'1 I..ti/ IY~bI_.$I There were 5 checks listed totaling S617.59. Seniors -don't Forget, PNC A'Iortgage, LLC offers Reverse A'Iortgages. Stop by or call your local branch to speak to a Reverse 1~lortgage Specialist. Bonovver tmtst be at least 62 years of age. All first inotlgage products are of~erecl and provided by PNC IV'Ioitgaae, LLC'. a°hich may at~•ange loans a iih third party providers. PNC Mortgage, LLC. may not be available in your area. (c)2QQ8 PNC 1\'Iortg~ e, I I C <1ll rights reserved Is paying for college htition in the pichtre for you this sununer'? PNC has many federal and private education loan options available to help pay for college at great rates and offering delayed repayment. Check us out at vr-w-w.pnconcarnptts.com. ~.! VERIZON CBO VERIZON PA 0006004591 VeJYjQA 350 GRANITE ST 2ND FLOOR BRAINTREE, MA 02184-9000 Telephone Number Description 717/766-8219 CREDIT BALANCE REFUND DATE TELEPHONE NUMBER TOTAL REFUND 08/12/08 7177668219 517.29 FOR ANY QUESTIONS, PLEASE CALL 800!483-3000 17.29 Mennonite Mutual Aid Association DETACH AND RETAW TFUS STATEMENT. THE ATTACHED CHECK IS IN PAYMENT OF ITEMS DESCRIBED BELOW. 0 ~ C ~ O C C Post Office BOX 483, Goshen, IN 48527 IF NOT CORRECT, PLEASE No71FY US PROMPTLY. O ~ u v U u DATE DESCRIPTION AMOUNT 8/13/20081 Refund due to death of Norman P Kase 1 $673.19 A# 5256659 rar TIAA Contract No: ID510112, ID510120 CREF Certificate No: OT708278 Norman P. Kase, deceased ILLUSTRATION OF BENEFITS FOR: DEBORAH FENSTERMACHER CONTINUATION OF ANNUIT'S~ INSTALLMENTS. A fixed income (contractual payment), plus dividends as declared, payable monthly beginning as of 08/01/2008 and continuing through 03/01/2011. Contractual Payment Current Dividend Total Initial Payment B E $13.18 = $26.11 $12.93 + N E SINGLE SUM PAYMENT T F I I The commuted value of the annuity installments was $400.02 on 07/01/2008. The total value A T actually payable in a single sum will be larger than this amount since interest will be A ' S' credited on this commuted value until payment is made. CONTINUATION OF ANNUITY INSTALLMENTS A fixed income (contractual payment), plus dividends as declared, payable quarterly beginning as of 10/01/2008 and continuing through 01/01/2011. B Contractual Payment Current Dividend Total Initial Payment E $23.91 + $24.85 = $48.76 N E F SINGLE SUM PAYMENT T I :T The commuted value of the annuity installments was $231.16 on 07/01/2008. The total value A actually payable in a single sum will be larger than this amount since interest will be A S credited on this commuted value until payment is made. CONTINUATIQN OF ANNUITY INSTALLMENTS Your CREF Stock Income is a variable income payable monthly beginning as of 08/01/2008 and continuing through 03/01/2011. Number of Annuity Units Per Current Value of Total Initial Payment Payment One Annuity Unit ~ $239.1911 - $74.63 312 X 0 E . N E SINGLE SUM PAYMENT C F R I The commuted value of the annuity installments was $2,228.37 on 07/01/2008. The total E T value actually payable in a single sum may be more or less than this amount, depending F S upon CREF's interim investment experience. September 9, 2008 Deborah Fenstermacher Email: tolefen@comcast.net Re: Hartford Annuity Contract # 990981353 Decedent: Norman Kase Dear Ms. Fenstermacher: Thank you for your correspondence regarding the above annuity contract. Hartford Life The death benefit payable under this contract is not considered "life insurance", reportable on IRS Form 712 (life insurance statement). Please find the below information in response to your request. Contract Number Owner Decedent Social Security Number Date of Death Date of Death Value* 990981353 Norman Kase Norman Kase XXX-XX-0652 07/19/2008 $28,311.84 *The Date of Death Value displayed above may include a Death Benefit Adjustment as outlined in the Annuity Contract. This figure is being provided for illustration purposes and is not equivalent to the final death benefit. The death benefit will be calculated on all contracts associated with this client the day we receive the certified death certificate. Once the death benefit is calculated, the benefit amount remains invested and is subject to mazket fluctuation until complete settlement instructions aze received. If you have any questions or concerns, please feel free to contact your investment professional, or one of our annuity specialists by calling 1-800-862-6668, Monday through Thursday from 8 a.m. to 7 p.m. and Friday from 9:15 a.m. to 6 p.m., Eastern Standard Time. We will be happy to assist you. Thank you for the opportunity to help provide for your financial needs. Sincerely, S. Klein Investment Product Services ICS-Death Benefit Contract Change Team Hartford Life Insurance Company Hartford Life Insurance Companies 200 Hopmeadow Street Simsbury, CT 08088 Toll Free 1 800 862 6868 Investment Product Services Mailing Address: P.O. Box 5085 Hartford, CT 06102-5085 Michael J. Malpezzi, Owner Jeremy J. Shartzer, Funeral Director FUNERAL HOME 8 Market Plaza Way • Mechanicsburg, PA 17055 • Phone: (717) 697-4696 August 22, 2008 Deborah K. Fenstermacher 8 N. Cdearview Drive Palmyra, PA 17078 The Funeral Service for Norman P. Kase 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 ifvou 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, Facilities and Cremation $3265.00 FUNERAL HOME SERVICE CHARGES $3265A0 SELECTED MERCHANDISE: Cremation Container $4000 ALTERNATE $395.00 Register Package $1 15.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED $3815.00 AT TIC TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN ACCOMMODATION. THE, FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES. CASH ADVANCES Opening Grave $250.00 Certitied Death Certificates $36.00 Newspaper Notices -Patriot $160.70 Newspaper Notices -Wilkes-Barre $60.00 Clergy/Mass Offering $150.00 Organist $75.00 TOTAL CASH ADVANCES AND SPECIAL CHARGES $731.70 SUB-TOTAL $4546.70 INITIAL PAYMENT /DISCOUNT /CREDITS TOTAL AMOUNT DUE $3546.70 ~~~/~ ~~ ~~~~ www.rnnlpezzifuneralhome.com j o~ERS~ floti•ers ~ g(fls 304 W CHOC AUE HERSHEY, PA (717)534-2834 Clerk#: 233 ANDREA 07/23/2008 Transaction: 66928 REG #1 3:16pm Ln# Pn Descr Qty Amount Ext Amt 1 23 FUNERAL 1 116.00 116.00 2 74 ROSE BOU 1 45.00 45.00 Tax: 9.66 Total: 170.66 B.C. UI Tender: 170.66 XXXX-XXXX-XXXX-5749 7/09 Authorization# 015536 Acct # credited for this sale:932062 Thank-You For Your Patronage www.royers.com Order Number: 79390 Delivery Date: 07/26/2006 Recipient: KASE Address; 100 MOUNT ALLEN DR City/State: MECHANICSBURG PA Order Number: 79391 Delivery Date: 07/26,2008 Recipient: KASE Address: 10U MOUNT ALLEN DR City/State: MECHANICSBURG PA Dining Service ReguestBill ~6~' July -Saturday Time: 1:00-3:OOpm Count: 45 Contact: Norman Kase Service -Meal Telephone: 838-6945 8 North Clearview Drive, Palmyra, PA 17078 Organization: Kase Family Luncheon Service Type: Delivery & Setup Service Time: 1 - 3 pm Room: Multipurpose Room Fire Side Grille: Gather all items & deliver and setup in the Multipurpose Room for service at 1 pm. Food will be supplied buffet style. Fire Side Grille Production: Prepare the following items for service on a food buffet. Assorted Tea Sandwiches & Wraps Pasta Salad Fresh Veggie tray w/dip Fruit Salad Potato Chips Assorted Cookie Tray -Sugar, Choc. Chip, Oatmeal Raisin, & Brownies Condiments -for sandwiches -Mustard & Mayo Assorted Beverages -Iced -Water, Iced Tea & Lemonade Decaf Coffee Scroll ware Plates w/silverware service Estimated Cost: $31.8.00 Account # to be billed: Final Count: Food Cost: 40 X $7.50 Sub Cost: $300.00 Tax 6%: $18.00 Total Cost: $318.00 Director/File Catering Itiitc6en Ordering Billing Contact ~y~~~~ ~ ~;1 ~ G RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17613 KASE NORMAN PAUL Estate File No.: 2008-00769 Paid By Remarks: DEBORAH K FENSTERMACHER AJW ------------------- Fee/Tax Description PETITION LTRS TEST WILL SHORT CERTIFICATE JCP FEE AUTOMATION FEE Check# 3115 Total Received......... Receipt Date: 7/22/2008 Receipt Time: 15:00:35 Receipt No.: 1053474 Receipt Distribution ----- -------- -------- --- Payment Amount Payee Name 135.00 CUMBERLAND COUNTY GENERAL FUN 15.00 CUMBERLAND COUNTY GENERAL FUN 40.00 CUMBERLAND COUNTY GENERAL FUN 10.00 BUREAU OF RECEIPTS & CNTR M.D 5.00 CUMBERLAND COUNTY GENERAL FUN ---------------- $205.00 $205.00 CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717) 2493188 Fax: (717) 249-2883 August 29, 2008 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Deborah K. Fenstermacher Norman P. Kase Estate RE: Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on following dates: August 15, August 22, and August 29, 2008 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 75.00 Total Amount Due $ 0.00 Becky H. Morgenthal, Executive Director The Patriot-News Co. 812 Market St. Harrisburg, PA 17101 Inquiries - 717-255-8292 FENSTERMACHER 8 N CLEARVIEW DR PALMYRA PA 17078 INVOICE ACCT # NAME the ~latriot News NOw you know ALL CHARGES ARE NET AD ORDER # DATE EDITION ADDTL. INFO. TYPE OF CHARGE AMOUNT 124750 Fenstermacher 124750 Fenstermacher 124750 Fenstermacher 124750 Fenstermacher 0001 08/04/08 REGULAR 0001884712 08/04/08 REGULAR 0001884712 08/11/08 REGULAR 0001884712 08/18/08 REGULAR BOLD TEXT CHARGE $4.00 BASIC AD CHARGE $93.90 BASIC AD CHARGE $93.90 BASIC AD CHARGE $93.90 AFFIDAVIT CHARGE $5.00 TOTAL: REMITTANCE ADDRESS The Patriot-News Co. 23794 Network PL Chicago, IL 60673-1237 $290.70 Please include the Account # or Ad Order # (above) with your remittance--Thank You NOTE: This Invoice replaces the Order Confirmation which we previously sent with Proofs of Publication i h ~.ss a \/~ L-t_AC- ~ 100 MOUNT ALLEN DRIVE, MECHANICSBURG, PA 17055 DEBORAH & TOM FENSTERMACHER 8 CLEARVIEW DRIVE PALMYRA, PA 17078 Form PB-01 QUESTIONS? CALL: 717 697-4666 RESIDENT # UNIT STMT. DATE 49102 030 D 08/31/2008 .RESIDENT S Mr. NORMAN P. KASE TOTAL AMOUNT DUE $0.00 DATE DUE 09/30/2008 DATE DESCRIPTION RATE Days! Urnts ''HARGES CREDITS BALANCE 08/25/08 Balance Forward PAYMENT RECEIVED -THANK YOU!!! 6,215.64 6,215.64 0.00 RESIDENT # 49102 CURRENT 0.00 OVER 30 0.00 OVER 60 0.00 OVER 90 0.00 OVER 120 0.00 TOTAL AMOUNT DUE $0.00 RESIDENT NAME Mr. NORMAN P. KASE Form PB-01 A 1 % finance charge may be assessed on accounts for which payment has not been received by the due date. Thank you! [f you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. Thank You! ~** ACTIVITY FOR KASE, NORMAN -KASEN - -49102 '. ~ !,06/06/08 7367853 52 OMEPRAZOLE 20 MG O1 10.00 .00 10.00c 06/06/08 7303258 26 RA2ADYNE ER 16 MG O1 39.50 .00 39.50c, 106/06/08 7313578 19 CITRUCEL CAPLET O1 * 5.19 .00 5.19 06/06/08 7290093 10 ASPIRIN 325 MG Ol * 2.62 .00 2.62 1 'I 07/15/08 1 Payment-Thank You 75.43- .00 75.43- i 1 Z J./ V !• V i LEGEND NON-LEGEND FOR MONTH FOR MONTH evioas Balance Charges thts month Finance Charge TOTAL CHARGES Total Paym®ot 8 Credits 75.43 + 57.31 + .00 - 132.74 75.43 FOR ALL PHARMACY RELATED INQUIRES PLEASE CALL Alert Pharmacy Services, fnc at 1-800-266-9954 Statement Terminology on reverse S~~ a-~ . o o'~ TOTAL TAXI AMOUNT DUE - 57.31