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Home My WebLink About10-06-09~ REV-1500 15056D7120 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO 60X.280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 9 0 0 3 5 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 181324760 01032009 12171922 Decedent's Last Name Suffix Decedent's First Name MI KESSLER VELDA I, (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 Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required (date of death after 12-12-52) ® 8 Decedent Died Testate ~ Decedent Maintained a Living Trust O (Attach Copy of Will) ^ (Attach Copy of Trust) 8. Total Number of Safe DepOSit Boxes ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date of death 11.Election to tax under Sec. 9113 A between 1231-91 and 1-1-95) ^ ~ ) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number KEITH D. WAGNER 7178386348 rv Firm Name (If Applicable) BRINSER, WAGNER & ZIMMERMAN First line of address 6 E. MAIN STREET Second line of address P.O. BOX 323 City or Post Office State ZIP Code :.7 ~C7 _. ~ -~ `._ J _. _, '_, i PALMYRA PA 17078 Correspondent'se{rtailaddress: kelth~bWZIaW.COm 6 E. Main Strl P.O. Box 323 SIGNATURE OF P Imyra, PA 17078 v i n~rc ~ nnrv RCrrt GJCN I H I IYC Keith D. Wagner DA /J ~ (:)~ ADDRESS ~ r 6 E. Main Street, Palmyra, PA 17078 Side 1 1505607120 1505607120 uncer penaioes or pertury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, i~t ^s^truei~correct an d oomplete; Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. i 1505607220 REV-1500 EX Decedent's Social Security Number oeceaenrSNama: KESSLER, VELDA L. 18132 4 7 60 RECAPITULATION 1. Real Estate (Schedule A) ....................................................................................... .... 1. 2. Stocks and Bonds (Schedule B) ............................................................................ ..... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .......... .... 3. 4. Mortgages & Notes Receivable (Schedule D) ......................................................... ... 4. $• Cash, Bank De its & Miscellaneous Personal Pro a P~ P rty (Schedule E) ................ .... 5. 1 2 6 7 5 6. 9 0 ~ 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ........... ... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ........... ... 7, 8. Total Gross Assets (total Lines 1-7) ..................................................................... ... g, 1 2 6, 7 5 6. 9 0 9. Funeral Expenses & Administrative Costs (Schedule H) ................................. ........... 9. 1 1 , 8 5 4 . 0 7 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ........................ ........... 10. 1 , 0 8 8 . 1 3 11. Total Deductions (total Lines 9 & 10) ............................................................ ........... 11 • 1 2 , 9 4 2 . 2 0 12. Net Value of Estate (Line 8 minus Line 11) ................................................... ........... 12. 1 1 3 , 8 1 4 . 7 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .......................................... .......... 13. 1 1 3 , 7 1 4 7 0 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................................ ........... 14. 1 0 0 . 0 0 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 .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 16. 17. Amount of Line 14 taxable at sibling rate X ,12 17. 18. Amount of Line 14 taxable at collateral rate X .15 1 0 0. 0 0 18. 19. Tax Due .................................................................................................................... . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505607220 15056072.20 15.00 15.00 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 0 9- 0 0 3 5 DECEDENT'S NAME Kessler, Velda L. ----- STREETADDRESS -- - -_ --" - --" - - Messiah V[Ilage 129 Messiah Circle CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 15.00 Total Credits (A + g + ~) (2) 0.00 3. InterestlPenalty if applicable p. Interest E. Penalty Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 15.0 0 A. Enter the interest on the tax due. (5A) g. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5g) 15.0 0 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :..................................................................................... _' ;; x b. retain the right to designate who shall use the property transferred or its income :......................................... ~ 'fix lI c. retain a reversionary interest; or ..................................................................................................................... ~ CI d. receive the promise for life of either payments, benefits or care? .................................................................. ~ C 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .......................................................................................................................... ~ ~. 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ............... ~, L^ i 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ ~~I x IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN or 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 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 )j. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF Kessler, Velda L. 21 - 09 - 0035 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 DESCRIPTION NUMBER _ -- 1 MetLife Investors Insurance Company -Non-Qualified Annuity Contract No. 1864689 2 Oppenheimer - AllianceBernstein Global Bond A (2944.402 Shares) 3 M & T Bank -Checking Account #5180990 (Includes accrued interest of $.05) 4 M & T Bank -Checking Account #951266111 (Includes accrued interest of $2.43) 5 SERS -Prorated Retirement Check 6 Cash on Hand 7 U.S. Treasury - 2008 Income Tax Refund 8 Miscellaneous Personalty _____ TOTAL (Also enter on Line 5, Recapitulation) VALUE AT DATE OF DEATH 39, 544.70 19, 904.16 3,943.36 62, 068.62 147.32 196.74 702.00 250.00 126,756.90 (~DIRE H COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN AM~A9CTi]ATT /C f~MTG~ RESIDENT DECEDENT /'Y~.^~~~7 ~ IW ~ ~YG ~I~J~7 ~ J ESTATE OF Kessler, Velda L. FILE NUMBER 21 - 09 - 0035 Debts of decedent must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. 1 Bunnell Funeral Home 1,674.07 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Gerald J. Brinser 6,300.00 Social Security Number(s) ! EIN Number of Personal Representative(s): 186-34-0218 Street Address 6 E. Main Street, P.O. Box 323 city Palmyra state PA zip 17078 Year(s) Commission paid 2009 2. Attorney's Fees Brinser, Wagner & Zimmerman 3,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills (Itrs. pd. $90.00 = $25,000 - $50,000) 140.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Register of Wills -Additional Cost of Letters 170.00 TOTAL (Also enter on line 9, Recapitulation) 11,854.07 Schedule H Funeral EIS 8~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN /~l[M'nlnlSd'atiVle Costs COI'1Thnued RESIDENT DECEDENT ESTATE OF Kessler, Velda L. 2 Vital Records -Additional Death Certificates 3 Register of Wills -Short Certificate 4 Register of 1/b'ills -Inventory Filing Fee 5 Register of Wills -REV 1500 Filing Fee FILE NUMBER 21 - 09 - 0035 36.00 4.00 15.00 15.00 Page 2 of Schedule H COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Kessler, Velda L. Include unreimbursed medical expenses. SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8~ LIENS ITEM NUMBER 1 Messiah Village -Balance Due FILE NUMBER 21 - 09 - 0035 DESCRIPTION I AMOUNT 998.02 2 ~ Alert Pharmacy ~ 90.11 TOTAL (Also enter on Line 10, Recapitulation) I 1,088.13 REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Kessler, Velda L. SCHEDULE J BENEFICIARIES NAME AND ADDRESS OF PERSONS RELATIONSHIP TO NUMBER RECEIVING PROPERTY O DECEDENT Do Not List Trustee(s) FILE NUMBER ~! 21 - 09 - 0035 SHARE OF ESTATE I AMOJNT OF ESTATE I. TAXABLE DISTRIBUTIONS[include outright spousal distnbutwns, and transfers under Sec. 9116 (a) (1.2)] 1 'Jill Deihl 1776 State Route 254 Orangeville, PA 17859 Niece Personalty i Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet 100.00 II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1 3 2 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS Messiah Village, 100 Mt. Allen Drive Mechanicsburg, PA 17055 Personalty Messiah Village, 100 Mt. Allen Drive Mechanicsburg, PA 17055 50% Residue Brookfield Bible Church, 3601 Brookfield Road Harrisburg, PA 17109 50% Residue 150.00 56,782.35 56,782.35 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET, 113,714.70 C~Op17 WILL OF VELDA L. KESSLER I, VELDA L. KESSLER, currently ofUpperAllen Township, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament, hereby revoking any and all prior Wills and Codicils made by me. I. I direct that all my just debts and funeral expenses be paid from the assets ofmy estate as soon as practicable after my demise. II. I direct that all estate and inheritance taxes that maybe assessed in consequence of my death, shall be paid out of the principal ofmy general estate to the same effect as if said taxes «~ere expenses of administration and all property includable in my taxable estate whether or not passing under this Will shall be free and clear thereof. III. I bequeath my Grandmother's Clock (Doneker) and my porcelain vase/figurine from my mother unto my husband's niece, Jill Deihl. IV. I intend to keep ~~~ith this my Will a separate memorandum concerning disposition ofceriain items oftangible personal property. I bequeath the items on said list to the persons designated. V. The remainder ofmy tangible personal property I bequeath unto Messiah Village, Mechanicsburg, Pennsylvania, to be used as it sees best. VI. All the rest, residue and remainder ofmy estate, of whatever nature and wherever statue, including property over «~hich I hold a power of appointment. I devise and bequeath as follows: A.One-half (''/z) unto Brookfield Bible Church. Harrisburg, Pennsylvania, to be used as it sees best. B.One-half (''/z) unto Messiah Village, Mechanicsburg. Pennsylvania, to be used in its Endowment Fund. VII. I appoint Gerald J. Brinser, Esquire, Executor of this my Will. In the event that he fails to qualify or ceases to act as Executor, I appoint Keith D. Wagner, Esquire, Executor of this my Will. VIII. I direct that no bond be required of my fiduciaries for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, VELDA L. KESSLER, herewith set my hand to this my Last Will, typewritten on tw~(2) sheets of pa er including the attestation clause and signatures of witnesses, this ~:3' day of j , 2000. 7/~~rr~ . . ~~~~ ,~~v 2_.i (SEAL, VELDA L. KESSLER Signed by VELDA L. KESSLER, by her declared to be her Will in our presence, who have hereunto subscribed our names as witnesses in her presence and at her request, this ~' day of ~~~ , 2000. residing at ~i-c~r~tti~' residing at ~~h~~~I~I.~I~I,~~G~,~~~~ -2- COMMONWEALTH OF PENNSYLVANIA COUNTY OF LEBANON WE, VELDA L. KESSLER, GERALD J. BRINSER and ~l1CN~ ~ .+~Niv~t & , the testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly affirmed, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and that she signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as witnesses and that to the best of our knowledge the testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ~ ~ VELDA L. KESSLER _/ ` ITNESS I~ WITNES Subscribed, sworn or affirmed and acknowledged before me by VELDA L. KESSLER, testatrix, GERALD J. BRINSER and ~~~ ~ ~ {-4 U~;,~~ NG ,witnesses, this ~3r`~ day of ~1~Cu~ , 2000. ~. ---1~ SEAL Not Public 0 ARI L MARILYN fL PEIFFER NOtARY PUBLIC PALMYRA BORO L~B1lNON COUNTY MY COMMISSION b(PIRE$ -3- PPENHEIMEI~ January 27, 2009 Gerald J. Brinser 6 East Main Street, 2nd Floor Palmyra, PA 17078 ~-~~ Oppenheimer & Co. Inc. 1015 Mumma Road Wormleysburg, PA 17043 800-722-2294 Member of All Principal Exchanges RE: Velda L. Kessler MetLife -Non-Qualified Annuity Contract No. 1864689 Dear Gerald: In regards to your letter of January 19, 2009, the above-referenced account was a single registration in Velda L. Kessler's name with Louise Snyder listed as the Primary Beneficiary. The values shown for the fund will be from January 2, 2009 and January 5, 2009. Value January 2, 2009 39538.32 January 5, 2009 39551.07 Also enclosed is an Annuity Beneficiary Claim Form which we can assist you with or you can send directly to MetLife. If you have any further questions, please do not hesitate to call. Sincerely, Mic ael G. Cro e Financial Advisor MGC/hk Enclosure PPENHEIMEI~ January 21, 2009 Gerald J. Brinser 6 East Main Street, 2°d Floor Palmyra, PA 17078 RE: Velda L. Kessler AllianceBernstein Global Bond A Dear Gerald: Oppenheimer & Co. Inc. 1015 Mumma Road Wormleysburg, PA 17043 800-722-2294 :~Sember of All Principal Exchanges In regards to your letter of January 16, 2009, the above-referenced account was a single registration in Velda L. Kesslers name. Since the date of her death was on a Saturday, the values shown for the fund will be from January 2, 2009 and January 5, 2009. ,Shares Price Value January 2, 2009 2944.402 6.75 19874.71 January 5, 2009 :2944.402 6.77 19933.60 If you have any further questions, please do not hesitate to call. Sincerely, c Mi hael G. Crouse Financial Advisor MGC/hk Q~MBTBank 499 Mitchell Road, Millsboro, DE ]9966 Mail Code DE-MB-12 Law Offices Brinser, Wagner & Zimmerman 6 East Main Street -Second Floor East Main & South Railroad Streets P.O. Box 323 Palmyra, Pennsylvania 17078 Re: Estate of yelda L. Kessler Social ,Security: 181-32-4760 Date of Death: January 03 2009 Phone (888)502-4349 Fax (302)934-2955 January 27, 2009 Dear Sir or Madam: Per your inquiry dated January 19, 2009, please be advised that at the time of death, the above-named decedent had on deposit with this bank the followinb: 1. Type ofAccount Checking Account Account Number 51080990 Ownership (Names oj~ Velda L Kessler* Opening Date 8/28/64 Balance on Date of Death $ 3,943.31 Accrued Interest $ 0.05 Total - _ ---- -- - ---- - - -- -- ------------------------------- - $ 3,943.36 2. Type ofAccount Checking Account Account Number 951266111 Ownership (Names o~ Velda L Kessler* Opening Date 5/19/03 Balance on Date of Death $ 62, 066.19 Accrued Interest $ 2.43 Total _- - - $ 62, 068 62 _ - _-.. Please be advised, there was no safe deposit box found for the above decedent. * If upon reviewing the information above, you believe there are additional accounts not referenced, please provide us with an account number and/or name of any possible joint account holder. For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, etc., please contact our Penbrook Office # 717- 255-2266. 'ncerely, Tracie Hare Adjustment Services DEPOSIT TICKET - ESTATE OF VELDA L KESSLER _- GERALD J BRINSER EXECUTOR - 6 E MAIN ST - ~ PO BOX 323 PH: 717-838.6348 Y PALMYRA, PA 17078-0323 ~~QQ -_ __= DATE 20~L OEVUti11S h1aY NOT RE AVa lLa BL FUA 161GEUIa ~E W/iHURa WnL - tiIGN HERE FUR [:aSH RECEIVED ~~~~ Jonestown Bank & Truat Co. Jonestown, ~annsylvanla 17038 ~: 500 1111000 1~: 8 71110 38111 611' H( 60-1205/313 CASH > ~ H ~ ~ 7 3~ E c (DO -/S~~ SUB TOTAL > / LESS CASH > ~ RECEIVED _ '' / ~/ / r / .~ O~ i i 4i ~ WATERMARKS 000705 $5 59123214 60-142 313 CHECK NUMBER 00000 I 061 I 070 031309 187010258 I 118382 I*****8392 CDC FUND DEPT PREP DATE VOUCHER WARRANT ID FULTON BANK ~ LANCASTER, PA VERIFICATION AVAILABLE - "POSITIVE PAY" PROTECTED PAY °" oN~ ~32 ~ TO THE ORDER OF GERALD BRINSER EXECUTOR VELDALKESSLER ESTATE PO BOX 323 ~ PALMYRA PA 17078 ~~~M^OS.`~ a~ry~2~~~~r.4 03/20/2009 DATE VOID AFTER 180 DAYS ~************147.32 0 n 0 -------------- -- ---~-1-~-'--M~1 - E~R OF PENNSYLVANIA --- II'S9i232i411' ~:0 3 130 14 2 2~: 1219 5384711' .. DEPOSIT TICKET - = ESTATE OF VELDA L KESSLER =- GERALD J BRINSER EXECUTOR - 6 E MAIN ST PO BOX 323 PH: 717-838-6348 - PALMYRA, P 1 78-0323 __= DATE 20~ DEPU tiITS' M1IgY N BE AVq ILAALE FOR IM1}hlEOlq iE WITHDRAWAL " - - 5lGN HERE FUR CgSH RECEIVED Jonestown Bank & Truat Co. - - ~~~ ® Jonestown, Pennsylvenla 17038 ~: 500 L111000 L~: 8 71110 38111 611' 15-51 60-1205/313 CASH > H c 7o a.~ o c U. s a~ .~F=. .~ .~E~:,~ J SUBTOTAL > /7 ~ ^ . J~ O LESS CASH > ` /~(` v RECEIVED $ '70 ~, d D 4l -~'~~ - Ooo A 581,945,346 ~!;1::Jr. , , Check No. ~ F ~ 05 15 09 19 AUSTIN, TEXAS 2309 88002623 .`~ - 2309 88002623 20090900 I30 OKESS KANS CYTAX REFUND Pale. III~IIIIIIIIIIIJIIJI~~I~IIIIIIII L~JJ~IIII~ILIIIILJ1111 <:the`oderof G ~ BRINSER EXEC 12/08 VELDA L KESSLER DECD 23 PO BOX 323 $****702*00 PALMYRA PA 1707 8-0323 _~, RFOIONN. [NSPURFINOOFFICtR VOID AFTER ONE YEAR it"_I-_-1' I=rlilLilf!;L-I:i=_001"i-1.. 11--ii_lilu-~I_I--_- - i~'_I-~1--~ I .I-I -I-I _1- I ~~.: •1: ~ ~~ ~ =a~i4 ~ i~~l 1=- I i I I;' --~;I,I~,!~tl_ 1_. 11----' -t _ III-' 1~ I II-•I~ l~-~ --, n_i,~ 11~_1~ i;;li= Il:.i._k-1r:r= -_I_ ~-, I.rl -1 .~._ ! il--~ 1-'-~ '_ -1-11-- ~li_Ilji~i~ll_ij7'-I?I;!_Illil~li`si!-1~ !I-~;i~1e: I_FI! ,ill=~~I~I~11=?I- cell= L'I I-I rl_II- II_I, ! _. I1~11 IIlISi~" ~ -...-.~ II-~~-II~'1_I 1.•-_j_I1~_' _lalc _I . Irlsirl- IL„:1d-~ri;~-l~ =,T~tT =$tai:ll=l-3rlas-?~= I-~-III- ~~~''~~09"!11' : ~ ~:000ODO 5 18~: 8800 2 6 2 3 511' 040 509 ,_ _~ : - ~ "~. _... BUNNELL FUNERAL HOME, INC. RODGER T. BUNNE LL FUNERAL HOM1? P.O. Box 150 179 East Main Street 435 Market Street Millville, PA 17846 Bloomsburg, PA 17815 (570)458-5031 (570)784-8344 Rodger T. Bunnell, Supervisor Theodore R. Bunnell Il, Supervisor STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED Charges are only for those items that you have 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 you selected arrangements such as direct cremation or immediate burial. If we charged for embalming, we will explain why below. For the Service of t ~~ ' ~ " - Date of Death Charge to: Name Address A. CHARGE FOR SF,RVICES SELECTED: I. PROFESSIONAL SERVICES Services of Funeral Director/Staff ............ .. $ Embalming ................................................. .. $ Other preparation of body Dressing & Cosmotology .......................... .. $ Hair Dresser ............................................... .. $ SUB-TOTAL OFPROFESS[ONALSF,RVICES ....................... A1$ ~ .''.rj city Other clothing Cremation um _ (Description) _ OTHER $ ~` TOTAL MERCHANDISE SELECTF,D ............................... B $ 2. FACILITIES AND SERVICES C. SPECIAL CHARGES: Use of facilities and services for Forwarding of remains to viewing (Visitation /Wake) ..............:5:.. $ ~~ ~ $ Use of facilities and services (Funeral Home) for funeral ceremony ............................... $ Receiving of remains from Use of facilities and services for $ Memorial Service .................................... $ (Funeral Home) Use of equipment and services Immediate Burial ................................ $ for graveside service ............................... $ ................. Direct Cremation .......................................... .. $ Other use of facilities ....... .. $ Church service ........................................ $ SUB-TOTAL OF SPE(:IAL CHARGES .............. ................. C $ Church viewing ....................................... $ D. CASH ADVANCED $ ;'. , .~ Opening Grave ...................................................... $ ~; • SUB-TOTAL OFFACILITIES /EQUIPMENT ..................... }:1 Cemetery Equipment ............................................. ... A2 $ ~ Lot and Deed ......................................................... $ $ 3. AUTOMOTIVE EQUIPMENT Newspaper Notices -Local ................................... ~_ $ ~'` Vehicle to transfer remains to Funeral Home Newspaper Notices -Out of Town ........................ $ ~. Local ........................................................... $ ~ Telephone & Telegrams ........................................ $ Hearse (Casket Coach) Airfare ................................................................... $ Local ........................................................... $ - Clergy /Mass Offering.......: ?..:'.... ~..:.:.'...' '....'.'.... $ .~. r-<t Limousine Pallbeazers ............................................................. $.. Local ........................................................... $ Certified Copies of the Death Certificate .............. $ Family car Police Escort ......................................................... $ Local ........................................................... $ i~ Flowers...~ ..........................4.:::.':T........................ $ Flower car or floral disposition Vault Service Charge ............................................. $ Local ........................................................... $ Coroner's Fee ........................................................ $ Lead car! clergy car Refrigera[ion ......................................................... . $ Local ........................................................... $ $ Cxr for pallbearers $ _ Local ....._ .................................................... $ I $ Ou[ of town transportation .......................... $ :'r , g ~ 9j ~~ SUB-TOTAL OF ADVANCES ............................. ' ~' ................. SUB-TOTAL OFAUTOMOTIVE EQUIPMENT ............ ... A3 . ' ' ' ' TOTAL OF PROFESSIONAL SERVICES, We charge you for our services in obtaining: FACILITIES AND AUTOMOTIVE', (specify cash advances that are marked-up) EQUIPMENT ...................................................................... ... A $ _'-: B. CHARGE FOR MERCHANDISE SELECTED: SUMMARY OF CHARGES Casket .........:...../..........:.... `..:..`:'L:............ $ (Description) A, professional Services, Facilities and Equipment, ~ ' and Automotive Equipment ................................. $ - _ :. ~.;. ,,.. • .. ~ B. Merchandise ......................................................... $ ~~ '•. Other Receptacle.........~ ................................ $ C. Special Charges .................................................... $ (Description) D. Cash Advances ..................................................... $ ~~ ./ TOTAL OF ALL SECTIONS ........................... $ ~t~ ,~. ....... Outer burial container ............... $ / ., f ................ PAID AT TIME OF, OR PRIOR TO ARRANGEMENTS .. .^w..: :: , : ............... $1~ QF (Description) , . ... . ...... . ................ BALANCE DUE ...:............................................ ..................... ..................: W ~ ;f~af {J . ( book s~ tcards Rek sor $ E SO / N FOR EMBALMING • -- :.. ~ ~ ~ur'°"''r owe/ ~G.Y ate-~u ~~ ~ tS g ry ................................ n o ,... . ,. ,- ~. . . . f Memo folders..........'..if!.. r .::...................... $ - If an law, cemete or cremato re uirements have re wired the `r rY~ ry q y purchase Prayer cards ................................................. $ y the items listed above [he law or requirement is explained below. Tem orar P Y grave marker ............................. $ t. 1 .f. ,..• "• - -,t r . Burial clothing ............................................ $ I agree that I have examined the items of goods and services selected above and found them to be correct and according to [he arrange ments I have re uested q . I acknowledge receipt of a copy of this Statement of Funeral Goods and Services Selected. 1 represent that I have sufficient funds available for payment of the cash price for the goods and services selected. I also agree to make payment of $ ~'- within days. I agree to be join tly and severally liable with anyone else who signs below. A late. charge of $ per month amounting to $ per year will be applied to the un paid balance beginning days from [he date of this agreement. 1 will also pay to the Funeral Director aI1 reasonable costs paid by [he Funeral Director [o collect amounts I owe under this agreement. Those costs may include attorneys' fees, court costs and other costs. Any additional services or merchandi se ordered or requested after the date of this a gr eement will be considered part of [his agreement and the cos[ thereof will be reflected on the final bill or statement. ) / / (Seal)-~~~ l / ~ r ~ ~ ,f' !~' ,E,i ~.. °I . r' ~ (Purchaser) ~ ~ (Date) (Seal) J ~ r- /_n.-s...~._..G' r (Purchaser) ~ (Licensed Funeral Director) State RECEIPT FOR PAYMENT GLENDA FARNER STRASB,AUGH Receipt Date: 1/13/2009 Cumberland County - Register Of Wills Receipt Time: 10:45:33 One Courthouse Square Receipt No.: 1055354 Carlisle, PA 17613 KESSLER VELDA L Estate File No.: 2009-00035 Paid By Remarks: BRINSER ET AL JN ------------------- ----- Rece:~pt Distrib ution ----- -------- -------- ---- Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 90.00 CUMBERLAND COUNTY GENERAL FUN WILL 15.00 CUMBERLAND COUNTY GENERAL FUN AUTOMATION FEE 5.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 20.00 CUMBERLAND COUNTY GENERAL FUN JCP FEE 10.00 -- BUREAU OF RECEIPTS & CNTR M.D Check# 1319 -------------- $140.00 Total Received..... .... $140.00 DATE DESCRIPTION RATE Days/ Units CHARGES CREDITS BALANCE Balance Forward -723.40 ""* Assisted Living xxx 01/02/09 PS2 -DELAWARE NO KITCHEN 89.68 2.00 179.36 -544 04 01/02/09 OXYGEN 17.50 1.00 17.50 . -526 54 01/26/09 PS2 -DELAWARE NO KITCHEN 89.68 17.00 1,524.56 . 998.02 (~ ~j `~l " ' q ~ o~ ~~ ~~ ~ ~ ~ \ ~ i - , ~~, i RESIDENT # CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 29101 998.02 0.00 0.00 0.00 0.00 $998.02 RESIDENT NAME Mrs. VELDA L. KESSLER Foam Pa-o, A 1% finance charge may be assessed on accounts for which payment has not been received by the due date. Thank you! If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. Thank You! V ~~~ 706 ** ACTIVITY FOR KESSLER, VELDA L 111/21/08 7376707 28 LEVOTHYROXINE 125 ''11/21/08 7363430 28 CALCIUM 600MG W/D '!,11/21/08 7369392 56 VITAMIN B-6 100 M 11/21/08 7384198 28 BENICAR 40 MG '12/04/08 7350359 15 REFRESH TEARS 0.5 '',,12/08/08 4098665 30 HYDROCOD/APAP 5/5 ',12/11/08 7463214 30 PROMETHAZINE 12.5 112/11/08 7463215 8 PHENADOZ 12.5 MG j12/11/08 7463206 15 CIPROFLOXACIN HCL X12/12/08 7463842 1 FUROSEMIDE 40MG 12/12/08 7463843 1 POTASSIUM CL 20 M ';12/13/08 7363432 60 FORADIL 12MCG ',,12/18/08 Payment-Thank You o~ ~~ ~0~~,5~'~~~`d ~~g;. i 1 ~~ -- ,~ .~- a°' ~ ~ n ~~~02' n ~_ - -29101 72.11 16.67 LEGEND NON-LEGEND' ~ __ FOR MONTH FOR MONTH' j Previous Balance Charges this month Finance Charge TOTAL CHARGES Total Payment a Creeks i 73.08 + 88.78 + .00 161.86 73.08 FOR ALL PHARMACY RELATED INQUIRES PLEASE CALLAIert Pharmacy Services, Inc at 1-800-266-9954 _ _. Statement Terminology on reverse O1 O1 O1 O1 O1 O1 O1 O1 O1 O1 O1 O1 -KESSV 7.30 3.48 3.45 18.00 9.74 3.35 10.00 8.22 4.30 1.35 1.59 18.00 73.08- ~~ .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .oo TOTAL TAX AMOUNT DUE 88.78 LAW OFFICES BRINSER, WAGNER &ZIMMERMAN 6 EAST MA[N STREET -SECOND FLOOR (EAST MAIN & SOUTH RAILROAD STREETS) P. O. BOX 323 PALMYRA, PA 17078 PHONE: (717) 838-6348 FAX: (717) 838-6912 GERALD J. BRINSER KEITH D. WAGNER JOHN M. ZIMMERMAN KATHY G. WINGERT October 5, 2009 Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 In Re: Velda L. Kessler Estate File No. 21-09-0035 Dear Register of Wills, MECHANICSBURG OFFICE MESSIAH VILLAGE 100 MT. ALLEN DRIVE MECHANICSBURG, PA 17055 PHONE/FAX (717) 697-4666 Enclosed you will find two (2) copies of the PA Inheritance Tax Return and an Inventory for the above-captioned estate. Also enclosed are two (2) checks: one in the amount of $15.00 in payment of the inheritance tax due; and one in the amount of $200.00 in payment of the additional cost of letters of $170.00, the filing fee for the Inventory, and the filing fee for the REV-1500. If you have any questions, please feel free to contact me. Thank you. Very truly yours, BRINSER, WAGNER &ZIMMERMAN erald J. Brinser~ GJB/wlc Enclosures c: file