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HomeMy WebLinkAbout01-08-10~f ~ r J 1505607121 PREY-1500 EX (06-05) epartrnent of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number PO BOX 280601 Harrisbu PA 17128-0601 RESIDENT DECEDENT a 1 0 9 0 9 7 1 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 2 0 9 1 2 8 8 3 8 1 0 0 9 2 0 0 9 1 2 2 0 1 9 2 5 Decedent's Last Name Suffix Decedent's First Name MI K E S S L E R L O U I S E C (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 Q 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) © 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 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 CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number R O G E R B I R W I N E S Q U I R E 7 1 7 2 4 9 2a3 5 3 Firm Name (If Applicable) ~, ,~., I R W I N & First line of address 6 0 W E S T Second line of address City or Post Office C A R L I S L E Correspondent's a-mail address: State ZIP Code REGIS ~F WILLS USEbNLY -`- ..z.. ~~/ -n . ~ r.T. ~,. ;R, . ~ ., . ~.. ~ `~ `~~~ ~ ~~ ,._ tV ,. ATE FILED w ~ S, y V'' .,, -=, ._... ~~ ...---1 P A 1 7 0 1 3 Under penalties of perjury, I declare that I have examined this return, including acxompanying schedules and statements, and to the best of my knowledge and belief, it is true, rrect and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SI RE OF PE S S IBLE FO FILING RETURN ~ DATE ~~ ~ ~d ADDRESS 753 KAMES HILL ROAD COLUMBIA PA 17512 SIGNATU F EPARER O ER TH REPRESENTATIVE DATE ~-- ~ U A~~R SS 60 WEST ~OMF/RET STREET CARLISLE PA 17013 rLtwSE U5E ORIGINAL FORM ONLY Side 1 L 150560?121 M c K N I G H T P C. 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(8 alnpayaS) sPuo9 Pue shoo}S 'Z .Z ........................................ (y alnpayaS) a}e}sa lead • ~ • 'L NOI1Hlftlidt/03b •~ 3 S I f 101 ~a'~"eN s,iuapaoaa ?! 31 S S 3~ Q E Q Q 2 2 6 0 2 aagwnN ~(}unoaS lelooS s,}uapaoaa X3 009 ~-n32i 422L09505'C Continuation of REV-1500 Inheritance Tax Return Resident Decedent ,, , LOUISE C. KESSLER Decedent's Name 09 0971 Page 1 File Number Correspondents Name R O G E R B Firm Name (If Applicable) I R W I N & First line of address I R W I N, E S Q U I R E Daytime Telephone Number 7 1 7 2 4 9 2 3 5 3 Second line of address 6 0 W E S T City or Post Office C A R L I S L E M c K N I G H T, P C . P O M F R E T S T R E E T State ZIP Code P A 1 7 0 1 3 Correspondent's a-mail address: 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. SIGN TU E O ERSON RESP SIBLE FOR F LING R RN DATE ADDRESS ~' ' /~ O 2235 LOOP ROAD CHAMBERSBURG PA 17207 REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME LOUISE C. KESSLER STREET ADDRESS 801 N. HANOVER STREET CITY CARLISLE Tax Payments and Credits: 1 • Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 182.25 3. Interest/Penalty if applicable D. Interest E. Penalty File Number 09 0971 STATE PA Total Credits (A + B + C ) Total Interest/Penalty (D + E ) 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. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. ZIP 17013 (1) 3,645.03 (2) 182.25 (3) 0.00 (4) 0.00 (5) 3,462.78 (5A) (56) 3,462.78 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 : ........................ b. retain the right to designate who shall use the property transferred or its income; .......................... ..... ^ c. retain a reversionary interest; or ............................................ d. receive the promise for life of either payments, benefits or care? ....................................................... ^ 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................... ^ ............................................................ ^ X 3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ......... ^ Q 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary 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)J. 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)J. 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)]. 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)J. 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-1508 EX + (g_g8) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF LOUISE C. KESSLER FILE NUMBER 09 0971 Include 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. ITEM -- NUMBER DESCRIPTION 1. PNC BANK -CERTIFICATE OF DEPOSIT #21001052979 2• I PNC BANK -CHECKING ACCOUNT #5140409214 3. IPNC BANK -SAVINGS ACCOUNT #5003813341 TOTAL (Also enter on line 5, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 7,049.45 2,123.00 86, 312.43 REV-1511 EX + (10-06} . , COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER LOUISE C. KESSLER 09 0971 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. 1. 2. 3. 4. 6 1 DESCRIPTION FUNERAL EXPENSES: EWING BROTHERS FUNERAL HOME CHURCH OF GOD HOME JUDY CARVER FUNERAL LUNCHEON ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Street Address City Year(s) Commission Paid: State __, Zip 2. Attorney Fees IRWIN & MCKNIGHT, P.C. 3. Family Exemption: (If decedents address is not the same as claimants, attach explanation) Claimant 4. Street Address City State __ Zip Relationship of Claimant to Decedent Probate Fees REGISTER OF WILLS 5. I Accountants Fees 6. 7 Tax Return Preparers Fees PATRICIA A. ROSENDALE, CPA REGISTER OF WILLS -FILING FEE AMOUNT 6, 729.00 100.00 50.00 129.36 5,500.00 244.00 350.00 30.00 TOTAL (Also enter on line 9, Recapitulation) I $ 13,132 (If more space is needed, insert additional sheep of the same size) REV-1512 EX + (12-03) ,~ SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, IN RE3 DAENT DECEDENTRN MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER LOUISE C. KESSLER 09 0971 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. CHURCH OF GOD HOME -NURSING 2• CONTINUING CARE RX -MEDICAL 1, 315.24 36.53 TOTAL (Also enter on line 10, Recapitulation) I $ 1,351 77 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (g-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES tJlAlt(J LO_ NUMBER 1. 2. 3. 4. II. F C. KESSLER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright sppousal distributions, and transfers under Sec. 9116 (a) (1.2)J KATHRYN L. DRAWBAUGH 2235 LOOP ROAD CHAMBERSBURG PA 17207 CHERYL L. MARTIN 753 KAMES HILL ROAD COLUMBIA PA 17512 ROBERT C. KESSLER 49 WARWICK CIRCLE MECHANICSBURG, PA 17055 STANLEY E. KESSLER 49 WARWICK CIRCLE MECHANICSBURG, PA 17055 FILE NUMBER 09 0971 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Lineal Lineal Lineal Lineal ~ AMOUNT OR SHARE OF ESTATE 81,000.75 1/4 REMAINDER X1/4 REMAINDER X1/4 REMAINDER ~ 1 /4 REMAINDER ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET 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 (If more space is needed, insert additional sheets of the same size) --' ~ .~ LAST WILL AND TESTAMENT I, LOUISE C. KESSLER, of North Newton Township, Cumberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressl Y revoking all Wills and Codicils heretofore made by me. 1. I direct my executrices to pay all of my debts, funeral and administrative expenses as soon as maybe done conveniently after my decease. 2. I authorize and empower my executrices to sell any realty owned by me at my death and not specifically devised herein, at either public or private sale, and to give good and sufficient deeds therefor, in fee simple, as I could do if living. 3. I give, devise and bequeath all of my estate of every nature and wherever situate to my children, share and share alike, the child or children of any deceased child taking the share their parent would have taken if living. 4. I nominate and appoint Kathryn L. Drawbaugh and Cheryl L. Detweiler to be the executrices of this my Last Will and Testament; they are to serve as such without bond. 5. I hereby suggest that my personal representatives retain the services of Irwin, ,. -- e. .. ~ McKnight & Hughes, as attorneys in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ day of September, 1995. ~ r ~ G sEAL~ LOUISE C. KESSLER Signed, sealed, published and declared by LOUISE C. KESSLER, the testatrix above named, as and for her Last Will and Testament, in the presence of us, who at her request, in her presence and in the presence of each other have subscribed our names as witnesses hereto. 2 '~ . ~, +~ ~ ACKNOWLEDGMENT AND AFFIDA VIT WE, LOUISE C. KESSLER, BETZI A. MORRISON and TERESA M. HENRY, the testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as a witness and that to the best of their knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS: Subscribed, sworn to and acknowledged before me by ,the testatrix herein and subscribed and sworn to before ~e by LOUISE C. KESSLER, BETZI A. MORRISON and TERESA M. HENRY, this ~-~day of September, 1995. n Jacquelin L Drawbaugh Notary [?ub~c Canis i3oro, Cumber~end County My Commission Expires Aug. 14, 1 X99 Member, Peru~syArarrlaAssodadbn of Notaries LOUISE C. KESS R ~•_ ~ ~5~ iauv, u, [vU7 I[, iUiia~ r!u~ Dhlut\ `FIL-IUJ-Ll~l luo. -~~y r, li I ~, ,, ~~ LEADf~IG ?HEM~A~M November 6, 2009 ~ I Irwin ~ McKnight PC Roger B Irwin Esq . 60 W Pomfret St Carlisle, PA 17013 . RE: Name: Louise Kessler SSN: 209-12-8838 DOD:. 10-09-2009 Dear Mr. Irwin; In response to your request for Date of Death (DOD) balances for the customer noted records show the following: above, our Certificate of Deposit Account # 21001052979 Established: 03-28- 1991 DOD balance: $7,046.63 + 2,82 ac LOUISE C KESSLER trued interest Checking Account Account # 5140409214 Established: 02-21-1984 DOD balance: $2,122.98 + 0,02 ac LOUISE C KESSLER trued interest Savings Account Account # 5003813341 Establishcd: OS-Z3 -2001 DOD balance: $86,303.94 + 8.49 etc L4UISE C KESSLER rued interest Please note that this office provides date of death balances for deposit accounts IRA Savings), we do not process any financial transactions or provide statements. ~ CoDs, Checking and any ofthese items, Please call 1-888-PNC-BANK (1-588 762_2265 or st b Y u need assistance with office. ) oP Y Yom' local PNC Bank branch Sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC \' n., _., ~ ,.r t _ .- Services of Funeral DinctorlStaff .. , . _`-~ - ......$ 4,695.t?0 . Embalamtng ..................... . .....~ $ -0- -0- Cremation Urn.. $ Other preparation of body- .................. -0- ~Description) $ -0- ... ..... .$ -f}- $ -0- SUB-TOTAL OF PROFESSOONAE. SERVICES.......... A~ $ 4,695.00 $ -0- w 2::. F~1CILITlES ANQ SERVICES TOTAL MERCHANDISE :SELECTED ........ • , , g $ 1,410.OC Use of facilities and services for `~'~~"'~ ' ' C:-' SIAL:~AfS .`. - - Viewing (Visitation/V1/ake) ................ $ -0- Forwarding of remains to Use of facilities and services for $ Funeral Ceremony ..... _a, (Funeral Home) -0 Use of faalitres .and services frir • • .. • • ~ - - ' Receiving,of remains from Memorial Service . ' -•• .........sue -0- $ -a Use of equipment and services•for (Funeral Home) Graveside Service. , .Immediate Burial. , , . $ _0_ Other use of facilities • • • • • ' • • • • • • . • • • . • • ~ ~~ ~ Dired Cremation .................. $ _0_ $ ^ -0- SUB-TOTAL OF S L CHARGES ........ ~ $ _ D. .. _p. -0- SUB-TOTAL OF FACILITIES/EQUIPMENT .. .......... A2 0.00 Wing Grave {Prepai ............$ _0_ Cemete ............... $ -0- 3. AUTOMOTIVE EQUIPMENT Lot and Deed, _ , • ... $ ~_ Newspaper Notices -Out-of-#own ... , . , $ -p_ Vehicle to transfer remains to Funeral Telephone 8~ Telegrams , .. , . $ 0_ Local .... ................. $ -0- Airfare.. ......$ Hearse (Gasket Coach) -' ........................ -0- Locai ..... ~ClergylMass Offering ............. $ 125.00 1 ..........................$ ~ Pallbearers.... ..................$ -0- Local.... , . ...... ........ .. $ Certfied Copies of the Death Certificate . $ 30.00 . .. . •••. .. _ Family.:Car-...: _ _""__ Police. Escort ....... $ .. ... Local ~. ...__....:.... -,Flo ........... $ v~e~ .... - - __.._._. __ . _. Flower car or floral disposition Vault Service Charge.. • , , , , • , _0_ Local ................................$ -0- Organist........ ......:$ 100.00 Lead carlCtergy The Sentinel pbit-w/Photo (Est) $ 175.00 Local .. ... • , • • , , . • • • . • • • . _ . • $ ~ The Vailev Times/Ship_pensbum $ 35.00 Car for pallbearers $ _0- Local......... .............. $ -0- ~ -0- Out of town. transportation ................$ _0. $ $ ~_ -0- $ -0- $ -0- SUB-TOTAL OF ADVANCES.... . ••••••.D$ 6 40 }fie c• a ou forour ervi sin obtainin SUB-TOTAL OF AUTOMOTIVE EQUIPMENT...........A3 $ 0.00 'Jpeci~y~Las~i advance r~ems~ g' TOTAL OF PROFESSIONAL SERVICES, FACILITIES AND AUTOMOTIVE EQUIPMENT... SUMMARY OF CHARGES: ' ' ' ' ' ' ' ' ' • • • ' • • • • • • • • • • • • • • • • • • • • A $ 4 695.00 A• professional Services, Facilities and B. CHARGES FOR MERCHANDISE Equipment and Automotive Casket .... .. .... . $ 1 410.00 Equipment... (Description) 18G ~Bethanv Chiff n ~ '• • ' ' ' ' ' ' ' ' ' • • • • • • • • $• 4.695.00 asket (Gasket) B. Merchandise .................... .$ 1,410.00 C. Special Charges.... _$ _0_ Outer Recepta e----';-"'+ D. Cash Advances . ' ' • • ' •$ . ~ 624.00 (Descripti ~ .... ................ . ~~- TOTAL OF ALL SELECTIONS $ Outer burial container......... $ PAID AT f,7 0 • • • • • • • ... -0- TIME OF OR PRIOR TO (Description)_Alternat ontaing~ ARRANGEMENTS... _ Acknowledgement cards.. BALANCE DUE , • ' ' ' ' ' ' ' $ O.OC ..............$ -0- • $_ 6.729.00 Register Book(s) .......................$ _p_ REASON FOR EMBALMING • • • • • • • . • • • • . ~ • • ~ ~ • • • Memorial folders ...................... =_ Required for traditional funeral with viewing Prayer cards ......................... $ .0_ If any law, cemetery or crematoryry requirements have,required the purchase of Temporary grave marker .......... . ..... $. _0_ any of the items listed above. thelaw or requirement rs explained below. Burial clothing ................... $ _0_ OBC by cemetery I agree that I have examined the terms of goods and servi elected above and found them to be correct and according to the arran e g merits I have requested and I acknowledge a copy of this Statement of Funeral Goods and Services selected. I represent. that I have sufficient funds available for payment of total price for goods and services selected. I also agree to make payment of $ 6.729.00 within 30 days. I agree to be jointly and severally liable with anyone who signs below. A late charge of 1.5%_-____per month amountrn to _ o beginning 30 days from the date of this agreement. I will also pay to the Funeral Director all reasona- bie~costs pa d by therlFunerapDirectorhto collect amance ounts $o.oo $o.oo ' - _ __. ____ $1,239.99 $75.25 ~D~te ------~---_ ~~ n $0.00 ~_____ __ $1,315.24 .> a~ys~ gate- Charges/ eats -- -- Un1ts `~ _~'~~ ~alance,~ (C~) Balance Forward _ _ _ _ 06/01/08 - 06/01/08 Adult Wipes $2,490.44 $2,490.44 06/01 08 - ~ (1) $3.25 $ 3.25 / 06/01/08 Pullups -Large ( ) $2,487.19 06/05/08 - 06/05/08 Wash Cream ~ (1) $14.82 $(14'82) $2,472.37 06/10/08 - 06/10/08 Pullups -Large (1) $6.75 $(6'75) $2,465.62 06/13/08 - 06/13 08 \, (1) $14.82 $(14.82) / Adult Wipes $2,450.80 06/17/08 - 06/17/08 Pullups -Large ~ (1) $3.25 $(3.25) $2,447.55 06/24/08 - 06/24/08 Adult Wipes (1) $14.82 $(14.82) $2,432.73 06/26/08 - 06/26/08 Pullups -Large (1) $3.25 $(3'25) $2,429.48 07/02/08 - 07/02/08 Wash Cream - (1-) $14.82 $(14.82) $2,414.66 07/05/08 - 07/05/08 Pullups -Large (1) ~ $6.75 $(6.75) $2,407.91 07/06/08 - 07/06/08 Adult Wipes (1) $14.82 $(14'82) $2,393.09 07/16/08 - 07/16/08 Pullups -Medium (1) $3.25 $(3.25) $2,389.84 07/19/08 - 07/19/08 Wash Cream (1) $13.66 $(13.66) $2,376.18 07/20/08 - 07/20/08 Adult Wipes ,(1) $6.75 $(6.75) $2,369.43 07/28/08 - 07/28/08 Pullups,-Large (1) $3.25 $(3.25) $2,366.18 07/30/08 - 07/30/08 Adult Wipes (1) $14.82 $(14.82) $2,351.36 08/08/08 - 08/08/08 Adult Wipes ~1) $3.25 $(3.25) $2,348.11 08/08/08 - 08/08/08 Pullups -Medium (1) $3.25 $(3.25) $2,344.86 08/09/08 - 08/09/08 Wash Cream (1) $13.66 $(13.66) $2,331.20 08/17/08 - 08/17/08 Pullups -Large (1) `$6.75 $(6.75) $2,324.45 08/24/08 - 08/24/08 Adult Wipes (~) $1,.4.82 $(14.82) $2,309.63 08/26/08 - 08/26/08 Wash Cream (1) $3.25... $(3.25) $2,306.38 08/26/08 - 08/26/08 Pullups -Large (1~ .:$6.75 $(6.75) $2,299.63 09/06/08 - 09/06/08 Wash Cream (~) $14.82 $(14.82) $2,284 81 09/06/08 - 09/06/08 Adult Wipes (1) $6.75 $(6'75) $2,278.06 (1) $3.25 $(3.25) $2,274.81 FACILITY NAME RESIDENT NAME CHURCH OF GOD HOME, INC ACCOUNT NUMBER LOUISE C KESSLER 802~8~