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HomeMy WebLinkAbout04-0719 PETITION FOR GRANT OF LETTERS Estate of GERALD A. SAOESKY No. ~ also known as GERALD A. SADESKY , Deceased Social Secudty No 194-40~4902 Petitioner(s), who is/am 18 years of age or older, apply)ies) for: (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut or ] Decedent, dated 5/21/2003 and codicil(s) dated named in the Last Will of the State relevant circumstances, e.g., renunciation, death of executor, etc Except as follows, Decedent did not marry, was not divorced and did not have a child bom or adopted after execution of the documents offered for probate; was not the viotim of a killing and was never adjudicated incapacitated: B. Grant of Letters of Administration (ct.a., d.b.n.c.t.a.: pendente lite, duranle absent a; du,.,,.l~.e~morita e) (:~ ; 77 Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was suo/~ved by the following spouse (if any) and heirs: ~ r~ Name Relationship Re~nce (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence at 37 East NoAh Street (list street, number and municipality) Decedent, then 54 years of age, died July 15 2004 at Carlisle, Cumberland County~ Pennsylvania ' ' (Location) Decedent at death owned property with estimated values as follows: (if domiciled in PA All personal property .......................... $ 100.00 (if not dornioilad in PA Personal property in Pennsylvania ................... $ (if not domiciled in PA Persocel property in County ................... $ Value of real estate in Pennsylvania .............................................................................. $ $ 100.00 Total ........................................................................................................... Rea Estate sJtuate;~l~s follows: Wherefore, petit~5/n,e~(s) respectfully request(.~e?probate of the Last Will and Codicil(s) presented with this Petition and the grant of ~etters in the appropnate fo~ ~.t{3e undersigned: / / .~ , [~' ~///// . ~? /~'/ -~ ' ~ Typed or pdnted name and residence Glenn E. Schneider 149 Fox Hollow Road Shermans Dale, PA 17090 Oath of Personal Representative Commonwealth of Pennsylvania County of CUMBERLAND The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to and affirmed and subscribed ct before me this day of DECREE OF REGISTER Estate of GERALD A. SADESKY Deceased No. also known as Social Security No: 194-40-4902 Date of Death' 4/3/02 .L~ AND NOW, ~t b((~ L,L~"~ ',~ ~ ~(~."~' ~-1 __ , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters I~ Testamentary [~ of Administration. ((c.t.a., d.b n.c,t.; pendente lile; duranle absentia; duranie minoriate) are hereby granted to.Glenn E. Schneider in the above estate and that the instrument(s), if any, datedMay 21, 2003 , described in the Petition be admitted to probate and filed of record as the Last Will of Decedent. FEES Letters .................................... $ I/~" C' C/ Short Certificates(s) ............... $ ,:.~-":{ C; C Renunciation .......................... $ Extra Pages ( ) ...............$ LO C C; I.T.R ....................................... $ JCP Fee ................................. $ ]O. C C~ Inventory ................................ $ Other ...................................... $ TOTAL ............................ $ Signature Attorney: Paul Bradford Orr, Esquire I.D. No: 71786 Address: 50 East High Street Cadisle PA 17013 Telephone: 717-258-8558 DATE FILED: OMMONWEALTH O/: PENNSYLVANIA · DEPARTMENT OF HEALI'H · VITAL RECORDS CERTIFICATE OF DEATH Gerald A. Sadesk~ Male ~ 194 -- 40 -- 4902 7-15-2004 ~ I * / ; e tz-5-~ i~!atrona He~gDt~ /~ ~' ...... "~"-" Cumberland Ik South Middletonl. Manor Care t."' ............ ~,, White ,,, Engineer _ 904 Petersburg Road ^CTU^L Carlisle. PA 17013 ~s ........ ,.. John Sadesky Dean Doris Mortimer 904 Petersbur Carlisle PA 17013 PA Crematory Harrisburg, PA 17109 Cremation Society of PA egi ter a[ CCum]berlanh CCountp Estate of Also known as ~.OATH OF SUBSCRIBING WITNESS ,Deceased (each) a subscribing wimess to the will/codicil presented herewith, (each) being duly qualified according to law', ,depose(s,) and say(s) })'~ present and saw V)'~.~. I ~1'¢~ , the testat 0 ~% si~ the same and that ~_ slued as a wimess at the request of the testat 0 ~ in h J ~ presence and (in the presence of each other) (m the presence of the other subscribing wimess(es). 4ame) Sworn to or affirmed and subscribed Before me this ~:~_r,/b day of (Name) (Address) ~_~..~[~_fH OF NON-SUBSCRIBING WITNESS Also known as .Deceased (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that k~.~ familiar with the signatare of C~/gl~ ~.~,~.+~L- ,~stattg{~ of (one of the subscribing wimesses to) the codicil/will presented here,~ith and that ~ believes the signature on the codicil/will is in the hand,aq:iting of ~0'F~lavl '~12 ~,g/~ ~jq to the best of ~(5\ 5 tmowledge and belief, Sworn to o~ affim~ed and subscribed Before me~.is 2~qD day,of ~ ,20 © q ,. ~ ,'~ (Name) (Address) (Address) LAST WILL AND TESTAMENT OF GERALD A. SADESKY I, Gerald A. Sadesky of 37 East North Street, Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declarc this as and for my I.ast Will and Testament, hereby revoking all other wills and codicils hcretoi'brc made by me. FIRST: I direct that all my just debts and funeral expenses, including my grave marker, shall be paid from the asscts of my estate as soon as practiO~ble after,my dece~'e. l direct to have a military burial. (Glenn Schneider has access to my DD 2! 4) Add~4onally, I dircct that the flag given at my burial go to my good fi'lend Heather L. Orr. cc~ SECOND: I give, devise and bcqucath the residue of my estate, o_f eve~ nature and wherevcr situate, to, Heather L. Orr, Glenn Schneider, and Paul B. Orr:~ho have bccn good friends of mine lbr many years, in equal shares, providing they shall suO4ive me bv thirty (30) clays. THIRD: I direct that all taxes that may be assessed in consequence of my death, of whatcvcr nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of thc administration of my estate. FOURTH: I nominate, constitute and appoint my friend, Glenn Schneider, Executor of this my Last Will and Testament. Should my friend, Glenn Schneider, f'ail to qualify or cease to act as Executor. I appoint Paul B. Orr, Executor of this my Last Will and Testament. FIFTH: I dircct my Exccutor and his successors shall not be required to gixe bond for the faithful performance of their duties in this or any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of two (2) typewritten pages, each identified by my signature, this ~ [ day of h',~ ~D ?5 ~"' ':GERALD A, SADE~' ' (SEAL) Signed, sealed, published and declared by the above-named Testator, Gerald A. Sadesky, as and for his Last Will and Testament, in the presence of us, who, at his request, in his sight and presencc, and in the sight and presence of each other, have hereunto subscribed our n'ani~;~n~s'~k.l'~~ ) , Witness , Witness COMMONWEALTH OF PENNSYI.VANIA ) :SS. COUNTY OF CUMBERLAND ) I, Gerald A Sadesky, Testator, whose name is signed to the attached or Ibregoing instrument, having been duly qualified according to law', do hereby acknowledge that l signed and executed the instrument as my Last Will and Testament: that I signed it willingly; and that signed it as my frcc and voluntary act for the purposes therein expressed. Sworn or at'tinned to and acknowledged betbre me by "' ~ ,~,,, ~ 4 ': ,,~ ~ ~q, the ~ "t'' 0 2003. /7 Testator, this ~ dayof , ~ ~ ,: _[,/// ~ ,' /"~ j~ ] ./ ald A. Sadesky, Testator Nota~ Public COMMONWEALTH OF PENNSYLVANIA ) :SS. COUNTY OF CUMBERLAND ) We, and . thc witnesses whose names are signed to the attached or foregoing instrmnent, being duly qualified according to law. do depose and say that we were present and saw Testator sign and execute the instrument as his Last Will and Testament; that Gerald A. Sadesky signed willingly and that he executed it as his free and voluntary act for the purpose therein expressed: that each of us in the hearing and sight of the Testator signed thc Will as witnesscs; and that to the best of our knowledge thc Testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed to before mc by,,lzT~ an0 (~. ~¢th,~ day of 2003. K,I ~,~ ~ L~/~~ (SEAL) · Witness , /\ (SEAL) , Witness Notary Public Name of Decedent: CERTIFICATION OF NOTICE UNDER RULE 5.6(al Date of Death: Will No. Admin. No. To the Register: I certify that notice of (beneficial interest) ~q~[~[]][~i~ required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on _ t-a ] ~ ~ } ,n / I : ' I Name Address Notice has now been given to all persons entitled thereto under Rule 5.6(a)..e. am~. · e,ephoue Iq Capacity: ~ Personal Representative Counsel for personal representative Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717)240-6345 Date: 11/01/2004 ORR PAUL BR3~DFORD 50 E HIGH STREET CARLISLE, PA 17013 RE: Estate of SADESKY GEP~ALD A File Number: 2004-00719 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPPLANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing will become delinquent on 11/13/2004 Your prompt attention to this matter will be appreciated. Thank You. cc: File Personal Representative(s) Judge GLENDA FARNER STRASBAUGH Clerk of the Orphans' Court Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717)240-6345 Date: 11/01/2004 SCHNEIDER GLENN 149 FOX HOLLOW ROAD SHERMANSDALE, PA 17090 RE: Estate of SADESKY GEP~ALD A File Number: 2004-00719 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing will become delinquent on 11/13/2004 Your prompt attention to this matter will be appreciated. Thank You. cc: File Counsel Judge GLENDA FARNER STRASBAUGH Clerk of the Orphans' Court ~EV.1500E~(I:i.{l(l! REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT .' COMMONWEALTH OF , PENNSYLVANIA DEPARTMENT OF REVENUE DEPT,280601 HARRISBURG, PA 17128-0601 FILE NUMBER 21 04 0719 COUNTY CODE 'fEAR NUMBER w .... ::c$U) " ."" w"" ",00 "".... ..Ill .. " DECEDENT'S NAME (lAST, FIRST, AND MIDDLE INITIAL) SADESKY, GERALD A. SOCIAL SECURITY NUMBER 194-40-4902 I- Z W o W U W o , DATE OF BIRTH (MM-DD-YEAR) 12/03/1949 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER DATE OF DEATH (MM-DD.YEAR) 07/15/2004 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) [i] 1. Original Return o 4. Limited Estate [!] 6. Decedent Died Testate (Attach oopy of W~I) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of dealh after 12-12-82) D 7. Decedenl Maintained a Living Trust (Atlachoopyof Trusl) o 10. Spousal Poverty Credit idale ofdealhbelween 12-31-91 and 1.1-95) 03. Remainder Retum (date of death prior to 12-13-62) o 5. Federal Estate Tax Retum Required 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (AtlachSch0) .... z w o z o .. U) w " " o " THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS PAUL BRADFORD ORR 50 EAST HIGH STREET FIRM NAME I"""""" CARLIS E PA 17 LAW OFFICES OF PAUL BRADFORD ORR L , 013 TELEPHONE NUMBER (717) 258-8558 z o ~ =>> l- ii: ct u W 0:: 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3 Closely Held Corporation, Partnership Of Sole-Proprietorship 4_ Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (ScI1edu~ E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G orL) (1) (2) (3) (4) (5) 0.00 , , 0.00 '. n '-"C) , 0.00 " , , ! 0.00 " ."] , 1'1 , J 2,890.24 _00 ...'';:': ---'.'---,. " - --I' 0.00 :-~} --I -:J 0.00 ).> (8) 2,890.24 2,348.00 6,708.03 (11) 9,056.03 (12) -6,165.79 (13) 0.00 (14) -6,165.79 x .0 (15) ,r'n 0.00 Iv . ,c'U 0.00 x .0 (161. , ::' /' x .12 (17) :';'--' ..UIJ 0.00 x .15 C \18~;:; ~-! ~~ z.." (";,~,Ll ~r:yI 0.00 ,,, Vi I ~ u (19) 0.00 (6) (7) 8. Total Gross Assets (total lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10_ Debts of Decedool, Mortgage liabilities, & liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (ScheduleJ) (9) (10) 14 Net Value Subject to Tax (line 12 minus line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o < I-' =>> D.. ::E o u ~ 15. Amount of line 14 taxable at the spousal tax rate, Of transfers under Sec. 9116 (a)(1.2) 16. Amount of line 14 taxable at lineal rate 17_ Amount of line 14 taxable at sibling rate 18. Amount of Une 14 taxable at collateral rate 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND R Decedent's Complete Address: STREET ADDRESS 37 EAST NORTH STREET CITY CARLISLE I STATE PA I ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 0.00 0.00 0.00 Total Credits ( A + 8 + C ) (2) 0.00 3. InteresVPenalty if applicable D.lnterest E. Penalty 0.00 0.00 TotallnteresVPenalty ( 0 + E ) (3) 4. If Une 2 is greater than Une 1 + Une 3. enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) 0.00 0.00 0.00 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE, (58) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 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;.......................................................................................... 0 [KI b. retain the light to designate who shall use the property transferred or its income;. ............................... .......... 0 [KI c. retain a reversionary interest; or... .................. ........................... . ............................ ..................... ...... D [i] d. receive the promise for life of either payments, benefits or care? ........................... .......................................... 0 [i1 2. If death occurred after December 12,1982, did decedent transfer property WIThin one year of death without receiving adequate consideration? ......... ................................... . . .......................... 0 [!] 3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death?... .......... 0 [KI 4. Did decedent own an Individual Retirement Account, annuity, or other non~probate property which contains a beneficiary designation? .............. ..................................... ............................... .................... 0 [i.J IF THE ANSWER TO ANY OF THE ABOV UESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN, .I DATE 08/24/05 Under penalties of ~ury, I dedare ltIat 1 have examined this m ncludi ccompanying schedules and statements, and to the best of my knowledge and belief. it is true, correct and complete. Dedaration ofpreria other than the personal representative on i alion ofwhictt preparer has any knowledge. SIGNATU~ X.' ~. ADDRESS :~~E-FOX~H~LLO:iWE:~T~D. ADDR . 50 EJI; ST EEl. RMANSDALE, PA 17090 EPRESENTATIVE DATE 08/24/05 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 3% [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 vaiue of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (iill. The statute does not exemot a transfer to a surviving slXluse 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 0% [72 P.S. ~9116(a)(1.2)I. The tax rate Imposed on the net value of transfers to or for the use of the deoedent's lineal benefidaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(111. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(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. LAST WILL AND TESTAMENT OF GERALD A. SADESKY I, Gerald A. Sadesky of 37 East North Street, Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking all other wills and codicils heretofore made by me. FIRST: I direct that all my just debts and funeral expenses, including my grave marker, shall be paid from the assets of my estate as soon as practicable after my decease. I direct to have a military burial. (Glenn Schneider has access to my DD 214) Additionally, I direct that the flag given at my burial go to my good friend Heather L. Orr. SECOND: I give, devise and bequeath the residue of my estate, of every nature and wherever situate, to, Heather L. Orr, Glenn Schneider, and Paul B. Orr, who have been good friends of mine for many years, in equal shares, providing they shall survive me by thirty (30) days. THIRD: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. FOURTH: I nominate, constitute and appoint my friend, Glenn Schneider, Executor of this my Last Will and Testament. Should my friend, Glenn Schneider, fail to qualify or cease to act as Executor, I appoint Paul B. Orr, Executor of this my Last Will and Testament. J FIFTH: I direct my Executor and his successors shall not be required to give bond for the faithful performance of their duties in this or any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of two (2) typewritten pages, each identified by my signature, this 21 day of 1f\A-'f ' 0.3 ;t (SEAL) Signed, sealed, published and declared by the above-named Testator, Gerald A. Sadesky, as and for his Last Will and Testament, in the presence of us, who, at his request, in his sight and presence, and in the sight and presence of each other, have hereunto subscribed our n es esses. , Witness -pO~l A ""'rncv.:>~ , Witness REV-1SDB EX+ (6-9B) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF GERALD A. SADESKY FILE NUMBER 21-04-0719 Include the proceeds of litigation and the date the proceeds were r~eiverl by \he estate. All property jointly-owned with righl of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. WAYPOINT BANK CHECKING ACCOUNT NO.: 100668540 2,890.24 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, msert additional sheets of the same size) 2,890.24 ~IWayP"qint Way Better Banking only from Waypoint Bank Receipt - Acct. #: 0100668540 TLR #:0531 DDA Closeout TR #: 104TR AMT: 2890.24 Date: 08/03/2004 Time: 13:43 Checks and other items received for deposit are sUbject to the provisions of the Uniform Commercial Code. Certain deposits are subject to delays in availability according to Bank policy. TEL-<l1G(=l Thank You For Banking At Waypoint Mom"" FDIC VI WayJ:tqi!1J p.o. Box 1711. Harrisburg. Pennsylvania 17105-1711 Member FDIC GERALD ALLEN SADESKY 37 E NORTH ST CARLISLE PA 17013 CLUB-ED ACCOUNTS, HELP YOUR CHILDREN LEARN. THERE IS NO MINIMUM INITIAL DEPOSIT. EVEN BALANCES AS LOW AS $1 EARN INTEREST. CALL TODAY TO START THAT LEARNING EXPER IENCE I ACCOUNT TYPE OF ACCOUNT 100668540 FOCUS FIFTY -1 STATEMENT DATE 8-D3-04 AVERAGE BALANCE 2,89D,10 ---------------------------------------------------------------------------- PREVIOUS BALANCE DEPOSITS WITHDRAWALS CHARGES INTEREST ENDING BALANCE * - - - - - - - - - - - -INTEREST SUMMARY- - - - - - - - - INTEREST EARNED FROM 7/22/04 TO 8/03/04 DAVS IN PERIDD INTEREST EARNED ANNUAL PERCENTAGE YIELD EARNED INTEREST PAID THIS YEAR INTEREST WITHHELD THIS YEAR * - - - - - - - - - - - - - TRANSACTION SUMMARY - - - - - - TRAN SACT I ON DEPOS ITS 1 CHECKSI DATE DESCRIPTION CREDITS DEBITS 8/03 CLOSE OUT WITHDRAWAL 2890,24 8/03 INTEREST PAYMENT ,14 THANK YOU FOR BANKING AT WAYPOINT BANK 2,890.10 .00 2,890.24 .DO .14 .00 * 12 ,14 ,15 % 2.20 ,00 - - * BALANCE .14- .00 , "'Way~qi!1J p.o. Box 17ft. Harrisburg. PEnnsylvania .7105.,7U Member FDIC GERALD ALLEN SADESKY 37 E NORTH ST CARLISLE PA 17013 CLUB-EO ACCOUNTS, HELP YOUR CHILDREN LEARN. THERE IS NO MINIMUM INITIAL DEPOSIT. EVEN BALANCES AS LOW AS $1 EARN INTEREST. CALL TODAY TO START THAT LEARNING EXPERIENCE' ACCOUNT TYPE OF ACCOUNT 100668540 FOCUS FIFTY STATEMENT DATE 8-03-04 -1 AVERAGE BALANCE 2.B9010 -----~--------------------------------------------~------------------------- PREVIOUS BALANCE DEPOSITS WITHDRAWALS CHARGES INTEREST ENDING BALANCE * - - - - . - - - . ~ ..INTERfST SUMMARY- - - - - - - - - INTEREST EARNED FROM 7/22/04 TO B/03/04 DAYS IN PERIOO INTEREST EARNED ANNUAL PERCENTAGE YIELO EARNED INTEREST PAID THIS YEAR INTEREST WITHHELD THIS YEAR * - - - - - - - - - - - TRANSACTION SUMMARY- - . - - - TRANSACTION DEPOSITS/ CHECKS/ DATE DE SCR I PTI ON CRED ITS DEBITS 8/03 CLOSE OUT WITHORAWAL 2B90.24 B/03 INTEREST PAYMENT .14 THANK YOU FOR BANKING AT WAYPOINT BANK 2.B90.10 .00 2.890.24 .00 .14 .00 * 12 .14 .15 % 2.20 .00 * BALANCE .14- .00 POO-5Q2(8J02) Customer Service Toll-Free 1-866-WAYPOINT (1-866-929-7646) . In York Area 717/815-4500 www.waypolntbank.com , VIWayR.qi!1J P.O. Box 17U. Harrisburg. PEnnsylvania 17105-17U Member FDIC STATEMENT DATE 7-22-04 GERALD ALLEN SAOESKY 37 E NORTH ST CARLISLE PA 17013 CLUB-ED ACCOUNTS. HELP YOUR CHILDREN LEARN. THERE IS NO MINIMUM INITIAL DEPOSIT. EVEN BALANCES AS LOW AS $1 EARN INTEREST. CALL TODAY TO START THAT LEARNING EXPERIENCE' ACCOUNT TYPE OF ACCOUNT 100668540 FOCUS FIFTY AVERAGE BALANCE 3,134.64 PREVIOUS BALANCE DEPOSITS WITHDRAWALS CHARGES INTEREST ENDING BALANCE 3.387.71 948.00 1.446.00 .00 .39 2.890.10 * - - - - . - - - -- ,-INTEREST SUMMARY. . INTEREST EARNED FROM6/ZZl04 TO 7/22104 DAYS IN PERIOD INTEREST EARNED ANNUAL PERCENTAGE YIELD EARNED INTEREST PAID THIS YEAR INTEREST WITHHELD THIS YEAR * - - . - - - - - - - - - TRANSACTION SUMMARY. TRANSACTION DEPOSITSI DATE DESCRIPTION CREDITS 7/09 OVER COUNTER DEBIT 7/12 OVER COUNTER DEBIT 7/13 OVER COUNTER DEBIT 7/14 ELECTRONIC TRANSACTION US TREASURY 303 SOC SEC 7/15 CHECK 95 7/22 INTEREST PAYMENT * 30 .39 .15 % 2.06 .00 * 948.00 CHECKSI OEBITS 527.00 254.00 565.00 DATE 95 7-15 .39 - -CHECKS AMOUNT 100.00 100.00 BALANCE 2860.71 2606.71 2041.71 2989.71 2889.71 2890.10 * - - NO. PAlO. NO. DATE . - .* AMOUNT THANK YOU FOR BANKING AT WAYPOINT BANK pnn."J'l?IAIO?\ Customer Service Toll-Free 1-866-WAYPOINT (1-866-929-7646) . In York Area 717/815-4500 www.waypointbank.com '~IWay~qi!lJ p.o. Box 1711. Harrisburg. Pennsylvania '7105-17U Member FDIC GERALD ALLEN SADESKY 37 E NORTH ST CARLISLE PA 17013 RELATIONSHIP CHECKING OFFERS CD BONUS RATES. LOAN DISCOUNT RATES AND MANY MORE BENEFITS. STOP BY YOUR LOCAL BRANCH TODAY. OR CALL US AT 1-866-WAYPOINT (1-866-929-7646). ACCOUNT TYPE OF ACCOUNT 100668540 FOCUS FIFTY STATEMENT DATE .6-22.04 AVERAGE BALANCE 3.662.06 ---------------------------------------------------------------------------- PREVIOUS 8AlANCE DEPOSITS WITHDRAWALS CHARGES INTEREST ENDING BALANCE * - . - - - . - - .. '.INTEREST SUMMARY. - INTEREST EARNED FROM 5123/04 TO 6/22104 DAYS IN PERIOD INTEREST EARNED ANNUAL PERCENTAGE YlELD Ei\RNED INTEREST PAID THIS YEAR INTEREST WITHHELD THIS YEAR * - - - . - - - . - - -. TRANSACTION SUMMARY. TRANSi\CTION DEPOSITS I DATE DESCR I PTI ON CREDITS 5124 OVER COUNTER DEBIT 5/27 DEPOSIT 150.00 6107 ATM WID 000000005417 17 W. HIGH STREET CARLISLE PA 6107 OVER COUNTER DEBIT 6/07 OVER COUNTER DEBIT 6107 OVER COUNTER DEBIT 6108 DEPOSIT 390.00 6109 ELECTRONIC TRANSACTION 948.00 US TREASURY 303 SOC SEC 6109 OVER COUNTER DEBIT 6111 DEPOSIT 300.00 6/11 OVER COUNTER DEBIT 6116 OVER COUNTER DEBIT 6118 OVER COUNTER DEBIT 6121 OVER COUNTER DEBIT 6/21 OVER COUNTER DEBIT 6/22 INTEREST PAYMENT .45 CONTINUED ON NEXT PAGE CHECKS I DE B ITS 50.00 200.00 150.00 60.00 50.00 22500 240.00 200.00 200.00 250.00 185.00 3.409.26 1.788.00 1.810.00 .00 .45 3.387.71 * 30 .45 .15 % 1. 67 .00 * BALANCE 3359.26 3509.26 3309.26 3159.26 3099.26 3049.26 3439.26 4387.26 4162.26 4462.26 4222.26 4022.26 3822.26 3572.26 3387.26 3387.71 POD-502 (8102) Customer Service Toll-Free 1-866-WAVPOINT (1-866-929-7646) . In York Area 717/815-4500 www.waypointbank.com -~lWayRqi!1J p.o. Box 1711. Harrisburg. PEnnsylvania 17105-1711 Member FDIC GERALD ALLEN SADESKY STATEMENT DATE 6-22-04 FOCUS FIFTY 100668540 PAGE 2 THANK YOU FOR BANKING AT WAYPOINT BANK Customer Service Toll-Free 1-866-WAYPOINT (1-866-929-7646) . In York Area 717/815-4500 www.waypolntbank.com POD-502 (8102) 1"lWayRqiKlJ p.o. Box 1711. Harrisburg. Pennsylvania 17105-170 MemberFDIC GERALD ALLEN SADESKY 37 E NORTH ST CARLISLE PA 17013 RELATIONSHIP CHECKING OFFERS CD BONUS RATES. LOAN DISCOUNT RATES AND MANY MORE BENEFITS. STOP BY YOUR LOCAL BRANCH TODAY. OR CALL US AT 1-866-WAYPOINT (1-866-929-7646). ACCOUNT TYPE OF ACCOUNT 100668540 FOCUS FIFTY PREVIOUS BALANCE OEPOSITS WITHDRAWALS CHARGES INTEREST ENDING BALANCE -INTEREST SUMMARY- 4/22/04 TO 5/23/04 * - - - - - - - - INTEREST EARNED DAYS IN PERIOD INTEREST EARNED ANNUAL PERCENTAGE YIELD EARNED INTEREST PAID THIS YEAR INTEREST WITHHELD THIS YEAR * - - - - - - - - - - - - TRANSACTION SUMMARY- TRANSACT I ON DEPOS ITSI DATE DESCRIPTION CREDITS 4123 OVER COUNTER DEBIT 4/27 DEPOSIT 50.00 4/30 ATM WID 000000002303 17 W. HIGH STREET CARLISLE PA 4/30 OVER COUNTER OEBIT 5/03 OVER COUNTER DEBIT 5/06 OVER COUNTER DEBIT 5/12 ELECTRONIC TRANSACTION US TREASURY 303 SOC SEC 5/13 OVER COUNTER DEBIT 5/14 OVER COUNTER DEBIT 5/18 OVER COUNTER DEBIT 5/23 INTEREST PAYMENT 94B.00 .38 CONTINUED ON NEXT PAGE CHECKSI DEBITS 50.00 20.00 50.00 50.00 50.00 50.00 50.00 50.00 STATEMENT DATE 5-23-04 AVERAGE BALANCE 2.960.49 2.780.88 998.00 370.00 .00 .38 409.26 * 31 .38 .15 % 1.22 .00 * BALANCE 2730.88 2780.88 2760.88 2710.88 2660.88 2610.88 3558.88 3508.88 3458.88 3408.88 3409.26 Dt"\n_<:tv)/IlHl':l\ Customer Service Toll-Free 1-866-WAYPOINT (1-866-929-7646) . In York Area 717/815-4500 www.waypointbank.com VIWayl=tqint p.o. Box 1711. Harrisburg. PEnnsylvania 17105-1711 Member FDIC GERALD ALLEN SADESKY STATEMENT DATE 5-23-04 FOCUS FIFTY 100668540 PAGE 2 THANK YOU FOR BANKING AT WAYPOINT BANK POD-502 (8102) Customer Service Toll-Free 1-866-WAYPOINT (1-866-929-7646) . In York Area 717/815-4500 www.waypointbank.com ~l Wayt:tqillJ Member FDIC ~~ - 7-:.2-0</ .5 i J r: ()}I'JI?r4S..,4 CJ'!1A)",,- ,r..^X....J...f. . " . ,..,/.I/,.I~~ DolI..~.ti\;e:::- ~f ::; .,,,- /' .i......,~'.# ~. . I' W~, .&/..v-,.,I'~{~ '11.'It=<'-' . ~ .n COWQLL8S"DlP LoDIiS "OODDOlO i - t:llU7H&1 i 5 100 . 00 7/15/04 9 1$ 110.",,, POD-503(2102l Accoun I # 100668540 Page # 2 REV-'511 EX. 1'2-991. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF GERALD A. SADESKY FILE NUMBER 21-04-0719 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: CREMATION SOCIETY OF PENNSYLVANIA - Paid 7-26-04 1,300.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Represenlative(s) GLENN SCHNEIDER Social Security Number(s}lEIN Number of Personal Representative(s) 181-42-9566 SlreelAddress 149 FOX HOLLOW ROAD City SHERMANSDALE Slate P A Zip 17090 Year(s) Commission Paid: N/A 2. Attorney Fees 975.00 3. Family Exemption: (If decedent's address is not the same as daimant's. attach explanatiOf1) 0.00 Claimant Street Address City Slate Zip Relationship of Claimant to Decedent 4. Probate Fees 73.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enler on line 9, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 2,348.00 ~~'flON SOc] (;'9;: ;;. . 1'1/ , ~<' v-- --::_,~- 'The Simple Dignified Choice" . " \ PE;NNSYLVI'>~ 7-16-2004 Mr. Dean Sadesky 904 Petersburg Road Carlisle, PA 17013 Gerald A. Sadesky - Deceased X Direct Cremation Special 48 Hour Or Weekend Cremation Service Nationwide Guarantee Program Worldwide Travel Protection Program X Private Family Viewing/Witnessing Cremation Cremation Container Medical Documents/Courier Fee X Ivory Plastic Container Urn Burial Vault Arrange For Burial Personal Delivery Of Cremated Remains Arrange/Deliver Ashes To National Cemetery Scattering Charge Packaging And Forwarding Cremated Remains Express Mail X Certified Copies 10 @ $2.00 Register Book Memorial Folders Thank You Cards # Memoriai Service Package Flowers Newspapers X Cumberland County Coroner Cremation Approval Fe DNA Preservation X Discount X mailing waived family picking up TOTAL 7-26-2004 PAID BALANCE DUE www.cremationsodetyofpa.com Nationwide 1-800-722-8200 240827 MW-5 $1,095.00 $125.00 $35.00 $20.00 $25.00 (-5.00) $1,300.00 $1,300.00 $0.00 Paul Bradford Orr Law Offices 50 East High Street Carlisle, PA 17013 (717) 258-8558 Bill To: Estate of Gerald Sadesky FileNo. Terms 04-158-P $150.00 p/hr Date Services Rendered Ship To: Page: 1 Invoice Number: 3632 Date: July 20, 2005 File Type Estate 07/26/04 07/28/04 08/16/04 08/16/04 08/20/04 . 08/20/04 08/20/04 09/09/04 09/15/04 09/23/04 11/08/04 03/23/05 04/05/05 06/30/05 07/15/05 Cremation Society: phone calls & corr. (0.50 hrs) Memo & meeting re: Wrongful Death Action (0.50 hrs) Corr. to Julia w/Kelly Services (0.25 hrs) Corr. to Layden Sadesky (0.25 hrs) Carr. David Baric w/Manor Care (0.25 hrs) Corr. to Dept. of Welfare (0.25 hrs) Corr. to John Malish (0.25 hrs) Corr. to Waypoint Bank (0.25 hrs) Corr. to PPL (0.25 hrs) Corr. to Carlisle Hospital (0.25 hrs) File Review (0.50 hrs) Corr. to Neighbor Care Pharmacy (0.25 hrs) Corr. to Apex Asset Management (0.25 hrs) Work on Estate (1.5 hrs) ,Work on Estate (0.50 hrs) Thank You for your business!! Have a great day! Amount 75.00 75.00 37.50 37.50 37.50 37.50 37.50 37.50 37.50 37.50 75.00 37.50 37.50 225.00 75.00 Paul Bradford Orr Law Offices 50 East High Street Carlisle, PA 17013 (717) 258-8558 SUI To: , Estate of Gerald Sadesky FileNo. 04-158-P Date Services Rendered Review of file and letter to Dept. of Revenue (0.50 hrs) 07/19/05 Terms $150.00 p/hr Thank You for your business!! Have a great day! Ship To: Page: 2 Invoice Number: 3632 Date: July 20, 2005 File Type Estate Total Amount 7500 $975.00 RECEIPT FOR PAYMENT ------------------- ------------------- Cumberland County - Register Of Wills Hanover and High StreeE Carlisle, PA 17013 Receipt Date: Receipt Time: Receipt No.: 8/03/2004 09:04:40 1037416 SADESKY GERALD A Estate File No. : Paid By Remarks: 2004-00719 P B ORR ESQ VZ ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name PETITION FOR PROBA EXTRA PAGES SHORT CERTIFICATE JCP FEE Check# 1381 Total Received.. ....... 18.00 6.00 24.00 10.00 ---------------- $58.00 $58.00 CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN BUREAU OF RECEIPTS & CNTR M.D REV.l512 EX' 112-03) .- COMMONWEALTH OF PENNS't'lVANIA IM-tERlrANCE TAX RETl..fiN RESDEHT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE UABILmES, & UENS FILE NUMBER 21-04-0719 ESTATE OF GERALD A. SADESKY Report debts Incurred by the _nt prior to <loath wblch remained unpaid as of tlle date of death, Including unrelmbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 11. 12. 13. 14. 15 16. 1. BOROUGH OF CARLISLE - Final Water. Decedenfs Apartment located at 37 East North Street CarUsle PPL ELECTRIC . Final Electric - Decadenfs Apartment located at 37 East North Street, Carlisle UGI GAS SERVICE. Final Gas. Decedenfs Aparlment located at 37 Easl North Street, Carlisle 182.80 53.65 2. 180.60 3. 4. 5. 6. KRUGER'S RENTAL SERVICE (U-Haul) . Removal of Decadenfs belongings from Apartment 46.49 HCR MANOR CARE. Care Home for Decedent prior to Death. Medical Expense 2,859.00 LANC HMA PHYS MGMT CENT PEN. Medical Expense SADLER HEALTH CENTER CORP. - Medical Expense CARLISLE REGIONAL MEDICAL CENTER. Medical Expense JAMES L. HARDESTY, MD. Medical Expense CUMBERLAND GOODWILL FIRE & RESCUE. Medical Expense GUISTWITE FAMILY PRACTICE. Medical Expense CENTRAL PENN MEDICAL GROUP - Medical Expense CARLISLE HOSPITALlSTS - Medical Expense ANDORRA RADIOLOGY. CRMC . Medical Expense COMCAST HARRISBURG SERVICE - Final Cable 921.00 7. 45.06 8. 42.00 9. 160.00 10 364.00 215.85 260.00 705.00 564.00 15.87 72.71 BOYD E. DILLER, INC. . Trash/Dump Expense contents of Decedenfs Apartment TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 6.708.03 BOROUGH OF CARLISLE . ACCOUNl' KIIMIIIlR SERVICE ADDRESS BILL DATE READINGS PRIOR PRESENT USMIB 1I11EDIN !llQC)JlIIC feET) SEWER REAPING TYPE 07/15/2004 08113/2004 1117 1119 2 2 Actual Sewer 6.58 Water 9.60 Current Charges 16.18 ~ '\ \ ,,1\0'-1 Previous Balance 37.47 Payments 0.00 Penalties 0.00 ~ ~ SJjb< Adjustments 0.00 Past Due Balance 37.47 iv\l; D~q Total Amount Due 53.65 REMINDER: BOROUGH BAGS PLACED AT THE CURBSIDE FOR PICK-UP MUST BE SECURELY TIED OR THEY WILL NOT BE PICKED UP. DUE DATE I AMOUNT DUE 09/29/04 53.65 THIS BILL BECOMES DEUNQUENT 23 DAYS FROM THE BilL DATE. A LATE PENALTY OF ONE PERCENT WILL BE ADDED EVERY 30 DAYS.. IF PAYMEHTHAS NOT BEEN RECEIVED Wt:rHIN 54 DAYS OF THE BILL DATE, YOUR WATER WILL BE DISCONTINUEO. BUSINESS HOURS: 7:30 A.M. TO 4:30 P.M. (MONDAY - FRIDAY) BUSINESS PHONE: 717-249-4422 Visit our website www.car/islepa.org PPL Electric Utilities Electric Servirc ~ For: GERALD SADESKY 37 E NORTII Sf CARLISLE PA 17013 Questions about this bill? Ple"se contact us by Sep 14 at 1-800-342-STIS 01' 484-634-4900 or "'Tite to: Customer Se."vice 827 Hausman Rd. Allentown, PA 18104-9392 www.pplweb.com ppft.. Page 1 YOIlf BiUA"""""'-NUlllbeJ: 81180-77024 Summary Page Balance as or Aug 24, 2004 $ 128.28 Ch",~s: Totarppl. ELECIRIC UTILI11ES Ch"'ges $ 52.32 Total Charges $ 180.60 l~aY:~~~U~ttNQ""te~~ Sl:ll~_L: ~~:. . ..~.;;:::, 1~69! Account B"lance $ 180.60 Electric Use This graph shows your electric use over the last 13 months. Types of Meter Readill~s: Actual _ Estimated D Customer c:J 48 40 KWH - Average Per Day 32 24 16 8 o ASONDJ FMAMJ JA 2003 Months 2004 Meter Reading Information 9668 9122 ~ Average -Aug Temperature KWH Per Day Yearly Use: Sep 2003 - Aug 2004 2003 75F 28 2004 72F 17 Total Use 8153 A verag( Monthl, 67~ Other important information on back -+ b,r,~"" Bllllna Summary IIlr Servlc. to: GERALl) A SADESKY EST PAUL ORR 37 E NORTH ST CARLISLE PA 17013 Rate CI.sslllcatlon: Residential Heating Billing Period: 07114/2004 la 08112/2004 (29 days) Estimated Read Ouestlon.? Call 1-800-276-2722 or write to UGI at PO 80X 13009 Reading, PA 19612-3009 . Vour current UGI charges include State ta..s la, ling $ 2.63. CPT 219777 Q90891 (t Past Bllllnfarmatlan - UGJ UtIlity The account balance on your last bill was ............. Payments ......................................................................... Vour balance as of 08/1612004 ................................ $150.43 .-... 0.00~ 150.43 Current BllllnIIlrmatlon .. UGI UtIlity Cuslomer Charge ........................................................... 8.55 Commodity Charge ( 16 CCF at $0.88188) ............ 14.11 Oistribution Charges (First 16 CCF at $0.36250) . 5.80 PA Slate Tax Surcharge ................................................ -0.D3 PA Sales Tax .................................................................... 1.71 T Dial Current Charges.. UGI utility ............................ 30.14 UGI UtIlity charg.. awed thl. bIll .........................................._............................ Total AnIount Du., Pl.... P.y by Due Date (09/0712004) .................................... $180.57 $180.57 11.20 10.08 8.96 7.84 6.72 5.60 4.48 3.36 2.24 1.12 0.00 Averagl CCF P.r Day . .. .... AS _'.' D J F M A M J J A 2003 Month. 2004 . = Estimated Usage Last This Average Vear Vear CCF/day 0.55 0-..;1., t~mnfN'9ture 720F Meter InIIlrm.tlon .. Next Read Da'" September 13, 2004 Meter Number Prevlou. Reading Present R.adlng 1244698 6757 (remote) 6773 (estimated) Message. from UGI .Vour current price 10 compare is $ 0.88179/CCF. CCF U..d 16 .Vourtolalannual usage is 1,032 CCF. Vouraverage monthly usage is 86 CCF. . Please pay your bills pmmpUy or your credit hislory may be affected. . Help prevent pipeline damage, accidents and service disruptions. If you see someone digging near your home please call UGI. ~ <J1., ~D ~i'> \ \) \ 0 q [1<;' [ bY If you pay at a payment agent please lake your entire bill. Make check payable 10 UGI. u. . ~ ~--- ___~.... '__.......nt Information I.s on the back of this bill. f;(::t ,>t HCR*ManorCare FILE COpy MANORCARE CARLISLE 372 940 WALNUT BOTTOM ROAD CARLISLE, PA 17013 (717)-249-0085 PRIVATE STATEMENT ROOM 125 - A DEAN SADESKY FOR GERALD SADESKY 37 E NORTH STREET CARLISLE, PA 17013 SADESKY, GERALD A 24121 07/02/04 07/15/04 7/31/2004 JB \11,* '". . ",..'? !iii1.~ ~y.:..~ ,!(';.: '''~:::;- 7/15/2004 INTERMITTENT INCONTINENCE DAILY FEE @ 4.50 7/5/2004 OCCUPATION THERAPY VISIT @ 30.00NlSIT 7/5/2004 OCCUPATION THERAPY EVAL@ 30.00/EVAL 7/14/2004 WOUND THERAPY TO LEFT ARM @ 8.00ITREATMENT 7/03-07/12/04 WOUND THERAPY TO LEFT FOOT @ 8.00ITREATMENT 07/02-07/14/04 ROOM CHARGE @ 187.00/DAY $63.00 $60.00 $30.00 $8.00 $80.00 $2,618.00 if: Payment Due Upon Receipt Amount Due $2,859.00 j:~. 329875 IRe: IMl P1riS M;Mr QiN.I' PEN P 0 IrJX 4337 ~ PA Jg6()6 v1252 N4169 N&12 11M 005 0575 L STATEMENT - o CHECK HERE For Credit Card Payment SHOW AMOUNT $ PAID HERE (888) 673-8944 OFFICE PHONE NUMBER 01/10/05 CLOSING DATE 329875 YOUR ACCOUNT NUMBER 04 PAGE NO. 921.00 NEW BALANCE GERALD SADESKY LANC lIMA PHYS HGMT CENT PEN POBOX 4337 READING, PA 19606-0037 1...111.1...11..11....11..11...11."..11.1...1..11.1...11..1.1 NOTE: Charges and payments not appearing on this statement wm appear on next month's statement. PLEASE RETURN THIS PORTION WITH PAYMENT DATE PROVIDER EXPLANATION OF ACTIVITY PATIENT NAME CHARGES PAYMENTS NAME AND DEBITS AND CREDITS CHARGES APPEARING ON THIS STATEMENT ARE NOT INCLUDED ON ANY HOSPITAL BILL OR STATEMENT 123~04 BtTECKI NO DPR ADJUSntEB'l' -77.00 XlIV: 26 063004 JlITEClU YO CIlT: 99232 pos: CRH INPATIENT SUBSEQ SADESKY , G 94~OO XlIV: 27 123104 nDCKJ m """ PADE!IT -16.00 IBV: 27 123104 HITECK! NO DPW ADJUSTlrENT -77.00 ZNV: 27 070204 At.8a:tGRT 141) CPT: 99238 pos: C1UI INPATIENT DISCHAR SADESKY I G 117.00 XlIV: 29 123104 AI.BlUGHT MD I)PR PAYIO!HT -16.00 XlIV: 29 123104 AI.8RIGHT MD Dl'W ADJUSTMENT -100.00 ZJrv: 29 ~T~1f~J~~T"'; 0" ~1 n "OS PLEA.SE INDICATE YOUR ACCOUNT NUMBER WHEN CAlLING OUR OFFICE: INS PENDING PATIENT BAL TOTAL BAL CURReNT BAL PAST DOE 3298'75 NEWIlALINCE PAYTHISAMOUHT 9'1..00 921.00 921.00 921. 00 SEND INQUIRIES TO: IJUtC HYJ\ PH!'S M:;Hl" CENT PEN POBOX 4337 HADING PA ~9606 IRS t: 233013255 (888) 673-8944 329875 IRC 1M!. PHY5 J.GfZ' C1iNJ! PEN P 0 BJX 4337 REllDI1'G PA 19606 v1252 N4169 WE12 11M 005 0574 L STATEMENT - o CHECK HERE For Credit Card Payment SHOW AMOUNT $ PAID HERE - (888) 673-8944 OFFICE PHONE NUMBER 01/10/05 CLOSING DATE 329875 YOUR ACCOUNT NUMBER 03 PAGE NO. CONTINUED NEW BALANCE GERALD SADESKY LANC SMA PHYS MGMT CENT PEN POBOX 4337 READING, PA 19606-0037 1...111.1...11..11....11..11...11.....11.1...1..11.1...11..1.1 NOTE: Charges and payments not appearing on this statement will appear on next month's statement. PLEASE RETURN THIS PORTION WITH PAYMENT CHARGES APPEARING ON THIS STATEMENT ARE NOT INCLUDED ON ANY HOSPITAL BILL OR STATEMENT DATE PROVIDER EXPLANATION OF ACTIVITY PATIENT NAME CHARGES PAYMENTS NAME AND DEBITS AND CREDITS 061804.mLDER HD CPT: 99223 -25 POS: CIUI INPATIENT INI SADESKY, G 259.00 IRV: 1.2 12.2804 HI.LDEJI 1m DR PAYMBHT -40.00 IBV: 1.2 12.2804 HILDEN Ul DR ADJUSTMENT -214.00 IRV: 12 062204 ALBRIGHT Me CPT: 99233 -25 POS: C}UI INPATIENT SUB SADESKr, G 1.44.00 IBV: 18 1.21004 ALBRIGHT NO DPR' PAYHmT 0.00 IRV: 18 121004 JlJJlIUGHT MIl DI/R AD.roST>lI!NT 0.00 IBV: 18 062504 COLLINS NO CPT: 99231. pos: CRH INPATIENT SuasEQ SADESKY, G 67.00 IHV: 22 062904 JnTECKI llI) CPT: .9232 pos: CJUI INPATIENT SUBSEQ SADESKY, G 94.00 IJIV: 25 123104 RITE~ YO Dn l'AnEIlT -1.6.00 DJV:26 . ~m1T~J~lTE: 01/10/05 PLEASE INDICATE YOUR ACCOUNT NUMBER WHEN CALLING OUR OFFICE: 329815 NEW BAlANCE PAYTHlSAMOUNT COJr.l'IJIUBD SEND INQUIRIES TO: LNlC lIMA PHrS H.;Mr' CENT PEN (888) 613-8944 POBOX 4337 READIRG PA 19606 lU t: 233013255 329875 IAN:: 1M! PHYS ~ C1!Nr PEN P 0 1D'C 4337 RE:Il1J.rN:; PA 1.9606 v1252 N4169 WB12 11M 005 0573 L STATEMENT - o CHECK HERE For Credit Card Payment SHOW AMOUNT $ PAID HERE - (BBB) 673-B944 OFFICE PHONE NUMBER 01/10/05 CLOSING DATE 329B75 YOUR ACCOUNT NUMBER 02 PAGE NO. CONTINUED NEW BALANCE GERALD SADESKY LANC HMA PHYS MGMT CENT PEN POBOX 4337 READING, PA 19606-0037 1...111.1...11..11..,.11,.11..,11."..11.1,..1..11.1.,.11..1,1 NOTE: Charges and payments not appearing on this statement will appear on next month's statement. PLEASE RETURN THIS PORTION WITH PAYMENT CHARGES APPEARING ON THIS STATEMENT ARE NOT INCLUDED ON ANY HOSPITAL BILL OR STATEMENT DATE PROVIDER EXPLANATION OF ACTIVITY PATIENT NAME CHARGES PAYMENTS NAME AND DEBITS AND CREO/IS 052804 COLLINS Me CPT: 99232 !?OS: CRH INPATIENT SUBSEQ SADESKY , G 94.00 IIiV': 4 010705 ~NS MD Dl'lf PAYH;:BT 0.00 D1V: 4 010105 COLLINS Me PEa IllS-NO COVERAGE 0.00 DIV: 4 052904 COLLINS Me CPT: 99232 pos: CRH INPATIENT SUBSEQ SADESKY, G 94.00 DIV: 5 010705 COLLINS Me DPB PAYlIENT 0.00 I:RV: 5 010105'COLLias NO . PER IlIS-HO COVERAGE 0.00 DIV: 5 053004 COLLINS "" CPT: 99231 pas: CRH INPATIENT SUBSEQ SADESKY, G 67.00 II1V: 6 010705 COLLINS "" DR PAntEHT 0.00 IRV: 6 010705 COLLINS ~ PER. INS-NO COVERAGE 0.00 IIIV: 6 ~[~rT"~GE~ATE: 01/10/05 PLEASE JNDlCATE YOUR ACCOUNT NUMBER WHEN CALLING OUR OFFICE: 329815 NEWIlALANCE PAY THIS AMOUNT COIIT1NUED SEND INQUIRIES TO; LANe lIMA PRYS H.;Mr CENT PEN (888) 613-8944 POBOX 4337 READING PA 19606 IRS t: 233013255 010596 329875 Il!l!C lMl PHYS MMl' aiNX PEN P 0 B:1X 4337 ~ PA 1.9605 V1252 N4169 WB12 IIM 005 0"'<: ... STATEMENT - o CHECK HERE For Credit Card Payment SHOW AMOUNT $ PAID HERE (888) 673-8944 OFFICE PHONE NUMBER 01/10/05 CLOSING DATE 329875 YOUR ACCOUNT NUMBER 01 PAGE NO. CONTINUED NEW BALANCE GERALD SADESKY 50 E HIGH ST STE 1 CARLISLE, PA 17013-3036 1,..111...111......11..11...11,11,....11..11..11......11.1.1.1 LANC HMA PHYS MGMT CENT PEN POBOX 4337 READING, PA 19606-0037 1...111,1..,11..11",,11..11,..11,...,11,'.,,1..11,1...11..1.1 NOTE: Charges and payments not appearing on this statement will appear on next month's statement. PLEASE RETURN THIS PORTION WITH PAYMENT CHARGES APPEARING ON THIS STATEMENT ARE NOT INCLUDED ON ANY HOSPITAL BILL OR STATEMENT DATE PROVIDER EXPLANA nON OF ACTIVITY PATIENT NAME CHARGES PAYMENTS NAME AND DEBITS AND CREDITS 052504. .A.'tMUGHT Kl Cl"l': '9223 pos: CRH INPATIENT lNITIAL SADESIC.Y, G 259.00 nov: J. 010705 ALBRIGHT MD _ PAYMENT 0.00 IRV: 1 010705 At.BlUGHT MD l'D. IRS-NO COVERAGE 0.00 I1IV: 1 052604 COLLINS m CPT: 99232 POS: ClUI INPATIENT SUBSEQ SADESKY, G 94.00 INV: 2 010105 COLLINS NO DPR P.AYMENT 0.00 nov: 2 010105COLLIRS NO PEll IRS-HO COVERAGE 0.00 nov: 2 052104 COLLINS NO Cl"l': "232 pos: CRH INPATIENT SUBSEQ SM)ESKY. G 94.00 rRV: 3 010105 COLLINS Me Db I>AYMENT 0.00 nov: 3 010105 COLLINS MD .DR. INS-NO COVERAGE 0.00 1._: 3 8J~1;T~~1TI=: n1 ~1 0 10"'- PLEASE INDICATE YOUR ACCOUNT NUMBER WHEN CALLING OUR OFFICE: 329815 NEW IW.ANCE PAY THIS AMOUNT COJITlRUI:D SEND INQUIRIES TO: LANe HYA PRYS lrI3Ml CENT PEN (888) 673-89'4- POBOX 4331 READING PA 19606 1"" t: 233013255 Ot0439l 04310 SADLER HEALTH CENTER CORP 100 N HANOVER STREET CARLISLE PA 17013 ACCOUNT NUMBER PAGE STATEMENT DATE I 11/04/04 FOR PAYMENT 2229 SADESKY,GERALD SORRY, WE DO NOT ACCEPT I CREDIT 1 CARDS FORWARDING SERVICE REQUESTED . '2STERCARO IZl ~A PAY THIS AMOUNT $ 45.06 $ MAIL PAYMENT TO ADDRESSEE SADLER HEALTH CENTER CORP 100 N HANOVER STREET CARLISLE PA 17013 GERALD SADESKY ::: 50 E HIGH ST STE 1 .. CARLISLE PA 17013-3036 1...111...111......11"11,,,1,1.1,,1,,1,1...1111...11...1.1,,1 1...111...111"""11"11",11,11"...11,,11,,11,,,,,,11.1.1,1 o Please check box if above addressee is incorrect or insurance information has changed, and indicate change(s) on reverse side. STATEMENT OF ACCOUNT PLEASE DETACH AND RETURN TOP PORTION WITH YOUR PAYMENT DATE DDCTDR DESC CHARGE PAYMENTS ADJUST BALANCE 06/10/04 CRIM OFC/OUTPT ElM ESTAB HOD-HI 25 HIN 06/10/04 CRIH COLLECTION VENOUS BLD VENIPUNCTURE 06/10/04 CRIM LAB FEE 06/08/04 CRIM OFC/OUTPT ElM ESTAB MOD-HI 25 MIN 06/18/04 GRIMSTE OFC/OUTPT ElM ESTAB MINOR 10 MIN 06/14/04 KRETZIN COLLECTION VENOUS BLD VENIPUNCTURE 06/14/04 KRETZIN LAB FEE 54.83 -20.00 -39.83 -5.00 4.00 0.00 0.00 4.00 7.53 0.00 0.00 7.53 54.83 0.00 -39.83 15.00 12.00 0.00 0.00 12.00 1.00 0.00 0.00 1.00 10.53 0.00 0.00 10.53 ..."Y" IN INS COLUHN = INSURANCE FILED,"." AFTER BALANCE = PENDING INSURANCE... MAKE CHECKS PAYABLE TO: SADLER HEALTH CENTER CORP CURRENT 0.00 OVER:ID DAYS 0.00 OVER 80 DAYS FOR BILLING INQUIRIES, CALL (717)218-6670 0.00 PAYMENT 12/04/0 DUE DATE PROVIDER! PRACTICE NAME SADLER HEALTH CENTER CORP . AN ASTERISK APPEARS ON ACCOUNT CHARGES FILED FOA INSUAANCE NUMBEA 2221 SADESKY,GERALD STATEMENT DATE 45.06 45.06 OYER 120 DAYS PLEASE PAY THIS AMOUNT TDaNc:.at'":TlnNc:. AI=TI=D TIoII= ,..,1 nc:.INr.. nATI= WII I ADDI=AD nN vnllD NI=YT c:.TaTI=UI=NT ~'" ;tfl' CARusLE REGIONAL p,O, Box 4100 ME D [C ^ L- C E NT E R Carlisle, PA 170134100 ADDRESS SERVICE REQUESTED PATIENT ACCOUNT STATEMENT 007852 8S8HHA 000318L IF PAYING BY CREDIT CARD, FILL OUT BELOW AND SEE REVERSE SIDE CHECK CARD USING FOR PAYMENT . ~ASTERCARD . ~SCOVER IZl ~SA I'~=~ ~ERICAN EXPRESS ~;IIQ.; ,,~~_llA'II!""__ - ~'" ,'~U~5liUD4 'J 9283036 10/1112004 $21.00 MAKE CHECKS PAYABlI5TO: SADESKY, GERALD A 50 E HIGH ST STE 1 ::: CARLISLE <> PA 17013-3036 CARLISLE REGIONAL MEDICAL CENTER 246 PARKER ST. P.O. BOX 4100 CARLISLE PA 17013-4100 111I11I11I11I......11..11,1111I1,1..1111I...1111...11...1..1,1 1..,111...11I......11..11...11.11.....11,,11..11......11,1,1,1 o Please check if above address is incorrect and indicate change on reverse side. TO INSURE PROPER CREDIT, DETACH AND RETURN THIS PORTION IN THE ENCLOSED ENVELOPE. flEDICAID, 'AYflEIO', ' MEDICAID ClflfTRAtNAL ADJUSTMEtU A "aUDit; 05n5/.2u04 INPAtIENT DRCIIlPmiN' SO,5~..'1 ACCOUNT BALANCE DUE $21.00 PAYMENTS AND CHARGES RECEIVED AFTER THE STATEMENT DATE WILL BE REFLECTED DN THE NEXT STATEMENT. ...... '.- .' ;0ir:;;;;";' '::,,',':,':. ; " .', ." _' ';'; . - - ',' " .,' _ . ;;;'r;i~B;amoul1t shaWft~tt1hl ~ iilowlltandlngat t:it:t~. 'l'ou'liltOOipt~wilttle9"'~ ., ~Ied ... .'. " . a . ::,:;> ::2 'h. . FOR BilLING QUESTIONS, PLEASE CAll: (717) 218-8852 "^>" ".", ," "q, , - :JIn"S/28811 I PATIENT ACCOUNT STATEMENT r qCARusLE '-.../0 ~CIONAL P.O. Box 4100 ME 0 J C ^ LeE N T E R Carlisle, PA 17013-4100 ADDRESS SERVICE REQUESTED 007852 858181A 000322R IF PAYING BY CREDIT CARD, FILL OUT BELOW AND SEE REVERSE SIDE CHECK CARD USING FOR PAYMENT . ~ASTERCARD . ~SCOVER ~ ~SA _UtO,. ..!fI'''''I1lllEliT.I'!l1l! ~ouEc -- 9Z84934 lO/is1'2B14 , ";;',' ",'; '" IIMKIi elil~p~$'.AVAB~ TO: CARLISLE REGIONAL MEDICAL CENTER 246 PARKER ST. P.O. BOX 4100 CARLISLE PA 17013-4100 1...11I."11I"""11,,11,11...1.1,,11,,,,,,1111...11...1,,1.1 SADESKY, GERALD A 50 E HIGH ST STE 1 ~ CARLISLE ... PA 17013-3036 1...11I...11I"...,11"11...11,11,,...11,,11,,11......11.1.1.1 o Please check if above address is incorrect and indicate change on reverse side. 10/ll/Z004 TO INSURE PROPER CREDIT, DETACH AND RETURN THIS PORTION IN THE ENCLOSED ENVElOPE. simeSKV. GERlILIJ A DAtE , .'2"~S4 , ,';, ;)::;~~::;;:~;",:"l~>~: 10/04/14 11'04/04 flEDICAtD ,IMlER:' ....' MEnlCAtD COMffA~A~ QJIfSTMEIIT ,,", ,:T;~;""" PAYMENTS AND CHARGES RECEIVED AFTER THE STATEMENT DATE WILL BE REFLECTED ON THE NEXT STATEMENT. FOR BILLING QUESTIONS, PLEASE CALL: (717) 218-8852 - ~: fGll!~2o..l1 MAKE CHECKS PAYABLE TO: JAMES L. HARDESTY MD 816 BELVEDERE STREET CARLISLE, PA 17013 ru '" .Jl ... In & .... .... '" '" '" '" w .... '" .... '" .... 1646B-VB66 RETURN SERVICE REOUESTED STATEMENT DATE PAY THIS AMOUNT ACCT. 1# 11/04/04 $160.00 000551-00 PAGE: 1 of 1 SHOW AMOUNT $ PAID HERE OFFICE PHONE: 717-241-5070 Claim Questions? 717-249-2482 ADDRESSEE: 1",111",111"""11"11",11,11.""11,,11,,1,,,,,,,11,1,1,1 GERALD A SADESKY 50 E HIGH ST STE 1 CARLISLE. PA 17013-3036 100104 REMIT TO: 1",111""11"""1",1",1,.11""11,,,,,,11,,,11,11",11,,1 JAMES L. HARDESTY MD 816 BELVEDERE STREET CARLISLE, PA 17013-4001 1646B-VB66" 1 DDORGG51000031 Please check box if address is incorrect or insurance o information has changed, and indicate changelsl on reverse side. I- PLEASE DETACH AND RETURN TOP PORTION WITH YOUR PAYMENT STATEMENT DATE DR PATIENT 06/19{04 001 Gerald 99ZS2 Inpatient COnsult New Or Est Final Notice: If we do not hear from you within 10 days, this account will be turned over to our collection agency. "Amounts pending with insurance are not included in the balance due. You will be billed once your insurance responds to our claim. ACCT: 000551-00 CURRENT 30-60 DAYS 60-90 DAYS 90-120 DAYS OVER 120 DAYS INS BALANCE 0.00 0.00 0.00 0.00 0.00 PATIENT BALANCE 0.00 0.00 0.00 160.00 0.00 717-241-5070 II II PATIENT DUE II $160.00 II JAMES L. HARDESTY MD 816 BElVEDERE STREET CARLISLE, PA 17013 II II II II 16466-VB66 ", DDORGG51000031 1...111111011111.0111 PO BOX 67533 Harrisburg, PA 17106-7533 CREDIT PLUS COLLECTION SERVICES 2491 PAXTON STREET HARRISBURG, PA 17111 (717)236-3520 OR (800)238-5877 Phone Hrs: 8am-9pm EST M-Th 8am- 8pm EST Fr 8am-5pm EST Sat Office Hrs: 8:30am-5pm EST M-Fr Re: CUMBERLAND GOODWILL FIRB&RBS For: SADESKY, GERALD A Client ID: CG0401902 Acct#: 08606541-MO Return Service Requested 111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 December 9, 2004 GERALD A SADESKY 08606541-MO-121S 50 E HIGH ST STE 1 CARLISLE PA 17013-3036 1",111",111"""\1"11",11,11"",11"11,,11,,,,,,11,1,1,\ AMOUNT DUBS 364.00 THE ACCOUNT LISTED ABOVE HAS BEEN REFERRED TO THIS OFFICE FOR COLLECTION. IT IS TO YOUR BENEFIT TO PAY THIS CLAIM. DO NOT NEGLECT YOUR OBLIGATION ALL PAYMENTS MOST BE MADE DIRECTLY TO THIS OFFICE FOR PROMPT CREDIT TO YOUR ACCOUNT OR CALL 800-238-5877 TO MAKE ARRANGEMENTS. UNLESS YOU NOTIFY THIS OFFICE WITHIN THIRTY-DAYS AFTER RECEIVING THIS NOTICE THAT YOU DISPUTE THE VALIDITY OF THE DEBT OR ANY PORTION THEREOF, THIS OFFICE WILL ASSUME THIS DEBT IS VALID. IF YOU NOTIFY THIS OFFICE IN WRITING WITHIN THIRTY-DAYS FROM RECEIVING THIS NOTICE, THIS OFFICE WILL: OBTAIN VERIFICATION OF THE DEBT OR OBTAIN A COPY OF A JUDGMENT AND MAIL YOU A COPY OF SUCH JUDGMENT OR VERIFICATION. IF YOU REQUEST THIS OFFICE IN WRITING THIRTY-DAYS AFTER RECEIVING THIS NOTICE, THIS OFFICE WILL PROVIDE YOU WITH THE NAME AND ADDRESS OF THE ORIGINAL CREDITOR, IF DIFFERENT FROM THE CURRENT CREDITOR. THIS IS AN ATTEMPT TO COLLECT A DEBT AND ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE. THIS COMMUNICATION IS FROM A DEBT COLLECTOR. Please detach and return this portion of the notice with your payment: If requesting a receipt, please enclose a self addressed stamped envelope. All payments must be made directly to the address below. If your check is returned for insufficient funds or closed account, a $25.00 return check charge will be added to your account. ( ) Enclosed is my payment in full. ) Enclosed is my VISA or MASTERCARD number: Card Number: Name on Card: Expiration Date:_____/_____ Amount to Charge to Card: $ 1IIIIIIIIIIIIIIIIIIIIIrnlfli"w~IIiI~IIIDIlIIm Acct#: 08606541-MO CG0401902 CREDIT PLUS COLLECTION SERVICES PO BOX 67533 HARRISBURG PA 17106-7533 Date Phone: GERALD A SADESKY CUMBERLAND GOODWILL FIRE&RES December 9, 2004 AMOUNT $ 364.00 2-CBH121SLL0008B00350 Guistwite Family Practice 522 S. PITT ST. CARLISLE. PA 17013 TAX 10. #23-2104174 Send Payment To Kenneth R. Gulstwlte, M.D. 522 S. PITT ST. CARLISLE, PA 17013 (717) 243-1516 Statement Date Statement Date 12/01/04 12/01/04 GERALD A. SADESKY C/O LAYDEN SADESKY 664 FOURTH STREET BEAVER PA 15009 Account Number Account Number 3409 (1) 3409 Detach this stub and return with payment. GERALD A. SADESKY ( 3409. ( 3409.0) 07/02/04 NURSING HOME NEW PATIENT L 145.00 07/06/04 Adjustment 0.00 07/06/04 Adjustment 50.22 94.78 07/02/04 07/06/04 NURSING HOME EST PATIENT L 100.00 07/09/04 Adjustment 0.00 07/09/04 Adjustment 32.79 67.21 07/06/04 07/15/04 NURSING FACILITY DISCHARGE 85.00 07/19/04 Adjustment 0.00 07/19/04 Adjustment 31.36 53.64 07/15/04 TOTAL FOR GERALD A. SADESKY 215.63 Totsl Due Current 31 - 60 Days 61 - 90 Days 91 -120 Days Over 120 Days 215.63 0.00 0.00 0.00 94.7 120.85 '\ " ~. 215.63 (:J Please pay this amount! AMS Accounts Man age men t S e r vie e s, In c. A Full-Service Collection Agency . P.O. Box 1618. Reading, PA 19603.800-845-7941.610-375-1604. FAX 610-375-6285 GERALD A SADESKY 37 E NORTH STREET CARLISLE, PA 17013 Date: 11/11/2004 Creditor: CENTRAL PENN MEDICAL GROUP AMOUNT: 260.00 Interest: O.OORate: 0.00 Fees: 0.00 Total Due: 260.00 Account No: 87937-64223 Your account has been listed with us for collection. If paid in full to this office, all collection activity will be stopped immediately. Unless you notify this office within 30 days after receiving this notice that you dispute the validity of this debt or any portion thereof, this office will assume the debt is valid. If you notify this office in writing within 30 days from receiving this notice, this office will obtain verification of the debt or obtain a copy of a judgment and mail you a copy of such judgment or verification. If you request this office in writing within 30 days after receiving this notice, this office will provide you with the name and address of the original creditor, if different from the current creditor. As required by law,you are hereby notified that a negative credit report reflecting or your credit record may be submitted to a credit reporting agency if you fail to fulfill the terms of your credit obligations. This is an attempt to collect a debt, and any information obtained will be used for that purpose. i\.n-rr'~ ~\.'-LL-6.. J 89 J Santa Barbara Drive, # 204 Lancaster. PA 17601 Telephone: 717-519-1770 Toll Free: 888-592-2144 I\uet j\tanageIl1~I't, LLC Gerald Sadesky Ste I 50 E High St Carlisle PA 17013-3036 Account For: CARLISLE HOSPITALISTS Client Account #; 329815 BaJancePl1e: $705.00 MAR 30 2005 Your account(s) with CARLISLE HOSPITALISTS bas been placed for collection. List of accounts: 111_ Clien~ Reference Vi.i~ Da~ BaJ.ance Due SADESKY GERALD A 329615 CARLISLE HOSPITALISTS OS/25/04 105.00 Please contact this office at 717-519-1770 or 888-592-2144 to make suitable arrangements to pay this outstanding balance. This is an attempt to collect a debt and any infonnation obtained will be used for that purpose. Unless you notify this office within 30 days after receiving this notice that you dispute the validity of this debt or any portion thereof, this office will assume this debt is valid. If you notify this office in writing within 30 days after receiving this notice, this office will obtain verification of the debt and mail you a copy of such verification. If you request from this office in writing within 30 days after receiving this notice, we will provide you with the name and address of the original creditor, if different from the current creditor. This conununication is from a debt collector. Please refer to our account number 1463782 when calling or writing about this account. 009457-APEX12415330677439 111.llllumlll.IMIMI.1111 PO Box 7044 LancasterPA 17604-7044 RETURN SERVICE REQUESTED - Plea... _ below and return In the enclosed envelope wllh your payment- If you -. to poy Joy _ 0IIl'd, pIeue _r file nq-..IlDfOlDlllllOP In -PnMded I.... 0 lEI 0 iii 0 III 0 Date: MAR 30 2005 Amount: $705.00 A~: 329875 Conl#:________________ E...-Date: ~_rIze4: S SIpultare: 3 J>lcIt SeearIly Code (b8d<of canI) ___ BlIIlncAddreN: CPMC411463782 1241 LAN Gerald Sadesky Ste1 50 E High St Carlisle PA 17013-3036 1,"11111,11111111111..1111111,1111111111111"11"11"11.1.1.1 Send Payment To: APEX Asset Management. LLC PO Box 7044 Lancaster PA 17604-7044 1.,,111,"1,111111"111111111,111111,1111.1111,1,,1,1,,11,1,,1 PO BOX 67533 Harrisburg, PA 17106-7533 CREDIT PLUS COLLECTION SERVICES 2491 PAXTON STREET HARRISBURG, PA 17111 (717) 236-3520 or (800) 238-5877 Phone Hrs: 8am-9pm EST M-Th 8am- 8pm EST Fr 8am-5pm EST Sat Office Hrs: 8:30am-5pm EST M-Fr (Phone Only) Client ID: 92849341 Return Service Requested ~~~~~~~~oo~@~~~~~~oo~~ May 9, 2005 GERALD A SADESKY 08853523-MO-121 50 E HIGH ST STE 1 CARLISLE PA 17013-3036 '...111...11'......11..11...11.11111..11..11..11......11.1.1.1 AMOUNT DUB$ 584.00 THE ACCOUNT(S) LISTED BELOW HAS BEEN REFERRED TO THIS OFFICE FOR COLLECTION. IT IS TO YOUR BENEFIT TO PAY THIS CLAIM. DO NOT NEGLECT YOUR OBLIGATION. ALL PAYMENTS MUST BE MADE DIRECTLY TO THIS OFFICE FOR PROMPT CREDIT TO YOUR ACCOUNT OR CALL 800-238-5877 TO MAKE ARRANGEMENTS. UNLESS YOU NOTIFY THIS OFFICE WITHIN THIRTY-DAYS AFTER RECEIVING THIS NOTICE THAT YOU DISPUTE THE VALIDITY OF THE DEBT OR ANY PORTION THEREOF,THIS OFFICE WILL ASSUME THIS DEBT IS VALID. IF YOU NOTIFY THIS OFFICE IN WRITING WITHIN THIRTY-DAYS FROM RECEIVING THIS NOTICE, THIS OFFICE WILL: OBTAIN VERIFICATION OF THE DEBT OR OBTAIN A COPY OF A JUDGMENT AND MAIL YOU A COpy OF SUCH JUDGMENT OR VERIFICATION. IF YOU REQUEST THIS OFFICE IN WRITING THIRTY-DAYS AFTER RECEIVING THIS NOTICE, THIS OFFICE WILL PROVIDE YOU WITH THE NAME AND ADDRESS OF THE ORIGINAL CREDITOR, IF DIFFERENT FROM THE CURRENT CREDITOR. THIS IS AN ATTEMPT TO COLLECT A DEBT AND ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE. THIS COMMUNICATION IS FROM A DEBT COLLECTOR. CREDITOR ACCT# 08853523 08853522 AMOUNT DUE ANDORRA RADIOLOGY - CRMC ANDORRA RADIOLOGY - CRMC 49.00 535.00 Total...............> 49.00 535.00 584.00 Please detach and return this portion of the notice with your payment: If requesting a receipt, please enclose a self addressed stamped envelope. All payments must be made directly to the address below. If your check is returned for insufficient funds or closed account, a $25.00 return check charge will be added to your account. ( ) Enclosed is my payment in full. ( ) Enclosed is my VISA or MASTERCARD number: Card Number: Name on Card: Expiration Date:_____/_____ Amount to Charge to Card: $ 1IIIIIIIIIIIIIIIIIIIIIiI~lmimooi~ll_ Acct#: 08853523-MO 92849341 CREDIT PLUS COLLECTION SERVICES PO BOX 67533 HARRISBURG PA 17106-7533 Date Phone: GERALD A SADESKY May 9, 2005 AMOUNT $ 584.00 121 T7006BOQ023 P.O. Box 837 Newtown, CT 06470 Return Service Requested EASTERN ACCOUNT SYSTEM OF CONNECTICUT, INC. New York License #1015456 P.O. Box 837 NewtoWl1, CT 06470 (800) 750-6343 (914) 763-3351 December 20, 2004 PERSONAL & CONFIDENTIAL Sadesky, Gerald 1556194 50 E High St Ste 1 Carlisle, P A 17013-3036 1,"111111 111," '" II, ,II III IJ.lIIIIIIIIIIII..1 1......11,1.1.1 ACCOUNT IDENTIFICATION Creditor #: 364875-5 Creditor: Comeast Harrisburg Service EAS Account Number: 1556194 Balance Due : $15.87 * * * FIRST NOTICE * * * Your account has been placed with this office for collection. To avoid further collection activity, pay it in full. If you can not pay it in full or have a problem, contact our office. * * IMPORTANT * * Unless you notify this office within 30 days after receiving this notice that you dispute the validity of this debt or any portion thereof, this office will assume this debt is valid If you notify this office in writing within 30 days from receiving this notice, this office will: obtain verification of the debt or obtain a copy of a judgment and mail you a copy of such judgment or verification. If you request this office in writing within 30 days after receiving this notice, this office will provide you with the name and address of the original creditor, if different from the current creditor. We are a debt collector. This is an attempt to collect a debt Any information obtained from you or anyone else will be used for that purpose. Office hours are 9am to 5pm EST, Monday - Friday. - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - Detach and Return with Payment- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- Enter the requested information in the spaces provided below:: Change of Address: For: Gerald Sadesky Street Address: Creditor #: 364875-5 Creditor: Comeast Harrisburg Service Notice Date: December 20, 2004 EAS Account Number: 1556194 Balance Due: $15.87 City, State, Zip: Telephone: Amount Enclosed: $ Eastern Account System of Connecticut, Ine. P.O. Box 837 Newtown, CT 06470-0837 11111111111111111111 111111 1I1II11I11II11.I1II1..II.IIIIJ.I.1.1 Enclosing this notice with your payment will expedite credit to your account FIRST 000525A 1 972000050 358 065427 S-CRE COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF REVENUE \-r\0\ r't rr-rf,Q\"'\\:T\ ('kl- \..i'::~)\ NOTICE OF INHERITANCE TAX TAXg,;,lJ\ :":"-< '- "~I'Ptl.AISEMENi, ALLOWANCE OR DISALLOWANCE ,_." ,._ r- " . . . OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP (06-05) BUREAU OF INDIVIDUAL INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 DATE 11-21-2005 ESTATE OF SADESKY GERALD A DATE OF DEATH 07-15-2004 FILE NUMBER 21 04-0719 COUNTY CUMBERLAND ACN 101 APPEAL DATE: 01-20-2006 ( See reverse side under Objections) A.ount Re.1tted[ ~ MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALON. TWIS LINE ... RETAIN LONER PORTION FOR YOUR RECORDS +-- ------------------------------------------------------------------------------------------- REV-l..T EX AFP (03-0.) NOTICE OF INWERITANCE TAX APPRAISENENT. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SAOESKY .ERALD A FILE NO. 21 04-0719 ACN 101 DATE 1l-21-200. 28 \,';1 '3: 04 lU~jS i~'\ ',' PAUL BRADFORD-ORR P B ORR LAW OFFICES 50 E HIGH ST CARLISLE PA 17013 T AX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (schedule A) 2. Stocks and Bonds (schedule B) 3. CloselY Held stock/partnershiP Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. cash/Bank Deposits/Mise. Personal property (schedule E) 6. JointlY owned property (Schedule F) 7. Transfers (Schedule G) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. .00 .00 .00 .00 2.890.24 .00 .00 (8) (1) (2) (3) (4) (5) (6) (7) 2,890.24 2,348.00 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. DebtS/Mortgage Liabilities/Liens (Schedule 1) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/GOVernmental Bequests; Non-elected 9113 Trusts (schedule J) 14. Net Value of Estate subject to Tax (9) (0) 6.708.03- 9.nJ;~ n3 6,165.79- .00 6,165.79- (1) (2) (3) (4) NOTE' If an assass.ant vas issuad .ra.iouslY. linas ". " and/or ". 11. ,. and 19 viII raflact fiouras that includa tha total of ALL returns assessed to data. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at collateral/Class B rate 19. principal Tax Due TAX CRE ITS: PA MENT RECEIP DI COUNT (+) DATE NUMBER INTEREST/PEN PAID (-) OS) .00 X 00 .00 (6) .00 X 045 = .00 (7) .00 X 12 = .00 (8) .00 X 15 = .00 (9)= .00 AMOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) .00 .00 .00 .00 ~ l.t.l C) G:.. t.'__ c:: . " .. e Register of Wills of Cumberland County ST A TUS REPORT UNDER RULE 6.12 Name of Decedent: Gerald A. Sri des k y Date of Death: .I1I1 y 15, 2004 Estate No.: 21 04-0719 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: I. State whether administration of the estate is complete: Yes [jJ No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the perso~presentative file a final account with the Court? Yes 0 No-,,\ b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the perso~presentative interest? Yes)6\ No D c. Copies of receipts, release accounts may be filed with , l t !'\ a I '" C' attached to this report. Date:~ C") If) ~ c.: 0"\ N :::..,. ~:) Lf"'") C';:) = C'I ( Signature PR111 RrRnfnrn Orr, Esql1ire Name 50 ERst High Street. Carlisle Address (717) 258 85')8 Telephone No. Capacity: 0 Personal Representative 6[]: Counsel for personal representative \Jt