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09-02-11
r J REV-1500 ex(ot-,off 1505610148 PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 OFFICIAL USE ONLY Harrisburg, PA 17t2g_ INHERITANCE T count ENTER pECEDENT INF osol AX RETURN y Code Year Social Securi ORMATION RESIDENT File Number tv Number BELOW DECEDENT 21 10 10 8 0 171- 2 8 - Date of Death 4 4 55 MMDDYYYY Date of Birth Decedent's Last Name 0 914 2010 MMDDYYYy KLINGER, SR. 02241935 Suffix Decedent's First Name (If Applicable) Enter Surviving Spouse's Infor Spouse's Last Name DEAN M I mation Below suffix E Spouse's First Name Spouse's Social Security Number _ MI THIS RETURN MUST BE FILED IN FILL IN gppROPR1ATE BOXES BELOVy REGIST pUPLICgTE WITH THE 1. Original Return ER OF WILLS ^ ^ 2• Supplemental Return 4. Limited Estate ^ ^ ^ 4a. Future Interest Com 3. Remainder Return (date of death 6• Decedent Died Testate ^ Prior to 12.13-82~ (Attach C ^ death after 12- Promise (date of ^ opy °f Wdl1 ~. Decedent M 12 82) 5• Federal Estate Tax R 9. Litigation Proceeds Received (Attach Co amtained a living Trust eturn Required ^ Py of Trust) - 8. Total N 1 ~• Spousal Povert umber of Safe De CORRESPONDENT - between 1 y Credit (date of death Posit Boxes Name THIS SECTION MUST 2-31-91 and 1-1-gs ^ 11. Election to tax under Sec. 9113(4 BE COINPLETED, qLL CORRESPONDENCE AND)CONFIDENTIgL TgJt INFO MARK E . (Attach sch. O~ ) HALBRUNER , ESQ . RMgT10N SHOULD sE DIRECTED TO: Daytime Tele h P one Number 717-731-9600 First line of address REGISTElt>~LLS USE~Ly ~~ 1013 MUMMA RD, ~'~ __ Second line of S TE ' 100 ~ -`- address `: i-r_T t , 7 `~, City or Post - -;` _ 'n ---, _. Office - - LEMOYNE J=`t ''~' - State ZIP trpde ~~ t -, DATE FILED ~ ~ Correspondent's e- PA 17043 4 mail address: Under penalties of it is true, peflun'.Ideclarethatl ~HALBRUNER~GATESLAWFIRM•COM correct and have examined this return, includin SIGNATURE OF p °Omplete. Declaration of re ERSON RESP p parer other than the 8 accompanying schedules and statements, TERRY L , ONSIBLE FOR FILIN personal representati ADDRESS KLINGER , A D M R , G RETURN '~ is based on all info and to the best of m rmation of which y knowledge and preparer has an belief, 561 OLD ORCHARD ~ Yknowledge SIGNgrURE OF PREP LANE r/ DATE MARK E . ARER OTHER CAMP ~ ~ HALBRUNER ,hIAN REPRESENTATIVE ~ HILL , ~ ADDRESS ESQ . P A _ 17 p 11 1013 MUMMA ROAD, .~-t, ~~' -> STE • 100 ' _ DAr~ ~. L 1505610148 Side 1 9M4647 4,000 LEMOYNE . FORM n...., PA 17043 1505610148 16 ~ ~;~, ._J REV-1500 EX 1505610248 ~~~~~~~ s rvame: RECAPITULATION Decedent's Social Security Number 1~ 1- 2 8- 4 4 5 5 1 ~ Real Estate (Schedule A) • 2• Stocks and Bonds (Schedule B 1' ).. .......... 3. Closely Held C $o.oa or oration, Partnershi or Sole-P p p 2 ro rietorshi p p(Schedule C). 4• Mortgages and Not 3 $ Q • 0 0 es Receivable (Schedule p) •.. $0.00 4 5. Cash, Bank Deposits and Miscellaneous Person l a Pro ert p Y (Schedule E) 6. Jointly Owned Pr 5 $ o • Q Q o ert P y (Schedule F) ' 7. Inter-Vivos Transfers & Miscella g Requested ^ t a m $22, 097 • 4 7 neous Non -Pro a (Schedule G) ^ 6. e p opeBy Se $ parate Billing Requested 8. Total Gross A 7 Q ' 0 0 ssets (total Lines 1 through 7) ••.... $76,980.48 ... 8 9. Funeral Expenses and Administrative Costs (Schedule H) $99,077 • . 10. Debts of Decedent, Mort a ~ ' 9• 9 ge Liabilities, and Liens (S h .95 $ 6 15 0 c edule I) 11. Total Deductions (total Lines 9 and 10) ~ ~ ~ 10. .3 8 ~ ............ 12. Net Value of Estate (Line 8 min 11. $4,369.97 us Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 12 an election to tax has not be $10 , 520.35 en made (Schedule J) • ...... 14• Net Value S b ~ 1 $88,557.60 u 3. ject to Tax (Line 12 minus Line 13) TAX COMPUTATION $Q • QO -SEE INSTRUCTIONS FOR ~ 15. Amount of Line 14 taxable APPLICABLE 14 at th RAT $ ES e spousal tax rate or 8 8 , 55 7.6 0 , transfers unJ~er Sec. 9118 (a)(1.2) X .0 u 16. Amount of Line 14 t xable at lineal rate X 0 4 ~ $ Q • Q Q 15 . . 17• Amount of Line 14 taxable $88, 557 at sibling rat • 6 Q $0.00 e X .12 16. 18• Amount of Line 14 taxable at collateral r $ o • o Q t $3 ~ 985.09 a e X .15 17. $o.oo 19. TAX DUE 18. $o•ao ....................... $0.00 . 19 . 20. FILL IN THE BOX IF YOU ARE RE $ 3' 9 8 5 • (] 9 QUESTING A REFUND OF AN OVERPAYM ENT L 1505610248 Side 2 9M4648 4.000 1505610248 REV-1500 EX Page 3 Decedent's Complete Address: DECEDENTS NAME KLINGER, SR, STREETADDRESS Tax Payments and Credits: 1 • Tax Due (Page 2 Line 1 g) 2 Credits/Payments A. Prior Payments B. Discount $ 5 , 0 0 0.0 0 3, Interest $ 9 File Number Total Credits (A + B ) 4• If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAY Fill in box on Page 2, Line 20 to request a refund. MENT. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. D80 ZIP (1) $3, 985.09 (z) $5,199.25 (3) _ $0.00 (4) $1,214.16 (5) Make check payable to: REGISTER OF WILLS, AGE PLEASE ANSWER THE FOLLOWING NT. 1 • Did decedent make a transfer and: QUESTIONS BY PLACING AN ~.X., IN THE APpROpRIATE BLOCKS a. retain the use or income of the property transferred; b. retain the ri ht to desi Hate who shall use the ro Yes g 9 ^ c. retain a reversionary interest; or . P Perty transferred or its income; . d. receive the promise for life of either payments, benefits or care?. ^ 2. If death occurred after Dec. 12, 1882 ^ without receiving adequate consideration d decedent transfer ro ~ ^ 3• Did decedent own an "in trust for" or p ~~ within one year of death payable-upon-death bank account or security at his or her death? 4• Did decedent own an individual retirement account, annuit , ^ contains a beneficiary designation? Y or other non-probate ro IF THE p i~ertY. which ANSWER TO ANy OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G ^ For dates of death on or after Jul 1 AND FILE IT 3 percent [72 P.g g 116 Y 1994, and before Jan. 1, 1995, the tax rate im AS PART OF THE RETURN. For dates of death on Posed on the net value of transfers to or for the use of the survivin [72 PS §9116 or after Jan. 1, 1gg5, the tax rate im osed (ii)]. The statute does not exempt a transfer to a survivin filin (a) (1.1 P on the net value of transfers to or for the use of the surv~ ~ g spouse is g a tax return are still applicable even if the surviving spouse is the onl For dates of death on or after Jul 1, 9 spouse from tax, and the statuto re lvln Y 2000: Y beneficiary. 9 spouse is 0 percent • The tax rate im rY quirements for disclosure of posed on the net value of transfers from a assets and adoptive parent or a ste • The tax rate im PParent of the child is 0 deceased child 21 posed on Percent [72 P.$, §9116(a)(1 2 Years of age or younger at death to or for the use of a natural parent, an 72 pS the net value of transfers to or for the use of §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 si decedent's lineal beneficiaries is 4.5 Section 9102, as an individual who has at least one parent in common with the deced Percent, exce t P as noted in bungs is 12 percent [72 P.S, 9116(a)(1.3)]. A sibling is defined, ent, whether by blood or adoption. under 9M4671 2.000 REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA SCHEDULE E INHERITANCE TAX RETURN CASH RESIDENTDECEDEN7 , BANK DEPOSITS ESTATE OF PERSONAL PROpERN ISC. Dean E. Klin er Sr. Include the proceeds of litigation and the date the proceeds FILE NUMBER ITEM All p'Operty jointJy'OWned with 21 10 NUMBER tha rt9ht of survivo were received by the estate. 10 8 0 -shiP must be disclosed on Schedule F. 1 Wachovia VALUE AT DAT Checking Acct OF DEATH . No. 1014128384376 2 Wachovia Certificate of D eposit No $989.92 . 2474023032666 40 3 Graystone Tower Bank Savings Acct. No. 1730002480 $2,195.73 4 1978 Pontiac Catalina (value is sale price) $9098 12 5 Sovereign Bank Certificate of D eposit No $300.00 . 0925282196 6 Susquehanna Bank Savings Acct. No. 246504469 Interest $8,012.79 accrued to 9/14/2010 7 1984 To 0 y to Van $200.90 (value is sale price) $0.01 8 1985 Ch r'1'sler Fifth Avenue (per a r $1 000 g eement of s ale) , .00 $300.00 3W46AD 1,000 TOTAL Also enter on line 5, R (If more space is needed, Insert ~ itU18ti0I1 additional sheets of the same size) $ $22 , 0 97.4 7 REV-1510 EX + Ipg_09) Pennsylvania DEPARTMENTpF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ~CTwT.- _- SCHEDULE G INTER-VIVOS TRANSFERS qND MISC. NON-PROBATE PROPERTY This schedule must be completed and filed if the answer to an FILE NUMBER ITEM DESCRIP770N OF P Y of questions 1 through 4 on 21 10 1080 WCLUJE of NOME OF 7FE TRgrySFEREE, THEIR Ro7Pjp~ TM Q DECEDENT qN0 JMBE h¢ pq~ OF rR~FER qTf page three of the R gCHq COPY OF THE DEED FOR REAL ESigiE. `ATE EV-1500 iS yes. ~ • O_F DEATH o Susquehanna Bank Acct. No. 10005863104 (Account in trust for Jrn) Dean E. Klinger, Interest accrued to I 9/14/2010 2 Susquehanna Acct. Bank No. 333178713 (Account in trust for daughter, Diane L. Klase.) Interest accrued to 9/14/2010 3 Vanguard IRA Acct. No. 0084-09920830351 Owner: Dean E. Klinger Beneficiary; Diane L. Klase 4 MetLife Annuity No. 8200720055 Owner/Annuitant: Dean E, Klinger Beneficiary; Terry I, Klinger /o OF DECD'S $10,058.091100.0000 $2.971100.0000 EXCLUSION 1 ~- 'I`APPLICABLE) T'~ABLE $0.001 $10,058.09 $2.97 $19'784.931100.0000 $10.251100.0000 $0.001 $19,784.93 $10.25 $32'982.731100.0000 $14,141.511100.0000 TOTAL (Also enter on line 7 swasAF z o00 ~ Recapitulation) $ If more space is needed, use additional sheets of paper of the same size. $0.001 $32,982.73 $0.001 $14,141.51 76,980.4 Rev_,s„ Ex. r1o_os> Pennsylvania DEP.4RTMENTOF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ITEM Oecedent's debts must be reported on Schedule I. NUMBER 'q FUNER,q~ FxpENSES: DESCRIPTION ~. Sullivan Funeral Home funeral goods ~ services Total from continuation schedules FILE NU EgMNU R AMOUNT $995.00 $400.00 4 5. 6. 7. 1 2 9W46AG 2.000 B' ADMINIS ~ TRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid; State __~ ZIP 2' Attome F Y ees: 3' Famil y Exemption: (If decedent's address is not the same as claimant's, attach exPlanatio Claimant n.) Street Address City ~~ Relationship of Claimant to Decedent State -_ ZIP _ Probate Fees: --~~ Accountant Fees: Tax Return Preparer Fees; Cumberland Law ,journal Publication fee Patriot-News Publication fee Total from continuation schedules , if more space is needed, use addihbn0 I sh(Also enter on Line 9, Reca Bets of Pitulation) g Paper of the same size, $4,250.00 $75.00 $410,95 $19.43 50.38 Estate of: Dean E. Klinger Sr. Item No. Description Schedule H Part 1 (pays 2) 2 Rev. Dr, Galen Russell, III memorial service 3 Chapel Hill United Church of Christ funeral luncheon 4 Daniel Boone's Memorial Slide Shows photos for memorial service 21 10 10 Amount $200.00 $100.00 $100.00 Total (Carry forward to main schedule) $400.00 Estate of: Dean E. Klinger Sr. 3 U• S• Postal Service postage Schedule H Part 7 (page 2) 21 10 10 $19.43 Total (Carry forward to main schedule) $19.43 REV-7512 EX+ (72-06) Pennsylvania ~P~T~'IE~n OF REVENUE INHERITANCE 7AX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE( MOR GAGE UABIL TEES &TLIENS in er Sr. Report debts incurred b FILE NUMBER y the decedent prior to death that remained iTEM unpaid at the date 21 10 1080 NUMBER of death, including unreimbursed t , medical expenses. East Pennsboro DESCRIPTION Ambulance Service VALUE AT DATE emergency medical trans Inc' ' OF DEATH port 2 Quantum Imagin g medical bill $707.00 3 Pinnacle Health Hos petal m s edical bill $94.65 4 Associated Cardiolo i g sts, p.C medical bill $2,206.00 5 Sate, Gette & p C Diamond Dermatol ogy Assoc $5.49 ., medical bill 6 West Shore EMS emergency medical transport $7.70 7 Pinnacle Health Emergenc medi y cal bill $1.032.34 8 Heri to 9e Medical Goup L , LP medical bill $66.41 9 Moffit Heart & Vascula r Group medical bill $89.53 $160.85 6W46AH 2.000 pitulation) 5 If more space is needed, insert addAona (sheets of the same size 4 369.97 REV-1513 Ek+ (p 1.10) Pennsylvania DEFaRTMENTOF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT STATE OF: SCHEDULE ,1 BENEFICIARIES "viotK NAME AND ADDRESS OF p [ TAXABLE DISTRIBUTIONS [InGude oEnRg O p[ou'sal d s nlbution sanOd~aRfe ~ under Sec. 9116 (a) (1.2).] 1. Terry L. Klinger 561 Old Orchard Lane CAP Hill, PA 17011 IMetLife Annuity No. 92pp720055 Inventory Value: $14,141.51 One Quarter of Residue: $2,894.28 RELATIONSHIP TO DECEDENT Do_ NO~t Trustee(s) Son ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHO I I I I NON-T WN ABOVE ON LINES 15 THROUGH 18 OF REV- AXABLE DISTRIBUTIONS 1500 COVER SHEET, AS gppROPRIATI=. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-T swasAi z o0o ARABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. If more space is needed, use additional sheets of paper of the same size S FILE NUMBER: AMOUNT OR SHARE OF ESTATE $17,035.79 0.00 Estate of: Dean E. Klinger Sr. Schedule J Part 1 (page 2) Item No. Description 2 Diane L. Klase 324 S. Diamond Shamokin, PA 17872-6321 Susquehanna Bank Acct• No. 333178713 (Account in trust for daughter, Diane L. Klase.) Inventory Value: $19,784.93 Accrued: $10 25 Vanguard IRA Acct. No. 0084-09920830351 Inventory Value: $32,982 73 One Quarter of Residue: $2,894.28 3 Tommy L • Hake 230-R Spring Lane Enola, pA 17025 One Quarter of Residue: $2,894.28 4 Dean E. Klinger Jr. 203 State Street, Apt. 1-A Harrisburg, pp, 17101 Susquehanna Bank Acct. No. 10005863104 !Account in trust for son, Dean E. Klinger, Jr.) Inventory Value: $10,058.09 Accrued: $2.97 One Quarter of Residue: $2,894.28 Daughter Daughter Son Relation 21 10 10~ Amount $55,672.19 $2,894.28 $12,955.34 ..- lei \ _,~. LQCAL RE~IS1'~,gR'S C~:RT~IFICATIQ~ WARNING: It is ir[egar to dupricata this co ~~ d~aT~ pY hY photostat or pr,otograph. ee for This cer,ificate. 5(i.r)O P--1804354 C'er,il~ieati~m Numher ~i~his is to certify that the informalion he rorrre[I~' copied from an original Certificai duly filed with me as Loral Registrar. Ti crriificate ~~'ill he torn'arded to the S Records Oft7cc for permanent filing, ~~ Local Registrar e a17'~i(e °I~ EV 11IcV(1g ~N COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH .VITAL RECORDS ,,N,,,,,d CERTIFICATE OF DEATH °ece°em (~. ~. met adr~) (See instructions and exam les on P reveres) Dean E. Klinger Sr. 2. Sax STATE FILE NUMBER 5. ARe ~ BtrormyJ UM« 1 r Under 1 3' S0~ Se~R' Number 7 5 vrs. Maro• ~", "am Mew, e. Dam or elfin ? aro, Ma 1 e 1 71 - 2 8 ,- ~ ~' mr, reeq and emu « Ba. Pboe d Daetli pugr o~ 4 4 5 5 J[( - ~a Bb. Coumy of Drum &. ~f ~, r•P. p oxm Feb 2 4 , 1 9 3 5 K 1 i n Naapiml: // gerstown, pa other: Dauphin ~ Fpm' Name (R not MwtlNtlon, She a6ap and mun6erJ ~ 1` Irquerq ^ ER / OutpsMenl pooh p w,,,. „ Decada,ry,~y Harrisburg g. Wec o ^9 Noma ^ R 16tlpxerR done Harrisburg Hospital (stoG,6yi ~°'? ~~ ^vea ee1D.^ga~ ~t~ack Wlwe~pa Kmdd Wane rr~p ae. Do na ebb t3rM d Bueawesl6Mus6y 1f. U S AtFaaa7 ro ~` 13. Decadence Eduptlon (Spad(y aryl' hlGieat P~rW Rkan, etc.) IgOay~ iB. oeeedprra n e CO ^ Yes No Emmenu~' / teary (0.12) ~` °~~) +4. Menml Stable: Married Nerer Merded, +5. Wh l t e ~re Aadreea (strep, eNY /town. stare r1p code) U )~ (1-q or 5~) Widowed, oNarced (sprsYlyj S~uvNiig Spouse (R wile g6'e maiden name 561 Old Orchard Rd. Aral "` Widower ) 17¢Smm ni oldoecemm +& Fetlur'a Nenu (Prat. mitlde lam. au(fix) 176. Count' C'7+m }. i _ Uve Ina 17c. [] Yea, Decedenl4ved h William Klinger -~" ? 1Td'C}~NO, ~mm use wRhln rwp. 29tt kdamuM's Name (Type /Prim) 19. Mo1MYe Name (Flret mMdla maden aururtte) Actual linRb d Diane L. Klass Magdalena Wetzel ~/B°`° 2I9. Matlpd of obpoeleo„ 5.6n11 enra Maw Ad~ass (Street ri ^ ~ Buml ; ®Creuutlon ^ Darutlon S . r D l amon~ ~`J t~~ ~P ma. Remwel frem stale 216. Dau of Dlep(Monm, day, Yeer) x1c. Placed • ~hamokin, Pd r M dladlw~rtbn «~ AWrodrb Dbposiy«i Memo d ~ pF SeMaa (« ,,,,~~°`"""~'°'"'? ~E7YbpN~Se t 16, 2010 Evans Cremation rory«~deaeJ p 21tl, tomtlon (CR1/ro•n, slate, dp Dods) 22c. Name ppA~ppF Service Leola, pa 23ea «+r w+,.n a 23e. ra RU beet of FD011897_L °~'' Sullivan Funeral Home 0°roh' Gaup d a.•Yaaede p thna «meth ro ^N 4oMedga, deem «uatuedp tle tlnu, deb eM pbca stated (Sipnalure end Xtle) D n 1 P 17025 ,~ x~~ by peraan za. rmb a m zib. uronae Nummr shed (Monts, ~ 2s. m , mr, year) z3c. Dare sf aey, rear) 0 I,,. Ibrri 27. Part I: Emr the CAUSE OF DG.ATX (Sae Inatry•CNgM a ) / O ~. Wes Case Rpeaed ro Metlke' ra~•+M' arrep, «ven6kuhrflbrwalbn~"wMha# ~" ~ ~ m~ ~~ ~ daeMi. DO ~ ^ Yes ~ ~ Ewnlmx / Cumnar tar a Resarxi Olher Run Cremetlon « Dorietlon? aaEOilAiE CAUSE n9 ma etl0l0wY. Lip aMy aru cause on exh Ir~ie anaar bmeul avpm such es cardiac arrest r ((F~~~ r ~0U'^ab 4Merval: Pan II: Erwer oRyr>~nt mrvnxl,., oondllan nWtlrig ,~ deem) deeese « r Cruet to Deem -~ a. 5 " !`~ ~ i bul rpl rewltlng m Rre umm~ymg cause given b Pan L 2R.O Yobe«o Uee Comibub to Dam? Due to « m e ` t ; ~ ^ P ~~an w`~ie~a 6. ( ~~ fl u M6 t No ~Urda~awn Eat UNDERLYMdD CAUSE Due m ~ • Z V (' ~ r ~~ 29. M Fe (deeaee «Ylpuy Rut Ytltle~ ye (« ea a erne a7J; t male: °1°~'~^9 ^ deem) usr. c. r ^ N« L G , ~--•~ ^ PrePtartl wlMb peat year Duero (« as a ~ue0up¢e otJ• ` ' PrePUnt et Rrne of deem d. , Np Pregnant but Pregnern wMhin I2 days 3Ra. wAubpey 306. were ~ p math Avaiepb Prbr m r ~~ ^ Nol Pregnem, drt Pregnam U mye ro + year of DeeMCortbletlm 31. M~~ o~m ~ 32e. Dam al u 7' ^ Nonscitla IM N (MruM, my, Year) 326. Deacrbe Now Iryun Docurad ^ 6elare ream ^ Yea ~ No ^ Yea ~ No ^ Acddent UNOpwri tl pregnant wphln Ru Pap year 33a. Derahr y J ^ SWdm ~ a b ~`~ 32d. rime d input' ^ lYes p WorIC) ,.nap«leaa•, h(ury /y},ayyJ ~ owce Buudr,g, ete(j Fecdory, 327. R T ~Ym- P6Yalciart M. ^ No ^ DMp/DPeraror ~ Paaserpa, ^ Pempden ~~ Locatbn p mlury (Sheet cryr / mwn, emu) • (Pnn pbMno cause p deem °tl"r' sP•ah' . To UM bap «mY trgrAadw.. dudr xeurred due to eayq( aa) ~~rrururr r at M death arts ewriplamd Ilem 23) 33h. Slpnamre aM cab W CertlMr /~ ToP tltabW wm~y by ~ oavrr`w pntM P10A01"~"g deem ens caruryh,gmcwsa o~ -------- ---- f~' - • ~p~ punartYlm pp/«I ~`'dpa antl Pmca, antl dw to tlu a'a•(a)mennsr ae ahmd---------------- y~ unmr r^'•aUWtmn, M my opmlon, mats oecurrod p the time deb, and - - ^ 33c. LkanseN ~ /~ / 33d. m sigwd (M , my, yearG~ 35. arp r Pmce, and due to the auaa(a)and marwMlq ALJ717" Q~ ~ 35 We0 ~- ^ ~~ W Pereon ~abd Ce of Death (Ram T /PAM ~~ ~/D i i T 9~i6~''o o /lob% Ff~'~~~~/1~ ~.~.//~~a n DlepapRan Pemdt No. t~ /V ~ .Y~ ~ / !~ /, fJ'/~.~L/ CERTIFICATE GRANT °f LETTERS of ADIVIINISTRAT10 N COMMONWEALTH OF PENNSYLVANIq COUNTY OF CUMBERLAND SHORT CERTIFICATE 1 ~ GLENDA EARNER STRA SBA UGH Register for the Probate Letters of A °f Wi11s and Granting dmini s tra ti on in and for CUMBERLAND County, da hereb the 29th da Y certi fy that on Y of October, Two Thousand anal Ten, Letters of ADM/N/STRAY/ON in common form were granted by the Register of estate of DEAN E KL/NGER SR said County, on the IFiist, Midd/e, Last/ 1 a to of WORMLEYSBURG BOROUGH a /k,/a DEAN E KL/NGER in said county, deceased, to TERRYL KL/NGER and ./First, Midd/e, Lastl that same has not since been revoked. IN TESTIMONY WHEREOF, seal of said office a t I have hereunto set CARLISLE, mY hand and affixed the Two Thousand and PENNSYLVANIA, this 29th Ten. day of October Fi 1 e No . 2010- 01080 PA Fi 1 e No . 21- 10- 1080 Date of Death 9/14/2010 S . S . # 171-28-4455 G ~ . epuYy NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL PA REV-1500 SCHEDULE E CASH, BANK REPO SITS & MISCELLANEOUS PERSONAL PROPERTY Fax Transmittal 1/25/2011 1:08:06 PM PAGE 1/002 Fax Server ~H[l~Vlt~ Reference ID: 3264202 Wachovia Bank Balance Confirmation Services P O Box 40028 Roanoke, VA 24022 January 25, 2011 GATES HALBRUNER HATCH & GUISE PC ** SUBJECT: Verification / Con~mation of Aooount and Customer: DEAN E ~n°e ~°rnl$tion provided for: KI.INGER SR (SSN# IBC XX-445 Date °f ~tb: September 14, 2010 Visit Account Information A~eo~ T AQDD1°'t Date of Death Ave YPe Nianber rage Balance Dam Motu . mowed M~ 'uY hdeneat _ CERTIFICATE OF ODS~6640 Rate ~~ DEPOSTf 52,195.73 12!31/2007 Dau IrfereatPaid Closed LEGAL TITLE: DEAN E KLIlVGER 50.64 510.20 11/29x1010 CLOSWG BALANCE: 52199.53 CHECKING X74376 5989.92 ------- I.EGALTITLE: DEAN E KIINGER 6/5/19% NA 11129x2010 I-OSING BAfANCE: 5989.92 Pe9e 1 of 2 Fax Transmittal 1/25/2011 1:08:06 PM PAGE' 2/002 Fax Server ~Ht7~i~ No Safe Deposit Box formd far custaaner F Hate ~ death balance duce Omt include aovued interest. Referaioe ID: 3264202 * if date O{dearh oeelrrfs an a weekend Oi 8 bolt day, date of death balance does na[ Include any tranaacticos [haz mere made during that tune pared ~~~~ Diana Sffiton Servicenter Associate Phone~(540)5~3-~~ ~~ BY accepting this information, the recipient thereof rapresentrr and _ We-s Fargo does not The recipient ogees repres®t and warrant that the information is ~~' unkas ~ to do so by leg ~~' that the recipient is authorized by the customer to receive and We17s Fargo. The info cemplate and aceurate. The recipient fwtlrar ' and that it wi- lawfu-y use this information the lawfiilly this infamatioa. maation is subjad to change without entice to the ~o~~s drat the info recipient acknowledges that disclosure and use of the information by the recipient or from the breach recrp~ent The recipient agrees to indermit'y, de ~n ~' not d~loae the entire relationship ~ by the racrpiant of a~ mod. and hold We-s ~r® haRnky from and aBreermant, reprmattatioq or waranty contained ~'Q anY claim rmuhiog from the W~wia Bank and Wachovia Bank of Delaware are divisions of We11a Fargo Bank, N.A Page 2 of 2 Jan, 20. 2011 4:35PM GRAVSTONE TOWER BANK No, 0369 P, 1 VIA FACIMILE January 20, 2011 Tracie L. Sepkovic, Paralegal Gates, Halbruner, Hatch & Guise, P.C. x-013 Mumma Road, Suite 100 Lemoyne, PA 17043 RE: Estate ~of Dean E. Klinger, Deceased Soaal Security Number: 17T-28.4455 Date of Death: September 14, 2f11a Dear Ms. SepkoviG: Please be advised the above held one account with Graystone Tower Bank. Please see below for additional information. Graystone Statement Savings, Accou~ No. 1730002480 Individually Owned, No Beneficiaries. Date of Death Value: $9,098.12 (Current Value: $9093.17+AcGrued Interest: $4.95) Account Opened: October 7, 2D08 Should you have any questions, please contact me at 717-728-2619, Thank you. - ---. Deposit Operations Analyst Fax (717)2324603 January 10, 2011 GATES,HALBRUNER,HATCH & GUISE ATTN: TRACI L. SEPKOVIC 1013 MUMMA RD SUITE 100 LEMOYNE, PA 17043 ~: Dean E. Klinger, Sr. Estate DOD: 09/14/10 SS#; XXX_XX_4455 Sus u~f~~n .~ ~' ~u Susquehanna Bancshares, Inc. 26 North Cedar Street P.O. Box 1000 Lititz, PA 17543-7000 Te11.800.311.3182 Fax 717.625.4478 To Whom 1t May Concern: In response to your letter of January 5, 2011, here is the above customer account information as of September 14, 2010. • Account Title • Account Type/# • Date Opened /Maturity Account # 1 Dean E. Klinger Account #2 Dean E Klinger Revoc. Totten Trust CD/333178713 3/24/06 / 9/24/11 opened as titled .90% 19, 784.93 10.25 127.97 Account #3 Dean E Klinger ITF Dean Klinger Jr. CD/10005863104 ] 0/2/08 / 10/2/11 opened as titled .90% 10,058.09 2.97 100.10 Svg/246504469 3/10/06 • Interest Rate: .10% • Account Balance*: 200.90 • Accrued Interest: .O1 • YTD Interest: 12 *Account balance does not include accrued interest. ® There is no safe deposit box in the name of the decedent. ^ There is a safe deposit box # 0 in the name of the decedent located at the branch Beneficiary for CD #333178713 is Diane Klace. name. If I can be of further assistance, please feel free to call. Sincerely, Dawn M Bernier Deposit Research -Reporting Department Lead 1-717-625-6546 DMB/LJR C A T Er Q F. '~ F~?~2' _ ,~ ~ A pDnfA'; M IlE a ~k`i ~,*'~ ~ ~': : -~. ~~,,,-, , ~~s~- yN ~ T~ri~ o-= 9Y •: ; ,em . '.. AUTHORFZEp REPRESENTATIVE ~- SE'CONtl`WEN RELEASED IdAIL1N(iADDRE88 ~ :.:.3 - DATE. . 9V: - ' .. AUTHORI2Etl REPREBENiATIVE ,. - DEAN.E KLINGER - S61 OCD ORCHARD LN ~ ~ ~; CAnP HILL PA 1707,1 ~ ' pennsyivania DEPARTMENT OF TRANSPRgTATI t. _ _.-. .~ ... .. ~. ~ ~r, ~ ~ - . ~ F «~-. a e.. _d.t. ~ ~.. ~» t o<-~. _ ~ ~ ALLEN D °~ 7Yelwponatlon reflect that the Pareon(e) or company named ~ ~ - ..,~,. .. IEHLER ~ l of Temaportdtbn a iea•a..~.>•~~~^.i:1PU~Ali1t~~11~Q~~i~~1~~~ ~ 1 nal aasr a ~ ~~ UBSCRIBm AND S woRN ~ A oo~tlrAlee9r other N1an Your ePouee ie Asted end ~E' p`~, ~: ,~ra~w-„ . ,x. .~ ~.,.. ~ be Hated erst.tr~iad 7 ..ewa..._.. ........ _ .You WBtIt the ikle r ~ < r »~~ ,~a ~ ,~~..; ,~ i ~~ ~ ~ ~M7.FerMlkewNf361tl~'irr. ~~~ '~' ~BlCiN.4T(~AE OF ~ CAN[ 9n A.~IryE`jgIZEO SW NF3j /'~ W 18T UEryN NANCIA41N8 ON NUMB ~, ~. '-~+'''-. 1 F as IF •u!n~.In~~w~ LI ~{~CK Q IB'i SAN, -_. ]~-. ,N'~iirz~.. 2~~ ~MT'7 ~F ~Q~iF.W REC]I IIGFn1 vcc.Cl .v.l'~ ~~~ STRf CITY STATE LP ~~ ~~m (TYPE OR PRINT) Certificate of Title must be submitted within 20'days, unless the purchaser is a registered dealer holding the vehicle for WARNING FEDERAL AND STATE LAWS REQUIRE THAT U STATE THE MILEAGE IN CONNECTION WITH THE TRANSFER OF OWNERSHIP. FAI TO COMPLETE OR PROVIDING A FALSE STA MENT MAY RESULT IN FINES OR IMPRISONMENT. Mplcund dWxe mua cnmPlets romp MVZ7A w M 79 LAST ASSIGNMENT OF TITLE .. r., l,w py l.,,. upurd~, ~t~oT. nplMend deilsr FlRST MIDDLE N t•! ~ I 11 tl•~lo Host w_mrrrited s wa. -- PURCHA32ki OR FJP1. ~~~~ 8 r kr1 e tl ter readfnQ Ef041N. v~Uf" y J~ Oren qgc CAP rrH~ge~ ._. ~ . 1 ~ °~ ~ r ~tual leage iha6 h pfe ~ _ _ " f~ a '~,^ ''~ ~~SfBEErr - ~ ,a ~ ~ ~ ~~ ~ u ~~, abC9eeS f'nd r ~ ~, OT r,e e tr sl nHnaPa ~._ __ _ v Yr ,. _ xcesa I ~ ~ I„6 ARNING: OC(orpef r]ecrgpa t~J ~ CR "~. UWB ~ r certNy that Ids la h 'of eny a rents and that the awn ~r•;r. ; ~p r ~Lry ~ ~ -'-- - - tten9(eRed to ItIB (1afaOft B a the deaYBr Aeiatl. f ~.. ,. F ~P ASE PP - ~ G~1 L N * } ~- Mo on ',`~ ~ A ~ ~ ~ ~"~ I Y Y f~FC>r~~~i+n~~.e a 4 ~ ,. ;'r2~ .; -^~~' ~aFePSf~nswak,iis ra'+ooA Y ~i~ ~` ~ ~ J - ~ ~ ~ URC RAN ~ Ftl, "~ ER 91G __~~ T CO-PURCHASER MUST x ~^ "~°Yx ~ 'T - a irter; 6ELLER $ fA ~ HA~PR NR NAME HERE ` TKO ~f' ZP Ma beet 9lwtllY/eut Mat reedln9 b ~ ~, •r ~~ - _. - - ~M ~y. ~, MID ra of 1}I9~vehl~ t ~ ~ f -OR F~ '~' ~ . RNIMICi~ ~ ac et a ~ f .~` '_- ~ and thet I y ita11 0 frlB FIe d d. ~.. R~ ', ~. ellr®' .. r ~ ... 'CITY - e EF MAN RN ~ __ - DA TE ZIPr :. ~ " UpPSE P~( R :.. ~ a 4J fi, 1: INO RC+t R ',GNATUR6 } t ~ t ~MM' `.(i. RC R PU E x ~`f~ ~ ~~' `~~ - ~. Y fit', ,r'~ ~°~_ f/~. ; ~, ~t~r..: d~' °r••.." <Y~~ R MAME'kER'L f . • ~ ~ _ • ~ . !!~a cefdN,.la Me bMS,pI„b7,y~our Imo pe Mar n,Mx,satlirry ie ~ ~ - - - - _ NtH ~. k ~ t t~ ~}~ LAST F MIDD - an ual mi~pe d 1ho-;ehi~B ~'t t. - WRa-rASEFrOR Ye Rr t ~N~NAME~ `€ _ I OT thIA' ~ 'cRTUHf~lA4Ea- ~ _ RNINO ` d ~ F"-`- s _ ~ d entl that {ship r # ORf ~ ~~ b , C D RN RN ~ EF M ~'.. DA TE ziP ~?t ,L lttFf~. EP~(~ ~: ~:~s ` J k „J .. ., 5 A, to ~ +~~ L~((~ ,. y.. ~ _ . ~~ t . ~` ~ +.' ;~ ~,,4. y W c ~ P iHCH4' R Sl r dT inv ^c f ~+,IFF • RCH ~ PAN ~~ ~ ~ ~ 75 ~„ -. f' ~ ~FURO E its.-. ` ~~~ i~ I' .~ 1 l i h '.~T Q f x~ 7 ~~ .'.~A , J .._. (A ~ ~ ~ ~ ~'' ~ . - t - ~.." - - ~ ~" HANDP NAME HP}~ ~ a ~ a ~ ~& DIY -~ tlra beet 4tt!7!kur krlowtedpe Mat Me odorrleter rearing ~ - ~ - - _ _ .. LAS .. w; e ~ ~i tlia ~" FlR MIDDLE re efg~ tehl~ jar ~ ~ R ~£ 4 T NAME ~"; 9e Pt a- r~ i AME. ~_ ~ ~, ~ !t ~' Y aCO-HJF74~k8ER ~ . ~ RNIN(3~+JdomRARR~ _- ~~, ~ ~~ othe~ ~ ~ ~ end tha[ihe [*lwrernhip ~~~ ~pp~,'' ~`£ Pa Ue ed. w ~n ` cm S CRI DAN RN EF M , ,. z+- ±. ~ _~ ~,~, DA 4~ '~ ZIP Rrril1h°iE NICE ~ Tua~ ~vEa~mrtkr~aiNO ~ ~ rM a~ ~"~ ~, 3 t icrrasER sraruAn. ,. - y W ~9r o +~~k':u~ ~'' rW ~ueFu',W~~n~ ~ . w 4~ ., ~ ^~ y~±' i C6P ACNASER 10 ~~`~~ S ~~ ~- RURCHA ER ANB/pR y o c ~, ~ ~ROHASER MUST ~ ,..Ir,J r~ny r~,. ~~~ ~~-~VFe,. ~ 1'- ~~ ~ ~ ~ TLd ~ OF I iM, a i~i~~" ~ ~j9. L ~~ ~ r SELLER MUST ~I '~ n ~- J~u"" ~,~+~B~IIpfaAd~IFtA HANOPHI~ME~.CU HnTREt~VutWtBFEi~R~x.ILT,L{II~CZ.EEES'S Y ~^ ~ ~- No. ~~~-~~~~ ~'I. ~' A PATn1E NUMBER (AS SHOWN( O r W w v VEI >> a B. o: LAS w J rW C0. z f b .W "•~/ snnrcc ut vEMI(:LE MODEL YEAR -. - __ -. _. --q--: ~ ~-- IC (-,. ~ `7 ~ (~ ~ ~'~ ~ ~-' PURCHASE PRICE (See Nde on Reverse) _ ~ _/ ~ r~l CONDITION ! ~ - - _.._-.- - t, j , f ~ L D GOOD ~ FAIR D POOR ~~ TRADEaN 7 ~ FIRST NAME MIDDLE NAME - - --- TAXABLE AMOUNT ~ -_ _. J ~ : j ~, 1. SALES TAX DUE _ 7R57 NAME MIDDLE NAME PA DLIPHOTO Ip8 DATE OF BERTH t ~ OR BUS. ID# r X 6% (.OB) OR X 7% (.07) * (S~ Nde on Reverse}. ~+. '°' E~ -[~.~'.[~ ~7 i~. ~ .1 1A EXEMPTION - - _ -- ~ W CO-PURCHASER LAST NAME FIRST NAME MIDDLE NAME PA DUPHOTO IDA DATF;yOF BIRTH ~ REASON CODE (must be a number from 1 to a t w 29oro x ~ _ 1B. FIRST _ -_ TB. SECOND a r COUNTY CODE E ~ ASSIGNMENT 4 ~ pN O. EXEM NO. Y CITY STA - ~ ZIP CODE DATE ACQUIRED/ . 2 TITLE FEE o.;~ `' ~'~ • ~~~ PURCHASED ~ REFER TO COUNTY COPES _ _ ?= ~-~'~J ~ .. .., ) L,~_..-~,~ t ~ ~ ~ USTOJGONREVERSESIDE -- - - . .. , ~ ~ f ) Z : , U . ,_%.. ! OF YELLOW COPY 3 L D I AST NAME (OR FULL BUSINESS NA'.AAE) FRST NAME MIDDLE NAME PA DLIPHOTO I OR BUS I D# DATE OF BIRTH . IEN FEE . D# -- -- -- - 4. REGISTRATION OR ~, ~"~~, _ ~ W O~PURCMASER LAST NAME FIRST NAME MIDDLE NAME pA DLlPHOTO IDO DATE OF BIRTH PROCESSINCa FEE ~ ~ /) ~ r z ~ FEE EXEMPT NUMBER ' ~~- - - - - b U AS ASSIGNEE BYTHE ~ STREET COUNTY CODE DEPARTMENT a o. - - - ~ n ~ r ~ 5. DUPLICATE REG. FEE NO. QF CARDS CITI' STATE ZIP CODE DA TE ACQUIRED/ - - -- PURCHASED REFER TO COUNTY CODES LISTING ON REVERSE SIDE 0 TRANSFER FEE OF YELLOW COPY E MAKE OF VEHICLE VEHICLE IDENRFICATION Nl1MBER -- - - - wp 7. M-CREASE FEE J VO QS MODEL YEAR BODY TYPE (CP, TK ETC.) CONDITION _ _ _ B. REPLACEMENT FEE D GOOD D FAIR D POOR F' D PLATE TO BE ISSUED BY D TRANSFER OF PREVIOUSLY ISSUED PLATE TOTAL PAID (ADD 1 THRU 8) 9• -_ - -70. DEPARTMENT (PROOF OF D TRANSFER 8 RENEWAL OF PLATE INSURANCE MUST BE D TRANSFER 6 REPLACEMENT OF PLATE 1!. GRAND TOTAL ~p OptE CHECK IN } -.ry ATTACHED.) D TRANSFER OF PLATE 8 REPLACEMENT ~ STICKER (ADD 9 8 !O) , D EXCHANGE PLATE TO 8E - THIS AMOUNT ~ ' ~ ISSUED BY DEPARTMENT PLATE NO. REASON FOR REPLACMENT __ - ~ - - . D TEMPORARY PLATE ISSUED EXPIRES M nth D LOST O DEFACED D STOLEN D NEVER RECENED (Lost in LL' z BY FULL AGENT o Year NOTE: N `NEVER RECENED` bbdc is dredced, applicam moat COmpbfe Form MV~4. C ~ TRANSFERRED FROM TITLE NO. i= U ~ SIGNATURE OF PERSON FROM WHOM, ~GN HERE a w TEMP. PLATE NO. PLATE IS BEING TRANSFERRED {IF ~ OTHER THAN APPUCAN7) TO 1 CERTIFY TNAT ON MONTH -- uwrc DAY YEAR ISSUING AGEM (PRINT NAME) AGENT NO. - -- - - - ISSUING I HAVE CHECKED TO DETERMINE THATTHE VEHICLEIS INSUREDAND AGENT ISSUED TEMPORARY REGISTRATION 70 THE ABOVE APPLICANT, IN INFORMATION COMPLIANCE WITH ALLAPPLICABLE PROVISIONS OF THE VEHICLE ISSUING AGENT SIGNATURE TELEPHONE NO. CODE AND DEPARTMENT REGUUITIONS. ( ) G' I/VPE CERTIFY THAT I)YVE HAVE EXAMINED AND SIGNED THIS FORM AFTER ITS COMPLE710N AND THAT THE INFOfiMAT10N GIVEN IS TRUE AND CORRECT IF ANY EXEMPTION tS CUUME THE PURCHASER FURTHER CERTIFIES THAT HE/SHE LS AUTHORIZED TO CLAIM THIS EXEMPTION- I/VIIE ACKNOWLEDGE THAT WYE MAY LOSE MYlOUR OPERATING PRMLEGES(S} OR V REGISTRATION(S) FOR FAILURE TO MAINTAIN FINANCIAL RESPONSIBILITY ON THE CURRENTLY REGISTERED VEHICLE FOR THE PERIOD OF REGISTRATION. 1)WE ACKNOWLEDGE THAT ~ MAYBE SUBJECT TO A FINE NOT EXCEEDING 55,000 AND IMPRISOI{MENi OF NOT MORE THAN TWO YEARS FOR ANY FALSE STATEMENT THAT INVE MAIa= ON THIS FORM. Sipnaarre of Fa& Purelresa LL AIgSIGN_ "` ~' =-CA_ ~---~i~ :~s_"~.~ 1 Telephone No. W MEN7 of Co-Purtltaaer otAuygrized S~gr ( ) v 2ND - SigrmWro of Seoorxi Pwdtaser of Authorized Signer Teephone No. - _ _ - ASSIGN- MENT same ( ) H. ~ z NOTE: IF A CO-PURCHASER OTHER THAN YOUR SPOUSE IS LISTED AND VOU WANT THE TITLE TO BE LISTED AS `JOINT TENANTS WITH WGyT OF SURVNORSHIP' (ON DEATH OF Or G w < OWNER, TITLE GOES TO SURVMNG OWNER.) CHECK HERE O. OTHERYVISE, THE TITLE WILL BE ISSUED As 'TENANTS IN COMMON' (ON DEATH OF ONE OWNER, INTEREST OF DES ~ f ~ OWNER GOES TO HISMER HEIRS OR ESTATE-) Z NOTE: IF THE VEHICLE IS TO BE USED AS A DAILY RENTAL OR LEASED VEHICLE, CHECK THIS BLOCK O. IF BLOCK IS CHECKED, COMPLETE AND ATTACH FORM MV-1 L. MESSENGER NO.c - - - -- - -- - - - 2. DEALER /ISSUING AGENT -- C ~`f' E< O F. '~' l.'~' L E FORA }/ ~ F1-1~,C ~.;~E: -,. ~:° p -~~` ~~. - - -- taieeu AND SWpRN ~ H a co-pu~Chesar other then _ - - your spouse is fleted e(M you want the 111 ~~ ,,. , : --..'» jm» ~y>,~, be Ind a8~IUIM Tenants. „YYith RIaM of Su[yiwrah[o• (on dmH,, .u . to is - ,~~ ~sr'~r(Hp ~ - ~ ~ ! ~~ ~s~ ~ , is ~ r t . _~ ~ -~ r i, ~~~~ l ~ ~ ~ ~~i: t ~' r - t ~~ t :. r„ O $~~ ~T+;~. ab,,.. a r ~r~ , d T'M w ti MfM~ororylE • . IF t~,~D I.I W ~ acy ~ _ k.µ r»,~ ~_-;, 2NG"i.IEN ~ N ~ ~:ti ~ ~ „~ x ~ ,' ;'UAE oF,N'FtJCNR'~14~tt~'J~gtVffp BIeNEH W .. STREET a ~ f 4TRTE m'~a~~y..„ ^ IS'~yS AN . M ~~F cm STATE LP (TYPE OR PRINT) Certificate of Title must be submitted within 20 days, unless the purchaser is a registered dealer holding the vehicle f~ W~ Q N ~ ~~ ~ FEDERAL AND STATE LAWS REQUIRE THAT YOU STATE THE MILEAGE IN CONNECTION WITH ruF Taeuccco nc....•.~rs..•..:~ -- 0 - - •- -- • --• • - • • • • •~^•~ ^ • ^~~~ ~ • •• 14. ASSIGNMENT OF TITLE ~ tl ir.ywsd 0~y Wei M~~m~~ ~~ MVT/A W MV27B qucheaer b NOT a raeMared dealer, r rrv nrvca vn IMPHISUNMEN7 LAST FlRST ~-- - - MIDDLE d Mb bm, ba d ,.,...,`` oL~r I . • i ""£ ~'IB I'/`tI~A^I"uu IVlgrie $B M6rf~q•od,fe1 readinfl 19 ;~ . ~ ++ PURCHASER OR Fl1LL -BUSINESS"NAME ~ - t~ - T. ; • . lE . ~+I - +-~: ~"fiHeE and r+'~Cte vry ual mile e f tt hld V "- ~ ~ CO•PURCHASER ~ - t ~ o 19 e e, afl ?*-+Ti ~~ F'*`~T 19be ~1y s ,heaFed Z !~' •" ~ tI~ y ~ 4Pl ~ i u~ 'STREET ADDRESS 1Ty - oBes ;anlcal l~p~ ml+ r WAR ING ecerdlscrepan INye V~'w4r certtty that hide la trod of I,r , dn;~lm Nance and that the ownerehlP le her ~ cy - eby I -- - ~ " -• +s~' tfef$tfi(+=J ~'~ NLq pard]n(b) Or the dealer lbtE+d. '' TATS Zlp PvRCHAJt PRIDE -- OscRt~v syvoRN ~~-oti „~l1~ll~~) -~---,,,- - - EFQI ~ l - OR DIN ,z .." FEM -B "- `~tlti I a l + - - GAV- Fes ~ • ~~ ° ~ PURCHASER SIGNATURE _ .. _ ,„ `[-. 1 „~_ '{. • ' T R " - & ~ ~._ I?ERh~N+~Df~INIGTERIN 3 •% ~R+:n OAY~" . ~ h . _" ~ _ - C0.PURCHASER SIGNATURE. ~ , ,PURCHASER AND70R C ~P pRCHASER MUST ERE - ~_ ~_ _ ~ ~ f P F F - a- I~i.l ~ Q .;. ~ slclwn~eoFCo- (E~r~ - ' f~,'G~§, -- ~ CO.3~ELLEAR MU9T ~ HANDPRINT NAME HERE ~ . • e B e -, - • Bilii UWe certlly, to the best lour Wgwledge 7lat the odometer leadlrp h •...rvA.o...,.... ru .•.. ~~MHe ° ~ ~m ~ mUeape al thhlN~ e dpi ~ ~; P - LAST PSIRCHASEROR FUEL Bl/81NESS NAME -- --- _- - - -- - - s. FIRST - "~ t "e "'+ - - MIDDLE ; . ~ r the aausl inl NING~ d C0.PURCHA9ER ~~ t ^ Q ortleteepanc ~ ~ . ~ e E end that the ownership le here y by A~DDEFt 86 ~ ~F ~ ~ ~~ rb~ S SCRIB DAN o1NORN CITY "'~"'F,~~ '~ ~[- d EF M ra ,KT 15..,! 4U. ~' #I ~JI%« r, TE ~ m ~'"";' nR _ PURCHASE PF{f7:E _ DH ~ `I aR DIN ~'B ~"~ _ ". '""~u'"w I rr ~' ,~w x- z " I,~i F T °" F.~E A()/,11t) RiN30 r%W'~ ~.~p~ ~' ~I ! *~y~~~ Pl1R SER SIGNJI '~ ; - - ILLLLLII ~~~~ ~~~tln ~ u ge,>5~~~'~lil "'s, _ ~rt >i - ;. ~ - -, ~ `- P RCHASBR ANLV~D F pRCHASER MU ~ ,~ I~''~~ ~~~ , I~ h , i ~ • ~ - r gELLER ~yjg HA ' ~ k aF 1~ _ ~" NDPR/ry1 NAME HERE "W, ~ ~ ~ . • . - e e . a e erg WlCtvledpe 71st bn„ /our odometer reeNnfl N ". .eene ~ ~~ _ - _-4 AST _ __ _ -_--- _- -_ , i ~„~ ~. - _ ......?.. ...,. ,. .•. ~.~ ,.•. ~ .e,,...,.. ' , i mllenge of the RWIrIC(e, a . - •'p. } SUBINE9S. ~ ENLL FI V" ~ • ~ F ;ir:r µ, T MID fir" T tne{swal mttg NING 1%OmetlY dre g~gh ~ 'C4RJRCFUCSER 1~~`n4, ~) . a cy ~~!' e b end that•tlgownereNrp le"hereb y ~ gq , + SCR DAN E ORN EF ME 4 ~• ~ ", 4~ CRY M. k , _ ' DA ~ A. ZIP PV~ASE PRK~' pR O1N• ~ ~~ ~"3~ !~ F •` ~ ~ ~~ y ~ f 'b` PE• F E I` ~ RING ~ ~ A ~ N . ~ P ~~ J ~ k E~ , P I R T ~~. Q ~t x - ~ R CCkPU ST H I ..NE . ro~ ~ ~~ h14q~ ~ ~ ' ~~~ ~ ~ a ~ . . rx. u ~ a i. ki J.;. ~ ~ ~ I ~ . , ~ ~ OF .. ~ , USN ~ HA ~ Snr.r;'{ ~l ~ h ~ ~ ! NA~ HERE I u... ~ • ~ ~ • r - mo vvre csmry. ro•me beat. ot. mY/our blowle7ge mat the odaneter reetBnp M -_ - LAST FI M TFN7H :: 41N kl m „ ., A RST~ IODIXEy.,,.a~„ ~;~~ ~ rtn arr~'~roMddlSi ~V~,II rnNeapa or the venlcik, ruRCwwEavR ~u T ~ u _,,y~.~~~~ ~i 'o ~' '. BUSINE83 NAME ,. ,•. ,,~ r!P ~ ~ It1~OT the ectudl ml a CO'L~JR~aSER ~ - ~ fb ~ >dealYf~ ed. ~y~~~,~,~~~ NINGr OUOmeterdfsc &7AE~ ~ '. ~ ~ _-a ~ Ie enNA.MwirNtaNCe etld ihel t[re ownereNp IsherBby ADDRESS ~ [ ~. the penbP ~ rq, - . CITY - _ . +:': Y 6:" - i SCRI~D AND SWpRN ,. ;~ ~'~~ EF ME„~ .' zw - _ t •- MO ~ DAY Y AR• ~ rS"rATE t R 41RCHASE PEALS . ,:,, IGNATUREOFPER"ON INI TERING OAYHe PIiRCWASER SIGNATURE - ~ s ~ ~ y - . S ~ D C.O-PUR R IGNATU - PURCHASER ANDrDR - A~NDPU H! NAMM~E~•R '~~° ^ h a ' { ... G- ~,~ ,. ~ ~ ~ 91GNATURE OF fiR ~ `•, .~~.~ ~~ .. .- ~ SELLER MUST . e ' - ~ HANDPRINT NAME HERE - m.~ ~~I ~'U,iFi ____._ - -Inurnv urnr rr wnel /n wTV~u CAO 11Cw1 CC_TITI F AW~1 /V1fiaD1 CTC CCPT1nu n rrrr .e.w ~~~.. PA REV-1500 SCHEDULE G INTER-VIVOS TRANSFERS and MISCELLANEOUS NON-PROBATE PROPERTY January 10, 2011 GATES,HALBRUNER,HATCH & GUISE ATTN: TRACI L. SEPKOVIC 1013 MUMMA RD SUITE 100 LEMOYNE, PA 17043 RE: Dean E. Klinger, Sr. Estate DOD: 09/14/10 SS#: XXX-XX-4455 _~_ SC~'SCG~ L1€'~I ~l ~l f?t~t .-'"~ Susquehanna Bancshares, Inc. 26 North Cedar Street P.O. Box 1000 Lititz, PA 17543-7000 Tel 1.800.311.3182 Fax 717.625.4478 To Whom It May Concern: In response to your letter of January 5, 2011, here is the above customer account information as of September 14, 2010. • Account Title: • Account Type/# • Date Opened /Maturity Account # 1 Dean E. Klinger Account #2 Dean E Klinger Revoc. Totten Trust CD/333178713 3/24/06 / 9/24/11 opened as titled .90% 19,784.93 lu.2s 127.97 Account #3 Dean E Klinger ITF Dean Klinger Jr. CD/10005863104 10/2/08 / 10/2/11 opened as titled .90% 10,058.09 2.97 100.10 Svg/246504469 3/10/06 • Interest Rate: .10% • Account Balance*: 200.90 • Accrued Interest: .O1 • YTD Interest: .12 *Account balance does not include accrued interest. ® There is no safe deposit box in the name of the decedent. ^ There is a safe deposit box # 0 in the name of the decedent located at the branch name. Beneficiary for CD #333178713 is Diane Klace. Vanguar February 3, 2011 TRACT L SEPKOVIC GATES HALBRUNER HATCH & GUISE PC 1013 MUMMA RD STE 100 LEMOYNE PA 17043 Re: Estate of Dean E. Klinger Dear Ms. Sepkovic: P.O. Box 2600 Valley Forge, PA 19482-2600 www.vanguard.com We are responding to the letter we received requesting a valuation of Dean E. Klinger's Vanguard account as of September 14, 2010. The information requested is included on the enclosed account value report. If you have any questions, please call us at 800-662-2739. You can reach us on business days from 8 a.m. to 10 p.m. and on Saturdays from 9 a.m. to 4 p.m., Eastern time. Sincerely, Retail Investor Group Vanguard hsm Enclosure(s): ** Dean E. Klinger -Rollover IRA Account Value Report 51684067 DA~~ (~1S~r ~~~ ~ ~S~ Dean E. Klinger C/o Diane L Klase 324 S Diamond St Shamokin, PA 17872-6321 Dean E. Klinger -Rollover IRA , Y ~ ~ Page > 1 of 1 +~" Vanguard Report for 09/14/2010 Client Services: 800-662-2739 Total report value: $33,023.23 (Total report value includes any accrued dividends.) Acaount~valgesummary. ~~ Name Fund & Account Date Price Per Accrued Number ~ Opened ~ Shares Share ~ Value` Dividends Total Bond Mkt Index Inv 0084-09920830351 ; 07/20/1998 II 3,045.497 $10.83 $32,982.73 $40.5c - _ _-- - -- -- ---____ ____ ~_ ------ -L... - ------ ----- --------- - -- - --- _- Totals E32,982.73 540.5! accrued dividends. 1314914942 02/02/2011 16:34:09 MetLife P.O. Box 10366 Des Moines IA 50306-0366 MetLife January 12, 2011 LAW OFFICES OF GATES, HALBRUNER, HATCH & GUISE, P.C. ATTN: TRACT L. SEPKOVIC 1013 MUMMA ROAD STE 100 LEMOYNE, PA 17043 RE: METLIFE INVESTORNGER INSURANCE COMPANY CONTRACT 9200720055 OWNER DEAN E KL Dear Ms. Sepkovic: Thank you for your recent inquiry regarding the contract referenced above. Our records indicate that the date of death and the account value on that date are: Date of Death: September 14, 2010 Account Value: $14,141.51 Contract Issue Date: April, 3, 2006 Beneficiary: Terry L Klinger Interest Earned: $300.31 (From January 1, 2010 to September 14, 2010.) If you have any questions, please c Frda ybetween 8:30aalm and 6:30 p.mStETer Service Center at 1-800-255-9448 Monday through y Sincerely, Maggie Miller Sr. Annuity Representative -Post Issue Processing MetLife Annuity Operations and Services CUMBERLAND ORD STREET 32 SOUTH BEDF CARLISLE, PA 17013 Tele: (717) 249-3166 Fax: (71T) 248-2883 January 7, 2011 Friday by the Cumberland County Cumberland Law Journal is published every d is designated by the Court of Common Pleas as the official legal Bar Association umberland County and the legal newspaper for publication of legal publication for C notices. TO: Mark E. Halbruner, Esquire Dean E. Klinger Estate RE: Friday Noon. All legal advertising Legal advertisements must be received able to: Cumberland Law Journal. must be paid in advance. Make all checks pay -------------------- Advertisement inserted on following dates: December 24, December 31, 2010 and January 7, 2011 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 75.00 Total Amount Due $ 0.00 Becky H. Morgenthal, Executive Director (ease Remit PaY~'-~t'Fo: ast Pe+~nsboro Ambulance Senrice Inc ~illing Office ~_p_ Box 726 New Cumberland, PA 17070 4tyE~ONS ABOUT THIS BILL? Phone: 877-214-6018 Fax: 717-214-6020 Email: info~ambulancebilling~Ce•GOm Please visit our website to provide insurance or make payment, and uently asked questions: for additional payment options and freq wvvw.ambulancebitlingo~ce.con'a revious billing requests. Your account * ~ Your account remains unpaid despite our p ******* en i this bill remains unresolved. ******* This account is Past Due der collection review and may be.f°n"~ded to our collection ag CY ~ `^ ---~_'-_-~-~_~_~^~~ is now un ----- :;.{; --- _ . : ~ ~::: _--~ .r ~ ~=.,_- 1 680.00 3!31/10 Basic L'rfe Suppo~Emergency A0429 A0425 3 3/31110 Mileage Total . ,_ _-- - ----- DETACH ANDp RE] ._____-_'-- '_,n foil by check;` credit .card or electronic we accept PaY~^t ~ ent choice belo~' ~{Sectc dedurtian•- Please indicate your paym and fifV in r~Uease~{~~ at 877 214-6oi8~9e~ents are necessary, P 9.00 __ 2_ 7•~0 ~ 0 707.00 0.00 URN BOTTOM PORTION Wi OUR PAYMENT.-__ ----------- ab/e Tar s • s /1~[_ Please Make CFreCk Pay s East Pennsboro Ambulance { Service Inc 10-136632 $ 707.00 -` -----^ DISC ;1/Hf a --~ VISA _ AMERICA_ N EXPRESS- ±~ DI--_ R Credit Card-!„l~TERCARD ----=- - Caro caur,.c_ ExPira[ian P:ar'z on ward -~ E____._ Electronic Check Deduction Please send a wiled check OR P~~ lnfermariort below: t=-=---'" Checking Account Number Bank Rovcin9 Number ~~ Espanol: 866-724-4114 Amount Paid: Please make any coiTe~'ons to address below. DEAN KLINGER 561 OLD ORCHARD RD CAMPHILL, PA 17011 Sianawre gate of Service: ~f2010 15:18 Patient Name: KLINGER, DEAN From: <Public Location> To: Harrisburg Hospital (Pinnade) lJZI NV t JZ;1Vll YAY M,C1V 1, 1 U fit. 19b87 ~~ ~pp 194956 ~~~u,i®®s®ao® tyworre~ east ~cu'°E~~ ----- accouNT uo• s ~A-rEnnEr-T raATE ~AV Tlils ~oAr ~~aT 325856 10/26/2010 $67.93 Far billing questions caH: X17)932-5955 or. (877)932-5955 Fax; (T17)932-4856 Office Hours: 8:00 AM - 4:30 PM ~s ADDRESSEE: DEAN KLIN6ER 561 OLD ORCHARD LN CAT1P HILL PA 17011-1829 1~~~111~~~11{......11...11...111.1~~~l~ll.l~~~ll~~~~.ti~~it~l Quantum Ima$-uS and Therapeutic Associates p O Box 62165 Baltimore, NID 21264-2165 i~~l~i~~~ll~~l~i~il~~~1~~1~~1.I~~~ll-ll~.~l.l.~ll~.~l•l~ll~~~l ." PLE YOUR PAYMEtJTO gy ENCLOSED ENVELOPE 17H _ J ~_ ] Please check box'd above and Indicate hange(r) on ureverse side. ~~ormahon has changed, H ARRISBURG I.{OSPiT t patient: DEAN KLIPiGER ~~ices Rendered At: e paymer>~ 5 Ad'ustments Account: 325856 oc ion ~~~ Charg 34.84 45 154 r Date Code PMT MEDICARE PART B-tiIGI-IMARK MEDICARE S CARE PART g-HIGHMARIC MEDICARE 37.00 . 7 ~ 10/6/2010 0/6/2010 1 74000 9/10 CR Adjustment MEDI ABDOMEN KUB PMT MEDICARE PART B-HIGHMARK MEDICARE S HIGHMARK MEDICARE i3 36.00 27.83 10/612010 1612010 10 010 - CR AdjustrneN~ FRONT T CHEST SINGLE GHMARK MEDICARE S 734 26.83 71 9(5/2010 10 PMT MEDICARE PART B-HI MEDICARE PART B-HIGHMARK MEDICARE S 37.00 734 10!620 10162010 74000 9/5/2010 CR Adjustment ABDOMEN KUB }~ MEDICARE S PMT MEDICARE PART B-HIGHMAR HIGHMARK MEDICARE S B x.00 27.83 10/62010 - CR Adjustment MEDICARE PART 7 ~ 10/6/Z010 71010 9/7/2010 CHEST SINGLE VIEW FRONTAL PMT MEDICARE PART B-HIGHWIARK MEDICARE S HIGHMARK MEDICARE S 36.00 26.83 10/62010 10/62010 010 CR Ad}ustment MEDIC~E PST 8' CHEST SINGLE VIEW FRONTAI- GHMARK MEDICARE S 7 34 26.83 9/8/2010 71 10/6/2010 PMT MEDICARE PART B-HI t MEDICARE PART B-HIGH~K MEDICARE S 37.00 7 ~ 10!62010 740 9/g/2f110 CR Adjustmen ABDOMEN KUB pN-T MEDICARE PART &HIGHMARK MEDICARE S HIGHMARK MEDICARE S 27.83 10162010 CR Ad}'ustment MEDIC~E PART B- 10/62010 Currey 0.00 91 -120 Over 120 31 - 60 61 - ~ 0.00 0.00 67.93 °-0° THIS ACCOUNT BAL-p-NCE IS YOUR RESPONSIBtt_iTY- PLEASE REMIT PAYMENT INGEMENTS ANDIORR OFFICE IF PAYMENT ARRA INSURANCE INFORMATION IS NECESSARY. ~m~~xm ---- X67.93 BgLANCE DUE PAY BY _ November 25, 2010 For trilling questions tali: C~1~932-5955 or. (877)932-5955 Fes; (717)932-4856 Office Hours: 8:00 AM - 4:30 PM Tax ID. 251792806 ~TA'f'~t'~~~~ SEE REVERSE SIDE FflR IMP£?I~TANT '$ILL31+lG Il~FL1g1~A°DON -~~~~y-_ ' ,; SHOW AitAOUNT PAID HERE .~:-~ MAKE CHECKS PAYABLE ~ REMrrTO: t961D - 4 DO NOT SEND pAYMENTS TO THIS DRESS Dept. 19687 p O Box 1259 Oaks, PA 19456 ~rrrrr~!~rrrrrrr For billing questions call: (717)932-5955 or. (877)932-5955 Fax: (7177932-4858 Og;~ Hou a Res M~ .4:30 PM 11'1111111'Il~flil'1'IIIIII~~~III11111.~~I~11~~.~1111111'1'IIIII' DEAN KLINGER $ "-` 561 OLD ORCHARD LN CAMP NILL PA 17D11-y829 Please check box if above address is incorrect or insurance information has changed, and mdtcate change(s) on reverse side. ~ omcav~aT---- ~~ ^wsrfac~ ~ ww ,,,~Tna„~s~n ~ ""~ i sEgtnmr r~ ~ ~~~ __---- ~---- AccouNT Nf3. .PAY TH15 Af 1{2UNT STA7EMENT_DATE -------- 325856 9/28/2010 $26.72 F ~ - r _;,~~, SHOW AMOUNT C4A? ;E$ 0 C cg} i)E Art ~ lc.i r,r,~~ ~.~~~~.,, n-, o ~',,Ext st tEtcP~T F'AlD HERE ~ MAKE CHECKS PAYAEtLE / REMIT TO: ,9~o3as Quantum Imaging an+d Therapeutic Associates p O Box 62165 Baltimore, MD 21264"2 L65 i~~l~i~~.II~~I~I~II~~~I~~1~~1,I~~~11~11~~~1~1+~II~~~1~1~11~~~1 PL~YDUR PPAYMENT N ENCLOSDED ENVRELpPE iTH patient: DEAN KUNGER Services Rendered At: flgKi(l~ounv ••---- -- gccount:325856 Description Charge 188.00 Prot Date 10 Code 70450 CT SCAN BRAIN W/Q CONTRAST HIGHMARK MEDICARE S T B 8/31/20 928/2010 - PMT MEDICARE PAR R Adjustment MEDICARE PART B-HIGHNIARK MEDICARE S 278.00 8/28/2010 0 70496 C CT ANGIO(3R1'HY HEADWNVO CONTRAST HIGHMARK MEDICARE S B 8!31/201 8/28/2010 - PMT MEDICARE PART ART B-HIGHNIARK MEDICARE S M E ~ ~+ + 928/2010 CR Adjus~ V~E FRO TAL W ST SING ~ ~ ' 8/31/2010 71010 CHE EST SINGLE VIEW FRONTAL 36.00 + 8131/2010 71010 71010 CH CHEST SINGLE VIEW FRONTAL ~ ~ 198 ~+ 9/1/2010 9/1/2010 71010 CHEST SINGLE VIEW FRONTAL CAN BRAIN W/O CONTRAST 37 00' + 8/2/2010 70450 74000 CT S ABDOMEN KUB 37 00 ~ ~. 9/312010 8/3/2010 74000 ABDOMEN KUB ST SINGLE VIEW FRONTAL 198.00+ " X412010 71010 CHE CAN BRAIN W/0 CONTRAST 37.00 8/5/2010 915/2010 70450 74000 CT S ABDOMEN KUB CHEST SINGLE VIEW FRONTAL ~ ~ 37.00' " X512010 9/5/2010 71010 74000 ABDOMEN KUB HEST SINGLE VIEW FRONTAL 36.00 ~-~; * 9/7tZ010 71010 C CHEST SINGLE VIEW FRONTAL 3Z QO_ 9/812010 9/8/2010 71010 74000 _ _ _ ___ - ABDOMEN KUB -- Current 26.72 BALANCE DUE PAY BY 34.84 154.45 72.03 187.96 526.72 October 28, 2010 For billing questions call: (717)932 5955 or: (877) THIS ACCOUNT BALANCE IS YOUR RESPONStBIUTY. Fax: (71~g32-4856 PLEASE REMIT PAYMENT IN FULL OR CAL! OUR Offce Hours: 8:00 AM - 4:30 PM OFFICE IF PAYMENT ARRANGEMENTS AND/OR INSURANCE INFORMATION tS~N~ECESSA-RY. ~' insurance. TaX ID. 251792806 / Those charges shown v+nth ao md~cate Pe ~ STATEMENT SEE REVERSE SIDE FOR IMPORTANT BILLING INFORMATION t~-~ --- - ~rrrrr ~r~r~r _____ __ ___ _____ _ __ _ _ 91 -120 Over 120 31 -60 61 -90 0.00 0.00 O.oo fl•~ OF MEDICAL SERVICES STATEIVIENT LAST STATENEIIT DATE: to/o9no $0.00 NEM CiMR6ES: $0.00 NHI PAYNENTS° $0.00 NEN ADJUSTME~S ° SO.00 ~[rjjy/~GL~.~~~-~~ ItWiRANGE BALANCE' $1106.00 13YC?'~~n- YOUR BAL~INGE: PHl6 AT 717-231-8%0 OR 1-800-565-6229 If AnY ~stions, P~i° Contac{: 1~/~~ 11~ accouNn': 13033087 FED TAX 111 B ?51709054 DEAN ~(j,~NGER 77y51JRAPCE YOUR NCE gALA1~E CHARGE PAYFIENI'S AD•~ST~ BALA . DEAN KL7?6ER »> PATI@IT' 00,/31/10 TO Oq/14/10 ~- __----- ---- -- - IP 083110 091410 --- _ _ __-- ---~---'- ~_IpBPI'FA~--- 294.00 PERFDRl~ED BY : ~LO6Y ASSOC ~~ 294.00 aIITIAL 1T~'T ~IlLT LVLS 08/31/10 ~~ D1~p6IS: 434.41 PMt%EDIAtE 47.00 97.00 ~~ t~SP CARE LVL2 09/OL10 ~; 4~~y1 25 DIAL gg232 1]5.00 . PROCEDURE; 115.00 E~3 Ai1AKE 8 ASLEEP-PROF 09/01/10 PRpCE~E; 9581926 DIAB1'Q6IS: 434.91 97.00 97.00 ~qU@(~ IDSP CARE LVL2 09/02/10 u}34.91 p~E; 99232 DIA~~: 97.00 97.00 SE~ tQ6P CARE LVL2 09/03/10 SIS PROCEDURE; 94232.25 DIA~~: 434.91 17,5.00 115.00 09/03/10 EEGs ANAKE A ASLEEP-PROF DIAENO,~= 780.47 0 PROCE~; 9681926 47.0 97.00 T 09/04x/10 SlO1SEHUENr F~6P CARE LVL2 PAGE lOF 2 ~o HI2 PINNACLE HEALTH MED SVGS Pg~SBIJBG PA 17108-1286 ADDRESS SERVICE REQUESTED Cheek bOx end enter any address or ^ insurance corrections on back 00000646 0l DEAN KLIpGER 561 OLD ORCHARD RD CAMP HILL PA 17011-1829 Make Check Payable To PINNACE ~~"`~~ ~' ^"`" -" - - ~u~~~~ur{nr~~~~ur~u~uu~~n~r~`n{u~~n~n~u~~an x~~~~ PINNACLE HEALTH MEII SVCS PO BOX 1286 HARRISBURG PA 17108-1286 33087 CHARGE PAYMENTS ADJUSTMENTS PROGEWRE; 99232 DIAGIIOSIS: 434.91 PERFORMED BY: FpSPITALIST AT G60H 97.00 09/04/10 SUBSEQUENT FgSP CARE LVL2 pRpCEDURE: 99232 DIAGNOSIS: 780.39 PERFORMED BY: NEUROLOGY ASSOG PFD'S 97.00 04/05/10 SUBSEQUENT NOSP CARE LVL2 PROCEDURE: 99232 DIAGNOSIS= 434.91 DEAN KLIN6ER BALANCE: ACGOUNi- IS FfE HAVE NOT RECEIVF~ YOUR PAYMENT IN FULL. YOUR PAST DUE. PLEASE CONTACT OUR OFFICE IpMEDIATELY TO MAKE PAYMENT ARRANGEMENTS. IF PAYING BY GHARb'E ~~ aFEY~OEU ~~ E Titf THREE DIGIT SECURI CODE LOCATED [IN i'F~ ;~ YOU FOR GFtOt>SING p~pCLE HEALTH MEDICAL SERVICES. OUR OFFICE Ftat1RS ARE 8:OOAM TO 4:30PM, NOF®AY, FFEDNESDAY, FRIDAY AND B:OOAM TO 6:00PM TUESDAY AND TMIRSDAY THIS BILL REFLECTS CHARGES FOR PHYSICIAN SERVICES PROVIDED BY PINNACLE FIEALTH MEDICAL SERVICES. PLEASE F'IDTE, ANY LAB OR pIp~OSTIG SERVICE iFTLL BE BILLED SEPARATELY THRWJGH PINNACLE HEALTH ~PITALS OR AN IttDEPENDEMT LAB• 11/06!10 INSURA~E YOUR BALANCE BALANt 97 . t 97.t 06.G ..~.„.. n~formatian ce W make corrzcNon~ m y°~ a~ ~ ... --- PFease use this spa PINNACLEHEALTH HOSPITALS DEAN id-1NGER 561 OLD ORCHARD LN CAMP HILL PA 17011-1829 ~ s Patient Name: Klinger ,Dean Statement Date: 11/11/10 Service Date(s): 08131 /1 0-09/1 4/1 0 Account Number. 110056905 Primary Diagnosis Code: 434.91 • .00 Ins. 1: MEDICARE A Ins. 2: Ins. 3: Ins. 4: . ~ t YOUR ACCOUNT IS PAST DUE. PLEASE CALL OR PAY IMMEDIATELY. For Account Information, please Call Jane (717)230-3419 or 1-800-603-6064 for Out of Area Calls. If payment has been sent, please disregard. Pay online at: http:l/wvvw.pinnaclehealth.org/bitlpaYl 5114,298.61 Total Charges: g113,198.61- Payments/Adjustments: 51,100.00 account Balance: $1,100.00 Patient Balance: s~,100.00 Please Pay This Amt: For questions, call our Billing Help line at: 717-230-3717 for local calls or 1-800-603-6064 for Out of Area. Customer Service Hours: Mon-Wed-Fri 7:00 AM to 4:00 PM Tues-Thurs 7:00 AM to B:00 PM ician will bi11 separately for professional services. please Nate: Your phys _ - _.__-_____ Make Checks Payable To: PinnacleHeafth Hospitals pue Now II~IN~IIN®I~~~~fl~~llfl PinnacleHealth Hospitals PO Box 2353 Harrisburg PA 17105 Ct~sck 6mc if ~„r ~dtass or insura~ inform.tion las ,:trny~d_ Ptaad ,Mb cAanYea on bstk. oana2~o1 001 0.53 DEAN KLINGER 561 OLD ORCHARD LN CAMP HILL PA 17011-1829 ^ 0 ~ TM CNV2 Mum6sr is tlw Isst 9 digits on tM Oack of your vedn ~' ~ yO1R s,ppturs I...111...1...1111....1.1--I I--1 PINNACLE HEALTH HOSPITALS P.O. BOX 2353 HARRISBURG, PA 17105-2353 OOOU0110056905000001100001100000001 ASSOCIATED CARDIOLOGISTS, P.C• 856 CENTURY DRIVE MECHANICSBURG, PA 17055 RETURN SERVICE REQUESTED Billing Phone: 717-591-7122 Billing Fax: 717-591-7153 Office Hours: Mon-Fri 8:00-4:00 PAGE: 1 of 1 ADDRESSEE: ea~ta~i Ht.V V~••• ~--- STATEMENT DATE PAY THIS AMOUNT $5.49 216343 11/15/2010 ,. ~ _ _, ~ SHOW AMOUNT r;; rs PAID HE s~;cs ~ ~~, ~_-~ ,,, ~ RE ~~ MAKE CHECKS PAYABLE /REMIT TO: DEAN KLINGER s 561 OLD ORCHARD LN ASSOCIATED CARDIOLOGISTS P• ° •r •` CAMP HILL PA 17011-1829 856 CENTURY DR m MECHANICSBURG PA 17055-45D5 I+~~I11~~~111~~~~1~1~~1~1~~1~~1~1~1~11~~~~1~1~1~1~~1~1~~11«~i PLE YOUR AYMENTD N ENCLOSED ENVE OPE ITH Please check box if above address is incorrect or insurance ~ gAI,ANCE information has changed, and indicate change(s) on reverse side. CgARGE CREDIT - DATE OF PROCEDURE DESCRIPTION PROCEDURE DIAGNOSIS -------- -------- ------ _-- 83 1 SERVICE ____ CODE _____-_-_-___ r--- _ ~ NTERPRETATION/REP - -- . 23 17 780.79 25.00 1,83 25.00 23.17 79 3 08/31/10 93010 ECG I ECG INTERPRETATION/REP 780. 25,00 23.17 1.8 79 -- 780 ----- 09/01/10 93010 ECG INTERPRETATION/REP . ------------ ____-------- ---------- 09/O1/10 93010 ------ - - STATEMENT ,., ~.ennQTnNT BILLING INFORMATION AMOUNT DUE $5.49 i u~,~, .,o~2,e SAYE, GETTE & DIAMOND DERM ASSOC, p•C• 2201IS U~RG, PA 17112I1089SUITE 7 HARK '~ ~ e „~., 10/15/10 44430 ~~ 7.70* Security _HC _VISA _ Disc '? Code '"~ Cards Exp _/_ ". Sign _ 31936 SAYE, GETTE & DIAMOND DERM ASSOC, P.C. DEAN RLINGER 2201 FOREST HILLS DRIVE SUITE 7 561 OLD ORCHARD ROAD HARRISBURG, PA 17112-1089 CpMp HILL PA 17011-1829 _r. ------- __ -.. -- - -- _-_ - - - -- ---- -- ______________ nRa'Vlfi II 3 ~ _ ! C - ,~ .. _ ~ _..~~- 52_5 *** *******~~*~*~*~*~~~***~~~ E PROBLEM 99231 692.9 50.00 30,79 1 1 L SUB HOSPITAL CARent. -11.51 7.70* 09/01/10 Medicare Paym 10/08/10 Accept Assign Add. 10/08/10 ---~,°-_~ SAYE, GETTE & DIAMOND DERM ASSOC, P.C. pKE -'~ 2201 FOREST HILLS DRIVE SUITE 7 HECK 0.YABLE70:~ HARRISBURG, PA 17 1 1 2-1 089 PRV~ 1-SAYE, WILLIAM H•, JR., M PAT~~ 1-DEAN ICI,INGER 0.00 ~ 7.70 ,f ~; 7.70* Ph:(717)-652-5063 Acct: 44430 Date: 10/15/10 page 1 of 1 WEST SHORE EMS -ALS ,--- - t- -i i C ~ P.rn __ 205 G 01ITE 211 RANDVIEW PAE1 ON REVERSE SIDE ,~ ~ ~a 7 CAMP H l Tax ID: 23-2463002 Phone #: ^~ 800 367-0512 Federa ( ) „~ ~- ~, . ~ ~i~iLLt< ~i. r~~'~'~` MEDICARE B MDEN INSURANCE: B pAT-ENT NAME: DEAN KLINGER 08131/2010 DATE OF CALL: 626 ENOLA RD GALL NUMBER: 1015947A FROM: HARRISBURG HOSPITAL TO: ACCOUNT SUMMARY 1032.34 DEAN KLINGER TOTAL CHARGES: 0.00 561 OLD ORCHARD RD PAYMENTS/ADJUSTMENTS: 1032.34 CAMP HILL, PA 17011 PLEASE PAY T HIS AMOUNT: DETACH ALONG PERFOR,gTION AND RETURN STUB WRH PAYA/1EAtT AMOUNT QUANTITY UNIT PRICE DESCRIPTION OF CHARGE 967.62 ALS EMERGENCY LEVEL 1 A0999 1.0 1 0 967.62 14.72 14.72 6.72 20GTT TUBING A0394 A0394 1.0 6.72 3.20 ANGIOCATH (14-24) 4 0 A0396 0.80 25.04 EKG ELECTRODES (1) 2.0 A0394 12 52 7.08 EXTENSION SET 8" NEEDLELESS 1 0 7.08 3.48 GLUCOSE BLOOD A0394 A0394 1.0 3.48 1.92 NSS 0.9% 1000cc Bag 1 0 A0394 1.92 2 56 2.56 OP SITE SALINE PREFILLED SYRINGE A0394 1.0 . Total Charges 1032.34 ~- AMOUNT RECEIPT PAYMENT DATE DESCRIPTION OF PAYMENT 0.00 09/17/2010 Denied by Medicare Total Credits .. _ _ ~ _ -~. ~ X1032.34 AMOUNT PAID: CALL NUMBER; 1015947A PATIENT NAME: KLINGER, DEAN _ - ~- -~ ~~_ ~ • THIS ACCOUNT IS NOW 40 DAYS PAST DUE!! Please send your payment now. PROTECT YOUR CREDIT! WEST SHORE EMS -ALS 205 GRANDVIEW AVE SUITE 211 CAMP HILL, PA 17011 credit card, please check box and fill out information below. '' I! If paying by ^ ~± ~~ ^c ...r., ~,.,T PINNAWLSNOWVILLEERDRGENCY 6880 SUITE 210 BRECKSVILLE OH 44141 Ta Pay Your Bill Online '`~~',~} Please Visit: "~`'~ yrniw.meddatabillpay.comlPH1 DEAN KLINGER 561 OLD ORCHARD RD CAMP HILL PA 17011-1829 I~~~III~~~III~~~~~~11~~~11~~~111~~1~~~1>,Il~lrr~ll~~~~~ll~~ll~l PLEASE CHEC HAS C'Hp~GED gN~RINDICATE CHANG (SOON REVERrS~E SIDE CARD NUMBER EXP DATE SIGNATURE ,y This Amount AccOO"` `'°"C 1015 7 2 3 66.41 PH1 Payment Due Date SHOW AMOUNT 11/OS/10 11/25/10 PAID HERE 5 e ~ PINNACLE HEALTH EMERGENCY PO BOX 8500-55168 PHILADELPHIA PA 19178-5168 1~~~111~1~~~~~111~~~11~~1~~1~1~~~~11~11~~1~~1~~1~~11 PLEASE DETACH AND RETURN 70P PORTION WITH PAYMENT. - ^ INFORMATION 66.41 - 1 Please Pay: ~ Account #: PH1 1015723 Payment Due: 11/25/10 • ~ . ~ _ ~_ 43.98 ~ _ 478.00 -175.94 OS/31/10 ELA WALT CPYMTMMEDICARELASSIGNEDN -258.08 W/OFF MEDICARE ASSIGNED 329.00 22.43 -89.70 08/31/10 ELA WALT I PYMTAMEDICAREOASSIGNED E -216.87 W/OFF MEDICARE ASSIGNED ,_, ~, Account `'~~ * * PAST DUE '~ ~ ~ Balance: Am~o66 ~ Due f, PLEASE NOTE THAT YOUR ACCOUNT IS PAST DUE. ~,,, PAYMENT IN FUPL~SER ONTACT USFIMMEDIATELY TOEMAKE $66.41 ~~.~, ~~~-''' PAY IN FULL, FORMAL PAYMENT ARRANGEMENNTS . Billing inquiries: Patient Name: DEAN KLINGER Ph sician Services Provided By: To Pay Your Bill Online 1-877-846-7929 E-MAIL: questions@meddat ESl PINNACLE HEAL 68 EMERGENCY ~Y ~y ~ Please Visit: 8500 551 ,~ www.meddatabi{tpay.com~'PH1 . ~y MON. -FRI.8:OOam to 6:OOp PO BOX PHILADELPHIA PA 19178-5168 ~ ;, i ti H~.IT'~~.~E MEI~ICi~L_: ~1~Ot.IP Z Conner Rich Associates CamH H II, PA 1701Suite 101 P N m FORWARDING SERVICE REQUESTED ^ Please check if address or insurance information is incorrect and complete form on back- Fill In Beio~v 3° P-v Sir Cr~_ edit Card~~, ~ ~ r ' Visa i~ . i , ~ ^ MasterCard ~ .4 ~_ ^ Discover ~_._ nzso 5ecuntY Co 1 I+++III+++III++++++II+++II+++111+.I+++I+II+I+++II+++++II++II+I Heritage Medical Group, LLP ****..***•********3-DIGIT 170 PO Box 8230 °°~°°' Lancaster, PA 17604-8230 DEAN E KLINGER 561 OLD ORCHARD LN CAMP HILL PA 17011-1829 ~05865230D0029D34717000~08953 9 PLEASE DETACH AND RETURN T ~ PCR ~~ ~ li 11'2310 T r<..~~~~.~~°_~ ~~0 290347 I~I~,~~ i`~~~:~o $89.53 ` GC Gr~enl ~~c~i~i~r today Gnci pay your bill ~nlin~ at ~fl= ri~a pl~nCic~r~ ~ Corn, ~~ (Jose"it?ticr~ `~at:~ ~ 124.00 124.00 DEAN E KLINGER ID# 290347/ROBERT D KUSZTOS MD -34.47 01/13/2009 OFFICE /OUTPATIENT VISIT ESTABLISHED PATIENT DETAILED 01/21/2009 SYSTEM CONTRACTUAL ADJUSTMENT FROM MEDICARE _89 53 89.53 01/21/2009 PAYMENT FROM MEDICARE 01/21/2009 PATIENT RESPONSIBILITY -THE BALANCE IS YOUR DEDUCTIBLE WHICH IS NOT COVERED BY YOUR INSURANCE. 0 89,53 BALANCE TICKET #CRA109977 I ~~'°i:.•~'iiat";~, ~~6~-`a~~c?f-? t~~!S'"<~~4t,f:Y ~iE~Q4iB".°,: reatly appreciated! Prompt payment is 9 t` °~~°~ ~;r ~~~`F Medical Group, LLP x;°f~~~~~~ ~ ~: Heritage PLEASE DO NOT SEND CASH THROUGH THE MAIL __ - _ °;'~°~f i`~~.I.°+'~r':~ 89.5 jr~~,^;.~~''°~ ~`?k~ 89.5 ~'; . ~: ~ (71T) 761-8331 - - - -------------- MOFFITT HEART & VASCULAR GROUP 1000 NORTH FRONT STREET WORMLEYSBURG, PA 17043 Address Service Requested -- - ~ lp/27/10 200535 ~ Continued Security _MC _VISA Disc Code _ Sign 30729 MOFFITT HEART & VASCULAR GROUP ESTATE OF DEAN RLINGER 1000 NORTH FRONT STREET 561 OLD ORCHARD RD WORMLEYSBURG, PA 17043 Cep HILL PA 17011-1829 --- .---- - e., ,. ~., ,.._ . ____ ---- --------------- - - SELOW _ ~ . ~- ~ i~tESSAGES E7:PLAl1~lEf} s - • • . ~ *9c* ~ . ~c~c~c that our *** Please Pay -Amount Due Now From Patient- See Red Box Thank You!!yy *** rompt payment. If it becomes necessarou will be *** *** Thank you for your p t p R wi~h ~uestions. *** unpaid balance lllfct*o****~~~*~~~~~*******~~***~**~~*~*** ** ***************** *** ch~r~e~d a ~Ox ~~ ******* * **** *** **~** 99223 427,31 230.00 154.65 09/01/10 1 5 L HOSPITAL INITIAI,eCnAtRE 3 -36.69 Medicare Paym 10/12/10 Accept Assign Add. 160.00 10/12/10 56.35 09/01/10 1 5 L ECHO (2D) COMPLETE, HOSPI 93306 424.0 _gq,56 09/24/10 Medicare Payment 09/24/10 Accept Assign Adj. L HOSPITAL SUBSEQUENT CARE 99232 427.31 80.00 55.70 09/02/10 1 8 ent, -10.38 Medicare Paym 10/O1/10 Accept Assign Add. 10/O1/10 55.70 L HOSPITAL SUBSEQUENT CARE 99232 427.31 80.0 09/03/10 1 8 ent, -10.38 10/04/10 Medicare Paym 10/04/10 Accept Assign Add. 50.00 L HOSPITAL SUBSEQUENT CARE 99231 427.31 30.79 09/04/10 1 9 ent. -11.51 Medicare Paym 09/28/10 Accept Assign Add. 09/28/10 30.79 HOSPITAL SUBSEQUENT CARE 99231 427.31 50.0 09/05/10 1 9 L ent. -11.51 Medicare Paym 09/28/10 Accept Assign Add. 09/28/10 30.79 L HOSPITAL SUBSEQUENT CARE 99231 427.31 50. 09/06/10 1 9 ent, -11.51 Medicare Paym 09/30/10 Accept Assign Add. 09/30/10 55.70 HOSPITAL SUBSEQUENT CARE 99232 427.31 80.0 0o~0~/ip0 1 12 L Medicare Payment ._ ~ _ , . - ~ DATE LAST PAID AMOUNT 38.66* 14.09* 13.92* 13.92* 7.70* 7.70* 7.70* 0©/pp/Op 0.00 -- MOFFITT HEART & VASCULAR GROUP AKE 1000 NORTH FRONT STREET HECK pp. 17043 pYABLETO: WORIiLEYSBURG, 1-DEAN RI,INGER PRV~ 5-NGUYEN, THACH N, ~'FACC PAT pRy~ 8-PAWLUSH, DAVID, MD, PRV~/ 9-SMITH, MICHAEL F, MD, FA PRV~ 12-1iANDAK, JEFFREY, MD, FA__~ _____ Continued ph:(7i7)-731-0101 Acct: 200535 Date: 10/27/10 page 1 of 2 MOFFITT HEART & VASCULAR GROUP 1000 NORTH FRONT STREET WORi'ILEYSBURG, PA 17043 Address Service Requested ESTATE OF DEAN KLINGER 561 OLD ORCHARD ~ CAMP HILL PA 17011 -------~------- --------------------------^Ft..OVN C9ESSAGt=S EnPLAtNED ___ _,~~ _- -- \ = ' ~ " 200535 10/27/10 160.85* _MC _VISA Disc Card~~' Sign MOFFITT HEART ~ VASCULAR GROUP 1000 NORTH FRONT STREET WORMLEYSBURG, PA 17043 ~~ 10/12/10 Accept Assign Adj. CARE 99232 427.31 80.0 09/08/10 1 L HOSPITAL SUBSEQUENT 12 Medicare Payment 10%12%10 Accept Assign Adj. 99232 427.31 80.00 09/09/10 1 HOSPITAL SUBSEQUENT CARE 18 L Medicare Payment 10/12/10 10/12/10 Accept Assign Adj. 99231 427.31 50.0 09/10/10 1 L HOSPITAL SUBSEQUENT CARE 18 Medicare Payment. 10/12/10 10/12/10 Accept Assign Add. 99231 427.31 50.0 09/12/10 1 T CARE 18 L HOSPITAL SUBSEQUENt Medicare Paym 10/07/10 Accept Assign Add. 10/07/10 Security Code Exp _/_ -10.38 13.92* 55.70 _10.38 13.92* 55.70 _10.38 13.92* 30.79 _11.51 7.70'` 30.79 _11,51 7.70* a or co-ins. Please make payment. L-The 'PLEASE PAY' includes unpaid co-p y . ~aTE LAST Palo gMOUtvr ~ 0.00 0.00 0.00 146.76 14.09 0.00 ----- 00/00/00 0.00 MOFFITT HEART & VASCULAR GROUP AKE 1000 NORTH FRONT STREET HECK >Yas-.ETO: WORMLEYSBURG, PA 1704 KLINGER PRV~/ 18-MYERS, LOUIE, D0, FACC PAT~~ 1-DEAN , ~~:7 .- 0.00 160.85 160.85* ph;(717)-731-0101 Acct~~: 200535 Date: 10/27/10 Page Z of 2 INVENTORY REGISTER OF WILLS OF COMMONWECU~B~RLANDSYLVANIA 1 SS COUNTY OF ) . .- ,_,L......Ar Pcrn,ire. - al-lo-loco File Number_~- ,v,a,,......_-- Counsel of the Estate of Dean E. Klinger, Sr. earin in the following inventory include all of the personal assets wherever situate p p osite each item of said deceased, depose(s) and say(s) that the items app g 11 of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation act o p e decedent's death, and that Decedent owned noo real estate outside of the and a inventory represents its fair value as of the date oft i 7 ommonwealth of Pennsylvania except that which appears in a memorandum at the end of this i/nven ry C ~ -_ I verify that the statements made in this Inven- M rk E. Halbruner, Esq. tory are true and correct. i understand that enaltiesatof Counsel for Estate ments herein4904 elating toJ unsworn fasification to 18 Pa.C.S. § 66737 authorities. (Supreme Court I.D. No.) Mark E. Halbruner, Esquire Attorney -- (Name) Gates, Halbruner, Hatch & Guise, P.C., 1013 Mumma Road, Suite 100, Lemoyne, PA 1704 (Address) 717-731-9600 (Telephone)s-- DATE OF DEATH September 14, 2010 CUMBERLAND COUNTY PENNSYLVANIA FIGURES MUST BE TOTALED Wachovia - Checkitrg Acct. No. 1014128384376 Wachovia -Certificate of Deposit No. 247402303266640 Graystone Tower Bank -Savings Acct. No. 1730002480 1978 Pontiac Catalina Sovereign Bank -Certificate of Deposit No. 0925282196 Susquehanna Bank -Savings Acct. No. 246504469 1984 Toyota V an DECEDENT'S SOC. SEC. NO. 171-28-4455 989.92 2,195.73 9,098.12 300.00 8,012.79 200.91 1,000.00 300.00 1985 Chrysler Fifth Avenue =:: ~ ~ , ;~.~ _ ~ -_ _~~ ; _~ ~ ~ :-^ > r'- .. r-r-I _ ' ~.. l..`7 ~~ r ~ (r. TOTAL: 22'097 47 (Attach additional sheets as needed) f real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each ry. See 20 Pa. C.S. § 3301(6)) NOTE. The Memorandum o item, but such figures should not be extended into the total of the Invento ~ Form RW-09 rev. I0.13.~6 LAST RESIDENCE 561 Old Orchard Lane, Camp Hill, PA 17011 LAW OFFICES OF BRUNER, HATCH & GUISE, I' •C • GATES, HAL 1013 MUMMA ROAD • SUITE 100 • LEMOYNE, PENNSYLVANIA 17043 BRANCH OFFICE: (717) 731-9600 • FAX: (717) 731'9627 3 y,/EST MONUMENT SQUARE, SUITE 304 CORRESPONDENCE ADDRESS: LEWISTOWN, PA 17044 Lemoyne Office (717) p48-6909 LOWELL R. GATES, LL. M. LL. M. in Taxation WEB SITE: STACEY L. NACE Also Admitted to Massachusetts Bar ww.,v.GatesLawFirm.com paralegal/Office Manager MARK E. HALBRUNER TRACI L. SEPKOVIC CRAIG A. HATCH, CELA paralegal Certified as an Elder Law Attorney by TRACI L. HILFERDING the National Elder Law Foundation paralegal CLIFTON R. GUISE Also Admitted to practice before the U.S. Patent & Trademark Office ,. 1'3 n ~ ` "~- September 1, 2011 ~ C? v-. ___ T,~r~ ~ - ~,~ ~ , `, ~ ~ , ~~ tom`' r , (y_, --~-, -.;,. __. Cumberland County Courthouse ~`~ ~.,, ~-- Office of the Register of Wills 7 n.--: One Courthouse Square Carlisle, PA 17013 RE; Estate of Dean E. Klinger, Sr. File No. 2110-1080 Dear Register of Wills: licate and Inventory Enclosed for filing are the Pennsylvania inheritancd with the filing of t is ret rn. A check in for the Estate of Dean E. Klinger, Sr. There is no tax owe ent and return them to our of $30.00 as payment of the filing fees for the i hedocumtax return and Inventory 1s the amount of eac enclosed. Please time-stamp the additional photocopy office in the enclosed envelope. Thank you for your assistance in this matter. Sincerely, Traci L. Sepkovic Paralegal Enclosures cc: Terry L. Klinger, Administrator F ___,~ . Ci, F=~ , . •r~+ (~(~'~ '~T r~l l : °J , PA Lp,W OFFICE OF GUISE, P.C. LBRUNER, ~`TCH & ;DATES, ~ SUITE 100 1013 MUMMA ROAD, LEMOYNE, PENNSYLVANIA 17043 - Cumberland County Courthouse Office of the Register of Wills One Courthouse Square Carlisle, PA 17013 I~„III~~~111~~~„.11„11,1„ICI ~:~. ,, . r ... ... ~_.~