HomeMy WebLinkAbout10-16-13 (2) � 1505610143
REV-7�00 �"°Z.,,' '�'
PA Depar6nent of Revenue OFFICIAL USE ONLY
p�nnsylvania CaunlyCOde Yeaf FIIeNUmber
Bureau of tndivldual Taxes °BM1Y°MiOFRf�""
aoeox.zeoeo� INHERITANCETAXRETURN 21 13 00497
Harr�aburg,PA 1712&0801 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
SoGal Securiry Number Date of Death Date of Birth
203 18 6559 04 10 2013 03 17 1928
DecedenPs Last Name Suifix OecedenPs First Name MI
OELSCBLEGEI, CATHERINE G
(H ApPlkabN)Enter SurviWng Spouw'a Iniormallon Below �
Spouse's Last Name Sufix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN MPROPRIATE OVALS BELOW
� 1. Oripinei Retum � 2. Supplemerrtel Retum � 3. �a�'R�Z;(�ate of DeaM
� 4. limNed Esfate � qe,Futuro Interest Comwanlss � 5. Federal Esfate Tetc Ralum Requlred
(tlab ol tleeM eftx 12-12A2)
� B' (A�Capyd Will� ❑ �� A e M°i���,uwne rn,s� � B. Total Number of Sate DeposR Boxes
� 9. LiBgaHOn Praeeds Recaived � 10.���"��dt+De��a Dsa1h � 11.�A�h Scnedub O)Sec.9113IA)
COqREBPONDENT-THIB SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION BHOULD BE D�RECTED TO:
Name Daytlms TeNphor�[lwnber
HRUCE J �iAR3HAW3KY 7Y9 238 �70� m
co r� �-,
R�II�..�YE�4QF VWLt3 l��lLY
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First Lins of Address r � c-�� ;,t.� ::�
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2320 NORTH SECOND STREE '".� ', '-'' ' "
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Second Lirn W Addnu � ..- �._, �c'i
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� h� ;li [�
t�' DATE F1�ED 4n
Cky or Pwt OHles State LP CaN
HARRI3BURG PA 17110
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&ONA7UREOF FORF�I �RETURN DATE
�9�Y ����'c%�Fi`J� Norman E. Oelschlegel /U�g -/�
ADDRESS
2268 ConCOrd Circle Harrisburg. PA 77110
SIONA OF PREPME�.�7HER RE TIVE - DATE
y���/�L> �,�i���"Bruce J.Warshawsky �� "9'/ .3
2320 North Second Stnet, Hartisburg, PA
Side 1
� 1505610143 1505610143 �
��
� 1505610243
REV-1500 EX
DecedenPs Social Security Number
�+�•aNa�: Oelschlegel, Catherine G. 203 18 6559
necnrm►unoN
1. Reai Estate(Schedule A)....................................................................................... 1.
2. Srocks and eonds(Schedule e)............................................................................. 2. 12�083 . 10
3. Closely Held Corporation,Partnershtp or SolaProprieWrehfp(Schedule C)......... 3.
4. Mortgages&Notes Receivable(Schedule D)........................................................ 4.
5. Cash,Bank Deposits 8 Miscellaneous Personal Property(Schedule E)............... 5. 12 9�315 . 97
8. Jolnqy Owned Property(Schedule F) ❑ SeDareta Billing Requested............ 8. 5�500 . 00
7. Inter-Vivos Transfers&Miscellaneous -Probate Property
(scneauie c� � Separate BIIIing Requested............ 7. 23'J ,233 . 71
e. 7ota�Grou Asaets(tota�unes� mrough 7)........................................................ a. 384 ,132 . 78
9. Funeral Expenses and Administradve Costs(Schedule H).................................... 9. 2 6�458 . O B
10. Debts of Decedent,Mor�age Liabilities and Liens(Schedule I)............................ 10. 6, 965. 04
11. Total Deduetlons(total Lines 9 and 10)................................................................ 11. 33, 423 . 12
12. Nst Value of Estate(Line 8 minus Line 11).......................................................... 12. 350 ,70 9. 66
13. Charitable and Oovemmental Bequests/Sec 9113 Trusts for which
an elecdon M tax has not b�n made(Schedule J)............................................... 13.
14. Nst Value SubJeet to Tax(Line 12 minus Line 13)............................................... 14. 350� 70 9. 66
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
t5. Amount of Line 14 ta�ble
at the apousal fax rate,or
trensfers under Sec.9118 �5 O . O O
(aX1.2)X.00
16. Amount of Line 14 taxable 0 . 00 18. 0 . 00
at Ilneal rate X .045
17. Amountof Line 14 taxable 350 �709. 66 ��. 42 � 085 . 16
at sibling rate X.12
18. Amount of Line 14 taxable �
atcollateralrateX.15 0 . 00 ia. 0 . 00
19. TAXDUE................................................................................................................ 19. 4Z , 085 . i6
20. FILL IN TME OVAL IF YOU ARE REQUESTING A REFUNO OF AN OVERPAYMENT. �X
$Ide 2
� 1505610243 1505610243 J
REV-1500 EX Page 3 File Number 21-1$-00487
Dec�d�nYs Compleb Address:
DECEDENT'S NAME �
Oelschlsgel,Catherine G.
STREETADDRESS
325 Wssley Drive
Apt. 3132
CITY STATE ZIP
INechanicsburg PA 17095
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 42,083.18
2. Credits/Payments
A. Prior Payments 40,000.00
B. Discount 2,104.26
Total Credits(A +B) (2) 42.104.28
3. IMerest (3)
q. It Line 2 Is greater than Line 1 +Line 3,enter the dlfFerence. This is the OVERPAYMENT. (4) 19.10
Chaek box on Papa 2,Lim 10 M roqwsl a refund
5. If Line 1 +Line 3 is greater ihan Line 2,enter the difference. This is Ne TAl(DUE. (5)
Make Check Payable to: REtiISTER OF 1AIN.I,S,AGENL ___ ___
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedmt make a transfer and: Yu No
a. retain the use w income of the praperty transferred:............................................................................... ❑ ❑x
b. retaln the right to designate who shall use the property transferred or its income:.................................. ❑ �
c. refain a reversionary IMerest�or............................................................................................................... �� x
d. receive the promise for Iife of either paymenffi.benefits or care?............................................................ LJ ■
2. If death occurred after Dec. 12, 1982, did decedent transfer propeAy within one year of deaCi without
receivirg adequate consideratlon?.................................................................................................................... ❑ ❑X
3. Did decedent own an"in Wst for" or payable upon deaM bank account or security at his or her death?....... ❑x ❑
4. Did decedent own an irWividual re8rement account,annuity,or otlier non-probate propeAy which
contains a benefldary designation4.................................................................................................................. ❑� ❑
IF THE ANSWER TO ANY OF iHE ABOVE QUESTIONS tS YEB,YOU MUST COMPLETE SCHEDULE G AND PILE R/1�PART OF THE RE7URN.
Fa detes of dealh wi or atter July 1, 1994 and before Jan.1, 7995,the tax rate Imposed on the net value of transfers to or for the use of the surviving
spouse is 3 petcent[72 P.S.§8118(a)(1.1)(i)j.
For dal�of d�th on or atter January 1,1985,the tax rate Imposed on the net value of hansfers to a for the use of the survivirg apouse Is 0 percent
[72 P.S.§9118(a)(1.1)(II)]. The statute does rat exemD�a transfer to a surviving spouse from tax,and the sNalulory requirements for disGosure of
assets and filing a tax retum are stlll applicable even if the surviving spouse Is the only beneflciary.
For dates of tleath on w aker July 1,2000:
•The tau rate imposed on the net value of transfers from a de�ased child 21 years of age w younger at death to w for the use of a nalural parent,an
adoptive parent,or a stepparent of the child is 0 percent[72 P.S.§9116(a)(12)].
. The tax 2te imposed on the net value of hansfers to or for Me use of the decedenYs Ifneal benefwiaries is 4.5 percent,except as noted in
[72 P.S.§9118(a)(1)1.
.The tax rate Imposed on Mre net velue of Vansfers to or for the use of the decedenPS siblings is 12 percent[72 P.S.§9118(a)(1.311. A
sibling is defined under SecHOn 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoptlon.
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STOCKS & BONbS
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INMERITMICETNIRENRN
RESIOENT 0!ClOEIlT
ESTATE OF FILE NUMBER
Oelschkpel Catherine G. 21-13-00497
NI propMy�olntlyownM wNh rlpM ol sunivonhlp mwl W tlMCbwd on SeMduM F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 322 Shares of Wells Fargo Stxk 12,083.10
TOTAL(Also enter on L1ne 2,Recapitulatlon) 72.083.10
�rc moro eaece is neeaea,addroonai Payee m me sema duJ
Copyright(c)2002 fortn soflware oMy The Lackrrer Group,Ina Form PM7500 Schedule B(Rev.6-98)
a..�nwe ex.��i.to�
� SCHEDULE E
CASH, BANK DEPOSIt3, 8� MI3C.
PERSONAL PROPERTY
canrcnormeurn oc rEr�HSVw,wi�
INNEpRMICETNlRETUNN �
RE8IDENT pECEOEM
ESTATE OF FILE NUMBER
Oelschiegel, Cathe�ine G. 21-13-00497
i�d�ame raceaasaimgaaa,.�ameda�emeo�awaercca�dnymee.me.
NI proparyjoPMly�mvnM wXh IIM rlpM N�urvhonNp muR b�tlhcbrtl on whMUM F.
ITEM VAIUE AT DATE
NUMBER DESCRIPTION OF DEATH
7 MetLifs—Lif�Inauranu proceeds—not taxable-538.87 0.00
2 Rstund of Health Ins.Promium 37.20
3 Verizon Refund 9•27
4 WsaMeld Insurance REfund 8.00
5 NNd-Penn Checking Acct 77000880 128,B58.15
8 Net recelved irom items aold at auetlon 703.35
TOTAL(Also enter on Line S, Recapkulatlon) 129.315.97
(H mora space Is needeE,adtlitionel papas W the same alze)
Copyright(c)2010 fortn soMvare only The Lackner Group,Ina Form PA-1 S00 Schedule E(Rev. 11-10)
Rw-760B E%+�07-70)
SCNEDULE F
�„„,E„�,„�,�„,�n�µu JOINTLY-OWNED i'ItOPERTY
iH�trtu+csrrocnenNw
qesroedrceCecexr
ESTATE OF FILE NUMBER
Oelschlegel Catl�erine G. 21-13-00497
M�n uM wp m�MJoinl wMYn wr Y�of iM dw�MMY Mb of EuN.M mirt M npoMd on t¢MtluM a.
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
A Norman E Oelschlegel 2269 Concord Cirole Brother
HaMsburg, PA 17110
B.
C.
JOINTLY OWNED PROPERTY:
DESCRIPT�ON OF PROPERTV ^/o OF �^TE��T„
ITEM LETTER DATE INCLUDENAMEOFFlWWCULINSTtMIONANDBANKACCAUNT DATEOFDEATH pECD'S DECEDEM'S�NTEREST
NUMBER FOR JOI MADE NUf.BEROR SIMILAX IDEHfIFVING NUMBER.ATfACH DEED FOR VALUE OF ASSE INTEREST
TENANT JOINT JpINTLV-HELD REAI E3TAlE.
t A HH Savings Bornls--see altached Schedule 11,000.00 50.00 5,500.00
TOTAL(Also erMer on Lirre 6, Recapkuladonl S.S00.00
(M rtwre space Is needeE,atlditlonel pagas of the seme alze)
Copyright(c)2010 fo�n sothvare only The Lackner Group,Inc. Fortn PM1500 Schedule F(Rev.01-10)
Rw-7510EX4�0!-0B) scH��u�e o
� INTER-VIVOS TRAN3FERS AND
MISC. NON-PROBATE PROPERTY
cow.ionweu.TM os v�msnv,w i�
irwEwru�rnx neiuw+
R¢SWENIOECEOEM
ESTATE OF FIIE NUMBER
Oelschlegel CatheHne G. 21-13-00497
This acheEule muat be canpleted antl flled if Ihe enswer lo any M quesllone 1 Mrough 4 on Oage throe of the REV-13001s yea.
ITEM DESCRIPTION OP PROPERTY DATE OF DEATH �oF oECO�s �CLUSION TAXABLE
NUMBER TM�pq�p'��T�g�a.�n�n�cNnECOrv��EEDFO��n°EeM.4TniE. VALUEOFASSET ��RE� OFAPPLIGBLE) VALUE
1 Fox ChaaelRA 55,070.88 55,010.88
2 Washington Savings IRA 76,783.59 78,783.59
3 PNC In Trust for Norman E.Oslschlegsl and Lawrenee 7.029.68 1.028.68
E.Oelschlegel-CD 31300335242
4 PNC In Trust for Norman E.Oslschlegel and Lawronce 20,312.55 20,312.SS
E.Oelschlegel-CD 31800334034
5 PNC In Trust for Norman E.Oslechlegsl and Lawronce 10.047.82 10,047.62
E.Oehchlsgel-CD 3180033170
8 PNC In Trust for Norman E.Oslschle�l and Lawrenee 34,457.45 34.457•45
E.Oslsehlegel-Checking 5004894374
7 PNC In Trustfor Norman E.Oslschlsgsl and Lawronce 38,581.94 39,581.94
E.Oelschlegel-Savungs 5004894489
TOTAL(Also enb�on Llne 7,Recapitulatlon) 237.233.71
(H rtare sPece Is neadett�atltlltiorial pages M tha same size)
Copyright(c)2009 form soitware only The Lackner Group,Inc. Fortn PA-7300 Schedule G(Rev.0&09)
REV•7737 EX+(10-0Y)
sCHEDULE M
FUNERAL EXPENSES AND
�� .�•�'��A ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Oelachleyel,Catherine G. 21-13-00497
DecedenPs debts must be repmtsd on Schedule I.
ITEM DESCRIPTION AMOUNT
p, FUNERAL EXPEN3E3:
See contlnuatlon schedule(s)attached 73,es9.38
B. ADIYHNI8TRATIVE CO3T3:
1. Personal Representative's Commissions
Name of Persaial Representative(s)
Street Address
City State Zio
Year(s)Commfssion Paid
z, nnornev�s Feea Cunningham �Chernicotf, P.C. 12,000.00
3. Family Exemptlon: (If decedent's address Is not the same as daimanPs,attach e�lanatlon)
Clalmant
Stroet Address
City State Zio
Relatbnshio of Claimant to Decedent
4. Probate Fees 373.50
5. AccountanPa Fees
6. Tax Retum Preparers Fees
7. Other AdministraUve Costs 225.00
See cor�Hnuadon schedula(s)attached
TOTAL(Also enter on Ilne 9,Recapitutalion) 28,458.08
Copyright(c)2009 tortn software only The Lackner Gmup,Inc Form PM7300 SchedWe M(Rev. 10-09)
scH�ou�c H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OP FILE NUMBER
Oelschlegel Catharine G. 21-13-00497
ITEM
NUMBER DESCRIPTION AMOUNT
F m�rsl nanaas
1 Luncheon-Irish Rover 152.89
2 Malpsui :Punsral Homs 72.258.89
3 Our Lady of Grocs Csmstary ��450•�
H-A 13,859.58
Oth�r Adminiatratlw Custs
4 Legal Adv�rtlsing-CW 75.00
5 Legal AdveMsingJoumal 150.00
H-67 225.00
Copynght(c)2002 torm soNware only The Lackner Group, Ina Form PM7500 Schedule H(Rev.E98)
R�v.1513 E%+(77-08)
� scHe�u�E i
DEBTS bF DECEDENT,
�������µ��
MORTGAGE LIABILITIES AND LIENS
���„�r��,�,�,
������
ESTATE OF FILE NUMBER
Oelschlegel Catherine G. 21-13-00497
RWnR aMb IneWnd 4Y tM A�cM�M P��lo MN�MH�Wmd unOMa H tlM a�b d tlxth�InCludln0 uMFnbuetM mMle�l�apxNM.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OP DEATH
1 Bethany Vlllage 2.358.80
2 Capital Cardiovascular 102.89
3 Check#183 PNC Acct—for Bethany Village,writtsn on April 8, 2073 and eashed after DOD 2.449.75
4 Cheek f1184 PNC Aeet—for Bethany Village,writbn on April 9,2013 and cashed a(�r DOD 1,482.00
S Pinnacle Hsalth 558.00
8 Verizon 17.80
TOTAL(Also sntsr on Llne 10,Recapltulation) 8,985.04
crc mo�e sw�e is neeaea,addmonai�a�ea a nx same s�ze)
Copyright(c)2008 fortn soTlware only The Lackner Group,Inc. Form PM1500 Schedule 1(Rev.12-08)
flEY•teY3E%�(m48} �
scH�ou�e �
�°""� , ���Y""'" BENEFICIARIES
ESTATE OF FILE NUMBER
t3etsch ,GaHwrine G. 21-93-00447
NAME AND ADDRESS OF RELATION3HIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUM9ER pERSON(Sl RECEIVING PROPERTY DECEDENT (yyorrls) (ES$)
I TAXASLE DISTRtBU7tpNS [inGude ouUight�ai
distribUtbns,arrd tran9fefS
under Sec.911 a 12
No►man E.Oalschlegel Brolher All
22�Cone�d Clrcle
Harrisburg,pA 17110
�awronce E.Oelschlegsl Brothsr Nonalntarest
140 faculty Lane dlscFaitr�
Romeorille,it 8UM8
j
Total
ler ounb far dishibutlons sFwwn eDpve on Ilnes 15 16 on Rev 1 as te.
NtSN-TAXABI£DISTftiBUTkIX+iS:
II. A.SPOUSAL DISTRIBUTtONS UNRER SECTION 8113 FAR WtIICH RN£LECTIt7N TQ TAX iS NOT TAKEFi
8.CHARITABLE ANO t�7VERNMENTAI DISTRIBUTI4NS
TQT P. -ENTER TOTAL NON-TAXA6lE O45TRiBUt{ONS tN1 I.INE 13 t7F REV-t�k'}C4VER 3MEE
Copyright(c)201 Q form so%ware only Trie Lackner Group,Ino. Fortn PM1ki00 Schadule J(Rev.Ot-10)
_ _ , __ ,_ .
.
Y \
LAST WILL AND TESTAMENT
OF
CATHERINE O. OELSCHLEGEL
Dated thia day_��?�of _ __, 1996
�
�
} •
M �
LA3T W2LL AND TES7AMENT
OF
CRTNERINE O. OELSCN�E�6L
F� CATHERINE 0. aELSGHLEOE�, a resident of a�d
domiciled in Philadtlphia� P����yivania� makey publish end
declarr thi� to b� my �iat Will and Teatament, rsvoking all wills
a�d codicils at any timo herstafor� mad• by m�.
�IRST� I direct �hnt th• expanses of my Yast i11nQS�
a�d funaral � the �xp�ns�s af th� administrat3on of my estate, and
all e�tata� fnheritance and �imil�r taxea payabla wfth r�spwct to
prop�rty included in my estate, whathar or �ot pasaing und�r this
will , and ��y interest or pe�alties theroon� shall be paid aut of
my r4s3duary est�t�, wfthaut appartfarsment and with no rfght af
reimbursement from any recipient of any such propsrty.
8ECONDt I giva� d�visa and baqueath aII thr r�st,
residuo and remeinder of my proparty and estate, bnth real and
pgrsa�al , including any real eatatQ and haus�hold co�tants of
p�emists commonly knawn as 17i5 Bri22 St�e�t� Phi2ad�2phia,
P�nn�ylva�ia, ii any� and all othwr propQrty and a�tatw of what-
evar kind and whwrevar located, that I own or to which I shali be
in any mann�r entitled at thf tims of my dfath {collactively
referred to as my "residuary estate"}, as fc3lowss
€�3 If my �roth�r Narman E. Oelschl�q�l a�d my brather
�awrence E. Delschleg�l or �ither of tham �hali aurvive
me, tn thosv of my brother Norman E� O�1�ch1Rg�1 and my
brothar Lawre�co 6. Oel�chl�gsl wha survive ms, in aqual
sharos.
4b) If none of the beneficiarios under clausa {a)
a�ove shall eurviv: mw�y my rasiduary e�tate shail be
paid �rtd distribut�d to tho�� af my n3�cg Martinr
DaLorrnzo Ang�loni , my niec• Euqonia DeLorenzo, my
niecQ Tereffia DeLorenzo 7rza�ka� my niece Francine
De�or�nza �nd my nface Carolyn Be�oFenzo wha �urviv�
me, in equal share�.
7MIRDt If a�y prop�rty of my estate vRSts fn absolute
nwner�hip in a minor or incomp�t�nt, my Executor, at any tima
and withaut court authorization, maya distribut� th� whole or
�
���
.* • ' ,
any part of such property to the beneficiary� or us� the whol� or
any part for the health, education, maintenancQ and support of
the beneficiary; or distribute the whole or any part to a
,�uardian, committet or other legal represantativa of th•
b eneficiary, or to a custodian for th• baneficiary undar any
gifts to minors or transfsrs to minors act� or to ths parson or
perso�s with whom the beneficiary residas to uss for th•
b eneficiary. The recQipt of the perso� to whom the di9tribution
is so mada shall relaase my Executor from any liability with
r espect thereto, even though my Executor may 6e such porson. If
such beneficiary is a minor, my Ex@cutor may daf�r thv
distribution of the whole or any part of such property until ths
b eneficiary attains the age of twonty-one {21} yoars, and may
hold the same as a separate fund for th� benaficiary with all of
the powers dascribed in Article FIFTH hereof. If th• bQneficiary
dies hefore attaining said age, any balance shall be paid and
distribut�d to the estate of the beneficiary.
FOURTH� I appoint my brothar Norman E. O�lschleqel �
curre�tly of Harrisburg, Pennsylvania, initial Exacutor of this
will and my brother Lawrence E. Osischlegel , currently of
Romeovill�, Illi�ois, as 3ubstituta Executor of this will . If my
initial Executor �hall fail to qualify for any resson as Executor
or, having qualified shall dia, rasign or cease to act for any
reaaon as Executor, my Substitute Executor �hall serv� as my
ExQCUtor. I direct that no ExQCUtor shall be r�quired to fila
or furnish any bond, surety or other security in any
jurisdiction.
FIFTHt I grant to my Ex@cutor ali powers confwrred
upon axecutor� wharever my Executor may act. I also grant to my
Executor power to retain, s�ll at public or privata aalo,
exchange, grant options on, invest and rainvost, and othmrwise
deal with any kind of prop�rty� real or personal , for cash or on
credit� to borrow money and ancumber or pledg• any property to
a�cur• loa�s� to divid� and distribut� prop�rty in cash or in
kind� to exercise all powers of an absolute owner of property� to
compromise a�d relQas• claims with or without considvration� and
to ��nploy attorn�ys� accountants and othar p�raons for sarvicea
or advist. The term "Executor" wherevar used herein ahall mean
the exQCUtor, executrix or administrator in office from time to
t i me.
3IXTH: I direct that for purpos�s of this will a
6enaficiary shall be deQmed to pred.cQase me unless such
beneficiary survives mf by more than thirty days.
C�
IN WITNESS WHEREOF, I, Catheri�e G. Oelschlegel , sign,
seal , publish and c�re this in trument as my la�t will and
testamsnt this _ ��p___ day of �-� _ , 1996. I also have
affined my initial� on the bottom o• f eath of the preceding pages
h er eof.
���yEt2[�iLO� l�,�p@I� 3.
Cath�rine 0. O�lschlegal
The foreqoing instrument was signed, sealed, published
and declared by Catherine G. Oelachlegel � the above-named
Testatri�c , to he her last will a�d te�tament i� our presQnce, all
bein� pr�e�nt at the same timQ� and wo, at her request and in her
presance and in the presenc• of each other,hava �ubscribed our
names as witness�s on the date abova written.
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ACKNOWLEDGMENT AND AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA, COUNTV OF PHILADELPHIA� 88. �
/��� �(athf�i}�� 0. Oelschl�gsl and /!�aa,!� _____
and �_yCL1�. �`...Lj�t�� � the Tastatrix and the wi essvs
r espe lrively, fvhose names are signed to the attachod or fors-
�oing instrumant, being first duly sworn, do hareby dsclar• to
the und@r5igned authority that tha Testatrix, Catha'!n� 0.
Delgchlegel , signed and executQd said instrumont as h�r last will
and testamant in the presence and haaring of th• witnrss�s� and
thwt she had signed wiliingly, and that she execut�d it as her
f ree and voluntary act and deed for thQ purposes th�rain
expressed, and that each of the witnesses at the rsqu�st of tha
Testatri:� , in the preaance and hearing of the T��tatrix and each
other, sig�ed the will aa witne�s� and that to th• best of his or
her knowl�dge the Testatrix was at tha tim• at laast •lpht�en
yeara of ago, of sound mind and und�r no constraint, duress�
f raud or undue influence.
� - ---------� - �-- -----
atharina 0. Oelschloge�
Tastatrix
_ li�uiS'��_°__.�_. (gign)
��1LG�!�i � dGS�s!�__ (print)
Witness � --
_.�����������.�`c4"`� -------(s i g n)
WitnQSs
�1---� '..Cli�,�------(p r i n t)
Subscri6�d, sworn to and ack�owledg�d b�fore me by the
said Catheri�e f3. Oalschlegel , Testatrix, and aub$cribad a_nd
swor to b�forv me by the above-named witnesses� this__r�T4_day
of ,�.�___, 1996.
---- -- -�-- -- ------
Notary Public
My commimsion expires on � ' ` 1 �.
�
NOTARFN.9EAL �
ELLA M.NYAN.Meb!Pulb
Cly d PIW�dMpWb PIW�.CawMy
Cam�loe Eo b Mrah 1 tif7
5
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;,�:� c:c,tPY FHOM FiEGOEiD
fn (estNriofly wMfOf, 1 ft�flMUlb�
( Of eSSit�yGOtNt C.�1�1l,�� � , .
7 is?diryl
CkNk oF#N O RItN1R ' � � .
IN ltE: ESTATE OF : lN TFIE COURT OF COMMQI�Ml��'�°tMi1►f •
CATIiER1IVE G. OELSCHLEGEL, : CUMBBRi,AND COUNTY, PENIV3YLVAy[A
Deceased .
: N0: 21-13-0497
Narman E. Oeisch(egei, Executor . � �
: ORPHANS'COtT1tT DIVISI{��y �,;, �, ar
� mb c � o
� � � = cn �d
ABSOLUTE t1ISCLAIMEi2 = c�' � v :,..=' a
�
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WHBfCEAS, Catherine G. Oelschiegel, (heroinut�er referred to as the"D�edentr , theiEac,
�7 :._ h�
� G� O
resident of 325 Wesley Drive,Apartment 3132,Lower Allen Township,Cumberland C�nty, �t
Commonwealth of Pennsylvania,died on April 1 Q 2013;
AND WHEREAS,on April 3d, 20i 3, Decedent's brother,Idorman E. Oelsehiegei,applied
ta{aad wss granted by}the Cumberltutd County Ragister of Wills for Letters Testamentary in
accordance with'fhe Pennsylvania Prpbate, Estates and Fiduciaries Code("PEFC(7DE'� in that
Decedent died testate;
ANI} WHEREAS,purstrant to the PEFC{}DE, L7ecedent's iirother,LaFmYSCt E.
Oelschlegel, the undersigned, who resides at 110 Faculty Lane, Romeoville,Illinois, would be
endtled,pursuant to the PEFCODE and under the Decedent's Will, to a portion ofthe Estate of
Decedent.
WHEl2EA5, tha Decedent's brother, Lawrenct E. Oelschlegel, wishes:
L To hereby disclaim his entire interest in�ll of tho aforesaid estate and assets and
any oiher assets there rnay be ia which Decedent hcld an interest at the time of her
death and which formed part of her probate ar otherwise tarcable estate for
inheritance and death ka�c purposes or which aue reportable for inheritance taac
��.
purposes, whether ur nut tu:cable, including, but not limited to, two (2) (RA
Accounts held by For Chase Bank and Wssahington Savi�gs Sank; and
2. Ta state that ha has not heretofore recoived or accapted any benefit from said
assets.
NOW TFIEREFORE, pursuant to the PEFCQDE,20 Pa. C.S.A. Saction b20T et.seq.,Thc
Pennsyivania lnhcritance and Estate Ta.c Ac#,72 P.S. Section 9116{c)and Section 2528 ofthe
Internal Revanue Code, and su►y and all other applicablc law, the undersigned, Lawrence E.
Oel�chlegel, without sonsideration, doea irnvocably renounce and disclaim his interest in a!1 of
the aforesaid assets, togethor with any asnd aiI income earned thereon wfsether hefarc the date af
Deccdent's death or theroafter.
The undersigned further request the Clerk of the Orphana' Court Division of the Court of
Com�non Pleas af Cumberland Caunty> Cammanwealth of Pennsylvania,to�cegt and fila this
Absalute Disclaimer. The undersigned specifically irrevacably waives any sind all pnwers which
he may have to revoke this tlbsolute Disciaimer. FuRher, the undersigned has read this Absolute
Disclaimer, signs it voluntarily and�vithout duress, states thut he hns had an opportunity to consult
counsel prior to signing and intends to be legally bound hereby.
Ds►te: �/ � 1 /J
La nce E. Oelschlegel
STATE OF ILLINOIS )
) SS:
COUNTY OF "W`'�'�' )
On �/lI�-�,.oZ/, 02(11_.�_—, z013, before me personally appeared Lawrence E.
Oelschlegel, kno to me to be the person who executed the forogoing instrument, and who duly
acknowledged to me that he executed the same.
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�����
IMIIp R�I�iN B�iK
May 30, 2013
Cunningham & Chemicoff, PC
Attomeys at Gaw
PO Box 60457
Harrisburg PA 17106-0457
Re: Estate of Catherine G Oelschlegel
Date ot Death: Apri110,2013
SSN: XXX-XX-6559
Dear Mr. Warshawsky:
In response to your recent letter requesting information on the accounts of Catherine G
Oelschlegel, I have accumulated the necessary data below:
Account Name: Cat6erine Oelachlegel
Account#: 170008b0-Checking Account
Date Opened: May 6,2008
Balance DOD: $127,53339
Balsace Accrued Intereet DOD: $25.16
Totsl DOD Balance: 5127,558.55
Date Joint Ownero6ip Established: N/A
If you have any questions, please contact me at(71� 896-5388.
S�'y,
(�t�— I�`�
Karen Tarbeil
Deposit Support Specialist
349 Union SheN, Millenburg, PA 17061 • 1-866-642-7736 • midpennbank.com
AAember FDIC
���T f„/'�e Mntropolitsn Wfe insurutce Campany Notice of Ciaim Faymest
erlrnsc nt�r oau�na�a
500 SCNOOLHOUSE AOAD
JOHNSTOWN, PA. 15915
NAME OF DECEASED DA7E OF DL=ATH OIST PHONE NIJMBER
CBTHERiHf G. (1FtCCHi_FGF! � {bt0} 348-0100
�,�*oTP**�
BRUCE J WARSHAWSKY ESQt1IRE
CUNNINGHAM AND CHERNTCOFF P C
232Q NORTH SECOND STREET Pleaae9aeIarportutNoticsoaRersrae9ids
HARRISBURG PA 17110
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BELLER3 NAME d"n"Qn 8 � DATE iA�j
ADDRE33 °?°Zl" �?"� PHONE 3��
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AUCTION DA'CE/LOCATION CLERI{ %
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`� �� f�� �
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Lesa Sa1e Expenee:
�^%Gommise�on Auctianeer � ��' f.Z_' --"
9b Coaunisalon Glerke E
QTHER: /J�a.�.�Gc.,i.Z� �� �S''r,,r-
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BELLERS NET$ � o � �
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Settlament Pdorm�a�7 0� lschlegal 657 �:;F9 Paye : 1
Seller: �
c�G9 Conc:ord Cr.
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- -- -------. .._.___.--__ ____ . _._.___._._._ + __ ._ _ _�:. iTO---
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- ,ieassuck ;
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- Mi.rrar/recliner ' ^c. 00
-- �nd tabla 1 ic^. iDO
- Co�.tntry table t 15. 00
3et oP bl�ae r_hair^s 1 �0. 00
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- Cedar chest -Qu?�n f�nn � 7Q, ��
- LJat �ar-°all �ani.ty R. ctool 1 �. 00
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- Sewiny inachine c�binet , 1. 00
- Round mirrar i �0. 00
- Desk 1 17. 50
- 2 pc. bedr•oom set 1 190. 00
- 3 pc. coFfee ta6;e ❑et 1 1. 00
- Single mattr-ass set/ Fr�aine 1. 11N. 00
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Iteins : 21 Aino�,tnt : 1, 1�9. ��0
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��SS adj�_i;tment5 : -.j98. F�5
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DON JAC0881N8 Si4RVICEB INC
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717�2-$4t10
Rasao�: CANCELLATIQF! OTt#6R
(naured's Namr. CATHERINE OEISGNLSGEt
Date Palicy Number Account Number Amount
O�t2Wt3 HOP �080187 37TW�ASIF001-Q0001� 6.00
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41M2 390 D6f�420pNi CATt�iE OEL8CNLEt�Et CR
1?MY2 S!DO 061i4�Od11N NORMAN OELBCHLEQ�L,
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June 6,2013
Cunningham&Chemicoff, P.C.
Attomeys a Law
P.O. Box 60457
Harrisburg,Pa 17106-0457
RE: Estate of Catherine Ci Oelschlegel, dxeased April 10,2013.
Account Number 240962886—Certificate IRA
Tide Catfterine C)Oelschlegel—Sole Owner
Norman E. Oelxhlegel—Bduficiary
Lawronce Oeischlegel—Beneficiary
Date Opened 10/OS/1992
Tide Changed N/A
Date Changed N/A
Principal 554,967.79
Interest to D.O.D. 543.09
Balance as of D.O.D $55,010.88
Interest from Ol/01/2013 to 04/10/2013 542935
Other:
Sincerely>
G�
eollan Geiger
Deposit Services !
510 E. Township Line Rd. Ste 200 • Blue Bell,PA 19422 • (215) 775-1436
I
Serving The Communiry Since f 903
June l2, 2013
Cunningham& Chernicot�; P.C.
Attomeys At Law
P.O. Box 60457
Harrisburg Pa 17106-0457
Re: Estate of Catherine G Oelschlegel
To Whom It May Concern:
C�therine Oelschlegel held one account with Washington Savings Bank at the time of her
death. fRA account numbcr 400007084. "fhe account is tided Catherine Oelschlegel [RA
beneficiary Norman G OelschlegeLThe account was opened on March 22, 2005. T'he
principle date of death balance is$76731.39. The acerued interest on the date of death is
$52.20. The interest from January l, ZOl3 to April 10, 2013 is $ 518.57. You will be
rcceiving a letter from our [RA department with instructions on changing the IRA into
Norman E Orlschlegel name. The contact name for IRA department is Irene Coia.
Sincerely
�`�
Meg Jusuti
Assistant Manager
2900 Comly Road, Philadelphia, PA 19154-2107
Q Phone: 215•698•9400 Fax: 215•698•1250 MemberFDIC
���� www.washingtonsav.com
A
y Jun. 3. 2013 1;35AM PNC eank No. 6102 P, 1
�,��
7me 3, 2013
C�moiagham�ClurmcoffP.C.
P O Box 60457
2320 N 2°�9t
HeQisbia�g.PA 17110
RE: Catberine OeLvohlegel
3SN: 203-16-6559
DOD: 04-l0-2013
Dar 3ir/Msd�on:
In reeponee to your nquest Eor Dabe of Da�eh(DOD)belances S�r the cu�toma aoted ebove.o�u
reoords ahow ihe following:
C�te ef Dspoti!
Account�t 31300335242 Eatabli�be�d: 10-09-2008
CATT�RIIQE QELSCHIrEaEL 1TF
NOICMAN B OffiSC�.EdEL
LAWRBNCE E OELSGHI.BQEL
DOD balanc�e: S 1,029.67+O.OI accrupd iater�t
Accouat�f 3I600334034 F.stsbli�d: 10-09-2008
•CAT'f�RIIdE OELSCfII,FAEL 1TF
NORMAN B OEL9Q�.EOEL
LAWitENCE E OELSCHLE(3EL
DOD bslance: S 20,312.44+0.11 eccxued iaterest
Aocount iF 31800333170 Establiehed: 09-23-2008
CATFIERIIYE OELSCHI.FAEL ITF
NORMAN E OELSCHI.EOEL
LAWR�NCE E OELSCHI.EGEL
bOD bstance: S 10,04538+2.24 scaned intaest
Ch�Aaaa�t
Acco�mt M 5004894374 F.�tabliaLed: 09-26.2008
CATf�RIIVE OELSCHLEQEL ITF
NOi2MAN E OELSCFILEGET.
I.AWRENCE B OELSCHLEC3EL
DOD belance: S 34,457.23 +0.12 ac�sued intmroat
Page 1 of 2
,
v Jun. 3, 2013 1: 35AM PNC eank No, 6102 P. 2
ssvmp Aaoant
Aa:o�mt�f 5004894489 Establiahed: 09-262008
CATHERIIQE OEISCFII.ECiEL ITF
NORMAN E OELSCHI+EOOF.L
T.AWRENCE E OELSCY�OEL
DOD belsoc�e: S 39,590.53+ 1.41 acctved'miereat
Flcus aas t�t thv officx providu d�of dath bala000e fa dep�t�oimdi(IRAe,CDe.Che�cn8 aud
savimp� w.da aok prea�ati�1 a�ctled or pe+a�We aataseat� Tf yoa med wi�mcs with
my of thme itema,Pleaee cv!1-iti-PNGBANK(1-88i-762-2265)or eoop by yaa local Pl�Bmlc breuch
omoe.
Si�seerety,
N'ffiia�l Finmcial Servicea Center
PNC H�nk N.A.
Memba FDIC
Tl�it n►srsogr/s biterdtd fa�the'we of tM f�ilviabmJ or sntlty to wldcl►it ts aadabesaed artd exay
co�rtuv� irg/'o►�io»t�rsPrTMteB�d ��+'�d�d�su�1�'aTr dtsdosm�s undar a�plicabl�taw.
lftlee reeia�a of tlkta me.tsage rs nnr rhr tnrenakal secipisrs or tbe s,�ploye�or agwr resporoibls for
deH�wing thtr messag�e to tia tntandnd ncipisnt.Yow are hereby rar�Jied d�a�t a,ry d�iwsnrfiwtion,
diserlburioro ar copyheg of rl�f�r conwnoqcatton�J�sfrtctlypsolitbtird b'yor have ncslved tMs
com�r+wdcml�an in error,pleaae xottfy me i�rneedlately by reply os by M/aplrovrs at 800-762-1775 m�d
inunedioYely dtriray rhit fated docununt.
Page 2 of 2
i
Our Lsdy of Grace Cemetery ,
1215 Super Highway•Langhorne,PA 19047
215-752-3244 • Fax 215-752-3242
�
I
Date April 17 2013 I
Interment of Catherine G Oelechleael I
In Section 5 RanBe a Piot � a Grave I! 3 At i .
Cemetery Charges
Purchase of New Grave s
Perpetual Caro s
Opening of Grave s-1�
Opening of Grava(3 R.or less) s
Temporary Nameplate s
Cemetary Tent s
Fowtdetion Fee for Monument S i
Other s
Total Psid S
Check Number 1 A s �_
i
Payment Received from '
Address
Name on Deed(Lot Hoidw)
!
Thank You, ti/
No�IM1N�,oa�Cw.Na 1138
�M� rmmf
IMl�wr. mtoaw ������� ae
O d , � $ /.2, �tSL�
T' �., 4 � �_-�.�-��� S�. 9�-�n�. e �
������
��� � /�
Far �Ll��D �iN'�M. C D�i+I�l�r
�:03L3 � 2738�: 5L � 2020367r ii38
...�.
. . Malpezzi Funera� Home
$ ���� � '
::�� c�t��,-.�
M P/►17oss www. ' �mm.tHome.com
Jan�y J. ,FD MkY�tl J.Ma�Ow�ey FD Krlt C. RD
A�xi122,2013
Norman E.Oelschlegel
2269 Concord Circle
Harrisburg,PA 17110
This is the fiial shtament for the funaral s�vicee of Catherine G.Oelschlegel
We sinc�rety apprecisLe the confidence ya�have piaoed in w md will continue to sssi�you in evary way.. --
%tOR[SBIONAL SERVICES:
Qu of town anupo�utlon 5175.00
SwicaofFunmal Diraclor/Statr s5.473.00
FUNBRAL HOML SRRVICL CHARG6S u,(�p,p�
SBLRCfLD MERCAANDISL:
Steel Cadcat 53,475.00
12 Chuge Rsgul:Steet Vwk $1,535.00
r+��� 573.00
TH�COBf OR OUR$CAVIC�B.6Ql1RMENT�AND MERCFANDISE
TNAT YOU HAVL S�I.�CfLD Slb,?35.00
CASH ADVANC64:
At tlw tLesfrnnd�raiga�a�tr woe wadR ws adv�ad certdn paynunp to oN�rs ar m��cosadatlon
7rie jollawing ir m�aaw�o�tb�ojthosr ch�g�er.
C�+e�Y��t STA0.00
Certiftad De�th Catifiptes 572.00
Newnqpor Noticd-Petriot SI99.89
Clerpr/Mttr Offering 5130.00
Or�n�s� SI23.00
Clappr for(haveside Saviee 575.00
Flowaa S230.00
Altv Servara 520.00
Monument Eng�avinQ Permit Fae SS0.00
Maiumait Eugaving 5380.00
TOTAL CASA ADVANG78 AND SrLC1AL CNAAGZS S1,S21.89
coKrw►cr e�ci s��s�.s�
TO'[AL AMOUMf DUR BY May 12,2013 slZ,i36.�9
[f you have a�ry questiona or concems roguding this bill,plesee cell our offtce�(71'n 697-4696.
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__ IRISH ROVER ___ __ __ _ . __ .
_ __ �.
28 W Lincoln Highway. '
_---_ ________ Pennde�A 1�147 , --- -----.-___ `.
(215) 757-]260
_ _ -------- -- _ . _—
Server: Brandy DOB: u�/17/2013
01:31 PM 04/il/2013 _ .. __----------_ _ _ _ _ __� _ ___---- _ _
-- — Table 24/1 I/10001
_- -- -- ---- ---
SALE -
_ ------_._..----- -- --
-----__ VISA
1048578
Card «ifXi(xNX�xXf(XX36%8
— - --- -__�_ ___ _ __ _.
- Magnatir, card preaent: Yes
Card Entry Method: S
Appro��nl: 612592
Amou�t: S 126.69
+ Credit Card 1ip:: _ , ZL
= Tutal: _--__/,'aT. �9 _ _.
I a9ree to Gav the above ----_._._�. ----------------_. _ . _.
total amount according to the
- ----. card issuer aureement. — - ---
Y ----�---...._.— ..--
TNANY YOI� _.__.._.-------- __
���ruS�omer � - ----
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------ _�C q�! _-- -- ------- --__, -_ -----
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--- � �----_... __ _--.-�
-- _ --- - --�._ _-
RECEIPT FOR PAYMENT
=3==�==='=s=====___
GLENDA FARNER STRASBAUGH Receipt Date: 4/30 2013
Cumberland County - Register Of Wills Receipt Time: 12 : 1 :43
One Courthouae Square Receipt No. : 1074003
C arlisle, PA 17Q13
OELSCHLEGEL CATHERINE G
E state File No. : 2013-00497
paid Hy Remarka : N�RM31N E OELSCHLEGEL
Receipt Distribution ------- ----—--'-"""'
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST 260 . 00 CUMBERLAND COUNTY GENERAL FUN
W ILL 15 . 00 CUMHERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 40 . 00 CtJI�ERLAND COUNTY GENERAL FUN
JCS FEE 23 .50 BUREAU OF RECEIPTS & CNTR M.D
AUTOMATION FEE 5 . 00 CUMSERLAND COUNTY GENERAL FUN
I NVENTORY 15 . 00 CUMBERLAND COUNTY GE�N�ERAL FUN
INH TAX RETURN
Check# 1137
-------$373 . 50--
Total Received. . . . . . . . . $373 . 50
_ __ _ _ _ _ __
I N V O I C E
1500 Paxton Street
JOURNAL Harrisburg,PA17104 �„�„
M U LT i M E D I A T.717-236-4300
F.717-236-6803 ORDER IL• 90064
www.journalmultimedia.com TEpMS; NN 3p p�ys
iNVOICE TO ADVERTISER
Cunningham 8 Chemicoff, P.C. Cunningham 8 ChemicoH, P.C.
Ac�unta Peyabie
P. O. Box 80457
Harris�urg, PA 17106
iervaarro:�aw.us..
DESCRIPTION Of CHAROE8 COST � CREDR � BALANCE
PUBLICATION: CLASSIFIED/CENTRAL PENN BUS.JRNL
COVER DATE: 8I7/2013 THEME: CLASSIFIED AD/CENTRAL PENN BUSINESS JIX1R
RATE CARD:
DE8CItlPT10N OF AD:
Legd lieting: Eatate of Catherine G.Oalschlegel
REP�B):
MARKSUNDAY
SIZE: LEf3A1.LISTING, PAOB: 150.00
. COLOR: %W 0.00
SPACE 8U&TOTAL: 150,
' BM.ANCE IX1E: 150.00'�
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cu���vi�o �,aw,�ou�a��t�.
32 SOUTH BEDFORQ 8TREET
CAR�{SLE, PA 17013
Tslr. t717y 2+l0.8186 Fs�c i71T)2�Y-2Q0�
dune 7, 2013
Cumbertand Law Joumaf ia publiahed every Friday by the Cumb�iand County
Sas Associ�ian and is designated by the Court of Cammon Pleas aa the offidal legsl
pubficatian far Cumberland Courtty and the lega! newspa�r far pubHcatian of lepa!
notices.
TO: Bruce 3.Warshawsky, Esquire
RE: Catherirt�e G. O��legel Estate
l.egai adveRisements must be received by Friday Noon. All legal adverNaln�
mua#be paid in advance. Make ali checka payable to: Cumberland �aw JoumaL
__�ffi�==-a�====��===s��===_��=_=_�=____ffi====�a===s��:==__*�=___��==_
Advertiaement inserted on the foilowing dates:
May 24, May 31, and 3we 7, 2013
AdveRising Coat $ 75,00
Proof of Publication ffi 0.00
Secarxi Proof R+dqt�st $ 0.44
Payment raceived $ 0 .00
Tatal Amount Dus S 76•00
�sastuaas�
Paymerrt teceived by
( T�o'tal B�nking Statement
' r..w p.d.��ae�srs�ta a wa���
C�For 24hour intormatbn,siqn onfo PNC BankOn4im Bankiny CATHERINE OELSCl�.EGfL t7F�C4
�—''�on pn¢.pom. Primsry acoaunt�wm6x:50�04BaC3?4
AecouM nuwMn 51WU4tll1-4Y7#•coniva�ucl Pap�2 of 4
�s�� As of 04/24,a!WI of{.M91n iM4nrt war
anmuM PNpnlayM tiumM at�ys Awnpil eeihetW im�t PaN Pxki Mi�Yqt.
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paM AmsuM awoNa+� toaunq f��.lts.N.
fk1/UY 1��,517.2N Dnpoul Refnrencn Nu. Ci$96WN`:�1
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Pynnuk R�aiv�d(3I18/2013) -1�581.00 � .
1lZ013 13 MoMhly Servk.�Fee 1.00 M 7,482. 1,�82. 51,482.
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TOTAL
TOTAL RESIDENT RESPONSIBILITY s����
* �1SBURY
�ETHANY STATEMENT P�� � °� �
VILLAGE � .,�„� 2� �,3
Anticipate More
325 Wesiey Drive .
Mechanicsburg,PA 17d55
OBJ'43/2Q13 50.00
Notmaut Oeischiegei � �
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Harrisburg, PA 1'1110 . OelschlagN, Catherine
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PLEASE DE"CAGH AND RETURN UPPER F4RTION REMITTANCE
OelschlegN,Cetherine Bethany Vii -Ths Osks 08108120i3
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Pbsae c:ontsd JemrdFsr 81ack�7�17-5$1-8025 wiHt bi�ing qt�stiona.Thenk youi
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p�t�hieget,Getha�� Bethsny Uliage-The Oaks 4510?t2413
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Peyment Received(4l1212013) -967.'7 $1,A82.00
Payment Raceived(4/25ML013) -1,482.00 $0.00
13 1012013 12oom a�BoBrd 8.00 Day 347. 2,458. $2.458.OQ
112t113 l0212013 MedicareAlMC HMd Coinsursnc� 2.OQ Oay 148. 296. $2,T52.�6
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Oe�chlegel, Catherine Independent Living 05/07/2013
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3/312013 a ance orwar .0
Payment Received(4/12/2013) -2,984.00 -$1,482.00
Payment Received(4/25/2013) 1,482. $0.00
1Y1013 /30/2013 Monthly Service Fee 3952 -$39520
7his credit has been applied to your
Skilled (The Oaks)account.
Please contact Jennifer Bladc at 717-661-8029 with billing questions.Thank you.
TOSAL
TOTAL RESID�NT RESPOtVSIB4LITlf -sa�.s
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�gwc Z353alth Sospital
Harriebnr9� PA 17105-2353
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paymente maY be made b7f returain9
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Sincerely,
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Financial Covas� �Dartment
p�t�ent Acc�
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