Loading...
HomeMy WebLinkAbout01-13-15 (3) 1505611101 RI x °Z-'I' EV-1500 " lvania OFFICIAL USE ONLY PA Department of Revenue Penns y Bureau of Individual Taxes County Code Year File Number PO BOX28o6oi INHERITANCE TAX RETURN (9-113 Harrisburg,PA 17128-o6oi RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 1 0920I 4 1 22s 27 Decedent's Last Name Suffix Decedent's First Name MI K 1 5 :51 NGE R C' RA RL 6TTE D (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return O 2.Supplemental Return Q 3. Remainder Return(Date of Death Prior to 12-13-82) O 4. Limited Estate Q 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) 4W 6. Decedent Died Testate O 7.Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number CO REY D K 1 SS i N GER 4 84 18S g580 REGISTER OF WILLS USE ONLY ry First Line of Address n cr-r rr 122 COOKS GLEq RD S Second Line of Address 0C') a. W City or Post Office State ZIP CodeDATEF.ILED n ._a n SP 'R. M I �� G TY '� � 1 q4 7s95 � CD r- I n (� `-1 ( Q Correspondent's e-mail'address: Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the personal representative.is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE / `2— A5 ADDRESSr !� /!")O KS CLL 0 S PR 1/ C jV PA jgy7s SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505611101 1505611101 J Y J 1505611201 REV-1500 EX Decedent's Social Security Number Decedent's Name: RECAPITULATION 1. Real Estate(Schedule A). .. . .. . .... . ... .. . ... . . ... . ..... .. ..... .... .. 1. 2. Stocks and Bonds(Schedule B) . .. .. . . ... .... .. .. ..... .... .. . . ... .... . 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) .. ... 3. . 4. Mortgages and Notes Receivable(Schedule D) .... ..... .. .. .... .. ..... . .. 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E).. .. .. . 5. ( 1 7 Q 6 7-' S 6. Jointly Owned Property(Schedule F) p Separate Billing Requested . ..... . 6. - 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested.... .... 7. 2- 1 0 O .y 8. Total Gross Assets(total Lines 1 through 7). ... .. .... .. .. .. .. .. . .... . .. . 8. ( �) V l/,l 6 q-43 9. Funeral Expenses and Administrative Costs(Schedule H). ... . .... .. .. .. . ... 9. 10 2-5-8 - 23 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1). . .... .. . .... . . 10. 11. Total Deductions(total Lines 9 and 10)... . .... .... . ... ... . .. .. .. .. .. .. . 11. 2- 0 4 6 0. T S 12. Net Value of Estate(Line 8 minus Line 11) . .... .. .. ... . . .. . . .. . .. .. .... . 12. 1 17 6(:) b. 9 8 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which _ an election to tax has not been made(Schedule J) .. . . .. .. ....... . .... ... .. 13. /+ 8 C� C-1pp ,14. Net Value Subject to Tax(Line 12 minus Line 13) .. . . .. .. .... .. . . .. . . .... 14. ( -7 (S O - 1 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.0_ 15. 16. Amount of Line 14 taxable + - at lineal rate X.0!9--5 ( 17608 . 98 16. . 4 0 17. Amount of Line 14 taxable at sibling rate X.12 17. 18. Amount of Line 14 taxable T at collateral rate X.15 - 18. QZ- 4 i. 19. TAX DUE .. .. ... . . .. . .. . ... . :... ... . .. .. .. . . .. .... .. ... . .. .. ... . . .. 19. 57 2 ( 2- / V 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505.611201 1505611201 J REV-1500 EX Page 3 File Number 20 (q- - 0 /13J Decedent's Complete Address:/' ] �//� L 1�f� DECEDENT'S NA1S WT T' D K 15,5/ STREET ADDRE L 5§)fit H CIRCLE ROOM 303 CITY STATEZIP m �C�Am 1 C5 BUR(- PA 170 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 5 2q2,,Z10 2. Credits/Payments A.Prior Payments B.Discount n 2 26 / �Q2 Total Credits(A+B) (2) 3. Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 5027-76 Make check payable to: REGISTER OF WILLS, AGENT. a .�. ., , >r:. t -part.:•", 3:T.' k..is .! �`.�i: j +A"'-t ..X , 7 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes ' No a. retain the use or income of the property transferred.......................................................................................... ❑ 9 b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ c. retain a reversionary interest.............................................................................................................................. ❑ 9 d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ 2. If death occurred after Dec.12, 1982,did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................................. ❑ 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ 9 4. Did decedent own an individual retirement account,annuity or other non-probate property,which containsa beneficiary designation? ........................................................................................................................ ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND'FILbT AS PART OF THE RETURN. For dates of death on or after July 1, 1994,and before Jan'1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a'surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S. §9116(a)(1.3)].A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-1508 EX+(o8-12) pennsytvania SCHEDULEEI DEPARTMENT OF REVENUE ' CASH, BANK DEPOSITS & MISC. INHERITANCE rax RETURN PERSONAL PROPERTY . RESTDENT DECEDENT ESTATE OF: FILE NUMBER: CHARLOTTE D KISSINGER 2014-01131 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship,must be disclosed on Schedule F.- ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH !SAVINGS,0413.02007 FULTON BANK,.P,O.BOX 4887,LANCASTER,PA 17604 533.35 2." ;CHECKING`040745744 FULTON BANK,'P.O.BOX 4887,LANCASTER,PA 17604 8,330.29 3.' SAVINGS 0000518233-0000 MEMBERS 1ST FCU,P.O.BOX 40,MECHANICSBURG,PA 17055 5.00 4• MONEY MNGMT 0000518233-0005 MEMBERS 1ST FCU, P.O.BOX 40,MECHANICSBURG,PA 17055 107,431.13 1 r 5. CHECKING 0000518233.0011 MEMBERS 1 ST FCU,P.O.BOX 40,MECHANICSBURG,PA 17055 673.35 6. CASH 94.83 TOTAL(Also enter on Line 5, Recapitulation) $ 117,067.95 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+ (12-12) -L] pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER CHARLOTTE D KISSINGER 2014-01131 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Enh Living apt,misc svcs 10/1/14-10/31/14 Messiah Lifeways at Messiah Village,Mechanicsburg,PA 7,086.00 2. Enh Living apt,nursing care 11/1/14-11/9/14 Messiah Lifeways at Messiah Village,Mechanicsburg,PA 3,064.05 3. Credit card balance due to Discover Card account ending in 8394 52.17 TOTAL(Also enter on Line 10, Recapitulation) $ 10,202.22 If more space is needed,insert additional sheets of the same size. REV-1513 EX+(01-10) i pennsylvania SCHEDULE ] DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: CHARLOTTE D KISSINGER 2014-01131 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec.9116(a)(1.2).) 1. Darryl S.Kissinger, 18 Hippie Ln.,Bemville,PA 19506-8495 Son 33.33% 2. Diane S.Achenbach,253 Winding Way,Camp Hill,PA 17011-8462 Daughter 33.33% 3. Corey D.Kissinger, 122 Cooks Glen Rd.,Spring City,PA 19475-9502 Son 33.33% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE, II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART 11— ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size. S LAST WILL AND TESTAMENT OF CHARLOTTE KISSINGER I, CHARLOTTE KISSINGER, of 606 South Seventh Street, Hamburg, Berks County, Pennsylvania, declare this to be my Last Will and Testament and I revoke all wills and codicils which I have previously executed. 1. Disposition of Tangible Personal Property. All tangible personal property which I may, oNNm at the time of my death shall be sold by my Executor at fair market value.and the net sale proceeds shall be blended with my residuary estate. 2. Disposition of Real Property. All real property which I may own at the time of my death shall be sold by my Executor at its fair market value,and the net sale proceeds shall be blended with my residuary estate. 3. Payment of Death Taxes. All inheritance, estate and other death taxes which are payable as a result of my death and any interest and penalties with respect to those taxes shall be paid by the principal of my residuary estate, at such time or times as my Executor shall select, without apportionment or right of reimbursement. 4. Disposition of Residuary Estate. I give the residue of my estate to be divided as follows: A. One (1) share representing one-third (1/3) of my residuary estate to my son, DARRYL S. KISSINGER, should he survive me, or should he not survive me, to his issue then surviving,per.sti es; B. One (1) share representing one-third (1/3) of my residuary estate to my daughter, DIANE S. ACHENBACH, should she survive me, or should she not survive me, to her ti C. One (1) share representing one-third(1/3) of my residuary estate to my son, COREY D. KISSINGER, should he survive me, or should he not survive me, to his issue then surviving,per stupes. Any share or partial share to be distributed to any beneficiary who has not attained the age of twenty-five (25) years shall be held as a separate trust by the Trustee I have appointed below, IN TRUST, on the following terms: a. From the share or partial share of the living beneficiary,Trustee shall pay to or expend for the beneficiary, after taking into account funds available from other sources, so much or all of the income and principal as Trustee may deem appropriate for the beneficiary's health, education, maintenance and support. Any unused income shall be accumulated and added to principal. When the beneficiary attains eighteen(18)years of age,Trustee shall pay the beneficiary the net income of the trust quarter-annually, and shall continue to administer the trust principal as before. When the beneficiary attains twenty-one(21)years of age,Trustee shall pay the beneficiary half of the principal of the trust. When the beneficiary attains twenty-five(25)years of age,Trustee shall pay the beneficiary the other half of the principal of the trust. Prior to the beneficiary attaining twenty-five (25)years of age, the Trustee is authorized to pay or apply such part or all of the trust principal as Trustee, in its discretion, may consider appropriate to enable the beneficiary to start a professional practice,to purchase or assist the beneficiary in purchasing an interest in a business,or to purchase or improve a principal residence. Trustee is to have complete discretion in evaluating the price to be paid for any such purchase, in evaluating the advisability of any such proposed -2- K at time all. Illi, . pwchssee t"im.Idl; 1,x'emu an pix pose. If the Trustee, in its sole discretion, decides that any trust described in this Section 4 should be or has become uneconomical to administer,Trustee may avoid or terminate that trust by distributing the trust estate,or what would have become the trust estate if the trust were funded,to the beneficiary for whom that trust was created. 5. Appointment of Trustee. I appoint my son, COREY D. KISSINGER, as Trustee,of the Trust created in this Will. 6. Appointment of Executor. I appoint my son, COREY D. KISSINGER, as the Executor of this Will. In the event that my son, COREY D. KISSINGER, is ineligible, unable, or unwilling to serve as Executor at any time, for any reason, I appoint my daughter, DIANE S. ACHENBACH, to serve as Executrix in his place. 7. Powers of Executor. My Executor, in addition to all powers conferred by law shall have the following powers: A. The discretionary authority to retain any property which I own at my death without liability for failure to diversify investments;exercise any options,rights or privileges for the purchase,sale,exchange or redemption of any property; borrow money at any time for the benefit of my estate from any source,including from any Executor or other personal representative; secure any loan by a pledge or mortgage of any estate assets,renew any loan and give additional security; lease for any term, exchange or sell at public or private sale any estate assets, and grant options to lease for any term,exchange or purchase any assets, in each case without court order; disclaim any -3- 1 interest m property on my e a w1 ou co a o can;m partly in each and to allocate specific assets among the beneficiaries in such proportion as may appear best, without regard to the income tax basis of any such asset, so long as the total market value of any beneficiary's share is not affected by such allocation;employ such agents, custodians, attorneys,accountants or investment counsel and rely on advice given by such attorneys,accountants or investment counsel as may be reasonably necessary or desirable in managing, protecting and investing any property; and invest principal and income without restriction to so-called "legal investments" for fiduciaries. B. My Executor may,in addition to the foregoing and without liability for self- dealing retain,purchase as an investment, sell, vote or refrain from voting securities issued by any corporate personal representative;exercise or refrain from exercising any options,rights or privileges available to my Executor for the purchase of any such securities; invest principal or income in the common trust funds of any corporate personal representative;and borrow money from any corporate personal representative for the benefit of my estate. C. No bond or other security shall be required of my Executor or other personal representative duly appointed to act for any purpose in any jurisdiction. 8. Spendthrift Clause. No beneficial interest under this Will may be assigned by any beneficiary or attached by the beneficiary's creditors until actual distribution to such beneficiary. IN WITNESS WHEREOF, I have executed this Will this day of y2 tw , 2001. (SEAL) CHARLOTTE KISSINGE -4- lot y Signed,sealed,published and declared by the within named CHARLOTTE KISSINGER,as and for her Last Will and Testament, in the presence of us,who, at her request and in her presence, and in the presence of each other, have subscribed our names as witnesses thereto. J4, rC 4-fy f-.-- FREDERICK K. HATT W`Vitne`ss COMMONWEALTH OF, PENNSYLVANIA ss. COUNTY OF BERKS f We, CHARLOTTE KISSINGER, FREDERICK K. HATT,and ' ©max-., the Testatrix and the witnesses, respectively, whose names are signed to the foregoing in6frument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she had signed willingly,and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix and of one another, signed the Will at as witnesses and that to the best of his or her knowledge the Testatrix was at that time eighteen(18)years of age or older,of sound mind and under no constraint or undue influence. CHARLOTTE KISSTN R x--- t +-"� FREDERICK K. HATT Witness Subscribed, sworn to and acknowledged before me by CHARLOTTE KISSINGER, the Testatrix, and subscribed and sworn to before me by FREDERICK HATT, ESQUIRE, and _—T the witnesses,this �� day ofc.L,-1 ,2001. - Notary Public fda.arie l Seal V - -5- Me!anfe A.Taylor,Notary Public Womissfng Ec��,fieri s Cour y .P r My fS3foti Expfres Nov.9,2002 r FultmBank LISTENING IS JUST THE BEGINNING December 12, 2014 Corey D Kissinger 122 Cooks Glen Rd Spring City PA 19475-9502 Dear Mr. Kissinger, RE: Charlotte D Kissinger, deceased 11/9/2014 In response to your recent inquiry concerning the accounts maintained in the name of the decedent,please be advised that the following accounts were open at the date of death: Checking#0407-15744, opened 5/6/93, date of death balance $8330.29, (accrued interest of.09 would not have been payable had the account been closed on the date of death)titled in her name alone, with Diane Susan Achenbach as power of attorney. Savings 40413-02007, opened 5/6/93, date of death balance $533.35, plus accrued interest of.01, titled in her name alone, with Diane Susan Achenbach as power of attorney. DATE OF DEATH ACC IRA CD# BALANCE INT RATE OPEN ROLL OVER MATURITY 999-0604725 21001.48 75.89 .99 3/10/95 11/13/12 11/13/16 (titled in her name alone,with Corey Kissinger,Darryl Kissinger and Diane Achenbach as beneficiaries) If you should have any further questions, please do not hesitate to contact me at 717-327-2497. Very truly yours, #n, V" This inforrnalior is furnished as 5 matter of business cc..urtesj in answer to, your rr,:rtiiry, s f ; : 3'.Jt nfi' tSol use only.ali The bank `�rr'sl t'9 thi r , c^pr •:ss not represent or April Billett guarantee the a.cc:{r acy: c m ; r,ess or 'EAiabilily of the, Credit Confirmation Processor information provided. fvc 'e, ?C:,lSlii;bl°y.s assum by the bank or any of its officers,csr i ees or agents Any cp�rion herein expressed is surn'ect to change without notica 1.800.FULT©N.4 fultonbank.com Fulton Bank,N.A.Member FDIC. Member of the Fulton Financial Family. Page 1 of 1 S ` MEMBERS 1st FEDERAL CREDIT UNION Account Statement CHARLOTTE D KISSINGER For Account: 0000518233 CHARLOTTE D KISSINGER ROOM 303 MESSIAH CIRCLE MECHANICSBURG,PA 17055 Reporting Period: 10/01/2014 to 11/09/2014 0000 REGULAR SAVINGS Balance $ .00 0005 MONEY MANAGEMENT Post Date Transaction Description Amount New Balance 10/23/14 Deposit Check $19,515.00 $94,686.28 Check Received 15,383.00 Check Received 4,132.00 10/28/14 Deposit Check $5,178.17 $99,864.45 Check Received 5,178.17 10/31/14 Dividends:Tiered Rate $ 13.84 $99,878.29 11/04/14 Deposit Check $7,552.84 $107,431.13 Check Received 202.84 Check Received 7,350.00 0011 CHECKING Post Date Transaction Descriotion Amount New Balance 10/20/14 Deposit Check $7,595.00 $8,108.35 Check Received 7,595.00 10/24/14 Draft:000115 $7.,435.00- $673.35 12/1/2014 P 65 S. Fourth St. 223 Peach St. Hamburg, Pa 19526 Leesport, Pa 19533 610-562-7823 610-926-2737 M. DOMER LEIBENSPERGER DONNA M. LEIBENSPERGER PARR President/Supervisor Vice-President/Branch Supervisor FUNERAL HOMES, INC. www.lei benspergerfuneralhomes.corn Mr.Corey D.Kissinger November 20,2014 122 Cooks Glen Road Spring City,PA 19475 The Funeral Service for Mrs. Charlotte D. Kissinger,who died on November 9, 2014 1. PROFESSIONAL SERVICES Services of Funeral Director and Staff $2495.00 Embalming Procedure $ 795.00 Dressing,Casketing,Cosmetology $ 225.00 STAFF,SERVICES,FACILITIES AND EQUIPMENT Use For Funeral Ceremony $ 700.00 2. AUTOMOTIVE EQUIPMENT Removal of Remains(local) $ 300.00 Hearse $ 350.00 Flower/Clergy Car $ 230.00 FUNERAL HOME SERVICE CHARGES: $5095.00 SELECTED MERCHANDISE Casket $1500.00 Outer Burial Container $1140.00 Register Book $ 50.00 Memorial Folders $ 35.00 Acknowledgement Cards $ 15.00 THE COST OF OUR MERCHANDISE THAT YOU HAVE SELECTED $2740.00 CASH ADVANCES Opening and Closing Grave $ 800.00 Death Certificates $ 12.00 Hairdresser $ 40.00 Newspaper Notices(Reading) •$ 135.00 Flowers $ 40.00 Tax on Flowers $ 2.40 Stone Engraving $ 195.00 TOTAL CASH ADVANCES AND SPECIAL CHARGES $1224.40 Total Cost: Sub-Total $9059.40 Initial Payment/Discount/Credits TOTAL AMOUNT DUE $9059.40 Terms:Balance Due Net 30 days. A service charge of 1.5%per month or an annual percentage rate of 18%is applied to the unpaid balance. Add a Service Fee of$135.89 if the balance due is not paid on or before 30 days from the above date. BLUE MOUId1'RIN FMLY RST ROADSIDE DR EXIT 23 SHARTLESVILLE,PA 1955} 11.14 2014 14:35:54 CREDIT CARD p VISA SALE CARD= XXXXM+XX;ti1405 INVOICE 0023 SEQ 1#: 0023 Batch-7 001376 Aprcova!Code: 311153 ' 7 E&Y Method: Swoed , t Made: . Onlbe PRE-TIP AMT 5589-55 TIP p TOTAL AMOUNT s _CUSTOMER COPY lco�I 857066 RECEIPT FOR PAYMENT ------------------- ------------------- LISA M. GRAYSON, ESQ. Receipt Date : 12/01/2014 Cumberland County - Register Of Wills Receipt Time : 11 : 16 : 54 One Courthouse Square Receipt No. : 1079815 Carlisle, PA 17013 KISSINGER CHARLOTTE D Estate File No. : 2014-01131 Paid By Remarks : COREY D KISSINGER HMW ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 260 . 00 CUMBERLAND COUNTY GENERAL FUN WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 15 . 00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 35 . 50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 105 $360 . 50 Total Received. . . . . . . . . $360 . 50 CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717)249-3166 Pax:(717)249-2663 January 9, 2015 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal-newspaper for publication of legal notices. TO: Corey D. Kissinger RE: Charlotte D. Kissinger Estate Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on following dates: December 26, 2014 and January 2, and January 9, 2015 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 Zbe PatriotXtws Order Confirmation Now you know Ad Order Number Customer Pavor Customer 0002322683 KISSINGER KISSINGER Sates Rep. Customer Account Pavor Account maldddge 250047 250047 Order Taker Customer Address Payor Address maldridge 122 Cooks Glen Road `-122`6aoks Glen Road Spring City PA 19475 USA Spring City PA 19475 USA Order Source - Phone Customer Phone Pavor Phone 484-985-9580 `'.-.'484=985=9580 PO Number Special Pricing Ordered By None Corey Kissinger Customer Fax Customer EMail coreykissinger@gmail.com Tear She@ts Proofs Affedavits Blind box Promo Type 0 0 1 Invoice Text ateri Is Net Amount Tax Amount Total Amount $173.78 $0.00 $173.78 Payment Method Payment Amount Amount Due $0.00 $173.78 Ad Number Ad Type Ad Size Color 0002322683-01 Legal Liners : 1.0 X 14 Li <NONE> Production Method Production Notes Ad Booker External Ad Number Ad Attributes Ad Released Pick Uo No 12/10/2014 3:15:02PM 1 Ad Preview ESTATE NOTICE Letters Testataevary in the Estate of Charlotte D.ICtssi g ,of Upper Allen Township,Ctmmbatamtd Conary. psnnsyh'ania.deceased.have been - gtanted to Corey D.Kissinger. ... . All persons ittrotcing thmtsely to be indebted b said estate will t>mkt payment immtdiattly and those having claims will present them for settlement without delay to: Corey D.Kissinger,Exemlor 122 Cools Olen Road Svritut City,PA 19475 Product Information Placement/Classification Run Dates Run Schedule Invoice Yext Sort Te PNCO::FuIIRun 860-Community Legals 12/2312014, 12/30/2014, 1/6/2015' ESTATE NOTICE Letters Testamentary in the I ESTATENOTICELETTERSTESTAMENTARYIN #inserts Cost 3 $161.28 Onllne::FUIIRun 860-Community Legals 12/23/2014, 12130/2014, 1/612015 ESTATE NOTICE Letters Testamentary in the± ESTATENOTICELETTERSTESTAMENTARYIN #Inserts 3 $7.50 12/10/2014 3-.15:02PM 2 9 - - -V- 1 MESSIAH s t a t e m n Form PMS Life w. . ays at MESSIAH VILLAGE 100 MT.ALLEN DR.,MECHANICSBURG,PA 17055 RESIDENT# I UNIT ISTMT. DATE 61314 1 303 1 11/30/2014 RESIDENT(S) COREY KISSINGER CHARLOTTE D. KISSINGER 122 COOKS GLEN ROAD SPRING CITY, PA 19475 TOTAL AMOUNT DUE $10,150.05 DATE DUE 12/31/2014 DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE $ ...........................-...........-.................................... ................ -----.........................!!+I'!1041f!!T_I�EMt7T�D. DATE DESCRIPTION " ' RATE Days!— CHARGES _ CREDITS CE Units Balance Forward p 7,086.00 Nursing Care *** 1/106114 PREVAIL`BRIEF'.� 1:4 _ i r - G�' 5 9.06 `� 13:0 5 j 7;099. 05 11/06/14 RM/BRD- NURSING -PRIVATE 11/06-1110 E 359.00 3.00 1,077 00 n 8,176.05 �it/69A4 MEAL 6;00 J :a: '' ._`s- _` `72 00 8,1.04.D5 *** Enhanced Living 11i(ilha'` MEAL CREDIT "" , _:J i f �.':'>k'4 =:8.00 3.>; . ._ _..� - 96;0.0 _$ 008,05 _:11/4111114' ELHS -SUSQUEHANNA 81NGLE 11/01-11/1 153.00 14.00 2,142.00 10,150.05 .its1. Please make sure to allow adequate time for your payment to be received in our office by Page 1 12/31/14.Any payments received after the due date will be considered late and will not be reflected on your next statement. RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 61314 39064.05 7,086.00 0.00 0.00 0.00 $1 RESIDENT NAME CHARLOTTE D. KISSINGER ?AID (� ( f y- �F°m,PB-°, Please make check payable to Messiah Lifeways at Messiah Village. 14 I L tJC� A 1%finance charge may be assessed on accounts for which payment has not been received by the due date. If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. . a�S��VE�' Discover More Card Account number ending in 8394 Open Date:Sep 21,2014-Close Date:Oct 20,2014 Cardmember Since 2,002 Page 1 of 4 ACCOUNT SUMMARY PAYMENT INFORMATION Previous Balance $596.89 New Balance _ $77.60 a Payments and Credits $596.89 Minimum Payment Due $35.00 Purchases $77.60 N Payment Due Date November 15,2014 Balance Transfers + $0.00 Cash Advances + $0.00 Late Payment Warning:If we do not receive your minimum payment by the Fees Charged + $0.00 date listed above,you may hove to pay a late fee of up to$35.00 and your Interest Charged + $0.00 purchase and balance transfer APRs for new transactions may be increased up to the Penalty APR of 15.99%variable. New Balance $77.60 See Interest Charge Calculation section following the REWARDS Transactions section for detailed APR information Credit Line -u ' $5,500 Cashback Bongs® Anniversary Month Credit Line Available $5,422 January Opening Balance $ 50.08 --�— Cash Advance Credit Line $2,800 New Cashback Bonus This Period Cash Advance Credit Line Available $2,800 Everywhere Else + $ 0.18 - --Redeemed This-Period _.__-- _.-___--. ..-_-..___�... _ __ _____0-00 - - �. You may be able to avoid interest on Purchases. Cashback Bonus Balance $ 50.26 See reverse for details. To learn more,log in at Discover.com Me �-� xo -_ 796 fj/�''T�j 6i0 �_ _ R+'•n 300 Your FICO*Credit Score on 10/14/14. AWSOMMOW More at Discover.com �..• Thank you for your continued enrollment in DirectPay automatic payments. Your next automatic payment of$77.60 will be on November 10,2014. See'Information For You' section for additional details. Make Check payable to Discover. NOTICE:SEE REVERSE SIDE FOR IMPORTANT INFORMATION Please fold on the pedorat➢on below,detach and return with your payment. a !?QytllElta ,oUE30tt lCy©Rllti@ F !?�ll01t@ Account number ending in - - 8394 ease not fold cti of stdpls ` lJ�sc aXer ccm T 80(?347b$3 '`r Minimum Payment Due $35.00 !tlIIIII!llllttllllltlll�IlllltllIlii11{Itlltt!!{!!Il1tlltlltltl! New Balance-----_.__._� �j_-_---- 000108242 01 AT 0.403 T2 20 SDS1RA05 481 Payment Due Date November 15,2014 CHARLOTTE D 1CISSINGER r,; 253 WINDING WAY Amount enclosed $YZ CAMP HILL PA 17011-8462 - t 6 r- (( t j 2jO� 524(? XkN 14-5 6 7 PO BOX 71084 CHARLOTTE NC 28272-1084 tlnllt!!I!!!{I!!1{Intl+Itllll!!t!1{llltt!!!!!Illlltlllt!!lttlll Phone and Internet payments must be received by SPM ET to be credited as of the some day. � Address,e-mail or telephone changed?Note changes on reverse side. 000007,986458862938459000776005608500003500 - 7 Lid/