HomeMy WebLinkAbout10-02-06
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
GAVIN-CASNER ROSEMARIE
1209 BAUMAN COURT
MECHANICSBURG, PA 17055
n___n_ fold
ESTATE INFORMATION: SSN: 190-56-5727
FILE NUMBER: 2106-0197
DECEDENT NAME: CASNER KERRY D
DATE OF PAYMENT: 10/02/2006
POSTMARK DATE: 10/02/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 02/11/2006
NO. CD 007275
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $780.93
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: CASNER ROSEMARIE GAVIN
CHECK# 105
SEAL
INITIALS: AJW
RECEIVED BY:
REGISTER OF WillS
$780.93
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
....:g\
lS0Sb04104b
REV-1500 EX (05-04)
PA Department of Revenue .
Bureau of Individual Taxes
Dept. 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
County Code Year
File Number
Date of Birth
Decedent's Last Name Suffix
Decedent's First Name
MI
(If Ap~licable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
_ 1. Original Retum
c:::>
2. Supplemental Return
c:::>
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
c:::>
4. Limited Estate
c:::>
-
c:::> 4a. Future Interest Compromise (date of
death after 12-12-82)
c:::> 7. D~cedent Maintained a Living Trust
(Attach Copy of Trust)
c:::> 10. Spousal Poverty Credit (date of death c:::> 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
-1L
8. Total Number of Safe Deposit Boxes
c:::>
Cor~espondent's e-mail address: }, ea muc.s (6) eP; X. ~ et
Under penalties of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is tru correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
ONSIBLE FOR FILING RETU DATE
, ~
/lA 17~sS-
DAT
ADDRESS './1tIt.t.~ IF. S#IE"l.J)S t:tr; ~ifI.
h C/bUsr "'~ /Jf~MluJIt!.$bll:;: ~ I"A- /7D$"S-
. PLEAS SE ORIGINAL FORM ONLY
~.
Side 1
L
15056041046
15056041046
--.J
-.J
REV-1500 EX
Decedent's Name: Kliltll
RECAPITULATION
150'56042047
--
.-
~
"
/ '
v. Clf-S~
1. Real estate (Schedule A). . . : . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . : .. 1.
2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 2.
3. Closely Held Corporation, Partnership ~r Soie-Pro~ri~torship (Sched';!'e C) .: .., 3.
4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5.
6. Jointly Owned Property (Schedule F) c:::)Separate Billing Requested . . . . . .. 6.
o~, ! .
7. Inter-Vivos Transfers & Miscelianeous Non-Probate Property
(Schedule G) c:::) Separate Billing Requested.. . . . . .. 7.
8. Total Gross Assets (total Lines 1-7). . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8.
9. Funeral Expenses & Administrative Costs (Schedule H). . . .'. . . . . . " . . . .. .. .. 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10.
11. Total Deductions (total Lines 9 & 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.
12. Net Valu~of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (ScheduleJ) . . . .;. . . . . .." . . . . . . . .,. . . . 13.
14. Net Value Subjectto Tax (Line 12 minus Line 13) .. . . . . . . . . . . . . . . . . . . . . . . 14.
TAX COMPUTATION - 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 .alL
16. Amount of Line 14 taxable
at lineal rate X.O!lS'
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
15.
16.
17.
18.
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .'. . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
L
15056042047
C)
Side 2
15056042047
-.J
REV-1500 EX Page 3
D.ecedent's Complete Address:
DECEDENT'S NAME
I<E~ey D. CASJlJPf
File Number
21- ()~ - /97
STREET ADDRESS
12()~ /'J,f-1I1J( II-N t!.1:
CITY
IJIEeJf/MIlt ~ .8t/At;.
I STATE 1'/1
I ZIP 17oS~
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payment~
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
~
7tfo. ,.3
o
o
()
Total Credits ( A + B + C ) (2)
()
3. Interest/Penalty if applicable
D. Interest
E. Penalty
o
()
B. Ehter the total of Line 5 + 5A. This is the BALANCE DUE.
(3) ()
(4) t)
(5) , 7?tJ.?3
(5A) 0
(5B) ?7f'o. fJ
Total Interest/Penalty ( D + E )
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.......................................................................................... D ~
~: ~::::~ :h~e~;:i~~:~s:~t:~::;:~. .~.~.~.I~. ~~~. ~~~.:.~~~~.~. .t~~.~.~~~~~~~. ~~. ~~~ .i.~.~.~.~.~.;.:::::::::::::::::::::::::::::::::::::::::::: B ~
d. receive the promise for life of either payments, benefits or care? ...................................................................... D ~
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
3. ~:~h~~~~:~:~::~~~::~u~~~~~~::~~~;~;~..~;~.~~~;~.~~~~.~~~~~~~.~~.~~~.~~~.~~. .hi~.~~.~~; .~.~~~~;:::::::::::::: B ~
4. Did decedent own an Individual Retirement Account, annUity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ IXI D
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent [72 P.S. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent
[72 P.S. ~9116 (a) (1.1) (ii)). The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. ~9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. ~9116(a)(1.3)]. 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.1503El<+,(1.97) ~_
. 'ftIIIlt
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 8
STOCKS & BONDS
ESTATE OF
FILE NUMBER
:1./- ~t, - /97
C AStl€It.J KE~~Y D.}
All property jointly-owned with right of sUlVivorshlp must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
I-IEllrrAGF /1f/I"ESrdJEAlr AJAAlIIGGAJElfIT Co R P.
ONE -NAI-F IN7: of KG~Y J). t!ASNI5f A-S 7G/fIAAlr /./1 &16,1fI
A De r. III me ND.. ID7
(SEE' VlftlfA7i,1II ~E rrE7t ArrAt!/le--1J)
f / J ~ 18/.9/
TOTAL (Also enter on line 2, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$ 1/7.. 7gl. 98
U~
..... ....=--- Investors Management Corporation
7101 Wisconsin Avenue, Suite 1112
Bethesda, Maryland 20814-4878
301-951-0440
301-951-4954 (FAX)
March 3, 2006
Ms. Rosemarie Gavin-Casner
1209 Bauman Court
Mechanicsburg, PA 17055
Re: Rosemarie Gavin-Casner and Kerry Casner Tenants in Common
each with an Undivided One-Halffuterest in the Whole
RIMC No. 807
Dear Rosemarie:
Please accept our condolences for the sudden loss of Kerry and let us know if we
can help in any way.
We are enclosing the Date of Death Valuation as of February 11, 2006 for Kerry's
..ltOrtion of this account. We assume that the cost basis for these assets should be
stepped up to this information. Please let us mow what changes to make
regarding the title of the account.
We need a certified death certificate for our records.
If you have questions or need additional information, please call me.
Sincerely,
~.e
Michael S. Comfeld
President
MSC:gat
Enclosure
Kerry Casner
Date of Death Valuation
February 11, 2006
Security 2/11/06 Accrued
Shares Number Security Description Taxlot Date Avg Pr Market Value Income
25 AIG AMERICAN INTL GROUP INC 07/24/2002 67.6325 1,690.81 0.00
75 AMGN AMGEN INC 05/04/1998 71.0225 5,326.69 0.00
13 BA BOEING CO 06/19/1998 72.2975 903.72 3.75
38 BA BOEING CO 12/16/2002 72.2975 2,711.16 11.25
50 BAC BANK OF AMERICA CORP 01/13/2005 43.6725 2,183.63 0.00
31 C CITIGROUP INC 01/02/1951 45.7400 1,408.93 15.10
74 C CITIGROUP INC 08/28/1998 45.7400 3,393.77 36.36
50 CAG CONAGRA FOODS INC OS/20/1998 20.4800 1,024.00 13.63
50 CAG CONAGRA FOODS INC 11/08/2005 20.4800 1,024.00 13.63
38 COP CONOCOPHILLlPS 08/14/1998 59.3825 2,226.84 0.00
50 CSCO CISCO SYS INC 10/19/2004 19.6625 983.13 0.00
75 DELL DELL INC 11/08/2005 31.5750 2,368.13 0.00
100 DIS DISNEY WAL T CO 09/17/2001 26.5600 2,656.00 0.00
25 EK EASTMAN KODAK CO 05/11/1998 24.4300 610.75 0.00
16 FD FEDERATED DEPT STORES INC 10/01/2002 68.5450 1,062.45 0.00
50 FDC FIRST DATA CORP 12/17/2002 44.1050 2,205.25 0.00
25 FNM FEDERAL NA TL MTG ASSN OS/20/1998 54.3350 1,358.38 6.50
25 FNM FEDERAL NA TL MTG ASSN 09/09/2005 54.3350 1,358.38 6.50
50 GOT GUJDANT CORP 04/14/2000 74.8875 3,744.38 0.00
75 GE GENERAL ELEC CO 09/04/1998 33.1950 2,489.63 0.00
75 GPS GAP INC DEL 12/23/1999 18.2225 1,366.69 0.00
50 GPS GAP INC DEL 06/15/2005 18.2225 911.13 0.00
50 HD HOME DEPOT INC 03/03/2000 39.2425 1,962.13 0.00
25 HD HOME DEPOT INC 06/06/2002 39.2425 981.06 0.00
50 HON HONEYWELL INTL INC 06/29/2001 39.5775 1,978.88 0.00
25 IBM INTERNATIONAL BUSINESS M 10/18/2000 80.9375 2,023.44 5.00
100 INTC INTEL CORP 04/04/2001 21.1650 2,116.50 10.00
50 JNJ JOHNSON & JOHNSON 03/29/2000 58.4200 2,921.00 0.00
25 KMB KIMBERLY CLARK CORP 03/17/1998 57.3075 1,432.69 0.00
50 KO COCA COLA CO 10/19/2004 41.0350 2,051.75 0.00
50 MAR MARRIOTT INTL INC NEW 12/16/2002 69.1625 3,458.13 0.00
75 MCD MCDONALDS CORP 04/04/2001 36.3300 2,724.75 0.00
50 MO AL TRIA GROUP INC 10/19/2004 71.6875 3,584.38 0.00
25 MOT MOTOROLA INC 06/19/1998 21.4375 535.94 0.00
75 MOT MOTOROLA INC 12/17/2002 21.4375 1,607.81 0.00
50 MSFT MICROSOFT CORP 02/10/2000 26.6100 1,330.50 0.00
50 MSFT MICROSOFT CORP 04/17/2002 26.6100 1,330.50 0.00
25 NKE NIKE INC 03/25/1998 83.8150 2,095.38 0.00
25 PEP PEPSICO INC 05/08/1998 57.6575 1 ,441 .44 0.00
25 PEP PEPSICO INC 11/30/1999 57.6575 1 ,441 .44 0.00
38 PFE PFIZER INC 08/28/1998 25.5700 958.88 9.00
13 PFE PFIZER INC 06/15/2005 25.5700 319.63 3.00
50 PFE PFIZER INC 11/08/2005 25.5700 1,278.50 12.00
50 PG PROCTER & GAMBLE CO 03/08/2000 59.5475 2,977.38 14.00
Page 1 of2
Kerry Casner
Date of Death Valuation
February 11,2006
Security 2/11/06 Accrued
Shares Number Security Description Taxlot Date Avg Pr Market Value Income
75 PMI PMI GROUP INC 08/12/1998 42.7850 3,208.88 0.00
50 RDS.A ROYAL DUTCH SHELL PLC 09/21/2001 62.6975 3,134.88 27.83
3 RTN RAYTHEON CO 01/02/1951 42.6750 128.03 0.00
22 RTN RAYTHEON CO 05/12/1998 42.6750 938.85 0.00
25 RTN RAYTHEON CO 11/30/1999 42.6750 1,066.88 0.00
50 SGP SCHERING PLOUGH CORP 02/29/2000 18.3875 919.38 2.75
50 SGP SCHERING PLOUGH CORP 10/19/2004 18.3875 919.38 2.75
25 SLB SCHLUMBERGER L TO 03/17/1998 117.7575 2,943.94 0.00
150 STZ CONSTELLATION BRANDS INC 12/17/2002 26.4100 3,961.50 0.00
50 T AT&TINC 03/09/2000 27.4750 1,373.75 0.00
50 T AT&TINC 06/14/2005 27.4750 1,373.75 0.00
25 UPS UNITED PARCEL SERVICE INC 11/08/2005 74.6700 1,866.75 0.00
50 UTX UNITED TECHNOLOGIES CORP 09/19/2001 57.0700 2,853.50 0.00
50 WMT WAL MART STORES INC 02/02/2005 45.6375 2,281.88 0.00
50 YUM YUM BRANDS INC 05/01/1998 49.7500 2,487.50 0.00
4,570.05 CASH SEI TAX EX INSTNL TAX EXE 1.0000 4,570.05 0.00
Subtotal 117,588.86 193.05
Accrued Income 193.05
Total Portfolio 117,781.91
Page 2 of2
_'D~':.~ '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF e AS'; Jilf) K 8 fly 1> .
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
,;J /-1)& - 1?7
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
fi;1t~ escAPE- dl~ol I tyPE sw
TlrtE : SSl(o/(2.J>oo:z. e4
tIN! IF/lf ruo3181KE S 7911 1
CtJ N 1>. G-Dt>D
(VM,.UA-1i,Al ~y El>/H/,f.-AJ1>S. CoM ,4 7'TA-OHE"l:>)
( XLT)
A-IA..Tbm.
~S, D/)() ht/LGS
A{~ t'lw. 57etiR11I6~
tv I AI OtJ (,oJ S, (.IJ l.k$
LJ C YL.
~
101 ~3f,,1Jt)
TOTAL (Also enter on line 5, Recapitulation) $ /01:1.3 ? 60
(If more space is needed, insert additional sheets of the same size)
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~,..~'~"'" .
COMMONWEALTH OF PENNS) LoVANIA
INHERITANCE TAX RETURN
RESIDENT DE EDENT
ESTATE OF CAs
AIL: ~ I< ~LJ Je Y )).
,Vc:;;- ~ I ~
SCHEDULE F
JOINTLY-OWNED PROPERTY
FILE NUMBER .2/- I)' _ / *I 7
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A.
SE"E
sOJAbJ-rG" /A',qKAtJ!-7/M/A-L
A-N~ /JAr~ 5N~73 ATM-t!NGD
B.
c.
JOINTLY -OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Al\ach DATE OF DEATH DECD'S VAlUE OF
NUMBER TENANT JOINT deed for jointly-held real estate. VAlUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A.
TOTAL (Also enter on line 6. Recapitulation) $ 17,3 S-tf.IJ"
IlL ___~ _____ :_ ___............ :___-' _........:.:___1 _L..__...... #>0" ......... .......__ ...:__\
;Plfr,f SIIGlFr HR S797#FN 1:. eA-S#~
S CJlr;- /). F
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Send Inquires to:
5000 Louise Drive
PO Box 40
Mechllnlcsburg, PA 17055
www.members1st.org
Main Switchboard: (717) 697-1161 or (800) 283-2328
EZ Call: (717) 697-4372 or (800) 283-4372
TOO: (717) 697-5312 or (800) 283.2328 ext. 5312
TeleBranch: (717) 795-6049 or (800) 237-7288
MEMBERS 1st
FEDERAL CREDIT UNION
21252 1 AV 0.293 42503-21252
1...11111.111'11,1,1"1,1.1.1....11,11'11,,1,111,,.1,1..1.1..1
RYAN G CASNER
1209 BAUMAN CT
MECHANICSBURG PA 17055-9302
jo
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!!!!!!!!!!!!!!!
Statement of Accounts
Jan 01, 2006 thru Mar 31. 2006
Account Number:
186727
Account Balances at a Glance:
Checking: 0.00
Savings: 462.21
Certificates: 11,013.56
Loans: 0.00
Money Management: 0.00
Page: 1 of 2
Begining in June the statement end date will be the 24th of the month. Please
read the enclosed insert for more information.
SAVINGS ACCOUNTS
00 - SAVINGS
Date Transaction Descriotion
Jan 01 Balance Forward
Joint Owner: ROSEMARIE GAVIN-CASNER
Jan 31 Deposit Dividend 1.000%
Annual Percentage Yl8ld Eamed 1.()(}(J% from 01/01/2006 through 01/31/2006
Feb 28 Deposit Dividend 1.000%
Annual Percentage Yield EamedO. 99CI% from 02/01/2006 through 02/28/2006
Mar 31 Deposit Dividend 1.000010
Annual Percentage Yield Eamed 1.0()(J% from 03/01/2006 through 03/31/2006
Mar 31 Ending Balance
Additions Subtractions
Balance
461.08
461 .47
0.391
0.35 Ii
0.39 t!
461.82
462.21
~~.
462.21
)\~ -k" ~ ,I
ransaction Descri tion
Balance Forward
oint Owner: ROSEMARIE GAVINkASNER
Joint. Owner: KERRY D CASNER \
Jan 31 Deposit Dividend 3.200%; ,
Annual AJ'f1tage Yield Eamed 3.25fJ% from 01/01/2006 through 01/31/2006
f I
Feb 23 Deposit Dividend 3.200010 ",\'" i "",'
Annual Pe. 'f1tage Yield Eamed 3.25fJ% frOrr;}'{J2(Ot/?fJO(J"thii?ughc02/22/20rJ6
I Renewed at 3.590%t0 'niature'02123/07d \,' -,
Feb 23 J Withdrawal Transfer To Share<.~ '
12 MONTH CERT MONTHL Y Closed
. u"This is the mal statement presenting information on this product"U
"u Please retain this Dnal statement for tax reporting purposes "u
'------
Additions
Subtractions
Balance
5,841.97
15.88
5,857.85
11.30
5,869.15
5,869.15-
CD
- - - Continued on followino Daoe - --
.-'
,.
~r
MEMBERS t"
'lDIMLallXT UNION
.2506-21252
Jan 01, 2006 thru Mar 31, 2006
Account Number: 186727
Page: 2 of 2
45 - 11 MONTH CERT Maturity Date - Jul OS, 2006
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Date Transaction Descriotion
Jan 01 Balance Forward
Joint Owner: ROSEMARIE GAVIN-CASNER
Jan 31 Deposit Dividend 3.59()O/o
Annual Percentage Yield Eamed 3.65Q% from 01/01/2006 through 01/31/2006
Feb 28 Deposit Dividend 3.59()O/o
Annual Percentage Yield Eamed 3.65Q% from 02/01/2006 through 02/28/2006
Mar 31 Deposit Dividend 3.5000k
Annual Percentage Yield Eamed 3.65O'h from 03/01/2006 through 03/31/2006
Mar 31 Ending Balance
46 - 11 MONTH CERT Maturity Date - Jan 23, 2007
Date Transaction Descri tion
Feb 23 Balance Forward
Joint Owner: ROSEM IN-CASNER ~ i
Feb 23 Deposit Transfer From Share 42 ~\
Feb 28 Deposit Dividend 4.31 0
Annual Percentage Yield Eamed 4.40Q% from 02/23/2006 thn 'IJ,
Mar 31 Deposit Dividend 4.310%
Annual Percentage Yield Eamed 4.40Q% from 03/01/2006 through 03/31/2006
Mar 31 Ending Balance
Additions Subtractions Balance
5,073.70
15.47 j 5,089.17
14.02 ./ ~ 5 \\~olJ 5,103.19
15.56 ./ 5,118.75
5, 118.75
Additions Subtractions
Balance
0.00
8
5,894.81
5,894.81
5,869.15 /
4. 16 \I
21.50 /
YTD SUMMARIES
TOTAL DIVIDENDS PAID
00 SAVINGS
42 12 MONTH CERT MONTHLY
45 11 MONTH CERT
46 11 MONTH CERT
1.13
27.18
45.05
25.66
Total Year To Date Dividends Paid
NOTE: Total includes closed shares
99.02
Don't forget about our new Member Loyalty Rewards Program.
The more products you have with us, the more benefits you'll receive.
Ask an associate for details or visit our website at www.members1st.org for details.
-"~'."~' '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
ESTATEOF CASN~, KE"ltI2Y 1:>.
,21-{)~-/97
ITEM
NUMBER
1.
~.
hr
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND THE DATE Of TRANSFER.
ATTACH ACOP'l OFlHE DEED FOR REAl ESTATE.
0/0 OF
DECO'S EXCLUSION
INTEREST f1FAPPUCABlEl
TAXABLE VALUE
DATE OF DEATH
VALUE OF ASSET
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Capital BlueCross
, ~. J .'.;. / .L J . _/J /'
t, <."-"/J/_'>/~(,)--
July 18, 2006
Charles E. Shields, III
6 Clouser Road
Comer of Trindle and Clouser Roads
Mechanicsburg, PA 17055
Dear Mr. Shields:
Our former employee, Kerry D. Casner, was vested in the Capital BlueCross Retirement Plan.
At the time of his death on February 11, 2006, the present value of his accrued vested benefit
under the Retirement Plan was $81,924.00.
The full amount of this benefit was paid to his beneficiary, Rosemarie Gavin-Casner on May 10,
2006.
Please call me at the telephone number below if you have any questions or need additional
information.
Thank you.
Sincerely,
J~4
Sonya M. Charlesworth
Sr. Benefits Analyst
Tel. (717) 541-6015
Fax (717)651-8708
Sonya. Charlesworth@CapBlueCross.com
Health care benefit programs issued or administered by Capital BlueCross and/or its subsidiaries, Capital Advantage Insurance Company6 and Keystone Health Plane Central.
Independent licensees of the Blue Cross and Blue Shield Association. Communications issued by Capital BlueCross in its capacity as administrator of programs and provider
relations for all companies.
C-60 (512005)
Harrisburg, PA 17177 · www.capbluecross.com
~_~6.
9--IIGHMARK@
July 19, 2006
Mr. Charles E. Shields III
Attorney- At-Law
6 Clouser Road
Mechanicsburg P A 17055
RE: Estate of Kerry Casner
Dear Mr. Shields:
This letter is in regards !o your request for information concerning the Highmark
Investment Plan account for the late Kerry Casner.
I contacted Ameriprise our record keeper and fund manager about his account balance.
Ameriprise confirmed that his account balance as of2/11/06 was $37,667.93.
If you have any further questions, please feel free to contact me at 412-544-2068.
Sincerely,
"
~.J'4
Sherry Finnerty
Benefits Representative
lHP.IIO IR4-03J
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July 18, 2006
Charles E. Shields, III
Attorney-At-Law
6 Clouser Road
Corner ofTrindle and Clouser Roads
MechanicksburgPA 17055
ft. CUNA Brokerage Services, Inc.
A broker dealer of the CUNA Mutual Group
Re: 6CR-550961 (IRA) and 58C184551 (Roth IRA)
IRA FBO Kerry D. Casner
Dear Mr. Dietrich:
Enclosed is the requested information for the IRA accounts for Kerry D. Casner, which are held at CUNA
Brokerage Services, Inc.
The Account of Kerry Casner, 6CR550961 and 58C184551, had the following market prices as of the close
of business on February 11, 2006:
58C184551 Close High Low
. 100 shares of CMCSA $26.55 $26.70 $26.15
. 400 shares of GG 24.37 25.00 23.75
. 300 shares ofSCUR 12.69 12.90 12.60
. Money Market 4,933.15
6CR550961
. 150 shares of AYE $33.35 34.05 33.24
. 300 shares ofMORX 17.21 17.40 16.95
. 100 shares of AIG 67.90 68.00 67.13
. 200 shares of AMA T 19.96 20.11 19.75
. 200 shares ofBMY 22.40 22.56 22.22
. 200 shares of CSCO 19.76 19.88 19.60
. 200 shares of CNX 64.38 64.90 62.60
. 750 shares ofEMC 13.30 13 .44 13.28
. 150 shares ofFNM 54.64 55.00 53.88
. 200 shares of GE 33.28 33.37 32.87
. 300 shares ofGG 24.37 25.00 23.75
. 600 shares ofHLEX 30.64 30.93 30.05
. 250 shares of RX 24.69 24.80 24.41
. 100 shares of JLG 55.05 55.90 54.27
. 200 shares of JBL 38.78 38.90 37.85
. 200 shares ofNYT 27.72 28.07 27.71
. 225 shares ofNSC 49.00 49.08 47.77
. 500 shares of ORCL 12.69 12.80 12.56
. 1000 shares of PKD 10.12 10.47 9.86
. 2000 shares ofRAD 3.53 3.57 3.52
. 200 shares of TWX 18.32 18.45 18.23
. 5000 shares ofVTSI .10 .11 .09
. 150 shares ofWAT 40.82 41.16 40.52
. Money Market 17,491.65
Office of Supervisory Jurisdiction. 2000 Heritage Way · Waverly, IA 50677-9202
Business: 319/352-4090 · Fax: 319/352-1441
Member NASD/SIPC
....
..
Pershing LLC carries this account as clearing broker pursuant to a clearing agreement with CUNA
Brokerage Services, Inc. Both Pershing LLC and CUNA Brokerage Services, Inc., do not provide tax,
investment, or legal advisory services. The market prices have been obtained from various quotation
services which we believe to be reliable; however, we cannot guarantee their accuracy. Our customers are
encouraged to consult their tax advisors for verification.
Please know that we are always here to assist you with any transactions or answer any questions you may
have regarding the brokerage accounts. If you need any assistance, please be sure to contact your
MEMBERS Financial Service Representative at your local credit union, or our Customer Service area at
1-800-369-2862 between the hours of8:00 a.m. and 9:00 p.m., Central time.
Sincerely, \ _
h~y lit'Y'~ ^-0fP
Kathy HenMngs 0
Brokerage Cashier
RE~..1511 EX'I~2.99.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
CA-.sAl~~/ KB2~Y :/).
FILE NUMBER
21-{)~ - /97
ITEM
NUMBER
A.
Debts of decedent must be reported on Schedule I.
DESCRIPTION
1.
FUNERAL EXPENSES:
IYJA-tI'EZZ.1 Fp;/E,e,<<. ~Ate A!etWAJllaBul(.t;, ~A
"
jJ"'~UlAg 191= f!.EAlET1/9I.Y AoT AT GArG "~H~ t!E4IGr41't}'
T-TEmS r;;~ FJiI/lElUt.. A1G"/Ii. fURVlA-S€"h Ai (;//I-lJr S7D,.(!E
ZNrBVIIEN'T rEF, GJrTE Dr HEA-yB/ CEIJIEII::71Y
.1.
3.
J.f.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s) h$Efi1Iff/./E G/4.VlN-f!.AsAJE/Q.
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 12.~ , ~AtlIJfI'1N e.-r:
City 11/r:=tHAAI/t!.S8ltJ2G
2.
State ~ Zip !7oSS-
Year(s) Commission Paid:
Attorney Fees t!.JI,flll6S E: SH I JFl,/)S :PL
3.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant /b;.SGIHA-IlIG (;.A.f'lN -MSAlETI
Street Address I ZoO ? /SJ(.q iliA-IV c. r:
City I1IEMA4IICS6 "N &-
Relationship of Claimant to Decedent lAJ ID() W
State -'!1L Zip /1 () s S
4.
Probate Fees W I>r~:lIo1 i ~S u.e. of .short c.e-rti /''ca,-ht..s
Accountant's Fees :s l r. t ' /I.. (. J')
<1reedDI) HDrrntlUtJ aM - GI"Uf1O,w....l f (.D. Ut1eS'JlJt.
Tax Return Preparer's Fees
5.
6.
7.
r:; /"17 fl." fD 1?~i~kr f)f tv/lIs {;,r fil,'M; I.nhe,., 1i.y Rdu,.n
Aeld,' h' "11"'/ fl""IJtI,fe fee.
/hltl/hdAa/ s/lPrt (!erf/~Ca/is
8'.
Cf.
AMOUNT
,-
II" f)I s: S7J
~'70"DD
~ .5 tf-t:;. DO
, 71 S.f)tJ
WA III t:b.
t!
I, t, Sf), PO
-I
3,~. /}'(J
"'2, DO
'/ ~.... OtJ
~
::J..'lo. (){)
'f I d. . PO
TOTAL (Also enter on line 9, Recapitulation) $ IS; 3S-f, .sz>
(If more space IS needed, Insert additional sheets of the same size)
Michael J. Malpezzi, Owner · Jeremy J. Shartzer, Funeral Director
8 Market Plaza Way · Mechanicsburg, PA 17055 · Phone: (717) 697-4696
May 23,2006
Rosemarie Gavin-Casner
1209 Bauman Ct.
Mechanicsburg, PA 17055
The Funeral Service for Kerry D. Casner
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can.
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
1. PROFESSIONAL SERVICES
Services of Funeral Director/Staff
3. AUTOMOTIVE EQUIPMENT
Family Car
FUNERAL HOME SERVICE CHARGES
SELECTED MERCHANDISE:
Solid Cherry Casket
Clark.7 Ga. Vault
Register Package
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED
AT THE TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN
ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES.
CASH ADVANCES
Cemetery Equipment
Certified Death Certificates
Newspaper Notices - Patriot
Newspaper Notices - Out of Town
Clergy/Mass Offering
Organist
Flowers
TOTAL CASH ADVANCES AND SPECIAL CHARGES
SUB- TOTAL
INITIAL PAYMENT / DISCOUNT / CREDITS
TOTAL AMOUNT DUE
"
Please
$3545.00
$185.00
$3730.00
$3895.00
$2310.00
$85.00
$10020.00
$120.00
$120.00
$210.00
$80.00
$100.00
$250.00
$185.50
$1065.50
$11085.50
$11 085.50
""lIAn.., 'ltMrrln~"'''7.;fi,...n'V'nlz"rl'rJI'Jn I""'1"l'JoM
REV'.1512 EX. P2.-03J ...
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
,;J./- tJGI- /97
ESTATE OF
C,AJtJE~1 /<EI2.~Y 2.
ITEM
NUMBER
1.
:1..
'3.
4.
s:
,.
7.
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
VALUE AT DATE
OF DEATH
~ J, J il.3..z.3
~
" ~.r{. /UJ
t} 3 S. f)()
, ~ ,3,70
~
9S7),~1)
DESCRIPTION
WGUS /IAN IIEAt.71I1 y,~/, /lPS'1 TAt..
1)/t.t,S &I/ItG AAli!IIt.M~
PINh'Ae LG 11 E1k."TN HoSPlrAtS
!IIINll-eLI:" Hfi"At,7N JIbSP/1/H..S
OoVJnt. ~ ,4-t.S
:TO'Nr OI3L/(ioP- OAI /YI()1l7GAG~ j)r:~T 70 CHAfE.
PR.I/IIle~Ai I3AiANelF t?J= l)El3T A7 ZJd)/~, tv,"
f: 3') O~f, 9/ (fla {!HAS€' STA-r€/JtENT A-rfTA-t!l-/Et)
HG2CTIJ) tJ.
4fJe.-h4{{(~) IJt ~ ~le .:: I~, DI'I, 91
A-Tt-AlJrIS f?oo/..~, &/fLJ.NrJE ()J()1f1:> ON l'P"l.
1
J{?, OIl/. 9/
F' .5Vtt)..tJ()
TOTAL (Also enter on line 10, Recapitulation) $ :1./,.:l '10. 8 c;
(If more space is needed, insert additional sheets of the same size)
- ,~
..
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=t'~LL FC)F: \!'!:C~E.~~~
.. "
WELLSPAN
HEALTH
YORK HOSPITAL
1001 S GEORGE ST
YORK, PA 17405-7198
. -----
E.:N", 'nL~~;PtH,,~(;lnLl P/\F:l''''
-
!ilL-LINt' DJ;Tl !\[;GDUl\'T NO,
CASNER,KERRY
05/03/06 129076154
Question about this bill? Please call :
717-851-2102
800-84 2-1783
Mon-Thurs, 9:00 am to 5:30 pm - Fri. 9:00 am to 4:00 pm
DATE OF SERVICES
021106 021106
02/27/06
02/27/06
05/02/06
PHARMACY
PULMONARY SERVICES
EMERGENCY DEPARTMENT
C/A-HIGHMARK BLUE SRIELD
PMT-HIGHMARK BLUE SHIELD
DEDUCTIBLE / CO -;PAYDUE
7070
7172
7230
54692
102376
2100121
222.30
0.00
992.00
91.07-
0.00
0.00
. ~,I' ~ \)~
~ ~ )~}, ~c! \~"\
mWWlSfJ~' nus EI'
________J
;:,,;.~-;.
.___. ___.,_.___u_______ __.___
.--_._---~.~
JVftL'l:tED
NEW! GO TO WWWWELLSPAN.ORG TO PAY YOUR BILL ON LINE.
PLEASE SEND YOUR PAYMENT OR CONTACT US TODAY.
,\:J,~'.~.-.
06/02/2006
'P.LEASE 'PAY '"THIS AMOUNT
$1:123.23
PU:Jli:[ rLD TI1:~: '''llF:nON Fur; YOllH REC(Jn[J~;.
PAGE NO.
1 OF 1
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-~~.----
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WELlSPAN
HEALTH
YORK HOSPITAL
1001 S GEORGE ST
YORK. PA 17405-7198
:_H,!,/'.Y~~~!!~~~r~C"Fl[~~ [~~~~~~i:.~I~;A ~f~~~~R.:.CM FoXPR~~~ Fill OUT Bll-OW.
CHIJX SMU' U~;Ii~c;' 1'0f, /-'!\YIv1E'~':
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ADDRESS SERVICE REQUESTED
a:&l-:""
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(:l,l<:l. uo; ,i c\c1lirt);;:, hE<iov' I~, 1/1(:011 r;(:i
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129076154
05/03/06
"'"'''"''' r." ,., ",.~..,...>".,
$1123.23
-------_..,~-
651206C
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HJ:....i....III!C, pi,"n
r,::. -~: :.- ',~:-; ~~:::~-~]:1~'~~:~:'::~,!~-;'l;;: _ j _ U ~- ~ t-; i : ~~ ~.~ L r 1~~;JJ':i:~-:~.:,,;,:-~~:;;..:::.:.~:;;,~;'0';(~.~~m:';~:;:i::-
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0101
I J J ,1111,.111111,111111,1 J \11 J 'I' 11.\11,".1.\1\, J 11.1. J I J \,.\
KERRY CASNER
1209 BAUMAN CT
MECHANICSBURG, PA 17055-9302
8269-T576
\1,,11\11.1,111 111""1.1,\.,,1,"11,,1,1.1..1,,1,1.1,,1,, 1111
YORK HOSPITAL
P,O. BOX 15124
YORK, PA 17405-7124
DILLSBURG AMBULANCE C/O PROMED SERVICES, INC.
4807 JONESTOWN RD SUITE 247
HARRISBURG, PA 17109
1-866-678-6855
Patient Bill
KERRY CASNER
1209 BAUMAN CT
MECHANICSBURG, PA 17055
Page: 1
Printed: 04/21/06 07:40
10: DiII-1301
DOB: 09/05/1961
Lme Dilte Rnngc Prov Procedure DxRcf pas Charge Un! Apprv'rj P! Pd Ins Pd Adjusted PI Due Balance
10: 1301 OOB: 09/05/1961
1 450.00 0.00 0.00 450.00 450.00
16 144.00 0.00 0.00 144.00 144.00
50.00 0.00 0.00 50.00 50.00
644.00 0.00 0.00 0.00 644.00 644.00
I Total Amount Due By Guarantor: 644.001
Patient: CASNERt KERRY
Claim Number: 64600137DiaQnosis 1) 427.5
Ins: 1) PBS/Non HIM103711980oo1
01 02/11-02111/06 007 A0429SH 1 A 450.00
Procedure: BLS EMERGENCY SERVICE
Date first billed: 03/02/06 Over 30
0202/11-02/11/06 007 A0425SH 1 A 144.00
Procedure: MILEAGE
Date first billed: 03/02/06 Ovar 30
03 02/11-02111/06 007 A0422SH 1 A 50.00
Procedure: OXYGEN
Date first billed: 03/02/06 Over 30
Patient Totals: 644.00
<}~V
~ cY '~~ \) t\\"
vwvvv DETACH HERE vvvwv
PLEASE MAKE CHECKS PAYABLE TO DILLSBURG AMBULANCE
Prov Codes: 007=Dillsburg Ambulance
- - . - - - - - - - To Insure proper credit, please clip and mall the bottom section for each page and Include with payment - - - - - - - - -
Guar: CASNER, KERRY #: DiII-1301 elms: 64600137
Page 1 Total Due (all pages): 644.00
, ,
)
Pinnacle Health Hospitals
\..>!9!iX'.',\'.!"i~..(t.i-t\;i~~~~'@";~";'lt;;#J;l~1,i'4J~,,~-j~~;',~t,~;j,:~.'i.'~'ir~':h;..:,<.;J,":'-:i~.\lf'~t-'H~\~.Tc1':(J:'iJ.~\'~~'i:ii!i.'t"~k;,..gYJ;;'!ii:.;:jr....:My.t-,';~<-'<;i';~~,'.'Qj;1},~.i;rt'>w.~;.((;....~;.:'.-.,,;,f~id:~:,~.t-*L~;;~~''',~~-~Rl&,'[!?I~jti;~..:i.11fjl:.--.'"i.Wt:"P.f;,';J.,~r,~~2'I~:..~m.:s:1l;1;\'If.-0ii,t_'i,'i1~'i;~r;t;.!
P.O. BOX 2353
HARRISBURG, PA 17105
111:111\111
(717) 230-3717
For AccOUllt IDfimDation, Please CaIl(717) 230-3717
r
Transaction Date
01/30/06
02/05/06
03/10/06
Description
PREVIOUS BALANCE
1 LIPID PANEL 80061
SYSGEN PA BLUE SHIEL 274 BLUE CROSS
PA BLUE SHIELD CONTR 274 BLUE CROSS
Amount
.00
35.00
2.06
2.06-
Edim"'d Iasarance Due:
.00
Total Patieat Credits:
Account Balance:
35.00
CUSTOMER SERVICE HOURS
MON-WED-FRI 7:00AM TO 4:00PM
TUES-THUR 7;OOAM TO 6:00PM
CAU 717-230-3717 LOCAL OR 1-800-603-6064 OUT OF AREA
PINNACLE HEALm HOSPITALS
P.O. BOX 2353
HARRISBURG, PA 17105
P..... dMIICh.1III Mum with your .-y...nt
For Hasp"" u.. Only
ADM OT: 013006
OSH OT: "NONE'"
OX CD: 272.2
Sipwure:
HOSP SVC: REF
Make CheCk Payable To PINNACLE HEALTH HOSPITALS
· TJu: CVV2 Number is t/u: lut 3 diatts on t/u: bact. of your aedit canI, by your slpatun!
DDDDDD8~ 01
001
1...111...1. ..1111....1.1.. .1.1..11..1.1...11..1.1.. .11..1.1.1
PINNACLE HEALTH HOSPITALS
P.O. BOX 2353
HARRISBURG, PA 17105-2353
ttI J f/~
frrJ( 'I I
450235304
KERRY D CASNER
1209 BAUMAN CT
MECHANICSBURG PA 17055-9302
n Please check Ibis boK If yaw adcha or Insarance InfDrmallon has changed and record the changes on the back of this statement
KERRY CASNER
1209 BAUMAN COURT
MECHANICSBURG PA 17055-8302
1 or 2
PINNACLEHEALTH
ACCOUNT #
190565727
STATEMENT
DATE: 03/10/06
LAST STATEMENT
DATE:
IF ANY QUESTIONS, PLEASE CONTACT: PHMS AT 717-231-8960 OR 1-800-5&5-6229
DP RECUR MED 1190.565127
PERFDIIED BY: MECHANICSBURS F MaLY PUC
DlI3D/06 99386.25 Y7D.D PREVENTIVE VIm NP 40-64 163.00
02113106 BLUE SHIELD POS PA'tItENf 145.00-
02113106 BLUE SHIELD POS CONT ADJ 18.00-
01130/06 90718 Y06.5 DIU DTITD 25.00
02114/06 APPLIED TO DEIU:TIBLE 0.00
02114/06 BLUE SHIELD POS CIIU ADJ 6.40-
02ll4/06 TRANSFER TO PATIENT RESPllBIBI
Oll3D/06 9CM-71 Y06.5 AlII YACITOX 1ST-sINGLICIJI 10.00
02114/06 APPLIED TO DEIKTDLE 0.00
02114/06 BLUE SHIELD POS CONT ADJ 7.90-
02114/06 TRANSFER TO PATIENT IlESPCHSDI
01130106 36415 Y70.0 COLLEcrm. YENm BLDDD 12.00
02114/06 APPLIED TO DEIU:TIBLE 0.00
02ll4/06 BLUE SHIELD POS CIIU ADJ 9.00-
02114/06 TRANSFER TO PATIENT RESPCI.lSDI
BALKE: KERRY CASNER $23.7D
INDICATES HEN FINKIAL ACTIVIlY sncE LAST BILL.
0.00
18.60
2.10
3.00
FUll PAYMENr 114 YIUl ACCIUn' BALKE IS IIJE. IF THIS BILL lIB
tIJT REFLECT THE CORRECT INSURKE INFDIIIATIClh PLEASE CONTACT
CIJR OFFICE.
THK YlII FOR lBINS PItI1IACLE HEALTH MEDICAL SERVICES. CUI. OFFICE
IIIJRS ARE 8:3O.IM TO 4:00PM, tINlAY, NEHSDAY, FRIDAY AN)
8: 30AH TO 6: OOPM TUESDAY AND TllJRSDAY
THIS BILL REFLECTS CHARGES FOR PHYSICIAN SERVICES PROVIDED BY
PItI1IACLE HEALTH MEDICAL SERVICES. PLEASE tIJT"E, Ill{ LAB DR
DI8GSTIC SERVICE MILL BE BILLED SEPARATELY 11IRIIJGH PItI1IAClE
HEALTH taSPITALS OR AN INDEPENDENr LAB.
CHECK.BOX AND ENTER ANY ADDRESS OR INSURANCE CORRECTIONS ON BACK
KERRY CASNER
1209 BAUMAN COURT
MECHANICSBURG PA 17055-9302
2 of 2
PINNACLEHEALTH
ACCOUNT #
190565727
STATEMENT
DATE: 03110106
LAST STATEMENT
DATE:
. . IF AtIY QUESTIONS, PLEASE CONTACT: PHMS AT 717.231.8960 OR 1-800-565-6229
BALKE SlItIARY
RESPCI4SDLE PARtY
... GUARJNTOR RESPllmBILIlY
POLICY I
TOTAL
$ 23.70
J
_ _ORTMt11.PJ,US' on,CH ... RETURtf 80TT"" PORTION 9U!'Tt!PTlf YO" PAY"_____.~.._......
HI2
PINNACLE HEAL 1H MED SVCS
CBO I PO BOX 1286
HARRISBURG PA 17108-1286
STATEMENT DATE:
03110106
GUARANTOR RESPONSIBILITY:
$ 23.70
1...111...1...1111...1..1....11..1.11..1..11111. .1..11....1.11
MJi-o:l PINNACLE HEALTH MED SVCS
CRO / PO BOX 1286
HARRISBURG PA 17108-1286
DDD100~1 02
KERRY CASNER
1209 BAUMAN COURT
MECHANICSBURG PA 17055-9302
"FlCE USE ONLY
CHECK ONE
FOR CREDIT CARD PAYMENT, PLEASE flU-IN INFORMATION BELDW
-_._---~---~ ---
-___--~_'":o-_-:..-_-::-_-:..__-_
--- --- ----
...--------------
VISA
-M/C
DISC
190565727
EXP DATE
";;';;.;;:~......;:r' ;.-..-..;~-..;-..-..:~:%':~' ..
'-"-- .. .---......---., ..
. :::..~:"_-_-:~~::-..;- -_-_~Z"..::.:;:"_~:r..t: ::. ..-_.._______..
03131106
~; I2HO
CARDHOLDER NAME (PRINT)
--....-.... -......-----..
..----- -----------.
-.,:" ".-:r_-.:.~,~o:~:':...-.:._:: .;.':...-:..-:~:':.:"::,
. .. ___ __"__' m.
CREDIT CARD SIGNATURE
CHECK BOX AND ENTER ANY ADDRESS OR INSURANCE CORRECTIONS ON BACK
MAKI:: CHI:::CK:> I-'AYAfjLI:: TO:
Dover Area ALS-Medic98
Billing Office
P.O. Box726
NewCumberland, PA 17070
~.
! .' ) ~ASTERCARD . I VISA 10
i . 0 " DISCOVER -- VISA
CARD NUMBER EXP. DATE
SIGNATURE AMOUNT
INVOICE DATE RUN NUMBER PAY THI[; AMour,;
4/9/2006 06-6444 $950.00
Local TEL: (717) 214-6018 TIN: 23-1352222
Toll Free TEL: (877) 214-6018
FAX: (717) 214-6020
email: info@ambulanceblllingoffice.com
KERRY CASNER
1209 BAUMAN COURT
MECHANICSBURG, PA 17055
11111111""1"'"11111111111 ~IIIIIIIIIIIIIIIIIIIIIIIIIII
Patient Name: CASNER, KERRY
Patient SSN: XXX-XX-5727
Date of Service: 2/11/2006 14:28
From: SKI ROUNDTOP
To: Treatment/No Transport
Primary Payor: Highmark Services Co - Pennsylvania
Secondary Payor: Bill Patient
PLEASE MAKE ANY CORRECTIONS TO ADDRESS ABOVE.
1I111l11l1~111I~1I11111111~1
DETACH AND RETURN TOP PORTION wrTH YOUR PAYMENT.
2/11/06
2/fij()6
. 27i'fJ06
2/11706
2711706
2/fi7os"
ALS Treatment Only - Level 2
cardiac. Monitor - ........
uUALs DefibSuppHes-....
nnALSNSuppHes.-n
ALS'.'Dlsposahie"SuppHes
.. A~~fnf~~~~I~h~~ppji~sn._.
Total
600.00
100.00
n 56.bo-
....................................................
50.00
50.00
. _ ,___ .......___ _______,'n
100.00
600.00
. . "160:06 ...
.-..............._.................____n.....
50.00
.,.-... --....._...............
50.00
....-..........------.................
50.00
............................................................ ..
100.00
950.00
0.00
0.00
A bill was submitted directly to your insurance company. Their policy is to send payment direct to
you. You are responsible for payment in full regardless of.the amount paid by the insurance
company.
Dover Area ALS - Medic 98.877 214-6018
CASNER, KERRY 06-6444
III. PAYTHIS AMOUNT 111..'
$950~OO I
CHASE 0
Customer Care Phone: 1.800.848.9136
Please send payments ONLY to: PO BOX 830016
BALTIMORE MO 21283-0016
Hearin,lmpaired (lDO): 1.800-582-0542
MORTGAGE LOAN STATEMENT
loan Number: 1514732563
Statement Date: 02/07/06
Payment Due Date: 03/01/06
Property Address:
1209 Bauman Ct, Mechanicsburg PA 17055
-
0.0208 2005 CHFS008 ET2005 BOR
#BWNJCCl
#3131514732563024#
6123Z BRE HEI CC 0
Loan Information:
Balances:
Principal Balance on 02/07/06
Escrow Balance on 02/07/06
Pavment Factors:
Interest Rate
Principal & Interest
Escrow Payment
Optional Products
Past Due Payment
Unpaid Late Charges
Miscellaneous Fees
Total Payment
Year-to-Date:
Interest
Taxes
Principal
$36,029.81"
". $0,00
1...111111111....1.1..1.1.1.1'1..11.11'11..1.111'111.1111.1III
5.00000%
$737.42
$0.00
$0.00
$0.00
$0.00
$0.00
$737.42
$307.55
$0.00
$1,167.29
-
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KERRY D. CASNER
ROSE M. GAVIN-CASNER
1209 BAUMAN CT
MECHANICSBURG, PA 17055-9302
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Chase Presents The Following Opportunities To You
REV.~513 EX. I~.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF C. A:SA)f3?~ 1</F,eJ(f' 2>.
FILE NUMBER
2./-I)/, -/P7
NUMBER
I
RELATIONSHIP TO DECEDENT
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s)
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
I?t>~EIJf"'I2It;; GAVIN'f!.~SNEI? W I'DDu..)
12.0"1 dAtlAlHN er:
/J1EeHI'IAI/~S4qJe6, ,4tf /70SS"
1.
AMOUNT OR SHARE
OF ESTATE
100%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
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No. 2006-00197 PA No. 21-06-0197
Estate Of: KERRY D CASNER
(First, Middle, Last)
Late Of:
UPPER ALLEN TOWNSHIP
CUMBERLAND COUNTY
Deceased
Social Securi ty No: 190-56-5727
WHEREAS, on the 6th day of March 2006 an instrument dated
January 26th 2006 was admitted to probate as the last will of
KERRY D CASNER
(First. Middle, Last)
late of UPPER ALLEN TOWNSHIP, CUMBERLAND County,
who died on the 11th day of February 2006 and
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, GLENDA FARNER STRASBAUGH Register of Wills in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARY to:
ROSEMARIE GA VIN-CASNER
who has duly qualified as EXECUTOR(RIX)
and has agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 6th day of March 2006.
,~lif!ifl{l tC "-1'aIJU-1 _..J{;1 culm / A4~
Register of Wills ---'::"-V'/L./ tl'
"-v)jZ.ll{~ ~
Deputy
**NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
.'
LAST WILL AND TESTAMENT OF KERRY D. CASNER
I, KERRY D. CASNER, of Upper Allen Township, Cumberland County, Pennsylvania,
being of sound and disposing mind, memory and understanding, do make, publish and declare
this to be my Last Will and Testament, hereby revoking and making void all former Wills by me
at any time heretofore made.
1.
I direct the payment of all my just debts and funeral expenses as soon as conveniently
may be after my decease.
2.
All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever
and wheresoever situate, I give, devise and bequeath unto my wife, ROSEMARIE GA VIN-
CASNER, to her own use and benefit absolutely.
3.
In the event, however, that my said wife should predecease me, or should die at about the
same time as I die, such as in a disaster common to both of us, I give, devise and bequeath my
said Estate to my wife's sister, JANET KNECHT, Trustee, in Trust for the following purposes.
In the event that she is unable or unwilling to act as such Trustee, I appoint my wife's brother,
ANDREW GAVIN, to be Trustee in her place and stead.
A. The income from said Trust Estate, as well as so much of the principal as is
needed according to the discretion of the Trustee, shall be used and expended for
the support and maintenance, including medical, surgical and hospital care, and
college education, or other such formal education, such as any internship,
apprenticeship, residence, clerkship, or the like of my sons, RYAN G. CASNER,
MICHAEL G. CASNER, STEPHEN G. CASNER, and any after-born children
who survive me. The decision of my Trustee as to the completion of formal
education by any of the above children shall be final.
B. The payments authorized by Subparagraph (A) of this Paragraph "3" shall be
made without any regard to equality of distribution among any of the said
children. The amount to be paid for the benefit of any of the above children shall
be determined from time to time by the need of each of the said children, and the
amounts and times of said payments shall be determined by such need. The said
payments may be made by my'said Trustee directly to each ofthe said children, or
to such of them as may be, in the sole opinion of my Trustee, of such age and
ability to handle properly the funds so paid to such child, or may be made by my
said Trustee directly to the person having the custody and care of said child, or
may be made by my said Trustee directly to any institution entitled to such
payment by reason of services rendered or to be rendered to any of the said
children.
C. In the event that any of my said children shall become wholly or partially
incapacitated, disabled or the like, and should they qualify to receive or be
receiving any public assistance or the like at the time of the inception or during
the term of their Trust, my Trustee is to use the income andlor principal of their
Trust only in a manner to supplement or augment such assistance or the like and
not to replace or supplant it. Additionally, my Trustee is to consider all available
scholarships or other educational subsidies that may be available or may be
applied for in connection with educational expenses, it being my intention therein
to augment or supplement the same and not to replace them.
D. To pay one-half (1/2) of the principal then remaining in his/her hands to the said
children, share and share alike, when all the children shall have attained the age of
twenty-five (25) years. The balance shall then be set off equally to each such
child, each to receive the income from his Iher set off share. The income to be
paid out monthly or quarterly as my Trustee deems best. The balance of principal
and any accumulated income thereon shall then be paid over to them when the
youngest shall have attained the age of thirty (30) years.
E. I direct that the interests of all beneficiaries in the Trust hereby created, whether
in the principal or income thereof, shall be free from liability to attachment or
other legal process issued at the instance of any creditor or assignee of such
beneficiary, and I direct that no payment shall be made by way of anticipation of
sums which may thereafter accrue to any beneficiary.
F. If the Trustee has taken into the Trust Estate any real estate, and as Trustee
considers it feasible to sell the same, I hereby authorize, empower and direct the
said Trustee to sell at public or private sale or sales, and to convey any such real
estate to the purchaser or purchasers thereof, and to give good and sufficient deed
or deeds for the same.
G. It is my wish that my Trustee, so far as circumstances as they may exist from time
to time will permit, use the services of Michael S. Cornfeld, of Heritage Investors
2
,.
Management Corporation, 7101 Wisconsin Avenue, Bethesda, Maryland 20814-
4878 for investment guidance and advice.
4.
In the event any of my above children, predeceases me or die during the term of this
Trust, then upon the termination of this Trust, his/her share of principal shall go to his/her
surviving issue in equal shares, ver stirpes. Should all my children fail to survive me or die
during the term of this Trust and is not survived by issue, then I direct that the balance in this
Trust at its termination shall be divided and distributed equally, ver capita, amongst my and my
spouse's nieces and nephews who are living at the time of such termination. In the event that
any of them are under the age of twenty-five (25) years at such time, then his or her share or
shares, as the case may be, shall remain in Trust upon the above stated terms and conditions,
excepting however, that each such child shall have an equal share and any withdrawals for his or
her benefit shall be credited against his or her own share only. Additionally, I authorize my
Trustee to maintain all the said Trusts in one pooled Trust Fund to keep administrative costs to a
minimum if Trustee, in his/her sole discretion believes the same can be done in a reasonable
manner while maintaining separate credits and bookkeeping entries for each child's Trust.
5.
I hereby nominate, constitute and appoint my wife's sister, JANET KNECHT,
Guardian of any property which passes otherwise than under this will to a minor and with respect
to which I am authorized to appoint a Guardian and have otherwise not specifically done so.
Such Guardian shall have the power to use principal as well as income from time to time for the
minor's education, support and welfare, or to make payment for these purposes without further
responsibility to the minor or to any person taking care of the minor. If she is unable or unwilling
to act as such Guardian, I appoint my wife's brother, ANDREW GAVIN, to act as such
Guardian in her place and stead.
6.
In the event that my wife predeceases me, I appoint my wife's sister, JANET KNECHT,
Guardian of the persons of any of the above-named children who may be minors at the time of
my death. If, for any reason, she is unable or unwilling to act as Guardian of the above-named
children, I appoint my wife's brother, ANDREW GAVIN, as Guardian of the persons of the
above-named children who may be minors at the time of my death.
7.
I nominate, constitute and appoint my wife, ROSEMARIE GA VIN-CASNER, to be the
Executrix of my Estate. In the event that she is unable or unwilling to serve in such capacity, I
appoint my wife's sister, JANET KNECHT, to be the Executrix in her place and stead. In the
3
. .
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.
event she is unable or unwilling to act as such Executrix, I appoint my wife's brother-in-law,
DALE KNECHT, as Executor in her place and stead. Ifhe is unable or unwilling to act as such
Executor, I appoint my wife's brother, ANDREW GAVIN, as Executor in his place and stead. I
direct that they shall not be required to file a bond to secure the faithful performance of their
duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this r2~ I{ day of
~ ' A.D., 2006.
V. KE~L~
(SEAL)
Signed, sealed, published and declared by the above-named KERRY D. CASNER, as
and for his Last Will and Testament, in the presence of us, who, at his request and in his
presence, and in the presence of each other, have hereunto subscribed our names as witnesses.
~ ~~.iiL
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4
GEORGE M. HOUCK
(1912-1991)
Register of Wills
Cumberland County Court House
1 Court Square
Carlisle, P A 17013
Dear Register of Wills:
~
CHARLES E. SIDELDS, HI
AITORNEY-AT-LAW
6 CLOUSER ROAD
Corner ofTrindle and Clouser Roads
MECHANICSBURG. PA 17055
TELEPHONE (717) 766-0209
FAJ( (717) 795-7473
September 28, 2006
Re: Estate of Kerry D. Casner
No. 21-06-0197
Please find enclosed for filing 2 copies of the Inheritance Tax Return for the Kerry D.
Casner Estate as well as Check No. 103 in the amount of $15.00 for the filing fee, Check No.
104 in the amount of$240.00 for additional probate and Check No. 105 in the amount of
$780.93 for Inheritance Tax due.
Thank you for your kind attention to this matter.
CES/mjj
Enclosures
Very truly yours,
f!IMjp !.~
Charles E. Shields, III
Attorney-At-Law
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