Loading...
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) .. ,. tdmunds used Ford Escape car appraisal. Used Ford car pricing. .:...... . ,_.,. 'JSIGNltfjJ 14gl~U ,'Jiit;-__-" ,,",,-",,-.,' ed~ "'\11_H'J. . Edmunds.com I Inside Line I Your Account MAAt<<TPi.FicE Financino As Low As 7.29% APR Free Insurance Ouote 08/01{2006 11;22 AM HelD I Directory USED CARS CAR REVIEWS liPS & ADVICE fORUMS HOME NEW CARS CERTIfiED CARS 0'---- . -- - ----1 E., LOAN ~- .-.- - --- -- ~.- III Get a free CARFAX record check. Buy your next used car with confidence. Great Rates. No Lender Fees. . Search for Used Cars in your area . Sell your car online . Research Used Cars (~ Apply Now) <y Use the links below to '" research this vehicle f'ft 10 NG AND COSTS · TMV Pricing , Appraise Your Car · Resale Values · Payment Calculators · Vehicle History Report · Certified Program · True Cost to Own CAR FEATURES . Standard Features · specifications . Colors · Safety · Photos & Video · Maintenance · Standard Warranty RE'\lIEWS ANO RATINGS . Vehicle Overview . Consumer Reviews . Awards & Road Tests . Ratings · Consumer Discussions Nuer srEPS Used Vehicle Listinas Sell Your Car Calculate Monthlv Payments Get a Bad Credit Car Loan Frp.p. Jn~llranr.p Ountpo;: 2001 Ford Escape 4 Dr XLT SUV View 2001 Stvles Other years for this style '=-2~o.~JJ C~ Consumer Ratina 7.9 I IRWI'Il'i:!I'.I11 119 Reviews J.D, Power Ratinas I View all Ratlnas I Overviews . Search Used Ford Listinos . Download to PDA 1:1 . Calculate Low Pavments . Free Extended Warranty Quote Used Car Appraiser Back STEP S Review Edmunds.com Pricing Report &001 Ford Escape XLT - True Market Value@ p..icing Trade-In Private Dea ler 2WD 4dr SUV (2.0L 4cyl 5M) ~ ~ National Base Price $7,579 $8,742 $9,815 Ootional Eauioment $334 $395 $501 Compact Disc Changer $152 $180 $228 4-Speed Automatic Transmission $182 $215 $273 Color Adiustment $24 $28 $31 Gold Reaional Adiustment $-140 $-162 $-182 for Zip Code 17055 Mileaoe Adiustment $1,236 $1,236 $1,236 25,000 miles Condition Adiustment $0 $0 $0 Clean Total $9,033 $10,239 $11,401 Certified Used Vehicle $12,483 Price Another Vehicle Print Private Party Window Sticker I Print Dealer Window Sticker Next Steps Get a Free Price Quote on a New Car http://www.edmunds.com/used/2001/ford/escape/l00000896/options.html?tmvaction =vd presu It ,ll.,dvertisement 'f' Page 1 of 3 ... ... Edmunds used Ford Escape car appraisal. Used Ford car pricing. 'free Warrantv'Ouote CARFAX Record Check FIND p, RELATED CAR 2001 Stvles Previous Years Other Ford Models Other Comoact SUVs Other N/A SUVs Other Crossover SUVs SlUel J\NOTHER MODEL Select a Make -';'\ y Select a Model ._~-\ Trv Advanced Search tJS[FUI. TOOLS E-mail this Paae to a f!:!!mQ Learn Your Credit Tier & Get Local Finance Rates Download to Your PDA ADDraise Your Trade-in Calculate Monthlv Pavments Looking to buy a new car? Get a Free Dealer Price Quote from dealers in your area. ~et a Free Quote' View Used Car Listings Instantly search thousands of used car listings. Target your search by year, price, mileage and distance. (Viewtistings Near You~ Zip Code: 17055 Sell Your Used Car Online Get the best price for your car, fast! List vour car in several on-line classified sites. (Sell'your Vehicle ~ Get A FREE CARFAX Record Check Order a CARFAX Vehicle History Report ... your best protection against buying a used car with costly, hidden problems. (' FreeCARFAX Record'Check ~ Buy a U5l~d Car Find cars for sale in your neighborhood: 08/01/2006 11:22 AM I Coveragef)ne I liornE ! New Cars: Certlflee! ! UseeJ Cars I Car Reviews I Tips & Advice I Forums I Insicle Line I Your Account About I Dealer Inquiries Search I Directorv I HelD r~rd '~--_._~ , I ZIP: Go powered by Auto7hlderO Sell Your (ar Get your car in front of millions of on-line car shoppers! ZIP: Go powered by Autcl1hH:terGt . Sp~rrh lJc;pc1 Fnrn Li~tin(]~ · Download to PDA 19 · Calculate Low Payments · Free Extended Warranty Quote hltp: I /www.edmunds.com/used/2001/ford/escape/l00000896/options.html?tmvactlon=vdpresult Page 2 of 3 .. . ~~ Edmunds used Ford Escape car appraisal. Used Ford car pricing. 08/01/2006 11:22 AM Edmunds.com IS hlnn9! Emplovment Opportunities @ 1995. 2006 Edmunds.com, Inc. Privacy Stat.ement I Visitor AQreement http; Ilwww.edmunds.com/used/2001/ford/escape/100000896/options.html?tmvaction=vd presult Page 3 of 3 ~,..~'~"'" . 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 (PA6€I) .~.jr OF fMON'EN. KQltY.1>. 21-~'-/f7 ______________ ____--+----______ __m_____ ~ ____~_________________________.._______________ .___________ ._______________ ---.---- I I ~-..--.-----~-lK-IA!E~ #()TF J_____7!/(.L..?h'''UfP_ let ,eDH>~4S __.sn'''~L.Il_._T~E __.__ I ___________ &LL.~&tJ/N6 ///166 .fi/~ ~S'1ITf '?~~__&~~" ~IIP,(. /# _~#vh#(!7/"A/ /.e//7"H T...vc:- /#~I/?""/HA'n'AI .I'f/~T/~_SG"'!Ir._____ I ~KL.. ~Y'7#E 2)CP7: I)r /&ErBY~E: ~~ _ ~~t:7"!!eW____ u __ ~&' //APt ./)/'&B?T ~2> _"HVE"" atJT.+/A'/ANi _~ A:'J~.M/& __ ,________~ 1ge,?/II _ ~F ~T qA//~~ ~F ~/9E ~4'-r_ I ~~~/Y.J' ~__/JE /fJ!t!N/Uf7iF. /fa /2E~ca A:.>~7:S'. ~____ - /!-7 AtEAliBa!.~ IS,.FCt!J /JIG(!IIA-/Y/e5 ~&(,f. G,. .~_________~_____ ~,eJ/i~.N6- _ fT; 7~ - S72=~NF;t/ 6.~A/Gif. ~ ~/#;t! S"AI - - - .------ ~ -"--~---+---~-- ----------- - II'" .-~------ /. _ /ft!~r; Jf'1" J' 9- ~o_ _ EST~~. //-/3- ~O >__________ _____-p.D~ZJ. v""~__>__ ~ II ~ 11 _ --- ____1_ 364', II ___~_~L"f.____u_ ---~--~- -~ /'&,.~~u_ ----- -_._-----_._._---,-,---------_.,----~-_.~-_.__._-_.._~~--~-----.._-~--_._-------~~._----_._.._--'--~_.._...~----..------..-- _____>_____ 2,) .lJt!~(._lt..t'_' ?-:-_~:l_. .u___E;5.T:~_~._~.___~~~~ ~~s- ___.~_______.>________._____ . , ,-__________ . _______~-S'i ~:.!!l_______>~_J~IJL________________________________.. . ______.___~~1:!.{._S"x..un ..- ~_________J.. !(!(!~ .if/: '.il- '1$:____ ~Sfil.4. tP- -$ -I:) S' .____ __ ~-r5; . ~.2t;1'_______~-.M~_..______ _ __?i.?TA%. ~ .:J, $'17. /) 9 f' , 03 2. ~J, ____.__u_~___________ ___~_~_____._._ ,-t~~'TJDIJ!rl._ IKFI2. _..JloTFi:~ &~4:t~G" ti!ftlAf. ~.sIJl~L~..._7Ne:_.______ lH'/o~M ~E_ KElMY C!/I;$41~., _.8@f #,1AfF ~<!t~J/~~fff~X._~/~_____ ~n_ __ ~&" u A#~;W~ ,.JZ_TE#~-"#' ~!ffFj}~ 7#Ei:.u&&>"'E"_",f#LJ nu__ __________> __ __>_~H~':V'IN~- ./-t!qpU.# r~____Lr ~__~~__I//Y./J.~~r:.A-!'!,/)/'ri._-Z~!'f T ____u_ _____ ___.__+7 N~_J2~~~___7H~.e _~~__~slE!?((__#rIt_.!"'_~_ .s;r,~_ ""z; dGT? ______ i ___._--+~H~ /YCUJ /J$__z€~__LH}(_ ~r;~~7/~~. ~Yz-_________ ~--__----~----~E:.-Lk;(Lt'A"---~t?.Ll-~-~~t!#--~-~..--~-~~---_.___ , I IJII-TIf SHE~T re>~ /J1/(!.H4-e. c. CA-SA/~ (!'A ~€ Z) ! SeHBJ j:: 8 Z . .()I;.C'ASIY~# K~Y~.P. ." .~I=tP~ -t?Z ..~IfF...._/-1!~' N'P7"€ ~...._#P'-~_/#'~.AI~.~. 01'1/. (iJAb~dJ.... ......... ___... SU/ltZIt(A.I.~....v7;.ZtG"~.= ..bJ.Lc.~~g.__~...eA:SA(~/.. .;f..!.?tL4'~~_.,_~~_..__.._..... /..L_~~~r/lf!.Z~1..._-:.t:Jo__,_. , _.J~~.L"bf!!/...__~-7.~f?~'I__ ~ J;~~___ _......__....._... _.__...... ..~~2~_~.,.,__..,,__1k......~..._.. .....'If.l...l!l.__. _________..____~ _.M."[.JJ" 7 2.~ - ~~______...___._.__E;SZ."'_d~..._3 . Z~_::__~~._ ._ ~~_!.!!_~~_t,?__.____l~.__~ " :< 9.3/.so ._"'..--,~, ..._-----,---- "._.4) .. t:~~.T___1.s:.'_7:?2.:._tf~____. ,.. ._~"L"'!!t.,__~_:$:_ _:~ .r. ,. _________.._____..,,__.._ _,__..~_?;jL,ffi"Ltf-- .._.__.a ,.,.~ !': .." _,,_,,~~~!t:Jf___. .." ~ , S. '77. '13 ... ...-...,---...."...--.-....-..., --- 7ii'TAL 1JA-7A- ..s.Y6FT ~/( I'<.Y4N~. CAsA/4F7( (P',I6lF 3) St!NE'D r:; /i?T_RE_.[}!~~_ __g~Y.1:?-:::JL-:C!~/" Z (SE"~ _' /~cP _-1P??E__~_~~0._/Ar=t; AI~l'G" 0# (I!_~.F t)l________________ ,.$l!~fl((~€,_~_ 2'€4. == _~~JI[~_~___c:t!!_SA!€?f~,,-d.t!1LI!t(!~,~~----- - _ .___l.)__~~_z: l.tPnZ,7-:--.t!?!2,____~ZA&__I:=(~__:L~~l____b_!J_.J!'.,{1t.:L__. ,.. ~, /'~f! _."___'_ ____ ___fd.__b,f._ ,,;'/ 3f?__.~_m_._ __.._________.____:? _.fl- ~ C~._ II'..."Z? , ___~?:._..__,_______._€!!?:1:.~.___~~_ ~~:~_~~ ___ ________. (*~~~!s._.!!:'..~..7~~~~__~. ,LU.7_Zf,::._~~__ - D- .".._-,.~'''".~,._._-._.,~_..,,_._. .., _~. __.~T;_J..lQ~!i=.__'l~.._ .,. .._.~~?':~~. .... _.cf'...s--:~~o.r....._.__. .. . ._______ ~..'t..1_~_~.lZ___,___ _ .__~,_!lit ,- .? l./7F. S'l .. -.,..--....,-. -,,_.,_. -.--.,.-.....-.-... - ...; '\ 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 ~ !!!!!!!!!!!!!!! - "'- ;;;;;;;;;;;;&; - n ...== -~ === , !!!!!!!!!!!!!!! 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 ~ ,,- ---- "= - n ... ~- === f 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 ~A,ITAt. 'BLUE- CA.b5S tee 7J/lEAlcA./T RAIJ 11 DES/~EG": t..JIDDW ~SE/I1"IfUE (i;.4VlAI- J'~ ?;;~.,(') /DtJJ, CA.sNGIt (Wlff' P,f-tIlJl- fillN ~ E 7'7i!!f7f A T?;tf t!# tD ) H"flhlII-JeK /Nf&S7A1GA/r I'UMJ , ~~N~E: pltll..,-,e.IPlf-IIt's E.s71fre (7/.1~Ht;F J/IA- ~/~( ~ UI/&>~~) (St?1F VAlUlt7iIJ.I!I L E' T~ A 777fJ-t!H;b) -0- ; Itl, 9 z~ hJ ,. 3~ "7.'3 IOO~ , -0 - 3"7," 7.93 3. CutJA- ~ fb;>TH 1M (SEE DAm LE" T ~~~ Af,Y~. IT7TAal(tr1>) (! [,{ AlA - t< E6ttt.A-l(. I/C A (SEE l>A7/1- t..G7~ /IN/J t17rA(!/oIEtJ ) 1/()7l! /)E(Je/)EAJr tLJA;J t(,AJ /)d Sf ~ YBlltS t?F /f&E A-T p.6.b. 7Nt:-SE F/~t{1Uf3 h2E SkP"~/FO ~Ii!. /AJ~ ?u/l./'pS6S AN.IJ AttE ~ !JIJ-YA-.I3LE 7b SA::;HS&: /AI MY ErE7/1T AT A (J % INf.{. m.x t€A7E: '1-.21, I S3.IS ~/.*7?NIIS JOO?D ~ -0 - ;111 IS 3. I~ 1. ~ C ,tf-t..(!1t LA 1l4A/j /7 f I Oh 3. 90 , 17~~'3. 90 IDO~ -0- TOTAl (Also enter on line 7, Recapitulation) $ 318 J f()". 9 g" (If more space is needed, insert additional sheets of the same size) . 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 $37,667.93. If you have any further questions, please feel free to contact me at 412-544-2068. Sincerely, " ~.J'4 Sherry Finnerty Benefits Representative lHP.IIO IR4-03J :ES7: o~ CII-S4IBt, K€,e/lY '1>. .:2/-()f. -/97 ____, ___ __~ _(!~t!.m~€_f"~~~___PE" .... _~_~__~_mj~'~ILAlIf:t!:__.i.f'._C.L,p-'I_.s:~') ~~------ T(~~~#"F ~T1-_!'€Lr~Hf.if,M( ClLAI,{nArr/!t!~JfPJ . --~------.Ajl /A7 s..~,--_~__CAlJ!~__--_----------m------m m ---.-.-----..---,---,-------- n_n=-_~t ~~.~=3~.7P-/~~.!S- H~=taVe.~~~~-l~A ~ '~?J-_=~~n_i,:~~~=~ __-.--ti.4~.~..Gc;._~_.-.-n---n-.-n--_.~-..H ~--~...- i It,' "25:1JO'. f, 'd3.75' :: ~y~ . t d'!,31 . X ~/)O____ -=- ~9, 752. /)0 ..------------~~J- .....~l!? sit. .E__~u ~ h I:J.' /) L '1 " ,J,1L. :::::'__~'_ __ . I.~_~_____ _' 1# l.,~ .... ~~~-"l~__jf_J~ - ,. J 1<$:oD -----J-----..----.-- ~ ___._" ___..________JJ_. /II/~,f'LJ1lHlJ:E[ _ ._..._.m___ ___ _. _..__ _______,_,____"________ _ _ __~____, ,____,__,___,____.m_ _ _____,_m_,_ _." ..__ ~# 933, IS ...... ____m______ _____.. __ ______________h ____m______ .__ _____________.____..___ ________________m_ _____L~~____m__ ~_'_l5'~_L~---- I -_.,----~~_..~-_._.._-,._"-_._---~. ._- I :<S7: t>,t::." ~~ K~Y ::z>_ I n_ - :-~~::--:~;~';;::~=~t(~~:;::'CA'-~S-~W --.-------.-------- --~-~------------------------ --------- . _._-_._----------~-------------_._----------- ____AJt/Rk?_Jk. ~ ~YE _______~_J..___A,._'3t:~S-____ 10. _~3'. ~'1__ - 41!~.~.t..!. 's...____l5..L~!L___=________ ~_3'S: ~~-- _~. J 1__~<<2_Jk. ,/ /J/J)RX . .______________n________________._______~_.____________ I ~ ~ ~ __ __________--+__h~?,_"tP__k ~ ~. 9~___=_'lI".~___LZ./'_.x_n_J.oo -=-_______ S;_Lf..'L~~o u__ i ______________C'-4-_J.fl!f!.JIJi _-"L_ /II G.. .._ ________________.___ - _. __ ____ __ ____J_____._6L_~ ~t!P __ __..h__~' l /~_=__~..___~_, 7. S 7.)5__.1~~L______.___ ~~_7~Z,-De: _____.P.) _ J~~~-.s~.'--tf AIII,fr .._._______u_____________u -- ._._ _____u. -------.----------------------- ! 1 . ~ " ________________~----lt;'----- ';1),// . _.lPm__Y" zs- -:_ ~._____L!l.. 9.3_-'x__."?~{)___=_.______.___.J.J-'i i~_"() un u___~L--:l tJe_ "k.. _~t___~./Jfy..__.___.____u_______un___.________u___.______----------- ..-.-.. ----------------------------- ___u_____.___ __.._.____._____~!..___~iL~______A.__~ ~~~_2,~__=_~ ~__ ~l.;J~_2A_~ ~.=__.__._____~:!t'izt I)~--- 6) ._da;. .56.__,}: ... ~.I..C!2__________ .------ .----.------ ..- ------- -..------------.----------- " - ~ ,. .__..____________ _____JJ_L__ (9.lT __ ~__.L~_~f!____~_~_.____Ltt._Z!t-__.X_~():n_______~2Jt~-~t)- G. ),2/JO.fl.. ,feAl)' _______u_ _____u__.. -------- m_____ . .._..________un ___._~~_ ___~i.!f,___'t!!_____~_! f1,~".R..__~ ____~ '___~ ".3. 7S_A.._~e(2 ==__w______._~ I ~ 7~t). D~_~_ -n---HlfS1J~h. of E~_u___n_. u..____~__._n_ - .... ... __~_._ ..) t .6L~ /3.85 -.~ t/3.2f =l1!!!~__~~3. 3r._!5..2sr;=_ . --. "'o.o.zo.t1fJ.._ . _____ T. ~",-6....6:f FN~_____________. _. __ .... W ____ ___. _____. _____________-1____.6i_Un~~S;__f!'L___jg_.__:5J~ll...:::_ IUAL. ______ ~.~ '19 __~ ./Sl> ._:_____nu____~-I'~..~b . .___.:r;)l~sf1~-.1!t ~ ---.----.- ___1__/'" .~J~~_~1 _~~4._?..{7 =: 4ML . "_~~.JZ.. )(~_~Q.. =_ ______:'~_~~f_~~__ -.-.~lJ~-~~-'- .... tI.QG-__. _.--- -----"-------- .. -- ____m___..__ _ .----.---- .. _t_____~L_ ~:}s.~() _k_~l?/l~__:=~. ~'f.3f)<. 300 =-_ __~~_~!tf. '~___ __ ___L .)JJ&tlg~t _If ..lItEX.__u____ .Un -------------------- _________ ___ i. .__6J.__~;,D. ~J___h~~.Ps:_~__OMl..____-!~_'t'!..x___~~e::= _______.~{~_~f_~!'!!__ ____ _..._~IUtt.d)---.w---_.--n---------- ...----.. . ~ - t)" - / 9 7 EST "F eA...5A1i:7( / /</!:-?&ty ]). A 1- p" - /9 7 t1~GE .2 ",c C!./N.~. ~ /t€(;tlt..l'!te tZLt Ill'; kA __......._._.___ ._. k._.t!l)_~~__J"~.__~_&r-------...--....---- __.__.____.__.__. u_._.h!.~_._?~:~._ ~_._~.t:f~_.~~ .~_'t..~L._.~_2~7!__~. _.!!J /t'~~4:__.'!f dLG- . ~ ~ '" .. .___' ..__..__.__ ._____~_~~_'_R_..h ._~'f..~__._=...~_..._. ~~.~tX. /~~......... .... ." .__.._.._'__ _.____~) .. 2et2~L ~_.{,sl.._...____ .__..._____.___.__._..._ __._._AL~~~~_. Io..__~?:-'!~___..=_._H~~~___~~~, ~~-..!!._~-:---- . I , IS if. ::,'/) .Jf-..--....------ .. ~ .s: SlJ9.. IJ I) ... ..__. ...L....._..............._..._...._. "7 '7h. DO -. . "'"'-.-.... .J.... "'. -..... ..'-'."-' .. ..._.___._.._._ .. _.1:). __ d I!!!_~~.~~._,fl yL____._.... ..' ____.__... ._____.________..________...__..._._ . ~ ~ ~ ___II.i. ._~ ~z._._Lk..__~~!t.._..=.___~~-..._ _.._~?_=_~."...... .X...~'? ...::.... ....._.. ...._ ____-'f)_~.~~sJJ_l!l__~~'_.._.___ _.___H_____._.____.. . ....-----..... -----.---. I f ~ ..._____.__...._____.. ._.!!.I..__._.t.~,,1_~...B 7!_.~._.~:.. ...._._'I.f!'i~.___~ ... ?__~~ ::...._ ..._.__._.f)_.$Pp._.$.~:_d.__r!.t!.~f.__..__.__.._..__.__.._.._ .---.---....----.--- h f. f ., ..______" ....___l:______J ~~i~__k_.J..?~~_..=__.nf:4!!~._.__ ._!.?l.~_~t .._~_ SP.l!_::.___.__ S.. I PO() S~. "" 1J~.l> ._ ____ _.._._____. .."_.__._ _/.. ._..____.__.... ________..._________..._. .._._____ .__._____._.._.._._._____... .____ .... _..._._._.w.._____ __c. ___.........___.___.__._....______ . f tI ". ~ __.._____..... ___________ "--'.__--..!..'!:_f~__..iI!_.__~!..!!__=_____~_~.__.__...f!!.~_/_I_.!5._!".~~!..._ =._.________.__.___ __L () i I? IJ ~~~...._ _ _J;)_~b{?~"_:__d._~___.. .________._....______________ . ..___Al.____~~~~__..l~__~~:..~~..__~__ _. .~~ .:~_~f_~..;bl!E~::=. _. ..__ _~~_l~(l~.~~...___ . . .UJ ..B20J..h__../)I....&lX.__ ~ .._.__.hL~t& 'i~ .nlL_~/~~~._. ::: n_ t:tuL. ./tJY __ _~ ...,,;3Qp. = ~ l___S~L(I.$k~__l!l... .kZ~z:....__ n6i-lt__IP. .~t - ..~. ..llL )C.~I'Jf?t! = N.) _l$l)~h.~f. If!.!:.r 6,' Y/.lcf;nk~tf!!.,S2. :::: ~, ~ ~.8C/ ~ /5?J =: .. s: .~?~,~~..__ "/0 8f,.7S" . _...._._.-:J..... .______.._..___..._. r , 3Ytl, 6D ____L. __.___ .......__...._....._. ~ 3 ",r, 1)0 . .__.. '.1... ._...._ ._..___ .'. . _. ._..._ ]I ...~f!. (J~ . /He NeYlltlf!!kiFT ", 1.2'..{)0 _ _ ..._L ,. /7" ..1I9 (. ~.s- '.... - .. 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) - ,~ .. ,,,,, .,',.,''''...a........... =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 111111......111111111101111111 t- f"i:()!'[) CHElJlI l'U,Ni:~ UClf\C:I: 1\1-1: i F\I:'! UHI, 'liW.. VULlF IJ/\'{IVt!+r II" THe f.1,(;_(J.~;U) l+iVC:IOPi -~~.---- .-....- ~ 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'~': 'I.~?~I \;~'.:;rEH(.i".J. S;;U)\fIRl.I1SA .1 t~f" _ ~:I~~H1I(,,1' ,:I'i';;' ! CAi{-1-i-I~Ji:.~t11~:f~---~------ ----~-----_. ----- - ----- ,_._~ -------~ - -Tf~MC)lji~ri- ,.~,',_:;,i;:l"iil. -------.-.---- , ,i,l\f!~)l-I()~_[)t:l: Hhi:\[ . \'f-,-j ~U,:'I hhH; 1....,\ ~,\'(~l~:-_;H\, r F/::drl '\ ADDRESS SERVICE REQUESTED a:&l-:"" ~~ ?i . (:l,l<:l. uo; ,i c\c1lirt);;:, hE<iov' I~, 1/1(:011 r;(:i !~~j J((,1.1 i~;( H"J10r!11{__t110! hct~ CIIU.il~j(;( Ii IdIC;c:(lt 129076154 05/03/06 "'"'''"''' r." ,., ",.~..,...>"., $1123.23 -------_..,~- 651206C ;.l, r..: (:otli'f! NO. HJ:....i....III!C, pi,"n r,::. -~: :.- ',~:-; ~~:::~-~]:1~'~~:~:'::~,!~-;'l;;: _ j _ U ~- ~ t-; i : ~~ ~.~ L r 1~~;JJ':i:~-:~.:,,;,:-~~:;;..:::.:.~:;;,~;'0';(~.~~m:';~:;:i::- t~~~:. hilr..l'~r 1:';-'iE'C,:L~: r'hYl-.bLE "re): ~:~ 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 - = ~ == - - -- KERRY D. CASNER ROSE M. GAVIN-CASNER 1209 BAUMAN CT MECHANICSBURG, PA 17055-9302 iii !!! ~ iiii = 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 $ -- -- ~ ...... == " ;...~~~..- .... , ~ ~. c -~-.., "."'1 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 . . i' . 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 ~~ 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 o -n 1'1 .,.C) "CC;;r- " ,-i'n ~j~'~ ~ (.-)0 ~.2-T'I \_- . J.J ::':J ---I !> 1'-' = <::::) c..-- o n -i I N ----n ""Tl (~) c.) . :.",:) ~ -. C~:] I""' , ." i'l :~:J -0 ::!:: :-.'-':;s~ ~'_.~~ ~~ , .--- 1 ~ ') ~ o N -- u.. Cj "" f:.": u.! --' < . C). ~:,.>. c)::.... <5 ~ \ .....:. :::=r :::- -::---:::::. ~ ru 1.0 1.0 Q ~ Q.) ~ ~ o ~ .... ,.. ~ o U ~ ~ ; S ~O~r- :O=U"'''!'''"'I ~-e~< ~ i $~-- ... ... .... ~ ~Q.)...- ~.Q=;! .~ a 0 ... ~ := U ~ ~U"!"'"'lU - -= ::r - CJ ~ CJ - CJ -----== CJ ~ r:.'\ - r:.'\ -- - =-=== rn - - ~ - - -- = ~ ..( :S ~ "QS ~>Q ~ ."", ~ to:l ~ ~~Q~ .<~.a ~ ~ t .~ ~ ~ ~ ; ~=~..c= ~~~(J ..c=~'WI~ u..('-O~