HomeMy WebLinkAbout12-11-06 (2)
REV-' 500 EX + (6-00)
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV -1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
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F:7 NUrB~R DO S - d S
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COUNTY CODE YEAR NUMBER
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Gottshall Michael A
DATE OF DEATH (MM-DD-Year)
SOCIAL SECURITY NUMBER
DATE OF BIRTH (MM-DD-Year)
1 9 2 - 6 0 - 2 6 7 5
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
12/01/2004 08/08/1967
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
[X] 1. Origi~al Return
D 4. Limited Estate
[X] 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a}(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20. It
SOCIAL SECURITY NUMBER
D 2. Supplemental Retum
D 4a. Future Interest Compromise (date of death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy ofTrust)
D 10. Spousal Poverty Credit (date of death between 12-31.91 and 1-1-95)
D 3. Remainder Return (date of death priorto 12-13-82)
D 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BEDJRECTED TO:
NAME COMPLETE MAILING ADDRESS
James H. Turner 4415 North Front Street
FIRM NAME (If Applicable)
Turner & O'Connell
TELEPHONE NUMBER
717-232-4551 Harrisbur PA 17110
1. Reai Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
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)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
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OFFICIAL USE ONLY
27,949.651
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123,792.59
8,697.21
96,988.77
(11)
(12)
(13)
105,685.98
18,106.61
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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(14)
18,106.61
0.00 X _(15) 0.00
18,106.61 X .045 (16) 814.80
X .12 (17) 0.00
0.00 X .15 (18) 0.00
(19) 814.80
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TOANSWERAI..LQUESTIONSON REVERSE SIDE AND RECHeCK MATH < <
'~ce en s ompee ress:
"STREET ADDRESS
3 Patricia Drive
CITY I STATE I ZIP
Enola PA 17025
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Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
814.80
1.935.02
40.74
3. InteresUPenalty if applicable
D. Interest
E. Penalty
Total Credits (A + 8 + C)
(2)
TotallnteresUPenalty ( 0 + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
1,975.76
0.00
1,160.96
0.00
0.00
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred; ........................................................................... D
b. retain the right to designate who shall use the property transferred or its income; ........................................ D
c. retain a reversionary interest; or ...................................................................................................... D
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
without receiving adequate consideration?... ............................ ....... ..... ..... ............. ...................... ........... D
3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death? ................. D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
t . b f" d' t' ? I)(l
con alns a ene IClary eSlgna Ion. ....................................................................................................... ~
No
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IKl
IKl
IKl
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
DAT,E./ /
///2./ / ()
ADDRESS
DATE
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 3%
[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 0% [72 P.S. ~9116 (a) (1.1) (ii)].
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child 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 0% [72 P.S. ~9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, 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 12% [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-1503 EX + (6-98)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Gottshall. Michael A
FILE NUMBER
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
Wachovia Securities account #3804-2993-3804-3024 as of 12/1/04
VALUE AT DATE
OF DEATH
27,704.99
2
Dreyfus Money Market account #00100023951 as of 1/18/05
244.66
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
27 949.65
REj-'50' EX' ".
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Gottshall Michael A
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
checking account #0192602675-04 as of 12/1/04
VALUE AT DATE
OF DEATH
1,077.94
2
2002 GMC Envoy motor vehicle (voluntarily repossessed to payoff lien-sold on 4/5/05)
17,200.00
3
2002 Camper Trailer (sold at consignment)
8,000.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
26277.94
REV-1509 EX + (6-98)
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SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Gottshall Michael A
FILE NUMBER
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. Mary E. Huber
3 Patricia Drive
Enola, PA 17025
mother
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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 DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 12/7/99 Real Estate at 3 Patricia Drive (owned with mother as 139,130.00 50. 69,565.00
joint tenants with the right of survivorship) assessment
value as of 12/6/04
0.00
TOTAL (Also enter on line 6, Recapitulation) $ 69565.00
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (6-98)
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SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC. NON.PROBA TE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Gottshall. Michael A
FILE NUMBER
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
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST VALUE
(IF APPLICABLE)
1. PSECU 401 K plan 19,193.57 100. 19,193.57 0.00
2 PSECU Management Money Purchase Pension Plan 20,747.00 100. 20,747.00 0.00
TOTAL (Also enter on line 7 Recapitulation) $ 0.00
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (12-99)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Gottshall. Michael A
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Memorial marker 1,600.00
2 funeral expenses 6,593.38
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees Turner & O'Connell
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountanfs Fees
6. Tax Return Prepare~s Fees
7. Advertising costs 241.07
8 expenses paid by executor 262.76
TOTAL (Also enter on line 9, Recapitulation) $ 8697.21
(If more space is needed, insert additional sheets of the same size)
~1V-1'" EX . (6-.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
Gottshall. Michael A
FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. Discover Bank account #3011002130549553 as of 12/1/04
VALUE AT DATE
OF DEATH
2,066.00
2 Dell Financial Services account #6879450119012463075 as of 12/1/04
2,565.61
3 Real Estate Mortgage to Washington Mutual account #0610380867 as of 11/4/04
48,013.23
4 GMAC Financing (loan on GMC Envoy)
17,266.96
5 Capital One #1150739
4,381.72
6 Citibank (Sears Roebuck & Co) #5121079702753804
11,127.15
7 Chase Bank Card #5188635200214019
11,568.10
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
96,988.77
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
~ntt!':h::lll Mir.h::l~1 A
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS ~nclude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Diane Fetterman Sibling 0.08
3 Billman Road
Catawissa, PA 17820
2 James Gottshall Sibling 0.08
715 Shuman Street
Catawissa, PA 17820
3 David Lash Sibling 0.08
670 Whisler Road
Etters, PA 17319
4 Phyllis Smith Sibling 0.08
12 Springers Lane
New Cumberland, PA 17070
5 Robert Gottshall Sibling 0.08
3 Patricia Drive
Enola, PA 17025
6 Janice Hevel Sibling 0.08
72 Main Street
Duncannon, PA 17020
7 Mary Huber Lineal 0.50
3 Patricia Drive
Enola, PA 17025
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 $
(If more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
I BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
TURNER JAMES H ESQ
4415 NORTH FRONT STREET
HARRISBURG, PA 17110
h__hn fold
ESTATE INFORMATION: SSN: 192-60-2675
FILE NUMBER: 2105-0025
DECEDENT NAME: GOTTSHALL MICHAEL A
DATE OF PAYMENT: 02/28/2005
POSTMARK DATE: 02/25/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 12/01/2004
NO. CD 004996
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1,935.02
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TOTAL AMOUNT PAID:
REMARKS:
CHECK# 118
SEAL
INITIALS: JA
RECEIVED BY:
TAXPAYER
$1,935.02
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
,FROM :J...JOLFTAS
I
FAX NO. :7172459661
Feb. 08 2005 01:41PM P2
I, MICHAEL AGOTrSIlALL, now doDlici1ed in Cumberland County, Ponnsylvania,
declare this to be my Last Will and Testament I revoke all other will. and codicils that I may have
previously made.
LAST WILL AND TESTAMENT
OF
MICHAEL A. GOTTSHALL
Article I
My just debts and expenses of my last illness. funeral. and administration of my estate shall
be paid by my Executor from the principal of my reoiduaIy estate as soon as practicable after my
death.
,...,.
Article IT (') ~
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All inheritance, estate, and SUCCession taxes (including interest and penalties ~ bnt;'t
including any generation skipping tax) payable by reason of my death shall be pai~an~
C)(3=f1 3:.
cIuuged genenlly against the principal of my residuary estate without reim~from ~
C)
person. 'This provision is not a waiver of any right which my Executor has to claim reimbursement
for any anch taxes which become payable as the resuJt of any pIOpertyover which I bave the power
of appointment.
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FROM :WOLFTAS
I
FAX NO. :7172459661
Feb. 08 2005 01:41PM P3
Article ill
I give, devise and bequeath in accordance with any memorandum which I have either
handwritten or signed, located with mywiII or with rnyvaluable papers and found within 30 days of
the probate of my will. Gifts may only be to persons who survive me or to organizations whicb exist
at my death, and ifthere is a conflict, the memorandum having the latest date shall govern.
Article IV
I direct my Executor to payoff my mortgage from the principal of my residuary estate as soon
as practicable after m.y death.
Article V
All the rest, resjdue and remainder of my estate. of whatsoever nature and wheresoever
situate. I give, devise and bequeath according to the following,schedule:
A. F.IFIY PERCENT (50%) to my mother, MARy E. HUBER, of
Cumberland County, Pennsylvania.
B. ' FIFfY PERCENT (50%) IN EQUAL SHAREs to my brother, DAVID
LASH, of York County, Pennsylvania, to my brother. JAMEs
GOTTSHALL, of Columbia County,' Pennsylvani~ to my brother,
ROBERT GOTTSHALL, of Cumberland County. Pennsylvania, to my
sister, DIANE FETTERMAN, ofNorthumberland County, Pennsylvania, to
my sister. PHYLLIS SMITH, of York County, Pennsylvania, and to my
sister, JANICE BEVEL, of Perry County, Pennsylvania.
-2-
. FROM ~'WOLFTAS
I
FAX NO. :7172459661
Feb. 08 2005 01:42PM P4
If One of the beneJiciar:ies named in this Article predec..... me or fails to SUrvive me by
thirty (30) days, I give, devise and beqneaa, the share helshe would have roceived to the
,l'cInaining nllDled beneJiciary(iea) in thia Article who survives me by thirty (30) days, PER
CAPITA. NOT PER STIRPES.
Article ~
I nominate, constitute, and appoint DA VlD LASH. as Executor of my Last WllI and
Testament. In the event of the renuncistiou, death, OJ" Inability to act, fur any reason whatsoever of
my Executor. I noDlinate, conatitute and sppoint PHl'LLIS SMITH. as successor Execntrix of my
Last Will and Testament. I direct that my Executor or SllCCcssor Executrix be perDJitted to serv.
without bond' and in addition to those powm" gr&nted by law, I grant them power to diatribute in cash
or in lcied in like OJ" in unlike shares and to Ii Ie any quali1ied disclaimer I could have filed ifliving.
My Eo:ecutor and SUocesaor Executrix shall receive reasonable compensstion fur services rendered to
my estate.
Article VU
In addition to the POWers conferred by law, I authorize my Executor and IIUcCessor Executrix,
in hislher absolute discretion:
(a) to retain in the fonn received and to sell either at'public or private sale, anyreal estate or
personal property except that which I specmcally bequeath herein,
(b) to manage real estate)
investments, and without regard to the prinoipal of diversification.
(C) to invest and reinvest In all fones of property without being confined to legal
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FROI'1 :'WOLFTAS
FAX NO. :7172459661
Feb. 08 2005 01:42PM P5
(d) to exercise any option or right arising from the ownership of investments.
(e) 10 COIIlJ>romise chWn. wi1hout COm approval and wi1hout consent of any beneficiary,
(1) to file any federal income tax _ for any year for which I have not filed such rel1m!
prior to my death,
(g) to make distrt'butions in cash or in kind, or in both, and to delOImine the value of any
such property,
(h) to employ any attorney, investment advisor, or other agent deemed necessary by my
Executor; and to pay from my estate reasonable compensation for all their services.
(i) to conduct alone or with others. any bUSiness in which I am engaged in, or have an
interest in at time of my death. and
(j) to receive reasonable compensation in accordance with their standard schedule offees in
effect while their services are performed.
IN WITNESS WHEREOF, 1, MICHAEL A. GOTTSHALL, hereby set my hand to this my
Last Will and Testament, on
II-~'J.
. .2004.
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In our presence) the above-named MICHAEL A. GOTTSHALL signed this ~d declared
this to be his Last Will and Testament and now at his request, in his presence, and in the presence of
each other, we sign as witnesses.
Nam~
'J) Ou ~ ~ "'9 _ t'l'\ \ \ \0- f1.J
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Address
sC\).:3 N.. 2-\)\-~~ ~9 l~ \( P& nOll
503 N~J~ ~j2JjJ !A17ou
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FROM :WOLFTAS
FAX NO. :7172459661
Feb. 1218 21211215_~.1.: 42P~. p.~. _"__.'__
1, IIUCIlAEL A. GOTl'SILu.L, Testator, who signed the foregolug lnstnunen~ ha\>ing
been cIuJy qualified -lug 10 law, aclcnowlcdge that I signed and executed this inatnunont as my
Will, and thet I.;goed it willingly as my free and voluntary act for the PUlpo." thereJn Ol<)lresacd,
SWorn to or affirmed and
acknowledged before me by
MICHAEL A. GOITSHALL, the Testator,
On I f~ :Jd-... ,2004.
d~~~D01~t a,~
otary blic
A. GOTTSHALL
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We, the1lDdenigncd wi1JJesaes who oigoed the foregoing instrum...~ beD,g duly qualified
lICCOrding to law, depose and say that we were present and saw the Teatator aigo and execute this
instrument as hi. WiI~ that he signed and executed it wiUingJy .. hia free and volDDtIlI)l act for the
pwposes th....in cxp.t'eased; that each of ua in hi. .ight and bearing signed the Win.. witnesses, snd
that to the beat of our knowledge, that he was at that time eighteen (IS) }'OlIIlI or more of ase, of
sound mind, and under no constraint or undUe influence.
SWorn to or affirmed and
subscribed to before me
bYf~"~" e., ~ '/-}
and _ UJu..p;~ .I fD-"
witnesses) on 11- d ~ , 2004.
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Witness
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MICHAEL GOrrSHALL TO 3-DIGIT 170
3 PATRICIA DR
ENOLA PA 17025-1931
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.Dreyfus
TRANSAcnONADVICE
Dreyfus Service Corporetlon, Distributor
A MELLON FINANCIAL COMPANY
January 18, 2005
Dreyfus Money Market Reserves - Class R
Page 1 of 1
a
For~ODS about your account
PleasecaJll-BOO-645-6561; inNYC
1- 718-895 -1206.
POt' IDOO DM.'....IOZJET en .. 1 I.. 1-----__
.................... I....
MICHAEL A GOTTSHALL
3 PATRICIA DR
ENOLA PA 17025-1931
DreyfiiS Money Market Reserves - Class R
Account number: 0717-0100023951
Trade
date Descri.
. Balance forward
01/18105 Shares Purchased -Automatic Asset Builder
Market Value as of 01118105 $244.66
Dollar amount
$219.66
25.00
Share rice
$1. 00
1.00
Shares this
transaction
25.000
T01a/ shares
owned
219.660
244.660
D
To purchase additional shares, make
your check payable in U.S. dollars to:
The Dreyfus Family Of Funds
and mail together with this slip to:
The Dreyfus Family Of Funds
P.O. Box 105 .
Newark NJ 07101 -0105
Dreyfus MQDey-Market Reserves - Class R
Fund Account #: 071'7-0100023951
MICHAEL A GOTTSHAll
3 PATRICIA DR
ENOLA PA 17025-1931
Minimum investment:
Amount enclosed: , $
$100.00
X
Signature(s) Data
If your address is incorrect, please make any changes above, have ai/registered
owner(a) algnand return this slip. Do not write inthe white area below.
0717 0100023'51 02D2010014 0000010000 7
1I1IIIIII
0192602675 GOTTSHALL,MICHAE Share 04: CHECKING Transaction Summary 01/13/2005
10 Eft Oate Transaction Balance. .. IntlP... Fees New Balance Oescription/Pmt Prev Available
S04 01/11/2... ACH PAlO AS A COURTESY
S 04 01/11/2... TYPE: GMAC PAYMT 10: 9538007001
S04 01/11/2... ACH Withdra... -539.58 0.00 0.00 -342.67 GMAC 196.91
S04 01/11/2... Transfer Oep... 16.71 0.00 0.00 196.91 From Share 01 180.20
S04 01/11/2... GMAC
S04 01/11/2... Fee Withdra... -30.00 0.00 0.00 180.20 Overdrawn ACH 210.20
S04 01/03/2... TYPE: PREM DEBIT 10: 9069584002
S04 01/03/2... ACH Withdra... -108.83 0.00 0.00 210.20 ENCOMPASS INS 319.03
S 04 01/03/2... TYPE: INVESTMENT 10: 1911384879
S 04 01/03/2... ACH Withdra... -25.00 0.00 0.00 319.03 717 MM RES R 344.03
S 04 12/31/2... %% APYE Avg Daily Bal 799.99
S 04 12/31/2... %% APY Earned 0.25% 12/01/04 to 12/31/04
S04 12/31/2... Dividend De... 0.17 0.00 0.00 344.03 0.250% 343.86
S 04 12/30/2. .. TYPE: CENTRAL PA 10: 0000009547
S 04 12/30/2... ACH Withdra... -42.24 0.00 0.00 343.86 COMCAST CENTRAL 386.10
S04 12/28/2... Draft Withdr... -85.00 0.00 0.00 386.10 Draft Number: 003439 471.10
S 04 12/20/2... Draft Withdr... -287.50 0.00 0.00 471.10 Draft Number: 003438 758.60
S 04 12/15/2... TYPE: INVESTMENT 10: 1911384879
S 04 12/15/2... ACH Withdra... -25.00 0.00 0.00 758.60 717 MM RES R 783.60
S 04 12/14/2... Draft Withdr... -300.00 0.00 0.00 783.60 Draft Number: 003437 1,083.60
S 04 12/13/2... TYPE: GMAC PAYMT 10: 9538007001
S 04 12/13/2... ACH Withdra... -539.58 0.00 0.00 1,083.60 GMAC 1,623.18
S 04 12/10/2... TYPE: PAYMENTS 10: 1223344794
S 04 12/10/2... ACH Withdra... -51.63 0.00 0.00 1,623.18 VZW VISION CEPS 1,674.81
S 04 12/10/2... TYPE: PAYMENT 10: 1008096660
S 04 12/10/2... ACH Withdra... -49.20 0.00 0.00 1,674.81 PAWC 1,724.01
S 04 12/10/2... TYPE: PAYROLL 10: 9111111101
S 04 12/10/2. .. ACH Deposit 779.90 0.00 0.00 1,724.01 PSECU 944.11
S04 12/06/2.. . TYPE: PREM DEBIT 10: 9069584002
S 04 12/06/2. .. ACH Withdra... -108.83 0.00 0.00 944.11 ENCOMPASS INS 1,052.94
S 04 12/01/2... TYPE: INVESTMENT 10: 1911384879
S 04 12/01/2... ACH Withdra... -25.00 0.00 0.00 1,052.94 717 MM RES R 1,077.94
c;J11/1-C
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Page 1
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GMAC
-
P.O. Box 7041 Troy M148807-7041
877-839-1560
April 12, 2005
How We Calculated Your Surplus or Deficiency
To The Estate Of Michael Gottshall
3 Patricia Dr
Enola, PA 17025
Subject: Account Number 020-9014-08209
Dear Sir or Madam:
Your 2002 GMC Envoy, VIN 1GKDT13S322512181, was sold on April 5, 2005. As of the date
of this letter, the amount you still owe us under the terms of your contract is $679.28. This
amount was calculated as follows:
Unpaid balance before subtracting money from sale
This amount was calculated as of March 2, 2005 and reflects a
rebate of unearned finance charges. See below.*
Money from sale
Unpaid balance minus money from sale
Known expenses of taking, holding, preparing for sale, processing,
and selling vehicle, attorney fees, and other legal expenses:
Repossessing & transporting $ 150.00
Storage & reconditioning 274.74
Selling costs 108.50
Title & registration fees 57.50
Attorney fees and legal expenses the law permits 0.00
Late Charges 21.58
Total expenses
Known credits:
Rebate of unearned insurance premiums
Extended service contract refunds
Insurance and service contract claims
Total credits
Deficiency/( surplus)
$
0.00
0.00
0.00
kjl
POSTSALE91rt-g592Irad\1
$ 17,266.96
17,200.00
$ 66.96
+
612.32
0.00
$ 679.28
Estate Of Michael Gottshall
/14-08209
-2-
April 12, 2005
~ Amount calculated as follows:
Amount you owed before finance charge rebate
Less: Rebate of unearned finance charges
$ 17,266.96
- $ 0.00
The amount of any deficiency/surplus shown above may change be~use of future additional
credits, rebates, or charges. Any deficiency shown above may also change because of
additional interest accruing after the date of this letter.
For more infonnation about this transaction or to make payment arrangements, you may call
us at the telephone number at the top of this lelter or write us at the address at the top of this
letter.
Signed,
WE ARE ATTEMPTING TO COLLECT THE AMOUNT OUR RECORDS SAY YOU OWE US
NOW. ANY INFORMATION WE OBTAIN WILL BE USED FOR THAT PURPOSE.
Credit Administrator
kjf
POSTSALE9\rt-9592trad\1
EXCLUSIVE CONSIGNMENT CONTRACT
FOR SALE OF MANUFACTURED HOME OR RECREATIONAL VEHICLE
IN THIS CONTRACT THE WORDS !. ME AND .MY REFER TO THE OWNER(S) SIGNING THIS CONlRACT. THE WORDS YQ!.! AND YOUR REFER TO THE RETAILER OR AGENT.
I UNDERSTAND THAT THE TERM "UNIT" USED IN THIS CONTRACT REFERS TO THE MANUFACTURED HOME AND ALL ITS COMPONENTS OR THE RECREATIONAL
VEHICLE AND ALL ITS COMPONENTS.
To rF,F\ 'D('I B n {.{ (/~IS
In consideration of your agreement to use your efforts to find a Purchaser for the unit herein described I hereby give you the sole
and exclusive right to sell within described unit for a period of days from this date, and thereafter until this agreement
shall have been revoked by ten (10) days notice of termination in writing delivered to you, but in any event for not longer than
month(s) from date.
(I r\fYl P II\lL
-j.l< P Il CI<<,
I ,_ ,., Lf ,.._'
INC.
MAKE
~)Uj\lL INt
SERIAL NUMBER
I L\ ,- ~
~N
') H 't L LI ';; S II '!In-I
FINANCED THROUGH
OWNER'S ADDRESS & PHONE NO.
$
You are hereby authorized to negotiate for the sale of, and to sell, said unit for not less than $ , of which not
less than $ , shall be paid as earnest money by the Purchaser, to be h~ld by y'ou until closing. If sale is closed,
I agree to pay you a minimum commission of % on the agreed selling price, and, If sold for more, to divide equally
between you and me the excess over and above said selling price.
Or I agree to accept a net flat price of $ q(}()O.OO, authorizing you to retain any amount received over and above
said net price as reimbursement for expenses involved and, as a selling commission.
2. I agree to deliver said unit to Purchaser free and clear of all liens including taxes, assessments, license fees, etc. and that said
unit is free and clear of all personal property judgements or encumbrances and to pay for all personal and other taxes which may be
levied thereon, other than as indicated herein.
3. I agree to carry liability and comprehensive insurance to protect against theft, pilferage, fire, windstorm, water damage, hail
and vandalism, thereby releasing you from any and all liability. I
4. Evidence of title will be furnished in the form of either a bill of sale or, in title states, a certificate of title. I
5, You are authorized, on my behalf, to qualify and accept the offer of a Purchaser which shall be in accordance with said terms,
and to execute a contract of sale therefor.
6. You are further authorized to negotiate for the sale of and to sell said described unit for such lesser sum or upon such
different terms (including the acceptance of other property in trade), if I shall accept such changes in writing.
7. The exclusive right to advertise said unit is granted to you which advertisement may be done by insertion of ~ds in
newspapers, the broadcasting of same on radio, the placing of a "FOR SALE" sign on the unit or by such other means of
advertising as are commonly used. If, by mutual consent, the above described unit be withdrawn from sale before the
expiration of this listing contract I agree to pay you one and one-half percent (1-1/2%) of the last quoted sales price on
said unit, as liquidated damages to reimburse you for advertising, sales costs and losses incurred as the result of my
failure to adhere to the full term or period of this contract.
8. If a sale or exchange is made or a purchaser procured therefore by you, by me, or by any other person, at the price or upon
the terms specified herein, or at any other terms and price accepted by me durina the lifF! of thi~ /"'('\nfr"',.... 1M ...:....:_ .1..__ - ,~.
mnnthc: ~ftc,. tho .or~ir"\_"'i,..,_ _&. .1."":_ - - -_.&--- - . .
AMOUNT OWING
ACCOUNT NO.
Page 1 of 1
Detailed Results for Parcel 09-14-0836-181. in the 2004 Tax Assessment Database
DistrictNo 9
Parcel ID 09-14-0836-181.
MapSuffix
HouseNo 3
Direction
Street PATRICIA DRIVE
Owner! HUBER, MARY E
C/O & ROBERT DALE GOITSHALL
PropType R
PropDesc & MAGARO ROAD
Liv Area 1638
CurLandVal 32280
CurImpVal 106850
CurTotVal 139130
CurPretVal
Acreage 0.39
CIGrnStat
TaxEx 1
SaleAmt 1
SaleMo 3
SaleDa 3
SaleCe 20
SaleYr 5
DeedBkPage 00267-04037
YearBlt 1969
HF _File_Date 12/6/2004
HF Approval Status A
http://taxdb.ccpa.netldetails.asp?id=09-14-0836-181.&dbselect=l
6/6/2006
r':mn~
FAX NO, :7172459661
f7.lh1J ~lr:l t!. e1
l1t,~\.) 1 e.,.,
TIUS DF-lm. mIIda thc~ of '4.~
nOtlE;~i' fl. !IEt:LER
REOORO,H OF DEEDS
OUMBEF\L,ol.'Il1 COUNTY-P~
,1990
"99 OED 13 AI'Ill 39
B'BTWBEN MARY E. HtlBER. oIBut PCllDlbolO Township. CumbarlllJd Counry, PcnnIylVlllia
Omnb:lr haeln,
MIl l\IIAAY 2. HUBER &114 MICHAEL A. OOTISIW.L of Bu. PIIIIIlIbora TOWIIIIbip,
Cwnberlaad, PCDIII)'1vanla, C'1IBIIlccI hadn .. Joint IellllDII wIdI riaJII of 8IIrYiYODbip:
Wl'INESSET,H. dJ8IMaEy E, Huber, GIIIItOt hereiD, taUM inCllllliclcmdDa oflhulIlIloIo.
($1.00) Do.IIII'. his pIIIcd, bIrpIned,lOId, llieDed. rei..... ~ BDd by thCIC pICIelIlI
dou sruu. bBrpin, KI!.IIlIen. rei.... _ ~rm, 111110 M8ry B. Huber end ~ A. Gotllblll,
GnDttes ~
AJ.r.. 'JliAT cnR.TAIN PIRCE. p-=l1rId lot of land liblllc I.a IIIIl TlIWIIIbIp ofJllll PeaDJboro,
ColllUy of CWDberlaad IIIld 51'10 of POllRl)'Ivania, boImded IIIId delcribed liS fblIoWl:
BEGINNING er. .. poiDI on lhe weatenlllllll of I"lIII'i. Drive on the hMriuUlBr _tiaaecI PIm of
Lou 8t \he DOdheaII_ ofLat No. 1 011 Mid PlAD; thence by the dlvUUaa line bet_ Loll "No.
I _ !I Oft IlIid PIaII Soulh 49 cIqreeIJO minuteS WllIf, OPe bundnld ~ lIIIIi ei~
one-ftundrcdtba C 126.88) feel 10 .. poilu; lbaIcc by tbe m'Vidiq line __ lolli No. . _ II 011
lAid PIlln. North 33 depllC8 S4 minutes 40 ~ WCIIl., one ~ .oRJ-aac lIDd IblII.y-two 0.-
hundl'edLh. (151.32) Coct to. point an !he IGtllhcm line oflhe aC-'d Palriola DrIW; lhIuce by
said Patricia Drive, Ncmh 49 degrHlI :40 n\lnUlAll EuI, e1pry.ane IIIIcl ei&h~ ~
(81.18) feet lD G poiDl: thIDce by an arc or c:unra 10 Iho riSht whh a radius of lWBRty-fiWl (25) fi:c:hn
arc cIiJlInco of tblrty-.Dlne IIICI '-IJ-~ _lnmdn:dlha (39.21) feet 10 II point; dImllI by Ihe
SlIIIIC Sout.b. 40 ~ 30 mil".. JialI, ana bllndrcd ~ty.nw: (125) feet 10 a pain!, !he p\IlIle or
BBOlNNINO.
BEING Lot No.9 in the PIUl of1.o15 ofSberwood Park, SecLlon I. wlIlc:It Plan ill ofrccotd in 1hc
Cwnberllllld CoWLly Rcc:onfcr'. Ol11oe In PIIIl Roalt 12. II pap 29. Tho P1m of Sherwood PKk ill
lhe ._ lllao of lotIllid out by Theoclole Eo Sarlanoli. ec we, and dcRiSllllaed II Noll AlnB, which
Pllli WlI.II'lIll of J'CCOrd.
HA VINO lboiam crccm.i I OM ..ory tanOh clwalllna h- IcnowD and numbered II 3 Palricia
Olive.
BElNG Ibll _ pn:m_ which k:.-I C. Huber and Mary B. HlIbor, hla w1fil, by.deed dB.. the
2"" dBY of April, 1972, and _nIod ill the Office orlM Ilccorder or 0..... in anet for CUlllherllnCl
County, Pcanaylwni.. In DMd Book P2<1, PIIp 376, .,..... and CIOIiV~ onto MU7 B. iWbet,
Grant<< bereln.
SUBJBCT. NEvERTIJELESS to lIII cilht (8) mol Ullllly -.. along Ibe rear lIIld side liu. or
the aforcaid 1'OId.
Thil i. a CGmIC)'IIDc:C ftom I1IDlber 10 ItIIllllor IIId IIOJI Uld i.1ax QCmpl for puIp)IICII oftrullfcr IIX,
aUiJJ 213 rAti ~o
:"~.' . .~..'
D~c, 14 2004 12:04PM Pi
"
FROM :WOLFTAS
FAX NO. :7172459661
Dec. 14 2004 12:04PM P2
"
:~
....;.
TOOETHiR w1dl a11111d IInpIar lIIe bulldlap,lmplOWlllMll....,.. --.. .... W8l!InlalDU,
dahU. llbeni., privilcpa. hcndilamlnllllld IIpIllIIfeIlIllllOll 10 me _ II&!IuaPlI or III III)IWiIe
lIpJlMlIinins; 8IId !be revenlOlI ~ ~. Rlll8indcr axll'Mlllndcn. .... ....... and JlIQflIl
IhINo~ and of rJCrJ pIIt 8IId pInlIllheNor: AND ALSO aIIlhe ..... dght, tllle inIInIt, \1M,
....... JlIDJ*lY. c:IaIm ud c\8nIIod ~ver of'the GnIdor both 1111&,., and III tClUk1. of, In
and to tile preaWlea hertla de8oribod and nay pM 8Dd pBIOIllbereof w11h the 8pIIIIII8II8IIC TO
HA VB AND TO HOlJ) aU _III_ the pNmiIu helellI cl8lcribld roplhar wi. Ihe J.ed!1IIIIaIIs
and I~ unID !he a..... and 10 0'111'" proper _1IIId bc:ncIilmn:wr.
AND Iha 0rInr0t COW\1IIItlI tb8l, ac:cpt u may be hetein I8f IbrrII. . doeIIlnd will r_
WlIIftIlE IIIId cIefcncI the land. .. pI8III.... hefed/tMIeAU 8Dd applll1l:MnCell IRaby conveyecI.
ISalnlt the Orllllor llIClllI oaber pBrIlIIIIlawfMIly cJllimi"ll tbc .. (If 10 c1&1m "1Il\llIlI.
Wherawr in tbU inItnlmenl MY pl\d)' Ihall ba daipaled 01' rCand 10 by IIIIIIe or ......
n:Iereace. 1RIc11 clellpadllll " lllllllldlld 10 8IIll1hal1 have lbe nme etrIot II if lhe words "bill.
~ ~ penonll or t.aal repmenratl\ltlll, _ IOd ...isu" bad beeD
iuet1lId Ifter each ad ev<<y .ucIa d_l&nation.
IN Wl'JNESfl WHEREOF, lbe OrIDlot has henNnlO HI her hand IIIId nallbe cIlI)' IInII )'eDI'
fil'lt above wrll10JL
SIIIJ1ClI. Sealed and DcliVCRd
iD lbe JIIW8IIClI of
& L-"'"l"<-" 6~,.J
WiIDlal
1....7f~ ~.,:jL.kv_
MaIy llbet, G r
COMMONWBALTl{ OF rENNSYLV ANI!.
COUNTY OF 8AtffIRH C,""...bu.LM l:
ss.
Bo it RenIetobend, dwt 01\ Pu...."'~'t. to '1" 1999, before Jlle. Notary hblle, lhe
IIIIIIIniped omoer. pmDD8Ily .,.-n:c! MIry Eo nilher' IrnnWllIo me (or IIliaCIctariIy pIOWIl) 10
be the ~ wi.- _ i. Nblcrlbed 10 Ihe wilhlft Deled, and acIcncNIlJd&ed 11181.e II\IICIIlIlld
die __:lbr the plllpGlU thel8bl ClOIUiDeL ~,,_.,.:.:::.
IN WJnfflSS WElBIWOP. I UIeuAlo lee my bud MIl ..I.
Notary
[i-NOiAl'IL~ bc.... .......
HIUN M. 8RIfFl'ltl. ..., .-..
ill! .............. CIIIIIftId CII.
"'~bphI..".aI
DbDK 213 rAG!! 21
FROM :WOLFTAS
FAX NO. :7172459661
Dec. 14 2004 12:04PM P3
,
] do !-=by Gll'dty that the pra:IIe reIldIuI:I- C(lIIIfIIra ~
Ol'llllleos i.
Mary E. Hubcrr IIld ~lchu1 A. 0
3 PIIriola Ddw
Blat '-boro. JleruIIylvania 1
COMMO?nWALTB OY PENNSYLVANIA
coONTY or CUMDERUND
55
RECORDED In the Office far Racnrdlna of o..cu In lIIICl Cor ClImbedllld CowllY. ill
Record 800Q3 Pqe NodD-
WlTNE&lIiI m)' bIBcl_ _I of OJ11celhia \,5
de,yoC 'l)oc... 1999. .
oJ/~~~ ~)CC
~uo~ 213 '''Iif 22
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I . iPSECIIP
I the financiallinkTM
I ,
December 23,.2004
Mary E.. Huber
3 Patricia Drive
Enola, PA 17025-1931
mlh7/; CAl,?~..
///// ~ ./J/J
(/L.uiLl-l/ Ii. r--v
/2/j, oh 9' .
6~4$~dV/&U-e;a~..
Dear Mrs. Huber:
First, I would like to express my condolences for Michael's passing. Although it doesn't diminish
the pain, it should be a great comfort to you that he Was truly a wonderful person. His strength
and courage was an inspiration to us all.
In ~eg~.rds to the de. a!bbenefits'~abl~, PI.ease be ~dvi~.ed that Mich~elhad a life insur~nce
policy In the amount Q! -i72,000 wt]jth lists you as hiS pnmary beneficiary. The necessary
paperwork has already1)Elelr"COf1'ij)leted and forwarded to Highmark Life Insurance Company to
initiate the distribution of death benefit proceeds to your attention. You should receive that.
check shortly. .
Michael was also a participant in the company retirement plans. You are listed as the primary
beneficiary in both of thOse plans as well. Therefore, I am forwarding paperwork for your
completion. Once completed, one copy of the distribution forms for each plan should be
returned to my attention. As soon as it is received, it will be forwarded to the appropriate
companies for processing. .
The approximate dollar amounts payable under each plan is ..as-fOltoWs:.....,.....
.... "',
PSECU Management 401 k Retirement Plan: /.0" $19,193.57)::?/Tl4?t..~
PSECU Management Money Purchase Pension Plan:,,-- $20, 747.00 .~ ~ ((~~
Please be advised that these amounts are estimates as the'V;iUecfiangE;'s daily due to J~
fluctuations In the market. . . d<-J---h ~ {>A--c /
Lastly, you may want to seek the advice of a tax advisor as to the best way to handle these /71 (/?ck-/ ,
assets. One specific issue would be that since you were specifically listed as the beneficiary,
these proceeds may not a. part of Michael's estate and therefore not SUbject to the specifications
in his Last Will and Testament. You may also feel free to contact Steve Franke at PSECU
Financial Services for some assistance. You can reach him at 717-777-2557.
If you have any questions, please do not hesitate to contact me at 717-777-2325.
Yours sincerely,
9~/(j)a~
Jean Kratzer
HR Benefit Manager
PENNSYLVANIA STATE EMPLOYEES CREDIT UNION
Main Address: 1 Credit Union Place, Harrisburg, PA 17110-2990 '(717) 234-8484. (800) 237-7328
Mailing Address: P,O, Box 67013, Harrisburg, PA 17106-7013 . (717) 777-2100 (TOO) . (800) 472-1967 (TOO)
Web Address: wWw.psecu.col1:l
Savings fedarally Insured up to $100,000 by the National Credit Union Administration.
MEMORIALS Since 1921
5243 Simpson Ferry Road, Mechanicsburg, PA 17050
. (717) 766-5622 · Fax (717) 766-8007. www.gingrichmemorials.com
ingricl
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ORDER FORM
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ingricJ
MEMORIALS Since 1921
5243 Simpson Ferry Road, Mechanicsburg, PA 17050
(717) 766-5622 . Fax (717) 766-8007
www.gingrichmemorials.com
SOLD TO: Tht [,tJit o't ~:t~Il';( ht'f.hcJ.l
C ((;0 r'L/. 'f))VI'\ LG.\ h
c; 10 CdI-.; ..{rr- 12001
Ett H',. P f'l (}'1 fC1
Phone (H) q ~ SO. ~ g 3 i (W) C.v. \ I :;0,'1 i . ( ~ c;
lettering
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Manufacturer
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Date Rec'd
Found. Ordered
Position Verified
Date of Order
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location
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lot #
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Approx. Date of Completion
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Type of Memorial b~ve.\ M {).v- \kY'":
Size ~ X l:L X ~ Finish
Size _ X _X _ Finish
Misc.
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Material -B1 V ( 12<:: (\( \ ~ If''G"l,V\'i\-..:;
location t r
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Agreement: A 50% deposit Is required to commencement of work.
Agree to pay stated ball!nce upon erection regard'eSs of labor troubles or shipments or any other good reasons. This order or contact Foundation
cannot be cancelled by customer unless agreed by both parties. The article herein mentioned shall remain theproparty of James R.
Gingrich Memorlais until paid In full and they reserve the right to remove the same Is not paid as stated.
I agree to carefully Proofread all names and dates for accuracy and accept full responsibility for any errors or C!missions. THERE
WILL BE AN ADDITIONAL CHARGE FOR ANY LETTERING ADDED TO THIS MEMORIAL AFTER ERECTED ON THE
CEMETERY.
I further agree to pay the balance stated for the work performed under this contract wfthln thirty (30) days of receipt of the final Invoice
and further agree that Interest shall accrue at the rate of one and one-half percent (1l2%) per month On the unpaid ballllice owed to
JenleS R. Gingrich Memorials not paid wfthln thirty (30l'days of the Invoice date. In addition thei'elo, I agree If It becomes necessary
for James R. Gingrich to Institute legal Proceeding to COllect any funds due from me for my account being past due thirty (30) days, Balance Due
to pay all court costs and attorneys fees Incurred by James R. Gingrich Memorials to coliElct the same. I ' r\ ~
~pon Completion $, r C,, \." . ...... I
r~::~:omoe YEllOW.P~_~U~::,cu~~~f~b~~~, ..dome..,. ~I
Dealer
r-)
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Price
$ ";"~r:~'c:;-
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$ A) ,
$
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$
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TOTAL c k .'*'
DEPOSIT I f 0
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,
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10 1\:, -
Date
1/19/05
To
Mr. David P. Lash
. ...,....,~u...."...I~..'...,...:........_..l"1'.._......_....._...r-._...._.
Funeral Service of
Mr Mirih;:u:,' lI. r.nt-t-c::h?"
Complete Funeral Services Include ,
PROFESSIONAL SERV.lcE's':'sHfr ass is. i Items Paid by Us for Your Convenience
tarice in local removal from place of i
death. scientific preservation and reslora- Lady's Service, Hairdresser, etc.
lio,n. obtaining and recording vital slalis-
I ics. see uriIJU>>_~ li.liQ...s.W!I"F,s,!.lj[j!i,.aJ.t. J........_.~. , I Notice in Paper (Patriot) 320 38
and olher necessary forms and permiB. ,
coordinating arrangements with derg y i Telephone. Telegrams
and cemetery. obituary' information 10
newspapers. arrangemenis of nowers and Certified Copies of Death 80 00
their deliver) to local. cemetery, funeral
couseling with the availabililY 24 hours Cemetery Charges
per do y a nd,"!! se~vi~.~sJ ",f$eSSar,t en ,11 k i
arran~emegqp~,:,qir.~~lWifJ}f IIi.Vuh~r: r , Cemetery Lot
!
FACILITIES AND E~UIPMENT: l'se <1.1. !
chapel. prepar:~~~ri .rog~. I~,Y,Q.~,~ fr~ti , Flowers 200 00
I
tlon and parking areas, All nen'ssary i
religIOUS paraphenalia and equipmenl. A I Minister 100 00
visitors register book,. memorial folders, i
acknowledgeme~l: Fa~Ysrrl~~j~1mp~r!r~ , Transportation
! .
gr~ve mar ker if needed. Use uf automotive ,
I Inscription on Stone
eq~'pmenl, funeral c~~.~. f~,'~!I) c~r ~n~ t
r
cle.rgy ~ar to local. cemefer)'/"J ,1l'L" ...... !
f ~loomsburg News 61 00
.4"cal ' A distance uf 20 miles
Professional Service 112915. 00 U"""li- 'roo f"}.,,,,,,...t'T ~t:: 'H'
Facilities & Equipment ~
550 100
Vault 895 !oo
Clothing !
!.
j
Merchandise 1"nr Inn
~
1 Total above Items 826 38
1
Total Mercharidise&'Seruic'es 5755 :00 - Total Merchandise & Services 5755 00
~ l.' .~""'.,'
The lcrrm of paymem are net within Ihiny (30) days fromldale Penna. Sales Tax on Flowers 12 100
of sclCC'lio.n. Afterwa~~~I.a fUljlIlfF:~harge of one and one;haJf Total 6t;q~ 138
percem per momh on lheprevious unpaid balance, which ~s an .
, .
annual percemage rate of elgmeen percem (18070).
. "~:.rrlb'" .....~......,..,._'...,-..~,..........'1...
Balance Due.
Thank You
TURNER AND O'CONNELL
ATTORNEYS AT LAW
4415 NORTH FRONT STREET
HARRISBURG, PA 17110
717/232-4551 Telephone
717/232-2115 Facsimile
JAMES H. TURNER
jht@tunlerandoconnell.com
Estate of Michael A. Gottshall
C/o David Lash, Executor
670 Whisler Road
Etters, P A 17319
May 6, 2005
TIMOTHY J. O'CONNELL
tjo@tumerandoconnell.com
************************************************************************
Reimbursement of advertising
Cumberland Law J oumal
The Sentinel
Total due
Legal Services Rendered Re:
~
$ 75.00
$166.07
$241.07
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---------------------_____n________M_ ------ ---
'11"'11I1111,.1111'11I11.11.1111"'11I11"11'11I11"11'11,,11 Late Charges +
WASHINGTON MUTUAL FA _ 1.l/~ At ~i Additional Principal +
PO BOX 830214 ClITr=t:.1;- il.-f. Y' Additional Escrow +
BALTIMORE MD 21283-0214 ~-re. 1b J'
1,1,1"1111,1111,,11111,11,1111,,,1,1111,,111,11,11,.11,111.11,,111.,1.( . i ,r, ~e Payments
If.), 00 I..VV r F'~x. t.~ Totlil Amount Enclosed _
... Washington Mutual
HOME LOANS
Washington Mutual Bank, FA
Custome<r Care: Toll free 1.866. WAMU.
Se habla espariol Hearing Impai,,,d: Dial 7-1-
www.WaMuHomeLoans.com
f
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#BWNCLNN
~ #3906109380986792#
W 2017249 01 AT 0.292 ..AUTO 120930817025-1931 24 MA1
CO ""111,111,1...'"""1,1.",111."",11,,,,1,1111,,.11,1,.,.,
~ MICIIAEL A GOTTSHALL
.w-- 3 PA I RICIA DR,.. .\r }
> ENOLA PA 17025-1931 l{ ~ / 1
~. ~ c1'~j \~\ ~)\p~) /
~ r Your Next Payment
W Next Payment Due: December 01, 2004
~ Principal and Interest: $ 435.30
~ t ~~~~~~ Payment: 1; ~~~:b~
~ ~~;~A_"~tDue2"/J/1H(l::::v;}oa?~
Z~ ~'f . ~ f /''j (l{lJD'
<(~ {\J\v" I I /~ .
0" \,"'r Lf
--1\J ~portant Messages
W
~
J
I
* To avoid a late charge of $21.77, we must receive your
payment of principal, interest, and any escrow deposits
and/or past-due payments by 12116/04 during our business
hours. If this date falls on a weekend or holiday, your
payment must be received by the next business day.
f'lease see the reverse side for Recent Account Activity.
908-B
MICHAEL A GOTTSHALL
I
)'
t
Loen Number:
Statement Date:
0610380867
November 04, 2004
()
o
Please write your loan number C'n your check.
Make check pay8b1e to Washington Mutual.
Please check here if chal)98 of address or tele~
number is indicated on the reverse side of this form.
201724900113.13
Page 1 of 2
Home Loan Statement
November 2004
November 04, 2004
October 14, 2004
0610380867
.~
.~~
~
'\j
~
~
~
I Your Property and Loan Information ~
Property Address: 3 PATRICIA f)R
ENOlA PA 1 "7'125
48,01:.28
5.87500%
423.80
Principal Balance:
Interest Rate:
Escrow Balance:
$
$
I Year to Date Account Activity
Principal Paid: $
Interest Paid: $
Property Taxes Paid:
Insurance Paid:
I'
i
~t
I~
2,139.22 . ~ ~
2,649.08 ~
1 ,753.46 ~
334.00 ~ ~
~
'f
Old You Know?
For details about your home loan, visit us at
www.WaMuHomeLoans.com. Check recent transactions,
order copies of your loan documents, view your current
principal balance, or use one of the many helpful loan
calculators. If you're a first-time user, simply click on "My
Home Loan" and follow the prompts to register by
selecting a UserlD and Password.
~~
~~
r 01,2004 "-. "'/~\
$ 603.02 ~ )
$ 603.0;~ ,d 'b (\ lr
December 16, 2004 ~. ~ '~~
$ 624.79 ~.~ 1
~~ J
Making Your Payment ~ ''',. ""~ Ij",
Please write in any additional funds that you may be including ~ ~ "" ~ I
with your payment. If )fou include additIonal funds and do not .<:::::,\,~. ""'.....
indicate hOw to apply them, we will apply them first to applicable '~~ ~~' ::$
advances, then to any fees due and then to principal. ~ \:l ~ ~
~ ~ \o~.~
-~~~~~
- .~.~,~~
V'J"
Payment Due Date:
Current Payment:
Total Amount Due:
If Received After:
Total Amount Plus Late Charges:
+
1/1,'.)....: (,1/.,'5 f; t.... ~V-
000000 0000000 0000000 Ob103808b7 00b0302 0002177 00b0302 7
WELTMAN, WEINBERG & REIS CO., L.P.A.
AITORNEYSATLAW
175 South Third Street, Suite 900
Columbus, Ohio 43215
800.325.9965
614.801.2710
www.weltman.com
BURLINGTON, NJ
609.914.0437
CHICAGO, IL
847.940.9812
CINCINNATI,OH
513.723.2200
CLEVELAND,OH
216.685.1 000
DETROIT, MI
248.362.6100
PHILADELPHIA, PA
215.599.1500
PITTSBURGH, P A
412.434.7955
February 3, 2005
Cumberland, Register Of Wills
One Courthouse Square
Carlisle, PA 017013
Re: Estate of Michael A Gottshall
Case No. 21-05-0025
Our Client Discover Bank
Account No. 6011002130549553
Balance Due: $2,066.00
Our File No. 4050960
Dear Clerk of Courts:
This law firm represents Discover Bank in connection with its claim which we wish to file on our client's behalf into the estate
of Michael A Gottshall, deceased. Enclosed is our check in the amount of $5.00 which we understand is the filing fee for this
claim.
Our client's claim is based upon its account number 6011002130549553 in the amount of $2,066.00. As of the date of this
letter, this is the amount du~. Included with this letter is the claim form which we wish to present to this court and which we
are forwarding to the attorney and/or fiduciary of this estate.
It would be appreciated if all correspondence and disbursements with respect to this matter be forwarded to our office and to
the attention of the undersigned. Additionally, it would be appreciated if any notices of any hearings also be forwarded to the
undersigned. Thank you for your cooperation in this matter.
Sincerely Yours,
~y
Authorized agent for the claimant
NDP:sek
Enclosures
cc: David Lash. Fid
James Turner, Esq
WWR # 4050960
STATEMENT OF ACCOUNTS
FOR:
Discover Bank
DECEDENT'S NAME: Michael A Gottshall
ADDRESS:" 3 Patricia Dr
CSZ: Enola, P A 17025
SSN: 192-60-2675
DOD: 12/01/04
ACCOUNT #: 6011002130549553
BALANCE DUE: $2,066.00
i
EXHIBIT A
WWR#4050960
FORM 93-0.C. DIVISION
IN THE COURT OF COMMON ~LEAS
of
CUMBERLAND, REGISTER OF WILLS, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE: ESTATE
OF
No. 21-05-0025
Michael A Gottshall
Deceased
For an installment loan ~ith Discover Bank,
Account No. 60110021p0549553
l
CLAIM
To the Clerk of Orphans' Court Division:
Index and make proper entry in your official records of the claim of Discover Bank
c/o Weltman. Weinberg & Reis Co.. L.P.A.. 175 South Third Street. Suite 900 Columbus OH 43215
(Claimant)
in the amount of $2.066.00
against the estate of the above named decedent.
This claim is filed under Section 3532 (b) (2) of the Probate, Estates and Fiduciaries Code.
The said decedent, who resided at 3 Patricia Dr
PA 17025 , died on 12/01/04
(Address)
Written notice of this clairii was given to David Lash. Fid James Turner. Esq
on
Enola
(Personal representative, if any, or counsel)
670 Whisler Rd Etters. PA 17319 4415 North Front StHarrisburg PA 17110 .
Add'ess 0' Pe<sonal Rep,esenlative, if any, 0' counsel . ~
N~tney
Authorized Agent for Claimant
Weltman, Weinberg, & Reis Co., L.P.A.
175 South Third Street, Suite 900
Columbus,OH 43215
WELTMAN, WEINBERG & REIS CO., L.P.A.
AlTORNEYS AT LAW
175 South Third Street, Suite 900
Columbus, Ohio 43215
800.325.9965
614.801.2710
www.weltman.com
BURLINGTON, NJ
609.914.0437
CHICAGO, IL
847.940.9812
CINCINNATI,OH
513.723.2200
CLEVELAND,OH
216.685.1 000
DETROIT, MI
248.362.6100
PHILADELPHIA, P A
215.599.1500
PITTSBURGH, PA
412.434.7955
March 17, 2005
Cumberland, Register Of Wills
One Courthouse Square
Carlisle, P A 017013
Re: Estate of Michael Gottshall
Case No. 21-05-0025
Our Client: Dell Financial Services
Account No. 6879450119012463075
Balance Due: $2,562.61
Our File No. 4060106
Dear Clerk of Courts:
This law firm represents Dell Financial Services in connection with its claim which we wish to file on our client's behalf into
the estate of Michael Gottshall, deceased. Enclosed is our check in the amount of$10.00 which we understand is the filing fee
for this claim.
Our client's claim is based upon its account number 6879450119012463075 in the amount of $2,562.61. As of the date of this
letter, this is the amount due. Included with this letter is the claim form which we wish to present to this court and which we
are forwarding to the attorney and/or fiduciary of this estate.
It would be appreciated if all correspondence and disbursements with respect to this matter be forwarded to our office and to
the attention of the undersigned. Additionally, it would be appreciated if any notices of any hearings also be forwarded to the
undersigned. Thank you for your cooperation in this matter.
STY DIXON
Authorized agent for t e claimant
CLD:sek
Enclosures
cc: David Lash. Fid
James Turner, Attorney
. .
WWR # 4060106
STATEMENT OF ACCOUNTS
FOR:
Dell Financial Services
DECEDENT'S NAME: Michael Gottshall
ADDRESS: 3 Patricia Dr
CSZ: Enola, P A 17025
SSN: 192-60-2675
DOD: 12/01/04
ACCOUNT #: 6879450119012463075
BALANCE DUE: -.J~,562.61
EXHIBIT A
4 .
WWR#4060 1 06
FORM 93-0.C. DIVISION
IN THE COURT OF COMMON PLEAS
of
CUMBERLAND, REGISTER OF WILLS, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE: ESTATE
OF
No. 21-05-0025
Michael Gottshall
Deceased
For an installment loan with Dell Financial Services,
Account No. 6879450119012463075
CLAIM
To the Clerk of Orphans' Court Division:
Index and make proper entry in your official records of the claim of Dell Financial Services
c/o Weltman, Weinberg & Reis Co.. L.P.A., 175 South Third Street. Suite 900 Columbus OR 43215
(Claimant)
in the amount of $2.562.61 against the estate of the above named decedent.
This claim is filed under Section 3532 (b) (2) of the Probate, Estates and Fiduciaries Code.
The said decedent, who resided at 3 Patricia Dr
P A 17025 , died on 12/01/04
(Address)
Written notice of this clairrt was given to David Lash. Fid James Turner, Attornev
at !
Enola
(Personal representative, if any, or counsel)
670 Whisler Rd Etters P A 17319 4415 North Front Street Rarrisbur
Address or Personal Representative, if any, or counsel
Christy Dixon
Authorized Agent for Claimant
Weltman, Weinberg, & Reis Co., L.P.A.
175 South Third Street, Suite 900
Columbus, OR 43215
.
Estate Information Services, LLC
2323 Lake Club Drive, Suite 300
Columbus Ohio 43232 Deceased Account Collection Agency
PH: (614) 322-2758 (877) 714-3739 FAX: (614) 322-2761 Website: www.probate-services.com
December 6, 2005
JAMES TURNER ESQ.
4415 NORTH FRONT STREET
HARRISBURG PA 17110
RE: Estate Of: MICHAEL A GOTTSHALL
Claim Of: CAPITAL ONE
Matter No: 1150739
Dear JAMES TURNER
As attorney for the estate, you are by now aware that the undersigned presented an estate
claim on behalf of our client, CAPITAL ONE in the amount of$4,381.72.
It is imperative that we inform our client if the estate has recognized the claim as valid. In
matters such as these, personal representatives should have access to supporting
documentation such as cancelled checks, statements or check registers indicating past
payments made by the decedent without dispute. Occasionally, additional information
such as copy ofa final statement is needed. We can provide this information if absolutely
necessary.
If you wish to discuss an early settlement of the claim, please feel free to call our Estates
Division, and one of our probate specialists will assist you.
Thank you for your prompt attention to this matter.
This is an attempt to collect the debt and any information will be used for that purpose.
This communication is from a debt collector.
~~
TAMMY WOLFE
Estate Assistant
SEND ALL WRITTEN REPLIES TO:
ARIZONA OFFICE:
64 E. BROADWAY ROAD
SUITE 175
TEMPE, AZ 85282
DIANA THEOS - AZ, CO
SARAH DE LA ROSA - AZ
.MINNESOTA OFFICE:
JAMES A. BALOGH. MN
GARY W. BECKER. DC. FL. IL. MN. WI'
'CREDITOR's RIGHTS SPECIALIST
AMERICAN BOARD OF CERTIFICATION
CHELSEA A. WHITLEY - MN. WI
ANGELA M. HORN - MN
MICHAEL D. JOHNSON - MN
MARY ELLEN WEEMAN - KS. MN. MO
THERSIA O. LEE - MN
CHAD J. BOLlNSKE. MN
JASON R. FOSTER - MN
MEAGAN M. PROBST - MN
MICHAEL J. DOLlGHERTY - MN
MICHAEL D. BOLlNSKE - MN. OR
JILL M. GEMLO - MN
EMILY L FINGER - MN
ANDREW S. MILLER - MN
MATTHEW R. EICHENLAUB - MN
NAOMI R. HOWLAND - MN. OH
BALOGH BECKER, LTD.
ATTORNEYS AT LAW
TELEPHONE 763-852-8440
FAX 763-852-8499
TOLL-FREE 877.768-4494
08/02/05
FLORIDA OFFICE:
120 SoUTH OLIVE AVENUE
SUITE 501
WEST PALM BEACH, Fl 33401
ANTHONY J. MANISCALCO - Fl
4150 OLSON MEMORIAL HIGHWAY, SUITE 200
MINNEAPOLIS, MINNESOTA 55422-4811
OF COUNSEL:
lITOW LAW OFFICES, P.C.
(IowA)
LUSTIG. GLASER & WILSON, P,C.
(MASSACHUSmS)
JAMES TURNER
4415 NFRENCH ST
HARRISBURG, PA 17110
Re: In the Estate of
MICHAEL GOTTSHALL
Probate Case No.
Social Security No:
Last known residence:
Our Client:
Account Number:
AmOlmt of Debt:
BBL TD File No.:
21200525
192602675
3 PATRICIA DR ENOLA, PA 17025
CrrIBANK USA, N.A. (SEARS ROEBUCK & CO)
5121079702753804
$ 11127.15
1487093
Dear JAMES TURNER
Enclosed herewith is a copy of the Creditor=s Claim for the above-referenced Estate. The original was
mailed to CUMBERLAND COUNTY COURTHOUSE
If you have any questions or if this is a duplicate claim, please call our firm toll free at 1- 877-768-4494
Cordially,
Balogh Becker, Ltd.
Attorneys at Law
Enclosures
cc: Court
Personal Representative
This letter is an attempt to collect a debt and any information obtained will be used for that purpose. This
letter is from a debt collector.
6067
8/112005
1392794
.
~
COMMONWEALTH OF PENNSYLVANIA
NOTICE OF CLAIM
COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
ORPHANS' COURT DIVISION
In Re: The Estate of:
MICHAEL GOTTSHALL
Deceased
Court File No: 21200525
TO: THE CLERK OF THE ORPHANS' COURT DIVISION:
Notice of claim by creditor, Pursuant to Section 3532(b )(2) of the Probate,
Estates, and Fiduciaries Code, 20 PA.C.S.A. g3532(b)(2).
CITIBANK USA, N.A. (SEARS ROEBUCK & CO)
1) Claimant's name:
CIO BALOGH BECKER LTD, 4150 OLSON MEMORIAL
2) Claimant's address: HWY #200
MINNEAPOLIS, MN 55422
877-768-4494
3) Creditor listed below is the owner and holder of a claim in the amount of
$ 11127.15
4) The facts upon which this claim is based:
This claim is based on an account for credit evidenced by the attached
Affidavit of Account Stated.
5) Decedent's address: 3 PATRICIA DR ENOLA, PA 17025
6)
Date of Death:
12/01/04
7) That the claim arose prior to the death of the decedent on or about
8) That the claim is secured by
On behalf of the claimant, I do solemnly declare and affirm under the penalties of
perjury that they Information and representatio made herein are true and correct
to the be"f/f my knowledge, information and b ief.
Dated: - / 0 - OS-
Chelsea Whitley/Angela Hom! d Bolinske/Michael BolinskelThersia Lee, Atty-in-Fact
Written notice of claim was given to Personal Representative and/or his/her counsel
as stated below:
DAVID LASH
Name
670 WHISTLER RD
Address
ETTERS, PA 17319
CitY/State/7iP
~ )f ks-
Date notic mailed
.
IN RE EST A TE OF: MICHAEL GOTTSHALL
~
AFFIDAVIT OF ACCOUNT
The undersigned, being first duly sworn deposes and states the follows:
1. Your Affiant is authorized by the Claimant as its Attorney-In-Fact to make this Affidavit.
2. Your Affiant has reviewed the account records of the Claimant with respect to the
decedent. Your Affiant is familiar with these records and accounts and reviews them as a
regular part of hislher duties.
3. The Decedent purchased merchandise in the amount of $ 11127.15 evidenced by
account number 5121079702753804
4. The unpaid balance does not include any post-death late payment charges, accrued
interest, collection costs or attorney's fees.
Further your affiant sayeth not
By:
Attorn s-in-Fact:
Chelsea A. Whitley _ Angela M. Horn_
Thersia O. Lee Chad J. Bolinske-l----!
4150 Olson Memonal HIghway, SUIte 200
Minneapolis, MN 55422-4811
Subscribed and sworn before me
This 10 day of
~ ,2005.
e STEP I JOHNSON
NOTARY PUBLIC - MINNESOTA
l MY COMMISSION EXPIRES 1/31/08