HomeMy WebLinkAbout03-05-07
REv.f500 EX (8-00)' Rev-1500 OFFICIAL USE ONLY
COMMONWEALTH OF
PENNSYLVANIA ....................................................................................
DEPARTMENT OF REVENUE FILE NUMBER
DEPT. 280601 INHERITANCE TAX RETURN ~~ oln ~'l~
HARRISBURG, PA 17128-D601 -
RESIDENT DECEDENT County Code Year Number
I- DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
Z EVANS, CLARA RUTH 179-22-0888
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0 DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
W
U 06-04-2006 03-04-1930 REGISTER OF WILLS
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0 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
<D X 1. Original Return 2. Supplemental Retum 3. Remainder Retum (d'" of _ 1''''' 10 12.13-82)
~~UJ ~ - r--
g g-u 4. Limited Estate 4a. Future Interest Comprise (date of death after 12.12.82) 5. Federal Estate Tax Retum Required
.c:~.Q - - '--
o 8:al X 6. Decedent Died Testate (Attach copy of Will) I- 7. Decedent Maintained a Living Trust (Attach a copy of Trust) 8. Total Number of Safe Deposit Boxes
<( -
9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death between 12.31.91 and 1.1.95) D 11. Election to tax under Sec. 9113(A)
- L..- (- sa, 0)
THIS SECTION MUST BE COM~LETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
c: NAME COMPLETE MAILING ADDRESS
Q.)
-= JENNIFER ABRACHT, ESQUIRE
=
8- FIRM NAME (If Applicable) 610 MILLERS HILL
en
~ RIGLER & PERNA, LLC P.O. BOX 96
0 TELEPHONE NUMBER KENNETT SQUARE, PA 19348
'-'
61 0-444-0933
1. Real Estate (Schedule A) (1) $0.001 OFFICIAL USE ONLY i
: c"__)
l_" '
2. Stocks and Bonds (Schedule B) (2) $0.00 ~'" c;J
~~.~ __.J i
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) $0.00 ,"
:..-,...,...., ,
..c.'_.
Z 4. Mortgages & Notes Receivable (Schedule D) (4) $0.00 .~. \
0 <or,
~ 5. Cash. Bank Deposits & Misc. Personal Property (Schedule E) (5) $8,255.12 ".
-:;
-- -
....I 6. Jointly Owned Property (Schedule F) (6) $0.00 _n'"
::> CJ Separate Billing Requested c.)
l- .-
n. -
7. Inter-Vivos Transfers & Misc. ~Ion-Probate Property (7) $0.00 v:>
<( .......................................................e.
0 (SchedUle G or L)
W 8. Total Gross Assets (total Lines 1-7) (8) $8,255.12
c::
9. Funeral Expenses & Administrative Costs (Schedule H) (9) $12,562.61
10. Debts of Decedent, Mortgage Liabilities & Liens (Schedule I) (10) $69,524.35
11. Total Deductions (total Lines 9 & 10) (11 ) $82 086 96
12. Net Value of Estate (Line 8 minus Line 11) (12) ($73,831.84)
13. Charitable and GovernmentaL Bequests/Sec 9113 Trusts for which an election to tax has not been (13) $000
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) ($73,831.84)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of line 14 taxable at tile spousal tax
Z rate, or transfers under Sec. 9116 (a)(1.2) x (15) $0.00
0 -
i= 16. Amount of line 14 taxable at I'neal rate ($73,831.84) x .045 (16) ($3,322.43)
X<( -
<(I- .12 (17) $0.00
I-:J 17. Amount of line 14 taxable at sibling rate x
a.
~ .15 (18) $000
0 18. Amount of line 14 taxable at collateral rate x
U
19. Tax Due (19) ($3,322.43)
20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address:
STREET ADDRESS
1133 COLUMBUS AVENUE, APARTMENT 3
CITY I~TATE I~IP
LEMOYNE PA 17043
Tax Payments and Credit~:
1. Tax Due (Page 1 Line 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
($3,322.43)
Total Credits (A + B + C) (2)
$000
3. Interest/Penalty if applicable
D. Interest
E. Penalty
5.
Total Interest/Penalty (D + E) (3)
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)
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)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
$0.00
4.
$3,322.43
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN X IN THE APPROPRIATE BLOCKS
3.
4.
Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred; ~
b. retain the right to designate who shall use the property transferred or its income;
c. retain a revisionary interest; or
d. receive the promise for life of either payments, benefits or care?
If death occurred after Decer]1ber 12, 1982, did decedent transfer property within on year of death
without receiving adequate consideration? r==J
Did decedent own an "in trust for"'or payable upon death bank account or security at his or her death? c=J
Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? (==:l Q:J
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
No
m
ED
1.
2.
examined this return. including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete,
al representative is based on all the information of which preparer has any knowledge.
'1 J~ 0
SIGNATURE OF
/'
C
ADD S
RIGLER & PERNA, LLC, P.O. BOX 96, KE~INETT SQUARE. PA 19346
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 s4rviving 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-150B EX + (1-97)(1)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
CLARA RUTH EVANS
FILE NUMBER
2006-00746
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.
2.
3.
4.
5.
6.
7.
8.
DESCRIPTION
VALUE AT DATE
OF DEATH
$797.20
$1,487.00
$200.00
$4,100.00
$286.28
$9.64
$500.00
$875.00
PNC BANK CHECKING ACCOUNT
PNC BANK CHECKING ACCOUNT
PROCEEDS FROM SALE OF SEVERAL PIECES OF FURNITURE
PROCEEDS FROM SALE OF AUTOMOBILE (1997 ACURA)
APARTMENT REFUND (SPRINGWOOD REAL ESTATE SERVICES)
HERITAGE MEDICAL GROUP (REFUND)
PERSONAL EFFECTS/HOUSEHOLD FURNISHINGS
FUR COAr
***COPY OF FUR COAT APPRAISAL ATTACHED HERETO AS "EXHIBIT A"***
TOTAL (Also enter on line 5, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$8,255.12
REV-1511 EX + (1-97)(1)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
CLARA RUTH EVANS
FILE NUMBER
2006-00746
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. KUZO & GRIECO FUNERAL HOME, INC. $6,274.60
2. FUNERAL LUNCHEON $558.31
3.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City State Zip
-
Year(s) Commission Paid:
2. Attorney Fees: RIGLER & PERNA, LLC $4,100.00
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 CUMBERLAND COUNTY REGISTER OF WILLS $135.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Advertising Fees: $343.10
8. Costs of Storing and Disposing of Personal Effects and Household Furnishings $1,007.00
9. Reimbursement to Executor for Expenses Incurred in Administering Estate (Post office box rental, mailing costs, $144.60
advertising costs associated with sale of automobile and listing for sale of furs)
TOTAL (Also enter on line 9, Recapitulation) $12,562.61
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (1-97)(1)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF
CLARA RUTH EVANS
FILE NUMBER
2006-00746
Include unreimbursed medical expenses.
ITEM
NUMBER
1. WACHOVIA (ACCT. #5490998311489414)
2. HECHTS (ACCT. #41-437593688-0)
3. BOSCOV'S (ACCT. #003651347)
4. CITI CARDS (ACCT. # ENDING 8542)
5. CHASE
6. BON TON
7. VERIZON
8. MBNAAMERICA NA (ACCT. #5329031999981952)
9. CREDITORS FIN. (ACCT. #4264298997500486)
10. SWISS COLONY (ACCT. #049924402984A)
11. CINGULAR WIRELESS
12. SUNOCO
13. WALMART
14. JCPENNY (0837329184)
15. SHELL OIL
16. AMERICAN EXPRESS
17. PPL
18. COMCAST CABLE
19. WEST SHOE EMS
20. CARE MARK PHARM
21. HERITAGE
22. PENN STATE
23. BLUE CROSS
24. CMS MEDICAL
25. IRS (1040-2003)
26. IRS (1040-2004)
27. AT&T WIRELESS
28. STEPHENSON
29. UROLOGY CENTER OF CHESTER COUNTY
30 CENTRRE HEAL THCARE
DESCRIPTION
AMOUNT
$15,322.66
$287.18
$594.18
$9,656.81
$10,506.34
$653.14
$88.23
$3,489.85
$10,320.85
$80.00
$101.08
$117.78
$4,006.15
$556.06
$1,261.16
$6,268.71
$150.16
$47.81
$610.98
$150.00
$5.36
$180.00
$17.10
$24.89
$2,285.53
$1,560.00
$143.57
$23.06
$18.60
$997.11
***COPIES OF DEBTS ATTACHED HERETO AS "EXHIBIT B"...
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$69,524.35
Register of Wills Cumberland County, Pennsylvania
INVENTORY
Estate of CLARA RUTH EVANS
No. 2006-00746
also known as C. RUTH EVANS
Date of Death June 4, 2006
, Deceased
Social Security No. 179-22-0888
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets
wherever situate end all of the real estate in the Commonwealth of Pennsylvania of said, Decedent that the valuation placed opposite each item
of said Inventory represents its fair value as of the date of the Decedent's death, and th Decedent owned no real estate outside of the Commonwealth
of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this inventory
are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to
unsworn falsification to authorities.
I.D. No.:
JENNIFER ABRACHT, ESQUIRE
90489
Attorney
Address
RIGLER & PERNA, LLC, P.O. BOX 96
KENNETT SQUARE, PA 19348
610-444-0933
Dated
Telephone:
Description
Value
Personal Property
PNC BANK CHECKING ACCOUNT
PNC BANK CHECKING ACCOUNT
PROCEEDS FROM SALE OF SEVERAL PIECES OF FURNITURE
PROCEEDS FROM SALE OF AUTOMOBILE (1997 ACURA)
APARTMENT REFUND (SPRINGW60D REAL ESTATE SERVICES)
HERITAGE MEDICAL GROUP (REFUND)
PERSONAL EFFECTS/HOUSEHOLD FURNISHINGS
FUR COAT
$797.20
$1,487.00
$200.00
$4,100.00
$286.28
$9.64
$500.00
$875.00
Total from Continuation Page(s) $0.00
(Attach additional sheets if necessary) Total: $8,255.12
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of personal representative, include the value of
each item, but such figures should not be extended into the total of the Inventory.
.
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R I C H A R D - DON A L D FUR 5 INC.
713 MARKET STREET. WILMINGTON, DELAWARE 19801
PHONE (302) 656-1693
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TO WHOM IT MAY CONCERN:
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w. hereby appraise a ~<Jt1tfL~t1I<:'-6M;;ZSf-Ll<.=;r;; ~L-
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at $ 81:J -
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Zip
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OJ,53447J,002b250000054909983J.J,4894J,4
( )
WOft<phone
Cash or Credit Allailable
11.-'"
CIosin Date
Total MInimum Ps nt DIHI Ps nt Due Date
$13,200.00
04111/06
$2,625.00
05/10106
CI8dIts (eft)
APRIL 2006 STATEMENT
Ch"'ll"S
CREDITS
5541 Me EXPRESS PAYMENT - THANK YOU
TOTAL FOR BILLING CYCLE FROM 03/14/2006 THROUGH 04/11/2006
$0.00
315.00 CR
$315.00 CR
'I~~ds~%~;\'~~~;~'~~
$O~OO
$305.08
$0.00
$15,344.71
P8st Due Amount .............. $2,305.00
Cummt P8yment .............. $320.00
Total Minimum Payment
Due ............................... $2,625.00
'ANCE CHARGE SCHEDULE
otegory
sh Advances
A. BALANCE TRANSFERS, CHECKS
B. ATM, BANK ................
C. PURCHASES ..................
D'. OTHER BALANCES .............
Perloclc Rate
~ng
percentage Rate
Balance
~:u..
FOR YOUR SATISFACTION, EVERY HOUR, EVERY LMY
. Fa CU5lomer SalIsIactialllld 14I to 1he milute aJlomated ilfamatbl i1clJdilg.
baIlrlce, lMliIlmle credt. payments receWed, payments We, We date, yayment
*ess ilfamatllJ1. a to relJll!Sl wpllcate statements, call 1-1300.47 -9131.
. Fa TOO IT eIecommunk:atbl Devk:e fa the Deal) asslsllrlce,
call-8Ol:J.J46.3178.
. Mail payments 10: BANKCARD SERVICES, P.O. BOX 15137, WLMINGTON, DE
19886.5137.
. BiIIiIg riahts ae preserved mly by Millen i1QJiy. MaR bBIi1g i1qJries, usilg
fam mlhe back, lIld oIher il(JJries to:
BANKCARD SERVICES P.O. BOX 15026. WIlMINGTON. DE 19850-5026.
0.068438% DLY
0.068438% DLY
0.068438% DLY
0.068438% DLY
24.98%
24.98%
24.98%
24.98%
$0.00
$0.00
$5,053.43
$10,318.39
'R THIS BILLING PERIOD:
~'MM I
HECHT'S
NOW PART OFTHE MA('{'SFAMllY
For the period ending May 13. 2006
Days in billing cyde: 30
WlUiam Evans
Account number: 41-437-593-688-0
Questions? CalI1-8OD-S67-7067
Page: 1 of 1
Account summary
Revolving
250.61
- 25.00
+ 56.91
+4.66
287.18
$10.00
Balance of last statement
Payments
New transactions this statement
FINANCE CHARGES
" New balance
Minimum payment due on Jun 7,2006
Revolving account transaction details
Amount
Date Store
May 04 Capital Cty-H
Description
Misses Karen Scott
Karen Scott Sportswear
Misses Moderate Knits
Receipt total
Payment-thank you
Alfred Dunner Petites
Receipt total
Misses Karen Scott
Receipt total
16.99
23.78
7.64
48.41
- 25.00
25.49
25.49
- 16.99
- 16.99
May 04 Capital Cty-H
May 07 Capital Cty-H
May 07 Capital Cty-H
The creditor is FDS Bank..
o New address or phone number?
Please provide the information on the reverse side.
Account name - Type
Revolving - 20
67-04 34143
WILLIAM EVANS
C RUTH EVANS
APT 3
1133 COLUMBUS AVE
LEMOYNE, PA 17043-1731
1...11I...111... .1111. .11..11111...1..11. ...1111.. ...11.11...1
834140
Financial terms
I. Average daily balance
Daily periodic rate
CORRESPONDING
ANNUAL PERCENTAGE RATE
$262.58
0.05918%
21.60%
in store...
Your Hecht's acX:ount number 41646479 is
now a part d the Macy's family! Your new
Maty's account number for this account is
41437593688. WeIoometoMac:y's!
Amount enclosed
n
1.1.1.11.....11. .11..1..1.1.1. ....111.1...1.1.1.1...1.1.11...1
PO BOX 689195
DES MOINES IA50368-9195
000004143759368820 0001000 0028718 0002500 6710
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Boscov's, Inc.
P.O. Box 4116, Reading, PA 19606-4116 / Ph:61 0.779.2000 / Fx:61 0.370.3495 / www.boscovs.com
06/20/06
309
ESTATE OF C RUTH EVANS
PO BOX 4536
GREENVILLE DE 19807~4536
ACCOUNT NUMBER: 003651347
EXECUTOR OF THE EVANS ESTATE;
PLEASE ACCEPT OUR SINCERE CONDOLENCES ON THE PASSING OF YOUR
LOVED ONE. WE ARE ALWAYS SORRY TO RECEIVE THIS TYPE OF NEWS.
PLEASE BE ADVISED THAT 'THE NOTICE OF ADMINISTRATION, AS WELL AS
ALL DISBURESEMENTS TO BOSCOV'S BE DIRECTED TO THE ADDRESS LISTED
BELOW, ATTENTION: KAREN SAKALIDIS.
WE HAVE ENCLOSED A COPY OF THE LAST STATEMENT,AND'WOULD
APPRECIATE YOU CONTACTING US AT 1-800-755-7872,EXTENSION 2414,
DURING NORMAL BUSINESS HOURS.
s 1 Y , ...2-. .3.
SINCERELY,
......
~~~~~
KAREN E SAKALIDIS
BOSCOV'S CREDIT OFFICE
PO BOX 4274
READING, PA 19606
1-800-755-7872
/~
~
Corporate Offices: 4500 Perkiomen Avenue, Reading, PA 19606-0516
MINNES01A OffICE:
JAMES A. BALOGH. MN
GARY W. BECKER - DC. fL. IL. MN, WI'
'CREDITOR'S RIGHTS SPECIAlISl
AMERICAN BOARD Of CERTifiCATION
BALOGH BECKER, LTD.
ATTORNEYS AT LAW
CHELSEA A. WHITLEY - AZ, KY, MN, WI
ANGELA M. HORN. MN
MARY ClLW WEEMAH - KS. MN, MO
STEVEN M. TOMS - MN
MEACAN M. PROBST. MN
MICH.AEl .I. DOUGHERTY - IN. MN
J,U M. GEMlO - MN
AHDRcW S. MillER - MN
MAlTHEW R. [ICHEI.lLAUB . MN
JEtllfER C. MElbY' NJ. T X
ROB'" R. lLDoHIlE - CA, MN
J.c. ATNIP III . CA, MN
JA50" R. A':1RUP - MN. NO
Iv RillA Mt-.
JASO': A. IAI"'IL'tlE . CT. MN. RI
KIM8ERLY J. MAP - MN, OR
MARTHA .I. BALDW";. MN
SEND ALL WRITTEN REPLIES TO:
4150 OLSON MEMORIAL HIGHWAY, SUITE 200
MINNEAPOLIS, MINNESOTA 55422-4811
TELEPHONE 763-852-8440
FAX 866-234-0503
TOLL-FREE 866-234-0513
OF COUNSEL:
llTow lAW OffiCES. P.c.
(IOWA)
lUSflG. GLASER & WILSOI". P.c.
(MAS5ACHUSElTS)
December 1 , 2006
Account No
5424180470752541
Unpaid Balance
$10320.90
Reference No
3197023
Dear Sir or Madam:
This letter is sent to you SO:8!Y in your capacity as per~onClI representative.
Our law firm represents Citibank (South Dakota) N.A.. We have learned that C R EVANS, who was a valued
customer, has passed away. Our client sent this accoUri'fto our law firm for professional handling. Please accept
condolences from our client and our law firm.
As indicated above, there is an unpaid balance on this account. Citibank (South Dakota) N.A. has asked us to
explore resolving this matter and we are asking you for your assistance. Please accept this letter as a Notice of
Claim on behalf of our client. If you have information regording this estate, contact us toll free at 1-866-234-0513.
Cordially,
Balogh Becker Ltd.
Attorneys at Law
IMPORTANT NOTICE
Unless you notify this office within thirty (30) days after receiving this notice that you dispute the validity of the debt
or any portion thereof, this office will assume the debt is valid. If you notify this office in writing within thirty days after
receiving this notice, this office will obtain verification of the debt or a copy of a judgment against you, if any, and a
copy of such verification or judgment will be mailed to you by this office. Upon your written request within the same
thirty-day period, this office will provide you with the name and address of the original creditor, if different from the
current creditor. This firm is a debt collector. We are attempting to collect a debt and any information obtained
will be used for that purpose.
CO!\:HAI.OO 17(NJI
1.011111111111111111811111 III. UIII III 11111
LAW FIRM OF BALOGH BECKER, LTD
4150 Olson Memorial Highway, Suite 200
Minneapolis, MN 55422-4811
ADDRESS SERVICE REQUESTED
Account #: 5424180470752541
Balance: $ 10320.90
----.
Client ID:CITI32
December 1, 2006
1I.11.IIIDlII~IIII.IWIIIIIIII.II.1111I11
BALOGH BECKER, LTD
4150 Olson Memorial Highway Suite 200
MinneapOlis MN 55422-4811
1,1,1"1,1,,1,,1,,1,1,,1,1,1,, 11,,1 ""11,,,11,1,1,11,,",11,1
--
#BWNHRMD 369081 3287
# 1201 0749 0003 2871 # 3197023-700 1
1".111,1"1,.1,11..,1,.,1,1"1,1,1",11,,11,,.,11.,11,, 1,,1.1
Personal Representative for the Estate ot:
C R EVANS
PO Box 4536
Greenville DE 19807-4536
MlNNESOIA OffiCE:
JAMES A. BALOGH - MN
GARY W. BECKER - DC. FL. IL. MN. WI'
'CREDITOR'S RIGHIS SPECIAlISI
i .MERICAN BoARD OF CERTIFICATION
BALOGH BECKER, LTD.
AnORNEYS AT LAW
FLORIDA OFFICE:
2900 UNIVE~SITY DR
SUITE 54
CORAL SPRINGS. Fl 33065
ANTHOtlY J. MANISCALCO - FL
CHELSEA A. WHITLEY - AZ, KY. MN. WI
ANGElA M. HORN - MN
MARY ELLEN WEEMAN - KS, MN. MO
STEVEN M. TOMS -- MN
MEAGAN M. PROBST - MN
MICHAEL J. DoUGHERTY -IN. MN
JILL M. GEMLO - MN
ANDREW S. MILLER - MN
MATTHEW R. EICHE"LAUB - MN
JENIFER C. MELBY NJ. TX
ROBII-l R. LEDONNE - CA. MN
JAC< An-up III - CA. MN
JASO" R. ASTRUP -- MN. ND
h R,HA- MN
JASON A. IANNONE - Cf. MN. RI
KIMBERLY J. MAn- MN. OR
MARTHA J. BALDWIN MN
SEND All WRITTEN REPLIES TO:
4150 OLSON MEMORIAL HIGHWAY, SUITE 200
MINNEAPOLIS, MINNESOTA 55422-4811
TELEPHONE 763-852-8440
FAX 866-234-0503
TOLL-FREE 866-234-0513
Of COUNSEL:
LlTow LAW OFFICES. r.c.
(IOWA)
LUSTIG. GLASER & WILSON. P.c.
(MASSACHUSETTS)
December 1, 2006
Account No
5410658415298452
Unpaid Balance
$10926.45
Reference No
3210799
Dear Sir or Madam:
Thb letter is seni to you solely in youl capacity as personal representutive.
Our low firm represents Citibank (South Dakota) N.A.. We hove learned that C R EVANS, who was 0 valued
customer, has passed away. Our client sent this account to our low firm for professional handling. Please accept
condolences from our client and our low firm.
As indicated above, there is on unpaid balance on this account. Citibank (South Dakota) N.A. has asked us to
explore resolving this matter and we are asking you for your assistance. Please accept this letter os 0 Notice of
Claim on behalf of our client. If you hove information regarding this estate, cont oct us toll free at 1-866-234-0513.
Cordially,
Balogh Becker Ltd.
Attorneys at Low
IMPORTANT NOTICE
Unless you notify this office within thirty (30) days after receiving this notice that you dispute the validity of the debt
or any portion thereof, this office will assume the debt is valid. If you notify this office in writing within thirty days after
receiving this notice, this office will obtain verification of the debt or 0 copy of 0 judgment against you, if any, and 0
copy of such verification or judgment will be moiled to you by this office. Upon your written request within the some
thirty-day period, this office will provide you with the nome and address of the original creditor, if different from the
current creditor. This firm is 0 debt collector. We are attempting to collect 0 debt and any information obtained
will be used for that purpose.
CONBALUIl1711111
1.0111..1.11.1.11.111.11
LAW FIRM OF BALOGH BECKER, LTD
4150 Olson Memorial Highway, Suite 200
Minneapolis, MN 55422-4811
ADDRESS SERVICE REQUESTED
Account #: 5410658415298452
Balance: $10926.45
Client ID:CITI32
December 1, 2006
Ig.II..IIIIIIIII.IIIII!IIIIIIIIIII!WI~gllll!
BALOGH BECKER, LTD
4150 Olson Memorial Highwo,/ Suite 200
Minneapolis MN 55422-4811
1.1.1..1.1..1..1..1.1..1.1.1..11..1", ,III ,.11,1.1.111111I11.1
#BWNHRMD 369082 3288
#1201074900032889# 3210799-7001
1...111.1..1..1.11...1...1.1..1.1.1...11..11..,.11..11,.1,.1.I
Personal Representative for the Estate of:
C R EVANS
PO Box 4536
Greenville DE 19807-4536
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alement for account number: 5260 2100 1046 3502
I Balance Payment Due Date Past Due Amount Minimum Payment
1,559.56 10/01/06 $1,255.00 $3,404.56
CHASE 0
)unt Enclosed 1$
I Make your check payable to Chase Card Services.
New address or e-mail? Print on back.
52b02100104b35020034045~0115595b0000009
12087 BEX Z 24906 D
C R EVANS
PO BOX 4536
WILMINGTON DE 19807-4536
111.111.1111..1.1..1..1111.1.1.11.11.1.1.1111..1.1.1111..11.11
CARDMEMBER SERVICE
PO BOX 15153
WILMINGTON DE 19886-5153
111.111.1111111.11111111.1.1111.1.1.11111111111111..11111..1.1
I: 5000 ~ 1;0 281: l.:I ~OO ~O l. I; :150 2 ~II.
'\
CHASE 0
Statement Date:
Payment Due Date:
MinilTlum Payment Due:
08107/06 - 09/06106
10/01/06
$3,404.56
CUSTOMER SERVICE
In U.S. 1-800-945-2000
Espanol 1-888-446-3308
TOO 1-800-955-8060
Pay by phone 1-800-436-7958
Outside U.S. call collect
1-302-594-8200
JlASTERCARD ACCOUNT SUMMARY Account Number: 5260 2100 1046 3502
ACCOUNT INQUIRIES
$11,230.70 Total Credit Une $9,700, P.O. Box 15298
+$39.00. Available Credit $0 Wilmington, DE 19850-5298
+$289.86 Cash Access Una $5,820
$11,559.56 Available for Cash $0
revious Balance
urchases. Cash, Debits
inance Charges
ew Balance
PAYMENT ADDRESS
P.O. Box 15153
Wilmington, DE 19886-5153
VISIT US AT:
www.chase.comlcreditcards
08/15/2006
HSBC RETAIL SERVICES
P.O. BOX 5244
CAROL STREAM, IL 60197-5244
HSBC ID
WILLIAM A EVANS
C RUTH EVANS
1133 COLUMBUS AVE
APT 3
LEMOYNE, PA 17043
~
(-(;,
Account Number: 0002116041000969718
Current Balance: $783.46
Minimum Amount Due: $250.00
Re: BON TON
Dear WILLIAM A EVANS:
Your account is seriously past due. As a result of your
continuing delinquency, we must now demand that you pay
your account balance.
Prompt payment of this account will stop further damage to your
credit standing. Failure to pay your account balance will result
in further action against you. This action may include the
referral of your account to a local collection agen~y for
immediate action.
You can eliminate your delinquent status, and avoid the
unnecessary time and expense of further action, by making
payment or appropriate payment arrangements. If you wish
to discuss this account, you may contact us toll free at
800-365-2028.
Collection Department
~~:~""cWe_ are required by law,- if applicable, to notify you that we care
. attempting to collect a debt, and any information obtained will
't:),eused for that purpose.
'~,~'_can take advantage of our check-by-phone p1rogram.
~9ur toll-free number 800-927-5322.
lC;,7--------------------------------------------------------
~.,,~',lclude this portion of the letter with your payment or
~~~ence to ensure prompt attention.
.:}':gVANS
~.~er: 0002116041000969718
!.,If:'It: $
:<.Retail Services
..B.ox 4144
01 Stream, IL 60197-4144
~
WCftAJII
,7
,--
Billing Date: 05/16"
Telepho~e Number: 7t..
Account. 717303267'3'
How to Reach Us: See .....
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_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ,!D.2ta.Eh2~II!"e.a~~t~ip~i!!!Y~U':5h~~P.!Y<!>I~o'ye!!Z~.- - -
.......... ....... ................_........ .... .. ...._..... ..._............ ._.. . . n .__ ._,..... .
We nevet'stop 'IIIOI1dng for you.
C RUTH EVANS
Account Summary
Previous Charges
Payments Received thru May 17
Past Due Charges (Please Pay Now)
$91 .18
-48.05
$43.13
New Charges
Verizon (page 3)
MCI (page 6)
Total New Charges due Jun 12
$26.85
18.25
Total Due (Past Due + New)
Mail payments to:
Verizon, PO Box 28000, Lehigh Vly PA 18002-8000
Change of billing address?
Go to verizon.comlbillingaddress or see page 2.
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C RUTH EVANS
1133 COLUMBUS AVE APT 3
LEMOYNE PA 17043-1731
11111111111111111111111111111111111111111111111111111111111III
Account: 717 303 2673 230 89 Y
New CVharges Due: 06/12106
Total Due $88.23
Amount Paid:
$ 00.00
Verizon
PO BOX 28000
LEHIGH VL Y PA 18002-8000
111111111111111111111111.111111111111111111111111111
10971703032673230302802117000006000000431330000008823700000
C0
NATIONAL ENTERPRISE SYSTEMS
29125 Solon Road · Solon. OH 44139-3442
C Ruth Evans 00002266 6118
PO Box 4536
Wilmington DE 19807-4536
~_. . .....-..
~ RE: MBNA AMERICA BANK, N.A.-~
Client ID: 5329031999981952 --=----
For:
Date of Referral: 07/11/06
Date of Service: 04106/06
Please contact:
(800) 882-9325
October 18, 2006
Total Amount Due: $3,489.85
We have been authorized by our client to settle your account for something less than the balance in full. Please
contact this office if you would like to discuss this offer.
This is a communication from a debt collector. This is an attempt to collect a debt and any information obtained
will be used for that purpose.
You can also pay by automated phone system at (866) 294-0188 or on the internet at www.nesi.paymybill.com.
Just enter your account number 00002266. Transaction fees will be charged if you use the automated phone system
or the internet to make payment on this account. You are not required to use the automated phone system or the
internet to make payment on this account. If you make payment on this account by check, the face amount oftlle
check may be presented to your bank by paper draft or electronically as permitted by law.
67DAKS1638874
NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION
...PLEASE COMPLETE AND RETIJRN THE FORM BELOW WITH YOUR PAYMENT.'.
1(1
DAKSII68
PO Box 1022
Wixom MI 48393-1022
ADDRESS SERVICE REQUESTED
Daytime Phone: (_>
Evening Phone: <----)
o Enclosed is Payment in Full
#BWNHRMD 1348631 23987
#1018171700239871# -874
I. ..111.1. .1. .1.11. ..1...1 a I. .I.I.I...II..! 1....11..11. .1. .1.1
"PERSONAL & CONFIDENTIAL.
C Ruth EVIns
PO Box 4536
Wilmington DE 19807-4536
127
Please forward all payments and correspondence to:
NATIONAL ENTERPRISE SYSTEMS
29125 Solon Road
Solon OH 44139-3442
1.1..1.1..111.111111.1.1....11..1..1.1.. 1111.1..1.1.1.1.1.1..1
October 18, 2006 00002266 ML
Client lD: 532903 t 999981 952
Amount Due: $3.489.85 Amt Paid $
NCA Financial, Inc.
1731 Howe Avenue #254
Sacramento, CA 95825
(800) 258-6520
Fax (916) 830-0544
/""
'-)
Date: October 2, 2006
250/0 DISCOUNTED OFFER
IF YOU ACT NOW!
C EVANS
PO BOX 4536
GREENVILLE, DE 19807-4536
Re: Debt Reduction Opportunity
Card Issuer: MBNA BANKCARDS
Account #: 5329011988007779
Current Balance Showing on our records: $ 15,893
Our File #: 876469
Dear Customer:
This letter concerns the debt above. An Arbitration award was issued against you based on the above debt.
Typically, the next steo is a conversion of the award to a civil iudgment. followed bv lee:al actions to enforce the
iudgment
Now you have an opportunity to pay just 75% of this debt and get it paid off, thereby preventing any further legal
or collection steps from being taken. This means that instead of $ 15,893 all you have to pay is $ 11,920, a saving
of $ 3,973!!
To take advantage of this offer, you must contact NCA for a suitable program to pay this advantageous debt
reduction settlement (before the expiration date below), which will be valid only if it is confirmed by you and NCA
in writing.
Upon full payment your credit record on our books concerning this account can show a "Paid in Full" status! After
payment, if you request, we will also issue you a written letter confirming that you have paid this account with a
rating of "paid as agreed." Please Note: We strive to maintain our data in as current a status as possible. Ifby
chance a judgment has already been entered, the above amount may not be correct. In this case please contact us for
a discount quotation.
But you must act now to take advantage of this offer! I need to tell you that if you do not accept this opportunity and
act on it within the time allowed in this letter, NCA is compelled to take the next collection step towards collecting
the full amount.
I urge you to take advantage of this offer now! Please call NCA as soon as you get this letter!
Sincerely,
1)./1
Ii ifn~~rrister
Important: This offer is only valid until October 30, 2006. Act now!!
This is an attempt to collect a debt. This has been sent to you by a debt collector. Any information obtained
will be used for that purpose. Please see further important information regarding your rights on reverse.
@ ~eSwiss Cl!!t?~f!!j
CUSTOMER STATEMENT
Account Number 049 924 402 984A
New Balance $113.09
Payment Due Date 07/05/2006
1112 7TH AVENUE
MONROE WI 53566-1364
)0
Check box if address.
telephone or Ernail has
changed. Print changes
on back.
Minimum Payment Due
$80.00
$'
111I11111I11111I.1..1..1111I.11I11I1..11.11I11I111I..11.1111.1
************AUTO** 3-DIGIT 170
MRS WILLIAM EVANS SR
1133 COLUMBUS AVE APT 3
LEMOYNE PA 17043~1731
ENTER AMOUNT ENCLOSED
Company name MUST show through window of payment envelOpe.
4
THE SWISS COLONY
049924402840016001130900080004
Please qetach and relUm top portion wtth remittance
'J'e Swiss Cololfg For Customer Service call 608-324-41 00 Mon.-Fri. 8 a.m. - Midnight CT. Please
have your account number ready.
Or write 1 1 1 2 7th Avenue, Monroe WI 53566-1 364.
To place an order, call 608-324-6000 or visit us at www.swisscolony.com
DATE REFERENCE NO DESCRIPTION PURCHASESI PAYMENTSI
CHARGES CREDITS
.
(I6(f)?J'2f)(I~ F~l~~JJ5l)a9.< <:FJ: I'IAN.~I:: CHARGE........................... ..................................:..........2.;.. l) 4...............................
.-.-.....-............
. . . . . . . . . . :.lfotrQ~TMI,...Ml;$$A~l5fQ~:ttR.S..I5VAN.S{> . . . . :.: . . . . . . . . . .
. . . . . . . . .......
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . <<Do r1t)~if;i!;;l(,ytJ"'r!tJppt)r.;~IJr'\i~y..~t).t)l)~a.ir( ~f~CI.i.~ ir:1 the future.~>"'"
...-..........-.."
. . . . . . . . . . . . . . . . . . . :>we ..f~p.tJftrl~g~tiv~:.i#fofill~ntJr'\>~tJ the c:reditbureau.>>.....
.......... .......-...................-..
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PAVME HTS AND t~ED I r S ~EtE I "ED AFrE~ 0 '/0 '1 /2- lJ i:J 6 tl i L L App EA~ ON VO OR NEXT stAtEMENT .
ACCOUNT SUMMARY
Your account number is
049 924 402 984A
.>l':a~vi9~$.~Ai..M,;9g>...
~=~:s.>..
111.05
1\lO;QF.oAvsilil.. .........itEI'IAGEDAILY.>..
B1U1NG.PERIOO> ...............BAIANCE..:...
..........-...... . ..... ..........
30 108.79
FINANCE CHARGES are computed using the average dally balance as follows:
PERIODIC RATE ANNUAL PERCENTAGE RATE
1.875 Yo 22.500 Yo
06/07/2006 07/05/2006 $80.00
BALANCES UP TO Remtt new balance by payment
$9 J 999.99 due date to avoid further
finance charge.
Monthly Minimum FINANCE CHARGE Is 5.50
TO ENSURE TIMELY RECEIPT OF YOUR PAYMENT WE SUGGEST YOU MAIL NO LATER THAN 06/27/2006
_ _ _____ ___ ___ .____ _......_ ___ ...~~"T"A."I-r .a..r-nn..ATIr'\"-1
June 26, 2006
C!!::J
...." "'11,~ula'
raisin the harT"''''''
1m nt Customer Information:
Account #: 159-2203420126
Amount Due: $143.57
Amount
Paid: $
. ._........, I""" ." " ,,"oJ'-LfJUl
097780016824015~703-12
'..."'.1..'..1.1"11'11.'.1.'.1
RUTH CEVANS
PO BOX4536
GREENVILLE DE 19807
1..1.1...11..1. ",.,..1.. .1...1'.1.1. .1111.1..111.11.11111111.1
CinguJar-MacroCell
PO BOX 17514
BALTIMORE MD 21297-1514
0000000200159000002203~2012b30000000143574
rt DETACH HERE AND PLACE IN RETURN ENVELOPE n
Re: CingularWirelessAccount Number: 015900002203420126
Total Amount Now Due: $143.57
We have attempted numerous times to obtain your cooperation in resolving the serious delinquency on
your Cingular Wireless account. Cingular Wir~less may soon be left with no alternative but to refer your
account to a collection agency for further collection. This may result in a negative report on your credit
history.
Only an immediate payment of $143.57 can resolve this issue. You may remit your payment in the
envelope provided; please be certain to include your'account number on your check or money order.
If you would prefer, we are able to take your credit card or check payment over the telephone by contacting
a Receivables Management Representative at (800) 544-3859 at no charge.
Thank you.
ReceivableS Management
Cingular Wireless
129
PO BOX 6700
NORCROSS GA 30091-6700
RETURN SERVICE REQUESTED
TSYS TOTAL DEBT MANAGEMENT, INC.
Post Office Box 6700
NORCROSS, GA 30091-6700 I -S
September 30 2006
150
1111111111
~-~_..
~UT Client G E Money Bank ~.
'---- Retailer: Wal-mart
Account Number: bb3220719Q3 0
TDM Number: 074542272
Balance: $3901.59
THE ESTATE OF C EVANS
PO BOX 4536
WILMINGTON DE 19807-4536
To the Estate ofC Evans:
We have been informed by our client, G E Money Bank, of the recent passing ofC Evans. Please
accept our condolences for your loss. During times like these it is very difficult to focus on financial
matters. We here at TSYS Total Debt Management (nTDM") understand and would like to offer
our assistance in settling the above-referenced account of C Evans.
Please contact our office Monday through Friday, 8:00 a.m. - 5:00 p.m. ET at 866-313-1902, to let
us know who is representing the Estate so we may contact them directly. If you prefer to take care
of the balance at this time, payment in the amount of $3,901.59 may be sent to TSYS Total Debt
Management at P.O. Box 430, Columbus GA 31902-0430.
Once again, we are truly sorry for your loss. Please contact us if you have any questions or
require assistance.
Sincerely,
TSYS Total Debt Management, Inc.
** IMPORTANT CONSUMER INFORMATION **
This office will assume this debt is valid unless you notify this office within 30 days after receiving
this notice that you dispute the validity of the debt or any portion thereof. If you notify this office
in writing within 30 days from receiving this notice, this office will: obtain verification of the debt
or obtain a copy of a judgment and mail you a copy of such judgment or verification. If you request
from this office in writing within 30 days after receiving this notice, this office will provide you
with the name and address of the original creditor, if different from the current creditor.
TIllS IS AN ATTEMPT TO COLLECT A DEBT. ANY INFORMATION
OBTAINED WILL BE USED FOR TIIA T PURPOSE.
TIllS IS A COMMUNICATION FROM A DEBT COLLECTOR.
Please detach and foward with Payment
TSYS Total Debt Management, Inc.
P.O. Box 430
Columbus, GA 31902-0430
1111\111111\111.11111111111\111111111111.11111111111111111.111
Name: C Evans
Account Number: 6032207190351080
roM Number: 074542272
Balance: $3901.59
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:'ACC6UNTsUMMARY' .. .. H...
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. c
~
Minimum payment due includes
$56.00 past due.
Please pay the past due amount PROMPTL Y.
PLEASE DETACH AND RETURN THIS STUB WITH YOUR PAYIIENT
JCPENNEY ACCOUNT.NUMBER : 083-732-918-41
PAYMENT SHOULD REACH US BY : 08-09-06
\,
Remit to GEMB
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636 .41 87 00
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CHECK HERE IF ADDRESSlPHONE
NUMBE~ HAS CHANGED. SEE
REVERSE SIDE.
'f AllIN TOTAl BELOW 'f
$00000.00
RUTH EVANS 1Z5173
1133 COLUMBUS AVE
APT 3
LEMOYNE PA 17043-1731
11111111111111111111111111111111111111111111111111111111111111
. P.O. BOX 960001
ORI,.ANDO, FL 32896-0001
1111111111111111111111111111111111111111111111111111
0125173
357
0837329184 20 00087000063641
5433 181Z T9D 1 7 10 060710 X Page 1 Of 1 9119 oalo D147 lZ5173
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MAY 15,
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"
WILLIAM A EVANS JR
APT 3
1133 COLUMBUS 'AVE
LEMOYNE PA 17043-1731
1111111.11111....1..111111111111.1111111.1..1111111111111111.1
Dear Customer:
Your account has been suspended because it is currently
No other charges will be authorized at this
Statement on the Reverse.
I;IOPtlma" Platinum
· from American Express
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PreparedFcr
WlWAM A EVANS
Accounl Nlntler CIasiIg Dale
3737-396613-63004 .05.112/06
Page 1 of6
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10430066 uaUOFllBEVERAGESlSNACKS 04114106
04t.21/06 WINE & SPIRITS 2215 HARRISBURG PA
11136063 uaUOFllBEVERAGESlSNACKS 04t.21106
..-......,:._._,;;.. -.
. ,"'-'. ......,
"oj ,~:
15.89
15.89
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Please enter account
number on all checks and
correspondence.
Make'check payable to
,''.,; ,$ 6.1,!+01~~ Ex(Jress~
. .."'+~i~~~
,..,;:;,.-, '
#BWNDVFW 01
#240620701104#
RUTH EVANS
PO BOX 4536
GREENVILLE. DE 19807-4536
Your past due account has been placed with this office for payment.
i1J'{;;:0 ,.. This account may be posted to your credit record for such time as allowed by law.
ft"\/'..:Uniess you dispute the validity of the debt or any portion of it, within 30 days after 'you receive this notice, we will assume
~/>';' , .' this debt is valid. If )"ou notify us in writing within 30 days after you receive this notice, we will obtain and mail to you
',e,'. proof of the debt or a copy of a judgment. Also, upon your written request within 30 days after you recehre this notice, we
~, ' wiUgive you the original creditor's name and address if different fl"Om the current creditor. This communication from a
- debt collector is an attempt to collect a debt, and any information obtained \vill be used for that purpose.
.,
ACCOUNT REPRESENT A TIVE
(412) 503-9230
SEE REVERSE SIDE FOR IMPORTANT INFORMATION
2406207011000015016
-:.,01\<') _ A1~
@omcast.
DATE
DUE
TOTAL-
AMOUNT DUE
ACCOUNT
NUMBER
Visit us on the web at
www.comcast.com
07/07/06
$47.81
09547 221329-04-2
How 10 reach us...
How.to reach us:
4830 Carlisle Pike, Suite 0-14
Mechanicsburg, Pa 17055
[117)540-8900
Telephone Customer Service
24 hourS a day, s9Ven da.ysa'Neek
News from Corneast
Thank you for your prompt payment. For your convenience, we now accept regular
and automatic monthly credit card payments and direct debit. 1 -
@~rnEgst~
4008 N DUPONT HWY
NEW CASTLE DE 19720-6328
Please detach and endose this coupon with your payment.
Do not send cash. Make checks payable to:
COMCAST CABLE
Date Due
Total Amount Due
AMOUNT
ENCLOSED
$
ADDRESS SERVICE REQUESTED
07/07/06
$47.81
000-06-06-D-C
Account Number 09547221329-04-2
MB 01 051738 47355 B 223 A
C RUTH EVANS
C RUTH EVANS
P.O. BOX 4536
GREENVILLE DE 19807-4536
1...111.1....11.1.1..1..111111.11...11....1.1.11....1.1.1...11
COMCAST CABLE
POBOX 3005
SOUTHEASTERN PA
19398-3005
1...111.1..1..1.11,"1...1.1..1.1.1...11..11'11111..11..1..1.1
(~~
'WFSf SHORE
EMERGENCY MEDICAL SERVICES
,"<",-,-,.,.
~{~~:ipi~NT NUMBER:
:~i~
;~:~'::~~LLER: , " ,':~
;:FRQM:
',',TO: '
33175
,3064027A
05/11/2006
MOEN
ECAR
CLARARlf:rij EVANS <', '
1133 COLUMBUS AVE APT 3
LEMOYNE, PA 17043
1133 COLUMBUS AVE APT 3
, HOLY SPIRIT HOSPITAL
I
REASON(S)
FOR '
TRANSPORT
Unresponsive Patient
INVOICE
DESCRIPTION OF CHARGE ,
" ,QUANTITY UNIT PRICE AMOUNT
PARAMEDIC INTERCEPT A0999 1.0 588.11 588.11
10GTT TUBING A0394 ' 1.0 8.36 8.36
5CC/10CC SYRINGE A0394 1.0 4.33 4.33
ANGIOCATH (14-24) A0394 1.0 5.24 5.24
OP SITE A0394 . 1.0 4.94 4.94
T )tal Charges 610.98 .
DESCRIPTION OF ,PAYMENT,
RECEIPT
"-"
PAYMENT DATE
Total Credits
0.00
j
I
PLEASE PAY THIS AMOUNT - INVOICE DUE UPON RECEIPT -..
RETURNED CHECK FEE - $31.00
$610.98
DETACH ALONG PERFORMATlONAND RETURN STUB WITH PAYMENT
AMOUNT DUE 610.98
~l1ENT NAME: EVANS, CLARA RUTH S CALL NUMBER 3064027A AMOUNT $
~l1ENT NUMBER: 33175 BILLING DATE: 06/02/2006 ENCLOSED
......-...-... - ..-.. ."..._....,.~. . ..-...-.....-....-----"-.--. . ----.---.
THESE SERVICES ARE NOT COVERED BY MEDICARE AND ARE YOUR
RESPONSIBILITY.
~ VISA [.1
... AND
MASTER CARD
ACCEPTED
~~
P.O. BOX 961066
FORT WORTH, TX 76161-9854
1-800-966-5772
2--0
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'1201060358 ....
RUTHCEVANS. .,.. .'
.6701 JONESTOWN RD. . .... .
. .. 'HARRISBURG, P A 17112-3329
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< ~.:;/' " "
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Date of Fill: 03/2012006
HUMULIN VIA 70/30
000028715
30.00
LILLY
Shipping and Handling:
Sales Tax:
Resulting in Your Cost of:
0.00
0.00
30.00
120.00
PREVIOUS BALANCE:
RECEIVED AMOUNT:
PLEASE PAY THIS AMOUNT:
150.00
Check #:
Please include Acet # 1201060358 on check
If paying by credit card, please complete the following:
Card Type (circle) Visa Me AMEX Discover
Card Number: Expiration Date:
Signature: Amt Charged:
. '~~eosurethat~()urdQCtor .writes.the.ino~tlfcJayl\11C;lYc:.8l'()~Iill~fiptiQns ~t y()~~~1IIitto9atemarlc.Prescipti<!nswithO\lt thisinfm-ination
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~isa~Cy\vithyotlrqider,PJe#:ContaCt~SUStomerCare1vithiD~.~rs,. .,' . . .. '.' .'. .,.. .
Caremark
Accounting Department
2105 Eagle Parkway
Fort Worth, TX 76177-2311
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1.1111111111111111.11..11.11111111111111....11111111111.111..1
CLARARUTH S EVANS
1133 COLUMBUS AVE
APT 3
LEMOYNE PA 17043-1731
Your Medicare Number: 179-22-0888A
I
If you have questions, write or call:
HGSAdministrators (#00865)
P.O. Box 890413
Camp Hill, PA 17089-0413
Call: I-800-MEDICARE (1-800-633-4227)
Ask For Doctor Senices
BE INFORMED:. Protect your Ntedicare
number as you would a credit card number.
TTY Users Only Should Call 1-877-486-204
Business Hours M - F; 9:00 - 4:30 EST.
This is a summary of claims processed on 03/27/2006.
PART B MEDICAL INSURANCE - ASSIGNED CLAIMS
Dates
of
.Sefvice
Services Provided
Amount
Charged
Medicare
Approved
Medicare
Paid
Provider
You
May Be
BiDed
See
Notes
Section
Claim number 15-06062-005-150
Premier Eye Care Group Inc,
92 TuScarora Street, HanislJurg, P A 17104-1667
Dr. Brent, Geoffrey J. M.D.
01/27/06 1 Office/outpatient visit, est (99213)
$87.50
$49.89
$0.00
$24.89 a,b
Notes Secti,m:
I
a This approved amount has been applied toward your deductible.
b The amount listed in the You May Be Billed column assumes that your primary insurer paid
the provider. If your primary insurer paid you, then you are responsible to pay the
provider the amount your primary insurer paid to you plus the amount in the You May Be
Billed column.
TUI~ I~ NOT A. RII.T, - Keen this notice for your records.
~
;~~-- j'='-
~\ 2- - \
'", I
" '
--------~.~ -- ~ ,,/
004395
200312 SBX
Dep"l
J IlIte~limellt of the Treasury
NA" n~lI Revenue Service
~IR j~ q,.OH 45999-0025
CINC~
Notice Number: CP 504
Notice Date: 12-04-2006
7105 5678 7187 3099 2900
SSN/EIN:
Caller 10:
179-22-0888
508634
R U 'rH EVANS
1~~3 COLUMBUS AVE APT 3
L ~OYNE PA 17043-1731030
1IIIIIIIillllllll~II~IIIIII' I~I
~f17922088810 1*
Urgent! !
i We intend to levy on certain assets. Please respond NOW.
/,,0 ~ additional penalty and interest, pay the amoont you owe within ten days from the date of this notice.)
(10 d
!171"11f indicate that you .h~ven't paid ~he amount you owe. The law requires that YO~I pay your tax ~t the
J,'iJ ,,~your return. ThIS IS your notice, as reqll1red by Internal Revenue Code Section 6331(d), 01 our
tlJ1.lrrccif~/ 1(;;d)' (take) any state tax refunds that you may be entitled to if we don't receive your payment in
I(Ol,CYOl' !;J d}tion, we will begin to search for other assets we m.ay levy.. We can also file a Notice of Federal
luycnl !O~:" 1 we haven't already done so. To prevent collection action, please pay the current balance
.1 t l.lln fT ~/ ~~~ve already paid, can't pay, or have arranged for an installment agreement, it is important that you
7----:.le. 7~~ "-~nediately at the telephone number shown below. Current balance may include Cl\'il Penalty, if
~.'" I( ,
,,,JUs t .
~ ~sscd.
Account Summary
1040 I Tax Period: 12-31-2003
Current Balance: $2,285.53
Includes:
Penalty:
Interest:
Last Payment:
$19.26
$34.51
$0.00
For information on
your penalty & interest
computations, you may
call 1-800-829-8374
f\... See the enclosed Publication 594, The IRS Collection Process, and Notice
I h~all US at 1-800-829-8374 12198, Notice of Potential Third Party Contact for additional information.
At/J>> Is part with your payment, payable to United States Treasury. Notice Number: CP 504
or Notice Date: 12-04-2006
II
~ ~ n your check:
,~.b 12-31-2003 179-22-0888
~~~formation about filing and paying taxes at: www.irs.gov
Keyword: filing late (or) paying late
Amount Due:
$2,285.53
, ~'venue Service
~~ATI, OH 45999-0025
I _ 1.1 .. .. I. II
RUTH EVANS
1133 COLUMBUS AVE APT 3
LEMOYNE PA 17043-1731030
J-..{.
EXMOO
FORM 5564(Rev. June 1992)
Department of the Treasury - Internal Revenue Service
NOTICE OF DEFICIENCY - WAIVER
Symbols
phi1ade1p'.
STOP S623
o Copy to Authorized Representative
Name and Address of Taxpayer(s)
RUTH EVANS
1133 COLUMBUS AVE APT 3
LEMOYNE, PA 17043-1731030
ViDUAL INCO"
January 22, 2007
179-22-0888
DEFICIENCY
'~
2004 Increase in Tax
$1,560.00
Penalties
I consent to the immediate assessment and collection of the deficiencies (increase in tax and penalties) shown
above, plus any interest. Also, I waive the requirement under section 6532 (a) (1) of the Internal Revenue COde that a
notice of claim disallowance be sent to me by certified mail for any overpayment shown on the attached report.
I understand that the filing of this waiver is irrevocable and it will begin the 2-year period for filing suit for refund of
the claims disallowed as if the notice of disallowance had been sent by certified or registered mail.
Date
cu
...
:s Date
-
ftI
C
0 TTitle
ii) By Date
Note: If you consent to the assessment of the
deficiencies shown in this waiver, please sign and
return this form to limit the interest charge and
expedite our bill to you. Please do not sign and return
any prior notices you may have received. Your
consent signature is required on this waiver, even if
fully paid.
Your consent will not prevent you from filing a claim
for refund (after you have paid the tax) if you later
believe you are so entitled; nor prevent us from later
determining, if necessary, that you owe additional tax;
nor extend the time provided by law for such action.
If you later file a claim and the Service disallows it,
you may file suit fbr refund in a District Court or in the
United States Claims Court, but you may not file a
petition with the United States Tax Court.
Who Must Sign: If you filed jointly, both you and
your spouse must sign. Your attorney or agent may
sign this waiver provided that action is specifically
authorized by a power of attorney which, if not
previously filed, must accompany this form.
If this waiver is signed by a person acting in a
fiduciary capacity (for example, an executor,
administrator, or a trustee), Form 56, Notice
Concerning Fiduciary Relationship, should, unless
previously filed, accompany this form.
If you agree, please sign and return this form; keep one copy for your records.
FORM 5564(Rev. 6-92)
ill
ACTIVE CREDIT SERVICES, INC.
PO BOX 22329
PORTLAND, OR 97269-2329
(503) 292-2077
Fax (503) 292-3633
Toll Free: (888) 357-2131
\/~~
'- ~~
File number: 1101701 EXT: 4
-
Date of Notice: 07-20-06
Amount Due: 143.57
PO BOX 4536
WILMINGTON, DE 19807
Please make money order or
check payable to ACSI in
U . S~ FUNDS ONLY
EVANSRUTHC
---------------------------------------------------------------------------
To ensure proper c~edit. pl~aBe remove top po~ticn and return with your payment.
YOU ARE HEREBY NOTIFIED THAT:
1. The below-referenced account has been assigned to us for
collection.
2. This is a communiqation from a debt collector.
3. The purpose of this notice is to collect a debt. Any information
obtained will be used for that purpose.
4. We may report information about your account to credit bureaus.
Late payments, missed payments, or other defaults on your account
may be reflected in your credit report. .
Ref# Date Creditor
1222244 07-18-06 AT&T WIRELESS (SE)
Amount
143.57
Int Handling
0.00 0.00 $
Total Due
143.57
Total amount now due:
U. S. FUNDS ONLY
$
143.57
1101701 EVANS RUTH C
Unless you notify this office within 30 dais after receiving this notice
that you dispute the validity of the debt, or any portion thereof, this
office will assume the debt is valid. If you notify this office in writ-
ing within 30 days of receiving this notice that you dispute the vali-
dity of the debt, or any portion thereof, this office will obtain veri-
fication of the debt or a copy of a judgment against you and mail you a
copy of such judgment or verification. If you request in writing within
30 days of receiving this notice, this office will provide you with the
name and address of the original creditor, if different from the current
creditor.
Si desea recibir comunicaciones subsiguientes 0 futuras en espanol
por favor llame a nuestra oficina al 866.637.1869. Gracias.
1111111111111111
L56
07/31/06
024663
~
Billing Date
Account No.
$
AMOUNT ENCLOSED
PLEASE REMIT TO:
WILLIAM C RUTH EVANS
PO BOX 4,536
GREENVILLE DE 19807
**
P.O. BOX 330
LEBANON, PA 17042
JONESTOWN ROAD
717-545-5081
Please detach here and return top portion with remittance.
i!~e'b~i1I'T\i;JhvOlCllNo. '+1 "Description,..t
( Previous Month's Balance)
08/01 9999999 REBILLING CHARGE
Recipient
'C"" )].:An'lotJnt",
$21.06
$2.00
\,
PLEASE USE THE RETURN ENVELOPE PROVIDED FOR YOUR CONVENIENCE!
YOUR EASY ORDER ACCOUNT NUMBER IS 024663 Due upon receipt
60Da
$23.06
07/31/06
$2.00
$19.06
BAlANCES UNPAID BY THE 30TH OF NEXT t.4ONTH WILL BE SUBJECT TO A RE.BILUNG CHARGE OF 1 '1,% (ANNUAl RATE 15%) OR A MINIMUM OF $2.00.
024663
YOUR ACCOUNT HAS BECOME 30-60 DAYS PAST DUE.
WE NOW ACCEPT CREDIT CARDS AS PAYMENT
STATEMENT
;,.,....::....- .,". :,
UROLOGY CENTER OF CHESTER COUNTY
915 OLD FERN HILL RD., BLDG.B, STE 202
WEST CHESTER, PA 19380
KENNETII P COLLINS, MD
DONALD H ANDERSEN, MD
KENNETII J FITZPATRICK, MD
FOR ALL BILLING INQUIRIES PLEASE CALL 610-692-4070. FOR YOUR CONVENIENCE WE
ACCEPT AMEX, VISA AND MASTERCARD. THANK YOU
r
Clara R Evans
1133 Columbus Apt 3
Lemoyne P A 17043
L
41
I
ACCOUNT NUMBER BilLING DATE PAGE O"FICE USE ONLY
10/11/06
53271
PCHBS
-
~c)
..J
ICOP\'RIGHT 2002. ST1 COMPlJTB'l SERVICES, INC.
... PLEASE DETACH HERE AND RETURN TOP STUB WITH YOUR PAYMENT ...
J!,ERFECT
CARE @
DESCRIPTION I PROV ;JNITS ,,'~'h CHARGE 'NS~:(r'Cc ADJUSTME!,;T PATIENT PAID BALANCE :JUE
t.
05/30/06
Detailed Low Cc 011.00
Evans - 53271
Provider: Kenneth P Collins
Personal Choice
185.00
18.60
74.40
92.00
MESSAGE: SEE REVERSE SIDE IF AN INSURANCE MESSAGE APPEARS'"
lIii~rf~'11I~~.~'~\'f'~ Cm. R Evans
!':~32'71 ~~<i... ....'.. .>:.. <..' .. . 18.60i . .. . . I
Urology Center Chester County. 915 OLD FERN HILL RD " BLDG.B, STE . Suite 202 . West Chester, P A 19380 7
PLEASE PAY .
18,60
,~;. ,: :J :;:, '-f ... .,
3c,
"
r -'.
t(f, :
CENTERRE HEALTHCARE
West Chester Rehabilitation Hospital
7733 Forsyth Blvd.
Suite 800
St. Louis, MO 63105
Office: 314-889-2700
Toll Free: 888-545-6555
Fax: 314-889-2727
February 16,2007
Mrs. Clara R Evans
1133 Columbus, Apt. #3
Lemoyne, PA 17043
Final Notice
Re:
Patient: Evans, C.
Acct #: 00268.01
Balance Due: $997.11
Dates of Service: OS/24/2006 - 06/02/2006
Dear Mrs. Evans.:
West Chester Rehabilitation Hospital has worked oui two different payment options for you. Unfortunately,
we will only be able to accept one of the following arrangements. Please review and contact our office
with which arrangement will work best for you.
. $197.11 will be submitted to West Chester Rehabilitation Hospital by March 15, 2007 - Plus will
submit $150.00 per month for 5 months and a final payment of $50.00 which will pay the above
account in full
. $97.11 will be submitted to West Chester Rehabilitation Hospital by March 15, 2007 - Plus will
submit $100.00 per month for 9 months which will pay the above account in full.
We are including an agreement for you to sign. Please sign next to the chosen arrangement that you agree
to. We regret to inform you that fuilure to respond will leave us no other choice but to pursue unwanted
collections. Please return your signed agreement immediately as well as contacting our office. A self
addressed envelop has been enclosed for your payment remit and signed agreement. Please include your
account number for proper handling.
If you should have any questions and/or concerns about this account please contact me at 888-545-6555,
extension 2723.
Sincerely,
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Pamela Murray
Patient Account Representative
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LAW OFFICES
RIGLER A PERNA, LLC
EARL K. RIGLER, JR. +
MICHAEL R. PERNA ++
JENNIFER ABRACHT +++
610 MILLERS HILL
POST OFFICE BOX 96
KENNETT SQUARE, PENNSYLVANIA .19348
TEL (610) 444-0933
FAX (610) 444-5695
E-MAIL: rp4law@aol.com
FRANK M. PERNA
1922-1992
+ ADMITTED IN PA
++ADMITTED IN PA,TX AND CO
+ ++ ADMITTED IN PA AND AZ
February 28, 2007
Via UPS Delivery
Cumberland County Courthouse
Cumberland County Register of Wills
1 Courthouse Square
Carlisle, PA 17013
Re: Estate of Clara Ruth Evans
File No. 2006-00746
Dear Sir or Madam:
Please find enclosed one (1) original and three (3) copies of the Inheritance Tax Return
(REV-1500) with copies of the decedent's Will, for the above-referenced Estate.
Please refurn two (2) time stamped copies of the Return to our office in the self-addressed
stamped envelope provided herein.
Thank you for your prompt attention to this matter. Please contact me if you have any
questions.
rOj:
Very truly yours,
'/5)/L/1 C:~/CG
'...1;"-
- Jennifer Abracht
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Enclosures'-
cc: SA~vans
r:-:-~"): "" .
LAW OFFICES
EARL K. RIGLER, JR. +
MICHAEL R. PERNA ++
JENNIFER ABRACHT +++
RIGLER & PERNA, LLC
610 MILLERS HILL
POST OFFICE BOX 96
KENNETT SQUARE, PENNSYLVANIA. 10348
TEL (610) 444-0933
FAX (610) 444-5695
E-MAIL: rp4law@aol.com
FRANK M. PERNA
1922-1992
+ ADM ITTED IN PA
++ADMITTED IN PA,TX ANDCO
+++ ADMITTED IN PA AND AZ
March 1, 2007
Cumberland County Courthouse
Cumberland County Register of Wills
1 Courthouse Square
Carlisle, PA 17013
Re: Estate of Clara Ruth Evans
File No. 2006-00746
Dear Sir or Madam:
Please find enclosed our firm's check in the amount of $15.00 representing payment for the
filing of the Inheritance Tax Return (REV-1500) forwarded to you on February 28, 2007 via
overnight courier delivery for the above-referenced Estate.
Please file the original Inheritance Tax Return and return two (2) time stamped copies of
the Return to our office in the previously-sent, self-addressed stamped envelope.
Thank you for your prompt attention to this matter. Please contact me if you have any
questions.
Very truly yours,
i~/' (""0 v j j
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Jennifer Abracht
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Enclosures
cc: S. Evans
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