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Home My WebLink About06-07-07 .-J 15056051047 REV-1500 EX (06-05) PA Department of Revenue '* Bureau of Individual Taxes . PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Securit Number Date of Death OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN RESIDENT DECEDENT Date of Birth Decedent's Last Name Suffix Decedent's First Name MI (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW _ 1. Original Return t:::) 4. Limited Estate -c:;) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required c::::> 2. Supplemental Return -C) c::::> c:;) 4a. Future Interest Compromise (date of death after 12-12-82) ~ 7. Decedent Maintained a Living Trust (Attach Copy of Trust) c::::> 10. Spousal Poverty Credit (date of death c::::> 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes cC:) c. Correspondent's e-mail address: Ad. ree c.:e .1" to. "(l6~e1 W ~1< I C{)M Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declar tion of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIBLE FOR FILING RETURN ADDRESS ~~~ cJ e.J1J rt1 ttUI rJ"J (J 9S"'o ~ DATf slrsl() -, ,)"n .'J 1\ '" \UI DATE SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 .-J <t -I 15056052048 REV-1500 EX Decedent's Social Security Number Decedent's Name: RECAPITULATION 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 1. Real estate (Schedule A). ..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . ., 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) c:::::> Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c:::::> Separate Billing Requested.. . . . . .. 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)................................... 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 taxable at lineal rate X.O_ 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X. 15 18. 15. 16. 17. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ................ 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~d'3/rg fJD y-oa ~: 101-, I~~ I eJ'J :x.~ 1>-\53 '6'-' L--. 15056052048 Side 2 15056052048 --.J REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME J~~ STREET ADDRESS 105__'= I ~ ff't (n',\ \AN (1)fk\ ~t CITY ()1 € C ~ AY)\ es..bu ~ --~----1STATE pi\------TZiP/70Ss=-~---~--~ Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty ---------- ------ Total Interest/Penalty ( D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) A. Enter the interest on the tax due. Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... 0 00 b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 ~ c. retain a reversionary interest; or.......................................................................................................................... 0 g] d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 ~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 K] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. 99116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. 99116 (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 zero (0) percent [72 P.S. 99116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. 99116(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. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY fkM',UAh ~-~.,"" '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~e K FILE NUMBER o '8;) I (ry'1 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION ,/'{\ e~ ntRS \(-\- 6?t(\ \( Use6 tA(\( l \ r-rc... t,,~ Iqq~ L~\ V -l n C) ~OO }'V\ ru (I' \ -\-U lLe f' u V\ " ~U (Z -e. tS f(~ (<uo (n ( { O~5' fi( <.60 (I (K~\\~ ~iUl ~~) FAII~ VALUE AT DATE OF DEATH Y(I \{.cO 2 I ~ ft5'-~~ 500. (f7) 3~(t),OO OJ Sj ,(JO TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) , \00 WER'S nam, 1dress, city, state, and ZIP COI rd tetephone no. Payer's RTN (optional) OMB No. 1545-0112 MEMBERS is'.!.' FEDERAL CRED IT L .tON 1 Interest income ~@O6 Interes'. 5000 LOUISE DRIVE P.O. BOX 40 $ 37.68 I lCOme MECHANICSBURG PA 17055 2 Early wtthdrawal penalty 800-283-2328 $ 0.00 F. 1099-INT f\YERS Federal identification number \ RECIPIENT'S identification number 3 Interest on U.S. Savings Bonds r reas. obligations Copy B 23-1360906 189-38-5777 $ 0.00 For Recipient :CIPIENT'S name Street address (including apt. no.) Ctty, state, and ZIP code 4 Federal income tax withheld 5 Investment expenses This is important tax JOE R MCMILLAN information and is g; 0.00 $ 0.00 being furnished to the Internal Revenue C/O ADREECE TAYLOR 6 Foreign tax paid 7 Foreign country or U.S. Service. If you are 525 PRIMROSE CT $ 0.00 possession required to file a return, a negligence penalty or BELLE MEAD NJ 08502 8 Tax-exempt interest 9 Specified private activity other sanction may be bond interest imposed on you if this income is taxable and ccount number (see instructions) the IRS determines that 0000150078 g; 0.00 $ 0.00 it has not been reported. o CORRECTED (if checked) rm 1099-INT (keep for your records) Department of the Treasury - Internal Revenue Service 99070276 TITLE WILL BE PRINTED CENTRALLY NEW JERSEY - MOTOR VEHICLE SERVICES THIS IS A RECEIPT DOCUMENT ONLY PLATE NO: GOOD THRU: VIN: 1 1G6KF5297TU210563 T0964 01166 05732 ADREECE F TAYLOR 525 PRIMROSE COURT MONTGOMERY NJ 08502-6440 MAKE: CAD YEAR: 1996 TYPE:4 DR. MODEL:DEV COLOR:GN PT: MILEAGE: 075000 REG FD REG: POST AUDIT: PLATE FEE: TITLE I: SALES TAX: 20.00 5 STXEXP EQ:8 REGCD:OO TOTAL: (C) 20.00 EF SV20062440210 . c= i _ _.1 c=:.=J PAID Off,CE OF "RSO'.'" MANAGEMEN' By RE"REME'" SERV,CES ",OGRAM P.O. BOX 45 BOVERS, pA '60'7-0045 STA,.ENlEtl'T Of s~,,\VO~ ",""urN PAID \----\ ...-""__ _ ___4 2006 COPY B _ file with federal taX return. Sta\8 , State income taJL withheld NONE Stato 2 Stat. income taJL withheld NONE p1>-'IER'S fodoral Idontification Nu",bo 52_6083699 r:: survivor's Social Security No. \'l a '> 175-62-9500 a i N '" - . Health \nsur.nee Premiums ~ " '" ~ . . 0.00 ~ > - . !; ~': Retirement Claim No. . -c'" ct . ~ ~ . f7075750A ~ .!! "C E"7 " >- Distribution code a - ~ ~ "," \Ao '" . DEA'TH 8EMEfI'T o. ! 4 (/) ",.... (,) .. . .- ~ e ",- 0- .. _.. 0 . 0 E-c \Ao ~ . ~~ .. .. ~~ , ,. F adoral inco",a ta~ withhol Gross annuity a",ount PA\O ADREECE 'TAYLOR TO 525 PRIMROSE C'T . 8ELLE MEAD M\l 08502 -.--.---- . \ 1 0 S~'~. -..----------- REV-1511 E~+ (12-99). COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF "}ot K Me ~Ytl \Av\ FILE NUMBER CZ~/(J~1 ITEM NUMBER A. B. 1. FUNERAL EXPENSES: ti\C;S~A' F\J~~~\ \1omt, tJA'\Al'~ ~n\lrA-\ h(}'{n~ Debts of decedent must be reported on Schedule I. DESCRIPTION 1dt,,~ f'\J(\trPt \ ~6~~ 1(,~\ (\J~rA \ ~C~~ N~rA~ nJft,~ eJ.'\R r~).p S C\"",H11 Qe9's~ o~ (<.p!315'~ Q~ FSond ADMINISTRATIVE COSTS: W, \ \s Wllu 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City Year(s) Commission Paid: 2. Attorney Fees State _ Zip 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant _Ad(ee(~ -Y;~I(I' Street Address S.}. 5 "~\w\(M e c.1- Cily 1S.el\.(> "'~ State~Zip ogS"d2. Relationship of Claimant to Decedent S-\-~ S Clv'"\ 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. AMOUNT 3,7d-O,OO L.j i47 ,00 . .;; 35, dO q;) ,en:) 1~.C0 5 dC, lib IdO TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17G13 Rece.'.}.pt Date: Rece+pt Time: Recelpt No.: 8/21/2006 12:57:14 1045449 MCMILLAN JOE R Estate File No. : Paid By Remarks: 2006-00718 JA ------------------------ Receipt Distribution -------------------_____ Fee/Tax Description PaYment Amount Payee Name PETITION LTRS ADM AUTOMATION FEE SHORT CERTIFICATE JCP FEE BOND RENUNCIATION Check# 1190 Total Received......... 20.00 5.00 32.00 10.00 15.00 10.00 ---------------- $92.00 $92.00 CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN BUREAU OF RECEIPTS & CNTR M.D CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN ROBERT P. PETRI & DAUGHTER; SUSAN PETRI GENERAL INSURANCE 258 RYDERS LANE - P. O. BOX 820 MILL TOWN , NEW JERSEY 08850 PHONE: (732) 545-4540 - FA~32) 545-7623 ReceivedfromJAr..oOOQ~ t~t~ =t!~k..1. ~ ,llc-r\.P~ M>~- In reo ~ \~ ~ t- 'S.~ ~ \ ~~i'a AMOUNT OF ACC'T $ .. _ . . _ . . . _ . . _ $ SdO.,-~.. .... 4398 <?'( tS- loOh DATE .. - Dollars $S'~. .~. . . I B~XUE $.. CAt) CHECK ( ) OTHER ........... THANK YOU! RO:'E~P'~JSA~ PETm AMOUNT PAID WALLACE FUNERAL DIRECTORS, INC. 717.939.9950 l06 AGNES STREET HARRISBURG, PA 17104 717.939.9952 FAX Charles H. Wallace, Jr. F.D., Supervisor John W. (Jay) Harris, Jr. Funeral Director 'SERVING YOU BEYOND YOUR EXPECTATIONS' June 28, 2006 Mr. Adreece F Taylor 525 Primrose Ct Belle Mead, NJ 08502 I want to acknowledge the receipt of your payment. The balance below reflects the amount remaining after the payment was recorded. You have the right to pay the entire amount due at any time to avoid future interest charges. Services for: Joe R McMillan BALANCE Payment Received Adreece Taylor BALANCE AFTER PAYMENT Interest Added Late Charge Added NEW BALANCE PAYMENT AMOUNT DUE DATE PAYMENT DUE MONTHS REMAINING $4,847.00 $4,847.00 00'2800 $0.00 $0.00 $0.00 1 Interest at the rate of 1.5 % per month ( 18 % per annum) will be added to balance after 30 days. (A late payment fee of $20.00 will be assessed if not paid by the due date) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Detach and return this portion with your payment ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . June 28, 2006 Services for: Joe R McMillan BALANCE $4,847.00 Payment Received $4,847.00 BALANCE AFTER PAYMENT $0.00 Interest Added Late Charge Added NEW BALANCE PAYMENT AMOUNT DUE DATE PAYMENT DUE MONTHS REMAINING 00'2800 $0.00 $0.00 Make Your check payable to: Wallace Funeral Directors, Inc. 106 Agnes Street Harrisburg, PA 17104 86/88/2886 15:82 717-257-4726 Joe Robert McMillan ll\ Joe Robert McMillan m MechanicsbUfi. passed away ~ay,June6,~. Son of the late Carrie Woodard McMillan and the late John- ny "Jack" McMillan. be was born Sep- tember 20, 1947,1n. Johnstown. He was a Il'aduate of Greater Johnstown HlSh School. Class oC 1968, wbere be eiOOled In all athletics; he wu a two.time winner oC the Point Stadium Award. He played in the Can. dlan Football League, Ottawa ROUlhriders. A Navy veteran. he was amliated with Ameri. caD Lesion World War I Memo- rial, Post 109. Mr. McMillan re- tired ft'oDl the Mechanicsburg Naval Depot. He1eavesanbonorable lega- cy to be cherished by son, Adree<:e F. Taylor and his wife, Kenja JUlfl Taylor; grandson, Iroa4 Taylor. aU of Belle Mead, N.J; two brothers, John McMUlan. Jr., of Johnstown, David McMillm and hls Wife, Judith Morgan McMillan or St. Louis, MO; devo1ed cousin, Betty Mae Lewis of Johnstown; niece, TebbicaDawkinsofKan. sas City, NO; greatnepbews; cousins, other relatives and many friends. A timeofvisitationand view- 1nI w1ll be held ft'om 5 p.m. to 7 p.m., today, Friday, June 9, 2006, at W8Dace Funeral Direc- tors, 106 AIMS street (offS. ~ PATRIOT I'EWS or') S .;)..0 PAGE 81/82 ~ g.0 SO 1;). · ~~ REV-1512 EX+ (12-03) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER 6Rd I () ~ (1 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. VALUE AT DATE OF DEATH ~ (V\c. (Y\~\\\~vJ ITEM NUMBER 1. DESCRIPTION tAp.ltA' ()ne D\ Re+ TV :PP}L U~I Ct2Qd J Ct1~ '/334,Y7 Q,/7 ?? 7? TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) H105.905MS REV.(5-Q5) This is to certify that this IS a true copy of the record which is on file in the Pennsylvania Division of Vital Records In accordance with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953. ~s illegal to duplicate this copy by ph_stat ;:g;~ No. Charles Hardester State Registrar Calvin B. Johnson, M.D., M.P.H. Secretary of Health 0821089 JUN 2 8 2006 Date H1D5.144 REV. 02f2D08 ,n1'&lIfIN"ll (r=:' #30-261 1......0I_tf'....-.....-, Joe 5. "'(LooI_I 58 COMMONWEALTH OF PENNSYLVANIA . DEPARTMENT OF HEALTH . VITAL RECORDS CE.RTIFICATE OF DEATH (CORONER) STATE FILENUMIlER 3._SooIIlIy_ McMillan 189 _ 38_ VII. 6. DllloIBirfI Sep. 20, 1947 Ind "or R ~I lib. CounlyolDNII Cumberland 811. F..,.N.,..lllnol........pvesnetand~ 105 E. Allen Street -OOller-SpoclIr 10. ~: AmeltcIn hIM..., V'tMt, * -BlaCk ftlllII:~. ...Donal........ rtK1==t 1.. ___--1.........'-.-...-1 105 E. Allen street Mechanlcsburg, PA 17055 lib."""" Cumberland 17C.O Y..~~1n 17d~:"'~dl.hled"" T.... "",- 2Do. -...... (Typo _ Adreece F Taylor Carrie Bell "" ------.~!Yit,.:..=e ct Belle Meed, NJ 08502 19. Mobt'I N.". (Flnl. "**,IIIIIdIn......) 1. F.........(fIIIl._....-, John McMillan Sr. w ~ 21c. F-.of~(NImeofCMlltlry.CNI'nIIDryarolllr"') Benshoft Hili Cemetery 21d. ~ (CIly l'awn,..... zip cort.) Johnstown, PA 15906 ,.. ........, -- 01 F'";.,allace Funeral Directors, Inc. 108 Agn.. Street Harrl.burg, PA 17104 ZIl. l.icanttNlrnber 23c.___.........., 25. ""'............__..,....., M. June 6, 2006 .. OF DeATH (See _tructIone .nd ......pIn) 111m 77. PART t: EnIIrfle~.......... orClCll'flpllc:ll-1WI dncIy ~ "deIII. 00 NOT....mn.I '"'* 1UCtl. cani8c 1rTwt, ,.,.."....... or~.................. ....... LiltOlttf ORa'*- on NCh 1M ::.==-~ , BV1)ert~~sive Cardiovascular Disease I5:::i'~CCir_.~oI) 26. w. c.e AlNrNd ao MIdIcII e...... lCoronerb...... at.... 0emIIicr1 or 0l:lMlian? )It v.. 0... Beaatic Cirrhosis 28. [Jd Tobeo:o U. CondluII" CHIll? o v.. 0-.- 0'" u_ :z9.IfFema o .......... -...... 0_.......- 0"'-''''''''''''-'''''' 01_ 0..._..........."...."'_ ol_ 0-........-........ 32c. PtlDtof Inpy: Home,FIIm. Sbet. FEtory, OIIcoB_."'.I_ ~lnIiImt: 0n00I " """" PIrt.:ErMrolher......~~ID~ tMnotreUlngi'l "'~C8UM ghJen in PIl't I. ~..condIIDnI,lflRY. ~':~"':c!'.GE . DueIOIOl'_.~or): =-~':.,...~ Duetofor._--.-ofl" d. o v.. ~... o v.. 0... 31. ........of )f.- D- O- 0__"", r...oI...., 0- OCouid........- M 3Oe.w.~AutlpIy -' 3011___ A'IIIIIbII Prior 10 CompIIIan ole... of o..h? I ~ I 33lI.~("""anly""l . ~~"':::=:',,"::':=...~~~~_':':~------------------jJ . ==:,.~=~ ..::.=:::::::"...""::.'=::-"'::"":i'"~ ....-.. -. __ _ _ _ _ _ _ _ _ _ _ _ - - - - jJ .' =~~""/or~In"".....~~.............Iftdpllce.anddultD..,*..)-_.IIIiIft._ Coroner ~ 3301.___....._1 June 7, 2006 34. NImIInllAddr.-of~WhClCcmPlledc...af~{ItIm27) Type/Print 36 !loIIF.... ,.~/' Michael L. Norris. Coroner I~/ 1P71 /Y I' 9/1f/J h ~~~fia~1~~g~~e ,R~1dI78~ote #1 (See Instructions and exampl.. on rev....) = = - - - - ~ = - - - - - Previous Balance ( . ) Payments & credits ( + ) Current charges & taxes Statement Date: OS/27/06 Page I o( J /i>r: JOE MCMILLAN For Service at: 105 E ALLEN ST APT 316 MECHANICSBURG. PA 17055-3395 c Start End OS/24 OS/26 06/25 OS/26 06/25 $82.61 ~~'''''-'-''-'':>'' f 5;J.11 '\\ ) a / &fTtP..// = AMOUNT DUE ACCOUNT ACTIVITY Description Previous Balance Payment - Thank You Subscriptions For Receiver: 1707-309504 HBO, STARZ', and SHOWTIME Monthly TOTAL CHOICE Monthly Sales Tax AMOUNT DUE 78.94 79.00 82.67 $82.61 Amount Important Notice: After 6/2li06. Fox Movie Channel (Ch 258). will only be available to customers with tht~ TOTAL ClIOlCE@ PLUS package or above. To continue to el~joy this channel. change your package at D1RECTV.com Benents of Viewing Your 8111 Online at IllRJ<:CTV.com: - See up to (, months of statement history - View updates to your account since the past statement - Make a payment online W791-OOO1 126 _.... _ _ _ _.... _... _....... _ ...._....... ""'.... ......... _ _ ""!" ""._.'" _. _ _......... _....,,-;: _.,_......... -......... -,-';...~",:!l'.,~...~......-"'''' -... ....,........ ....-..'!"',..,....... ...._""'_}',..~"!!'.."'!'_...~"~~,..,J~_._~'l)!!~l,)!!'!..-r"'._,!"!!}',,.,....""','.,.".....,.. .........'..... - -... - '!II'._ -."!".-. - - - - - -.-.- - -.... -. -....... 09/13/200~ 3:48 5143222761 EISI f= ,- ~~, ~e 'nformation Services 2<lke Club Drive, Suite 300 mm!.1~~ infr' c- 1; ~.';~;.bus) OH 43232 Deceased ACCCtlnt o,lleclion Agency -;-;-; '/1.1)322-2758 (877) 714-3739 FAX: (614) 322-2761 Wcbsite: wwwp SEPT 13 2006 .A !\Ptr~CB TAYLOR P r. :-JOE MCMILLAN Client Name: CAPITAL ONE EISI Matter Number~ 1506576 ~~\) ~fP _ TAYLOR F d- ' L. -'1' ''It ~cn Services, LLC has filed a claim on behalf of our r 1.-..,' CAP T' , ! (\"..1' ..,(; (;:stateofJOE MCMILLAN in the amount of$1334.4 (I"r . "j;1Zed this office to accept settlement of$l,ooo.OO as P'>'~~ r ,{cfenced account. This offer is valid until 9120/06 0:'1 t PleBse put our matter number in the memo section of the check or money order. .. ..., Jl1~1.-e the check payable to CAPITAL ONE Please mail your check to the folIc" F("'~",,, fom'lation Services) Inc. t'],.;) Dr. Ste 300 ') 2') '-: r Cr " U".,r :!!l1ount, a Release of Claim will be sent to you. If ynu have any further questions or concerns, please feel free to contact the 1''''< to'1 ~ ". 1- "'7" - 714- 3 739 ext 172, so that we may bring this matter to a C"'V 1., . 1h:' " att. P' to collect a debt and any infonnation obtained will be used for i I y- matter is greatly appreciated. s;~~ ~- E'" , ""istant \':ll:. 11'L ;:-: 1 I ., - ...................,..-.-....-, ~~1 ~ '" it, ~ jj ~ .-< .-L-+ ~ -.3)'t a -::::..L ~~ cl5~ ~M <.l..(~. ~ <\.t~' _ Co . ~3~~ u: ~ ~.1:~ v~ <I: ~ V') ~ ,J ~ ~ -cU~ ~ <.../} <C ...... QI - <57 ~ Q..J <: ~~ ooJ fl ", ,.,J ~, ~j :;;. ~ 'bn ~ ~ <.ca ~J~~ ~ ~ ""' Q,; 4 <:f" ~ ~ ~.~ ...,...",. .-=-.