HomeMy WebLinkAbout01-02-08
--I
15056041125
REV-1500 EX (06-05)
PA Department of Revenue '*
~~~~:~~~~~uaITaxes . INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFiCiAL USE ONLY
County Code Year
2 1 0 7
File Number
00210
Date of Birth
181347278
o 2 032 007
12291942
Decedent's Last Name
Suffix
Decedent's First Name
RAM S E Y
STANLEY
MI
D
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
lliI 1. Original Return
o 4. Limited Estate
o
o
2. Supplemental Return
o
D
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death D 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
D
o
D
o
8. Total Number of Safe Deposit Boxes
HUB E R T
Firm Name (If Applicable)
x .
GILROY,
E S Q
717 243 3 3 4 1
~?;
MARTSON
LAW
OFFICES
REGISTER.OF WILLS USt6HL Y
. c.) .
First line of address
'i--'
I
f0
-r::l
" '---:-J
',1
--.\
:>--')
11+\
1 0 E A S T
H I G H
STREET
..,..,......
Second line of address
(...)
..
~)
City or Post Office
State
ZIP Code
'. j
DAft FILED
",.
CARLISLE
P A
17013
Correspondent's e-mail address:
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. Dee ration of preparer other than the personal representative is based on all information of which pre parer has any knowledge.
SIGNA F P SO PONS/BLE FOR FILING RETURN ATE
/. z..- O?
CARLISLE
PA 17013
//1-A E 1
PA 17013
THAN REPRESENTATIVE
CARLISLE
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
5056041125
15056041125
.-J
^\
-I
15056042126
REV-1500 EX
Decedent's Name: STANLEY D. RAMSEY
RECAPITULATION
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) D Separate Billing Requested . . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) D Separate Billing Requested. . . . . .. 7.
8. Total Gross Assets (total Lines 1-7)
........................... 8.
9. Funeral Expenses & Administrative Costs (Schedule H) . . . . . . . . . . . . . . .. 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . 10.
11. Total Deductions (total Lines 9 & 10)
. . . . . . . . . . . . . . . . . . . . . . . . . . . 11.
12. Net 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.
- 171926.94
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
o . 0 0
15.
o . 0 0
16.
o . 0 0
17.
o . 0 0
18.
19. Tax Due
. . . . .... . ... . . . .... .............................19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L
15056042126
Decedent's Social Security Number
181347278
23763.53
1 1 7 0 5. 7 3
3 5 4 6 9. 2 6
7 9 9 5. 0 5
1 9 9 4 0 1. 1 5
2 0 7 3 9 6. 2 0
- 1 7 1 9 2 6. 9 4
O. 0 0
O. 0 0
O. 0 0
O. 0 0
O. 0 0
D
15056042126
--.J
REV-150{)'EX Page 3
Decedent's Complete Address:
File Number
21 07 00210
DECEDENT'S NAME
STANLEY D. RAMSEY
STREET ADDRESS
3414 LOUISA LANE
CITY I STATE I ZIP
MECHANICSBURG PA 17050
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
0.00
Total Credits (A + B + C) (2)
0.00
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)
0.00
0.00
0.00
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(58)
A. Enter the interest on the tax due.
0.00
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 00
c. retain a reversionary interest; or ................................................................................................ 0 00
d. receive the promise for life of either payments, benefits or care? ....................................................... 0 00
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... 00 0
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ......... 0 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................. 00 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent [72 P.S. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent
[72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. ~9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. ~9116(1.2) [72 P.S. 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. ~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-150a EX + (6-98)
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
STANLEY D. RAMSEY
FILE NUMBER
21 07 00210
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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Halifax National Bank, Checking Account #134275010 13,298.53
2. PNC Bank, Checking Account #50-0502-7395 6,222.00
3. Cash in possession 18.00
4. Firearms, appraised value 1,475.00
5. Household and personal property 250.00
6. 1996 Pontiac Bonneville, poor condition 2,500.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
23.763.53
REV-1510 EX + (6-98)
'*
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
STANLEY D. RAMSEY
FilE NUMBER
21 07 00210
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 DECO'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST VALUE
(IF APPUCABlE)
1. Cash on various occasions between March and October, 2006 to 8,000.00 100. 3,000.00 5,000.00
Jennifer Ramsey, daughter
2. TIAi\ Traditional Retirement Account #A596780-5; beneficiary 6,705.73 100. 6,705.73
Constance S. Ramsey, former spouse
TOTAL (Also enter on line 7 Recapitulation) $ 11 705.73
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (12-99)
.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
STANLEY D. RAMSEY
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21 07 00210
ITEM
NUMBER
A.
DESCRIPTION
FUNERAL EXPENSES:
Hollinger Funeral Home and Crematory, Mt. Holly Springs, P A
1.
B.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) Jennifer Ramsey
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 28 Garden Parkway
1.
State P A
2.
3.
City Carlisle
Year(s) Commission Paid: 2007
Attorney Fees Martson Law Offices (estimated)
Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
4.
Probate Fees Register of Wills of Cumberland County
5.
Accountanfs Fees
6.
Tax Return Preparer's Fees
7.
8.
9.
10.
11.
Cumberland Law Journal, Advertising Letters of Administration
The Sentinel, Advertising Letters of Administration
Register of Wills, filing fee, Inheritance Tax Return
Vehicle transfer fees
Reserved for additional probate and other filing fees
AMOUNT
1,395.00
3,000.00
Zip 17015
3,000.00
Zip
100.00
75.00
151.55
15.00
108.50
150.00
(If more space is needed, insert additional sheets of the same size)
TOTAL (Also enter on line 9, Recapitulation) $
7,995.05
REV-1512 EX + (12-03)
'*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
STANLEY D. RAMSEY
FILE NUMBER
21 07 00210
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
See Attachment Page(s)
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
199401.15
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
STANLEY D. RAMSEY
Decedent's Name
Page 1
21 07 00210
File Number
Schedule I - Debts of Decedent, Mortgage Liabilities, & Liens
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
DESCRIPTION
Progressive Insurance, auto insurance, account payable
AMOUNT
93.86
The Brambles, rent
610.00
P A American Water, account payable
22.24
UGI, account payable
144.97
PPL, account payable
24.74
Comcast, account payable
19.85
Uninsured medical expenses for services occurring within six months of death [see attached list]
5,061.57
Uninsured medical expenses for services occurring more than six months from death [see
attached list]
178,868.95
Arrow Financial Services, LLC-Chase, credit card account No. 14395329070500694
6,739.01
Bank One, credit card account No. 4417124750480441
4,810.39
Capital One Bank, credit card account No. ---------6469 (settlement amount)
105.74
Academy Collection Service for Citibank (SD) Na., account No. 5491130334748035
2,324.73
Collection Center for Commonwealth Telephone Co., account payable
89.28
Penn Credit Corp for History Book Club, account No. 940685605
189.69
Penn Credit Corp for Military Book Club, account No. 793613075
117.76
SUBTOTAL SCHEDULE I
199,222.78
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
STANLEY D. RAMSEY
Decedent's Name
Page 2
21 07 00210
File Number
Schedule I - Debts of Decedent, Mortgage Liabilities, & Liens
ITEM
NUMBER DESCRIPTION AMOUNT
16. Penn Credit Corp for Book of the Month Club, account No. 079855814 178.37
SUBTOTAL SCHEDULE I 178.37
GRAND TOTAL SCHEDULE I $ 199,401.15
/"
MAY-03-2007 THU 11:23 AM Hal ifax National Bank
FAX NO. 7178968599
P. 02
E.IJlJD
Halffax National Bank
May 3, 2007
Martson Law Offices
10 East High Street
Carlisle PA 17013
fax to 7l7~243-18S0
Re: S David Ramsey a/k/a David S Ramsey
SSN: 181-34-7278
DOD: 02.03.2007
Account Number(s)
134275010
Type of Account
Regular Checking Account
Date Opened
August 6. 1997
Principal Balance at date of death
$13,298.53
Accrued Interest not
disbursed as of date of death
N/A
Maturity Date
N/A
Primary Owner of Account
S David Ramsey
Name of Joint Owner, if any
N/A
Beneficiary, if any
N/A
Date Joint Ownership was
Established
N/A
Ifwithin 1 year of death of
Decedent could prior Account
Be traced into a prior Joint
Account in existence over
I year prior to death of
Decedent
N/A
Nam~ of Owners of any
Safe~Deposjt Box(s)
N/A
t~ 6
By' v/-o.-1. .. ~
MlSty.. VI ser
Third St., P.O. Box A. Halifnx, PA 17032 · Phone: (717) 896-3433
SC,E-I, t::. T~
.----------MAY-08-2007 17: 04
PNCBANK
412 768 3458
P.01/01
o PNCBAN<
May 8, 2007
Corrine L. Myers
10 East High Street
Carlisle, P A 17013
RE: Estate of David S. Ramsey, deceased
SSN: 181-34-7278
DOD; 2/312007
Dear Ms. Myers:
b1 response to your request for Date of Death balances for the customer noted above, our
records show the following:
Checking Account
Account #5005027395
Established 11/0212006
DAVID S RAMSEY
DOD balance; $6,012.73 + $.25 accrued interest
Please note that this office only provides date of death balances for deposit accounts
(IRAs, CDs, Checking and Savings accounts). We do not process any rwanda.)
transactions or provide statements. If you need assistance with any of these items,
please call1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank: braneh
office.
~LJ~
Rachelle Wells
1-800-762-1775
P7-PFSC-04~F
500 first Ave.
Pittsburgh P A 15219
Member FDIC
$C H. E -::s:. Y-e-vu. z.
~
TOTAL P.01
F:\F1LES\Clients\ 12427 Ramsey\12427.1.credilors.medical.exh
Estate of Stanley David Ramsey
Medical Expenses for Services Within 6 Months of Death
Date of Service Creditor Collection Agency Creditor Account Balance Due
No.
12/19/06 Holy Spirit Hosp Computer Credit 29025269 3,148.78
12/18/06 Spirit Physician Services 1353986 182.00
12/18/06 Camp Hill ER Phys HYP29025269 607.00
12/18/06 West Shore EMS-ALS Consolidated Collection Service, 3076228A 753.79
Inc.
12/17/06 Hampden Twp Ambulance 0602240 370.00
08/24/06 Pinacle Health Hospitals Computer Credit 4503145500 355.00
TOTAL 5,061.57
SCH. -L /.::L:'~
'1 (,/7)
-
ACA
COMPUTER CREDIT, INC.
CLAIM DEPT 082515 640 INest Fourth Street. Post Office Box 5238 vVinston-Salem NC 27113-5238 338-761-1538
July 30, 2007
INTERNATIONAL
The' j\.~,~(..n~,\lOL ur Crcdll
"nd (.()n....~:I(;ll Profe-s.')Jnrl.lk
II..,:{H
126 00 SH7 30484 0426763084
Stanley D Ramsey
For: Ramsey, Stanley Davie!
28 Garden Pkwy
Carlisle, PA 17013-9255
CREDITOR DETAIL
Holy Spirit Hospital
Attention: Patient Financial Services
Telephone: (717) 763-2138
111111111.11111111.11..11.1.11...1.1.1.1..1.1...1." ..1.1...11
Acct No. 29025269 A
Date of Service: 12-19-06
AMOUNT DUE: $3,148.78
~
Dear Stanley D Ramsey:
Despite our previous communication to encourage you to pay your delinquent account with Holy Spirit Hospital, you still
have an outstanding balance. This is our FINAL NOTICE and you must take action to resolve this overdue account. Pay
the amount due to discharge your debt owed to the hospital.
This letter is sent as a final demand for payment in the amount of $3,148.78. Computer Credit, Inc. is a debt collector and a
member of ACA International, the Association of Credit and Collection Professionals. Be advised this is our LAST
A TfEMPT to collect this debt and any inforn1ation obtained will be used for that purpose.
We expect YOll to resolve your financial obligation.
~
E. Barksdale
President
Rerurn trliS r-,uri,cn v':"ith your ,Ci.-i'y'07erd
IF PAYING BY CREDIT CARD, PLEASE FILL OUT BELOW
01 VISA I
C~RD Nur,l13ER
ell]
o !OOC~
EXP D.~ TE
SECURITY.:':'=':CE
.A~~1CUi'n
GUAR NAME
PA TIENT NAME
ACCOUNT NO
AMOUNT DUE
Stanley 0 Ramsey
Ramsey, Stanley David
29025269 A
$3,14878
S\l:;I~A.-r,_.qE
PRil'jT C,A,;:;;Ch<::LDER"S I'L::..}..lE
You may make check payable to:
BilLING "DDRESS
Bill'NG zp ceDe
Holy Spirit Hospital
P.O. Box 822183
Philadelphia, PA 19182-2183
Computer Credit, Inc.
CCI KE~ 0426763084
H710 Zo31891 30484
11.1111.1..11.1111.1..11.11.1.1.1.111.11.1.11.1..11..11..1..11
X..7
(2-), )
SPIRI PHYSICIAN SERVICES
205 GRANDVIEW AVE STE 210
CAMP HILL PA 17011
STANLEY RAMSEY
3414 LOUISA LANE
MECHANICSBURG PA 17050-7379
STATEMENT OF PHYSICIAN SERVICES
1 of 1
ACCOUNT #
1353986
STATEMENT
DATE: 02103/07
lAST STATEMENT
DATE: 12130/06
FED TAX ID # 251766971
INS CHARGE PAYMENTS- - GUARANTOR
ADJUSTMENT BALANCE
IF ANY QUESTIONS, PLEASE CONTACT: SPIRIT PHYSICIAN SERVICES 717.972-4490
DATE P~:'RE g:~ QTY DESCRIPTIO"
>>> PATIENT: STANLEY RAMSEY 13.53_
PERFOIIIED BY: aHAN GORt1.6 HD HD
PL~E OF S'fC: 21
PERFORHED AT: ItS
12118106 9923.5 251.2 EBSERYE OR INPT CARE, tCJD
BALKE: STANLEY RAMSEY $182.00
182.00
182.00
PATIENT BALKE StuN ~ THIS STATEMENT IS WE FRIll Yell. PLEASE
REMIT FULL AtIU{f PRlJlPTL Y. PAYMENT IS IXJE UIQI RECEIPT OF THIS
STATEMENT .
HHTHESE SERVICES HERE PROVIDED BY SPIOT PHYSICIAN H&
HHSERYICES AND ARE SEPARATE FRIll Mlf taSPITAL FEES H&
HHPLEASE CALL n7-972-4490 NITH Wi QUESTICWS H&
~ERNIN& THESE CHARGES. HH
__________________________.J.ME..OR"{A..NI.~E..t€~.E.JJ.fT ACH Ni!l.!!.E.IY1HU1.MIJHLP"'QItTI.Q.tLPLJ!T AL€M..~_"I.If!.'LQ.YItP.AYM~l!..r________________________
SI2
SPIRIT PHYSICIAN SERVICES
205 GRANDVIEW AVE (HP)
STE 210
CAMP HILL PA 17011
STATEMENT DATE:
02103/07
GUARANTOR RESPONSIBILITY: MINIMUM PAYMENT:
$ 182.00 $ 182.00
11111111111111111111111111111111111111111111111111111111111111
M~ SPIRIT PHYSICIAN SERVICES
To: 205 GRANDVIEW AVE STE 210
CAMP HILL PA 17011
00002023 01
STANLEY RAMSEY
3414 LOUISA LANE
MECHANICSBURG PA 17050-7379
JFFfCE USE ONLY
CHECK ONE
FOR CREDIT CARD PAYMENT, PlEASE ALL IN INFORMATION BElDW
_M/C
_VISA
I
1353986
K
EXP DATE
T
$ 182.00
4.MOlJfIT: .
EIfCI.O$~
He: 12S0
CARDHOLDER NAME (PRINT)
CREDIT CARD SIGNATURE
SPIRIT PHYSICIAN SERVICES
o CHECK BOX AND ENTER ANY ADDRESS OR INSURANCE CORRECTIONS ON BACK
UCJ.Ul!'-'
N
r I.'~I AI""IUUn'''IVIIoll'''lt.lU'-I~-
STATEMENT OF ACCOUNT (2)
Ita_mint Da_: FEBRUARV 18. 2007
I~~"N"
TIX ID t: 20.4817340
Account Balance: seo7.oo
Amount "-ndlnt
lnaurance: 10.00
Amount Due from
Patient (CUrrent): 10.00
Amount"Due from
PatJtnt (Pill Due): se07.00
IPa, ThIe Amount: '107.'0 I
VOlMACCOUNT.. NOWIIRIOUILV
PAIT DUe. AND A DlUNQUlNCV
RIVIeW "D!INCI CONDUOTID. .......
""'to coupon below for ...,1IIIftt
IlIItructlane.
CAMP HILL EMERGENCY PHYSICIA
PO BOX 13693
PHILADELPHIA, PA 19101-3693
1...111...1111 11.111.11...1...1..11.1...11.1, '1,.11.1..1111.,1
082516-0000029025269-06
'BWNJFDB
#0000000HYP3668831
STANLEY 0 RAMSEY
3414 LOUISA LN
MECHANICSBURG PA 17050-7379
Account D.,."
I MTlINT
PIli" 1'IId" 1'IId" AIMunt Due ,..... MLANCIl
.,... . I eM.. I'ht 1M. CItMr 1M. PatIIIt AdIullMl InlUlMII
121111III 1 112M EMI!AG!NCY IYAL" MGIMT ....1.00
ILVL4) ~TAL
DIlC:7IO.0I DR.I"AJARDOIHOLY"NT Hal
1211.... 2 M'JIO-ZI.a NON-INVMI\II! PULta 141.00
OXIMETRY PrrAL
DX:7IO.0I DR. FAJARDOIHOt. Y ..AlT Hal
1211.... I lION IlM:I AI!QITD 10P11. tAM IN _00
Eft
DIlC:7IO.0I DR.I"AJARDOIHOLY IPINT ~ P1TAL I YO MAD!! AT Till
THI.ITATEMENT MAY NOT R!PI.!CT' ANY ~YMI!NTa 01"
IEIMCl!.
To"" "'.00 ea.oo ea.oo ea.oo ea.oo ea.oo "'.00
.
ImporlMlt "...."...
Thllllltllllent II,., the cIhIl n.tmInt IMler 8UIIlINIIIIn dI_1'IU ......... ......, fNm III ~ """* It..... t\oIpl!II. TIle fell,., :=:=- JhvIIlIIIn
nlllld ........ fNm anr hoIDIII...... 01' ofhIr "",,,11onII fell,., wtiDh WIl! ~.... 1Ie!WfIiNIIII. 'fIMIrIl'n.1hiIuJij you NGIIIM a 11II frIm the ,,;...
phpIoIInI fOr ~ .. ....... wIIlllill viii. ... Mt NUIe the...... .....lIIl1l11.........
"paym.nt Plana" Acc.pted I Ace.mas "Pia... d. P..o"
Que.tton .bout thla .tatem.nt? ILI.m. de LUftH a Vlem..'
C.,11-800-351-2470 Monda, through Friday 1:30AM - 4:00PM.
Your automated .,.tem accna code Ia 801-21025211, or ,OU can ..nd em.1I to
bllllllLqu..tIona..mc.....com.
P..... detach .nd rMUm bOttom~ruon WIth ,our ...mlttanc..
~~ F.vor de ..parar, m.ndar Ia parte de abaJo con .1 ch.q.... ~ ~
STATEMENT OF ACCOUNT
sta>>rnent DI_: FEBRUARV 111,2007
ICUE~ HYP2~~2!l~
Patient Name: ITANLIY D RAMaIV
paJlMnt Due."
'eehl De Vlflclmltnto: PAIT DUI
Amount DutI
'11"'l8ta CantldacI: '107.00
Amount Inctoeeelll
CantldaclPap:
PROMPT PAY DIICOUNTED
BALANCE: . 384.20
STANLEY D RAMSEV
3414 LOUISALN
MECHANICSBURG PA 17050-1379
YOU MAV PAY THIS BILL WITH YOUR CREDIT CARD
PLEASE SEE REVERSE SIDE.
Make ChecklMoMy 0.... pa,ablt to:
111.11111,1,1.1111,1,11.11..11,111,11.1....11.1,1.11
CAMP HILL EMERGENCY PHYSlCIA
PO BOX 13693
PHIlADELPHIA, PA 19101-3693
InIUIMIIlnftnnIIIDn Mt 11I11I
o If your addr... ha. changed, check thl. box
and complet. the rave.... aide ofthla form.
40% Dlacount Off.r
My blTance not applied to your
Ineurance can1erdeduetlble,1a
eligible for . prompt ply
d~nt
08251b00000290252690DDb07nnnnnnnnnnnnnn~
-1.-1
(4/7 )
WESTSHOREEMS-ALS
205 GRANOVIEW AVE
SUITE 211
CAMP HILL, PA 17011
Phone #: (800) 367-0512 Federal Tax 10: 23-2463002
,JL..
....-
......~
-
"VEST SIIORE
3076228A
PATIENT NUMBER:
CALL NUMBER:
DATE OF CALL:
TIME OF CALL:
CALLER:
FROM:
TO:
57372 PRN
3076228A B
12/18/2006
l'AT!ENT NAME:
STANLEY RAMSEY
i~SURANCE:
3414 LOUISA LN
HOLY SPIRIT HOSPITAL
STANLEY RAMSEY
3414 LOUISA LN
MECHANICSBURG, PA 17050
REASON(S)
FOR
TRANSPORT
Hypoglycemia
ALTERED MENTAL STATUS
INVOICE
DESCRIPTION OF CHARGE QUANTITY UNIT PRICE AMOUNT
PARAMEDIC INTERCEPT A0999 1.0 617.52 617.52
3CC SYRINGE A0394 1.0 1.70 1.70
ANGIOCATH (14-24) A0394 2.0 5.50 11.00
EKG ELECTRODES A0396 1.0 4.70 4.70
DEXTROSE 25GM A0394 2.0 9.48 18.96
GLUCAGON A0394 1.0 63.49 63.49
GLUCOSE BLOOD A0394 3.0 6.42 19.26
NORMAL SALINE 500CC A0394 1.0 3.30 3.30
OP SITE A0394 2.0 5.19 10.38
INFECTION CONTROL SUPPLIES A0382 1.0 3.48 3.48
Total Charges 753~
DESCRIPTION OF PAYMENT I i1ECEIPT ?AYMENT DATE !\MOUNT
I I
i
i
I I I Total Credits
;?LEi~SE PAY fHiS AMOUN r. iNVOICE DUE UP{JN tH:CEIPr .,...1
'ETUHNEO CHECK j:EE-";J2.CO .
~
I
I
Q,9~
$753.79 !
~~._., ~._.----"
I
I?ATIENT NAME: ~~;7;Y' STANLEY D
PATIENT NUMBER:
I
DETACH ALONG PERFORMATlON AND ;lETUAN STUB \;VITH PAYMENT
AMOUNT DUE
AMOUNT S
ENCLOSED
753.79
CALL NUMBER
BilliNG DATE:
3076228A
02/08/2007
THIS ACCOUNT IS NOW 40 DAYS PAST DUE!! Please send your
payment now. PROTECT YOUR CREDIT!
:I-1
( 5 /7 )
VISA
.:Ii i\ND
MASTER CARD
,l\CCEPTED
...~
.,
WEST SHORE EMS - ALS 205 GRANDVIFW AVr:: ('AUD UII I
nA ..--~ ~
HAMPDEN TOWNSHIP AMBULANCE
230 SOUTH SPORTING HILL ROAD
INVOICE #: 0602240
MECHANICSBURG, PA 17055
(717) 761-5343
TAX # 23-6050136
DATE: 03/30/2007
PATIENT: DAVID RAMSEY
BILL TO:
DAVID RAMSEY
3414 LOUISA LANE
MECHANICSBURG, PA 17050
ACCOUNT #: SELF 12/17/0CONTROL #: 0602240
DATE OF SERVICE: 12/17/2006
PATIENT PICKED UP: 3414 LOUISA LANE MECHANICSBURG, PA 1705
PATIENT TAKEN TO: HOLY SPIRIT HOSPITAL
)lease send insurance information. Thanks
DESCRIPTION
2006 BLS BASE RATE
2006 MILAGE CHARGE
UNIT COST
A0429 350.00
A0425 5.00
QTY.
1.0
4.0
AMOUNT DUE-
350.00
20.00
Comments: THIS IS YOUR THIRD NOTICE. PLEASE SEND
PAYMENT OR CALL TO SET-UP PAYMENTS. (761-5343)
THIS INVOICE IS YOUR RESPONSIBILITY.
PLEASE PUT INVOICE NUMBER ON CHECK. THANK YOU
THANK YOU.
SUBTOTAL
AMOUNT
PAID
370.00
0.00
TOTAL
370.00
I-7
(/')1)
//Computer Credit, Inc.
CLAIM DEPT 083307 _ 640 West Fourth Street. Post Office Box 5238 _ Winston-Salem. NC. 27113--5238 _ 336-761-1538
-
ACA
December 11, 2006
INTERNATIONAL
The ASSOCl;l.tior:. of Credit
and CoJlec:lOn Professwnah
.\.1fmb"
086 00 SH7 22161 0391489070
Stanley Ramsey
3414 Louisa Lane
Mechanicsburg, PA 17050-7379
CREDITOR
1...111...111....1.1.11...1"11..11.1...11.1.....1111.11111,11
ACCOUNT
Dear Stanley Ramsey:
Date of Service: 08-24-06
After repeated attempts to encourage you to pay your long overdue account with Pinnacle Health
Hospitals, there is still an outstanding balance. This final letter is sent as Computer Credit, Inc.'s last
attempt to collect this debt, and any information obtained will be used for that purpose. Computer
Credit, Inc. is a debt collector.
While we suggest that you take steps to settle this long overdue account, this is our FINAL NOTICE.
Your cooperation is anticipated.
~/~.~~~.
E. S. Barksdale
President
RETURN THIS PORTION WITH YOUR PAYMENT
[]American Express
EXP DATE
ACCT. NA~:St."hitY~m..,y
ACCT. ~..
'--..'-"., ,.. .
410314550 ()
SECURITY CODE 13 OR 4 DIGIT #
ON BACK OF CARD)
PRINT CARDHOLDER'S NAME
AM UNT
$
AML DlJE: . $$$$.00'
You may make check payable to:
S
ZI
Computer Credit, Inc.
CCI KEY: 0391489070
H7 Z=2J126 2216~
Pinnacle Health Hospitals
PO Box 2353
Harrisburg, PA 17105-2353
111.11111.1.1.1111.11.1.11111.1..1111111.1.11..111.1111..1.1.1
SIGNA TURE
l-1
(7)7)
F:\FILES\Clients\ 12427 Ramsey\ 12427.1.creditors.medical.exh
Estate of Stanley David Ramsey
Medical Expenses Incurred More Than Six Months Prior to Death
Date of Creditor Collection Agency Creditor Account Balance Due
Service No.
02/05 Associated Cardiologists National Recovery (w/Quantum) 212013 3,145.00
06/05 Cardiology Diag Asso RAMSTOOO 35.00
01/05 Cardiology Diag Asso McClure Law Office RAMSTOOO 175.00
2/17/05 East Pennsboro Amb Commercial Acceptance Co 05-301 50.00
2005 Hal S. Fineburg, M.D. 102000 291.00
1-2/05 Harrisburg Foot & Ankle Credit Plus Collection Services 09019977 481.00
2005 Hematology & Oncology Consult American Agencies of CA 627 1,454.43
03/08/05 Holy Spirit Hospital Bureau of Account Management 25065020 42.35
2005 Holy Spirit Hospital HBCS vanous 1,658.85
04/05 Kantor & Tkatch Consolidated Collection Serv 738990 174.00
09/05 Frederick Lorenzo MD 681 108.00
09/05 Frederick Lorenzo MD 663 67.00
2005 Frederick Lorenzo MD 512 569.00
01/05 Millersburg Area Amb Co Collection Center, Inc. 052508 1,493.50
2005 Roy Monsour M.D. 1008 2,921.00
02/05 Morganstein Rehab Assoc Bur of Acct Management 34 440.00
2005 Nephrology Assoc Commercial Acceptance Co 5177-00 554.00
01/05 OSL DBA Orth Institute of P A 242652 64.00
Pa Gastroenterology Consult Capital Recovery 105489 140.00
06/05 PharMerica (Beverly HC West Shore) 5702-14-19580 1,802.49
2005 Physicians of Rehab Credit Plus Collection Serv 039622 578.00
01/05 Pulmonary and Critical Care 43854 1,395.00
01/05 Quantum Imaging National Recovery Agency D64619 710.00
2005 Riverside Anesthesia Asso Peerless Credit Services 183795 3,065.00
02/05 Smith Radiology Peerless Credit Services 8511200 42.62
06/05 Susquehanna Twp EMS 3404 405.00
06/05 Susquehanna Twp EMS 3404 70.00
Oli05 Vascular Associates National Recovery Agency RAMSSOOO 159.00
02/05 Watkin Freshman & Nipple 283602 271.00
s:.1+_:[)~ ~ ciJZ-)
6/27105 Pinnacle Health Emer Accounts Recovery Bureau 800464619 430.00
1/15/05 Pinnacle Health Emer Accounts Recovery Bureau 800464619 463.00
9/8/05 Pinnacle Health Hospitals Accounts Recovery Bureau 260055808 814.00
8/15/05 Pinnacle Health Hospitals 450169334 60.00
08/11/05 Pinnacle Health Hospitals Accounts Recovery Bureau 260035967 1,293.00
6/27/05 Pinnacle Health Hospitals Accounts Recovery Bureau 250318736 1,255.20
6/23/05 Pinnacle Health Hospitals Accounts Recovery Bureau 450148777 176.00
6/1 0/05 Pinnacle Health Hospitals Accounts Recovery Bureau 450143501 252.00
6/2/05 Pinnacle Health Hospitals Accounts Recovery Bureau 250294595 932.00
5/4/05 Pinnacle Health Hospitals Accounts Recovery Bureau 250268164 1,132.00
4/4/05 Pinnacle Health Hospitals Accounts Recovery Bureau 250235578 2,120.00
1/31/05 Pinnacle Health Hospitals Accounts Recovery Bureau 250184687 15,455.80
1/15/05 Pinnacle Health Hospitals Accounts Recovery Bureau 250170768 119,601.41
2005 Pinnacle Health Hospitals Accounts Recovery Bureau 250213178 3,785.00
8/15/05 Pinnacle Health Med Svcs 181347278 77.00
4/14/05 Pinnacle Health Med Svcs Bur of Acct Management 25310319 2,654.60
4/6/05 Pinnacle Health Med Svcs Bur of Acct Management 25260449 2,586.20
3/11/05 Pinnacle Health Med Svcs Bur of Acct Management 25093154 2,467.10
1-2/05 Pinnacle Health Med Svcs Bur of Acct Management 800464619 953.40
TOTAL 178,868.95
-L -8
[z/2.)
Kevin Landberg
* Admitted in Minnesota
Joseph 1. Pezzuto II
* Admitted in Arizona
The Law Office Of Joe Pezzuto, LLC
Attorneys at Law
6636 Cedar Avenue South
Suite 330
Minneapolis, MN 55423
(Local) 612-861-7270
(Facsimile) 612-861-7323
(Toll Free) 866-526-0101
May 24th, 2007
28975200/14395329070500694/2779 (#329) 14389
S DA VlD RAMSEY
28 GARDEN PKWY
CARLISLE, PA 17013
11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111
RE: Creditor: ARROW FINANCIAL SERVICES, LLC-CHASE
Original Creditor: CHASE MANHA TT AN BANK
Account Number: 14395329070500694
CURRENT BALANCE: $6,739.01
Dear S DA VID R.~\ISEY:
This office has been retained to collect the debt owed by you in the above-referenced matter. This letter is a demand for
payment in full. Please contact this office to make arrangements for payment.
At this time no attorney with our law firm has personally reviewed the particular circumstances of your account.
Please call our office at 1-866-526-0101.
Unless you notify us within thirty days of the receipt of this letter that you dispute the debt or any portion thereof, the debt
will be assumed by us to be valid. Additional information in regard to questioning the debt is set forth below. This
information is being provided to you in accordance with the Fair Debt Collection Practices Act.
1. If you notify us in writing within thirty (30) days of receipt of this letter that the debt, or any portion thereof, is
disputed, we will obtain verification of the debt or a copy of the judgment against you and a copy of such
verification or judgIl!ent will be mailed to you.
2. Upon your request in writing within thirty (30) days of receipt of this letter, we will provide you with the name
and address of the original creditor, if different from the current creditor.
It is our sincere hope that you will be able to arrive at a method of payment on this obligation. However, we cannot work
with you unless you contact us. We would appreciate hearing from you soon. If you would like to make a payment online
please go to www.pezzutolaWgrouD.com.
Sincerely,
Kt:vin Landberg, Esq.
BE ADVISED, THIS IS AN ATTEMPT TO COLLECT A DEBT BY A DEBT COLLECTOR. ANY
INFOR1\tlA TION OBTAINED WILL BE USED FOR THAT PURPOSE. AS REQUIRED BY LAW,
YOU ARE HEREBY NOTIFIED THAT A NEGATIVE CREDIT REPORT REFLECTING YOUR
CREDIT RECORD MAY BE SUBMITTED TO A CREDIT REPORTING AGENCY IF YOU FAIL TO
FULFILL THE TER1\tfS OF YOUR CREDIT OBLIGATION.
SCJi.:1:) Ih q
:<:',r::fY;';:;?{':;:~1;:::i(:,:'-.,;,.':'t<,:9:'~'L?,y::,~t~~:-~;:';'):*~,~ir'{::"," ',': ,'.,,' :~))::";'W,:;,:.'(.c'::::''k{,~,j" '<';P_v:':''>s,;,_,'' L:,:,::.,,:,~'L,.::>;<:
Statement for account number: 4417124750480441
New Balance Payment Due Date Past Due Amount Minimum Payment
$4,810.39 03109105, $0.00 $120.00
BANKfONE.
Amount Enclosed 1$
I Make your check payable to Bank One.
New address or e-mad? Print on back.
Did you know you could
transfer balances online?
Check out if you qualify by
going to www.bankoneBT.com.
441712475048044100012000004810396
CARDMEMBER SERVICE
PO BOX 15153
WILMINGTON DE 19886-5153
1",11I,1..1"1.1,,1,,11,,,1, I "., 11.1, I ," II .,1,1," II "I I "I
1...111...111....11.....11...11..1.111.1111.111.11111......111
72825 BE X Z 04305
S DAVID RAMSEY
990 EMERALD LN
MILLERSBURG PA 17061-1211
.: 5000 ~bO 2B': 2 2 ~L,? SOL,BOL,L, ~bll.
BANK~ONE.
Statement Date:
Payment Due Date:
Minimum Payment Due:
CUSTOMER SERVICE
In u.s. 1-800-436-7927
Espanal 1-888-446-3308
TOO 1-800-955-8060
Outside U.S. call collect
1-302-594-8200
Account Number: 441712475048 0441 ACCOUNT INQUIRIES
Total Credit Line $9,000 P.O. Box 15298
Available Credit $4,189 Wilmington, DE 19850-5298
Cash Access Line $1,800
Available for Cash $1,800 PAYMENT ADDRESS
PO. Box 15153
Wilmington, DE 19886-5153
01/13/05 - 02/12/05
03109105
$120.00
VISA ACCOUNT SUMMARY
Previous Balance
I;'ayment, Credits
Purchases, Cash, Debits
Finance Charges
New Balance
$5.091.94
-$433.00
+$38.46
+$112.99
$4,810.39
VISIT US AT:
www.cardmemberservices.com
TRANSACTIONS
SC.H . I) I- knt. ~O
l Please return top portion with payment. See reverse side for return address.
Plaza Associates
RE ~ S RAMSEY
Date ~ January 30, 2007
Creditor ~ CAPITAL ONE BANK
Account Number ~ xxxxxxxxxxxx6469
Balance ~ $264.34 -
Control Number ~ 60160108-11
$105.74
A SETTLEMENT OFFER
Please be advised that we are a professional collection agency.
We have been authorized to offer you the opportunity to settle this account with a lump sum payment for 40%
of the above balance due, which is equal to $105.74.
This settlement offer will be valid as long as our client, referenced above, continues to authorize this office to
accept this amount.
If you have any questions regarding this offer, please contact this office at the number(s) provided above.
Unless you notify this office within 30 days after receiving this notice that you dispute the validity of this debt
or any portion thereof, this office will assume this debt is valid.
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 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.
You are invited to visit our website resolve.plazaassociates.com to make a settlement offer and payment
online. You will need your Invitation Code, which is PLAZOASl601601OS.
Notice: Please see reverse side for important information. I
PLEASE USE THIS ADDRESS FOR PAYMENTS ONL Y
Plaza Associates
JAF Station, PO Box 2769
New York, NY 10116-2769
.
ACA
Plaza Associates ~ 370 Seventh Ave, New York NY 10001-3900
1-866-897-4576 ~ (212) 613-5563
l;ooTERN^rlO~,'l
fh(. ,\~~')U.tiOl~ of( :n:,\it
"IIJ C..f1C-C1:,}I1 PlUt~<lun;l.h
Office Hours:
Monday - Thursday 8:00am-Midnight EST
Friday 8:00am-8:00pm EST
Saturday 8:00am-4:00pm EST
PLZASl
AS1V9
438835
:.f.-mbc,
60160108-11
sc.}-I.. :I- __ I~ 1\
-10965 Decatur Road
Philadelphia, PA 19154-3210
Return Service Requested
February 28,2005
ACADEMY COLLECTION SERVICE, INC.
Main Office: 10965 Decatur Road
Philadelphia, PA 19154-3210
1 (800) 220-0605 or (215) 281-7500
Hours: M-rn 8am-9pm, F 8am-5pm,
Sat 8am-12noon
S D Ramsey 10786938
990 Emerald Ln
Millersburg, PA 17061-1211
1...111...11I....1111...11...11111.1.1111...111.1..11...11.111
ACCOUNT IDENTIFICATION
Creditor: Citibank (South Dakota) Na (P)
Fwd Creditor :
Account # : 5491130334748035
Academy File # : 10786938
Total Bal As Of 28 Feb 2005: $2324.73
Number Of Accts : 1
This is to advise you that Citibank (South Dakota) Na (P) has transferred your delinquent account to our office
for pre-legal collection. They may be willing to settle this account for less than the current balance.
As of the date of this letter, you owe $2324.73. Because of interest, late charges, and other charges that may vary
from day to day, the amount due on the day you pay may be greater. Hence, if you pay the total balance due
shown above, an adjustment may be necessary after we receive your payment.
Unless you notify this office within 30 days after receiving this notice that you dispute the validity of this debt or
any portion thereof, this office will assume this debt is valid. 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 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.
If you do not dispute this debt, pay the balance or make satisfactory arrangements, we will return this account to
the creditor who may forward your account to an attorney in your area with the authority to file suit against you.
If you pay us by check, the check writer authorizes Academy or its agent to re-present the check electronically if
the check is returned for insufficient or uncollected funds.
A returned check charge of $6.00 may be added to your account if any check is ultimately returned as unpaid.
This is an attempt by a debt collector to collect a debt. Any information obtained will be used for that purpose.
Yours truly,
Tom Reed, Debt Collector Ext 2738
NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION.
Side 1 of 2
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Please Detach and Return Bottom Portion with Payment - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Enter the requested information in the spaces provided below:
From: S D Ramsey
Change of Address:
City, State, Zip:
Telephone:
Employer:
Address:
City, State, Zip:
Telephone:
Ext:
Total Balance Due
Amount Enclosed
Creditor Acct #
Academy File #
: $2324.73
: $
: 5491130334748035
: 10786938
ACADEMY COLLECTION SERVICE, INC.
10965 Decatur Road 10786938
Philadelphia, PA 19154-3210
1.1111I11111111111.1.11.111.1111111111.1111..1111.111.11111III
Enclosing this notice with your payment
will expedite credit to your account.
1 PL2 000211 A 1 43600009459011000 S-CRE
SCJ-} ..::[ .> T. ~ 12-
PO Box 8666
Lancaster PA 17604-8666
ADDRESSSER~CEREQUESTED
COLLECTION CENTER, INC.
(717) 569-5515. (800) 260-8264
September 9,2005
AG No: 453537-1
Amount Due: $89.28
453537-1 - 9 - 003237
David Ramsey
990 Emerald Ln
Millersburg PA 17061-1211
111111111111I111I111111111111111111111111111111111111111111111
Collection Center, Inc.
PO Box 8666
Lancaster PA 17604-8666
111111111111111111111I1111111111111111111111111111111111111111
* * * Detach Upper Portion IU1d Return with Payment * * *
1.32 - CCIN2OO9195E82DF91
Client: COMMONWEALTH TELEPHONE CO
AG No: 453537-1
Client Ref#: 7176920913 100
Date of SVC: 03/23/2005
Amount Due: $89.28
Dear David Ramsey,
We have not received satisfactory results regarding your past due account. Unless we hear from you within
fifteen (15) days from the date of this letter, we will be forced to record your lack of attention and consider
further collection procedures.
You can avoid any additional collection efforts that may be taken by calling us at 800-260-8264 to make
arrangements for payments, or remit your balance due in the enclosed envelope.
Please be advised that not paying this bill in full, could jeopar dize your credit rating. If this debt is reported
on your credit file, this record will remain for seven years. Such records are marked satisfied when paid in
full, although the record of indebtedness remains on file for the full seven years.
This is an attempt to collect a debt by a debt collector. Any information obtained will be used for that
purpose.
Sincerely,
"DDHatd ie il<~
Donald R. Roberts
Collection Supervisor
SC.H.I 7T.~ 13
PO BOX 988
HARRISBURG, PA 17108-0988
2J>&n/n Yf?<edr;t CG(}/YUYJI'.aCt{)/}
2006/01/12
800 900-1380
Hours: Mon- Thur 8am-1 Opm,
Fri 8am-5pm, Sat 8am-12pm
(Eastern Standard Time)
- -
1111/111111111111111111111111111111111111111111111
ID 06527086
S. DAVID RAMSEY
990 EMERALD LN
~~~O"$ 4
" "'..
"o"'a~ot"...
l.d. ,., ";
~~ -:"';'::J.,l
"~'''V,;
"~qo"A f\O"~ ]\I
MILLERSBURG, PA 17061-1211
TOTAL BALANCE DUE $189.69
The below referenced account(s) has been assigned to this office for collection. This communication from a debt
collector is an attempt to collect a debt and any information obtained will be used for that purpose.
Unless you notify this office within 30 days after receiving this notice that you dispute the validity of this debt or any portion
thereof, this office will assume this debt is valid. 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 judgement and mail you a copy of such judgement or
verification. If you request 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.
NEW
OLD
ACr.ClU1\.lT i\IllMRFA
BALANCE
BOOK CLUB
History Book Club
ACCOUNT I\HIMRfA
940685605
$189.69
Detach and return In envelope for proper account Identification
2006/01/12
We accept Visa, MasterCard and check by phone.
S. DAVID RAMSEY
990 EMERALD LN
MILLERSBURG, PA 17061-1211
Check one:
ID NUMBER: 06527086
BALANCE DUE: $189.69
o Visa
o Mastercard
Card#: ________________
Expiration Date: -1-1
Signature:
- ~ lL-\.
Sc. H. I. ;, j...
pr.r.
9enn ct~ ct{)/)t/juw-atim
PO BOX 988
HARRISBURG, PA 17108-0988
800 900 -1380
Hours: Mon-Thur 8am-10pm,
Fri 8am-5pm, Sat 8am-12pm
(Eastern Standard Time)
2006/09/1 5
...."TOilS .....
"O";,;j ~o(l...
f ,dj .., ";
~ --..... ~
~.. ,~...,.. ~
'/~.V,,"
1>..,... A TlO~~)j)
11111111111I11111111111111111111111111111111111111
1007772266
S DAVID RAMSEY
990 EMERALD LN
MILLERSBURG, PA 17061-0000
TOTAL BALANCE DUE $117.76
The below referenced account(s) has been assigned to this office for collection. This communication from a debt
collector is an attempt to collect a debt and any information obtained will be used for that purpose.
Unless you notify this office within 30 days after receiving this notice that you dispute the validity of this debt or any portion
thereof, this office will assume this debt is valid. 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 judgement and mail you a copy of such judgement or
verification. If you request 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.
NEW
OLD
793613075
47022524095
BALANCE
$117.76
BOOK CLUB
MILITARY BOOK CLUB
AC'COIlIllT NIlMRFR
Ac~n1J1\IT i\lUMAF=R
Detach and return in envelope for proper account identification
2006/09/15
We accept Visa, MasterCard and check by phone.
S DAVID RAMSEY
990 EMERALD LN
MILLERSBURG, PA 17061-0000
10 NUMBER: 07772266
BALANCE DUE: $117.76
o Visa
[] Mastercard
Card#: ________________
Expiration Date: -1_1
Check one:
Signature:
SC.H - -L ...:r..~ 15'
PCC
PO BOX 988
HARRISBURG, PA 17108-0988
9enm ~~~~tw
2006/05/11
800 900-1380
Hours: Mon-Thur 8am-10pm,
Fri 8am-5pm, Sat 8am-12pm
(Eastern Standard Time)
11111111111111111111111111111111111111111111111111
ID 07075149
S. DAVID RAMSEY
990 EMERALD LN
.....c:;TOII. ......
ClO"'~ ~oCl,
! ,c1. .., Y;
~ .-.... ~
~. ..~..,.. !
',+'''V'Y''
"~It"AT\O"~ Jj)
MILLERSBURG, PA 17061-0000
TOTAL BALANCE DUE $178.37
The below referenced account(s) has been assigned to this office for collection. This communication from a debt
collector is an attempt to collect a debt and any information obtained will be used for that purpose.
Unless you notify this office within 30 days after receiving this notice that you dispute the validity of this debt or any portion
thereof, this office will assume this debt is valid. 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 judgement and mail you a copy of such judgement or
verification. If you request 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.
NEW
OLD
BOOK CLUB
Book of the Month Club
ACCOUNT NUMAFR
ACCnrH\lT ;\UJMA'::R
079855814
00000000000
BALANCE
$178.37
Detach and return in envelope for proper account identification
2006/05/11
We accept Visa, MasterCard and check by phone.
S. DAVID RAMSEY
990 EMERALD LN
MILLERSBURG, PA 17061-0000
Check one:
10 NUMBER: 07075149
BALANCE DUE: $178.37
C Visa
C Mastercard
Card#: ________________
Expiration Date: _/_/
Signature:
SCH. I ,) J:~ llo