HomeMy WebLinkAbout03-20-08
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15056051058
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 Security Number Date of Death
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
County Code Year
File Number
~I
01
~1/
Date of Birth
177-42-4957
07/10/2007
06/18/1949
Decedent's Last Name
Suffix
Decedent's First Name
MI
Gehr
Ruby
(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
. 1. Original Return
2. Supplemental Return
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
4. Limited Estate
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a living Trust
(Attach Copy oITrust)
10. Spousal Poverty Credit (date of death 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
o
8. Total Number of Safe Deposit Boxes
Michael A. Scherer, Esq
Firm Name (If Applicable)
O'Brien Baric & Scherer
(717) 249-6873
19 West South Street
C")-=
REGISTER'eF~LS USE ~1Y
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TO
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First line of address
i'J
a
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Second line of address
r".~)
City or Post Office
State
ZIP Code
DATE FILED
c...,JI.)-
CO
Carlisle
PA
17013
Correspondent's e-mail address:
Under penalties of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
._DATE 1\0
.;; - I, . vo
ADDRESS
Evelyn R. Reeder, Executrix! 570 East Old York Road, Boiling Springs, Pennsylvania 17007
SIGNAT E OF PREP RER OTHER THAN REPRESENTATIVE
ADD ES
Michael A. Scherer, Esquire/19 West South Street, Carlisle, Pennsylvania 17013
PLEASE USE ORIGINAL FORM ONLY
DATE
3.17.og
Side 1
L
15056051058
15056051058
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Id,_
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15056052059
REV-1500 EX
Decedent's Name:
Ruby
Gehr
177-42-4957
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) Separate Billing Requested. . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) 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/Sec 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 .O~
16. Amount of Line 14 taxable
at lineal rate x.o 45
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
15056052059
Side 2
L
Decedent's Social
15.
16.
17.
18.
23,284.19
23,284.19
17,525.79
18,861.91
36,387.70
-13,103.51
0.00
15056052059
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REV-1500 EX Page 3
Decedent's Complete Address:
File Number
DECEDENT'S NAME DECEDENTS SOCIAL SECURITY NUMBER
Ruby I Gehr 177 -42-4957
STREET ADDRESS
21 Hidden Noll Road
CITY \ STATE 1 ZIP
Carlisle PA 17015
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
0.00
Total Credits (A + B + C ) (2)
0.00
3. InteresVPenalty if applicable
D. Interest
E. Penalty
TotallnterestJPenalty ( 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)
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
0.00
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(5B)
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 [KJ
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 [KJ
c. retain a reversionary interest; or.......................................................................................................................... 0 [i]
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [i]
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0 [i]
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ............., 0 [i]
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0 [i]
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.
REV-1508 EX+ (6-98) '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Ruby I Gehr
FILE NUMBER
21-07-0671
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1. Reliance Insurance policy proceeds
6,500.00
5.00
2. Members First Federal Credit Union Savings Account # 250297-00
3. Orrstown Bank Checking Account # 143000484
469.18
4. Household goods, furniture and furnishings and miscellaneous personal effects valued at sale prices
1,107.02
5. 2001 Fleetwood Anniversary mobile home, serial no. VAFL 119AB55532HE13; One-half ownership
15,000.00
interest as tenant in common based upon actual sale price
6. Robert Hughes, 2007 real estate tax proration on mobile home sale
192.67
7. Robert Hughes, lot rent proration
10.32
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
23,284.19
REV-1511 EX+ (12-99).
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Ruby I Gehr
FILE NUMBER
21-07-0671
ITEM
NUMBER
A.
B.
1.
10.
Debts of decedent must be reported on Schedule I.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Hollinger Funeral Home & Crematory, Inc.
2,815.00
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) . Evelyn Reader
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 570 East Old York Road
2,500.00
City. Boiling Springs
Year(s) Commission Paid: 2008
State PA Zip 17007
2.
Attorney Fees
7,500.00
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
103.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
The Sentinel (legal advertising)
Cumberland Law Journal (legal advertising)
Terrance Kimball, appraisal of mobile home
Northview Mobile Home Park, Mobile Home Lot Rent, 2 months
198.52
75.00
100.00
615.00
8.
9.
**CONTINUED ON NEXT PAGE**
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
17,525.79
SCHEDULE H- FUNERAL EXPENSES
& ADMINISTRATIVE COSTS CONTINUED
Park Place Properties, Commission on Sale of Mobile Home
( One-halftotal)
North Middleton Authority, Water and Sewer (one-half of total)
Cumberland County Tax Claim Bureau, Delinquent Real Estate
Taxes (one-half total)
Mobile Home Doctor, mobile home winterization/de-winterization
(One-halftotal)
Robin Sollenberger, 2007 County and School Taxes (one-halftotal)
Northview Mobile Home Park, lot rent (one-half total)
Robert Hughes, repair mobile home water leaks (one-half total)
Doug and Ann Reeder, mobile home cleaning (one-half total)
Register of Wills, reserve for accounting
TOTAL:
1,250.00
348.96
441.37
87.50
524.42
340.00
37.50
90.00
500.00
$3,619.27
REV-1512 EX+ (12-03) '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
Ruby I. Gehr
FILE NUMBER
21-07-0671
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including un reimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
10.
11.
12.
13.
14.
1.
Members First Federal Credit Union Unsecured Loan # 250297-03, Joint with Charles Nelson
2,147.53
(one-half total)
2.
Members First Federal Credit Union Unsecured Loan # 250297-04, Joint with Charles Nelson
243.29
(one-half of total reported)
3.
Members First Federal Credit Union Used Vehicle Loan for 2002 Jeep Grand Cherokee Laredo, Joint
4,020.95
with Charles Nelson (one-half ottotal)
4.
East Pennsboro Township Ambulance Service, Inc./wheelchair van transportation for Ruby
80.00
5.
HCR ManorCare, Inc.
496.00
6.
HCR ManorCare, Inc./private payment for June, 2007
8.50
7.
HCR ManorCare, Inc./private payment for August, 2007
1,984.00
8.
Yellow Breaches Ambulance Service
419.50
9.
North Middleton Authority, water & sewer, one-half of total
306.51
Susquehanna Valley FCU, Joint Loan with Charles Nelson (one-half total)
3,288.27
49.00
Comeast
Embarq
211.00
NCO Financial Systems
5,457.92
West Shore EMS
149.44
18,861.91
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
-. .----r__________.
L.ftJY[WILL ft!NtD rztEJYf.AAf.Wd
O'F
<1t'l.XB~ I qEJf(]{,
I, RUBY I. GEHR, of 1502 Holly Pike, Apt. 6, Carlisle, Cumberland County,
Pennsylvania, declare this instrument to be my ~ast Will and Testament, in manner and
form following:
FIRST: I hereby expressly revoke all Wills and Codicils heretofore made by
me.
SECOND: I hereby direct my Executor to pay all my just debts, funeral and
administrative expenses out of my estate, as soon as practicable after my death.
THIRD: I direct that all taxes which may be assessed in ~nsequence of my
death of whatever nature and by whatever jurisdiction imposed shall be paid out of my
estate as a part of the administration of my estate.
FOURTH: I give and bequeath such of my.personal property as may be listed
on an unsigned memorandum kept with my Will to persons named thereon, provided they
survive my death. Should such a memorandum not be found with my Will, it shall be
cOnclusively presumed that none was prepared, and all of my personal property shall be
considered a part of the remainder of my estate.
FIFTH: I give, devise and bequeath all the rest, residue and remainder of my
estate, real, personal and mixed, whatsoever and wheresoever situate, to CHARLES J.
NELSON, of Mt. Holly Springs, Cumberland County, Pennsylvania.
SIXTH:
In the event the said CHARLES J. NELSON shall predecease me, I
then give, devise and bequeath all the rest, residue and remainder of my estate, real,
personal and mixed, whatsoever and wheresoever situate, to EVELYN REEDER, of
Boiling Springs, Pennsylvania, IN TRUST NEVERTHELESS FOR THE BENEFIT OF
Kylee Ury, of Carlisle, Cumberland County, Pennsylvania.
The Trustee shall invest the funds in g~od and safe sec~rities, . legal for Trust
funds in the Commonwealth of Pennsylvania and may use the income derived therefrom
as the Trustee shall determine, for prescription medications for. the beneficiary of the
Trust; and shall pay the beneficiary principal and accumulated income, if any, 'upon her
attainment of the age of twenty (20) years.
SEVENTH: I hereby nominate, constitute and appoint CHARLES J. NELSON,
to be the Executor of this my Last Will and Testament. In the e~ent CHARLES J.
NELSON is unable to act as Executor for any reason, I then nominate, constitute and
appoint EVELYN REEDER, to be the Executrix of this my Last Will and Testament. No
personal representative shall be r~quired to file bond in this or any other jurisdiction.
IN WITNESS WHEREOF, I hereunto set my hand and seal this :s'd
day of 1itJuJ- ,1999.
'v
SIGNED, SEALED, PUBLISHED and
DECLARE n the presence of:
~j),~d~_
uby I. Gehr
,
i
f
)
,I
2
COMMONWEALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLAND
I, RUBY I. GEHR, Testatrix, whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that I
signed and executed the instrument as my Last Will; that I signed it willingly; an~ that I
signed it as my free and voluntary act for the purposes therein expressed. .
Sworn or affirmed to and acknowledged before me, by RUBY I. GEHR, Testatrix,
this .srr day of ~ ,1999.
~~~. ~-
Rub . Gehr, T~statrix
~p2c~n'I-W~A ~
. NOT AAIAL SEAL.
TERESA J.1UN<HOlD!R, HoWy ~
Cat1IIle, Cumbertend CouriIy, "A
My CommIMIon &pirM Fib. 21, aooo
3
COMMONWEALTH OF PENNSYLVANIA
55.
COUNTY OF CUMBERLAND
We, ~~L J if AJiJSFlY and ~~-1 W. r-:".L//(.lI~ u/2...
th~ witnesses whose names are signed to the attached or foregoing instrument, being
duly qualified according tq law, do depose and say that we were present and saw
Testatrix, RUBY I. GEHR, sign and execute the instrument as her Last Will; that she
signed willingly and that she executed it as .her free and voluntary act for the purposes
therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will
as witnesses; and that to the best of our knowledge the Testatrix was at that time 18 or
. more years of age, of sound mind and under no constraint or undue influence.
Sworn or affirmed to and. subscribed to before me by
and \.JI:JmFS ~. P'$ J,tJt:~ &.. , witnesses this.
t_t1uJ~Ld ,1999.
0:J,eQL J. l/ItIIJ.:5/!/
t..,.$tY day of
i
!
~~~4'1J
Notary Pu Ie
NOTMW.IEAL
TERHAJ. ~ NaWy NlIc
CWIM. C\IrIlbelWld County. "A
~ Oo.llltlulclI ~ ,.. 2t. JOOO
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WARNING. FEDERAL AND STATE LAWS REQUIRE THAT YOU STATE THE MILEAGE
(ODOMETER READING) IN CONNECTION WITH THE TRANSFER OF OWNERSHIP.
FAILURE TO COMPLETE OR PROVIDING A FALSE STATEMENT MAy' RESULT IN
FINES AND/OR IMPRISONMENT.
IMPORTANT NOTICE
Please be advised that in lieu of notarization on this form, verification of a person's
signature by an Issuing agent who Is' licensed as a vehicle dealer by the Pennsylvania
State Board of Vehicle Manufacturers, Dealers and Salespersons, or Its employee Is
acceptable. The signature and printed name of the Issuing agent or the Issuing agent's
employee, date of verification, the Issuing agentlllcensed dealership's dealer Identifi-
cation number (DIN) and business name, must be listed In the space provided for
notarization. Vehicle seller and purchaser must sign only In the presence of an officer
empowered to administer oaths or an authorized agent as Identified above.
,-
PA DEPARTMENT Of TRANSPORTATION
BUREAU Of MOTOR VEHICLES
_~_.lA 17106-8593
MV-4ST (5-001
VEHICLE SALES AND USE TAX RETURNI APPUCATION FOR REGISTRATION
AT1l\CH "" Tm..E -INSTRUCTIONS FOR THIS FORM
ARE lIlCWIlED ON MV.1A - TYPE OR PAINT
MAKE CHECK ""YABLE TO COMMDNWEAI.TH Of PENNSVlVAMA
<>> PfllNTED ON REC,"CUO PJ\PEA
~
-- ~- - - -- --- --- - - -- - --- --- - -- - - - - -. - - -- -- --. - - ---
No. 3321197
..
A. "" TITLE NUMBER (AS SHOWN ON AT110CtED TITLE) MAKE OF VEHICLE IMODEL YEAR PURCHASE
" 59906562402 GE Heritage 2001 PRICE 30,000 .00
iJ (See.- on.........) .
VEHICLE IDENTIACR10N NUMBER CONOfTI()N
VAFL117AB55532HE13 I VI GOOD LESS ~
o FAIR o POOR TRADE-IN . .
B. ( ) .""'T NAM TAXABLE
~ Gehr (Deceased) Ruby I. AMOUNT ~ . .
~ CO-SELLER 1. Sa6ea Tax Due
N",' "on (n. n -. T ~~~t~IO( ~
See note on reo.ersel. . .
i C. LAST NAME (OR FUlL BUSINESS NAME) F1RST NAME MIOOl.E lNlTIAL DATE ACQUIRED/ e'S'~ '.. ~" . ...
I Hughes Robert P. ~~07 \fA~,_l' "-"";3"'" .ii-,;:;> '.'i -:<"
I CO-PURCHASER 1 B FlrlII Aooi(Jvnonl I lB _ Aooi(Jvnonl
S ~:fH~ \:~ 'HL~., J ;;,.\(\1 -- ;.t;i,_::~i
. '-&- - ..
~ STREET COUNTY CODE
S 21 Hidden Noll 112 11 2. Title Fee 22 .50
.
CITY STATE ZIP CCDE REFER TO COLWTY CODES
Carlisle PA 17013 USTH3 ON REVERSE SlOE 3. Uen Fee 5 .00
OF PH< CCPf .
D. LAST NAME lOR FUlL BUSlNESS NAME) ARST NAME MIDOLE lNlTIAL I DATE ACQUIRED/ 4. Registration or
PURCHASED
Processing Fee . .
CO-PURCHASER Fee"-_
i as_by tho
I I Bureau
STREET COUNTY CODE 5. Duplicate Reg.
~ 11 I Fee
~ ~ No. 01 Ca<ds_ . .
~ CITY STATE ZIP CODE REFER TO COUNTY CODES
USTING ON REVERSE SlOE 6. Transfer Fee
OF PINK CCPf . .
E. MAKE OF VEHICLE I VEHICLE IDENTIFICATION NUMBER
7. Increase Fee
ijril . .
~~ MODEL YEAR I BODY TYPE (CP. TK, ETC.) I CONDITION
0??oo o FAIR o POOR 8. Replacement
Fee . .
F. ORIGINAL PlATE ./ Check One o lRANSFER OF PREVIOUSLY ISSUED PlATE TOTAL PAID 9. 10
0 PLATE TO BE ISSUED BY o TRANSFER. RENE,^",- OF PlATE (Add 1 thru B) 27 .50 .
BUREAU (PROOF OF /N- O TRANSFER. REPLACEMENT OF PlATE Send One
SURANCE MUST BE AT-
TACHED.) o lRANSFER OF PlATE . REPLACEMENT OF STICKER l1.GRAND TOTAL Check in 27 . 50
(Add 9 & 10) This Amount .
0 EXCHANGE PlATE TO BE ~NQ.. ','-", " ',' i IREO:c,~REPlACEMENT 0 DEFACED 0 STOlEN
ISSUED BY BUREAU
~ 0 TEMPORARY PlATE EXPIRES 1 D~~~~1~~~~E~b" block is checked anolicant musl c-DITDIAte Form MV-44.
!I ISSUED BY FUlL AGENT Month y..,
TRANSFERRED FROM TITLE NO. IVlN
" . ~1UJE0F IS ~ ~ ~SlGNHERE I RELATIONSHIP TO APPUCANT
I.' .... '. TEMP,IUJENO. ",),}, FEARED IF OTHER lliAN APPUCANn
VEHICLE PURCHASED . GVWR I UNLADEN WEIGHT I~EQ REG. GROSS WT. I ~EQ REG. GROSS COMa
W:~LE\ INCLUDING LOAD WT. (IF APPUCABLE)
INSURANCE COMPANY NAME 1 POUCY NUOR I POUCY EFFECTIVE I POLICY EXPIRATION
ATTACH BI ER) DATE DATE
ISSUING I CER1FY THAT ON MONTH OAY_YEAR_ ISSUING AGENT (PRINT NAME) AGENT NO.
AGENT I HAVE CHECKED TO DETERMINE n-w THE VEHICLE IS INSURED AND
INFOR- ISSUED TEMPORARY REGISTRATION TO THE NY:NE APPUCANT. IN ISSUING AGENT SIGNATURE TELEPHONE NO.
MATION COMPIJANCE \'11TH ALL APPUCABlE PROVISIONS OF THE VEHICLE CODE
AND DEPARTMENT REGUl.A'I1ONS. ( )
G. IlWE CERTIFY THAT I!'M: HAVE EXAMINED AND SIGNED THIS FORM AFTER ITS COMPLETION AND THAT THE INFORMATION GIVEN IS TRUE AND CORRECT. IF AN EXEMPT10N
IS C.......ED. THE PURCHASER FURTHER CERT1F1ES THAT HE/SHE IS AUTHORIZED TO C....... THIS EXEMPTION.IlWE .tCKNOWLEDGE THAT I/WE MAY LOSE MY/OUR OPERATING
PRMLEGE(S) OR VEHICLE REGISTRATION(S) FOR FAILURE TO MAINTAIN FINANCIAL RESPONSIBlUTY ON THE CURRENTLY REGISTERED VEHICLE FOR THE PERIOD OF
REGISTRATION IlWE ACKNOWLEDGE THAT I!WE MAY BE SUWECT TO A FINE NOT EXCEEDING $5.000 AND IMFRISONMENT OF NOT MeRE THAN TWO YEARS FOR ANY
FALSE STATEMENT THAT IlWE MAKE ON THIS FORM.
I - ~~~~od.S<l"" TELEPHONE NUMBER S~'X::', ~ r""" R I?&.i.... (" ..... .A
1ST I ) . '~,I .
ASSIGN- S<lnalur. 01 Co-F'u>chaa<< /Ti1lo 01 Aulhorized Signer S;g~c;;r;r- /J2. ~
MENT Gx&:., .
U Signal"", 01 Second Purchaser 0< Authorized Signer TELEPHONE NUMBER Signature ot'SeIler
2ND
ASSIGN- ( )
MENT 5;gnaturo 01 Co-F'u>chaa<</T'" 01 Authorized_ Signature of Co-Seiler
H. Id NOTE: If a co-purchaser other than your spouse is listed and you want the title to be listed as . Joint Tenants With
Right of Survivorship. (On death of one owner, title goes to surviving owner.) CHECK HERE D. Otherwise, the title
will be issued as .Tenants in Common. (On death of one owner, interest of deceased owner goes to his/her heirs or
~ ~ ~~i:~:~E VEHICLE IS TO BE USED AS A DAILY RENTAl OR LEASED VEHICLE. CHECK THIS BLOCK 0 ,IF BLOCK IS CHECKED. COMPLETE AND ATTACH FOAM MV-ll.
MESSENGER NUMBER:
1. BUREAU OF MOTOR VEHICLES
DecE~mber 2BL?.9_Q'L___
DATE
Sellers:Es~ate o~ Char~es Nelson & Estate of Ruby G~~_
Buyers: _____~<:>.b~!_~I~~h~!l_
SELLERS TRANSACTION
SALE PRICE :
LESS Commision
LESS ~ Delinquent Taxes
LESS Other Unwinterization
LESS Other 2007 Sch&Co Tax
LESS Other Lot Rent
PLUS Proration of Lot Rent
PLUS Proration of Taxes
PLUS Other: /
DUETO~
SETTLEMENT STATEMENT
List #
1895
07-:37
Job #
$
30,000.00
2,500.00
882.74
50.00
1,048.85
680.00
20.65
385.32
o
(-)
5,161.59
405.97
(+ )
$ ___~?~2Y,:.38
~~*.*_**~**~~~*.***t*.~.******...~.~...Pf.~t...~.t..+*~....~*.*t.****..***.**.*...t....++...........*.******
Closing Fees:
Proration of Lot Rent:
Proration of Taxes:
School_)~~_.7? _ County _ 1.60
Other ___~ ___L___
Other_________L ____
Other_______t____ ________
Other ___00_ ___ __L_H _
Other
Other
SUBTOTAL
BUYERS TRANSACTION
SALE PRICE:
Title Fees:
___________ L ___ Insurance
/
Less Deposit Received:
LESS Amount Financed:
TOTAL CREDITS
DUE "N!JXI FROM BUYERS
$
30,000.00
27.50
P.O.C.
600.00
20.65
/
Years
385.32
o
o
-------- ----
o
--.---.---.. --..------
_________0____ _______
n__________fJ___ ________
________J____ _____
$ nJ~'?:3}~47 ____
500.00
-----------._-----
___15!QQQ:QO _
_ __15..,_2Q9_,_QO___
$ ----.J.~2.!12: 47__
***********t..**************..*.t.+tt~*....*.tt+*....**~tt**********************+t**.*.....*.....****.***.**
DISBURSEMENTS
Estate of Charles Nelson - 1/2 Proceeds
-----------------_.~--- ._--~---~----_._-- -~------
Estate of Ruby Gehr - 1/2 Proceeds
1 2 , 622 . 19
12 ,622. 19
Park Place Properties, LLC - Commission
1,048.85
2,500.00
Robin Sollenberger, Tax Collector- 2007-8 Taxes
Fred Gettys (Delinquent Lot Rent)
Cumberland County Tax Claim - Delinquent Taxes
882.74
--~._---
670.00
Park Place Properties, LLC Closing Fee
600.00
PA Dept of Transportation - Transfer Fee
North View Manor, LLC - Lot Rent Due
Mobile Home
(- ,) /! ,
( f).'(f'SEtL~"-' Jf_
Doctor - Unwi~ization
/3a7/~
27.50
10.00
-4-/ql/~OO
BUYER
NORTH MIDDLETON AUTHORITY
240 Clearwater Drive
Carlisle, PA 17013-1100
Telephone (717) 243-8269
Final Water and Sewer Bill
ACCOUNT NO.: 12001025
SERVICE ADDRESS: 21 Hidden Noll, Carlisle
OWNER: North View Manor Mgmt
Final Meter Reading
Previous Meter Reading
Usage
691,000 gallons
691,000 gallons
0,000 gallons
12/27/2007
10/13/2007
Total Balance Due
$ 25.00
$ 54.90
$ 618.02
$ 697.90
.......--...----....
/&C/ ~ ~ 1':L-
. /;P;~7. JIlL )
&f)tlM; ~.. ~ /~
North ~ddleton Authority
Water Charge
Sewer Charge
Previous Balance
Please make
7)Pfu~ 1r;J,
/J~;r: ~
checks payable to:
Thank You for letting us serve you.
FAXED TO: Diane at Park Place 12/27/2007
258-4574
ll/L(ILD~( lD;l~
lllLt.iU/~.:s::,
'_,I-!i"ll:l "-",,j I Y II..\,<, IJLI'\lf\l
~:Sl12'2007
- Ct.M&S6
11/27/2007
..~.~... DIGT/crL 29 50&875 ........
NELSeN, CHARI..Ii:~ .1
60 RU'S'i ! CO!il:R
21 HIDDEN WOLL ROAD
c~L!SLE p~ 17013
~~-NoaTH M~ooLETON ~OWN;~I~
21110-CARL!SLE ~RA S.D.
~'t'1l.Tt!S C
O~TE CODE DBSCR~prI~
01/09/07 400 SeH.CAR~~;LE A~EA
01/09/01 201 VILIWC rEE
02/02/07 202 PosrAG~ ~ET & CLAIM
10/09/07 30S POSTAGE FEE REMIVOER
CUMaE~LAND COUVT1 ~~~ CLA!M .UREAU
ONE cOuarHOUSE ~QUARE
CARL!$~! PA liC13
TAX C~M IWOUYRY
snt:s. :n
HIIX>BN NOLL ll.0N>
PROP!~1Y-NORTft ~SW MANOR
DKSC -LOT 45
-Mobile Home - >:'0 Land
BOOr.;~AGE
LA"ro USS
J>.CRE.AGl!:
'lAL1,;Z
T
57,g~0
VAt.r.:'I:: C&G
RECEIPT
lD TAX
'7:29.01
PENAI"TY
72.90
INTo:REST
$4..,0
200' t'1\.'C TOT1o.L
20:>S FlSE :rorAL
"
200' 'Y!lAR TOTALS " BALMCE
!STIMATED BALANCE pus ~~XT HO~
--. ----- ------- .---- ~ .--..-..----......
CLI\:t1'1 TO':''':'.
ESTIMATED TOTA~ D~~ N!XT MONTK
MIse RECeY~TS - - - - - . - - - - - - . - - - -
CHUC!lS
85G.r.l
55..11l
1.5.00
!5. 2S
.'11
:la.'ll
877. '-7
977.'.7
PP.ON& 717 240-'36~
FAX 711 J40-'78~!
R II III ARK ~
CERT MAI~-t.IC 114563
CBil.T IO.IL-SAL!
MAP no 29-15-11S1-055
PA,VJoII!:NT S
BAWIoNCE
DUB
t"A'.:lt. tJ.ll tl.l
PJl.QS
1
T1l.1.0HB
l1rT A!lOlm
!~OI MO
~.47
.00 871.27 5.4'7
/- 8'a~. 74 .)
- . ... . :--:-----
.oc S'17,27 S.47
882.74
MOBILE HOME DOCTOR
Paul S. Reich
P.O. Box 449
Shermans Dale, PA 17090
..117 258 Q4Ba
1-877 771 1245 -
(- - <:..' ",
,/ \.".:......_'?
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INVOICE
Your order n}J. . -<./~ ..... . Invoice no. Date
Iv" / 1 ..", .,) 2 { J 2 -.J I -0
)/Y'\.. :1.. I?, C. - // l '
Quantity Description Unit Price Amount
V "1 "'V i', ~.Cr< ~!.. .f.' S-b oL
SUB TOTAL
TAX
TOTAL -S ""I:) "
7
'\
NET: 30 DAYS: A finance charge of 1 1/2% per month will be charged on all accounts over 30
days. This is an annual percentage rate of 18%
MAKE CHECKS PAYABLE TO:
Robin Sollenberger
5 HILL DRIVE
CARLISLE, PA 17013
RETURN SERVICE REQUESTED
THIS TAX IS DUE AND PAYABLE, YOU ARE HEREBY
REQUESTED TO MAKE PAYMENT THEREOF.
NELSON, CHARLES J
& RUBY I GEHR
21 HIDDEN NOLL ROAD
CARLISLE, PA 17013
~~;.\~\~\\t.~
11585.12002
CARLISLE AREA SCHOOL DISTRICT 2007/08 REAL ESTATE TAX NOTICE
TAXPAYER'S COpy · KEEP THIS PORTION FOR YOUR RECORDS
MUNICIPAL CODE: 29
BILL DATE: 07101107 PROPERTY: 021 HIDDEN NOLL ROAD
BILL NO.: 2881 MAP CODE: 29-15-1251-0s6
TAXES PAYABLE TO: TAX MILLS: 13.10
RobIn Sollenberger ASSESSED VALUE: 57950
CASH
CHECK 1# AMOUNT $
2% DISCOUNT FACE PENALTY
TO 08131107 09101107 TO 10/31107 11101107 TO 12/31107
$743.96 $759.14 $835.05
FIRST PAYMENT SECOND PAYMENT FINAL PAYMENT
N/A N/A N/A
If Paid On or Before If Paid On or Before II PaId On or Before
8/31107 9/30/07 10/31107
FULL
PAYMENT
OR
INSTALLMENT PLAN
NO DISCOUNT
SEE REVERSE SIDE FOR TAX NOTICE INSTRUCTIONS
....................................................................................
IF TAXES ARE IN ESCROW, FORWARD TO MORTGAGE CO
$1.00 FEE FOR ADDITIONAL RECEIPTS
PAYABLE
TO:
ROBIN K SOLLENBERGER
5 HILL DRIVE (717)249-0747
CARLISLE, PA 17013
OESC: ASSESS. NO - 00506875
MAP NO: 29-15-1251-056 TR10398
21 HIDDEN NOLL ROAD
NORTH VIEW MANOR
LOT 45
Mobile Home - No Land
MOBILE HOME - LEASED LAND
TAX
PAYER
NELSON, CHARLES J
& RUBY I GEHR
21 HIDDEN NOLL ROAD
CARLISLE PA 17013
OFFICE MAR-APR-JUL-AUG TUES 10-4 & THUR
HOURS: 10-6; MA Y-JUN-SEP-OCT THURS 10-6
APPT ONLY JAN-FEB-NOV-DEC
CALL FOR HOURS LAST WEEK OF DISC
Control No: 029 - 506875
REMINDER COPY
2007 Statement of Real Estate Taxes
2!U
3/01/20
Bill No:
Bill Date'
Assessed Land Improvement Mineral Total
Values 0 57 950 0 57.950
COUNTY OF CUMBERLAND D18COunt FIIC8 PenaIt
Rates .00228500 2 % 10
COUNTY R/E 132.42 129.77 132.42 145.1
Rates .00018000 2 % 10
COUNTY LIB 10.43 10.22 10.43 11.'
TOWNSHIP OF NORTH MIDDLETON
Rates I .00088900 2 % 10
MONIC. R/E 51.52 50.49 51.52 56. ,
TAX AMOUNT DUE-> $190.48 $194.37 $213.=
J:f Paid OIl or After 3~0~?007 5~0~?007 7 fol/2o'
J:f Paid OIl or Before 4/30 2007 6130 2007
IF NOT PAID BY 12115f20071H1S BILL WILL BE RETURNED TO TAX
CLAIM BUREAU FOR COlLECTION AND RUNG OF A UEN AGAINST
YOUR PROPERTY.
.. SEE REVERSE SIDE OF BILL FOR A BREAKDOWN OF YOUR COUNTY TAX DOlLARS
2881 Return Bill with Payment. For a Receipt, Enclose Self Addressed Stamped Envelooe.
. . .... .. .. .
Administrative Office:
2001 Martet Street. Suite 1500
Philadelphia. PA 19103-7090
a DCMcompany INSURED: NELSON,CHARLES,J.
CLAIM NUMBE~: 2007-219-082
CUMBERLAND mUCK EalJlPMENT co.
..... 01aclL1aaa
Check No. 3001374800
.WachoVia Bank of Delaware. NA-'" ~
. "C: 311
Life Insurance Company
Date: 08130I2OO7
~~ ~~rn Of: SIX THOUSAND FIVE HUNDRED AND 00/100 Dollars
[ *******6,500.00)
Not Negotiable Alter 180 Days.
A
o
o
R
E
S
S
E
E
THE ESTATE OF RUBY I. GEHR, LETTERS
TESTAMENTARY IN COMMON FORM GRANTED
TO EVELYN R. REEDER . .
19 WSOUTH ST
CARLISLE PA 17013
d~ ~/--r
&;;::;p~
AUTHORIZEO SIGNATURE
. . . ... . . . . .. .
II- ~ 0 0 ~ ~ ? l. aDo II- I: 0 ~ ~ ~ 0 0 2 2 51: 20? q q 500 SOb l. ? II-
RELIANCE STRNDARD
Ufe Insurance Company
Check No. 3001374800
a DftMcompany
CLAIM NUMBER: 2007~219-082
CUMBERLAND TRUCK EQUIPMENT CO. EXAMINER:ANNA
INCURRED DATE: 06/14/2007
SERVICE FROM: 06/14/2007 TO: 06/14/2007
GROUP NUMBER: GL00140381-
- - --- - - - - - - - - - - - ------ - - - - - -- -- --- --.. - -- - - - --- --- - ------ -------- ---- - - ---- ----
DESCRIPTION OF PAYMENT
WAGE BASE
AMOUNT PAID
TOTALS
$6,500.00
$6,500.00
GROUP LIFE BENEFIT
EXPLANATION OF BENEFITS
424 THIS PAYMENT REPRESENTS THE GROUP LIFE INSURANCE BENEFIT.
MAIL TO:
O'BRIEN, BARIC & SCHERER
ATTN: MICHAEL A. SCHERER
19 W SOUTH ST
CARLISLE PA 17013
~
ORRSTOWN
BANK
A Tradition of Excellence
77 East King Street
P.O. Box 250
Shippensburg, PA 17257
July 27,2007
To: O'Brien, Baric & Scherer
19 West South Street
Carlisle Pa 17013
From: Traci Shaffer
Orrstown Bank
Customer Service Center
PO BOX 250
Shippensburg, Pa 17257
Re: Estate of Ruby I Gehr
Date of death July 10, 2007
IT IS HERERBY CERTIFIED THAT THE ABOVE NAMED DECEDENT, ON THE
ABOVE DATE, HAD THE FOLLOWING ACCOUNTS WITH ORRSTOWN BANK.
CHECKING ACCOUNT
Account # Title of Account
143000484 Ruby I Gehr
Date opened
08/04/04
Principle
469.18
Accrued Interest
0.00
SA VINGS ACCOUNT
Account # Title of Account
Date opened Principle
Accrued Interest
CERTIFICATE OF DEPOSIT
Account # Title of Account
Date Opened Principle
Accrued Interest
[.',0:\ ,<4 ,,~ ~ ''''i''' ~ ri~~
.. ," .~. ,( ",..,,'~ 'j ::.':J ,0'
r~11~7~oo7~'c'1
{ I
i'.a.\.'.&\.Wl.U illh1_{l~i'j.1Il'UJ I J
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MEMBERS 1st
FEDERAL CREDIT UNION
SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
250297 -00
08/31/2004
$5.00
$.00
$5.00
None
LOAN ACCOUNTS:
Account NumbeoSuffix
Date Loan Established
Principal Balance at Date of Death
Loan Type
Interest Rate
Collateral Held as Security
Name of Co-Borrower
250297-03*
10/18/2005
$4,295.06
Unsecured
10.50%
Signature/Contractual Pledge of Shares
Charles Nelson
*Loan paid by credit life insurance.
LOAN ACCOUNTS:
Account NumbeoSuffix
Date Loan Established
Principal Balance at Date of Death
Loan Type
Interest Rate
Collateral Held as Security
Name of Co-Borrower
250297-04*
01/27/2006
$486.57
Unsecured
9.40%
Signature/Contractual Pledge of Shares
Charles Nelson
*Loan does not have credit life insurance.
LOAN ACCOUNTS:
Account Number/Suffix
Date Loan Established
Principal Balance at Date of Death
Loan Type
Interest Rate
Collateral Held as Security
Name of Co-Borrower
250297 -05*
01/27/2006
$8.041.89
Used Vehicle
7.24%
2002 Jeep Grand Cherokee Laredo/Contractual Pledge of Shares
Charles Nelson
*Loan does not have credit life insurance.
~~BERS 1ST FEDERAL CREDIT UNION
l))~~,(.L~
Danielle A. Kline
Insurance Services Specialist
August 15. 2007
Estate of: RUBY GEHR
Date of Death: 07/10/2007
Social Security Number: 177-42-4957
" ~
1.'-- ..,..-~ ~" ,..-.. ....,.."'\~."'!":" "';'"',
I' f*1b1.(:i~j~-?\rl
' . .-----.-
o
5000 Louise Drive . Po. Box 40 . Mechanicsburg, Pennsylvania 17055 . (717) 697-1161 · "\vww.memberslst.org
MCHS Carlisle
940 Walnut Bottom Road
Carlisle, PA 17015
(717) 249-0085
STATEMENT
Patient: Gehr, Ruby (27134)
location: -
Statement Date: 2/1/2008
Obrien, Baric & Scherer.
Obrien, Baric & Scherer
19 West South Street
Carlisle, PA 17013
,PA
PLEASE DETACH AND RETURN WITH YOUR PAYMENT
Amount Due $1,992.50
Amount Enclosed $
MCHS Carlisle
940 Walnut Bottom Road
Carlisle, PA 17015
(717) 249-0085
Patient: Gehr, Ruby (27134)
Location: -
Statement Date: 2/1/2008
Date
Description
Units Unit Amount
Amount
BALANCE FORWARD
6/26/2007 Medicare A Co-insurance Jun 26-30 2007
6/26/2007 ** Medicare A Co-insurance Jun 26-30 2007 **
7/1/2007 Medicare A Co-insurance Ju11-6 2007
7/1/2007 ** Medicare A Co-insurance Ju11-5 2007 **
7/6/2007 ** Medicare A Co-insurance Jul 62007 **
5
~5
6
-5
-1
$124.00
$124.00
$124.00
$124.00
$124.00
$1,992.50
$620.00
($620.00)
$744.00
($620.00)
($124.00)
BALANCE DUE
$1,992.50
In order to prevent collection letters we would greatly appreciate your payment be made by the 12th of the month.
~@.~
Hollinger Funeral Home & Crematory, Inc.
Eric L. Hollinger, Supervisor
501 North Baltimore Avenue
Mount Holly Springs, Pennsylvania 17065
STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED
Charxe. are only for those ilems that you selected or that are required. If we are required by law or by a cemetery or crematory to u.<e any items. we will
explain the reason in wtiling below.
If you selected a funer.t\ that may require embalming, such as a funeral viewing, you may have to pay for embalming. You do not bave to pay for embalm-
ing you did not approve if~ se~ed 'Te;l such as direct cremation or immediate burial. If we cbarged for embalming. we wil!9-p!ain why below.
For the Service of ~ r __~HR Date of Death ~/~7/~A'a:J7
Charge 10: LVLLY.Af ~ ~#f~P 571} ;f'{Kd ~d;Y
~ame Address City , State
A. CHARGE FOR SERVICES SELECTED:
I. PROFESSIONAL SEIMas
Services of Funer:d Direaor/StaIf .
Embalming ..
Other cIOfhing
Cremation urn4-ktl.t0. . . $~
(De",nptionl6b;i" ~'~.t/
/- v//c, / __~
OTHER . / $_
$_ ....B$~.c(.
/'
....$_
$-
~Prepa..tiond~ ~
'F/IIy~ :;/ 71- // ~ wit!
.............................. $
SUB-TOTAL OF PROFESSIONAL SERVICES. . . . . . . . . .AI $_
TOTAL MERCHANDISE SELECTED
C. SPEOAL CHARGES:
Forwarding of remains to
,
I
~
2. FACIUTIES MiD SElMas
Use of facilities and oervices for
viewing ('VlSitation:''':"ue) .
Use of facilities and oervices
for rune..l ceremony $_
Use of facilities and ~ lor (Fune..1 Home)
Memorial Senicef:!)ltVl!t-et. ~. . . $ V. /1 / Immediate Burial O~.. .~.. $~,......
Use of <quipmenl and services ~ et:bQ Dtrect Cremat~ er~.. $-L.Z.A:>
forgraVesideserviceb!r/"LfI $."...!....J..L 7)JSt!- n ~ ~ 7J $- JeOr- ~
Other use dfaci1itiC5 nv7e~J'7. /h/ SUB-TOTALOFSfEOAL GES . .... .... ....C $~.
........... $~' ~~ F-d D. CAS~:V~~)1!:$1. ... $dfi/2
SUB-TOTAL OF FACIUI1ES/EQUIPMENT . . . . ..A2 $_ Cemetery Equiptnent .............. $~
3 AIJTOMOmr: EQLlPME'IT LoI and Deed ....... 0....' rL" .. $~
. Newspaper Nolice...Local,)"i't:"t.: . . . . $ /J__
: _ ./ Newspaper Notices-Out4-town . . . . . . $ ~~
:~~Ie .[~ .~.~~ ~~.~ .F~~~ ~.~---L..L- Telephone & Telegrams $_
He3rse (Casket Coach) Airfare. . . $
=us~ .$- ~~~~~~e~~.:.. :::: 7S-
Local .... $- Certified Cueie. ofthe~tw....... $-----r-n-
Family car CertifiC3te/O .X,)1S!I'".~....... S~
='er car or IIonI di>position . . . 1_ P~~:';:';ici-iO?~d: :~
~Cff.!-M"'(: V ~~~;;y;~.....,
Local ..$- ~'1Z,<'l). ~//J
Out of town tranSporUtion . . $- ~. l~-""- _ $~ ~
1_ ~TOTALOF VANCES.......................D $.!:9$":
SUB-TOTAL OF AI.lTOMOTIVE EQUIPMENT. . . . . . . ..M $_
TOTAL OF PROFESSIONAL SERVICES,
FACIUIlES A..'lD AUrOMOTIVE
EQUlPMENI'
$_
....$_
(Funeral Horne)
Receiving of remains from
$-
We charge you for our services in obtaining:
(specify cash ad,...nces tbat a,. marked-up)
..A$_
B. CHARGE FOR MEROIANDISE SELECTED:
Casket ... $_
(Description)
SUMMARY OF CHARGES
A. Professional Services, Facilities and
Equipment. and AutomOlh'e
Equipment
B. Merchandise
C. Special Charges
D. Cash Advances
TOTAL OF AU. SECI10NS
PAID AT TIME OF OR PRIOR TO
11th ARRANGEMENTS............................. $
~.fJt1 ~;;m~~~(4j6;;d~-
If any law, cemetery, or crematory requirements h3ve required the purchase (
of any of the items listed above, the bw or requirement is explained below.
...$----
....$~.
....$~
....$~
. ... s;uLs: ~
Other Receptacle
(Description)
Outer huri31 conuinct
(Description)
..1_
.$_
Acknowled~yuds::... Z:.... $ ~
Register book(~~t;Yt'''. $~
Memory folders ~L~r#int:Y~
Prayer cards .................... $_
Temporary gra,'e marl<er . . . S_
Burial cIorhing . . . . $_
I agree lhal I have examined the ilems of goods and services selected above and found lhem to be correct and according to the arrangements 1 have requested. I acknowledge
receipl of a copy d this StoIernent of Funeral Goods and Services Selected. 1 represent lave sullkiem funds available for p3yment of the cash price for the goods
and services seletted I also agree 7~ p3yment of $ within days. 1 agree to be jointly and severaUy liable with n.:.. else who
.igns below. A !ale cIwge d per month amounting to e1. per year will be applied to the unp3id balance beginning _ days
from the date of this agr=nent~ 1 also p3Y to the Funeral D~ettor b1e costs p3id by the Funeral Director to collett amounts I owe under this agreemenL
Those costs may indude aaorneys' fees, coon costs and other costs. Any additional services or merch3n<lise ordered or requested after the date of this agtttmenl will
be con.' red d this t and the """ ill be ret1ected on the ftnal bill or statement.
-""""""
-tJ/1'l3;;L.
180-l Washington Blvd
Mailstop -l50
Dept 03
Baltimore, MD 21230
NCO FINANCIAL SYSTElVlS INC
Calls to or from this company may be monitored
or recorded for quality assurance.
877 --l02-2599
OFFICE HOURS:
8AM-9PM MON THRU THURSDAY
8AM-5PM FRIDAY
8AM-12PM SATURDAY
Nov 2, 2007
604.114
CREDITOR: CITIFINANCIAL
ACCOUNT #: 3306580312567
REGARDING: PAST DUE BALANCE
PRINCIPAL: $ 5-l57.92
INTEREST: $ 0.00
INTEREST RATE:
COLLECTION CHARGES: $ 0.00
COSTS: $ 0.00
OTHER CHARGES: $ 0.00
TOTAL BN-ANCE: $ 5-l57.92_
AY2214
RUBY I GEHR
21 HIDDEN NOLL RD
CARLISLE, PA 17013
* * * SETTLEMENT OFFER * * *
We can accept $3820.54 as a lump sum settlement of the above amount. This offer may expire without notice. Before
making payment, please confirm with one of our representatives that this offer has not expired.
If you have any further questions or need assistance, please contact us at 877-402-2599.
You may also make payment by visiting us online at www.ncofinancial.com. Your unique registration code is
CA Y22140-328VBG.
.,
~.. .t'~ /"1 "":'~'\ 1ll ", '1 !~h-F';
f':>.""",,."" I. '-,"",-,..." '~. >. ! ~.. '~"1.."
. ~~~,'il'1-J~"':':'~S:'
- .-
This is an attempt to collect a debt. Any infomlation obtained will be used for that purpose. This is a
communication from a debt collector.
._________________!:!:~~~_~_~_~]:~~~_!~~?~_~~!~~_~IT_~_2:~':l_F3_.!:~~~_~_~_"!"j~_~..f55_~~~~~~~~~~~~~O~~_T_':l_~9_~~~_yvl~~<?wL__________
Account #
A Y2214
RUBY I GEHR
Payment Amount
Total Balance
$ 5-l57.92
.
$
.
Check here if your address or phone number has
changed and provide the new information below.
Make Payment To:
1...111.1,,1,.1,,1.1,1111,,1.1.,1.,1,1.1,,11...1,1..11,1111,.1
NCO FINANCIAL SYSTEMS
PO BOX 15456
WILMINGTON DE 19850-5456
010300AY221440000001400000000005457928
NCO E2
114