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HomeMy WebLinkAbout02-0053PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of ~ t~ ~{ O ~4~'~ ~, ~0 l..~ No. also known as ~3 / ~ To: Deceased. Social Security No. ] ~ ~-~ ~ 5~ '-" ~-z?7,~ 21.02'53 Register of Wills for the County of P_' U od l~t~e n,~in ,the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, appl .t c ~-rr~t/for letters of administration on the estate of (d.b.n.; pendente lite; durante absentia; durante minoritate) the above decedent. D cendent was domiciled at death in 9 k~ c~, /p ~/_ ~v~ r~t.~ Count , Pennsylvania with ~¢ Y ~ , h /-~ last family or principal residence at (list street, number.and ~nunicipality) - Decendent, then __' ~--~-'~ _ years of age, died ~.~ ~'~ ' ~. '~9. ~ , q~- Z ~ ~ J at. '73 q[coKI;I ~ mtJ~' b°~'Q k-C I-q ~ /L/) ¢._C'~:'.~j,~.('% 'ix'tO Decendent at death owned property with estimated values as foillows: (If domiciled in Pa.) All personal property $ (If not domiciled i'n Pa.) Personal. property in Pennsylvania $ (If not d0~miciled in Pa.) Personal property in County $ Value of r~i] estate .in Penn'sylvania $ situated as follows: P,tc~ ~ ~: Petitioner. the following spouse (if any) and heirs: jr) ~ - Name ao. d ,,%. after a proper search haft' ascertained that decedent left no Will and was survived by Relationship THEREFORE, petm6ner(s)~respectfully request(s) the grant of letters of administration in the appropriate form to ~h~ unde~s~gned. OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF CUMBERLAND The petitioner(s) above-named swear(s) or affirm(s), that the statements in the foregoing petition are true and correct to the best of the knowledge, an.d belief of petitioner(s) and that as personal representative(.s) of ~he:above decedent petitioner(s) will well and truly administer th~e-e~ta&,according to law. Sworn to or affirmed~ ~an~!' subscribed before-me this' 14th.~ ~_ :"- ~ day of !/// ~ '' ~t9c2002 J~AURY 7 ~ ~ - - ~ ~ ~-: ~.~- ..- ,-- © O '-- ::5' Es~te 0~, ~ , ~w~ ~oss ~ ' , Deceased ~NT OF LETTERS OF ADMINIST~TION AND NOW JANAURY 16 Y~2002 , inconsideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED 'that JUDY METZ EAGLE is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to JUDY METZ EAGLE in the estate of DAVTD ROg.q EAGLE FEES Letters of Administration '. .... $ 25.00 Short Certificates( ) .......... $ 9.00 Renunciation ................ $ 5.00. JCP $ 5.00 TOTAL __ $. 44.00 Filed ...J..AN.....1.6. .......... 'A.D. ~1~) 2002 ' "~ / --'-: ~Re~er of Wills/ ' / A~ORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE RENUNCIATION 21-02-5~ To the Registe? of Wills of ~_..Y/,n~ 6 e o' /~F.~/~ ~_~' County, Pe~sylv~ia. the above d~edent, hereby renounce(s) ~he ri~t to .adjuster the estate ~d resp~tfully ~k(s) that Letters - ~ /~ ~. WITNESS. hand this t/ day of 0,/ (Signa rt~e) (Address) · (Signature) (Address) (Signature) (Address) t05.9OSMS ~V.(09/0~) 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. WARNING: It is illegal t'o duplicate this copy by photostat or photograph. Robert S.(Z.~a4nerman, Jr., MPH Secretary of Health 011743~ No. 21-02-53 Charles Hardester State Registrar JAN 0'4 2oo2 Date H105.144 Rev. 1191 PERMANENT COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH (Coroner) David R Eagle ale .. November 4. 2001 AGE {Lasl B*tzhday} UNDER,YEAR UNDER 1 DAY DATE OF BIRTH BIRTHPLACE (Crly and I PLACE OF DEATH (Check on~y ..... 25 June 9. 1976 Nodh Little Rock, o.,~o.t ~ ER/Out.atlent ~D~ HomeUUrsi"9 ~ ~ ~her Arkansas Resi~nce (S~i~) WAS C EDENT OF HISPANIC ORIGIN? ........ G~,ty) RACE'Americanlndla~,Black, Whlte, etc. ~ite Cumberland Upper Allen Lot 73, Roll'o Court ~M,~=~.:.o*.~.~ ' ..... ~Op~br Warehousing Elemena~econ ~t~ Collie" ........ ~0. Wi~, ( ...... give ma~ .... ) 73 Rolo Cou~ I~CT~ ...... s ........... . ES DENCE decca Mechamcsburg Pennsylvama 1705~,,~,~ Cumberana er i e} U township? No ~eden ired E~ ' . J( 17b. Coumy 17d.~ withinacua m so ' .... o ....... o, ~,,~os ....... ~ ..... ~ ~.~,m~ o.. ~s~,~. ~1 Nov ~, ~001 J uonolRe uremato~ I Schaefferstown ~ennsylvania 22 ' ~, I ~-~/~/DD-E I MyersFuneral Home Inc 37 East Main Streel Mecham~burg Pa ~ =, 5'00 p ~ J=~ November 4, 2001 ,'~,,~ ~%'~]')L . Dilated Cardiom~opathy ' . ~ ~ ~ ~ I acclo*m ~ Pending Investlgat~n ~ i3Oa. [30b. M [3~ 13~ ' ' Tothe~stotmyknowledge, deal~curmdalthetime, o.te, a~place, an~uetolhecau,es andman~ ..... t~t~ ................. ~ .~. Il,.. December 20, 2001 'MED2CALEXAMINERICORONER , ltem27)Typeo~Print Nlchae[ L. Norrls. Coroner ~*...,...t.t~ .......................................................................... 6375 Basehore Road. Sulte ~tl Hechanlcsburg. Pa. 17050 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Will No.: To the Register: Name: Mr. and Mrs. David N. Eagle DAVID ROSS EAGLE 11-4-2001 21-02-00053 I certify that notice'of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on October 17, 2000: Address: 3902 Chestnut Street, Camp Hill, PA 17011 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None Date: COYNE & COYNE, P.C. f/a Marie Coyne,/Esquire /'/3'901 Market Street VCamp Hill, PA 17011-4227 (717) 737-0464 Pa. Supreme Ct. No. 53788 Counsel for Personal Representative IN RE ESTATE OF: DAVID R EAGLE AFFIDAVIT OF ACCOUNT The undersigned, being first duly sworn deposes and states the follows: Your Affiant is authorized by the Claimant as its Attorney-In-Fact to make this Affidavit. Your Affiant has reviewed the account records of the Claimant with respect to the decedent. Your Affiant is familiar with these records and accounts and reviews them as a regular part of her duties. The Decedent purchased merchandise in the atnount of $1,322.46 evidenced by account number 0178825597580. The unpaid balance does not include any late payment charges, accrued interest, collection costs or attorney's fees. Further your affiant sayeth not Chelsea A. Jagusch~/' Angela M. Horn __ Balogh Becker, Ltd. 4150 Olson Memorial Highway., Suite 200' Minneapolis, MN 55422-4804 Subscribed and sworn before me This /4g4~day of/r~ff~d.~_.~, 2002. AFFIDAVIT OF MAILING I, (~,~'~ ~'~¥'~.("~'~ , declare under penalty of perjury that on SII~!~"~. Iplaced the envelope for collection and mailing on the date and place shown below following our ordina~ business practices. On the same day that correspondence is placed for mailing, it was deposited in the ordinary course of business with the United States Postal Service in a sealed envelope with postage fully prepaid. Personal Representative: JUDY METZ EAGLE 3902 CHESTNUT ST CAMP HILL, PA 17011 Attorney for Estate: HENRY S COYNE 3901 MARKET ST By:~CAMP HILL, . Date 3/tql. oz_ i' COMMONWEALTH OF PENNSYLVAN~CO~aau**~-Ce RS~t~:; ','COURT OF COMMON PLEAS OF CUMBERLAND .COUNTY ORPHANS' COURT DIVISION · oTzc 25 :54 Xn Re: The Estate of: DAVID R EAGLE Deceased Cou~ Fil~ No: 21-02-00053 Cumbe ', ........ TO: THE CLERK OF THE ORPHANS' COURT DIVISIO~otice of claim by creditor, Pursuant to Section 3532(b)(2) of the Probate, Estates, and Fiduciaries Code, 20 PA.C.S.A. §3532(b)(2). 1) Claimant's n. ame: SEARS, ROEBUCK AND CO. 2) 3) Claimant's address: CIO BALOGH BECKER LTD, 4150 OLSON MEMORIAL #200 MINNEAPOLIS MN 55422 8887629997 Creditor listed below is the owner and holder of a claim in the amount of $ 1322.46 4) The facts upon .which this claim is based is a credit agreement between Creditor and Decedent, identified as account number which is evidenced by the attached affidavit of account stated. 5) Decedent's address: 73 ROLO CT MECHANICSBURG PA 17055 6) Date of Death: 11/04/01 7) That the claim arose prior to the death of the decedent on or about 8) That the claim is secured by On behalf of the claimant, ! do solemnly declare and~ffirm under the penalties of perjury that they !nformation and representation~Cna~le herein are true and correct to the best_o~ ~ny knowledge, information and b~ief. / ~ ~ I ~ Cl~3~3ant CHELSEA a JAGUSCH, Aq-I-Y. Written notice of claim was given to Personal Representative and/or his/her counsel as stated below: JUDY METZ EAGLE Name 3902 CHESTNUT ST Address CAMP HILL PA 17011 City/State/Zip SEE AFFIDAVIT OF MAILING Date notice mailed COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) EV,, s00 INHERITANCE' TAX RETURN RESIDENT DECEDENT FILE NUMBER .21 COUNTY CODE 02 00053 " YEAR NUMBER SOCIAL SECURITY NUMBER EAGLE, DAVID R. I DATEOF BIRTH (MM-DD-YEAR) l 1/04/2001 06/04/1976 IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE.INITIAL) [] 1. Original Retum [] 2. Supplemental Return [] 4. Limited Estate [] 4a. Future Interest Compromise (date of death after 12-12-~2) [] 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attec~ of W~II) copy of Trust) [] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) Lisa M. Coyne, Esquire :IRM NAME (If applicable) Coyne & Coyne, P.C: 717/737-0464 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Mens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 166-68-5473 THIS RETURN Mus'r BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIALSECURITYNUMBER [] 3. Remaincle~ Relant (date of death pder to 12-13-82) [] 5. Federal EstateTax Return Required 8. Total Number of Safe Deposit BOxes " [] 11 .Election to tax under Sec. 9113(A) (Attach Sch 0) 3901 Maxket Street Camp Hill, PA 17011-4227 None · None None None 17,475.00 266.71 None 5,628.00 50,797.47 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to lax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Erie 13) -- (8] (11) (12) 17,741.71 56,425.47 ' . insolvent'.' '- (13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPUCABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or tmnsfem under Sec. 9116(a)(1.2) x .00 (15) 16. Amount of Line 14 taxable at lineal rate x .045 (16) 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due x .12 (17) x .15 (18) (19) )pyright 2000 form soft~ra~ only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) DeCedent's.ComP!ete Address: rSTREET ADDRESS ' 73 Rolo Ct. CITY Mechanicsburg STATE PA ZIP17055 Tax Payments and Credits: 1. Tax Due (Page I Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 1 Line 20 to request a refund 5. If Line1 + Line 3 is greater than lJne 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) 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 Ne a. retain the use or income of the property transferred; ............................................................................. [] [] b. retain the dght to designate who shall use the property transferred or its income; ................................ [] [] c. retain a reversionary interest; or ............................................................................................................ [] [] d. receive the promise for life of either payments, benefits or care? .................. · ........................................ [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................................... [] [] 3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death? ...... [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ............................................................................................................... [] [] · IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE ITAS PART OF THE RETURN. Ur.,~ p~,-~aW~e~ of perJuw. I (~,~,~-e that I have e,,~fi~;..ed this return, including accompanying schedules and statements, and to the best of my knowledge and beik~, it is t~'ue, correct and complete. Dectam§oa of peeparer othe~' ~ the personal representaUve is based o~ all information of which preparer has any knowledge. SIGNA~;I~RE OF PERSON RESPONSIBLE FO~,iFILING ~-"rURN ADDRESS 3902 Chestnut St. Camp Hill, PA 17055 3901 Market Street Camp Hill, PA 170114227 ' z~- .~"~ oz.,. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value.of transfers to or for the use of the sup/k, ing spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The lax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's sibiings is 12% [72 P.S. §9116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in. common with the decedent, whether by blood or adopUon. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ', 'SCHEDUEE E-~.:,~- 'CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER EAGLE, DAVID R. 21 - 02 - 00053 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 DESCRIPTION VALUE AT DATE NUMBER OF DEATH Miscellaneous personal property and furniture 1992 Ford Tempo-- 75,200 miles, fair condition (Bluebook Value) Trailer-- Purchase price (2001) TOTAL (Also enter on Line 5, Recapitulation) 1,000.00 1,475.00 15,000.00 17,475.00 Kelley'Blue Book Used Car Values Page i of 2 Th~ Twsted Resource New Car Pricing Build a C~r ~ncentlve~ I~ly Car's Value l~ed Car Retail Buy a New Car Buy a Ust~d Car Sell YOur ~ Motorcycles Financing ~nsuranCe ~n Clteck wafl-anties ~Hes ¢~ Pr~ie~ DeCiSion Guides Home I real cam. rea~ prices, rea!'time: Click on the image above to visit this advertiser' Blue Book Private Party Report PonnsylYania · FeBruary 15, 2002 1992 Ford Tempo GL Sedan 2D Engine: 4-Cyl. 2.3 Liter Trans: Automatic Drive: Front Wheel Drive Mileage: 75,200 Buy a New Car Buy a Used Car List Your Car For Sale Online Financing Quote Insurance Quote Warranty Quote Payment Calculator Equipment Air Conditioning Power Steering Cruise Control AM/FM Stereo Cassette Consumer Rated Condition: Fair "Fair" condition means that the vehicle probably has some mechanical or cosmetic defects, but is still in safe running condition. The paint, body and/or interior need work to be performed by a professional in order to be sold. The tires need to be replaced. There may be some repairable rust damage. The value of cars in this category may vary widely. A clean title history is assumed. Even after significant reconditioning this vehicle may not qualify for the Blue Book Suggested Retail value. Private Party Value $1,475 Private Party value represents what you might expect to pay for a used car when purchasing from a private party. ]:t may also represent the value you might expect to receive when selling your own used car to another private party. Get a Used Car Trade-Zn Value Get [nvoice& MSRP on New Cars h.../kw.kc.ur?kbb;308057&;p&722;Ford; 1992% 20Tempo&Il; FO;V3 02/15/2002 ACCOUNT: 00000000 A.PPL~f: 5359442 BILL OF SALE KNOW ALL MEN BY THESE PRESENTS, that the undersigned in consideration of $ does hereby grant, bargain, sell and transfer unto DAVID R. 7_~GLE 73 ROLO COURT (Buyer) of MECHANICSBURG, PA 17055 (Address of Buyer) 15500.00 the goods and chattels hereinafter described. New or Year Make.or Length or ' Color or Mfg Serial Used Trade Name Description Model Number USED 1990 70 X 14 SPRUCERIDGE 501109782 TO HAVE AND TO HOLD all and singut~r the said goods and chattels to said grantee(s), (its) their successors and assigns. The undersigned covenants with said grantee(s) that the undersigned is the lawful owner of said above described unit that is free from all encumbrances, except as set forth below, that the Undersigned will warrant and defend same against all lawful claims and demands of all persons. '(EXCEPTIONS) LIENS OR ENCUMBRANCES Address '.' .'.",'j.'~ WITNESS the'.l~d'.; In favor of ~'~ ~/'~---- Amount Due $ / (If no~l~'~ exists write'"NONE" above) o, the undersigned this ~' day of 71~;~¢'~'~, ,~. (Seller sign here) (If seller is a corporation show corporate name above with signature and title of corporate officer below) Witness or Notary Public: X By X (Two witnesses must sign) (Title) GT- 18-00-043 jmboszz COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER EAGLE, DAVID R. 21 - 02 - 00053 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Jud. y Metz Eagel Mother 3902 Chestnut Street Camp Hill, PA 17011 JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM LETTER DATE Include name of financial institution and bank account number DATE OF DEATH DECD'S FOR JOINT MADE VALUE OF NUMBERTENANT JOINT estate.°r similar identifying number. Attach deed for jointly-held real VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1 - A. 05/10/1994 PSECU Checking Acct. 527.26 50~ 263.63 2 A. 05/10/1994 PSECU Savings Acct. 6.15 50% 3.08 ¢ TOTAL (Also enter on line 6, Recapitulation) 266.71 · ..: .~ ,:' Checking Accounts: ' ~i ,.'. :'". :~: · ' ' ,,73.'i¢ Number: ~_':,,:.%. ~,?.:' · · 'b. ~,% ~. ,.: .~ Nme of Jo~t :~.-.::, '~? ~?}?Om~, if ~y: · '.: :. Bal~ceatDa~ ~ ~ · of Dea~: ,, ,:.~;. Nmber: "'01,66685473 0166685473 Date Opened: '..3 Name of Joint Owner, if any: Balance at Date of Death: Maturity Date: ".' Interest Rate: Name 0fBank: PSECU Si(~ture of Bank or Savings A~soc OffiCial Interest Paid Quarterly, Semi-Annual, etc. ~" Others: Estate off David Ross Eagle COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER EAGLE, DAVID R. 21 - 02 - 00053 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER Ao 1. 2. 3. 4. 5. 1 2 3 FUNERAL EXPENSES: Myers Funeral Home, Mechanicsburg, Pennsylvania Honorarium Flowers Reception Grave Marker and Engraving ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Secudty Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees Coync & Coy~e, ?.C. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent Probate Fees Register of Wills State Zip Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Legal Advertisement-- Cumberland Law Journal Legal Advertisment-- Patriot News Filing Fee-- Inheritance Tax Return Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) 2,204.00 100.00 100.00 200.00 700.00 1,500.00 44.00 75.00 100.00 10.00 595.00 5,628.00 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Schedule H Funeral Expenses & Administralive Costs conlinued ESTATE OF FILE NUMBER EAGLE, DAVID R. 21 - 02 - 00053 Death Certificates-- additional Reserves Taxes Due-- 2001 Cleaning of Trailer-- Mr. N. J. Bahn 15.00 100.00 100.00 380.00 Page 2 ofScheduleH COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER EAGLE, DAVID R. 21 - 02 - 00053 Include unreimbursed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Comcast Cable Lower Allen Ambulance Association Merk Medco Hurley State Bank (Shop At Home Account) Bowflex Account American Express Account AT&T Universal Mastercard CitiBank Mastercard Sears Account Providian Account Associates National Bank Account Agway Energy Products Pinnacle Health Franklin Mint Gateway Computer Account U.S. Department of Education Judy Eagle PSECU Personal Line of Credit Rolo Court Lot Rent Conseco Company -- Secured Loan for Trailer Total of Continuation Schedule(s) TOTAL (Also enter on Line 10, Recapitulation) 121.20 384.00 10.00 593.78 2,245.50 1,449.31 7,274.85 3,901.62 1,270.24 680.89 738.39 36.55 220.00 213.01 1,986.68 129.41 7,500.00 5,499.64 280.00 15,560.00 467.40 50,797.47 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS continued ESTATE OF 'FILE NUMBER EAGLE, DAVID R. 21 - 02 - 00053 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 21 22 23 24 25 26 Wellspan Medical Group Cumberland Valley School District Milton Hershey Physicians Carlisle Emergency Physicians Holy Spirit Hospital Quantum Imaging 235.00 213.40 40.00 148.00 25.00 41.00 Page 2 of Schedule I COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE Do Not List Trustee{s) ~'o TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 Mr. and Mrs. David N. Eagle Parents 100% of Residual Estate Enter dollar amounts for distributions shown above on lines 15 through 17, as appropriate, on Rev 1500 cover she~ II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE T EAGLE, DAVID R. FILE NUMBER 21 - 02 - 00053 ' Estate Recoveri, es, Inc. Over 15 Years of Service tO ~he Financial Industry May 30, 2002 Register Of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013-3387 !Ssa:ate O.!' Day. Cd'R:-- Eagle, deceased. Our File#~ Estate' #:~ Dear Si~;~aadara .... ~ ...... Enclosed please find our claim regarding the above captione.d' esta, t~,which is being filed.on,behalf,bf~American Ex~r..ess, ,creditor. . -':,'.:: :4 ..... ' ...... .~ .'. ~,i ,.~ j' :.,,.';.[.;:",.: · A:6opy of this claim is being forwarded to Judy Eagle, Representative for the es{ate. If yc}u have' any'q~estiofls concerning the attached claim, please do not hesitate to contact this office. Sincerely, J~u~kirk, Ext. 156 See Reverse Side For Special State Disclosures. This communication is from a debt collector. This is an attempt to collect a debt and any information obtained will be used for that purpose. P.O. Box 24566, Baltimore, Maryland 21214 · 5543 Harford Road, Baltimore, Maryland 21214 Monday- Friday 8:00 am- 6:00 pm Eastern Time · Telephone: 410-444-8022 · 800-229-8472 · Fax: 410-426-4051 SpeCial State DisclOsures Colorado You may request Estate Recoveries, Inc. to cease calling you at your place of residence or place of employment.,", This request must be in writing and once received no further contact by telephone shall be made. ..~ .... ~ If you refuse to pay the debt or you wish Estate Recoveries, lnc. to cease further Comn~unication with~you, then this agency will not communicate further with you with.respect to such debt except for a written communication which: a. Advises you that this agency's further efforts are being terminated; b. Notifies you that this agency may invoke specified remedies which are ordinarily invoked by .this agency; or c. Notifies you that the agency intends to invoke a specified remedy permitted by law. Estate Recoveries, Inc. is licensed by the Colorado Collection Agency Board, 1525 Sherman Street, Fifth Floor, Denver, Colorado, 80203. Do not send pay~nents to ihis BOard. ' ': Maine The business hours for Estate Recoveries, Inc. are Monday - Friday 8:00 a.m. - 6:00 p.m. Eastern Time. This agency may be contacted using the following numbers: 800-229-8472 or 410-444-8022, Fax: 410-426-4051 Massachusetts " Notice of Important Rights: You have the right t° make a written or oral request that telephone calls regarding your debt not be made to you at your place of employment. Any such oral request will be valid for only ten days unless'you provide written confirmation ofthe request postmarked or delivered within seven days of such request. You may terminate this request by writing to Estate Recoveries, Inc. · Minnesota Estate Recoveries, Inc. is licensed by the Minnesota Department of'Commerce. New York The license number for Estate Recoveries, Inc. in New York City is as follows: 0976707 ....................... ~N'o'rth Carolina The permit number for Estate Recoveries, Inc..in North Carolina is as follows: 3523 Tennessee This collection agency is licensed by the Collection Service Board, State Department of Commerce and Insurance, 500 James Robertson Parkway, Nashville, Tennessee 37243. IN THE MATTER OF ESTATE OF: DAVID R EAGLE A/K/A ** DAVID ROSS EAGLE ** STATE OF PENNSYLVANIA IN THE ORPHAN'S COURT, OF CUMBERLAND COUNTY ESTATE#: 21-02-00053 .. STATEMENT OF CLAIM 1 ....The creditor, American Express, certifies that there is due and owing by DAVID R EAGLE, deceased, the sum of ONE THOUSAND FOUR HUNDRED FORTY NINE DOLLARS ~ THIRTY ONE CENTS ($1,44.9.31). 2. The nature of the claim is a PERSONAL CARD account 373961143051003, which was established in 07/01/01. 3. The name and address of the claimant is: American Express, 40 Wall St., 16th floor, New York, NY 10005. 4. The name and address of the claimant's agent is: Jennifer L. VanBuskirk, Estate Recoveries, Inc., P. O. Box 24566, Baltimore, Maryland 21214. 5. ;l'his claim is not contingent and is not secured by any liens or judgments. 6. This claim is not based on any one instrument. Said balance has accrued since the account was established. On behalf of American Express, creditor, I do solemnly declare and affirm'under the penalties of perjury that the information in the foregoing claim is true and correct to the best of my knowledge, information and belief. ~IFER~NBUSKIRKi' -- - 'Estate Recoveries, Inc. P.O. Box 24566 Baltimore, Maryland 21214 (410) 444-8022 County of Baltimore, Maryland: IN WITNESS WHEREOF, I'hereunto set my hand and Notarial Seal this May 30, 2002. KJtTHLEEN M. SPINELL~, Notary Public My Commission Expires: June 1, 2003. 'IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION File No. 21-02-00053· Estate of David R Eagle A/K/A ** DAVID ROSS EAGLE ** , Deceased NOTICE OF CLAIM by JENNIFER L. VANBUSKIRK, AGENT FOR AMERICAN EXPRESS Filed Pursuant to Section 3532 (b)*(2) of the Probate, Estate, and Fiduciary Code, 20 Pa. C.S.A §3532· (b) (2) . To,the Clerk of the Orphans' Court Division: Enter the claim of ./EN~IIFER L. VANBUSKIRK. AGENT FOR AMERICAN EXPRESS (Claimant). - in the amount of $1,449.31 , against the above entitled estate. The Decedent, who resided at 'Mechanicsburg, PA 17055 , · .. (City) "·· Pennsylvania, died on 'November 04, 2001 Of said claim was given to Judy Eagle his Counsel) 73 Rolo Court (Street Address) , Cumberland written nOtice. County, (Persgnal Representative, or . If known to claimant, at 3902 Chestnut Street Camp Hiil~ PA 17011 (Address) ,on May 30, 2002 (Date) ~tT///tx~X~ d ~//~Claimant Post Office Box 24566, Baltimore, Maryland 21214 (Address) Claimant s Counsel: (Address) Cards Prepared FO~ DAVID R EAGLE * Indicates posting date. DUPLICATE'COPY ~)~', C... ' - (24 hours / 7 days) Page 1 of 3 www.amencanexpress.?,om Personal card Statement-of Account - Closing Date,'Account Number · ' Octobe~ 2, 200~ 3739-611'4~0-51003 Previous Card BeJance $ Card Payments/Credits $ New Card Charges $ ' New Car~l'l~lance $ Please Pay Immediately Your account is seriously past due. Pay by 10/24/01 to avoid delinquency charge. Please refer to page 2 for important information Card Transactions for DAVID R EAGLE . . . ~mou,t ~ regarding your account Card 3739-611430-51003 Activity for DAVID REAGLE Other Card Acc(~unt Transactions . New Charges' · Payments/Credits 0~00 :225.39 October 2, 2001' ' " :.' .... 33168 DELINQUENCY CHARGE ON i,347.02 Total of Card Activity ~ I;lew Charges 33.68' · ' Payments/Credits -225.39 Please fold on the ~_ dora.tion below; detJ~ch and return with yOUr Payment Coupon Account Nur~r 3739-611430-51003 DAVID R EAGLE 73 ROLO CT MECHBG PA 17055-58'61 Mail Payment to: Continued on reve'rse, ~ , Please Pay Please enter account Immediately number on all checks and correspondence. AMERICAN P.O. BOX NEWARK.NJ Total Amount Due $1,435.70 EXPRESS 1270 07101-,1270 To avoid additional Finance Charges on Purchases, pay New Balance before Payment Due Date. · Note any address and/or telephone number change · on reverse side. Unless you check here, this . change will apply to all of' your Card Accounts except any Corporate Card Accounts you may have. 0000373961143051003'000143570000003368 02rtd r , DUPLICATE COPY Prepared fo~ . , i . ~ ACcount Number ' "' ~ ': ' ' ' -.: .. ':' ,:'3739~611.430-510031 Page2of3 DAVID R EAGLE ~ ..... Payments:' Your monthly statement is payable in full ul~.n receiRt.. P,~yrne'.nts m, ust b~. in U;S. D6ilars .a. nd dra~n,'~n~, Telephone bank Iocate. d in th.e US ,a. nd(e.xcept for e, lectronic payments)-p~aced in the en01osea'enve~ope.with the remi~ance stun ana .'- Numbers . ' .tile account numoer inaicatea on your cneck. Do not send cash. PaYments r~ceived after 12:00 noon or~ on weekends or' ~ _ notidays'may not be credited unti/thenext business day. Please do-not:send post-dated checks. Theywill be.depoSited ' To ~ay By Phone ,uPon re,ce Pt..If paym. entis rnad.e'at any other location, there may be adelayin prOcessing: ff Your;check is:retUrned unPaid 1-800-472-9297. · .oy'youroankforinsurticientfunds, we maY re-preSent ydur checkelectronically: :. . . .. ' ~-~ ~:~ L_ost Or,Stolen Card: 'If theCard is lost or stolen in the United States, contact, us.immediately at 1'-800-992-3404. Customer serVice - Outside the U.S., contact the nearest American ~-xpress Travel serVice office ct: call us bollect~at 336-393:1 ! 11. You are 1-800-528-4800 fully protected against any fraudulent use of the-Card when You notify American Express'before it is fraudulentlY uSed...:-~/24 hours to free · YourmaximumhabilityiS$50shOuldyoufailtoreportitSlossortheft. ";. ' ' ~ .'::' · ' ?.~-i :.*~- : ~. : ' . ~ ' _ Charge Card and Statement Infonnation:. ' Ttie~annual'fee is $55.00' for'the' Basic"Card and $30:00 for each, . Ex,,ress Cash 'i~l ~; ' Addibonal Card An additional $5 is charged for billing.addresses outside the .U.St'.'Renewal Cards'are;issued every three ~ ~,~n ,-,,,gu ,.,,~,^, I ' y,.ears. If the Car.d yo,u ca,rry i,s damag~..d, you ma.,v .ha~e it~rep ac~.dlsobner by:calling Cust, omer' S. ervi.ce.' .You may ·-~uu- .... - ~j.' oiscontinue your nnemoersn~p Dy calling L;ustomer ~ervice.' ue sure to Keep Your copy of the Charge's~ips'to~' cempai-isdn :'. ..... to your billed charges. The Statement Closing Date is th'e last'date that charges and credits are ProceSSed to appear ,on the' - ,LO~St,,,or,,S~o~,n~,, ara · s, tatem_en, t. Your aCCOunt will be Past Due if payment for your'previous month's statement was received after the c~osifig ~ a_a. te.' to_keep your aCCOunt current, pay bythe payment due date shown on yours, tatement. : :. ~ = ' I nt I collect: Billing Hights Summary:. In Case of Errors.. o.r, QUeStions About Your uill: If you think your bill, s wrOng, o..r if you ~' 336-393-1111 n, eed more .information a~0ut a transaction wnicn appears, on- y0ur.statement, contact us at the L;ustomer bei~ice ', oepartrflenLindicated on your paper statement, or click on the C~Jstomer service link Online. We must hear from .you no,.. Hearinr, Imnaired later than 60 days.after we sent-you the first bill on which the error, or problem appeared. Although you may telephone.us;.' TTY' ~ s~n~)~-,~21 doinnsowill notnreserve your rights. . . . .'~'* - . . . . .: ..... ~ , , .. .....~ ... ~.o~v~. ~-ax ] ~uu ~ ~u~u Wha~ we Ne~c~ From You ~/hen You Have A.'Billing Inquiry: 1.' Your name and account number; 2. The dollar ~. · . ' ' ' ..... amount of the SusPectederror!-3, Describe.the.error and exolain, if you can, why you believe there is an error.' If.you nei~d :, , · more information, describe th~ item you are unsure afi0dt' ¥o~ i~16'hot'havb tO ~b.~, g. nY~.fno~idt'in~Cib~{tibn':Whil~ We!a?e~:~'~Addri~se~: .... ,'~.~-> investigating, but you are still ~bliga~ed to pay theparts.of your/billthat are 'not in question· While we inv~stigate~(dur!: .... ~.,ustomer berV,ce 'nertinen tovou da~minquiry' we cannot report you as delinquent or take any actibn to cbl!ect theamount in question'. Please retain anyrec~ip~s ' p O Box 297804 ,~ci-alt~l~r ~=~Charge Card Purch,se~: ff'~;ou have' a problem witil tile ,uaiity of:goods or s~rvices.th'a¥1y~u' ~3~lu. Td~)~ale, FL. purchased with the L;ard, and you have tried.in good faith to correct.the problem with the merchant; you may'not haveto.' ' r pay the remaining amount.due on the goods or service~. You have'this protection only When the Pu'rchase pn~e'was more ::- _ ~ , than $5Oand the p. urchase was made m your home state or within~100 mile~ of your mailing:address: (If we0wn or OPerate - .Express L, asn--. the mercl~ant or if we mailed you the adverti§'ement for the'l~r0Perty'or,serVices, all pUrcl~ases are coVe~'ed regardless of : Funds Access services amount or location of purchase.) . ' ' ' · ' ' ' ' ' -~ -'.' P.O. Box53809 Express Cash Information: incase of E~'rors °~;Q'uesti°n~ .~bout:Y6ur Electronic,.Transfers:~lf~youthini~y0ur ' Phoenix, AZ Express Cash statement or receipt is wrong, or if you need more information about a transfer on the Statement'~or i-eceipt;' ~: 85072-3809 ' ' qall1-800-CASH-NOW or write to the Express Cash ;~ddress indicated on your paper statement; or click on thb Customer ,~ · '" Service link online. We must hear from you no late[ than 60 daYS ~fter'we sent ~ou the FIRST Statement on.which the err. or Payments P.O. BOX 1270 NEWARK NJ 07101-1270 or roblemappeared. .. ' . . . .".,' . '. - i ' ... Wl~n contacting us: 1. Tell us your name and acc0bnt number; 2. Provide the'dollar·amouni of.the ~uspoctbd erroi'~. 3. Describe the error or the transfer you-are unsure of;and exPlain a§ Clearly as you Can why you believe there is an error,-- or why you need'more information. We will investigate yOur complaint and wdl correct any error promptly: If we.take more.. than 10 business days to do this we ,will credit your a~, uht for the amouht you th_ink is in e~or,.so that YOU Will have u, se ct" th, e..money d,urin9 the time ~t taKes us 'to ~mplete our 3n.vestig.abon.- ~..xpress L;as_h 'partici.,o~,ntS' .w. no n.a:~e." ~._n._an_ ec~t~h_eir bank a_c_cgunt must contact us to obtmn proper upaating rorms, un not Use bxpress Casn until the DanK., a~untcha~en~nfirmed. ' .~ ' .' ..... -'- ' . ' . : /. i' i'~'. Credit Balance: If a credit balance (designated "CR") is shown on'this statement, it represents money owed to you. You may make charges against the. credit balance Or r,eques,t a refund· Requests for refund,s, sltould be~made in w~ritingto,th,e ' Refund Unit at the Customer ~erVice address inai~ateaon your p~per'statement, or c~ick on the L, ustomer ~erV~ce ~inK online. If you do not make sufficient charges a~lain,,tthe c. redit balance or request a refund, we will, within 30 days after expiration of the six-month period folloWing the aate.of the nrst statement indicating the credit'balance, issue a check to YOu for the credit balance in your account if the amount is $1.00 or more; Important Notice to North Dakota Residents: an account is mst due for two or more billing Cycles,:',a late Payment fee of 1 :.75%of all past due amounts Will be added. Change o! Address Il correct on front Street Address ' City, State ' ~' ZipCed~ ' .. , Area Code and ' Hom~ Phofie. ' . Alea Code and Work Phone Email Providing your email addressto American Express will enable you to receive special offers, suitedto your needs. " Membership Rewards9 - '; ,_ ,. ' -. Page 3 of 3 Monthly state~eH't~aha~.~?" :,:. "' !: ,.',~-,~ cards _Program_ NeWS~'~:~*'~ _/__ ~ .... :/~. _,~.~:_~'..-_ ~ ................................................ · For questions a~ut' your- . ' Statement Period ' ' ,: ' .~ ~ . ] - ~-': ;._.. '.'.' ,,'., .... (:*', J--,: _ ~' , -, = r: - · J~-'.. ~- ~-~ i~ '~'k ~*~r r ~;~3,~,, '../z;,.A~u~t'~ty~a~er,th~s ~nod does'fiot;~ar on th~s state~ent~ :;, ,(* ;~,' .~.-'r; " i .. . . -4 ."'.' ' .,: '-~:L~':~','; · ~.~eric~expre~s.~m/rewar~,.'. ~h~bwAr~nt Nu~ .".' :". · -- ~ .: ,.:- ~.,, ....... .. .:.. ' _ .:' -'.. - J ~ . .. '." .'..'.': American Express: .-.. : - ,-. , - Mem~hip ~ewards - - Pointsare available when charges are paid in full ~nd all=your a~ounts'Are'in ' - : PO Box 2978f 3 ' : g~d st~ding. Ft. Lauderdate, FL 33329-9785' Point8 do not have expiralion dates. Account Summary Opening points balance New points earned Points transferred or redeemed Reinstated points and adjustments New points balance 0 +1,586 0 0 .. =1',586 08/01/01 - 08/31/01 Points Activity On Bonus Point~' Total Points Activity Eligible Charges Awarded Per Card Personal 1,586 0 1,,586 3739-611430-51003 -Totals .......................... ~embersh~ Rewards points earned may be transferred or redeemed as Ion~j as ail enrolle~ Card a~unts are in goad standing. Points transferred or redeemed cannot be reversed beck into the program,. For~lted points can be reinstated for a fee by Calling the number provided below. EIk:Jible Cand chargas are outlinod in tho Morn~r$1~ Rewards p*Ogram Terms arkl Conditions in your L-'-'-'-'-'-'-'-'-'~01 Rewards Guh:t~ ~ you hove qu~tioas 1-800-AXP-EARN [297:3276). From overseas call collect 305-816-2799. ' -' ' ' .,.. ' ',.. :' -" : .~ .: ,,,*:..-~": .-;!~,~ '~ . .: ..'.,,~ ,,'. i,~;~ ,?: ~.: .... ~, -, .. -,.,.. .: · ,-. . _ ...... '..:..: ~.._, .,,,, .,;~,; . ,~'~ ·...,'.:, ...~,. - DUPLICATE COPY . ". .. Customer_Service Page I of 3 Cards' ' ~ -~ .....:,,. .... 800-528-4800 - (24 hours / 7'days) - Personal Card Statement of ACcoUnt -. Plepared For CI0sing Date Account Nar~3er DAVID R EAGLE November 1,2001 3739-611430-51003 Previous Card BaJance $ Card Payments~red~ $' Indicates posting date. New Card C~iarg;;s $ 40,28 New Card 8ala~e $ Please Pay Immediately Urgent - cancellation pending, Pay by 11/23/01 to avoid delinquency charge. Card Transactions for DAVID R EAGLE Please refer to page 2 ' for important information ~mou'nt ~- regarding your account Card 3739-611430-51003 Activity for DAVID R EAGLE New Charges 0.00 Payments/Credits 0.00 Other Card Account Transactions November 1, 2001' ' 40.28 DELINQUENCY CHARGE ON 1,347.02 -- 'Tbtid-(~f-C~fd Abti~ity .................................. ' .... N~w-Ch~h3e~ ............ ~10;28 ........................ Payments/Credits 0.00 ~ P{~a. se fo,~jrot3 ?e pedoration'~lov;,Td~tech and ~etuin ~ith your pa~,.ment ~, Payment Coupon ~unt Number 37~9-6114~0-5t00~ DAVID R 73 ROLO MECHBG EAGLE CT PA 17055-5861 Continued *on reverse- ~ Please Pay Immediately Total Amount Due $1,475.98 Mail Payment to: AMERICAN EXPRESS P,O', BOX 1270 NEWARK NJ 07101-1270 Please enter account number on all checks and correspondence. To avoid additional Finance Charges on Purchases, pay New Balance before Payment Due Date. Note any address and/or telephone number change on reverse side. Unless you check.here, this change will apply to all of your Card Accounts except any Corporate Card Accounts you may have. 0000373961143051003 000147598000004028 01Hd DUPL!CATE COPY Prepared For - Account Number' Page 2 of 3 DAVID-R EAGLE ....... .: 3739-611z130-51003 Payments: Your monthly statement is payable in full upon receipt. Payme,nts m, ust b~, in'U.S: Dollars .a. nd dra~n, on a. - Telephone bank located intheUS and(except for electronic payments) p aced in the enc esau'enveloPe with the remittance Stud ancl Numbers - the account number indicated on your check. Do not send cash. Payments recall/ed after 12:00 noon or on weekends or ~ ~ ' holidays may not be'credited until the next business day. Please do hot send,post-dated.checks. They will be deposited To Pay By Phone ,upon te,ceip, t..If pay .rn,,ent.islm. ad.e at any other Iobatio.n there, ma,~/,b~;a delay in Processing. If your check is retumed unpaid 1-800-472-9297, Dyyour Dank to~ insu~Ticient funds,we may re-present your cnecK eiectronic~lly.'~- · ' .. · . - ' - ' Lost Or'Stolen 'Card: If the Card islost or stolen in the United States, contact us immediately at'1-800:992-3404 Customer Service Outside the U.S., contact the nearest American Exp~e§s Travel Service Office or call us COllect at 336-393-1111. You are 1 ~nn 52~ ,~qnn fully protected against any fraudulent use of the Card when you notify Arflerican Express before it is fraudulently used. ..;,:v,,,- v,-.~,.,,,.,, , Your maximum llabilityis $50 should you fail to report its loss,or theft. ~ . . ...,..~..... ~: tz,~ nours, to, tree) Cha~je Card and Statement Infmznation: The annual,fee is$550'0 for'tl~e Basic Card. and $30.00 ;f'o~ each Addibonal'Card. An additional $5 is charged for billing addresses outside the U.S:' Renewal Cai'ds are issded every three Ex,',reos years. If the Card you carry is damaged, you ma~ have it replaced sooner by calling Customer Service. You may - "°uu'"'~°n'm~Jvv discontinue.your Membership by calling Customer Service:Be sure to'keep your COpy of the charge slips for compa~ son ...... to your billed charges. The Statement Closing Date is the last date that charges and credits are processed to aPpear on the ' LOSt or Stolen ~aro statement. Your account will be Past Due if payment for your previous month's statement was received after the.closing · 1-800-992-3404 date. To keep your account current, pay bythe payment'due date shown on ~,our·statement. " . .~ I nt'l collect: Billing Rights Summary: /n Case of Errors' or Questions About Your Bill: If you think your bill'is wrong, or if you - 336-393-1111 n, eed more inf,o, rmation about a transaction which, appears o_n .yoUr statement, contact us at. the Custome{.Service aepartment inaicated on your paper statement, or click on the Customer Service link online. We must hear from y0b no ' Hearing Impaired later than 60 days after we sent you the first bill on which the error or problem appeared. Although you may telephonebs;. '· TTY' 1 800 221-9950 doings'owillnot'preserveyourri~hts, ' ' ' ' ""' ' ' ~' "' ' ~ ' ' ........ "' Fax" 1 ~00~959090 What We Need From,You When You Have A Billing Inquiry: 1. Your name-and account number'-2;.The dollar- - ' ' ' ' amount of. the suspectea error; 3. Describethe error-and explain,-if you can why you believe there is an error.. If ~ou need;~ more information describe the item you are unsureabeut. You ddnbt ha~,~ t~5 pay'any amount in'questiod W~hi ~.~Tb:'~:b~- nv .......... ' esbgatmg but you are soil obligated to pay the parts-of your bdl that'are not in quesbon. Wh e we nvest gate your- ~' ^ .. m r - rvi inquiry we cannot report you as delinquent or take any action to collect the amount, n quest on P easereta n any re~ pts. ~u...st~ e ~e_.~.ce Spe~, iai .Rules For. charge Card Purchases:'~ Ifyou ha~/e a'pr(~blem wit~ithe quality of goods or-se~ices that'you. ~F~'~a~u~doer~ale, FL purchased with the LJard, and you have tried in good faith to correct the problem with the merchant, you may not hereto ' pay the remaining amount due on the goods or services. You have this protection only when the purchase pnce was more' _ ' than $50 and the-purchase was made ~n your home state Or within 100 miles of you'rmailing'address: (If weown o~ operb, te: :..-I=xpress-g;ash the me.rch ,ant or ~f w.e ma!led y.ou the advertisement for tire prolberty or services, all purchases are covered regardless of ' Funds Access Services amount or location et purcnaseJ ..... ~ ,..". i,' ~- . ~.. · ...... . . ~. ' · .-" .... ' .... P O Box 53809 EExpress~.Ca.sh .In. forma, tion: In Case of Err0rs.orl Questions About Your Electronic Transfers: If you think yotJr Phoenix, AZ xpress uasn statement or receipt is wrong, or ir you need more information about a transfer on the statbment or receipt, ~ 85072-3809 call1-800-CASH-NOW or write to the Express Cash address indicated on your paper statement, or click on the Customer, Service link online. We must hear from you no later than 60 days after we sent You the FIRST statement on which the error Payments whP~n contacting us: 1. Tell us your name and account 'number; 2. P;'ovide the dollar amount of the sbsbected error; P.O. BOX 1270 3. Describe the error or the transfer you are unsure of,and explain as. clearly; as you can why.you believe there is an error ~ NEWARK NJ or why you'need more information. We will investigate your'complaint and wdl correct any error promptly; If we take more.' 07101-1270 than 10 busine, ss days to d.o this, we ,will credit your acc9, U'nt for the amount you think is in error, so that you Will.have'use or · tl,~e money auring the time' ~t .taKes us to COmplete. our qnvestigat~on: Express ;Cash pa'rtici, i~oants who have, _c.n_ang~_d..t,_h_e_ir b~a_n_k_account ..must ,contact. us to o~a~n' proper Updating forms· DO not use ~-xpress ~;ash Udtil the bank accountcnangenas~eencontrmeo ' ~' ~- · : '!-.- ,. ~; ' ' . . . . .' .. Credit Balance: .If a credit balance (design'ated "CR")'is'shown on this statement, it represents mo 3ay,owed to you. You -. may make charges against the credit balance or request a refund;' Requests for refunds should be maae inwriting td the· · Refund Unit at'the Customer Service address indicated on your paper statement, or click on the Customer'Servlce'link online. If you do not make sufficient charges against the credit balance or request a refund, we will, within 30 days after ' .expiration of the six-month period following the date of_the first statement indicating the credit_balance,.issue achec~ to you'. for the credit balance in your acceunt if the amount is $1.00 or more. Important Notice to ~orth Dakota ~esidents: :If - an account is past due for two or more billing cycles, a I.ate payment fee. ofl.75% of all Pa. st due amounts will be added. Change o!.Address If correct on front do not use ". - . Street Address City, State 'F'-T' ' I J L / [ I -I/ ~F-~T7 ~: l ~FT-~' ' -' - "~'~-~- ' " '" /'-, L'J__J:_.2J___l. L-L__J_" I".'_~l .' ,' ' ' ." ', ' . ' '. .... : .' :.f Providingyouremall .A,r~aC2C~a~d'"" · ' ' ' F---TT-77I' --F' T~.' E~.,q=~l --' .- ".. ~ .--~, .-=-'-: -,: ;,addresstoAmercan .: .omo ~none':' :,' 5,re~.~,ode'a.d "' ' ' 'i I ~3'='.T---F "1-"'1 'l' ' l-~l '; .... -: ' ,' .... ; ~ B toreceivespecialoffers, _ L &L · I =_L,~_-'J_% [* I__ I I'_ J ..... .. . : .. ~ su~tedtoyou needs. DUPLICATE' COPY Membersl~/p ;~. ,e,~r~a.:rdS®': ' !. Page 3 of 3 Men ...atement;. an ,j.. Program NewS" - ~m~'*' 2~1 ~ent=mh=F 30 A~nt a~ v ty affer, th,s ~r, od does· not ~ar on, th,s statement.~. (297-3~76) .. Prepared for - ..... www.amencanexpress:com/rew.ards American Express Membership Rewards' ' ' .- Points a~'e avail~.l~ielWhen charges are paid in full and all your ac,~oun.{§.~eb ,T....... PO BOX 297813 ' Ft. Lauderdale, FL 33329-9785 - Points do not have expiration dates. ,.. Account Summary Opening point~balance 1,586 New points earned Points transferred or redeemed Reinstated points and adjustments New points balance - 1,586 O 0 =0 New Points Earned. ~' 09/01/01 - 09/30/01 Points Activity On Bonus ~oints "Due To Total Points Activity Eligible Charges Awarded Late Payment Per Card Personal .0 0 -1,586 -1,586 3739-611430-51003 09/2001 . Totals .............................. ' ' - -,- 0 ......................... 0 ................ 1,586 ................. 1,586. Membership Rewards ~i~ ~n~ may ~ tr~s~err~ or ~ ~ Io~ ~ ~1 enroll~,C~d ~nts ~e m ~ st~ P~nts ff~ferr~ or r~ ~ ~ r~em~ ~k into the ~r~. Fo~l~d pol~:~ mln~d fei a f~ by ~lllng ~ nu~r provl~d ~1o~. EI~ C~ ch~ ~e ~lin~ in the ~r~ R~a~ pr~r~ ~ ~ Con,ions in your ~1 Rew~s Gu~ ~ y~ have qu~t~ns ~ vis~ ~w.a~rl~nex~ss.c~/mwa~e ~ ~11-~P-EA~N [~7;3276). 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Forfeited points can be reinstated for a $15.00 fee fo~ each month of ~oints reinstated per Card account, once a Card account is restored to go~3 stancilng. Important Notice - Membership Rewards~ Cancellation Policy Update ,;~,,'~, ~ -, ~.~"-J~'"~_.:_...._.l..:...Effective'January 1,2002, when a Ca~dmer~l~ercancels their ~1!'.. · I' Membership Rewards® account, but maintains at least one ~1~1~!? I · Card account issued by American Express, the.Cardmember ~li:: ' I will have six months from the date of cancellation to redeem' If a Cardmember'cancels all of their American Express®' Card accounts, Points are subjeCt to immediate forfeiture. Redeem MembershiP Reward~ P-oint~-for Gi~ts If you have any questions regarding this or any other Membership Rewards policies, please call us at 1-800-AXP-EARN (1-800-297-3276) (RB 500440) Redeem Membership Rewards points fo~ a $25 or $50 FOot'..- ' Call 1-800-AXP-EARN or Locker or Champs Sports certificate! .So many options! 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BUREAU OF /ND/V/DUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 LISA M COYNE ESQ COYNE & COYNE $901 MARKET ST CAMP HILL COMMONNEALTH OF PENNSYLVAN/A DEPARTMENT OF REVENUE NOT/CE OF ZNHERZTANCE TAX APPRA/SENENT, ALLO#ANCE OR DISALLO#ANCE OF DEDUCT/ONS AND ASSESSMENT OF TAX RE¥-1;47 EX AFP (01-02) '02 HAY 17 P2:dl DATE 05-15-2002 ESTATE OF EAGLE DATE OF DEATH'11-Oq-ZO01 F/LE NUMBER 21 02-0055 COUNTY CUMBERLAND ACH 10i I Amount Remitted DAVID R MAKE CHECK PAYABLE AND REMTT PAYMENT TO: REGISTER OF MILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THzS LZNE ~ RETAZN LONER PORT/ON FOR YOUR RECORDS ~ REV-1547 EX AFP (01-02) NOT/CE OF ZNHER/TANCE TAX APPRA/SEMENT, ALLONANCE OR DZSALLONANCE OF DEDUCT/ONS AND ASSESSMENT OF TAX ESTATE OF EAGLE DAVID R FZLE NO. 21 02-0055 ACN 101 DATE 05-15-2002 TAX RETURN NAS: (X) ACCEPTED AS F/LED ( ) CHANGED ' RESERVAT/ON CONCERN/NG FUTURE /NTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: 1. Real Estate' (Schedule A) 2. $. q. 6. 7. 8. ORIGINAL RETURN (1} Stocks and Bends (Schedule B} (2) Closely Held Stock/Partnership Znterast (Schedule C) (S) Mortgages/Notes Receivable (Schedule D) (q) Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) Jo/ntly Owned Property (Schedule F) (6) Transfers (Schedule G) (7) Total Assets APPROVED DEDUCT/ONS AND EXEMPT/ONS: 9. Funeral Expanses/Adm· Costs/MAsc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule 1) 11. Total Deduct ions 12. Nat Value of Tax Return 1:5. lq. (9) (10) Char/table/Governmental Bequests; Non-elected 911:5 Trusts (Schedule J) Nat Value of Estate Sub~act to Tax .00 17tq75.00 266.71 .00 .00 NOTE: To insure proper .00 credit to your account, .00 submit the upper portion of this form with your tax payment. (8) 5,628.00 NOTE: 50t797.q7 (11) (12) (1:5) (lq) Zf an assessment Has issued previously, lines 14, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 1~ at Spousal ra~a (15) 16. Amount of Line 1~ ~axabla at Lineal/Class A rate (16) 17. Amount of Line lq at Sibling rata (17) 18. Amount of Line lq taxable at Collataral/Ciass B rate (18) 19. Principal Tax Due RECEZPT NUMBER DISCOUNT (+) /NTEREST/PEN PAZD (-) · 00 X O0 = . O0 x Oq5 = . O0 X 12 = · 00 x 15 = (19)= TAX CREB/TS: PAYMENT DATE ZF PAZD AFTER DATE /NDICATED, SEE REVERSE FOR CALCULATZON OF ADDITIONAL INTEREST. AMOUNT PAZD 17,7ql .71 $8,685.76- .00 $8,685.76- 18'and 19 w111 .00 .00 .00 .00 .00 TOTAL TAX CREDZT I .00 BALANCE OF TAX DuEl " '-' .00 /NTEREST AND PEN. ' .00 TOTAL DUE .00 ( ZF TOTAL DUE ZS LESS THAN ~1, NO PAYMENT ZS REQUZRED. ZF TOTAL DUE IS REFLECTED AS A "CREDZT' (CR), YOU MAY BE DUE A REFUND. SEE REVERSE S/DE OF THZS FORM FOR INSTRUCTIONS.) RESERVATION: PURPOSE OF NOTICE: PAYNENT: REFUND ~CR): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying ~n or before December 12, 19BZ -- if any future interest in the estate is transferred in possession or' enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for'years, the ;ommonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section Z10`0 of the Xnh~ritance and Estate Tax Act, Act Z3 of ZOO0. (TZ P.S. Section 910`0). - Detach the top portion of this Notice and submit with ~our payment to the Register of Hills p/inted on tho reverse side. --Hake check or money order payable to: REGISTER OF NZLLS, AGENT A refund of a tax credit, ~hich was not requested on tha Tax Return, may ba requested by completing an "Application for Rafund of Pennsylvania Inheritance and Estate Tax" (REV-1513). Applications ara available at tha Office of the Register of Nills, *any of the 23 Revenue District Offices, or by calling the special Z0`-hour' ansmering service for forms ordering: 1-800-36Z-ZOSO; servi~m~ for taxpayers with special hearing and / or speaking needs: 1-800-0`0`7-30Z0 (TT only). , Any party in interest not satisfied mith the appraisement, allowance, or dismllomance ef deductions, or assessment of tax (including.d~scount or.~ntarest) as shown on this Notice must ob~act within sixty (60} days of receipt of this Notice by: --mritten pretest to the PA Department of Revenue, Beard of Appeals, Dept. ZBIOZI~ Harrisburg, PA 171ZB-10Z1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: pA Department of Ravanue, Bureau of XndividuaX Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Xnheritance Tax Return for a Resident Decedent" (REV-lEO1) for an explanation of administratively correctable errors. · If any tax due'is paid within three (~) calehd~ months after the decedent's death, a riva ~ercent (5Z) discount of the tax.paid.is allowed. The 15Z tax amnasty non-participation penalty is'~o~putad on the total of the'tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you mould appeal the tax and 'interest that has been assessed as indicated on this notica. Intarast is charged beginning aith first day of delinquency, or nine (9) months an~ one (1) day ;re= the date of 'death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate'of six (6Z) percent per annum calculated at a daily rate of .000160`. All taxes which bacama delinquent on and pftar January 1, 1982 mill bear interest at a rate mhich mill vaFy fram calendar year to calendar year aith that rate announced'b~ the PA Department of Revenue. The applicable interest rates for 198Z through ZOOZ are: Year Interest Rate Daily Intarast Factor Year Interest Rate Daily Interest Factor*' 198Z ZOZ . 00050,8 1983 167. . 0000`38 198o, 11Z .000301 1985 13Z .000356 1986 ZOZ .000270` 1987 92 . OOOZ0`7 1988-1991 117. . 000:501 --Interest is calculated es follows: TNTEREST = BALANCE OF TAX UNPAI'D 1992 97. .00020`7 1993-1990` -77. .OOD19Z 1995-1998 97. .OOOZ0`7 1999 7Z .O0019Z ZOOO 82 .O00219 ZOO1 97. .000Z~7 200Z 6Z .000160` X~ NUNBER OF DAYS DELXNqUE~T X DAXLY XNTEREST FACTOR --Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to ,fifteen (151 days beyond the date of the assessment. If payment is made after the interest computation date shomn on tha Notice, additional interest must ba calcuIated. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORpHANS' COURT DIVISION File No. 21-02-00053 Estate of David R Eagle ***AKA DAVID ROSS EAGLE*** , Deceased NOTICE OF CLAIM by SHANNON K, HEIM. AGENT FOR HOUSEHOLD RETAIL SERVICES. USA Filed Pursuant to Section 3532 (b) (2) of ,the Probate, Estate, and Fiduciary Code, 20 Pa. C.S.A §3532 (b) (2) . To the Clerk of the Orphans' Court Division: Enter the claim of SHANNON K. HEIM. AGENT FOR HOusEHOLD RETAIL SERVICES. USA (Claimant) in the amount of $2,134.59 , against the'above entitled estate. The Decedent, who resided at Camp Hill, PA 17011 (City) Pennsylvania, died on November 04, 2001 3902 Chestnut Street (Street Address) , Cumberland Written notice County, of said claim was given to Judy Eagle his Counsel) (Personal Representative, or · If known to claimant, at 3902 Chestnut Street Camp Hill~ PA 17011 (Address) ,on June 11, 2002 (Date) ., Claimant SHANNON K. HEIM, AGENT Post Office Box 24566, Baltimore, Maryland 21214 (Address) Claimant's Counsel: (Address) 'opoD d~ld aq~ jo (Z) (q)l:~$~ .. uo!DoS o, }ugns.~nd pop. j VSI1 'S~tDIAH~IS qlV.L~I (VIOH~ISflOH ~q uq. glD jo ~Dol~I 'pos~a~op ~,~lqDV~I SSOII (IIAV(I V)IV~ ~IRDV~t It (IIAVO: ~IO ~IJN&S~I NOSIAI(I .LHI1OD S,NVHdltO SV~tqd NOIAIIAIOD dO ,LHflOD IN THE MATTER OF IN THE ORPHAN'S COURT ESTATE OF: OF CUMBERLAND COUNTY DAVID R EAGLE ESTATE#: 21-02-00053 ***AKA DAVID ROSS EAGLE*** · STATEMENT OF CLAIM 1. The creditor, Household Retail.Services, USA, certifies that there is due and owing by DAVID R EAGLE, deceased, the sum of TWO THOUSAND ONE HUNDRED THIRTY FOUR DOLLARS AND FIFTY NINE CENTS ($ 2,134.59). 2. The nature of the claim is a BOWFLEX account 0151601100795519. 3. The name and address of the claimant is: Househoi'd Retail Services, USA, Post Office Box 15522, Wilmington, Delaware 19850-5522. 4. The name and address of the claimant's agent is: Shannon K. Heim, Estate Recoveries, Inc., P. O. Box 24566, Baltimore, Maryland 21214. 5. This claim is not contingent and is not secured by any liens or judgments. 6. This claim is not based on any one instrument. Said balance has accrued since the account was established. On behalf of Household Retail Services, USA, creditor, I do solemnly declare and affirm under the penalties of perjury that the information in the foregoing claim is true and correct to the best of my knowledge, information and belief. SHANNON K. HEIM Estate Recoveries, Inc. P.O. Box 24566 Baltimore, Maryland 21214 (410) 444-8022 County of Baltimore, Maryland: IN WITNESS WHEREOF, I hereunto set my hand and Notarial Seal this June 11, 2002'. · 'S':~B VA/I/ -:**, J~qNIFF~'VAN BUSKIRK, Notary Public My Commission Expires: August 8, 2004 .. .: Page: 1 Document Name: untitled ~RSD'( ) HRS USA~ST ~ 2.§' · PASE 03 02/19/2002 ON-LINE STATEMENT HISTORY DISPLAY 11:04:46 ORGANIZATION 151 LOGO 601 ACCOUNT 0000151601100795519 * ...... '-- INFORMATION BELOW REFLECTS THE ACCOUNT AT STATEMENT TIME ......... * BILLING CYCLE '""25 STATE OF RESID. PE2 INTERNAL STATUS A BLOCK CODE 1 E BLOCK CODE 2 P STATEMENT FLAG CASH LIMIT STAT CODE PA CASH AVAIL BD PH LGC 1 Y-T-D INTEREST INS STAT Y-T-D LATE CHG GUARANTOR Y-T-D OVLM CHG ST CP # 07 LAST YTD INTR SPCL CLASS INT THIS STMT EMPLOYEE CODE F/S BEG BAL '. CREDIT CLASS I1 F/S EARNED RECENCY FLAG 2 F/S ADJ DAYS IN CYCLE 30 F/S DISB NBR OF pLANs 1 F/S END BAL PFi=ARM~J PF2=ARTD' PF3=ARIQ DATE THIS STMT 10252001 DATE LAST STMT 09252001 CYC/DATE DUE 03 11192001~ GRACE EXPIRE 11192001 CREDIT LIMIT .00 OPEN TO BUY **********.00 .00 .00 263.69 100.00 .00 .00 43.87 0 0 0 0 PF4 =ARIH SHORT NAME EAGLE, DAVID R CUST NER 0000151601100795519 ALT CUST REL NBR STORE ORG 151 ID 061611501 OVRLIMT INCLUDED N CURR PMT DUE 61.~0 TOTAL PAST DUE 122.00 TOTAL PMT DUE 183.00 FIXED PMT AMT 61.00 INTEREST FREE BEG BAL DEBITS 2 CREDITS 0 END BAL PF5=ARQB 2,134.59 2,065.72 68.87 .00 2,134.59 PF6=ARQE Date: 0~/19/2002 Time: 2:04:47 PM Page: 1 D~c,ument Name: untitled ARSD ( ) ORGANIZATION HRS USA W~S?AP~ 2~g PASE O4 02/19/2002 ON-LINE STATEMENT HISTORY DISPLAY 11:04:53 151 LOGO 601 ACCOUNT 0000151601100795519 RQ EFF POST '"" CR DATE DATE' AMOUNT TXN PLAN * ........ D E S C R I P T I O N ....... * 1021 1021 25.00 D701 7 LATE CHARGE ASSESSMENT PTS= 0 0 DEPT= REF=10016115010000000149650 AUTH~ SEQ=01 STORE=001611501 SKU=000000000 GLS=i SALESCLERK=P01 TKT= P/O= R/REF=00000000000000 ITM=49650 ORG=000 MERCH=000000000 CAT=0000 CARD#/SEQ#=0000151601100795519 0000 1025 1025 '43.87 D714 7 BILLED FINANCE CHARGES PTS= 0 0 DEPT= REF=10016115010000000416140 AUTH= SEQ=01 STORE=001611501 SKU=000000000 GLS~i SALESCLERK=P01 TKT= P/O= R/REF=00000000000000'!TM=16140 ORG=000 MERCH=000000000 CAT=0000 CARD~/SEQ~=0000151601100795519 0000 *** END OF TRANSACTIONS *** PFI=ARMU PF2=ARTD PF3=*TOP* PF4=*BOT* PF5=*BWD* PF6=*FWD* Date: 0~/19/2002 Time: 2:04:53 PM Page: 1 D~cUment Name: untitled ARSD ( ) HRS USA WEST APWH 2.5 ~' PAGE 03 ON-LINE STATEMENT. HISTORY DISPLAY o2./i9/2oo2 11:05:03 ORGANIZATION .151 LOGO 601 ACCOUNT 0000151601100795519 * ...... '-- INFORMATION BELOW REFLECTS THE ACCOUNT AT STATEMENT TIME ......... * BILLING CYCLE '""25 STATE OF RESID. WA INTERNAL STATUS A BLOCK CODE 1 E BLOCK CODE 2 STATEMENT FLAG CASH LIMIT STAT CODE CASH AVAIL BD PH LGC 1 Y-T-D INTEREST INS STAT Y-T-D LATE CHG GUARA/qTOR Y-T-D OVLM CHG ST CP # 07 LAST YTD INTR SPCL CLASS INT THIS STMT EMPLOYEE CODE F/S BEG BAL CREDIT CLASS I1 F/S EARNED RECENCY FLAG 0 F/S ADJ DAYS IN CYCLE 31 F/S DISB NBR OF.PLANS 1 F/S END BAL PFi=ARMU PF2=ARTD PF3=ARIQ DATE THIS STMT 11252001 DATE LAST STMT 10252001 CYC/DATE DUE 01 12202001 GRACE EXPIRE 12202001 CREDIT LIMIT .00 OPEN TO BUy, **********.00 .00 .00 310.46 100.00 .00 .00 46.77 0 0 0 0 PF4=ARIH SHORT NAME EAGLE, DAVID R CUST NBR 0000151601100795519 ALT CUST REL NBR STORE ORG 151 ID 0~1611501 OVRLIMT INCLUDED N CURR PMT DUE 66.00 TOTAL PAST DUE .00 TOTAL PMT DUE 66.00 FIXED PMT AMT 66.00 INTEREST FREE '2,181.36 BEG BAL 2,134.59 DEBITS 1 46.77 CREDITS 0 .00 END BAL 2,181.36 PF5=ARQB PF6=ARQE Date: 0~/19/2002 Time: 2:05:03 PM P~ge: 1 Document Name: untitled ARSD ( HRS USA WEST ApWH ~.5 PAGE 04 ON-LINE STATEMENT HISTORY DISPLAY 02/19/2002 11:05:09 ORGANIZATION 151 LOGO 601 ACCOUNT 0000151601100795519 RQ EFF POST ''"" CR · DATE DATE' AMOUNT TXN PLAN * ........ D E S C R I P ,T I O N ....... * 1125 1125 46.77 D714 7 BILLED FINANCE CHARGES PTS= 0 0 DEPT= REF=10016115010000000398220 AUTH= SEQ=01 STORE=001611501 SKU=000000000 GLS=i SALESCLERK=P01 TKT= P/O= R/REF=00000000000000 ITM=98220 ORG=000 MERCH=000000000 CAT=0000 CARD~/SEQ#=0000151601100795519~000~ 1125 1125 .00 M999 7 FIN CHG CALC~TION CHANGED TODAY PTS= 0 0 DEPT= REF=99999999999999999999999 AUTH= SEQ=01 STORE=001611501 SKU=000000000~ GLS=i SALESCLERK= TKT= P/O= R/REFA00000000000000 ITM=98230 ORG=000 MERCH=000000000 CAT=0000 CARD#/SEQ#=0000151601100795519 0000 *** END OF TRANsAcTIONS *** PFi=ARMU PF2=ARTD PF3=*TOP* PF4=*BOT* PF5=*BWD* PF6=*FWD* Date: 0~/19/2002 Time: 2:05:09 PM Page.: 1 Document Name: untitled Al{SD'( ) }{RS USA WEST A~WH 2.5 PAGE 03 02/19/2002 ON-LINE STATEMENT HISTORY DISPLAY 11:05:18 ORGI~NIZATION 151 LOGO 601 ACCOUNT 0000151601100795519 * ........ INFORMATION BELOW REFLECTS THE ACCOUNT AT STATEMENT TIME ......... * BILLING CYCLE.-,-R5 STATE OF RESID WA INTERNAL STATUS A BLOCK CODE 1 E BLOCK CODE 2 STATEMENT FLAG STAT CODE BD PH LGC 1 INS STAT GUA/~ANTOR ST CP # 07 SPCL CLASS EMPLOYEE CODE CREDIT CLASS I1 RECENCY FLAG 1 DAYS IN CYCLE 30 NER OF PLANS 1 PFi=ARMU PF2=ARTD DATE THIS STMT 12252001 DATE LAST STMT 11252001 CYC/DATE DUE 02 01192002 GRACE EXPIRE 01192002 CREDIT LIMIT .00 OPEN TO BUY **********.00 CASH LIMIT .00 CASH AVAIL .Y-T-D INTEREST Y-T-D LATE CHG Y-T-D 0vLM CHG LAST YTD INTR INT THIS STMT F/S BEG BAL F/S EARAIED F/S ADJ F~S DISB F/S END BAL~ PF3=ARIQ .00 349.60 125.00 .'00 .00 39.14 0 0 0 0 PF4 =ARIH SHORT NAME EAGLE, DAVID R CUST NBR 0000151601100795519 ALT CUST REL NBR STORE ORG 151 ID 001611501 OVRLIMT INCLUDED N CURR PMT DUE 66.00 TOTAL PAST DUE 66.00 TOTAL PMT DUE 132.00 FIXED PMT AMT. 66.00 INTEREST FREE 2,245.50 BEG BAL DEBITS 2 CREDITS .0 END BAL PF5=ARQB 2,181.36 64.14 .00 2,245.50 PF6=ARQE Date: 02/19/2002 Time: 2:05:19 PM Page: ' 1 D~cument Name: untitled & ARSD' ( ) HRS USA WEST APWH 2.5 PAGE 04 ON-LINE STATEMENT HISTORY DISPLAY 02/19/2002 11:05:27 ORGANIZATION 151 LOGO 601 ACCOUNT 0000151601100795519 RQ EF~ POST -*" CR DATE DATE' AMOUNT TXN PLAN * ........ D E S C R I P T I O N ....... * 1221 1221 25.00 D701 7 LATE CI{ARGE ASSESSN[ENT PTS= 0 0 DEPT= REF=10016115010000000141880 AU~H= SEQ=01. STORE=001611501 SKU=000000000 GLS=i SALESCLERK=POI TKT= P/O= R/REF=00000000000000 ITM=41880 ORG=000 'MERCH=000000000 CAT=0000 CARD#/SEQ#=0000151601100795519 0000 1225 1225 39.14 D714 7 BILLED FIN/kNCE CHARGES PTS= 0 0 DEPT= REF=10016115010000000380640 AU~"H= SEQ=01 STORE=001611501 SKU=000000000 GLS=I SALESCLERK=POi TKT= P/O= R/REF=00000000000000 ITM=80640 ORG=000 MERCH=000000000 CAT=0000 CARD#/SEQ~=0000151601100795519 0000 *** END OF TRANSACTIONS *** PFi=ARMU PF2=ARTD PF3=*TOP* PF4=*BOT* PF5=*BWD* PF6=.*FWD* Date: 02~19/2002 Time: 2:05:27 PM Page:'l Document Name: untitled ARSD '( ) HRS USA WEST APWH 2.5 PAGE 03 ON-LINE STATEMENT HISTORY DISPLAY 02/19/2002 11:05:34 ORGANIZATION 151 LOGO 601 ACCOUNT 0000151601100795519 * ........ INFORMATION BELOW REFLECTS THE ACCOUNT AT STATEMENT TIME ......... * BILLING CYCLE STATE OF RESID WA INTERNAL STATUS A BLOCK CODE 1 K BLOCK CODE 2 S STATEMENT FLAG 0 STAT CODE ER BD PH LGC 1 INS STAT GUARAiqTOR ST CP ~ 07 SPCL CLASS EMPLOYEE CODE CREDIT CLASS I1 RECENCY FLAG 2 DAYS IN CYCLE 31 NBR OF PLAIqS 1 PFI=ARMU PF2=~RTD DATE THIS STMT 01252002 DATE LAST STMT 12252001 CYC/DATE DUE 03 02192002 GRACE EXPIRE 02192002 CREDIT LIMIT OPEN TO BUY ********** CASH LIMIT CASH AVAIL Y-T~D INTEREST Y-T-D LATE CHG Y-T-D OVLM CHG LAST YTD INTR 349 INT THIS STMT F/S BEG BAL F/S EAi{NED F/S ADJ F/S DISB F/S END BAL PF3=ARIQ 00 00 00 00 00 00 00 60 00 0 0~ 0 PF4=ARIH SHORTNAME EAGLE, DAVID R CUST NBR 0000151601100795519 ALT CUST REL NBR STORE ORG 151 ID ~01611501 OVRLIMT INCLUDED N CUI~_R PMT DUE 66.00 TOTAL PAST DUE 132.00 TOTAL PMT DUE 198.'00 FIXED PMT ~ 66.00 INTEREST FREE 2,245.50 BEG BAL DEBITS 0 CREDITS 0 END BAL PF5=ARQB 2,245.50 .00 .00 2,245.50 PF6=A/{QE Date: 02/19/2002 Time: 2:05:34 PM PENNSYLVANIA OR~HANS' COUP.T, DIVISION COUNTY ESTATE OF ) 0eceased ) To the Clerk of the Orphans' Court Division: Index~n.d ~.a_~9. 9r_0pe= entry in your official records '~f the ~~ against the estate of the ahove-n~ed decedent.. This claim is .fil~ under Section 3532 (b) ~2) PEF Code, 2~ Pa. C.S. Ss. 3532 (b) (2). kno~ residence was at - T e sai~decedenc, whose~s= ~ritten no~ice of =his claim was given to ..~'S~.,/~&~,'r 7930 NWllO Str~% Kans~ Ci~, M064153 (Claimant's Address) 7. L: L a 9L -ii'i[' ZO. -. Payment Due Date NOW DUE 5715 5715 D/ 1 12 Make checks payable to: SHOP AT HOME $593.78 8 SH Your Account Number 6035 2601 0901 8487 AccOUnt Statement Minimum Payment Due Amount Enclosed $76.00 I 6035260109018N87005937800057000007600 DAVID R EAGLE 73 ROLO COURT MECHANICSBURG PA 17055-5861 5715 B AVSH SHOP AT HOME PO BOX 9025 DES MOTNES lA 50368-9025 Print address changes above. S.h~°P~A~w Ho °.m? ' shopathOmetV, com Closing Date NOVEMBER 12, 2001 ~ Please detach here. Send Notice of Billing Errors to: SHOP AT HOME PO BOX 8181. GRAY TN 37615-8181 Customer Service: 1-800-767-1419 THIS ACCOUNT ISSUED BY HURLEY STATE BANK Next Closing Date I Credit Limit DECEMBER 12, 2001 I $0.00 Account: 6035 2601 0901 8487 Previ°us Balance [ Payments & Credits I Purchases/Other Charges$593.78 $0.00 $0.00 FINANCE CHARGES$0.00 Credit$0.00Available CURRENT ACTIVITY Transaction Date Transactions Your account is closed, balance in full is due upon recelpt of this statement. To resolve your delinquency and avold additional late fees, take advantage of our convenient Western Unlon Quick Collect Payment optlon. Slmply go to your local Western Unlon locatlon wlth your payment, account number and give the Code Clty "Charlle, TN." If you wlsh to pay by Master Card,'Dlscover, or Vlsa call 1-800-634-3422. Glve the operator the requested information along wlth the Code Clty "Charlle, TN." Oversight in putting your payment in the mail? Call 1-800-767-7720 to pay by check over the phone. Have your checkbook ready when you call.: CREDIT PLAN sUMMARY Billed Minimum Previous FINANCE Payments & ' Plan Monthly Balance CHARGES Credits Balance Payment CASH ACCESS $82.35 $82.35 $17.00 REVOLVING CREDIT PLAN $511.43 $511.43 $59.00 Accrued FINANCE Expiration CHARG ES Date FINANCE CHARGE suMMARy Corresponding Days In ANNUAL* Average Daily DAILY ANNUAL Billing PERCENTAGE FINANCE Balance Periodic Rate PERCENTAGE RATE Period RATE CHARGES Miscellaneous Fees Current Billing Period CASH ACCESS $83.16 REVOLVING CREDIT PLAN $516.49 0.06740% 24.60%V 31 24.60%V 0.06740% 24.60%V 31 24.60%V Previous Billing Period NONE REVOLVING CREDIT PLAN 0.067404 24.60%V 30 *Includes periodic finance charge and transaction charges. V = RATE MAY VARY PAGE 1 OF 1 ACSNCr 903024 .j Citicorp Credit Services, Inc. USA Citicorp Credit Services, Inc. USA A Subsidiary of Citicorp Kansas City Regional Center 7920 N. W. 1 l0th St Kansas City MO 64153 CUMBERLAND COUNTY CRTHOUSE 1 COURTHOUSE SQ ROOM 102 CARLISLE, PA 17013 July 2, 2002 RE: The Estate of DAVID R EAGLE File Number: 2002-00053 Dear Sir/Madam, Please find enclosed our claim against the above mentioned estate. return a FILED stamped copy in the enclosed envelope. Thank you for your attention to this matter. Very Truly Yours, Kristen Wells Manager, of Citicorp Credit Services, Inc. USA under limited ~ower of attorney for CITIBANK USA.NA Please STATUS REPORT UNDER RULE 6.12 Name of Decedent: Mar~_ M. Clarke Date of Death: November 29, 2001 Will No. 0053-2002 Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of'the above-captioned estate: State whether administration of the estate is complete: Yes xx No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No XX' b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes .XX No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Date: 12/13/02 ~~~,~ S~gnatur-e _~ ames D. Bogar, Esquire ~ Name (Please tylP. e or print) ?:= ~.~ -. One West Main St. · ~ ~; Shiremanstown, PA 17011 Address (MAH:rmf/AM3) {717) 737-8761 Tel. No. Capacity: __Personal Representative X __Counsel'for personal representative