Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
03-0929
Estate of also known as Register of Wills of Dauphin County, Pennsylvania PETITION FOR GRANT OF LETTERS , Deceased Social Security No. 369- 22- 310 ? Peri[icl)ells). who is/are 18 veers of age el oldel, appl¥(ies) lei: (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner(s) is/ak-~the execut c~- named in the Last Will of the Decedent, dated 9/1 5/1988 and codicil(s) dated 4/8/1991 State lelevent c~fcumstances, e.g, renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: B. Grant of Letters of Administration Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional ;heats if necessary. Cumberland County, Pennsylvania, with his/her last family or principal Decedent was domiciled at death in residence at 5430 Oxford Drive, Mechanicsburg, PA Decedent, then 75 years of age, died NOvember 6 ,20Q3_, at Holy Spirit Hospital (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property .............................. $ (If not domiciled in PA) Personal property in Pennsylvania ...................... $ (If not domiciled irt PA) Personal property in County .......................... $ Value of real estate in Pennsylvania ............................................... $ Total .............................................................. $ Real Estate situated as follows: Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Typed or printed name and residence RW-7 Oath of Personal Representative Commonwealth of Pennsylvania County of 1~;SX~bli¢~ CUMBERLAND The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate accor~ng to lav)~ /~ Sworn ,o .,i me before me this 7TH day of N0VEHBER 20 03 Estate of also known as DECREE OF REGISTER JOYCE M. TTMMON$ Deceased No. 21 - 03 - 929 Social Security No: 369 - 22 - 3107 Date of Death: NOVEMBER 6, 2003 AND NOW, NOVEMBER 10 , 2003 ,in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters [] Testamentary [] of Administration (C.t.8.; d.b.~.¢* ! ; pendente lite; durance absentia; dufante minoritate~ are hereby granted to BRUCE D. FOREMAN ._ _ in the ab~)ve estate and that the instrument(s), if any, dated WILL DATED 9-i5-1988 C0DICTL DATED described in the Petition be admitted to probate and filed of record as the last Will of Dec~a~lt.991 FEES 25.00 Letters ........................... $ Short Certificate(s) .......... $ 9,00 Renunciation .................. $ Affidavit ( ) ................. $ Extra Pages (8) ............ $ 24.00 Codicil ..........................$ 10.50 JCP Fee ........................ $ 10.00 Inventory & Tax Forms... $ Other ............................$ 78.50 TOTAL ................ $ gW-7a Mailed letters to attorney on 11-10-03 Attorney: ~.)~ '"~.- ~3-~ I.D. NO: Address: Telephone: DATE FILED: NOVEMBER 7, 2003 his is to certify that the information here given is correctly copied f'rom an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent "filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00P 9641038 ~~c~~~,~=.~~~.~: ~ ~~'~- ~~~Local Registrar. ~///~. ,~q~C~ '~ ,t~ No. ~ ' { Date -t H105 143 Rev 2/87 TYPE/PRINT PERMANENT BLACK iNK NAME OF DECEDENT (First, Middle, Last) COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH .............. SOCIAL SECURITY NUMBER DATE OF DEATH (Month. Day, Year) AGE (Last Birihday) DATE OF BIRTH BIRTHPLACE (City and (Month, Day, Year) Slate o~ Foreign Country) CITY, BORO, 3WP OF DEATH FACILITY NAME (, DECEDENT'S USUAL OCCUPATION DECEOENI'S EDUCATION MARITAL STATUS - Man,ed, Nave*' Married, Widowed, (Specify) ~.I../ SURVIVING SPOUSE METHOD OF ~ SPOSITI~ -- I DATE OF DIS~S T ON ceth~ cause o~ dea~. I 23b. ITM D~TH DATE PRONOUNCED D~D (Mon~, Day, Year) I WAS C~E REFERRED TO A MEDICAL E~MINER/CORONER? ~ Enter UNDERLYING ~ ~ cu~ C~ WAS AN AUTOPSY WERE AUTOPSY FINDtNG5 1 MANNER OF DEATH PERFORMED? AVAiLAbLE PRIOR TO COMPLETION OF CAUSE Natural OF DEATH? I Accldefll [] Pending Invesfigatmn Yes [] No [] Yes [] No [] I Suicide [] Could nof be d .... ined · CERTIFYING pHY~ClA~I. II~ .y~.. ce~ytng ~ause of death vv~n a.nothe, r physician ha.s i~lr~nounced death and coml.qelnd item 23) [] city/bo~o []~E]IDATE °F INJURY {M°nl;l' OIv'Y~)3Oa. [ TIME OF tNJURY30b. M. 30c.INJURY AT WORK? I DESCRIBE HOW INJURY OCCURRED'yes[] No[] I 3Od. SIGNATUI~E AND TAND TITLE OF CERTIFIER LICENSI~UMI~ER NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH CODICIL TO THE LAST WILL AND TESTAMENT OF JOYCE M. TIMMONS I, JOYCE M. TIMMONS, now of 5430 Oxford Drive, Mechanicsburg, Cumberland County, Pennsylvania, declare this to be the sole Codicil to my Last Will and Testament dated September 15, 1988. ITEM I: I specifically bequeath to my daughter, MARY T. TIMMONS, now of Melville, New York, my large living room mirror with Victorian frame and the two corday living room lamps with brass base. In all other respects I republish my Last Will and Testament of September 15, 1988. IN WITNESS WHEREOF, I have hereunto set my hand this 8th day of April, 1991. JOY~ M.~ TI~MONS~ The preceding instrument, consisting of this and ONE (1) other typewritten pages, identified by the signature of the Testatrix, JOYCE M. TIMMONS, was on the day and date thereof signed, published and declared by JOYCE M. TIMMONS, the Testatrix herein named, as and for her Last Will, in the presence of us, who, at her request and in her presence and in the presence of each other, have subscribed our names as witnesses hereto. ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA : : SS. COUNTY OF DAUPHIN : I, JOYCE M. TIMMONS, the 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; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by JOYCE M. TIMMONS, Testatrix, this Sth day of April, 1991. JO .~.~ M% TiMMONS Notary Publ i~PJ Q - NOTARIAL SEAL CYNTHIA LOU MYERS, Notary Public Harri.~burg, Dauphin County, Pa. My Cornmisolon Expires Sept. 7, 1992 COMMONWEALTH OF PENNSYLVANIA : : SS. COUNTY OF DAUPHIN : WE, the undersigned witnesses, whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix, sign and execute the instrument as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Will as a witness; 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 to or affirmed and subscribed before me by the undersigned witnesses, this 8th day of April, 1991. No%~y PubliC- ~ NOTARIAL SEAL --1 YNTH1A LOU MYERS, Notary Public ~ · ~'n County Pa. ' Harrisburg, gsg~,,i .... 197~4 My Commission Expires Sept. 7, CODICIL TO THE LAST WILL AND TESTAMENT OF JOYCE M. TIMMONS LAW OFFICES NICHOLAS & FOREMAN 3207 NORTH FRONT STREET HARRISBURG, PENNSYLYANIA 17110 (717) 236 0301 LAST WILL AND TESTAMENT OF JOYCE M. TIMMONS I, JOYCE M. TIMMONS of Mechanicsburg, Cumberland County, Pennsylvania, declare this to be my Last Will and revoke any Will or Codicil previously made by me. ITEM I: I direct that all expenses of my last illness and funeral, including my gravemarker and perpetual care, shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. ITEM II: I devise and bequeath all of my right, title and interest and ownership and possession of a condominium which I own at 5430 Oxford Drive, Mechanicsburg, Pennsylvania, jointly with my daughter, Mary T. Timmons now of Melville, New York, to my daughter, Mary T. Timmons provided that she survives me for a period of thirty (30) days following my death. ITEM IV: I devise and bequeath all of the rest, residue, and remainder of my Estate of every nature and wherever situate in equal shares to the following individuals on the condition that they survive me for a period of thirty (30) days following my death: A. One share, equaling one-sixth of my estate, to my daughter, Joy Zipper, now of Melville, New York. B. One share, equaling one-sixth of my estate, to my daughter, Geraldine Read, now of Hampden Township, Pennsylvania. C. One share, equaling one-sixth of my estate, to my daughter, Eleanor Rossman, now of Camp Hill, Pennsylvania. D. One share, equaling one-sixth of my estate, to my son, Paul Timmons, now of Carlisle, Pennsylvania. E. One share, equaling one-sixth of my estate, to my daughter, Mary T. Timmons, now of Melville, New York. F. One share, equaling one-sixth of my estate, to my daughter, Carol Timmons, now of Camp Hill, Pennsylvania. If any of the individuals named above in this item fail to survive me for thirty (30) days then, in that event, their share shall go to their issue, per stirpes, if any, who survive me for a period of thirty (30) days, and, if the named beneficiary fails to survive me for a period of thirty (30) days leaving no issue who survive me for a period of the thirty (30) days, then their share shall lapse and be divided equally among the remaining shares listed above. ITEM V: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate, without apportionment. ITEM VI: I appoint my attorney, BRUCE D. FOREMAN, Executor of this, my Last Will. In the event that BRUCE D. FOREMAN is unable or unwilling to serve as Executor, I appoint my daughter, JOY ZIPPER, to act as substitute Executrix. IN WITNESS WHEREOF, I have hereunto set my hand this /~ day of ~,~T7=-4~-~ 1988. JO~E~M. TIMMONS The preceding instrument, consisting of this and five (5) other typewritten pages, identified by the signature of the Testatrix, JOYCE M. TIMMONS, was on the day and date thereof signed, published and declared by JOYCE M. TIMMONS, the Testatrix therein named, as and for her Last Will, in the presence of us, who, at her request and in her presence and in the presence of each other, have subscribed our names as witnesses hereto. of / . ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA : : SS. COUNTY OF DAUPHIN : I, JOYCE M. TIMMONS, the 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; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by JOYCE M. TIMMONS, Testatrix, this I b~_~ day of .... ~ ,...., 1988. ary Public NOTARIAL GEAL JANICE L. GLENN, NOTARY PU~I.IC DUNCANNON BORO, Pc~_Rt' COUNTY MY COMMISSIOH EXPIRES MA~CH ~, 1590 Member, Pennsylvania COMMONWEALTH OF PENNSYLVANIA : : SS. COUNTY OF DAUPHIN : WE, Cynthia L. Myers , Sandra Miller and Steve C. Nicholas , witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix, sign and execute the instrument as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Will as a witness; 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 to or affirmed and subscribed before me by the undersigned witnesses, this 15th day of September , 1988. //N~ ~ry Publi~ NOTAN)~L St-AL JANICE L GLENN, NOTARY PU~IO DUNCAN~iO:~ B~O, P~g~ OOUN~ MY C~MI~ ~RE$ MARCH Member, Pennsylvania As~ecl~tlo~ ef Notifies rule5-6.not CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: JOYCE M. TIMMONS, Deceased Date of Death: November 6, 2003 PA File No. ~ I - O,3 - c5' St c~ To the Register: 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 November 13, 2003. Name Mary Timmons Geraldine Read Eleanor Rossman Paul Timmons Carol Timmons-Fencel Joy Zipper Address 19 Stiles Drive, Melville, NY 11747 122 Seminole Lane, Boca Raton, FL 33487 520 Joyce Road, Camp Hill, PA 17011 1209 Edinburg Circle, New Cumberland, PA 17070 882 Acri Road, Mechanicsburg, PA 17055 19141 Fox Landing Drive, Boca Raton, FL 33434 Notice has now been given to No exception. Dated: November 13, 2003 all persons entitled thereto under Rule 5.6 except: Signature ~.~~or~~m an, Esq. 4409 North Front Street Harrisburg, PA 17110 Capacity: __ Personal Representative ~ Counsel for Personal Representative Name (s), address (es), and telephone number (s) of all counsel Name Address Bruce D. Foreman 4409 North Front Street Harrisburg, PA 17110 Telephone (717) 236-9391 Additionali_'_mformation may be obtained from the undersigned. Dated: November 13, 2003 Signature /.,~q/ :'- Bm'ce D. Foreman, ~zsq. ~i 3207 North Front Street ~ Harrisburg, PA 17110 Capacity: ilk PersQWal Representative _ Counsel for Personal Representative J EX · '"'*'~ '::~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-060t REV-1 500 1' FILE INHERITANCE TAX RETURN RESIDENT DECEDENT I o0u. - E LU Z Z O D.. (,'3 n- O (.3 Z DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) TZFIFIONS, Joyee Fl. DATE OF DEATH (MM-DD-YF. AR) November 6, 2003 DATE OF BIRTH (MM-Db-YEAR/ December 25, (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) 1927 SOCIAL SECURITY NUMBER 369 -- 22 -- 31 07 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER E1 1. Odginal Return [---] 2. Suppleroentat Return ~___~4. Limited Estate E~ 4a. Future Interest Compromise (dateof death after 12-12-82) ----]6. Decedent Bled Testate (Attach copy of wi,) E~ 7. Decedent Maintained a Living Trust (Attach copy of Trust) [---] 9. Litigation Proceeds Received E~ 10. Spousal Pove~ Credit (date of death between 12-31-91 and 1-1-95) ME ~uce D; Foreman, Esquire FIRM NAM,E .... Foreman & F_o..r~man_. PC TELEPHONE Nu,v,6c~ 717.236.9391 E~ 3. Remainder Return (date of death prior th 12-13-82) I---~ 5. Federal Estate Tax Retum Required 8. Total Number of Safe Deposit Boxes ~111. Election to tax under Sec. 9113(A) (Attach Sc~ O) COMPLETE MAILING ADDRESS 4409 N. Front Street Harrisburg, PA 17110-1709 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 O) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property. (Schedule F) (6) E""] Separete 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, & Liens (Schedule t) (10) 11. Total Deductions (total Lines 9 & 10) !2. Net Value of Estate (Line 8 minus Line 11) 13. 14. 20,326.84 66.98 (8) 20,393.82 10¢697.83 1 ,910.25 Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made [Schedule J) Net Value Subject to Tax (Line 12 minus Line 13} (11) 12 ¢ 608.08 (12) 7,7 85.74 (~3) (14) 7,785.74 OFFICIAL USE ONLY SEE INBTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the sbousal tax rate, or transfers under Sec. 9116 (a~(1.2) 16. Amount of Line 14 taxable at lineal rate 17. ,&mount of Line 14 taxable at sibling rate 7,7 8 5.7 4 !8. Amount of Line 14 taxable at coilateral rate ~9. Tax Due × .o__ (15) x 0 (16) :( 12 (17) x 15 (18) (19) 934.29 > > BE' SU RE TO'~R-~A:kL;, Q1.;IES~I3ON~¢'OI~REVERSESIDE}AND;.REOHEC~,, Decedent's Complete Address: ISTREETADDRESS 5430 Oxord Circle Cl~ Mechanic sbu~ rr. g_, ..... -, Tax Payments and Credits: 1. Tax Due/Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Pdor Payments C, Discount (1) Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) . 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTION8 BY PLACING AN "X" IN THE APPROPRIATE BLOCKS IF THE ANSWER Did decedent make a transfer and: Yes No 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 premise for life of either payments, benefits or care? ...................................................................... [] [] If death occurred after December 12, 1982, did decedent transfer properly within one year of death without receiving adequate consideration? .............................................................................................................. [] [] Did decedent own an "in trust for~' or payable upon death bank account or secudty at his or her death? .............. [] [] Did decedent own an Individual Retirement Account, annuity, or other nompi'obate property which contains a beneficiary designation? ........................................................... :.:i~. ........................................................ [] TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I dec'lam that i have examined this return, including accornpanymg schedules and stalements, 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 wi]ich preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE Bruce D. Foremanr Esquire ADDRESS -- 4409 N. Fron~Street, Harrisburg, SIGNATURE OF 'PREP~R~~.N ~?!qESENTATIVE /' "- k/ ADDRESS ! "" PA 17110-1709 DATE 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 I, 1995, the ~ax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1! (ii)]. The statute does not exempt a transfer to a surviving spouse from tax. and the statutory requirements for disclosure of assets and filing a tax return are still applicaPle 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 b, ven~-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. ~9116fa)(1.2)], ,-he [ax ra[e imposed on the net value of transfers ~o cr for me use of the decedem's i[neal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1,2) [72 P.S. ~9116(a1(1 The tax rate im~)osed on the net value of transfers ;o or 'or the use of the decedem's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102. as an ndividuat who has at least one parent in common with {he oecedent, w~ether by blood or adoption, SCHEDULE A REAL ESTATE Estate of JOYCE M. TIMMONS Item Description File Number: Value at Date of Death Total $0.00 Estate of JOYCE M. TIMMONS Item Description 1. Dividend - Hilliard Lyons Dividend - Hilliard Lyons 2. PNC - Investments SCHEDULE B STOCKS & BONDS Total File Number: Value at Date of Death $81.80 $81.43 $20,163.61 $20,326.84 SCHEDULE D MORTGAGES & NOTES RECEIVABLES Estate of JOYCE M. TIMMONS Item No. Description 1. None File Number: Value at D/O/D Amount SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY ESTATE OF JOYCE M. TIMMONS File Number Item It 1. 2. Description Hartford Insurance (Policy Cancellation) Clearpoint Direct. Corn Refund Amount $57.00 $9.98 Total $66.98 SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF JOYCE M. TIMMONS File Number Joint Tenant(s): NAME ADDRESS RELATIONSHIP TO DECEDENT A. None B. C. Jointly-Owned Property: ITEM # 1.ETTER DATE DESCRIPTI()N OF TOTAl, VAI,UE DECD'S DOI.I,AR VA1.UE FOP, IVlAI)I~ PP, OPIi~R'I'Y Ot: ASSET % INT. OF I)ECD'S INT. JOINT JOINT ................... ~.F.,.~../LN ~' ........................................................................................................................................................................................................... 1. None TOTAL $ Estate of JOYCE M. TIMMONS SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS File Number: FUNERAL EXPENSES: 1. Neil Funeral Home, Inc. 2. Diocese of Harrisburg, Catholic Cemeteries ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions: Name of Personal Representative(s): Social Security Number(s) of Personal Representative(s): Address: Year(s) Commission Paid: 2. Attorney Fees: FOREMAN & FOREMAN,PC 3. Probate Fee - Register of Wills 4. Register of Wills - Short Certificate 5. Advertising- Cumberland Law Journal 6. Advertising- Evening Sentinel $7,995.00 $1,275.00 $1,200.00 $78.50 $3.00 $75.00 $71.33 TOTAL $10,697.83 SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS Estate of JOYCE M. TIMMONS File Number: Item No. Description Conner - Rich Associates 207 House Avenue, Suite 101 Camp Hill, PA 17011 Amount $8.80 ENT Facial Plastic Surgery Group, P.C. 1857 Center Street Camp Hill, PA 17011 $32.37 Health South Diagnostic Center PO Box 710 Reading, PA 19607-0710 $68.80 Holy Spirit Hospital 503 North 21st Street Camp Hill, PA 17011-2288 $405.64 0 IDT America 135 S. Lasalle, Dept. 8025 Chicago, IL 60674-8025 $8.38 o Kilmore Eye Associates 890 Century Drive Mechanicsburg, PA 17050 $79.81 ° Moffitt Heart & Vascular Group 1000 North Front Street Wormleysburg, PA 17043 $104.66 o PPL 2 North 9th Street - RPC - Genni Allentown, Pa 18101-1175 $78.71 ° Pennsylvania American Water PO Box 578 Alton, IL 62002-0578 $50.00 10. UGI Gas Service PO Box 13009 Reading, PA 19612-3009 $46.12 11. 12. 13. Verizon PO Box 28000 Lehigh Valley, PA 18002-8000 PNC Bank Bankcard Services PO Box 15137 Wilmington, DE 19886-5137 USPS Shiremanstown, PA $7.96 $694.09 $324.91 Total $1,910.25 SCHEDULE J BENEFICIARIES ESTATE OF JOYCE M. TIMMONS File Number Be Taxable Distributions Name / Address of Beneficiary_ Mary T. Timmons-Perillo 19 Stiles Drive Melville, NY 11747 Geraldine Read 122 Seminole Lane Boca Raton, FL 33487 Eleanor Rossman 52o Joyce Road Camp Hill, PA 17011 Paul Timmons mo9 Edinburg Circle New Cumberland, PA 17070 Carol Timmons-Fencel 889 Acri Road Mechanicsburg, PA 17o55 Joy Zipper 19141 Fox Landing Drive Boca Raton, FL 33434 Nontaxable Distributions Name / Address of Beneficiary_ None. Relationship daughter daughter daughter son daughter daughter Relationship Amount or Share of Estate 1/6 1/6 1/6 1/6 1/6 1/6 Amount or Share of Estate CQMMOi"~'WEA~TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003425 FOREMAN BRUCE D 4409 NORTH FRONT STREET HARRISBURG, PA 17110 ........ fold ESTATE INFORMATION: SSN: 369-22-3107 FILE NUMBER: 2103-0929 DECEDENT NAME: TIMMONS JOYCE M DATE OF PAYMENT: 01/09/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUM BERLAN D DATE OF DEATH: 11/06/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $934.29 TOTAL AMOUNT PAID' $934.29 REMARKS: CHECK# 5420 INITIALS: AC SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH DEPUTY REGISTER OF WILLS REGISTER OF WILLS BUREAU OF ZNDZVZDUAL TAXES ZNHER~TANCE TAX DTVTSZON DEPT. ,'.80601 HARRZSBURc, PA 17128-0601 COMMONWEALTH OF PENNSYLVANZA DEPARTMENT OF REVENUE NOTZCE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLONANCE OR DZSALLOHANCE OF DEDUCTZONS AND ASSESSMENT OF TAX REV-l;47 EX AFP COl-DS) BRUCE D FOREMAN ESQ FOREMAN & FOREMAN 4409 N FRONT ST HBG - ' i~.~; Of DATE 03-01-2004 ..... ~uiijS ESTATE OF TIMMONS DATE OF DEATH 11-06-2003 FZLE NUMBER 21 03-0929 FEB 27 ? 1 :lt °uNTv CUMBERLAND ~CN 101 JOYCE M Amount: Rem'i ;c'l:ed MAKE CHECK PAYABLE AND REMZT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THZS LZNE ~ RETAZN LOWER PORTZON FOR YOUR RECORDS ~ DZSALLOWANCE OF DEDUCTZONS AND ASSESSMENT OF TAX ESTATE OF TIMMONS JOYCE MFILE NO. 21 03-0929 ACN 101 DATE 03-01-2004 TAX RETURN HAS: ( ) ACCEPTED AS FILED (X) CHANGED SEE ATTACHED NOTICE RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Reel Es~a~e (Schedule A) (1) 2. S~ocks and Bonds (Schedule B) (2) 3. Closely Held SJcock/ParJcnership Interest (Schedule C) ($) q. Hor~gages/No~as Receivable (Schedule D) (q) 5. Cash/Bank Deposits/Misc. Personal Proper~y (Schedule E) (5) 6. Jointly Owned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To~el Asse~s APPROVED DEDUCTZONS AND EXEMPTZONS: 9. Funeral Expenses/Adm. Cosmos/Misc. Expanses (Schedule H) (9) 10. Debts/Hot,gage Liabili~cies/Liens (Schedule [) (10) 11. To,al Deductions 12. Ne~ Value of Tax Re~urn 20/326.84 .00 66.98 .00 NOTE: To insure proper credi~ ~o your account, sub. i~ ~ha upper portion .00 of ~his fora wi~h your ~ax payment. .00 .00 (8) 10,697.83 13. 14. NOTE: 20,393.8Z 1~910.25 (11) 17.61]1~. I]8 (1;) 7,785.74 Charitable/governmental Bequests; Non-elected 9115 Trusts (Schedule J) (1:3) NeJc Value of Es~a~:e Subjec~ '~o Tax (lq) :Zf an assesseent was issued previously, llnes 14, 15 and/or 16, 17, reflect flgures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amoun~ of Line 1~ a~ Spousal ra~e 16. Amoun~ of Line 1~ ~axabla a~ Lineal/Class A rata 17. A.oun~ of Line 1~ a~ S~bZ~ng ra~e 18. A.oun~ of Line lq ~axable a~ Collateral/Class B re~e 19. Pr~ncipeZ Tax Due TAX CREDZTS: PAYHENT RECEZPT DZSCOUNT (+J DATE NUMBER ~NTEREST/PEN PA~D (-) 01-09-2004 CDOO34Z5 17.52 .00 7,785.74 ZF PAZD AFTER DATE ZNDZCATED, SEE REVERSE FOR CALCULATZON OF ADDZTZONAL ZNTEREST. 18 and 19 will (1.q) .00 X O0 = .00 (16) 7,785.74 X 045= 350.36 (17) .00 X 12 = .00 (18) .00 x 15 = .00 (19)= 350.36 AHOUNT PAZD 934.29 TOTAL TAX CREDZT I 951.81 I BALANCE OF TAX DUE 601.45CR ZNTEREST AND PEN. .00 TOTAL DUE 601.45CR ~.~, ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS RE~UZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDZT' (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SZDE OF THZS FORM FOR ZNSTRUCTZONS.) ~EV-1470 EX (6-88) :~.~~ INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG~ PA 17128-0601 DECEDENT'S NAME FILE NUMBER Joyce M. Timmons 2103-0929 REVIEWED BY ACN Sheila Megonnell 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES J Lineal heirs are taxable at the rate of 4.5% for dates of death on or after 07-01-2000. Row Page 1 ~'~ ~ ~. COMMONWEALTH OF . ~-".~ PENNSYLVANIA ~,c~'..~':~'(-,.~ DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT J OFF C~AL USE ONLY FILE NUMBER AL 0_3__ 9_2__q_ COUNTY CODE YEAR NUMBER -- -- LU ~oo I.- Z LU Z O Z DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL) TZN.MONS, JO¥CE N. DATE OF DEATH (MM-OO-YF-AR) I DATE OF BIRTH (MM-DO-YEAR1 November 6, 2003 December 25, (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) 1:917 SOCIAL SECURITY NUMBER 369 -- 22 -- 3107 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER ~I 1. Original Return ~ 2. Supplemental Return Amended ~ 3. Remainder Return (date ofdee~ prior to 12-13"82) ~ 4. Limited Es~te ~ 4a. Future interest Compromise (date of d~m a,, ,2-,2-82) ~ 5. Federal Estate Tax Return Required 6. Decedent Died Testate {A~ copy ~ wi,) ~ 7. Decedent Maintained a Living Trust (A~c~ ~,y 0¢ T~st) 8. To~I Number of Safe Deposit Boxes ~ 9. LitigaUon Proceeds Received ~ 10. Spousal Pove~ Credit (~m ¢ dead be~n 12-31-91 and 1-1-95) ~ 11. Election to tax under S~. 9113(A) (A~ Sch O) ME ~ruce D; Foreman, Esquire ICOMPLETE MAILING ABDRESS FIRM NAM~ Foreman & Foreman, PC 4409 N..Front Street TELEPHONENu'v'u:~ Harrisburg, PA 1 71 1 0-1 709 (717) 236-9391 1. Real Estate (Schedule A) (1) 2. Stocks and 8onds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole--Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Sank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Proper'b/(Schedule F) (6) E~ 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, & Liens (Schedule I) (I0) 11. Total Deductions (total Lines 9 & 10) !2. Net Value of Estate (Line 8 minus Line 1l) 20,326.84 12,161 .48 1 ,868.25 OFFICIAL USE ONLY' 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an etection to tax has not been made (Schedule J) !4. Net Value Subject to Tax (Line 12 minus Line I3) (11) 14,029.73 (12) 9,486.72 (t3) (14) 9,486.72 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the soousat tax rate. or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line !4 taxable at lineal rate !7. Amount of Line 14 taxable at sibling rate !8. Amount of Line !4 taxable a~ collateral rate x .0__ (15) x .0__ (16) 9,486.72 x .12 (171 1 , 138.41 Less Payment .Made -.g3.4.~_9 x 25 (181 i19) 204.1 2 Tax Due > > BE SU RE TO 'AN~VVAz~AL-L~ QCIESTIONS*OI~RE~ERS~'::SIDE~ANDr RECHEC~ MA~TH¢<: < Decedent's Complete Address: STREETADDRESS 5430 Oxford Circle CITY Mechanic sbur.~ _ ...... _ Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Povert7 Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty .4. (I) Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE, (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + EA. This is the BALANCE DUE. (5B) 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; .......................................................................................... [] 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 nompi'obate property which contains a beneficiary designation? ......................................................... L:.'i.: ......................................................... [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU ~vlUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other th,~ the personal reoresentaWe~s,~based on all information of whicf~ prel3arer has any knowledge. ADDRESS 'Bruce D. Foreman, Esquire Foreman & Foreman, PC 4409 N. Front St. Hbg. PA SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE 1 7 1 1 O- 1 7 0 9 ADDRESS 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 I, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax. and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse ~s the only beneficiary. For dates of death on or after July !. 2000: The tax ra~e 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 stebparent of the child is 0% [72 P.S. ~9118(a)(1 The (ax rate imposed on the net value of transfers to or for the use of the deceoen('s iineal benefic~anes is 4.5%, excent as noted in 72 P.S. ~9116(i .2) [72 P.S. §9116(a1(1 The tax ,~ate imposeo on (he net value of transfers to or -'or the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, ,~s an !ndividuai who has at teas~ one parent in common with ~e decedent, whether by blood or adoption. SCHEDULE A REAL ESTATE Estate of JOYCE M. TIMMONS Item Description File Number: Value at Date of Death Total $0.00 Estate of JOYCE M. TIMMONS Item Description 1. Dividend - Hilliard Lyons Dividend - Hilliard Lyons 2. PNC - Investments SCHEDULE B STOCKS & BONDS Total File Number: Value ~ D~e of Death $81.80 $81.43 $20,163.61 $20,326.84 PAY TO THE ORDER OF JOYCE M TI~ONS 5430 OXFORD DR MEC~{ANICSBURG PA 17055-4452 ii" 800 ~0[. ,:Oh 550 ~ 2'?1: ~O0qSg 25 ~8,' TO THE MECIIAiqICSBURO PA 17055-4452 ~ DARK TO LIGHT WITH DARKER A~I~ ..... ' PNC BaRk, N.A. N:Ci:: :::~?!!:::i:: :::i..- Jeannette, PA ·' . : '. :!. 60-1621433 · · !:~i !' i .. :' ~:::: 02/03 PAY ~E: .:.: . :' ::: :'i' ;:::: "":: .'::::::: !:'~ 2 / ** * * 8 i. 4:3!!: .:: ::: ':.: i~:~~~PAY ' ..::: ~::.: m"-0h ~ %D &?-, 2 ?m: ~OOqS~ 2 :~ :~ P.," .?:!~ ::'. I~OL!ISV'iLLE;i'K Y"'" '> · .... Jeannette,'P.~ :: · 60-162 ' i-: ~! ': :':.MEMBER NEW YORK STOCI~ EXCHANG~ I~C ..... 4~- : ':: · : ' '": .... -'. ' i""i2/29/03 PaY ***20163.61 BRUCE D FOREMAN EXECUTOR PAY ESTATE OF JOYCE M TIMMONS ORDER OF HARRISBURG PA 17110-1709 180 DAYS .... "'qOq~5~' I:0~0~?,: ~OOqS~5~l~' SCHEDULE D MORTGAGES & NOTES RECEIVABLES Estate of JOYCE M. TIMMONS File Number: Item No. Description Value at D/O/D Amount 1. None SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY ESTATE OF JOYCE M. TIMMONS File Number Item # 1. 2. 3. 4. 5. Description Hartford Insurance (Policy Cancellation) Clearpoint Direct. Com Refund Comcast Financial PNC Bank PNC Bank Total Amount $57.00 $9.98 $17.93 $3104.38 $0.32 $3,189.61 DATE 11/06/03 IF YOU HAVE 1-800-423-6789 ANY QUESTIONS. PLEASE TIMMONS JOYCE M 5430 OXFORD DRIVE MECHANICSBURG CONTACT THE COMPANY PA 17055 CHECK NO. AT; 20960436 TFOltD PAYEE: TIMMONS JOYCE M INSURED REG POLICY SYM POLICY NUM PROD CODE ACCOUNT NUM 055 0126600 80274355 CHECK AMOUNT **********.*'57.00 CHECK DESCRIPTION 80274355 55 PHE377382 POLICY CANCELLED Form T-258-7 Printed in U.RA. PAY TO THE ORDER OF P.O. BOX 3508 CHAMPLAIN, N.Y, U.S.A. 12919 Custcrr..,er Nc,, JOYCE TD CANADA TRUST U23980 2OOl UNIVERSITy STREET MONTREAL, QUEBEC H3A 2A6 47941-004 OrrJer Da~ R,:,un,.~ Date U.S. DOLLAR ACCOUNT SJ'~;'~(~):{ -Q/'~)/J(~J,J 1-324/260 -. TIM. MONS ~9.9§ MEMO ""0 2 ~ q,o, 0,. 170.~a PER ~ PER 1, ? q t,,,, ? :, O 2 I~ 2 5," DOLLARS COMCAST FINANCIAL AGENCY CORPORATION ,\ COMCAST CABLE COMMUNICATIONS GROU. P COMPANY 155747613 11/20/03 PAY EXAOTLY: SEVENTEEN AND 93/100 TO THE ORDEFI OF: 8UB$ORIBER ~b~OuNTNUMBERi Issued ltv hdcgraled I'ayment Sy~t~li~ Ine~ Eflglewk~d. Colorado:[]] ]:]::~ ~. : ':}k:.:.:: .:::... Pkmk One. NA. Dem'ef. L'oh~Tado :: :: 17.93....... ] VOl I) Al"'! Ell. 9O Al tTHt)F. 17ED SIGN.*,. lURE : f-,RO0 ~, S 5 ?!, ?P, ~. Cashier's Check ~ PNCBAN( PNC Bank, National Association Southcentral PA No. 1164683 6o-,,,,,.,,3 Date ~"IB'ER 15 200~ Pay to the Or C' '" ' - ...... ~,::' ~' ....... ~i:~,~ ,~,~ ~ ,~ .............. Dollars REMITTER CLO.'.:;E ~CCT , National Association OFFICIAL SJGN/~E' 3 ~ I~" ,1, i g h g,Et :t,, FORM103755-0300 Cashier's Check ~. PNCBAN( PNC Bank, National Association Southcentral PA No, 1164684 DateC, EL-:ENE:ER 15, 200._'5 60-1273/313 Pay to the r'oq-.,tn-~- .... it-- - : --- ~'~ · - - - Orderof IE,',I,.~,|~I_tF ,IIII'I.;F ~'1 TThl~,llq~q:R I$ ~,', ~.~, J 7~Di'I ,,~ub:~,~ ~ ~ ~ ~:.,, ~. ,:., ~.'~,~ .~ -~. ~ .~- ~ ~ C, ,-, .,i.,1.~ ~ PNC B~, Nafion~ ~sociafion 5 &qqqq0 ? ], SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF JOYCE M. TIMMONS File Number Joint Tenant(s): NAME ADDRESS RELATIONSHIP TO DECEDENT None Jointly-Owned Property: ITEM # L E TT E R FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY TOTAL VALUE OF ASSET DECD'S DOLLAR VALUE % INT. OF I)ECD'S INT. 1. None 2. TOTAL $ Estate of JOYCE M. TIMMONS SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS File Number: A. FUNERAL EXPENSES: 2. 3. 4. 5. 6. 7. Nell Funeral Home, Inc. Diocese of Harrisburg, Catholic Cemeteries St. Lawrence - Funeral Mass Tom Liebel - Organist Resurrection Cemetery - Burial Cash - Rillo's Catering - Funeral Meal Wine & Spirits - Funeral ADMINISTRATIVE COSTS: Personal Representative's Commissions: Name of Personal Representative(s): Social Security Number(s) of Personal Representative(s): Address: Year(s) Commission Paid: 2. Attorney Fees: FOREMAN & FOREMAN,PC 3. Probate Fee - Register of Wills 4. Register of Wills - Short Certificate 5. Advertising- Cumberland Law Journal 6. Advertising- Evening Sentinel $7,995.00 $1,275.00 $150.00 $135.00 $700.00 $200.00 $278.65 $1,200.00 $78.50 $3.00 $75.00 $71.33 TOTAL $12,161.48 NEILL Funeral Home Inc. ~40 i Market Strec~ C~m~p Hill, PA - ! 7011-4428 ~cl 717~73718720 lax 717-737-[859 John J. Peters FUNERAL DIRECTOR ~01 Dcrr? Street Har-isburg PA- 17111-1817 tel 717-50412033 thx 717-561_9c)18 Member of ALDERWCX3DS GROUP Neill Funeral Home, Inc. 3401 Market Street Camp Hill, PA 17011 Tel: 717-737-8726 Fax: 717-737-1859 Robert J. Pramik, ED., Supervisor CONTRACT STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED CASE # Charges are only for those items that you select or that are required. If we are required by law or by a cemetery or crematory to use any item, we will explain the reason in writing below. Arrangements for: ..... ,- ~- ~ ~ ~'' ~ ~ ~ '--~ ~ r~ SERVICES, FACILITIES, AUTOMOBILE, OTHER EQUIPMENT AND OTHER SERVICES: Itemized General Price List: Basic Professional Services of Funeral Director and Staff: $ ?''r Other Care of the Deceased: Embalming $ Sanitary Care of the Unembalmed Remains ./.-.,-~, . Dressing, Casketing and Cosmetology Post Autopsy Care/Post Organ Donation Restoration Charge Refrigeration ,7.,~. Care and Custody While Sheltering Remains Other Care of the Deceased: Total Care of the Deceased Directing of Services and Use of Facilities: Visitation Funeral Ceremony Memorial Ceremony Graveside Special Hrs. Charge Total Directing of Services and Use of Facilities Automotive, Other Equip., Other Services and Other Charges: Date of Arrangement: Date of Death: .,.., · MERCHANDISE: Outer Burial Containers: Cremation Urn: ' ,20 ,20 ~- - Cremation Container: Clothing as Selected: Grave Marker: Acknowledgment Cards as Selected Memorial Register Memorial Folders/Prayer Cards Combination Shipping Unit/Air Tray Total Merchandise CASH ADVANCES: Sales Tax: Cemetery: Death Certificates (No..- - @ Permit Disposition/Burial Permit Medical Examiner's Charge Honorarium: MusiciansNocalist: Air or Other Transport: Out of Town Funeral Homes: $ $ ) Newspaper Notices: -, -6 .... ,'- OfiPost Office Box 3651 Harrisburg, Pennsylvania 17105 ce of Catholic Cemeteries SALESMAN NO. SALES CONTRACT AND TEMPORARY BURIAL AGREEMENT N© NO. A/N X P/N 8812 Interment Spaces ...... @ $ Burial Vaults ......... @ Crypt Spaces ......... @ $ .... Section _~ Lot __~Grave{s). t Block Crypt(s) Selection must be made within 30 days or cemetew will make AIR Price ............................. $ 3. Un~id ~alan~ {1-2} .................. 4. [inan~ Cha~e ...................... fi. ~efermd Payment ~mount {3+4} .......... 8. lotal Cri~ (1+4} .................... '. 7. ~roximate ~onth~ Payment ........... 8. ~umbor of ~onthl~ Pa~ment~ ............ O. First ~onthl~ Payment Duo ............. 10. ~nnual Per~nt~e ~ ....... , ......... _1 t ~[ t _ erms: ~asn , _ In~allment -- The payment is due on the date stated above and the remaining payments on the same day of each succeeding month. -- Buyer may prepay in advance the full amount due without penalty and will be entitled to a proportionate refund of the unearned -- Upor~ default in the payment ufa y, stahmqnt due nereurmer for aperiod in excess of one hundred twenty (120)days, Sel{er may at its option, void this agreement and retain all payments made by Buyer as liquidated damages. -- BuyE~r hereby acknowledges receipt of an exact executed copy of this agreement at the time of execution hereof. -- Before any burial is permitted in this lot, or any memorial placed on this lot, the price of the grave and memorial must be paid in fuil. -- The Purchaser(s) agree(s) to abide by all rules and regulations of the cemetery now in force as well as any rules and regulations which may hereafter be adopted. Said rules and regulations may be seen upon request at the Seller's office. -- Upon fulfillment of the conditions of this agreement and receipt of all the above described payments, Seller agrees and binds itself to convey to the Buyer, by its cemetery easement, for interment purposes only, the above mentioned number of sites. -- YOU, THE PURCHASER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. , - x (Aut~horizec~ Repr~ese~ative) NOTICE: See other side for additional information. (Purchaser's Signature) (Co-purchaser's Signature) BP/5900 RECEIPT FOR PAYMENT Cumberland County - Reqister Of Wills Hanover and HiGh Street Carli~le, PA 17013 Receipt Date 11/10/2003 Receipt Time 11:29:13 Receipt No. 1034648 TIMMONS JOYCE M File Number Remarks 2003-00929 FOREMAN & FOREMAN PC DO Tran~' 'tion Description PETIi iN FOR PROBA SHORi 2ERTIFICATE EXT~- PAGES CODI~i ~ JCP 7 ~ Distribution Of Receipt ........................ Payment Amount Payee Name 25.00 9.00 24.00 10.50 10.00 CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY'GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN BUREAU OF RECEIPTS & CNTR M.D Checi 2549 ~778.50 Teta .~eceived ......... 8 50 RECEIPT FOR PAYMENT Cumberland County - Register Of Wills Hanover and Hiqh Street Carlisle, PA 17013 Receipt Date 12/22/2003 Receipt Time 09:06:04 Receipt No. 1035042 TIMMONS JOYCE M File Number Remarks 2003-00929 Trans,: gion Description SHORT ERTIFICATE Distribution Of Receipt Payment Amount 3.00 Cash Total eceived ......... 33-00 O0 Payee Name CUMBERLAND COUNTY~ GENERAL FUN RETAIN THIS PORTION FOR YOUR RECORDS REMll-rANCE ADDRESS BILL TO THE SENTINEL - LEGAL FOREMAN & FOREMAN P.O. BOX 130, CARLISLE, PA 17013 AD NUMBER J CLASS SALESPERSOk BILLING DATE LINES 255729I 10 PUBLIC NOTICES 29 12/17/03 19 AD DESCRIPTION START DATE STOP DATE LETTERS TESTAMENTARY ON THE ESTATE 11/28/03 12/12/03 PUBLICATION INSERTIONS RATE NET AMOUNT GROSS AMOUNT 3 THE SENTINEL - LEGAL 3 LGL 64.98 TOTAL AD CHARGE 64 . 98 3 PROOF OF PUBLICATION 01PRF 6.35 DAYS RUN PURC.ASE ORDER PAY THIS AMOUNT 71.33 85.60* Joyce M. Timmons MESSAGE: * AFTER 01/16/04 Thank you for advertising with The Sentinel. Deadlines for in-column legal advertisements: Monday is Friday at 11 a.m.; Tuesday is Friday at 4 p.m.; Wednesday is Monday at 12 Noon; Thursday is Tuesday at 12 Noon; Friday is Wednesday at 12 Noon; Sunday is Thursday at 12 Noon. If you have any questions regarding your Legal bill please call Lori Saylor 243-2611 ext. 201 Fax your legals to 243-3754, attention Lori Saylor You can also EMAIL your legal to Classified ads: ads@cumberlink.com. Please send a cover letter including your name and address as an attachment PROOF OF PUBLICATION State of Pennsylvania, County of Cumberland. Rich Canazaro, Internet Director of THE SENTINEL, of the County and State aforesaid, being duly sworn, deposes and says that THE SENTINEL, a newspaper of general circulation in the Borough of Carlisle, County and State aforesaid, was established December 13th, 1881, since which date THE SENTINEL has been regularly issued in said County, and that the printed notice or publication attached hereto is exactly the same as was printed and published in the regular editions and issues of THE SENTINEL on the following dates, viz Copy of Notice of Publication LETTERS TESTAMEN- TARY on the Eatate of JOYCE M. TIMMONS, late of the Mechanics- burg, Cumberland County, Pennsylvania, having been granted to the undersigned, all per- sons'indebted to the said Estate are required to make immediate pay~ ment and those having claims will present them for settlement to: · Bruce D. Forem~n, Esquire Foreman &~F~reman, P.C. 44G9 Neilh FYont S. treet Harrisburg; PA 171 iO-1709 November 28, December 5 & 12, 2003 Affiant further deposes that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statement as to time, place and character of publication are true. ~.~ _~7 December 18, 2003 Sworn to and subscribed before me this day of.. ~·. ~Cember, 2003 18TH ~Notary Public My commission expires: ¢4GTARIAL SEAL APRIL D. SHEAFFER, Notary Public Carlisle, Cumberland County My Commission Expires April 23, 2006 CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 DECEMBER 12, 2003 Cumberland Law Joumal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Bruce D. Forman, ESQUIRE RE: Joyce M. Timmons, ESTATE Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on following dates: NOVEMBER 28, DECEMBER 5, 12, 2003 Advertising Cost Proof of Publication Second Proof Request Payment Received Total Amount Due $ 75.00 $ 0.00 $ 0.00 $ 75.00 $ 0.00 Payment received NOVEMBER 24, 2003 by Becky H. Morgenthal/Executive Director PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 STATE OF PENNSYLVANIA : : COUNTY OF CUMBERLAND : SS. Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland' Law Journal on the following dates, viz: NOVEMBER 28, DECEMBER 5, 12, 2003 Timmons, Joyce M,, dec'd. Late of Mechanicsburg. Executor: Bruce D. Foreman, Es- quire, Foreman & Foreman, P.C., 4409 North Front Street, Har- risburg, PA 17110-1709. Attorneys: Bruce D. Foreman, Esquire, Foreman & Foreman, P.C., 4409 North Front Street, Harrisburg, PA 17110-1709. Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are tree. SWORN TD AND SUBSCRIBED before me this 12 day of DECEMBER, 2003_ F I~ff'~l.~L SEAL ~/ j LOIS E. 8NYDER, Notary Public J Carlisle Bom, Cumberland County [. My Commission Expires March 5, 2005 BINE & SPIRITS SH61~PE 21091~-~-,-,~" 3441 SIMPSON FERRY RD CAMP HILL PHONE ~73i-0482 UUESTIONS, CONCERNS OR SUGGESTIONS CALL 1-800-2?2-PLCB 2109 002 A 00504024 6285 7666 * 6 Al 4518 1 AT 5146 * 6 AT MONDAV PVT CHARD 19.99 SALE 119.94 SMIRNOFF VOD 80PF 22.99 22.99 MONDAV PVT CAB SAIJ 19.99 SALE 119,94 SUBTOTAL 262.87 6.0% SALES TAX 15178 TOTAL 278.65 INVOICE NUMBER 311581 Debit Card Debit Card Number ***~*******'2273 Aufh ~: 132670 278 65 TOTAL UNITS SOLD 13 PLCB REVENUES BENEFIT ALL PENNSYLVANIANS CUSTOMER COPY 11/07/03 16:24 []Gas / Electric ~ Cred!t Card ~ Medical / Dentel [~ Telephone ~ Taxes [~ Dependent Care []Food Insurance ~(Ufe, Home, Auto) [~Savings & lnvestmen~ [~] C~othing Home improvement ./' ~-, ~(Maintenance~Repairs) ~Other~ 'RetaindupliatesinD xeCheckbox , . f ~. BAL FOR' NEGOTIABLE ¢' Track 'four Expenses... []Mortgage/Rent r~mransportaonE~JEntertainment&Travel DO NOT USE [] G~s / Electric [] Credit Card [] Medical/Dental F O R R E O R D E R I N G [~Te[ephone []Taxes []Dependent Care /; ~I "~ [] Food Insurance ~ ~ (Life. H .... Auto) I~ Savings & Investment ~ /'~ ' '.'~/ []Clothing (Mainte~Repairs) []Other . BAL. FOE'• THIS · Carry baJance forward ] OTHI · Check type of expense BAL ..... ' '- ~,. ~ c~ c ~J'" N-OT NEGOTIABLE ... Here's How: · Carry t~alance forward · Check iype of expehse · Add details o~ memo ne · Retain du~pNca[es n Deluxe Check box ,/' Track Your Expenses.,. ~ ~ [~Mortgage/Rent []Transportation .[]Entertainment&Travel iDO NOT USE ', [] Gas / Electdc [] Credit Card [] Meal,cai / Dental FOR REORDERING 283 [] Telephone []Taxes E~ Dependent Care []FOOd [] l~i~,:aH' oC~e, Auto, E~ Sa~/ings &[nvestment '''~'-- ll.j-O.'('~.~ [] f~laintenance> Repairs) [] Other __ BAL : cC~;cry~b~t/IP':cO1 te~pr~rsde / F ~ B .....' I~]Mortgage/Rent [~transpo~ahon F"]Entertainment&TraYel DO NOT USE [~] Gas, Electr,c ~lOredi, Card []Medical/Dental FOR REORDERING 2;.~0 [] Food [] l~-i1~aHr oCr~e, Auto) ~ Savings & Invest .... E~ C'o'i~i~g~? [](Mai ......... Repaffs) []Other ti ' 4 ' ' NEIIi, FUNERAL HOME, INC. Harrisburg, Pennsylvania (717) 564-2633 Camp Hill, Pennsylvania (717) 737-8726 Services For ,.,/'0 ,Y'c' ~ ~ The Following Items Checked Are Needed: [~CLCLOTHI NG: E~CIAL SECURITY NO. E~LASSES [;~'~:WELRY I]~'~,'OSARY [] PHOTO OR SNAPSHOT [] VA DISCHARGE PAPERS [] MOTHER'S MALDEN NAME [] FATHER'S NAME WILL BE REQUIRED FOR: ~ PayableTo "¥,.s-~- ~-~.' ~. f ).. ~ Payable To ~ ~ ' ' o~ Payable To SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS Estate of JOYCE M. TIMMONS Item No. Description Conner - Rich Associates 207 House Avenue, Suite 101 Camp Hill, PA 17011 File Number: Amount $8.80 ENT Facial Plastic Surgery Group, P.C. 1857 Center Street Camp Hill, PA 17011 $32.37 o Health South Diagnostic Center PO Box 710 Reading, PA 19607-0710 $68.80 Holy Spirit Hospital 503 North 21st Street Camp Hill, PA 17011-2288 $405.64 IDT America 135 S. Lasalle, Dept. 8025 Chicago, IL 60674-8025 $8.38 Kilmore Eye Associates 890 Century Drive Mechanicsburg, PA 17050 $79.81 Moffitt Heart & Vascular Group 1000 North Front Street Wormleysburg, PA 17043 $104.66 PPL 2 North 9th Street - RPC - Genni Allentown, Pa 18101-1175 $78.71 Pennsylvania American Water PO Box 578 Alton, IL 62002-0578 $30.00 10. UGI Gas Service PO Box 13009 Reading, PA 19612-3009 $24.12 11. 12. 13. Verizon PO Box 28000 Lehigh Valley, PA 18002-8000 PNC Bank Bankcard Services PO Box 15137 Wilmington, DE 19886-5137 USPS Shiremanstown, PA $7.96 $694.09 $324.91 Total $1,868.25 CONNER - RICH ASSOCIATES INTERNAL MEDICINE 207 HOUSE AVENUE, SUITE 101 CAMP HILL, PENNSYLVANIA 17011 Billing Office 761-8345 Medical Office 761-8331 CONNER - RICH ASSOCIATES 207 HOUSE AVENUE, SUITE 101 CAMP HILL, PENNSYLVANIA 17011 JOYCE M. TIMMONS 5430 OXFORD DRIVE MECHANICSBURG PA 17055 11/05/03 23835 (1) 11/o5/o3 23835 o6/13/o3 o7/11/o3 o7/11/o3 09/30/03 lO/O8/O3 10/08/03 08/15/03 09/04/03 09/04/03 10/20/03 Description JOYCE M. TIMMONS (23835.0 OFFICE VISIT - ESTAB PATIE Ins Pmt-HGS ADMINISTRATO Adjustment Ins Pmt-UNITED HEALTHCAR Payment - Thank You Payment - Thank You OFFICE VISIT - ESTAB PATIE Ins Pmt-HGS ADMINISTRATOi Adjustment Ins Pmt-UNITED HEALTHCARi TOTAl Charge 60.00 ~.S 60.00 '~S FOR JOYCE M. Total Due 8.80 Cu,;=nt I 31-60Days I 61-90Days 8.801 0.00 I 0.00 91 -120 Days ~ 0'01 Credit 39.05 11.19 0.00 9.76 0.50 33.19 18.51 0.00 TIMMONS Over 120 Days 0.0~ Detach this stub and return with payment. Balance Date 0.50: 8.30 8.80 23835.0) 06/13/03 o8/15/o3 P/ease 8.8 ( pay this amount! ....... .................... ;~ ::_1 y ,::: ~:'d ., -38 t' F i ,:: e U :i. ::- :i..t:. ~ I :i ~: '~c. :. ',% :. ....... - :::,-... ::.'--~ ;~ 7 .' i :':~ ,.' ¢?: {}? 1:': ..-'~ n .... <:., ¢ ~ 6 ?, ?..; ': "" ' "'-' C ., ¢:: -;- . _, ~' . .~ _ ..l · ~ i... :~ 'h ~-', .-'*:,.4 --'r", -~- ,-~ ;-, m .~ 4 :~ '?..." i ;fl. / :3 3 F..'.:,,,., ii~ ,';:. .... ~'"., '? '" ........., ~ ,<?.,, ,, ' ...... , ,? ,.., ~.'~:, ''~' f* ,:'.: I :';i :": - ':' o :", I'-' '[ I ,-'-' .=, t: : :I-: ,"" / '.- ~.". · "''' ..... .." ',;:: 5 .' :7:2 '-' - ' :':': <.:; n % -?~, ......, <~, ~, :..: '/,::. ;.: ::~. ?_,' ..... · 'l:;:~i '~ uhc ail, pl;'l "6i::, t..':-- i"::i:.:,ns,. , , ., ,<,: 'E. li':n .Tm~:,'-,c. .'~ .r='.-?~ I ':? -:.'¥':Ii0 ~.;.,'-.".r'iv .?'" ;::..'. ]~:":i ,,:.-¢ ,. ,' :'{i ' . ~::~::., ~_.. c., .~. ........ · ':' '"' ......- ............... I': ~ '"*' ~' ""?' '""*' ....... "" ......... " ".::<:, .%.!; :;~'7/ '3.':,::,.:., m,..~..: . i.,::a:'e ¢~. i , e :-.-:..: ,,,::.:¢,:_..F'..,..~, ' ,- ~ -"-,-" : 'Y,." ~ ,:}:GE:ii :,i: ':: 'il. I ?'c-~,, '::-,q/"~'"~"-' ........... :., c., 3 .-' :-' I ,, I I ! 'T :Lm m c, n s ;, .ir (3 y .::: ,.:: ~,1 e c: h ..:t n J c' s .:,_.t.:, u.'r' :.! ,~ F:' ¢:i :t 7 0 !5 iE M F;~ (3 :: 7 ]. '7 -... '7 F3 .t- :!. 3'7':: E !'d i::' L. ":' ,: Send payments to: HEALTHSOUTH DIAGNOSTIC CENTER CAMP HILL PO BOX 710 READING, PA 19607-0710 JOYCE TIMMONS 5430 OXFORD DRIVE MECHANICSBURG, PA 17055- Account Number: 004110 Patient: JOYCE TIP~ONS Account Balance; $68.~0 Date of Study ~--~-0'~ Type of Study ~ Your insurance has paid their portion of your account. The balance is now your responsibility and your prompt attention will be appreciated. If you have any questions regarding your account, please call us at 1-717-441-1047. If you prefer, your payment may be charged to your credit card by completing the following information: Visa Card Number MasterCard Expiration Date Visa Debit (Check Card) Amount to Apply $ Signature BAL HOLY SPIRIT HOSPITAL The Spiri~ of Caring Holy Spirit Hospital 503 N 21ST STREET CAMP HILL PA 17011 717-763-2141 ~r Account Information, Please Call 717-763-2141 Statement of Account 10/22/03 Transaction D~e , Description Amount PREVIOUS BALANCE 7,265.26 01/22/03 DISC ELECT AD 6 5.00 01/22/05 IV CATH 16.00 01/22/03 TRANSPARENT DRESSING 1.00 01/22/05 OXYGEN PER HOUR ~2.00 01/22/03 LEVEL V FC 606.00 01/22/03 ED LEVEL V PC 313.00 01/22/03 NON-EVA EAR/PUL OX FOR 02SATUR 32.00 01/22/03 RHYTHH ECG 1-3 LEADS INTER&REP 7Z.O0 06/2Z/03 AUTO ZERO PHT H81 AUTO INS .00 06/03/03 MEDI PYMT-HOSP IP M81 AUTO INS Z,667.28- 06/03/03 MEDI C/A HOSP-IP M81 AUTO INS 3,756.80- 07/29/03 MEDI PYMT-HOSP IP M81 AUTO INS Z,667.Z8 07/29/05 MEDI PYMT-HOSP IP M81 AUTO INS 2,667.26- 07/29/03 MED! C/A HOSP-IP M81 AUTO INS 3,756.80 07/29/03 MEDI C/A HOSP-IP M81 AUTO INS 6,716.76- 08/01/03 OTHER PATIENT NON CO MDO MEDICARE I/P 15.10- 08/13/03 MEDI PYMT-HOSP IP M81 AUTO INS 2,667.26 08/13/03 MEDI PYMT-HOSP IP M81 AUTO INS Z,667.Z6- 08/13/03 MEDI C/A HOSP-IP M81 AUTO INS 6,716.76 08/13/03 MEDI C/A HOSP-IP M81 AUTO INS 6,816.76- Estimated Insurance Due: .00 Total Patient Credits: Account Balance: 405.64 /181 AUTO INS .00 Mg0 MEDICARE liP .00 :32 UNITED HEALTH .00 'LEASE DISREGARD THIS STATEMENT IF YOU HAVE PAID. Please detach and return with your Imyment For Hoapital Uae Only Account Number. ADM DT: 012203 20307492 I Patient Name: Due By: DSH DT: 012303 TIMMONS ,JOYCE M ~/06~03 SB: 21020 717-766-9633 ~ vi. ~ Ca~ Numbe~ ~. Data: HR: HSG Sl~atum: ~ouat ~ld: 530.81 Make Check Payable To HOLY SPIRIT HOSPITAL HOLY SPIRIT HOSPITAL 503 N 21ST STREET CAMP HILL PA 17011 # ADDRESS SERVICE REQUESTED I,,,llh,,llh,,,I,h,hl,,h,l,h,l,hh,,hh,ll,lh,,,h,II 00006159 1 AT 0.292 02 20307692 JOYCE H TIMMONS 5650 OXFORD DR MECHANICSBURG PA 17055-665Z h,,llh,,llh,,,,,Ih,,Ih,hh,hllh,,,h,llh,,,,Ihhh,I HOLY SPIRIT HOSPITAL 503 N 21ST STREET CAMP HILL, PA 17011 ] Please check this box if your address or Insurance information has changed and record the changes on the back of this statement HOLY The Spirit o[ Caring Holy Spirit Hospital 503 N 21ST STREET CAMP HILL PA 17011 717-763-2141 For Account Information, Please Call 717-763-2141 Statement of Account 10/22]05 Transaction Date 10/21/05 Description UNITED HEALTH CARE P ZSZ UNITED HEALTH Amount 657.56- Page # 2 520 BROAD STREET NEWARK, NJ 07102 RE: OUTSTANDING BALANCE Joyce Timmons 122 SEMINAL LANE RATON, FL 33483 Dear Joyce Timmons Date : 12/23/2003 Account No : 3238435 Payment Due : $8.38 Balance Due : $8.38 This is to remind you that your IDT Long Distance account is over 45 days outstanding in the amount of $8.38, plus any additional incurring charges. Please kindly remit payment upon receipt of this letter to: IDT AMERICA 135 S. LASALLE, DEPT. 8025 CHICAGO, IL 60674-8025 If you have any questions about your bill or would like to discuss alternate payment arrangements, please call our collections department toll free at (888) 213-8406, Mohday through Friday, 9am - 5pm EST. We presently accept the following payments methods: Visa, MasterCard, American Express, Money Order, Check or APS(check over the phone.) Additionally, please be advised that: · Unless you dispute the validity of this debt, or any portion thereof, within 30 days, the debt will be assumed to be valid. · If, within 30 days, you notify us in writing that the debt or any portion thereof, is disputed, verification of the debt will be provided to you. We will suspend your service if you fail to pay your outstanding balance. Please avoid such action by making your payment of $8.38 to the address listed above by 01/05/2004. If payment has already been mailed, please disregard this letter. Thank you for your coperation with this matter. IDT LONG DISTANCE COLLECTIONS DEPARTMENT KILMORE EYE ASSOCIATES V. Eugene Kilmore, Jr.,M.D. Foster E. Kreiser, O.D. Steven C. Weller, O.D. John A. Wetherhold, O.D. Glen W. Elliott, O.D. 890 Century Drive Mechanicsburg, PA 17050 (717) 697-1414 FAX 697-4921 Foster Kreiser O.D. 890 Century Drive Mechanicsburg, PA 17050 December 3, 2003 Joyce Timmons 5430 Oxford Drive Mechanicsburg PA 17055 Dear Joyce Timmons, This is a reminder that there is an outstanding balance of $62.33 for services provided to Joyce Timmons on 04/01/2003. Your account has reached 90 days PAST DUE. Your account will ' be automatically transferred to CacheQuest Systems for collection. Please refer to our ."Accounts Receivable Policy Letter" which was mailed to you earlier. If you would like to avoid this action being taken, please send in your payment today to stop the process of our actions. We kindly ask your cooperation in paying this amount at your earliest convenience. If you have any questions regarding your account please call (717) 697-1414. Thank you. Kilmore Eye Associates Pay to: Kilmore Eye Associates 890 C~entury Drive Mechanicsburg, PA 17050 (717) 697-1414 Mrs. Joyce Timmons 5430 Oxford Drive Mechanicsburg, PA 17055 04/01/2003 34/01/2003 34/01/2003 :)4/01/2003 :)5/05/2003 :)5/05/2003 )6/09/2003 )6/09/2003 )6/09/2003 36/09/2003 )6/09/2003 )6~09~2003 (Detach and remit with payment) Mrs. Joyce 'l~mmons(17417)/Foster E. Kreiser O.D./037106 Location: Century Drive Established Patient, Comprehensive Exam Visual Field,extended Refraction Retinal Tomography Insurance Disallowed Adjustment from Medicare Part B *** Medicare payment Payment from Medicare Part B *** Insurance payment Payment from United HealthCare These expenses are not eligible under the subscriber's coverage, Insurance payment Payment from United HealthCare These expenses are not eligible under the subscriber's coverage. Insurance payment Payment from United HealthCare Insurance payment Payment from United HealthCare These expenses are not eligible under the subscriber's coverage. Transfer from Insurance COINSURANCE Transfer from Insurance Patient Statement Wednesday, December 03, 2003 11/10/2O03 Payment Type: r--]Cash [] Check ~]Visa [] Mastercard [] Discover Account # Expiration Date / / Signature Date __/ /, Reflects transactions posted through 12/3/2003 for 17425 $92.00 1.00 $92.00 $0.00 $78.00 1.00 $78.00 $0.00 $20.00 1.00 $20.00 $0.00 $75.00 2.00 $150.00 $0.00 8807776 ($28.32) $0.00 8807776 ($233,35) $0.00 LE2530 $0.00 $0.00 LE2530 $0.00 $0.00 LE2530 ($16.00) $0.00 LE2530 $0.00 $0.00 LE2530 ($4.00) $4.00 LE2530 ($58.33) $58.33 Mrs. Joyce Timmons(17417)/V. Eugene Kilmore Jr. M.D./047598 Location: Century Drive )8/21/2003 Established Patient, Comprehensive Exam $92.00 )9/10/2003 Insurance Disallowed Adjustment from Medicare Part B *** 8808628 )9/10/2003 Medicare payment Payment from Medicare Part B *** 8808628 10/06/2003 Insurance payment Payment from United HealthCare 0000000 10/06/2003 Transfer from Insurance 0000000 COINSURANCE Insurance payment Payment from United HealthCare $0.00 $62.33 0000000 1.00 $92.OO $0.00 ($4.59) $0.00 ($69.93) $0.00 $0.00 $0.00 ($17.48) $17.48 $0.00 $0.00 $0.00 $17.48 Your account is seriously PAST DUE! Please call our office to make an arrangement for payments. Kilmore Eye Associates * 890 Century Drive * Mechanicsburg, PA 17050 * (717) 697-1414 MOFFITT HE/LRT & VASCULAR GROUP 1000 NORTH FRONT STREET WORMLEYSBURG, PA 17043 Address Service Requested *******AUTO**3-DIGIT 170 JOYCE TII~ONS 5430 OXFORD DR MECHANICSBURG PA 17055-4452 23804 400 70 10/23/03 5.00* MC VISA Card# Signature Disc Exp MOFFITT HEART & VASCULAR GROUP 1000 NORTH FRONT STREET WORMLEYSBURG, PA 17043 *** Account Balance is Over t~ · · - ** *****, , , , ** ~ , due.. Make Pa ent Now to avoxd Collection A enc "* ******* *** ***************************************************************** 01/22/03 1 12 HOSPITAL CONSULT INITIAL 99255 410.71 270.00 02/28/03 Medicare Payment 145.83 02/28/03 Accept Assign Adj. -87.71 06/17/03 UNITED HEALT Payment 0.00 06/17/03 UNITED HEALT Payment 0.00 01/23/03 1 16 J CATH LEFT HEART 93510 411.1 600.00 02/28/03 Medicare Payment 177.91 02/28/03 Accept Assign Adj. -377.61 06/17/03 UNITED HEALT Payment 0.00 01/23/03 1 16 J INJECT FOR CORONARY ANGIO 93545 411.1 90.00 02/28/03 Medicare Payment 16.26 02/28/03 Accept Assign Adj. -69.68 06/17/03 UNITED HEALT Payment 0.00 01/23/03 1 16 J IMAGING SUPERVISION PUL/C 93556 411.1 80.00 02/28/03 Medicare Payment 33.86 02/28/03 Accept Assign Adj. -37.67 06/17/03 UNITED HEALT Payment 0.00 01/23/03 I 16 J IMAGING SUPERVISION VEN/A 93555 411.1 80.00 02/28/03 Medicare Payment 33.02 02/28/03 Accept Assign Adj. -38.73 06/17/03 UNITED HEALT Payment 0.00 01/23/03 1 16 J INJECT FOR HEART ANGIOGRA 93543 411.1 60.00 02/28/03 Medicare Payment 11.76 02/28/03 Accept Assign Adj. -45.30 06/17/03 UNITED HEALT Payment 0.00 J-Your Ins has made payment, it is your responsibility to pay balance due. 36.46* 44.48* 4.06* 8.47* 8.25* 2.94* ATE LAST PAID AMOUNT oo/oo/oo o.00 0.00 ,KE ~ MOFFITT HEART & VASCULAR GROUP ECK r 1000 NORTH FRONT STREET YAeLETO:~ WORMLEYSBURG, PA 17043 Budget Payment Due--> 5.00* PAT# 1-JOYCE TIMMONS DR# 12-MANDAK, JEFFERY, MD DR# 16-JONES, STEVEN, MD Ph:(717)-731-8315 Acct#: 102574 Date: 10/23/03 Page 1 of 1 PPL I=lectrlc Utilities 827 Hausman Road Allentown, PA 18104-9392 Tel. 800.342.5775 (484.634.4900) Fax 484.634.3484 www.pplweb.com JOYCE G TIMMONS 5430 OXFORD DR MECHANICSBURG PA 17055 i I I November 25, 2003 Bill Account #: For: 13390-96u006 5430 OXFORD DR MECHANICSBURG PA 17055 ABP Plan Remove Date: Due Date: Balance Due: November 25, 2003 December 10, 2003 $78.71 Dear Joyce G Timmons: We have removed your account from our Automatic Bill Payment Plan because your payment of $78.71 on November 17, 2003 was returned for payment stopped. Your current bill WILL NOT be automatically withdrawn from your bank account. You can pay your bill either on-line by signing up at www.pplweb.com or mail your payment to: PPL Electric Utilities RPC - GENN1 2 N. 9th Street Allentown, PA 18101 If you cannot pay the bill account balance by the due date, or if you have any questions, please contact us at 1-800-342-5775 between 8:00 a.m. and 5:00 p.m. Sincerely, PPL Electric Utilities abpmn~7.doc_009950_296178 I PPL Electric Utilities Electric Service For: JOYCE G T1MMONS 5430 OXFORD DR MECIIANICSBURG PA 17055 Final Bill Questions about this bill? Please contact us by Nov 12 at 1-800-342-5775 or 484-(>34-4900 or write to: Cus! omer Service 827 ! tausman Rd. Alle :~ town, PA 181(:4-9392 wwxv.pplweb.com Page I Summary Page Balance as of Oct 24, 2003 $ 0.00 Charges: TotaYPPL ELECTRIC U'IILITIES Charges $ 78.71 Total Charges $ 78.71 Account Balance $ 78.71 Electric Use This ~raph shows yot, r ~qectric use over tile last 13 lllOlllhs. VeP c s of let Readings: Actu:d 1 Estimated ~ Customer ~ KWH - Average Per Day Meter Reading Information 36 ~!eter//80673164 30 IOct 23 Actual 4497 [Sep 25 Actual 3942 24 [ 28-Days kWH Billed ~ Average - Oct 2002 2t}03 18 Temperature 55F 55F 12 KWH Per Day 18 20 Yearly Use: Total Average 6 Use Montldy Nov 2001 - Oct 2002 6911 576 0 Nov 2002 - Oc! 2003 7199 600 ONDJ FMAMJ JASO 2002 Months 2(}03 Other important information on back I,,,III,,,III,,,,I,h,M,,I,,M,,I,M,,,hI,,II,II,,,,I,,II JOYCE O TIMHONS 5630 OXFORD DR MECHANICSBUR$ PA 17055 -6452 PPL EI,ECTRIC UTILITIES '~ NORTH 9TH STREET RPC-GENN1 ALLENTOWN PA 18101-t 175 I 6900000787190000078717 1339090006 PPL Electric ' Utilities Page 3 Electric Service For: JOYCE G TIMMONS 5430 OXFORD DR MECHANICSBURG PA 17055 Final Bill PPL Electric Utilities Customer Service 827 Hausman Rd. Allentoxvn, PA 18104-9392 1-800-342-5775 or 484-634-490O www.pplweb.com Total from Last Bill Payment Received Oct 16 - Thank You! $53.00 $53.00 Billing Details Btdance as of Oct 24, 2003 Current Charges Charges for - PPL ELECTRIC IITILITIES Residential Rate: RS for Sep 25 - Oct 23 Distribution Chame: Customer Ch ar~e 6.47 200 KWIt at 1.79600000¢ per KWH 3.59 355 KWH at 1.59400000¢ per KWH 5.66 Trauslnission Chame: 555 KWH at 0.3'7700000¢ per KWH 2.09 Transition Charge: 200 KWH at'1.55900000¢ per KWH 3.12 355 KWH at 1.38400000¢ per KWII 4.91 Generation Char~:e: Capacity and Energy 200 KWH at 4..c/6200000¢ per KWH 9.92 355 KWH at 4.35900000¢ per KWH 15.47 PA Tax Adjustment Surcharge afl.26000000% 0.65 Total PPL ELECTRIC UTILITIES Charges Budget Plan as of Last Bill $ 0.00 I51.88 26.83 Account Balance $ 78.71 General Information Budl~et Settlement Summary after 12 months: W~e billed you $661.71 Including t-his bill, you used 661.71 We have added $26.83 to this bill to settle your Budget Billing Plan. Generatiou prices and charges ale. set by the electric generation supplier yo.u have chosen. The Pubric Utility Commission regt~lates distribution prices .a,4 servi.ces. Tt}e Fed. eral Energy RegulatorvTommission regulates transm ms,on prices anu servsces. ' PPL Electric Utilities uses about $7.'79 of this bill to pay state taxes. In addition, about $3.46 of this bill pays the PA Gross Receipts Tax. h'he Tr,?psi.tign Charge in. eludes an Intangible Transition Charge (ITC) and e apphcat,~2e gross receq)ts tax which together amount to $6.~52.' The ITC? ~s a ..... per usa~ze c~are, e approved__ by_ the Public. Utilit, y Commission.. ..... which PPL Electrm Utfi~hes collects zts agent for PPL Electric Uhlmes Trans~hon Bond Company LLC and which that company uses to service debt incurred to recover a portion of PPL Electric Utilities' stranded costs. The gross receipts tax, which is collected for the Commonwealth of Pennsylvania, is equal to 4.4% of the ITC. 00024066272870000000000005000016 PO BOX 578 ALTON, IL 62002-0578 For Service To: 5430 Oxford Dr 000021411 01 AT 0.292 I,,,llh,,lll,,,,I,h,hl,,h,hl,,I,l,l,,,hl,,Ihlh,,,I,,ll Joyce Timmons C/OGERRY READ 5430 Oxford Dr Mechancsbrg PA 17055-4452 AMOUNT DUE $50, O0 DUE DATE Dec 31, 2003 ELECTRONIC AMOUNT PAID PAYMEm nn ~T DAV IWl=k~m[am#mmmillkl mZlZii[mZli~Jiilm~ ~ Pennsylvania American Water PO Box 371412 Pittsburgh, Pa. 15250-7412 h,,ll,l,h,,hhhhll,,,h,,hl,,h,,ll,,hl,,Ihl Please check here to add H20-Help to Others contribution to bill your monthly or to change your address or telephone number, and print information on reverse side. Customer Account Information For ServiceTo: Joyce Timmons 5430 Oxford Dr Account Number: 24-0662728-7 Premise Number: 24-0391242 Billing Period & Meter Information Billing Date: Dec 11,2003 Rate Type: Residential Billing Summary .......... Prior Balance ..................... Balance from last bill Payments prior to Dec 11, 2003. Thanks/. Total prior balance, Dec 11, 2003 ......... Adjustments .......... Return Check Charge Total adjustments, Dec 11, 2003 .......... AMOUNT DUE ................... Do not send payment. Total Amount D~ from your bank account on Dec 31,200: $50.90 -20.90 30.00 20.00 20.00 I ,$o.oo will be deducted BillingSummary for Service to: JO¥CEM TIMMONS 5430 OXFORD DR MECHANICSBURG PA 17055 Rate Classification: Residential Heating Billing Period: 09/10/2003 to 10/23/2003 (43 days) Final Read Questions? Call 717-232~1811 or write to UGI at PO BOX 13009 Reading, PA 19612-3009 Your current UOl charges include State taxes totaling $ 0.78. CPT 220 708 7371 07 1 Past Bill Information - UGI Utility The account balance on your last bill was ................ $ 72.00 Payments .......................................... 0.00 Adjustments ........................................... i ................. -72.00 Your balance as of 10/27/2003 ................................... 0.00 Current Bill Information - UGI Utility Customer Charge .............................................................. 12.26 Commodity Charge ( 13 CCF at $0.52231) .............. 6.79 Distribution Charges ........................................................ 5.12 PA State Tax Surcharge .................................................. -0.05 Total Current Charges - UGI Utility ............................... 24.12 UGI Utility charges owed this bill .................................................................................. $ 24.17 Current Bill Information - UGI Services Tariff Charge ..................................................................... 22.00 Total current UGI Services Char~les ............................. 22.00 UGI Services charges owed thru bill .............................................................................. $ 22.00 Total Amount Due, Please Pay by Due Date (11/18/2003) ..................................... $ 46.12 Average CCF Per Day 6.50 5.85 5.20 4.55 3.90 3.25 2.60 1.95 1.30 0.65 0.00 2002 Months 2003 · = Estimated Usage Meter Reading Information Meter Number Previous Reading Present Reading CCF Used 1167503 9103 (estimated) 9116 (final) 13 Messages from UGI · Your current price to compare is $ 0.52206/CCF. · Your total annual usage is 752 CCF. Your average monthly usage is 62 CCF. · Thank you for your business. You have maintained an excellent payment history with UGI. This bill may be used as a credit reference for obtaining future utility service. · Equipment breakdowns..no problem! A UGI Advantage Service Agreement covers parts and labor and guarantees same-day service. Add the Iow monthly charges to your gas bill, Call 1-800-322-6013 for details. · Help prevent pipeline damage, accidents and service disruptions. If you see someone digging near your home please call UGI, Last This Average Year Year CCF/day 0.28 0.30 Daily temperature 67°F 59°F If you pay at a payment agent please take your entire bill. Make check payable to UGI. Keep this part for your records. Important information is o~n the back of this bill. UGI Utilities, Inc. Post Office Box 13009 Reading, PA 19612-3009 Please pay by the due date to avoid the late charge. Please return this portion with your payment. CPT 220 708 7371 07 1 h,lh,,Ih,h,lh,hh,,h,,Ihhh,,Ih,lh,,,hh,hhlh,I *********AUTO** MIXED AADC 195 JOYCE M TIMHONS i22 SEMINOLE LA ROCA RATON FL RH November 18, 2003 $ 46.12 270 220708737107111801000046120000300000000000000000000000 .PNCBAN< ~,~* I,,,llhl,,I,,I,l,,h,ll,,,I,l,,,,ll,,Ihh,,h,hll BANKCARD SERVICES P.O. BOX 15137 WILMINGTON, DE 19886-5137 For account Information call 1-800-807-6779 Pdnt change o~ address o~ new talephone number balow Address pLATINUM www. pncnetaccess.com CARDHOLDER SINCE 1988 ACCOUNT NUMBER 4264 2990 7045 4088 PAYMENT DUE DATE NEW BALANCE TOTAL TOTAL MINIMUM PAYMENT DUE AMOUNT ENCLOSED DETACH TOP PORTION AND RETURN WITH PAYMENT JOYCE M TIMMONS - 1ZZ SEMINOLE LN BOCA RATON FL 33~87-153622 city state ;ap ( ) ( ) Home phone Work phone Account Number C~ed/t L/ne 4264 2990 7045 4088 I $13,400. O0 - osUng Transa~lon ]Referan(=e ICard Catego~/ Transactions ,~e ID' I"urn"' ITY" I I URCHASES AND ADdUSTMENTS 2/15 12/15 0657 VS C LATE FEE FOR PAYMENT DUE 12/14 TOTAL FOR BZLLZNG CYCLE FROM tl/15/2003 THROUGH 12/1.5/2003 00069409000045000004264299070454088 Cash ~ Cmd~ A,,wdtsble ~1i~ cy=~ Cl~l~ Date 31 12/15/03 DECEMBER 2003 STATEMENT Total Minimum PaFnent Due Paj~eni Due Date $45.00 I 01/15/04 Charges Credits (CR) 29.00 $29.00 $0.00 ! OUR RECORDS SHOW YOUR ACCOUNT IS PAST DUE IMPORTANT NEWS AN IMPORTANT AMENDMENT TO YOUR ACCOUNT TERMS IS ENCLOSED. PERHAPS IT WAS AN OVERSIGHT, BUT WE HAVE NOT RECEIVED YOUR PAYMENT. IF YOU NEED ASSISTANCE, PLEASE CALL 1-866-740-4120, OR GO TO WWW.BANKCARDFIRST.COM. ENdOY THE CONVENIENCE AND PEACE OF MIND OFFERED BY OVERDRAFT PROTECTION. ENROLL YOUR PNC BANK CHECKING ACCOUNT TODAY! CALL 1-888-PNC-BANK. KEEP TRACK OF YOUR HOLIDAY SHOPPING. VISIT US ONLINE AT WWW.PNCNETACCESS~COM. SUMMARY OF TRANSACTIONS (-) Payments !1 (+) Cash ] (+) Purchases and (+) Pedodl¢ Rate and Credlt~ I Advances ] AdJualmanta fiNANCE CHARGE8 $0.00 $0.00 $29.00 $7.31 Previous Balance $657.78 ~NANCECHARGE$CHEDULE Category P~lcRate ;ash Advances A. BALANCE TRANSFERS, CHECKS-o.035589% DLY B. ATM, BANK ................. 0.035589% DLY C. PURCHASES ................... 0.035589% DLY 12.99% FOR THIS BILLING PERIOD: ANNUAL PERCENTAGE RATE. .................. (Ino~u~ee Peeted/o Ra~e and Trarma~lon Fee F/nanee Cherge~ ) PLEASE SEE REVERSE SlOE FOR IMPORTANT INFORMATION. C~eap~dlng ~oual PementageRate 12.99% 12.99% 12.99% !(+) Transaction Fee I FINANCE CHARGE8 $o.oo (=) New Balance Total $694.09 TOTAl. MINIMUM PA$'A~C;;T DUE Past Due Amount ................. $ 30. O0 Cunent Payment .................. $15.00 To*al Minimum Payment Due ......................................$45.00 Subject to Finance Charge $0.00 $o. co $662.24 4264 2990 FOR YOUR SATISFACTION, EVERY HOUR, EVERY DAY · For Cuslome~ Sa~laclJan and up to Ihe minute anlomated info/malice i~cluding, b~ance, available uedil, paymmls recaved, payments due, due date, payment add~eas ial=malim, or to request duplicae stalanants, cai 1-800-807-6779. ·For T. DD ~'elecmnmunicaUan Device tm the Deal) assistance, ca~ 1-800-346-3178. · Mai payments lo; BANKCARD SERVICES, P.O. BOX 15137, WILMINGTON, DE 19886-5~37. Bilrm9 rights we I~esmved only by written mquky. Mai biang inquires, using lam an Ihe back and olher in(lukias Io: BANKCARD SERVICES P.O. BOX 15026 WILMINGTON_ DF 19850.5026. ' ' 2110 06H 2BB 1202 0000 O0 7045 4088 PAGE 1 OF 1 USPS SHIREMANSTOWN BRANCH SHIREMANSTOWN, Pennsy)vanta 170119997 ~3/2003 <800)275-8777 03:17:11 I Sales Receipt Juct Sale Unit :rtption Oty Price Prlc.- ~ RATON FL 33434 :el Post mmachtnable Parcel Post Issue PVI: ~,. ~ RATON FL 33434 :el Post -:--3nmachlnable Parcel Post Issue PVI: A RATON FL 33434 :el Post onmachtnab]e Parcel Post Issue PVI: A RATON FL 33434 ce1 Post onmachlnable Parcel Post Issue PVI: fund PVI A RATON FL 33434 cel Post onmachlnable Parcel Post Issue PVI: A RATON FL 33434 ce1 Post ionmachlnable Parcel Post Issue PVI: :A RATON FL 33434 $20.¢ $2.7 $22,7: $22.0' $2.7~: $24.8~ $18.08 $2.75 $20.83 $t9,23 Void $21.98 -$21.98 $19.57 $2,75 $22.32 $~9,57 $2.75 $22.3~ $2O.74 Nonmachinable Parcel Post Issue PVI: BOCA RMON FL 33Q34 Parce] Post Non$achlnable Parcel Post Issue PVI: tOCA RATON FL 33434 )arce] Post Nonmachlnable Parcel Post Issue PVI: ~OCA RATON FL 3343~ arcs1 Post Nonmachtnable Parcel Post Issue PVI: ~.OCA RATON FL 3343q '~rce] Post Nonmach~nable Parcel Post Issue PVI: 'CA RATON FL 33434 ~cel Post ~onmachinable Parcel Post Issue PVI: ;A RATON FL 33434 ·cel Post ?lonmachlnable Parcel Post Issue PVI: al: '~tb~lrd ;)eblt Card Purchase Back $20.8: $19.7~ $2.7~ $20.33 $2.75 $23.08 $21.H $2.75 $23.86 $20,Z9 $2.75 $22.94 $18.08 $2.75 $20,83 $~9,57 $2,75 $22.32 $292,91 50. O0 :#: 1000201340089 ~'~'k: 01 ~e¢'~?4~' ~nl\, n~r OHM P014 verlTon Please make payment to Verizon and return this .page with your p_a__yment Page 1 of 9 717 766-9633-833 36Y November 5, 2003 Due Immediately ...................... Fill in Amount Paid JOYCE TIIVlVlONS 122 SEMINAL LANE BOCA RATON FL 33487- 1536 I,,11,,,11,,I,,11,,I,1,,,I,,,11,1,1,,,11,,11,,,,I,1,,I,1,11,,I PO Box 28000 Lehigh Vly PA 18002-8000 11771707669633833802802128999991000000251060000000796300000 R21 028 SCHEDULE J BENEFICIARIES ESTATE OF JOYCE M. TIMMONS File Number Bo Taxable Distributions Name / Address of Beneficiary_ Mary T. Timmons-Perfllo 19 Stiles Drive Melville, NY 11747 Geraldine Read 192 Seminole Lane Boca Raton, FL 33487 Eleanor Rossman 520 Joyce Road Camp Hill, PA 17011 Paul Timmons 12o9 Edinburg Circle New Cumberland, PA 17o7o Carol Timmons-Fencel 889 Acri Road Mechanicsburg, PA ~7o55 Joy Zipper 1914~ Fox Landing Drive Boca Raton, FL 33434 Nontaxable Distributions Name / Address of Beneficiary_ None. Relationship daughter daughter daughter son daughter daughter Relationship Amount or Share of Estate x/6 1/6 1/6 1/6 Amount or Share of Estate Estate of Also known as Register of Wills of Dauphin County, Pennsylvania INVENTORY JOYCE M. TIMMONS ., Deceased. No. Date of Death: November 6, 2003 Social Security No. 369-22-3107 Personal Representative(s) of the above-Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. IfWe verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: I.D. No.: Address: Telephone: Bruce D. Foreman, Esquire 21193 4409 North Front Street Harrisburg, PA 17110-1709 (717) 236-9391 Personal Representati~r~ Bruce n~_or_eman ~/ ~-- Description Value Personal Property Real Estate (Attach Additional Sheets if necessary) Total $ NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at thc election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RECEIPT AND RELEASE AGREEMENT This Agreement is made by and between Bruce D. Foreman, Executor of the Estate of Joyce M. Timmons, deceased ("Executor") and Mary Timmons-Perillo, Geraldine Read, Eleanor Rossman, Paul Timmons, Carol Timmons-Fencel and Joy Zipper, individually and jointly beneficiaries of the estate ("Beneficiaries"). In accordance with the desire that the administration of the Estate of Joyce M. Timmons be terminated without the expense and further delay of the court accounting, the parties hereto, in consideration of the mutual covenants herein contained, and intending to be legally bound hereby, agree that: 1. Joyce M. Timmons, died on November 6, 2003 and her estate is now in the process of administration having been filed with the Dauphin County Register of Wills, Orphans' Court Division to No. 2003-00929. 2. Under the provisions of the decedent's Last Will, one-sixth (1/6) of the net estate will be distributed each to Mary Timmons-Perillo, Geraldine Read, Eleanor Rossman, Paul Timmons, Carol Timmons-Fencel and Joy Zipper, beneficiaries. 3. The combined balance of principal and income of the estate for distribution pursuant to the attached Inheritance Tax Return filed to the same is $23,516.45. The costs of funeral expenses, administration and debts of the estate as set forth iri the attached Inheritance Tax Return are $14,029.73; the Inheritance Tax remittance is $1,138.41, leaving a remainder of $8,348.31 for disbursement. Tax Returns. The Executor will disburse all funds as set forth in the said Inheritance The remainder of $8,348.31 will be disbursed: Mary Timmons-Perillo - $1,391.39 Geraldine Read - $1,,391.39 Eleanor Rossman - $1,391.39 Paul Timmons - $1,391.38 Carol Timmons-Fencel - $1,391.38 Joy Zipper - $1,391.38 Total Distribution $8,348.31 5. The Beneficiaries acknowledge that the Executor has received the assets and has made the payments set forth in the Inheritance Tax Return. The Beneficiaries approve the said Inheritance Tax Return of the Executor as stated, in its entirety. 6. The Beneficiaries consent, approve and agree that the remaining balance of the estate assets shall be distributed as set forth in paragraph 5 hereinabove. 7. The Beneficiaries represent that no state and/or federal income tax return on behalf of the Estate of Joyce M. Timmons for the year 2003. In the event that the tax requires payment, all assets being distributed hereunder, each beneficiary acknowledges that he or she will be required to pay one-sixth of the cost of the federal and/or state income tax. 8. Without intending to limit the rights or remedies of Executor or his attorneys, the Beneficiaries further agree to indemnify the Executor or his attorneys, and save them harmless against all liability, loss, and expense (including, but not limited to, costs and counsel fees) which they, may incur, whether due to their, negligence or otherwise, as a result of making the above-described distributions without a court audit. The Beneficiaries hereby forever fully release, compromise, settle and discharge any and all claims, demands, actions or causes of action, legal or equitable, absolute or contingent, vested or hereafter to accrue, which they may have against any other party hereto or against the Estate of Joyce M. Timmons or the Executor or his attorneys thereof, by reason of any matter, cause or thing growing out of or relating to any property or assets of the said estate, or growing out of or relating to any act of the Executor or his attorneys, in the administration of said estate, even if attributable to negligence, and agree that in no event shall the said period for collection of any erroneous distribution or distributions be less than two years after the actual discovery thereof by the Executor or his attorneys. 9. The Beneficiaries agree to execute such additional releases as the Executor or his attorneys, may submit to them in order to confirm their discharge from any further liability to the parties in connection with the said estate. 10. This Agreement may be executed in multiple counterparts and, when so executed by all parties hereto, shall be binding upon all the parties, and their respective heirs, next-of-kin, personal representatives and assigns. IN WITNESS WHEREOF, the parties have hereunto set their hands and seal the day and year hereafter set forth. ,2OO4 ,2004 Dated Dated '~7~& ~ Dated '7~ ~ ,2004 Dated ~.J,.t,- ~ ,2004 ,2004 Date4.~ b ~ Bruce , Esquire, Executor l~I'~r~ T~ns-Perillo, Beneficiary G r~dine Read, Beneficiary PaniC'ns,- Beneficiary Dated ~/~. F /, ,2OO4 Dated ~1)~ ~// ,2004 ~r, ~neficiary COMMONWEALTH OF PENNSYLVANIA · COUNTY OF ~Lk,]t~x ~,,,V~,-~'-~ . ss. Personally appeared before me, a Notary Public, in and for said Commonwealth and County, Carol Timmons-Fencel, Beneficiary of the Estate of Joyce M. Timmons, who being duly sworn according to law, deposes and says that the facts contained in the foregoing Inheritance Tax Return are true and correct to the best of her knowledge, information and belief. Carol Timmons-Fencel SWORN to and subscribed before me this ~.-Z,-k4x, day of ~.~a ~.~.~ 2004. ~'~-otary Public- My Commission Expires: BU~'EAU OF TNDTV'rDUAL TAXES INHERITANCE TAX DIVISION DEPT. 28060! HARRISBURG, PA 171Z8-0601 COHMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOT/CE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DISALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1S47 EX AFP (OX-D3) BRUCE D FOREMAN ESQ'-' FOREMAN & FOREMAN qq09 N FRONT ST HBG DATE 05-10-200q ESTATE OF TTMMONS DATE OF DEATH 11-06-2005 FILE NUMBER 21 05-0929 COUNTY CUMBERLAND ACN 101 J Amoun'l: Rami'l:~ed JOYCE M MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DISALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF TTMMONS JOYCE MFILE NO. 21 05-0929 ACM 101 DATE 05-10-ZOOq TAX RETURN NAS: ( ) ACCEPTED AS F/LED { X} CHANGED SEE ATTACHED NOTTCE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN NO. 01 1. Reel Es~a~a (Schedule A) (1). . O0 2. S~ocks and Bonds (Schedule B) (2) . O0 5. Closely Held S~ock/Par'cnarship [n~aras~ (Schedule C) ($) . O0 q. More:gages/No,as Receivable (Schedule D) (q) . O0 $. Cash/Bank Deposit:s/Misc. Personal Propar~y (Schedule E) ($) ~511:):7 · 65 6. Jointly Owned Propar~y (Schedule F) (6) . O0 7. Transfers (Schedule G) (7) .00 8. To,al AssaYs (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 1,q65.65 9. Funeral Expansas/Adm. Cos:~s/Mis¢. Expanses (Schedule H} (9) 10. Debits/Mortgage Liebili~:/as/Lians (Schedule Z) (10) . O0 11. To,al Daduc~/ons (11} 12. Ne'l: Value of Tax Re~curn (12) NOTE: To insure proper cradi~ ~o your account, subm/~ ~ha upper pore/on of ~his fora w/~h your ~ax payment. 5,122.65 ].,658.98 Chari~abla/Govarnaan~al Bequests; Non-elected 9115 Trusts (Schedule J) (15) Ma~ Valua of Es~a~a Sub~ac~ ~o Tax (1~) If an assessmen~ ~as ~ssued previously, ~nes ~, ~5 and~or ~, ~?, reflect ~gures ~ha~ ~nc~u~e the to~a~ of ALL returns assesse~ to ~a~e. ASSESSHENT OF TAX: .00 x O0 15. Amoun~ of Line lq e~ Spousal ra~a (15) = 16. Amoun~ of L/ne lq ~axabla a~ L/naal/Class A ra~a (16) 7,785.7q X 0q5 = 17. Amoun~ of Line lq a~ Sibling ra~a (17) 1,658.98 x 12 = 18. Amoun~ of Line lq ~axabla a~ Collateral/Class B ra~a (18) .00 X 15 = 19. Princ/pal Tax Due (19)= TAX CREDITS: PAYMENT RECEIPI DISCOUNT DATE NUMBER INTEREST/PEN PATD (-) 01-09-Z00q CD00~qZ5 ZT.q7 13. NOTE: AMOUNT PATD 9~q.29 TOTAL TAX CREDIT I BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 9,qqq.72 18 and 19 will .00 550.56 199.08 .00 5q9.qq 961.76 qlZ.32CR .00 q12.32CR ( TF TOTAL DUE IS LESS THAN $1, NO PAYMENT TS RE{IUTRED. TF PAID AFTER DATE TNDZCATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL TNTEREST. TF TOTAL DUE TS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE S/DE OF THTS FORM FOR ZNSTRUCTZONS.) RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 1981 -- if any futura interest in the estate is transferred in possession or enjoyment to Class B (collataral) beneficiaries of the decedent after the expiration of any estate far life or far years, the Coaeonaaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the laaful Class B (collateral) rate on any such futura interest. Ta fulfill the requirements of Section ZI~O of the Inheritance and Estate Tax Act, Act 13 of ZOO0. (72 P.S. Section Detach the top portion of this Notice and submit aith your payment to the Register of gills printed on the reverse side. --Make check or money order payable to: REGISTER OF NILLS, AGENT A refund of a tax credit, which ams not requested on tho Tax Return, amy be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office of the Register of Nills, any of the 23 Revenue District Offices, or by calling the special Z6-hour ansaaring service for forms ordering: 1-800-361-10S0; services for taxpayers eith special hearing and / or speaking needs: 1-800-~67-3DZ0 (TT Any party in interest not satisfied aith the appraisement, alloeanca, or disalloeanco of deductions, or assessment of tax (including discount or this Notice by: --arittsn protest to the PA Department of Revenue, Board of Appeals) Dept. Z81011, Harrisburg, PA 171lB-lOll, 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 Revenue, Bureau of Individual Taxes, ATTN: Post Assassssnt Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1SOi) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SI) discount of the tax paid is alloeed. The 151 tax amnesty nan-participation penalty is computed on the total of tho tax and interest assessed, and nat paid before January 18, 1996, the first day after tho and of tho tax amnesty period. This non-participation penalty is appealable in the saaa manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning eith first day of delinquency, or nine (9) months and one (l) day fram the date of death, to the date of payment. Taxes ~hich became delinquent before January 1, 1982 bear interest at the rate of six (61) percent per annum calculated at a daily rate of .00016~. All taxes ehlch became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year aith that rate announced by the PA Department of Revenue. Tho applicable interest rates for 1982 through 2006 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ 2OZ .000548 ~T~-1991 llZ .000301 ~ 9Z .000267 1983 16Z .000q38 1992 9Z .O00Zq7 20OZ 62 .000166 1986 XXZ .000301 1993-X996 7Z .000192 2003 SZ .000137 1985 13X .000356 1995-1998 9Z .O00Zq7 ZOO6 6Z .000110 1986 lOX .000Z76 1999 7Z .OOOIgZ 1987 lOX .OOOZ7~ ZOOO 7Z .000192 --Interest is calculated INTEREST = BALANCE OF as follows: TAX UNPAID X NUNBER OF DAYS DELINItUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest oust be calculated. [EV-1470 EX (6-88) INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 28O6O1 HARRISBURG, PA 17128-0601 :)ECEDEN~S NAME FILE NUMBER Joyce M. Timmons 2103-0929 ~EVIEWED BY ACH Sheila Megonnell 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES E & H Accepted additional assets and debts. I Forwarded to Post Assessment Review Unit in reference to the reduction to Schedule "1" ROW Page 1 BUREAU OF TNDZVZDUAL TAXES TNHERITAHCE TAX DTVISIDN DEPT. 'Z80601 HARRISBURG, PA 1T].Za-0601 CONHONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ' Z~HERZTANCE TAX RECORD ADJUSTMENT REV-I~gS EX AFP COl-g3) BRUCE D FORE~ ili~'( 28 ~ '" '-~ ESq FOREHAN ~ FORE~AN ~09 N FRONT. ST HBG ?:~.~: .PA 17110 DATE 05-07-200q ESTATE OF TIHMONS DATE OF DEATH 11-06-2005 FILE NUHIIER Z1 05-0929 COUNTY CUHBERLAND ACN 101 Amount Rem'?l:tad JOYCE H HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credit to your account, submit the upper portion of this form w/th your tax payment. CUT ALONG THIS L/NE ~,~ RETAIN LONER PORT/ON FOR YOUR RECORDS ~ REV-1593 EX AFP (01-03) ~# INHERITANCE TAX RECORD ADJUSTMENT #~ ESTATE OF TIMMONS JOYCE H F/LE NO. 21 05-0929 ACH 101 DATE 05-07-200q ADJUSTNENT BASED ON: ADH/NISTRATIVE CORRECTION VALUE OF ESTATE: 1. Reel Estate (Schedule A) (1) . O0 2. Stocks and Bonds (Schedule B) (2) 201,~26 3. Closely Held Stock/Partnership Interest (Schedule C) (3) . O0 o,. Mortgages/Notes Receivable (Schedule D) (q) . O0 5. Cash/Bank Deposlts/Misc. Personal Property (Schedule E) (5) '~ 1189.61 6. Jolntly Owned Property (Schedule F) (6) . O0 7. Transfers (Schedule g) (7) 8. Total Assets DEDUCTIONS AND EXEMPT%ONS: 9. Funeral Expenses/Administratlve Costs/ Miscellaneous Expanses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule ]:) (10) 11. Total Deductions 1Z,161.~8 1,868.25 (8) Z$,516.q5 12. 1:5. lq. Net Value of Estate Sub.~ect to Tax TAX: 15. Amount of Line 1~ at Spousal rate 16. Amount of Line 1~ taxable at Lineal/Class A rata 17. Amount of Line 1~ at Sibllng rata 18. Amount of Line lq taxable at Collateral/Class B rate 19. Prlnclpal Tax Due TAX CRED/TS: DATE NUMBER 01-09-200~ CDOOSqZ5 Nat Value of Tax Return Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) (lq) INTEREST/PEN PAID (-) 21 (15) (16) (17) (18) 1~z029.7~. 9/~86.72 .00 9 ,, ~.86.72 .00X 00 = .00 9~q86.TZX 0~5= qZ6.90 .OOX 12 = .00 .OOX 15 = .00 (~9) qZ6.77 AMOUNT PAID ) 9~5q .~ TOTAL-~'-~'~- ~T'._L 955.6:5 ]iALANCE OF ~E-~- SZ8.86CR 'rNTEREST AND PEN./ .00 TOTAL DUE ! 528.86CR IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDZT/ONAL /NTEREST. ( IF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR ZNSTRUCTZONS.} PAYMENT: Detach the top portion of this Notice and submit elth your payment made payable to the name and address printed on the reverse side. -- Hake check or money order payable to: REGISTER OF #ZLLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Hills, any of the Z$ Revenue District Offices or from the Department's 24-hour answering service for forms ordering: 1-800-36Z-Z050; services for taxpayers aith special hearing and / or speaking needs: 1-800-447-30Z0 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Xndividual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601, Phone (717) 787-6505. DISCOUNT: PENALTY: INTEREST: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SI) discount of the tax paid is allowed. The 15Z tax amnesty nan-participation penalty is computed 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. Interest is charged beginning with first day of delinquency or nine (9) months and one (1) day from the date of death to the date of payment. Taxes which became detinquent before January 1, 198Z bear interest at the rate of six (6Z) percent par annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates far 198Z through ZOO4 are: Interest Dally Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198Z ZOZ .000548 1988-1991 11Z .000301 ZOO1 9Z .000247 1983 16Z .000~$8 199Z 9Z .000247 2002 6Z .000164 1984 llZ .000301 1993-1994 7Z .OOOl9Z 2003 52 .000157 1985 Z3Z .000556 1995-1998 9Z .000247 200~ 4Z .000110 1986 ZOZ .000274 1999 7Z .000192 1987 92 .000Z~7 ZOO0 82 .OOOZ19 --Interest is calculatmd as follows: ZNTERBST = BALANCE OF TAX UNPAZD X NUNBER OF DAYS DELXNQUENT X DAZLY ZNTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calcuJatmd. REV-1470 EX (6-B8) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 [')~CEDENT'S NAME JOYCE M TIMMONS REVIEWED BY SCHEDULE 'INHERITANCE TAX EXPLANATION OF CHANGES 2103-0929 101 Deductions and Assessment of Tax has been adjusted to reflect the reduction to Schedule I as reported on the Supplemental Return and to correct the Assessment of Tax Line 17. Dianne McClain EXPLANATION OF CHANGES The May 10, 2004 Notice of Inheritance Tax Appraisement, Allowance or Disallowance of ROW Pa~e 1 LAW OFFICES FOREMAN & FOREMAN, P.C. BRUCE D. FOREMAN JEFF FOREMAN 4409 NORTH FRONT STREET HARRISBURG, PA 17110-1709 TELEPHONE (717) 236-9391 FAX (717) 236-6602 ieff.raJforeman-foreman.com bruceiAlforeman-foreman.com October 17, 2005 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Re: Estate of Joyce M. Timmons, Deceased File No. 21-03-929 Ladies/Gentlemen: Please find enclosed one original and one copy ofthe Status Report Under Rule 6.12, with attached Receipt and Release Agreement, with regard to the above-referenced estate. Please file the original and return the additional time-stamped copy to the undersigned. Should you need anything further, please contact our office. an BDF.mam Enclosures PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF THE ESTTE IS NOT COMPLETED, FILE A 6.12 FORM YEARLY UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 Name of Decedent: Joyce M. Timmons Date of Death: November 6, 2003 Estate No. 21-03-929 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-referenced estate: 1. State whether administration of the estate is complete: Yes X 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 X B. The separate Orphans' Court No. (if any) for the personal representative's account is: (Not applicable in Dauphin County) C. Did the personal representative state an account informally to the parties in interest? Yes X No D. Copies of receipts, releases, joinders and appr vals of formal or informal accounts may be filed with the Clerk of the 0 p ns' Court and may be attached to this report. Date: October 17, 2005 Signat Capacity Bruce D. Foreman, Esquire Foreman & Foreman, PC 4409 N. Front Street Harrisburg, PA 17110-1709 (717) 236-9391 Personal Representative X Counsel for Personal Representative t5 lrJ , !.. I ~ c5,-,- k 1.1 C) r-.:J. ." " {MAH:nntjAM3}"' . '-J. c:) C'. c~ 6 U, LJ.J ,: Cc C-.:;. '.'-.. ._R.W.,.i!:; ~" C~:~ C::J "" ( V't: RECEIPT AND RELEASE AGREEMENT This Agreement is made by and between Bruce D. Foreman, Executor of the Estate of Joyce M. Timmons, deceased ("Executor") and Mary Timmons-Perillo, Geraldine Read, Eleanor Rossman, Paul Timmons, Carol Timmons-Fencel and Joy Zipper, individually and jointly beneficiaries of the estate ("Beneficiaries"). In accordance with the desire that the administration of the Estate of Joyce M. Timmons be terminated without the expense and further delay of the court accounting, the parties hereto, in consideration of the mutual covenants herein contained, and intending to be legally bound hereby, agree that: 1. Joyce M. Timmons, died on November 6, 2003 and her estate is now in the process of administration having been filed with the Dauphin County Register of Wills, Orphans' Court Division to No. 2003-00929. 2. Under the provisions of the decedent's Last Will, one-sixth (1/6) of the net estate will be distributed each to Mary Timmons-Perillo, Geraldine Read, Eleanor Rossman, Paul Timmons, Carol Timmons-Fencel and Joy Zipper, beneficiaries. 3. The combined balance of principal and income of the estate for distribution pursuant to the attached Inheritance Tax Return filed to the same is $23,516.45. The costs of funeral expenses, administration and debts of the estate as set forth in' the attached Inheritance Tax Return are $14,029.73; the Inheritance Tax remittance is $1,138.41, leaving a remainder of $8,348.31 for disburs~t. ~~- "d g ~f ~ 4. The Executor will disburse all funds as set forth in the said Inheritance Tax Returns. The remainder of $8,348.31 will be disbursed: ~ "J Ul a. b. Mary Timmons-Perillo - $1,391.39 Geraldine Read - $1,,391.39 Eleanor Rossman - $1,391.39 Paul Timmons - $1,391.38 Carol Timmons-Fencel- $1,391.38 Joy Zipper - $1,391.38 OJ c. d. e. f. Total Distribution $8,348.31 5. The Beneficiaries acknowledge that the Executor has received the assets and has made the payments set forth in the Inheritance Tax Return. The Beneficiaries approve the said Inheritance Tax Return of the Executor as stated, in its entirety. 6. The Beneficiaries consent, approve and agree that the remaining balance of the estate assets shall be distributed as set forth in paragraph 5 hereinabove. 7. The Beneficiaries represent that no state and! or federal income tax return on behalf of the Estate of Joyce M. Timmons for the year 2003. In the event that the tax requires payment, all assets being distributed hereunder, each beneficiary acknowledges that he or she will be required to pay one-sixth of the cost of the federal and! or state income tax. 8. Without intending to limit the rights or remedies of Executor or his attorneys, the Beneficiaries further agree to indemnify the Executor or his attorneys, and save them harmless against allliabiIity, loss, and expense (including, but not limited to, costs and counsel fees) which they, may incur, whether due to their, negligence or otherwise, as a result of making the above-described distributions without a court audit. The Beneficiaries hereby forever fully release, compromise, settle and discharge any and all claims, demands, actions or causes of action, legal or equitable, absolute or contingent, vested or hereafter to accrue, which they may have against any other party hereto or against the Estate of Joyce M. Timmons or the Executor or his attorneys thereof, by reason of any matter, cause or thing growing out of or relating to any property or assets of the said estate, or growing out of or relating to any act of the Executor or his attorneys, in the administration of said estate, even if attributable to negligence, and agree that in no event shall the said period for collection of any erroneous distribution or distributions be less than two years after the actual discovery thereof by the Executor or his attorneys. 9. The Beneficiaries agree to execute such additional releases as the Executor or his attorneys, may submit to them in order to confirm their discharge from any further liability to the parties in connection with the said estate. 10. This Agreement may be executed in multiple counterparts and, when so executed by all parties hereto, shall be binding upon all the parties, and their respective heirs, next-of-kin, personal representatives and assigns. . IN WITNESS WHEREOF, the parties have hereunto set their hands and seal the day and year hereafter set forth. Dated~ '/1/ Dated D ~ Dated ':f.. ~ r Dated j..Ak ~ Date~ b 'Z Dated .-;t~ P /\ Dated j.J. Y ,2004 A4~ Bruce D. Foreman, Esquire, Executor ,~ ons-Perillo, Beneficiary ,2004 ,2004 -9:~ ~ G r dme Read, BeneficIary ,2004 ,2004 Pa immons, Beneficiary ,2004 (lib) ~ ~~(}VJ -~~ Carol Tirrunons-Fencel, Beneficiary ,2004 Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 10/11/2005 FOREMAN, BRUCE D 4409 NORTH FRONT STREET HARRISBURG, PA 17110-1709 RE: Estate of TIMMONS JOYCE M File Number: 2003-00929 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS. COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 11/06/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~~ GLE~~A FA~~ER ST~ REGISTER OF WILLS cc: File Counsel Judge -~ L-