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Home My WebLink About01-0069 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION I Estate of also known as CHARL07TE I. YONTZ No. To: ;)!- OI-OO~7 Social Security No. Register of Wills for the County of Cumber land in the Commonwealth of Pennsylvania Deceased. 196-14-3445 The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, applies r d \'l4!s d~ (d.b.n.; pendente lite; durante absentia; durante min0ritate) the above decedent. for letters of administration ____ on the estate of Decedent was domiciled at death in cuwberland County, PennsylvaniaH with h pr last family or principal residence at 30 pennsyl vanla Avenue, camp l ~ Boro (list street, number, Twp. or Boro.) Decedent, then 7 7 years of age, died 26 N ov emb 2 r 20 0 0 at Woodland Nursing Center, Lewisberry, PA ,4~XX 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 in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: None $4,500.00 --0---- $ $ 0 $ 0 Petitioner__ after a proper search ha~ ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: Name Relationship Residence Cynthia A. Shearer Daughter 891 Old Silver Sprl ~1echanic sburg , PA 1 - ng Road 7055 THEREFORE, petitioner(s) :-espectfully request(s) the grant of letters of administration in the appropriate form to 'he undersigned. ,- , '" Qj' u s:: dJ ]3 dJ .... o::dJ s:: -00 c': ~.= ~~ 1:),- ;; 0 ~ c:: 00 Vi //- (A-.k~/?J j' . /~~ /7 ~. --_.~~~ AJ /& ~O:J- --/3 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF CU:xIBERLAND } 55 The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and before me this 16 th Januar ?f ~ - v.I - U '"' =' ... as = t:IO Vi No. 21-2001-0069 Estate of CHARLOTTE I. YONTZ , Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW J an u a ry 16. 200 1 J1jxxxx~m consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that CYNTHIA A. SHEARER is/ are entitled to Letters of Administration, and in accord with such finding, Letters of Administration (] h n are hereby granted to ('YNrrHT"A"A ~ HR"A RRR in the estate of CHARLOTTE I. YONTZ /!/}7 /:' C_/1. I j I t-- 'I/!L!/[il ( 'b;/Ui.H~~?U 1/1';d10/~f..); , ,/1 R' f W'll Mary . LeW1S' '/ eglster 0 1 s - $ 25.00 $ 9.00 $ $ 5.00 TOTAL _ $ 39.00 Filed .. J. Q fl.l.l pXY. . 1.6 , 20 0\1. D. 19..xx.xx x x FEES Letters of Administration Short Certificates( 3) . . . . . . . . . . Renunciation ................ JCP Samuel L. Puldes (17225) ATTORNEY (Sup. Ct. I.D. No.) 525 N. 12th Street, Lernoyne, PA 17043 ADDRESS (717) 761-5361 PHONE MAILED LETTERS AND ORDER TO ATTORNEY I . I J ' I t j j \tl' I f'II,,";" \v!r]~ 111(' 1\' b w that rhe lllJorl11:1l10!1 nere gl\\:n IS CO!Tl'\:t y u)[)iell HU!l1 JI1 ql~llLl ccni ICJtl' () (,', " <. II -,-. Rq2.iSlLll. Thl' 'Higin:;l ,cnd'ILJrC \\ill he t~){"\\mkd ((1 the ~Llr<. \iLII 1':,'lIHds ()llicl' l~ll Ii Ill<' WARNING: It is illegal to duplicate this copy by photostat or photograph. tl\.' j, J r [hi, l \.' nit I... J !c'. "__. I ) II _"ll,(~(,~'otPf:i>;~" :./~~>/. .' ..... "/JIJ;l~~\ l'~<<' . ~j,,"<L \:. , ~ ,. -p '\ ~ ~ r- _' :~~'. ~ .~~ !~ c::::>. ..:,;' h~1 .~ u,,;. ;' ;1 \~ '* ..; =. . ~* ' ,', *~, \<?' - ~/I \'\~~b,.. '. ~~,.~;I '-~~2' MEN' ~<~ ~ ""' '<~':~~/;lJ/~!.~!.U_.I!- D r 5820909 \, l \. 21-2001-0069 ./7 --:t'''':--''l ;,1.... .~. " " .' , r.,,,'/., j ~ . . ___.i.o{...-:{'..,_-:~~!" _, ,_,.:_!-....~'--t:1_'~7~~r; ;-.--- /,.7 I )\,,1 (/ UD-~4-2OOfJ---- t )", Re.. 2JB7 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH NAME Of DECEDENT (Forst Mld<lIe, LasI) 1. Charlotte I. SEX J'emale Yontz AGE (LaS! BirlMay) UNDER 1 YEAR Months DayS STATE F'LE NUMBER SOCIAL SECURITY NUMBER 3. 196 -14 3445 DATE Of DEATH ,Month, Day. '1eaI) 4. Nov. 26, 2000 77 Vra :=:;'~(~:'~~a. :~~ DEATH (Check only one - _,nstrUCI,CI>S on oIhe. _I Vest Falrvlew Inpall8lll D ERiOulpallenlD DCA D 7. Ie. fACILIT'I' NAME (If nollnsl1lullon. g,.e slreal and numbe" Woodland Center for Nursing R_"" D UNDER 1 0Itt Hours Minut.. 5. COUNTY OF DWH OTHER: ~~;:'9~ ~=,ty) 0 SURVIVING SPOUSE (If"'/e. g..e m8lden name, MOTHEM~ ~l"sl, M,ddle. Malden Surname) Sheetz 111. 1~~A'8i~AI~ fORESS (~eeI, CtlTown, lf~' Zip ~l h 1 b ~~! ver pr ng . ec an CB urg, Pa. PLACE OF DISPOSITION. Na_ 0' C.m.l.ry. C,.malory LOCATION. CityfTown, Sial.. Zip eoo. 0' Other Plac. York Fairvlew Twp. Ie. KIND OF BUSINESs/INDUSTRY WAS DECEDENT EVER IN US ARMED FORCES? Ves D N<>Xl lb. DECEDENT'S USUAL OCCUPATION (GI.e Iund of .WOfk done eju,,"9 moo! 01 wo,king hie; do nol uli8 retired ) . l1a. Credit Card Fraud l1b. Bell DECEDENT'S MAILING ADDRESS (Sir""'. CltylTown. State, Zip Codel 780 Voodland Ave. Lewlsberry, Pa. Te;Lephone DECEDENT'S ACTUAL RESIDENCE (See InSlruclKlflS on other Side) 12. 17a. Stala Pa. York 17b. County 1'. fATHER'S NAME (forst, M'ddle. Last) 1.. Raymond INfOR(r,NT'thrE (T YrP"n~ h 2, yn a . earer METHOD OF DISPOSlT~v O Bunal ~ C,.",..lIon U Remo.a1I,om Slal. 0 Oonaloon OIhe' (Speclly . 21a. :N~O~ CotrlpMta rt.ms 23a-c only wIllIn certifying __ physic"'" IS nol a.allable at 11m. 01 dealh to ~ cendy causa 01_11>. o II..... 24.26 mU8l ~ compIMed by __ per80Il who pronouncea <lItalll. :it 24.. M 25. (:) ~ ~ 27. MAT I: Enla' the diseasas, inluries or complicatIOns which caused tt\edealh 00 nllantar lhe mooeoldyong. sucn as cardiac o,resPoratory arr..... shock or haart lailura LiSl only one causa on each lin.. navis - - WAS DECEDENT OF HISPANIC ORIGIN? Non Yea 0 If ya, II"lCIIy Cuban. Mexican, Puerto Rican. 8IC. .. RACE. Amancan Indian. BlaCk, Wh~a. etc. (SpeclIy) W hi te Did deced8nl liwtfla townShip? MARITAL STATUS. Married Ne.., Married. Widowed, DillOrced (Spec,fy) 14. widowed 15. Fairview ~ 17d.o :;'~":'~1~01 clly.'bO" 30, 2000 LICENS'bN~l~~ L 22b. Iha blIat 01 my knowledga, deall> occurred al the hm.. dele and piac. slaled (Signature and Tlllel 21c~olling Green Mem. Park n~r Allen Twp. Cumb. Co. Pa NAUE ANq"t.DORESSgf FACILIty usselman .l4'uneral Home 324 HWIUIlel Ave. Lemoyne, po 22c. . . . ...., __ LICENSE NUMBER DATE SIGNED (Monlto. Day. ,&all \ 23b.~3. \ ~ 0 ~ f\. - L 231:. \ \. \'rl....\o. ~o WAS CA REFERR D TO MEDICAL EXAMINERICORONER? ,,-,/ ~aD No~ IMMEDIATE CAUSE (F.naJ rnsease Of condition resulllng "' <ltialh)- ~ .. -= Sequentially US! cond~oons ~ if any. I8adinglO irrItNdiala ~ causa. Enl'" UNDERLYING ,_ CAUSE (0_ or ",JUry '....Ihal "","'lea """"... ,- resulllng "' lle8lI'l) LAST DATE OF INJURY (Monlh. Day, Vear) , 'MS AN AUTOPSY .= PERFORMED? :~ .... .. ''! d WERE AUTOPSY FINDINGS AVAILABLE PRIOR TO COMPLETION OF CAUSE OF OE.fJH? Natural g--- Homicidol D 0 PendIng InlltlsllgallOn D 0 Could not be deterrnlned 0 :lOa. PLACE OF INJURV . AI home, farm. street. factory, oflica bUilding. elC. (Speclly) 30e. v... D M. JOe. NoD MANNER OF DEATH Accident No~ _0 Ves 0 SuICide No ii :t :;) ~~ 2... 21b. CERTIFIER (Chack only onel IlCEATIFYING PHYSICIAH (Physac~n certifYIng causa at death when another phys.c1an has pronounced death ana comp'eled Item 231 To !he _I 01 my know'-dge, de.1Il occu""'" dLMIO lI>a causa(a) Ind mannar aa alallKl. . . . . . . . , . . . . . . . . . . . 21. . PRONOUNCING AND CERTIFYING PHYSICIAN (Ph~SIC..n boIh >>,,,,,ourong uealh and cer1lIYlng 10 cau,", 01 death) TO !he _, 01 my knowladi., dealll occurrlKl aim. Um., dala, and piau, and Clu.lo Ih. causa(s) and mannar as allIed .MEDICAL EXAMINER/CORONER On tha baaia ola.aminatlon andlor invesllgation, in my opinion. dealh occurred allhe 11m., dal., and placa, and dualo Ih. causa(s) and mannar aa staled.. . . . . . . . , , . . , . . . . , . . . . . . , . . . . , . . , . . . , . . , . . . . . . . . . . . . . . . . . . , . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . , 31a. 'S SIGNATURZ~A...4f 1t? ..~. _ .-- ~I/~I/f I 21. I Approxomat. : int8fVaI ~..n I 01lMl and deall> I I I PART II: OIIlar signillcant c:ondlliona contrillu\ln91O ..ith~ but not rasulting in Iha uncMt1ying 08.... gill'" ,n PART I. TIME OF INJURY DESCRIBE HOW INJURY OCCURRED, INJURY AT WORK? 31b. LICE~J\ N~BER D 31c.' 1 \yD L-.s~/4. -t 31d. f ,..- Z 7-00 NAME AND AOORESS OF PE.RSON WHO COMPLETED CAUSE OF DEAT!} I (Item 27) Type(J(Prinl Cl ~ A ~ c.'c..~/'~.JI. ~ o 32. ~~ t~~;1;~L ~~L?(Q.7Q DATE FILED (Month Day Year) -- 34. IN RE: ESTATE OF IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION CHARLOTTE YONTZ NO. 21- 0 1- 6 9 IN RE: FIRST AND FINAL ACCOUNT OF CYNTHIA A. SHEARER, EXECUTRIX OF THE ESTATE OF CHARLOTTE I. YONTZ ORDER OF COURT AND NOW, this 22nd day of June, 2004, upon consideration of the objections filed to the first and final account of Cynthia A. Shearer, executrix for the estate of Charlotte I. Yontz at No. 21-2001-69, the account will not be confirmed, and counsel are requested to contact the Court for further disposition of this matter. By the Court, -i1/1 lJ j'." ; ,/ - I 1.'/ / *}}NI i v/ L-:/X, (. //(, J . Wesley ~6~~.;/; Jr.~ 1 J. ;,-J r0- Ll- / ,- rf\ ;:-:., -;; f--Samuel L. Andes, Esquire Ix.. I.- kJ ~ ,525 North 12th Street ,,-=-:J Dip. O. Box 168 C,~ i Lemoyne, PA 17043 ~~ ) For Estate C"j '";>.~ ( Donald R. Reavey, Esquire __-;; 2 51 Michael B. Volk, Esquire W~51 2933,North Front Street "'T ;1 i::'; 1 H a r r l s bur g , P A 1 7 11 0 -~ Li I, ~""_For Obj ectors -........;.... ,-j i-- . '_,.' : ma e vI Jl I......J lL....::- I~ (--' ~ "--.~ .....J r--1 '-....I :7 C::. .;- y-Lurn -.J t.J._ ~ l..L! i-- ~ - f1. '7 U -l, 1\ \..J ('y' ;: c-= ~~ ~ '- ~ii Lu IN RE: ESTATE OF CHARLOTTE YONTZ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-01-69 IN RE: FIRST AND FINAL ACCOUNT OF CYNTHIA A. SHEARER, AGENT UNDER POWER OF ATTORNEY OF THE ESTATE OF CHARLOTTE I. YONTZ ORDER OF COURT AND NOW, this 22nd day of June, 2004, upon consideration of the objections filed with respect to the Yontz account at No. 21-2001-69, the account will not be confirmed at this time, and counsel are requested to contact the Court for further disposition of the matter. 1'-. Samuel L. Andes, Esquire 525 North 12th Street P.o. Box 168 Lemoyne, PA 17043 For Estate Donald R. Reavey, Esquire /' Michael B. Volk, Esquire I 2933 North Front Street HarriSburg, PA 17110 L For Obj ectors :mae By the Court, I I /,. I, / ':." / I, I ." ..~ /. 1 " J c.. 1. /' / ~' ;' j ..iL-/ L-;7 . ..(~. L. . I /1' J;. /vt-esley oi~}), Jr., J. iJ \i t Ii IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA WOODLAND CENTER FOR NURSING 780 Woodland Avenue Lewisberry, P A 17055 v. Ms. Charlotte Yontz, Decedent 891 Old Silver Spring Road Mechanicsburg, P A 17055 and Ms. Cynthia Shearer 891 Old Silver Spring Road Mechanicsburg, P A 17055 Personally and as Attorney In Fact for Charlotte Yontz, Deceased. s s s s s s s s ~ s s s s s s s s s s NO.: 2003-3009 CIVIL ACTION - LAW CONSOLIDA TED IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHAN'S COURT DIVISION INRE: ESTATE OF CHARLOTTE YONTZ S NO.: 21-01-69 S CONSOLIDATED S SSN: 196-14-3445 S DATE OF DEATH: November 26, 2000 OBJECTIONS OF WOODLAND CENTER FOR NURSING, A CREDITOR OF THE ESTATE OF CHARLOTTE I. YONTZ, TO THE FIRST AND FINAL ACCOUNT OF CYNTHIA A. SHEARER, AS EXECUTIRIX OF THE ESTATE OF CHARLOTTE I. YONTZ, DECEASED. Pursuant to Pennsylvania Orphan's Court Rule 6.10 Woodland Center for Nursing hereby files its objections to the First and Final Account of Cynthia A. Shearer, as agent under Power of Attorney for Charlotte r. Yontz and as Executrix of the Estate of Charlotte 1. Yontz, Deceased as follows: FACTUAL AND PROCEDURAL BACKGROUND 1. Woodland Center for Nursing is a creditor of the estate of Charlotte I. Yontz, deceased, who provided nursing home services to her from December 22, 1999, through November 26, 2000. 2. On or about December 22 1999, Charlotte 1. Yontz, while in the presence of Cynthia A. Shearer, signed an admissions agreement with Petitioner that included, among other things, an agreement to pay the charges for nursing servIces. 3. Charlotte 1. Yontz died on November 26, 2000. 4. An estate was opened for Charlotte 1. Yontz on January 16, 2001 at docket #21-01-69 and Letters of Administration were granted to Cynthia A. Shearer. 5. Petitioner's claim against the above-named estate for $36,916.50 plus interest was filed against the estate and thus presented to Cynthia A. Shearer, personal representative of the estate on or about November 18, 2002. 6. Cynthia A. Shearer was personally informed of these charges on a monthly basis through billing statements forwarded to her home address by Woodland Center for Nursing and she has paid no portion of the existing claim. 7. Cynthia A. Shearer served as the attorney in fact or as a fiduciary for Charlotte I. Yontz during her lifetime. 8. During the admissions process for Charlotte 1. Yontz, Cynthia A. Shearer represented that she was the attorney in fact for Charlotte I. Yontz, that she had access and control over the income and assets of Charlotte I. Yontz, and that she would insure that payment was made for nursing home services and/or assist in the preparation of an application for Medical Assistance if it became necessary. 9. Due to her increasing age and infirmity, Charlotte 1. Yontz relied heavily upon Cynthia A. Shearer for assistance in making decisions prior to her entry into Woodland Center for Nursing. 10. Cynthia A. Shearer, attorney in fact and/or fiduciary for Charlotte 1. Yontz, refused and/ or failed to provide Woodland Center for Nursing with information necessary to submit a complete Medical Assistance application on behalf of Charlotte 1. Yontz during her lifetime. 11. Cynthia A. Shearer, attorney in fact for Charlotte 1. Yontz, refused and/or failed to respond to requests for payment for nursing services from Regina Nursing Home. 12. Cynthia A. Shearer's negligent behavior constitutes an ongoing breach of her fiduciary duty to both Charlotte 1. Yontz and to Woodland Center for Nursing. 13. As the personal representative, fiduciary , and/or power of attorney for Charlotte 1. Yontz, Cynthia A. Shearer represented that she had full custody and control over the assets and income of Charlotte 1. Yontz. 14. As the personal representative, fiduciary, and/or power of attorney for Charlotte 1. Yontz, Cynthia A. Shearer agreed to use the assets and inCOlne of her mother to pay for her full time care and induced the Woodland Center for Nursing to undertake the responsibility of providing full time care for Charlotte I. Yontz. 15. As the personal representative, fiduciary, and/or power of attorney for Charlotte I. Yontz, Cynthia A. Shearer failed to pay at least the legitimate monthly debt to Woodland Center for Nursing 16. Woodland Center for Nursing filed a complaint against Cynthia A. Shearer in the Civil Division of the York County Court of Common Pleas at Docket No. 200I-SU-0225I-Ol. 17. Defendant Cynthia Shearer filed preliminary obj ections to Plaintiff s Complaint on or about May 24, 2001. 18. Plaintiffs Proof of Claim was filed with this Honorable Court on or about November 18, 2002. 19. A Petition for the Removal of Cynthia A. Shearer as Executirx and Petition for Accounting was filed on or about March 7,2003. 20. A rule to Show Cause regarding the Petition for the Removal of Cynthia A. Shearer as Executirx and Petition for Accounting was issued on or about March 26, 2003. 21. By agreement of the parties, the civil action against Cynthia Shearer filed in York County was consolidated with this estate action in the Orphans' court division of the Cumberland County Court of Common Pleas on or about July 21, 2003. 22. An order making absolute the Petition for the Removal of Cynthia A. Shearer as Executirx and Petition for Accounting was filed on or about Decen1ber 11, 2003 and as such, Cynthia A. Shearer was removed as Executrix as of that date. 23. A Motion for Sanctions compelling an accounting of the Estate and of Cynthia A. Shearer's actions as Power of Attorney and/or fiduciary was filed on or about April 28, 2004. 24. On or about May 7, 2004, the the First and Final Account of Cynthia A. Shearer, Executor for the Estate of Charlotte Yontz, Deceased (hereinafter "Account). The scope of the account was from the time of Charlotte 1. Yontz's passing on November 26, 2000 to December 31,2003. A true and correct copy of the Account is attached hereto as Exhibit" 1." OBJECTIONS TO THE ACCOUNT 25. Woodland Center for Nursing objects to the Account on the basis that the accountant has failed to account for the her own misrepresentations to Woodland Center for Nursing that she, Cynthia A. Shearer, had full custody and control over the assets and income of Charlotte 1. Yontz and would use them to pay for Charlotte 1. Yontz's nursing home care. The Woodland Center for Nursing intends to present admissible testimony and evidence regarding these misrepresentations. 26. Woodland Center for Nursing objects to the Account on the basis that the accountant has failed to account for her actions as attorney in fact and/or fiduciary for Charlotte 1. Yontz, in refusing and/or failing to provide Woodland Center for Nursing with information necessary to submit a complete Medical Assistance application on behalf of Charlotte 1. Yontz during her lifetime. If Cynthia A. Shearer cooperated with the Woodland Center for Nursing in providing this information, Charlotte 1. Yontz would $4,590.00 was distributed the Musselman Funeral Home. As such, Woodland is entitled to a distribution of at least $2,295.00. 30. Woodland center for Nursing objects to the accounting based upon the fact that the Estate of Charlotte Yontz is a party to the ongoing litigation involving its Executirx and as such, should not be closed. Alternatively, Woodland respectfully requests that it be appointed administrator of the estate and that the account be closed up to the point where Cynthia A. Shearer was removed as Executrix of the estate. WHEREFORE, the Woodland Center for Nursing respectfully requests that a hearing be held in this matter to determine whether or not Cynthia A. Shearer has improperly used the assets of Charlotte I. Yontz and to determine whether or not she should personally, or in her capacity as a fiduciary, personal representative and/or power of attorney be held liable to pay these amounts back to the Estate of Charlotte I. Yontz. Date: ~ fL 2-0<4- Respectful.lY SUbmif'~~. .. CAPOZZI & ASS;_j , P.C. By: /!;tAlJ 1- Don~ld R. Reavey, Esquire Attorney ID No. 82498 Michael B. Yolk, Esq. Attorney ID No. 88553 2933 North Front Street Harrisburg, PAl 711 0 (717) 233-4101 have qualified for Medical Assistance relieving her estate of the $36,916.50 burden it has incurred. The Woodland Center for Nursing intends to present admissible testimony and evidence regarding these issues. 27. Woodland Center for Nursing objects to the Account on the basis that the accountant has failed to account for all her own actions as alleged in the Amended Complaint filed on August 21, 2002 under Civil Docket 01-19754 and incorporated herein by reference. These actions as alleged include, but are not limted to, negligence, breach of contract and failure of statutory duty to support. The Woodland Center for Nursing intends to present admissible testimony and evidence regarding these issues. 28. Woodland Center for Nursing objects to the Account on the basis that the accountant has failed to account for all her own actions as alleged in the Petition to Remove Cynthia A. Shearer as Executor filed on or about March 7, 2003. The Petition is incorporated herein by reference. These actions as alleged include, but are not limited to, negligence, misrepresentation, and breach of contract. The Woodland Center for Nursing intends to present admissible testimony and evidence regarding these issues. 29. Woodland Center for Nursing objects to the accounting based upon the fact that pursuant to 20 P.S. 3392, it is a Class3 Crditor of the estate, providing Decedent with medicines, medical and nursing services within 6 months of her passing and has not been listed as such, despite filing a valid Proof of Claim. As a Class 3 Creditor, the Woodland Center for Nursing is entitled to a pro rata share of the funds available for distribution. In this matter, It is important that the Account be carefully examined. Requests for additional information or questions or objections should be addressed to: Cynthia A. Shearer clo Samuel L. Andes P.O. Box 168 Lemoyne, PA 1 7043 I. RECEIPT OF PRINCIPAL The Accountant received the following assets during the administration of the Estate: Checking Account No. 301-106-1508 with Mellon Bank having a $6,448.73' value on the date of death of: Savings Account No. 00300443113 with Mellon Bank having a value $0.00 on the date of death of: Total Receipt of Principal $6,448.73 II. RECEIPT OF INCOME Your Accountant received no income during the administration of this Estate. Total Receipts of Income and Principal $6,448.73 III. DISBURSEMENTS During her administration of Mrs. Yontz's Estate, your Accountant made the following disbursements: lThis represents the date of death value. After Mrs. Yontz's death, transactions which were in process on the date of her death were completed and the actual cash balance in the account was reduced. Please see First and Final Account of Cynthia A. Shearer as Agent, Under Power of Attorney, for Charlotte I. Yontz filed contemporaneously herewith. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA WOODLAND CENTER FOR NURSING 780 Woodland Avenue Lewisberry, P A 17055 v. Ms. Charlotte Yontz, Decedent 891 Old Silver Spring Road Mechanicsburg, P A 17055 and Ms. Cynthia Shearer 891 Old Silver Spring Road Mechanicsburg, P A 17055 Personally and as Attorney In Fact for Charlotte Yontz, Deceased. s s s s s s s s s s s s s s s s s s s NO.: 2003-3009 CIVIL ACTION - LAW CONSOLIDATED IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA ORPHAN'S COURT DIVISION INRE: ESTATE OF CHARLOTTE YONTZ VERIFICATION S NO.: 21-01-69 S CONSOLIDATED S SSN: 196-14-3445 S DATE OF DEATH: November 26, 2000 I, Michael B. Volk, an attorney for the Woodland Center for Nursing, do hereby verify that I am authorized to make this verification on behalf of Woodland Center for Nursing and that the averments of facts set forth in this Objection to the First and Final Account of Cynthia A. Shearer as Executrix of the Estate of Charlotte I. Yontz. The averments contained herein are true and correct to the best of my knowledge, information and belief. I understand that any false statements therein are subject to the penalties contained in Title 18 of the Pennsylvania Consolidated Statutes Section 4904, relating to unsworn falsification to authorities. g' ;/ ~,-\A "------- Michael B. Yolk i/i /I~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA WOODLAND CENTER FOR NURSING 780 Woodland Avenue Lewisberry, P A 17055 v. Ms. Charlotte Yontz, Decedent 891 Old Silver Spring Road Mechanicsburg, P A 17055 and Ms. Cynthia Shearer 891 Old Silver Spring Road Mechanicsburg, P A 17055 Personally and as Attorney In Fact for Charlotte Yontz, Deceased. s s s s s s s s s s S 9 9 9 S S S S S NO.: 2003-3009 CIVIL ACTION - LAW CONSOLIDA TED IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA ORPHAN'S COURT DIVISION INRE: EST ATE OF CHARLOTTE YONTZ S NO.: 21-01-69 S CONSOLIDATED S SSN: 196-14-3445 ~ DATE OF DEATH: November 26, 2000 CERTIFICATE OF SERVICE I, Michael B. V olk, Esquire, do hereby certify that on this the ll:" \1""- day of ~L , 2004, T placed in the United States Mail a true and correct copy of the Objections to the First and Final Account of Cynthia A. Shearer, as Executrix of the Estate of Charlotte 1. Yontz addressed to the following: Samuel L. Andes, Esq. 525 North 12th Street P.O. Box 166 Lemoyne, P A 17043 Respectfully submitted,/ /I CAPOZZI AN~S~CI~ES, P.c. /l/ t~/ j( .." ~ald R. Reavey, Esquire Attorney ID No. 82498 Michael B. Yolk, Esq. Attorney J.D. No. 88553 2933 North Front Street Harrisburg, PAl 711 0 Phone: (717) 233 - 4101 Attorney for Plaintiff WOODLAND CENTER FOR NURSING, Plaintiff IN THE ORPHANS COURT OF CUMBERLAND COUNTY, PENNSYLVANIA vs. CHARLOTTE YONTZ, Deceased, and CYNTHIA SHEARER, Defendants ORPHANS COURlf:rnt<SrmiVED I '114' l : ?OC:t i I j I NO. 21-01-69 IN RE: IN THE ORPHANS COURT OF CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF CHARLOTTE YONTZ, Deceased ORPHANS COURT DIVISION NO. 21-oi~69 c ...;:,. FIRST AND FINAL ACCOUNT OF CYNTHIA A. SHEARER AS EXECUTRIX OF THE ESTATE OF CHARLOTTE I. YONTZ, DECEASED PURPOSE OF ACCOUNT: Cynthia A. Shearer was appointed Executrix of the Estate of her mother, Charlotte I. Yontz, on 16 January 2001. Cynthia A. Shearer offers this Account to acquaint interested parties with the transactions that have occurred during her administration of the Estate. Significant dates are: Date of Death: Date of Executrix's appointment: Accounting Period: 26 November 2000 16 January 2001 16 January 2001 through 19 December 2003 :; ~ lS EXHIBIT 1 I 10 August 2001 Musselman Funeral Home, Inc. - $4,590.00 decedent's funeral bill 28 November 2001 Rolling Green Cemetery Company - $760.00 purchase of burial plot 30 September 2001 Samuel L. Andes - attorney's fees $2,000.00 19 January 2001 Cumberland Law Journal -advertising $ 75.00 20 February 2001 The Sentinel - advertising $80.87 13 December 2000 Register of Wills - probate fee $ 39.00 Total Disbursements of Principal and Income $7,544.872 IV. BALANCE ON HAND FOR DISTRIBUTION Total Receipts of Income and Principal $6,448.73 Total disbursements of Principal and Income ($7 ,544.87) TOTAL ON HAND FOR DISTRIBUTION $0.00 Cynthia A. Shearer, Executrix of the Estate of Charlotte I. Yontz, Deceased, hereby declares under oath that she has fully and faithfully discharged the duties of her office, that the foregoing First and Final Account is true and correct and fully discloses all significant transactions occurring during the accounting period and that she has properly disclosed all of her dealings and transactions with the assets of the said Estate. (~~eJ /j,~ @{nthia A. Shearer II' Sworn to and subscribed before me this f'l-t4. day of A{J J2.., L , 2004. Not~~ ~ NOTARIAL SEAL LYNN EHRENFELD, NOTARY PUBLIC LEMOYNE BORO., CUMBERLAND CO. MY COMMISSION EXPIRES AUG. 17 2004 2The funds disbursed for the administration of the estate exceeded the probate assets received by your Accountant. Your Accountant paid that additional expense from her own funds. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA WOODLAND CENTER FOR NURSING 780 Woodland Avenue Lewisberry, P A 17055 v. Ms. Charlotte Yontz, Decedent 891 Old Silver Spring Road Mechanicsburg, P A 17055 and Ms. Cynthia Shearer 891 Old Silver Spring Road Mechanicsburg, P A 17055 Personally and as Attorney In Fact for CharlotteYontz, Deceased. s s s s s s s s s s s s s s s s s s s NO.: 2003-3009 CIVIL ACTION - LAW CONSOLIDATED D BJICT ( C ~ S r-=1 kl2'l.) ~!' / B . [> Ll BY'. c/4-.rC'Z.L.1 t~ A sso cs Accr. hLE<D 5-7.04 B "t ~ SiYfYl ~LPt-- ~ D [-:> F 5lr\ "- . IN THE COURT OF COMMON PLEAS OF CI______n_ - PENNSYLVANIA ORPHAN'S COURT DIVISION INRE: ESTATE OF CHARLOTTE YONTZ S NO.: 21-01-69 S CONSOLIDATED S SSN: 196-14-3445 S DATE OF DEATH: November 26,2000 OBJECTIONS OF WOODLAND CENTER FOR NURSING, A CREDITOR OF THE ESTATE OF CHARLOTTE I. YONTZ, TO THE FIRST AND FINAL ACCOUNT OF CYNTHIA A. SHEARER, AS EXECUTIRIX OF THE ESTATE OF CHARLOTTE I. YONTZ, DECEASED. Pursuant to Pennsylvania Orphan's Court Rule 6.10 Woodland Center for Nursing hereby files its obJections to the First and Final Account of Cynthia A. Shearer, as agent under Power of Attorney for Charlotte 1. Y ont~as Executrix of the Estate of Charlotte 1. Yontz, Deceased as follows: -:I:" h "Q.~~. r.= bi-~~ ~+ U,~kAk y'-*.+~ WOODLAND CENTER FOR NURSING, Plaintiff IN THE ORPHANS COURT OF CUMBERLAND COUNTY, PENNSYLVANIA vs. ORPHANS COURT DIVISION CHARLOTTE YONTZ, Deceased, and CYNTHIA SHEARER, Defendants NO. 21-01-69 FIRST AND FINAL ACCOUNT OF CYNTHIA A. SHEARER AS AGENT, UNDER POWER OF ATTORNEY, FOR CHARLOTTE I. YONTZ PURPOSE OF ACCOUNT: Cynthia A. Shearer is the daughter of Charlotte I. Yontz. Charlotte I. Yontz died on 26 November 2000. Prior to her death, she had appointed Cynthia A. Shearer as her attorney-in-fact. During the final few months of Charlotte I. Yontz's life, Cynthia A. Shearer exercised control over her financial affairs and this account is provided to acquaint interested parties in the transactions that occurred during her handling of her mother's financial affairs. It is important that the information in this Account be examined carefully. Requests for additional information or questions or objections should be discussed with, and directed to: Cynthia A. Shearer c/o Samuel L. Andes P.O. Box 168 Lemoyne, PA 17043 I. RECEIPT OF PRINCIPAL The only financial asset owned by Charlotte I. Yontz of which Ms. Shearer took possession or control was a checking account at Mellon Bank, N.A., over which she assumed control on or about 15 August 2000. At the time she assumed control, the account had a balance of: $4,043.23 II. RECEIPT OF INCOME The only income received by Ms. Shearer during her administration of her mother's account were: 1 September 2000 Social Security payment 3 October 2000 Social Security payment 3 November 2000 Social Security payment $828.00 $828.00 $828.00 Total Receipt of Income $2,484.00 Total Receipts of Income and Principal $6,527.23 III. DISBURSEMENTS During her administration of Mrs. Yontz's account and financial affairs, Ms. Shearer made the following disbursements: 1 5 August 2000 Cynthia A. Shearer Payment of household and $700.00 other miscellaneous personal expenses for Mrs. Yontz 22 August 2000 Mellon Bank Payment for checks $18.50 1 3 Septem ber 2000 Cynthia A. Shearer Reimbursement for personal $60.00 expenses incurred for Mrs. Yontz 28 November 2000 Cynthia A. Shearer Reimbursement of $800.00 household and personal expenses paid for Mrs. Yontz 20 December 2000 Social Security Administration Automatic withdrawal of $828.00 Social Security payment for month of November Total disbursements of Principal and Incorlle $2,406.50 IV. BALANCE ON HAND FOR DISTRIBUTION Total Receipts of Income and Principal $6,527.23 Total disbursements of Principal and Income ( $2.406.50) $4,120.73 The above funds remained in the Mellon Bank checking account at the time of the death of Charlotte I. Yontz and were thereafter distributed to her estate. Cynthia A. Shearer, agent for the said Charlotte I. Yontz pursuant to a Power of Attorney, hereby declares under oath that she has fully and faithfully discharged the duties of her office, that the foregoing First and Final Account is true and correct and fully discloses all significant transactions occurring during the accounting period and that she has properly disclosed all of her dealings and transactions with the assets of the said Charlotte I. Yontz. /j ~ ~:a~ 79. · ~ // ynthia A. Shearer Sworn to and subscribed before me this ('1 ~ day of /tfltZ./ L , 2004. I /~a~~ Nota(y Public I .;~~. NOTARIAL SEAL LYNN EHRENFElD, NOTARY PUBLIC LEMOYNE BORO., CUMBERLAND CO. MY COMMISSION EXPIRES AUG. 17. 2004 COMMONWEAL TH OF PENNSYLVANIA SS: JUNE 22, 2004 I, Glenda Farner Strasbaugh, Register for probate of Wills and granting Letters of Administration for the County of Cumberland, in the Commonwealth of Pennsylvania, do hereby certify the foregoing to be true and accurate copies of the FIRST AND FINAL ACCOUNT OF CYNTHIA A. SHEARER, AGENT UNDER POWER OF ATTORNEY FOR THE ESTATE OF CHARLOTTE I. YONTZ, CUMBERLAND COUNTY, PENNSYLVANIA, DECEASED. as the same were passed and advertised and remain on file and of record in this office. IN TESTIMONY WHEREOF, I have hereunto set my 7.~ n~. and official seal on the date above. ffIe~ ~~ J#;i:tiau Jl Glenda Farner Strasbaugh, Register of Wills G'- ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ NOW TO WIT, JUNE 22, 2004 came into Court CYNTHIA A. SHEARER, AGENT UNDER POWER OF ATTORNEY and presented an account and statement of proposed distribution, which were examined, passed, approved, and confirmed with a balance in his hands of $ 0 and the accountant was directed to distribute said balance in accordance with the statement of distribution filed. ~~ ~J/Ztad;h{p~ Glenda Farner Strasbaugh, Clerk of the OrphaQ' Court ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ COMMONWEAL TH OF PENNSYLVANIA SS: I, Glenda Farner Strasbaugh, Clerk of the Orphans' Court, in and for said County, do hereby certify the foregoing to be a true copy of the account and statement of proposed distribution of CYNTHIA A. SHEARER, AGENT UNDER POWER OF ATTORNEY. as full and entire as the same remain on file and record in this office. IN TESTIMONY WHEREOF, I have hereunto set my hand and official seal at Carlisle, this 22nd day of June, 2004. a-k- ~~J-( ~cUk~ Glenda Farner Strasbaugh, Clerk of the Orp~s' Court Q ~ ~ .5 - 0: ~j N '...J q ~ ~ a - l.la. - to .J ~ ~ (t' l::l- '2 - ri r- ..( N ,.J r "Z h ~ ~ ~ ~, -1 ~ w to '2 ~ t= .> 7- j .) '~ [I () Vl II p Ii II II Ii II II II I I i III WOODLAND CENTER FOR NURSING, Plaintiff II II II I' "I I I I I II II II II I I I IN THE ORPHANS COURT OF CUMBERLAND COUNTY, PENNSYLVANIA vs. ORPHANS COURT DIVISION CHARLOTTE YONTZ, Deceased, and CYNTHIA SHEARER, Defendants NO. 21-01-69 IN THE ORPHANS COURT OF CUMBERLAND COUNTY, PENNSYLVANIA IN RE: ESTATE OF CHARLOTTE YONTZ, Deceased ORPHANS COURT DIVISION NO. 21-01-69 FIRST AND FINAL ACCOUNT OF CYNTHIA A. SHEARER AS EXECUTRIX OF THE ESTATE OF CHARLOTTE I. YONTZ, DECEASED PURPOSE OF ACCOUNT: Cynthia A. Shearer was appointed Executrix of the Estate of her mother, Charlotte I. Yontz, on 1 6 January 2001. Cynthia A. Shearer offers this Account to acquaint interested parties with the transactions that have occurred during her administration of the Estate. Significant dates are: Date of Death: Date of Executrix's appointment: Accounting Period: 26 November 2000 16 January 2001 16 January 2001 through 19 December 2003 (~~ It is important that the Account be carefully examined. Requests for additional information or questions or objections should be addressed to: Cynthia A. Shearer c/o Samuel L. Andes P.O. Box 168 Lemoyne, PA 17043 I. RECEIPT OF PRINCIPAL The Accountant received the following assets during the administration of the Estate: Checking Account No. 301-106-1 508 with Mellon Bank having a value on the date of death of: $6,448.73' I I Ii I I I II. I Savings Account No. 00300443113 with Mellon Bank having a value on the date of death of: $0.00 Total Receipt of Principal $6,448.73 RECEIPT OF INCOME Your Accountant received no income during the administration of this Estate. Total Receipts of Income and Principal $6,448.73 III. DISBURSEMENTS During her administration of Mrs. Yontz's Estate, your Accountant made the following disbursements: 'This represents the date of death value. After Mrs. Yontz's death, transactions which were in process on the date of her death were completed and the actual cash balance in the account was reduced. Please see First and Final Account of Cynthia A. Shearer as Agent, Under Power of Attorney, for Charlotte I. Yontz filed contemporaneously herewith. I II II II II II 10 August 2001 Musselman Funeral Home, Inc. - $4,590.00 decedent's funeral bill 28 November 2001 Rolling Green Cemetery Company - $760.00 purchase of burial plot 30 September 2001 Samuel L. Andes - attorney's fees $2,000.00 19 January 2001 Cumberland Law Journal -advertising $ 7 5.00 20 February 2001 The Sentinel - advertising $80.87 13 December 2000 Register of Wills - probate fee $39.00 Total Disbursements of Principal and Income $7,544.872 IV. BALANCE ON HAND FOR DISTRIBUTION I, Total Receipts of Income and Principal $6,448.73 I Total disbursements of Principal and Income ($7,544.87) TOTAL ON HAND FOR DISTRIBUTION $0.00 Cynthia A. Shearer, Executrix of the Estate of Charlotte I. Yontz, Deceased, hereby declares under oath that she has fully and faithfully discharged the duties of her office, that the foregoing First and Final Account is true and correct and fully discloses all significant transactions occurring during the accounting period and that she has properly disclosed all of her dealings and transactions with the assets of the said Estate. ~dh,~/7,~~ ({>nthia A. Shearer I I Sworn to and subscribed before me this f 9 ~ day II of A-lJ/LIL ,2004. Not;!~~ ~ NOTARIAL SEAL LYNN EHRENFELD, NOTARY PUBLIC LEMOYNE BORa>, CUMBERLAND CO. . MY COMMISSION EXPIRES AUG> 17. 2004 II I 2The funds disbursed for the administration of the estate exceeded the probate assets received by your Accountant. Your Accountant paid that additional expense from her own funds. COMMONWEALTH OF PENNSYLVANIA SS: JUNE 22, 2004 I, Glenda Farner Strasbaugh, Register for probate of Wills and granting Letters of Administration for the County of Cumberland, in the Commonwealth of Pennsylvania, do hereby certify the foregoing to be true and accurate copies of the FIRST AND FINAL ACCOUNT OF CYNTHIA A. SHEARER, EXECUTRIX FOR THE ESTATE OF CHARLOTTE 1. YONTZ, LATE OF CAMP HILL BOROUGH, CUMBERLAND COUNTY, PENNSYLVANIA, DECEASED. as the same were passed and advertised and remain on file and of record in this office. IN TESTIMONY WHEREOF, I have hereunto set &h n. d and Of~fiCial~al on~the date abo~ve. . :.... /1__ / ~ en ~r tras~fi, egister of Wi I '. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ NOW TO WIT, JUNE 22, 2004 came into Court CYNTHIA A. SHEARER, EXECUTRIX and presented an account and statement of proposed distribution, which were examined, passed, approved, and confirmed with a balance in his hands of $ 0 and the accountant was directed to distribute said balance in accordance with the statement of distribution filed. ~J.c~~<.~ Glenda Farner Strasbaugh, Clerk of the Orpha~ourt ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ COMMONWEAL TH OF PENNSYLVANIA SS: I, Glenda Farner Strasbaugh, Clerk of the Orphans' Court, in and for said County, do hereby certify the foregoing to be a true copy of the account and statement of proposed distribution of CYNTHIA A. SHEARER, EXECUTRIX. as full and entire as the same remain on file and record in this office. IN TESTIMONY WHEREOF, I have hereunto set my hand and official seal at Carlisle, this 22nd day of June, 2004. jg~ ~~ ~hnaJ? Glenda Farner Strasbaugh, Clerk of the Orph~~~urt- ~ --- STERLING 1620 Route 22 East Union, NJ 07083 Phone (908) 687-1010 Fax (908) 687-1077 ,; 1-)' - 1.09 2nd Floor Registrar of Wills 1 Court House Square Carlisle, PA 17013 01/29/2001 ATTN: Sir or Madam RE Sterl ID Amount Client's ID: Client Charlotte Yontz (Estate of) D-2000-002861 6730.84 34838 NeighborCare - Allentown Dear Sir or Madam: Attached is our claim for the Estate of Charlotte Yontz. Also attached are copies that we already sent to the personal representative and the attorney. Our self addressed stamped envelope is enclosed for you to return confirmation of our claim. Thank you. This is an attempt to collect a debt and any information obtained will be used for that purpose. Very truly yours, STERLING RECOVERY, LLC. /1 ' t;? Y; (~lt[1t ( ~lJ1/JL./' Cheryl ynn Account Manager CL/sm ,~-- In the Estate of: /!! ' .. / ' / f" -L G/ Jt2 K,'t)/lc i/{)L/II.Z / Estate No. ('YI; j- !)/ -- &1 9 Dale <Timl iU) .J ~I A O/j / / CLAIM AGAINST DECEDENrS ESTATE The claimant certifies that there is due and owing by the decedent in accordance with the attached statement of account or other basis for the claim the sum of $" ? 17~31J/ f'if r I solemnly affirm under the penaltIes of perjury that the contents of the foregoing claim are true to the best of my knowledge, information and belief. /1/~1 (Jlbe',icl (Ill' t- /J//-c e/;/;; Nama of lalmanl tl/) / {Ii L /;J!T t 7!) (f ~g , Tolsphane Number FIl.ED; RECORDED; ClaIms Dockot Llber Folio NeighborCare" 888-SE.5-E.7!Z1,9 STATEMENT OF ACCOUNT 7010 SNOWDRIFT ROAD SUITE ALLENTOWN PA 1810E. For the account of YONTZ~ CHARLOTTE 115 1050 THE WOODLAND CENTER FOR NSG. Customer No. 3.4838 CHARLOTTE YONTZ (115-1050) c/o CINDY SHEARER 8S1 OLD SIVER SPRING PD MECHANICSBURG, PA 17055 _1iImim!I~ I :7:7/1i.../(7:!~ R....,/""l/..-',Q-r CHARGr III ( ! l.if i ~f!.L' .~ ::t"""tC , u { . .,c 07/14/00 R3342815 CHARGE 07/14/00 R3994035 CHARGE 07/14/00 R3998510 CHARGE \217/17/00 R4001 \2123 CHARGE 07/24/00 R4010418 CHARGE 08/02/1210 R3942787 CHARGE 08/11/00 R3942815 CHARGE 08/11/00 R3942822 CHARGE 08/11/00 R3944918 CHARGE * * * CONTINUED ON NEXT PAGE * * * BILLING UHj~: 11/28/00 AMOUNT PAID SEND PAYMENT TO: NEIGHBORCARE PHARMACY f=lf] E,!JX 20.347 L_EHIGH VALLEY ~:p 1800E:-0347 Please Return This Portion Of Your Bill With Your Payment . DESCRIPTION r.mmD AMOUNT ARICEPT (DONEPEZIL) 10MG TAB DAYS SUPPLY: 28 NDC: 52855-0246-41 ZYPREXA *** 2.5MG TABLET DAYS SUPPLY: 28 NDC: 00002-4112-60 K-DUR 20MEQ TABLET SA DAYS SUPPLY: c NDC: 00085-0787-81 MIACALCIN (CALCITONIN) NASAL SPRAY (200IU/DOSE) DAYS SUPPLY: 20 NDC: 00078-0311-30 CLOTRIMAZOLE 11- CREAM (RP:LOTRIMIN) DAYS SUPPLY: 10 NDC: 59930-1570-0.3 K-DUR 20MEG TABLET SA DAYS SUPPLY: 4 NDC: 00085-0787-81 ARICEPT (DONEPEZIL) 10MG TAB DAYS SUPPLY: 28 NDC: 62856-0245-41 ZYPREXA *** 2.5MG TABLET DAYS SUPPLY: 28 NDC: 00.002-4112-60 SUCRALFATE (CARAFATE) IBM TABLET (RP:CARAFATE) DAYS SUPPLY: 28 NDC: 510.79-0.871-20 CARDIZEM CD 180MG CAPSULE DAYS SUPPLY: 28 NDC: 00088-1796-42 .-1'" C..:, 102.79 28 137.64 8 8.04 c 32:. 53 45 19. 10 4 f. tZ! 2 15 68.03 .-,--r c,r 132.83 104 82. 9'3 28 46. 10 1""00 Fo",," I New 0,,,,,,, j R",~, Ch",~ [ P'ym,"" I AMOUNT DUE I 10-. I~'~ I~'ro I~'OO~% NeighborCa re'" NeighborCa re'Y ,988-565-5708 STATEMENT OF ACCOUNT 70~i SNOWDRIFT ROAD SUITE ALLENTOWN PA 18105 For the account of YONTZ~ CHARLOTTE 115 1050 THE WOODLAND CENTER FOR NSG. BILLING DATE: 11/28/00 AMOUNT PAID Customer No, 34838 CHARLOTTE YONTZ (115-1050) CIO CINDY SHEARER New Charges Finance Charges Payments I AMOUNT DUE I I~d I~'ro I Oro' 00 ~~ 8S1 OLD SIVER SPRING RD ~ECHANICSBURG. PA 17055 _1imiIEI_ I 08/11/00 R4010404 CHARGE 08/11/00 R4010411 CHARGE 08/11/00 R4014272 CHARGE 08/11/00 R4023291 CHARGE 08/22/00 R3998510 CHARGE 08/29/00 R3942822 CHARGE 08/29/00 R3944918 CHARGE 08/29/00 R4010404 CHARGE 08/29/00 R4010411 CHARGE 08/29/00 R4014272 CHARGE * * * CONTINUED ON NEXT PAGE * * * Balance Forward 10000l NeighborCa re'" '=;Er~D PAY1'rENT TO: NEIGHBORCARE PHARMACY PO BDX 20347 ~EHIGH VALLEY pp 18002-03~7 Please Return This Portion Of Your Bill With Your Payment DESCRIPTION E&:iii1 AMOUNT LEVOXYL (LEVOXINE) 0. 05MG TABLET (RP:SYNTHROID) DAYS SUPPLY: 32 NDC: 00589-1118-05 LANOXIN (DIGOXIN)-- 0. 125MG TABLET DAYS SUPPLY: 28 NDC: 00173-0242-55 PRILOSEC 20MG CAPSULE DAYS SUPPLY: 5 NDC: 00186-0742-31 CELEXA 20MG TABLET DAYS SUPPLY: 30 NDC: 00456-4020-63 MIACALCIN <CALCITONIN) NASAL SPRAY (200IU/DOSE:> DAYS SU NDC: 00078-0311-90 SUCRAL ARAFATE) lGM TABLET ( RP : TE) DAYS PLM:.88 NDC: 51079-0871-20 CARD I, CDiH~~MG CAPSULE DAysl;JStJpPLY: '28 !\tDe: 00088-1796-42 LEVOXYL (LEVOXINE) 0. 05MG TABLET (RP:SYNTHROID) DAYS SUPPLY: 28 NDC: 00689-1118-05 LANOXIN (DIGOXIN)-- 0. 125MG TABLET DAYS SUPPLY: 28 NDC: 00173-0242-55 PRILOSEC 20MG CAPSULE DAYS SUPPLY: 28 NDC: 00186-0742-31 27 11.S4 7 5.3Q; C"'-I -.lC 199.48 <7 1, 39.22 C ":;.j. =f~t .:. i 1..... 19.03 21 35.29 iC 1-.1 8.24 5.30 ""C ,,:;,J 135.20 A NeighborCare' STATEMENT OF ACCOUNT 7010. SNOWDRIFT ROAD SUITE ~ ALLENTOWN PA 18106 For the account of YONTZ, CHARLOTTE 115 10.50- THE WOODLAND CENTER FOR NSG. Customer No. .~>+838 CHARLOTTE YONTZ (115-1050) c/o CINDY SHEARER 891 OLD SIVER SPRI~G ?D MECHAN!CSBURG. PA 17055 _1iI&EI~ I 08/23/0.0. R40.23231 CHARGE 0.8/29/0.0. R4054175 CHARGE 0.8/30./0.0. R40.54175 CHARGE 0.3/0.1/0.0. R40.72140. CHARGE 0.3/0.1/0.0. R40.72148 CHARGE 0.9/0.1/0.0. R40.72150. CHARGE 0.9/0.1/0.0. R40.72156 CHARGE 0.9/0.1/0.0. R4072165 CHARGE 0.9/0.1/0.0. R40.72170. CHARGE 0.9/0.1/0.0. R40.72175 CHARGE ,988 -565-570.8 AMOUNT PAID BILLING DATE: 11/28/00 SEND PAYMENT TO: NEIGHBORCARE PHARMACY PO BOX 20347 LEHIGH VALLEv PP 18002-0347 Please Return This Portion Of Your Bill With Your Payment DESCRIPTION CELEXA 20.MG TABLET DAYS SUPPLY: 28 NDC: 0.0.456-40.20-53 DEPAKOTE 125MG TABLET DAYS SUPPLY: i NDC: 0.0.0.74-5212-11 DEPAKOTE 125MG TABLET DAYS SUPPLY: 7 NDC: 0.0.0.74-5212-11 CELEXA 20.MG TABLET DAYS SUPPLY: 7 NDC: 0.0.456-40.20.-53 LANOXIN (DIGOXIN) e.. 125MG TABLET DAYS SUPPLY: 7 NDC: 0.0.i73-0.242-55 PRILOSEC 20M8 CAPSULE DAYS SUPPLY: 7 NDC: 0.0.186-0.742-31 LEVOXYL (LEVOXINE) 0..1MG TAB (RP:SYNTHROID ** (100.MCG)) DAYS SUPPLY: 7 NDC: 00689-1110-0.1 SUCRALFATE (CARAFATE) IBM TABLET (RP:CARAFATE--) DAYS SUPPLY: 7 NDC: 510.79-0871-20 MIACALCIN (CALCITONIN) NASAL SPRAY (200IU/DOSE) DAYS SUPPLY: 20. NDC: 00078-0.311-90. ZYPREXA *** 2.5MG TABLET DAYS SUPPLY: 7 NDC: 12112112102-4112-60 * * * CONTINUED ON NEXT PAGE * * * m!lmDD AMOUNT 21 47.78 ':'Q L.... 15.4EI 6 6.54 7 17.83 4.77 14 55.73 7 5.40 28 24.43 .-, c 33.53 , I 3E~. 55 I"on", F~,"' I N~ Ch",,, . J ""'oc, Ch",,, I P'ymon" I AMOUNT DUE I lax~l I~'OO I~'OO I ~'90 Day, NeighborCa re;" :: HI::' . NeighborCare'" STATEMENT OF ACCOUNT 70i0 SNOWDRIFT ROAD SUITE 1 ALLENTOWN PA 18105 888-555-5708 For the account of YONTZ, CHARLOTTE 115 1050 THE WOODLAND CENTER FOR NSG. Customer No. 34838 CHARLOTTE YONTZ (115-1050) C/O CINDY SHEARER 831 OLD SIVER SPRING RD MECHANICSBURG, PA 17055 _1iJB1B~ I 09/01/00 R4072195 CHARGE BILLING DATE: 11/28/00 AMOUNT PAID SEND Pi::('{MENT TO: NEIGHBORCARE PHARMACY PO BOX 20347 LEHIGH VALLEY pq 18002-0347 Please Return This Portion Of Your Bill With Your Payment DESCRIPTION DEPAKOTE 125MG TABLET DAYS SUPPLY: 7 NDC: 00074-6212-11 CARDIZEM CD 180MG CAPSULE DAYS SUPPLY: 7 NDC: 00088-1796-49 CELEXA 20MG TABLET DAYS SUPPLY: 28 NDC: 00455-4020-63 LANOXIN (DIGOXIN) 0. 125MG TABLET DAYS SUPPLY: 28 NDC: 00173-0242-56 PRILOSEC 20MG CAPSULE DAYS SUPPLY:2a NDD: 00185-0742-31 LEVOXYL (~OXINE) 0.1MG TAB (RP: BY lD.Jf* (100MCG) 1 DAYS fai NDC:006S9-1110-01 SUCRA (CARAFRTE) IBM TABLET (RP: FAlE........) DAYS lRPL~,: .ga ...,.. ,NDC: 51079-0871-20 ZYPRE ,***'2.5MGTABLET DAYS SUPPLY: 28 NDC: 00002-4112-50 DEPAKOTE 125MG TABLET DAYS SUPPLY: 28 NDC: 00074-6212-11 CARDIZEM CD 180MG CAPSULE DAYS SUPPLY: 28 NDC: 00088-17S5-4S FUROSEMIDE 20MG TABLET (RP:LASIX) DAYS SUPPLY: 7 NDC: 51079-00.72-20 * * * CONTINUED ON NEXT PAGE * *' *' New Charges Finance Charges Payments I AMOUNT DUE I I~'~ I~OO I~MOO~~ 09/1211/00- R407221 it CHARGE 09/08/00 R4072140 CHARGE 09/08/00 R4072148 CHARGE 1219/1218/00 R4072150 CHARGE 09/08/00 R4072156 CHARGE 09/08/00 R4072165 CHARGE 09/08/0111 R4072175 CHARGE 09/08/00 R4072195 CHARGE 1219/1218/00 R4072214 CHARGE 09/21/00 R4095298 CHARGE Balance Forward I~ NeighborCa re<M mttmiii1 AMOUNT 2i 12. 2.7 7 of "'? f.8 1-.-1. 4 . 1. 70 1 c:. 4c 51 if. b~t. 35 9 l::" 81 J. 16 15. 10 '+ L-L. .. - .l. ':-7 1...:, . 71 .....~ 4 SQ 1:"] ....J ,-' 4. 14 NeighborCare'" 888-555-5708 STATEMENT OF ACCOUNT 7010 SNOWDRIFT ROAD SUITE 1 ALLENTOWN PA 1810.5 For the account of YONTZ, CHARLOTTE 115 1050 THE WOODLAND CENTER FOR NSG. BILLING DATE: 11/28/0.0 AMOUNT PAID Customer No. 34838 CHARLOTTE YONTZ (115-1050) C/O CINDY SHEARER a91 OLD SIVER SPRING RD MECHANICSBURG, PP 17055 _1iImimEI---- I 09/30./00 R4107478 CHARGE SEND PAYMENT TO: NEIGHBORCARE PHARMACY PO BOX 20347 LEHIGH VALLEY ~!p 18002-0347 Please Return This Portion Of Your Bill With Your Payment DESCRIPTION mtmmiD AMOUNT 1219/30/0121 R4107486 CHARGE 1219/30/00 R4107487 CHARGE 10/1212/00 R4072140 CHARGE 10/02/00 R4072214 CHARGE 10/02/1210 R4108905 CHARGE 113/02/00 R4108928 CHARGE 10/05/00 R41l172148 CHARGE 1121/1216/1210 R4112757 CHARGE 1121/08/1210 R41217215121 CHARGE ZYPREXA *** 2.5MG TABLET DAYS SUPPLY: 7 NDC: 000.02-4112-50 PHENERGAN 25MG SUPPOS. DAYS SUPPLY: ~ NDC: 121012108-121212-01 PROMETHAZINE (1 ML) 25MG/ML AMPUL (RP:PHENERGAN (1 ML)) DAYS SUPPLY: 2 NDC: 0121641-1495-35 CELEXA 2121MG TABLET DAYS SUPPLY: 28 NDC: 00456-4020-53 CARDIZEM CD 180MB CAPSULE DAYS SUPPLY: 28 NDD: 0012188-1796-49 CELEXA ***20MG (HALF~TAB) DAYS SUPPLY: 7 NDC: 00456-4020-63 METOPROLOL TARTRATE ** 5121MG (HALF-TAB) ( RP : LOPRESSOR) DAYS SUPPLY: 7 NDC: 0~378-0032-01 LANOXIN (DIGOXIN) 0.125MG TABLET DAYS SUPPLY: 28 NDC: 00173-0242-56 ZYPREXA *** 2.5MG TABLET DAYS SUPPLY: c NDC: 121121002-4112-60 PRILOSEC 20MG CAPSULE DAYS SUPPLY: 28 NDC: 00185-0742-31 * * * CONTINUED ON NEXT PAGE * * * 12 50.52 12 49.30 10 A 1 :=. is 431:50 19 32.03 c 7.85 4 6.00 12 7.10 r o 31. 73 E:"t::" 210.83 Balance Forward New Charges Rnance Charges Payments I AMOUNT DUE I I~~I I~'~ I~'~ I~'OO~~ NeighborCa re'" . NeighborCare'" STATEMENT OF ACCOUNT 70i0 SNOWDRIFT ROAD SUITE ALLENTOWN PA 18106 For the account of YONTZ, CHARLOTTE 115 1050 THE WOODLAND CENTER FOR NSG. 888-565-6708 BILLING DATE: 11/28/00 AMOUNT PAID Customer No. 34838 CHARLOTTE YONTZ (115-1050) C/O CINDY SHEARER 831 OLD SIVER SPRING PD MECHANICSBURG, PA 17055 _1iIBlB1EBI I 10/08/00 R4072155 CHARGE 10/08/00 R4072165 CHARGE 10/08/00 R4072195 CHARGE 10/08/00 R4095298 CHARGE 10/08/00 R4108905 CHARGE 10/08/00 R4108928 CHARGE 10/08/00 R4112757 CHARGE 10/08/00 R4114931 CHARGE 10/09/00 R4119362 CHARGE SEND PAY~1ENT TO: NEIGHBORCARE PHARMACY PO BOX 20.347 LEHIGH VALLEY Dp 18002-8347 Please Return This Portion Of Your Bill With Your Payment DESCRIPTION m!1miii AMOUNT LEVOXYL (LEVOXINE) 0.1MG TAB (RP:SYNTHROID ** (100MCG)) DAYS SUPPLY: 28 NDC: 00689-1110-01 SUCRALFATE (CARAFATE) 1GM TABLET (RP:CARAFATE--) DAYS SUPPLY: 28 NDC: 51079-0871-20 DEPAKOTE 125MG TABLET DAYS SUPPLY: 28 NDC: 00074-6212-11 FUROSEMIDE 20MG TABLET (RP:LASIX) DAYS SUPPLY: 28 NDC: 51079-0072-2Q: CELEXA ***EBMS(HALF-TAB) DAYS S 28 NDC:00456-4020-63 METOPR f'.tRAtE ** 50MS> (HALF-TAB) (RP: SOR) DAYS PL\':28 NDC: 00378-0032-01 ZYPRE **02.~MGTABLET DAYS PLY: 28 !\IDC: 012101Zl2-4112-60 LANOXIN (DIGOXIN) 0. 125MG TABLET DAYS SUPPLY: 28 NDC: 00173-0242-56 DURAGESIC (FENTANYL) (25MCG/HR) ADH. PATCH DAYS SUPPLY: NDC: 50458-0033-05 * * * CONTINUED ON NEXT PAGE * * * :. Cl L....\-I 3.52 103 85.85 ,94 42.27 11 5.45 r= .-' 13.63 .S 8.00 21 103. '34 4 5.04 15. 10 Balance FOIWard New Charges Finance Charges Payments I AMOUNT DUE I I~I I~'~ I~'~ I~'OO~~ NeighborCare'" ~: H ::'. NeighborCare'" STATEMENT OF ACCOUNT 70i0'SNOWDRIFT ROAD SUITE 1 ALLENTOWN PA 18106 888-555-6708 For the account of YONTZ, CHARLOTTE 115 1050 THE WOODLAND CENTER FOR NSG. Customer No. CHARLOTTE YONTZ (115-1050) C/O CINDY SHEARER 891 OLD SIVER SPRING RD MECHANICSBURG, PA 17055 -~~ I 10/09/00 R4119392 CHARGE 10/11/00 R4122217 CHARGE 10/25/00 R4143500 CHARGE 10/26/00 R4142261 CHARGE 11/02/00 R4095298 CHARGE 11/06/00 R4072150 CHARGE 11/06/00 R4072156 CHARGE 11/05/00 R4072165 CHARGE 11/06/00 R4108928 CHARGE BILLING DATE: l1i28/00 AMOUNT PAID 34838 SEND PAYMENT TO: NEIGHBORCARE PHARMACY PO BOX 20347 LEHIGH VALLEY PA 18002-0347 Please Return This Portion Of Your Bill With Your Payment DESCRIPTION mamrJ AMOUNT DURAGESIC (FENTANYL) (25MCG/HR) ADH. PATCH DAYS SUPPLY: 15 NDC: 50458-0033-05 K-LYTE/Cl CITRUS 25MEQ TABLET EFF DAYS SUPPLY: ~ NDC: 00087-0766-41 PHENERGAN ****** 12.5MG TABLET DAYS SUPPLY: 5 NDC: 00008-0019-01 DURAGESIC (FENTANYL) (25MCG/HR) ADH. PATCH DAYS SUPPLY: 30 NDC: 50458-0033-05 FUROSEMIDE 20MS.TABLET (RP:LASIX) DAYS SUPPLY: 28 NDC: 51079-0072-20 PRllOSEC 80MG CAPSULE DAYS SUPPLY: 28 NDC: 00186-0742-31 LEVOXYL (LEVDXINE) 0.1MG TAB (RP:SYNTHROID ** <10/21MCG)) DAYS SUPPLY: 28 NDC: 00689-1110-01 SUCRALFATE (CARAFATE) 1GM TABLET (RP:CARAFATE--) DAYS SUPPLY: 28 NDC: 51079-0871-20 METOPROLOL TARTRATE ** 50MG (HALF-TAB) (RP:LOPRESSOR) DAYS SUPPLY: 28 NDC: 1210378-121032-1211 * * * CONTINUED ON NEXT PAGE * ~ * C' 64.52 ...J b 11.25 6 5.44 10 i,-.r 19 C.Wa ~ 4. 14 1 48 184.35 '-Ie 9.03 c....J 90 72.20 .-,t:' 15.73 Co..! Balance Forward New Charges Finance Charges Payments I AMOUNT DUE I I~'~ I~'OO I ~,90 DaY' I~t NeighborCa re'" . NeighborCa rew STATEMENT OF ACCOUNT 70~0 SNOWDRIFT ROAD SUITE ALLENTOWN PA 18106 For the account of YONTZ, CHARLOTTE 115 1050 THE WOODLAND CENTER FOR NSG. 888-565-t;708 BILLING DATE: 11/28/00 AMOUNT PAID Customer No. 34838 CHARLOTTE YONTZ (115-1050) C/O CINDY SHEARER 891 OLD SIVER SPRING RD MECHANICSBURG, PA 17055 _1iIElEI-.- I 11/13/00 R4171921 CHARGE 11/14/00 R4173300 CHARGE 11/17/00 R4178327 CHARGE 11/17/00 R4178329 CHARGE 08/11/00 R3942790 CHARGE 08/11/00 R3942792 CHARGE 08/11/00 R3942818 CHARGE 08/11/00 R3942842 CHARGE 08/11/00 R4045954 CHARGE Balance Forward Current NeighborCa reS" SEND PAYl'o1ENT TO: NEIGHBORCARE PHARMACY PC) BOX 20347 LEHIGH VALLEY PA 18002-0347 Please Retum This Portion Of Your Bill With Your Payment DESCRIPTION OXY-IR (IMMEDIATE RELEASE OXYCODONE) 5MG CAPSULE DAYS SUPPLY: 2 NDC: 59011-0201-10 LORAZEPAM 0.5MG TABLET (RP:ATIVAN) DAYS SUPPLY: 3 NDC: 51079-0417-21 FUROSEMIDE 20MG TABLET (RP:LASIX) DAYS SUPPLY: 7 NDC: 51079-0072-20 LANOXIN (DIGOXIN) e.. 125MG TABLET DAYS SUPPLY: 7 NDC: 00173-0242-56 SUBTOTAL RX mmiiD AMOUNT ASP I R IN //(:HILDRENS ORANGE ********* 81MG ~r; DAYS ~. ~D~: 55966-2800-09 DAILY TIeLBVITAMIN-i':"TABLET DAYS PL'{:,28 ,: NDe :57480-0203-01 OYSTE ELl: C~UjlUM 500MG TABLET (RP:OS-CAL 500) DAYS SUPPLY: 28 NDC: 00904-1883-61 ACETAMINOPHEN 325MG TABLET (RP:TYLENOL) DAYS SUPPLY: 28 NDC: 51079-0002-20 CEROVITE W/ MINERALS **** TABLET (RP:CENTRUM) DAYS SUPPLY: 28 NDC: 00536-3442-38 * * * CONTINUED ON NEXT PAGE * * * New Charges Finance Charges Payments I AMOUNT DUE I IQM'~ I QM,oo I ",", 90 0." 30 l..j.~a 20 16.76 c:- -J -. ~.." \-1. ._:.....; -4 .-. nt: L.u -::J...J 2832. 18 .-11 Cf 0. 18 28 " !::"c 1. JJ 57 6. 18 ':IC:; L... '-' 1 1::";; ~. J-::; .-~ li CO 1 . 3'3 H::" NeighborCare'" STATEMENT OF ACCOUNT 70)0" SNOWDRIFT ROAD SUITE 1 ALLENTOWN PA 18105 For the account of YONTZ, CHARLOTTE 115 1050 THE WOODLAND CENTER FOR NSG. Customer No. 34838 CHARLOTTE YONTZ (115-1050) C/O CINDY SHEARER 891 OLD SIVER SPRING RD MECHANICSBURG, PA 17055 _1iIBEI---- I 08/17/00 R3942792 CHARGE 888-555-6708 BILLING DATE: 11/28/00 AMOUNT PAID SEND PAYMENT TO: NEIGHBORCARE PHARMACY PO BOX 20347 LEHIGH VALLEY PA 18002-0347 Please Return This Portion Of Your Bill With Your Payment DESCRIPTION DAILY MULTIPLE VITAMIN-- TABLET DAYS SUPPLY: 28 NDC: 57480-0203-01 ASPIRIN (ASA) CHILDRENS ORANGE********* 81MG TAB CHEW DAYS SUPPLY: 28 NDC: 55966-2800-03 CEROVITE WI MINERALS **** TABLET (RP:CENTRUM) DAYS SUPPLY: 29 NDC: 00535-3442-38 ASPIRIN ORANGE 81MG.TAB CHEW (RP:ASPIRIN (ASA) CHIL.DRENSORANGE*********) DAYS SUPPLV: ....28 NDe: 63739-0250-30 CALCIUM (OYSTER SHELL) 500MG TABLET (RP:OS.....CQLi500) DAYS SUPPLY: 28 NDC: 63739-0040-01 ACETAMINOPHEN 325MG TABLET (RP:TYLENOL) DAYS >~YPPLY:28 NDC: 63739-0002-01 ASPIRIN (ASA) CHILDRENS ORANGE********* 81MG TAB CHEW DAYS SUPPLY: 7 NDC: 55966-2800-09 DAILY MULTIPLE VITAMIN-- TABLET DAYS SUPPLY: 7 NDC: 57480-0203-01 DOCUSATE SODIUM 100MG CAPSULE (RP:COLACE) DAYS SUPPLY: 7 NDC: 51079-0019-01 * * * CONTINUED ON NEXT PAGE * * * 08/29/00 R3942790 CHARGE 08/29/00 R4045954 CHARGE 08/29/00 R4064745 CHARGE 08/29/00 R4064748 CHARGE 08/29/00 R4064751 CHARGE 09/01/00 R4072135 CHARGE 09/01/00 R4072143 CHARGE 0'3/01/00 R4072201 CHARGE mvmiiD AMOUNT 12 0.65 14 0.09 18 0.89 7 --> 0. 14 34 2.59 24 1. 51 c. 0.01 7 0.39 21 2.39 Balance FOIWard New Charges Finance Charges Payments I AMOUNT DUE I I~'~ I~ro I~'OO~~ 10._ NeighborCa re'" :.: ::::', NeighborCare'" STATEMENT OF ACCOUNT 70i0'SNOWDRIFT ROAD SUITE 1 ALLENTOWN PH 18105 .988-555-5708 For the account of YONTZ, CHARLOTTE 115 1050 THE WOODLAND CENTER FOR NSG. BILLING DATE: 11/28/00 AMOUNT PAID New Charges I 1111II- I Finance Charges Payments AMOUNT DUE I~'~ I~'OO I~OO~~ Customer No. 34838 CHARLOTTE YONTZ (115-1050) C/O CINDY SHEARER 891 OLD SIVER SPRING RD MECHANICSBURG, PA 17055 SEND PAYMENT TO: NEIGHBORCARE PHARMACY PO BOX 20347 LEHIGH VALLEY PA 18002-0347 Please Retum This Portion Of Your Bill With Your Payment DATE 1DiIDJ_ DESCRIPTION 09/01/00 R4072205 CHARGE FERATAB (SUB FOR FERROUS SULFATE/FES04 324MG/325MG) 300MG TABLET DAYS SUPPLY: 7 NDC: 00245-0053-01 09/08/00 R4072205 CHARGE FERATAB (SUB FOR FERROUS SULFATE/FES04 324MB/325MG) 300MB TABLET DAYS SUPPLY: 28 NDC: 00245-0053-01 09/08/00 R4074372 CHARGE DOCUSATE SODIUM 100MG CAPSULE (RP:COLACE) DAYS SUPPLY: ZB NDC: 53739-0089-01 09/08/00 R4074373 CHARGE ASPIRIN ORANSE:81MB TAB CHEW (RP:ASPIRIN (ASA) CHi pORANBE*********) DAYS S 8 NDC: 63739~0250-30 09/08/00 R4074374 CHARGE DAILY TAMINSTABLET(RP:DAILY MULT ~ ~~) DAYS PLI'\: tea" ND!3:63739-0068-01 10/08/121121 R412172205 CHARGE FERAT SU;~ ~\9R lf~R~DYSSULFQTE/FES04 324M 5MG) h~00MG TABLET DAYS SUPPLY: 28 NDC: 00245-0053-01 10/08/00 R4074372 CHARGE DOCUSATE SODIUM 100MG CAPSULE (RP:COLACE) DAYS SUPPLY: 28 NDC: 63739-012183-01 10/1218/1210 R4074373 CHARGE ASPIRIN ORANGE 81MG TAB CHEW (RP:ASPIRIN (ASA) CHILDRENS ORANGE*********) DAYS SUPPLY: 28 NDC: 63739-0250-30 * * * CONTINUED ON NEXT PAGE * * * Balance Forward I~l NeighborCare'" m!1miii1 AMOUNT ~l 1. 37 t:::"'~; 1 . SIll c~ c.bc 0.05 3 0.33 7'3 5. 14 80 3. 1.3 ;;:4 1. 11 NeighborCa re'" 888-565-6708 STATEMENT OF ACCOUNT 7010 SNOWDRIFT ROAD SUITE 1 ALLENTOWN PA 18106 For the account of YONTZ, CHARLOTTE 115 1050 THE WOODLAND CENTER FOR NSG. Customer No. 34838 CHARLOTTE YONTZ (115-1050) C/O CINDY SHEARER 891 OLD SIVER SPRING RD MECHANICSBURG, PA 17055 _1iEBI---- I 10/08/00 R4074374 CHARGE 10/08/00 R4146301 CHARGE 11/03/00 R4157901 CHARGE 11/03/00 R4157903 CHARGE 11/05/00 R4074372 CHARGE 07/14/00 R4007445 CREDIT 07/14/00 R4007447 CREDIT 07/14/00 R4007451 CREDIT * * * CONTINUED ON NEXT PAGE * * * BILLING DATE: 11/28/00 AMOUNT PAID SEND PAYMErJT TO: NEIGHBORCARE PHARMACY PO BOX 20347 LEHIGH VALLEY PA 18002-0347 Please Return This Portion Of Your Bill With Your Payment DESCRIPTION AMOUNT ~ DAILY MULTIPLE VITAMINS TABLET (RP:DAILY 30 MULTIPLE VITAMIN--) DAYS SUPPLY: 28 NDC: 63739-0068-01 OYST-CAL-D 500 **** 500MG TABLET 16 (RP:OS-CAL 500+D) DAYS SUPPLY: 28 NDC: 00182-4439-10 MILK OF MAGNESIA LIQUID 50 DAYS SUPPLY: 2 NDC: 00121-0431-30 SKIN-PREP WIPES 50 DAYS SUPPLY: /10 NDC: 99999-9999-99 DOCUSATE SODIUM 100MGCAPSULE 55 (RP:COL..~pr!) DAYS SUPPL.Y: 28 NDC: 63739-0089-01 SUBTOTAL OTC 1. 09 0.37 0.90 7.85 ... r:::-.... { . ..J..j 58.55 SUBTOTAL CHARGES 289121.83 ZOLOFT 50MG TABLET DAYS SUPPLY: 28 NDC: 00049-4900-41 CIPRO (CIPROFLOXACIN) 500MG TABLET DAYS SUPPLY: 28 NDC: 00026-8513-48 PREDNISONE 1MG TABLET DAYS SUPPLY: 28 NDC: 00054-8739-25 -18 -39.30 _7 ..J -10.8121 .-,1::' -C,-' -0.77 I.."m F~"d 1_ Ch"", J R~~ Ch",,, I p~,"" I AMOUNT DUE I 10-' I~d I~'OO \'''''' 0")'" NeighborCa re'M . NeighborCare'" STATEMENT OF ACCOUNT . 7010 'SN-OWDR I FT ROAD SU I TE 1 ALLENTm.;N PA 18105 For the account of YONTZ, CHARLOTTE 115 1050 THE WOODLAND CENTER FOR NSG. 888-565-5708 BILLING DATE; l1i28/00 AMOUNT PAID Customer No. 34838 CHARLOTTE YONTZ (115-1050) C/O CINDY SHEARER 891 OLD SIVER SPRING RD MECHANICSBURG, PA 17055 SEND PAYMENT TO: NEIGHBORCARE PHARMACY PO BOX 20347 LEHIGH VALLEY PA 18002-0347 1iIBtEJ~ DATE 07/14/00 R4007453 CREDIT 07/14/00 R4007457 CREDIT 09/0B/00 R40B07B6 CREDIT 09/09/1210 R4072150 RETURN 1219/1219/00 R4072214 RETURN 11/06/1210 R4166629 CREDIT 11/06/00 R4156634 CREDIT 11/09/00. R4155525 CREDIT Please Return This Portion Of Your Bill With Your Payment DESCRIPTION PROPOXYPHENE NAPSYLATE WITH ACETAMINOPHEN 11210MB/650MG TABLET (RP:DARVOCET N-100) DAYS SUPPLY: 28 NDC: 51079-0322-20 PROPOXYPHENE NAPSYLATE WITH ACETAMINOPHEN 11210MG/650MG TABLET (RP:DARVOCET N-100) DAYS SUPPLY: 28 NDC: 51079-0322-20 ARICEPT (DONEPEZIL) 10MG TAB DAYS SUPPLY: 2a NDC: 62856-0246-41 PRILOSEC PSULE DISP: NDC: 00186-0742-31 CARDIZ CApSULE DIS .',< ~DC: 00088"'1796-413 DEPAK 125Ma~TABLE[ DAYS PL(= >~B) .... ~DC~00074-6212-11 ZYPRE **"2.'SMGTABLET DAYS SUPPLY: 28 NDC: 00002-4112-50 CELEXA *** 20MG (HALF-TAB) DAYS SUPPLY: 28 NDC: 00456-4020-53 SUBTOTAL RX * * * CONTINUED ON NEXT PAGE * * * AMOUNT ~ -16 -1.50 -14 -0.82 r. -"J -36.2E -14. ':Ii -4.58 -lB -3.51 ---:i'? ...j...J -155.01 c:- -J -7.85 -276.51 Balance FOIWard I Now Ch"g'" I A",~ Ch",~ I ~~oo. I AMOUNT DUE I Current I~'~ I~'OO I~OO~~ NeighborCa reS" NeighborCa rew STATEMENT OF ACCOUNT 7~10 SNOWDRIFT ROAD SUITE 1 ALLENTOWN PA 18106 For the account of YONTZ, CHARLOTTE 115 1050 THE WOODLAND CENTER FOR NSG. Customer No. 348.38 CHARLOTTE YONTZ (115-1050) c/o CINDY SHEARER 891 OLD SIVER SPRING RD MECHANICSBURG, PA 17055 _1iImiIB~ I 10/08/00 R4119634 CREDIT 1121/08/1210 R4119636 CREDIT 10/08/00 R4119639 CREDIT 11/06/00 R4166624 CREDIT 11/06/00 R4166627 CREDIT 11/06/00 R4166632 CREDIT 888-565-6708 BILLING DATE: 11/28/00 AMOUNT PAID SEND PAYMENT TO: NEIGHBORCARE PHARMACY PO BOX 20347 LEHIGH VALLEY PA 18002-0347 Please Return This Portion Of Your Bill With Your Payment DESCRIPTION OYST-CAL-D 500 **** 500MG TABLET (RP:OS-CAl 500+D) DAYS SUPPLY: 28 NDC: 00182-4439-26 CEROVITE WI MINERALS **** TABLET (RP:CENTRUM) DAYS SUPPLY: 28 NDC: 00536-3442-38 ACETAMINOPHEN 325MG TABLET (RP:TYLENOL) DAYS SUPPLY: 28 NDC: 5112179-1211211212-20 ASP I R I N ORANGE ... ElIMGTAB . CHEW (RP : ASP I R I N (ASA) CHIlI)RENSORANGE**~******) DAYS SUPPL,'l128 NOC: .....63739-0250-30 DAILY MUl.:.T E i VITAMINS TABLET ( RP: DAIL Y MULTI~~~< AM1N.......) DAYS~ypP Y: 28 NDC:63739':"012168-01 OYST-~~B""'D 500**** 500MG<TABl..ET ( RP : @,j"{9AL500+D) DAYS SUPPLY: 28 NDC: 00182-4439-26 SUBTOTAL OTC SUBTOTAL CREDITS Balance Forward New Charges Finance Charges Payments 412121.44 261121.40 0.00 0.00 Current OIer 30 OIer 60 OIer 90 Days 2610.40 0.00 587. 10 3533.34 EVmiiD AMOUNT 1'-' -0.70 -4 -0.20 -19 -1.21 -15 -0.69 -10 -0.36 -13 -0.76 -3.92 -280.43 AMOUNT DUE E.730.84 DR. CLEM CICCARELLI PHARMACY NABP: 3959244 FOR PATIENT : YONTZ, CHARLOTTE 115 1050 CUSTOMER TYPE: PRIVATE Neigh~(~S~: tf/ONDAY - FRIDAY 8:30 AM - 5:00 PM EST ~80NE: 888-565-6708 MAY 0 7 2004 ~ .~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLV ANIA WOODLAND CENTER FOR NURSING 780 Woodland Avenue Lewisberry, P A 17055 NO.: 2003-3009 Ms. Charlotte Yontz, Decedent 891 Old Silver Spring Road Mechanicsburg, P A 17055 ~ S S S ~ S ~ S S S S CIVIL ACTION - LAW CONSOLIDATED v. and s Ms. Cynthia Shearer 891 Old Silver Spring Road Mechanicsburg, P A 17055 Personally and as Attorney In F act for Charlotte Yontz, Deceased. s s s s s s s INRE: ESTATE OF CHARLOTTE YONTZ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHAN'S COURT DIVISION ---------- (f,:NO.: 21-01-69.-:) ~ CONSOLlUATED S SSN: 196-14-3445 S DATE OF DEATH: November 26, 2000 ~ And now, on t his the II'. day of , 20~4, ujon consideration of Plaintiff's ~ck~O~ RED a 0. I~ ~ ~~_~ . 1.-6~~~tion for Defendant's contempt of this ~er,jU~t iS~bY ente~l" r Plaintiff in the amount of$36,916.50. ~ 2. Defendant is hereby ordered to pay Plaintiff reasonable attorney fees in the amount of ~ $1,500.00 for the cost of bringing this action for sanctions and judgment is hereby entered for the M..I sa;;;unt,;;;;::;;;6.91:0. ~ r ~ ~tAM~-(. ~ I. I}lC · , 1 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA WOODLAND CENTER FOR NURSING 780 Woodland Avenue Lewisberry, P A 17055 v. Ms. Charlotte Yontz, Decedent 891 Old Silver Spring Road Mechanicsburg, P A 17055 and Ms. Cynthia Shearer 891 Old Silver Spring Road Mechanicsburg, P A 17055 Personally and as Attorney In Fact for CharlotteY ontz, Deceased. s s s s s s s s s s s s s s s s s s s NO.: 2003-3009 CIVIL ACTION - LAW CONSOLIDATED IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHAN'S COURT DIVISION INRE: ESTATE OF CHARLOTTE YONTZ S NO.: 21-01-69 S CONSOLIDATED S SSN: 196-14-3445 S DATE OF DEATH: November 26, 2000 MOTION FOR SANCTIONS AGAINST DEFENDANT CYNTHIA SHEARER AND NOW, comes Plaintiff, Capozzi & Associates, P.C., by and through its attorneys, Donald R. Reavey, Esquire and Michael B. Yolk of the law firm Capozzi & Associates, P .C., hereby file this Motion for Sanctions against the Defendant Cynthia Shearer, for failure to comply with this Court's order directing her to file an account of all actions taken on behalf of Charlotte Yontz including, but not limited to a detailed financial statement of all financial transactions undertaken in her capacity as power of attorney for Charlotte Yontz and as executrix of the estate of Charlotte Yontz, in accordance with Pa. R.C.P. 1530; In support of said Motion, Plaintiff respectfully shows this Honorable Court the following: 1. Movant is Plaintiff, Capozzi & Associates, P.C. 2. The Respondent is the Defendant, Cynthia Shearer. 3. Plaintiff filed a Complaint against the estate of Charlotte Yontz on May 4,2001. 4. Defendant filed Preliminary Objections to Plaintiff's Complaint on May 24, 2001. 5. Plaintiff filed its Petition for Removal of Cynthia Shearer as Executrix for the Estate of Charlotte Yontz for Mismanagement of the Estate and to Compel Cynthia A. Shearer to Account to the Estate in her Capacity as a Fiduciary to the Decedent on March 7, 2003. 6. The Court entered an order on March 25, 2003, issuing a rule upon Defendant to show cause why Plaintiff is not entitled to an accounting of all transactions of Charlotte Yontz. 7. The parties entered into a stipulation whereby it was agreed to transfer venue of this action to the Cumberland County Court of Common Pleas on April 14, 2003. 8. The Court entered an order consolidating the action filed in the Court of Common Pleas and the Estate action in the Orphan's Court of Cumberland County, where the estate of Charlotte Yontz was opened. 9. Plaintiff filed a Motion to Make Rule Absolute on December 11, 2003. 10. The Court signed an Order on December 19, 2003 making the /rule absolute, removing Cynthia Shearer as executrix and ordering her to file an account of all actions taken on behalf of Charlotte Yontz, including, but not limited to a detailed 2 statement of all financial transactions undertaken in her capacity as power of attorney for Charlotte Yontz and Executrix of the Estate of Charlotte Yontz. 11. To date, Defendant has failed to provide an accounting as ordered. 12. Defendant has not formally or informally requested an extension of time to provide the accounting. 13. Defendant's unwillingness to provide an accounting, as ordered, necessitates the Court's intervention. 14. Defendant's failure to respond has resulted in Plaintiff accruing additional attorney fees in the amount of$1,500.00. Furthermore, due to Defendant's contempt of this Court's order, the sanction of Default Judgment in the amount of $36,916.50 is appropriate. WHEREFORE, Defendant respectfully requests that the Court sanction Defendant by entering a Default Judgment in the amount of$36,916.50. In the alternative, Plaintiff requests that Defendant be held in civil contempt and that a warrant issue for her arrest until such time she complies with the Order of this Court. In the alternative, if the Court deems it necessary to first give Defendant an opportunity to respond, it is hereby requested that a rule be entered in the proposed form. 3 Respectfully sub1TI;~ted,/)/ ~ CAPOZZI & ASSOCI1\. rES, P .C. /i,~~~/",) _ .." (/(//c--- CJ. ';j Date:;: 0 a.r~ /-004-- By: i Donald R. Reavey, Esq. Attorney J.D. No. 82498 Michael B. Yolk, Esq. Attorney I.D.#88553 2933 North Front Street Harrisburg, Pennsylvania 17110-1310 Telephone: (717) 233-4101 Attorneys for Plaintiff 4 VERIFICATION I, Michael B. Yolk, hereby verify that I am an attorney for the Plaintiff. I have sufficient knowledge or information based upon investigation into this matter by my client, to take this Verification. I hereby verify that the statements in the foregoing Motion for Sanctions Against the Defendant are true and correct to the best of my knowledge, information, and belief. I understand that false statements contained herein are made subject to the penalties of 18 Pa. C.S.A. S 4904 relative to unswoIlJ:'falsification to authorities. /1 i ,/'1 1/ ' By: ///k/) / C J ,/} 7- 9 (111y''/~! ?c7" /1-. Date: f- P- 0{' / ( /. - -----..... Donald R. Reavey, Esq. Attorney LD. No. 82498 Michael B. Yolk, Esq. Attorney LD.#88553 2933 North Front Street Harrisburg, Pennsylvania 17110 Telephone: (717) 233-4101 Attorney for Plaintiff 5 CERTIFICATE OF SERVICE ~<Y'- oJ I certify that I am serving this 28'- day of '-f .. , 2004, a copy of the Plaintiffs Motion for Sanctions Against the Defendant upon the person(s) indicated below by first class mail, addressed as follows: VIA CERTIFIED MAIL: 7003-2260-0000-9890-5416 VIA FIRST CLASS MAIL: Samuel L. Andes, Esq. 525 North 1ih Street P.O. Box 166 Lemoyne, P A 17043 I /? Date: rz eo.1j/,A~' Z404 By: (' ~' ,. // .// ,L~ Donald R. Reavey, Esq. Attorney I.D. No. 82498 Michael B. Yolk, Esq. Attorney I.D.#88553 2933 North Front Street Harrisburg, Pennsylvania 17110 Telephone: (717) 233-4101 Attorneys for Plaintiff 6 ~ IN THE ORPHAN'S COURT OF CUMBERLAND COUNTY, PENNSYLVANIA Woodland Center for Nursing 780 Woodland Avenue Lewisberry, P A 17339, Plaintiff v. Ms. Charlotte Yontz, Decedent 891 Old Silver Spring Road Mechanicsburg, P A 17055 And Ms. Cynthia Shearer, 891 Old Silver Spring Road Mechanicsburg, P A 17055 personally and as Attorney- in-fact for Charlotte Yontz, Decedent, Defendants NO. 21-01-69 NOTICE AND SERVICE OF ORDER MAKING RULE ABSOLUTE To: Samuel L. Andes, Esquire 525 North Twelfth Street PO Box 166 Lemoyne, PA 17043 Attorney for Defendant Cynthia L. Shearer Please be advised that the Honorable George E. Hoffer issued the attach~ Order Making Rule Absolute on December 19,2003./ /);/ ///j/I /' / ~ ~V'\'-'" .j' ( ... tl ,/\.' ~ ichael B. Yolk, Esquire J.D. No.: 88553 Capozzi and Associates, P.C. 2933 North Front Street Harrisburg, PAl 711 0 717-233-4101 Attorney for Movant Woodland Center for Nursing 1 IN THE ORPHANS' COURT OF CUl\IBERLAND COUNTY, PENNSYLVANIA IN RE: ESTATE OF CHARLOTTE YONTZ ORPHANS' COURT DI\llSION No. 21-01-69 \Voodland Center for Nursing 780 Woodland Avenue Lewisberry, P A 17055 v. Ms. Charlotte Yontz, Decedent 891 Old Silver Spring Road l'v1echanicsburg, P A 17055 And Ms. Cynthia Shearer, 891 Old Silver Spring Road Mechanicsburg, P A 17055 Personally and as Attorney in Fact for Charlotte Yontz, Deceased. ORDER l\IAKING RULE ABSOLUTE AND NOW, upon no answer to the Rule given as a result of the Petitioner's Petition for Removal of Cynthia A. Shearer as Executrix and Motion to Compel an Accounting filed on March 26t\ 2003, it is ordered that Cynthia Shearer be removed as Executrix for the Estate of Charlotte Yontz. It is further ordered that Cynthia A. Shearer lay aside all business and excuses whatsoever, and: (1) file an account of all actions taken on behalf of Charlotte Yontz including, but not limited to a detailed statement of all financial transactions undertaken in her capacity as power of attorney for Charlotte Yontz and as Executrix of the Estate of Charlotte Yontz, in accordance \vith Pa.R.C.P. 1530; (2) The Respondent shall file an accounting to the petition within 7 days of service from this Order; (3) Notice of the entry of this order shall be provided to all parties by the petitioner. Witness my hand an official seal of office at Carlisle, Pennsylvania, this l)tC / / , 2003. 11 \if t 51 &/h( J. / ~ I q Ti~ day of IN THE ORPHAN'S COURT OF CUMBERLAND COUNTY, PENNSYLVANIA Woodland Center for Nursing 780 Woodland Avenue Lewisberry, P A 17339, Plaintiff v. NO. 21-01-69 Ms. Charlotte Yontz, Decedent 891 Old Silver Spring Road Mechanicsburg, P A 17055 And Ms. Cynthia Shearer, 891 Old Silver Spring Road Mechanicsburg, P A 17055 personally and as Attorney- in-fact for Charlotte Yontz, Decedent, Defendants Certificate of Service 1, Michael B. Yolk, Esquire, hereby certify that I did cause a true and correct copy of the Notice and Service of Order Making Rule Absolute to be served upon the following parties and/or their counsel via regular U.S. mail: Samuel L. Andes 525 North Twelfth Street P.O. Box 166 Lemoyne, PA 17043 1 ~~_//fl' c:,~ Mich/e1 B. Yolk, Esquire J.D. No.: 88553 Capozzi and Associates, P. C. 2933 North Front Street Harrisburg, PAl 711 0 717-233-4101 Attorney for Movant Woodland Center for Nursing /7 // 2 DEe 1l~Ol@~ r<L-__ "0, IN THE ORPHANS' COURT OF CUMBERLAND COUNTY, PENNSYLVANIA INRE: ESTATE OF CHARLOTTE YONTZ ORPHANS' COURT DIVISION No. 21-01-69 Woodland Center for Nursing 780 Woodland Avenue Lewisberry, P A 17055 v. Ms. Charlotte Yontz, Decedent 891 Old Silver Spring Road Mechanicsburg, P A 17055 And Ms. Cynthia Shearer, 891 Old Silver Spring Road Mechanicsburg, P A 17055 Personally and as Attorney in Fact for Charlotte Yontz, Deceased. ORDER MAKING RULE ABSOLUTE AND NOW, upon no answer to the Rule given as a result of the Petitioner's Petition for Removal of Cynthia A. Shearer as Executrix and Motion to Compel an Accounting filed on March 26th, 2003, it is ordered that Cynthia Shearer be removed as Executrix for the Estate of Charlotte Yontz. It is further ordered that Cynthia A. Shearer lay aside all business and excuses whatsoever, and: (1) file an account of all actions taken on behalf of Charlotte Yontz including, but not limited to a detailed statement of all financial transactions undertaken in her capacity as power of attorney for Charlotte Yontz and as Executrix of the Estate of Charlotte Yontz, in accordance with Pa.R.C.P. 1530; (2) The Respondent shall file an accounting to the petition within 7 days of service from this Order; (3) Notice of the entry of this order shall be provided to all parties by the petitioner. Witness my hand an official seal of office at Carlisle, Pennsylvania, this~ day of ~. , 2003. IN THE ORPHANS' COURT OF CUMBERLAND COUNTY, PENNSYL VANIA INRE: ESTATE OF CHARLOTTE YONTZ ORPHANS' COURT DIVISION No. 21-01-69 Woodland Center for Nursing 780 Woodland Avenue Lewisberry, P A 17055, Plaintiff, v. Ms. Charlotte Yontz, Decedent 891 Old Silver Spring Road Mechanicsburg, P A 17055 And Ms. Cynthia Shearer, 891 Old Silver Spring Road Mechanicsburg, P A 17055 Personally and as Attorney in Fact for Charlotte Yontz, Deceased, Defendants. MOTION TO MAKE RULE ABSOLUTE AND NOW, comes Movant Woodland Center for Nursing, (hereafter, "Movant") by and through its attorney, Michael B. Volk, of the law firm Capozzi & Associates, P.C., and hereby files this Motion to Make Rule Absolute against Executrix Cynthia A. Shearer, (hereafter, "Respondent") in her capacity as Power of Attorney and Executrix for Charlotte Yontz. In support of this Motion, Movant respectfully shows this Honorable Court the following: 1. On December 22, 1999, Charlotte Yontz (hereafter, Decedent") and Cynthia A. Shearer executed a contract wherein Decedent to receive nursing care and services from Petitioner's nursing facility. Charlotte Yontz died November 26,2000. 2. On December 22, 1999, Cynthia A. Shearer signed an Admission Agreement as the Power of Attorney for Decedent, in which she agreed to utilize the funds of the Decedent in order to make payment for the nursing care and services rendered to Decedent at the Woodland Center for Nursing, which were not covered by Medicare, Medicaid, or other insurance benefits. 3. Letters of Administration were granted to Samuel L. Andes and Cynthia Shearer, by the Register of Wills of Cumberland County, on January 16,2001, in the Orphan's Court of Cumberland County. 4. Plaintiff filed a Proof of Claim on November 18,2001, in Cumberland County. 5. On May 5, 2002, Plaintiff filed a Complaint in the Civil Court against Defendant for $39,916.50, in the Court of Common Pleas, York County. 6. On March 25, 2003 Movant filed a Petition for Removal of Cynthia A. Shearer As Executrix for the Estate of Charlotte Yontz for Mismanagement of Estate and Petition to Compel Cynthia A. Shearer to Account to the Estate in Her Capacity as a Fiduciary to the Decedent, in the Orphan's Court of Cumberland County. 7. A rule was issued, for the Petition to be answered in twenty days from the issuance of the rule. A true and correct copy of the rule is attached hereto as Exhibit "1". 8. This rule was served upon Respondent's Attorney through regular mail. 9. Respondent's attorney had less than twenty days notice after the issuance of the Rule and as such, Petitioner's Attorney and Respondent's Attorney agreed to postpone the date the answer to the rule was due. lO. Petitioner's Attorney and Respondent's Attorney agreed to consolidate both actions to 2 the Orphan's Court as it involves an estate, a decedent and an accounting of the estate by the Executrix. 11. Although the last stipulation was July 21, 2003 and the Rule was ordered to be answered in twenty days from March 26,2003, Respondent's Attorney has filed neither an answer or accounting with the Court. 12. Petitioner requests that Cynthia Shearer be removed as the Executrix of the estate and that she be compelled to account to for her fiduciary activities as the attorney in fact and Power of Attorney for Charlotte Yontz as well as in her capacity as Executrix of the Estate. WHEREFORE, Movant respectfully requests the court to approve the proposed order attached hereto removing Respondent Cynthia Shearer as Executrix of the Estate of Charlotte Yontz and compelling the Respondent to file a F onnal Accounting. Date: \ ~ -\\ -O"_~ Respectfully submitte~:.I CAPOZZI}1/. /:S:~9'ATE~~ ~c. By:/ i//./ &1:ichae1 B. Yolk, Esquire Attorney J.D. No. 88553 2933 North Front Street Telephone: (717) 233-4101 Attorney for Movant Woodland Center for Nursing 3 VERIFICATION I, Michael B. Yolk, hereby verify that I am an attorney for the Movant, Woodland Center for Nursing. I have sufficient knowledge or information based upon investigation into this matter by my client, to make this Verification. I hereby verify that the statements in the foregoing Motion to Compel are true and correct to the best of my knowledge, information, and belief. I understand that false statements contained herein are made subject to the penalties of 18 Pa. C.S.A. S 4904 relative to unsworn falsification to authorities. ,/ I , i/ / Date: \~ \ , ,\Ci3 \ . By: ~/( I ; / {~ chael B. Yolk, Esquire Attorney I.D. No. 88553 2933 North Front Street Harrisburg, Pennsylvania 17110 Telephone: (717) 233-4101 Attorney for Movant Woodland Center for Nursing 4 1~ RE: EST ATE OF CHARLOTTE YO:\TZ 1:\ THE COLRT OF CO~rvl0\: PLEAS ORPHA:\S' COLRT 01VIS10:\ CL\IBERL\:\D COL:\TY. PC\:\SYL \".\\:\.\ :\0. 21-2001-0069 RULE WE CO\1\L-'\~D, you that laying aside all business and excuses whatsoever, you be and appear in your proper person before the Honorable Judges of the Court of Common Pleas, Orphans' Court Division at a session of the said Court there to be held, for the County of Cumberland to sho\v cause why ( 1 ) the petitioner is not entitled to the relief requested: (2) The Respondent is ordered to file an account of all actions taken on behalf of Charlotte Yontz including, bu not limited to. a detailed statement of all financial transctions in accordance with Pa. R.C.P. 1530. (3) The Respondent shall file an answer to the petition with 20 days of service. ( 4) ------ (5) Notice of the entrv of this order shall be provided to all parties bv the petitioner. \Vitness my hand an official seal of office at Carlisle, Pennsylvania, this 26th day of March, 2003. 1" (\ t ,'-, .' ,"'---1"'(',1 '~-++L' i S'i'\, 'I': I " I \ ~,Y-( '-i~ l., . \..J../ L/, , (,--->''''-t-. ,_ ~ . I~,.(""'::_' L I ,'/' Clerk, Orphans' Court Division Cumberland County, Carlisle, P A My Commission Expires on the 1 st Monday January, 2006 EXHIBIT = ) II 1 " " 'il ~ , ! h..1 r', " , ,.(\.J.:.~{..I. / ''--' 'k+" j Certificate of Service I, Michael B. Yolk, hereby certify that I did cause a true and correct copy of Plaintiffs Motion to Make Rule Absolute to be forwarded to: VIA FIRST CLASS MAIL Samuel L. Andes, Esq. 525 North Twelfth Street P.O. Box 166 Lemoyne, P A 17043 Attorney for Respondent Cynthia L. Shearer. ;1 / l.____ ichael B. Yolk, Esquire J.D. No.: 88553 Capozzi and Associates, P.C. 2933 North Front Street Harrisburg, P A 17110 717-233-4101 Attorney for Movant Woodland Center for Nursing 5 Q-, .,. JU ~ L 1 8 2003 J IN THE ORPHAN'S COURT CUMBERLAND COUNTY, PENNSYLVANIA Woodland Center for Nursing 780 Woodland Avenue Lewisberry, P A 17339, Plaintiff v. NO. 21-01-69 rvls. Charlotte Yontz, Decedent 891 Old Silver Spring Road Mechanicsburg, P A 17055 And Ms. Cynthia Shearer, 891 Old Silver Spring Road Mechanicsburg, P A 17055 personally and as Attorney- in-fact for Charlotte Yontz, Decedent, Defendants $t- ORDER AND NOW, this 't( day of ~, 2003, in consideration ofthe Motion To Consolidate Actions in Orphans' Court it is hereby ordered as follows: This matter is consolidated in the Orphan's Court of Cumberland County. Pennsylvania. J. IN THE ORPHAN'S COURT OF CUMBERLAND COUNTY, PENNSYLVANIA Woodland Center for Nursing 780 Woodland Avenue Lewisberry, P A 17339, Plaintiff v. NO. 21-01-69 wIs. Charlotte Yontz, Decedent 891 Old Silver Spring Road Mechanicsburg, P A 17055 And Ms. Cynthia Shearer, 891 Old Silver Spring Road Mechanicsburg, P A 17055 personally and as Attorney- in-fact for Charlotte Yontz, Decedent, Defendants STIPULATION TO CONSOLIDATE VENUE AND NOW, comes the Plaintiff, Woodland Center for Nursing, by and through its attorneys, Capozzi & Associates, P.C., and Defendant aver the following: 1. On May 4, 2001, Plaintiff filed a Complaint in the Court of Common Pleas York County, Pennsylvania. 2. As of May 23,2003 the action was transferred to Cumberland County Court of Common Pleas, and marked inactive in York County Court of Common Pleas. 3. The transferred action in the Court of Common Pleas was numbered as 2001- su- 02251-01 in York County. 4. Upon information and belief, Grant of Letters of Administration was issued appointing Cynthia Shearer as Executrix of the Estate on January 16,2001, in Cumberland County. 5. On or about November 18, 2002, a proof of claim was filed against the Estate by the Plaintiff in the amount of $36,916.50, in Cumberland County. 6. Attorney Samuel Andes for Defendant and Attorney Amy Backenstose for Plaintiff have signed this stipulation for the consolidation of actions to the Orphan's Court. 7. The proper venue would be Orphan's Court as this matter involves a decedent's estate, pursuant to 20 PA C.S. S 711 (1) WHEREFORE, the Plaintiff respectfully requests that this Honorable Court enter an Order in the proposed form consolidating both causes of action to the Orphan's Court of Cumberland County Pennsylvania. Respectfully submitted, CAPOZZI AND ASSOCIATES, P.C. & II: 6<e/~~ By: Amy H. Backenstose Identification No. 87008 2933 North Front Street Harrisburg, PAl 711 0 Phone: (717) 233--4101 Petitioner and Attorney for Plaintiff . , t .... IN THE ORPHAN'S COURT OF CUMBERLAND COUNTY, PENNSYLVANIA Woodland Center for Nursing 780 Woodland Avenue Lewisberry, P A 17339, Plaintiff v. NO. 21-01-69 Ms. Charlotte Yontz, Decedent 891 Old Silver Spring Road Mechanicsburg, P A 17055 And Ms. Cynthia Shearer, 891 Old Silver Spring Road Mechanicsburg, P A 17055 personally and as Attorney- in-fact for Charlotte Yontz, Decedent, Defendants STIPULATION OF PARITES As the matters filed in the Court of Common Pleas and in the Orphan's Court both involve a decedent, and a claim against the decedent's estate and the executrix who was the power of attorney for the decedent, the parties hereby agree to consolidate the causes of action to the ORPHAN'S COURT of Cumberland County, where the estate was opened. ~~ h ff6-<<k;W uel Ande Amy H. Backenstose 525 North Twelfth Street 2933 North Front Street P.O. Box 166 Harrisburg, PA 17110 Lemoyne, P A 17043 Capozzi and Associates, P.C. Attorney for Defendants Attorneys for Plaintiff IN RE: ESTATE OF CHARLOTTE YONTZ IN THE COURT OF COMMON PLEAS ORPHANS' COURT DIVISION CUMBERLAND COUNTY, PENNSYL VANIA NO. 21-2001-0069 RULE WE COMMAND, you that laying aside all business and excuses whatsoever, you be and appear in your proper person before the Honorable Judges of the Court of Common Pleas, Orphans' Court Division at a session of the said Court there to be held, for the County of Cumberland to show cause why (1) the petitioner is not entitled to the relief requested: (2) The Respondent is ordered to file an account of all actions taken on behalf of Charlotte Yontz including, bu not limited to, a detailed statement of all financial transctions in accordance with Pa. R.C.P. 1530. (3) The Respondent shall file an answer to the petition with 20 days of service. ( 4) ------ (5) Notice of the entry of this order shall be provided to all parties by the petitioner. Witness my hand an official seal of office at Carlisle, Pennsylvania, this 26th day of March, 2003. " I II L )' \. " i ' ", ,1 /,- ..>"-. }./ ~ 'j I I \ \ ('1' -. (i'.~ i iJ\/r'\ (J.. ,j --Z./l,~. I Clerk, Orphans' Court Division Cumberland County, Carlisle, P A My Commission Expires on the 1 st Monday January, 2006 ';\ ~, L-'\ I r\ ""') : ~~\_.H: ~ ()' \ \ Y-< / +- L-. ~j / ( j ! MAR 1 1 2003W IN THE ORPHAN'S COURT OF CUMBERLAND COUNTY, PENNSYLVANIA IN RE: Estate of Charlotte Yontz Docket No.: 21-01-69 ,. ~ ORDER AND NOW, this ))) day of ~ 2003, upon consideration of the foregoing petition, it is hereby ordered that (1) A rule is issued upon the Respondent to show cause why the petitioner is not entitled to the relief requested; (2) The Respondent is ordered to file an account of all actions taken on behalf of Charlotte Yontz including, but not limited to, a detailed statement of all financial transactions in accordance with Pa.R.C.P. 1530; The Respondent shall file an answer to the petition within ').II , ~~~\ (3) days of ~ ~} 1.... Lva.llng SHall ut: nelO OIl ~u eVUlllUVUl Vl lhe .I. IJlllr)p.rl::J.n~II' I _...1 (5) Notice of the entry of this order shall b rovided to all parties by the petitioner. 4 IN THE ORPHAN'S COURT OF CUMBERLAND COUNTY, PENNSYLVANIA IN RE: ESTATE OF CHARLOTTE YONTZ ) ORPHANS' COURT DIVISION ) No. 21-01-69 AND NOW, this day of ,2003, upon consideration of the annexed Petition of Petitioner, Woodland Center for Nursing, it is hereby ordered and decreed that a citation be awarded, directed to Cynthia Shearer and Samuel L. Andes, to show cause why they should not file an Account of their administration of the Estate of Charlotte Yontz, deceased, within twenty days. Returnable this _ day of , 2003. BY THE COURT: J. 5 IN THE ORPHAN'S COURT OF CUMBERLAND COUNTY, PENNSYLVANIA IN RE: ESTATE OF CHARLOTTE YONTZ ORPHANS' COURT DIVISION No. 21-01-69 PETITION FOR REMOVAL OF CYNTHIA A. SHEARER AS EXECUTRIX FOR THE ESTATE OF CHARLOTTE YONTZ FOR MISMANAGEMENT OF ESTATE AND PETITION TO COMPEL CYNTHIA A. SHEARER TO ACCOUNT TO THE ESTATE IN HER CAPACITY AS A FICUCIARY TO THE DECEDENT TO THE HONORABLE JUDGES OF THE SAID COURT: Pursuant to 20 Pa. C.S. 3182, Woodland Center for Nursing petitions this Honorable Court to remove Cynthia A. Shearer as the personal representative of the Estate of Charlotte Yontz, deceased. The Petition of Woodland Center for Nursing respectfully states that: 1. Ms. Charlotte Yontz died November 26, 2000, a resident of Mechanicsburg, Pennsylvania, Cumberland County, Pennsylvania, leaving no will. 2. Letters of Administration were granted to Samuel L. Andes and Cynthia A. Shearer, by the Register of Wills of Cumberland County, Pennsylvania, on January 16,2001. 3. Samuel L. Andes' address is 525 North Twelfth Street, P.O. Box 168 Lemoyne, PAl 7043. 4. Cynthia A. Shearer's address is 891 Old Silver Spring Road, Mechanicsburg, PA17055. 5. Petitioner is the Woodland Center for Nursing, located at 780 Woodland A venue Lewisberry, Pennsylvania, 17339, who administered nursing care and services to Decedent from December 22, 1999 until November 25, 2000. 6. On Deceluber 22, 1999, Petitioner, Decedent and Cynthia A. Shearer executed a contract for Decedent to receive nursing care and services from Petitioner's nursing facility. 7. On December 22, 1999, Cynthia A. Shearer signed an Admission Agreement as the Power of Attorney for Decedent, in which she agreed to utilize the funds of the Decedent (resident) in order to make payment for the nursing care and services rendered to Decedent (resident), which were not covered by Medicare, Medicaid, or other insurance benefits. 8. On January 15, 1993, Cynthia A Shearer was appointed Power of Attorney for Charlotte Yontz, to use all lawful ways and means for the recovery from debts and obligations due to Charlotte Yontz. 9. Each month Cynthia Shearer would be copied on the monthly invoice detailing the nursing care and services provided to Charlotte Yontz by Petitioner. 10. Cynthia Shearer, attorney in fact for Charlotte Yontz, refused and/ or failed to provide Woodland Center for Nursing with information necessary to submit a complete Medical Assistance application on behalf of Charlotte Yontz during her lifetime. 11. Although Cynthia Shearer had access to the assets and income of Charlotte Yontz, she refused to use the income and assets of Charlotte Yontz to pay for the nursing care and services provided to Charlotte Yontz by Petitioner. 12. Cynthia Shearer, attorney in fact for Charlotte Yontz, refused and / or failed to respond to requests for payment for nursing services from Woodland Center for Nursing. 13. Cynthia Shearer's obstructive and deceptive behavior constitutes an ongoing breach of her fiduciary duty to both Charlotte Yontz and the Woodland Center for Nursing. 14. Cynthia Shearer's deceptive behavior toward her mother, Charlotte Yontz, while serving as the attorney in fact and / or as a fiduciary for Charlotte Yontz during her lifetime demonstrates that she is unfit to serve as the Executrix of the Estate of Charlotte Yontz. 15. Petitioner is a party in interest in the Estate, being a creditor of the Estate: for $36,916.50. 16. Petitioner filed a civil complaint against the estate of Charlotte Yontz for $36,916.50 plus interest was presented to Cynthia Shearer, Executrix of the Estate, on or about May 4,2001 in the York County Court of Common Pleas at Docket No. 200 I-SU-2251-0 1. 17. More than six months have elapsed since the first complete advertisement of the grant of letters and as of February 5, 2003, no account of the administrator has been filed. 18. Death tax closing letters have been received from the Internal Revenue Service and the Department of Revenue of the Commonwealth of Pennsylvania. 2 18. Death tax closing letters have been received from the Internal Revenue Service and the Department of Revenue of the Commonwealth of Pennsylvania. 19. As the personal representative and power of attorney for the Estate of Charlotte Yontz, Cynthia Shearer agreed to use the assets and income of her mother to pay for her full time care and fraudulently induced the Woodland Center for Nursing to undertake the responsibility of providing full time care for Charlotte Yontz. 20. As the personal representative for Charlotte Yontz, Cynthia Shearer failed to pay at least the legitimate monthly debt to Woodland Center for Nursing and converted the assets and income of Charlotte Yontz to her own benefit. 21. Two years have elapsed since the death of the Decedent and there is no reason that Cynthia Shearer should not account for all actions taken as a power of attorney or fiduciary pursuant to Pa.R.C.P .1530. 22. The Executrix has failed to provide Petitioner with an account of their administration, despite her requests that they do so. 23. The Executrix may now be cited to file their account pursuant to 20 Pa. Cons. Stat. S 3501.1. WHEREFORE, Petitioner requests that a citation be awarded, directed to Samuel L. Andes and Cynthia Shearer to show cause why they should not file an account of their administration of the Estate of Charlotte Yontz, Deceased, within twenty days; and that Cynthia Shearer be ordered to appear and show cause why she should not be removed as executrix of the Estate, to account for her activities as the Attorney in Fact and/or Fiduciary for Charlotte Yontz, and that the court grant such other and further relief as may be deemed proper. Date~ 311 ) {)3 f!&- ~dk~{( / Amy Backenstose, Esquire Identification No. 87008 Capozzi & Associates, P.C. 2933 North Front Street Harrisburg, PA 17110 (717) 233- 4101 3 . IN THE ORPHAN'S COURT OF CUMBERLAND COUNTY, PENNSYLVANIA IN RE: ESTATE OF CHARLOTTE YONTZ ) ORPHANS' COURT DIVISION ) No. 21-01-69 VERIFICATION I, Amy H. Backenstose, hereby verify that I am an employee of the Petitioner. I have sufficient knowledge or information based upon investigation into this matter by my client, to make this verification. I hereby verify that the statements in the foregoing Petition are true and correct to the best of my knowledge, information, and belief. I understand that false statements contained herein are made subject to the penalties of 18 Pa. C.S.A. 94904 relative to unworn falsification to authorities. ~tL /7 ~- ,r . ,. C4'C.QUN4--0 Am : Backenstose, Esquire Date: 3/1 J{)/ 6 Mar 05 03 03:30p W , 03-05-0] 15:00 FROM-CAPOZZI AND ASSOCIATES p.2 9095311 T-580 P.QZ/OZ F-57T IN TIlE ORPHAN'S COURT OF CUMBERLAND COUNTY, PENNSVLV' ANIA IN RE: Estale of Charlotte Yontz Docket No.: 21..01-69 VERIFICATION I) Susan MitryZk, Administrator. of Woodland Center for Nursing. do hereby verify that I am Duthorized to make this verification on behalf of Woodland Center for Nursing and that the tlvennems of facts set forlh in the attached Petition for Removal of Cynthia Shearer as Personal Representativt for the Estate of Charlotte Yontz and Petition to Compel Cynthia Shearer to account to the Estate in her Capac;ty as a Fiduciary to the Decedent are true and correct to (he best of my knowledge, information and belief. I understand that any false statements therein are subject to the penalties contained in Title 18 of the Penn.sylvania Consolidated Statut~s Section 4904, relating to unsworn fal~ificfttion to authorities. Date: 3~ 1m or 7 , IN THE ORPHAN'S COURT OF CUMBERLAND COUNTY, PENNSYL VANIA IN RE: Estate of Charlotte Yontz Docket No.: 21-01-69 CERTIFICATE OF SERVICE I, Amy Backenstose, Esquire, do hereby certify that on this l day of I~bl(; IL., 2003, I placed in the United States Mail a true and correct copy of the Petition for Citation to Compel Application for Letters Pursuant to 20 Pa. Cons. Stat. Ann.s3155 addressed to the following: Samuel L. Andes Attorney for Defendant 525 North 12th Street Lemoyne, P A 17043 Respectfully submitted, CAPOZZI AND ASSOCIATES, P.C. k Jcidy-k~ By: my Backenstose, Esquire Identification No. 87008 2933 North Front Street Harrisburg, PAl 711 0 Phone: (717) 233 - 4101 Attorney for Plaintiff 8 ~ r IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA INRE: ESTATE OF CHARLOTTE YONTZ ) ) ORPHANS' COURT DIVISION No. 21-01-69 PROOF OF CLAIM To the Clerk of Orphans' Court Division: Index and make proper entry in your official records of the claim of Woodland Center for Nursing, 780 Woodland Avenue, Lewisberry, PA against the estate of the above named decedent in the amount of$36,916.50 (thirty-six thousand nine hundred sixteen dollars and fifty cents). The claim is filed under Section 3532 (b) (2) of the Probate, Estates and Fiduciaries Code. The decedent, who resided at Woodland Center for Nursing, 1200 Spring Street, Bethlehem, P A 18018 died on November 26, 2000. An estate was opened for the decedent on January 16, 2001. Claimant delivered notice of the claim by first class, postage paid regular mail and certified mail, dated November 13,2002 to the attorney representing the estate, Samuel L. Andes, Esquire, at 525 North Twelfth Street, Lemoyne, Pennsylvania 17043. Claimant also delivered notice of the claim by first class, postage paid regular mail and certified mail, dated November 13, 2002 to the executor of the estate, Cynthia A. Stearer, at 891 Old Silver Spring Rd, Mechanicsburg, Pennsylvania 17055. - 1 - Date: November /~2002 Claimant's Address: Woodland Center for Nursing 780 Woodland Avenue Lewisberry, P A 17339 Respectfully Subl11itted, ~~~:=-- ---- Donald R. Reavey, Esquire Identification No. 82498 CAPOZZI AND ASSOCIATES, P.C. 2933 North Front Street Harrisburg, PA 17110 (717) 233- 4101 - 2 - t JRD/June 30, 1992/17858 In Re: Estate of Charlotte I Yontz Late of Camp Hill Borough ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLV ANIA Estate No.: 21-01-69 NO. NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT ORPHANS' COURT RULE Personal Representative: Cynthia A Shearer Counsel for Personal Representative: Samuel LAndes Esq Date of Grant of Original Letters: January 16, 2001 Date of Delinquency Notice: April 26, 2001 The undersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 5.6, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court Orphans' Court Rules, was given by the Register of Wills on April 9, 2001, and that the ten (10) day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6(e) the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: May 25, 2001 ) ) ~Ju-*PJ'l. ~--> . J-; ,_ ~;{ZJ J f Wills ( j Distribution: Personal Representative Counsel for Personal Representative Estate File A hearing is scheduled forH,t, ~:}tI in Courtroom No.3. If the Certification of Notice is filed prior to the hearing date, the hearing will automatically be cal}celled. Georg ...Jj _l A . ~ Ot:::., ~ ~ '- ~;J;>.- Ol 'If ---- CERTIFICATION OF NOTICE UNDER RULE 5.6(al Name of Decedent: Charlotte I. Yontz Date of Death: 26 November 2000 Will No. Admin. No. 21-01-69 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 1 6 January 2001 . Name Address Cynthia A. Shearer 891 Old Silver Spring Road Mechanicsburg, PA 17055 Notice has now been given to all persons entitled thereto under Rule 5. 6(a) except: None Date: to- 2-0,-0 I ,r-.. ~. F' , \ \. (. if, {ff" -,.'. ., cr -~ Signa e Name: Address: Samuel L. Andes 525 N. 12th Street Lemoyne, PA 17043 Telephone #(717) 761-5361 Capacity: Personal Representative L Counsel for Personal Representative " I~ THE COURT OF CO~I~ION PLEAS OF C{;l\tIBERLA~D COUNTY, PENNS'{L VANIA \VOODL.-\ND CENTER FOR ?\iCRSING 780 \Voodland Avenue Lewisberry, P A 17055 v. Ms. Charlotte Yontz, Decedent 891 Old Silver Spring Road iv1echanicsburg, P A 17055 and Ms. Cynthia Shearer 891 Old Silver Spring Road Mechanicsburg, P A 17055 Personally and as Attorney In Fact for CharlotteYontz, Deceased. " ',j " ';oj S S S S S S S S S S ~ ~ S S S S S NO.: 2003-3009 CIVIL ACTIO1\" - LAW CONSOLIDATED IN THE COURT OF COMMON PLEAS OF CUlVIBERLA-'\TD COUNTY, PENNSYLVANIA ORPHAN'S COURT DIVISION INRE: ESTATE OF CHARLOTTE YONTZ ~ NO.: 21-01-69 S CONSOLIDATED S SSN: 196-14-3445 S DATE OF DEATH: November 26, 2000 OBJECTIONS OF WOODLAND CENTER FOR NURSING, A CREDITOR OF THE EST;\' TE OF CHARLOTTE I. YONTZ, TO THE FIRST AND FI~AL ACCOUNT OF CYNTHIA A. SHEARER, AS EXECUTIRIX OF THE ESTATE OF CHARLOTTE I. YONTZ, DECEASED. Pursuant to Pennsylvania Orphan's Court Rule 6.10 Woodland Center for Nursing hereby files its objections to the First and Final Account of CYnthia A. Shearer, as agent under Power of Attorney for Charlotte 1. Yontz and as Executrix of the Estate of Charlotte 1. Yontz, Deceased as follows: FACTUAL AND PROCEDl"RAL BACKGROr~D 1. Woodland Center for ~ursing is a creditor of the estate of Charlotte 1. Yontz, deceased, who pro\-ided nursing home services to her from December 22~ 1999, through No\-ember 26, 2000. 2. On or about December 22 1999, Charlotte 1. Yontz, while in the presence of Cynthia A. Shearer~ signed an admissions agreement with Petitioner that included, among other things, an agreement to pay the charges for nursing servl ces. 3. Charlotte 1. Yontz died on November 26,2000. 4. An estate was opened for Charlotte 1. Yontz on January 16, 2001 at docket #21-01-69 and Letters of Administration were granted to Cynthia A. Shearer. 5. Petitioner's claim against the above-named estate for $36,916.50 plus interest was filed against the estate and thus presented to Cynthia A. Shearer, personal representative of the estate on or about November 18, 2002. 6. Cynthia A. Shearer was personally informed of these charges on a monthly basis through billing statements forwarded to her home address by Woodland Center for Nursing and she has paid no portion of the existing claim. 7. Cynthia A. Shearer served as the attorney in fact or as a fiduciary for Charlotte 1. Yontz during her lifetime. 8. During the admissions process for Charlotte 1. Yontz, Cynthia A. Shearer represented that she was the attorney in fact for Charlotte 1. Yontz, that she had access and control over the income and assets of Charlotte I. Yontz, and that she would insure that payment was made for nursing home services and/or assist in the preparation of an application for rv!edical Assistance if it became necessary. 9. Due to her increasing age and infirmity, Charlotte 1. Yontz relied heavily upon Cynthia A. Shearer for assistance in making decisions prior to her entry into Woodland Center for ~ursing. 10. Cynthia A. Shearer, attorney in fact and/or fiduciary for Charlotte I. Yontz, refused and/ or failed to provide Woodland Center for Nursing with information necessary to submit a complete Medical Assistance application on behalf of Charlotte I. Yontz during her lifetime. 11. Cynthia A. Shearer, attorney in fact for Charlotte I. Yontz, refused and/or failed to respond to requests for payment for nursing services from Regina Nursing Home. 12. Cynthia A. Shearer's negligent behavior constitutes an ongoing breach of her fiduciary duty to both Charlotte I. Yontz and to \V oodland Center for Nursing. 13. As the personal representative, fiduciary, and/or power of attorney for Charlotte I. Yontz, Cynthia A. Shearer represented that she had full custody and control over the assets and income of Charlotte I. Yontz. 14. As the personal representative, fiduciary, and/or power of attorney for Charlotte I. Yontz, Cynthia A. Shearer agreed to use the assets and income of her mother to pay for her full time care and induced the \\'oodland Center for Nursing to undertake the responsibility of providing full time care for Charlotte I. Yontz. 15. As the personal representative, fiduciary, and or power of attorney for Charlotte 1. Yontz, Cynthia A. Shearer failed to pay lt least the legitimate monthly debt to Woodland Center for Nursing 16. Woodland Center for Nursing filed a complaint against Cynthia A. Shearer in the Civil Division of the York County Court of Common Pleas at Docket No. 200 I-SU-0225I-0 1. 17. Defendant Cynthia Shearer filed preliminary objections to Plaintiffs Complaint on or about May 24, 2001. 18. Plaintiffs Proof of Claim was filed with this Honorable Court on or about November 18, 2002. 19. A Petition for the Removal of Cynthia A. Shearer as Executirx and Petition for Accounting was filed on or about March 7, 2003. 20. A rule to Show Cause regarding the Petition for the Removal of Cynthia A. Shearer as Executirx and Petition for Accounting was issued on or about March 26, 2003. 21. By agreement of the parties, the civil action against Cynthia Shearer filed in York County was consolidated with this estate action in the Orphans' court division of the Cumberland County Court of Common Pleas on or about July 21, 2003. 22. An order making absolute the Petition for the Remo\'al of Cynthia A. Shearer as Executirx and Petition for Accounting was filed on or about December 11. 2003 and as such, Cynthia A. Shearer was removed as Executrix as of that fdate. 23. A Motion for Sanctions compelling an accounting of the Estate and of Cynthia A. Shearer's actions as Power of Attorney and/or fiduciary "vas filed on or about April 28, 2004. 24. On or about May 7, 2004, the the First and Final Account of Cynthia A. Shearer, Executor for the Estate of Charlotte Yontz, Deceased (hereinafter "Account). The scope of the account was from the time of Charlotte 1. Yontz's passing on November 26, 2000 to December 31.1003. A true and correct copy of the Account is attached hereto as Exhibit "1." OBJECTIONS TO THE ACCOUNT 25. Woodland Center for Nursing objects to the Account on the basis that the accountant has failed to account for the her own misrepresentations to Woodland Center for Nursing that she, Cynthia A. Shearer, had full custody and control over the assets and income of Charlotte I. Yontz and would use them to pay for Charlotte 1. Yontz's nursing home care. The Woodland Center for Nursing intends to present admissible testimony and evidence regarding these misrepresentations. 26. Woodland Center for Nursing objects to the Account on the basis that the accountant has failed to account for her actions as attorney in fact and/or fiduciary for Charlotte 1. Yontz, in refusing and, or failing to provide Woodland Center for Nursing with information necessary to submit a complete Medical Assistance application on behalf of Charlotte I. Yontz during her lifetime. If Cynthia A. Shearer cooperated with the Woodland Center for Nursing in providing this information, Charlotte 1. Yontz would have qualified for ,\Iledical Assistance relieying her estate of the 536,916.50 burden it has incurred. The Woodland Center for Nursing intends to present admissible testimony and evidence regarding these issues. 27. Woodland Center for Nursing objects to the Account on the basis that the accountant has failed to account for all her own actions as alleged in the Amended Complaint filed on August 21, 2002 under Civil Docket 01-19754 and incorporated herein by reference. These actions as alleged include, but are not limted to, negligence, breach of contract and failure of statutory duty to support. The Woodland Center for Nursing intends to present admissible testimony and evidence regarding these issues. 28. Woodland Center for Nursing objects to the Account on the basis that the accountant has failed to account for all her own actions as alleged in the Petition to Remove Cynthia A. Shearer as Executor filed on or about March 7, 2003. The Petition is incorporated herein by reference. These actions as alleged include, but are not limited to, negligence, misrepresentation, and breach of contract. The Woodland Center for Nursing intends to present admissible testimony and evidence regarding these issues. 29. Woodland Center for Nursing objects to the accounting based upon the fact that pursuant to 20 P .S. 3392, it is a Class3 Crditor of the estate, providing Decedent with medicines, medical and nursing services within 6 months of her passing and has not been listed as such, despite filing a valid Proof of Claim. As a Class 3 Creditor, the Woodland Center for Nursing is entitled to a pro rata share of the funds available for distribution. In this matter, $4,590.00 was distributed the Nlusselman Funeral Home. As such, Woodland is entitled to a distribution of at least 52,295.00. 30. Woodland center for Nursing objects to the accounting based upon the fact that the Estate of Charlotte Yontz is a party to the ongoing litigation involving its Executirx and as such, should not be closed. Alternatively, Woodland respectfully requests that it be appointed administrator of the estate and that the account be closed up to the point where Cynthia A. Shearer was removed as Executrix of the estate. WHEREFORE, the Woodland Center for Nursing respectfully requests that a hearing be held in this matter to determine whether or not Cynthia A. Shearer has improperly used the assets of Charlotte 1. Yontz and to determine whether or not she should personally, or in her capacity as a fiduciary, personal representative and/or power of attorney be held liable to pay these amounts back to the Estate of Charlotte 1. Yontz. Date: ~~ 1-0<4- RespectfullY. SUbmet'tted,. CAPOZZI & ASSO A , P.c. By: ~~ '- DonAld R. Reavey, Esquire Attorney ID No. 82498 Michael B. V olk, Esq. Attorney ID No. 88553 2933 North Front Street Harrisburg, PAl 711 0 (717) 233-4101 IN THE COURT OF COl\I~ION PLEAS OF Cr"IBERLAND COUNTY, PENNSYL VANIA \VOODLAND CENTER FOR NURSING 780 Woodland Avenue Lewisberry, P A 17055 v. Ms. Charlotte Yontz, Decedent 891 Old Silver Spring Road Mechanicsburg, P A 17055 and Ms. Cynthia Shearer 891 Old Silver Spring Road Mechanicsburg, P A 17055 Personally and as Attorney In Fact for CharlotteYontz, Deceased. s s ~ s s s s s s s s s s s s s s s s NO.: 2003-3009 CIVIL ACTION - LA \V CO?\SOLIDA TED IN THE COURT OF COl\'IMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA ORPHAN'S COURT DIVISION INRE: ESTATE OF CHARLOTTE YONTZ S NO.: 21-01-69 ~ CONSOLIDATED S SSN: 196-14-3445 S DATE OF DEATH: November 26, 2000 VERIFICATION I, Michael B. Volk, an attorney for the Woodland Center for Nursing, do hereby verify that I am authorized to make this verification on behalf of Woodland Center for Nursing and that the averments of facts set forth in this Objection to the First and Final Account of Cynthia A. Shearer as Executrix of the Estate of Charlotte 1. Yontz. The averments contained herein are true and correct to the best of my knowledge, information and belief. I understand that any false statements therein are subject to the penalties contained in Title 18 of the Pennsylvania Consolidated Statutes Section 4904, relating to unsworn falsification to authorities. (;/ f!;-f/J~ Michael B. Yolk IN THE COURT OF COi"IMON PLEAS OF Cr'IBERLA.""D COU~TY, PENNSYL VANIA \VOODLAND CENTER FOR NURSING 780 Woodland Avenue Lewisberry, P A 17055 v. Nls. Charlotte Yontz, Decedent 891 Old Silver Spring Road rvlechanicsburg, P A 17055 and Ms. Cynthia Shearer 891 Old Silver Spring Road Mechanicsburg, P A 17055 Personally and as Attorney In Fact for CharlotteYontz, Deceased. ~ S S S S S S S S S S S S S S S 9 S S NO.: 2003-3009 CIVIL ACTIO~ - LAW CONSOLIDA TED IN THE COURT OF COMMON PLEAS OF CUMBERLA1~D COUNTY, PENNSYLVANIA ORPHAN'S COURT DIVISION INRE: EST ATE OF CHARLOTTE YONTZ S NO.: 21-01-69 9 CONSOLIDATED 9 SSN: 196-14-3445 ~ DATE OF DEATH: November 26, 2000 CERTIFICATE OF SERVICE ~' Michael B. Yolk, Esquire, do hereby certify that on this the / >3 V"-. day of , 2004, I placed in the United States Mail a true and correct copy of the Objections to the First and Final Account of Cynthia A. Shearer, as Executrix of the Estate of Charlotte L Yontz addressed to the following: Samuel L. Andes, Esq. 525 North 1 ih Street P.O. Box 166 Lemoyne, P A 17043 Respectfully submitted, // //' CAPOZZI A1'oj~ss6C1~ES, P.c. vJ A~~~- By: Donald R. Reavey, Esquire Attorney ID No. 82498 Michael B. Yolk, Esq. Attorney I.D. No. 88553 2933 North Front Street Harrisburg, P A 17110 Phone: (717) 233 - 4101 Attorney for Plaintiff vVOODLAND CENTER FOR NURSING, PI aintiff IN THE ORPHANS COURT OF CUMBERLAND COUNTY, PENNSYLVANIA vs. ORPHANS COUR~(srIDiVED CHARLOTTE YONTZ, Deceased, and CYNTHIA SHEARER, Defendants 'i.> , : ?C~t NO. 21-01-69 . . IN RE: IN THE ORPHANS COURT OF CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF CHARLOTTE YONTZ, Deceased ORPHANS COURT DIVISION NO. 21-oi:69 c ~ FIRST AND FINAL ACCOUNT OF -., CYNTHIA A. SHEARER AS ;. EXECUTRIX OF THE ESTATE OF CHARLOTTE I. YONTZ, DECEASED PURPOSE OF ACCOUNT: Cynthia A. Shearer was appointed Executrix of the Estate of her mother, Charlotte I. Yontz, on 1 6 January 2001. Cynthia A. Shearer offers this Account to acquaint interested parties with the transactions that have occurred during her administration of the Estate. Significant dates are: Date of Death: Date of Executrix' 5 appointment: Accounting Period: 26 November 2000 16 January 2001 16 January 2001 through 19 December 2003 EXHIBIT I 1 - It is important that the Account be carefully examined. Requests for additional information or questions or objections should be addressed to: Cynthia A. Shearer c/o Samuel L. Andes P.O. Box 168 Lemoyne, PA 17043 I. RECEIPT OF PRINCIPAL The Accountant received the following assets during the administration of the Estate: Checking Account No. 301-106-1508 with Mellon Bank having a $ 6,448.731 value on the date of death of: Savings Account No. 00300443113 with Mellon Bank having a value $0.00 on the date of death of: Total Receipt of Principal $6,448.73 II. RECEIPT OF INCOME Your Accountant received no income during the administration of this Estate. Total Receipts of Income and Principal $6,448.73 III. DISBURSEMENTS During her administration of Mrs. Yontz's Estate, your Accountant made the following disbursements: 'This represents the date of death value. After Mrs. Yontz's death, transactions which were in process on the date of her death were completed and the actual cash balance in the account was reduced. Please see First and Final Account of Cynthia A. Shearer as Agent, Under Power of Attorney I for Charlotte I. Yontz filed contemporaneously herewith. . 10 August 2001 Musselman Funeral Home, Inc. - $4,590.00 decedent's funeral bill 28 November 2001 Rolling Green Cemetery Company ~ $760.00 purchase of burial plot 30 September 2001 Samuel L. Andes - attorney's fees $2,000.00 19 January 2001 Cumberland Law Journal -advertising $ 75.00 20 February 2001 The Sentinel - advertising $80.87 1 3 December 2000 - Register of Wills - probate fee $39.00 Total Disbursements of Principal and Income $7,544.872 IV. BALANCE ON HAND FOR DISTRIBUTION Total Receipts of Income and Principal $6,448.73 Total disbursements of Principal and Income ($ 7,544.87) TOTAL ON HAND FOR DISTRIBUTION $0.00 Cynthia A. Shearer, Executrix of the Estate of Charlotte I. Yontz, Deceased, hereby declares under oath that she has fully and faithfully discharged the duties of her office, that the foregoing First and Final Account is true and correct and fully discloses all significant transactions occurring during the accounting period and that she has properly disclosed all of her dealings and transactions with the assets of the said Estate. ~~~/9,~ @1nthia A. Shearer II' Sworn to ond subscribed before me this 14 ~ day I of A-fJ 12.J L , 2004. Not~~ u NOTARIAL SEAL LYNN EHRENFELD. NOTARY PUBLIC LEMOYNE BORG.. CUMBERLAND CO. MY COMMISSION EXPIRES AUG. 17 2004 2The funds disbursed for the administration of the estate exceeded the probate assets received by your Accountant. Your Accountant paid that additional expense from her own funds. 1:...., \2t.~ E.,4-~ <..~ C.ha,l)~t~ ~w""t~ WOODLAND CENTER FOR NURSING, Plaintiff IN THE ORPHANS COURT OF CUMBERLAND COUNTY, PENNSYLVANIA vs. ORPHANS COURT DIVISION CHARLOTTE YONTZ, Deceased, and CYNTHIA SHEARER, Defendants NO. 21-01-69 FIRST AND FINAL ACCOUNT OF CYNTHIA A. SHEARER AS AGENT, UNDER POWER OF ATTORNEY, FOR CHARLOTTE I. YONTZ PURPOSE OF ACCOUNT: Cynthia A. Shearer is the daughter of Charlotte I. Yontz. Charlotte I. Yontz died on 26 November 2000. Prior to her death, she had appointed Cynthia A. Shearer as her attorney-in-fact. During the final few months of Charlotte I. Yontz's life, Cynthia A. Shearer exercised control over her financial affairs and this account is provided to acquaint interested parties in the transactions that occurred during her handling of her mother's financial affairs. It is important that the information in this Account be examined carefully. Requests for additional information or questions or objections should be discussed with, and directed to: Cynthia A. Shearer c/o Samuel L. Andes P.O. Box 168 Lemoyne, PA 17043 I. RECEIPT OF PRINCIPAL The only financial asset owned by Charlotte I. Yontz of which Ms. Shearer took possession or control was a checking account at Mellon Bank, N.A., over which she assumed control on or about 15 August 2000. At the time she assumed control, the account had a balance of: $4,043.23 II. RECEIPT OF INCOME The only income received by Ms. Shearer during her administration of her mother's account were: 1 September 2000 Social Security payment 3 October 2000 Social Security payment 3 November 2000 Social Security payment $828.00 $828.00 $828.00 Total Receipt of Income $2,484.00 Total Receipts of Income and Principal $6,527.23 III. DISBURSEMENTS During her administration of Mrs. Yontz's account and financial affairs, Ms. Shearer made the following disbursements: 1 5 August 2000 Cynthia A. Shearer Payment of household and $ 700.00 other miscellaneous personal expenses for Mrs. Yontz 22 August 2000 13 September 2000 Mellon Bank Payment for checks $18.50 Cynthia A. Shearer Reimbursement for personal $60.00 expenses incurred for Mrs. Yontz 28 November 2000 Cynthia A. Shearer Reimbursement of $800.00 household and personal expenses paid for Mrs. Yontz u 20 December 2000 Social Security Administration Automatic withdrawal of $828.00 Social Security payment for month of November Total disbursements of Principal and Income $2,406.50 IV. BALANCE ON HAND FOR DISTRIBUTION Total Receipts of Income and Principal $6,527.23 Total disbursements of Principal and Income ( $2,406.50) $4,120.73 The above funds remained in the Mellon Bank checking account at the time of the death of Charlotte I. Yontz and were thereafter distributed to her estate. Cynthia A. Shearer, agent for the said Charlotte I. Yontz pursuant to a Power of Attorney, hereby declares under oath that she has fully and faithfully discharged the duties of her office, that the foregoing First and Final Account is true and correct and fully discloses all significant transactions occurring during the accounting period and that she has properly disclosed all of her dealings and transactions with the assets of the said Charlotte I. Yontz. Sworn to and subscribed before me this I ~ +h day of /1(1;</ L , 2004. L~ fdt/~ Notary Public NOlARIAl SEAL lmt EHRENFELD, NOTARY 'UBlIC lEMOYNE BORO., CUMBERlAND CO. MY COMMtSSION EXPIRES AUG. 17.2004 ..~....... ~ , '\ II WOODLAND CENTER FOR NURSING, Plaintiff IN THE ORPHANS COURT OF CUMBERLAND COUNTY, PENNSYLVANIA vs. ORPHANS COURT DIVISION CHARLOTTE YONTZ, Deceased, and CYNTHIA SHEARER, Defendants NO. 21-01-69 IN RE: IN THE ORPHANS COURT OF CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF CHARLOTTE YONTZ, Deceased ORPHANS COURT DIVISION NO. 21-01-69 FIRST AND FINAL ACCOUNT OF CYNTHIA A. SHEARER AS EXECUTRIX OF THE ESTATE OF CHARLOTTE I. YONTZ, DECEASED PURPOSE OF ACCOUNT: Cynthia A. Shearer was appointed Executrix of the Estate of her mother, Charlotte I. Yontz, on 16 January 2001. Cynthia A. Shearer offers this Account to acquaint interested parties with the transactions that have occurred during her administration of the Estate. Significant dates are: Date of Death: Date of Executrix's appointment: Accounting Period: 26 November 2000 16 January 2001 16 January 2001 through 19 December 2003 ~~~~ ~~~ It is important that the Account be carefully examined. Requests for additional information or questions or objections should be addressed to: Cynthia A. Shearer c/o Samuel L. Andes P.O. Box 168 Lemoyne, PA 17043 I. RECEIPT OF PRINCIPAL The Accountant received the following assets during the administration of the Estate: Checking Account No. 301-106-1 508 with Mellon Bank having a $ 6 ,448.73' value on the date of death of: Savings Account No. 00300443113 with Mellon Bank having a value $0.00 on the date of death of: Total Receipt of Principal $6,448.73 II. RECEIPT OF INCOME Your Accountant received no income during the administration of this Estate. Total Receipts of Income and Principal $6,448.73 III. DISBURSEMENTS During her administration of Mrs. Yontz's Estate, your Accountant made the following disbursements: 'This represents the date of death value. After Mrs. Yontz's death, transactions which were in process on the date of her death were completed and the actual cash balance in the account was reduced. Please see First and Final Account of Cynthia A. Shearer as Agent, Under Power of Attorney, for Charlotte I. Yontz filed contemporaneously herewith. lL 10 August 2001 Musselman Funeral Home, Inc. - $4,590.00 decedent's funeral bill 28 November 2001 Rolling Green Cemetery Company - $760.00 purchase of burial plot 30 September 2001 Samuel L. Andes - attorney's fees $2,000.00 19 January 2001 Cumberland Law Journal -advertising $ 7 5.00 20 February 2001 The Sentinel - advertising $80.87 13 December 2000 Register of Wills - probate fee $39.00 Total Disbursements of Principal and Income $ 7 ,544.872 IV. BALANCE ON HAND FOR DISTRIBUTION Total Receipts of Income and Principal $6,448.73 Total disbursements of Principal and Income ($ 7 ,544.87) TOTAL ON HAND FOR DISTRIBUTION $0.00 Cynthia A. Shearer, Executrix of the Estate of Charlotte I. Yontz, Deceased, hereby declares under oath that she has fully and faithfully discharged the duties of her office, that the foregoing First and Final Account is true and correct and fully discloses all significant transactions occurring during the accounting period and that she has properly disclosed all of her dealings and transactions with the assets of the said Estate. ~a'M~ /7, .~ ~nthia A. Shearer Sworn to and subscribed before me this , 9 ~ day of A-P iiI L , 2004. Not~~ ~ NOTARIAL SEAL LYNN EHRENFELD, NOTARY PUBLIC LEMOYNE BORO., CUMBERLAND CO. MY COMMISSION EXPIRES AUG. 17 2004 2The funds disbursed for the administration of the estate exceeded the probate assets received by your Accountant. Your Accountant paid that additional expense from her own funds. \ REV- 15lJlI E "~;G I COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 INHERITANCE TAX RETURN RESIDENT DECEDENT t- Z W o W o W o DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITiAL) Yontz Charlotte I. DATE OF DEATH (MM-DD-YEAR) / b-o.U;~ - /~ REV-1500 iJ";t::: FILE NUMBER Z. I - 0 1 OOQ~3- NUMBER COUNTY CODE YEAR SOCIAL SECURITY NUMBER 196 3445 DATE OF BIRTH (MM-DD-YEAR) - 14 11/26/2000 02/07/1923 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST. AND MIDDLE INITIAL) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WillS SOCIAL SECURITY NUMBER W I- ~~(/) uO::~ wo..u J:oo uO::...J o..Cll 0.. <( o 1. Original Return D 4. Limited Estate D 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future interest Compromise (date of death after 12-12-82) D 7. Decedent Maintained a Living Trust (Attach copy of Trust) o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) D 3. Remainder Return (date of death prior to 12-13-82) D 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach Sch 0) JI1ISSEC.TIQN'MOST BECQ"MPL~'fEp.'ALl..QQRRE~P9N[)ENCE"ANQCQNFlt)i:NtIAl.l,r)Q<INFORMAl'16t-,f'sHOU~[)Be'pIREC"EP,T():'J NAME COMPLETE MAILING ADDRESS Samuel L. Andes I- Z W o z o 0.. (/) w 0:: 0:: o U z o ~ ..J :J .... 0: <( () UI ~ FIRM NAME (If Applicable) TELEPHONE NUMBER (717) 761-5361 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule i) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 525 North 12th street Lemoyne, PA 17043 (1 ) (2) (3) (4) (5) 6 ,448.73 'OFFfcIACUSEONlY.... (6) (7) 12 ,905.06 l__________.._..__.___..___,.____ (8) 19,353. 79 (9) 7, 544 . 87 (10) 54,256.53 (11 ) 61,801.40 (12) (42,447.61) (13) (14) (42,447.61) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) z o ~ ~ :) a.. ~ o () >< ~ SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate i 7. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due x .0_ (15) x.O_ (16) x .12 (17) x .15 (18) (19) None CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 20. D > > BE SURE TO ANSWER ALL QUESTIONSOt-J REVERSE SIDEANDRECHECK MATH < < Decadent's Complete Addres . rEET ADDRESS ~T 303 Pennsylvania Avenue CITY STATE PA earn Hill Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) None Total Credits (A + 8 + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( 0 + 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) ZIP 17011 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) 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT None PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred;.......................................................................................... D b. retain the right to designate who shall use the property transferred or its income; ............................................ D c. retain a reversionary interest; or.......................................................................................................................... D d. receive the promise for life of either payments, benefits or care? ...................................................................... D 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................................... ......... ........ ........... ........ ......... ...................... D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ............. ............................................... ........ .............................. ...................... I8J No lZJ ~ [ZJ ~ ~ ~ o IF THE ANSWER 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 declare thai 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 pre parer other than the personal representative is based on all information of which preparer has any knowledge. I'..0A:URPF .:EjSON R~~7PONSIBL .*" /.1FIL:;~1'~)RN DRESS 891 old Silver Spring Road Mechanicsburg, FA 17055 SIGNATURE OF~RER O~~~ ADDRESS ~ ?u ~ Ib<6j L-~~PF). 1'7D4-'3. c.......}." DATE ''if 5ep :? i'>f'll 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)I. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. S9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. s9116(a)(1.2)1. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. S9116(1 .2) [72 P.S. s9116(a)( 1 )]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. s9116(a)(1.3)). A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. . REV.l50B E,,' (1.97) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY CHARLOTTE I. YONTZ FILE NUMBER 21-01-00069 ESTATE OF Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly.owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Account No. 301-106-1508 with Mellon Bank $6,448.73 2 . Account No. 00300-443113 with Mellon Bank $0.00 NOTE: See letter from Mellon Bank attached. TOTAL (Also enter on line 5, Recapitulation) $ 6, 448 . 73 (If more space is needed, insert additional sheets of the same size) . . @ P.O. Box 7899 Philadelphia, PA 19101-7899 Mellon Bank February 05, 2001 Samuel L. Andes 525 North Twelfth Street P.O. Box 168 Lemoyne, P A 17043 Attn: Samuel L. Andes Estate Of Charlotte I Yontz Date of Death: 11126/2000 SSN 196-14-3445 Dear Sir/Madam: In accordance with your request, the attached information sheet has been provided in the above decedents name as of his/her date of death. For IL or LC accounts, contact our Loan Department at 1-800-537-5591. For all other inquiries, please call (215) 553-1585. ~B~ Mellon Bank, N .A. Deposit Support Services 199-5355 Page 1 of 2 . ~ Mellon Bank Account Number Account Title . Monday, February 05, 2001 301-106-1508 Charlotte I Yontz 00300-443113 Charlotte I Yontz Date Opened: 11/04/1987 Principal Sal Int from Last as of DOD Posting to DOD $6,448.73 $0.00 Date Opened: 10/17/1990 Principal Sal Int from Last as of DDD Posting to DOD $0.00 $0.00 Account Type: DO Account Sal YTD Int to as of DDD DOD $6,448.73 $0.00 Account Type: SA Account Sal as of ODD $0.00 YTD Int to DDD $0.00 Page 2 of 2 REV-1510 EX . (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CHARLO'ITE I. YONTZ SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21-01-00069 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY %OF ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE ATTACH A COpy OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE \ NUMBER 1. Accrued pension benefit payments due from Bell Atlantic as of the date of decedent's death: Gross amount due $6,200.00 LESS: reimbursement due for prior overpayment ($444.96) Net payment from pension plan $5,755.04 100% None $5,755.04 NOI'E: See letter from Bell Atlantic In Toucr Center attached. 2. Death benefit paid fran Verizon, Inc., for the Bell Atlantic pension plan (see letter from Verizon and copy of,_ check attached) $5,580.00 100% None $5,580.00 3. Additional death benefit paid by Verizon for the Bell Atlantic pension plan (see copy of check and explanatory document attached) $1,570.02 100% None $1,570.02 TOTAL (Also enter on line 7, Recapitulation) $ 12,905.06 (If more space is needed, insert additional sheets of the same size) Bell Atlantic InTouch Center Beneficiary Support T earn P.O. Box 455 Little Falls, NJ 07424-0455 1-800-843-7122 TTY: 1-800-833-8334 . .~ ~ - ~ ~----... May 17, 2001 The Estate of Charlotte Yontz C/o Samuel Andes P.O. Box 168 Lemoyne, PA 17043 Dear Mr. Andes: On behalf of the Bell Atlantic InTouch Center, may I extend my deepest sympathy to you on the loss of Charlotte Yontz. A Special Retiree Pension benefit has been paid retroactive to January 01, 2001 resulting in an incomplete payment of 444.96. The Estate of Charlotte Yontz is due a total of $6,200.00. Please remit the requested amount and the total lump sum amount will be paid to the estate once payment has been received. SRSPB Payment $444.96 Total $444.96 There are two ways the overpayment may be remedied: a. You may return the original check(s). OR b. You may remit a check in the above amount made payable to Wachovia Bank N.A. To ensure proper crediting of the check, please be sure to include the decedent's name, Social Security Number, and the words "Bell Atlantic" on the check. If you have any questions concerning Bell Atlantic benefits, please call me at 1-800-843-7122, extension 30836, or the Teletypewriter (TTY) for the hearing impaired at 1-800-833-8334. I am available from 8 a.m. to 5 p.m. Eastern Time, Monday through Friday, excluding holidays. Sincerely, '" rrU1!di. (ftUI?~ Mandi Davis Case Analyst . . Bell Atlantic InTouch Beneficiary Support Team P.O. Box 455 Little Falls, NJ 07424-0455 ~ . verl7011 1-800-843-7122 TTY: 1-800-833-8334 Cynthia Shearer Summary of Benefits as Beneficiary of Charlotte Yontz Social Security Number: 196-14-3445 Group Life Insurance $ 5,500.00 This claim will be forwarded to the insurance carrier on your behalf as soon as we receive proof of your Social Security Number (e.g., copy of Social Security card, health insurance card, etc.). Concession Telephone Service Concession telephone service for the decedent's home telephone, if applicable, will continue for three full billing periods beyond the date of death. Subsequent months will be billed at the full rate. To change the listing or to disconnect the service, contact the appropriate telephone service provider. Long Term Care Insurance If the decedent had authorized a deduction for Long Term Care Insurance, and if the return of premium option was elected, a return of all or a portion of premiums paid may be returned to the estate. Mutual of Omaha will return a percentage of premiums paid based on the years of service the employee had completed, decreased by any benefits paid, pending or due, and any dividends or experience rating credits paid or due. Questions regarding this benefit may be directed to Mutual of Omaha Insurance Company at 1-800-877 -1052. Social Security Application for any Social Security death benefits should be made directly with the Social Security Administration. . . NJ 07424 ~ Ver;70n 04801214 ( , l i ! ! t i r i t ! i I ! ! ! t I I I ! I I ! r ! I I .o.-:Ii~i~.i [~-I~-i.:;. ~I;j~li~-F:f~ ..i:i.;;V:1i.;l~-~-ii.flru"i':'kl~~-;i~ili,'~C:;i~ii:ii;i~~7.":'i;li'~i;.:,~-i~,~[~i;a-(;rJI~;:,i;:ri:i;~i~:ii~~~[;;i:~f.i~J;~4;;;~' VERIZON'S BELL ATLANTIC INTOUCH CENTER P.O. BOX 435 LITTLE FALLS 66-49/531 VOID AFTER 90 DAYS Net Amount Date Pay Exactly :):l:~:~:"f:)~:~:::;!ii:::)~!:l:::i!":;i!!~::~I,i:~~;~i:':,~I~~!!I~::::i:'II'llil!,;:i,:i~j~~=,'i:::~i:iii:~~n!~:~'!::!::I:I'j'i:!i 06/15/2.001 $***5,580.00 I TO THE ORDER OF \rOOO:glg:tttt::~r,ttttt\r=::tt::::::~:::::~:::~r:ttt~rt=:::=~=:=tttttttt::::::t~::::=::::::~tt=t:=r:::=~:::::::~:t~tt: \\ESTAT~.t:::Ot::\'CMRtmE\~yb.fjwir:::=~::m:m::::r::::m:{{{{~:=:::::m::::::::r:::r:m:::::t: ::::r:3:03.:t::PENHS.ttVAlttA(rtAVit::::~:r:::::t:rrrrrr::::r:::=::::r::rr::r::::::::::=:::r::::=::::=':::::':t rtCAMirrH'Ittrt=tr]iAtr:~:::])10:1f+5:4:3:9::t::=:~::::tt:::r:r::=r:::::::::rrtt:::::::r:::::::::::::: :::::::::::::::::::::::::::;:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::;:;:;:::::::;:;:::::::::;:::::::::::;::::::::'::::::::::;:::::::::::::::::::::::::::::::;...........:::::::::::'::::::;::::::::::::':::':::::::::::::: ':I:;:I:;;:;,:,',:)::;!:j:I::ii::::::l:;',:::lj',:j'!::,.:::::1~;,:i'::,:I:~':::i::'-:1~i':::::i!:':'1::!!!:i1~'ii:,j'::!:',:j::i1,::::::':~':::i~:::::'_:::i:',::'j':i:1:j:i:':!,','j':!,i:i,!:',=:::::::::::I::::::'1::::l=i:j:i::=",:,:;:::":::::;::,:~,:-;,': r Wachovia Bank, N.A. Winston-Salem, NC 27150 ~~~~i.. \)__ ... n ...... ___.n Authorized Signature II- 0 ~ B 0 . 2 . ~ . 2 II- I: 0 5 ~ . 0 0 ~ g ~ I: B 7 ~ 7 0 0 2 5 7 b II- ; VERI:lON'S BELL ATLANTIC . INTOUCH CENTER P.O. BOX 435 ~ITTLE RALLS NJ 07424 ~.. - Ver.70(l 1111111111111111 II ~ 111111111111 006 1 1 8 EST OF CHARLOTTE YONTZ C/O SAMUEL ANDES P.O. BOX 168 LEMOYNE PA 17043 . 0480124395 Page 1 of 1 FOR INFORMATION CALL VERIZON'S BELL ATLANTIC INTOUCH CENTER 1-877-235-5482 PAY ON: 09/10/2001 CHECK NUMBER: 0480124395 Date ..... '. .':'\':!::~!~.~\~.~~!2)~I:j';:D&t,~~'t:$!:::::'~~!:.I!''~.::;:';g~\;;\:,~!';:!:I~s~~~:'~::'.:\i:";::\:':O 9/10/2 001 '::::006'118::'::' ... ................. ................. .. ...................... ll~i_I';II~lllllllillflliillltli;l,~~;;l'ii ASSOCIATE REG PENSION PLN VERIZON EST OF CHARLOTTE YONTZ BA 028823800A1 196143445T 02 FINAL PAYMENT ADJUSTMENT REIMBURSEMENT DESCRIPTION CASH DISTRIBUTION NET PAYMENT AMOUNT VERIZON'S BELL ATLANTIC INTOUCH CENTER P.O. BOX 435 LITTLE FALLS NJ 07424 \~ Ver.70n Pay Exactly TO THE ORDER OF Wachovia Bank, N.A. Winston-Salem, NC 27150 II- 0 ~ 8 0 . 2 ~~ g 5 II- THIS PAY 1570.02 1570.02 0480124395 VOID Net Amount $***1,570.021 ~cyiiJ~ Author;zed S;gnature 3t~':'fn'iT.G'W;Ij~~ffi3..fi.=J&Y.~1!J-.-f~~~~~~~";r~ffl~~ 7 b II- REV-1511fi_ + (1-97) '*' SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CHARLOTTE I. YONTZ FILE NUMBER 21-01-00069 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Musselman Funeral Hame, Inc. (see bill attached) Rolling Green Cemetery Co. (purchase of cEmetery lot) $4,590.00 $760.00 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) I EIN Number of Personal Representative(s) None so.oo B. Street Address City State Zip Year(s) Commission Paid: 2. 3. Attorney Fees Samuel L. Andes Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation) NONE Claimant Street Address $2,000.00 $0.00 City Relationship of Claimant to Decedent State Zip 4. Probate Fees Register of Wills $39.00 5. Accountant's Fees None $0.00 6. Tax Return Preparer's Fees None $0.00 7. Estate advertising: Cumberland Law Journal The Sentinel $75.00 $80.87 TOTAL (Also enter on line 9, Recapitulation) $ 7 ,544 .87 (If more space is needed, insert additional sheets of the same size) Mllll~~e~ mSlIt1l IFlllllI1l<eIrJ 1HIome, rrlI1l<C. Established 1895 Brian C, Musselman, ED. Supervisor William G. Pegan, ED. P.O. Box 137 324 Hummel Avenue Lemoyne, PA 17043-0137 (717) 763-7440 To Funeralees of CHARIDTTE YONTZ (statement of Services) Provided to Samuel L. Andes, Attorney 525 North 12th street Lemoyne, PA 1 7043 2000 November 30 . PROF. SERVICES RENDERED, FACILITIES & AUTOS IIJacksonll Steel Casket Burial Gown Cash Advance Items: Flowers Certified copies TOTAL (York Co. burial benefit pd. 3/6/01) SUB-TOTAL & Balance Due FOR APPOINTMENT PHONE 717-763-7440 June 19, 2001 $3,050.00 1, 350.00 100.00 $4,500.00 1 74 .00 '1 6.00 190.00 $4,690.00 100.00 $4,590.00 L4-LD 'B-/O-O[ , . J GAllERY PRINTING CO . HOUSTON, TX. . 713-B88-7441 . . ROlliNG GREEN CEMETERY COMPANY 1811 Corll.1e Rood . ~ HIli, PA 17011 . (717)161~055 N~ 801586 THIS AGREEMENT PROVIDES FOR ENDOWMENT CARE CEMETERY INTERMENT RIGHTS, MERCHANDISE AND SERVICES PURCHASE/SECURITY A(;REEMENT \ \-d-~ ~D () 624 No. Date: The undersigned, referred to as "Purchaser", hereby agrees to purchase the Interment Rights, Merchandise and Services described herein, subject to aCf&llt~nce a d approval of the ahove named cemetery, hereinafter rderred to as "Seller". PURCHASER L{V\ ~W ELEPHON"1:,(;'lq -~g3'~ ADDRESS \ ~. ~ c:s" \o^-AAo. ,u J ~'l 0 S..'t C Zip CLC"- . ~~ NameofDeceased Description oflnterment Rights: Issue Certificate of Interment Rights to: Address City Zip INTERMENT RIGHTS, MERCHANDISE AND SERVICES Interment Rights (including Endowment Care of S Interment Fees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . Memorial/zallon - Type Size ) ... --, (" 0 ()[') Design Memorial Base - Type Size Memorial Endowment Cue of . . . . . . Memoriallnstallatlonllnspecllon Fee. . Outer Burial Container - Material Model - Color Supplier Cremation Charge. . . Urn - Type Flower Vase - Type Nameplate, . . . . Lettering. . . . Other Other Sales Tax .'.... Size TOTAL CASH PRICE....... LESS: Down Payment Cash. . Other Credit ........ Total Down Payment UNP AID BALANCE OF CASH PRICE . -r G, 0 J.J.LL s '7 (C) (\ 0) $<7 (, D. () 0 > $ REMARKS: TERMS-CASH SALE The Total Cash Price is due and payable as of the date of this Agreement. A delinquency charge of _ percent will be assessed monthly on any balance not paid within 30 days ofthe date of this Agreement. Hless than full payment is received, Sellcr shall deduct the accrued delinquency charge from the amount received, and credit the remainder of the payment received to the Unpaid Balance. SECURITY INTEREST: Seller (or its assigns) will have a security interest in the Interment Rights and Merchandise being purchased as described above. Seller will retain title to said Interment Rights and Merchandise until the Total Cash Price, together with any delinquency charges thereon have been paid by Purchaser to Seller. Purchaser agrees that all rights conveyed under this Agreement are subject to, and Purchaser agrees to at all times comply with, the present (and as may be hereafter adopted amended or altered) Rules, Regulations and Bylaws of Seller, which arc available for eumination in Seller's office. NOTICE: BY SIGNING THIS AGREEMENT, PURCHASER IS AGREEING THAT ANY CLAIM PURCHASER MAY HAVE AGAINST THE SELLER SHALL BE RESOLVED BY ARBITRATION AND PURCHASER IS GIVING UP H1SIHER RIGHT TO A COURT OR JURY TRIAL AS WELL AS HISIHER RIGHT OF APPEAL. Purchas r GRANDVIEW CEMETERY ASSOCIATION dba ROLLING GREEN CEMETERY COMPANY 1811 Corllsle Road . Comp Hili, PA 11011 Purchaser <<.,,,, b" ~ eleUoaohJp ~ \ \ Aulbo..d .pr"~ole~ Counselor: ~f\.\\V\ lj~\rt" RelaUODehlp \j'- NOTICE: SEE OTHER SIDE FOR ADDITIONAL TERMS AND CONDITIONS WHICH ARE PART OF THIS AGREEMENT FORM 220PA REV (12198) C 1998 SCI Man_.anent Corponlion WHITE - CEMETERY COPY YEnOW - APPROVED CUSTOMER COPY riNK - CUSTOMER COPY ~fv.I.)ll fX+ (1-931 E5TAl f OF '*' . . C.OMMONWrA1YI1 Or rENN5YlYANIA INHfRIJANCr TAX IlE1U~N IlrSIOEtJ} DEctDHH SCHEDULE I DEBTS Of DECEDENT, MORTGAGE LIABILITIES AND LIENS CHARIDTI'E I. YONTZ rlease Print 0' Type L!'- NUMBER 21-01-00069 ITEM NUMBER 1. 2. 3. DESCRIPTION BlackBox of Dillsburg, Inc. (sheltered care living expenses at Outlook Pointe Assisted Living Ccmnunity from 25 September 1999 until 15 April 2000, see letter and statEment attached). Sterling-Neighbor Care (Bill for nursing services to decedent prior to her death, see Claim Against Decedent's Estate and related documents attached) . Woodland Center for Nursing (charges for nursing heme care during final months of decedent's life) NarE: Woodland Center for Nursing has filed suit to collect this debt and a copy of its complaint is attached hereto. TOTAL (Also entor on lino 10, Recapilulation) (If more spoto i~ f1f)cded, ;nserl uddi/inoQI ~hQots of ~om9 size.) AMOUNT $10,609.19 $6,730.84 $36,916.50 S54,256.53 . ()~II(}(}//J&'hle. . c./8.,e~ ~M'\:j~<J.)~ 6s~}~ ~l~/~ AT D1LLSBUKG ^ BALANCED CARE ASSISTED LIVING COMMUNITY February 14,2001 San1uel L. Andes Attorney -at-Law 525 N. 125th. Street Lemoyne, P A 17043 Dear Attorney Andes: Per the enclosed estate notice, I am submitting a bill for services provided to Charlotte Yontz. Charlotte was a resident at Outlook Pointe at Dillsburg from 9-25-99 until 4-15-00. Outlook Pointe is still owed $10,609.19. Please see the enclosed bill. If there is any information needed, please do not hesitate to call me. I can be reached at 717 -502-1000. Sincerely, ~~~~ Colleen Smyser Community Director Enclosure 153 Logan Road. Dillsburg, PA 17019 . 717-502-1000 . Fax 717-502-1005 w\VW.balancedcare.com . . Black Box Of Dillsburg, Inc. 153 Logan Road DiIIsburg PA 17019- (717) 502-1000 I Cynthia Shearer I 891 Old Silver Springs Road Mechanicsburg PA 17055 STATE:\1E~'T OF ACCOUNT Charlotte Yontz 10/25/00 DESCRIPTION DATE QUANTITY CHARGES / (CREDITS) BALANCE Private BALANCE FORWARD 09/25/99 04/15/00 09/30/99 10,609.19 $10,609.19 PLEASE DETACH HERE A..'lD RETUR~ TIllS PORTION wrrn YOUR PAnlE~T _ _____________ Please pa~his ~mount by 11/10/2000 - Thank you! $10,609.19 Charlotte Yontz % Cynthia Shearer YONTZ C Please Remit Payment To: I Black Box Of DiIIsburg, Inc. 153 Logan Road Dillsburg PA 17019- 891 Old Silver Springs Road Mechanicsburg PA 17055 . . able tQ non- Jricedfn the d expiration I Sentinel J to non-con- ems must be j~ days of ad i '" - ...-"'.''' ~ 141~ Miller nu. Dauphin. PA 17018 Ronald E. ./l,rc!-.e~, Esquire Attorney-at-Law 711 Hanna Street Houtzdale, PA 16651 ESTATE NOTICE Letters of Administration on the Estate of .. CHARLOTTE I. YONTZ, late of the Borough of ' Camp Hill, County of Cumberland. Pennsylva- nia. deceased, were ;. " granted to Cynthia A. Shearer onJ~ J~nuary )'):' 2001. All persoris ,,"'. knowing themsel~es,to ',', . be indebted to said ' Estate are requested to make immediate payment, and those having claims will present them, without delay, to the und~rsigned. Samuel L. Andes Attorney-at-Law 525 N. 125h Street Lemoyne. PA 17043 ESTATE NOTICE Letters Testamentary on the Estate of BLANCHE E. GENSLER, late of Upper Allen Township. County of Cumberland, Pen:;syhrania, c1eceased, were granted to Gwendolyn J. Myers on 31 October 2000. All persons knowing themselves to be indebt- ed to said Estat~ are ~i;~r -.. Decem P.L. 14 Jo Law OffiC\ N NOTICE IS EN that A poration , February the Com Pennsylv Departme Harrisburg for the pur ing a Carti Incorpora The name of organize9 Pennsylva Corporatio 1988, Act' 21,1988, 177, as am supplemen RITNER C CONDOM I ASSOCIA The purpose f Corporatio organized i a condomi1 tion for t~~ " condomlnlu at 1909 Ril Carlisle, PBj RHOADS & ~ Thomas J. N One South M ~ "",Uo. CI"l"\r P ~ I iLL "V."-t"-t.J VL/VV V..l ..l"-t"V..l !V"JILIU__!J'JLl I\LL-UVLI'-J L.L.""' I MI\' .JVVVV r ..I. V r f r MLlL .J . . - ,~-- In the Estate of: . CiJfl/!.J()J/e 0/1fz ~7 Est~t9 Now c1 / -/) / -jp 9 Dale c-Jit;1ifl.RJ .d!l; AOI)/ CLAIM AGAINST DECEDENT'S ESTATE The claImant certifies that there Is due and owIng by the decedent in. accordance . . with the attached statement of account or oth~r basIs for the claim the sum of " . $ ?; .7g~,t~ I solemnly affirm under the penalties of perjury that the contents of the foregoing clafm are true to the best of my knowledge, information and belief. ;Ve/{jhbtJJ!{,dJ!C lJIc'e/;/Jtl "C/ Numa or ,chllmQnl J Jve !}hbfJP(!/!!lrJflr 1/-kt iJn:'/! y . 114 j;J {J g.7- J fl/ 1l no f)Ot2R- JLI7/fJI7L iV..j ~7f)t3_ (f~t}~!7-/()k '1.llS~hQ'flG N1Jrnb,~ FJI-ED; RECORDED: ClaIms DOQkot Lfb.'J" Fono f--1LC I\JO.44-J VL:/VO V1. 14-U1. 1 U' J I Cr\L 11\JtcI r\ClvUVCr\ I LLlv rHA' 0VOUO I 1.V I I rHuc <4 . . , STERLING 1620 Route 22 East 2nd Floor Union, NJ 07083 Phone (800) 880-9949 Fax (908) 687-1077 Charlotte Yontz (Estate of) c/o cindy Shearer 891 Old silver Spring Rd. Mechanicsburg, PA 17055 01/29/2001 ATTN: cindy Shearer RE: Creditor Claim Balance Acct. # NeighborCa~e - Allentown $6730.84 0-2000-002861 Dear Ms. Shearer: Attached is a copy of the claim we filed against the Estate of Charlotte Yontz. As instructed by the Registrar of Wills, we are providing this information to you. This is an attempt to collect a debt and any information obtained will be used for that purpose- sincerely, STERLING RECOVERY, LLC- cheryl Lynn Account Manager CL/sm rILe I\lO.i4i4-2> VC./VO V1. 1.i4.V1. . ~. NeighborCare- I U. 0 I Lf'.L 11\lU J'\LvUVLI'\ I LLv I H/\' .::JVOVV ( 1. V! ( . STATEMENT OF ACCOUNT :010 SNOwDRIFT ROAD SUITE 1 ALLENTOWN PA iS105 BBB-555-c7lJ8 YONTZ, CHARLOTTE 1151050 THE WOODLAND CENTER FOR N5G. BILLING 0AT~~ 11/28/0~ AMOUNT PAID Customor No, 34838 CHARLOTTE YONTZ (115-1050) c/e CINDY SHEAR~R 831 O~D SIVER SPRING RD MECHANICSBURG, PA 17055 SEND pqYMENT TO: NEIGHBORCARE PHA~MACY PO BO~ 2~347 ~E~!GH VALLEY PA 18002-~347 r J:~~;1~;l~~ For tho 'account''-of "'", ';'r" DATE PIC::l5C Rerum This Portion Of Your Bill With Your PBymcnt . DESCRIPTION ' . e7/14/00 R3'34281fJ CHARGE 07/14/0,0 R33'34035 CHARGE 0.7/14/llJllJ R33'3BS10 C!-lARGE 07/17/00 R4e01023 CHARGE 07/2-'t/00 R40104!B CHARGE 08/02/1210 P.3942787 CHARGE 08/11/00 R394.2816 CHARGE 08/11/00 R3'342B22 CHARGE 08/ 11 /~'?l0 R3944Sl18 CHARGE ARICE~T CDCNEPEZIL) 10MG TRB DAYS SUPPLY: 28 NDC: 62B56-e246-~1 ZYPREXA *** 2.5MG TABLET DAYS SUPPLY: 28 NDC~ 00002-4112-60 K-DUR 20MEQ TABLET SA DAYS SUPPLY: 2 NDC= 0008S-~787-81 MIACALCIN (CALCITONIN) NASAL SPRAY (2~01U/00SE) DAYS SUPPLY :,,?~:~;:~':~'~:'};:Y~~,8C;;'~I:uc.,,0.,,007B-0:311-'3iZl CLOTR rMAZOLE,";i'f't,~:~:tl{E~,M,:.:'.~,:<;RP:{,eO;rR I M IN) K ~~~~ ~~.i;*~~~€~~~;J;~~gC:~irl~~t~\~S70~03 DAYS SBPP,E~,,: ''', \"4~";',,!,,(:,:,1 NDD: ~0~0B5~.eJ787~B 1 " -1",-"r'~"~~I<<;"""j",'.>l" "'Wo::- 'L:',I'"t,\ 1-,_,"'; 1"".1 Jill." ,~I""I~I..,.,r "I~'I~'~~'lh, A R r CE~J.:;:i~!:(.'DONcPE';~I;t'~,) ,+J?IM,p',~~ftB 11::::\21'k DAYS (S'tJP..PL~:; :e:8\~'::::;:}1 ~D~;: ~628'5~~~12'~,5-41 ZYPRE~"':;""rl,I}JJ -, t;;: ',,;:,,1 Q ):"T ~~\i:'l; ~\;'}:d:i'" ,8~1.l\.~j**t'!,,,c.. ,.~MG,,;'\JAe-':L"'t" :l~' 1'~; /'VI.'I "",/',':';' DAYS !.:SURPL.. \t: '2'8 !!it,! ~bd:1 0"00~2i!..f1~:1;,2-bQl SUCRRLFATE (CARAFATE) 1GM TABLET (RP:CARAFATE) DAYS SUPPLY: 28 NDC: 51079-0871-20 CARDIZEM CD 180MG CAPSULE DAYS SUPPLY; 28 NDe: ~0088-1796-42 * * ~ CONTINUED ON NEXT PAGE ~ * * 07/14/00 R3S427B7 CHARGE t.m"~.n.'. AMOUNT 23 102.79 28 137.64 8 8.eJ4 --. .:.. .:,~_5~ 45 19.10 4 6.02 15 58.03 27 132.B3 104 82~9'3 28 4b.10 &J6r'1C.. FOrWard N<>w ChnrQD'-' AMOUNT DUE I : Fl'1<lnc& Charge" r'~"~' 1~'OOo.~ ~.... 'I'.'J:~ ~:. ;:", 1. ' 'I " .I~.l., ','.: I":;/;::~'::~;;:"l 1 ..'.,I.."h", I~'~ !:,~:' ... . '1.- . -_ ~ NeighborCare\- ~...~. '.60 , J . ~ NeighborCare" .1 .LI . '--' I LI 'L... ! I \lU I \LvU 11 LJ '\ I L..L...v I Hf\. OVOUO I .L V! ! r"Hl:lt::. 0 . STATEMENT OF ACCOUNT 7~10 SNOWDRIFT ROAD SUITE BB8-5b5-57~a ..c:.-...=:::: ALLENTOWN PA 1810c , , ""':~'~~~~~~'T{~g~;O~3~,;~~!~:I""'i,:;\"':>".:\'".'," YONTZ, CHdRLOTT:E" i\:i'5:'\~-5'0 " TH~ WOODLAND CENTE~'FOR NSG. BI~LING DATE: 11/28/00 AMOUNT PAID Customgr No. 34838 CHARLOTTE YONTZ (115-1050) C/O CINDY SHEARER B9~ OLD SIVER SPRING RD MECHANICSBURG: PA 17055 LEVOXYL (LEVOXINE) 0.~5MG TABLET CRP;SYNTHROID' DAYS SUPPLV~ 32 NDC: 00S8S-111S-~5 LANOXIN (DXGOXIN)-- 0. 125MG TRBLET DAYS SUPPLY: 28 NDC: 00173-0242-55 PRILOSEC 20MB CAPSULE DAYS SUPPLY: 5 NDC: 0018c-0742-31 CELEXA 20MG TABLET DAYS SUPPL Y :"'r~~~/.'~I:'~i'?:;!lt~9~,:,~,::..,\~04Sb-4020-53 M I ACALC I N W~,~,%WiTP~i!,1~;:~(';'~iw.e~~~~~!",;,SP RA Y ( 200 I U 1 D~ EO)~~fl'\I",'"'II,\._....t,"'I'~"";I"'b""j'",, .". U,ljIJ'I' . ~l" ~ . \ Q.';f~1 .r'4Ah/,'ji,\;'~".' ;':.- -""I.Il.'~" ,'il "I: "II,~I,IA'-I":J,),l.l"t!~\'~'~'_.'l.J':'" DAYS S" :''':'.1;:, '~"':'t;:i,':' '^,NDC~~::~:~'0I.0~'l8;;'1~171311-912l . 'hJ ,r.t "-.(lf~ \4'11'1 ,1::",qt~".y""I'~.l ,:~:, SUCRAL,' ,'" , , H'T81~~ f~GM'I\iT:eBLE'II':I" (RP: TE" ~\t~~:~~:; ~. "bt.. ~:i:J/:'I:~'''\il~I~~!~'':'' ".'i~~j~ II ~t ~ "Vr ", .'t.l DAYS' PL~: j@8'~~'~,';,'j i\\!D@,'): \,'~,107~J',', "'lb,,', I~" 1-20 CARD I, COal ~~M f~j:;A~SLJk~~;~ ~' ~Ii, J!,;%j~,~ DAYS ' PLY: ~8 l~;,.,r;:i ~Dd!;c to,00:S8'-1;:;, ".96-42 LEVOXYL (LEVOXINE) 0.05MG TABLET (RP:SYNTHROID) DAYS SUPPLY: 28 NDC~ 0~5a9-111B-05 LANOX!N (OXGOXIN)-- 0. 12SMG TABLET DAYS SUPPLY: 28 NDC: 00173-0242-55 PRILOSEC 20MG CAPSULE DRYS SUPPLY: 28 NDC: 001Bc-0742-21 * * ~ CONTINUED ON NEXT PAGE * * * DATE .:t~it=l.:I~~lltf=ll .'1:.1 08/11/0~ R4010404 CHARGE 0B/11/013 R4r211r21411 CHARGE 08/11/00 R4014272 CHRRGE 08/11/00 R40232'31 CHRRGE 08/22/00 R3'3'38510 CHARGE 08/29/00 R3942822 CHARGE 08/29/00 f13944918 CHARGE 08/'2'3/00 R40104Cl14 CHARGE 08/2'3/00 R40112l411 CHARGE 08/2'3/00 R41211L~272 CHRRGE [ ..,,~ c_~ I N_ c,"'~" _-=r,M Currenl !,.;OJo,"" ".,,1 30" . ~~.r, ... ,. . },... I .J'::':'~.',: .- :' ':.1. I, ',.'.~ . ~ NeighborCare'. SEND PRYMENT TIJ: NEIGHBORCARE PHARMHCY PO BOX 20347 LEHIGH VPLLEY ~p 18002-0347 PJelJ5tJ Return This Ponion Of YCJl,Jr BIJI WIth Your Payment DESCAIPnON [.1I"'~1I.1I.1 AMOUNT . 27 11.b4- -: 5~3e; C" " ..JC 19'3.48 17 33.22 2 33..53 ~1 '-~ 1'3-03 21 35.2'3 15 8~24 7 5.30 35 135.20 I I J:~'~<' IP~m_ I, ~r.oo Duyu ,....: ,..,., -~~ ---~ AMOUNT DUE . ~. NeighborCare" l1.J.-JILI'-L.ll~o.:J I'-LvUVLI'1 L.L.V I Hf\. OVOlJO ( 1. V ( ( rHo.:JL . STATEMENT OF ACCOUNT 7010 SNOWDRIFT ROAD SUITE i ALLENTOWN PA lBl~5 ,'F'o~,theaCCollnt of , ';(':::>' YONTZ, CHARLOTTE 115 1050 THE WOODLRND CENTER FOR NSG. 885-555-6708 BiLLING DATE: 11/28/0~ AMOUNT PAID Customer No. 3/+838 CHRR~OTTE YONTZ (115-1050) c/o CINDY SHEARER 891 OLD SIVER SPRI~G SD MECHAN:CSBURG, PA 17055 . ;1::"'; ~;l:tHei~ .'.:.1 DATE, 08/23/0e R4~23291 CHARGE SEND pqY~1ENT TO: NEIGHBORCARE PHARMACY PO BOX 20347 LEHIGH VALLEY p~ le0~2-0347 P1Gf)se Return This Portion Of YOv( Bill With Yovr P(J.yment OESCA,P110N r"h"'~IH.. AMOUNT 08/29/Q)QJ P.406J+ 1 ,2- CHARGE 08/30/00 R4064175 CHARGE 09/01/00 R4072140 CHARGE 09/01/00 R4Q172148 CHRRGE 0'3/01/00 R4072150 CHARGE 0'3/01/00 P.4Q;72156 CHARGE Ql9/01/QlQl R4072165 CHARGE (2)9/(2)1/00 R407217rfJ CHARGE 09/01/00 R407217'6 CHARGE CELEXA 2~MG TABLET DAYS SUPPLY: 28 NDC= 00456-4020-63 DEPRKOTE 125MG TABLET DAYS SUPPLY: 7 NDC: 00074-'6212-11 DEPAKOTE 125MG TABLET DAYS SUPPLY: 7 NDC: 00074-'6212-11 CELEXA 20MG TABLET DAYS SUPPLY: 7 NDC= 0~45b-~020-D3 LAND X I N ( D I GO ~),:~;:~t;'::!:~:~D\1i?,~.m~ . TABLET DI"\YS S' Ir ~ 1 ",,(,t,"I.,,,.t;'7.,,,IIL:, 1\ , "fN'D':C.~. "("''';;n.17~ ,71-=>4-' r::'t: n ut"'rr-IL,:\,,;,,'hl,\>,I:I'~'il::"\': \I'r"~:', .. :::!,:'::!v:>-,: " ~-"''''' .:: -..10 P R I L OSEe .,/f:~~'~;(r:t,~B,~~~~:~~:':~i,~:,:;):::~~:'~::'::~,~';:;?:;:f:;:~~?:1, _ n ~ DAYS SUp,:PL,~..,:",~".tr;.:17".":~iD',.:( I:JDC':..,',.,0(l1,tB,6.-;:,QlI 4c -..J 1 LEV 0 X vU'~;:~.i:I(;illE\vh>:~WE'P'M' e~~h MG ::I:r:'A\'B;:':"~:.;> i:"":;'I' j '" "I':~:;': "~~~.~. '> '~',.~, 1'.~t1~I,.rt,;.~,,~t': , ~~ h,,1' ,I~,'\,>ol\,:.,,,, L~L'.. ur, ":'::A (RP: ~XN:~.RRO r D ~~~~J 1 ~,e;l';pG);') .. . ';;:".>::~" DAYS it~5tfePLYI\:: ~~<"';';;':}'-i ND{)'~\ '00B'89::'1..:1j,1!0-01 sue RAG!F.'4Sfu ;'("CAHA~8'~E )'\' l~GM<;T ABLEi:';'J~.' (RP: 8i~;'R\~FAf:E -~:) :~{~:~~ ~(d ~){! :rl;;: '~:', r::',l' ,?y':,!/;:- DAYS SUPPLY: 7 NDC: 51~7g-~B71-20 MIACALCIN (C~LCITONIN) NASAL SPRAY (200IU/DOSE) DRYS SUPPLY: 20 NDC: 0~078-0311-90 ZYPREXA *** 2.SMG TABLET DAYS SUPPLY:, NDC; 00002-4112-60 * ~ ~ CONTINUED ON NEXT PRGE * * * 21 47. 78 .::>q L..- 1 S. '+S 6 E.. 54 7 17.83 3 4.77 ll~ 55.73 7 5.40 .28 24_43 2 ""'7 c~ ~....,...J,:J 7 36.55 I A","~ Ck>"oo I I I"'" Ch",~ r~ ::;'.\.' \I.(;{\" , I ""''"~ .-." r o...r/'Clt'll i, <~. ./!.. ~f' ,"... I'.,: ".' ~ NeiqhborCa re'. r'~'". I ~~ 0.% AMOUNT DUE [~'~ I ~v . ..........v VLJ VV Vol .l.... VJ , . ~ ~. NeighborCare'~ ! 1.) . JILl "L ! I \ICl "L'-'U V LI' I LL~ I Hf\. OVOVO ( .1 V ( ( rH\.:lL 0 ~ STATEMENT OF ACCOUNT 7~10 SNOWDRIFT ROAD SUITE 888-5E.5-E,708 . "'F'~?~,'"tf.~1~Y?tt~~,~, ':.:,l:~ YONTZ, CHARLOTT~t,'1''i5 10'50 THE WOODLAND CENTER' FOR NSG. ALLENTOWN Pri lB10c BILLING DATE: 11/2B/00 AMOUNT PAID Customer No. 34838 CHARLOTTE YONTZ (115~1050) C/O CINDY SHEARER 831 OLD SIVER SPRING RD MECHANICSBURG, PA 17055 DATe .:l~j::f:I;i~{-i=- .-1 ;J ~9/01/00 R4072195 CHARGE 12I9/01/t2l~ R4ClJ7221.(~ CHARGE 09/08/00 R4072140 CHARGE 0'3/08/00 R4el72148 CHARGE 09/08/00 R/-l>fZ)7215lZt CHARGE 0'3/08/0;2; R4072::'S5 CHARGE 09/08/~e R4~72165 CHARGE Cl19/1218/12l\21 R41217217b CH~RGE 09/08/0121 R40721'35 CHARGE fZl9/lZJ8/iZIQ1 R4lZl72214 CH~RGE 09/21(fli0 R'+12l95298 CHARGE * * * CONTINUED ON NEXT PAGE * SEND PAYiVlENT TO~ NEIGHBORCARE PHARMACY PO BOX 20347 LEHIGH URLLEY PA !8082-03~7 Plc:J.:;c Fl6tvtn (his Portion Of Your Bill Wit)] Your Pnyml1nf DESCRIPTION [.111"~"1Il'. AMOUNl" , " :DEPAKOTE 125MG TABLET D~YS SUPPLY~ 7 NDC: 00074-6212-11 CARDIZEM CD lB0MG CAPSULE DAYS SUPPLY= 7 NDC: 00088-1796-49 CELEXA 20MB TABLEr DAYS SUPPLY~ 28 NDC: 00456-402~-b3 LANOXIN (DIGOXIN) 0. 125MG TABLET DAYS SUPPLY: 28 NDC: 00173-02~2-56 P R I LOSEe 20MG,,,.SlAg?~~.5tP,~\~"~"~,,,, DAYS SUP.PI. 'ti....S~I;.,R.' ~:i".~,f//2\?,~~P...,r..;..~::f.:,:.'i?e.f1l .1.6. .5.~. 07 42~ 31 ::r.';(I!r.!., ,.hIE~""!'1,9, 'i'(':~;\'''''.''.\o.\,~",'''''" LE V 0 X YL tt&l:ViQ' ..1t~;~t:S;O";4Qi~~~1.r~"!S'~ff~:e::~~~,,. (RP: SYN' .I'~ ~;l.':Jl~' '~,iij."e~ ~*;.~;;'("i~, 0t'1CG"~d~X}~l~~'~~'~:~~':::1,:\" " ',~ '~~, 1'.?1!\~:!l"I~ f.'ll,~1 lr','f"\I~;' ~'''':~'l'~~' DAYS ..:. ~ .,' ~~:J\Y;i;.~ ,1l\{D~'~ :il ~~. S ,:I!:,!'~ 10-01 ffl . I. . ~~" ~(fl,,\d I.,~, ':::'~, i~,~"", ,~l\ ~""~ SUCRA .. (CA'R EffTE) r GMI'~~:rABLE,II,,~~;; ( R. p. .. ' F A:~ ~) ~~~ r:$.' ;~", I lfI~~~.~, '[It', (r~ I.;:I'~.~~." DRYS p~~ :aB I:;:~ ~~D6l~ ~J\~1Cr\7S~~":;'~71-2Q1 Z Y P RE "," .'UoL' ~ M ~~ rv. LEi~7 ii!:'li\'! i~l 6lJ, !'I'.W, :~::.'!:i _ .....,.. . ..JI'I ~I>~ H! 1./ "f.I!"", "dl,/."" DAYS SUPPLY: 28 NDC: 0~002-4112-50 DEPAKOTE 125MG TABLET DAYS SUPPLY~ 28 NDC: 00074-6212-11 CARDIZEM CD 180MG CAPSULE DAYS SUPPLY: 28 NDC: 00088~1796-49 FUROSEMIDE 20MG TABLET CRP:LASIX) DAYS SUPPLY: 7 NDC: 51079-0072~20 * '* 21 12.e7 7 13.68 ~, 11. 70 'J '- 4.51 16 63.35 '.3 5.81 15 15. 10 4 22.:!.1 ...,~ ,.:,.~ 13.71 -'t 3.53 4. 14 -l="~C"~'" I ""'~O. ,~.~ ['.',0.1. ....r~. '.} ',",' . I . l~.. , ' , . : ",'l.~: :".~ j' . I N_ ,h."." [,::,,~. r. so l IV,"," ~';~';~:';, ~ NeighborCarew I AMOUNT D:EI J P.""OO" j ~0r~~ lr~ . ~ NeighborCare'. .1 U . V I LI \.L.. 1 I....U I \LvU V LI \. I LL..v I M/\ "0VVVVr l.Vr r rHuL ~ . STATEMENT OF ACCOUNT 7010 SNOWDRIFT ROAD SUITE 1 ~LlENTOWN PA lB10~ Fo.r thee;~counto1 YONTZ~ CHARLOTTE 115 1~50 THE WOODLAND CENTER FOR NSG- 8B8-565-67I2lS BILLING DATE: 11/28/00 AMOUNT PAID Customer No. 34B38 CHARLOTTE YONTZ (115-1050) C/O CINDY SHEARER 891 OLD SIVER SPRING RD MECHANICSBURG, PP 17055 BcJIl"CO Forw;uo Nil.... ell Qflllill nl1..n~" Ch;lrQC'" F'aylllenlB I I ikil~;;S~:l~l'I[-f=- ,'~~ DATE 09/30/00 R4107478 CHARGE 09/30/00 R410748E, CHARGE 09/3:Z:/lZ;tZl R4107487 CHARGE 10/Q\2f~0 R4072140 CHHRGE 10/iZl2/t2l11 R437221-+ CHARGE 10/02/flllZI R41fll89f2l5 CHARGE 10/02/12:0 R4108928 CHARGE 10/05/00 R4072148 CHARGe: 1121/06/00 R4112757 CHARGE 10/08/00 R/+el721 S0 CHARGE * 4 * CONTINUED ON NEXT PAGE * r~rrenr [pm, ~ ....1,:.;'..... '. '~~~:.'::I:":.', '~( . ~ NeiahborCare'. SEND PAV!YIENT "TG~ NEIGHBORCARE PHARMACY PO BOX 20347 LEHIGH VALLEY PP 18002-0347 P/tl[lse Aeturn This Portion Of Your Bill With Your PBymel1t DESCRIPTiON [.lIH~U\l.~ AMOUNT !YPREXR *** 2.5MG TABLET DAYS SUPPLY: 7 NDC: ~0~~2-4112~6~ PHENERGAN 25MG SUPPOS. DAYS SUPPLY: 3 Not: 00008-0212-01 PROMETHAZINE (1 ML) 25MG/ML AMPUL (RP:PHENERGAN (1 ML)) DAYS SUPPLY; 2 NDC: 00641-14g5-35 CELEXA 2~MG TABLET DQYS SUPPLY: :'.-'8. .:.r\'~n':";:~t:11NiDC/:J"' e. .0.4. 56-402QJ-E,3 CA RD I Z EM CD,.'1.f(~0J!jBj~.;cg~:s'8\'~~'!.g'tn::i.". "I.'\~:0'",,"~'l"";:~.'.'\. .,., :,.W~',~\I '''''m.''~. \f'~:":.' ., " I;~ DAYS SUPPC::.Yi:~..'.;t\::a.l,~".j;J.~~:~:::"N'UH)~:,'i~J1'000.H8~ 1796-43 eEL E x A *:;;~:.\f.i'~~WrG:~):)\';(87ACP::'~~B~{<'~~(2J.t::;I,~i;., .. il'yv;~"l(A". ""i''-).l'lliI~~~'.ii':''''''l~'~ ~.,. -':: b E'" ~'" .. '1.' ~ .;'1. '\}~,~ /1.,. DAYS SUnr-.l!"Y'..'. ."'1; ~iJ/I.\ .;.~ . Ii l?ll'.r;;'t:;." '.1:"""-,'1- ~- METOPRb\2~m~~;~~IT~~J~ :;* ~I';~~'g~~~~~~'f~;';~ (RP . ttrdr:/o'css..o, R\~\'" "~.:'t.;~.~ (~;',~ :~~ \r',r:. :.:j c~ '"r;~~;I:j.:;, . 'ir,...; .1,lr',;~,~ . ,I(,(; li}(': 'l4u L',,,,.\.~,~..:, ......\. !~~:,'.J,:",.. DAYS ;,:~~\~:~?U?\i~ ~~? ~~:Wi ~pc;~ ~q;~~I~F~,~~2-~ 1 LANOX liN.,~'~I;L\'DI GOX IN Hil~.Qtw ~:E:5MG;:!:::TABLE t;~:b~., DAYS SUPPLY: 28 NDC: 00173-0242-56 ZYPREXA *** 2.5MG TABLET DAYS SUPPLY: 2 NDC: 00002-4112-60 PRILOSEC 20MG CAPSULE DAYS SUPPLY: 28 NDC: ~~lab-e.742-31 * * 12 50_62 12 49_3G1 10 B. 12 .,... .L::: 43_50 19 22..03 2 7.85 4 E_flll2l 12 7.1121 b 31. 73 55 210.83 I I AMOUrtl~E '~'M 1..7:'....00.... ~~. . ...._....1.'::... . I"~ .'.- :~' . rILL I ~u . LtLt C> \.JcJ \.JO \.J .1 .1 Lt . \.JLt . ~, NeighborCare'M 1 U. C> I Cf'-L illJl,:] f'-CGUV Cf'- I LLG r H^ . .::;JVOUO I J. V I I r'Hl.:lL J.V . STATEMENT OF ACCOUNT 7010 SNOWDRIFT ROAD SUITE t ALLENTOWN PA 18~05 8S8-5SS-E;70S B!~LING DATE: 11/28/00 AMOUNT PAID Customer No. 34828 CHARLOTTE YONTZ (115-105~) C/O CINDY SHEARER 891 OLD SIVER SPRING RD MECHANICSBURG, PA 17055 DATE ..1~;.I~~I=1~Iti~ U:;.I ":':}i0\~~~t'~~~V~~~;:{if~;~~:;},:~{:j;;-" ,....' , , YONTZ, CHARLOTT'E:',Yfs 1'12I5\Z1 THE WOODLAND CENTE'R FOR NSG. 1~/08/~~ R4~72155 CHARGE SEND PAYMENT TO: NEIGHBORCARE PHARMACY PO BOX 2/Zl34 '7 LEH!GH V~LLEV p~ lB002-03~7 Please Return This Portion O( Your Bill With Your P~ymcnt DESCRIPTION LEVOXYL (LEVOr.INE> 0.1MG TAB (RP:SYNTHROID ** (100MCG)) DAYS SUPPLY: 28 NDC: 00689-1110-01 SUCRALFATf (CARAFATE) lGM TABLET (RP~CARAFATE--) DAYS SUPPLY: 2B NDC: 51079-0871~20 DEPAKOTE 125MG TP.BLET DAYS SUPPLY: 28 NDC: 00074-c212-1~ FUROSEMIDE 2Q1,~r8:~~,~:B1?t;:'€',I''I,;tq~p.: LAS! X) D A V S SUP Pt{~:"~2e~:"~:~~';.'I:~;!'NDC::~:':~/'5"1'-0.7 '3 -00 72 - 2 QI CELEX A * .&" '" 'l(I'''(;~~.;~~..\~8.~.~.~.''r:TiA.'\.Ji,);!~;~;i'\.~.:I: ;~i~dl~I\'~'~; ",).1...".;::-,: ,f.. ~:\':I.I";,,l,,~:~.r.,:\.,;, DAYS S~ ~JIi' ,,'~~:.~S;f*"'~DG.":::~'~\~.,f~~~.'~~0. 20-53 METOP R ,,~rJ8:~E f~* ~~F.~,@G~ij~f'i~F - T AB } ( RP : ' ' SO m~~W,:AJ~'~ . l'fi tt;:~~'>'::~~:;~t, DRYS" ,Pl~= ~~~~ (f:jD@ iW3i1a:;-~t~~2-"1 ZYPRE 4...~.~M~dfA,~L~l ~Wj :~I~ ~~ ~~":}~~;:;! DAYS . PL'I: c.B lr,'~ tfu~: ..12l:iZl002.:..4:1,,1'2-E.0 LANOXIN (DIGOXIN) 0. 125MG TABLET DAYS SuPPLY: 28 NDC: 0~173~0242-5c DURAGESIC (FENTANYL) (25MCG/HR) ADH. PATCH DRYS SUPPLY: 1 NDC: 50458-0033-05 + * ~ CONTINUED ON NEXT PAGE * * * leJ/l?lS/r2l0 R4072165 CHARGE 10/08/00 R407f~ 1 '.35 CHARGE 10/08/\l10 R40'35298 CHARGE 10/08/00- R41089QI5 CHARGE 10/lZt8/QlQI R41Ql8928 CHARGE 10/08/tZll2l R4112757 CHARGE 1l2l/QlB/tZJ0 R4114931 CHARGE 10/0'3/00 R4119362 CHRRGE r.IIT''''~iiin "Mel-HI ...; 9.83 I I ,86. 85 23 10':] 84 42.27 11 5- ~.6 5 12.E.3 8 8.00 21 1(?;3.'34 '+ S~04 1 15.112\ 8alanoe fOlWIlNl AMOUNTbuE 1- """OM :;o~:~~r ' , 'ij1N ft\ NeiahborCare>W -l H".~" Ch.... I I . (Nor tIO I Po,.,o" r'oo ~~ '::' ~.", /:,,:\~::::;', l.'.'J I I 1 L.L I~V. '-+'-+J VL/ VO V.l.l4 . VJ . '. . ~ 'NeighborCare'. 11) - oJ I Cr\L 11\Jicl r\CL-UV t::J\. T LU-, I H^ . ~U606 ( 1 U ( ( f-l~Gt. 11 . STATEMENT OF ACCOUNT -===. 7010 SNOWDRIFT ROAD SUITE 1 PLlENTOWN PA 181e.S , - ~', , \','F,~(~he'~c=.~~unfof",I, ' . ." '".'. ,'\. '..1,' '._1 of YONTZ, CHARLOTTE 115 1~50 THE WOODLAND CENTER FOR NSG. BB8-SE;5-f,708 BILLING DATE~ 11/28/00 AMOUNT PAID Customer No, 34838 CHARLOTTE YONTZ (115-1050) C/O CINDY SHEARER 891 OLD SIVER SPRING RD MECHANICSBURG, PA 17055 DuRAGESIC (FENTANYL) (25MCG/HR) ADH. PATCH DAYS SUPPLY: 15 NDC: 50458-0033-05 K-LYTE/CL CITRUS 25MEQ TABLET EFF DAYS SUPPLY: 2 NDC: 00087-~7c6-41 PHENERGAN ****** 12.5MG TABLET DAYS SUPPLY: 5 NDC: 000~8-0019-01 DURAGESIC (~ENTANYL) (25MCG/HR) ADH. PAT CH ,~~,j~'~I#'iI'J::~fi$F)':')~I:::"":r.,r,;;,.. , DAY S SUP P L YII;:e::;:,\;l0:\1!1.1'~;;~;~::;:~~Db'~!]~::g045B-QJ QJ 33 - 05 FUROSEMI.~~~.t~~~~~~~M~g~~~~RB~~9~;X) D A YS SUP (j1;"~~,rJ~,~~,,,.!y:tJ:~,""" A-h "ND' C::;':"~~~0~., d~0''''7 ';:0 - -;:. ,"J. ,.l"~, I",_~,lll\~y' .....~lk -....,,,.; I ',;;J\I,'" It) I;:. ....~l ~''l.""uY''''J'' ""'"1' lir"1' ,,",V~:[J~,',J~. ""', ('" ~'I,t~ ,1~lCII' ". I,' 'Y:'P.J\ PRILOS~g.}:~g,~~G~~r~~~f9L:,~: i:f~~. i~r.11\~~" ~ ".', OqyS ,Lt~~!BPL Y: C.\S':~~0,~t ~PC1:; ~~l,~6 .~:l~~2-31 LEVOXI'1~~.i~iLEP10X;1N:N~.:~:'.1:~~ el;::fu.,., M,(? t~~'.~B::!~ g,~. .':.l;1.1.!"".~" (RP ~....v.~'''IIll.~RO:;{D *~~I;I;.L;( 1 O\I~MC \' ';' " ,~}i .:,~'ii' '1'\11 ~' '-1, \:,\:\\ fit' "\"9 "Jf:. ~~ , ':/11 DAYS ,\', . PPL Y: 1:;;.8 ~,~,_,~1J. wvCt:, I 0b8'3- ft4llJ,0-01 SUCRALFATE (CARAFATE) 1GM TABLET (RP:CARAFATE--) DAYS SUPPLY: 28 NDC: 51QJ79-0871~20 MEiOPROLOL TARTRAiE ** 5~MG (HALF-TAB) (RP:LOPRESSOR) DAYS SUPPLY: 28 NDC: 00378-0032-01 * * * CONTINUED ON NEXT PAGE + * * .;:I~iI~:I.::m63 :II DATE 10/09/00 R4119392 CHARGE 10/11/00 R4122217 CHARGE 10/25/~fl, R414350f1i CHARGE lrt/25/f30 R4142251 CHARGE 11/02/00' R4095298 CHARGE 11/05/00 R4072150 CHARGE 11/06/0e. R4072156 CHARGE 11/lZlE../01Zl R40721E.5 CHARGE 11/05/00 R41!Zl8928 CHARGE SEND PAYMENT TG= NEIGYBORCARE PHARMACY PC BOX 20347 LEHIGH VALLEY PA 180~2-0347 PI1)8Se Retum This Portion Of Your Bill With Your P9ymen/ DeSCRIPTION [.lINO~i..' AMOUNT " 5 64.52 f, ,11. 25 E, 5. 44 10 125.13 4. JA 48 184.35 25 9-03 90 72~20 25 16. 73 I I r 6eJanclI folWllorO New Char06B Paymen!8 A~E r-; n...no;;c Ch"'(S1Q~ I OJ(~I \~t,If*r:;'f:':', , .. . :0-( 30 ~ "~~~~': ',\~:: .:;I~.~'>~ ,I '\'1' ' ~ NeiahborCare'Y "Over 60 V~~',;~ D01~ I \, :.-J..'"'' . I...., I\4V.............0 VL...../ VV Vi.1......... .VJ . ~"NeighborCare'. 1 U . V I LI 'L... 1 I "lU I 'L"-../LJ U LI \. I L.L.."-../ . STATEMENT OF ACCOUNT 701~ SNOWDRIFT ROAD SUITE 1 ~LLENTOWN PA lBl~5 885--S65~S708 '~.';~~,~:\', ::."~~:~.~~r~,'0~;~'~~:\~' I YONTZ~ CHAR~OTTE~if5 1050 THE ~OODLANO CENTER FOR NSG_ BIL~I~G DATE: 11/28/00 AMOUNT PAID Customer No. 3<+838 CHARLOTTE YONTZ <115~10S0) cia CINDY SHEARER 891 OLD SIvER SPRING RD MECHANICSBURG, PA 17~55 SEND PAYME;-n 10: NEIGHB02CARE PHRRMACV PO EOX 2121347 ~EHIGH VALLEY PH 18002-03~7 OXY-IR (IMMEDIATE RELEASE OXYCODONE) 5MG CAPSUL.E DAYS SUPPLY: 2 NDC= 59011-0201-10 .LORAZEPAM 0.SMG TABLET (RP:~TIUAN) DAYS SUPPLY: ~ NDC: 51079-0417-21 FUROSEMIDE 2~MG TRBLET (RP:LASIX} DAYS SUPPLY: 7 NDC: 51079-~~72-20 LANOXIN (DIGOXIN) 0. 125MG TABLET DAYS SUPPLY: ~':fj;;~I~;;;:~~lND,C,~..lZIfZl173-0242-56 <t ,!'fi' :;I,,:~t:'\~:'I:{/~(::.';,:,'j~':'\~~~!~'k ~ ~' . , SU B TOT R I R X ,/rfJ., w.::?1:1'~)ii:I.'\;l.)\\~I~"f,,~J,i~":;,t:~:~'::., ; . I..- -'" 'l':l.'d",-,.~{~~t, I, "},t'\I'''I'''~,I,.,,,..,, I'. &.~~' )~~""',"',,,"'~' 1:.I:I:';,en:\~;~..t'..'::. . :.""';~:" ASP r R I N ~;{~' ':' ft.";. '" . " ~l:~:1{)RENS-.....oR.AN~:E*,:l:****'*** ~,g .. , . "." l:l:' I IF.J'1 ,~.~" .I:lli.,"t., 81 MG .' " if. ~~ '~i!~~'!:~i~I'Y'~i;:'~~;;';;::\ DAYS L Y: '1i i,I'~:I:'1 ~D~: ~~S'356~,2'812i0-tll'3 OR I L Y' T. I Inl DOWJ lJ , .~.~l. M~~~:N ~~ ~b BL rif ff^',~l~ DAYS . . P~~8 ..:,1 ~D~ ~I; 't'~;'l~~].~.3~01 OVSTf, ELL C~Lwg1!ttM215'41lltvro:, TABLE:[r.~1 (RP:OS-CAL S0QJ) DAYS SUPPLY: 28 NDC= ~0904-1883-Gl ACETAMINOPHEN 32SMG TABLET (RP:TYLENOL} DAYS SUPPLY: 28 NOC: 51079-0002-20 ,CERDVITE WI MrNER~LS **** TABLET (RP:CENTRUM) DAYS SUPPLY: 28 NDC: 0053E-3442-38 * * '* CONTINUED ON NEXT P~GE * * * El:l~~;I::m8j=ll ,T. :J DATE 11/13/00 R4171321 ,CHARGE 11/14/0e. R417330~ CHARGE 11/17/00 R417B327 CHARGE 11/17/~0 R4178223 CHARGE ~8/11/00 R3342730 CHARGE 08/11/00 R3942792 CHARGf ~8/11/00 R3942818 CHARGE 0B/l1/00 R3942B42 CHARG~ 08/11/00 R4045954 CH~RGE a.~I~n~ ~O<Wllrd NQw CtlQr'\)Il!; Pleas$ Rerum This Portion 01 YOV( 8ill With Your Payment O~$eRIPTION AMOUNT .' ' [.lll.:HU..... 30 13.38 20 ,16.70 --5 3,,33 -4 2.95 2832. 18 27 0. 1.8 28 1-55 57 0-18 ,-,c c....J 1.59 .-. ,.. ~o 1. 39 FlnanCt'l Ch;>I'QO': Paymen18 AMolJNT DU~ I I I I Current (MirSQ , ':Oy,er Bll ~r." ,:,f' " ~~!:!i\;)i{f:.;., ,<.','" ,'. i.t",'" :\- 'J""', ~ 1.'.11. ;J, ~ N~iahbarl~rp.~ I~V.~~0 VC-J\JO V.1. .1.-4-VV . ~ NeighborCarew IlJ -.,:) I CT\L 11\J\.::i r\C~UVC.r\. J LLl" I H^ - ~VbOb { 1 V { ( r'HGt. 1.5 . STATEMENT OF ACCOUNT 712110 SNOWDRIFT ROAD SUITE 1 ALLENTOWN PA 1810~ 888-565-671218 ,"FQr::~~'e,:~f~.o~j,tof ..../. "_,:",:,,,. l", , I.. YONTZ, CHARLO"fTE" 115 105121 THE WOODLAND CENTER FOR NSG_ BILLING DATE~ 11/28/0.0 AMOUNT PAID Customer No. 34838 CHARLOTTE YONTZ (11S-10S0) C/O CINDY SHEARER 891 OLD SIVER SPRING RD MEC~ANICSBURG, PA 17055 DATE ~~bi~;j:m~;i a:4;.l 08/17/00 R3942732 CHARGE 08/2'3/00 R394279lZ1 CHARGE 08/2S/012l R4045954 CHr:1RGE 08/2'3/\210 R4,tZlEA 7 45 CHARGE ~8J29JeJ(L! R~Q;tS474B CHP.RGE 08/2'3/00 R40E.4751 CHARGE 09/01/lZl0 R4Q172135 CHARGE .09/01/00 R4072143 CHARGE 09/01/00 R40722eJl CHARGE * * * CONTINUED ON NEXT PAGE SEND PAYMENT TO: NEIGHBORCARE PHARMACY PO BOX 20347 LEHIGH VALLEY PA 18002-0347 Pfen:;o Al}tum Thi::; Portion Of Your Bill With Your Payment DESCRIPT.ON AMOUNT I.I'H~IIU'~ DAILY MULTIPLE VITAMIN-- TABLET DAYS SUPPLY: 28 NDC: 57480-0203-01 ASPIRIN CRSR) CHILDRENS ORANGE********* 81MG TAB CHEW DAYS SUPPLY: 28 NDC: 55955-2800-09 CEROVITE WI MINER~lS **** TABLET (RP:CENTRUM) DAYS SUPPLY: 29 NDC: 0053~-3442-3a ASP I R I N ORANG~~,::,1,~:.M~ll2,~&.~'~~;:~JS.~~W ( RP : ASP I R r N (ASA) CH I L~~~NS\~!~'O:RB~GEjf.'~'~:W;'~l*** j '1.'111 ./. 'I"~, /;:"""'"".1,1 ". ,', ;:;t~\l~I'II", '~.'" ,.,:,:"t.,..}~::r;:", t ", I "'. DAYS SURP.~M'I,:I~t::,'~2&i:I,~:~r': ~Num=~'I'~e3,:Z39:;:-025Ql- 3121 CAL C I UM "~~:G~gm.S,#~,P$r";if'tt1~::::S~0IM1s~~:miABLET 1~I~mt"'.J '~WI.""m,',~1:,,::\f';':\:" r;/o', ~~r. ''',l~!',',:',t'':t!'i~l''1Ii~~t!'\ ( RP : O~~,t,:.;filt~J60171~Ki~II~";!~'~.,J ~~~, f;';'; ~~;1{~~~'~1 ~\.,'~.~!i;,;t; ~'~,r15'''''''' ~ "'I~".f\':],,:.:I ~... ~.I.\;,:~", ~i~ '",I~I,II DAYS1~~~\I)~L Y; ~'e.::ll~~~I;! \@S~,~ ~~~~ 739::!.10i]l!':~0-~ 1 ACEYA r!\"I\l'SPH~N :p~5M., G iH~Ei;:r.'h~ (;RR:t: :'\~~.ENOL) DAYS!"I~QilipL~~ ,@B 11'\~;i;; I'JDC~ )i;37.uZ9.-J~0~-Q11 ASP I R\',Jf4m~~~S~;) ftH I'~~R~Ns.~~~ArlGE:1J~~I~*il-** 81MG TAB CHEW DAYS SUPPLY: 7 NDC; 553S6-2800-03 DAILY MULTIPLE VITAMIN-- TABLET DAYS SUPPLY: 7 NDC: 57480-0203-~1 DOCUSATE SODIUM 100MG CAPSULE (RP:COLACE) DAYS SUPPLY~ 7 NDC~ S1079-0~19-01 '* * * 12 llJ-c5 14 .0.09 113 ~.B9 Ill. ll~ 34 2.69 24 1. Sl 2 121.01 7 0.3'3 21 2.39 i I I A~~. ""'~-- I a.l~noe Forward AMOUNT 6bE I N_ COw_ " 130 :tm;t~:,{::. , ~ NeiahborCare'w . l~: IP'~~ L..,~...i .....'~ On.Y't..' ;,'.'>'.,,' . . 'Il:,~:>~:'~?',.~ _ '. " '.Over 60 I .1.L.L I\4V .~~v VL./ VV V..1...1.~ .VV . ~ 'NeighborCare'- .1. U . V I LI '..L.. .1. I \4U I \.L\.JLJ U LI \. I L..L...v . STATEMENT OF ACCOUNT 7010 SNOWDRIFT ROAD SUITE 1 ALLENTOWN PA 181~S 888-555-&708 . .. . . :::I~r'" "':F~'~;"~7:~;t@Q:~~~:"1J\:lt:~:'. . VONTZ~ CHARLOTTE:';~15105~ lHE WOODLAND 'CENTER FOR NSG. BILLING DATE: 11/28!~~ AMOUNT PAID Customor No. 34838 CHARLOTTE YONTZ (115-1050) C/O CINDY SHEARER B91 O~D SIVER SPRING RD MECH~NrCSBURG, PA 17055 SEND PAY:r1EN: TO: NEIGHBORCARE PHnRMACY PO BOX 20347 LE~rG~ VALLEY PA 18002-0347 09/01/00 R4072205 CHARGE . FERATAB (SUB FOR FERROUS SULFATE/FES04 324MG/32SMG) 300MG TABLET DAYS SUPPLY: 7 NDC: 0~245-~053-01 FERATAB (SUB FOR FERROUS SULFATE/FES04 324MG/325MG) 300MG TABLET DAYS SUPPLY: 28 NDC: 00245-0~53-01 DOCUSATE sonIUM 10~MG CAPSuLE (RP:COLACE) DAYS . SUPPLY: ,;;;::,~.. ';fir!,~~.;i:':~Pl~;'~I",,\\63739-~089-01 ASP 1 R I N ORA~Gg~:t,' ~l.:'~G:::~'.i.a.e..~:~.t'CB:E:.~ ( RP : ASP I R I N ( RSA. ) . C ';l't~"':' ~~'13b~~G.8~~~'*:*~f; **) .,.'.;: 'j'J11.rl.~.. ~ ..........I:.;.,t;, ,. 11'i"~'}: DAYS S. l" ~"'.,~;:lj~,.'-"NG'f;~~:"6~7.3.:9I'.'025Ql-3~ DRILY:' '. ~~.:. '1~.~,~hM~l.'.I'NS"I':I' ~~""','~.''''lclE~ij;<.':'\RP: DA IL Y , ' . :klf ,~"'~ ~t ~,.I'l"\:'\ '''~'~\'('t MUL T T ,I, ';:-;-) ~, v~~~ ~\~~.I(~,!, . .,~,'l~ ,-,. .5.~ l't'f.~ "'.1) (l. DAYS 'PL:ml: flg8 11 ~D~J~ ~~~37B~~~~~~B-12l1 F~RAT SU~l FiQR ~fF\~8~~ ~~~tt~lil'~~ES04 ~24f1 .. sMT5) ~00MG 1\J.HjE.~\1 ~.)f,~. DAY~"'SUPPLY: 28 NOC: 00245-0053-~1 .DOCUSATE SODIUM 10~MG CAPSULE (RP:COLRCE) DAYS SUPPLY: 28 NDC: ~3729-00a9-01 ASPIRIN ORANGE 81MG TAB CHEW (RP:ASPIRIN '(ASAr"~HILDRENS ORANGE*********) DAYS SUPPLY: 28 NDC: 63739-0250~30 * * * CONTI~UED ON NEXT PAGE * * * DATE .:t~ii=t:l::m-I=II .~';.l 1Zl'3/08/01l1 R4072205 . .CHARGE 12l9/e.B/Q)Q; R4074372 CHARGE 09/08/tJJfl:, R4074372 CHARGE QJ9/08h~0 R4074374 CHARGE 10./08/0.0. R4Ql72212lS CHARGE 10/08/00 .R4074372 CHARGE 10/08/0121 R4074373 CHARGE 1""_ F~~ I N_ Ow~, fr~~>:' ; ;..... ~.(.,:{::..., .; r'j(). ~1:/~'i~1~\111"::::.' . ::;"t~i~ ,':'J:,I', ..:I.~il "~\'''' "~'\}}"'::::" ls~. ,(.,..1",. . ~ NeiahborCare'M P/eE!.$(J Retum Tnis Portion Of Your BI/I With Your P:Jymcnt DESCRIPTION AMOUNT (.ll"H"~I'. 21 1-37 'J-=' .......... , 1.50 23 2.62 8. IllS Sl 0..j.j ~Cl I ~ 5- 14 80 '3. 13 24 1. 11 AMOUtJltl DUE ] I ""M~ c-".",.. IP~- _ J ~~- --=J I :~(60 1.,.',':\.; .:1,,:,'1("1,,: ..,"'." I....V .. .......................J VL-/ VU ..l.t - v ( . ~. NeighborCare'. 1 U . ---> I Lr,L 1 J'lJU r\.CL-UVCr\. I LLL- rH^. ~VOOO ( .tV ( ( r'Hl:lt=. 1::::> . STATEMENT OF ACCOUNT. 7010 SNOWORIFT ROAD SUITE 1 ALLENTOWN PA 18106 888-565-670B YONTi~ CHARLOTTE 115 1~50 THE WOODLAND CENTER FOR NSG. BILLING DRTE: 11/26/00 AMOUNT PAID Customer No. 34838 CH~RLOTTE YONTZ (115-1050) C/O CINDY SHEARER 89l OLD SIVER SPRING RD MECHANICSBURG, PA 17055 DATE .;l~;I~:l~n~=II ~~:.l ":I\~ .(' Fortna. accorio'tof ' ." ,';t ' 'r.',~--'-"'~:'I'...I."'." 10/~B/00 R4074374 CHARGE 10/08/00 R4145301 CHARGE 11/03/0~ R4157301 CHARGE .11/03/00 R4157903 CHARGE 11/0E/00 R4~74372 CHARGE 07J14/~0 R4007445 CREDIT 07/14/0~ R4007447 CREDIT 07/14/00 R4007451 CREDIT SEND PAYMENT TO: NEIGHBORCARE PHARMACy PO BOX 20347 LEHIGH VALLEY PA lB002-0347 PIOi1$H Return This PortIon Of Your Bill W/rh Your Pnym~nt P~SCRIPTlON DRILY MULTIPLE VJI~MINS TABLET (RP:DHILY MULTIPLE VITAMIN--) DAYS SUPPLY: 28. NDC: 63739-0068-01 OYST-CAL-D 500 **** 500MG TABLET (RP:OS-CAL 500+0) DAYS SUPPLY: 28 NDC: 00182-443'3-10 MILK OF MAGNESIA LIQUID DAYS SUPPLV~ 2 NDC: 00121-0431-30 SKIN-PREP WIPg,e~q;~r:t;~,~ ;~~I'r:i'~h:I"'" DAYS SUPP~':1 ,1\", 'I v\,. 'T'le:~:M:99'999-9'399-99 DOCUS A TE , tI ',.,,' :"&~:t~:R~~'I:mJ;q,~.~ .,.~~'~' "'"'- ~:I""V""'I.\I"~,, ( RP - CO ,<h'G ,.;,. ,....-.....:.::;.I'f.l~,..t;I':"!'.~I,ir~ t~. .. ; 1lil""'''''I''~ f'l "j ;fJj.nJI\W~l1:I.lI-,. 'l\l'II'~I., DAYS I,' , :.1' ~DGr: '.~b~I~~~~&8'3-01 ;:)> " ~l ~~1!'>' SUt:~-.":"[AL OTe . ~~,:,li ';I\r 'Nfl. ~ hl';T ~1I~ '~ ~.I.\ \~ ~g~ :r~ f.\ll 'I' ~\~; ~r,~ .,~ 8m"; BTOTAII\~':"(\:~""HARGES ,uJ' r~ ~I.',',l " ;\'JI, j,~.'!, lu.-g;",...t. .",) ,il:~:i :lll7 ~::,. ~ '. ZOLOFT 50MG TABLE1 DAYS SUPPLY: 28 NDC= ~0049-4300-41 CIPRO (CIPROFLOXACIN) 500MG TABLET DAYS SUPPLY: 28 NDC: 0~02b-8513-48 PREDNISONE lMG TABLET DAYSS~PPLY: 28 NDC: ~0054-8739-25 * * * CdNTINUED ON NEXT PAGE ** * &lance Fcrwatd NllW Ctlarg91l ~;'~~~~';I~:~~~,>\ ' .\,~\,1ii'l;\.I".'''I''\'' " i:';t!~~+,~Y0;:g::':' <.', ;OiietSQ r ~;?~t.%?;l:',?~ '.' ,\,.,.1,.,\,1". ',!>I,l..,.!,:'" e. NeiahborCare~ (..lIH~Hl~ AMOUNT 312J L 0'3 16 . 0. 37 (;lZ1 0.90 Si2I 7.85 66 7.53 5B.E.5 2890.83 ~18 -39~3Ql -3 -10.8eJ -25 -121.77 PlIYmunls AMOUNT DUE I Hn'1noo Chargea I 'Over60 ,~i.~{~:~", ~~~~ I .1 L...L . 'IV . ~"""-t-' VL/ VO V.L.L~. VO " '. . ~ "NeighborCare'. 1 U .-=> I CKL 11\J1.:l KCL,.UVCK r LLG IH^.~V()O(){lV{{ r-'~Gt. 10 . STATEMENT OF ACCOUNT 7010 SNOWDRIFT ROAD SUITE 1 QlLENTOWN PA 18105 888-56S-57iZ8 . i(,!o.~t,fs:rt!k\'W,'t~~t':';>F'. YONTZ, CHARLOTTE"'11S 1050 THE WOODLAND CENTER ,FOR NSG. B!LLING DATE: 11/28/00 AMOUNT PAID Customer No. 34838 CHARLOTTE YONTZ (115-1~S~) C/O CINDY SHEARER agl OLD SIVER SPRING RD MECHANICSBURG, PA 17055 -HL ..1=f;f=t-19n1.~ .T~ t'-'~ 07/14/0~ R4007453 CREDIT 07/14/00 R4007457 CREDIT 09/08/00 R4080786 CREDIT 09/09/00 R4072150 RETURN 09/09/00 R4072214 RETURN 11/06/00 R4156529 CREDIT 11/05/~0 R41G6634, CREDIT 11/09/00R41b6525 CREDIT SE~O PAYMENT TO: NEIGHBORCARE PH~RMRCY PO BOX 20347 LEHIGH VALLEY PA 18002-0347 P/tJ85f' Return ThJs Portion Of Your B/II Wilh Your PHyment DESCRIPTION :',<:};'ROPO XYPHENE NAPSYlA TE WITH '~ACETAMINOPHEN 100MG/650MG TABLET (RP:DARVOCET N-10ill) DAYS SUPPLY: 28 NDC: 51073-0322-20 'PROPOXVPHENE NAPSVLATE WITH ACETAMINOPHEN 10~MG/650MG TABLET (RP:DARVOCET N-100) DAYS SUPPLY: 28 NDC: 51079-0322-20 ARICEPT (DONEP,~'~~}!:1~Ji:~1.*~~'~j" TAB DAYS SUPPL-.Vd~~~.:a\~'~~~':I;lSl~,~K1D' :~( l;~ '2856-0246-41 PR I LOSEC '0;\d~~!Bgp$~m:~"" f:':~;'I: "J : '~~:l/;.':m,,!t"'- .I\.(.~, o ISP: I\f.: 't't)l?l'<,~fl'''.'NEit;:~ '0 ''8kl~,0? 42-31 ~. 11 ~I~ I j~. ~\ ) I 11\~'II't:'1q " CA RD I Z ~. A.eS~~ ~- '1~(.'~1!':~I', DIS 7Q11 j ~DC~:' 0fl8~1!%S6-4'3 \ ~ I' . "( \'!Il DEPAK 1 asM~T~ ,l ,\' M~ . ,~: I; t~ t~~r~i DAYS p~- ~~8 ~l r~~ ~ ,u0f074~~~~2-11 , ZYPRE -"'* Mt:',lli "'1 ,11:!ft 1iil:n ,~.j,,,~~1 " ... ~ l,;J,I/i!li.' H . '1' , ~"M;!' " DAYS SUPPLY: 28 NDC: QJ00e2-4112-o121 'CEL;EXA"*** 20MG (HALF-TAB) DAYS SUPPLY: 28 NDC: 00456-4~2~-63 SUBTOTAL RX 'I I,'" rK- * * CaNT I NUED ON NE;X'T PAGE *,~~i,.,:..' IlIIlce Forwara ~~T~f~,:';i'/ mt:\ NeighborCare" 'i(.-....'. l J"~O ~~ [.~~. "l lit'tlO...., "',' , ,,6-, " , ~, .1. If .., . \- _ _ ' j'r""i ''''r\.....' (i~\;;~i~::~~:: .' ,'~r90DeYII . h;t'll.",,'( I _, .......v '1/. . "~11r~.~~~r\," :' ~"""'"'' ': . ,~,:~j:":",;~,, '" ~y" ~'I;M;" "","'.'.', :.',~'/1 ".~'.i I .:', " '".:" r;\IT'~~ii.(~ AMOUNT -lS -1 . 50 -:.:,. -0.82 -'3 -3G.25 ~14.91 -4.68 -18 -3.(;1 -33 -15S.01 -5 -7.85 -27(;.51 AMOUNT DUE I . ~' NeighborCare'M .lU"-JILI'L.!I'<U "LvUVLI" L..L..v I Hf\' OVOUO ( .l V ( ( rHuL .l ( . STATEMENT OF ACCOUNT 7010 SNOWDRIFT ROAD SUITE 1 AL~ENTOWN PA 18106 8BB-565-6708 . ':Fo'r';:ttie 'B:ccountof ", ',,;""1,"_ _:.':' I:,.:'.~,~".: . ,r, ,. ,'I;. " YONTZ, CHARLOTTE' 115 1050 THE WOODLAND CENTER FOR NSGM BILLING DATE: 11/28/00 AMOUNT PAID Customer No. 3J~838 CHARLOTTE YONTZ (115-10S~1 C/O CINDY SHEARER 891 OLD SIVER SPRING RD MECHANICSBURG, PR 17055 DATE .:l::til::(:l~~[e.l=- 10/08/0~ R4119634 CREDIT 10/08/00 R4119b25 CREDIT 10/08/0~ R4119633 CREDIT 11/05/00 R~1bGb24 CREDIT 11/05/00 R416cb27 CREDIT 11/05/00 R41b6632 CREDIT SEND PAYMENT TO: NEIGHBORCARE PHARMACY PO BOX 20347 LEHIGH VALLEY PA lB002-0347 P/tJlJse Retum Th/:; Portion 01 Your Bifl With Your Payment DESCRIPTION OYST-CAL-D 5~0 **** 5~~MG TABLET <RP:OS-CAL 500+D) D~YS SUPPLY: 28 NDC: 001B2-4439~2b CEROVITE WI MINERALS **** TABL~T (RP:CENTRUM) DAYS SUPPLY: 28 NOC: ~053b-3442-38 ACETAMINOPHEN 325MG TABLET (RP:TYLENOL) DAYS SUPPLY: 28 NDC: 51~73-0002-2~ ASPIRIN O~~NG~~~~.~~~~.A"~~.:T~ EW (RP:ASPIRIN (ASA) CHI~~;~~t:-:I91.\j:O~'At)l,GE*~; "I ;ltl+~4) .. 1....'1' l"t., 1~~'\"i...~\lrll;'\lf 'f'\I';l>jl;I~/j/~.~~I\ 'I\,! .' ~.",'~~ DAYS SUP,P, '.\ ", :"1"~'~8; 1>')" ~ '~NlJU' .' g,@.>:-0250-30 DRILY Mu~~r~~~~~'~t:&~AmrNS~ ~~~t~RP:DAILV I").,r,."',,,,l\IJr';t "~~Ii.~:'II. ~~'~ ~~,r'~~ liI'.'~~r~"~~~*'lt~. ~~~~ Ij~~~~~;: ~~~~~f) ~p "~.,:l~ :~~;~~~/~(~68-01 o YS. T -~~~i:n S:00:]j~tlt;>;~'4 ~.0 ',~G? ~AB~E "~Ji1.~, '"( ~, .i~ ~~~llj'!J' lIt "E:~I' (RP: ~~i~~tLI~?~~tD.'r~il' i~ d"~\:~. ~ trl'. ~ ).J~j~1J.;: DAYS ~1S~~~L Y: '2'S II '~J;; ND .f:: rSZ:"'''f:4iS9-26 SUBTOTAL GTe SUBTOTAL CREDITS l.ljl'~""Mlr1 AMOUNT , -12 -0.70 -4 _ -0. 2Ql -19 -1. 21 -15 -0. E.'3 ~1fl -Q1.36 -13 -0M76 -3.92 -28flJ. 43 N_ Ct1ar~d -..- B..hmco Fl)(W~rd R""rlC9 CI1artl68 ',P~"'fT'Q"U; 4120144 2610M40 0-~Q) ~. . ~f~?i~;;{;)::: \'. ~:~:.~: ~~A,.<<:{L:;;"::,,,';.;,2610~ 4eJ , I..~: ,I"i~ ~fr'~' .',J. . ".'.".,,' :', , (30 f'!i~.~;il:i~ ':" h~J~';'t;\. .' ~"I :'\ :,., 0100 DR. CLEM CICCARELLI PHARMACY NABP: 3959244 FOR PATIENT : YONTZ, CHARLOTTE CUSTOMER TYPE: PRIVATE ~ Neighb'o'C~'~: 00J AMOUNT QUE 673eL 84 \~'~i~"~):'l' :.'IIJr.)I,.,:;:"" '''; ill..\I:J_'\Y,y',',: '\: :~;J:}~(r'~:{" ': ., , 3533.34 ;w;~T 587.10 115 1050 MONDAY - FRIDAY 8:30 AM - 5:~~ PM EST . . IN THE COURT OF COMMON PLEAS YORK COUNTY, PENNSYLVANIA Woodland Center for Nursing 780 Woodland Avenue Lewisberry, P A 17339 , ,p (\';( ~/7S~/rC51 tL 61) (~ 0--~. ~ () r;r-- 0--' Plaintiff, v. CIVIL COMPLAINT NO. Ms. Charlotte Yontz, decedent 891 Old Silver Spring Road Mechanicsburg, P A 17055 Ms. Cynthia Shearer, 891 Old Silver Spring Road Mechanicsburg, P A 17055 personally and as attorney in fact for Charlotte Yontz, decedent I<E(:,TZM~fJ MAY 0 5 2001 'B: y' -- ~.;:::;:::-._-===----- Defendants, Type of Pleading: COMPLAINT Filed on behalf of: Plaintiff Counsel of Record: JONATHAN C. JAMES, Esquire Identification No. 68214 CAPOZZI & ASSOCIATES, P.C. 2933 North Front Street Harrisburg, P A 17110-1250 Telephone: [717] 233 -4101 [877] 855-0846 [toll free in P A] -'r::' S~~) ::~~~.j S"?" .d. ('J _:~.... r. 1 (-~ .~ t..-:::, c::::":> - ~) 1 ">.l ) ! - - ; ','U "'1 ."J ,',- ::! 'i< r"rJ :,0 ,) ./::"" ,:"j W ,.:) ~,..," " . . NOTICE TO DEFEND You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after the complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief requested by the plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Lawyer Referral Service of the York County Bar Association York County Bar Center 137 East Market Street York, Pennsylvania 17401 Telephone No. (717) 854- 8755 A VISO Le han demandado a usted en la corte. Si usted quiere defenderse de estas de estas demandas expuestas an las paginas signientes, usted tiene veinte (20) dias de plazo al partir de ia fecha de la demanda y ia notificacion. Hace falta asentar una comparencia escrita 0 en persona 0 con un abogado y entregar a la corte en forma escrita sus defensas 0 sus objeciones alas demandas en contra de su persona. Sea avisado que si usted no se defiende, Ie corte tomara medidas y puede continuar la demanda en contra suya sin previo aviso 0 notificacion. Ademas, la corte puede decidir a favor del demandante y requiere que usted cumpla con todas las provisiones de est a demanda. U sted puede perder dinero 0 sus propiedades u ostros derechos importantes para usted. LLEVE EST A DEMANDA A UN ABOGADO INMEDIA T AMENTE, SI NO TIENE ABOGADO 0 SI NO TIENE EL DINERO SUFICIENTE DE P AGAR TAL SERVICIO. V A Y A EN PERSONA 0 LLAME POR TELEFONO A LA OFICINA CUY A DIRECCION SE ENCUENTRA ESCRIT A ABAJO PARA A VERIGUAR DONDE SE PUEDE CONSEGUIR ASISTENCIA LEGAL. Lawyer Referral Service of the York County Bar Association York County Bar Center 137 East Market Street York, Pennsylvania 17401 Telephone No. (717) 854- 8755 2 . . IN THE COURT OF COMMON PLEAS YORK COUNTY, PENNSYLVANIA Woodland Center for Nursing 780 Woodland Avenue Lewisberry, P A 17339 Plaintiff, v. CIVIL COMPLAINT NO. Ms. Charlotte Yontz, decedent 891 Old Silver Spring Road Mechanicsburg, P A 17055 Ms. Cynthia Shearer, 891 Old Silver Spring Road Mechanicsburg, P A 17055 personally and as attorney in fact for Charlotte Yontz, decedent Defendants, COMPLAINT AND NOW, comes Plaintiff, Woodland Center for Nursing, 780 Woodland Avenue, Lewisberry, Pennsylvania 17339 by and through its attorneys, Capozzi & Associates, P.C., and avers as follows: 1. Plaintiff, Woodland Center for Nursing, (Woodland), provides long term care and skilled nursing services; Plaintiff is located at 780 Woodland Avenue, Lewisberry, P A 17339, York County. 2. Defendant, Cynthia Shearer is an adult individual residing at 891 Old Silver Spring Road, Mechanicsburg, P A 17055. 3. Defendant Charlotte Yontz, deceased, was an adult individual who last resided at the Plaintiffs nursing facility located at 780 Woodland Avenue, Lewisberry, P A 17339, York County. 3 . . 4. On information and belief Cynthia Shearer is the daughter of Charlotte Yontz. COUNT 1- BREACH OF CONTRACT 5. Plaintiff hereby incorporates ~~ 1 through 04 of the Complaint as if set forth in full. 6. On or about 22 December 1999 the Defendants requested Woodland admit Charlotte Yontz to the facility so she could receive nursing care and services. 7. On or about 22 December 1999 Woodland admitted Charlotte Yontz to the nursing facility. 8. On or about 22 December 1999, Plaintiff and Defendants executed a contract for nursing care and services in which the Plaintiff represented a promise to provide nursing care and services to Charlotte Yontz and Charlotte Yontz represented a promise to pay for the nursing care and services rendered. 9. Plaintiff rendered nursing care and services to Charlotte Yontz for the duration of her stay at Plaintiff Woodland's nursing facility. 10. Each month, Woodland invoiced Charlotte Yontz for the nursing care and services rendered. 11. Each month, Charlotte Yontz would refuse to pay the invoices in full. 12. Due to Charlotte Yontz's refusal to remit payment in full each month for the nursing care and services rendered to her by the Plaintiff, the account for Charlotte Yontz is in arrears in the amount of $36,916.50 (thirty- six thousand, nine hundred sixteen). 13. Woodland has been damaged by Charlotte Yontz's breach of the contract for nursing care and services. 4 . . 14. Cynthia Shearer is the attorney in fact for Charlotte Yontz and at all times material to this lawsuit did represent herself to the staff and administration of Woodland as the attorney in fact for Charlotte Yontz. 15. On information and belief, Cynthia Shearer had access to the assets and income of Charlotte Yontz, including, but not limited to, on information and belief, her bank account, her checking account, her social security and pension checks, her home and her car. 16. Each month Cynthia Shearer would be copied on the monthly invoice detailing the nursing care and services provided to Charlotte Yontz. 17. Cynthia Shearer has refused to use the income and assets of Charlotte Yontz to pay for the nursing care and services provided to Charlotte Yontz by the Plaintiff. 18. Cynthia Shearer, in refusing to use the income and assets of Charlotte Yontz to pay for the nursing care and services provided to Charlotte Yontz by the Plaintiff has breached the contract. 19. Cynthia Shearer, in refusing to use the income and assets of Charlotte Yontz to pay for the nursing care and services provided to Charlotte Yontz by the Plaintiff has damaged the Plaintiff. WHEREFORE, Plaintiff respectfully requests that this honorable Court enter an Order as follows: a. Granting judgment for Plaintiff and against Defendants in the amount of at least $36,916.50, exclusive of interest and costs; b. Granting Plaintiff its expenses, including reasonable attorney fees incurred in connection with this action; and c. Granting such other relief as the Court deems appropriate. COUNT 2- BREACH OF IMPLIED CONTRACT 5 . . 20. Plaintiff hereby incorporates ~~ 1 through 19 of the COlnplaint as if set forth in full. 21. On or about 22 December 1999 the Defendants requested Plaintiff Woodland admit Charlotte Yontz to the facility so she could receive nursing care and servIces. 22. On or about 22 December 1999 Plaintiff Woodland admitted Charlotte Yontz to the nursing facility. 23. On or about 22 December 1999, pursuant to a request for nursing care and services made to the Plaintiffby Charlotte Yontz and Cynthia Shearer, Plaintiff promised to render nursing care and services to Charlotte Yontz provided Charlotte Yontz pay for the services. 24. On or about 22 December 1999 Defendants represented a promise to pay for the nursing care and services rendered. 25. Plaintiff did render nursing care and services to Charlotte Yontz for the duration of her stay at Plaintiff Woodland's nursing facility. 26. Plaintiff and Defendants have an implied contract for the provision of nursing care and servi ces. WHEREFORE, Plaintiff respectfully requests that this honorable Court enter an Order as follows: a. Granting judgment for Plaintiff and against Defendants in the amount of at least $36,916.50, exclusive of interest and costs; b. Granting Plaintiff its expenses, including reasonable attorney fees incurred in connection with this action; and c. Granting such other relief as the Court deems appropriate. 6 . . COUNT 3- QUANTUM MERUIT 27. Plaintiff hereby incorporates ~~ I through 26 of the Complaint as if set forth in full. 28. At the request of Defendants, Plaintiff Woodland provided Charlotte Yontz with nursing care and services. 29. Defendants knew or should have known that Plaintiff Woodland expected payment for providing Charlotte Yontz with nursing care and services. 30. Plaintiff Woodland had a reasonable expectation of payment for provision of nursing care and services. 31. Defendants refused to pay for the nursing care and services provided to Charlotte Yontz. 32. Defendants were unjustly and unconscionably enriched through Defendants' use of Plaintiff Woodland's nursing care and services without providing Plaintiff Woodland with proper and agreed upon payment. WHEREFORE, Plaintiff respectfully requests that this honorable Court enter an Order as follows: a. Granting judgment for Plaintiff and against Defendants in the amount of at least $36,916.50, exclusive of interest and costs; b. Granting Plaintiff its expenses, including reasonable attorney fees incurred in connection with this action; and c. Granting such other relief as the Court deems appropriate. COUNT 4- BREACH OF FIDUCIARY DUTY Cynthia Shearer 33. Plaintiff hereby incorporates ~~ 1 through 32 of the Complaint as if set forth in full. 7 . . 34. Pa. C.S.A. section 5601 (e) states that an agent acting under a power of attorney has a fiduciary relationship with the principal. 35. On information and belief, Cynthia Shearer did at all times relevant and material hereto hold herself out as the attorney in fact for Charlotte Yontz. 36. On information and belief Cynthia Shearer specifically represented herself to the staff and administration of Woodland as the attorney in fact for Charlotte Yontz. 37. On information and belief Cynthia Shearer specifically represented to the staff and administration of Woodland that the staff and administration of Woodland were entirely justified in relying upon her to act as the attorney in fact for Charlotte Yontz. 38. On information and belief, Cynthia Shearer specifically represented to the staff and administration of Woodland that she would use the income and assets of Charlotte Yontz to pay for her nursing care and services. 39. On information and belief, the income and assets of Charlotte Yontz were at all times relevant and material hereto accessed and controlled by Cynthia Shearer. 40. As the attorney in fact for Charlotte Yontz, Cynthia Shearer had a fiduciary duty to act in Charlotte Yontz's best interests. 41. As the attorney in fact for Charlotte Yontz, Cynthia Shearer had a fiduciary duty to use Charlotte Yontz's income and assets to serve her best interests. 42. On information and belief Cynthia Shearer refused to make the income and assets of Charlotte Yontz available to Woodland to pay for her nursing care and servIces. 8 ~ ' . . 43. Cynthia Shearer violated her fiduciary duty to Charlotte Yontz by refusing to use her income and assets to pay for her nursing care and services. 44. As a result of Cynthia Shearer's violation of her fiduciary duty to Charlotte Yontz, Plaintiff has not been paid for the nursing care and services rendered to Charlotte Yontz. 45. Woodland has been damaged by Cynthia Shearer's violation of her fiduciary duty to Charlotte Yontz. \VHEREFORE, Plaintiff respectfully requests that this honorable Court enter an Order as follows: a. Granting judgment for Plaintiff and against Defendant in the amount of at least $36,916.50, exclusive of interest and costs; b. Granting Plaintiff its expenses, including reasonable attorney fees incurred in connection with this action; c. Directing Defendant Cynthia Shearer to produce an accounting of the property of Charlotte Yontz and d. Granting such other relief as the Court deems appropriate. COUNT 5- ACTION IN ASSUMPSIT-DUTY TO SUPPORT Cynthia Shearer 46. Plaintiff hereby incorporates ~~ 1 through 45 of the Complaint as if set forth in full. 47. As the nursing facility providing Charlotte Yontz with nursing care and services, Woodland had a legal duty to provide care, maintenance and assistance to her. 48. Charlotte Yontz's' average monthly expenses incurred at Plaintiff Woodland's nursing facility are three thousand nine hundred dollars ($3,900.00). 49. Charlotte Yontz's reasonable monthly living expenses incurred at Woodland significantly exceeded her monthly income. 9 . . 50. The monthly income of Charlotte Yontz at all times material and relevant to this action was insufficient to adequately provide for her care, maintenance and support. 51. Upon information and belief, Cynthia Shearer had at all times material and relevant to this action, sufficient financial ability to pay for Charlotte Yontz's maintenance and support. 52. Title 62 of the Pennsylvania Statutes Section 1973, et. seq., requires children and spouses with sufficient financial ability to pay for the care and maintenance of their indigent parents, and to provide their parents with financial assistance. 53. Charlotte Yontz is "indigent" within the meaning of Title 62 Section 1973. WHEREFORE, Plaintiff respectfully requests that this honorable Court enter an Order as follows: a. Granting judgment for Plaintiff and against Defendant Cynthia Shearer in an amount to be determined by the court upon reasonable investigation into the Defendant's ability to pay; b. Granting Plaintiff its expenses, including reasonable attorney fees incurred in connection with this action; and c. Granting such other relief as the Court deems appropriate. Respectfully submitted, CAPO~SSOC1 - '----------. JO THAN C. JAMES, sq 're 1denf lcation No. 68214 OZZ1 AND ASSOCIATES, P.C. 2933 North Front Street Harrisburg, P A 1 711 0 (717) 233- 4101 Attorneys for Plaintiff Date: ,S-"-- 0 2.~.. L OJ \. 10 . , . . IN THE COURT OF COMlVION PLEAS YORK COUNTY, PENNSYLVANIA Woodland Center for Nursing 780 Woodland Avenue Lewisberry, P A 17339 Plaintiff, v. CIVIL COMPLAINT NO. Ms. Charlotte Yontz, decedent 891 Old Silver Spring Road Mechanicsburg, P A 17055 Ms. Cynthia Shearer, 891 Old Silver Spring Road Mechanicsburg, P A 17055 personally and as attorney in fact for Charlotte Yontz, decedent Defendants, VERIFICATION I, Jonathan C. James, counsel for the Plaintiff, do hereby verify that the facts stated in the foregoing Complaint are true and correct to the best of my knowledge, information and belief. This verification is being made by counsel because no authorized representative of the Plaintiff is available to make this verification. Counsel will substitute a verification of an authorized representative of Plaintiff as soon as it becomes available. This verification is made pursuant to Pa.R.C.P. 1024 and is based on interview, conferences, reports, and records in the file. I understand that false statements herein are made subject to the penalties of 18 Pa. C. S. 94904 relating to on sworn falsification to authorities. 11 'J · . . IN THE COURT OF COMMON PLEAS YORK COUNTY, PENNSYLVANIA Woodland Center for Nursing 780 Woodland Avenue Lewisberry, P A 17339 Plaintiff, v. CIVIL COMPLAINT NO. Ms. Charlotte Yontz, decedent 891 Old Silver Spring Road Mechanicsburg, P A 17055 Ms. Cynthia Shearer, 891 Old Silver Spring Road Mechanicsburg, P A 17055 personally and as attorney in fact for Charlotte Yontz, decedent Defendants, CERTIFICATE OF SERVICE I certifY I am serving a copy of the above captioned Complaint upon the persons and in the manner indicated: Service by process server, pursuant to the Pennsylvania Rules of Civil Procedure, hand delivered to the address below. Ms. Cynthia Shearer, 891 Old Silver Spring Road Mechanicsburg, P A 17055 Date: :.r /U L - l-Od , I ( .- ~ J?~AiHAN C. JAMES, Esqu' e -.....Tdentification No. 68214 CAPOZZI AND ASSOCIATES, P.C. 2933 North Front Street Harrisburg, PAl 711 0 (717) 233- 4101 Attorney for Plaintiff 12 REV.1513 EX + (1.97) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CHARIDTrE I. YONTZ FILE NUMBER 21-01-00069 RELA TIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 1. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. daughter Cynthia A. Shearer 100% 891 Old Silver Spring Road Mechanicsburg, PA 17055 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. NONE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. '. TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $0.00 (If more space is needed, insert additional sheets of the same size) Vb -c2CJ;2. - /y COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 ~.. HARRISBURG. PA 17128-0601 ~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX SAMUEL LANDES 525 N 12TH ST LEMOYNE DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 11-05-2001 YONTZ 11-26-2000 21 01-0069 CUMBERLAND 101 REY-1547 EX AFP 112-00) CHARLOTTE I Amount Remitted PA 17043 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV = iS4j-ix--AFP--ci"2"=OOY-NCifici--oF-YtiHEifiTANCE-i'-Ajr"A-ppR"A-isiMENT-,--ALi-oWAN-ci-OR-------- --- - - - --- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF YONTZ CHARLOTTE I FILE NO. 21 01-0069 ACN 101 DATE 11-05-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 6,448.73 .00 12,905.06 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 7,544.87 54.256.53 (1ll (12) (13) (14) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 19,353.79 61 801 40 42,447.61- .00 42,447.61- NOTE: 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. If an assessment was issued previously, lines reflect figures that include the total of ALL ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: .00 X 00 = .00 X 045 = .00 X 12 = .00 X 15 = (19)= (15) (16) (17) (18) .00 .00 .00 .00 .00 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE fOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ~ " Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 10/08/2002 CYNTHIA A SHEARER 891 OLD SILVER SPRING ROAD MECHANICSBURG, PA 17055 RE: Estate of YONTZ CHARLOTTE I File Number: 2001-00069 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 will become delinquent on: 11/26/2002 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, i)~~H:b~4~L7j/fi MARY C. LEWIS ~# REGISTER OF WILLS i7 cc: .J File Counsel Judge ". [, /01\ , STATUS REPORT UNDER RULE 6.12 Name of Decedent: CHA-~Lo~ ..:r Y (}fvj:C Date of Death: Nov, 010 I 2voo Will No. Admin. No. 2,001 - DOOb9 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 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: Al IA' t 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)( b. The separate Orphans' Court No. (if any) for the personal representative's account is: ~/fi c. Did the personal representative state an account informally to the parties in interest? Yes X No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the :::::o~(ze?~r:hans' Court and maY~be ~~~~. S1gn e ~ S /1-(\(\ ~ L L. ,A N D E-..s Name (Please type or print) S ZS- N. I?. -fL.. sfI<.e.eA- Leo 1"'Vl () 'f tVc ~/1 J 70 'f.1 Address ( 711 ) 7 b ( S 3 hI Te 1. No. Capacity: Personal Representative ~caunsel for personal representative (MAH:rmf/AM3)