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HomeMy WebLinkAbout10-26-06 15056041125 REV-1500 ~( (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number PO BOX 280601 2 1 0 7 1 0 1 7 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Socal Security Number Date of Death Date of Birth 1 6 2 2 2 4 5 6 4 1 0 1 9 2 0 0 7 0 5 3 1 1 9 2 8 Decedent's Last Name Suffuc Decedent's First Name MI E I S E N B E R G ER B E V E R L Y J (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS Q 1.Original Retum ~ 2. Supplemental Retum ~ 3. Remainder Retum (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of 0 5. Federal Estate Tax Retum Required death after 12-12-82) QX 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUIL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number H A R O L D S I R W I N I I I 7 1 7 2 4 3 6 0 9 0 F' N f IRn ame (I Applicable) I RW I N LA W O F F I C E First line of address 6 4 S O U T H P I T T S T R E E T Second line of address City or Post Office C A R L I S L E State ZIP Code REGISTER OF LS USE ONL'j :~ ~ c:~ r - --i .~ ;;~ c~~ !,-~ - 'n ;~ - ' ~,. .,_ DATE-FILED P A 1 7 0 1 3 Correspondent's e-mail address: irwinlawoffice@gmail.com Under penalties of perjury, I dedare that I have examined th's return, inducting accompanying schedules and statements, and to the fleet of my knowledge and it is true, correct and complete. Dedaration of preparer otller than the personal representative is based on all information of which preparer has any knowledge. .C- ~1, r~~ {'~ ~: ~ ~::;) c::~~ _l~ ~,y j i-~'r°a _.I _ra <, ~ - rj SIGNATU~~OF P~RSC~N RESPO~ISJBLE Fr~1R FILING RETURN ADDRESS° 182 ATT CIRCLE DOVER PA 17315 SIG E REPRESENTATNE l~ T AD E 64 SOUTH PITT TREE CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 15056041125 15056041125 J 15056042126 REV-1500 EX Decedent's Social Security Number Decedent's Name: BEVERLY J. EISENBERGER 1 6 2 2 2 4 5 5 4 RECAPITULATION 1. Real estate (Schedule A 1. 0 0 0 2. Stocks and Bonds (Schedule B) ........ .......................... 2. 0 0 0 3. Closely Hekl Corporation, Partnership orSole-Proprietorship (Schedule C) ..... 3. 0 0 0 4. Mortgages & Notes Receivable (Schedule Dj ................... ..... 4. 0 0 0 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .. ..... 5. 4 6 5 5 8 5 6. Jointty Owned Property (Schedule F) ^ Separate Billing Requested .. ..... 6. 7. Inter-V'rvos Transfers & Misoellaneou~ N n-Probate Property (Schedule G) b S t 0 0 0 epara e Billing Requested ... .... 7. 8. Total Gross Assets (total Lines 1-7) ........................... 8. 4 6 5 5 8 5 9. Funeral Expenses 8~ Administrative Costs (Schedule H) ............ 9. .... 2 1 1 0 0 0 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ........ .... 10. 3 2 6 8 3 0 9 11. Total Deductions (total Lines 9 8~ 10) ....................... .... 11. 3 4 7 9 3 0 9 12. Net Value of Estate (Line 8 minus Line 11) ..................... .... 12. - 3 0 1 3 7 2 4 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .............. .... 13. 0 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) .............. .... 14. - 3 0 1 3 7 2 4 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2)x.o _ 0 0 0 15. 0 0 0 16. Amount of Line 14 taxable at lineal rate X •045 0 0 0 16. 0 0 0 17. Amount of Line 14 taxable 0 0 0 at sibling rate X .12 17, 0 0 0 18. Amount of Line 14 taxable 0 0 0 at collateral rate X .15 18 0 0 0 19. Tax Due ................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0 0 0 Y Y sides 15056042126 15056042126 REV-1500 FCC Page 3 Decedent's Complete Address: DECEDENTS NAME BEVERLI~ J. ElSENBEROER STREETADDRESS 1100 GRANDON WAIT CITY STATE Zlp MECNANIC3BUR0 PA 17050 Tax Payments and Credits: 1 • Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty ifapplicable D. Interest E. Penalty 4. 5. ff Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. ff Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (5) 0 00 (5A) (SB) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transfemed : ...........................................:.......................... ^ b. retain the right to designate who shall use the property transferred or its income; .....:......................... ^ c. retain a reversionary interest; or .................................................... ............................ ............. d. receive the promise for life of either payments, benefits or care? 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? .......:............................................................................... ^ © . 3. Did decedent own an "in Dust for' or payable upon death bank account or security at his or her death? ......... ^ Q 4. Did decedent own an Individual Retirement Account, annu'Ity, or other non-probate property which contains a beneficlary designation? .................................................................................................. ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994 and before January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates ~ death on or after January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even ff the surviving spouse is the only beneficlary. For dates of death on or after July 1,2000: The tax rate imposed on the net value of transfers from a deceased chVd iwlsnty-ond years of age or younger at death to or for the use of a natural parent an ' adoptive parent, or a stepparent of the child is zero (0) percent (72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal t~eneficlaries is four and one-half (4.5} percent, except as noted in. 72 P.S. §9116(1.2) (72 P.S. §9116(x)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent (72 P.S. §9116(a)(1.3j]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 0.00 Fite Number 101 Total Credits (A + B + C) (2) .0.00 Total InterestlPenalty (D + E ) (3) 0.00 (4) coo -~.~ i ~~. REV-1502 EX + (&98) 'A~ CONMIAONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE `°' ^' ` yr FILE NUMBER BEVERLII' J. E1sENBEROER ~p~~ All real propeRy owned eol~t or ae a bnaM in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a wilting seller, rmither being compelled fA buy or sell, both having reasonable krwwledge of fhe relevant fads. Real ro which k -owned with ht of survivorehi must be dkclo:ed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. NONE 000 y I y ~ y TOTAL Also enter online 1, Reca 'tulation S 0.00 REV-1503 EX + (8-98) COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS 8t B©NDS ca ~Ar c vr• FILE NUMBER BEVEI[Ll~ J, EISENBERQER 1017 All properly 1oiMlyo~ with right of survivorship must be dleclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. NONE 0.00 . ~` a TOTAL (Also enter on line 2, Recapitulation) I s O 00 ~ sncieta of fha cnmo aixl ,~ REV-1504 EX + (8-98) COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER BEVERLI/ J. E1sENBEROER 1017 Schedule G1 or G2 (induding all supporting information) must be altadred for each closely-held corporstion/paMership interest of the decedent, other than a sole-proprietorship. See instructions for the supponting information to be submiaedforsole-proprietorships. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. NONE 0.00 ~ Y TOTAL (Also enter on line 3, Recapitulation) ~ s O 00 (If more space is needed, insert additional sheets of the same steel REV-1507 EX t (8-88) CONNNONYVEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT SCHED~/LE D MORTGAGES & NOTES RECEIVABLE w ~ ~+~ ~ yr FILE NUfMBER BEVERLI~ J. EISENBEROER ~p~~ All property joirttly~oMmed with the right of survivorship must be dtscloaed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. NONE 0.00 y TOTAL Also enter on line 4, Recapitulation s 000 Of more soaoe Ls needed. insert additional sFweha of tAa same ci~e1 REV-1508 EX + (egg) St~lki~'1~l~1'C-!~ G COMMONWEALTH OF PENNSYLVANIA CASH, BANIK DEPOSITS, ~ MISC. IN RESIDENT DE EN RN PERSp~IAL PROPERTY CED ESTATE OF FILE NUMBER BEVERLI~ J. EISENBERGER 1017 Indude >he proceeds of litigation and the date the proceeds were received by the estate, All property jointly-owned with ht of survivorship must be discbsed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. PNARMERICA 180 40 Refund 2. M d T BANK 2,284.11 Chec%!ng Account Balance See Exh/b/t "B" 3. CUNA M!/TlIAL GROUP 2900 Reflood 4. US TREASURI~ 1,782.90 Income Tax Refund 5. PSECU 113.44 Checking Ac~unt Ba/ancs See Exb/b/t "C" TOTAL (Also enter on line 5, Recapitulation) I s (If more space is needed, insert additional sheets of the same size) REV-1509 EX + (6.98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDl1LE F . JOINTLY-OWNED PROPERTY jai n ~ ~ yr FILE NUMBER BEVERLI~ J. EISENBERGER 1017 H an asset was made joint within one year of the decedeM'a date of death, it must be reported on Schedule G. SURVMNG JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A• NONE ~ ~ B C JOINTLY-OYYNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTERES7 1. A. ^ ~ e TOTAL (Also enter on line 6, Recapitulation) I S (If more space is needed, ir~'t additional sheets of the same size) REV-1510 EX + (8-98) • , SCHEDULE G INTER•VIVOS TRANSFERS & COMMONWEALTH OF PENNSYLVANIA INHERITANCETAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER BEVERLI~ J. E13ENBER6ER 1017 This sdtedule must be completed and tiled ff the answer to any of questions 1lhrough 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM "~u'°Ens""~°F"~rau,TM°RSa''n°'re"Proo~c~+T^wo DATE OF DEATH 960FDECD'S EXCLUSION TAXABLE NUMBER TMEO"TEOF "n~+"'~+'0F'"E°EE°'~rsr~xwT"t~. VALUE OFASSET INTEREST 1. NONE oFA VALUE 000 0.00 TOTAL Also enter on line 7 Reca itulation ~; p pp (If more space b needed, insert additional sheets of the same size) REV 1511 EX + (12-89) ' SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES ~ IN ~ RN ADMINIStRATIVE COSTS RES D NT DECEDENT ESTATE OF FILE NUMBER aEVERLr ~. EISEN9ERGER >r0>r~ Debts of decedent moat be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: ~, Personal Representative's Commissions Name of Personal Representative (s) Sodal Security Number(syEIN Number of Personal Representative(s) SfiaetAddress Ctiy State Zip Year(s) Commission Paid: Q, Altomey Fees IRN//N LAW OFFICE X000 00 3. Fampy Exemption: (K decedents address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. pate Fees CUMBERLAND COUNTI~ REGISTER OF WILLS 80.00 5 Accountant's Fees 6. Tax Retum Preparer's Fees 7. CUMBERLAND COlINTI~ REGISTER OF WILL$ - FIIe Inventory and Appra/semenlt 30.00 TOTAL (Also enter on line 9, Recapitulation) ~ S (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (12-03) SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE'. LIABILITIES ~ LIENS RESIDENT DECEDENT ~ ESTATE OF FILE NUMBER BEVERLY J. EISENBER~iER 1017 Report debts incurred by the decederrt prior to death which remained unpaid as of the date of death, inciuding unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESICRIPTION OF DEATH 1. WEST SHORE MERGENCI~ MEDICAL !,393.98 Medlca/ BNIs 2. METRO MED SERVICE 120 90 Medlca/ Bill 3, NEW BLOOMI:/ELD EMS TRANSPORT INC. 108,00 Medlca/ Blll 4. NEIGHBORCARE - 1~ORK !,267,85 Med/cal BIII 5. SUSQUEHANNA TOWNSHIP EMS INC. YO ~ Medlca/ BIII 6. QUANT!/M /MAO/NQ & THERAPEUTIC ASSpIC/AYES 3.74 Med/ca/ BIN 7, PENNS]~I.VANIA STATE EMPLOYEES CREDl1' UNION 3,966 72 Credk Card Balance ~ EAST PENNSBORO AMBULANCE SERVICE, NC. ~~ Medlca/ BIII 9 CLAREMONT NRSA/NO AND REHABILITATION CENTER 25,75690 NursMg Nome Balance Due See Exblbk °D° Y TOTAL (Also enter on line 10, Recapitulation) ; ,,,, ee~ ,,,, (If more space is needed, insgft additional sheets of the same size) REV-1513 EX + (9.00) COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES es7a7e of FILE NUMBER BEVERLI~ J. EI3ENBEROER 101T RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PF~QPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS (indude oufig ~ spousal d~butbns, transfers undue Sea. 9116 a 1.2 1. DALE L MASTERS L/neal 1325 Wyatt Grrrle 100% Res/due Dover, PA 17315 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABpI1JE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. NONE 0.00 I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS I 1. NONE 0.00 ~ e s TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBIf1TIONS ON LINE 11 OF REV-1500 COVER SHEET ' = 0.00 (If more space is needed, in "additional sheen of the same size) s EXHIBIT "A" 1 f1 __ I LAST WILL AND 'I TESTAMENT I, BEVERLY J. EISENBERG R, of 104 Hill, Cumberland County, Pennsylva pia, do her my last will and testament, hereby r~ oking all Drive, Apartment 6, Camp make, publish and declare this to be s heretofore made by me. 1. I direct my personal rep'r'esentative to pay all of my debts, funeral and administrative expenses as soon as convenient fter my decease. I direct that all inheritance taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property, vl~,hether or not such property passes under this Will, shall be paid by my personal represd~htative out f my estate. 2. I authorize and empow~r my peroo and/or personalty owned by me at m~ death and herein, at public or private sale or saps and to gi bills of sale therefore, in fee simple, ~~ I could do authorized and empowered to engage in any bu; death, for such period of time after m~ death as ; ral representative to sell any realty not specifically devised or bequeathed re good and sufficient deeds and/or if living. My representative is in which I may be engaged at my expedient to said representative. 3. I give, devise and bequ~bth all of my estate of whatever nature and wherever situate to my daughter, Dal' L. Master . 4. I nominate and appoint r~,y daughter representative of my estate, to serve r~Yithout bonc then I appoint my sister Ruby McCartN~y to be the also without bond. I 5. I suggest that my persor~~l represen Irwin, III, Carlisle, Pennsylvania in the'~ettlement ~ Dale L. Masters, to be the personal . If she cannot or does not serve, substitute personal representative, retain the services of Harold S. my estate. X~~3~ Y a ,Q, 4 ~• IN WITNESS WHEREOF, I have hereunt~ set my hand and seal this 23~d day of March, 2001. '~, (SEAL) BEVER Y J. EISENBERGER Signed, sealed, published and'I,declared b the above-named person as and for a last will and testament, in our presen' e, who at aid person's request, in said person's presence and in the presence of each other hav hereunto set our names as subscribing witnesses. .S4 WE, BEVERLY J. EISENBE ER, RHO DA S. IRWIN and HEATHER A. BARBOUR, the testatrix and witness s respecti ely, whose names are signed to the foregoing instrument, being first duly worn, doh reby declare to the undersigned authority that the testatrix signed and '~executed t e instrument as her last will and that she had signed willingly, and that sh ~I executed i as her free and voluntary act for the purpose herein expressed, and that Bch of the itnesses, in the presence and hearing of the testatrix, signed the will as a w mess and t at to the best of their knowledge the testatrix was, at that time, eighteen y ears of age r older, of sound mind and under no constraint or undue influence. 'ENT AND A g Fa'"~o'a"~ BEVERt~Y J. EISENBERGER ~ i /.1 ~ RHOND~p- S. COMMONWEALTH OF PENNSYLV NIA :ss: COUNTY OF CUMBERLAND Subscribed, sworn to and ack EISENBERGER the testatrix herein, RHONDA S. IRWIN and HEATHER 2001. A. BARBOUR wledged b fore me by BEVERLY J. d subscri ed and sworn to before me by ~ BARBOU ,witnesses, this 23~ day of March, Notarial Seal Harold S. Irwin III, Notary Public Carlisle eoro, Cumberland County My Commission Expires Sept. 23, 2002 Member : ~3n~ sy{ ~°=r a ~r9oC18t1on of Notaries ~/ `' Notary F iblic EXHIBIT ^B" ~ - -- - Ifl _. ~ - _. ~ M&T Bank ' ACCOUNT N0:` ACCOUNT TYPE 23541970 CLASSIC CHECKING 00 0 06123M NM I17 BEVERLY J EISENBER6ER C/0 MASTERS 1825 WYATT CIR DOVER PA 17315-3679 1111 OCCC1l1NT Sl1MMdRY :.~ t :k t ~~~o-~ ~~ ~___~i WEST SHORE PLAZA G ~/-LAMCE TS i . bTHER; ADDITItM1S CHECKS PAID H SU~~flAC'TIONS IN7.ERESt PD BALAMICI: NO. AMOUNT N0. ANOINT N0. AMOUNT ' 505.09 2 .,687.19 2,494.00 5 188. 6 0.00 509.72 eCC[111NT eCTTVTTV ;> ,. T BATE 'CRANSACT ON ESCRIPTI & OTHE Abp Q1tS HD R. Q H S ~~t11C# l.Y BA ANC 09-22-07 BEGINNING BALANCE 1505.09 09-24-07 ATM CASH MITHDRANAL ON 09/23 21.00 MUTZABAUGH. 3 FRIENDLY DR BUNCANNON PA 09-24-07 EFT SERVILE CHARGE 2.00 482.09 09-25-0 866-290-0505 INS PYMT 1.56 480.53 09-28-07 PA TREASURY DEPT ANNUITANT 1,782.19 2,262.72 10-03-07 US TREASURY 303 SOC SEC 905.00 3,167.72 10-05-07 CHECK NUMBER 6691 76.00 3,091.72 10-09-0 CHECK NUMBER 6690 2,218.00 10-09-07 CHECK NUMBER 6692 200.00 10-09-0 VERIZON ARC CHECK PYMT 000000000006693 94.00 579.72 10-22-07 MiT ATM CASH MITHDRANAL ON 10/20 70.00 DOVER2, 3995 CARLISLE ROAD, DOVER, PA 509.72 ENDING BALANCE 1509.72 -. ... ~HKCKS. PAID SSM1N14RY 6690 10-09-07 2,218.00 6691 10-05-07 76.00 6692 10-09-07 200.00 ,z.~ _~ ~: ,r =~ ~LQ(~A (B+D~ ` ee t EX BIT ~~ R~^~~ V PSE(~k June 1 ~, 2009 Irwin Law Office 64 South Pitt Street Cazlisle, PA 17013 Dear Mr. Irwin: Enclosed is a check, in the amount of 1113.44 the r Beverly J Eisenberger. These funds az being rele Enclosed is a Notice of Claim of Credi ~ rs on Ms. balance. pining funds in the account of to her Estate per your request. nberger's outstanding Visa If you have any questions feel free to Ontact me at (800) 237-7328 or (717) 234-8484 enter 6 then extension 3120. r -~ , ,Q-~c~c~ Myers t Advisor s Pennsylvania State Employees Credit Union Main Address l Credit Union P ace, Harrisburg, PA 1 71 1 0-2990 • 717.234.8484 • 800.237.7328 Mailing Address: P.O. B 67013, Harrisb rg, PA 1 71 06-701 3 • 717.777.2100 (TDD) • 800.472.1967 (TDD) pseeu.com This credit union is deralfy insured by the National Credit Union Administration. Equal Opportunity lender - - _ i ~ _ ~ ~~ _ T e EXHIBIT I"D" r ~ ~ I LA sHA &. cK ATTQ PLEASE REPLY TO: 1V1eChdrilCSburg WRITER'S E- MAIL: smontres®ldylaw.com Harold S. Irwin, III, Esq. ', Irwin law Office ', 64 S. Pitt Street ~ Carlisle, PA 17013 'I RE: Estate of Beverl Eise Y ' er er S Estate No. 21-2007-101 Claremont Nursing an !Rehabilita Our File No.:1028-08 I Dear Mr. Irwin: II' Please lae advised that we represent aremont 1` respect to the account of Beverly Eisenberge I. An outst unpaid on her account. Claremont had pre ously note of letter dated May 6, 2008. Please let me k ' w the stat convenience. Thank you for your attention to this after. Y~ ~AVIS YOHE ?NNA, P. C. IEYS AT LAW 5, 2i Center ursing and Rehabilitation Center with nding balance of $25,755.90 remains ied you of this outstanding balance by way ~.s of the estate at your earliest Ste n M. Mon esor cc: Viola Byerly, Business Office Manage ', 1700 Bent Creek Boulevard, Suite 140 • Mech ' icsburg, PA 170 0 • (717) 620-2424 • FAX (717) 620-2444 350 Eagleview Boulevazd, Suite 100 • Ex 'n, PA 19341 • ( 10) 524-8454 • FAX (610) 524-9383 3000 Atrium Way, Suite 251 • Mt. La k, NJ 08054 • (8 6) 231-5351 • FAX (856) 231-5341 171463 Maryland ~ephone: (410) 7 7-2810