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01-19-10 (2)
15056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Indivithial Taxes County Code Year File Number PO BOX 280601 ~-.--_~_.._....... INHERITANCE TAX RETURN '; 21 ~09 0506 Harrisburg, PA 17128-0601 RESIDENT DECEDENT , ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 178-16-4575 05/20/2009 03/16/1921 ;..___._.~,_._~~.~..._~_ ~ __.______...___.._~..~...w.._..__..._.~..: _______ Decedent's Last Name Suffix Decedent's First Name MI Harris ~ Alice lM (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI . None I ~.~~ _ _ __ ~ i ' .................. Spouse's Socal Security Number "~__"~.-.__"mm" THIS RETURN MUST BE FILED IN DUPLICATE WITH THE :_.__._.____._.m__.__..~~....~.~....~..__~_~_.~._._. REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW t'!~ 1. Original Retum 2. Supplemental Retum O 3. Remainder Retum (date of death prior to 12-13-82) C'~ 4. Limited Estate Ci 4a. Future Interest Compromise (date of CI 5. Federal Estate Tax Retum Required death after 12-12-82) C~3 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) C.::::"-'} 9. Litigation Proceeds Received t'~ 10. Spousal Poverty Credit (date of death t'~ 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 CONFIDENTIAL TAX INFORMATNNI 8HOULD BE DIRECTED TO: Name Daytime Telephone Number Michael Cherewka (717) 232701 Firm Name (If Applicable) -- ~ REGISTER OF WILLS US~NLY Law Offices of ~ n- ~ -- ~ First line of address ~ r:v~ o '~ ; [ ti --r C-~ ~ - ~ 624 North Front Street ~ ' ~~"' ~ -- ? .I7 W ~ Second line of address ( 1 ` ti1}' C r- t 7 - _, _ , 7 -> i ~ ~~ ~ ~ _ i E t ~ , ~` ~ _4 Gty or Post Office State ZIP Code DA LED ;Wormleysburg ~.___.~_ ~ _~.~ ..___.__..._._.__~~W_W___-_ ~ PA __.__ ;17043 _~.__ _ r~ Correspondent's e-mail address: Under penalties of perjury, I declare that I have examined this relum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preperer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF ERSON RESPONSIBLE FOR FILING RETURN DATE / ~// 2312 Yale Avenue, Camp Hill, PA 17011 SIGNA~F~i~~RF~C~T®ERdrH~ SENTATIVE DATE r//~/o ADDRESS "~ vv~- w -- 624 North Front Street, Wormleysburg, PA 17043 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 J 15056052059 REV 1500 EX Decedent's Social Security Number Alice M Harris ' ~ 178-16575 Decedent s Name: a RECAPITULATION 1. Real estate (Schedule A) ............................................. 1. ' 138,635.37 2. Stocks and Bonds (Schedule B) ....................................... 2. ' 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0.00 4. Mortgages 8 Notes Receivable (Schedule D) ............................. r 4. 3 0.00 5. Cash, Bank Deposits 8 Miscellaneous Personal Properly (Schedule E) ........ 5. ~ 3 108,771.57 ', 6. Jointly Owned Property (Schedule F) C~ Separate Billing Requested ....... 6. ~ 80,861.02 7. Inter-vvos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) t-7 Separate Billing Requested........ 7. ~ 0.00 ? 8. Total Gross Assets (total Lines 1-7) .................................... 8. ? 328,267.96 9. Funeral Expenses 8 Administrative Costs (Schedule H) ..................... 9. ; 25,122.68 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ................ 10.3 24,758.81 11. Total Deductions (total Lines 9 & 10) ................................... 11. 49,881.49 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. ~ 278,386.47 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. = 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. j 278,386.47 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 .0_ ~ 15. ', 0.00 16. Amount of Line 14 taxable ~"""""""""i -` ~'~"`" at lineal rate X .0 45 ~ 278,386.47 16, ' 12,527.39 17. Amount of Line 14 taxable "~~' ~ at sibling rate X .12 ~ i 17. 18. .,.-.,,.,,.,....,,.,-,.»,»,».,».»»_.~,._. Amount of line 14 taxable ~ ~ at collateral rate X .15 ~ ; 18. F 19. TAX DUE ......................................................... 19. 12,527.39 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 C 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: 21 09 0506 ~~ DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER Alice M Hams 178-16-4575 STREETADDRESS 2143 Yale Avenue CITY STATE ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InterestlPenalty if applicable D. Interest E. Penalty 11,000.00 578.93 0.00 0.00 (1) Total Credits (A + B + C) (2) Total Interest/Penalty (D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If 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. (3) (4) (5) (5A) (5B) 12,527.39 11,578.93 948.46 948.46 0.00 948.46 Make Check Payable to: REGISTER OF WILLS, AGENT ~» ~` :z.: 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 properly transferred :...................................................................................... .... ^ b. retain the right to designate who shall use the property transferred or its income : ........................................ .... ^ Q c. retain a reversionary interest; or ...................................................................................................................... .... ^ d. receive the promise for life of either payments, benefits or care? .................................................................. .... ^ 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? .......................................................................................................... .... ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .......... .... ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................... .... ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE 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 of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (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 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 beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) (72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedents siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)J. 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. REV-1502 EX+ (11-0$) ~~~' pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ALICE M. HARRIS 21-09-0506 All real property owned solely or as a tenant in wmmon 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 willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real properly that is jointlyrowned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedents interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1' 2143 Yale Avenue, Camp Hill, Cumberland County, Pennsylvania. Tax #01-22-0535-037 See HUD-1 attached 138,635.37 If more space is needed, insert additional sheets of the same size. D. NAME AND ADDRESS OF BORROWER: Martin W. Klingmeyer and Cobi M. Klingmeyer 2143 Yale Avenue Camp Hill, PA 17011 E. NAME AND ADDRESS OF SELLER: Estate of Alice M. Harris ~~. ~ ~ F. NAME AND ADDRESS OF LENDER: Metro Bank 3801 Paxton Street Harrisburg, PA 17111 G. PROPERTY LOCATION: 2143 Yale Avenue Camp Hill, PA 17011 H. SETTLEMENT AGENT: 25-1857112 Midstate Abstract Company I. SETTLEMENT DATE: October 27 2009 Cumberland County, Pennsylvania PLACE OF SETTLEMENT 2331 Market Street Camp Hill, PA 17011 , J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: 101, Contrail Sales Price 150 000.00 401. Contract Sales Price 150.000.04 142. Personal Pro 402. Personal Pro e 103. Settlement Char es to Borrower Line 1400 ~ 6138.28 403. 104, 404. 105. 405. Ad'ustments For Items Paid B Sailer in adva»Ce Ad'ustme»ts For !tams Paid B Seller in advance 106. C' !Town Taxes to 406. C' !Town Taxes to 107. Coun Taxes 10/27/09 to 01!01!10 130.'11 407. Coun Taxes 10/27/09 to 01!01!10 ( 130.11 108. School Taxes 10/27!09 to 07/01/10 707.92 408. School Taxes 10/27/09 to 07/01/10 707.92 109. 4th Qtr. Sewer 10/27/09 to 01/01!10 44.84 409. 4th Qtr. Sewer 10/27/09 to 01/01/10 3 44.84 110. 410. 111. 411. ~ 112. 412. , i24. GROSS AMOUNT DUE FROM BORROWER 157,021.15 424. GROSS AMOUNT DUE TO SELLER 150,882.87 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. De osit or earnest move 2 000.00 501. Excess De osit See Instructions 202. Princi al Amount of New Loans 147,283.00 502. Settlement Char es to Seiler Line 1400 12,247.50 203. Existin loans taken sub'eil to 503. Existin loans taken sub'eil to 204. 504. Payotf of first Mortgage 205. 505. Pa off of second Mort a e 206. 506. ! 207. 507. De osit disb. as roceeds 208. 50$. 209. I 509. ~ Ad'ustments For items U» aid 8 Seller Ad'ustme»ts For Items Un aid B Seller 210. C' /Town Taxes to 510. Ci /Town Taxes to 211. Coun Taxes to 511. Coun Taxes to 212. School Taxes to 512. School Taxes to ! 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. ~ 220. TOTAL PAID BY/FOR 80RROWER 149,283.00 520. TOTAL REDUCTION AMOUNT DUE SELLER f 12,247.50 300. CASH AT SETTLEMENT FROMlTO BORROWER: 600, CASH AT SETTLEMENT T0IFROM SELLER: 301. Gross Amoun# Due From Borrower Line 120 157 021.15 601. Gross Amount Due To Seller Line 420 150 882.87 302. Less Amounfi Paid 8 !For Borrower Line 220 ( 149 283.00 602. Less Reductions Due Seller Line 520 ( 12,247.50 303. CASH (X FROM) ( TO J BORROWER 7,738.15 603. CASH (X TO) { FROM) SELLER 138,fi35.37 The undersigned hereby acknowledge receipt of a completed copy of pages 182 of #his statement & any attachments referred to herein. Borrower Seller Martin W. Klingmeyer Estate of Alice M. Harris Cobi M. Klingmeyer 801. Loan Ori ination Fee 0.4244 % to Metro Bank `* 625.00 8Q2. Loan Discount % to 803. Appraisal Fee io Minnici Appraisal Services POC:B400.00 804. Credit Report to Equffax Mortgage Services 19.36; 805. Lender's Inspection Fee to 806. Mort a e Ins. A .Fee to 807. Assumption Fee to 08. Underwriting Fee to Metro Bank POC: L $410.00 809. Overnight Mail Fee to Unishippers POC: L $16.00 810. Flood Cert~cation Fee to Wolters Kluwer Financial Svcs. PCi POC: L $6.00 811. MFRS Assi nment Fee to MERS POC: L $6.95 800. ITEMS REQUIRED BY LENDER TO i3E PAID tN ADVANCE 901. Interest From 10!27109 to 11/01/09 @ $ 20.175804/day ( 5 days %) "* 100.8 902. Mort a e Insurance Premium for months to Metro Bank 2,533.13 903. Hazard Insurance Premium for 1.0 ears io State Faun Insurance 448.00 904. 945. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance 3.000 months $ 37.33 r month 111.99 1002. Mort a e Insurance months $ 65.90 r month 1403. Ci (town Taxes months $ r month 1004. Coun Taxes 14.000 months $ 59.96 r month 599.60 1005: School Taxes 5.000 months C~ $ 85.43 per month 427.15 1006. months $ r month 1007. months r month 1008. ate Ad'ustment months r month -590.58 1900. TITLE CHARGES 1101. Settlement or Closin fee to 1102. Abstract or Title Search to 1103. Title Examination to 1104. Title Insurance Binder to 1105. Electronic Document Pre . to Midstate Abstract Com an *' 50.00! 1106. Closin Service Letter to Midstate Abstract Com an "' 75.00' 1107. Attorney's Fees to includes above item numbers: ~ 1108. Title Insurance to MIDSTATE ABSTRACT *' 943.99 164.76; includes above item number51102 1103 8 1104 1109. Lender's Coverage $ 147,283.04 1110. Owner's Coverage $ 150,000.04 1,108.75 1111. Endorsements 1 0, 300, 8.1 to Midstate Abstract Company 150.00' 1112. Notary Fee to Midstate Abstract Company. 10.00: 1113. Notary Fee to Midstate Abstract Company 5.40 1114. Overnight Fees & Handling to Midstate Abstract Company *" 15.00 1115. rocessing Fee to R !MAX Realty Professionals `* 175.00 1116. Processing Fee to RElMAX Realty Professionals 1 1117. Tax Certification to Janet Miller, Tax Collector 1118. 4th Qtr. Sewer to Camp Hill Borough Authority 62.50 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 49.50; Mortgage $ 65.50; Releases $ `* 115.00 1202. Ci /Coun Tax/Stam s: Deed 1 500.00 • Mort a e 1 500.00 1203. State TaxJStam s: Deed 1,500.00; Mort a e 1,500.00 1204. 2009 Coun Borou h Taxes to anet Miller Tax Collector POC:S719.56 1205. 2009 School Taxes to Janet Miller, Tax Collector POC:S1046.12 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Surve to 1302. Pest Ins coon to Sudden Death Termite 8~ Pest Control 40.4Q 1303. Radon Test to TC5 industries 125.00 1304. Radon Miti ation to American Radon Solutions 700.00 1345. 1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103LSectfon J and 502, Section K 6,138.28 12,247.54 By signing page 1 of this statement, the slgnatorles acknoNAedge receipt of a completed copy of page 2 of thb two page statement. Midstate Abstract Company Settlement Agent Certified to be a true copy. REV-1503 EX+ (6-98) SCNEDVLE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ALICE M. HARRIS 21-09-0506 All property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1507 EX+ (6-98) SCNEDVLE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES &' cNOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER ALICE M. HARRIS 21-09-0506 All properly jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (6-98) SCNEDI~LE E COMMONWEALTH OF PENNSYLVANIA CASH BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT (If more space is needed, insert additional sheets of the same size) ~OV~1~Y1 BBIIk STATEMENT OF ACCOUNTS `~, Statement Period 05/01/09 TO 05131/09 1-877-SOV-BANK (1-877-768-2265) www.sovereignbank.com MONEY MARKET • '' ALICE M HARRIS ACCOU11t # 1054169624 Balances ~. <. ,.:- _~=~~i`-~`'..~.,~'' ~~urrectit~atal~~ ..'',fit z~" ~ '' ,; Deposits/Credits + $124.70 Average Daily Balance $102,146.87 ~ ~ . ~ H r ~ . '~fl`~(f ~_ ~ t~ Interest ~~ - . ~,. ¢~-. , ~.~ p~ 124.7G ~ "r..,,,.~t.,~ ~~~zP2tcentagA .Yield~Eame~ `~ ~~` ,~ ~ ~ ~` Sfi.~S9~ " ,'( ~-- Eamed~this Period $ 124.7+~0i Paid Last Year $1,463.83 ~ 1 - 8t~-rj "ikt~ x.. ~°~"`~~ ~ ~~ ,. t{_a' r~ 92.59 C "k~ F{ Y `~` L' t ' ~'~~~ it, ~ ~y 0 R ~~u'S "The interest earned and the interest paid may differ depending on when interest is credited to your account. Account Activity Date Description Additions Subtractions. Balance 05-01 Beginning Balance $102,146.87 05-31 Ending Balance $102,271.57 page 3 of 3 1054169624 REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY OWNED PROPERTY ESTATE OF FILE NUMBER ALICE M. HARRIS 21-09-0506 If an asset was made joint within one year of the decedent's date of death, R must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JDfNT TENANT DATE MADE JGINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTK)N AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JGINTLY•HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE DF DEATH W~LUE OF DECEDENTS INTEREST 1. A. 12/28173 M&T Bank Checking Account #40988198 30,103.38 50% 15,051.69 2. A. '. PNC Bank, Certificate of Deposit, account #000011020029203 10,000.00 500'' 5,000.00 3. A. PNC Bank, Certificate of Deposit, Account #000011020029204 10,000.00 S0%' 5,000.00 4. A. Bainbridge Securities, Inc. 9,888.10 50% 4,944.05 5. A. Sovereign Bank, Savings Account#2331030529 101,730.56 50% 50,865.28 TOTAL (Also enter on line 6, Recapitulation) 13 80,861.02 (If more space is needed, insert additional sheets of the same size) MBTBank 499 Mitchell Road, Millsboro, DE (9966 Mail Code DE-MB-12 Phone (888) 502-4349 Fax (302)934-2955 June 9, 2009 Law Offices of Michael Cherewka 624 North Front Street Wormleysburg, Pennsylvania 17043 Re: Estate of Alice M. Harris Social Security: 178-16-4575 Date of Death: May 20, 2009 Dear Sir or Madam: Per your inquiry dated June 3, 2009, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Checking Account Account Number 40988198 Ownership (Names oj~ Alice MHarris* Jane L Patrick* Opening Date 12/28/73 Balance on Date of Death $ 30,102.50 Accrued Interest $ 0.88 Total $ 30,103.38 Please be advised, there was no safe deposit box found for the above decedent. * If upon reviewing the information above, you believe there are additional accounts not referenced, please provide us with an account number and/or name of any possible joint account holder. For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, eta, please contact our West Shore Plana Office # 717-255-2271. Sincerely, ~~CG~, Tracie Hare Adjustment Services Certificate of Deposit Maturity Notice Certificate Number: Maturity/Renewal Date: Matu-7ty/Renewal Yalue: Renewal Investment: 919 ALICE M HARRIS JANE PATRICK 2143 YALE AVE CAMP HILL, PA 17011-5452 Dear Cttstoiner: PNCBANK 000011020029203 03/05/2009 $10,000.00 12 MONTHS FIXED RATE Thank you for uivesting in a PNC Bank Certificate of Deposit (CD). The CD shown above, will be maturing on 03/05/2009 with a value o f $10.000.00. A Certificate of Deposit is a sate and easy way to keep your savings growing at a guaranteed rate. ti'Ve'd like to see you continue that growth by reim~esting your fluids. However, if your needs have changed, or you want to explore other products or services to help you reach your financial goals, we can help you do that, too. Here are just some of the re-inveshnent options available to vou: Automatically Renew For An Additional Tetm -Your CD is scheduled to automatically renew for the amotu~t and renewal investment period shown above, which may be different from your origuial term. The Account Agreement on the back of this letter provides additional information about the renewal of your CD and should be retained with yotu• other account records. Upon renewal, interest will be credited to your CD, unless you receive a periodic interest payment. When your CD renews, your fluids will earn the interest rate and annual percentage yield in effect on 03/05/2009. Because viterest rates and annual pen;entage yields may change bettiveen now and 03/OS/2009 , please call 1-877-BANK-PNC on or aater this date for renewal rate infornation. Add to Your CD and Earn More ... Even Change Your Investment Selection - To add to your CD, supply complete the Renewal Authorization attached and rehirn it to us no later than ten days after 03/05/2009. A postage-paid em~elope is enclosed for your com~enience. You can also change the investment period of your CD using the Renewal Authorization. Terns between seven days and ten years are available. Once we receive your Renewal Authorization, we will send a confirmation sltowu~g the changes you have made to your Cll, as well as the new interest rate and ann~~11 percentage yield. Explore Other Investment Choices -From time to tame, you may need to re-evahiate your urneshnent strategies to meet your ever-changing needs. No matter what your situation, we can help you make the riglrt saving and investment choices based on pour financial goals and personal dreams. In today's environment, eve tlvnk it's particularly important to ask: - Do you have enough savings that can be accessed ui case of emergenc}~? - Do you have longer term im~est~nents working for you? - r1re yotu• borrowing costs as low as they can be? Stop by yotu• local branch office at yotu• convenience or call us behveen the bolus of 8:00 am and 9:00 pm at 1-877-BANK-PNC ~Ve appreciate pour business and thank you for banking with us. Sutcerely, ~-~ Nieinber FDIC Egttal Housing Lender Ricltani R. Dietrich, Vice President Product 1\'Ianagement and Marketing C'erti~icate of Deposit Maturity Notice 840 ALICE M HARRIS JANE PATRICK 2143 YALE AVE CAMP HILL, PA Dear Customer: 17011-5452 PNCBANK Certificate Numbet: 000011020029204 Alaturity/Renewal Date: OS/27/2009 A'Laturity/Renelval Y'alue: $10.000.00 Xenelval brvestment: 12 NIUNTHS REAll~' ACCESS C); Thank you for investing in a PNC Bank Certificate of Deposit (CD). Tlie CD sho«~1 above, «~ll be mahlring on 05/27/2009 with a value of $10,000.00. :~ Certificate of Deposit is 21 st-fe and easy ~c ay to keep yotu• savings srocving at a guaranteed late. RTe'd like to see you continue that growth by reinvesting yo~u• fiords. Howvever, if yotu• needs Dave changeci, or you want to explore other products or services to help you reach your finvlcial goals, we can help you do that, too. Here are just some oFtlte re-investment options available to you: Automatically Renew Fot• An Additional Term - Yotu• CD is scheduled to automatically renew for the amotuit and renewal imrestment period shown above, which may be dit~erent from your otignlal terns. The Account Agreement on the back of this letter provides additional information about the renewal of yotu CD and should be ret<lined with your other account records. Upon renewal, interest will be credited to yotu• Cll, wlless you receive a periodic interest payn.~ent. ~~~hen your CD renews, your fiords will earl the uterest rate and anm4il percentage yield in eitect on 05/27/2009. Because interest rates and annual percentage yields foray change between now and OS/27/2009 , please call 1-377-BANK-PNC on or after this date for renewal rnte information. Add to Yout• CD and Eats: Alone ... Even Change Your Investment Selection - To add to your CD, supply complete the Renewal Authorization attached and return it to us no later than ten days alter 05/27/2009. A postage-paid eln~elope is enclosed for your convenience. You can also change the uiveshnent period of your CD using the Renewal Authorization. Terms behyeen seven days and ten years are available. Once we receive your Rene~ral Authorization, we will send a coniinnation shoring the changes you have made to your CD, as «-ell as the new interest r<lte and almtlal percentage yield. Explore Other Investment Choices - hrom tune to time, you may need to re-evaluate your im~eshnent strategies to meet yotu• ever-chan~ine needs. 1\~o matter what your siltl<ltion, we can help you hake the ltight saving and investment choices based on your financial goals and penonul dreams. In today's envirolmnent, eve think it's particularly mtpoliant to ask: - Do you have enoush savnlgs that can be accessed in case of emergency'? - Do you have longer term im°eshnents working for you? - Are your bolrowillg costs as low as they can be'? Stop by you local branch oilice at your convenience or call us between the hours of 3:00 ant and 9:00 pnt at 1-377-BANK-PNC ~Ve appreciate your business anti thank you for bankiig with us. ~~(~~~ ~~ Sincerely, -~,.a..d ae o.u.~~c,. Member FDIC Equal Housing Lender Richard. R. Dietrich, ~~ice President Product Alanasentent apes 11'Iarketin~ N 0 N 0 a 0 °m N '~ V ~' ~_ OQC~ V c V ~~ ~-- f. ~ ~~~~'~~~ ~~o~~ ~ ~ ',y ''1 ro~~ ~'w~"o'-'a A .+ '~' b •• ~t~JOW o p C H ~ p Z T ~ ~ Z 0 ., b~ AA G y~y~~ C y ~ O ~~" C ~ '~~t titpp O ~ C. A ~' ~ ~ o ~ ~ ~ ~ ~ o, ~ a, ~ ~~~ p y O b ~ ~ ~ O ~., y ~~~. '~'' eOp O C~ `Tj O ~ fin. n ~ ~~ n o~ ~~ ?~ ~' ~s . ~. ~,~ 'V O ^N" DO ~-ID~o 3Wmmf1~ 2~ZD~1 D ~ o_ rr-m~7°y~ DC~7ncA°D m v, o V ~ O ~p '~ O ~P ~ ~ O N O_ O ~O O J N D ~onw A A O h.. p Wz o~ r o ;b ~ o ~ ~~~ °r ~ < a ~, a °~ ~ ~ ~ 1~1 n ~ ~ a o 7? n C o ~ ^ O 3 vdi ~ ~ a N io ^ C Z ~ O ~ O C ~ m N ° %» n O ~ O Z ~ ., D a "- 3 '» ~ ~ ~ ~ n ego 1° a D v' D ~ ~ ov ° C m ~ ~ ~ c ~ ° ~ v ~ o z ~ ~o "'I "~ b ~ 0~0 ~ O W1 i OW1 10 ~ 0~ 2 ~ ~ ~ W V O O O p N H ID 10 ~ ~ = .. N OD O rn O N < ~ G N V N ~ n m O OD O O N ~O ~~ f. O ~~~ M ~ CJ1 ~p ."3 }~- sovereign Bank STATEMENT OF ACCOUNTS - Statement Period 05/01/09 TO 05131109 1-877-SOV-BANK (1-877-76&2265) www.sovereignbank.com PREMIER MONEY MARKET SAVINGS ..Interest _~ r f~i~f mar .~:+ Eamed this Period $ 91.20 Paid Last Year $2,686.05 ~583~ ~ ~~ ~aid~'i~~'~'~ •,~ ;'. t`~ ~ ; x " ; r ,"~. ~: ~,~. ~ _. .. ~ .. ;~. r~ ar r . , , 'The interest earned and the interest paid may differ depending on when interest is uedited to your account. Account Activity Date Description Additions Subtractiorss Balance inning Balance B e g -0 1 0 5 x101,639.3 6 ~ ~~. L~ ~C. { j {"~g'F~ }W 1/ w F ~ ~ y {'~~ 05-31 Ending Balance `.... $101,730.56 REV-1511 EX+ (12-99) SCNEpYLE M XPENSES & E FUNERAL COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ~ w ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Alice M. Harris 21-09-0506 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES:......... __ _ _ _. 7 700 00 t. .Myers-Harrier Funeral Home , . 2. Rolling Green Cemetary 1, 570.00 3. Funeral Luncheon 300.00 _ _ _ B. ADMINISTRATIVE COSTS: _ __ ~ . Personal Representative's Commissions 0.00 Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) _ ____ '_ Street Address _ _ . City '. State _ 'Zip Year(s) Commission Paid: 15,000.00 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 0.00 Claimant Street Address ' City :State _Zlp __ Relationship of Claimant to Decedent 322.00 4. Probate Fees 0.00 5. Accountant's Fees g. Tax Return Preparer's Fees 0.00 ~. .Legal Notices -Cumberland Law Journal 75.00 s. Legal Notices -The Sentinel _ 155.68 TOTAL (Also enter on line 9, Recapitulation) S 25,122.68 If more space is needed, insert additional sheets of the same size) MYERS-HARNER FUNERAL HOME, INC. 1903 MARKET STREET CAb1P HILL, PEM3SYLVANIA 17011 717-737-9961 [.OCAI,LY OWtiED ArD OPERATED June 2, 2009 Mrs. Jane L. Patrick 2312 Yale Avenue Camp Hill PA 17011 Services for Alice M. Harris May 23, 2009 Charges for Services Selected Professional Services Use of Facilities Automotive Equipment Charges for Merchandise Selected Casket Vault Cash Advanced Newspaper Notice/Local Certified Copies Flowers Hair Dresser Total due within thirty days, please: $ 4,590.00 $ 1,570.00 1,080.00 $ 170.00 60.00 185.00 45.00 ROBERT H. HARNER SUPERVISOR DUST.CV R BAKER Fll'NERAL DIRECTOR $ 4,590.00 $ 2,650.00 $ 460.00 $ 7,~ RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17613 HARRIS ALICE M Estate File No.: 2009-00506 Paid By Remarks: JANE PATRICK AJW ------------------- Fee/Tax Description PETITION LTRS TEST WILL SHORT CERTIFICATE JCP FEE AUTOMATION FEE Check# 6399. Total Received......... Receipt Date: 6/01/2009 Receipt .Time: 11:13:56 Receipt No.: 1056976 Receipt Distribution ----- -------- -------- --- Payment Amount Payee Name 260.00 CUMBERLAND COUNTY GENERAL FUN 15.00 CUMBERLAND COUNTY GENERAL FUN 32.00 CUMBERLAND COUNTY GENERAL FUN 10..00 BUREAU OF RECEIPTS & CNTR M.D 5.00 CUMBERLAND COUNTY GENERAL FUN ---------------- $322.00 $322.00 CUMBERLAND LAW JOURNAL 32 SOUTM BEDFORD STREET CARLISLE, PA 17013 Tele: (71 T) 249188 Fax: (71 T) 249-2883 June 26, 2009 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the ofFcial legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Michael Cherewka, Esquire Alice M. Harris Estate RE: Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on the following dates: June 12, June 19, and June 26, 2009 Advertising Cost Proof of Publication Second Proof Request Payment received Total Amount Due $ 75.00 $ 0.00 $ 0.00 $ 0 .00 $ 75.00 Payment received by RETAIN THIS PORTION FOR YOUR RECORDS THE SENTINEL - LEGAL MICHAEL CHEREWKA P.O. BOX 130, CARLISLE, PA 17013 AD NUMBER CLASS SALESPERSON BILLING DATE LINES 370214 10 PUBLIC NOTICES cartc 06/26/09 28 * 2 AD DESCRIPTION START DATE STOP DATE NOTICE NOTICE IS HEREBY GIVEN THAT 06/12/09 06/26/09 PUBLICATION INSERTIONS RATE NET AMOUNT GROSS AMOUNT 3 THE SENTINEL - LEGAL 3 LGL 148.68 TOTAL AD CHARGE- 148.68 3 PROOF OF PUBLICATION OlPRF 7.00 DAYS PURCHASE ORDER PAY THIS AMOUNT Est A. Harris 155.68 186.82* MESSAGE: Thank you for advertising with The Sentinel. Deadlines for in-column legal advertisements: Monday is Thursday at 5 p.m; Tuesday is Friday at 5 p.m.; Wednesday is Monday at 5 p.m; Thursday is Tuesday at 5 p.m; Frl.day is Wednesday at 5 p.m Saturday is Wednesday at 12 Noon; Sunday is Wednesday at 5 p.m. If .you have any questions regarding your Legal bill please call Classified Manager at 717-240-7176 Fax your legals to 717-243-3754 attention Classified Manager You can also EMAIL your legal to Classified ads: classifiedc~cumberlink.com Please send a cover letter including your name and address as an attachment DETACH AND RETURN THIS PORTION WITH YOUR PAYMENT THE SENTINEL -LEGAL Est A. xarris r.V• YV/~ IJV V AD NUMBER ~ •. •.v CLASS START DATE STOP DATE Q 370214 PUBLIC NOTICES 06/12/09 06/26/09 AD DESCRIPTION BILLING DATE TELEPHONE NUMBER NOTICE NOTICE IS HEREBY GIVEN THAT 06/26/09 717-232-4701 MICHAEL CHEREWKA 624 NORTH FRONT STREET WORMLEYSBURG, PA 17043 I~~~IIL~~III~~~~I~~i„IL~I~I~I GROSS AMOUNT OF 186.82 DUE AFTER 07/26/09 TOTAL AMOUNT DUE 155.68 ENTER AMOUNT ENCLOSED ~0200000003702140000000000000001868200000155689 REV-1512 EX+ (12-08) ~ pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER l1,1 ICF M_ HARRIS 21-09-0506 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Medco _ _ _ 2.75 2. !: Central PA Pulmonary Group 489.07 3. ' Camp Hill Emergency Physicians 41.90 4. . Pennsylvania American Water Company 20.85 5. PPL 41.82 6.' ' Holy Spirit Hospital 42.45 7. Landscape and Mowing Services 100.00 8. l Moffit Heart Group 35.10 9. ! UGI 29.92 10.' ' C. Frank & Sons, Repairs to House for Sale 882.79 11. Pennsylvania American Water Company 48.75 12.' !:Neurology Center 44.18 13. ! PPL 28.61 14. ': Verizon -Final Statement 8.02 15. Comcast -Final Statement 13.30 16. Pennsylvania American Water Company 18.72 17. 'Landscape and Mowing Services 100.00 18.' Jim Moyer -Roof RepairslReplace 5,000.00 19.' Jet Tee Inc -Sewer Repair required by Borough 5, 710.00 20.' Penn Waste, Inca 48.75 21. ' UGI 14.05 22. Center for Kidney Disease & Hypertension 22.57 23. 'Comcast -Final Statement 7.35 24. Quantum Imaging & Therapeutic Association 3.98 25.' ' Azizkhan Internal Medicine Associates 130.31 TOTAL (Also enter on Line 10, Recapitulation) $!' 12,885.24 If more space is needed, insert additional sheets of the same size. ~t t. Estate of Alice M. Harris Schedule I Debts of Decedent, Mortgage Liabilities & Liens File Number 21-09-0506 Car over from Pa e 1 $12,885.24 26 Jim Mo er General Re airs to house 4 850.00 27 S irit Ph sician Services 91.98 28 Hol S irit Hos ital 1 309.77 29 Hol S irit Hos ital 1 575.08 30 Hol S irit Hos ital 1 631.25 31 Borou h of Cam Hill -Sewer 62.50 32 PPL 79.22 33 Penns Ivania American Water 21.60 34 UGI 14.05 35 Cam Hill Borou h-Sewer 62.50 36 Landsca e & Mowin 200.00 37 Cumberland Coun -Real Estate Taxes 523.06 38 UGI 13.88 39 Hol S irit Hos ital 1 438.68 TOTAL $24,758.81 ,; ,~ t :. ^ AD-Automatlc Deposit ^ APB Payment ^ ATM Teller Machhn ^ DGDebit hard ^ T Tax Deductibb ^ TiTelephaie Trnsfer NUMBER OR -- CODE. ATE ~ TRANSACTION DESCRIPTION PAYMENT AMOUNT ~ FEE DEPOSTf AMOUNT S ~3~ ~ is 3n~dcD ,33 ~ a9~ ag ~~b3 ~ - ~~:.lr-E~. __ ~~~~ ~.., . ~ 6.3,ya P./~ ~C. ~ ao _ f37 a,q ~-~~ b~ i DP~''_ 3 o ~ ss ~ 39/ ~cs~ „~ 1 37 . .:. . . . ... y ~ ~ + . ~`~'-~"" ~ LZSY i ,3 ova ~ ~,~, : ~ ~ - _ ' ~r~ ~ - ---- ~ ~~~ ~ . ~~ _ ~°~ ~ .~" T ., ~~ ~~ ' / i~_~~_ loa ~99g1 0 ~ ~ ~ -~- --- ~l ~ oda ~~ I i~ ~5a< _ -- - ~ - ~`T R ~S` ,. 63 ~ ay Ce.~n~%1-ae~ ~ ~9y 6 7 ~ -- ~~ ~ 68 ~39~ ~ > p~~C ! ~o . ~ ~~ '~ ~~~s~~ ~ q3 ~ 6~3 9 8` ~ I - ~ ~,~f ~~~ ' ~~ ~ .,~- 3 6C' ' l } 5321 4G o o ~ ~, ~, - ,~~:~ ~~ , ° o ~ ~ -- ~ .~ ~ ~, 6 03 rn~ --- .,~, _ WV / -L_ f ,~_~t i. ^ AD-Auwmatic Deposit ^ AP-Automatic Paymem ^ ATM Teller Machine ^ DC-Debit Card ^ T Tax Deductible ^ TT Telephone Transfer NUMBER OR CODE __ ~o~' DATE ~ TPANSACTION DESCRIPTION ~.,;~,, ~,~- '~ ~~~~ PAYMENT AMOUNT ~ ' ~ - !-1 ~ ` " PE -~ ~ DEPOSIT AMOUNT - -~-- L $ t has , ~`>~' ~ ' ~~' - 1~ .. ~S ~0 ~ (p 7 ~O~'L __ ~ PIy ~ ~ ~ ~ ~ ~r ~~ ~ i f ~o41 ~ ~ S~ .. ~ ~ o ~ b.~~ -~ ~ .z b ~ ~ «,~,~ ,~a-~L 1 ~ ~ - ~~ I 13 1 ~~ k 30" eli ~ ~ ~ ~/' ~~ ~ =~~, 7 2y ~ o ~ ~C ~~n ~ $6t t~ r-0 ~ : ,: ~- . . , _ _ T ~ ~ ~ ~ ~ ~ Uy~ ~ ?~ ~~ ~ t - , L x 11 ;< _ ~ - _ _ _ - ---~--r - - ~-. - ~~ ~~ I I f 1 _ _ - - ~ ~~ _ - j ' ~ _ - ,_- t -' - - ---~- ~ F-- -- - - - ~ - - 1 - - -+__ - - ~--- -~ I ~ ~ 1 , _ ~ I ~~i '~I ~L I~~ ~ ~ 11 ~ _ ___ _ _ I ~ PROTECT YOURACC6Urii•USE DMIIXXWHEN WAITING(NE[if. NEVEX UiE PEXOE 0I EMSABIF INL IF ANY QUESTIONS, PIF~ASE CONTACT: ~ 07/02/04 ~ 07t24J09 I~ 06/1~J09 9923a 42x.0 ~ D7l14/09 MCARE ERA CONTR/ADJ COMMERCIAL PAYFENI' PERFORIED BY: CHRIS KAHLENBORN MD MD pERFORFED AT: IB HOSPITAL DISCHARGE c30 MI MID 100.00 MORE ERA PIER ID 7.30- D.00 13.14 ~ 0.00 ~ IIDICATES NEN FINAIrKIAL ACTIVITY SINCE LAST BILL. PATIENT BALANCE SHDBI ON THIS STATEMENT IS OUE FROM YOU. PLEASE REMIT FULL AMOUNT PROMPTLY. PAYMENT IS OUE UPON RECEIPT OF THIS STATEMENT. :neeETfESE SERVICES MERE PROVIDED BY SPIRIT PHYSICIAN !seat al,:sr~ERVICES AND ARE SEPARATE FROM ANY HOSPITAL FEES asset I~IerPLEASE CALL 717-972-4490 MITH ANY i~UESTIONS asset ERI~QIA; THESE CHARGES. aetlet I~F~ORTANTsPLEASE DETACH AND RETURN BO~TO~ PORTION OF S~ATEAFEN! la%T({ YO PAY ~ sl2 SPIRIT PHYSICUN SERVICES 205 GRANDVIEW AVE (HP) STE 210' CAMP HILL PA 17011 STATEMENT DATE: GUARANTOR RESPONSIBILITY: MINIMUM PAYMENT 07!25/09 ; 91.98 ; 91.98 1...111...111......11...11...III...III...i..1.I11..11...1..1.1 00001930 o z M+V~ SPIRIT PHYSICIAN SERVICES ALICE HARRIS To: 205 GRANDVIEW AVE STE 210 2143 YALE AVENUE CAMP HILL PA 17011 CAMP HILL PA 17011-5452 OFFICE USE ONLY FOR CREDIT CARD PAYMENT, PLEASE FlLL IN INFORMATR7N BELOII CHECK ONE I I~ I I I' ~ I I I I~~ I~ I 1727411 M/C DARD NUMBER EXP DATE : 91.98 ~ ~- vlsA CARDHOLDER NAME (PRINT HC: 1250 CREDIT CARD SIGNATURE ( SPIRR PHYSICIAN SERVICES CHECK BOX AND ENTER ANY ADDRESS OR INSURANCE CORRECTIONS ON BACK SPIRIT PHYSICIAN SERVICES ALICE HARRIS 2 of 2 205 GRANDVIEW AVE STE 210 2143 YALE AVENUE STATEMENT CAMP HILL PA 17011 CAMP HILL PA 17011-5452 DATE: 07/25/09 LAST STATEMENT ACCOUNT # 1727417 ~T~ STATEMENT OF PHYSICIAN SERVICES SPIRIT PHYSICIAN SERVICES 205 GRANDVIEW AVE STE 210 CAMP HILL PA 17011 ALICE HARRIS 2143 YALE AVENUE CAMP HILL PA 17011-5452 STATEMENT a-TE: 07/25/09 LAST STATEMENT DATE: 1 of 2 IF ANY QUESTIONS, PLEASE CONTACT: SPIRIT ACCOUNT # 1727411 SERVICES FED TAX ID PERFORMED BY: CHRIS KAHLFaBORN MD MD PUKE OF SVC: 21 PERFORMED AT: HS ~ 05/08109 94223 428.0 INITIAL HDSP CARE LEVEL I Z89 198.OD ~ 07/16/09 MCARE ERA PMT 142.21- I~ 07/16/04 DARE ERA CaiTR/ADJ 20.24- PERFORMED AT: HS ~ 06J04/D4 44232 428.0 SIBSEQIENT HOSP, LEVEL II Z89 73.E ~ O7/16JD4 DARE ERA P!R 52.56- ~ 07/16104 MCARE ERA t~(TR/ADJ 7•~' PERFORMED AT: HS ~ 05/].0/09 44?32 4ffi.0 Sl$SEQUENT HDSPs LEVEL II Z84 73.D0 ~ 07/16/09 DARE ERA PMT 52.56- ~ 07/16/04 DARE ERA CONTR/ADJ 7.30- PERFORMED AT: NS ~ 05/11/04 99232 4ffi.0 SI~SEQIlENT HASP, LEVEL II 289 ~•~ ~ 07/16/04 IxARE ERA PMT 52.56- ~ 07/16/09 MCARE ERA t:drRR/ADJ 7.30- PERFORMED BY: SHAHJAHAN MDLLA MD MD PERFORMED AT: HS ~ 05/12/D4 4423Y 4ffi.0 SI~SEgtEMIi' HDSP, LEVEL II ~•~ ~ 07/02/04 MCARE ERA PMT 52.56- ~ 07/02/04 MICARE ERA t:OM(TWADJ 7.30- :E 07/24/09 COM~ERGIAL PAYMENT 0.00 13.14 PERFORMED AT: HS ~ 06/13/04 99232 424.0 Slt$SEQtJOIT HDSP, LEVEL II 73.00 ~ 07/OP109 MCARE ERA PMT 52.56- ~ 07/02/04 MIGARE ERA COFRR/ADJ 7.30- ~ 07!24/04 COIMERCIAL PAYMENT O.OD 13.14 PERFORMED AT: HS ~ Q5/14/04 49232 428.0 SIISSE~UENT HDSP, LEVEL II 73.OD ~ 07/02/09 MCARE ERA PMT 52.56- ~ O7/D2/04 MCARE ERA CQrRR/ADJ 7.3D- ~ 07/Z4/04 C0~lERCIAL PAYMENT 0.00 13.14 PERFORMED AT: NS ~ 05/15/D9 94232 4ffi.0 SI$SEQlR41T NOSP, LEVEL II ~•~ IE O7/DY/04 FARE ERA PMT 52.56- ~ O7/D2l09 M~CARE ERA t~tl'R/ADJ 7.3D- ~I 07/24/09 COI~lIERGIAL PAYMENT 0.00 13.14 PERFORMED AT: HS ~ Q5/16/04 44232 428.0 Sl$SEQUENT HDSP, LEVEL II 73.00 * OT/02/04 MCARE ERA PMT 52.56- ~ O7/02/09 MGARE ERA COrRR/ADJ 7.3D- ~ D7/24/09 CO1lERGIAL PAYMEM' 0.00 13.14 PERFORMED AT: HS ~ Q5/17/04 44232 428.0 SIAS~UENT HDSP, LEVEL II 73•~ ~ O7/02/D9 MCARE ERA PMf 52.56- ~ D7/D2/04 DARE ERA CatTR/ADJ 7.30- ~ D7124/09 COI~lERCIAL PAYMENT 0.00 13.14 PERFORMED AT: HS -_.._.......'-.__ .............__.........._......._...._................_W........_. - _..~.._....................._ _._........._._._.~_..... .........._....._........_W_......... ....._~................................. _ - _ ___..._.._......._...__-- - --- ^ CHECK BOX AND ENTER ANY ADDRESS OR INSURANCE CORRECTIONS ON BACK ~ O m ~ a a rn ~~~_~ g~=F- U ~ d ~ ~ a Q ~ ~ ~ U a ti j a OW 1=-W a~'p~ Q ~a ag ~~ Yv ~~ W W~ W~ ay Y~ ~~ 0 m a~ w~ ~ 0 r ~' ~ a ~ ~ ~_ ,ate JQd U ~" 2 . n gw~ Q~~ VAC LL H _~ ~ J Q o~ i ~~ I m N ~~ ~~ ~~ ~~ ~T~ 1" O w>a J Q nWJ J J VI } 2 O `' ~ m d O J Q SN V N Q w W Qt W o = l11 o ~ ~ J o L!1 H O w U c Z \ N 01 \ ~ O ~ N w W = O d N . l0 \ O t y W J N Z m ? ~ _ F _ a O w W y ~ z W a i O j Q j z W O O ' O O ~ y m ~ a z ~ N J 01 y 9 0 O Q O W O ~ Z' ~ r"I Q ~' O~ \ F m ~ Z W F Q \ ~ r-I rI W > ~ W N Q. ~ ~ ~ d 3 ° o\o N O U w a i O O m N lD Z ~ O Z O ~ i o ~ ~ J V N V 1" a ~ W > rn a ~ ~ W Qo ct J N } D 0\0 PPL Electric Utilities Electric Service For: J LEO HARRIS 2143 YALE AVE CAMP HILL PA 17011 Questions about this bill? Please contact us by Aug S at 1-800-342-5775 (1-800-DIAL-PPL) or write to: Customer Service 827 Hausman Rd. Allentown, PA 18104-9392 www.pplelectric.com Electric Use This graph shows your electnc use over the last 13 months. Types of R di ea Meter ngs: Actual . Adjusted Estimated Customer 0 ,~~~ ~~•;.~~~:,:~.- Page 1 . ~, ..__ ... .••, pp ` •~. Summary Page Balance as of Ju115, 2009 :, ya~uf II.` `: , , 66475 23346 ::...::... . .:..:..:.... ..:.::.:.::........... . Char es: Tota~PL ELECTRIC UTILITIES Charges so.o0 $79.22 Total Charges $7y.ZZ ::;.:;:: ~a:~.'1'~us:;~knrownl~;ter>tb~o:~o .~:~0[f~>~ ......::.. ..:.:::~~~,~. Account Balance $79.22 KWH -Average Per Day 36 - 30 24 18 12 6 0 JASONDJFMAMJJ 2008 Months 2009 Meter Reading Information Meter #60811842 Ju115 Actual 24263 Jun IS Actual 23554 30Da s KWH Billed 709 Average -Jul 2008 2009 Temperature 74F 7lF KWH Per Day l5 24 Yearly Use: Total Averagge Use lbiont6ly Aug 2007 - Jtil 2008 3775 315 Aug 2008 - Ju12009 5276 440 Other important information on back ~ --------------------- - Return this part to address below with a check payable to PPL Electric Utilities Corporation 66475-23346 AV 01 007210 469618 29 A*'5DGT J LEO HARRIS 2143 YALE AVE CAMP HILL PA 17011-5452 I~~i~~~~~~~~i~~~~~l~l~llii~llil~~~l~i~i~lli~l~~ll~~lill~ill~~~~~1 ,,: .. _..'Pl~ tri 8 . ' ~ .. ~: Fw~ T1tr~ Aiax~ut~t :. '~ ug ~5, 2009 $79.22 Amount Enclosed PPL ELECTRIC [JTILITIES 2 NORTH 9TH STREET RPC-CrENNI ALLENTOWN PA 18101-1175 1 37000007922700D0079226 6647523346 000240633795200DODOOOD0002160011 ,,, Pennsylvania American Water PO Bax 371412 Pittsburgh, Pa. 15250-7412 For Service To: 2143 Yale Ave 0174631 AV0.3351463/17463/001463 060 1 PCJ171 I1111111111111111111111111111111111111111111111111111111111111 J LEO HARRIS 2143 YALE AVE CAMP HILL PA 17011-5452 Pennsylvania American Water PO Box 371412 Pittsburgh, Pa. 15250-7412 I111111111111111111111111111111111111111111111111111 Please check here to add H2O-Help to Others contribution to your monthly bill or to change your address or telephone number, and print information on reverse stde_ Customer Account Information Billing Summary For Service To: J Leo Harris -----Prior Balance----___-_____ 2143 Yale Ave Prior Water Balance Account Number: 24-0633795-2 Prior Balance Other Premise Number: 24-0374603. Payments prior to Ju117, 2009. Thanks! Total prior balance, Jul 17, 2009 Billing Period & Meter 'Information -- ---Current Water Charges----- Billing Date: Jul 17,.2009 Service Charge Billing Period: Jun 10 to Jul 13 (33 days) Water Volume ($.006809 x 500) Next reading on/about:.Aug 12,.2009 SFAS PAWC Water-0.i5% Rate. Type: Residential DS! -PAWC Charge 4.68% Total Usage Billed o Meter readings in current billing period: . - --Other Current Charges-----_ Meter Number N000013799 is a 5/8-inch meter. Customer Protection. Waterline Present-actual 217900 Total other charges,. Jul 17, 2009 Last-actual 217400 Gallons used 500 -------AMOUNT DUE -----_-------_ $13.22 $5.50 -18.72 .00 12.00 3.40 -.02 .72 16.10 5.50 5.50 ^ AD-Automatic Deposit ^ AP-Automatic Payment ^ ATM Teller Machine ^ DC-Debit Card ^ T Tax Deductible ^ TT Telephone Transfer NUMBER OR CODE DATE TRANSACTION DESCRIPTION PAYMENT AMOUNT ~ ~ FEE DEPOSIT AMOUNT $ (~ ~• ~~.r+ ~' -- i~s73 Ss, ~Q q ,~ _,~,~ e gg ~ F ~ ~; ,~~o ~ ~ p~~~ t~ 7 ` ~`°~'33 ` SI a 4 ~ _ o ~' ~~~~ ~ 1 ~ ~iO~ . ~r V© ~ ~~ ~ ~ ,~~~, ~~ ~ 7~a3 i ~- ~i ~ 7~ ~ T: ~ T 8 7 ~!' ~ `~ I ~ ~~3 d ~.Zir~tz t, ~'~ ~ ~rt,oe.e~ ~ ~ ~"~ ~ ~ ~ ~ ~ ~ a .~.. . o .~ 8 ~ ~ ~ Z~ ~ ~ , c~ ~ g~ ,~, ~ ao o ~ 8~ as~~ a3`~`~ 9 ~ 'I ~ ~ ~ g tc. ~ /3 1 b ~z~ ~/ P~' ~ ~-e~ 7~ 9~ ~ ~ ~-~~ ~. s ~ / 1 °' a ~ 9 ~ tc, G- ~ ~ ~ , ~ t ~ ~a~ ~~ ~ ~ 3 o y~-i .~~~ UJ~.2tr. ~ b ~ ' 7 L: ~t~ ~ ~' ~ ~ ~l t ~ NUMBER OR CODE DATE TRANSACTION DESCRIPTION PAYMENT AMOUNT ~ FEE DEPOSIT AMOUNT $ ~ 't ~Cf .~ {,~.. 1 6 r ~ y ~ - ~ ' 3 ~" ~ to ,~ (.fit-~..~ /GG' ,~ 3 c~ ~,~-- ~ / .~' ~ , (o`~"~~ 7 o1z rs - ~ ar 7~ 3~S 1 ~ ~~ 3 ~ ~ ~9 ~' 3 PP.~ app ~~ '7b ~ ~ ~ 1- ~ ~ ~- o ~0~~ ~ ''' jr ~~ tug- ,~- 9~ ~ 8 1 - - - - - (r KllllU iUUB AI.I.VUI'll - )tlXCU U1tllCLLCU ltlLLfJ, UtlV)LU ULfU)11 IIll1C1) XIfY GXIIA)IXI LI'I LIIU l7tlCX UUlXXU111 V. ~:~:03~30~2955~: ' a REV-1513 EX+ (11-08) '"~i Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE ~ BENEFICIARIES ESTATE OF FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR 5t1ARt NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] _. ..._ 1. Jane Patrick, 2312 Yale Avenue, Camp Hill, PA 17011 Daughter 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN If more space is needed, insert additional sheets of the same size. ti~ WILL OF ALICE M. HARRIS I, ALICE M. HARRIS, of Camp Hill, Cumberland County, and State of Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I. I direct that all my just debts and funeral expenses, including my gravemarker and all expenses of my last illness, and any and all taxes and assessments imposed by any governmental body as a result of my death, whether on property passing under this will or otherwise, shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. ITE M II. I give, devise, and bequeath to my husband, J. LEO HARRIS, all my possessions and estate of every nature and wherever situate, provided he survives my death by sixty (60) days. ITEM III. Should my said husband predecease me or be deceased on the sixty-first day after my death, I give, devise, and bequeath all of my possessions and estate of every nature and wherever situate to such of my issue, per stirpes, as survive my death by sixty (60) days. executor of this I ITEM IV. I appoint my husband, J. LEO HARRIS, my last will. Should my said husband predecease me or otherwise fail ~ to qualify or cease to serve as executor of this my last will, I J_ appoint my daughter, JANE L. PATRICK, executrix of this my last will. ITEM V. I direct that my personal representatives shall not be 1 required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~~~ day of ~ ~ 1984• ALICE M. HARRIS - The preceding instrument, consisting of this and TWO other typewritten pages, each identified by the signature of the testatrix was on the date thereof signed, published, and declared by ALICE M. HARRIS, the testatrix therein named, as and for her last will, in the presence of us, who at her request, in her presence, and in the presence of each other, have subscribed our names as witnesses hereto. w ~ .,/ ~o COMMONWEALTH OF PENNSYLVANIA ) ( SS.. COUNTY OF CUMBERLAND ) The undersigned, being the testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, does hereby acknowledge that I signed and executed the foregoing instrument as my last will, that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. s~ ALICE M. HARRIS Sworn or affirmed to and acknowledged before me by the testatr,,i Jx,,''Anamed above this ~(~-~1 day ~~(J~,Q~I.~v+ ~ 1984. tOU AN~,~ ZtTTO. Notary public °mrnm~. CI7r1^F+arlan~ COUrItY. Pa. Notary Publi - ~~~ G~Mm'~""" Expires April 7, 19R~ COMMONWEALTH OF PENNSYLVANIA ) ( SS.. COUNTY OF CUMBERLAND ) WE, GEORGE A. VAUGHN, III, and MICHAEL L. BANGS, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the testatrix sign and execute the instrument as her last will; that she signed it willingly and that she executed it as her-free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix signed the will as witnesses; and that to the best of our knowledge, the testatrix was at that time 18 or more years of age, of sound mind, and under no constraint or undue influence. Sworn or affirmed to and acknowledged be ore me this ~Q -~'1 day of ~,rn~~ ~ 1984 . D ~/~i ~..r Notary Public ii)U ~~"~ 7_`sTT^, dietary Pun1iC 1-»rrnv^ Ce"" ~ . ~"~ County, Pa. fv~y Cernssioe~Expires April 7, 196: Law Offices of Michael Cherewka 624 North Front Street Wormleysburg, Pennsylvania 17043 (717) 232-4701 Fax (717) 232-4774 January 7, 2010 Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 RE: Estate of Alice M. Harris Our File No. 2836.00 ~"~ ..,,v ~... ' ~~~ 1 iJ ' a ~ .. U C'1 t._" l ~ Z < - } - - -~_~ rj7 ~ `: ~: ~r -~ ._ ~ ,_ _.~ n ,, -v . - . Enclosed please find REV 1500, Inheritance Tax Return for Resident Decedent and Inventory. Enclosed you will also find an Estate check in the amount of $948.46 made payable to "Register of Wills, Agent" to cover the tax due and our check in the amount of $30.00 to cover the cost of filing the Inventory and the Return. If you have any questions, please call the undersigned. Thank you for your consideration in this matter. Very truly yours, ~ , .., Michael Cherewka MC/11 Enclosures INyENTORY REGISTER OF WILLS OF CUMBERLAND CObLMONWEAL'IH OF PENNSYLVANfA ~ SS COUNTY OF ~~ COUI~iTY, PENNSYLVANIA Ft7e Number 21-09-0506 Personal Represert~ive(s) of the Estate of ALICE M. HARRIS decxased, depose(s) and say(s) thatthe ittmLS appearm8 inthe following inventory include all ofthe persovaal seeds whtaever situate and all ofthe real estate in the Coomamtanwealth ofPe~sylvania of said Decedent, that the valaationPlacal each item of said im,~, its fair value as of the date of the decedent's death, and that Docedeut owned zto zeal esta~be t~tut$ide of the Con~on~veslth of Pennsylvania except that which apps in a at the end of this imrtsm[ioo<y. I verify that the statements made in this Inven- tory are tree and cosset. I understand that false state- ~ts btu aro made subject to the penalties of 18 PaC.S. §4904 relating to unsworn falsification to authorities. Miclmel Cherewks (.'~rgnsenee Cottrt ZD. No.) 35073 . Attorney - (Nmae) {Addrass) 624 North Fzant Street, Woaamdeysburg, PA 17043 ~e~) 717 232701 c~~ of o~-~tt May 20, 2009 usr Camp Hill, PA o~errs t;ac. t~ Wo. 178-I6-45'15 FIGURES MUST BE TOTALED 1. 2143 Ysie Avenue, Camp Hl1i , Gad County, Pe~Y1v~ ~ pn~ 2. 2005 Ford Yantis Sudan 3 Sovea+eign 13anlc, Mtmey Maticet Awl #1054169524 138,63537 6,500.00 202,27157 Q -- . ~ - ` ~ ,, ~ ~ a ~, ~ --- _ ; _~ ._ . ' ~ ?v;~ c- ~ ~.. ~ N /e~ rl slye~eb as 247,40694 NOTE: The M~oraa~ of iol eataoe aotside the Cbm[nmwoaith of Ptmsyl~ia ma9. at the ekCtion of the petamal teprc~re tha raiuo of ouch ;ten, tart Latch fi~ should mt he extended iomo thz tout of the Y. {See Z(1 Pa GS § 33U1(b)) ~'a~nRW-09 Irv IQI3.06 M 0 r N 0 M V ~ ~ W ~ •- w O d ~ O Gi ~ ~ ~_ m ~, ~ o V C C ~ ~ to .--~ V ii ~ ti ~ ~ 4-I U W p~.~ m,~ Z ~ O b ~ F: O ~ ~ ~ ~ W r~1~.+ a i~ +~ ~.+ is GO ~ v ~ ~ ~ .-i 00 _u c+ r~ c.a .-. ~"" ~`(