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HomeMy WebLinkAbout01-19-10 15056051058 REV-1500 EX (06-05) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number INHERITANCE TAX RETURN PO BOX 280601 Hamsburg, PA 17128-0601 RESIDENT DECEDENT o~ j i a 9 Dyg.~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 163-54-9692 ' 05/18/2009 04/06/1968 Decedent's Last Name Suffix Decedent's First Name MI Shenk ' ' Dawn N (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name jell Ritchie Nelson L Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 202-38-6626 RE ILLS FILL IN APPROPRIATE OVALS BELOW _;;~" 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of . „__ 5. Federal Estate Tax Return Required death after 12-12-82) >'~ 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 ~~w,. 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 INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Mark W. Allshouse, Esq. .. (717) 582-4006 Firm Name (If Applicable) _ REGISTER OF WILLS USE ONLY Christian Lawyer Sol. First line of address r.,.~ ~ c ~a "I,y) 4833 Spring Road <~©z~ c._ r _Yi' c :, _ ~- Second line of address ~, r ~ 4~ ~ j ~ _,_. " i"1 J h ll~J -- City or Post Office State ZIP Code - .. ~ _ . ~ Shermans Dale PA :17090 ,~ = + ~'v r ~ ~'~` ' ;~ ~ r~ t~ Correspondent's a-mail address: mark@christianlawyersolutions.com Under penaRies of pery'ury, I declare that 1 have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which prepa knowledge. SIG TURE OF PERSON R PO SIBLE FO FILING RETU DATE ~~C ADDRE 405 uffman Street, Boiling Springs, PA 17007 SIGNATU OF ARER AN REPRESENTATIVE DATE /' ~ - n t~~V AD ESS 33 Spring Road, Sher ans Dale, PA 17090 ... r= r r_i PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 J 15056052059 REV 1500 EX Decedent's Social Security Number Decedents Name: Dawn N Shenk 163-54-9692 RECAPITULATION 1. Real estate (Schedule A) ............ . ............................. ... 1. 0.00 2. Stocks and Bonds (Schedule B) .................................... ... 2.' 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 0.00 4. Mortgages & Notes Receivable (Schedule D) .......................... ... 4. 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... ... 5. 13,389.91 6. Jointly Owned Property (Schedule F) Separate Billing Requested .... ... 6. ' 1.00 7. Inter-Vvos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested..... ... 7. ' 0.00 8. Total Gross Assets (total Lines 1-7) ................................. ... 8. '; 13,390.91 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. 11,966.97 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule !) ............. ... 10. 10,109.27 11. Total Deductions (total Lines 9 & 10) ................................ ... 11. 22,076.24 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. -8,685.33 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 0.00 ~._.._.....w......_~. ........~ _ ........ . .. ....._~.~_ ....., ,. ~.._...._......., .. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES ....... w~~ . ,.. ,......~..,~...~,..,,,,.,,, 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 at lineal rate X .0 _. 16. ' 0.00 17. Amount of Line 14 taxable at sibling rate X .12 17. 0.00 18. Amount of Line 14 taxable at collateral rate X .15 1g, 0.00 19. TAX DUE ...................................................... ...19. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: File Number ~i 09 a S'8S' DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER Dawn N Shenk 163-54-9692 STREET ADDRESS 27 East South Street CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 0.00 Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total InterestlPenalty (D + E) (3) 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. (4) 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. (5) (5A) (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.......................................................................................... ^ Q 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 trust for" or payable upon death bank account or security at his or her death? .............. ^ ^x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ ^ 0.00 0.00 0.00 0.00 0.00 0.00 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 ~,es not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The 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 decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. 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-1508 EX+ (6-98) SCHEDI~LE Ep COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Shenk, Dawn N. 21-09-0485 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Metro Bank checking account number 513364299 187.11 2. Orrstown Bank checking account number 146001288 682.51 3. Erie Insurance Refunds - refund of renter's insurance ($61) and automobile insurance ($140) 201.00 4. 2007 Ford Taurus automobile (value based upon sale of collateral) 7, 700.00 5. Personal property 3,600.00 6. American Bankers Life Assurance Company of Florida -insurance policy obtained through Kay 976.19 Jewelers for the sole purpose of paying the Kay Jewelers credit account balance, which was paid directly to Kay Jewelers 7. Comcast Cable - refund of cable television bill payment 43.10 TOTAL (Also enter on line 5, Recapitulation) E I 13,389.91 (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDI~ILE F JOINTLY OWNED PROPERTY ESTATE OF FILE NUMBER Shenk, Dawn N. 21-09-0485 Nan asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A• Nelson L. Ritchie 9 Brook Lane Fredericksburg, PA 17026 spouse B. C. JOINTLY-OWNED 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 INTEREST 1. A. 06116105 Metro Bank -checking account number 537042798 2 00 50% 1 0 . . 0 TOTAL (Also enter on line 6, Recapitulation) J = 1.00 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) SCHEDI~LE N FUNERAL EXPENSES & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT pECEDENT ESTATE OF FILE NUMBER Shenk, Dawn N. 21-09-0485 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 ~ Ronan Funeral Home - Professional services 3,100.00 Casket, um, register book and other merchandise 995.00 Death Certificates 120.00 Clergy, organist, sexton 505.00 Newspaper notices 451.97 Flowers, grave opening, coroner, crematory fee 777.50 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)IEIN Number of Personal Representative(s) _ Street Address City .State Zip Year(s) Commission Paid: 2. Attorney Fees 2,108.50 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00 Claimant Shelby L. Shenk street Address 405 Kauffman Street city Boiling Springs State PA _zip 17007 Relationship of Claimant to Decedent daughter of decedent (SEE ATTACHED) 74.00 4. Probate Fees 5. Accountant's Fees g. Tax Return Preparer's Fees ~. Cumberland County Register of Wills office -filing fee for Inheritance Tax Return 15.00 $. Cumberland Law Journal -estate advertising 75.00 s. Journal Publications -estate advertising in Central Penn Business Journal 115.00 ~ o. Cumberland County Register ofWills -filing fee for First and Final Accounting 130.00 TOTAL (Also enter on line 9, Recapitulation) $ 11,966.97 (If more space is needed, insert additional sheets of the same size) Schedule H. Continuation Sheet for Dawn N. Shenk No. 21-09-0485 3. Family Exemption: Trenton M. Ritchie 9 Brook Lane Fredericksburg, PA 17026 Minor child of decedent. Note: Surviving spouse of decedent forfeited family exemption. Both minor children resided with the decedent at 27 East South Street, Carlisle, Pennsylvania on May 18, 2009, the date of death. Addresses listed are current addresses. FEV-1512 EX t (iZ-08) ~~ pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT INHERITANCE TAX RETURN , MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Shenk, Dawn N. 21-09-0485 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1• Andrews & Patel Associates, PC -medical bill 62.00 2. Blue Mountain Anesthesia Associates -medical bill 43.20 3. Alexander Springs ER Physicians -medical bill 400.60 4. Quest Diagnostics, Inc. -medical bill 2 54 5. Carlisle Oncology -medical bill 20.00 6. Carlisle HMA Physician Management -medical bill 20.00 7. Carlisle Regional Medical Center -medical bill 1, 344.43 8. Capital Tax Collection Bureau -unpaid taxes 58.73 9. UGI Utilities, Inc. -utility bill 14.06 10. Tribute MasterCard -credit card account 230.57 11. Capital One Bank MasterCard -credit card account 218.05 12. Regional Acceptance Corporation -deficiency claimed on 2007 Ford Taurus automobile 6, 530.12 13. PPL Electric Utilities 125.72 14. Kay Jewelers -credit card account 1, 039.25 TOTAL (Also enter on Line 10, Recapitulation) I $ 10,109.27 If more space is needed, insert additional sheets of the same size. s - ~~~{~ E T Ro ~i r~ BAN K 3801 Paxton Street Harrisburg ^ PA ~ 17111 my~~v`:~obank.com 888.937.0004 July 1, 2009 Mark W. Allshouse 4833 Spring Rd Shermansdale PA 17090 RE: Estate of: Dawn N. Ritchie (Shenk) Tax Identification Number: 163-54-9692 Date of Death: May 18, 2009 To Whom It May Concern: This letter is in reference to decedent account information you requested for the individual listed above. We are able to provide the following: Account Type: Checking Account Number: 513364299 Date Opened: 10101 /2001 Date Closed: 06/17/2009 Primary Owner: Dawn N. Ritchie Date of Death Balance: $187.11 Accrued Interest: $0.00 Principal Balance: $187.11 (Jx~sTO~vN B~~ A Tradition of Excellence 77 East King Street P.O. Box 250 Shippensburg, PA 17257 June 8, 2009 Mark W Allshouse, Esquire 4833 Spring Rd. Shermans Dale, Pa 17090 RE: Estate of Dawn N. Shenk (a/k/a Dawn N Richie) To Whom It May Concern: The following information is being provided per your request. The above had an individual checking account with Orrstown Bank, account 146001288 which was opened 5/27/08. This is the only account held at Orrstown Bank in her name. Balance as of 5/18/08 was $682.51 with accrued interest from last statement (5/12/09) to can-ent of $1.23. There was no other relationship prior to 5/2008. Any questions please feel free to call me at 717-258-1129. Sincerely, ~--- Judith N. Cornman Branch Executive Officer Seven Gables Office 1 Giant Lane Carlisle, Pa. 17013 ~~~ 11 i ACCEPTANCE CORPQRAT~ON 266 Beacon Drive Winterville, NC 28590 0236543417 DAWN SHENK 27 E. SOUTH ST. RD CARLISLE, PA 17013 Explanation of Calculation of Suralus or Deficiency Account Number: 0236 543417 Description of Collateral: 2007 FORD TAURUS Vin #: 1FAFP53UX7A159913 Dear: DAWN SHENK '~ As a result of your default we sold the above referenced collateral for $ 7700.00. Explanation of some terms: 08/05/09 Surplus: The net disposition proceeds (after deducting applicable costs and expenses and attorney's fees) are greater than the amount you owe us, resulting in a surplus that we will either return to you or pay someone else claiming an interest in the collateral. Deficiency : The net disposition proceeds (after deducting applicable costs and expenses and attorney's fees) are less than the amount you owe us, resulting in a deficiency. You remain liable to us for this deficiency which you are required to pay in full upon receipt of this communication. Calculation of Surplus or Deficiency: 1. Amount you owed us as of 06/04/09 (including interest, other fees and any other amounts added to your debt as allowed by law): $13982.25 ~` 2. Sale Price of Collateral: 3. Unpaid Amount (#1 minus #2): 4. Expenses: 5. Credits: 6. Amount paid on your behalf to other secured party: 7. AMOUNT OF SURPLUS: s. AMOUNT OF DEFICIENCY: $ 7700.00 $ 6282.25 $ 59037 $ 342.50 $ o.oo $ 0.00 $ 6530.12 ICF American Bankers Life Assurance Company of Florida cJo DFS Claims and Activatiais, PO 8mc 977122, Miami, FL 33197-7122 September 15, 2009 ESTATE OF DAWN N SHENK 327 S HANOVER ST CARLISLE PA 17013-3911 I...III~~~ill~~~~~~ll~~ll~~~ll~l~l~~~~~ll~~~ll~~l~ll~~~l~l~l~l Re: Claimant: DAWN N SHENK Account No.: 3679 Claim Number: G6583679 Date of Loss: 05/18/2009 Please accept our sympathy for your loss. You recently received notice of a claim payment that was issued on 09/15/2009 in the amount of $975.59 - An additional interest amount of $.60 has also been issued at a rate of 0.179'0 . Sincerely, DFS Claims and Activations Tel: 1-(800)-859-0490 Fax: 1-(305)-252-6910 www.benefitactivations.com ~~~~i~~niw~a~ww~rm~rh~~~r~~~w~~ ESTATE QF DAWN 44176 N SHENK LARRY D SHENK, EXEC 4833 SPRING RD SHERMANS DALE PA 17090 SPRL!IG GARDEN BECinNZNS.;. :DEPaSITS:$ ACCOUNT SUMMARY _. BALANCE OTHER ADDITIONS NO. ANOINT OTHER CHECKS PAID.: CURRENT.: ~~RACTTONS ENDING 0.00 6 1,045.06 ~Ifii:EREST::Pp . ~- A~fOIINT N0. A~WIINT 0 ! -`BALANCE ~ 0.00 0 0.00 0.00 1,045.06 POSTING _, ACC[DUNT ACTIVITY DAI`E TR'ANSACTId1+I DESCRIPTION DEPOS2'3'$,INTEREST ..:.CHECKS ~8; O'INER : ::: &:.OTHER ADD]fti`rONS ~.~'TItACi"IONS ~ ~tAILY 05-27-09 BEGINNING BALANCE . BALANCE OS-27-o9 DEPOSIT 06-10-09 DEPOSIT `502.00 $0.00 06-1I-09 DEPOSIT L98.96 502.00 i 06-16-09 DEPOSIT '.100.00- ~r/~ 700,96 800 06-18-09DEPOSIT 61.00 "rty7fc~S i~IS, i"7 % "'~ .96 06-22-09 DEPOSIT , l 140.00 - Clt(,fZ! i ~"r S; 861.96 ; C~~M~"QSt~- 43.10 i,0o1.96 r~ fj,~ nC,~, 1, 045.06 } ENDING BALANCE ~ 51,045.06 Ronan Funeral Home Phone 717-258-9863 Tuesday, May 26, 2009 Paula Hollowell 327 S. Hanover Street Carlisle, PA 17013 Dear Paula, 255 York Road Carlisle, Pennsylvania 17013 Fax 717-241-4041 Lynn A. Ronan, Funeral Director We Caze 100% Our Family Serving Your Family Thank you for selecting our funeral home to provide services for yotu family during yottr time of bereavement. I hope that you found our services, so far, to be of the highest standards that we always try to achieve. TIYe following is a summary- of the service charges as previously explained and provided in written form on the services for: PROFESSIONAL SERVICES DAWN N. SHENK Basic service of funeral director and staff $ 3,100.00 Other Prepazation of Body $ Incl. TOTAL PROFESSIONAL SERVICES Use of Facilities & Staff for Visitation $ Incl. Use of Facilities & Staff for Memorial Service at Funeral Home $ Incl Transfer of Remains to Funeral Home . $ Incl. Hearse /Funeral Coach $ Incl. MERCHANDISE SELECTED Casket: Minimum Alternative $75.00 Acknowledgement Cards Incl Register Book Garden Path $ 145 00 Memorial Folders . Incl Keepsake pendants (2) $ 400.00 Um /Vase $375.00 TOTAL MERCHANDISE SF'i,E('TEn CASH ADVANCES Certified Copies. of Death Certificate Clergy Honorantun Newspaper Notice Sentinel Newspaper Notice Patriot-News Flowers Opening Grave Sexton Organist Crematory Fee Coroner Fee TOTAL OF SERVICES $ 120.00 $ 300.00 $ 159.05 292.92 $ 132.50 $ 400.00 $ 80.00 $ 125.00 $ 220.00 $ 25.00 CASH ADVANCE TOTAL BALANCE DUE If there are any questions or concerns that remain unanswered, please call me. Sincerer, ~' L n A. Ronan Funeral Director $3,100.00 S995.00 $1,854.47 $5,949.47 55,949.47 Lei/ c I'f~ ~ ~ ~ I ~ ~~ l~ ,~; -~/,~ C/ ~. RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17613 SHENK DAWN N Estate File No.: Paid By Remarks: ------------------- Fee/Tax Description 2009-00485 LARRY D SHENK CJ PETITION LTRS TEST WILL SHORT CERTIFICATE JCP FEE AUTOMATION FEE Check# 1206 Total Received......... Receipt Date: 5/27/2009 Receipt Time: 10:08:03 Receipt No.: 1056918 Receipt Distribution ----- -------- ------- ---- Payment Amount Payee Name 20.00 CUMBERLAND COUNTY GENERAL FUN 15.00 CUMBERLAND COUNTY GENERAL FUN 24.00 CUMBERLAND COUNTY GENERAL FUN 10.00 BUREAU OF RECEIPTS & CNTR M.D 5.00 ---------------- CUMBERLAND COUNTY GENERAL FUN 574.00 $74.00 CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717J 248.3186 Fax: (71 ~ 248-2663 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 official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Mark W. Allshouse, Esquire Dawn N. Shenk 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 following dates: June 12, June 19, and June 26, 2009 Advertising Cost $ 75.00 Proof of Publication Second Proof Request Payment received Total Amount Due $ 0.00 $ 0.00 $ 75.00 $ 0.00 Becky H. Morgenthal, Executive Director 1NVC~ICE 1500 Paxton Street ;; ;, .~ "`> * ~ Harrisburg, PA 17104 ' ~y _~ Q~~~~ 117-236-4300 ®~ D ~ ~ ~ A T 1 n t~1 ~^ 717-236-6803 FAX i" A~ 1 4 U IY J www.{ournalpub.com -------------- INVOICE TO ------_~_ Christian Lawyer Solutions, LLC Accounts Payable 4833 Spring Road Shermans Dale, PA 17090 6/30/2009 ORDER #: 65163 TERMS: Net 30 Days ------------ ADVERTISER ----------- Christian Lawyer Solutions, LLC INVOICING: Advertiser DESCRIPTION OF CHARGES COST CREDIT - BALANCE PUBLICATION: CLASSIFIED/CENTRAL PENN BUS. JRNL COVER DATE: 6/26/2009 THEME: CLASSIFIED AD/CENTRAL PENN BUSINESS JRNL RATE CARD: DESCRIPTION OF AD: Legal IisUng: Estate of Dawn N. Shenk REP(S): MARK SUNDAY SIZE: LEGAL LISTING, PAGE: 115.00 COLOR: BS~W 0.00 SPACE SUB-TOTAL: 115.00 " BALANCE DUE: 115.00 RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARMER STRASBAUGH Cumberland County - Orphans Court One Courthouse Square Carlisle, PA 17613-3387 Receipt Date: 11/30/2009 Receipt Time: 10:08:14 Receipt No.: 1041133 SHENK DAWN N File Number: 2009-00485 Paid By Remarks: CHRISTIAN LAWYER SOLUTIONS LLC JN ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name ACCOUNTS 50.00 CUMBERLAND COUNTY GENERAL FUN ADVERTISING 80.00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 2087 $130.00 Total Received......_.. $130.00 AlV~REWS ~ PATEL ASS®CfATES, R ~. 3912 TRINDLE RD. ' '' ~ CAMP HILL, PA 17011 ANDREWS & PATEL ASSOCIATES, P. 3912 TRINDLE RD. PHONE: (717) 761-8740 CAMP HILL, PA 17011 ~, i ~• 09/29/09 09/29/09 DAWN N. SHENK (ESTATE) 27 EAST SOUTH STREET " ~~ ;~ CARLISLE PA 17013 27798 (1) 27798 Detach this stub and return with paymen' DAWN N. SHENK (ESTATE) (27798.0) 27798.0) 02/23/09 AVASTIN 10 MG 50242-0060 -0 12,420.00 03/25/09 Ins Pmt-HIGHMARK BLUE SH3ELD 3 140.32 03/25/09 Adjustment , 8 913.60 ~ 03/25/09 Rebill-PATIENT ACCESS NETWORK 0 00 04/'D9/09 Ins Pmt-PATIENT ACCESS NETWORK . 366.08 04/09/09 Ins Pmt-PATIENT ACCESS -NETWORK 30.'.00 30.00 02/23/09 09/01/09 LATE PAYMENT PENALTY 10.40 10.00 09/01/09 09/29/09 LATE PAYMENT PENALTY 10.0,0. 10.00 09/29/09 09/29/09 COLLECTIONS FEE - 12.00 12.00 09/29/09 .TOTAL FOR DAWN N. SHENK (ESTATE) 62.00 YOUR ACCOUNT WILL BE SENT TO THE COLLECTION AGENCY IN I T)AY~ AT.G!~CG' Mnu~ nrlrt~rt~rrrr+ ,,,rtir.T TOTAL DUE 62.00 61 - 90 DAYS ~ 91 -120 DAYS 0.00 0:00 120 DAYS ~ ~ 3 ©. 0 0 6 2. 0 0 Please pay Phis CURRENT ~ 31 - 60 DAYS "32, 00 0.00 BLUE MOUNTAIN ANESTHESIA ASSOC PO BOX 947 CHAMBERSBURG, PA 17201-0947 (800}827-3458 X407 8AM-4PM BMA ADDRESSEE: DAWN N RITCHIE ~.,'{~ 327 S HANOVER ST ° CARLISLE PA 17013-3911 Please check box if above address is incorrect or insurance Information has changed, and indicate change(s) on reverse side. naeo - to PLEASE DETACH AND RETURN TOP PORTION WITH YOUR PAYMENT IN ENCLOSED ENVELOPE Date Ptocedare Code PatietTt NarT>ie DescnptEan Bilfect; Amount Balance Physician/Location 04/16J0$ 00532 DAWM N ANESTHESIA ACCESS CENTRAL VENOUS CI 675.00 43.20': HOWARD ALSTER 05/05/08 DAWN N AETNA ADJl15TMENT 459.00 - 361 ALEXANDER SPRING RD Please Pay 43.20 YOUR CLAIM HAS BEEN SUBMITTED TO YOUR INSURANCE COMPANY. THE REMALNING BALANCE IS YOUR RESPONSIBILITY. PAYMENT IS DUE. WITHIN 30 DAYS. I ~~ STATEMENT SEE REVERSE SIDE FOR IMPORTANT BILLING INFORMATION IF PAY IM 6 BY VISA OII YAtiiEpCAi1D, Fil OUT BELOW (( ~~ i~ ^v~ L~~ O MABTERC~ uwo MIS ow. oAT T BKNiAT1JtE MUST INCLUDE 3 DIGIT SECURITY CCDE FR(MA BACK C7F CARD r 571i~ `t7DAT~~ ' ~ PRX~.daHf~U ACCOUNT NO. 4/18/09 43.20 7172-G SHOW AMOUNT PAID HERE ~ MAKE CHECKS PAYABLE / REMIT TO: ~~ BLUE MOUNTAIN ANESTHESIA ASSOC PO BOX 947 CHAMBERSBURG, PA 17201-0947 ~n~~~~n~~u~~~~~unn~~~~n-~~~u~~n~~n~~~ 17480-BMA-10 PO BOX 15630 DEPT 99 WII..MINGTON DE 19850 I I I IN I I I N 11111111111111111111111111111111111111111111111111111 Calls to or from this company maybe monitored or recorded for quality assurance. 5G2MR7 DAWN RITCHIE 27 E SOUTH ST CARLISLE PA Dose-sa3 17013-3427 NCO FINA.:ivCIAL SYSTEMS INC 507 Prudential Roac, Horsham, PA 19044 1-800-597-4549 OFFICE HOUR ~: 8AM-9PM MOh( THRU THURSDAY 8AM-SPM FRII'AY 8AM-12PM SA"URDAY Tan 7, 2009 CREDITOR; A[ FX.y. QED-~epRTUG5 ER PHYSC ___, ACCOUNT ##:91098167 0014524 PRINCIPAL: $ ~=00.60 INTEREST: $ 000 INTEREST RA' ~: COLLECTION ~HARGES: $ 0.00 COSTS: $ 0.00 OTHER CHARGES: $ 0.00 TOTAL BALAPdCE: $4~_ It is important' hat you forward payment in full The named creditor has placed this account with our office for collection. If you choose not to respond to this notification, we will assign your account to a collector with instructions to collect this balance. Send payment in full to the address below. Returned checks may be subject to the maximum fees allowed by your state. You may also make payment by visiting us online at www.ncofinancial.com. Y.iur unique registration code is C5G2MR79-9BVMRPB. Unless you notify this office within. 30 days after receiving this notice that you dispute the validity of the debt or any portion thereof, this office will assume this debt is valid. If you notify this office in wasting ~ rithin 30 days from receiving this notice, this office will obtain verification of the debt or obtain a copy of a judgement and mail you a eo of such judgement or venfication. If you request this office in writing within 30 days after receiving this notice, this office will provide you with the name and address of the original creditor, tf different from the current creditor. This is an attempt to collect a debt. A,ny information obtained will be used for that purpo:;e. This is a communication from a debt collector. PLEASE RETURN THIS PORTION WITH YOUR PAYMENT (MAKE SURE ADDRESS :}ROWS THROUGH WINDOW) QUeS~ Diagnostics GXBEJH 10205 10.510 1-1 17011U81U023895 57U6797983I2 DAWN N SHENK 27 E SOUTH ST ~~ CARLISLE, PA 17013-3427 ~ Intl~lnlll~nnnl~nlluillnln~nltllullnltllullullll Page 1 Laboratory Invoice For services not includetl in your physician's bill. Invoice Number Lab Code 5706797983 KQP Customer Service LOG ON NOW at wvtniv.guestdiagnostics.com/bill to convenient) pay your invoice or give us your feedback on our patient survey. Phone Fax 1-800-766-2604 1-800-601-6608 Weekdays 8AM - 6PM Se Habla Espanol 9AM-6PM Tiempo del Este Please have your invoice available for reference. Laboriltory Tests. Were Requ~ $y: lion ~ tip ~tlied YO: " Referring Physician: D71029ANDREWS,ALBERT T Insurance Name: HIGHMARK BLUE SHIELD Physician Address: 3912 TRINDLE RD Insurance ID: 859717794 CAMP HILL, PA 17011 Group Number: 105 Wti.R~s.and Diagrrosfs Questions Mtist 6e,4-xwe[es1.By.Voea~h~c~Y, Patient Name: DAWN N SHENK Invoice Date: March 31, 2009 Responsible Party: DAWN N SHENK Amount Due: $2.54 Date of Service: March 9, 2009 Payment Due Date: 04/21 /2009 THE BALANCE DUE REPRESENTS YOUR COPAY OR DEDUCTIBLE AS INDICATED BY HIGHMARK BLUE SHIELD. THE CHARGES RESULTED FROM LABORATORY TESTING ORDERED BY YOUR DOCTOR AND PERFORMED BY QUEST DIAGNOSTICS. THESE CHARGES WERE NOT INCLUDED IN YOUR DOCTOR'S BILL AND REPRESENT YOUR FINANCIAL RESPONSIBILITY. WE APPRECIATE YOUR PROMPT PAYMENT. THANK YOU FOR USING QUEST DIAGNOSTICS. ~ ~ ~ D t CPT C d " ~ I Insurance I Insurance I Medicare) I Patient Patient a e --- -- o e -- - Test Descnpuon - ----- - ------- ----- - - --------- --- - -- -- - Charge _ I iii Discount --_.... Paid ~ Medicaid Paid - ---- _ _~ --- ---~- 1 Paid Owes ~ 03/09/09 1 83615 LACTATE DEHYDROGENSE 1 $qp 00 -- - -" " -- -'- -- ~ 03)09(09 80053 COMPREHEN METABOLIC PANEL 1 $42.85 i I 03/30/09 PAID BY INSURANCE I i ($14 44) 03/31109 i j ~ ( i ADJUSTMENT I ~ I I ($65.87) ~ ~ j I ~ i ! i I ~ ~', l Tax ID: 38-2084239 ICD-9 Codes: 174.9 i62.as ($ss.a7)I ($ta.4a) So.OO So.oo~ 52.54 'The CPT codes provided are based on AMA guidelines and without regard to specific payor requirements. __.._ • Please fold and tear payment coupon along perforation and remit with payment in the envelope provided • A88 N 6 pg Quest e ~ Diagnostics Payment Coupon LOG ON NOW. Pay your bill online securely anytime - day or night at www.questdiaanostics.com/bill or call 1-800-766-2604 Quest Diagnostics also accepts credit cards and on-line check payments v-sa Please make your check payable to Quest Diagnostics. Be sure to include invoice number on your check. ^ Check here if address has changed. Please provide your new address information on the back. Quest Diagnostics reserves the right to assign this receivable t0 any oT its affiliates. Lab Code: KOP Amount Due $2.54 Due Date: 04/21/2009 Invoice Number: 5706797983 Patient Name: DAWN N SHENK Amount Enclosed: If you received an explanation of benefits showing your responsibility is less than the amount shown on this bill, please pay the lesser amount To fully resolve your invoice, please provide a copy of your explanation of benefits. MAIL PAYMENTS ONLY TO: QUEST D[AGNOSTICS INCORPORATED PO BOX 74U77~ CINCINNATI OH 45274-077 Itltill)tlfttlllltilltltill)tltllitlltt~ltllltltttltltltllttll O7rKOP48015706797983000002543033111?01910135890000008 ASSET MANAGEMENTuc 1891 Santa Barbara Drive, ~i204 Lancaster, PA 17601 717-519.1770 or 888.592-2144 Dear DAWN N SHENK, Acct ~Ur: CARLISLE ONCOLOGY RE: 654809 Dater.. June 04, 2009 Batasne Due: $ 20.00 We thank you for choosing CARLISLE ONCOLOGY for your health care needs. You should have received a bill for services provided by CARLISLE ONCOLOGY. The balance in fuN of S2D.D0 is now due for payment in full. We realize this could be an oversight and not a deliberate attempt to disregard your obligation. You may take care of this obligation today by returning a check, money order, or charge card information with this letter. Please mail your payment in the enclosed envelope. VISA and Mastercard are also accepted over the phone by calling 717-519-0753 or toll free at 877.205-3879. If you need to make other payment arrangements, please call 717-519-0753 or toll free at 877.205-3879. If fuA payment is not received in thirty days your account maybe considered for collection activity. In the event full payment has been made or payment arrangement. has been establisfied, please accept. our thanks and disregard this notice.. This is an attempt to collect a debt. Any information obtained wiU be used for that purpose. Unless you notify this office within 30 days after receiving this notice that you dispute the validity of this debt or any portion thereof, this office vvitl assume this debt. is valid. If you notify this office in writing within 30 days after receiving this notice this office will obtain verification of the debt and mail you a copy of such verification. If you request from this office in writing within 30 days after receiving this notice, we will provide you with the name and address of the original coeditor if different from the currem creditor. This communication is from a debt collector. APEX ASSET MANAGEMENT LLC PO Box 7044 Lancaster PA 17604.7044 Please tear off and return lower portion with payment. 01769 II~~II'I~I~~~~~~II'IIIII~II~II~~1'II~II~~1~I~I~II~1'~I~~If~~I~lll CARL70 8301103105 LAN HSP Dawn N Shenk 19083-03 8 27 E SOUTH ST CARLISLE PA 17013-3427 ~~ v.. ~~~~ .~ ^ ~ ...me.. W.~ ae o.~~c~ u1c n~nnillaunl ill uitl VtlD fVV1OtlV. i 7/JM ^ i~ Card # Security Code E~iration Datr Billing Address Signature Amount Authorized CARLISLE ONCOLOGY PO BOX 468 EAST PETERSBURG PA 17520.0468 'fig _~~~~,~, ~,~_y~:(: 65^4809 ;5~J~~ S7l` nn tamerw 1...... nA ~fnnn 654809 '~~'~~ ~ G ~~ PAYMENT OPTIONS CARLISLE HMA PHYSICIAN MANAC~NI Check # Amt $ PO BOX 281629 ATLANTA, GA 303841629 viaoiQ ono 539aD SA18 RETURN SERVICE REQUESTED >23614 7214698 O01 D92D96 DAWN N SHENK 27 E SOUTH ST CARLISLE PA 17013-3427 Please Include Secu ' Code From Back Of Card CHECK CARD IISfNO FOR PAYMENT MASTERCARD Y/SA OSA ~ D^ISCOVER CARD NUMBER EXP. DATE CARDHOLDER NAME SECURITY CODE S1f3NATURE AMOUNT REMIT TO: CARLISLE HMA PHYSICIAN MANAGEM PO BOX 281629 ATLANTA GA 30384-1629 ~n~~~~~un~~~~~n~n~n~n~~~~~~nu~~~~i~nn~~~~~~un~~~~ Office Phone Number Statement Date Your Account Number Page No. SHOW AMOUNT X717 519-0753 04/17/09 654809 1 20.00 PAID HERE CHARGES APPEARING ON THIS STATEMENT ARE NOT INCLUDED ON ANY HOSPITAL BILL OR STATEMENT 30509 ),dALCO![ !tD OFFICE VIS .EST PT INV# s 19 3HENR, DAaTN ..40.00 031809 BLIIE SHIELD`PAYIKENT -1.25 031809 BLIIE SHIELD ADJVSTIdENT` -18.75. Insurance Balance: 0.00 Patieat Balances 20.00 statement PLEASE INDICATE YOUR ACCOUNT NUMBER WHEN CALLING OUR OFFICE: gate: 04/17/09 654809 Current 31-60 Daya 61-90 Days >90 Days Total Ins`P~nding- ~°~ aooo o.oo o.oo o.o0 20.00 0.00 20.00 SEND IN(}UIRIES / PAYMENTS T0: CPRLI3LE HltA PHYSICIAN i4AL3AC3EM PO BOX 281629 ATLANTA, CAA 303841629 717'.519-0753 ?3614 7214686 023615 02361$ 00001lOOi001 920966902 ~/ The NE''t~i' j=~ ~~; +~ R.EGIt~T1~~i,, ~'"~° MEDICAL CENTER June 30, 2009 Mark W Allshouse, Esquire 4833 Spring Rd Shermansdale, Pa 17090 Re: Dawn N Shenk Dear Mr. Allshouse: We have received your letter here at Carlisle Regional Medical Center. I have looked up the accounts of Dawn Shenk or Dawn Ritchie. It looks as if the total of her accounts come to 1,344.43. Should you have any questio~is or need additional information feel free to contact me at 717-960-1680. Sincerely, ~,. r , Carlisle Regional Medical Center Business Office 36i Alexander Spring Road ^ Carlisle, PA 1~oi5 ^ ~i~-249-1212 ^ www.CarlisleRMC.com X07/07/2009 15:55 TAXPAYER DELINQUENT ACCOUNTS 1163 54 9692 SHENK DAWN N, ESTATE !YEAR TYPE TAX I/P/BC COSTS 2007 BDUE 1201 49.96 7.34 0.00 ;2008 BDUE 1175 1.40 0.03 0.00 TOTAL DELINQUENT TAXES DUE 58.73 CTCB PAYMENT EXON DOCKET 57.30 1 / 12 / 2009 X 1.43 6/05/2009 R DATA OK?(YES,ADR,HST, CAN,PGE) 7/7/2009 3:58:29 PM TigerTerm -TigerTerm ~.~. ~;r~ ;, 6 M ~ r .%~ ~~ ~ ~ ~ ~ ~^ ~~ ~ ~ ~~ ti _~ .~. ~ - `~. S^ v '. t ;. -.. 'u ~ V M~~~~t ~ MIP ,~ ~ ~ ~- ~~ ~~- _ -~ ~:~:~::~~ dAS dEd Y/CE Billingg Summary for Service to: DAWNTI SHENK 27 E SOUTH ST CARLISLE PA 17013 ooo~ssa 6 Rate Classification: Residential Heating Billing Period: 04/21/2009 to 05/19/2009 (28 days) Remote Device Read Questions? Call 800-276-2722 or write to UGI at PO BOX 13009 Reading, PA 19612-3009 "Your cum:nf UGI charges include State faxes totaling about $ 0.45. Past Bill Information -UGI Utility I The account balance on your last ill was ................ $ 59.33 Thank you far your payment of ..................................... -59.33 215 250 049814 Late Charge ....................................................................... 0.01 Your balance as of 05/22/2009 ................................... ~j~ Current Bill Information -UGI Utility Customer Charge .............................................................. 8.55 Commodity Charge (4 CCF at $0.91750) ................. 3.67 Distribution Charges (First 4 CCF at $0.42500) ...... 1.70 PA State Tax Surcharge .................................................. -0.04 Total Current Charges -UGI Utility ...............................~$$ UGI Utility charges owed this bill ..................................................................................... S 13.89 Total Amount Due, Please Pay by Due Date (06/12/2009) ....................................... $13.89 Meter Information -Next Read Date June 19, 2009 4.50 Average CCF Per Day Meter Number Previous Reading Present Reading CCF Used 4.05 1436752 482 (remote) 486 (remote) 4 3.60 3.15 Messages from UGI 2,70 ^ Yaur current price to compare is $ 0.91570 /CCF. 2'25 ^ Your tofal usage is 486 CCF. Your average monthly usage is 48 CCF. 1.80 1.35 ^ Help prevent pipeline damage, accidents and service disruptions. Call 811 before you. dig. 0.90 ^ Sign up to view and pay your future UGI bills online at www.ugi.com. 0.45 0.00 MJJASONDJFMAM 2008 Months 2009 Last This Average Year Year CCF/day 0.14 Daily temperature 61 °F If you pay at a payment agent please take your entire bill. Make check payable to UGI. Keep this part for your records. Important information is on the back of this bill. UGI Utilities, Inc. Please pay by the due date ~_~ PO Box 71203 to avoid the late charge. Philadel hia, PA 19176 Please return this portion P _____ with your payment _..-........ dAd dEAY/dE Customer Number 215 250 0498 14 RH June 12, 2009 i.,,iii,,,ui,,,,,,n,.n,,,ii„i„i„i,~i,,,i„i,n,,,i„ri,i r I ****~******AUTO**5-DIGIT 17013 DAWN N SHENK $ 13.89 _27 E SOUTH ST CARLISLE PA 1701::3-3427 $14.06 zso 2152500498140612020000138900001700DOOOOOOOOD0000000002 i u~aii iii gill ilia ii i i~ iu ilia ail ii~~i iiii i ii iii alit ui~i ul ua P.O. Bo1484~8 Oak Park. Ml 48237 Return Service Requested 09/24/09 DAWN SHENK 40i KAUFFMAN ST BOILING SPRGS PA 17007-9799 I~~~III~~~III~~~II~~~I~~~II,I~~I~~~II~I~~I~I~~II~~~~I~I~~II~~I Phillips & Cohen Associates, Ltd. Ph 866-690-0884 F~ 302-368-0970 Office Hours: M - Th: 8am - 9pm Fri: 8am - 6pm Sat: 8am-12pm 1002 Justison Street Wilmington, DE 19801 Reference #: 1641209 Balance: $230.57 -------------------------------------------------------- *** PLEASE DE'I:4CH :1ND RF,7'[TRN IN THF. ENCLOSED ENVELOPE ~'VITH YOLJK PAYMENT *** RE: Client: Jefferson Capital Services Original Creditor: TRIBUTE MASTERCARD Client Acct#: 4620 Reference: 16541209 Balance: $230.57 To the Estate of DAWN SHENK: Our client. Jefferson Capital Services. now ovens the debt previously owed to TRIBUTE MASTERCARD. Jefferson Capital Services recently received notification that DAWN SHENK passed away . Initially, on behalf of our client, please accept our condolences. At the time of the passing of DAWN SHENK. an outstanding debt in the amount of $230.57, vvas owed to Jefferson Capital Services. To resoh'e this matter and prevent any further collection activity, either full payment must be sent to this office at the above address or infornnation regarding the Estate of DAWN SHENK must be received, by mail or telephone, by our office. IF YOU HAVE ANY QUESTIONS, YOU MAY CONTACT OUR OFFICE AT THE ABOVE TELEPHONE NUMBER. Sincerely, Phillips & Cohen Associates, Ltd. * * IMPORTANT CONSUMER INFORMATION Unless you notify this office within thim• (30) days after receiving this notice that. you dispute the validity of this debt or any portion thereof,, this office will assume this debt is valid. If you notifi' this office in writing within thirty (30) days from receiving this notice, this office will: obtain verification of the debt or obtain a copy of a ludglnent and mail you copy of such verification or.judgment. If you request this office in writing vvithn~ thirty (30) days of receiving this notice, this office will provide you with the name and address of the original creditor. If different from the current __._ creditor. This communication is from a debt collector. This is an attempt to collect a debt and any information obtained _ will be used for that purpose. Phillips & Cohen Associates, Ltd. 1002 Justison Street • Wilmington, DE 19801 866-690-0884 Estate Information Services, LLC 2323 Lake Club Drive Suite 300 ~:_j;~tf..~.~r4~~'.~j ti ~13t ;-;f`~"&1t'-~. ~~;, Columbus, OH 43232 Hours: Mon-Thu Sam-gam and Fri Sam-Spm EST PH: (614) 322-2758 (800) 604-5435 FAX: (614) 322-2761 Website: www.probate-care.com July 20, 2009 To The Family of Dawn N Shenk 405 Kauffman St Boiling Springs PA 17007-9799 RE Creditor Name: CAPITAL ONE BANK (USA) NA Account Type: MASTERCARD Debtor: Dawn N Shenk Amount of Debt: $ 218.05 Reference #: 2214902 Dear Family: We understand this may be a difficult time for the family. Estate Information Serviceshas been hired by our client to assist the Estate in bringing to a resolution the outstanding balance owed by the decedent on the above account. Therefore, we need to receive from you pertinent estate information so that we can file an estate claim for ourclient. Please call this office at the number above with this information. However, the balance may be paid by merely returuning the below payment coupon, along with payment of the amount referenced above, $ 218.05 and no estate claim will be filed. Again we extend our deepest sympathies to the family during this difficult time. You have our commitment that we will do our best to make the resolution of the payment process as quick and as easy as possible. Unless, within thirty (30) days after receipt of this notice you dispute the validity of the debt, or any portion thereof, we will assume the debt is valid. If you notify us in writing within said 30 days that the debt or any portion thereof is disputed, we will obtain verification of the debt and will mail such verification to you. In addition, upon your written request within said 30 days, we will provide the name and address of the original creditor if different from the current creditor. This is an attempt to collect a debt from the Estate and any information obtained will be used for that purpose. This eommunicatioa is from a debt collcctor. -----------------------------------------------Cut along this line-------------------------------------------- {LSS,';.)i{ UtErt~~SPi: St;YY 'F`ly: ir. f .. Please Make Check Payable To: Debtor: Dawn N Shenk CAPTTAL ONE BANK (USA) NA Reference #: 2214902 Amount Due: $ 218.05 Mail Payment To: Account Type: MASTERCARD Estate Information Services, LLC. 2323 Lake Club Drive, Suite 300 Columbus, OH 43232 See Reverse Side for Special State Disclosures ^~~~~~~~ ACCEPTANCE CORPORATION 266 Beacon Drive Winterville, NC 28590 0236543417 DAWN SHENK 27 E. SOUTH ST. RD CARLISLE, PA 17013 Explanation of Calculation of Surplus or Deficient Account Number: 0236 543417 Description of Collateral: 2007 FORD TAURUS Vin #: 1FAFP53LTX7A159913 Dear: DAWN SHENK As a result of your default we sold the above referenced collateral for $ 7700.00. Explanation of some terms: 08/05/09 Surplus: The net disposition proceeds (after deducting applicable costs and expenses and attorney's fees) are greater than the amount you owe us, resulting in a surplus that we will either return to you or pay someone else claiming an interest in the collateral. Deficiencv : The net disposition proceeds (after deducting applicable costs and expenses and attorney's fees) are less than the amount you owe us, resulting in a deficiency. You remain liable to us for this deficiency which you are required to pay in full upon receipt of this communication. Calculation of Surplus or Deficiencv: 1. Amount you owed us as of 06/04/09 (including interest, other fees and any other amounts added to your debt as allowed by law): $13982.25 2. Sale Price of Collateral: $ 7700.00 3. Unpaid Amount (#1 minus #2): $ 6282.25 4. Expenses: $ 590.37 5. Credits: $ 342.50 6. Amount paid on your behalf to other secured party: $ O.oo 7. AMOUNT OF SURPLUS: $ 0.00 s. AMOUNT OF DEFICIENCY: $ 6530.12 -~ ^~~ ', Page 1 _ ::..aur Bill: Asr~,w~i A'6~bcr :: ,< >' PPL EIeC#1~ie ~~ ~ ~ 96230 85020 Utilities '~ `" ... Electric Summary Page Service Balance as of May 21, 2009 $92.53 For: Char es: ~ DAWN SHENK PL ELECTRIC UTILITIES Charges $33.19 Tota 27 E SOUTH ST CARLISLE PA I7oI3 Total Charges $125.72 Final Bi11 ,. ~ .'~6is:Antoun~,~io Latec.#hao ~~n.1~ :2 ; . ~' .:$1~5'L. Account Balance $125.72 Questions about this bill? Please contact us by Jun I 1 at 1-800-342-5775 (1-804-DIAL-PPL) or write to: Customer Service 827 Hausman Rd. Allentown, PA 18104-9392 www.pplelectric.com Electric Use 48 40 32 24 16 8 0 KWH -Average Per Day 11~ieter Reading Information This part of your bill helps you understand your electnc use. Types of 111~eter Readings: Actual - Adjusted Estimated Customer 0 SONDJFMAMJ 2008 Momhs 2009 11•ieter #23320582 May 2l Actual 26932 May 4 Actual 26651 17 Davs KWH Billed 281 The graph sows the average number of KWH you used each day. You used 281 KWH -n 17 days, or an average of 16 KWH a say. The average daily temperature for your area last month was 60F. Other important information on back ~ _ Return this part to address below with a check payable to PPL Electric Utilities Corporation - ,.. ... .. ;, <:;.. •I~a ;Ttus AmQUnt :.:: ~ oi~ ~~ AecoiEic~t Ntailit a.. F]case::P~ : 3 96230-85020 Jun 11, 2009 $125.72 AT 01 054086 273698257 A"*3DGT DAWN SHENK LARRYSHENK 40,5 KALIFFMAN BOILING SPRINGS PA 17007-9799 ~~Il~~~~l~l~ii~~~~~lll~~~l~~iii~~~~~l~~~l~lill~lllllill~~~~ull~l Amount Enclosed ^. ^ ^ ^ . PPL ELECTRIC UTILITIES 2 NORTH 9TH STREET RPC~'iENNI ALLENTOWN PA 18101-1 l75 1 7900001257290000125726 9623085020 Page: i of 1 ~ ~ W~ i_ c R S =v2'y KISS b°5i~?S '~^d?h i<3y. kay~.c~m uawn Iv ~nenK Account# 3106583679 Closing Date 06/25/2009 D~fe Date 07/20/2009 Past Due $160.00 Minimum Payment $SO.00 To#a9 flue $240.00 Previous Balance Purchases & Other Charges , -- Credit Insurance' Payments &`Credits $975.59 ! $47.56 I $16.10 I $0.00 I $1,039.25 t Balance Payable to Avoid Further Finance Charges $1, 0 3 9 .2 5 NOTICE: See reverse side for important information. Please detach and return this portion with your payment Account# 3106583679. New Balance $l, 039.25 Jue Date o~/2o}loos 109131065836790002400000080001039256 Total Due $240.00 Amount Enclosed I S .. Please make your check payawe to Kay Jewelers. - "v = - _ Payment mailing address is for remittance only. "' ~ ' " ~8y ~O( KAY JEWELERS P.O.Box 740425 Cincinnati OH 45274-0425 #BWNCKTF # 1301066528366797 # Dawn N Shenk 27 E South St Carlisle PA 17013-3427 Address or Employment Payment Mailing Address: Customer Service Address: Change? Check Box and P.O.Box 740425 PO Box 3680 complete reverse side Cincinnati OH 45274-0425 Akron, OH 44309 . Plan Average. Daily Balance Monthly Periodic Rate Minimum Payment REG I $891.40 I 2.0825$ I 24.99$ I $18.56 I $80.00