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HomeMy WebLinkAbout06-30-10i M ;. 1505607121 ~~~~~ ~~~ ~ (~5) OFFtC1Af. USE ONLY PA Deparsl~ent of Re+renue of ~ Te~aee INHERITANCE TAX RETURN cats Y~ ~ r~wnber Po ~x 1 2 1 1 0 0 3 5? _ M, .,~,~ .~+, P,A 17~~,1-0601 RESIDENT DE~~IVT EN'f~t DECEDENT INR+I~RMA710N BELOW Socda! Security Number Date of Death Date of Birth 1 7 1 2 8 0 4 4 9 0 2 0 5 2 0 1 0 0 5 1 1 1 9 3 5 Decedent's Last Name Suffix Decedent's First Name MI S H E A F F E R N IN A 1 (fif Applicable) Entr~r Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Secxirtty Number FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REiSR +01~ W~~LS .~ 1.Original Re>vm ^ 2. Supplemental Retum ^ 3. Remainder Retum (date of death prior to 12-13-82) ^ 4. Lmtited Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Retum Required death after 12-12-82) ® 6. Decedent Died Testate ^ 7. Decedent Maintained a living Trust 8. Total Number of Safie Deposit Boxes (Attach Copy of Wiq) (Attach Copy of Tn~st) ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date of death ^ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - TH18 SECTIOIwI MUBT fEI~E COfiIPI.El'ED. ALL CORRESPONDENCE AND CONF~IENTIAL TAX NIFORMATIClM SIIOtN.O ~ DIRECTED T0: Name ~ Daytime Tebphone Number R O G E R B I R W I N E S Q U I R E ? 1 7 2 4 9 2~ 5 3 Firm Name (If Applicable) I R W I N ~ M c K N I G H T P C- First line of address 6 0 W E S T Second line of address City or Post Office C A R L I S L E State ZIP Code .~., REGISTEt~~ILLS'US~LY ~"9 ! ~ ~~ y P,~ r~a ~ C] f ~ :7 ter' C. ;' F" ~ ~~ "'Y"i :~ ~~ ~ ~' n~ ~ ~'~"~ ~. DATE FILED ~w...J `..~ '7...~ `~n# ~, ,~. «~ P A 1 7 0 1 3 Corrosponcbrrt's e-mail address: Under peraltles of perry, I deoan>i~ I have eigntined tl~ mourn, inckiding accompanying edledi~les and , and b ~e beN of m!- ~ and t~ef, ~ is gue, oomatand colnpieM. I~adaration of pidrperoroit~~ the pweona> repr+eeenprtlve is t~aaed on aN ofwhich prepamr hre any Imowbdge. SK3NJlTURi~~9C~' `..~jl'~,,, SP~~ FOR MIG RETURN --- ATE - --- ~~~ ~1 ~ v 60 WEST PQ~MpRET STREET. CARLISLE PA 17013 SIGNATURE OF PRE ER OTHER THAN REPRESENTATNE DATE ADDRESS 60_WEST POMFRET STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY L 1505607121 P O M F R E T S T R E E T Side 1 1505607121 J~ J 1505607221 REV-1500 EX Dececbnt's Social Security Number naoedanCs twine: MINA 1• S H E A F F E R 1 7 1 2 8 0 4 4 9 RECAPrruLATION 1. Real estate (Schedub A) ..................................... 1. • 2. Stocks and Bonds (Schedub B) .................................. 2. • 3. Closely hisid Corporatism, Partnersh~ or Sob-Proprietorship (Schedub C) ..... 3. • 4. Mortgages 8~ Notes Receivabb (Schedule D) ........................ 4. • 5. Cash, Bank Deposits 8~ Miscellaneous Personal Property (Schedule E) ....... 5. 8 5 4 0 . 5 2 6. Join9y Owned Property (Schedub ~ ^ Separate Billing Requested ....... 6• • 7. Inter-Vivoa Transfers 8~ MbceNaneous Probate Property (Sdredub G) u Separate Biting Requested ....... 7. 8. Total arm Aassts (total Linea 1-7) ........................... 8. 8 5 4 0. 5 2 9. Funeral Expenses ~ Administrative Costs (Schedule H) ................ 9. 6 3 0 9. 4 8 10. Debts of Decedent, Mortgage UabHiaes, 8~ Liens (Schedub I) ............ 10. 2 8 1 6 3 • 8 1 11. Thal Deductions (total Lines 9 8~ 10) ........................... 11. 3 4 4 ? 3. 2 9 12. Net Vaiu~e afi Estate (Line 8 minus Line 11) ......................... 12. - 2 5 9 3 2. 7 ? 13. Charitabb and Governmental 8equests/Sec 9113 Trusts for which an ebt~ion to tax has not been made (Schedub J) .................. 13. 14. Net Yaiue Subject bo Tax (Line 12 minus Line 13) .................. 14. - 2 5 9 3 2 . ? ? TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxabb at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0 15. 16. Amount of Line 14 taxabb at lineal rate X .0 16. • 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxabb at collateral rate X .15 1 g. 19. Tax Due ................................................19. • 20. FILL !N THE OVAL IF YOU ARE RE~JESTING A REFUND OF AN OVERPAYMENT ~ f ~ L 150567221 Slc~ 2 1505607221 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 10 0357 DECE~NTS NAME INA I. SHEAFFER REET ADDRESS 35 EASTGATE DRIVE APARTMENT 306 CITY STATE ZIP CARLISLE PA 17015 Tax Payments and Credits: ~• Tax Due (Page 2 Une 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. Interest/Penalty if applk~lble D. Interest E. Penalty Total Interestl~nalty (D + E) (3) 4. If Une 2 is greyer than Une 1 +Une 3, enter the difference. This is the OVERPAYMENT. FiN In ovN on Page 2, Line ZO do roquest a refund. (4) 5. If Une 1 +Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tic due. (5A) B. Enter the total of line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REG/ST~R OF i~LL.S, AG~'NT ... ~ EsF G` ,.,, . w, .,,.. `. ... . ..... :r. ... ...<....... a .4.E . ~ .`° PLEASE ANSVYER THE FOLLOWING QUESTIONS BY PLACING AN'"X" IN THE 14PPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. ruin the use or incorrre of the property tr~sfemed : ...................................................................... ^ b. retain the right to designate who shall use the property transferred or its income; ............................... ^ c. retain a reversionary ingest; or ................................................................................................ ^ d. receive the promise for life of either payments, benefits or care? ....................................................... ^ 2. ff death ocxurred after December 12,1982, did dec•,edent transfer ldY within one year of death without receiving adequate consideration? ....................................................................................... 3. Did decedent awn ~ "in trust for" or payable upon death bank aa~unt or security at hiss or her death? ......... 4. Did decedent own ~ Individual Retirement Account, annuity, or other non-pn~bate property which oont~ns a benefiaary designation? .................................................................................................. ^ IF THE ANSWER TO AMY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCH~ILE G AND FILE Cf AS PART OF THE RETURN. .~ ~ x ...... 4 .. .:..~~ ...:....~.. ~.... f:. , .. .. ~ ., ~...: ~ ` For dates of death on or after July 1,1994 and before January 1,1995, the tax rate imposed on the net value ofi 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)J. The statute des rwt exem~ a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filiru~ a tax return are still applic.~able even if the surviving spouse is the only benefidary. For dates of death on or after July 1,2000: The tax nets imposed on the rret v~ue of tr~sfers from a d child twenty-aye years of age or younger at death to or for the use of a natural par~lt, an adoptive parent, or a stepparent of the child is zero (0) perr~ent (72 P.S. §9116(a)(1.2)). The taut rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries isfour amdone-half (4.5) p~oent, 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, ~ an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-15Q8 EX + (6-98) a /+ /~ S~lr1~E1'~U LE E CONNAONWEALTH OF PENNSY! VANIA v~"~~~, ~K QEPOSITS, ~ MISC. IN RESrrar~E T ERETURN PERSONAL P'RC~PERTY ESTATE OF FILE NtINER NINA I. SHEAFFER 21 10 0357 include >he of Ndga#ion and ~-e de~a the wane by the elate. AM wl#N otw bed on Sctwdule F'. ITEM NUMBER DESCRIPTION 1. M&T BANK -CHECKING ACCOUNT #9850129405 2. PERSONAL PROPERTY -SETTLEMENT SHEET ATTACHED 3. CASH 4. JEWELRY -APPRAISAL ATTACHED TOTAL (Also ~#er on line 5, Recapitulation) ~ ~ (If move space is needed, insert add~io~nal st~ee4s of the sa~rie size) VALUE AT DATE OF DEATH 1,163.39 7,118.50 8.63 250.00 REV-1511 EX + (10-06) s COMMONWEALTH OF PENNSYLVANIA ` INHERITANCE TAX RETURN SCH~LE N FUNERAL EXPENSES ADI~lNiSTRATiVE COSTS ESTATE OF FILE NINA I. SHEAFFER 21 10 0357 Dsitta of detredtlnt mwt bs nporbed on Stdradule I. ITEM NUM~R DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. EWING BROTHERS FUNERAL HOME 514.59 B. ADMINISTRATIVE COSTS: 1. Persanad Representative's Conxttissrons Name ~ Personal Representative (s) ROGER B. IRWIN street Address 60 WEST POMFRET STREET cry CARLISLE state PA ,_ ~ 17013 Year(s) Commissbn Paid: 2, Adomey Fees IRWIN 8~ McKNIGHT, P.C. 3. Fammify Exemption: (If deoedenCs address is not the same as da~rianCs, ash explanation) Claimant Street Address City State _ Zip Relationship of Claimant tD Decedent 4. ~ Probate Fees REGISTER OF WILLS 5. ~ Accountant's Fees 6. ~ Tax Return Preparer's Fees PATRICIA A. ROSENDALE, CPA 7. REGISTER OF WILLS -FILING FEE 8. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 9. THE SENTINEL -ESTATE NOTICE 10. REGISTER OF WILLS -SHORT CERTIFICATE 11. NOTARY FEES 12. ROWE'S AUCTION SERVICE -PUBLIC SALE COMMISSION 13. TRASH REMOVAL 1,200.00 1,200.00 67.50 350.00 30.00 75.00 176.92 4.00 25.00 2,491.47 175.00 TOTAL (Also attar on line 9, Recapitulation) I i (If nwre space is needed, insert ad~tiorral sheets of the Sarre sire) * COMNONWEA~TH OF PENNSYLVANW INHERITANCE TAX RETURN SCMEQVLE 1 DEBTS OF DECEDENT, MORTGAGE LIAB1LtTiES, & LIENS NINA I. SHEAFFER 21 10 0357 Report irrcurr+ed bYlhe da~dent prior to death vrhich r+e~rgMdned unp~d sa of the dt~be of'~aIlh, irg u~+eht~ureed medM.N expen:as. N ~R I ~~ I ~ ~~TM~ See Attachment Page(s) TOTAL (Also enter on line 10, Recapitulation) (If more is needed, insert additlonal afieeb ~ the same sire) Continuation of REV-1500 Inheritance Tax Return Resident Decedent NINA i. SHEAFFER 21 10 0357 Decedent's Name Page 1 File Number Schedule 1-Debts of Decedent, Mortgage Liabilities, ~ Liens ITEM NUMBER DESCRIPTION AMOUNT 1. ROBERT C. CAIRNS -TAXES 4.90 2. HARTFORD LIFE -ANNUITY REIMBURSEMENT 323.88 3. DOUBLEDAY LARGE PRINT -OUTSTANDING INVOICE 9.51 4. WOMAN WITHIN -CREDIT CARD 5. EASTERN ACCOUNT SYSTEM OF CONNECTICUT, INC - COMCAST -CABLE UTILITY 368.16 6. SPRINT -TELEPHONE 90.59 7. ASCENSION POINT RECOVERY SERVICES, LLC ON BEHALF OF ALLIANCE DATA 498.76 (WOMAN WITHIN) CREDIT CARD 8. CHESAPEAKE REHAB EQUIPMENT -MEDICAL 154.46 9. FOREST PARK HEALTH CENTER -NURSING 1,174.00 10. CUMBERLAND-GOODWILL EMS -AMBULANCE 75.00 11. GUISTWITE FAMILY PRACTICE -MEDICAL 35.00 12. ORTHOPAEDIC ASSOCIATES -MEDICAL 50.00 13. DISCOVER FINANCIAL SERVICES -CREDIT CARD 3,869.04 14. CARLISLE REGIONAL MEDICAL CENTER -MEDICAL 300.00 15. BOSCOV'S -CREDIT CARD 81.37 St~7'OTAL SCHEDt1tiLE I 7, 034.67 Continuation of REV-15001nheritance Tax Return Resident Decedent NINA I. SHEAFFER 21 10 0357 Decedertt'a Name Page 2 File Number Schedule I -Debts of D~ecedant, Mortgage Liabilities, ~ Liens ITEM NUMBER DESCRIPTION . AMOUNT 16. HILL-ROM - REINISURSEIIAENT OF PENSION PAYMENT 93.39 17. CENTURYLINK -TELEPHONE 159.72 18. BANK OF AMERICA -CREDIT CARD 17,671.65 19. PHILLIPS 8~ COHEN ASSOCIATES, LTC. - HSBC BANK -CREDIT CARD 3,204.38 SUBTOTAL S~~Ei1liLE 1 21,129.14 GRAND TOTAL SCHEOUL.E I i 28,163.81 REV-1513 EX + (9-00) ~ COMUONWEALTH OF PENNSYLVANIA INHERrfANCE TAX RETURN RESIDENT ~CEDENT SCHEDULE J BENEFICIARIES ESTATE t)F NINA I. S HEAFFER 21 10 0357 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Da Nat List Try) OF ESTATE I. TAXABLE DISTRIBUTIONS 116 (a (1 ).~ ] ~~ and tram under 1. PATRI~CIA NEILES (DECEASED) 2. BETTY CHRISTAKOS (DECEASED) ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 AS APPROPR~TE ON REV-1.500 COVER SHEET II. NON-TAMABLE DtS"I`I~8t1TN©IVS: . A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. THE HUMANE SOCIETY OF HARRISBURG AREA, INC. 7790 GRAYSON ROAD HARRISBURG, PA 17111 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET : (If more space is needed, insert addRional streets of the same size) LAST WILL A1Y.D TES'T~9l11L~1VT I, NINA L. SHEAFFER, of Mechanicsburg, Cumberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, herby expressly revoking all Wills and Codicils heretofore made by me. 1. I direct my executor to pay all of my debts, funeral and administrative expenses as soon as may be done conveniently after my decease. 2. I authorize and empower my executor to sell any realty owned by me at my death and not specifically devised herein, at either public or private sale, and to give .good and sufficient deeds therefor, in fee simple, as I could do if living. 3. I give, devise and bequeath all of my estate of every nature and wherever situate as follows: (a) My jewelry to Patricia Neiles. (b) $500.00 to The Humane Society of Harrisburg Area, Inc., Eppley Road, Mechanicsburg, Pennsylvania, and a ~ (c) All the rest, residue and remainder to Betty Chnistakos, of Mechanicsburg, i Pennsylvania. 4. I nominate and appoint Roger B. Irwin to be the executor of this my Last Will and Testament; he is to serve as such without bond. Should he die before my c~sath, renounce or refuse to serve for any reason, or die leaving any of my estate unadministered, Inominate and appoint Marcus A. McKnight, III and James D. Hughes, as substitute executors, also to serve as such without bond, with the same powers as are given herein to my executor. 5. I hereby suggest that my personal representative retain the services of Irwin, McKnight & Hughes, as attorneys in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seat this /~ ~ day of April, 1999. (SEAL,) NA L. SHE Signed, sealed, published and declared by NII~TA L. SHEAFFER, the testatrix above named, as and for her Last Will and Testament, 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. 2 M ~[ . WE, NINA L. SHEAFFER, CHERYL L. CLELAND and MARTHA L. NOEL, the testatrix and witnesses respectively, whose names are signed to 'the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the test~,rix signed and executed the instrument as her Last Will, and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose herein. expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as a witness and that to the best of their knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. ~ ~~ `N11'~TA~L. 3~AFFER CHER .CLELAND ~a ~~~ T L. E COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by NINA L. SHEAFFER, the testatrix herein and subscribed and sworn to before me by CHERYL L. CLELAND and MARTHA L. NOEL, witnesses, this /.S~'day of April, 1999. ~7i'~n 3. dom. Public I~uial seal ca~sTe eono~cu My Commission Exphes Oci. 3~ Member, Pennsylvania Association of Notaries C ROWCl3 AuC#~On ~7l1"'V1C@ 285 Iii sway Calks, PA 17@15 717-249-?677 249-~19-7~3 697-4794 MatYrch 11, 2014 To: Roger B. Irwin, Attorney 60 V~. Pomfi~et St. Carlisle, PA 17013 From: Rowe's Auction Service 2505 Rihaer Highv~ray Carlisle, PA 17015 Re: Nina Shaeffer Estate Auction Proceeds Auction Total $7118.50 Less 35% commission - 491.47 X627.03 Less Trash Removal •. 5.00 Total Due $4452.03 Q--~-'-------~."~ V~illiam G. Rawe B~~tk t 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Phone (888)502-4349 Fax (302)934-2955 March 5, 2010 Irvin & McKnight West Poret Professional wilding y -. . 60 West Facet Street Carlisle, PA 17013-3222 Re: Estate of: Nina Sheaffer Social Security: 171-28-0449 Date of Death: February 5, 2010 Dear Sir or Madam: .~~~~~~ BAR o ~ ~Q~~ ~itWl~ ~ NfcKNiGH~' ~W OFFICES Per your inquiry, please be advised that at the time of death, the abovenamed decedent had on deposit with this bank the following: 1. Type of Account Account Number Ownership (Names o, fl Opening Date Balance on Date of Death Accrued Interest Total Checking Account 9850129405 Nina Lee Shea,,~`er 07/17/n9 $ 1163.38 $ 0.01 $ 1163.39 °__________ Account # 10143730-checking was closed on 9/15/09, ovvnership-Nina Lee Sheaffer, closed-out amount $83.85. Please be advised, there was no safe deposit box found for the above decedent. * If upon reviewing the information above, you believe there are addit~nal accounts not refer, p1e~e provide us with an account number a~/or name of any poes~le joint account holder. IFor any add~onsl iafvramttion on the above accounts, including ownership and any changes, closures and/or reimbku~ement of li~nds, etc., pkme eontac~ our Stonehedge branch, 960. Walnut Bottom Road, Carlisle, PA 17013. Office # 717-240-4524. Sincerel , .. ... Nor' sa Sears Adj stirient Services ~:_ ~- t ~~ ~ Appreigal by: ~~~ «!' r _ Harry E. Vinson CARU3LE COIN SHOP 25 Circe L3rive C~rlisie, PA 17013 NINA sHEAFFER ESTATE dlold - 243-8943 ' R+1 y ~NI~++~ fRL~I ~, .~- ~~ ub C 5~ ~ May 24, 2010 ~. ,.. Estate of Nina Sheaffer 60 W Pomfret Street Carlisle PA 17013-3243 Subject: Contract Number: GrA20232-038 Annuitant: Nina Sheaffer Carlisle Hospital To Whom It May Concern SAY ~ ~ X010 IRWIN & NicKNiGH~f i_AW QFFICES The Hartford was recently notified Ms. Sheaffer passed away and would like to express our sympathy to you and the family. Ms. Shea#~er was receiving retirement income under a Life Annuity. Although this option provides a monthly income, it does not. have a provision for a death benefit. Therefore upon death of the annuitant a contract terminates and no further benefits are payable. Prior to The Hartford receiving notification of Ms. Shea#~er's death, her monthly annuity payment(s) in the amount of $323.'$8 was paid by checck(s) to her home. According to the terms of the contract, this distribution was not due, and therefore must be returned to The Hartford. Please note that it is The Hartford's policy to issue a stop payment on check(s) to recover the over payment that occurred. In order to close our file on Ms. Sheaffer, we will require the following: ® Return of an overpayment in the amount of $323.88, payable to The Hartford ® A certified copy of the Death Certificate For your convenience an envelope has been enclosed for you to return the required information. If you have any questions or concerns, please call our Service Center at 1.800.678.2282. Our service representatives are available to assist you Monday through Thursday 8 a.m. to 7 p.m. and Friday, from 8 a.m. to 6 p.in. Eastern time. Sincerely, . ,. {t t' ~w Deborah L. Johnston Senior Service Specialist Annuity Service Center Hartford Life Mailing Address: P. O. Box 1583 Hartford, CT 06144-1583 PO Box 916400 Rantoul IL 61866-8400 71791 ~-2665 La BLEDePr~ nt ~ ~~~~~ ~ oooc~aoooe6 l,000tUrt # StstClnl7lt D>ttl2 ~ 0~~ 0 olnenosfli~NT ~s:2o 100223-8~1: 010412.34419086 NINA EAFfER MS otiano RETURN owoano ~ 2a~ . 35 E14~STt3A1'E DR APT 306 0~ °o - CARLISLE PA 1 X015 omoano PRICE coRREC~noN Q2/04n0 RETURN -art -1Il.M ~rrrj~~rrr~~rrrn~~t~~~rr~~u~r~rrrr~r~rrrf~ ~rr~rrrr~~~r~rr~ ~-noRETURN _ TOTAL NOW DUE X51 ~_ ,~~ ~ '~~ ~~ !MAR 0 I~110 r f~~N & NicitNiGFlj LAW OFFICES Dear Nfs. Nina Stieaffer, ~ - -.- - - - - - - - - We hope you are enjoying the selection(s) we recently sent to you. Our records indicate that payment has not yet been received. if payment has already been made, thank you. Please send us a check, money order, or your credit/debit card information for the full amount due of X9.51-. You may also pay onlN~s at www.~doublsdarylaryoom. Your account will be credited promptly when we receive your payment. Please send your payment along with the bottom portion of this letter in the envelope provided. Recent credits for payments or returns may not be reflected on this statement. Thank you, DOUBLEDAY tARE~E PRINT Customer Service Department DREaFP t~Li -__ __ A PI.tAf! OEpK31~i 1~ Nt~ii rOTT'OM POR?gM WITH PIAYMIM: KWeP TOP PORTION FOR YOUR RECOR06. A OiIBQN-FR-11CO.~DN-RE-41 O~TX,Y 1002220001 00534000650 9000951 2 004650394 3000951951 R~ENTLY SHIPPED ITEMS bdAY NOT B8 INCLUDED QN. THIS STS' .. .. P/1Yi~1'i'S.hI/liJ,~ 1Q.S P~'[O$ ~O STATF,t~i'1' DiA~'B IrdkY;t~' B)' Ij~Pl.~C,T~]3 di+1.Y0IJRA000(JN~', ' cuo5s427 Po ~ 1022 Wixom 393-1022 S SERVICE REQUESTED Notice Date: May 17, 2010 P.O. Box 837 • Newtown, CT 06470 (800) 750-6343 • Fax (203) 426-9630 ACCOUNT IDENTIFICATION EAS Account Number: 24197925 24197925-FiRS't~CBL 336535792 Crodita' #: 391780- 1 ~~~I~~Il~ltit~~wi~llf~l~~llp1~~11~~~1'tfll'~lilll~l~' ~'~ ~MCA"T HARRISBURa SERVICE PERSONAL'8t QONFIDENI'IAL Service .Balance Due : $ 118.16 NINASHEAFFER Equipment Balance (if not returned) : $ 250.00 60 W PomR+et St Ste 2 Total Balance Due : $ 368.16 Carlisle PA 17013-3243 * * * FIRST NOTICE * ~* Yottt account has been placed with this office for collection. To avoid further collection activity, pay it in full. If you can not pay it in full or have a problem, contact our office. **IMPORTANT** 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 will assume this debt is valid. If you notify this office in writing within 30 days from receiving this notice, that you dispute the validity of this debt or any portion thereof, this office will: obtain verification of the debt or obtain a copy of a judgment and mail you a copy of such judgment or verification 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, if different from the current creditor. To be sure of proper credit and to stop further procedure make your payment in full. This is an attempt to collect a debt. Any information obtained from you or anyone else will ~be used for that purpose. This communication has been sent by a debt collector. Office hours are gam to Spm EST, Monday-Friday. s~cuoss~rrnsrcm. Detach aad Return with Paynumt Eater the requested I~fi~ation I®.the gaca~ provided below: ' #• 391780- 1 Change of Address: For. NINA SHEAFFER Street Addreus: City, State, Zip: Telephone: Please charge to my: 0 ®D~ D® ~~ Amount Enclosed: S 1°"a' Card Number Expiration Date / Security Code (from back of card) Name of Cardholder ___ Signature r ' :~ Encliaiag tl~s notice with year payment will expedite credit to your account. EASTERN ACCOUNT SYSTEM OF CO1~fNECTICUT, INC. Creditor . Creditor. COMCAST HARRISBURQ~ SERVICE Notice Data May 17, 2010 EAS Account Nwnba : 2419?925 Amount Enciosed:'S Eastern Account System of Connecticut, Inc. PO Box 837 Newtown CT 06470-0837 ~~~~~~t~~~~~~~~~~i~~~~~~~~~~~~~~~~~~~~~~~~~~~~~r~~~~~~~~~~~~~~ Service Balance Due: $ 118.16 Equipment Balance (if not returned): $ 250.00 Total Balance Due: $ 368.16 F(RSTCBL PO BOX 3827 ENGLEWOOD CO 80156-38!27 • ~~INlocrx saes o~ar~rrs®a s os~o AD 01 0~410a 'T1i~f0~ N 7~4 A NINA CARI.IlIL.E PA 1T913-SZ4~ ~~~~Irltlitlrll~lh~~~~lu.~'~n'll~l~I~Ill~~it~~l~'I~IIIu11nIN D ~ Sprint j rt,~t o i 2mo . ii i.. ~ :Z, :-~''"`qr Your /4ccownt ~nlrotmrtion CC)LLECTit~l ~!~'sENICY ALERT Qear.NMIA..SI-IEIAFFER:. You are a vied Sprint cu~omer, and we would like to work with you to~resioNre any issue I account to became past due. As of the date above, we have nvt received fuM payment; the sc~ieduted to be pieced w~ a adledion agency wkhin the next seven days. Our goal is to reactivate your Spt~t account as soon as poss~te, so please caN (877) 888-102 sperdc to one of our Imow~clgeabie Customer Finance Service representatives. We'd review th ava~ble fio you and any other account conoems you may have. It is important that you cats us further ooNedbn action that may include: • Your acxx~tt being sent tv an cwtside collection agency. • An early termir>etivn fee appNed to your account y the Sprint services are canceled w • Your account ~ "bad debt"' wlth Sprint if the account remains unpaid ~ the b st d • f..I. ~.~3~ 2010 c X90.59 ~Y~`a ~~ .~ 2Y ,. yl,,: ~~ ~ s `s~rJ.^ f't ': ~.Y'~ 4 s~ . .. r. =ate ii: A~[~tt 1~.~~ ~~~ _.. .._. • Your account reported to the three national cxedk ureaus as pa ue. Please caN us today at (877) 88&1028 and atkrw us to help you avoid addit~nal won `~ ~ ~~~ : ` S~cerely, Sprint Customer Finance Servk:es ~ r Not r: This tet~r k an Apr ro oa~Necc a der owed ro Sprtrt Any ~nfnnned~on aba~i-~ed wllw bp: ;'I~t Pu-P~ ~Y t~abonwt' FManoe S~rrioes Howe ~ian Monday-Friday: 8 am. do 8 p.m.; Shy-~~f~i.11 a.m. bo 5 p.m. IMPORTANT: TO INSURE PROPER CREDIT, PLEASE RETURN THIS LOWER PORTION TOGETHER WITH YOUR RE~AITTANCE. NINA SHEAFFER 60 W P'tliNiFRET ST CARLISLE PA 17013 Your A~tf+~ hf~aKmation Amodnt~M~~ ~' 2010 Po eox 4191 CAROL ~ It 80197-4191 I~Ill~li~~.~~1~~~~~lll~~~i~~t.Il~~l~l~~lr~'~~'~II'1~"~1~~111~111 ,, 207077305 000000471 0000085bb0 0000090598 f .~ COURT ~OF COMMON PLEAS OF Cumberland COUNTY, PENNSYLVAI~TIA ORPHANS' COURT DIVISION ESTATE OF Nina Shaeffer ,DECEASED No. 21 2010-00357 To the Clerk of the Orphans' Court Division: Enter the claim of AscensionPoint Recovery Services, LLC on behalf of Alliance Data ~ the ~~~ amount of $ 498.76 , ~~~ the above entitled Estate. The Decedent, who resided at ~ W Pomfret St. Ste. 2 -- (So-eet Address) Carlisle, PA 17013-3243 , ~~ on 02/05/2010 .Written notice of (Date of Deady said claim was given to Roder B. Irwin (Personal Representative or lefs/her coso~se~ at 60 W Pomfret St. Carlisle, PA 17013 on 06/04/2010 (D~l n/a --- (C~aieem~t's Counsel NOTICE C)F CLAIM (Filed Pursuant to 20 Pa. C. S. § 3532) (Srq~reme Court I.D. No.) (Address) lZ'~~) (Address) APRS R esentative (claimant) 200 Coon Rapids Blvd. Suite 200 (Street Address) 'Coon Rapids, MN .55433-5876 (Ciey, State, Zip) Form OC-07 rev. !0.13.06 STATEMENT Remit To CHESAPEAKE 'REHAB EQUIPMENT PO B4X 64048 BALTIMORE, MD 21264- ( 717 )731-1655 Sbtement Date 05/31/10 Nina Sheaffer 35 EAST GATE DRIVE APT 306 CARLISLE, PA 17013- Patient Name Nina Sheaffer Account Number 2371 Afifiliatipn Account Terms Ari~ount Paid PLEASE DETACH TOP PORTION AND RETURN WITH YOUR REMITTANCE 02/20/06 Fsy Check VISA -25.00 -25.00 10/15/09 561060 lnv Service Date: 9/16/2008 89.69 64.69 11/23/09 571393 Inv Service Date: 10/16/2009 89.77 154.46 ~ y. ,. ;, P RSE EMIT PAYMENT BY P~II~- ~ ~AI~~ ~~ I~~~IIM~I I11~~ 1111 JINNI Iq II I~ Total Due: 154.46 Month Service Provided May April March February -25.00 Prior to February 179.46 SUITE 104 - 75 UTLEY DR -CAMP HILL, PA 17011 -Phone: (717) 731-1655 -Fax: (717) 731-1658 - 00005546 ~'orost Park Health Canter 700 ~slnut Bottom Road Cat=lielo, PA 17013 Qu®stions ruing This Invoia~? Bi11er.Na Dawn J. Ext. 865 Phone 1-888-880-7090 Fax 1-814-265-1377 Email djordan@guardianeldercare.net NINA L SHEAFFER 35 EASTGATE DRIVE APT 306 Carlisle PA 17015 Please Detach and Return with your payment Resident# 22721 Resident SHEAFFER NINA L Discharge Date 09/16%2009 Statement Date 04/30/2010 Payments Posted Through 04/30/2010 CALL 1-888-880-7090 DAWN @ EXT 865 USE MASTERCARD/VISA/DISCOVER PANT ENCLOS$D DATA D~8t~itIPTiO~T L1NIT8 RBH'~ A~i0~'1' HAI~AN~ pg~IpDg g,~,~Cg 1,17 4.0 0 1,17 4.0 0 1 174.00 Yt7tlR P]-Y!~'1' OF i, ins . oo is avs v~a~ Rscae=mar Forest Par)r'k Health Cent 1-888-880-7090 `t SHEAFFER NINA L 22721 ~w...w~..vs..w ~IVrM~~~~~ ^ ~~ V• \VVVMV . PO BOX 12910 w ~'' PHILA, PA 19176-0910 Pholne ~: (800). 367-0512 Federal Tax ID: 23-2298422 PATIENT NAME: NINA SHEAFFER PATIENT NUMBER: 13655 ESTATE CALL NUMBER: CG0904551 NONE INSURANCE: DATE OF CALL: 11/ ~~cT~l'. ~.., : . ~+HtNA sHEAFF'LR Cl0 MARANATHA CARiJB~E P O BOX 1330 CAt!~LISt.E, PA 17013 TIME OF CALL: CALLER: FROM: TO: REASON(S) FOR TRANSPORT INVOICE 17/2009 08:14 AM 35 E GATE DR APT 306 TREATED ~ SCENE NO TRANSPORT UNSPECIFIED DIAGNOSIS DE$CI~PTION OF CHARGE QUANTITY UNR PRICE AMOUNT BlS RESPONSE AND TREATMENT A0998 1.0 75.00 75,00 ,._ ~~ ,Vr~ ~ r ;.,; „ i .. , ~~~ Total 75.00 ~ DESCRIPTKIN OF PAYMENT I RECEIPT I PAYMENT DATE I AMOUNT PLEASE PAY THIS AMOUNT ~ X75.00 DETACH ALONG PERFORMAfiON AND RETURN STUB WITH PAYMENT AMOUNT DUE 75.00 PATIENT NAME: SHEAFFER, NINA CALL NUMBER 000904551 AMOUNT s PATIENT NUMBER: 13655 BILLING DATE: 03/19/2010 ENCLOSED WE ARE AWARE THAT THE PATENT IS DECEASED AND YOUR OFFICE IS HANDL.Mit3 THE ESTATE. PLEASE FORWARD PAYMENT TO ABOVE VISA ADDRESS AS 800N AS POSSIBLE.. AND MASTER CARD ACCEPTED Cumberland-Goodwill FireRescue PO BOX 12910 PHILA, PA 19176-0910 c~u~stwrte ramrry rractrce 522 S. PITT ST. `' CARLISLE, PA 17013 TAX I D. #23-2104174 (tl7) 3-1516 NINA L. SHEAFFER- 35 EASTGATE DRIVE APT# 306 CARLISLE PA 17.013 03/30/10 4298 (1) ~4 r ~, ~ ~ ~ ~~ t NINA L. SHEAFFER ( 4298.0 /20/0 OFFICE VISIT EST PATIENT L 115.00 1 9 Ins Pmt-HEALTH AMERICA 79.53 12/07/09 Adjustment 25.47 1 OFFICE VISIT EST PATIENT L 85.00 09 Ins Pmt-HEALTH AMERICA 49.37 12/29/09 Adjustment 25.63 01/08/10 OFFICE VISIT EST PATIENT L 115.00 02/11/10 Ins Pmt-FREEDOM BLUE 80.25 02/11/10 Adjustment 19.75 TOT FOR NINA SHEAFFER ~~~~~vr "':'!' 4 .r J S~~~J .. roar nue Cunw,t ~~ - so Dogs et - ~- ~ ~~ -~zo ays o+ror ~sv t)ays 35.00 0.00 15.00 0.00 20.00 0.00 i~ Kenneth R. Ouistwks, M.D. 522 S. PITT ST. CARLISLE, PA 17013 03/30/10 4298 D~ pie stub smd return wwin, payrment ~ 4298.0) 10.0011/20/09 10.0012/11/09 is.ooloi/oa/io 35.00 - -- . i A~'R 0 2010 . •. Y ~' lr ~r~se pay thfs amount! Statement Tax I D : 251202240 -~ ORTHOPAEUiC ASSOCIATES Phone #: (717)264-6211 1035 WAY AVENUE Date : 02/17/2010 Page : 1 CHAM SBURG PA 17201 Patient : NINA SHEAFFER Account # : 39757 NINA SHEAFFER Amount Paid : $ 35 E QRIVE APT 306 Credit Card #: Exp. Date '' CA A 17015 Signature : Date : EFFECTIVE JULY1, 2008 ALL CO-PAYS MUST BE PAID AT TIME OF SERVICE OR YOUR APPT W ILL BE RESCHEDULED Des Cads DNCription ......... ..P'rovi~eior.. s - Lion Amount . irnursn©s .....B~tar~os...... Pstisrtt ..-8efa~'ico..... Balance Forward: 0.00 0.00 08/20/09 99203 OFFICE/OUTPATIENT VISIT, NEW KR 782.3 ADV 194.00 25.00 11/08/09 INCK INSURANCE CHECK -84.20 11/08/09 INWO INSURANCE WRITE OFF -104.80 08/i7/09 9921.2 OFFICE VISIT EST PATIENT LEVEL KR 782.3 ADV 55.00 ~ ~ _ ... .._ . 25:00 - _ 09129/09 BAL IS CO PAY - .. _. _ . .. - - - - . ....- .... _ ... __ _ . , 09!29/09 INCA . INSURANCE:CHECK. ~ ." ~: - -- -- -...-- --.. ......-- - ... .. . ........_ .. .:: .._-.1D..75.- ----- - - .. --- ~ _. 09/29/09. INWO INSURANCE WRITE OFF -19.25 ~~~~ MA 0 3 20 Q' ~17w1 ~ ~~Iwic . OFFICES +`Cur't+ert: X0:00 ~ ~ ''Pest Due ' ~~ $50.00 ., Total amount : ~~ $0.00 $50.00 `~PI'OVit~r ~' KR ~ ~ - . Please pay this amount : $50.00 fTHiB: AtXOUNT 18 SCHEDULED TO BE SENT TO COLLECTIQNS ~/a~/~ YMENT ~,, CALL OUR-OFFS iMl1AEDiATELY TO MAKE PA ~~1fMENT A~IRAN~3E~+~~NTS TO STOP PROCEEDINQS IF -YOU<:HAVE ALREADY MADE PAYMENT THANK YOU ik .:.. .:a ~,.:.. ~. ~;.:. x^_, i - ACl~OLII'it ~ : 3ti75? w r state Information Services, LLC 2323 Lake Club Drive Suite 300 PH: (614) 32Z-2758 (800) 6045435 FAX: (614) 3222761 March 8, 2010 ~ To The Family of NINA L SI~~sAFFER 35 EASTGATE DR APT 306 CARLISLE PA 17015-3243 • RE Creditor Name: DISCOVER FINANCIAL SERVICES, LLC Ac©omst DISCOVER CARD Debtor. •NINA L SHEAFFER Amount of Debt; 53,869.04 Reference #: 265125E Dear Family; Thu Sam 9ta~ and Fri Sam-Spm'EST ~~~~, Website: www.probato-care.com =~ ~r~' :w 4k..~ e~rrr ~ ~ J ~ _ 'i ~aR 1 s 200 ~, IRWIN & McKNIGHT LAW OFFICES - We undes~stand this may be a difficult time for the family. Bstate Dion Ser'viceshas been hired by our clie~ to asaist the Efate iz- bring~iung m a roactlution the aug balance owed by the• decedent on the move account. Therefore, we aeod m receive from you pertinent estate mSa~rmation so that we can~8le an estate claim for ourclieat: Please call this office ax the number above with this information. . ~ If the family merely wants to pay the balance on the account mow, radon the below payment coupon~a~ng~ with payn~eat of the amount referenced above, 53,869.b4, and no estate claba will be filed. There is ao 'persona'l liabilit3~ associated with a payment. However, if an ewe ham. beeq filed, at that time tlie~ estate ~is liable. ..... ~ . ~ , ' ~ ~ ~ . Again we extend our deepest sympaxhies to the family durigg this difEcult time. You have our comet that we will do our best to make the resolution of the payment process bs quick and as easy as possible. Unless, within thirty (30) days a#ter receipt of this notice you d~ute the validhy of the debt, or any portion thereon we will assume the debt is valid. If you notify us in writing wither said 30 days that the ddrt or any portion thereof is , we will obtain v~ of the debt and will mail such von 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 catrrent creditor. 17th is sn~ apt to collect s debt from the F~abtte sod s~ny inforienstion obhis«I .rlll be used for that ~riwse. 1'bfs oom'nouic is from s debt collector. ___~__----------------------------------------Cut along this line-----------__________~_______________~ -t~ ~n~i-e-mncirm ~w;~s, lbs. Plase Mste C~~Psyabl0 To: Debtor: NINA L SI~~AFFER DISCOVER FIl~IANCIAL SERVICES,. LLC Re&renre #: 2651250 Amount Due: 53,869.04 M~iU Payeosnt To~s~~• Account Type:. DISCOVER CARD Bstate'I~rmation~Sesvices, LLC. 2323 Lalae Club Drive; Suite 300 Columbus, 0H.43~232 ~ ~. ~ ~ . . See Reverse Side for Special State Disclosures L ...;-, ~, ~;. i Undeliverable Mail Only: " P.O. Box 1954 Southgate, MI 48195-0954 ~, II~~~~INN ~1 Il~eomtersr~ce. ;` i MM1/85571520/10~a 00834872896 OOOa226100Q4 _` ~it~lllni„~IIIEi~tilli~~~iiir~l~~l~iir~r~r~~,~~itl~~l~~~i~~i~~ Nina L Shaeffer -'"~ fi0 W Pomfret St --- Carlisle, PA 17013-3243 _._._ _..__ Dear Nina L Sheaf~er: Healthcare Division P.O. Box 361596 Columbus, OH 43236-1596 Toll Free: 800-790-0278 Mon-Fri Sam to 10pm EST Die of Service: Julyy 14, 2009 B~ance: $~?.00 Account Numt~er: 855Ti 520 Client Ref Nurr~er: 9439506 Date: April 2fi, 2010 We thaty~ 4 r our ~ teaer you. Your d~ru~entct remanns unpaid and,we intend to continue our ~c on b~~alf of our d'~nt We urge you tD eve the metier yo<x ar~enbon. ~k~htx e. Ill have tl~~lettier wean d lr should you wish fio initiate a payment by you c~ . !~ ,Inc. We are a debt coilecbor aitlerr~ing th ccalllect a debt and any infonr~ation obtained III be used for that purpose. Please vole that if your fina~aal ins~butron ~ and returns yon pa~~nnen#s fa any reason, a service fee - tt~ maximum ~ by al~p~~able law -may ati~d th your Dance. t~~CE1YED rr~tt z s 20,0 ~ ~ r~lcntcl~rt ~-w ~~tc~s ~~ Date: Affil 2fi, 2010 Sincerely, CNent Ref Number: 94395~fi ~ R ~ C CARLISLE REGIONAL MEDICAL CTR 800-79t1-~~ Amount Due: $50.00 Amourrt Rer~tted: $ Allied Irrt+erstale, Inc. Payment and Correspondence Address: MM1/85571520/858 Allied interstate, Inc. Healthcare Division P.O. Box 361596 Columtws, OH 43236-1596 I~I~~I~~Ii~~~i~l~~ll~~ll~~~~~ll~l~l~l~l~~~ll~~~~~lli 105 Carlisle Reg~'oval Medical Center P.O. Box 15618 ~` Wilmin on DE 19850 ~/ St I I~~''I'~' ~ ~ ~ ~' M Ir v I~ CL~ cc eK~ C~11B~snle PA017015-3661 ~ 82.1008535.8802 ' ~~~~1~~~ Phone: 800-381-9160 MAY 06 2010 Statement: 1008535 MAC ~ ~ 20,E 0 sR ~~ O ~~ Account: 9456706 007-00 Patient Name: NINA L SHEAFFER N 1008535 Service Date: 02/05/10 • NINA L SHEAFFER ' 60 W P011FRET STREET Balance: $250.00 CARLISLE, PA 17013, Dear NINA L SHEAFFER, You have ignored our previous requests for payment of your past due account. Your account is seriously DELINQUENT! If we do not receive the balance in full within ten (10) d, we will recommend that your account be referred to a professional Collection agency. This, a FINAL N C The only way to avoid this action is to pa in full or contact our office at the number above. You may pay with Mastercard, Visa, Discover or American Express by filling out and signing the form below. PAY ONLINE 7 DAYS A WEEK Z4 HRS/DAY AT wrvw.carlulermc.co® PLEASE RETURN LOWER PORTION WTTH YOUR PAYMENT ® ~ ® ~ CAROH~LOER'8 NUMBER EXPIRATION GATE AMOUNT CARDFIOI.bER'S NAME C/iRDEg1.DER AODfM:SS ~p COpE SIf3NATURE OF CAROHOlOER NINA L SHEAFFER 60 W POMFRET STREET CARLLSLE, PA 17013 Account: 9456706 Patient Name: NINA L SHEAFFER Service Date: 02/05/10 Balance: $250.00 PLEASE UPDATE CHANGE OF ADDRESS OR INSURANCE INFORMATION ON REVERSE SIDE Carlisle Regional Medical Center P.O. Box 281442 Atlanta GA 30384-1442 e~_~_~r_~ 00000945670600000025000NINA L SHEAFFER 5 r HSBC RETAIL SERVICES ``~ P.O. B0 5244 CAROL REAM. IL 60197-5244 HSBC m NINA L SHEAFFER 35 EAST GATE DR f306 CARLISLE, PA 17013-0000 RE: BOSCOV'S Account Nuwbers 0000000000002247712 Current Balan~•: 081.37 Awount Dins (81.37 Dear NINA L SHEAFFERs ~'i~~x e J ~~~+HV & Ivlc~ifViG~I~r AW OFFI(,k For the past several weeks we hav• repeatedly requested your cooperation in bringing your credit card accorsnt up to date. So far, there has been no response in the forty of paywent. M!e wust once again insist that you sind the aMount due iwwediately and contact us to inforw us of your arrangewents. Your continued avoidance of this obifgation could negatively iwpact your ability to obtain .future credit. Moreover, should this delinquency persist, your credit card account way b• referred to an outside collection agency for further collection action. You can avoid future negativo reports to credit bureaus, future late charges, and possible r.ferral to a collection agency, by sending your paywent in full iwwed~ately. You can take advantage of our check-by-phone prograw by calling toll-free 800-755-3177. Collections Departwent This is an •ttewpt to collict~a debt; and any inforwation obtained Nfil b• used for that purpose. ----------------------------------------------------------------- Pleas• include this portion of the letter with your paywent or correspondence to ensure prowpt attention. NINA L SHEAFFER 8 Account Nuwbers 0000000000002247712 Paywent Awount: • Send Tot HSBC Retail Services P.O. Box 4144 Carol Streaw, IL 60197-4144 03/10/2010 L909 Hill-Rom Rust Irio~cs o~i Owrp~yen~nt Fk1iNi~y R~irwnertt 8arv1~ C~eK 1-877-20~B-f?~5 TtiO ntioe for the M impairod 1-800.610-4015 June 2, 2010 THE ESTATE OF NINA SHEAFFER 35 EASTGATE DR, APT 3~ CARLISLE, PA 17015 RE: File Number W018787-21 MAR10 Dear Estate Of NINA SHEAFFER: ~~~cvco ~iJUI~ 0 9 201 lRWlf~ & McitIVIGN~ lAt~ OFFICES Pisses acxept our condolences for your loss. Our records show'that The Estate of NINA SHEAFFER has received an overpayment of benefits from the H~1-Rom, .Inc. Pension PIS in the ~ncx~nt of $93.39, distributed on March 2010. The overpayment occurred because payments should have ceased after NINA SHEAFFER's death. The Plan is a tax-qus~ified wed benefit retirement ptan under the Internal Revenue Code. To maintain the Plan`s tax-qualltled status, the Plan Spa~sor must ensure that all cored employees, retirees, and beneficiaries receive only the benefits to which they are entitled under the Plan. In the event of an ov®rpayment, the Plan is required to recover the net amount of the overpayment totaling $9;3.39. Please repay this amount in one lump sum by July 2, 2010. To return the overpayment to the plan, please send check or money on~er for ~e above amount payable to .Please cxarnpiate the enclosed Re~yrnont Foam and put reference number Wo18787-21 MAA10 on the check, with a note stating this is a return ~ a Pian overpayment. The check and repayment form should be returned to the Fklelity Retirement Service Center in the enclosed envelope. Please note that the overpayment amount is not eligible for favorable tax treatment acxa'ded to distributions from qualified plans, and is not et~ible for rollover to another employer-sponsored retirement plan or IRA. Therefore, if you roiled over the origlnai annuity payments, you should contact your new plan sponsor or IRA custodian immediately to arrange to have the overpayment returned to the Plan. Your new plan sponsor or IRA custodian can follow the instructions in the preceding sentence in order to return the amount to the Pian. If you return the overpayment in 2010 your Plan distribution tax record (IRS Form 1099-R), at year end, will reflect the correct distribution amount. If your repayments cross tax years, the amount repaid in a subsequent tax year will not be reflected in your IRS Form 1099-R, instead you may I~ eligible for a credit or an itemized deduction on your taxes for the year in which you repay the Trust. Please see IRS Publication 525, Taxable and Nontaxable Income, for more information. In order to underst~d ail of the options available to you, including the availal~lity of a credit or an itemized deduction, we strongly encxaurage you to discuss all of the options available to you with your tax advisor. 312B~18t? 001 3 TMP-8~31A VI1b18787-21A~4Ri0 ~PYYl~~1~'~ t,M ~ 9 T ~ :..a T f ~ ~'~:wd'lds ~ M~..~c~uwuic Ll.C ~' .~ ~ ~~ ~ ~. ) ~ ~ iJ 2081 G 44~h Avz W Lynnwabd. W 98036 iRW111 ~ iV1cKiUiGN'i Dear tourer: ~ AI~V t)FFiCES Your account, listed below, ltas been assigned to Receivables Performance Managc~ncnt for payment processing, on behalf of Embarq, for your LTD (Coca! Telephone Division) acroount. If you leave say questions or need assistance, please cell TOLL FREE 1-866.212.7~i~. . Reference Number: 7172180297582 Creditor: CenturyLink formerly EMBARQ Date: 06-14-10 Amount: $159.72 Amount Due: $159.72 (U.S. FUNDS ONLY) Please make paynnents payable to: Embarq PO Boa 96064 Charlotte, NC 28296-00!64 Ui~e~yn+o#~his office within 30 days after recei this notice that y~ ~ the validity of this debt or any po s office will assume this debt is vali~you notify this "ice in wri within 30 days fmm rxeiving this nrotic:e. that you ~e the validity of this debt or any rtion t~eersof: thisrniwe will: obtain verification of the dtbt or obtain a of a ~ud~ent and mail yon a cry of ~,~u~dgn~nt or verific~ion. If yrou ~oquest taus officx in writi~ within 3U Sys after receiv3ing this notice, this office v~ll provide you with the name and address of the origi~l creditor, if differen from the current creditor. Tlds a~ is frma a debt collector. The purpose of this notice is to collect a debt. Any information obtainal rr~l be used for that purpose. Estimado Cliente: Su cu~ta, se senala mss adelante, ha sido enviada a Reveivables Performance Management gars ~proeesar el pago a r~ombre de ,pare la coasts de LTD (Local Telephone Division). Si time alguna pregunta o neoesita awda, siivase llamas GRATIS nunnem 1-866.212.7408. Numeeo ~ referenda: 7172180297582 Acreedor: CenturyLink formerly EMBARQ Fecha: 06-14-10 Cantidad: $159.72 Cautidad adeudada: $159.72 (MONEDA DE EE.UU.SOLAMENTE) Sivase pacer el pago a: Embarq PO Boa 96064 Charlotte, NC 28296-0064 Este of~cina aaunir~i qua la dada es vdlida a menos q~, a mds t~rdar 30 dins des~u~s de recibir eta notificacibn, usted anise a e~ amt de mega la valide~i total o parcial de esta deuda. Si a nos taniar 30 dies de~ufs de recibir eats noti~icucibn, anise a e~sfa oftcina de qua mega la validez total o parcial de est~ ; hs~nos to ate: v~tm de la deuda u obtendremos una copia de la sentenaa de ley y le enviaremas una oopia. Le . daremos e1 ~ y di~necci+bn del acroodor original, si es diferente ai acreedor presence, si used asi io Bide por escnto a eats oi`icina a mds tardar 30 dies d de recibir este aviso. Este caumeicado ea de un r~udader ~ deudas. I.a finatidad de eats natificacibe es recaudar ~a deuda. Cualquier iafor~nacidn obtcnhla se utilizard con eate fin. det'acb ~ baitom ' v t edit,. Ploaae .., paitioa of ~ n~tioe ~ return w~ you payme~. we sa acxedite ed p~go~ c~orte Is D+ute mfariar de estf not>i~acibn v envfda can su e~no_ ~-*~ j~ !~D~~~~ ~ i SAY .~ ~ ~0~~ STATE OF PA STATEMENT AND PRCR?F OF FILE NO: RW19V & I~cf~iiGHl PROBATE COURT CLAIM 21-10-x337 iAW OFFICE Cemtber~nd COUNTY Estate of N~TA ~HEAFFER Roger B. Irwin 60 W PO~MFRET STREET Carlisle, PA 17013 Phillips ~i Cohen Associates, LLC, on behalf of Chase located at P.O. Box 94014, Palatine, IL 64094 submit the follovrring claim against the estate for the sum set forth. UE5CA;IPTION VALUE ccount #: 8188 punt Due: $3204.37 File #: 16988921 There is now due on the claim, above all legal set-offs, the sum of : $3204.3 It is declared that this claim has been examined by one of Phillips & Cohen Associates, Ltd. representatives and that its contents are true to the best of our information, knowledge, and belief. ,_-- Aethorized Signs Phillips & Cohen Associates, Ltd. The Creditor's Rights & Bankruptcy Group \ A Division of Phillips & Cohen Associates, Ltd. ~`~ 1002 Justison Street ~~ ~ ,_ Wilmington, Delaware 19801 `~,, Telephone: (866) 907-6832 speclalform ...~.~. ,, 1 FORM 93--0. C. DIVISION IN THE COURT ~}F CC~N PLEAS C R~C- Ct~JNTY, Pl" ''I'~l'LV~A IIV RE: ESTATE OF NI~U4 S#1EAFFER (~) Estate No. 21-10-0357 To the C-~k of Orphans' Court Division: Index and rr~tk~e proper entry in your alffl revonds af~the c~aun of B.,,~H A~~ca, (Cnt} awount #42fi428791531.63, in the'~,amount ofi $1767, 1.65 a~nst the estate of the above Hamad:.:... , , .....~ . Thy claim is filed under Section 732 (b} {2) of the Fiduaa~ies Act of 1949 as amended. ....: ~ ~ ~ _ _ The said decedent, who resided at 35 EASTGATE DR, CARLISLE PA ~.:, :S '. Y' 17015, died on 02105J'2010. Writt~ nvfice of this claim was given to RJR 8 IRIII~IN~ 60 W PaMFRET ST, ~~ARLIS~.E PA 17013. (Personal rerrtativ~e, i# any, or counsel). (Claimant) . Bank of America . ~ ~ ~~. ~ Estate unit DE5-014-02-03 .: ti7-_.:`:: _ . .. .... 1 OOO~ Samoset- Qrive . . ~~~E~~~E~ ~ ~ ~ Wilmington, DE1'98&4 877-767-9383 APR 1 9 2010 (Claimant's Address) i &,^~mlr~l~eur,~~ ~~ v. . IVM~