The URL can be used to link to this page

Home My WebLink About12-22-10~~ i LAW OFFICES BARBARA SUMPLE-SULLIVAN 549 BRIDGE STREET NEW CUMBERLAND, PENNl3YLVANIA 17070-1981 PHONE (717) 774-1445 FAX (717) 774-7059 December 22, 2010 Ms. Glenda Farrier Strasbaugh Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 Re: Estate of Dianne H. Morningstar No. 2010 -00315 Dear Ms. Strasbaugh: Enclosed for filing are two (2) original Pennsylvania Inheritance the above captioned Estate. Also enclosed is a check in the amount of $15.00 for the filing fee Should you have any questions, please contact the undersigned. BSS/as Enclosures L{41 Vl{LK I/iW11J1V /M+~a. N N l o- ~ ,~ ca c ~"'''.; ~ c1'a ~~~777 ^~ N ~ ~ N ~ . ~ ~, n r- ~i ` c.~. in cc: Ms. Amy Korsun Estate of Dianne H. Morningstar --~ REV-1500 Ex (os-os> 15056051058 F OF ICiAL USE ONLY PA Department of Revenue County Code Year Fb Number Bunau a Il-dividual Taxes INHERITANCE TAX RETURN I--~---~ Po Box 21)0801 .RESIDENT DECEDENT ~ "'.~ I ,~ ~ Ot~39 5 4Lnidr+m_ PA 97AM1Wn1 ENTER OECEOENT fliFORMATfON BELOW Social Security Number Date of Death 22~-$d-$~ Much 22, 2010 ~-l Decedent's Last Name Suffix rnfri~tpr (M Applicable) Errtsr Surviving Spouse's Information Below Spouse's Laat Name Suffix Date of Birth ~. 1944 1- Decedent's First Name M1 C3~Ine H. _..~_~ H. Spouse's First Name Mi iD Spouse's Socal Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRUTE OVALS BELOW ~e 1.Original Return o 2. Supplemental Return o 3. Remainder Return (date d death prior to 12-13-82) 0 4. Limited Estate o 4a. Future Interest Compromise (date o 5. Federal Estate Tax Return Required d deatlt aRer 12-12-82) 0 6. Decedent Died Testate o 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy d VVdl) (Attach Copy of Tnlst) 0 9. Litigation Proceeds Received o 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-g5) o (Attach Sch. 0~ CORRESPOMDEIt;T - TFN! SECTION tt~T taE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX MIFORtMATION BFIOIxD SE'DtitECTEO TO: Name Daytime Tpbpltone Number ~'ba"$ Sillviir~.°fz~ue (717) 7741 ` Finn Name (If Applicable) ~ First line of address ~`~`~. N Srrt9 Btic~. Stet ~ $ ~ ~ Second line of address ~, .~' DATE FILED ~ City or Post Office State ZlP Code New Cumbt~land PA 1.7070 Cortespondertt's e~9naii addr9~ss: Under penalties of pelf ury, I declare that I have examiner) this rotum, including accomparryirrg schsdubs and statements, and to the best of my knowledge and belief, it la true correct and pksM. of prepanu other flan the personal represerMstive is based on all Information of which prsparer has arty knowledge. SIG RE OF ON ES ISLE FOR FILING RETURN DATE Amy Rist Korsun, Executrix ~ Z j ~b It0 AD :2304 , Richm4rtd, VA 23238 SIG OTHER THAN REPRESENTATIVE DATE Barbara Sumple-Sullivan, Esquire /a./~ /~/ b 548 Brit3ge Sheet, New Gumber4and, PA 17070 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 ~~ car ~n ~kppraisal5ervices, fnc. The Estate of Dianne H. Nlornin~$tar ' [_ocation: 2301 Old Coach Lane, Henrico, Virgini Requested by: I ~!,I Amy L. Korsun, Executor i 2301 Old Coach Lane I, Henrico, Virginia ~~ i I ~~ Effective Date of Value: March 22, 2010 Date of Inspection: September 30, 2010 I' II. ~~~~ .. ...,. ~i I Appraised by: Corbin Appraisal Services, Inc. '~~ Christine N. Corbin, ISA - CAPP Certified Appraiser '~, ~~ I, The International Society of Appraisers I! ~ Antiques and Residential Contents & Decorative Arts I ', Licensed 8~ Bonded Virginia Auctioneer !, I, I i~ ~~ ~I The Estate of Dianne H. Morningstq~r DESCRIPTION OP PE SONAL PROPERTY ~~, 1 Dresser Victorian Walnut Dresser, Eastlake Form, Attache Mirror with Scalloped Crest, Two Glove Drawers, Chest with Three Drawers. ~ l i Value per Liveauctioneers.com I 2 Cupboard Two-door Reproduction Pie Safe, Punched Tins an ~ Doors, One Drawer, Porcelain Knobs, Low Form. Value per Liveauctioneers.com 3 Chair Victorian Bow-back Armchair, First Haff of 20tH Century, Painted White. ~ Value per Liveauctioneers.com 4 Wash Set Three-piece Stoneware Wash Set, Assembled, ~ ! Consisting of: (A) C. P.C.B. Pitcher ~ ~ ` (B} Rothwell Bowl (C) Covered Soap Dish (Broken Handle) Value per Liveauctioneers.com S Condiments Two-piece Cream and Sugar Set, Gilded Decoration, Victorian, English, Worn Decoration. Value per Liveauctioneers.com ' 5 Painting r e Watercolor, Huffman Coat of Arms, Modern F am Mostly Family Value. Value per Liveauctioneers.com 7 Jewelry Group of Lady's Silver Jewelry, Consisting of: (A) 5 Pairs of Earrings (B) 1 Choker Neck Chain (C) 3 Rings Value per Liveauctioneers.com 8 Ring Diamond Ring, Custom Made, 14K Ye11ow Gold, ~'~ Diamond is 4mm in a White Gold Prong Setting, Asymmetrical Center Prong Setting, Marked "14K". I Value per Liveauctioneers.com I ~' $215.00 $30.00 $50.00 $20.00 $4.00 $10.40 $50.00 $275.00 Prepared for. Amy L. Korsun, Executor Corbin Appraisal Services, In . Date of Value: March 22, 2010 1504 Santa Rosa Rd. # 108 Ri hmond, VA 23229 Type of Value: Fair Market Value 804-385-7537 * corbinapp is IsQver~zon.net Page 9 The Estate of Dunne H. Morningstar DESCRIPTION O~ PERSONAL PROPERTY. Continued: 9 Ring Yellow Gold Wedding Band, Marked "Solid Gold L", ~I, ', $40.00 Engraved inside "JEC to RLG", Approximately 14K. _ Total Value -Personal Property belonging to The Estate of Dianne H. Morningstar: I ', $694.00 'I Estate Appraised by: ~I '. < I' ~ I ristine N. Corbin, ISA-CAPP I' I ~~ O Date Prepared for. Amy L. ICorsun, Executor Corbin Appraisal Services, I c. ~i Date of Va{ue: March 22, 2010 1504 Santa Rosa Rd. # 108, icffimond, VA 23229 Type of value: Fair Market Value 804-385-7537' corbinappra sal~C~verizon.net Page 10 ~~ltrJGJ. ~:C3t?,T~.i/t~~=i4..ll.~..f_ i C)C~l, t~`L~iv! f. e ~; c i e €r: f_ r~ h ±,~ I ~'iCrl1`.J~ :'~9~.If~'+J i's~GS T €~i-~ ~'~"{" a~li~:t"" 1;. Item F~eac,'it3'ta.~~ .~..~..._.~~,~.._....~~~......~.~~+._.."..~....1'~%L.~~G)~~rt-i J•Y~i ~.V`~h~t'tt..~~~.."~~.......~...~."..~..-._.............~........ _..."~. ~....~..__ ~..Jr.. .... i, _.. ~,..._V'•'.N~k i`~{1 ~. f~~:~...~.._....._. r~ I 1 I Ji ~ ~ :~ "a S. ~ i~ a 3" T~f ~ a i Cvm~tii ~~ •. n,. .~t 'lit, I~tl~~l;~f"i. ,14:.~~s.%N't~'} I i ~. ^ ~' v icy t~ ,:) ~..~. 5 Z tit t? 2"T 1: '~ ; 1 TJ-it~=~i~I!•': ~'C_'~; t ~'C:if~ ~E(_LIP~i~ "f 1-iF?;~t.;'~!-~ ~uR: rat!GT"t~C~.! I'~ i i .. ...., ~~~ .GC% ~~ S 2 ~,~: ~~.~ Geoffrey Thulin fine art 131ue Orchard Studio Post Office [3ox 93 Cashtown, PA ~73~0 77-337-3532 s~eoff ~ aeoffrevth ~ I i n mm After having looked at the painting "Dianne" by the late Joyce (Joy) Mill teaming more about the artist, I would give it a value of approximately $ Geoffrey Thulin September 24, 2010 and ' ~~~ ~~ ~t~1N ~'INC~I • www.finchjewetrycom INCH ~.. 1841 Columbia Ave., Lancaster, PA 17603 • 717:243.3333 l i0 wxo+1 rt NiRtt CONOHtIN rit is w ww it w n ~ r ~r ~ ~ pdn.ie Rsdia~ ww ~ a Jropt~ Nr~ 1rw11 dy Ir~lw lswM Isr~uMW i GNwtp ~ rAd~c Mi ulf~ dr rruK a 6Md fir kirwa a drr pipes b ~hr anal a1i viM4 ~1 rsdml r MIMr lets, M mkiq IYt A~n6{ M de ai spa M npMn dr ^11da. i I', . Pat Matz Oct© 6, 2010 580E. Millpart Rd Lititz, Pa 17543 I ~, 1. Ladies diamond vintage style ring. Three well matched round brilNant cwt diamc diameter of 4.50mm ~d a combined weight of approximately 1.14 c~rais. The diamond; char~teristics of H-l coku, SI1 clarity. Each diamond is set flush in the filigree style ring ; diamond is securmi by eight prongs. The mounting is hollow under the diamonds; inside 14K. See photo. Values $3,500.00. y .:Y' y ~Y M ~/t All weight, color, and clarity are provisional insofar as mounting permits This appraisal was completed by Iessica Finch, Graduate Gemologist {GlA). Pr using Rapaport Diamond Report, Gemworld Price guide and prevailing market. All or some of the following equipment was need at the lime of esamination. America stereo star mfcroscope, GIA Dnpkz II refractometer, GIA Gem Set, IDnminator polar CM200 electrnnic carat/gram scale, Ohans Scant scale, Tri Electronics GXL-18 ekch Master Color diamonds, Gill gem diamond life and gem Sber life. Ceres Reliance AC Secure each have a re quality ig~; each ~k stamped pt, Mettler gold tester Ceres f ` rho hrsNitq ll~to6d k asd. rii i~ wdr~laeiM 1hM do Appeba ameta es iab>tiryr eid~ rand M mry sloe ~a ~ ~ ldutt sa tits 6esu ~ M~ __ _. _,. __ .-- ___ _ _. _..... _._ ..__--_-~--__._ _ __ ---w ... _ _ ..,., ~_.... _ ~ ~~s. 1841 Columbia Ave. Lancaster, PA 17603 717.293.3333 www.fincbjewelry.com 1':. i:''~~f'_L t?yF .i_..l...~{ ~~iili l"f 1:7 i"ij"~~}.~.1 C:i~ii'~if-` i•s't'...L.. F'fi 1';?'i'~11 1:~k1b~;. is~~l~"t'~.tl~it~Ul:`"i".f.tJi•d, f_`s~.'•iy! .` ~K~11~rY: 1 i~:?fi -, J J''i' uJ~i :s~• 1 F'EuIST3~L L ~=IS!';!w'T cn~~,wa~E l~Civlfaf IT„=~~ 7 TEit~C F'ta'f'TE RV SLR TC~SES I ?~ tai7E~ LAlttF' EC~;r,E LAi~f~ I-'.. I i'Ci-iEPa G-=tI3>~aET~ hil:wC JEbJi~L ~p { I ~GCd i~ I aC EL_E C ~ I ~i'CHl::ha LN~t~='S F'I:CTURE~ FFtt~I~lES I7 t ~i-IES C[JRn!ICvG4J~~€?E ~.ur:HE~r~ ~;ET ~;~~cE~~ I.AdI VET r.L~sswar•~E MIF;F;S~ ~F~RA;~ELL.i=1 F'i~TTER`I~ CI_.fi~E F'C)T'TF's~4 4~UILT= WHITE ;•': I TCHL{'d ~'~:E,~'..i ~.r~F~E CC.f C3!•iEFi ~. F'r• i ~: ~ ~it, ~ 's ca'G a I a. _._....~___.r____.._ _ ... _ .... . ._ _ - -. ..,. . _. -- _ __,. . __ 1 . _ =i ~ . 1~ ic'~ 1 1 !~~_"s. t~~ I is=:«~. t~~4's i 1. ic1~ '.:i,. ~Gl ;~' 1 yrs. G_'~i~ 1 i~> . ~~~ J. :. 1L1~ 1 1.. ~~~ ~ i 1,i~~ 9. _, Qty 1 1 c:, ihk~± 1 a. t7_I~'a '~ ?. ~ 1 i . ~'t~ 1 , ~t~EL! 1 l , L~t~ ''~ i.J. ~k'I ~ .1. 171~ 1 i_'? ~t {{ ~iJ. ~~ kk ~y ~~K.~. ~~1~ ii 1. f~ ''t 11~. i~l~ 1 i `~. l~t~o 3 . ~~~~ ~ ~~, +~~ ~. , -;~~~ ~ 1~~ 1. ~~4~i i.l 14'.i . ~+~i i~!~ ~.~a. X21! :~ ~ ~. ~~ . k1i~~ 1' "~;. his 1 ~ 'l. , rL~;~~ i, j I ~:~I~'.rr~a~ ; ~at-i~'~"IC3~a ~~:~~:~ICE •"~ ~"'~~, iris ~" ~" Y ~Zl(_f RCa ~l4i'i~f t, ~.. s. C;:~i~3~' }~ I t..l... t='F{ 1 :'~ 1 1 i ~rIWW. Cft,"-.s"i'iw~?;~:ri+liJ3.7 7 [3~~. t.~Qi~ i met u i ~mz:nt 1?TAI~fi~fE r~t?;?r~~II'~+~~Tar ~"~1" ~ ~~r~.r~ ; ;~~ ~z G 1 7 ~: r, ; ~; ~ i ~~i~ 1 L;L~ CCs^it M L~~J rte~r L~~sc;~iptio~~ 'rice ~ ~'t~' 3'v.~~~1 F;Ea"rEP. ~ i ~.~. i~i4'1 ELEC fiFT'i_ I,=~rICE:~i ~, i i . Stu', - 5~'a~in '~, 1 ~~'. ~c"~ - Fah ~ ', 1 ~,1~ , ~i~'t -- WaCT3 wTAt~lL? i c4~.1~k - R[7X L~?T 1 ~', ~~~ _. LArr!~' ~ i 1 c.4~1~i i'~-tI GFfT51'FaI~tI".~ 1 I ~. ~,tli Fia~11 C ~ 1 ~, i?ir?i - t~Clf3Kt='aSF' '~ 1 7. +r~IZ- ~-- WIC1'~EF GA~i ~ i. 14?i.~~ WICiiF_r~ C.-ialR I t=_~;. ~~7 ~- ~L~;c~ '~ra~L~s ~- ~ ~ ~ 1~. I~ni~ -- 3 btiI(~F;ER 1'a~l...E~=, ~~ 1 ~. IZ~t~ _ CtAi' 'TAEt_F ,~, :W,, III; - I~JIC~.i~~t t:,FIIsIhlET ~. ?-7.i. f,~i~ -- SMat_L WaF~ROLE '1 cls~.I~:t?~ - rtar?Lrs ~~. ~, i~k~l - CAF-'E"r '~:I . IIZ+, ti5>~1 "_ i ~J L~ ~ Ate.? ~~ JJ E:, J : t%1 Q1 G. !. ~~ 1~ . ~lIL 3 t e:n a : ~, f a m ~:> >., n t : ~~ 7. , ~. ~' 7.. k'it~~1 .t',.r]mmi557.e]Tl ~'~ ..:'~~~. k'J4;k1?« 4~..:,. ~~'•7 L_.e ~L ac4j+_RS~4meriE= --~1 ~" ~~ .._,~, ~-~t c~rs a irD 3~I1r?r° ~ 7L,r. r.1~, l'i-lA~l~: 'r`CtC.i F'CJ~^c .r7E:LLI;d1Is "('}-i(~i.]I.iGH []Z.tR i=i~..lC'fIi];'~! ~;~ I I~, I II I ~~~ ~o~ ` Keith A Bowman, RPT BOWMAN'S PIANO SERVICE 1020 Red Road Harrisburg PA 17110 717-599-7782 bowmanpiano ~a IComcast,net ~~ i '~' ~j 7-28-10 Trinity United Methodist Church 415 Bridge St New Cumberland PA 17070 APPRAISAL Samick Grand Piano, Model SG-155 (5' 1") # HIJG 0492, Mfg. 1989. Oak satin finish. With original bench. AGE: 21 years. CONDITION: Cabinet, bench, finish: Good to Excellent. Structure - soundboard, bridges, pinblock, strings, etc, Good. Action wear -Appears #o have been lightly used. Action condition -Poor regulation -may not have had any mechanical s ce'~, performed. Design Quality -Poor Overall condition -Good VALUATION - $ 7,000.00 ES'TIlvIATED REPLACEMENT VALUE $ 12,000.00 (Exact model or finish may not be available) ~,~ ! ~~ _~~_ Keith A owman ~ ..: - •--~ ~~ This appraisal is based on the ezperience and ,rydgment of the appraiser, who shall not b~ hfid liable for damages or other consequences as a result of use of this appraisal Keith Bowman, Registered Piano Technician, Piano Technicians CH[9RCH OF, Tf~ BRETHIZEN J ~ E O ~ t 1015 2 i4S1 DUNDEE AVENUE ~~.,,',~ o BLGIN, II• bU120-1694 2-171Q ~ ~eCK %~ ~.~J.~i7 aaTe .~ ~ ~. 7 E 4 ~ q ~^ ~~5 l.'41 +.~:tt :~lr~.~. -LMSSM) Wh•'.~~ 't~ ~L'.'lr ... G7 T~ ~.' ~ ~•5 L~. ai~n~ ~{'~~ ~lltf [~S. [C .. TO ~~a Per s, 'se Rr -:tc THE ORDER Camp Ni' : ~ ~ 1 ?: OE ~~' LO L 5 2 7i~" ~:0 7 10000 L 3~: TO THE ESTATE OF DIANNE H MORNINGSTA 428 PARK SIDE ROAD CAMP HILL, PA 17411 000068 • Please Fold At Perforation Before Tearing 9213 0~ 121678-1 ~ ~~ S.. „~ s. ;Y:.. .~, t.. '~ f' IYr w ! dd i ~. yi - v. : _. 'Y. l.n.~+^~'riwn.~a.n/r.n~ y x... ~ .w• K i~:s.~ f..:~~.• ~~: f ! i' ~ • •~ ! o f~ ~ ~ ~.. °r #. ~ ~ 7 : :r.~.,,t ~ S:• x, a,e„ i t4 `. '~ ~....'{~ xr~ • e„_. ~{ • ~. ~. x.: . !~._ ~w. ..3. Y. `^ ~~ f s a i r Q.. ~ ~ s • s .: ~: a k t +ry s.„~ ~ ~, r. z. ~ ,~ ` ?`. ~' ~~~ ,~u~ `.~ .~ ~ ; i r r ~ ~ a . ~ g N ~: 'CHF~G C§ , MB~fi'~ a ~ , ; , ~,~ ~.< , Ies~rt~C•fipel~a~r MY11~4T ,~ ~ i s r' y"" f r `~• rs, \, rA ,~ ~.,•:-" . -~„~~•,~: ",Ai9 ~a~2l:10 .... -c ,w- ~ ~' , , ~ P Y WIS AMOUNT :t~ iri~alid:~ .. ... ,.: . . ` ~ $42~'~ dol~ars.:and~ 72. "cents' $427.72 ifter S months ., ;~ ~AY;TO:,428TPARKSSIDE ROADIANNE H ~MORNINGSTA CAMP HILL, PA 17011 ~~ .. .' ~ ~ A . R ' ; . SI~NA~URE u'3202459~~' ~:02L309379~: 60i~«8~~~4L737~~' I j ooooss ~ 9 3Q-121678-1 TO THE ESTATE OF DIANNE H MORNINGSTA 428 PARK SIDE ROAD I'I CAMP HILL, PA 17011 • Please Fold At Perforation Before Tearing x - a.•. ~ \- ~,~ Y.,. ti. t ! F I• a r ~ ~ ~, f ~ t ~N! •A ! 4'~~ r '~,. b a a `. ~ + .. '+r + t +'f •. +. .: ~~ :. ~~. ~ t 3 .t. r .. ~ ~~'.` Gam.. ~_ ~ ~ yay~. ,F a ~ ~ ~ p :. _ { bra a , , _ ~ a f ? ~ _' C C t~JM~Et~,'. ` '.1P1~. _. r k, ~~ a . `~ + f• ~ .. K .. ~ cK~~, : j .' \ •. r ~ ~ r ' f + .s f r . ". s . •`~ /~,A ~p~r .: s r ~ :: f ~ ~'~k.e a / ~~ .:e '" ~iFe 9e ,: .r, •i y ~s%a x ?o++. ^a ~~ ~ %w ~ . ~ "'*°:.A. p ~ x7lrJ o ~ :3F ~.~""~.~ /.w ~'wR j`•~~-1-, t-: . II ~ _ ~ P Y 1S AMOUNT e .4 °•..AUTH R ~~.' n' 3 20 3 2 5 2u• ~:0 2 1 30 9 3 7 9~: 60 L~~~B~~~ 4 17 3 7~~' EMERITUS C~RPQRAe~'lbN ~ Y :. .:~ ~ - ~ ' :. ~ 3131 ELUdTT AVENUE SUITE SO'D' `- , . f ~~ ' ~ ~ - . ~ WeJls Fargo BariT~r,~{ ~ ~ i;75 Hosp~ Drive ¢'' _ - - ~ 190950 :'I SEATTLE, WA 88121 , Van~Wert 0~ii 45891 14P19l2~1 ~ ssaez~~~2 . , ~< yY4 .C? :' . ', X a nr`,. . y- i a ff ~ : .~ t ~ Yi, ~y PAY ONE THOUSAND FIVE-Hl1~DR~C~ TWE y L ~ Y , ~ .:sd~ LVE 1~OLLAR~`,~ND 28 CENTS - „. ~ £ „~,,. ., ;x V ID jAFTER 180 DAYS ~: ~- ~ ~ .. e .~ z , 3.3 > ~. .; x -z. ~ ;°A ~d ELIZABETH D{ANN 1VlbR~1]NGSTAR ~ )BOER OR AMY KO.RSUM - '` - ~ R,- r.. , ; ~ x ' ~ ~F 2301 OLD COACH ~A(~E , x ~, ~:~ r , . X1'1 HENRiCO VA 232`8; " ~.,s. . `:°~<°>'~:: `~~~ , ,gq ' ' ~ . ^ L ' G ~ ~ I " a Y F~ ! y! SEC;irs{ i ... ..,._. '.aC+s€ s1Ti:RcS 11•c . Eft]E u. _:141L8 ON BAG;:. tn .. ~E.,.,:::::~5;::..._ ~.,.__t-¢.. _ _..r, ~ n' L909 5011' x:04 1 20 38 24~: 9600 i 2 S 39 81+' i m ' ~,3 a 1 c rn m o a ~ , o, ~. ~' ~ ~ ~ o ~.. _~ . ~.. ~.., ~" ,,. . .: ~:: a ~ .; - .. _. A. ' ~.. ~ ". ~ ~ ~~ < ~ . ~~ O _ O .~ ~ .pZ Z ~`. . ., ~,:.. n'. .Z1. c o. ~ ~ ` ~- 3 ~' ~~ I c r~,r w i ~ s J I ~1 , _0 -~:. ''`` V, Q Y ~., :..~'~_ N •. `• r ~ r,,<=- O ~, N ~ i , ETRO BANK >16774 6297249 001 092140 DIANNE H MORNINGSTAR 428 PARKSIOE RD CAMP HILL PA 17011 Metro Bank 3801 Paxton Street Harristwrg PA 17111-1418 1-BBS-937-0004 mymetrobank.com YYi1ro hero 7 days a arwek, 21 hours a day at 1-88&837-0004. aasse PERS STATE ~ ..~~ 'YY t~ :..~i _'>~ , . _ M~ ~~~#}FS..j~ticna ~~vlA..t4 ~~t~.i6:.ae~?a Transactions By Date Date Desist tton -~.,~. 02/2x/10 INTEREST PAYMENT interest Summary ~I . ~~ . _. '; ... Fees Summary S~IVINGS 0626612576 °_~r ;',;lo-.'., f1.95i_12:~i ~-sdl Balance 50.21 51,35~.f+7 G , - ~ ,< o.zsx, } ~ ti f ~1 ~ L i~ Y " F~ ~ ~ ~ ~,,, L.,i y~yam.~ . //~~ ~ 5~'L~ { ~ ~/~, y~ yam~{{ ~~~ ibt'1...i~.e~tu~rTiL-. a.lve~s~'~~C~-Yrit~~,K.~I.':u~e h ~ ~ f`,~ .. 1 ~ a' . . A The Fees Summary above does not reflect any refunded or waived items credited to your accou~ht. '~, FUNDS AVAILABILITY: Chsdc deposits made beforo 6 pm aro available on the nbxt business day, provided to a hold. Beglnntng Fsb. 27.2010, bald ftsms wits be delayed until the 2nd bustnsss day (proviously the 51 certain dreumstancss, funds may bs MM until tM 7th business day (prwiously tM 11th ttustness day). hold K placed on your funds for any rosson. FEES 3 CHARGES: Certain fees will be rorised as follows effective April 1, 2010: Cash or DeposN item Ref Cashia"s Chsdc -18.00; Closing Account (1x0 Days) - No charge; Closing Account-Wall Request -520.00; t dornsstlc/550.00 forrtgn; Dormant Account-Chsdclnp/Money, Market - 55.00 per month; Dormant Account-Sa Money Order -55.00; Wfro 7ronsfer Domestic-Outgoing - 520.00. NATO • CCC n~ nn~ omr ~e~c• a •.....+~w ...~ ...r..r.u ~ •n~u deck is not subject ~nsss day). Under will be notiflsd H a - 572.00 per Item; don Items - 520.00 -15.00 per month; I~, sge 1 of 2 -.I -- e .. 0 Io w • ~ SCHEDULE F -~ - ~~ MEMBERS 1st FEDERAL CREDIT' UNION N N o o~ *~ Send Inquires to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.memberslst.org Main Switchboard; (800) 283-2328 Q Ca11E (717) 697-4372 or (800) 283-4372 TDD: (717) 697-5312 or (800) 283-2328 exL 5312 TdeBranch: (800) 237-7288 Statement of Accounts Mar 25, 20,10 thru Apr 24, 2010 Account Balances at Checking: Savings: Certificates : Loans: Money Man< Swipe 5 YTI miler: 172575 a ~ Glance: 0.00 0.00 0.0 0 M O.W Ig~ment : p - 00 steward: p,20 Page : 1 of 2 rajl program. 18510 1 1hIB 0.382 37019-18510 I„Irl~~ll~rrlrlr~llrlr~l~„Il~ll~r~„I~I~Ir~lll~~r~~rll„I~II E D MORNINGSTAR C/O AMY KORSUN, EXECUTRIX 2301 OLD COACH LANE RICHMOND VA 23238 Your aggregate balance as of April 1st is $38,725.88. An aggregate balance of $2,500 and having 3 products will place you in the Silver MLR level. Want to earn some extra cash? Take advantage of our CASH4U Ask an associate for details. CHECKING ACCOUNTS SAVINGS ACCOUNTS .+uw 0000 -REGULAR SAVINGS Date Mac ~ T Mar 29 Ford _ ~~ Additions ; Withdrawal ACH SOC SEC ~.. .RETURN DEPOSIT R ~~~ :~5~ S S anos 1T~'~ Mar 30 , ''Deposit- Transfer From Sh 1,U86.00- 15.960.72. Mar 30 . am Deposit. Dividend ~1~. ~1L ~~.~• I~3~11~Y 13'.938.65. ~(nnua/ Mar 30 ~ ,Y~(d Een>'Bd 0_ 6.09 ` V1lithdiawal by Chec fin 0.?/0>/2f110 hiougoh t2?/3>/2YIf0 . - 29 ;897:37 ~:903.g6 REGULAR SA V/I4fGS Cbsed _ 29 903 46 ...~_,~s d5ie;fi>~l-sbfen~nf ••• p/aase~retab P/~a~di~g ,e7forrr~adhir on• t/ics .,wr~duyt••• d>:Es~ fii•-a/ slbfemeent 1br far- , .. - 0..00 9 Pu~se~' '•, --- Contimrwri nn fnllnudnn nano _-- SCHEDULE H a---~-~- Grandle Funeral Home, Inc. 148 East Lee Street P.O. Box 114 Broadway, VA 22815 Bill To Amy Karsun 230f Otd Coach Lane Richmond, VA 23233 Date arzorzolo Terms Date of Death '~ Name of Deceased Net 30 3-22-10 Dianne Morningstar Description Amount Grave Opening Cemetery Charges Sales Tax 100.00 40.00 0.00 Total slao.oo Payments/Cred ~ so.oo Balance Du slao.oo • .f .~ ...~.. PARTHEM 1303 Bridge Street P.O. Box 431 - New Cumberlanc'1, PA 17070 (717) 774-7721 (Fax) 774-5546 www.parthemore.com Gilbert W. Parthemore, Founder Gilbert J. Parthemore, Supervisor Stephen K. Partheniore, CFSP Bruce lt. Parthemore, ?re-Need Coordinator, CPC rofessional Memberships: !FDA • PFDA ~CFDA • CCFDA • .~ ,.r..MrarrM• tee Rule You Know. x People You T3vst -~ o S.~YV1Gt.. i A Family Tradition ~aring® services, Inc. IS 3!24!2010 assist you in every way T'he following that you selected ORE Funeral H Cremat2oi Mrs: AmyR~st Korsun ,, 2301 Old -Coach Lane Jiearico, VA 23238 For the Service of Elizabeth Morningstar We sincerely appreciate the confidence you have placed is us and will contra we can. Please feel free to contact us if you have any quesdioas in regard to t is an itemized statement of the services, facilities, automotive equipment and when making the funeral arrangements. . Perms Due Date Account # Net 30 4/23!1010 2010021.3 -~ Description Amount SERVICES ~ MERCHANDISE t2tomation with Memorial Service 4,180.00 Homage. Verdi Green Urn 649.00 Total Services and Merchandise 4,$29.00 CASH ADVANCE TTBMS .. .. - . Death Notice, Harrisburg Patriot 506.77 Death Notice, I-ancaster 575.00 Death Notice,York . 374.90 peath Notice, Harrisonburg Daily News lzecerd - 341.25 16 Certified Copies of Death Certificate ', 96.00 . {2) Clergy I#onoraria ' _ 250.00 Organist Honorarium - - I 125.00 , Flowers, Um Wreath ~ 196.10 ~ D hin Co Coroner Fee, Cremation Authorization ~p ~h' 25.00 Total Cash Advances i 2,490.02 ADDTITONAL TEEMS 24" X 36" Photo Enlargement ~ 82.68 Total Additional Items ~ 82.68 Total ~ a7,4o1.70 _ ' , T Ir~-r~~c, ycu .. ~~~sa ~+~~ Payments/Credits ~ s-7,4olso ' '''~ wz >ray b ~ - Balance Due so.0a Funeral ~ ~teeon ~-' ~~ F~ -- nseS ~# seiyed~ ~~ r x ~io~ " --"'- paPet ~ ~ pot! _._.-~-- Ca-ffe+~ ~~ ~ .t~ ~! -total EXp'e'~~~ ~ . united 1K+~°dist ble to ,~ fi`nl'~y' Chi ,pa-ya- funeral, wig nai'~`~ ~ List of v°lunt~; ~~ ~~~ ~~ ~- r.. 61~~ ~i __ ~~~' ~~~ BARBARA SUMPLE-SULLTVAN, ESQUIRE 549 Bridge Street New Cumberland PA 17070 Invoice submitted to: Ms. Amy Rist Korsun Estate of Dianne H. Morningstar 2301 Old Coach Lane Richmond, VA 23238 May 16, 2010 Invoice #67221 Professional services Barbara 4/29/10- Review of email; email to client 5/10/10- Letter to client SUBTOTAL: Paralegal 5/14/10- Email to client SUBTOTAL: ,For professional services rendered Hoi r~ 0.1 0.1~ Amount [ 0.2Q 45.00]. 0.10 [ 0. OI 6.50] 0. 0, $51.50 _ _ _ _: Ms. Amy Rist Korsun Page 2 5/15/10- 7 F 5/6/10- F E Client Fund RECEIPT FOR PAYMENT GLENDA FARMER STRASBAUGH Receipt Cumberland County - Register Of Wills Receipt One Courthouse Square Receipt Carlisle, PA 17613 MORNINGSTAR DIANNE H ate: 3/26/2010 e: 12:03:26 ~ 1060503 Estate File No.: 2010-00315 Paid By Remarks: A N IY R KORSUN W Z ----------------------- - Receipt Distribution -------- --'--- ------- ---- Fee/Tax Description Payment Amount Payee Name i j PETITION LTRS TEST 90.00 CUMBERLAND CO Y GENERAL FUN WILL 15.00 CUMBERLAND CO Y GENERAL FUN SHORT CERTIFICATE 20.00 CUMBERLAND O GENERAL FUN JCS FEE 23.50 ~ BUREAU OF C I TS & CNTR M.D AUTOMATION FEE 5.00 CUMBERLAND CO Y GENERAL FUN Cash ~ - $153.50 Total Received......... $153.50 ~I .._ , CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (T17) 249-8168 Fax: (717) 249-2883 July 23, 2010 Cumberland Law Journal is published every Friday by the Cumt Bar Association and is designated by the Court of Common Pleas a~ tl publication for Cumberland County and the legal newspaper for public notices. TO: Barbara Sumple-Sullivan, Esquire RE: Dianne H. Morningstar Estate Legal advertisements must be received by Friday Noon. All I~ must be paid in advance. Make all checks payable to: Cumberland Advertisement inserted on following dates: July 9, July 1fi, and July 23, 2010 Advertising Cost Proof of Publication Second Proof Request Payment received Total Amount Due ~d County 9cial legal of legal $ 7 .t~0 $ .QO $ .d0 ~I $ 7 .Ob Becky H. Morgenthal, Executive Director The,patriot-News Co. ' 2020 Technology Pkwy °~~" Suite 300 Mechanicsburg, PA 17050 Inquiries - 717-255-8213 BARBARA SUMPLE-SULLIVAN 549 BRIDGE STREET NEW CUMBERLAND PA 17070 the ~latriot•~ews Now you know INVOICE ACCT. # AD ORDER # DATE EDIT ON ADDTL. INFO." 13197 BARBARA SUMPLE-SULLNAN 0002079470 07/10/10 REGULAR 13197 BARBARA SUMPLE-SULLIVAN 0002079470 07/10/10 REGULAR 13197 BARBARA SUMPLE-SULLNAN 0002079470 07/17/10 REGULAR 13197 BARBARA SUMPLE-SULLIVAN 0002079470 07/24/10 REGULAR TOTAL: REMITTANCE ADDRESS The Patriot-News Co. 23794 Network PL Chicago, IL 60673-1237 Please include the Account # or Ad Order # (above) with your rem NOTE: This Invoice replaces the Order Confirmation which we previously sent with ,ALL CHARGES ARE NET ~~ AMOUNT OLD TEXT CHARGE $ASIC AD CHARGE ~ASIC AD CHARGE E~ASIC AD CHARGE /{AFFIDAVIT CHARGE i~ c~--Thank You fs lof Publication ~, 54.00 Ss4.7s 584.76 584.76 55.00 X263.28 Keith A Bowman, RPT ` BOWMAN'S PIArNO SERVICE 1020 Red Road Harrisburg PA 17110 717-599-7782 bowmanpiano ~ Comcast,net 7-28-10 Trinity United Methodist Church ~, 415 Bridge St New Cumberland. PA 17070 INVOICE Service call to examine Samick grand piano. Appraisal attached. Service ca11- $ 100.00 Tax exempt TOTAL $ 100.00 Thank You. This appraisal is based on the ezperience and judgment of the appraiser, who shall not a Feld liable for damages or other consequences as a result of use of this appraisal Keith Bowman, Registered Piano Technician, Piano Technicians Guil i vrbc~. ~4.ppraisat Services, Inc. Ms. Amy L Korsun, Executor 2301 Old Coach Lane Henrico, Virginia 23238 II~tVaI~E '' INVOICE DATE I '4ctober 8, 2010 TERMS Net 30 days INVOICE REFERENCE: The Estate of Dianne H. Morningstar ...-.~j ~~ `_ = - .:. 9/23/2010 On-Site Inspection, Valuation, Market Analysis and $295.00 Report Compilation Total Amount Due: $295.00 Less Payment Received (Check # 1015 dated 9/29/10) -$295.00 Total Fee= $...per object/{ot Please remit the fee below with a copy of this invoice to: ', Corbin Appraisal Services, Inc. A service charge of 1.5% per month on the balance wi{I be charged to accounts 30 days past due, an annual rate of 18% per annum. '. Corbin Appraisal Services, Inc. 3805 Foxf{eld Court, Richmond, VA 23233 I, Phone: (804) 385-7537 • E-mail: corbinappraisals@verizon.n~t I ~, THANK YOU FOR THE OPPORTUNITY TO WORK WI ~( YOU! I ~ ~ t Kansas City, MO 64999-0102 We rernmmend that you use one of these IRS-approved methods to send your of mailing to avoid a fate filing penalty: - U.S. Postal Service certified mail. - DHL Same Day Service. - FedEx Priority Overnight, Standard Overnight, 2Day, International Priority, or - United Parcel Service Next Day Air, Next Day Air Saver, 2nd Day Air, 2nd Day F~cpress Plus, or Worldwide Express. Step 5 - Keep a copy Print a second copy of the return for your records. We recommend that you also' supporting forms, which don't need to be sent to the IRS; - -Background Worksheet - -Last Year's Data Worksheet - -Form 1099-INT/OID - -Form 1099-G - -Charitable Worksheet - -Social Security Worksheet 2009 return information -Keep this for your records Here is some additional informati on about your 2009 return. Keep this information v You will need your 2009 AGI to e lectronically sign your return next year. Quick Summary Total (Gross) Income $37,295 Adjusted Gross Income 37,295 Taxable Income 26,545 Total Federal Tax 3,561 Total Payments 3,155 Penalties 0 Refund Amount 0 Amount You Owe $406 rn. Retain the proof rational First. M., Worldwide and retain these your records. _~ _ESTAfiE OF ~DUINN~'MORNINa3TAR ~ ~ 1:4 _ AMY ~ KOR~4UM, ~E.. ---.... 68-346/544 ._ 23A1.OLD.f~14CH U!! .. ._... .. n H~II~O.YA 23236..........__._........ ... `fy `,u ~Z.t ZW Q .... .... ...... .....--- -...._ ......._.. ,r- e ~OrderiiE..:.::f:J~.~-~.~...~.5.~.~ye5 Svr.. -._ u .. o~v_: _- :: -::~ ~ -.-_ .:_- .~~_~'2.3-Co~1-~~~g- tOR"l0 +2.13t~v „P x:05 L403 i64i: 43.6 i695n' i0 4 .r..~... 1 ..~~` East Pennsboro Ambulance Service, Inc. Post Office Box 47 Enola, PA 17025 (717) ?32-5552 FAX (717) 728-9501 Federal Tax Number 23-2464545 BILL TO Momingstar,Elizabeth do Amy Kosson 2301 Otd Coach bane Henrico, VA 23238 Statement DATE 6192010 DUE DATE AMOUNTED E , AMOUNT ENC. 6192010 s164.oq DATE DESCRIPTION AMOU T ', I BALANCE 02/182010 INV #10-0317. Drn 021182010.Orig. Amount 5164.00. -- STRI WAY Non Member 584.00 --- Stretcher I~leage, 50 (a~ 51.60 ~ 80.00 1 .00 I I, i~ 164.00 . I CURRENT 1-30 DAYS. 31-60 DAYS 61-90 DAYS OVER 90 S AMOUNT DUE 0.00 0.00 0.00 0.00 164.00 5164.00 YOUR PAYMENT 15 uuE uF'VN xtctir i ur I nl~ .71 H 1 CMCIY 1 , mCU14ARC, IvICN14/11 V /'y1Y ~w w ~ INSURANCES DO NOT PAY FOR THIS SERICE. APPROPRIATE COLLECTION ACTION M;~AY B TAKEN ON ACCOUNTS OVER 90 DAYS OLD. THANK YOU. VISA-MASTERCARD-DISCOVER ACCEP E 'I ~ ~I P.O. Box 3268 S'am' mais"~own, PA 17011 August 03, 2010 OOOOOD0284 ~lll~~ln~+X111'!11"Ill~lllll~'I'IIIIIIIIIIILllr111~r11r11'IIII ELIZABETH MORNINGSTAR 2301 OLD COACH LN RICHMOND, VA 23238-3024 k~ ~:~ x..,. Commercial AcK Accounts Rece~ Phone: Ince Company Management 901-4557 219- CLIENT-NAME AGENCY CLIENT-# TOTAL-PAID BALANCE Camp Hi11 `Fire ..Company No 622432`1086423 $. 0 $83.79 TOTAL: $.~0 $83.'79 The creditor listed above has assigned your account to our agency for collection. o r dntire balance is to be paid directly to our office at the above address: tf your account balance is not satis le ,further collection .activity will result. You; are hereby notified that your credit rating may be negatively coed if you fail to .resolve your obligation. ~ ` This communication is from a debt collector. This is an attempt to collect a tlebt an a y~,infoi-mation obtained will be used for that purpose. There willbe a $20.01) (twenty dollar) fee for any che~k ettlrned by your bank. The. representative assigned to your fi{e is: ED MARINO at .Extension: 219-- ' 1 Unless you notify this office within 30 days of receiving this notice that you dispute a validity of the debt or any portion thereof, this office wiN assume the debt valid. {f you notify this office in t ng, within 30 days of receiving this notice that you dispute the validity of this debt, this office will obtain v ri cation of this deft or a copy of the judgment against you and mail you a copy of stack judgment or ver~cati n If~ you request this office in writing within 30 days after receiving this notice, this office will provide you tf~e name and .address. of the original creditor, if different from: the current creditor. You may now pay your bill online at our secure site, www.paycac.com. You will need to enter yo~lr For security reasons, credit card payments will not be processed without the security code from the a EACAAD ~ f CARD NUMBER CYV2 CODE AMOUNT S4GNATURE Account Number EXP. DATE Bill Dste $83.79 622432 8/3/10 - ~ ELIZABETH MORNINGSTAR ~ency number, 622432. balck of the card. Remit payment to: P.O. Box 328 Shiremansto~m, PA 17011 A01 _ _ _ r ~_ _ _ _ _ _ _ _ • WEST SHORE EMS -BLS ~ 205 GRANDVIEW AVE l SUITE 211 ~ ~~~j CAMP HILL, PA 17011 ' ~~~~ ~~©~ Phone #: (800) 367-0512 Federal Tax ID : 23-2463002 Ena~RC$rrcY" AdED1CAL SER'JICES PATIENT NAME: ELIZABETH MORNINGSTAR PATIENT NUMBER: $9538 II NMCI CALL NUMBER: 10041128 ~ SUP2 INSURANCE: DATE OF CALL: 03/03/2010 TIME OF CALL: CALLER: 10041128 FROM: LOYALT~N ~ CREEKVIEW T0: HERSHEIY E ICAL CENTER ELIZABETH MORNINGS7AR C/O AMY KORSUN REASON(S) WOUND ~ B OCK 2301 OLD COACH LN FOR CANCER' RICHMOND, VA 23238 TRANSPORT ', INVOICE DESCRIPTION OF CHARGE QUANTITY UNIT PRICE AMOUNT BLS EMERGENCY BASE RATE A0429 1.0 824.74 I~! 824.74 BLS MILEAGE A0425 19.0 13.73 260.87 I C 1085.61 DESCRIPTION OF PAYMENT RECEIPT PAYMENT DATE I AMOUNT Medicare Assignment Adjustment 04/12/2010 , 639.72 Medicare Part B Payment 109811522 04/12/2010 ' 356.71 PLEASE PAY THIS AMOUNT -INVOICE DUE UPON RECEIPT -~->.- 585.18 RETURNED CHECK FEE - $31.00 --T- • DETACH ALONG PERFORMATION AND RETURN STUB WITH PAYMENT ' AMOWN DIE 89.18 PATIENT NAME: MORNINGSTAR, ELIZABETH CALL NUMBER 10041128 AMOt~ s i PATIENT NUMBER: 89538 BILLING DATE: 07/08/2010 ENCLjOS D This account is now PAST DUE!! Payment must be received WITHIN 10 DAYS. Collection process will begin. ~, VISA AND TER CARD WEST SHORE EMS -BLS 205 GRANDVIEW AVE CAMP HILL, P/~-1~011 ' ~. ~~ s !~ 08/06/10 ~ 50.00 2987901ads PO BOX 62510 FOR PORTABLE ULTRASOUND BALTIMORE MD 21264-2510 SERVICES PROVIDED AT: PAL YRA NURSING HOME =~~" PRIMARY INSURANCE: AET A'12733 RETURN SERVICE REQUESTED SECONDARY INSURANCE: MED C/#RE PA o~o~ zee o~ ELIZABETH D MORNINGSTAR ADS AMY KURSON PO BOX 62510 23301 OLD COACH LANE BALTIMORE, MD '~21 64-2510 RICHMOND VA 23238 I~~'I(~'~i1~"11~I11~~~1~1~~1~' I'1~~"~Ii11~~111~~11~1~~11~11~11 AMOUNT'OF PAYMENT: DATES OF SERVICE: 02!05/10 - 02/05/10 ~ r C¢eda Ged Peyments See R®~.se Slde Please detach hETe., arcd enclose thispnrtion with ycnir prompt payment. Thank y u! o~ooo These charges are bifled directly to the patient because a copay, deductible is dus or your',cla m ras denied by our insurance company. It is the patient's responsibility to provide current insurance inform io (s reverse side. 02/05/10 93971 VENOUS EXT UNI OF 50.00 .00 .0 .00 50.00 TOTAL 50.00 .00 ' .0 .00 50.00 PATIENT NAME: ELIZABETH D MORNINGSTAR A ~UNt DUE: 550.00 Please call 800-786-8015 between the hours of 9:00 am and 4:30 PM EST. IL PAYMENT TO: ADS PO BCbX 2;510 BALTIIwI R~ MD 21264-2510 ~~ 1138-MXRSTM-622435-764331615-P; 3611496-1-262; 30718073-1; 1 i Mai10029.JPG - Gmail .~--.~. r~ ~• ~ t~ c = ~ ~„w* ', ~ 7„~.'~'', .~ i 4 ~ +y*~-~y ~m ~..,~ ~ i 1' G ~i ~: ~ F .~ ,. 1 _ t ~~ t f ~ ~ F f~T. '.i ~ ~- k 1 t'PM F ~~rrt ~'i .~.•~. iY '•,~ a y L~~ u~ ~ r #~ r r . ~~: _ ~~ R~ ' ~~ ~ Yage 1 of 1 ~ ~ ~ ~~ ~` ~:? 6e.~ r '} y ~~ f y ~ ~ ~iS~LL ~~ ~ https://mail.google.com/maiU?ui=2&ik-OGe365d171 &view=att&th=128ad2731341e1 ~a~&a... 5/24/2010 4 Filing Checklist For 2009 Pennsylvania Tax Return Filed On Standard Farnt~ Prepared on: 04/13/2010 09:36:16 pm Return: ~:\Users\Brian\Documents\HRBlock\Dianne Morningstar 20051.T Quick Summary PA Net Taxable Comp. $29,749 PA Gross Taxable Inc 29,971 PA Other Deduct D PA Net Taxable Inc 29,971 PA Tax 920 PA Tax Prnts & Cr 913 PA Refund 0 Amount You Owe $7 ..r_.._. To file your 2009 tax return, simply follow these instructions: 1 - Si nand date the return Step g Step 2 -Assemble what you need to mail In addition to the forms the program will print for you, you must review the documents required by your state. - your payment must be submitted with your Form PA-V - PA Payment Vc - NOTL: Make sure you include both page 1 and page 2 of your PA-40. 9 for any other Step 3 -Pay the balance due on your taxes Make your check or money order for $7 payable to "Pennsylvania Department of Rev cash. Write the following on your check or money order: - the last four digits of your Social Security number, "2009 PA-V", and your da im - don`t staple or otherwise attach the payment to the voucher. Instead, just place i1 envelope with the voucher. ~I Step 4 -Mail the return PA Department Of Revenue ~'i PAYMENT ENCLOSED 1 Revenue Place Harrisburg, PA 17129-0001 We recommend that you use one of these methods to send your return. Retain e avoid a late filing penalty: . Don't send phone number. fajose in the pf mailing to a - U.S. Posta! Service certified mail. (if not mailing to a P.O. Box, you may also use one of the following) - DHL Same Day Service. - FedFac Priority Overnight, Standard Overnight, 2Day, International Priority, on In - United Parcel Service Next Day Air, Next Day Air Saver, 2nd Day Air, 2nd Day Ai Express Plus, or Worldwide Express. Step 5 - Keep a copy Print a second copy of the return for your records. We recommend that you als pi supporting forms, which don't need to be sent to the state: - Background Worksheet I anal First. Worldwide n~ and retain these ~ r _ ~ _ • Clinical Practices of the University of Pennsylvania Clinical Practices of the University of Pennsylvania BOX 7579 PHILADELPHIA PA 19175-7579 ~voooeo osazseeo~ Questions? Telephone 800-406-1177 Mon-Fri 8:OOAM - 6:OOPM EST ELIZABETH D MORNINGSTAR 428 PARKSIDE RD CAMP HILL PA 17011-2127 Irr~lll~rrlllirurillrrrll~rlrlrrrll~rlrllirrl~rlrllrrlrlrrlrl Account Summary Statement Date 09/09/08 Patient Name ELIZABETH D MORNINGSTAR .Account Number 053269601 Total Charges $ 1285.00 About Your Statement Page 1 Thank you for choosing the Clinical Practices of the University of Pennsylvania for your health care. This is a statement of your account(s) r'Physician/Health Care Provider services onlyy. You ay'i receive a separate bill for Hospital Ancillary or Labortat ry IIs~ervices provided at several locations within the H alth System. The reverse side of this state e~tt details the Physician/Health Care ProVid r Involved In our care. For your convenience, the cha ge s)) for services) provided along with any payment(s)~or d~u5#ment(s) made to your account(s) has been items ed If you wish to pay by credit ca d,'please complete the stub below and return it in the a cl s d envelope or contact us at 800-406-1177 to pay by ph n .Most major credit cants are accepted as payment. ' ~, The Univers~'ty of Pennsyly ni ealth System provides urgently needed services t al rsons without regard to their ability to pay. If you a e ing difficulty paying yyour bill, please contact us at 8 1177 to determine fhe type of funding for which y u a~ be eligible or to make payment arrangements. Our customer service reprise ves are available Mon-Fri between 8:00 AM $n 6: 0 PM EST. Payments will be applied Ito h~ oldest open balance on your account including n~M accounts that have been transferred'to colleditll ns_L Insurance Information Amount You Owe $ 89.95 Details/lnformation on Reverse Insurance 1 CIGNA EXISTING EXPLO Insurance 2 EXPIRED MANAGED CARE Insurance 3 HEALTH ASSURANCE/AMERICA Important Message Please Indicate changes to insurance Information on the reverse side of this form. If dental or vision The personas balance on your account is past due. Please pay Insurance is listed above, that Insurance is only immediatey. ff you have recenty submitted the payment, please billed forappllcable servlCe. disregard this notice. PLEASE DETACH HERE AND RETURN THIS STUB WITH YOUR PAYMF_NT Clinical Practices of the Patient Name Account Num University of Pennsylvania ELIZABETH D MORNING T R' 053269601 MAKE CHECKS PAYABLE TO: CPUP Amount Due ~ Ai}tount Enclosed (Clinical Practices of the University of Pennsylvania) $ 89.95 Due Date 09/24/08 Credit Card: ^ VISA ~ ^ MasterCard ^ AMEX n Card Number: Amount Charged: $ Exp. Date Name on Card Clinical Practices of the Un~ve~sitly of Pennsylvania BOX 7579 PHILADELPHIA PA 1917-7 7~ In~lllrlnrrrlllr~~lrl~l~lrnlrl~l~l~'Ynl ~Irlrlrnll~lru~ll~l Signature 00532696010000008915 ~F uppy~~_~ II 1 PAP-575-A-0 1 The Hospital of the University of Pennsylvania sr>~ N ri:.sh,.~sa~.t4~ ELIZABETH D MORNINGSTAR 428 PARKSIDE RD CAMP HILL PA 17011-2127 Patient Name: Morningstar ,Elizabeth D Statement Date: 11/18/08 Service Date(s): 10/23/07 Account Number: 7296iS3Z68601 Medical Record Number: 053269601 • Ins. 1: TYGO ELECTRONI CS Ins. 2: ins. 3: Ins. 4: Important NViessage Your Insurance Comp Portion Of This Bili. F Remaining Balance Is University Of PennsyP Provides Financial Cc Patients Regarding TI Services. if You Are l Concerns About Your Customer Service Div Paid Their ayment Of The ~ted. The aRh System I Services To ty To Pay For i Or Have Please Call Our 1-877-433-5299. Total Charges: Payments/Adjustmen#s: Account Balance: ~' i Please Pay This Amt: For questions, call (877) 433-5299. 0787.00 0684.69- 0102.31 ' 0102.31 at: Pie~ase irl-ote: Your physician roil/ bfN separefie/y tav~ profiessione/ services. rn.r+o,Fro.rarn. ADDRESS SERVICE REQUESTED Clrelc Ymr Nparr oNroon or irorrrreo irYorrrxfon ^ hos eHnn/M. Plrnoo ~nrlen eAon~r~ eA lret i]Of734~94 001 0.53 ELIZABETH D MORNINGSTAR 428 PARKSIDE RD CAMP HILL PA 17011-2127 0 ` TM CW2 Mrmfur in lbn In! >t }lid I~~~IILI~~~~d11~..IJ.~J HOSP UNIV OF PA BOX 7777-9500 PHILADELPHIA PA 19175 ' 12118/08 on Mr 6oek o1 ynrr end'R anl, y pear p~vNSTA-i-E 1st Statement Milton S. Hershey Pa e 1 of 2 Medical Center This bill represents the portion r ertnaining. after your Po Sox s43291 Pltlsburph, PA 15284-3291 insurance company has prdce sed your claim. Please send your payment for the fill -~ount due. If you have any questions concerning hpvr youur insurance company processed your claim, please all'them. ELIZABETH MORNINGSTAR C/O AMY KORSUN woosoa l 2301 OLD COACH LN i HENRICO VA 23238-3024 I~~I~I~~II~~~I~I~~II~I..I...{I.II~~~~~I~I~I~~III~~~~~~I1~~1~11 Patient Name MORNINGSTAR ELIZABETH D DATE DESCRIPTION ', AMOUNT Statement Date 10/12/10 Service Date(s) 02/09N p 02/09/10 BLS NON-EMERGENCY ` SP'r 960.00 ~ LE 02/09/10 BLS MILEAGE, PER M 108.00 OUTPAT{ENT Type of Service ~ r 06/16/10 AETNA PAYMENT 0.00 Account Number 14078427 TOTAL ~ 1068.00 New Charges/Adj $ 0.00 New PaymentsJAdj $ 0.00 Account Balance $1,068.00 Amount Pending Insurance $ 0.00 Amount You Owe $ 1,068.00 This new statement has been specially designed For billing questions or incur nc ranges: with you in mind. Let us know what other Para preguntas acerca de su facttua ' bi do seguro contamos con improvements we should make. ~ a representantes disponibles pare as a munidad hispana ~ Phone: (717) 531-5069 or (800) 2 4-2 1 Please e-mail your ideas to: Available Aoura: Monday, Tuesday esday 8:00 am to 5:30 pm StatementideasCa)hmc psu edu Thursday & Frida 8: aMm to 4:30 pm or write to us at: Penn State Milton S. Hershey Medical Center Written Correspondence: Penn State Milton S. Hershey e~.ical Center Statement Ideas, PO Box 854, MC A410 Patient Financial Services ep ent Hershey, PA 17033 PO Box 854, MC A410 Hershey, PA 17033-0854 Please Note: Your physicians will bill separately for their professional e>!•vices. HERSHEYST-01 PENNSTATE Statement !?ate: 1 0/12/10 1? ter~i~anie ` ~-- Acccu~l+lumber` ~~~` " ` Milton S. Hershey ' .Upon FZ~ceipt TvIORNINGSTAR~ 14g7842Z -~ , ~ ® Medical Center ~ p,~~~ . ~~, ~,~, ELIZABETH Dna .k, ,,~~ ,~ ~~ ~.,~ - '~~ ~' ~ ,_ r ~~ , J 1 Rrhau,~t~-~a~ ~- ~ Amou rrt-Due- ;~.~,: PPiltaburph, PA 15284-3291 $ 1, 068.00 - ~` "' s~ ',~ ~__ _ _,_ ~ o _ ~. ._. :,- . CHECKS SHOULD BE MADE PAYABLE AND SENT TO: MS HERSHEY MEDICAL CENTER PO Boz 643291 Pittsburgh, PA 15264-3291. I~~~II,I~I~~~I~I~II~~~I~~I~~I{~~~I~{I~I~~~~~III~~~II Check here ii your address Please /rrdcate changes on To pay by credit card: For y MasterCard or Discover Card. F proferencs, provide the account Account No. Expiration Date Signature 00000001407842702091011 tce JrNormatlon has changed. of this page. mience, you may pay by Visa, irate your credit card rn, and sign below. ~W Code L~LOaoa0~o6a0o serv ces 41SO OLSON MEMORIAL HIGHWAYS SUITE 200 MINNEAPOLIS, MINNESOTA 55422-4811 TELEPHONE 763-852-8620 Hours (CT): ', X:00 am - 9:00 pm M - TH FAX 877-326-8784 x:00 am - 5:00 prn F TOLL-FREE 877-326-5681 ~ x:00 am - 12:00 pm S August 27, 2010 RE: Estate of: Our Client: Account No: Unpaid Balance: Reference No: Dear AMY R KORSUN: DIANNE MORNINGSTAR BANK OF AMERICA N.A. ************7880 $2400.29 6359092 This letter confirms your receipt of a proof of claim for BANK OF AMERICA N.A.. If, for a ~ t copy of the claim, please contact our office at 1=877-326-5681. If we do not hear from y u, was received. Please also contact our office should you have any questions, or to resolve h Cordially, DCM Services, LLC This company is a debt collector. We are attempting to collect a debt and any information Wpb purpose. Calls may be monitored or recorded for quality assurance purposes. NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION '-: ~~~~~ "'Detach Lower Portlon and Return wRh Payment'"' DCM Services, LLC 4150 OLSON MEMORIAL HWY STE 200 Reference #: 6359092 i to MINNEAPOLIS MN 55422-4811 Unpaid Balance: $24009 ADDRESS SERVICE REQUESTED Checks Payable to: BA K ~~~~~~~~M~~~,~~~~~~~ Amount Enclosed: ~- August 27, 2010 ~~;t~-zz aeosaeos ~. 'E The E~state~of DIANNE MORNINGSTAR AMY R KORSUN 2301 OLD COACH LN HENRICO VA 23238-3024 on, you did not receive a will assume that the claim led will be used for that , 1 of 2- ~tC ID: BOAM61 b4MERICA N.A. DtM Services - Paymlen processing PO Box 9317 Minneapolis MN 5544p- 3~7 ~~~~~u~~~n~n~~~n~~~n~~~~nu~~n~r~~ n~~ui~~~u~~~~u~~ 6359092 7880 I ~ss~~aeoa-ss A.~CTION AGREEME.~T The undersign owner f property hereby employs MIKE COSTEA, auctioneer, u er 1. Real estate to be sold by auctioneer includes the following: 2. Auctioneers commission on Real Estate 3. Any Real Estate sold will be ^ Absolute Auction or ^ With Reserve. 4. Personal~~'tY to be sold by auctia~ r includes the following: 'd~~ 5. Auctioneers Commission on Personal. Property ~ % ncludinc 6. Date of sale f Q ~ v/ 20 /~ 7. In addition to the said commissions, owner will pay auctioneer for the follow a. Tent cost. c. Extra labor /5~ b. .Moving and packing d. v~-~' 8. ctioneer will receive amounts due him hereunder upon settlement wit Agent 9. Owner shall be responsible for their own insurance coverage. Seller 10. Settlement (14) fourteen days after auction. THIS AGREEMENT is made this day of 20 i, ~r the following terms: :I~ding clerks. .~pense of sale: -+-- ~ ~ ~ ~~ -r- ~~ completion of sale. M /NAME ADDRESS,1- ' '~ TELEPHONE Owner ..~1:"1.5~.....K~S~~ ................ Z3~t....~~'1^...~:'.~.~,r'~~C~?..... ~~ . .~~~~.-~.~.~.t..... VQ Z3Z3~ ~~ 33~-0031 Owner .................~~...__.~~............................... .............................................................. .........!,.................................... Auctioneer.~~~'~~~:, .~~~t~~l~ ............ .............................................................. I~'~ .................................. MIKE STEA AUCTIONEE 8 l~-PPRAISER 208 Creekwood Drive • C m Hill, Pennsylvania 17011 Phone: (717) 737-0000 Storas~e Receipt Customers Receipt No: 811055-00003229-00031853 BRIAN KORSUN 2301 OLD COACH LANE RICHMOND, VA 23239 Page 1 of 1 VACATED ON 6/29/2010 ROOM DESCRIPTION 208 MOVED OUT: 10X20X9 DRIVE UP 1 OUTSIDE NON-CLIMATE r ~-09 5~~~~ 9y X Customers Signature Tuesday -6/2920101-1 h :22:15 AM U-HAUL MECHANICS UF~G, 811055 4725 GE BURG RD MECHANICSSU G~ PA 17055 17~) 763-7677 THRU AI i ~~AMOUNT ~ ~ $0.00 Paid t I: ~~ $0.00 Unpaid o L• ' $0.00 Tax P~ 6 0: i $0.00 Fes To L• $0.00 CA H ! $0,00 Payment to I: I $0.00 Account Bal~nc $0.00 Employee's Signature (BRADLY)' Thank you for being a Premier Customer Club member! Next time make your payment online at www.uhaulstorage.oom. NO DRIVING. NO MAILING. NO HASSLE. https://www.webselfstorage.com/customer_receipt.aspx?retail=False&AutoPrint~;Tr~e&th... 6/29/2010 SCHEDULE I ~ . M M 0 _m N ~ O f~~J O~~ , H ~~~~ s e { e ~ ~~ G - ' ~~ ~ _~ ~` to =N c3 €~#° ~ ~ ~, =o ~~ ~ ;~ { ER _~ ~°~ !9 ~ is ~~~~ ~~ ~ 1 Y w 8 v rt a O Y • ~~ r A ~ {1yYr O Gam. ~~ OW~~ ~. ~a~~ t~iJi7Nl7 m ~ N C °~ NN NN N N ~~00O ~ !~ ~ ! vgp i~M ~ ` i O i~~0 i i e :~ ~o~v E ` e!~' ~ :'. ~ 5~~ ; ~ 1 ~ tea. ~ ~~ M.... i= i~ .. ~~ €~ a ~ i.-'u. ~ ~ ,,,, o ~~L' d ~~~b~~~ "~aa $ '~ L1C1U~SdF- ~ F~ R v v ~ _ ~v O ,a CV C h ~ , , C ~ ~ ~ M ~ ~ C ~~ .. $'S 0 ! N p~ ~ r~ ^ 0 ~A 0 ~ ~ ~ 0 ~~ ^ ~~ ~ \ ~ (C C o ~ C 9 mi m ~- 0 a~ _. 'O ~~ v~ u~ A ~v ~. r ~~ 1~. rt ~~ ill a ~ ~ .y ~~ tii- ac-roo - - ' 9 t OD ,a ~ ~ =° , ~.. ~ 3 ~ ~ .- , ~°, v ~ m ~, ~a n m - (~ i ~ m m ~+ G m~ n ~ r C ~ C y N ~ .O it ~ N m ~~ m f j (~ ~ R ~ ~ p `" p ~ O ~ R ~ ~'.. C ~ .u ~ ~ ~ ~ m a ~ E - '~ ~ ~ ~ o o. .'' b ~~ E ~ I ~~ o ~ ~ ~ ~ s~ p ~o ~ a 8 R~~ ~ g I ~~ 7 a . g g ~ ,`~ a ~ ~ ^ ^ ~ ^ ^ ^ ', N 4' i~0 m O N Y t~C m 0 r~ ~d v; ~ v ri ni .= o 0 ~_ ~ O LJ. 0 ~ ~ ~~ q N ~p n J ~- r Its a~ ~ .w+ M• tC N r- N ~ NN . N cw N ~ i i ~ ~t ~_ j ~~ ~~,~~ ~~~ ~ ~ ~ N ~~ ,• ~~~ W C ~~~~ ~, si o ~ t i` ~~~~~~ ~~ ~ ~~ ~ ~' ~ ~ ~ ~-~ ~ ~ 1~ m ~~, ~ ~ ~~ r' m ~ '~ A ~~~ ~« ~~~ ~~ ~~~~~_ ~~ 4 1 ~K . ~ N N ~ t .~ A r s ~~ ~~ Q~ ./ ~g~ ~~$a~N~~ d ~~~~ ~~,~ ~~ ~~ ~, ~ a 8~,~ a~ ~~ ~ i ~~ M ~~. ~~ ~, 6 a- ~• ~'~ .- m ~ I ~'m ,~ °o,~ s~ a a~ ~ ~ ~I S NM ~ S e p '~ R y ~' a ~ ~ ~ ~ ~ o ~ ~~ ~ z m ~~ ~. ~ ~~ ~ ~ ~ ~ .~~ ~ ~ ~ ~~~ y A~.~ ~ G r g .~ ~ ~ m ~ is j ~ tlN Q, ~ O > 10 { f ~ ~ ~ r _a `~ ~, u '~ a ~~ ~ a ~~ 's+ •+ m m ...+ ~~ ~` ~.~ Abp G ~~ i ~ °~ ~ ~~ ~~ ~ 7 ~ ~ `,. ~g ~ o~ o ds ~ ~ r~ ~~ ~~ ,~ .._-_-- Account: 717 76!1 Now Charges Due: Pay Total Duo: ~ 3.67 Amount Paid 00013739 Ol AT 0.357 0073 F DIANNE MORNINGSTAR 1100 GRANDON WAY RM 614 HAMPDEN PA 17050-3024 '~'III11111~~1~111~~~111~~11~~~1~1~11~~illl~~~~~1111~~1~1~1~~1111 DIANNE MORNINGSTAR Account Summary Previous Chagos $ 71.10 No Payment Received .00 Past Dua Chagas (please pay now) S 71.10 Now Chagas Verizon (page 3) - $ 67.43 Total Now Chagas Duo - S 67.43 Total Dw ~ 3.B7 Please pay upon receipt - FlNAL BILL - This Final Bill may have already been referred to an outside collection a®ency. Pay your bill online at verizon.com/payhnalbilt Questions about your bill? Visit verizon.com or call 1-800-VERIZON (1-800-837-4966) Billing Date: 04/07/10 Page 1 of 6 Telephone Number : 717 761-8650 Account Number: 717 761-8650 214 15Y ~ •• ~~ is Verfzon Maki With one caN Verizon can h Internet 6 phc Call today ani is available in Verizon take i up all your ea Servke eveDabn ~ •. ~~ i We Want You You are a valu deliver the ver to you. Call us find out about can save you ~ being your pro to keep you wl improving your Movtng9 Let 1 Call 1-866-VZ- pow~ar of fhe N home. We aan Internet & phoi before you're t Plus, we have needs and you 5ervke ave0abil1l Change of billing address? Go to verizon.~m/billingaddress or call us. Verizon PO I30X 28 LEHIGH VA ~m~~~u~t~~n 11771707b186502146028021049999910000007110 wMg Easy 100-871-1238 3t up your TV, your new address. if Verizon FiOS Dome. Let ury out of setting ~ment services. ray IIMth us rstomer & we want to service & value 888-226-0725 to ew ways Verizon money. We appreciate and we would I~Ne ibnger by ron experience. Help i to bring the to your new :t your N, unpacking. s to fit your ~ Detach & return payment~lipl with your check, payable to Verizon. ~p 21415Y sio•rrBxnAt ooo9a~oo iamoooosza ih rocaipt 33-PA P063 ~ms~s6so 0407b0 ~ I ~ a.^^ PA 18002-8000 nu~~~~n~~~~u~~~ni~~nun~~~ 000367300000 911 3 7 - _ Erie ~\ Insurance' 100 Erie Ins. Place • Erie, PA 16530 NOTICE OF PAYMENT DUE FAMILY AUTO POLICY NUMBER Q011108108 E DIANNE MORNINGSTAR 428 PARRSIDE RD CAMP HILL PA 17011-2127 BILLING AGENT NUMBER STROCR IN AA7685 7 03-22-10 CE AGENCY 7-5405 PAST DUE AMT MUST BE R~C~IV~D WITHIN ,15 DAYS TO RETAIN PLAN B DISCOUNT & AVOID LATE FEES 01-11-10 PREMIUM $ 724.00 01-08-10 PAYMENT $ 162.000R 01-11-10 RETURN PREM $ 21.000R 01-11-10 SERVICE CHG $ 10.00 01-11-10 SERVICE CHG $ 10.000R 01-11-10 RETURN PREM $ 209.000R 02-12-10 PAYMENT $ 167.000R CURRENT BALANCE $ 165..00 TRANSACTIONS OCCURRING IN THE LAST 10 DAYS MAY NOT APPEAR IF THERE IS AN ERROR, PLEASE CONTACT YOUR AGENT OR TH 11900 RETURNED PAYMENT FEES WILL BE ADDED TO YOUR A KEEP THIS PORTION FOR YOUR RECORDS E DIANNE MORNINGSTAR 428 PARKSIDE RD CAMP HILL PA 17011-2127 ADDRESS CHANGE ^ PERMANENT ^ TEMPORARY PHONE ( ) Erie ~ Insurance' 100 Erie Ins. Place Erie. PA 16530 031 1 THIS STATEMENT. ME OFFICE. PLEASE RETURN THIS PORTION WITH YOUR PAYMENT '~` DETACH HERE AA7685 ~' STROCK INSURANCE AGENCY Q011108108 FAMI~Y AUTO POLICY T PLEASE SHOW ABOVE POLICY NUM ER ON YOUR CHECK MAKE CHECK PAYABLE TO: AMOUNT O~l .ARE PAYING ERIE INSURANCE GROUP I PAY PLAN $ SEEP YIWIENT PLANS ON REVERSE SIDE iE PAYMENT PLAN TO OUR AGENT FOR OTHER CHANGES -010176850111081080321100000003-d0~650000016500- ' _~ 000241824503700DOOOD000006382d16 Pennsyt~ranfa American Water P0.8ox 371412 Pflfsiwrgh, Pa. 15250-7412 -Far S~rvi6e To: 42S Ptukside Rd . ~.~ _ ~st6sa F~nt.~exalisisaiooo~s3 ~z2 i((t~1ctceo .~l~~ittt~'lH~iiq~~t~1•f/tif~~t'~tttti~'t'iil~ttfilW'~Itltl' ' ESTA7`E ;©F D~AlWf+ME ' H NDRNIN6STAR '~ COQ ~/~lAitY: f~ KCJI~SUN 23a OLD COAf~-1 W Ht~ti~ICa VA 2323&3024 ~h~geYo~ad~s~laionrMxnber,- ~~- meyo~n'mraw :~~!m~x4~cG~ k...~'~. fi~rd`on , BIt1l~tge`S sr~nn~a~~a-rna~~i•r • 24-1 AMOUNT DUE .DUE DATE `JV~ 1 AMOUNT PAID 71 .52 10 i Pennsylvania American ~~ PO Box 371412 Pitts1burgh. Pa 15250-7412 ~nt~~t~t~tti~tit~t~t~~ut~ut~t~n~nt~~n~t u~~t~ :~ ~ ~ s- 1.x.0.45 ~2i9~l1 ~~ 00 ,~~iQ as .~,; ' ~ ` ~~ ~ 1 0.45 ~. .~ ~ "~ - y ~ .,i -3.83 ~ ~ ~' `, -?1.31 {~ r' ~y~~~ ~ ~ - .20 r { ~ '~~' ~ . 18 .T~ . ~ s~ ~ -~ `. ' ; . 1.41 ~, ~ nn,~ 20~' - . -..6.93 e i_. :S,g+a,:i~ `2" ry.9 'ail' .+. s'. ~, " '' , F c~, .. f : , \ ,.X ~] ` F 5 - '. F ,. ~. ~. ~_ d.^ }:]9~Vr~53~'StL.si 1. Si Z. _~.i ~.. ~ ..'4s.,Gti~4 T... i.7~ u n• f .:2df 4 . .L....._ .3. ~:'l:.w .+ ~... ._. ...... ... ., a F _ _ _ _, -.r J .. . , _ o .. -- --~ 1.1 -=_- a s '. ;.; ` ~ ~1w1~ j • ~ ~ '• ~ f --'• ~ .•; . ~~ ~ • ' , ~ ~ V :: ._ w~ J d. ~ ~. ~ -~ ~~ wWi4 4 '/. ` 4 .~ ~~ ~~ ;•4 O 4y' C!~ ~ U 4 W ' a ~ ~ ~ ~ ~ w]l ~/~ ` ~ ~a. 1~ ~a ~ ~ ~ F+ H d _ ~ M ~/1 .l1n t~(1 h O W o0 b~ NVdi~ ei~ M ~~~~ ~ g~ ~ ~ '~ ~° 4~ t+7 N ~y ~~~ y ii ~ ~ y Pr ~ w cv `~ A ~N. '~ ~~ 0 dN ~ W A `" A a x ~o o (~1 ~p ~o 0 00 ~ M N -+ ~~ ~ ~ ^a~ ~ ~ ~ r ~U~~~ ~ w ~ ~ ~.~ ~ r~ ~~ rv ~~ a~ O F+~'~ (n W A a I ~J 0 .~ d .r.~ O ~+~ . ,. ~:~`~ C`~ ~.. _~ .; ~~ ~ ~~. ~ ~Y ~ - ,s ~~- ~-~:: ~-..; - . ~. x.,, ~~~. fiL~9LOLEQfi Q2~6'C'000~092C16'i't00~09L '[ ~~qq~•PI~I~d~InPl••l~~~gyil~ihlm~~i~i~~r~hdi~iwq SL I I-TOT8I 1o'd NMOZN3TN Il~Il~IIO~'JdH-Zs~'3HZS HZ6HZ~IO1dZ 591,rrnrn affil~~Tdd ~ ~~ ZO'6I I$ OIOZ `SI Iat ... ....... . ... mo~uuod~ s~a~ a~eg~_ a4 a~ad~aga u i ~ZOE'HQ£Z VA QNO~ 1SIH"JVOJ Q'TO TOEZ 1~S3-g VISflHINgO~ 91+iNViQ Y 97~, 9 99S:ZB 999090 40 9N t~L09L-OL£$~ . :.. - F ~~E(I IIO IIOI~EIII.iO~IIi ~II~Od~ 06S £869 OIOZ ~f -6002 NI 6ST8 6002 ~f - 8002 lit ~ nn - v . T+4a'Z ~n ~a ~Q ~L 3L9 aml~am~ay -OTOZ 6002 ~r - a8s~s`r ~ SZ6£9 ~ I~+' SZ ~1i 806£9 l~ 6Z ~-1 t~Z6SL568# ~+t un~s~a~ Zi ~4~7AI OTOZ t7~I~T~3tQHOS~*t t a~ 8~' 9ij .~Z~, Z£I~, Ob ~~~d~v-~ P3 P~P'~' t~'d :~~ •scguoa[ asn ~p maC . ~ ~~ ELI. asn a~3~I~ ~oo-~n~apaldd-.~+es Z6£6-60T8i ~'d `uresa~aaIId ~'3I ~S LZ8 ZO'6I i$ :.a~ a{~trpet so aaas~eg ZO'6i I~ ~l9~ L9'TLS ~~~ CaT_Tl'TLT-t'7 ~I~t~3'II'Idd s~-Lbs ~LO9L-OL~s~ @ ~~~ :a~i oTOZ `~z ~r~ ~ ~~ alga ~~~a~an~ ~~.• .a +~ ~~- add -~ .. a k. s .~~ t'Idd~'hQ'008"T? ', SLLS~'f+£-608-i ~~ SI .To! 1--44 ~ two ~ ~ '~ ITOLT Vd1'IDidWV'~ agaaIIS~tava szti ~T.v,LSa sr-. c~.,nra-o~ mu~TVta ao3 aa~as a~al~ - ~or~~ast. Service Details Corrtact us: [C~.~ www.comcast.com CA 1-800-XFINITY Account Number 09547185029-04-3 Billing Date 03/14/10 Unpaid Balance $111.35 -Due Now New Charges $111.35 -Due 04/07/10 Total Amount Due I $'222.70 Page 2 of 2 ` _./ Standard Cable 03J29 -04/28 55.95 .......... . ... . . ............................................................. Add9 Outlet . . ..... .. . ...................................... 03/29 -04/28 0.00 2 ~ $O.OOeach ............................................................. ................................................................ Service Protection Plan 03J29 -04128 3.95 Total XFINITY TV $59.90 0 Internet SerNce 03/29 - 04/28 42.95 Performance ............................................................................................................................. Modem Rental 03J29 -04/28 5.00 Total XFINITY Internet $47.95 TV Frarx~ise Fee 03/29 -04/28 3.13 ............................................................................................................................ FCC Regulatory Fes 03/29 -04/28 0.07 Internet Sales Tax 03!29 -04/28 0.30 Total Taxes, Surcharges ~ Fees $3.50 Lobby Hours 4601 Smith St Harrisburg, PA 17109 Mon-Fri Sam-7pm, Sat 830am-4pm 4830 Carlisle Pike Mechanicsburg, PA 17055 Mon-Fri 930am-530pm, Sat 830am-4pm Lata Foes: Accounts that are more than 45 days delinquent will be assessed a late payment fee. To ensure proper credit to your account, please check the due date on your bill and allow 5-7 days for your payment to reach us by mail. 8 a payment does not appear on your statement, it may not have been received by the date your bill was printed. Closed Captioning: For immediatE (800)266-2278, fax(215)28fi-470 chat at www.comcast.com/suppa contact: Frank Eliason, Comcast 1701 John F. Kennedy Blvd., Phil call:(215) 286-4697. Distance call: go online for email or live x written complaints red Captioning Office, A 19103-2838, n, fax: (215) 286-4700 or Franchise Authority: PA0423 Camp Hiil Borough 2145 Walnut St Camp Hill, PA 17011-3830 .._--- Wchard A. Forbenbaugh, DD3, PC 502 Bridge Street New Cumberland, PA 17070 (717)7747274 Ellzabefh Morningstar 428 Palkside Road Camp Hill, PA 17011 TO ENSURE PROPER CREDIT PLEASE DETACH AND RETURN THIS PORTION OF THE STATEJNEM WITH YOUR PAYMENT DATE DESCRIPTION 01N5/20'10 PREVIOUS BALANCE ., r ~_ __ STATEMENT A C UNT NO. PAGE NO. ', 8'8900 1 BILLING DATE Or Payrnenfs Attar Billtnp Date On NmQ Ststemsnt I' March 1, 2010 i _ Amount Remitted VI$A pCHECK OM/C ~ Sipnahue ! Date 3 dlpit seauilY cods - see tlaclc of REFERENCE CHARGES 10. CREDITS CURRENT 30 DAYS BO DAYS 90 DAYS ~~ CE SURANCE P PAY E o.oo o.oo o.o0 10.00 10.00 0. 0 1a:ao= ~acnaro w. ronoenwuan, wa, r~., ova soaps auvsi, nisw ~umoenana, rn vuiu r-AMY KORSUN 2301 OLD COACH. LAN E RICHMOND VA 23238 ELIZABETH D MORNINGSTAR Palmyra Nursing Home 341 North Railroad Palmyra PA 17078- ', (717) 838-3011 ~ II OF ACCOUNT _. _ ,. . nacrpianeN DATE CUANTITI' CHA O / (CREDITS) BALANCE $167.50 PLEASE DETACH HERE AND RETURN THIS PORTION WITH YOUR PAYMENT ' _ _ _ __ ..._- _. Please pa~-thls~amountby8l512010_-Thank-Y°ul - --------- -_-------.._.__ .--7 ----$167.50 i ELIZABETH D MORNINGSTAR ''MORN E Please em Payment To: _~ ~ AMY KORSUN i Palmyra Nursing Ho e, 2301 OLD COACH LANE RICHMOND VA 23238 ~ P.O. BOX 8500-130 Philadelphia PA ~ 19178- __. _... __. __.._ ~'+ _. __. _.._ _.____... ~. .. _ ._. I~~~T _. ___.. ~ INVOICE ORDINAL ~ LOYALTON OF CREEKV~W 4941_ ' ' For Products ee From 1100 GRANDON WAY 1/13/2010 Thr~ ug~i 3/4/solo MECHANICSBURG, PA 17050 i 717-730-4033 MORNINGSTAR ELIZABETH DIANE MORNINGSTAR TYPE: 0101 - ASSISTED LIVING/PRI T~ DATE: 03/09/10 DATE NUMBER MISC DESCRIPTION DISP BY QTY PRICE EXTENDED ACTUAL SRC 02/19/10 0610-626-01 ATTENDS PULL-ON BRIEF LRG 18/P 1 11.7 ' 11.70 11.70 B 02/26/10 0700-282-01 ADULT WST WIPES 1 3.4 3.42 3.42 H 02/26/10 0700-282-O1 ADULT WST WIPES 1 3.4 ~' 3.42 3.42 H 03/03/10 0190-146-01 DIAL TOTAL BODY WASH 1 3.2 ', 3.22 3.22 B 03/03/10 0320-410-01 ST GAUZE 4X4 BPLY 1 0.2 ' 0.26 0.26 B 03/03/10 0610-626-01 ATTENDS PULL-ON BRIEF LRG 18/P 1 11.7 ', 11.70 11.70 B TOTAL CHARGES FOR PRIVATE 33.72 33.72 N IN OICS SUMMARY TOTAL CHARGE6 FOR PRIVATE ' 33.72 33.72 TOTAL CHARGES I 33.72 AMOUNT YOU OWS ~' 33.72 CuraScript an Express Scripts company Account Number Currently Due From Patient 44604190 From Insurance Dab of Service Rx # RF Description Previous Balance Due For Billing Inquiries: 1-888-773-7'376 Tax ID: 58-2593075 Page: 1 of 1 Current Due 30 Days 60 Days 90+ Days Total Due 0.00 0.00 0.00 F 80.00 $80.00 Authorization Amt Billed II Depending on your plan, you can now reflU most apedaitir pay This A Thank you for choosing CuraScrlpt, medications and check the status of your order through our t+ve appreciate your business. website or by simply dialing the phone number printed on (Envie eats cl your CureScript patlent contad card.Express 3cxipts members may log on to www.express-scripta.com;all other patlents should use www.curescript.coMmyaccourlt. ~ 1376-CURASTM-685552-802126745-P; 3801305-2-1159; 30840049-1; 1 ^ Please check H below address is incorcect TO INSURE PROPER CREDIT, DETACH AND RETUR and Indicate change on reverse side. IF PAYING 9Y MASTERCARD, DISCOVER, VISI CHECK CARD USII Curascript, Inc. ^ ®^ !~ 23857 Network Piece MASTERCARD DISCOVER I. Chicago, IL 606731238 CARD NUMBER tt~ of loa otot ELIZABETH MORNINGSTAR 428 PARKSIDE RD CAMP HILL, PA 17011-2127 hnlllllllllllllllllllrlllnlllllllllrllllllllllllllldlnllllll STATEMENT DATE PAY THIS AMOU 09/30/10 $80.00 I authorize Nl orders to bs charyed to this Please irxluda accfaM on check Patient 80.00 $80.00 520091A I T IS PORTION IN THE ENCLOSED ENVELOPE. OR AMERICAN EXPRESS, RLL OUT BELOW. G F PAYMENT I~dA- ~ ^ V15A AMERICAN EXPRESS ACCT. 44604190 sHOwAMOUNT PAID HERE (Cantldad de su pago CURASCRIPT PHARM 23857 NETWORK PL CHICAGO, IL 60673-12 'llll'I'lllllllllll'l lllllllllll'I r~ INC. I~Illlhllrlldlllll'lllll ',, ~_ -- --- 09/29/10 ~ 3'~;31j01 Lebanon 'Valley Family Medicine, Inc. 1400 S. FORGE RD., SUITE 1 Palmyra, PA 17078-9513 ~5.65* 42266 I '; AMY RORSUN Lebanon Valley Fami y~Medicine, Inc. 2301 OLD COACH LANE 1400 S. FORGE RD., U$TE 1 RICHMOND VA 23238-3024 Palmyra, PA 17078- 5~3 II~ •• •• ~ MESSAGES EXPLAINED BELOW *** ACFCOCUNT PAST pDUER-ECrOLLETCTION AGENCCY AND~DIiSoMISgSCA~L~,PENDINGl3 01/28/10 1 2 L Initial Nursing Facility 99305 172.9 143.00 02/25/10 Medicare Payment. 02/2S/10 Accept Assign Add.' 03/15/10 CIGNA HEALTH Payment 02/04/10 1 2 L Subsequent Nursing facili 99308 172.9 77.00 03/03/10 Medicare Payment 03/03/10 Accept Assi n Adj. 06/25/10 CIGNA HEALT~ Payment *** *** *~N************ .6~,3 -25.96 .010 23.41* .9h -15.79 .Op 12.24* I ; The 'PLEASE PAY' includes unpaid~co-pay or coins. Please make payment. ~E LAST PAID AMOUNT )0/00/00 0.00 0.00 0.00 0.00 12.24 23.41 0.00 0.00 35.65 _ Lebanon Valley Family Medicine, Inc. III !~ , ., ~ ~ 1400 S. FORGE RD., SUITE 1 sleTO: Palmyra, PA 17078-9513 35.65* ~I ; Ph:(717)-838-1301 PAT~~ 1-ELIZABETH D MORNING PRV~/ 2-Wagner,l. Rent L., M.D.• Acct~~:33101 'Date: 09/29/10 Page 1 of 1 ~T P 'IVNSTATE Milton S. Hershey Medical Center PO Box 643291 Pittsburgh, PA 15284-3291 ELIZABETH MORNINGSTAR 1voo91a 428 PARKSIDE RD CAMP HILL PA 17011-2127 I,,.Ill, t, l l l r,, t., I I,„I I„I, i,,, I l t, 1, l i, t, l t t i, l l t, 1, l„I, I Patient Name MORNINGSTAR ELIZABETH D Statement Date 04/12/10 Service Date(s) 01/18/10 - 01/27/10 Type of Service INPATIENT Account Number 13973135 New Charges/Adj $ 0.00 New Payments/Adj $ 0.00 Account Balance $ 1,100.00 Amount Pending Insurance $ 0.00 Amount You Owe $ 1,100.00 This new statement has been specially designed with you in mind. Let us know what other improvements we should make. Please e-mail your ideas to: StatementideasCcbhmc. sp u.edu or write to us at: Penn State Milton S. Hershey Medical Center Statement Ideas, PO Box 854, MC A410 Hershey, PA 17033 Thank you for your recent I your account. However, to activity, please send your p immediately or contact our budget plan. DATE DESCRIPTION 03/15/10 "BALANCE TOTAL For billing questions or insure Para preguntas acerca de su facture o representantes disponibles pare asisti Phone: (71'7) 531-5069 or (800) 25 Available Hours: Monday, Tuesday ~ Thursday & Friday Written Correspondence: Pena State Milton S. Horsb Patient Financial Services 1 PO Box 854, MC A410 Hershey, PA 1'7033-0854 Please Note: Your physicians will bill separately for their profession I $ervices. HERSHEYBT-01 pENNSTA-i-E Statement Date: 04/12/10 1Vlilton S Hershey ® Medical Center PO Banc 843291 Pittsburgh, PA 15284-3291 CHECKS SHOULD BE MADE PAYABLEAND SENT TO: iVIS HERSHEY MEDICAL CENTER PO Boz 643291 Pittsburgh, PA 15264-3291 I,,, I I, I, I,,, I, I, I I,,, i„I„I I,,, I, I I, i,,,,, I I I,,, I I $ 1,100.00 i~L Check here if your address ~ ,••1 Please indicate changes on To pay by credit card: For y MasterCard or Discover Card. F preference, provide the account Account No. prance information has changed. ick of this page. nveniance, you may pay by Visa, indicate your credit card anon, and sign below. Expiration Date Signature 3rd Statement ant toward the balance on ~ any further collection ant for the full amount I to discuss a monthly AMOUNT 1100.00 1100.00 ohanges: bios de seguro contamos con comuaidad ]rispana. inesday 8:00 am to 5:30 pm am to 4:30 pm Center CVV`Code 000000013973135011b1b01412100000110000 PEN 1Vlilton S. Hershey Medical Center Po Box 843291 Pitbburgh, PA 15284-3291 ELIZABETH MORNINGSTAR C/O AMY KORSUN ,w,oae 2301 OLD COACH LN HENRICO VA 23238-3024 Inlrlrrlliiililirllrlrrlnillrlluurlilrlrrlllrruullrilill Patient Name MORNINGSTAR ELIZABETH D Statement Date 06/03/10 service Date(s) olns/1o Type of Service OUTPATIENT Acgunt Number 13975922 New Charges/Adj $ 0.00 New Paymenta/Adj $ 0.00 Account Balance $ 92.07 Amount Pending Insurance $ 0.00 Amount You Owe $ 92.07 This new statement has been speaally designed with you in mind. Let us know what other improvements we should make. Please e-mail your ideas to: Statementideas[~hmc.psu.edu or write to us at: Penn State Milton S. Hershey Medical Center Statement Ideas, PO Box 854, MC A410 Hershey, PA 17033 This bill represents the portion insurance company has proce responsible for any amounts n insurance. Do not delay takinc longer. Please send your payn DATE DESCRIPTION 01/28/10 RAD TREAT CMPLX 11 01/29/10 CONTD RAD PHYSCS ; 01/29/10 RAD TREAT CMPLX 11 03/16/10 MEDICARE PAY HOSP 03/16/10 MEDICARE CONT ADJ TOTAL far billing questions or insuran Para preguntas aceirs de su facpua o c represeutaatas dispombles pars asistir Phone: (717) 531-5069 or (800) 254 AvaWble Honrs: Monday, T'oesday & Thursday ~ Fridays Written Correspondence: Penn State l~filtoa S. Hershc Patient Financial Services Di PO Box 854, MC A410 Hershey, PA 17033-0854 2nd Statement Inaining after your ~d your claim. You are hovered by your ire of this matter any it for the full amount. AMOUNT 598.00 189.00 598.00 -301.16 -967.n 92.07 seguro coatamos con idad hispsaa. xlay 8:00 am to 5:30 pm to 4:30 pm Canter Please Note: Your physicians will bill separately for their professions services pF-IVNSTAI-E Statement Date: 06/03/10 Milton S Hershey ® Medical Center Po Box 843291 Pitbjburph, PA 15284291 CHECKS SHOULD BE MADE PAYABLEAND SENT TO: MS HERSHEY MEDICAL CENTER PO Boz 643291 . Pitbburgh, PA 15264-3291 I~~~II~I~I~~~I~I~II~~~I~~I~~II~~~I~II~I~~~~~III~~~II 92.07 r-L Check here /f your address or ~••1 P/easB fildicefe Changres orl dh To pay by credit card: For yyon MasterCard or Discover Cana. Ple, preference, provide the account Inf ^ ~ ^ Account No. ....... HERSHEYST-01 rce fnfomratlon has changed. of this page. :nonce, You m++Y PaY by ~. Icate your credit card m, and sign below. Expiration Signature X 000000013975922012810 CW Code 1b03100000009207 Milton S. Hershey Medical Center PO Box 643291 Pittaburph, PA 15284-3291 1st Statement P 1 of 2 If you have any questions rega m,g this bill please contact our office. If not, we loq~k forward to receiving your payment in full. ~i ELIZABETH MORNINGSTAR C/O AMY KORSUN ,voo,s, 2301 OLD COACH LN HENRICO VA 2323$-3024 Iril~lnllnililiilliliiliiillilliiinlililiillluniill~ilill Patient Name MORNINGSTAR ELIZABETH D Statement Date 05/12/10 Service Date(s) 02/01/10 Type of Service OUTPATIENT Account Number 13975922 New Charges/Adj $ 0.00 New Payments/Adj $ 0.00 Account Balance $ 29.53 Amount Pending Insurance $ 0.00 Amount You Owe $ 29.53 This new statement has been speaalty designed with you in mind. Let us know what other improvements we should make. Please e-mail your ideas to: StatementideasCd~hmc. su.edu or write to us at: Penn State Milton S. Hershey Medical Center Statement Ideas, PO Box 854, MC A410 Hershey, PA 17033 DATE' DE3CRIPTIOM 03/30/10 "BALANCE FORWARD" TOTAL For billing questions or insurat,o Para preguntas acxrca de su facture o, ca representantes disponibles pare asistit a Phoae: (717) 531-5069 or (800) 294; Available Hours: Monday, Tuesday 8c' Thursday & Friday 8: Written Correspondence: Penn State Milton S. Hershey Patient Financial Services 1'xl PO Box 854, MC A410 Hershey, PA 17033-0854 AMOUNT 29.53 29.53 seguro contamos coa idad hispana. sday 8:00 am to 5:30 pm to 4:30 pm Center Please Note: Your physicians will bill separately for their professional ~erlvices. „EasH~rsr-0, PENNSTATE Statement Date: 05/12/10 Milton S Hershey Medical Center Po Box 843291 Plttsburyh, PA 15264-9291 CHECKS SHOULD BE MADE PAYABLE AND SENT TO: MS HERSHEY MEDICAL CENTER PO Boz 643291 Pittsbnrgb, PA 15264-3291 I~~~II~I~I~~~I~I~II~~~I~~I~~II~~~I~Ii~I~~~~~lll~~~ll 29.53 f-L Check here Jf ynur address or H '~1 Please indkate changes on dhe To pay by credit card: For yqur MasterCard or Discover Card. Plea, proferonce, prove the account i~-nfoi ^ ® ~..I Account No, Expiration ~e informatlon has changed. oflhis page. rnience, you may pay by Pisa, k:ate your credit card ~n, and sign below. ICW Code Signature X 000000013975922020110 12100000002953 ~ _ _- P,~, ~niNS~~rE Milton S. Hershey 'cal Center PO Box 843291 Pittsburgh, PA 152843291 ELIZABETH MORNINGSTAR C/O AMY KORSUN ,vo,oe~ 2301 OLD COACH LN HENRICO VA 23238-3024 Irrlrlrrllrrrlrlrrllrlrrlrrrllrllrrrrrlrlrlrrlllrrrrnllrrlrll Patient Name MORNINGSTAR ELIZABETH D Statement Date 08/03/10 Service Date(s) 02/08/10 Type of Service OUTPATIENT Account Number 13937412 New Charges/Adj $ 0.00 New Payments/Adj $ 0.00 Account Balance $11.02 Amount Pending Insurance $ 0.00 Amount You Owe $ 11.02 This new statement has been specially designed with you in mind. Let us know what other improvements we should make. Please e-mail your ideas to: Statementideas(a~hmc. su.edu or write to us at: Penn State Milton S. Hershey Medical Center Statement Ideas, PO Box 854, MC A410 Hershey, PA 17033 This bill represents the porkic insurance company has pros responsible for any amounts insurance. Do not delay taki longer. Please send your pa} DATE DESCRIPTION 02/08/10 CC OUTPATIENT VISIT S'1 03/05h0 MEDICARE PAY HOSP 03/05/10 MEDICARE CONT ADJ /P TOTAL For billing questions or insturan Para preguntas acerca de su factrua o c representantes disponibles pare asistir Pbone: (717) 531-5069 or (800) 254 Available Hours: Monday, Tut~day & Thursday & Friday ! Written Correspondence: Penn State Milton S. Hershc Patient Financial Services Di PO Box 854, MC A410 Hershey, PA 17033-0854 Please Note: Your physicians will bill separately for their professional services PENNSTATE Statement Date: 06/03/10 Milton S I3ershey Medical Center PO Boot 843291 PMbburph, PA 15284-3291 CHECKS SHOULD BE MADE PAYABLE AND SENT TO: MS HERSHEY MEDICAL CENTER PO Boz 643291 Pittsbnrgh, PA 15264-3291 It~illiltltt~ltltlltttlitl~illritlilltlirtttllltttll $ 11.02 I~ Check here If your addross or ~i P/e9Se 1/1dIC8Ge CI1811g@S O11 fh To pay by credit card: For you MasterCard or Discover Card. Plat preference, provide the account inf Account No. ice inronretlon has changed. of U-!s page. rnlenca, you may pay by visa, irate your credit card .n, and sign below. Expiration Date Signature 2nd Statement gaining after your I your claim. You are ~vered by your e of this matter any for the full amount. AMOUNT 68.00 -44.07 -12.91 11.02 seguro centamos con idad hispana. inesday 8:00 am to 5:30 pm am to 4:30 pm Center r CW Code OOOD00013937412020810 6103100000001102 ._ _ _ _ ~ - ;rSTATE Milton S. Hershey cal Center PO Bwr 843291 Pribburgh, PA 15284-3291 ELIZABETH MORNINGSTAR C/O AMY KORSUN ,vaos4s 2301 OLD COACH LN HENRICO VA 23238-3024 Irrlrlrrllrrrlrlrrllrlrrlrullrllrrrrrlrlrlrrllfrrrrrrllrrlrl) Patient Name MORNINGSTAR ELIZABETH D Statement Date_ 06/14/10 Service Date(s) 02/09/10 Type of Service OUTPATIENT Account Number 14070643 New Charges/Adj $ 0.00 New Payments/Adj $ 0.00 Account Balance $ 88.78 Amount Pending Insurance $ 0.00 Amount You Owe $ 88.78 This new statement has been spedally designed with you in mind. Let us know what other improvements we should make. Please e-mail your ideas to: Statementideas@.hmc. psu.edu or write to ua at: Penn State MiRon S. Hershey Medical Center Statement Ideas, PO Box 854, MC A410 Hershey, PA 17033 This bill represents the portior insurance company has proc~ send your payment for the full any questions concerning hove processed your claim, please DATE DESCRIPTION 1st Statement remaining after your ~st~d your claim. Please armount due. If you have yqur insurance company all them. seguro contamos con idad hispana. :day 8:00 am to 5:30 pm to 4:30 pm Center Please Note: Your physicians will bill separately for their professional services PENNSTATE Statement Date:Oti/14/10 Milton S Hershey Medical Center Po Box a4s29~ Plefsburph, PA 152843291 CHECKS SHOULD BE MADE PAYABLE AND SENT TO: MS HERSHEY MEDICAL CENTER PO Boz 643291 PIttaburgh, PA 15264-3291 lirrllrliliiilrlrllirili~lrillirrlillrliriiilllrrrll $ 86.78 02/09/10 CBC W/PLT/DIFF AUTO 62.00 02/09/10 TRAAAADOL 50MG 6.00 02/09/10 PULSE OXIMETER SNS Al~L 34.00 02/09/10 BASIC METABOLIC PAN L ~' 55.00 02/09/10 ROUTINE VENIPUNCTU ' 22.00 02/09/10 THERAlDIAG INJ, SUBC Ails 35.00 02/09/10 EMERGENCY VISIT, L L 540.00 02/09/10 ENOXAPARlN SODIUM I J ' 299.45 ~F.orl~i!'ll;i~;.questiotJ,s; gr;irls.~rar Para preguntas axrca de su fachua o c rcpreserntantes disponibles pars asistir Pbone: (717) 531-5069 or (800) 254 Available Hours: Monday, Tuesday dt Thursday dt Friday f Written Correspondence: Peen State Milton S. Hexshe:~ Patient Financial Sexvices De PO Box 834, MC A410 Hersluy, PA 17033-0854 Check hers if your address or it Please ind/caEs d-anges o~n tire To pay by credit card:For your MasterCard or Discover Card. Plea: preference, provide the account irrfoi ^ ~ ^ Account No. AMOUNT HERSHEY8T-0, toe information has changed. o/th/s page. lnienoe, you may pay by Visa, kite your credit card m, and sign below. Expiration Date Signature 000000014070643020910 CW Code ~41000D0008678 _. TiATE Milton S. Hershey Medical Center , PO Box 643291 If you have any questions re Pittsburpn, PA 152843291 contact our office. If not, we payment in full. ELIZABETH MORNINGSTAR C/O AMY KORSUN ,~~ 2301 OLD COACH LN HENRICO VA 23238-3024 I~rlrl~rllrr~l~l~rll~lr~lrr~ll~il~~~~rl~l~l~~lll~~~r~~lir~l~ll Patient Name MORNINGSTAR ELIZABETH D DATE DESCRIPTION Statement Date 10/19/10 Service Date(s) 02/09/10 02/09/10 ALS EMERGENCY TRAI _ Type of_Service _. .. .OUTPATIENT _ 02/09/10 OXYGEN Account Number 14078391 02/09/10 ALS MILEAGE, PER MIL New Charges/Adj $ 0.00 04/14/10 MEDICARE CONT ADJ C 05/07/10 HMO PAYMENT HOSP New Payments/Adj $ 0.00 06/16/10 AETNA PAYMENT Account Balance $ 1,890.00 TOTAL Amount Pending Insurance $ 0.00 Amount You Owe $ 1,890.00 This new statement has been specially designed For'bilting questianswr~insuran with you in mind. Let us know what other Para preguntas acerca de su facture o c improvements we should make. rcpresentantes disponibles pars asistir; Phone: (717) 531-5069 or (800) 254 Please e-mail your ideas to: Available Hours: Monday, Tuesday & StatementideasCa~hmc.psu.edu Thursday & Friday f or write to us at: Written Correspondence: Penn State Milton S. Hershey Medical Center Penn State Milton S. Hershey Statement Ideas, PO Box 854, MC A410 Patient Financial Services De Hershey, PA 17033 PO Box 854, MC A410 Hershey, PA 17033-0854 Please Note: Yolrr physicians will bill separately for their professions PENNSTATE Statement Date: 10/19/10 N1Clton S. Hershey ®Medical Center PO Box 643291 Pittsburgh, PA 152643291 CHECKS SHOULD BE MADE PAYABLE AND SENT TO: MS HERSHEY MEDICAL CENTER PO 13oz 643291 Pittsburgh, PA 15264-3291 I~~~II~I~I~~~I~LII~~~I~~I~~II~~~I~II~I~~~~~III~~~II 1st Statement ing this bill please forward to receiving your AMOUNT 1800.00 125.00 90.00 -125.00 0.00 0.00 1890.00 ios de seguro contamos con :amunidad hispana. 9 Inesday 8:00 am to 5:30 pm am to 4:30 pm dical Center s$rvices. i HER3HEYST-07 ~- ~ l~ccou R" ~dm -' `~'Amount`bUe` k ~ ~~ ~,~ ~. A~ o :~d, $ 1,890.00 :~ ' ~ ~ ,.. ..~. ._-_ ..__ar. .., _ .~_._~ f ~ Check here if your address or Ir ~1 Please Indicate changes on dhe To pay by credit card: For your MasterCard or Discover Card. Pleas preference, provide the acxount infoi Account No. _ Expiration Date Signature ~ Information has changed. of this page. -nienoa, you may pay by visa, irate your credit card m, and sign below. CW Code 000000014078391020910 09100000189000 i i PENNS Milton S. Hershey ® Medical Center ~.~~291 This account is past due and ' Piir:awrgn, PA 15284-9291 and for us. To avoid any furth 1 send your payment for the full s are experiencing difficulty in u or making payment, please re e Responsibility section of this s < ELIZABETH MORNINGSTAR C/O AMY KORSUN ,~,» office for further assistance. 2301 OLD COACH LN HENRICO VA 23238-3024 11111111111111111111111111111111111111111111111111111111111111 Patient Name MORNINGSTAR ELIZABETH D DATE DESCRIPTION Statement Date 06/02/10 05/05/10 ;"BALANCE FORWARD Service Date(s) 09/30/09 -10/01/09 TOTAL Type of Service OUTPATIENT Account Number 13552467 . New Charges/Adj $ 0.00 New Payments/Adj $ 0.00 Account Balance $ 336.67 Amount Pending Insurance $ 0.00 Amount You Owe $ 336.67 This new statement has been spedaly designed For billing questions or insuranc with you in mind. Let us know what other Para PnB~ acerca ~ ~ facture ° ce improvements we should make. rcpresentantts disponibles pare ssistir a Phone: (717) 531-5069 or (800) 254; Please e-mail your ideas to: AvaWble Hours: Monday, Tuesday &' Statementideas(iiihmc.psu.edu Thursday & Friday 8; or write to us at: Written Correspondence: Penn State Milton S. Hershey Medical Center Penn State Milton S. Hershey Statement Ideas, PO Box 854, MC A410 Patient Finaaciat Services lkj Hershey, PA 17033 PO Box 854, MC A410 Hershey, PA 17033-0854 3rd Statement serious matter for you ~Ilection activity; please ount immediately. If you rstanding this statement .o the Financial Iment or contact our AMOUNT 338.87 336.87 de seguro contamos con wmidad hispana. Iday 8:00 am to 5:30 pm to 4:30 pm Center Please Note: Your phystctans wrll bill separately for their pro essaon se ...... ............ .... , ..:...... ,,,, ......... lrvices. HERSHEYST-07 pF~NN$TA-i-E Statement Date: 06/02/10 11Tilton S.Iierslhey Medical Center Po 6olc e49291 Piusburpn, PA ~s2sa-32s~ CHECKS SHOULD BE MADE PAYABLE AND SENT TO: IVLS HERSHEY MEDICAL CENTER PO Boz 643291 Pittsburgh, PA 15264-3291 II-~II~I~I~~~I~IIII~~~I~~I~~II~~~l~ll~l~~~~~lll~~~ll 336.67 Check here ff your address or fr Please lndfrate changes on ahe To pay by credit card: For your MasterCard or Discover Card. Plea preferonoe, provide the account info ^ ® ^ Account No. Expiration Date Signature X 000000013552467093009 $ Ica infavmatfon has changed. of thfs page. xlienoe, you may pay by Ylsa, kate your credit cans In, and sign below. !,CW Code 42100000033667 -1.~_ o7na~ o~ ~, t 4s.aa $324.00 sar~soo J L, H A'~ t ~/ ' Atxount ntmtber: 4228 6102 5286 8142 y Make your ohack payable to: aQ7 Chase Catd Services. Please write amount encbsed. New address or a-mail? Print on back. 42266102528681420D03660000214888DOOOOOOOOOb010D5 18284BEXZ17410D jnrlllrlrrl~litltr~ EST OF DIANNE H MORNINGST,4R 428 PARKSIDE RD CAMP HILL PA 17011-2127 ~ In~lllaril!nrurllrullulrlurllnlrllinlnlillrrlrlnlrl t: 5000 160 28~: 9 5 ~0 2 5 2868 i4 2 511' .. Maneye your account onNne: A, ~slate« ' from CHASE a www chase.com/c[edilcards con' ACCOUNT SUMMARY Account Number: 4228 8102 5288 8142 Previous Balance $2,148.88 I,~,v 6alarrbe $2,148.88 OpeninglClosing Date 05!24!1 0 -06/2311 0 Total Credit lane $2,300 Available Credit $151 Cash Access line $2,3~ Available for Cash $0 ~~Ilrrrlrlr~rrllrlrlrr~fir~lrlrrrllrrllrrl ~ARDMEMBER SERVICE PPOO BOX 15153 1hfiLMINGTON DE 198t36-5153 contsct information boated on reverse side New Balance ' $2,148.138 Payment Due Date 07!20!10 Minimum Payment Due $3.00 Late Payment blaming: I f wedo not receive your minimum payment by the date listed boy~e, you may have >p pay up to a $39.00 late fes and your ~r~rW be sutrject to increase to a maximum Penalty APR of gel %. Minimum Payment Wemi g: if you make ony the minimum payment each period, you II y more in interest and it will take you longer to pay off your For example: If you make no You w y off the And you wiN end up additional charges ba e~aNm on paying an estimated using this card and this tatdment in total o(... each month you fit... pay... Only the minimum y~are $7,172 Payment $so ye$re $3,256 (Savings=$3,916) tf you would like information a credit counseling services, call 1-868-797-2885. You haven't made the required payments and your credit cans account is 90 days past due. result, your credit bureau may be updated with a negative rating. Please send your payment Immediately or call us at 1-800-9 830 (collect 1-302-694-8200) today. Total fees charged in 2010 $78. Total interest cha in 2010 $144.1 Year-to-date totals reflect all charges minus any refund applied to your account on or after January 31,2010. ' Your Annual Percentage Rats {APR) is the annual interest rate on your account. Annual Balance Accrued Baance Percentage Rate (APR) Subject To nt~reat Interest Type . 31 Dava In Cvcle Interest Rate h rase Charaos _r-r-- , ` services 4150 OLSON MEMORIAL HIGHWAY, SUITE 200 MINNEAPOLIS, MINNESOTA 55422-4811 TELEPHONE 763-852-8620 Hours (CST): Fe-x 877-326-8784 TOLL-FREE 877-326-6761 June 24, 2010 RE: Estate of: DIANNE MORNINGSTAR Our Client: Discover Bank a corporate affiliate of DF5 Services LLC Account No: ************5662 Unpaid Balance: $7504.51 Reference No: 6220925 Dear AMY R KORSUN: 700 am-9:OOpmM-TH 70dam-S:OOpmF 80dam-12:OOpmS We presented a proof of claim in the amount of $7504.51 in the above referenced Estate some are requesting payment on this account. If payment is not immediately possible, please provld which the Estate will make payment. Please reply at your earliest convenience or see one of our easy pay options below. To resolve an account, please follow one of the easy steps below: 1. To make a payment over the phone, please call 1-877-326-6761. 2. To make a payment via mail, detach lower portion and return in envelope provided. Cordially, DCM Services, LLC This company is a debt collector. We are attempting to collect a debt and any information purpose. CaNs may be monitored or recorded for quality assurance purposes. NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION ~r~, ~r "'Detach Lower Portion end Rsturn wMh P~rment"' DCM Services, LLC ie ago. At this time we ~ estimate of the time at obtain d liwill be used for that -Side i ~Of 2- 4150 OLSON MEMORIAL HWY STE 200 Reference #: 6220925 Clien I~: DISC31 • MINNEAPOLIS MN 55422-4811 Unpaid Balance: $7504.51 ADDRESS SERVICE REQUESTED Checks Payable to: Discover Bank a corporate af6 ia~e of DFS Services I~I~i~l~®111~,~1~~1®~l~#t~~~l~~~q~l LLC Amount Enclosed: li June 24, 2010 rasa-~ 6720825.7611 sp 7hE~stale~of DIANNE MORNINGSTAR DCM Services - Payment P otessing C/0 AHY R KORSUN PO Box 9317 2301 Ol_D COACH LN Minneapolis MN 55440-931 HENRICO VA 23238-3024 ~,~r~u~r~u~n~~~u~~~n~~~~uu~~un~~~u~~~ ~~~~ni~~~u~~ 4 a a 6220925 5662 I I ~~~~'7611-89 DISCOVER =- New tsaiance Minimum Nayment~'Uue 1 $4,260.77 $341.00 JI Payment Due Date May 4, 2010 ~luillin"(~uilriiii(~IIIIiiUi~i~uli~~~liriiill~iinli~ni 00078415 01 AT 0.357 T1 09 SDSi RA06 364 DIANNE MORNINGSTAR 428 PARKSIDE RD CAMP HILL PA 17011-2127 Address, e-mail or telephone change$ Go to www.Discowr.eom or print change in space obova. D000019864585311203230426077000000000344~0' _~ tl= ~_ .~ Opening Date: March 10, 2010 - Discover More Card Account Summary Cardmember since 1496 Account number ending in 5128 Previous Balance $4,260.77 Payments And Credits - 0.00 Purchases + 0.00 Balance TronsFers + 0.00 Cash Advances + 0.00 Finance Charges + 0.00 Other Fees t + 0.00 New Ba once ,260.77 See Finance Charge Summary section Following transactions For detailed APR inFormation Credit Line $7,800.00 Credit line Available - ~ ~ - - ~'~. °' ' ~.~ Cosh Advance Credit line $4,000.00 Cash Advance Credit Line Available $0.00 You maybe able to avoid Periodic Finance Charges, see the reverse side far details. f t See transaction detail For a description of any Fsss Cd5 kIaCIC BonuSe Anniversary Month May Opening Cashback Bonus Balance $ 9.39 New Cashback Bonus This Period + 0.00 Redeemed This Period - 9.39 i i o ! 3 Easy Ways to Contact Us - ~ 9 :-Across yooraccountsecurely at'www:Discovrr:com 2. Cali 1-800~DISCOVER (1-800-347-2683) Please hove your Discovers card available. 3. Write to us of Discover, PO Box 30943, Soh Lake City, UT 84130 For TDD {Telecommunications Device For the DeaF) assistance, please call 1-800-347-7449. Account Number ending in b 118 Enter Amount Enclosed Below ~~ Please make check payable to Discover Card. Minimum payment due includes a past due amo~ of $ 58.00. Phone and intemet payments must mace by S:OOpm ET For same day posting. Go page es~s and make your account informati rtiore secure with password- protect statements only you can access. Learn m re 8t discover.com/paperless. PO BOX 7108 IIhuII~~~Il~ulslnu~Ill CHARLOTTE N '28272-1084 i,u(1i11~ I~i~I(i..Inii,i..i.Ilniiyiriiliiii,,,i,iii.i,liill :I ~~ ~Q~~ i page 1 of 2 Payment Inform 'fin New Balance ~ $4,260.77 Minimum Payment Du * $344.00 Payment Due Date May 4, 2010 *Includes past due am un} of $258.00 late Pbymnf Wamm • IF jrvs do not receive your minimum payment by the date li !above, you may have to pay a late fee of up to $39.00 an your purchase APRs Gor new transnetioris may be i ceased up to the DsFauk APR of 24.2490 variable. Minimum Payment Wa ir4g: IF you make only the minimum payment each period, will pay moro in interest and N wiH take you longer to pay fF your balance. For example: Curly the minimum 11 years $4,261 payment IF you would like inform ioh about credit counseling services, call 1-804347-1121. Manage Your Acc~ _ .... -• _ . Accesa free online t to y down your E bills onlirre and sos' • Make your money ~ and redeem cosh n • NEWT Access your mobile phone Transactions Trans. Post Dais Dais Online at www.Discovsr.amt lee Paydown Plannsrto'crsaten~p~+n' e, securoly access statements, pay :k all transactions moron-Find easy ways to cam unt securely through your BankofAmerica ' www.bankofamerica.com LL 0617 H 976 000 00245 #!O1 SP 0.000 ESTATE OF DIANNE MOBNINGSTA& 428 PASHSIDE BD CAMP HILL PA 17011-212728 i June 19, 2010 Old Account No.: 4800 1130 4678 3713 New Account No.: 4800115994784882 Dear Estate of Dianne Morningstar: Please advise us of the status of the Estate of Dianne Mo ni~ngstar and whether funds are available to pay our claim of $4,108.78. ~f funds are available to pay the claim, please send payment.. by eg rgss service to Bank of America 1000 Samoset Drive, Wilmington, DE 19884-x,2331, ATTN: PDP. As a reminder, please place the new account n ~'r on the payment. If you have any questions, or would like to arrange for pa Vent over the phone, please call Sherrie Ferrell at 1.888.221.4299, o~iday through Friday from 8 a.m. to 5 p.m. Eastern. If you prefe ,~~,you may write to. Bank of America P. 0. Bog 15409, Wilmington, DE 1 8,185-5409. Sincerely, Sherrie Ferrell Estate Department eherrie ferrell MBM &SCU 1-i U3-EN O1 of O1 6/ /% ~, STATE OF PA PROBATE COURT Cumberland COUNTY FILET NO: 21-10- STATEMENT AND PROOF !, 015 OF CLAIM Estate of Dianne Morningstar Amy Korsun 2301 Old Coach Lane Henrico, VA 23238 Phillips & Cohen Associates, LLC, on behalf of Bank of America located a 'fate Uni DS-014-02-03, 1000 Samoset Drive, Wihnin~ton, Delaware 19884, submit ~ following claim against the estate for the sum set forth. DESCRIPTION V ALUE Bank of America - 4800113046783713 AMOUNT DUE $4, 3 .42 File# MD8348945 ' There is now due on the claim, above all le a1 set-offs, the sum of : $4, 3 .42 Notice to interested persons: This is a claim by a personal representative. "1' -~ claim will be allowed unless notice of an objection by an interested person is deliv rid or mailed to the personal representative not later than I declaze that this claim has been examined by me and that its contents are a to the best of my information, knowledge, and belief. G „~.~ G - ~wa~y A~~u,°t'h' prized sign~a~~re Elizabeth A. Hansen Name Phillips & Cohen Associates, Ltd. c% Bank of America DES-014-02-03 Estate Department 1000 Samoset Drive Wilmington, DE 19884 Telephone:888-221-4299 ~ ~'I I Platinum MasterCard NEW BALANCE $5,279.34 Available CrediC 50.00 a Previous Balance 55,175.05 .~ s N e N Page 1 of 2 1-800-25d-9319 vvvvw.CapitalOne.COm/sOluti0n5 Aug.16 -Sep. 15, 2010 31 Days in Billing Cyde IMPORTANT ACCOUNT UPDATES 5178-0521-2972-1706 Your full balefrce b due. An t y paymen make wld reduce your balance and help pay off PAYMENT DUE DUE DATE your debt faster. The amount you owe m~y differ N youlre entered into a separate payment agreement. $5,279.34 PAST DUE i~ Payments and Credits Fees and Interest Charged 7ransactio s '. New Balance 60.00 • 5104.29 + 60.00 0 65,279.34 TRANSACTIONS PAYMENTS, CREDITS & ADJUSTMENTS FOR E D MORNINGSTAR #1706 w Help is Available. lust pick up th iphone. Call 1-800.258-9319 and a pe¢ially trained agent will be happy to help you check yo r Balance and make payments. INTEREST CHARGE Your Annual Percentage Rate (APR) is t e a noel interest rate on your aoounL Type of Balance Annual Percentage B~Itxtce Subject to Interest Charge Rate f%4PR) 'Interest Rate Purchases 17.9096 D ' 65,215.73 679.29 Cash I 24.9096 D 60.00 I 50.00 PLEASE RETURN PORTION BELOW WITH PAYMENT OR LOG ON TO WWW.CAPITALONE.COM/SOLUTIONS TO KE'IYOUR PAYMENT ONLINE. 1.5178052129721706 15 527934010005279345 Account Number. 5178-0521-2972-1706 Due Date New Balance Amount Enclosed Ma11ag! y0U Past Due $5,279.34 account onli @~ Visit www.capitalone.co~n/solutions to manage your account online. Ha a ijlformation at your fingertips 24/7 without irking up the phone. 400004 E D MORNINGSTAR at<zsa 2301 OLD COACH LN. HENRICO, VA 23238-3024 ~~ Capital One Bank (US >, N. A. III'1111'II'II'II'111111'IIII'IIIII111'I"111'1111"I'I'Illl'Illl Charlotte71NC328272- 08~ nlllll'lll"nlll'Irllllnlr'I nIM"II'I'lll'll"IIIIIIII'Inl Please make cheda payable to Capital One Bank (USA), N.A. and mail with this coupon in the en losed envelope. I FEES 1 13 SEP PAST DUE FEE 625.00 Total Fees This Period 625.00 Total Fees This Year 6298.00 INTEREST CHARGED INTEREST CHARGE:PURCWISES 679.29 Total Interest This Period 679.29 Total Interest This Year 6636.55 ~~~i~~au 1120 W Lake Cook Rd Ste A Buffalo Grove IL 60089-1970 ADDRESS SERVICE REQUESTED October 26, 2010 2072220-11101 420855008 I'll'lllll~~~ll~~lll~llrl~llllllllllllllllllli'I"I~1ll~ll„~II11 John Morningstar 2301 Oid Coach Ln 311 Henrico VA 23238-3024 Apex Financial Management, LLC 1120 W Lake Cook Road Suite A • BuffalQ Grove IL 60089 Toll Free: (866) 912:7390 Hours of Operation: Mon: Thurs. 8:00 am-B:OOpm (CST) Fri. 8:00 am-4:00 pm (C3T) Sat. 8:00 am-12:00 pni (C6T) APEX FINANCIAL MANAGEI 1120 W Lake Cook Road Suit Buffalo Grove IL 60089-1970 I~I1~~11~~~11~~~1~~1~1~1~~~~~111~1~~1~ EMIT, LLC A' il~~~~l~~~l~~ll~ll,~~l Original Creditor. HSBC BA Current Creditor. Equable A Previous Account #: 21160410 Apex Arxount #: 2072220 Balance: $1,422.59 Detach Upper Portion and Return with Payment Original Creditor: HSBC BANK NEVADA, N.A. Current Creditor. Equable Ascent Financial, Lic. Previous Account #: 2116041001518001 Apex Acxount #: 2072220 Balance: $1,422.59 This is to advise you that Equable Ascent Financial, LLC has purchased the above referenced debt y. Hsbc Bank Nevada, NA.. Unless you notify this office within 30 days after receiving this notice that you dispute the validity of th thereof, this office will assume this debt is valid. If you notify this office in writing within 30 days from i you dispute the validity of this debt or any portion thereof, this office will obtain verification of the debt judgment and mail you a copy of such judgment of verification. _And if, within the same period, you re and address of the original creditor, our office will furnish that information too. If you do not dispute this debt or any portion thereof, please contact our office to discuss a repayment Financial, LLC has authored Apex Financial Management, LLC to offer you the opportunity to settle your balance. To take advantage of this offer your payment of $995.81 would need to be in our office 2010 7:14pm. If you are unable to take advantage of this offer and wish to discuss other payment err contact our office at (866) 912 7390. We are not obligated to renew this offer. Please direct all payments and all correspondence to: Apex Financial Management, 1120 W Lake Co Grove, IL 60089-1970, toil free: (866) 912 7390. Sincerely, Apex Financial Management, LLC This is an attempt to collect a debt and any information obtained will be used for that purpose. In is from a debt collector. IEVADA, N.A. it Finandal, Llc. 8001 ' previously owed to t or any portion ing this notice that !ain a copy of a in writing the name n. Equable Ascent r account for 30°~6 off pater than Nov 30 dements, please F~oad Suite A, Buffalo ithis communication To make a payment on line, log on to www.aoexfm.com and click on make payment. ~ If you wish to pay by VISA, MasterCard or Discover, fill in the information below and return the entire I of to us. 3 Digit Security Code (see reverse side of credit card ) Card Holder Name Signatu RGLHILC0211~01 WESTERN{ I4UICK UNION COLLECT Tho 6rtaA wny to sand ~ pnymant QWC DIANNE MORNINGSTAA Account Number 633 9026 5047 Visit us at wwvl .gvc.com I Customer Service: 1-800-~i87-9444 Summary of Account Activity ., `Paynxnt Information Previous Balance $805.56 New Balance $8$1.14 + Fees Charged 539.99 Minimum Payment This Period $~I4.00 + Finance Charges 518.89 Amount Past Due $41.00 New Balance 5861.14 Total Minimum Payment Due $5.00 Payment Dua Data 04 0!$010 Credit limit $1,050.00 Late Payment Warning: It we do not receive your mi imWm Available Credit $1 ~•~ payment by the date listed above, you may have to pa a tlate Statement Closing Data 03/23!2010 fse up to $39.99. Days in Billing Cycle 28 ~m N Minimum Payment Warning: If you make only the mi~imiui payment each period, you will pay more in Interest and t w1H take you longer to pay off your balance. For example: }F you mafco no You wil{ pay off _ And you wiN er~d additional charges `the balance , up payirig an using this`card shown on this estimat6d total ' -:arid each month statement in ; of ..." . -you pay :... about ... , . Only the minimum ~ 6 years ` $1 payment If you would like Information about credit counseling call 1-877-302-8775. .Transaction Summary ; _° Tram Date Post Date Order Number Item # Description of Transaction or Credit A oust 03123 03J23 LATE FEE $ 9.:~9 03/23 03/23 "FINANCE CHARGE" $ 5.a9 Finance Charge Calculatlcn ':' , Corresponding Average Daily ANNUAL FINANCE CHARGE Expiration Daily Periodic PERCENTAGE Due to Transactlon Bal ce Dat® Balance Rate RATE Periodic Rate Faes M® oa Regular Purchase NA $813.05 0.06847% 24.99% $15.59 $0.00 2 TOTAL FINANCE CHARGE: $i .59 ANNUAL PERCENTAGE RATE purchases ... ................................... 24.99% THE PERIODIC RATE SHOWN ON THIS STATEMENT MAY VARY. ~MiCardholderNewsandlnformatioq Please Note: Enclosed ~ the Privacy Policy for this account Please take a moment to read it, then keep it with other llnancial documents. CaMholder Benefits and nforrnatio~ _ Enhance your wardrobe r£ your home with apparel, jewelry ~ home decor from some of our most popular designers, Get Tota~ Access to our Designing Men, 4/7-10 at 2 $ 7pm ET daily. eAYMENT DUE BY 5 P.M. (E~ ON THE.QUE DATE. NOTICE: We may convert your payment inta an electronic debit. See reverse for details, Billing Rights Information and other important Information. r 5444 ODZ9 ANH 1 7 23 100323 D PAGE 1 of 1 9339 30D0 OVD9 OlIV54d4 X54 1 Detach and mail this portion with your check. Do not include any correspondence with your check. -' ~ ~ Account Number. 633 9028 5047 ~~® DO NOT SEND PAYMENTS OR CORRESPONDENCE TO THIS ADDRESS Department # 6129 ............._._ P.O. Box 1259 Oaks, PA 19456 NI1111 f II I Ilrl~ll I ~I~I~Illai I ~ III ~ III Office Hours (Eastern Time) M - Th: 9:OOam - 9:OOpm -Fri: 9:00 am - 5:00 pm 1-866-794-1321 Fax: 443 X51-2701 5418.44 Estate Of Dianne Morningstar ` 428 Parkside Rd Camp Hill, PA 17011-2127 April 19, 2010 IDENTIFYING INFORMATION Estate Recoveries Inc. File No.h ARMS00000141059 Creditor Account Number: ~ 371508860041006 Creditor: i, American Express Estate of: DIANNE MORNINGSTAR ACCOUNT BALANCE: ',$1247.65 Dear Sir/Madam: On behalf of the creditor, we wish to extend our condolences for your loss. Estate Recoveries, Inc. customer's families and estates during difficult times such as this. The balance owed on this account is $1247.65. If there is an estate, please forward the Notice of Administration form to our office for processing. from the Probate Court or your attorney). If the account has credit life insurance, please contact our office. We would be happy to assist you v Otherwise, please send all payments to ERI with the remittance slip found at the bottom of thi envelope. To ensure proper posting, please write the ERI File Number on your check or money orde ]f you have any information regarding an estate, including if there is no estate, or if you have que with this matter, please contact us at 1-866-794-1321. Our representatives will be glad to assist you Sincerely, Estate Recoveries, Inc. NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMA Estate Of Dianne Morningstar 428 Parkside 12d Camp Hill, PA ]7011-2127 in working with (C~ne may obtain this form +itH this process. leEtter using the enclosed S. ', ~tidns or require assistance IDENTIFYING RMATION Estate Recoveries Inc. File No.: 500000141059 Creditor Account Number: 3 15 8860041006 Creditor: 'can Express ACCOUNT BALANCE: $ 24 .65 Make Check Payable To ~i Estate Recoveries, Inc. ICI P.O. Boz 15380 Baltimore, MD 21220 L~I~L~~ILJJ~~I~III~~J 2 5418.44 _ __ _ 1_ _ _- . __ FIA CARD SERVICES' ' www.FlACardServices.com ESTATE OF DIANNE MORNINGSTAR 428 PARKSIDE RD -- CAMP IiII,t PA~701~~~27--~ --- ~- Apri112, 2010 Account No.: 5329065496649423 Dear Estate of Dianne Morningstar: We have recently been informed of the passing of Dianne Monningstaz and offer our be assured that this account has been closed. Dianne Morningstaz was a valued FIA I customer since October 20, 2005 and we greatly appreciate the past business with us. understand this is a difficult time for the family, we do require the necessary informa~ financial affairs since there is a balance of $2,400.29 remaining on the above referent The information requested on the following page will enable us to take the appropriate the personal representative handling the financial affairs of the decedent. Please comp: Estate Status Form and return it to us using the postage paid return envelope provided i you have access to a fax machine please feel free to fax the form to 1.302.458.0644. Y obligated to send us a death certificate unless the above referenced account was enrolls credit insurance, cardholder security or credit protection plus products. Should the family or legal counsel determine that opening an estate is not the best cow have the Personal Representative of the decedent take a moment to call one of our seni number below to discuss the various options available to satisfy the remaining balance reminder, whether or not, you are the personal representative, executor or attorney han the decedent, you are not personally responsible for this debt. Subject to the above, if ; position to mail a payment in full, our mailing address is: Fl'A Cazd Services PO Box 15409 Wilmington DE .19850. For overnight mail please use the following ad Services 1000 Samoset Dr. Newark DE 19713. When sending a payment to our office, whether through the U.S. Postal Service or via please do not forget to write the account number listed above on the face of the the payment is coaectly credited to the account. Again please accept our condolences on 1 Morningstar. ff you should you have any questions with regard to the above reference options, or how to answer the questions on the Estate Status Form attached, please doi contact one of the senior associates in our Estate Department at 1.877.767.9383. Our ] aze Monday through Thursday, 8a.m to 8p.m. and Friday, 8 to 5 Eastern. Sincerely, The Associates of F1A Cazd Services Estate Department Enclosures Please ale we certainly . >~egarding the account. 'ion and contact :d the enclosed ttiis package. If i ;are not one of the cif action, please associates at the l$2,400.29. As a ~Ig the affairs of a are in a FIA Cazd ensure the .s of Dianne punt, payment ~itate to of operation . ~ - , ~ t ~; Filing Checklist For 2009 f'~x Return Filed On Standard Forms a Prepared on: 04/13/2010 09:33:04 pm !~ Return: C:\Users\Brian\Documents\HRBlock\Dianne Morningstar 2009.T0 To file your 2009 tax return, simply follow these instructions: Step i -Sign and date the return Because Elizabeth died before filing the return, the personal representative dr other ukhorized filer must sign the tax return. If the return includes Form 1310, the personal represents ei or other authorized filer must sign Form 1310 as well If your return is signed by a representative for you, you must have a power of alto eyl, attached that specifics{ly authorizes the representative to sign your return. To do this, you can use Farm 2848, Power of Attorney and Declaration of Representative. Step 2 -Assemble the return These forms should be assembled behind Form 1040 --U.S. Individual Income Tax R turrn - Schedule M - Form 1040-V Staple these documents to the front of the first page of the return: Form W-2: Wage and Tax Statement 1st (Trinity United Methodist Church) Step 3 -Pay the balance due on your taxes Make your check or money order for $406 payable to the "United States Treasury". D Write the following on your check or money order: - "2009 Form 1040" - Your name and address - Your daytime phone number - Your Social Security Number On the right side of the check or money order write the dollar amount of the payment, I. $406.00. Don't staple or otherwise attach the payment to the return. Instead, just place it loose i with the return. Step 4 -Mail the return Mail the return to this address: Department of the Treasury Internal Revenue Service Center n'ti send cash. this: i the envelope