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HomeMy WebLinkAbout03-28-111,50561,01,05 REV- ~ 50Q FX {oz-u) (FI) ~ OFFICIAL USE ONLY PA Department of Revenue Pennsylvania Bureau of Individual Taxes ~` ~ " ~ County Code Year File Number PO BOX z8o6ot pINHERITANCE TAX RETURN 2 Harrisburg PA 1'7128-0601 RESIDENT DECEDENT O ~ ~ b ~~'~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 579-42-8135 05/04/2010 08/13/1929 Decedent's Last Name Suffix Decedent's First Name MI FORTNEY MARY H (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 1. Original Retum O 2. Supplemental Return O 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A} Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number JANE M. ALEXANDER (717) 432-4514 REGISTER OF WILLS USE ONLY First Line of Address 148 S. BALTIMORE STREET Second Line of Address City or Post Office DILLSBURG State ZIP Code PA 17013 N C .._. ..r 'Sl7 r;" ~? ~ MNN ; =~1 --- -_ `~~ w ~`~ GO -C" "r~ Correspondent's a-mail address: Under penalties of perjury, 1 declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SI TURE OF PERSON RE~POt~IBLE F~IA RETURN q ~ DATE 2204 COUNTY LINE ROAD, SPRINGS PA 17372 !~ Side 1 1505610105 1505610105 i,51~567,0205 REV-1500 EX (FI) Decedent's Social Security Number Decedent's Name: MARY H. FORTNEY 579-42-8135 RECAPITULATION 1. Real Estate (Schedule A) ...................... ................... ... 1. 95,000.00 2. . Stocks and Bonds (Schedule B) ............... L. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 4. Mortgages and Notes Receivable {Schedule D) ........................ ... 4. 5. Cash. Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. 11,139.07 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. 7. inter-Vivos Transfers & Miscellaneous Non-Probate Property 67 729 71 (Schedule G) O Separate Billing Requested..... ... 7. , . 8. Total Gross Assets (total Lines 1 through 7) .......................... ... 8. 173,868.78 9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. 22,440.50 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............ ... 10. 6,086.08 11. Total Deductions (total Lines 9 and 10) .............................. ... 11. 28,526.58 12. Net Value of Estate tLine 8 minus Line 11) ........................... ... 12. 145,342.20 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made {Schedule J) ..................... ... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ..................... ... 14. 145,342.20 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 45 145,342.20 16. 17. Amount of Line 14 taxable ai sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE .........................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610205 1505610205 6,540.30 6,540.30 O REV-1500 EX (FI) Page 3 Decedent's Complete Address: File Number MARY H. FORTNEY STREETADDRESS 503 MILL RACE ROAD CITY STATE ZIP CARLISLE PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) _ 6,540.30 2. CreditslPayments A. Prior Payments 4,860.00 -_- __ B. Discount 270.00 ?otal Credits (A + B) (2) 5,40 . 3. Interest (3) 32.69 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1,172.99 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred .................................................................................... ...... ^ b. retain the right to designate who shad use the property transferred or its income ...................................... ...... ^ c. retain a reversionary interest ........................................................................................................................ ...... ^ ^ d. receive the promise for life of either payments, benefits or care? ................................................................ ...... 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................................................................................................ ...... ^ 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? ........ ...... ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? .................................................................................................................. ...... ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ~~i pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER MARY H. FORTNEY 2110-0495 Alt real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1' ~ ALL THAT CERTAIN UNIT, BEING UNIT N0.26 (THE UNIT) OF WILLOW CROSSING, A CONDOMINUM, LOCATED IN SOUTH MIDDLETON TOWNSHIP, CUMBERLAND COUNTY PENNSYLVANIA, WHICH UNIT IS DESIGNATED IN THE DECLARATIONOF CONDOMINIUM OF WILLOW CROSSING, A CONDOMINIUM ("THE DECLARATION OF CONDOMINIUM') AND DECLARATION PLATS AND PLANS AS RECORDED IN THE RECORDER'S OFFICE OF CUMBERLAND COUNTY IN MISCELLANEOUS BOOK 386, PAGE 889 AND PLAN BOOK 61, PAGE 62 AND FIRST AMENDMENT TO DECLARATIONOF CONDOMINIUM. 95,000.00 TOTAL (Also enter on Line 1, Recapitulation,) I $ 95,000.00 If more space is needed, insert additional sheets of the same size. Tax Parcel ID No.: 40-22-0485-071-U26-255 Address: 503 Mill Race Road Carlisle, PA ] 7013 South Middleton Twp., Cumberland Cty. aC~jig ~eeb ~I~ ~,) c Made this `~ ay of ' ~ ter.--:~- ~_=~=~%'~""~,~._,i~ the year of our Lord Two thousand Eleven (2011), ,~ `i I BETWEEN ESTATE OF MARY H. FrORTNEY, late of the Township of South Middleton, County of Cumberland and Commonwealth of Pennsylvania, by LORENA A. SCHAFFNER, Administratrix, GRANTOR AND DONNA J. BAKER, of the Borough of Camp Hill, County of Cumberland and Commonwealth of Pennsylvania, GRANTEE WHEREAS, the said Mary H. Fortney died intestate, a resident of 503 Mill Race Road, Carlisle, County of Cumberland, Pennsylvania, on May 4, 2010; and WHEREAS, Letters of Administration were duly issued by the Register of Wills in and for Cumberland County for the Estate of Mary H. Fortney on May 17, 2010, to Lorena A. Schaffner, Administratrix; and WHEREAS, the said Mary H. Fortney, in her lifetime and at the time of her death was owner in fee simple of all that certain land situate in the Township of South Middleton, County of Cumberland and Commonwealth of Pennsylvania, as hereinafter described; and WITNESSETH, that in consideration of Ninety-five Thousand and no one-hundredths ($95,000.00) Dollars, in hand paid, the receipt whereof is hereby acknowledged, the said GRANTOR does hereby grant and convey to the said GRANTEE, her heirs and assigns: ALL THAT CERTAIN unit, being Unit No. 26 (the "Unit"), of Willow Crossing, A Condominium, located in South Middleton Township, Cumberland County, Pennsylvania, which Unit is designated in the Declaration of Condominium of Willow Crossing, A Condominium (the "Declaration of Condominium") and Declaration Plats and Plans as recorded in the Recorder's Office of Cumberland County in Miscellaneous Book 386, Page 889 and Plan Book 61, Page 62, and First Amendment to Declaration of Condominium for Willow Crossing, A Condominium (the "First Amendment to Declaration of Condominium") and Declaration of Plats and Plans as recorded in the Recorder of Deeds of Cumberland County in Miscellaneous Book 388, Page 412 and Plan Book 61, Page 97, and Second Amendment to Declaration of Condominium for Willow Crossing, A Condominium (the "Second Amendment to Declaration of Condominium") and Declaration Plats and Plans as recorded in the recorder of Deeds of Cumberland County in Miscellaneous Book 526, Page 907 and Plan Book 72, Page 106. TOGETHER with an individual two and twenty-seven hundredths (2.27%) per cent interest in Common Elements as more particularly set forth in the aforesaid Declaration of Condominium and Declazation Plats and Plans, as amended. TOGETHER with the right to use the limited common elements applicable to the Unit being conveyed herein, pursuant to the Declaration of Condominium and Declaration of Plats and Plans; BEING known as 503 Mill Race Drive, Carlisle, Pennsylvania; IT BEING the same premises which Robert V. Waggoner and Carolyn J. Dove, Executors of the Estate of John H. Waggoner, by their deed dated August 24, 1998, and recorded in the Office of the Recorder of Deeds in Cumberland County, Pennsylvania in Deed Book 185, Page 208, granted and conveyed unto Mary H. Fortney. The said Mary H. Fortney having died intestate May 4, 2010, and Letters of Administration were granted by the Register of Wills of Cumberland County, Pennsylvania, on May 17, 2010, File No. 2010-00495, to Lorena A. Schaffner, Administratrx and GRANTOR herein. UNDER AND SUBJECT, NEVERTHELESS, to easements, conditions and restrictions of prior record pertaining to said premises. And the said GRANTOR will SPECIALLY WARRANT AND FOREVER DEFEND the property hereby conveyed. IN WITNESS WHEREOF, said GRANTOR has hereunto set her hand and seal the day and year first above written. Signed, Sealed and Delivered In the Presence of MARYH. FORTNEYESTATE bv: ,- '~ ~.~ ~Y~C~~ :~.r)_:'~ (Seal) Lorena A. Schaffner, ministratrix Commonwealth of Pennsylvania County of ~ ~ , ~i , ,;,,,~ On this, the ~~ ~~~day of ~'~~~'~~~~ ~ 2011 before me , a Notary Public in and for said County and State, the undersigned officer, personally appeared Lorena A. Schaffner, Administratrix, known to me (or satisfactorily proven] to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set da~nd notarial seal. Notary Public My Commission Expires: Certificate of Residence I hereby certify that the precise address of the GRANTEE herein is as follows: SC Ridgeland Lane, Apt. 12, Camp Hill, PA 17011 Af~ew~-- ~'~~., Prepared by: Jane M. Alexander, Esquire Attorney at Law 148 S. Baltimore Street Dillsburg, PA 1 701 9-0421 Phone: (7/7J 432-4514 / /'~. Settlement Statement (HUD-~, OMB Approval No 2502-0265 1. Q FHA 2. ©RHS 3. Q Conv. Unins. 6. File Number: 7 Loan Number: 2010125AB 8 Mortgage Insurance Case Numt 4. Q VA 5. ^ Conv.lns. 1070261646 44-021262904615 C. Note; This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agents are shown Items market "(p.o.c)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. D. Name & Address of Borrower: E. Name 8 Address of Seller: F Name 8 Address of Lender: Donna Baker Estate of Mary H. Fortney 5 C Richland Lane, Apt. 12, Camp Hill, PA 17011 JP Morgan Chase Bank, N A. 2204 County Line Road. York Springs. PA 17372 1400 East Newport Center Drive, Deedield Beach, FL 33442 G. Property Location: 503 Mill Race Road, Unit #26 H. Settlement Agent: I. Settlement Date: OV74/2011 Absolute Abstract LLC Carlisle, PA 17013 South Middleton Township , Disbursement Date: OV14/2011 125 West Harrisburg Street, Dillsburg, PA 17019 Telephone:717-432.7102 Fax: 717-432-1535 Place of Settlem t en . TitleExpress 125 West Harrisburg Street, Dillsburg, PA 17019 printed OV14/2011 at 12:47 pm by CEC 100. Gross Amourrt Due from Borrower 101. Contrail sales price „_ _ _ __ ~• Gross Amount Due to Seller , 103. Settlement charges to borrower (line 1400) 402 104 9 806 54 403. --~ ...a~nonw rvr mama atl b seller in advance 106. CityAown taxes Ad ustments for items aid b seller in adva 107 to . County taxes to 406. nce City/lowntaxes to 108 . School taxes 01n412011 Lo 06/30/2011 407. County taxes to 109• CondoDues/January 01/1412011 to 01/31/2011 430.95 408. School taxes O1I14I20t1to06/30/2011 430 95 110. 65.81 409. Condo DueslJanuary 01114/2011 to 01/3112011 . 65 81 111. 410. . 112. 411. 120. Grose Amount Due from Borrower 412. 2~• ArnouMs Paid or in BehaNof Borrower 105,303.30 420. Gross Amount Due to Setter 95,496.76 201 • Deposit a earnest nroney 500. Reductions in Amount Due to Seller 202. Principal amount of new loan(s) 500.00 501. Excess deposit (see instructions) 203. Existin loa s taken sub'ect to 98,445.00 502. Settlement charges to seller (line 1400) 7,434.13 P04. 503. Existin loa s taken sub'ect to 205. 504. Pa off of first mort a e loan P06 505. Payoff of second mortgage loan 207. 506. 208. 507. 209. 508. Ad ustments for items unpaid b seller 509. 210. City/town faxes t0 Adjustments for items un aid b seller 211. County taxes 01/0112011 to 01114/2011 510. City/town taxes to 212. School taxes to 9.89 511. County taxes O1I0112011to 0111412011 g 89 213. 512. School taxes to 214. 513. 215. 514. 216. Seller Assist " 515. 217. 6,200.00 516. Seller Assist " 6,200.00 218. 517. 219. 518. ~0• Total Paid b ffor Borrower 105 154 89 519. 520 300. Cash ffi Settlement fromfto Borrower , . . Total Reduction Amount Due Seller 13.644.02 301. Gross amount due from borrower line 120 ( ) 6~• Cash at Settlement toffrom Seller 302. Less amounts paid by/for borrower (line 220) 105,303.30 B01. Gross amount due to seller (line 420) 95,496.76 303. Cash QX From ~ Tp gOef 105,154.89 602. Less reductions in amount due seller (line 520) 13,644.02 k lam ~x a`~iol.n. amMM va~a ane <axml,wme....w wnr "~` `•+ro... a c /Ilo,r,.N Menli.6ry k ok Inis discbs 148.41 we k manGalory~Tm 603. Cash ~X To ~ From Seller s koEesq,ya la pwi0e In psitiess to a RESPa mr.,M Iranuciion w,ln~,nlamalro r.. o < n Cwinp Ine o 81,652.74 e Previous etlitions are obsolete Page 1 of 4 HUD-1 7M 7.d.,r o.,..~ c_._._ o -- --• ••--• ~a.o.z ~~..~~~ tuns .° o,ruu.uu Division of commission Iine700 as follows: Paid From ' Paid From 701. $2,850.00 to ERA-NRT Borrower s Seller's 702. $2,850.00 tp REIMAX A-1 Realty Inc Funds at Funds at , 703. Commission paid at settlement Settlement Settlement 704. Add'I Brokerage Fee ERA-NRT t 5,700.00 o 705. Add'I Brokerage Fee to RE/MAX A-1 Realty, Inc.. 195.00 195.00 800. Items Pa ble in Co ti ith nnec on w Loan 801. Our origination charge (Includes Origination Point % or $1,181.34) $5,894.19 (from GFE #1) 802. Your credit or charge (points) for the specific interest rate chosen $-3,301.85 (from GFE #2) 803. Your adjusted origination charges (from GFE A) 2 592 34 804. Appraisal fee to CR Consultin $425.00 P.O.C. B' (from GFE #3) , . 805. Credit re rt tp (from GFE #3) 806. Tax service to JP Mor an Chase Bank, N.A. (from GFE #3) 807. Flood cert~cation 87.00 to Corel is (from GFE #3) 808. Flood Delennination Initial 5.00 to Corel is (from GFE #3) g,pp 900. Items R aired b Lender to be Paid in Advance 901. Daily interest charges from from 01/14!2011 to 021012011 @ $14.1598lday (from GFE #10) 254 88 . 902. Mortgage insurance premium for months to USDA (from GFE #3) 3 445 58 , . 903. Homeowners insurance fw ears to (from GFE #11) ~~ months to from GFE #11 1000• Reserves IJe iced with Lender 1001. Initial deposit for your escrow aarount (from GFE #9) 1002. Homeowner's insurance months $ O.OOlmonth $ 799.76 1003. Mortgage insurance months $ O.OOlmonth $ 1004• Property taxes 8 months $ 21.48Inwnth $171.84 1005. County taxes months $ 21.48/month $ 1006• School taxes 8 months $ 78.491month $627.92 1007. Aggregate Adjustment $ 1100. Title Cha es 1101. Title services and lender's title insurance from GFE #4 1,162.98 1102. Settlement or dosin fee g to $ 1103. Owner's title insurance -first American Title Insurance Compan y from GFE #5 1104. Lender's title insurance -First American Title Insurance Company $767.48 1105. Lender's title policy limit $98,445.00 Lenders Policy 111]6. Owners title policy Limit $95,(1(10.00 Owners Policy 1107. Agent's portion of the total title insurance premium $637.01 1108. Undi;rwriters portion of the total the insurance premium $130.47 1109. Notary Fee to Carrie E. Ra an $35.00 25 00 1110. 100 No Vio11100 to Absoute Abstract, LLC $50.00 . 1111. 300 Survey1300 to Absolute Abstract, LLC $50.00 1112. 810 Condo14.1 to Absolute Abstract, LLC $50.00 1113. 900 EPL-Res18.1 to Absolute Abstract, LLC $50.00 1114. ClosingSvd_Ir1Cl to Absolute Abstract, LLC $75.00 1200• Government Recordin and Transfer Cha es 1201. Government recording charges $ (from GFE #7) 1202' p~ 564.00 Mort a $124.00 Release $ 188.00 1203. Transfer taxes $ (from GFE #8) 1204. City/County tax/stamps Deed $950.00 Mort a e $ 950.00 ~( 1205. State Tax/stamps Deed $950.00 Mort a e $ 950 00 1~' Deed $ Mort a e $ . 1207. $ 1300. Additlonal Settlement Cha es 1301. Required services That you can shop for (from GFE #6) 1302. Survey to $ 1303. Inspection to $ 1304. Condo Resale Cerl. & Dues (l01/31/to Willow Crossi Condo Assoc . 445. 1305. Condo Assoc. -Initiation Fee (o Willow Crossin Condo Assoc. 120 00 . 1306. Tax Cert. Fee -Reimburse to Absolute Abstract LLC , 5 1307. Final Water/Sewer to South Middleton Townshi Munici al Authorit 114 t ~~^, . r ~ ~ ~ - ~ ~ ~ - ~ r ~ ' 9,808.54 7,434.13 'Paid outside of closing by (B)orrower, (S)eller, (L)ender, (I)nvestor, Bro(K)er. "Credit by lender shown on page 1 "'Credit by seller shown on page t ~ - ~Ile~ C~eC'~ t~ ~ Previous editions are obsolete Page 2 of a HUD-1 Com arison of Good Faith Estimate GF and HU0.1 Char es Char es That Cannot Increase Good Faith Estimate Our origination charge HUD-1 Line Number HUD-1 Your credit or charge (points) for the s pecrf~ interest rate chosen # 801 5 894 19 Your adjusted odginatlon charges # 802 . . -3 301 65 5,894. t 9 Transfer taxes # 803 , . 3,301.85 # 1203 2.592.34 2.592.34 Cha ~ That in Total Cannot Ineraaan u...e Tr.__ .,e, 950.00 950.00 loan term is Your initial interest rate is Your initial monthly amount owed for principal, interest, and any mortgage insurance is your interest rate rise? Even if you make payments on time, can your loan balan Even ii you make payments on time, can your monthly amount owed for principal, interest, and mortgage insurance rise? Does your loan have a prepayment penalty? Does your loan have a balloon payment? Total monthly amount owed including escrow account payments 30. years 5.2500% $543.62 includes QX Principal QX Interest ^ Mortgage Insurance Xn No. ~ Yes, it can rise to a maximum of will be on I I and can change again every dale, your interest rate can increase or decrease by interest rate is guaranteed to never be lower than Q No. ^ Yes, it can rise to a maximum of $ XC~ No. ~ Yes, the first increase can be on / / amount owed can rise to $ The maximum it can ever rise to is $ %. The first change years after ! I .Every change %. Over the life of the loan, your or higher than %. and the monthly ^X No. ~ Yes, your maximum prepayment penally is $ No. ^ Yes, you have a balloon payment of $ years on / / due in You do not have a monthly escrow payment for items, such as property taxes and homeowner's insurance. You must pay these items directly yourself. 0 You have an additional monthly escrow payment of $99.97 that results in a total initial monthly amount owed of $643.59. This includes principal, interest, mortgage insurance and any items checked below Q Property faxes ^ Homeowner's insurance Flood insurance 0 School taxes Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form, please contact your lender. Previous editions are obsolete Page 3 of 4 HUD-1 Your initial loan amount is $98,445.00 I have carefully reviewed the HUU1 Settlement StatemeDntCand ToFhe bes'OoNmOy k B wleo9 AND SELLER true and accurate statement of au receipts and disbursements made on my account or by me in this transaction. 1 further cenify that I have received a copy of the HUD-1 Settlement Statement. ^-naan.ni L.u''~i r' A UWInB Bak@r ` ` ~ , Esta of Mary H. Fortney The HUQ1 Settlement Statement which 1 have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be disburs 'n accords ce with this statement. I ~ ! 1 SETTLEMENT AGENT DATE WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: U S CODE SECTION 1001 AND SECTION 1010 Previous editions are obsolete Paqe 4 of 4 HUD-1 i~ pennsylvania ~ DtPAFTMEMi O: tiEVENUE SNHEkITANIE TAX RETURN RESIDENT DECEDErvT ESTATE OF: MARY H. FORTNEY ~~NEDU~E E CAS~i, ~iANi( DEPOSITS & MISC. PERSONAL PRt~PERTY Include the proceeds of iitiGation and the date ,he proceeds w1e e received by the estate. A!1 araoerty iointly nwnoa ,n.:*ti ,.:..~. _F _.._..-. _ _ . . FILE NUMBER: 2110-0495 - ••~•- ,r~~~ ~-, ~~__~~~~.,, ~~~~ auuiuuna! sneers nr paper or pie same size. _ - Chec!<ing/MMA Deposit Accou,~T - ( + ,{; _~ .. „. _ _,_ NUMBER t['1 r~ ~ ~ 4 ~" - M 0 N 0 0 e 0 0 0 NAME CJ~ 1'` ~~ ``- :-( U~~`'"'' 7 ~ ~ ~~ ~~ ~u GATE ~ ~ :} SIGN HERE If CASH RECEIVED FROM DEPOSIT 1.0. (BANK USE ONLY) LtSS CASH TOTAL $ ~~ ~ ~~ t0 5990B~t b b 5 Sae HOLD DOCU M ENT UP TO T H E LIG HT TO VIEW TRUE WATERMARK r (]~~( pp ~T p~ py ~p Manufacturers and Traders Trust Company BUFFALO, N.Y. 14240 r'1f1P•;= H c~ fir, i ,-.i['~~ ~ E..T(=; > REMn7ER ~ PAY TO THE ORDER OF E~~THT~ ..x..~.._~.T(~(i' THn~_!c;s:hdC~ f Ct!_!r. ~! !~--~~~I<:EC~ F~ If-•:T`r CIhHT .rl,j C (1 ;~ i l~ii i::r::+:! ~~=_r.,,~t 2.~.r-_ M _ 8 - ~ ,s4.= ,iji _ - ~, --- -------------- i~RH ~L9IUAE-! i~° 200 l b44 36n° too 2 2000046to b 700 20 b99 2604 7i~' ~~'0 30 7 2 78u' ~:0 360 76 b 500 6 20 54 5 2 58 1~~' ~~` ®~~` ~~~~~ -~~~~~ '~I~r EIOL~OCUMEiJT UP TO THE LIGHT TG VIEW TRUE WATERMARK Y `.'- 200114436-© 10-4/220 DATE '-'c,' i c',;'~~ I i r( IF OVER 3 CHECKS 1.15? CHECKS ON THE REVERSE SIDE _ _ __ . EFORM 7 20935-0600 0 r r m r r .-. 0 w r W r ru W i• O O r O O m r 3 d ~c O N 0. ~i ~Oy- a x ~7 m a m \ 1 L-~ ~^ \ 1 ^~^ lJ v ~.i z V n b0 ,'k- m 0 a,~' _~ ~ m' 0 0 z z o- d 0 w_- o- ao N d Z O c~ o ~ o ~ rn N ~ O ..... 0 a P i t X S T c:LNTURYTEL, INC. DO~ument / Date ATTN: Controllers Group 2000519441 / 05/17/2010 ~1~~ P.O. BOX 4065 "~ MONROE, LA 71211 Your vendor number CenturyLink•` 1'877-386-7151 500000 Document Invoice Date Gross Amount Deductions Net Amount Text Payment is made on behalf of EQ United Tel-PA, Tss6. 1900018401 7172494747 05/14/2010 25.16 0.00 25.16 Refund Questions? Call 1 888 723 8010 Sum total 25.16 0.00 25.16 _. ~ayrrtet1t dvOlt-t~i;~it Ct1e0k tt~trt7bel' 2f~bi}~19441 btiD~'762~78 Clate ~urr~rlCy ~?~yr1'r~ttt art3ount b5/17/2E110 USD ~`***~***~***'25.16* CENTURYTEL, INC. Check Number ATTN: Controller's Group 0002762278 ~~~~ P.O. BOX 4065 JPMORGAN CHASE BANK, ~,1~ MONROE, LA 71211 SAN ANGELO 88-88/1113 CenturyLink'• 1-877-386-7151 Void after 90 days 05/17/2010 *** TWENTY-FIVE USD and 16/100 *** Pay to the order of: MARY H FORTNEY 503 MILL RACE RD CARLISLE PA 17013-2574 USD ************25.16* R ~,~. Protected by positive pay ~~'000 2 76 2 2 ?8~i' ~: L ~ L 300880: i~'0 58000 798 7i~• 1-1ULD DOGR~2d1L!`d~' ff~ LIGH"B"i0 VERIFY Yt9A-iEl~ir~~r. 00000 002 018 052210 02040015 446871 025066 62.22 57 1519101' CDC FUND DEPT PREP DATE VOUCHER WARRANT ~p 311 CHECK NUMBER WACHOVIA BANK ~ PHILADELPHIA, PA L;u~~"' °`"` 1! ' r ~,,, ; `" VERIFICATION AVAILABLE - "POSITIVE PAY" PROTECTED O ° PAY ° ONL ~ 0 TO THE ORDER OF ° O ~ MARY H FORTNEY ° DLN 097010199837 REV REBATE ° 503 MILL RACE RD ° CARLISLE PA 17013-2574 o " ~~n~~~n~~~~n~~n~~n~~~n~~~~~~~i~n~~~~u~~~u~n~~~~~n~) 07/01/2C DATE VOID AFTER 180 DAY: ********~~**500.0 „ ~! TREASURER OF PENNSYLVANIA ~p~ II' 15 L9 ~0 L511' x:03 L X00 2 25~: 20 7 9 9 50008 60 211' ,. - ..t l _, ..,.. .. Pennsylvania SCHEDULE G DEPARTMENT OE REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ealait ur FILE NUMBER MARY H. FORTNEY 2110-04x5 i nis scneauie must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE. THEIR REUTIONSHIP TO DECEDENT ANG THE DATE OF TRANSFER. ATTACH A COPY Of THE DEED FOR REAL ESTATE. _ ~ DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (lr APPLICABLE) TAXABLE VALUE I ~ BENEFICIARY- JENNIFER BAKER DISE -DAUGHTER 2 AMERIPRISE -TAX EXEMPT HIGHT INCOME A 8,450.03 100 8.450.03 3 AMERIPRISE-HIGH YIELD BOND A 16,818.05 100 16,818.05 4 AMERIPRISE- HIGH YIELD BOND A IRA 16,852.38 100 16.852.38 5 AMERIPRISE- DISCIPLINED EQUITY A 11,481.94 100 11,481.94 6 AMERIPRISE- RATE ADVANTAGE 3 ANNUITY 14,127.31 I 100 14.127.31 TOTAL (Also inter on Line 7, Recapitulation) $ I 67,729.71 if more space is needed, use additional sh?ets of paper of the same size. The Personal Advisors of Ameriprise -~ Financial July 9, 201 U Jane Alexander, Esq. 148 South Baltimore Street Dillsburg, PA 17019-1007 Dear Jane, Doris E. Brytz Ameriprise Financial Services, Inc. Financial Advisor Suite 101 11 Triplett CT Dillsburg, PA 17019 Tel: 717.432.7722 Fax: 717.4322424 Toll Free: 800.311.4067 doris.e.brytz@ampf.com Belo~~~ ar-e the accounts and date of death values for decedent Mary• F'ortney. All values are as of 05!04/2010. "f~a F_.xen~.l?t High lncorte A = $8,450.03 Higl_ Yield Bond A = $16,818.~s Hig?~. Yield Bond A LIRA = $1.6,852.38 Disciplined Equity A = $11,481.94 Rate Advantage 3 Annuity = $ ] 4,127.31 Approximate total = $67,729.71 V~'e can handle the settlement of these accounts with our home office for Mrs. Fortney's beneficiary, Jennifer Dise. Please call us with any questions. 717-432-7722. Thank you. Sincere! , Doris B~~'tz An Ameriprise Financial franchise. Ameriprise Fuiancial ~ vi ;c s, r-; ~~ n. ia~ ~ aurp ivi r's. investments, insurance and annuity produc[s. ~ RiveiSouice"-' products are offered by affiliates of Amenpiise Tina ~,~ ;en moo,. ~rw., ~~i~nwer rICVkA and StF'G. /~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER MARY H. FORTNEY 2110-0495 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: '' COCKLIN FUNERAL HOME- FUNERAL EXPENSE 14,127.70 e. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) LORENNA SCHAFFNER Street Address 2204 COUNTY LINE ROAD City YORK SPRINGS State PA ZIP 17372 Year(s) Commission Paid: 3,406.00 z Attorney Fees: J~ jvj. AI. 4,084.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant NONE CLAIMED Street Address City __-- -- __ _ _____. __ __ State ZIP Relationship of Claimant to Decedent 4. Probate Fees: ~ OF L~ 1 •S 305.50 5. AECOUntant Fees:.TOIVFS A~NTIl~ 150.00 6. Tax Return Preparer Fees: ~• THE SENTINEL- ADVERTISING GRANT OF LETTERS 212.30 s. CUMBERLAND LAW JOURNAL- ADVERTISING GRANT OF LETTERS 75.00 s. FILING INHERITANCE TAX RETURN & INVENTORY 25.00 ~o. RESERVED FOR FILING RELEASE 35.00 t 1. NOTARY FEE 20.00 12. TOTAL (Also enter on Line 9, Recapitulation) ~ $ 22,440.50 If more space is needed, use additional sheets of paper of the same size 5,' 1 3; 2030 10:32 c14 F4(Na: Fay: T•J: 502- lOfi 7 °AGE Cocl.lin Funeral Home, Inc 30 N. Chestnut St. Dillsburg, P.A 17019 (717)432-5312 May 13, 2010 Mrs. Lorena A Schaffner 503 Mill Race Rd. Carlisle, P:~. 17013 The Funeral Service for Mary H. Fortney 002 OF 002 r~~,;l ~-~ ~ r ~: y, ~ ~ , ~ .~ ~ ~ ~ L ~` We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOVb'ING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES,AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAILING THE FUNERAL ARRANGEMENTS Professional Services Funeral Director & Staff 3,725.00 ---------------- --------------- ota) Professional Services 3,725.00 Merchandise Y46 Tapestry Rose 6,450.00 Monticello 1 27000 Burial Clothing 140.00 Total Merchandise Selected ----------°---- AT THE TIIv1E FUNERAL ARRANGEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN ACCOMMODATION THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES. Cash Advances Cemetery Charges ? 50.00 Newspaper Notice Harrisburg 165.52 Newspaper Notice Carl isle g 1 80 Clergy Honorarium 1 Op 00 Flowers 215.18 Cemetery Memorial 940.20 Organist 75.00 Death Certificates 60.00 Cemetery Equipment 155.00 Total Cash Advances -------`----"-- ~-~d~'1a ---' SALES TAX 0.00 SUB-TOTAL 14,12770 INITL4L PAYMENT /DISCOUNT: CREDITS 0 00 TOTAL AMOUNT DUE 14,127.70 The unpaid balance over I days is subjected to a U °:° serncz charge per month - 0 % per annum. Page S .O Q'..NC Dr~ A.r~ITI w -~ -~ ~ .;~ ~ ~~Z m, 7o r? ~ N. a y. S ~ ~ D 3 mfr: } r~p_ , ~ u ~ z r. ~~ .r r <W Q? .r ~-' ~. ru, ~. , _, i.; ~~= p - r o. ~,, w, ~. . J 8 W ~ O f SS # 2 ~ ~ O ~:' ~. .: 1. ~ t . ~-V ..:_ rl'he Sentinel www.cumberlinlc.com s r!-tS~'d~ ;A?!hx';~::3:...'.(i ~e;Fy CJtin:Y ATTORNEY AT LAW JANE M. ALEXANDER 148 SOUTH BALTIMORE ST. P.O. SOX 421 DILLSBURG, PA 17019-0421 71732-4514 AD NUMBER PAGE NO_ 384285 1 of 1 BILL DATE SALESPERSON 06/07/10 wolfc START DATE STOP DATE 05/22/10 06/05/10 ~ 384285 ~ ADMINISTRATION NOTICE ESTATE OF MA 10 PUBLIC NOTICES 32 2 cols Publication Insertions Rate Net Amount Gross Amount 3 THE SENTINEL -LEGAL 3 LGL $169.92 TOTAL AD CHARGE $169 92 3 PROOF OF PUBLICATION 01 PRF $7.00 a t_,1"+`J ~ ~ , ~ ,t ~t i 1 ~`\„i Vt Purchase Order EstMaryFortney PAY THIS AMOUNT $176.92 $212.30* *AFTER 07/02/10 Thank you for advertising with The Sentinel! Deadline for in-column legal ads is 4:00 p.m. two business days prior io date of insertion. For questions, call (717) 240-7130. THE SENTINEL c/o LEE NEWSPAPERS PO BOX 540 WATERLOO IA 50704-0540 Ketum this portion with your payment Check # ~ Credit Card ^®^~^^ ACCt #: Ems. Date: m m Name on credit card Signature THE SENTINEL c/o LEE NEWSPAPERS PO BOX 540 WATERLOO IA 50704-0540 Legal Ad Number 384285 Billing Date 06/07/10 Amount Due $ 176.92 ~' "~_ Eta" :'.'r Please make checks payable to: THE SENTINEL oooato ATTORNEY AT LAW JANE M. ALEXANDER 148 SOUTH BALTIMORE ST. P.O. BOX 421 DILLSBURG, PA 17019-0421 THE SENTINEL Go LEE NEWSPAPERS PO BOX 742548 CINCiNNATIOH 45274-2548 ~r~u~i~i~m~~~~n~~~'n~u~~~i~~~n~u~~n~n~~~~~n~~~n.~~ 21540200000003842850000000000000002123000000176924 Cc~t~~1t, ~: ~~ CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717) 249-3166 Fax: (717) 249-2663 June 11, 2010 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legs! publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Jane M. Alexander, Esquire RE: Mary H. Fortney Estate Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on the following dates: May 28, June 4, and June 11, 2010 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 0 .00 Total Amount Due $ 75.00 Payment received by i pennsylVania ~~~~'~11L~ ~ Dc'.^PRTMEN t' OF RE VEN'tIF' i ~E~T~ ~~ LL~EI~E NT H 1NHERIT4NCE Tyr RET!J~N ;MORTGAGE LiABILI`TIES & LIENS RESIDENT DECEDENT ESTATE OF MARY H. FORTNEY FILE NUMBER Repo 2110-0495 rt debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimburs d di ITEM e me -- ---~_ cal expenses. NUMBER CESCRIPT[ON ~ VAIUE AT DATE 1 OF DEATH ' PP&L ELECTRIC ~ 346.19 2. LITITZ MUTUAL INSURANCE- INSURANCE FOR CONDO 47.00 3. EVERLAST WINDOWS- WINDOW FOR CONDO 1,365.00 4• SOUTH MIDDLETOWN TWP- WATER & SEWER 324.90 5. CITI ADVANTAGE- DEBT OF DECEDENT 210.52 6. CITIBANK -AT&T UNIVERSAL CARD- DEBT OF DECEDENT 147.24 7. CITI CARD- DEBT OF DECEDENT 151.62 8. CUMBERLAND GOODWILL EMS- EXPENSE OF LAST I LLNESS 50.00 9• ROBERT CAIRNS- TAX COLLECTOR- REAL ESTATE ~ COUNTY & TOW NSHIP 1,206.59 10. BILL CRESSLER- CARPENTER- (FIXED LAZY SUZY) 125.00 11. JOANNE WITMER-APPRAISAL OF CONDO 300.00 12. WILLOW CROSSING CONDO- MONTHLY FEE 930.00 13. ARLENE BOOK- FOOD FOR FUNERAL 125.10 14. LORENA SCHAFFNER- REIMBURSEMENT FOR ANDERSON- DAMAGE FR OM HAIL STORM 72.76 15. BOSCOV'S- DEBT OF DECEDENT 84.16 16. NORI ~ BILL FOR PACKING UP PERSONAL PROPERTY FOR SALE 600.00 TOTAL (,41so enter on Line 10, Recapitulation) I $ 6,086.08 If more space is needed, i is2rt acditionai ;heels er the same size. PPL Electric Utilities Electric Service For: MARY H FORTNEY 503 MILL RACE RD CARLISLE PA 17013 Final Bill Questions about this bill? Please contact us by Feb 4 at 1-800-342-5775 (1-S00-DIALrPPL) ., or write to: Customer Service 827 Hausman Rd. Allentown, PA 18104-9392 www.pplelectric_com Electric Use This graph shows your electric use over the last 13 months. Types of Meter Rea dings: Actual - Adjusted Estimated Customer Q n ~ ~ 6Ut~$SI~?Aca'AitHi:~F~HltHBe'r ~: page 1 53820-82005 ~ _ .:EJbG tv#i£trcall~iti~4r WfJ1~ltt Summary Page ,. ,~~ ~~ ~, Balance as of Jan 14, 2011 ,~A~'~' $67.51 a Char es: Tota~PPL Electric Utilities Charges $26.68 Total Charges $94.19 .: ;. .... ::'T-fits; A,>mot->a~a~ ~ ~atciK<~1~H, ~'E~i _ A ~1111G ~p ~ Account Balance $94.19 48 40 32 24 16 8 0 KW H -Average Per Day Meter Reading Information Meter #84509476 Jan 14 Actual 2087 Jan 3 Actual 1900 11 Da s KWH Billed 187 Average -Jan 2010 2011 Tem~pperature KWH P D 3lF Z6F er ay 44 17 Yearly Use: Total Average Use Monthly Feb 2009 -Jan 2010 12253 1021 Feb 2010 -Jan 2011 4090 341 F M A M J J A S O N D J F 2010 Months 2011 Other important information on back ~ Return this part to address below with a check payable to PPL Electric Utilities Corporation .. ... .P :'its {l~a?iiiuc..... 53820-82005 Feb 4, 2011 $94.19 Amount Enclosed AV 01 008491 67880A 40 A" 5DGT ^ ^ ^ ^ ^ ^ ^ MARY H FORTNEY 503 MILL RACE RD CARLISLE PA 17013-2574 PPL ELECTRIC UTILITIES 2 NORTH 9TH STREET RPC-GENN I ALLENTOWN PA 18101-1175 ~Inli~~lt~~~lllirllll~lil~lll~url~~llill~lltl..l,l,,.li~„e.i 1 850000094],950^00094199 5382082005 a Page 1 _ - _ - Y._eur Bftl tixe,oi3tfr;~pn~E~cr ~ PPL Electric ~ X3820-820015 Ut.~ities '" - f ~3C lS~3C8:~C~S1~7ifi;'4?F Y/II Electric Summary Page Service Balanre as of Jun 3, 2010 $66.05 For: MARY H FORTNEY Char es: Tota~PL ELECTRIC UTILITIES Charges $69.59 503 MILL RACE DR CARLISLE PA 17013 Total Charges $135.b4 '~his.ltintetl>~af ~n~a#~r:~a ~la[In:3~x ~(#~~ <$~~~;. Account Balance $135.64 Questions about this bill? Please ~ ~`~ ~,, ' contact us by Jun 24 at 1-800-342-5775 PPL I DI , ~ , <, ~~ ~~~ ) r A (1-800- R~ ,. or write to: . ~ `'~1~' { Customer Service ~ 827 Hausman Rd. ` Allentown, PA 18104-9392 www.pplelectric.com Electric Use This graph shows your electric use over the last 13 months. Types of Meter Readings: Actual - Adjusted Estimated Customer 60 50 40 30 20 10 0 KWH -Average Per Day J J A S O N D J F M A M J 2009 Months 2010 Meter Reading Information Meter #84509476 Jun 3 Actual May 4 Actual 30 Da s KWH Billed 948 483 465 Average -Jun 2009 2010 Temperature 62F 17 65F 16 KWH Per Day Yearly Llse: Total Averagge Use Monthly Ju12008 -Jun 2009 15203 1267 Ju12009 -Jun 2010 9570 798 Other important information on back ~ = Jul 2 ~1uuJtiubbivu Yil~c~ auu ~~, vl~,cb. additiolncabou t$8 00 of th s b 11 pays the PA GrossoKece pts T~es. In For your convenience, you can now pay your bill using your Visa, MasterCard, Discover, or ATM Card. Call BillMatrix at 1-800-672-2413. BillMatrix will charge your credit and ATM card a service fee for making this payment. Before digging-around your home or property, you should always call the state's One Call notification system to locate any underground utility fines. You can do this by simpl dialing 811, which wtll connect you to the One Call system. Be safe andycall 81I before you dig. With paperless billing, you can receive and pay your PPL Electric Utilities bills online. The process rs free, quick, convenient and secure. To learn more or sign up, visit www.pplelectnc.com. P~Electri~ iJtilities Electric Service For: MARY H FORTNEY 503 MILL RACE DR CARLISLE PA 17013 Questions about this bill? Please contact us by Jul 23 at 1-800-342-5775 (1-800-DIAL.-PPL) .. or write to• Customer Service 827 Hausman Rd. Allentown, PA 18104-9392 www.pplelectric.com Electric Use This graph shows your electric use over the last l 3 months. Types of Meter Readings: Actual - Adjusted Estimated Customer Tc1Qr f ~ f': 4 ' t Yvur $iH:ii,;bt,6i#nt:Nufn6er . E ~ ~ 53820-82005 ~ ~ ;~::: ~ ~#saacatli .'ar.~~i i - i ;t ~ Summary Page r~t ~ ~~ -~ ~~ ~~:. <___ Balance as of Jul 2, 2010 `" 'i $0.00 Charges: T otal PPL ELECTRIC UTILITIES Charges $17.50 Tota) Charges $17.50 .. "~. At~>~ia~ J~~. lcr.:>E~aH:::lI~aE ~~,. ~8~~1. _, .... <: '7 : Accotmt Balance .: : . $17 50 60 50 40 30 20 10 0 KWH -Average Per Day Meter Reading Information Meter #84509476 Jul 2 Actual 1017 Jun 3 Actual 948 29 Da s KWH Billed 69 Average -Jul 2009 2010 Temperature 70F 74F KWH Per Day 20 2 Yearty Use: Total Average Use Monthly Aug 2008 - Ju12009 14926 1244 Aug 2009 -Jul 2010 9061 755 J A S O N D J F M A M J J 2009 Months 2010 Other important information on back 3 Call system. Be safe andcall 817 before you dig With paperless billing, you can receive and pay your PPL Electric Utilities bills online. The process is free, quick, convenient and secure- To learn more or sign up, visit www.pplelectric.corn. Save postage and late charges -sign up for Automated Bill Payment. Close drapes, blinds and shades on the sunny side of your home during the hottest part of the day. It eases the load on your cooling system and saves energy. Infonnation about appliance energy use and tips on saving energy are available through the Energy Library on our Web site, www.pplelectnc.com. Page PPsi~lectrie ~p -"~~ j~.Jf ~- Utilities "' ~ i`~. r ~~:~~ Electric Summary Page ~' Service Balance as of Aug 3, ?010 For: Char es: MARY H FORTNbY Tota~PL ELECTRIC UTILITIES Charges 503 MILL RACE DR CARLISLE PA 17013 Total Charges .........::. Account Balance Questions about this bill? Please contact us by Aug 24 at 1-800-342-5775 (100-DIALrPPL) ., or write to: Customer Service 827 Han~,tnan Rd_ Allentown, PA 18104-9392 www_pplelectric_com Electric Use This graph shows your electric use over the last 13 months. Types of Meter Readings: Actual - Adjusted Estimated Customer 60 50 40 30 20 10 0 KWH -Average Per Day AS~NDJFMAMJJA 2009 Momfis 2010 Yop;I3ilI:tLecs»utt TTiif~6u' s,82o-s2oos 17~e. :sia~cal.:. ~iiri~vrftaii $0.00 $ls.8b $15.86 $1s.86 Meter Reading Information Meter #84509476 Aug 3 Actual 3u1 2 Actual 32 Da s KWH Billed 1074 1017 57 Average -Aug 2009 2010 Temperature 72F 79F KWH Per Day zz z Yearly Use: Total Averagge Use Montlily Sep 2008 -Aug 2009 14721 1227 Sep 2009 -Aug 2010 8404 700 Other important information on back ~ tall system. fie. sale and call 817 before you dig. With pa rless billing, yott can receive and. paY your PPL Electric Utilities bills online. The process Is free, quick, convenient and secure. To loam more or sign up, visit www.pplelectrc.com. Save postage and late charges -sign up for Automated. Bill Payment. Don't set your thermostat lower than normal when you hIrn on your air conditioner. It wlll NOT cool faster. It WILL cool to a tower temperature than you need and waste energy. Information about app_Hance energy use and tips on saving energy are available through the tinergy Library on our Web site, www.pplelectnc.com_ Electric Service For: MARY H FORTNEY 503 MILL RACE DR CARLISLE PA 17013 Questions about this bill? Please contact us by Sep 22 at 1-800-342-5775 (1-800-DIAL-PPL) .. or write to: Customer Service 827 Hausman Rd. Allentown, PA 18104-9392 www_pplelectric_com Electric Use This graph shows your electric use over the last 13 months. Types of Meter Readings: Actual - Adjusted Estimated Customer Q `-_--- I I: 41~e vrl~c.~~sathn~or~~>t>~si~~ Summary Page Balance as of Sep 1, 2010 $0.00 ~~'' ~k, ~C 60 50 40 30 20 10 0 KWH -Average Per Day SONDJFMAMJJAS 2009 Months 2010 \~~~ Meter Reading Information Meter #184509476 Sep 1 Actual 1126 Aug 3 Actual 1074 29 Da s KWH Billed 52 Average -Sep 2009 2010 Temperature 74F 75F KWH Per Day 23 2 Yearly Use: Total Average Use Monthlyy Oct 2008 -Sep 2009 14550 12l 3 Oct 2009 -Sep 2010 7789 649 Other important information on back ~ .,u ~..._ ~...._., .. _ -------------------- Call system. Be safe arid'call 81~ before you dig. ~ _ With paperless billing, you can receive and pay your PPL Electric Utilities bills online. The process is free, quick, convenient and secure. To Team more or sign up, visit www.pplelectnc_com. Save postage and late charges -sign up for Automated Bill Payment. Dish washers use about 13 allons of`hot water per load. That's less than washing dishes by hand Algways use fiill loads on the shortest cycle. When washing dishes by hand, don't let the hot water nuI continuously- Information about ap liance energy use and tips on saving energy are available through the~nergy Library on our Web site, www.pplelectnc.com. Page [ _ Y:ayt~ Bill r~ccaiirii ;IQ,imtxa l PPL' Electric p p 5 ~82~-82(X15 Utilities ~- ' . ae ~ iexi gall' ~rr:K: r;tit Electric Summary Page Service Balance as of Oct 1, 2010 ~-~ For: MARY H FORTNEY Char es: Tota~PL Electric Utilities Charges $18.22 503 MILL RACE DR CARLISLE PA 17013 Total Charges $1822 . :. .: T~s; A>-a~t Vie, ~:attr. itliaH 3,Z,. ~~~tl! :....:: ..:>:... ~~$.~ Accotmt Balance $18.22 Quesfions about this bill? Please contact us b Oct 22 4 5775 at 1-800-3 (1-800-DIAL.-PPL) or write to- Customer Service 827 Hausman Rd_ Allentown; PA 18104-9392 www_pplelectric_com Electric Use This graph shows your electric use over the last 13 months. T of eter Readings: Actual - Adjusted Estimated Customer (~ 60 50 40 30 20 t0 0 ONDJFMAMJJASO 2009 Months 2010 Meter Reading Information Meter #84509476 Oct 1 Actual Sep i Actual 30 Ua s KWH Billed 1203 1126 77 Average -Oct 2009 2010 Temperature 65F 69F KWH Per Day 16 3 Yearly L1se: Total Average Use Monthly Nov 2008 -Oct 2009 14237 1186 Nov 2009 -Oct 2010 7374 61 ~ Other important information on b;~,~j,~ ~ _ ___ ___ _____________ -~tnd uti[~~y ~....~. Z .. -' _ -~ ....~. A .: y .. ~~.. ~ ..aa ..r i i, rv ~i..,.i w iii ~~.,.u~.;ct you to the One Call system ~ Be safe and'ca1181 ~ before you dig. With pap erless billing, you can receive and pay your PPL Electric Utilities bills onrine. The process Is free, quick, conveiuent and secure. To team more or sign up, visit www.pplelectric.com. Keep limit bulbs and fixtures clean. Dust and dirt absorb light and can reduce light output by as much as half. Save postage and late charges -sign up for Automated Bill Payment. Information aboui appliance energy use and tips on saving energy are available through the Energy Library on our Web site, www_pplelectnc.com. KWH -Average Per Day PPL Electric Utilities Elects Service For: MARY H FORTNEl' ?03 MILL RACE DR CARLISLE PA 17013 Questions about this bill? Please contact us by Dec 22 at 1-800-342-5775 (1-800-DIAL-PPL) or write to: ~~ Customer Service 827 Hausman Rd Allentown, PA 18104-9392 www_pplelectric_com Electric Use This graph shows your electric use over the last 13 months. T of eter Readings: Actual - Adjusted Estimated Customer YtYds;hill>tceiiiiptNiifl~ber ,.. j s ~g2a-s2oas t • _h3e iau: ~alhtc~iir writiire. ':, f ; ,f Summary Page ,~ ~- ~ Balance as of Dec 1, 20111 $18.09 Char es: T ~ l ota ectric Utilities Charges PL E $31.65 Total Charges $49.74 Tom, ~Plliit!tI1~B#~ 1~~' I.~klfef,fL~H ~t'~E 22~ :~~{I ,. > ; . . ? _ Accoturt Balance $49.74 KWH -Average Per Day 60 SQ 40 30 20 t0 0 DJFMAMJJASOND 2009 Months 2010 Meter Reading Information Meter #84509476 Dec l Actual Nov I Actual 30 Da s KWH Billed 1451 1279 172 Average -Dec 2009 2010 Temperature 47F 44F KWH Per Day 26 6 Yearly Use: Total Average Use Monthly Jan 2009 -Dec 2009 13613 1134 Jan 201 U -Dec 2010 6286 524 Other important information on back ~ Bi1lMatrix w111 charge your crews au.r t~ ~ rvi .,n.u n ~t.t ~ rw i.-~ -.~- ---~-•---~ this payment. Before diggin around your home or~property, you should always call the state's One Ca~ notificatron system to locate any underground utility lines. You can do this by simply dialin 811, which will connect you to the One Call system. Be safe and ca1181~ before you dig. With pa erless billing, you can receive and pay your PPL Electric Utilities bills onlPine. The process Is free, quick, conveluent and secure. To learn more or sign up, visit www.pplelectnc.com. Brighten your holidays safely. Check 1i t strin s before usin to snake sure cords and plugs are intact. Tum olnside ~ohday lights ~efore you go to bed. Save postage and late charges -sign trp for Automated Bill Payment. 1"~~` 1 ______,.--. I'vur Sili::A~cw3-stsl~iufnbe~'> _ PPL Electric ~ ~ i s;82o-s2oos Utilities '° ~ "' >t7ae.v,~lea~a11~ (i~:yrF Electric Summary Page Service Balance as of San 3, 2011 $0-~ For: Charges: MARY H FORTNEY Total-PPL Electric Utilities Charges $67.51 503 MILL RACE DR CARLISLE PA 17013 Total Charges $67.5 ] .......... .:...:'Tlhn~'Am~iiat~.~ 1~~_ L~fer.>tL~>g: ~~h ~, ~fl~ i.: ...: ,.; 9r6~.~~ Account Balance $67.51 Quesfions about this bill? Please contact us by Jan 24 atl-S00-342-5775 (1110-DIAIrPPL) or write to• ~~ Customer Service 827 Hausman Rd. Allentown, PA 18104-9392 www-pplelectric-com Electric Use This graph shows your eleclnc use over the last l3 months. T of eter Readings: Actual - Adjusted Estimated Customer li .~~ c ~~ t \ (~- ~ u r \ ~ ~. (~ °°'JJJ ~l ~-fir KWH -Average Per Day 60 50 40 30 20 IO 0 J F M A M J J A S O N D J 2010 Months 2011 Meter Reading Information Meter #84509476 Jan 3 Actual Dec 1 Actual 33 Da s KWH Billed 1900 1451 449 Average -Jan 2010 2011 Temperature 32F 30F KWH Per Day 47 14 Yearly Use: Total Average Use Monthly Feb 2009 -Jan 2010 13287 1 l 07 Feb 2010 -Jan 201 l 5168 431 Other important information on back ~ - - - -_-.. _,.. ___. ._-. ,~iES-l'7ii1; l'_.7fii Ial.•~~.~ r.-: j---- :--------- You can do this by supply dialuig 811, wtucli tvillt connect you to the vile Call system. Be safe and ca1181 I before you dig. With paperless billing, you can receive and pay your PPL Electric Utilities bills online. The process is free, quick, convenient and secure. To learn more or sign up, visit www.pplelectnc.com. A fireplace.can lose more heat up the chimney than it provides. Glass doors and fight fitting dampers help reduce heat loss when you are not using it. Save postage and late charges -sign up for Auptomated Bill Payment. aaoilablei hr ughtthe~ne gy L b~ry on oudrtWeb sitevnig energy are www.pplelectnc.com. z G~ O O f ~0 0 0 w ~~~~ N~r~ ~~~ m i ~rn ~ no ~ ~ 2 ch ~ ~ aN ~- O N V w ~ U ~ 7+ r ~ r ~z r ~ :~ d z o ~- --~ V ~ -.] ~ ~ ~~oa E-+ V O E+ --~ w oa ~-, ha F anaa ~ ~ ~~,. ~z 4 v; ~~ ~~ ~~ u- O ~~ 2 Q Q w J ~ a ~¢ wa ~z ~a Z oa ~~ Q~ J ~ W> m~ W U W W ~ J W n 01 ~ ~ r--I ~ ~ 00 ~~ ~-' \ \ ~ ~ •--I ~ N r-i N \ \ ~ CO Ql M O r-i O r-i w f-- QOq FAQ x c~= a a ~ z Zz ~+H w _ °~ 'Q '¢ a in: ( j w ~ a Aa '¢ `r' 'Q z w ., Boa ~~ a m y ~vaw ~ ~ zo~~ ~~ h a ,~ ~° aaMa 0 o.~ 3i V O~ A ~ ~-- r'wOV~i °~ etyma `<D ~~Z~ r- ~ i a D o.a~ ~ N ~ ~mn m~a~ ~~ Z 0 a 7p O nZ~ .r' _ -C x o ~ \ a a'~o ~Q~ \~rn ao - o ~+ o W o z. F~ aM O W Q x N O W a H z c x~aa ~+~w acne Boa a -maw Hao~a a-aMa w3~V N i M r-i 0 .--i a~~wa ~ o ~? m c~ ~~ wa -' __ ~ ~ rn `~ ~i O w O m r LJ1 0 .. 0~ n,i rti r r w 711 J~,.i ,~ o n N ~` N ~ ~ d } v+ 1 ~ ~ ~,~~~ o+-~~J r~~_„-~a+•.:,,., : 7-f ^._ i'i P'.+......,;~. Y1.34J l-~ fiu°~LDHLfS South Middleton Township Municipal Authority 345 Creswell Drive, P.O. Box 8, Boiling Springs, PA 17007 (717) 258-6476 SERVICE ADDRESS ACCT. NO. METER ID # 0 61 C METER READINGS CURRENT PREVIOUS TOTAL GALLONS USED METER # 1 ~ METER # 2 SERVICE UNITS GALLONS CURRENT TYPE BILLED BILLED CHARGES WATER 3,000 28.00 SEWER 80.30 PAST DUE ALL PAST DUE AMOUNTS DUE IMMEDIATELY UPON RECEIPT CREDIT METER # 4 METER READING KEY A =ACTUAL E =ESTIMATED ~.~~ I JU TTT ;,l . , 'r j ~r TOTAL BILLING PERIOD DUE COVERED 28.00 FROM 80.30 TO ,....- - -- - PAY NET BY': DUE DATE` PLEASE SEE ADDITIONAL IMPORTANT INFORMATIOI ON THE BACK OF THIS BIL METER READING UPGRADE-Over the next few years, SMTMA will be upgrading the water meter reading system to a radio frequency reading system. This technology will allow meters to be read more efficiently and accurately. Customers with newer compatible meters will notice the addition of a small transmitter box being installed on the outside of their home or business which will send the meter reading remotely to our receiving equipment. Customers with okler meters will be contacted by our staff to schedule a time for replacement of the existing meter and addition of the radio transmitting equipment. RATE INCREASE-This billing reflects a 10% sewer rate increase for all sewer customers. This increase was approved by the SMTMA Board beginning with April 1, 2010 services. HYDRANT FLUSHING-SMTMA staff will be flushing water mains and fire hydrants during the summer months as part of the annual water system maintenance. If flushing is being done in your area, you may experience cloudy water or air released from your faucet. This discoloration or air in the lines is temporary and will clear as you run the faucet. This maintenance causes no safety or health related effects on the drinking water . METER # 3 .._._.. ....... .... .. ~ .-.. .ri.. erl Yi iA.`y South Middleton Township Municipal Authority 3~J (:;ris+~a;fl_Urlv~, P_U_.f3ox _8, Boiling Springs, PA 17007 (7i7} 258-6478 SERVICE ADDRESS 503 MILL RACE ROAD, CARLISLE AccT. Nta. 00908610 METERND# 06381478 METER READINGS METER # 1 METER # 2 METER # 3 METER # 4 METER READING KEY CURRENT 385 A 0 0 O A=ACTUAL E =ESTIMATED PREVIOUS 385 A 0 0 0 TOTAL GALLONS USED SERVICE UNITS GALLONS CURRENT TOTAL BILLING PERIOD TYPE BILLED BILLED CHARGES PAST DUE CREDIT ~ DUE COVERED WATER 28.00 i 28.00 FROM 07/01 /2010 SEWER 80.30 80.30 To 09/30/2010 11 /02/201 ALL PAST DUE AMOUNTS DUE IMM • 119.13 PAY NET BY " ' ' ' DUE DATE Y UPON RECEIPT I 108., ~~~.~ ~ll ~ ~~f ~ ~ ~~ ~~ t PLEASE SEE ADDITIONAL IMPORTANT INFORMATIOI ON THE BACK OFTHIS BIL METERING EQUIPMENT UPGRADE-Over the next few years, SMTMA will be upgrading the water meter reading system to a radio frequency reading system. This technology will allow meters to be read more efficiently and accurately. Customers with newer compatible meters will notice the addition of a small transmitter box being installed on the outside of their home or business which will send the meter reading remotely to our receiving equipment. Customers with older meters bill be contacted by our staff by either a personal visit or by letter to schedule a time for replacement of the water meter and addition of radio transmitting equipment. South Middleton Township Municipal Authority 345 ~;riswell Drive, P 0 Box 8, Boiling Springs, PA 17007 (717) 258-6476 SERVICE ADDRESS -- 503 MILL RACE ROAD ACCT. NO. 00908610 METER ID # 06381478 ~ ETER READINGS METER # 1 METER # 2 METER # 3 METER # 4 METER READING KEY CURRENT 385 A 0 0 A =ACTUAL 0 PREVIOUS _ -- 385 A p E =ESTIMATED 0 0 TOTAL GALLONS USED SERVICE UNITS GALLONS TYPE BILLED BILLED CURRENT CHARGES PAST DUE CREDIT TOTAL BILLING PERIOD DUE COVERED WATER 1 2$,QQ 2$ 00 FROM . 10/01 /2010 sewER 1 80.30 -10.83 69.47 To 12/31/2010 `i (~= i ~ ~f ~ ~ C__~ ~ ~~ 02/03/2011 ALL PAST DUE AMOUNTS DUE IMMEDIATELY UPON RECEIPT ~~ ~C ~ L. ------ PAY NET BY ~ \ 108.30 DUE DATE PLEASE SEE ADDITION IMPORTANT INFORMATIC 97 47 oN THE BACI< of THIS SI HYDRANT FLUSHING-SMTMA staff will be periodically flushing fire hydrants throughout the township. This process is part of maintenance to the water system to clear sediment from the lines and ensure proper function of the hydrants. If flushing is being done in your area, you may experience discolored water or air released from your faucet. This discoloration or air in the lines is temporary and will clear as you run the faucet. This maintenance causes no safety or health related effects from the drinking water. METER EQUIPMENT UPGRADE-Over the next few years, SMTMA will be upgrading the water metering system to a radio frequency reading system. Customers with newer, compatible meters will notice the addition of a small transmitter box on the outside of their home or business which sends the meter reading remotely to our receiving equipment. Customers with older meters will be contacted by our staff by either personal visit or by letter to schedule a time for replacement of the old water meter and the addition of the transmitting equipment. ~~ service s 41SO OLSON MEMORIAL I'~IGH4YAY~ SUITE ZOO MINNEAPOLIS MINNESOTA SS422-4$1 Y TELEPHONE 763-852-8620 Hours (CT) Fax 877-32b-8784 TOLL-FREE 877-210--9135 July 21, 2010 Account No ************4467 Dear Sir or Madam: Unpaid Balance Reference No $210.52 6395446 ~~. ~1 ,~ ~ ~ ~; -, 1 ~ ~l. 7:OOam-9:OOpmM-TH 7:OOam-S:OOpmF 8:OOam-12:OOpmS Our company represents Citibank (South Dakota) N.A. CITI AADVANTAGE WORLD MASTERCARD. We have learned that MARY i-1 FuFCTNEY, Who Was a valued cuscUlTlei", has EiaSSeu' away. ricoSC aCCEN~ i.JiuGi~~ic5 fivi~i viir Ciici~t a'~iu Oi:r company. This letter is sent to you solely in your capacity as personal representative of the Estate of MARY H FORTNEY. Our client is seeking payment only from the estate of the deceased. It is our client's policy not to seek payment from fami members or survivors or to hold them responsible for repayment of the debt. At this time, we are seeking information regarding the Estate of MARY H FORTNEY. Please call our office toll free at 1-877-210-9135 to discuss resolution of this matter and payment on this account. We are trying to contact the personal representative, the person in charge of the final affairs of the deceased, to ensure tl proper handling of this account. If you have opened this letter and you are not the personal representative, please contac us with the name and address of the personal representative or attorney who is handling the estate. Cordially, DCM Services, LLC *IMPORTANT NOTICE* Unless you notify this office within 30 days after receiving this notice that you dispute the validity of this debt or any poiti~ thereof, this office will assume this debt is valid. If you notify this office in writing within 30 days after receiving this noticE that you dispute the validity of this debt or any portion thereof, this office will obtain verification of the debt or a copy of a judgment and mail you a copy of such judgment or verification. If you request of this office in writing within 30 days after receiving this notice this office will provide you with the Hanle and address of the original creditor, if different from the current creditor. This company is a debt collector. We are attempting to collect a debt and any information obtained will be used for that purpose. Calls may be monitored or recorded for quality assurance purposes. NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION -Side 1 of 2- ~~~~~~~II~+~ ""Detach Lower PoRion and Return wilts Payment"" s ~ ~ ~ O O m m E ~ u c~ ~ o ,... {~~ '°°// p ~ N j 1/1 A E N N E Q Q q O O G v 0 O O u A m g ~ ~ a °' > ? V! - ~ ~ ~ C 7 t 4 /1 ~\iAA ~- N ~n ~ c O V O O O ` W ~~. 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