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Home My WebLink About08-16-11 (2) ~,5056~,J~,05 REV-150Q EX (o~-ii) (FI) j!j fib PA Department of Revenue Pennsylvania OFFI~GIAL USE ONLY --- Bureau of Individual Taxes 'FP~~.`.""`°`k`""~` PO BOX 280601 INHERITANCE TAX RETURN County Code Year P' j f Fiie Number ~ f ~~ Harrisburg, PA 1'7128-0601 R ESIDENT DECEDENT / ' ~ 1 ( l ENTER DECEDENT INFORMATION BELOW ~ r Social Security Number Date of Death MMDCYYI'Y pate of Birth MMDDYYYY 123-30-6713 12/10/2010 07/28/1941 Decedent's Last Name Suffix Decedent's First Name MI SHORTELL JEFFREY P {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 (~ 1. Original Retum p 2. Supplemental Return O ;t. Remainder Retum (Date of Death Prior to 12-13-82) Q 4. Limited Estate O 4a. Future Interest Compromise (date of O Ei. Federal Estate Tax Return Required death after 12-12-82) t~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust f.. 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. ~)113(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 (71'7) 432-4514 First Line of Address 148 S. BALTIMORE STREET Second Line of Address City or Post Office DILLSBURG Slate ZIP Code PA 17019 REGISTER QF LS USE O ,~-~.- ~ ~,,,,,,, i ~ ~rATE FILED ~ r~~l-- L- ~- fi;~, -r-~ ~'o ~~., ~.7 ,;':~ F t=f t Correspondent's a-mail address: Under penalties of perjury, I declare that 1 have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief. it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON SPONSIBLE~OR FI ING RETURN DATE ADDRESS ---~->~~~-~i~ ROBERT J. EDWARD ~ OF 178 FRANKLINTOWN ROAD, DILLSBURG, PA 17019 SIG TURE OF PREPA R O E RES TATIVE - DATE ~'^ -J s A S E M. ALEXAN ER OF 14 S. BALTIMORE STREET, DILLSBURG, PA 17019 PLEASE USE ORIGINAL FORM ONLY ~ ~~~ Side 1 15056101,05 1505610105 '~51~S61,O~n~ REV-150G EX lFl} Decedents Naire: JEFFREY P. SHORTELL Decedents Social Security Nr.imber 123-30-6713 RECAPITULATION 1. Real Estate (Schedule P.) ... ...... .... 1. 2. Stocks and Bonds (Schedule B) ..... - ... 2. 3. Closely Held Corporation, Partnership or Sole-Prcprletore;i~ip fSchedule C) 3. 4. Mortgages and Notes Receivable (Schedule C} ... 4. 5. Cash. Bank Deaosits and tvliscellaneous Person„~I Proozrty (Schedule E) 25,250.31 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. Inter-Vivos Transfers & Miscellaneous Non-Probate Property fSchedule G) O Separate Billing Requested.... 7. 8. Total Gross Assets (total Lines 1 through 7) ....... ..... 8. 25,250.31 9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. 2,225.50 10. Debts of Decedent. Mortgage Liabilities and Liens fSchedule i i ............ ... 10. 6,805.15 11. Total Deductions (total Lines 9 and 10)....... 11. 9,030.65 12. Net Value of Estate (Line 8 minus Line 111.... ....... 12. 16,219.66 13. Charitable and Governmental Bequests/Sec 9113 ?rusts for which an election to tax has not been made fSchedule .I~ .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13! ... ............... ... 14. 16,219.66 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 _ 16 ??. Arr;ount of Line 14 taxable at sibling rate X .12 16,219.66 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 amide 2 1,505610205 ],5056],0205 16,219.66 1,946.36 O REV-1500 EX (FI1 Page 3 File Number nP(_PfIP_rlf~C Cntllt]IP_tE AC~C~rLSS: DEDEDENT'S NAME ____ ~ _____ JEFFREY P. SHORTELL _ _ STREET ADDRESS 4007 SENECA AVENUE ~ CITY _ _ _ STATE CAMP HILL _ PA ZIP 17011 Tax Payments and Credits: i. Tax Due jPage 2, Line 19) (1) _ __ _ 1,946_36 _ Credits(Payments A. Prior Payments 0.00 B. Discount - ___ - - Dotal Credits (A + B ; (2; __ 3. Interest 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) 1,946.36 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOGKS 1. Did decedent make a transfer and: Yes No __ a. retain the use or income of the property transferred .............................._ _................................................... LJ b. retain the right to designate who shall use the property transferred or its income ........................................... ^ :,. 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? .............. ~ 1 4. Did decedent own an individual retirement account, annuity or other non-probate property, which .......................................................................... contains a beneficiary designation? ........... ~ • -••• - ~' A IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES. YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. nor dates of death on or after July 1, 1994, and before Jan. 1, 1995; the tax rate imposed cn 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}j. The tax rate imposed on the net value of transfers to or for the use of the decedents 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)j. Asibling is defined, under Section 9102. as an individual who has at feast one parent in common with the decedent, whether by blood or adoption. ~,i r'y'e-tyG] ~.\-r ~.~i'iGj ®,~ p~~nsy~var~~~ U[PAR?MCN? O~ R[VcNL1E TNNERITANCE TAX RETURR! R,.~IDENT DEC=DENT i WIE~I-L E CASH, ~A.N~f DEPOSITS & MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER: JEFFREY P. SHORTELL 211-0103 n.luJe the proceeds of fitig~tion and the datF the proceeds +,vere received by the estate. All property jointly owned with right of survivorship must be disclosed on .schedule F. If more space is needed, use additional sheets of paper of the same sizt~. Q MBTBank 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Phone 888-502-4349 F ax (302) 934-2955 February 1, 2Q1 I Jane M Alexander Esq 148 S Baltimore Street Dillsburg, PA 17019 Re: E_ state of Jeffrey P Shortell Social_ Security: 123-30-6713 Date of Death: December 10, 2010 Dear Sir or Madam: Per your inquiry on January 25, 2011, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Checking Account Accoujat Number 12882229 Ownership (Nantes o,~ Jeffrey P Shortell Opening Date 11 /01/95 Balance on Date of Deat{a $21,298.11 Accrued Interest $ .00 Total ............................................... $21, 298.11 For further account information, closures and/or reimbursement of funds please call the Carlisle Pike Office at #717-795-1710. We were unable to locate any safe deposit box for the above-mentioned decedent. This letter does not include any accounts in which the deceased may have been listed as Power of Attorney, Custodian of Uniform Transfers, Representative Payee, or Trustee under a Written Agreement. Sincerely, --•, F Tammy Spencer Adjustment Services William H. Wessels since 1986 811 Route I S N, Dillsbr:u~g, PA 1 X019 • Pho~1e 432-2918 • tivesselsuse~car-s.coi7~r Notary Public Temporary Tags 12i20i10 To whom it may concern: The 2006 Chrysler PT Cruiser owned by Jeffrey P Shorteli appraises for $3875.00. Sin ely, Mark eal William H Wessels Used Cars Inc. John Hancock Llfe Insurance Company (U.S.A.) Post Office Box 111 Boston, Massachusetts 02117 JEFFREY PAUL SHORTELL 4007 SENECA STREET CAMP HILL PA 17011 POLICY NUMBER 064113298 S056125 ENSURED JEFFREY PAUL SHORTELL PAYEE JEFFREY PAUL SHORTELL STATEMENT OF CHECK] 0 3 1610 8 3 CHECK NO. 820- 50316108 CHECK DATE 10-11-10 AMOUNTS DUE AMOUNTS DEDUCTED A DIVIDEND 39.83 TOTAL DUE 39.83 TOTAL DEDUCTED CHECK AMOUNT 39 ED. 2010 Y~ i~ r° ~. '~.. john Hancock Life Insurance Company (U.S.A.) o-s.3 CHECK NO. 820- 5031610 21? :DST CTR. L. C. OFF. AGY AGENCY NUMBER AGENC AIT BATCH TRAN POLICY NUM E CHECK DATE DOLLARS 060 0:1 0:00 HAWAII 503161083 146 802 064113298 10-11-10 ~-***~:3.9 ~ 'M ~i 4.:... ~ .Y...• **~~~~~7~'~~~*~~~~~ ***~EXACTLY T HIRTY NINE DOLLARS AND 83CENTS*`*~***~~':*~*~~~*~~~*~~*~ :. . - ;::4:. PAY T~O : J E ~Fi.F Rr~E ;~ ~ z~''A ~~1 : S~H 0 R T E~,L`~L - ~ . : ~ ~ ~ - ~ ~' . ~ Cx~14~., 4007 ~EN4~ ST'REE'T ... ~ ~ ~._~ _..: ~-- 4 CAMP ''~I I L L~ ' ~ ~ P A 17 '011 JPMorgan Chase Bank, N.A. Syracuse, NY ~~ w rite O~,l~ R. (r~.. u•O 50 3 L 6 L08 3n• i:O 2 L 309 3 79~: 8 ~ 108889 71I• ~'~` wW~ r '~`i r W r' ^^ ~! LIl ; W p ,d a. ,Y ~ o O~ ~. (D ~. O.. (D;. 'o m m x m S ~' CD m a. (~,~ O O 0 0 ~ n 0 C~:~~ o. . ~-; << ~ ~ a ~ ~`~ O~ ~ ~ r ~ `~ o d ~ ~: .b ~ ... cD~ N ;, a:, ~ ~ ~ ~ ~ . :, ;. b ~,' v Vin, N' ~0 Off: CI1 r-u O S t - .. .. ~ 1 T u - `~ ~ ~'. 0 3 e .. ,. i Et fL S - ~ ;_ --. PLJ . ,_~ . (~ W i ,. _O ~ ~ r; ~. <N ~ C RJ ~ : _ f ` 1 ~TgF~i~i ~,~ ~ : C ~y ads O D `o < '1 . ~~ ~ V 's f #-: E '" _ *, * ' A s ~ e. j~T Y ;~. t ri r~~h, F . - ~ - rt W.! ~ ...7 U ~ ! r ~~. j ... ~i, Y _ r. ~EDULE r pennsylvania DEPART Mr_NT (7F REVENUE ~ F>~NERA~, E~CPENSE~ AND INHERITANCE TAX RETURN ~ ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER JEFFREY P. SHORTELL 2111-0103 Decedent's debts must be reported on 5chedufe I. ITEM ~ ~- Ni1MBER i)E~CRIPTICIN AMO!!NT A. FUNERAL EXPENSES; 1' PRE-PAID ~ j i( , a. ADMINISTRATIVE COSTS: 1, Personal Representative Commissions: 750.00 Name(s) of Personal Representative(s) ROBERT J. EDWARDS Street Address _ 178_ FRANKLINTOWN ROAD__ __ __ _ ___ ______ City _DILLSBURG _ State _~A__ ZIP 1701.9 _ _- Year(s) Commission Paid: _ 1,260.00 2. Attorney Fees: I 3. Family Exemption; (If decedent's address is not the same as claimant's, attach explanation,} Claimant N/A Street Address _ I City __ State . _ _. ZIP -- - __-- -- , Relationship of Claimant to Decedent ~ 141.50 ~. Probate Fees: 5, Acr_ountant Fees. 6. Tax Return Preparer Fees: l ~~ REGISTER OF WILLS-CUMBERLAND COUNTY- SHORT CERTIFICATE ' 9.00 8. WITNESS FEE- AMY HAMBRIGHT 25.00 s. NOTARY FEE- AMY HAMBRIGHT 20.00 10. REGISTER OF WILLS- CUMBERLAND COUNTY- FILING INHERITANCE TAX 15.00 11 CLERK OF ORPHANS' COURT, CUMBERLAND COUNTY -FILING RELEASE 1 5.00 TOTAL (Also enter on Line 9, Recapitulation) ~ $ 2,225.50 If more space is needed, ~~se additional sheets of paper of the same size. - ---o -- y~ _ ~ ~ Q V O m ~~ ~~ ~ r ~ T ~ C ~ ~ m ~_ n 1 `fi e~+ :p Z ~ ~ ~" ~ ~ D v ~~ D Z ~ 2 ^ ~Nw -'Or*'~ ~Y (}~, ~Zmm .'v ~ ~_ ;D~C'1r F, r {A ~ ~ ~ m 0 ~ ~ a D ~' - 01 ~ m 7~ .. ~- O ~ w ~ ~ ti ~: O ~ ~ ~ r ~- O ~ , ~~ .. °' cT~ ru ~.~ rv ~ , u~ r r w w w `- ~~ F ~ V } Q ~ ~ i i t E 1 ! ~ ~ i i .~ i ~ w~^ ~/ 1 ~ Cr1 ~ y ~ ~ ! ~ '~ a ~ mores ~ O ~~ -_ ~ _ o ~ ;-_ ~~PY JEFFREY P. SHORTELL ESTATE ROB EDWARDS EXEC 178 FRANKLINTOWN RD. DILLSBURG, PA 17019-9764 /1 Pcrv to th.e ~, order of _ . Citizens Bank 104 t (_ 3 3-?u 15!360 Date x s _~ I Gri~~~~..:~ T pF~a.....~~ F ~ , _ -- ~_~ ~ - -- i~'000 LO 4n' ~:0 3 60 ? 6 L 50~: 6 2 2 5 ~, 4 3 3 3 2~~' ~, ~ ~ ~,~ . ~~~ `'~~~ 1un.lcu ~,Y.. O 0 r O .. O w O r O ~~ ~~ Q' ! ~ LJ'1 r r ~ < < j ~ W A W r i I W ~ ~ r1.~ I °. } '~ i ~ 4 t i i I i ~ ~ i ~ f i i j '. J i :~ ~~ ~~ v~ .:i -i ~v nm C ~~ ~m 3 ~ mYj' zc m mZ -x-10 -1~ -~ '~ O m 7D ~~ n n ~O ~ O = `~ N m m ~ ~. a v rn .~~ 0 O r r ° ~~~ l Z O ~a v~ ~. ,~ m o o cmr, i~ ~ D m O i o~O,rn ~ v~_ m ~ •~ c a=m,~ ' ~r0°: ~ ~.~~ ~o; fA ~ m 0~_= ~' o~yo ~ Q~ i rnm g A~r m ~ (` y D (.~ 1 m co~v ~ pennsyLvania ~CHEDIULE ~ DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT --- FILE NUMBER JEFFREY P. SHORTELL 2111-0103 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses, ITEM NUMBER ~ DESCRIPTION , VALUE AT DATE OF DEATH 1 ~ SHEAFFER'S CARPET CLEANIN- DAMAGE CAUSED BY DEATH 135.68 2. NCO FINANCIAL SYSTEMS,INC- VERIZON BILL- DEBT OF DECEDANT 74.67 3. PORTFOLIO RECOVERY ASSOCIATION, INC- BANK OFAMERICA- DEBT OF DECEDANT 1,800.00 4. MIDLAND FUNDING, LLC- PROVIDIAN BILL- 50% SETTLEMENT- DEBT OF DECEDANT 756.62 5. DEFENSE FINANCE & ACCOUNTING SERVICE- RETURN OF NAVAL PAY- OVER PAYMENT 1,365.18 6. MST BANK- REIMBURSEMENT OF U.S. TREASURY FOR OVERPAYMENT 2,673.00 TOTAL (Also enter on Line 10, Recapitulation) ~ $ 6,805.15 If more space is needed, insert additional sheets of the same size, ;J ~ ~ ^~ t~~ ° ULTRA BRIGHT ~ ~. CA ~''~'~ RPET CLEANING ~, ~`i"t r~ ~'~ (7'17) 732$843 ~~ ~ ~ COM ERCIA - IDENTIAL SPECIALIZING IN CARPET & UPHO~;~TERY CLEANING 5207 TERRACE ROAD, MECHANICS6URG, PA 1;050 TO: Rob Edwards DATE: Jan . 2 4 , 2 01 1 178 Franklintown Road Dillsburg, Pa. 17019 INVOICE#: 11009 .:; `~~~ REF: ;- :;. ::~ ;, .. .,= , DATE DESCRIPTION ? UNIT TOTAL 1-20-11 .Steam clean car etin at 4007 P g Seneca Ave. Shire- , manstown 4 rooms/ hall $128.00 tax $ 7.68 $1 35 ° 68 JEFFREY P. SHORTELL ESTATE ROB EDWARDS EXEC 178 FRANKLINTOWN RD. DILLSBURG, PA 17019-9764 101 ~p r+ ~ ~• ~ ` ^ ^, ~ 3-7615/360 Pay to the ~ ' ~ ~~j° (p~j order of QI~. hU r "~( - d Dollars LJ a:~k~",°'" -r- ~~ Citizens Bank For caro~t cleaning. inYOic~~ l I pOq __ ..______ --______ ^~ il'000 LO fin' ~:0 3 60 ? 6 ~ 50~: 6 2 2 5 4 4 3 3 3 2~i• PLEASE NOTE: PAYMENT IS DUE UPON COMPLETION OF WORK. o -t a Qom` '` °~pr*i ~~ fo L ,r„ ~ w ~ ~ ~ R o ~ ~ ~ m A n _, ~ ~~n~ Cp rt1 r.~. -~ z ~ O ~. TI -• ~ v -~ ~ ~ ! ~ ~' ~ ~ o~x~ ~ r r ~ ~ • ~ 1'U ~ ~ ~ " n m S s i ^^ ~ 6 , ~ Q~ r O .^ Ut r1.1 LJ1 r r w w w ru ~. I i ~l x ~ W '~' i ~, ~~ ~ ~~ ~ ~ d ;~ J ~ w J ? ~ m0'+~ ~ O Uwe -<< o N f ~ re= .re ~,, v yi~4 •~ ~ss.,. .r:%.l ~ _ ...,~~„yi }„ . ,,5, rn d CAD 0 ~, n D N O lJi ~ W N --~ ,z~~~~ ~~~~ .D ~ ~ ~ ~ ~.~~ ~' a '~ ~ Cl~~~pp in Zi ~ a t3, !~ ~ ~ a ~b ~ ~ c ~~ ~ ~ i'~p ~ :~ ~~ N O i?n 4 ~~ c~ ,~ ~ ~ ~~ ^ w ~_ }v{ ~, ~~ ~ o ~ b O ~ r-. d O r~ C Q ~ ~ ~ ~ O i ~ ~ 'd O ~. z ~. a 1 ~~ ~~~ ~ ~ ~ ~~ (~ w (~ ~k d ~~ ~ N A' ~ ~ O~ J r JEFFREY P. SHORTELL ESTATE ROB EDWARDS EXEC 178 FRANKLINTOWN RD. DILLSBURG, PA 17019-9764 105 Lac ~~~, ~ i /~ fi ~ ~ 3-?6 I S/360 Pay to the ]~~ order of ~~r'T :'~ C..1 ~o ~ ~~Q~ ~.~1 ~a L-i~l..r I 4~ 1 ~ c.~ooe R ~g W Sacu•1~y Faa~.•ea ~ ~~ J Dollars ~ Oele~la on Back Citizens Bank For. ~' ~ ~ ~-3 iq 4 x-4-10 i dt~S3 034- ~ _~~~-- _-.- -----____- ~~'OOO ~05~~' ~:0360?6 ~50~: 6 2 2544333 2~~' . x ~4~,rr ~~..~ wu~ ~av1.~,ur.i _ ~r~r~egn uixn, r r J.r l 'CICCrl1 U11fCi dI lU FJI VGZ''UU'f dl' ` ~I :~ *4 ~~ , 't~c~~s to~:guard yo~fr ndnp~bl~c.per~onal~~irt o'r:~~~~on:,` r , ~ , . ,;. _ s r M ~ , 4 :~~~ ~ ~ ~,3X ~ ~ ~~rF`~s~~~~~`~~ debt. collector and ~ ran atfem ~ t t~ collect a debt. ~.~.. ... ~~y, in'~~.r~mm~f#_~bn ;obta~ine:d weal be used fort "at purpose. ,r .~~ ,;~,, nmiamiiiaeumm~aAmwiaiinuiiie ADDRESS SERVICE REQUESTED .. _-~_ First ~lational_Collection Bureau, I~ 610 Waltham Way • Sparks, NV 89434 ~~,~ ~ ~E~1 (800) 824-6191 March 05, 2011 Office Hours: Mon. - Fri. 6 a.m. - 6 p.m., Sat. 6 a.m. - 12 noon Pacific Standard Time **Ple~rse remit all correspondence to the above address** IIII.~1~1~,11~~~1111~~1~'1'~ " " 11~1~~111~11~1111 " 1~1'1~'1~11~~1 21298-9203 #BWNJGZF Creditor: MIDLAND FUNDING LLC ' ~ Original Creditor: PROVIDIAN s ~ #2129806439281694# Account #: MCM-00000000008510006987 m JEFFREY SHORTELL 178 FRANKLINTOWN RD Ref #: 030941968 DILLSBURG PA 17019-9764 Total Due: $1,513.24 This is to advise you that your delinquent account has been assigned to our office for collection by the above mentioned clier Unless you notify this office within 30 days after receiving this notice that you dispute the validity of this debt or an}r portion thereof, this office will assume this debt is valid. If you notify this office in writing within 30 days after receiving this notice tha you dispute the validity of this debt or any portion of it, this office will obtain verification of the debt or obtain a copy of a judgment and mail you a copy of .such judgment or verification. If you request of this office in writing within 30 days after receiving this notice this office will provide you with the name and address of the original creditor, if different from the curren~ creditor. In order to aid your financial situation, as may be necessary, we could set up your account on a monthly payment plan. We would like to extend the following settlement offer: A 60% discount payable in 5 payments of $121.06. Each payment within 30 days of the previous payment. We are not obligated to renew this offer. For your convenience you may pay via a check over the phone or credit card. G"' ~~ ~~e~`Y~'X1~~ C~ JCS C~ You have our word that your account executive will treat you fairly and with respect. Sincerely, ~ `~ ~ ~~ ~ ~ Z First National Collection Bureau, Inc. ~-~ ~ i3(lg(~1 This is an attempt to collect a debt. Any information obtained will be used for that purpose. This is a communication from a d collector. NF P A l N Y ~ BY VISA OR MAST6iGARD, Fal. dJf BEI:OW ~~ .y ~s ul i q 1 []VISA L~ ^ t~ABTEFICAFID Iwl Gib I.A191 0~. DATe wMOlx+r PRINT NAME AS R APPEARS ON CARD N~OMmUiE MUST INCLUDE ZIP CODE FROM STATEMENT ;50 minimum is required for credit card payments. Payment by Credit Cards -Transaction Fees MasterCard and Visa: $5.00 per $150.00 COPY ~ ~- No- 1007 _ C~it~izelns~Ba:n,k : .7815 38 Pennsylvania f (DATE 1 r t ~~~~X,1 ~`T~ ~ .2JO1 PAY'TO THE - ~ '~ I' ~ ~ CJ~: (~~L ORDER 'OF ~ ' `~ -, ~ ~ _ (^ ~ _ "~ ~~ - DOLLARS 8 ~~ ,1 T 1 JEFFREY~P-SHORTELL.~ ESTATE ESTATE OF ' - ROB..EDrVI~'A1;D$? EXEC ~'~' BAL'r~Mb~iE,ST ~ ~ ~ ADMINISTRATOR o Dlll~ R~i`PA ~ 01..9-1007 - M' PERSONAL _ -.-.___..__.~__.---.----- .__ _... _.__._....__..._.___ _._-_..__-__------- -..-.-- -- - REPRESENTATIV FOR ~ LrL - , X .` , . , , .. _ ___.. _. M' TRUSTEE ~~~ ~ 0~0~~-iac~~ .____----._.-.----.-- ._ _ .__. -__ . __... ___.----------.- . li'O'O~:L00?Il' x:036076 L50~: 6 2 2544333 2n' . •1•willll•N~AII!•Pil~IIR1Yi1111raiGfT'7 - _ _ _ __ i~ O ~ ~ D -~ m O ~_ '~' ~.M '~'w .~,.~ ~'VI c~ ~r O Q ~; r -v`~.. . a.o~, ~ ~1 ~+ ~ m.' O o~~. . 0~ ~_ ~ ~ . j ~ ~"] V •^ W Q ~ ~ y 1~1 ~ "~~ .~ r U'1 O • • nJ /~~ t 1 r\ RJ i ~ _ r ~ - r w w ~ ~~ ~ : ~ ~ 3 ~ . ~ .~ i i i j ,~ ~~ ~~~ , ; ~ ~ . ~. . i. ~ i ~v m >m ox m ~ m0 m ?A O C m D Dr I - D~ m ~ -~ m:~o v~~. .~D ~3., y0 Q: m r~n n ~• 1. _~ ~~ ~~ ro n ~~ ~ h O = `` N -n m ~ ~p d ~~ -- -'~J~ i r ~~ 1 -- rn ~_ m. fi4 o ,.._ O '' r r D ~o =.. ~ €€ ~ ~3 ~ ~ ~n Z O ~ 0 ~~ 0 CAPY P.O. Box 4650 *** This is an Advice *** ACH/EDI Services Buffalo, NY 14240-9975 (800) 724-2240 Date: Wednesday, March 23, 2011 JEFFREY P SHORTELL ROBERT J EDWARDS 178 FRANK.LINTOWN RD DILLSBURG PA 17019 Subject: Notification of Death /Reclamation Case Number: 33700 Funds Deposited to Account: * * * * * * 8229 $2,673.00 Funds Owed to the U.S. Treasury: $2,673.00 Due to the fact that JEFFREY P SHORTELL has passed away prior to the issuance of the credit, the Treasury of the United States is requesting reimbursement. In accordance with Federal Regulations, direct deposits may not be retained by the beneficiary unless the beneficiary lived through the entire month prior to the date of issuance. Our records indicate that the non-entitled benefits have been withdrawn from the account of deposit or the account has been closed. If you have already returned these funds, please send us a photocopy of your remittance check. If these funds have not been returned, full payment for the balance above is immediately owed to the U.S. Treasury. Please remit payment payable to M&T Bank. A self-~~ddressed stamped envelope is enclosed for your convenience. Please reference the case number above on all co~Tespondence. Should you have any questions about the remittance of the outstanding amount, please call and refer to the case number above. Respectfully, Citizens Bank Pennsylvania COPY ecurirv enhanced document. See hack for details. rvo. 1009 3-7615/360 //~~ ,,~~ (( 319 DATE ~fJl_~I f 1JC% ~ ~ PAY TO THE ~~~ ~~ ORDER OF ` DOLLARS 8 ESTATE OF JEFFREY P SI'IORTELL ESTATE ROB EDWARDS EXEC ~ ~ .~ 148 S BALTIMORE ST ~ ? ^,.~,,.~,.~ ~`j ,/`^~ ~"-`~~ f - EXECUTOR/ DILLSBURG PA 17019-1007 ~ ~~ ~ ~ (~~ ~ ~, FOR ~ ~ ADMINISTRATOR .. 1~ ` f~ _ .. _ .... __. ~, _. I!'~' PERSONAL '(c'T ~ r IC," '~~ ~~ K (`~~ ,;~ ~~-~(/'~ ~ REPRESENTATIVE ` ili . . _ . _ .... ..... .. _ ... .. ~ .. 1NP TRUSTEE Il'00 i00 911^ ~:0 3 60 7 6 L 50~: 6 2 2 5 4 ~. 3 3 3 2n^ ~;~~ ~e~~sy~v~~l~i~i SCHEDULE ] DE~ARTf~+.ENT OF Rr~,rGJUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: JEFFREY P. SHORTELL 2111-0103 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a} (1.2).] 1• THOMAS CRAIG SHORTELL BROTHER 100%RESIDUE 14 FOURTH STREET, CAMDEN , NY 13316-1408 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 (:OVER SHEET, AS APPROPRIATE. II NON TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. N/A B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. NIA TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed, use additional sheets of paper of the same sizE~. +~tt~t zll ~ut~ (~ estttmnnt ®f ~leffrep ~. ~fjurteU I, Jeffrey P. Shortell, the Township of Lower Allen, County of Cumberland and Commonwealth of Pennsylvania, being of sound mind, memory and understanding, do hereby publish and declare this to be my Last Will and Testament, hereby revoking and declaring null and void any rind all Wills and Codicils heretofore written by me ITEM I. I direct that all my just debts and funeral expenses be paid as soon after my demise as may be a~nvenient to the proper administration of my estate. ITEM II. I direct that all the rest residue and remainder of my estate into cash at either public or private, whenever in her/his discretion it may be most expedient for the proper administration of my estate. In the event of such conversion, I authorize my said Executrix/Executor to execute a good and sufficient Warranty Deed to the purchaser of any real estate of which I may die seized, in the same manner and capacity as 1 could if living. ITEM [II . I direc•: that a.ll inheritance and estate taxes be paid on the proceeds of the above conversion and on all the rest residue and remainder of my estate from the residue of my estate prior to further distribution ITEM IV. I then order and direct my hereinafter-named Executor/Executrix to convert my entire estate into ~~ash at either public or private sale, whenever in his/her discretion it may be most expedient for the proper administration of my estate. [n the .°,lent :.f St: i;]' _~~ii': ...., .: t:. ~ _il:i:~:!~t(,~ i1 i;' ::::•. 1 '._:~Ull'; 'L:4 G:Uir1.K lJ ~XC:: Ute a ~O 'J drld sufficient 3Jatranty Deed to the purchase of any real estate of which I may die seized, in the same manner and capacit~~ as I could if living. .Page ~ of 2 ITEM VI. I then give. devise, and bequeath all the rest residue and remainder of my estate including the proceeds of the above-mentioned conversion to my brother Thomas Craig Shortel, per :;tirpes aftd not per capita. ITEM VII. I nominate. constitute and appoint my friend, Robert J. Edwards, as Executor of this my Last ~/ill and Testament. t direct that my Executrix/Executor shall not be required to post bond other than her/his personal assurance for her/his duties as Executrix/Executor. [N WITNESS WI-IEREOF, I, Jeffrey P. Shorter have hereunto subscribed my hand to this my Last Will and Testament, this • __',~__ day of -- -~--~---~_._~- _ 2009. 1 ~' _ _e~'re F?;;Sh e SIGNED, PUBLISHED and DECLARED by the above-named, Jeffrey P. Shorter as and for her Last Will and Testament in the presence of us, who at his request and in his presence and in the presence of each other, have signed our names as attesting witnesses hereto. _-__ residing at ~ "% ~ - ~ ~~._~_ residing~at ... .~: <~ ,j ; ~ , Page 2 of 2