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Home My WebLink About08-11-111505610105 REV-1500 Ex ~oz-~~, ~F~, Pennsylvania OFFICIAL USE ONLY PA Department of Revenue pEV1RTMENTOFREVENUE County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN ~ ~ n PO BOX 280601 ~ ' Harrisburg, PA 1'7128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 195-46-2149 01 /25/2011 11 /13/1956 Decedent's Last Name Suffix Decedent's First Name MI HETRICK STEVEN ! M (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 Return O O 4. Limited Estate O O 6. Decedent Died Testate O (Attach Copy of Will) O 9. Litigation Proceeds Received O 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust.) 10. Spousal Poverty Credit (Date of Death Between 12-31-91 and 1-1-95) O 3. Remainder Return (Date of Death Prior to 12-13-82) O 5. F=ederal Estate Tax Return Required ~ 8. Total Number of Safe Deposit Boxes O 11. Election to Tax under Sec. 9113(A} (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Jacqueline M_ Verney Esa (717) 243-91 ~ -~ First Line of Address 44 S. Hanover Street Second Line of Address C' _ P t Offi e State ...ZIP Code i '--~ - _., .~~: T.,, ~- ~: _.. ity or os c Carlisle PA 17013 Correspondent's a-mail address: Under penalties of perjury, I 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. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS GNATURE OF PREPARER OTHE THA PRESENTATIVE DATE DDRE PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 J 1,50561,0205 REV-1500 EX (FI) Dec:edent's Social Security Number Decedents Name: Steven M. Hetrick 195-46-2149 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 135,000.00 2. Stocks and Bonds (Schedule B) ....................................... 2. " 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 1,370.58 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 0.00 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. ', 0.00 '. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property - __ _. - - 00 0 (Schedule G) O Separate Billing Requested........ 7. . 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 136,370.58 9. Funeral Expenses and Administrative Costs (Schedule H) .................. . 9. 11,968.05 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) .............. . 10. 54,958.38 11. Total Deductions (total Lines 9 and 10) ................................ . 11. ' 66,926.43 '' 12. Net Value of Estate (Line 8 minus Line 11) ............................. . 12. 69,444.15 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ....................... . 13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ....................... . 14. 69,444.15 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 0.00 0 00 (a)(1.2) X .0_ 15. . 16. Amount of Line 14 taxable at lineal rate X .0 45 69,444.15 16. 3,124.98 17. Amount of Line 14 taxable 0 00 0 00 . at sibling rate X .12 17, . __ 18. Amount of Line 14 taxable 0 00 0 00 . at collateral rate X .15 18 . 19. TAX DUE ........................................................ . 19. ' 3,124.98 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C'!~ Side 2 1505610205 1505610205 REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S -NAME Steven M. Hetrick __ STREET ADDRESS 1256 Kuhn Road CITY STATE Boiling Springs Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments _ __ _ 3, 000.00 B. Discount 150.00 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. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. ', ZIP PA 17007 (1) 3,124.98 Total Credits (A + B) (2) (3) (4) (5) 3,150.00 0.00 25.02 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 shall 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. REV-1502 EX+ (11-08) ~ Pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Steven M Hetrick FILE NUMBER 21-11-0268 All 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. ..__~ _____......~.,. s~ i.,:..t:.._n.unnei witH ~~~hr ~t eunrivershie must be disclosed on Schedule F. If more space is neeaea, Insert aaaitionai sneers vi uic Dania ~~«. HUD -1 UNIFORM SETTLEMENT STATEMENT OMB Approval No. 2502-0265 -rr .RMF.NT STATEMENT - A. U.S. ilEPARTMENT OF HOUSING wivli uxnrur u~ v ~L"r""1" 6 File Number: 7. Loan Number: B. TYPE OF LOAN 2 011- - 5 1. FHA 2. FmHA 3. Conv. Unins. 4. VA 5. Conv. Ins. 8. Mortgage Insurance Case Number C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c.)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. NOTE: TIN = T et's Identification Number D. NAME AND ADDRESS OF BORROWER: E. NAME, ADDRESS AND TIN OF SELLER: None AME AND ADD}tESS OF LENDER: Scott Hench Estate of Steven M. Hetrick Joanne E. Hetrick 251 Sheaffer Road Carlisle, Pa 17013 G. PROPERTY LOCATION: H. SETTLEMENT AGENT NAME, ADDRESS AND TIN 1256 Kuhn Rd Jacqueline M. Verney, Esquire Boiling Springs, Pa 17013 44 South Hanover Street Carlisle PA SE~~MENTDATE PLACE OF SETTLEMENT 44 South Hanover Street 03/31/2011 (Sellet'sSignature) Estate of Steven M. Hetrick (Seller's Signature) Joanne E. Hetrick Pa e 1 form HUD-1 (3/86) ref Handbook 4305.2 ~ EASY SOFT, Inc. 2001 Previous editions are obsolete g SELLER'S STATEMENT The information contained in Blocks E, G, H, and I and on line 401 (or, if line 401 is asterisked, line 403 and 404) is important tax information and is being furnished to the Internal Revenue Service (see Seller Certification). If you are required to file a return, a negligence penalty or other sanction will be imposed on you if this item is required to be reported and the IRS determines that it has not been reported. You are required to provide the Settlement Agent with your correct taxpayer identification number. If you er identification number, you may be subject to civil or criminal penalties imposed by law. Under penalties of do not provide the Settlement Agent with your correct taxpay ~ identificadon number. perjury, I certify that the number shown on this statement is my correct taxpay L. SETTLEMENT CHARGES pAID FROM PAID FROM used on rice S 13 5 0 0 0.0 0 BORROWER'S SELLER'S FUNDS AT FUNDS AT V io J 1305. Mar Murra Tax C.011CCwi ~~~- --- - 1 932.00 28 515.4.1 1306. Wave Line Direct Inc. Jud ement 1400. TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section reviewed the HUD-1 Settlement Statement and to the best of my 1rnowledgH~ bsliei; i ' t St~atemen~ ccurate ement of all receipts an CERTIFICATION: I have carefully disbursements made on my account or by me in this transaction. I further certify that I received a copy o Bono Scott H nch Seller Estate o Steven M. Hetrick Oa~YL-'L~i L~~7~L~ Borrower oanne E . Hetrick the undersigned as part of the settlement of Sel er The HUD-1 S ement Statement which I have prepared is a true and acc;irate account of the funds disbursed or to be disbursed this transaction. ~ ~ () 3 / 31 / 2 011 Y uire Date S ement ent Jacqueline M. Verne , sq knowin make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine an . It is a crone to glY imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010. Page 2 form I-ItJD-1 (3/86) ref Handbook 4305.2 ® EASY SOFT, Inc. 2001 Previous editions aze obsolete REV-1504 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. (If more space is needed, insert additional sheets of the same size) Citizens Bank- Account Number 6100114708 Account Title SMH ASSOC INC DBA DATAWORD MEDIA SERVICES Date ened 1/9/2001 Account T e Checkin Princi al Balance as of DOD $1370.58 Interest from Last Postin to DOD $ .00 Account Balance as of DOD $1370.58 YTD Interest to DOD $ .00 *Please note this is the business acct with a tax id number of 25-1828222* REV-1511 Ex+ (10-09) SCHEDULE H ~ Pennsylvania DEPARTMENT OF REVENUE FUNERAL EX TIVEECOSTS INHERITANCE TAX RETURN ADMINISTRA RESIDENT DECEDENT FILE NUMBER ESTATE OF 21-11-0268 Steven M. Hetrick Decedent's debts must be reported on Schedule I. AMOUNT ITEM DESCRIPTION NUMBER A. FUNERAL EXPENSES: 2,485.00 1• Hollinger Funeral Home & Crematory Inc 501 N. Baltimore Ave. Mt. Holly Springs, PA 17065 g, ADMINISTRATIVE COSTS: 1_ Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address ___________ State _. _ .ZIP ..__ _--. -_ _ _ _. _._ _ ._. _.._ . .. City --.._._._ _._.-_--_. _. ___ ._ _. ___ ___ ..___._. _ ._._ ..___.._ _.. Year(s) Commission Paid: _. 2. Attorney Fees: 3. Family Exemption: (If decedent`s address is not the same as claimant's, attach explanation.) __ Claimant Street Address ._---_- ._ _ _.._. __ ...-- -___.___ State _. _ __. ZIP _ __ _ _._ __ _ ,t _________ ___._____.__.__.__._.__. _.---_...__ Relationship of Claimant to Decedent _ .-- 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: ~. Advertise letters of Administration Sentinel $176.92; CLJ 875.00 B. Expenses in connection with sale of real estate hotel-$561.26; Plumbing work $165.00; Mail $59.49; house cleaning $187.90; self storage $58.83; plumbing supplies $88.80; door locks $54.54; gasoline $1230.31;1% transfer tax $1350.00 TOTAL (Also enter on Line 9, Recapitulation) $ If more space is needed, use additional sheets of paper of the same size. 5,000.00 400.00 75.00 251.92 3,756.13 11,968.05 04/22/2011 13:36 7247354836 NELSON TIRE PAGE 02!43 ,~ H~'inge~r Fw,tlrai !f>~r,,. ~ Cranc~olw. (iro. . \J' Wt Nod ~ Seri PA 17E~S • ~ ~ (71~ 4~tr3~3 5i'A~' 4P ~CTIY,ERA,L ta00DS AND S~VIC,ES S~:CT~D w eharSen oro only fol ct>">ac; tte=tn rho you setecred or Ittat: are roqulred If we.ttt~ tegttired by I:w tx by a cemertry Vr crematory to vse any ioem+, *~ wltl flt~1(sir) (}]c it~.9a/1 in 'aytiting bclpgr, iC y~l aclcard a fund dmt msY rpquirr ctt>baitriirtB, such a ~ furletal vMwJng, yru tray have ~ ~r for embalming. You da na have to pay far cenbahn- mgyou did sor appmvc U ~~sre-k+!ctc~d~am to es ' Ictatmtfon ar -nrmcdlatc banal tE we ~ hrv ?Fob e1Ue 3cri3oe ~ ~-~ p~~4 ~ B. ,ve an brtbrr. ~ 1D~t+c O!f chi ~« . ~. /~~c'' i~~s~• ~~~_~~ _ ~.~._ ,_ , , _~ ,~_.. - - ti Fo>R s~vsc>rs s~xcc~o- ~. f~01~~5t~NU sttavrct~ servitra c>r t'inletal ntmtxor/RCaf! ...... s_~e.~ ~airtling .......... . . . .. f Oils prepinrbA of V ~ ~" .. . I 3[Jb'[O"!AL OP PROFBS3100NAL S1~fCTS , . , „A1 S 2 PIACtiJ1165 AND ~RV1f:FS Lke trf (aCtlilids aed .r.eir.s F+r (Vt,eaMOa~'a1trJ ......... s l.lsc p~ CaCilitite and scnrlca for funeral ceremony ...... , .. S tJse of faCi}ice and Servka, fer Ctlr! of equiFmtenr arKt t+erlce, fa- ara~e lcrkz ........ , .... i_.~~. t7rlrCt LLiQ aG GadlWn odtCr dcrt,in8 _ T ctanadae un~'~~..~.. c' . ~ Cf>~ - s_ 'K0~'A)<.1~CHAND~StE 9ELEC)iPD .. . ~-~~ , . , ,8 S~ ~ , G SP~CCfAL GSIA>RG)eS: Ftir'ltrardhtg n! rCRtiliTM OD (i ~1 Homy s_ ' ASCeNit1(~ d'remain, fmm ~~ l t~omwj [trimctliate Ihtrial . Dues Crem ~~, , .. 5 fr~ '"~ - _- 1 SLrg-l~d'1~11L CP SKIM. . ..............C y ~ ~ . , ......... S I A. C~S)<1 ADVANCED ~~ , . SIJH-7CTA4 OF FA , ,A2 = f ~ Cer Crae . ~ ' .:........ . .. ~ ~-,~~ t - 3. ~lVtr]bfOtlvT i:OtJIPFtifF~17i Vehklc to ttanr,f~ rerta-!ns tv Fu+ter3t 1-h~rte i ~ .. ~ lot arxi feed, . , N°9°SP°I~ Nottcee-~kay~T.. 3 ''~ ~ ~ l.or~rl ......... . ~ ~ ~ _~r ~~IK7 Nt1tIM~-Calftoftrnm . , , i ~~/ ~7~ -!' ..... .... . ~ Hr.~ne fGskrx t'.narl~l i 7tllttphonc ~ Tek'stnme ........... S„„__ A~~,~~ ' ...... . . . . ........... s ) ~ ~ -,. `_ Limau arnr . Clergy/MsFS UffcNng ......... .. ~.~.~ ~ rar- .. F ... 1 ...... ~ ~V Q~. C~In(At(~II .. ... ...... ~ ~7 A .. _ . I . .. ~. Police $sgvt ' . - " ~ - . lower ar Or }IOrdl dlslxtaltlr>R 1. ~ ~ .. ~ ....... . . . _ __ lACal ...... .............. 5 ' Floae» .......... ..,...,.......! -~• ... Ir:wi 1~/rlrrgF nr i ~lih SeNtCe CIL1rge . , ........ $~ ... ....... .. S ~ s--4,t ~~? ~ ~ G Itx palllrCtrers 10 Llxal ........................ S Ilia rd~ Ine-r ^~^iR^fL![tit„f .... .... ~ ~~... ~ S~ ~7B-TOTAL O'F AVl'OMOTlYIQ P_Q~$JyT , , , ,A,i ~~~ 5[7B•TOUL dp ADYA~VC~ ....... ,; , ...... , ...D ! `~"7~: 'In'1{h,L OF tIODFI±,~IONAL ~RVt~C:t?t ' t ~ chttge ~ fac our sisvk+a m atrtiining: (+p«yy ~•n *NMraea llfwd .oe npj F A G> ~' 3 ANDA>~CN-~QrIlVE ~r".i~ ~,,.~ ~C (~ d ~ ' ~ ~ ~ ~ y ,.~"""..,'~' .. , ....... ~ ............ ........ ..A s. i . . r I l- ~ ( ~:d( 8. QiARf:F.1mR C~akct..... ........... .....i i (neratl>KOn i --~ ~ i (Dcertrrflrnl Outer burial corttaincr ...... , ...... s„`_ ~ f~r~crtpuo~ ~~iro~letlgettenr ~tde ....... .. ! ' - - M~xV alit( •ers ~ ...' ,.•~~~_ ~- -- ~,,,, , • _ ..,. ._ _.. . rrayort~nde .... ................ S T°^'POMry Save rtarka 5 ~CJMMAIR tDF C7RAltr,,s~ A. ~ofe6aional 5etvicet, F^cllltte! arul Lgclprtrttl, and Auplrnetlvr. fr~tipmcrtl .... . . . ......... . . 5,,,_ 1S. Mctdtandlae ...... . ! C. Spcch I Ghargea ....... . . .......: 3~ 0, ~ ~. 9fiG'I~CMlB ~ ... , ... S ~ y ~ PAID AT'I'tMP. OF (1R A~MYGE3~1'11'~(~ . ,~ ~ t~~, ~A>!fCE DCily ' '~ L~RXfG,~~ C~ .rw~w-.~...._~ w If :ny kw, ce+netery, of o~ematiory mqulr+etrietta have regdrcd the putrh~ae o! stay of ttte Iterne lfatctl alw~e the Inv cx eegaMeereet is nrpialned bl:low, ttnrigl clattirg ... , . , . ~ ... ~ ... ~ . ~ ~ i __ I ~Sree that t fL1ve crwmicxd the kenra o! gdrdc and selectd 1!ilskd RhnuC add fotntd theta to be mrt+ect and tocordinp to the aeeruurSttrmne: l have +ratteBrCCl,1 acknowledge teccipt of a copy of .oti., SrAeemeru o! Fltrcal Goods and Sestiir~l 3deaed. t rtptraent dbe 1 h^*e iuft3clatt lands availahle for payment of the r.+sh price For the gaode and aervlees selected, t al.o agree en of 3~_ wifhlrt dttya. t aRre~t lu be }~ttey and +everally tiablt *tCh anyone eke wha drprs MMv. A hr. ah.r~. n1 ~ rYr mach .uau,uryt IV ~~ !~ y~ 1Ptu be appa~7 to the nnpttld Mlfnee beSlnnfesa day. from the da-c of dift agrocrr-rnt, r apl bro pay to the Fla+eral Dtri.,.~or aII r6aaotwbl ooRt paid by the Fnrxrd rrireeuyr to coiled uaortrtta f o,Pe rtnder tlWlr s Ttlac cola may -nclvdc 1tiCrrxy~' Geer, GdUR Mp isd alter oasts. Atry a1ldiGcami ta:rvicas nr rrrelchandix oedtre3 a remoe~ted afrer the date Of thi! agrrement will he a*t, pas of this trylrertrcnr l&a caa dtereot ertll be setleeted an O+e flml tNll ar anoaretrc. I Cre"ti •.- I ~fiO1~ a) ~ ,.- i ~PtlM.hafCl~ (rJGfna'~t •ttirlCrdl 'ri,.r) m Penmvhnlb A~nml drrrR,~ Awx11dM1 ~ . Rlserll tlhrrlar Y~IlOW hluthtl r~xtQ HI+R CuAOlatr form • C()0 RcvLacd ll4d CUMBERLAND LAW JOURNAL 32 SOUTH 6EDFORD STREET CARLISLE, PA 17013 Tele: (717) 249-3166 Fax: (717) 249-2663 March 25, 2011 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Jacqueline M. Verney, Esquire Steven M. Hetrick Estate RE: Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on following dates: March 11, March 18, and March 25, 2011 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 75.00 Total Amount Due $ 0.00 Becky H. Morgenthal, Executive Director PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1'784 COMMONWEALTII OF PENNSYLVANIA • ss. COUNTY OF CUMBERLAND • Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the Couna Law State aforesaid, being duly sworn, according to law, deposes and says that the Cumberlan Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal '~ 1952 been re ularl periodical for the publication of all legal notices, and has, since January .~, g Y issued weekly in the said County, and that the printed notice or publication attached herd Law exactly the same as was printed in the regular editions and issues of the Bald Ctunberlan Journal on the following dates, viz: March 11 March 18 and March 25 2011 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. " L' a Marie Coyne, Edi or SWORN TO AND SUBSCRIBED before me this 25 of March, 2011 Notary Hetrtelc, gteven M., deed. Late of Monroe Township. ,administrator: Sean Hetrick c/o Jacqueline M. Verney, Esquire 44 South Hanover Street, Carlisle, PA 17013. Verne Attorney: Jacqueline M. y~ Esquire, 44 South Hanover Street, Carlisle, PA 17013. NOTARIAL SEAL DE&ORAH A COLLINS Notary Public CARLISLE 80ROUGH, CUMBERLAND COUNTY My Commission Expires Apr 28, 2014 'die Sentinel www.cumberlink.com c+ua~ s-~~+vse~~c ~r courrr A_ D NUNBER 394885 Publication 3 THE SENTINEL -LEGAL TOTAL AD CHARGE 3 PROOF OF PUBLICATION JACQUELINE M. VERNEY 44 SOUTH HANOVER STREET CARLISLE, PA 17013 717-243 9190 ADMINISTRA' ' ~ ~.~ ~~ ~ ~,~ a3~s 9I~j Purchase Order Est. S. Hetrick pF qp 10 PUBLIC NOTICES ~ 32 * 2 cols Insertions Rate Net Amount Gross Amount 3 LGL $169.92 $169.92 01 PRF $7.00 .. PAY THIS AMOUNT Thank you for advertising with The Sentinel! Deadline for in-column legal ads is 4:00 p.m. two business days prior to date of insertion. For questions, call (717) 240-7130. $176.92 $212.30* *AFTER 04117/11 THE SENTINEL c/o LEE NEWSPAPERS PO BOX 540 WATERLOO IA 50704-0540 Return thls portbn with your payment ~~~--. Check # ^ Credit Card Ad Number _ 394885 THE SENTINEL c% LEE NEWSPAPERS ~ ® ~ ®~ ® ~ i Billing Date 03/23/11 PO BOX 540 Amount Due $ 176.92 WATERLOO IA 50704-0540 Acct ~' Ems. Date ~ ~ ., Name on credit card ~,E~i1~, os~. Signature Please make checks payable to: THE SENTINEL ooos~ JACQUELINE M. VERNEY 44 SOUTH HANOVER STREET CARLISLE, PA 17013 . THE SENTINEL c/o LEE NEWSPAPERS PO BOX 742548 CINCINNATI OH 45274-2548 I~I~~I~i~l~~~l~ll~~~l~l~~l~~i~l~l~l~~l~~li~~l~~l~~ll~~l~l~~~ll 21540200000003948850000000000000002y23000000176929 PROOF OF PUBLICATION State of Pennsylvania, County of Cumberland Jackie Cox, Retail Sales Manager, of The Sentinel, of the County and State afore r~ , being duly sworn, deposes and says that THE SQL, a newspaper { bushed circulation in the Borough of Cazlisle, County and State aforesaid, was es December 13,1881, since which date THE SE1~TI'INEL has been regularly issued in said County, and that the printed notice or publication attached hereto is exactly the same as was printed and published in the regulaz editions and issues of THE SENTINEL on the following day(s): Mazch 9, March 16 and Mazch 23, 2011 COPY OF NOTICE OF PUBLICATION . #DMINISTRATOR NOTICE Letters.nt Administration-on the Estate of STEVEN M. HE~R~CK, fate of the . Townsh~ of MonroerC.umberland County, Pennsylvania, deceased; have bserr9ranted~ta-the undersigned: Al) pg,rson& mowing the~seives.to be; indebted to sa+d Estate wili make 'paym'ent fntnsetlisitteiy, aMd'~frose h>3i~{ng ei~ima wilF present them for - sedlement- Sean Hetrick, Administrator c/o Jacqueline M. ~Lemey . 44 South Hanover Street Carlisle, PA 17013 =.lat~ueline M_ gamey, Attorney.. ~ _ Affiant further deposes that he /she is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statement as to time, place and character of publication are true. and subscribed before me this My commission expires: NOTARIAL SEAL BAMBI ANN HECKENDORN Notary Public CARLISLE BOROUGH, CUMBERLAND CNN My Commission Expires Jan 27, 2014 Notary Public 0412212011 13:36 7247354836 - I I LODE'S I HOME CENTERS. IifC. . 650 EAST HY8t1 STREET CARLISLE, PA 17013 (717) 258-7700 ~- SALE - SALES A: 61710CR~ 15p04d6 09-20-11 . 135343 DURACELL RAR 20 PACK 9.97 85001 ~11EReIZER D 8PK ~ ~ ~ 11.27 .~ 6432 PB PAO,IECT PACK TYLO 34:92 1 SUBTOTgL: 56,16 ~I • TAX: 9.35 IH~OICE 09244 T07RL: 5~J.5q I VISA: 59,54 ' ~ i UISA:XXXXXXXXXXXX4194 AMOUNT:5g.54 AUTHCp:20§530 SifIPED REFID:803996077 03!20/11 13:19:6 TRANSACTION AMT EFFZ#INQ AAL • 59.54 0.00 ! ' t~~~ . SPORE: 1714 TERMINAL: 09 • 0~/'aOlf 1 i3:1B:26 . ~ . ~ iyE ITEMS I~'UR~HRSED : ~~ • -• { EJfCLUDES FEES, SdiVICES ~ AMD SPECIAL ~ ORDER I1'E1fS~ ! 7HRNK YOU FOR SHOpPIMB LODE'S. SEE REVERSE SIDE FOR RETURN POLICY. ! STORE MANAQER: RICH TAOSS HRVE A COMaENT OR FEEDBACK? LET US KN01f RT: • .~..0~[s.c~/FEE~-BAC~c 5T~2E (~IpE: 17100-32011-0244 NE KRVE THE LOIPEST PRICFS~ GUARANTEE! IF YOU FtHR A L061ER PRICE. WE MILL BEAT IT 8Y 103. --- - - `_ - •SE~9RE-f0i}-UEFAIti£~--• ~•~ - --,~-~--~~ I ~i ' YO!!R OP;WOMB COEINT : ~ * R~TSTEA TO VIi4 A 35.000 L011E'S GIFT CARD'. ~ ~ ~ # AE6ISTFR AY I'~1MP1 FTZIVF R F,~i~CT ~ATT~Cat'TTt1m ettancv ~ NELSON TIRE PAGE 10/43 J , ~ ~~ `•. R ~~ •,`, `, LQUE' 3 HOFIE CEtITERS, IN1;, '. 850 f.OST NIQH STREET . CARLISLE, PA 17013 c717) Z~8-noo - SALE r ', ~„,-.~,. ,ALES ~ ~ 51 ~i4W12 ~T565••~-~~02 . a ~ t f 121721 L IPTIWV GREEN TEA PL .-~-4& 1216 PEPSI 20U[ P'L Stil 1.4ri~-T • 11857 KDBALt 10"EX HIDE WRENCH( ~F0.97 . 54946 ~25' NZ-UI5 TAPE 5,~ i2~6 PFISTEA iH GH YISFARY 34:DO ' 45364 4 Ot ND. 5 THREAD SE~.RT 6.9$ 37o~s EMEAetzEta_AA~ _taaa PRCR 7.47 . 10190 PCTER ICKING 10CR FAST R1: i3.28 5U1fTOTgL: 66.64 Iysl8~3L~i3177 ~'DTAL: 91.76 . ~ ~~~ . ~ CA5N : 100.00 CH 8.24 S1`aRE:1710 TERMINRl.:10 OQ1i9,t1112a1?:01 ~ OF ITEMS Pl1RCHpSEU : 8 ExCI,UDES FEES, SERVICES AND SPECIAL ORDER ITEMS Ti~RNK YOU FOR 5HOPPINB LOfdE'S. '~-"w'9~fl~E1{SE°-F9R~pETbt~4L~:CY~:• .. : _ _ STORE ~lANA9ER: RICH TAQSS HAVE A COpIME1~T dA FEEItBRCK? LET US KllObl RT: I~VVW. LOME5.COM/FE~D@ACK•~- STORE CODE: 17100-21911-10777 bE HAUE THE LOiIEST WRICES , S11ARp11TEE0 ! .~ iF YOU tZMD A Lt>MER PifIGE- ME k~iLL 6Et#T IT BY 105. sEE STORE FOR oETRns. _ -`~* `~ w ~ 4 LOYf'S NOME CENTERS, INC. 850 EAST NIGH STREET CARLISLE. PA 17013 1711} 258-7740 LOYE'S HOME CENTERS, iNC. 850 EAST NI6N STREET - _ S Al. € - CARLISLE, PA 1?013 (717) 258-7708 SALES rF: S1I14CR2 1538444E 03-24-11 135343 OURACELL AAA 2fl PACK 9.97 85OOT~ENER8I2ER 0 8PK 11.27 , 6432 P8 PROJECT PACK TYLO 34.92 SUBTOTAL: 56.16 TAX: 3.38 INVOICE 49244 TOTAL: 59.54 VISA: 59.54 UISA:XXXXXXXXXXXX4194 AMOUMT:59.54 AUTNCD:245530 SYiPEO REFID:803996077 43/20/11 13:19:28 tRANSACTION AMT ENDING BAL 59.5{ 0,04 STONE: 1~ERMINAL: 09~ 120/11 i3.1D:28 OF ZTEMS PURCIiA~EO: 3 - EXCLUDES fEES, SERVICES fll>1I! SPECIAL ORDER ITEMS i t f iNAMK YOU FOR SHOPPING LOYE'S. SEE REVERSE SIDE FOR RETURN POLICY. STORE MANAGER: RICH TROSS - SALE ~,,, R ,,ALES N: 517~ODAr.-#07589--~'"'~,02-13-11 121721 LIPTON GREEN TEA 2002 PL ~~ 121650 PEPSI 20Ot PI_ SGL a..48~-- 17851 KOBALT 10"EX YIDf YRENCN( w.97 9484E 25' HI-UIS TAPE 5.98 120896 PFISTER 1N CN YlSPRAY 39:00 45364 4 OZ N0. S TNREI~1 SEAINT 6.98 37073 ENER6IZER..AAA .1tl+.2 PACK 7.47 10190 PLIER LCKING tOCR EAST RE 13.28 SUBTOTAL: 88.64 __ ~ - ..~~_...5.d,2__...._ I! 7 -TiDTAI: 91.7E Q~ CASH 100.00 '~ ~ ~ ' v"' . 8.24 ST1NiE: 1710 TERMINAL: 10 02f13I11 12:12:01 # CIF ITEt4S PUf#>CNASEQ EXCLUDES FEES, SERVICES AND SPECIAL ORDER ITEMS 1 I TNiYlK YOU FOR SHOPPAMI LOYE'S. ,. '...~f~1€ ~R^RfTIr~++POI-~Y: _ ._. STORE MANAGER: RiCN TROSS HAUf A COMMENT OR FEEDBACK? LET US KNOY AT: il.~E~ES.CtFE~tCK STYE t~IDE : 17100-32011-09244 DE HAVE THE LOYEST PRICES, GUARANTEED! If YQU FTND A LOYER PRICE, YE Yll.l BEAT IT BY 10#. _ . __ _.._._ ....SEf~5f8RE FOR- ~HAIIS•: - - ..~ _ , _..._ . _._,_ _, ~ YOI1R OP3Ni0MS tX}IiNT NEBTS'tEN TO 11RI11 R ~. LtiliiE'S BiFT CANtt! x REGISTER 8Y COMPL£tINB A GUEST SATiSfACTION SURVEY ~ } UITHIN ONE PEEK AT: aaa.laaes.Sursurvay.cnA Y O U R I D S 49244 1710 079 NO PURCHASE NECESSARY TO ENTER OR YIN. ~ VOID YHERE PROHIBITED, Ml3ST BE 15 OR OLDER TO ENTER. * OffICIAt RULES 4 YINNERS AT: ~w.loaes.l~rsurvey.coa ~c ~F%tx?t~* ** *: ACS ~#* ~Y *x*?~K~IM~*+~~!*~*~7k*aF"~~7~x**sM~*i~7K****~F is*a## STONE: 1718 TERMINAL: 09 03110!11 13:19:26 ~~ NAVE A COMMENT OR FEEDBACK? LEi US KMOY AT: STO~t~ t:ODE : 171 ~-21911-10777 YE HAVE THE LOYEST PRICES. 6UANA1lTEED! If YOU FIND A LOYER PRICE, YE -zlt BEAT IT BY 103. SEE STORE FOR DETAILS. ~. i~elcome to Rtatter's Farm Store 0055 Welcome o Ru t tens 1455 York Road R o a Q C 11 s 6 Carlisle l ar PennSyl~ania 17 Pennsylvania 015 717"`~~~-5635 A t or a :006 6 ppr:023559 Fuej Prepay Pump 16 F repay Fuel l T t 5100.00 00 $100 Pup No: R e g u l a r, ~ S~ 4 9 91 E V a Sut, a . o use: lb. 62 Gal ' Gas Total: 59..00 -~ - 00 5100 Change . 50.00 XXXXXXX~XXXX4194 Balance : ~ 0.00 l-~i:'W ~G[) 1~~tY~~-iEF~E ELSE 03/2012411 20:2'~i:49 REG#3 CS`~i# ~ i'l 1 I~# t TRAN# 4/212011 2:36:28 P~f ST# 309252 0055 a b a~ r e e t o a y t h e ove Tot Amount (CU~st~r ~ according "Card I suer ASreement . NoNSurchargglebAlM's WHY GO A _'.,_. _ _-- NYWHERE ELSE ~` ~\ \~ I{WIK, FIiiL #388 KWTK k Tll # ~ ~ 9 ~,~ ; ~y ~;1"Al E Rl1UTE 8 I65~J. W. MAIN STf~EET HHI~RISVTLl.E:.PA 16L~38 GPD'lE CITY. f'A 1612? 814-78b-82~Q 724 - 748- 4391 _ __ _ _ .... _ _ . _ ... __ _ .. _ . _ _ .. _ _ _ _ ._ _ _ _ _...._...__._____.. _. ; _. _--.. .. ___ fl19 CA1HlER 9 Store: 4388 2 Sfi 012 CASHIER ore:. 0279 ~~e~,~t~-:° tk fl1. RECeiPt#:b4bi4 ~~~ I3u~ 1 i cater ~~~ ME~T-~C1--+ANT C;C~IF"Y Rey i ~f er "'# 01 : ' . _ Rece i Ff~ : T36"¢~ ,~ t F1~r• 02 2v 1 1 Q4 : 98 : 33 Sat Aer 0? 20`1 24:41.•43 ---_. _ ~3t~triF' ~r Q 1 ~ ~ ~--~ _. _...___.._---- --__-.__ __ _ .. ._ _ . _ - .. 104.OC~ Ft'EPJy AP1olJf~t Pump # 02 FUEL, 1$.16 @ ~ 4.05 14.932 Ga! 1 ons @ ~ REC~~ NO-LEAD ~40 Ofl ! ~F~~t~? UIF.~~EL ~ ~ ~ . l5 .- . 40004flflfl 1007 .. _ _ _ _.. __._.._ f=kLPrIY` f° 1.1{_~. DFPT $ -2h . L~ Sub#elta I ~4U, Qty . _ . 1•ax 1~o fi d ~ ._ . . _ . __ .....:.~.. ~. _... r ._- $0.00 _. ~ _ .. Totaf ~90.~14 Purim # 03 F llEL Cash X40.04 Pr~P~~-~ Amount 1 . Q4 - .___ __.. ___ IHANICS Ft1Ft SC(3PF'INC PLEAS~~ _,_~ 18.$6'..= to ~ 3.bo I~Ni_~:A17E~L~ F2EG~.1t AR ~ 69•C~:S COME AGAIr1 FOR STIi7NS & CUMh1ENT~; ._ .. _._ ~ ~ 3G .9"r f'RC F'i~Y Ft.IE~. DEPT PLERSE: CALL Dee t , 1 OQ 1-800-443-3523 F1tT 9834 _. .. PEPSI DIET ~1.25T;~t - ..- _ - f}1204p40 i 30 t S~:btc~tal ~-55.97 6 . c'su~c $4 . u75 .<tan 1Uf~1 $t~.08 Items 1 ~Tatc~ i ~ -55.89 Cash, ~ -55 , $9 THANKS FOR STOPPING PLEASE COh~ AGAIN PLEASI_ FALL t ~r,~i_443_.3523 Ek.l 9834 KWCK FTC..(.. ~38F3 5574 STATE. ROUfE 8 MARRISV'TLLC,f'A 3~03t~ ~ 14.7D~, - ~2'~,~ Ut ~~ ilS'l f" i a t vre : O,S$8 ~~~ L3u~ 1 i L~~-e ~~~ ' Pe~a~ter• ~ Of. R~~pi~t~:52989 M~RCHgN-T_ COPY ~~, M~ as 2oj ~ a~ : ~ 9: ~ ~ F'REF~A'r Ft1EL DE+'~' ~4C~.4G C1eP t . 1 CCU ` ._------~--` -~~:R~~ f'h'E~'AY RECETPT ~~~ f'R~CiUr1: UNLEAOFD Kfrf~;f_AR P1JMP# 2 ~aO.OQ ~,~tt~ta i X40. Q4 l~3x Tr fal ~v.1t? 1;, t ~~ f ~~r . oG i:a~:;n ~40.4(- Tf-dt~~a FOR STDFf'ZIVG f'L EASE CGh1E i I N FOf? (~E.S T IOfiI F (;~!MENTS PLEA:;E CALj_ t -BOCK--aa3--352~ f°fT ~~3a ` --T I'EMS t _ . _._,~. BankafA~nterica - SEAN Ht=TRICK Account Number: 4264 2927 7211 7111 February 15 -March 16, 2()11 Account {nformation: tLZCti'. hall k4fa CTCPrIi'7:.C; ~)fp Malt bitting inquiries to: tlRCtlt cyC an1P1'if R ~~'ilrnitT~ron, I)E i;)~:,~t:}-;zi.)~:i.) Malt payments to: Bank of America PA. Bc:-x iti5i318 tib'itmin~tntt, I7E: IA~13E'r:i01`? Customer Service: t.iit)f) 3dii~317S 7°Il' Trr~rt,9acticn ,pbstintj Bate Dater New Balance Total .....................................................................3$,612.89 Current PaymenE Due ....................................................................5277.00 Past Due Amount ..........................................................................5237.00 Total Minimum Psyrnerrt Due ..........................................................3524.00 '~, Payment Due Date ........................................................................4/ 12/ it Late Payment Waming: If we do not receive your Tote{ Minimum Payment by •the date listed above, you may have to pay a late fee of up to $35.00. Total Mlnlr»um Payntertt Warnlnt: If you make only the Total Minimum Payment each period, you will pay more to interest and it will take you longer to pay off your balance, Far example: l~vsrrrpk!an Previous t3atar-ce ........................3fi.858,Z8 Payments arxt Other Credits . ...................0.~ Purchases and Adjustments ................563.61 ', foes Charged .................................................35.04 ', trnerest Charged,.. .......................................1.58.00 I t~ew Balance Total ........................38,612.89 ~ Credit Line .......................... ........$24,$00.00 CreditAvailabie ................... ........316,187.11 Statement Closing Date ........ ............3f16j21 Gays in Billing Cycle ....:, ...... ................:.....30 Rerlarancr ACectunt ,Numtstr tVu!r,~berr Amarmt Total l19 02; 21 rrtertts EXXOIWNOBIL 47751 OAL t3llRG P 1591 711.1 71.62 02,122 02,' C R V 1948 711.1 .99 222446438 03n31 U3, 02 WRECKMASTER tNC 566601-2733 NY 8456 71],1 445.00 5733455977 03j01 0302 LISPS CHANGE OF66104959 8042383150 TN 1118 711.1. .1.00 000700290686458 03/01 03!02 LISPS CHANGE OF6fi100959 8002383150 TN 8445 711.1 1.00 000700290687657 5563.61 13 008612840005140D00087500Q~Q4264292772117111 BANK flt= AMERICA P.O, BOX 15019 WILMtNGTQN, DE 19886-5018 Account Number: 4264 2927 7211 7311 __ _ New Balance Total ...........................................................38,$12.89 Total Minimum Payment Due .................................................514.00 Payment Due Date ...................................................04j12`11 SEAN HETRICK Enter payment amount $ 323 GEORGE JUNit3R RD ' GRAVE CITY PA 1 61 27-441 9 Check .here fvr a change o/ mailr•~g acia7ess u~ r~+ona numherrs. ~$g$d J7rC7VJQt4 81I COrIBCI.~Qn5 fJl7 t/1r9 114{R3f$!t $!(/'$. Msil this coupon along with your chunk peyabl• to 8snk of Artmica t.5 240 2 2 2 50i. 08$82??21~?~"r<Ltt• !f you would like information about credit counseling servrces, call 1.86&-300.5238. ~~ ~ ~1?~t ~ ~ tt ~w-e~r~~r~rs~r ~~~~ ~6~ .~~,~''~t`'.3 ''' ~:Cy338i~8~~~" ~D2085~.i6~~~~34 rv https:/lwwtiv. rriidatlanticcorp.org/Phoenix/UI/Accounting/Irnageslimagc.aspx?aba=2433 81... 4/Z 1. /2A 11 REV-1512 EX+ (12-48) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT FILE NUMBER ESTATE OF 21-11-0268 Steven M. Hetrick Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed mediALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER 16,250.00 1• Marital Settlement Agr dated 511/2007 remaining real estate balance to Joanne E. Hetrick pare 2 Marital Settlement Agr dated 51112007 equitable dist owed to Joanne E. Hetrick pars 7 to date of death 8,250.00 2. Marital Settlement Agr dated 51112007 back health ins owed to Joanne E. Hetrick pare 4 to date of deat 1,788.11 3. Marital Settlement Agr. dated 51112007 back car ins owed to Joanne E. Hetrick pare 5 to date of death 1,400.00 4. 2,367.39 5. ' LVNV Funding LLC v. Hetrick #10-2103 judgment 26.04 6. Pa Dept of Rev 06-5926 7,433.50 7. Waveline Direct, Inc. judgment 541.70 g. 2011 Cumberlandcty/Monroe Twp taxes 34.00 g. :Waste Management trash bill 312111 10. 'Aqua water bills 2111111 $302.68; March 2011$59.80; 4114111 $50.77 413.25 245.00 11. Monroe Twp sewer Jan-Mar 2011 12. West Shore EMS-Carlisle 205 Grandview Ave Suite 211 Camp Hill, PA 17011 1,035.18 13. Camp Hill Emergency Physicians P.O. Box 13693 Phila, PA 19101 1,110.00 14. Yellow Breeches EMS, Inc P.O.Box 726 New Cumberland PA 17070 880.10 15. Holy Spirit Hospital 503 N. 21st Street Camp Hill, PA 17011 9,512.10 575.44 16. MetEd 2,996.08 17. Wells Fargo mortgage payments 100.49 18. Penn Waste trash removal 54,958.38 TOTAL (Also enter on Line 10, Recapitulation) ~ If more space is needed, insert additional sheets of the same size. 03/02/2011 12:21 7247354836 NELSON TIRE PAGE 06/22 DECREE IN DIVORCE JOANNE E. HETRICK ......................... Plaintiff versus 5TEVEN NI. HETRICK . ......................... Defendant ~N T~iE CURT tai CC,~~IIIMt~N FLEAS QF MERC~a C~7UNfiY, P~-. ti ~ No. ~ 2004.1403 ~ . ~ r r I 1 Grounds: Irretrievable Breakdown;`., ~ ~,~. . ~ ~'. ~ ~ Q 1 ' ~ ..{ r ~ ~ ~ t1] ~ f '_.~ -.y .t.- ~~ +i 4 ~ 1 r. w .-.1 . ~.•, ~ ~ ~ ~, ~„n (ill ~-R ' ~ 1~ .~~ , ~, ~•~a AND NQ1N, .........~..~~ ..................200.~.1'he Court having heard this case and having fully considered ar~d proceeded to detemrtir~e fihe same as to lave and jus#fce appertain. Da Sentence and Decree that JCaANNE E. HETRICK and STEVEN M. HETRICK be divorced and separated #rom the nuptial #ies and bonds of m~atrir~tony heretvfo~e contract between them, the acid J~A-1'~N~ E. H ETR~CK, the Plaintiff, and the Said STEVEN M. HETRICK, Defendant: And that thereupon all and every, the duties, rights and claims accruing to either the said Flaintdf ar the said Defendant at any time herefiQfore in pursuance of said mvrriage, shall cease and determine, and the said Plaintiff and pefendant shall severally be cat liberty to marry agc~-n in like manner as if they have never been married. The Agreert~tent attached hereto shall be mt~de p part hereof D$ Encarparated more fully of lengfih herein. BY THE COURT: ._ ... -.... __._..._ c2~ ,. COMMC3NWEALTH CAF p1rNNSYLVANiA } } } 1, Elizabeth F. Fair, Prothano#ary of the CQUrt of Common Pleas in and for the county aforesaid, do hereby certify the above and fvregoir~g to be d Prue end correct copy of the decree of sold Court entered in the above onfitied cas~_ IN TESTIN~ONY WHEREGF, I have hereunto sefi my hand and affixed the seal of said Court at Mercer, in said County, t17151~daY of 1''~3' . A.D. 20~? ,- Pro#hono#ary COUNTY OF MERCER 03/02120111I 12:21 ' - li 724735483 NELSON TIRE AGREEMENT Pa~E 07122 THIS A+~REEMENT is made and entered into this day of 2007, by and between: JOANNE E. HETRICK, of GroVE City, Mercer County, Pennsylvania, hereinafter referred to as "Wife", aiva STEVEN M. HETRICK, of Boiling Springs, Pennsylvania, hereinafter refierred to as "Husband"; t~VITN ESSETH 4GATY & SMTTH, P,C. till !.n~nh t;~w~ir Ww>~r F+tRt ARkr ISnx t12'i ~rmrr t:arK t'ennRylvan~ IRt 27 »a ~~;,tt 7ttt~t 1NHEREAS, the parties hereto are Husband and Wife, being married on the 17~' day of May, ~ 9~0; and WHEREAS, .unhaPPY differences hive arisen between ~ltre parties, aid as a result, the parties are living separate and apart; and 1NHEREAS, based upon the previously referred t~ status cif the parties, an action in dissolution in their marriage has been filed at No. 2004-1~Q3 in the Ct~urt of Common Pleas of Mercer County, Pennsylvania; and WHEREAS, the parties have two children to this marriage, both over the age of eighteen (18) years of age; and. WHEREAS, the parties desire to setCle their property rights, economic rights, and any other rights, duties and obligations growing out of their marital status. 03/0212011 12:21 724735483 NELSON TIRE PAGE 08!22 NQW, THEREFORE, for and in consideration of the covenants and promises hereinafter mutually to be kept and performed by each party, as well as far ether gUUCi and valuatale 4~ri5ic~~ratic~r'i, with tl~e intenti~rn to be legally bound hereby, it is agreed as fo[Iaws: F1RST: Each party shaft retain as his/her separate and sole property, without claim of the other, all items of persnna~ property currently in his/her possession subject however fio any contrary provision canfiain~d herein. The parties further agree to sign any necessary documents such as tifiles or bills of sale for property which will became the sole property of the other. The execution of said transfer documents shall be made within thirty days of the date presented to the party who is required to sign the same. SECOND: Thy parties are currently the owner of real estate located at 125b f)GATY ~ SMTTH~ P.G. U)1 G..orh t':.w~..r l..~~ ~ Pma 1'~tllcc Hnx k2; imec C.In; tYnnzylvnMn !Atli 724.45t~ k~~ Kuhn Road, foiling Springs, Pennsylvania, and said praperky is currently titled to them as tenants by the entireties. Wife agrees ~tt~ trdri~fer Pier' title and interest to said real estate to Husband by a special warranty deod upon his payment to her of the sum of $3C1,OCICI.OC1. Payments on the $30,000.00 buyout for the marital real estate shall be made by Husband to Wife in an amount of at least $500.00 per month beginning on the 30,n day of the month in which this settlement document is executed and continuing on a monthly basis with the payment date being the last day of each month until the entire sum is paid. in any event, the entire sum of $30,000.00 shall be paid within five years of the date of the first payment. In the event the amount is not paid in full within the five year period, then any balance owing shall be fully due at that time and shall be assessed interest at the ratE of b°!o per annum from the due date until paid. 03/0212011 12:21 II i~o(;ATY ~t SMITH. P.C• I l11 i++uth Ccn~!K G~+.K Rug U1ftcC UMC tt25 t;n~v~ Gay, I'cnnryh~nia 1~+t 17 72473548:~~ NELSON TIRE PAGE 09!22 ife shat{ execute a special warranty deed transferring 17er intere~~ iri said real W estafie to Husband. I he Deed shall be held 'ln escrow k,y Attorney Raymond H. Boga~. The Deed shall tie turned over to the Husband upon his payment of the Pnfire ~0 OOO.oo sum. Wife shall sign an Autharizatinn t~ enable Attorney ~ogatY to turn $ , hE escrowed nPP~ over to Husband when she has received full payment. The parties t further a ree that if in the event Husband obtains refinancing an the existing mortgage g he roe so as to acquire sufficient funds to pay V~life off, the Deed may be or sells t p p ~Y closin a ent in escrow contingent upon her rECeiving the balance of funds sent to t~-e g g C{Ue t0 hEr. THIRD; Husband agrees to maintain insurance sufficient to cover all risks to the marital real estate and to Warne 1Nife as an additional insured as her relating interests may exist until she is paid ofF in full. Upan request of Wife, proof of insurance shall be supplied at least on an ar~riual basis. UR'Y'H: Husband agrees to continr.ce ttn provide Wife with health benefits - ludin hlns italization insurance comparable to the existing insurance she now has Inc g l7 • based u on him providing the same for her. He shall pay atil premiums for the in place p nci health benefits and keep them current. Hie shat! provide said health insurance a urance fora eriad of five years with the effective date being date of b~enef its and ins p execution of this Agreement. H; Husband shall provide Wife with automobile insurance on her FI FT vehicle or an substitute vehicle she obtains to replace said vehicie for ~ period current Y . execution of this ,~greernent. The autcrnubile insurance shall of five years f ram date of 03/02/2011 12:21 724735483E NELSON TIRE PAGE 10122 be for one vehicle and shall be at a level comparable to the existing automob+le insurance provided to Wife by Husband. g~~'t-~1; The health insurance and automok~ile ir•+surance provided to Wifrr by Husband shall be i+i addition to the payment sct forth far the marital resiclenr.'P considcrcd to be a portion of equi#abie property division and an attempt to equalize the distribution of the marital estate. SEVENTH: Husband shall unto Wife the sum of $500.04 per month far five years with the first payment being due within thirty X30) days of the date of the execution of this Agreement. Subsequent payments shall be due monthly at or on a similar date as was the first payment due under this provisi+~n. This payment obligation shat) be considered to be additional property settlement and not new money to the marita[ estate. Said payment is made for the purpose of equalizing the marital estate and shall inurQ to the benefit of her heirs, assigns, and successoT~s. EIGh~Ttl: Husband sha11 maintain his current life insurance police in the amount of $200,OgQ.OC?, and he sha11 name Sean Hetrick and Jocelyn 1~letrick as irrevocable hen~fic-iaries of said policy. He shall supply Wife with annual proof that said children have been named as irrevocable beneficiaries and that the policy is in full force and effect. N I IVT1-!: H usbat~d sha) i maintain al I right, title and i nteresfi to hi s I30GATY ~ SMlTT1, P.c. 101 S.~n1~~ ta•mar wrcw f`r+c g1Acr Ilex KI'~ Gmrc City.l'~nflaylr.~nla 1612'1 72~-5 i0- ~rnx~ consulting business without claim of Vl/ife. Wife shall sign any necessary documents to give up any interest she may have in Husband's consulting business. Husband shall be entitled to receive any accounts receivable and all income generated from said business subject to his obligations contained herein. 03102/2011 12:21 724735483 NELSON TIRE PAGE 11122 TE1~fTl-I: Vllife would be entitled as her Sole and separate property tt~e following items that remain at the marital residence: the i rur ~ Fake+-'s rack, daughter's day bed, treadmill, wicker porch set, iron lawn chair sct, a.nd family items such as the items for the Garden Avenue home and items belonging tc~ or were gifts from her family together with hPr personal items such as clothes and hobby items and all other items that she may have owned prior to marriage. She shal I be entitled to receive these items and they shall be made available to her within sixty days of the date of this agreement if they have not already been made available to her. Wife agrees to pick up and tame into her possession aSl said items within sixty days of the date of this ,agreement. ~IEVENTH: Husband specifically retains as his sole and Separate prapert}r the truck he is currently using and Wife shall retain as her st>le and separate prupeity the automobile she is currently using. ~'illCs will be transferred within thirty days of the date of tl~is agreement with the title tran,fer costs far each vehicle being horn by the party who is receiving that vehicle. Ty11ELF7'}i: Neither party has a reti rement plan, pension, 401 tk) or other retirement plan, and, therefore, no division of said assets is required. The parties havE made a ful! and fair disclosure of all assets and debts relating td their m2~ritai situation, and fihis,~greement is specifically premised upon said full and fair disclosure. THIRTEENTH: The parties agree to continue making payment on all debts QOGATY ~ SM1TH, FL. 101 ym[H trn[cr Hrec[ p~+~[ 11f(k~ linx:i2h GR~.'C fly, TrhlhyliATIA 111 ZI ~~•I.,:~Il.snrn~ or bills for which they are now making payment. Both parties are unaware of bills or payments that o ligate the other party that have not been disclosed. Each shall k,e 03!02!2011 12:21 72473548~~ NELSON TIRE PAGE 12/22 responsible solely for the payment of any indebtedness they have incurred since their separation or that exists in their own name. A~aIT1~i~lAL PR~VIS~~NS ~. Any property currently 'tn the possession of a party, ~_inlpss ntherwi~ agreed herein ar obtained subsequent to the date of this Agreement shah be the sole and exclusive property of the party in possession without further claim of the other. 2. This Agreement may be submitted to a Pennsylvania Court of appropriate jurisdiction far its approval. 3. Each party to this Agreement acknowledges and declares that he or she respectively: {a} Is fully and completely informed as to the facts relating fio the subject matter of this Agreement and to the rights and liabilities of both parties; {b} Has made a full ciisclusure u~ rtiar'ild) property as that term is used in the Pennsylvania Divorce Cade; {c) Enters into this Agreement voluntarily after being given the opportunity to seek the advice of independent counsel; (d) Has given careful and mature thought to the making of this Agreement; (e) Has carefully read each provision of this Agreement; a~arY ~ sM~zN. ec. ins 5-~--h t:r~dn titn•~y R,a C7mrc 1k-x K2 i ;~~~ cry: r~ri~~,~ lnt zl 7:4.4:0-3000 (f} Eully and completely understands each provision of this Agreement, bath as to the subject matter and legal effect. ~4. Each party hereto releases the other from all claims, liabilities, debts, obligations, actions and causes of action of every kind that have been incurred relating to, arising from the marriage between the parties and~or existing between the parries at the time of the execution of this Agretirnenl, exc:epl d5 uutlin~cl above. NeithEr party, 03/02!2011 12:21 724735483 NELSON TIRE PAGE 13/22 however, is relieved or discharged from any obligation under this Agreement or under any instrument or document executed pursuant to this Agreement. 5. Each parry reNreser'rts and warrants to the other that he or she has not incurred any debt, obli~a#ion or other liability, other than those desr:rih~-1 in this Agreement, can which the other parry is or may be liable. Each early covenants and agrees that if any claim, action or proceeding is hereafter initiated seeking to hold the other party I fable for any other debt, obligation, I iabi I ity, act or omission of such party, such party will, at his or her sole expense, defend the other agoinst any such claim or demand, whether or not well-founded, and that he or she will indemnify and hold harmless the other party in respect of all damages resulting therefrom. 6. Each party shall live separate and apart from the other far the rest of their lives at any place or places that he or she may select. Neither party shall molest, harass, annoy, injure, threaten, or interfere willr ll~~e otl~er party in any manner whatso~vcr. Each party may carry on and engage in any employment, pmfPSSinn, h~~siness car other activity as he or she may deem advisable for his or her sole use and benefit. Neither party steal( interfere with the use, ownership, or disposition of any property now owned or hereinafter acquired by the other. ~UGA7Y bz 5MITH. PG. Ins ~....~7.r«..~...w.r.~ Nna ~ NOt.~ Ew~ft 712 i "~rnrr f.Irv, NennrylvuHn 1e127 T 14.iR11.iS(11111 7. The Husband and Wife each renounce ~.nd waive any and all right: (a} To inherit any part of the estate of the other at his or her death; (b) To receive property from the estate of the other by bequest or devise, except under a wi l l or codicil dated subsequently to the effective date of this Agreement; (c) To act as a personal representative under the will of the other, unless so nominated by a will ol~ codicil dated subsequently to the effective date of this Agreement. 03!02/2011 12:21 724735483 NELSON TIRE PAGE 14/22 8. each of the parties shat I on demand execute and del fiver to the other any deeds, bills of safe, assignments, titles, and other documents and do cause to be done any other acts and things as may be necessary or desirable to effectuate the provisions and purposes of this Agreement. 9. This Agreement, except as otherwise expressly provided herein, shall be binding on, and shall inure to the benefit of the respective legatees, devisees, heirs, executors, administrators, assigns, and successors in interest of the parc~es. 10. It is further acknowledged and dECreed that payment, made under this agreement are support payments and are not intendacl by the partiwS to h~ rlPhts, which may be discharged in bankruptcy. 11. This Agreement Shall be gt~verrtied by and shelf be construed in accordance with the laws of the Commonwealth of Pennsylvania. This Agreement may be filed with the Prothonotary or other Court official or may be adapted by a Court of competent jurisdiction and become a binding Court Order upon motion of either of the parties. 12. It is specifically understood and agreed by and between the parties oCATY ~ SMrrH, Ec. I(1t Vnoe1. CrMe~ kreet :nHX tqv T'rntr~h~anu 161:7 7z4-a~o•~ocx~ hereto that each paragraph hereof shall be deemed to be a separate and independer~t covenant and agreement. Ef any term, condition, clause or provision of #his hgreement shall be determined or declared to be uoid or invalid, by a court or otherwise, th~!n only that term, condition, clause or provision shall be stricken from this Agreement and in all other respects, this Agreement shall be valid and continue in full force, effect and operation. 0310212011~~ 12:21 724735483 NELSON TIRE PAGE 15/22 13. !t is further agreed, covenanted and stipulated that this Agreement, or the essential parts hereof, shat! be incorporated in arty decree hereinafter passed by any court of competent jurisdiction in any divorce proceedings that nave been or may be instituted, for the lirriiled purpose of enforcement of the contractual obligations of the parties pursuant to the relevant provisions of the Divorc-l~ T~ecree. This Agreement shall not be merged in any ~~~ch Decree but shall in all respects survive the same and be forever binding and conclusive upon the parties. 14. This Agreement shall rat be invalidated or otherwise affected by the reconciliation between the parties hereto or the resumption of manta! relations between them unless a subsequent agreement is made and executed with the same formalities as this Agreement. 15. In addition to being the full and complete agreement of the parties relative to all economic issues arising from their marriage, it is agreed anci c:uver~anted that by signing this Agreement, bvt>•~ pdrlies specifically give up, relinquish, and forever waive any claim for property (including cash) against the other party based upon the marital relatinn~hi~ unless specifically set forth herein. This Agreement is a full and complete settlement of all economic matters stemming from the marriage. ~ 6. The parties further agree that neither party shall have any obligation to R(K~ATY !~t SMITH, ~'C. Itll Snwh Earner ~rnct n~ rlr~~ ~ rz~ c:revr flat Kemsvh~nia 161I7 r3ti 4x~ 50tw pay to the other spousal support, alimony, alimony pendente cite, counsel fees, and expenses or costs of a divorce action, either pending or to be filed by either party, even though a court might award such if requested to do so unless other wise specified in this Agreement. EACH PARTY SPECIFICALLY 1NAlVES ANY CLAIM HE OR SHL MAY HAVE TO SUCH ALIMONY, SPOUSAL SUPI~UK 1, A~IMUN~( PENDENTE LITE, 03!0212011 12:21 724735483 NELSON TIRE PAGE 16!22 COUNSEL FEES, EXPENSES OR COTS OF SUIT Uh1DER TF~E PROVISIQNS OF THE PENNSYLVANIA DIVORCE CODE. a. The parties acknowledge llidl' if not fear this Agreement, a court having proper jurisdiction under the Pennsylvania Divorce Code could allow alimony, as it deems reasonably, to either patty only if it finds thafi alimony is necessary. b. Each party further understands that in determining the nature, amount, duration and manner of payment of alimony, the Court would have to consider all relevant factors, including: ~ . 1 he relative earnings and earning capacity of the parties. 2. The ages and the physical, mental and emotional conditions of the parties. 3. The sources of income of both parties, including, but not limited to, medical, retirement, insurance and other benefits. 4. The expectancies and inheritances of the parties. ~. The duration of the marriage. ~. ThP contribution by one party to the education, training or increased earning power of the other party. 7. The extent to which the earning power, expenses or financial obligations of a parCy wilt be affected by reason of serving as the custodian of a miriar child. $. The standard of living of the parties e$tablished during the marriage. 9, The relative education of the parties and sUGAxY Sr SMI~'~T, pc. the time necessary to acquire sufficient education or F,K,,,m~~,X„~; training to enable the party seeking alimony to find c~~r.~~~~n~~~,~~ic:izt appropriate employment. i2!-4',~-'d0A 03/02/2011 12:21 724735483 NELSON TIRE PAGE 17/22 _ II 1 d. The relative assets and I iabi I ities of the parties. 11. The property brought to the marriage by either party. 12. The contribution of a spouse as homemaker. 13. The relative needs of the parties. 14. The marital misconduct of either of the partiQS during the marriage. The marital misconduct of either of the parties from the dale of final separation Shall not be considered by the Courtin its determinations relative to alimony; excciat that the Court shal I ,consider the abuse of one party by the other party. As used in this paragraph "ak~r.r~e" shall have the meaning given to it under Section 61Q2 (relating to definitions. 15. The Federal, State and Iocal tax ramifications of the alimony award. 1 f~. vVhether the party ~eekirrg dl it ~ ru~~y lacks sufficient property, including, but riot limited to, property distributed under equitable clivisian, to provide for the party's reasonable needs. 17. Whether the party seeking alimony is incapable of self-support through appropriate employment. 3UGATY dT 53~riTH, T.C. 1111 ~.erth rrnl-r W rro, ram ClffKt her R23 C~nm GN:1q~m>rh•au~. 1b12T T21-4 iA-i11f1A 17. Nothing in this Agreement shall be construed to be a waiver or relinyuislrrrrer'rt by either party to a claim they do or may have under the Social Security law based upon their own earnings and/or the earnings of the other party hQrwtn. 18. Each patty acknowledges that he/she shall be responsible for his/her own counsel fees unless otherwise prgvided herein. Raymond H. ~agaty, Esquire represents the Wife in this transaction. It is acknowledged that Husband has had an opportunity to review this Agreement and to submit said Agreement to an attorney of his chaise far 03/02/2011 12:21 724735483r NELSON TIRE PAGE 18122 review. Each parry acknowledges that he or she has received, or had the opportunity to receive, independent legal advice from counsel of his or her selection anti eac.:l~ fully understands the farts dncl F~~s k.~~eri advised of their respective rights as granted to them under and by virtue of the Pennsylvania Divorce Code of '19$0, effective ac of Jrrly 1, 1gR[l, in~liltiing, but not limited to, their respective rights to equitable division of the property owned by the parties as husband and wife and by the parties as individuals, including all property owned by the parties jointly or individually which was acquired during the course of their marriage and prior to separation. Bath parties specifically acknowledge and understand the following provisions of the Pennsylvania Divorce Code relative to equitable distribution of marital property. a. Each party understands that under the Pennsylvania Qivorce Code al I property (including pensions), whether real or personal, acquired by either party during the marriage and prior to separation is presumed tv be "marital property" subjec# to equitable distribution by the Court, except fUr: 1. Property acquired prior to marriage or property acquired in exchange for property acquired prinrtc~ the marriage:, except far the increase in value during the marriage. 2. Property exc) uded by vaf id agreement of the parties entered into before, during or after the marriage. 3. (property acquired by gift, bequest, devise or descent; except for the increase in value during the marriage. BUGATY 6z SMiTH, I'.C. 11~I VI111t11 (.1"11/7 }IMM Mncr c )ITMr 111~t N2 i Gm.c Glr Tt~nrYlrni,, 1/,l )7 i:d 130 31100 4. Property acquired after separation until the date of divorce; provided, however, if the parties separate and reconcile, all property acquired subsequent to the final separation until their divorce. 03/02/2011 12:21 7247354836 NELSON TIRE 5. Property which a party has sold, granted, conveyed ar other disposed of in good faith or for value prior to the time proceedings for tk~e c~ivca~rce are commenced. 5. Veterans' benefits exempt from attachment, levy or seizure pursuant to the Ac-fi of September 2, 1958, Public Law 85$57, 72 Statute 1229 as amended; except for those benefits received by a veteran where such veteran has waived a portion of his military retirement pay in order to receive veteran's compensation. 7. Property to the extent to which ~uc:tr property his been mortgaged or otherwise encumbered ;n goad faith for value prior to the time proceedings for the divorce are commenced. 8. Any payment received as a result of an award or settlement for any cause of notion or claim which accrued prior to the marriage or after the date of final separation regardless of when the payment was received. PAGE 19/22 b. The parties further urTdei~tand that, absent this Agreert~ent, a court having proper jurisdiction under the Pennsylvania Divorce Code would, upon the request of either party, egttitahly divide, distribute or assign the "marital property: between the parties withnr.rt r~garci fin marital misconduct in such proportions as the Court deems just considering all relevant factors including: 1. The length of the marriage. ~. Any prior marriage of either party. ~(~GATY ~ SMTTT~, P.C:. IPI nrut~l C~Illc~ Sa~r..•c I\M f1R'~t• Itanfc 412 i t:~mve C.try~ PcnnsvT«ma IB] 27 7:4 X30 fdM ~. The age, health, stafiion, amount and sources of income, vocational 5lcills, employability, estate, I iabil ities and needs of Fatr.h ref the parties. 4. The contribution by one petty to the education, training ar increased earning power of the other party. 5. The opportunity of each party for future acquisitions of capital assets and ir~cvrr•~e. 03/02/2011 12:21 724354836 NELSON TIRE PAGE 20!22 6, The sources of income of both parties, including, but not limited to, medical, retirement, insurance or other benefits. 7. The contribution or dissipation of each party in the acquisition, preservation, depreciation or apprer-iati~n of the marital proparty, including the contribution of a party as homemaker. 8. The value of the property set apart to each party. 9. The standard of living of the parties established during the marriage. ~ 0. The econam is circumstances of each party at the time the division of property is to become effective. 11. Vllhether the parry wi I I be serving as the custodian of any dependent minor children. 1~1 ~nuh c:cmrr ~n~ F~fl4 ~NfG•p 14~x rm~c C.in,, YentKylwi~ia 16127 r'1'F•4in• iOIM} c, Understanding these facts, both parties have chosen to enter into this Agreement voluntarily without the benefit of appraisals of their motor vehicles, fumi#ure and applidnCeS, tools, equipn~ent, husband's pension fund, wife's pension fund, any other undesignated pPr~~nal prnpFrty. Rnth parties 2cknnwledge that each is willing to enter into this Agreement even though he or she may not be receiving what a court might consider to be an equitable or fair division Qf the marital property because each believes the provisions made for himself or herself under the Agreement are sufficient and fair. EACH PARTY DQES HERESY WAIVE ANY AND ALL RIGHT PERTAINING TO EQUITABLE DISTRIBUTION OE SUCH ASSETS AND AGREES 7'~ BE 6C~UND, IN THE ALTERNATIVE, BY THE' TERMS OF THE wiTHIN AGREEMENT. 19. This Agreement may not be modified except by a writing signed by both parties hereto, and it is acknowledged that this Agreement contains the entire understanding of the parties and all prior or contemporaneous agreements or understandings are hereby merged into and have become a part of this Agreement. Yhis is the entire understanding and agreement of the parties hereto. 03/02!2011 12:21 7247354836 NELSON TIRE PAGE 21122 II 20. This Agreement may not be construed against the party drafting the d,greerrierrt irr ire event there is ambiguity or otherwise simply i~ecause that party is the draftsperson. The Agreement has been drafted by or on behalf of one of the parties to aCCammnc~atP ~, rPsnltrtion of this matter and is based upon input from bath parties AND New, with the intention to be bound hereby, we have set our hands hereunto an the date previausiy stated and intend fihat the aforestated date sha) I be the effective date of this Agreement. W I7N~ .. i~ f~ , jc~ E~iE E. I-IETRICK STEVEN A~. ~-IET~I~:IC '-' aGATy & SMITH, F.G. tnt yn~th Ccrncr w~ i4w QRKx i3ns t3~'' mvr C:t~ rc~l~~yfvania (4127 T:4-450-3(~U 03/02/2011 12:21 7247354836 NELSON TIRE STATE OF PENNSYLVANIA , ss. COUNTY C)F MEtiCER . PAGE 22/22 (~N THIS, the day of ~~ , 2007 before me the ' undersigned officer, personally appeared jO,e~NNE HETR~C~C, known to rrie (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that she executed the same for the purposes herein contained. IN WITNESS WHEREOF, I hereunto set my h, - a~n fficial seal. ' ~ ~ ,' (SEAL) N Lary Pu ~li~-'" , . ~MMONWEALT!-! OF pENNSYLVANlA Nntarlat Seal Rnbia L legal, Rlc~ary Pablic gave C4tjr Boron Mer+~er Ca~mly My CbmtAission Eaq~ir~ ~, 9~ ~b10 M@~~- P~nna~veni~ Association of NotarteS STATE OF PENNSYLVANIA CO U NYY CAF h~I~C:E~ ON THIS the ~ da 1 I t . y of , 200, before me the undersigned officer, personally appeared STEVEN Ni. ETRICK, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and ~c:;kricrwlecigec~ liiat fie executed the same for the purposes herein contained. ~N WITNESS WHEREOF, (hereunto set hand and official seal. w Notary Public ~~1~ Stwdh Ccn~eT tin•n r~,~y C~Ilia Ik~r S2S tti.•r Cil~ 1`cnnn Ivrmfn 1 t~ 1 J ~ i 24.4511-SOfk~ .• ~ ~ • -~ . .. ` ` v~ .. . • .. ~ ` , - , ~ti ~ ', ;, ., '• w - ~ ~ , . , ,.• ..~ .,~_ ,. ~, .:OMM01~11N'~.TH~I li0r'tA1lMl L. NALER~ F. C1.l, l+~Oti~rytc Ca~ilsle 8g1p., Cwr~be~nd '~~ ~'~,rrnm~siort Expir~ea fiber ~, ~ ~~ C~ btp., lam ,i~n.~~4~lge Oc~~1~ Invoice for unpaid balances under Marital Settlement Agreement Balance due on Real Estate: $16,250.00 Equitable Distribution owed: $8,250.00 Health Insurance: $1,788.11 Car Insurance: $1,400.00 03123/2011 13:42 72473548;' NELSON TIRE PAGE 02120 I .. .. ..... ... ...... . .. _. ... ... .. 2no.8 ~ ./,...Sao . O:Q ' . 2.009 ~ fir.7.50..oa_:.. ~ . ~..~, .. . _.,.. c~ 0 ... . .......... .. ... ....... ._ 1,VNV F`UNDFNG LLC as assignee of GE In the Court of Common Pleas of Capital "' CUiV1BERLAND County, Pennsylvania ~ ~ ~, c% Edwin A. Abrahamsen & Assoc. Civil Division Z, ~Y, ~ .,,., 120 North Keyser Ave. -z, ~ ; •: ~ ; ~i .-U Scranton, PA 18504 =- . Plaintiff NO: !0'~ 'V' : "~~f.ry1 c,? •:. ~ ~r ; !.~• r r ..l• ,. • ~f..' w~~ ;•~ 47 • P1L4EGIPE FOR ENTRY OF JUDGMEN'~ --- ~cr Steven Hetrick c.:.~ -•t 125b KUHN RD r~~ BOILING SPRFNGS PA 17007-9b49 Defendant To the Prothonotary of CUMBERLAND County: 1) Bnter Judgment on the attached Certified copy of Judgment from a District Justice. A) Date of instrument: 12f04109 B) Amount of Judgment: ~"2340.I4 . C) Interest From: 12104!09 Z) Enter the ,judgment in favor or the original holder, or (unless expressly forbidden in the instrument) in favor of the assignee or other transferee; 3) I hereby certify that the address of the plainti#f is: LVNV FUNDING Ll.C as assignee of GE Capital cfo Edwin A. Abraharnsen & Assoc. 120 North Keyser Ave. Scranton, PA l 8504 4} I hereby certify that the address of the defendant is: Steven Hetrick 1256 KUHN RD BOILING SPRINGS PA 1?007-9649 Michael F. Ratchford, Esquire Edwin A. Abrahamsen & Associates, P.C. 120 N. Keyser Ave Scranton, PA 18504 570-558-SS1Q Ext. 101 Attorney ID 8b285 F. for Plaintiff ~a~.a~ pb ~~y C~~ ~~il8Z ~~ a~ ~rt~ i86S-E~Z-LiL ~uedwo0 '8 uoa0 dET:SO it 6z Qe~ ~ . LVNV FUNDING LLC as assignee of GE !n the CourE of Common Pleas of Capital CUMBERLAND County, Pennsylvania Civil Division Plaintiff NO: vs. Steven Hetrick NOTICE OF FILING ,NDGMENT 1256 KUHN RD BOILING SPRITIGS PA 17007-9649 Defendant - --- _- ' Notice is herby given that a money judgment in the above-captioned matter has been entered against you in the amount of $~~ 3 4p .~ ~ on a ~ l o By' ~~ If you have any questions regarding this notice, please contact the filing party: Edwin A. Abrahamsen & Associates 120 N. Keyser Avenue Scranton, PA 18504 Telephone: (574)-558-5510 ~ ~~ {Notice is given in accordance with PA Supreme Court Rule of Civil Procedure No. 236) S•d Z86S-E~Z-LtL Ruedwo~ '~ uoo~ d~T:SO iT 6c qa~ 03/07!2011 12:22 717-772-r ' ENFORCEMENT PAGE 02102 CDMMQNWEIeIt,TH G1F PENNSYLVANIA euedtu o~ ea~~i~ce DEPARTMENT ~F R~VENjUE ~o emc zeo~~e w-aeessu~te a- c~iz~we+se ~14'1~011 VALERIE JACQUEl.xNE M YERNEY fiSq 44 SOUTH H1-NOYER ST CARLISLE PA 17013 Dear V,~.lLF.1tIE: 1~Mt01/ !!I iN.l~f S/E~itn Pavo, f,~, f_Co~e Number LP0O~757 Re: STEVEN 1V1 ~TRIC.K Type of Tax; A,NNiJ,AI, ID Number: ~9S-4b-xXd9 I7ocl~et Number: 06-59Zd~`I' Zn r SC t0 iecCAt in ~~ Y~ ~uY ~8~m8 a PaYo~ ~$~~ as of Marnh 3 i. ~t111, for the above-rcfetcnc~cd lien, tf your case bas been pia~ced with an outside collections a$en~r, Under Act 40 of ~q05, additiansl collection costs, lincludlag bot not limited to few of up to 39 ~ercemt of the amount due and attoraey ~'~ incurred is securing payment, may be imposed a-n any liability net paid prior to referral to a collection agency or contract counsel. Liab~ty Collection Agency Fee ~'ptal 517.54 50 5~6*p4 To expaditE paymcnt processing, plcase inctudc the bottom portion of this totter with your paym~t. Fleasc also inctudc tl~e payoff code nutnbor on your check. Please ptvvide us with the address to wbioh you want the satfsfactian notice sent, once the lien is satisfied. Si ely, PA~'RIG'E FCIR'I`ER PIS Department of Roveaue Lien Section, Enforcement Divisicm Ad~he~sswhe~f dvrlrn! _ En : PA t of Ra~v~rrw, 8srt+~su d! Cam lisne+z, ath end iNs/nut Sfceei~, Hatrlsb.N..~yy~~ PA i7t18 rr..... •.•rrrrrrr... ~i•rTi.rrw.,-3-rrrr.rr.rw...~rr.~r.rr......r.i rrrrr ~.....r rrwrr. rrw....rrrrr. r..r......r.~"i •r•ww....~rr.r••^w.-... Pr~yQtt C.odo Number: Ro~ ~~ ~ I~TRtcR Piryo~ nct~ M.~113 t. 20 l l j ib t9s~lo Za~ts ~-~nauot ow~eds ~26.oa t --~ Typo of Twac: ANNU14L ~~ ~~' ~'~~T Amwnt Ec~elo~ed (INCLUDE THig P~RTIQN WIYH PAYMEI~ C0~1~ONW~ALTH OF P~ti _ __ .,'LVANIA counir~r o~: ~ ~ .. Ntsq. Dist. tvc.: 09-3-04 • MJJ Name: FiOn. S ~ ~~ THOIi71~8 A. PLACSY ~ . ~~ ~ ~ 104 8: SFO~LrI~g ~I~ LLD `~ ir88~t~, PA • " TRIep110r16: (~ ~.7) 7 ~ 1 ~ ~ 2 ~ ~ 17 ~ 5 ~ -'°Y ~~~ ~~u. n~~ ..~~a~S DZ3tECT, I]fiC ' 19 2 HmtFT . itQ]1D ~C`~~IC88HiLt~, PA 7.7 0 5 a THIS [S TO NOTIFY. YOU THAT: • Dg1rAIILT J~D4~r N~~'~C~{s~ JUR ~~ IVT~'RA~SCRi~T •.~ CIVIL CASE PtA1NTIFF: Ng1r1E and ADDRESS ~11A'V8L11~ DIHRCT, Il~C ~ 192 HS~[Pr ROAD ~CHA~IC88II~tQ, P7~ 1~ O5 a L .. ~ DEFENDAi~tT: vS' • NAOiAE and ADDRESS raves ass~TC~ - DArA ~roaD ~ ~ i2ss ~r ~~oAD BflII~IMGf SP~tl3iibS, FA 178Q7 L J Docket IVa.: Cv~ o 00 oars- 06 Date Fifed: 5f X3/06 . Judgment: '~pL'~`Y" (Date of Judgment) 6/2a/o6 Judgment was entered for: ([Name) ~AVBLIH~- DIB,ECT, IBC • ~ Judgment was entered against: jName}. .BTaVHH 88T~LIC~ -DATA wpRn in the amount of $ 7 ~ 43a • 5 Defendants are jointly and severally liable. Amount of Judgment $ 7.285: 00 Judgment Costs ~ $-~~~ Damages will be assessed on Date & Time Interest Qn Judgment $ ___ .~iS . _ ~ ~ Attorney Fees $ . 40 This case dismissed without Rrejudjce. - . Total -~ 7'. X33.50 Q Amount of Judgment Subject fa Attachmentld2 Pa.C.S. .8127 ~ . .:~ ~ - ~ - • - § t'ost Judgment Credits $ Post Judgment Costs $ Portion of Judgment fQr physical damages arising out of ~ ~ "~==-=~=_ ~residentiat lease ~ ~ . CertNied Judgment Total $ ANY PARTY HA$ THE RIGHT Tp APPEAI-.yyi-~~ 30 PAYS AF`rER THE ENTRY OF JUDGEMENT BY FlUNG A NOTICE OF APPEAL 1hIITH THE PROTOiQN4TAAYlCi:EAK'OF.IHE COURT OF COMMON PLEAS, CIVIL D1VISi0iV. YOU MUST INCLUDE A COPY OF THIS NOTICE OF JUD~MENT/TRANSCRIPT FORM WJ7N YOUR NOTICE~OF APPEAL EXCEPT AS QTHEAWISE PROVEDED:iN THE~RULES QF CXVIL, PROCEDURE FOR MAGISTERIAL DISTRICT JUDGES, IF THE • JUDGEMENT HOLDER ELECTS TO ENTER THE;JUDGINENT IN THE COURT QF CQMM4N Pl:EAS, ALL FURTHER PROCESS ROUST COME i+AQM THE COURT pF COMMON PLEAS 11NQ NO FUEtTHER PROCESS MAY 8E ISSUED 8Y THE MAGISTERIAL DISTRICT JUDGE . ,_, UNLESS THE JUDGMENT IS ENTERED W THE COURT OF CQMMON PLEAS, ANYt3NE INTERESTED W THE J~JDGME:NT MAY FILE A REQUEST FOR E:NTAY OF SATESFACTEQTI ~~ ~ MAGISTERIAL DlSTAICT JUDGE IF THE JUDGEMENT DEBTOR PAYS IN FULL, SETTLES, OH O~~SE•COMPLIES WITtI~TFIE.IUDGMENT. ,_~ .•~ ~ .:a :.:t i ~1 My commission expires first ~Monda}~~of~J"anuary, 2010 AC3PC 315-06 ~ , 6 , d ~ ~ Dl~TB-• PAil~rB,Ds ~.~.: ~~•8~~21~%QS IB6S-E~Z-GIG ~.C;:g~.$•,~or~ai~~dg .t~e~~udq~iaeAfi~ : '!~: = _•. :?-: .. • ~' I~Ig~r~t~naf ~ C?~c~Ct ge .. . . v.. Ruedwoa ~ uooa ~ dS i ~ SO .. i i. 8Z qa~ PA DEPARTMENT OF REVEhRIE DUREAU~OF C@tPLIAMCE IIEt{ SECTION Po aflx tno9aa HARRiS811RG PA 171zn-C94S Cie. ~ ~ ~ 3 ~ ~ ~ BY,a't SEP 22 2006 R[li-Ii! CI F1 1FP [32-16) COURT OF COMMON PLEAS OF v^~0, '` - 0 ~~ TO THE PR4TFION07ARY 0I SAID GOURTi ra-,r.,,e ~. tr. s....r tr. a...nw.teA •t r.nnsir[s.oia. ~• is Asrsritr trsssvttN s Csrtlfls^ Cs~ sf . Lls. to b. sntarsr sf rsuN 1. ra! toMty~ NAME AND ADDRESS: CUMBERLAND COUNTY, PENNSYLVANIA STEVEN M HETRICK JOANNE E HETRICK 125b KUHN ROAD BAILING SPRGS PA 17007 CERT3FSED COPY flF LIEN 195-46-2149 CLASS of rAx PERIOD ~-~ OF TAX tCR CUE DATE) AiiEiSMEJ~IT DETER/IINA710N ID~EJJ'1'IRY ING 1 OR SETTLE TAX ~~ TOTAL P • I - T. O i--O 1-02 TD s MAR 31 2006 4 s ` 12-31-02 T22729 1,086.00 1,589.74 C`~ ~= rv ° ~ • ~ r ~ r . ~+ ~~ Lj~ , ~ ~.~~`ti~ .. ul •< IHTERES7 CDIIPUTA710N DATE tJ C T ], 3 2 0 0 6 TDTALs ~I 086.00 ~1 589.74 y1LIND FL-E;S) TAs rndoraL~nod, the goerotsry of Rovsnu^ toe his orthoriZod dolossto) o} tho Caaiporfrroslth of P.nnsytvshi^. eortifios this to bs o tru• ohd aorroot oosy o! ^ ilon •sslnst tho sbovo• AQDITIOKAL INTEREST As~ad tasiPOyor for unPSid tsx, 1nt^foot, sddltions or Pon^ltioi thoroon dtio }roar such tss• Psyor and wh1oA. sftor do^^nd for Psyuant th^rop}, r.*.ins unASld. Tho swount of suoA un- P^ld tax. !nt^rost~ saaitiens or 8ETTLEMEI;T TOTAL upon tho tsxP^i- ~^ Pomltlos is • li^a in f^troc of the Ceor-eiwoaith of P+nnsylvanis PcoPOrtY, roal, Psrsonsl, or both, ss tbo easo •oy p.. o • ~ F SECRlTARY OF REVENUE O C ~ ~ ~ `• ~~~ IQR AUTHORIZl;D DELECATl:) DATE . d D/rl~T '1 .. rA !3r DR'7'A TuC* ev ee..nrs~*un ne~~*ne T 86S-E~bZ-~, j ~, Ruedwo0 '8 uoo 0 d~j•SO Ii 8Z qa~ 03/25/2011 10:16 5705585511 EAA ASSOC PAGE 02/02 6CIwiN A. A9RAHAM~~N MICHAEL F. aATCliroRD N~/1YM16R K. WpoDRI.IrF* •wLeO Mr_1~g~R of R'1.. eAR V.TA 1*"ACSTMIL.E (117) 243-351$ Jacqueline Verney, Esquire ~,awv Of..fice of JacqueUne Vex~iey 44 S. Hanover Street Carlisle, PA 17013 lvigrch 25, 2011 fie: ~ ~ Funding ,LLC v. Stephen ,~etrick C;umher~and G'ourxiy ~ C.P. C;'ivil Action No, : 20.1.0-103 Ora f le no.: ,~09-339G 1'uynf f ~mou~tl~, $,2, 37.39 dear IV.is. Verney: }'lease a~law this to confirt~. that the above-noted judgment can be satxslied with one payment cif ~2,3G7.39. ~~Yrther, this payoff amount is valid through ,A,pxil 7, X011. Ifyou should have any questions ox concerns, you are welcorxte to call me at (570} SS$-SS 10 ext 101. Thank you. mt'r THE LI~W Ol~"!CE ^F' EpWIN ~. AB~AWAMBEN & A3~3DCIA'TE9~ P. C. wv,rw.Eap~~Aw.cowt Michae~ 1 20 N©RTH KEYSER /AV£NLIt :CRANTpN, PA 1 65G~ ` (p) 5707 1.55 1 O + (F) 57C1.959.55~ 1 1 03/23/2011 13:42 7247354836 ~_~~R WAS'T'E MAIyA~EMENT WorRtP. tlanar~aRPr~t Of CENTRAL PA NELSON TIRE . PAGE 06/20 • r ~ ~ 3/02j2011 RE: Account #~'E1 -OO7o81~-0061 -~ WM ezPayy AcCOUnt Ib: OOOg6-38782.224Q4 AMOUNT QUE; $31.OQ STEVEN M HETRICK 1256 KUHN AD ~3C~.L L1N[~ SPRINGS PAl ~ 7047 - 964J Service Location; STEVEN M HETRICK 1256 KUHN RD BOILING SPRINGS PA X7007-9649 Dear Customer; Your account has a fast due balance in the amount of $3.00, Since our previous attempts to collect this balance have rover proceed~to place your account with a collect~onr1a~e ' . ., g ncy or attorney. Thais action can be avv~,ded by paying your account in toll. Payment can be made by the following ptethads: On-Line at www.wm.corn ,by automated attendant at 1-866-964-2.729. * Calling our office at 1 -80Q-6428850. and t~si.ng your checking account or debit/credit Gerd. '* By mail using thy? enclosed remittance and return enve~gpq This ~.etter is sent for the purpose of collecting a-debt which you owe and any infarmatior~ which you provide will be used to c:vl~.et; ~ that debt . Sincerely, WASTE MANAGEMENT OF EASTERN PENNSYLV~NtA CENTRAL PA District# OQ61 PLEASE DETACH HFRF AhiO gE'T'uRN i~(1TTfaM P(;)pnay yy~F{ YQI,IR PAYMEM- wAS'~ ~IIANAaGEME111r 03102120 t 1 611-00708 ~ ~ -0061-8 OOOo000 -Ob61-2 ~S 1.04 i~~r~~~~~m~~~~~~n~~nn~ d,3Q0 ZNL~U8TRIAL pAAK FiaV1D CAIN' HILLS PA 17011 (717)909.1440 FAX s ~ ~~W 006161~00708y50oaop000000doD00U00D00nD0o3100 4 iil~ll01~~~~m~ 00050 STEVEN M HET~iICK WASTE MANAGEMENT 1256 KUHN Rd PO BOx i3~77 BOILING SPRINGS PA 17pp7-964g PNi'i A17F1 PHTA PA 1$101-3577 ~rrr~~~r~~r»r~~~~nnn~~n~~rr~r~r~ur~~~rr~~n~~~ni~n~r~~ roe. m ne~aar~e,.a~ex.HtteeQ 1 rvm everyday coliectzort to errvinonmenta(pret.~!ctio», COIIM WAAR1~~ M~v ~prt7~ 03123/2011 13:42 7247354836 NELSON TIRE PAGE 04!20 Service To: ~ •• .. - ~ - ... ~ ... .. • -' ~~::~:~., ... . Account Number A ~ ~ _ 1Z5f~EKUHfN fRbCK Q~11~0~~'6 0$003 8Y,IILING SpRZ1VGS, PA x.7007-9649 VVl~Il iE ROCK '! 157153 PWSID # PA721gC148 Aqua ~nnsytranra, Ina. Tel: 877.987.2782 Questions about your water Service?... ContlCt us befiore tine due date. 762 W. Larrcas~er Avenue Fax: 866.780.8292 Bill Date Total Amount Due Cur'renC Charges Due Date Bryn Mawr, PA i901o-3489 ~ M~u~ c~~~~~,r~agU~an~~.;~.oom Macch i4, 2011 $ 59.80 April 05, 201 lw$tietDatia Meter 5¢e BillinaPerrdd pays ReadTy~! nAatarRaa~ings u~~ Unitrs 55074854 SJ8 a3/f8111 29 Actual 411000 5,000 Galbns _. 8?J10t11 Actual d12bb0 Average Dally Usage =178 . Galbns To1~ Days: 28 ~~ •- ,. Tabl Usage: 5,000 Galbrrs Billing Detail Amount Owed from I. agt iii fl , .............................. , . $ 302.68 i'otal Payments Received ........................ .. 302.68 Remaining Balance .............................• 0 00 Customer Cherc,~e ................................................... 15.00 2,000 pagans ~ X0.00798 per gallon ................... 15,96 Next 3,000 gallons ~ $0.009105 per gallon ......... 27.32 Total Water Charges ............ ....................... 5$.28 DStC Charye.......... ................................................. 1.52 .,.... Amount Dae ... .................................................. ~ 59.80 Water Usage !,History ~ioo .... „~, ... ~~ ~ ... 0 ~~ ~ .. ~o .. ° M mead 7~-Ftcs: Me55age Cert#~ef (see reverse side for other infamationf C~fFective January 't, 2011 the ~tlk~wafJlr3 DSIC charge is 2.BQ 9~. This reflects ~ bta million in system imprvverr~en#s m by the company sing Jay 2010. These improver-lents include the t~eplacement of aging water pipes and other infrastr~ture as well as improvements to the quality of the water that we serve. ^ The due date refers ka current charges arrly, if you do rat pay your bip an time, your service could be si~ject to interruption. To ensure proper CI~9dit please remember to provide your full f 6-~git aa:ount dumber when paying your bill. ~P Pordort for your records. ~ XX fZcturn this portron with your payrtl~d. Ser"'ce To: A~~l'i W~~~r ~I'~ srEVEM Hi1~tXGK 1256 KllHN ~iD Agga Renar~yhrania, Inc f1YrdYl.IN~ SPRDIIGS, PA 17007-+964A 762 W. l.drrc:a5•ter AVenue + Bryn Mawr, 1'A 1'~t310-34$9 beq=91301 Cyc=15R91u~gg;,880 9301 1 AV D 3.'x.5 **~*~*AitTO**5-DIGIT 170E]7 C 32 P 3? ETCVCN 1 IETF~rCK 1256 KUHN Rp BalL.ING SPRINGS !~A 'I70a7-9840 III!'lll~l,'II'f"~{'~'~~~"I~II~1~111~'I~I11'~~"'I~I'~I~Illlrlll ACivunt Numtur ~~~.1~0~76 O$04fl33 Amount Due Current Charges Uue pate $$~,$p April OS, ~Q~1 Amount enclosed oeoaosa _( _ ~^ ~\ l 1.:~1_l ~ .I O 11~,.~..i Please make check payable to Aqua PA. Prim, your account number An ycx,r rh~:rk, t.l~en mail to address on back. 0^]~100C76D804033D^Q0000059802 1191BIINIIIIIII~I~IIIAIN' a., ~ Acbuaf ^ estimated ~ Custortifer f ~ .xct rtLC tv. Hl.WUIfC fVUffi!!Cr /~1 ~ i~ i s6 tcc~H t~n~~ ~U1,1~{D276 ~$~4~~3~ _ BOILING SPRINGS, PA 17Q07-9649 WHITE ROCK 1 t 57153 PW S l p# PA721 LX348 Aqua Rennsylvanlra, Inc. Tel: 877.987.3?82 Questions about your wataEr sen,ice?... Contact us before the due date. 762 w. Lancaster Avenue fax: 8C-6.78II.8~12 811! [}~ Taal Amount Due Current fitarges Dine Gate Bryn M~ov; r'A 19010-398'9 a Mail: custsarvl~a~uaamaRir.a.co~» February 14,1111 $ 382.68 Marct>r 118, 211 1H~t@r ~~~ Meter Size 6iiling Penad Days Read Type Meter Readinga Usage Untts -- -- 55074054 ~ 5J8 02/10/11 28 Actual 412000 _...~__ ~ 31,000 Gallons _~_ _ 01!13/11 Actua! 3810 Average Daily Usage =1,107 Gallons Total Days: 28 Total Usage: 31,004`Gallons Billing Detail --Ar~~OU~t +Qwed fc~ Last FOIE ..:.,..., . ,,, ..~ .:..:. ....................... $ 2f39.26 Total Payments Received .............................................. 209.26 Rer~ining Balance ...................................................... 0.00 Customer Charge ................................................... 15.00 2,000 gallons @$4.00798 per gallon .................. 15.86 Next 29,0430 gallons @$0.0439105 per gallon........ 264.05 Total UVater Charges ..................................................... 295.01 Qslc charge .................................................................. 7.6? Amount Du~ ................................................................. ~ 302.68 INa Usege His~olryr ~' 3f• Read Types: ~ Actual ^ Eskitrnatad ~ ~Crssfia~ar ~~ ~r . `~ ~ ~ ~. Message C:en#~er (see reverse side for other infarrr~tior~) * Effective January 1, 2()11 the allowable DSl4: charge is 2.60 %. This reflects ~ 66 minion in system im~roveme~ts made by the con~any sine July 2010. These impraverrrents include the replacemen# of aging water pipes and other infrastructure as wall as improvements to the c~tality of the water that we serve. • The due date refers to current chi only, if you do not pay your bill on time, your service could be sc~j~ect to internlption. To ensure proper credit please remem~r to provide your full 16-t~~if account nurrrber wl~t paying your bill. 03!23/2011 13:42 7247354836 NELSON TIRE • . • PAGE 05! 20 M~NF~~~ TOVIINHIP • 1220 Boiling SpRngs (bad Mechanicsburg; PA t 7055-9794 (777) 25$•8842 Ext 223 (717) $97-4673 Ex# 223 www monroetwp,net Statement of Account 1~r Sewer 5trviCeS Account Number: Due Date Before Due Date 293 3131!2011 $245.00 Service Address: After Due date 1256 KUHN RD $289.50 Billing Period .--......... _..---- Praviot,s Balance: 0.00 From 01/0112011 Current Chargc: S2#5,00 --,------ Other Charges: To: 03/3112011 ~._....... _--... _. .. _._ ............ ...~ w _._ ~_-Ocrtstanding Baiance: -~ -' ~'~'~-' Pay this amount on or before due date: ~ ........ Total Con$umptian: -~ 5245.00 .._ ......_..___ ..._ ____.___.......__...._.. rill this amount alter due date: 3zo9.~ Hours: The Township office is open 8;30 AM - 4:30 PM daily. The Township offers an outside mai(drop, if you should visit when we are closed. Emergency: Fvr 24/7 Ert»rger~cy Service allot GuSiriess ilc~urs: Northern District ~ 1.3320 ~QUth~rn Distt'i0# 4$7-2809 Failare of any owner t+a receiva a bill far atrarg~es dt~e and payable shall not be considered en exrnse for non paymen>~ nor s/~a!! such failure result !n an exferisiorl Of the period of time during which the nef bill shall be payable. 200~R5, Sec~'on 209 For account prablema - exfenslan 2.73. ._ _._ .-Te~'ece • --_ ..... _- ~ --• -- • 'i'~rHere ~• Tear.Here ..... Tyr rfiere- ------- - Manse Township Make check payable to: Monroe ~'o~wnship 1220 8oifing Springs Raad Remit ta: 1220 Bolling Springs Road M@Chai~ICSbUrg, PA 17p55-9794 Mec~+anicsbur~, PA 17055-9T94 South Account #: 293 Irnroice #: $3118 Due Date: 3/31/2011 JOANNE HETRIGK Amnunt Ry ~I1P. I]atA~ $245.00 343 GEORGE JUNIOR ROAD Amoun# After Due Dom: $269.x0 ?0 . ponalty on late px~vrttprlGs GROVP CITY, PA ~ Altar 45 days irate ;.rues daily at the tale of 1/2'r~ per month 03/23/2011 13:42 7247354836 Alaroll 11, 2D11 ~nne..wor....~ ate! Pstled: Fab 10 b Mar 11, 20tt fa 30 deya Ne>d Rea~rq Galt On a etlolt Apr 11, 2011 gip tiaead Oa: E kNler t&ainq yyasller Rebbd Eawl Payment Pun Proweed RAI PELSON TIRE PAGE 83/28 IIl0a0Ua raxr~ 10 W ~l 1841 J 1 f ~~yc , w ~ M71 911 far. FL'TAT6 OF STEVEN M HE7RICK 1256 KUHN RO BOILING 6PRINOS PA 17001 . . ® ;.r.,;.. . gill i wad try: PO Box 16001 ~~ . ~Ou~~tl~+0 , t eBe Resdlrg PA 19612-0001 ~~ • -6444877 C0~0~011f Ia00-902.4e4e YkN as ep~llle al Ialeu i~lerreflTealp, Yar otnem PRICE TO COItPAR@ rar per,trseon and barratleelon ft»m Mot 6d is Ibled below Fa ou b ~ auppler'a Dltos moat be bwar. . y saw lteeidenliN Tana Of Day . NOi:341G~t! LS1 eenle per ttVYh Cuealmw neelvee the lipt b chap 1tx an eleeak suppl'iar. t.,u.. Return DNS part with s eherlc ur nrorwy order ~~ Payable to IAst-Ed I-crxrutrt IVtarrper. 100021109711 l'd~r~hi1h11~hl~IhtNtttlgP,ptt~pi•q•tptD•pllt•l~t~ Alnnoane Pala ^~llrtEatt+tltNftAUTOrHES-DIGIT 17007 Please Pay ~yQ,00 e0003e00 01 AV a.Eb3 oue9y itpnv4,2trtt ESTATE OF STEVEN N HETRICK I25~ KUNN RD NET-EO IOIlltilr SPRINGS PA PO trOX 3f07 17007-l449 AKRON ON 44319-3197 LLd,lnh.lbllud dnnllullolu66u11ab1o.L,d11 D210002338973]0000000000000000000000029200000029200a Ei11Ad IDOOree ei Gledt (EITCj it ~ fax aedt fa aertin btirr~inoalw hrtiMe and (ndivtduale, For Inbnnelal end b detamlilw it Vau quaYy. aknply dY i~100849.1od0 a vieR wiw,Ma.lovMndviduYe. RMMnk. R.eycla• Rerlwrd Chenos era Iha old lelgeratar a Ieealr in your baealrwlt a garage k nmillp up your utBNy bit by an avw-ape a s 1w. year. ~ieoyde H, i.a,a. yo,r anwpy,a,,.nd hwp hwnwu melemu out a irldrdts. we1(plck K up of ro sort end ytxi7 pklf l4 i50.7oteam mole, volt www.eneryysexepAoom end slick an ADP~~e TttltHn ProQam aoe8 i-0Tl-1T0~3621. lsNew Mth. Pdolo IAed•EdY OefiW Selviw itav9 a new Pita to CortperR e0ectlur March 1.2011. Please ca,npene ilNOnrletlon etxlwn on cape 1 d yolr oft QRac6re March 1, 2011. Mrs sa a aflerga b M Plor,.Utlily tsa,wedon Ctnlga, wtlkh recovws aorta se.aaiaprd 11~hOlalifaee Dear emb•.~ „s,. ~,..~ asr. __._.__ x, Cal MiEd al 1.100.645.771f rNO aovlds ~~ ' tArwlene ea fllaaa eJlxlae. 9aaie Charles Cueba.r NueN,a. oeoraeioTS oass4aew - ReMdelltlal TMaa Ot 0ay. ktE-RTo l O etEufon ~n oNlonn~ r ~ o ~ ai ~ . i oe Total DfatrtbtAlon Chelgaa ~~ OFPKWH x 0.013066 :z o 30.E Careurwr Eduuaan Chsge 3,T1rJ KiMN x U.000130 BoIK ~rofnarb Charpa 3 715 ~~ 1ZS.82 0.4, , KWN x 0.000070 Default ~"'~ ~ 3,715 KV1M x -0 001250 0.21 . ~IJ<hb Gwwnlon Clwlge 1,363 KVYN x 0.007950 x 0.3167 10 84 rLN Tutd NariA#y t,~ar,aradon Chalge f~R952 KYIM x 0.005450 . --~~ Prloe b ~e ~~ Sella 1,363 KWN x 0.088800 x 0.3687 120.78 2~ ~• Default SarNa Ct yw KWH x QOb2A60 195.12 ~ Smart MMer brpe ~ 515.11 Stab Tax Surchwgs -•--..._ ... _._ 0 3a 1Aa Total etch Tu 3u,oharge deeyee .. ~ . -`~ Y - •.•~_ . Taw charl.e ~ 9.l1 ~ Pryernes: .-rt at . o2r:ertt -266.19 Total Paymeltee Tehl PaynleMa Aed AdJue0etale X291.1! To pa/ lrour accotak is ttlK yea owe f1,3e7-9s. 03/2312011 14:08 7247354836 NELSON TIRE PAGE 04104 4~count N~mbe~; 1(3 UU 11 1t~/ 3 S rage .s or a ESTATE 4F STEVEN M HETRICK invoice Number: 954427256 >49~'1 Earned invome Tax Credrt {EiTC} is a tic credit far certain lower-income families and indvidueis. For information and to detennit~e if you qualify, simply dea11~00.829-1040 or visit www.€rs.gov~n~viduals. Rethink. Ftecyclc. Reward. Chances are,,tlie old refrigerator a taer in your basement or garage is running up vow utility bill by an average of $15a a year. •Recycle it, reduce your enemy use and keep harrrtfLd materials out of landfills. We'fl pick it up at• r1o cost and yore'// pick up X50. To Loam more, visit www.energysavePA.com and click on ~+ppiiance Turn-In Program a< call 1-877-27Q~521. Gusromers receiving Med~Eds [)efavit Service have a new price to Compare, eilectlve March 1, 2011. Please review the Pnce ro Compare information shovun on page 1 of your biH. Effective March 1, 2019, there is a change to the Non-Utility Generation Charge, which recovers volts associated ...'.lL _..~L--- ------- ... ..__ irxa•an Etec~tc Generapan Supplier, please prord~te the-c~rstomer nur Call Me~Ed at 1-8d~-5~45.~'74~( v~ifh questions on drew charges, Basic Gnarrges Customer iVuttrt~er: Ot301581076 0002349949 - R~idcr~al Timc Of pay - ME-RTD Dtatribution Custflrner Cha~e 1.593 ONKUVW x a.06a~45 2,322 •OFFKWH ~ x O.p93058 Total Disiriibution Charges Consumer Education Charge 3,715 KWW Solar Requirements Charge 3,715 KVIIH Default service Support Charge 3,715 KWH Non-Utility Generation Charge 1,363 KWH 2,352 KWH Total Non~Utelity Generation Chargo Charges Pace to Compare Default Service 1,363 KWH 2,352 KWH Total Price to C Default Service Charges Smart Meter Charge State Tax Su~harge 11.00 84.20 30.52 ---i 2- 125.57 0.48 0.?.6 -4.s4 x 4.000130 x 0.000070 x -U,o~79250 x a.0Q7g50 x 0.3667 10.84 x a.oo~a~o 92.82 23.66 x 0.085604 x 0.3667 120.76 x 0.082860 195.12 513 .88 ~.~.- ..«~..-. •- .... .w .. ~ . .. .. -. .r... -. .. ..-..... .. .. . -.. Total StatE Tax Surcharge Chcrgoc Total Charges ._ ~ Date Reference Amount • Payme~: 02~28l11 -296.19 Total Payments Total Payments and Adjustrnen~ 23.66 - 315,88 1.0~ 0.3$ ~rrrrw~ {,~ 0-'~ 0.56 ... -;296.19 04f 22/2011 13:36 •. 7247354836 NELSON TIRE PAGE 04f43 WEST SHONE EMS - ~A~LjSL~ ~ . ~Q'S GRANtiV~~W AVM ' SI~~TE 2'f'1 ~ vr.~ a ~av~ CAMP 1i1~.~., PA 17011 Phone #: ($OQ~ 3~7~05~12 F~-dera~ Tax 1d: 23-24.5300 ~ oN REVERSE~pE PATIENT NAME: STEVEN HEl'RICK CALL NUMBER: '~'~ ~~ ~$~ STEVEiV HETRICK 343 dEORGE .1ltN~OR RD GROVE CITY, pA 16127-44'18 D~~4Cf /ALONG PE'RF~ • -:DESCRiP'ir:Ia1V~.~F:CH#I~CE~~:•: - -• ~ .~ ti • 7~C5 E'NCE'Rc~"Nr:Y LEVEL 7 ...-. .... .RO~ ao~rr Tu~IN~ Ao ANOIOCATH (1424) • A03g4 EKG EE.ECTRQpE$ (')) A4396 EXTEtVSION SET 8" NEEDLEI.ESS AQ394 GLUCOSE BLOI'?t7 A039A IVSS 0.9°/a 1000CC Bag A0394 OP SITE A0394 SALINE PREFI[.LED SYRfiVGE Ag394 iN3URANCE: PRfV DATE CAF CALL: 01/24/2011 C FROM: 1256 KUHN ISO To: ~ HOLY BPIFtt1' HOSPITAL TOT1~L CFIARC~S: '~ 035.1$ • PAYMEPfTSJADJUSTNIENTS: O,pO ~-sE ~aY TH1$ A1~rouNT: 1035.18 fiN~ REFURN_SiT IB W IT_ N FAYM,,~NT_ _ ~ . ~~ ~( ~~ s ~~K y~LLyy~y.yy~~y.. ~'a.'. 1.0 9©7.62 9'67.62 1.0 14.72 14.72 1'0 8.72 6.72 20.0 p,$0 1$.00 1.0 12.52 12.52 1.Q 7.08 7.08 1.0 3.48 3.48 1.0 1.92 1.92 z.o z.5o 5.1 ~ . Total Charges • 1T R~~ • ' • •:.• D~IP`Y'i'OH :C~ ~A1~IVIEN7''~ ~ •~ ~ . _P~ . ., ,.. :.. ~_ _ _ ._ ~ Total Credits ~.OQ . PLEASE PAYTHIS AMOUNT-INVOICE DUE UPON ~ECEIF~T •-~- ~ . •~• :~.~ ~ ~ ..' .. ~ .• '• • ' . ~~~ ..4: RETURNED GI-IE~K EEE ~ $3~.OQ ~ • • PATIENT NAME: •, HETRICK' STEVEI~I~' .. • ~C/~Gti'iVt~M~~R:' ~ "~:'~ 6r~~'' • ~ ~ • ' • ' . .. • . IIVIPORT14NT MES`SAC~,ES: • Tfais account 1$ raw PAST' L1t1E2t P~ment must be re~fved • WITHIN 10 DAYS, Collection process will begin. ~ WEST' SHORE E1VI5 - CAt~LISLE Z05 GIiANCiV1i;VY VE SUI'CE 211 CAMP HILL, PA '17011 04/22/2011 13:36 7247354836 NELSON TIRE PAGE 05/43 ' N I , G 18TCE1b, Oi OQt 001 UI~1 Q1 BRQ01'TCE' U ~ . -~._ C~-MP •NILL ~JfEF~GENCY Ph~tY~ICIA ' ' / T ~ ~~) . St ~ SOX 1389.3 • F ~temet>t D~te:.February 25 2011 PHILA[1EL1~HiA, PA 1O1O~I-3693 ~ , B R: !'iYP389~7~#61 ~$-~ ~iIA • Potii N~ ~ F ent -. . Accoclrlt ~fdttCe: $1,'118 04 ' . ~ttrount Fendii~y~ . Ial~tirartce: ~Q.00 • ~rtt~~rr~r~rt~l~hr~rih~rlt~~~lttrr~i•~t~i~.tli~ritt~a ~~t~t rr Amount Due From • n $i~,f ia.oo . , ~o~n ~e~o • r t . •~8'2~]re[~i~•C]ODLaa~$'~l~?N61~ ~b ~ r .. .~ttent. past sue :'aa ,po . • ~`~~~ '#~OOOpOH.Yf?~A~59978i# , ~. Pay 7~'fie Atrioslnt: s1;iiD,oo ~ ~~ • `~'~`. ~VEN'M #~~TJ~J~K 9256'KUF~N Rd' ' . P~EASE~R'ENIfT'P14YMEIV•T9Y "paYl~+ra~v`rt~•u~ sr' oA~ SA - BOtLIIVC SPF~GS ~A 17'00?,9649 ~ . NK You. Please•~er tb c:o~p~ berow tar . • PgS~~i ~R5tR1CtiORS. ,~'~Y yacrr larn ~e~.r~ly ~anlirte:anygme at vyww,~yiyMedicalP • ~ • aYrttents.corn . . ~~11 +~oe 1 t~2 88~ MERGgvc:v SEAL a n~c~ Paid y ~ ~Ir~ frir, Older f bg. Patbr~t aim ~ r~ t 1t7VT useed • 7nsurrr,ea 5I1ll~NCE ~ • S1,ChtW t)X;427.S DR, Dt1EINMIpIY ' .• ~~~ _ ~SPIR1THO5P17At 2 99D83 5'RVC,S REdsTq 90PM. 8AM IN ., St,a24.00 ~4a7.S CR, LXJBINMQLY . ' ._ . SPtR1T No$pITAL ._ . :_ .~~ - ; , '~1~5l1, 3 947Bp-28-213 N4N-iNV1~.911-E PULSE , ~S3ab0 0?UMETRY S54,Op 0X,427.5 C1R. bUBIN/FIdLY l~IR17 HOSPJT,M. ' . • ' ~vl~ EN~lT ~IAY IVaT R~LeCr ArcY PAYMENTS U MADE r ' . SSa.a4 TIBAS OF ~ • 1 ' ~ ~• ~~ l'LJl•i41;S: ' 5,,~~lOOfi ,5C-.00 - •10.00 Shao .. , ia.GO ~ sa,w 1~~t#'~~~e .. ai,i,aoo Tf-is GIs (br thadirsd t+ti'~rierrt and/or xu Hi ' ars bAkd ssQaraaey,finrn ~,~, ~Pl~.chA~es ~ other I>~sslonal.~ ~or~a ~~ from an. ~'A~'n~Y'Physlctan•a! Holy Spiritl.•} PhY'-ems 1br d+arves p1 dav~;r~r, Mfr nn: viG?, tt wrh r+ot Inrk:d~ irhr Aerrtdr II~bO o~if eis ~~~,~~s~rtafbFe.' 7H~nd'eu+~,:.el~a~•y~+t s b~~rh ~~ P~ Dt-y9ldan . r~+i~yiGMar dhg~ •; ' "R~tym~en# J~ians" Ac~~ed ~4uastii~r~s abr~ut the st~t~triet~t? j I..i,~T1e ~de Lune~.•a~ Wiarrteg7 • Ca 111 ~~ t1O'..2~~'~0 M o nday th roeggh ~rtdayy 9: 3'OAII~• - •4:06 f~Jili, Your autarnated system ac~~a~ code.is Q8O~1~894T461, or • brtling ,q~~l~ons~c>fhcawe.~om. ~~:caR•Slnd ~triail'to •Pieas~~ detach a~td ~rotu~ .bo~rn.:portiort••with ~i~ur rer~tiltar~e: ~ ~ ~~ 04122/2011 13:36 7247354836 NELSON TIRE PAGE 06/43 ~~;~r%^~.•.~~;~,.~.•-,...4,~T .i:a"4-,' ~4r.ar?=~yy,w.:••~~"'t''^• 1~y ~•"~:'~,'ra'k3'. r..... Si~lirlg Mice ~ . :... ' ;~: `: ', _: ~ 'i 1-89419 p'~. Bax 728 ~ ~ ; • 2/~~12011 $880.1Q New Cumberland, P/~ 17070 QVESTI4hIS ABbUT TN~S BIL~p phony: $77-2x4-6018 l:,sq~nol: 888-~Za~4114 Faxs 7x7-Zi4-6420 Fina~t` ir+4~e~-arr~but °- #t1C+Vi tltn ~~~C~.corr Date of Service: 1/25/2011 OO:t77 Patient Name; Hk•fRlCK, STEVEN M, case visit our wAhsitP to provide insurance cr makc Payment, ~~,~ From; RESIbENCE for additional payment options and fi'equencly asked questPons: To; Holy Spirit Hr~4pi~fif www.arnbyiancebiiiin~offi~e,com ' . ~*r`(YrGti7C•f~~~.I..;,:f'{. `Jn.,. d'C3'.r1 .K°~i;?~~:.'~`•- ~.~•~~,{~7•':• . •«y 7, a<f~.; /}~/~~~ J~••.r :; ".iY.'.~ '^'•, 't ( ~ h ~~ry~ 4F •~ ',~i; ` ~~lr•~yyy1~~~.///~~~~Y`rk ~'~~ ~ ~! r~ yS'a 'e. ,~f'C ,n.K~..~.Y`...~/wq: w~S. r'.•; - • ~M I.~~• ~[~ •'~~~r ~Y ~i pFyy •,a r i'` •.h' ~ ~ ^ ~' ~ 1.~. • . ', ~.;~~~•~ •1 . ~~-~~~iC~~`I~'I~~ •.J f',~~ iii ..1 '~'v. M : - ~M~:.., J. .'. ,3 . ,.~.'•-'•; ~'~ -~+~~..e '.~ ~'V1IL~r!f'i0 yy~J •!• ~/f~Z '? ''•.,•,.~,ew(•r 7: w~+-.t.. •? • w.:,, ~'•.'; -1+. ~ .,r. 1 4~1i ..J~ • • ~ ~ P 1/25!11 6LS Emergency Transport Ap429 9,d 650.00 - .. . 1!25/11 Miieage 650.00 !10425 1 ~' 7 i 3.00 230.10 Tota! . sso. ~ o o. oa o. 00 f 04/22/2011 13:36 ?247354836 NELSON TIRE ~ r r~ OF .... _ , . • ~ «. ;~, ~. ~ f'71.. Bp.L >~7EpF9l~ U~pt= ~~3 ~ ~~~T ~T PRi`1I, BtIA ~_ PAT~p~ NAME f , PATIENT NUM9ER GW1RANspR ST~',r~r~ M HETR Z ~i~S NAME ~ ~ ~~ ~ ~~~' HMO ~ ~ ~ L I N^ ~P R. x ~t~~ f•' A 17(}07 acvaESs NAME GROuP MlM9BR p•-- t'i Pi.EASE RETURN THfS ~'OaT)Oiv WI '~ YOUR •PAYM~NT. '~~~ I~~~~ AMOtnvr OF . _. .._ - DATA .. .. ff'''~'+'~r'"' PAYMENT .~ - ... , '4STSd rio8p TNpg~ CES 6~~E TOTAL FST COVERAGE w ... _ -- . . •- (:NdRf~~g rN~. C4. No. t E3T: CovERAGE RcT f,`C51~fiRAQE ~ ~~ ~ NW ~~ rNS. co, NO.z iNS• Co. NO.3 C~ covtnA~r PArrENT ~i4~ ~~w~ ~ ~hEU ~ ~~''~'~`~"3 ~ ~ tIYS. Cp, NO.d eun~ u.,. ~~S C.._ i ~~VIPU1~iG7~ij~ .-~ .a a~ ~i z ~a~ .s~'. 4G~ ~~s ~~~ ~ ~~ ~~~~r,~z~ ~ w~~ s a~~.s~a= ~s~ ~~. ~a s~. ~a ~r^^_~ r~~- ~?1~~~.~253. i its. C14 l~'~ , ~~ $i~tt~ C?1~~1QE'~~ $9 ~^~. EiQ !~~ ~ r~TA~Q~ i C i='~i~~t X31 ~ ~~~p X59. 4th !~~ f~~ . ~~TC3TtE, Plr~~i:~- 4Ic~2Q1'~G2 p~ Ib9. QQ ~~~ tar~~~aT. ~~~o~~~~a~.~a ~$ b~. ~~ f ~~ c~~~~~a~i.ti LCn~€~3~,~ = I~.~A~. Q1~S2~~44~ bb. 4~ ~ ~~~ 1~~ TAT DR~~ ~~' A~Df~~2Qf~~~S 7AT 2 b. {~~ i~i~ DD f~~, DR~J€~ d~ A~~S1~~~0~f z TAT D~~l~ ~~ ~,~'~}~~a~£~ . 1D4. QQ f~S ~r 1. R~~I, ~N~ f~t~l~aD~~~2?t1L~ C~~. Da ~~~ ~~~• ~ ~~., At~TC3 DI~F D f ~.53~i~J 1 R>'~rHFZ~]M~ I ~ -•r I eta x ~s~Q3 1 i ~. t~(3 ~~5 ~t?7 ~~Ih1~#~, C~UA~ITI i C~f~'S~04~0'~ ' '~~ `~S ~~f t~h1IN T D1~~~Q~~?~f iC~ ~. 4D ~'i OQ `~3 XYwEI~! F'~~i I~l~~3RCli 5t?'iQ!-~?4 ~NTfA~ 't"E~P . .. fr , 44' '~a .. ~A~1~~3 f .~at7~~3?05 fNTUBATIOi~i ASSit~1.~~~a~IC~ ~4r~2. Q~ ~~ I ~ ~' ~~ ~ ~ ~ 1 1 ~ 1 C~C)~7~~ 2~ RIT~CA~ ~.t4, wQ ~R9. 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Q~ i ~ ~'"fR,' Q ~ .~ ~'~ . ~~ 1~~. ~C i 84 . ~~ a~. ~C 3E# . CC i. 0~ . IY PRAT t7f INSUpArvGE 04122/2011 13:36 X247354836 NELSON TIRE ~rf_~ C>,4TE OF 81L1. ~'f'F 0~ ' ~~~ ~ ~ ~. ~T ~~` PRFy. elll. ~t~q~r1 ~ ~A,"fp ~f1'L~,~ PA i PAl'IENT NANtE PATiCNT NUM9E~ • i - GUAf~arrrnR ~TLt~E~; I''ir1~TF~ I ~!~ NAWE ~ ~ ~~ ~ V ~~'~ R:~.i AND g~ZE,.i NCa ~pRlhi6~ Prq 1 fCi~~ ADaRE,Rg AC3E ADMIS9fON DqT~ DISCHARGE DA~~ DAYS a~.~AS~ ~~-u~rv THis Pc~ ~ ~ ~o~r w1TFf Yl7Ut~ii ~AYM~tvT ~~x~ ^~+ . v ~ C P 3tED OESCRI p N06PtTALPTION ~ _SERVICE Si:RVICE;S . ~ .. ._ _ I~'i ~'Y MEIY T ~ - - f~TA CODE z ~~ C:I.~~'i ~ ~~T G~~~ C~ v ~ c ~Aeee ~ta c~AGE ErN3 CO-nRp 2E F ~ ~ ~~a~ ccr. apv~~~ ~ Q. Nfl.3 INS. Cp. 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O~ ~~. ~#{ G 1 Sa4Q3~~} 1 ~s . OQ i ~C . ~7c: i~. ~C ~r1:FiAt rDGNT. PiO. ~3 Y at t*r.~; PATIENT NUMBEl4 REFEfq ALL QV~5TIONS TID ~HI~, ' BuSSNF,., (~FFIGE (717) 763-213$ P~~ASE SEND PAYAAENT T(7: . HOLY SPIR#T HOSPITAL, ~Q3 NORTW 21ST STR~ST' CIiA Gr_s NOT S7'EOIWHEN TFIIS BELL WS SR PR~p ~K CAMPHiI~I,, I''H.1TU11-2288 ~ T~hRiEf a QUNTSCgH01MVfUNDEt~ ESTIMATEDNntgU RANG Cta1 :E. PAGE 08/43 PAC,F r i 1 r' 13f S6 35'flt~ 04/2212011 13:36 7247354836 NELSON TIRE 81J_L DltTE OR AIL PRE~BILF.L X43 ~ ~ €13T ,~~' . • ~2/fly/ 1 ~ CAf`?P hIZL~., PA ~ai~~~ r~ ~ 7b3~-~~ ~8 PATIENT ~IAMF , S ' ~ ~' PATIi:NT NUM6Efi ~~RANTdR ST,~4f~~ ~`'1 i-i~7'R r~K NAME ~ G~y K~~"f~ ~~ c~ aaaRESs AGE ADMt5S10N pA~ DISCHARGE ~,. DATt; DAY$ PI EASE RETURN TT-113 P4 RTIQ(~ WI1.Ff YOUR PgyMENT: ~~~ ~ AMOUNT ~ ~ BATE OESCRIpnON OF ... .~~D I"IOSPITAL SERViCF$ SERVICE - - .. ~ , Op ~,, Ir - ~ ' PAYMENT . .. CObE CHARG E"£ E NS.COGOI!EN`gGE EST. {`, RAC,f~ SST. C~AAeE _ INS. jvp, ~ IN$, CO. N0 3 C~ Cpv~~E PATIENT , ms. 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J.S•i T~~~. ~~ rtDCRAI IOCrrr. +~a,1:i-1517. l4T 'A'GENT NUMBER REFER AI.~ QUE3TIQN5 TO THE ~~c~,~'7,~~ ~ BU$INg5S OFFIgg t7Z~1~83~2138. ~1L~` ~P ~ R ~ T Nf,1~E~ T T~~ PLEASE SEND PAYMENT Tp; HC)LY SP~~1'~ HosPITAI~ 503 NOR'i"H 2iST $TFIE~ CAMP HILL, PA. i7p1 i-2288 ~~ P{~Y TH~b A~1£3tJN7 ~5~~. 1~ ADDIT.ONA~ PATIENT BILLING MaY 8E NEC69&4RY ppq aK RA FG ~ ~URAhlCE SC pRtE~ENDO Nsp"r8'I r~v1`/w~NYpR~RTRo THE aMQUNT$ SHOWN UNDER ESTIMATF_D INSURANC' C4UE.T PAGE 09/43 RAGE N ~ ~ ~ ~ ~f ~~ ~~>~~i 03/2312011 13:42 7247354836 _ 1 H~?LY TYPE~t7F EDAT aF Bi- BATE OF SQ~ GILL PRPLJ RTI 1 ~ h~b ~l2I 2fii 7i,7 F ALIbD NELSON TIRE SF' ~ R I'f HL~P ~ TAI. h# 2i8T ~T wtI LL., I:'A 7~3--R 13S PAGE 18/20 . PAGE N0. R T~"'~-D14~"~ HOSR No. 11/1~15b 34Q00• PATIENT NAME ~ PATIENT NUMQER ISEX~ AGE i ADM15510N [LATE D13CHARGE DATE DV1Y8 GUARANTOR 1'IAM! APlO AOOPE$S STEVEN M 1-I~"t'~ x Cat i ~Sb Kv~~~ ~n H£1~LING BPRIhIGB PA 1'?CS07 ~U~ NAME ~ csROUP ~M~p j PQLICY NtNuIBER PLEASE RETURN THIS PORTIUN WITH YpUA F'AYIUIENT. ~~~ ~~ AMQtJNTOF F74YMENT $ ~~,. .. ~ w BATE DESCRIPTION OF POSTED HpSPI'TAL SERVICES SERVICE CODE TOTAL. CMiARGE5 ES I, C:6wrHn~t INS. CO. Np~1 le3T, GdvRRAG6 INS. Cd. N0.2 Cti*T. GOVERAtiE fNS. Cb. NO. S Esr. COVCR~OG IN$, CO. N0.4 Ix'RBVT AMOUNT ~ETAI _ f_1F f:! 1RF~FIV1' Ct~ARGES. PA Eld"f5 AN AI3JU2TM T~'a ~i25 PDRT PIMP SETQ2~~1.~40~?1. 57.40 57, ~} L 125 IAIJ ATI~tQP IIVE SU4144 x.2007 17. 5Q i'~, 5 ! ! c 5 I nl•~ AT!'t C1f' Y IWE S~J4 .R 44 i 2Dg0'7 1.7. 5Q i ~' . 5 z /25 ~iVJ ATRi]P I~IE a~`U~p 144 i 2043 17.54 1?', 5 i /25 ~~IJ ATRt~P I~JE ~V414412C?t~7 17. 5{~ 37. 5 i J 2S I ICJ ATR i~P ~ N~ ~U U 14412t?O7 17.50 ~,1 _ i X25 Tl~J ADR~I4AL.I M Q41.441.2441 17. 15 17. 1 Ll25 XI~,~ ADRL-NAl.,.ZM C?Q1~~•i2041 1~'. ~,5 ~7. ~ I, / 25 I NJ ADR ANAL I ~ 001441, 2f~41 17 . i 5 ~ ~ . i i f 25 I MJ ADR~IVAL. 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QO 3F~. Q 1.185 t~~ PG--INT'~RPI~i~C}1?3132045 38. QU 38. q FEDERAL IDENT. N0.23-151277 PATIEPlT NUMBER R~F~R ALL QUESTIONS TO ~'ME BIfSINESS OFFICE (717) 753-2138. 7247354836 NELSON TIRE I*1t~L.1~ ~P ~ >~ I T ~o~P ~ TI~~. 543 N ~tST ~T ~f4MP NILI.., ~~'~ ~ f 7 ?~:~-~ i 3~ PLEASE SENQ PAYMENT TO: HOLY SPIRIT HOSPITAL 503 NORTH 21ST STREET CAMP HILL, PA.17011-2288 ADDITIONAL PATIENT BI~UNG MAY 9E NECESSARY FOR R ':(•IAAGEa NdT POSTCb WIIEIJ Tlil~ ®ILL W/~3 Fi"iCIW ~ IF INSURANCE CARRIERS 00 NOT PAY ANY PART CIE AMOUNTS SHOWN UNDER E5T!MATEO INSURA~ COVERAGE. TYPE o 81t,1 ! P AUOD PAGE 20/20 . PEE [30. B I ~t~'N-~AT~ Hasp No. 11l13/~~ 90Qg' ~ ~ PATIENT NAME PATIENT NUMBER 5EX AGE ADMi3.`'sION QATE DISCHAROts DATE DAYS T , 3 1 D.O.B. INSURANCH CdMPiWY NAME o~ouP nNMeER POI,IGY NUMBER GUARANTOR STEti1EN ~ 1~i~TR ~C,,K n~rwe t 2 ~tS ~t1.tf-~Id RD BQII...IhiG SPRIN~~ FA ~,7Q10~ A~ nDDAE55 .. f7LEASE RETURN THIS PORTION WITH YOUR PAYMENT. ~~~i~G ~ A~otMEN°F ~ .. - _ .. DATE DEBCRiPTiUN OF `.irt•IVIC:t TU'T)4L EST. GOYCI'IIK9C Eg'f, GQSIEPSA3E C"JT. OOti/G~IAC : CET. GCVERAQfe WITIC(~fT P03TED HQSPITAL SERVICES CODE CHAIRGES INS. CQ~ NO.1 IN$. Ca, N0.? INS. CO. N0,3 INS. CO. NO.t AMQUNT ~UI~M Y OF O~3~Ii~NT OWAR~GE~ f'WARi''IflG Y ~~D 39~ . ~{~ 3~, 3. 5 r~~s ~UR~~~~s ~~a ~5x . bn 851. ~ LA~~RA~TORY 3t~{~ 1 ~Sb3. QO ~+~f~3.0 RESPIRaTpf~Y 5U 410 E?f3~3{?. 00 ~C~O. t~ ~i+'F~R~~NCY ROa!"! 454 3138.00 ~ 3138. Q F1r.+afECQ 7'34 ebb . Qq 66~i . (~ ~U~~- TAl_ OF CUR~i . >;HARGES X518. ~t~ 9518. 1 FEDERAL /DENT. N0. ~-151 Z7Q T a T A L S ~S#.8.14 A4TIFNT NUMBER REFER ALL QUESTIONS TO THE pLEA$E $END PAYMENT TQ: 38947'47 ~~~ ~~ ~ ICE HOLY SPRIT HOSPITAL HC3LY Sly I R I T HC1SP I TAL 503 NORTH 21ST STREET CAMP HILL, PA. 1 701 1-2288 CAMP HILL, PA 03/23!2011 13:42 7241354836 NELSON TIRE ~ #~ QLY 5E~ ~ R I T NIISg T T1~~ ~ DATE Of' BILL nATE 4F ~Q3 fy ~ S ~T ST t~RFV RII I ~ ~~~ H ~ ~~ + ~. t~2lQ~! 3,1 ? ~ 7 763-21 ~~ 9512.: I PAY TMIS AMD4NT 9518.: hDDIT10NA4 pATI NT BILIMIG MAY FI'£ NECESSARY FOR 'NARCES NOt ~a$TFD WHEN THi5 811.E Wl1ti F'Mltt'A A iF INSURANCE CARRIERS OQ NOT PAY ANY pART THE RMUUNTS SHOWN UNDER ESTIMATED IN$uRA co~~r~nr,>:, Febxuary 07, 20i 1 Steven Hetrick 1256 Kuhn Rd Boiling Springs, PA 17007 N~klCl ~ ~ ;Z C~ *~'~~~~IAL, ~~3TI+CE~~~~ Dear Customer: We have made numerc:us attempts to contact you regarding customer number 734894-4Ufl0. Your account with Penn Waste is SERIOUSLY PAST DLTE. The total axtaount due 552.6.4 This is our final attempt to collect directly from. you. For your convenience, we accept VISA and NiASTERCARD. Please visit our website at WWW.PENNWASTE.COM to pay by internet.~ To pay by phone with your credit or debit card, please call us at 7l 7-767-4456, or .fill out and return the foam below. if payment is not rcceived iminediatety. your account will be referred to the District Court. ff you have already paid the above amount ox have sct up a payment arrangement with us, please disregard this notice. If you have questions regaa-ding your account, please contact us at the number listed above. Sincerely, Penn Waste Inc: ray . n ~+r~tnt-r ris ~a»t FENN WASTE, INC P.O. BOX 3U66 YORK, PA 174Q2 Phone (7l ~ 767-4455 Fax (717) 76?-4285 REV-1513 EX+ (01-10) ~ pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Steven M. Hetrick 21-11-0268 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME ANO ADDRESS OF PERSON(S) RECENING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1• Sean Hetrick 323 George Jr. Road Grove City, PA 16127 son 50% 2. ~ Jocelyn Larson 1735 East 33rd Street Savannah, GA 31404 daughter 50% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $ If more space is needed, use additional sheets of paper of the same size.