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Home My WebLink About03-0454PETITION FOR PROBATE and GRANT OF LETTERS Estate of ' ?c,,s_,x, \, cx o... ~). kS~' k'~ No. also known as ~.;V,,mq., Dee_- 4: ~\ To: Social Security No. Deceased. 21- as- qsq Register of Wills for the County of C-- Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), whot~are 18 years of age or older an the executo in the last will of the above decedent, dated and codicil(s) dated in the named i~q~-:~_ zo, z.ooo (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in C,,,~-"'xXoc-~l~c~'xc~ County, Pennsylvania, with. h ~ last family or pnnc~pal residence at ~- ~ ...... , - . ...... ' ' (list ~tre~number and muncipality) ' ' - ~ ( Decendent, then ~ years,o[age, died ~"~ ~ , W ~oe & at ~,x~l ~',~:~ ~5~ ~ Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: ctM~ [.%.0'"-' S'Vcee-¥ Ne-~ ~..;~.~-¢ck,..-~ ?^ 0 WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters ~ ~ c~'-°-~<r/x°"~'~c ~ I (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. OATH OF' PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ COUNTY OF a_~,,.,%~,_n_.u~.~.A f ss The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoi.ng petition are true and correct to the best of the knowledge and belief of peti~oner(s) and that as pe~onal represen- tative(s) of the above decedent petitioner(s) will well an_d trul/fjidministe, r~he estate~ording to law. /'3// Sworn to or affirmed and subscribed ~ ~/c~ ~/~.~' ~ before me this ~ day of / / .... ~ ~' r o. OS- Estate 0f '~.~\*,f~e__ X3. DECREE OF PROBATE AND G~NT OF LET~RS , Deceased AND NOW ~L~c~0._. ~: ,-~0{).;~ ~'. , in consideration of the petitionon the .reverse side hero f, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated ~' ? ~; ~ 2_~, Zoo o described therein be admitted to probate and fil.ed of record as the last will of ~-'~o.--.t.--:c,e.._ ~ . and Letters are hereby granted to FEES Probate, Letters, Etc .......... $. Z '3 ~' .o,2 Short Certificates( ~ .......... $. ~ ~-' o~ lc~F $ Filed .~a .'.~.. 7..O,..~ ........ ,.: .............. A'I'TORNEY (Sup. Ct. I.D. No.) PHONE his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Ix)cai Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 9 0 9 4 5 2 6 0 5 [00 Local Registrar No. Date COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH D. Hill ,Female ,.174 -- 14 --0778 84 ~,. , : ayl 0,1918 ewickley,PA ,.~,,,~ ~o~,,.., O ~O "~ ,~.Cumberland ~ast PennsboroTw~ ~/~ ~,k,W ~,~/ 1~ .... ~o,~ .... ~,~. White ,,b Home ,, ,~ {0,~ 0~s., Wid~~ ,.. Homemaker . . . . ,. ,,. DECEDENT'S MAILING A~RESS ~1,~. C~.~n. ~. Z~C~} ACTUAL~CE~NT'S ''.. St.,. PA o~ ,,.,~ v., ~ ~ ~. Fa irview 318 Emily Lane .~s,o~ ~. New Cumberland,PA 17070 ~..,,,o.~ York ,~..~.~ m.~ ,.. John Michael Hanusik ,,Mary Kostival ,0..oonn a. ~a~nv~e ~. 318 Em~7 Lane, mew Cumberland, P~ 17070 8~al~ CromalM~ Re~h~Stale~ (M~.Day,~) ~.,~.O ~,,s~ Oa~pril 5, 2003 ,~gn-o-Lite Crematory [a,~chaefferstown,PA 17088 ~"~ ~FUNE .~CE LICENSE OR PER~. ACTI ASS~H IL~ENSE NUMBER NAME AND A~RE~ ~ FACILI~17 7 ', ~u~. EnIM U~LYI~~ /-- -~,c~ ~,.~o.o.~. / ,,galion, in my oD .... deMh ....... d ,, the lime. date ,ndpl ..... d due ,o Ih ...... (,} ,,d ~/I f~ ~ ,,.. ..........~ .,,.....,-.." ................................................................. : ........ : ....................... o ,,. C~./~' PA /v0,/ LAST WILL AND TESTAMENT OF PAULINE D. HILL I, Pauline D. Hill of 949 16th Street, New Cumberland, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils by me at any time made. ITEM I: I direct that all inheritance and estate taxes becoming due by reason of my death, whether such taxes may be payable by my Estate or by any recipient of any property, shall be paid by my Executor out of the property passing under this Will, which is not specifically devised or bequeathed, as an expense and cost of administration of my Estate. My Executor shall have no duty or obligation to obtain reimbursement for any such tax paid by my Executor even though on proceeds of insurance or other property not passing under this Will. ITEM II: I hereby exercise all powers of appointment which I may have at the time of my death in favor of my Executor, and all property subject to all such powers shall be included in my Estate. ITEM III: I direct that all of my household fumiture and furnishings, automobiles, books, pictures, jewelry, china, linen, silverware, wearing apparel, and all other like articles of household or personal use and adornment pass to and become part of my residual estate and pass as set forth under Item IV below. ITEM IV: I give, devise and bequeath all of the rest, residue and remainder of my property, real, personal and mixed, to my issue, per stirpes, to be distributed to them by my Executor in his, her or their sole discretion. In the event any of my issue predecease me and are not survived by issue themselves, then such share shall be divided equally among my surviving issue, per stirpes. ITEM V: In the settlement of my Estate, my Executor shall possess, among others, the following powers to be executed for the best interests of the beneficiaries: (a) To sell either at public or private sale and upon such terms and conditions as my Executor may deem advantageous to my Estate, any or all real or personal estate or interest therein, whether owned by me severally or in conjunction with other persons or acquired after my death by my Executor, and to consummate said sale or sales by sufficient deeds or other instruments to the purchaser or purchasers, conveying a fee simple title, free and clear of all liens or trust and without obligation or liability of the purchaser or purchasers to see to the application of the purchase money or to make inquiry into the validity of said sale or sales; also, to make, execute, acknowledge and deliver any and all deeds, assignments, options or other writings which may be necessary or desirable in carrying out any of the powers conferred upon my Executor in this Paragraph V (a) or elsewhere in my Will. (b) To pay all costs, taxes, expenses and charges in connection with the administration of my Estate. My Executor shall pay all legal expenses of my last illness and my funeral expenses. (c) To distribute my Estate in kind or in money. If any assets are distributed in kind, they shall be distributed at their respective value(s) on the date(s) of their distribution. (d) To retain any investments I may have at my death so long as my Executor may deem it advisable to my Estate so to do. (e) To vary investments, when deemed desirable by my Executor and to invest in such bonds, stocks, notes, money markets, real estate mortgages or other securities or in such other property, real or personal, as he shall deem wise, without being restricted to so-called "legal investments." (f) To mortgage real estate and to make leases of real estate. (g) To borrow money from any party to pay indebtedness of mine or of my Estate, expenses of administration or inheritance, legacy, estate and other taxes. (h) To vote any shares of stock which form a part of the Estate and to otherwise exercise all the powers incident to the ownership of such stock. (i) In the discretion of my Executor, to unite with other owners of similar property in carrying out any plans for the reorganization of any corporation or company whose securities form a part of the Estate. (j) To distribute my personal property directly to the Guardian of the person of any minor beneficiaries hereunder. (k) The right and discretion to elect the most appropriate settlement options for any pension plans, individual retirement accounts or other employee benefit options, as deemed most appropriate by my Executor, assuming such election shall be in accordance with procedures established by the plan's administrative committee or administrator, as the case may be, if such elections have not been made prior to my death. (1) To do all other acts in judgment of my Executor necessary or desirable for the proper and advantageous management, investment and distribution of my Estate. (m) The right to engage accountants, attorneys, appraisers and other agents, as deemed necessary by my Executor, to render advice to and/or represent my Executor, as my Executor deems necessary or appropriate to the administration and preservation of my Estate. ITEM VI: Any person who shall have died at the same time as Testatrix or in a common disaster with her, or under such circumstances that it is difficult or impossible to determine who died first, or who shall fail to survive Testatrix by a period of thirty (30) days, shall be deemed to have predeceased her. ITEM VII: I nominate, constitute and appoint my son John A. Rainville, now or formerly of 318 Emily Lane, New Cumberland, Pennsylvania, 17070, as my Executor (herein referred to as "Executor"). In the event of the death, resignation, refusal or inability of John A. Rainville to serve as Executor, I nominate, constitute and appoint my daughter Arlene Hess, now or formerly of 306 Reservoir Road, Mechanicsburg, Pennsylvania, 17055, to serve as Successor Executor in his place. My Executor is specifically relieved from the duty or obligation of filing any bond or bonds or other security whatsoever. ITEM VIII: If at any time, any minor child or legally incompetent person shall be entitled to receive any assets hereunder, John A. Rainville shall act as Guardian of the assets payable to such child or legally incompetent person and shall have full authority to use such assets in any manner as such Guardian shall deem advisable for the best interests of such child, including college, university, post-graduate or other education, without securing court order. In the event of the death, resignation, refusal or inability of John A. Rainville to serve as Guardian of such assets, then I nominate, constitute and appoint Arlene Hess as successor. My Guardian is specifically relieved from the duty or obligation of filing any bond or bonds or other security whatsoever ITEM IX: In all references herein to any Executor, Guardian, Beneficiary, Child or other, the use of any particular gender or the plural or singular number is intended to include the appropriate gender or number as the text of this my Last Will and Testament may require. ITEM X: At the time of the execution of this Will, I have three (3) surviving children, namely: John A. Rainville; Arlene Hess; Alyce Jo Lentz, now or formerly of 949 16th Street, New Cumberland, Pennsylvania, 17070; and one deceased child, namely Alexis Mullikin, who is survived by her three children: Christopher Mullikin, Michelle Cunningham, and Amy Mullikin. All references in this, my Last Will and Testament, to my child or children are intended to include any additional child or children born to me or legally adopted by me subsequent to the execution of this Will and if any such child or children or issue thereof shall survive me, then and in such event, such child or children or issue thereof shall have no rights in my estate other than those granted by this my Last Will and Testament. IN WITNESS WHEREOF, I have set my hand and seal to this my Last Will and Testament, consisting of this, the next two (2) pages and the preceding three (3) pages this ~0 ]-~ day of ~J"~-t ~'// ,2000. ' Pauline D. Hill SIGNED, SEALED, PUBLISHED AND DECLARED by the above named Testatrix, Pauline D. Hill, as and for her Will, in the presence of us, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses in attestation thereof. Witness Name // Witness Name Witn~qame~ /~ Address .4 F ' Address Add4~;$s ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA · COUNTY OF DJ~b/-J,J'3/(/z/L) .:ss': I, Pauline D. Hill, the Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Swom to or affirn~ed and acknowledged before me by Pauline D. Hill, the Testatrix, this flO/b~ day of C_.97f3 £r / ,2000. Pauline D. Hill Notary Publi~ ,K/' My Commission Expires: (SEAL) NOTARIAL SEAL JOHN R. BEINHAUR, Notary Public Lower Paxton Twp,, Dauphin County My C,ommtaslon Expi. rg~larch 13, 2003 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA : COUNTY OF /'~ ,~ V tO/e//A/ .:SS': and .~-~sep/~ ~ ~t r~4, '[~0 , the witnesses whose names a~e signed to the attached or foregoing Instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her Last Will; that the Testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness, in the hearing and sight of the Testatrix, signed the Will as a witness; and that to the best of our knowledge, the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. /~ Sworn to or affirmed and subscribed to before me by - /,j~..%,Z ~/J. ~"/o'~"~'. , witnesses this ~O& day of ~, ~ ~'r / 2000. Witness ,~J/My Cbrnmission Expires: (SEAL) ~ NOTARIAL SEAL ,dOiqN.~R, BE~N_HAUR, Notary Pub~ ~_ L~W~ p~toa Twp,, Dauphin County REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Estate of Pauline D. Hill a/k/a Pauline Dee Hill Date of Death: April 4, 2003 SSN: 174-14-0778 File No.: 2003-00454 To the Register of Wills of Cumberland County, Pennsylvania: I certify that Notice of Estate Administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on June 20th, 2003. Name Address John A. Rainville 318 Emily Lane New Cumberland, PA 17070 Arlene Hess Alyce Lentz Aimee Scullen Michelle Cottingham Christopher Mullikin 306 Reservoir Road Mechanicsburg, PA 17055 306 Reservoir Road Mechanicsburg, PA 17055 18475 Woodhaven Drive Strongsville, OH 44149 202 N. Prince Street Shippensburg, PA 17257 PMB 7301 658 Front Street Lehaina, HI 96761 Notice has now been given to all persons entitled there~u~r Rule 5.6(a) except: Date: June 20th, 2003 A~thony J. Foschi, Esquire SHUMAKER WILLIAMS, P.C. P.O. Box 88 Harrisburg, PA 17108 (717) 763-1121 none. Capacity: X Personal Representative Counsel for Personal Representative :156261 IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE. Whether you will receive any money or property will be determined wholly or partly by the Decedent's Will. If the Decedent died without a Will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA In re: Estate of Pauline D. Hill a/k/a Pauline Dee Hill No. 2003-004545 TO: John A. Rainville 318 Emily Lane New Cumberland, PA 17070 Please take notice of the death of Decedent and the grant of Letters Testamentary to the personal representative(s) named below. The Decedent, Pauline D. Hill a/k/a Pauline Dee Hill, died on the 4th day of April 2003, at Holy Spirit Hospital, East Pennsboro Township, Cumberland Coun _ty, Pennsylvania. X The Decedent died testate (with a Will); or The Decedent died intestate (without a Will). The _j~ersonal representative of the Decedent is: John A. Rainville 318 Emily Lane New Cumberland, PA 17070 If the Decedent died testate, the Will has been filed with the Office of the Register of Wills of Cumberland County, Cumberland County Courthouse, One Courthouse Square, Carlisle, Pennsylvania 17013; (717) 240-6100. A copy of the Will or Petition may be obtained by contacting Anthony J. Foschi, counsel for the estate at the below address. Date: June 20th, 2003 Anthony J. Foschi, Esquire SHUMAKER WILLIAMS, P.C. P.O. Box 88 Harrisburg, PA 17108 (717) 763-1121 Capacity: X Personal Representative Counsel for Personal Representative :156262 IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE. Whether you will receive any money or property will be determined wholly or partly by the Decedent's Will. If the Decedent died without a Will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA In re: Estate of Pauline D. Hill a/k/a Pauline Dee Hill No. 2003-004545 TO: Arlene Hess 306 Reservoir Road Mechanicsburg, PA 17055 Please take notice of the death of Decedent and the grant of Letters Testamentary to the personal representative(s) named below. The Decedent, Pauline D. Hill a/k/a Pauline Dee Hill, died on the 4th day of April , 2003, at Holy Spirit Hospital, East Pennsboro Township, Cumberland County, Pennsylvania. X The Decedent died testate (with a Will); or __ The Decedent died intestate (without a Will). The personal representative of the Decedent is: John A. Rainville 318 Emily Lane New Cumberland, PA 17070 If the Decedent died testate, the Will has been filed with the Office of the Register of Wills of Cumberland County, Cumberland County Courthouse, One Courthouse Square, Carlisle, Pennsylvania 17013; (717) 240-6100. A copy of the Will or Petition may be obtained by cont, aCting Anthony J. Foschi, counsel for the estate at the below address. Date: June 20th, 2003 , Anthony J. Foschi, Esquire SHUMAKER WILLIAMS, P.C. P.O. Box 88 Harrisburg, PA 17108 (717) 763-1121 Capacity: X Personal Representative Counsel for Personal Representative :156262 IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE. Whether you will receive any money or property will be determined wholly or partly by the Decedent's Will. If the Decedent died without a Will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA In re: Estate of Pauline D. Hill aJk/a Pauline Dee Hill No. 2003-004545 TO: Alyce Lentz 306 Reservoir Road Mechanicsburg, PA 17055 Please take notice of the death of Decedent and the grant of Letters Testamentary to the personal representative(s) named below. The Decedent, Pauline D. Hill a/k/a Pauline Dee Hill, died on the 4th day of April , 2003, at Holy Spirit Hospital, East Pennsboro Township, Cumberland Coun _ty, Pennsylvania. X The Decedent died testate (with a Will); or __ The Decedent died intestate (without a Will). The personal representative of the Decedent is: John A. Rainville 318 Emily Lane New Cumber_t'4x!d, PA 17070 If the Decedent died testate, the Will has been filed with the Office of the Register of Wills of Cumberland County, Cmberland County Courthouse, One Courthouse Square, Carlisle, Pennsylvania 17013; (717) 240-6100. for the estate at the below address. Date: June 20th, 2003 Anthony J. Foschi, Esquire SHUMAKER WILLIAMS, P.C. P.O. Box 88 Harrisburg, PA 17108 (717) 763-1121 Capacity: X Personal Representative Counsel for Personal Representative :156262 IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE. Whether you will receive any money or property will be determined wholly or partly by the Decedent's Will. If the Decedent died without a Will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA In re: Estate of Pauline D. Hill a/k/a Pauline Dee Hill No. 2003-004545 TO: Aimee Scullen 18475 Woodhaven Drive Mechanicsburg, PA 17055 Please take notice of the death of Decedent and the grant of Letters Testamentary to the personal representative(s) named below. The Decedent, Pauline D. Hill a/k/a Pauline Dee Hill, died on the 4th day of April 2003, at Holy Spirit Hospital, East Pennsboro Township, Cumberland County, Pennsylvania. X The Decedent died testate (with a Will); or __ The Decedent died intestate (without a Will). The personal representative of the Decedent is: John A. Rainville 318 Emily Lane New Cumberland, PA 17070 If the Decedent died testate, the Will has been filed with the Office of the Register of Wills of Cumberland County, Cumberland County Courthouse, One Courthouse Square, Carlisle, Pennsylvania 17013; (717) 240-6100. A copy of the Will or Petition may be obtained by con~cting Anthony J. Foschi, counsel for the eState at the below address. Date: June 20th, 2'003 ,/~iihony J. Foschi, Esquire SHUMAKER WILLIAMS, P.C. P.O. Box 88 Harrisburg, PA 17108 (717) 763-1121 Capacity: X Personal Representative Counsel for Personal Representative : 156262 IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE. Whether you will receive any money or property will be determined wholly or partly by the Decedent's Will. If the Decedent died without a Will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA In re: Estate of Pauline D. Hill a/k/a Pauline Dee Hill No. 2003-004545 TO: Michelle Cunningham 202 N. Prince Street Shippensburg, PA 17257 Please take notice of the death of Decedent and the grant of Letters Testamentary to the personal representative(s) named below. The Decedent, Pauline D. Hill a/k/a Pauline Dee Hill, died on the 4th day of April , 2003, at Holy Spirit Hospital, East Pennsboro Township, Cumberland County, Pennsylvania. X The Decedent died testate (with a Will); or __ The Decedent died intestate (without a Will). The personal representative of the Decedent is: John A. Rainville 318 Emily Lane New Cumberland, PA 17070 If the Decedent died testate, the Will has been filed with the Office of the Register of Wills of Cumberland County, Cumberland County Courthouse, One Courthouse Square, Carlisle, Pennsylvania 17013; (717) 240-6100. Date: June 20th, 2003 A copy of the Will or Petition may be obtained by contacting Anthony J. Foschi, counsel for the estate at the below address. ~ Anthony J. Foschi, Esquire SHUMAKER WILLIAMS, P.C. P.O. Box 88 Harrisburg, PA 17108 (717) 763-1121 Capacity: X Personal Representative Counsel for Personal Representative : 156262 IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE. Whether you will receive any money or property will be determined wholly or partly by the Decedent's Will. If the Decedent died without a Will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA In re: Estate of Pauline D. Hill a~c/a Pauline Dee Hill No. 2003-004545 TO: Christopher Mullikin PMB 7301 658 Front Street Lehaina, HI 96761 Please take notice of the death of Decedent and the grant of Letters Testamentary to the personal representative(s) named below. The Decedent, Pauline D. Hill a/k/a Pauline Dee Hill, died on the 4th day of April , 2003, at Holy Spirit Hospital, East Pennsboro Township, Cumberland County, Pennsylvania. X The Decedent died testate (with a Will); or __ The Decedent died intestate (without a Will). The personal representative of the Decedent is: John A. Rainville 318 Emily Lane New Cumberland, PA 17070 If the Decedent died testate, the Will has been filed with the Office of the Register of Wills of Cumberland County, Cumberland County Courthouse, One Courthouse Square, Carlisle, Pennsylvania 17013; (717) 240-6100. A copy of the Will or Petition may be obtained by contracting Anthony J. Foschi, counsel for the estate at the below address. Date: Jun e20th, 2003 '~n'/// ~o'//~Yj~-~ schi,~ Anttio Esquire SHUMAKER WILLIAMS, P.C. P.O. Box 88 Harrisburg, PA 17108 (717) 763-1121 Capacity: X Personal Representative Counsel for Personal Representative :156262 ~v.(0,/0~) This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records in accordance with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953. WARNING: It is illegal to duplicate this copy by photostat or photograph. 2872344 No. Charles Hardester State Registrar JUl 1 6 2OO3 Date COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH ,, VITAL RECORDS DATE: 7-16-03 j'~t CERTIFICATE OF DEATH #29-058 ,. William ,. 85 ,,. Cumberland ,,. r~v~-~,t~v- Blue Cross u~OAu~T'$ MAILFN~u.=~% ISlmet. C~.own, ~e Zip C~) ~i~ ~ S 343 N. 19~ S~t ~'~)RE=~NCE ,,~ Hill, PA 17011 ~ ~ett ~ ~%~P; ~isb=g, PA 17103 ~ 2~ m~ ~;~;~ I~u~ °F D~H Aprx. IO~ P~OUN~D ~ ~M~, DaY, ~r) I. . ~,.gn~ . Occlusive Coronary Artery Disease ~ ~" ~) ~ I I I*~ June 26, 2003 'aI~lN~ (,~2~T~P~ Michael L. Norris, Coroner ~~.~.~ ~.~ ~.~ ~.~ ......................................................... ~chanSesburg, Pa, 17050 ! (Coroner) ~ FILE NUMBE~ Lipsett 2. Male 0' ~flq-,O~*~O~ ~. June 25, 2003 ..- ,?ct.25,1917 7. Pottsville, ~ 343 N. 19th Street %~%%S~tC~=UENTOFHIS[;%~NICORIGIN? ~':"~} White Camp Hill . ~t~ 2 (,.40~+~ ~ ~rlotte K. Stuck SHUMAKER WILLIAMS LEGAL AND BUSINESS COUNSEL WRITER'S DIRECT DIAL: (717) 909-1657 WRITER'S EMAIL: foschi~,shumakerwilliams.com January 5, 2004 Cumberland County Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Estate of Pauline D. Hill Our File No. 701-03 Dear Ms. Lewis: We enclose, for filing, on behalf of our client, the Estate of Pauline D. Hill, a completed REV-1500 Inheritance Tax Return, Resident Decedent, with all supporting documents. The Return is submitted to your office in duplicate as requested in the Department of Revenue's instruction booklet for the same. We also enclose two checks, both made out to the Register of Wills, on in the amount of $25.00 as payment of the filing fee, and one in the amount of $4,425.41 as payment of the Pennsylvania Inheritance Tax due. If you have any questions, please contact the undersigned. By AnthonY'J. Foschi AJF :rafh ~ 62251 Enclosures CORRESPONDENCE: RO. BOX 88 HARRISBURG, PA 17108 PHONE: 717.763.1121 FAX: 717.763.7419 STATE COLLEGE, PA 814.234.3211 TOWSON, MD 410.825.5223 READING, PA 610.929.5808 mail@shumakerwilliams.com COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003408 FOSCHI ANTHONY J ESQ P O BOX 88 HARRISBURG, PA 17108 ........ fold ESTATE INFORMATION: SSN: 174-14-0778 FILE NUMBER: 2103-0454 DECEDENT NAME: HILL PAULINE D DATE OF PAYMENT: 01/05/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 04/04/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $4,425.41 REMARKS: TOTAL AMOUNT PAID: 84,425.41 CHECK# 1064 INITIALS: SK SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH DEPUTY REGISTER OF WILLS REGISTER OF WILLS EV-1500 PENNSYLVANIA DEP^RTMENT OF REVENUE INHERITANCE TAX RETURN DEPT. 280601 .ARR,SBURG, PA17128-0601 RESIDENT DECEDENT LU Z 0 Z O DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Hill, Pauline D. DATE OF DEATH (MM-DD-Year) I DATE OF BIRTH (MM-DD-Year) 04/04/2003 I 05/10/1918 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ~-]1. Odginal Return [~4. Limited Estate [~6. Decedent Died Testate (AttachcopyofWill) D9. Litigation Proceeds Received [~2. Supplemental Return E~4a. Futura Interest Compromise (date of death after 12-12-82) E~7. Decedent Maintained a Living Trust (Attach copy of Trust) [~ 10. Spousal Poverty Cradit (date of death between 12.31-91 and 1-1-95) OFFICIAL USE ONLY FILE NUMBER 2 1 -0 3 0 4 5 4 COUN~' COD~ YEAR NUMBER SOCIAL SECURITY NUMBER I-. Z UJ Z O LU o o 1 7 4- 1 4-0 7 7 8 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER --'] 3. Remainder Return (date ofdeath priorto 12-13-82) ~--~5. Federal Estate Tax Return Required m 8. Total NumberofSafe Deposit Boxes r'~l 1. Election to tax under Sec. 9113(A) (A~ach Sch O) COMPLETE MAILING ADDRESS 3425 Simpson Ferry Road Camp Hil PA 17011 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Uodgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) ] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 143,000.00 0.00 4,948.47 OFFICIAL USE ONLY (8) 147,948.47 11,201.09 38,404.85 (11) 49,605.94 98,342.53 (12) (13) (14) 98,342.53 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due x ~ (15) 98,342.53 x .045 (16) 4,425.41 X .12 (17) X .15 (18) (19) 4,425.41 ~> ~ SURE TO ANSWER ~L QUESTIONS ON REVERSE SiDEAND RECHECK MATH< < TELEPHONE NUMBER 717-909-1657 NAME Anthony J. Foschi FIRM NAME (If Applicable) Shumaker Williams, P.C. THiS SECTION MUSTBE COMPlEtED; ALE CORRESPONDENCE AND CONFiDENT~ T~ INFORMATION SHOULD BE DIRECTED TO: Decedent's Complete Address: STREET ADDRESS ; ~ 318 Emily Lane New Cumberland ISTATE PA Iz~P 17070 Tax Payments and Credits: 1. Tax Due(Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty (1) Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to request a refund (4) If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + EA. This is the BALANCE DUE. (ED) Make Check Payable to: REGISTER OF WILLS, AGENT 4,425.41 4,425.41 4,425.41 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; or ...................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ............................................................. [] [] 2. If death occurred after December 12, 1982, did decedent transfer properly 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. Under penalties of perjury,,[ declare that I have examined this return, incl~ling accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declarationj;~,preparer oJYCr than the personal representative is based,e'F'all information of which preparer has any knowledge. SIGNA,T0'RI~ OF RE'ON RESP.,i~SIBLE4~t FILING RF_jlZJ~'RN DATE ADD ~-~:~ 318 Emily,J~ane / New C_urj~berland PA 17070 SIGN,~TURE OF PR~ DATE ADDRESS '~42~impson Ferry Road Camp Hill PA 17011 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [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 twenty-one 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% [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%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Hill. Pauline D. 21 03 0454 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 pdce at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 949 16th Street New Cumberland, PA 1823 Regina Street Harrisburg, PA 125 Clear Springs Road Biglerville, PA VALUE AT DATE OF DEATH 90,000.00 35,000.00 18,000.00 TOTAL (Also enter on line 1, Recapitulation) $ 143,000.00 (If more space is needed, insert additional sheets of the same size) Pennsylvania's Online Realty Pro's 310 Third St., New Cumberland, PA 17070 (717) 909-9400 Fax (717) 909-7725 Anthony Foschi Shumaker-Williams, P.C. 3425 Simpson Ferry Road Camp Hill, PA 17011 RE: Opinion of Value of Realty for Estate of Pauline Hill December 20, 2003 Dear Tony: Here are the values, I apologize for the delay in getting this to you. · 949 Sixteenth St., New Cumberland, PA 17070 - Brick 2 Bedroom ranch $90,000 1823 Regina St., Harrisburg, PA 17103 -Brick 5 Bedroom semi-detached $35,000 125 Clear Spring Road, Biglerville, PA - Brick 4 Bedroom $18,000 The house in New Cumberland is in Average condition, as is the one on Regina St.. The propety in Biglerville has no running water, septic system, or heat system. It is basically a shell. The value is primarily ion the ground, half of which appears to be wet lands, behind the house. Please let me know if you need photos or anything else. S~ncerely, ,~{ ~ fane Adams, Broker/Appraiser COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Hill, Pauline D. 21 03 0454 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION PNC Bank Money Market Account #50-0314-8492 PNC Bank Interest Check Account #51-4010-4197 VALUE AT DATE OF DEATH 2,980.19 1,968.28 TOTAL (Also enter on line 5, Recapitulation) $ 4,948.47 (If more space is needed, insert additional sheets of the same size) 12/31/2003 13:07 71779S$187 WINDSOR PARK PAGE 82 ~..R~~Edca L $~lllegel 12/31/2003 08:31 AM To: Jessica Camhldi/ConsumerlSCP/PNC~PNC Subject; Date of deal~ balance Estate of Pauline D Hill (Deceased) SS# 174-14-0778 DOD 04-04-2003 ACCOUNT NUMBER *DATE OF DEATH BALANCE + ACCRUED INTEREST DDA ~140104197 $1,968.28 + $0.00 SVG ~5003148492 $2,975.74 + $4.45 If you selected the balances to be sent to the "Branch" they will only be sent to the requestor by Lotus Notes. Have a gmat day!l! :-) OMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Hill. Pauline D. 21 03 0454 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT 1. 2. 3. 4. FUNERAL EXPENSES: Stone & Murray Funeral Home - Funeral Reverend Fox Luncheon Internment ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) John A. Rainville Social Security Number(s) / EIN Number of Personal Representative(s) Street Address 318 Emily Lane City New Cumberland State PA Year(s) Commission Paid: 2004 AttomeyFees Shumaker Williams, P.C. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant 209-50-6088 Zip 17070 Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Cumberland County Register of Wills Accountant's Fees Tax Retum Preparer's Fees The Sentinel - Proof of Publication Cumberland County Law Journal - Proof of Publication 1,830.00 300.00 687.98 3,431.00 2,000.00 2,500.00 275.00 102.11 75.00 TOTAL (Also enter on line 9, Recapitulation) $ 11,201.09 (If more space is needed, insert additional sheets of the same size) C~/~ (m m~r mc.p~b) ......................... AU~f~k~,,~,m C,,~,... ~ ......... /,,,,,~___~ Ragisler BoQk .................... ././. ..........: _~ Memo.,y ~o~ders/Prayer ~ .... ~ ............. ~enMtJon Um C~d~g - Stone & Murray Funeral Home DLnW ~ PENNSYI. VA~qA 17O70 C?IT) ?74-z-/s0 _~Cagiee d Demh Oemrk~m · $ ~,?- c::::d~ em~ .... 'fl X Z 0 12/29/0~ MON 12: 11 FAX O01 TRI-COUNTY MEMORIAL GARDENS Executive ~d Busincss Officcs 740 Wyndamcrc Roud Lewisberry, PA r/339 Phone; (?17) 938-3435 Park Location: Wyndamcrc Road RETAIN TH'" PORTION FOR YOUR RECORDS REMITTANCE ADDRESS ' BILL TO THE SENTINEL - LEGAL SHUMAKER WILLIAMS, P. C P.'O. BOX 130, CARLISLE, PA 17013 ' AD NUMBER I CLASS SALESPERSON BILLING DATE LINES 246869I 10 PUBLIC NOTICES c31 07/23/03 28 AD DESCRIPTION START DATE STOP DATE ESTATE NOTICE NOTICE IS HEREBY GIV 07/03/03 07/17/03 PUBLICATION INSERTIONS RATE NET AMOUNT GROSS AMOUNT 3 THE SENTINEL - LEGAL 3 LGL 95.76 TOTAL AD CHARGE 95.76 3 PROOF OF PUBLICATION 01PRF 6.35 DAYS RUN PURCHASE ORDER PAY THIS AMOUNT 102.11 122.53* PaulineD. Hill * AFTER 08/22/O3 MESSAGE: Thank you for advertising with The Sentinel. Deadlines for in-column legal advertisements: Monday is Friday at 11 a.m.; Tuesday is Friday at 4 p.m.; Wednesday is Monday at 12 Noon; Thursday is Tuesday at 12 Noon; Friday is Wednesday at 12 Noon; Sunday is Thursday at 12 Noon. If you have any questions regarding your Legal bill please call Lori Saylor 243-2611 ext. 201 Fax your legals to 243-3754, attention Lori Saylor You can also EMAIL your legal to Classified ads: ads@cumberlink.com. Please send a cover letter including your name and address as an attachment CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 JULY 25, 2003 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: Anthony J. Foschi, ESQUIRE RE: Pauline D. Hill aka Pauline Dee Hill, ESTATE Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on following dates: JULY 11, 18, 25, 2003 Advertising Cost Proof of Publication Second Proof Request Payment Received Total Amount Due Payment received JULY 9, 2003 by Becky H. Morgenthal/Executive Director $ 75.00 $ 0.00 $ 0.00 $ 75.00 $ 0.00 COMMONWEALTH OF PENNSYLVANIA iNHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Hill. Pauline D. 21 03 0454 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. 29,000.O0 10. 11. 12. 13. 14. 15. PNC Mortgage Account #400 100 801 516 3038 Robert Piatt's Remodeling Repairs/Expenses for 1823 Regina Street, Harrisburg, PA ($331.31) Repairs/Expenses for 949 16th Street, New Cumberland, PA ($276.00) Keystone Oil (Repair to Boiler) Case No. 00002483-03 Sollenberger Colon & Rectal Surgery, LTD Account #15908 and Account #39428 Pennsylvania G.I. Consultants, PC Account #28905 West Shore Pathology Account #262616043 Holy Spirit Hospital Account #20670022 Quantum Imaging Account-#A93 309783 TAMDOT Account #18016532507 Snoke Family Practice Account # hillpa-001 Smith Radiology Account# 044008-00 Nephrology Associates Account #000926-00 Bankcard Services Accoun~ 5490 9990 1860 3356 Selective Insurance Company Account #266-324-582 Readers Digest Account #0768-0000 607.31 3,100.00 182.85 95.52 15.78 855.49 84.41 8.80 48.81 67.62 518.80 196.00 25.41 TOTAL (Also enter on line 10, Recapitulation) $ 38,404.85 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent Hill, PaulJ,qe D. 21 03 Paqe 1 Schedule I - Debts of Decedent, Mortgage Liabilities, & Liens 0454 ITEM NUMBER DESCRIPTION AMOUNT 16. 145.50 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. Heritage House Account#03566-8857 Carlisle MPO - Certified Mail Fees Robin Gasperetti, Tax Collector CTL 25 7603 Garry R. Fair, Butler Twp. Tax Collector Reference No: 07,E08-0013-000 Property Tax for Biglerville Property Robin Gasperetti, Tax Collector Map No: 26-23-0543-162A Property Tax for 949 16th Street, New Cumberland, PA h.b. McClure Account# 026-607 Oil Delivery for 949 16th Street, New Cumberland, PA Associated Products Customer # E12761 Waste Management for 318 Emily Street PP&L Account # 44640-74024 Comcast Account # 09547 175286-01-7 Verizon Account # 717 774 2274 421 61 Y Met ED Account # 10 00 477312 27 PA American (water bill for 949 16th Street, New Cumberland, PA) Account # 24-1200114-7 Borough of New Cumberland (water bill for 318 Emily, New Cumberland, PA) Distric~ 240367415 Account # 052325 Attorney Beinhaur (Litigation Legal Fees) Account # 11.16 9.80 275.16 292.82 131.46 228.96 135.12 39.63 56.56 92.25 55.51 117.58 2,000.00 SUBTOTAL SCHEDULE I 3,591.51 GRAND TOTAL SCHEDULE I $ 38,404.85 Robert Piatt's Remodeling & Contracting 208 A York Rd. New Cumberland Pa. 17070 Ph.# $$4-7443 E-mail piattcontracting~msn.com Invoice Customers Name: Pauline Hill Estate Customers Address: 318 Emily Lane Project: Lawn Maintance (949 16th St.) Invoice: 0730033 Date: 7-30-03 3ob D~m:ription Dal~ Labor Mowed grass, cut weeds, and picked up trash. 7-25-03 $35.00 Togal I~lal~rial~ To~al Labor $35.00 Total Permits Total Due $35.00 *Due Upon Receipt Robert Piatt's Remodeling & Contracting 208 A York Rd. New Cumberland Pa. 17070 Ph.# 554-7443 E-mail piattcontraeting~nsn, com Invoice Customers Name: Pauline Hill Estate Customers Address: 949 16th St Project: Lawn Maintaience (1823 Regina St.) Invoice: 0620037 Date: 6-20-03 grass, cut weeds, and picked up trash. 6-17-03 Total Mnteri~ls Total Labor $20.00 Total Permits Total Due $20.00 *Due Upon Receipt ,~ ~ Robert Piatt's Remodeling & Contracting 208 A York Rd. New Cumberland Pa~7070 Ph.# 554-744Z E-mail piattcontrac~n~g(~msn.com Cn~tomer~ Address: 949 16th 8t D~te: 6-2~0~ Project: Lawn Maintaience ~ cf ~l~ ~% ~'~ Mowed grass, cut weeds. 6-17-03 $35.00 Total Materi~ Total Permit~ Total Due *Due Upon Receipt $35.00 $35.00 Chris Kifer 208A York Dr. New Cumberland Pa. 17070 Invoice c/e/X Customers Name: Polly Hill Estate Customers Address: 318 Emily Lane Project: !823 Regina Invoice:234568 Date: 5-30-03 Coated back rial: roof. ~lzed wa'car spots and ceiling pa~hes. installed smoke dela~ors. wc~un~ ~ .~. ~?°3 $7o.o0 " Cut weeds, and picked up t~sh. Total blatarill~ Total Labor $70.00 Total Total Due $70.00 *Due Upon Receipt ~ Piatt's Remodeling & Contracting 208 A York Rd. New Cumberland Pa. 17070 Ph.# $$4-7443 E-mail piattcontracting~msn, com Invoice Customers Name: Polly Hill. Estate Customers Address: 318 Emily Lane Project: Codes punch out Invoice: 0S30033 Date: 5=30=0.3 Insl~led Balsters 5-28--03 fixed flashing around chimney. ISled radiator in back bed room. Pa~hed ce~ting. $g6.00 ~ ~ box. Re-attached clown spout and gutmr on gamcje. ~o ~id $I00.00 Total Materials 'l'ot~! Pemlita Total Due *Due Upon Receipt $24.31 $192.00 $216.31 Robert Piatt's Remodeling & Contracting 208 A York Rd. New Cumberland .Pa. 17070 Ph.# 554-7443 E-mail piattcontracting(~sn, com Invoice Customers Name: Polly Hill Estate. Customers Address: 318 Emily Lane Invoice: ~'/~ o 3 t Date: ~-19-03 Project: Lawn Maintenance ( 1823 Regina St.) .]ob De~cription Date Labor Cut weeds, picked up trash, and cleaned off walk ways. 5-12-03 ToI~I Materials Total labor $25.00 Total ~ Total Due *Due Upon Receipt $2~.00 Robert Piatt's Remodeling & Contracting 208 A York Rd. New Cumberland .Pa. 17070 Ph.# 554-7443 E-mail piattcontracting~msn.com Invoice Customers Name: Polly Hill Estate Customers Address: 318 Emily Lane Invoice: Date: S-19-03 Project: Lawn Maintenance ( 949 16th St.) Mowed grass, cut weeds, picked up trash, and cleaned off 5-~2-03 $35.00 walk ways. Total Mat~iala Total Labor $35.00 Total Permits Total Due $35.00 ~Due Upon Receipt Robert Piatt's Remodeling & Contracting 208 A York Rd. New Cumberland Pa. 17070 Ph.# 554-7443 E-mail piattcontracting~msn.com Invoice Customers Name: Polly Hill Estate Customers Address: 318 Emily Lane Project: lawn maintenance Invoice: 0512033 Date: 5-12-03 3ob Descriplion Date' Labor Mowed grass and cleaned up yard of sUcks and limb. $35.00 Total Haterials Total Labor Total Pern~'--~ Total Due *Due Upon Receipt $35.00 $35.00 Robert Piatt's Remodeling & Contracting 208 A York Rd. New Cumberland Pa. 17070 Ph.# $54-7443 E-mail piattcontracting~msn.com Invoice Customers Name: ~o Customers Address: Invoice: 0411031 Date: 4-11-03 Project: 949 16Th St Roof Repair/Replacement New Cumberland, Pa. 17070 5ob Descti~ion Date Labor Removed old shingles from lel~ rear section of house. 4-10-03 Inst~lled new 15 lb felt paper and ddp edge. Installed 2.1 sq of 25yr Tamco 3-tab shingles. Cleaned gutterst ground, and removed roofing debris. $175.00 Maberials: R.F. Fagers $70.49 Dillers $55.50 Total paid bo start job $200.00 Tot~l cost of job. $301.00 Total D~e $101.00 *Due Upon Receipt Harris Financial Recovery Systems August 19, 2003 450 + OFFICES NATIONWIDE John A Rainville 310 3rd St New Cumberland, PA 17070-2157 I,,,111,,,111,,,I,,,111,,,,,I,1,,,11,1,1,1,,,I,,,1111,,,I,1,,I Dear John A RainviHe: Re: Keystone Oil Products Corporation Vs: John A Rainville Court Case No.: Amount: $3435 00002483-03 The above plaintiff, have fried a lawsuit $3435. WE DO ***ORGENT MESSAGE*** and in court If t need to W The court may enter a for the full amount. What is worse, where state law permits, you could FACE A GARNISHMENT of your wages or an ATTACHMENT OF YOUR BANK ACCOUNT. Also, negative information can remain on your credit report from 7 - 10 years. Don~ delay. Get help now - Don't let this matter get worse. CALL FOR HELP NOW! 1-(800) 731-9067 over 50,000 of your neighbors have placed their trust in us! SOLL-ENBERGER COLON & RECTAL SURGERY,LTD 1511 NORTH FRONT STREET HARRISBURG, PA 17102 *******AUTO**3-DIGIT 170 PAULINE D HILL 15908 318 EMILY LANE NEW CUMBERLAND PA 17070-3141 15526 113 49 04117103 15908 $ 120.00' SOLLENBERGER COLON & RECTAL SURGERY,LTD 1511 NORTH FRONT STREET HARRISBURG, PA 17102 *** FOR OUESIONS: CALL ON TUESDAY OR THURSDAY AND ASK FOR WENDY DUE:05-09-03 *** 04/02/03 1 1 HOSPITAL CONSULT INITIAL 99253 569.3 120.00 120.00' DATE LAST PAID AMOUNT oo/oo/oo 0.00 120.00 0.00 0.00 0.00 0.00 0.00 0.00 120.00 ~CK ~ SOLLENBERGER COLON & RECTAL SURGERY,LTD 1511 NORTH FRONT STREET "AYAMLMTO:~ HARRISBURG, PA 17102 PAT# 1-PAULINE D HILL DR# 1-SOLLENBERGER, LARRY L. M Ph:(717)-232-4567 Acct#: 15908 Date: 04/17/03 Page 1 of 1 ~EXPLAiNED THE OFFICE WITH YOUR S CONDARY INSURANCE OR SUBMIT pAYMENT ,4* E *** 4** PLEASE CALL VE . AND .~.~!~, ************4**4******** *** WE NOW 4,***~***,44,~ ..... 106.68 04/02~03 1 4 HOSPITAL CONSULT INITIAL 99254 780.09 256 Medicare payment -122.65 05~05~03 Accept Assign Adj. 05/05/03 99231 780.09 58.00 25.37 o4/o3Zo3 1 05?05Z03 05/05/03 4 HOSPITAL SUBSEQUENT CARE Medicare payment Accept Assign Adj. -26.29 26.674 6.34* LAST PND AMOUNT 00/00/00 0.00 33.01 0.00 PENNSYLVANIA NEURO ASSOC LTD 110 LOWTHER STREET CHECK LEMOYNE, PA 17043 0.00 0.00 0.00 PAT# 1-PAULINE D HILL DR# 4-JANTON, FRANCIS J. III, 0.00 0.00 33.0I ph:(717)-774-220~ Acct#: 39428 Date: 05/06/03 Page 1 of 1 04/02/03 05/05/03 05/05/03 05/19/03 04/02/03 i 4 06/03/03 06/03/03 04/03~03 1 4 05/05/03 05/05/03 05/19/03 bATE ~ST PAID > 05/19/03 *** PLEASE CALL THE OFFICE WITH YOUR SECONDARY INSURANCE OR SUBMIT PAYMENT *** **8 TODAY ! ! *** *** WE NOW ACCEPT VISA. MASTERCARD. DISCOVER. AND MAC ~t *** 1 4 HOSPITAL CONSULT INITIAL 99254 780.09 256.00 Medicare Payment 106.68 Accept Assign Adj. -122.65 Check-Personal Payment 26.67 ELECTROENCEPHALOGRAM (EEG 95819 780.09 205.00 Medicare Payment 45.19 Accept Assign Adj. -148.51 HOSPITAL SUBSEQUENT CARE 99231 780.09 58.00 Medicare Payment 25.37 Accept Assign Adj. -26.29 Check-Personal Payment 6.34 i 33.01 11.30J 0.00 0.00 0.00 0.00 0.00 0.00 PENNSYLVANIA NEURO ASSOC LTD ~fK 110 LOWTHER STREET PAYABLETO:T LEMOYNE, PA 17043 PAT# 1-PAULINE D HILL DR# "4-JANTON, FRANCIS J. III, 0.00 11.30' 0.00 11.30 02 Acct#: 39428 Date: 06/04/03 Page 1 of 1 *** FOR QUESIONS: CALL ON TUESDAY OR THURSDAY AND ASK FOR WENDY DUE: 8-25-03 ' *** Your Account Balance {s Overdue! Please make Payment Immed{atelv~tl 04~02~03 1 1 HOSPITAL CONSULT INITIAL 99253 569.3 120.00 05~31~03 Medicare Payment 74.16 05/31/03 Accept Assign Adj. -27.30 18.54' ~t AMOUNT oo/oo/oo o.oo o.oo ~ ~SOLLENBERGER COLON & RECTAL SURGERY,LTD ~K~ 1511 NORTH FRONT STREET ~£T°'~HARRISBURG, PA 17102 PAT# 1-PAULINE D HILL DR# ]?SOLLENBERGER, LARRY L. M 18.54 18.54' Ph:(717)-232-4567 Acct#: 15908 Date: 08/05/03 Page 1 of 1 PENNSYLVANIA G.I. CONSULTANTS PC 899 POPLAR CHURCH ROAD GAMP HILL, PA 17011-2206 16466-MC56 ADDRESS SERVICE REQUESTED LAST PMT: 04/24/03 AMOUNT: 382.08 Please check box if address is incorrect or insurance information has changed, and indicate change(s) on reverse side. ADDRESSEE: PAULINE D HILL 318 EMILY LANE , NEW CUMBERLAND, PA 17070-3141 STATEMENT CHECK CAHD US)NO FOR PAYMFNT MASTERCARD VISA CARD NUMBER AMOUNT SIGNATURE STATEMENT DATE 05/05/03 PAGE: 2 PAY THIS EXP DATE ACCT. # 28905 REMIT TO: i ~ ~ ~ I~ I!~ ~ HH I,,,111,,,111,,,,,,11,,,11,,I,I,,I,II1,,,,11,,I,1,,I,I,,,,I,II PENNSYLVANIA G.I. CONSULTANTS PC 899 POPLAR CHURCH ROAD CAMP HILL, PA 17011-2206 16466-MC55°OY4OWC9C80OO375 PLEASE DETACH AND RETURN TOP PORTION WITH YOUR PAYMENT Date Doctor DeScription char~es Credits 'Balance Pen] Furlon MD ~ HOSpiTAL CONSULTATION 125.00 18.54 03/31/03 9 ' MEDICARE INS 0NL 74 16 ! Check Payment from Medicare . · Transfer From Ins MEDI to Patient -2 30 Medicare Adjustment · 3 . CheCk payment from Medicare 04/01/03 Furlong MD HOSPITAL DAILY VISIT 75.00 i0.48 MEDIC_ARE INS ONLY 2 Check Payment from Medicare 41.9 Transfer From Ins MEDI to Patient Medicare Adjustment 22.60 L Check Payment from Medicare 04/02/03 Furlong MD COLONOSCOPY W/POLY 710.00 56.02 MEDICARE INS O~LY Check Payment from Medicare 224.08 Transfer From Ins MEDI to Patient Medicare Adjustment 429.90 Check Payment from Medicare 04/03/03 Furlong MD HOSPITAL DAILY VISIT 75.00 10.48 MEDICARE INS ONLY Check Payment from Medicare 41.92 Transfer FrOnl Ins MEDI to Patient Medicare Adjustment 22.60 · *Call Vivian at Ext 320 with Any questions** I Current i 30 Days i Days ' 90 Days 120 Days Total B-lance 95.52j o.ooj 0.00 0.00 0 oo 95.52 0.00 ~s.s:~, I Account Number I Message 2 8 9 0 5 Make Checks Payable To: PENNSYLVANIA G.I. CONSULTANTS PC 899 POPLAR CHURCH ROAD CAMP HILL, PA 17011-2206 16466-MC55 ~OY4OWC9CSOOO375 Statement Date 05105/03 Billing Questions (717) 763-0430 I#llllllllllllllllllllllJ Date Doctor °04/02J~3 ANJALI G BHATT,MD 05/2'7/2003 05/27/2003 Code Description 88305 SURG PATH SINGLE COMP (2 Times) 1199 MEDICARE CONTRACTUAL ADJUSTMENT Page I of 1 Amount 260.00 -181.08 -63.16 ACCOUNT NUMBER 26*2616043 PATIENT NAME PAULINE D HILL THESE SERVICES WERE PERFORMED BY THE PATHOLOGIST AT HOLY SPIRIT HOSPITAL. Billing questions? Call: 800/238-3614 BALANCE AMOUNT DUE DATE OF STATEMENT PAYMENTS AFTER THIS DATE VVILL APPEAR ON 1 5.78 06/02/2003 YOUR NEXT STATEMENT INSURANCE PAID THEIR PORTION ON THIS ACCOUNT. YOU ARE RESPONSIBLE FOR THE BALANCE. PLEASE MAIL PAYMENT IN FULL TODAY. BILLING HOURS ARE leAH TO 4PM Place of Service: HOLY SPIRIT HOSP IP Referring Doctor: JSTEVEN SNOKE MAKE CHECKS PAYABLE TO: WEST SHORE PATHOLOGY PO BOX 750 SCRANTON PA 18501 800/238-3614 SEE REVERSE SIDE FOR IMPORTANT BILLING INFORMATION HOLY SPIRIT HOSPITAL 503 NORTH 21ST STREET CAMP HILL, PA 17011-2288 Patient Name: Account Number: Patient Responsibility: PAULINE D HILL 20670022 AUG 07 2003 Date of Service: 04104103 I,,,111,,,111,,,I,,,111,,,,,11,,,,11,1,,I,,,11,,,111,,I,1,,,11 1640 0 AT 0.292 PAULINE D HILL 318 EMILY LN TRO0006 NEW CUMBERLAND, PA 17070-3141 Dear Patient/Guarantor: Payment has not been received in response to our recent requests. Your account is now past due. Please remit payment in full, or contact our Patient Financial Services at (Toll Free) 1-877-254-9239 if you have any questions. If you have already paid the balance, thank you, and please disregard this letter. Sincerely, Patient Financial Services If you have multiple accounts, please indicate the account numbers and the amount applied to each on your check. Payments received without an account number may be applied to the oldest account. If Pa.~yrnent Has Already.. Been Made Please D_isregar_d_Tl~i_'s_Le_tter ................. QUANTUM IMAGING & THERAPEUTIC BILLING OFFICE / A93 2527 CRANBERRY HIGHWAY WAREHAM MA 02571-5010 800-299-9770 OR 508-295-5556 251792806 FORWARDING SERVICE REQUESTED If you have an HMO please reply promptly 19260 1 AT 0.292 PAULINE HILL A93'309783 318 EMILY LANE NEW CUMBERLAND PA 17070-3141 I,,,lll,,,lll,,,I,,,llh,,,,ll,,,,ll,l,,I,,,ll,,,lll,,h h,,ll PAGE1 o3/24/o3 HOLY SPIRIT HOSPITAL 71020 514 CHEST PA & LATERAL ( 45.00 080 04/29/03 MEDICARE PAYMENT -8.54 04/29/03 MEDICARE ADJUSTMENT -34.32 03/25/03 HOLY SPIRIT HOSPITAL 76770 593.2 U/S RETROPERITONEAL 153.00 080 04/29/03 MEDICARE PAYMENT -29.06 04/29/03 MEDICARE ADJUSTMENT -116.68 03/28/03 HOLY SPIRIT HOSPITAL 70450 437.1 CT HEAD W/O CONTRAST 198.00 080 04/29/03 MEDICARE PAYMENT -33,58 04/29/03 MEDICARE ADJUSTMENT -156.03 MSG 080 = MEDICARE HAS PROCESSED THIS CLAIM BY EITHER PAYING 80% OR APPLYING ALL OR A PORTION TO YOUR DEDUCTIBLE. QUANTUM IMAGING 8, THERAPEUTIC BILLING OFFICE / A93 2527 CRANBERRY HIGHWAY WAREHAM MA 02571-5010 800-299-9770 OR 508-295-5556 251792806 FORWARDING SERVICE REQUESTED If you have an HMO please reply promptly 19783 1 AT 0.292 PAULINE HILL A93'309783 318 EMILY LANE NEW CUMBERLAND PA 17070-3141 I,,,111,,,111,,,I,,,111,,,,,11,,,,11,1,,I,,,11,,,111,,I,1,,,11 PAGE 1 04/02/03 HOLY SPIRIT HOSPITAL 7101026 511.9 CHEST SINGLE VIEW 36.00 080 05/07/03 MEDICARE PAYMENT -7.10 05/07/03 MEDICARE ADJUSTMENT -27.12 04/02/03 HOLY SPIRIT HOSPITAL 36489 459,81 CVP LINE OVER 2 YRS 339.00 080 05/15/03 MEDICARE PAYMENT -103.02 05/1 5/03 MEDICARE ADJUSTMENT -210.23 04/02/03 HOLY SPIRIT HOSPITAL 7694226 4.59.81 U/S NEEDLE BIOPSY 171.00 080 05/15/03 MEDICARE PAYMENT -26.70 05/15/03 MEDICARE ADJUSTMENT -137.63 04/03/03 HOLY SPIRIT HOSPITAL 36489 459.81 CVP LINE OVER 2 YRS 339.00 080 05/15/03 MEDICARE PAYMENT -103.02 05/1 5/03 MEDICARE ADJUSTMENT -210.23 04/03/03 HOLY SPIRIT HOSPITAL 7694226 459.81 U/S NEEDLE BIOPSY 171.00 080 05/15/03 MEDICARE PAYMENT -26.70 05/1 5/03 ME DICARE ADJUSTMENT - 137.63 MSG 080 = MEDICARE HAS PROCESSED THIS CLAIM BY EITHER PAYING 80% OR APPLYING ALL OR A PORTION TO YOUR DEDUCTIBLE. CUSTOMER NUMBER INVOICE INVOICE DATE MAKE CHECK PAYABLE TO: T ............ .-. ~,. : ;.'-~- '~'-"",D~ · ;-!':"'~L;~ ~ ~ ! r?d~EL.:-.tR~:. 0:.:"- ~'-.~, ..:"-.i ./. '-.z'! .=. :.:'. ~. , :c_l:.. ! DATE PAID CHECK AMT~ PAID P.~UL. INE HILL c-ll.c/,, c:..., i.STH S--".' NEW :iUIdB EP..L.ANE: T 0 D E L I V ~::, £: ,. .-. -,' ~ E T O ,, PLEASE DETACH HERE AND RETURN TOP PORTION WITH YOUR REMITTANCE" THIS IS A BILL FOR SERVICES PROVIDED (SAME AS BILL TO UNLESS SHOWN BELOW) :::0- i NS ~ AUTHORIZED BY: F'¢:,UL i NE Hit. L SALES TAX INVOICE TOTAL TOTAL AMT DUE Po~.~,~ScF_.hRI~'~I oT~IoS~yORiT~,I ~ITR YOUR PAYMENT TO: DATE DR. PATIENT PROCEDURE CODE 04/22/02 03/20/03 ncs Pauline 04/17/03 04/17/03 71020 DESCRIPTION AMOUNT Payment: 3605 Chest, 2 Vw Plan Payment:. Adjustment PREVIOUS BALANCE--> 26,10 ..... ,; Bill Balance--.) ~. 0~00, 93.~00 Medicare 60.28~ Bill Balance--> 6._~4 ...... BILLING INQUIRIES: 8:30 - 3:15 MON - FRI ONLY · re has paid its share M_edtc.a_ bi%l-you are resP~°n~ ot you~. ,.,~uctibles ~' sible tot _u~'~ns on your non..cover~u ' assigned Medicare claim. IF FULL PAYMENT IS NOT RECEIVED A MONTHLY SERVICE CHARGE WILL BE ADDED TO YOUR BALANCE. '6.54 044008-00 6.54 0.00 0.00 Nephrology Assoc. Of Cen PA POB 2, 425 N 21st St Camp Hill, PA 17011 717-972-2821 ACCOUNT I AMOUNT DUE I CLOSE DATE IPAGE 000926-001 67.62104/11/03101 TO: Pauline Hill 949 16th St New Cumberland, PA 17070 WE ACCEPT M~Tk~CARD, ViSA AND AMERICAN EXPRESS. PREVIOUS BALANCE--> 39.71 DATE I DR. I PATIENTIPROC CDEI DESCRIPTION I DIAG I AMOUNT 03/25~03 03/12/02 04/11/03 04/n/03 rg. Pauline 99254 Initial %Dpatient Cq Payment:3567 Plan Payment:10458936Medicare Adj:Medicare WriteoffMedicare 584.9 179.00 39.71- 65.73- 45.65- PAY THIS AMOUNT --> 67.62 ACCOUNT NOICURRENT I 31-60 I 61-90' --[-'-91'£i20 I OVER 120 000926-00 67-62I 0.00 5490999018603356 $11,400.00 [ $11,155.45 I 32 Posting Transaction Raterance Card Categmy Transactions Date~ ID.e. INumber ITypel I AUGI.IST 2003 STATEMENT PURCHASES AND ADUUSTMENTS 08/11 08/11 0203 MC C LATE FEE FOR PAYMENT DUE 08/10 o8/11/o3 $30.00 TOTAL FOR BILLING CYCLE FROM 07/11/2003 THROUGH 08/11/2003 A REMINDER: IF YOU MISS THE PAYMENT DUE DATE, YOU WILL LOSE THE PROMOTIONAL RATE ON CATEGORY A. AS A COURTESY WE DID NOT CHANGE IT THIS TIME. 39.00 $39.00 09/10/03 Credits (CFI) $0.00 IMPORTANT NEWS ENUOY THE CONVENIENCE AND FLEXIBILITY THE ENCLOSED CHECKS OFFER-- OR CONTACT US AT WWW.IBSCASH.COM OR 1-888-515-3309. YOU ARE A VALUED CUSTOMER. WE WANT TO MAKE SURE YOU ARE AWARE THAT WE HAVE NOT RECEIVED YOUR PAYMENT. PLEASE SEND THE AMOUNT DUE TODAY. IF IT HAS BEEN MAILED, THANK YOU. WWW.PNCNETACCESS.COM - ENdOY THE CONVENIENCE OF FREE, 24-HOUR ACCOUNT ACCESS. SUMMARY OF TRANSACTIONS Previous Balance $203.2! (-) Payments and Credlt~ $o.oo (+) Cash Advances ~0.00 (+) Purchases and Adjustments ~39.00 +) Periodic Rate II. CE CHAI~ FINANCE CHARGE SCHEDULE Con'espondlng Category Pedodlo Rate Annual Percentage Rate Cash Advances ,, A. BALANCE TRANSFERS, CHECKS.o. O00000% DLY 0.00% B. ATM, BANK ................. 0.035534% DLY 12.97% C. PURCHASES ................... 0.035534% DLY 12.97% FOR THIS BILDNG PERIOD: ANNUAL PERCENTAGE RATE. .................. (Ir~ludee Pedod~ ~ end T~ Fee Finar~e Charge~ ) 12.97% I PLEASE SEE REVERSE SIDE FOR IMPORTANT INFORMATION. I+NAN) Transaction Fee CE CHAREIE8 · ~2.34 Balance Subject t~ Finance Charge $0.00 $205.55 5490 9990 1860 3356 TOTAL MINIMUM PAYMENT DUE To, at Past Due A~'nount ................. $15.00 Current Paymant .................. $15.00 $0. O0 $244.55 Total Minimum Payment Due ...................................... $30.00 FOR YOUR SATISFACTION, EVERY HOUR, EVERY DAY ·Fm Customa Salisfaclion and up to Ihe minute automated infarmalion including, balance, available credit, payments received, paymanls due, due date, payment address inlarmal~n, a lo requesl duprmate statemests, call 1-800-807-6779. · Far TDD (Telecommunicel~o Device ~ ~e Deal) assistance, ce~ 1-800-346-3178. · Mail payments to: BANKCARD SERVICES, P.O. BOX 15137, WILMINGTON, DE 19886-5137. · Billing rights are preseved only by ,,wittan in,ky. Mail bi~ing inqukJes, using fo~m on Ihe back and olhar in~uirins to: BANKCARD '~ERVICES, P.O. BOX 15026; WILMINGTON: DE 19850-5026. 3674 55R Y 42G 0200 0000 O0 PAGE I OF I _~c<.n_ _,~ Numbe~ CredR Une I 1860 3356 I $11,400.00 Posting Traneacflo~ Reference Card Category Tran~ac~ons Date Date Number Type PAYMENTS AND CREDITS 04/17 J$10,971.68 05/12/03 32 MAY 2003 STATEHENT Tc~I MIrSmum PaFtmnt Due Pat/merit Due Dale $15.00 J 06/10/03 Charg®a Oredlts 4189 MC PAYMENT - THANK YOU ~ TOTAL FOR BILLZNG CYCLE FROM 04/11/2003 THROUGH 05/12/2003 $0 29.23 CR $29.23 CR IMPORTANT NEWS SUMMARY OF TRAN~ACTION~ ENUOY THE CONVENIENCE AND FLEXIBILITY THE ENCLOSED CHECKS OFFER-- OR CONTACT US AT WWW.IBSCASH.COM OR 1-888-515-3309. AN IMPORTANT AMENDMENT TO YOUR ACCOUNT TERMS IS ENCLOSED. ACCESSING ADDITIONAL CASH IS EASY! PRESENT YOUR CREDIT CARD AT THE BANK COUNTER, OR CALL 1-800-771-3575 TO REQUEST A PIN CODE FOR USE AT AN ATM. TOTAL MINIMUM PAYMENT DUE Prevfl)ul BaJance (-) ~dm~d~ G452.65 G29.23 FINANCE CHARGE SCHEDULE Categay Parlodlo Rate Cash Advances A. BALANCE TRANSFERS, CHECKS.o.o35534%DLY B. ATM, BANK ................. 0.035534% DLY C. PURCHASES ................... 0.035534% DLY (+) ~ J (+) Purohane~ and (+) Pedm:llc Rate Advancel I Adjuilmants FINANCE CIIAR~iE8 GO.OO GO.O0 G4.90 12.97~ ANNUAL PERCENTAGE RATE. .................. PLEASE SEE REVERSE SIDE FOR IMPORTANT INFORMATION. i(~l~L~lansanUo~ Fee CE CHARGE8 GO.OO (-) TNo~lBalance G428.32 Pa~t Due Amount ................. GO. O0 Cu~r~tt Paymant .................. G15.00 Totol Minimum Payment Due ...................................... G15.00 ~ge ~e 12.91% 12.9 12.9 g 8aHect to Flnance Charge $0.00 $431.29 FOR YOUR SATISFACTION, EVERY HOUR, EVERY DAY · For Cuslomm Salinfadim and up to Ihe n~ete automated infmmalim including, belauce, available c~edit, paynrl~ls received, paymmts due, ~ date, j~/_me~l_ address informalion, or lo request dup~ate ~lMemenls, cai 1-800-80 i~ //g. · For TOD (Tdecommunicaliau Device fm the Deaf) au~ce, MI 1-8(X)-346-3178. · Mail paymauts to: BANKCARD SERVICES, P.O. BOX 15019, WILMINGTON, DE 19G86-5019. · Bing righls are preserved ~ by wfiltau bq~my. Mail baling inquk~, using form oe Ihe back and olher in~kia,~ lo: BANKCARD ',~ERVICES= P.O. BOX 15026~ WlLMINGTON~ DF 1985O-5O26. 163 57Z Y 05F 1 102 0000 O0 5490 9990 1860 3356 PAGE 1 OF 1 5490 9990 1860 3356 J $11 ,400.00 7.35 30 04/10/03 Po~Jng TramcecUon Reference Card Cal~gmy J TramaactJoal D~te Dgite Numbe~ Type APRXL 2003 STATEMENT PURCHASES AND ADUUSTMENTS 03/15 03/13 7006 MC C CVS //1630 MEN CUMBERLANPA 03/17 03/14 0653 MC C CVS //1630 MEN CUMBERLANPA 03/19 03/16 6643 MC C LZZ CLAIBORNE OUTLET # HERSHET PA 04/10 04/10 0423 MC C LATE FEE FOR PAYMENT DUE 04/09 TOTAL FOR BILLING CYCLE FROM 03/12/2003 THROUGH 04/10/2003 17.43 33.56 343.41 25.00 $419.40 $0.00 IMPORTANT NEWS ENdOY THE CONVENIENCE AND FLEXIBILITY THE ENCLOSED CHECKS OFFER-- OR CONTACT US AT WWN.IBSCASH.COM OR 1-888-515-3309. YOU ARE A VALUED CUSTOMER. RECEIVED YOUR PAYMENT. NE WANT TO MAKE SURE YOU ARE AWARE THAT NE HAVE NOT PLEASE SEND THE AMOUNT DUE TODAY. IF [T HAS BEEN MAILED, THANK YOU. ACCESSING ADDITIONAL CASH IS EASY! PRESENT YOUR CREDIT CARD AT THE BANK COUNTER, OR CALL 1-800-771-3575 TO REQUEST A PIN CODE FOR USE AT AN ATM. SUMMARY OF TRANSACTION8 Pl~oul ~]ce (-) P~/me~t~ J (+) Ca~h amd ~J A~ ~29.23 ~0.00 ~0.00 FIN~CE CH~GE SCHEDULE ~ P~lc ~ Cash Advances A. BALANCE TRANSFERS, CHECKS.o.o35534%DLy B. ATM, BANK ................. 0.035534% DLY C. PURCHASES ................... 0.035534% DLY J(+) Pumhacea amd AdJu~tm,~tm ~419.40 E CHAR(aE8 $4.02 Con'espondlng Annual ~'mcer, taoe Rate 12.97% 12.97% 12.97% J ~-~----'~-P~,~e~.a,~-~T~o,r~F#~,~Ch~) 12. 97% J ANNUAL PERCENTAGE RAT~ ................ PLEASE SEE REVERSE SIDE FOR IMPORTANT INFORMATION. (+) Tran~a~Uofl Fee J FINANCE CI-IA.q~Es (') TNoe~lBalance ~0.00 ~452.65 TOTAL MINt."_'J.M_ P~',~E:;T DUE Pa~t Due Amount ................. ~15.00 Cun'mlt Pm/merit .................. ~;15.00 Tatal Minimum Pm/merit Due, ...................................... G30.O0 Rnamce Charge $0.00 $o.oo $377.56 5490 9990 1860 3356 FOR YOUR SATISFACTION, EVERY HOUR, EVERY DAY · For Cuslome~ Salisladian md up to the minute automated klormalim kduding. ~ce,.avagal~.. cre~t, payments rec~k,~l, i~ymmts due, due dale, payment ess m~ma~m, or to request dupic~e statements. ~ 1-800-80T-G77.q °Fm TDD ('l'elecommunicalion Device for the Deaf) ~tmce ~ 1-800-346-3178. ' · Mail payments to: BANKCARD SERVICES, P.O. BOX 15'137, WILMINGTON, DE 19886-5137. · .B~.g ~.ts a~e ix~sorved ~.~ by ~Uen inquk',/. Mail being inquirk~, ]~3l'~Na~ me b_ _a_ck and othor Inauidm te: KcAR sERvices P.O_ .ox l e. W LU N TO. DF 19850-5026. ' ' 1198 53C Y 19Y 0200 0000 O0 PAGE 1 OF 1 I I '2 03/11/03 5490999018603356 $11,400.00 $11,370.77 '9 lflteg TranN~o~ Ral'emn=® Card C~tego~y Tren~tctl~ts ~ Numt~ T~ ~ 2~3 STATEME~ PUR~SES ~D ~JUSTME~S 03/10 03/09 1127 MC C Bd ~HOLESALE ~25 ~OX HARRISBURG PA TOTAL FOR BZLLZ~ CYCLE FROM 02/11/2~3 THROU~ 03/11/2~3 $15. O0 04/09/03 $0.00 IMPORTANT NEWS SUMMARY OF TRANSACTION8 TOTAL MINIMUM PA;MENT DUE $o.o0 (o) Payment~ and Cmdb $o.oo (+) $0.00 Purohlme~ and AdJudment~ $29.23 $0.00 Past DueAmount ....... ~ ......... $0.00 CunofltPayme~t ............. ; .... $15.00 Total~nimumPayme~t Oue ...................................... $15.00 HNANCE CHARGE SCHEDULE Percentage RaM Cash Advances " A. BALANCE TRANSFERS, CHECKS.o.o04657% DLY 1.70% B. ATM, BANK ................. 0.035534% DLY 12.97% C. PURCHASES ................... 0.035534% DLY 12.97% ANNUALPERCENTAGERAT~ ............. SEE ABOVE PLEASE SEE REVERSE SIDE FOR IMPORTANT INFORMATION. Balance 8ubt~ to Finance Che~go $0.00 $0.00 $0. O0 5490 9990 1860 3356 FOR YOUR SATISFACTION, EVERY HOUR, EVERY DAY · Far Cusloma Salblaclim md up Io be minule automated bf~malim indading, balance, avalbMe a'adit, paymants received, paymants due, due date, paymml address hformalian, or Io request dupicate statements, cai 1-800-807-6779 · For TDD (l'decommuninalk3o Device for the Deal) assistance cea 1-800-346-3178. ' · Mail payments to: BANKCARD SERVICES, P.O. BOX 15019, WILMINGTON, DE 19896-5019. · Biling rights me pranefvad only by w1~ inquJy. MeJ biing inquifian, using form on the ~ and ob'ia' in ' ins BANKCARD SERVlCE~.. P_O_ BOX 15026. WILMINGTON; DF 19850-50'26. 4588 541 52¥ 1202 0000 O0 PAGE I OF 1 40 Wantage Avenue Branchville, NJ 07890 SELECTIVE Insurance PAULINE D HILL 9~9 16TH ST NEId CUMBERLAND PA 17070-1519 I,,,111,,,111,,,I,,,111,,,,I,1,1 Bill Date: 05/51/Z005 Number Balance 266-32~-58Z 202. O0 J Premium Changes 171.00 AGENT: 00-02881-00000 AMERICAN INSURANCE ADMINSTRATORS INC ~550 LENA DR HECHANICSBURG, PA 17055-~922 717-591-8280 BILL STATEMENT 1 From You To You Balance 04/Z0/2005 -ZOZ.O0 Z5.00 196 196 H 1121418 04/20/2002 HOHEO#NER PAULI*NE D HILL ,\ PREVIOUS BALANCE 202. O0 ENDORSEHENT 04- 2 O- 2002 - 25.00 PAYNENT, FRON YOU 04-10-2002 -202.00 PAYNENT TO YOU 0.6-01-2002 2.6.00 NEW BALANCE . O0 H 112141& 04/20/200:5 HOHEOt'/NER PAUL/NE D H'rLL PREV/OUS BALANCE . O0 RENE#AL POL/CY PREMTUM 04-20-200:5 196.00 / NEI4 BALANCE 196. O0 196. O0 Enroll in SelectPay today to vlew and pay your bills alectronAcally! It's as easy as 1,2,:5. I - Tnquire and enroll at www.selective.com or call 888-974-7400. 2 - Check your mail for the PIN letter wa sand when you enroll. For your security, you must use your P]:N to open ~our account. :5 - Call or log on to =pen your account. He will give you the date your payments can start. It's tha~ simple. En.ioy the conve~ience of Selec~Pay... sign up today! tOTALS 173. . OO -177 . O0 196 . 00 RESULT !NDING: DENIAL OF BREACH ,ave not received paYment f°ry~ur ~ BESTi [o slop, we will Send MYSTI 2 t° 3 m, =nths for There is no commitment to buy a minimum number of BI OF ALL TIME and You may stop at any time.' Negle~ing to pay prior bills has made your aCCount Prompt payment of the above bill is required, Return th, in the er~closed 'priority attention' envelope immediate~: Steve Clark Director of Interna Date Pd 5~ Check #. BEST MYSTERIES OF ALL TIME POST MORTEM $25.41 (SHIPPED 08/02) Detach here and retain this part for your records. ANGEL OF PEACE - WIND BENEATH PREVIOUS BALANCE PAYMENT RECEIVED BALANCE STILL DUE 89.75 0.00 89.75 PAYMENT MAY BE MADE BY SIMPLY CHARGING THIS ITEM TO YOUR CREDIT CARD. PROVIDE THE NECESSARY INFORMATION AT THE TOP OF OF THIS PAYMENT FORM - IT'S THAT EASY! YOUR ACCOUNT NUMBER ~ 03566-8857 INSf132-f4RO HINS02-70725 Detach here and retain this part for your records. HUMMINGBIRD - WIND BENEATH PREVIOUS BALANCE PAYMENT RECEIVED BALANCE STILL DUE 55.75 YOUR ACCOUNT NUMBER ~ 03566-8857 LBMO29-02RO PAYM£NT MAY B£ MADE BY SIMPLY CHARGING HLBMf2-71030 THIS I?[M TO YOUR CREDIT CARD. PROVIDE ~ TH[ NECESSARY INFORMATION AT THE TOP OF ~®p~;.oi~i<o.3~5.~.Ss..~,?2a0 OF ?H NT frORM - IT'S THAT EASY! CARLISLE MPO CARL .~SLE. Femr~syl vani a ~7013Z)35 uS/OG/'2[Iu3 (800}2 75--¥//7 12:l~:b7 ..... Sales Receipt ....... Pcoduct Sa]~ :,;i-~ ~ t Final Descpi pti on QZy ~r ~ce PF'~ ce CAMP HILL_ PA !701~ $0.37 First-Class Return Receipt $~. 75 Certified $2.30 Label Ser;a[ ~: 7001114UOOu325197517 £ssue PVI: Sq.q2 NEW CUMBERLAND PA ! 7(37U $[, 3/ First-Class Return Receipt $i .75 Cert i f i ed $2.3:5 Label Se~-lal I~: 70011140000325197524 Issue PVi: $4.42 Paid by: (/ash $20 OC Change Due: -$!].16 Bi~!¢: 1000201195558 2,erk: 02 Refunds only pe; 'iMM POlq qFhank you foF yo~ business -- Customer Copy' TAXPAYER COPY ADAMS COUNTY HILL, PRUI_INE DF-E 07; EOB-be i 3---000 TAX NOTICE DATE TYPE 'r~ PER CAPITA TAX COUNTY BORO/TOWNSHIP 0.3101103 RAT~ AMOUNT for 2003 BUTLER 0'7U OCCUPATION ASSESSED VALUATION TAX ON REAL ESTATE OCCUPATION TAX couN~ ,o,o~wNs,,. cou~w .o,o~row~smP $241.97 81. l, 'J. 87 TOTAL TAX AT PAR ._-.~! Discount County ~_/. .~ ~. -r. ~ ~ ~ ~" *" Penal~ County 2 % Discount Boro~wp / ...... / ..... Penal~ Boro~wp / .... $275~6 / APR };0 $2A0. 7A --~ JUN 30,2003 $306.'~2 JUN 30, 2003 ~ ~Prompt ~ent is mquest~. No receipt is m~ll~ unle~ s~m~ addre~ envelo~ is encl~ed. The a~ve t~es will ~ delinquent as of the commen~ment of the a~ve-stated ped~ a~ will ~ereaNer ~ M ~ ' be su~e~ to alternate coll~on meth~s, including wage a~ach~nt an¢or refer~l to a delinquent t~ colle~on age~ (per ~ and ~u~tion t~es) and filing of liens with the Adams Coun~ Tax Claim Bureau (real estate taxes). Delinque~ taxes will be 8ubj~ to pe~ities and ~sts required by law in addition to the a~ve penal~es. Please bdng this nct~e ~h you to pay ~es. Ga~-v R. Fa.i'r', Butler Twp. ]'ax F:ollecto'r PAULINE DEE HiLL ~A~ P. 0. Box 564, BiDlerville. PA ~/~., ~[1" ,]-~T Z5 3/~ ~m~ ~ OFFICE LOCATION: NEW CUMBERLAND PA 170'70 ~ ~ ~ ~ 2085 Biglervilie Road, Gettysb t~-g, PA 17325 ~ /~ ~ ~; HUU,,o: Mor, da, 9:00am - 00pn, .- // "~ P~' ,, 7: Tuesday, Thursday, Friday 9:00am - 5:00p~u Fo~~ other ti~es, call for appointment. (7:L7)~..4--,o8c_ or . . by ~a. '-~ ~ r~ IMPORTANT - If you have filed bankruptcy, please send a copy of your notice of bankruptcy to this tax collector immediately and we will discontinue billing you for MISC pre-petition taxes, otherwise, you will continue to receive taxes and may be subject to normal tax collection procedures. PAYABLE TO: ROBIN GASPERETTI, TAX COLLECTOR 1113 BRIDGE STREET NEW CUMBERL32~rD, PA 17070-1634 DESC. BILL DATE 3/01/2003 BILL NO 2166 2oo3 PERSONAL T*X NOTICE COgNT¥ O~ CDlV/~ERLAN-~ BORO~G~ OF NE~ CUI~BERI.~A_AfD $2.00 FEE FOR ADDITIONAL RECEIPTS UNPAID TAXES SUBMITTED TO DELINQUENT COLL 12/31/03 CTL 25 7603 SSN ' 174-14-0778 HILL, PAULINE DEE 949 16TH ST. NEW CUMBERLAND PA 17070 TUES,WED,THURS 7:30-11:30AM ALSO TUES 2-6PM WED 2-4PM MONTHS OF MAY,SEPT,DEC,JAN, FEB TUES 8-11AM CLSD 12/23,HOLIDAYS 717-774-7424 CNTY P/C 5'i00000 4.90 .:. .5. 5. MUN P/C 5. 0000o_, 4.9'0!:,.: : 5.~0C: 5. 9.80 10.00 11.00 CNTY P/C 2.0% FACE PENALTY MUN P/C 2.0% 10.0% 5/01/2003 AFTER TO TO 4/30/2003 6/30/2003 6/30/2003 IF TAXES ARE IN ESCROW, FORWARD THIS BILL TO YOUR MORTGAGE CO. *$2.00 FEE FOR ADDITIONAL RECEIPTS* PAYABLE TO: ROBIN GASPERETTI, TAX COLLECTOR 1113 BRIDGE STREET NEW CUMBERLAND, PA 17070-1634 DESC: MAP NO: 26-23-0543o162A 949 16TH STREET ACRES .140 DEED 00219/00809 ZIMMERMAN ACRES LOT 2 BLK B PB 3 PG 51 Residential Building RESIDENTIAL TAX HILL, PAULINE D PAYER 949 16TH STREET NEW CUMBERLAND PA 17070 ...... TI II::R ~ABCD TI-Il IR.R 7'."4C}-11 'ROAM ALSO TAXPAYER COPY Bill NO: 1203 Control No: 026 - 000613 2003 Statement of Real Estate Taxes Bill Date: 3/01/2003 Assessed Land [ Improvement Mineral Total Values 15,300I 48,970 0 64,270 COUNTY OF CUMBERLAND Discount Face Penalty Rates .00204600 .00204600 2 % 10 ~ COUNTY R/E 31.30 100.19 128.86 131.49 144.64 Rates .00010300 .00010300 2 % 10 ~ COUNTY LIB 1.58 5.04 6.49 6.62 7.2~ BOROUGH OF NEW CUMBERLAND Rates .00250000 [ .00250000 2 % 10 ~ MUNIC. R/E 38.25[ 122.43 ,~ 160.68 176.75 TAX AMOUNT DUE ,~.~ ~ $298.79 $328.67 If Paid On or After .~_~0~/2003 5/01/2003 7/01/200: If Paid On or Before 4/30/2003 6/30/2003 IF NOT PAID BY 12/31/2003 THIS 3ILL WILL BE RETuKNED TO TAX CLAIM BUREAU FOR COLLECTION AND FILING OF A LIEN AGAINST YOUR PROPERTY. / HARRISBURG, PA 17105 PHONE (717) 232-4328 .~ NO FINANCE PLEASE INSERT CHARGE ON AMOUNT TO BE BUDGET PAID ABOVE :':.~-.': r w: MEt4:: RRE NO]',' r,.EF,..,:.L ~ ~ THE ANNUAL CHARGE is COMPOT[O .v A Ptmomc .,,rl[ oF 'i / ~ ~6 PER MONTH WHICH I" AN ANNU~ ~E~AGE ~ ~ ~ ~ APPLIED TO THE PAET DUE IALANCE FROM WHICH CURRENT PAYMENTS AN~OR CREOIT~ HAVE BEEN D[DUCTED P.O. BOX 1745 HARRISBURG, PA 17105 PHONE (717) 232-4328 )N TH.~ = ,.00 ,,.O0 e 800-433-2070 FAX 717-766-4299 ASSOCIATED PRODUCTS SPECIALISTS IN WASTE MANAGEMENT. 2 EAST RD MECHANICSBURG, PA. 17055 GROUP STATEMENT DATE=08/01/2003 BETTY PIAT 318 EMILY LANE NEW CUMBERLAND, PA 17070 CUST #= E12761 PHONE= 909-4403 FAX= DATE INVOICE# INVOICE $ PAID $ BALANCE 05/03/2003 462575 76.32 0.00 76.32 05/31/2003 463842 76.32 0.00 76.32 06/28/2003 465247 76.32 0.00 76.32 BETTY PIAT/ TOTAL FOR ACCT= 12761 228.96 TOTAL FOR ALL ACCTS= 228.96 PPL Electric Utilities Electric Service Fol%' PAULINE D HILL 949 W 16TH ST NEW CUMBERLAND PA 17070 Questions about this bill? Please contact us by Aue 26 at 1-800.342.579e5 or 484-634-4900 or write lo: Customer Service 827 Hausman Rd. Allentown, PA 18104-9392 wWW.pplweb.com Electric Use This graph shows your electric use over the last 13 months. Readings: Actual ~ Estimated ~ Customer [~] Page I Summary Page B',dance as of Aug 5, 2003 Charees: $ 23.25 'Ibta/"PpL ELECTRIC UTILYIIES Charges $ 25.85 Total Charges ~:'~'~::'~" ......................... ~ ............ $ 49.10 Account Balance $ 49.10 KWH - Average Per Day "---- 24 Meter Reading Information 20 ~_~ ~al ' 853] 12 ,~A verage. Aug 2002 2003 ~~-/ ~ emperature 78F 7 8 ~ KWH Per Day 22 48F Yearly Use: T~sael Average oSep 2001- Aug 2002 4~e Mont,hJy. ~ep 2002 - Aug 2003 3Y~ 33,4 265 ASONDJ FMAMJ JA 2002 Months 2003 ............................. Other important intbrmation on back --~ s PPL Electric Utilities uses about addition, about $2.16 of this bill pays the PA Gross Receipts 'Fax. 'lhe Transition Charge includes an Intangible Transition Charge (ITC) and the applicable gross receipts tax which t6eether amount to $2.'78,' Th6 ITC ~..a. p~.~.r usage, dh.ar, ge app. roved by the Pub']ic Uti?y Commission which I'['L l~lectnc Utilities collects as agent for PPL Electric Utilities Transition Bond Company LLC and which tliat company uses to service debt incurred to recover a pqrtion of PPL Electric Utilities' stranded costs. The gross receil~ts tax, which is collected for the Commonwealth of Pennsylvania, is equaI to 4.4% of the ITC. For your convenience, you can now ~avvour bill usin~ your Visa. MasterCard, Discover, or ATM Card. U~l BilIMatri~ fit 1-800-672-2413. BillMatrix will charge your credit and ATM card a service fee for making this payment. PPL e tri¢ Utilities ..",-',' Electric Service Page 1 Summary Page Balance as of Jun 5, 2003 For: Char~2es: $ 25.24 PAULINE D HILL T°taf~PPL ELECTRIC UT/LIT/ES Charges 949 W laTH ST Total Charges $18.70 NEW CUMBERLAND PA 17070 Questions about this bill? Please contact us by Jun 26 at 1-800-342-5775 or 484-634-4900 or write to: Customer Service 827 Hausman Rd. Allentown, PA 18104-9392 wWW.pplweb.com Electric Use 24 KWH - Average Per Day Meter Reading Information This g.raph shows your electric use over the last 13 months. 20 16 aM~a 9 ~ctual 4,;9 za verage. Jun 2002 2003 Temperature 62F 58F 8 KWH Per Day 7 5 4 Yearly Use: Total Averat~e 0 J.u.l ~001- .tun 2002 AaU~s~e Monthly JUl 2002 - Jun 2003 -,-o/ 355 4023 335 2002 MtoDnt~sF MA M20~3 /~lYePteers ° f Readings: Actual Estimated Customer off ................................................. Other important in for red to~f~-~oYe-c-a-~ ............ malion on ka,,b ~ rece]pts tax, which is colJectea to~ m.--.:~ ............. ~ is equal to 4.4% of the ITC. - ........................ For your convenience, you can nownav your bill usine your Visa, Discover, or ATM Car& Call BlllM~trlx at 1-800-6~-_413. BlllMatrix will charge your credit and ATM card a service fee for making this payment. Now you can receive and pay your PPL Electric Utilities' bill online. Checl~ our web site for more information and to sign up -- www.pplweb.com No charge Convenient Secure SAVE MONEY Save postage mid late charges - sign up for Automated Bill Payment. ppl PPL Electric Utilities Page 1 Electric Service Fol': PAULINE D HILL 949 W 16TH ST NEW CUMBERLAND PA 17070 t~ueStions about is bill? Please contact us by Apr 29 at 1-800-342-5775 or write to: Customer ~.rvice 827 Hausman Rd. Allentown, PA 18104-9392 www.pplweb.com Summary Page Balance as of Apr 8, 2003 $ 21.97 Char~es: TotaI-PPL ELECTRIC UTILITIES Charges $ 20.11 Charges ~, ~ ~ $ 42.08' Total Account Balance ~ Electric Use This graph shows your electric use over the last 13 months. l~/pe s of ter Readings: Actual l Estimated ~ Customer ['--] KWH - Average Per Day 24 Average - Apr Temperature 20 KWH Per Day 16 Yearly Use: May 2001 - Apr 2002 12 May 2002 - Apr 2003 8 0 AMJ JASONDJ FMA 2002 Months 2003 2002 2003 43F 44F 7 5 Total Average Use Monthl~ 4656 388 4128 344 Other important information on back PPL Electric Utilities Page 3 Electric Service PAULINE D HILL 949 W 16TH ST NEW CUMBERLAND PA 17070 PPL Electric Utilities Customer Service 827 Hausman Rd. Allentown, PA 18104-9392 1-800 -3 42 -~5~..5 www.pplweb..com Total from Last Bill $ 21~07 Billing Details Amount You Still Owe as of Apr 8, 2003 Current Charges Cha .rges for - PPL ELECTRIC UTILITIES Residential Rate: RS for Mar 10 - Apr 8 Di~ribution C~harge: L~stomer ~narge 6.47 151 KWH at 1.79600000¢ per KWH 2.71 Transmissiou Charge: 151 KWH at 0.3"/700000¢ per KWH 0.57 Transition Charge: 151 KWH at~.55900000¢ per KWH 2.35 Generation Charge: Capacity and Energy 151 KWH at 4.9'6200000¢ per KWH 7.49 PA Tax Adjustment Surcharge afl.26000000% 0.25 Total PPL ELECTRIC UTILITIES Charges Other Charl~es for PPL Electric Utilities Late Paymen'~ Charge 0.27 Total of Other Charges $ 21.97 $19.84 $ 0.27 Account Balance $ 42.08 General Information Next meier readin~ on or about May 8 KWH Use By Meter Reading Dates Meter Meter Meter Reading Kilowatt PreviousTPresent Number Constant Previous/Present Hours Mar 10 Mar 18 38674806 1 48437 48491 54 Mar 18 Apr 8 90470060 1 00000 00097 97 Total 151 Your account is overdue. If you do not pay in full or call our office to arrange payment in 10 days, your electncify may be shut off. Call us weekitays 8am to 5pm at ]-800-358-6623. The $21.97 balance includes $0.27 in prior late payment charges. Generation prices and charges ar.e. set_by the.ele, ctric ge,ne~rati~qn.s.u, pp~!ier you have chosen. The PubFic Utility ¢~omm~ss~on reg.9.~ates o~stnouuo,n. prices and services. The Federal Energy Regulatory ~.;ommission regulates transmission prices and services. PPL Electric Utilities uses about $4.16 of this bill to pay state_taxes. In addition, about $1.85 of this bill pays the PA Gross Receipts Tax. The Transition Charge includes an Intangibl.e Transition Ch~g~e. (IT~C) mdc the applicable gross receipts tax which together amount to $1.~. ~ne ~ is a l~r usage charge app. roved by the Public Utility Commission which PPL Electric Utilities collects as agent for PPL Electric Utilities Transition Bond Company LLC and which ttiat co.m. pan. y uses. to. service~debt incurred to recover a pq. rtion of PPL Electric Utilities' stranclea costs, i ne gross receipts tax, which is collected for the Commonwealth of Pennsylvania, is equal to 4.4% of the ITC. ( omcast. ACCOUNT NUMBER 09547 175286-01-7 DATE DUE 04/30/03 TOTAL AMOUNT DUE $39.63 Suite B Fees News from Comcast Thank you for your and automatic mo Comcast presents;..; alumni will face of the Giant {~enter. q Ticketmaster. Proceeds veriz Account 717 774 2274 421 61 Y Page 1 of 6 PAULINE HILL 949 16TH ST NEW CMBRLND PA 17070-1519 h,,llh,,llh,,h,,llh,,,,,ll'hh,,,llhh,,h,lhh,,Ih,I To enroll in the yerizon Direct Payment Option pleaSe read and sign the agreement On the rever~e Mde of the loayment form below. Account Summary Amount of Last Bill 28.24 Payments through Mar 26 .00 Unpaid Balance. Please Pay Now. 28.24 Current charges Verizo~ Charges- .... 24.61 Verizon Long Distance charges 3.71 Current Charges Due by Apr 21 Total Amount Due Please write in amount enclosed and send this coupon with your check or money order in US funds to address below. May 15, 2003 Bill for: Billing Period: Apr 16 to May 15, 2003 for 30 days Next Reading Date: On or about Jun 16, 2003 Invoice Number. 95400373491 BETTY J PLATT 125 CLEAR SPRING RD BIGLERVILLE PA 17307 Page 1 of 4 M71 Bill Ba~ed On: Actual Meter Reading To avoid a 1.5% Late Payment Charge being added to your bill, please pay by the due date. M J J A S O N D J F M A M IA -Actual E,Estimate C-Customer N-No Usage May 02 May 03 Average Dally Use (KWH) 0 3 Average Dally Temperature 58 57 Days in Billing Period 29 30 Last 12 Months Use (KWH) 1,263 ?.,..{ 105 , __~~~~Avera. e Monthly Use {1~, I 'totsl Paymen~ and Adjustments August 18, 2003 Bill for: BETTY J PLATT 125 CLEAR SPRING RD BIGLERVILLE PA 17307 Billing Period: Jul 17 to Aug 15, 2003 for 30 days Next Reading Date: On or about Sop 16, 2003 Bill Based On: Actual Meter Reading Residential Page I of 4 M71 Your previous bill wes Total payments/adjustments 0.00 Current Basic Charges Met-Ed - Consumption 22.54 Met-Ed-Late Payment Charges 0.60 To[al Current Charges 23.14 .................... ..:~,.,,.,. ,,,.,~..,,,:. :~:,::,:: :::.:,:.~, :.~ "~1 ..... b :"S' '08:2003:;'~[~='~'~: ' ~i$'~ii~a~ ~ :!!~ ~:'?::?:i::i~ To avoid a 1.50% Late Payment Charge being ¥ I I = I .B, ilI. i_ss, Y: ..... Customer Sen/ice ! _-~-..54~/77~.. I I~=1 I _M_.e',;,t:a ..... ~ Emer~ncy/Power Outage Ilmlm I I-'U UOX 1010/ A~.,~.~,c~,,~ Colloctions 1-OUU'~3Z-w°~4° I I R~dn.cl PA 19612-5152 -~ .~_~. ----j-- . ,,~- ._~.:. ----~ ........... t,-usromer Account inrormarlon For Service To: Pauline Hill 949 16th St Account Number: 24-1200114-7 Premise Number: 24-0367415 Billing Period & Meter Information Billing Date: Aug 05, 2003 Billing Period: Jul 01 to Aug 01 (31 days) Next reading on/about: Sep 02, 2003 Rate Type: Residential Meter readings in current billing period: Meter Number N000116291 is a 5/8-inch meter. Present-actual 179 6 0 0 Last-actual 17 95 0 0 Gallons used 100 Water Usage Comparison 41 Monthly usage in hundred gallons. 2 A $ O N D J F M A M J J A 2 ~ u · c o · a e a a u u ~1~ g p t v c n b r ~) y n I unnng eummary ~ Prior Balanc= Balance from last bill Payments prior to Aug 05, 2003. Thanks! Total prior balance, Aug 05, 2003 ......... Current Water Charges Service Charge Water Volume ($.005277x 100) STAS PAWC Water 0.07% DSI - PAWC Charge 1.34% Total water charges, Aug 05, 2003 ....... Other Current Chargea~ Late Payment Charge Total other charges, Aug 05, 2003 ~.AMOUNT DUE - o.65 .00 10.65 10.50 .53 .01 · 15 11.19 · 16 · 16 ~22.00 Messages to you from Pennsylvania American * Any portion of this water gill which is not paid as of 9/02/03 will be subject to a 1.50% penalty. The due date pertains to current charges only. Any past due balance should be paid immediately. * At Pennsylvania American, our customers are our top priority. Please let us know how we can serve you better. * With over 100 years of water service experience. Pennsylvania American is a trusted leader in the industry. We consider it a privilege to supply water and wastewater service to more Pennsylvanians than any other provider, and we consider it aprivilege to serve you and your family. * RESIDENTS: A VOID COSTLY SERVICE LINE REPAIRS... To learn how you can protect yourself against unexpected and costly service line repairs, call (866) 430-0819, and ask about the Water Line Protection Program. Your peace of mind is worth it. * Sign up for American Water's automatic payment plan. Through electronic transfer, you can take advantage o..f this convenient way to pay your bill automatically on the da.)/it's due. No more checks, stamps, or late bills! vail the.. 24. -h.our Customer Service Center to request an application. You will need your Account Number when you call. dusr press I for the option to hear about Account and Billing Information, then choose the option to r, equest an application for automatic payment. Fill out the form and mail it back to us It's that easyl *. E. .f~._. t~v__e.July, 1, 20.03, .the O!str/bution System Improvement Charge (DSIC) has Increased from 1.17% to l.~,; Y~o. I hiS cnarge runt,s replacement of water distribution facilities. Customer Service & Emergencies 1-800-565-7292 (24 Hours) For Hearing Impaired Customers TDD 1-800-300-6202 (24 Hours) Visit us on the INTERNET: www.pawc.com ~ ~ ASM 21)12 For Service To: Pauline Hill 949 16th St Account Number: 24-1200114-7 Premise Number: 24-0367415 Billing Period & Meter Information Billing Date: Jun 04, 2003 Billing Period: May 01 to Jun 02 (32 days) Next reading on/about: Jul 01,2003 Rate Type: Residential Meter readings in current billing period: Meter Number N000116291 is a 5/8-inch meter. Present-actual 1795 0 0 Last-actual 179500 Gallons used 0 .... Prior Balance ..... Balance from last bill Payments pdor to Jun 04, 2003. Thanksl Total prior balance, Jun 04, 2003 ...... Current Water Charges~ Service Charge STAS PAWC Water 0.07% DSI - PA WC Charge 1.17% Total water charges, Jun 04, 2003 · AMOUNT DUE Water Usage Comparison Monthly usage in hundred gallons. 2 J J A $ O N D J F M A M J 2 8 u u u e c ° e a era a u 8 n I g p t .v c n b ~ y n 2 3 $11.17 -11.17 .00 10 .$0 .01 · 12 10.63 $10.63 Message~ to you from Pennsylvania. American ** Any, portion of this water bill.which, is not paid. as of 6/30/03 will be sub'ect to a 1.50% nal. .Its a .we!l-known fact that drinking water ,s crucial to your health, so '~J~k up and eUn;;~e r~e'nefits of rap warert * RESIDENTS: A VOID COSTLY SERVICE LINE REPAIRS... To fearn how you can protect yourself against unexpected and costly service line repairs, call (866) 430-0819, and ask about the Water Line Protection Program. Your peace of mind is worth it. * .S.i.g.n up for Amedcan Water's auto. matic payment plan. Through.,. electronic transfer, you can take advantage or mis convenient way to pa~ your Dill automatically on the day it s due. No more checks, stamps, or late bills/ Call the.. 24. -h.our Cus~rn?.r Serv. t. ce Center to. request an application. You will need your Account Number when you Call. dust press I mr me option to hear about Account and Billing Information, then choose the option to ,re~,,u~_t an a, ppl.~a~on ~r automatic payment. Fill out the form and mall ti back to ul. Itl thai ealyl , ~..l~e~.,nsy. lva. n.l_a ~_me__rl~..n,_our. ?s..torne_~ a. re o. ur top priority. Please/et us know how we can serve you better. -~ls~Ve ,~.nl I? 200.3, ~e ulfrn. Du,o. n ~.yslem Improvement Charge (DSIC) has Increased from I. 1~% to I. 17%. ~s charge tunas replacement or water alstrlbution facilities. Customer Service & Emergencies 1-800-565-7292 (24 Hours) For Hearing Impaired Customers TDD 1-800-300-6202 (24 Hours) Visit us on the INTERNET: www.pawc.com AIM 13596 For Service To: Pauline Hill 949 16th St Account Number: 24-1200114-7 Premise Number: 24-0367415 Billing Period & Meter Information Billing Date: May 05, 2003 Billing Period: Apr 01 to May 01 (30 days) Next reading on/about: Jun 02, 2003 Rate Type: Residential Meter readings in current billing period: Meter Number N000116291 is a 5/8-inch meter. Present-actual 179500 Last-actual 179400 Gallons used ........ Prior Balance .................. Balance from last bill Payments prior to May 05, 2003. Thanks/ Total prior balance, May 05, 2003 ...... Current Water Charges ........ Service Charge Water Volume ($.005277 x 100) STAS PAWC Water 0.07% DSI - PA WC Charge 1.17% Total water charges, May 05, 2003 ........ AMOUNT DUE .................... Water Usage Comparison Monthly usage in hundred gallons, __ 2 M J J A $ O N D J F M A M 2 0 a u u u · c o e al {) a ~) a 0 0 y n I g p t v c n b r . Y 0 2 3 $11.71 -11.71 .00 10.50 .53 .01 .13 11.17 $11.171 Message~ to,you from Pennsylvania - American o * Any portion of this water billwhich is not paid as of 6/02/03 will be subject to a 1.50 ~ penaltY. * RESIDENTS: A VOID COSTLY SER VICE LINE REPAIRS... To learn how you can protect yourself against unexpected and costly service line repairs, call (866) 430-0819, and ask about the Water Line Protection Program. Your peace of mind is worth it. * Sign up for American Water's automatic payment plan. Through electronic transfer, you can take advantage of this convenient way to pay your bill automatically on the day it's due. No more checks, stamps, or late bills! Call the 24-hour Customer Service Center to request an application. You will need your Account Number when you call. Just press I for the option to hear about Account and Billing Information, then choose the option to request an application for automatic payment. Fill out the form and mail it back to us. It's that easy/ * At Pennsylvania American, our customers are our top prioritY. Please let us know how we can serve you better. * Effective April 1, 2003, the Distribution S.~/stem Improvement Charge (DSIC) has increased from 1.12% to 1.17%. This charge funds replacement of water distribution facilities. Customer Service & Emergencies 1-800-565-7292 (24 Hours) For Hearing Impaired Customers TDD 1-800-300-6202 (24 Hours) Visit us on the INTERNET: www.pawc.com ~ ~ A1M 13218 For Service To: Pauline Hill 949 16th St Account Number: 24-1200114-7 Premise Number: 24-0367415 Billing Period & Meter Information Billing Date: Apr 03, 2003 Billing Period: Mar 03 to Apr 01 (29 days) Next reading on/about: May 01,2003 Rate Type: Residential Meter readings in current billing period: Meier Number N000116291 is a 5/8-inch meier. Present-actual 179400 Last-actual 179200 Gallons used 200 Water Usage Comparison Monthly usage in hundred gallons 2 A M J J A S 0 N D J F M A 2 U · ¢ 0 · a · 0 ..... Prior Balance-----------~ Balance from last bill Payments prior to Apr 03, 2003. Thanks/ Total prior balance, Apr 03, 2003 .... Current Water Charges-~m Service Charge Water Volume ($.005277x 200) STAS PAWC Water 0.07% DSI - PAWC Charge 1.17% Total water charges, Apr 03, 2003 ....... AMOUNT DUE ~10.6: -10.6: 10 .S( 1.0~ .0: · lZ ll.7j Messaaes to vou from Penns fvania . A ' ' An ' . ,, . mencan y portion of this water b,~[ which is not paid ,, of 14~2S8~/~ will be, ' * At · . . ubject to a 1.50% penalty. Pennsylvania Amencan, our customers are our to non . Please ! * Effective . . . o__p..p_ by et us.know, how we can serve you better. ....... Al?Il., 200.3, the Dis. tri. bu#on S.~/stem Imp;uvement Cha e DSIC nas inc. reas ; nm (;F';frg~ RvYil~S r~Dlac~r or wal~r rli;trih.tinn fa~.iliti=e rg ( ) ed from 1.12% to 1.17%. ' Criminals may pos~ as utility work~ 'to-'g-a"i~-a'~'s~'"y~o~r home. For your safety, PA WC employees am required to cerry photo ID at all times and wear standard, company-issue uniforms. In addition, most PAWC ledlaoe aaltl are ~oheduied in advance for the convenience of the customers. Water's automatic payrnent plan. Through electronic transfer, you can take advantage Cew'- ~ ? on the day it's due. No more checks, stamps, or late bills! ~4' ~o r~lu~, t an application. You will need your Account Number when lO ~ dJ~_~ AOOount and Billing Information, then choose the option to payllt~ Fill out the form and mall it back to us. It's that easyl Customer Service & Emergencies 1-800-565-7292 (24 Hours) For Hearing Impaired Customers TDD 1-800-300-6202 (24 Hours) Visit us on the INTERNET: www.pawc.com ~ ~ A1M 6796 IdI3031~ I=iNOA SI SIH.L /cll~ ,BI~! I=INOA SI SIN/ ~'ON lllNEIBd I '¥d 'ON~H:NBINNO ~A..~N I Ol¥c139VNSOd SN I 91¥1~ SSY'IO ISBI4 I REV-1513 EX + (9.nm COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Hill, Pauline D. 21 03 0454 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE o II. 1. TAXABLE DISTRIBUTIONS [include outdght spousal distributions, and transfers under Sec. 9116 (a)(1.2)] John A. Rainville 318 Emily Lane New Cumberland, PA 17070 Arlene Hess 306 Reservoir Road Mechanicsburg, PA 17055 Alyce Jo Lentz 306 Reservoir Road Mechanicsburg, PA 17055 Aimee Scullen 18475 Woodhaven Drive Strongsville, OH 44149 Michelle Cottingham 202 N. Prince Street Shippensburg, PA 17257 Christopher Mullikin PMB 7301,658 Front Street Lehaina, HI 96761 Son Daughter Daughter Grandaughter Grandaughter Grandson 1/4 1/4 1/4 1/12 1/12 1/12 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) INVENTORY Estate of Pauline D. Hill also known asPauline Dee Hill , Deceased No. 21 03 0454 Date of Death 4/4/2003 Social Security No. 174-14-0778 Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unswom falsification to authorities. Name of Attorney: Anthony J. Foschi I.D. No.: 55895 Personal Rep~sentative: hn A. Rainville PA 17011 Address: 3425 Simpson Ferry Road Dated December ,2003 Camp Hill Telephone: (717) 763-1121 949 16th Street New Cumberland, PA 1823 Regina Street Harrisburg, PA 125 Clear Springs Road Biglerville, PA PNC Bank Account #50-0314-8492 PNC Bank Account #51-4010-4197 (Attach Additional Sheets if necessary) Description Total Value 90,000.00 35,000.00 8,000.00 2,980.19 1,968.28 147,948.47 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 BUREAU OF /NDZVZDUAL TAXES TNHERTTANCE TAX DTVTSZON DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVAN'rA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-lg07 EX AFP C01-03) ANTHONY J FOSCH! SHUMAKER WILLIAHS 3425 SIMPSON FERRY RD CAMP HILL ~ .~ Of DATE ~i:~ ~. ~ Wii~$ ESTATE OF DATE OF DEATH FILE NUHBER '04 FEB 27 P 1 ..0~AcNOUNTY PA 17oi~,~mb~ii~nd Co., PA 02-25-2004 HILL 04-04-2005 21 05-0454 CUMBERLAND 101 Amoun~ Remi~ed PAULINE D HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUH]iERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credi~ ~o your account, submit: ~he upper port:ion of ~his for..i~h your ~ax payment. CUT ALONG THIS LINE ~- RETAZN LONER PORTION FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) ~(-~( ZNHERZTANCE TAX STATEMENT OF ACCOUNT ~t( ESTATE OF HILL PAULINE D F*rLE NO. 21 05-0454 ACN 101 DATE 02-25-2004 THTS STATEMENT TS PROV/DED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAMED ESTATE. SHONN BELON TS A SUMMARY OF THE PR/NC/PAL TAX DUE, APPLTCATTON OF ALL PAYMENTS, THE CURRENT BALANCE, AND, TF APPL/CABLE, A PROJECTED /NTEREST FTOURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-Z4-ZO04 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 4,425.41 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 01-05-2004 CDOOSq08 .00 q,q25.41 IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. { ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT 1S REQUIRED. ZF TOTAL DUE IS REFLECTED AS A 'CREDIT' {CR), TOTAL TAX CREDIT 4,425.41 BALANCE OF TAX DUE .00 INTEREST AND PEN. .49 TOTAL DUE .49 YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THTS FORM FOR INSTRUCTIONS. PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- Tf RESIDENT DECEDENT make check or money order payable to: REGISTER OF #ILLS, AGENT. -- zf NON-RESIDENT DECEDENT make check or money order payable to: COMMON#EALTH OF PENNSYLVANIA. REFUND (CA): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or from the Department's 24-hour answering service for fores ordering: 1-800-362-2050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-3020 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, phone (717) 767-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedant's death, a five percent (52) discount of the tax paid is allowed. PENALTY: The 152 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (l) day from the date of death, to the date of payment. Taxes which became delinquent before January l, 1982 bear interest at the rate of six (6X) percent per annum calculated at a daily rate of .000164. AIl taxes which became delinquent on and after January l, 1982 will bear interest at a rate which mil! vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are: Interest Daily Interest Daily Interest Year Rate Factor Year Rate Factor Year Rate Daily Factor 1982 ZOZ .000548 1987 92 .000247 1999 72 .000192 1983 16X .000438 1988-1991 112 .000301 ZOO0 8Z .000219 1984 llZ .000301 1992 92 .000247 2001 92 .000247 1985 132 .000356 1993-1994 72 .000192 ZOOZ 62 .000164 1986 IOZ .000274 1995-1998 9Z .000247 2003 5Z .000137 --Interest is calculated as follows: TNTEREST = BALANCE OF TAX UNpATD X NUI~BER OF DAYS DELTNI;IUENT X DATLY TNTERBST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date sheen an the Notice, additional interest must be calculated. BUREAU OF ZNDZVZDUAL TAXES TNHERTTANCE TAX DTVZSTOH DEPT. 280601 HflRRTSBURG, PA 17128-n601 COHHONNEALTH OF PENNSYLVANZA DEPARTNENT OF REVENUE NOTZCE OF ZNHERZTANCE TAX APPRAZSENENT, ALLOI/ANCE OR DZSALLOI/ANCE OF DEDUCTZONS AND ASSESSMENT OF TAX ANTHONY J FOSCHI SHUMAKER WILLIAMS SqZ5 SIMPSON FERRY RD CAHP HILL i;.. ~,i DATE 02-Zq-2OOq ~' . ~ 2~ ?~iifS ESTATE OF HZLL PAULINE D DATE OF DEATH Oq-Oq-200$ FTLE NUMBER 21 05-0~5~ '0~ FEB 27 P1 'n~OUNTY CUHBERLAND '~CN 101 I HAKE CHECK PAYABLE AN~ REH~T PAYHENT REGZSTER OF NZLLS CUHBERLAN9 CO COURT HOUSE CARLZSLE, PA 1701~ CUT ALONG THZS LTNE ~ RETATN LONER PORTTON FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTZCE OF ]:NHER:I:TANCE TAX APPRA]:SEHENT, ALLONANCE OR D]:SALLONANCE OF DEDUCT]:ONS AND ASSESSHENT OF TAX ESTATE OF HTLL PAULINE D FZLE NO. 21 05-0~5~ ACN 101 DATE 02-2q-200~ TAX RETURN UAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVAT'rON CONCERN'rNG FUTURE ZNTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~e (Schedule A) (1) 2. S~ocks and Bonds (Schedule B) (2} $. Closely Held S*ock/Par~nership q. Mor~gages/No~as Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Proper~y (Schedule E) 6. Jointly Owned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) B. To,al Assa~s APPROVED DEDUCTZONS AND EXEMPTZONS: 9. Funeral Expenses/Adm. Cos*s/Mlsc. Expenses (Schedule H) (9) 10. Deb*s/Mortgage Liabilities/Liens (Schedule T) (10) 11. To,al Deductions 12. Ne~ Value of Tax Ra~urn lq$~000.00 .00 .00 .00 q/9q8.q7 .00 .00 (8) 11,201.09 NOTE: To insure proper credi~ ~o your account, submi~ ~ha upper portion of ~his fora ~i~h your ~ax payment. lq7,9q8.q7 58,q0q.85 (11) 69.605.96 (12) 98,$q2.55 1:5. 14. NOTE: ASSESSHENT OF TAX: 15. Amoun~ of Line 14 a~: Spousal ra~e 16. Amount: of Line 14 ~axabZa a~ Lineal/Class A ra~:e 17. Aeoun~ of Line 14 a~ Sibling ra~e 18. Amoun~ of L/ne 14 ~axabla a~ Collateral/Class B ra~e Chari~ceble/Governmen~el Bequests; Non-elac~ced 911:5 Trusts (Schedule J) (13) . O0 Ne~ Value of Es4:a~e Subjac~c *o Tax (14) 98,~5~2.5~5 Zf an assessment Nas issued previously, 11nas 1~, 15 and/or 16, 17, 18 and 19 N111 reflect figures that lnclude the total of ALL returns assessed to date. 19. Principal Tax Duo TAX CREDTTS: PAYMENT RECEIPT DATE (16) .00 x O0 = .00 (16) 98,3q2.55 x Oq5 = q,qZ5.ql (17) . O0 X 12 = .00 (18) .00 x 15 = .00 (1~)= q,~Z5.q1 NUHBER DZSCOUNT ~+) TNTEREST/PEN PAID (-) INTEREST IS CHARGED THROUGH 0~-10-Z00~ AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TF PATD AFTER DATE TNDTCATED, SEE REVERSE FOR CALCULATTON OF ADD/TTONAL TNTEREST. AMOUNT PAZD TOTAL TAX CREDZT I .00 BALANCE OF TAX DUEl fi,425.41 ZNTEREST AND PEN. $Z.15 TOTAL DUE q,~57.5~ ( ZF TOTAL DUE TS LESS THAN $1, NO PAYMENT TS REI;)U/RED. /F TOTAL DUE TS REFLECTED AS A "CREDTT" (CR), YOU .AY BE DU{E%~ A REFUND. SEE REVERSE STDE OF THTS FOR" FOR TNSTRUCTZONS., RESERVATION= Estates of decedents dying on or before December 1Z, IaBZ -- if any future interest in the estate is transferred in possession or enjoyment to CIess 8 (cottateraI) beneficiaries of the decedent after the expiration of any estate for Iifa or for years, the ComaonweaIth hereby axpressIy reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Ctass 8 (collateral) rate on any such future interest. PURPOSE OF NOTICE: PAYMENT: REFUND (CA): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To ~ulfill the requirements of Section ZZqO of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (72 P.S. Section 91qO). Detach the top portion of this Notice and submit aith your payment to the Register of Mills printed on the reverse side. --Make check or money order payable to: REOXSTER OF NXLLS, AGENT A refund of a tax craditj which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Xnheritance and Estate Tax'" (REV-ISIS). Applications ara available at the Office of the Register of Hills, any of the Z5 Revenue District Offices, or by calling the special g4-hour answering service for fores ordering: 1-BOO-36Z-ZO50~ services for taxpayers with spacJaI hearing and / or speaking needs: 1-800-q47-30ZO (TT only). Any party in interest not satisfied with the appraisement, aIlowance, or disaIloaanca of deductions, or assessment of tax (incIuding discount or interest) as shown on this Notice must object ~ithin sixty (60) days of receipt of this Notice by: --~ritten protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal raprasentativej OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in Nriting to: PA Department of Revenue, Bureau of Individuai Taxes, ATTN: Post Assessment Review Unit, Dept. Z8060I, Harrisburg, PA ITIZa-060i Phone (7173 787-6505. Sea page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SI) discount of the tax paid is aIIo~ed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same tiaa period as you Mould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning Nith first day of daIinquency, or nine (9) months and one (i) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (BI) percent per annum calculated at a daily rate of .000164. All taxes which became deZinquent on and after January 1~ 1982 wi11 bear interest at a rate which will vary from calendar year to calendar year eith that rate announced by the PA Department of Revenue. The applicable interest rates for 19BI through ZOO3 are: Interest Daily Interest Daily Interest Daily Year Rata Factor Year Rate Factor Year Rate Factor 198Z ZOZ .000548 1987 9Z .000247 1999 7Z .O0019Z 1983 16Z .0004~8 1988-1991 llZ .000~01 ZOO0 8Z .000Z19 1984 11X .000301 199Z 9Z .000247 ZOO1 9Z .000247 1985 13Z .000356 1993-1994 7Z .O0019Z ZOOZ 61 .000164 1986 IOZ .000274 1995-1998 9Z .000Z47 ZOO3 5Z .000137 --Interest is calculated as folloes: ZNTEREST= BALANCE OF TAX UNPATD X NUNBER OF DAYS DELTNI;IUENT X DA'rLy TNTEREST FACTOR --Any Notice issued after the tax becomes delinquent ,ill reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date sho.n on the Notice, additionaI interest must be catcuIated. ~ BUREAU OF INDTV/DUAL TAXES ZNHERITAHCE TAX DTVTSTOH DEPT. 280601 HARRZSBUR(;, PA 17128-060! COMNONNEALTH OF PENNSYLVANZA DEPARTMENT OF REVENUE NOT/CE OF INHERITANCE TAX APPRAZSEHENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-1547 EX &FP (01-03) J ROBERT STAUFFER ATTY MARKET SQUARE BLDG NECHANICSBURG PA 17055 ~.~i o~-o1-2oo~ i'=,:i=::~ : Of ~TE OF HORST DATE OF DEATH 06-16-2005 FILE NUMBER 21 05-05q5 FEB 27 cP~T~3 CUMBERLAND ACN 101 Co., PA Aeoun~ Reei t'l'ed BERNICE R MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGTSTER OF MILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LO~/ER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HORST BERNICE R FILE NO. 21 03-05q5 ACN 101 DATE 05-01-200q TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) $. Closely Held Stock/Partnership Interest (Schedule C) ($) q. Mortgages/Notes Receivable (Schedule D) (q) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) ($) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTZONS AND EXEMPTZONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule 1) (10) 11. 12. 15. lq. NOTE: q9~O00.O0 qSZ.ZO .00 .00 25~$89.66 .00 .O0 (8) 18,q52.9~ .00 Total Deductions (11) Net Value of Tax Return (12) Cherltable/Governeental Bequests; Non-elected 9113 Trusts (Schedule J) (15) Net Value of Estate Subject to Tax (1~) ;f an assessment ~as issued previously, llnes 1~, 15 and/or 16, reflect figures that include the total of ALL returns assessed to date. NOTE: To insure proper credit to your account, submit the upper port/on of th~s fore with your tax payment. 7q,871.86 ASSESSHENT OF TAX: 15. Amount of Line lq at Spousal rata 16. Amount of Line lq taxable at Lineal/Class A rate 17. Amount of Line lfi at Sibling rata 18. Amount of L~ne lfi taxable at Collateral/Class B rata 19. Principal Tax Due TAX CREDITS: PAYHENT REgE~rl DISCOUNT DATE NUHBER /NTEREST/PEN PAID (-) 01-15-200q CDOOSq~q .00 18.~52.93 56,~18.93 ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL ZNTEREST. TOTAL TAX CREDZT I 2,538.85 BALANCE OF TAX DUEl .00 INTEREST AND PEN. .00 TOTAL DUE . O0 ( TF TOTAL DUE TS LESS THAN $1, NO PAYMENT TS REI~UIRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU HAY BE DUE A A REFUND. SEE REVERSE S/DE OF THTS FORH FOR INSTRUCTIONS.) .~ 2,538.85 AHOUNT PAID .00 56,q18.95 17, 18 and 19 will (15) .00 x O0 = .00 (16) 56,q18.95 x Oq5 = 2,5:58.85 (17) . O0 x 12 = . O0 (18) .00 x 15 = .00 (19)= 2,538.85 RESERVATION: Estates of decedents dying on or before December 12) [982 -- if any futura interest in the estate is transferred in possession or enioyaent to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years) the Comaonaaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class S (collateral) rate on any such future interest. PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ZSTRATZVE CORRECTIONS: DZSCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section 21~0 of the Inheritance and Estate Tax Act) Act Z3 of ZOO0. (TI P.S. Section 91~0). Detach the top portion of this Notice and submit aith your payment to the Register of Nills printed on the reverse side. --Make check or money order payable to: REGISTER OF NILLSj AGENT A refund of a tax credit) which was not requested on the Tax Return) may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office of the Register of Nills) any of the Z3 Revenue District Officest or by calling the special Z~-hour ansaerJng service for forms ordering: Z-800-$6Z-ZOSO~ services far taxpayers with specie! hearing and / or speaking needs: 1-800-~7-30Z0 (TT only). Any party in interest not satisfied aith the appraisement, allowancat or disallowance of deductions, or assessment of tax (including discount or interest) as sheen on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. Z81021) Harrisburg, PA 17128-1021, OR --eIection to have the matter determined at audit of tho account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered an this assessment should be addressed in writing to: PA Department of Revenue) Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z&0601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-[50[) for an explanation of administrativeLy correctabIe errors. If any tax due is paid within three (5) calendar months after the decedent's death) a five percent (SI) discount of the tax paid is alloeed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed) and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you mould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning eith first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6Z) percent par annum calculated at a daily rate of .00016~. All taxes which became deLinquent on and e~ter January 1, 1982 will bear interest at a rate which ail1 vary from calendar year to calendar year with that rate announced by tho PA Department of Revenue. The applicable interest rates for 1982 through 2003 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 20X .OOO5~S 1987 92 .O00Z~7 1999 72 .00019Z 1983 16Z .000~38 1988-1991 112 .000301 ZOO0 SX .000219 198~ 112 .000501 199Z 9Z .0002~7 ZOOX 9Z .O00Z~7 1985 132 .000356 1993-199~ 72 .O0019Z ZOOZ 62 .00016~ 1986 lO[ .O00Z7~ 1995-1998 9Z .O00Z~7 2003 5Z .000157 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPATD X NU/IBER OF DAYS DEL/NQUENT X DAILY XNTBREST FACTOR --Any Notice issued after the tax becomes delinquent wil1 reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date sheen on the Notice, additional interest must be calculated. BUREAU OF ZNDZVZDUAL TAXES TNHERZTANCE TAX DTVTS]*ON DEPT. 280601 HARR*rSBURG, PA 171Z8-0601 COHHONWEALTH OF PENNSYLVANTA DEPARTMENT OF REVENUE ZNHERZTANCE TAX STATEMENT OF ACCOUNT '04 I'i/ R 12 ANTHONY J FOSCHI SHUHAKER WILL'rAHS 3qZ5 SINPSON FERRY CAMP HILL PA P1 DATE O$-Oq-ZO0~ ESTATE OF HILL DATE OF DEATH Oq-O~-ZO03 FiLE NUMBER Z1 05-0~5q COUNTY CUHBERLAND ACN 101 I Aeoun~ Reei~ed REV-I~O? EX AFP C01-03) PAULINE D HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credit to your account, subeit tho upper por~:ion of this fore with your tax payeen~. CUT ALONG TH'rS LINE ~' RETA'rN LOWER PORT'rON FOR YOUR RECORDS ~ ESTATE OF HILL PAULINE D F'rLE NO. 21 03-0q5~ ACN 101 DATE 05-0q-200~ THTS STATEMENT TS PROVTDED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAMED ESTATE. SHONN BELOM TS A SUHHARY OF THE pRTNCZPAL TAX DUE, APPLTCATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, TF APpLTCABLE, A PROJECTED TNTEREST FT6URE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 03-01-200q PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYHENTS (TAX CREDITS): PAYHENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 01-05-Z00~ 05-05-200q CD003~08 WRITEOFF .00 .00 q,q25.q1 .q9 XF PAID AFTER THXS DATE, SEE REVERSE SXDE FOR CALCULAT/ON OF ADDXT/ONAL INTEREST. ( XF TOTAL DUE 1S LESS THAN $1, NO PAYMENT 1S REQUXRED. XF TOTAL DUE XS REFLECTED AS A "CREDXT" TOTAL TAX CREDTT q,q25.fi1 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR TNSTRUCTTONS. PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- Zf RES/DENT DECEDENT make check or money order payable to: REGTSTER OF NTLLS, AGENT. -- Tf NON-RESIDENT DECEDENT make check or money order payable to: COMMONNEALTH OF PENNSYLVANTA. REFUND (CR): A refund of a tax credit, ahich ams not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-Ii13). Applications are available at the Office of the Register of Nills, any of the Z3 Revenue District Offices or from the Department's 24-hour answering service for forms ordering: l-BOO-56Z-ZOSO~ services for taxpayers with special hearing and / or speaking needs: 1-800-447-30Z0 (TT only}. REPLY TO: questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of lndividual Taxes, ATTN: Post Assessment Review Unit, Dept. ZB0601, Harrisburg, PA 171Ze-0601, phone (717) 787-650S. DISCOUNT: If any tax due is paid within three (~) calendar months after the decedent's death, a five percent (BZ) discount of the tax paid is allowed. PENALTY: The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. INTEREST: Interest is charged beginning aith first day of delinquency, or nine (9) months and cna (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 19BZ bear interest at the rate of six (6g) percent per annum calculated at a daily rate of .000164. Al1 taxes ~hich became delinquent on and after January l~ 198Z ~ill bear interest at a rate ~hich will vary from calendar year to calendar year ~ith that rate announced by the PA Department of Revenue. Interest Daily Year Rate Factor The applicable interest rates for 198Z through Z005 are: Interest Daily Interest Year Rate Factor Year Rate Daily Factor 1982 ZOX .000548 1987 9Z .000Z47 1999 7Z .00019Z 1985 16Z .000¢38 1988-1991 11Z .000501 ZOO0 8Z .O00Zi9 1984 llZ .000301 1992 9Z .000247 ZOOX 9Z .000Z47 1985 13Z .000~56 1995-1994 7Z ,00019Z ZOOZ 62 .0D0164 1986 lOX .000274 1995-1998 9Z .000247 2003 5Z .000137 --Interest is calculated as folloas: 'rNTEREST = BALANCE OF TAX UNpATD X NUHBER OF DAYS DELINQUENT X DA'rLy TNTEREST FACTOR --Any Notice issued after the tax becomes delinquent ~ill reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation data shomn on the Notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES TNHERZTANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE ~NHERZTANCE TAX RECORD ADJUSTMENT RE¥-I;gS EX AFP (OI-OS) ANTHONY J FOSCHI '0~ lIAR 19 SHUHAKER WILLIAHS 3q25 SIHPSON FERRY RD CAMP HILL PA DATE O$-OZ-ZOOq ESTATE OF HILL DATE OF DEATH O~-O~-ZO0~ FILE NUHBER Z10$-OR5R :Zi~2COUNTY CUHBERLAND ACN 101 Aeoun~ Remi~ed I PAULINE HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA I70I$ D NOTE: To insure proper credi~ ~o your account, submit: ~:he upper portion of ~:his fore ~i~:h your *ax payment:. CUT ALONG THTS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ESTATE OF HILL PAULINE D FILE NO. 21 05-0q5~ ACN 101 DATE 03-OZ-ZO0~ ADJUSTMENT BASED ON: ADHINISTRATIVE CORRECTION VALUE OF ESTATE: 1. Reel Es~a~e (Schedule A) (1) 2. S~ocks and Bonds (Schedule B) (2) 3. Closely Held S~ock/Per~:nershlp In~:eres~: (Schedule C) (3) . O0 ~. Non'gages/No,es Recelvable (Schedule D) (q) . O0 E. Cash/Bank Depos1~cs/Nisc. Personal Proper~cy (Schedule E) ($) ~ r 9~8. q7 6. Jointly O~ned Proper~y (Schedule F) (6) . O0 7. Transfers (Schedule G) (7) .00 8. To,al Asse*s DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adeinis'cra~cive Costs/ Miscellaneous Expenses (Schedule H) (9) 11, ~01.09 10. Deb~s/Hor~gage Liabilities/Liens (Schedule Z) (10) 11. To,al Daduc~/ons 12. Ne~c Value of Tax Re~urn 1~$~000.00 .00 (8) 1~7,9~8.~7 $8,q0~.85 (11) q9;605.9q (12) 98;3q2.55 TAX: 15. 16. TAX Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) Ne~ Value of Es*a*e Subjec~ ~o Tax .00 98;3q2.55 17. 18. 19. CREDITS: ~AYfI~N I DATE 01-05-200q Aeoun~ of Line lq a~ Spousal ra~e Amoun~ of Line lq ~axable at Lineal/Class A ra~e Amoun~ of Line lq e~ Sibling ra~e Amoun~ of Line lq ~axable a~ Collateral/Class B Principal Tax Due N~lYl UI~UUNI NUMBER INTEREST/PEN PAID (-) CDOOSq08 ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. (1.,;) .OOX O0 = .00 (16) 98~3q2.55 x Oq5= qzqZS.ql (17) . O0 x 12 = . O0 (18) .OOX 15 = .00 (19) q~,qZ5.q1 .00 AHOUNT PAID q,q25.q'l TOTAL TAX CREDIT I q,q25.ql BALANCE OF TAX DUEI .00 .q9 INTEREST AND PEN. TOTAL DUE .q9 ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ;~EV-1470 EX (6-88) INHERIT, ~.NCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG~ PA 17128-0601 ~)ECEDENT'S NAME FILE NUMBER PAULINE D HILL 2103-0454 REVIEWED BY ACN Dianne McClain 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES The Notice of Inheritance Tax Appraisement, Allowance or Disallowance of Deductions and Assessment of Tax has been adjusted to reflect the January 5, 2004 payment made to the Register of Wills. Row Pa.cle I Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 3/03/2005 FOSCHI ANTHONY J ESQ POBOX 88 HARRISBURG, PA 17108 RE: Estate of HILL PAULINE D File Number: 2003-00454 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 4/04/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~~~ GLENDA FA~E~T~~GH REGISTER OF WILLS' cc: File Personal Representative(s) Judge uR Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: Pauline D. Hill Date of Death: April 4, 2003 Estate No.: 2003-00454 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: . Yes [l No 0 2. lfthe answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. lfthe answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes 0 No 0 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes 0 No 0 c. Copies of receipts, releases, joinders and a oval of formal or informal accounts may be filed with the Clerk Orphans' Court and may be attached to this report. Date: 3/7/05 Anthony J. Foschi Name 3425 Simpson Ferry Road, Camp Hill, PA 17011 Address 717-763-1121 Telephone No. Capacity: o Personal Representative I!l Counsel for personal representative uA