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HomeMy WebLinkAbout11-28-12 (2)J 1505610105 REV-1500 IX (oz-ss) (Fq'rl PA Departmenk of RPVenUe pennSyLVanid OFFICIAL USE ONLY °`""'"`"'°'"""`""` Coun ear File Number PO eoX z8 6o1duaL Taxes INHERITANCE TAX RETURN ~ yI ty Code Y ~ ~ ~~ HarrtsburD PA 17128-0601 RESIDENT DECEDENT J` ENTER DECEDENT INFOR MATION BELOW Social Secudty Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 ame ,. Suffix _ Decedents First Name ~ MI Brown _ L Albert (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number ~ - - THIS RETURN MUST BE FILED IN DUPLICATE WITH THE __ REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW m 1. Odginal Return O 2. Supplemental Return O 3. Remainder Return (Date of Death O 4. Limited Estate Prior to 12-13-82) O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Requiretl death after 12-12-62) t>p 6. Decedent Died Testate (Attach Cop of Will) O 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes y (Attach Copy of Trust.) O 9. litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATN)N SHOULD BE DIRECTED T0: Name Dayfime Telephone Numbe~ Nathan C. Wolf, Esquire `t. (717) 2436 r~ m ..... rn First Line of Address 10 West High Street Second Line of Address City or Post Office Carlisle Correspondent's a-mall address: nathancwOlf emb: Under panaltles of perjury, I tleclare mat I have examined this return, it it is true, correct and complete. Declaration of Dreparer other than the SIGNA E OF RSON R~SPONSI~j.GiFOR FILING RETURMv 40 Greenfield Drive, Carlisle, PA 17015 SIGNATURE OF P~rP~IREy,e'gyegiHAN REPRESENTATIVE DATE 2 PA 17013-2922 Side 1 1505610105 State ZIP Code PA 17013 rte' n' ~ z rn N rr n ~ ~ ~ .Z' ~ o~ ~ a c> O C S7 ~ y I--a r`-: !" y DATE FI O LBd ] U) naouies ano statements, and to the best of my knowledge entl belief, is based on all information of which praperer has any knowledge. 1505610105 J J 1505610205 REV-1500 EX (FI) Decedent's Social Security Number _ . _ Dacedenrs Name: Albert L. Brown RECAPITULATION 1. Real Estate (Schedule A) .......................................... ... L _.. _ _... 2. Stocks and Bonds (Schedule B) .................................... ... 2.. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. ' 4. Mortgages and Notes Receivable (Schedule D) ..... , .. , , .. , . 4 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... .. 5. _ ~ 1,098.00; ~ 6. Jointly Owned Property (Schedule F) O Separete Billing Requested .... ... 6. 111 210 61 7. Inter-Vvos Tasnsfers & Miscellaneous Non-Probate Property , -- -- - -- (Schedule G) O Separate Billing Requested..... ... 7. 8. Total Gross Assets (total Lines 1 through 7)........ ...... .. 8 112,30$.81 9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. ~ 15,124.19 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I)... ....... .. 10. ~ 1,657.90 11. Total Deductions (total Lines 9 and 10) ......... ........ .. 11. ~- 15,782.09"~~ 12. Net Value of Estate (Line 6 minus Line 11) ............................ .. 12, '. 95 526 52 ~' 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which , . ~ - - --"- - an election to tax has not been made (Schedule J) .. . ................... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ........... ........... .. 14. ',.. 95 $26.52 ' TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES , 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 - _ .. (a)(1.2) X .OQ i6. Amount of Line 14 taxable °`" °-- - 15 . _.. .... ; at lineal rate x .0 45 95,526.52 ' is _. _ . 4 298.69 17. Amount of Line 14 taxable ~ " ".. __ _.._ _ _ , _. at sibling rate X .12 17 '. 18. Amount of Line 14 taxable ... ~_. _. ........ ... _.°.. _.. ... _.. _ _. at collateral rate X .15 _. .. .. .._. _._ 18. 19. TAX DUE ....................................................... .. 19. __.. _ 4,298.69 '. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505610205 1505610205 O REV-7500 EX (FI) Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME Albert L. Brown STREET ADDRESS .--_. _...-- __ ..._ _._.....____...__..______.._. _____ ___ 40 Greenfield Drive CITY - ._-- Carlisle STATE -.--_.-_.. ZIP -_-- PA 17015 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 4,000.00 B. Discount 226.25 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the di%erence. This is the OVERPAYMENT. FIII in oval on Page 2, Line 20 to request a refund. (1) 4,298.69 Total Credits (A+ B) (2) 4,226.25 (3) (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the di%erence. This is the TAX DUE. (5) 72.44 Make check payable to: REGISTER OF WILLS, AGENT. ,~ PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred ................................................................................... ....... ^ b. retain the dght to designate who shall use the propedy transferred or its income ..................................... ....... ^ c. retain a reversionary interest .......................................................................................... d. receive the promise for life of either payments, benefts or pre? ............................................................... ....... ^ 2. If death occurred aHer Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate censideration? ........................................................................................................ ...... ^ 3. Did decedent own an "intrust tor" or payable-upon-death bank account or security at his or her death? ........ ...... ^ 4. Did decedent awn an individual retirement account, annuity or other non-probate property, which cenfains a benefidary designation? .................................................................................................................. ...... ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994, and before Jan. 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dales of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and fling a tax return are s011 applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 20~: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefidades is 4.5 percent, except as noted in [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Secticn 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REVa5D8 EX+ (o8-u) pennsylvania ~iT DEPARTMENTOFREVENUE INHERITANCE iAX RETURN RESIDENT DECEDENT SClIEpt1LE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Albert L. Brown 21-12-0437 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must he disclosed on Schedule F. If more space is needed, use additional sheets of paper of the same size. REV-f5o9 E%+ (of-fo) Pennsylvania Yli DEPFFTMENT OF REVENUE INHERITANCE TA% RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF: Albert L. Brown FILE NUMBER: 21-12-0437 it an aacet became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A• Cathy L. Brown 140 Greenfield Drive, Carlisle, PA 17015 ~ Daughter 8. C. JOINTLY OWNED PROPERTY: ITEN NUMBER 1. LETTER FOR MINT TENANT A. DATE MADE MIM 08/10197 DESCRIPTION OF PROPERTY INCLUDE NAME OF nNANCLAL INSfiRInON AND BANK ACCWM NUMBER 011 SIMILAR IDENnFYING NUMBER. ATTACH DEED FOR MINRY HELD RFAL ESTATE. Residence - Deed attached -Value tax assessment ~ Dr9E dF DEATH VFLUE OF ASSET 191,600.00 % of DECEDENTS ]MEREST 50 WTE aF DEATH VALUE OF DECEDENTS INTEREST 95,800.00 2 A 05/06/10 Savings-Account 15004217253688-DODvalueatlached 9,098.72 50 4,549.36 3 A 05/06/10 Checking-Account 405256-DOD value attached 1,639.86 50 819.93 4 A 05/06/10 CD-Account 31003916441626 -DOD value attached 20,082.63 50 10,041.32 _ TOTAL (Also enter on Line 6, Recapitulation) I; 111,210.61 If more space is needed, use additional sheets of paper of the same size. REV-15ll EX+ (10-U9j ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TA% RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Albert L. Brown 21-12-0437 Decedent's debts must be reported on Schedule [. Z. Attorney Fees: 4 200.00 I 3. Family Exemption: (if decedent's address is not the same as claimant's, attach ezplanation.) 3,000.00 i claimant. Cath~L. Browq__ street Address 40 Greenfield Drive -- -- -.. city Carlisle state PA ztP 17015 Relationship of Claimant to Decedent DeU hYer 9__...._... -- ..._ - ____ - _...----- - -.. 4. Probate Fees: 5. Accountant Fees: 205.00 6. Taz Return Preparer Fees: z Register of Wills-inheritance tax return fling fee 15.00 a' Reserve for outstanding expenses 300.00 TOTAL (Also enter on Line 9, Recapitulation) ;';, 15,124.19 If mare space is needed, use additional sheets of paper of the same size ftEV-1512 EX+ (12-OB) Pennsylvania Y^T DEPRRTMENT OF REVENUE INHERITANCE TAX RETURN RESIDEM DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Albert L. Brown 21 12 0437 Repo rt debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimb ursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Remaining mortgage payments at time of death (balance as of 1/1712012 =1241 87 div b 2) . y 620.94 2 Messiah Village (Paid 1/1812012) 367.50 3 ATT Credit Card 411.94 4 Comcast Cable 89 74 5 Cumberland County Aging Office 54.78 6 Messiah Village (Final payment) 113.00 TOTAL (Also enter on Line 10, Recapitulation) I; 1,657.90 If more space is needed, insert additional sheets of the same size. REV-lsls Ex+ (ol-lol ~ Pennsylvania DEPARTMENT OP REVENUE INHERRANCE TA% RETURN RESIDENT DECEDENT SCHEDULE? BENEFICIARIES ESTATE OF: FILE NUMBER: Albert L. Brown 21-12-0437 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1• .Cathy L. Brown 40 Greenfield Drive, Carlisle, PA 17015 'Daughter 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWNABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: °. l.nNnu NDLt Nnu bVV[NNMtN IAL UI6TRIBUTIONS: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON ISNE 13 OF REV-1500 COVER SHEET ~ , If more space is needed, use additional sheets of paper of the same size. LAST WILL I, ALBERT L. BROWN, of the Borough of Carlisle, Cumberland County, Pennsylvania, declaze this to be my Last Will and revoke any wills previously made by me. I. I direct that any and all inheritance, estate and transfer taxes imposed upon my estate passing under my will or otherwise, shall be paid out of the principal of my residuary estate. II. I devise and bequeath my estate of whatever nature or wherever situated to my wife, Dorothy. V. Brown. In the event my wife does not survive me, then I bequeath my estate to my daughter, Cathy Lee Brown. III. I appoint Cathy Lee Brown to be executrix of this my Last Will. In the event she fails to qualify or ceases to act, then I appoint Mazk A. Brown to be executor. IV. I duect that my personal representative need not file bond in this or any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last will this I6` day of October, 2002. The preceding instrument consisting of one (1) page(s) was on the date thereof signed, published and declared by ALBERT L. BROWN, the testator herein, as and for his Last Will, in the presence of us, who at his request, in his presence, and in the presence of each other, have subscribed our names as witnesses hereto/. ~~ ~a.Q Y~1 , ,rn STATE OF PENNSYLVANIA :. SS COUNTY OF CUMBERLAND :: We, ALBERT L. BROWN, Frances H. Del Duca and Cazol A. Morrow, the testator and witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declaze to the undersigned authority that the testator signed and executed the instrument as his Last Will and that he had signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the will as witness and that to the best of his lmowledge the testator was at that time eighteen yeazs of age or older, of sound mind and under no constraint or undue influence. Testator Witness Witness SUBSCRIBED, sworn to and acknowledged before me by Albert L. Brown, the testator, and subscribed and sworn to before me by Frances H. Del Duca and Carol A. Morrow, this 1st day of October, 2002. otary Publi wore mwtar o. aareiaw, Morwn rua~c crw se~wMti a.~ewrd aw+r Apr Co..rro. s~r« Mren s, soot ____' A.~„A .,., c~.~ ;° ' U4U " ~ "~",~~~ auiy-mwrnarnevenueservra (gg) ~T U.S. Individual Income Tax Return 2U1 L OMB NO-15t5-007d IRS Use On -0orrot write MSta sin lnias ace Fw me roar pan ,-o« m. zoo, w oOWr Lx yo.r eaemmrq . , zot t. arwm9 , zo See se crate instructions Your foal name eM initial Lnl name . Deceased Y Albert L Brown our soeitl ecudq number O1 17 ' 12 193-18-2918 II a lent return, spouse s M1fst name antl milial Last name epause'e sadal sacudq number Mama addres! (numeer and llrea0. II yw niva e P D eaF, Bee meVUdionl. 40 Greenfield Dr Apl no . Mexa aura the SSNIe) seova arM On lln. ep are tuned Crty. town or port oRicv. !late. and 21P mde If you nave a rormgn address. also wmplete spews below (see mewdiona) Prealdentlal ElectlOn Cempalgn Carlisle PA 17015-7661 cnea nw. ayoa, ar yppr !pool. a filirq piney. went a] to go to tNs FwaiOn cpuNry name Foreign prpvincalgpunly Foreign pO61al Cpda Mt ~an~ ~a bazoWbw~ I Filing Status 1 }[ Single Head ahouaatpld Tvdlh qua! X You spouse dYirq peraonl. (See inetraaione.) tt 4 " 2 Mertied fill ng pintlY (even a only one nad income) 1ne wl I p dY M perwn is a tltiltl eat nd your dependent enter Nre child's name oars. - 'hark onto non 3 Mercedfiling separately. Enlar lpwae'l SSN above I--t RI In,,.rr,,;,,,...:.r.....,_.,_~.._ _.. ~.. 6a Exemptions b G If more than tour dependents, see instructions a check here -~ Yourself. Ii someone can claim you as a depentlenl, do not check box 6a SAOUSe l eo Ton Dependents: ) First name Lest name 121 Dependant's eor al aecuri number n' (]) Dependent's glatiormNp to you /41 no. of cnimn ~atl urger On 8C WhO: age t)gWl.• Iged WIN' rot mile • did not INr tax aedil , lees msv you dw t0 dt or aeparrtbn (see IniWCfl DepeMarTh r oat eMUad a ro 1 Ou _ wah rOrOe >nal,_ n 6c wve _ on - Income 7 - Wegw, salaries, ripe, etc. Anarh Fortnlc) W-2 7. one apoW ~ + Attach Fonn(s) W 2 h Al 8a b Taxable interest. Attaeh Schedule B rf required Tax-exempt Interest. Do not include on line 8a 8b Ba 587 - ere. so attach Forms W-2G antl 9a b Ortlinary dividends. Attach Schedule B if required - ~ .... Qualified dividends ___. _. ._ - - ... 9b ga 1086-R If tax 10 Taxable refunds, credits, or offsets of state and local income lazes ~ ~ - 10 was withheld. 11 Alimony received ~ 11 If you did not 12 Business income or (loss). Attach Schedule C or C-E2 _ _ 12 get a W-2, 13 Caglal gain Or (TOSS). Aaach Schedule D N required.lf not repaired, ch«k here - ~ ~ 13 see instructions. 14 Other gains or (losses). Attach Form 4797 td 15a IRA distributions 15a b Taxable amount 15b t6a Pensions and annuities 16a b Taxable amount t6b 1$ 857 Enclose, but do not attach an 17 Rental real estate, royalties, partnerships, S corporations, trusts, et c. Attaeh Schedule E 17 , y payment. Also, 18 Farm income or (loss). Attach Schedule F _.. _. _.. _.. 18 please use 19 Unemployment compensation 19 Form 1040-V. 20a Social security benefits ~ 20a ~ 14 , 6941 b Taxable amount 20b $ 96 21 Other income. List type and amount 21 22 Combine the amounts in the far d ht column for lines 7 throw h 21 . This is our total Income - 22 20 340 23 Educator expanses 2g Adjusted 24 Certain business expenses of reservists parformin adisls and 9 GrOS$ fee-basis government officials. Attach Form 2108 or 2106-EZ ?4 Income 25 Health savings account deduction. Attach Form 8889 25 26 Moving expenses. Attach Form 3903 26 27 Deductible part of self-employment tax. Attach Schedule SE 27 28 Self-employed SEP, SIMPLE, and qualified plans 28 29 Self-employed health insurance deduction 29 30 Penalty on early withdrawal of savings 30 31a Alimony paid b Recipient's SSN - 3 32 IRA deduction 3p 33 Student loan interest deduction 33 34 Tuition and fees. Attach Form 8917 ~ 34 35 Domestic production activities deduction. Attach Form 8903 35 38 Atltl lines 23 through 35 36 -_ 37 Subtract line 36 from line 22. This is vour adlusbd prose income .. - 37 Tax and 36 Credits Sea Stands-- rd L---b Deduction 40 for- 41 People who 42 Aleck any cox on one 43 398 pr 39b or who can ba 44 aa~mee ae a 45 tlepandenl, sea slrudrons 46 All ethers. 47 $vfOla or 48 Mamed thou separately, 49 ss.eoo 50 Manie0liling pinny a 51 DwIMYirg ~a0 52 sll,soo 53 Heaa of houaeMld. 54 Other 66 Taxes 57 68 59a b 60 62 Pa merits 63 n you have a 4a avahryirp b a,nd, eosin sa,edwa Elc. 65 66 87 66 69 70 71 72 Refund 73 74a Daea oepesm - b sae - d inatrugiona. -----i s Amount 76 Amount from line 37 (adjusted gross income) Check r X You were born before January 2, 1947, if: (l Spouse was born before Janus 2, 1 g47 Blind. Total boxes If your spouse itemizes on a separate return or ou were a de Blind. } eheeked - 39a Itemized deductions (from Schedule A) or your standard deduction (see left margin) - 39b Subtract line 40 from line 38 Exemptions. Multiply $3,7D0 by the number on line 6tl Taxable Income. 8ubead line 42 hum line 01. I(lina 41 is more Man line 41, solar ~0~ ' ' -' Taz (see insM.). Check it any from: e ~ Form(s) b ^ Form q6p ... ...... - - Alternative minimum tax (se BBtd 4871 d ^ slap,. _ e instructions). Attach Form 6251 Add lines 44 and 45 -- - -..... _.. Foreign tax credit. Attach Form 1716 if requred - - - - Credit for child and tlependent care expenses. Attach Form 2441 48 Education cretlits from Form 8863, line 23 Retirement savings contributions credit. Attach Form 8880 49 50 Child tax credit (see instructions) Residential energy credits. Attach Form 5695 61 Other credits from Form: a ~ 3800 b ~ 8801 c ~ ~ ~ - 52 Atld lines 47 through 53. These are your total credits 53 Subtract line 54 from line 46. If line 54 is more than line 48 enter -0- , Self-employment tax. Attach Schedule SE Unreported social security and Medicare lax from Form: a ~ 4737 b ~ 8g19 Additional tax on IRAs, other quatifiad retirement plans, etc. Attach Forth 5329 'rf required Household employment taxes hom S h d l c e u e H First-time homebuyer credit repayment. Attach Form 5405 if required Other taxes. Enter code(s) from instructions ' Add lines 55 fhrough 60 This is yourtotal tax ~ ~ '~ Federal income tax withheld from Forms W-2 and 7099 2 62 1 011 estimated tax payments and amount applied from 2010 return 83 Eametl Inconn <nalt (EIC) -' fide Nontaxable combat pay election 64b Additional child tax credit. Attach Fonn 8812 American opportunity credit from Form 8863, line 14 65 68 First-time homebuyer cred8 from Form 5405, line 70 - 87 Amount paid with request for extension to file 68 Excess social security and tier 1 RRTA tax withheld 69 Credit for federal tax on fuels. Attach Form 4136 - 70 Cratlla Iron Form • ^ 2a39 b O 8839 e ~ 8801 tl 8885 71 Add lines 62, 67. fide, aIM fi5 Mrough 71. These ale your tobl paymanb If line 72 is more than line 61, subtract line 61 from line 72. This is the amount you overpaid A mount of line 73 ou want refunded to you. Ii Forth 8888 is attachetl, check here - Routing number 031302.955 - c T e: ~ Checking ~ Savings Account number 0000405256 Amount you owe. Subtract line 72 from line 61. For details on how Estimated tax Denalrv rave I.,~t.~~.»;...._. - 17z instructions - Third Party Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Complete Designee Dau9nse'a PeraonaliWnbficelion number lPlNl - name - Arlanc 17 r_« S 1g n D^oer panalliea of paraxy, I Eeplare Inal I nave axe Here n'ey ere true. wood and complete Dedarelion of Joint reNm~ yW! BIan01410 \( $ae in91r (~ Ksep a copy ' for your $POUSe s sipneWre II a pint relarn, both must sign records PnnVTypa preperora name Paid Aclsne a c, Preparer Firm's name - Use Only Flrm•s address - loner Irian rax~~~e~ ~-i basep m PII iniw~meilon o~wblch Ip Ina I PaY 1~ preparer Dale I YWr pprLpilion De1e I $ppuce'a occupation Preparw'a aiprplure Carlisle PA 17015 pamw. U No 5844 717-243-036f erq beliaj, ~~~~ Deycros peons number II W IRS sent you an teen Dale ICneu it PTIN Frcm's EIN- 26-011 PMna no 717-9e4-r19GG 476 Cumberland County Tax Parcel 40-24-0748-122 (Lot No, 144, Phaee 4A) ~4~ ~~Y DEED 'THIS DEED is made the IO ~, day of , 1997, B E T W E E N GREENFTELD COURT LIMITED PARTNERSHIP, a Pennsylvania limited partnership, record owner, and MAX D. MARBAIN, an adult individual, equitable owner, (together "Grantor"), A N D CATHY L. BROWN, single woman, and ALBERT L. BROwD7 and DOROTHY V. BROWN, husband and wife, as tenants by the entireties and as joint tenants wiCh right of survivorship with Cathy L. Brown ("Grantee"): w I T N E S S E T H That the Grantor in consideration of One Hundred Twenty Six Thousand Nine Hundred Dollars ($126,900.00) paid by the Grantee to the Grantor, the receipt whereof is hereby acknowledged, does hereby grant and convey unto the Grantee: ALL THAT CERTAIN lot or parcel of land situate in South Middleton Township, Cumberland County, Pennsylvania, being designated Lot No. 144 (Phase 4A) on a certain Final Subdivision Plan for Greenfield Phase IV-A dated December 12, 1994 and recorded in Cumberland County Plan Book 70, Page 47 (the "Plan"), as more particularly described as follows, to wit: BEGINNING at a point on the northern right-of-way line of GreenEield.Drive (50 feet wide), said point being on the dividing line between Lot No. 143 and Lot No. 144 as shown on the Plan; thence continuing along the said dividing line North 30 degrees 48 minutes 31 seconds west a distance of 123.11 feet to a point on line of Lot No. 150 as shown on the Plan; thence continuing along same North 59 degrees 11 minutes 29 seconds East ~K ~~ PAGE Q~ a distance of 36.00 feet to a point on the dividing line between Lot No. 144 and Lot No. 145 as shown on the Plan; thence continuing along the said dividing line South 30 degrees 48 minutointlon thednorthern distance o£ 123.11 feet to a P right-of-way line of Greenfield Drive aforementioned; thence continuing along same South 59 degrees 11 minutes 29 seconds West a distance of 36.00 feet to a point on the dividing line between Lot No. 143 and Lot No. 144 as .shown on the Plan, said point being the point and place of BEGINNING. BEING Lot No. 144 and CONTAINING 4,431.99 square feet. UNDER ANA SUBJECT to a 10 feet wide drainage easement along the northwestern side of the lot as more particularly shown on the Plana BEING part of the same premises which Max D. Marbain, Agent, by deed dated May 11, 1990, and recorded in Cumberland County Deed Book O, Volume 34, Page 239, granted and conveyed unto Greenfield Court Limited Partnership. AND the said Greenfield Court Limited Partnership entered into an Agreement of Sal=ncnd(~hechAgreement"), November 1, 1990, with Marbain, a Memorandum of which isPaeeoi028 in Cumberland County Miscellaneous Book 415, g ANA the said Marbain, Inf.'s interest in the Agreement was assigned to Max D. Marbain, an adult individual, by Assignment of Purchaser's Interest in Agreement dated May 27, 1993, and recorded in Cumberland County Miscellaneous Book 445, Page 299. UNDER AND SUBJECT to a Master Declaration of Covenants, Conditions and Restrictions Applicable to Building Lots in Greenfield Residential Development dated March 4, 1993, and recorded in Cumberland County Miscellaneous Book 439, Page 185. FURTHER UNDER-AND SUBJECT to all easements, restrictions, encumbrances and other matters of record or which a physical inspection of the premises would reveal. Grantor hereby covenants and agrees that Grantor will warrant SPECIALLY the property hereby conveyed. - 2 - ~aK 164 PACE 455 IN WITNESS WHEREOF, the Grantor has caused this Deed to be duly executed as of the day and year first written above. WITNESS: GRANTOR: GREENFIELD COURT LIMITED PARTNE HIP: By / Max D. Marbain Attorney-in-Fact Gj "l// // ~..~/~ Max D. Marbain ('~^\ W 1~ _ 1 J yro (~? l') 7 ~ SrI -r1 iTi 1 D U '~ O ^~ "' J ~ r _. O C "" .C 2 ~ ~ -i m rn i~ y CJ ~i ~ .n i. BOOR 164 PRCE 9~ I C c r (JYJ Y rv ~ ~ r~i u ~_i i"~i iR i74 ~ •i-m m rn c-c rnn}rn ' ` re ~, ,~ !.. C:J ~.a - G1J IY} ITf. Y„~Y --I ~.~ I :I~ :1: ~ ..Y G: u :p I ) 1 ~4 :Jf. 90 . : hr 0.1 6) p LH ...~-1 a7 . 7 s. Ij~ 7 .'i, .~C .:9 r;:. ~~ i rv-1 tip PJ ti .l OJ ~ 1 y rTi f.Ji rv '~'. ~} `7 1 ~1 14 CuJ. ~ ~ ' ma 2 rvy .Ln rri~ Git C'1 ~ , y ~ ~y L' J j m ~ ' 1 'b y1M1 N t ~~ l Y ' ~9 - .n ~} c - 3 r -„ rn r+ A .; •N .tl4 O ~#^ Gn ~ 4 4 n i ~ f . i '3 O '? Q ~ ~ O t Jl Y>] COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND On this, the ~ day of /~.~ 1997, before me, a Notary Public in and for the above-named Commonwealth and County, the undersigned officer, personally appeared MAX D. MARBAIN, individually and as Attorney-in-Fact for GREENFIELD COURT LIMITED PARTNERSHIP pursuant to Power of Attorney dated April 6, 1992, and recorded in Cumberland County Miscellaneous Book 415, Page 1034, as restated in Miscellaneous Book 434, Page 883, known to me (or satisfactorily proven), to be the individual who executed the foregoing instrument, and duly acknowledged to me that he executed the same on his own behalf and as Attorney-in-Fact for Greenfield Court Limited Partnership for the purpose contained therein. IN WITNESS WHEREOF, I hereunto set my hand and official seal. Notarial Seal Anna Marie Mader, Notary Public Camp Hill Boro, Cumberland County My Commission Expires AUg. 7, 2000 Member, Pennsylvania Association of Notaries 800K 1~ PACE X37 I hereby certify that the precise residence of the Grantee herein is: n~ LiSC.~. -f7 /~Di.?~ (__~/attorney or gent for Grantee COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND RECORDED in the Office of the Recorder of Deeds in and for said County in Deed Book ~, Pag~ WITNESS my hand and official seal this ~~ day of 1997. «~ t,, Recorder of Deeds :~._ ,. Fla,. :'?A, `` ~f 4 ,, a li... • ~5 ";: r'°' ~. 5 ~,° 1% ,,,.: ,..~: a ~;I ,, s. '!~'~,,, 'ti'l Q. Page: _1 Document Name: untitled PSBLCDAO Customer Service Workstation EBRNDEF Cert, of Deposit Account Balance ~~ 12:07:06 12/03/23 Account #: 31003916441626 Product: CDA SubCode: AH Title 1: 2: ALBERT L BROWN CATHY L BROWN M&T BANK SSN/TIN: 193182918 Package: Region CEPA Status OPEN Current Balance Maturity: 12/05/ $ 20 27 Restraint: N Accrued Interest $ ,000.00 8 Last Deposit Amount: $ Int Pd Prior Cycle $ 2.63 170.73 Last Deposit Date Pledged Amount $ .00 BFF Indicator Date Transaction D/C Amount 05/27 *RENEWED AT 0.50$, MATURES C $ 20 000 00 05/27 INTEREST TRANSFER OUT D $ , . 170 73 05/27 INTEREST PAYMENT C $ . 170 73 05/27 *RENEWED AT 0.85$, MATURES C $ . 20 000 00 05/27 INTEREST TRANSFER OUT D $ , . 219 18 05/27 INTEREST PAYMENT C $ . 219 18 05/27 *RENEWED AT 1.09$, MATURES C $ . 20,000.00 F2 Options F3 Main Menu F6 Referral F11 Title F12 Previous 170.73 11/05/27 Date: 3/23/2012 Time: 12:07:15 PM Page: 1 Docume ---- nt Name: untitled STMT STFD 1 THE TRANSACTION STMT FORMAT 12/03/23 12.08 00 CO 96 OP EBRN MS 50852 ACTION COMPLE . TE ACTION COID PROD CODE DDA ACCT 405256 SHORT NAME BROWN ALB ERT L CURR CODE ACTH POST PAGE 1 SEARCH FROM 112/01/05 THRU 112/03/20 EFFECTIVE CHECK NUMBER TRAM AMOUNT D/C BALANCE TRACE ID DESCRIPTION * 01/05 7261 118.69 D 2 531 91 8107011565 CHECK NUMBER 7261 , . * 01/09 7262 487.10 D 2 044 81 * 012009006835317 CITICARD PAYMENT CHECK PYMT 0000 , . 00000007262 O1/10 7265 95.93 D 1 948 88 * 012010007947522 NELL'S WALNUT BO PURCHASE 7265 , . CARL PA 01/11 7266 50.00 D 1 898 88 5800785955 CHECK NUMBER 7266 , . * 01/11 7264 130.00 D 1.768 88 5900802641 CHECK NUMBER 7264 . * Ol/11 7263 44.88 D 1 724 00 8108934885 CHECK NUMBER 7263 , . * 01/17 7268 84.14 D 1 639 86 * 012017001844713 NELL'S WALNUT BO PURCHASE 7268 , . CARL PA 01/19 7267 367.50 D 1 272 36 8002159961 CHECK NUMBER 7267 , . PF: 1-HELP 3-P LVL 6-INQ 7-SB 8-SF 9-ASUM 11-CUTO -STSM Date: 3/23/2012 Time: 12:08:09 PM Page: --- 1 Document Name: untitled -- ---- aU --- STMT STFD 1 THE TRANSACTION STMT FORMAT CO 96 OP --- 12/03/23 12.08.17 EBRN ACTION COID MS 50861 LAST PAGE OF TRANSACTIONS PROD CODE DDA ACCT 15004217253688 SHORT NAME BROWN ALB ERT L CURR ACTN CODE PAGE 1 POST EFFECTIVE SEARCH FROM 111/12/07 THRU 112/03/08 CHECK NUMBER TRACE ID TRAM AMOUNT D/C BALANCE DES CRIPTION * 12/07 I-GEN111120700011591 INTEREST .37 C PAYMENT 9,098.46 * 01/06 I-GEN112010600030865 INTEREST .26 C PAYMENT 9,098.72 _ * 02/07 I-GEN112020700011462 INTEREST .24 C PAYMENT 9,098.96 _ 02/21 6508620007 CUSTOMER 200.00 D WITHDRAWAL 8,898.96 03/07 I-GEN112030700011174 INTEREST .21 C PAYMENT 8,899.17 03/08 2,600.00 D 6,299.17 6505469063 Branch Telephone Transfer/Withdrawal PF: 1-HELP 3-PLVL 6-INQ 7-SB 8-SF 9-ASUM 11-CUTO -STSM Date: 3/23/2012 Time: 12:08:24 PM to MANUFACTURERS AND TRADERS TRUST COMPANY CONSUMER ACCOUNT UPDATED CHANGE REQUEST ADD/DELETE CUSTOMER MAINTENANCE ACCOUNT TITLE AND ADDRESS OFFICE OF ACCOUNT ALBERT L BROWN ~ 4345 CATHYLBROWN ACCOUNT NUMBER 4U GREENFIELD DR 00031003916441626 CARLISLE PA 17015 ACCOUNT TYPE Product Type; CDA Subproduct Codc; AH 1931 By signing below, I (we) (I) rCquebl that M&T Bank open in my (our) nanus the do it account i witlr the fistures rcqucslal, and (2) acknowledge aceipt of, and agar: to all prrovisOns ol', the Gcncmtl~Depos t Acwum Agrtttnent. Availability Disdasurc for Cunswncr 0.persit Accounts, the Spa;ific Fcatuas and Terms containing inl'onnalion about the account, the applicable 1'ce schalule and, if the account is a Jumbo Certificate of Deposit, the Agrec~ncm for Tdephonc Iaswclions. By signbig below, I (we) acknowledge and agree that if the account is opened in the names of two or moo: individuals, unless the account is a fiduciary or custodial account, it will he a Tenancy By Thc Entirnics Account Wilh Right of Survivorship if the sole irdividuals in whose name the accowd is oponcd arc husband and wife, and, in all other cases, a Joint Account Wilh Right of Survivorship Certification. Under penalties o(pcrJury, I (customer 1) certify: (1) that the number shown on this form is my correct Tezpsyer Identifirntion Number (or i am waiting for a number to be issued to me), and (2) that 1 am not auhject to barkup withholdingg bMauac (a) I am exempt from barkup withholding, or (b) 1 have not been notified by the Internal Revrnue Servlee (IRS) that 1 am subject to backup wlPoholding at a result of ^ failure to report all Interest or dividends, or (c) the IRS has iiotlfiM me that 1 am no longer subJect to backup witbholding, and (3) that 1 am a U.S. person (includingg a U.S. resident alien). Certification Inatruetlona -You moat cross out item (2) above if you have been notified by the IRS that you ere currently subject to backup withholding because of underreporting interest or dividends on your tax return. (Also sec Pert 111-Certification under Specific Insfrorliona on the separate W9 farm.) Thc IRS does not require your consept to any provWo~~f tlds docuu nt~the~an the cerlificet{ons required to avoid barkup withhddine. LL OO CURRENT TITLE: NEW TITLE: ALBERT L BROWN ALBERT L BROWN CATHY L BROWN CUSTOM ER ADDED CATHY L BROWN 210445867 Original • Accoum Services WI'n008 (Ix/071 m Q q IV QO W 00 DEF Updated OS/l1G/10 a.,,,,~:, Al~~~..1.... na aa< MANUFACTURERS AND TRADERS TRUST COMPANY CONSUMER ACCOUNT UPDATED CHANGE REQUEST ADD/DELETE CUSTOMER MAINTENANCE ACCOUNT TITLE AND ADDRESS OFFICE OF ACCOUNT A LBERT L BRO W N 4345 CATHY L BROWN ACCOUNT NUMBER 40 GREENFIELD DR 00015004217253688 CARLISLE PA 17015 ACCOUNT TYPE Product Type: DDA Subproduct Code: 9M CUSTI SSN: I931R2918 CUSTOMER TYPE CODE: TI CUSP 2 SSN: 210445867 CUSTOMER TYPE CODE: TZ By signing below, I (we) (I) rcyuesi dual M&T Bank open in my (our) names the deposit account requested below with the features rcqutwled, and (2) acknowledge receipt of, and agree to ail provisions of, the General Deposit Account Agrcnnenl, Availability Disclosum fnr Consumer Dgxxcit Acenunlc, the Specific Features and Terms containing iufonnation about the account, the applicable fee schedule and, if the awount is a Jumbo Cenificale of Deposit, the Agrrement for Tde honc Inslr li B • i p vc mts. 3 s gnhrg below, I (wc) acknowittlge and agitc Thal if the nccoum is oprncd in the names of two or more individuals, unless the account is a fiduciary or custodial acwunl, it will be a Tenancy By The Entireties Account Wilh Right of Survivorship if [he sole individuals in whose name the nccounl is opened am husband and wilt, and, in all othtt cases, a Joint Account With Right of Survivorship Certlficalimr. Under penalties of pcrjnry, I (customer 1) cenify; (Q Thal the number shown on this form is my correct Taxpayer Identification Number (or I am wailing for ^ number to be Issued to me), and (2) that 1 am rrat subjttl to backup withltoldirtg bttause (e) 1 am e m t f b k p xe rom ae np withholding, or (b) 1 have not been notified by the Internal Revenue Service (IRS) that 1 am snbjttt to backup withholding as a result of a failure to report all interest or dividends, or (r) the IRS has notified mu that I am no longer subJect to backup x911drolding, and (3) that l am a U.S. person (includingg a U.S. rcddcnt alien). Cerlifiealion Inarruellous -You must cross out Item (2) above If h b you ave een notified by the IRS that you are arrrcnlly subject to backup withholding because of underreporting interest or dividends on your tax return . (Also sec Part 111 - Certification under SpeclOc Inslruclions on the ceparate W-9 form.) The IRS does nor require your consent to n o ocu t other Then the certifications required to asroid bocku wlihh ldi o n . r SIGNATURE CUST I DATE SIGNATURECUST DATE ~ iO SIGNATURE CUST 3 DATE SIGNATURE CUST 4 DATE IDENTIFICATION CUST I: DL 02/13 05881856 PA IDENTIFICATION CUST 2: DL 08/10 15768431 PA ORIGINAL OPENING DATE: 02/07/08 TITLE CHANCE CURRENT TITLE: ALBERT L BROWN NEW TITLE: ALBERT L BROWN CATHY L BROWN CUSTOM ER ADDED CATHY LBROWN 210445867 G Q A7 CA V Original - Accnunt Services WI'A008 (13/07) DEF Undmed n[mrnn VYJYJ MANUFACTURERS AND TRADERS TRUST COMPANY CONSUMER ACCOUNT UPDATED CHANGE REQUEST ADD/DELETE CUSTOMER MAINTENANCE ACCOUNT TITLE AND ADDRESS OFFICE OF ACCOUNT ALBERT L BROWN 4319 CATHY L BROWN ACCOUNT NUMBER 40 GREENFIELD DR 00000000000405256 CARLISLE PA 17015 ACCOUNT TYPE Product Type: DDA Subproduct Code: H2 CUSTI SSN: 193182913 CUSTOMER TYPE CODE: TI CUST2 SSN: 210445367 CUSTOMER TYPE CODE: T2 By algning below, I (wc) (I) Rque51 lhet M&T Bank open in my (Dory numes the deposit aeeounl rtqueslttl below wish the frnlures nquesled, and (2) acknowledge rixcipt of, and agnx to ell provisions of, (hc Gencml Deposit Acwunl Agna:mcul. Availability Diuluwn: 1'or Consmncr Dclmsil Accounts, the Specific Fastens and Tenns containing infonnalion alxmt the account, tlM applicable fm schedule end, if the account is a Jumbo Ccnificatc of Deposit, the Agmement tilt Telephone Instmclions. By signing below, I (wc) acknowledge and agree Thal if the aceuunt is opened in the names of two or more individuals, unless the trecounl is a fiduciary or custodial account, it will be a Tenancy By The Entireties Account With Ri ht f S i g o urv vorship if the sole individuals in whose name the account is opened am husband ;Irld wife, and, in all other cases, a Joint Account Wilh Right of Survivorship CcrtiOtation. Under pcnaltles of pcryury, 1 (customer q certify: (I) That the number shown on This form Is my eorrecl Taxpayer Identification Number (or I am waiting for a number to be issued to me) ead (2) that 1 am , nat subJc[t to batkup x•ilhholdingg because (a) I am exempt from backup withholding, or (b) 1 have not bcen notlRed by the Infernal Revenue Service (IRS) lhet I am tub ct t b k i l h Je o at up w t ho ding as o result of a failure to report ell interest or dvidends, or (r) the IRS has noti0ed me Ibat I am no longer subject to backup withholding, and (1) /hot i am n U.S. person (indudbrg a U.S. restdart alien). CertiBralion Irntrurtiona - Vou meal cross out item (2) above if yo ave been notiRed by the IRS that you arc currently subject to backup wilhboWing because of anderre orl' i t t di id p n eres or v ends on your tax return. (Also ace Part III - Certigcelion under SpcdRt Insl earl on t ante W-9 form.) The IRS does trot require ymrr rnnsrnt to any pr i menl olh an the cerliticetioro rcquircd to scold betku withholdin . SIGNATURE COST I DATE SIGNATURE CUST DATE l SIGNATURE CUST3 DATE SIGNATURE CUST4 DATE IDENTIFICATION CUST I: DL 02/13 05881856 PA IDENTIFICATION CUST 2' DL 08/1015768431 PA ORIGINAL OPENING DATE: 09/01/67 TITLE CHANGE CURRENT TITLE: ALBERT L BROWN NEW TITLE: ALBERT L BROWN CATHY L BROWN CUSTOMER ADDED CATHY L BROWN 210445867 m Q Q N OD QO Q) Original -Account Services W I'A008 (11!07) DEF Ewing Brothers Funeral Home, Inc. 630 South Hanover Street Cazlisle, PA 17013- . (717)243-2421 January 25, 2012 Cathy Lee Brown 40 Greenfield Drive Carlisle, PA 17015 The Funeral Service for Albert L. Brown We sincerely appreciate the confidence you have placed in us and will continue to as i t i feel free to contact us if you have any questions in regard to this statement. s s you n every way we can. Please THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT , AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. 1. PROFESSIONAL SERVICES ' Services of Funeral Director/Staff , $1865.00 Embalming, $895.00 Dressing, Casketing Cosmo e[c. $295.00 2. FACILITIES AND SERVICES Viewing (Visitation/Wake) . _ _ $495.00 Funeral Ceremony, $495.00 3. AUTOMOTIVE EQUIPMENT Vehicle to transfer remains to Funeral Home, $275.00 Hearse (Casket Coach) $275.00 Utility Vehicle for DC retrieval/filing , _ $125.00 C. SPECIAL CHARGES Direct Cremation , $325.00 FUNERAL HOME SERVICE CHARGES $5045.00 SELECTED MERCHANDISE: Solid Poplar rental casket $600.00 Acknowledgementcazds, $10.00 Register Book(s) $40.00 Memorial folders , _ $85.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED $5780.00 Cash Advances Opening Grave, $600.00 Clergy/MassOffering, $150.00 Certified Copies of the Death Certificate , $48.00 Flowers, , . . . . . . . . . . . . . . . $132.50 Organist $150.00 Cantor . $75.00 3 Altar Servers, $60.00 Sentinel w/photo , $213.69 Blue Cultured marble Um $195.00 TOTAL CASH ADVANCES AND SPECIAL CHARGES . $1624.19 Total Total Cost . . . . . . . . . . . . . . . . $7404.19 NeK ~ P~e~~l-ems ' ~ SUB-TOTAL $7404.19 INITIAL PAYMENT /DISCOUNT /CREDITS 0.00 TOTAL AMOUNT DUE $7404.19 The unpaid balance over 30 days is subjected to a 1.50 % service charge per month - 18.0000 %per annum. ~ lal~ ~~ ~~cetJc~ ~~ ~ ~N~~ ~ c m Opossum Lake Accounting & Tax Service 99 Campground Rd Carlisle, PA 17015 717-243-0366 February 13, 2012 CONFIDENTIAL Albert L Brown 40 Greenfield Dr Carlisle, PA 17015-7681 For professional services rendered in connection with the preparation of yoiv 2011 individual tax return: Form 1040 (Individual Income Tax Return) Schedule A (Itemized Deductions) Form 13 ] 0 (Refund Due a Deceased Taxpayer) General Sales Tax Worksheet PA Form PA-40 (Income Tax Return) PA Schedule SP (Special Tax Forgiveness) Preparation fee 205.00 Received on account -205.00 Amount due $ 0.00 DATe _.. DE5CRi~'"F!t7F! Balance Forward '18/2012 PAYMENT RECF,ivF.n _ TH RATE ""Y" ' CHARGES CREDIT'S BALANCE ' Units K YOU! 367.50 367.50 0.00 56.5" 2 113e.~AI " .1 ~3':0'II` ~~°` ~ ,~ U~~~ vv t ~~ ~~,~~ RESIDENT # CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL A NT DUE 571176 113.00 0.00 0.00 0.00 0.00 $113.01 RESIDENT NAME Mr. ALBERT BROWN Form PB-01 A 1% finance charge may be assessed if balance is not paid by the due date. Thank You! Please contact the Business Office directly at 717-790-8220 if you have questions or concerns about your statement One Team ...One Minion Albert L Brown 40 Greenfield Dr Carlisle, PA 17015 CUMBERLAND COUNTY AGING & COMMUNITY SERVICES 1100 CLAREMONT ROAD, CARLISLE, PA 1701$ (717)240-6110 oR 1-888-697-0371 EXT 6110 rAx: (717) 240-6118 Barbara B Cross Chairman Jim Hertzler Vice Chairman INVOICE FOR SERVICES Gary Eichelberger Secretary Tarty L Harley Director Invoice Number: January-12-4 Invoice Date: March 7, 2012 SERVICE PROVIDED: ADC-Full Day MONTH OF SERVICE: January 2012. ACTUAL COST PER Full Day 42.45 YOUR REDUCED SLIDING FEE SCALE RATE PER Full Day 9.13 TOTAL Full Day(s) OF SERVICE YOU RECEIVED ~- 6.00 PLEASE PAY THIS AMOUNT 54.78 Payment Due Upon Receipt of Invoice. Payment Is Delinquent if not paid by March 29, 2012. Contact CCOA if any issues. ~~~ " ra7~' ~~~~ Make Checks Payable To: CUMBERLAND COUNTY OFFICE OF AGING FEB-16-2012 THU 1140 AM FRX N0. P. 02 Phillips & Cohen Associates, l,t~h 10041ustison Street Wilmington, AE 1980.1. Phone - 800-477-fi441 Fax - 302-3fi8-2152 February 16, 2012 Office ,Hours .Mon-Thu: Sam - 9pm Fri: Sam - 6pm Sat: Sam -12pm The Estate of: ALBERT BROWN' 40 G12EENFIELD DR CARLISLE, PA 17015--7681 Our Client: Ciiibank, N.A. Client Account #: xxxxxxxxxxxx4021 C~tn-enC B; ~L:nce: $4 1.94 Our Account#' 18343699 To Whom Tt May Concern; Regazdin;;. CI' 2 AT&T UNIVERSAL MAS- Ti:; tCARIa Pursuant to our telephone conversation, the above referenced account was ~ e erred [o us'I y Citibank, N.A. because we are specialists in the area of deceased account caze. Please remembe.7 that fatni:y members/la red ones are not personally liable for this debt. Effective immediately Phillips & Cohen Associates, Ltd, has been authoriz x co accept $ 11,94 cis payment in full on the above referenced account if consummated as follows: AMOTJNT DATE _.. •"'5411.94 ,._02/22/2012 You agee to make each payment by Check or Money Order, regtilazlcertiti e. I mai 1. Please send payments to: Phillips & Cohen Associates, Ltd 1.004 Justison Street Wilmington, DE 19801 Please make payments payable to Citi. Upon receipt and clearance of the above referenced payment(s) the estate ~e it be released from a»y further obligation to Citibank, N.A. regarding the about referenced account. This azrangement '.vi Il be cunceli ~d if pa;VmenCS are not made in accordance with the indicated, schedule. Thank you for your prompt attention to this matter. ~~ Sina~, ~ •'y5 ~~ ~-- l~Dc;'e(/~ i 'll.i}cs +!t open ; sociatcs, Ltd. This is an attempt to collect a debt and any information obtained will be use d fir tkiet purl ose. This communication is from a debt collector, O .. ~ e oe~~ ~ G O K n~ren m~ m .~ W t, ~jl I~ Q ~ ~ m W ~ y o `" g ~ ~~~ m c ~ ^~ r'~ 9 Oe D O ~ m $ o Z~O m Z nZ M `U ~ ~I~ "V m ~ d ~ O ,"""! r _ ~ ~ ~ ~ ~ ~_~ ~ (D ~~ € Comcast. D9547 37889501-5 01/28112 $89.74 02/25/12 Page 1 of 2 Contact us: C~ www.comcast.com ~ 717-243-4818 ~____ ALBERT BROWN For service at: 40 GREENFIELD DR CARLISLE PA 170157681 News from Comcast Comcast has all the speed you need to do everything you want on the Internet -faster, inGuding our Pertormance Staner tier, with speeds up to 6 Mbps, for $49.95 per month Thank you for your prompt payment. For your convenience, we now accept regular and automatic monthly credft cans payments and direct debit. HearingfSpesch Impaired Ca11711 Account Number Billing Date Total Amount Due Payment Due by On February 29th, the "Preferred Collection" On Demand folder will no longer be available.