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HomeMy WebLinkAbout12-14-12 (2) 1505610140 REV-1500 EX (°'-'°' PA D tm t f R OFFICIAL USE ONLY epar en o evenue Bureau of Individual Taxes County Code Year File Number PO 80X 260601 INHERITANCE TAX RETURN Harrisburg, PA 1712&0601 RESIDENT DECEDENT 2 1 1 2 1 1 1 7 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDVYYY 1 8 6 2 4 8 1 8 6 0 9 2 4 2 0 1 2 0 3 2 2 1 9 2 8 Decedent's Last Name Suffix Decedent's First Name MI C O M P D O N A L D W (If Applicable) Enter Surviving Spouse's Information Etelow Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED I N DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return ~ 2. Supplemental Retum ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limned Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTULL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number R O G E R B I R W I N E S Q U I R E 7 1 7 2 4 9 2 3 5 3 r.,, EGISTER OF LS ~ OM.Y '" rytm ~o First line of address ~ ~ p u-s n ~ r~-r ~ c ^1 x c~ ~ n :~ I R W I N & M c K N I G H T P C ~~ s yr • Sewnd line of address ~ ~ ~ ry 60 WEST POMF RET STREET ` '~© -~ ~-tom ~ ~ City or Post Office State ZIP Code ~ D FIL n C A R L I S L E P A 1 7 -o r - ~ ° V' ~ 0 1 s +i Correspondent's e-mail address: Under pan of perjury, I are that I have examined this return, induding accompanying schedules and statemerns, antl to the hest of my knowledge antl belief, it is We, ar~compDeclaretion of preparer other than the pereonal repreaentahve is based on all information of which preparer has any knowledge. 297 OAK FLAT ROAD NEWVILLE PA 17241 SIGNATURE OF ~PA~RrE~R OTHER/THAN REPR ENTATIVE DAT PLEASE USE ORIGINAL FORM ONLY Side 7 1505610140 3 1505610140 150561024 REV-1500 EX Decedent's Social Securtry Number Decedent's Name: DONALD W• COMP 1 8 6 2 4 8 1 8 6 RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1. 2. Stocks and Bonds (Schedule B) ...................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprtetorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) .......................... 4. 5. Cash,. Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers & Miscellaneous -Probate Property (Schedule G) ~ Separate BilCng Requested .... ... 7. 8. Total Gross Assets (total Lines 1 through 7) ........................ ... 8. 9. Funeral Expenses and Administrative Costs (Schedule H) ............... ... 9. 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule 1) .......... ... 10. 11. Total Deductions (total Lines 9 and 10) ............................ ... 11. 12. Net Value of Estate (Line 8 minus Line 17) ......................... ... 12. 13. Chadtable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) ................... ... 13. 4 4 0 2 7. 0 3 4 4 0 2 7. 0 3 3 5 4 2. 0 4 1 8 3 3. 5 2 5 3 7 5. 5 6 3 8 6 5 1. 4 7 14. Net Value SutrJect to Tax (Line 12 minus Line 13) .. ........... .. ..... ... 14. 3 8 6 5 1 . 4 7 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9i16 16. Amount of Line 14 taxable at lineal rate x .045 3 8 6 5 1. 4 7 1s. 1 7 3 9. 3 2 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17. 0. 0 ~ 16. Amount of Line 14 taxable at collateral rate X .15 0 0 ~ i 6. ~. 0 0 19. TAX DUE ...................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610240 1 7 3 9. 3 2 150561W240 REV-1500 EX Page 3 Decedent's Complete Address: Flle Number 21 12 1117 DECEDENT'S NAME DONALD W. COMP STREET ADDRESS 297 OAK FLAT ROAD an sraTE zIR NEWVILLE PA 17241 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 8. Discount 3. Interest 86.97 4. If Line 2 is greater than Line 1 +Line 3, enter the difference. This is the OVERPAYMENT. FIII in oval on Page 2, Line 20 to request a refund. It) 1,739.32 Total Credits (A + B) (2) 86 97 (3) (4) 0.00 5. If Line 1 +Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1,652.35 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ................................................................ ^ .... b. retain the right to designate who shall use the property transfened or its income; .............. .. ..... ^ c. retain a reversionary interest or ..................................................................................... . ^ ^Q . .... d. receive the promise fa life of either payments, benefits or care? .................................................. ..... ..... ^ ^X 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate considerafion? ........................................................................... ..... ^X 3. Did decedent own an'in trust for' orpayable-upon-death bank account a secudty at his or her death? .... ..... ^ X^ 4. Did decedent own an individual refiroment account, annuity or other non-probate property, which contains a beneficiary designation? ............................................................................................. ..... ^ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent ]72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent except as noted in 72 P.S. §9116(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 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in crommon with the decedent, whether by blood or adoption. REV-1508 EX* (11-10) pennsylvania OE7ARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY and Me date the proceeds vrere received ^~~ R~~wrn NrrmY oxmea vmn npm or survivorship must he dbcbsed on Schedule F. ITEM NUMBER VALUE AT DATE DESCRIPTION OF DEATH .. I rvra i or~rvn - i,nccnlrv~i ACCOUNT if23659971 28,748.13 2. IPPG INDUSTRIES -EMPLOYEE SAVINGS PLAN BENEFICIARY: THE ESTATE OF DONALD W. COMP TOTAL (Also enter on Line 5, more space is needed, insert atldhbnal sheed of paper of the same size 15,278.90 5 REV-1511 EX+(10-09) ' Pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND I"RE"sioEei~c o NeruRN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER DONALD W. COMP 21 12 1117 Decedents debp must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. 8. 1. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State _ Year(s) Commission Paid: p, AltomeyFees: IRWIN & MCKNIGHT, P.C. 3. Fatuity Ezemption: (If decedent's address's not the same as daimam's, atlach ezplanation.) Claimant Street Address City ~~ Relationship of Claimant to Decedent 4. PretreteFees: REGISTER OF WILLS 5 Accountant Fees: 6. TaXRetumPreparerFees: PATRICIAA. ROSENDALE, CPA 7. REGISTER OF WILLS -FILING FEE 8. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 9. THE SENTINEL -ESTATE NOTICE ZIP 2,750.00 ZIP 122.50 375.00 30.00 75.00 189.54 TOTAL (Also enter on Line 9, Recapitulation) I ; rare space is needed, use add'N'onal shee4 of paper of the same size. REV-1512 E~(+ (12-08) pennsylvania DEPARTMENT OP REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE( DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8r LIENS rILC nYaltfGK DONALD W. COMP 21 12 1117 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unrNmbuned medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. CUMBERLAND GOODWILL FIRE RESCUE EMS -AMBULANCE 25.23 2. (MILLENNIUM PHCY SYSTEMS MECHANIST -MEDICAL 3. (CARLISLE REGIONAL MEDICAL CENTER -MEDICAL 4. (ASSET PROTECTION UNIT, INC. -REIMBURSEMENT OF BENEFITS 5. ~CENTURYLINK-TELEPHONE 499.74 50.00 1,200.00 58.55 TOTAL (Also enter on Line 10, Recapitulation) I S If mae space is nestled, insen atlddronal sheers of the same size. REV-1513 EX+ (Of -10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT """ "" ' FILE NUMBER: DONALD W. COMP 21 12 1117 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY lb Not Llst Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include ouMpht spousal distributbns and transfers under Sec. 91 6 (a] (1.2].] t. STEPHEN W. COMP Lineal 38,651.47 297 OAK FLAT ROAD REMAINDER NEWVILLE, PA 17241 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. E If more space Is needed, use addltlonal sheets of paper of the same size. © M,~TBank 499 MiMhell Road, Millsboro, DE 19966 Adjustment Services Phone 888-502-4349 Faz (302)934-2955 October 31, 2012 Irwin & McKnight, P.C. West Pomfret Professional Building 60 West Pomfret Street Carlisle, PA 17013-3222 Re: Estate of Donald W Comb Social Sectuitv:186-24-8186 Date of Death: September 24 2012 Dear Sir or Madam: Per your inquiry on October 24, 2012, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: L Type ofAccounr Account Number Ownership (Names ofl Opening Date Balance on Date of Death Accrued Interest Total Checking Account 23659971 Stephen W. Comp(POA) _ Donald W. Comp Kay E Comp(POA) 1228/1974 $ 28,748.11 $ .02 $28,748.13 For any additional information on the above accounts, induding ownership end any changes, dosures andlor reimbursement of funds, please ®II the Walnut Bottom at 717-532-TAld. We were unable to locate any safe deposit box for the above•men8oned decedent This leifer does not indude any annunts m which the deceased may ha`x hren listed as Power of Attorney, (.hstodian o[ Uniform Tranders, Representative Payee, or Trustee under a Written Agreement Sincerely, Valazie Mercer Adjustment Services RECEIPT FOR PAYMENT ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17Q13 COMP DONALD W Estate File No.: Paid By Remarks: 2012-01117 IRWIN AND MCKNIGHT HEA Fee/Tax Description PETITION LTRS ADM SHORT CERTIFICATE JCS FEE AUTOMATION FEE Check# 032586 Total Received......... Receipt Date: 10/16/2012 Receipt Time: 14:11:20 Receipt No.: 1071747 Receipt Distribution ------------- -------- --- Payment Amount Payee Name 90.00 CUMBERLAND COUNTY GENERAL FUN 4.00 CUMBERLAND COUNTY GENERAL FUN 23.50 BUREAU OF RECEIPTS & CNTR M.D 5.00 ------- CUMBERLAND COUNTY GENERAL FUN $122.50 $122.50 PPG Industries DONALD W COMP ESTATE STEPHEN W CONP ADM 297 OAE FLAT EOAD NENVILLE, PA 17241 Beneficiary Account Transfer TRANSACTION DATE: 1 Lff//2012 This statement confirms the amount transferred to an account in the PPG Employee Savings Plan on your behalf. ECMb Employee Savings Plan Transfer Amount(s) $13,954.99 $1,323.91 Investment Fund Stable Value Fund PPG Stock Fund Total: Source Name Before-Tax Deferrals Company Contributions. Total: Your account access information will be sent to you under separate cover. $15,278.90 Transfer Amount(s) $13,519.94 $1,758..98 $15,278.90 Please reviewand keep Ihk rx~ce for your records. 8 you havearry Quesdorts about Cds notlce, cab the PP6 Plan IMonrretbn Lure at 1-888774.4011 w to obtain aN3tlonel plan or axouM inhxmetlon, aaeesyour aawum e< htlpaJIPPG.ingplens.com. CuetarnerService Associates ere available Morx~y through Friday, 8 am. to 8 p.m. Eestem Time, except on NewYOrkSlodc Exchange hotkxrys. EW1XfEM P ff e i 1 i N 4 O r O Q a a c m N y; c ~~ a N E v m c a Y Y N ~ E ~ .. y 0 c u ~ c v d N C C d ~ ~ G ~ O 6 C o L y c v n E a >. v m 3 a ~ c a o ;,, .N > ~ d m w N a e a n a i t e f F M '` z i god o ~;r 7 ~:' m~U Z o ~ =0~ CC W ~'?'m a z ~ a d d U ~ I ~' g ~ m ~+j C O N ~ p_' r y o a O W rn U U $uiE • m Q Z LL d O m m oa N N N N lO O 0 O V ~ fV ~ °o n v O V; r r O ~ fh O Q N c H d C Q C 'iu U N C O1 N _ ,,NE d ~. 5~a i°- N N N rnrnrn f i:'p 2 :. 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Hi W!- ~I o~ Z. . i. u 1:; ¢~. w! ~'~, •0811720'12 6536565 30.00 Spidva HandiHaler Inhalation Capsule 18 MGG $ 306.10 $ 0.00 $ 308.10 RX 00597-007541 0910112012 66287 48.00 sucralFate oral Tablet 1 GM $ 38.05 $ 0.00 $ 38.05 RX „ % 00591A780-05 d 09/01/2012 6536288 12.00 Klor-Con M20 Orel Tablet Extended Release 20 MEO $ 1.12 c $ 0.00 $ 1.12 RX 00245-0058-15 09/0112012 6536289 24.00 Mucinex Orel Tablet Extended Release 12 Hour 800 MG $ 8.39 $ 0.00 $ 8.38 OTC 83824-0008.60 09/01/2012 8536290 24.00 Famotltline Oral Tablet 20 MG $ 46.78 $ 0.00 $ 46.76 RX 59578-0938-03 - 09I01I2012 6538558 12.00 DIBlazem HCI Coated Beads Owl Capsule Extended Release 24 He $ 1.98 c $ 0.00 $ 1.98 RX 00093-5118-98 09/01/2012 6536563 72.00 Furoaemide Oral Tablet 20 MG $ 0.84 c $ 0.00 $ 0.64 RX 83304-0524-10 09/0112012 8536564 24.00 Metoprolol Tartrate Orel Tablet 25 MG $ 0.40 c $ 0.00 $ 0.40 RX 00378-0018-01 09/01/2012 6538588 24.00 GebepeMin Orel Capaute 100 MG $ 0.51 c $ 0.00 $ 0.51 RX 78714-0881-Ot 09/0112012 6567674 27.00 Beano Orel Tablet $ 2.53 $ 0.00 $ 2.53 OTC 41383-08300 09/03/2012 8538586 5.00 Metolazone orel Tablet 2.5 MG $ 13.51 $ O.OD $ 13.51 RX 85580-0843-71 09/04/2012 6538293 15.00 Iprefropium BromWe Nasal BolWOn 0.08 % $ 49.42 $ 0.00 $ 49.42 RX 00054-004847 09/04/2012 8585261 12.00 Beano Orel Tablet $ 1.12 $ 0.00 $ 1.12 OTC 41383-08300 ~. 0910512012 8565826 24.00 Beano Orel Tablet $ 2.24 $ 0.00 $ 2.24 OTC ' 41383-08300 09/1912012 8568889 90.00 ldbuterol-Iprefropium Inhela8en Solution 2.5-0.5 MGI3ML $ 2.85 c $ 0.00 $ 2.65 RX 00487-0201-01 09/1912012 8576991 15.00 PretlnISONE Orel Tablet 20 MG $ 0.37 c $ 0.00 $ 0.37 RX 00143-14n-0t 0924/2012 6575604 5.00 Avelox owl Tablet 400 MG $ 19.34 c $ 0.00 $ 19.34 RX 00085-1733-01 0924/2012 8578992 2.00 PredniSONE Oral Tablet 10 MG $ 0.21 c $ 0.00 $ 0.21 RX 00143-147310 09/2412012 2031520 30.00 Morphine Sulfate $ 3.48 c $ 0.00 $ 3.48 RX 00054-040444 0924/2012 4026015 2.00 Lorezepam Orel Tablet 0.5 MG $ 0.23 c $ 0.00 $ 0.23 RX 00591-0240-05 09242012 4025938 30.00 Lwaupem Oral Tabet 1 MG $ 0.69 c $ 0.00 $ 0.89 RX 00591-0241-OS $ 0.00 $ 57.15 09/172012 $ 0.00 $ 0.00 $ 0.00 $ 485.48 $ 14.28 $ 0. $ 0.00 499.74 ~~< ~~~ ~U -,s `~ N i+o~ov E t ~ O) M (O ', p . -. _ ~ ODOf~ aDO U1 C J ~ M V M ~ (O~/ ~ ~ U ~ c- ~ ~ ~ C ~ U ~ N 'v O U N L ~ ~ ~ 3 _. >_ ~' c a i d £ ~ O ~ ~ O O U N ~ O ~. f0 u O _N C C d y ~ N ~ ~ O . ~ n U U ' o m E m m v ~ ~ ° ~ _ • .n C - ~ y w . 3 ~ N ti N N m p (~ E N U ~ N C O ~ l0 d C O '~ U ~ N ~ p -O ~• _ C~ m n ~ U U Ol N. ~ 7 C O1 V N d O~ m p ~m O N J E m ~ -a¢ m m a i ~ a aF 0 am N Erg.- N U m o, n~ Eo o o v ~rn°o 0 0 p O N U V O Z O~ U O O r) (D O O ~v ~rn~ a i~ m ~ ~ ~ w ° ~ mm~m~ w o v rim ~ ~ E~ 'OrNi ~ r f»ra C l0 O? C O N N o g ~ m ~ ~ m~ U 0 W 0 ~ ~ LL 0 N d ~ ~ ~ N d W O N W O o °' ~ ~~ ~~~ U N ~ O Y ~ N T E °. ~ ~ ~ ~ E g' ° E d i o p E d v E o ~ ~E• mm ~ ~~ t m • o ~ m ~ aNi~ma ~i m E~ 2 Z nz N c E 3 ~ m C m¢ a= N W } ~ 0 Z VJ F- U .~ 7 Z ~ N ~ ~ Q7 U~ N 3 ~ O1 U p7 ~ j 7 Q . m y Z m~ E p E S yE ~ E ~2S a i o • E E o ~' - a¢o m5 za ¢ dwc~ F-p 5¢ ¢ a E a Y m m .~ a a W a d `~ • 3 C • E N a b s §' ~...~..- m E 0 v 1i OOWO]SIBA m _ Or.~6er 12, 2012 ESTATE OF DONALD W COMP 297 OAK FLAT RD NEWVILLE PA 17241 RE: APU Reference Number: 101260055 Insured: DONALD W COMP Patient: SAME Patient DOB: 3/22/1928 Claim Number: 55229736 Policy Number: 737107 Paid Date: 7/27/2012 Payment for coverage date(s): 6/1/2012 - 7/31/2012 Dear Estate of Donald W. Comp, Asset Protection aMt, Inc P.O. Box 30969 Amarillo, TX 79120 On behalf of Senior Health Insurance Company of Pennsylvania (SHIP), Asset Protection Unit, Inc. would like to express our condolences for your recent loss. As per the attached letter of authority, we are administering all overpayment recoveries on behalf of SHIP. As part of that process we have instituted a computerized auditing system to review all of their payment records. Our review indicates benefits were paid under this policy in the amount of $3,100.00 Eor Long Term Care services. Our review indicates that the correct amount of the payment should have been $1,900.00. We believe the overpayment in the amount of $1,200.00 occurred for the following reason: Paid on Tax-Qualified Policy. This policy is atax-qualified policy, and will not cover any services paid by Medicaze. Dates of service of 7/20/12 to 7/31/12 were paid by Medicare, and thus would not be paid by the policy. Claim 54802187 paid 31 days x $100.00 for dates of service 7/1/12 to 7/31/12 but should have paid 19 days x $100.00 for dates of service 7/1/12 to 7/19!12, which caused an overpayment of $1,200.00 Please see the attached list for additional details concerning the overpayment. Please review your records. If you agree that SHIP made an overpayment to you please refund $1,200.00 to us within 30 days of the date of this letter. Please make refund checks payable as follows: Asset Protection Unit, Inc. C/F Senior Health Insurance Company of Pennsylvania P. O. Box 30969 Amarillo, TX 79120 If you think SHIP's records are in error, or if you have already issued a refund, please call us at (866) 434-8303, or e-mail us at reply®apuinc.com. We thank you for your attention to this matter! Sincerely, Asset Protection Unit, Inc. (866) 434-8303 0 0 ^ ~ ~ a 0 ~ c ~ ~ ~ S ~ ~ ~ ~ ~ a ~ in ~ o a o N O 0 $ ~~ ~ 0 ~ Q Y ti a ~ ~ ~ ~~ E m ¢ L o ~ D ~ m O ~ o~ o 0 W ~ 0 ~~ o gg o U .~c ~ ~ O ~ o o 0 a ~ O O o O O ~_ - P' fll Q. __ = m O~ - " - s F = ~ - o ~ - o w = ~, m ~ o ~ ~ m a ~ ~ O > o ~ °' __ ~ ~ ~ gg a w - O1U `~ xgaa = C ~ Z N ~~~LL