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HomeMy WebLinkAbout01-15-13 c l e0 C") c."_' ill C"? a C_J. 6D W 4:''1 r i John B. Zonarich, Esquire m c-) Email: jbz@skarlatoszonarich.com - r- C- Identification No. 79989- cn Elizabeth B. Place, Esquire Finail: ebpnskarlatoszonarich.com Identification No. 44682 b Skarlatos Zonarich LLC - ~ Skarlatos & Zonarich Building 17 South Second Street, 6th Floor Harrisburg, Pennsylvania 17101 Telephone (717) 233 - 1000 ,lttorneys for Petitioner, Gloria J. Banks, Guardian of Inez H. Davis, an Incapacitated Person COURT OF COMMON PLEAS ESTATE OF INEZ H. DAVIS, CUMBERLAND COUNTY, An Incapacitated Person. PENNSYLVANIA ORPHANS' COURT DIVISION O.C. NO. 21-07-0200 PETITION FOR ALLOWANCE OF DISTRIBUTION OF PRINCIPAL OF AN INCAPACITATED PERSON TO THE HONORABLE, THE JUDGES OF THE SAID COURT: The Petition of Inez H. Davis, an Incapacitated Person, by her daughter and guardian, Gloria J. Banks, by and through her counsel, SkarlatosZonarich LLC, respectfully requests: 1. Petitioner is Gloria J. Banks, an adult individual who resides at 5776 Catherine St., Harrisburg, PA 17112; Petitioner is the daughter and the plenary guardian of the estate and person of her mother, Inez H. Davis. I. BACKGROUND 2. Inez H. Davis, the Incapacitated Person, was adjudicated fully incapacitated by Order dated April 12, 2007, of the Honorable Wesley Oler, Jr., of the Court of Common Pleas of Cumberland County. A copy of the Order is attached hereto as Exhibit "A". 3. By virtue of the April 12, 2007 Order, Gloria J. Banks was appointed plenary guardian of the estate and person of Inez H. Davis. See Exhibit "A". 4. The Incapacitated Person was born June 1, 1930; her mother and father are both deceased. 5. The Incapacitated Person is single and has six children: Carolyn A. Henderson (daughter) 16838 Ceres Ave., Apt. 106 Fontana, CA 92335 Elsie L. Baker (daughter) 7367 Central Ave., #152 Highland, CA 92346 Katheryn L. Alvarez (daughter) 1933 Lenox St. Harrisburg, PA 17104 Donald Ray Davis (son) 927 Cabrera San Bernadino, CA 92411 Michael Anthony Davis (son) 22015 Cherokee Rd. Apple Valley, CA 92376 Gloria J. Banks (daughter, plenary guardian of estate and person, Petitioner) 5776 Catherine St. Harrisburg, PA 17112 6. The Incapacitated Person is currently residing at The Jewish Home of Greater Harrisburg, 4000 Linglestown Rd, Harrisburg, PA 17112. -2- 7. The Incapacitated Person suffers from advanced progressive dementia and is in need of twenty-four hours a day care, including assistance with all activities of daily living. She is not able to verbalize her thoughts, needs assistance dressing, eating, and bathing, and is confined to a wheelchair. 8. In December, 2006, Petitioner moved the Incapacitated Person from California to the Harrisburg area, where Petitioner lives, so that Petitioner could provide better care and advocacy for her. 9. The Incapacitated Person resided in Golden Living Center, West Shore, Camp Hill, PA, from December 2, 2006 until August, 2012 when she was moved to The Jewish Home, just a few minutes from Petitioner's home. II. INCAPACITATED PERSON'S ESTATE 10. On November 26, 2012, settlement was approved in the matter of Gloria J. Banks, Guardian of Inez H. Davis v. GGNC Camp Hill West Shore, LP, et. al., docketed in the Cumberland County Court of Common Pleas at Civil Action No. 10-924 (hereinafter "Davis Civil Litigation"). The litigation stemmed from injuries the Incapacitated Person suffered at Golden Living Center as a result of untreated falls, resulting in debilitating injury to vertebrae and a lengthy, painful recovery. 11. As a result of the receipt of proceeds from the approved settlement, the estate of Inez H. Davis has increased from $301.00 to $247,082.54; her monthly income is $1,368.26, consisting of $333.90 Social Security and $1,053.36 pension. 12. The Incapacitated Person receives Medical Assistance benefits for long-term care. Her monthly Social Security and pension income, less $45 dollars personal needs allowance, is paid to the nursing home to offset the cost of her care. -3- III. PROPOSED DISTRIBUTION 13. The primary goal of Petitioner in requesting distribution of principal is improving, and safeguarding, her mother's quality of life by accessing health care treatments; improving the comfort and functionality of her nursing home room; facilitating her ability to venture into the community; maximizing her ability to enjoy extended visits to Petitioner's home; and generally improving all aspects of the Incapacitated Person's activities of daily living. 14. Petitioner's long-held desire and hope had been for the Incapacitated Person to live with Petitioner and her husband, a retired pastor, and their two children. To that end, Petitioner purchased a home with a first floor bedroom and bath suite for her mother. 15. Subsequently, the Incapacitated Person sustained falls in the nursing home and her condition declined markedly. 16. Petitioner was herself diagnosed with Neurosarcoidosis and Pulmonary Sarcoidosis, i as well as Fibromyalgia, and now requires the assistance of personal care aides. 17. Petitioner's goal for the Incapacitated Person has thus, to her great regret, shifted from care at Petitioner's home to distribution of principal which best allows the Incapacitated Person to reach her maximum potential while residing at the nursing home. It is believed this is accomplished by distributions which maximize the time the Incapacitated Person spends with Petitioner and the extended family and at Petitioner's home. 18. The benefit to the Incapacitated Person of visits to Petitioner's home cannot be overstated; it is there that she is happiest and her mental status is at its best: 'Neurosarcoidosis and Pulmonary Sarcoidosis are rare chronic long term, non-curable, autoimmune disorders which attack various organs and bodily systems in a way that destroys muscle, brain matter, and organ tissue, causing non-functionality and severe pain. Among other things, Petitioner suffers from extreme muscle pain, stiffness, and cramping; deteriorated discs in her vertebrae; arthritic complications and neuropathy in extremities; extreme sensitivity to temperatures; and debilitating fatigue. -4- a. she remembers the layout of her bedroom suite; b. she responds more readily to restroom prompts and enjoys the dignity of taking as long as she wants to use the restroom; C. she spends considerable private time at the sink and mirror, attending to her dental and personal hygiene; d. always a proper, immaculately dressed woman, in the comfort and familiarity of Petitioner's home and with the patient support of Petitioner and her family, the Incapacitated Person comes closest to resuming her lifelong habit of tending to her personal appearance; e. she is calmer, relaxed and happier at Petitioner's home, sharing fellowship with her extended family, most notably her daughters, Petitioner and Katheryn Alvarez, and their families. 19. To meet the objectives outlined above, distribution from settlement proceeds is sought as outlined below. A. Medical Treatment 20. The Incapacitated Person's dementia is exacerbated by her diminished ability to hear, see or eat; she is in need of hearing aids, cataract surgery and dentures to improve these functions. 21. Petitioner seeks permission to expend principal for the following medical expenses, to the extent the costs are not covered by health insurance: a. Two hearing aids (Beltone Hearing Centers quote attached as Exhibit "B") $ 9,083.00 b. Dentures (Higgins Family Dentistry quote attached as Exhibit "C") $ 2,816.00 C. Cataract Surgery (oral quote from Dr. Farrell) $ 4,200.00 $ 16,099.00 -5- B. Durable Medical Equipment and Supplies i. Wheelchairs 22. The Incapacitated Person is confined to a wheelchair; she is able to ambulate only with assistance and for a very short distance. 23. Her current wheelchair does not adequately support her, does not tilt to improve her positioning and is difficult to handle for purposes of transporting her to doctor appointments or to Petitioner's home. 24. Approval is sought for the purchase of an Invacare Solara Tilt Wheelchair for the Incapacitated Person's use at the nursing home. Central Medical Equipment Co. quote of $6,549.00 for Tilt Wheelchair is attached as Exhibit "D". 25. The Incapacitated Person would also benefit from having an additional wheelchair at Petitioner's house, available for her frequent visits while protecting the tilt wheelchair referenced in paragraph 24 above from the wear and tear of use outside the facility. Central Medical Equipment Co. quote of $800.00 for standard wheelchair is attached as Exhibit "E". ii. Lift Chairs 26. The Incapacitated Person is not able to transfer out of a chair without assistance; transfer would be much less difficult for the Incapacitated Person and the aides assisting her if she had a lift chair. 27. The Incapacitated Person would benefit from having lift chairs at the nursing home and also at Petitioner's home, which she visits frequently for extended periods of time; Petitioner suffers from physical impairments which make transfer of her mother without a lift chair very difficult. -6- 28. Whitco Home Furnishing quote of $1,985.38 for two lift chairs is attached as Exhibit "F". iii. Support, Rehabilitative and Therapeutic Items 29. The Incapacitated Person is in need of support rehabilitation, and therapeutic items to increase strength and provide support and safety given her poor muscle strength. 30. Petitioner seek permission to expend principal for the purchase of durable medical equipment and supplies as follows: a. Active Passive PRO LowerBody Exerciser $7,575.00 (Patterson Medical quote attached as Exhibit "G") b. Miscellaneous cushions, stimulation devices $2,436.66 and care items2 2 a. Two gel cushions (Central Medical Equipment Co. quote $370.00 attached as Exhibit "E") b. Cervical Roll (Central Medical Equipment Co. quote $17.00 attached as Exhibit "E") C. Bed Wedge (Central Medical Equipment Co. quote $35.00 attached as Exhibit "E") d. Therapeutic Carrots for hand rehabilitation (Patterson $775.50 Medical, 4 cases of 6, quote attached as Exhibit "H") f Gel Top Sensory Stimulation Tray & Gel Pad (Patterson $132.30 Medical quote attached as Exhibit "1") $44.40 g. Lighted Nail Clipper with Magnifier (Mountainside $7.79 Medical Equipment Company quote attached as Exhibit "ill) ( quote for medical equipment and supplies referenced in subparagraphs g-u attached as Exhibit "J') h. Bionix Safe Straw (2) $170.00 i. Provale Regulating Drinking Cup (2) $88.00 j. Waterpik Classic Water Flosser (2) $98.00 k. Waterpik Classical Jet Refill Tips (6) $55.40 1. Alzheimer's Wandering Motion Alarm $25.00 m Gait Belt with Metal Buckle or Delrin Buckle (2) $12.00 n. Skil-Care Position Plus Cushion $128.00 o. Aquaphor Healing Ointment (2 @ 144 per box) $82.00 p. ChairPro Under Wheelchair Seat Alarm $95.00 q. Aquaphor Healing Ointment (3) $51.27 r. Baza Clear Moisture Ointment Packets 33/case (4) $105.00 S. Baza Cleanse and Protect Perineal Lotion (4) $37.00 t. Kendall SureCare Underpads 1550 (2) $66.00 U. Hartman Reusable Quilted Cotton Birdseye Underpads (3) $42.00 Total $2,436.66 -7- C. Personal Items 31. The Incapacitated Person is in need of personal items, including clothing, outerwear, shoes and accessories. 32. The Incapacitated Person would also benefit from having a compact refrigerator and freezer in her room since she is prone to suffering from dehydration and malnutrition and is lactose intolerant; these appliances would make it possible for Petitioner and nursing home staff to cater to the Incapacitated Person's dietary needs more effectively. 33. The Incapacitated Person would enjoy a television to replace her small, aged television which, due to her poor eyesight, is difficult to view from her bed. 34. The Incapacitated Person would enjoy a CD/tape player on which to listen to her beloved gospel music. 35. The Incapacitated Person would benefit from a photo phone, designed to improve the ability of those with diminished capacity to place phone calls. 36. Approval is sought for the distribution of principal as follows: a. Clothing (clothing, outerwear, accessories) $ 2,000.00 b. Sneakers (Non-skid - 3 pairs @ $100.00 each; $ 300.00 C. Orthopedic Shoes (3 pairs @ $145.00 each; Invoice attached as Exhibit "K") $ 435.00 d. Refrigerator/freezer (nursing home grade with lock, Warranty & Installation; Appliance Connector Estimate attached as Exhibit "L") $ 800.64 e. Television (47 inch with Skype/video capabilities for communicating with distant -8- family; Estimate attached as Exhibit "M") $ 1,179.97 f. CD/Tape Player (Best Buy estimate attached as Exhibit "N") $ 186.00 g. Photo Phone (modified to allow visual clues for placing calls; Patterson Medical Estimate attached as Exhibit "O") $ 121.20 Total $ 5,022.81 D. Purchase of Burial Plot and Establishment of Irrevocable Funeral Reserve 37. Petitioner seeks permission to expend principal for the purchase of a burial plot and marker up to $4,702.00 and the funding of an irrevocable funeral reserve, not to exceed $10,000.00 unless approved by the Dauphin County Assistance Office. Neill Funeral Home estimate of costs attached as Exhibit "P". E. Outstanding Nursing Home Bills 38. Golden Living Center is owed $1,819.21 for services rendered to the Incapacitated Person. A copy of the invoice is attached as Exhibit "Q". 39. This bill accumulated due to the withholding of taxes from Incapacitated Person's pension income, which income was owed to the facility as part of the Incapacitated Person's share as a Medical Assistance patient; federal tax returns have been filed to obtain refunds of the amount withheld. 40. Approval is requested for payment of $1,819.21 to Golden Living Center; upon receipt, the federal income tax refund will be added to the Incapacitated Person's principal. 41. Approval is sought for the payment of $55.00 to the Jewish Home for services rendered since August 2012; Jewish Home Invoice for services is attached as Exhibit "R". -9- F. Reimbursement to Michael Davis 42. Since the Incapacitated Person lacked funds, her son Michael Davis paid $670.00 to duplicate medical records needed to pursue the personal injury litigation referenced in paragraph 10. 4 Approval is requested for payment from principal of $670.00 to Michael Davis as reimbursement for record duplication costs. G. Handicapped Accessible Vehicle 44. Petitioner seeks the transfer of assets to her sufficient to purchase an accessible vehicle. 45. The Incapacitated Person has no vehicle and is dependent on Petitioner and her family for transportation to doctor appointments and to Petitioner's home. 46. The Incapacitated Person derives great joy from excursions outside the facility; she is noticeably more verbal and animated when she is "touring" in the car. 47. Because of Petitioner's disabilities, it is not possible for her to transport her wheelchair-bound mother in Petitioner's non-accessible car; Petitioner must rely on her husband to pick up the Incapacitated Person and lift her and her chair into their car, greatly limiting the opportunity for the Incapacitated Person to leave the nursing home.3 48. The Incapacitated Person, five foot seven inches tall and strong-willed, is difficult to transfer into non-accessible cars; in particular, the need for her to stand as part of the transfer process creates safety concerns for her and those helping her. 3 Petitioner's medical condition results in extreme muscular pain and swelling, especially after a day where she has struggled to assist with transporting the Incapacitated Person in Petitioner's non-accessible sedan, it can take a full day for Petitioner to recover, reducing the time she can spend with her mother. -10- 49. A handicapped accessible vehicle, along with a vehicle transport wheelchair, would enable the Incapacitated Person to leave the facility much more frequently, enjoy the stimulation of being out in the community and visit Petitioner's home with greater ease. 50. Petitioner seeks the transfer of principal to her in the following amounts: a. Handicapped accessible van $ 59,937.30 (Total Mobility Services estimate for a 2012 Honda Odyssey ($59,937.30) is attached as Exhibit "S")4 b. Vehicle transport wheelchair (CME Estimate attached as Exhibit "E") $ 165.00 c. Extended warranty (See itemized expense on Total Mobility Services estimate attached as Exhibit "T") $ 1,035.00 d. Insurance and maintenance $ 1,500.00 TOTAL $ 62,637.305 H. Handicap Accessibility Renovations 51. As stated in paragraph 14 above, Petitioner's home was purchased in order to have a first floor bedroom suite for the Incapacitated Person's use. 52. As stated in paragraph 18 above, the Incapacitated Person reaches her fullest potential, showing glimmers of her former self, when she is at Petitioner's home. 53. As a result of the Incapacitated Person's decline, along with Petitioner's own medical problems, it is not possible for the Incapacitated Person to live with Petitioner full-time. 4 If Petitioner is able to find a quality, lightly used van at a lower price, Petitioner proposes that the savings be applied toward future insurance and maintenance expenses. Attached as Exhibit "U" is an AMS Vans quote for a vehicle Petitioner could currently purchase for $55,175.00, allowing a reserve for insurance and maintenance expenses for next few years. 5 MA regulations would permit the purchase of the vehicle directly by the Incapacitated Person. However, due to the cost of insurance and maintenance, it is proposed that the funds be transferred to Petitioner since regulations also allow transfers of assets to a disabled child. See paragraph 64 below. If the Court does not approve this request, Petitioner alternately requests approval of the purchase of an accessible vehicle by the Incapacitated Person. It should be noted that the cost of a vehicle conversion package alone is $28,880.00. Total Mobility Services estimate attached as Exhibit "T" itemizes this expense, including cost of conversion, step flare, wheelchair restraint and roundtrip transport. (This could be reduced by $1,300.00 ifroundtrip transport is not necessary.) - Il - 54. Particularly if a handicapped-accessible van is available to facilitate transporting the Incapacitated Person, it is Petitioner's goal that the Incapacitated Person will visit Petitioner's home frequently and for extended periods of time. 55. Petitioner seeks the transfer of principal to her in an amount sufficient for making renovations to her home so it is handicap accessible. 56. The bathroom that is part of the Incapacitated Person's bedroom suite and the front entrance to Petitioner's house are in need of remodeling to accommodate a wheelchair. 57. An estimate from Travis Lauchman Remodeling, attached as Exhibit "V", establishes the cost of remodeling the bathroom and building a ramp and accessible entrance to the home per ADA standards at $18,135.00. 58. Petitioner seeks authorization to transfer principal to her in the amount of $18,135.00 to make her home handicap accessible. 1. Principal to Petitioner 59. Petitioner. formerly a successful attorney and law professor who provided financial support for her mother and siblings through most of her adult life is now permanently disabled. 60. Petitioner struggles financially since she is no longer able to work; her husband retired early to care for Petitioner and their combined social security disability and retirement income is not sufficient to hire the full-time personal care aides or purchase the durable medical equipment Petitioner needs to maximize her health, or to cover over $5,000 annually in Unreimbursed medical expenses. 61. Petitioner's financial distress is due in part to the resources she and her husband have spent assisting her mother during the years of her disability, including moving her from -12- California, storing her furniture, paying her life insurance premiums, pursuing appointment as guardian, and providing the Incapacitated Person with clothes and personal items; Petitioner's expenditures have exceeded $22,550 since December, 2005' 62. Approval is sought for the transfer of principal in the amount of $22,550 to Petitioner. J. Distribution of Principal to Disabled Children 63. The receipt of assets such as litigation proceeds by a Medical Assistance recipient can result in a period of ineligibility for MA until the recipient spends down assets paying privately for care or transfers assets in a manner allowed by MA laws and regulations. 64. MA regulations allow a ;VIA applicant to transfer assets to a disabled child or to a trust established solely for the benefit of the disabled child. 6 By way of example, Petitioner and her husband spent $4,004.83 in legal fees relating to the guardianship proceedings in which Petitioner was named plenary guardian of the estate and person of the Incapacitated Person. A copy of the invoice for legal services is attached as Exhibit "W". Petitioner spent $1,650.00 in travel costs to move the Incapacitated Person to Pennsylvania and $864.00 in storage expenses for the Incapacitated Person's belongings incidental to her move to a nursing home. Petitioner has made premium payment for the Incapacitated Person on her three life insurance policies at a combined rate of $83.52 per month since December, 2005. Consistent with the Incapacitated Person's intent in procuring these policies, they were kept in place primarily to have funds available to pay for the Incapacitated Person's funeral. Copies of correspondence from Colonial Penn Life Insurance Company showing premiums are attached hereto as Exhibit "V. Petitioner and her husband paid total premiums in the amount of $6,972.00 for the Incapacitated Person. Petitioner and her husband have supplied the Incapacitated Person with hair, nail and skin care supplies at an average cost of $25.00 per month since December, 2006, totally in excess of $1,800.00. Petitioner and her husband have purchased clothing (coats, boots, shoes, sweat suits, pant suits, skid- free slippers, nightgowns, undershirt camisoles, socks, etc.) at an average cost of $100 per month since December, 2006, totally in excess of $7,200. Petitioner recently paid for the Incapacitated Person's evaluation for dentures in the amount of $55.80. Higgens Family Dentistry bill attached as Exhibit "Y". The items outlined above cost $ 22,546.63. 7Pennsylvania Department of Public Welfare regulations regarding Medical Assistance eligibility provide: (e) An individual will not be ineligible for payment for NFC if: (1) The assets were the resident property and title to the home was transferred to: (ii) The individual's child who is under 21 years of age, or blind or permanently and totally disabled as determined under § 140.81 (relating to deductions from earned income), or is blind or disabled based on SSI criteria as specified in 42 U.S.C.A. § 1382c(a)(3). - 13 - 65. The Incapacitated Person can transfer her assets to her disabled children while continuing to be eligible for MA benefits, receiving the same nursing home care that she would receive as a private pay patient. 66. Petitioner requests that, i n the exercise of its judgment for that of the Incapacitated Person and consistent with the Incapacitated Person's lifetime giving pattern, the Court authorize the transfer of assets to her disabled children as outlined he~rein.8 67. The Incapacitated Person has a lifetime pattern of generously sharing her assets with her adult children when they are in need. 68. Petitioner seeks permission to transfer funds to Special Needs Pooled Trusts for the sole benefit of Carolyn A. Henderson, 9 age 62, and Elsie L. Baker, 10 age 61, and Petitioner (2) The assets were transferred to one of the following: (iii) The individual's child described in paragraph (1) (ii), or to a trust, including one described in § 178.70, established solely for the benefit of the individual's child. 55 Pa. Code § I78.104(e), emphasis added. The Department of Public Welfare regulation restates federal law found at 42 U.S.C.S. §1396p(c)(2)(B)(iii)(2). 8 Section 5536 (B) of Pennsylvania's guardianship statute authorizes the Court to substitute its judgment for that of an incapacitated person with respect to making gifts, outright or in trust, of the Incapacitated Person's property. 20 Pa. C.S.A. §5536(b)(1). The statute provides: in rile exercise of its jud-nnent for that of the Incapacitated Person, the court, first being satisfied that assets exist which are not required for the maintenance, support and well-being of the incapacitated Person, may adopt a plan of gifts which results in minimizing current or prospective taxes, or which carries out a lifetime giving pattern. The court in exercising its judgment shall consider the testamentary and inter vivos intentions of the Incapacitated Person insofar as they can be ascertained. 20 Pa. C.S.A. §5536(b)(1). The Incapacitated Person is a Medical Assistance (MA) recipient with advanced dementia who will continue to require care in a nursing facility; as long as the Incapacitated Person remains eligible for Medical Assistance. her maintenance, support and well-being are secure. 9 Carolyn, who lives in California, suffers from a debilitating case of Fibromyalgia and is currently being treated a second time for breast cancer. 10 Elsie, who lives in California, has suffered two major strokes. -14- Gloria J. Banks,' 1 age 50, the Incapacitated Person's disabled children as that term is defined by the Social Security Administration. 69. Carolyn and Elsie do not own reliable vehicles and they are dependent on modest social security disability or SSI benefits; all three of the Incapacitated Person's disabled daughters have unmet needs. 70. If she had capacity, it is averred that the Incapacitated Person would transfer assets to trusts for the benefit of her three disabled children because: a. the transfer does not jeopardize her MA benefits or the care she receives; b. she has a history of helping her children financially; C. Based on her history of supporting her children to the best of her ability, it is believed that the Incapacitated Person's intention - as with most parents - would be to transfer her assets to her disabled children who are in financial need; these assets will otherwise be depleted in less than one year paying for the same care which she is already receiving as a Medical Assistance recipient. 71. Approval is sought for the distribution of the Incapacitated Person's principal remaining after all other distributions approved by the Court pursuant to this Petition have been made to Special Needs Pooled Trusts for the sole benefit of Carolyn L. Henderson and Elsie L. Baker and Gloria J. Banks; provided, $8,000 shall be retained in the Incapacitated Person's account, representing the maximum amount the Incapacitated Person may have in order to remain eligible for Medical Assistance. 72. It is requested that principal available for distribution to trusts for the benefit of the Incapacitated Person's children be distributed to three separate trust as follows: twenty-five (25%) per cent in trust for the benefit of Carolyn L. Henderson and twenty-five (25%) per cent in " Petitioner suffers from Neurosarcoidosis and Pulmonary Sarcoidosis, as well as Fibromyalgia, as outlined in footnote 1 above. -15- trust for the benefit of Elsie L Baker and fifty (50%) percent in trust for the benefit of Gloria J. Banks. 73. Upon Court approval of all distributions requested herein, the amount of principal available to fund each special needs trust for the benefit of Carolyn L. Henderson and Elsie L Baker is estimated to be $14,636.00; approximately $29,273.00 would be available to fund the trust for Gloria J. Banks. 74. Petitioner has sought a greater share for herself than for her sisters, after consultation with her sisters to address their needs, because it is believed this is what the Incapacitated Person would do based on Petitioner's pressing financial and medical needs over her life expectancy, her significant and on-going responsibility for managing the Incapacitated Person's care and the need for Petitioner to maximize her health in order to continue caring for her mother. 12 75. While all of the Incapacitated Person's children have a loving relationship with her and maintain contact with her, Petitioner has provided ongoing primary financial support, constant care, companionship and advocacy to the Incapacitated Person as Petitioner herself has struggled financially and physically. 76. In a very real sense, amounts transferred to a trust for the benefit of Petitioner will improve Petitioner's health, allowing her to best serve the Incapacitated Person, to whom she is devoted despite her own debilitating illness. 13 12 As the significantly younger sibling, Petitioner has a much longer life expectancy over which she will have needs relative to her disability. Petitioner also will continue to assume greater responsibility for her mother since she lives just a few miles from her mother while her disabled sisters live in California. 13 By way of example, Petitioner, who currently is provided personal care aides forty hours per week, could purchase additional hours of assistance. (Eight additional hours of care per week over her mother's life expectancy (8.31) years would cost $65,682.00.) This assistance, along with the accessible van will make it possible for Petitioner to take the Incapacitated Person out of the nursing home more frequently. Among other things, Petitioner will not have to depend on the availability of other family members to assist with the transfer of the Incapacitated -16- i. Consent 77. Counsel for the Department of Public Welfare, Lisa A. Dees, Esquire, does not object to the transfer of assets of the Incapacitated Person to her disabled children; the transfer does not jeopardize the Medical Assistance benefits for the Incapacitated Person currently receives. 78. The Consent of Petitioner Gloria Banks is attached hereto as Exhibit "Z"; notice has been sent to the Incapacitated Person's other children contemporaneously with the service of this Petition. K. Legal Fees 79. Petitioner seeks permission to invade principal to pay for legal fees for services rendered on the Incapacitated Person's behalf. 80. Legal services provided by SkarlatosZonarich, LLC have included a. counsel regarding nursing home placement and Medical Assistance eligibility; b. counsel regarding and preparation of guardianship reports; C. counsel regarding and preparation of income tax returns for the Incapacitated Person; d. Preparation of Motion for Court Approval of Settlement and Petition for Allowance for Distribution of Principal; e. Medical Assistance planning and discussion with the Department of Public Welfare regarding MA planning; 81. Legal fees are $20,410.00; costs are $247.15. The invoice for services, redacted as necessary for confidentiality, is attached as Exhibit "AA". Person. Petitioner also has durable medical equipment needs of $6,000.00 (treadmill, exercise bike and electric scooter) and annual unreimbursed medical expenses in excess of $5,000.00. -17- 82. Additional legal fees in the amount of $795.00 were incurred by Petitioner for consultation with the law firm that handled the Incapacitated Person's guardianship petition. The invoice for services, payable to Rhoads & Sinon, LLP, redacted for confidentiality, is attached as Exhibit "BB". L. Miscellaneous Monthly Expenses 83. Petitioner seeks approval to spend up to $125.00 per month from the Incapacitated Person's principal for miscellaneous expenses such as restaurant visits, birthday cards for family and incidental personal expenses. WHEREFORE, Petitioner respectfully requests this Court authorize Petitioner to distribute the Incapacitated Person's principal as described herein pursuant to the attached proposed Order. Respectfully submitted, SKARLATOSZONARICH LLC Dated: January 15, 2013 By: 41denificationn Zonarich, Esquire No. 79989 Elizabeth B. Place Identification No. 44682 Skarlatos & Zonarich Building 17 South Second Street, 6th Floor Harrisburg, Pennsylvania 17101 Telephone (717) 233 - 1000 Facsimile: (717) 233 - 6740 Emall.jbz@skarlatoszonarich.com ebp@skarlatoszonarich.com Attorneys for Petitioner -18- VERIFICATION I, Gloria J. Banks, am the Petitioner in this action and hereby verify that the statements made in the foregoing PETITION FOR ALLOWANCE OF DISTRIBUTION OF PRINCIPAL are true and correct to the best of my knowledge, information and belief. I understand that the statements in said Petition are made subject to the penalties of 18 Pa.C.S.A. §4904 relating to unsworn falsification to authorities. Dated: 3 Gloria J. B #1s, Petitioner EXHIBIT A IN RE: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA INEZ H. DAVIS, ORPHANS' COURT DIVISION An Alleged Incapacitated Person 21-07-0200 IN RE: PETITION TO ADJUDICATE PERSON AS INCAPACITATED AND., APPOINT GUARDIAN OF THE PERSON/ESTATE BEFORE OLER, J. ORDER Of COURT .-71 AND NOW, this 12th day of April, 20Q ,-`upon. F'V consideration of the Petition To Adjudicate Person As Incapacitated and Appoint Guardian of the Person/Estate with Respect to Inez H. Davis, and following a hearing, at which the presence of the allegedly incapacitated person was excused pursuant to an affidavit from her physician indicating that her presence would be harmful to her health, and for the reasons stated in!the accompanying opinion, Inez H. Davis is adjudicated an incapacitated person, and .her daughter, Gloria Joan Davis Banks, Esquire, is appointed permanent plenary guardian ofher estate and person. The guardian shall timely file with the Court all reports and accounts required by statute. No bond shall be required of the guardian-. Inez H. Davis is hereby notified of her right to petition at any time for amodification or termination of the guardianship provisions contained in this order. 1. The allegedly incapacitated person is Inez H. Davis, a domiciliary of Cumberland County, Pennsylvania, born June 1, 19301, and residing at the.Golden Living Center, 770 Popular Church Road, Camp Hill, Cumberland County, Pennsylvania, 17011. 2. Petitioner is Gloria Joan Davis Banks, Esquire, an adult individual, an attorney and a professor at Weidner Law School who resides at 5776 Catherine Court, Harrisburg, Dauphin County, Pennsylvania, 17112; Professer Banks is the daughter of Inez H. Davis_ 3. Inez H. Davis, the allegedly incapacitated person, suffers from a condition known as Alzheimer's Disease, which displayed its onset in 2004. 4. Ms. Davis's condition has deteriorated to the paint that her ability to receive and evaluate information effectively and communicate decisions is impaired to such a significant extent that she is totally unable to manage her financial resources and totally unable to meet essential requirements for her physical health and safety. 5. Unfortunately, at the present time the prognosis for improvement with respect to Ms. Davis's mental condition is not promising. 6. The estate of the allegedly incapacitated person is minimal in nature. 7. The allegedly incapacitated person is in need of a plenary guardian of her person and estate. 8. The duration of the necessary guardianships must be considered at best indefinite and for practical purposes permanent. 9. Gloria Joan Davis Banks, Esquire, the daughter of Inez H. Davis, is a person qualified to serve as guardian of her person and estate under 20 Pa. C.S. Section 5511(f). 10. The foregoing Findings of Fact are made on the basis of clear and convincing evidence. DISCUSSION The provisions respecting an adjudication of incapacity are contained in 20 Pa. C.S. Section 5570 et. seq. The Petitioner has substantially complied with these provisions, and based upon the foregoing Findings of Fact the following Order of Court will be entered: ORDER OF COURT AND NOW, this 12th day of April, 2007, upon consideration of the Petition To Adjudicate Person As Incapacitated and Appoint Guardian of the Person/Estate with Respect to Inez H. Davis, and following a hearing at which the presence of the allegedly incapacitated person was excused pursuant to an affidavit from her physician indicating that her presence would be harmful to her health, and for the reasons stated in the accompanying opinion, Inez H. Davis is adjudicated an incapacitated person, and her daughter, Gloria loan Davis Banks, Esquire, is appointed permanent plenary guardian of her estate and person. The guardian shall timely file.with the Court all reports and accounts required by statute. No bond shall be required of the guardian. Inez H. Davis is hereby notified of her right to petition at any time for a modification or termination of the guardianship provisions contained in this order. Any existing general Power of Attorney executed by the incapacitated person is hereby specifically revoked and rendered null and void. By the Court, /s/ J. Wesley Oler, Jr., J. J. Wesley Oler, Jr., J. David K. Kruft, Esquire One South Market Square P.O. Box 1146 Harrisburg, PA 17108-1146 For Petitioner Inez H. Davis C/o Golden Living Center 770 Poplar Church Road Camp Hill, PA 17011 :mae Any existing general Power of Attorney executed by the incapacitated person is hereby specifically revoked and rendered null and void. By the Court, J. s gey 0 J_ David K. Kruft, Esquire 0 South Market Square .0. Box 1146 Harrisburg, PA 17108-1146 For Petitioner Inez H. Davis C/o Golden Living Center 770 Poplar Church Road Camp Hill, PA 17011 :mae INVOICE BELTONE HEARING CENTERS 5405 JONESTOWN RD. SUITE 109 HARRI SBURG, PA 17112 (717) 540-4355 (717) 540- 1535 SHIP TO: GLORIA BANKS 5776 CATHERINE STREET HARRISBURG PA 17112 BILL TO: GLORIA BANKS 5776 CATHERINE STREET HARRISBURG PA 17112 Consultant Date of order: 10/8/2012 Payment terms: Due Upon recie t Date order shi d: Method of shipment FOB int. 5405 Jonestown Rd. Hb PA Invoice number. Invoice date: 10/8/2012 Order number. ITEM NO. QTY. DESCRIPTION PRICE EACH AMOUNT 1 BELTONE TRUE 17 78D 3,845.00 7,690.00 10 CASE Beltone Batteries 45.00 450.00 2 REPAIRS 349.00 698.00 5 OTOCLIPS 35.00 175.00 5 SANITIZERS 10.00 50.00 5 EARGENE 4.00 20.00 MICHAEL D. MURPHY BC-HIS Sub total: 9,083.00 Tax rate: Tax: Shipping & handling: Previous amount owing: Credit: You pay this amount: 9,083.00 EXHIBIT C Higgins Family Dentistry 'Dr. Eric J. Higgins PRIMARY TREATMENT PLAN Dr. Edward S. Geyer 4010 Linglestown Rd November 8, 2012 Harrisburg, PA 17112 (717)657-2230 x Page 1 Current Dental Terminology (CDT) © American Dental Association (ADA). All rights reserved. Prepared for: Inez Davis (ID: 464701) Group Planned Code Dr T Surf. Description Patient Insurance Total Accepted 1 11/08/12 5213.00 6 Maxillary Partial Denture - Ca 1,300.00 0.00 1,300.00 No 1 11/08/12 5214.00 6 Mandibular Partial Denture - ( 1,300.00 0.00 1,300.00 No 1 11/08/12 65.01 6 Sonicare W Sanitizer 137.00 137.00 No 1 11/08/12 330.00 6 Panoramic Film 79.00 0.00 79.00 No TOTALS: 2,816.00 0.00 2,816.00 E F 0 P 6 9 24 25 D G N Q 7 10 23 26 6 11 22 27 C H M R B UPPER I L LOWER S 4 5 UPPER 1 13 20 1 LOWER 229 A J K T 3 14 19, 30 RIGHT LEFT LEFT RIGHT 2 15 1831 1 16 17 32 RIGHT LEFT LEFT RIGHT Financial Arrangements Additional Information on Financial Arrangements and Insurance Coverage Available Upon Request Patient Signature: Date: I REQUEST AND AUTHORIZE THE DOCTOR AND/OR SUCH QUALIFIED ASSIGNEES TO PERFORM THE DENTAL WORK LISTED ABOVE. i Joint commission on Accreditation of Healthcare Organisations CENTRAL MEDICAL EQUIPMENT CO. QUOTE TO: INEZ DAVIS RE: CUSTOM WHEELCHAIR INVACARE SOLARA 3G TILT WHEELCHAIR PURPLE BACKREST, HEADREST, CUSHION CALF SUPPORTS PER SPECS DISCUSSED AT EVAL MSRP.......................$7,277.Your price .(A deposit of 1/2 down and 1/2 at delivery is required. Once the order is placed there is a 30% restocking fee if cancelled.) j j I r /e, 1l ~ Mark Nice, ATP, CRTS DATE CENTRAL MEDICAL *PRICES ARE GOOD FOR 60 DAYS. 35 Sarhelm Road • Harrisburg, PA 17112 • (717) 657-2100 • Fax (717) 657-2176 524 Greenbriar Road • York, PA 17404 • (717) 764-8300 • Fax (717) 764-8383 1397 Arcadia Road • Lancaster, PA 17601 • (717) 390-2700 • Fax (717) 390-2724 Toll Free: 1-800-845-4204 Web site: www.centralmedicalpa.com EXIIIBIT E Joint Commission on Accreditation of Healthcare Organizations CENTRAL MEDICAL EQUIPMENT CO. OCTOBER 15 2012, RE: QUOTE: INEZ DAVIS SEAT LIFT CHAIR PURCHASE To whom it may concern, The purpose of this letter is to provide you with a quote for a 2 SEAT LIFT CHAIRS and 1 transport chair as you requested. Large Relaxer in Brisa fabric $2,144.00 Cloud with maxi comfort with standard fabric with fabric protection $1,490.00 Vehicle Transport Wheelchair $165.00 Standard Wheelchair for multiple uses $800.00 2 Gel Cushion $370.00 1 12" Bed Wedge $35.00 1 Cervical Roll $17.00 The patients out of pocket expense will be $5,021.00. As always payment is expected prior to delivery. Upon receipt of your check in the amount of $5,021 and fabric protection. 00, we will contact you regarding delivery. Thank you for contacting Central Medical Equipment and should you have any questions, please feel free to contact us at 717-657-2100 Sincerely, Mitzi Spizzirri Customer Service Rep 35 Sarhelm Road • Harrisburg, PA 17112 • (717) 657-2100 • Fax (717) 657-2176 { 524 Greenbriar Road • York, PA 17404 • (717) 764-8300 • Fax (717) 764-8383 1397 Arcadia Road • Lancaster, PA 17601 • (717) 390-2700 • Fax (717) 390-2724 Toll Free: 1-800-845-4204 Web site: www.centralmedicalpa.com CON MILT No. 40 3 5 7 ' Whitco Home Furnishings INVOICE • Carpeting & Floor Covering Commercial Carpet Tiles Custom Draperies • Furniture • Office Furniture DATE 5010 Linglestown Road • Harrisburg, PA 17112 • (717) 652-5577 • Fax (71.7) 545-0783 *.f' www.WhitcoHomeFurnishings.com ,SALESMAN #PA040006 INSTALLER PURCHASER a a' n t = , DIRECTIONS ADDRESS %r pr , r OWICE PHONE TYPES OF PADDING TAPE` [IEMtNi"fAC.Ki.M JBFAMILY L.R. D.R. FOYER STAIRS HALLS CLOSETS BEDROOMS BATH KITCHEN W/W R DN UP OCCUPIED VACANT LIFT - TACKLESS PAD & TACK WOOD CONCRETEI NO. OF UPHOLSTER WASTE C.O.D. OTHER QUARTER ROUND NO. OF YDS. DOWN LESS DOWN CAP STEPS STEPS RET LEAVE TAKE LEAVE UP DOWN WORKROOM INFORMATION TOTAL a -00 - ia,, L-7 cM TOTAL SALES SALES TAX TOTAL AMOUNT DEPOSITED WITH ORDER TERMS & CONDITIONS ON REVERSE SIDE - •D , • COD Service charge 114% all be added to accounts over terms listed. This is the equivalent of 18% per annum. Customer's Signature . CUSTOMER Patterson Medical - Exercise Equipment Page 1 of 1 custlxnr SW." a BirwichRalp Locator PAT ERSON CAU" Request MEDICAL Go to PM Canada U rt• ~,1~+f1~lSa't11~1' 4~iir/tOl9HllIPC tn.~ltfCl~t` _.:M'fA0b11!l~li90K '~MWM1lylfdC~i~►' 3MIILl► -•y00M1AtfT Exercise Equipment Product Search: Home > Exercise Eoufpmenb Cardio Eouipmenb Bikes> Active Passive PRO eyword, Product or Mfr. # e© Browse Next > Active Passive PRO ryp: t Provides upper and lower body therapeutic exercise for geriatric and post-acute patients. The bi- directional Passive Range-of-Motion phase allows users with a lack of strength or coordination or .REGISTRATION HELP tY cardiopulmonary or orthopedic limitations the ability to exercise. The Active Resistance phase enables patients to progress beyond their original lower functional level to exercise at a higher functional level. Measures 28"W x 34"L x 42'H. ``°9`illlll Other features include: ■ 4-color touch screen provides biofeedback which facilitates patient participation Aids to Daly Living ■ Television screen helps reduce the rate of perceived exertion by providing entertainment Bath and Toileting IAAdditional Images ■ Bilateral readout gives biofeedback to exerciser to balance muscle strength ■ Integrated Spasticity Management System CPM ■ Voice activated Start, Stop, and Spasm control Dining Evaluation AP Pro Sell Sheet AP Pro Use Manual Exercise Equipment O Email this Product Mobility Products Accessories Related Products Modalities Item Qty Description Price Orthopedics More Info $7575.00 564088 1 Active Passive PRO Pediatrics Inventory Status: In Stock *ipi Rehab Supplies 566186 0 Upper Body Exerciser More Info $5550.00 Sensory Motor Inventory Status: Drop Ship - Ships from factory in approx 14 days Splinting Tourniquet and Cuff 566187 0 Lower Body Exerciser More info $5550.00 Treatment Furniture Inventory Status: Drop Ship - Ships from factory in approx 14 days Wheelchair 565439 Optional Vicore Seat More Info $494.95 Wound & Scar Care Inventory Status: Discontinued 565440 0 Auto Wheelchair Tethers - Retrofit for Active Passive Pro More Info $196.90 About Patterson Medical Inventory Status: Drop Ship - Ships from factory in approx 14 days Career Openings Platinum Partners E-Literature Pediatric Manuals Pediatric Order Forms To add an item: enter qty. and choose Add To Cart Workshops HCPCS Search it Latex Wanting Hygiene Product I soi Additional Shipping Charges Bariatric Rated © Hazmat c tt cs Searc~ J QUICK ORDER MY SUPPLY LIST MY ACCOUNT MY ORDER MY ADDRESS BOOK SHOPPING CART HELP CONTACT Privacy Policy Site Security Copynghtf` 2817 Patterson Medical Holdings, Inc. hap://www.pattersomnedical.com/app.aspx?cmd=getProduct&key=IF_92894 1/10/2013 EXHIBIT 11 If you have any questions please contact customer support at: 1-800-323-5547 or Email at: CustomerSupport@pattersonmedical.com Coding Healthcare Common Procedure Code) These are suggested codes only. Patterson Medical cannot guarantee they are the most currer code. You should consult your coding guidelines for further recommendations. r Item QtyQescriptionPrice Extended Price Original Carrot Blue, One size, Case of 6 $193.90 $775.60 Inventory Status: In Stock HCPCS Code: A9270 Subtotal:$775.60 Apply Promotion Code Here i . 44 1 'i"Ut What is a Promotional Code? '0 Shipping Charges -Continue Shopping Note: - If you have a linked Online Account and your applicable terms and pricing are not displaying p - If your account has been linked to an incorrect account number contact Site Support. -J- Latex Warning I Hygiene Product I Additional Shipping Charges I Bariatric Rated I Hazmat EXHIBIT I Patterson Medical - Wheelchair Page 1 of 1 Customer Service m " 7'' C BrancbdRep Locator ci PA; + ERON Catalog Request .2 MEDICAL. Go to PM Canada 1- 8OUICKORDEF . I MY SUPPLY UST I f J UY ACCOUNT I C=J MY ORDER MY ADDRESS BOOK ( SHOPPING CART I HELP I -j CONTACT Wheelchair Product Search: Home>V.'hel::halr>Wl:eeldiair T7avs>Padae<I>6-1'o y.•<sn:c itir:~:iatie~;'Pra~. Byword, Product or Mfr. # Q Pry>wous j Browse JNext > ,~qr Gel-Top Sensory Stimulation Tray Clear vinyl surface shows tiny stars that move through midnight-blue water-based gel. Velcro® strips .FORGOT YOUR PASSWORD - ^t- secure tray to armrest pads, (included which cushion sensitive elbows when the tray is not in use) Fits REGISTRATION HELP 16"- 18" standard arm wheelchairs. Sensory stimulator gel pad provides stimulation and decreases restlessness. Measures 7"W x 16"L. r Sensow Gel ensorv Sti iT S~Imulatot i r_z In truch~r•5 . Aids to Daily Livin Pad g-_- c - Instructors Bath and Toileting !,.Additional Irraaes CPM p~ ( Dining SHL iJ F rcaatsxrrr~rcxlosa Evaluation Exercise Equipment ED Email this Produoi . Mobility Modalities ?tc? ;bt Disc, Orthopedics 562208 1 Lift-Away Tray h5o_:; InPq $132.30 Pediatrics Inventory Status: In Stock Rehab Supplies 562557 1 Sensory Stim Gel Pad More Info $44.40 Sensory Motor Inventory Status: In Stock Splinting _ 563338 0 Tray with Strap Moreno $10&05 Tourniquet and Cuff Inventory Status: In Stock Treatment Furniture Wheelchair Wound & Scar Care To add an item: enter qty. and choose Add To Cart Abort Patterson bivdirat „Latex N.tarnino ,y.;,3 tl ~crene Prcduc_ Additional Shipping Charogs 6 f.atnc, Rated lla,mat Platinum Partners E-Literature - Pediatric Hanuais Pediatric Order Forms Workshops HCPCS S-ch con eiltor Cross Search Islil®BI~VIItlY~ QUICK ORDER MY SUPPLY LIST' MY ACCOUN'T' MY ORDER MY ADDRESS BOOK SHOPPING CART tiEL.l> CONTACT Privacy Policy Sire Security Co{:yrigho":201$ Panerson t":@11C,di FIQI]inr;s. In http://pattersonmedical.com/app.aspx?cmd=getProduct&key=IF_921016119 1/8/2013 EXHIBIT J Cart Items Qty Item Price Item Total Subtotal: $1,062.76 Shipping (Free Shipping): $0.00 Grand Total: $1,062.76 Lighted Nail Clipper with Magnifier 1 $7.79 $7.79 Bionix Safe Straw 2 $85.00 $170.00 Waterpik Classic Water Flosser 2 $49.00 $98.00 s, . Alzheimer's Wandering Motion Alarm 1 $25.00 $25.00 Gait Belt with Metal Buckle or Delrin Buckle 2 $6.10 $12.20 r f. Skil-Care Position Plus Cushion 1 $128.00 $128.00 5 P " Aquaphor Healing Ointment Packets 144/Box 2 $41.00 $82.00 Cart Items Qty Item Price Item Total Provale Regulating Drinking Cup 2 $44.00 $88.00 F' Cart Items Qty Item Price Item Total ChairPro Under Wheelchair Seat Alarm 1 $95.00 $95.00 Aquaphor Healing Ointment 3 $17.09 $51.27 Waterpik Classic ]et Refill Tips 6 $9.25 $55.50 Baza Clear Moisture Barrier Ointment 4 gram 1 $105.00 $105.00 Packets 300/Case Baza Cleanse and Protect Perineal Lotion 8 oz 4 $9.25 $37.00 (237 ml.) Kendall SureCare Underpads 1550 (Extra 2 $33.00 $66.00 Large) Hartman Reusable Quilted Cotton Birdseye 3 $14.00 $42.00 Underpads El XHIBIT K new balance BIRKENSTO[K HARRISBURG ~ac..M.,~•s.rd...:,..mt RHoffner Colonial Park Mall AssiNeN eral Managr Rt. 22 & Colonial Road e Manager H arrisburg, PA 17109 rob@newbalancehanrsburg.com PH: 717.671.0970 www.NewBalanceHanisburg.com FX: 717.67 1 .0973 KIDS ~y SHOE FLY 1q SHOE FLY new balance BIRKENSTOCK HARRISBURG °``J`"~•'•rd'"'°°^° fns Rob Hoffner Colonial Park Mall Assistant General Manager Rt. 22 & Colonial Road Harrisburg, PA 17109 New Balance Manager rob@aewbelanceharr(sburg.com PH: 717.671.0970 www.NewBalanceHarrisburg.com FX: 717.671.0973 KIDS ~~U1119'S SHOE FLY SHOE FLY z My Cart AppliancesConnection.com Page 1 of 2 Hello. Sign In View your cart for extra savings. The more you buy, the more you save. Start here. I 2 items Frr s ~n,~,ayyyy t • - r= Call. Search f ~Y?!r t 800-299-9470 teed Help? Advanced Search I Financing I Wish List 18 Log In I Order Tracking Laundry Refrigeration I Cooking ! Dishwashers Air Conditioning Outdoor Living Plumbing Furniture More Brands FShopvvithConfidence ----.....--'-'--._.....r___...._.__ ......................._........._..................._......_.............._...._.................._.....................__...._..............................._.........__......_.........................................................................................................................J' _ Shopping on Shopping Cott AppliancesConnection ,t is safe & secure f Conear~ s;; Guaranteed! I You'll pay nothing if . unauthorized charges are made Product Name Price Qty Total to your credit card as a result of shopping at AppliancesConnection. Consumer Protection Service LGAP51000 5 Year On-Site Major Appliance Warranty Under $1000 1 Ir~ TRUSTe' $99.99 Update $99.99 - - Summit CT66LSST6 x 3 Remove Sgmmrt CT66L55T6 CT66LSST6 24" 5.1 cu. ft. Compact Refrigerator with Adjustable Glass Shelves, Zero Degree Freezer, Factory Installed Lock, Cycle Defrost: Stainless Steel VNorton " . Free In-Home Delivery on Orders ever $99.99 In,H:me White Glove vpry St%aal q`fer ■ Save Cn H A s ay4uy0,K $675.65 Update $675.65 ! ~sTe + n Protect Your Product With Extended Nationwide Warranty: Remove Select Optional Extended Warranty All information is encrypted and transmitted without risk using a Secure Sockets Layer (SSL) Removal Of 1 Appliance: $39.99 c protocol Installation of Refrigerator - Excludes Built-In Units: $99.99 Appliance Financing Add Express Trucking Delivery for 569.99 pu, Financing From 6 To 18 Months Shipping Calculator ship to camp Hill, PA: promo Code Q: r* - Ground: FREE Subtotal: $775.64 Zip Code: 17011 In-Home Delivery: FREE It11 1'+"t ' } ry' ~ Shipping: $25.00 tit i ~ al7tj Camp Hill PA In-Home White Glove: $25.00 Sales Tax: $0.00 ter lRl~i.7 4'[~I rMore Detailsl Total Price: $800.64 r [More Info] It's an easy, secure way to make everyday purchases or to finance ® REWARDS projects and large purchases. You Earn 774 Points with this Purchase. Click here for details. Builder Pricing <Con - Stgppmp d iY « " TI ■I~ Benefits Government discount n Wholesale discounts Em.rt Cart n Volume rebates or n Large inventories 4 Save My Cart cheek aat paypal ll The safer, easier way to palA specialized commercial sales team in each of our markets will cater to - t:r - your needs before and after the sale. Guu Ile _Rewards Program Earn More, Save More. » It's Free to join! n Earn Points for shopping. » Use points for money off. n Earn badges. .u1,7.J Every 100 points is redeemable for $1 towards a future qualifying purchase'. paypa! Get 6 Months to pay on S99+ ,zk cur. wz: t, pay Pal Me Latef http://www.appliancesconnection.com/cart.html 1/11/2013 My Cart ( AppliancesConnection.com Page 2 of 2 Email Deal Alerts Customer Support Resources Convenience: Features Company Information HO `DAv Sign up fOf great deals My Account Bulk/Contractor Sales Wishlist About Us LI I ~A' and special offers this Order Status Site Map Bookmark Us Contact Us &E holiday season. Return Polity Affiliates Account Login Payment Options Help Brand Stores Rebate Center Store Hours Enter Email Address Privacy Policy Specialty Pages Deals and Coupons Why Buy From us _ Frequently Asked Questions Follow us on: t: You Rebate Feed :New Product Feed Norton } 1'`1TRUSTe. STELLA TESTED OA1LY 11-f>=7{ . Service Shop~Maniao5iC337it1t © 2000-2013 AppliancesConnection.com http://www.appliancesconnection.com/cart.html 1/11/2013 12/28/2012 15:44 7175411187 FEDEX OFFICE PAGE 02/07 HOME THEATER EXPERIENCE WORKSHEET CONTACT INFO Customer Name;...... Contact Info: Date: Sales Consultant: Store Phone; Store Location: Have you seen or researched anything that interests you? What is most important to you; picture quality, size, aesthetics, Internet capability or 3D?,. Where is the TV going (e,g„ living room, bedroom)? Will the TV be mounted on a wall or placed on a stand? How will you get HD content (Cable, Satellite, Antenna, Internet streaming)? How do you plan to listen to your TV? EXISTING EQUIPMENT NOTES 1 RE OMMENDATIONS BLU-RAY/SET-TOP BOX SOUND U q r 7( 10k -P A0 e uggestio ^f oound bar, 2.1 urrou d S und, 11TI9, Com Went ACCESSORIES VIDEO SERVICE INTERNET PROVIDER/SPE fZ0 L? S Suggestions: Suggestions; Suggestions: HDMI'", Remote Control, Mounts, Rurniiion., Direc'fV, Cable Cable/D51. Surg? Protnctor, Screen Cleaner 10Mbps per user ESTIMATED PRICE BUYING POWER PERFECT Prices & Offers valid from: (beforetsx) + REWARDS MATCH 0 Financing PROMISE_ IV- $ ❑ Reward ZoneO to Received Time°1Dec, 28 a'2012'~~ 3:44°M"No 429P1PRQMISE"r"-omduroivkim(HNYSokainns,inc. . . ............:...n...:...:.,. 201-0273801 %110 PERFECT HOME THEATER EXPERIENCE WORKSHEET MATCH Name Address Phone Date w z ~rr, Pecs _ a S ~ aF t + ■ , lii ' ~ ~J t cY rJ~ :,y `~}1 {~~j contact Mlle it 3 `1 3 2-14 Name Employee # Phone Store - • Have you seen or researched anything that interests you? • What is most important to you: picture quality, size, internet capability or 3D? • Where is the TV going (e.g., living room, bedroom)? • Will the TV be mounted on a wall or placed on a stand? • How will you get HD content? • How do you plan to listen to your TV? TV Usag tWhat`s Mist hMae a 'io Yau r r Picture Quality Smart Connectivity 3D Size Display Type ❑ Smart Apps ® Instant Entertainment ❑ Wire (Ethernet) ❑ Active Diagonal ❑ LCD ❑ LED ❑ Plasma Refresh Rate ❑ Smart Web ® Web Browser ❑ Wireless (Wi-Fi) ❑ Passive Height ❑ 60Hz ❑ 120Hz ❑ 240Hz ❑ 600Hz ❑ Smart Search Multimedia Search ❑ Ethernet over Power Width B ist~nq; quipTen Ndtes, -5 JAI, Y+, R k nmendatian ound ecommendation TY Rece t en tiori Blu-ra 0~2 _ Suggestions: Suggestions: Wired, Wireless, 31), Smart Soundbar, 2.1 Surround Sound, HTIB, Component Recorinddtessaries' Reco~mnenddyCoraectins r~Rcorimehdeci iint: Suggestions: HDMI", Remote Control, Mounts, Suggestions: Suggestions: Furniture, Surge Protector, Screen Cleaner DireciV, Cable, High-Speed Internet CinemaNow w ~ B ly g Pdwer Re~uu T prr a x a V1 ❑ Financing Reward Zone" $ Prices & Offers valid from to © 2011 BBY Solutions, Inc NI laghts Reserved. 201-XXXXXXX Patterson Medical - Aids to Daily Living Page 1 of 1 Customer Sorwico tS PATTERSON Wanctt,'Rep Locator 3 M E D I C A L Catalog Request a Go to PM Canada _rT■ QUIC K OR DE R,, --~•-MY SUPPLY List-L>j MYACCOUNT 2WYORDER ~ W ADDRESS DOCK ~ SHOPPING CART ~ ?HELP I z-CONTACT Product Search: Aids to Daily Living Home > Aid, to DaiN l.+'.inn,> Hume F• re-or':e<> -eleplrones> Fhp*,o Fho!rvi- eyword, Product or Mfr. It Previous I Browse Next > ~!g!lwlww■~~!~ Photo Phone f ;ifs t'fil J a #AF '.;f,Ia1_ Enables individuals with cognitive deficits or functional hand problems to dial the nine most commonly -FORGOT YOUR PASSWORD called phone numbers by pressing a "photo memory"button. Photo buttons are 314"H x VW. An 4REGISTRArION HELP adjustable amplifier makes calls 10 times (20+ dB) louder,and an adjustable loud ringer and bright flash q, ft? announces incoming calls. Includes a hearing aid,T-coil compatible handset, radial, hold and flash buttons. Large,easy-toread buttons make dialing easy. Latex free. Aids to Daily Living ~ Bath and Toileting 1Additional Images «i. CPM Dining 71 Emaii INS Proauct Products .,dialed Products Evaluation Stmt Qty Descrp ion Price Exercise Equipment No items were added to the cart. Make sure the correct quantity was entered and iry again. Mobility 920386 0 Photo Phone More In $121.20 Modalities Inventory Status: Backordered - Inventory expected in 2 davs Orthopedics Pediatrics Rehab Supplies To add an item: enter qty. and choose Add To Cart Sensory Motor Splinting .aw Latex Warnino Additional Shi •~i~Ch-roes De a.L_io Rated j He mat Tourniquet and Cuff Treatment Furniture Wheelchair Wound & Scar Care ri r Aboal P.0wi, t htadioal Can!ar Opaaings Mafinom P.M.— E-Liternture Pediatric h•,mraals N•diatric Order Forrns Workshops HCPcS Search Com atitor Cross Search rrrr~~uu~wwu~rue~ Privacy Policy Site Securely Copyri~hl`:• Zt773 Path:reon },iedical hl.9dings. ;nc. http://pattersomnedical.com/app.aspx?cmd=getProductDetail&key=070_921020073 1/8/2013 SELLER: PART ONL OF Tw:O PAR"t•S NEILL FUNERAL HOME (1 3501 DERRY STREET O 3401 NARKET STREET HARRISBURG, PA 17011 CAMPHILL, PA 17011 717-564-2633 717-737-6726 7412 STEPHEN J. WILLSBACH, SUPERVISOR KEVIN SCHILLABEER, SUPERVISOR Agreement No. STATEMENT OF FUNERAL GOODS AND SERVICES SELECTEDNPURCHASF., ACrRI F.,1•iF.N'I' D:ae of Death-__.; I [)ale rf SmIce. Name) U :l'ecl 'aJt t 1 f ,f.*. ill ni ;ill Y'! Date of F3i-t'I ytra D;? v) c-n - d I- Ad 1r State _.Zip lock P urcha I Nam,_- Phone 'N I'mChan-, ;I,,mc Address City Scat;.. Zip Code Co..Furch;l,er'c Nine Phone No. Co-Rn'chaser's Hnn:c Add,esa _ _-Clrv - State - Zip Code AI'linin'( fi:rlar " Cod:: 'r. 41115 I- laeni Itte ,\'ord, yom and your' rcfe: r0 the P--alehas.;r ar,<1 Co R tehaser.:! ary, usnu•p; this Agi,er to •I The e, a -I rmr re;;.i ,o :hc Pum_I,d Pia. ider or Si 11, lose ,,rile and ai ICs.. appeal t re. For good .u,l -,al I ,e t'onsiderau:~n. which each palsy rckni wiedg,~ -rceiv ing, yntl agxx to boy the ,h.ods ::noet nt. uescrllaed below. lbu umhe i s 1; I r I r - ed - t 4 the ) ,dY f to e dent mil d i t u A I , m and to on duet the fur,t.: uu..-r I_es x .J a '.C r ,he eMubes limed in >aid A.-m rt. We ha 11 e rl dt, (ICollect the total am vv. - du., mild.,, this A21MYIC it b0:o ,Illy li-IS01 Who signs th s Agreement as PI n has.•r ur Co P; rch.i cr. Charges are ooh' for those items that ytn, selected or that are required. If we are required by law or by a cemetery nr crematory to use any items. ue will explain the reasons in writing helgw. If you selected a funeral that may require embalming, .such as a funeral with viewing, rou nu,y have to pay for embalming. You tit, riot have to pay for embalming trot, did not approve if yoo svie.cfed arrangements such as a direct mvization-or immediate burial. 11' We ehar[;ed for (Millal,Tiing, +ve will ccPlain why below. SrC1'ION I - SFRVICES AND MERCHANDISE NMERCHANDISE; 11iNE.t21r. DIRECTOR AND STAFF SF;IZVICES ~1 ,tuft i, r x 1 Sal)pli I i3as i I Senn:e F. Nwnh Model Niimcd\ Marc, iai PACKAGE I'L.ANS Sr- cien of :'.rood . f Lre,•tCren+tuon Type of 4letal-_.. immediate 8 mi.l Weight/G tse...-...._... Fora-arui:q! Remain, to Another Futimil Home She! Style Reca.•:in:± IZi•ma ns from Another Fune.r.!I Hun)a S - Interior •:,r _ Om:.r Burial l',;nntincr CARLEANDPRE'ARATIONOFRLNLIIN5 Alnni.faci:rcr.'Sm ot'e, _ - + • Y , Model N ur -W:,mt , • : . Olh_ I) ;nit,).. ---y t c Dr.•u lual m) liodel Nann:Rtiiur;har USE OF FACILI'T'IES AND STAFF liateriui.-_ Q'L, of F:raiue5 and Sum ' Servieex for Visitaio, ; . ~ 1 ..........Nays) y.._..... U'o 1 f Vries i i.sIaiP el"ices fn Strv'CC mom Cuapcl 5`` • tit:di vI:,r Funeral Service in i)dx, Faci'it;'........... - x.._.................._..._ Uvc I F- I l J Sc if .SF 11c 1 ti.r:• M'1 L( It, aas plLS, t,i ou f m,,el TOTAL SECTION I Sr.;fl'>crvicC> for .vlemonio Service (wamut reaiaiu s p-, .::.:x,•I I-a.Jltt-.. SECT [ON 11 - CHARGES TO BE INCURRED 131' US ON YOUR BEHALF L:. I. ,.ha a:. •r.ly -ii,nowd 'r. ,;ors cuur r;:IJ N'.: ci ~t ,,a Lv o.rt Othel ! ,o o, Facilgw, and Staff per vu: u; ^ht In-c Menu narked -:h :;n 'N'. . Dc J C=."Irory TRANSPORTATION Flow-s.. S aro :i.un_ I:mains to tuneral hone C] Otii„a) i r.nhvcs 'y - Funeial vehicle ~o' > s'`>-s O EsconS............. . b Family chi: le Ft' ]Cc]tified cr},fcs ..-s-: S~-_ i=k,,.vtr schicir 'J Outside Poneral Director':: Er,perac Jtrv a - - _Li_ J Cie, L,,RtI;_:ms Faci Im , Addis I tr.:nspnu::o:r J ~4 u.-rcians o: Sinecrs - 5.... u P roar,.,.. _ OTHER GOODS AND SERVICES e;honnl bunk J . A Acknc.,,.ialeluen: curd>....... ti en I p ka,, rcrhA t. sE:CruIN H - ' a . h[ a .h,e TOTAL SECTION I CIIARCES.._... n y....... TO"IALSECTIOiN It CHARGE ~ e.;; _ s__ TOTAL SECTION I AND It CHARGES....... I _ 12/28/2012 15:44 7175411187 FEDEX OFFICE PAGE 04/07 r Enhancing lives through I, C-1 I innovative heatthcareGOLDEN .T. JVINGCENTL: - P.O. Box 180970 Fort Smith, AR 72918 GLORIA BANKS 5776 CATHERINE ST HARRISBURG PA 171,1.2 NOV 26 2.01.2 RE: Name - - INEZ DAVIS Account Number 114381.-00285-40538 Current Balance--- $1819.21 Duri,n.g the course of regular account audits, i.t has come to my attention that the account listed above still has an upaid balance of $181.9.21. nuE to the age and total dollar amount of the account, our normal. procedure would be to forward this outstanding balance to an, attorney to pursue payment via legal process. However, legal fees are cosr-1y, the process can be lengthy, and winning a judgment is no guarantee of payment. More importantly, we do not want to cause any added stress to you and your family. Our goa:L is to recover payment for the services we provide in the best way possible for Everyone involved. That being the case, I would like to propose the following offer for you to consider. Our office will discount the balance due by 30% if you will pay the remaining balance of $1273.45 in full by 01/10/13. We accept check, money order, Visa, Mastercard, Discover, debit cards. If you would, like to take advantage of this offer, please contact the following account representative that has been assigned to your account: Account Repa:estative: CONNIE PURR Toll free: (877) 367-1716 Please understand that this offer, will expire as of 12/26/12, Sincerely, Rita. Donnelly Manager - Golden Living, Fort Smith. Recovery Department (1210) www. goldenliving.com PO Box 180970 Received Time Dec, 28.,t201,2tr j,;44PM,(No,4297F)of)e:877-367-1716 • F@x:479-478-2625 N N '~O - I 8 s a LL m + I ~ o O M O M M O 10 O LO O O O 0 0 0 l0 10 O )O M M O )O co O V O O N O O N N N N N N N O O O N O O Lo Ln Lo m N O O O O N N N J b o b o o b y p N O N_ O O N_ N N N N N N N N N N_ N N N O O N N_ O N W O O O O O O O O O O O O O O O O O O O O O O O O O j d al i V O V O 0 O W 00 0 0 N W 00 00 O O 00 m N O V V V O > O I O O O O M M M M M 1~ M M M M M M M M O O O O O O M r O N 00 O M M O M M 1 m<m N 69 N r- EH r N I~ r n n ti r ti 69 N N 'V Lr) O r 17:7m N N ~ r r r r N r r r r r r r r r~ ...ri E!- 69. fA ~ EA 6., fA Zq K3 Q'91 EA ffl fA fA EA fA fA EA fA fA Efl U+- err O V O V O M M O O O O 0 a O 0 0 r 0 0 D O O O O C M O co O C M O _W OD t~f V, N N 43' N N W h 1 N W ~ n _ N N ~ N M N N O `i Vi ~ N ~ fA ~ EA ~ b! 1R K 17' V V O N O O O O CO CO^ O O O O O O O N O W V O O O O _ r M O O O O M Cl) O O O O O O O Cl) O O O O O m o _o p I of M M o )n 0 0 0 0 0 0 0 0 0 0 0 vi s E N N N 0) j 1~ f9 EA EA b% I~ EA fA fA (fl to 69 b9 N Vf (0D Q N n r r O N [h N 64 69 6% EA 1-7 b 1 m ~ I p ~ N i O CO I~ t` n M M f/1 d M L ~ T 0 Z d N 7 0 W M E ~ td ! 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Ave. 7'917 Derry St / Harrisburg, PA 15531 Boswell PA. 15531 814-629-9935 g8~ 3414 Convenient se/em OMcox, Showrooms, and Service 814-629-9937 Fax in Boswell, PA - Harrlgburg, PA - Pr-ederfck MO Cbarlie®tmserviccs.eom Date - Ray®tmecrvices 7917 Derry St. Ste, 1.24 10/26/2012 Harrisburg, PA. 17111 REV. GARY & GLORIA BANKS 717-558-4301. + 5776 CATHIltNE ST. 717-558-4303 FaxI + 4, 14ARIUSBURG PA 17112 GregQtmservicca ~ I! 717-979-1390 IIIII{I~ I~ !i ''tii{• 5415 Yukon Ct. Ste. E Frederick, MD. 21.703 240-490-7840 ~'++f 240-490-7843 Fax Ship To Sul@tmservices INAZ DAVIS Websi,te Terms www.tinservices.com Item Description' Qty Total CB 1.13056 2012 T30NDA ODESSY EX SMOKEY TOPAZ EXT, TRUFFLE 1 32,455,OOT CLOTH, TNTERIOR VTN# 5FNRL5H48CB113056 244-HP.3.5 IITER,24VALVE,SOHC i-VETEC V6 .T;NGINE,S-SPEED AUTO TRANS ALL STD SAFTEY FEATURES .120 WATT AMIFM6 DISC FLASH MEMORY AUDIO, 6 SPICKS, TRT-ZONE CLIMATE CONTROL W REAR CONTROLS DRIVERS 8-WAY POWER SEAT POWER FRONT & MID ROW WINDOWS CARGO & MAP LIGHTING HOME LINK SYS, MAINTENCE MINDER SYSTEM SHAD 2ND ROW,I T X7.0 ALLOY W -IEELS,HEATED MIRRORS DUAL POWER SLIDING DOORS, HONDA DESTINA17ON CHARGES MISCTT TITLE AND TRANSFER 1. 375,00 CONVERSION REBATES / DISCOUNTS FROM MANUFACTURE VMJ. STOCK I. -2,000,00T UNITS NORTHSTAR HOND... 2011-13 HONDA N-STAR PLUS 12 3/4 " IN FLOOR RAMP 1 24,695,00 SYSTEM. WITH SURE_ DEPLOY COLOR ORDINATE CARPETWO LOWERED FLOOR PROVIDING 55" PWR KNEELING STEP FLRS HONDA STEP FLARE PKG 1 390.00 Q_8100-A-L Q-STRAINT QRT 8100A-L SELF WRACHETING 1 895.00 WHEELCHAIR OCCUPANT RESTRAINT SYSTEM W/LAP & SHOULDER BELT FREIGHT OUT TRANSPORT FROM PLAT TO PA 1 1,300,00 * PLEASE SEE ATTCH HONDA MOBILITY CLAIM FORM FOR DETAILS- UPON PAYMENT AND'SUBMITAL TO HONDA UPON THERE APPROVAL A CHECK FOR. $1000.00 WILL BE SENT DIRECTLY TOO YOU. ACCEPTANCE SIGNATURE Subtotal $58,110.00 CHASIS PAYMENT DUE AT ACCEPTANCE & 50% CONVERSION AND 13AL ® Sales Tax 6.0% COMPLETION ) $1.827.30 Total $59,937,30 'Received Time Dec,28. 2012 3:44?M No,4297 12/28/2012 15:44 7175411187 FEDEX OFFICE PAGE 06/07 d) Ln CL (D 5 o 401)' §1 01 I~, k N •C~. 3 R v rn N 110 a' f _ & w p ~~.p¢ak Ent h 52 w p. G 0 h, E a c u_ ~ G w o m O a a u 60- giv_ g' W~. ~m ' cm) `0q . 2, iii ~ a ~ V a N! 1 3 LL LL a r3 :6 :3 M Ilia a ° 2fl W.1 u ul N W ~w 4 V ti ~pY Q ~I~_• m o~ O ~LL °z~~ b OM z~.8 ON S$ in DIP 1h H G Ogr1C~,$$~ €Q 3 ll~¢ ?+G~a~~~t d'l~jts~jLWp amrwn! a geg e W It -v- ffi ~'e !ma ~y F a E prn 8 ~iur JrO W1e 41@L ZyXn PS'++'d1 5•rn'E aJ~LYY { 9 F' m ai u..1 A :a -A . ~.}u ~yrs° ~ Rp vJ m'I j:~pi ru I U. lerS F-NC° Received Time Dec•28. 2012 3:44PM No.4297 I 75 ftA 3 locations to BETTER Estimate serve you Ccrlc'oiiauze 4785 Penn Ave. Estimate # 7997 Derry St / Harrisburg, PA 15531 Boswell PA. 15531 -Convenient Sales Offices, Showrooms, and Service 814-629-9935 BEEL 3834 In Boswell, PA - Harrisburg, PA - Frederick MO 814-629-9937 Fax Charlie@tmservices.com Date Ray@tmservices 7917 Derry St. Ste. 124 1/3/2013 • REV. GARY & GLORIA BANKS Harrisburg, PA. 17111 . I M, Fir 717-558-4301 5776 CATHIIZNE ST. 717-558-4303 Fax HARRISBURG PA 17112 Greg@tmservices.com r ® ~ 717-979-1390 O" 'ToddO,,tmservices.com 2 5415 Yukon Ct. Ste. E Frederick, MD. 21703 e~ Ship To , 240-490-7840 `94sc~►~~a`, 40490-7843 Fax INAZ DAVIS Sul@tmservices Website Terms www.tmsel-vices.com Item Description Qty Total HONDA 2012 USED HONDA ODESSY EXL-RES 1 31,500.OOT VIN#3FNRL5H66CB008548 WHITE EXT, TAN LEATHER INTERIOR 13800 MILES MISCTT TITLE AND TRANSFER I 375.00 NORTHSTAR HOND... 2011-13 HONDA N-STAR PLUS 12 3/4 " IN FLOOR RAMP 1 24,995.00 SYSTEM WITH SURE DEPLOY COLOR ORDINATE CARPETING LOWERED FLOOR PROVIDING 55" PWR KNEELING STEP FLRS HONDA STEP FLARE PKG 1 390.00 Q-8100-A-L-HBG Q-STRAINT QRT 8100A-L SELF WRACHETING 1 895.00 WHEELCHAIR OCCUPANT RESTRAINT SYSTEM W/LAP & SHOULDER BELT FREIGHT OUT TRANSPORT FROM PA TO VMI PLANT AND BACK 1 2,600.00 *EXTENDED WARRENTY S1035.00 ACCEPTANCE SIGNATURE Subtotal $60,755.00 CHASIS PAYMENT DUE AT ACCEPTANCE & 50% CONVERSION AND BAL @ COMPLETION Sales Tax (6.0n) $1,890.00 Total $62,645.00 Used 2012 Wheelchair Accessible VMI Northstar For Sale on a Honda Odyssey EXL Page 1 of 3 t- Welcome guest! or > handicap vans > used wheelchair vans for sale > 2012 honda odyssey exl 2012 Honda Odyssey EXL rice: Min to Max VMI Northstar with Side Side in floor ramp UsedAccessible Vehicle with UsedMobility Conversion Iles: Min to M8X f.~ Stock Number: 019711 Pr Include Rear Entry iL Include Side Entry F- Only New Conversions . F- Only Used Conversions 4 Search Vehicles Was: $57,17.5 Save $2,000 1,728 miles 4655,175 Wheelchair Van Sales w, dEW o W: AMM.- .0"04 !40 *AM $13,175 2001 Chevrolet Venture Like 0 Print Email We Take Trades I ode in our used van, car, truck Used VMI Wheelchair Vehicle y Price: o SUV for new or used handicap v ns and accessible vehicles. Call Now Vehicle & Conversion $56,900 Discount -$2,000 \ Contact a Mobility Consultant Documentation Fee $275 j Trade Select Delivery Method enter zip Get aTrade-In Appraisal I I Total: $55,175 Jump To Vehicle I Select Handicap Vehicle Upgrades F nd wheelchair van or handicap v hicles quickly by entering a ~a sock number below:.. , I Find by Stock#: I http://www.amsvans.com/handicap-vans/used-wheelchair-vans/vmi-northstar-2012-honda-... 1/10/2013 Used 2012 Wheelchair Accessible VMI Northstar For Sale on a Honda Odyssey EXL Page 2 of 3 go Add to quote Add to quote Add to quote Add to quote EZ Lock base only Leadership L51 Hand Controls Jump Seats $650 $1,350 Transfer Seat starting at $999 $2,400 I heelchair Van Reviews Dave O This is Josh, Overview Vehicle Conversion Warranty 11 Trade In and he (along with all of us) absolutely love the new van. It rides like dream, and has given Overview for used 2012 VMI Northstar on a Honda Odyssey EXL Handica us a new sense of freedom!! p Accessible Vehicle - Dave O This van is here on consignment! Pre owned VMI Northstar Honda Odyssey! stle Rock, Colorado This van is as close to new as you can get without actually being new. This van is NEARLY perfect and has ALL the goodies... Leather, Nav, Sunroof, Heated Handicap Van Reviews seats, Dual power doors and more! 30" wide ramp, 55" door opening and 58" interior height. This van also has a EZ lock already installed in the front passenger area! Join the Club! Vehicle Price: $54,900 Mileage: 1,728 mi ay Informed With Secret Sales o Handicap Vans, Monthly News, Manufacturer: VMI Nobility Promotions & More! Conversion Model: Northstar mail Address: Wheelchair Access Type: Side in floor ramp Wheelchair Access Side: Side Sign Up New / Used Conversion: Used VIN: 5FNRL5H62CB019711 Year: 2012 Make: Honda Model: Odyssey EXL Engine: 3.5L V6 Transmission: Stock#: 019711 Exterior Color: Deep Cherry Interior Color: Grey Leather Wheelchair Van Classifieds Used Handicap Accessible Vans Wheelchair Vans For Sale Sell your wheelchair accessible vehicle on All of our certified used, newly modified Find new and used handicap vans for sale. our "for sale by owner" classifieds and get wheelchair vans are backed with our low Choose from accessible minivans nationwide exposure to thousands of price guarantee. Browse our inventory of conversions with side and rear entry buyers seeking used handicap vans for pre-owned mobility vehicles for sale to find models from AMS and other popular sale. the used handicap van right for you. wheelchair van manufacturers. http://www.amsvans.com/handicap-vans/used-wheelchair-vans/vmi-northstar-2012-honda-... 1/10/2013 12/28/2012 15:44 7175411187 FEDEX OFFICE PAGE 03/07 TRAVIS LAUCHMAN CONTRACTING PA#084429 Hershey, PA Travis M. Lauchman CLIENT: Gary & Gloria Banks DATE: 12/612012 ADDRESS: T FOR SERVICES- ftL SERVICES TO BE PERFORMED: HANDICAP ACCESSIBLE RAMP AND FRONT DOOR LANDING: $6,870.00 Elevate front door landing to the level of front door threshold. Pour concrete ramp extending from landing toward right of house aproximatly 14' at a drop rate of V per foot in accordance with handicap guidlines. Add one step at end of landing at driveway to accomadate elevation of landing Overlay landing, step, and ramp with standard red brick to match house brick. Add railings to both sides of ramp and new lights to illuminate handicap landing and ramp. HANDICAP SIDEWALK: $3,675.00 Install new 4' wide handicap accessible sidewalk extending from driveway to street sidewalk, Add red brick overlay to match house landing and ramp brick. Add lighting along walkway connected to existing lights. HANDICAP ACCESSIBLE BATHROOM REMODEL: $7,590.00 Widen and install new batroom door to allow fbr wheelchair access. Install new vanity and sink to allow for wheelchair access. Install new large seat toilet with handicap arm hold bars. Install new handicap accessible tile shower stall with handicap holl bars and glass enclosure doors. Install new medicine cabinet to match vanity and sink top. Install new ceramic tile bathroom floor, OTHER CONDITION: All craftmanship gaurenteed for five years from date of completion. COMPENSATION- eighteen thousand one hundred thirty five dollars and 00/100 $18,135.00 Date: 12/6/2012 Date: 12/6/2012 Authentication Travis M. Lauchmaan~ / L-Z~-- Received Time Dec,28, 2012 3;44°M No,4297 RHOADS & SINON LLP ATTORNEYS AT LAW ONE SOUTH MARKET SQUARE P.O. Box 1146 HARRISBURG, PA 17108-1146 TELEPHONE (717) 233-5731 Page 1 Inv# 248632 Date 05/15/2007 Gary and Gloria J. Banks Client # 5480 5776 Catherine Street Matter # 2 Harrisburg, PA 17112 SAS Re: Guardianship Petition For Professional Services Rendered: HOURS 12/26/06 DKK Conference with Mr. Smith, file .17 12/27/06 DKK Conference with Mr. Smith, draft 4.83 Petition for Guardianship, Preliminary Decree, Decree, Citation and Notice 1/05/07 DKK Edits to Petition, dictate memo to .50 Stanley A. Smith 1/09/07 DKK Review/edit documents .50 1/23/07 DKK Phone call, dictate/edit .33 1/25/07 DKK Review documents, draft/edit cover .75 letter for documents 2/13/07 DKK Edits to materials; Dictate/edit letter. .92 2/14/07 DKK Review/edit documents; Cover letter. .83 2/28/07 DKK Review Documents, review procedure, 2.00 phone call with Register of Wills, compile and mail documents 3/07/07 DKK Coordinate with Orphans' Court, Ms. .50 Banks, Dr. Szada re: hearing 3/12/07 DKK Coordinate regarding guardianship .17 hearing. 3/15/07 DKK Coordinate with Dr. Szada .25 3/16/07 DKK Issues re: guardianship, documents, 1.17 coordinate with Mrs. Banks, Dr. Szada 3/21/07 DKK Coordinate with Mrs. Banks, edit letters .75 to partners in interest, send 3/28/07 DKK Draft/edit follow-up letters to Mrs. .33 Banks, Dr. Szada 4/04/07 DKK Praecipe; Certificate of Service; .83 Affidavit regarding counsel; Cover letter. 4/10/07 DKK Coordinate with Dr. Szada re: hearing .25 4/11/07 DKK Coordinate re: hearing .50 4/12/07 DKK Preparation for hearing, hearing 4.00 Page 2 Inv# 248632 Date 05/15/2007 Client # 5480 Matter # 2 4/23/07 DKK File, wrap-up, tickler .50 TOTAL HOURS 20.08 TOTAL SERVICES 3,815.60 2/28/07 FILING FEES 50.00 3/28/07 POSTAGE 52.99 4/05/07 MILEAGE - STAFF 25.00 4/05/07 OUT OF TOWN COURIER 10.00 4/12/07 TELEPHONE 2.64 4/15/07 TRAVEL PARKING .25 4/19/07 COPIES 48.45 TOTAL EXPENSES 189.33 TOTAL SERVICES 3,815.60 TOTAL EXPENSES 189.33 TOTAL THIS INVOICE 4,004.93 RETAINER APPLIED -.10 INVOICE BALANCE 4,004.83 REMITTANCE ADVICE Mail Payments to: Rhoads & Sinon LLP One South Market Square P.O. Box 1146 Harrisburg, PA 17108-1146 To ensure proper credit, please complete and return this advice Client Number - 5480 - Matter Number 2 Gary and Gloria J. Banks 5776 Catherine Street Harrisburg, PA 17112 Invoice Number Date Amount 248632 May 15, 2007 4,004.83 Your Check No. Date Amount $ Total Outstanding Balance Due 4,004.83 .5 COLONIALI EINIp Colonial Penn Life Insurance Company - 399 Market Street - Philadelphia, PA 19181 September 17, 2012 RE: Ins: Inez H Davis Account Number: TR32220570 Inez H Davis 5776 Catherine St Harrisburg, PA 17112-2208 Dear Ms. Davis: We've received your recent inquiry and we're happy to answer your question. Your account is currently paid to August 12, 2012. As of this date, the accumulated cash value of your coverage is $254.36. When your outstanding loan of $14.40 is deducted, the available cash value is $239.96. The face amount of your coverage is $735.00. Please remember, however, that any loan or interest amount still outstanding will be deducted from the face amount of your policy when a death claim is presented. If you have any further questions, please call us toll-free at 1-800-523-9100. Our service representatives will be happy to help you. As always, it's a pleasure to serve you. We look forward to satisfying your insurance needs now and in the future. Sincerely, `bia ire p `74~til Diane J Tull Policyholder Services P.S. Find out more TODAY about additional life insurance from Colonial Penn. Call us now, toll free at 1-800-543-7389. J60R 8 GDLONIALTEW Colonial Penn Life Insurance Company - 399 Market Street - Philadelphia, PA 19181 1-800-523-9100 September 17, 2012 RE: Ins: Inez H Davis Account Number: TR32220570 Inez H Davis 5776 Catherine St Harrisburg, PA 17112-2208 Dear Ms. Davis: We're writing in response to your question about your premium payments. The premium for your coverage is $6.95. And, your account is paid to August 12, 2012. Thank you for the opportunity to serve you. It's always our pleasure to help in any way we can. Sincerely, Diane J Tull Policyholder Services J60R 3-30-871 Colonial Penn Life Insurance Company 399 Market Street - Philadelphia, PA 19181 STATEMENT OF COVERAGE COVERAGE UNDER THE PLAN OF INSURANCE DESCRIBED BELOW WAS ISSUED BY COLONIAL PENN LIFE INSURANCE COMPANY ON THE ISSUE DATE SHOWN. COVERAGE WAS STILL IN EFFECT ON THE DATE THIS STATEMENT WAS PREPARED AND THE COVERAGE INFORMATION DESCRIBED BELOW IS BASED ON COMPANY RECORDS ON THAT DATE. THIS IS NOT AN INSURANCE POLICY/CERTIFICATE. THIS STATEMENT IS BEING ISSUED UPON REPRESENTATION THAT THE ORIGINAL DOCUMENT HAS BEEN LOST OR DESTROYED. Date Prepared: September 17, 2012 Coverage Information Insured: Inez H Davis Account Number: TR32220570 Type of Insurance: WHOLE LIFE Issue Date: September 12, 2003 Plan of Insurance: Graded Benefit Life Issue Age: 73 Owner: Inez H Davis Premium: $6.95 5776 Catherine St Monthly Harrisburg, PA 17112-2208 Face Amount: $735.00 Additional details of the terms and conditions of coverage, including information about loans, benefits and nonforfeiture values will be furnished by the Company upon request. President COLONIALI ENN' Colonial Penn Life Insurance Company - 399 Market Street - Philadelphia, PA 19181 September 17, 2012 RE: Ins: Inez H Davis Account Number: TR31623298 Inez H Davis 5776 Catherine St Harrisburg, PA 17112-2208 Dear Ms. Davis: We've received your recent inquiry and we're happy to answer your question. Your account is currently paid to August 8, 2012. As of this date, the accumulated cash value of your coverage is $1,619.90. When your outstanding loan of $1,091.82 is deducted, the available cash value is $528.08. The face amount of your coverage is $4,668.00. Please remember, however, that any loan .or interest amount still outstanding will be deducted from the face amount of your policy when a death claim is presented. If you have any further questions, please call us toll-free at 1-800-523-9100. Our service representatives will be happy to help you. As always, it's a pleasure to serve you. We look forward to satisfying your insurance needs now and in the future. Sincerely, V u r y <I "Ll Diane J Tull Policyholder Services P.S. Find out more TODAY about additional life insurance from Colonial Penn. Call us now, toll free at 1-800-543-7389. J60R 3-30-871 Colonial Penn Life Insurance Company 399 Market Street - Philadelphia, PA 19181 STATEMENT OF COVERAGE COVERAGE UNDER THE PLAN OF INSURANCE DESCRIBED BELOW WAS ISSUED BY COLONIAL PENN LIFE INSURANCE COMPANY ON THE ISSUE DATE SHOWN. COVERAGE WAS STILL IN EFFECT ON THE DATE THIS STATEMENT WAS PREPARED AND THE COVERAGE INFORMATION DESCRIBED BELOW IS BASED ON COMPANY RECORDS ON THAT DATE. THIS IS NOT AN INSURANCE POLICY/CERTIFICATE. THIS STATEMENT IS BEING ISSUED UPON REPRESENTATION THAT THE ORIGINAL DOCUMENT HAS BEEN LOST OR DESTROYED. Date Prepared: September 17, 2012 Coverage Information Insured: Inez H Davis Account Number: TR31623298 Type of Insurance: WHOLE LIFE Issue Date: April 08, 2003 Plan of Insurance: Graded Benefit Life Issue Age: 72 Owner: Inez H Davis Premium: $41.70 5776 Catherine St Monthly Harrisburg, PA 17112-2208 Face Amount: $4,668.00 Additional details of the terms and conditions of coverage, including information about loans, benefits and nonforfeiture values will be furnished by the Company upon request. President GxONIALI ENN' Colonial Penn Life Insurance Company - 399 Market Street - Philadelphia, PA 19181 September 17, 2012 RE: Ins: Inez H Davis Account Number: RP34502246 Inez H Davis 5776 Catherine St Harrisburg, PA 17112-2208 Dear Ms. Davis: We've received your recent inquiry and we're happy to answer your question. Your account is currently paid to August 4, 2012. As of this date, the accumulated cash value of your coverage is $1,115.67. When your outstanding loan of $656.37 is deducted, the available cash value is $459.30. The face amount of your coverage is $3,480.00. Please remember, however, that any loan or interest amount still outstanding will be deducted from the face amount of your policy when a death claim is presented. If you have any further questions, please call us toll-free at 1-800-523-9100. Our service representatives will be happy to help you. As always, it's a pleasure to serve you. We look forward to satisfying your insurance needs now and in the future. Sincerely, b eq Diane J Tull Policyholder Services P.S. Find out more TODAY about additional life insurance from Colonial Penn. Call us now, toll free at 1-800-543-7389. J60R t~ .rrj ® . GDLONIALI EW Colonial Penn Life Insurance Company - 399 Market Street - Philadelphia, PA 19181 1-800-523-9100 September 17, 2012 RE: Ins: Inez H Davis Account Number: RP34502246 Inez H Davis 5776 Catherine St Harrisburg, PA 17112-2208 Dear Ms. Davis: We're writing in response to your question about your premium payments. The premium for your coverage is $34.75. And, your account is paid to August 4, 2012. Thank you for the opportunity to serve you. It's always our pleasure to help in-any way we can. Sincerely, Diane J Tull Policyholder Services J60R 3-30-871 Colonial Penn Life Insurance Company 399 Market Street - Philadelphia, PA 19181 STATEMENT OF COVERAGE COVERAGE UNDER THE PLAN OF INSURANCE DESCRIBED BELOW WAS ISSUED BY COLONIAL PENN LIFE INSURANCE COMPANY ON THE ISSUE DATE SHOWN. COVERAGE WAS STILL IN EFFECT ON THE DATE THIS STATEMENT WAS PREPARED AND THE COVERAGE INFORMATION DESCRIBED BELOW IS BASED ON COMPANY RECORDS ON THAT DATE. THIS IS NOT AN INSURANCE POLICY/CERTIFICATE. THIS STATEMENT IS BEING ISSUED UPON REPRESENTATION THAT THE ORIGINAL DOCUMENT HAS BEEN LOST OR DESTROYED. Date Prepared: September 17, 2012 Coverage Information Insured: Inez H Davis Account Number: RP34502246 Type of Insurance: WHOLE LIFE Issue Date: August 04, 2004 Plan of Insurance: Graded Benefit Life Issue Age: 74 Owner: Inez H Davis Premium: $34.75 5776 Catherine St Monthly Harrisburg, PA 17112-2208 Face Amount: $3,480.00 Additional details of the terms and conditions of coverage, including information about loans, benefits and nonforfeiture values will be furnished by the Company upon request. President 12/28/2012 15:44 7175411187 FEDEX OFFICE PAGE 05/07 - STATEMENT o1F; Hig'gi.ris. Farrtif ' 6enti$try SERVICES Dr. Eric J..Hioglns Dr. Edward S. doyer REND'E,RED 4010 Linglestdwn Ind Thursday ~Hardsbmrg; PA 17112 . November 8, 2012 t717)W-i= AC6O~ I,NT UNUN MBER ,ACGOIJNT;iIaM :iAN :ADDRESS 464700 Inez Davis 5776 Catherine Street STATE 'ENT a=OR" ATIENT Harrisburg, PA 17112 Inez Davis EST. INS PATIENIT O,DE DESCRIPTION TH. SURF. AMOUNT Inez 140 Limited Oral Evaluation - Prob Focused 6a..oo 0ca Inez 51 Senior Citizen Discount 25.00ca Inez 1 Cash Payment 30.80ca Inez 12 Visa Card Payment PREVIOUS NEW PLEASE PAY TODAY'S TODAY'S PATIENT THIS AMOUNT PATIBAIENT ENT CHARGES PAY*tNTS BALANCE 0.00 01.00 55.80 55.80 0.00 Day Date Time ReAson Next Appt. . Additional Comments P1oaaF make checks oavable to Higgins Family Dentistry! Thanks Received Time Dec,28, 2012 3:44PM No,4297 rl v.nnl nantni TAnninoloov (CDn C American Dental Association (AAA). All rights reserved. CAUIFICATE OF CONSENT I, Gloria J. Banks, daughter and Guardian of Inez H. Davis, do hereby certify that I have reviewed the attached Petition, concur therewith, join in the Petition and pray that this court approve it. Dated: t ~I ! 3 Gloria hanks, Petitioner SkarlatosZonarich LLC 17 S Second St, 6th Floor Harrisburg Pennsylvania 17101 Telephone (717) 233-1000 Fax (717) 233-6740 INVOICE SUMMARY Inez Davis January 15, 2013 c/o Gloria Banks File DAVIIN1202 5776 Catherine Street Inv 58999 Harrisburg, PA 17112 Attention: RE: Elder Law TOTAL PROFESSIONAL FEES $21,767.50 TOTAL EXPENSES MADE TO YOUR ACCOUNT $218.65 TAXES $0.00 PAYMENTS AND CREDITS $0.00 TOTAL BILL AMOUNT FOR INVOICE # 58999 $21,986.15 PREVIOUS BALANCE $0.00 INTEREST ON OVERDUE BALANCE $0.00 PLEASE PAY THIS AMOUNT (Please see attached invoice detail) $21,986.15 A 1 1/12% PER MONTH REBILLING CHARGE WHICH IS AN ANNUAL RATE OF 18% WILL BE APPLIED AFTER 30 DAYS. FEDERAL I.D. #25-1839294 PLEASE INDICATE YOUR INVOICE NUMBER ON YOUR REMITTANCE DAVIIN 1202 58999 2 INVOICE DETAIL Inez Davis c/o Gloria Banks 5776 Catherine Street Harrisburg, PA 17112 Attention: RE: Elder Law DATE DESCRIPTION HOURS RATE AMOUNT Jul-10-12 JBZ Emails to/from I. Norris; telephone call with 1. 0.40 $300.00 $120.00 Norris; email to EBP Jul-24-12 JBZ Telephone call from I. Norris regarding new 0.40 $300.00 $120.00 client matter and expected call from Gloria Banks; office conference with EBP Jul-25-12 EBP Telephone call with Gloria Banks regarding 0.60 $275.00 $165.00 MA planning Jul-30-12 EBP Conference with Janet regarding care issues 0.20 $275.00 $55.00 Aug-07-12 JBZ NO CHARGE Emails to/from W&M 0.20 $300.00 $0.00 regarding update Aug-16-12 JBZ NO CHARGE - Review and archive 0.20 $300.00 $0.00 correspondence and time Sep-04-12 EBP Telephone call with Gary Banks regarding 0.20 $275.00 $55.00 meeting Sep-05-12 JKD NO CHARGE Print correspodence and 0.20 $125.00 $0.00 prepare envelope Sep-06-12 EBP Meeting with Gloria and Gary Banks regarding 1.60 $275.00 $440.00 long term care planning, etc for Inez Davis EBP Correspondence to clients regarding planning 0.50 $275.00 $137.50 options Sep-10-12 EBP Addition to correspondence; materials to client 0.20 $275.00 $55.00 JKD NO CHARGE Revise correspondence to 0.60 $125.00 $0.00 Gloria and Gary Banks regarding MA JBZ Office conference with EBP regarding update 0.20 $300.00 $60.00 Sep-11-12 JBZ Office conferences with Elizabeth B. Place, 0.30 $300.00 $90.00 Esq. JBZ Telephone call with B. Sause regarding MSA, 0.20 $300.00 $60.00 release and other issues - spoke DAV IIN 1202 58999 3 JBZ Emails to/from B. Sausee and I. Norris 0.40 $300.00 $120.00 regarding release, MSA and other issues EBP Conference with JBZ regarding 0.20 $275.00 $55.00 settlement/release, MSA EBP Telephone conference with Gloria Banks; 0.50 $275.00 $137.50 conference with JBZ Sep-25-12 EBP Conference with Jatoya regarding guardianship 0.30 $275.00 $82.50 reports; conference with JBZ regarding guardianship order Sep-26-12 SLD NO CHARGE Create additional subfolders 0.20 $125.00 $0.00 per JBZ's request JBZ Emails to/from B. Sause regarding court 0.80 $300.00 $240.00 approval; emails to/from S. Wells regarding docs needed for court approval of settlement; begin work on petition to approve settlement Sep-27-12 JKD Research guardianship information for Gloria 0.40 $125.00 $50.00 Banks; spoke to Gloria regarding assisting her annual reports Sep-28-12 EBP Meeting with Gloria and Gary regarding 1.40 $275.00 $385.00 guardianship filings; taxes; sole benefit trust EBP Conferences with JBZ regarding petition for 0.40 $275.00 $110.00 approval of settlement; sealing record; review of petition for approval of settlement JBZ Emails to/from L. Simpson regarding docs 2.00 $300.00 $600.00 needed for petition for court approval; continued drafting of petition for court approval of settlement Oct-01-12 SLD Telephone call to Cumberland Cty Proth to 0.20 $125.00 $25.00 check on the following: no filing fee for EOA, no online filing; original plus our copies; EBP Instructions to staff regarding materials and 0.10 $275.00 $27.50 guardian reports SLID Prepare EOA for filing & service; prepare 0.60 $125.00 $75.00 filing/service ltr; copy, file, serve; place follow up on calendar; JBZ Review and sign EAO civil and filing letter 0.20 $300.00 $60.00 Oct-03-12 JKD NO CHARGE Make copies of original 0.60 $125.00 $0.00 documents; scan and save to file SLD NO CHARGE Scan and save time-stamped 0.20 $125.00 $0.00 EOS to pclaw matter; place copy into paper file; email same to BSause; JBZ Receive and review time stamped EOA; 0.20 $300.00 $60.00 instructions to paralegal; email to EBP regarding request for update DAV IIN 1202 58999 4 Oct-04-12 BJM NO CHARGE print priority postage; mail 0.20 $125.00 $0.00 to client JKD Correspondence with enclosures to Gloria 0.20 $125.00 $25.00 Banks regarding original documents; scan and save to file EBP email exchange with JBZ 0.10 $275.00 $27.50 JBZ Emails to/from EBP regarding update and 0.20 $300.00 $60.00 documents needed from client Oct-09-12 JBZ Office conference with EBP regarding 0.60 $300.00 $180.00 additional information needed for petition for court approval; review and revise Petition; emails to/from W&M regarding comments and approval pf Petition Oct-10-12 EBP Telephone message to Gloria; conference with 020 $275.00 $55.00 JBZ JBZ NO CHARGE - Office conference with EBP 0.20 $300.00 $0.00 regarding update Oct-12-12 JBZ Emails to/from EBP regarding update and 0.20 $300.00 $60.00 court approval petition EBP Telephone call with Gloria Banks regarding 0.70 $275.00 $192.50 distribution of settlement proceeds Oct-17-12 JBZ NO CHARGE - Email to EBP regarding 0.20 $300.00 $0.00 request for update Oct-18-12 EBP Telephone call with Gloria regarding treatment 0.30 $275.00 $82.50 issues, documentation for Petition and guardianship reports Oct-24-12 EBP Telephone call with Gloria Banks regarding 0.40 $275.00 $110.00 MA application, guardianship reports, tax filings, petition for distribution, petition for approval of settlement Oct-26-12 EBP Preparation of guardianship reports; telephone 0.30 $275.00 $82.50 message to Gloria Banks Oct-28-12 EBP Review of materials and preparation of 0.80 $275.00 $220.00 guardianship reports Oct-31-12 EBP Telephone call with DPW; Telephone call with 1.00 $275.00 $275.00 Independent Enrollment Broker; Telephone call with Gloria regarding guardianship reports, taxes; request for distribution and Independence waiver EBP Telephone call with Gloria regarding 1099s etc 0.40 $275.00 $110.00 EBP Preparation of guardianship reports 0.60 $275.00 $165.00 JBZ NO CHARGE - Emails to/from Elizabeth B. 0.20 $300.00 $0.00 Place, Esq. regarding update DAV IIN 1202 58999 5 Nov-05-12 JBW Prepare prior period income tax returns - 2008 2.40 $200.00 $480.00 through 2011 as requested by EB Place. Process out and give to EB Place to deliver to client. JBZ Emails to/from EBP regarding meeting with 0.40 $300.00 $120.00 client regarding court approval petition; office conference with EBP regarding same EBP Conference with JBZ regarding settlement 1.00 $275.00 $275.00 petition; calculations and preparation regarding guardianship forms EBP Meeting with Gloria Banks regarding 2.00 $275.00 $550.00 guardianship reports, taxes, Petition for approval of settlement and Petition for Distribution; conference with Jackie Wolpert, CPA regarding tax preparation EBP NO CHARGE Telephone message from 0.20 $275.00 $0.00 and to Gloria Nov-06-12 JBZ Emails to/from I. Norris regarding update on 0.40 $300.00 $120.00 status of settlement petition; review settlement agreement; emails to/from 1. Norris regarding no requirement to file petition under seal Nov-05-12 EBP NO CHARGE Message from and return 0.20 $275.00 $0.00 message to Gloria Banks Nov-09-12 EBP NO CHARGE Follow-up message to Gloria 0.20 $275.00 $0.00 Banks EBP Telephone call with Gloria Banks regarding all 0.70 $275.00 $192.50 pendancies Nov-12-12 EBP Preparation of Guardianship reports (paralegal 2.00 $125.00 $250.00 rate); instructions to Toya; instruction to Beth regarding redaction of petition ELF NO CHARGE Redact document; 1.00 $125.00 $0.00 JKD NO CHARGE Telephone call to Gloria 0.20 $125.00 $0.00 Banks; set up appointment with Elizabeth B. Place, Esq. Nov-13-12 EBP NO CHARGE --Attention to prebill and 0.30 $275.00 $0.00 invoice for services; scheduling of appointment JBZ NO CHARGE - Office conference with EBP 0.20 $300.00 $0.00 regarding update Nov-12-12 SLD Prepare petition for filing & service; draft 0.60 $125.00 $75.00 filing/enclosure Itr re same; Nov-14-12 EBP Review of taxes, reports and redacted materials 0.30 $275.00 $82.50 EBP Meeting with Gloria Banks regarding taxes, 2.30 $275.00 $632.50 guardianship reports; conference with JBZ regarding Petition for Approval; instructions to DAV IIN 1202 58999 6 Toya regarding filing guardianship reports and tax returns JKD Make copies of orginial documents (NC .8 1.00 $125.00 $125.00 hours); revise guardianship account document (I hour) JBZ Office conference with EBP regarding update; 0.40 $300.00 $120.00 emails to/from W&M regarding update; instructions to paralegal regarding filing Petition Nov-15-12 SLD Telephone call to Cumberland Cty Proth filing 0.20 $125.00 $25.00 requirements for Petition to Settle JKD NO CHARGE Make copies of tax return 0.80 $125.00 $0.00 information; scan and save documents to file; mail tax documents SLD Continue preparing Petition for filing & 1.40 $125.00 $175.00 service; prepare enclosure ltr to Cumberland Cty Proth; schedule fed ex shipments; prepare sase envelopes for service of Order and include in packet to Proth; place follow ups on calendar; JBZ Final review of Petition for court approval of 0.40 $300.00 $120.00 settlement before filing; email to W&M regarding update Nov-16-12 JKD Make copies of annual reports (2008-2012) of 0.50 $125.00 $62.50 guardian of the estate and person; scan and save to file (NC); telephone conversation with Cumberland County ROW to discuss filing fees and procedure; request filing fee check from Susan; file reports BJM print postage for letters; 0.20 $125.00 $25.00 EBP NO CHARGE Conference with Toya 0.20 $275.00 $0.00 regarding filing guardianship report Nov-18-12 EBP Preparation of Petition for Distribution 3.00 $275.00 $825.00 Nov-19-12 EBP Meeting with Inez Davis and Gloria Banks at 1.80 $275.00 $495.00 facility Nov-26-12 SLD Telephone call from Carl @ Judge Guido's 0.20 $125.00 $25.00 chambers SLD Draft ltr to Judge Guido; prepare fax 0.40 $125.00 $50.00 coversheet; locate W*M expense detail; scan & email all to JBZ for review; print in final, sign, and fax to Judge's clerk (Carl) per his request Nov-27-12 EBP Conversation with JBZ regarding status 0.20 $275.00 $55.00 JBZ Office conference with EBP regarding update 0.20 $300.00 $60.00 on status of court approval of settlement DAVIIN 1202 58999 7 Nov-29-12 EBP Telephone call with Gloria Banks regarding 0.60 $275.00 $165.00 distributions for benefit of Inez; sole benefit trust for sister etc Nov-30-12 JBZ Receive and review order approving 0.60 $300.00 $180.00 settlement; emails to/from W&M regarding same Dec-03-12 SLD NO CHARGE Scan & save signed Order & 0.40 $125.00 $0.00 TS Petition to pclaw matter; place paper copy into paper file; EBP Drafting petition regarding substitute judgment 0.50 $275.00 $137.50 EBP Telephone call with Gloria regarding approval 0.20 $275.00 $55.00 of settlement Dec-05-12 JBZ Office conference with EBP regarding update 0.20 $300.00 $60.00 JBZ Receive and review W&M settlement package; 0.60 $300.00 $180.00 work on settlement package checklist; instructions to SZ staff Dec-07-12 EBP Preparation of Petition for Distribution; 6.00 $275.00 $1,650.00 telephone call to Gloria Dec-10-12 EBP Revisions to Petition; email exchange with 1.00 $275.00 $275.00 JBZ; instructions to Toya Dec-07-12 EBP NO CHARGE Two telephone messages to 0.20 $275.00 $0.00 Gloria regarding emailing of Petition for Distribution and receipt of settlement funds Dec-10-12 EBP Telephone call with Gloria Banks regarding 0.20 $275.00 $55.00 petition for distribution, receipt of settlement proceeds and DPW Legal Counsel approval; email with attachments for Glorai JBZ Emails to/from EBP regarding review and 0.20 $300.00 $60.00 revisions to Petition for Distribution Dec-11-12 EBP Telephone call with Jeanetta of Metro Bank 0.20 $275.00 $55.00 regarding Gloria's endorsement; email with attachment to Gloria EBP Email exchange with Gloria regarding 0.30 $275.00 $82.50 revisions to Petition Dec-14-12 EBP Email to Gloria Banks regarding completing 0.20 $275.00 $55.00 draft of Petition and additional information needed. Dec-17-12 EBP Telephone call with Gloria Banks regarding 0.20 $275.00 $55.00 petition for distribution Dec-20-12 EBP Conference with Janet regarding medical 0.40 $275.00 $110.00 insurance; attention to reimbursement for Gloria Banks EBP Additional drafting of petition; email to Gloria 2.60 $275.00 $715.00 DAV IIN 1202 58999 8 Dec-21-12 JBZ Emails to/from S. Wells and EBP regarding 0.20 $300.00 $60.00 payee and bank issues with checks Dec-28-12 EBP Email exchange with Gloria regarding requests 0.30 $275.00 $82.50 for distribution Dec-29-12 EBP Preparation of Petition per revisions from 3.00 $275.00 $825.00 Gloria Banks; review of emails and materials from Gloria Banks Dec-31-12 EBP Preparation of Order and Excel Sheet; email to 2.00 $125.00 $250.00 Gloria (billed at paralegal rate) Jan-02-13 EBP Continued revisions and drafting of drafting of 5.00 $275.00 $1,375.00 petition for distribution; email exchanges and review of materials from Gloria Jan-03-13 JKD NO CHARGE Revise petition with Sherry 1.80 $125.00 $0.00 Devlin SLD Format Petition for EBP; 1.00 $125.00 $125.00 EBP Extended telephone conference with Gloria 1.10 $275.00 $302.50 regarding petition for distribution and SNT trust for disabled children Jan-07-13 EBP Preparation of Petition and Exhibits; email 6.00 $275.00 $1,650.00 exchanges with Gloria Jan-08-13 JKD Review and revise petition 0.80 $125.00 $100.00 EBP Revision to Petition regarding additional DME 1.30 $275.00 $357.50 etc; instructions to staff, emails to Gloria JBZ Receive and review W&M lien reserve letter; 0.20 $300.00 $60.00 emails to/from EBP regarding same Jan-10-13 JKD Revise petition 0.70 $125.00 $87.50 Jan-11-13 EBP NO CHARGE Travel to/from Gloria Banks' 0.70 $275.00 $0.00 house EBP Meeting with Gloria regarding petitions and 6.00 $125.00 $750.00 exhibits; revisions to Petition; printing of exhibits etc (billed at paralegal rate) EBP Telephone call with Gloria; revisions to 0.30 $275.00 $82.50 exhibits EBP Revision to distribution request 0.70 $275.00 $192.50 EBP Revision and compiling Petition (billed at 2.00 $125.00 $250.00 paralegal rate) JKD Revise petition; telephone conversation with 3.60 $125.00 $450.00 Cumberland County Orphans' Court regarding filing petition Jan-12-13 EBP Email exchanges with Gloria Banks regarding 3.00 $125.00 $375.00 DAVIIN 1202 58999 9 revisions; revisions to Petition (billed at paralegal rate) Jan-13-13 EBP Email exchanges with Gloria Banks regarding 0.40 $275.00 $110.00 petition and requests for distribution Jan-14-13 SLID Revise Petition; discuss same with EBP; 1.50 $125.00 $187.50 JKD Preparation of exhibits and compilation of 1.40 $125.00 $175.00 petition JBZ Office conference with EBP regarding contents 0.20 $300.00 $60.00 of Petition for approval of expenditures Professional Fees $21,767.50 EXPENSES: Black & White Photocopies $20.00 Overnight Delivery Charges $40.05 Postage $20.85 Nov 16/12 Cumberland County Register of Wills filing fee for Annual Reports of Guardian 2008-2012 $60.00 Okd) Jan 15/13 Register of Wills Cumberland County Filing Fee - DAVIIN1201 Okd) $15.00 Oct 01/12 Expense Recovery Black & White Photocopies 15 @ 0.25 $3.75 Nov 15/12 Expense Recovery Black & White Photocopies 236 @ 0.25 $59.00 Total Expenses $218.65 Total Taxes Charged $0.00 DAVIIN 1202 58999 10 Total due this invoice $21,986.15 Previous Balance $0.00 Payments received on previous balance $0.00 Interest due on overdue balance $0.00 Please Pay This Amount $21986.15 A 1112 % PER MONTH REBILLING CHARGE WHICH IS AN ANNUAL RATE OF 18% WILL BE APPLIED AFTER 30 DAYS. FEDERAL I.D. #25-1839294 DAVIIN1202 EXHIBIT BB Jan 15 13 10:08a Edward Stevens 17176711823 p.1 RHOAD S & SINON LLP ATTORNEYS AT LAW ONE SOUTH MARKET SQUARE P_O. Box 1146 HARMS9URG, PA 17108-1146 TELEPHONE (717) 233-5731 Page 1 Inv# 347350 Date 01/10/2013 Gary and Gloria J Banks client 5460 5776 Catherine Street Matter # 2 SAS Harrisburg, PA 17112 Re: Guardianship petition -J j7AV15 For Professional Services Rendered: HOURS 1.50 12/04/12 SAS Meeting with client; review re: settlement proceeds. .15 12/05/12 SAS Meeting with 1.00 12/05/12 #W Meet with S Smith; research; corr JW ; tele TOTAL HOURS 2.55 TOTAL SERVICES 795.00 TOTAL EXPENSES .00 TOTAL SERVICES 795.00 TOTAL EXPENSES .00 TOTAL THIS INVOICE 795.00 Received Time Jan, 15, 2013 10:07AM No. 4371 Jan 15 13 10:08a Edward Stevens 17176711823 p.2 RE14ITTANCE ADVICE Mail Payments to; One Sinon Market LSquare P.O. Box 1146 Harrisburg, PA 17108-1146 To ensure proper credit, please complete and return this advice 5480 - Matter Number 2 client Number - Gary and Gloria J Banks 5776 Catherine street Harrisburg, PA 17112 Date Amount Invoice Number January 10, 2013 795.00 347350 Date Amount $ Your Check No. 795.00 Total outstanding Balance Due Received Time Jan. 15. 2013 10:07NM No, 4311 CERTIFICATE OF SERVICE I, Jatoya Dayton, an employee with the law firm of SkarlatosZonarich LLC, hereby certify that I this day served a copy of the foregoing PETITION FOR ALLOWANCE OF DISTRIBUTION OF PRINCIPAL upon the person(s) indicated below by United States Mail, postage prepaid, at Harrisburg, Pennsylvania, and addressed as follows: Gloria J. Banks Donald Ray Davis 5776 Catherine St. 927 Cabrera Harrisburg, PA 17112 San Bernadino, CA 92411 Carolyn A. Henderson Michael Anthony Davis 16838 Ceres Ave., Apt. 106 22015 Cherokee Rd. Fontana, CA 92335 Apple Valley, CA 92376 Elsie L. Baker Katheryn L. Alvarez 7367 Central Ave., #152 1933 Lenox St. Highland, CA 92346 Harrisburg, PA 17104 Lisa B. Dees, Esq. Office of Chief Counsel Department of Public Welfare 3rd Floor West, Health & Welfare Building 7th and Forster Streets Harrisburg, PA 17120 Date: January 15, 2013 J o a Dayt L I Assist t