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06-28-13
1505610105 REV-1500 PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes . County Code Year File Number }�(/ Ha BDx rg,PA i d INHERITANCE TAX RETURN t(�HJ It! C) C 3 Harrisburg.PA t7t28-o6ot RESIDENT DECEDENT �J ENTER DECEDENT INFORMATION BELOW 0311212013 02/0811937 Decedent's Last Name Suffix Decedent's First Name MI Buckles Jr Charles A (If Applicable)Enter Surviving Spouse's Information Below - - Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE PILED IN DUPLICATE NTH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW OIC 1.Original Retum O 2.Supplemental Return CS 3. Remainder Return(Date of Death Prior to 12-1382) O 4,Limited Estate p 42.Future Interest Compromise(date of p 5. Federal Estate Tax Return Required death after 12-12-82) CID 8.Decedent Died restate O 7.Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9.LXigation Proceeds Received p 10.Spousal Poverty Credit(Date of Death C=D 11,Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Mabel M Vazquez (717)728-1162 REAM_ OF WAIL SE 014:G rtl T] CT Z t✓ First Line of Address rV t`u't 818 Wertzville Rd > N x °o `� Second Line of Address c') C) n a7 cc t— t.l City or Post Office State ZIP Code --iDATE FI D tin C? Enola aD PA 17025 Correspondent's e-mall address:Chaerikar@aol.com Under panaMres of perjury,I declare that i have examined this return,including accommmyrig schedules and stataments,and to the best of my knowledge and header, A is true,correct ate complete.Dedanda n of preparer other than the personal representative is based on an inflammation of which preparer has any knowledge SIG�RE O PER N RESPONSIBLE FOR F 'G RETURN DATE 1. uw ADDRESS �„/, 1NeY-,+& t t pct 9e'to- PQ_ 1-7 Q:).S IGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 1505610205 REV-1600 EX(F'I) RECAPITULATION 1. Real Estate(Schedule A). ..........."................................ 1. 149,000.00 2. Stocks and Bonds(Schedule B) ....................................... 2. 0.00 3. Closely Held Corporation,Partnership or SoL-Ptoprietwship(Schedule C) ..... 3. 0.00 4. Mortgages and Notes Receivable(Schedule D),.......... ............... 4. 0.00 5, Cash,Bank Deposits and Miscellaneous Personal Property(Schadule E)....... 5. ` 7,550.00 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. 0.00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property ` -- "'-'-""' """" -- ---- ---' (Schedule G) O Separate Billing Requested-, . 7. 10,736.60 8. Total Gross Assets(total Lines 1 through 7)......................... 167,286.60 9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 15,696.75 . 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. 2,871.47 It- Total Deductions(total Lines 9 and 10)................................. it. 18,568.22 12. Not Value of Estate(Line 8 minus Line 11)......................... , 148,718.38 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) ...""........."......... 13. 10,736.60 14. Not Value Subject to Tax(Line 12 minus Lim 13) ........................ 14. 137,981.78 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 ramble at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.O__ 15. 16. Amount of Line 14 taxable at threat rate X.0 45 137,981.78 . 16. 6,209.18 17. Amount of Line 14 taxable `.""„•,.•__ .-.. . ___ __. -._,.,.._ .__„_........,,.�._... ..._.�,_.. at sibling rate X.12 17. t8" Amount of Line 14 taxable " at collateral rate X_15 tg, _ ._...m. 19. TAX DUE......................................................... 19. 6,209.18 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 L 1505610205 1505610205 REV-1506 Eli(FI) Page 3 F09 Number Decedent's Complete Address: DECEDENTS NAME Charles A Buckles Jr STREETADDRFSS 818 Wertzville Rd CITY STATE ZIP Enola PA 17025 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 6,209.18 2. CredblPayments A.Prior Payments 8.Discount Total Credits(A+B) (2) 3. Interest (3) 4. If tine 2 is greater than Line 1+Una 3,enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 5. If Line 1 +Line 3 is greater than tine 2,enter the difference.This is the TAX DUE. (5) 6,209.18 Make check payable to: REGISTER OF WILLS,AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decadent make a banter and: Yes No a. retain the use or inane of the property transferred_........_.............................................................................. 0 0 b. retain the right to designate who shall use the property transferred or its Income ............................................ 0 E c, retain a reversionary interest........................................_................................................................................... 0 ■ d. receive the promise for life of either payments,benefits or care?...................................................................... 0 E 2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death without receiving adequate consideration?...................................................................................._....................... 0 E 3. Did decedent own an 5n trust for or payable-upon-death bank account or security,at his or her death?.............. 0 0 4. Did decedent own an individual retirement accowl,annuity or other non-probate property,which contains a beneficiary designation? ........................................................................................................................ N 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETURN. For dates of death on or after July 1,1994,and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent 172 P.S.§9116(a)(1.1)(j)]. For dates of death on orr after Jan. 1, 1995, the tax rate imposed on the rtet value of transfers to or for the use of the surviving spouse is 0 percent ]72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from lax,and the statutory requirements for disclosure of assets and Ming a tax return are still applicable even 9 the surviving spouse is the only beneficiary, For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent or a stepparent of the child is 0 percent(72 P.S.§9116(a)(1.2)1. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 pawl,except as noted in]72 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent]72 P.S.§9116(a)(1.3)).A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. Ad Preview The Estate of Charles A Buckles Ir. Letters of Administration In Rte Estate of Charles A Suckles,lone of East PennSWm Township,Enola,PA Co. March 124813),have Iselin...Merl to the undersigned,all Perron Indebted to mid estate arc reau]red to make Immediate payment,and those having all clalmawi I present Mem without delay to: Mabel M.Vazauez 018 Wertz dl le Rd Enolu,PA IM25 Product Information Placerient/Classification Run Dates Run Schedule Invoice Text Sort 7 PNCO::FullRun 840W-Metro West Legals 5/14/2013, 5/21/2013,5/28/2013 The Estate of Charles A Bucldes jr. Letters of THEESTATEOFCHARLESABUCKLESJRLETI #Inserts Cost 3 $90.09 Online::FullRun 840W-Metro West Legals 5/14/2013, 5/21/2013,5/28/2013 The Estate of Charles A Bucides jr. Letters of A THEESTATEOFCHARLESABUCKLESJRLETI #Inserts Cost 3 $7.50 5/61201311:40:32AM 2 f paITi0t*'XtWS Order Confirmation Now you know Ad Order Number customer Pavor CUStamer 0002259141 VAZQUEZ,MABEL M. VAZQUEZ,MABEL M. Sales Rep. Customer Account Pavor Account jrogers 21375 21375 Order Taker Customer Address Pavor Address jrogers 818 Wertrville Rd. 818 Werkzville Rd. Order Source ENOLA PA 17025 USA ENOLA PA 17025 USA Phone Customer Phone Pavor Phone 717-728-1162 717-728-1162 PO Number Special Pricing Ordered By None Mabel M.Vazquez -email Customer Fax Customer Entail Tear Sheets Proofs Affidavits Blind Box Promo Type 0 0 1 Invoice Text Materials Net Amount Tax Amount Total Amur $102.59 $0.00 $102.59 Payment Method Payment Amount Amount Due $0.00 $102.59 Ad Numbe Ad Type Ad Size Color 0002259141-01 legal Liners : 1.0 X 13 Li <NONE> Production Method Production Notes Ad Booker External Ad Number Ad Attributes Ad Released Pick Up No 5f6+201311:40:32AM 1 Homeowners policy bill Steleerlr ,Once fi i •V7' .. +: 3&20 Markel St _ -comp Hitl,PA 77017 dli(id 111111((umi(I(dLI(k(pn(I(((I(kirirPl6liilidtiir Information as of February 11,2013 Policyholder Page 1 of 2 CHARLES A BUCKLES 1 R Charles A Buckles Jr 818 WERTZVILLE RD - Policy number - ENOLA PA 17025-1833 008900703 r - Your policy provided by - Allstate Insurance company, . -- Covered property .. 818 WERTZVILLE RD . .+ .-- . . . ENOLA PA 17025-1833 To pay in full $543.40 Policy period - ! ,.' r If . Effective February 3,2013 through - Minimum premium amount due 49.40 .February 3,201412:01 a.m.standard time ' Installment fee —' 3.50 Your Allstate agency is 90 Steiner Insurance _ Minimum amount due by March 3,2013 $52.90 731.5456 You may pay the minimum,or any amount up to the remaining$S4a40 premium amount If you— pay less than$S43.40,we will charge the$3.50 installment fee.You will be charged a$3.SO installment fee each time you pay the minimum amount due or any amount between the minimum HOW TO amount due and the pay in full amount You can ovoid paying installment fees if you pay the pay in EARN A full amount.In that case,you will not he sent a bill until your policy renewak unless you make a "PAYCHECK" . change in coverage resulting in additional premiums.Please see the bock of this bill for payment schedule and history. 1011 LIFE.- Worry less when you retire.An annuity can give you several payout Ways to pay options—including payments for life- - Phone and on-line seH service options are available at call yourAlistate agency to learn more. (1-800-901-1732)or www.allstate-com Go Paperless!View and pay your bill on-line.You can apply for a-Bill by visiting My Account at alistate.comjebiii or go to MyCheckFree.com.Access your bill easily and lower the chances of fraud or identity theft.We'll send you an email letting you know when It's time to view and pay your bill. - - - - Sign up for an automatic payment plan and have your payments automatically deducted from your bank account,credit,or debit card. _ (continued) Detach bottom portion here r ............................._-............-.................-..-......._.....--....................................................................-......................--............-. ...... Return this portion with your payment a"a' �Atfs#a#e. . To pay in full $543.40 You're in good hands. Policyholder Minimum amount due by March 3;2013 $52.90 Charles A Buckles Jr Amount enclosed Policy number Do not 008900703 $$ Da write address arpofky Make caeak armoneyewe, 1'Jill sill l'1"Iii'Ilinlli((rI((li(I(llln(Uli'pll'1'(1'lii"I' change requests on this return Ccrep y.Nealetet alley a ALLSTATE INSURANCE COMPANY porttony mn adyaur agemy. ca1kym P7a,cemdMeraa, PO BOX 4310 pdkyrrum6er.Aaowfrce dots ta,desvexy. CAROL STREAM IL 60197-4310 w)'t J0100700376D000DDD0 8900 703020330005290200000000005434 051 REV-1512 Ex+(12-08) pennsylvania SCHEDULE I DEPARTMENT DE REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN RESIDENT DECEDENT MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH Cwt rai o 75a. / (v yy PennSylvanici_ NQUrolo��'eQJ QSsbeiGt_fCS /�, o0 Nea-I+act "Ct ead 9rC',L`P ao, o0 1�2a ESQ& , 7a Xe e y�l . y a -u.S�ria.p -/aaceS Iu. c�v C24Q Staff 'l��me of �r�aRaS q7, 0 � sc� q y TOTAL (Also enter on Line 10, Recapitulation) If more space is needed, insert additional sheets'of the same size. REV-1511'EX+(10-06) ab SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Charles jfe-- Debts of decedent must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERALEXPENSES: 99J�O .00 1 pxvjt aid son feln't.rQ.( harrL.e 7 Clut�'� Yttie,mozi.a_Q-o j/� Oct , 0 0 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions u �p o}/iptuS /O e`1 5 Name of PersonalRepresentative(s) Street Address lR/g City Jio LQ— State Q-p .G Year(s)Commission Paid: 2. Attorney Fees 1-0 3. Family Exemption:(If decedent's address is not the same as claimant's,attach explanation) Claimant Qb e,l_M�0.i uCpZ 3 5 o b Street Address J<? City Ejanx-0%— State ` 0. zip Relationship of Claimant to Decedent 4. Probate Fees 300-!5b 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL(Also enter on line 9, Recapitulation) $ � 5 (If more space is needed,insert additional sheets of the same size) REV-1510 EX+ (08-09) pennsytvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY Of THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST pFAPPUCaeLEI VALUE 1. (jl vi J0.- /1.y/9,q.2 170 fu,7,*, TOTAL (Also enter on Line 7, Recapitulation) $ U 13 D If more space is needed, use additional sheets of paper of the same size. REV-15U8 EX+(u-io) '-rl-E pennsylvania SCHEDULE E l' DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F, ITEM NUMBER C_. DESCRIPTION VALUE AT DATE 7= _ OF DEATH �g ClVO„yl � /3oO. o 0 56 Ci. 0U '18 Foc' /500. fitsZ S CIOI'I1IIS a, 000 , `=' FLLr n.{{Ur-e_ r 5 U �aa1S a�v ^�JIU n mcsvvers / S116Ve1S 360, TOTAL (Also enter on Line 5, Recapitulation) $ O If more space is needed, use additional sheets of paper of the same size. REV-1502 EX+ (01-10) li:MF pen nsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION �. Qcrz o? bXnl U Bj8 Vv"ertZVktl� �nol� f+l� /d� 000.oo G7 TOTAL(Also enter on Line 1, Recapitulation.) $ If more space is needed, use additional sheets of paper of the same size. DEBBIE LUPOLD,TREASURER TAXPAYER'S COPY 98 S ENOLA DRIVE;ROOM 101 KEEP THIS PORTION FOR YOUR RECORD]S ENOLA,PA 17026 TEMP - RETURN SERVICE REQUESTED 056553-**'*'**"*'**'AUTO'*5•DIGIT 17025 CHARLES A BUCKLES JR 818 WERTZVILLE RD ENOLA PA 17025-1833 Payable To: Office Hours MON THRU THURS SAM-4PM Bill No 1838 DEBBIE LUPOLD,TREASURER OVER 70 ONLY PAY HALF OF BILL Bill Date: 311113 98 S ENOLA DRIVE;ROOM 101 BIRTHDATE f f Control No:09-018210 ENOLA.PA 17025 SIGNATURE PHONE(717)901-9392 111111111111111111111111111 Hill 1111111111111111111111111111111111111 Discount Face Penalty COUNTY PC $4.90 $5.00 $6.50 1,00 FEE FOR ADDITIONAL RECEIPTS MUN PC $4.90 $5.00 $6.60 Tax Payer: CHARLES A BUCKLES JR TAX AMOUNT DUE $9.80 $10.00 $11,00 918 WERTZVILLE RD If Date of Payment Is on 311113 thru 4130113 511113 thru 6130713 711113 or Late ENOLA PA 17026-1833 ........ .. Cumberland County Pennsylvania TAX COLLECTOR COPY-RETURN WITH PAYMENT FOR PROPER CREDIT Bill No: 1938 CHARLES A BUCKLES JR Bill Date: 311113 SIB WERTZVILLE RD Office Hours: MON THRU THURS 9AM-4PM Control No: 09-018210 ENOLA PA 17026-1833 OVER 70 ONLY PAY HALF OF BILL BIRTHDATE— I i SIGNATURE Payable To: occ DEBBIE LUPOLD,TREASURER 98 S ENOLA DRIVE;ROOM 101 Discount Face Penalty ENOLA,PA 17026 COUNTY PC $4.90 $5.00 $5.50 PHONE(717)901-9392 MUN PC $4.90 $5.00 $5.60 TAX AMOUNT DUE $9,90 $10.00 $11.00 If Date of Payment Is on 3/1113 thru 4130113 611113 thru 6130113 711113 or Later TAX PAYER'S COPY- KEEP THIS PORTION FOR YOUR RECORDS Payable To: Office Hours:MON THRU THURS SAM-0PM Bill No: 1838 DEBBIE LUPOLD,TREASURER OVER 70 ONLY PAY HALF OF BILL Bill Date: 3/1113 98 S ENOLA DRIVE;ROOM 101 SIRTHDATE-1-1 Control No:09-018210 ENOLA,PA 17025 SIGNATURE _ PHONE(717)901.9392 OCC klllllllllllllllllllllllilllllllllllll Discount Face Penalty COUNTY PC $4.90 $5.00 $6-50 MUN PC $4.90 $5.00 $6.60 Tax Payer: ..—.- CHARLES A BUCKLES JR TAX AMOUNT DUE $9.80 $10.00 $11.00 818 WERTZVILLE RD If Date of Payment is on 311113 thru 4130113 611113 thru 6130113 711/13 Or Later ENOLA PA 17025-1833 "- TAX INSTRUCTIONS - READ CAREFULLY If you require an official receipt,send your check,two copies and a self-addressed stamped envelope. If not paid by 12131/2013 this bill will be submitted to a collection agency for delinquent collection. Failure to receive a bill does not relieve you from liability for prompt payment. No partial payments or postdated checks will be accepted and payment must be received or U.S.post marked by the due date. '�&ax�E'llau! • � ' • ' • NEW INFORMATION CURRENT INFORMATION Control No: 09-019210 CHARLES A BUCKLES JR 818 WERTZVILLE RD ENOLA PA 17026-1833 Homeowners policy bill Stn7nnr lnso,price Q)Allstate. 3820Market5t You're in good hands. Comp Hitt PA 77077 Information as of March 13,2013 Policyholder Pagel of 2 CHARLES A BUCKLES JR Charles A Buckles Jr 818 WERTZVILLE RD Polic number ENOLA PA 17025-1833 008 900 703 Your policy provided by Allstate Insurance Company Covered property 818 W ERTUILLE RD ENOLA PA 17025.1833 To pay in full $494.00 Policy period Effective February 3,2013 through Minimum premium amount due 49.40_ February 3,201412:01 a.m.standard time Installment fee 3.50 Your Allstate agency is Minimum amount due by April 3,2013 $52.90 Steiner insurance (717)731-5456 You may pay the minimum,or any amount up to the remaining$494.00 premium amount.If you pay less than$494.00,we will charge the$3.SO installment fee. You will be charged o$3.S0 installment fee each time you pay the minimum amount due or any amount between the minimum HOW TO amount due and the pay in full amount.You can ovoid paying installment fees if you pay the pay in EARN A full amount.In that case,you will not be sent a bill until your policy renewal,unless you make a y rt change In coverage resulting in additional premiums.Please see the bark of this bill for payment PAYCHECK schedule and history. FOR LIFE. Worry less when you retire.An annuity can give you several payout Ways to pay options—including payments for life. Phone and on-line sell service options are available at Call your Allstate agency to team more. (1-800.901-1732)or www.allstate.com Go Paperlessl View and pay your bill on-line.You can apply for a-Bill by visiting My Account at alistate.com/ebill or go to MyCheckFree.com.Access your bill easily and lower the chances of fraud or identity theft.We'll send you an email letting you know when it's time to view and pay your bill. Sign up for an automatic payment plan and have your payments automatically deducted from your bank account,credit,or debit card. (continued) Detach bottom portion here ..........................................................................._.........................._............................................................................................................................ Return this portion with your payment o2/0 W Allstate. To pay in full $494.00 You're in good hands. Minimum amount due by April 3,2013 $52.90 Policyholder Charles A Buckles Jr Amount enclosed Policy number Is Do not w 703 Do not write address or Colley Makecheckwmo "rli'1'irlllili'i'iillll"Illiii 111'Ir'iir'iil'r'lil'iii"I'I'irl change requests on this return My want portion,contact your agency. Company,Msseinclude yaw ALLSTATE INSURANCE COMPANY policy nu beer.A include grow PO BOX 4310 polity number.Allow live days for delwery. CAROL STREAM IL 60197-4310 K /010070037600000000690070302033000529020000000000494005/ 152069 Homeowners polic bill Page 2 of 2 Policy number: 008 900 703 g Effective date: February 3,2093 Agency: Steiner Insurance (717)731-5456 Visit My Account at www,alistate.com or contact your Allstate agent The cancellation notice will include the fees and the Minimum Amount to apply. Due for this installment. On-Line Banking when you select online banking through your Terms of agreement forOne•TlmeElectronicWithdrawal financial institution be sure to enter 0089007030203 as the account number and P.O.Box 4310 Carol Stream,IL 60197.4310 as the If you choose to make a payment using your checking account payment address. information,you may be asked to provide the following code 00703. By using this code you authorize Allstate and its affiliates to initiate a one-time electronic withdrawal from your checking account in the amount you specify.Future payments you initiate using the same Transaction history checking account will be sent to your bank as an electronic withdrawal for the amount you specify.The withdrawal may be made from your Date Transaction Amount - Balance checking account as early as the next business day. ` 2/11/13 Previous Balance $54140 If you have any questions,please_contact your agent 3/7/13 , Payment received -52.90 490,50 3/7/13 Installment fee charge +3.50 494.00 Balance(to pay in full) $494.00 Installment schedule i April i May June i July August September - .i 2073 2013 ;2073 2073 '2073 '2073 . .............:..1.................1..............L.......... .....i...l.............:..L............. 3rd 3rd 3rd 3rd 3rd 3rd $52.90 $52.90 $52.90 $52.90 $52.90 $52.90 October i November i December i January _ 2073 c 2073 ;2073 2074 - 3rd 3rd 3rd 3rd $52.90 $52.90 $52.90 $52.90 , What you should know We value your business and want to make sure your policy continues to protect you.Please make sure that we receive this installment payment by the due date so that you are not sent a cancellation notice. (continued) Homeowners policy bill Your Allstate agency is Steiner Insurance o 3820 Market St ° 0 Camp Hill,PA17011 m O 0 m H O N N i M M O M O no Q 0 O O^ G uti Q N O�p N 0 M O 0,0 O k O Account Number Due Date Amount Due 799000 8768012934 06 3125/13 $6418.99 Account Information Statement Date: 311/13 ' 31✓P9'.'!iu�9N' CHARLES BUCKLES AcaOdnz4'h4ngaa--� Phone: 717-728-1162 DIi94mead/P4rPor-y{wr -'..Y _ Gloyreea tadaq ` � Account Summary Previous Balance $433.77 No Payment Received MY VeriZ66 News Balance Forward $aT3.n Great Deal On STARZ Package Now you can get STARZO and ENCORE®for only New Charges $6.00/mo.for 12 momhs.Enjoy up to 29 channels of great programming with 5 in HD.Call Currant Activity - $20794 1-888-456-4491 now to order.Limited—time offer. Specials and Promotions —$8.50 Availability varies and restrictions apply. Taxes,Governmental Surcharges and Fees $5.91 Get More,Save More Vedzan Surcharges and Other Charges&Credits $9,87 Call 1-888-301-7244 to ensure you're getting the Total New Charges due by March 25,2013 $21522 best Vedzon services at a great value—from phone, Internet and TV,to money saving bundles,international Amount Due plans,and tun add—ons.Together we'll find ways to $648.99 save you even more. MOVING?Call 1-866—VZMOVES Call Vedzon before you move to set up your Internet, TV and phone for your new home.Plus,ask about our great new money—saving bundles.Don't wail Call ahead!1-866—VZMOVES.Service availability varies. Warn Automatic Payment? Questions about your bill or service? View your bills in detail at verizon.com or call 1-800—VERIZON(1-800-837-4966). Enroll below or at deduct tit eamou to authorize your financial When asked for your account number,please enter 8768012934.Customers with institution to deduct the amount of your monthly bill from the account associated with your enclosed check and d'ISeblldies call 1-800-974-6006 TiY. send payment directly to Vedzon.To discontinue Automatic Payment,call Vedzon.Please keep a copy of this authorization. lw Please return remit slip with p payment. _______________________________________________________ To enroll in Automatic Paymem/Sign and date below) Account Number: 79 9000 8768012934 06 . New Charges Due: Mar25,2013 Amount Due: $648.99 030113 ay sianmp above I verify Nall nave renewH antl Make check e Abd Ne haa,,arM mWatas at Payable to Venzon vem=.coMaampxyNrms inr aabnaac bin paym $ ❑❑❑.❑❑ KEYLINE CHARLES BUCKLES 818 WERTZVILLE RD VERIZON ENOLA PA 17025-1833 PO BOX 920041 IrrJllrrJllrrdrLLldrrrrllLJr�alliralLnJlLddrJll DALLAS TX 75392-0041 ILr,W,LrrILL1.,61JI1rrrlLrr�l„LrrllLl�l 79 9000 8768012934 06N00000043377 00000064899 08 sery ces 7641 PENN AVE S,SUITE A600 MINNEAPOLIS, MINNESOTA SS423-5004 TELEPHONE 612-243-8620 Hours(CT): 7:00 am - 7:00 pm M -TH FAx 877-326-8784 7:00 am - 5:00 pm E TOLL-FREE 877-326-6762 May 02, 2013 Account No Unpaid Balance Reference No ************1236 $952.18 8967861 Dear Sir or Madam: Our company represents Capital One NBC.. We have learned that CHARLES A BUCKLESJR, who was a valued customer, has passed away. Please accept condolences from our client and our company. As indicated above, there is an unpaid balance on this account. Please accept this letter as a Notice of Claim on behalf of our client. This letter is sent to you solely in your cappacity as ppersonal representative of the Estate of CHARLES A BUCKLESJR. Please understand that it is Capital One N A.'s policy to inform you that only the estate is responsible for any outstanding balance on this account and not you personally. Please call our office toll free at 1-877-326-6762 to discuss resolution of this matter and payment on this account. If you are not the personal representative please contact us with the name and address of the personal representative or attorney who is handling the estate. Cordially, DCM Services, LLC *IMPORTANT NOTICE* Uniess you notify this office within 30 days after receiving this notice that you dispute the validity of this debt or any portion thereof, this office will assume this debt is valid. If you notil this office in writing within 30 days after receiving this notice that you dispute the validity of this debt or any pportion thereof, this office will obtain verification of the debt or a copy of a judgment and mail you a copy of such judgment or verification. If you request of this office in writin within 30 days after receivin this notice this office will provide you with the name and address of the original creditor, indifferent from the current Creditor. This ° a sima d bt coN ctor. We are adttedr tln8 lit collect a debt and any information obtained will be used for that purpose. y�e mon ored or recor a r q a y assurance purposes. NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION -Side 1 of 2- ""Dotach Lower Portion and Return with Payment- DCM SERVICES, LLC 7601 PENN AVE S, SUITE A600 Reference #: 8967861 Client ID: HSBC44 • MINNEAPOLIS, MN 55423-5004 Unpaid Balance: $952.18 ADDRESS SERVICE REQUESTED Checks Payable to: Capital One N.A. Amount Enclosed: 1$ May 02, 2013 If-"fill 11.111111"11111111171 1111.,1.111Crr11d1'IdIHi,,iP11 16517-89 The Estate of CHARLES A BUCKLESJR DCM Services/Capital One Attn:MABLE VASQUEZ PO Box 1420 818 WERTZVILLE RD Minneapolis MN 55440-1420 ENOLA PA 17025-1833 8967861 1236 16517-7099-89 *IMPORTANT INFORMATION* Under the law we are required to notify you of the following information. This list does not include a complete list of rights consumers have under State and Federal Laws. NOTICE ABOUT ELECTRONIC CHECK CONVERSION When you provide a check as payment, you authorize us either to use the information from your check to make a one-time electronic fund transfer from your account or to process the payment as a check transaction. When we use information from your check to make an electronic fund transfer, funds may be withdrawn from your account as soon as the same day we receive your payment, and you will not receive your check back from your financial institution. FOR CALIFORNIA RESIDENTS The state Rosenthal Fair Debt Collection Practices Act and the federal Fair Debt Collection Practices Act require that, except under unusual circumstances, collectors may not contact you before 8:00 a.m. or after 9:00 p.m. They may not harass you by using threats of violence or arrest or by using obscene language. Collectors may not use false or misleading statements or call you at work if they know or have reason to know that you may not receive personal calls at work. For the most part, collectors may not tell another person, other than your attorney or your spouse, about your debt. Collectors may contact another person to confirm your location or enforce a judgement. For more information about debt collection activities, you may contact the Federal Trade Commission at 1-877-FTC-HELP or www.ftc.gov. Nonprofit credit counseling services may be available in the area. FOR COLORADO RESIDENTS FOR INFORMATION ABOUT THE COLORADO FAIR DEBT COLLECTION PRACTICES ACT, SEE WWW.COLORADOATTORNEYGENERAL.GOWCA. A consumer has the right to request in writing that a debt collector or collection agency cease further communication with the consumer. A written request to cease communication will not prohibit the debt collector or collection agency from taking any other action authorized by law to collect the debt. Colorado Office Information: Colorado Manager, Inc. 80 Garden Center, Suite 3, Broomfield, CO 80020, (303) 920-4763. FOR MASSACHUSETTS RESIDENTS NOTICE OF IMPORTANT RIGHTS YOU HAVE THE RIGHT TO MAKE A WRITTEN OR ORAL REQUEST THAT TELEPHONE CALLS REGARDING YOUR DEBT NOT BE MADE TO YOU AT YOUR PLACE OF EMPLOYMENT. ANY SUCH ORAL REQUEST WILL BE VALID FOR ONLY TEN DAYS UNLESS YOU PROVIDE WRITTEN CONFIRMATION OF THE REQUEST POSTMARKED OR DELIVERED WITHIN SEVEN DAYS OF SUCH REQUEST. YOU MAY TERMINATE THIS REQUEST BY WRITING TO THE DEBT COLLECTOR. FOR MINNESOTA RESIDENTS This Collection Agency is licensed by the Minnesota Department of Commerce. FOR NEW YORK CITY RESIDENTS New York City Department of Consumer Affairs License Number: 1239504 To discuss this account, please call our toll free number to speak with Matthew Overas. A representative will be able to assist you during our normal business hours. FOR NORTH CAROLINA RESIDENTS North Carolina Permit Number: 4440 FOR TENNESSEE RESIDENTS This Collection Agency is licensed by the Collection Service Board of the Department of Commerce and Insurance. �y Questions?Please /r3a Visit us aniine at Page 1 RPM *: : �►1 contact us by Apr 12. �J ppieiectric.com t_ 14804-DIAL-PPl Bill Acct. No. Date Amount Due '; , (1-800-342-5775) 56770.72011 Apr 12,2013 kt «1 aw_et«�cuuenoa M-F:gam to 5pm $ Your Electric usage Profile Billing Summary (Billing details on back) Service to: Balance as of Mar 22,2013 $0.21 CHARLES BUCKLES JR Charges: 818 WERTZVILLE RD Total PPL Electric Utilities Charges $269.34 ENOLA, PA 17025 Meter:42267078 Total Charges _ $269.55 Your next meter reading is on or about Apr 23,2013, aunt pipg BY Apr,i2;2Q13 ' twt i r E my $2 .5$ This section helps you understand your year-to-year Account Balance $269.55 electric use by month. Meter readings are actual unless PPL Electric Utilities'price to compare for your rate is$0.07237 per kWh. otherwise noted. This changes the 1st of Mar,Jun,Sept,and Dec.Visit papowerswitch.com 2012 2013 or www.oca.state_pa.us for supplier offers. 120 s 100 Your Message Center — 3 . Budget Summary: eo We billed you $480.00 B 60 Including this bill,you used SWEA After this payment,your budget is behind $126.46 40 and$117.37 remains from last year's Budget Plan a 20 settlement. 0 • With paperless billing,you can receive and pay your $ I F M A M J t A s o N D PPL Electric Utilities bills online.The process is free, g Months quick,convenient and secure.To learn more or sign up, visit pplelectrk.com. Monthly Days Average Avera : Information about appliance energy use and tips on Comparison saving energy are available through the Energy Library an our Web site,pplelectric.com. Mar 2013 2g 2500 89 37F Mar 2012 29 1829 fi3 48F BillingPeriod Type Readin Payment Methods Mar 22 Actual 74541 Online at: ©By phone:1-800-342-5775 Feb 22 Actual 72041 ppielectric.com or call BitlMatrix(service fee applies) at 1-WD-672-2413 to pay using Visa, 28 Days kWh Billed 2500 MasterCard, Discover or debit card. _ Total Yearly Comparison ® By Mail: Correspondence should be sent to: o Apr 2012- Mar 2013 2708fi 2 North 9th Street Customer Services 2257 _ CPC-GENN3 827 Hausman Road Apr 2011-Mar 2012 24217 2018 Allentown,PA 18101-1175 Allentown,PA 18104-9392 Other important information on the back of this bill p '0•,'_ ® Return this part in the envelope - s, - Annotint • - ppt provided with a check payable ,IK Ej�umm„ to PPL Electric Utilities. 56770-72011 1 Apr 12, 2013 7 $269.55 Amount Enclosed: qp7 AV 01 007790 31556B 28 A*•5DGT ❑n FIF]❑[111 IL,I!l�,i61,11lIld'll°11 1'it°II'II'111l11111911'1,111„6d CHARLES BUCKLES,JR PPL ELECTRIC UTILITIES 818 WERTZVILLE RD 2 NORTH 9TH STREET CPC-GENNI ENOLA,PA 17025-1833 ALLENTOWN, PA 18109-1975 III .III III i„1111111111`I']lll ill 111'11F1'll'l113.1.1„lII,II'II 1 7500002695550000269552 5677072011 Your Default Supplier Contact info. Billing Details - (Bill Acct. 56770-72011) rage 2 For questions regarding the generation and transmission Previous Balance portions of this bill,please contact your supplier at: Payment Received Mar 5,2013-Thank You -$269.13 ' ® PPL Electric Utilities Phone: Customer Services 1-80D-342-5775 Balance cis of Mdr11,2013 $0.21 827 Hausman Rd (1-800-DIAL-PPL) Allentown, PA 18104-9392 Charges for-PPL Electric Utilities ppietectric.com Residential Rate:RS for Feb 22-Mar 22 Distribution Charge: Customer Charge 14.17 Manage Your Account 2,500 kWh at 3.146000001 per kWh 78.65 PA Tax Adj Surcharge at-0.07300000% -0.07 Visit pplelectric.com for self-service options Transmission Charge: Including: 2,500 kWh at 0.687000000 er kWh 17.18 . -View your bill,payment,and usage history. PA Tax Adi Surcharge at-0.08500000% -0.01 payment,set up a payment agreement. Generation Charge: -Make a p Capacity and Energy -Start/stop service. 2,500 kWh at 6.624999000 per kWh 165.62 -Enroll in paperless billing,automatic bill pay, PA Tax Adj Surcharge at-0.08500000910 -0.14, budget billing. Total PPL Electric Utilities Charges -$275.40, -Report an outage,check outage status,and more. Your Budget Plan Amount $240.00 View your rate schedule at pplelectric.comjrates or call i-800.342-5775 to request a copy. Other Charges for PPL Electric Utilities Budget Settlement Installment Amount 29:34 General Information °° " Tbfai of Other Charges, $29.34 Generation prices and charges are set by the electric generation supplier you have chosen. The Public Amour"nTDue B Ipr 1 2013 $264a`�5 Utility Commission regulates distribution rates and Account Balance $269.55 services. The Federal Energy Regulatory Commission regulates transmission prices and services. PPL Electric Utilities uses about$0,28 of this bill to pay state taxes and about$14.17 is used to pay the PA Gross Receipts Tax. .-- Understanding Your Bill Budget Billing-Plan that provides for equal monthly State Tax Adjustment Surcharge-Charge or credit on electric payments. rates to refie t changes in various state taxes included In your Customer Charge-Monthly basic distribution charge to cover bill. The surc arge may vary by bill component. costs for billing,meter reading,equipment,maintenance and Transmission Charge-Charge for moving high voltage advanced metering when in use. electricity from a generation facility to the distribution lines of 11 Distribution Charge-Charge for the use of local wires, an electric distribution company. transformers,substations and other equipment used to deliver Type s)of Meter Readings: electricity to end-use consumers from the high voltage ACual-Reading by distribution company. - transmission lines. Generation Charge-Charge for the production of electricity. kWh(Kilowatt-hour)-The basic unit of electric enersy for which most customers are charged. The amount of electricity used by ten I00•watt lights left on for 1 hour. Consumers are usually charged for electricity in cents per kilowatt-hour. Rate RS-Rate for service to a private home. ! $269.34 EASTERN ACCOUNT SYSTEM Y Po sox 1022 OF CONNECTICUT, INC. Wixom MI 48393-1022 ADDRESS SERVICE REQUESTED P.O.Box 837 • Newtown,CT 06470 (800)750-6343 Notice Date:January 11,2013 ACCOUNT IDENTIFICATION EAS Account Number:25857074 25857074-FINALCBL 953632181 Creditor#* 187901-2 'I'I'lll�il'�I'II'IIIII�I'lll�"'��JI�I�'Idlh�ll�rllr�ll�llhl Creditor:COMCAST HARRISBURG SERVICE PERSONAL&CONFIDENTIAL Balance Due: $69.51 CHARLES BUCKLES JR 818 Wenzville Rd Service Balance Due: $ 69.51 Enola PA 17025-1833 Equipment Balance (if not returned) : $ 0.00 Total Balance Due: $ 69.51 ***FINAL NOTICE*** Our records indicate that you owe$69.51 which is long past due. Pay this account immediately. This is absolutely final. **IMPORTANT** To be sure of proper credit and to stop further procedure make your payment in full. This is an attempt to collect a debt. Any information obtained from you or anyone else will be used for that purpose. This communication has been sent by a debt collector. 69CU065427FINALCBL ------------------------------------------------------Detach and Return with Payment------------------------------------------------------ Enter the requested information in the spaces provided below: Creditor#: 187901-2 Enclosing this notice with your payment will expedite credit to your account. Creditor:COMCAST HARRISBURG SERVICE Change of Address: Notice Date:January 11,2013 EAS Account Number: 25857074 For: CHARLES BUCKLES JR Balance Due: $69.51 Amount Enclosed:$ Street Address: City,State,Zip: '1'@lephone: Eastern Account System of Connecticut, Inc. Please charge to my: PO Box 837 DW Amount Enclosed:$ I 'II" Newtown CT 06470-0837 Card Number ���nu�l w�n��u�lllu���ur�u�urlll�u��ulhlur�r�r��� Expiration Date / Security Code(from back of card) Name of Cardholder Service Balance Due: $ 69.51 Signature Equipment Balance (if not returned) : $ 0.00 Total Balance Due: $ 69.51 All completed payments are subject to a$2.95 processing fee charged FINALCBL by a third party vendor.Or visit www.castempayments.cwm. greatcall. P.O. sbad, C28 Remittance section Carlsbad, CA 92018 people you can count on! Invoice Date: Feb 17, 2013 Account Number: 759009 Past Due- Please Pay Immediately: $0.00 Address Service Requested Current Charges Due by 3/7/2013: $64.44 Please return this remittmce with your check and make payable re:Jitterbug D Check here for change of address(see reverse for details) Please wit your payment col 2963001630 PRESORT 18301 AB 0.354 PIC18<Br 4tn!!lflfuflfllnn111h111t1b111lttf Eltha•uytl.plt4lgi GREATCALL,INC. CHARLES BUCKLESJR DEPT 892102 515 wERTZVILLE RD RO BOX 122102 ENOLA PA 17025-1833 DALLAS,TX 75312-2102 flu.fldflptpinuallalillftfflfnldllhfgfflllulluPpl.f 0022459276000075900900000064442 Please return above portion with your payment Keep tower portion for your records. Account Summary Never miss an important date or Payments T_......... _..Y. ... .............................. $-64.44 appointment with MyCalendar. Previous Balance ................................................................. $0.00 Keeping track of important events has nn Maypps+ never been easier. The MyCalmdar app ^ tA9PMajinn bw Monthly Service Charge .... $53.99 will u sound h alert on need t ne bug°to lei uohn a ai uw,y '°"""'°""""""""""""""""" you know where you need to be and when. I Regulatory Fees and Taxes .......... $10,45 GreatCau®operators can even add events P"s """""""'"""""" to your calendar for you,so updates appear Total Current Charges ....-......... $64,44 right on your phone. Best of all,this app ""'°"""""""°""""""" is FREE! MyCalendar is a great reminder r-------- -•—�°- --^------------9 tool to keep you connected to friends and kTota! Amount Due in USD: ............................ $64.44 family,plus managing Mycatendar is easy — L_______�_ at mygreatcaiLcom. In I- A 1,, U.S.e sivi Ont S uemmmnGfil(o wail 6rcarttlrs IMink.II.S.n,in snvke.`411 k`6tpnu+w w ,nnav, xhkhti ni Er smnInaih din,s sefibed"Car'. Nun in On opnm.pin n tie ral5 al the nil re nir[N nm[t1M br r' epeenotplustn MtlilbM SMlmiMS.CPonithnitllthuatM4lnKtllnn rcsiumsiraimuntdcrmtsfl.'n.smcuantm�ercdnadmurt olStmHmt(intmits[o..Utl.[Pons(MO1012 WtKalttn<. Important Message: Get free shipping with the purchase of a Beaded Lanyard. Designed to clasp easily to the top of the Jitterbug,the$14.99 beaded lanyard is the stylish way to secure your phone. Call 1-800-733-6632 today to purchase your lanyard, and you'll even get FREE ground shipping on your order! Free games designed to improve !�® � memory and focus Introducing Quick Match and Make A Pair— two innovative new Brain Games developed by Posit Science,a leading provider of clinically proven brain fitness games.They're available now for FREE on your Jitterbug,and you can play them > anytime,anywhere,by simply using the buttons on your phone.Cali 1-800-733-6632 112:3 it to activate Brain Games today and see if you can set the high score! - There are no additional fees to call GreaK6tl's 24-hour U.S.Based Customer Service.However for calls to an Operator in which service is completed,minutes will be deductedfromyour monthly batameecual to the length of the call and anycaii connected by an Operator,plus an additional 5 minutes Jitterbug and GreatCaii are registered trademarks of GmatCall,Inc.Samsung is a registered trademark of Samsung Electronics Co.Ltd.Copyright 02013 GmatCall,Inc. page I of 4 Copyright 2010 Greatcall.Inc Have you moved or changed your phone number? Please provide your new address or telephone number and return this portion with your payment. Account Name: Account Number: New Address: Phone Number: City: State: Zip: Phone Number: Wbrk Number: "Place of primary use" (PPU) -The home or business mailing address indicated above is for the person using the phone and is the person's residential street address or primary business street address: YES, NO_ If NO or for multi-line accounts with more than one PPU address,please contact our Customer Service Department at 1-800-733-6632. Usage Charges We charge airtime for incoming and outgoing calls,including toll-free and operator assisted calls and calls to retrieve voicemail messages from your phone.You will incur usage charges at a minimum rate of$0.35 per minute if you exceed your service plan minutes.Sending and receiving photos is billed $0.25 1photo up to a maximum of$10.00 per month;services such as Simple Text may also have additional charges. Taxes, Fees and Discretionary Charges Taxes.fees and other charges will apply to your wireless service and will be reflected on your bill.GreatCall Imposes a Regulatory Cost Recovery Charge to help defray costs incurred to comply with State and Federal telecommunications regulations,such as E91 I deployment,State and Federal Universal Service,and other government mandates.These charges are not taxes or government required assessments on end-user customers. An explanation of these charges can be found at http:Jt www.greatcall.com/AboutGreatCallService, International Calling and Text Charges If you use your phone while traveling or connecting with friends and family in countries outside the United States or Canada,international rates will be charged,including mobile to mobile calls placed under our Simply Share plans. • There are no long distance(or roaming)charges for any calls made to Canada.Regular plan minutes are deducted for the length of the call. • To call Mexico,Puerto Rico or the US Virgin Islands,you will be charged$0.20 1minute for each minute of the call. In addition,regular plan minutes are also deducted for the length of the call. • To call everywhere else in the world from the United States,you will be charged$1.00/minute for each minute of the call,In addition,regular plan minutes are deducted for the length of the call. • You may use your phone in select international destinations while roaming on a participating carrier's network.You will be charged$2.00/minute for each minute of the call. • You may use your phone on select cruise ships. You will be charged$2.501minute for each minute of the call. • Incoming text messages from international locations are charged at $0.20 per message.Outgoing text messages to international locations are charged$0.50 per message. Simply Unlimited Calling and Text Charges With the Simply Unlimited rate plan,domestic available minutes are unlimited and there are no fees assessed for calls to our Operator Assistance. Standard and International text messaging rates apply,W ith unlimited minutes,the following international calling rates will be charged in place of those noted under International Calling and Text Charges: • To call Mexico,Puerto Rico or the US Virgin Islands,you will be charged$0.55 1minute for each minute of the call. • To call everywhere else in the world from the United States,you will be charged$1.351minute for each minute of the call. • Cruise ship and international roaming rates apply. Operator Assistance Our friendly,U.S.based Operator Assistance is available 24 hours a day to assist you.For each call to our Operator Assistance you will be charged a 5 minute connection fee in addition to the minutes used both for the length of the call with the Operator and any call transferred by the Operator, Calls to Verizon or National Directory Assistance will be charged$1.50 per call plus airtime. Service Cancellation • If for any reason you are not completely satisfied with your service and you wish to cancel,you'll be able to do so at any time according to the terms of cancellation described below.However,if you have purchased any Add on Minutes,they are not refundable and these minutes will expire after your last bill. • You will receive a final bill that will detail all the charges and credits on your account, • If you wish to cancel your service before the end of a given month,you'll be responsible for any account charges and overages through the date of your last bill. • Although cancellations are effective immediately,we do not bill for partial months;therefore.you will be charged for the entire month in the billing period. • Please call our Customer Service Department at 1.800-733-6632,24 hours a day,7 days a week,to cancel your account For More Information Please refer to your Customer Agreement or contact us: fly phone: Customer Service at 1-800-733.6632 Via email: Billing @GreatCall.com Via mail: Customer Service,P.O.Box 4428,Carlsbad,CA 92018 Hours of operation: 24 hours a day,7 days a week. Remit payments to: Dept 892102,P.O.Box 122102,Dallas,TX 75312-2102 Visit www.GreatCall.com to view your bill online,update your phone list,make a payment or make changes to your profile. bug-168933 page 2 of 1 Copyright 2010 Greatuii,Inc. r Date Pat#I Prvo I Msg Service Description CPT Dx I Charge JPayme ** Payy�mm�ent due u[[tt1�on Receipt. If you have any questions please call the *** tfri*c*t.Brti:irfctDi&,t De ar m-.ent Toes-Friday*8am-4pm taut*7 17-7F,7t4-2 2ib2t*�°tT<ti3,'t*r.***********A*,*tfr* 02/08/13 1 8 L OFFICE VISIT EST LEVEL 3 99213 436 120.00 02/08/13 Credit Card Payment 25.00 02/20/13 FREEDOM BLUE Payment 34.85 02/20/13 Accept Assign Adj . -50. 15 10.00* Ala-° L-The 'PLEASE PAY' includes unpaid co-pay or co-ins. Please make payment. DATE LAST PAID AMOUNT • , • .� • � 02/08/13 25.00 10.00 0.00 0.00 1 0.00 1 0.00 0.00 0. 10.00 Pennsylvania Neurological Associates MAKE 110 Lowther Street CNECN PAYA8LEro: Lemoyne, PA 17043-2012 Payment Due Upon Receipt 10.00* Ph: (717)-774-2202 PAT# 1-CHARLES BUCKLES JR PRV# 8-FAIRCLOTH, VIVIAN C. , M. Acct#: 60828. Date: 02/26/13 Page 1 of 1• Account #: 261745 Please Pay: $20.00 Due Date: 06/03/13 Date Description Charges Insurance Patient Balance Balance CHARLES A BUCKLES JR IDM 261745/WALTER B WATKIN MD 01/30/2013 LIPID PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: CHOLESTEROL, SERU 35.00 35.00 01/30/2013 COMPREHENSIVE METABOLIC PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: 25.00 25.00 01/30/2013 HEMOGLOBIN: GLYCATED 23.00 23.00 01/30/2013 BLOOD COUNT: HEMOGRAM AND PLATELET COUNT, AUTOMATED, AND AUTOMATED C 19.00 19.00 03/01/2013 CONTRACTUAL ADJUSTMENT FROM BLUE SHIELD -45.02 _ _03/01/2013 PAYMENT_FROM BLUE SHIELD -36.98 - MESSAGES EXPLAINED__-._BELOW------..--...-.-..-.—.._..-...__-..-..__...-..e.o.__._-..._N_„_.._..._.___...�.._._._.._._...__..,,._.a......_..._ D- • • • • • - * Payment due upon Receipt. If you have any questions please call the i°** ** Billing Department Tues-Friday 8am-4om at 717-774-22 2 opt3. *** isiriri:*t.rYfiicir rksc:r ic�k iri:t.,i ir�ti:�:irir��,ir�Yr4t* ri;i.-i:irir r3c 4r3:firticstirtrir�:iciriric attirr.,Yiriricir x;s;r;is 4c:ri:rtr4a4 r:iric irir�Y 02/08/13 1 8 L OFFICE VISIT EST LEVEL 3 99213 436 120.00 02/08/13 Credit Card Payment 25,00 02/20/13 FREEDOM BLUE Payment 34.85 02/20/13 Accept Assign Adj. -50.15 10,00* �r4-0 L-The `PLEASE PAY` includes unpaid cc-pay or co-ins. Please make payment. DATE LAST PAID I AMOUNT J11= • - i -9-" 0ver12O 02/08/13 25.00 10.00 0.00 0.00 0.00 0.00 0.00 0. 10.00 Pennsylvania Neurological Associates CHECK 110 Lowther Street PArneLETO: Lemoyne, PA 17043-2012 Payment Due Upon Receipt 10.00* Ph: (717)-774-2202 PAT// 1-CHARLES BUCKLES JR PRV// 8-FAIRCLOTH, VIVIAN C. , M. Acct#: 60828 Date: 02/26/13 Page 1 of 1 Account #: 261745 Please Pay: $20.00 Due Date: 06/03/13 Date Description Char es Insurance Patient 9 Balance Balance F A BUCKLES JR ZD# 281745/WAITER B WATKIN 1MD 01/30/2013 NEL THIS PANEL MUST INCLUDE THE FOLLOWING: CHOLESTEROL, SERU 35.00 35.00 01/30/2013 NSIVE METABOLIC PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: 25.00 2S.00 01/30/2013 HEMOGLOBIN; GLYCATED 23.90 23.00 01/30/2013 BLOOD COUNT; HEMOGRAM AND PLATELET COUNT, AUTOMATED, AND AUTOMATED C 19.00 19.00 03/01/2013 CONTRACTUAL ADJUSTMENT FROM BLUE SHIELD -4S.02 03/01/2013 PAYMENT FROM BLUE SHIELD -36.98 03/01/2013 PATIENT RESPONSIBILITY - THE BALANCE IS YOUR CO-INSURANCE WHICH IS -20.00 20.00 NOT COVERED BY YOUR INSURANCE. HOWEVER, IF YOU ARE ENROLLED IN AN HRA OR HSA PLEASE CONTACT YOUR PLAN ADMINISTRATOR PRIOR TO MAKING PAYMENT. THIS WILL AVOID AN OVERPAYMENT ON YOUR ACCOUNT. .` BALANCE 'TICKET #PLAB046S90'• 0.00 20.00 Important Messa a About Your Account Total Balance 20.00 Insurance Pending Amount Due 20.00 Make Checks t� For Billing Questions Call: Payable To: Pinnacle Health Medical Group, Inc (717) 809.7118 z 22 PLEASE DO NOT SEND CASH THROUGH THE MAIL PGP039 000ioea Your Check is Good Here CHECK POLICY By using a check for payment, you agree to the following terms: In the event your check is dishonored or returned for any reason, you authorize us to electronically (or by paper draft) re= present the check to-your-ba n k-accou nt-for.col lectionof. the amount of the check, plus any applicable fees as permitted by state law. s 866/860-5906 Re$ubmltlt t`' .r 'ah ;`�.. ¢�� ;'ta�'S OtiT�ID - lrJ• � � -rY•.'C���:� C t�'+ �.y i``�'E o`sn�� 3' > �uf�ill�.z�i�� � :t•e,>,'Y'sti•' y .wP 'h ". � '.I lR.sis1.V..,•11y.SfhK�IY ...�� �� y _ 1 rr.�'� � ixa: ¢X?,p - ��g�iyT'l""•r5 �J _ '+i' �'- � , -- � -� T 'rsn3� fY'*�'Y3y iti g.TVU �Stl bilY'-w�S�YCiCT7CCL3. '_ .Na5y�; "� ,rL•: ��C;4�.t1�"�,^��+'.-': w '� :+Pa%s"+.F' ..y-.ac. ��H$r�X '%k :�a'�'Mat�'�rPeisonat ->entative-'���_,�'�',�s.��HI,,,���.•�1�&57"'i?�'�` -i•5�,v�'Iai7�;�UrCounsetc�!Ezmn� ti�'�y"�"'a�e��.''��:-x&v �' .ri° iRYA N J RECEIPT NO. Payee Name: Sean Potter, Esq. Payer Name: Mabel Vazquez Address: 15 East Main Address: City, ST ZIP Code: New Bloomfield, PA City, ST ZIP Code: DATE DESCRIPTION: AMOUNT 3/19/13 Retainer $330.00 SUBTOTAL TAX TOTAL $330.00 Auto policy bill Policy number: r9-2-89-89-13-11 Page 2 of 2 Effective date: November 16,2012 Agency: Steiner Insurance (717}731-5456 Visit My Account at www.alistate.com or contact your Allstate agent using this code you authorize Allstate and its affiliates to initiate to apply. one-time electronic withdrawal from your checking account in the On4ine Banking when you select online banking through your amount you specify.Future payments you initiate using the same financial institution be sure to enter 9289891311116 as the account checking account will be sent to your bank as an electronic withdrawal number and P.O.Box 4310 Carol Stream,IL 60197-4310 as the for the amount you specify.The withdrawal may be made from your payment address. checking account as early as the next business day. If you have any questions,please contact your agent. You can keep the Responsible Payer Discount through your policy Transaction history period as long as we receive at least the minimum amount due for each bill by the specified due date{ Date Transaction Amount Balance 1/26/13 Previous Balance $261.21 2/9/13 Payment received -90.57 170.64 2/9/13 Installment fee charge +3.50 174.14 Balance(to pay in full) $174.14 Installment schedule March ;April 2013 :2073 ,.......f........................: Mth 16th $9057 $90.57 What you should know We value your business and want to make sure your policy continues to protect you.Please make sure that we receive this installment payment by the due date so that you are not sent a cancellation notice. The cancellation notice will include the fees and the Minimum Amount Due for this installment. Terms of agreement for One-Time Electronic Withdrawal If you choose to make a payment using your checking account information,you may be asked to provide the following code 89131.By (vantinuedi Auto policy bill ry M w Your Allstate agency is Stelaerinsurance 3820 Market St a Camp Hill,PA 17011 m m ry 0 gm F 0 as N 1�Q Y,1,O IV CI Q O G JN O n O ry m O O�� Auto policy bill Steiner ImalanCe 3820 Market St Camp Hill,PA 17011 Information as of February 23,2013 �lIll rrllrlIrlurl III rsy'lllllllllrl1illll11 lllrrl"I��IIIIi1lll Policyholder Page I of 2 CHARLES BUCKLES JR Charles Buckles Jr 818 WERTZVILLE RD ENOLA PA 17025-1833 Policy number 92 8 9 89 131 Your policy provided by Allstate Fire and Casualty Insurance Co Covered vehicles 1978 Chevy Truck Blazer 1988 Dodge Vans Grand Carlow To pay in full $174.14 Policy period Effective November 16,2012 through Minimum premium amount due 87.07 May 16,2013 12:01 a.m.standard time Installmentfee 3.50 Your Allstate agency is Minimum amount due by March 16,2013 $90.57 Steiner Insurance (717)731.5456 You may pay the minimum,or any amount up to the remaining$174.14 premium amount.if you pay s� less than$174.14,we will charge the$3.50 installment fee You will be charged a$150 installment fee each time you pay the minimum amount due or any amount between the minimum amount due HOW TO and the pay in full amount.You can avoid paying installment fees if you pay the pay in full amount. EARN A i In that case,you will not be sent a bill until your policy renewal,unless you make a change in coverage resulting in additional premiums Please see the bock of this hill for payment schedule and "PAYCHECK" history. FOR LIFE. Worry less when you retire.An Ways t0 a annuity can give you several payout y pay options—including payments for life. Phone and on-line self service options are available at CallyourAllstate agency to learn more. (1-800-901-1732)or www.allstate.com aaaaaaal Go Paperlessl View and pay your bill on-line.You can apply for a-Bill by visiting My Account at allstate.com/ebill or go to MyCheckFree.com.Access your bill easily and lower the chances of fraud or identity theft.We'll send you an email lettingyou know when it's time to view and pay your bill. Sign up for an automatic payment plan and have your payments automatically deducted from your bank account,credit,or debit card. (contimred) Detach bottom portion here ........................................................................................................................................................................................................................ Return this portion with your payment 11/16 ®Allstate. To pay in full $174.14 you're in good hands. Minimum amount due by March 16,2013 $90.57 Policyholder Charles Buckles Jr Amount enclosed Policy number 928989131 $ Do not write address orpollcy Make shed ar money arde. nII11sIl11rrl�ll'�II'IJd"I1II"'Irs11111-11111,11111111 change requests on this return payable to A/&late Fire and portion,contact your agency. Casuaay insurance Ca Please ALLSTATE FIRE AND CASUALTY INSURANCE CO include your policy rumber. PO BOX 4310 Alkne flue days far delivery. CAROL STREAM IL 60197-4310 /027010037300000042896913111162000905710000000000174144/ Ad Preview The Estate of Chorle&A Bucklo Ir. Letters of Administration In the Estate of Charles A Buckles,late of Egat Pennsbon Township,Enolu,PA(d. MWO 11,101]),hove Oven Granted to The underall all Person Indebted to mid nfate one required to make Immediate payment,and those having all claims will preeent them without delay to: Mabel M.Vazquez 619 Wert"I lie Rd Enolo,PA 1N Product Inforrnallon Placerrfent)Classi8cation Run Dates Run Schedule Invoice Text Sort Text PNCO::FullRun 84OW-Metro West Legals 5/14/2013, 5/21/2013, 5/28/2013 The Estate of Charles A Bucldesjr. Letters of A THEESTATEOFCHARLESABUCKLESJRLETl #Inserts Cost 3 $90.09 Online::FullRun 840W-Metro West Legals 5/14/2013, 5/2112013, 5/2812013 The Estate of Charles A Bucldes jr. Letters of A THEESTATEOFCHARLESABUCKLESJRLETI #Inserts cost 3 $7.50 5/6/201311:40:32AM 2 he Paftid-NCWS Order Confirmation Now you know Ad Order Number Custorner Pay"Customer 0002259141 VAZQUEZ,MABEL M. VAZQUEZ,MABEL M. Sales Rea Customer Account Pavor Account jrogers 21375 21375 Order Taker Customer Address Pavor Address jrogers 818 Wertzville Rd. 818 Wertzville Rd. Order Source ENOLA PA 17025 USA ENOLA PA 17025 USA Phone Customer Phone Pavor Phone 717-728-1162 717-728-1162 PO Number Soecial Pricing Ordered By None Mabel M.Vazquez -email Customer Fax Customer EMail Tear Sheets Proofs Affidavits Blind Box Promo Tyoe 0 0 1 Invoice Text Materials Net Amount Tax Amount Total Amount $102.59 $0.00 $102.59 Payment Method Payment Amount Amount Due $0.00 $102.59 Ad Number Ad Tyne Ad Size Color 0002259141-01 Legal Liners : 1.0 X 13 Li <NONE> Production Method Production Notes Ad Booker External Ad Number Ad Attributes Ad Released Pick Uo No 516t201311:40:32AM 1 Homeowners policy bill Steiner Insurance 3820 Market St Camp Hill,PA 17011 Information as of February 11,2013 1111114 111114111111111111111 Policyholder Page Iof2 CHARLES A BUCKLES J R Charles A Buckles Jr 818 WERTZVILLE RD Poll c number ENOLA PA 17025-1833 008900703 Your policy provided by Allstate Insurance Company Covered property 818 WERTZVILLE RD ENOLA PA 17025-1833 To pay in full $543.40 Policy period Effective February 3,2013 through Minimum premium amount due 49.40 February 3,201412:01 a.m.standard time Installment fee 3.50 Your Allstate agency is Minimum amount due by March 3,2013 $52.90 Steiner insurance (717)731-5456 You may pay the minimum,or any amount up to the remaining$54340 premium amount.If you pay less than$543.40,we will charge the$3.50 installment fee You will be charged a$3.50 installment fee each time you pay the minimum amount due or any amount between the minimum HOW TO amount due and the pay in full amount.You can avoid paying installment fees if you pay the pay in EARNA o;O full amount.In that case,you will not be sent a bill until your policy renewal,unless you make a "PAYCHECK" change in coverage resulting in additional premiums.Please see the back of this bill for payment schedule end history. FOR LIFE. Worry less when you retire.An annuity can give you several payout Ways to pay options—including payments for life. Phone and on-line self servke options are available at Call yaw Allstate agency to team more. (1-800-901-1732)or www.allstate.com Go Paperless!View and pay your bill on-line.You can apply for a-Bill by visiting My Account at allstate.com/ebill or go to MyCheckFree.com.Access your bill easily and lower the chances of a fraud or identity theft.We'll send you an email letting you know when it's time to view and pay your bill. Sign up for an automatic payment plan and have your payments automatically deducted from your bank account,credit,or debit card. (continued) Detach bottom portion here ........................................................................................................................................................................................................................ Return this portion with your payment 02/03 Allstate. To pay in full $543.40 You're in good hands. Minimum amount due by March 3,2013 $52.90 Policyholder Charles A Buckles Jr Amount enclosed Policy number Do not 703 $ Do rrot write address orpollry Make char[or money order 111111 gill 11111111 gill nlll 'III�II�Illlll'Ilil'1'il'l "1B change requests on this return payable to Marine Insurance ALLSTATE INSURANCE COMPANY portion,contact your agency. Company.Please indude your PO STATE I0 pdu:y number.Allow five days fmde&ery. CAROL STREAM IL 60197-4310 /0100700376000000008 90070302033000529020000000000543405/ Cumberland County Pennsylvania rr I • • W, • • • :• -• TAX COLLECTOR COPY- RETURN WITH PAYMENT FOR PROPER CREDIT Bill No 889 BUCKLES,CHARLES A JR 818 WERTZVILLE ROAD Bill Date: 311113 818 WERTZVILLE RD &MASLAND ROAD Control No:09002668 ENOLA PA 17025-1833 �—q AND APPROX 1 ACRE MAP NO: 09-14-0835-064. P° k. cres 1 Deed 0019400980 n I� q Payable To: WAY 2 0 201 A sessed Value: Land:52.000 Improvement:97,000 Total:149,000 DEBBIE LUPOLD,TREASU E F 98 S ENOLA DRIVE;ROOM EBBIE LUPOL Discount Face Penalty ENOLA,PA 17025 �aST PEAINSSOR0 Countv RE 2.131 311.17 TREA.Si'(cR ounh,Lib 9 0.143 $20.88 $21-31 $9344 PHONE(717)9019392 1111111111111111111111 fill 11111111 A TAX AMOUNT DUE $471.79 $481.42 $529.56 If Date of Payment Is On 311t 3 Ibru 413011 3 5 1/ 3 hr 6 3 F13 / 13 o La Sovereign Mini-statement ESTATE OF CHARLES A BUCKLES JR Account numbex:231372691 210"/531358 A list of recent transactions on your account BALANCE SURR Y Type Amount($) Available 11169.08 Ledger 1,169.08 PENDING ACTIVITY Date Details Deposit($) Withdrawal($) POSTED ACTIVITY Date Details Deposit($) Withdrawal($) Balance($) 06/03/2013 Deposit '138.00 1,169.08 05/28/2013 Check 000000000102 -461.42 431.06 05/22/2013 Check 000000000995 -10.00 912.50 05/22/2013 Check 000000000103 -20.00 922.50 05/07/2013 Check 000000000101 -162.00 942.50 04/26/2013 Deposit 1,104.50 1,104.50 P-r+n-t—K-eV--B u-t-p-u t pa-g-e-1— • 1 5761SSI V6R1MO 080215 SlOSS97E 05/20/13 13: 38: 16 2 3 - 4—D-i-s-p-l-a y-De v-i-c-e . . . . . .—DSP05 - User . . . . . . . . . CELINE -1-NGU-I-R-Y— UT-H-I-T-Y--C-U STOMER-AGGOUNT-1-N 7 - UC511S-2 Customer Balance Inquiry 13: 38: 13 ---C --E-S-A --C-us-t-I-D. -HARL 2 Sery Loc ID. WERTZVILRD00818 Sery Loc. . . . 618 WERTZVILLE ROAD L 1 Screen. . . . . . . A 12 - 3 - Since Last Bill Period-to-Date 14 Previous Balance . 00 16 9 - Pmts, Applied Dep -138. 00 -828. 00 17 - Adjustments . 00 . 00 to—p-ena-l-ty-/-D-i-s-c-ount G- Current Charges . 00 82e. 00 7,—Cu-r-ren-t-Ba-"n-e-e A—, 22 0 ; Last Payment Amt 136. 00 Budget Billing ? 24 Y 0 Last Bill ID 20130412 IM Last Bill Date 04/01/2013 Delinquent Notice ? N 17 201 1 029 HELP F3=E xit F6=Switch F20=Notepad ,� 32 33 31 11 !36 42 43 44