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02-05-14 (2)
1 1505610105 �I REV-1500 PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 28o6oa INHERITANCE RESI TAX RETURN `f[ ,x Harrisburg,PA i7m8-o6o1 RESIDENT DECEDENT �/j( P ENTER DECEDENT INFORMATION BELOW a3 i�( aD1-3 —J o—sai i9 3.3 1 Decedent's Last Name [(Suf"Rx Decedent's First Name {MCI L- L`ov rMAA/ l..___ —J f—ox � FI (N Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE � N A REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW AM 1,Original Return Q 2.Supplemental Return C=) 3, Remainder Return(Date of Death Pnor to 12-13-82) p 4.Limited Estate C:)i 4a.Future Interest Compromise(date of C=> 6. Federal Estate Tax Return Required - death after 12-12.82) { C=D 8.Decedent Died Testate C=) 7.Decedent Maintained a Living Trust ! 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) C= 9,Litigation Proceeds Received C=> 10.Spousal Poverty Credit(Date of Death C=> 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-96) (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name _ - Daytime Telephone Number --}{ iCO3RA C. I>12'('C11 REGISTER OF WILLS USE ONLY First Line of Address { Lill 4 cKoRy ROAD I C= Second Line of Address r— rn m rn City or Pmt Office�- State ZIP Code %TE Im c>_.c -?t Corresponthnrs etnaD address- Q 2-to CR• o r tr-, } C1 M ri.i 1 s C'OAA -ri --} c`1 - rrv- ITt UMer penalties of Part",,I declare that I have examined this return,including accompanying schedules and statements,IrA to the best of riowle6tlga arW belief, It is torn,correct and complete.Declaration of pmparer other than the personal representative Is based on all Information of which preparer has any knowledge. SIGNAT4tW_OF P=N RESPONSUILEFOR FILING RETURN 1••-�D¢TE5 a� ADDRESS - ti4 o�u � i�AD , CA �° LiSLE� PA 17015 SIGNATURE OF PREPARER OTHER TH REPRESENTAT GATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 i 1505610105 1505610105 I 1 1505610205 REV-1500 EX(Fl) , ce RECAPITULATION / !. Real Estate(Schedule A). ...... ,...... 1. i © I 000 t 00 2. Stocks and Bonds(Schedule 8) ........................................ 2. 0 . 00 3. Closefy Held Caporallon,Partnership or Sole-Proprietorship(Schedule C) ..... 1 Gr � � 4, Mortgages and Notes Receivable(Schedule D)........................... 4. 0 r (`�Q S. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5, 7 0 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... C 0, 00 7. Inter-Wros Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested,.,..... 7. 9i 57 01 c F o h v h 8. Total Gross Assets(total Lines 1 through 7)............................. o 9 & Q 0 . 9. Funeral Expenses and AdmtnistraWs Costs(Schedule H)................ 10. Debts of Decedent,Mortgage Liabilities and Lions(Schedule 1)............... 10. ( 3 Ll 1 00 11. Total Deductfons(total Unes 9 and'10)......, 12. Net Value of Estate(Una 8 minus Line 11)............................... 12, �._/� (') ! 13. Charitable and Governmental BequestsfSec 9113 Trusts for which `�'�V an election to tax has not been made(Schedule J) ........................ 11 6100 14. Not Value Subject to Tax(Line 12 minus Line 13) ........................ 14. y a 6 @ r q1 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Una 14 taxable at the spousal tax rate,or transfers under Sec.9118 -----•- (ax12)X.0.,,_ - 15. 16. Amount of line 14 taxable �1 / �/ / p p —•° at lineal rate X.0 Q}5' 1_J o� 6 �' D , // 16. 17. Amount of Una 14 taxable l at sling rate X 12 77. 18. Amount of Una 14 taxable ' at collateral rate X.15 t8, 19. TAX DUE......................................................... % 1 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Will 2 1505610205 1505610205 REV-1500 EX(FY) Pap 3 File Number Decedent's Complete Address: DECEDENTS NAME Lo 1' 5 T. CLOU -rMAN STREET ADDRESS `109 86"'(6147-01V 1Dk4f CITY L f 6 STATE G7 I Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) 2. CreftPayments A.Prior Payments B.Discount Total Credits(A+8) (2) 1 Interest (3) 4. It Line 2 is greater than Urve I+Line 3,enter the difference. This is the OVERPAYMENT. F1111 In oval on Page Z Une 20 to request a refund. (4) 5. If Line I+Une 3 Is greater than Une 2,enter the difference.This is the TAX DUE. (5) Make check payable to: REGISTER OF WILLS,AGENT 7 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN nXn IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes NO a. retain the use or incomai of the property transferred........--.......,».........._......,..._............_........_...... ❑ 91 b. retain the right to designate who shall use the property trarisferred or Its income ............................................ c. retain a reversionary interest..........................................-..................................................................... H d. receive the promise for life of either payments,benefits or care?..... ......... ............... ❑ 2. 9 death occurred after Dec.12, 1982.did decedent transfer property within one year of death without receiving adequate consideration? ............. .......—....-......... ❑ 3. Did decedent own an'in trust W or payable-upon-death bank account or security at his or her death?.............. 1:1 4. Did decedent own an individual retirement account,annuity or other non-probate property which contains a beneficiary designation? ......................................-.:.......-......................................--.......... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994,and before Jan.I,1M.the tax rate imposed on the net value of transfers to or for the use of the survMng-spouse is 3 percent[72 F.S.§9116(a)(1.1)@]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)@)).The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and fifing a tax return are still applimWe even if the surviving spouse is the only beneficiary. For dates of death on or after July 1.2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent or a stepparent of the child is 0 percent R2 P.S.§9116(a)(1,2)]. • The tax rate imposed on the not value of transfers to or for the use of the decedents lineal beneficiaries is 4,5 percent,except as noted in V2 P.S.§9116(a)(1)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. ' r REV-1502 EX+(12-12) _: pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INNEWANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Lo 1 S Y Ct...ov- mlol 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 jolnity-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 DESCRSFTIDN hor��Dr,v�P�. _y �a-_ - ► 3pI poc2 1 Clt Pti SZo , A_ _--,.pA7� u TOTAL(Also enter on line 1,Recapitulation.) s.__—J 6,o-ot 'rI If more space Is needed,use additional sheets of paper of the same size. . Previous edBiass araabsaere tam tiUG-}ia78fiYieFYIar6corm ads A. Settlement Statement U.S.Dsoartment of Housmo and Urban Development S.Type of Loan OMB Approval No,25020265 1. OFHA 2. OFmHA 3. OCom.Unins. 6.File Number 7.Loan Number 8.Mortgage Insurance Case Number 4. OVA 5. 00onv.Ins. PY013.OMS Ne'ai Pa t TtleExpress Settlement System C.Note: HemsnWkee is ac6 ewh paid raWGatemoeere shown hero to ism ir" any sairre twn.pedarm ma Wtels. WARNING;nisadimet.e arxr or make fart.stetemas Wthe V(Wat S.Code Sedaarryotlrer soar fam.PenAltles upon axwicam cmtinGU.eatme mtd en .Fa+fesaits sea�Tak}8U.S.COtle Section 1001 and S.cu.n 7616. D.NAME OF BORROWER: June R.Baer ADDRESS: E.NAME OF SELLER Estate of Lois Jean Cloutman l ADDRESS: 1 F.NAME OF LENDER: ADDRESS: G.PROPERTY ADDRESS: 109 Brighton Drive,Carlisle,PA 17015 Parcel 40.09.0529090 South Middleton Township H.SETTLEMENT AGENT: Pyramid Land Transfer LLC PLACE OF SETTLEMENT: 26 West High Street Carlisle,PA 17013 I.SETTLEMENT DATE: 09/2612013 J. SUMMARY OF BORROWEMS TRANSACTION: K SLIMWAY OF SELLEWS TRAM A-MO : 100.GROSS AMOUNT DUE FROM BORROWER 400.GROSS AMOUNT DUE TO SELLER 101. Contract sales price 1300Q0.00 401. Contract sates price 130000.00 102, Personal propeft 402 Personal property 103. Settlerneat durnies to borrower(fine 140D) 874.50 403, 104. 404. 105. 405. 'ustments for items paid bv setier'at advance Ad tntents for flerrts Paid by seller in advance 107. County taxes 0912611302131113 84.95 407. como taxes 09t26tt3t612131113 84.95 108. Schod Texas 09126H306P30714 790.57 408._SclwdTaxes 09PL6fl3ta06r30H4 790.57 109. 405. 110. 410, __ -.__ 111.' 411. 112. 412. _1_20.GROSS AMOUNT DUE FROM BORROWER_ ..,...-------.._133,2§0=02 420.GROSS AMOUNT DUE TO SELLER � 130875.52 200.AM61JifS PAID BY OR ON SENALF OF BORROWER 500.REDUCTIONS IN AMOUNT DUE TO SELLER 201. Detxici ar camnst .net _ 2 000"r _ 501. _> Demull(see tstrcx r��. Zif2.Pars amourst ruwk�n _ _ 5}2 -..-------------._8.54-46 201 Existng_iva* take wb`egto_._., 503. Exisiin nars'takarsr 3to 2M. PRC Bank Payoii 0 - „---._.. Ascensionyoint Recovery 207. 507. BonTon Ctaun 800.00 As,conslonpoint Recovery 208, 508. Sears Mastercard Claim 1980.00 Ascensionpolyrt Recovery 209. 509. Capital Bank HSN Claim Z156.79 Asconsionpolat Recovery Adjustments for items unpaid by seller Adjustments for items unpaid bw seller 213. 513, 214. 514. 215- 515, 216. 516, 217. 517. 218, 518. 219. _ 519. 220.TOTAL PAID 8YIFOR BORROWER _. ..7a0tlQ.Olt..,520.TOTAL REDUCTION AMOUNT DUE SELLER 1_�..._. ...117,275.9t1 300.CASH AT SETTLEMENT FROM OR TO BORROWER Btkl.CASH AT 5ETTLF* ETiT TO OR FROM SELLER 301. Gross amount due from borrower litre 120 133 750.02 601. Gross amount due to sober{f w 4201 .�_. 130,875.52' arratrcds�lt�r.Zge 520 - " 117275°0 121 GROSS AMOUNT DUE FROM BORROWER 133,750.02 420,GROSS AMOUNT DUE TO SELLER 200.AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500.REDUCTIONS IN AMOUNT DUE TO SELLER 201. Deposit w eamest num 2,000.00 501. Excess Deposk(see htsbucgons) 2D2. Pdndpal amount d new toans 502 WftTmA0aMLstg sew trmel400) 8,544.46 203. Eyisfing loan ts)taken.subledto 503. EdAng &Wen su *ed to 204. 504. Nyoff of Fast Mortgam Lm 99 764.65 PNC Bank - -- --------------------'i�-------------- 205. -565. flayWof semW mmtqme 506. MMaskmwd(Um 4.030.00 ntRecov 207, 507. BonTon Cwm 800.00 Ascensionpoint Recovery 208. 508. Sears Magemad Ckim 1,980.00 A=nion 'rd Rocoymy 209. 1 509. CapW Sank HSN Uaim Z156.79 Ascension�- Recav ... Adiusq-merft for ftons lm aid by seftr Adfushnoft. for ftem unsaid by s d le-r 213. 513. 214. 514. 215. 515. 216. 516. 217 517. 218. 518. 219. 519. 220.TOTAL PAID SYTOR BORROWER 2,000.00 520.TOTAL REDUCTION AMOUNT DUE SELLER 275.90 300.300.CASH AT SETTLEMENT FROM OR TO BORROWER 600.CASH AT SETTLEMENT TO OR FROM SELLER 301. Gross amount due from borrower are 1201 133,75D.02 601. Gmss amount 1 1 130,875.52 302.-1m.ammaftPaidbyffort 602. LeSSm&xfmwmuntgp§0�ft5m 117,275LW 303.CASH FROM BORROWER 131,750.02 603.CASH TO SELLER 13.599.62 SUBSTITUTE FORM IWO SELLER STATEUMT r0k7fona5onow**Wdlw,ob l5knpoia WkftMa�a1disb==t0thet �= a rewml� SELLER INSTRUCTIONS: complete the�'-,mb'e pmts OFwm4797,Famr6252andlorSd.dLdRD(F..IG40). You are tK4 J1 by law W PfUwde ft Wftlernent agent(Fed.Tax ID No: yow cor tupayor i0enldiration nwm -9 YOU dorove Provide Yom coe umm1w x1arlKwafiml TIN: J SELLERS)SIGNATURNS): I SELLER(S)NEWMAUNGADDRESS: Pre+iws etli .obsof r form HUD4(M)ref"Mxbuo643052 U.S.DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT He Number:PY013.82 PAGE 2 SEAMEMENT STATEMENT TitleExpress Setllemwt Svstem L SETTLEMENT CHARGES PAID FROM PAID FROM 700. TOTAL SALESIBROKER'S COMMISSION based an price 5130 000.00 4.500=5,850.00 BORROWER'S SELLER'S DivWon of commission me 7110 as follows: FUNDS AT FUNDS AT 701. 3250.00 to Remax Realty SETTLEMENT SETTLEMENT 702. 2,600.00 to Real Estate Excel 701 Commission Md at SetUement -5.8-5-0.0-0 704. Transaction Fee to Real Estate Excel 250.00 800.ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Od 'nation Fee % 802. Loan Discount % 803. Appraisal Fee 804. Credit Report 805. 806. 807. 808. 809. 810. 811. 9D0.ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest Rom to /day 902 ModgmelaarmcePremium for to _ 903. Hazard Insurance Premium for to State Farm 293.00 904. 9115. _ 1000.RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard hmrrance mo. /mo 1002 w4w hlsurax:e m0.0$ !m0 _ 1003.Crty Roperty Tax mo. hrm -- 1004. Tax mo. E Imo 1005. S(acol Taxes mo. loro _---- 1009.Aggrecoe ushwm 1100.TITLE CHARGES 1101. SeUlancmt or Closkm Fee 1102 Ab*worTNeSeamh 1103.Tide Fxm*k#!on _ 1104. Title Insurance Binder__ 1105. Document Preparaflon is Salzmann Hughes 75.00 1106. Notary Fees 1107.AUome s fees indudes above items No: 1108.Title Inswace to Pyramid Land Transfer LLC 1050.00 indudes above Uems No: 1109. Lenders Policy 1110. Owneesporicy 130 000.00 -1050.00 1111. 1112. 1113. 1200.GOVERNMENT RECORDING AND TRANSFER CHARGES 1201.Recording Fees Deed$67.00 -Release 67.00 12112. Deed 1 .00 1 .00 1203. State Taxlstamps Deed$1.300.00 :Mod9aee 1300.00 1204.Electronic FlI ing Fee to ACCP Eloqtronic Filing 4.50 1205. - 1300.ADDITIONAL SETTLEMENT CHARGES mm 1301. Feral Water/Sewer to SMTMA 11727 I-lyngo 1302. Roof Repair Reimbursement to Xm CoiOns _ 2p.00 b R rt Catms 351. 3 $10. 900.ITEMS RMUMM BY LENDER TO BE PAID IN ADVANCE 901. Inkast From 902, MoNyp mwmm fte"m for to 9D3. Hazard kMrdAM Pro ft= far to State Farm 293.00 904. 905. 1000.RESERVES DEPOSITED WITH LENDER FOR 1001.Hazard hsmame mm as 1002 Mortgagge kmmm mo.a$ h"D 1003.City PmpertY Tax m(@$ /MD 1004.CwW PM"Tax coo.@$ /MO 1005.Saw Tam mo.Q /M IOD9.AgMegate An*sis A4mfIvaial 1100.TrrLE CHARGES 1102 Ab"or TMe Search 1103. Tiffeg�!�on 1104. rifle lrmrdnoeBklm 1105. Moo lim NOUNYFM 1107.AflerrrWs fees Cmdudes above A"MY ..... 1108,Tit hisorance tD Pyrinald Land Transfor LIC 1050.00 fmdu*s abm ftem No, 1109.Lender's y 11#O.ONDa's1 d" ,130000.00 -1050.10 1112 m ------- 1113. 1200.GOVERNMENT RECORD0I6 AND TRANSFER CHAR 1201,RemmSMFees DaW$67A :Morlww$ Release$ 67.00 1202, DountyfuMarrm Deed$1,300.00 ;Mortgage$ 1 00 1203.Stater Deed$1,300.00 -Mort $ 1.300.00 1204.Eledrunic Fdh-q Fee to ACCP Ekcb=*Filing 4.50 12DS. 1300.ADDITIONAL SETTLEMENT CHARGES 1301,Fbial WaterSevver w SUM 117.27 1302.Roof Repair R&&nevnent to AM COMM 200.E 1303_2013Com Taws -_to g2bgrt Cairns 351.63 13D4,Tax Cwt kafim to Robert Calms 1305.0wTw,*SpOcWAaseTSnla ftSum:rTcrftWH0A 169.00 1306.Res*C!9- to Surnmerfield HOA 100.00 n 160.00 160.00 130&OMMLd� to ra WdLarid.Transfer LLC 30.56 1400.TOTAL SETTLEMENT CHARGES jErIwon Ines 103 Sedw J Td- Sedw 8,544.46� HWCMTWICATMOFSUVVRANOSElI R Im to IRA)- am*mm IOSa s mooms a copy at ft HLDl Smilmod T.-a R-Mw- r.-Y 7w x WARNING,IT IS A CRIME TO MOVKNGLYMAKr FALSE STATEMENTS M IM The Hulm%ommi swwmMamidl share wapod is a wI mw =.*a ascpraat aft Vaasmlaa. UNITED STATES ON THIS OR ANY SOAR FORM,PENALTIES UPON CONVICTION I Im"eaaeal w coa.etlm fix,4s Mb d.Wwd in CAN INCLUDE A FINE ANO RA MOMIENT FOR OETA&S SEE TITLE 18: US.CODE SECTION IMI AND SECTION 1010, 15-1 3�� So. VAIL REV-1508 E)(+(08.12) i pennsy[vania SCHEDULE E RiT DeARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH J001 C.hg5fPr_PT Cruiser 1_ 3700., 00 accovltt ;4- 34,33609 �-- 0.1 G_ 3� PMC Gkp c �-In 9 ac,c,ov� } jt Sl I y3 -ad 3 LNJo -- . _ _ .� . . `� ' J✓�Pv� ►den s S� r c tJ ce r ;Fd c� �_Sa.u,�9 s I.o .aa-7.3S o�ccovn�huM.�_a�(13g3 _ 5' PmkllawN Giro dens I &76 . 5-0 �. CID_nfienfis dF SAFe dQpoS; F hoX _q( y.a�6a 7�' {�ou,S?ho-Id_Cnooas 0. 00 r - I _ L TOTAL(Also enter on Une 5, Recapitulation) $ i cjs- 0i� If more space Is needed,use additional sheets of paper of the same size. + 1 31 5 5 34 2702 323001 t 13155 3427 025323-001 WID: 13155 3427 025323-001 REcoRD: 20833 TIT S574S384 3 AL 0610612023 PA Messenger solutions Pennsylvania Department of Transportation Applicant Summary Statement Transaction: PA Title,registration Processor: Sollenbergers - Carlisle/83-532 Processed By: DAN - Darcie Heil Purchase Date: 6/4/13 Process Date: 6/4/13 - Temp Tag Date: 06/13 Prev Title No: 55745384 Prev OuD Title Count: State of Date VIN: 3C4FY4882IT604954 Condition: G unladen weight: Chassis wftr: yr/Hake: 2001 CHRYSLER Body: SW GVWR: Body make: Odom Readingg: 58047 Fuel: GASOLINE/G GCwR: Seat Cap: Odom kual: ACTUAL MILEAGE/O Purch Prc: 3,700.00 No of Axles: Brands: T140MA5 R 6 JENNIFER A ALLEMAN/s - [ ] Tenant in 575 RIDGE RD Survivorsh'z? ' OILLSBURG PA rx) 17019 :t'----R' CCF Disabled veteran: Trade in J1 Information lien Holder [1 information Fees A sales Tax Information VIN: ARA: Tax exempt Reason: Sales/use Tax: c YR: Tax Exempt NO: Motor van. Fees: Make: Taxable Sale Price: 3,700,00 Other Fees: 0100 Condition: sales tax credit: 0.00 Total: 780.50 Allowance: override Code: Trade In r2: Amount waived: .00 Allowance: [ ] ELT Lien Holder I2: ASSigned Tag Type: PASSENGER/01 Class: Assigned Exp Sticker NO: Assigned Tag NO: 3HT3856 Beg. Gvw: class Sticker No: - A55i ned EXP Date: 05/31/2014 RED. GCW: Transferred Title No: - sfgnatwc of Person fran Man Tag IS acing Transferred: Transferred Tag No: [ ] w/Renewal Relation To Applicant: [ ] W/Tag Repl No of Du Reg Cards: 0 f I w EXCh I/we ackrowledge that I/we may lose my/our operating privileges) or vehicle registration(s) for failure to maintain financial responsibility on the currently registered vehicle for the period of registration. Ijwe further acknowledge that Ilea maybe subject to a fine not exceeding S5,000 and imprisonment of not more than two (2) years for any false statement that I/we make on this form, and I/we certify that t/we have examined and signed this form after its completion; and that if an exemption from payment of sales tax is claimed, I am/we are authorized to claim this exemption. I/we further certify that all statements herein am true and correct and make application for certificate of title for the vehicle described above. Date subscribed and Sworn to: 51 tun cant grryuthorized Signer: 06/04/2013 /dC Signature of Notary Administering oath: Si Ature of c6-own er/T f A oriz S [ ] VIN/GVWR C rtificatioO or Tracing is Reoui-edi E Place Signature of Person verifying VI`:F_^.,y: «-s-..at....,� #.w. I hereb certify that I i-ave ve^—s� t-= A this veKicle and the +<.:^>,^rc °st'.e. aa-a= L - SIGN' ,ar- .•' OET8GTt here - - - - -.• - - - - - - -• - - - — in Wp''M— - - - - - - — n '. .••- OetaC-6 Hem COMMONWEALTH OF PENNSYLVANrA RSMWI#A$ION `t."� I M % a1. fr+Ca �'� EXPIRY: MAY 31,2014 AL ID �1lioi _ O PURE 7Hf $6 SIG E Y Ia i` VIM S� ill 1 . '' $b g�.a... jf w kY'y yi 'm YR/SNKE. 'it 'a tYSiiEN't P- 'n 'ay< ' = i'a `R h F ,! - l eamby admaimiedge Bxa day Ban f news reteWed ..D .TYPE:, N '14 Y"°^.-�4r` '� ::..;>:.a �+�.?' - n ooms of fie pmdmaee of seotbn 37M of Be vie" WID: -'13155 3427 025323-001 EMISSIONS INSPECTION RWrRED/DIESEL VEHICLES EXEMPT COUNTY:YORK W 039036 THOMAS R & JENNIFER A ALLEMAN 575 RIDGE RD + DILLSBURG PA 17019 ! m3 : 1 IM FMM20 South Main Street PO Box TF M Chmbersbu r g,PA 17201 Last statement: April 16, 2013 Page 1 of 2 This statement: May 16, 2013 0003433609 Total days in statement period: 30 111 Direct inquiries to: ,,,,,,,,, - AUTO"3-DIGIT 170 717 960-1400 25370.77&1 AB 0.384 11199 F&M Trust "I,hlillo11111'1411i11914111'"11111111'1'11"1'11'1'1119 1901 Ritner Highway LOIS JEAN CLOUTMAN Carlisle, PA 17013 109 BRIGHTON DR CARLISLE PA 17015-6930 Freedom First Checking Account number 0003433609 Beginning bal 0.56 Enclosures 1 Total Ions 16 . Low balance $-110.56 subtractions 8.0 Average balance $-48.88 jEnding balance $49.66 Avg collected balance g-48,0 Interest paid year to date $0.02 DEBITS Date Description Subtractions __ -- ---- 115 76 - Service Charge - - ---- --_- -- -- — ___ - 8.00--=°- ---�- MAINTENANCE CREDITS Date Description Additions 05-06 Credit Memo 130.22 05-06 ' Overdraft Fee Refund 30.00 - 04/04/13 COURTESY COVERAGE FEE 05-p6 ' Maintenance Fee Rfnd 04/16/13 FEE 8-00 DAILY BALANCES Date Amount Date Amount Date Amount 0416 110.56 05-06 57.66 05-16 49.66 INTEREST INFORMATION Annual percentage yield earned 0.00% Interest-bearing days 30 Average balance for APY $21 14 Interest earned $0.00 Performance Checking Statement PNCBANK PNCBmdr P—ary account number. 51-1431-2232 Page 1 of2 Forthepadod 03==13 to 0910812013 Number of enclosures., 0 LOIS JEAN CLOUIMAN 95 For 24-hour banking,and transaction or 109 BRIGHTON DR interest rate information:sign-on to CARLISLE PA 170158930 PNC Bank Online Banking at pnc.com For customer service call 14865-PNC4000 Monday-Friday-7 AM-10 PM ET Saturday 8 Sunday.8 AM-5 PM ET Para servicio an espanol,1.866-HOLA-PNC Mtwing7 Please contact us at 1-866-PNG 4000 ® Write to: Customer Service PO Box 609 Pittsburgh,PA 152304738 BARBARA MILLER Relationship Manager Visit us at pnc.com Private Client Group TOD terminal:1.800.531-1648 1-717-240.0059 bartrommiller@pnc.com For hearing impaired clients only Performance ChecWng Lots Jean Clouanan Interest CheMng Account Summary Annul number, 51-1431-2232 Overdraft Protection has not been established for this account Please contact us If you would like to set up this service. Overdraft Coverage -Your account is currently Opted-M. You or yourioint owner may revoke your o"or optout choice at any time. To team mere abmn PNC Overdran solutions visa us Orem at pnc.mMwcdreflsdWw Call 1-877-5118-36(15.vist any smnch.or Sign on to PNC Online rdanNrrg and selectare'Overdran SotWoW reds under the Aocount Servkes section to menage both your Overdraft Coverage and Over" ProAeWm settings. Balance Summary 8= Oapadla and Checlm and ettm balarne other sddlew dedudbns bala�tree 2,795.98 502.70 493.11 2,805.57 Average a fees 2,576.68 .00 Interest Summary s As of 04/08,a total of$.03 in interest was paid this year. Annual P�ercemaa Number ddays in Averapemgacted Interest paid Vhdd APYE) interest peow bagncefwAPYE this period 0.01% 31 2,576.68 - .02 Activity Detail Deposft and Odw Additions There were 2 Deposits and Other Date Amount Doser"on Additions totaling$502.70. 03/29 502.68 Direct Deposit-Pension FIDELITY INIVESTM X)000(32358 04/08__ .02 Interest Pavmertt Mar DedyCdOns There was 1 Other Deduction Dare Amount Desulption totaling$493.11. 03115 493.11 Loan Payment 00000 4001008116547664 -��rtormance Cheddnq Statement areoerlod 03I9M13 to 0410812013 '+`_, r«zuanainf«meuoaylgammrnc a.ataarme eenwia LOIS JEAN CLOUTMAN Pdmervaccount member. 51-143112-q7 Account Number. 51-1431-2232 -wntinuol Pepe 21."" Daily Balance Detail Date Balenw Dam Bamnw Date Belenw Dare 6alanw 03/09 2,795.98 03115 2,302.87 03129 2,805.55 04108 2,80557 Buying? Refinancing? Go with Today's interest rates are at near-historic lows.If you are planning to buy a new home or refinance your -axistina loan to lower your rate or monthly payment,talk with a PNC Mortgage Loan Officer today!Stop by your local PNC Bank branch or call 855-892-6335. E PNC s a registered service mark of The PNC Financial Services Group,Inc.("PNC").PNC Mortgage is a division of PNC Bank,National Association,a subsidiary of PNC. All loans are provided by PNC Bank, National Association and are subject to credit approval and property appraisal. ic)2013 The PNC Financial Services Group,Inc.All rights reserved. PNC Bank,National Association. Member FDIC. PNC Mortgage is an Equal Housing Lender. --ti Member FDIC Q Equal Housing Lender fit" i3E:3: .a , ., ;" .a,rF. ' .,,, i!.'..'T'i'.*�i , � .. _. .:'t inn � G St 60Send 00 Inquires Statement of Accounts 6000 Loulse Drive PO Sint 40 Mechanicsburg,PA 17055 Feb 25, 2013 thru Mar 24, 2013 v .membnalstcrg vi Maln Switchboard: (800)283.2328 EZ Call: (717)697.4372 er(NO)283.4372 Account Number: 241393 ® TDD: (717)697-5312 or(800)283-2328 ext.5312 TeleBrnnch: (800)237-7288 MEMBERS V Balances at a Glance: FEDERAL CREDIT UNION Checking: 0.00 4687 1 AV 0.360 9373-4687 Savings: 34.80 _ lP�hlhdrllnlrllll'lulllrunll"PI'Puuhgplpllplll Certificates: 10, 185.73 LOIS J CLOUTMAN Loans: 0.00 109 BRIGHTON DRIVE Money Management: 0.00 CARLISLE PA 170156930 Swipe 5 YTD Reward: 0.10 Page: 1 of 2 Your current Member Loyalty Rewards level is Silver. Your aggregate balance as of March 1st.is $10,355.53. An aggregate balance of$15,000 and having 3 products - ---- will move you to.the.Gold level. We're looking for the"Best of Show-Dog"-and "Best of Show-Cat"I Enter our Pet Photo Contest today. See the enclosed insert for more details. CHECKING ACCOUNTS 0011 -CHECKING Date Transaction Description -- Feb 25 Balance Forward '.. . Feb 28 Deposit Swipe 5 Rebate 0, " S: Mar 05 Deposit Transfer From Share 0000 2^,- 135.95 Mar 05 Withdrawal ACH AD8D800-860-7182 . 1 300- 400 TYPE: INS PREM ID: 1621282786 DATA: MEC!3=RS 1ST FEDERAL CO: AD&D800-860-7182 Mar 24 Ending Balance 0.00 SAVINGS ACCOUNTS r 0000-REGULAR SAVINGS f, Date Transaction Description ; Additions M Subtractions Balance - Feb 25 Balance Forward t 54.86 Feb 28 Deposit Dividend 0.2000,6 0,01 54.87 Annual Percentage Yield Earned 0.240%from 0210 112 0 13 through 0212812013 Mar 05 Withdrawal Transfer To Share 0011 ! 20.07- 34.80 Mar 24 Endbrg Balance J I 34.80 CERTIFICATE ACCOUNTS., ; ;, 0040-19 MONTH CERT Maturity Date.-Apr 05, 2013 Date Transaction Description Additions Subtractions Balance Feb 25 Balance Forward 10,176.05 Feb 28 Deposit Dividend 1.240% 9.68 10,185.73 Annual Penrnlage Yield Earned 1.250,6 from 02101/2013 Onough 0212812013 Mar 24 Endbrg Balance 10,185.73 Farklawns Memorial Gardens and Mausoleums April 3, 2013 ,,bra Dortch 44 Hickory Road _ Carlisle, PA 17015 Dear Ms. DortCh. We are contacting you in regards to the inquiry you made about the casket that was purchased by your mother, Lois Jean Cloutman. As we discussed we are refunding 70% of the purchased price, the amount held in Trust. The amount of the check would be $1676.50. Enclosed is an authorization form for us to issue the refund, if you are in agreement, please sign and selection a payment option and return to us in the enclosed envelope. If you have any questions or concerns, please do not hesitate to contact us_ Sincerely, Goa�-� Robert B. Moore Jr. Manager Enclosures �19BL Y VS+x,hA� 3218 Philadelphia Avenue•Chambersburg,PA 17201•717-263-4125+Fax 717-263-9663 www.DignityMemorial.00m REV-185 EX(0504) 48500041046 SAFE DEPOSIT BOXINVENTORY PA Department of Revenue PLEASE USE ORIGINAL FORM ONLY Social Security or Death Certificate Number Date of Death County Code Year File Number D" ade suffix I _ — —_--— FnYN� MI _ r�c.A- ter l L I t�S ?J1' ADDRESS OF DECEDENT STREET: )U�1 ri`�t T ^ CITY: �� 1 S� STAT� �P CO NAME AND ADDRESS OF PEPS N REQUESTING THE FPENT OFF THE SAFE DEPOSIT BOX iNAME: �IJ� �G✓f Gil Zip l STREET `M CITY: nsTATE: f ! Or ( \ I NAME,ADDRESS AND RELATIONSHIP(IF Y)TO DECEDENT,OF PERSON(S)PRESENT AT THE SOX OPENING 1� j a. NAM ( rr a S RELATIONSHIP JN/ IV\®r��lc LI\ �J� , Ctc < STR ET ADDRESS., ITY: STATE ZIP CODE i / RELAT�IOISHIP: f b. �E.�� t�'ln y��/�.f�✓LO J�'Y 1-CJrh.Q-�.f `C� STREET ADDRFS CITY, STATE: ZIP CODE: � ar.ml.�r� �7 j c. NAME: RELATIONSHIP: ' I j STREET ADDRESS: Cf yYl STATE: ZIP CODE: I NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED i I STRE DRESS: (� 'CITY. ST TE 21P COD 'IWO* �O f�!") 1 1 `e`"e+ AY-I`S Jt �l7� FNAME OF PERSON MAKING LAST ENTRY N DATE AND TIME OF LAST ENTRY r DATE F CO CT TO RENT BOX 13 NUMBER OF BOX I TILE UNDER V,'H:CH BOX IS Rrv;Ev - oa NAME AND ADDRESS OF PERSON(S)HAVING ACCESS TO BOX 1 a. NAME: b. NAME: 6 I STREET ADDRESS: STREET ADDRESS: I CITY: STATE: ZIP CODE: CITY: STA:c: Z7=�- I NAME AND TITLE OF EMPLOYEE TAIONG THE INVENTORY WAS A WRL M THE BOX? ❑ YES ;kNO Hyes. a.Date of will: 1 b. Name and address of personal representaLVe,N named In the will NAME: iSTREETADDRESS: CITY: STATE: ZIPCC--E: i c. Name and address of attorney,N any j NAME STREET ADDRESS: CITY: STATE: AP CC= L 48500041046 48500041046 di, lo R %oj j-*4j •ro NP Ul"OCl% It f-4-- YM3 • cr ••Xe r 90 3� IJA lr jA 1141i,ap uu , ;-C XC)-3I•1 14 "rMcl,"ll" JASOIUMO; M. 201;liltii 2wAj 14 T I N l`:I-.x XCM! M0435 NArt ly i, P wC `U-1 ?Wl —:,I•Al,l.l V Xw kli A -IF !4 l4iJllj I.1vG ijiVV c V ;7tJ-.! 4p Ov.oo[j 0 14.1 REV-485 EX SAFE DEPOSIT BOX INVENTORY Page of INSTRUCTIONS (1) Cash:Report total only. (2) Stacks:List in detail every common or preferred Certificate,warrant or other rights found in bo)L Stocks are to be designated by name of company,certificate number,date of Certificate,name in which stock is registered,and number of shares and class of stock. (3) Obligations of U.S.Government:Number of items,date of Issue,face value,names in which registered and type of ownership, i.e.,jointly held,payable on death,at. (4) Bonds:Designate by name,amount,serial number,or other designation.(Bearer Bonds) (5) Bank and Savings and Loan Passbooks:State name of depositor,number of book,last date appearing in book name of bank and branch,and balance. (8) Jewelry,Coins,Stamps,Manuscripts,etc.List and describe as fully as possible. (7) Deeds,Mortgages,Current Insurance Policies or other evidences of Indebtedness,List and describe as fully as possible. (8) All other contents. (9) Return completed form to: DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT.280801 HARRISBURG,PA 17128-0801 REM ITEM DESCRIPTION NO. 4 a I LL A S,IkK 10 Kai t r k Pt ,-,77 r XA t 4 7 1 CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS PERSON RECEIVING COPY OF € CORRECT AND COMPLETE TO THE OF MY KNOWLEDGE AND BELIEF SAFE DEPOSIT BOX INVENTORY: 316NA RE GNATIRE � � C , PR NAME ,J"' " PRINT NAMEAND CHECK APPROPRIATE BOX BELOW: -G'e ire i>e r C PRINTTRLE DATE CHECK APPROPRIATE aOX: AJ r'71- a'(3 �nrenr *h) El Ads ) ❑E900 ❑A0gdwma,0fW%dep03aowr NOTE:Attach additional 811='x 11'sheets)M necessary or use duplicates of this page of form. TheDepa6nent bauhmiaid bylaw,42 US.C.W(c)(2)(Ckii,W requiredisdasureotSocul Searcynmibas noxnrcxLonantad rtrp state lax Ism.The DaWhent uses tre Social Saurfly rurterb idadiy the decadent and personal represerdalives of the rsb4e.The CmImmmalh may also use the IMamffiac In exdiaga of tax nbmmtim agTke nmft wfh Federal and local tuM. aWDrAies.The slats law the Common ealWs fersonnal from mr6dardial tax nbamallon w=pt III d6dal W" MOUNTZ Trust Your Special Moments To Mountz. November 4,2013 Jeffrey and Debra Dortch 44 Hickory Road Carlisle,PA.17015 Dear Jeffrey and Dortch, At your request l examined the jewelry you submitted for valuation and have provided an opinion of the Approximate Fair Market Value for the est _"o Lois an date of death 3/14!2013. This report is valid only'in its en ' and the final figure excl es any applicable taxes. You may wish to take this into consideration when ing the report. The value lusions are subject to limiting conditions that are set forth in the body o e report. "To the best of my owledge and experience, 1 estimate the jewelry has a total Approximate a r Market Value of$484.00. Photographs are included with rr original report for your rence. I suggest that you keep your copy of. this report in a safe place. This report was prepared in accordance with the Uniform Standards of Professional Appraisal Practice (USPAP). .. If 1 can be of any further assistance,please call. Sincerely; l Al S Amy SI Rausch Certified Gemologist Appraiser,AGS Enclosures 1160 Walnut Bottom Road • Carlisle,PA 17015 • 717.243.4936 • (F)717.243.8785 • mountzjewelers:com Pagelof8 Y®N OEM - ae,e►ar REV-1510 EX+(06-09) pennsylvania SCHEDULE G DEPANTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INNERRANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIOW OECEDEW 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. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECO'S EXCLUSION TAXABLE mDUOE lrrE xANE a INE*awxssaEF.INDa EDAnoxsno ro DEaonrr NID NUMBER nE wrevrAV�el.AnwiAOxr or INE DECD roE aEU gr�rE. VALUE OF ASSET INTEREST eonl VALUE 1 �-ftt9 �dwntid Tones T)2hra bdfi-L'1'I— bavlhfeo' jq NO 50% ly� Z63 a x� aww�d JoA, S /IM Ilndk AAatb01144 ba(I Iva63 Sa� 1ya6� TOTAL(Also enter on Line 7, Recapitulation) $ a g Sa(� .00 If more space is needed,use additional sheets of paper of the same size. = C O A n m e 0i , N < N !! y Z v tri v; a c� ao ® T N 40J. c W 2 LL 03 an?� K M 00, O O 1�1 Z m - a0 cc .O A y ' N K W 0 LO co O Y W ` f O N f0 tp m m N N N N �Y T m �p 3 0 (D - - Q. a L C w N y 'mva No O m _3 V uj I- o W V) Q O y -OJ W W ` W m N 3 2 IL �+ x Z ' 3 y N O � Ol � 7 m y dUZ W �W C w m y 4, m x E > r CCo � v � E o me 2 «W c « to a N O : go m o m> o Em >'< s'! Ui> CL ik NT O ': %?`'" mom } Ch 0 N O C o m O y N � T 2 m_ rn V > > a t Q W - m m m V .iJ .> r > > to m n m fA O v m O Q W R w 7 Q j z Q N m O r « U a m . L E C O . � o C A m � mL F E ++ 7 y 0 C m = W E to E O G LO' J -1 m O m Q. O � W cc C Q O ++ J O a r �'Q W m m W wg '<::<: :;;<::�»::: :`:::� LL m u rU > 9 > > ?n REV-1511 EX+(08-13) _jIZv_pennsylvania SCHEDULE H lid D8"MOTOFREVINM FUNERAL EXPENSES AND INNERRANrE TAX RMRN ADMINISTRATIVE COSTS RESIDEM DKEDEW ESTATE OF FILE NUMBER Gov}vkut✓�� Decedent's debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: CQMe �ar Ser✓cK4� Cn�tl±dlic_ — b0 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State_ZIP Year(s)Commission Paid: . - 2. . Attorney Fees: - - 3. Family Exemption:(if decedent's address is not the same as daimant's,attach explanation,) Claimant Street Address ON State ZIP Relationship of Cement to Decedent n o 4, Probate Fees: 3 / D 50 S. - Accountant Fees: - 6. Tax Return Preparer Fees: 7. i✓inGvk f°r�nf;.✓- gnul_ �ew�-l. NOtiGt°.� -____-� a__-1 �r•_—��-?—)�{� 110,• I; �Reyl Gst�te LK`_Pe�sel 5 CfdrA+;A,.� c��pefireP��� ei�\� ; III . —_fZesl GSDx}e 5®le- Se-kk eMeAi - , _ 1_ �hw�es_�f* xe_s�a n/e,A J �gTU 5 l L Seweler APP!n!-5 �� TOTAL(Also enter on Line 9,Recapitulation) If more space is needed,use additional sheets of paper of the same size. SALANDRA FUNERAL SERVICE, INC. Joseph P. Sdandra,Supervisor 304 West Pike Street, Canonsburg,PA 15317 724-745-8120•Fax 724-745-1808 April 10, 2013 Cumberland County Veterans Affairs 18 North Hanover Street, Suite 103 Carlisle, PA 17017 For Funeral Services Of Lois Jean Cloutman Professional Services Facilities and Equipment Automotive Equipment $3,625.00 Merchandise Casket $1,388.00 Vault 923.00 Total $2,311.00 Cash Advances Newspaper — Obituary $ 131.00 Death Certificates (10) 60.00 Total $ 191.00 Ronan Funeral Home' $1,162.00 Total Amount of Funeral Services $7,289.00 5% Discount of Merchandise $ -116_00 Total Amount Due $7,173.00 RETAIL INSTALLMENT CONTRACT AND SECURITY AGREEMENT AGREEMENT NoI 8 5 O 15 _ `,1 THIS AGREEMENT between The Catholic Cemeteries Association of the Diocese of Pittsburgh,718 Hazelwood Avenui, Pittsburgh,PA 15217,hereinafter referred to as Seller,and Buyer(s)Indicated below: r Cemetery#i Mausoleum#,,t1__ :, •, Date Y ' Owner# x Buyer(s) - Address Telephone# Parish Certificate To Batsatted In Name(s)Of!` ,' -Y . r x, See page 2 for names: Cemetery: ❑Graves ❑Lawn Crypt Upright Memorial Permitted: ❑Yes ❑No # Spaces$ _ $ Section ti� Block �_ Lot 4 g= Row Grave(s) � Privilege:❑Double Interment ❑Cremation Interment ❑Cremation Entombmenf i $ +Lettering$ =Total $ Mausoleum:Crypt(s) Niche(s) Tier Spaces $ plus Sec.Name: Type Lettering$ =Total $ Memorialization: ❑Bronze ❑Granite ❑Cemetery incising ❑Additional Crypt Incising/Lettering Memorial$ +Foundation$ +Memorial Foundation Care Fee$ =Total $ Burial Vaults: ❑Regal ❑Majestic ❑imperial ❑Uftima ❑Other # Vaults x$ = $ Ptensed: ❑Interment OD 0 Interment ED ❑Entombment ❑Inurnment(Monday-Friday only)#—x$ _ 'S _ b At Need: ; Interment OD ❑Interment ED ❑Entombment ❑ Inurnment(Monday-Friday only)# i x$ ,fir _ $ Other(Specify) c. , _s _a. S� $Other(Specify) - $ NOTICE TO BUYER Itemization of Amount Financed 1. You are entitled to a completely filled-in copy of this C Total Purchase Price $ 1 4 _(1} agreement at the time you sign it. A. Memorial Discount $ _ 2. Do not sign this agreement before you read it or if it B. Vault Discount $ contains blank spaces. C. GravetCrypli icheDisc$ ._v 3. Under the law,you have the right to pay off in advance D. Grave Enhancement $ the full amount due and under certain conditions to 2. Total Deductions..........(A+B+C+D) $ (2) obtain a partial refund of the finance andtor service 3. Total Cash Price .............. (1 -2) $ charge. E. Cash/Check $ Any holder of this Consumer Credit Contract is subject F. Credit Card� $ to all claims and defenses which the debtor(buyer)could ^ %£- assert against the seller of the goods or the services G. Trade-in $ obtained pursuant hereto dr with the proceeds hereof. 4. Total Down Payment..........(E+F+G) $ .. .. _ (4) Recovery hereunder by the debtor (buyer) shall not S. Unpaid Balance-Amount Financed(3-4) $ (5) extol amount paid by the debtor(buyer)hereunder. S. Finance charge $ (6) If you do not meet your contractual obligations,you maylose 7. Total Payments Due(5+6) - _ $ _ (7) the funds paid under this agreement held in a trust account. $. Total Sala Price(4+b+S) $ CONSUMER CREDIT DISCLOSURES 1.ANNUAL 2. FINANCE CHARGE 3.AMOUNT FINANCED 4.TOTAL OF PAYMENTS TOT L S E P CE PERCENTAGE RATE The dollar amount the (unpaid balance) The amount you will tware a of The Cost of your credit will cost you. The amount of credit paid after you have made purchase o credit as a yearly provided to you or on your all payments as scheduled. ncludin our down rate. behalf. payment of {Box 2+Box 3) (Box 4+down payment) Number of Enritents I Amount of Pa manta When Payments are Due:Monthly Beginning on: INTEREST FREE PERIOD: You will not be charged a Finance charge during the first months from the date of this agreement. SECURITY: You are giving a security interest In the goods or property being purchased. LATE CHARGE: If payment is late(10 days or more after due date),you maybe charged 5%of the payment due or five dollars($5.00)whichever Is lesser, with a minimum charge of one dollar($1.00). Only one late charge will be collected on each Installment regardless of the period during which the installment remains In default. PAYMENT. if you pay off early,you will not have to pay a penalty and you may be entitled to a refund of part of the Finance Charge. DEMAND FEATURE: This obligation has a demand feature. NOTICE: See the remainder of this agreement for additional information about nonpayment,default,security interests,any required payments in full before the date,and pre-payment refunds and penalties. WIG i' J E W E L E R S Jeffrey and Debra Dortch Jeffrey and Debra Dortch 44 Hickory Rd 44 Hickory Rd Carlisle,PA 17015-9706 Carlisle,PA 17015-9706 Phone:717-385-6900 Phone:717-3855900 Nov 9,2013 292799 Immediate Cw AR 1.0 7224-105-846 $95.00 $95.00 - please appraise for estate - 1.0 4150-537-783 $190.00 $190.00 - please appraise for estate 1.0 1486-674-414 $0.00 $0.00 please appraise for estate Visa-----2091 Approved: ($285.00) 0435261305797496:: Signature: Sub Total: $285.00 Shipping: $0.00 F rq i 5� 3780 Ttindle Road•Camp Hill,PA 17011 •717-763-1199 Total:Tax: $0$285.00.00 C OS"� 0 �p 1160 Walnut Bottom Road•Carlisle,PA 17015 •717-243-493 4520 Jonestown Road•Harrisburg,PA 17109•717-545-7508 ayment: ($285.00) mounujewelers.com Balance: $0.00 I l Lois Cloutman Estate-Schedule H Detail: f=uneral Expenses and Administratvie Costs Cost Type Paid To: Amount: Date Paid: Funeral Salandra Funeral Service,Inc Canonsburg,PA $ 7,173.00 4/10/2013 Funeral Catholic Cemetaries Assn,Pittsburgh PA $ 1,625.00 3121/2013 Funeral Total $ 8,798.00 Admin Register of Wills Fee —PO"'8A ` E (�C $ 378.50 5/13/13 Admin Check Printing Fee,PNC $ 1915 7-i 5/9/13 Admin Check Printing Fm PNC(new acct#) $ 18.15 7/18113 Admin Cumberland Law Journal Death Notice $ 75.00 6/10/13 Admin Sentinal News Death Notice $ 178. 2 6/10/13 Admin Total $ 669.72 Medical Carlisle Dermatology $ 13.40 617/2013 Medical Dr.Mohamed Ismael $ 20.05 6/7/2013 Medical Carlisle HMA Physicians $ 27.50 6/712013 Medical Crumay Fames Associates $ 34.34 6/7/2013 Medical Total $ 95.29 Utilities PPL $ 109.81 617/2013 Utilities COMCASTCable $ 354.31 6/7/2013 Utilities Water,South Midileton Township $ 121.31 6/7/2013 Utilities Gas,UGI $ 135.22 6/7/2013 Utilities Gas,UGI $ 23.95 7/812013 Utilities PPL $ 60.48 7/8/2013 Utilities Gas,UGI $ 1177 8/27/2013 Utilities PPL $ 34.11 8/27/2013 Utilities Water,South Midlleton Township $ 147.79 8/27/2013 Utilities PPL $ 27.19 9/20/2013 Utilities PPL $ 18.02 10/3/2013 Utilities Gas,UGI $ 25.32 10/3/2013 Utilities Total $ 1,07118 Real Estate Expenses Carpet,Home Depot $ 1,453.52 6/18/2013 Real Estate Expenses Paint/Repair Products $ 271.41 6122/2013 Real Estate Expenses Cleaning Supplies,K-Mart $ - 25.40 Q22/2013 Real Estate Expenses Cleaning Supplies,boxes UPS Store $ 25.57 4/6/2013 Real Estate Expenses Paint/Repair Products(Home Repot/Cowes) $ 304.99 7/1/2013 Real Estate Expenses Homeowners Insurance.(aug30bep26) $ 151.48 8/30/2013 Real Estate Expenses Total $ 2,232.37 Real Estate Sale Costs Property Taxes owed $ 24147 9126/2013 Real Estate Sale Costs Settlement Charges $ 8,544.46 9/26/2013 Real Estate Sale Costs Total $ 8,787.93 Jewelery Appraisal Mountz Jewelers,Carlisle PA $ 285.00 11/9/2013 Jewelery Appraisal Total $ 285.00 Grand Total $ 21,939.59 . , � . . - _ _ .. ;. S • r r REV-1512 EX+(12-12) ,. i pennsylvania SCHEDULE I ' DEPARTMENT OF REVWUE DEBTS OF DECEDENT, INHEFU A nK RESIDE T OECED AX UF RETURN 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 w OF DEATH La .30 ��lI ►4 a 0/ t 5 1 M.o�n f na_cic P-d.I lOQr00C� accI#�Yoat 6o=8w6.5 SOAPS MASTCACA2b • y1 Cad,_+� t�sN . . . : • . i�s�_o� . fTV 5039 :11 Tc�P G �? r i a 1 • I • TOTAL(Also enter on Line 10,Recapitulation) ; 916 U V If more space Is needed,Insert additional sheets of the same size. ��IIIII Page 1 of 4 OLNACS# ISM7564 Direct Installment Loan Disclosure and Note Q PNCBANK SOMW+er_LOIS3EANCLOUTUAN Lender.Pm;oak natiasatAsssaetion Date: IZJIIIZD12 Item proceded fry"Q'are not applicable unless marked"®"or the epuivakmt. Truth-in-Lending Disclosures Itemization of Amount Futanced FE FINA�IICE Anmunt Financed Total of Payments Anwar Financed T AGE C}tALtGE The aomant of credit She ammmt t6o Borrower $Son t{ efatemmg The doSlar amount the aedt provided to the Borrower wR have f after Borrower 173 Armin*m drecdy to Borrower he, wM cost the Rerravror. or on the$orrower s fms made all paymm�ts as edit as a behalf. schaduted- $Sae sno men Slimmer M Amid paid se Barowefs mom .270% $77,519,60 $1 GtI,089.110 $177,519.60 $See Snouted s�rreat m 131 Armua retained by Lordo for INTEREST RATE AND PAYMENT SUMMARY „,..._.e._.„......_._.._,. Few a tfioKdtiY t'avmatr? $J :wtia bf SataaG _ _ Interest fiaJe....-.... 4.270 14i Ammem paid to others on BmmwWs ....... .... . ....................._....._....................................................... P' +tme:.s3 Efflegm 4i33.11 behdf tr-=W=l[.-Cm r z : ?a?to f" offk-i4s Taut fast.Mpg! v PavRem __ �. 11 493.11 _ .�. $See Settlerma Staterne::t fa!tar cein axoro tca {c{to See seniarmm Statemo t Senior i.eader is Wft a society,is rest in PralrertY and Iota Charge:0 Not Apdreabta, f�I. If W? f is in paid $ deposits held by tartar, aM, it payments an made by in fill witfmu 15 days of its du-date,Barroom may fa charged Ili to prea rthadred ex mac funds tr. der from an accarm WO Hai prener of 840.00 or 10%of the total paymtd. another fmamxd m hh tion, deposfks held by that frore aS Marry $ infinrJot4 awk —NA not ban to fey a poifty.0 It checked,8erreamt #_I to Note. film at firmly berg porchWA may liana to roeairvSe Low for Cerune taxes„ I „ Real Estate. pagvi ad Deposit Bal&nmfx1 Not Ati icatde,0 The Awed 0 I ° Perct reap reD in take nic ate,[ nay mirmi ed depsit Sri- st r.«i1;,40W*;r.ow;,,,w-`'3�:;;r3H;;•.t:;:.r«x7 �° " » ;a.:. ==-d G, z u •2':. . --Ta.a¢ at era raterrtcisr ashzMis tath ?etc. r ridtal e =:01 At am:Ie cnavk rofthe3oaa SI'g i 1i @59r {urro Ti�.u'�.r n'ri yW�u�riia�.r.it'v.j.Tii::���:F«4.'iG tri t.�.tri'a:we to:..�.�i rr". rv.e<ise 4:Gt w•C/.r•�a..M �ri$[ to •u••,�•---•� See ppono�contran docu mms far any add4mrtai)niv" oo abow r - et- x r schamrkd date and leepay ent refuels and peuhiaL wr l:ayrnat>~deft,airy tey.drud vary^yrrmnt b felt aef^.!o luau _I ¢ At nemriCd drscfaum except the We charge dssckmn are estimates. Prepaid _C4a e - $ SettievffinlStatemert The Interest Rate and Paym of Sammry,above,does not mdude Credo bar ence Premivars,'d appieabfe, Itemiration of Amours paid by Borrower at the fm the loan isfive- (1) . Soe Setttemeutt Statement (21 Credo Insurance Is Not Required. Borrower May Cancel Credit Insurance at Arty -nne without M Penalty.Credit Life fie esce and Credt 04ahNty msuanoe era rot mWiM to obtain erefit,and wN not be provided odes Borrower *a belm and agrese to on the adtitiutal mats)•l araoce am be pudm al on the ft of are or two Roane Cr¢di Disati3ty Imarance may be puchned an ady ono Burrower. ' ter may=4 va reraw451-a 1 411 to€um earf is porgy of mormce.If& nerd droto tenter,the esf red Cost of the imersave is afafadb".The can coots be tow 4 (4yardris are cwt I)"'oA t Am%1 *watl„w inw,of 4i+e inswram id ich is stated belnv,my be Im then the Cerro of the loam If the turn of the ban is greater than the tam of ft ir,4,a*10k iha;W,ire ra?t e 1;0v Ya by ncra*n'.s a1,iai z ie;Farr(0 the 1amatiea. farffcT 064%'ral lerrF[ arna of tlRhniv. 4 irti f3ttct.'of iv--m to bt 7FtriQae tr - €-Tct We hmm��- ('"•Suit S!t..'f t ljr;�'r'trGw:fi`o-„:V±re";,^w=t e`ra04r_•;{irr"#.lf'Fef[liie�Ei aik:c v7 ,rry-:Y:�, - ateErn t;fermi is p i'r?+dot.-"?�w„$!iia.i:Tl tti£,wissa see.e;R.pz Wet scat lit Cry td;,W=-rp tires ec= fc il}t'ofifral ter-m a{i'u:es x;:of ^�',-Pa!+^no L fie in --f:-J%'m o-r�t€i?v i-t -_ 1 i I?^_rr•,tot a�xs.t;a*,d:.rao err is ratdg7�for obi�sascn.�Crscgt r..e*�-iu(rat�s+T. fnr 11es rare .�. _�---.._.__�� S"e[maf:xY Of tLrrms[m - -----= 07:43 From: To:B17176055936 Pase!2�4 Asce msionPoint Recovery Services,u.L 200 Coon Rairlds Blvd.Suk-- -n nadids.MN 55433.5$76 (RR$)806-9074 Phone - (763)235.4055 fax 161—Ars:Mondav-Friday 8:00AM to S:OOPM CSr Creditor. Citibank,NA 91251'z7vAs Account No.: )00000(X70000(9509 Reference Nd.: 1375796 - nce: $5,756.34 Doar Estate of LOIS CLOUTMAN: Thank you for your prompt response regarding the Citibank, A.-CITIMASTERCARDa tforLOIS AN-AS agreed,Crab;IM4 NA-CiTI MASTERCARD has accepted an fferto settle the balance 1 it for$4,030.00. U on receipt of funds,our records will be updated to reflect that the oho account has been . We are not obliga ed to renew . this offer. For convenience,we offer the option to pay by phone using a eheddngJsav ngs account by co ng one of our representatives today at: (888)806.9074. Please remit payment of$4,030.00 using the coupon below or call(8$8)806.9074 no later than 09/27/2013. Whenever $600.00 or more in principal of a debt is forgiven as a result of settling a debt for less than the balance owing,the creditor may be required toseport the amount of the debt forgiven to the internal Revenue Service on a 10990 form,a copy of which would be mailed to the estate representative by the creditor_ if the estate representative is uncertain of the legal or tax consequences,we encourage the estate representative to consult a legal or tax advisor. Very truly yours, Christina Mallon AkensionPoint Recovery Services,LLC This communication is from a debt collector. This is an attempt to collect a debt and any information obtained Will be used for that purpose.This Is an attempt to collect a debt front the estate and not from the assets owned byyou personally-You personally are not required to payany of the debts from the estate. ACA: '[AalkwmimdGma . ' mltSet�ei'mrWtal . - --•----detach coupon Phone Number.(888)8110.9074 Amount Endosed• tmdhur:Cbibanty NA Amount No.:3tX)00000DO0004509 Reference W.1375798 Settlement Offer.$4,090A0 Ail payments should be made pwyable?JD tdeVelour asted above PLEASE SEND PAYMENTS&CORRESPONDENCE TO: DE13RAC DORTCH 44 HICKORY ROAD � ASMNSIONPOINT RECOVERY SERVICES,LLC _ tl CARLISLE.PA 17015 200 COON RAPIDS BLVD.SURE 210 COON RAPIDS;MN 55433-5876 SIF1 SEP-25-2013 07:44 Pram: Ta:817176055938 Paee:3�4 Y AscensionPoint Recovery Services,LLC ZOO Coon Rapids Mud.Suite ZOO Coon Rapids,MN 65433-5876 (888)420-2530 Phone - (763)235.405S Fax Hours:Monday—Friday 8:OOAM to S:OOPM CST Creditor Comen)ty Rank 9/25/2013 Account No.; XVJOWJOO()=0048 Reference No.: 1389454 Relents $1,138.10 Dear Estate of LOI5 CLOUTMAN: 1hank You for your prompt response remdmg the Corn eaY > DnCountacting CLOUTMAN.As agreed, ComenRy,Bank-SON-TON has accepted an offer to settle a balance in fall foreceipt of funds,our retards will be updated to reflect thafthe above account satisfied. Wen ted to renew this offer_ Far convenience,we offer the option to pay by phone using a checking( one of our representatives today at: (888)420»2510. , Please rents payment of$800.00 wing the coupon below or can{888)42b--2510 no later than 09/27/2023. Very truly yours, Christina Marren AscenslonPoint Recovery Services,LLC This oommunicatiam isfrOm a debt collector. This is an attempt to collect a debt and anyinfonnation obtained will be used for that purpose.This is an attempt to collect a debt from the estate and not from the assets owned by you personaiV.You permnna0y are not 9"Wred to pay arty of the debts from the estate. ACA' # >araoratxnxac - taeAm�rgdbs$ .MCe4mmYr�mmS .- °--- coupon ."° Ptmne Number.!888)920.2570 amount EnNosad: ' t}edime:Cam9n,t}.8ank . Awown Nov.*00000m000mm Raf0eam No: 7389454 SetOementDNe;$070.0D - .. - AaParMM Smmabe.made parable to tft oeiBmr llsd above. PLEASE SEND PAYMENB&CORRESPONDENCE TO: DERRAC DORTCH 44 HICKORY ROAD ASCENSIONPOINT RECOVERY SERVICES,LEC ° CARUSLE,PA 17015 200 COON RAPIDS 8LV0,SLF TE 200 COON RAPIDS,MN SM33-5876 SIR SEP-25-2813 10:51 Prom: To:81 7176055938 Pa9e:2j2 AsamsionPoint RecoveryServivei,TLC 200 Coon Rapids Blvd.Suite 210 Coon Rapids,MN S5433.5076 (888)806.5074 Phone - (763)2354055 Fax Hours Monday—friiday8:00AM to S:ODPM CST Creditor: Citibank,N,A. 9125/2013 Account No.. 7ap000ODO X70(6672 Reference No„ 1390584 Balance: $2,823.19 Dear Estate of L401S CLOUTMAN: Thank you prompktqRLmnse regarding the Citibank,N.A.-SEARS GOLD MASTERCARD unt for LOTS Citibank,N. .- ASTERCARD has accepted an offer to the balance in full for $1.980. . Upon receipt of funds,our records wig be u a effect that tfie above unt has been satisfied. We are obligated to renew this offer. " For convenience,we offer the option to pay by phone using a checking/savings account by contacting one of our representatives today at (888)806.9074. Please remit payment of$L980.OD using the coupon below or rag(888)806-4D74 no later tl�n'04J27/2013. Whenever a $600.00 or more in principal of a debt is forgiven as a result of settling a debt for less than the balance owing,the creditor may be required to report the amount of the debt forgiven to the Internal Revenue Service on a 1099C form,a copy of which would be mailed to theestate representative by the credbor. if the estate representative is uncertain of the legal or tax consequences we encourage the estate representative to consult a legal or tax advisor_ Verytrulyyours, Christina Magen AscenslonPOlnt Recovery Service,TLC This communication is from a debt collector. This is an attempt to collect a debt and any information obtained will be used for tftat purpose.This is an attempt to collect a debt frwn the estate and not from the assets owned by you personally.You personally are not regoired-tepay any oftfee debts from the estate. - .t4 CX .fArIIaAt9'tOAAr. ' 7lbMrgi�daolSSndee m1e detach .._____a.+§*r Phune Number.(83B)IOr+^SOM . AmountrndGWdn, __ �_ „ oedrtat.ckftnk A.A. ' AxDUtttta.:)a�0t>Cfl00npar£SrZ Referencai4a t39aSa4 ' ssutemmrt'Otter$L990A0 - AOp3ymer:ushoW6�Ma6ePagaMntntheaMtaTw$icnv::,emr. - PLEASE SEND PAYMENTS&CORRFSPONDEMM TO: DEBRA C-DORTCH 44 HICKORY ROAD liSM-NSIONPORITRECOMYSERVICES TIC � CARLISLE,PA 17015 - MO COON RAPIDSSLVD,StRTiE 71D COON RAPIK MN 55433-5876 sdFz F^om: To:817176055938 Pase:4/4 AscensionPoim Recovery 5ervices',sLs 200 Loon Rapids Blvd.Suite 20, .-on Rapids,MN SS433-5876 (888)42D-2510 Phone - (763)Z35-4055 Fax Hours:Mondav—Fridav 8.00AM to 590PM CST Creditor. Comenitv Capital Bank 9125/2011 Account No.: X100000000=1159 _Reference No.: 1392657 !!glance: $2,156.79 Dear Estate of LOIS CLOUTMAN: Thank you for your prompt response regarding the Co Capital Bank-HSN account for LOIS CLOUTMAN. agreed, Comenity Capital Bank-HSN has accepted an offer to ettle the its in full for$1,510.00. Upon receipt of f ds,our records will be updated to reflect that the above accou has been satisfied:we are not obligated to renew th offer. For convenience,we offer the option to pay by phone using a ng/$avings account by contacting on our representatives today at: (888)420-2510. Please remit payment of$1,510.00 using the coupon below or call(888kt20-2510 no later than 09/27/2013. Whenever A $600.00 or more in principal of a debt is forgiven as a result of settling a debt for less than the balance owing,the creditor may be required to report the amount of the debt forgiven to the Internal Revenue Service on a 1099C form,a copy of which would be mailed to the estate representative by the creditor. If the estate representative is uncertain of the legal or tax consequences,we encourage the estate representative to consult a legal or tax advisor. Very truly yours, Christina Mallet AscensionPoint Recovery Services,LLC - This communication Is from a debt collector. This is an attempt to collect a debt and any information obtained will be used for that purpose.This is an attempt to collect a debt from the estate and not from the assets owned by you personally.You personally are rot required to pay any of the debts from the estate. - v /� A/tea A. - taiaaaartawa� yatA"adA—iCa+ru rt CaGtlim Ndmiegb detach coupon Phone Number:(888)420-2SM - Amount Enclosed: Cmdknr.Cemenily Ca)W Bank Araolmt Ahm XWOOD)MM2159 aefemsto No: 3392557 Settlement offer.5131040 Ali payments should be made payable to the creditor Ested obese. PLEASE SEND PAYMENTS&CORRESPONDENCE TO: DEBRA C.DOKrM - 44 HICKORY ROAD ASCENSIONPOINT RECOVERY SERVICES,LLC ° CARLISLE,PA 17D15 s 200 COON RAPIDS BLVD.SUITE 200 COON RAPIDS,MN 55433-5876 SIFT jineruty Capital Bank-HSN Page 1 of 2 0 Dortch<debra.dortcliftntail.corn> Comenity Capital Bank - HSN 3 messages Sean Shultz<sshuItz@ssr-attorn6ys.cOm> Thu, Sep 26,2013 at 2:06 PM To:"karl@rorningerlaw-corW<kwWrorrdngerIaw.com>,"guyer@romingedaw-corr <guyen@rornir W- Ulaw.com> Cc."debra.dortc;h@grnaH.conr<debrs.dork;hftr=I.conw>,Renee Munay<ffnuffay@ssr-afiorneysoom> Karl: You represent Debra Dortch in her capacity as execubbi of her rnuffier's estate We went through with closing on the home this morning w!M some updated payoffs on several of the claims trade against the estate. Debra Worried me that the Goinenity Capital Bank claim is still in dispute We are holding the 1UP65 IQW U jI.2Y011 C""Vi ZdA 9;1;U-iff r)fIX A 0 1 Y)01�bran Oft days Iftom today to give you 6 M loseffla that dism'de. If it is not.5-WICA by ftm waa vA reed to make that payment to prolact the buyees interest in the You will than Ime to pursue any claim or defense of the estate against Contently. By the end of business tomorrow,please advise rrtc of the offrent status of your negotiations on that claim. I have copied your client as she and I discussed today at settlarnmt Thank you, Sean Sean M Sladt4 EsWure, Saidis,Sullivan&Rogers 26 West High Street Carlisle,PA 17013 717-243-6222-Phone 717-243-6486-Fax This e-mail may contain privilegedconfiderifial,copyrighted,or tatr jo4-aWj;(rP Wynn are not the ka-ally Pro;xded or miended recipient(even if the e-mail address above is yours.),you may not ii-c'Oppy or re"Wistriij this e-mail Ifyou have received this by mistake please notify us by retain e-malthen delete Thank you.Saixlis,Sullivan<agois'web she is W W W.SSR-ATTORNEYS.COM To oomply with IRS regulations,we advise yon that any discussion of federd tax issoeg in this e---mail is not tobe used,and cannot be relied upon by you 01 promotopadcrt or recommend to another party any F000rp transact r4 email-Comenity Capital Bank-HSN Page 2 of 2 D Dortch<debradortch@gmail com> Fri,Sep 27,2013 at 12.54 PM To: Deb Dortch<debra.dorIch@navy.mjl> [Quoted text hidden] D Dofth<debra.dortch@gmaii.com> Tue,Oct 1.2013 at 2:31 PM TO Sean Shultz<sshuftz@ssr-aftDmeysoom> Cc "kart@rommgerlaw cW<imrf@rormngerlaw com>,nguyer&=mgerlaw oW <guyer@romwtgerlaw.com>. Renee Murray<mwrray@ssr-atlomeys-com> Boc.-hickoryroad@=ncastner<hWcoryroad@wmcasInet;>,Jeffrey Dortch<jeffrey.dorWH@gmail.com>, Deb Dortch<debra.dortch@navy mil> Mr. Shultz, I Ptease move forward with perytrig the HISN debt in the amount ofI,916I0x*,sealing vq knovat ewn-w vne—ft against the estate of Lob J.Cin-t*-mart ft OfSeptember 26 Per your holding of$2156-79.1 will anticipate reMM,19 a ditaM of dilaarertt;e in aim aywint of 1$6".19 made Payable to the estate. I kindly request confirmation of these transactions. Marty thanits for your support in this matter. Debra D�Ioutrwn Dortch Ekewbtx for the Estate of Lds J.Cloutman 44 Hickory Rw%i Garlisfe, PA 17105 lQuoted text hidden] 1 A,c I All IIIAI� r SIMM ASSOCIATES 800 PENCADER DRIVE NEWARK,DELAWARE 19702 (866)572-9374!(302)283-2800 lOf2/2013 Debra C. Dortch clo Lee Mandarin,Esq. 155 South Hanover Street f (� Carlisle,PA 17013 RE:Estate of Lois Cloutman,deceased. Fstate:21-2013-0505 FU". 7491945/7446873 Dear Sir/Madam- Enclosed please find our creditor's claim. If you have any questions or require additional information please don't hesitate to contact this office. Sincerely, r Patti Banks ' Probate Care(9619572-93 74 fA \ f "PLEASE SEE REVERSE SIDE OR SECOND PAGE FOR VKPORTANT INFORMATION" THIS IS AN ATTEMPT TO COLLECT BY A DEBT COLLECTOR ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE. & It �e �dt STv Probate Orgnl Clm PRIATY 04232013 NOTICE TICE OF CLAIM (Filed Pursuant to 20 Pa.C.S. § 3532) COURT OF COMMON PLEAS OF Cumberland COUNTY,PENNsyLvANIA ORPHANS' COURT DIVISION ESTATE OF LOIs Cloutman .DECEASED No21-2013-0 5Q5 To the Clerk ofthe Orphans'Court Division: Entw the claim of BILL M LATER INC CIO Simm As. i9 es Inc. in the ct=1ahmmej anmunt of 5 $.�1 against 8,e above entitled Estate. The Decedent,vko resided at 44 HICKORY RD _ A IKa�- 1 Qix ,d on 03f14MI3_� `j . w ttmnoticeof said claim was given to Debra C. Dortch CIO Lee MandanoEso at 155 South Hanover Street Carle AA1w70 3 w on 101212013 BILL ME LATER INC aO Simm Associates,Inc. 800 Rancader ter. Ne . rs,�xlat�rl - NOTICE OF CLAIM (Filed Pursuant to 20 Pa.C.S. §3532) COURT OF COMMON PLEAS OF Cumberland coUNTY,PENNmvAmA ORMANS'COURT DIVWON ESTATE OF Lois Cloutman DECEASED No.29 2{313-0505 To the Clerk of the Orphans'Court Division; Enteze+daim of$1 t M ATR 1G I{} �,��Ol ' S- Ir1c in the amount of S$2.476t$7 against the above emitted Estate. The Decedent,who resided at 4� ti1ClCORY RD �► iL ��. PA 17 159706 diet on 03114/2013 ' writtest notice of said maim was gives tD Debra C. Dortch CN#;m nno at 1 anon t on 1012120 13 .. ` ' 4 Eli-ME LAT m tas wrrc. t�am+ms0 600 Pencader Dr. New! DE 19x02 Pa�.acsx „,safaca artch, Debra C!V NAVSUP CORP COMMS From: Susan Guyer[gayer*romingerlaw.corn] Sent: Thursday,October 17,2013 4:45 PM To: Dortch,Debra CIV NAVSUP CORP COMMS v Subject: Cloutman Estate Follow Up Flag: Fallow up Flag Status: Flagged Debbie: i spoke with Estelle at Simms Associates today and they are willing to settle both claims for$5,039.11. Estelle requested check by phone since that would be fastest and easiest i told her I would give you the info and you would make that decision. If you have any questions or need any further assistance,just let me know. Thank you, Susan K.Guyer,Legal Assistant Rominger and Associates The information contained in this message and its attachments is intended only for the personal and confidential use of the intended roapent(s). This message may be an attorney-dent communication or other confidential information and as such is PRIVILEGED and CONFIDENTIAL If the reader of this message is not the intended recipient or an agent respomibte for delivering it to the handed recipient,you are hereby notified that you have received this canmunicabDn in error and that any review,dissemination,distribution,or copying of this message is strictly probfbited. If you have received this communication in error,please no ily us immediately by a-rrxA and delete the original message. Thar k You. vA t yerformance Checking Statement For the period 00111/2013 to 07/09/2013 For 24-hour information,sign on to PNC Bank Online Banking EST OF LOIS JEAN CLOUTMAN DECD en pnc.com. Primary account number.51-1431-2232 Account number:51-1431-2232-continued Page 2 of 6 Balance Summary Beginning Deposits.and Checks and other Ending balance other additions deductions balance 16,376.57 .11 15,585.59 791.09 Average monthly Charges balance and fees 13,052.62 .00 transaction Summary Checks paid/ Check Card POS Check Card/Bankcard withdrawals signed transactions POS PIN transactions 12 0 O Total ATM PNC Bank Other Bank transactions ATM transactions ATM transactions 0 0 0 Interest Summary As of 07/09,a total of$30 in interest was Annual Percentage Number of days Average collected Interest Paid paidthisyear. Yield Earned JAPYE) in interest period balance for APYE this period 0.017 29 13,052.62 .11 Activity Detail Deposits and Other Additions There was 1 Deposit or Other Addition ]ate Amount Description totaling$.11. )7/09 -11 Interest Payment ^ Checks and Substitute Checks heck Date Reference - Check Date Reference Lumber Amount paid number number Amount paid number 1244 354.31 06/13 086064289 1251 13.40 06/14 086869938 1246* 135.22 06/17 083397361 1252 27.08 06/14 083154427 1247 109.81 06/12 085398282 1253 75.00 06/14 086864515 1248 121.31 06/20 085892535 1254 178.92 06/19 085321702 1249 20.05 06/27 086264992 1255 1,834.07 06/28 089077249 1250 34.34 06/13 086247236 Gap in checksepuence There were 11 checks listed totaling . _ tr7.903St. A....m�r-".dJ�4 .. � _-. � a_�,� T.e.o y„y�3en..1:J:�•'.g_.�_,� )ate Amount Description Deductions totaling$2,11111111-07. M/17 37256 Payment,E4lreck Check.Pymt Jc Peony 2245 x6/25 362.89 Online Transfer To 0000005115004397 17/08 1,453.52 Online Transfer To 0000005115004397 - Other Dcddt*i:r3 _ter There were 200wDedwYionstotafing )ate Amount Description - $10,483.11. x6/17 493.11 1. Payment 00000 4001008116547664 )7/08 10,000.00 Withdrawal Reference No. 523286264 )ate 'naiarxe Elate balance Date Balance Date Batance x6/11 16,37657 06/1.4 15,762.63 06/20 14,46151 06/28 12,244.50 x6/12 16,266.76 06/17 14,761.74 06/25 14,098.62 07/08 790.98 !6/13 15,878.11 06/19 14,582.82 06/27 14,07857 07/09 791.09 /'^ RE RL COME WiTH A JCP CREDIT CARD When you use your jcp credit card on qualifying purchases, you can earn a $10 jcp reward for every $100 spent in a month - up to $100 in jcp rewards: `See a Team Member or visit jcprewards.com/credit for details rmards - --- --------- - -- ---------- - ------------------ ---------------------------------------------- LOTS JEAN CLOUTMAN �10 1. Visit us atjopcom/credit Account Ending: 952 41 CusiDmor Service:1-800-527-3369 o Ej PO Box 965009 Orlando FL 328965009 Previous Balance• $241.64 Now Balance $344-48 •Purchases/Debits $64.12 Amount Past Due $67.74 •Fees Charged $35.00 Toted Minimum Payment Due $135.58 •Interest Clanged $3.72 Payment Due Date 05/022013 New Balance $344.48 Late Payment Warring: If WO do not receive your minimum payment by the date fisted above,you may have to pay a late Gradit Limit $5,300.00 fee up to 535.00. I Available Credit $4,955-00 Minimum Payment Warning: If you make only the Statement Closing Date 04/092013 minimum payment each period,you will pay more in interest Days in Billing Cycle 30 and it will take you longer to pay off your balance. For example: If you make no You will pay-off Arid you will end additional charges I the balance up paying an using this cud j shown on this es6malsdtDtdI-. and each month y statement in Of... you pay about..., Only�LWMmimurn� 8 months 59.00 payment I If you would like information about credit counseling services.call 1-877-302-8775. ,Transaction Surm-nary ran Balance Date Reference Number Type Description of Transaction or Credit Amount 0323 P9119D02K0ISSX642 R STONEBRIDGE INSURANCE PLANO TX $4.15 www.slonabridge-icIi.00m 1-800-527-9027 ACCIDENT POLICY POLICY If 72A50N8981 PREMIUM 03-2613 TO 04-25-13 03/26 P9119002M0ISQFZ53 R STONEBRIDGE INSURANCE PLANO TX $36.53 www-slonebridge-icp.corn (Continued on next page) PLEASE NOTE YOUR MAILED PAYMENT MUST BE RECEIVED BY 5 P.M.(ET)OR YOUR IN-STORE PAYMENT MUST a: RECEIVED DURING STORE HOURS ON THE DUE NOTICE:Your payment may be converted into an electronic debit.See reverse for details,Billing Hiones inrormaaon ana o*_^— i REV-1513 EX+(01.10) pennsytvarria SCHEDULE 7 DECARiMENT OEREVENDE INNERRANCE TAX RETURN BENEFICIARIES ' RESIDENT DECEDENT ^�(' /�f-0 v ! 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