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Home My WebLink About04-07-14 J 1505611185 REV-1500 EX(02-11)(FI) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 21 13 00972 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW 07092013 12041970 Decedent's Last Name Suffix Decedent's First Name MI HAINES AIMEE B (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW ® 1. Original Return ❑ 2. Supplemental Return ❑ 3. Remainder Return(Date of Death Prior to 12-13-82) ❑ 4. Limited Estate ❑ 4a. Future Interest Compromise(date of ❑ 5. Federal Estate Tax Return Required death after 12-12-82) ❑ 6. Decedent Died Testate ❑ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) ❑ 9. Litigation Proceeds Received ❑ 10. Spousal Poverty Credit(Date of Death ❑ 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number CRAIG A . HATCH, ESQ, CELA 717-731-9600 ti REGISTEW WILLS USE'�V ;:0 ;:0 rrl First Line of Address rn 2 c7 (n t fT rn a 2109 MARKET STREET c„ Second Line of Address C) CD O p o c '� 3 City or Post Office State ZIP Code DATE FILED ~ f" y O CAMP HILL PA 17011 co Correspondent'se-mall address: C • HATCH@HHGLLP - 00M Under penalties of perjury, I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the personal representative is based on all Information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE SUSAN K. LAKE, ADMINISTRATRIX ADDRESS !TT 45 ASPEN DRIVE D;LJrSPIJRGi PA 17019 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE T CRAIG A - HATCH, ESQ . , CELA 3 ADDRESS 2109 MARKET STREET CAMP HILL, PA 17011 PLEASE USE ORIGINAL FORM ONLY Side 1 1505611185 OM46473.000 1505611185 / 1505611285 REV-1500 EX(Fl) Decedent's Nam, ATM F 6 RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 0 . 00 2. Stocks and Bonds(Schedule B). . . . . . . . . . . . . . . . . . . . . . . . . 2 0 • 00 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C), • , , • 3. 0 • 00 4. Mortgages and Notes Receivable(Schedule D) , . . . 4. 0. 00 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E) , , • • . 5 271157 • 65 6. Jointly Owned Property(Schedule F) Separate Billing Requested , • . . 8 17 • 88 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) El Separate Billing Requested . . . . 7. 0 • 00 S. Total Gross Assets(total Lines 1 through 7) • • • • . . • 8 271175 • 53 9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . 9, 61614 • 23 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) • . • . . . . . , 10 141944 • 81 11, Total Deductions(total Lines 9 and 10)• • . . . . , . 11 21,559 .04 12. Net Value of Estate(Line 8 minus Line 11) • • • • , , • , • 12 5,616 • 49 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J)• , . . . • 13 0 • 00 14. Net Value Subject to Tax(Line 12 minus Line 13) • 14. 5,616 • 49 TAX CALCULATION •SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers unfjer S .9116 (a)(tz)X.o_ 0 . 00 15. 0 . 00 16. Amount of Line 14 xable atlinea .r ,,.o4 5,616 . 50 s. 252 . 74 17. Amount of Line 14 taxable at sibling rate X.12 0 . 00 17, 0 . 00 18. Amount of Line 14 taxable at collateral rate X.7 5 0 . 00 18. 0 . 00 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 252 . 74 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505611285 1505611285 OM4648 3.000 REV-1500EX(FI) Page File Number Decedent's Complete Address: 21 13 00972 DECEDENTS NAME HAIN S AIMEE STREET ADDRESS CUMB LAN CITY STATE ZIP NEWV LLE PA 17241— Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 22.74 2. Credits/Payments A. Prior Payments _ 0. 00 B.Discount 0.00 Total Credits(A+6) (2) 0.00 1 Interest (3) 0.00 4. If Line 2 is greater than Line 1+Line 3,enter the difference.Th(s is the OVERPAYMENT. Fill In box on Page 2, Line 20 to request a refund. (4) 0 . 00 S. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 252 -74 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN"VIN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or Income of the property transferred . . . . . . . . . . . . . . . . . . . . . . . . ❑ IE b. retain the right to designate who shall use the property transferred or its income - . . . . . . . ❑ c, retain a reversionary interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ d, receive the promise for life of either payments,benefits or care? . . . . . . . . . . . . . . . . . . ❑ 2. If death occurred after Dec.12,1982,did decedent transfer properly within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? . ❑ 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. 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(I)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116 (a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent 172 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 RS,59116(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. OM46TI PAtla REV-1508 E%+(0&12) pennsylvania SCHEDULE E CERARTNENroR REVENUE RETURN INHER ITANCE TAX CASH, BANK DEPOSITS & MISC. RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: Aimee H. Haines FILE NUMBER: Include the proceeds of litigation and the dale the pmceeds were received by the estate. 21 13 00972 All propert 'ointl owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH t 2007 Jeep Liberty, VIN 1JBGL48K97W531510 7,454.84 2 Members 1st Federal Credit Union, Savings Account #292909-00 5.00 3 Members list Federal Credit Union, Checking Account #292909-11 16,062.81 4 2000 Suzuki LTF 500 ATV, VIN: JSAAM41A4Y2106114 1,635.00 5 2006 Honda TRX 350 ATV, VIN: IHFTE254664504792 2,000.00 TOTAL(Also enter on line 5,Recapitulation) $ 27,157. 65 2W46AD 2.000 if more space is needed,use additional sheets of paper of the same size. RP/-1509 EX.(01.1o) Pennsylvania SCHEDULE F REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: Aimee B. Haines 21 13 00972 Man asset became Jointly owned within one year of the decedent's date of death,M must be reported on Schedule G SURv IV M j0NT TENANT(S)NAMRS) ADDRESS RB-AToNSHP TO M21ENT A Haines, Andrew B 1480 Ashland Drive, Charlottesville, VA 22911 Father JOINTLY OWNED PROPERTY: TEM LETTER DATE NIADEE OESCRMON OF PROPERTY DATE OF OFATIi % OATEOFOEATH INOXM w W OF FINANOAL INGTITInIa ANO RANK A0.1 N.ER w 61MIAR DECEDENTS VALUEOF NJbEEt TENANT MINT IGEWIwINGNN.BER ATTna.,FD RJONTLVNELOPEALE37ATE. VALUE OF ASSET INTEREST DECHIBNI'SMERd_ST 1 A 9/22/2008 PNC Bank, Checking Account #5005832909 35.75 50.0140 17.88 TOTAL (Also enter on Line 6, Recapitulation) $ 17.88 9W46AE 2.000 If more space is needed, use additional sheets of paper of the same size. REV-i$fit E%+{to-pa} pennsyfvania SCHEDULE H DEPPATMENTOF REVENUE FUNERAL EXPENSES AND WERTANCE TAX RETURN ADMINISTRATIVE COSTS RES�EM GECE�Nr ESTATE OF FILE NUMBER Aimee B. Haines 211300972— Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL_EXPENSES: t, Etzweiler Funeral Home 3,875.73 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representatives) Street Address - City State ZIP Years)Commission Paid: 1 2. Attorney Fees: 2,500.00 3. Family Exemption:(If decedent's address is not the same as Claimant's,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 163,50 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. 1 Cumberland Law Journal, publication of estate notice 75,00 TOTAL Also enter on Line 9,Recapitulation) $ 6,614.23 9W46AG 2.000 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX 1(12-12) pennsylvania SCHEDULE I OEPARTMENTOE REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN RESIDENDECEDENT MORTGAGE LIABILITIES & LIENS T ESTATE OF FILE NUMBER Aimee B. Haines 21 13 00972 Report debts Incurred by the decedent prior to death that remained unpaid at the data of death,including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. PSECU, repossession of 2007 Jeep Liberty 7,454.84 2 Cumberland Goodwill Fire Rescue EMS, ambulance bill 201.76 3 Barbara A. Cline, Tax Collector, Cumberland County per capital taxes 10.75 4 Shelby L. Winter, Tax Collector, Big Spring School District personal taxes 11.00 5 Ascension Point Recovery Services, LLC, on behalf of GE Capital Retail Bank, credit card balance 1,660.37 6 Capital One, Account #xxxx-xxxx-xxxx-9160, credit card balance 5,428.49 7 Capital One, Account #xxxx-xxxx-xxxx-1563, credit card balance 177.60 TOTAL(Also enter on Line 10,Recapitulation) E 14 944.81 2w46AH 2.000 If more space is needed, insert additional sheets of the same size. REV-1513 EX-(01-10) pennsylvania SCHEDULE J DEPARTMEW REVENUE INHERITANCE BENEFICIARIES INHE TAX RETURN RESIDENT DECEDENT ESTATE OF: Aimee B. Haines FILE NUMBER: 21 13 00972 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS(include outright spousal distributions and transfers under Sec.9116(a)(1.2).] 1. Susan K. Lake 45 Aspen Drive Dillsburg, PA 17019 50% of Residue: 2,808.25 Mother 2,808.25 2 Andrew B. Haines 1480 Ashland Drive Charlottesville, VA 22911 50% of residue: 2,808.25 Father 2,808.25 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. E 0. 00 9W46AI 2.000 If more space is needed, use additional sheets of paper of the same size. °' 1° PSE1 01/06/2014 TO THE ESTATE OF AIMEE BLAKE HAINES 1482 CENTER RD NEWVILLE, PA 17241-9775 .NOTICE OF VOLUNTARY SURRENDER AND SALE The 2007 JEEP LIBERTY, VIN# 1J8GL48K97W531510, which we are financing for you has been voluntarily surrendered and is now in our possession. The vehicle is being stored by: Primeritus Financial Services 311 1't Street Summerdale, PA 17093 The vehicle will remain in storage until 01/21/2014. You have the legal right to redeem this motor vehicle within fifteen (15) days after the mailing of this notice by making a payment of the amount necessary to the below address. Amount of Unpaid Balance $6,408.28 Amount of Interest $31.56 Plus Expenses: Repossession Expense $195.00 Storage Expense @ $35/day (12/31-1/21) $770.00 Late Fees $0.00 Redemption Fee $25.00 Personal Property Redemption $25.00 AMOUNT NECESSARY TO REDEEM VEHICLE (Cash or Certified Check): $7,454.84 You are hereby notified that the holder, intends to offer the vehicle at public sale at the expiration of fifteen (15) days after the date of mailing this notice, and shall continue to be offered for sale thereafter until sold. Any personal belongings left in the vehicle must be redeemed by you within 15 days from the date of this letter or they will be disposed of accordingly. Please call us at 1-800-237-7328, option 6; extension 3116 to discuss whether other redemption options may be possible if you cannot afford the entire payoff amount. Sincerely, Member Services P. 0. BOX 67013 HARRISBURG, PA 17106-7013 800.237.7328 »psecu.com THIS CREDIT UNION IS FEDERALLY INSURED BY THE NATIONAL CREDIT UNION ADMINISTRATION.EQUAL OPPORTUNITY LENDER. KENNEDY RV & POWERSPORT (2u Uo zxl� L 0 co m 1394 OLD YORK RD. DiLLSBURG, PENNSYLVANIA 17019 (717} 432-9741 (840) 443-0062 1891 www.kcnnedM&ndpowersparts.com PLEASE INDICATE THE ABOVE NUMBER WHEN ORDERING TO �V �^ A� / / ( • QUOTATION DATE SALESPE SON, qS45Pe1t 1 1),e, INQUIRY DATE INQUIRYNUMBER ESTIMATED SHIPPING SATE I SHIPPED VIA FD.9. -- QUANTITY Y/T "DESCRIPTION PRICE AMOUNT ab60 5U� Gk / L T/= ,$"DD ��3SaD I Z 00o 2006 h10tvD,¢ TRk 3SO i' i I I I , I WE ARE PLEASED TO SUBMIT THE ABOVE QUOTATION FOR YOUR CONSIDERATION.SHOULD YOU PLACE AN ORDER,BE ASSURED IT WILL RECEIVE OUR PROMPT ATTENTION.THIS QUOTATION IS SUBJECT TO THE CONDITIONS PRINTED ON REVERSE SIDE,AND IS VALID FOR DAYS.THEREAFTER IT IS SUBJECT TO CHANGE WITHOUT NOTICE. BY ACCEPTED DATE ACCEPTANCE �,,. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF CONSERVATION AND NATURAL RESOURCES CERTIFICATE OF TITLE FOR AN ALL-TERRAIN VEHICLE Issued in accordance with Section 7712.1 of the Vehicle Code, Tide 75, Pennsylvania Consolidated Statutes z NAME: AIMEE B HAINES r;.= ADDRESS: 1482 CENTER RD NEWVILLE PA 17241-9775 B199234 2000 SUZUKI TITLE NUMBER f YEAR MAKE OF ALL-TERRAIN VEHICLE JSAAM41A4Y2106114 1 LTF500 VEHICLE IDENTIFICATION NUMBER CLASS MODEL 08/31/2011 04/11/2001 DATE OF ISSUE DATE OF ORIGINAL TITLE DUPLICATE TITLE �'i" ., FIRST SECURED PARTY ❑ SATISFIED ❑ RELEASED NAME: ADDRESS: DATE BY AUTHORIZED REPRESENTATIVE SECOND SECURED PARTY ❑ SATISFIED ❑ RELEASED NAME: ADDRESS: ` DATE t ^, BY AUTHORIZED REPRESENTATIVE - -1 car* that reasonable diligence has been used in examining the statement presented in the Application for Certificate of Title to the All-Terrain Vehicle described hereon, and that the proof of ownership of said vehicle presented with said application warrants the issuance of this certificate naming the applicant as lawful owner of said vehicle. Wherefore, I certify that as of the date Inscribed hereon, the official records of the Pennsylvania Department of Conservation and Natural Resources reflect that said applicant is the lawful owner of said SECRET R OFD TMENT 1 All-Terrain Vehicle. CONSERVA & NA AL RESOURCES o=• KEEP IN A SAFE PLACE — ANY ALTERATION OR ERASURE VOIDS THIS TITLE 8100-FMFRO100 8/20111 ,t N I� 4.i', TITLE NUMBER REGISTRATION NO. 8388240 - 30M68 MWI�OF VEHICLE ow HONDA TRX350 MANUFACTUREWS SI7HAL MR®ET YEAR 1HFM254664504792 2006 EXPIRATION DATE Cuss 09/30/2013 - 1 AI 1Q:8 8 RAMS 1482 CMrM RD 278NVILLB PA 17241-9775 ALL-T RRAIM VEHICLE CERT r-A'M-0FR4GISTRATION. a+ V ti;i a lIALX)A7 O �LIbNIf,YEALTM��PE[1NBVl�A - V x Mar, 11, 2014 2:53PM PNC Bank No. 8162 P, 1 PN UAWWTIAWAY March 17,2014 Stacey L Nace Halbruner Hatch&Guise LLP 2109 Market St Camp Hill,PA 17011 RE: Aimee B Haines SSN: 227-39-0551 DOD: 07-09-2013 Dear Sir/Madam: In response to your request for Date of Death (DOD)balances for the customer noted above, our records show the following: Checking Account Account#5005832909 Established: 09-22-2008 AIMEE B HAINES LEWIS V LAKE DOD balance: $ 35.75 non interest bearing Please note that this office provides date of death balances for deposit accounts(IRAs,CDs,Checking and Savings). we do not process any financial transactions or provide statements. If you need assistance with any of these items,please call 1-888-PNC-BANK(1-888-762-2265)or stop by your local PNC Bank branch office. Sincerely, National Financial Services Center INC Bank,NA_ Member FDIC This message is intendedfor the use of the individual or entity to which it is addressed and may contain information that isprivileged, confidential and exemptfrom disclosure under applicable law. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering this message to the intended recipient,you are hereby notified that any dissemination, distribution or copying of this communications is strictly prohibited If you have received this communication in error,please note me immediately by reply or by telephone at 800-762-1775 and immediately destroy this faxed document. Page 1 of 1 f tz�eiler Family Funeral Service Etzweiler Funeral Home E[zweiler Ilmeral Home,Inc. 1111 East Market Street 700 Want Street M.RobPennsylvania rt Etz ania,Covn Wrightsville,Pennsylvania 17368 71 Robert ErsaeBer,Owner Rodney B.Beck,Supervisor FAX 71 -845-8 717-252-1313 FAX 717-845-8734 etzth @comcast.net Mrs. Sue K.Lake September 12,2013 45 Aspen Drive Dillsburg,PA 17019 Funeral of. Aimee Blake Haines 2013-15124 Professional Service Discount given -895.00 Cremation with Memorial Service 3,480.00 Total Professional Service ------------------2,59910--- Merchandise Mileage to Carlisle/York 75.00 Total Merchandise Selected ---------------------- AT THE TIME FUNERAL ARRANGEMENTS WERE MADE,WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES. Cash Advances Newspaper Notices-Carlisle 301.52 Newspaper Notices-Harrisburg 419.21 Clergy/Mass Offering 150.00 Certified Copies of the Death Certificate 120.00 Cumberland County Coroner 25.00 Hoffman Roth 150.00 Cash 50.00 Total Cash Advances ----- ------------;2[573--- TOTAL 3,875.73 PAYMENTS RECEIVED flA0 TOTAL AMOUNT DUE 3875.731 TERMS:NE1'30 DAYS A SERVICE CHARGE OF 1.S%PER MONTH OA AN ANNUAL PERCENTAGE la%WILLBE 13 ADDED TO THE UNPAID BALANCE BEGA G 60 DAYS FROM THE DATE OF TFm FUNERAL PURCHASE AGREEMENT A / I]_/{t L 0 ,15 SELECTED ,Independent .- .. AND c° CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717)249-3166 Fax:(717)249-2663 February 28, 2014 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Craig A. Hatch, Esquire RE: Aimee B. Haines Estate Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on the following dates: February 14, February 21, and February 28, 2014 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 0 .00 Total Amount Due $ 75.00 Payment received by PSECO 01/06/2014 TO THE ESTATE OF AIMEE BLAKE HAINES 1482 CENTER RD NEWVILLE, PA 17241-9775 NOTICE OF VOLUNTARY SURRENDER AND SALE The 2007 JEEP LIBERTY, VIN# 1J8GL48K97W531510, which we are financing for you has been voluntarily surrendered and is now in our possession. The vehicle is being stored by: Primeritus Financial Services 311 1 sc Street Summerdale, PA 17093 The vehicle will remain in storage until 01/21/2014. You have the legal right to redeem this motor vehicle within fifteen (15) days after the mailing of this notice by making a payment of the amount necessary to the below address. Amount of Unpaid Balance $6,408.28 Amount of Interest $31.56 Plus Expenses: Repossession Expense $195.00 Storage Expense @ $35/day (12/31-1/21) $770.00 Late Fees $0.00 Redemption Fee $25.00 Personal Property Redemption $25.00 AMOUNT NECESSARY TO REDEEM VEHICLE (Cash or Certified Check): $7,454.84 You are hereby notified that the holder, intends to offer the vehicle at public sale at the expiration of fifteen (15) days after the date of mailing this notice, and shall continue to be offered for sale thereafter until sold. Any personal belongings left in the vehicle must be redeemed by you within 15 days from the date of this letter or they will be disposed of accordingly. Please call us at 1-800-237-7328, option 6, extension 3116 to discuss whether other redemption options may be possible if you cannot afford the entire payoff amount. Sincerely, Member Services P. O. BOX 67013 HARRISBURG, PA 17106-7013 800.237.7328 >>psecu.com THIS CREDIT UNION 15 FEDERALLY INSURED BY THE NATIONAL CREDIT UNION ADMINISTRATION,EQUAL OPPORTUNITY LENDER. I 'Please Remit Payment To: Cumberland Goodwill Fire Rescue EMS Billing Office 13-177109 8/11/2013 $110.28 PO Box 726 New Cumberland, PA 17070-0726 QUESTIONS ABOUT THIS BILL? Phone: 877-214-6018 Espanol: 866-724-4114 Fax: 717-214-6020 Email: infooambulancebillingoffice.com Please visit our website to provide insurance or make payment, and Date of Service: 7/3/2013 13:42 for additional payment options and frequently asked questions: Patient Name: HAINES,AIMEE B. yyyyyy,ambulancebillingoffice.com From: Carlisle Regional Medical Center To: RESIDENCE IMPORTANT "Final Notice" If we do not receive payment within 10 days, your dccount may be referred to collection Contact our office to make payment arrangements. This service is not covered by most insurance carriers. Date Description Procedure Code Qtv Unit Price Total Charge Discounts/Adjustments Payments 7/03/13 Stretcher Van One-Way Transpo A0130 1.0 80.00 80.00 7/03/13 Mileage S0209 17.3 1.75 .28 Total 110.28 0.00 0.00 �3 DETACH AND RETURN BOTTOM PORTION WITH YOUR PAYMENT. ------------------------------------------------------------------------------------------------------------------- o. Please Remit Payment To: - Cumberland Goodwill Fire Rescue EMS Billing Office 13-172549 8/7/2013 $ PO Box 726 New Cumberland, PA 17070-0726 QUESTIONS ABOUT THIS BILL? Phone: 877-214-6018 Espanol: 866-724-4114 Fax: 717-214-6020 Email: info @ambui a jMi'Rs? rc .eam p1/ I W Please visit our website to provide insurance or makI payment, and Date of Service: 6/22/2013 15:19 for additional payment options and frequently asked questions: Patient Name: HAINES,AIMEE B. office.com Www.ambulancebillin From: Carlisle Regional Medical Center www.ambulancebillingoffice.com HERSHEY MEDICAL CENTER IMPORTANT Medicare has paid theirportion of these charges. The balance due is your responsibility. Ifyou have supplemental insurance which covers this co-poy amoun; please complete the back of the invoice or contact our billing office Thank you. Date Description Prooedure Code Qtv Unit Price Total Clharge Discounts/Adjustments 6/22/13 BLS Non-Emergency Transport A0428 1.0 553.61 553.61 6/22/13 Mileage A0425 35.3 13.40 473.02 6/22/13 Adjustment-Insurance -448.81 8/07/13 Adjustment-Insurance -127.77 8/07113 Payment -162.35 8/07/13 Payment -196.22 Total 1,026.63 -576.58 -358.57 DETACH AND RETURN BOTTOM PORTION WITH YOUR PAYMENT. --------------------------------------------------------------------------� a. —1 PION dPO d°o ry N O. U W� m w n O0 d N m d d tl1 O •d N O \S� In I� tr n � IQd u < „> M O O A Cl) 'ru n 0 oR n Cl m0' V ! 'm Um U O O O N sQ N �- w M dPO oV m p oo 30 w y N m ry m o Y t m o 0 Y r M o \d w ¢w J E o 0 j • m 0 >" O z 1 d a Q w O >MZ a Z MOM U HO o ¢D QF m < N Z OO Y U N _� N O b b n= m LLWLLI C �N O D rC M =Ox W � ¢ o o X rH IilO nI • Z�,L'f I Q N N o o Q Om Z BOO F- w o � aU L Z E o � �U 7 > 2 O u • _° Oa o n V d F U o C7 2_ O Z ¢ U O L � �2 ��_� (? rou mcxi 3 mxdm �, 31 o .I� U L� J Vl O Z J „I • U L • F M i� M1 0d NO m �I W H O m 9 j�NW t zo a c7 y W aN NZ UO a Z a� a w wte a ¢ Solna K WJ ^ Z!-W m a a Qa- W QZJ ca 0 Or WNU QN WIyOY n wIt Z z W J R'a O i.'W U- ZQ^ O WW^ WO-0 m° Z a ' AscensionPoin RECOVERY SERVICES, LLC 200 Coon Rapids Blvd., Suite 200 Coon Rapids, MN 55433-5876 Phone: 888-420-2510 Fax: 763-235-4055 9/20/2013 To Whom It May Concern: We are filing a claim on a probate/estate filed in reference to the individual listed below. AscensionPoint Recovery Services, LLC is filing this claim on behalf of GE Capital Retail Bank-CARE CREDIT VET. Please see our claim form (enclosed) for details. Decedent Information: Case Number: 212013-00972 Balance: $1,660.37 Date of Death: 07/09/2013 Name: AIMEE HAINES If you have any questions please feel free to contact our office at your convenience. Respectfully, AscensionPoint Recovery Services, LLC — -------------------------detach coupon----------------------------------------------------- Reference No: 1459381 Phone Number:888-420-2510 PLEASE SEND PAYMENTS&CORRESPONDENCE TO: CRAIG ALLEN HATCH 1013 MUMMA DR STE 100 ASCENSIONPOINT RECOVERY SERVICES, LLC LEMOYNE, PA 17043 200 COON RAPIDS BLVD.SUITE 200 COON RAPIDS, MN 55433-5876 CVRLTR_v1.2_20130709 NOTICE OF CLAIM (Filed Pursuant to 20 Pa.C.S. § 3532) COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF AIMEE HAINES , DECEASED No. 212013-00972 To the Clerk of the Orphans' Court Division: Enter the claim of AscensionPoint Recovery Services, LLC on behalf of GE Capital MOB -CARE CREDIT VET XXXXXXXXXXXX1557 (Claimant) in the amount of$ $1,660.37 against the above entitled Estate. The Decedent,who resided at 1482 CENTER RD,NEWVILLE,PA (Street Address) 17241-9775 died on 07/09/2013. Written notice of said claim was given to (Date of Death) SUSAN K. LAKE, (Personal Representative or his/her counsel) at 45 ASPEN DR DILLSBURG PA 17019. (Address) on 9/20/2013. (Date) r APRS Re resentati (Claim ntJ r�lr(� 200 Co apids Blvd. Suite 200 (Street Address) Coon Rapids, MN 55433-5876 (City,State,Zip) Robin LeDonne—IL Bar#6294763 (Claimant's Counsel) 200 Coon Rapids Blvd. Suite 200 (Address) Coon Rapids, MN 55433-5876 888-420-2510 (Telephone) CLM FRM PA_v1.1 20121120 As sionPoint Recovery Services, ' 200 Coon Rapids Blvd. Suite 200 Coon Rapids, MN 55433-5876 Ascension P"{ ii[ (888) 420-2510 Phone- (763)) 235-4055 Fax RECOVERY SERVICES,LLC Hours: Monday-Friday 8:00AM to 5:OOPM CST Creditor: GE Capital Retail Bank Account No.: XXXXXXXXXXXX1557 Reference No.: 1459381 Balance: $1,664.37 September 20, 2013 Dear estate of AIMEE HAINES, We would like to offer our deepest condolences during this time of loss for you and your family. Thank you for promptly attending to this important matter in the life of AIMEE HAINES. The GE Capital Retail Bank-CARE CREDIT VET account in the amount of$1,660.37 for AIMEE HAINES has been placed with our office for collection. Please contact our office toll-free at(888)420-2510 to discuss options for the estate. Payments and/or the estate information coupon on the reverse side can be mailed to the address listed above. All payments should be made payable to the creditor listed above. Please remember that only the estate of the deceased is liable for the debt owed and family members are not personally responsible for payment of this debt. Again,please accept our condolences during this difficult time. Very truly yours, Christina Mallen,AsccnsionPoint Recovery Services,LLC Federal law requires that we give the following disclosure: Unless 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 notify this office in writing within 30 days after receiving this notice that you dispute the validity of this debt or any portion thereof,this office will obtain verification of the debt or obtain a copy of a judgment and mail you a copy of such judgment or verification. If you request of this office in writing within 30 days after receiving this notice this office will provide you with the name and address of the original creditor,if different from the current creditor. 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 not required to pay any of the debts from the estate. * * *PLEASE SEE REVERSE SIDE FOR IMPORTANT INFORMATION ABOUT YOUR RIGHTS AND THE PROBATE COUPON. * * * W ACA INTERNATIONAL The Auociation of Credit PLEASE DETACH AND RETURN BOTTOM PORTION WITH THE ESTATE'S PAYMENT and Collection Professionals iWerrzAer DEPT 303 9548270413091 Phone Number: (888)420-2510 PO BOX 4115 Amount Enclosed: CONCORD CA 94524 Creditor: GE Capital Retail Bank Account No.:IIIIIIIII Jill IIIIIIIIIn11111111111111111111111111111111111111 JIM 1111111111111111111Jill RefeenceNO.:X145938XXXXX1557 Balance: $1,660.37 ADDRESS SERVICE REQUESTED #BWNFTZF#TAM9548270413091# All payments should be made payable to the creditor listed above. �tltl�y�ttt�l�llntlEll�llt�i�llltlll�lltl�ttlt��ltt�tultl�lq� PLEASE SEND PAYMENTS&CORRESPONDENCE TO: 1459381 CRAIG ALLEN HATCH 1013 MUMMA RD STE 100 ASCENSIONPOINT RECOVERY SERVICES, LLC LEMOYNE PA 17043-1144 200 COON RAPIDS BLVD.SUITE 200 COON RAPIDS, MN 55433-5876 TAMNLB-0920.387444338-00075-75 Capita° 7601 ' i Account No. Remaining Balance Reference No. For the Estate of: ************9160 $5428.49 20147069 AIMEE HAINES September 16,2013 Dear CRAIG ALLEN HATCH: Toll-Free: 855-234-1142 We wish to talk to the person handling the estate of AIMEE HAINES. If you are not that Fax: 877-326-5689 person,we'd appreciate it if you'd please call us with the contact information for that individual. You can reach us toll-free at 1-855-234-1142. Our office hours are indicated to the right- If you have any questions,we're here to help. Cordially, Capital One Estater Care Team 7:00 am-7:00 pm CC(M-1b) 7:00 am-5:00 pm CT(F) Please acrept this letter as a notice of claim. NOTICE: PLEASE SEE REVERSE SIDE FOR IMPORTANT INFORMATION 0 - 7601 Penn Ave South, Suite A650 ***Detach Lower Portmeand Rewmwnh Payment*** Minneapolis,MN 55423-5007 Capital One Reference #: 20147069 Client ID: ZCAP12 7601 Penn Ave South Unpaid Balance: $5428.49 Suite A650 Checks Payable to: Capital One Minneapolis,NN 55423-5007 Address Service Requested Amount Enclosed: Illll�illl lit Illlfll�lllillllllllllll�liill<I�� September 16,2013 �'Pull'nll llml'Ifu'1'lllhhlr'll 11"hlhnld llllllll 52834-92 The Estate of AIMEE HAINES Capital One C�.61tF CRAI6 ALLEN HATCH P.O. Box 815 6"S�iS'rrEE 2109 MARKET ST Minneapolis MN 55440-0815 CAMP HILL PA 17011-4723 lili�n�rlulullnlllarillui�u�uullili�uu��ilalmli�� 4 L a Pn1,47n1,9 eii.kn 52834.39992 � 1&r e 7601 Penn Ave South,Suite Mtnneapohs,MN N 554 55423-5007 7 Toll-Free 855-234-1142 7:00 am-7:00 pm CT (M-Th) Total Unpaid Balance:$5,428,49 Fax 877-326-5689 7:00 am-5:00 pm CT(F) PF Reference No: CL522657 Probate Case No:2013-W972 !!uuII IIIIII IIII IIIIII IIII Date of Death:7/9/2013 y �IIB��tIII�IIINl��O�i��€II�I�) CRAIG ALLEN HATCH 2109 MARKET ST CAMP HILL,PA 17011 SEPTEMBER 13, 2013 Dear CRAIG ALLEN HATCH You'll find a copy enclosed of our claim against the estate of RIME .BLAKE.MAIN S If you have questions,please contact us toll-free at 1-(855)234-1142, Cordially, Capital One Estates Can Team NOTICE:PLEASE SEE REVERSE SIDE FOR IMPORTANT INFORMATION Attemq Csc,}cae�Up�4A20i M3i5 NOTICE OF CLAIM (Filed Pursuant to 20 Pa.C.S. § 3532) COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,PENNSYLVANIA ORPHANS' COURT DIVISION I ESTATE OF AIMEE BLAKE HAINES DECEASED No. 2013-00972 _ To the Clerk of the Orphans' Court Division: Enter the claim of CAPITAL ONE (Claimant) in the amount of$ 5,428.49 against the above entitled Estate. The Decedent,who resided at (Street Address) died on 7/912013 Written notice of (Date of Death) said claim was given to CRAIG ALLEN HATCH (Persona!Representative or his/her counsel) at 2109 MARKET ST CAMP HILL PA 17011 (Address) AMM on p 1 � , , Au ftrized Represefft ive (Dam-)- y /3.�-/1.LC` CAPITAL ONE N/A N/A 7601 PENN AVE SOUTH,SUITE A650 (Claimants Counsel) (Supreme Court LD.No) (Street Address) N/A MINNEAPOLIS,MN 55423 (Address) (City,State,Zip) NIA N/A (Telephone) Fort OC-07 rev.10.13.06 PA Oe Wt=121019 Claim Detail CL522657 IN RE THE ESTATE OF: AIMEE BLAKE HAINES CASE CF MBER: 2013-00972 PF REFERENCE NO: CL522657 Claim detail is as follows: ************9160 CAPITAL ONE $5,428.49 UNSECURED. THE DECEDENT PURCHASED GOODS AND/OR SERVICES IN THE AMOUNT OF $5,428.49, EVIDENCED BY ACCOUNT NUMBER ************9160. Claim Balance: $5,428.49 CAPITAL ONE REFERS TO EITHER CAPITAL ONE N.A. OR CAPITAL ONE BANK USA, N.A. CW.ne.n,CA1;0�uo1vss7 Gapita 'nneapolis,MN 55423-5007 Account No. Remaining Balance Reference No. For the Estate of: ************1563 $177.60 20146732 AIMEE B HAINES October 23,2013 • Dear CRAIG ALLEN HATCH: Toll-Free:877-326-5680 We wish to talk to the person handling the estate of AIMEE B HAINES.If you are not Fa : 877-326-5684 that person,we'd appreciate it if you'd please call us with the contact information for that individual. You can reach us toll-free at 1-877-326-5680. Our office hours are indicated to the right. If you have any questions,were here to help. Cordially, Capital One Estates Care Team 7:00 am-7:00 pm CT(M-Th) 7:00 am-5:00 pm CT m Please accept this letter as a notice of Claim. NOTICE: PLEASE SEE REVERS E SIDE S 0 FOR IMPORTANT INFORMATION 7601 Penn Ave South, Suite A650 ***Detach Lower P= .r and Return with Pqy ,*** Minneapobs,MN 55423-5007 Capital One Reference#:20146732 Client ID: ZCAP12 7601 Penn Ave South Unpaid Balance: $177.60 Suite A650 Checks Payable to:Capital One Minneapolis,IVIN 55423-5007 Address Service Requested. Amount Enclosed: 1$ Nlll�l�III IIIIII�I�IIIIIIIIIIW!lI�IIllllllf III October 23,2013 I�rLt'!'1�1�'�l f.,�'r�9tf'!lft�'�l.f�L1Ed�'q!}}l11�"t�'�If szaaa.sa The Estate of AIMEE 8 HAINES Capital One g CRAIG ALLEN HATCH P. O. Box 815 t 2109 MARKET ST Minneapolis MN 55440-0815 CAMP HILL PA 17011-4723 (rlr�rr�r�u lu�r�n��errlEnr ln�nrrllrlr�uu��tlr�rtrlrl� m 0 d a 20146732 1563 52934-395.38