Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
04-29-14 (3)
REV-1500 EX(02-11) 1505610143�° OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County code Yew File Number Bureau of Individual Taxes °°"'"MtlR°efl'°g1C PO BOx.280601 INHERITANCE TAX RETURN 21 13 1257 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth _ 10 30 2013 11 27 1932 Decedent's Last Name Suffix Decedent's First Name MI KNIPE PATRICIA A (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 0 1. Odglnal Return 2. Supplemental Return 3, Peo alondZr R 2 '(Date of Death ❑ 4. Limited Estate ❑ 48.Fume Interest Comormuae F1 5. Federal Estate Tax Return Required (date or deem after 2-12-87) R 8, DilowlerriDledlTestre, 7. UAfuGe eOt pA;1V 8 UNng Trust 0 e. Total Number of Safe Deposit Boxes (Attach copy of will 1 to n g. 1-10gallon Proceeds Recelved E] 10.g=nl PM?g 1.Electlon to tax under Sea 9113(A)A { ��b a (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number BRUCE J WARSHAWSKY 717 23:8 6570 si c> REGISTER OF'WILLS US)YJNLN 17 j !— L. r— N rrl First Line of Address 7` cD .:j 2320 NORTH SECOND STREE o =13 -n -ri ri C C) n 3 Second Line of Address , . m I ' r STATE FILED 'V C City or Post Office State ZIP Code HARRISBURG PA 1 Correspondent's e-mail address: bjw @cclawpc.com Under true.e.corrr ct anperjury,mlete Dedaraton of peepamer other than theipe�nalare sentattNe is based on allll loformation'of whithe reparerr has any knk mNedge.�llel, ZIt E OF PERSON RESPONSIBLE FOR FILING RETURN DATE Tf&' ( KyraM. Noll ADDRESS 1015 Harriet St., Carlisle PA 17013 SIGNATURE OF PREPARER OTHER THAN REPR SE FIT ATIVE DATE uce J.Warshawsky ADDRESS 2320 North Second Street rrisburg PA Side 1 L 1505610143 1505610143 J fin` Printed with pdfFactory Pro trial version - purchase at www.pdffactory.com �v t . PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF FILE NUMBER Knipe, Patricia A. 21-13-1257 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#2 Name Kevin L.Knipe Addressl 23 stiles Drive Address2 City, State,Zip Marysville PA 17053 Date Printed with pdfFactory Pro trial version - purchase at www.pdffactory.com 1 1505610243 -J REV-1500 EX Decedent's Social Security Number Decedent's Name: Knipe, Patricia A. RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 116 ,380 . 00 2. Stocks and Bonds(Schedule B)............................................................................. 2. 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3. 4. Mortgages&Notes Receivable(Schedule D)........................................................ 4. 5. Cash, Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 8 ,253 . 43 6. Jointly Owned Property(Schedule F) [X] Separate Billing Requested............ 6. 3 , 842 .50 7. Inter-Vivos Transfers&Miscellaneous NtProbate Property (Schedule G) u Separate Billing Requested............ 7. 45 ,256 . 67 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 173 ,732 . 60 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 22 , 601 . 01 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 875 . 52 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 23 ,476. 53 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 150 ,256. 07 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J)............................................... 13. 14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... 14. 150 ,256 . 07 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.00 15. 0 . 00 16. Amount of Line 14 taxable at lineal rate X .045 150 ,256. 07 16. 6, 761 . 52 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.15 0 . 00 18. 0 . 00 19. TAX DUE................................................................................................................ 19. 6, 761 . 52 20, FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. El Side 2 L 1505610243 1505610243 J Printed with pdfFactory Pro trial version - purchase at www.pdffactory.com REV-1500 EX Page 3 File Number 21-13-1257 Decedent's Complete Address: DECEDENTS NAME Knipe, Patricia A. STREETADDRESS 297 Charles Rd. CITY STATE ZIP Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 6,761.52 2. Credits/Payments A. Prior Payments 5,664.26 B. Discount 298.12 Total Credits(A +13) (2) 5,962.38 3. Interest (3) 4. if Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2,Line 20 to request a refund 5. If Line 1+Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 799.14 Make Check Payable to: REGISTER OF WILLS AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;............................................................................... b. retain the right to designate who shall use the property transferred or its Income;.................................. c. retain a reversionary Interest;or...................................................................................4........................... x d. receive the promise for life of either payments,benefits or care?...........................4...44...44...................... 2. If 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 for" or payable upon death bank account or security at his or her death?....... ❑ ❑x 4. Did decedent own an individual retirement account,annuity,or other non-probate property which contains a beneficiary designation?....4.4................44...........4.......4..................................4.......................4.......... ❑ 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)(141)(i)]. For dates of death on or after January 1,1995,the tax rate Imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)]. The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent,or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in (72 P.S.§9116(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. Printed with pdfFactory Pro trial version - purchase at www.pdffactory.com Rov-1502E%+(01-10) _ SCHEDULE A REAL ESTATE LOM IWERR L111 T XJWn.001 INMFRRANCE CIREW RESieENr OEGEDEM ESTATE OF FILE NUMBER Knipe,Patricia A. 21-13-1257 All real property owned solely or as a tenant In common must be reported at fair market value.Fair market value is darned as the price at which property would be exchanged between a willing buyer and a wlllin seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant lads. Real property that Is�Intlyawnod with right of suMvomhip must be disclosed on schedule F. Attach a copy of the settlement sheet if the property has been sold Include a copy of the deed showing decedent's Interest If owned as tenant in common. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 297 Charles Rd., Hampden Twp., Cumberland County, PA 17050-see HUD-/sale 12/12/13 110,000.00 .2 Cemetery Plots at Rolling Green(4) 6,380.00 TOTAL(Also enter on Line 1, Recapitulation) 116,380.00 (If more space Is needed,additional pages of the same size) copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule A(Rev.01-10) Printed with pdfFactory Pro trial version - purchase at www.pdffactory.com Rev-1508 Ex*(11-10) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALm OF PENNSYLVANIA INHERRANCE TA%RETURN RESIDENTDECEDENT ESTATE OF FILE NUMBER Knipe, Patricia A. 21-13-1257 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Comcast refund 106.68 2 Fed.Tax Refund 1,048.00 3 Reimbursement of prepaid RE Taxes-See HUD-1 on RE on Sched.A 581.17 4 The Bridges refund 3,052.55 5 UGI refund 32.03 6 1999 Chevy Malibu 1.828.00 7 Personal Property 1,605.00 TOTAL(Also enter on Line 5, Recapitulation) 8,253.43 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10) Printed with pdfFactory Pro trial version - purchase at www.pdffactory.com Rev-1509 E%-(01.10) SCHEDULE F f:OMMONVIFALTHOFPENN9VLVANIA JOINTLY-OWNED PROPERTY MNERRANOE TM RETURN RESIDENTOEMD NT ESTATE OF FILE NUMBER Knipe, Patricia A. 21-13-1257 If an asset was made joint within one year of the decedent's date of death,It must be reported on schedule G. SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT A. Kevin L. Knipe 23 Stiles Drive Son Marysville, PA 17053 B. C. JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD'S VALUE OF NUMBER FOR JOIN MADE NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR ALOE OF ASSE DECEDENTS INTEREST TENANT JOINT JOINTLY-HELD REAL ESTATE. INTEREST 1 A 1210912011 Centric 7,685.00 50.000% 3,842.50 TOTAL(Also enter on Line 6, Recapitulation) 3,842.50 (If more space Is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule F(Rev.01-10) Printed with pdfFactory Pro trial version - purchase at www.pdffactory.com Rsv-1610 EX-(08-09) SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY couNOrAVEALm or PErmsnvAmA itmEanAnLE iA E RESRESIDENT OELE QENT Nr ESTATE OF FILE NUMBER Knipe, Patricia A. 21-13-1257 This adwdule muat he completed and filed if the answer to any of Questions t through 4 on page three of the REVA 500 Is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % DECO•S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FFODECEDENT STATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1 Vanguard IRA A/c 9974823864 45,256.67 45.256.67 TOTAL(Also enter on Line 7, Recapitulation) 45,256.67 (If more space Is needed,additional pages of the same size) Copyright(c)2009 form software onty The Lackner Group,Inc. Form PA-1500 Schedule G(Rev.08-09) Printed with pdfFactory Pro trial version - purchase at www.pdffactory.com REV-1151 EXi(10-09) SCHEDULE H COMMQI{W Df�N��VLN ANIA FUNERAL EXPENSES AND NlttEt� EACXE `f` ADMINISTRATIVE COSTS ESTATE OF R FILE NUMBER Knipe, Patricia A. 21-13-1257 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s)attached 1,543.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(s)Commission Paid 2. Attorney's Fees Cunningham &Chernicoff, P.C. 5,500.00 3, Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State ZiD Relationship of Claimant to Decedent 4. Probate Fees 358.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 165.00 7. Other Administrative Costs 15,034.51 TOTAL(Also enter on line 9, Recapitulation) 22,601.01 Copyright(c)2009 form software only The Lackner Group, Inc. Forth PA-1500 Schedule H(Rev. 10-09) Printed with pdfFactory Pro trial version - purchase at www.pdffactory.com SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Knipe, Patricia A. 21-13-1257 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Myers-Buhrig Funeral Home 1,543.00 H-A 1,543.00 Other Administrative Costs 2 Boyd Diller,trash removal from House on Schad.A 47.43 3 cost to return Medic Alert 7.25 4 Final health ins.premium Penn National 48.00 5 Legal Adv. (CCBJ and CPBJ) 225.00 6 Notary Fees/Tax.Cart.on sale of RE on Schad.A(see HUD-1) 22.00 7 Personal Property Appraisal-Kerry Pas 150.00 8 PPBL Charges on Real estate on Schad.A.to closing 70.78 9 Real Estate Commission on sale of RE on Schad.A(see HUD-1) 6,905.00 10 Seller Assist/Repairs on sale of RE on Schad.A(see HUD-1) 2,250.00 11 Termite service from House on Schad.A 95.40 12 The Bridges monthly bill 4,050.65 13 Transfer Tax on sale of RE on Schad.A(see HUD-1) 1,100.00 14 UGI on house on Schad.A to closing 63.00 Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98) Printed with pdfFactory Pro trial version - purchase at www.pdffactory.com SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Knipe, Patricia A. 21-13-1257 ITEM NUMBER DESCRIPTION AMOUNT H-B7 15,034.51 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) Printed with pdfFactory Pro trial version - purchase at www.pdffactory.com Rev-1512 EIIP 112-091 SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESICENTDECECENT ESTATE OF FILE NUMBER Knipe, Patricia A. 21-13-1257 Report debts mourned by the decedent pdor to death that remained unpaid at the date of death,including unrelmbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Alert Rx 343.55 2 Capital One 107.00 3 Golden Living 61.50 4 Hampden Twp. 170.56 5 Stale check--gift to Kyra and Rick Noll, never cashed, replaced 150.00 6 Wamp Hill Emergency Physicians 42.91 TOTAL(Also enter on Line 10, Recapitulation) 875,52 (If more space is needed,additional pages of the same size) Copyright(c)2008 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev. 12-08) Printed with pdfFactory Pro trial version - purchase at www.pdffactory.com REV-1513 U.(0110) SCHEDULE ) COMMQNWEAlT_H_O 1& &R BENEFICIARIES BENEFICIARIES ESTATE OF EN� FILE NUMBER Knipe, Patricia A. 21-13-1257 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not List t..1.1 I. TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 Erin Brown Grandchild 6.25%of 23 Stiles Drive Residuary Marysville, PA 17053 2 Kevin L Knipe Son 50%of 23 Stiles Drive Personalty and Marysville, PA 17053 40%of Residuary 3 Clinton Knipe Grandchild 6.25%of 23 Stiles Drive Residuary Marysville, PA 17053 4 Jack R. Knipe III Grandchild 6.25%of 1132 Rana Villa Ave. Residuary Camp Hill, PA 17011 5 Patricia L. Knipe Daughter-in-Law $500 967 W.Trindle Rd. Lot 25 Mechanicsburg, PA 17055 See continuation schedule attached Continuation Total Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as approp riate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev.01-10) Printed with pdfFactory Pro trial version - purchase at www.pdffactory.com SCHEDULE J BENEFICIARIES (Part I,Taxable Distributions) ESTATE OF: Patricia A. Knipe 10/30/2013 200-24-1665 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 6 Ryan Knipe Grandchild 6.25%of Residuary 23 Stiles Drive Marysville, PA 17053 7 Kyra M. Noll Grandchild 50%of Personalty and 1015 Harriet St. 35%of Residuary Carlisle, PA 17013 Total 1 Printed with pdfFactory Pro trial version - purchase at www.pdffactory.com Last Will of Patricia A. Knipe I, Patricia A. Knipe,of Mechanicsburg,Cumberland County, Pennsylvania,being of lawful age, sound mind and memory, and under no restraint, do publish this as my Last. Will, revoking all other Wills or Codicils previously made by me. FIRST: All expenses,fees,costs,and taxes related to this estate shall be paid from the,probate estate assets, including but not limited to funeral expenses, grave marker,the costs of my final illness, Inheritance,Estate and Fiduciary.Taxes;and all gifts and bequests shall be.paid from the net distributable estate. SECOND: I make the following specific bequests: (A) To my daughter-in-law, Patricia L. Knipe (the,surviving spouse of my deceased son, Jack R. Knipe, Jr.), the sum of Five Hundred Dollars ($500.00) in recognition of'her continued love and devotion, but also In recognition that she has already directly received financial benefits from Jack R. Knipe Jr.'s Estate, provided she survives me by 30Ziays;per stirpes. (a)To my son, Kevin L. Knipe, any and all automobiles which 1 own at the time of my-death-,'free and clear from any liens and encumbrances, which, if any, shall be paid from my'Residuary Estate(defined below)provided he survives me by 30 days,per stirpes. (C) To my. Granddaughters, Jennifer L. Nall (the only daughter of my deceased son, Jack R. Knipe, Jr.)and Erin Knipe(the only daughter of my Son, Kevin L. Knipe), any and,all jewelry which 1 own at the time of my death, free and clear from any liens and encumbrances, which, if any, shall be paid from my Residuary Estate (defined below),to be divided as equally as is practicable,in the sole determination of my Executors provided they survive me by 30 days, per stirpes. (D)To my Granddaughter, Jennifer L. Noll and my Son, Kevin L. Knipe,any and all furniture, household and personal effects, and other tangible personalty of like nature., other than cash or securities, together with any existing insurance thereon and which i own at°the'time of my death, free and clear from any liens and encumbrances, which, if any,, shallbe paid from my Residuary Estate (defined below), to be divided as equally as is practicable, in the sole determination of my Executors provided they survive me by 30 days, per stirpes. (E) To the following individuals provided they survive me by 30 days, per stirpes,the following percentages and share of the net(of all taxes, debts and expenses of sale, which shall be paid from the gross proceeds) proceeds from the sale of any real estate which I own at the time of my death and which I hereby direct my Executors to sell at fair market value as soon as is practicable after my death: (1) To my Son, Kevin L. Knipe-40%; (2) To my Granddaughter, Jennifer L. Noll-35%; (3) To my Grandson, Jack R. Knipe, III (Rusty)-6.25%; (4) To my Granddaughter, Erin Knipe-6.25%; (5) To my Grandson, Clinton Knipe-6.25%; and (6) To my Grandson, Ryan Knipe-6.25%. THIRD: I give, devise and bequeath the rest, residue and remainder of my estate, real, personal, or mixed, of every kind and nature, and wherever situated, which I may own, or hereafter acquire, or have a right to dispose of at my death ("Residuary Estate")to my Granddaughter, Jennifer L. Noll and my Son, Kevin L. Knipe, provided they survive me by 30 days, per stirpes. FOURTH: In making my specific bequests in Paragraph Second and Residuary gifts In Paragraph Third above, I am fully aware of all my relations, understand financial resources and have given great though to the disposition of my estate. 1 have given great thought to the distribution of my estate. Kevin L. Knipe is my only surviving child, and Jennifer L. Noll has been more like a child than a grandchild to me since her father (my son), Jack R. Knipe, Jr. died and even more so since my husband, Jack R. Knipe, Sr. died. 1 love all my family members very much. I have carefully considered my decision to treat my other grandchildren (Erin Knipe, Clinton Knipe, Ryan Knipe and Jack R. Knipe, III) equally. FIFTH: I nominate and appoint my son, Kevin L. Knipe and granddaughter, Jennifer L. Noll to be the Executors of my Last Will, granting to them authority to sell and convey any or all of my estate, real and personal, or mixed, upon such terms and prices as he and she shall deem proper, without obtaining any prior order of the court therefore. I also grant them full power and authority in the settlement of my estate, to compromise, adjust, and settle any and all debts and liabilities due to or from my estate, bc- for such sums, and upon such terms and conditions as he shall deem best. In the event that either shall for any reason fail to qualify or cease to act, then I nominate the other, solely to act as Executor (trix). SIXTH: I direct that no bond or surety shall be required of any guardian, trustee, executor, administrator or fiduciary named herein. IN WITNESS WHEREOF, I have hereunto subscribed my name, and acknowledge and publish this instrument as my Last Will in the presence of the undersigned witnesses, on this_#:�day of Aw-4H ,u //n , 2005. ' Patricia A. Knipe The preceding instrument consisting of four pages, including this page, was on the date thereof signed, published and declared by in the presence of us, who, at her request, in her presence, and in the presence of each other, have subscribed our names as witnesses hereto. Bruce Warshawsky lh/t� of Harrisburg, PA John Hyams of Harrisburg, PA Commonwealth of Pennsylvania ss County of Dauphin I, Patricia A. Knipe, the Testatrix, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will, that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein expressed. yoay� 4t, Patricia A. Knipe �- SWORN or affirmed to and acknowledged before me by the above named Testatrix this W?Z day of rnd,�ej-7 2005. "� Sul footary Public N" N otary PubUC,auphin County. es Feb. 22,2007 Commonwealth of Pennsylvania ss County of Dauphin We, the undersigned witnesses whose names appear above, being duly qualified according to law, do depose and say that we were,present and saw Patricia A, Knipe, the Testatrix sign and execute the instrument as her Last Will; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses and that to the best of our knowledge the Testatrix was at the time eighteen (18) or more years of age, of sound mind and under no constraint or.undue influence. Bruce Warshawsk ' John H ams SWORN or affirmed to and acknowledged before me by the above named Testatrix this llm day of MQ./d(h ' 2005. tary Public ' N TARIAL SEAL t JULIEANNE AMETRANO, Notary Public City of Harrisburg, PA Dauphin County, My Commission Expires Feb.22, 2007 ;�il� OMB Approval No.2502-0265 A. Settlement Statement (HUD-1) FINA L NA -of r. 1.❑FHA 2.❑RHS 3.❑Conv.Unins. 6.File Number: 7.Loan Number: 8.Mortgage Insurance Case Number: CP13-00736 4J-]VA 5.❑Conv.lns. C.Note:This form is furnished to give you a statement of actual settlement costs.Amounts paid to and by the settlement agents are shown Items marked "p.o.c)"were paid outside the closing;they are shown here for informational purposes and are not included in the totals. D.Name&Address of Borrower: E.Name&Address of Seller: F.Name&Address of Lender: TAMMY ANN BROWN THE ESTATE OF PATRICIA ANN KNIPE P.O.Box 201,Mechanicsburg,PA 17055 G.Property Location: H.Settlement Agent: I.Settlement Date:12/1212013 297 CHARLES ROAD,HAMPDEN TOWNSHIP Homesale Settlement Services Disbursement Date:12/12/2013 MECHANICSBURG,PA 17050 4000 Cmms Mill Road,Suite 101,Harrisburg,PA 17112 Hampden Township 717-071-9876 Place of Settlement: TitleExpress 3435 Market Street,Camp Hill,PA 17011 Printed 12/1212013 at 8:56 am by BM vim .1 11P 100. Gross Amount Due from Borrower 400. Gross Amount Due to Seller 101. Contract sales price 110,000.00 401. Contract sales price �, 110,000.00 102. Personal property 402. Personal property 103. Settlement charges to borrower(line 1400) 2,355.50 403. 1D4. 404. 105. 405. Adjustments for items paid b seller in advance Adjustments for items paid b seller in advance 106. Cilyllown taxes to 406. CityAmn taxes to . 107. County taxes 1211211013 to 12/31/2013 15.62 407. County takes 12/12/2013 to 121312013 15.fi2 108. School taxes 12112013 to 06/30/2014 531.84 408. School taxes 17/122013 to 06/3012014 531.84 109. Sewer 1211212013 to 12012013 33.71 409. Sewer 17/122013 to 12/3112013 33.71 110. 410. 111. 411, 112. 412. 120. Gross Amount Due from Borrower 112,936.67 420. Gross Amount Due to Seller 110,581.17 200. Amounts Paid by or in Behalf of Borrower 500. Reductions In Amount Due to Seller 201. Deposit or earnest money 1,000.00 501. Excess deposit(see instmctions) 202. Principal amount of new loan(s) 502. Settlement charges to seller(line 1400) 13,527.00 203. Existing loos taken subject to 503. Existing loa s taken subject to 204. 504. Payoff of first marl age loan 205. 505. Payoff of second mortgage loan 206. 506. 207, Seller Assist 1,500.00, 507. Seller Assist 1,500.00 208. Repairs 750.00 50B. Repairs 750.00 209. 509. Adjustments for Items unpaid by seller Adjustments for Items unpaid b seller 210. City/town taxes to 510. Cityllown taxes to 211. County taxes to 511. County taxes to 212. School taxes to 512. School taxes to 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. Total Paid by/for Borrower 31250.00 520. Total Reduction Amount Due Seller 15,777.00 300. Cash at Settlement fromito Borrower 600. Cash at Settlement tolfrom Seller 301. Gross amount due from borrower(line 120) 112,936.67 601. Gross amount due to seller(line 420) 110,581.17 302, Less amounts paid by/for borrower(line 220) 3,250.00 602. Less reductions in amount due seller(line 520) 15,777.00 303. Cash ❑ From ❑ To Borrower 109,686.67 603. Cash 0 To ❑ Fromsener 94,804.17 Bislom.unMUll Yisgq.m,nNIy.ICOMO m„IMnumY,.MwftluWWlYtl.�✓b:Nb GNasun O�muWVVby tM It OeypnN,ope.E.N.pNn11o�PE5PI.wMOlnnntlian MNlnlom.,YUYWry1M� v aellWmnl pony Previous editions are obsolete Page 1 of 4 HUD-1 L.SettlemjM CCar es 700. Total Real Estate Broker Fees $6,9D5.00 Paid Fr m Paid From Mien of commisslol line 700 as follows: Borrower's Seller's 701. $0650.00 to RemaxlslAdvanlage Funds at Funds at 702. $3255.00 to PmdentialHomesaleServkesGroup Settlement Settle 703. Commission paid at setUement 6,905.00 704. Broker Fee to Prudential Homesale Services Group 225.00 ((}} 800. Items Payable in Connection with Loan "1 801. Our originalon charge (Includes Origination Point 0.000%or$0.00) S (from GFE 41) 802. Your credit or charge(points)for the specific Interest rate chosen S Oran GFE 02) 803. Ywr adjusted origination charges (from GFE A) 8D4. Appraisal fee to tram GFE 03 805. Credtre to from GFE 03 8D6. Tax service to from GFE 03 807. Flood certification to from GFE 03 8D8. to 900. Items Required by Lender to be Paid In Advance 901. Dally interest charges from from 12/12/2013 to 0110112014 @$0.0111day (from GFE 910) 902. Mortgage Insurance premium months to from GFE 03 903. Homeowners insurance months to (fm GFE 911 904. months to from GFE 011 MO.Reserves Deposited vAth Lender 1001.Initial deposit for your escrow aaounl (from GFE 09) 1002.Homewmers insurance months 9D$ /month 1003 Mart a e Insurance months A$ hnenlh 1004, PMWY taxes months 0$ /month 1005.Canty,taxes months f@ S 23.76h mth $ 1006.Assessments maths 5 80ABOranth $ 1007.Aggregate Adjustment $ 1100.Title Charges 1101.Tide services and lenders title insurance from GFE 04 1102.Settlement or dosing in to S 1103.Owners fide insurance-Old Republic Tide Insurance Company (ran GFE#5) 950.00 1100.Lenders fide Insurance-Old Republic Tide Insurance Company $ 1105.Lenders We policy funk$0.00 Landefs Percy 1106.Owners dde policy limit$110,000.00 Owners Polity 1107,Agent's portion of the total tide insurance premium $945.50 to Homesale Settlement Services 1108.Underwriters portion of the total title Insurance premium $104.50 to OM Republic Tide Insurance Company 1109. 1200.Government Recording and Transfer Charges 1201.Govemment recording charges S (from GFE q7) 75.50 \ 1202 Deed$75.50 Mornialie S Release S 1203.Transfer faxes $ (from GFE A8) 1,100.00 1204.Cily/County laxlslamps Deed$1,100.00 Modgagell 1205.Slate Tax/stamps Deed$1,100.00 Mort a eb 1,100.00 1206. Deed S Mor e S 1207. $ 1300.Addigonel SetOement Charges 1301.Required services that you can shop fa (from GFE ft6) 1302. D 1303. 10 1304.IMerilance Tax Payment to Register d Wills "5,5DO.13D5.Notary Fees to.Nol Public 5.1306.Tax Cart to Homessle Settlement SeMces r ,ii t r 2,355.50 13,527.00 'Paid atside of dosing by(B)onw,er,(S)ellcr,(L)ender,(I)mastor,BroKer.-Credit by lender shmm on page 1.-Credit by seller shown of page 1. Previous editions are obsolete Page 2 of 4 HUD-3 HUD CERTIFICATION OF BUYER AND SELLER I,have mrefully reviewed the HUD-1 Settlement Statement and to the hest of my knoMedge and belief,it is a tme and amurate statement of all recelpts and disbursements made on my account or by me in this transaction I further ceNfy that I have remind a copy of the HUD-1 Settlement Statement TAMMY ANN BR THE ESTAT 0— FPATRICIA ANN KN The HUD1 Settlement Statement which I have prepared le a two and accurate account of this transaction I have mused or will cause the funds to be disbursed in amordanm with this statement `;�ice✓ /a/a/r� SETTLEME ENT DATE r WARNING:IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT.FOR DETAILS SEE TITLE 18:U.S.CODE SECTION 1001 AND SECTION 1010. Previous editions are obsolete Page 4 of 4 HUD-1 �a v a O T x a 5 „ rd y ' y ^ i e d Z$ 0 e d cc m f4 N ro o W Ln M U 0 O a y� E 3 d a' CL a� J E a v U L C R r T yd., ti I�o����ngCnee�n�JUleu�on�a� CandeNs 111 Cl Cefttl , �nlS lS � LQd JACK y THAT' . . . . . R.. . .KNIPE. . . . . . SR.. . . . . .and. PATRICIA. . . . . . . . A.. . . . . KNIPEf wrs.,. of. 297 Charles .Road, Mechanicsburg,. Pennsyivania 17055. _ IS OR ARE THE OWNER OR OWNERS OF SPACES .1,,2,3, ,ar(d, A. , . , LOT NO 931). . . . . . . . . BLOCK .A . . . . . . . . . . . . . . . . �I oQpirg gneer �le►mohiaQ ganders FOR INTERMENT PURPOSES ONLY, subject to the following conditions, reservations, restrictions and rules and regulations to wit: (a) No transfer or assignment of any interest or rights acquired by Grantee shall be valid without the written consent of Grantor and being thereafter recorded on its books. (b) No monument or other memorial, tree, plants,objects or embellishments of any kind shall be placed upon,altered or removed from the above-described property by the Grantee without the consent of Grantor. All grading, landscape work and improvements of any kind, and all care on the above-described property,shall be done,and all trees and plants of any kind shall be planted, trimmed or removed, and all interments, disinterments and removals, including all openings and closingsof graves, shall be made only by Grantor with its equipment. All interments shall be made to use the type of outer container as shall be designed by Grantor in its rules and regulations. (c) Grantor, at the expense of Grantee and as a charge against the above-described property,-may repair or remove any monument or other memorial which is improper or offensive or which has become dangerous or dilapidated; and may remove any tree, Flower or plant,or other object or embellishment that becomes unsightly or dangerous. (d) Grantor shall not be liable for loss or damage caused by an act of God, common enemy, thieves, vandals, strikers, malicious mischief makers, unavoidable accidents,riot or order of any military or civil authority. (e) Only bronze memorials as prescribed by the rules and regulations situate flush with the lawn will be permitted. (f) The enumeration herein of certain conditions, reservations, restrictions and rules and regulations shall not be considered as the only limitations, but the Grantee shall always hold all his interest and rights limited by and subject to the rules and regulations and by-laws of Grantor now existing or which may be by it hereafter adopted either by amendment,alteration or the adoption of new ones. These rules and regulations are on file for inspection in Grantor's office and are specifically referred to and herein inserted as if set forth in full. (g) All the above conditions, reservations, restrictions and rules and regulations are binding upon Grantee, his heirs, devisees, executors, administrators and assigns, and are enforceable only by Grantor or its successors in interest. Nothing herein contained shall be deemed to restrict the use of any gther portion of the cemetery than the burial property herein described,or to restrict the Grantor from conducting any activity either within or without its boundaries that is incidental or convenient to either or both the care or memorializing of the human dead. IN WITNESS WHEREOF, The said ROLLING GREEN MEMORIAL GARDENS has caused these presents to be executed, this . 17th. . . . . day of . . . . October . . . . . . . . . . 19 .8.8. RO IN G ME IA RDENS . . . . .�. . . . . . xecutive :Vice ,Prq.jGiexit. . . . . . Bruce Warshawsky From: Grim, Renate <Renate.Grim @Dignitymemorial.com> Sent: Friday, March 14, 2014 1:28 PM To: Bruce Warshawsky Subject: Good afternoon from Rolling Green Cemetery Dear Sir Thank you for contacting Rolling Green Cemetery today. The cost for cemetery plots in Block A is currently $1595 per space. Sincerely Renate Grim Family Service Supervisor Rolling Green Cemetery 717-761-4055 717-761-4826 fax Wise is the person who has made provision before the hour of need! 1 COMCAST 1555 SUZY STREET L O ATTN: LEBANON SUPPORT SERVICES \ LEBANON, PA 17046 Ccomcast PATRICIA RNIPE 28138 0846-61-10-3DG 297 CHARLES RD ' MECHANICSBURG, PA 17050-3002 �IrldIrIII��I���I�IIII���IIi�Id���Il�lilq�m11114�I�h�Ii� PAYMENT SUMMARY CHECK NO: 0011904814 ACCOUNT NO: 09547-19590801 CHECK DATE: 10/21/13 Dear PATRICIA RNIPE, The attached check represents a refund for account number 09547-19590801 in the amount of $106 .68. If you are a Comcast RFINITY customer and have questions regarding your refund check, you can write us at the address above, call Comcast's toll free customer service number at 1-888-COMCAST (1-888-266-2278) , or chat with us at www.comcast.com/chat. our representatives are available to assist you 24 hours a day, 7 days a week. If you are a Comcast Spotlight client or agency, please contact your local Spotlight office. DETACH AND RETAIN THIS STATEMENT THE ATTACHED CHECK IS IN PAYMENT OF ITEMS DESCRIBED ABOVE. IF NOT CORRECT,PLEASE NOTIFY US PROMPTLY.NO RECEIPT DESIRED, COMCAST FINANCUILAGENCY CORPORATION , =A COMCi1S T CA$LE COMMUNICATIONS'GROUP CO COMPAN 60-6 6160/433 J .,a . q, .d C ?•a �t Sa^ t f'. . •w..' A t. e L :.. ' e .y� i ACCOUNT NUMBER CHECK DATE CHECK NUMBER � . �E r� " i'09547-19590801 ,,,•1012V2013`: f-0011904614 -r,� •s VALID FOR 160--DAYS KNIPE x To` *PATRICIA., a s .� -. _ ._._ THE v 297 ;i CHARLES .RO ' .`h. ' 5....*+'106.68 Yt• , ORDER';, *ECHANICSBURG• PA m0=3002 tY Y jru F t� �� •/ya'y'y� 1 A (/N{{A[Arl", THE BANK*OF 'NEW -Y OR K MELLON PITTSBURGH,' PENNSYLVANIA 11000 1 1 9048i411' 1:04330160 P: 113111783[till KNI1665 MWM4 a41 PM �V E DeP� of it*TnoV%oy-4Kemal Revenue SerNro (99) LL 0 U.S. Individual Income Tax Return 2013 oMe NO.,sasaDt4 IRS Use nn wdle« In MIS For de yoor ten.1-0ea 31,20,7.«odor lox yoor .2017.erdnq 20 "See separate Instructions. Your by name eM Wd lap name Deceased Yo«.ocl.l.ecudly number Patricia A Rai 10/30/13 11 a kkd gnun tpouee.bet Come erd Ndd lap name spaw.'@ ao of secumy numM F nno addmes(numbw end abeee.n you lme.P.O.bm.tee Ins uU . Apt no. . Make awe Ina SSNI.)oboes 1015 Harriet Street Bndonmoecmm e° Residenud Becton Canpdgn city,loan«pop oMa,ppe,wd DP woe.X you have a foreign adbeM,also oompba epowe beiav(sae hsbucdane). Cho*ben n you,or your.pwsa Carlisle PA 17013 a rank hoInM.ww w b 0a to w. NM,ch.dN.bra bpaw»a Forelai oxxroy name Portion dab Fodgn Dm1a Code wt dnnao your tm«You sp Filing Status 1 skta 4 ;aoen,wtti,mua WM'" 2 MwdeG tuna W rdy(own X only one had Income) dW...h no.► Check only one 3 Memel sat wpon,".Emw spme .esN above 6 ❑ Dua%l t~ad WM dewndem dvd box. end M name hen.► 6a Yourself. If someone can claim you as a dependent,do not check box 6a .. .. .......... l Bww cue 1 f on 6a and 6b Exemptions b M souse No.of children c Dependents: l• vaeer on 6c who: (2)Dependant. 17)DepmdW$ apo 17 qud • lived with you _ owe saexXy camber aloft ft to yes m crap a did not true divorce FM name lap name .e.Inpr. you adouaeelo divorce if more than four (see InsWc�tons) dependents, see Instructions and ZTedents on 6c check here►U not entered above_ d Total number of exemptions claimed Add number�on 1 .. ..................................... ................. Imes above 7 waaoo,sel.dee,cps•M Atlerh Fo n(s)war..... ....... 7 ............................... Income 8a Taxable Interest.Attach Schedule B If required ....................... ............................... 8a 22 Attach Form(s) b Tax-exempt Interest.Do not Include on line 8a 8b W-2 here.Also 9a Ordinary dividends.Attach Schedule B If required 98 30 attach Forme b Qualified dWends - ................. ..9ti.........................30 ,.'. W-2G and .....................I............................ - 1099-R H tax 10 Taxable refunds,credits, or offsets of stale and local Income taxes ................................... 10 was withheld. 11 Alimony received ...................................................................................... 11 If you did not 12 Business Income or(loss).Attach Schedule C or C-EZ.........................I..................... 12 get a W-2. 13 Ca"gahn,u(on).Aftmh Sdaduie D d required.X not mMaed,dock hen►......................I................ 13 see Instructions. 14 Other gains or(losses).Attach Form 4797 ...................... . ...... . .... . . ............... 14 16a IRA distributions 16e 14 142 b Taxable amount 16b 14,142 16a Pensions and annultles 18a b Taxable amount 16b 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E ............. 17 18 Farm Income or(loss).Attach Schedule F............................................................. 18 19 Unemployment compensation......... ........................... ...............I...I.............. 19 20a Sold security benefits . ..._. 120a 18,479 b Taxable amount 20b 1 0 21 Other Income. List type and amount ,,,, , 21 .................................................. 22 Combine the amounts In the far right column for lines 7 through 21.Thls Is our total Income ► 22 1 14 194 23 Educator expenses.................................................. 23 . Adjusted 24 Certain business expenses of reservists, performing artists, and Gross fee-basis government officials. Attach Form 2108 or 2106-EZ 24 26 Health savings account deduction.Attach Fonn 8889 26 Income ............... 26 Moving expenses.Attach Forth 3903 26 27 Deductible part of self-employment tax.Attach Schedule SE 27 28 Self-employed SEP, SIMPLE, and qualified plans 28 29 Self-employed health Insurance deduction .......................... 29 . 30 Penalty on early withdrawal of savings .............................. 30 31a Almorry paid b Recipients SSN► 31a 32 IRA deduction 32 ....................................................... -... 33 Student ban Interest deduction 33 34 Tuition and fees.Attach Form 8917.................................. 34 36 Domestic production activities deduction. Attach Forth 8903 36 36 Add lines 23 through 35 ............................................................................... 38 37 Subtract line 36 from line 22.This is your adjusted gross Income ... .. ....... .. ► 1 37 1 14,194 For Dlsdwurs,Privacy Act and Paperwork Reducton Act Mike,see separate Insbuclkns. Farm 1040 f2D13) DM KNI188S 02/1/12014 9H PM Form 1010 2013 Patricia A Knipe fa 2 Tax and 39 Amount from line 37(adjusted gross Income) .......... 38 14 194 ................... Credits 390 Cheri / You were both before January 2, 1949, 81ind. Total bones H; t Spouse was bom befog January 2, 1848, 6Gnd. } Cheeketl ► 390 1 Standard b If your spouse Ham)2es on a separate MIUm or you were a duabstetus alien,check here► 39b Deduction 40 ttemlzed deductions(from Schedule A)or your standard deduction(see left margin) 40 7,600 for— 41 Subtract line 40 from line 38.......................................... . ...................... 41 6,594 1''d0da wrm . ......... 42 Exemptions. n 0np 3a 5 1150,000 a Ieee,mw*$3�s x b,pis Inllnbef w Ira ad.omenwe,sae ftW-o m 42 3.900 b mAie 43 71(81118 in07me.Suatrad We 42 tan tie 4l.a is 425 m�xa OM 13041,air 0 ............. 39aa3ab or ❑ ................................_...., 2,694 who an ae 44 Tai(We 1sh.).Chad t limy from a 0 8814 s) b❑cis z e cis 266 d ° 45 Alternative minimum tax (see instructions).Attach Form 6251 46 sae .............................. 48 MlabwbMe. Add lines 44 and 45 _ ,,.,..____._......... .......... 10, 46 266 All We 47 Foreign tax credit Attach Form 1116 H required 47 ..... .. ..... stripe w 48 Credit for child and dependent pre expenses.Attach Form 2441 48 Mwmlee AM 49 Education credits from Form 8863,line 19 sap r. 49 60 Retirement savings contributions credit.Asada Fours 8880........... 50 t4ema 0%p a 61 Child tan coedit.Attach Schedule 8812,H required OvWryiV 51 62 Residential energy credits.Attach Form 5895 62 s12,2w' 53 Other aedib from Form:a [] 3800 If a 6601 C �......... 63 +read a irmsmad, 54 Add Ones 47 through 53.These are your total credits 58.950 . . 6d 65 Subtract line 54 from line 48, if line 54 is more than line48 enter. 56 266 Other 66 Self-employment tax,Atach Schedule SE 66 Taxes 57 Unreported social security and Med6ra tax from Form:...s... 4137....11 8919 67 68 Additional tax on IRAs,other qualified rebremerd plans,etc.Attach Forth 5329 H required 58 $98 Household employment taxes from Schedule H 698 b FIBt4hne homeb(t�ryer credit repayment Attach Form$405 H required 60 Taxes from: a t...! Form&958 b ❑ r.M 5968 C n fim ^air am a'W'.. .....•. 59th 69 61 Add lines 55 Oho h 60.This Is our total tax 111' 61 266 62 Federal Income tax withheld from Forms 1h-2 and 1099 62 1 314 Payments 63 2013 estimated tax payments and amourt applied from 2012 retum 83 n you tame 648 Earned Income credit EIG .......... ......._....... .......... ( } N4 64Is au°�'° b Nontaxable combat pay elad' gob child,anarn Slft!0 Me EIC. 65 Additional child lax credit Attach Schedule 8812 fib Amerkan opportunity credit from Form 8883.frre 8 66 67 Reserved 67 68 Amount paid with request for extension to file 68 69 Excess social security and der t RRTA tax withheld S9 ................. 70 Credit for federal tax an fasts.Attach Pone 4138 7a 71 Cn4a hour Farm: a 2p9 b 0 Pem%md c❑seas tl 0. 71 72 rot Miss 6P,e3,64a,ad 65 81mIIgh 71,these an,tour twr payments ► 72 1 314 Refund 73 if line 72 is MDre ben line 61,subtract line fit from line 72.This is the amount you overpaid 73 743 Amount of One 73 you want refunded to ou.H Form 8888 Is attached,check here .. ....... ► 74a 1 04 8 sw depoelrr ► b Routing number }ODppDt7pp( ► c Tyne: E] Checking E] SWngs „amwxxmi ► d Account number �---- "� 76 Amount of line 73 You want a Hed to our 2814 astim—Mad tax► 75 Amount 76 Amount you owe,Subtract fine 72 from line 61.For details on how to ay,a"instructions ► 76 YOU Owe 77 Estimated tax not """ (see instructions .......... � Third Party Do you want to allow another person to discuss this Arum with the IRS(see Instructions)? Yea. Complete below. No Designee °°"w"I'• Gaamm wsrff the nwba(AN) ► 74848 `M`rrl"--►-CrYsta1 St. Omer Roy CPA Ftmae ► 717-761-5080 18011 reaauea M Pxkry I detlae aa1 I rove hied eta cedar aq aommperryYq aahpm4m and mmemeaa,W m tlm hen a m Here . ywr 70.We, a id m ape e Detlan bn d ^ Pepenr has Wry 0 k2mne/..1*9Op/, Da Yw appm 1a4 re aameaidw, tW Rpomae te e„d bw n,a PPPo a S0N I N e MMMW a°°lNfid r°e119% tired mr x SPaea M e)oht mt % a mum ap% 00% Saaapa wovatiun Irn IRS aim. 0 31n Wwa,l emlda rY2 guRa7pp Recere's rare Paid c atel se, amr ao cv e a O 0a 6068 Prepa►gr Firm mile ► C stal St. Omer Roy, CPA FWn EIN► 86-1052337 Use On1Y Fm amass ► 212 S Sporting Kill Rd Mechanicsburg PA 17050 717-761-5080 oM Faro 11040(2013) M11665=9014 0.41 PM SCHEDULE B Interest and Ordinary Dividends oMa140. 15450074 (Form 1040A or 1040) ► Attach to Forth 1040A or 1040. 2013 DeM.1"Re enthe Treasury ► Infomlation about Schedule B Fom11040A or 1040 and Its instructions ts at www.ire ovlacheduleb. Atlaainenl internal Revenue Servha ( ) 9 sewarse No. 08 Names)shown on return Your social security number Patricia A Knipe Part I 1 List name of payer. If any Interest Is from a seller-financed mortgage and the Amount Interest buyer used the property as a personal residence,see Instructions on back and list this interest first.Also, show that buyer's social security number and address► Centric Bank 1036086 DDA 22 . . ........................................... . ............................................................................................................. (See irtstrud'are ............................................................................................................. on back and the instnrabns for Form1040A,or ....................................................:........................................................ Form1040, ............................................................................................................. 1 lineBe.) ............................................................................................................. Note.if you ............................................................................................................. receiveda Form ............................................................................................................. 10994NT, Firm ............................................................................................................. 1099-0ro, or substitute ............................................................................................................. statemeNfrom ............................................................................................................. abrokerage firm, .............................................................................................................. list the tom's ............................................................................................................. 2 22 name as the 2 Add the amounts on line 1 ..........................bond ................................................. ft to e 3 Excludable Interest on series EE end I U.S.savings bonds Issued after 1989. son ny� Attach Forth 8815 3 ......................................................................................... forth. 4 Subtract line 3 from line 2.Enter the result here and on Forth 1040A.or Forth 1040 line 8a ► 4 22 Note. If One 4 Is over$1,500,you must complete Part III. Amount Part II 6 List name of payer► MetLife ..................................................... 30 Ordinary ............................................................................................................. Dividends ............................................................................................................. (See Imtnwtbre onback and the ............................................................................................................. Instructionsfor .....................................................................................I....................... Form1040A,or ............................................................................................................. Form1040, ............................................................................................................. line 9a) ............................................................................................................. 5 Note. If you ............................................................................................................. receiveda Form ..............................................................................I.............................. 1099-0N or ............................................................................................................. substitute staterhentfrom ............................................................................................................. abrokerage fin, ............................................................................................................. list the firm's ............................................................................................................. nartre as the ......................................................................................... payer and enter .................... Na ordinary 6 Add the amounts on line 5. Enter the total here and on Form 1040A,or Forth dividends shown 1040 One 9a ► 5 30 on that form. Note. If line 6 Is over$1,500,you must complete Pert III. You must complete this part if you(a)had over$1,500 of taxable Interest or ordinary dividends;(b)had a Yea No foreign account or(c)received a distribution from,or were a grantor of,or a transferor to,a foreign trust. Part III 7a At any time during 2013,did you have a financial Interest In or signature authority over a financial account(such as a bank account, securities account,or brokerage account)located in a foreign Foreign country? See instructions .................................................................................................... Accounts If'Yes;ere ycu le FI required to file Forth 114,Report of Foreign Bank and Financial and Trusts Accounts(FEAR),formerly TD F 90.22.1,to report that financial interest or signature aulhority? See FinCEN Form 114 and its instructions for filing requirements and exceptions to those - (See requirements ................................................................................................................... trrshudbrls on b If you are required to file FInCEN Form 114,enter the name of the foreign country where the back.) financial account Is located ................. ► 8 During 2013,did you receive a distribution from,or were you the grantor of or transferor to,a foreign trust?If"Yes"you may have to file Form 3520.See inductions on back............................................. For Paperwork Reduction Act Notice.see your tax return Instructions. Schedule B(Form 1040A or 1040)2013 0n NNI 1685 OVIND14 sn PM Form 8948 Preparer Explanation for Not Filing Electronically OMB NO.154s270a (Rev.sepemnx zolz) ► Attach to taxpayer's Form 1040,1040A,1040EZ,or Form 1041. oepedmaM m me Tmaavy hteaul Rmenue s ► Information about Form 8948 and Its Instructions Is available at www.lrs. ovRom18948. Nemelr)W tax n Tex yea d mevn Tn4.0e%N.Wft bw Patricia A Knipe 2013 Prepaara n PMamr Tex IdanD=Wn N Ixx(PTIM Crystal St. Omer Roy, CPA P00316068 Three out of four taxpayers now use IRS*-file;Go to www.1m.govlefile for details on using IRS o-filo.The benefits of electronic filing,Include the following. ;.- Faster refunds • Secure bensmisslona - , •':E-payment options - More accurate returns. ,• Easier filing method - • Recelpt.-acknowledged _.. Check the applicable box to Indicate the reason this return Is not being filed electronically. Do not check more than one box. 1 Taxpayer chose to file this return on paper. 2 The preparer receNed a waiver from the requirement to electronically file the tax return. Waiver Reference Number Approval Letter Date 3 11 The preparer Is a member of a recognized religious group that Is conscientiously opposed to filing electronically. 4 F1 This return was rejected by IRS e•file and the reject condition could not be resolved. Reject code: Number of attempts to resolve reject: 5 El The preparers e-file software package does not support Form or Schedule attached to this return. 8 Check the box that applies and provide additional Information If requested. a The preparer is Ineligible to file electronically because IRS a-file does not accept foreign preparers without social security numbers who live and work abroad. to The preparer Is Ineligible to participate in IRS e-file. C Other: Describe below the circumstances that prevented the preparer from filing this return electronically. This return is being filed by a court-appointed personal representative and ..... .... ......... is...not elic, 1P...to..be...£iled electronically,............................................................................ . ...................................................................................................................................................................... ....................................................................................................................................................................... ....................................................................................................................................................................... ....................................................................................................................................................................... ....................................................................................................................................................................... For Paperwork Reduction Act Notice, see Instructions. gam 8948(Rer.61012) oar µ -1 AI gC3 m� r a n> n ro Na co ' O o O rr x-t o CL w .ru N H N. . .°° o O m P- mm °ra r N ct q1 W tT1; w . k N .: '. ..:.; N N cD .:..9. x m c ort ` uj w J �.. � H: a ° r* r - `O w m x O - W r Cn Ln cn w > LW. o. w O" D0'd a 3 Era N m O QJ'G W W \ �mx I ' r 1.0 f w cn: Lj i � y > l Lnn u' W ROBC Limited Partnership statement 202 Black Matt Road Douglassville, PA 19518 Account: horobc-0248-hoknipat Date: 11/19/13 Patricia Knipe Payment: c/o The Bridges At Bent Creek 2100 Bent Creek Blvd,Rm 248 Mechanicsburg,PA 17050 Date Description Charges Payments Balance Balance Forward 0.00 08/22/13 Non Refundable Deposit 11500.00 1,500.00 08/22/13 Telephone Set Up Fee 30.00 1,530.00 08122113 Rent 8/22/13-8131/13 1,19100 2,72100 08122/13 Telephone Sery 8/22M 3-8/31fl3 5.00 2,728.00 08/22/13 Level of Care 8122/13-8131/13 117.00 2,845.00 08/26/13 chk#5606 1,500.00 1,345.00 09/01113 Rent 3,630.00 4,975.00 09/01/13 Basic Local Telephone Service 15.00 4,990.00 09/01/13 Level of Care Plus 350.00 5,340.00 09/10/13 Beauty Shop-Nall Trim 8127 8.00 5,348.00 09/10113 Beauty Shop-Wash&Set 8127 17.00 5,365.00 09/17113 Guest Meal-8125 Supper 11.00 5,376.00 09/17/13 Pers Care Items 8/16-9/15 18.80 5,394.80 10/01113 Rent 3,630.00 9,024.80 10/01/13 Basic Local Telephone Service 15.00 9,039.80 10/01/13 Level of Care Plus 350.00 9,389.80 10/07/13 chk#ACH 9,389.80 0.00 10117/13 Laundry-9122 2 Loads 10.00 10.00 10117/13 Laundry-91291 Load 5.00 15.00 10/18/13 Pers Care Items 9/16-10115 40.65 55.65 11/01/13 Rent Charges(11/2013) 3,630.00 3,685.65 11/01113 Basic Local Telephone Service 15.00 3,700.65 11101/13 Level of Care Plus 350.00 4,050.65 11/05/13 chk#ACH 4,050.65 0100 11/11/13 Credit Rent 11/11/13-11/30/13 -2,387.00 -2,387.00 11/11/13 Credit Telephone Sery 11/11113-11/30113 -10.00 -2,397.00 11/11113 Credit November Level of Care -350.00 -2,747.00 11/11/13 Cr Tens Briefs Medium -13.55 -2,760.55 11/11/13 Credit Level of Care 10/17/13-10131113 -292.00 -3,052.55 11/19/13 Amount to be refunded 3,052.55 0.00 11/19/13 (Pay#135897)Move out refund -3,052.55 -3,052.55 11/19/13 Check#32014293 paid out -3,052.55 0.00 Current 30 Days 60 Days 90 Days Amount Due 0.00 0.00 0.00 0.00 0,00 ............. ........ .. . ....... ... ........................... .. . ... . ........ .. . ..... ........... . .. Check No. 20758209 Date 1/9114 PATRICIA A KNIPE SUITE 248 2100 BENT CREEK BLVD MECHANICSBURG PA 17050 Gross Discount Net Invoice H ''Inv Date PO Number Description Amount Amount Am e 14010790116 2 I/A1-07 RFF1JNDS117533300003297 CHARLES RD 32.03 0.00 31.03 �s4 Direct inquires to: Accounts Payable Dept,PO Box 13578,Reading.PA 196133578 1 Total I 32.03 1 0.00 1 32.03 REMOVE DOCUMENT ALONG THIS PERFORATION !. q The Bank of New York Mellon Check No. 20758209 tr ® Pilnburgh,Pa Date 1/9/14 a rr<t rur. 7we. 60-160/433 ;:3 Clieek"A'iuouot8?'s3 PAY 76irty?nuOaRanAn(76roCkau 32.03 TO THE PATRICIA A.KNIPE G i ORDER SUITE 248 could"219 'tun esqutroe Rinvurd 19 65,000 er alora OF 2100 BENT CREEK BLVD MECHANICSBURG PA 17050 , - --- - ---- ----- -- - ----- - ---- ---------IUaiweme579'ixluro _ _ . ...................I........._............. - ..._......_....._....._. .-- . ........._.. .. ....... ... _.__.... .. _.. x' 20758209111 1:0 4 3 30 160 11:. 105111069 &110 1999 Chevrolet Malibu Sedan 4D Trade In Values-Kelley Blue Book http://www,kbb.cam/chevroleVmalibu/1999-chevrolet-malibu/sedan-4.. $.1 ,Q 21P CODE:170551 Sign in for Sign up) home car values cars for sale car reviews awards b top Ins I research tools Popular at KBB.com The 40 mpg Cars of 2013 i Advwasemunt Why ads? > fl49 Chevrolet Malibu 2999 ame>Car Values>Chevrolet>Malibu>19 Oo Style>options>Sedan 4O Your Blue Boo k°Value Show Used Car Prices I Price Your Next Car R w». (CC 1999 Chevrolet Malib (X IA) Trade Evaluator Your Opinion"Counts! Trade In your old vehicle for a new Kla Optlma,it i Your Input cm inaueno.thewW.0i.Indust,In the faltim might be easier than you think. ", vie...uYenewmamen4 teprovme yowopinlen.and let 20141Ga Optima MSRPr $25,100 Cot ad ymevdce ee nest a t0a thssd ._ Your Estimated Trade-In Vaii 42,303 No thanks Continue TIa ... _ to a Print report "11 A=Kelley Blue Book "m hare.. MAR TINTELLIGENCE 2014 WeOptime $22,797 . a New Car Trade-in Yalue Then browse reviews,photos,, specs and rte, See Program Details $1a8za .—� See what you should pay tea.mkema i - AdvenkemvR - ., whv;e.! I. Instant Cash Offer Find local dealers ready to buy your car-today! Get your offer `i fair condition Trade-in Valuad valid for your area through 1116/2014 Track this car's values Adverti:ema4 why ads? Tell Us About This Car Owmm like you rated the 1999 Malibu 0.8 out Write your own review Of 10, Next Steps to Selling Your Car Benchmark Local Prices" see listings- - See what dealers and private sellers in your area arc asking for your car. Give Buyers Confidence Enter%N(optici Go Show them a clean AumCheck vehicle No VIN?No Problem! history report and close the deal fast, Recently Viewed Cars I My Saved Cars Save car I of 2 1/13/2014 9:47 A Appraisal Report El Estate of Patricia Knipe Kevin Knipe &Kyra Noll, Co-Executors 297 Charles Road Mechanicsburg, Pennsylvania 17050 (717)241-5379 Prepared for: Bruce Warshawky, Esquire Cunningham& Chernicoff, P.C. 2320 N. 2nd Street Harrisburg, Pennsylvania 17110 (717)238-6570 File#Knipe Prepared by: Erica Shea Taylor, Certified Appraiser&Auctioneer Kerry Pae Auctioneers 1111 Gapview Road Dauphin, Pennsylvania 17018 (717) 587-8000 Member: Certified Appraisers Guild of America { Table of Contents Title Page I Table of Contents 2 Summary 3 Analysis 4 Conditions of Appraisal 5 Certification 5 Purpose of Report 6 Method of Valuation 6 Definition of Value 6 Basis of Appraisal 6 Description 6 Appraiser Qualifications 7 Value Listings Appendix A Page: 2 of 10 Summary On December 5,2013, at the request of Bruce Warshawky of Cunningham& Chemicoff, P.C., I personally inspected the assets of the Estate of Patricia Knipe, 297 Charles Road, Mechanicsburg, Pennsylvania. Value Fair Market Value The Fair Market Value for the property in total is: $1,605.00 This is not the appraisal report. The appraisal report must be read in its entirety. Page: 3 of 10 Conditions of Appraisal The value stated in this Appraisal Report is based on the best judgment of the appraiser given the facts and conditions available at the date of the valuation. The use of the report is limited to the purpose of determining the value of personal property for Estate Tax purposes. Any additional research or testimony required by the client or the court will be billed at the current rates. Disclosure of the contents of the report is governed by the Standards and Practices of the Certified Appraisers Guild of America. Certification of Report Neither Erica Shea Taylor,Kerry Pae Auctioneers nor any of its employees have any present or future interest in the subject property. No prohibited fee was assessed for this report. Erica Shea Taylor of Kerry Pae Auctioneers has successfully completed the personal property appraiser certification program with the Certified Appraisers Guild of America and is a member in good standing. This report was prepared in accordance with the Uniform Standards of Professional Appraisal Practice and with the Standards and Practices of the Certified Appraisers Guild of America which has review authority of this report. Erica Shea Taylor has personally examined the subject property. The statements of fact contained in this report are true and correct to the best knowledge and belief of the appraiser. Ob* 017614 By: Eri hea T ylor, C.A.G.A Kerry Pae Auctioneers Page: 5 of 10 5 Purpose of the Report The purpose of this report is to determine the value for Estate Tax purposes for Cunningham& Chernicoff, P.C.,Harrisburg, Pennsylvania. Method of Valuation The method of valuation used for this appraisal is the Fair Market Value. Definition of Value Fair Market Value Under the United States Treasury regulation 1.170-1c Fair Market value is defined as: The price at which the property would change hands between a willing buyer and a willing seller, neither being under compulsion to buy or compulsion to sell and both having reasonable knowledge. Basis of Appraisal Valuation Date The date of valuation for determining the value estimation is December 5, 2013. Date Appraisal Conducted This appraisal was conducted on December 5, 2013. Limitations of Property There were no limitations on use or disposition of this property. Description An itemized list with descriptions is in Appendix A. Page: 6 of 10 Erica Shea Taylor; Certified Appraiser & Auctioneer Kerry Pae Auctioneers I 111 Gapview Road Dauphin, Pennsylvania 17018 (717) 587-8000 Education & Special Training Mrs. Taylor holds Bachelor's degrees in art history and business management from Lebanon Valley College. She is a graduate of the Harrisburg Area Community College Auctioneer's Program and became a licensed Pennsylvania auctioneer in 2001. She worked as a personal property appraiser and auctioneer for several auction companies where she gained experience selling antiques,collectibles, fine art, vehicles,commercial assets, real estate and restaurant equipment. Mrs. Taylor began working as a personal property appraiser in 2001 and successfiilly completed the personal property certification program with the Certified Appraisers Guild of America (C.A.G.A.). She has taken classes in Appraisal Studies at New York University and completed the Uniform Standards of Professional Appraisal Practices (USPAP) course in conjunction with the Appraisers Association of America. While working with Cordier Antiques& Fine Art from 2001-2003, Mrs. Taylor was able to gain valuable experience appraising home furnishings, antiques, art and collectibles for insurance purposes, estate taxes and divorce settlements. Erica Taylor owned and operated Classic Edge Auctions&Appraisal Services in Hershey, PA from 2003-2008. Mrs. Taylor oversaw the daily operations of the business and conducted auctions and appraisals. The company specialized in stamp and coin, antique, and cataloged specialty collection auctions. Mrs. Taylor continued to do appraisal work for banks, insurance companies and attorneys. In 2008,Mrs. Taylor joined Kerry Pae Auctioneers as an auctioneer and personal property appraiser. Kerry Pae Auctioneers specializes in business liquidations,bankruptcies and commercial liquidations. Her appraisal work has included business and industrial appraisals for attorneys, banks, insurance companies,US Middle District Bankruptcy Court, Pennsylvania State Treasury Bureau of Unclaimed Property, Commonwealth of Pennsylvania Attorney General Office and individuals. Professional Membership Erica S. Taylor has been an active member of the American Business Women's Association, Harrisburg Young Professionals,National Auctioneer's Association,Pennsylvania Auctioneers Association and American Mensa. Page: 7 of 10 Y Appendix A Fair Market Value Kitchen 1. $130.00 Contents of Kitchen: -Glassware ($10.00) -Microwave($10.00) -Kitchen linens ($5.00) -Plastic ware($5.00) -Glass canister set with oak lids and rack($10.00) -Pots, pans and bake ware($10.00) -Toaster($5.00) -Flatware ($5.00) -Blonde television tray set($10.00) -Retro kitchen table with chrome base,yellow floral surface,c.1940's ($35.00) -Set(3) black vinyl chairs,NOTE: some repairs($10.00) -Folding step stool/chair with vinyl seat($5.00) -Collector plate ($5.00) -Covered glass candy dish with red/gold fade ($5.00) Living Room 2. $120.00 Miscellaneous Contents of Living Room: -DVD player($10.00) -VCR($5.00) -Small Vizio flatscreen television($45.00) -Stereo, turn table, cassette deck and speakers ($20.00) -Collection of records,VHS tapes, CD's, cassette tapes($15.00) -Magazine rack($5.00) -Coca-Cola collection, including wall clock, metal trays, advertising glass bottles ($20.00) 3. $255.00 Furniture in Living Room: -Entertainment center with leaded glass door, oak,contemporary ($35.00) -Recliner, tan upholstery, overstuffed, contemporary($35.00) -Lamp table,wood surface,wrought iron base,contemporary($20.00) -Sofa,three-cushion, overstuffed,contemporary ($25.00) -Rocker, dark pine finish, stenciled decor on backrest($35.00) -Barrister bookcase,three glass doors, oak, contemporary ($45.00) -Desk with bookcase back, dark cherry laminate finish, contemporary ($35.00) -Desk chair, black upholstery ($10.00) Page: 8 of 10 r -Two-door cabinet, light maple laminate finish($15.00) 4. $140.00 Dark Pine Curio Cabinet Pine finish, glass door, one drawer, contemporary($75.00) Contents of Cabinet: -Assorted glassware,mugs, amber glass votive candle holder($15.00) -Avon ceramic and peter collectible car figurines ($50.00) 5. $170.00 Corner Cabinet Walnut, two glass doors,contemporary($75.00) Contents of Comer Cabinet: -Collectible eggs, carousel horse figurines, Precious Moments figurine, vases, assorted glassware and collectibles($45.00) -Porcelain carousel figurine set on fitted wooden base ($50.00) 6. $225.00 Curio Cabinet Two glass doors, mirrored back, contemporary($100.00) Contents of Curio Cabinet($125.00): -Glass vases -Porcelain tea cups and saucers -Gospel music collector plate -Normal Rockwell mug -Silver plated serving pieces -(4)Pieces blue Wedgwood -Blue opalescent glass candy dish -Ceramic juicer with blue flower trim -Chocolate set,hand-painted in Japan -Princess House Fantasia pattern casserole -Pink glass bowl with etched trim -Oriental ginger jar,contemporary -Cobalt blue cut to clear glass votive holder -Clear glass baskets -Assorted glassware and collectibles Master Bedroom 7. $100.00 Bedroom Suite (Bed with Mirrored Headboard with Shelves, Mattress, Dresser with Tri-fold Minor and Chest of Drawers) Dark oak wood laminate finish, contemporary. Page: 9 of 10 Y 8. $180.00 Jewelry: -1 Okt yellow gold ladies class ring with red stone ($85.00) -1 Okt white gold mother's ring,NOTE: missing one stone($60.00) Costume Jewelry ($35.00): -Brooches and pins -Watches -Earrings -Beads -Necklaces 9. $50.00 Miscellaneous Contents of Master Bedroom: -(2) Jewelry boxes ($10.00) -Precious Moments miniature teapot set($10.00) -Hoover upright vacuum($10.00) -Color television($10.00) -DVD/VHS combo player($10.00) Second Bedroom 10. $185.00 Contents of Second Bedroom: -White Rental sewing machine($20.00) -Oak curio cabinet with one door, glass shelves, contemporary($65.00) -Love seat sleeper sofa, contemporary($25.00) -Two-drawer metal filing cabinets ($10.00) -Paper shredder($10.00) -Kneehole desk with wood laminate finish and chair($10.00) -(2)Vintage dresses ($20.00) -Lane cedar chest,blonde finish,NOTE: finish heavily damaged ($25.00) Outdoor Storage 11. $50.00 Contents of Outdoor Storage Areas: -Croquet set -Wood step ladder -Lawn chairs -Yard tools -Child's rocker -Folding chairs -Small toolbox with assorted tools $1.605.00 Total Page: 10 of 10 CENTRIC BANK We Revolve Around You. D 7 Cunningham &Chernicoff, P.C. Attorneys at Law P.O. Box 60457 Harrisburg, PA 17106-0457 Attention: Bruce J Warshawsky RE: Estate of Patricia A Knipe File No: 615613 Dear Mr.Warshawsky: Mrs. Knipe did hold a checking account at Centric Bank (1036086). The account was opened as an individual account on 12/1/1986 and changed to a joint account(with survivorship)on 12/9/2011 when Mr. Kevin L Knipe was added. The principal balance on the date of death was$7,683.04 and there was$1.96 worth of accrued interest. The amount of interest earned on the account from January 1, 2013 until the date of death, October 30, 2013 was$20.29. Please let me know if you need any additional information. Thank you, Denise M Schiano Deposit Operations Specialist dschiano@centricbank.com 4320 Linglestown Road Harrisburg,PA 17112 T 717.657.7727 F 717.657.7748 www.centricbank.com Page > 1 of 1 VaIivllle'LCde Patricia A.Knipe :Report:fok(19/30l?0�3 < ss U ,r'r i y.sr' a ..i: /C/O Kevin L Knipe Voyager Services:800-284-7245 23 Stiles Dr Marysville,PA 17053-9722 Total report value: _ — $45,256.67 (Total report value includes any accrued dividends.) ^^Z.M F, !�1 a.%Tc"�•"9 Patrtc�fa b Knipe . R411over IRA f `; ' � r y ,.x,h�r; ACcount value summary ' f i°xr ? ) r y ti tr S9 /r= mt qFr t m Name Fund&Account Date Fnce Per Acxiued .: Number Opened Shares �.>Share Value` , Dividends Prime Money Mkt Fund 0030-09974823864108/31/2004 45 258.290 $1.00 $45,256.29 $0.38 -- _-- - — Totals $45,25829 `'$0 38,. •Dcesn't include accrued tlivltlends. 1578660067 03/1712014 09:36:00 a yers 2�1J_uhrig:: Funeral M.m -:Crematory INVOICE Kyra&Rick Noll 1015 Harriet Street Carlisle, PA 17013 Invoice Number: 10988 Invoice Date: Nov 19,2013 Page: 1 .Name of.Deceased ;:, :Date of-Death ' Payment Terinsq. r Funeral>Director i Patricia A. Knipe I October 30, 2013 Net 30 Days I Wilfiam'L. Chnstopher Item Number-. Quantity Description i," ;;; ' ^ ,. Unit Price• / Amount..`k CA Cash Advances- 10Additional Death Certificates $ 60.00i i i ank vou for allowing us to serve you and your family. Subtotal $ 60.00 We gladly accept the following fors of payment Shipping $ 0.00 !Cash, Check, Visa, MasterCard, Discover,American Express Sales Tax / $ 0.00 'Kindly make your check payable to: Total Invoice Amount $ 60.00 Myers-Buhrig Funeral Home and Crematory Payment/Credit Applied,-/ $ 0.00 Past due accounts are subject to interest charges of 1.5%per month. L12MLDUE ', Walking with Those in Grief Robert'Bob"L.Buhrig,Jn,Fn.sup gym.•William"Bill"L.Christopher.Fo Phone (nL 766.3421 • Fax: (7r+)795.7291 • 37 East Main Street • Mechanicsburg.PA 17055 • www.Myem-Buhrig.com Dircctom@Myem-Buhrig.com Myers-Buhrig.com �;yS: . . io 9A c� LdgZYl .. Funeral Florae Crrematory u. sw November 8,2013 Kevin Knipe 23 Stiles Drive Marysville, PA 17053 Dear Kevin: Thank you for allowing us the privilege of serving you and your family. We know that financial statements can be confusing,so below is a summary of your account. Statement of Goods& Services $ 12,661.00 Plus: Contract Addendums 407.00 Less: Savings from Preneed Guarantee 1,351.00 Subtotal: Invoice#10967 $ 11,717.00 Less: Payment from Insurance (9,361.00) Less: Terms Discount 833.00 Your Balance Due by December 1,2013 $ 1,523.00 We have enclosed a complete invoice fot your records. + f`� Please call us at any time that we may be of service. With Warm Regards, Michelle L. Buhrig Treasurer Enclosure Malking with Those in Grief Robert"Bob"L.Bob rig,Jr.,FRSuinoim •William"Bill"L.Christopher,FD Phone: 0171 766.3421 • Fax: O171795.7291 • 37 East Main Street • Mechnniesburg,PA 17055 • www.Myers-Buhrig.cont Dimctom(@Myers-Suhrig.com Myers-Buhrig.com 1/1 7/2014 tttp---, View Depositlrtwge C E \�r TRIC BANK ONLINE BANKING F Centric Bank • Member FDIC • Equal Housing Lender 4320 Unglestown Road, Harrisburg 717.657.7727 y 1625 Market Street, Camp Hill 717.730.2816 6480 Carlisle Pike, Mechanicsburg 717.591.1360 1201 W. Governor Road, Hummelstown 717.533.7626 View Deposit Image I • 12G91 l err.•'SB,�irfv?FunemLJ.lgr+cengdCn n ��'��yy,��� -'57 LtOn�FVln anIt rl{111f i11 H mn:� -2M O. i� ultm,minrorliilxc 0'$49 ' me 2,.013 !1 caau",ils .It•1GYR s $ te0'.ab Page 1 of 1 P,1V:ppo HYnuno sntl 0W 100 DOgrrs view $100.00 Image View cF- rc Image $100.00 r4(n Knipp 218flef Dmv' VIM'LrFI V I V01911.410 1:131 13b 0, 2 b: 1524• 56 76 5n' t _ 1� {f ye ig Funeral Homy w. Crematory „ 7 1,} - -0' i iii i►F '" ! 1i PATRICIA A. KNIPE ESTATE t #$ _ i` ► _ jj'$j 11}_.t,ft{ { KEVIN L. KNIPEEXECU70R.��'�; 1 :iii;i "i�� #� � "� i..}{I $}j s8t�!s ,l Z-100i 'r'"'} 3 }}I laI#i_:KYRANF.NOLLEXECUTOR'11fV #33:• �}13--�it 1 i--:i}i:-i3i iil� # ( ':#ft #fI — •#}} }}}.r}, "' • # -H 1075 HARRIQT STREET- "'� "" $ 11 t+_. 3Lsa �z AR ASLE,PA 17013{• t,x ..+- ,"-^ ,•,•- „_, j ;inttgFu$ iiim,t�aDa(x�$D{�,L$at "3'�iAym'lBC:-i#� fir}3i iii Jii:Yi3f #1i�-•3i} !�} -iii-= ,. ��. i}iii." , � �_ { alAnBr _ i i{: fJ i 2 =si.+ +:. $"t sit iii- tJf tit tlltl .-iii Jli -iii if#"" : } "`ii iit TWO SIGNATURES REQUIRE OUAL, C,HE CENTRIC GkS4 r,i 11i°=fi "i 46 A M,Ki �.�li- ' " .. . cu3 rMR f!! '•`�!,�rLLC.j �1 i�(j������` }�}ti��{`t� "`t{ry"=�;7� ••..SS'����t�i"`•i1i'""`i�s•...:3L'} ��'"'t��li`�}}i• "{� i, 3S 7�5-2 6,9:1 -1#_ f},_S •p013Q6it'i i.[ 3{ -r'J'L M ers-B' Fuaeial fJtome Aad Crematory,ltd. , { 1107 Mta:6nir*b ;ig;PA 17055 (717) 786.3421 \+� M ran y�\j�� `. •Y.{/( i�i.1 Y1iJi.V Cam. is ].1�� a'�"""-Lj(•j �� 131 :I f a '' \ �`1 ,' ['�'t�.44 ,r , t r t..t.AR.eI. 1 FOR Sh ♦ .t IN g \4 11VV , AMOUNTOFACCOONr [:]•CA THIS PAYMENT ,,.- ACA K B n '•� SAWCEDUE M,o,',\ THAN YOU Walking with Those in Grief Robert"Bob"L.Bub rig,3r.,FD,Sap M.•William"Bi8^L.Christopher,FD Phone: (717)766.3421 • Fax: (7t7)795.7291 • 37 East Main Street • Mechanicsburg,PA 17055 • w .Myers-Buhrig.com Directors®Myers-Buhrig.com RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Receipt Date : 11/25/2013 Cumberland County - Register Of Wills Receipt Time : 14 :21 :27 One Courthouse Square Receipt No. : 1076327 Carlisle, PA 17613 KNIPE PATRICIA A $ Estate File No. : 2013-01257 Paid By Remarks : KEVIN L KNIPE CJ - -- ------ --- - -- --------- Receipt Distribution ------------ -------- ---- Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 260 . 00 CUMBERLAND COUNTY GENERAL FUN WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 25 .00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 23 .50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 5633 328 .50 Total Received. . . . . . . . . ?328 .50 RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Receipt Date : 11/25/2013 Cumberland County - Register Of Wills Receipt Time : 14 :22 : 02 One Courthouse Square Receipt No. : 1076328 Carlisle, PA 17013 KNIPE PATRICIA A Estate File No . : 2013-01257 Paid By Remarks : KEVIN L KNIPE Ci - -- - ----------- --------- Receipt Distribution - ----------- ------------ Fee/Tax Description Payment Amount Payee Name INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 7638 $30 . 00 Total Received. . . . . . . . . $30 . 00 Crystal St. Omer Roy Certified Public Accountant 212 S Sporting Hill Road - Mechanicsburg, PA 17050 - 717.761.5080 February 19, 2014 Patricia A Knipe 1015 Harriet Street Carlisle, PA 17013 For professional services rendered in connection with the preparation of your 2013 individual tax return: Form 1040 (Individual Income Tax Return) Schedule B (Interest and Dividend Income) SSA-1099 Documents 1099-R Documents PA Form PA-40 (Income Tax Return) PA Schedule W2S (Wage Statement Summary) PA Schedule SP (Special Tax Forgiveness) Amount due $ 165.00 Payment is due upon receipt Thank you! SS � a6C c cc o 0 i w N CLa a° o z gZ 0 0 0 z W x 0 Oti vN a -a H�9 Q`U' d = 3 090 Cam I # M N 41 lf1 O H N N O m I M'D t0 N O 7 -+ •-� I io d �N O Cam] ~-� N EL P-1 b ••d Y W ��yy w as f�- y v ►-a C K W3 �-, mN x O¢ L io f- O �- y ao C~ I N# Q U a� ate@ w Z 1 0 ac 0 0 0 y z 0 0 , o 0 0 M l D O O O O Q' m l m rv' O 4 O F O to LB w � Q ry Ln � x4 �Jm Z .. H H~O Z m t m rA U _ a H =O T _ D OVIS ,,�aA-+yN fD GSn<So hl rtl A 10< l �+ a TI D f101 x 6 6 6 3 6 n w GGS mm .- a"ZN E a NGZ'1(7N N SII C7 a xN 3m N (D f) y Cy 6w J A n y mn ZM N w O n z v m mN r) Q S moopm mJr� 7 0006 wE D ^� C666y6 AyD J Q `' ! (D 6 6 6 yA J �. =6 6 6 B~ O Z YI W ti O A y r y y <•• r A( D z cA ny r m 7 0° NJS n r rt a � 6 y A C Z NIm B p < C JC y .. O e .Z T o-b !L _ aM LAO fu LU 01 it w rnb/ �vri ^� m'ngr� ra' V Or �,�1;,• S � ,� ,•/ �l 5 'Y 1i y 4 F ' (�� F a r� i � . I:C •� f� r. tit m cn `' iT212014 Centric Bank Account Transactions , Nr1'RIC i , BANK ONLINE BANKING All Tronsactlons Disa b�pry� View Transactions for: Current Balance: 3,674.02 Golden 0001 T $ Available Balance $3,674.02 _ View Range: Since [ ta[ m �r 1 7 Davc 1 Da c 0 Days I All Date:C' Re(/Check No: Description: 01/08/2014 Debit: —_ Credit: Balance PAYMENT -$21.58 -- PENNSYLVANIA-AME $3,674.02 7008096660 01/08/14 ID# TRACE 3/02/2014 ELEC SVC PPL EU n/ 1230959590 GO /��`Q_b y $3,695.60 01/02/14 ID # TRACE ( /'�l•(� `�((fl 12/31/2013 '#INTEREST ELEC SVC PAID $0.81 ELEC SVC PPL EU -$34.62 � $3,708.19 1230959590 $3,707.38 12/23/13 ID# TRACE 32/13/2013 #-031000037971533 DV02DT1213 METLIFE INC $9.90 $3,742.00 2431912740 12/13/13 ID#TRACE 12/06/2013 Vmage DDA DEBIT MEMO 215 iew I 12/OS/2013 J,Q,Qg CHECK#2003 -$110.00 $3,732.10 12/04/2013 View Image DDA DEBIT MEMO -$170.56 $3,842.10 12/02/2013 2m CHECK#2002 -$440.00 $4,012.66 11/30/2013 INTEREST PAID -$95.40 $4,452.66 11/27/2013 5633 CHECK# 5633 $0.84 $4,548.06 11/27/2013 View Image DOA REGULAR -$328.50 $4,547.22 DEPOSIT $3,052.55 $4,875.72 11/22/2013 2001 CHECK# 2001 11/21/2013 ELEC SVC PPL EU -$1,535.00 / $1,823.17 1230959590 -$23'57 I/ $3,358.17 11/21/13 ID#TRACE 11/21/2033 -0310000 UTILITIES GI -$63.0 $3,381.74 lO�ly 3231174060 11/21/13 ID#TRACE 11/08/2013 - 430002656357 5631 A PENN NATION AL IN -$48.00 \ $3,444.74 3230961349 11/08/13 CHECK#-5631 T CE 11/06/2013 #-091000019135094 ,/ INS. PREM.COLONIAL -$34.67 - !'[/��c71 LIFE $3,492.74 1570144607 11/06/13 ID # TRACE 4 --�__.. --____#-02100002.365.4553 _ 1/05/2013 ELEC TRANS BRIDGES /'CV I r� AT BC -$4,050.65 / $3,527.41 1232995605 /144,Q/ 11/05/13 !D # TRACE 11/04/201 5630 CHECK# 5630 x,30/31/2013 INTEREST PA1O -$107.00 $7,578.06 10/30/2013 5624 CHECK# 5624 $2.02 $7,685.06 10/25/2013 5623 CHECK# 5623 -$125.00 $7,683.04 10/24/2013 5626 CHECK# 5626 -$100.00 $7,808.04 10/23/2013 ELEC SVC PPL EU $17.00 $7,908.04 1230959590 $32'22 $7,925.04 10/23/13 10# TRACE 10/23/2013 #-031000036010049 UGI BILL UGI -$63.00 $7,957.26 1148?aA(,5 INVOICE 1500 Paxton Street JOURNAL Harrisburg, PA 17104 1/13/2014 MULTIMEDIA T. 717-236-4300 F.717-236-6803 ORDER q: 93734 www.journalmultimedia.com TERMS: Net 30 Days -- INVOICE TO ------ ADVERTISER Cunningham &Chernicoff, P.C. Cunningham &Chernicoff, P.C. Accounts Payable P. O. Box 60457 Harrisburg, PA 17106 INVOICING:Advertiser DESCRIPTION OF CHARGES COST Q CREDIT a BALANCE PUBLICATION: CLASSIFIED/CENTRAL PENN BUS.JRNL COVER DATE: 1/1012014 THEME: CLASSIFIED AD/CENTRAL PENN BUSINESS JOUR RATE CARD: DESCRIPTION OF AD: Legal listing: Estate of Patricia A Knipe REP(S): MARK SUNDAY SIZE: LEGAL LISTING, PAGE: 150.00 COLOR: B&W _ 0.00 SPACE SUB-TOTAL: 15 0 BALANCE DUE: / 15000 1 ,. r A. u � D I . CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717)249.3189 Fax:(717)249-2883 January 3, 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: Bruce J. Warshawsky, Esquire RE: Patricia A. Knipe 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:. December 20, December 27, 2013 and January 3, 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 r December 5,2013 C�97 ►�1 ATTN: Bruce Warshawsky, Esquire Cunningham &Chernicoff, P.C. 2320 N.-2nd Street Harrisburg, PA 17110 I INVOICE APPRAISAL SERVICES 2 hours x$75.00/hour $150.00 I i TOTAL $150.00 i ----Please rriake check payable to: _.. "Kerry Pae Auctioneers" and remit to: 1111 Gapview Road Dauphin,PA 17018 "PLEASE NOTE OUR NEW ADDRESS" KERRY PAE AUCTIONEERS •Auetloneers •Llquldators •Consultants 2 Chickadee Circle, Palmyra, PA 17078•(717)236-3752 www.kerrypae.com '!r ® Questions?Please Visit us online at Page 1 contact us by Nov 18. U pplelectric.com 1-SOD-DIAL-PPL li ��'<, (1-800-342-5775) 63820-84000 Auto Pay';, •pa el�v,�uuuu•• M-F:Sam to Spm Your Electric Usage Profile Billing Summary (Billing details on back) Service to: Balance as of Oct 31,2013 $0.00 PATRICIAA KNIPE Charges: 297 N CHARLES RD Total PPL Electric Utilities Charges $23.57 MECHANICSBURG, PA 17050 Meter: 84573128 Total Charges $23 57 Your next meter reading is on or about Dec 2,2013. utomaUC'BdLPayme"rit on Nov 21,2013 7 77 1 ., .. This section helps you understand your year-to-year Account Balance $23.57 electric use by month. Meter readings are actual unless PPL Electric Utilities'price to compare for your rate is$0.08777 per kWh. otherwise noted. This changes the 1st of Mar,Jun,Sept, and Dec.Visit papowerswitch.com 02012 2013 or www.oca.state.pa.us for supplier offers. es Your Message Center 2a :t • Go Paperless,and receive a FREE LED at pplelectric.com/gopaperless Bz> T• ; t e =' r % • Information about appliance energy use and tips on is saving energy are available through the Energy Library s F —on.our_Web.site,.pplelectric.com/e=power a 7 1 s , •' • Before digging around-your home or property,you o AJ ^F M `A M �J yJ ,A s `O `N D should always call the state's One Call notification system to locate any underground utility lines. You can Months do this by simply dialing 811,which will connect you to the One Call system. Be safe and call 811 before you .- li• dig. Oct 2013 Zg 7g 3 56F � g� oc8 Oct 2012 29 564 19 55F • Payment Methods Oct 31 Actual 81591 Online at: O By phone:1-80D-342-5775 Oct 2 Actual 81513 v pplelectric.com or call BIIIMatrix(service fee applies) at 1-80D-672-2413 to pay using Visa, 29 Days kWh Billed 78 MasterCard, Discover or debit card. _ ® By Mail: Correspondence should be sent to: Nov 2012-Oct 2013 6508 542 2 North 9th Street Customer Services CPC-GENN3 827 Hausman Road Nov 2011-Oct 2012 8433 703 Allentown, PA 18101-1175 Allentown, PA 18104-9392 Other important information on the back of this bill 4 PPI a PPL e;•cwc uwm•• • 63820-84000 •� Auto Pay AV 01 001793 31555 B 6 A•'SDGT III(II„1,1,11,1,X11,1„I1�il�illll'�IIII�IIIII,11111111�'Ill'��' ��t2�1�! PATRICIA A KNIPE PPL ELECTRIC UTILITIES 297 N CHARLES RD 2 NORTH 9TH STREET CPC-GENN1 MECHANICSBURG.PA 17050-3002 ALLENTOWN, PA 18101-1175 1 7300000235730000023574 6382084000 ' ® Questions?Please Ja, Visit us online at Page 1 contact us by Dec 18. V pplelectric.com "Ao upRyl 1-80D•DIAL-PPL I8!'''� (1-80D-342-5775) 63820-84000 ay ' vx oe�we uunuee M-F:Sam t0 Spm Your Electric Usage Profile Billing Summary (Billing details on back) Service to: Balance as of Dec 2,2013 $0.00 PATRICIA KNIPE Charges: 29 N 297 N CHARLES RD Total PPL Electric Utilities Charges $34.62 MECHANICSBURG,PA 17050 Meter:84573128 Total Charges $34.62 Your next meter reading Is on or about Jan 2,2014. — :::.:.. ..:...::.:, . . . lifomatie',Bili;aaymehtori�Dee23;.20135'i=>.`�};;:;!u�u,:•:,; y,.:;:'<•<,: , $34:62 This section helps you understand your year-to-year Account Balance $34.62 other electric. e by month. Meter readings are actual unless PPL Electric Utilities' rice to compare for our rate is$0.08754 per kWh. otherwise noted. This changes the 1st of Mar,Jun,Sept,and Dec.Visit papowerswitch.com Ig 2012 012013 or www.oca.state.pa.us for supplier offers. 42 3 35 Your Message Center 28 • With Paperless billing,you can receive and pay your c; ? PPL Electric Utilities bills online.The process Is free, a 21 quick,convenient and secure.To learn more or sign up, 14 "Ja visit pplelectric.com. >r ' • Information about appliance energy use and tips on a PP gY P o ? 3 4 M d saving energy are available through the Energy Library on our Web site,pplelectric.com/e-power 1 F M A M J 1 A s 0 ,N 0 • Before digging around your home or property,you Months should always call the state's One Call notification TIN system to locate any underground utility lines. You can •• do this by simply dialing 811,which will conned you to - the One Call system. Be safe and call 811 before you Dec 2013 32 171 5 41F dig. Dec 2012 30 1 739 25 40F " Payment Methods Dec 2 Actual 81762 ✓F� Online at: ©By phone:1-80D-342-5775 Oct 31 Actual 81591 V ppleledric.com or call BIIIMatrix(service fee applies) 32 Days kWh Billed 171 at 1-80D-672-2413 to pay using Visa, MasterCard, Discover or debit card. • •• _ By Mail: Correspondence should be sent to: Jan 2013-Dec 2013 5940 495 2 North 9th Street Customer Services CPC-GENN1 827 Hausman Road Jan 2012-Dec 2012 8590 . 716 Allentown, PA 18101-1175 Allentown,PA 18104-9392 Other Important information on the back of this bill 4 I?°�f• o s . I s i• Efeeo,�Vy 63820-84000 IrAuto Pay AV 01 001913 44548 8 8 A•'5DGT "� ®� N �J /0Lb-3�l 111111,1I'•1'I'"I(I I I I'I I„III,,•11111'I I I,1 1,111,1 111'I'111'I I' PATRICIA A KNIPE 29 PPL ELECTRIC UTILITIES 297 N CHARLES RD 2 MECHANICSBURG,PA 17050-3002 NORTH 9TH STREET CPC-GENN1 ALLENTOWN. PA 18101-1175 Ilu,q,il„Ih”PD'u'Idlli°dll,llull,ypl'lllll.l„11111 1 990000034629nnnnn146P4 6aAanA4nnn ,varoverpestx _. . .____.. . •0.SOX 17167 i' MEMPHIS,TN 38187 7334 0100 No RP La 11102013 aTYrYTMx b932016$L T130 Please a B �• f' 32096 1 AS 0.381 Pay y: 12/02/2013 Total Due: $95.40 PATRICIA KNIPE 2100 BENT CREEK BLVD STE 248 PAY ONLINE MECHANICSBURG PA 17050-1835 Customer.Terminix.com 11'1"1111111'I'I II I I I I'l l'1111111'1'l I l i111I11111111111"III"I' PAY BY PHONE 1.800.TERMINIX QUESTIONS • Local Office:717.796.1710 1 S�. 1. • Toil Free:1.800.TERMINIX Paying your bill is easy, especially online. Just click "Lo " • Online:Terminix.com at Terminix.com and sign up with your 9 in Customer Number: 2682279 and phone number ..to.start..paying-b,i(ls_online.-... SERVICE DESCRIPTION OF SERVICES INVOICE i DATE SERVICE ADDRESS' CHARGES PAYMENTS NET NUMBER /CREDITS AMOUNT 11/14/2013 General Pest Control 329971980 Location:297 CHARLES RD, $95.40 MECHANICSBURG PA 17050 $95.40 12/02/2013 J .;. . . .. . ^y Thh statamont raflocts paymonts rocptvnd by IIA8113. Ir you haw not paid your provbas belanco,ptaaso malt p ' •t $ 5.40 `" your payment today. ..-.PJedselcar along//notaremlQ ._. - - -- -- - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - Payment Options: salesA9reemerlt: 3005415 Customer Number: 2682279 _.. • EasyPay automated payments (sign up at Terminix.com) _ • Pay online at My Account at Terminix.com PATRICIA KNIPE • Pa b when you pay 297 CHARLES RD Pay y phone at 1.800.TERMINIX 1-Year in advance MECHANICSBURG PA 17050 • Pay by enclosed check Credit card payment. Please fill out the following: Circle One: DISCOVER VISA MasterCard American Express SEARS Exp date: Name (as it appears on credit card): REMIT TO: Authorized Signature: TERMINIX PROCESSING CENTER Amount Due: $95.40 1 year in advance: $362.52 P.O. BOX 742592 Amount Paid: CINCINNATI OH 45274-2592 Irr1"111111'11111111rI rr r111'11'11'I'lllillrlorlrlr111111i1ILl 3 00000000 11 000026822797 00000000000030054155 0000954000036252 9 INI HARRISBURG METRO Residential General73.0"1lleot 5040 lOUISE DRNE SUITE 108 Master Agreement#129473.022]165 MEOMICSBURG,PA 17055 Work Order#111869243321 a (717)796-1710 Qebm MN 1141NNF Naal"Mc (W)761-0674 faAaT.dMh%M I01m.DAN1ElL onbl7e.m un+rzlllozaA+1 fbMad N.ma Wa Ph.m rnwl./..Nwale: IP1A �+ .. LW�aia! I Ce.AmNM6.oi Wa.deaNa: rlsea Ove 11111VJ71TOaS1AN An1a.AMma 291 CNaa13 PD fl.�u�7� O.W!, 6eT Dww/ge6a T IYTINEWL NFOWOCi PA]A91 lad 7%Da6n 11!10.07 NMa.i)pn RTAr Mn Addro.1 297 W PA I= DlbeYf111pi 5/l6W General Llfonnatlon AmalmpeoN:Ietla Material Usaae p4fti PubTaryded P4*TmahneRPnayWau Adin OM Mai . UWGLI'1WDMM1 " SP*dn Unlaam-No AO*ftWW Do ooh obw wwmbbW diMm,lab to hmdVmptm ' EPA Rog as IOD-1056 tem6lbMft to mnbcww bow a adry. CnA&CMbTruOnenl Kwu.pP AppN"A=a 31600 owu arbam�aW a�'ado4 oft uJ damn&wk 1.off 6uW MIQ spmyw Ann fTmabd C MN AL ROOM L EN Roo ,C/'•1�7�( 1 Comments SPFR,y . TMnkyou br Tnmill6a Peal badneteb ax Summary of es a0`i01°e. tom cu"M sOO.OD SaNstac 690m Ip' rac tS,/p Tabli $9SA0 6q h BuelwT.dadchn e/(J Dam 11MR013 sknrt m DaW 1111412013 lAIX KNi9E OAIDELL]0196 Cogaeefp.rm &un be made!Blest i V.1 mi* e/dr MR&V pllm bIM n=MeHIM109 OnAr,F0 BuN25n C,,*u4 CM 4SV4,=Plm iroW,yoornldarar namda,nokd aaola U.Iaia}IrRM/AUXm`d ansavro arb Bndwf,dooY ar Dry pry oylBlc /' kooS2 (� S b2i1V1 So U , IAL Ce01.e00.TERM04JX w Vok TemVrb.com r ALERT PHARMACY SERV. INC. A FINANCE CHARGE OF 1.50 % PER MONTH 219 NORTH BALTIMORE AVE. (AN ANNUAL PERCENTAGE RATE OF 18.0%) OR A MT HOLLY SPGS, PA 17065 MINIMUM SERVICE CHARGE OF $ 1.00 WILL BE CHARGED ON ALL AMOUNTS 30 DAYS OR MORE PAST DUE IF YOU RECEIVE A NEW INSURANCE CARD FOR YOUR PRESCRIPTIONS BE SURE TO SUPPLY US WITH A COPY. 11/30/2013 PMT DUE . . 12/29/13 KNIPE, PATRICIA A KNIPPA 30 DAYS. 44 . 66 BRIDGES AT BENT CREEK GRP-58 60 DAYS. 239. 25 2100 BENT CREEK BLVD PAGE 1 90 DAYS . 65 . 01 MECHANICSBURG PA 17050 ALERT PHARMACY SERV. INC.219 NORTH BALTIMORE AVE. MT HOLLY SPGS, PA 17065 800-266-9954 ** ACTIVITY FOR KNIPE, PATRICIA A -KNIPPA - -58 08/21/13 9106771 8 ONDANSETRON CDT 4 01 16.05- .00 16.05- 08/21/13 9106757 270 IPRATR-ALBUTEROL 01 35.48- .00 35.48- 11/04/13 9106759 29 MYTAB GAS 80 MG T 01 * 1.30- .00 1.30- 11/04/13 9123062 60 ACETAMINOPHEN 325 01 * .34- .00 .34- 11/04/13 9106749 29 ANTACID CHEWABLE 01 * .54- .00 .54- . 00 51 . 53- 2 . 18- LEGEND NON-LEGEND FOR MONTH FOR MONTH 402 . 63 .00 5 .23 407. 86 53 . 71 354 . 15 3 9 3-55 S.3-7 0cT- F'N F-�-o- 1 t -aZ/L11 219 North Baltimore;Ave A rINANCE CHARGE OF $1.50 PER MONTH PHARMACY SEMCas,INC x Mt Holly Springs, PA 17065 (AN ANNUAL PERCENTAGE RATE OF 18.0$) OR A Responsive. Innovative. Reliable. 800-26 6-5954 (717)486-5606 $ w OF ww.AlertPharmacy.¢om MINIMUM SERVICE CHARGE 1.00 WILL BE CHARGED - ON ALL AMOUNTS 30 DAYS OR MORE PAST DUE STATEMENT OF ACCOUNT IF YOU RECEIVE ANEW INSURANCE CARD FOR YOUR PRESCRIPTIONS BE SURE TO SUPPLY US WITH A COPY. Date 11/30/2013 PMT DUE. . KNIPE, PATRICIA A KNIPPA 3b.> DAYS BRIDGES AT BENT CREEK GRP-58 ,66 'DAYS- 2100 BENT CREEK BLVD PAGE 1 96.,,'DAYS . MECHANICSBURG PA 17050 Amount Pa ... .. ... .. PLEASE DETACH AND RETURN TOP PORTION WITH YOUR PAYMENT ALERT PHARMACY SERV. INC.219 NORTH BALTIMORE AVE. MT HOLLY SPGS, PA 170fi5 r T sy�t ** ACTIVITY FOR KNIPE, PATRICIA A -KNIPPA - -58 'V8-/2"1/13 " 91'06771""-8'- "-"- ONDAWSETRON ODT-4" 701" ----7.7-05- ' 08/21/13 9106757 270 IPRATR-ALBUTEROL 01 •S0 16.05- 11/04/13 9106759 29 MYTAB GAS 80 MG T 01 * 35.48- .00 35.48- 1.30- .00 1.30- 11/04/13 9123062 60- ACETAMINOPHEN 325 01 * .34- 11/04/13 . '9106749 29 ANTACID CHEWABLE 01 * '00 .34- .54- .00 . 54- 3-7 Z S.23 �V_ r I YOUR ACCOUNT IS CONSIDERABLY PAST DUE, BE TURNED OVER FOR COLLECTIONSHI 51. 53- 2 . 18- . 00 LEGEND NON-LEGEND TOTAL TAX FOR MONTH O eYlous Balance Cha as this month Finance Char a TOTAL cmARMS lr m P.ymoar a Crsdns AMOUNT DUE 402 . 63 + . 00 + 5 . 23 =. 407 . 86, ' 53 . 71 354 . 15 OR ALL PHARMACY RELATED INQUIRES PLEASE CALLAIert Pharmacy Services, Inc at 1-800.266-9954 Statement Terminology on reverse 6 t , �y ktr✓ �r'Fit �4� tjN `L, �w"' �O s ��M .vtA�de Y • � AYE °, F M0 ���'i:Wk ulf 7 �4.0 O H O O lW s �a u o a4am oy $ � a m v�v�u//ia�� pp,, ��,,(( flfl g� MmChecklmege CE N' BANK+ :'•v:�� Y K ONLINE BANDING Centric Bank • Member FDIC • Equal Housing Lender 4320 Linglestown Road, Harrisburg 717.657.7727 1625 Market Street, Camp Hill 717.730.2816 6480 Carlisle Pike, Mechanicsburg 717.591.1360 1201 W. Governor Road, Hummelstown 717.533.7626 View Cheek Image Fiir Rotote Return �.t�.KN1PL Atc',} #5523-I&t)$�oy$I- sr•��3iy 29T 4TiARLl g`RLinln: 6 Q ' ��C}i.LYfCSDL'l:C;f'A �:USIt`3tpt ' 107f. CENTRIC 8, M--.,.,gin 6=W,Y. :0333 �:52.69�: 6[]86x' S'& 3D I �Fii { IIII�IIIIIsil,II�III,IIsI4IiIIIllli�illill1 7400448b8 golden � STATEMENT 1 living centers QUESTIONS YOUORNBILL? (866)325.5606 WEST SHORE STATEMENT DATE PATIENT.NAME ACCOUNT NUMBER 10/01/2013 PATRICIA KNIPE 00285448180001 PREVIOUS BALANCE NEW CHARGES PAYMENTS ADJUSTMENTS NEW BALANCE 2,590 .34 1 0 .00 0 .00 1 -2,528 .84 61.50 DATFJPERIODCOVERED ACCOUNTACTIVITY - JOTY/DAYSI CHARGES I PAYMENTS I ADJUSTMENTS 06/12/13 06/12/13 LAB -1 -18.64 06/09/13 06/19/13 ROOM CHARGE -11 -2,510.20 When returning home, patients often require ongoing care that family members cannot easily provide. In these Cases, AseraCare Home Health is an ideal solution. Visit homehealth.aseracare.com for more information. Thank you for choosing Golden LivingCenters. MAIL YOUR PAYMENT USING THE COUP W ON BELOW' PAYMENT 10/15/2013 DUE DATE OR PAY YOUR-BILL ONLINE AT www.goidenliving.com -• - AMOUNT DUE • 61 . 50 DETACH HERE AND RETURN BOTTOM PORTION WITH YOUR PAYMENT FOR TIMELY PROCESSING ------------------------------------------------------------------------------------------------------------------------------------------------------ACCOUNT NUMBER PATIENT NAME GOLDEN LIVINGCENTER-WESTSHORE 00285448180001 1 PATRICIA KNIPE C/O PATIENT ACCOUNTING-ADM OFFICE BILLING DATE DATE AMOUNT ,AMOUNTOUE 1000 FIANNA WAY FORT SMITH AR 72919-2263 10/01/13 10/15/13 r777761.5 0 Check here to pay by credit card and enter credit card intonation below. AMEX 0 VISA MASTERCARD 0 DISCOVER CARD NUMBER CVV CODE' ZIP CODE Check box if address below is incorrect or insurance information has changed. Indicate CARDHOLDER NAME EXP. DATE changes on reverse side. SIGNATURE AMOUNT The CVV code u o th,.,fth number,nuelly Io"d on the bark d your credh card Please Make Check or Money Order Payabte To: JENNIFER NOLL GOLDEN LIVINGCENTER- WEST SHORE 297 CHARLES ROAD PO BOX 644407 MECHANICSBURG PA 17050-3002 PITTSBURGH PA 15264-4407 1049970028544818100011001201300006150D0000000009 i HAMPDEN TOWNSHIP 230 S SPORTING HILL ROAD ' I 4 � P MECHANICSBURG,PA 17050 "II (717)761-0119(Township Office) (717)909-7145(Utility Billing) `COME COO _ PAST DUE NOTICE - PATRICIAAKNIPE RE: Account Number 009590-000 297 CHARLES RD Account Name PATRICIAAKNIPE MECHANICSBURG,PA 17050-3002 Service Location 297 CHARLES RD Past Due Amount $155.05 (�,� O Additional Charge $15.51 / C' Amount Due $170.56 Due Date Saturday, November 30,2013 )ear Customer: _ 11/01/2013 Payments received after October 31, 2013 are not reflected on this statement. If you have already made your payment, please disregard this notice and accept our thanks. Payment of the past due balance is due by November 30,2013 in order to avoid additional penalties and interest. We accept cash,checks. Visa and Mastercard. Checks returned by the bank are subject to a$20.00 fee. Credit card payments may be made on our website found below. Please contact our office with any questions. N W O V v .y I I II 1 11 m N 1 11 L O O W O I 1 1 i O O U� L ii ti V U V1 11 H ti Z Y A 3 6 Q i p fA f9 a m C 11 � 3 u 7 H 11 C } ' a r I .. � .. c u Y Y m 11 m O 2 n I HAMPDEN TOWNSHIP 230 S SPORTING HILL ROAD 1 MECHANICSBURG,PA 17050 (717)761-0119(Township Office) A9E C�MbF` (717)X9.7145(Ulm y Wiring) 1 . - PAST DUE NOTICE PATRICIAAKNIPE RE: Account Number 009590-000 297 CHARLES RD Account Name PATRICIAAKNIPE MECHANICSBURG,PA 17050-3002 Service Location 297 CHARLES RD Past Due Amount $155.05 Additional Charge $15.51 Amount Due $170.56 Due Date Saturday,November 30,2013 )ear Customer: 11/01/2013 Payments received after October 31,2013 are not reflected on this statement If you have already made your payment, please disregard this notice and accept our thanks. Payment of the past due balance is due by November 30,20131n order to avoid additional penalties and interest. We accept cash,checks,Visa and Mastercard. Checks r9tumed by the bank are subject to a$20.00 fee. Credit card payments may be made on our webslte found below. Please contact our office with any questions. sincerely, Utility Billing Hampden Township 230 S.Sporting Hill Rd. Mechanicsburg,PA 17050 www.hampdentownship.us Payment , youon _._._._.. .._.. ._ ._. ....-- .... ._.. ..._......... . . .. ._ ' PAST DUE AMOUNT $155.05 LATE CHARGE $15.51 PLEASE RETURNTE11S PORTION ALONG WITH YOUR PAYMENT TOTAL AMOUNT DUE BY 1113012013 $170.56 PLEASE MAKE CHECK PAYABLE TO: HAMPDEN TOWNSHIP - ACCOUNT: 009590-000 REMIT PAYMENT TO: SERVICE ADDRESS: 297 CHARLES RD BILLING DATE: 11/01/2013 Hampden Township 230 S.Sporting Hill Rd. DUE DATE: 11/3D/2013 Mechanicsburg, PA 17050 PATRICIA KNIPE www.hampdentownship.us 297 CHARLES RD I���I��Ull��®O1��Itb�Yglll���81 MECHANICSBURG,PA 17050.3002 Hampden Township 11/27/2013 09:50 Receipt No. 00304943 PATRICIA KNIPE Customer 0: 009590 Payments Received: SEWER - SWO1 114.25 TRASH SERVICE - TR01 40.80 TRASH PENALTY - PNT 4.08 SEWER PENALTY - PNS 11.43 ------------------------- Check 0:002003 Check: $170.56 Cash: $0.00 Change: $0.00 Total: $170.56 Cashier: ubcounter Station: UBCOUNTER Thank You Hampden Township PATRICIA A:KMPE 60-ISW313, '5560 297 CHARLES ROAD. 'Y - .. , ::• . •NMCHANICSBURC PA' 17050.3002 z Div ol .PAYfO ` {` '-(JN�� !`i'un10aF0� �l= = I'''mo—Y!�"`� m..oeLLnas re � • . , 3 "CENTRIC; BANKt} t H�FA 17112 �N n+�o HAP�t'AN NI✓�SiA`A`I :�4�' : . 1/�" ,� .,,n, � . cle a •. i'..uo°' 41:0-3.13152691: " 30360861' 5560 ' i 3@12014 ViewChe nege CENTRIC Bj..>1T . ONLINE BANKING Centric Bank • Member FDIC • Equal Housing Lender 4320 Linglestown Road, Harrisburg 717.657.7727 1625 Market Street, Camp Hill 717.730.2816 6480 Carlisle Pike, Mechanicsburg 717.591.1360 1201 W. Governor Road, Hummelstown 717.533.7626 View Cheek Image Fiic Ra�tate ReY�rn PA70MIAA.1SMIPELSTATE o:{m[,aii j,u�ry KEVIN L.KNOM EXIMUTUR ' KYRiCrm NoLktb.:at 4 Ra Zt!'rt HNT.6'fFEE1' qau• . . CJlMU9i>:RM1•i7J1a'. .�_: �_ c:�i�i'I.1tIC. l� 0. • �+�! r1`NIt;t4ncgVwF7g1U,.l'r�P[r.:r -- Ir001Ct �.Sn' .t:b313!i �PSi: t 1234491i•' iJ(egt�' /� '... - . - :.ra-'�- •:.;+.:n..°'ti"!C-'CS'YtL.1�i-iir-1^a..i' 'r�l-.�..00n9mTMFw•7?u�'T':f!F.• e.. _.�_.-..�....r—r STATEMENT CAMP HILL EMERGENCY PHYSICIANS Statement I PO BOX 13693 ACCOUNT NUMB PHILADELPHIA, PA 19101-3693 Patient Name:PATRICIA Taxi Account Bala Amount Pen Insura lu'Ih"illulll'b'^'10'IIIIPl6hlll"Ihu1f11''"'4'd' AP°ni(cur� 082516-0000046363883-06 Amount Duel #BWNJFDB Patient(Past[ lit #OOOOOOHYP8018594# Pay This Amo PATRICIA A KNIPE 2100 BENT CREEK BLVD PLEASE 1 MECHANICSBURG PA 17050-1836 DUE B to to Pay your bill securely online anytime at www.MyMedicalP< Date it Description Charge Paid By Paid By Paid I First Ins- Other Ins. Patio i 10!10113 1 OMI-25 CRmCAL CARE 30-74(SICKNESS) $143400 DX'427.5 DR,PAULMOLY SPIRIT HOSPITAL 12/19/13 MEDICARE CLAIM DENIED�NOT DEEMED MEDNEC -50.00 12/19/13 MEDICARE CONTRACTUAL ALLOWANCE 01/02114 BLUE SHIELD CLAIM DENIED�PRIMARY PAID MORE TH IN 50.00 SECNDRY ALLOWS 01/02!14 BLUE SHIELD CONTRACTUAL ALLOWANCE 03/09/14 MEDICARE CLAIM DENIED,NOT DEEMED MEDNEC 30.00 03109114 MEDICARE CONTRACTUAL ALLOWANCE 0320014 BLUE SHIELD CLAIM DENIED•PRIMARY PAID MORE TH N -$0. SECNDRY ALLOWS 03120/14 BLUE SHIELD CONTRACTUAL ALLOWANCE 0321)14 MEDICARE CONTRACTUAL ADJ ADJUSTMENT 0321/14 MEDICARE CONTRACTUAL ALLOWANCE 03/21/74 MEDICARE PAYMENT S-168.21 03121114 MEDICARE Sequestration 2%Cut 10110013 2 31500 ENDOTRACHEAL IWUBAT10N $935.00 DX 427 5 DR.PAULMOLY SPIRIT HOSPITAL 12/18/13 MEDICARE CONTRACTUAL ALLOWANCE 1211W13 MEDICARE Sequestration 2%Cut 1XIGV13 MEDICARE PAYMENT $85 B1 0IM214 BLUE SHIELD PAYMENT $.21. 10/10013 3 99292-25 CRITICAL CARE.74 $71700 DX.427.5 DR.PAULMOLY SPIRIT HOSPITAL TOTALS: CONf1N En CON WUEO CON NUEU CO m" Important Messages: This statement is for the direct treatment and/or supendsion of care you recently received fmm an Emergency Physician at Holy: Physician are Wed separately hem any hospital cha,"or other professional teas Ire,,ouch you may also be roapanslble. Ther hospital or other physicians for charges in Connection wilh this visa.It will not include the items listed on this Statement "Payment Plans"Accepted Questions about this statement?/Llame de Lunes a Vi Cali 1-800-355-2470 Monday through Friday 9:30AM -1 Your automated system access code is 0801-46363883, or you c billing_questions@emcare.com. 91384.01-525 �'J' Please detach and return bottom portion with your rer -- - - -- - -- - ------ -- - ------- - - - -- - PATRICIA A KNIPE STATEMEN1 2100 BENT CREEK BLVD Statement Date: MECHANICSBURG PA 17050-1836 ACCOUNT NUMBER: YOU MAY PAY THIS BILL WITH YOUR CREDIT CARD I Patient Name:PATRICIA A KI PLEASE SEE REVERSE SIDE, Payment Due By: Amount Due: Account Detail (9) HYP46363883 Page 2 Of 2 Dale It Description Charge Pald By Paid By Paid By Amount Due Fmm PATIENT First Ins. other Ins. Patient Adjusted Insurance BALANCE 1211x113 MEDICARE CLAIM DENIED BUNDLED SERVICES 5000 1211913 MEDICARE CONTRACTUAL ALLOWANCE $41700 01/02/14 BLUE SHIELD CLAIM DENIEDWRIMARY PAID MORE TH N -51r SECNDRY ALLOWS 01/02/14 BLUE SHIELD CONTRACTUAL ALLOWANCE 40 03109/14 MEDICARE CLAIM DENIED-BUNDLED SERVICES -$000 09M14 MEDICARE CONTRACTUAL ALLOWANCE ,500• 03108/14 MEDICARE CLAIM DENIED-BUNDLED SERVICES 5000 031=14 MEDICARE CONTRACTUAL ALLOWANCE -SO.W 032414 BLUE SHIELD CLAIM DENIED.PRIMARY PAID MORE TH N .50 SECNDRY ALLOWS 032914 BLUE SHIELD CONTRACTUAL ALLOWANCE 40.0 03!2914 BLUE SHIELD CLAIM DENIED-PRIMARY PAID MORE TH N 40. SECNDRY ALLOWS 032914 BLUE SHIELD CONTRACTUAL ALLOWANCE 4(100 0312914 BLUE SHIELD CLAIM DEMED�PRIMARY PAID MORE TH N 4000 SECNDRY ALLOWS 032914 BLUE SHIELD CONTRACTUAL ALLOWANCE 40, 5000 i i I I TOTALS. 53,086.00 -5254.02 -52189 $0.00 -$2,76716 5000 54291 PLEASE • • NOT USE RED INK WHEN COMPLETiNG • New Address: Insurance: Address 1: ❑MEDICARE ID MEDICAID ❑OTHER Address 2: Company Name: City: State: Zip: Address 1: Telephone: Address 2: Credit Cards: ❑Visa ❑Mastercard ❑American Express City: State: Zip: 1 1 1 1 1 1 1 1 1 1 1 1 1 1 (J I I I I NAME AS IT APPEARS ON CARD-ALL CARDS Telephone: A WMASTERCARD NUMBERS ONLY L�LJ 3-0188 Number lmm Back of vi a M4 wm,e Plan Holder Name: I I I I I I—I I 1 1 1 1 Relation of Patient: J SELF ❑SPOUSE ❑CHILD AMERICAN EXPRESS NUMBER ONLY _ I ( I Mc °onof mrE p`ze POLICY#: F nella Card EXPIRATION DATE-ALL CARDS GROUP#: