HomeMy WebLinkAbout10-09-14 (2) � 15056101�5
REV-1500�``O2_ll,«, �
PA Department of Revenue Pe�nsYNarria OFFICIAL USE ONLY
Bureau of Individual Taxes �"""'"`"T "` "` County Code Year file Number
PO BOX z8o6oi � INHERITANCE TAX RETURN �/ / �
Harrisbur ,PA i�128-o6oi RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
07/18/2014 09/02/1918
DecedenYs Last Name Suffix Decedent's First Name MI
Kurtz Kenneth M
(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 DUPIICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1.Original Retum O 2.Supplemental Retum p 3. Remainder Retum(Date of Death
Prior to 12-13-82)
O 4.Limited Estate p 4a.Future Interest Compromise(date of p 5. Federal Estate Tax Retum Required
death after 12-12-82)
� 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT— THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CQNFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
Kathi Ziegler (717)724-4136
REGISTER OF WILLS USE,QNLY
n ��
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First Line of Address C� � � r� rn
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j_'„' "(� C"'] f'� p
19 West Coover Street -,� '� � —+ -� �,-,
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Second Line ofAddress � r ��r7
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City or Post Office State ZIP Code '4�"�E}?1�ED..:� '� 7 a
Mechanicsburg PA 17055 - � � '� r`�� �
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7
CorrespondenYs e-maii aadress:kziegler53@hotmail.com
Under penalties of perjury,I declare that I have examined this retum,induding 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 informatlon of which preparer has any knowledge.
SIGNATURE O/F/_PF�RSON�PO SIBLE FOR FILING RETURN �Q DApTE f�
ilu�lL ! /
ADDRESS
19 West Coover Street, Mechanicsburg,PA 17055
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1505610105 1505610105 J
�_ � i �
-
� 1505610205
REV-1500 EX(FI)
DecedenYs Social Security Number
Decedent�5 rvame: Kenneth M. Kurtz
RECAPITULATION
1. Real Estate(Schedule A). ............................ ................ 1. 84,000.00
2. Stocks and Bonds(Schedule B) ..... ..................... ............. 2. 0.00
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. 0.00
4. Mort a es and Notes Receivable Schedule 0 4. �.00
9 9 � )...........................
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 3,511.45
6. Jointly Owned Property(Schedule F) O Separate Biiling Requested ....... 6. 0.00
7. inter-�vos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested........ 7. 0.00
8. Total Gross Assets(total Lines 1 through 7)............................. 8. 87,511.45
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 3,264.66
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............... 10. 41,922.46
11. Total Deductions(total Lines 9 and 10)........ ......................... 11. 45,187.12
12. Net Value of Estate(Line 8 minus Line 11) ................... ........... 12. 42,324.33
13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) ............. ........... 13.
14. Net Value Sub'ect to Tax Line 12 minus Line 13 14. 42,324.33
1 � ) ........................
TAX CALCULATION-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.0_ 15.
16. Amount of Line 14 taxable
atlinealrate X.045 1,904.59 �g, 1,904.59
17. Amount of Line 14 taxable
at sibling rate X.12 17.
18. Amount of Line 14 taxable
at collateral rate X.15 18.
19. TAX DUE ............................... .................... ..... . 19. 1,904.59
20. FILI IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
� 1505610205 1505610205 �
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENTS NAME
Kenneth Morrell Kurtz '
STREETADDRESS
16 West Marbie Street
arr srArE ziP
Mechanicburg PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 1,904.59
2. Credits/Payments
A.Prior Payments
B.Discount
Total Credits(A+B) (2)
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4)
5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 1,904.59
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.............................................................................................................................. ❑ �
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ �
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?.............. ❑ �
4. Did decedent own an individual retirement account,annuiiy or other non-probate property,which
contains a benefiaary designation? ........................................................................................................................ ❑ �
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1,1994,and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent[/2 P.S.§9116(a)(1.1)(i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(aj(1.1)(ii)].The statute dces not exempt a transfer to a su►viving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax retum are sfill 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�e use of the decedenYs lineal beneficiaries is 4.5 pe�cent,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 decedenYs 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.
REV-1502 EX+(O1-10)
. �pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERIfANCE TAX REiURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
�e.v�h� (Ytoc�r�l� l�r�'z-
All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller,neither being compeiled to buy or seli,both having reasonable knowledge of the relevant facts.
Real properly that is jointiywwned with right of survivorship must be disciosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
REM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1. Qr���'� a'� (l� 1J�, �Ylcirb�e S� -
r,r� Q�} !'?OSS '�S� O�o -�d
�(Y�ec�v���sbu l ,
TOTAL(Aiso enter on Line 1, Recapitulation.) $ �' �Qd
,
If more space is needed,use additional sheets of paper of the same size.
- _ . _ .
REV-i5os Ex+(ii-io>
� pennsylvania SCEIEp�JLE E
. DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERIfANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
l��.hne,�� �b1vt'rel l �u�r�-
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property gointly owned with right of wrvivorship must be di�losed on Schedule F.
�M VAWE AT DATE
NUMBER DESCRIP?ION OF DEATH
�. P��. �A�� A�:��,,-� �3s-��. ys'
T07AL(Aiso enter on Line 5, Recapitulation) $ 3 s�� y,�j
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(10-09)
. �pennsylvania
SCHEDULE H �
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
1�eh�e�`� �rr��l l ��v���
Decedent's debts must be reported on Schedule I.
N MBER DESCRIPTION AMOUNT
A. 1 FUNERALEXPENSES: CrCYW�-�Uttl D������'` a��� ��
g, ADMINISTRATNE COSTS:
1. Personal Representative Commissions:
Name(s)of Personai Representative(s)
Street Address
Gty State ZIP
Year(s)Commission Paid:
2. Attomey Fees: ��� ,�o
3. Family Exemption:(If decedenYs address is not the same as claimant's,attach explanation.)
Claimant
Street Address
��� State ZIP
Relationship of Claimant to Decedent -
4. Probate Fees: ���, J a
5. AccounWnt Fees:
6. Tax Retum Preparer Fees:
7.
TOTAL(Also ente�on Line 9, Recapitulation) $ ?Jc���, ��/
If more space is needed,use additionai sheets of paper of the same size. �
REV-1512 EX+{12-08)
� � pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERiTANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
1��,vt�n��t�n (Y�o�Y�tl �i�r-t�-
Report debts incurred by the decedent prior to death that remalned unpaid at the date of death,including unreimbursed medicai expenses.
ITEM
NUMBER VALUE AT DATE
DESCRIPTION OF DEATH
i. `7'Mornwalc� l�c►vr�� (�,or-�Avic� �p$ �,pS'
a. QPI� ele�r�Lb�li �';,r,�l, ���� ao5.7�
�, �c�n�Clu�'� �e���� l �►v� 8i t � �1 S. 1�
�I. N-1�-RP �rn� �s�r-�.��� ��.� �'�' 1� �1�0. 3y
�`: ���l�r- �vn� �.���- �� �na.l �alct,v►G�, 3�t�s.o(�
� - PA rn��� �. �,�,��v�s� �m��� �,s$� . ��
TOTAL(Also enter on Line 10, Recapitulation) $ �l��af ��j
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(O1-10)
� �pennsylvania SCHEDULE �
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DKEDENT
ESTATE OF: FILE NUMBER:
����`ul ��� ��'�
RELATIONSHIP TO DKEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RKEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include oufight spousal distributions and transfers under
Sec.9116(a)(1.2).]
�. �a�n`� `�i��.e� ;���fl�-�er 1 aD�lo
1�! 1r� , L.vv v-�� ��--
fYlec�vLtics1ar.t.r�, QA" �'��5�
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINE515 THROUGH 18 OP REV-1500 COVER SHEET,AS APPROPRIATE.
II NON TAXABIE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 fOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
L
TOTAL OF PART II—ENTER TOTAL NON TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEEf. $
If more space is needed,use additional sheets of paper oF the same size.
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Cl)M��RI.AIyD CO., PA.
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I, Kenneth Kurtz, presen�ly residing in Mechan.icsburg, Cumberland County,
Commonwealth of Pennsylvania, hereby declare this to be my Last Will an.d
Testa.ment, revoking any and all other Wills and Codicils that I previously may
have executed.
SECTIQN 1: DEFINITIDNSANDAPPOINTMENTOFFIDUCIARIES.
The definitions and designations set forth in this Section 1 shall apply in
con.nection with the administration of my estate and the construction of this Will.
1.01. For purposes hexeof, the term "Fiduciary" an.d/or "Fiduciaries,"
however expressed, shall refer to my Personal Representative(s) andlor my
Trustee(s) who may be serving at any time. Whexe powers or discretions are
conferred upon the fiduciaries, such powers or cliscretions shall be exercised by the
Personal R,epresentative(s) as such, oi the Trustee(s) as such, as the case may be, in
their respective capacities and not by their joint action.
1.02. I am presently widowed. I have three (3) children: James Kurtz, David
I�urtz and Kathi Ziegler.
1.03. For reasons known to me and my chi.ldren, I hereby am excludi.ng
James Kurtz and David Kurtz as beneficiaries undex this Will.
1.04. I designate and appoint my daughter, Kathi Ziegler, to serve as my
Personal Representative. The teim Personal R.epresentative shall be construed as
meaning the same as Executox/Executrix.
.._. .,,�:. m„ -.—.. ,s.,..,, „ r�.,.,_ ._.....,:;.:.. ..;; .,,�� .o.. .- . - � `'���K^�
1.05. I hereby egcuse those persons named in or appointed pursuant to this
Wi]1 as Personal Representatives and Trustees from the necessity of posting any
bond or other security for the faithful performance of their respective duties.
SECTION 2: FUNERAL EXPENSE.
2.01. I direct my Personal Representative to pay the expenses of my funeral
(including, if no provisions therefor shall have been made during my lifetime, the
costa of a cemetery plot and headstone and markers for my grave}, in such amount
as my Personal Representative may deem proper, without the necessity of obtaining
the approval of any court having jurisdiction over the administration of my estate
and without regard to any applicable statutory limitation.
SECTION 3: DE�TS.
3.01. I direct my Personal Representative to pay all debts and claims which
are legally enforceable against me, except that all mortgages, liens and other
encumbra.nces on property owned by me at the time of my death shall be a charge
on the property so encumbered, and my estate shall not be liable for any such
indebtedness.
5ECTION 4: �ISPOSITION OF TANGZBLE PERSONAL PROPERTY.
4.01. I give the balance of my personal and household effects, automobiles
and other tangible personal property to Kathi Ziegler, per stirpes. My Personal
Representative shall divide such property in shares as neaxly equal in value as
practicable and by such method as my Personal R.epresentative may deem equitable.
To the extent possible, my Personal Representative shall make such division and
distribution to said ehildren in accordance with their wishes, but if my children do
not agree, my personal property shall be divided by lot. The decision of my Personal
Representative with respect to the division of such property, when made, shall be
�inal and binding upon all distributees. My Personal Representative shall be
authorized to sell or convert any of said property if my Personal Representative
. deems it practical.with the proceeds thereof to become part of my residuary estate.
4.02. If, prior to my death, I shall have left with my Personal Representative,
with this Will or among my important personal papers, instructions indicating I
would like any specified articles of my tangible personal pi•operty that any legatee
may inherit under this Section 4 to pass to any designated individual or individuals,
2
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"' t�e �poee anp #rust ar legal. obligation.s upon such legatee or Personal
Representative to do so, I am confident that said wishes would be followed.
SECTION 5: PAYMENT OF TAXE3.
5.01. All federal, state and other death taxes payable on the property
forming my gross estate for those purposes, whether or not it passes under this Will,
or whether it passes by reason of joint ownership thereof, such as certificates of
deposit, savings bonds, etc., shall be paid out of the principal of my probate estate
just as if they were my debts, and none of those taxes shall be charged against any
beneficiary.
SECTION 6: RESIDUARYESTATE.
6.01. My residuary estate shall consist of(a) all property or interests therein
not otherwise effectively disposed of in this Will, of whatever kind, nature or
description, and wherever located, including any property to which I shall be in any
way entitled at the ti.me of my death, any and all property over which I may have a
power of appointment and any insurance proceeds which may be payable to my
estate, less (b) all valid claim.s asserted against my estate and all expenses incurred
in administering my estate, includ.i.ng expenses of administering nonprobate assets.
SECTION 7: DISPOSITIONOF'RESIDUARYESTATE.
7.01. I hereby give my residuary estate to Kathi Ziegler,per stirpes.
SECTION 8: POWERS OF PERSO�VAL REPRES�NTATIVE.
8.01 My Personal Representative shall serve without bond.
8.02 My Personal Representative shall have all powers and discretions
conferred by Pennsylvania law, and all powers and discretions with respect to my
estate that are set forth or referred to with respect to the Trustee hereunder, to be
exercised without court order.
� 8.03 My Personal Representative is authorized to execute on my behal£ or
on behalf of my estate any tax return which may be filed.
3
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8_04 11�y Persanal Representative shali have, in addition to any other power,
the speeific powers to i.nvest, reinvest, sell, mortgage or otherwise dispose of any
part or all of my estate, �vithout the necessity of obtaining priox or subsequent court
approval.
8.05 Distributions may be made in cash or in kind in the discretion af my
Personal R,epresentative.
8.05 No Personal Representative shall be personally liable to any
beneficiary or othex party interested in my estate or to any third parties, for any
claim against my estate for the diminution in value of estate property xesulting
from matters involving hazardous substa.n.ces, including any reporting of or
response to (i) the contamination of estate property by hazardous substances, or (ii)
violations of any environmental laws related to my estate.
8.07 In making my designation of Personal Representative, I recognize that
said i.ndividuals may be placed in a position of potential conflict with other fiducial
responsibilities and representations arising out of their position and/or interest in
assets in which I may have an interest. I hereby direct that the Personal
Representative shall be exonerated from any personal liability ari.sing out of any
decision which they may make or act which they may take in fixrtherance of the
position to which I have appoi.nted them.
SECTION 9: SPENDTKRIFT PI�tOVISlONS AND FACILITY OFPAYMENTS.
9.01 Except as otherwise specifically provided in other portions of this Will,
my Fiduciaries shall make all payments hereunder directly to the beneficiary
entitled to them and not to any other person. A deposit of funds to the beneficiary's
account in a bank or other financial institution is the equivalent of direct payment
to the beneficiary. No payment may be assigned, anticipated, or encumbered by the
beneficiary; nor may any payment be attached, garnished, or executed upon by any
creditor of the beneficiary.
. 9.02 My Fiduciaries shall have the further power to make payments of any
income or principal for a beneficiary (i) directly to the beneficiary; (u) ,to the
individual wbo is, in the judgment of my Fiduciaries, in proper charge of such
person, regarclless of whether there is a court order to that effect; (iii) in the case of
a minor, to a custodian for the mi.nor named by my Fiduciaries, to held as a gift
under the Pennsylvania Uniform Transfers to Minors Act, with the custodial
4
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arrangement continuing unt�7 the beneficiary reaches twenty-one {21) years of age;
or (iv) by paying or applyi.ng any pai�t or all thereof for a beneficiary's benefit or on a
beneficiaty's behalf; and in eve2y such event payment may be made without any
neceasity of obtaining a receipt or the approval of any cou��t, and such payments
made in good faith shall be deemed proper and shall be a complete release and
acquittance of my Fiduciaries therefor.
9.03 My Fiduciaries may make discretionary payments of income or
principal to any person after taki.ng into consideration, or without taking into
consideration, as my Fiduciaries deem appropriate, any other income or financial
resources reasonably available to said beneficiary. All aspects of decisions with
respect to discretiona�.y payments of incame and principal shall be made by my
Fxduciaries in their sole and absolute discretion, such that no creditors of any
beneficiary, in.cluding any governmental agencies which may furnish services,
payments or benefits to a beneficiary, shall have a.ny claim to any of the income or
principal of my estate or any trust.
SECTION 10: GENDE�AND HEADINGS.
10.01 Any use in this Will of pronouns of the masculine or feminine gender
shall be interpreted as includi.ng persons of the female and male sex, where the
sense so requires.
10.02 The headings, titles, and subtitles in this Will have been inserted
solely for convenience, and shall be ignored in its construction.
IN WITNESS WHEREOF,I have signed my name to this Last Will and Testament this 4th
day of November,2013. -r
--��,,.�-�.-���' .
Kenneth Kurtz
?"� � � �� �� � �
_ ��'�=�-�°� Address: �� i,.9 . �� 0.��\� ;�st- •
WifiesS j' 1\'�C�rv�v�=.(,��j:rS� �� ��a�'�
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Summary Appraisal Report • Residen ial
.� �lt '
AI Reports�
of
16 W.Marble Street
Mechanicsburg, PA 17055
As Of:
11/16/2012
Prepared For:
Thomas W.Zeigler,Jr_
Thomas W.Zeigler,Jr.
19 W.Coover Street
Mechanicsburg, PA 17055
Prepared By: ,
RJ Fried
R.J. Fried&Associates
2323 Patton Road
Harrisburg, PA 17112
�
>._,� , <,�� �,,�., ..� . ,.. . ..�..�� �� � rw�. .., _-.�u
ft J.Fried&Assceiates
File No. ZEIGLER
Uniform Residentiai A ►�isal Re ort ��No. ZEIGLER
Tha oF Uds s is b the lerder/client wtth�aaauate�d u su ed 'rdon of the ir�ket vaiue of fhe u '
ress 16 W.Marble Street Mechanicsbu SfaEe PA Code 17055
Bomower Thomas W.Ze ler OwneroFPuWicRecad Kurtz Kenneth M.&Ma a�tA. Coun Cumbertand
al " Deed BooWPa e-Not Available
s Parcel# 18-24-0787-712 T�Yeaz 2012 RE Tm�es 3 013
horhoodName Mechenicabu Borou h � ADC:3118/J-7 CensusTract 01�5.00
OCdI X Owner Tenent Vaqnt ' Ass�ssmenls 0 PUD HOAS 0 monih
•• 'hts X Fee ' Leasehold Otl�er dessaibe
Ass'nrtientT Purd�ase Transaction f�lin�ce Transadion X Otl�er desc�ibe Market Valuatlon
LendedCient Thomas W.Zei ler Jr. Add�ess 19 W.Coover Stree Mechanicsbu PA 17056
Is Ihe s ' cu oftered for sale a hes tt been otfa►ed�or sale in the hNelve monC�s ' �the efteciive da�of lhis ' ? Yes X No
d�a s ased ofieri ' s �d d s. MLS
1 d'd did not snalyze the contract for sale for the subject pu�hase transeotion.Ex��lain fhe�esults of the analysis of the contract ior sale orwhy Ihe analysia vras iat
. Contract Price Dahe oF Contract is tlie sellw the owner oF blic recotd? Yes No Dala s
Is theie am finm�ciel assisiance(ban chages�sale oor�cessions�9ift or downpaymant asistence.etc.)to be P�bf'�f'P�Y on beF�f of tlie barowre(t Yes No
• If Yes tlie Eotal dolla amount des�xibe ihe iterts�o be
NoEe:Raeemd(heraclel com ofihe are nof ' faetors.
��� _ . ��•-� N'�-y :�"'��-za�g"`�._ __ �/.l11�S,`��' � k�►!��`�1[���.' _�!ltiA7tl��� '"
La�lion Uiban X SuMuban Rural V� Incressi X Stable Ded'' s PRICE AGE� OnelJnit 75 T%
� Bu�t-U X OYer75% 25-75% Under2596 Dernandl Sh X InB�ar�ce Ou�S� 000 2�Umt 3 %
. C�owlh X Stable Sbw Marked Time lMder3mUis X 36mlhs Orer6mfis 20 Low 1 Multi-Famd 2 96
'hborhood Boundaries The ' hborfbod bou�daries are on the enclosed addenda which rise 450 h 140 8 %
' the Borou h of Mechanicsbu . 100 Pred. 70 Otl�er 12 96
'hborYaod ' This ' hbortaod Cordains ' reflec.ti simil� uaf mainbenance desi n and marketabil' tio tt�e au '
The su ' ro is r�di awalable to all ner,essa facilities indudi schools em e sho i and houses of worshi . Avera e
ro maintenance ms observed.Em I eM is within 15-30 minute drive from sub�ed
Marlaet Caidt6ons i su brthe above cau�usias The se�art;h of coun �x records and ttie MLS servioe show ' stable. The MLS service
indicates that the icai sells in 36 moMhs. e funds are readi available fiom a vari of sour�with cmrventional loans bei
3.5%to 5.0%interest foaed 30 ear mo u to 3 ints.Sellers are not uired to offer sales or finanan concessions.
Dimensions No I Desai 'm Provided Nea 7841 sf Sh Rectan ular Y�ew N�Res•
' Classificalion RM ' Des�i ' Residential Medium
Zoni X al ' C�aidfatl�red Use No Zoni II al describe
Is the 'hest aid best u5e oF su' as' or as ans and U�e use7 X Yes No If No descdbe.
lltllT6aa Pu66c Otlwr deso�e PubNc Otlrer desaHie 0lf�slh T Pu6Ac Pifvate
X Wa�r X Shcet Mapdam X
Gas None San" Sewer X N�cadam X
FEMh ' Fbod Fi�ard Atea Yes X No FEMA Fbod Zone X FEMA # 42041 CO259E FEMA Date 03N 812009
Are ihe utiG�as andlor dFsile' ical For the maloei area? X Yes No If No descdbe.
fve tlie�e an adverse siBe conditions a exle�na�fadOrs ea�nenis encroachments environmant�conditions land uses etc.? Yes X No HYes desaibe.
, �-;, �_ ,� - � -
z'� rT.�' ..�.r� �as�mxt �-, �..�X6af�`..., __ - f � '�- _ -,.:�
Umis X One One rvilh Unit Coiw�ete SI� Qawl� Farcdalion Wells StonelA Fbors �Ca Wood/Av
#of S6ories 200 Fuli Basement X artialeasmneM E�erior Wa&s /Asb.Tile WoodlA Wails II/Av
T X Att S-DetJEndUnit BasementArea 938 .it RoofSurface Shin les RubbedA TrinVF'mish Wood PM/Av
X ' UnderCanst BesementFnish 0 % Gut�s8 Aluminum/A BalhFloor Wood/Av
'n S Tradffional Outside IFxi Su Pu VlrndowT Mixed/A BathWahscot CeramiGA
Year BuBt 1888 Evidenceof I�estation Stortn Sasl�lnsulated PartiaUAv Caz S None
Efiective rs SO SeiHement S�reans PartiaUA X #ofCas 2
N(ti� None Fwp Radient Amenides W s#0 Surhace As hatt
Steir X Stairs X Oth�.v Steam Fuel Oii F'ire s# 0 Fenc�None #of Cars 0
Flaor St�UIe Cool' Cenhal Air CondiGqi�in Pabolpedc 0 X Pordt Cov Front X #of Cars 2
Rnished HeaBed Individual Otlier None Pool None X Otl� Enc Porch Ait X Det Bu�t-in
a�es X tor X Dishwas Nicrorrave X Washer er Otl�er describe
Fu�ished aea above rade contax�s: e Rooms 4 Bed�ooms 1.0 Balh s 2192 uare Feet oF Gross Livi Ama Above Grade
� Add�feaWres s ' efficient i�ems etc. T iql for nei hborhood.
� Desaibe the condition of tlie mclu�G needed�e 'rs deterior�ion renov ' �nodeli etc.. C5•iGbdien-not u ted•Bathrooms-not u bad'The
construction ual' is 'cat for e in oom ' n to com 'n nei hborhoods. Based on maintenance condition and com rison to oom 'n
hborhoods the estimated e is bebw the adual :No economic or func6onal obsolescence noted. The home is in need u u rades and �
u ates throu hout the home. Items such as electrical wirin and lumbin i should be ins ed a licensed rofessional.
Are ttre�e ' deTiciem�es w adve�se ca�difions that a�Fect the livabif soundness or strucWral in ' of the Yes X No If Yes descnbe i
I
Does tlre coniam lo Ihe 'hbatrood functional ub1' s condidon use construc6on e�.? X Yes No H No desaibe
Freddie Mac Fortn 70 Ma�h 2005 Fannie Mae Fam 1004 AAardi 2005:
Produced by CI'K:kFORMS Soflware 8DU-622-8727 Page 1 Of 27
R.J.Fried&Associates
Flle No. ZEIGLER
Uniform Residentia/A raisa/Re ort ��No. ZEIGLER
The�e�e ' cu ofiered for sale in ttie sub ' ' m from 6u . I
There are al in e 1 h wtlhin t iwelve rtpntl�s ' x�sale � to
FEATURE SUBJECT COMPARABLE SALE#1 COMPARABLE SALE#2 CAMPARABLE SALE#3 )
Add�ess 18 W.Marble SVeet 128 W.Green Strcet 473 S.York Sheet 17 E.Portland Street '
Mechanicsbu PA �7055 Mechaoicsbu PA 17055 Mechanicsbu PA 17055 Mechanicsbu PA 17055 i
' ' Fo Su' �t�:„N t <` 0 53 miles NW 0 26 miles W D.63 miles N �
Sale Price E , :? = 71 904 - -- 75 000 �;-f ::� 78 500 I
Sak PricBlGtoss Liv.Area 0.00 .1t 57.62 � .ft� F-''.'�$ J 58.50 T. ft _�� � 81.71 .ft ��:�;:1
Date Sou s �-z����'j�� 4:` MLS-10204727•DOM 251 MLS-10203232'DOM 5 MLS-10225112•DOM 77
Verificatim Sou s , �'� �' Tax Assessment Records Tax Assessment Records Tax Assessment RecoMs
YALUEAUIUSTN�MS DESCRIPTION ~ DESCRIPTION - Ad' DES(�tIPTION - Ad'usfineni DESCRIP'TION - Ad' trnen
SaleorFin ��`"'�� ArmLth ArtnLth ArtnLih
Ca�essions �r��� '' Conw1438 -1 4 Cash•0 ConvO �
DadeofSale/fime � � ' s12/11�c1D/11 s01/11'C12/10 s1Dl12•c09/12
Location N•Res� N•Res' N�Res- N•Res• I
LeaseholdlFee Si Fee Sim le Fee Sim le Fee Sim e Fee Sim e
5i� 7841 sf 8278 sf 8098 sf 4792 sf
Viflw N•Res' N'Res• N'Res' N•Res'
Tradi�onal TradiGonal Tradi�onal Traditionai
Qu of Canstruc6on Q4 Q4 Q4 Q4
Nciu� e 124 164 112 1�0
Condition C5 C4 7 50 C5 C5
A6ove C�rade Taial Bd Balhs Total Bdms Balhs Tofai Bdms Balhs Total Bdrtr� Balhs
Room Caunt 8 4 1.0 7 4 1.0 6 3 2.0 -2 8 6 3 1.1 -1 40
Gioss ' Naa 2192 1 249 .fl. +14 20 1 282 .R +13 70 1 272 .ft +13 80
B�t�Fnished 998sfOsfin 624stDSfin 560sfOsfin 587siUsfin
Roorts Below Grade
FuncHonal ' Ave e Avera e Avera e Avera e
St�m/None HtWtrMone HtWtrMone FWA/None
Eifiaentl�ens Standard Standard Standard Sta�dard
2 Car Ca rt Det None +2 00 None +2 00 1 Car Gara e
� Po�olDeck Cov F Enc Po Stoo Dedc +80 5too Cov Porch +40 Cov Poroh Patio
OUier Item Se Toilet/Shower None +50 None +50 None +50
. i
• NetAd'usUnent o Y � �~ � ` X + - 5 8 562 X + - $ 13 800 X - $ 12 900 �
Adj�l Sale Price ' � ��� �Net Adj:12% Net AdJ:18% Net Adj:18°k (
Of �:.�-.:�F--��.-".�GtOSS Ad':3796 E 80 466 GID8S Ad:26% S 86 8Q0 GrosS Ad�:20% E 91 400 �
i X �tid did not teseach 1he s�e or 6ansfer h' of ihe su' and co sales.If �
�ese� d'd X did not reveal "r saies or h�sFsrs oFihe su' for the three 'r�ihe eflective dale of ihis
Data sou s MLSlfax Records
research did X did�t�veal an ' s�es or Uan.�ers of ihe s�es for the ear ' b the da�e of sale of the com s�e.
Dafa sou s MLSlfau Recortls
the�esuHs of the research and an 's of the rior sale or trans(er fi�sto of the su' and s�es rt addiiUai� � sales on e 3.
ITEM SUBJECT COMPARABLE SALE#1 CAMPARABLE SALE#2 COMPARABLE SALE#3
Da�e of Priof Salalfransfer
Price af Prior Sele/Tr�sfer �
Dafa Sou s Public Records Public Reaords Public Records Public Records �
EfiecUveD�eoFD�aSou S 11/23/2012 11/23/2U12 11/23/2012 11/23/2012
M sis of ' sale or tr�sfer hisb of the su' and le sales The sub' ro has not transFerted in the st three r as noted in
the above rid and the com rable sales have not transferred in the ast ear as noted in the above rid.
Sumrnary of Sales Con�parison App�oach ""SEE FIRST COMMENTS PAGE FOR SUMMARY'"'
�
;
I
I
ind'u�tea v�ue sa�s sa o0o j
lnal(cated VaN►e b.Sales Com on 84 00o Cost o Ucane ddevNo i
Due to the ladc of rer�tal data the Incom ch is t a riate. Due to the a e of the su ' the Cost oach is not considered vaiid.
� Greatest wei M is iven to the Sales Co roach as R refleds the icat actions of b ers and sellers in the mark lace. :
i
' This�praisal is mede X 'as is,' subjact 10 oomP�P�P�and spe�7�ations on the basis oF a hypothetical cond'fion that ihe imqovements have been i
cwrnpieled,Q subject to ihe iolbwing Bpaiis or�feretions on the basis of a hypolhetiql condition that the repairs w aHerations have bee�oompieted.or❑subjecttolhe !.
� followi i�ed i� 'n based on tlie exbaordi assu don Ihat Uie oondiUon a dces not uire alteration a a�: No wartan of the a raised is '
iven or im lied. No tiabil' is assumed for the structural or mechanical elements of the
. Based �vfsw!Mspectlon of dhe lnfaBor and a:lwiormeu of fhe wbJsct proparty,definedscape o►wo►k saten�ent oiaasumpfbns and 16nftl�
a►►d a ce►lficaffon,rm'(aer)oPMfon of Ure nrmkat+�g,as defleed oftlrerealprvpe�tytt►atis ihe wbJect olthis reportis
� as of 11l1 Bl2012 which ts tlre dafe o/ins on and eflxHve dsh oflhis a
fred .Fam 2005 F�nie Mae Fam 1004 Ma�h 2005
R.J.Fried&Associates ,
Flle No. ZEIGLER
Case No. ZEIGLER
Uniform Residentiai A raisal Re rt j
The IMended Use is to evaluate the ihat is the su ' of this a raisal for a mort e finanoe transac�ion s � to the sco of wo
of 1he a lsal uiremerris of this a 'sal rt fortn and Definkbn of Market Value. No addidonal users are idendfied
the a raiser. Descri 'on of the raisal Process/Sc:o of Work �
I
I
The a raisal rocess is intended to"describe the extent of the rocess of oollectin confirtnin and re rtin data" In order to re re an
a raisal rt on the sub ect the followin afe were involved: '
The sub'ect stte and n ' hborhood were nai ins b the a ' c The in cor►side�ed Uie various local ec�nomic indic�tors
with res to their tial i d on the sub'ect sRe. The stren s end weaknesses of the eneral eoon were wei hed as th affed
the value of the sub'ecL �
�
All relevaM tacLs related to the su 'ed were oollected and verififld indudi but not limited to zonin utllibes land and buildin area iestrictions �
encumbrances easemeNs environmentai fadors and other items of a similar nature deemed a licable� �
I
No bu0din lans were available. The bulidin uare foote e was derived Trom adual measurement and the e�tistfn assessment reoords in �
order to detertnine s uare foota .
� Basement uare foota e measurements for the com rable sales were defired from tax assessment sketches and are not adual �
I
measuremerds. Th are a Gose a robmation needed for UAD com liance and are not to be deemed as 100%accurate. i
i
� A hi hest and best use ana is was com eted. �
,
' The C Sales ' n and Income d�es to value weie caisidered and the Sales Com rison' roach was used in the valuapon �
� of fhe sub'ed ro
!
Daia was collec:ted durin this from various sources. This infortnation is believed to be reliable anil verification of sales data inGuded �
reliance on coun deed records andlor third- coMirmations. The a �ser has no reason to sus inaaxiracies in an infortnatio
rovided and the ana is and condusions are based on the reliabil of this infortnation. !
{
The raiser is not an in' ' i moki mildew I�d base int nor asbestos. If the dient has a conoem then 1 stro recommend the ;
dient corrtact an in the environmental andlor home ins "on field s. ;
�
If an estimated value ar sales rice rrds induded eilher on the a raisal uest Tortn or verbal irom another invoNed in the transactlon :
the value rovided had no influence on final estimate of value. j
: �
�-�- _ �*� �'" - �'`_�� _ -A�tl� 'ilii+e�U6 , -�►re�1Na��' � _ �
�{�� � �
�Y.z..,. ., : , � j ,, v v �-.: !.
_. ,._��. _ _ . , . _ ..� . :- . _
Pmvide u�e i�omia6on tor the lenderlclient to icate r cost u►es and ca�ulaiions. �
Su fir 1he ' of site walue of co land sales or otlrer methods for esdma6 site value �
i
ESTIMATED REPRODUCiION OR REPIACEMENT CAST NEW OPINION OF SITE VALUE
� Sou�e of cast dffia Dwelli 2 192 .Ft - '�
: p„ ' Uomoasts�vioe EfiecEiyeda�ofcostdam Bsmt 936 .fL =S i
: Cormienls on Cost mach mss i'' area calculatlons d ' etc �
The Cost A roach will eneral resuk in an excelient estimate oF value 528 .Ft = �
• ff the buildin is new or reasonab new and Me im rovemenis reflect Total Esti�ta of CosMew - 0 I
the hi hest and best use of ttie of the 18nd. However when items of l.ess Ph ical Functional F�demal ;
siql de reCiatlon and obsolescence must be estimated an ar�of 'ation 0 � i
'u ment is imolved which is sub'ect to ertor. The Cost roach was 'a6ed Cost of 1 ts - 0 1
not utliized due to the a e of the sub'ect '/�+s'Value of 56e� mveme � j
Eshm�ed Rerre�n Ecawmc lde UD axl VA ai Yea Indu�d Value Cosl � �
� _ ��" r��OI�E�AR�R- ��;�'V%1�'�E:n�`��-,y "aTel�/aes-'` � .� } - �
� Es6maled Nbnih Maket Rent . x C�oss Multi �er =S Ind'u�d Ualue Income V
Su of Income ioach mcludin su for market rent ard G �
��� „���<�� ,.� ,� - ^�?�Ql1L�L'i�.� F.�iMl1`l�10�f�=`F�R�1'C�D� _ e 't �
Is the deveb IbuBder in oontrol of Uie hlaneowners,4ssociation HOA? Yes No Unit s Detad�ed Atfa�hed j
Provkle the fdbwi intonr�ation for PUDs ONLY'rf the de lbuilder is in oonUd oF the HOA and ihe su' is an altached dwelNn unit ;
i
al N2fIlE Of � I
Toialnumberof � TdalnumberofuniLs Tofalnumberofunitssold
� Tol�number of units rented Tatal number of unds for sele D�a sau s j
- Was ihe • qea� ihe conversion of exis' buildi s into a PUD? Yes No If Yes dale of conversion. �
. Does ihe ' t conNain ai mulltdwelfi uniLs9 Yes No Data sou�e.
' Are the uniLs carrtan efert�enLs and rep�on faalibes te? Yes No if No descdbe ttie sla6us of tion.
!
,
• Are the canvtan elert�en�leased fo a the Hortieoxmers Assaciation? Yes No fl Yes desaibe the r�fal iemis and o
Describe cartuian elert�entr�d reaea�facalffies.
F�eddie Mac Form 70 Ma�h 2005 Farmie Mae Fam 1004 Ma�h 2005
Produced by ClidcFORMS Software 800-622-8727 Page 3 of 27
.>.., :_ �_ . : ,,�. _ . ��.� ..,-�.-�.,�,��,,.� ,��-� ., n
Senior Checking Plan Statement �PNCBANK
PNC Bank
Primary account number: 50-0487-7208
Page 1 of 2
For the perlod 06/28/2014 to 07/30/2014 Number of enclosures: 0
KENNETH M KURTZ � For 24-hour banking,and transaction or
16 W MARBLE ST interest raie information,sign-on to
MECHANICSBURG PA 17055-6424 '� PNC Bank Online Banking at pnc.com
For customer service call 1-888-PNC-BANK
Monday-Friday:7 AM-10 PM ET
Saturday 8 Sunday:8 AM-5 PM ET
Para servicio en espanol,1-866-HOLA-PNC
Moving? Please contact us at 1-888-PNC-BANK
� Write to: Customer Service
PO Box 609
Pittsburgh,PA 15230-9738
�. Visit us at pnc.com
� TDD terminal:1-800-531-1648
For hearing impaired clients only
Senior Checking Plan Kenneth M Kurtz
Regular Checldng Account Summary
Account number. 50-0487-7208
Overdraft ProtecUon has not been established for this account.
Please contact us if you would like to set up this service.
Overdraft Coverage -Your account is currently Opted-Out
You or your joint owner may revoke your opt-in or opt-out choice at any time.
To learn more about PNC Overdraft Solutions visit us online at pnc.comloverdraftsolutions.
Cali 1-877-588-3605,visit any branch,or Sign an to PNC Online Banking,and select the"Overdraft
Sotutions"link under lhe Account Services section to manage both your Overdraft Coverage and Overdraft
Protection settings.
Balance Summary
Beginning Deposits and Checks and other Ending
balance otheradditions deductions balance
2,248.55 3,994.00 6,310.15 67.60-
Average monthly Charges
balance and fees
3,291.15 36.00
Transaction Summary
Checks Check Card POS Check Card/Bankcard
paid/withdrawals signed transactions POS PIN transactions
4 0 0
Total ATM PNC Bank ATM Olher Bank ATM
transactions transactions transactions
0 0 0
Overdraft and Retumed Item Fee Summary
Total for this Period Total Year to Date
Total Overdraft Fees 36.00 36.00
Activity Detail
Deposits and Other Additions There were 3 Deposits and Other
Date Amounl Description Additions totaling$3,994.00.
07/01 1,758.00 Direct Deposit-Xxva Benef
US TREASURY 310 XXXXX2299 00 10
Deposits and Other Additions continued on neM page
�.�,� �. a�� x... �...���, ,� �� �F ���� .�..� _v . _
Senior Checking Plan Statement
For the period O6/28/2014 to 07/30/2014
� For 24-hour intorma�ion,sign on to PNC Bank Online Banking KENNETH M KURTZ
on pnc.com Primary accoun►number: 5D-0487-7208
Account Number: 50-0487-7208 -continued Page 2 of 2
Deposits and Other Additions -co�rin�ea
Date Amount Description
07/01 750.00 Direct Deposit-Revenue
PA TREASURY DEPT XXXXXXXXXXX9466
07/03 1,486.00 Direct Deposit-Xxsoc Sec
SSA TREAS 310 XXX>CX2299A
Checks and Substitute Checks
Check Date Reference Check Daie Reference
number Amount paid number number Amount paid number
217 1,797.34 07/08 049211321 7047' 405.89 07/02 085615043
218 1,082.05 07/28 051820490 7048 2,0OO.OD 07124 083763963
*Gap in check sequence There were 4 checks listed totaling
$5,285.28.
Online and Electronic Banking Deductions There were 3 Online or Electronic
Date Amount Description Banking Deductions totaling
$988.87.
07/09 358.95 Direct Payment-Ins. Prem
United American XXXXXX7711 0714
07/23 168.92 Direct Payment-Elec Svc Ppl Eu
X�CXXX5003Ws
07/25 461.00 Direct Payment-Cash Trans
H B McClure Co.51-026
Othef DeduCtlons There was 1 Other Deduction
Dale Amount Description totaling$36.00.
07/29 36.00 Overdraft Item Fee
Daily Balance Detail
Date Balance Date Balance Date Balance Date Balance
O6/28 2,248.55 07/03 5,836.66 07/23 3,511.45 07/28 31.60-
07/01 4,756.55 07/08 4,039.32 1,511.45 07/29 67.60-
07/02 4,350.66 07/09 3,680.37 07/25 1,050.45
Do your plans for retirement protect you and your family from the unexpected?
Insurance products can be very helpful when it comes to safeguarding your future.
A PNC Investments Financial Advisor can work with you to identify your unique needs and help you plan for the
unexpected by discussing insurance products as part of your financial plan. Protect your finances in
retirement with our help today-stop by your local branch or call us at 1-877-487-3417 for a complimentary
insurance review and policy evaluation.
Important Investor Information: Brokerage and insurance products are:
Not FDIC Insured--Not Bank Guaranteed--Not a Deposit
Not Insured By Any Federal Government Agency--May Lose Value
Securities and brokerage services are provided by PNC Investments LLC,a registered broker-dealer and
investment adviser and member FINRA and SIPC.Annuities and other insurance products are offered by PNC
Insurance Services, LLC a licensed insurance agency.
Member FDIC Q Equal Housing Lender
�.� �.� � � �,�.�. .�,E-�: ,�,. �.� ,�;�:,�..���,. ����.� ,�,..�,�� � _ _
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August 18,2014
Kathi Zeigler
19 West Coover Street
Mechanicsburg,PA 17055
Dear Kathi:
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 $ 7,215.00
Plus: Contract Addendums 103.00
Subtotal:Invoice#11280 $7,318.00
Less:Pavment from Insurance (4,194.84)
Less:Terms Discount (495.00)
Your Balance Due by Au ust 31,2014 $2,628.16
We have enclosed a complete invoice for your records.
Please call us at any time that we may be of service.
With Warm Regards,
r,GYZ�c:r.�� �
Michelle L.Haag
Treasurer
Enclosure
Walking witJr Those in Grief
Robert`Bob"L.Buhrig,Jr.,FD.Supervisor•William"Bill"L.Christopher,FD
Phone: ��u�7663421 • Fax: (n��795.7291 • 37 East Main Street • Mcchanicsburg,PA 17055 • mvw.Myers-Buhri�.com • Directors��Mvers-Buhne.com
RECEIPT FOR PAYMENT * DUPLICATE *
-------------------
-------------------
LISA M. GRA.YSON, ESQ. Receipt Date : 7/31 2014
Cumberland County - Register Of Wills Receipt Time: 12 : 8 : 15
One Courthouse Square Receipt No. : 1078754
Carlisle, PA 17Q13
KURTZ KENNETH MORRELL
^ Estate Fi1e No. : 2014-00715
Paid By Remarks: KATHI J Z��LER
DB1
------------------------ Receipt Distri.bution ------------------------
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST 210. 00 CUMBERLAND COUNTY GENERAL FU
WILL 15 . 00 CUMBERLAND COUNTY GENERAL FU
JCS FEE 33 .50 BUR.EAU OF RECEIPTS & CNTR M.
SHORT CERTIFICATE 10 . 00 CUMBERLAND COUNTY GENERAL FU
AUTOMA.TION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FU
INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FU,
INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FU
----------------
Check# 1037 $303 . 50
Total Received. . . . . . . . . $303 . 50
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� Invoice No.: 903
'��'� 130 W. Church Street, Suite 100
SafetyNet ;, Dillsbur PA 17p19
olutionsfarY 9� Date: 09/17/14
e�rYour-' ' (717) 884-4963
.:LOy¢d 0 �•' (717) 502-7143
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INVOICE: Kathi Ziegler
Terms: All inclusive flat fee
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1 �Estate Deed+ Statement of Value i o9/1�/1a zoo.00
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1$ �Filing Fae with the Recorder of Deeds � j � 83.00
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Thank you for your business! , ,
Please remit check made out to:
"DAGGS LAW, ��c"
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STATEMENT
Thornwald Home Statement Date: 07/O1/2014
442 Wainuf Bottom Road
Carlisle, PA 17013 Due Date: 07/25/2014
Telephone: (717) 249-4118
Amount Enclosed $ � �C(j p�,(�S
Amount Due: $ 1,082.05 ',
Account#: 20116 ,
RE: Kenneth M Kurtz
Kenneth Kurtz ,
19 West Coover Street
Mechanicsburg, PA 17055
Days
`Date Descri tion uant �Rate 'Ghar es +Pa ents . Balances
Balance B/F 987.15 987.15
06/23/14 KURTZ, KENNETH M 987.15 .00
07/01/14 Insurance Premium Credit -1 358.95 -358.95 ' -358.95
07/Ol/14 RESIDENT INCOME 1,545.90 1,186.95
07/Ol/14 Insurance Premium Credit -1 104.90 -104.90 1,08Z.05
Current 31-60 Days 61-90 Days Over 90 Days Amount Due
1,082.05 .00 .00 .00 1,U82.05
Payments MUST be received BY the 25th of each month. If payment is
not received timely,an interest fee may resuit. Statement Ddte: 07/01/2014
MA redpients: Please remember to keep sending your deduction Due Date: 07/25/2014
- paperwork to ensure proper4redit. � ”- ""
Kenneth M Kurtz - Account #: 20116
Thornwald Home
442 Walnut Bottom Road
Carlisie, PA ll013
Telephone: (717) 249-4118
STATEMENT
Thornwald Home Statement Date: 08/O1/2014
442 Walnut Bottom Road
Carlisie, PA 17013 Due Date: 0$/25/2014
Telephone: (717) 249-4118 i
Amount;Enclosed $
Amount Due: $ .00 ;
i
Account #: 20116 '
• RE: Kenneth M Kurtz i
Kenneth Kurtz �
19 West Coover Street i
Mechanicsburg, PA 17055 '
_ DayS; . ;
`Date Descri tion uant -Rate Ghar es 'Pa ents � `Balances
Balance B/F 1,082.05 1,082.05
07J28/14 KURTZ, KENNE�'H M 1,082.05 � .00
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Current 31-60 Days 61-90 Days Over 90 Days Amount Due
.00 .00 .00 .00 .00 !;
Payments MUST be received BY the 25th of each month. If payment is
not received timely,an interest fee may resuit.
Statement Date: 08/01/2014
MA recipients: Please remember to keep sending your deduction DUe Ddte: 08/25/2014
papervvork to ensure proper credit. " � - -- - --
Kenneth M Kurfz-Account#: 20116
Thornwaid Home
442 Walnut Bottom Road
Carlisle, PA 17013
Telephone: (717) 249-4118
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PPL Electrlc Utilitles � � �� �
2 North 9th Street CPC-GENN1 Ailentown, PA 18101-1175 ''�''i''�:-'
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Tel.800.358.6623 Fax 484.634.3713 �•--
pplelecvlc.com pp �.;°y
PPL ElwcMC Ud11tiN
AB 01 002789 70295 B 6 A
I�I��IU�����I�'���I��IIJI��1��I���1'I'�11�����'��'�I��11������1
KENNETH M KUR1Z AU 3t 2g, 2014
16 W MARBLE ST �
MECHANICSBURG PA 17055-6�124
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___� _. _Bill-AccountNo:�38ZD1=�5G�3 _ __---� -...-�iiit�astDue: �2�5::�5- - --- �- ----- -------
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Deax Customer: `�-�----._.___.__.__.___.
Your final bill with PPL Electric Utilities is overdue for the amount shown above. We
understand it is easy to forget a�nal bill when moving or changing service. For this reason, PPL
Electric Utilities offers various methods of bill payment such as credit card payment, speed pay
(we automatically process your check over the phone), and payment agreements.
If your account remains overdue,we m�y refer your balance to one of our collection agencies or
attorneys. An unpaid account balance could have a negative effect on your cred.it rating.
To avoid collection action,please contact us within the next 10 days. Our telephone number
is 1-800-358-6623 and our hours are 8 AM to 5 PM. When you call,you can either pay the
amount you owe or set up a payment agreement.
If you have already paid this bill, thank you for your payment. If you have an,y_QUestions please
call us at the above telephone number. ,�
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Mailed payments must be sent to PPL Electric Utilities, _
Attn: CPC-GENNl,2 N. 9th St.,Allentown,PA 18101. �,� �,/
_-� - _ - � _ � � __ .�, « -- .
�Revenue Collections Supervisor � ..
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600 S_ H m'�urg 232-4328•Hershey�534P 2661�_17� DatC: 07/01/2014 .
Carlisle 243-9011'York 845-43,28
www_hbmcciure.com
7'+usts QnaRf,]+Valae...S1n�ae 1'8114
Dsefgn Bulld Mechenbal Contraotor•Piumbfig•HeaNng•Atr Corxiitioning
Electricai•3ervice-wd on-Propnne-Duat Cleaning�Geothetmal•Solar
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Kenneth M Kuriz Same
16 W Marble St
Mechanicsburg, PA 17055-6424
n� �— �� � ���mien� _ v ,��.��roir � = C�� � Ct�eu�"� � -
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_ _. —_�_.— ----.____ _ . .- PRE--�/-IOI�S-BAL-ANCE — .. .__ . _ _ .. ._ . 581.10-
06/25/14 SB10781 2_12 0614EFT272 Budget Payment Line 466.00
� -- _v� �t����$` _ �=; =Acco�t-B�anc�� 115.10
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Homeowner lnsurance Bil1 :
AI��1*1•1 AutoBHomsinsunnee�
"�'s•\Rr i WoBrem�.
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Hartford _Insurance Ca of the Midwest
_ _ _ _
Statement Date Q3J31/14
Bill Account Number 80305850 _
KIJRTZ KENNETH M Policy Term 05/10/14-05/10/15
16 VU`MAFiBLE ST Policy Number 55-RB 657238
'MEGHANICSBURG PA 17055
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IMPORTANT INFORMATION
05/10/14 $81.21 $911.00
Thank you for your'business. Please refer to #he
back of the bill for additional information. ACCOVNT $(JMMA'RY since oa/Oa/13
If we receive the minimum amount due hy the due Previous Balance: 5883.00
. date, you will avoid a $12.�0 (ate payment fee. Premium Activity:' 5911.00
Payments & Adjustments:' -5878.00 '
'. Fee(S): (Does not apply if�PAID IN FULL) $0:��
'Current Account Balance: ` 5916.00 +�
' ` See back for more defails.:. "
:_ How to pay your bill:`:
Online: www.thehartford:com/myaccount
' Phone-(24/7�:1-800-423-6789
MaiL• Mail your check with attached Payment S#ub
INSTALLMENT :OPTIONS �Please choose any of the below payment�ptions this month.)
Amount Due Remaining Next Invoice Next Invoice Next:lnvoice
by 05/10/14 Payment lssued . Due Amount'
$911.00 0 --/--/-- --/--/--
' 6 .6 *> , 1 " 11/04J14 11/24J14 :$460 34 *
$�08.88* 2 09/04J1� : 09/24/14 _ - 8.�6 *
$157.10* 5 , 07/04�14_ 07/24/14 - $156.78;*
' $81.21 * 11 06J04/14 06/24/14 _ $80.89'*
� lncludes a $5.00 service fee.
- --------------•--•---------..._._._._-------------------------------•---....__.___..--------------------------------- - ---------------------------- -
^ Please write your policy number on your check. If you are paying multiple policies, please send in corresponding payment stubs.
Ku rtz Ken neth M ���,(�� Thank you for your business!
Polic Number 55RB657238 ��� Homeowner Insurance Bill
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� DUE DATE MINIMUM DUE
The Hartford o5/10/14 $81.21
P O Box 660917 , +�, ��
Dallas TX 75266-0917 L� 0( ' AMOUNT ENCLOSED:
�u���l��li�l�i�il��illn�li������l�l�nlul�lill�ll�lll���l��ll� �
. Make check payable to:The Hartford
55803058505070000DOOOOODOD��08121001571000460660009110061006
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Tom Ziegler
19 W. Coover St.
Mechanicsburg, PA 17055
717-766-4442
INVO/CE -
Customer
Name Ken Kurtz Date 6/30/2014
Address 16 W. Marble St. Order No.
City Mechanicsburg Pa ZIP 17055 Rep
Phone 766-5364 FOB
Hours Labor Unit Price TOTAL
1 Balance $3,475.06 $3,475.06
No charge
Units Materials
SubTotal $3,475.06
TOTAL $3,475.06
-, H.%$., �.��, ,�.-�-�.���.�,£.�,,��_� .�,�-�_.,� � � �. .� �- .�..�:��, � � .�
Tom Ziegler
19 W. Coover St.
Mechanicsburg, PA 17055
717-766-4442
INVOICE -
Customer
Name Ken Kurtz Date 5/30/2014
Address 16 W. Marble St. Order No.
City Mechanicsburg Pa ZIP 17055 Rep Tom
Phone 766-5364 FOB
Hours Labor Unit Price TOTAL
No charge
�� 3a, �a
Units Materials
1 Plumbing, Electrical, Lumber, Paint $542.64 $542.64
SubTotal $542.64
TOTAL
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Tom Ziegler
19 W. Coover St.
Mechanicsburg, PA 17055
717-766-4442
INVOICE -
Customer
Name Ken Kurtz Date 4/30/2014
Address 16 W. Marble St. Order No.
City Mechanicsburg Pa ZIP 17055 Rep Tom
Phone 766-5364 FOB
Hours Labor Unit Price TOTAL
No charge p�
/l��0. �/
Units Materials
1 Plumbing, Electrical, Lumber, Paint $2,284.01 $2,284.01
SubTotal $2,284.01
TOTAL ,
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Tom Ziegler
19 W. Coover St.
Mechanicsburg, PA 17055
717-766-4442
INVOICE -
Customer
Name Ken Kurtz Date 3/30/2014
Address 16 W. Marble St. Order No.
City Mechanicsburg Pa ZIP 17055 Rep Tom
Phone 766-5364 FOB
Hours Labor Unit Price TOTAL
No charge
Units Materials
1 Plumbing, Electrical, Lumber $1,248.41 $1,248.41
SubTotal $1,248.41
TOTAL $1,248.41
� �04 �
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COMMONWEALTH OF PENNSYLVANIA
BUREAU OF PROGRAM INTEGRITY
DNISION OF THIRD PARTY LIABILITY
RECOVERY SECTION
PO BOX 848G
HARRISBURG,PA 171058486
September 16,2014
STATEMENT OF CLAIM SUMMARY
� NAME } Estate of KURTZ,KENNETH
�`�ID„; 990 980 017
, ,� . . `����
MED1CAl,� st � � 'CLASS:3 , t- CLASS 5'f "` TOTAL ��„.;
INPATIENT .00 .00 .00
OUTPATIENT .00 .00 .00
LONG TERM CARE 29,378.26 7,205.9D 36,584.16
DRUG .OU .00 .00
..,c�,
REIMBURSEMENT.TO DPW,: ;° 29,378.26 7,205.90 36,584.16
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��f�y�� COt�(i110NWEALTIi:OFt�PENNSYLVANIA �� °
" DEPARTMENT OF P116L1G W�C,FARE '
�s�... � _ �
EIN 23-60031'13 t ;���,; -
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