HomeMy WebLinkAbout11-19-14 � 1505610140
REV-1500 EX (02-11)(FI)
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
Po BOx 2soso� INHERITANCE TAX RETURN 2 1 1 4 0 8 2 5
Harrisbury, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
0 8 2 1 2 0 1 4 0 8 3 0 1 9 1 9
DecedenYs Last Name Suffix DecedenYs First Name MI
STANKOVI CH MI CHAEL S
(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
a 1.Original Return � 2. Supplemental Return � 3. Remainder Return(Date of Death
Prior to 12-13-82)
� 4. Limited Estate � 4a. Future Interest Compromise(date of � 5. Federal Estate Tax Return Required
death after 12-12-82)
QX 6. Decedent Died Testate � 7. Decedent Maintained a Living Trust 8.Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
� 9. Litigation Proceeds Received � 10.Spousal Poverty Credit(Date of Death � 11. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime�lephone Nuri�kier �
R . M A R K T H O M A S , E S Q U I R E 7 1 � d 9 � 2 � � 0
p;,,, =F' .=� :� o
R�G�STER 6F WILL$'USE�I�IL�.,�
f j�
, � C� � t�J �
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First Line of Address I , c":>
� ; . , � �, �L7 � ':'3 i
1 01 S . MARKET STREET , � - -� - `�'
�
; . _..:: �
Second Line of Address � � J� W r� t`��
C..� G� Q
' �a "T1
City or Post Office State ZIP Code DATE FILED
M E C H A N I C S B U R G P A 1 7 0 5 5
CorrespondenYs e-mail address: RMARKTHOMAS@GMAIL.COM
Under penalties of perjury,I declare that I have examined this retum,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.
SIG�NA/TURE OF PERS�ON RESP NSIB/LEl FOR FILI TURN DATE
/� ` QJI►A��l/!�L'/1 i C� � C!/Y�i�C!}ZI�C'� ��� � Z-- �T
ADDRESS
242 FOUR SEAS NS LANE ENOLA PA 17025
SIG PA R THAN REPRESENTATIVE DATE
�— /� / ��
ADDR SS
101 S. MARKET STREET MECHANICSBURG PA 17055
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610140 1505610140 � :r
�J
� 1505610240
REV-1500 EX(FI) DecedenYs Social Security Number
DecedenYsName: MICHAEL S. STANKOVICH
RECAPITULATION
1. Real Estate(Schedule A) �• '
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. •
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . . . . . 3. •
4. Mortgages and Notes Receivable(Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . 4. •
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . . . 5. 2 3 9 2 6 . 1 6
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. •
7. Inter-Vivos Transfers&Miscellaneous N�-Probate Property
(Schedule G) Separate Billing Requested . . . . . . . 7. .
8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 2 3 9 2 6 , 1 6
9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9• 3 � 2• 3 . 5 7
10. Debts of Decedent,Mortgage Liabilities, and Liens(Schedule I) . . . . . . . . . . . . . 10. � 1 5 7. 1 . 2 4
11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. � 4 5 9 4 . $ �
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12• 9 3 3 � . 3 5
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. 9 3 3 � . 3 5
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 _ � . � O 15. O . � �
16. Amount of Line 14 taxable
at lineal rate X .0_ � . � O �g. O . � �
17. Amount of Line 14 taxable
at sibling rate X.12 � . � � 17. � . � �
18. Amount of Line 14 taxable
at co��atera�rate X.15 9 3 3 1 . 3 5 �8. 1 3 9 9 . 7 0
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. � 3 9 9 . 7 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
Side 2
� 1505610240 1505610240 J
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address: 2� 14 os25
DECEDENT'S NAME
MICHAEL S. STANKOVICH
STREET ADDRESS
CITY i STATE j ZIP
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 1,399.70
2. CreditslPayments
A,Prior Payments
B.Discount 69.99
Total Credits(A+B) �2� 69.99
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) 0.00
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 1,329.71
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 ...................................................................... ❑ �X
b, retain the right to designate who shall use the property transferred or its income ............................... ❑ X�
c. retain a reversionary interest ..................................................................................................... ❑ X❑
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ 0
2. If death occurred after December 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,annuity or other non-probate property,which
contains a beneficiary designation?.................................................................................................. ❑ X❑
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
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an
adoptive parent or a stepparent of the child is 0 percent[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 p2 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)J.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-1508 EX+(OS-12)
pennsylvania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS 8� MISC.
INHERITANCE TAX RETURN
RESIDENTDECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
MICHAEL S. STANKOVICH 21 14 0825
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. M&T BANK ACCOUNT NUMBER 9839006500 23,291.60
INCLUDING ACCRUED INTEREST .16
2 WINTERDALE -225 FOUR SEASONS LANE, ENOLA, PA 610.00
SECURITY DEPOSIT REFUND
3 VERIZON REFUND 0.49
4 COMCAST REFUND 24.07
TOTAL(Also enter on Line 5,Recapitulation) $ 23 926.16
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+(OS-13)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MICHAEL S. STANKOVICH 21 14 0825
DecedenYs debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
2 AttomeyFees: R. MARKTHOMAS, ESQUIRE 1,000.00
3, Family Exemption:(If decedenYs address is not the same as claimanYs,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 155.50
5 Accountant Fees:
6. Tax Retum Preparer Fees:
7. PPL-28980-83060 SEPTEMBER 80.12
8 VETERANS AFFAIRS- REIMBURSEMENT DUE FOR AUGUST, 2014 BENEFITS 1,758.00
9 ESTATE CHECKS- M&T BANK 29.95
TOTAL(Also enter on Line 9,Recapitulation) $ 3 023.57
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT�
INHERITANCETAXRETURN MORTGAGE LIABILITIES& LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MICHAEL S. STANKOVICH 21 14 0825
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. VERIZON PAYMENT CK 1690-8/18/2014 17.90
2. PHYSICIANS OF REHAB CK 1691 - PAID 8/18/14 76.19
3. HOME INSTEAD , 502 LENKER STREET, S#101, MECHANICSBURG 6,976.40
CK#1693 8/20/14
4. QUANTUM IMAGING -CK#1694 8/20/14 4.16
5. HOLY SPIRIT HOSPITAL 1,243.01
ACCT#48344691
6. HOME INSTEAD , 502 LENKER STREET, S#101, MECHANICSBURG 2,718.34
CK 1015 10/15/14
7 SPIRIT PHYSICIANS ACCT#78780 146.19
CK#1006-70.95, CK#1010-75.24
8. NITTANY VALLEY MEDICAL ACCT# 12748 7.74
9. PINNACLEHEALTH CARDIOVASCULAR INST. 24.71
ACCT#261522
10. WEST SHORE PATHOLOGY 9.94
ACCT#5424 48344691.1
11. CAMP HILL EMERGENCY PHYSICIANS 34.43
ACCT# HYP48344691
12. SMITH RADIOLOGY, INC. 11.58
ACCT# 180324-00
13. PHYSICIANS OF REHAB, IND & SPINE MEDICINE, PC 104.49
ACCT#5507
14. AZIZKHAN INTERNAL MEDICINE 196.16
ACCT#26347
TOTAL(Also enter on Line 10,Recapitulation) $ 11 571.24
If more space is needed, insert additional sheets of the same size.
y REV-1513EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
MICHAEL S. STANKOVICH 21 14 0825
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. MARGARET C. STANKOVIC Collateral 100.00
242 FOUR SEASONS LANE
ENOLA, PA 17025
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
.
REV-1500 Discount, Interest and Penalty Worksheet
Discount Calculation
Total Amount Paid within three calendar months of the decedent's date of death: _ 1,330.00
Discount: 69.99
Interest Table
Year Days Delinquent , Balance Due Interest
� this time period this year this period
Before 1981 '
1982 -�
1983
1984 ; ;
1985 '
1986
1987
1988 throu h 1991
1992
1993 throu h 1994
1995 throu h 1998
� 1999 _ i I
--�
2000 _ _�
2001 '
2002 � ' �
F � ;
2003
2004
2005 �
2006 �
2007
', 2008
2009 �_ _
2010 �
2011 throu h 2014 ' �_
� �
j TOTALS '
Penalty Calculation
If the decedent's date of death was on or before March 31, 1993, insert the applicable amount:
Total Balance Due on January 17, 1996:
Penalty:
I,AST WILL AND TESTAMENT
BE IT REMEMBERED THAT
I, MICHAEL S. STANKOVICH, a resident of Dauphin County, Pennsylvania, being of
��,
sound and disposing mind, memory and understanding do make,publish and declare this to be my
LAST WILL and TESTAMENT, hereby revoking any and all Wills and Codicils previously made
by me.
I
I declare that I am not married, and that Ihave no children.
II
I direct that all my just debts and funeral expenses shall be paid from my residuary estate as
soon as practicable a$er my decease.
III
I direct that all taxes that may be assessed in consequence of my death, of whatever nature
and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the
expense ofthe administration ofmy estate.
IV
I give, devise and bequeath all my property, whether real or personal, wherever situate,
including any property over which I may have a power of appointment to my sister-in-law,
MARGARET C. STANKOVIC, per stirpes, provided that she survives me by thirty(30)days.
V
If my sister-in-law, MARGARET C. STANKOVIC, shall predecease me or fail to survive
me by thirty (30) days, I give, devise and bequeath all of my property, whether real or personal,
wherever situate, including any property over which I may have a power of appointment, to the
children of MARGARET C. STANKOVIC, per capita.
VI
I nominate, constitute and appoint my sister-in-law, MARGARET C. STANKOVIC, as
Executrix of this LAST WILL, to seive without bond.
IN WITNESS WHEREOF, I, MICHAEL S. STANKOVICH, have set my hand to this
LAST WILL this 4th dayof November, 2010.
�,��✓ ������,
1VIICHAEL S. STANKOVICH
Signed, sealed,published and declared by the above-named MICHAEL S. STANKOVICH,
as and for his Last Will and Testament, in the presence of us, who, at his request and in his
presence, and in the p�esence of each other, have hereunto subscubed our names as witnesses.
/`� ;' /
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ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA :
: ss
COUNTY OF CUMBERLAND :
I, MICHAEL S. STANKOVICH, Testator, whose name is signed to the attached ar
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 as my free and voluntary act
for the purposes therein expressed.
f�c..�(.*�'V'`...�t u���-�-'/;
MICHAEL S. STANKOVICH
Sworn or affirmed to and acknowledged before me by MICHAEL S. STANKOVICH,
Testator, this 4th dayof November, 2010.
f '�'t.�f .� �� //�(����f E�"��`��
NOTARIAL SEAL aIy PUblIC �
JOETTE L MCGOWEN
Notary Public C
MECHANICSBURG BORO,CUMBERLAND CNTY
My Commission Expires Jul 7,2014 AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA :
: ss
COUNTY OF CUMBERLAND •
.
We, R. Mark Thomas and �����E�f ��C c ��.�c. ,the witnesses
whose names are signed to the attached or foregoing instnunent being duly qualified according to
law, do depose and say that we were present and saw Testator sign and execute the instrument as
his LAST WILL; that MICHAEL S. STANKOVICH signed willingly and that he executed it as his
free and voluntary act for the purposes therein expressed;that each of us in the hearing and sight of
the Testator signed the Will as witnesses;and that to the best of our knowledge, the Testator was at
the time 18 years of age or more, of sound mind and under no constraint c�r undue in$uence.
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Sworn or affirmed to and acknowledged before me by R. Mark Thomas and
�_ ,
t�3 �z� c'�s�/�- �k_ l��'��% 't��` ���J this 4tb day�f November, 2010.
n
'if -- �� ��,J" ��jGl/l/��``
. (
� tary Public
NOTARIAt SEAI �'
JOETTE L MCGOWEN
Notary Public
MECHANICSBURG BORO,CUMBERLAND CNTY
My Commission Expires Jul 7,2014
Q MBT���nk
499 Mitchell Road.Millsboro,DE 19966 Records Management
Phone 888-502-4349
F ax (302)934-2955
September 30,2014
R. Mark Thomas
Attorney at Law
101 South Market Street
Mechanicsburg,PA 17055
Re: Estate of Michael S. Stankovich
Social Security: 187-07-8135
Date of DeathAu�sut 21, 2014
Dear Sir or Madam:
Per your inquiry on September 18, 2014, please be advised that at the time of death,the above-named decedent
had on deposit with this bank the following:
1. Type ofAccount CheckingAccount
Account Number 9839006500
Ownership(Names o� Margaret C. Stankovic(POA)
Michael S.Stankovich
Opening Date 10/04/2005
Balance on Date ofDeath $ 23,291.44
Accrued Interest $ .16
Total $ 23,291.60 _ _ _ _
For any additional information on the above accounts,including ownership and any changes,closures and/or reimbursement of funds,
please call the Paxton Street at 717-255-2240.
We were unable to locate any safe deposit box for the above-mentioned decedent.
This letter dces not include any accounts in which the deceased may have been Gsted as Power of Attorney,Custodian of Uniform Transfers,
Representative Payee,or Trustee under a Written Agreement
Sincerety,
Valarie Mercer
Records Management
i�V - VERIZON CR
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Description ��wELL, Mq 01851-8100
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CREDIT BqLANCE REFUND
DqTE ACCOUNT
09����14 7177326938033R TOTqL REFUND
� $0.49
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Winterdale Statement
225 Four Seasons Lane
Enola, Pa 17025 Billing Period Staternent[3ate
2/22/11 -9/3/14 9/3/14
�� Property , Unit , Type < , Acc#
! Win 184 Four 1 BR D 1109
�
Previous Current Current Ba,lance
Balance Charges Credtts d�te��.�
0.00 25,470.00 -25,470.00 0.00
DATE TRANSACTION DESCRIPTION A
.,... �..
09/03/14 Security Deposit Refund Security Deposit Refund 610.00 ��
09/03/14 Security Deposits Security deposits from holdings �M=�.00
Sub Total 0.00
Unapplied Credi#s ' 0.00
BALANCE f�U'E ` 0.00
j^
COMMENTS
�� � .. _� � ti '��. i_ 1•� ��1 �� 9 � '`•-��1
, Page 4 �� _ '��1,�!;�.�%"i;'
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��+�'� pennsylv�nia
'' .
DEPARTMENT OF PUBLIC WELFARE
September 23, 2014
R MARK THOMAS ESQUIRE
101 S MARKET ST
MECHANICSBURG PA 17055-3851
Re: Michael Stankovich
SSN: ###-##-8135
Dear Attorney Thomas:
Pursuant to your letter dated September 18, 2014, the Department's, Estate
Recovery Program, has reviewed the information you provided regarding the
above-referenced individual.
It has been determined that this individual did not receive any type of assistance
during the questioned period.
Therefore, according to the information you provided, the Department's Estate
Recovery Program will not seek any recovery from this estate. If your client applied for
Medical Assistance and had an application and/or hearing pending at the time of death,
please advise us and provide any additional information that may affect a recovery by our
Department.
Thank you for your cooperation in this matter. If you have any questions, please
contact me.
Sincerely
'�� ��
�5..�� � �d'�
Vince A. Porter
Recovery Section Manager
(717)772-6604
Bureau of Program Integrity � Division of Third Party Liability � Recovery Section
PO Box 8486 � Harrisburg, Pennsylvania 17105-8486
RECEIPT FOR PAYMENT
LISA M. GRAYSON, ESQ . Receipt Date : 9/03/2014
Cumberland County - Register Of Wills Receipt Time : 14 : 31 : 13
One Courthouse S quare Receipt No . : 1079062
Carlisle, PA 17613
STANKOVICH MICHAEL S
Estate File No. : 2014-00825
Paid By Remarks : R MARK THOMAS
HMW
-- -- -- - --- -- -- -- - --- ---- Receipt Distribution -- - --- -- -- ------------ --
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST 60 . 00 CUMBERLAND COUNTY GENERAL FUN
WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 10 . 00 CUMBERLAND COUNTY GENERAL FUN
JCS FEE 35 . 50 BUREAU OF RECEIPTS & CNTR M.D
AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN
INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN
INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN
------- ---------
Check# 334.7 $155 . 50
Total Received. . . . . . . . . $155 . 50
ii i i i iii i i i ii i iiiii iiiii i ii iiiii i io ii iiiii i iiiiiiii ii si iiii iiiii sii iiiii iiiii iiii i i�iiii iiiii iiii iiiii iiiii iiii iii ei
�¢a DEPARTMENT OF VETERANS AFFAIRS
��� Debt Management Center
- Bishop Henry Whipple Federal Buildang
P.O. Box 11930
St. Paul, MN 55 1 1 1-0930
AUGUST 27, 2014
REPRESENTATIVE OF THE ESTATE OF: File Number: 12097639
MICHAEL S STANKOVICH Payee Number: 00
184 FOUR SEASONS LN Person Entitled: M STAN
ENOLA PA 17025-2131 Deduction Code: 30
E-Mail Address: dmc.ops@va.gov
(Please provide the information above
on any email correspondence.)
We are sorry to learn of the death of the beneficiary and wish to express our sympathy.
WHAT YOU SHOULD KNOW
Please be advised that beneficiaries are not entitled to benefits for the month in which death occurred.
The entitlement to benefits ends on the last day of the month preceding the beneficiary's death. Any
checks received after the date of death or any monies electronically deposited in a bank account after
the date of death should be returned. Instructions for returning the funds can be found on the back
of this letter. Our records show the deceased was not entitled to benefits in the amount of
$ 1 ,�5s.00. If you are the spouse of the deceased, you may be entitled to the benefit for the mont�
of death. To obtain information regarding the surviving spouse benefit, please call 1-800-827-1000.
Hearing impaired should call 1-800-829-4833.
Pursuant to 31 U.S.C.Sec.3713, "a claim of the United States Government shall be paid first when . . .
the estate of the deceased debtor, in the custody of the executor or administrator is not enough to pay
all debts of the debtor". Furthermare, this statute provides "(a) representative of a person or an estate
paying any part of a debt of the person or estate before paying a claim of the Government is liable to
the extent of the payment for unpaid claims of the Government." 31 U.S.C.Sec.3713(b) If it appears
the estate will not be large enough to pay all debts of the deceased, the United States must be paid first
from the proceeds of the estate.
LEGISLATIVE CHANGE
On June 30, 2008 and October 10, 2008, the President signed laws providing equitable debt relief for
members of the Armed Forces who die on active duty and for Veterans who die as a result of injuries
incurred or aggravated in the line of duty while serving in a theater of Gombat oneratzons on c►r after
September 11, 2011. Please contact us for more information.
WHERE DO YOU CALL IF YOU HAVE QUESTIONS REGARDING THIS LETTER
You should contact the VA Debt Management Center at 1-800-827-0648.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - �
FOR PROPER CRED/T TO YOUR ACCOUNT, PLEASE DETACH AND RETURN W/TH YOUR PAYMENT
� _ , . � _ , 2 014 2 3 9 PAYMENT REMITTANCE
ri1209763900301327192001,1427 r112097639 0030 13271920011427 0175800 5
it FILE N0. , AMOUNT ENCLOSED ENTER YOUR CURRENT ADDRESS BELOW ONLY IF THE ONE ABOVE IS INCORRECT.
12 0 9 7 6 3 9 t � � PLEASE INCLUDE YOUR ZIP CODE,
PAYEE NO. � �Q S i 1 �� x;X
PERSON ENTITLED , YOUR TELEPHONE No.
M S T A N (Include Area Code)
DEDUCTION CODE � 3O
* Please include this number on our check or mone order.
FL 4-571, APR 2014 �
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STATEM E NT
09/02/2014 PAGE: 1
If paying by credit card, please complete Ihe information below and mail
NITTANY VALLEY MEDICAL [o the billin department...... ___,
301 SCIENCE PARK ROAD SUITE 119 CHECK ONE: AMOUNT APPLIED
❑ i]MC TO CRE01T CARO CREDIT CARD NUMBER SECURITY CODE
State College, PA 16803 v�sa
(814) 272-5805 �� I
PRINT CARUHOLDER NAME CARD EXPIRATION DATE
I I
I CARDHOLUER DATE
I S16NATURE (X) S16NED / /
TO: STAIJKOVICH, MICHAEL S ACCOUNT NO: 12748
184 FOUR SEASONS LANE CATEGORY: MB
INSURANCE: MCAR
ENOLA, PA 17025-2131 `� � �f
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N�tNSE HE7UHN THIS PUHTIOitl WITN YOUR PAYMENT
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_ _ _ _. __ _ ____ _ _.__ ___ _ _ _
_ _ __ __ _ __ _ __ _ _
DATE DOCTOR ; D E S C;R 1 P T I q N CHARGE PAYMENT'- ADJUSTNIENT BALANCE
PREVIOUS BALANCE O . O
07/18/14 McCAUL LVL 1 SUBSEW HOSP C 65 . 00
08/08/14 MCAR PMT -30 . 32
08/08/14 MCAR ADJ -26 . 94
08/08/14 ICN: 1814205117300
07/18/14 Balance 7 . 7
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APPa�ntment Service Description �� �������
* � 07/30/14 - MICHAEL - Charge Payment A ' .
ROLLE JR, WILLIAM A, M:D. d�ust Patien
� HOSPITAL DISCHARGE DAY
� 68/20/14 MEDICARE PA Payment781�2 163.00
� 68/20/14 Accept Assign Adj. 55.61 14.1<
� 7he 'PLEASE PAY08ineludes�unpaidscogpaydor co-ins. Ple -92 0�
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08 21 14 76,19 Patient
� 104.49 0.00 0.00
EASE 0.00 0.AA
4KE CIiECK PHYS OF REHAB, IND & SPINE MEDICINE, p� 104.49
rn�a�F ra; 4310 LONDONDERRY RD, STE 106
HARRISBURG, Pq 17109 � �
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Payment Due Date 09/19/14 i� �
Ph:(717)-591-4405 ,� 104.49
Statement Date: 09/04/14 Acct#:5507
Page 4 of 4
MEDN 14090515930.023073.04.04.100000
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09/04/14 � 5507 ; � Continued
� �
PHYS OF REHAB, IND & SPINE MEDICINE, PC � ° � � ° ° �
4310 LONDONDERRY RD, STE 106 � � , ..,., � �`��� ��=�� � ��:;�, j �;
HARRISBURG, PA 17109 ; ��T �
�CARD NUMBER AUTHORIZATION CODE u❑f�,I�
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jSIGNATURE �XP.DATE
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�:� MICHAEL STANKKOVICH
� 184 FOUR SEASONS LANE PHYS OF REHAB, IND & SPINE MEDICINE, PC
ENOLA PA 17025 4310 LONDONDERRY RD, STE 106
HARRISBURG, PA 17109
-;Plezse ci�eck box if above address is incorrect or insurarce �; � f-I p!ease check box F credit card biliing address is di.fferent than state-
-irfosmation has changed,ar.d indica?e change(s;on reverse side. �-:ent address ane write in adcress on back.
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Appointment Service Description Charge Payment Adjust Patient
07/25/14 - MICHAEL - LUPINACCI, MICHAEL F, M.D.
HOSPITAL SUBSEQUENT CARE 99231 781.2 102.00 7.74
08/19/14 MEDICARE PA Payment 30.32
08/19/14 Accept Assign Adj . -63.32
08/19/14 Accept.Assign Ad� . -0.62
The 'PLEASE PAY' includes unpaid co-pay or co-ins. Please make payment.
07/26/14 - MICHAEL - ROLLE 7R, WILLIAM A, M.D.
HOSPITAL SUBSEQUENT CARE 99231 781.2 102.00 7.74
08/19/14 MEDICARE PA Payment 30.32
08/19/14 Accept Assign Adj . -63.32
08/19/14 Accept Assign Ad� . -0.62
The 'PLEASE PAY' includes unpaid co-pay or co-ins. Please make payment.
07/27/14 - MICHAEL - LUPINACCI, MICHAEL F, M.D.
HOSPITAL SUBSEQUENT CARE 99231 781.2 102.00 7.74
08/19/14 MEDICARE PA Payment 30.32
08/19/14 Accept Assign Ad�. -63.32
08/19/14 Accept,Assign Ad� . -0.62
The 'PLEASE PAY' includes unpaid co-pay or co-ins. Please make payment.
07/28/14 - MICHAEL - LUPINACCI, MICHAEL F, M.D.
HOSPITAL SUBSEQUENT CARE 99231 781.2 102.00 7.74
98/191�4 MCQICARE PA Payment 39.32
08/19/14 Accept Assign Ad� . -63.32
08/19/14 Accept Assign Ad� . -0.62
The 'PLEASE PAY' includes unpaid co-pay or co-ins. Please make payment.
07/29/14 - MICHAEL - LUPINACCI, MICHAEL F, M.D.
HOSPITAL SUBSEQUENT CARE 99232 781.2 122.00 14.19
08/19/14 MEDICARE PA Payment 55.63
08/19/14 Accept Assign Adj . -51.04
08/19/14 Accept Assign Ad� . -1.14
The 'PLEASE PAY' includes unpaid co-pay or co-ins. Please make payment.
LAST PAYMEt+3T RECElVED
08/21/14 76.19
LEASE PHYS OF REHAB, IND & SPINE MEDICINE, PC
tAKE GHECK 4310 LONDONDERRY RD, STE 106 �,��,� '� � ��
aYns�e ro: HARRISBURG, PA 17109
Continued
Ph: (717)-591-4405 Statement Date: 09/04/14 Acct#:5507 Page 3 of 4
M E D N 14090515930.02307 3.03.04.100000
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p . � � • k
� � 09/04/14 � 5507 � � Continued
� � - e e s e
PHYS OF REHAB, IND & SPINE MEDICINE, PC
4310 LONDONDERRY RD, STE 106 ; '� °�� ,
0 ..,_a ❑ v,�: ❑ .� ❑ �; �
HARRISBURG, PA 17109 ��ARONUMeEP �nuTNORizaTioNcooE �
I llast 3 or 4 diglYs on back ���`�
� i oi card in signature hne)
�SIGNATURE EXP.DATE
�\ � /
.�,4 MICHAEL STANKKOVICH
� 184 FOUR SEASONS LANE PHYS OF REHAB, IND & SPINE MEDICINE, PC
ENOLA PA 17025 4310 LONDONDERRY RD, STE 106
HARRISBURG, PA 17109
�,Please check box if above address is incorrect or insurance ��� . —1 P(ease ched<bex ii cred:t caro oiliing address is differenT ii�an sYz;e-
—�ir.fcrmation has changed,and indicate change(s)on reve!se side. ��' ment address and�rvr�te ir address on back.
--- ----- � — — — ----- _--- ---- i ---— - ---- --- ------ —---- ------ --- _—
—�-- ��"°'Er�[�Tk�F���"'t�TF�s€� � �;E�'o-"�[. s 4 4�4�!EF�' ��t�.�'c�`E'`��Y
Appointment Service Description Charge Payment Adjust Patient
07/20/14 - MICHAEL - LUPINACCI, MICHAEL F, M.D.
HOSPITAL SUBSEQUENT CARE 99231 599.0 102.00 �•74
08/08/14 MEDICARE PA Payment 30.32
08/08/14 Accept Assign Ad�. -63.32
08/08/14 Accept.Assign Ad�. -0.62
The 'PLEASE PAY' includes unpaid co-pay or co-ins. Please make payment.
07/21/14 - MICHAEL - LUPINACCI, MICHAEL F, M.D.
HOSPITAL SUBSEQUENT CARE 99231 781.2 102.00 �•74
08/12/14 MEDICARE PA Payment 30.32
08/12/14 Accept Assign Ad�. -63.32
08/12/14 Accept.Assign Ad� . -0.62
The 'PLEASE PAY' includes unpaid co-pay or co-ins. Please make payment.
07/22/14 - MICHAEL - LUPINACCI, MICHAEL F, M.D.
HOSPITAL SUBSEQUENT CARE 99232 781.2 122.00 14.19
08/12/14 MEDICARE PA Payment 55.63
08/12/14 Accept Assign Ad�. -51.04
08/12/14 Accept.Assign Ad�. -1.14
The 'PLEASE PAY' includes unpaid co-pay or co-ins. Please make payment.
07/23/14 - MICHAEL - ROLLE JR, WILIIAM A, M.D.
HOSPITAL SUBSEQUENT CARE 99231 781.2 102.00 7•74
�8;13/14 MEDICA°E RA �a��ment �Q•3�
08/13/14 Accept Assign Ad� . -63.32
08/13/14 Accept Assign Ad� . -0.62
The 'PLEASE PAY' includes unpaid co-pay or co-ins. Please make payment.
07/24/14 - MICHAEL - LUPINACCI, MICHAEL F, M.D.
HOSPITAL SUBSEQUENT CARE 99231 781.2 102.00 7•74
08/13/14 MEDICARE PA Payment 30.32
08/13/14 Accept Assign Adj . -63.32
08/13/14 Accept.Assign Ad� . -0.62
The 'PLEASE PAY' includes unpaid co-pay or co-ins. Please make payment.
LAST PAYMEIVT RECEIV�D
08/21/14 76 19
��eas� PHYS OF REHAB, IND & SPINE MEDICINE, PC . -
utAKE CHECK 4310 LONDONDERRY RD, STE 106 ���� �'�" °'''' ' �
�nYaste To: HARRISBURG, PA 17109
Continued
Ph: (717)-591-4405 Statement Date: 09/04/14 Acct#:5507 Page 2 of 4
MEDN 14090515930.023073.02.04.100000
. . _...—._- ----- —
b • i 8 • i
` ' I
' 09/04/14 ' S507 � � Continued
I i
PHYS OF REHAB, IND & SPINE MEDICINE, PC � ` � � ' � � �
4310 LONDONDERRY RD, STE 106 i ,. , v� �� ' �
HARRISBURG, PA 17109 � � ❑ � ❑ � ❑ �"
I CARD NUNBER AU i HORIZATION CODE �(��I�,
f I(last 3 or S digits on bark L�
i !i of card ir.signature tine)
1 SIGi�ATURE � �EXP.DATE
I
� � i
23073
�4 PHYS OF REHAB, IND & SPINE MEDICINE, PC
MICHAEL STANKKOVICH 4310 LONDONDERRY RD, STE 106
184 FOUR SEASONS LANE HARRISBURG, PA 17109
ENOLA PA 17025
�Please check box i'above address is incorred or insurance A ,��, Please chec!<box ii cred t card'oil,ing address�s diffefent Ynan sTaYe-
�mrormation has changed,ar,d indicate change(s)on reverse side. � �t — ment aocress ard wrte in address on back.
--- --- -- - - --- - --__ --- _._.... _- --- - --- - -- - _- ___ _. - - -__-- _ _ _- --_ -- ---- . _ .
r��TE�P,.t�"d"C?P��Ft€€C3t�4�f��S�1it��.C}V`J��#�C.���€�:3�
PLEASE MAKE YOUR PAYMENT WITHIN 28 DAYS FROM RECEIVING OUR SERVICES. TO
AVOID COLLECTIONS.
Appointment Service Description Charge Payment Adjust Patient
07/15/14 - MICHAEL - LUPINACCI, MICHAEL F, M.D.
HOSPITAL INITIAL CARE 3 99223 781.2 336.00 0.00
08/05/14 MEDICARE PA Payment 157.05
08/05/14 Accept Assign Ad�. -135.67
08/05/14 Accept Assign Ad . -3.21
08/21/14 Check-Per Ck#169� 40.07
07/16/14 - MICHAEL - ROLLE JR, WILLIAM A, M.D.
HOSPITAL SUBSEQUENT CARE 99232 599.0 122.00 0.00
08/06/14 MEDICARE PA Payment 55.63
08/06/14 Accept Assign Adj. -51.04
08/06/14 Accept Assign AdJ. -1.14
08/21/14 Check-Per Ck#1691 14.19
07/17/14 - MICHAEL - LUPINACCI, MICHAEL F, M.D.
HOSPITAL SUBSEQUENT CARE 99232 599.0 122.00 0.00
08/06/14 MEDICARE PA Payment 55.63
08/06/14 Accept Assign Adj. -51.04
0fi/a6/34 Acc2 1 �;ssi -n �,u] . -1.1Q
08/21/14 Chec�-Per C�#1691 14.19
07/19/14 - MICHAEL - ROLLE JR, WILLIAM A, M.D.
HOSPITAL SUBSEQUENT CARE 99231 781.2 102.00 0.00
08/12/14 MEDICARE PA Payment 30.32
08/12/14 Accept Assign Ad�. -63.32
08/12/14 Accept Assign AdJ. -0.62
08/21/14 Check-Per Ck#1693 7.74
LAST PAYMEtVF RECEPYEp
08/21/14 76.19
.eas� PHYS OF REHAB, IND & SPINE MEDICINE, PC
AKE CHECK 4310 IONDONDERRY RD, STE 106 � ��.� Y,��� � . ��g
,YABs.�rcr: HARRISBURG, PA 17109
Continued
�
Ph: (717)-591-4405 Statement Date: 09/04/14 Acct#:5507 Page 1 of 4
M ED N 14090515930.023073.01.04.100000
��������: �:26347 ������ ������ $196.16 �;���.� �����: 10/06/14
H:���,.,r;�n�:s� €-'a�i�r�t
�s`��..A �..}t:���t'?gY�;'= yi€a..s�e;v- _.
.K���� m`.�; r°��$�?3"G�
MICHAEL S STANKOVICH ID# 26347/STEVEN A PROPHET MD
07/15/2014 INITIAL HOSPITAL CARE (CONSULT) 210.00 210.00 0.00
08/11/2014 MEDICARE CONTRACTUAL ADJUSTMENT FROM NOVITAS SOLUTIONS, INC -9.67 0.00
O8/11/2014 SEQUESTRATION REDUCTION ADJUSTMENT FROM NOVITAS SOLUTIONS, INC -3.21 0.00
08/11/2014 MEDICARE PAYMENT FROM NOVITAS SOLUTIONS, INC 157.05 0.00
08/11/2014 PATIENT RESPONSIBILITY -40.07 40.07
BALANCE TICKET #HS014737 .00 40.07
MICHAEL S STANKOVICH ID# 26347/STEVEN A PROPHET MD
07/17/2014 SUBSEQUENT HOSPITAL CARE LEVEL 2 85.00 85.00 0.00
07/19/2014 SUBSEQUENT HOSPITAL CARE LEVEL 2 85.00 85.00 0.00
08/18/2014 MEDICARE CONTRACTUAL AD)USTMENT FROM NOVITAS SOLUTIONS, INC -28.08 0.00
08/18/2014 SEQUESTRATION REDUCTION ADJUSTMENT FROM NOVITAS SOLUTIONS, INC -2.28 0.00
08/18/2014 MEDICARE PAYMENT FROM NOVITAS SOLUTIONS, INC 111.26 0.00
O8/18/2014 PATIENT RESPONSIBILITY -28.38 28.38
BALANCE TICKET #H5014752 .00 28.38
MICHAEL S STANKOVICH ID# 26347/KIMBERLEY W JACOBS PA -C
07/18/2014 SUBSEQUENT HOSPITAL CARE LEVEL Z 85.00 85.00 0.00
07/21/2014 SUBSEQUENT HOSPITAL CARE LEVEL 2 85.00 85.00 0.00
08/18/2014 MEDICARE CONTRACTUAL ADJUSTMENT FROM NOVITAS SOLUTIONS, INC -28.08 0.00
08/18/2014 SEQUESTRATION REDUCTION ADJUSTMENT FROM NOVITAS SOLUTIONS, INC -2.28 0.00
OS/18/2014 MEDICARE PAYMENT FROM NOVITAS SOLUTIONS, INC 111.26 0.00
08/18/2014 PATIENT RESPONSIBILITY -28.38 28.38
BALANCE TICKET #HS014757 .00 28.38
MICHAEL S STANKOVICH ID# 26347/REZA G AZIZKHAN 7R DO
07/22/2014 SUBSEQUENT HOSPITAL CARE LEVEI 2 85.00 85.00 0.00
��s��,��s�t h"�es����/�a��a€��'�c��r�a�c�a�s�t
Fs��F;�� �ad���,=`:' 196.16 �
;rt�¢.�����;;� ��=��i's=}� .00
'�.���"�-��a �-���� 196.16
� � For Billing Questions Call
Make Checks �� (717) 7 2 4-212 6 ��
Payable To: Azizkhan Internal Medicine Assoc. � ' �i�:
:v
PAGE 1 OF 2
PDA042 000ssaa
• ' A�izkhar� Ir�ternal Niedi�ine Asso�e
Statemen� Date: 09f�5/14
= Account #: 26347
� �
- Insurance Patient
= Date Description Charges galance Balance
� 08/18/2014 MEDICARE CONTRACTUAL ADJUSTMENT FROM NOVITAS SOLUTIONS, INC -28.08 0.00
08/18/2014 SEQUESTRATION REDUCTION ADJUSTMENT FROM NOVITAS SOLUTIONS, INC -2.28 0.00
08/18/2014 MEDICARE PAYMENT FROM NOVITAS SOLUTIONS, INC 111.26 0.00
08/18/2014 PATIENT RESPONSIBILITY -28.38 28.38
BALANCE TICKET #H5014778 .00 2H.38
MICHAEL S STANKOVICH ID# 26347/KIMBERLEY W JACOBS PA -C
07/25/2014 SUBSEQUENT HOSPITAL CARE LEVEL 2 85.00 85.00 0.00
07/28/2014 SUBSEQUENT HOSPITAL CARE LEVEL 2 85.00 85.00 0.00
08/20/2014 MEDICARE CONTRACTUAL ADJUSTMENT FROM NOVITAS SOLUTIONS, INC -28.08 0.00
08/20/2014 SEQUESTRATION REDUCTION ADJUSTMENT FROM NOVITAS SOLUTIONS, INC -2.28 0.00
08/20/2014 MEDICARE PAYMENT FROM NOVITAS SOLUTIONS, INC 111.26 0.00
08/20/2014 PATIENT RESPONSIBILITY -28.38 28.38
BALANCE TICKET #HS014788 .40 28.38
MICHAEL 5 STANKOVICH ID# 26347/REZA G AZIZKHAN JR DO
07/26/2014 SUBSEQUENT HOSPITAL CARE LEVEL 2 85.00 85.00 d.00
07/27/2014 SUBSEQUENT HOSPITAL CARE LEVEL 2 85.00 85.00 0.00
07/29/2014 SUBSEQUENT HOSPITAL CARE LEVEL 2 85.00 85.00 0.00
08/20/2014 MEDICARE CONTRACTUAL ADJUSTMENT FROM NOVITAS SOLUTIONS, INC -42.12 0.00
08/20/2014 SEQUESTRATION REDUCTION ADJUSTMENT FROM NOVITAS SOlUTIONS, INC -3.42 0.00
08/20/2014 MEDICARE PAYMENT FROM NOVITAS SOLUTIONS, INC 166.89 0.00
08/20/2014 PATIENT RESPONSIBILITY -42.57 42.57
BALANCE TICKET #HS014801 .00 42.57
�
��„�w, PAGE 2 OF 2
Invoice 1692-page 2
Last payment(s) received Thank you for your payment!
DATE DESCRIPTION AMOUNT
---�
^ 08/22/2014 1693 $6,976.40
08/06/2014 1681 $365.48
Aging Summary
CURRENT 1- 30 DAYS 31- 60 61- 90 91+ TOTAL
/ ___ �
$0.00 2,718.34 0.00 0.00 0.00 ,718.34 \ ` ��
� ',i
� � `� .
�
�,
Hor»e Instead 242 �Iome Instead
5002 LenkerStreet
Suite 101
. �
Mechanicsburg, PA 17050 lct�r,��J»ercen.zl..
717-731-9984 �
Client Stankovich, Michael
Invoice Na. 1692
Invoice Date 08/312014
From 08/16/2014 to 08/31/2014
Michaei Stankovich
184 Four Seasons Lane Date Due Due upon receipt
Enola, PA �7025
--- ----------__ ------ --- _------ _-----
DESCRIPTION QUANTfTY RATE AMOUNT
_ _ __
� O8/16/14 08:30AM- 02:OOPM Barclay, Barry 5.50 hrs 24.14/hour $132.77
� 08/16/14 02:OOPM- 08:OOPM Campbell,Angela 6.00 hrs 24.14/hour $144.84
� OE/16/14 08:00?M- C8/17/14 06:OOAM Eckhart,Shannon 10.00 hrs 24.i4/hour $241.40
� 08/17/14 06:OOAM- 01:OOPM Martin,Donna 7.00 hrs 21.95/hour $153.65
08/17/14 01:OOPM- 08:OOPM Hosni, Melissa 7.00 hrs 24.14/hour $168.98
� 08/17/14 08:OOPM- O8/18/14 06:OOAM Moe,Yin 10.00 hrs 24.14/hour $241.40
08/18/14 06:OOAM- 09:30AM Cruz,Angelika 3.50 hrs 21.95/hour $76.83
O8/18/14 09:30AM- 05:OOPM Barclay, Barry 7.50 hrs 21.95/hour $164.63
08/18/14 05:OOPM- 09:OOPM Campbell,Angela 4.00 hrs 21.95/hour $87.80
08/18/14 09:OOPM- O8/19/14 09:OOAM Moe,Yin 12.00 hrs 21.95/hour $263.40
� 08/19/14 09:OOAM- 08:OOPM Barclay, Barry 11.00 hrs 21.95/hour $241.45
�A O8/19/14 08:OOPM- 08/20/14 06:OOAM Fisher,Sandra 10.00 hrs 21.95/hour �219.50
08/20/14 06:OOAM- 05:30PM Cruz,Angelika 11.50 hrs 21.95/hour $252.43
� 08/ZO/14 05:30PM- 10:00PM Barclay, Barry 4.50 hrs 21.95/hour $9g.7g
08/20/14 10:00PM- 08/21/14 06:OOAM Fisher,Sandra 8.00 hrs 21.95/hour $175.60
08/21/14 06:OOAM- 08:30AM Durham.Amanda 2.50 hrs 21.95/hour $54.88
Invoice Total: $2,718.34