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HomeMy WebLinkAbout04-29-15 (2) III'Il'.IIIIII IIIIII11 � � ;;�;; pennsylvania 1505618403 oEPnarrnENroFaEVENu�X(03-14) REV-1500 OFFICIAL USE ONLY County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po Box.2so6o� RESIDENT DECEDENT 2 1 1 4 0 7 8 1 Harrisburg,PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYW Date of Birth MMDDYYYY 202 16 9052 05 15 1926 DecedenYs Last Name Suffix DecedenYs First Name MI HERTZLER RUTH H (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 1. Original Return ❑ 2. Supplemental Return ❑ 3. Remainder Return(date of death priorto 12-13-82) ❑ 4, Agricultural Exemption(date of ❑ 5. Future Interest Compromise(date of ❑ g, Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) � �� Decedent Died Testate ❑ 8. Decedent Maintained a Living Trust � 9. Total Number of Safe Deposit Boxes (Attach copy oi will) (Attach copy of trust.) ❑ 10. Litigation Proceeds Received ❑ ��� Non-Probate Transferee Return ❑ 12. DeferraUElection of Spousal Trusts (Schedule F and G Assets Only) ❑ 13. Business Assets ❑ 14. Spouse is Sole Beneficiary (No trust involved) CORRESpONpENT-THIS SECTION MUST BE COMPLE7ID.ALL CORRESPONDEP�CE AND CONFlDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number GERALD J BRINSER 717 838 6348 First Line of Address 6 E MAIN STREET Second Line of Address 4� � "�' � rn PO BOX 323 � Q � � � c� City or Post Office State ZIP Code �,� � � ;;�.� � t'-� �.� :7 . ".'."9 PALMYRA PA 17U78 �'> r� N -^ r"^t " _ �'�' CD ... '� i,� � r-� Correspondent's email address: gJbrin@aol.com ` ; •�-n �; `c�_ ..... � . REGISTER Qf;WILLS U�E+ONL`F-� �Y `,7 (V �,._. � REGISTER OF WILLS USE ON�Y "'""� Q � Q DATE FILED MMDDYYYY � � � n DATE FILED STAMP Side 1 I II�II IIII IIIII IIIII�IIII IIIII IIIII IIIII I I �IIII IIII II�I � 15U5618403 15056184U3 �`� '�,� v ��� 1505618411 REV-1500 EX Decedent's Social Security Number Decedents Name: HERTZLER, RUTH H. 202 16 9052 RECAPITULATION 1. Real Estate(Schedule A)........................................................................................... 1. 2. Stocks and Bonds(Schedule B)................................................................................. 2. 14 , 813 - 28 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. 304 , 384 - 53 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested.............. 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested.............. 7. 3a . 711 . 7 0 8. Total Gross Assets(total Lines 1 through 7)............................................................ 8. 3 49 , 909 . 5 1 9. Funeral Expenses and Administrative Costs(Schedule H)........................................ 9. 23 , 747 - 12 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)................................ 10. 632 7 9 11. Total Deductions(total Lines 9 and 10)................................................................... 11. 24 , 379 • 91 12. Net Value of Estate(Line 8 minus Line 11).............................................................. 12. 325 , 529 6 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J).................................................... 13. 51 , 786 0 5 14. Net Value Subject to Tax(Line 12 minus Line 13)................................................... 14. 273 , 743 - 55 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 .00 15. 16. Amount of Line 14 taxable at lineal rate X ,045 273 , 743 - 55 16. 12 , 318 . 46 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. 12 , 318 . 4 6 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Under penalties of perjury,I declare I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the person responsible for filing the return is based on all information of which preparer has any know) e. SIGN URE F PERSON RESPONSIBL F URN Duane L. Hertzler DATE AD15RESS 4733 Rock Hollow Road, Loy ille, PA 17047 SIGNATURE OF PR ER OTHER T�RESENTATIVE Gerald J Brinser DATE ADDRESS Brinser,Wagner&limmerman 6 E. Main Street, Palmyra, PA 17078 I VIII �� IIII VIII IIID IIII II VIII IIII I III IIII IIII Side 2 1505618411 1505618411 J IIIIII'�IIIIII IIIIII11 � ADDITIONAL Personal Representatives Hertzler, Ruth H. SS# 202-16-9052 7/29/2014 Under penalties of perjury, the undersigned declare that they have examined this return, including accompanying schedules and statements, and to the best of their knowledge and belief, it is true, correct and complete. ._ ,, � �� � ;'Y 2 signature '� Gj � � ,/r� ,Gr,,; Name J i . Quickel Address 195 Mountain View Drive City,State,Zip York PA 17404 Date � � 7 ��� 3 Signature Name Address City,State,Zip Date 4 Signature Name Add ress: City,State,Zip Date 5 Signature Name Add ress: City,State,Zip Date 6 Signature Name Address: City,State,Zip Date REV-1500 EX Page 3 File Number 21 - 14 - 0781 DecedenYs Complete Address: DECEDENT'S NAME Hertzler, Ruth H. STREET ADDRESS 222 Messiah Circle CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 12,318.46 2. Credits/Payments A. PriorPayments 10,000.00 B. Discount 526.32 Total Credits(A +B) (2) 10,5 2 6.3 2 3. Interest (3) 0.0 0 4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2,�ine 20 to request a refund 5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) � ,7 9 2.�4 Make Check Payable to: REGISTER OF WILLS, AGENT. �..............�..._._.. _............. ,.r,..._...��.�... , �...�.,,.,.,.,.,...,�� ,...,�..........,.:..;_..;.;...,..,...,.,.,.,.,,.: ::��� ,.. ..,.,.,.,.,.��...:�; .� ...���_.. ..��,r�.::.............�_.., . �:.... .. �A��..x�a�vuc he��������R`CZR G�a��;e���v�..��.�F� ���.C�9 .\����.����..�..a3�.« �\��a.ax �wR c..� 3 �C. �4.Y..�G,F&G HS... .,k� t ,a. .�,�u»�� � ..�..�. �,e� ::c.. �c�,.:�, � x..�F,�»..g�. �..,,,�a��•� ��9 �».,,....�...H�u.... . ..,a»�� 5.:.:. ��"=k....xH.. � �..,�. �.,, : .... �. .� �. ,z a•� ..��.���� .,s�e� �r� �,�� ��..�..�x ����������. �... .....�.� �aa� ... ... "" E ..' aea.�������.� ��; �:. �......•�..�.�.�.��,; ..,,., ;..,.,,c�a a �.::.�.�..,•....:...;�.�. �� �..�.. ,�H, � �.,..�.�_.�:� . ,::�.���u� � " �.. ...,�s�,.....a.rz�r�t.�..���������v_.....�.,��,.,��,.,,,,�na�;..gxaear.ars�x���.. ' c�c;.,�c,�.,,�C,�„�.�,.,,,,x,'�,,,,e,�xr.�c�a�axam�.�.�.g,��,��C9�ac8e:aaa...�:.�,...�e ., a��..����..,.. .z......� :..,..a�"�a..F....���..�� .. •aaeee �a�..,�.....,..A�....,.z�.�aa�aaR��a��a��.:��"e.�����.� 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 incorne:......................................... x c. retain a reversionary interest;or..................................................................................................................... x d. receive the promise for life of either payments,benefits or care?.................................................................. x 2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death without receiving adequateconsideration?......................................................................................................................................... ❑ 0 3. Did decedent own an"in trust for' or payable upon death bank account or security at his or her death?............... � Q 4. Did decedent own an individual retirement account,annuity,or other non-probate property which contains a beneficiary designation?........................................................................................................................ � ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. >..x ���.. < .. . ............,... . . ��:::.:�.:::. �•�.�:::.a•..���•� .::... :.,.,H... .�.uH ...�..,.....r...� � �.......�.�...Hk,H ,.,. ,._.._.,... .��.......... :::.:x: �a...�.�.,.. n�c.�.���.....,:..::_... �sa...,. .,H�: �...,.a��. ���.�z.....w......�n.,.�qk �..o�... �� `�'� � a» � �.�... ,.�,:�: .,.F.a9��� � �.. �� .,� »aa�. �,a�...K.,..,.a.. ..����»"' ....v .�. ...�.. � "������ .�>::�������������;;,,�.�� g �g �g „..... ...... ...........:... .. �4���5�F:��..:�����P�:�:`�....... ... .1������� . ..u:�'»::..::s,.�.....:`.."......��9����axd..>....�..,..,���..»s .�..>�5�������,.:�. ...... .�:1�. ��:.v...C���6��� . ..%�� . : For dates of death on or after July 1,1994 and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after January 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent f72 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 stdl 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 step-parent 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 decedenYs lineal beneficiaries is 4.5 percent,except as noted in [72 P.S.§9116(a)(1)]. •The tax rate imposed on the net value of transfers to or for the use of the 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-1503 EX+(8-12) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSVLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF Hertzler, RUth H. 21 - 14-0781 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION UNIT VALUE VALUE AT DATE OF NUMBER DEATH 1 (1,296) Shares Fulton Financial Stock @$11.43 Per Share 11.43 14,813.28 TOTAL(Also enter on line 2, Recapitulation) 14,813.28 .�, pennsylvania SCHEDULE E �� DEPARTMENTOFREVENUE CASH, BANK DEPOSITS AND MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY FILE NUMBER ESTATE OF Hertzler, Ruth H. 21 - 14 -0781 Include the proceeds of litigation and the date the proceeds were received by the estate.All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 PNC Bank-Checking Account#5070080416 5,020.53 2 Stewardship Advisors- Pershing Individual Account#5DK407168 279,489.83 3 Stewardship Advisors- Pacific Life Annuity#VR06052425, with estate named as beneficiary. 18,922.85 4 Everence- Premium Refund 951.32 TOTAL(Also enter on Line 5, Recapitulation) 304,384.53 REV-1510 EX+(08-09) �;; pennsylvania � DEPARTMENTOFREVENUE SCHEDULE G INHERITANCETAXREfURN INTER-VIVOS TRANSFERS 8� RESIDENTDECEDENT MISC. NON-PROBATE PROPERTY ESTATE OF Hertzler, Ruth H. FILE NUMBER 21 - 14-0781 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH �`�F EXCLUSION Include the name of the trensferee,their relationship to decedent VALUE OF ASSET DECD'S TAXABLE VALU E NUMBER INTERE=ST (IFAPPLICABLE) and the date of transfer. Attach a copy of the deed for real estate. - 1 Stewardship Advisors- IRA with Principal Funds, so,711.70 100% 30,711.70 Account#07�00030957,with chairty named as the beneficiary. Note: This account is part of the total amount that is to pass to charity as shown on Schedule J, Part II, and is not in addition to that 116 Residue. TOTAL(Also enter on line 7, Recapitulationj 30,711.70 .. . . . .. .. REV-1511 EX+(08-73) .�, pennsylvania w'�p�/�� ��y�����+H�� /��� �� DEPARTMENT OF REVENUE �'�1UyyL G/�rCIw7GJ F11YD INHERITANCE TAX RETURN AI"V�AIt�11QTGATI�/C C�� RESIDENT DECEDENT /'\LAYIIIrIJ I fY'\I IYG FILE NUMBER ESTATE OF Hertzler, Ruth H. 21 - 14 -0781 DecedenYs debts must be reported on Schedule I. ITEM AMOUNT NUMBER FUNERAL EXPENSES: DESCRIPTION A. 1 Music Leader/Sound Technician/Funeral Luncheon 555.00 B. ADMINISTRATIVE COSTS: �. Personal Representative's Commissions Name of Personal Representative(s) Duane L. Hertzler Julia M. Quickel 15,000.00 Street Address 4733 Rock Hollow Road City Loysville State PA zip 17047 Year(s)Commission Paid 2015 2. Attorney's Fees Brinser,Wagner&Zimmerman--Gerald J. Brinser 7,500.00 3_ Family Exemption: (If decedenYs address is not the same as claimant's,attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills (Ltrs. Pd. $260.00 = $100,000-$200,000) 375.50 5. AccountanYs Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs � Register of Wills-Additional Cost of Letters 100.00 See attached 216.62 TOTAL(Also enter on line 9, Recapitulation) 23,747.12 REV-7511 EX+(08-13) �-`, pennsylvania �uleH �`'�' DEPARTMENT OF REVENUE „,�,�,� �+r INHERITANCE TAX RETURN FUI It7Q1 F�I�SeS� RESIDENT DECEDENT q,�ministrativ�e Cosfis c�or�tinued FILE NUMBER ESTATE OF Hertzler, Ruth H. 21 - 14 -0781 2 Cumberland Law Journal - Legal Advertising 75.00 3 The Sentinel - Legal Advertising 126.82 4 Certified Mail -(2) @$7.40 Each 14.80 Page 2 of Schedule H .�1�� pennsylvania SCHEDULE I ��\`` DEPARTMENT OF REVENUE DEBTS OF DECEDENT, MORTGAGE j�M INHERITANCE TAX RETURN RESIDENTDECEDENT LIABILITIES 8� LIENS FILE NUMBER ESTATE OF Hertzler, Ruth H. 21 - 14 -0781 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER 1 Alert Pharmacy Services 391.29 2 Messiah Lifeways 48.00 3 Mobilex-Outstanding Check Cleared After Death 193.50 TOTAL(Also enter on Line 10, Recapitulation) 632.79 REV-1513 EX+(01-10) � pennsylvania SCHEDULE J ' DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BEN EFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Hertzler, Ruth H. 21 - 14-0781 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY ooNot�istTrustee(s) I� TAXABLE DISTRIBUTIONS(include outright spousal distnbutions,and transfers under Sec.9116(a)(1.2)] 1 Dale Hertzler Son 1/5 Fulton Stock; 1/6 54,746.42 509 E. Conestoga Street Residue New Hoiland, PA 17557 2 Dean Hertzler Son 1/5 Fulton Stock; 1/6 54,746.42 2357 Stauffer Road Residue Mount Joy, PA 17552 3 Jeanette Martin Daughter 1/5 Fulton Stock; 1/6 54,757.85 4140 Emerald Drive Residue Colorado Springs, CO 80918 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. II. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX 15 NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 Eastern Mennonite Missions, 53 W. Brandt Blvd. 23,303.72 P.O. Box 458, Salunga, PA 17538-0458 45% of 1/6 Residue 2 Mennonite Central Committee U.S.,215 12th Street 23,303.72 P.O. Box 500,Akron, PA 17501-0500 45°10 of 1/6 Residue 3 Mennonite Disaster Services 5,178.61 583 Airport Road, Lititz, PA 17543 10%of 1/6 Residue Note: These amounts include the account passing under Schedule G. TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-9500 COVER SHEET 51,786.05 REV-1513 EX+(01-10) ��� pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCETAXREfURN BENEFICIARIES continued RESIDENT DECEDENT ESTATE OF I FILE NUMBER Hertzler, Ruth H. 21 - 14-0781 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) R EC E I V I N G P R O P E RTY Do Not List Trustee(s) I� TAXABLE DISTRIBUTIONS[include outright spousal distnbutions,and transfers under Sec.9116(a)(1.2}] 4 Julia Quickel Daughter 1/5 Fulton Stock; 1/6 54,746.42 195 Mountain View Drive Residue York, PA 17404 5 Duane Hertzler Son 1/5 Fulton Stock; 1/6 54,746.42 4733 Rock Hollow Road Residue Loysville, PA 17047 Page 2 of Schedule J . � � LAST WILL AND TESTAMENT I, RUTH H. HERTZLER, of the Township of Upper Allen, County of Cumberland and Commonwealth of Pennsylvania, hereby make, publish and declare the following to be my Last Will and Testament, revoking any and all Wills and Codicils by me at any time heretofore made. FIRST: Payment of Debts: I direct that all my just debts and funeral expenses be paid as soon after my decease as may be practicable. I further direct that all estate, transfer and inheritance taxes assessed with respect to my estate herein disposed of, or any part thereof, or any bequest or devise contained in this my�'ill be paid out of my residuaxy estate as administration expenses without proration or apportionment. SECOND: Contin eg nt Beguest- Personal Propertv: I give and bequeath all my clothing,books, pictures, tools, furnifure and furnishings and other articles of personal or household use and equipment(not including cash or securities), to my five children as shall survive me,to be divided among them as they may agree, or in the absence of agreement, as my Executors may think appropriate. However, I direct that any item which I have labeled or marked specifically, either by a written list which I have compiled and attached to this Will or otherwise, to be devised and bequeathed to a specific person, shall be so given, devised and bequeathed to such person by my Executors as I have directed. If I have not prepared any such lis�, then I direct my Executors to comply with the relevant portions of this paragraph regarding distribution of personal property THIRD: Specific Bequest of Fulton Bank Stock: I give, devise and bequeath all of my Fulton Bank stock to my five children, namely DUANE L. HERTZLER,DALE E. HERTZLER,DEAN M. HER7'ZLFR, JULIA M. QUICKEL and JEANETTE L. MARTIN, in equal shares. Because I received the Fulton Bank stock and original certificates from my mother, it is my wish (but not my Page - 1 requirement)that each of my said children shall keep and retain the said Fulton Bank stock as a family remembrance. If any of my said children do nat survive me,then I direct that their portion of my Fulton Bank stock shall be given and bequeathed to their children (i.e. to my grandchildren). FOURTH: Residuar�Be_quest: I give, devise and bequeath the rest, residue and remainder of my estate, of whatever nature and wherever located, in six (6) equal shares to be distributed as follows: One share to my son, DUANE L. HERTZLER, Loysville, Pennsylvania One share to my son,DALE E. HERTZLER,New Holland, Pennsylvania One share to my son,DEAN M. HERTZLER, Mount Joy, Pennsylvania One share to my daughter, JULIA M. QUICKEL, York, Pennsylvania One share to my daughter,JEANETTE L. MARTIN, Colorado Springs, Colorado One share (being 1/6th of my residuary estate) to the following non-profit charitable organizations : 45% of the said 1/6`h share of my residuary estate to EASTERN MENNONITE MISSIONS, Salunga, Pennsylvania 45%of the said 1/6th share of my residuary estate to 1�9ENNONITE CENTRAL COMMITTEE, Akron, Pennsylvania 10% of the said 1/6ih share of my residuary estate to MENNONITE DISASTER SERVICE,Akron, Pennsylvania If any of my said children do not survive me, then I direct that their share of my residuary estate shall be given and bequeathed to their children (i.e. to my grandchildren). FIFTH: Fiduciary Powers: I direct that my Executors, in addition to and not in limitation of any autharity given to them by law, shall have the following powers: A. To retain and to invest in all forms of real aTid personal property. B. To sell at public or private sale any real and personal property. Page - 2 C. To borrow from themselves or others, and ta pledge property as security for repayment of any funds borrowed, and E. To distribute in cash or in kind, however, my Executors are hereby directed that any items of mine which are labeled or listed on a written list, shall be distributed in accordance with the label thereon ar the list that I have made. These authorities are exercisable and shall continue in force until the actual distribution of all my property. SIXTH: Appointment of Executors: I nominate and appoint my son, DUANE L. HERTZLER, Loysville, Pennsylvania and my daughter, JULIA M. QUICKEL, York, Pennsylvania to serve as Co-Executors of this my Last Wi1l and Testament. I direct that my Executors shall not be required to file bond in any court for their faithful performance of duty, for any reason whatever. IN WIT`NESS WHEREOF, I have hereunto set my hand and seal this ��-- day of -� � � , 2008. 3�' ` �.� �� �'�'� � �'Lj::.r---{SEAL) RUTH H. HERTZLER`: SIGNED, sealed, published and declared by the above n�ned Testatrix, RUTH H. HERTZLER, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in the presence of each other, have ]lereunto subscribed our names as witnesses thereto. �+:� �k..:- '� `�1'L��.:d-.. residing at �ti\��e�:,.rt:��� r: ��r�.�'L -�.. residing at������1�-��'UrJ�'/ �� Page - 3 COMMONWEALTH OF PENNSYLVANIA : : SS: COUNTY OF LANCASTER : WE,r'�g�����• s�:�'r' and �t�-t.�l.;i���,�� �.�'��� , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her Last Will; that the Testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Will as a witness; and that to the best of our knowledge the Testatrix was at that time eighteen (18) years of age or more, of sound mind and under no constraint or undue influence. SWORN to or affirmed and subscribed to before me by ����-,��,_� . � ;v`�� and�j,[=.��t�1 L3 �L�����= , witnesses, this��day of _�� � � ` , 2008. • �����.... � , -��,.-,�,�: witnes � ���G'L�- - Witness COMMONWEALTH OF PENNSYLVANIA : : SS: COUNTY OF CUMBERLAND : ON THIS,the ;�_day of i , 2008, before me, a Notary Public,the undersigned officer, personal?ly appeared RUTfI H I�ERTZLER, Testatrix, and �- r.�1�=i .a�v,�J` and � �4��C-�I- C, lC.�vi� �� , Witnesses, known to e or satisfactorily proven to be the persons whose names are subscribed to the within instrument as Testatrix and Witnesses, respectively, and acknowledged that they executed the same for the purposes therein contained.. IN WITNESS WHEREOF, I have hereunto set my hand official seal. " ,-�`.,4 n , _r---- �`�,,. � j� f ��ar�a�Public � con��totvwFa�.�rH ar i=��r�r;�=�,°�.:v������a Notariai Sea!� � Judith A.Walter,hJotary Public Upper Allen T�vp.,CumSerland Counry My Commiss;crn�--x.:��•4,<�f��ay 12,2010 �Member.Pennsyf� ,�. .. ..�.`�.;i,!ntarie� Page - 4 _... . ... .._.... �S 1 � .�A 8NY MELLON COMPANY`" � L�01694g372 One Pershing Plaza,Jersey City,PIJ 07399 CAMBRIDGE INVFSTMENT RESEARCH Pershing LLQ mem6er FIPIRA,NYSE,SIPC 1776 PLEASANT PLAIN ROAD 62-35 Account No: SCR-838235-1 Fa[�'IELD, � 52556 s11 B�vx oF NEw Yo�c Date: 10/23/14 DELAWARE *****TEN THOUSAND AND NO/100 DOLLARS+++** ��+c�.,� � PAY TO T��ORDER OF $*��*�.0 fJ�Q 0 0 0' r:; 0 _:. ,... ._ REGISTER OF WILLS, AGENT VOID AFTER 180 DAYS '�a��� - FBO ESTATE OF RUTH H HERTZLER Two Signatures xequirea For �� ******************************** 1�nounts Ovex$250,000 �� � Auth Repr ntative �"�"' . ��.'r.;� ;�„�? ' Auth rized epresentative a;�, ��'40 16949 3 7 2�►' �:03 L 10035 L�: �i'0300956497��° Pershing LLc CAMBRIDGE IlWESTMENT RESEARCH 4016949372 One Pershing Plaza, Jersey City, NJ 07399 1776 PLEASANr PLAIN ROAD Date• 10/23/14 FAIRFIELD, IA 52556 Account No: • SCR-838235-1 Paid To: REGISTER OF WII..LS,AGENT DATE DESCRIPTION AMOUN'I' 10/23/14THIRD-PAR1Y PARTTAL ESTATE TAX P AYMENT VIA OVERNTI'E DELIVRY $l0,000.00 FROM ACCOUNI'OF : ESTATE OF RUTf-I H HER TZLER ESI'ATE NE'T AMOUN'I' : $lo,000.o0 r � i g�,� � )-:.; �I � � ����/ri,�� � � � � -U li. i ey.fS M ' � �i � � �. 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'_ �r:" `C R. ?; �F �F �F %� �...� a ��i � I m i r-x' �a� � � �� o �t � � � � � 'j �'' �,.� �� � �� � ,D^ro "•T � W Z �--I��� �� �� � /�i ��-"�`� �$ � > � � m `� o �,. y I m 'r" � �: � — ro � w G N r. 0 F��. .ai � �� y o � O � � � +��.,. �. g��- `4 �+'*' p O i � :�--- .��;� i O ,�+,,,, � E.,, � { ��:;��. '�'� � � m 9 m � � 5� �r,�..���;, f2 1N � � v� y ��� �. t K�.. .`� [�ti I\ � G � �'A� ���` �;.�„ '� � O 1 . ti 0 �� r:C. �_ �" , �� 4 �. . � Z�.. '' �' l ;_ ,�,7,II�N�o���z���� �i�j���I�pf1��MrM�V� }�� �y �irp��f���Wy�� � � ��/n��IIIIU��N����� �a€ �i ���Ilq I��,� ^" _ - � �, i l r -�� n.'� � Y�an . ane�_ .,.:1,�,.�,.,...� .. � �.w,r,x �'r7i.,.,,.�.. �{�, ., �...�s.�„ ...dnxn„� . ... . ..,���a �::..�... .,. . � , ' ,,�'.. .�,..`�S'_. �..�,,. . u . _ �...,.� � . . . . Oct, 27. 2014 ll; 26PM PNC Bank No, (�155 P. 1/1 � ,.�- �! '"+�� Oc�ober 27, 2014 Gerald J Brinser Esq. �rinser Wagner �Zimmerman 6 E Main St 2hd Fl � O Box 323 Palm��ra, �'A 17078 . RE: Ruth H Hertzler SSN: 202-16-9052 DOD: 07-29-2014 � Dear Mr. Briz�ser_ Tn response to your request for Date o�Aeath(DOD) balances for the customer noted above, our recorc�s show the following: Checl���ag,A.cco�nt Acco�c�.nti#.5070�804'16 Established: O1-01-1960 R'�(.7TH H�ERTZLER l�Ol7 balance: � 5,020.53 + 0.00 accrtted xzlterest Intcrest paid Ol-01-2014 thru 07-29^2014 $ 0.00 YTD Please ziote that this office provides date of de�tl�balances for deposi�a.cco�azits (IRAs, CDs, Checking and Savinas). '�'e do not process any financial transactao�as or provide state��ents. Tf you need assistance with an��of these items,please call 1-88�-PNC-BANi�(1-888-762-2265) or ,seop by your local PNC Bank branch office. S incerel��, National Fina.ucza� Se�`vices Center PNC Bank,N.A. Member FDrC This nzessage is intended for tlze use of the iraclivicli.tal or entity to�vlzic.Yr zt i�s addressed arad rriay co�-itui�z i3�fos��nut�o�� that is pf�ivileged, confadential a>zd exe�npt f�o�rt clisclosttre urlcle��upplicable law. rf tlze reacler of tl�is message is �aot tlr.e irate�zded recipie��t or•the errrployee or�c�gent�-esporzsrble fo�- delr.'ver-irz�tlais messccge to t�ie intencled recipier2t, you are hereby raot;i�ed th.at any c�issenzinatiotz, dr."strr.�ution or copyrn.g of this eonamunie�c�io�zs is strictly prohibited ,If you huve received this con�t�nu�ricatr"orz ir� er-ror,plea.se not�rne imme�li.ately by reply or�by teXeplzone at 800-76Z-177� a�zd ilrunediutely destroy this faxed document. Page 1 of 1 Holdings by Investor _______ Ruth H Hertzler John Simkins Hertzler,Ruth 222 Messiah Cir Stewardship Advisors Date. 07/29/2014 Mechanicsburg,PA 17055 1013 W Main St Created:08/13/2014 , Stewardship su�te s � Advisors,LLC Mount Joy,PA 17552 � walki�w�thyou on your journey 717 492-4787 D �'I� ��t?��l C(-� Ruth H Hertzler Acct Name:lndividual Pershing Acct No:5DK407168 AcctType:lndividual Asset Name Ticker AssetType Mgt.Name Quantity Price(3) Value($) ALGER SPECTRA A SPECX EQUITY ALGER FUNDS 606.86 18.79 11,402.92 BROKERAGE MONEY MARKET CASH OR BROKERAGE 14,437.69 1.00 14,437.69 EQUIVALENTS MONEY MARKET CALVERT HIGH YIELD BOND FUND CYBAX FIXED INCOME CALVERT 359.12 30.66 11,010.50 CLASS A FUNDS EQUITY INCOME CLASS A FFEIX EQUITY NUVEEN 546.01 17.42 9,511.53 MUTUAL FUNDS GBL EST SEC(A) POSAX EQUITY PRINCIPAL 2,400.60 8.62 20,693.15 FUNDS GLOBAL DIVERSIFIED INCOME(A) PGBAX BLEND PRINCIPAL 3,226.82 15.05 48,563.57 FUNDS METROPOLITAN WESTTOTP�L MWTRX FIXED INCOME METROPOLITA 1,282.42 10.85 13,914.26 RETURN BOND FUND CLASS M N FUNDS OPPENHEIMER INTERNATIONAL OIDAX EQUITY �UNDSHEIMER 407.17 15.04 6,123.78 DIVERSIFIED A PAX WORLD HIGH YIELD BOND PAXHX FIXED INCOME PAX WORLD 6,085.09 7.62 46,368.35 INDV CLASS MUTUAL FUNDS PRINCIPAL INVESTORS HIGH YIELD CPNYX FIXED INCOME FUNDSPAL 6,758.74 7.86 53,123.70 FUND II(A) PRINCIPAL INVESTORS MID CAP PEMGX EQUITY FUNDSPAL 1,097.84 21.34 23,427.99 BLEND FUND CLASS A STEELPATH MLP INCOME FUND MLPDX EQUITY �UNDSHEIMER 1,824.82 11.46 20,912.41 CLASS A Account Total: $279,489.83 Acct Name:Ruth IRA Acct No:07000030957 AcctType:IRA Individually Established Asset Name Ticker AssetType Mgt.Name Quantity Price($) Value(S) PRINCIPAL INVESTORS SAM SCBPX BLEND FUNDSPAL 1,904.01 16.13 30,711.70 BALANCED(C) Account Total: $30,711.70 Acct Name:Ruth VA Acct No:VR06052425 AcctType:General Asset Name Ticker AssetType Mgt.Name Quantity Price($) Value($) PORT OPT GROWTH FIXED INCOME PACIFIC LIFE 1,550.56 12.20 18,922.85 Account Total: $�8,922.85 Investor Total: $329,124.38 Page 1 of 2 Incomplete if presented without accompanying disclosure pages _ __. . .. ,rR i��� '.-�.,�,,��°�' �``t "� ° � i� `/-, RECEIPT FOR PAYMENT LISA M. GRAYSON, ESQ. Receipt Date : 8/21/2014 Cumberland County - Register Of Wills Receipt Time : 10 :21 : 17 One Courthouse S quare Receipt No. : 1078957 Carlisle, PA 17613 HERTZLER RUTH H _ Estate File No . : 2014-00781 Paid By Remarks : JULIA QUICKEL DMB ------------------- -- --- Receipt Distribution ---- -------- ------------ Fee/Tax Description Payment Amount Payee Narr.e PETITION LTRS TEST 260 . 00 CUMBERLAND COUNTY GENERAL FUN WILL 15 . 00 CUMBEF�LAND COUNTY GENERAL FUN SHORT CERTIFICATE 30 . 00 CUMBERLAND COUNTY GENERAL FUN INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN INH TAX RETURN 15 . 00 CUMBEP�LAND COUNTY GENERAL FUN JCS FEE 35 . 50 BUREALT OF' RECEIPTS & CNTR M.D AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN -- -------------- Check# 1713 $375 . 50 Total Received. . . . . . . . . $375 . 50 �J����D coG�'�- 1�1' o� �assoc��` CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717)249-3166 Fax:(717)249-2663 September 19, 2014 Cumberland Law Journai is published every Friday by the Cumberiand County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal r�ewspaper for publication of legal notices. TO: Gerald J. Brinser, Esquire RE: Ruth H. Hertzler Estate Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on the following dates: September 5, September 12, and September 19, 2014 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 0 .00 Total Amount Due $ 75.00 , r -r!� Payment received by ��!� ���`"` c���`�`�o _ __ _ PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOUR.'�1A.L (Under Act No. 587, approved May 16, 1929); P. L.1784 COMMONWEALTH OF PENNSYLVANIA : . ss. COUNTY OF CUMBERLAND . Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle i�n the C'ounty and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, viz: September 5 S�tember 12 and September 19, 2014 _ Affiant further deposes that he is authorized to verify this state,ment by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the faregoing statements as to time, place and character of publication are true. °u �e.�`i ._ 1�, � �_,k.,� ._-.�=�' � i'"'>' ;' � ; �`__�-�i-- � Lisa Marie Cc�yr�e, Editor SWORN TO AND SUBSCRIBED before me this 19 day of September, 2014 �� - Notary __ Hertzler,Ruth H.,dec'd. Late of Upper Allen Township. C.pa�1Ni0�`��'E�°.�.TFi OF F'EPlNSY'_';���i1N Co-Executors: Duane L. Hertzier � �-"LL;""NO'�IaRiAI��A� � � and Julia M. Quickel c/o 4733 Rock Hollow Road, Loysville, PA � DEBQRE�H A f:OLLINS 17047. Notary Pub1iC Attorney: Gerald J. Brinser, Es- CARUSLE BORJ.,CUNiBERLANO CNTY quire. My Commisslon Expires Apr 28,2018 • AD NUMBER PAGE NO. 'I`he Sentxnei ZIMMERMAN BRINSER,WAGNER& _ _ www.comberlink.com 6E.MAINSTREET,2NDFL. 433582 1 of1 P.O.BOX 323 BILL DATE SALESPERSON ��,�,_G��� PALMYRA,PA 17078 09110/14 wolfc �s�t�sit s 3�i�N:haa�, Pt�>Y r.�,;�;r. 717-838-6348 _--. - -- __ __ START DATE STOP DATE __ OS/27/14 09/10/14 AD NUMBER AD DESCRIPTION CLASS LINES ------_.__. 433582 NOTICE NOTICE IS HEREBY GIVEN THAT 10 PUBLIC NOTICES 22 * 2 cols Publication insertions Rate Net Amount Gross Amount 3 THE SENTINEL-LEGAL 3 LGL $116.82 TOTAL AD CHARGE $116.82 3 MOBILE SITE MOB2 $3.00 3 PROOF OF PUBLICATION 01 PRF $7.00 PurchaseOrder Est. R. Hertzler PAY THIS AMOUNT �f $126.82 $152.18* �'�""�""�"` *AFTER 10/05/14 Lee Enterprises no longer accepts credit card payments sent via e-mail. �p �� Emails containing credit card numbers will be biocked. Please use the coupon �`���; below to send credit card payment to our lockbox. THE SENTINEL �j '; ;,,�`'. �� You may also send the coupon to a secure fax at 319-291-4014. c/o LEE NEWSPAPERS �'`� PO BOX 540 �'J Thank you for advertising with The Sentinei! Deadiine for N/ATERLOO IA 50704-0540 in-column legal ads is 4:00 p.m. two business days prior to date of insertion. For questions, call (717)240-7130. � a PROOF OF PUBLICATION State of Pennsylvania, County of Cumberland Cathy Clark, Advertising Director, of The Sentinel,of the County and State aforesaid, being duly sworn, deposes and says that THE SENTINEL, a newspaper of general circulation in the Borough of Carlisle,County and State aforesaid, �vas established December 13th,1881, since which date THE SENTINEL has been rE��;ularly issued in said County, and that the printed notice or publication attached hei•eto is exactly the same as was printed and published in the regular editions and issues oE Au�ust 27,2014 and Se�tember 3, 2014 and September 10, 2014. COPY OF NOTICE OF PUBLICATION O iCE , Notice is hereby given that Letters Testamentary onthe Estate of RUTH H. Aff1121t fUTtI12T'C��pOSE'S�1dt�t2�5�12 1S 110t ` HERT2LER,Deceased,lateofUppefAllenTownship,CumberlandCounty, 1Tlt2T'eSteC�1Tl tlle SCLb�E'Ct ITldtt2T Of�12 Pennsylvama,have been granted to the unders�gned Co-Executors. qp persons therefore indebted to said estate are fequested to make itnmediate af OTeSa1Cl 110t1C2 OT dC�V Ert1Se111el1t, and that payment,and those hawng)ustclaimswiN P�ease P�esentthe seme,duly all allega�1011S lIl tlle f OT'eg0111g State111eT1t aS authenticated,for settlemenf;without de�aY.Duanet Hert2ler-atid 3ul�a M� Quickel,c/o 4733 Rock Hollow Road;Loysville,PA 17047,Co-Executors; to time,pIdC2 dllC� C11i�1 dCt2r Of pUbllCdtlOTt Gerald J.Brinser,Attomey. are true. � _ : , : . . . : . . �� � �"�-/���y----- � ' - � `�1 Sworn to and subscribed before me this 1�'�, t�f ' � ,; � ►`'f�f, !� - �� � �,�� .�`'� ���i1t1�'�f �1���T I . 3. , � � n, � � ��i�� ���•�!jj"j� j �,'t `r' 7 f� ��'"v'l 1(L P ( t Notar�Public My commission expires: �C�fs��,����'��:':z�d�;C:�t=E��P�f�lSYLVANIA MUt�.,.ai S2rvl Bethany M.Holtryr Pl(DtB�y PUI7IIC Carlisie Boro,Cumberiarzd County hiy C�mmlSsicn F:�c�;��s„�pt,2C>,20YS MEM6Fr.. �c>,r::�,, , ;,ninpN07AR1E5 � '• PALMYRA POST OFFICE . � . ' ' PALMYRA, Pennsylvania 170789998 o �� � , , � • • ' � '"' 4134870078 -0096 �' 12/11/2014 (800>275-8777 04:46:`.i2 PM �- " • �• �. � ., . •� �. �� � � �" - — Sales Receipt r�- ��' � J !•.,� Product S�1�, Uni t Fi nal °-' Pos�s9e $ Description Q�y Price Price �' m $�.ui! ti, -- CertNiedFee Pos�ne� MOIJNT JOY PA 17552-1219 Zone-1 9>1.40 � RetumReceiptFee �?n��l Hera First-Class Mail Large Env � (Endorsement Required) 2.EO OZ. � RestdcledDeBveryFee �ii,ntl Expected Delivery: Fi�i 12/12/14 (EndorsementRequlredi Return Rcpt (Green Card) y>2.70 o yl.�i: ��;�.�:wi�t_� �@ Certified y>3.30 � Total Pastage&Fees $ USPS Cert i f i ed Mai 1 �: 0 7G110110000239972490 SentTo =_-�__=__ 'a - -----�---)----------•-•--••--------•'�+� --�+._� --•--•----- Issue Posta e: 9�7.40 � Stresf.APt No.; �sV l a f. �a'���^ ....-.--- � or PO Box No. .---..._.---'-'--------'----- 'h°Io'ur-'�' -To , P�{ 175� =--- � Ciry State.Z/P+4 . TOtt�� : \ 9ii•�� "' ". Paid by: �� Personal Check 9>7.40 Q� For tracking or inquiries go rto USPS.com or call 1-800-222-1811. Order stamps at usps.com/shop or call 1-800-Stamp24. Go to usps.com/clicknshiip to print 5hipping labels with postage. For other information call 1-800-ASK-USPS. )CYt1tx]r;C:rY(:Y�Y(Y(:C�;rYCYCYCYc:tYCYf;C:YYCYc]CY(�Y[1CYt�C1tYc7C7c7:Y(:C �C�Y(IC�ICY(Y:Y()tY()t�Y(YfY(Yt:CY(Yc�:KY(*Y(ICY(Y(Y(IYYCY(Y(Yf7CM'ICY:Y(Ir � PALMYRA POST OFFICE .� � PAL.MYR170 g�ggg�vani a � � , � ' � � 4134870078 -0096 - • 12/31/2014 (800)275-8777 10:42:16 AM � �� u� n� Sales Receipt � . ��� . Pr�odu Sal e Uni t Fi nal p Sl,��] ilu��� Description �ty Price Price � Posiage $ 1.40 �. �;,��� �_�,• LANCASTER PA 17604-3215 Zone-1 9> r-� Certitied Fee poshnark F�rst-Cl ass Mai 1 Large Env Here 2.5� 02• O RetumReceiptFee �?�i�� Expected Delivery: Fri Ol/02/15 9,2 70 o �enaorseme�tReq���ed) Return Rcpt (Green Card) � Restricted Delivery Fee �Q,I,JfI 9i3.30 o p� Certified (Endorsement Requ�red) USPS Cert i f i ed Ma i 1 #: p #7,•�t� 1���������`� 70130600000019504725 __::_____ O TotalPostage&Fees � `° , � - `� �y Issue Postage: � '40 � SeniTo� ;^. , � � � , i� ��-- -------- .m � /� � � ��-1�,�� --S✓ -t t _�l r - —_ ----- / .' � Street,Ap[.No ---�_� ,� � • orPOBoxNo � ' ti,..?� '–'-- � - �: ��"' Total: ' O .C..=--",�-* 'Y ---- ../�� J f-- J_,t � f`- City State,ZIP+4 `�A ��j - ,� Pai d bY� 9;7.40 ,,, , ,,. Personal Check U��SpS�comrorkcagl�l-800u222e1811.to + Order stamps at usps.com/shop or call i-800-Stamp24. Go to usps.com/clicknship to print shipping labels with postage. For other information call 1-800-ASK-USPS. k Y(Yf Yl Yc Yc'X Y(7CY(YCY(Y(7C�Y(X Yf Y(Yc Y(Yc X:C�C�Y(Yc 1C Y(Y(Y(Y(:C Y(]C 7C Y�:X 7t ��K:C 1C�t Y(�CYIY(Y(Yc]r�7C Y(Y(Yc%'X Y(Y(Y!�c Y:Y(1C Y(IC]C Y!Y(]t Yc)C�C Yf'X 7:�t Yc �� � 219 North Baltimore Ave A FINANCE CHARGE OF 1.5 0 °s PER MONTH Px.utMnCY SF�vrcEs,uvC. Mt Hoily Springs, PA 17065 (� �Tr7UAL PERCENTAGE RATE OF 18 .0 0) OR A Responsive. Innovalive. Reliable. g00-266-9954 (717)486-8606 MINIML7M SERVICE CHARGE OF $ 1.00 WILL BE CHARGED www.AlertPharmacy.com ON ALL AMOUNTS 30 DAYS OR MORE PAST DUE STATEMENT OF ACCOUNT IF YOU RECEIVE A NEW INSURANCE CARD FOR YOUR I PRESCRIPTIONS BE SURE TO SUPPLY US WITH A COPY. Date 08/31/2014 _.__.—__._� PMT DTTE 09�24/� 4 � l HERTZLER, RUTH H HERTRU 3O DAYS . 391 . 29 I JULIE QUICKEL GRP-7W _ I � 195 MOUNTAIN VIEW RD PAGE 1 � YORK PA 17404 Amount Paid PLEASE DETACH AND RETURN TOP PORTION WITH���UI8 PAYMENT ALERT PHARMACY SERV. INC.219 NORTH BALTIMORE AVE. MT HOLLY SPGS PA 17065 �' ' e • � � � • � . . ** THIS AMOUNT PAST DUE ** --- -- . 0 0 TOTAL TAX �vious Balance Charges this month Finance Charge TOTAL CHARGES Total Payment&Credits AMOUNT DUE 391 . 29 + . 00 + . 00 = 391 . 29 - . 00 391 . 29 )RALL PHARMACY RELATED INQUIRES PLEASE CALLAIert Pharmacy Services, Inc at 1-8C�0-266-9954 Statement Terminology on reverse _ i' i u . =rom:Sarah Wert Fax:(717)482-4787 To: Fax: +1 (717}838-6912 Page 2 oF? 03I19f2015 1:56 PM i Standard Checlring Statement �p�CBAI�lK �or the psriod 07/1B/2014 to 08HB/2014 �'Fvr 24-hour Informaiion,slgn on to PNC Bank Oniine Hanking RUiN H HERTZLER �on pnacom. Primary accoun[nurnber.5�-7008-041G Pac�e3of4 Check Images R V7N H.HERT2LEA 728� !n DAIf QlAL _ 4r(GUMR�Wl�4�AIW.i3 �� /�`� ^r >r� � . f1��]MEd6 � , � v.,b.:= d�j�1�— _ _� $ �`� �� �/�i�/iP�,�/fL��y� ---- --���93,ov; �; � ';'�_ Q PNCBANK v �,,' �, ,.��,.., u, _— (r//nJ�L��� - �� `^� : �:031312730�: 5070080�,i6••//7281 � '�` ' l� 72s1 $�ss.so OR/01/4014 I I bVitT� YtiC Oniine Banicing,you can view,-pTint and save up to ihe�most recent 9D aays c,7 your canceled c��ecks-froni and 'aack--FRc[o; charge.Please contaci us tor acldiliona!options, P � c C��S y�� � �� � �-- � 3-�� {��� F.� .fi.�: PNDMLT01-J(lR 979fi7-id11.NnInINnINsn�_nnnn.w