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07-31-15 (2)
1505610105 REV-1500 EX(oz-a)(FI) ,$!1 1IS�77 OFFICIAL USE ONLY PA Department of Revenue pennsytvania County Code Year File Number 2 Bureau Individual Taxes _.... _ PO BOX 280601 INHERITANCE TAX RETURN Harrisburg,PA 17128-o6o1 RESIDENT DECEDENT J ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 11/03/2010 01/03/1925 Decedent's Last Name Suffix Decedent's First Name MI Flesher Clarice E (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 O 1.Original Return m 2.Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 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 CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number John F. Lyons,Attorney (717) 238-4777 ........ REGISTER OF WILLS USE ONLY First Line of Address 112 Walnut Street Second Line of Address p O Cil C.. 1 City or Post Office State ZIP Code f 0Ax FI ED O HarrisburgPA 17101 C-0 -� c� c ►--� m Correspondent's e-mail address:jflyonslaw@msn.com Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and tolhe besl of my knoKgge arWlen,* it is true,correctyp complete.Decl a' n of ep rpr otherlhan the personal representative is based on all information of wKich pie�arer has an nowledge SIGNATURE 0 tER� S IBL F R URN ' ADDRESS] 31 Eas i ing , Mechanicsburg, PA 17055 SIGNATU O EP THP SENTATIVE DATE _ ---- zz1 d/✓ ADDRESS 112 W4Xut Street, Harris4g, P 17101 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 J 1505610205 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: Clarice E. Flesher RECAPITULATION 1. Real Estate(Schedule A). ....... ... . ......... ......... ......... ...... 1. `. 138,987.50 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. 1,495.00 6. Jointly Owned Property(Schedule F) O Separate Billing Requested . ... ... 6. 7, Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested.... ... . 7. 8. Total Gross Assets(total Lines 1 through 7). ... ..... .. .......... .. .... .. 8. ' 140,482.50 9. Funeral Expenses and Administrative Costs(Schedule H)... . ..... .... . .. . .. 9. 16,896.85 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)... ..... ... ... . 10. 10,126.50 11. Total Deductions(total Lines 9 and 10).. ... ............... ....... ... ... 11. 27,023.35 12. Net Value of Estate(Line 8 minus Line 11) .. ............ ...... ... .. ... .. 12. 113,459.15 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. '113,459.15 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 at lineal rate X.0 45 113,459.15 16. 5,105.66 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.; 5,105.66 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 150561020-& 1505610205 J REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Clarice E. Flesher STREET ADDRESS 517 East Winding hill Road CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 5,105.66 2, Credits/Payments A.Prior Payments B.Discount 3. Interest Total Credits(A+B) (2) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT, (3) 623.39 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) 5,729.05 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.......................................................................................... ❑ 0 b. retain the right to designate who shall use the property transferred or its income ............. ❑ N c. retain a reversionary interest ............................................................................................................................... ❑ ■ d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ 0 2. If death occurred after Dec. 12,1982,did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................................. ❑ 0 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation? .......................................................................................... ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994,and before Jan. 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1,2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S,§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S. §9116(a)(1,3)].A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-1502 EX+ (12-12) i pennsytvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Clarice E. Flesher 21-12-1033 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 compelled to buy or sell,both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F, Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common, VALUE AT DATE NUMBER OF DEATH DESCRIPTION i, 517 E.Winding Hill Road,Mechanicsburg,Upper Allen Township 138,987.50 Cumberland County,PA 17055(Agreement for the Purchase of Real Estate and Modification of Agreement for Purchase of Real Estate is attached) valuation as assessed by Rept of revenue upheld by Appeals board reported value TOTAL(Also enter on Line 1, Recapitulation,) $ 138,987.50 If more space is needed,use additional sheets of paper of the same size. REV-1508 EX+(08-12) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Clarice E. Flesher 21-12-1033 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, Cremation Society of Pennsylvania(pre-paid) 702.00 2. M&T Bank(account no,33413169)(copy of monthly statement attached) 793.00 TOTAL(Also enter on Line 5, Recapitulation) $ 1,495.00 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+ (08-13) pennsytvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Clarice E. Flesher 21-12-1033 Decedent's debts must be reported on Schedule I, ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES:. Auer Cremation 25.00 2, Cremation Society of Pennsylvania 702.00 3, Rev.Pete Kuelda(service) 75.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2. Attorney Fees: 4,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 322.50 51 Accountant Fees: 6. Tax Return Preparer Fees: 7. Purcell, Krug&Haller(legal fees) 1,093.75 a. Real Estate Taxes(2010, 2011, 2012) 6,956,34 9. Upper Allen Township(sewer 2010 through December 31,2012) 1,297.26 10. Seller's Expenses attributable to sale of real estate: Settlement Statement Attached 1,175.00 R.E transfer taxes$900.00&Deed Prep$250.00 Fees;John F lyons Tax assessment appeal 750,00 TOTAL(Also enter on Line 9 Recapitulation) $ 16,896.85 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+(12-12) pennsytvania SCHEDULE DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Clarice E. Flasher 21-12-1033 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. James R.Harty,M.D, 12.72 2. DCM Services(Sears account) 2,551.31 3. Central Medical Equipment 108.42 4. Howard Ray Cohen,M,D, 9.78 5, West Shore Emergency Medical 10154 6. Diversified Dental Services 65,00 7. Manor Care 5,637.50 8. PP&L 297.58 9. York Waste Disposal 44.82 10. Shipley Energy 495.84 11. Kristi Sassaman(personal care services) 800.00 TOTAL(Also enter on Line 10, Recapitulation) $ 10,126.51 If more space is needed,insert additional sheets of the same size, REV-1513 EX+ (01-10) pennsylvania SCHEDU LEJ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Clarice E. Flesher 21-12-1033 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. Scott E.Flesher lineal 100% 31 E Winding Hill Road,Mechanicsburg,PA 17055 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: 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, OMB Approval No.2502.0265 s•III�III; A.Settlement Statement(HUD-1) a.Type of Loan 1.QFHA 2. RHS 3. ❑✓QonV.Unins. 6.File Number: 7.Loan Number. 8.Mortgage Imurerce Case Number. 4.El VA 5.❑Cony.ins. KWC65076 5801841900 C.Note, This form Is fu fished to she you a statement of actual settlement costs.Amounts paid to and by the settlement agent ere shown.Items marked'(p.o.c)'were pad outside the dosing;they are shown here far informational purposes and are not included in the totals. 0.Name 8 Address of Borrower. E.Name 6 Address of Soler.. F.Name 8 Address of Lender. GAGE A.KOSTER ESTATE OF CLARICE E.FLESHER FULTON BANK,NA 350 KUNKLE MILL ROAD 517 EAST WINDING HILL ROAD ONE PENN SQUARE DOVER,PA 17315 MECHANICSBURG,PA 17055 SUITE 304 LANCASTER.PA 17602 G.Property Location: H.Settlement Agent PINNACLE LAND TRANSFER,LLC I.Seltlemant0ate 517 EAST WINDING HILL ROAD 4242 CARLISLE PIKE,SUITE 151-B, 12119/2014 MECHANICSBURG,PA 17055(CUMBERLAND) CAMP HILL,PA 17011 (717)920-3331 (42.26.0245.037) Place Of Settlement: 4242 CARLISLE PIKE,SUITE 151-B, CAMP HILL,PA 17011 (717)920-3331 :J.Summary offlorrot6i's Transaction K.Summary ofSeller'sTransactlion' 100.Gross Amount Due From Borrower 400.Gross Amount Due To Seller 101:Contract sales price $170,000.00 401.Contract sales price $170,000.00 102.Personal Property 402.Personal Property 103.Settlement Charges to Borrower line 1400 $5,909.66 403. 104. 404. 105• 405. Adjustments for items paid by seller In advance Adjustments for Items paid by seller In advance 106.Ci (town taxes 406.CityAown taxes 107.Coun taxes 12/19/2014 to 12131/2014 $22.73 407.County taxes 12119/2014 to 1201/2014 $22.73 108.Assessments 12/19/2014 to 6130/2015 $1,028.26 408.Assessments 12/19/2014 to 6/30/2015 $1,028.26 109.Sewer 12119/2014.to 12/31/2014 $14.77 409.Sewer 12M912014,to 12/31/2014 $14.77 110. 410. 111. 411. 112. ., 412. 120.Gross Amount Due From Borrower $176,975.42 420•Gross Amount Due To Seller 5171 065.76 200.Amounts Paid B Or In Behalf Of Borrower 500.Reductions In Amount Due To Seller 201,Deposit or Earnest Money $2,000.00 501.Excess deposit see Instructions 202.Principal amount of new loan $136,000.00 502.Settlement Charges to Seller line 1400 $19,111.27 203.Existing1loan taken subject to 503.Existing Joan taken subject to 204. 504.Payoff of first mortgage loan.. 205. 505.Payoff of second mortgage loan 206. 506.See Addendum 506 $6,868.19 207• 507.Payout to Mark Boova $88,604.49 208. 508. 209, 509. Adjustments for Items unpaid by seller Atiustments for Items unpaid by seller 210.Cityltown taxes 510.CityAown taxes 211.County taxes 511.County(axes 212.Assessments 512.Assessments 213. 513. • 214 514 215. 515. 216. 516. ' 217. 517. 218. 518, 219. 519. 220.Total Paid ByfforBorrower,, $138,000.00 520.Total Reduction Amount Duo Seller 5114 563.95 300,Cash At Settlement FromRo Borrower 600.Cash At Settlement TolFrom Seller 301.Gross Amount Due From Borrower line 120 . $176,975.42 601.Gross Amount Due To Seller line 420 $171,065.76 302.Less Amounts Paid By/For-Borrower line 220 $138,000.00 602.Less Deduction in Amt.Due.To Seller fine 520 $114,583.95 303.Cash ✓From ' E]To Borrower $38,975.42 603.Cash ✓QTo From Seller $56,481.81 Previous editlons are obsolete Page 1 of 4 12/19/201410:04 AM HUD-1 700.Total Real Estate Broker Fees 1 a Paid From Paid From Division of CommissEan(line 100)as fWiows: Boaowats Ssiiers 70i.$3,595.00 to Remax i6tAdvantage Funds at Funds at .702.$5,100.00 to Keller Williams of Central PA Settlement Settleriient 703.Commission aid at SetBement $8.695.00 704;Broker Fee to Keller W illams of Central PA i $300.00 800,Items Payable in Corinection With Loan 801.Our origination charge$795.00 i. from GFE#i 802.Your credit orcha e'points for the specific interest rate chosen5850.00 from GFE#2) 803:Your adjusted o inationcha es 1 fromGFEA -$55.00 804.Appraisal Fee to Mark Heckman R.E.Appraisers POC$450,00 by Gage A.Koster from GFE 113 805.Credit Report to Crodstar I from GFE#3 $24.01 1806.Tax service to. from GFE#3 807.Flood Unification to Corel lc Flood Services 1 from GFE#3 $11.50 900.'Items Required By.Lender To Be Paid In Advance l i 901:Daity interest charges from 12/19/2014 to 1112015 @ 16.3014/day to Fulton Bank,NA from GFE#10 $211.92 902.,Mortgage Insurance Premium I: from GFE#3 903.Homeowners Insurance for 12.00 months to Juniata Mutual'Insurance Company from GFE#11) $495.00 1000.Reserves Deposited With tender: 1001.Initiai deposit for your escrow account i, from GFE#9) $1,327.23 ,1002 Homeowners insurance 3.00 months @$41.25 per month$123.75 '1003.Mortage Insurance 12,00 months @ per month I 1004.Property taxes 11.00 months @$57.46 per month$632.06 I 1005.School Taxes 7.00 months @ 5161.61 par month$1,131.27 1 1007.Aggregate Adjustment$559.85 i„ 1100.Title Charges 11D1.Two services and lenders He insurance I from GFE 94 $1,515.00 1102.Settlement or closing fee to Pinnacle Land Transfer,LLC $0.0011 $250.00 '1103:Owners title insurance to Pinnacle Land Transfer,LLC from GFE#5 $170.00 1104,lenders title insurance to Pinnacle Land Transfer,LLC $1,305,00 1105.Lenders tills policy limit $136,000,00 !... 1106.Owner's We policy limit $170,000.00 1. 1107.Agent's portion of the total Utla:insurance premium to Pinnacle Land Transfer,LLC $1,253,75 1108.Underwriters portion of the total tltle Insurance premium to Old Republic Natlonal Title insurance Company $221.25 1109.Closing Protection Letter to Old Republic National Title insurance Company $125.00 1120O.'bovemment Recording and Transfer Char as r '1201.Government recording charges from GFE R) $210.00 1202.0eed$79.00 MoggageV31.00 Releases$ 1203.•Transfeitaxes (from GFE#8 $1,700.00 $1,700.00 1104.Ci /Coun taxlstam s Deed$1,700.00 MortgWs t 1205.State taxistam s Deed$1,700.00 Mo e$ 1300:AddRionai Settlement Char es>' "s '1301.Required services that you can shop for from GFE#6 . 1302.Surve 1303.Pest Inspection 1305.2014 School Taxes to Dennis Zerbe $2,133.24 1306.Tax Car#to Pinnacle Land Transfer,LLC $15.00 1307.2014 County/Township County/TownshipTaxes to Dennis Zerbe 6758.48 '1306.SewenThru 12/31/14 to Upper Allen Township $1,068.04 1309.Radon Mitigation to Central Penn Radon,inc, 1 $765.00 .1310.Tax Claim to Cumberland County Tax Claim Bureau 63,036.51 1311.Home Warranty to Home Buryars Resale Warranity,Corporation i $390.00 1312.Attorney Fees to Attorney John Beinhaur,Esq t $300.00 :1400.Total SeWement Charges(enter on line 103,Sedlon J and 50Z Section K) 55,909.68 519,111.27 Previous editions are obsolete Page 2 of 4 12/19/2014 10:04 AM HUD-1 Compsdeon of Gbod Faith Estimate.(GFE)and HUD4 Charges Good Faith Estimate HUD-1 Charges That Cannot Increase HUD-1 Line Number Our origination charge 9801 $795.00 $795.00 Your credit or charge(points)for the specific interest rate chosen #802 -$850.00 -$850.00 Your adjusted origination charges #803 455.00 455.00 Transfer taxes #1203 $3,400.00 $1,700.00 Charges That In Total Cannot Increase More Than 10% Good faith Estimate HUD-1 Government recording.charges #1201 $184.00 $210.00 Appraisal Fee to Mark Heckman R.£.Appraisers(POC$450.00 by Gage A. #804 $450.00 $450.00 Flood Certification to Corelogic Flood Services #807 $11.50 $11.50 Credit Report to Credstar #805 $60.00 $24.01 # # # $705.50 $695.51 r •$9.99 or -1.416,02 1/6 Charges That Can Change Good Faith Estimate HUD-i initial deposit for your escrow account #1001 $2,800.00 $1,327.23 Daily interest charges #901 . $16,3014/day $489.04 $211.92 Homeownersinsurance #903 $750.00 $495.00 Title services and lender's title insurance #1101 $1,809.00 $1,515.00 Owners titre insurance to Pinnacle land Transfer,LLC 1111103 $25.00 $170.00 # Loan Terms Your initial ban amount is $ '136,000.00 Your.ioan term is 30.00-years Your Initial interesl rete is 4.375+i% Your Initial monthly amount owed for principal,interest,and any $ :679.03 includes mortgage insurance is QPrincipal ✓❑interest ❑MortgageInsurance Can your interest rate rise? ✓❑No. ❑Yes,it can rise to a maximum of %.The first change will be on and can change again every. after Every change date,your interest rate can Increase or decrease by %.Over the life of the loan,your Interest rate is guaranteed to never be lower than %or higher than %. Even if you make psyments on time,can your loan balance rise? R]No.❑Yes,it can rise to a maximum of$ Even If you make payments on time,can your monthly amount Q No. ❑Yes,the first increase can be on and the monthly amount owed for principal,interest,and mortgageinsurancerise? owed can rise to$ The maximum it can ever rise to Is$ Does your loan have a prepayment penalty? ❑✓No.❑Yes,your maximum prepayment penalty is$ Does your ban have a balloon payment? ONo. ❑Yes,you have a balloon payment of$ due In years on Total monthly amount owed including escrow account payments E3 You do not have a monthly escrow payment for Items,such as property taxes and homeowners Insurance.You must pay these Items directly yourself. �]✓You have an additional monthly escrow payment of$ 260.32 that results In a total Initial monthly amount owed of$ :939.35 .This includes principal,interest,any mortgage insurance and any Items checked below: ❑✓Property taxes Q Homeowners insurance ❑Flood Insurance ❑ ❑ 2]-School Taxes Note:If you have any questions about the Settlement Charges and Loon Terms listed on this form,please contact your lender. Previous editions are obsolete Page 3 of 4 12Jig/201410:04AM HUD-1 Supplemental Page HUD-1 Settlement Statement Addendums for Page 1 Amount Addendum 506 a.PA Inheritance Tax to John F.Lyons,Attorney at Law $6,868.19 b.Earnest money retained by Gage A.Koster $0.00 Total: $6,868.19 Itemization Buyer Seller Line 1101 a.E-Doc Fee to Pinnacle Land Transfer,LLC $50.00 b.Overnight Fee to Pinnacle Land Transfer,LLC $15.00 c.Notary Fees to Michelle L.McClung $20.00 Total: $85.00 $0.00 Line 1102 a.Attorney's fees to John F.Lyons,Attorney at Law $0.00 $250.00 Total: $0.00 $250.00 I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief it Is true and accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further certify that I have received a copy of the HUD-11 Settlement Statement. BORROWERS .. SELL S f GAGE A.KOSTER ESTATE OF CLARICE E.FL HER The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction.i have caused or t will cause the funds to be disbursed in accordance with this statement. e em t Ag n rt Date 1211912014 RE Agreement Purehase AGREEMENT FOR THE PURCHASE OF REAL ESTATE ' THIS AGREEMENT is made and entered into as of this day of L� w 2012, by and between The Estate, of Clarice E. Fleisher, by its Executor Scott E, ieisher, and (hereinafter referred to as "Seller"), and, Mark A. Boova and Jeffrey S. Norf6rd, adult individuals, their assigns or nominees whose address is (hereinafter referred to as "Buyer"). WITNESSETH, that for the consideration hereinafter set forth and intending to'be legally bound hereby, the parties hereto mutually agree as follows: I. PROPERTY: For the consideration hereinafter stated, Seller does hereby promise, and agree to sell to Buyer, and Buyer does hereby promise and agree to purchase from Seller, the following certain real estate subject to the terms and conditions of this Agreement: Land. All that certain tract or piece of land known as 517 East Winding Hill Rodd,Upper Allen Township, Cumberland County, Pennsylvania, together with all right,' title and interest of Seller in and to any land lying in the bed of any highway, street, road or avenue, open or proposed, in front of or abutting or adjoining such tract or piece of land and any easements and appurtenances pertaining thereto. Improvements. All the buildings, structures and other improvements situated on the Land, The Land and Improvements are jointly hereinafter referred to as the "Property". The parties hereto acknowledge and agree that the Improvements are accepted by the Bayer in its (Cas is" condition, The Seller has made no representation of any kind or type as to the condition of the Improvements. 2. PURCHASE AND SALE: Seller agrees to grant, transfer and convey and Buyer, or a designated entity, agrees to purchase the Property for the sum of Ninety 'Thousand ($90,000,00) Dollars (the. "Purchase Price"). 3. PAYMENT OF PURCHASE PRICE: The payment of the Purchase Prioe, shall be as follows: a. Buyer shall upon the execution hereof deliver to Seller the sum of Five Thousand Dollars, ($5,000.00), hereinafter referred to as th6, "Earnest Money Deposit" to be held by Seller or their agent or attorney. b. Buyer shall on or before December 13, 2012, deliver to Seller the sum of Two Thousand, Five-Hundred Dollars, ($2,500,00) on account of the Purchase Price, as additional Earnest Money Deposit, C. Commencing January 13, 2013, and monthly thereafter, Buyer 118hall -pay the sum of Five Hundred Dollars ($500.00), through December 13, 2013 as additional Earnest Money Deposit, d. Commencing January 13, 2014, and monthly thereafter, Buyer shall pay the sum of One Thousand Dollars ($1000.00), through December;14, 2014, as additional Earnest Money Deposit. e. The balance of Sixty Four Thousand, Five Hundred Dollars ($64,500.00) shall be paid in full on or before December 13, 2014, at which. time the parties shall close and transfer title to the property. 4. TITLE: The Property shall be conveyed to Buyer by Seller's special warranty deed (the "Deed") in recordable form, conveying good and marketable fee simple title'insurable at regular rates charged by a reputable title insurance company free and clear of all fiens and tenancies and subject only to easements and restrictions of record. Seller shall not intentionally further encumber the title to the Property between the date of this Agreement and the date of Closing(as defined herein), with the exception of monetary encumbrances from bank liens which can be paid at Closing. Other than monetary obligations which shall be paid at Closing by Seller, if title to the Property cannot be conveyed to Buyer at the time of Closing in accordance with the requirements of this Agreement, Buyer shall have the option of: (i) taking such title as Seller can cause to be conveyed and waiving the unfulfilled condition, without abatement of the Purchase Price, whereupon the parties shall consummate the transaction herein contemplated and the provisions relating to the condition of title shall be deemed waived by Buyer; or (ii) terminating this Agreement by written notice to Seller, whereupon this Agreement shall be deemed terminated as of the date of such notice, the Earnest Money Deposit and any interest earned or accrued thereon, shall be returned to Buyer, and neither Seller nor Buyer shall be further obligated to the other, 5. CLOSING: Closing (the "Closing or Close") shall be held on or before December 13, 2014 at a place to be mutually agreed upon by and between Seller and Buyer. Possession may be given to Seller prior to Closing, as the parties may agree. 6. CLOSING EVENTS: At the Closing, the following shall occur: a. Seller shall deliver the Deed in recordable form, duly executed and acknowledged; b. Buyer shall pay the balance of the Purchase Price.to Seller. 2 7. PRORATIONS: The prorations shall be as follows: a. No proration of real estate taxes and assessments. Seller shall pay all real estate taxes through December 31, 2012, after which Buyeri shall be responsible for the real estate taxes and assessments thereafter. b. No proration of municipal service fees. Seller shall pay all Municipal service fees through December 31, 2012, after which Buyer shall be responsible for the municipal service fees thereafter. C. The cost of real estate transfer taxes shall be paid by Buyer And Seller equally; d. Seller shall pay the cost of preparing the Deed; and el All recording fees for the transfer of title, Buyer's counsel feet, and the, cost of any title search and title insurance policies shall be paid b Buyer, 8. SELLER REPRESENTATIONS: Seller represents and warrant;, which representations and warranties shall survive the deed, to Buyer that: a. Seller owns good and marketable title to the Property, b. Seller has full power to execute and deliver this Agreement, 0. Seller has obtained all necessary authorizations and consents to enable it to execute and deliver this Agreement and the transfer documents to consummate the transaction contemplated hereby. d. There is no pending, or to the best of Seller's knowledge, threatened, litigation, condemnation or other proceeding affecting the ownership, operation,maintenance or use of the Property or Seller, e. During the period between the date hereof and the Closing, Selle,r shall not default in any material respect in the performance of any of the terms, covenants and conditions to be perfon-ned by it relating to the Property, f. There are no existing leases, licenses or other rights to occupy, whether oral or written, affecting the Property except the Sign Lease, 9. Seller shall pay homeowners insurance insuring the property through Closing, 9, BUYER REPRESENTATIONS: Buyer represents and warrants to Seller, which representations and warranties shall survive the Closing that: 3 a. This Agreement has been duly authorized by all necessary action on the part of Buyer and constitutes the legal, valid and binding obligation of Buyer, enforceable against Buyer in accordance with its terms, During the period between the date hereof and the Closing, Buyer shall not default in any material respect in the performance of any of the terms, covenants and conditions to be performed by it relating to the:Property. During the period between the date hereof and Closing, Buyer rriay make, improvements, but shall not reduce the value of the property, or otherwise cause waste to the property prior to closing. 10. BUYER'S DEFAULT: Should the Buyer violate or fail to perform any of the, terms or conditions of this Agreement including Buyer's failure to Close under the terms and conditions of this Agreement, Seller, as its sole remedy, may terminate this Agreement and retain the Earnest Money Deposit, and all payments made thereafter, and any interest earned or accrued thereon, as liquidated damages and this Agreement shall become null and void with no further obligations or liabilities of the Parties. All improvements or additions to the property', made by Buyer shall become the property of Seller. 11 SELLER'S DEFAULT: Should the Seller violate or fail to perform any of the terms or conditions of this Agreement, Buyer may, at its election, terminate this Agree'rnent and recover the Earnest Money Deposit, and all payments made thereafter, and any interest i eamed or accrued thereon or Buyer may require Specific Performance, The damage amounts in Paragraphs 10 and 11 are acknowledged to be full and sufficient and the remedies of the parties are limited to those set forth in such paragraphs. 12, CONDEMNATION: If, prior to Closing, the entire Property is ;taken by proceedings in condemnation, this Agreement shall terminate and Buyer shall have rro right to receive any compensation or damages awarded in such proceedings. Should only apart of the Property be so taken, Buyer shall have the option of terminating this Agreement or proceeding hereunder as to the balance of the Property, in which event Seller shall assign to Buyer all damages awarded in such proceedings. 13. RISK OF LOSS: Any and all risk of loss arising from ownership of the Property shall be borne by Seller until Closing. If the Property is damaged by fire or other cause prior to Closing, Buyer may elect to proceed to Closing without reduction in the Purchase Price and Seller shall assign any insurance proceeds payable in connection with the damages to,Buyer, or Buyer may terminate this Agreement, and neither party shall have any farther liability or obligation hereunder. 14, LISTING AGREEMENTS: Seller represents and warrants that thet'e are no effective listing agreements in connection with this sale with any Real Estate Broker or Agent. 4 15, NOTICES: All notices provided for in this Agreement shall be dfirected by registered or certified mail to the parties at the addresses set forth below, or at s�lch other addresses as the parties shall designate to each other, in writing. If to Seller, to: Estate of Clarice E. Fleisher c/o Scott E, Fleisher 31 East Winding Hill Road Mechanicsburg, PA 17055 With a copy to: Howard B. Krug, Esq. 1719 North Front Street Harrisburg, PA 17102 If to Buyer, to: Mark A, Boova 515 East Winding Hill Road Mechanicsburg,PA 17055 Or Jeffrey S. Norford 1521 Grandview Ave Mechanicsburg PA 17055 16, GOVERNING LAW: This Agreement shall be construed, interpreted and governed under and in accordance with the Laws of the Commonwealth of Pennsylvania without regard to its conflict of laws'provisions, 17, AMENDMENTS: This Agreement shall not be amended except in writing executed by both Seller and Buyer. i& ASSIGNMENT. Buyer shall not assign this Agreement without the pribr written consent of the Seller, which consent shall not be unreasonably withheld. Upon such assignment, Buyer shall remain liable and shall not be relieved of its contractual obligations hereunder. 19, ZONING CLASSIFICATON: The, zoning classification of the Property is Residential. 20, ATTORNEY'S FEES: If either party commences an action against!the other party arising out of or in connection with this Agreement, the prevailing party shall be entitled to have and recover from the losing party reasonable attorneys' fees and costs of suit, 21, TIME IS OF THE ESSENCE: Time shall be of the essence in respect to the performance by each party of its rights and obligations with respect to the exercise of this Agreement, including, without limitation, the conduct of Buyer's inspections and due diligence, 5 the giving by either party of any notices required hereunder, and the Closing of the pt rchase of the Property, 22. ENTIRE AGREEMENT: This Agreement shall be binding upon and inure to the benefit of the parties hereto, their respective heirs, executors, administrators, successors or assigns, This Agreement constitutes the entire understanding and agreement between t.lie parties and supersedes all prior written and oral and all contemporaneous oral agreeffients or understandings between the parties with respect to the subject matter hereof. No variation of the terms and conditions of this Agreement shall be effective unless in writing signed by both parties hereto, 23, COUNTERPARTS: This Agreement may be executed in multiple counterparts, with each fully executed counterpart deemed to be an original, and all such counterparts, taken together, constituting one and the same instrument. 24, REAL ESTATE RECOVERY FUND: A Real Estate Recovery Fund exists to reimburse any person who has obtained a final civil judgment against a Pennsylvania teal estate licensee owing to fraud, misrepresentation, or'deceit in a real estate transaction and who has been unable to collect the judgment after exhausting all legal and equitable remedies. Fori complete details about the Fund, call (717) 783-3658. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the day and year first above written. WITNESS: SELLER: The Estate of Clarice E. Fleisher By Scott E. Fleisher BY: 8R'ecutor WITNESS: BUYER: � I �� j J Mark A. Boova z � �� ) WITNESS: BUYER: Jeffrey S. Norford 6 MODIFICATION OF AGREEMENT FOR PURCHASE OF REAL ESTATE THIS AGREEMENT made this day of ii, 2014 by and betweOn Scott E. Flesher, Executor of the Estate of Clarice E. Flesher ("Seller") and Mark A. Boova, ("Buyer"), WHEREAS, Executor and Buyer entered into a written agreement ("Agreement") dated September 14, 2012, wherein Seller agreed to sell and Buyer agreed to, purchase certain real estate commonly known and numbered as 517 East Winding Hill goad, Upper Allen Township, Cumberland County, Pennsylvania ("Property"). WHEREAS, the Agreement, in paragraph 3, provided-for Buyer to make certain periodic payments which are designated "Earnest Money Deposit" and additional "Earnest Money Deposit" to be held by Seller or the agent or attorney, WHEREAS, such "Earnest Money Deposit" are to accrue until the close and transfer of title which is to occur on or before December 13, 2014 at which tirne, the entire remaining balance of the purchase price Sixty-Four Thousand Five Hundred ($64,500,00) Dollars shall be paid in full. WHEREAS, the parties also understood that Seller would use the funds received from Buyer to pay charges and expenses which are liens against the property; and which were then in arrears, but such use of the funds was not expressly provided for in the Agreement. WHEREAS, the parties desire that such use of the "Earnest Money Deposit" and additional "Earnest Money Deposits" by Seller be-adequately memorialized and document that Buyer consents to such use of the deposited funds, NOW THEREFORE, in consideration of the mutual obligations set forkin the Agreement, the mutual obligations and premises set forth in this Modification Agreement, the Buyer and Seller hereby covenant and agree as follows: 1. The Agreement is modified to permit the use by Seller of the Earnest Money Deposit and the additional Earnest Money Deposit to pay such charges:: , bills and expenses chargeable as liens against the Property such as real estate taxes, municipal lien charges and waste removal fees which have accrued prior to December 31, 2013 which are the responsibility and obligation of Seller under the terms of the Agribement, Paragraph 7 aft. Buyer consents to the use of the deposited funds for such purpose: by Seller. 2. At closing, Seller shall be entitled to credit against the purchase 'price for such Earnest Money Deposit and/or additional Earnest Money Deposits that have been expended, 3. Paragraph 11 shall be modified and -amended to provide that in the event of default by Seller, that Buyer may recover so much of the Earnest Money Deposit as remains in escrow. Buyer may also seek to recover the balance of the payments made by Buyer but expended by Seller by action at law or Buyer may require Specific Performance. The limitation on damage amounts set forth in paragraphs 10 and 11 are not changed, modified or amended hereby but remain in full force and effect, 4. All other terms and conditions of the Agreement shall remain in full force and effect, 2 IN WITNESS WHEREOF the parties have thereto set forth their hands;and seals r - A10. this day of-Apr , 2014, Seller: The Estate of Clarice E, Flesher Witness. By: Scott E, F sher, Executor Buyer, Witness: �. By. Mar/k A. Boa 3 STATE OF PENNSYLVANIA ss: COUNTY OF ON THIS, the day of 2014, before me, a notary public, the undersigned officer, personal)l appeared, Scott E. , Flesher, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purpose therein contained, IN WITNESS WHEREOF, I have hereunto set my hand and seal. 671 Notary Public .0 1jQU,,L:NN� IIA My Commission Expires: �YLVAN W NOTARIAL SEAL JILL SMEIGH,Notary Publio P My Commission Tvvp,Cumberland County Comml�T�'v e� My CommIsslon Explrer,February 12,2017 STATE OF PENNSYLVANIA ss: COUNTY OF ON THIS, the day of 2014, before me, a notary public, the undersigned officer, persoKally appeared, Mark A.i Boova, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and seal. Notary Public'j My Commission Expires: NOTARIAL 0 LV&aUpE_122.,NN',-,YLVANIA NOTARIAL SEAL JILL SMEIGH,Notary Publio Hampden Twp-,Cumberland County mis" My commi6slon Expires February 12,2017 4 j'' .. ::A:: �. ... .................... ....AGS.OW�tT...•T ................... $r:f.EM: :T` P : G:R P..3 > : . 33413169 RELATIONSHIP CHECKING WITH INTEREST OCT.22-NOV.19,2010 1 OF 5 00 0 06117M NM I17 15519 CLARICE E: FLESHER 517 E WINDING HILL RD MECHANICSBURG PA 17055-4911 INTEREST PAID YEAR TO DATE 0,22 MECHANICSBURG ACCOUNT SUMMARY i:;iii:ii :;iii:iii:i;ii iii•:iii :isiiiQT,::FI&R;...........::.....•::..G4#RRRN........ ....... ...E I ..... . ...... ..S.US::isRA0.T.10NSz:.:::;:<::.:,.tt1t• R£St...P.D NO. AMOUNT NO.7 AMOUNT NO. I AMOUNT 1,015.89 21 1,365.00 121 2,261.17 6 1 1171 .72 0.00 ACCOUNT ACTIVITY ACTIVITY .......... ;... ..•:....•......;..•...:......:A�PQS .+�,TN..£RSS::: �'..£GK"S;&•.Q:kM: isi 'i• : :t?: .., .. .. . .. ::::6A C.E.:........:....:..:...... ��.f�AN&AC.GxON•:.b.E56`"RII•.IdN..:,...::......:,:.::.:..•..&•..b.Tf�ER•: Db.Ih�.ZONS. SU8>:�tAE;�` b i::•>:::;:;:::;BALf%t2CE::::: :i::i:: 10-22-10 BEGINNING BALANCE $1,015.89 10-26-10 CHECK NUMBER 1926 400.00 10-26-10 CHECK NUMBER 1931 200.00 415.89 10-28.10 CHECK NUMBER 1932 110.00 10-28-10 VERIZON MAIN BILL PAY 66,32 10-28-10 CHECK NUMBER 1928 51.17 10-28-10 CITICORP SEAR CITI PYMNT 50.00 10-28-10 BILLMATRIX BILL PAY 3.50 134.90 11-01-10 CHECK NUMBER 1934 500.00 11-01-10 AMER,GEN.LIFE-OK INS PREM 4.90 370.00- •-11-03-10 US TREASURY 303 SOC SEC 1,363.00 11-03-10 CHECK NUMBER 1935 200.00 793.00 11-04-10 CHECK NUMBER 1927 100.00 693.00 11-05-10 CHECK NUMBER 1938 450.00 243.00 11-08-10 CHECK NUMBER 1939 100.00 11-08^10 CHECK NUMBER 1941 50.00 11-08.10 CHECK NUMBER 1936 25.00 68.00 11-12••10 CHECK NUMBER 1940 75.00 7.00- 11-1.5-10 INSUFFICIENT FUNDS FEE-CHECK NUMBER 1940 37.00 44.00- 11-191-10 SERVICE CHARGE 10.00 11-19••10 DIRECT DEPOSIT REBATE 2.00 52.00- ENDING BALANCE _ S52.00- •C R•� �. �P.. ..S Y. 1926 10-26-10 400.00 1927 11-04-10 100.00 1928 10-28-10 51.17 1931* 10-26-10 200.00 1932 10-28-10 110.00 1934* 11-01-10 500.00 1935 11.03-10 200.00 1936 11-08-10 25,00 1938* 11-05-10 450.00 1939 11-08-10 100.00 1940 11-12-10 75.00 1941 11-08-10 50.00 L008A.(8/07) .::........ . ; :: :R. 00 E 33413169 RELATIONSHIP CHECKING WITH INTEREST OCT.22-N0V.19,2010 2 OF 5 CLARICE E: FLESHER OVERDRAFT AND NSF:FEE SUMMARY . . 4.. L:::F-0 FQR.. HIS....•....... .............A..Ah.,"FOR.... SRNDA- ...... ... :i iiiS:fA'iE�fFiT TOTAL INSUFFICIENT FUNDS (NSF) FETES $.00 $74,00 TOTAL OVERDRAFT FEES $.00 $573.00 OVERDRAFT & NSF FEE WAIVERS, REVERSALS & REFUNDS - $37.00 TOTAL OVERDRAFT & NSF FEES LESS ANY WAIVERS, REVERSALS & REFUNDS $.00 5610.00 Total Insufficient Funds (NSF) Fees include per item fees charged when we return an item unpaid because there are not sufficient funds in the account to cover the item, Total Overdraft Fees include Per item fees charged when we pay an item that overdraws the. account as well as any Extended Overdraft Fees charged to the account. Overdraft & NSF Fee Waivers, Reversals & Refunds are only included in the year-to-date numbers even if a waiver or refund was applied to your account during the statement cycle, ANNUAL PERCENTAGE YIELD EARNED a 0.00 BEGINNING JANUARY 27,2011, THE EXTENDED OVERDRAFT FEE WILL BE REINSTATED FOR M&T CHECKING ACCOUNTS, IF YOUR ACCOUNT IS OVERDRAWN, WE WILL CHARGE YOU $10 FOR EVERY $ BUSINESS DAYS FOR UP TO 40 BUSINESS DAYS UNTIL YOU PAY US ALL AMOUNTS OWED. YOU WILL NOT BE CHARGED IF THE OVERDRAFT IS SOLELY ATTRIBUTABLE TO ATM AND EVERYDAY DEBIT CARD TRANSACTIONS AND YOU HAVE NOT ELECTED TO PERMIT US TO AUTHORIZE AND PAY THESE TRANSACTIONS WHEN YOU DO NOT HAVE SUFFICIENT AVAILABLE FUNDS IN YOUR ACCOUNT, REMEMBER, YOU CAN MAKE OR CHANGE THIS ELECTION AT ANY TIME. L008A(8107) ir1A'1 or�s�nyf�� C AVER CREMA10N,, S" y PENNSYLVANIA, INC. 4100 Jonestown Road • Harrisburg,PA 17109 • 1.804.720-8221 • Fax 717.541.9943 • Shawn E, Carper,Supervisor SYLVANIi'`� t . ';'. .Ii.:.,' r,,fit� il..`• / >,. + 1'11'.1 �;'\ . is t ,: 101123 AS-5 Nov 4 , 2010 Mr . Scott* .E. Flesher ;.. •r ,t: 517 East ,Winding' Hi 1 1 Road Mechanicsburg; PA 17055 s ... V, Clarice Clarice E, Fresher - Deceased`,iw,..-v SPECIAL CHARGES X Direct Cremation' $1 ,495 . 00 Nationwide Guarantee Program Worldwide Travel Protection ` ' TOTAL SPECIAL .CHA.RGES PROFESSIONAL _SERVICES i .; i'.. :•i nt il.::. ` D1, . & aff Included X 'Services ,o,f Funeral�i+ rectorSt Other Preparation, crty thei . Body, Fac'i l'i ti-esu'& `St`aff ,'ftr 'Memor'ia.l: Servhtce S ta,f & Equ`i pmen't +a'r Memorial` Service Witnessing the CreidVt i on'.. i : • ,, Private'' Fam'ily Viewing/Witnessi;ng Cremation Packaging Anid 'V6irvt'ard;i•ng Cremated. Remains X Personal Del iv"dry`;6V Cremated Remains $85._;y.0.' '•! Scattering of (Cremiaite•d' Remains ,J 3 Medical Documgms/0ourier'Fee �•. TOTAL. PROFESSIONALs••SM--VTCES i .•i . i.,. $85 .00 AUTOMOTIVE EQUIPMENT X:.1S.Reit�bval' Vehi;d`}1l'e .f. ,. :s , .�, 'i:ti;aji::i i'• —nalude-d Lead Car/Clergy Car Family Car Service Vehicle TOTAL AUTOMOTIVE EQUIPMENT $0 .00 G'l�ncR G'. ,5a(c�rs oS G'l 1940 h ?r c 76fr of 'T F7d, � �(!o'J1- .(�duurrt�r6u{y, sr:( r7r��8•�>� .R-h+-� d^c �- nwn,Frcnm�a,u9rnwcrre`nasrcataun 4t�3i3p2R5S�: 33ki3i69�'iRkO Check #1940 Paid r11/12/2010 475,00 c .hl i A y 1^ ' m Z �' w Check 91940 Paid t11/12/2010 475.00 177 .:4Nr :.•n.:;r a; .: ::.:. .; .:.T':-i.a :.: <:. . (.1f_-+�: ,,niwa+l► 1w?IF� •l.iRr'I'1#l:X^°^gf+4 .. �f�(�I,�.OKK•�"NQ.`:�7/F .y.h. oa;�; x{� 1719 North front Steleet Harrisburg, PA, 1710212392 . Phone (717) 234-4178 Fax (717) 233-1149' ' June 18, 2013 Invoice# 55842 HBK Estate of Clarice E. Flesher Our file# F01069-38902 C/o Scott E. Flesher, Executor Billing through 06/17/2013 517 E.Winding Hill Road Mechanicsburg,PA 17055 RE: Probate Estate Balance forward as of last bill dated 05/14/2013 - $143.75 Net balance forward $143,75 Billing Summary Total of new charges for this Invoice $0.00 Plus net balance forward - $143.75 Total balance now due $143.75 FORM NO.864 /.'•��- -• RECEIPTbate `� No, 2-26389 Received From AL"J. Address - ' _ Dollars �,.( 11.x. � .---•-�-.� - For K ,c� - :3 S�`r�.c� Z, F—How Paid Balance Due BY(' ^v- - �_ �..9'�T:. ,.ialr.ni";-�.'tat�t.�ts s.r;aG�« • :aa1;'�.: :.n..r�vr:sc..,,F ,. _ _-- ,_ l718North Front Street Harrisburg, PA 17102-2392' Phone /7I7\ 234'4178 Fax /717\ 233-1149 January 4/ 2O13 IDvoice# 53740 HBK Estate ofClarice E. Flesher Our0e# F01069'38902 8UU2O Billing o/oS�o�E.Roshe� Exooutor — --' 617 E.Winding Hill Road Mechanicsburg,PA17OSG RE:Probate-Estate Balance forward usoflast bill dated 12/03/201I $493.75 Payments received since last bill $50.00 Net balance forward $443.75 PROFESSIONAL SERVICES 12/06/2012 ASE Prepare Notice toBeneficiary and Certification tnbefiled with Orphans'Court 0.50 12/06/2012 H8K Correspondence client 0.35.. ' Total fees forthlsbill $150l0 Billing Summary ASE Shaffer,Angela S O.SOhm 125.00 /hr $62.50 H8K Krug,Howard B 0.35hm 250l0 /hr $87.50 Total professional services $15O.00 Total ofnew charges for this Invoice $150.00 Plus net balance forward $443.75 Total balance now due FOR YOUR CONVENIENCE: YVEACCEPT VISA MASTERCARD AND DISCOVER 17I9North Front Street Harrisburg, PA 17102-2392 Phone /717\ 234-4178 Fax(717) 233~114q November 3, 2O12 |nvoCe# 52978 HBK Estate ofClarice E. Flasher OurO|e# F01069-38902 c/o Scott E. Flesher, Executor Billing through 11/02/2022 617 E.Winding Hill Rood Mechanicsburg, PA 17056 RE: Probate-Estate Balance forward asoflast bill dated 09/24/2012 $406.25 Net balance forward $40$.25 PROFESSIONAL SERVICES 10/I7/2012 HBK Correspondence Executor 0.35 Total fees for this bill $87.50 HBK Krug, Howard 8 0.35hrs 250.00 /hr $87.50 Total professional services $87,50 Total ofnew charges for this Invoice $87.50 . Plus net balance forward $406.25 Total balance now due , FOR YOUR CONVENIENCE: VVEACCEPT VISA MASTERCARD AND DISCOVER gaxodl ' C(� 1719N0rthFrVDtQtr2et Harrisburg, PA 171O2-2392 Phone (717) 2 �4~4178 Fax (717) 23S'1149 September 24, 2V,12 |nvo\oe# 52274 H8K Estate ofC|adOurO\e# FD1U69-389O2ceE. Flesher 8U|\n8�hrou�hO9/21/2012 c/o Scott E.F\eshe� Executor 517E.Winding Hill Road Mechanicsburg,PA 17055 RE: Probate Estate PROFESSIONAL SERVICES 08/16/202 ASE Prepare Petition for Grant nfLetter; Prepare form SS4; Prepare Personal Reb 0.50 letter;Te|eoonRegister ofWills 08/16/2012 HBK Office conference client 1.25 ^ ' 09/12/2012 ASE Office conference John Purcell re:Sales Agreement 0.25 Total fees for this bill . $406.25 Billing Summary ASE Shaffer,Angela S O.75ho 125.08 /hr $93.75 H8K Krug,Howard B 1.25 hrs 250.00 /hr $312.50 Total professional services $406.25 Total ofnew charges for this Invoice $406.25 Total balance now due ' FOR YOUR CONVENIENCE: WE ACCEPT VISA MASTERCARD AND DISCOVER y :,,,_� COUNTY OF CUMBERLAND 4 T- TAX CLAIM BUREAU a T; ONE COURTHOUSE SQUARE CARLISLE PA 17013-3389 Phone 717-240-6366 Fax 717-240-7835 Received frpm: SCOTT FLESHER Date: 09/26/2014 Payment Type: Check# CA Receipt#: 1138 Mailed In RE!ceived by: JMC Quantity Description Amount 8 COPY FEE $2,00 I 1 i Total Received: $2,00 OFFICE OF THE Cumberland County Tax Claim Bureau One Courthouse Square Room 106 Carlisle PA 17013 Phone 717-240-6366 Fax 717-240-7835 MENOMWAVAIMINEW so= Payor: Rec4lpt#:0009-05-76-2010 JC F-LESHER,THOMAS J & CLARICE Final Partial Payment For Tax Year 2010 517 EAST WINDING HILL ROAD MECHANICSBURG PA 17055 DATE: 06/76/0009 i Owner; Control*42-001558 f-LESHER,THOMAS J & CLARICE Mao#:42-26-0245-037 517 EAST WINDING HILL ROAD TOPNSHIP OF UPPER ALLEN MECHANICSBURG PA 17055 E 51 E WINDING HILL ROAD LOT 100 DELINQUENT TAX YEAR PAYMENT - 2010 YEAR DESCRIPTION FACE j PENALTY I INTEREST TOTAL 2010 SCHOOL $1'508.36 $150.84 $226.20 $1,885.39 YEAR CHARGES BUREAU POSTAGE JADVERTISING[ MISC. TOTAL 2010 COSTS $124.00 $56,25 $0.00 $0.00 $180,25 TOTAL PAYMENT* $2,065.64 Payment Method/Receipt Comments: CASH Interest Calculation Date: 9/14/2012 Summary of delinquent taxes due if paid before the last day: September,2014 2013 $2,977.98 TOTAL $2,977.98 Received Payment: ic Thank you for your payment/ OFFICE OF THE Cumberland County Tax Claim Bureau One Courthouse Square Room 106 Carlisle PA 17013 Phone 717-240-6366 Fax 717-240-7835 Payor: Receipt#:0009-19-93-2011 MM FLE6HER,THOMAS J&CLARICE Final i Partial Payment For Tax Year 2011 617 EAST WINDING HILL ROAD MECHANICSBURG PA 17055 DATE: t9/93/0009 Owner: FLESHER,THOMAS J &CLARICE Control#: 42-001558 517 EAST WINDING HILL ROAD Mao#:42-26-0245-037 MECHANICSBURG PA 17055 TOWNSHIP OF UPPER ALLEN 517 E WINDING HILL ROAD LOT 100 05%11WRIMMEW FIXIMMM DELINQUENT TAX YEAR PAYMENT - 2011 YEAR DESCRIPTION j FACE , I PENALTY .1 INTEREST TOTAL 2011 COUNTY $85.02 $0,00 $1,92 $86,94 2011 LIBRARY $23.49 $2.35 $1.98 $27.82 2011 TOWNSHIP $212.24 $21.22 $17,49 $260.95 2011 SCHOOL $1,877,96 $187.80 $154.88 $2,220.64 YEAR CHARGES —1—BUREAU I POSTAGE JADVERTISINGI MISC. TOTAL 2011 COSTS $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL PAYMENT: $2,586,35 Payment Method/Receipt Comments: CASH Interest Calcilation Date: 12/28/2012 Summary of delinquent taxes due if paid before the last day: September, 2014 2013 $2,977,98 TOTAL $2,977.98 Received Payment: MIA DUPLICATE RECEIPT Thank you for youro�Znentl OFFICE OF THE .Cumberland County Tax Claim Bureau One Courthouse Square Room 106 Carlisle PA 17013 Phone 717-240-6366 Fax 717-240-7835 Payor: Recolpt#: 0009-10-49-2011 ic FLESHER,THOMAS J &CLARICE Final'Partial Payment For Tax Year 2011 517 EAST WINDING HILL ROAD MECHANICSBURG PA 17055 DATE: 1.0/49/0009 Owner: Control#: 42.001558 FLESHER,THOMAS J &CLARICE Map#:42-26-0245-037 517 EAST WINDING HILL ROAD MECHANICSBURG PA 17055 TOWNSHIP OF UPPER ALLEN 517 E WINDING HILL ROAD LOT 100 DELINQUENT TAX YEAR PAYMENT - 2011 YEAR DESCRIPTION FAC EI PENALTY INTERESTT TOTAL I 2011 COUNTY $227.48 $31.25 $18.72 $277,45 YEAR CHARGES BUREAU I POSTAGE' JADVERTISING1 MISC. TOTAL 2011 COSTS $15.00 $7.65 $0.00 $0.00 $22,55 TOTAL PAYMENT: $300.00 Payment Method./Receipt Comments: CASH Interest Calculation Date: 9121/2012 Summary of delinquent taxes due If paid before the last day: September,2014 2013 $2,977.9.8 TOTAL $2,977.98 Received Payment: ic DUPLICATE RECEIPT Thank you for your paymentl OFFICE OF THE Cumberland County Tax Claim Bureau One Courthouse Squaro, Room 106 Carlisle PA 17013 Phone 717-240-6366 Fax 717-240-7835 Payor: Receipt#: 2013-05-15-2954 MFM FLESHER,THOMAS J & CLARICE Partial Payment For Tax Year 2012 31 EAST WINDING HILL ROAD Mechanicsburg PA 17055 DATE: 06/15/2013 Owner: Control#: 42-001558 FLESHER,THOMAS J & CLARICE Mao,#:42-26-0245-037 31 EAST WINDING HILL ROAD TOWNSHIP OF UPPER ALLEN MECHANICSBURG PA 17055 517E WINDING HILL ROAD LOT 100 VARMW DELINQUENT TAX YEAR PAYMENT - 2012 YEAR DESCRIPTION FACE PENALTY INTEREST7 TOTAL 2012 COUNTY $286,64, $31,25 $9.36 $327.25 YEAR CHARGES BUREAU POSTAGE , JADVERTISING1 MISC. TOTAL 2012 COSTS $15.00 $7,75 $0.00 $0.00 $22,75 TOTAL PAYMENT* $350.00 Payment Method/Receipt Comments: CASH Interest Calculation Date: 5/15/2013 Summary of delinquent taxes due If paid before the last day: September,2014 2013 $2,977.98 TOTAL $2,977,98 Received Payment: MFM DUPLICATE RECEIPT Thank you for your pgZaentl OFFICE OF THE Cumberland County Tax Claim Bureau One Courthouse Square Room 106 Carlisle PA 17'013 Phone 717-240-6366 Fax 717-240-7835 Payor: Receipt#: 2013-09-18-6003 MFM FLESHER,THOMAS J &CLARICE Partl6l Payment For Tax Year 2012 31 EAST WINDING HILL ROAD Mechanicsburg PA 17055 DATE: 09/18/2013 Owner: Control#: 42-001558 C M E FLESHER,THOMAS J & CLARICE Map#:42-26-0245-037 31 EAST WINDING HILL ROAD MECHANICSBURG PA 17055 TOWNSHIP OF UPPER ALLEN 5171E WINDING HILL ROAD LOT 100 DELINQUENT TAX YEAR PgYMENT - 2012 YEAR DESCRIPTION FACE PENALTY INTEREST i TOTAL 2012 COUNTY $25.8$ $0.00 $0,76 $26,62 2012 LIBRARY $23.49 $2.35 $1.44 $27.28 2012 TOWNSHIP $230.02 $23.00 $13.84 $266.86 2012 SCHOOL $0.00 $65,40 $113.84 $179,24 YEAR CHARGES BUREAU I POSTAGE JADVERTISING1 'MISC. I TOTAL 2012 COSTS $0,00 $0.00 $0.00 $0.00 $0.00 TOTAL PAYMENT: $500.00 Payment Method/Receipt Comments: CASH Interest Calculation Date: 9/18/2013 Summary of delinquent taxes due if paid before the last day: September, 2014 2013 $2,977.98 TOTAL $2,977.98 Received Payment: MFM DUPLICATE RECEIPT Thank you for Your Paymentl OFFICE OF THE Cumberland County Tax Claim Bureau One Courthouse Square Room 106 Carlisle PA 17013 Phone 717-240-6366 Fax 717-240-7835 FBI Payor: Receipt#:2013-10-21-6253 JIVIC FLESHER,THOMAS J & CLARICE! Partial Payment For Tax Year 2012 31 EAST WINDING HILL ROAD C Z E 11 Mechanicsburg PA 17055 DATE: 10/21/2013 Owner: Control#: 42-001558 FLESHER,THOMAS J & CLARICE Mao#:42-26-0245-037 31 EAST WINDING HILL ROAD TOWNSHIP OF UPPER ALLEN MECHANICSBURG PA 170555 51TE WINDING HILL ROAD LOT 100 DELINQUENT TAX YEAR PAYMENT - 2012 YEAR DESCRIPTION FACE PENALTY I INTEREST7 TOTAL 2012 SCHOOL $361,37 $124.40 $14.23 $500,00 YEAR CHARGES BUREAU I POSTAGE JADVERTISING1 MISC. TOTAL 2012 COSTS $0,00 $0,00 KOO $0.00 $0.00 TOTAL PAYMENT- $500.00 Payment Method/Receipt Comments: CASH Interest Calculation Date: 10/21/2013 Summary of delinquent taxes due If paid before the last day: September,2014 2013 $2,977,98 TOTAL $2,977.98 Received Payment: JIVIC DUPLICATE RECEIPT Thank You for yo ur Pa Zaen tl OFFICE OF THE Cumberland County Tax Claim Bureau One Courthouse Square Room 106 Carlisle PA 17013 Phone 717-240-6366 Fax 717-240-7835 Payor,, Receipt#:2013-11-15-6438 JMC FLESHER,THOMAS J & CLARICE Partl6l Payment For Tax Year 2012 31 EAST WINDING HILL ROAD Mechanicsburg PA 17055 DATE: 11/1512013 Owner: Control#: 42.001558 FLESHER,THOMAS J & CLARICE Mao#:42-26-0245-037 31 EAST WINDING HILL ROAD TOWNSHIP OF UPPER ALLEN MECHANICSBURG PA 17055 517E WINDING HILL ROAD LOT, 100 DELINQUENT TAX YEAR PAYMENT - 2012 YEAR DESCRIPTION FACE I PENALTY I INTEREST TOTAL 2012 SCHOOL $536,98 $0,00 $11.52 $548,60 YEAR CHARGES BUREAU I POSTAGE JADVERTISING1misc. TOTAL 2012 COSTS $0,00 $1.50 $0,00 $0.00 $1.50 TOTAL PAYMENT: $550.00 Payment Method/Receipt Comments: CASH Interest Calculation Date: 11/15/2013 Summary of delinquent taxes due If paid before the last day: September, 2014 -2013 $2,977.98 TOTAL $2,977.98 Received Payment: JIVIC DUPLICATE RECEIPT Thank you for your payment/ OFFICE OF THE umberland County Tax Claim Bureau One Courthouse Square! Room 106 Carlisle PA 17013 Phone 717-240-6366 Fax 717-240-7835 Payor: Receipt#:2013-12-20-6725 JIVIC FLESHER,THOMAS J&CL RICE Final Partial Payment For Tax Year 2012 31 EAST WINDING HILL ROAD i Mechanicsburg PA 17055 -DATE: 12/20/2013 Owner: Control#: 42.001558 FLESHER,THOMAS J &CL RICE 31 EAST WINDING HILL RO Mapi#:42-26-0245-037 MECHANICSBURG PA 170 1 D TOWNSHIP OF UPPER ALLEN 5 517 E WINDING HILL ROAD LOT 100 "IMMMM. ""M DELINQUENT TAX YEAR PAYMENT - 2012 YEAR DESCRIPTION FACE PENALTY I INTEREST TOTAL 2012 SCHOOL $999,62 $0,00 $7.50 $1,007.12 YEAR CHARGES BUREAU I POSTAGE . JADVERTISING1' MISC. TOTAL 2012 COSTS $0.00 $0,00. $0.00 $0.00 $0.00 TOTAL PAYMENT: $1,007.12 Payment Method/Receipt Comments: CASH Interest Calculation Date: 12/20/2013 Summary of delinquent taxes due If paid before the last day: September, 2014 2013 $2,977,98 TOTAL $2,977.98 Received Payment: lime DUPLICATE RECEIPT Thank you for your payment! JOHN F, LYONS ATTORNEY AT LAW 112 Walnut Street Harrisburg, PA 17101 Telephone; (717) 238-4777 Fax: (717) 238-470 August 20, 2014 Upper Allen Towns l-1p 100 Gettysburg PikE Mechanicsburg, PA 17055 Re: Estate of Clarice Flesher Property; 517 E Winding Hill Road, Mechanicsburg, PA 17055 AccoL nt No. 516023 To Whom It May Concern: Enclosed ple, se find a check, number 1310, in the amount of $1,297,26, This is to pay accrued sewer harges on the above referenced property up to date of December 31, 2013, Please apply the payment first to the principal sum of the sewer charges, then interest and finally penalty, Should you have any questions, please do not hesitate to contact me, John F, Lyons JFL/jIk Enclosure cc: Scott Flesher Upper Allen Township Customer History-InquIN Page: i Report Dates:08/01/2011 -12/M12012 Jun 26,2014 11:24AM Report Criteria: Customer.Customer number=516023 516023 FLESHER,CLARICE E E WINDING HILI.ROAD 517 Account Summary: Period SWR PNT INT RC Billings Billing Adjustments Payments Other Balance CF AF 07/31/2011 452,67 08/31/2011 2.26 2.28 - 454.83 09/30/2011 112.00 2.27 216.27 671.10 27.00 75,00 10/3112011 5.60 2.27 • 7.87 - $78.97 11/30/2011 - $78.97 12/31/2011 112.00 - 2.88 • 114,88 793.85 01/3112012 - • 793.85 02/29/2012 6.60 2.88 8.48 802.33 03/3112012 112.00 3.60 116,60 - - 917.83 0 413 0/201 2 • 917.83 05/3112012 5.60 3,50 9.10 - - • 926,93 0813012012 112.00 • 4.12 • 116,12 • 1,043.05 07/31/2012 - - - 1,043.05 08/3112012 6.60 4.12 9.72 1,052.77 09/30/2012 112.00 4.76 116.75 • 1,169.52 10/31/2012 - • • 1,169.62 11/30/2012 • 5,60 4.76 10.36 • 1,179.87 12/31/2012 112.00 - 5,39 117.39 • • 1,297.2$ Totals: 672.00 28.00 42.69 844.69 - - 27,00 76.00 Metered Services: ;-40",�N;fi CY(11 5;., . . Ezpi aNniroiu:' Anriouiux lai- ;-ArMANE.Y. -� i::.•;;- "�Yd�FA'AECOUN3'• . . - '.� 3-3Si5j3��.;. 12, LLAh. �/ - ,�� "% �•}!'i '��` �+f. .�. _ _ _ _ S_ ` DES6R1F CtdN'` .�" AFV10lffN7 �`- ^: _ .�'j., :� ,1.:�• ';�tt1ZEN3$fYFi,K'' � � ^ '.� - - .. • • • • a, • MAl~CE CNEC:K`PAYABL�'TQ'(�RQVi-C9'ER. JAMES. HART-Y" 'D: ©PLEASE CHECK MianrcA B.YrLrNG.Srizvtc s INC. P-0. BOX' 16-6., HERE IF YOU HAVE PMB#302. . HUMMEL-STawo . PA 1.703'60168 INSURANCE& 275 CUMBERLAND PARKWAY COMPLETEHISSFORM RM BACKSIDE MECHANISCBURG.P.A.17055 OF THIS • e (717) 97-1455•FAx(717)697-3195 u e CLARICE FLE.SH:ER 517 E. WINDIN-G HILL RD M'ECHANICSBURG, PA •1''70.55 PLEASE CHANGE ADDRESS IF, ' INCORRECT QETAOki TWIS TUB:ANp:R TURN WITKPAY:MENT l — ---_- PATIENT FLAME DIAGNOSIS TRANSACTION PATIENT INSURANCE CODE DATE OPT DESCRIPTION CHARGES&CREDITS PENDING 458 . 0 08/25/10 99308 NURSING FAC/EST PAT/LEV 11 79 . 00 09/1.6/10 MEDICARE PAYMENT -50 .87 09/16/1.0 CONTRACTUAL ADJUSTMENT -1.5 . 41. 09/16/1.0 TRANSFER OUT-MEDICARE --12 .72 09/16/10 TRANSFER IN 12 .72 09/23/1.0 TRANSFER OUT-B/C B/S P -12 .'l2 09/23/10 NOT A COVERED SERVICE 1.2.72 i CURRENT OVER 30 DAYS OVER 60 DAYS OVER 80 DAYS OVER 120 DAYS ACCOUNT BALANCE a PENDINGE 0 .00 0 .00 0 . 00 0. 00 12.72 1.2.72 . 0. 00 ;:r)P ACCiq'TAhJN:(!AI I • 17171 A07-4nl%g ' ' s erV � c � � 4150OuyomMEMORIAL HsaxwAv SUITE 200 MINNEAPOLIS, MINNESOTA 55422~4811 TeiEp*VmE 763-852-8620 Hours (CT),, 7'00am - 9:00pmM - TH FAX 877~326`8784 7:00 am - 5:80 pmF TOLL-FREE 077~210-9112 8:00 am - 12:00 pm S March 17, 2011 RE: Estate of: CLARICE E FLESHER Our Client: *Citibank (South Dakota) Account No Unpaid Balance Reference No ************7881 $2551.32 66�--------- Dear Sir or Kadanl| We are trying to resolve the unpaid balance owed by the estate of the dgoaasod. We will accept $1275.66 as a resolution of the full amount owedrprovlded payment Is received In our office by 04/16/2011, Our d|eli[ | ~seeking payment only from the estate ofthe deceased, lL |Sour client's policy not toseek payment from family members or survivors or to hold them responsible for repayment of the debt. ' Please call one of our account representatives toll free at 1-877-210-9112 to confirm this arrangement or to make payment by telephone, Cordially, DCM Services, LLC This company Is a debt collector. We are attempting to collect debt and any Information obtained will be used for that purpose. Calls may be monitored or recorded for quality assurance purposes. NOTICE: SEE REVE.RSE SIDE FOR IMPORTANT INFORMATION -Side 1 of 2- '"Detach Lower Portion and Return w1th Payrn a nt*- ' -- - - . DCMSen/|ces/ LLC 4150 DLSDN MEMORIAL HVVYGTE 200 Reference #: 6694080 Client ID: SEAR41 MINNEAPOLIS MN 55422~4811 Unpaid Balance: $2551.32 Checks Pa ADDRESS SERVICE REQUESTED b{ato: Citibank (South ' 'Dakota) N A SEARS GOLD |\UU�0||�U)|NNN00H8UlNY�0Ul�U0@MU|N|OUB||M||ll}Y||||N||�|UM|YU0|YBUU�\||0UO ' von/mn/."m,mwoumo^opmmvum/uw/ownwu^xm."/omvwow/^um/vovmmvum/ MASTERCARD Amount Enclosed: March 17, 2O11 . | mm/-wo | #BVVNJGZF ' D[M Services/Citibank #1651707812591701# PO Box 1568 The Estate o � LRICE E pL2SH[R RrMinneapolis MN 55440-1568 537 E WINDING HILL RD M[�H�NI���URG PA �7O��~q��� � |/\JoUoIx1/1oill^moU'i'[/1\v1"1n/i"I o1JnlJ 6694080 7881 16617-505 1-482 Ot Mr 0010 Joint Commission on Acsrsdttatton at Xstaithcara Qrgantrations CENTRAL MEDICAL EQUIPMENT CO. CLARICE E FLESHER 517 EAST WINDING HILL ROAD MECHANICSBURG, PA 17055 Y December 3 2010 ' According to our records, you still have not settled your past due balance with us, If there.is a problem with payment,please contact us, The total balance due is $108.42 on invoice (s) 318203, 319682, 319980. We are hopeful this can be resolved by DECEMBER 15, 2010. If not we will have to send your claims to collections. 1 Y Please remit balance due to avoid Collection Action. If you would like to make a payment arrangement,please call me at (717) 657-2100 press option#2 zf pi�ym�i'it vas recei�tl:y::m�de..,ease disi•rv��:rd.this ncitice. Thank you for your prompt attention to this matter, MJP AR Department . Central Medical Equipment Accounts Receivable 35 Sarhelm Road • Harrisburg, PA 17112 • (717) 657.2100 • Fax (717) 657.2176 524 Greenbrlar Road • York, PA 17404 • (717) 764-8300 • Fox (717) 764-8383 1397 Arcadia Road • Lancaster, PA 17601 • (717)390-2700 • Fox (717)390-2724 Toll Free; 1-800-845.4204 Web site; www.centralmedlcalpa.com Statement HOWARD ROY COHEN, M.D. -lours by internal Medicine Telephone: appointment 4713 E Trindle Road 717-737-8686 Mechanicsburg, PA 17050 Estate of Clarice E. Flesher 517 E, Winding Hill Road Mechanicsburg, PA 17055 • DATE Family CURRENT Member BALANCE 6123/11 Clarice BALANCE DUE ON ACCOUNT: $9.78 The above amount is due from 9/12/10 date of service for coinsurance, Payment is requested upon receipt of this statement. Thank You. This account is being turned over to the District Justice. You will receive no when to appear in court. Cancellation of this act-Idn can only be made if pa before Y16 1t( . Court costs, Sheriff costs, and cost of petitions will be adde balance. CONSOLIDATED .COLLECTION SERVICE, INC. ' . -�PO BOX 60550,. :HARR.ISBURG;: PA` 17166 '800--52`L=75`5 ..Apr .11 , 2011 �.848`188#1:0'- LARICIE E.:F-L ES H-ER 517 E WINDING HLLL RD :M HAN1CSBURG -PAA 170:55 ETA�Ffi`�ERE�RI�D'Rf f'tlRiV"'TOP"FbRT-I'Ot�tTT�i'YOOR'P'A�NC�N CONSOLI DATED SERVICE , INC. STATEMENT Creditor :Account, # Regarding Amt.Owed WEST SHORE,EMERGENCY ME:D 2057.33W ROUTINE TRANSPORT ' ..303;54 PLEASE .BE ADVISED THAT THE ABOVE CLAAIM HAS BEEN REFERRED TO US _ FOR COLI_ECTI:ON IN FULL , THE. DELINQUENT BALANCE APPEARS AGAI:NS1 YOU WHICH YOUR .CREDITOR STATES IS 'DUE , THIS NOT-ICE IS A FORMA. DEMAND UPON YOU FOR PROMPT PAYMENT OF THIS CLAIM IN. FULL, CALL 800-521-.7559 IF-YOU HAVE ANY QUESTIONS , WE CAN ACCEPT CHECK BY PHONE , DEBIT CARD, VISA, AND *MASTERCARD-. PURSUANT10 S::U ::S . :.. .S' C .159° , -UNLESS WITHIN 30 :DA-Y'S AFTER RECEIPT. OF THIS LE.TTE.R Y.OU. DISPUTE THE VALIDITY OF THE DEBT OR ANY PORTION THEREOF THIS 0 FICE WILL -ASSUME. THIS .DEBT IS-. VALID ,. IF YOU NOTIFY CHIS .OFFICE :IN WRITING .WITHIN THE 30 DAY . PER-IOD THAT THE DEBT, OR ANY PORTION THEREOF , IS DISPUTED, THIS :OFFI:CE WILL .08TAIN VERI,F:ICAT.ION OF THE DEBTOR. IF APPLICABLE A :COPY OF A .,JUDGMENT AGAINST .�_OU: AND .MAI L YOU A COPY. OF SUCH VERIFICATION OR JUDGMENT. U ON. YOUR. WRITTEN RE.8UEST WIT IN- THE 30 DAY. :PERIOD, THIS :OFFICE WILL PROVIDE YO W-ITN TH . :NAME:AND� ADDRESS OFTT E -ORIGINAL :CREDITOR, IF DIFFERENT FROM THE °CURRENT CREDITO , THIS IS AN ATTEMPT TO CO.LLECT. A DEBT AND .ANY INFORMATION. OBTAINED WILL. BE .USED FOR THAT PURPOSE., THIS COMMUNICATION IS FROM A DEBT .COL.L:ECTION AGENCY-, OFFICE HOURS MONDAY-THURSDAY 8:OOAM-9:00PM * FRIDAY-.8':OOAM=.5:OOPM EASTERN 'STANDARD TIME. Diversified Dental Services 339 North Route 73 Winslow Professional Building, Suite 4 Berlin,NJ 08009 07%07 201 1. Clarice Flesher c/o Scott Flesher 517 E. Winding Hill Rd, Mechanicsburg, PA 17055 ._.:J�:ate___ _ Pai•. ,.�.�Code ._.�.__..:. P]!�sct�rl�t,`a'bm.._..... .......: . ._._.�_..._ Amo:u,nt�.___......_.�;i�la�i`ce..._.---.__._;.___._. .. ._. . Balance Forward 65.00 •P�tii;en�����la��:ea. 65�D0' Minimum Payment 65.00 Due Date 0712212011 Insurance Balance 0.00 Current Over 30 Over 60 Over 90 0.00 0,00 0.00 65.00 Make check payable to Diversified Dental Service. Any questions,call(856)753-1547. MCHS CAMP HILL 1700 MARKET STREET Patient: CLARICE FLESHER CAMP HILL PA 17011 Patient Number, 00583-3065 717-737-8551 Statement Date: 03/0112011 Account Summary GLEE=Previous Balance 7�1 =l � M $5,637.50 $0.00 $0.00 $5,637.50 $5,637.50 Transactions Detail BALANCE FORWARD $5,637.50 We thank you for your prompt attention to this statement.Please notify the business office of any changes to your benefits or Insurance. l IIIIII�loll VIII VIII VIII I�I�f Illli l�lll!1111 llll1111111118 _-----------------------------------------•----_-----Y-QV. 1AY..qQ.N.:�i9rJ.N-.tt$.Q,.f3MR...iJli> $a51.__.._......_- .._...1 Q DETACH HERE Q AND RETURN BOTTOM PORTION WITH YOUR PAYMENT MCHS CAMP HILL 1700 MARKET STREET CAMP HILL PA 17011 � � �iLLTtI i»11 al Kx M IT,I '' 00583-3065 FLESHER 03101/2011 RETURN SERVICE REQUESTED 177 z 07/08/2010_ 112010 1 _ ..._._ $5,637_50 4111111141111il,lh1fi}iti1.111111111 It 111 43302.8828 SCOTT FLESHER MCHS CAMP HILL 51? E WINDING HILI_ RD 1700 MARKET ST n MECHANICSBURG PA 1?055-4911 CAMP HILL PA 17011-4817 we-It %.,*% "A.,, i, , Page 3 2PL Electric PPI J�ft,, Utilities 51120-73001 Q',"t$'i4l i �75 Electric Total from Last Bill $222 72 Service or Billing Details F MARICE FLBSIiBR Amount You Still Owe as of Oct 15j 2010 517 B WINDING HILL RD $222.72 VMCHAMCSBURG PA 17055 Current Charges Charges for-PPL Electric Utilities PPL Electric Utilities Residential Rate:RS for Sep 16- Oct 15 r, Distribution Charge: customer Service Customer Cha 8.44 327 Hausman Rd. 200 KWH at r 06000000 5.81 k1lentown,PA IN ,per KWH 18104-9392 3 10 KWH at 2.640000000.per KWH 8.18 1-800-342-5775 PA Tax Ad Surcharge at 0,10300000% 0.02 Transmission Charge: ,1-800-DIAL-PPL) 510 KWH at 0.316000000 per 1.61 ffww..ppl electric,com Transition Charge-, 200 KWH at-0.66800000¢per KWH -1.34 310 KWH at-0,59200000¢per KWH -1,84 eneration Charr : Cac� andnf 7lO � al633000000 per KWH 20.27 310 KVvrH at 10.13300000¢per KWH 31.41 PA Tax Adj Surcharge at-0.1)1400000% -0.01 V Total PPL Electric Utilities Charges $72.55 lV Your Budget Plan Amount $79.00 Other Chares for PPL Electric Utilities Late P4ymeniq Charge 2.78 Phase-In Option Credit -6.92 Total of Other Charges $4.14 IMM Account Balance $297.58 General Buact Summary: billed you $158,00 Information Including f1iis bill, you used 120,87 After this payment,your budget is ahead $37.13 NUX.A.M.Uter ........ ...... ... ... read' an or about Your account is overdue, If you do not pay in full or call our office to Nov 15 arrang parent in 10 da Sam isvour electricity may be shut off. Call us week ys am to 5pm at - 0-358-6623. The$222.72 balance includes$2.74 in prior late payment charges. Generation prices and charges are set by the electric generation supplier yqu have chosen, The Public-Utility Commission regulates distril5iftion prices and services. The Federal Energy Regulatory-Cominission regulates ransiTfission prices and services, PPL Electric Utilities uses about$1.43 of this bill toP�Ly state taxes. In addition, about$17.96 of this bill pays the PA GrossReceipts Tax. Page I TL Electric PPI .0.0.. ......—,I ...... is Utilities 51120-73001 ,lectric Summary Page 3ervice Balance as of Sep 16, 2010 $148.78 or: Charges: LAPJCE FLESHER TotaFPPL Electric Utilities Charges $73.94 17 E WINDING HILL RD IECHANICSBURG PA 17055 Total Charges $222,72 Account Balance $222.72 )uestions about is bill? Please ontact us b 7 t 1-800'-34��5707t5 1-800-DIAL-PPL) r write to: 'ustomer Service 27 Hausman Rd. Allentown,PA 8104-9392 r,vw.pplelectric.cora AT le KWH-Average Per Day Meter Reading Information ectr* ,ase 48 Meter 458044655 Sep 16 Actual 52027 'his graph shows 40 Aug 17 Actual 51711 'our electric use 32 30 Days KWH Billed 316 ver the last 13 Average-Sep 2009 2010 ,ionths. 24 Temperature 70E 72F �pes of OR Per Day 20 11 eter Readings: 16 Yearly Use: Total Average 8 Use Monthly 0 Oct 2008-Sep 2009 7409 M vctual Adjusted ffffi 0 Oct 2009-Sep 2010 6525 544 stimatcd SONDJFMAMJJAS 2009 Months 2010 .ustomer Other important information on back 4 --------------- ------------------------------------------------------------------- ----------------------*-"--*------- Return this part to address below with a check payable to PPL Electric Utilities Corporation 51120-73001 Oct 7,2010 $222.72 Amount Enclosed AV 01 012418 213998 66 A**6DGT �' � ❑ CLARICE FLESHER 517 E WINDING HILL RD WCHANICSBURGPA 17055-4911 PPL ELECTRIC UTILITIES 2 NORTH 9TH STREET RPC-GENN I ALLENTOWNPA 19101-1175 1 5900002227290000222720 5112073001 CLA•RICEI FLE'SHER Invoice LRPy8LIC Page 1 of 2 3730 Sandhurst Drive York,PA 17406 - _Paym.entsFAdjustm.Ont's Date Description Reference Amount Account Number 3.0611.1228488 07/16 Payment-hank You 1873 444,82 Invoice Date September 16,2010 -- Invoice Number 0811.000397952 ,C.ur.r$:ri.t.lnylp.ice..Cha:rg,es, Previous Balance $44,82 PaymentstAdj/Ad)usustments •$44.82 Clarice B Flesher. 617 E Winding Hlli Rd (L1) . .. Unpaid Balance $0,00 Mechanlcsbitrg,.RA Current Invoice Charges $44,82 Contract:9611028(C2) 1 -Trash Cart(96196 Gallon) Scheduled Service (Si) Date De— scrioi ion Reference quantityUnit Price Amount rt 29/15 Re-9fidentiaTService 10/01/10-12/31/10 $44.$2 $44,82 $44.82 Current inv.olce Charges $44.-82 Due By: 10/05110 Customer Service (717)846-1567 Customer Service (800)210.9676 o . +r • FOR YOUR CONVENIENCE TWO ALTERNATIVE METHODS TO PAY:WWW.DISPOSAL,COM OR PAY BY PHONE 0 677.692.9729 BOTH METHODS HAVE NO PROCESSING FEE To pay an-line or sign up for4,8z 0ioo o:o.0 0.00 convenient auto pay, go to: F3 A • Vi'sit;6urw9baits;;www.dlsposaimpin to:m0e:yourpaymentelectronically onto'.signup for our convenlent automatic payment pian. Visit us at www.disposel.com • Please see reverse side for terms and conditions (� Please Return This Portion Pay This Am unt $44.82 4��ST 1) ilSAX With Payment Account Number 3-0811-1228466 Invoice Date September 15,2010 +R�FUSLfG Invoice Number 0611.000397962 3730 Sandhurst Drive Payment Due Date October 5,2010 York,PA 17408 t Return Service Requested 011465.000001.01146520644532240ST03_6 3 Make Checks Payable To: CLARICE E FLESHER 517 E WINDING HILL RD MECHANICSBU.RG PA 17055-4911 YORK WASTE DISPOSAL#611 PO BOX 9001099 LOUISVILLE, KY 40290-1099 306111,225466000000039?9520000044820000044828