HomeMy WebLinkAbout03-13-06
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REV-1500 EX + (0-00)
'* COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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Kramer Iva C.
DATE OF DEATH (MM-D[)"Year)
DATE OF BIRTH (MM-D[)"Year)
03/1112005 08/11/1925
(IF APPUCABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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00 1. Original Retum
o 4. Limited Estate
o 6. Decedent Died Testate (AlIachcopyofWIII)
o 9. Litigation Proceeds Received
o 2. Supplemental Retum
o 4a. Future Interest Compromise (dale of death aIler 12-12-82)
o 7. Decedent Maintained a Living Trust (Allllch copy of Trust)
o 10. Spousal Poverty Credit (date of death belween 12-31-91 and 1-1-95)
OfFICIAL USE ONLY
FILE NUMBER
2 1 -0 5 0 5 5 0
"COliNTvCOiiE -YEAR- - - NUtiER- -
SOCIAL SECURITY NUMBER
2 0 1 - 1 6 - 6 623
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Retum (daleofdealllpriorIll12-1U2)
o 5. Federal Estate Tax Retum Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Allllch Sch 0)
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ffi NAME
~ R. Mark Thomas
~ FIRM NAME (If Applicable)
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~ TELEPHONE NUMBER
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717 796-2100
COMPLETE MAILING ADDRESS
101 S. Market Street
Mechanlcsburg, PA 17055
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1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
o Separate Billing Requested
7. Inter-VIVOS Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
X _(15)
X _(16)
X .12 (17)
X .15 (18)
(19)
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
97.900.00
OFFICIAL USE ONLY
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3,951.82
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CO
101 ,851.82
128,120.59
-26.268.77
-26.268.77
(8)
9.663.11
118,457.48
(11)
(12)
(13)
(14)
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I t Add
Dece en s ampl e e ress:
STREET ADDRESS
135 Easterlv Drive
CITY I STATE I ZIP
Mechanicsburg PA 17050
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19) (1)
2. CreditsJPayments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
Total Credits ( A + 8 + C ) (2)
3.
InterestlPenalty if applicable
D. Interest
E. Penalty
5.
TotallnteresUPenalty ( 0 + E)
If Une 2 is greater than Une 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
If Une 1 + Line 3 is greater than Line 2. enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
8. Enter the total of Une 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
(3)
4.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Yes No
D 00
D 00
D 00
D 00
D
D
o
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred; ...........................................................................
b. retain the right to designate who shall use the property transferred or its income; ........................................
c. retain a reversionary interest; or ...................... ..... ......... ..... ....... ....... ....... ....... ......... ..... ......... ..........
d. receive the promise for life of either payments, benefits or care? .............................................................
2. If death occurred after December 12, 1982. did decedent transfer property within one year of death
without receiving adequate consideration?..............................................................................................
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? .................
4. Did decedent own an Individual Retirement Account, annuity. or other non-probate property which
contains a beneficiary designation? .......................................................................................................
00
00
00
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
ADDRESS
ADDRESS
101 S. Market Street
Mechanicsburtl. PA 17055
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[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% [72 P.S. ~9116 (a) (1.1) (ii)).
The statute does not exemDt 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 twenty-one 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% [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%, except as noted in 72 P.S. ~9116(1.2) [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% [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.
\ . I
REV-1502 EX + (6-98)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kramer Iva C 21 05 0550
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 fads.
Real DfODertv which Is Iolntlv-owned with riaht of survivors hiD must be disclosed on Schedule F.
SCHEDULE A
REAL ESTATE
ITEM
NUMBER
1.
DESCRIPTION
) bedroom condominium located at 135 Easterly Dive, Mechanicsburg, PA 17050
VALUE AT DATE
OF DEATH
97,900.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
97 900.00
, ' I
REV-1508 EX + (6-98)
*'
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
Kramer Iva C
FILE NUMBER
21 05
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jolntly-owned with right of survivorship must be dilclond on Schedule F,
0550
ITEM
NUMBER
1.
DESCRIPTION
Refund on School Porperty tax for year 2004-2005
VALUE AT DATE
OF DEATH
32.96
2.
Refund from prepaid condo fee for June 2005
25.38
3.
Refund from Penn Waste, Inc.
36.70
4.
Pommerce Bank
P.O. Box 5899
Pamp Hill, PA 17011
Household furnishings
1,156.85
5.
500.00
6.
Refunds from Magazines and Pharmacies
233.60
7.
Return of Escrow funds from Washington Mutual Bank FA
1,966.33
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
3951.82
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REV-1511 EX + (12-99)
'*
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kramer Iva C
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21 05
0550
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Malpezzi Funeral Home 8,710.50
8 Market Plaza Way, Mechanicsburg, PA 17055
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees R. Mark Thomas 500.00
3. Family Exemption: (If decedents address is not the same as claimants, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 264.00
5. Acoountants Fees
6. Tax Retum Prepare!'s Fees
7. Publication of Death Notice
a. Patriot News 113.61
b. Cumberland law Journal 75.00
TOTAL (Also enter on line 9, Recapitulation) $ 9 663.11
(If more space is needed, insert additional sheets of the same size)
. .
REV-1512 EX + (6-98)
.
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECeDENT
ESTATE OF
Kramer Iva C
FILE NUMBER
21 05
0550
Include unrelmbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
See Attachment Page(s)
TOTAL (Also enteron line 10, Recapitulation) $
(If more space is needed, Insert additional sheets of the same size)
118457.48
Kramer, Iva C.
Decedenfs Name
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Page 1
21 05 0550
File Number
Schedule I - Debts of Decedent. Mortgage Liabilities. & Liens
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
DESCRIPTION
AMOUNT
83,062.14
Nashington Mutual bank, FA (mortgage)
1200 W. Parkland Avenue
Vlilwaukee, WI 53224
Neils Fargo Financial Bank (mortgage)
201 North 4th Avenue
)ioux Falls, SO 57104-0700
RA-NRT, Inc. (Realtor's Commission)
01 Old Schoolhouse Lane
jI,1echanicsburg, PA 17055
~. Mark Thomas, Esquire (Legal fees at Settlement)
5,327.45
5,999.00
80.00
bum berland County, Pennsylvania (Transfer tax - Realty)
979.00
Silver Spring Township Sewer Authority
67.98
ed Ex fees - mortgage payoffs .
On April 12, 2005, decedent signed a sales agreement to sell her residence for $97,900.00. She died
:m June 11, 2005, just six (6) days prior to settlement on June 17, 2005.)
Mortheast Pharmacy Service (see enclosed bill)
32.00
20.77
ames. J. Freeman, D.O. (bill enclosed)
26.31
ehigh Valley Hospital (see enclosed bill)
456.00
~MAC (see enclosed bill)
5,038.11
~erizon
33.33
Wells Fargo Financial
6,276.41
Jiti Cards (Balance on Credit Card)
590.52
VlCI Phone Bill (see enclosed bill)
146.06
SUBTOTAL SCHEDULE I
108,135.08
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Kramer, Iva C.
Decedenrs Name
Page 2
21 05 0550
File Number
Schedule 1- Debts of Decedent, Mortgage liabilities, & Liens
ITEM
NUMBER DESCRIPTION AMOUNT
16. he Village at Willow Lane 10,322.40
~88 IIburtis Road
Macungie, PA 18062
SUBTOTAL SCHEDULE I 10,322.40
GRAND TOTAL SCHEDULE I $ 118,457.48
______I
A. Settttltht3t1t Statetneht
U.S. Department of Housing
and Urban Development
.......r.
,
B. Type ot Lostt
1. 0 FHA 2. 0 FmHA 3. 0 cdil~. Unlns.
4. 0 VA 5. 0 Con\!. Ins.
OMB Approval No. 250:2-0265
17. loan Number I' 8. Mortgage Ineurance Case Number
i
10030740401 r
C. Note: This form Is furnished to give you a slatement of actual settlement cosls. Amounts paid to and by the settlement agent are
shown. lIems marked "(p.o.c.)" were paid outside closing; Ihey are shown here for Informallonal purposes and not
Included In the tolats.
11. Neme and Address ~, Borrower
6. File Number
E. Name and Address 0' Seller
: F. Neme end Address 01 lender
ELAINE L. NACE
ESTATE OF IVA C. KRAMER
; ERA MORTGAGE
i PO BOX 5954
135 EASTERLY DRIVE
MECHANICSaURG
MECHANtCSBURG
lot: Block:
J. Summary ot Borrower's Transacllon
100. Gross Amount Due From Borrower
10 t. Contract sales price
102. Personal property
103. SeUlement charges 10 borrower (line 1400)
104.
105.
Adjustments 'or Items paid by seller In advance
106. Cfty/lown taxes 10
107. County lalles 6/17/05 10 12/31/05
108. Assessmenls ..~o
109. Schoollaxes 6/17/05 10 6/30/05
110. 10
Ill. Condo 'ees 6/17/05 10 6/3~/05
112. 10
H3. 10
114. 10
1l5. to
i20. Gross Amount DUe From Borrower
. .
PA 17050
I
I H. Selllement Agent
I R. MARK THOMAS, ESQ.
Place 01 Selllement
101 S. MARKET ST
I MECHANtCSBURG
i
iSPRINGFIELD
oH 45501-5954
PA 17050
G. Properly location
'135 EASTtRLY DRIVE
PA
17055
I. Sell/ement Dale
6/i7/05
DisbUrsement bate
200. Amollnti Plld By Or 111 Behal' Of Borrowet
201. Deposit or tjarnes\ money
202. Principal amo\.lnt 01 new loan(s)
203. ~xlsllng Ioan{s) taken subject to
204.
205.
206.
201.
208.
209.
AdJustmenls for lIemi lJnplld by sellet
210. Clly/loWn lalles 10
211. County lalles to
212. Assessmenls 10'
211 ~
214. 10
21~ ~
216. 10
2t1. 10
218. 10
21~ I~
K. Summary of Seller's Transaction
400. Gross Amount Due To Seller
97,900.00 401. Contracl sales price 0
402. Personal property
3,865.81 403.
404.
405.
Adjustments tor Ilems paid by seller In advance
406. Clty/lown laxes 10
130.57 407. County laxEls 6/17/05 1012/31/05
408. Assessmenls 10
32.96 409. Schooltaxes 6/17/05 to 6/30/05
410. to
25.38 41L Condo fees 6/17/05 10 6/30/05
412. to
413. 10
414. 10
415. 10
101,954.72 420. Gross Amount Due To Seller
500. Reductions In Amount Due To Seller
1,000.00 501. EllCeS$ deposit (see Inslructlons)
52,900.00 502. SeUtemenl charges 10 seller (line 1400)
503. Existing loan(s) laken subJecllo
504. Payoff 01 flrsl morigageloan Washington Mutual
505. Payoff 01 second mortgage loan
506. Payoff line 0' credillo Wells Fargo '
507.
506.
509.
AdJllstments for Items unpaid by seller
510. Clty/lown talles to
511. Counly taxes to
512. Assessmenls 10
513. 10
514. 10
515. 10
516. 10
517. 10
518. 10
51~ 10
97,900.00
I
I
130.57
32.96
25.38
98,088.91
7,i57.98
83,062.14
5,327,45
220. totil Paid byIFor Borrower
300. C:.sh At Settlement From/To Borrower
301. Gross Amounl due from borrower ~Ine 120)
. 302. less amount paid byl10r borrower (line 220)
53.900.00 520. Total Reduction Amount Due Seltet
600. C::!lsh At ~et~lement Toffrom Seller,
101,954.72 601. Gross amount due 10 seller (line 420)
53,900.00) 602. Less reductions In amI. due seller ~Ine 520)
95,547.57
303. Cash
l&J Fro;"
o . to Borrower
48,054.72 603. Cash
l&J To
o Ftom Seller
98.088.91
95,~41.57)
. 2,541.34
SUBSTITUTE FORM 1099 SELLER STATEMENT
The Inlormal~n conlalned In Blocks E, G. H, and I and on line 401 (or. line 403 and 404) Is Importanllax Inlormallon and Is being lurnlshed to the Internall'levenue
Service. \I yOll are tequlred 10 file 8 relurn, a negligence penally or other sanction will be Imposed on you " Ihls lIem Is required 10 be teported and the IRS delermlnes
Ihal II has nol been reported. IIlhis real eslate Is yout principal residence, lIIe Form 2119. Sale or Exchange 01 Princlpall'lesldence, lor any gain. wllh your Income tax
relllrn; lor other transactions, comptele Ihe applicable paris 01 Form 4797. Form 6232 and/or Schedule D. Form 1040). You are required to provide the Seltlement Agent
(named above) with your correct laxpayer Jdenllllcatlon number. If you do not provide the Settlement Agenl wllh your correctlaxpayer JdentlRcatlon number. you may be
sublectll1 clvlt or criminal. penalties Imposed by law. Under penallles 01 perjury. I certify Ihallhe number shown on this statement Is my correct taxpayer Identlllcatlon I1Umbet.
(Seller's Signalure)
//
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.~ges
p'les/Broker'. comlrilllsloh baeed oil price $
'. 'slon 01 Commission ~lne 700) as tollows:
5,874.00 10 ERA-NRT,INC.
10
97,900.00@
%=
Paid From
Borrower's
Funds AI
Seltlement
Paid From
Seller's .'
Funds At
Selllemenl
. $
702. *
703. Commission paid al SeUlemenl
704.
800. items !Sayable In cohnecllon With L~~n
801. loan Origination Fee 52,900.00
802. loan Dlscounl 52,900.00
803. Appraisal Fee
804. Credit Report
805. lender's Inspecllon Fee
806. Mortgage Insurance Appllcallon Fee 10
807. ASsumplion Fee
808. APJ'L1CATION FEE TO ERA MORTGAGE
809. FLOOD CERTIFICATiON TO STARS
810. DOCUMENT PREPARATION FEE TO ERA MOfHGAGE
tll I. CLOSING COSTS PAID BY ERA MORTGAGE TO ERA-NRT, INC.
812.
813.
900. Ilems Required By lender To Be PaId In Advance
901. Inleresllrom 6/17/05 10 6/30/05
902. Mortgage Insurance Premium lor
903. Hazard Insurance Premium lor
!;,874.oo
1.00 %
%
529.00
10
10 FNMA BEACON
19.20
500.00
19.~O
85.00
-623.70
EKcludelasl day In calcs . line 901
@$ 8.87 I day
monlhs 10
124.18
904.
905.
iooo. Reserves DeposIted WIth Lender
100 l. Hazard Insurance
1002. Mortgage Insurance'
1003. City property laxes
1004. County properly lalles 5
1005. Annualassessmenls
1006. 'School taxes
1007.
1008. r lile Accounlln
1100. TIlle Chatges
1101. Seltlemenl or closing lee
1102. Abstracl or IIIIe search
1103. Title ellamlnalion
I Io.t-. TIIIlllhsUrai1ce binder
1105. Document preparation
1106. Nolary 'ees
1107. Attorney's 'ees
(InclUdes above lIems numbers:
1I08. Title inSUrance
(includeS above Items hUmbers:
1109. lender's coverage $ 52,900.00
1110.0wtllir'scoverage $ 97,900.00
1111. CLOSING PROTECTIONtETIER TO PENN ATIO!=lNEYS
11 12.
1113.
bOb. Goverhmenl Recording and Trans'er charges
120" Reconllng lees: Deed $ 38.50
1202. City/CoUnty lalC/slamps: Deed $
t 203. Slale lax/slamps: Deed $
1204.
1205.
1300. Additional Seltlement Charges
1301. Survey 10
1302. Pesllnspection 10
1303. TRANSACTiON FEE TO ERA-NRTj INC.
i30.t. INCOMING WIRE FI:ES
1305. FINAL SEWER BILL TO SILVER SPRING TVVP. AUTHORITY
1306. FED EX FEES
1307.
1308.
1400. Total Settlement charlie' (ehtei' on nile. 103, Secllon J and 502, Section K)
CERTIFICATION
fully review he HUD.1 eltlemenl Stalemenl and 10 Ihe besl 01 my knowledae and bellel, It 1$ a lrue and accurale slalemenl 01 all receipts and dlsbursemenls .
unf or by me n this Ira action. I lurth~r Iy Ihall have r;celved a copy 01 tile HUD-1 Settle~s~temenl. . x:::::J n
. . ~ .... f ~// ~ Borrower'
ESTATE OF ER ELAINE L. NACE
years 10
years 10
13
monlhs@$
monlhS@$
monlhs@$
monlhs@$
monlhs@$
monlhs@$
months@$
20.47
per month
per month
per monlh
per monlh
per monlh
per month
per monlh
102.35
70.18
912.34
-81.81
10
to
10
10
10 R. MARK THOMAS
10 cASH
to R. MARK THOMAS
25.00
98i.75
75.00
5.00
10
35.00
; Mortgage $
979.00 ; Mortgage
979.00 : Mortgage
70.50 i Rele~ses $
108.00
979.00
$
$
979.00
. 125.00
10.00
125.00
16.00
67.98
32.00
3865.81
7.157.98
Seller
Borrower
ent Slalement which I have prepared Is slrue and accurate account I the lunds which were received and have been or will
selllemen' ollhlslransacllon.
Se\\Iement Agent Date
R. MA K THOMAS, ESQ.
WARNIN~: Ills a mime 10 knowingly make false slalemenls to the United Slates on this or any other similar I . Penallles upon conviction can Include a ftne and
Imprisonment. For delalls see: Tille 18 U.S. Code Secllon 1001 and Secllon t010. . _ _
.
Wle patriot-NtWs
Now you know
Order Confirmation
Customer
R. MARK THOMAS
Orderer Account Number
35242
Paver
Payer Account Number
35242
R. MARK THOMAS
ATTN: R. MARK THOMAS,101 SOUTH MARKET
STREET
Mechanicsburg PA 17055-3851 USA
Ad Order 0001338047
Sales rholton
Order Taker rholton
Order Source Fax
Special Prlclna None
PO Number ESTATE OF KRAMER
Ordered BY MARK
Customer Fax
Customer EMail
Customer Phone 717-796-2100
Payer Phone 717-796-2100
Tear Sheets
o
Proofs
o
Affidavits
1
Blind Box
Invoice Text
Materials
Total Ad Cost
$113.61
$0.00
$113.61 .
Payment Method
~L. -7j2S/OS
Payment Amount
Amount Due
Promo Type
<NONE>
Ad Number Ad TVDe
0001338047-0' legal Liners
Ad Size
: 1.0 X 17 Li
Color
<NONE>
Production Method Production Notes
Ad Booker
Product Information
Classification
846-Estate Notices-West
PNCO: :Full Run
~un Schedule Invoice Text
ESTATE NOTICEletters of Administration on the Estate of Iva C. Kr-4'mer
7/191200510:05:56AM
# Inserts
Run Dates
7/5/2005, 7/12/2005, 7/19/2005
3
1
THE PATRIOT NEWS
THE SUNDAY PATRIOT NEWS
Proof of Publication
Under Act No. 587, Approved May 16,1929
Commonwealth of Pennsylvania, County of Dauphin} ss
Joseph A. Dennison, being duly sworn according to law, deposes and says:
That he is the Assistant Controller of The Patriot News Co., a corporation organized and existing under the
laws of the Commonwealth of Pennsylvania, with its principal office and place of business at 812 to 818 Market
Street, in the City of Harrisburg, County of Dauphin, State of Pennsylvania, owner and publisher of The Patriot-
News and The Sunday Patriot-News newspapers of general circulation, printed and published at 812 to 818 Market
Street, in the City, County and State aforesaid; that The Patriot-News and The Sunday Patriot-News were established
March 4th, 1854, and September 18th, 1949, respectively, and all have been continuously published ever since;
That the printed notice or pllblication which is securely attached hereto is exactly as printed and published
in their regular daily and/or Sunday/ Metro editions which appeared on the 5th, 12th and 19th day(s) of July 2005.
That neither he nor said Company is interested in the subject matter of said printed notice or advertising, and that aU
of the allegations of this statement as to the time, place and character of publication are true; and
That he has personal knowledge of the facts aforesaid and is duly authorized and empowered to verify this
statement on behalf of The Patriot-News Co. aforesaid by virtue and pursuant to a resolution unanimously passed
and adopted severally by the stockholders and board of directors of the said Company and subsequently duly
recorded in the office for the Recording of Deeds in and for said County of Dauphin in Miscellaneous Book "M",
Volume 14, Page 317.
PUBLICATION
COpy
NOTAR PUBLIC
My commission expires June 6, 2006
R. MARK THOMAS
ATTN: R. MARK. THOMAS
101 SOUTH MARKET STREET
MECHANICSBURG, PA. 17055-3851
Statement of Advertising Costs
To THE PATRIOT-NEWS CO.
For publishing the notice or publication attached
hereto on the above stated dates
113.61
Publisher's Receipt for Advertising Cost
The Patriot News Co., publisher of The Patriot-News and The Sunday Patriot-News, newspapers of general
circulation, hereby acknowledge receipt of the aforesaid notice and publication costs and certifies that the same have
been duly paid.
By................................................................... .
PROOF OF PUBLICATION OF NOTICE
IN CUMBERLAND LAW JOURNAL
(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 swom, according to law, deposes and says that the Cumberland Law
Journal, a legal periodical published in the Borough of Carlisle in the County 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:
July 1, 8, 15,2005
Affiant further deposes that he is authorized to verify this statement 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 foregoing
statements as to time, place and character of publication are true.
".
kramer, . in C't dee'd.
Late of sUver Spring Township.
Executrix: Colleen M. Nudge.
5811 Musket Road. New Tripoli,
PA 18066.
Attorney: R. Mark Thomas, Es-
quire, Attorney at Law, 101 South
Market Street. Mechanicsburg
PA 17055. .
SWO TO AND SUBSCRIBED before me this
15 day of Julv. 2005
NOlARI SEAl
LOIS E. SNYDER. Notary Public
Carlsle Boro, Cumberland County
My Commission Expires March 5, 2009
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Mkhael J. M.lpeui, Owner · Jeremy J. Sluu1zer, Funeral Dinctor
8 Market Pla1.tl Way · Mechanicsburg, PA 17055 · Phone: (717) 697-4696
September 6. 2005
Colleen M. Nudge
5811 Musket Road
New Tripoli, P A 18066
The Funeral Service for Iva C. Kramer
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can.
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
1. PROFESSIONAL SERVICES
Services of Funeral Director/Slaff
3. AUTOMOTIVE EQUIPMENT
Out of town transportation
FUNERAL HOME SERVICE CHARGES
SELECTED MERCHANDISE:
Solid Poplar Casket
12 Ga. Regular .
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED
AT THE TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADV ANCED CERTAIN PAYMENTS TO OTHERS AS AN
ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES.
CASH ADVANCES
Opening Grave
Cemetery Equipment
Certified Death Certificates
Newspaper Notices - Patriot
Newspaper Notices - Out or Town
ClergylMass Offering
Flowers
TOTAL CASH ADVANCES AND SPECIAL CHARGES
Please
$3545.00
$120.00
$3665.00
$2675.00
$1085.00
$7415.00
$600.00
$130.00
$90.00
$80.00
$100.00
$100.00
$185.50
$1285.50
SUB-TOT AI..
INITIAL PAYMENT / DISCOUNT / CREDITS
TOTAL AMOUNT DUE
$8710.50
$8710.50
www.malpezzifuneralhome.com
0&/18/05 11;32 AH NFFB, via VSI-FAX
Page 2 of 2 .4~751 I;
I , I
".'1",1 T ~ I FINAN'(:'TAL
t ~ I I l' I
Wds hrgo FInIncIIla.nIr
3'2D1 NIdl. AwnuI
SIoux F.", Scd1 c*1altI 571044700
Phunl: sos.782-S184
ADc: 60$0782-5158
To: Jack Gaughen Realtor FD.#: 7176970822
From: Wells Fargo F"
Date: 6/1112005
Ref. # (pl__ includt
IVA C KRAMER
5811 MUSKETRD
NEW TRIPOLI PA
!l
Pl.... read clI'Ifullv i'!.t
The ,payoff amolllt you r, I. i i -
of this letter. I payment ~ ~ !fl
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-THIS IS A LINE OF ~iil
PAYOFF AND/OR VE lil! .
CLOSE THE ACCOU; I~ i~ .
CUSTOMER, ACCOU . J Ii -
CLOSED TO USEAGI I' I
ACCOUNT IS PAID IN
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Wells Fargo Financial B~ :.
PO Box 5943 Si
Sioux Falls, SO 57117...6: -:
0-
Overnight payments sho\,j'
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Wells Fargo Financial BSI f !' ,
3201 North ~ Ave ! !!l
Sioux Falls, SO 67104-0; !' n
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Mailing address:
Jenny
Real Estate Credit
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TO: Iva C Kramer
5811 Musket Rd
New Tripol i, PA :
~,~~.~VVy ~:VV YH ~^ti! i/3 R1zhtFax
XP431
DEMAND / PAYOFF STATEMENT
06-10-05
lva C Jera:l'ne:r
5811 Muskst 1M
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PAGE I ~
FINAta t:mm are calculated at a tOmlY PERIODIC RATE cF 1.~
UNtil RATE (f' 21.~) based upan an unpaid balance outstanding 31
days or lore.
PlEASE DIRECT llESTI(N; TO WR ~ RECEIVABLE
DEPARTIENT )llN)AY THRU FRIDAY 9AM - 5PM
TERMS NET 15 DAYS
STANDARD CREDIT TERMS
ST A tEMENf'OF ACC01.JNT '
STATEMENT DATE: 18/13/15
PAST' QUE,:
. " '
Accollnt. 2887
Invoice' STATEMENT
; ,;.,.'-r.'-:'..:~~:::t1~!:g.-j':.:~:"~_~~*tf:5};\::~;";~f?':__'
, IVA' KRIIER .
C/O COJ.EEN ttIOGE
5811 IUJ(ET rom
fEW TRIPCLIt PA 18866
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0.80
20.77
0.00
~ 20. n
.....
JAMES J FREEMAN DO PC
1650 VALLEY CENTER PKWY
CBO
BETHLEHEM, PA 18017
Tel: 484-884-4533
STATEMENT
Patient: KRAMER,IVA
Tax I.D. 611447402
KRAMER, IVA
5488 ALBURTIS RD
MACUNGIE,PA 18062
STATEMENT DATE PAGE
07/15/05 1
ACCOUNT NUMBER
9087968 ... 1 /MC
, INDICATE
AMOUNT ,PAID <$..
~. .. , .::l'\~_.; f.,':.
.1' '
-... - -... ... place. -coaeii:..... 'fjj~Iii - 'Pa:t.I eiif' -. - - - -oii;';oiif;" Pat] en t..... ER;Eme.rgeiicy'~oom"'" - - - -.-
I DATE IIICD9 CDllpL*1 DESCRIPTION I AMOUNT I
Balance forward last statement 0.00
OS/26/05 786.50 0 99204 INITIAL OFFICE VISIT, IV 170.00
07/05/05 MCCK MEDICARE CHECK -105.22
07/05/05 MCDS MEDICARE DISALLOWANCE -38.47
, . ,,'"':"
" --.......-..~-~ .-...-.... -_.. -_. -.. "
\'
,
Ref. Pby: JONES, MARIA MD
I CURRBlIT AMOUNT I PAST DUE AMOUNT I PLEASE PAY II 26.31 I
$ 26.31 $ 0.00 THIS AMOUNT $
MEDICARE HAS MADE THEIR DETERMINATION REGARDING
THIS INVOICE. PLEASE REMIT BALANCE UPON RECEIPT.
FOR YOUR CONVENIENCE, VISA/MASTERCARD ARE ACCEPTED
THANK YOU.
IF YOU ARE RECEIVING A STATEMENT, PLEASE RETURN THE TOP PORTION WITJ,fjoUR PAyMENT.
LEHU!H VAT l,~
HOSPITAL
AND HEALnI NETWORK
Patient Accountlng Department
P.O. BOX 4120
Allentown PA 18105-4120
1VOO320
PATIENT BILL
IVA KRAMER
VILLAGE AT WILLOW LANE
6488 ALBURTIS RD
MACUNGIE PA 18062-8487
1...111..1.11....11....1.11..1..1..11. i 1.111.11..1.1..1.11'111
In OIIlII.\1I1l1IlWIY
Patient Name
Patient Bill Date
Patient V1sit(s)
Type Of Service
Account Number
IVA KRAMER
09109105
05130/05 - 06108105
TRANSITIONAL SKILLED UNIT
104655923
$ 12,471.76
$ 2,604.18
$ 9,411.58
$0.00
$ 456.00
Total Charges
Insurance Payments
Account Adjustments
Patient Payments
What yoU owe - Please pay by 09/24/2005
III \ II I'll 11 el' III / 0 /'/l1ll 1;011
Please confirm this Information Is correct and indicate
changes on reverse side.
Primary Insurance MEDICARE
Group/Plan 10 2130901420
Only a primary Insurance I. on file. Please contact
us If yoU have secondary Insurance.
Account Number: 104655923
ImfJortallt .11n\lIge
Thank you for selecting Lehigh Valley Hospital for your health
care needs.
We have billed your insurance and they have determined your
coverage. Your account number 104655923reflects a balance due
in the amount of $ 456.00 for services provided on 05130105 -
06/08/05. Please contact our Customer Service Department If
you have any questions concerning your bill.
Please Note: This statement Is for hospital charges only.
You will receive a separate bill from the physician for their
professional services. Please retain this statement until
your account is paid in full.
Tamblen Tenemos Representantes Que Hablan Espanol @
1-800-608-6800.
\
Il'COlIllI f c1il';~I'
DESCRIPTION
AMOUNT
BILLED CHARGES
MEDICARE PAYMENT
OTHER INSURANCE PAYMENTS
ACCOUNT ADJUSTMENTS
$12,471.76
$0.00
$ 2,6<M.18
$ 9,411.58
Qlle\I;OIl \
Billing questions or changes in insurance coverage?
. Call us a.610-402-3025 or 1-800-608-6800 or
. Fax us at 610-402-3125 or
. E-mail usatpatient.billing@lvh:com
Customer Service Representatives are available Mon-FrI
7:30 a.m. to 4:30 p.m.
. . . . .. .. . . .. . . . . .. .. . . . .. . .... .... .. ... ... . ... .. .... ... .... . . .. PLEASE DETACH AND RETURN Witt-i"vOUR PAYMENT.. . . . . .. .. . . . . .. . .. .. .... . ....... . .. .. ...-
W1Il!11 V~ Patient Bill Date: 09/09/05
HOSPITAL
AND HEAL'I1I NE'lWORK
MAKE PAYMENT TO:
Lehigh Valley Hospital
P.O. Box 4120
Allentown PA 18105-4120
1...111.11..1.1111....1.1..1..11..111.1.111.1...1.111...1111.1
_HCM-21001.M
II Check here If your address or Insurance information has changed.
'-' Please Indlc8te changes on the bBCk of thIs page.
To pay by credit card: For your convenience, you may pay by VIsa,
MasterCard, Discover or Amerlcan Express. Please Indicate your credit
card preference, provide the account information, and sign below.
w.
fJ.
will
u.
Account No.
Expiration Date
Signature X
LVHST11
GMAC
-
P.O. Box 7041 Troy MI48807-7041
877.839-1560
August 24. 2005
How We Calculated Your SutDlus or Deficiency
Iva C Kramer
435 Easterly Dr
Mechanicsburg. PA 17050
Subject: Account Number 020-9047-56803
Your N04 Saturn L300. VIN 1 G8JD54R64Y509395, was sold on August 11, 2005. As of the
date of this letter, the amount you still owe us under the terms of your contract is $5,038.11.
This amount was calculated as follows:
Unpaid balance before subtracting money from sale
This amount was calculated as of July 22. 2005 and reflects a
rebate of unearned finance charges. See below..
Money from sale
Unpaid balance minus money from sale
Known expenses of taking. holding, preparing for sale. processing.
--. --.-,.... ~. 8fld.aeHing ,vehiolej"'attomey fees~ and other le.gal expenses:
Repossessing & transporting .. $ _. - 332.50
Storage & reconditioning 30.00
Selling costs 30.00
Title & registration fees 0.00
Attorney fees and legal expenses the law permits 0.00
Total expenses +
Known credits:
Rebate of unearned insurance premiums
Extended service contract refunds
Insurance and service contract claims
Total credits
Deficiency/( surplus)
$ 17,445.61
$
12.800.00
4,645.61
392.50
$
0.00
0.00
0.00
$
0.00
5.038.11
EL
POSTSALElI'4b-g592tradI1
Iva C Kramer
020-9047-56803
-2-
August24,2005
*Amount calculated as follows:
Amount you owed before finance charge rebate
Less: Rebate of unearned finance charges
$ "17,445.61
- $ 0.00
The amount of any deficiency/surplus shown above may change because of future additional
credits, rebates, or charges. Any deficiency shown above may also change because of
additional interest accruing after the date of this letter.
For more information about this transaction or to make payment arrangements, you may call
us at the telephone number at the top of this letter or write us at the address at the top of this
letter. "
Signed.
Account Specialist
El
POSTSAlE911b.g592\red11
SOLOMON
AND
SOLOMON
Attorneys at law
Mailing Address: Columbia Circle, Box 15019, Albany, New York 12212-5019
Located at Five Columbia Circle, Albany, New York 12203
Toll Free 1-800-233-7515 Fax: (518) 456-0651 Se Habl a Espafiol
Our office is open Monday through Thursday Sam to l1pm and Friday
8am to 5pm (EST). Please call 1-866-292-1319 (toll free) for assistance.
08/03/2005
1...111'11.11....11...11...,1.1., I, I, I, .1., .11" .11, ..111..1.1
IVA KRAMER 17067789
5811 MUSKET RD
NEW TRIPOLI PA 18066-2241
RE: OUR FILE NO. 17067789 ACCT NO.
VERIZON TELEPRODUCTS
Amount due as of 08/03/2005:
BQCMJ30101564599
$33.33
Dear Sir/Madam:
The above matter has been referred to this firm for collection. In view
of the small amount involved, please remit the amount above to this office.
Simply make your check payable to the above creditor and return in the
envelope provided.
This is an attempt to collect a debt. Any information obtained will
be used for that purpose. This communication is from a debt collector.
Calls are randomly monitored to ensure quality service.
VALIDATION NOTICE
Unless you notify this office within thirty (30) days after receiving
this notice that you dispute the validity of the debt, or any portion
thereof, the debt will be assumed to be valid by this office. If you notify
this office in writing within the thirty (30) day period that the debt, or
any portion thereof is disputed, this office will obtain verification of the
debt or a copy of a judgment against you and a copy of such verification
will be mailed to you by this office. Upon your written request within the
thirty (30) day period, this office will provide you with the name and
address of the original creditor, if different from the current creditor.
Very truly yours,
SOLOMON AND SOLOMON, P.C.
mw- ~
a:.~oJLJ~ -=4. O-.~.' ~'~~'A'j~
LhO-d~~.~ ~.b af~~ 'JJ ~ .
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.
STATEMENT OF ACCOUNT
(j] 208 If THIRD ST SUITE 110
RlRRISBURC, PA 17101-1513
286
37
PltlastJ return Ihls portion
with your flIIIl/tIance
.
FINANCIAL
Send Pllyment To:
(unltlss your payment Is automat/cIJtly meds by
preauthorlzed payment or pteaulhorlzed check.)
Pl 12809
II. .1.1.1... 11111.1... .11.1. .1.1.. .11. .1. .1. .11. .1. .1..1'1.111
WILLS fARCO rIIARCIAL
P.O. BOX 98784
LAS VICAS, IV 89193-8784
007528
1,"111. .1.111 ...II.ullll ..1.1..1.1.1111.1111...11...111..1.1
US. IVA C KRUll
5811 RUSKU RD
RIM TRIPOLI,PA 18066-2241
Statement Date
Next Payment Due Date
Total Payment Due
Account Number
08/25/05
09/12/05
394.21
56365603
0032/001
56365603000001280'071204000003'42756365603&
Can you believe it, IV1?
It's August already and suaaer is al.ost over]
Uh-oh . . . what about your end of .u..er expense.? Tuition,
school supplies, co.puters, clothes, vacation bills
Are you stressing just thinking about it? Don't worry,
be happy]
Wells rargo rinAncial is here. We can discuss how our
services best .atch your financial situation, which
could include applying for a ho.e equity loan to
consolidate your bills.
Call 1-800-945-9462 and .ention code 8024.
TRODS ". IWlTIIDALI
Your "ells rargo rinancial Manager and Staff
, '"
WELLS rARCO rIlfAlCI1L
208 If TRIRD ST SUITE 110 286 Statement Date 08/25/05
IWUtISBURC, PA 17101-1513 Regular Payment Amount 128.09
PhorNI No. 717-236-8091 Previous Balance 62?6.41
Psyments rflC8ived anllr date of this statement WIll be shown on next slalement. Account Number 56365603
7hJns. Code" OBtll Amount CharpllS or Interest Principal Unpaid Balance
l1U.rvUll ~ ~
~ fXCt-vL-L J --1nOr---
"See o/hBr side lor list of 7hJnsacllon Codes.
Unpaid Defermenl
AlIIOlII1tof DelInquent and'or ToIII Amount
Nt1Kt Payment Regular Amount Delinquency Due on If.xI
Due Dete Pllyment Due Charge Due """"'t Out Oaf.
\.. 09/12/05 128.09 256.18 10.00 394.27 ~
. .
.Vlsit us online It www.wellsfargofinanc/alcom"
'" Iddlt;o".to the IOCII phon. numb". ,"OW" I&cwt. flU' /IIt/onll
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~alanc.
'Sots7.17
0.00
$57.17
t+) purch...s
& Advances
$i9.OO
0.00
$ 9.00
(+) flNANCt . (.). N*W
CHARGe: 8alanct
$t.t.35 $5iOo52
0.00 . 0.00
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SUD PAYIIUTSTO: UTI CAItDS PO BOX 183060 COLUIIBUS, ON 43211-3060 2U61S
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154241&04201b'b5505'OS25'052~115
Your Account Numb.r
Peyrnetlt Du. Du.
Yeur TIt., "lend
MlnlmUll\ A_t Due
(
P..... Enter Amount or Ptymlllt Ene.....
($
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OCT 10 2005 $590.52 $590.52
226615 MCS 32 A 1 BR10l0S47
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IVA C KRAMER
5811 MUSKET RD
HEW TRIPOLI
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............ PhDM
PA 18066-2241
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eIlI CARDS
PO BOX 183060
COLUMBUS, OH 43218-3060
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MCI Account: 2FF59828 .
Telephone Number: 717795-6289
Customer Service: g www.mcl.comlservlce
Statement Date: 08/07/05
Page 1 of 3
. 1 888 624-5622
-_.----:.~
Mel
Summary of Charges
Previous Charges .......................................
Payments through 08106/05 ......................
Long Distance Adjustments ......................
Balance Forward .........................................
Late Payment Charge 10 1.20% ................
"'_ ~.......~..xx ........... ~'J ".-;............"... , ..",-"""~. ,.. ........... ......~.... '.J'.' J'."'~', ..... -, #0"'...' '._'..v..', "
Total Amount Due .....................................
.'" "'><~..' ......,....... ~.~.x.~_, .',,'" .,,_ .,.".. ......,-... -.....~ .. ..:'.,,,'---'.'.,,,
Past-Due Charges Due ............................
Current Charges Due ...............................
.>.'U","""JX.,X,_ r '. ~. ~"'_><..._u......"'........._"......A '"
$145.10
$.00
$.58
$145.68
$.38
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. .,__:......\.....J',_,.....'.. ......
$146.06
.... "~"";...-
UPON RECEIPT
08131105
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Please See Reverse For Important Account Information
, REMINDER: A 1.20% late pav.ment charge will apply to any
unpaid balance a8 of September 06. 2005 .
~. it~i'lt~~tle!CQW1lNj1f.}1ilQ.t;t~[B~RN:;()fjllll;ftHfiL.QWEB., I?QAtlQN~~ ~~
Statement Date: . , , , . . AUitust 7~2oo5' . , , , . . . , . . , , 'MCt'Account: . . , . . . . . . . . . . 2'FF59828 ' . . . , .
Payment Due Date: UPON Rt:.CEIPT Balance Due: $146.06
Indicate I
amount paid ,
Please make check or money order
PAYABLETOMCI. DO NOT SEND CASH.
Return this form wfth your payment.
1,"111"1.11....11...11'11.1.1..1.1.1111...11'1111,"111..1.1
'BWNBMMR .....0069-000-014182 ATl 292
.2FF59828NROOOOOO, 092 "WFMC.75.01"
IVA KRAMER
6811 MUSKET RD
NEW TRIPOLI , PA 18066-2241
MAIL TO:
1..11.11.....11..1..11..1..1.1...1.1111.1...11111I1.11111.1..1
MCI RESIDENTIAL SERVICE
PO BOX 105271
ATLANTA, OA 30348-5271
11.1.1..111..1111.11..11.111.11111I1111I.1.1.11.11 .111111.1.11
202096 02151505090802088 482775438 00000000 00014606
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Statement
The Village at Willow Lane
6488 Alburtis Rd. tIP 4'2./ 1/t'tJ
Macungie, PA 18062
Date
10/17/2005
To:
Iva C. Kramer
Rm. 308A
Amount Due Amount Ene.
$10,322.40 -..-.---..~.-.
Date Transaction Amount Balance
05/31/2005 Balance forward 8.170.00
06/17/2005 INV#1719. Due 06/17/2005. 1,106.00 9.276.00
08/30/2005 INV #Fe 19. Due 08/30/2005. Finance Charge 857.33 10.133.33
09/30/2005 INV #FC 32. bue 09/30/2005. Finance Charge 189.07 10.322.40
;J~ - bill
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CURRENT 1-30 DAYS PAST 31-60 DAYS PAST 61-90 DAYS PAST OVER 90 DAYS . Amount Due
DUE DUE DUE PAST DUE
0.00 0.00 189.07 857.33 9.276.00 $10,322.40