HomeMy WebLinkAbout04-12-06
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15056051058
REV-1500 EX (06-05)
PA Department of Revenue .'
Bureau of Individual Taxes . !.~ '.
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
~\
~'\)~ S.
~~~~
Date of Birth
208-30-4432
10/16/2005
07/16/1939
Decedent's Last Name
Suffix
Decedent's First Name
MI
Jones
Ann
M
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
t.,)
1. Original Return
2. Supplemental Return
'-...........-=.:
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
1.,..._.--,
4. Limited Estate
L_._,' 4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
, , 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST Be COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
r-- .".
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
8. Total Number of Safe Deposit Boxes
Kimberley Smith
Firm Name (If Applicable)
(717) 732-7884
REGISTER OF WILLS USE ONLY
First line of address
39 Heidi Terrace
Second line of address
City or Post Office
State
ZIP Code
DATE FILED
Camp Hill
PA
17011
Correspondent's e-mail address:
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all infonnation of which preparer has any knowledge.
:~D:T:~~RETURN _ -~-~~Q:-D_(p_
39 Heidi Terrace, Camp Hill, PA 17011
-. ---------..--------.---- ",-
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
L
15056051058
Side 1
15056051058
--.J
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15056052059
REVM 1500 EX
Ann
M Jone~
Decedent's Name:
RECAPITULATION
1. Real estate (Schedule A). .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1.
2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3.
4. Mortgages & Notes Receivable (Schedule D). . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5.
6. Jointly Owned Property (Schedule F) C=;, Separate Billing Requested . . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) C=:) Separate Billing Requested.. . . . . .. 7.
8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8.
.."" ,,- ..~~~"..,~... - ,- ~-'--'-~""-'-, "-'-'-"-.._'-'-"'","~-....--..-_.--..,-.,...-...,-, -.-.-.., ..~-~'---"_.._--'.................-'" ',_.-,.,..~,.. .---------'..""~~
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)...................................11.
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.
13. Charitable and Governmental Bequests/See 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.
TAX COMPUTATION. 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_
16. Amount of Line 14 taxable
at lineal rate X.O 45 2,720.35
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X. 15
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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Decedent's Social Security Number
15.
16.
17.
18.
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15056052059
Side 2
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208-30-4432
156052059
103,000.00
3,338.00
106,338.00
4,500.00
41,385.75
45,885.75
60,452.25
2,720.35
2,720.35
---I
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
Ann
STREET ADDRESS
646 Erford Road
FiI~ NUffiller
-- - ---- - ----- - ~---- -- . -- -
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--~- ~
DECEDENT'S SOCIAL SECURITY NUMBER
208-30-4432
M
Jones
CITY
Camp Hill
.- -- -------- ----.-TSTATEp~-- ---.
ZIP
17011
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
2,720.35
3.
InteresUPenalty if applicable
D. Interest
E. Penalty
Total Credits ( A + 8 + C ) (2)
4.
TotallnteresUPenalty ( 0 + E)
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund.
(3)
(4)
(5)
(SA)
(58)
2,720.35
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line S + SA. This is the BALANCE DUE.
2,720.35
Make Check Payable to: REGISTER OF WILLSJ AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN nXIIIN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.......................................................................................... 0 [iJ
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 (K]
c. retain a reversionary interest; or................. ....... ...... ......... ..... .............. ........ ............ ................... ......................... 0 [XJ
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [iJ
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .......... .......................... .................................. ...... ....... ....... .................... 0 !Kl
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 [iJ
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .......... ..... ...... .................................. ...... .......... .......... .......... ....... ...................... 0 [KJ
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 January 1. 1995, the tax rate imposed on the net value of Iran sfers to or for the use of the surviving spouse
is three (3) percent [72 P.S. 99116 (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 zero (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 twenty-one years of age or younger at death to or for the use of a natural parent, all
adoptive parent, or a stepparent of the child is zero (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 four and one-half (4.5) percent, except as noted in
72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)].
The lax rate imposed on the net value of transfers to orforthe use of the decedent's siblings is twelve (12) percent [72 P. S. !i9116( 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.
LAST WILL AND TESTAMENT
OF
ANN MARIE JONES
I, Ann Marie Jones, a widow of Camp Hill, Cumberland County, Pennsylvania, being of
sound rnind, mClnory and understanding, do hereby nlake and publish this my Last Will And
Testanlent hereby revoking all previous Wills and Codicils made by me.
Item 1. I declare for the purposes of this Will that, as of the date of its execution,
my farnily consists of the following:
The names of my children are:
Jeffrey Jones, Robert Jones and KiInberly SUlith
All references to my family and children are to them.
Item II. I direct that all debts enforceable against me during my lifetime and duly
allowed in the administration of my estate, the expenses of my last illness and funeral, including
the cost of a suitable monument at my grave, unpaid charitable pledges whether or not the same
are enforceable obligations against my estate, and the costs of administration of my estate be paid
as soon as practicable after my death. My Personal Representative may, in her sole discretion,
pay from my domiciliary estate all or any portions of the cost of ancillary and similar proceedings
in other jurisdictions.
Item Ill. I may leave a written list, which will be dated and either in my own
handwriting or signed by me, that sets forth my wishes regarding distribution of specific personal
property. If I do, then I intend it to quality as an amendment to this Will. If it should be
determined that any such list does not qualitY as an amendment to this Will, it is my hope that
those entitled to share in my estate will nevertheless respect it.
Page 1 of 4
Item IV. All of the rest, residual, and remainder of my estate, real, personal and
mixed of whatever kind and wheresoever situated, I give and bequeath in equal shares to my
children, Jeffrey Jones, Robert Jones, and Kimberly Smith, per stirpes.
Item V. I hereby nominate and appoint my daughter, Kimberly Smith, to be the
Personal Representatives of my estate. Should she be unwilling or unable to serve, then I appoint
n1Y son, Jeffrey Jones.
Item VI. I confer on my Personal Representative(s), in addition to those powers granted
by law, the following powers to be exercised in a prudent manner and applicable to all property
constituting a part of illY estate:
A. To retain and to invest in all forms of real and personal
property, without being confined to investments authorized by a statutory list,
without being required to diversifY and regardless of any principal of law limiting
delegation of investment responsibilities by personal representatives or trustees;
B. To compromise claims and to abandon any property which,
in my Personal Representative's opinion, is ofJittle or no value;
C. To sell at private or public sale, to exchange or to lease for
any period of time, any real or personal property, and to give options for sales or
leases;
D. To borrow from anyone, even if the lender is a personal
representative hereunder, and to pledge property as security for repayment of the
fimds borrowed;
E. To join in any merger, reorganization, voting-trust plan or
other concerted action of security holders, and to delegate discretionary duties;
F. To employ and to rely upon the advice given by investment
counsel, to delegate discretionary authority to make changes in investments to
investment counsel, and to pay investment counsel reasonable compensation in
addition to any fees otherwise paid to my Personal Representative(s);
G. To employ a custodian, to hold property unregistered or in
the name of a nominee (including the nominee of any institution employed as
custodian), and to pay reasonable compensation to the custodian in addition to any
tees otherwise payable to my Personal Representative(s);
Page 2 of 4
H. To procure and carry at the expense of my estate insur,Ulce
of kinds, forms and amounts deemed advisable by my Personal Representative(s)
to protect my estate and my Personal Representative(s) against any hazard;
1. To commence or defend at the expense of my estate any
litigation affecting lllY estate;
] . To conduct alone or with others any business in which I an1
engaged or in which I have any interest at my death, with all the powers of any
Owner with respect thereto, including the power to delegate discretionary duties to
others, to invest other property held hereunder in such business and to organize a
partnership or Corporation to carry out such business; and
K. To distribute in cash or in kind.
Item VII. My Personal Representative(s) shall be reimbursed for all reasonable
expenses incurred in the administration and management of the assets of my estate and shall be
entitled to receive a fair and reasonable compensation for its services.
Item VIII. Anyone named in this Will who dies within 30 days after my death (or
dies under circumstances such that it cannot be determined whether such individual died within
30 days after my death) shall be deemed, for purposes of this Will, to have predeceased me.
IN WITNESS WHEREOF, I,.Ann M. Jones, have to this my Last Will And Testimony
hereunto set my hand and seal this:fdday of AU<)~i:d ,2005.
,. i /' / )
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/,tJ/'1I'I,r I /r! - \1.",?;",,;"R.'t-.,/
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Ann M. Joil:es
SIGNED, SEALED. PUBLISHED AND DECLARED by the above-named Testatrix,
Ann M. Jones, as and for her Will, in the presence of us who, at her request, in her presence, and
in the presence of each other, all being present at the same time, have hereto set our hand as
\vi tnesses:
N AMB.<>,,:'l
'J J- ~I
RESIDINGAT . L1--~ ,~C II C[15jf:lr!,;~-? \~ i
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. /7. ;;,,,X/) RESIDING A 1'5 <; t. '/,. 7?</;;:..~,[ c'";;'
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Page 3 of 4
STATE OF PENNSYLVANIA
COUN'TY OF C~,;,vd)''';{k'/~
SS.
I, Ann M. Jones, having been duly qualified according to law, acknowledge that I
signed the foregoing instrument as my Will, and that I signed it as my free and voluntary act for
the pUrposes therein expressed.
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y'lf1.f...~').Jr' /' . "u--/ff/~.f''''Y
An~ M. JOU'eS
We, having been duly qualified according to law, depose and say that we Were
present and saw Ann M. Jones sign the foregoing instrument as her Will; that she signed it as
her free and voluntary act for the purposes therein expressed; that each ofus in her sight and
hearing and at her request signed the Will as witnesses; and that to the best of our knowledge, she
was at the time 18 years or more of age, of sound mind, and under no constraint or undue
influence.
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Witness .._-..----.-u-'-~~~)
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~W ittiess
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Subscri bed, sworn to, or affinned, and acknowledged before me by the above-
named Testatrix and by the witnesses whose names appear, on this }"'day of 1-)\. , " <+
2005, ,]
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Notafy Public '-.
Page 4 of 4
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Hope A. Mattos. Notary Public
Hampden Twp" Cumber1and County
My Commission Expires Oct. 11. 2008
Member. Pennsylvc)j)ja l\s$ociallon Of Notaries
STATE OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SHORT CERTIFICATE
I,
GLENDA FARNER STRASBAUGH
Register for the Probate of Wills and Granting
Letters of Administration in and for
CUMBERLAND County, do hereby cert,ify that on
the 4 th day of November, Two Thousand and Pi ve,
Letters TESTAMENTARY
--------'------._---~_._-----.__.,--_.-----.~
(first Middle', LeJst)
in COITUTIOn form were gran ted by the Regi s ter of
said County, on the
I late of EAST PENNSBORO TOWNSHIP
es ta te of ANN MARIE JONES
in said coun ty, deceased, to KIMBERL Y SMITH
(Filst, Middle, Last)
and tha t sanle has not since been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and aLfixed the
seal of said office at CARLISLE, PENNSYLVANIA, this 4th day of November
Two Thousand and ~F'i ve.
F'i 1 e No. 2005 - 00980
PA Pi_Ie No. 21- 05- 0980
Date of Death 10/16/2005
S. S'. # 208-30-4432
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L\lc'"i Registrar. ThL' original ccrtificale '.viII be forwarded to llle Slall' Vilal Records Office for pl'rnJanl'nl filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
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OCT 1 9 2005
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COMMONWEAlHf Qf Pf.r~~Yi.YAt-itA ~ OlePAA'TI\t~r O~ Hf,Al.TH . ViTAl". RacOROS
CERTJFICATE OF DEATH
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I
REV-1502 EX+ (6-98) ~"
-
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE Of
Ann Marie Jones
FILE NUMBER
All rea' 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 properiy would be
exchanged between a willing buyer and a willing seller, neilher being compelled to buy or sell, both having reasonable knowledge of the relevanl facts.
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
646 Erford Road, Camp Hill, PA 17011
103,000.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
103,000.00
o CORRECTED (if checked)
FILER'S name, street address, city, state, ZIP code, and telephone no. 1 Date of closing OMS No. 1545-0997
Pinnacle land Transfer, LLC 1/26/06 ~@O6 Proceeds From Real
3915 Market Street 2 Gross proceeds Estate Transactions
Camp Hill, PA 17011
$ 103,000.00 Form 1099-5
FILER'S led oral ,denti flea tion number I TRANSFEROR'S identification number 3 Address or legal description Copy B
05-0543147 For Transferor
TRANSFEROR'S name This is Important tax
646 Erford Road information and IS being
Estate of Ann Marie Jones Camp Hill, PA 17011 furnished to the Internal
Revenue Service. If you
Street address (including apt. no.) East Pennsboro Township are required to file a
return, a negligence
penalty or other
City, state, and ZIP Code sanction may be
4 Transferor received or will receive property or services 0 imposed on you If this
as part of the consideration (it checked) . . Item is required to be
Account or escrow number (see instructions) 5 Buyer's part of real estate tax reported and the IRS
determines that it has
PI006-1 0001 RCS $ 384.14 not been reported.
Form 1099-5
(keep for your records)
Department of the Treasury - Internal Revenue Service
Instructions for Transferor
For sales or exchanges of certain real estate, the person responsible
for closing a real estate transaction must report the real estate
proceeds to the Internal Revenue Service and must furnish this
statement to you. To determine if you have to report the sale or
exchange of your main home on your tax return, see the instructions
for Schedule D (Form 1040), Capital Gains and Losses. If the real
estate was not your main home, report the transaction on Form
4797, Sales of Business Property, Form 6252, Installment Sale
Income, and/or Schedule 0 (Form 1040).
Federal mortgage subsidy. You may have to recapture (pay back)
all or part of a federal mortgage subsidy if all the following apply:
· You received a loan provided from the proceeds of a qualified
mortgage bond or you received a mortgage credit certificate,
· Your original mortgage loan was provided after 1990, and
· You sold or disposed of your home at a gain during the first 9
years after you received the federal mortgage subsidy.
This will increase your tax. See Form 8828, Recapture of Federal
Mortgage Subsidy, and Pub. 523, Selling Your Home.
Account numbEtr. May show an account or other unique number
the filer assigneel to distinguish your account.
Box 1. Shows the date of closing.
Box 2. Shows the gross proceeds from a real estate transaction,
generally the sales price. Gross proceeds include cash and notes
payable to you, notes assumed by the transferee (buyer), and any
notes paid off at settlement. Box 2 does not include the value of
other property or services you received or are to receive. See Box 4.
Box 3. Shows the address or a legal description of the property
transferred.
Box 4. If marked, shows that you received or will receive services or
property (other than cash or notes) as part of the consideration for
the property transferred. The value of any services or property (other
than cash or notes) is not included in box 2.
Box 5. Shows certain real estate tax on a residence charged to the
buyer at settlement. If you have already paid the real estate tax for
the period that includes the sale date, subtract the amount in box 5
from the amount already paid to determine your deductible real
estate tax. But if you have already deducted the reaJ estate tax in a
prior year, generally report this amount as income on the "Other
income" line of Form 1040. For more information, see Pub. 523,
Pub. 525, and Pub. 530.
IF THE TAX 10 NUMBER SHOWN ABOVE AS "TRANSFEROR'S Identification Number" IS INCORRECT OR
BLANK, PLEASE FILL IN THE CORRECT TAX 10 NUMBER HERE: ,d) ..' '"" ,~o (;".+ '\
L../Lf - ? () / k-<c~ I ~.J-lv
../
SOCIAL SECURITY NUM TAX 10 NUMBER
Receipt of this statement is hereby acknowledged
this
day of
,20 .
-
L,:III.,04 /J{3J'O I ~~J.~'
ES~~nn Mar(e 1'l~s ~
CERTIFICATION FOR NO INFORMATION REPORTING
ON THE SALE OR EXCHANGE OF A PRINCIPAL RESIDENCE
This form may be completed by the seller of a principal residence. This information is necessary to determine
whether the sale or exchange should be reported to the sell, and to the Internal Revenue Service on Form 1099-5,
Proceeds From Real Estate Transactions. If the seller properly completes Parts I and II, and make a yes' response to
assurances (1) through (4) in Part II, no information reporting to the seller or to the Service will be required for that seller.
The term 'seller' includes each owner of the residence that is sold or exchanged. Thus, if a residence has more- than one
owner, a real estate reporting person must either obtain a certification from each owner (whether married or not) or file an
information return and furnish a payee statement for any owner that does not make the certification.
Part I. Seller Information
1. Estate of Ann Marie Jones
2. Address or legal description (including city, state, and zip code) of residence being sold or exchanged
East Pennsboro Township
646 Erford Road, Camp Hill, PA 17011
3. Taxpayer Identification Number (TIN) C2LJ - -p It ~ (2;.ji"-)
Part II. Seller Assurances
Check 'yes' or 'no' for assurances (1) through (4).
ff1 No
[ ] (1 )
~ [ ] (2)
~ [ ] (3)
1fJ [ ] (4)
I owned and used the residence as my principal residence for periods aggregating 2 years or
more during the 5-year period ending on the date of the sale or exchange of the residence.
I have not sold or exchanged another principal residence during the 2-year period ending on the
date of the sale or exchange of the residence (not taking to account any sale or exchange before
May 7, 1997). -
No portion of the residence has been used for business or rental purposes by me (or my spouse if
I am married) after May 6, 1997.
At least one of the following three statements applies:
The sale or exchange is of the entire residence for $250,000 or less.
OR
I am married, the sale or exchange is of the entire residence for $500,000 or less, and the
gain on the sale or exchange of the entire residence is $250,000 or less.
OR
I am married, the sale or exchange is of the entire residence for $500,000 or less, and (a)
I intend to file a joint return for the year of the sale or exchange, (b) my spouse also used the
residence as his or her principal residence for periods aggregating 2 years or more during the 5-
year period ending on the date of the sale or exchange of the residence, and (c) my spouse also
has not sold or exchanged another principal residence during the 2-year period ending on the date
of the sale or exchange of the residence (not taking into account any sale or exchange before
May 7, 1997),
Part III. Seller Certification
Under penalties of perjury, I certify that all the above information is true as of the end of the day of the sale or exchange.
Settlement date:
Sales Price:
File Number:
Seller Names:
Sellers New Address:
r/&4 Jos
.. ..
". Date
January 26,2006
$103,000.00
PI006-1 0001 RCS
Estate of Ann Marie Jones
SELLERS NEW ADDRESS:
REV-15GB EX + (6-98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Ann Marie Jones
FILE NUMBER
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
NUMBER
DESCRIPTION
Checking Account - Commerce Bank, 100 Senate Ave, Camp Hill, PA 17011 - Acct#05121 00421
VALUE AT DATE
OF DEATH
975.00
2 Savings Account - Commerce Bank, 100 Senate Ave., Camp Hill, PA 17011 - Acct# 0626126536
713.00
3 Misc. Personal Property (See attached inventory)
989.00
4 Pension Payment - State of Pennsylvania
661 .00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
3,338.00
Commerce
"Bank
Commerce Bank/Harrisburg N.A.
100 Senate Avenue
Camp Hill, Pa 17011
888-937 -0004
Page 2 of 3
STATEMENT DATE
ANN M JONES
JEFF E JONES
646 ERFORD RD
CAMP HILL PA 17011
11/03/05
0512100421
ACCOUNT NO.
10
CYCLE-001
-----------------------------------------------------------------------------------
*** BALANCE BY DATE ***
10/04 1,732.67 10/05
10/11 1,477.37 10/12
10/17 1,764.77 10/18
10/28 2,050.60 11/02
1,669.32
1,194.10
1,492.77
1,969.50
10/06
10/13
10/19
11/03
1,564.38
1,175.07
1,312.60
1,771.69
23-2324730
1.41
10/07
10/14
10/24
1,486.23
1,950.21
1,150.60
PAYER FEDERAL ID NUMBER
INTEREST PAID YEAR TO DATE
----------------------------------------------------
*** INTEREST EARNED THIS STATEMENT PERIOD
DAY S IN PERIOD .........................
INTEREST EARNED ........................
ANNUAL PERCENTAGE YIELD EARNED (APY)....
***
30
.19
0.15%
----------------------------------------------------
NOTE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION
Member FDIC
Commerce
.Bank
ANN M JONES
KIMBERLY A SMITH
646 ERFORD RD
CAMP HILL PA 17011
STATEMENT DATE
12/31/05
0626126536
ACCOUNT NO.
*** SAVINGS *** STATEMENT SAVINGS BEGINNING RATE
ACCOUNT NUMBER 0626126536
PREVIOUS STATEMENT BALANCE AS OF 09/30/05 ............ ............
PLUS 1 DEPOSITS AND OTHER CREDITS .. .................
LESS 3 WITHDRAWALS AND OTHER DEBITS ................
LESS CYCLE SERVICE CHARGE .....................
CURRENT STATEMENT BALANCE AS OF 12/31/05 .........................
NUMBER OF DAYS IN THIS STATEMENT PERIOD 92
.rISI-<:
0.25000
21625.01
.38
21623.39
2.00
.00
-----------------------------------------------------------------------------------
*** SAVINGS ACCOUNT TRANSACTIONS ***
DATE DESCRIPTION
10/14 DEBIT MEMO
10/28 WITHDRAWAL
10/31 CYCLE SERVICE CHARGE
11/28 DEBIT MEMO
11/29 PMT ON OD ACCT
DEBITS
11200.00
11400.00
2.00
23.39
CREDITS
.38
-----------------------------------------------------------------------------------
*** BALANCE BY DATE ***
09/30 21625.01 10/14
11/28 .38- 11/29
11425.01 10/28
.00
25.01 10/31
23.01
PAYER FEDERAL ID NUMBER
INTEREST PAID YEAR TO DATE
23-2324730
4.55
-l \"--0 eI\.- +0 v- ~
Room Item $$
Living Room
Sofa jt !)50
Love Seat ~ r'7:5
Rocker ~ '15
TV "".&6
TV Stand .$ \0
2 End Tables ~. \O~~
Coffee Table .tt\5
2 Lamps ~.\O
Wall Decoration .. "-t D
Curtains !5
Kitchen
.. Refrigerator ~ '1 '5
~ Stove .d- 30
Dishes .g .;2 0
Pots/Pans $ 'YO
Glasses .Sl5
Silverware '5
~ Microwave b\S
~ Kitchen Table .n-IO
r 4 chairs -'5~.
Telephone :11.:2
Front Bedroom Craft Supplies ~5S
Curtains 5
Middle Bedroom White Dresser w/ Mirror ~~O
White Chest of drawers 1-1l 015
Back Bedroom Bed f5t55
Dresser ~2\)
.r- r" I j
, , I
~,
'tIJ1!d' i," ..l~.' i ~~l i
":D -" - '::;; :.1.1.":" '\ i
...I:l.f! , .,.... J L
\- 30\6
* J::-\e...-",-S . De \ l~
W \~ \\O\.l.l~X_ .
Chest of Drawers ;2{J
Night Stand (TV Stand) \ b
Clothing ;25
Bathroom "X Shower curtain t-:;..
Linen Closet Towels q
Sheets & Pillowcases lP
comforters ;;-::
Sweeper (7
Back Deck Patio Table \ (\)
4 Chairs ?
Shed Lawn Mower 3h
, --'
,~ r)
\ ;<, r;t-..
, ,.-J
Basement ~ Washer ,)t,
~ Dryer ,c30
VeklC. It- ~'LO
( \
COMMONWEALTH OF PENNSYLVANIA
STATE EMPLOYEES' RETIREMENT SYSTEM
30 NORTH THIRD ST STE 150
HARRISBURG, PA 17101-1716
1-800-633-5461
www.sers.state.pa.us
November 22, 2005
KIMBERLY SMITH, EXECUTRIX
ANN MARIE JONES ESTATE
39 HEIDI TERR
CAMP HILL PA 17011
Member SSN: XXX-XX-4432
Beneficiary SSN: XXX-XX-4432
Dear Beneficiary:
A check in amount of $660.25 will be mailed to you within two (2) weeks from the date of this letter.
The amount of $0.00 was withheld for Federal Withholding Taxes. If you have elected to rollover
then the taxable portion of $0.00 has been transferred to your qualified plans.
This payment represents your designated share of 100.000/0 in the Final settlement of the Account
of ANN MARIE M JONES with this retirement system.
If the individual listed above was a member of the Retirement system before January 1, 1982, their
contributions prior to that date were taxed as part of their gross income at that time. Therefore, no
taxes are being withheld on that portion of their contributions. The difference between the amount of
your payment and your share of the deceased member1s non-taxable contributions, if any, is
taxable for federal income tax purposes.
This payment has been reported to the Internal Revenue Service. If a 1 099R form is not enclosed
with this letter, you will receive one prior to January 31 of next year, with the necessary tax
information regarding this payment. Under current law there are no Pennsylvania state or local
taxes on any benefits paid from this system.
This letter and the 1099R form that you receive should be kept in a safe place, as you will need the
information when filing your Federal Income Tax Return. This is the only notice you will receive.
There is a $5.00 charge for each request of duplicate information.
Sincerely,
~,,~ m. )'n~
Linda M. Miller, Director
Benefit Determination Division
BEN31FSL
1111111111111111111111111I11111I111111111111111111111111111111 "" 1111
REV-1511 EX+ (12-99)_
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Ann Marie Jones
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Burial - Richardson Funeral Home (Enola, PAl
Clergy
Refreshments & Flowers
Obituary- Patriot News
1,995.00
1 00.00
289.00
66.00
2.
3.
4.
B. ADMINISTRATIVE COSTS:
1.
Personal Representative's Commissions
Name of Personal Representative(s) N/A
Social Security Number(s)/EIN Number of Personal Representative(s)
0.00
Street Address
City
State
Zip
Year(s) Commission Paid:
2.
Attorney Fees
1,935.00
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
115.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
4,500.00
fJ(ichardson guneral ~me, &nc.
j 29 SOUTH ENOLA DRIVE
ENOLA, PA 17025
(717) 732-0587
MICHAEL G. MURRAY
STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED SUPERVISOR
Ch"g" "e only for ,h"'e lrem, 'lu, you 'deered 0>" 'har "e requIred. If we 're required by I,w or hy , "melery or "'malory '0 u" 'uy irems, we will
explain in writing below.
/I you "leered , fU"'r~ 'h" m'y require embalmiog, 'urb " afooe~ wirh vieWing, you may have '0 p'y foremb'hning. You do nor have '0 p' y for embalmIng
you did nO>" approve If you "Ierred "range""'u~ ,ueh '" direel erema'ion or immed'are bun'/If we eharged for emlulmlng, we wW explain why below.
FOrthe Servlr. of - : 6 Oat< ofD<ath ".., dO
Charg<lo, J::: /..,6t"_/e. fJ . -f"'....~"'- -7/
Name Address City
A. CHARGE FOR SERVICES SELECTED: Other clothing
I. PROFESSIONAL SERVICES
Services of Funeral Director/Staff .. S_
Embalming. . . . . . . . . . . . . . . . . . . . . . ,_
Other preparation of body
Cremation urn
(Description)
'-
'-
S_
...................-
SUB-TOTAL OF PROFESSIONAL SERVICES. " Al '_
2. FACIlITIES AND SERVICES
Use of facilities and services for
viewing (VisitationlWake). . . . . . . .. '_
Use of facilities and services
for funeral ceremony . . . . . . . . . . " '_
Use of facilities and services for
Memorial Service . s_
Use of equipment and services
for graveside service. . . . '_
Ot her use of facilities
OTHER '_
S_
'-
TOTAL MERCHANDISE SELECTED...... '" B'_
e. SPECIAL CHARGES:
Forwarding of remains to
(Funeral Home)
Receiving of remains from
'-
'-
(Funeral Home)
Immediate Burial. ,_
Direct Cremation. . . . . . . " . A . . . . " . ~
--",-,.,.~ /.;"'c.... r ,'~_ .~, .
SUB-TOTAL OF SPECIAL CHARGES
D. CASH ADVANCED
Uperung urave '. s_
<.;emetery Equipment. . . . . ,_
Lot and Deed. . . . . . . . . . . . . . . . . . .. . '7"7-:r; i)
Newspaper NoticeS-Local ......... . ~
Newspaper Notices-Out-of-town . . .. ._
Telephone & Telegrams........... '_
Airfare. . . . . . . . . . . . . . . . . . . . . . . .. ,_
Clergy/Mass Offering.............. ~()
Pallbearers . . . . I ~
Certified Copies of the Death
Certific:lte '..
Police Escort
Flowers ....
Vault Service Charge
.-
............... ...1_
SUB- TOTAL OF FACILITIES/EQUIPMENT. . . . . . . . . . . A2 '_
3 AUTOMOTIVE EQUIPMENT
Vehicle to transfer remains to funer31 Home.
Local.............. ._
He:lrse (Casket Coach)
Local. . . . . . . . '. . .
Limousine
Local.
Family car
Local.
Flower car or floral dispOsition
Local .
lead car/clergy car
local.
Car for pallbearers
local.
Out of IOwn tranSportation
C'_
'-
'-
'-
'-
I_
,-
SUB-T01'At OF AUTOMOTIVE EQUIPMENT........ A31_
TOTAL OF PROFESSIONAL SERVICES,
FACILITIES AND AUTOMOTIVE
EQUIPMENT
SUB-TOTAL OF ADVANCES..
.. .. ,-=--
..'-
...8_
'-
'-
. --:---
I_
,-
s_
'--
D . / fJ' . -en
'-
........-
.............A '_
=
We charge you for our services in obtaining:
(SPecIfy casb advances tbat are marked-up)
B. CHARGE FOR MERCHANDISE SELECTED:
Casket. . . '_
(Description)
Other Receptacle
(Description) .
'-
SUMMARY OF CHARGES
A. Professional Services, Facilities and
Equipment, and Automotive
Equipment . . .
B. Merchandise....
C. Special Charges . .
D. C:lSh Advances. . . " ...........
TOTAL OF All SECTIONS.
PAID AT TIME OF OR PRIOR TO
ARRANGEMENTS. . . . . . . . . . . . . . '_
BALANCE DUE. . . . . . . . . . . . . . . . . . . . . . .. '.L9.!i.s _ I t-
REASoN FOR EMBALMING 1'.6. ~ ~
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If any law, cemetery. or crematory requirements have required the p rc ase
of any of the items listed above the law or requirement is explained below.
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Outer burial Container
(Description)
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Acknowledgement cards
Register book(s) . . . . . . . . . . . . . . . .
Memory folders . . . . . . . . . . . .
Prayer cards
Temporary grave marker
Burial clothing
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I 'gree 'lu'l have examioed ,be i,ems of gOO<!.> 'nd 'm;." "'hied 'bove and fuund ,hem '0 he eorrer, and acrotrting In rhe '""",,,","~ I luY< reque'led. , 'drnowledgr
""'Pl 01, ropy of 'hi, S''',men, of Fulte~ Good, and So.,., SeJeeled. f "pre",u',"" I bave ,u/firieUl food. 'V.'''''k for />2ymeUl or l/te ""'.prire for ,he good,
'nd "'tv.." "'''tied. I abu 'gree lo,e />2ymen' of I wllbtu _ "'Y'. I '#'" '0 be ",,".y and ",v=lIy "ab".w.rh..nyoue er" wbu
'ign, below. A ure elu",e nf p." mnu'b 'mounting 'n __ per year will be 'pplied '0 ,he unpaid "","" hegiuning ~ d,y,
frorn ,''' d>l< 01 Ih" ,gee"""", 1 will abo />2y '0 rhe Fune,,' Oireeroe ," reuouabk '"'~ paid by ,be F,,",,~ "Uerror.o eoll<o amouo~ I owe no"" rh. 'Ilte<ntenl.
Th"" 1.0," may iudud< ,"om,y" fee" rooM ""'~ and o,he ,~. Auy addilioR2l ."vi", or merrJund'" """red or reque"ed 'fter !he <fa,. uf rhi, .geeemen, will
be considc a parr of this :Igreement an e 0 reo' ected on the final bill Or Slate t.
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form - 600 Revised 4194
MICHAEL S. TRAVIS
ATTOR N EY AT LAW
3904 TRINDLE ROAD
CAMP HILL, PA 17011
TELEPHONE (717) 731-9502
FAX (717) 731-9511
November 29. 2005
Kimberly A. Smith
Executrix. Estate of Ann jones
39 Heidi Terrace
Camp Hill, PA 17011
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The following is a summary of legal services perfonned on your behalf related to the
above estate:
Re:
Professional Services Rendered, Estate of Ann M. Jones, No. 2005-00980
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Dear Ms. Smith:
Initial Office Consultation wlyou, re: estate opening~ Rec'd $500.00, Thank you: Legal
research, debt priority payment; Telephone conference w/Register of Wills. Prepare Petition for
Letters, Information Sheet; Attend Register of Wills \,\I'lyou, petition for letters~ granted; Travel
time tolfrom same; Telephone conference w/J. Jones, re: inventory, call to PSECU~ Rec'd
message from PSECU, return call, re: payoff; Rec'd message from you, Telephone conference
w/J. Jones~ re: short certificates; Revise estate notices(2); Prepare letter to PSECl.J and you;
Prepare estate Fiduciary Form/EIN application; Revise same; Telephone conference w/P. Jones,
Prepare letter to you, re: caution representation issues; Telephone conference w/you~ revise letter
tv YG~: Rcc ~ d, rc~,," d 8[11(;3 /\gr~~m~nt, Rcc' d, r~v' d PSEC1....~ 0tLt..:mcr:t., p~ to yet:; PrcPQre letter
to you, re: Form 56, inventory; Review file, Prepare notices to beneficiaries (hold for address).
(Services Rendered October 28. 30, November 2. 4, 7, 8, 9, 10, 11. ] 2, ] 3, 14, 18, 21, 23 and 25.
2005) $ 685.00
Probate fee paid: $115.00
Postage paid: $ 2.31
Advertising fee paid: $75.00
Amount Due and Payable: $ 377.31
Please pay the amount due within ten days, or as soon as assets becon1c available to the ,
estate account. .J) \
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REV-1512 EX+ (12-m) '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
ESTATE OF
Ann Marie Jones
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
10.
1.
Settment Cost (see attached statment)
8,293.69
2.
House Insurance (through Donegal)
215.00
3.
Personal Loan - PSECU - Acct# 208304432 (see attached satisfaction letter)
6,745.65
27.00
4.
PSECU - Line of credit recorder fee- (see attached satisfaction letter)
5.
Blair - Acct# 005780981003682677 - (see attached satisfaction letter)
808.52
6.
ERI Financial Services - Acct.# 0499601100225732 - (see attached satisfaction letter)
1,800.00
7.
Boscov's - Acct.# 003096742 - (see attached statement)
2,059.28
8.
Lowe's - Acct.# 82222390871790 - (see attached statement)
1,834.92
1,409.61
8,000.00
9.
Wal-Mart - Acct.# 6032203131068057 - (see attached statement)
HSBC Bank - Acct.# 5407070006411999 - (see attached satisfaction letter)
11.
MBA Bank - Acct.# 5490998999914337 - (see attached letter)
8,960.00
12.
Refuse - Acct.# Jonesrl001 - (see attached statement)
132.00
13.
Property Repairs - 646 Erford Rd., Camp Hill, PA 17011 - (see attached receipts)
401.00
14.
Utilities - (see attached statements)
699.08
41,385.75
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
-
)revious editions are obsolete
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
SETTLEMENT STATEMENT
File Number: PI006-10001
S
form HUD-1 (3/86) ref Handbook 4305.2
PAGE 2
TitleExoress Settlement :ivstem rinte at
L. SETTLEMENT CHARGES PAID FROM PAID FROM
700. TOT AI... SALES/BROKER'S COMMISSION based on price $103 000.00 @ 5.883 = 6 060.00 BORROWER'S SELLER'S
Division of commission (line 700) as follows: FUNDS AT FUNDS AT
701. $ 3.055.00 to 0' Anaelo SETTLEMENT SETTLEMENT
702. $ 3 005.00 to ERA-NRT. Inc.
703. Commission oaid at Settlement 6 060.00
704. Transaction Fee to ERA-NRT Inc. 125.00
aOO.ITEMS PAYABLE IN CONNECTION WITH LOAN
80t Loan Oriaination Fee %
802. Loan Discount %
803. Aooraisal Fee to Stars (P.O.C.) 300.00 Buyer
804. Credit Reoort to FNMA CBC (P.O.C.) 19.20 Buyer
805. Lender's Insoection Fee
806. Mortaaae Aoolication Fee to ERA Home Loans (P.O.C.) 500.00 Buver
807. Flood Certification Fee to STARS (P.O.C.) 19.50 Buyer
808. Document Preoaration Fee to ERA Home Loans (P.O.C.) 85.00 Buver
809.
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From 01/26/2006 to 02101/2006 (Q)$ 16.8100 /dav 6 Davs LR 100.86
902. Mortaaae Insurance Premium for to
903. Hazard Insurance Premium for 1 year to Erie Insurance (P.O.C.) 413.00 Buyer
904.
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001. Hazard Insurance 3 mo. @ $ 34.42 /mo 103.26
1002. Mortaaae Insurance mo.@$ /mo
1003. City Prooerty Tax mo. (Q) $ /mo
1004. County Prooerty Tax 8 mo. (Q) $ 18.92 /mo 151.36
1005. School Taxes 5 mo. @ $ 74.90 /mo 374.50
1009. Aooreoate Analvsis Adjustment to ERA Home Loans -16.20
1100. TITLE CHARGES
1101. Settlement or closina fee
1102. Abstract or title search
1103. Title examination
1104. Title insurance binder
1105. Deed Preoaration to Pinnacle Land Transfer. LLC 75.00
1106. Notarv Fees to Pinnacle Land Transfer LLC 22.00 10.00
1107. Attorney's fees
(includes above items No: )
1108. Title Insurance to Pinnacle Land Transfer. LLC 873.75
(includes above items No: )
1109. Lender's Policy 103000.00 -
1110. Owner's Policv 103.000.00 - 873.75
1111. END 100 300 8.1 to Pinnacle Land Transfer. LLC 150.00
1112. Insured Closino Letter to Pinnacle Land Transfer. LLC 35.00
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordina Fees Deed $ 38.50 . Mortaaae $ 64.50 . Release $ 103.00
1202. City/County tax/stamos Deed $1 030.00 . Mortaaae $ 1 030.00
1203. State Tax/stamos Deed $1.030.00 . Mortaaae $ 1 030.00
1204.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Home Insoection to CNB Property Evaluations Inc. (P.O.C.) 300.00 Buver
1302. Pest Insoection to CNB Property Evaluations. Inc. (P.O.C.) 40.00 Buyer
1303. 1st Qtr SewerlTrash to East Pennsboro Township 115.00
1304. Wire Transfer to Pinnacle Land Transfer LLC 10.00
1305. Courier Fees to Pinnacle Land Transfer LLC 20.00
1306. Document Retrieval to Pinnacle Land Transfer LLC 50.00
1307. 2005-06 School Taxes to Tax Claim Bureau 1 003.69
1308.
1400. TOTAL SETTLEMENT CHARGES (enter on lines 103 Section J and 502 Section K) 3 132.53 8 293.69
P d 01/25/2006 1354 TK
HUD CERTIFICATION OF BUYER AND SELLER
I hahve carefull~ reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account or by me
In t IS transact!..on. I further ce'1lfy that I have received a copy of the HUD-1 Settlement Statement.
A/1/ /7 j7s~
~~ 4 __.
~n~n~Vj11 WLOJj (~W-JnK
WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE
UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION
CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18'
U.S. CODE SECTION 1001 AND SECTION 1010. -
The HUD-1 Settlement Statement which I have prepared IS a true and accurate account of this transaction.
I have ~r ~e funds 10 be d~b",..ed In accordance with this "atemenl. .
t _____5:-::>__----.. > 1/'2fR ( 0 (p
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-
form HUD-1 (3/86) ref Handbook 4305.2
:>revious editions are obsolete
A. Settlemel1t Statelnent
U.S. Department of Housing and Urban Development
B. Type of I.pan OMS Approval No. 2502-0265 (expires 9/30/2006)
1. iJFHA . 2. OFmHA 3. KlConv. Unins. \ 6. File Number I 7. Loan Number 18. Mortgage Insurance Case Number
4. OVA 5. OConv. Ins. P1006.1 0001 RCS 0034476440
C. Note: This form IS furnished to give you a Statement of actual settlement costs. Amounts paid to and by the settlemenf ~gent ar~ shown. \ TitleExpress Settlement System
Items marked ~(p.o.c.)~ were paid outside the closing; they are shown here for information purposes and are not Included In the totals.
WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon Printed 01/25/2006 at 13:54 TK
conviction can include a fine and imprisonment. For details see: Title 18 U. S. Code Section 1001 and Section 1010.
D. NAME OF BORROWER: Michael P. Schroder
ADDRESS: 16 W. Main Street Apt 5 Mechanicsbura. PA 17055
E. NAME OF SELLER: Estate of Ann Marie Jones
ADDRESS:
F. NAME OF LENDER: ERA Home Loans
ADDRESS: 3000 Leadenhall Road Mount Laurel NJ 08054
G. PROPERTY ADDRESS: 646 Erford Road, Camp Hill, PA 17011
East Pennsboro T ownshio
H. SETTLEMENT AGENT: Pinnacle Land Transfer, LLC
PLACE OF SETTLEMENT: 3915 Market Street, Camp Hill PA 17011
I. SETTLEMENT DATE: 01/26/2006
J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION:
100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER
10t Contract sales mice 103 000.00 401. Contract sales orice 103 000.00
102. Personal Prooertv 402. Personal Prooertv
103. Settlement charaes to borrower (line 1400) 3 132.53 403.
104. 404.
105. 405.
Adjustments for items paid bv seller in advance Adjustments for items paid by seller in advance
108. School Taxes 01/26/06 to 06/30/06 384.14 408. School Taxes 01/26/06 to 06/30/06 384.14
109. SewerlTrash 01/26/06 to 03/31/06 83.05 409. SewerlTrash 01/26/06 to 03/31/06 83.05
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 106599.72 420. GROSS AMOUNT DUE TO SELLER 103467.19
200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. Deoosit or earnest money 1 500.00 50t Excess Deoosit (see instructions)
202. Princioal amount of new loans 103 000.00 502. Settlement charaes to seller (line 1400) 8 293.69
203. Existina loan(s) taken subiect to 503. Existina loan(s) taken subiect to
204. 504. Payoff of First Mortaaae Loan
205. 505.
206. 506.
207. Seller Assist 2 000.00 507. Seller Assist 2,000.00
208. 508.
209. 509.
Adiustments for items unoaid bv seller Adjustments for items unpaid bv seller
211. County taxes 01/01/06 to 01/26/06 15.55 511. County taxes 01/01/06 to 01/26/06 15.55
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BY/FOR BORROWER 106,515.55 520. TOTAL REDUCTION AMOUNT DUE SELLER 10.309.24
300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER
301. Gross amount due from borrower (line 120) 106599.72 601. Gross amount due to seller lIine 420) 103.467.19
302. Less amounts oaid by/for borrower (line 220) 106 515.55 602. Less reduction amount due seller (line 520) 10 309.24
303. CASH FROM BORROWER 84.17 603. CASH TO SELLER 93,157.95
SUBSTITUTE FORM 1099 SELLER ST~TEM.ENT: The informati~n.cont~ined ~erein is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return,
~n~e~~~ean~~v~e::~~ti~t~~ht~~ s~~~~~~~I~:eed~tt~~~dt~nn~~~t!~~~IS Item IS reqUired to be reported and the IRS determines that it has not been reported. The Contract Sales Price described on
SELLER INSTRUCTIONS: If this real estate was your principal residence, file Form 2119. Sale or Exchange of Principal Residence. for any gain, with your Income tax return; for other transactions,
complete the applicable parts of Form 4797, Form 6252 and/or Schedule D (Form 1040).
You are required by law to provide. the settlement agent (Fed. Tax ID No: ) with your correct taxpayer identification number. If you do not provide your correct taxpayer identification
number, you may be subject to cIvIl or Criminal penaltIes Imposed by law. Under penalties of perjury, I certify that the number shown on this statement is my correct taxpayer identification number.
TIN:
SELLER(S) SIGNATURE(S):
SELLER(S) NEW MAILING ADDRESS:
ANN MARIE JONES
646 ERFORD ROAD 717-732-9339
CAMP HILL, PA 17011
Commerc~ ......
"Sanlc ;;:riCa's Most Convenient Bank<!J
... 1-888-YES-0004
To Reorder 1.800.355.8123
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N~C?~}"EGOTIABLE
DONEGAL e~SUREDS COpy
MARIETTA, PENNSYLVANIA 17547-0302 RENEWAL OF POLl CY G
0849492
HOMEOWNERS POLICY - PREFERRED
RENEWAL DECLARATION * * * * EFFECTIVE 07/15/05
JONES, ROBERT L. & ANN MARIE
646 ERFORD RD.,
CAMP HILL, PENNA 17011
717 761-1919
ACaRDIA NORTHEAST INC
4900 RITTER RD 2ND FLOOR
POBOX 1220
MECHANICSBURG PA
05
17055
RESIDENCE PREMISES LOCATED AT ABOVE ADDRESS UNLESS OTHERWISE STATED HEREIN:
E. PENNSBORO TWP., CUMBERLAND COUNTY, PA
--------------------------------------------------------------------------------
ZONE PROT #FAM CONSTR DED AMT FT HYDR FIRE DEPT PREM GRP YR CNST
29 06 1 FR&SIDING 100 1000 5 MILES 353 1963
SECT I
--------------------------------------------------------------------------------
SECT II
COVERAGES LIMIT OF LIABILITY
COVERAGE A - DWELLING 130,000
COVERAGE B - OTHER STRUCTURES 13,000
COVERAGE C - PERSONAL PROPERTY 91,000
COVERAGE D - LOSS OF USE 26,000
COVERAGE E - PERSONAL LIABILITY 500,000
COVERAGE F - MEDICAL PAYMENTS 2,000
COVERAGE E/F PREMIUM
ENDORSEMENT PREMIUM
TOTAL PREMIUM
DONEGAL'S 12/60 RENEWAL DISCOUNT
LOSS FREE DISCOUNT
NET PREMIUM DUE
THIS IS A PRIMARY RESIDENCE.
PREMIUM
355.00
INCL.
INCL.
INCL.
11.00
94.00
460.00
22.00CR
22.00CR
416.00
FORMS: *H00003 02/05, HO-291 01/81, H00496 04/91, *HP-244 08/04, HP-501 12/02,
H02363 12/02, HP-508 09/95.
ENDORSEMENTS:
H00003 HOMEOWNERS 3 SPECIAL FORM
HO-291 PENNSYLVANIA NOTICE
H00496 NO COVERAGE FOR HOME DAY CARE BUSINESS
HP-244 INFLATION GUARD (H00002 AND H00003)
'L-2 (9/88)
06/07/05
od~~
CONTINUED ON REVERSE SIDE
President
REFER TO FINAL PAGE FOR BILLING NOTICE
-
PSE(~
the financiallinkTM
March 1, 2006
Ms. Kimberly Smith
39 Heidi Terrace
Camp Hill, PA 17011
Dear Ms. Smith:
Enclosed is a check in the amount of$19.96, the remaining funds from the account of
Ann M. Jones.
The check of$6,746.65, for the balance of the Personal Service Loan, was received and
applied to the loan balance.
This account is now closed.
If you have any questions feel free to contact me at (800) 237-7328 or (717) 234-8484
enter 6 then extension 3120.
Sincerely,
/1 \
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Roxann Myers rJ
Account Advisor
Pennsylvania State Employees Credit Union
Main Address: 1 Credit Union Place, Harrisburg, PA 17110-2990 . (717) 234-8484 . (800) 237-7328
· MailingAddress: PO. Box 67013lHarrisburgl PJ\ 17106-7013 ~(717) 777-2100 (TOO) . (800) 472-1967 (TOO)
Savings federally insured up to $100,000 by the National Credit Union Administration WWw.psecu.com
PSECIMa
PENNSYLV ANIA
STATE EMPLOYEES
CREDIT UNION
January 11, 2006
ANN M. JONES
646 ERFORD ROAD
CAMP HILL, P A 17011
Dear Melnber:
Re: 0208304432 - 50
Your Real Estate Equity Loan is paid in full. There is a fee of$27.00 charged by the
CUMBERLAND County Recorder of Deeds Office to release the lien on your property. You
need to pay this fee by choosing one of the following:
· authorize us to take the fee from one of your PSECU accounts
· send a check or money order payable to PSECU
If you have any questions, or would like to authorize us to take the fee frOlTI one of your PSECU
accounts, please call1ne at 234-8484 within the Harrisburg area or 800-237-7328 outside the
Harrisburg area. At the Options Menu enter 6 and when asked enter extension 5673.
Sincerely,
~?t~
Hope L. Reese
Member Service Representative
Real Estate Servicing
Enclosure
. . W .~
Main Address: 1 Credit Union Place, Harrisburg, PA 17110-2990, (717) 234-8484, (800) 237-7328
Mailing Address: P.O. Box 67013, Harrisburg, PA 17106-7013, (717) 777-2100 (TDD), (800) 472-1967 (TDD)
Savings federally insured up to $100,000 by the National Credit Union Administration
P:\REPORTS\MORTSERV\Pu)Offs ww Sulisfuclioos\Salisfuclioll FecRlljUl:liI.DOC _ HLR
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INNr,SOTA FFICE: ~.., i i ,- ", j l, '. I I
JAMES A IlALOGH-MN ._f L\ -.' /"-// C(l . it '- . ALOGH BECKER l TO
~C:~D~O:'~~~~H~sDS;E~~ll~~ MN, WI I .
AMERICAN BOARD (,~r: CERTIFICATION Arro RN EYS AT LAw
CHELSEA A WHITlEY - MN, WI
ANGELA M. HORN - MN
MICHAEl D. JOHNSON - MN
MARY ELLEN WEEMAN - KS, MN, MO
THERSIA O. LEE - MN
CHAD J. BOllNSKE - MN
STEVEN M. TOMS - MN
MEAGAN M. PROBST - MN
MICHAEL J. DOUGHERTY - MN
MICHAEL D. BOllNSKE - MN, OR
JILL M. GEMLO - MN
EMIL V L FINGER - MN
ANDREW S. MillER - MN
MAnHEW R. EICHENLAUB - MN
NAOMI R. HOWlAND - MN, OH
k~~f~RR~iJ:^6E~~NE ~~l~MN
JACK ATNIP 111- CA MN
JASON R. ASTRUP - M~I ND
ABRAHAM N. BOBST - MN
TVLER J. JOHNSTON - fA
Tv A. RIHA - MN
ARIZONA OFFICE:
64 E. BROADWAY ROAD
SUITE 255
TEMPE, AZ 85282
DIANA THEOS - AI, CO, WA
SARAH DE LA ROSA - AI
SEND ALL WRITTEN REPLIES TO:
FLORIDA OFFICE:
120 SOUTH OLIVE AVENUE
SUITE 501
WEST PALM BEACH, FL 33401
ANTHONV J. MANISCALCO - FL
4150 OLSON MEMORIAL HIGHWAY, SUITE 200
MINNEAPOLIS, MINNESOTA 55422-4811
TELEPHONE 763-852-8440
FAX 866-234-0503
TOll-FREE 877-768-4502
OF COUNSEL:
lITOW LAw OFFICES, P.C.
(IOWA)
01/25/06
~ (Q)'S~p=N'PC
MICHAEL TRAVIS
4076 MARKET ST
CAMP HILL, PA 17011
Re: In the Estate of
ANN M JONES
Probate Case No. 2005-980
Social Security No: 208304432
Last known residence: 646 ERFORD RD CAIvIP IllLL, PA 17011
Our Client: WORLD FINANCIAL NETWORK NATIONAL BANK
Account Number: 005780981003682677
Amount of Debt: $ 808.52
B BL T9-- F i 1 c N o;-~---- 2S S 8 S OJ 6-.---- --.-,.-- -...., _."--.__.._ -___n_________ u._. __.' _ ._.__._ .__.. _'____.
Dear MICHAEL TRAVIS
Enclosed herewith is a copy of the Creditor's Claim for the above-referenced Estate.
If you have any questions or if this is a duplicate claim, please call our firm toll free at 1- 877-768-4502
Cordially,
Balogh Becker, Ltd.
Attorneys at Law
Enclosures
This letter is an attempt to collect a debt and any information obtained will be used for that purpose.
This letter is from a debt collector.
7450
1/25/2006
1492531
-
COMMONWEALTH OF PENNSYLVANIA
NOTICE OF CLAIM
COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
ORPHANS' COURT DIVISION
In Re: The Estate of:
Court File No: 2005-980
ANN M JONES
Deceased
TO: THE CLERK OF THE ORPHANS' COURT DIVISION:
Notice of claim by creditor, Pursuant to Section 3532(b)(2) of the Probate,
Estates, and Fiduciaries Code, 20 PA.C.S.A. g3532(b )(2).
WORLD FINANCIAL NETWORK NATIONAL BANK
1) Claimant's name:
C/O BALOGH BECKER LTD, 4150 OLSON MEMORIAL
2) Claimant's address: HWY #200
MINNEAPOLIS, MN 55422
877 -768-4502
3) Creditor listed below is the owner and holder of a claim in the amount of
$ 808. 52
4) The facts upon which this claim is based:
This claim is based on an account for credit evidenced by the attached
' Affidavit of~Account-stated: '-'--'__'n_____.__,_~ _ _~~_,___
5) Decedent's address: 646 ERFORD RD CAMP HILL, PA 17011
6)
Date of Death:
10/16/05
7) That the claim arose prior to the death of the decedent on or about
8) That the claim is secured by
On behalf of the claimant, I do solemnly declare and ffirm under the penalties of
perjury that they Information and representations ade he ein are true and correct
to the best of y k7~wledge, information an~ bel" Andr-:w S; {\1ile (
Dated: 0 <.3\ () U --- ,A~:'C;'i:~;:'l'in-?'Clct
Chelsea Whitley/Angela Hornl had Bolinske/Micha I BolinskelThersia Lee, Atty-in-Fact
Written notice of claim was given to Personal Representative and/or his/her counsel
as stated below:
MICHAEL TRAVIS
Name
4076 MARKET ST
Address
CAMP HILL, PA 17011
City /state/z1i I I .
;). _, b f..-{,\ b
Date notice ailed
IN RE ESTATE OF: ANN M JONES
AFFIDAVIT OF ACCOUNT
The undersigned, being first duly sworn deposes and states the follows:
1. Your Affiant is authorized by the Claimant as its Attorney-In-Fact to make this Affidavit.
2. Your Affiant has reviewed the account records of the Claimant with respect to the
decedent. Your Affiant is familiar with these records and accounts and reviews them as a
regular part of his/her duties.
3.
The Decedent purchased merchandise in the amount of $ 808.52
account number 005780981003682677
evidenced by
4. The unpaid balance does not include any post-death late payment charges, accrued
interest, collection costs or attorney's fees.
FUliher your affiant sayeth not
Anc~r~~/!S. t\i~t::~or
By: LA-~::'{)~;:::'~/-;ri:"FQct
Attorneys- in-F act:
Chelsea A. Whitley _ Angela M. Horn _
Thersia O. Lee Chad J. Bolinske
Michael D. Bolinske
4150 Olson Memorial Highway, Suite 200
Minneapolis, MN 55422-4811
Subscribed and sworn before me
This -i-- day of __~-'_, 2006.
~,'~'~"';;;:::~ HE';~~i;A~;L~;;l
..' {\!m'~~,!ESO"~, t
"'~'<""""_'N~,"~~'~~~";':'~":::;~lr~J
'.......
..'>(~' .,:,..;.;..~/'j'''''.~~~li;'./.
~R/J ~~n::~;rvi~~i~s~~eries, Inc.
February 15, 2006
'," j,'~'. tl0' I;:-:1Uj' '!A,-w..,'l~~. \,,\tlO,.. ;'-';,i
i !,) 1.;.. '~::J ; :. '
U(~6fQ1/~'
REGISTER OF WILLS
CUMBERLAND COUNTY COURTHOUSE
1 COURTHOUSE SQUARE
CARLISLE, P A 17013-3387
Our File #: ERlli19804
Dear Sir!.Madam:
Enclosed please find a release to be filed in the estate as referenced. ]f there are any
questions concerning the enclosed document, please feel free to contact our office.
Thank you for your cooperation in this matter.
Sincerely,
l~~
Financial Department
410-444-8022 Ext. 294
Enel.
Sys:relcvr
NOTICE: SEE REVERSE SIDE FOR lMPORTANT INFORMATION
This communication is from a debt collector and
is an attempt to collect a debt. Any information obtained will be used for that purpose.
~O. Box 3542, Baltimore, Maryland 21214'
Monday. Thursday 9:00 am. 9:00 pm - Fridav 9:00 am. 6:00 om . 866.504.4174 . F,,,.41().47h.4(V;1
Boscov's, Inc.
PO. Box 4116, Reading, PA 19606-4116 / Ph:61 0.779.2000 / Fx:61 0.370.3495 / www.boscovs.com
C2C
02/04/06
rJ-
Credit Division
ANN M JONES
39 HEIDI TER
CAMP HILL PA 17011-1141
RE:003096742
BALANCE:$2,084.28
PAYMENT DUE DATE: 02/18/06
DEAR ANN M JONES:
Please be advised we are in receipt of your recent payment.
This payment has been credited to your BOSCOV'S Charge account.
However, your account still reflects a past due amount of
$341.74.
To prevent this from adversely affecting your credit rating,
please remit the past due amount immediately.
If yOU have any Questions concerning your account, please contact
a credit representative at the number listed below.
SINCERELY,
BOSCOV'S CREDIT OFFICE
1-800-755-3177
PO BOX 4274
READING, PA 19606
E-MAIL: CREDIT AT BOSCOVS.COM
Corporate Offices: 4500 Perkiomen Avenue, Reading, PA 19606-0516
A6ttttH':U'."
Emfp~1~ ..::.
.. ""--e',' ._ .........
:$'a~I~n.c~WEi
'$'Av~i.i~bJ~H'
0... ......_.._.___...... ",_. ....
Dti~[:t)~tiji::;:H.
$Out!:HW ..::..;;..
003096742
01/18/06
2,059 28
o
DUE NOW
341 74
ANN M JONES
39 HEIDI TEA
CAMP HILL PA 17011-1141
1.11111.11111..11..11.1111...11...11.111111.11.1..1.11....11.1
..REGULAR CREOIT PLAN'{1-G)---.
12/19/05 CORP
12/20/05 CORP
12/21/05 CORP
MAJORPURCHASEPlAN(2~
12/19/05 CORP
FINANCE CHARGE REBATE
lATE CHARGE ASSESSHENT
lATE FEE REVERSAL
-34.79
25.00
-25.00
FINANCE CHARGE REBATE
- .52
l)mB~~m~.ii~~~;%~ffi~:~!:: ::w~~m~~~~~~~Hi mm~m~j~~~~mjij~~~il
2,028 06 25 00 34 27
.....-.........-. . ...._....u _.__..__,..... ......h.................. ,.....
.. :!i!rrimffi~~it~f~~*!m ijiii~if!!irrii!i~~~rn~i~~iW!i;!i!
31 74
00
25 00
52
34.79
59 79
52
60 31
00
00
00
~!!!!W!!i~!!!~~~~:F~i...::::.
2,027 54
I
TOTAL I
2,059 80
31 74
"'A~~~~~~~t'" .'. :m!iil~m=.~~~~',~'~'~I~,'IOCtl:!iiim]!!~,,~~mlll~lllii! :lrll~tI1~1!.I!I~~~111.~II~i!!][~,1 :i[!I:!:il!il~~~1if!i!il~"'l
2,059 28
1,988 68
X 1 750%
34 79
21 0%
236 22
02/15/06
341 74
Xl~ Important information enclosed lW. Federal law requires that we provide written disclosures of the
steps we take to protect your privacy.
Dear valued customer, your Charge account is two payments past due. May we count on your payment today?
For questions, call 1-800-755-3177.
2> IJ:J .QlY
q \\ \.9
Q
.--- - -----------...---.---....-------.------------------------------ ------------------- -------- --------
Please be sure Boscov'S
address shows through
Envelope Window.
Account #:
Due Date:
Amount Due:
Balance Amt:
003096742
DUE NOW
341.74
2,059.28
Address Change
(Please make changes on reverse side.)
Payment $
ANN M JONES
39 HEIDI TEA
CAMP HILL PA 17011-1141
PO BOX 13601
PHilADELPHIA PA 19101-3601
1...111.1.....1111.1....11..11..11..11......111..1.1
1 0030967422 0205928 0034174
-t.~AccountStatem&Rt --------------------------ACC9Um.tI-9/dw;- A/IIN-M-,JON ES
Account Number: 82222390871790 Billing Date: 01/10/06 Payment Due Date: 02105/06
BALANCE SUMMARY
Plan
hR!L
REG
TOTAL:
Previous
Bara nee
$1,834.92
$1,834.92
Payments +/- ANANCE +
& Credits CHARGE (~tl
$000 $0.00
$0.00 $0.00
+/- Debt Cancellation,
Purchases Insurance & Adiustmenfs
$0.00
$0.00
$2.79
$2.79
= New
j8lance
$1,837.71
$1,837.71
Minimum
Payment
$162.41
$162.41
TRANSACTIQN..SUMMARY
Tran Date Invoice Number
0111 0
Description
LEAVE OF ABSENCE PREMIUM
Plan Type
Amount
$2.79
......FIf~A~cS:cfi~flGe.$lJMMARy:::>: .
Plan Tvpe
REG
BIG
Balance Subject To
Finance Charqe
$0.00
$0.00
Daily CorrespondinaANNUAL Days This FINANCE Balance
Periodic Rate PERCENTAGE RATE Billing Period CHARGE ~
.05754 % 21.00% 31 $0.00 2D
.03809 % 13.90% 31 $0.00 2D
Total Periodic FINANCE CHARGE: $0.00
..qARO:tfO~DE:.Fl.N~W$'&.INf9RMAT10N.::...:...
YOUR CREDIT INSURANCE COVERING YOUR ACCOUNT AS DESCRIBED IN
YOUR CERTIFICA TE(S) OF INSURANCE WILL BE CANCELLED AFTER YOUR
NEXT BILLING CYCLE IF YOUR ACCOUNT REMAINS DELINQUENT.
CUSTOMER SERVICE: For account information call 1-800-444-1408
NOnCE: PLEASE SEE REVERSE SIDE FOR BILLING RIGHTS AND IMPORTANT INFORMATION.
PAYMENT DUE BY 5 P.M. ON THE DUE DATE. We may convert your payment into an electronic debit. See reverse for details.
7009 0002 9WD
2
7 10 060110
I X Page 1 of 1
9294 0010 N076
28220
0&,
.. Detach and mail this pOl1ion with your check to LOWE'S. Please use blue or black ink. ...
'Payme.rf Past DQ~:<: : . : Minimum. . .
. Due Date:: >Amount:- Payment Due
New.
Balance.
0210512006 $108.62
$162.41
$1.837.71
82222390871790
Fill in amount completely
$DDDDD
.
DO
o
Yes, I have moved or I have changed
my email address. Check the box and
submit changes on the reverse side.
Minimum payment due includes
$108.62 past due.
Please pay minimum payment amount PROMPTL Y.
IIII~I ~IIIIIIII ~llm II~ 11111111 ~ 111/1 II~ III
ANN M JONES
646 ERFORD RD
CAMP HILL PA 17011-1124
28220
1111111111111111111111111'1111111111111111111'11111111.1111.11
Make Payments to: LOWE'S
P.O. BOX 530914
ATLANTA, GA 30353-0914
'111'1111111111.1"'1111'11'11111'.11111'1111"11. 1111'1' f I" f
Check"'.
Page 2 of 2
Date
2/13/06
---
Account
537106841
---
{
1 ~~~~ i
~
D.QO ~
--~
OllARS ~ =-_ ~
. ~
-"'-l-~~~ -t
-~~- .~~-~~-: j ::~.,." ~
~ tOOOOO~5000~ i
'---~~---"'~~'~I':~~-"~'~
Check 104, Amount $150.00 Date Presented 1/20/2006
Check 1 06, Amount $808.52 Date Presented 2/2/2006
Check 109, Amount $17.15 Date Presented 2n/2006
~ 7E---:~~~"-' '" .... '''-'''''.- ""~~i
1'~;~:~7'''' ~~$~:~;;,rl
. ~~~ "-~~^~ -.... fY. ~.q <lI.~ ~~\\~ -OOLL~~S.~.ES:"~
~ E~ATE ()F ;;:l:rp. ,~_" ...J .. . . . f'l.~fl~ . ~~. ....~~~. !
~ --:ft".w : ~~1il~~::.., j
~'FOA DO-:1.,l \...1 u.;;l. f-----~----_____=j :=""7~:-
~ "ooo&. n.. '~O:i'BO &.81.1;,,: ~~~~~" \.. --'/0000 msq'i!B...f
:... .~--. .-~'--"'~""'__--CA_.___~,_,~-".,,~__ .~."'--""--"'_"""'_-'_.o1a.--.~...~~__~'''''''''~~
r:hp.~k 11::l Amount $? 059 28 Date Presented 2/13/2006
Check 110, Amount $16.97 Date Presented 2/6/2006
~~~=_:'""'..... ...... ... ... ... ":~~j~ (I ~O:l~~~ I
l.'"nO~ t:) .' .' '--, $ I"''' .",'1
'J \O~ROF~ /\" ,.~ f'\ ..' 111 . . ..' ,
'~~~.~....Lu{IJ.~' ..,K.JI~.OlR~...kiL...J...L -n/ll....,4&l /'iIliOLLAAS~<:E::'i
~ ---rJ() \ nlJll~S''''08/. J ?~Q
~ ESTATEOF ~.:t~" ~~~~r~~ I
t FOR_<:r.;;l::):'l~ ::'~I)~ }_____ ___ ,_ ,-----!"'( ~
~ t____ -_'!'} ........' . i
L_'~__~~~!!:.=.:..: ~~~~~o..'2~~.!~_l m6~~ _.~~_'" ._." __~~'r:.~:: ~~.~:.? ....,1
Check 114. Amount $1.837.71 Date Presented 2/13/2006
WAL* MART ,
Payment PastDlJe Minimum New Account Number
DUB Dale Amount Payment. Due &/ance
02112106 $121.00 $178.00 $1.360.33 6032 2031 3106 8057
O New address or emall?
Check the box at left and
print changes on back.
Fill in amount completely $ D D D D D
.
DO
Minimum payment due Includes
$121.00 past due.
PleastI pay minimum payment amount PROMPn Y.
II~IIIIIIIIIIWII~IIII~~
ANN M JONES
39 HEIDI TER
CAMP HILL PA 17011-1141
23563
1.,.111.,,11111,.111111.11.,.11.1111.111111.111111.1.11111.111
MtI/rePtI}'nlcnl To: WAL-MART
P.O. BOX 530927
ATLANTA, GA 30353-0921
1..11.".,..."..,.1...",1,...1.1....,.11...,..1."...".1,.1
00178000005bOO
00178000013b033023 6032203131068057 23
A Make check payable In U.S. Dollars to Wal-Mart. Plea.e u.e blue or black ilk. Detach and mallthl. portion with your payment to the addr... abo..
ACCOUNTINFORMAnON
Account Number:
Statement Date :
Payment Due Date:
Days In Billing Period
BALANCE SUMMARY
60322031 31068057
01/1812006
0211212006
31
Previous Balance
- Payments
+1. FINANCE CHARGE (net)
+ New Purchases
+ Cash Advances
+1- Acct Security, Insurance, Fees &
DebitlCredit Adjustments (net)
= New Balance
Minimum Payment
$1,409.6'
$0.01
. $49.21
$0.01
$0.01
$0.01
$1,360.3:
$178.01
: TRANSACnONSUMMARV<::::!<<::ii: ..
Post Tran Reference
Date Date Number
. . . .. -,. .,
""... .- .....
. - . . . . . . . . - . , . . ...
. ....... ......
Description
Plan
1i e
Amount
12128 12128 F911200BAOOOFC362 *FINANCE CHARGE* PURCHASES REFUND
THE PERIODIC RATE SHOWN ON THIS STATEMENT MAY VARY.
$49.28(
FINANCE CHARGESUMMARV<::::::
How Your FINANCE CHARGE
Was Calculllted
... ". ..- ,.,. .... .... '.'."
.. - ........ ...... '...
'" '. . ..., ....-.... -. - "'"
. . . ..- ... -...
PurchsstI!I and Cash Advances
ANNUAL PERCENTAGE RA TE
Computed on Plan Daily Co"espondlng
Average Daily Type Periodic Annual
Balance Rate Percentage Rate
$0.00 REG .07189% 26.24%
26.240% Total Periodic FINANCE CHARGE
FINANCE
CHARGE
Save your Stamp.l-N~ou.ca.n-pay-ycw~U at any
Wal-Mart or SAM'S CLUB nationwidel Payments are
accepted at any Wal-Mart or SAM'S CLUB register.
Please bring either your current billing statement or
Wal-Mart Credit Card for recessin .
$0.00
$0.00
CAROHOLDER. NEWSAJNFOilMA TION<::' .
:.:jC)
Check~w
Page 2 of 2
Date
3/14/06
--- ---
Account
537106841
---
f ........ .....;.. ..........'.. .... .... .... ...
I ~'_'rR_ . . . DATE ~ h l" .;;::cO<o . .. J
. P~~_L..Q)~ . . .! S \\~. as :
, ==:~~..._~""~,~~_~,~~~~~~ o,~:s:~ I
t- ~ATlrO;: ""..JOND :..~ - - . ~~- n' LJ ~ , .. i~ _
I :"~~,! . ~ ~ "'. ~ ==-'
FOR Ut )o:'J ~O~ \ ~ol.C ~<> '5 ......,. ~ .' . "j __ .
f' . ...........,.",. !
~ '.. .. - ... f
." II"OOOUC" I:'o;u:m~a..&.: 52 ?~O&a.. ~..' 0"000013&033"..3.
:w
Check 112, Amount $1,360.33 Date Presented 2/15/2006
~OTA OFFICE:
JAMES A. BALOGH - MN
GAR; W. BECKER - DC, FL, IL, MN, WI"
"CREDITOR'S RIGHTS SPECIALIST
AMERICAN BOARD OF CERTIFICATION
CH[LSEAA.WHlTLEY'~ M-N', wi--
ANGELA M. HORN - MN
MICHAEL D. JOHNSON - MN
MARY Ell EN WEEMAN - KS, MN, MO
THERSJA O. LEE - MN
CHAD J. BOI.INSKE - IL, MN
SnVEN M. TOMS - MN
MEACAN M. PROBST - MN
MICHAEL J DOUGHERTY - MN
MICHAlL D. BOllNSKE - MN, OR
JILL M. GlMI.O - MN
EMILY L. FINGER - MN
ANDREW S. MILLER - MN
MAHHlW R. EICHENLAUB- MN
NAOMI R. HOWLAND .. MN, OH
JlNIFlR C. MELBY - NJL TX
ROBIN R. LEDONNE .. CA, MN
j;~6NA~N~SI~~~I~~\l~~ NO
ABRAHAM N. BOIlST - MN
i~.LlR~I~~I~N~T~N - IA
JASON A. IANNONE - CT, MN, RI
BALOGH BECKER, L TD~ i3Tlfjl"
ATTORNEYS AT LAW
'ARIZONA OFFICE:
164 E. BROADWAY ROAD
'SUITE 255
TEMPE, AZ 85282
DIANA THEaS - AZ, CO, WA
SARAH DE LA ROSA - AZ
SEND ALL WRITTEN REPLIES TO:
41 50 OLSON MEMORIAL HIGHWAY, SUITE 200
MINNEAPOLIS, MINNESOTA 55422-4811
FLORIDA OFFICE:
120 SOUTH OLIVE AVENUE
SUITE 50 I
WEST PALM BEACH, FL 3340 I
ANTHONY J. MANISCALCO - FL
TELEPHONE 763-852-8440
FAX 866-234-0503
TOll-FREE 888-762-9997
Qf COUNSEL~
lITOW LAw OFFICES, P.c.
(IOWA)
LUSTIG, GLASER & WILSON. P.c.
(MASSACHUSETTS)
MICHAEL TRAVIS
3904 TRINDLE RD
CAMP HILL PA 17011
February 28, 2006
e ry [9 \\v(
~~/~J J t
Re:
Estate of
Our Client:
Account No:
ROBERT L JONES
HSBC Bank
5407070006141999
Dear MICHAEL TRAVIS:
Enclosed herewith please find a Satisfaction and Release of Claim. Please file it at the county
courthouse where the probate proceeding occurred.
Thank you for your cooperation in this matter.
Cordiall y,
Balogh Becker, Ltd.
Attorneys at Law
This letter is an attempt to collect a debt and any information obtained will be used for that purpose,
This letter is froIn a debt collector.
MINNESOTA OFFICE:
JAMES A. BALOGH - MN
GARY W. DECKER - DC, FL IL MN, WI.
~ED'TORoS RIGHTS SPECIALIST
~ AM ERIC_AN BOARD OF CERTIFICATION
BALOGH BECKER, LTD.
ATTORNEYS AT LAW
ARIZONA OFFICE:
64 E. BROADWAY ROAD
SUITE 255
TEMPE, AZ 85282 IiI
DIANA THEOS - AZ, CO,WA
SARAH DE LA ROSA - AZ
CHElSEA A. WHITlEY - MN, WI
ANGELA M. HORN - MN
MICHAEL D. JOHNSON - MN
MARY ELLEN WEEMAN - KS, MN, MO
THERSIA O. LEE - MN
CHAD J. BOllNSKE - MN
STEVEN M, TOMS - MN
MEAGAN M. PROBST - MN
MICHAel J. DOUGHERTY - MN
MICHAEL D. BOllNSKE - MN, OR
JILL M. GEMLO - MN
EMILY L. fiNGER - MN
ANDREW S. MILLER - MN
MATTHEW R. EICHENLAUB - MN
NAOMI R. HOWLAND - MN, OH
JENIFER C. MelBY - NJ, TX
ROBIN R. LEDONNE - CA, MN
JACK ATNIP 1/1 - CA, MN
JASON R. ASTRUP - MN, NO
ABRAHAM N. BOBST - MN
TYlER J. JOHNSTON - IA
TY RIHA - MN
JASON A. IANNONE - CT, MN, RI
SEND ALL WRITTEN REPLIES TO:
4150 OLSON MEMORIAL HIGHWAY, SUITE 200
MINNEAPOLIS, MINNESOTA 55422-4811
TELEPHONE
FAX 866-234-0503
TOLL-FREE 763-852-8440
FLORIDA OFFICE:
J 20 SOUTH OLIVE A VENUE
SUITE 501
WEST PALM BEACH, fL 3340 I
ANTHONY J. MANISCALCO - FL
OF COUNSEL:
llTOW LAw OFFICES, P.c.
(IOWA)
February 8, 2006
LUSTIG, GLASER & WilSON, P.C.
( MASSACHUSETTS)
Account Number
5407070006141999
Balance
9134.01
Reference Number
2633056
Dear MICHAEL TRAVIS:
I am writing to inform you that our law firm now represents HSBC Bank in the Estate of ROBERT L JONES.
This letter confirms an unpaid balance of $9134.01 on this account.
Please call this office toll free at 1-877-768-4495 to resolve this matter.
Cordially,
Balogh Becker Ltd.
A ttorneys at Law
I , IMPORTANT NOTICE
Unless you notify this office within thirty (30) days after receiving this notice that you dispute the validity ot
the debt or any portion thereof, this office will assume the debt is valid. If you notify this office in writing
within thirty days from receiving this notice, this office will obtain verification of the debt or a copy of a
judgment against you, and a copy of such verification or jUdgment will be mailed to you by this office.
Upon your written request within the thirty-day period, this office will provide you with the name and
address of the original creditor, if different from the current creditor. This is an attempt to collect a debt
and any information obtained will be used for that purpose. This letter is from a debt collector.
GONBALOOl7107
11111111111111111/111111111111111111111111111111111111111 1111111111111111111111111 111111111111111 11111111111/111111
LAW FIRM OF BALOGH BECKER, LTO
4150 Olson Memorial Highway, Suite 200
Minneapolis, MN 55422-4811
ADDRESS SERVICE REQUESTED
Account #: 2633056
Balance: $9134.01
Client 10: HSBC41
February 8, 2006
2633056-7107 1742101 22993
1.11111.1111111111111.1111.1111..1.1.'11'."11111111'1111111.'
MICHAEL TRAVIS
3904 Trindle Rd
Camp Hill P A 1 7011-4246
11111l11I111 11111 111111111111111 11111111111111111111 11111 11111 111111111111/11 /1/11//1111/1111111111111111
BALOGH BECKER, L TO
4150 Olson Memorial Highway Suite 200
Minneapolis MN 55422-4811
1.1.1111.1111111..1.1111.1.1111111111..11...11.1.1. II ..11.11.1
MINNESOTA OFFICE:
JAMES A BALOGH - MN
GARY W BECKER - DC, FL, IL, MN, WI.
. CREDITOR'S RIGHTS SPECIALIST
AMERICAN BOARD 0;' CERTIFICATION
O-,CLS-EA A~-WHrrLEY - MN, WI
ANGELA'/\I\. HORN - MN
MICHAEL 0, JOHNSON - MN
,,^^RY EllEN WEEMAN - KS, MN, MO
THERSIA O. lEE - MN
CHAD J. BOUNSKE - MN
STEVEN M. TOMS - MN
MEAGAN M. PROBST - MN
MICHAel J. DOUGHERTY - MN
MICHAEL 0 BOllNSKE - MN, OR
JILL M. GEMLO - MN
EMILY l. FINGER - MN
ANDREW S. MILLER - MN
"^^ TTHEW R. EICHENLAUB - MN
NAOMI R HOWLAND - MN, OH
JENIFER C. MELBY - NJ TX
ROBIN R LEDoNNE - CA, MN
JACK ATNIP III - CA, MN
JASON R. ASTRUP - MN, NO
ABRAHAM N. BOBST - MN
TYLER J. JOHNSTON - IA
Ty A. RIHA - MN
BALOGH BECKER, L T~ f~~~~IJ;~(t
ATTORNEYS AT LAw
:"AR"ZONA OFFICE:
6~ f. BROADWAY ROAD
. SUJ;tE 255
TEMPE, AZ 85282
DIANA THEOS-AZ, CO, WA
SARAH DE LA ROSA - AZ
SEND ALL WRITTEN REPLIES TO:
FLor<~rlA OFfiCE:
"f2"QS'O'UTH OLIVE AVENUE
SUITE 501
WEST P"'LM BEACH, Fl 33401
ANTHONY J. ,,^^NISCALCO - fl
4150 OLSON MEMORIAL HIGHWAY, SUITE 200
MINNEAPOLIS, MINNESOTA 55422-4811
TELEPHONE 763-852-8440
FAX 763-852-8499
TOll-FREE 888-762-9997
OF COUNSEL:
LlTow LAw OFFICES, P.c.
(IOWA)
lUSTIG, GLASER & WILSON, Pc.
(MASSACHUSETTS)
MICHAEL TRAVIS
4076 MARKET ST
CAMP HILL, PA 17011
February 10, 2006
Re:
In the Estate of
Probate Case No.
Social Security No:
Our Client:
Account Number:
Amount of Debt:
BBL TD File No.:
ANN M JONES AKA MRS ROBERT L JONES
2005-980
208304432
HSBC BANK
5407070006141999
$9134.01
2633056
Dear MICHAEL TRAVIS
Enclosed ple.asefindLaCreditor~ Claim forJhellhove-:-refcrencJ;d Esl~te, l)PQD distri..bJniQD oJ tl1e _Estate
assets, please forward payment to the above address.
If you have any questions or if this is a duplicate claim, please call our finn toll free at 1-888-762-9997.
Cordially,
BALOGH BECKER, LTD.
~ 0 1
By: I, ~
Attorney-in-Fact for clain1ant:
Chelsea A. Whitley Angela M. Horn _
Thersia O. Lee Chad J. Bolinske
Michael D. Bolinske
Enclosures
This letter is an atten1pt to collect a debt and any information obtained will be used for that purpose.
This letter is froIn a debt collector.
. COMMONWEALTH OF PENNSYLVANIA
NOTICE OF CLAIM
COURT OF COMMON PLEAS
CUMBERLAND COUNTY
ORPHANS' COURT DIVISION
In Re: The Estate of:
ANN M ]()NES AKA MRS ROBERT L JONES
Deceased
Court File No: 2005-980
TO: THE CLERK OF THE ORPHANS' COURT DIVISION: Notice Of claim by
creditor, Pursuant to Section 3532(b)(2) of the Probate, Estates, and Fiduciaries
Code, 20 PA.C.S.A. 93532(b)(2).
1) Claimant's name: HSBC BANK
2) Claimant's address:
C/O Balogh Becker, Ltd.
4150 Olson Memorial Highway, Suite 200
Minneapolis, MN 55422-4811
3) Creditor listed below is the owner and holder of a claim in the amount of
$9134.01
4) The facts upon which this claim is based is an account for credit evidenced by the
attached Affidavit of Account Stated.
5) Decedent's address: 646 ERFORD RD
6) Date of Death: 10/16/0-5
7) That the claim arose prior to the death of the decedent on or about
8) That the claim is secured by
On behalf of the claimant, I do solemnly declare and affirm under the penalties of
perjury that they Information and representations made herein are true and correct
to the b:=.: of my ~.noWledge, information ane b~lief. "fy A. l<iM
Dated: \vb I ':J ( 20Db ':S>v e L A!1'Otn\?V"in-Facf
Chelsea A. Whitley/Angela M. Horn/
Chad Bolinske/Thersia Lee/Michael Bolinske,
Attorney-in-Fact for Claimant
Written notice of claim was given to Personal Representative and/or his/her counsel
as stated below:
See attached Certificate of Mailing
,3 /c; ~)h
Date notice' mailed
0? / f1:=: i ~~l-;:'~1t,
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7 S. ~3 ~~~ S:? (j 4 Ii 9
BAU]GH BECl<ER L TI)
MINNfS~TA Off}C/[~
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CHHIDA, W1i~MN:-wr
A.N':4EL~ M. HO'lN -MN
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"""'''t'ELLEN h'Ct:MAN_ KS, MN, MO
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CHAC J. BOUNl:lt=.E - MN
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Mt.::l-i....rl, 0, SC'_il"'SK~ - MN, OR
In.1. M. GE:MlO - MN
E;...\c,' t. l"r~,'::;t:8 - J\..l.;-..1
ANC~~W S. ,Y,l.llH - Mr-j
M..TTHr;W It EiCI-iENl....'-1il _ MN
NAOMI/(, hOWtMolD-MN, OH
JIONIFI'II C. Mf.!.M - Nt 1"):,
~:~~~~~~~l~~'flj:~~j~l ~~N
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BALOGH BeCKER, LTO.
ArrORNEY5 AT LAy-,..
- .==:;;--~
$~ND ALL WRITT~N R~PLfES l"O~
/>~ ~O rD) If: ~
\"~ V:::::!) ~!l.ru' NO. ell;
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F.!":;:~:(JE E~~:2 / 02
4150 OLSON MEMORtJ'U. HIGHWA"r, $ iJU'fE 200
MINNEAPOLIS.. MINNESOTA SS422...~.:.a 11
TE(f;PHONE 763.B52 ~8440
FAX 866-234-0503
'Toa.FuE 888...762-9991
Floru04 Qffli;;~~
no 5.0UTH OLIVE AVF,NllF.
Slf"~= 50'~
W~lJrPALM 8F....CH, F' 3340r
^~-.lllj!-";Ot..~. t JV\.hH~Se:..L.CO _ ~~l
2l (;QVNSE~
I.l'fOw LAw OFFICF~. P C
!iW''I'iAj .
l\.1ICfIAEL TRAVIS
3904 "TRJNDLE RD
Cl\MP 1-fiLL P A 17011
February 8, 2006
\ "'
,\v\
g
I'L'1WG C, ~~;:: & W\l...30,\,; 1" C
;M^~~C-H~H~SI . "',
Re:,
Estate of
Our Cq i~nr~
ACc(}unt No,~
TJnpaid Balance. .Due;
Balogh Becker ,A.ccounl No:
ROBERT L JONES
llSBC Bank
5407070006141999
$9134.01
2633056
Dear r\rl.ICI{j.~EI~ TR1\ "VIS~
Our Client authorized us to accept $8000.00 as a final settlement on this account. This offer is good
until 03/10/06.
pj.:;ase pay this amOunt to 4150 Olson Memorial Highway, Suhe 200, Minneapolis, .MN 55422-4811.
To make payment over the phone, call us toll free at 1-877-768-W95.
Cordially,
Balogh Becker.. Ltd.
Attorneys at Lav.,'
This letter is an attempt to collect a debt and any infonnation O':Jiaincd will be used for that purpose.
This fetter is fron1 a dcb[ coilector.
~d
DW
\/
~\
AFSCME ADVANTAGE PLATINUM MASTERCARD STATEMENT
ROBERT L JONES
..
Page 1 of 1
BALANCE SUMMARY
ACCOUNT SUMMARY
PA YMENT SUMMARY
ACCOUNT
NUMBER
TOTAL CREDIT LIMIT
TOTAL CREDIT LIMIT
AVAILABLE
5407-07()()-0614-1999
PAST DUE AMOUNT
$466.00
PREVIOUS BALANCE
PAYMENTS/CREDITS
PURCHASESIOEBITS
$8,940.83
$0.00
$35.00
$9,300
$0
MINIMUM PAYMENT'
$285.00
'CURRENT PAYMENT DUE'
PAYMENT DUE DATE
$751.001
02/02/06
STATEMENT DA TE
. See reverse side for an explanation of
these amounts.
FINANCE CHARGE
NEW BALANCE
$158.18
$9,134.01
01/08/06
TRANSACTION SUMMARY
(For additional transaction detail go to www.unionpluscard.com )
TRAN POST TRANSACTION REFERENCE AMOUNT
~ ~ DESCRIPTION NUMBER CHARGES ~I CREDITS
01/02 01/02 LATE CHARGE ASSESSMENT 199999999800009974590 $35.00 I
YOUR ACCOUNT IS NOW PAST DUE. PLEASE CALL TODAY TO MAKE YOUR PAYMENT OVER THE PHONE. CALL US AT 800-201-0071.
FINANCE CHARGE CALCULATION
This is a grace account. Grace period information on back.
Ave/age Daily Days
Daily Periodic In Billing
Balance Rate Cycle
PURCHASES $8,890.37 .05477% 32
CASH ADVANCES - OLD $134.45 .054 77% 32
CASH ADVANCES $0.00 .00000% 32
Nominal
Annual
Percentage
Rate
ANNUAL
PERCENTAGE
RATE
FINANCE CHARGE
At Periodic Cash Advance!
Rate Transaction Fees
$155.82
$2.36
$0.00
$0.00
$0.00
$0.00
19.99%
19.99%
19.99%
19.990%
19.990%
19.990%
:> <;"'~O\.P
OC {'- / \V
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,/ MAI~ PAYMENTS TO:
UNION PLUS CREDIT CARD
PO BOX !7051
. BALTIMORE MD 21297-1051
1:r QUESTIONS?
24-HOUR CUSTOMER SERVICE
1-800-622-2580
OUTSIDE USA, COLLECT: 1-702-243-1575
TDD HEARING IMPAIRED: 1-8()()-655-9392
.IiiI Manage your account online at:
www.unionpJuscard.com
010812 E 07 ClOOOOO4000 G STMT57 D L 00012785
PLEASE DETACH AND RETURN BOTTOM PORTION WITH YOUR PAYMENT: To Assure Proper Credit Please Write Your Account Number On Your Check
t8j MAIL INQUIRIES TO:
UNION PLUS CREDIT CARD
PO BOX 80027
SALINAS CA 93912-0027
UP1
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ESTA.TE OF A"N"N 1VlARlE JONES
CIO WCB.AEL TR.A VIS
3904 TR.lNDL..E RO
CAi\1P ffiLL P.l\170 11
To~
Frotn:
I)ate:
Sul:ject:
ACCOUllt:
Estate of ~4nn l\larie Jones
Estate Department
!\.'1arch 8~ 2006
Settlement otTer
5490998801359127 c.Oangedto 5490998999914337
Plea'5e accept our condolences on the loss of i\.ID111arie Jones.
We are wtiring to offer a settlement of85% ofth.e balance on the above referenced acCQunt. rf a
payrnent of $8,960.00 is received hy the 25m of~furch 2006, tb.e account \viU be c.onsidered
satisfied. This offer expires on the 25\1) of~larch 20.06. .
Please send payment by express service to MBNA America, P.O. Bo~ 15137 Wilmini,.'ton, DE
19850)' please nut the 9l"COllnt IUJmber on front-of thE' naVlllerst
lfyoll have all} questions, or would like to arronge for payment over the phOUfC, please call Jim
AU,jayat (888) 221-4299, exrension 30890, Monday through Thursday U\J!ll 8 a,Ill, to 9 p.m,>
Friday 8 a.nl. to 5 p.:tn.(Eastem tilne},
Respectfiuly~
tOr] .1--'
1/ -? /./;
Y 'O'v""'';;--'" / t/I.A--y------,..,/}
/1 ,/uV L....--' (... / . '
.-r;~~n A~,ay
Senior Account M,anager
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MBNA I\merica Bank, N .,IJ....
Wilmington, Delaware 19884
mbna
MBNA America
P. O. Box 15409
Wilmington, DE 19885-5409
(302) 453-9930
~.m~~rrc:) "Vi.
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Michael Travis
3904 Trindle Rd.
Camp Hill, PA 17011
(0937)
RE: Estate of Ann Marie Jones
Account # 5490998801359127 changed to 5490998999914337
March 28, 2006
Dear Sir or Madam:
SATISFACTION AND RELEASE OF CLAIM
The undersigned creditor, MBNA America, whose social security or tax
identification number is 510331454, has received full payment of the claim filed in
this proceeding by the undersigned against the Estate of Ann Marie Jones, deceased,
on or about, January 9,2006 or has otherwise settled or compromised said claim,
and this Satisfaction and Release of Claim is executed to acknowledge discharge of
claim and to release the estate and the Personal Representative of the estate from
all further liability with respect thereto.
DATED this March 28, 2006
65-6262
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~X 717-796-9301
LUMBER
PL YWOOD
CEILING TILE
DOORS
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KIRBY'S PANELING CENTER
5200 E. TRINDLE ROAD - MEeHANICSBURI, PA. 17050-3594
CARPET, VINYL MILLWORK
CERAMIC, FLOOR TILE INSULATION
WOOD PARQUET FLOORS HARDWARE
INSTALLED OR RETAIL PRE FINISHED ~'LDING
4 S DATE~" 18
86880
OUR ORDER NO.
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JED FOR IN GOOD ORDER.
S PAST DUE ARE SUBJECT TO A SERVICE REC'D
OF 1,,% PER MONTH UNLESS APPLICABLE LAWS BY
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For Service To: Ann Marie Jones
646 Ertord Ad
Account Number: 24-0648483-8
Premise Number: 24-0382885
Billing Period & Meter Information
Billing Date: Jan 24. 2006
Billing Period: Dec 19 to Jan 20 (32 days)
Next reading on/about: Feb 17.2006
Rate Type: Residential
Meter readings in current billing period:
Meter Number N0453B7380 is a SIB-inch meter.
Present-actual 199200
Last-actual 199200
Gallons used 0
Water Usage Comparison
Monthly usage in hundred gallons.
F M A M J J
9 a p a u u
b r r y n I
A SON D J
u e c 0 e a
9 p t v c n
..,......::1 ....,............ J
---------- Prior Balance-------------___________
Balance from last bill
Payments prior to Jan 24, 2006. Thanks!
Total prior balance, Jan 24, 2006
----------Current Water Charges----------
Service Charge
STAS PAWC Water-0.29%
DSI - PA WC Charge 3.45%
Total water charges, Jan 24, 2006
----------Other Current Charges---------_
Customer Protection Water Line
Late Payment Charge
Total other charges, Jan 24, 2006
$23.79
-23.79
.00
11.50
-.03
.40
11.87
5.00
.28
5.28
----------AMOUNT DUE ----------___________
$17.15/
\ \ \.
\
\,
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./
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f)
.1 ,
2
o
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6
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j
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(,./4
v / ..,v
-/" 1)7
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3'/
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Messages to you from Pennsylvania American Wa,ef1
Any portion of the water charges which is not paid as of 2/21/06 will be subject td"a 1.50% penalty.
It Customers may use their credit card, debit card cr pay by electronic check only by cal!ing to!! free: 1-866-271-5522
Customers may also pay on-line at www.water.paymybill.com. A service fee will apply.
It Approximately 4.72 percent or $.56, of State taxes are included in your current bill.
It Effective January 1, 2006, the Distribution System Improvement Charge (DSIC) increases from 2.39%
to 3.45%. This charge funds the replacement of water distribution facilities.
.. Effective January 1,2005, the State Tax Adjustment Surcharge (STAS) decreased from .04% to -.14%.
,--...,
'-' r_,
\ /"\'()' t) d
I _,
{ \ \
\
) ({~
I..~
Customer Service & Emergencies 1-800-565-7292 (24 Hours)
For Hearing Impaired Customers TOO 1-800-300-6202 (24 Hours)
Visit us on the INTERNET: www.pawc.com
t\
\.9
356
A1M
17757
Summary Page
Balance as of Jan 26, 2006
Charges:
T otafPPL ELECTRIC UTILITIES Charges
Total Charges
PPL Electric
Uti I ities
, i
\ "".i I
, \. 11 II li I ,
pprl~:
", TM
Electric
Service
For:
ANN MARIE JONES
646 ERFORD RD
CAMP HILL PA 17011
Final Bill
Account Balance
Questions about
this bill? Please
contact us by Feb 16
at 1-800-342-5775 or
484-634-4900
or write to:
Customer Service
827 Hausman Rd.
Allentown, P A
18104-9392
W\vw.ppldectric.com
Page 1
.. . : ::YQ\irBillAcc()UlltNunlb~r.
52170-74000
$ 15.74
$ 1.23
$ 16.97
$ 16.97
KWH - Average Per Day
Meter Reading Infonuation
Electric
Use
18
15
I- .-.__
- -- -
~ - - - -
I- - - - -- -- - - -II-I. -lI-
T
This graph shows
your dectric use
over the last 13
months.
12
Ty))es of
l\1cter Ueadings:
Actual _
Estimated Iii
Customer 0
9
6
3
o
FMAMJJASONDJF
2005 Months 2006
75 180
Actual
Actual
KWH BJlled
9988
9981
---,
2006
36F
4
Average - .Jan
Tel11Qerature
KWH Per Day
Yearly Use:
Feb 2004 - Jan 2005
Feb 2005 - Jan 2006
2005
32F
12
Total
Use
4131
2863
Average
l\1onthly
344
239
Other important information 011 back -+
l'
JUf-I
.:~-c:-:c GAS SERVICE
Billing Summa!} for Service to:
ANN MARIE JONES
646 ERFORD RD
CAMP Hill PA 17011
Rate Classification:
Residential Heating
Billing Period:
11/29/2005 to 01120/2006 (52 days)
Estimated Read
Questions?
Call 717-232-1811 or write to UGI at
PO BOX 13009
Reading. PA 19612-3009
* Your current UGI charges include
State taxes totaling $ 15.34.
CPT 216 548 7305 04 1
(j
Past Bill Information - UGI Utility
The account balance on your last bill was .................
Thank you for your payment of ......................................
Your ba lance as of 01/25/2006 ....................................
$ 230.02
-122.28
107.74
Current Bill Information - UGI Utility
Customer Charge ............................................................... 14.83
Commodity Charge ( 277 CCF at $1.26794) ............. 351.22
Di stri bution Cha rg es ......................................................... 111.02
P A State Tax Surcha rge ................................................... -0.60
Total Current Charges - UGI Utility................................ 476.47
UGI Utility cha rges owed this bill ..................................................................................
Total Amount Due, Please Pay by Due Date (03/06/2006) .....................................
$ 584.21
$ 584.21
7.50
6.75
6.00
5.25
4.50
3.75
3.00
2.25
1.50
0.75
0.00
Average CCF Per Day
-
1111.1
.
JFMAMJJASONDJ
2005 Months 2006
· = Estimated Usage
Average
Last This
Year Year
CCF/day 5.00
Daily temperature 330F
5.33
340F
Meter Information - Next Read Date March 22, 2006
Meter Number Previous Reading Present Reading
1080944 3473 (customer) 3750 (estimated)
CCF Used
277
Messages from UGI
· Your current price to compare is $ 1.27139 /CCF.
· Your total annual usage is 1,123 CCF. Your average monthly usage is 93 CCF.
· Your bill was estimated because we were unable to read our meter. Your next scheduled
meter reading date is March 22, 2006.
· Help prevent pipeline damage. accidents and service disruptions. If you see someone
digging near your home please call UGI.
'If d~~ \
I - '"
\D4J. ~ ~
,,\0 ~
.~
if)
If you pay at a payment agent please take your entire bill. Make check payable to UGI.
Keep this part for your records. Important information is on the back of this bill.
"
rBf#
._~- GAS SE H'"
Billing Summa~ for Service to:
ANN MARIE JONES
646 ERFORD RD
CAMP HILL PA 17011
Rate Classification:
Residential Heating
Billing Period:
10/19/2005 to 11/29/2005 (41 days)
Customer Read
Questions?
Call 717-232-1811 or write to UGI at
PO BOX 13009
Reading, PA 19612-3009
* Your current UGI charges include
State taxes totaling $ 7.41.
CPT 216 548 7305 04 1
Correcting Bill - See Messages
(!t
Past Bill Information - UGI Utility
The account balance on your last bill was ................
Pa ym en t s ... ............ ..... ....... ........... ..... ............. ......... ...........
Ad jus tme n ts ....... ....... ................. ............... .......... ....... .......
Your balance as of 12/27/2005 ...................................
$ 400.56
0.00
-400.56
0.00 ( " ~ /
/~\J.;'v-;0/)
g~~~~~~~~~~:~~~~~.~.:..~.~~..~~.~~~........................ 11.69 . yJ-V.' \
Commodity Charge ( 151 CCF at $1.09185) ............ 164.87 ~\ '
Distribution Charges ........................................................ 53.78
P A State Tax Surcharge .................................................. -0.32
Total Current Charges - UGI Utility............................... 230.02 ., &
UGI Utility charges owed this bill .................................................................................. $ 230.02
Total Amount Due, Please Pay by Due Date (02/06/2006) ...................... ..... '" $ 230.02
0... I"'r;. ,,0"-0
~. ~ ~
\'V ~ ~ \/~O
7.50
6.75
6.00
5.25
4.50
3.75
3.00
2.25
1.50
0.75
0.00
Average CCF Per Day
-~
li11l1mI
DJFMAMJJASOND
2004 Months 2005
· = Estimated Usage
Average
Last
Year
This
Year
CCF /day 4.30
Daily temperature 39QF
3.68
46QF
Meter Information - Next Read Date January 20, 2006
Meter Number Previous Reading Present Reading
1080944 3322 (estimated) 3473 (customer)
CCF Used
151
Messages from UGI
.Your current price to compare is $ 1.27139/CCF.
· On 12/1105 the PA PUC approved an expansion of UGl's Low Income Self Help Program
(L1SHP) and a cost recovery Rider L1SHP. initially set at $0.01081 per ccf for residential
rates as of 12/2/05. Rider L1SHP may be adjusted quarterly.
· Your total annual usage is 988 CCF. Your average monthly usage is 82 CCF.
.This bill replaces your most recent bill. We corrected it based on your meter reading.
· We can make your energy costs easier on your budget with our 12 month Budget Billing
plan. Your monthly payment would be approximately $ 163.00. For more information
about this plan call UGI.
· Help prevent pipeline damage. accidents and service disruptions. If you see someone
digging near your home please call UGI.
If you pay at a payment agent please take your entire bill. Make check payable to UGI.
Keep this part for your records. Important information is on the back of this bill.
~...~u.,.. ,g, """"'U'II """"" .au"".
For Service To: Ann Marie Jones
646 Erford Rd
Account Number: 24-0648483-8
Premise Number: 24-0382885
Billing Period & Meter Information
Billing Date: Dee 22. 2005
Billing Period: Nov 17 to Dee 19 (32 days)
Next reading on/about: Jan 19,2006
Rate Type: Residential
Meter readings in current billing period:
Meter Number N045387380 is a 5/8-inch meter.
Present-actual 199200
Last-actual 198000
Gallons used 1200
Water Usage Comparison
Monthly usage in hundred gallons.
35
21
14
D J
e a
C n
F MA MJ J AS 0 N D 2
eap au u uecoe 0
br r y n I 9Pt v c g
J.lII""y .;.JUIIIIIIAI Y
---------- Prior Balance--------________________
Balance from last bill
Payments prior to Dee 22, 2005. Thanks!
Total prior balance, Dec 22, 2005
----------Current Water Charges-------___
Service Charge
Water Volume ($.005735 x 1,200)
STAS PAWC Water -0.14%
DSI - PAWC Charge 2.39%
Total water charges, Dee 22, 2005
----------Other Current Charges--------__
Customer Protection Water Line
Total other charges, Dec 22, 2005
I
$18.52
-18.52
.00
11.50
6.88
-.03
.4/..
18.79
5.00
5.00
-----..----AMOUNT DUE -----________________
$23.79/
y
/~ D9
. ~. .~tr'
~\J \\f
1.1 1)\)
Messages to you from Pennsylvania American Water
Any portion of the water charges which is not paid as of 1/17/06 will be subject to a 1.50% penalty.
· Customers may use their credit card, debit card or pay by electronic check only by calling toll free: 1-866-271-5522
Customers may also pay on-line at www.water.paymybill.com. A service fee will apply.
It Approximately 4.72 percent or $.88, of State taxes are included in your current bill.
It Effective October 1, 2005, the Distribution System Improvement Charge (DSIC) increases from 1.91%
to 2.39%. This charge funds the replacement of water distribution facilities.
It Effective January 1,2005, the State Tax Adjustment Surcharge (STAS) decreased fronl.04% to -.14%.
Customer Service & Emergencies 1-800-565-7292 (24 Hours)
For Hearing Impaired Customers TOO 1-800-300-6202 (24 Hours)
Visit us on the INTERNET: www.pawc.com
456
A1M
16339
- --- ----.-... - -----.... ......................,
&.I""'ltJ 'OJUII "lieu y
For Service To: Ann Marie Jones
646 Erlord Rd
Account Number: 24-0648483-8
Premise Number: 24-0382885
---------- Prior 8 a la nce------..-............_..
Balance from last bill
Payments prior to Nov 22. 2005. Thanks!
Total prior balance, Nov 22, 2005
..--------Current Water Charges----.-_.._
Service Charge
Water Volume ($.005735 x 300)
STAS PAWC Water-O.14%
OSI- PAWC Charge 2.39%
Total water charges, Nov 22, 2005
----.-----Other Current Charges----.-___.
Customer Protection Water Line
Total other charges, Nov 22, 2005
Billing Period & Meter Information
Billing Date: Nov 22, 2005
Billing Period: Oct 19 to Nov 17 (29 days)
Next reading on/about: Dec 19, 2005
Rate Type: Residential
$23.79
-23.79
.00
Meter readings in current billing period:
Meter Number N045387380 is a 5/8-inch meter.
Present-actual 198000
Last-actual 197700
Gallons used
11.50
1.72
-.02
.32
13.52
5.00
5.00
----.-----AMOUNT DUE ---.-.-----..-------- l
$18.521
Water Usage Comparison
Monthly usage in hundred gallons.
35
28 ;~~::::::
21 ;f~,
'14 :~f:
if,
0 i~~
2 N 0 J F M A M J J A S 0 N 2
0 0 e a e a r a u u u e c 0 0
0 v c n b r y n , 9 P t v 0
4 5
Messages to you from Pennsylvania American Water
Any portion of the water charges which is not paid as of 12/19/05 will be subject to a 1.50% penally.
· Customers may use their credit card, debit card or pay by electronic check only by calling toll free: 1-866-271-552
Customers may also pay on-line at www.water.paymybill.com. A service fee will apply.
It Approximately 4.72 percent or $.63, of State taxes are included in your current bill.
· Effective October 1,2005, the Distribution System Improvement Charge (DSfC) increases from 1.91%
to 2.39%. This charge funds the replacement of water distribution facilities.
· Effective January " 2005, the State Tax Adjustment Surcharge (ST AS) decreased from. 04 % to _. 14 %.
Customer Service & Emergencies 1-800-565-7292 (24 Hours)
For Hearing Impaired Customers TDD 1-800-300-6202 (24 Hours)
Visit us on the INTERNET: www.pawc.com
@~
A1M
5960
PPL Electric
Utilities
I j I
\ . I I I
'...\~::././ ~
ppl :~~t
Electric
Service
For:
ANN MARIE JONES
646 ERFORD RD
CAMP HILL PA 17011
Account Balance
Questions about
this bill? Please
contact us by Dec 13
at 1-800-342-5775 or
484-634-4900
or write to:
Customer Service
827 Hausman Rd.
Allentown, P A
18104-9392
www.pplelectric.com
Page 1
52170-74000
...<:::Yb~.l/B.iUAC~~Ot!J)tNunlwf. .
$ 0.00
$18.39
$ 18.39
$18.39
KWH - Average Per Day
Summary Page
Balance as of Nov 22, 2005
Char..ges:
T otafPPL ELECTRIC UTILITIES Charges
Total Charges
Electric
Use
18
15
-.------ -..- ~ - ---.--
- - - - - - -- I--
-. .- - -- f-
- - -. - - ~ -
This graph shows
your electric use
over the last 13
months.
12
TYI)CS of
Meter Readings:
Actual _
Estimated I/?'?::I
Customer 0
9
6
3
o
ND J FMAMJ JASON
2004 Months 2005
Meter Reading Infonllation
Average - Nov
Tel~erature
KWH Per Day
Yearly Use:
Dee 2003 - Nov 2004
Dec 2004 - Nov 2005
2004
49F
12
Total
Use
4269
3832
9787
9675
----rTI
2005
48F
4
Average
1\1onthly
35li
319
Other imporf.ant inforlnation 011 back ...
PPL Electric
Utilities
Electric
Service
For:
ANN MARIE JONES
646 ERFORD RD
CAMP HILL PA 17011
PPL Elcchic Utilitics
Customcr Service
827 Hausman Rd.
Allentown, P A
18104-9392
1-800-342-5775 or
484-634-4900
www.ppldectric.com
\ . I i I
'\"'~41 ,
~.:.....~.;...-
p p I .;~~~~
Page 3
.....:.....:..yQ~lf.BiUAccOQrit N1Jmh~f
52 1 70-74000
.. : .tJse\vhl."ncalJuie- orwdtine-
Total from Last Bill
Pavment Received Nov 1 - Thank You!
$ 35.50
$ 35.50
Billing Details
Balance as of Nov 22, 200S
$ 0.00
Current Charges
Char~es for - PPL ELECTRIC UTIl~ITIES
Residential Rate: RS for Oct 24 - Nov 22
Distribution Charge:
Custolller Charge
112 KWH at 2.19300000~ per KWH
PA Tax Adj-"~urcharge at 0.08800000%
Transluission ChaI~y:
112 KWH at O.50400000~ per KWH
TnYisll~OJilj:Pi~!32900000t per KWH
Generation Charge:
Capacity and Energy
112 KWH at 5.r8200000~ per KWH
Total PPL ELECTRIC UTILITIES Charges
8.00
2.46
0.01
0.63
1.49
5.80
$18.39
Account Balance
$ 18.39
General
Information
Next meter
reading
on or about
Dee 22
Generation prices and charges are set by the electric generation supplier
you have cnosen. The Public Utili~ COlluuission reg!llates distribution
prices ~nq servi,ces. The Feqeral Energy Regulatory LOllunission regulates
transllllssIon pnces and servIces.
PPL Electric Utilities uses about $1.23 of this bill to.pay state taxes. In
addition, about $1.08 of this bill pays the PA Gross Receipts Tax.
The Transition Charge includes an Intangible Transition Charge (ITC) and
the applicable gross receipts tax \vhich together atllount to $1.23. The ITC
is a per usage cl1arge app.roved by the Pul)lic Utility COllul1ission \vhich
PPL ElectrIC UtilitIes collects as agent for PPL Electric Utilities Transition
Bond COll1pany LLC and \vhich that cOlllpany uses to service debt inclined
to recover a portion of PPL Electric UtilitIes' stranded costs. The gross
receipts tax, \vhich is collected for the COllUll0n\vealth of Pennsylvania, is
equal to 5.9% of the ITC.
For your convenience, you can no\v pay your bill using your Vis~
MasterCard, Discover, or ArM Card. Call BillMatrix at 1-800-072-2413.
Bi,llMatrix will charge your credit and A TM card a service fee for lllaking
thIS paYluent.
Now you can receive and pay your PPL Electric Utilities' bill online.
Check our web site for lllore infolTIlatioll and to sign up __
W\vw. pp lelectric .COlll
No charge
COllvenlCllt
Secure
SAVE MONEY
Save postage and late charges - sign up for Automated Bill PaYluent.
PPL Electric
Utilities
Electric
Service
For:
ANN MARIE JONES
646 ERFORD RD
CAMP HILL PA 17011
PPL Electric Utilities
Customer SeJ"\'ice
827 Hauslnan Rd.
Allentown, P A
18104-9392
1-800-342-57i5 or
484-634-4900
www.pplelectric.coln
\ I. Ilii 4' I
, .. .,'\, ';. ::4/'/ -
ppl J~~:
..
, TM
Page 3
..: <.: .:;:.::::::Yo\i.r. BitFAi;:i;:\;1!.l~lt NUln~i::.:.: ......
52 1 70-74 000
. . :'::Us~\vh~J{baml:lii..~r.\~iifu& ...
Total from Last Bill
PavmeJJt Received Dec 12 - Thank You!
$ 18.39
$ 18.39
Billillg Details
Balance as of Dec 22, 2005
$ 0.00
Current Charges
Charges for - PPL ELECTRIC UTILITIES
Residential Rate: RS for Nov 22 - Dec 22
Distribution Charge:
Custolner Cha(ge
114 KWH at 2.19300000~ per K\VH
PA Tax AdLSuTcharge at 0.08800000%
Translllission 'Charoe:
114 KWH at 0.56400000~ per KWH
Transition Charge:
114 KVvTH at1.32900000~ per K\VH
Generation Charge:
Capacity and energy
114 KWH at 5.t8200000~ per KWH
Total PPL ELECTRIC UTILITIES Charges
8.00
2.50
0.01
0.64
1.52
5.91
$ 18.58
Account Balance
$ 18.58
General
Information
Next meter
reading
on Of about
lan 24
Generation prices and charges are set by the electric generation supplier
you have cnosen. The Pubtic Utili~ C0l111nission reg~.1lates distribution
prices ~nq servi,ces. The Feqeral Energy RegulatolY L~ol1llnission regulates
transllllsslOll pnces and serVIces.
PPL Electric Utilities uses about $1.25 of this bill tOJ1ay state taxes. In
addition, about $1.09 of this bill pays the PA Gross Receipts Tax.
The Transition Charge includes an Intangible Transition Charge (ITC) and
the applicable gross receipts tax \vhich together atnount to $1.25. The ITC
is a per usage c11arge app.roved by the Pu51ic Utility COIlllnission \vhich
PPL ElectriC Utilil1es collects as agent for PPL Electric Utilities Transition
Bond COlllpallY LLC and \vhich that COl1lpany uses to service debt incuITed
to re,cover a pOl1iol1. of PPL Electric UtilitIes' stranded costs. The gro~s .
receIpts tax. \VhIch IS collected for the COnil1lon\vealth of PennsylvanIa, IS
equal to 5.9~'O of the ITC. .
For your conve.nience, you can no\\' pay your .bill usi1~g your Vis~
MasterCard, DIscover, or A TM Card. Call BIIJ~latrJx at 1-800-072-2413.
Bi.l[\'latrix will charge yom' credit and A TM card a service fee for nlaking
thIS paY111ent.
Now you can receive and pay YOlU' PPL Electric Utilities' bill online.
Check our \veb site for lllore infonnation and to sign up __
\V\V\v. pplelectric .COlll
No charge
Convenient
Secure
SAVE MONEY
Save postage and late charges - sign up ft.)r Autolnated Bill PaYlnent.
'.........---- ,..:-:
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REV-1513 EX+ (9-00) *
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ann Marie Jones
SCHEDULE J
BENEFICIARIES
FILE NUMBER
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 Kimberley Smith, 39 Heidi Terrace, Camp Hill, PA 17011 Daughter 19,244.00
2 Robert Jones, 31 Lancaster Ave., Enola, PA 17025 Son 19,244.00
3 Jeffery Jones, 35 Red Barberry Drive, Etters, PA 17319 Son 19,244.00
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00
(If more space is needed, insert additional sheets of the same size)