Loading...
HomeMy WebLinkAbout97-03067 PA DEPARTHENT DF REVENUE 8UREAU DF CDHPLIANCE DEPT. 21D946 HARRIS8URG, PA 17128-D946 *' ~ ' .,~, (, (III). 97- 3(){P 7 C,:;~,~.7.:lfJr1 -.'.( ('," il In ;. I" "I' \ ,~' ( ,. . r ,':',', . ,. " HAY 01 1991 COURT OF COHHON PLEAS OF 1lq .uuQld c..u..tI 7?3lcl. ~~ 53C(p<1 CUHBERLAND COUNTY, PENNSYLVANIA NAHE AND ADDRESS. RODGER SHUGART & CATHY SHUGART 111 W LAKE DR CARLISLE 11013 PA TO THE NOTHONQTAIt'f 01 lAID COl.MT. Pw..,.t II 'Ill ,... It \fill ,_.IUII If '_.1....... ',...I.'*'..IUltr.....U'...c.rtIfIIfC"'.'.U_ II "..,.......,,"..,......C_I,. CERTIFIED COPY OF LIEN 209-36-16D2 DATE 01 CLA" 0If TAll mlOD "S"SUCHY IDlHTI"I..o onE.MINAHON TA' TOTAL TAX 101 our flATEI ........ eM: KITUJlCHT I , . . . . P. X. T. 01-01-93 TO AUG 17 1994 L39480 688,00 90S .17 12-31-93 TOf,'LI nOS.77 IHTUUT toM'Ul'ATlON DAT! HAY 26 1991 t688,OO 'ILI... 'UIII 'G.nn 'fl' ""..,.1'''1', 'fl. ...,U.,y If ...."". h,. "I. '"'fl"'", ul...UI If ,tI. C._."."U" ADOITIQt.6AL IN'lIlU If "",""h,"I', ..,UUn '"l" t. .. . UIII' '", ..,,..., ,.., If . UI" ...111'1 '"' ...". II.... 'U,."I' fer "11,.111I tll, III'.,nt, 'UU""' It ,.".UI.. '"'''''' h. f,.. ...... ,... unu....' TOlaL n,.r Ill' ."le". .fUr ....fl. ,.,. UytI'fl' "'IU,,'. ,.,.lInl unul.. Tfil. ".un'.' IIl'''llfl. ..I. ,.., Ifl"r..'. .UIU,fl' .,. "fl.1U.. It I IlIfl lfl ,,,.,. .f 'I'll C'_,"w..U" If ',flfl...h,"11 ",.fl "It t.......r.. ,ru.rt... r..l. """flll. tr ""'. It tll. .... .... ,.. ~a..~~~ CUTAl. D" 1fY["'1A: l~ AuTHOftllfD DELEGATEI PART ~ 1 - TO BE RETAINED BY RECORDING OFFICE I Iii "' .. "' !i: ... ~ .. "' ~ .. :l! "' .. . .. "' a .. a .. z "' ... .. 5 ~ . o . . ~ : . 0 : : .:'" .: .. c.. .. ...... .. . . ... .. c .. .. . .... ......... c :::;2:: :: ::II ::II...... ........ .a..... ... 10" .... .... l- e c . c.. .. .. ..... ....... . ........... ...c................ .. .. .. u.. .. ~ .. . ... ... 10 C ~ .. .. u .. ~:=..:...s~:...: )0..... .. II" .. ..... .. .. .. .. ...... .. ... .. ... .. :it... .. .. ....011:.......... ;;~:~::;:loll ~ . . ~ 'M ' , W ~ ::i.~.,.:,.:..: '!~..:2..;~~..;..:!: "'~._......a:OE. o = ~ . ~ : ~ ~ : . o .. o 0 ~ . . . .. c .... ~: .. ~ ... ~ :: .. 0 .:! : ~ ...... ......:: .. ..... c.. ~ :;; : :'''' .. ..... ..... .. .. .. >> c ... .. 1:.. .... .. .. .. c .. c c .....:11 ::. - ..... ....... to.... .. c c .. .. .. .... c .. ... ....- _00_ _Jo .. II .. ..... .. .. .. .... .. .. .. .. .. .. .... "4:'" .. 4: .. .. .. ......2 c .. ... .. .... .. c c _c ... .... a.. ... . .. II .... ..... .. ... .. ... .....e..... ........11I C .. ....... .. .. .. .. ... III C ..... .. .. ..... .... .. .. ... .. .. :a . o. .. .. ..... .. JOo a . ~ ...... ..... '~'g'" U II C'" . - - Coli:" .. .... ..... - , . 0 . . . :- . . .~ = . o . Q C .. Z C > ... >- III Z Z III ... ... o :I: I- ... :i :a z o lC lC o U . . . . . o . I- 1-0:: O::C III < l!l > l!l::l ::1:1: :l:lIl III >- 0:::1: lOll- l!lC CU C O::oll . . .-. a . . :; .. ~ ~ " ~ ( . . . - . :~ - ~ C .. g . II; :; :- c . . . . ... :: r= ; ~. 0 ~ i : . - . ....... . . . , o. .. .. .. .. .. .c .. .. ~ . - , ...... ., . c .... .. !::: .. I .. c u.. c ... - . . . t c., 41: ~:;.. .. ..... .. o ._ r'::: ..... ~:::: .. to I: .. Z....2 !i: "' lC "' .. I: "' .. . . ~ ~ o a . . : . . : : . w . . . o . . o : - = . o : a a : . :; :: . ~ . 0_ ~ o . . . , ~:: . . 0 . . ..:;:: ~::: ~ . - . . . ~ : . v . . ..~ . . . - . . . . ..~:: ~ 0 O~_ . . :: I! . . ~ . o . _ . . .. .. ~ &~: ... .... c . .. ..: ~ l c.. .. .. . - a . . 0 . ~. - . :: :.. . .. . ,. . . . .. . o. . ~ .~ I ;1 .. ::: - . . -. . ..- . 0 . ~~. : : z "' ... .. ~ I- .. g "' U ... l- i :: ~~~ ... ~ ~ ~ 000 i i. i . . . a a a ;; . . . E o :::::...... .. .. .. .. c .. .. .... .. .. .. :::=t.:;~ .. .. c c .......... It II 1I . . .. .. .. .. .. ---...~~ III:;::.... c c c c .... ... c c c .. .. ... ... .. .. .. . ..... ... ~~~~:.. ......- = .' ~: . . . , . . o 0_ . . . ~:: .: . . . . . .~ o~ ~ . o .. . . . . o . a - . .- o . .~ o . : , . . . .: :i "M"" ...... " , i':": ~-i~ _co ~&!ci -':.w ..: a:i . .. .. .. wi":..i::i uu.': Ii g .. "' U ... l- i !i ... .. ... .. .. a "' u c .. .. . ' :: a .. ~ ~ . : ~ .. )01:.'" .. .. .. ... .. ~ . . .. ...... .. 1:.... .. L.. .. ... u .. ... ...... c _.......c. ..... ...- .- .. .. .. .. ... a.. c.... ... )0" ... ...... ... .. .. ...... .. .. u .. .. .. .. .. ... u c....... .. .... ..... c .. ... .. .- :... .. .. .. : ... c .. .. or:; ...-~:..~ .. "c u,=; :; .. .... .. .. .. ... 01: .. .. .. .. .I: .. .. ~ .... . 0_ .. .. Ie .. .. .. z.... c c .~ .. ... ,... .. '-:.__C.I: ~.c _u .2. ... .. c .. 4!: ..... .. .. .. JI o . .. .. .. c ... .. c .. ...... ....... .... .....,. "...2.... .. ... c c .... ..... It oil: ,... ... .. .. .. .. .. .. ...... .. c .... .. .. . .. .. c c..... ... .. .. .. 0'-:_.1:'" .. ..... I .. . . . . . . ~ . J : ~ . : ~ !! - - . . . . - . . . . . .-- !! ~ - . . ~~ , , .= ~ : .. ..... to o . . . .. o . c ... c .. ..... .. c . . . 0_ . . . : : .. '" ,. .. c .. .. ..... ... o. . . It .. . ,... .. : ; .. .. =: ,.,: .. .. .. ..... It C C .. .. ....... . - 0 ~:::.:: ... ..... .. .. .. .. .. .. c .... .. ... a _.. . .. ..... .. .. .. :........: ..... ,... ..c....... .. .. .. .. . . ~ . 0 . ....... ..... .. .. ..... 41:......... ...... .. I- . 0 .. .......... ..... .. .. .. ".I:" .,.c.._ .. ~ - .II . .. ... , ,... .. ... c... ._ . . - ~... ~. a ~ .... .10 ... '"' . . . ....... ....e ......~ . , . . , o o . 11 : ~ c c c c ~ ~ I I ~ a " . . . MM' ~ ~ ~ : a a a . MMM. .......... I I I I I I I o ~ i. .:i w.o t;..: 0 o . 0 w :": ~:J~.~.~ ~'!..:2a;~~ ...",._",,11:0 "' u i . . . . ... .. . , .c. .. .. . ......... 10 ... ,...-.... .:...t.:":I . _... .. c... Of'" . _ _ C .. .. e . _..__ ........1tI ......:II..... ........1;. ... Z .. . 1;..... c c.. ,. c C C ............. :::::.."I:.~ , ..10........ . ..... . . .. u . .. ..... .... .. 10 ... . . . ..c...c,... u .... ~t:.c.. ... - ~ OO"'" .. .... . .. . II: C .. .. z.......N ....... ... ,. . - . .. . .. .i':':.:":~ Of" Of C .. .. ,. ..... 0" ... III _ .. . .I: ....... ...oo.. .: ::~~; .~: . _ . :II" . ,. .~..-........ ! .. '; .. ~.. ~ . .._c:...... ~,.I:.;~,.~.; ..... . .c. c. .... .....u ...- C. ...-.....S .. ....... ... .._.c..:IIlIo_. . .. .. C a" . .. _.. .. _ ....c. 0 :II . ,. . .. . ...c. ,.c_. ...-;.::.:~';t= . . .. . .. .. ... ... .. . ... .. C .. . .... I; C .... c .. c: _ . C .. .. .. . . ... . Z........ O~.I,.:..."'~ _.c.c..c.~" ""..u.....C.... .. g ~ ... .. g ... .. .. ~ - ~ . "' U ... l- i . ~ .. g .. C ,. ... ,. "' .. U ... I- ~ 5 c . o ; . ~ ~ . . :'! . L o N .N ~ , ~::: . . .- ~- - . . . , . . . 'u . - . . . . . w~ .. o . . . . ~ . ~ . : ~ . - . . . o . -" . ,. - ~ 0 . . o 0 . ~ : : . v . a . ~"'-" :~= ,N . 0 _~ :II :: ~: . . 'M . , ~ L ~ ... . .. i' .. L ~ o : - v . . M' . . 0 . . .... ",0 . ~: : ....:: . . - .... o.:! ... lit: :: z~:: ~!! ..- . . .M a . =L .N UN . . . .: .u ~- - . "": . II "' .. u ,~:~:!~:~:~ 1tI"""'''''''''_N ........... ......-.-. ~~~~~~~~~~ ~ : . ~ ; . . . . = . . . c . ; : . ; v : - . = : .!: . :: . . ~ . . . : .!: = . o :: . ; .~ - : . - . ~.!: . - i: i: .- . ~ . 0 - . . .: , . . , o ~ . . . ~ . o . .~ . 0 .- ~..= - 0 . . . - .~ . 0 I ~- .. . - . . . . a o ~-. = : .. ~ . . . . . 0 . - . .-- . - . ';' 1;. , , = . . . . N 0 " . .- - . . -~ . . . . . . . o . . . ~ 0 a .. : . . ~ . . . . ~ . . 0- : ~ o ~ . . . . . . o . - - -=~ . . . - . . . . v- a . . . ~ . . . . ~: . . ~ . v o. . ~~. , . . , . . , . . ::~~===~=::= N........ .. ~ . = : :i : . o N"''' III."" N." ............. :::::::::::::::::::: "'''''''''''''''''''''''''1fI .............................. =::::=::::::~::= ~ ~ . . ~ . o , ~ :II :II :II , , :II :II :II .. .. .. .. .. .. .. .. .. '" :;:;:;:;:;~~~~:; :::::~=::;z==: :::::::::::::::::::: :::::::::::::::::::: - . Si ~ . !! ~ .. - . ~ . . - ... . . ... ~ ~ :; . . . .c . . ... .. ....... .: . ... ... . C . o. :~":.:. . ...... u _ . .. . .. _.. . :II ... _ .. c: .. .. .. c:...... ..... .. ~.. t:: ';: .. u..... . .. .. coo .... .., - . . ,. . .. ,. . :II C C.. II ....... . C . ~ -.-... .. .. .. . c: ,. ...-. ....... .. . .. .. . . .. . C .. .. . . .. .. C . .. .. .. Of _ .. . .. . . .. aI.C_." . . - . ....c_..u . .... . ._u.l:.cc: II oo.. . . ... - ,. -...11.... .c ... _.. . .. ~ ... . 10 . .. . .. ~ . .. .. .c. . . . ..... ,... ... _ C 0 .. .......... . C . . ... ~:~ i ~ ;~; .... t: . .... .. .. . ... . C . ... . .c .. . . 10 . .. ~......III... . :. .':: ~ :..:,. : 10 II . . .... . ~ ... ..... c ~ ... ,... . .... ,. .. .... ... ..........:11. ... .. .. . . .. . . . :. .... ... . . ... ....... . . .. 10 C .c . . . .. C .. . .. I; . . . . :II. 10 :II ......... '" ... . .10.... .. ... C ... C",..:II.. .. . . 10 . . .. II . ... . . .. . ~:"'~~'i.,.~ . ... ... .. .. "'. c,... . .. . . ... c,. .c..c.c...... C:II ..:11..." .. ... '" . . '" .. _ :11_....... Jl .. . .. '" -..... ... 10 :II . .. .c .c . C .. .... ...... ,. - . . ,. . ....&......c.c. ... .I:..._.c. .. ......... . . II 1:... ,.... C 11I.....10...... ... II....... . .... ..... II . . ... . ... ........c.,.. ...:. .c_c .. . ".c. 10'" ............. . I: . . I: . ...... :..~.t=~..... c...... ..... _...C:II. "':100. ....c. ... ... . _ 10 .. I: . .. . . .... ....... .. II 10 C .. .,. . . ............ ..u.c. .c . ... ..,...... . ~ 10 . 10 . C .c ,. .. . C .. . :II .. .. .. ~ .. . III .. .. .. ...........c "'&:11""''''... ... : . . ~ ~ . NO . ~,; . . .. o ~ . - . . o : : . . . . M , - . , .N o . 0 . :: - . . . . M . a o . :'f :~ o- M" . 0 . . .- 0_ . . . . M : . . M . . a . . N ON . . OM o . a . _N . N . . ~ . . -c . = : _0 , . : -= . . . o . . ::-; : - . . :::: . . 0_ . . . ~ . .. ~ . - . :U . ~ . . .- . . . . o . :: - . ~ ~ - . . . . ~ . a M o. . . . ~. . 0 . . " . . . . . . . o '..; :-: '::! ., N . . 0 0= . ~ s : -=~ . M ..: , .N .N . . - . . -. - . ~ a - . a . : : . : : i - II ~ b i : . !! cv ~. ~~ ;~ E ~a ~ . = : :i , , , I ;: :i :: . . ~ ; . . . II . C '" . ~. C : :: ~ e .: ~II. ~. .. ..... . .~... '" ..~..... ~ . Of . .. c..... ........,. ~-...... ... ..... .c. II: 1:. 'III 1:..... C ... ... ii~i::: !:!;::! .... ..... c....__ MIo...-..........c.. ...1:;;;::I~;ft...;:: . .1010 10 ... 10. ... ... ... ............III.C. -.............. .-... . .. 10 10 .. . . . .. ... . .. . . . ~:~:;:;~::i:;!:;~:;:: .._-----------~:: ...N....ItI........ ....._N...."'....CC -------------..... ~ I- .. g III "' a .. u ..0..:. o-!. o. 0.0":'": '!lI:~~_:~~":~"!_=":~":~ u~uuua...W1.za1l:u..1II . . ,-- o .. _L . . . ..., CN"_" ...... .. . ,c ~ _ lC . . ... . ... . . C"'...."" ;, - 01 .. . . . .~W1a.. . . . ... 0 . .. I..c.... . . 0 III . M . . . 0 . .. . au... c:_ ... 10 . 0 .. 0" . ... .. .. ...c.... ... .. C .. Of N . . .. C .. . .. .. III . -:: . . .; . ... I: . . . .c . .::.~- . -, ... 0 . . I-.....CItI . . . C .., ..._.."'N C... _. . C II . C .. .. c. .. ':::: :II: . .. .. I: . .. c..... :;11I"':-::" . III .. . 0 ~ I: N. .... : . N .. : .:: . 0 .. . .. .. . . ...... CI:ZIo...... =: .- ""... 0 N_ ~: ::: c_.__ : . : a . . U . . o . . . o . . : , . . : ~ . :; :~ . M . U . . . . t L a" U: . . . ~ . I: U , : .: . . ~ o . . . -. - . ~ : N . . :'::1 .. . 0_ ,N '.' o _ . :: . . 0 c . . ,~. ..: ~ . . . a . . _c . - MO' _:.. 0_ . . . C .- ""... . .NN . ...,. C .. N N . 0 N . 0 . .. . C .. ~ ... . . ~- .. . .. .. ",.. . .. - M . ,. ~ .l. ~ . . . M ... lC . . I: ;, .. - . M . N . . N , . - : ~ ~ .. . . o . . . . . . . o 0 . . . . a. - . .. . 0 . Q . . c , . ~ ~ . . . : a . . U ~ . c . ,; ~ f'~ :>- 'b;~ ~~ .... :b -:if \r~~~ c:~ a. ~ ~\Jj 0 : ,.~ /'f;'!Z '0.. () (' ,: . ;", '1:_ : -...J ~S ' -- lo 0 ;j i j : "1d '") ~li ;'" , () ~. Q.. . ' ( \f\ r:l ~ 11 c;:. !. . ~ lrJ ill <. {I? 1+ 11 _J ~ ~( cJ . ' .~ \:i , ''oJ (j;:j If' ~~ ~ t! _ ~13 ~ t;j.. lil~~ ...:l ,~ ~~? I ;:::: ;.! t5 ~j :;]u ~ ~Iil! ~ ~~ ~!;! H I1.ffi U .0: i '~3 , ~ ~~~ !Boo > lJl . ~ ~~~~ :Il:Il lJl ...:l i ~rt lJl~ 00 ~~ ~ i "'s 0 ~~m , U, ~ 't lJlgj ~ ~ -..: ;~ ) F\f1LES\DATAFlLE\JIOSprrAL()()C\m.coM.11Iu Crated 05r'2lW71211:19PM RniIed. O6o')CW701:l5:30AM lO471t.m CARLISLE HOSPITAL AND HEALTH SERVICES, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 97- 2:J:J0 ~ CIVIL TERM v. JAMES LEE CORNWELL, Defendant JURY TRIAL DEMANDED NOTICE You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this Complaint and Notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so, the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the Complaint or for any other claim or relief requested by the Plaintiffs. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP: Court Administrator Fourth Floor Cumberland County Courthouse Carlisle, Pennsylvania 17013 Telephone (7 I 7) 240-6200 Attorneys for Plaintiff Date: June 10, 1997 " CARLISLE HOSPITAL AND HEALTH SERVICES, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 97- 30 (,.1" CIVIL TERM v. JAMES LEE CORNWELL, Defendant JURY TRIAL DEMANDED COMPLAINT AND NOW, comes the Plaintiff, Carlisle Hospital and Health Services, by and through its attorneys, Martson, Deardorff, Williams & Otto, and hereby avers as follows: I. Plaintiff is Carlisle Hospital and Health Services, a Pennsylvania non-profit corporation with its principle place of business at 246 Parker Street, Carlisle, Cumberland County, Pennsylvania 17013. 2. Defendant James Lee Cornwell is an adult individual residing at 8669 Springs Road, Warrenton, Virginia 22186. 3. On or about May 27, 1996 through June 5, 1996 Defendant was provided with reasonable and necessary medical care by the Plaintiff and the Plaintiff's agents, servants and employees. 4. The outstanding balance of$14,570.08 represents the reasonable and necessary value of the services provided to the Defendant and which Defendant has yet to pay. (A copy of the printout summary is attached hereto as Exhibit "A"). 5. Despite repeated demand for payment, Defendant has failed to pay for the services provided. COUNT I BREACH OF CONTRACT FOR PROVIDING NECESSARY CARE 6. Plaintiff hereby incorporates by reference the averments contained in paragraphs I through 5 of this Complaint. 7. Defendant has breached an expressed or implied agreement to pay the reasonable value of the services rendered. exhibit A nD,) Il ~/.6 .~aO~B.l IL.L..... I.L, ......,:, :.ov"'V lJlw '. 04. t J\J .AU'V.,J ItU .v.,}.1 I ,'.'. C:4"ll~II.~ 1Ic.:~~lrAL ......:'T r',:.TUt.;I "'4SH~ eeT 16, 1?96 ll:.e ~Ab. ~ rATn"-r "'Ie J"Or.~/.i" ''''rlCr.!. , I I ~ ~ T ~ A H r AHT Dur IRtiWELL, JAfE:; LEE IH70.05 re-!t't' .. ,~ \I L'11o"3 ~-e-'-_.- ----.. .. _. 0.. ., C.IG .;. r 1 ,~ 'SOU '"0 J3.3cH .6 5S516 '6 5~577 .{, sssrr .6 55507 16 55507 4 '3'~1 'b H516 '6 55 577 .s ; j S 71 '6 55612 16 55501 io sssar :0 60055 :0 60 30~ .8 .aerH, :0 60672 :0 60055 .0 ()Oe 10 :0 60305 :0 60501 :0 e;.830' :0 60305 :0 60501 .a ~03ijJ .0 HO o~ .0 2923> .~ Jt;u.a .0 30626 .0 29016 IV lfl40 .0 l0006 iO l0001 .0 l'IH6 .0 29016 .0 29016 w-t'geo[ .0 302!l ,0 l0211 .0 J"lll~ .0 30170 .0 l0221 rt-tflal .0 30222 .0 l0220 .0 "IJ:I r"y...t"('~ .'jO ~e I C!,G5 q~O~ C~liS .PO nlO.O~ P'I~V ~Al 1~510.0l OIS INS 14570.0. fIHl~~hll4LIY ,'lllH) .on "OI7l<t-"~"'~HV OT r~1 01 ~AT -HErfllC~CC Oe~CqlrTlc'I.-- 11.00 11,00 052~?6 O\Z~96 Cll INTFCE CI'G ~F"'AfCeRTT ~T .oe: )'.00 a'tr"".O"f'9.,~-c-tft-"trtlfCt C'.6-tttt:fl:JAt, "~\l145 19.0r. 19.00 0\119A O~1~~I, CIO II.T'C~ C~G I.,U~ STAIN 11.00 21.00 0521~6 ~529~f. ClI INHCF CHI, AEHn~IC ICENTHICATION 21;00-'- '-lr.00.'OHP96-0S'H96 C TO INTf(."; CHG-'ANl0B11:-'11lfNTUlCUICN H.OO 51.00 0>2896 0~~.96 ell INHCE CIlG 8ACTERlAl 5ENSITIVITIES H.OO ll.OO 0~2996 0,31>16 CIO INIFeE CHG ~AeTCRIAl SeNSITIVITIE5 )1'.08 )1.60 8'd)J1~ JHI6-9l'o ere If,Tfr.r e,l(. ft1LH::I~[# ~ot:m~ 19.00 19.00 060396 O~O<9t C 10 INTFO CHli bNA" SlAIN 21.00 21.00060396 060196 CIC INIFcr el16 4rRODle IOENTlFlCATICN [l.oo--~"60~96.'160196 CH-!_~eR6BIC IBEIIT HICATlBII 20.00 20.00 060lY6 OI.OHA ell INTFeE eMG ADDITIONAL SENSITIvITY H.OO .H.OO U040A OAOIOt CIO INTFC~ CHG PACTElllAl 5ENSITIVITleS )1.83 31.80 e-e-e'5-9'&'-ftO:il1-9l!'-C:l I,jfre~ el ~ lIJ.'TI'''tAL Se:l.JJTlolTI!S I 10~.co 10n.00 052116 OSZ116 ~I'O 11020 citeS( ROUTINe 2V I H.?D ~1.00 D~~196 D~n96 rHO 13590 TlalA rlBULA LEG HCUTlNf 1 113,.08 13Z,J6 ajZ7~" O~,Ti~+'He -_..... "-O:ff:-l-eo-.'TIB-F18 .... .~._.._._....-_.._- I 289.00 289.00 052196 052196 P,IO '"AG~ INTFNSIF IER FlVO~O 0 -I 108.00 -lOB.OO 05~796 05~S9t rHO 11020 CHE51 ROUTINE 2V 1 .---1rv;"CtD ,,~.e~ O,I."il O)~'96 PHO 11010 CHfH.-'t'HJ SJU6LC .J(w "',t? I 111.0U 112.00 05/K~6 OS~8~' PHO 7Js~a rE~Uq THIGH ~C~TI~C 2V I 91_00 91.00 0~la'i6 .H~ge ~HO 13510 Illr U~ILATERAI. qeUTlhf 7V 1 a1.0lJ 17.8a eS~dv" a~~ft4)-.,.,.,..ft-._. . TJ'etf~'ft9ut.:A LeG.ROulIHE......_u-. -I 112.00 -112.00 05~K96 0S1Y?6 ~HO 13550 fEHUR IIl1GH ROUTIhE 2V -I 97.00 -97.00 05H96 052'196 PHO 73510 HIP UNILATERAl RCUTHE 2V 1 6f..6Q H.ao 0401'te-O-trC19"JlUO 1!S90 fJ"tJ'" rIfU:JL~ LCO "GtHlf\t I 106Y.CO 1069.00 05279A ~HS9. ~"o OR TlHF 121-1S0 HT~ I 47.00 .,.00 0>27,^ 060496 ~36 Flfr.TNC5URG/CAl LNIT J .. 1"";1)0 ... '''1''.OO.D~2'Y6 01\0'9#1 "5"6'. g HlAJL[ !JI"I,l.A( I 14.00 14.00 052796 0.C'~6 q l6 SUTURE CHARGE CLASS I 2 246.56 '93.12 052796 0~O~96 R36 CLAMP 1 .1:1tG-..--:-)':'OO-(tff1"'9'fr-'\l~o"...t .J~ 1)..,,.,..1......'.-_. .--.---- I 117.00 IH.OO USU96 oeOU6 'H6 LAVAGE PACK lUUlhG SfT I ~I.OO 21.00 052196 060.~6 Q)6 l4VAOE HUl_T1 TI" llj}.O~ "'4!).~O e.J[T'~ ~rt't't6.tf''$- 3tH~l..I 3'''!.. 202_.0 404.80 052796 060406 Rl6 CONl/EeTlNG 11005 155.l6 932.16 052796 060496 IO~ CI AMP rl'.DO -- -'-111;-00-0'1016--0"010 "'0--. ~R-TIHE ~D Ill" 4\.00 H.OO 053096 060~~e IUS HCHOClIP PAe~ 5.00 5.00 053096 ~6049t Hn DACRON DATTI~G 1....1I4 l d.ae-(U3aJ~. 11(1)'t'fe-A5~ ~!J'U"[ CllAIUit t':lA33 1 11.00 11.00053096 06040t R~6 ON~S5ING TEGAOERM 6" ~ 8" B.DD H.OO 05JOV6 060496 RH ~EP"ACARNJ[R HFSH .l.l.ea 4l.00 01)"'6 Du',Ull; I\];!' ["'t\~" 6!flhAfO.,( H.OO ~~.OO OU096 000.96 R56 OI.Anf DEHHATO"f 5.UO ).00 OSlOY6 060406 ~~6 aOV1E TIP ClfANER "TeG' 41.40 O)]a'~96 IfS6 t:LCCTIUUtHI01('AL:"Ortlf---' I I --1 I I I I I 1 I . 2 6 I I 1 ! , . I 1 1 I I no,) 10/H/n ~t' .;t\~061 Q.I PAT1E~1 ~C 170~h" 'ATloNT N~~r. :O~N~.LL, JHES lEt !\l.t 3tt ~ Z:011t)..n. ..w-t- ~.to6 tlfV ..--Jlrt'I&JI~l lIO HH5 8.00 t78 elLSl ?4.0Q IN all!4 ~.OO liD H~31 I I S.OO lff-T9500 1. "--l+ot B 270 HUe I 14.0C 210 80~01 I 25.00 1'0 Ul(06 1 11.00 110 7941e I ~.OO 270 000&2 I ~. O~ 'fO lUlU 1 ~.ba 270 78S15 I &.00 210 19831 1 H.OO tfO'..dOO'~ 1 ). ~o 210 &0082 1 P.OO 210 7~?12 I 0,00 liD 'V8as 1 ll..OO. 210 79912 1 K.OO 210 7977~ I 8.00 210 -U2ito.-; a. u lID 79780 I '.no 270 78S15 I 8.00 270 7a204 I -r.oo-- 210 1922' 1 5,00 2ra 79125 I 14.00 N'O'i'-9I-H--- i.'-- ~. 88 210 7a528 1 lS.O' 210 7983e 1 6.00 l78 18S1S, J g.. 99 270 79890 I 5.00 270 78~13 1 5.00 i-?' 711S1~ 4-." ..~....oo 710 78S15 I !.OO 270 18515 ~ e.oo Z7t 1BZ99 1 $.80-' 274 78708 I ~.OO 301 55000 I 7.00 Jll S1211J 1 ~7'aOO 301 '5812 1 14.0C lOI )'000 1 1.00 JI2 S SI.a9 I ..'~+l. 93 302 55179 I 2A.OO l02 55890 I Il,OO 3'S-SU!:! 1 1...99-.. l05 SS03~ 1 76.00 J05 55016 &.00 ,el lf811 1 11.D9 1~L.'~.' 11 ~~~ ~~~~ "",,-_ "'....:1\1 J.V'\J.,J I,IoI.VVv .vv t:A\ol1 151 t 1!',)~"1 rI,l ~~r~' o~rlt~T ~~!rr~ QCT l~, l~9h 1?,4~ ,.,Atlt: ~ t~Allr,~ s ~~1 ~UC 14570.0" f'f.n't:HS . ~O ~f.T rHe,s .00 IofCOl'" CHt,:l .\330.00 ~kEY CAl 1~570.0' C/~ 1'15 HS10.08 o~u tLr'r~~~ltlllY ~:LLE~ ~~~ lp T '" T-5il\"-Il'l-p~~._.r)f -~~.,pffF...~tI- Ill. ~t N I ~11 ON ..00 OU090 0~1l90 "O~ B.\NOAGC KtRLIK ORtS~lhG .. "'-~r.ou 0~3096-0BI~6-f'/r-----t+et-'\t:-i'Y-5iltUHO"~~ - -...-. .... . 5.00 05J090 ~53l.6 ~~t ELrCTqOD~ PN~ r.U~l tLE~~~T n.oo 0~lO~6 053106 ~Y~ Tuat SALEH 5u~r ',vALYf ll.ee IlJU6 BSJtge.+'//;----.-..TUflt-ENDO-I..0. ~.H CUHtO" ..... 14.00 053006 OH1ge noo 5TYUTTE 1~ fRo 15.00 033006 OS3106 ~90 CINCUlt AOULT 1l.OO.O..,~D9t, ~!..1J~6 k\"6.--.n-- 1,.10:)]( ,l,1~CSTutstA SZ .:. ltj-,1l&- 5.~0 O~jO"'o 0~JH6 "H CATHETER SUCTIC~ 14 FR. 9.00 0530n ~SJH. ~9G luaE NON-CONOUCTIVE ll' '"U-05.30116.0S3HO R06 CANNI"'~'.UCTION-UOO~L' 6.00 053~06 0604ge Rl~ BANDAGE KERlIX ORE5511lG 11.00 0~3096 00049t H~l no.N SURGEONS X-lAHG~ ',.e8 OSJU6 e,,847t 'ISS -.----""8 PRC::-P!ll6 6.0U 053096 060,.t ?55 Tuac NO'l-CONOUCTTVC 12' 6.00 0~30;6 O~049t "SS ~I'ONGE LArAROTr..V 18 . 18 ll:OO-O"O'UrObOHt''lB. . ~-te-f1lC~UN&:e-At."""flOYI{:'. .... e.oo 033006 06U4ge ~ss SPCNGE LAPAROrc~Y 18 . 18 8.00 053096 ~6049t ?5l COVER TABLE '.88 IS3+906-(tH*96 n$!. ~TCRILC HUt ABTTlC l)Olfl ~.OO 05309(, ~60'9. 'no SYHING~ InRTGAYl~G ~ULR TV 8.00 055000 060496 R~6 BA~OAGE KF.~lU DRESSING S.II 1~3I71. atOri6.~Sbu_..'''-'.''-N)S IRRI-tr..-a&lii:f-il'iO-I4l-Z .... 5.00 053096 060400 H56 SOLUTION BElAD1Nr. 4 02 l'.OO 053096 06049& 056 PAD ELECTRODE PATIENT RETU ~.II 113'::. e:....fJ6 Ill." -~"'lAR (tIS' St:~llt,. I~.OO 05H;6 ~L0490 ';51, STOCKINETH 0" 5TtRlLE ..00 053016 060.96 ~\6 'IF'DLF. GUAkO tCUhT l200 e..Oo-eS3v~6 060...;6 "56 ..-.----oAUDJ.&C lleRl] II BffC&~It.& ~.OO 0530.0 060~~6 q56 SCRI6E SKIN 5.00 0002)0 060l9t ~21 eANDAGE CONFORM J. KL1~G 1l.U Bun ~b+4'Hr"'(.~ eAijDAvE-tt€RI:IX DRf~5ING 8.00 060H6 0.06~h Ill~ UANOAGf KEHLIX CRESSING 24.00060596 060HO kU HANOAGf ~ENLlK DRESSING !-.DO'OSM96. O~JO~6-fi'H" t.t' JRJrI&. BtHTlt. 1U,8 'l S.OO OlJ096 060<96 R", NS5 IRRIG. BOTTLE 1000 I<L 7,00 052796 0\2966 (10 1~IF(f CHr. PHLEBOTOMY FeE "~~.-O~i1~6 OH99~'JO IIllTFCC tilE nrT.tB9L1( :'"'UH II r 14.00 ~~~196 052996 tTO lNTrCE CHG SprCIAL HANDll~G 1.00 0\2a~0 OH996 t II I ~TFCl eHG rllLE60TOliY fEC 11.9C 8SZ19A..IlS2996 tlO ,..'Fef tHC~o-tV"E-'----'. "_'__"__0.._ 28.00 052196 0~l996 CIO INfFeE CRG ANTI eODY SCREEN 11.00 052796 ~H996 c: 10 1 N1FCF CHr. ~LOOO kH ".00. ""'96 O'~IU &U J.tJtrcr ern; !::TH 26.00 0521V6 OS29~6 CIO INTFef eHn CHC e.oo 0521~6 052996 .10 l'TrCf eHG ~CAN.OLOOD SI<fAR EX4HINATI 11.-90. O~~a'16 05-l~t 11 ItJTrl;C &11' 1I("'8tl..QQH~- ..---,--------. ... --....... -." .-_. ..---.-- no,) I~~'.-, !l-~~~-~~~V '.H." ow......;fV J.V'YU ',U.U'.!..' . .VJ .UH/H .F .;':1 "61\).1 '~~L l~Lr li::r\14l r'~!" "'I t!':r "'''~T'''' nCT ?~. 1?96 121-~ .A~t ~ ;." JL~T NO 11l4.,,, CII..'.r,t ') . A I I t 'I 1 ,..\,. t' ."T nl,Je J.rAYtlt~'~ htT CflC,fl 110')"'" CtiC.i :~RN'oICL.., J,.r~~ Lf" IH70.:1 .no .on .1110.00 ~'5~C ~ "~01':,*",~'---------'-'-"" o.t..:a t:LtC Tll:'l~t:: ALL t 'Ill I t'il C 1,10 ~~'V aAL 14570.0a OIS INS I.S70.0I dn C ..& iT,' ... IUiOUht ~. r ANT ~wv III PS I' '~~'_'I''''E'f''f''C ~ 'lE 5CHI f'T TON'" 170 7B~" I ~.OO S.OO OSUio 051596 "40 I" AI:tHS l'~H~LI~~ CANNUL ~H'1ti~'9---t 8.B( a.e. nZn4-1l528Y6 ,...C Sf,f-.I\ S8L SCeeflS...JaAl-f1C3 !TO 5:Ul I l'.JO Z4.00 J~279. 0S;Y91 R)Y 1030 .L IV SCLI.iTIQ- ANCSTH !IO aOH9 1 14.00 I~.OO 05/TH O.1YY~ ~5~ SC~SC~ ~SO~H'GEAL TE~PATuR :Ia I1$Jl 1 I~.O~ '-IS.DO'OHH<r-tT~'16-fl7t---_.... lU~tsAlfN SU"~'V/"'AI.vr'"-''-''-'''-''' !IO 1"00 1 11.0l lJ.OO 0S27P6 On990 liS' TUDE ENOO 7.0 ~N CUFFEe !TO 79"1 I 14.CO I_.CO 052796 C..lY96 1159 ~lYL[l1[ 14 FA. III IISSE I .. Z~.OO '7i;OO' oi'/PlJ-b 1H-9%-A51 --C;'''C-III~''~DULr' ,70 1020' I 14,00 h.CO 052796 0529~6 AS9 ".O:~A~r.E H~AT ~OIST PHL !IO 'HOb 1 11.01 11.00 OS2796 115Z~'n R~9 "AS~ ANESTHF.51A $1 6 Ln AD !-H"",..16.--t S.oe s,.ee 8:Hn~ JSZ7~~ A'i1 (;Alt1Flf-k.Sue-H~~R. .-.-...-- "0 19444 I 5.00 ~.OO 0~1796 0S299b H~9 uI,UUER SuClICN I~STAU"EH 170 800n I t.GO 8.00 OH79f, t\2991. R~9 TU9f ~ON-CONDUCTlVE 12' :78 TVUJ I"' 1.0U ~.oO-tit-?...<r-t~.q.,...~5' '-'-{'ANN{'~StK:HON.'1500"L" . /10 Id2'5 1 8.00 ..6U U527~b 1151096 Reo IV Sr.L 5H CONTINU~-HO 110 razoY I ~.DO ~.~O OH796 C'~~~b II~O ~,T IV ~Ol SCCCNOARY NCO ~;B 'bl1':! J.8t-'''-''-6~O''''O)Ui6 OS!OQ6 ff('lO .-5pe!~6( 4)U L,l.R6C rAEj( [Ii 3 ...-.. !73 19125 I 1~.00 14.00 052796 aO~96 R36 PAD HEtTHOO~ P~T1thT RErU /10 11100 1 S.OO '.00 051796 060~"'6 n,~ sHAHt H20 BOTTLE HOO"L ~1'1t-1tOIU I :.10 1.00 05P'i6 0~049b A36 p~n""~fPP"'B !70 79lbO I >.00 ..OU 05219b OhOHh ~~l ~VIIIMC :AIII~ATI~G 8ULa TV /10 19912 1 ~.OO ~.~O 05119h ObO'd6 1I\^ ;PONG[ l.APAADTC..Y 18 . 1d ~...H I" - I.U $.01 aSl71. ("~,~u f,J" .- "Y~IHlIEil-!J\JE+t(-H"lhSTRU"~~ no 7d510 I d.DO 1.00 OS2796 060~06 O~6 aA~OAGf ACE 6" 170 19444 I 1.00 5.00 OH7iO 060496 HH VANUUEII SUCTlCN I~STRUNtN [fO "Dl0 J lS.1'lOo-'''--i7;''O 05l196'O!l04~" ft3~ ""U~f-l'rtA-y-e-,UH' /10 7n4S 1 11.00 11.00 0517~6 0604'16 lt3~ ~H~ GASIC AII,I 170800H I I,on ~.OO 052796 ~60~"", All PAll PRF.PPING no 1&318 1 1).111 1~.6U {I$~7V':' G.;.tt4'ib'"'....-3-6---.--"Ii)fI(IUeTlt--6..-sTEIHl:t:-................ .~ .....---.. 210 100B? I S,OO 8.00 OS2796 060496 U36 TUBE NON-CONDUCTIVE U' no 71515 2 5.00 16.00 0"706 060Hb 1/ H ~ANOAGE ~EULl X DRH51NO lT~ T331'-' l"~."'--"ft~ II.U e;(r~.. co:.8J.tj) ,.).. e... .BAae KrfH.lll eftCS3I'Ht---~-..- 1I0 IYOA~ I II.tO H.OO 05H96 0604?t U36 PC!; F.L[CTROSUA~IOL "BeVI. 210 I9IJt I ..GO ~.OO 0511'h ;(04?6 ':~6 NlEJLE GUAnO CCUNT UOO l10.-H+tt-~.. A:CO.... '.~~""'b-ot1D."9rr"l.,t. .':iral~8r LAlrltl18yt/l, 18 .. 18 210 19900 I 'O.UO 20.00 OS2796 3DO~9~ U36 SIIEET LINB 210 7&50~ 1 5.00 5.00 052796 000,"6 R36 aA~OAGE ACE '" liS Have 1 .\.~O ~iOo'OH"'6 ~^0~"'^'1I", - "SCWTA!'"jl("N' ..---. ... 270 rH2S: 1.00 ~,OO OS2796 060~9~ w.\~ SOLuTION BCTlOINE 4 01 00 1~~05 I ..00 ~.OO 0527H 060~Y6 HHo (A~~ISTfH ~uCT10W 5000 ~L i!H-'7HOS-. I ;'''10-- A." H""" 80UY6-R30 ,A~NISTEII S%T101. Jllt-t+t-. 270 71253 I 3.00 :0.00 OH896 OSZn6 1170 IV ~Ol 5eT YHTED INJ SITE 210 78515 I ~.CO 5.00 U52896 OH99b 117. "AMIAOE ~EHL U ORESSING H&-'18S1.s._..~- 8.00 '6.88 n:-,J.\ H~8\t~ 11-91 a4~DAGE-KEALl'- 91lC~SltJt HO HIlS I .'.00 ..OU 05H06 011096 "YI HANOA[,( KERll X ORHSING 2IJ 7SIH I ~,OO 6.00 05.9.6 OIH'b 1101 IV ~UL DEI CONTINUE-nO ~7-.,a.-~-..O.OO. 10.0~ OUOYb 0~.\19A NOh ..____.IV_A~_VAL-\le-..5ET .. ---. 118S 0/2 U96 t.PB0610.1 "AT1e~T ~C l?~1,~42 -' AIIENT "AlIl OANWELL, JA~.S LEE u\o .0)1."" .. t'",ll" ...1" . ""ft. \ony .,, "~UU[l1 SO VICOl 2 S.OO ~YC1. . 2;30 '50 ACEO} ~ 1.00 :50 PRC51 -, 4_ 00 ~'" "CI~3 . I .. 1.GG - !SO PET15 I 6.00 !50 BEN73 -) 21.00 ~ '~J'j}. ! s..oe !SO LUBIO I 2.00 1S0 PC 175 I 6.00 ~-f-DI-' ~..oo :'0 VICOI I 5.00 ~s 0 tlPOI I 1'.00 :a (1 POl C 1 s. JO !SO DOCD1 I Z.OO :50 ClpOI I 1~.00 .S8 eIfel I 1 S. 81 !50 DOCOI I Z.OO !50 CIPOI -I 1).00 !iO tlre, I I s. ee no PET!, I ~.DO ISO VltDI I 5.00 :1' f..l") 1 +".00 !50 I'ftlS 1 6.00 ISO VICOI I 5.00 ,~B tIf'Ol 1 1 $.00 1)0 CIP'Z I I ~.OO ISO OOCOI I 1.00 ,sa tlf81 -I 1 ~. eo 250 CIPOZ -I 15.CO Z'O DOCOI -1 Z.OO lS8 eUJTf I ,,.';GO Zld DOlH Z 1.1.00 lIB B03H I 51.00 li'tl~.~---I"- ~).60 258 80Hl I 1l.00 2U B0312 l H.OO 116 16lt'fl-" 1 ' B. et- 210 78113 I ';.00 110 18116 I 1:1.0J lf8 18i-ltS 3.! a 210 19000 ~.OO 210 79104 S.OG lre fsrn ' ~.o.... . 2/0 lbHO 10.00 210 19095 ~.oo If,O r 1311 ;.80-. . I~~:l-tl(-~Q~-~~qo UCt ~J..~o lU:U~ "D.UU~ r.lu L' ~~ I :L, ~''',"'' AL r:;H.T 11'1 n:H .""St(fI eCT 2', I09~ Il:'d PAGe 3 CI;U;C'i"!\ API OJE P.;1"'T~ ~rr C~6S "CUll CUGS p"rv BAL O/S INS 14510.03 .OC .00 3130.00 IIHO.09 14510.0& ---.- ...---.. ,----.." U\'(I CU:C T d'H.1C....ll1 PlLleO oil,).., L^1'AIH SR';."r-r5~-01 !JAY r,-""'!It1'p-:et l)CSCRJ,"I!ul'l 10.01 UbU396 ObOb9t fIe INIF(e ,NG NynHotOOONC/ALETAHINOP"FN 1.00 0603Y6'Ot.Itt"t"~lC tNTFC! t:1V ,Y'1)qOGC'lo. '!Ih~^.~' ,..C.N. ',CO U60396 3^,C(~' ~IO !NTPCt r.~G ACtTA.I~OPNtNleoc 30 "G -16.00 060396 G~0791 Cll INIFti CIIG ~IIO~fTNAlINe I~JECTICH ~O~ '~6 lua4'6-0~06V" "11-'., r', C C.,h At~tl J\-lf"'l6f1ULI.1COI:JO ....rr--.--. 6.00060496 ObO(96 PII I~TFCE CH5 PFTRDLATUH DnESSI~G 5..9" -21.00060196 OA0696 PII INTFC~ eNr, BENZOIN COIIP T1NCTU~E 12011 1'. 0 6"OI\O'V6.~~:'a!l1} f I I-f.t:tFt"F.' (I.a 1" ,,"{)enDa~ fA" t ",..,lnOfl H[,. 2.00 CbO~96 ObOb96 Pll INTFcr e~G LUanJe~NT, 5TERTLC 6,OU Ob0496 060'-YO ~II INTece CNG PET"CLA1UIl DRESSING 5"X9" -16..00 o~e4Wu o,.l)t9~-"'I.l Il,T,.t~ CHG-MY(:)I\OCODO'-t,,,C.C1AtlINOPH!N 10.00 ObOl96 Ob0600 PI1 INTFcr CNO HYOROCODONE/ACETAIIINCPNEN 30.00 060496 D60796 =:, INTrCE rNo CIPROFLDXACIN TABLET 2~01lG .. '~.lJU Ilba496' 0607Q6'c-!O 11.Tfer CH(" CIPAorLox.\eJ/J Hd\lEl ..,-,...--. -"~ 4.00060496 ObD7"t C;O TNTrce CIIG OOCUSAH SODI'" CAPSULE 30.QO Ob0496 O~O/'t CIJ I~TFCE CHG CIPhUFLO.ACIN TABLET l'O~G '50..CJo-C"U~"b e~91'ib"IO INTler ene, eIP/ilaFtOlAC1r. I"'tsLl.T '.CO 060496 ObC7YO CIO I HTFCe CliO !lOC~SAIE SOD I U~ CAPSULE -IS.OO 060~Y~ 06019t CII INTFC~ CliO elPHOFLDXACIN TABLET lSO~G thOO 06DIY 6 '&lr.H~f.H-f NTFn r~" .el PA BrLBHC 111 .TABU'..-----.----. ~.OO 060\96 060b~t P!~ IN'FC~ CIIG PETRCLATUII ORE5SING 5"XY. lo.on 0605ib 0~069/ ~!2 INTFef clla HYDRCCOOONE/AC~TA~INOPNEN -b.1e HOS96 06D09~ "!2-t-frTi'~G.f'CTRCLATlItI II~eSSll.6 S"r.~. 6.00060596000691 "I: I"Tree CIIG PEIRCLATU" DRESSING S"X9" 10.00 060596 060696 Pl2 INTFCF r~G H1CACCODONE/ACETAHINOPNf~ 'a..08 O~"96 0607Qt.'-(.1' l'ilIff' "1& E141ROFlOX"CIU T"'SltT iSBf'G' .~D.UD 06U596 0601.,. t1: I NTrCE C,IG CI ppnFLOUCIN TAOLET 4.00 0/,050/, 0~019. t1: INTFCt "'IG OOCUSATIi 50DIU~ CAPSULE )h'O-tI146i" <16811: Cfoi-i+"..Ct CHG elfftSrL8XACl:j HnJL~T--liD"8 -~O.OO 060696 060196 CI2 !NTFCf C"G CIPROFLOXAeIN TABLET -4.00 06069b Ob079~ t 12 I NTFcr c~a DCCUSATC SOOIU~ CAPSULE ,H.t8 t'5l19~ c.,~~tt~ ._- IV SOl.-t"Cf,.\l[t RlI-l8CR9- 10 '6.00 05H96 .,/b06 H.O IV SOL SOU CHL 0.9% SO "L 31.00 052796 JS?a96 RIO IV SOL LACTATEC AI~OCR5 10 "'.Zl.I1G a~.:n[, DS2d'9-&-fto41I-.--. [J StSL S8e Citt.-O;,*".,O 1.1.. ?1.00 OS2796 OS}09b REO IV SOL DEXTROSE tNJ S' 64.00 052796 J~t09. RBO IV SOL LACTATEC RI~GENS 10 " 1,.tIII 'SC'1Q a,H~Y:' ftJ. Ph\3163ftL IAflJ8ATICH '100'0-...' .....- ,,00 05Z?9. OSl7?6 PliO IV PUMP INFUSION SEAVICf I Ill.CQ 05/19. 051796 PNO PUIIP PLeXIPuL5t IW PADS a~oo CH~~[' O:'f;j16-f1V~ h-50l 3[1 Cal.llr.tfE: FtC-' 8.00 051796 ~S1996 R~8 l4G ICE LARGE CI5P 1.00 052196 05B9t R40 CANNULA NASAL OXYGEN ::1.08 O-Sfl'90 0,..,...." ~u(t , .'IfT J. SOL'SECCNCtU'", r rt! 10.00 052796 017'90 n40 IV ADMIN CNECK YALVf SET ~.OO 051796 0)1~9~ W.O LINEN SAVERS Pble S.~ll DHn~ BSta'b R~O -- Uftl~"'.. Ol~f COMMONWEALTH OF PENNSYLVANIA BUREAU OF COMPLIANCE DEPARTMENT OF REVENUE PO BOX 280948 HARRISBURG PA 17128-0948 4/15/2013 REV-1328 CH(05-11)DOCEXEC(N) COMMONWEALTH OF PENNSYLVANIA AUTHORITY TO DELETE ONE DEPARTMENT OF REVENUE NAME FROM A FILED LIEN V. COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, RODGER L SHUGHART PENNSYLVANIA PO BOX 262 CARLISLE PA 17013-0262 Docket Number 97-3067 Date Filed JUN 10 1997 Class of Tax ANNUAL Account Number 209-36-1602 Assessment Number TO THE PROTHONOTARY OF SAID COURT: The Commonwealth of Pennsylvania, Department of Revenue,the Plaintiff in the above action, requests that satisfaction be entered upon the records of the above-captioned lien/judgment note for CATHY A SHUGHART only. You,the Prothonotary of said court, upon receipt of your costs of satisfaction, are hereby authorized and empowered, in the name and stead of the plaintiff,to enter satisfaction upon the record of the defendant only,to all intents and purposes,as we could were we present in person to do so. For doing so,this shall be your sufficient warrant of authority. IN TESTIMONY WHEREOF,there is hereunto affixed the Seal of the Department of Revenue, Commonwealth of Pennsylvania,this 15th day of April,2013. mco =M 5 "n;= r ;U=1 < 6-m Daniel Meuser 3>c--,) C:) 6 ; Secretary of Revenue C_ Mary Hubler Director, Bureau of Compliance Och umllab IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA , 97-3067 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE V. RODGER L SHUGHART AUTHORITY TO SATISFY t