HomeMy WebLinkAbout07-16-07
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15056051058
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REV-1500 EX (06-O5)
PA Department of Revenue *'
Bureau of Individual Taxes
PO BOX 280601
Harrisburg. PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
r~~~~!.~~~~!'!~~Et~"'''-''''''-''''''''''''-''''''''''''''j Date of Death
INHERITANCE TAX RETURN
RESIDENT DECEDENT
00947
Date of Birth
; 1 84-38-2284
1 0/16/2006
1 0/09/1954
Rush
Decedent's First Name
Decedent's Last Name
Virginia
MI
j.-..'.....-i
1_~J
(If Applicable) Enter Surviving Spouse's Information Below
~~~~Et:!~_s.t..~~':r!~......_____.._.__.._._____...__.._.._......_.__..
: !
Suffix
Spouse's First Name
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MI
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,~p()l!~El.~...~()~!lJl.~El<::.l!~ty!'!l!I11~l:lr.
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
~ 1. Original Retum c::>
2. Supplemental Retum
c::>
3. Remainder Retum (date of death
prior to 12-13-82)
5. Federal Estate Tax Retum Required
c::> 4. Limited Estate
c::> 4a. Future Interast Compromise (date of
death after 12-12-82)
c::> 7. Decedent Maintained a LMng Trust
(Attach Copy ofTrust)
c::> 10. Spousal Poverty Credit (date of death c::> 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.~Y!i.~!!I~p.~.~~.!.~~'!!~r.."___...._._.........""_
c::>
ca;J 6. Decedent Died Testate
(Attach Copy of Will)
c::> 9. Litigation Proceeds Received
8. Total Number of Safe Deposit Boxes
ZIP Code
! (717) 249-1177 I'.) I
..............--.....-........................."......................---..........c:::::J......................" . ,..
REGISTERe.. ~LSUSE~ i?,J CS
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! OA~FILED 1
.---..-..---....-.--.-.----------0--.
Stephanie Chertok. Esq.
Rrm Name (If Applicable)
r__....~_._...~.,.'...HH_._...__...H__........_..._._.....m..__..._...._
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.,.........._.._..._...~..,.............._..._....__..~.,..........~._..._......._......H'_'-,........_..__...._..~..~_.....,___..~.._,..._.._...~..._.
;
First line of address
61 West Louther Street
or Post Office
17013
Correspondent's e-mail address:
Under penaltfes of perjury. I declare that I have examined this retum, Including accompanying schedules end statements. and to the best of my knowledge end belief.
it is true, correct and complete. Declaratfon of preparer other than the personal representative Is based on ell intonnetlon of which preperer has any knowledge.
SIGNA! OF IlI'mp~R FILING RETURN pATE
~ '7//&' c
A RES .1 /7^- ^
01 vvEs;r fnh1/ef2 Sr: UIfZ USLE ,-->.4 /)ots
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
L
15056051058
Side 1
15056051058
--.J
dtll
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15056052059
REV-1500 EX
p.f3C8l:I.':!:l!:!_~~~~~_~':~~-"-~_~~.I11!>llE_,_...,
184-38-2284
Decedent's Neme:
Virginia
L Rush
RECAPITULATION
1. Real estate (Schedule A). ............................................ 1.
149,900.00
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. I
J"
131,193.19 \
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . ., 5.
~--------"'""'._-~. +
\
6. Jointly Owned Property (Schedule F) c:::> Separate Billing Requested . . . . . ., 6. I
7. Inter..Vivos Transfers & Miscellaneous Non-Probate Property ~
(Schedule G) c::> Separate Billing Requested... . . . ., 7.!
8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 8. I
"i
281,093.19 i
31,419.451
9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . ., 9.!
--""-'1
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . .. . . . . . . . . 10.
i-w-___"....-
61,289.93 !
92,709.38 I
11. Total Deductions {total Lines 9 & 10)...................................11.1
--{
;.....-
12. Net Value of Estate (Line 8 minus Line 11) .. . .. . . .. .. . ... .. . ..... .. . . . .. 12. I
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J) .. . . . . .. . . . . . . .. . . . . . . . . 13.
~=
188,383.81 ;
.~
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
(e)(1.2) X .0_
16. Amount of Line 14 taxable
at lineal rate X.O 45 20,000.00
17. Amount of Line 14 taxable
at sibling rate X .12 168,383.81
18. Amount of Line 14 taxable
at collateral rate X .15
188,383.81 !
15.
16.
900.00
20,206.06
17.
18.
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . ., . ., . ., ... . . .,. . . . . . . . . . .... . . .. . . . 19.
21,106.06
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
c:::>
15056052059
Side 2
15056052059
--1
L
REV-\100 EX Page 3
, Decedent's Complete Address:
DECEDENTS NAME
Virginia L Rush
STREET ADDRESS
20 Hillside Circle
L~2J~!~I~:~!r M
DECEDENl'S SOCIAL SECURITY NUMBER
184-38-2284
CITY
Camp Hill
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. I nterestlPenalty if applicable
D. Interest
E. Penalty
TotallnterestlPenalty ( D + E ) (3)
4. 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. (4)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(5)
(SA)
(58)
3,099.32
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.
3,099.32
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; .......................................................................................... D Ii]
b. retain the right to designate who shall use the property transferred or its income; ............................................ D Ii]
c. retain a reversionary interest; or.......................................................................................................................... D iii
d. receive the promise for life of either payments, benefits or care? ...................................................................... D Iil
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D Ii]
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D Ii]
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ Ii] 0
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 transfers to or for the use of the surviving spouse
is three (3) percent [72 P.S. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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, an
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. ~9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. 99116(a)(1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
-,
REV-1502 EX+ (6-9.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Virginia L. Rush
SCHEDULE A
REAL ESTATE
FILE NUMBER
00947
All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value Is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowladge of the relevant facts.
Real property which Is Jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
Hillside Circle, Wormleysburg, Pennsylvania
VAlUE AT DATE
OF DEATH
149,900.00
TOTAL (Also enter on line 1, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
149.900.00
~
~
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
A. HUD.1 UNIFORM SETTLEMENT STATEMENT
B. Type of Loan
1.[ J FHA 2.[ J FmHA 3.[] Conv. Unins. 6. File Number: 7. Loan Number:
4.[ J VA 5.[] Conv. Ins. 105.926 N/A
C. NOTE: This form furnishes a statement of settlement costs. Amounts paid to and by the settlement agent are shown. Items marked
"(p.o.c.)" were paid outside the closing; they Bre shown for informational purposes and Bre not included in the totals.
D. Name & Address of Borrower: E. Name, Address & TIN of Seller: F. Name & Address of Lender.
Charles F. Schubert, Sr. & Mary E. Schubert Estate of Virginia L. Rush N/A
841 Hillside Drive 20 Hillside Circle
Camp Hill, PA. Wormleysburg
G. Property Location: TIN of Seller:
20 Hillside Circle Place of Settlement
Wormleysburg. PA 139 W. High Street
Carlisle, Pennsylvania 17013 I. Settlement Date:
K. Summary of Seller's Transaction
400. Gross Amount Due to Seller'
(OMB # 2502.0265)
8. Mortgage Insurance Case Number:
, PA
H. Settlement Agent:
Anthony L. DeLuca, Esquire
J. Summary of Borrower's Transaction
100. Gross Amount Due from Borrower:
November 30, 2006
101. Contract sales price $149~00.00 401. Contract sales price $149,900.00
102. Personal Property 402. Personal Property
103. Borrower's settlement charges (line 1400) 2,648.25 403.
104. 404.
105. 405.
Adjustments for Items paid by seller In advance Adjustments for Items paid by seller In advance
106. Cityltown taxes 11/30/2006 to 12/31/2006 42.26 406. Cityltown taxes 11/3012006 to 1213112006 42.26
107. County taxes 11/30/2006 to 12131/2006 45.86 407. County taxes 1113012006 to 1213112006 45.86
108. Assessments to 408. Assessments to
109. School taxes 11130/2006 to 06/30/2007 959.32 409. School taxes 11/30/2006 to 0613012007 959.32
110. 410.
111. 411.
112. 412.
113. 413.
120. Gross Amount Due from Borrower $153,595.69 420. Gross Amount Due to Seller $150,947.44
200. Amounts Paid by or In Behalf of Borrower: 500. Reductions In Amount Due to Seller:
201. Deposits or earnest money $5.000.00 501. Excess deposit (see instructions)
202. Principal amount of new loan(s) 502. Settlement charges to seller (line 1400) $11,546.07
203. Existing loan{s) taken subject to ~03. Existing loan(s) taken subject to
204. 504. Payoff of first mortgage To: FNCB 41.144.98
205. 505. Payoff of second mortgage
206. 506.
207. 507.
208. 508.
209. 509.
Adjustments for Items unpaid by seller Adjustments for Items unpaid by seller
210. Cityltown taxes to 510. Cityltown taxes to
211. County taxes to 511. County taxes to
212. Assessments to 512. Assessments to
213. to 513. to
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219 519.
220. Total Paid Byltor Borrower $5,000.00 520. Total Reduction Amount Due Seller $52,691.05
300. Cash at Settlement Fromfto Borrower 600. Cash at Settlement Tolfrom Seller
301. Gross amount due from borrower (line 120) $153,595.69 601. Gross amount due to seller (line 420) $150,947.44
302. Less amounts paid bylfor borrower (line 220) 5,000.00 602. Less reductions in amount due seller (line 520) 52,691.05
303. Cash Irxll from II" 11 to Borrower $148,595.69 603. Cash rxl to II" 11 from Seller $98,256.39
Substitute Form 1099 Seller Statement
The information in Blocks E, G, H. I & line 401 (or, if line 401 is aslerisked, line 403 and 404) is important tax information and is being
furnished to the Internal Revenue Service. If you are required to file a relurn, a sanction will be imposed on you if this item is required to be
reported and the IRS determines that it has not been reported. If this reai estate is 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 andlor Schedule D (Form 1040). You are required to provide the Settlement Agent (named above) with your correct
taxpayer Identification number. If you do not provide the Settlement Agent with your taxpayer Identification number, you may be subject 10
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.
(Seller)
(Seller)
Estate of Virginia I. Rush
Estale of Virginia L. Rush
~
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L. Settlement Charaes
700. Total Sales/Broker's Commission: (based on price) $149.900.00 @ 6 % Paid from Paid from
Division of Commission Cline 7001 as follows: Borrower's Seller's
701. $4,522.00 To; Georoe L. Ebener & Associates Funds at Funds at
702. $4,472.00 To: M.C. Walker Realty Settlement Settlement
703. Commission paid at Settlement $B,994.00
704.
800. Items Payable In Connection with Loan
B01. Loan Oriainatian Fee
B02. Loan Discount
B03. Aooraisal Fee
B04. Credit Reoart
B05. Lender's Insoection Fee
B06. Mortoaae Insurance AODlicatian Fee
B07.
BOB.
809.
810.
Bl1.
B12.
813.
814.
900. Items Required bv lender to Be Paid in Advance
901. Interest from I I to I I (/j) $ I I per day
902. Mortoaae Insurance Premium for
903. Hazard Insurance Premium for
904.
905.
1000. Reserves Deooslted wIth lender
1001. Hazard insurance months $ oer month
1002. Mortaaoe insurance months $ per month
1003. Citv orooertv taxes months $ per month
1004. County orooertv taxes months $ per month
1005. Annual assessments months $ per month
1006. months $ per month
1007.
1008.
1009. Aoareoate Accountina Adiustment
1100. TItle Charaes
1101. SelllemenVclosina fee
1102. AbstracVtitle search
1103. Tille examination
1104. Title insurance binder
1105. Document preparation
1106. Notarv fees To: Notary Public 2.00
1107. Allomev's fees
(includes above item numbers
1108. Tille insurance To; A.L. DeLuca. Esa. Agent for Security Title Guarantee Coro. of Baltimore 1,108.75
(includes above item numbers 1101,1102,1103,1104
1109. Lender's coveraae
1110. Owner's coveraoe. $149,900.00
1111.
1112.
1113.
1200. Government Recording and Transfer Charaes
1201. Reeordina fees: Deed 3B.50 Mortoaoe Release 38.50
1202. Citv/countv tax/stamos: Deed 1,499.00 Mortoaoe 1,499.00
1203. State tax/stamos; Deed 1,499.00 Mortoaoe 1,499.00
1204.
1205.
1206.
1300. Additional Settlement Charaes
1301. Survev
1302. Pest Insaeetion
1303. Ovemioht Mailino To; Anthony L. DeLuca. Esquire 25.00
1304. County, Library and Borouoh Taxes To: William A. O'Donnell, Tax Collector 925.03
1305. Water bill To: Pennsvlvania American Water 103.04
1306.
1307.
130B.
1400. Total Settlement Charaes (This Number Transfers to Lines 103 & 502 Above) $2.648.25 $11,546.07
OE~'_
I have s;te;ully reviewed the HUD.' Settlement Statement and to the best or my n dge a . beli If,J is a UE ~ceurate statement or all receipts and
7.?/ mn"/". account or by me in this transaction. I rurther certify he . HUD.' Settlement Statement.
. .... .,.- --- Seller V ., ,...., Borrower
r::?"'jV- r I '!!S[ate u. .~.' s <:::;f), a.,,-Chaa Sr. ~ !l3; rt, Sri 7.
Seller ~ . Borrower
- , .. !l, Ma.r:y'E. Schubert
To the best or my knowledge the HUD-' Settlement Statement which I have prepared is true nd accurate account of the funds which were received and
settlement or this transaction.
Settlement Agent November 29, 2006 Date
. DeLuca, Esquire
ake ,... sllleme~llo lhe Unlled S1118. on InlS Dr any Olner Slfnll", lorm Penallltts upon c:onYicllOn can Include I fine Ind impnsonment For delails see: Tille 18 U 5
.. DISBURSEMENT REPORT
~
Name and Address of Borrower:
Charles F. Schubert, Sr. and Mary E. Schubert
File Number:
105-926
Contract Sales Price:
.Name and Address of Seller:
. Estate of Virginia L. Rush
20 Hillside Circle
Wormleysburg
$149,900.00
PA
Settlement Date:
November 30, 2006
PROCEEDS
201.
202.
Item
Proceeds from Bu r(s)
Deposits or earnest money
Principal amount of new loan(s)
Entity
Charles F. Schubert, Sr. and Mary E. Schubert
Amount
$148,595.69
5,000.00
$ 000
TOTAL:
$153,595.69
DISBURSEMENTS
Item
Entity
Amount
Disbursements to Seller(s) to Estate of Virginia Rush $98,256.39
Payoff of first mortgage to FNCB 41,144.98
Commission paid at Settlement to George L. Ebener & Associates 4,522.00
Commission paid at Settlement to M.C. Walker Realty 4,472.00
Notary fees to Notary Public 2.00
Tille insurance to A.l. DeLuca, Esq. Agent for Security Title 1,108.75
Guarantee Corp. of Baltimore
Deed to Recorder of Deeds 38.50
City/county tax/stamps: to Recorder of Deeds 1,499.00
State tax/stamps: to Recorder of Deeds 1,499.00
Ovemight Mailing to Anthony L. DeLuca, Esquire 25.00
County, Library and Borough Taxes to William A. O'Donnell, Tax Collector 925.03
Water bill to Pennsylvania American Water 103.04
to TOTAL: $153,595.69
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REV-1508 EX+ (6-98) *'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Virginia L. Rush
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
1. PSECU Regular Share Account # 0450116553
;PSECU Checking Account # 0450116553
Bank Savings Account # 0626796627
; Harrisburg Radio Lab Store Credit
TOTAL (Also enter on line 5, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
FILE NUMBER
00947
VALUE AT DATE
OF DEATH
513.35
4,162.77
103,531.01
3,686.06
18,500.00
800.00
Commerce
"Bank
Commerce Bank/Harrisburg N.A.
3801 Paxton Street
. Harrisburg, PA "111
888-937-0004
STATEMENT DATE
VIRGINIA L RUSH
20 HILLSIDE CIRCLE
CAMP HILL PA 17011
09/30/06
0626796627
ACCOUNT NO.
*** SAVINGS *** PREMIER SAVINGS
ACCOUNT NUMBER 0626796627
PREVIOUS STATEMENT BALANCE AS OF 06/30/06 ........ ................
PLUS 1 DEPOSITS AND OTHER CREDITS ...... .............
LESS 0 WITHDRAWALS AND OTHER DEBITS ................
CURRENT STATEMENT BALANCE AS OF 09/30/06 .......... ........... ....
NUMBER OF DAYS IN THIS STATEMENT PERIOD 92
BEGINNING RATE
CYCLE-051
2.47200
102,887.96
643.05
.00
103,531.01
*** SAVINGS ACCOUNT TRANSACTIONS ***
DATE DESCRIPTION
09/30 INTEREST PAYMENT
DEBITS
CREDITS
643.05
-----------------------------------------------------------------------------------
*** BALANCE BY DATE ***
06/30 102,887.96 09/30
103,531. 01
PAYER FEDERAL ID NUMBER
INTEREST PAID YEAR TO DATE
23-2324730
1,427.42
*** INTEREST EARNED THIS STATEMENT PERIOD
DAYS IN PERIOD . ..~.....................
INTEREST EARNED ........................
ANNUAL PERCENTAGE YIELD EARNED (APY)....
***
92
643.05
2.50%
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Pennsylvania Slole Employees Credit Union
II I
P.O. Box 67013 (717) 234-8484 (Harrisburg)
Harrisburg, PA 17106-7013 (800) 237-7328 (Nationwide)
website - http://www.psecu.com
TALK TO US FOR ALL YOUR
LOAN NEEDS! AUTOS & TRUCKS,
MORTGAGES, PERSONAL & MORE!
WWW.PSECU.COM OR CALL 800.LOAN.555
EQUAL OPPORTUNITY LENDER
II J 11111111111111111111111111111111111111111111I1111I111111111
VIRGINIA L RUSH
20 HILLSIDE CIR
CAMP HILL PA 17011-1818
JOINT ONNER
PAGE 1
" " "'"
P.O. Box 67013 (717) 234-8484 (Harrisburg)
Hmrisburg, PA 17106-7013 (800) 237-7328 (Nationwide)
WebS[fe - http://www.psecu.com
CONSOLIDATE HOLIDAY DEBT & PAY
JUST 4.9% ANNUAL PERCENTAGE RATE!
USE THE VISA~ BALANCE TRANSFER
OPTION IN PSECU_HOHE~ TO HOVE
BALANCES TO YOUR CAPITOL CARD~.
VIRGINIA L RUSH
JOINT ONNER
PAGE :2
0202 300 054 4 10
2002678
..
The HarrisbLr-g .. .
RADIO LAB. .
DISTRIBUTORS OF
CS'S .T.V:S. STEREO .VIDEO
19TH 1& PAXTON STS.
MAILING ADDRESS
909 SOUTH 19TH ST
HARRISBURG, PA 17104
PHONE (717) 236-9048
-ro ~ E S~~-rt 0 ~ V fU!rv~ ~uJ ft
U fQ.,G.,\,tJlJ\- {LUJ rt I+A-S AJJ rr 800.00
Cg &91t LD l-tit L~ Ur WJro L~ ·
CA~ ~lC{JfD ~JL j;N <;to(LLcfl€~rf-
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YOU'LL ALWAY
S DO BETTER AT THE RADIO LAB
Ewing Brothers Funeral Home, Inc.
630 South Hanover St.; Carlisle, PA 17013 Since 1853
Phone: ~717)243-2421 Fax: (717)243-7553 E-Mail: EwingBrothers@aol.com
STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED
Char3es are only tor those items that you selected or that are required. If we are required by law or by a cemetery or a crematory to lIse any items
we will explain the reasons in writing below. If you selected a funeral that may require embalming, such as a funeral with viewing, you may have to pay for '
embalmi.ng. YOll,do not ~ave to pay for embalming YOll did not approve if you selected arrangements such as cremation or immediate burial. If we charged for
embalmmg we will explom why below.
For the Service of: Virginia L. "Gini" Rush Date of Death October 16, 2006
Charge to: Charles Anthony Washington 245 E. Louther Sl. Carlisle
Name Address
Steven A. Ewing, Supervisor
Seymour A. Ewing, F.D.
William M. Ewing, F.D.
City
PA
State
$ -0-
$ -0-
$ -0-
TOTAL MERCHANDISE SELECTED........... B $
C. SPECIAL CHARGES
Forwarding of remains to
(Funeral Home)
Immediate Burial. . . . . . . . . . . . . . . . . . . $ -0-
Direct Cremation. . . . . . . . . . . . . . . . . . $ -o-
S -0-
C$
A. CHARGE FOR SERVICES SELECTE . Traditional Package Itemized Services
1. PROFESSIONAL SERVICES
Services of Funeral Director/Staff. . . . . . . . . .$ 3,695.00
Embalming . , . . . . . . . . . . . . . . . . . . . . . . . . .$. -0-
Other preparation of body
Other Clothino
$
$
Cremation Urn. . . . . . . . . . . . . . . . . . . . .$
(Description)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ -0-
SUB-TOTAL OF PROFESSIONAL SERViCES..... ..... A1 $
3,695.00
2. FACILITIES AND SERVICES
Use of facilities and services for
Viewing (VisitationlWake). . . . . . . . . . . . . . . ., -0-
Use of facilities and services for
Funeral Ceremony. . . . . . . . . . . . . . . . . . . . . $ . -0-
Use of facilities and services for
Memorial Service . . . . . . . . . . . . . . . . . . . . . . $ . . -0-
Use of equipment and services for
Graveside Service. . . . . . . . . . . . . . . . . . . . . ., . . -0-
Other use of facilities
(Funeral Home)
ReceiVing of remains from
SUB-TOTAL OF SPECIAL CHARGES. . . . . . . . . .
D. CASH ADVANCED:
Opening Grave (EstimateJ. . . . . . . . . . . .$
Cemetery Equipment. . . . . . . . . . . . . . .$
Lot and Deed. . . . . . . . . . . . . . . . . . . . . . $
Newspaper Notices - Out-of-town . . . . . . $
Telephone & Telegrams.... ..... .. ..$
Airfare. . . . . . . . . . . . . . . . . . . . . . . . . . . $
Clergy/Mass Offering. . .. . ....... ....$
Pallbearers. . . . . . . . . . . . . . . . . . . . . . . $
Certified Copies of the Death Certificate. $
Police :~...................$
t:J Flower~. . . , . . . . . . . . . . . . . . .$
Vault Serv ce Charge, . . . . . . '. . . . . . '. . .$
Sentinel obituary with photo (Estimate). . $
Patriot Obituarv withPhoto (Est.) $
Rock charge if any???? $
$
$
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$. -0-
SUB-TOTAL OF FACILITIES/EQUIPMENT. . . . . . . . . . . . A2 $
0.00
3. AUTOMOTIVE EQUIPMENT
Vehicle to transfer remains to Funeral
Local . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ -0-
Hearse (Casket Coach)
Local. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ -0-
Limousine
Local. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ -0-
.Family Car
Local. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ -0-
Flower car or floral disposition
Local. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ -0-
Lead car/Clergy
Local. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ -0-
Car for pallbearers
. 'I: _0_
-0-
-0-
-0-
3,990.00
$ -0-
$ -0-
-0-
750.00
-0-
-0-,
-0-
-0-
-0-
100.00
-0-
90.00
-0-
-0-
-0-
F5.00
275.00
-0-
-0-
-0-
~
" A Brenner Family
Dealership"
BRENNER
717 -697-8400
717-697-9133 FAX
BRENNERFAMILY.COM
61
MAILING ADDRESS: P.O. Box 1019
Camp Hill, PA 17001-1019
STREET ADDRESS: 6271 Carlisle Pike
Mechanicsburg, PA 17050
plG-A/;;(.-t/l ./Z/F$~ 7.s /3~:r.A-'to /T 2003, A/f~S<Y-W ~a?AA-()
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REV-1510 EX+ (6-98.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
Virginia L. Rush 00947
This schedule must be completed and filed if tha answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELAllONSHIP TO DECEDENT ANO
THE DATE OF 1RANSI'ER. ATTACH A COPY OF THE DEED FOR REAl ESTATE.
EXCLUSION
TAXABLE
VALUE
'SERS Retirement Account, March 2007, Carol L. Floyd, Sister
'SERS Retirement Account, March 2007, Anna M.lrwin, Sister
'SERS Retirement Account, March 2007, Beverly A. Murtoff, Mother
'SERS Retirement Account, March 2007, Lisa G. Puscian, Sister
!SERS Retirement Account, March 2007, James A. Rush, Brother
,SERS Retirement Account, March 2007, Jerome A. Rush, Brother
'SERS Retirement Account, March 2007, John W. Rush, Brother
SERS Retirement Account, March 2007, Mary I. Rush, Sister
'SERS Retirement Account, March 2007, Charles Anthony Washington,
, NepheYi
'SERS Retirement Account, March 2007, Fred Belardi, Friend
TOTAL (Also enter on line 7 Recapitulation) $
(If more space is needed, insert additional shaets of the same size)
..
COMMONWEALTH Of PENNSYLVANIA
STATE EMPLOYEES' RETIREMENT SYSTEM
30 NORTH THIRD STREET - SUITE 150
HARRISBURG. PENNSYLVANIA 17101-1716
TOLLfREE: 1-800-633-5461
www.sers.state.pa.us
Stephanie E. Chertok
Attorney at Law
61 West Louther Street
Carlisle, Pa. 17013-2936
Dear Ms. Chertok:
July 2, 2007
I am writing in response to your attached letter regarding the SERS retirement
accoun~ ot virgi~~.a .L. Rush, 184-38-2284..
In your correspondence you request a list of the beneficiaries and amounts
distributed as death benefits from Ms. Rush's account. After consulting with
the SERS Legal Department I have been advised that I can provide that
information. All money has been paid as follows:
Fred Belardi
Carol L. Floyd
Daniel Z. Floyd
Anna M. Irwin
Beverly A. Murtoff
Lisa G. Puscian
Ashley N. Rush
James A. Rush
Jerome A. Rush
John W. Rush
Mary J. Rush
Valerie J. Steinman
Charles Washington
Total
$234,661. 59
$51,013.39
$30,608.03
$51,013.39
$51,013.39
$5-1,013.39
$30,608.03
$51,013.39
$61,216.07
$51,013.39
$275,472.30
$51,013.39
$30,608.03
(23%)
(5%)
(3%)
(5%)
(5%)
(5%)
(3%)
(5%)
( 6%)
(5%)
(27%)
(5%)
(3%)
$1,020,267.78
Please also be informed that SERS funds are not subject to Pennsylvania state
taxes of any kind, including inheritance taxes.
If you have any questions I can be reached at (717) 237-0277.
Sincerely,
~ ~ ;?5:rector
Benefit Determination Division
REVo1511 EX+ (12099)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Virginia L. Rush
FILE NUMBER
00947
Debts of decedent must be reporlBd on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Ewing Brothers Funeral Home
Services of Funeral Director
Casket
Outer Receptacle
Opening Grave
Mass/Clergy
Obituary and Death Certificate
ADMINISTRATIVE COSTS:
0.00
B.
1.
Personal Representative's Commissions
Name of Personal Representative(s) : Charles Anthony Washington
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 245 East Louther Street
City Carlisle
Year(s) Commission Paid: . N/A
State PA Zip 17013
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
4.
Probata Fees
360.00
5. Accountant's Fees
6.
Tax Return Preparer's Fees
90.00
7. Settlement Fees
8. Advertisement for Tag Sale at Decedent's Residence
9. Estate Notice
TOTAL (Also enter on line 9, Recapitulation) $
(If more space Is needed, Insert additional sheets of the same size)
31,419.45
RECEIPT FOR PAYMENT
-------------------
-------------------
GLENDA FARNER STRASBAUGH
Cumberland County - Register Of Wills
One Courthouse Square
Carlislet PA 17U13
RUSH VIRGINIA L
Estate File No. :
Paid By Remarks:
2006-00947
CHERTOK STEPHANIE
CMM
Fee/Tax Description
PETITION LTRS TEST
WILL
SHORT CERTIFICATE
JCP FEE
AUTOMATION FEE
Check# 2332
Total Received.........
Receipt Date:
Receipt Time:
Receipt No. :
10/27/2006
14:16:41
1046148
Receipt Distribution ------------------------
PaYment Amount Payee Name
310.00
15.00
20.00
10.00
5.00
----------------
$360.00
$360.00
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
BUREAU OF RECEIPTS & CNTR M.D
CUMBERLAND COUNTY GENERAL FUN
/
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
A. HUD-1 UNIFORM SETTLEMENT STATEMENT
B. Type of L.oan
1.[] FHA 2.[) FmHA 3.[) Conv. Unins. 6. File Number: 7. loan Number:
4.[) VA 5.[) Conv. Ins. 105-926 N/A
C. NOTE: This form furnishes a statement of settlement costs. Amounts paid to and by the settlement agent are shown. Items marked
"(p.o.c.)" were paid outside the closing; they are shown for informational purposes and are not included in the totals.
D. Name & Address of Borrower: E. Name, Address & TIN of Seller: F. Name & Address of lender:
Charles F. Schubert, Sr. & Mary E. Schubert Estate of Virginia L. Rush N/A
841 Hillside Drive 20 Hillside Circle
Camp Hili, PA. Wormleysburg
G. Property location: TIN of Seller:
20 Hillside Circle Place of Settlement
Wormleysburg, PA 139 W. High Street
Carlisle, Pennsylvenla 17013 I. Settlement Date:
K. Summary of Seller's Transaction
400. Gross Amount Due to Seller:
(OMB # 2502.0265)
8. Mortgage Insurance Case Number:
, PA
H. Settlement Agent:
Anthony L. Deluca, Esquire
November 30. 2006
J. Summary of Borrower's Transaction
100. Gross Amount Due from Borrower:
101. Contract sales price $149;900.00 401. Contract sales price $149,900.00
102. Personal Property 402. Personal Property
103. Borrower's settlement charges (line 1400) 2,648.25 403.
104. 404.
105. 405.
Adjustments for Items paid by seller In advance Adjustments for Items paid by seller In advance
106. CI1y/town taxes 11130/2006 to 12/31/2006 42.26 406. City/town taxes 11/30/2006 to 12/31/2006 42.26
107. County taxes 11/30/2006 to 12/31/2006 45.86 407. County taxes 11/30/2006 to 12/31/2006 45.86
108. Assessments to 408. Assessments to
109. School taxes 11/3012006 to 06/30/2007 959.32 409. School taxes 11/30/2006 to 06/30/2007 959.32
110. 410.
111. 411.
112. 412.
113. 413.
120. Gross Amount Due from Borrower $153.595.69 420. Gross Amount Due to Seller $150.947.44
200. Amounts Paid by or In Behalf of Borrower: 500. Reductions In Amount Due to Seller:
201. Deposits or earnest money $5,000.00 501. Excess deposit (see instructions)
202. Principal amount of new loan(s) 502. Settlement charges to seller (line 1400) 511,546.07
203. Existing loan(s) taken subject to ~03. Existing loan(s) taken subject to
204. 504. Payoff of first mortgage To: FNCB 41,144.9B
205. 505. Payoff of second mortgage
206. 506.
207. 507.
208. 50B.
209. 509.
Adjustments for Items unpaid by seller Adjustments for Items unpaid by seller
210. City/town taxes to 510. Cityilown taxes to
211. County taxes to 511. County taxes to
212. Assessments to 512. Assessments to
213. to 513. to
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220, Total Paid Bylfor Borrower $5,000.00 520. Total Reduction Amount Due Seller $52.691.05
300. Cash at Settlement Fromlto Borrower 600. Cssh at Settlement Tolfrom Seller
301. Gross amount due from borrower (line 120) $153,595.69 601. Gross amount due to seller (line 420) $150.947.44
302. less amounts paid by/for borrower (line 220) 5.000.00 602. less reductions in amount due saller (line 520) 52,691.05
303. Cash fxl from f1 to Borrower $148,595.69 603. Cssh IIXlI to I I from Seller $98,25639
Substitute Form 1099 Seller Statement
The information in Blocks E, G, H, I & line 401 (or, If line 401 is asterisked, line 403 and 404) is important tax informalion and is being
furnished 10 the Internal Revenue Service. If you are required to file a return, a sanction will be imposed on you if this item is required to be
reported and the IRS determines that it has not been reported. If this real estate is your principal residence, file Form 2119. Sale or
Exchange of Principal Residence, for any gain, with your income tax retum; for other transactions, complete the applicable parts of Form
4797, Form 6252 and/or Schedule 0 (Form 1040). You are required to provide the Settlement Agent (named above) with your correct
taxpayer identification number. If you do not provide the Settlement Agent with your 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.
(Seller)
(Seller)
Estate of Virginia I. Rush
Estale of Virginia L. Rush
L Sett ement Charaes
700. Total Sales/Broker's Commission: (based on pricef
Division of Commission (line 700) as follows:
701. $4,522.00 To: Georae L. Ebener & Associates
702. 54,472.00 To: M.C. Walker Realtv
703. Commission oaid at Settlement
704.
800. Items Pavable In Connection with Loan
801. Loan Orioination Fee
802. Loan Discount
803. ADoraisal Fee
804. Credit Reoort
805. Lender's InsI'>Action Fee
806. Mortoaoe Insurance Application Fee
807.
808.
809.
810.
811.
812.
813.
814.
900. Items Reaulred bv Lender to Be Paid In Advance
901. Interest from I I to I
902. Mortoaoe Insurance Premium for
903. Hazard Insurance Premium for
904.
905.
1000. Reserves Deooslted with Lender
1001. Hazard insurance
1002. Mortoaoe insurance
1003. Citv orooertv taxes
1004.CountvDroDartvtaxes
1005. Annual assessments
1006.
1007.
1008.
l009.AMr6<]ate Accountino Adiustment
1100. Title Char"es
1101. Settlement/closino fee
1102. Abstract/title search
1103. Title examination
1104. Title insurance binder
1105. Documentoreoaration
1106. Notarv fees To: Notarv Public
1107. Altome-v's fees
-(includes above item numbers
1108. Tille insurance To: A.L. Deluca, Eso.-ACent for SecurilVTille Guarantee Corp. of Baltimore
(includes above item numbers 1101,1102.1103,1104
1109. lender's coveraoe
1110. Owner's coveraoe - 5149,900.00
1111.
1112.
1113.
1200. Government Recording and Transfer Charges
1201. Recordino fees: Deed 38.50 Mortoaoe
1202. City/county tax/stamps: Deed 1,499.00
1203. State tax/stamos: Deed 1,499.00
1204.
1205.
1206.
1300. Additional Settlement Charaes
1301. Survey
1302. Pest InsOBction
1303. OvamTciht Mailing To: Anthony L. Deluca, Esouire
1304. County, Librarv and Borouoh Taxes To: William A. O'Donnell, Tax Collector
1305. Water bill To: Pennsvlvania American Water
1306.
1307.
1308.
1400. Total Settlement Charaes (This Number Transfers to Lines 103 & 502 Abovel
CERTIFICt~~N
I have ~ully reviewed the HUD.1 Settlement Statement and to the best of my n \.t~gJ apl"ber.~ is a
disWMSernellf5 ma~ mv account or by me in this transaction. I further certify ha
// ", I/ :-~rr I O'P'>A'" Seller IA I'IJlV. V 1l3- L......
~71 '!'S'rate ~, s -"" ". Cha~ sl . Sj ~ rt, StJ 7
...-- ./ Seller '-nil ~ D. . Borrower
, " 1/ MaWE. Schubert .
To the best of m knowled e the HUD-1 SeUlement Statement which I have prepared is true ~nd accurate account of the funds which were received and
seUlemenl of this transaction.
SelUemenl Agent November 29, 2006
. Deluca, Esquire'
e '.IAII.emlnlslothe Unlled Sllles on Ihls 01 8")"DI"" Ilm..ar form p,nillhls upon cartYiChon tlfllnclude. line.rd imprl5Ol1menl For dellAls see Tille 111 U S
$149,900.00 @
6
%
Paid from
Borrower's
Funds at
Settlemenl
Paid from
Seller's
Funds al
Settlement
$8,994.00
T@5 I
lperdav
months
months
months
months
months
months
9i
$
$
$
$
$
oar month
oar month
oar month
oer month
oar month
oar month
2.00
1,108.75
Release
38.50
1,499.00
Mortl'laoe
Mortl'laQe
1,499.00
25.00
925.03
103.04
$2,648.25
$11.546.07
ccurate statement of all receipts and
HUD-1 Settlement Statement.
Borrower
Date
DISBURSEMENT REPORT
Name and Addrell of Borrower:
Charles F. Schubert, Sr. and Mary E. Schubart
File Number:
105-926
Contract Sales Price:
.Name and Address of Saller:
. Estate of Vir9inia L. Rush
.20 Hillside Circle
Wormleysburg
$149,900.00
PA
Settlement Date:
November 30, 2006
PROCEEDS
201.
202.
Item
Proceeds from Bu er(s)
Deposits or earnest mone
Principal amount of new loan(s)
Entity
Charles F. Schubert, Sr. and Ma E. Schubert
Amount
$148,595.69
5,000.00
$ 0.00
TOTAL:
$153,595.69
DISBURSEMENTS
Disbursements to Seller(s) to Estate of Virginia Rush $98,256.39
Payoff of first mortgage to FNCB 41,144.98
Commission paid at Settlement to George L. Ebener & Associates 4,522.00
Commission paid at Settlement to M.C. Walker Realty 4,4 72.00
Notary fees to Notary Public 2.00
Title insurance to A.L. DeLuca, Esq. Agent for Security Title 1,108.75
Guarantae Corp, of Baltimore
Deed to Recorder of Deeds 38.50
City/county tax/stamps: to Recorder of Deeds 1,499.00
State tax/stamps: to Recorder of Deeds 1,499.00
Ovemlght Malling to Anthonv L. DeLuca, Esquire 25.00
County, Library and Borough Taxes to William A. O'Donnell, Tax Collector 925.03
Water bill to Pennsylvania American Water 103.04
to TOTAL: $153,595.69
to
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.~be patriot-News
Now you know
Order Confirmation
Ad Order Number Customer Pavor Customer
0001603597 RUSH RUSH
Sales Rep. Customer Account Pavor Account
djones 130705 130705
Order Taker Customer Address Pavor Address
djones 245 E. Louther St. 245 E. Louther St.
Order Source Carlisle PA 17013 USA Carlisle PA 17013 USA
Phone Customer Phone Pavor Phone
717-243-7101 717-243-7101
PO Number Special Priclna
Ordered Bv None
mary V\
Customer Fax ~~ \ \ \ t>
pb
Customer EMall
Tear Sheets Proofs Affidavits Blind Box Promo Tvpe
0 0 0 Class Level 2
Invoice Text
Materials
Net Amount
$53.00
Tax Amount
$0.00
Total Amount
$53.00
Pavment Method
redit Card - VISA:619
Payment Amount
$53.00
Amount Due
$0.00
Ad Number Ad Tvpe
0001603597-0' CPPL
Ad Size
: 1.0X 15 Li
Color
<NONE>
Production Method Production Notes
Ad Booker
External Ad Number
Ad Attributes
Ad Released
No
Pick Up
11/14/2oo68:50:42AM
1
CUMBERLAND LAW JOURNAL
32 SOUTH BEDFORD STREET
CARLISLE, P A 17013
November 24, 2006
Cumberland Law Journal is published every Friday by the Cumberland County Bar
Association and is designated by the Court of Common Pleas as the official legal publication for
Cumberland County and the legal newspaper for publication of legal notices.
TO:
StephanieE. Chertok, ESQUIRE
Virginia L. Rush, ESTATE
RE:
Legal advertisements must be received by Friday Noon. All legal advertising must be
paid in advance. Make all checks payable to: Cumberland Law Journal.
Advertisement inserted on the following dates:
November 10, 17,24, 2006
Advertising Cost
Second Proof Request
75.00
$ 0.00
$ 0.00
$ 0.00
-------------
$ 75.00
Proof of Publication
Payment received
Total Amount Due
Payment received by
REV-1512 EX+ (12~3)
'*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILmES, & UENS
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Virginia L. Rush 00947
Report debts Incumd by the decedent prior to death which remained unpaid II of the date of death, Including unrelmbul'led medica' expenses.
ITEM VAlUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
\First National Community Bank Mortgage
41,144.98
2,400.00
114.99
441.93
2.
3.
Nerizon
5.,
i$ervice Oil Company
612.11
6.. :Tiger Trash
7.
y _ _...._~n~__~,..._'<<,,' 'h.M~""W ".........."",.,,..."',,. ,--.-,_" -__,'.,
., ."""~w.,,."_~n','.,~ ,,, "'-_'N','..__~"'_.. . ,..,
8.
9.
11. 101.25
12. 14,510.83
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
l
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
A. HUD.1 UNIFORM SETTL.EMENT STATEMENT
B. Type of L.oan
1.[) FHA 2.[) FmHA 3.[) Conv. Unins. 6. File Number: 7. Loan Number:
4.[] VA 5.[) Conv. Ins. 105-926 N/A
C. NOTE: This form fumishes a statement of settlement costs. Amounts paid to and by the settlement agent are shown. Items marked
"(p.o.c.)" were paid outside the closing; they are shown for informational purposes and are not included in the totals.
D. Name & Address of Borrower: E. Name. Address & TIN of Saller: F. Name & Address of Lender:
Charles F. Schubert, Sr. & Mary E. Schubert Estate of Virginia L. Rush N/A
841 Hillside Drive 20 Hillside Circle
Camp Hill, PA. Wormleysburg
G. Property Location: TIN of Seller:
20 Hillside Circle Place of Settlement
Wormleysburg, PA 139 W. High Street
Carlisle. Pennsylvania 17013 I. Settlement Date:
K. Summary of Seller's Transactlon
400 Gross Amount Due to Seller'
(OMe # 2502-0265)
8. Mortgage Insurance Case Number:
, PA
H. Settlement Agent:
Anthony L. DeLuca. Esquire
J. Summary of Borrower's Transaction
100. Gross Amount Due from Borrower:
November 30, 2006
101. Contract sales price $149;'900.00 401. Contract sales price $149,900.00
102. Personal Property 402. Parsonal Property
103. Borrower's settlement charges (line 1400) 2,648.25 403.
104. 404.
105. 405.
Adjustments for Items paid by seller In advance Adjustments for Items paid by seller In advance
106. City/town taxes 11/30/2006 to 12/31/2006 42.26 406. City,town taxes 11/30/2006 to 12'31'2006 42.26
107. County taxes 11130'2006 to 12/31/2006 45.86 407. County taxes 11130'2006 to 12131'2006 45.86
108. Assessments to 408. Assessments to
109. School taxes 11'30/2006 to 06130/2007 959.32 409. Schoollaxes 11 '30'2006 to 06/30'2007 959.32
110. 410.
111. 411.
112. 412.
113. 413.
120. Gross Amount Due from Borrower $153,595.69 420. GrollS Amount Due to Seller $150,947.44
200. Amounts Paid by or In .Behalf of Borrower: 500. Reductions In Amount Due to Seller:
201. Deposits or eamest money $5,000.00 501. Excess deposit (see instructions)
202. Principal amount of new loan(s} 502. Settlement charges to selier (line 1400) $11.546.07
203. Existing loan(s) taken subject to ~03. Existing loan(s) taken subject to
204. 504. Payoff of first mortgage To: FNCB 41,144.98
205. 505. Payoff of second mortgage
206. 506.
207. 507.
208. 508.
209. 509.
Adjustments for Items unpaid by seller Adjustments for Items unpaid by seller
210. City/town taxes to 510. Cityftown taxes to
211. County taxes to 511. County taxes to
212. Assessments to 512. Assessments to
213. to 513. to
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. Total Paid Byltor Borrower $5,000.00 520. Total Reduction Amount Due Selier $52,691.05
300. Cash at Settlement Fromlto Borrower 600. Cash at Settlement Tolfrom Seller
301. Gross amount due from borrower (line 120) $153,595.69 601. Gross amount due to seller (line 420) $150,947.44
302. Less amounts paid byffor borrower (line 220) 5,000.00 602. Less reductions in amount due seller (line 520) 52.691.05
303. Cash rxl from r 1 to Borrower $148,595.69 603. Cash 00 to rl from Seller $98,256.39
Substitute Form 1099 Seller Statement
The information in Blocks E, G, H. I & line 401 (or, if line 401 is eslerisked, line 403 and 404) is important tax information and Is bein9
furnished to the Internal Revenue Service. If you are required to file a return, a sanction will be imposed on you if this item is required 10 be
reported and the IRS determines that it has not been reported. If this real estate is 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 0 (Form 1040). You are required to provide the Settlement Agent (named above) with your c,orrecl
taxpayer Identification number. If you do not proVide the Settlement Agent with your 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.
(Seller)
(Seller)
Estate of Virginia I. Rush
Estate of Virginia L. Rush
L. Settlement Char~es
700. Total Sales/Broker's Commlsslon:-Cbased on Drlcel
Division of Commission !line 700) as follows:
701. $4,522.00 To: Georoe L. Ebener & Associates
702. $4,472.00 To: M.C. Walker Reallv
703. Commission gaid at Settlement
704.
800. Items Pavable In Connection with Loan
801. Loan Orloination Fee
602. Loan Discount
603. Aooraisal Fee
604. Credit Reoort
805. Lender's InsDection Fee
606. Mortoaoe Insurance Aoolication Fee
607.
60B.
609.
810.
611.
612.
613.
614.
900. Items Rellulred till Lender to Be Paid in Advance
901. Interest from I I to I
902. Mortoaee Insurance Premium for
903. Hazard Insurance Premium for
904.
905.
1000. Reserves DeDoslted with Lender
1001. Hazard insurance
1002. Mortoage insurance
1003. Citv orooarty taxes
1004. Countv oroDertv taxes
1005. Annual assessments
1006.
1007.
1008.
1009. Aooreoate Accounti"" Adiustment
1100. Title Charges
1101. Settlement/closino fee
1102. AbstracVlitle search
1103. Title examination
1104. Title insurance binder
1105. Document DreDaration
1106. Notarv fees To: Notarv Public
1107. Attornev's fees
(includes above item numbers
1108. Tille insurance To: A.L. DeLuca, Eso. ADent for Securitv Title Guarantee COrD. of Baltimore
/includes above item numbers 1101,1102,1103,1104
1109. Lender's coverace
1110. Owner's coverace - $149,900.00
1111.
1112.
1113.
1200. Government Recordlno and Transfer Charlles
1201. Recording fees: Deed 38.50 Mortoaoe
1202. Citv/countv tax/stamos: Deed 1,499.00
1203. State tax/stamos: Deed 1,499.00
1204.
1205.
1206.
1300. Additional Settlement Chaflles
1301. Survey
1302. Pest InsDection
1303. Overnioht Mailino To: Anthony L. DeLuca, Esouire
1304. Countv, Library and Borouoh Taxes To; William A. O'Donnell, Tax Collector
1305. Water bill To: Pennsvlvania American Water
1306.
1307.
1306.
1400. Total Settlement Charaes (This Number Transfers to Lines 103 & 502 Above!
CERTIFICA~
I have ca ully reviewed the HUD.1 Settlement Statement and 10 the best of my I dge a belilf, is anru ccurate statement or all receipts and
dls . _':.~m~a ~. account or by me in this transaction. I further certify, ha . T ...- HUO.1 Selllement Stalemenl
~~ ~ _" ~y/O.C~ Seller _ V .W....... Borrower
~ al~'''1I1Mio1 RUsh .--... ". Cha~ s . ~J.lllJrt, StJ TJ
/ Seller ~), 4.A~ fj . Borrower
-yTT /I Ma.eYE. Schubert
To the best or m knowle e the HUD.1 Selllemenl Statement which I have prepared is Irue ~nd accurate account 01 the funds which were received and
setllement of this transaction.
Setllement Agent November 29,2006
. DeLuca, Esquire.
I... SlatemenlJ 10 tM. United, Sta.s on UUS Of an"J' 0I.hel' S,","1r (oem P.naktes \.fPOr\ eon~hoI\ t:an Include: a line and impnsonmal'\t For det1lils ...- Title 18 U S
$149,900.00 Iiil
6
%
Paid from
Borrower's
Funds at
Settlement
Paid from
Seller's
Funds at
Settlement
$8,994.00
I /Ill $ r
I Der day
months
months
months
months
months
months
$
$
$
$
$
$
Der month
Der month
Der month
Der month
Der month
oer month
2.00
1,106.75
Release
36.50
1,499.00
Mortoaoe
MOHcace
1,499.00
25.00
925.03
103.04
$2,648.25
$11,546.07
Date
DISBURSEMENT REPORT
File Number:
105-926
Contract Sales Price:
.Name and Address of Seller:
. Estate of Virginia L. Rush
20 Hmside Circle
VVormleysburg
$149,900.00
PA
Settlement Date:
November 30, 2006
Name and Address of Borrower:
Charles F. Schubert, Sr. and Mary E. Schubert
PROCEEDS
Proceeds from Buyer(s) Charlas F. Schubert, Sr. and Mary E. Schubert $148,595.69
201, Deposits or earnest money 5,000.00
202. Principal amount of new loan(s) $ 0.00
TOTAL: $153,595.69
Item
Entity
Amount
DISBURSEMENTS
Disbursements to Seller(s) to Estate or ViraTnia Rush $98,256.39
Payoff of first mortgage to FNCB 41,144.98
Commission paid at Settlament to George L. Ebener & Associates 4,522.00
Commission paid at Settlement to M.C, Walker Realty 4,472.00
Notary fees to Notary Public 2.00
TItle insurance to A.L. DeLuca, Esq. Agent for Security Title 1,108.75
Guarantee Corp. of Baltimore
Deed to Recorder of Deeds 38.50
City/county tax/stamps: to Recorder 01 Deeds 1,499.00
State tax/stamps: to Recorder 01 Deeds 1,499.00
Overnight Mailing to Anthony L. DeLuca, Esquire 25.00
County, Library and Borough Taxes 10 William A. O'Donnell, Tax Collector 925.03
Water bill to Pennsylvania American Waler 103.04
10 TOTAL: $153,595.69
to
10
to
10
10
10
to
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Item
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~'~..Fi1.):.!i';;;l.;ro? ,,'.'t' J:" ~~~~]!'t ~\,~".. . ~w , ~ \. ;oj ~I ;.;..."s;~ 1. {:,,:, Qi,J;';',.rJ. ';1 f:lf~2} "'.1~- "":'P. .~;;,,~, ,~~~'C:::;;.'>f Ai': ~ ~':;i:,",1~. ~~l, :::\~,~":.tc, ");t.','''}~.i-:~~~~I-.~:~4.o:l''W~..1.,}1\:''''f.~.~/i~;~ JrJ'~ .>t:~;-li;}j!i~f~)l};: .I:;-}'~.~~~~ ~,?i;
,'~.{5'r.r{;::'f.~1~$f( .!:. ;-"'.... ~V~'}"-- ~ ;<~:c.(~ ~ ~. * .V- ;:tf1-t": fii, K '<Jt:. ;,~+:~~ I',z;; ';'i':; %",.r,'tf r l!i"""~~:t . ~;'; ~,t. ,:, ~bS.-,-~Jft~ ; .~>tiIF~~~- !~;j~:i'~"~~'>i.\:f(~~~.ty-~~ r,;~,~~-~,tj ~'l }~~I';:; {J,il?~~ ,~.\ ~ ~Jt;l r~:~~:I{~ ~ "''1
FIRST NATIONAL COMMUNITY BANK
192 EAST DRINKER STREET
DUNMORE PA 18512
(570) 346-7667
I'lnl NIIlIoaal 0xm0Iaity BIII1:
ANNUAL BORROWER STATEMENT
FOR TAX YEAR ENDING: 12-31-05
l.-.:IFNCB"
CD1lIUIJY Is Olllltll!lIAII
fJIcb.-. 1I-I77-'nY.PNCB
--
FORM 109B-MORTGAGE INTEREST STATEMENT
OMB1f 1545-0901
0255056 01 MB 0.326 -AUTO T1 0 2020 17011-181820 RM 2050
111I11111I11111111I111111111111111111111111111111111111I1111I1
VIRGINIA RUSH
20 HILLSIDE CIR
CAMP HILL PA 17011-1818
184-38-ZZ84
Z4-0566588
lZ-100168-4
08/06/91
001
BOX 1 - MORTGAGE IITEREST RECEIVEO FROM PAYER/BORROWER FOR TAX REPORTING
BOX 2 - POINTS PAID ON PURCHASE OF PRINCIPAL RESIDENCE FOR TAX REPORTING
BOX 3 - REFUND OF OYERPAID INTEREST FOR TAX REPORTING
OTHER -
2,251.99
.00
.00
::":";'l''';~m'Yf0'i''~:c;];m;!;fJ'1~;,,!:F,i;i'~:f,'ii;!~~B~~:~}:?';);,.~,~~~~i~iSi~i~.1i!:ill~8!SSGif:"if2ii1i1i\ft~tit~j;;;~tJi~~~~~~iZ:L~~~f,;if';;j;;:~if!'.b'&;~~:;~~;E:~:;;!"J~~7~;';;"!7.-'T~.t1,'~:'~;""-;~S;';:-;::+.Cf:L'S!r';:;.g:;.t95;t~,!~.;;;~";!
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Invoice
Invoice Number:
166;
I
I
Hospice of Central Pennsylvania
9B South Enola Drive
P.O. Box 266
Enola, PA 17025
Invoice Date:
10/1B/0t:
Page:
1
Voice:
Fax:
717-732-1000
717-732-5348
Resident:
Virqinia Rush
c/o Mary Irene Rush
245 E. Louther Street
Carlisle, PA 17013
Customer ID: RushV
-l---.--------,
Due Date
11/2/06
"
Payment Tenns
Net 15 Days
,', I
Description Amount
Residential Care 10109/06-10/16/06 2,400.0-01
!"'~ . .
Iii _.-
WllE1t.... iJ ~-- ;
'lJR13INIA RUSH ESTATE
f.~:ASHINGTON EXECUTOR 102
CARI.ISI.E, PI>; 17013 . . HIM (Db 1H1111ZS13
PAYTOTIlI W . DAn I
i
f OlIIlIIIOF rPf 1I.z' '<6 (I btiilfil.. A.- I $ i., <fOr;, /1)j6() ~
Ir-.t00 IJAlj'a'" rry,;.~ 0",.. 0{61l DrllAM ~ IF- I
PSECU: . I
HAIUV$Ill.IAG, At. 1711lJ.Gl1l ..... .~Cl~.
101
.: 2-313&H U:.':O~qc .
-OIoSblo 7B 2BBa'
!
!Ii
-'
. t
Total Invoice Amount.
2,400.00
"
':1
Check/Credit Memo No:
Payment/Credit Applied
. TOTAL
2,400.0C
Thank you for choosing Hospice of Central Pennsylvania.
~:.. ..:;;)i.:1i:i!~.:. ::~-~ ::':,.:'~~":::-:~:..;~.7:"" ...:-..
.. ..
SEWER
.;.. t *
TR~
.Btff6D u.s. POSTAGE P B 3 5 7 '1 9 i' .,
,2.4'4'2,fJ09~u~ MtH ~rMMtJ ~
~--", - .". '"",''' ~f.' ~
Cf~::~ -' '~.," '-. - '.~"$-,_
40130-0
SERVtCELOCATlON
'\2lIri':f1ILLSIDE DRIVE
"TOTAL.DUE:
. 114.99
IFPAlOAFTE
1.0/31/06
.. A:t
RUSH, VIRGINIA
MAIL TO: 2.0 -HILLSIDE DRIVE
.. _CAMP..HILL PA
, 7n,. '
_.~---_.
1701~2007 ~A06 22 1~/13/Q~
i.ENDER OF NEW ADDRESS '
GINIA .
. PAE1~8~!~S~2~T~
i mtn U lIu!lull. 111.1.1. Iwl.1l uj..J 111.1.1 JI ,I,ll
~
Accounting Associates
1849 W Lisburn Rd
Carlisle, P A 17013-9734
717-258-6671
March 22, 2007
CONFIDENTIAL
VIRGINIA L RUSH
245 E LOUTHER STREET
CARLISLE, PA 17013
We have prepared your 2006 tax returns for the Federal, State and local wage tax. Professional
services rendered in connection with the preparation are as follows:.
Form 1040 (Individual Income Tax Return)....................................................$
Schedule B (Interest and Dividend Income) ....................................................
P A Form P A -40 (Income Tax Return).............................................................
PA Sch A&B (Interest and Dividend Income).................................................
P A Form P A- V (payment Voucher) ................................................................
55.00
5.00
10.00
10.00
10.00
Amount due
$
90.00
If you have questions or would like to discuss this invoice, please do not hesitate to contact me.
:&1
Floyd Fahnestock
~
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VIRGINIA RUSH ESTATE
CHARLES A. WASHINGTON EXECUTOR
245 E. LOUTHER ST.
CARUSLE, PA 17013
LJ
60-8111/2313
DATE
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PSECU
HARRISBURG, PA 17110-2990
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01410 88MCE Oil
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liThe Company That Cares"
3798 Paxton Street, P.O. Box 1677
Harrisburg, Pa. 17105
www.servlceollco.com
564.1657
*** STATEMENT ***
EST. OF VIRGINIA RUSH
C\O CHARLES WASHINGTON
245 E LOWTHER STREET
CARLISLE, PA 17013
ACCT# t.!.E.18/
11/::::;0/06
. 'rlATE>
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11/10/06 8()23E, '#2'FUEL OIL '0' ....}OO c!)
11 /30/0€. .429.:315Q'((( . FINAI\!CECHARGE >}}
".' ....... . .'(.BALANCtt:DlJE ) . '. .. . . ..'
DELIVERED TO:20HILL8IDE CIRCLEiCAMPHILl., ....... .... ".' .....'.
7~?~~$a~~
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~UF:RENT
OVER :-':::0
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OVER 90
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. " A Brenner Family
Dealership"
BRENNER
717 -697 -8400
717-697-9133 FAX
BRENNERFAMILY.COM
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MAILING ADDRESS: P.O. Box 1019
Camp Hill, PA 17001-1019
STREET ADDRESS: 6271 Carlisle Pike
Mechanicsburg, PA 17050
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Pennsylvania State Employees Credit Union
III1II111
P.O. Box 67013 (717) 234-8484 (Harrisburg)
Harrisburg, PA 17106-7013 (800) 237-7328 (Nationwide)
website - h"p:/ /www.psecu.com
VISA-
PAGE
1
0184XXXXXX
01/25/07
TOTAl
. NEW BALANCI;
724.14
AMOUNT.PASTOUI;
MEMBER NUMBER
PAYMENT DUE DATE
68.50
+ .CURf\ENTAMQUNTDUE
I.
!
20.00
_ MINIMUM PAYMENT
I 88.50
405 1 AV 0.293
1...1111111111111111111.11.11111..1.11.11111111.1.111...1111.1
VIRGINIA L RUSH
20 HILLSIDE eIR
CAMP HILL PA 17011-1818
AMOUNT OF PAYMENT ENCLOSED
\(l
~'- \ 0"
\\~
$
p'>
1000901843002082284
TO REPORT A lOST OR STOLEN CARD' CAll OUR BUSINESS NUMBERS USTED AT THE TOP OF EACH STATEMENT PAGE
FROM 7 AM - 5 PM MONDAY TO FRIDAY AND B AM TO 12 PM SATURDAY, OTHERWISE CAll 800-556.5678
,---.- .. - ....._-_._~--_... '--.--. O' --.----.--..- -- I
MEMBER NUMBER . BTATE.MENT DATE PAYMENT DUE DATE CR!'DlT UMlT BA~
CBEASf.BEFORE i
DETACHING HERE T
0184382284 L 12/31/06! 01/25/07
ID 09 SUSPENDED VISA
POST TRAN REFERENCE
1201 1220
-
0.00
724.14
0.00
AVAILABLE
0.00
1130 1220
DESCRIPTION
ADJUSTMENT REMOVE lATE FEE
DCF - CORRECT lATE CHARGE
PAYMENT ADJUSTMENT ACCOUNT ADJUSTMENT:
DCI - VISA INTEREST ADJUSTMENT
AMOUNT
40.00-
11. 50-
YTD FINANCE CHARGE: YEAR TO DATE
1.72
f ". PREVIOUS BALANCE - P"YMENTS - CREDITS + ptj~~CAsH'-'.+" 'OeBrTADJUsNENTS + Ta;ALFIHAH~'C";;GE- -~ NEW BAlANCE
i PURCHASES . i . I' o. 00 I 0 . 00 I ... 5.91' I' 724. 14
i ADVANCES 0 . 00 I 0.00 I 0 . 00 0.00 i o. 00 ! 0.00 0 . 00
f~~;:~~~s----11~~[~}~?t TI~~~,A~~(?t-;~?~~~~I~:~fit..-~~
0301 000 600 0 10 2060737
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Charles Washington
245 E Louther St
Carlisle, PA 17013
11/28/06
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P.O. Box 2444 0 York, PA 17405-2444
(717) 699-11110 FAX (717) 699-0309
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YEAR/Mio A 06 ,
Transfer = T Direct De osll = DO
Debi! Card = DC
Teller Machine = ArM
Automalic Pa men! = AP
CODE .; PAYMEt/TUo....WAl
CODIGO T ~DELPAllO
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DEPOSIT
CANT1DAD DEL
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Tax Deduclibie = TO
BALANCE
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PPLElectric
UtiUties
Electric --
Service
For:
VIRGINIA RUSH
10 HILLSIDE CIR
CAMP HILL PA i7011
- -
.. ~..... .-.._., ...~- '.--"-~."'-_.__...-...._._. --.,.--
Final DupUeateBill
QuestioDs about .
tJiis bill? Please _'
contact us by Jan 4
at 1-800-342-5775
(l-SOo-DIAL-PPL)
or write to:
Customn Servi~ .'
827 Hausman Rd.
Allentown, PA
18104-9392
www.pplelectric.com
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Page 1
,\10
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Summary Page
Balance as of Dec 1, 2006
Char.Les:
TotarPPL ELECIRIC UTILmES Charges
Total Charges
C~07~9300~__ _ j
$158.35
$1.~
$ 159.60
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Account Balance
$ 159.60
Electric
Use
This graph shows
your electric use
over the last 13
months.
Types of
Meter Readings:
Actual _
Estimated lIII
Customer D
24 KWH - Average Per Day Meter Reading Information
1
20 Actual 24606
Actual 24604
KWH BIlled -----.,-
16
Average - Dee 2005 2006
12 Temmrature 31F 50F
KW Per Day 19 1
8
Yearly Use: Total A vera~c
4 Use Month {
Jan 2005 - Dec 2005 6839 57
0 . Jan 2006 - Dec 2006 607S SOl
I
DJFMAMJJASOND
2005 Months 2006
Other imDortant information on back ...