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Home My WebLink About08-12-08 (3)J 15056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Po Box zsosol INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 08 0197 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birch 174-05-0410 02/11 /2008 07/19/1910 Decedent's Last Name Suffix Decedent's First Name MI 8arner Mrs Gladys B (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return 2. Supplemental Return °... 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate _ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received 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. O) CORRESPONDENT - 7HIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Julie A. Beil (717) 243-6494 ,- ,, Firm Name (If Applicable) ~ ' ` REGISTER OF Wlt:LS_DISE ONLY .~ _.~ _..i First line of address ~ ~-"~ __ ~, 641 Valley View Dr. Second line of address -r7 ~~ -~ ---. .; DA7~~FILED t~ City or Post Office State ZIP Code ',,,,- Boiling Springs PA 17007 Correspondent's a-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 information of which preparer has any knowledge. SIGN^ATURE OF PERSON RE`~STPJO~~/VSIBLE FOR FILING RETURN )DATE 641 'Halley View Dr., Boiling Springs, PA 17007 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 ~ ;' ~--... ~` 15056052059 REV-1500 EX Decedent's Social Security Number Gladys B Barner 174-05-0410 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) Separate Billing Requested ..... .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 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 1) .............. .. 10. 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 13. Charitable and Governmental BequestslSec 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~ 0.00 15. 16. Amount of Line 14 taxable at lineal rate X .0 _ 250,484.27 16. 17. Amount of Line 14 taxable 0 00 . at sibling rate X .12 17 18. Amount of Line 14 taxable 555 035.92 , at collateral rate X .15 18 19. TAX DUE ....................................................... .. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 0.00 0.00 o.ao 0.00 165,800.85 0.00 656,333.28 822,334.13 16,810.89 0.00 16,810.89 805, 523.24 0.00 805,523.24 0.00 11,271.80 0.00 83,255.39 94,527.19 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 O8 0197 DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Gladys B Barner 174-05-0410 STREET ADDRESS 641 Valley View Dr. CITY Boiling Springs STATE PA ZIP 17007 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 94,527.19 2. CreditslPayments 0 00 . A. Spousal Poverty Credit B. Prior Payments 0.00 C. Discount 0.00 Total Credits (A + g + C) (2) 0.00 3. InteresUPenalty if applicable 0 00 . D. Interest E. Penalty 0.00 Total InteresUPenalty (D + E) (3) 0.00 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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 94,527.19 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 94,527.19 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 :................................................................................... ....... ^ b. retain the right to designate who shall use the property transferred or its income : ..................................... ....... ^ c. retain a reversionary interest; or ................................................................................................................... ....... ^ d. receive the promise for life of either payments, benefits or care? ............................................................... ....... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................... ....... ^ 3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ....... ....... ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................................................................................................. ....... ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before 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. §9116{1.2) [72 P.S. §9116(a)(1)]. The tax rale imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling 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-1508 EX+ (6-98) ~. COMMONWEALTH OF PENNSYLVANIA INHER{TANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Gladys B. Barner 21-08-0197 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointty-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (F>-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER. Gladys B. Barner 21-08-0197 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBS DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACHA COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLIGABLEI TAXABLE VALUE t ~ Metropolitan Life Annuity /Contract # 072910728AB 300,016.74 100 300,016.74 Ann Jordan -niece 2!11108 Nancy Shaub -niece 2(11108 Julie Beil -niece 211110! Deborah Kammerer -niece 2111108 Barbara Reineke -niece 2111108 Elizabeth Patterson -niece 2111108 Susan Bream -niece 2111108 2. Metropolitan Life Annuity / Contract# M9320277 179,286.11 100 179,:?86.11 Linda Brenneman -step-daughter 2111108 Gindy Bloser -step-granddaughter 2/11/08 Richard Harpe -step-grandson 2111101 James Harpe -step-grandson 2/11108 TOTAL (Also enter on line 7 Recapitulation) S I 479,302.85 (If more space is needed, insert additional sheets of the same size) 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 Gladys B. Barner 21-08-0197 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBS DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR REIATIONSHIP TO DECEDENTAND THE DATE OF TRANSFER.ATTACHACOPYOFTHEDEEDFDRREALESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IFAPPlICABLE) TAXABLE VALUE ~~ Metropolitan Life Annuity / Contract # 072918682 71,198.16 100 .'1,198.16 Linda Brenneman -step-daughter 2111108 Cindy Bloser - step-granddaughter 2111108 Richard Harpe -step-grandson 2111/08 James Harpe -step-grandson 2111108 2. Oppenheimer Pennsylvania Municipal Fund Contract # 007407400211992 106,032.22 100 106,032.22 Julie Beil -niece 2111108 Deborah Kammerer -niece 2111108 TOTAL (Also enter on line 7 Recapitulation) S I 177,230.38 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) SCHEDULE H FUNERAL EXPENSES & COMMONWEALTH OF PENNSYLVANIA iNHER17ANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Gladys B. Barner 21-08-0197 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 ~ Osiris Holding of PALLC ,Cumbe rland Valley Memorial Gardens Opening and closing plot fee -,780.00 Auer Memorial Home and Creamation Services Vault fee 525.00 Record fee 329.02 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 10,000.00 Name of Personal Representative(s) ~Ulle A. 6811 (nelCe) Social Security Number(s)/EIN Number of Personal Representative(s) 168-34-1363 _ street Address 641 Valley View Dr. city Boiling Springs .state PA Zip 17007 Year(s) Commission Paid: 2008 2. Attorney Fees 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 580.00 5. Accountant's Fees 6. Tax Retum Preparer's Fees 7. Medical expenses: (a) Millennium Pharrmacy Systems East 528.14 (b) Sarah A. Todd Memoirial Home -nursing care 3,944.66 s. Reception after Memorial Service -First Lutheran Church -food 103.07 9. Postage 21.00 TOTAL (Also enter on line 9, Recapitulation) $ 16,810.89 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Gladys B. Barner 21-08-0197 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE - TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 ~ Ann Jordan - 409 W. Louther Street, Carlisle, PA 17013 niece 2.6% 2~ Nancy Shaub - 233 Locust Road, Dover, PA 17315 niece 2.6% 3 ~ Julie Beif - 641 Valley View Drive, Boiling Springs, PA 17007 niece 16.1 4- Deborah Kammerer - 4178 Kittatinny Drive, Mechanicsburg PA 17050 niece 16.1 5. Susan Bream - 1340 Herr's Ridge Road, Gettysburg PA 17325 niece :9.1 6. Barbara Reineke - 1371 Browning Avenue, Salt Lake City, UT 84105 niece 9.1 7. Elizabeth Patterson - 6218 Gentry Avenue, North Hollywood CA 91606 niece 9.1 15% rate II ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TC!T4L AF PORT II - FNTFR rnrnt Nf1N_TAXGRI F IIISTRIRI ITIf1AIS riM I IAIF 17 !1G' RCV_14M rnv[o cuGCr I Q (If more space is needed, insert additional sheets of the same size) REV-f513 EX+ (g-Od) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEf{CIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Gladys B . Barner 21-08-0197 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 ~ Linda B. Brenneman - 25 Greenfield Drive, Carlisle, PA 17013 step-daughter 17.1 2• Cindy L. Bloser - 210 Barnstable Road, Carlisle, PA 17013 step-granddaughter 6.1 °1° 3. Richard W. Harpe - 2985 Emerald Chase Drive, Herndon, VA 20171 step-grandson 6% 4. James S. Harpe - PO Box 216, Grantville, PA 17028 step-grandson 6.1 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV•1500 COVER SHEET [[ 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 II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ (If more space is needed, insert additional sheets of the same size} ORRSTOWNBANK - A Tradition of Excellence ORRS P.O. Box 250 o Shippensburg, PA 17257 ~u~~~~n~~~~u~~~n~~n~~~~~ni~~n~u~~~n~u~u~n~~~i~~n) 000455 0.5745 AV 0.312 TR00003 Gladys B Banner 641 Valley View Drive Boiling Springs PA 17007-9618 0 0 0 0 0 0 0 0 0 0 a .-/ o ~ ~~ o ~n o rn i ~ cn o ~ o O .^i Building? Buying? Remodeling? We can help! 1.888.ORRSTOWN - orrstown.com Dat~ 3/31/x/ Primary P.ccount Enclosures S A V I N G S A C C O U N T S Account Title Gladys B Banner Prime Statement Savings Account Number Previous Balance Deposits/Credits 2 Checks/Debits Service Charge Interest Paid Ending Balance 706002129 151,372.15 .00 151,372.15 .00 647.21 .00 Statement Dates ~/O1./n8 thru Days In The Statement Period Average Ledger Average Collected Interest Earned Annual Percentage Yield Earned 2008 Interest Paid Page 1 706002129 0 3/3i !n8 91 .00 .00 647.21 2.88% 647.21 Detail Transactions By Date Date Description Amount BE~,IanCA _ ~7 i5~ 1 j22 Tel___e~hone Transfer D ~ r ~- ~.__.___- -----.~-_1_, OQO_._QO- _... ~ ~0 .~ 2 - - -~ 2/25 Interest Degosit 647.21 51,019. 2/25 Close Account 151,019.36- .00 Interest Rate Summary 12/31 3.200000% 1f22 2.720000% 1/31 2.620000% 2j25 0.000000% THANK YOU FOR BANKING WITH ORR5TOWN BANK To Reconcile Your Checking Account List and Total alt outstanding checks including those still outstanding from previous statements. Enter the "Balance This Statement" found in the last block of the summary fine on the front of this statement. List deposits and other credits not shown on this statement. Total items listed in steps 2 and 3. l:nterand Subtract the total of the outstanding checks as determined in Step 1 above from total in Step 4. This Figure should be your checkbook balance. If it does not agree, review the above steps, note the following insirudions and if necessary review your checkbook entries. O OUTSTANDING CHECKS NUMBER AMOUNT TOTAL RECONCILEMENT Q IN CASE OF ERRORS OR QUESTIONSABOUT YOUR ELECTRONIC TRANSFERS Telephone: 1-888-677-7869 • Address: R.O. Box 250, Shippensburg, PA 17257 If yo u think your statement or receipt is wro ng or if you need mo re informatio n about a tra nsfero n the statement or receipt, please contact us as soon as possible using the above telephone numberoraddress. We musthearfromyounolaterlhan60daysafterwesentyoutheFlRS7statementonwhichtheerrororproblemappeared. (1 } Tell us your na me and account number (if any). (2} Describe the error or the tra nsfer you are unsu re about and explain as Dearly as you can why you believe there is an error orwhy you need more i nformation. (3) Tell us the dol lar amount of the su spected error. If you tell usorally, we m ay require that you send usyour compla int or q uestio n in wrting within 10 business days. We will determine whether an error occurred within 10 business days (20 business days if the transfer involved a new account) after we hear from you and wifi correct any error promptly. If we need more time, however, we may take up to 45 days (90 days if the transfer involved a new account, apoint-of-sale transaction, or a foreign-initiated transfer} to investigate your complaint or question. Ifwe decide to do this, we will credit your account wthin 10 business days (20 business days ifthe transferinvolvedanewaccount) for theamountyouthinkis in error, sothatyouwillhavetheuseofthemoneyduringthetimeittakesustocompleteourinvestigation.If we ask you to put your complaint or question in writing and we do not receive it within 10 businessdays, we may not credit you r account. Your account is ce nsidered a new account fo rthe first 30 days after the first deposit is made, unless each of you already has an established account with us before this account is open ed. Wle will tell you the resultswithin three busin ess days afte r completing our investigation. If we decide that there was no error, we will send you a written explanation . You may ask forcopiesofthe documentsthatwe used in our investigation. LINE OF CREDIT ACCOUNT INFORMATION Important Information About Your Account Charges: We compute the FINAN CE CHARGE on yourawount by applying the periodic rate to the "average daily balance" of your account (including current transactions). Ta get the "average daily balance," we take the beginning balance of your account each day, add any new loans, and subtract any payments, credits, unpaid finance charges, and unpaid insurance premiums. This givesusthedailybalance. Then, we add upallthedailybalancesforthebillingcycleanddividethetotalbythenumber ofdaysinthebillingcycle. Thisgivesusthe"averagedailybalance." If a "finance charge adjustment' is shown on this statement, we computed this portion of the FINANCE CHARGE by multiplying the principal amount to which the adjustment applies by the periodic rate which applied inthe billing cycle forwhich the adjustment was made and by the number of days for which the adjustment was made. Billing Rig hts S umma ry In Case of Errors or QuestionsAbout Yo ur Statement If you think your statem ent is wrong or if yo u need more information about a transaction on yo ur statement, write us on a sepa rate sheet at the address shown on your statement as soon as possible. We must hear from you no later than 60 days after we sent you the first statement on which the error or problem appeared. You can telephone us, butdoing so will not preserve yourrights. In yourletter, give usthe folowing information: (1) Your na me and accou nt number. (2) The dollar amo unt of the suspecte d error. (3) Describe the a trot and explain, ifyou can, why you believe there is an erro r. If yo u need more information, describe the item yo u are unsure about. You do not have to pay a ny amount in question while we are investigating, but you are still obligated to pay the amounts on your statement that are not in questio n. While we investigate yo ur question, we cannot report yo u as de linque nt or to ke any action to col lectthe amount in q uestio n. ORRSTOWNBANK A Tradition of Excellence ORRS P•O. Box 250 o Shippensburg, PA ] 7257 ~n~~~~n~~~~~n~~ni~u~~~~~~u~~~nn~~~u~n~n~~n~~i~~u~ 003540 0.7744 AT 0.334 TR00019 Gladys B Barner °s Julie A Beil 641 Valley View Drive Boiling Springs PA 17007-9618 Building? Buying? Remodeling? We can help! 1.888.ORRSTOWN - orrstown.com Date`~2/25/08 Primary Account Enclosures C H E C K I N G A C C O LI N T S 0 0 0 N N 0 0 0 0 0 0 0 v o r, o v i ~ N r-1 o ~ o rn ~~ cn o ~ o ~~ o .-, Account Title Gladys B Barner Julie A Beil 50+ Interest Checking Image Account Number 400300 Previous Balance 4,461.36 7 Deposits/Credits 7,474.26 4 Checks/Debits 87.94 Service Fee 3.00 Interest Paid 1.04 Number of Enclosures Statement Dates 1/28/08 thru Days In The Statement Period Average Ledger Average Collected Interest Earned Annual Percentage Yield Earned Current Balance 11,845.72 2008 Interest Paid ~.--- Page 1 400300 0 2/25/08 29 7,966.18 7,966.18 :L . 0 4 0.160 2.40 Deposits and Additions Date Description Amount 1/28 SUP CON WD BANKERS LIFE AND 95.71 PPD 2/01 SOC SEC US TREASURY 303 1,458.00 PPD 2/04 ANNUITYPAY MET LIFE 1,544.37 PPD 2/08 ANNUITYPAY MET LIFE 286.14 PPD 2/20 PENSION METLIFE - P&SC. 2,475.00 PPD 2/20 PENSION METLIFE - P&SC. 1,575.00 PPD 2/20 INCOME SET MASSMUTUAL 40.04 PPD 2/25 Interest Deposit 1.04 PIa MassMutual Massachusetts Mutual Life Insurance Company Springfield MA 01 1 1 1-0001 FINANCIAL CROUP" MAILING AUDRI:SS CK440 JULIE A BE[L EXE/EST OF GLADYS B BARNER 641 VALLEYVIEW DR BOILING SPRINGS PA 17007 Amount of Policy includes Paid-Up Additions of $1,454.00 VEI3DOR NL7MBER : OVDCTRAD Check#:1089984 - April 01,2008 DOCUMENT VENDOR PO INVOICE AMOUNT DISCOUNT NET AMOUNT NUMBER INVOICE NO. NUMBER DATE 1908614579 0242029864 1205675 04/01/2008 2,609.98 TOTALS 2,509.98 0.00 2,609.98 0.00 2,609.98 ~, ORRSTOWNBANK A Tradition of Excellence Teller #/Transaction # Amount TimelDate Account # ,. ~ 1 , ~ I BR-36A °°n'~°' Please be sure to enter this transaction in your records. ~, e AIETROPOLI'CAN LIFE IV'SURANCE CO~IP:~N1' PO E30X 10342 DC~. MOIM?5 { _~ >U306-0342 Statement of Value of Annuity Contract 1. Name and address of Insurance Company 149etro~a)itan LifE Insurance Co;iipar~y, One IL1aui~on Avenue, i'Jewfork, NY 1O(~'ii) 2. Name of Annuitant 3. Date of Annuitant's Death 4. Annuitant's Social Sec. No. Gladys Barner 02/1 1 /2008 174 05 0410 5. Contract Number 6. Type of Annuity 7. Date of Issue 072 910 728 AB Nonqualifiecl 08/02/1994 8. Owner's Name 9. Assignee's Name 10. Date Assigned (Attach copy of Application) (Attach copy of assignment) Gladys Barner N/A NIA 11. Name(s) of Beneficiary(ies) 10% to be divided to Ann Jordan, Nancy Shaub, and Jane Patterson {Jane dcd 12/21/06) 90% to be divided to Julie Beil, Deborah Kammerer, Susan Bream, Barbara Reineke, and Elizabeth Patterson 12. Description of Contract Nonqualified Tax Deferred Annuity 13. Value of annuity contract on date of death of Annuitant 5300,016.74. This represents the death benefit as follows: Accumulation Value on Date of Death 5300,016.74 Cost Basis/Return of Payments 5174,259.87 Interest 5125,756.77 Total Payout See Remarks 14. How payable: One Sum See Remarks X 15. Remarks We have paid Ann Jordan (515,022.02), Nancy Shaub (515,008.06), Julie Beil (553,780.16), Deborah Iammerer {553,908.48), Barbara Reineke (554,155.92) and Elizabeth Patterson (553,988.51). As of this date, we Dave not received claim forms from Susan Bream. As of today s date, the value remaining in the contract which is payable to Susan is 554,191.17. The undersigned hereby certifies that this statement sets forth true and correct information. I~1ETROPOLIT:~N LITE INSURANCE COILII'ANY PO t30k 10342 DIES MC)INLS l:A X0306-03-12 Statement of Value of Annuity Contract 1. Name and address of Insurance Company iVietropc;iitan Life Insurance Cor»pany, One N(adison Avenue, fVew York, NY 10010 2. Name of Annuitant 3. Date of Annuitant's Death 4. Annuitant's Social Sec. No. Gladys Barner 02/11/2008 174 05 0410 5. Contract Number 6. Type of Annuity 7. Date of Issue M9320277 Nonqualified 01/1 1 /1993 8. Owner's Name 9. Assignee's Name 10. Date Assigned (Attach copy of Application) (Attach copy of assignment) Gladys Barner N/A N/A 11. Name(s) of Beneficiary(ies) Linda Brenneman - 50% Remaining 50 % to be divided to Cindy Bloser, Richard Harpe, and James Harpe 12. Description of Contract Nonqualified Tax Deferred Annuity 13. Value of annuity contract on date of death of Annuitant 5179,286.11. This represents the death benefit as follows: Accumulation Value on Date of Death 5179,286.11 Cost Basis/Return of Payments 598,338.49 Interest 580,947.62 Total Payout See Remarks 14. How payable: One Sum See Remarks X 15. Remarks We have paid Linda Brenneman (590,067.74), Cindy Bloser (530,042.06), and Richard Harpe (530,028.141. As of this date, we have not received claim forms from James Harpe. As of today s date, tl~e value remaining in the contract wf~ich is payable to James is 530,136.87. The undersigned hereby certifies that this statement sets forth true and correct information. 16. Date of Certification S ig nature Title •~ ' ~ May 13, 2008 / Claim Approver ME'1'ROPOLIT:~N L[f G INSURANCE COi~I P,~NI' PO BOa 103-12 DGS MUINt:S I;A ~030(~-03=42 Statement of Value of Annuity Contract 1. Name and address of Insurance Company Metrupolitan Lire litstj~a~-rce Commany, One Madison Avenue, ('dew York, NY 10010 2. Name of Annuitant 3. Date of Annuitant's Death 4. Annuitant's Social Sec. No. Gladys Barrier 02/1 1 /2008 174 05 0410 5. Contract Number 6. Type of Annuity 7. Date of Issue 072 918 682 AB Nonqualified 09/06/1994 8. Owner`s Name 9. Assignee's Name 10. Date Assigned (Attach copy of Application) (Attach copy of assignment) Gladys Barrier N(A N/A 11. Name(s) of Beneficiary(ies) Linda Brenneman - 50% Remaining 50 % to be divided to Cindy Bloser, Richard Harpe, and James Harpe 12. Description of Contract Nonqualified Tax Deferred Annuity 13. Value of annuity contract on date of death of Annuitant $71,198.1 6. This represents the death benefit as follows: Accumulation Value on Date of Death $71,198.16 Cost Basis/Return of Payments 563,988.15 Interest $7,210.01 Total Payout See Remarks 14. How payable: One Sum See Remarks X 1 5. Remarks We have paid Linda Brenneman ($34,527.23), Cindy Bloser ($11,516.57), and Richard Harpe (511,511.22). As of this date, we have not received claim forms from James Harpe. As of today s date, the value remaining in tl~e contract which is payable to James is $11,551.93. The undersigned hereby certifies that this statement sets forth true and correct information. 16. Date of Certification Signature Title May 13, 2008 Claim Approver OppenheimerFunds The Right Way to Invest DEBORAH J KAMMERER TOD JULIE A BEIL SUBJECT TO STA TOD RULES PA 4178 KITTATINNY DR MECHANICSBURG PA 17050-9138 004067 ln~llln~iiinnl~l~,~n~l~inn~iinil~inl~in~~in~nui~i Confirmation of Fund Activity April 8, 2008 Page 1 of 1 Your Flnanclal AdYlsar: THOMAS J SHEAFFER METLIFE SECURITIES INC 101 ERFORD RD STE 200 CAMP HILL, PA 17011-1802 (717) 671-8770 Vtstt us onttne ar www.oppenhelmerfunds.com to ^ view your account tralance, most recent transactions l~ 24hour automated service: 1-800-CALL-OPP (225-5677) ~ and the latest fund performance. Oppenheimer Money Market Fund, Inc. Account Number 00200 2003482451 Account Registration DEBORAH J KAMMERER TOD JULIE A BEIL SUBJECT TO STA TOD RULES PA Transaotion Date Transaction Description 04/08/08 Exchange in from 00740 7400315392 (Pennsylvania Municipal Fund A) Dollar Share Amount Ptlce $53,126.05 $1.00 Number Ending of Shares Share Balance +53,126.050 53,126.050 Oppenheimer Pennsylvania Municipal Fund Class A Account Registration DEBORAH J KAMMERER TOD JULIE A BEIL SUBJECT TO STA TOD RULES PA Transaction Data Transaction Description 04/08/08 Transferred from Acct. #00740 7400211992 04/08/08 Exchange out to 00200 2003482451 (Money Market Fund, Inc.} 04/08!08 Dividend OppenhelmerFunds News Account Number Dollar Share Amount Price $53,117.89 $11.63 $8.16 00740 7400315392 Number Ending of Shares Share Balance +4,567.316 4,567.316 -4,567.316 0.000 A hold has been placed on your account(s) that contain a Transaction Description of "Exchange 1n" above, preventing exchanges from this account into other accounts for 30 calendar days from the transaction date of the exchange You may exchange into Money Market Fund or Cash Reserves at any time; however, all of the shares in the receiving account will than be subject to a new hold period for 30 calendar days from the transaction date of that exchange Please note that beginning in October 2007, your 13-digit account number expanded to a 15-digit number. The new format appears as two zeroes (00) + your current account number. No action from you is needed at this time A Reminder About Your Checkwriting Option: If a check is used to purchase shares of a fund, these shares may not be redeemed via the Checkwriting Option within the first 10 days of purchase See your Fund's prospectus for details, or call us at 1-800-525-7048, if you have any questions. R t` N 0 i I8111 Iliillii111111IIIII IIII IIII PP...l1100..O1g5H91006.OG]61.O4J6)_E0I OPPD I.OCSOIOHG'.'.^f10~11001n0)o0]9H1651 ..06100.....000168]851 OppenheimerFunds The Right Way to Invest JULIE A BEIL TOD JACK N BEIL SUBJECT TO STA TOD RULES PA 641 VALLEYVIEW DR BOILING SPRINGS PA 17007-9618 004082 Confirmation of Fund Activity April 8, 2008 Page 1 of 1 Your Financial Advisor: THOMAS J SHEAFFER METLIFE SECURITIES INC 101 ERFORD RD STE 200 CAMP HILL, PA 17011-1802 (717) 671-8770 V,'s;t us c;;,;'ne at wtivw.~p;,Erl:cfinerfunds.ao:sz to ^ view your account balance, most recent transactions and the latest fund performance. O 24-hour automated service: 1-800-CALL-OPP (225-5677) Oppenheimer Money Market Fund, Inc. Account Number 00200 2003485036 Account Registration JULIE A BEIL Transaction Dollar Share Number Ending Date Transaction Description Amount Price of Shares Share Balance 04/08/08 Exchange in from 00740 7400315458 (Pennsylvania $53,125,99 $1.00 +53,125.990 ;13,125.990 Municipal Fund A) Oppenheimer Pennsylvania Municipal Fund Class A Account Number 00740 7400315458 Account Registration JULIE A BEIL Transaction Dollar Share Number Ending Date Transaction Description Amount Price of Shares Share 8a/ance 04/08/08 Transferred from Acct . #00740 740021 i 992 =~ ~ , !~ • `) ~~ +4 , 549.117 4 , 549.117 04/08/08 Exchange out to 00200 2003485036 (Money Market $52,906.23 $11.63 -4,549.117 0.000 Fund, Inc. ) 04/08/08 Dividend $218,76 OppenheimerFunds News A hold has been placed on your account(s) that contain a Transaction Description of "Exchange tn'" above, preventing exchanges from this account into other accounts for 30 calendar days from the transaction date of the exchange. You may exchange into Money Market Fund or Cash Reserves at any time; however, all of the shares in the receiving account will then be subject to a new hold period for 30 calendar days from the transaction date of that exchange Please note that beginning in October 2007, your 13-digit account number expanded to a 15-digit number. The new format appears as two zeroes (00) + your currant account number. No action from you is needed at this time. A Reminder About Your Checkwriting Option: If a check is used to purchase shares of a fund, these shares may not be redeemed via the Checkwriting Option within the first 10 days of purchase. See your Fund's prospectus for details, or call us at 1-800-525-7048, if you have any questions. ~ ~ ~ ~ ' ~~ N yO b ~~~~~~ (~~~~ (~~I~ ~~~~~ ~~~~~ ~~~~ ~~~~ ]PP...81~OO.,C149591006.04397.04391.E6IOPPOI.OCSD ID904~i~0411001001007490036...00100.....1CO1g99016 Osiris Holding of Pennsylvania, Inc. - Retail Installment Contract and Security. Agreement , _ er Cemetery L rib of Pennsylvania LLC ("aLlry_C") 1 Y) ~ Tri-Coun Y Memorial Gardens LLC ("LLy'') P Y O Westminsi ~ LC ( LLC") rig of Pennsylvania Subsidi LLC ("Com pan ~ Tri-Coun Memorial Gardens Subsrdiar LLC ("Com an ') Westminster Cetne Subsidtary LLC ("Company" Valley Memaria] Gardens (Cemetery) Tn-Count Memorial Gardens ("Cemete ) Westminster Cemetery ("Cemetery') ter Highway, Carlisle, PA 17013 740 Wyndamere Road, Lewisberry, PA 17339 1159 Newville Road, Carlisle, PA 17013 3541 717-938-3435 717-249-2029` rany (sometimes referred to collectively in this Agreement as "Seller") are owners and operators of the Cemetery. THIS AGREEMENT is made by and between Seller and \ . ... 3: THAT Purchaser agrees to buy and LLC and Company agrees to sell to Purchaser, or his designated beneficiary in-accordance with the tetm$ hereoft the following items to be prov tded or used PION OF BURIAL RIGHTS. The Burial Rights covered by the Agreement are shown by the map of such gardettlbuilding on file in the office of the CEMETERY,?and are more particul rrly Rights in: Grave Space(s) +Mausoleum: ^ Chapel ~ Garden ^ Tandem ^ Side-by-Side O Single (] Dev Lawn Crypt: ^ Double Depth ^ Side-by-Side Niche: ^ C'~tapel ^ Garden; ^ Single ^ Companion ^ Developed D Pre ^ Sin le ^ Develo ed ^ Preconstruction '~ " ~' ~' ~` ~ ~ °'~ g p +Maximum casket dimensions are:7engt6 85", width 19", height _6" 1st Choice 2nd Choice '1st Choice'. 2nd Choic Garden Building ~ Building, Section Section Section . Lot No.(s) No.(s) Space(s) Level Level 3. ITEMIZATION OF CHARGES LLC NDISE: (A) Butal Rights (as descnbedm Para. t above) ~ $ ere if merchandise is being purchased for use at another cemetery. (B) Perpetual. Care - $ s Name: (C) Less Certificate Discount $ -~ (D) Second Right of Interment $ (S) # I .Description ~ k' '` ` ` r " ~_.; _ (E) Vault(s) ~ _~ _ $ ~" ~~ #2. Description (F) Urn(s) ~ - (G)Mausoleum Lettering/Crypt Plate ; ): #1. Description (H)MemoriaUMonument' ~ - #2. Description (I) Granite Base(s)` ~ ` (J) Installa6on,Charge ~~ S RIAL INFORMATION: (K) Caskets ial Design: Vase: Y J N (L) Initial. Fee for,Interment _ ~___ $ ____ (M)Final Internient/EntombmenUInutnment Fee -' Size X Granite Size X (N) permanent Records & Processing Fee $ n (Section, etc.) (O) Other arrM "'~ ~> (P) Sales Tax ~ MENT INFORMATION: 4. TOTAL CASH PURCHASE PRICE (A THRU P) $$.«~ x f ~ =~~ ~' x Color: ~x P 'x P ITEMIZATION OF.THE AMOUNT FINANCED .~ z; (1) Total Cash Price ... ...:., ;.: .:;,~ $rr (2) A; Down Payment O Cash .O Check Credit Card .~ :~+~ ,S~.._ ~r S `- r-.,.. - B. Trade In>'~ . U _. .. x ' x Old Agreement No. - ~=' ~' ` ` T(S): C. Total Down Payment (2A + 2B) ... 5 __ (3) Unpaid Balance of Cash Price(1 2C) . '~ ~ °_ j Gauge: (4). Finance Charge ,,;... .... ~; ,~ yet - I g ,t Gau e' (5) Tota ~ (3 + 4) :... ~ ..~~~~ . , ~ ~-- the Company shall each remain secondarily liable to the other for the sales of items and services provided by one another pursuant to this Agreement; however, Purchaser shall ;ainst the LLC or the Company before proceeding against the other. ~ i a a,;' T ~zl'he Ptirchasei shallapap~.~ or"'such nights in accordance /ing disclosure statement: ,,;.~ ANNUAL.°'`t~ERC~NTAGE RATE " FINANCE`CHARGE''" ,°~ AMOUNT FINANCED,; t. -, ^,r~,..a. ,-. irTOTALtOF"PAYMENTS '~~ ~r The cast of your credit as a yearly rate. The dollar amount the credit will cost you. The amourifof credit p'rov~ded to you on your own behalf.'" ,The amount you will have paid after you have made all payments as scheduled. , r T~i~tQ al c '~' d Wn3i JIENT Number of Payments Amount of Payments FII"St Payment Due Date heeea e ILL BE: j~, . - {' $ c!f`~ .or` `~ O Monthl r or ., $ ~ p t, t , ,: ~ are giving a security interest in the goods or property being purchased or in part of the funds paid under this Agreement held in a Merchandise Trust Fund. If'you pay off early, you will not have to pay a penalty and you may be entitled to a refund of part of the Finance Charge: `- - '~ f ~ ~ -' rentainder of this Agreement (inc]uding General Provisions on the reverse side hereof) for additional information about nonpayment, default, delinquency charge; security mteiests any re9wred~pa~ .date, and re a merit refunds and enalties. ~ ~ ~ ~ i''` ~ ~ i=ct +ti~~,; ~; +: ~~:-• led' P P Y P :EMENT ,9,RISES OUT OF A CONSUMER CREDIT SALE AND IS SUBJECT TO THE ADDITIONAL GENERAL PROVISIONS CONS-,Al1v~D ~fN tEEMEN'Y, tvVHICH ARE A PART OF THIS AGREEMENT. ~ t w enC sh-a be binding upon the heii.~, executors, administrators, successors and assigns of the parties hereto. -. •' " ;~.~.~`„ '' ~I, Osiris Holding of Pennsylvania, Inc.. ~ ;: _ k(ta~„ • Retail Installment Contract and Security Agreement ` ~ ~ 'rt Pennsylvania LLC ("LLC") [] Tri-County Memorial Gardens LLC ("LLC") ^ Westminster Cemetery LLC ("LLC") Pennsylvania Subsidiary LLC ("Company") Tri-County Memorial Gardens Subsidiary LLC ("Company") Westminster Cemetery Subsidiary LLC ("Company') , , cy Memorial Gardens ("Cemetery") Tri-County Memorial Gazdens ("Cemetery") Westminster Cemetery (Cemetery") -? ; ; •~ [ighway, Carlisle, PA 17013 740 Wyndamere Road, Lewisberry, PA 17339 1159 Newville Road, Carlisle, PA 17013 ' 717-938-3435 717-249-2029 "' ' sometimes referred to collectively to this Agreement as Seller") are owners and operators of the Cemetery. THIS AGREEMENT is made by and between Seller and !l t / } :~ AT Purchaser agrees to buy and LLC and Company agrees to sell to Purchaser, or his designated beneficiary in-accordance with the terms hereof, the,following items to be provided or used art 1 OF BURIAL RIGHTS. The Burial Rights covered by the Agreement are shown by the map of such garden/building on file in the office of the CEMETERY, apd are-more particularly des hts in: Grave Space(s) +Mausoleum: ^ Chapel ^ Garden ^ Tandem ^ Side=by-Side ^ Single ^ Develol Lawn Crypt: ^ Double Depth ^ Side-by-Side Niche: ^ Chapel ^ Garden ^ Single ,^ Companion ^ Developed ^ Precoti ^ Single ^ Developed ^ Preconstruction +Moximum eusket dimensions are: length 85", width 19", height 16" ]st Choice 2nd Choice 1st Choice ' 2nd Choice" Garden Building Building Section Section Section Lot No.(s) No.(s) Space(s) Level Level ' 3. 'if merchandise is being purchased for use at another cemetery. #l. Description - #2. Description #1. Description #2. Description ~AL INFORMATION: Design: Vase: Y / N e X Granite Size X --- Section, etc.) ,~ -,~ c> ~':'' ~ .• ~- ~ ..; ,% . ,f' =r~~ .,... Y ENT INFORMATION: q, i x x . x Color: x~ P x' P x p ITEMIZATION OF CHARGES LLC* (A) Burial Rights (as described in Pare. t above) _ $ (B) Perpetual. Care . - $ (C) Less CeRificate Discount " $ ' (D) Second Right of Interment f $ ~'"% ~~ (E) Vaults} $ (F) Um(s) (G) Mausoleum Lettering/Crypt Plate „°, w (H) Memorial/Monument T- (1) Granite Base(s) ~ '~ t V " ` ~j~ (J) Installation Charge ~ ~ ~ ~ ~$~ "" `_ (K) Caskets (L) Initia3 Fee for Interment ,, ,~ ~ _" $ ~ x ~~~ (M)Final Interment/EntombmentMurnment Fee (N) Permanent Records'& Processing Fee , $ ~ """'` (O) Other ~ ~(s~ (P) Sales Tax r $ TOTAL CASH PURCHASE PRICE A THRU P ( ) ~ S ~ ~" ITEMIZATION, OF,THE AMOUNT;FINANC ED ,~R~ (1) Total:Cash Price ,.,,,.. ~,.:. ~ .~ 5 (2) A. DowmPayment O Cash O Check; D.CredirCard `:":;S ,_T. B. Trade In: t'.=,~ . ; ' .'. S ~ , ' OIdAgreementNo. `~ < ~ ~ `. ~ ~~' r ~ k~ ; C. Total Down Payment (2A+ 2B) ...- `;~g~" (3) Unpaid Balance of Cash Price (1 - 2C) .. : °'S "- - ~ ~ ~ Gauge: : 5 ''` Gauge: .. ... .... (5) Total ~Char~e (3 + 4) ..~........ . ~.~~ ~~..;S.. to Company shall each remain secondarily sable to the other for the sales of items and services provided by onej another pursuant to this Agreement; however; Purchaser,shail+nc inst the LLC or the Company before proceeding against the, other.. ..,;l,t,,,,;,,~~, J ~w_ .The Purchases"shall pa such rights in accordance ng disclosure statement: Number of Payments Amount of Payments First Payment Due Date _ Thereafter ;P yi NT n ~~. ~ ~ ;~, NILL BE.: ~,~~,-~ ~ / 1 ~:':~'/~.-, -.•„ ,y ~ Monthly on tt~ i ~r are giving a security interest in the goods or property being purchased or in part of the funds paid under this Agreement held in a Merchandise Trust Fund.' ` f "you pay off early, you will not have to pay a penalty and you may be entitled to a refund of part of the Finance Charge. ~ ~ -; , ~. ' remainder of this Agreement (including General Provisions on the reverse side hereof) for additional information about nonpayment, default, delinquency charge; security interests; any r~yuir i i~.icn.; '.d date, :and prepayment refunds and penalties. ' u , r ~,,', ' ' ~. EMEN'1' F,?ISES OUT OFA CONSUMER CREDIT SALE AND IS SUBJECT TO THE ADDITIONAL GENERAL PROVISIONS CONTAII~.'ED~ a+l~Tl EEMENT, WHICH AREA PART OF THIS AGREEMENT. • ~ r~ _; „ ~,:' nt shall be binding upon the heirs, executors, dministrators, successors and assigns of the parties hereto. r:~ ~~: "°` ~NNUAC"PERCENTAGE RATE FINANCE"CHARGE. ,AMOUNTFlNANCEd ";"F"" " ~.; "'~ ~'TO'Tb,~O'f""P11YMfENTS 0 The cost of our credit as a ead rate. y y y The dollar amoun t the credit will cost you. The amount of credit provided to you a~ The amount you will have paid after you ~~ The otal cost , w.„kM ,.fit ~) on you rro-w~n behaft: have made all payments a scheduledw4 `~~l wn ~ __ 20Gfi 06/;3 ~~` , r ' "~ :~ 4 ~e,. f ~ S ~ ~~ ~~. ~ ~.~°la; ;~t,r,;~~'~ ~ art: 5b7~ n~~t~ ; t,I ~ r~ a SIGN HERE -, "~ The i 1.., rid 'red .. N' i~ { 'n ~ ed ih t h TOTAL QTY. CLA DESCRS ON P ICE 7 ~~r ~ Vn ~ ~- t^ a o DATE ~ Z- ~ ~ ~ U~ AUTHORIZATION SUB TOTAL t ? D t .J ~ i ao REFERENCE NO. SERVER TAX _._---~---:----. ID-FOLIO/CHECK NORIC. N0. STATE REGJOEPT. CLERK TIP MISC. -- '--- ~ ~~ 5358530 4 ~ a !~~ Seuef 0 the enU 1 on IS { m s eut Ong to p8y a ali1o11n 8 OWrI ea upon proper presentation. I promise to pay such TOTAL (together with any other charges due -- -- - CUSTOMER: RETAIN THIS COPY FOR YOUR RECORDS thereon) subject to and in accordance with the agreement governing the use of euah r8 a ay N ~ lY ~i as to y U i, i ~. n MERCHANDISE X Register Book $35.00 6o Tax 52.10 $0.00 X Memorial Cards 100 @ $45.00 6o Tax 52.70 $0.00 X Thank You Cards 2 @ $15.00 6a Tax 50.90 $0.00 X Remembrance Package $80.00 6a Tax $4.80 $84.80 Casket X Solid Sheet Bronze Urn with Satin Finish Cremation Container Urn Burial Vault Veterans Flag Case Grave/Memorial Marker_ TOTAL MERCHANDISE CASH ADVANCED ITEMS Grave Opening Cemetery Equipment Vault Service Charge X Patriot News X Gettysburg Times X Carlisle Sentinel Church/Organist/Soloist Flowers Crematory Charge X County Coroner Cremation Approval Fee X 10 Certified Copies of Death Certificate X Patriot Service Announcement TOTAL CASH ADVANCED ITEMS SUMMARY OF CHARGES Special Charges Professional Services Automotive Equipment Merchandise Cash Advanced Items SUB TOTAL CREDITS TOTAL AMOUNT PAID BALANCE DUE NOV 23, 1995 $1,590.00 $55.00 $0.00 $182.80 $514.02 $2,341.82 -5767.80 $1,574.02 -$1,245.00 5329.02 ~` 598.00 --~"~''~ $224.67 ' 560.00 ~~ $119.88 ~ ----- 525.00 560.00 ~_. -- ~' $24.47/7 5182.80 5514.02 THIS STATEMEN'T' MAY NOT REFLEC'P ALL NEWSPAPER CHARGES __. Gladys B Barner Estate ___._ .. so-,soa,a,s 1007 641 Valley View Drive Boiling Springs PA 17007 DATE g ~ ,- PAY TO THE ~~~ $ ~U ~~ d g 1 / ORDER OF ~ -P-r-~ l / s r.. Cla ~ ` T {']cAs~;n~-mot ~ ~n[~--~cx~ { p.ti-~ DOLLARS ~ _ Orrstown Bank ~' Shippensburg, PA 17257 MEMO ~/~- L ~~'' ~:0 3 1 3 L 50 36~: L0600 LO 39~~' X00 7 ~-, 0 RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Sc(uare Carlisle, PA 17013 BARNER GLADYS B Estate File No.: 2008-00197 Paid By Remarks: JULIE BEIL DM ------------------- Fee/Tax Description PETITION LTRS TEST WIi~L SHORT CERTIFICATE JCP FEE AUTOMATION FEE Check# 107, Total Received......... Receipt Date: 2/25/2008 Receipt Time: 10:27:42 Receipt No. 1051700 Receipt Distribution ----- -- - ---- -------- --- Payment Amount Payee Name 510.00 CUMBERLAND COUNTY C'ErTF:R~T~ FU?~T 15.00 CUMBERLAND COUNTY GENERAL FUN 40.00 CUMBERLAND COUNTY GENERAL FUN 10.00 BUREAU OF RECEIPTS & CNTR M.D 5.00 CUMBERLAND COUNTY GENERAL FUN ---------------- 580.00 580.00 Statement United Church of Christ Homes Sarah A. Todd Memorial Home 1000 West South Street Carlisle, PA 17013 ~~ ~ k~ Statement Date: 02,/12/2008 L" Julie Beil ~~ ~\ f u~ 641 Valley View Drive ~ \`a \ Boiling Springs, PA 17007 ~ ~ -~~~ Due Date: 02/25/2008 .u `- Re: Gladys B Banner Account Nr: 100331 Date Description Days Rate Charges Payments Balance Quant BALANCE FORWARD 8,164.96 8,164.96 01/21/08 PAYMENT 8,164.96 .00 01/31/08 Personal Laundry Se 1.00 30.00 30.00 30.00 01/31/08 Cable Television 1.00 17.00 17.00 47.00 01/31/08 Oxygen 1.00 40.00 40.00 87.00 01/31/08 Medical Supplies 1.00 148.17 148.17 235.17 01/31/08 Incontinence Suppli 1.00 51.96 51.96 287.13 01/31/08 Personal Supplies 1.00 15.45 15.45 302.58 01/31/08 Medical Equipment R 1.00 975.74 975.74 1,278.32 02/01/08 Room & Board - Semi 10 226.00 2,260.00 3,538.32 NOTE: ***** PAYMENT IS DUE UPON RECEIPT ***** BUT NO LATER THAN THE 25TH OF THE MONTH ***** Please remit the LAST AMOUNT printed on your statement. Include the ACCT# from the statement on the MEMO LINE of your check. Payments after 02/06/08 do not reflect on statement. NOTE: ** LATE PAYMENTS ARE SUBJECT TO A 1.250 LATE CHARGE PER MONTH ** A $10.00 FEE WILL BE CHARGED for RETURNED CHECKS ** Statement United Church of Christ Homes Sarah A. Todd Memorial Home 1000 West South Street Carlisle, PA 17013 Julie Beil 641 Valley View Drive Boiling Springs, PA 17007 ~,7~0- ~" i ( ~~~ C ~ -j~ Statement Date: 03;13/2008 Due Date: 03/25/2008 Re: Gladys B Banner Account Nr: 100331 -------------------------------------------------------------------------------- Date Description Days Rate Charges Payments Balance Quant BALANCE FORWARD 3,538.32 3,538.32 02/25/08 PAYMENT 3,538.32 .00 02/08/08 Beauty & Barber 1.00 16.00 16.00 16.00 02/10/08 Cable Television 1.00 17.00 17.00 33.00 02{10/08 Personal Laundry Se 1.00 30.00 30.00 63.00 02/10/08 Medical Supplies 1.00 32.02 32.02 95.02 02/10/08 Medical Equipment R 1.00 266.39 266.39 361.41 02/10/08 Personal Supplies 1.00 1.87 1.87 363.28 02/10/08 Incontinence Suppli 1.00 23.06 23.06 386.34 02/10/08 Oxygen 1.00 20.00 20.00 406.34 NOTE: ***** PAYMENT IS DUE UPON RECEIPT ***** BUT NO LATER THAN THE 25TH OF THE MONTH ***** Please remit the LAST AMOUNT printed on your statement. Include the ACCT# from the statement on the MEMO LINE of your check. Payments after 03/10/08 do not reflect on statement. NOTE: ** LATE PAYMENTS ARE SUBJECT TO A 1.25% LATE CHARGE PER MONTH ** A $10.00 FEE WILL BE CHARGED for RETURNED CHECKS ** i ~~ i .~ () r ~} i 1 i~ <- zi _ ? ~~ , /~` ~~ ~' ~~~~~ /)~ (_~~~ (A -l ~a ~ , i :.a It K~ fs~i ~--- S~ ~l~'~l Pr V Bal. Lasf Pvmt` Last Payment Finance Chg. YYD Fin Chg. her., RX QTC I+! P? 'IV ~ `T~a~ $ 66.46 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 26.19 $ 0.00 $ 0.00 $ 0.00 92.65 ''C' a L i, ~~ ~~4s`~ dt~ 1 .~, e 4,~ `.s~~ Millennium Pharmacy Systems East ~~~tr ~ 2880 Bergey Rd., Ste. AA C~~ ~~~ Hatfield PA, 19440 ~ (, .r \U Due by 312 , .1 ~1J I. U INVOICE ~~-~,~t-~ ~~ 02/28/2008 ` Billiny office hours Mon-Fri gam = 5pm~;Toll ~~ee; 1.866=d66-7779 `~ Account Number: STMH1242 GLADYS GARNER 100331 c/o JULIE BEIL PVT 641 VALLEY VIEW DR BOILING SPRINGS PA, 17007 Amount Due: 222.64~~ Amount. Paid: ~~~'~ ~ ~' Please Detach Here and Return Top Portion With Your Payment ---------- Invoice Date:02l28/2008, Acct#:STMH1242, GARNER GLADYS, Sarah Todd NC, B, DAVID DELL Date Rx Number Quan itV , Description B~4SZC~ S '' ?fix : ~ ~`l 12!27/2007 6076428 1.00 Levaauin Oral Tablet 500 MG $ 9.00 c $ 0.00 $ 9.00 RX 00045-1525-50 12/28/2007 6013871 4.00 Detrol lA Oral Capsule Extended Release 24 Hour 2 MG $ 9.00 c $ 0.00 $ 9.00 RX 00009-5190-01 12/28/2007 6013211 4.00 Fluoxetine HCI Oral Tablet 10 MG $ 3.00 C $ 0.00 $ 3.00 RX 49884-0734-11 12/28/2007 6076623 4.00 Mirapex Oral Tablet 0.125 MG $ 8.72 c $ 0.00 $ 8.72 RX 00597-0183-90 02/03/2008 6014141 30.00 Spiriva HandiHaler Inhalation Capsule 18 MCG $ 9.00 c $ 0.00 $ 9.00 RX 00597-0075-41 02/06/2008 6148387 85.00 SSD External Cream 1 % $ 3.00 c $ 0.00 $ 3.00 RX 49884-0600-85 02/10/2008 6151561 90.00 Albuterol-Ipratropium Inhalation Solution 2.5-0.5 MGl3Ml $ 3.00 c $ 0.00 $ 3.00 RX 00185-7322-30 02/11/2008 6151902 2.00 Levaauin Oral Tablet 250 MG $ 9.00 c $ 0.00 $ 9.00 RX 00045-1520-50 02/11/2008 6013207 102.00 Genebs Oral Tablet 325 MG $ 1.32 $ 0.00 $ '1.32 OTC 00182-0141-10 02/11 /2008 6013208 17.00 Aspirin Oral Tablet Chewable 81 MG $ 0.55 $ 0.00 $ 0.55 OTC 00904-4040-73 02/11/2008 6013209 17.00 One-Tablet-Daily/Iron Oral7ablet $ 0.49 $ 0.00 $ 0.49 OTC 00182-4440-01 02/11!2008 6013210 17.00 Diltiazem HCI Coated Beads Oral Capsule Extended Release 24 He $ 34.68 $ 0.00 $ 34 68 RX 00093-5118-96 02/11/2008 6013214 34.00 Ranitidine HCI Ocal Tablet 150 MG $ 50.74 $ 0.00 $ 50.74 RX 49884-0544-01 02/11/2008 6013520 8.50 GlipiZlDE Oral Tablet 5 MG $ 6.68 $ 0.00 $ 6.68 RX 00591-0460-05 02111 /2008 6013606 7.00 Dipoxin Oral Tablet 0.125 MG $ 5.33 $ 0.00 $ 5.33 RX 00527-1324-10 02/11 /2008 4000507 17.00 Hvdrocodone-Acetaminophen Oral Tablet 7.5-500 MG $ 12.56 $ 0.00 $ 12.56 RX 00591-0385-01 02/11/2008 6074879 51.00 Senna S Oral Tablet 8.6-50 MG $ 4.08 $ 0.00 $ 4.08 OTC 00182-1113-10 02/11/2008 6151540 4.00 Levaauin Oral Tablet 500 MG $ 52.49 $ 0.00 $ 52.49 RX 00045-1525-50 `v Bal - s r Last Pvmt Last Payment Finance ~}ia.' YTD F(n Cha C~Lh.~ ~ .: QTS ':r~~ LY~l''~';~ '=~"~I t .~ ~ "tea ~~- $ 0.00 $ 186.66 03/06/2008 $ 0.00 $ 0.00 $ 0.00 $ 216.20 $ 6.44 $ 0.00 $ 0.00 222.64 12!28/2007 4000507 01/03/2008 6106393 01/08/2008 6014141 01 /09/2008 6101354 01 /09!2008 6101353 01/28/2008 6013208 01 /28/2008 6013209 01!28/2008 6013210 01/28/2008 6013520 01 /28/2008 6013606 01 /28/2008 6013207 01/28/2008 6013214 01/28/2008 6074879 01 /28/2008 4000507 30.00 Hydrocodone-Acetaminophen Oral Tablet 7.5-500 MG $ 3.00 C $ 0.00 $ 3.00 00591-0385-01 45.00 Clotrimazole-Betamethasone External Cream 1-0.05 % $ 3.00 c $ 0.00 $ 3.00 51672-4048-06 30.00 Spiriva HandiHaler Inhalation Capsule 18 MCG $ 9.00 C $ 0.00 $ 9.00 00597-0075-41 30.00 Amoxicillin-Pot Clavulanate Oral Tablet 875-125 MG $ 3.00 C $ 0.00 $ 3.00 63304-0509-20 30.00 Florastor Oral Capsule 250 MG $ 22.00 $ 0.00 $ 22.00 66825-0002-01 31.00 Aspirin Oral Tablet Chewable 81 MG $ 1.00 $ 0.00 $ 1.00 00904-4040-73 31.00 One-Tablet-Dailvllron Oral Tablet $ 0.89 $ 0.00 $ 0.89 00182-4440-01 31.00 Diltiazem HCI Coated Beads Oral Capsule Extended Release 24 He $ 6.00 c $ 0.00 $ 6.00 00093-5118-98 15.50 GlipiZlDE Oral Tablet 5 MG $ 3.02 c $ 0.00 $ 3.02 00591-0460-05 13.00 Digoxin Oral Tablet 0.125 MG $ 3.00 c $ 0.00 $ 3.00 00527-1324-10 186.00 Genebs Oral Tablet 325 MG $ 2.41 $ 0.00 $ 2.41 00182-o1a1-1o 62.00 Ranitidine HCI Oral Tablet 150 MG $ 6.00 c $ 0.00 $ 6.00 49884-0544-01 93.00 Senna S Oral Tablet 8.6-50 MG $ 7.44 $ 0.00 $ 7.44 00182-1113-10 31.00 Hydrocodone-Acetaminophen Oral Tablet 7.5-500 MG $ 6.00 C $ 0.00 $ 6.00 00591-0385-01 RX RX RX RX OTC OTC OTC RX RX RX OTC RX OTC RX r v i P mf" La t Payment Finance Cho. YTCI Fin Chq. O her ~ OTC IV P ~R Total $ 0.00 $ 84.42 01/15!2008 $ 0.00 $ 0.00 $ 0.00 $ 152.73 $ 33.93 $ 0.00 $ 0.00 186.66 •~, e Millennium.Pharmacy Systems East 2880 Bergey Rd., Ste. AA Hatfield PA, 19440 INVOICE 01 /28/2008 et" c. Amount Due: 186.66 L~ ti~ ,~ Dueby 2!27/2008 Billing office hours' Mon-Fri gam - 5pm. Toll Free 1-866-466-7779 Account Number: sTnnHl2ax 100331 PVT Amount'Paid: f `~~ ~ ~`~ Please Detach Here and Return Top Portion With Your Payment Invoice Date:01/28/2008, Acct#:STMH1242, BARNER GLADYS, Sarah Todd NC, B, DAVID DELL ~e f $3c Number~ l Quant,t y ~ Description I Amaunt ~ S alesT,~ I Total. ' _ IXB~, ` 11/28/2007 6013211 31.00 Fluoxetine HCI Oral Tablet 1D MG $ 6.00 c $ 0.00 $ 6.00 RX 49884-0734-11 11/28/2007 6013212 31.00 Folic Acid Oral Tablet 1 MG $ 2.97 c $ 0.00 $ 2.537 RX 00591-5216-01 11 /28/2007 6013520 15.50 GlipiZlDE Oral Tablet 5 MG $ 4.83 c $ 0.00 $ 4.133 RX 00591-0460-OS 11/28!2007 6013606 14.00 Digoxin Oral Tablet 0.125 MG $ 3.00 c $ 0.00 $ 3.00 RX 00527-1324-10 11 /28/2007 6013871 31.00 Detrol LA Oral Capsule Extended Release 24 Hour 2 MG $ 18.00 c $ 0.00 $ 18.00 RX 00009-5190-01 11/28/2007 6013214 62.00 Ranitidine HCI Oral Tablet 150 MG $ 6.00 c $ 0.00 $ 6.1]0 RX 49884-0544-01 11!28/2007 4000507 31.00 Hvdrocodone-Acetaminophen Oral Tablet 7.5-500 MG $ 4.64 c $ 0.00 $ 4.64 RX 00591-0385-01 12/10/2007 6014141 30.00 Spiriva HandiHaler Inhalation Capsule 18 MCG 00597-0075-41 NR $ 9.00 c $ 0.00 $ 9.00 RX 00597-0075-41 12/17/2007 6081423 45.00 Clotrimazole-Betamethasone External Cream 1-0.05 % $ 3.00 c $ 0.00 $ 3.00 RX 51672-4048-06 12/27/2007 6076428 15.00 Levaguin Oral Tablet 500 MG $ 9.00 c $ 0.00 $ 9.1)0 RX 00045-1525-50 12/2812007 6013210 30.00 Diltiazem HCI Coated Beads Oral Capsule Extended Release 24 He $ 3.00 c $ 0.00 $ 3.00 RX 00093-5118-98 12/28/2007 6013211 30.00 Fluoxetine HCI Oral Tablet 10 MG $ 3.00 c $ 0.00 $ 3.00 RX 49884-0734-11 12/28/2007 6013212 30.00 Folic Acid Oral Tablet 1 MG $ 3.00 c $ 0.00 $ 3.I)0 RX 00591-5216-01 12/28/2007 6013520 15.00 GlipiZlDE Oral Tablet 5 MG $ 3.00 c $ 0.00 $ 3.1)0 RX 00591-0460-OS 12128!2007 6013606 13.00 Digoxin Oral Tablet 0.125 MG $ 3.00 c $ 0.00 $ 3.1J0 RX 00527-1324-10 12/28/2007 6013871 30.00 Detrol LA Oral Capsule Extended Release 24 Hour 2 MG $ 9.00 c $ 0.00 $ 9.00 RX 00009-5190-01 12/28/2007 6013212 4.00 Folic Acid Oral Tablet 1 MG $ 5.27 $ 0.00 $ 5.27 RX 00591-5216-01 12/28/2007 6076623 16.00 Mirapex Oral Tablet 0.125 MG $ 9.00 c $ 0.00 $ 9.00 RX 00597-0183-90 12/28/2007 6013213 8.00 Oyster Shell Calcium/D Oral Tablet 500-200 MG-UN. " $ 0.19 $ 0.00 $ 0.19 OTC 00904-5460-80 12/28/2007 6013214 60.00 Ranitidine HCI Oral Tablet 150 MG $ 3.00 c $ 0.00 $ 3.00 RX 49884-0544-01 12'28/2007 6101354 1.00 Amoxicillin-Pot Clavulanate Oral Tablet 875-125 MG $ 3.00 c $ 0.00 $ 3.00 RX 63304-0509-20 BOILING SPRINGS PO BOILING SPRINGS, Pennsylvania 170079601 4134870007 -0097 02/29/2008 (800)275-8777 01:31:01 PM Sales Receipt Product Sale Unit Finai Descriptian Qty Price Price Forever 1 $8.20 $8.20 Stamp Booklet Forever 1 $8.20 $8.20 Stamp Booklet $4.10 i $4.10 $4.10 American Flag Bklt Total: $20.50 Paid by: Cash $21.00 Change Uue: -$0.50 Order stamps at USPS.com/shop or call 1-800-Stamp24. Go to USPS.com/clicknship to print shipping labels with postage. For other information call 1-800-ASK-LISPS. Bill#: 1000301968029 Clerk: 05 All sales final on stamps and postage. Refunds for guaranteed services only. Thank you for your business. ]C X YC :C YC :C 7C ]t 7CYC 7t W :C Y[Y( Y( Y<%7C r' * k :t ~ Y<Y!Y<X Yc X 1C )C YC :t :C JC :Y Y< x Yc YC 1C 1r ]1 ~ :t :r :t YI Y!'k Y( :C It ~ 7C X' 7t :C :t :t % :t 7c'K 7t 7C X 7t X' ;C >t 7t Y< Y~ Y(iC lk ~C X HELP US SERVE YOU BETTER Go to: http://gx.gallup.com/pos TELL US ABOUT YOUR RECENT POSTAL EXPERIENCE YOUR OPINION COUNTS ~~*~:~>r>r*~>t>r~~><~~><~~;~:~~~~:~~;:~~*>r>tx:~:~~:~~>r~x >r7C;F:Y;CYlYlY(7t:K ~1CICKY(M'~YlY(~YCY(X'>r 7t *Y(:t Yc AY(Yt'k Y(YC IC 1C 7t :r~ ~~ Customer Copy ~~~ `y~~U r7" PharM,Br.y Telet~hun,1~. c 7! .1 7i.r~ (7t~; ~ "''a 88x6 OZ!'~/0$ JJ:t:1AM THANK YOU 413 ;. ~131~#80i ~ t~ SHE<>rE~l, Hol f _ l~ iJESfFFtJ nr)LI i .':%9 F _ 12 WE` rFFN r~D! I l . `.)9 F _ . 12 fJE`itE.f"tN R011 1.'D9t~ . BRK~i1a !)l~r: ~fJ, 113.<Jq.F fRUTf If~'f''; ~~.; p 1 .~9 F ',~ REl_ISN ffAr ,~Pt Zri.`!5 {_ fAX NFIU 15.;)5 **~+~TOTAL 'JO ACCT F;Et:E1V~it$1 E 72,>3~ _ CHA1•IGE 72.13 ~3 t' TOTRE. NIJMB[M ~ . , ~ M'~ `iUl_0 = 2,21/013 9 8 .5 Hhl ill ' {t'/ ~+-?3 . ; tJ015 v . ..._ ._ 1 .58 . _.-___ GNT PLA1~~ 55CT _--BC _ SC BONUSBlJY 2`.-9 T SAVINGS pr : ce 2.00 CUP5 S~~rPa~ N I • ~'9- f @ z 2. GIANT 09 gDBBTR SI E:9 r 2 @ _ eC SC •t.t8 i- BONUSBUY SAVINGS price f 2 f f(l Or q T-0. E14-I= GIF i SC BONUSBUYFSAVINGS BC 2 ;.> ~- .;aRfICpICEe ~pLBPay 2,OU •93-p_ COFFEE-MATE i6 1 39 I= NP 1 , 69 i= TOTAL $EFORE SAVINGS YOUR 7QTAL SAVINGS TOTAL AFTER SAVINGS 7AX PAID ****TOTAL ACCT RECEIVABLr CHANGE TOTAL NUMBER OF ITEMS SOLD ty 2/19/0$ 2:37 PM O1l[ ld 006i' !t5 ~~~Yr,~ $OIvUSCARD SAVINGS SUMMAfiY r~*BR,f ~RNUSCARll SAVINGS ~3.Z-• ~~i 1 rpl 0611T U1'C - ~.~. (6 5 . a~~~ 36.53 5.40 3t ~.-t C6 32.39 3? 39 n ~.~ ,~,.... PR 1'701~'«~ Contract Owner: Gladys B. Barner Contract # 072910728 AB I, Gladys B. Barner, name the following persons as the Revocable Beneficiaries of my Annuity Contract #072910728 AB: 1.0% to be divided edually to the following: 1. Ann Jordan DOB 8/18/1926 409 W. Louther Street Carlisle, PA 17013 2. Nancy Shaub DOB 7/24/1931 233 Locust Road Dover, PA 17315 3, Tnnn U zinc r L_--~ ae~~ o_ 1 u«~~~ 90% to be divided ecluall~to the following: 1. Julie Beil DOB 7/18/1941 641 Valley View Dr. Boiling Springs, PA 17007 SS# 161-20-1456 SS# 168-26-3556 SS# Unknown Q ~ e e. u s f= ~. SS# 168-34-1363 2. Deborah Kammerer DOB 4/2/1950 SS# 204-40-3002 4178 Kittatinny Dr. Mechanicsburg, PA 17055 3. Susan Bream DOB 3/1/1952 SS# 182-44-2607 Gettysburg, PA 17325 4. Barbara Reineke DOB 10/5/1949 SS# 175-40-120G 1371 Browning Avenue Salt Lake City, UT 84105 5. Elizabeth Patterson DOB 14/9/1954 SS# 205-44-0492 6218 Gentry Avenue North Hollywood, CA 91606 Owner's Signature Date Contract Owner: Gladys B. Berner Contract #072918682AB u w~ r1 ~ 3 ~, c ~ ~ l I, Gladys B. Berner, name the following persons as the Revocable Beneficiaries of my Annuity Contract #072918682AB SO% to be payable to the following: Linda B Brenneman DOB 3/28/1938 SS# 179-30-4634 25 Greenfield Drive Carlisle, PA 17013 50% to be divided equally to the following: 1. Cindy L. Bloser DOB 10/17/1960 SS# 182-40-8411 210 Barnstable Road Carlisle, PA 17013 2. Richard W. HarpeDOB 4/3/1965 SS# 182-40-8412 2985 Emerald Chase Drive Herndon, VA 20171-2325 3. James S. Harpe DOB 11/1/1961 SS# 182-40-8413 PO Box 216 Grantville, PA 17028 Owner's Signature Date