Loading...
HomeMy WebLinkAbout04-0437 PETITION FOR GRANT OF LETTERS Estate of JEANETTE F. KELLY i-~:,: No. also known as ROBERT J. BURCHFIELD PetitJo~e~(s), who is/are 18 yea~ of age or older, apply)ies) for: , Dec~[~edl~/t¥ '&~ci~ ~ty No.172-32-2347 (COMPLETE "A" OR "B" BELOW:) ~;t ~1 ,*ii~ A. Probate and Grant of Letters and aver that Petitioner(s) is/are the executOr [] Decedent, dated 3/17/2004 and codicil(s) dated named in the Last Will of the State relevant circu,~stances, e.g., renunciation, death of executor, etc Except as follows, Decedent did not marry, was not divorced and did not have a child bom or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: B. Grant of Letters of Administration (c.l.a., d.b.n.c.t.a.: pendente lite, dureute absentia; duraute minoritate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence at 325 Pinewood Ddve, Shiremanstown, Lower Allen Township _~'~list street, number and municipality) Decedent, then 75 years of age, died Apdl 2~) ~"' ,2004 , at Claremont Nursing and Rehabilitation Center Decedent at death owned property with estimated values as follows: (Location) (if domiciled in PA All personal property ......................................... $. (if not domiciled in PA Personal property in Pennsylvania .................... $ (if not domiciled in PA Personal property in County .............................. $ Value of real estate in Pennsylvania $ Total Real Estate situated as follows: 325 Pinewood Ddve, Shiremanstown, Lower Allen Township, Pennsylvania 17011 i~VVeherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in appropriate form to the undersigned: . . _ '~vv/.,4_,.~ .,,, Typed or pdnted name and residence Robert J. Burchfield - 325 Pinewood Ddve~ Shiremanstown 110,000.00 180~000.00 290~000.00 Oath of Personal Representative Commonwealth of Pennsylvania County of CUMBERLAND The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as~ p~ersonal representative(s) of the Decedent, Petitioner(s) will well and truly adminis~r.!~e esl~te ~,cordin~/~to Sworn to and affirmed and subscribed before me this, I-3L't~-~ ROBiE'l: ~B'~R~I-FII~-- u _.-i ~ ~ -F, ~:~ day of DECREE OF REGISTER Estate of JEANETTE F. KELLY also known as Deceased No. o~.1 - (~ ~-~ - ~-~ ..~'~ Social Security No: 172-32-2347 DatL~/Of Death: ,4/21/2004 AND NOW, ~"~0.~ ,~ , c~0~, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters I~1 Testamentary I-I of Administration ((c.t.a., d.b.n.c.t.; pendente lite; durante absentia; dumnte minoriate) are hereby granted toRobert J. Burchfield in the above estate and that the instrument(s), if any, date~Nlarch 17, 2004 described in the Petition be admitted to probate and filed of record as the Last Will of Decedent. FEES Letters .................................... Short Certificates(s) ............... $ .. Renunciation .......................... $ Extra Pages ( I.T.R ....................................... $ ... JCPFee ................................. $ ~© ~O(~ Inventory ................................ $ Other ...................................... $ TOTAL ............................ $'~ tO. 0{~ Register of Wills Signature Attorney: Paul Bradford Orr, Esquire I.D. No: 71786 Address: 50 East High Street Cadisle PA 17013 Telephone: (717) 258-8558 1105,8{}5 REV 9/86 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as l.ocal Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 No. Local Registrar APR g 1 2004 Date COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH a VITAL RECOROS -'O CERTIFICATE OF DEATH L.~ FATHER',~,~ME MANT'$ NAME ENCE OF): I ~ ~ t~CE OF/NJURY - Al home. farm. street lact op/, office D~TE SIGNED (Mom~. Day. Yeao NAME AND ADDRESS O~ PERSON WHO COMPLETED ~AU,~OF~OEA~i~ r 'MEDICAL EXAMINER/CORONER On the bllll o! examlnltlon and/of inveatlgalion in my opinion death occurred It Ih illmlnnM' II stated .......................... '. ........... : ............. · Iai, date, and place, and dui to Ihe ClUie(I) &nd LAW OFFICES OF STEPHEN j. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 WILL OF JEANETTE F. KELLY I, Jeanette F. Kelly, of Shiremanstown, Cumberland County, Pennsylvania, declare this to be my last Will and hereby revoke all prior Wills and Codicils. I direct that all my just debts, funeral expenses, gravemarker and administrative expenses shall be paid from my residuary estate as soon as practicable after my death. I direct that all inheritance, estate, transfer, succession and death taxes of any kind whatsoever which may be payable by reason of my death shall be paid out of my residuary estate. 3. I direct that my entire estate be distributed as follows: I leave everything to Robert J. Burchfield. Should Robert J. Burchfield predecease me, I leave my estate to Tamara I. Gramley. I appoint Robert J. Burchfield as Executor of this my last Will. o The Executor of this Will shall have the power to distribute my estate in kind or in cash, or partly in either. I direct that no Executor acting under this Will shall be required to enter bond in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand this /'z~ day of -~,~. ~_~.l ,2004. ' JeanCte F. Kelly The preceding instrument cor~sisting of this and one other page was on the day and date hereof signed, published and declared by Jeanette F. Kelly, as and for her last Will in the presence of us, who at her request, in her presence and in the presence of each other have subscribed our names as witnesses hereto. WITNESS LAW OFFICES OF STEPHEN j. I-IOC~ 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 LAW OFFICES OF STEPI-m~N j. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 ACKNOWLEDGMENT State of Pennsylvania County of Cumberland SS I, Jeanette F. Kelly, the testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my last Will; that I signed it willingly and as my free and voluntary act for the purposes therein expressed. J 'ANETTE F. KELL Sworn to or affirmed and acknowledged before me by Jeanette F. Kelly, the testatrix, this ../'7 c~ day of 2004. , Notary Public/Attorney State of Pennsylvania County of Cumberland AFFIDAVIT SS We, ~,~~,.~ and~____.~Q.q).~.~, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the testatrix sign and execute the instrument as her last Will; that the testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testatrix signed the Will as a witness; and that to the best of our knowledge the testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. this Sworn to or affirmed and subscribed to before me by witnesses, / >Z:~,~ day of ~o~-~_z...._ ,2004. Not__ney I - .. Notarial, ....... I . .. Patricia A. Mecl~ N~,;.,v ::. 'hi COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 004181 BURCHFIELD ROBERT J 325 PINEWOOD DRIVE SHIREMANSTOWN, PA 17011 ........ fold ESTATE INFORMATION: SSN' 172-32-2347 FILE NUMBER: 2104-0437 DECEDENT NAME: KELLY JEANETTE F DATE OF PAYMENT: 07/20/2004 POSTMARK DATE: 07/20/2004 COUNTY: CUMBERLAND DATE OF DEATH: 04/20/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $30,000.00 REMARKS' ROBERTJ BURCHFIELD CHECK# 118 SEAL TOTAL AMOUNT PAID' $30,000.00 INITIALS: MW RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS CERTIFICATION OF NOTICE UNDER RULES Name of Decedent: Date of Death: Will No: JEANETTE F. KELLY APRIL 20, 2004 21-04-0437 To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served (via hand delivery) on or mailed to the following beneficiaries of the above- captioned estate on July 20, 2004: Robert J. Burchfield 325 Pinewood Drive Shiremanstown, PA 17011 Notice has now been given to all persons enlitt[~ thl~e/~ u~Rul~r~ except: No exceptions. Paul Bradford q,~, Esq. 50 East Street Carlisle, PA 17013 Phone: 717-258-8558 Capacity: Counsel for personal representatives C, ,vlMONWEAlTH OF PENNSYLVANIA D~ARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRIS8URG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BURCHFIELD ROBERT J 325 PINEWOOD DRIVE SHIREMANSTOWN, PA 17011 ___nn_ fold ESTATE INFORMATION: SSN: 172-32-2347 FILE NUMBER: 2104-0437 DECEDENT NAME: KELL Y JEANETTE F DATE OF PAYMENT: 04/20/2005 POSTMARK DATE: 04/20/2005 COUNTY: CUMBERLAND DATE OF DEATH: 04/20/2004 NO. CD 005228 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $2,400.00 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: ESTATE CHECK CHECK# 170 SEAL INITIALS: RSK RECEIVED BY: REGISTER OF WILLS $2,400.00 GLENDA FARNER STRASBAUGH REGISTER OF WILLS RE:V-I9XlEX{5-OOl '* COMMONWEALTH OF PENNSYlVANIA . DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 to- Z W C W U w C w .... ::.:::!It,Q u"'''' wll.U :1:09 uflD ll. " DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) KELLY, JEANETTE F. DATE OF DEATH (MM.DD-YEAR) 0412012004 ~APD REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT {jRlY OF~!Gl_l,\L USE ONLY FILE NUMBER 21 04 COlMY COOE 0437 YEAR NUMBER SOCIAL SECURITY NUMBER 172-32-2347 NAME PAUL BRADFORD ORR, ESQUIRE FIRM NAME (' .........) " -----.-- LAW OFFICES OF PAUL BRADFORD ORR TREPHONE NUMBER (717) 258-8558 DATE OF BIRTH (MM-OD-YEAR) 08/11/1928 THIS RETURN MUST BE ALED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MiDDlE INmAL) ~ 1. Original Retum o 4. Limited Estate ~ 6. Decedent Died Testate (__"''''') o 9. Litigation Proceeds Received o 2. Supplemental Retum o 4a. Future Interest Compromise (dale "'..... _'2-'Ul) o 7. Decedent Maintained a Living Trust (_ _ '" Trust) o 10. Spousal POW!I1y Credit (dale "'dealt .........,2.31..' "" ,.,.95) 03. Remainder Retum (dale ofdeall pm, to 12-13-82) o 5. Federal Estate Tax Return Required 8. Total NuntJer of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (_ Sdl 0) COMPlETE MAILING ADDRESS 50 EAST HIGH STREET CARLISLE, PA 17013 (1) (2) (3) (4) (5) 169,000.00 12,945.70 0.00 0.00 57,520.32 z o 5 ::J !:: 0- ct: U w a: z o ~ .... ::J 0- :E o U >< ~ 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held CorpoIation, Partner.;hip Of SoIlH'roprietOfShip 4. '-tlrtgages & Notes Receivable (Schedule D) 5. Cash, Bank Depostts & Miscellaneoos Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate BiIlin9 Requested 7. Inlel.V""," Translels & Miscellaneous Noo-Pmbate Property (Schedule G Of L) 8. TolaI Gross Assets (total Lines 1-7) 9. Funeral Expenses & Adninistralive Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule ~ 11. TolaI Deducllons (total Lines 9 & 10) 12. Net YUle of ~ (Line 8 minus Line 11) 13. Charitable and Governmental 8equestslSec 9113 Trusts for \\i1ich an eIeclion to tax has not been made (Schedule J) 14. Net YUle Subject to Tax (Une 12 minus Line 13) (6) 0.00 (7) 0.00 CD 239,466.02 26,867.17 212,598.85 212,598.85 31 ,889.83 31 ,889.83 J-- (9) (10) (8) 17,925.43 8,941.74 (11) (12) (13) (14) SEE INSTRUCTIONS ON REVERSE SIlE FOR APPlICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, Of transfer.; under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at coIateral rate 19. Tax Due 20.~ _ x .0 (15) (16) (17) (18) (19) .__ x.O x .12 212,59~.8~ x .15 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11.961 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BURCHFIELD ROBERT J 325 PINEWOOD DRIVE SHIREMANSTOWN, PA 17011 nnnn fold ESTATE INFORMATION: SSN: 172-32-2347 FILE NUMBER: 2104-0437 DECEDENT NAME: KELL Y JEANETTE F DATE OF PAYMENT: 04/20/2005 POSTMARK DATE: 04/20/2005 COUNTY: CUMBERLAND DATE OF DEATH: 04/20/2004 NO. CD 005228 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $2,400.00 I I I I I I I I I TOTAL AMOUNT PAID: REMARKS: ESTATE CHECK CHECK#170 SEAL INITIALS: RSK RECEIVED BY: TAXPAYER $2,400.00 GLENDA FARNER STRASBAUGH REGISTER OF WILLS H III.~,,,(I_~ I,r'\- (Ii~;() This is to certify that the information here given is correctly copied from an original certificate of death duly. filed with me as Local Registrar. The original certificate will be forwarded to the State VItal Records OffIce for permanent fIlIng. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate. $2.00 I '<j 0 -; "J ~~ .1 ? A~l-< ~ .i. 2004 I \.." '.-' ,J No. Date /) ~ ~:'istrar/;'41 A t'r '''~ 2/87 COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH 1. F. KE.LLY ,. F SlATE FilE lIIUM8ER SOCIAL SECURITY NUMBER DATE OF DEATH ,Mcnlh. Oa~,'8arl J. 1'12-.32 - :z34-'7 .. AMi/.....<o olootf ~.AME OF DECEDENT lFOfSl. M,dCll8, Last JEANETTE ------ Sex--- IllJ{;usr /I, 19:z.'l .. CITY, BORO. ~P OF DEATH gc;:,tylO AGE (laSl BwtMayj UNDEA 1 YEAR Month, Days UNDER 1 DHI H04.lrl MiIluI.. DATE OF BIRTH ,Month, Oay_ 'tean BIRTHPLACE rely <1M 31aleOf ~Cf&.gn Counlryl (!..ilmRJERJ..JIIli7) ... DECEDENT'S USUAL OCCUP,(J'!ON (~iv:o,~li~::O~:::zl,:f M I DDt-.E Sf)( MARtTAl STATUS.. Man.-cl N,~'r MaITittd. Widow.o, OivorCfd (Spec,ty) WI ~W~r, SUAVIVING SPOUSE (II """e. glve ma.oen namel liCENSE NUMBER FP Ooq(q:J L O~ _N wYlina lltI/nI3ERJ./lN/J lownatlip? 17d.D ~~~of MOTHER'S NAME iF~sl_ Moddle. Malden Sumamel II. IRENE R. I-EGo INFORMANT"S MAiliNG ADDRESS (Slreel. Cilyfbwn, S1a1e. Zip Code) # ,... .3.2-6- P/';'EtvU:l1:l /)Ii)it/e: SH//!,=/l1Ali/STOWI\! f1CIJN S VUlANIIj" :~<;.;, O:~~S~ITION Namtl of~ry. Cremalory . lOC,(fION.. CifylTown, Slatl, Z"IpCo4l ROLL-/NC GREeN MeMDfl.//l L- CA;n/lIi'~ ,1',;1- (7'" 1 21l;l. 2141. NAMEANDAOORE~OfFACIlITY 001 rn/f,o..}.lt:=r Sr, J.lA~/S,,1j,.J:'O- 22c. W.o~u",..J..e KlmfJ1EL FJ.4N~t..ItL '-f.tUY)f:,X,.)c_ o?A-'')'u7 DATE SIGNED (Month, Day, Yearl ..." r. l1b. COUl'lty ",-. DATE OF DISPOSITION (Monlh. Day, 'I'6ar) o AP,Qit...13,;1oo4 NoD IIIIIEDtATE CAUSE {f,nal dlseas8OfCOl"lOdlon rltSUlbnOlr'ldealt1l_ V\. ~ ~~ CA""C. '€ It DUE TO (OA AS A CONSEOUENCE Of)' <:., ~ -+0 .b.(\A, N ... ,ApprCllrimall I ifll~ be1WMn I OOMI and lSulh I : PART fl: OIMI signillc:anl conditioN; COIMribulin9 to death, but 1101 fIIlMU1it!9 in I'" UfIdIttyingalUNgiw..-linPART I. ~iaIy"condi'IiGroa if any, INding 10 mrnedi<Ill ~. Enter UNDERLYING CMJSE(o..easeOfIllfUr~ 1hlII1r'1Itiall\d&wlnlS 'esullnglfl~llAST DUE 10 (00 AS A CONSEQUENCE OF) DUE TO (OR AS A CONSEOuENCE OF)' w..s AN AUlOPSY PERFORMED? . WERE AUlOPSY FINDINGS A\fAjlA8t.E PRIOR TO COMPLETION OF CAUSE OF DE1JH? MANNEA OF DEATH DATE OF INJURY (MQflltl,Day.Year) TIME OF INJURY INJURY J(f 'NORK? DeSCRIBE HOW INJURY OCCURRED. Natural 0--- o o HomICide o o o ~E OF INJURY. Al home, farm, 5lreel.fac1ory, omc. building,elc_ISpec,I~1 .... YM 0 NoD M. 3Oc:. No Ace_ Sc.Iic:ide Pending II'IYlSltgation .MEDICAL EXAMINEAiCORONER On Ihebaele of Ill.mln.llon .nd/Ot' In....sllg.tion, in my opil'lion, dealh occurred el the tlml, dall, and place, and due to thl cau.e(.) and m.nner.l.lalld.............,.............,..,..........,.................. .""......,....".....,...,......... .., lX1 /1<4 /j' /1 o I...,a:z.~ "",0 No '(nO Couldnotbldelerrmned 2... 21b. CERTIf'IER ICheck only Oflej 'CERTIFYING PHYSlQAN (PhySICoan cefllly,ng cause oj dealh ~8r'\ allOlher PhySICllIn has pronounced dealh ana compleleClllem 23) To the... ot my Jrnowled"" death oc:cufTICI ell.. 10 tha !:aUM(I' and manl'l.' ae Itated. , >t. 'PRONOUNCING AND CERTIFYING PHYSICIAN (f't1ySlCoan tlOl1l prooounc'"9 aeatn and ceflllY'rlg to cause oj dealt11 To!he Met of my knowledge, death occurrlld at Ih.e IIml, date, al'ld place, and dUI to Ihl !:au..(a) and mal'll'le,.e .lal.o.. " ". WARNING: It. 's '1Ie'1a1Io alle'I""s copy or 10 duplicate by photostat or photograph. Hi05 112 500M REV 2-78 (100 Celt per booi<.) (FEE FOR THIS CERTIFICATE $2,00) CCMM(INWEAlTH OF PENNSYI.VANIA OEPAR rMErIT OF HEALTH-VITAL STATISTICS No.2 55342 5 LOCAL REGISTRAR'S C ;RTIFICATION OF DEATH Registered No. Residence )/' rst ,1..} ~- /l>~ Number Ii I/! 11./ r, Il ~;'l,f~ -' . 1 j~ ~ t, ( County / ) .~_,L 1,_ State Full Nanw of Dt.~ceased Place of Death Middle ..,==--~_iL~~:JL~ , Street City or Town JCi, County -r--- ... -'l'l < ,,,", Pennsylvania Hex /' . -11;",(..1- __ 1.J,,-->~ Date of lh,'ath I /I)~,r' ".....,J'....<it . f I Race tu-I. I c- Date or Birth .4.;-T ,1,) I r.~ ,'( Birthplaee '1 I Social Seeurity No. ,). t' i If .3 '; is''' --If?: l; L 1-,\ , ,~ ~. U r2 Marital Status 1// (, I~J.. n.. ?,y"-<;:, 1 ,t i v , .L.., O('('upation ) /t'~t..(, ( h,,'-~..t~, 1. '-_~ Veteran's Serial No. MEDICAL CERTIFICATE Part 1. Death was caused by: Interval Between Onset and Death Due To (e) d(,',ath but not related to the immediate cause given in immediate Cause (a) Due To (h) Part II. OTHER SIGNIFICANT CONIJITIONS: Part I (a) Accident. Suicide or Homicide How did injury occur Name and Title of Person 1. Li / t~ .. / Who Certified Cause of Death (M.D.. D.O., co;;ner, ~.E{' ,_ J ~:~ -~ ;:2;1 . Address IJ /Il.Ld .t~I' /,' _ L-L-/L<L/ Stre City II This is to certify that the infor ' tion here given is correctly copied from an t~ginal certificate ~f death duly filed me as Local Registrar, The original certificate will he forwar~ the State Vital Sx~stic.'s ()~ce fpr permanent filing. ~G.L.t.L P~/fv<./ 22,222 Local Registrar 01 Vital Statistics District No with (i-lo-Y1 Date at Issue 01 This Certi1ication 529 ~~rKlev Lane 2 c re!'\,A1dA'ssl 7104 H .rns.'u: ..' City, Borough, Township 11- 10 )/ Date Received by Local Registrar REGISTER OF WILLS CUMBERLAND County, Pennsylvania CERTIFICATE OF GRANT OF LETTERS ,..,... ~-(; '..~;:;~~4.., _~\ .' . /~....-- ~ -'.- .........--- ~...-, ...... -: :' ',(,> ~': ';: . , ~ 'I,. ;.: _ .. ~ ~ ~. _ 4'" ..... '::" ......." '"' ......-:;; ~ .~,;:;; ~ . . ,":"l> . . ~,. "~~.~"'t;' ..,,; 0 . No. 2004-00437 PA No. 21-04-0437 Es ta te Of: KELL Y JEANETTE F (Last, First, Middle) Late Of: LOWER ALLEN TOWNSHIP CUMBERLAND COUNTY Deceased Social Securi ty No: 172-32-2347 WHEREAS, on the 5th day of May 2004 an instrument dated March 17th 2004 was admitted to probate as the last will of KELL Y JEANETTE F (Last, First. Middle} la te of LOWER ALLEN TOWNSHIP, CUMBERLAND County, who died on the 20th day of April 2004 and, WHEREAS, a true copy of the will as probated ~s annexed hereto. THEREFORE, I, GLENDA FARNER STRASBAUGH Register of wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: BURCHFIELD ROBERT J who has duly qualified as EXECUTOR(RIX) and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 5th day of May 2004. **NOTE** ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE) LAW OFFICES OF STEPHENJ. HOGG 19S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 i/;:::) , :'--'-~ "'\\. /:7 ,I '.,j/ ','/ \ \ I ,-....".- } I \~--=:.:> LJ 1 J WILL OF JEANETTE F. KELLY I, Jeanette F. Kelly, of Shiremanstown, Cumberland County, Pennsylvania, declare this to be my last Will and hereby revoke all prior Wills and Codicils. 1. I direct that all my just debts, funeral expenses, gravemarker and administrative expenses shall be paid from my residuary estate as soon as practicable after my death. 2. I direct that all inheritance, estate, transfer, succession and death taxes of any kind whatsoever which may be payable by reason of my death shall be paid out of my residuary estate. 3. 1 direct that my entire estate be distributed as follows: A. I leave everything to Robert J. Burchfield. Should Robert J. Burchfield predecease me, I leave my estate to Tamara I. Gramley. 4. I appoint Robert J. Burchfield as Executor of this my last Will. 5. The Executor of this Will shall have the power to distribute my estate in kind or in cash, or partly in either. 6. I direct that no Executor acting under this Will shall be required to enter bond in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand this /'lIP; day of -Jj"og^ I!.l ' , 2004. \ '::( j./ . Jean~~F~~~IIY ~o..{~f LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 The preceding instrument consisting of this and one other page was on the day and date hereof signed, published and declared by Jeanette F. Kelly, as and for her last Will in the presence of us, who at her request, in her presence and in the presence of each other have subscribed our names as witnesses hereto. db,,'ffW . > WITNES ~, ,"/~.'" ." /:. '7.. 0". " i . c...' r_-............:__.~_<r:__ c.". ) L.._.c,~"'_.__ WITNESS LAW OFFICES OF STEPHEN J. HOGG 19S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 ACKNOWLEDGMENT State of Pennsylvania ss County of Cumberland I, Jeanette F. Kelly, the testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my last Will; that I signed it willingly and as my free and voluntary act for the purposes therein expressed. ( .. '-J / j , 'tl--y:>t-t::;:f.7i...t.._7' ,-~' ..e.L. "'I JANETTE F. KELL Sworn to or affirmed and acknowledged before me by Jeanette F. Kelly, the testatrix, this 17 c'-. day of '7?'ICI..""c.._.i_~ 2004. .- ("1 "..~ , .,' .,'.. I .-". ,J .' .."2.,v ?1::-1... c<" _...... ) )X.<:.-.,,{;_. Notary Public/Attorney AFFIDAVIT State of Pennsylvania ss County of Cumberland We, !)Q..vo,-<,.J_5d/IoI.M.f,t, and .),^.z;:::...-<.-<...,J':(~).,..t'"".c the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the testatrix sign and execute the instrument as her last Will; that the testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testatrix signed the Will as a witness; and that to the best of our knowledge the testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. ;:U'l~'r '7J .- --.... .-..... . /', \::'\.. ' ,-...~.,l:"j'-""l-L.A'.._A.-...C"._L~ ' --r)-')-12~~_f;L._. Sworn to or affirrTled and subscribed to before me by witnesses, this I '/"DL day of ""9-)_.)(,,--<-<::..(__ , 2004. -~~...l~L-"-~<_' {( .':P>u,"__.!_ / Not I ic/Attorney Notanal Sr~~;~ . . Patricia A Meek, I'JO;''''j\, "b;: I Middlesex Twp, Cum>","'",- I My Cornmissiorl ~U()S I Member, Penr1nylvt1niE! . -.-.,..,,~_....._~J Rb\j-I~O= EX4 ''''93)11>., ".~ If:.i',,' '~.". ~-: , " SCHEDULE A , REAL ESTATE C,OMftN)l'N'.JEA.LTH OF PENNSYLVA)\j!_:" iNl-n::RiT.4NCF Tl..Y Rcrum-.] RESiDFbiT DECEDENT ESTATE OF JEANETTE F. KELLY FILE NUMBER 21-04-0437 All real property owned solely or as a tenant in common must be reported at fair market value. Fair marke1 value is defined as 1he price at which property would be exchanged between a wiDing buyer and a wiDing seller, neilher being compelled to buy or sell, both having reasonable knowtedge of the relevant facts. Real property which Is jointly_ed with right of survivorship must be disclo.... on Schedule F. ITEM NUMBER 1. DESCRIPTION 325 Pinewood Drive, Shiremanstown, Pennsylvania 17011-6528 VALUE AT DATE OF DEAJH 169,00000 TOTAL (Also enter on line 1, Recapitulation) $ (!fmore space is needed, insert addttional sheets of the same size) 169.000.00 r: :zn:' , Mac Federal Home Loan Mortgage Corporation Owned by America's Savings Institutions seconllortgage Property Value Analysis Report 4-0505 R-1 Summary Report Borrower The Estate of Jeanette Kelly Property Address 325 Pinewood Dr City Shiremanstown Phone No. Res. NA No. of Rooms 8 No. of Bedrooms 4 Central Air DYes C8J No NEIGHBORHOOD Location DUrban C8J Suburban Buill Up DOver 75% C8J 25% to 75% Growth Rate D Fully Dev. D Rapid C8J Steady Properly Values D Increasing C8J Stable Demand/Supply C8J Shortage D In Balance Marketing Time D Under 3 Mos. C8J 4-6 Mos. Present Land Use ~% 1 Family ~% 2-4 Family ~% Apts. Change in Present Land Use D Not Likely D Likely Predominant Occupancy C8J Owner D Tenant SIF Price Range $ 70,000 to $ 650,000 $ 125,000 SIFamily Age ----1 yrs. to ----.1QQ yrs. Predominant Age 25 yrs. Note: Freddie Mac does not consider race or the racial composition of the neighborhood to be reUable appraisal factors. Comments including those lactors affecting maJ1<etability (e.g. public parks, schools, view, noise) The property beinQ valued is located in a suburban residential area in Cumberland Countv. PA. ShoppinQ. schools. and churches are located within 2 miles of the property. Full service shoppinQ is available at the Capital Citv and Camp Hill malls. approximatelv 3-5 miles. Public school students attend the MechanicsburQ School District. Emplovment centers are located in HarrisbuflJ. Camp Hill York and Mechanicsbura. SUBJECT PROPERTY Approx. Yr. Bh.19 72# Units ---.! # Stories 2 Type (det, duplex, semVdet. etc.) Detached Design (rambler, splh, etc.) Split-Level Exterior Wall Mat. Brick/Aluminum Roof Mat. Asph/FG ShinQle Is the property in a HUO-Identified Special Rood Haz. Area? C8J No DYes Special Energy-Effie. Items Insulation. The heat is Electric Radiant/BB. First Level: Fover: LivinQ Room: DininQ Room; Kitchen: Familv Room w/FP; Laundry/.5 Bath. 2nd Level: 4 Bedrooms; 2 Full Baths. Lower Level: Under Kit, LR, DR; StoraQe Comments (favorable or unlavorable incl. deferred maintenance) Property appears to be in averaQe condition. Interior access was obtained and information is from inspection and owner, SF from Courthouse Records. D Rural D Under 25% D Slow D Declining D Over Supply DOver 6 Mos, % Condo ~ % Commercial----1 % Industrial 10% Vacant % C8JTaking Place Frm. vacant land To Residential development ~% Vacant = Predominant Value Properly Compatibility General Appearance of Properties Appeal to Market Good D D D Avg. Fair C8J D C8J D C8J D Poor D D D PROPERTY RATING Condition of Exterior Compatibility to Neighborhood Appeal and Marketability Good D D D Avg C8J C8J C8J Fair D D D Poor D D [J COMPARABLE NO.1 324 Pinewood Dr. Shiremanstown 0.00 miles COMPARABLE NO.2 313 Glendale Dr. Shiremanstown 0.11 miles COMPARABLE NO.3 313 Somerset Dr. Shiremanstown 0.06 miles Baths: +4 335 -3000 +2 000 -5,000 1665 174235 Adjustments were Titie GA 000233L Date ATTACH CURRENT DESCRIPTIVE PHOTOGRAPHS OF SUBJECT PROPERTY AND STREET SCENE Estimated Market Value S 169,000 PA Certified General Real Estate A raiser as of 4-20 20 04 5-112004 Freddie Mac Form 704 1/B6 [Y2K] Form 704 - "TOTAL for Windows" appraisal software by a la mode, inc. - 1-800-ALAMODE GEORGE CLAUSER Subject Photo Page . - Borrower/Client The Estate of Jeanette Kellv Prooertv Address 325 Pinewood Dr CIIv Shiremanstown Counlv Cumberland State P A lio Code 17011-6528 Lender The Estate of Jeanette Kellv Subject Front 325 Pinewood Dr Sales Price Gross Living Area Total Rooms Total Bedrooms Total Bathrooms Location View Site Quality Age 1,954 8 4 2.5 Suburban Avg/Avg 32 Subject Rear Subject Street Form PICPIX.SR - "TOTAL for Windows" appraisal software by a la mode, inc. -1-800-ALAMODE Location Map ~ Borrower/Client The Estate of Jeanette Kellv Pronerlv Address 325 Pinewood Dr Cilv Shiremanstown Countv Cumberland State PA Zin Code 17011-6528 Lender The Estate of Jeanette Kellv ct .r .lJ . (.~, \\,~:;/ ~_ ,~. ~~. ~ l!: . ,;,...~ \'to ' --- ------~ ~ \'~ '1iC","" 'C '"'\ ~ "r.fiC'" , 1.l ---.,~~ ==-=--="0~ ,/, ~~,P- ~ n &:it-to C.nt~_BlYd'''',./ , ' <Ii ... Bfoo~af " tl ~ ',j o l' ,,-~---- ~ ~. ',\ , .' \9. '\"'. iQi\. .:=~~\" . -~~.~ .. ~ -'" '" -''{.-,' , ,"" o ~ '!j..' ~ '\<~J..>!"""":./ ' "J..~ :i8lb~.kl'lrj ~ ~ \~!;:> ' <\ \~\., \ '\ '~, Jp- " ' \.:; " ,'" It '\'" !....;.(' \:\" .....x~4- :/ ,,',....---. " ,Y' \,' .~ "" j ,~~;~'~, / ~\.-'~iO'r>\~'i . .\* ':\ "k~ '( ......~ \..'....' j>I.~., ..' ..,~.,., "'. ."~,,, ~7 x' .........- ' '.' ""'--.Ill:#-. .\'1 .. 'P.,. ,..04- J1.-~;;:-:"'.v--'-""" . .",/!W~"""~. ,!~ '. \: ....,., ':~lf! J........-. .'. /OIl'"'' /' ... ~.....-' >tlSllall .... .\ .. ;l ' ~j'\, " ,-'......~ Shiremanslown. \~ ","~ / -, --'"\ \,,~A \.'( i:. . U'l- ._, ,,<r('Y' ,", v $\ 1~1: ,''''' . ~ "'~, '. .,..;. ,<, " "".tfotI1\.....\ .' ". ~~:~:~~>, c~\; \~~~ ,,'<:;~'/'l'/ , '!f1!~"" '<~ \;:~':t~ /~"( /;:;;(/ (Ii . (,/ \~<:: '. .. \",-#,:/ "'>:/ \~.... ,,' / .", ",' \ '~'-"""" \ "'<,/(^\,,<, """'~~::// ..,f~:'~''''~ t. /_ \ <1, d .,' :,r r .' . . .' i ,/ ,/ /'/'","'l., 15>> \, ~ j" \ \ :'~' ~ I' .- / ,/ ) ,</ ~.~'"'~<~'" ". ~... \~.., " . ;t<:fl*" ~.1)1) . I . ' ./ '/'~rJi18 /.... '<#;"""', ," \C' ~,.., t, // ,/ "''''~\...~~~~,:'''/~< ~ \"<'C:0 J,>:;#//' J!J"j; '.'~ t 1 '. . \ 'v';'/ ,.,^,"~ "~~, .... j /~ \ '> ,/\ ) / /' ~"'.,.., \ < . ....<@. \~;:;"t.'." <~,~/;/ If '~O' 'i. ',",/ ,/ /""", \ <</ ///J;~;)4.~~'%~) 'r;;. // ../..../t/. //4.';"'~~'ll'<"-<:O" / J. /'~' //,><~/,. ,""- "a: >?' ....' ,/>'" ..' ,,1/-" ~"'/," '''~''" ~'I''' \, 8 ./ /,/ ,,,\0. '''''-', "'~ ," I {'" '> <~~. /<:' /,/D/;~/~i,fi~i~"~I.~":'~ '\:://~ ~~" / / , 'Il ~/ //;/#',> ""Ylrb 'Z~ ',< ~ 1 ;, ~~,,, ~~71 :12>/~~~~~'3~t~'~~~~'~ (i' ll', 1/,., ,...( '~-'-' , . ',' . , ~c::/F~/:/, <. ,,\\-~\\\~nam~9' \ ./ /'" ~- '\ . \,'(). ',,'\ i#'. ,/ /' , , \. \j t A.~. " &:it to ~oSsm~yn. Rd \ . '\\ <~ ~ ..",o' /0/ \, " ,\!, < ;/'/ / /' ""':'" \ \, ...<. ~ > ""'/ // //, \ "\ v/\:~," .... '~.' ()~"""f .//./ \ \., ~ \~ ~q it>' ///._.~>/'" '\\, , \~~, ~:-'--::J / /../ .' \,~; /~ /,/ /;. ..... i co ~ \li<llio'a Rd ;1' :;! '& 'iI \~\ \~ ''1. "C5l -.L.., ./ /.>{~ . ,{", ;'>-~:..f.,~ \. '.~ LOri Clr \\~ .;:~. "....... .-.1.~~-'t-- .~... :.-.:,.--.... ""'\'- #lQl. ~~ _Tl"j'wl> ~.- . p.-.e ~ Jf!-__.", " '~;~/;~;,; ..." ' ;.~;" \.h.''''~O. ".'.: . ....~<ll-.......:~ '\.~a ""'-<'" "--~, ''-<" \.<;i, '\ 'J... 1,/ .'t' ...~.-~ "./'j)~/,v'f, .. './. >..... :~. '~.....,...'... ...,.........q,~./ ,,' -" ,c" '" / ~,/' >", -.$' ~(/> ~ 1l \ ~ ;~, .,(~ \!1Clepe<1lle<1ce"''''' / .". / ,/'// /' c,/'/' -' '.'f1 ':7<6 ".*-<:0 '~~U" ..... / .~.'" .', \~.p,/ . // .(j:' ..,V/>"/ \p, Form MAP.LOC - "TOTAL for Windows" appraisal software by a la mode, inc. -1-800-ALAMODE REV.1503 EX+ (6.98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF JEANETTE F, KELLY FILE NUMBER 21-04-0437 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 DESCRIPTION VALUE AT DATE OF DEATH RYAN BECK & CO, PERSHING llC 9,132.62 2. ALLIANCE BERNSTEIN GOVT RESERVE MONEY MARKET ACCOUNT 469.33 3, WAYPOINT FINANCIAL CORP 120 SHARES 3,343.75 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 12,945,70 >- g g c 'J (', C d n ", ~ "0 :0 " ." " ; [ b ~. '" '" ~ 't r- S ". \ \; i\ i'i i.~ s." i i l~ F~ \'g: ;g ~? .~~ ~o: \~ ~'"i h \i ~ F~ \i~ ~ '" '" ~ V' '" C>- g 9 )II w o,q,. - _ rT' 0' -g 2" 1 9!- a . ~ ~CJ) i """'-(yl.p...... ~ ~ ~ !.t ~,;;;~L t 'S .. .c g B B \.t ,~~ll ,\\\1111\111\11\\\\\"'.' ~~l ~~~\ '-";;0 --;'0 . ~8i 0"\:5' o ~ ~ '< c: "2 "2 "fi ~ m "2 Cf.l(;J"d..... ';l:, Iv t<l ';Xl .....UlfJ,?-- ,~~~ z~O(:;.l ~Of.?: ~g0~ 7.d~~ .,; ~ 0 t<l ?--~c>-<l ..... Cf.l"G; ~ ~r ~ 0~ Q-, ,.;j' cJl 0 tv r r:p 0 ~ d :s . 0 _ 0 ::::g :. g :=,.. -~ . ,.. . 0 . 0 . n : ~ -" - ~ L~ =- - =- - :- - =- - =- =- =- =- =- :- =- == i\ 19 \\ ~ " \\~ \~n _ s ?:: HI"- J~~ ~ 1Jl \~_J \\0 i. 10C~t ~f t -::>2" .. \ \ .~C;?" E' ro~~ ~ t3~~ l-. ... % '" \ ~\\~ ~ '1' g ~.~ c:~ ,. ~. % , ..""" \ ii~ t It s~ 0' \ (\ ~~ '1 - I.&> , ~C4 \Q Q , s \ ... i:;l .... ~ 1 , " (p ~~ _ .... ~a' 4h 0~ ~e".I'" o CVJo..ollO..)!.. ~ g,;;;~~tls:. , ------ "0 e -I -I I ~t. '1'ii'.~~~iD-g t l 0 i ii:\"'0:P- <g ~ OJ ~ tp z ;2 ~- """ f =: ;0 - 7"';:;!' "8 " i:l ~V'ocP-UQS" 0 co:J:>rT1:;;O-- a ~ - I C:CJ900~ ~ t("\ .. ~ 0 "",%"'V' n"'Cl .. l ! ~ ~---\""oZQ)' ~ %. VI~ ;on-oC:- '" - t .. tT1063("'l '" -. 0 ~ ,g- o rTlg 'C:\,~c:r$ .. - ;;;::... _ ;;;:: ro 5 c::: 0. ;P"~ Z;p-"\!! '2 ~. .. r=-o;o 0~-n~ - E a @",,:::J ,-<;:; .. ~ i i ;;0.'50 ~;;;::a g ::;) S. 11\ :'-<'t....Jt'-> z" ~ ~ 'Z~b z - ~~@ ~ t ~ e 0 n\:3 ?6 ~ 1'0'> tT) '" i 8 Z a ~ ~ ;;;:: l ~ 0 0 C' a :a % e. \ 0' <> ~ .. -n g 13 :::J. ~ z c '3 ~ en >> -n J> pJ CJ .b 0 >:< '" ':'. '" i i $ il - O'tf~i' ~ -c:e I&: I&: ~ i-,,=rl ~.~ t~~ 0 " a -<""- t. .:=> ~ VI ~F3" 0-"", .. "'" " '" i-~~a. '" it ~ g 00- e. 3"= ~ ii il ~mrT1;' a .." . 1S 'P <B c.. -@... it. ~ , i=' - "".~ a "';p g g 8 g ill- C\ !~ i ~ ~?=\ ~?' <8 ~<;:; ~ ti 'g { s {~ it ..,. "'" t~ cP .... f $. !t l~ <B 1S Ji F? i=' ii u 8 g g Is. ~ 00 00 H ",0 ~~ l ~o: t~ 'S i"i 'S 1S 'is' 'i.f i=' ,I -h ~ I a.. ~ t:l t:l iff .... \\ .. ." i'iF c ~ - ::::j ..... e ii s.. ~ tt o~ F~ .Po <.0 '" .... U"l trl tJ 1; ... O'~ilI: t"\ i ." rn....V'I-.J;:;:O.,.,~< n 0 0 c: 0 a III :t~~~;;-;~~g 0 loT",,,, 0 ~ f =. 0 -~.! 11>>-0 ~OJzz-=.", g =::r ;::0- ;7C:::::!"! 0 ~ ~ ill: III )000 o",,-o@:!I 0 ::s D.= o::l)>~^,c.5 a ~ .! ~ Do - 0 -. A.ID C:CJ7'<oo = ~ =- t"\ 0 "Z^'Vl n~n It " III ill: !a- lii ~ -<-;""OZ-' (/, ~ ;;<J"-OC::!!!. .. '0 ::s III '" ::I: 8 Do 01- =- ., en 0 6 :3 n (II t"\ !l- E 0 ,.,,117 C!:\- '-'-erO It " III - s:!!lz 2S:0;= ~ '" I: Do ~;:'- n;P'.;S =- i' -. '-coO ~--n_ ::I @g;::J .-~! -. "' ~ .c:a )0 ;D " ;::0,--,,0 -<- I: ... i! ~ t-..J tv z.. ... III ii' ;; :t>l.N-J:,. Z - z-"-' -on ::I z: <0'0 ;D n III en"''"'' ~ .... "IV 0 i! m Q ""~ ;;<J ~ m .. n z a z: 0 ~ So s: .. "8 -. z: 0 C\ t :I 0 ~ o' '" !a ::! ~ '" .... (Xl 0 ~ S rn .... '"' f!J C< i i ~ ff - !O i~ei'~ :I ~:e ... ... ... a ... ... ... ::l :::r--" -'ID - ... ~117 CI 01 () :co ~ s: a -<~ r &::=3~'" ID;; "'-"'Ill It III ., Ig-SCi, ... '" (II ii ;;! .,.00_ c: ~ i i 13"'a i ff 'Oi:1 a ... . ~ 1lI;;<J I I a -, -< ll: ll: ll: ...;>> '" 3:Z ~ IlJ Ill"" ~ "'Pi ,.."" ~ !1" <0 !!!.s: fs c !'! <;R it I'V ~ to' 0 ~ ~,! J>. !I.!O' C:N I' 00 ! is' H (l l'ii' ~ ~p ~ Ii Ii s ss 00 u a S8 . S ~. ii e ee f... i:z il .H :i Ul UlUl ii H ... Ii .. p ~l - .... t:Jo~ Fi:g a. i .... toJi..Nill .... en '" SAVE THIS STATEMENT FOR TAX PURPOSES Investment Plan Statement for Shareholders of 5024 WayeN2!fc!t If you have any questions regarding your account, please contact Investor Relations at 1-800-368-5948 or at info@rtco.com. Internet: rtco.com ( ROBERT J BURCHFIELD EXECUTOR ESTATE OF JEANETTE F KELLY 325 PINEWOOD DRIVE SHIREMANSTOWN PA 17011 Issue# 5024 Account# 1701511018 Stock Symbol WYPT Dividend Reinvestment Information OPTIONAL CASH INVESTMENTS MUST BE RECEIVED FOR NEXT INVESTMENT DATE BETWEEN 10/08/2004 AND 11/09/2004 Record Date: 08/05/04 I Payable Date: 08/13/04 I Reinvestment Option: FULL REINVESTMENT FOR PLAN SHARE RECORD DATE SHARES ENROllED IN REINVESTMENT Amount Withheld From Gross Net Amount Securltv Certificate and Book Shares i Plan Shares iTotal Reinvestment Shares Rate($) Gross Amount($) Tax($) I Fee($) Relnvested($) Common Stock I I I Plan Account Activity Date Description Fees andlor Net Dollar Price per Transaction Total CommissionsC$l AmountC$l Share($) Shares Shares in Plan Balance Forward 06/22 CREDIT SHARES - OTHER 120.0000 120.0000 07/08 FULL LIQUIDATION 120.0000 Year- To-Date Investment Summary Total Tax OptionalNoluntary Discount Fees and/or Commissions Tax Reportable Company Paid Dividends($) Withheld($) Investments($) Income Paid by You($) Fees andlor Commissions($) Total Total Holdings and Market Value (Value of all shares are based on last purchase price) Security Certificate Shares Book Shares Plan Shares Total Shares Price per Share($) Market VaJue($) COMMON STOCK ACCESS YOUR ACCOUNT ONLlNEI You can access and manage your account online through the Registrar and Transfer Company website. To login simply go to www.rtco.com and click on "Online Services' to apply for a User ID and password. W · t ROBERT J BURCHFIELD EXECUTOR Transaction Form aynoln ESTATE OF JEANETTE F KELLY r=:'NANCIALCORP. 325 P INEWOOD DRIVE Partial Withdrawal Continue Plan participation SHIREMANSTOWN PA 17011 Issue a certificate for I this number of shares Sell this number of shares I Issue#: Account#: 5024 1701511018 Slgnature(s) for Issuance or sale and/or change of address, .. Medallion Signature Guarantee required for sale request of $10,000 or higher. All joint owners must sign. Names must be signed exactly as shown on this statement (PartnerlOfficerrrrustee must sign as PartnerlOfficer/Trustee.) Optional Investment Make check payable to: Registrar and Transfer Company Amount enclosed in U.S. Dollars: I I Your Optional Investment can be a minimum of $250.00 per Investment and a maximum of $2,500.00 per quarter Full Withdrawal Terminate Plan participation D Issue a certificate lor all full shares and a check for fractional shares D Sell all Plan shares Address change or share transfer Mark box and complete the appropriate portion on the reverse side . D This statement provides a record of your account activity and balance. If you write to us, please include the issue number, your account number and daytime telephone number with area code in your correspondence. Please note: Some dellnltlons outlined below may not pertain to your Investment Plan. If your account Is In a Direct Registration Program that does not offer dividend reinvestment, most of the deflnhlons below will not pertain to your account. A GUIDE TO UNDERSTANDING YOUR STATEMENT Record Date - The date on which shareholders must be registered on the books of the issuer to be paid the declared dividend. This includes shares held in cer- tificate form and book entry form. Payment Date - The date the dividend is payable. The purchase of shares for your account with dividend funds usually begins on this date. Reinvestment Option - The manner in which your dividend is reinvested andlor paid in cash. Rate - The dollar amount of the dividend paid per share or the rate of stock dividend or stock split. Tax - Any taxes withheld in accordance with IRS non-resident alien back-up withholding or tax lien requirements. Net Amount Reinvested - Gross dividends on eligible shares less applicable taxes, fees or charges. Price per Share - The price per share purchased or sold under the Plan. Transaction Shares - The number of shares acquired or sold through the Plan. Total Shares In Plan - Number of shares held in the Plan account as of the transaction date. \ L Total Dividends - The gross amount of dividends reinvested, paid by check, and electronic lunds transfer. OptlonalNoluntary Investments - The net dollar amount used to purchase additional shares of stock. Fees and/or Commissions Paid by You - Fees andlor commissions paid by you as outlined in the Plan. Tax Reportable Company Paid Commissions - Commissions paid lor you by the company. This figure will be included in the dividend income reportable on Form 1099-DIV or 1042S. Total - The total sum of net dividends, optional/voluntary investments and other investments. Market Value - The total value of the shares using the average 01 the high and the low of the market sales price as outlined in the Plan description. The figure is used as the cost basis for the calculation of capital gains and losses. Please consult you tax advisor. TRANSACTION FORM OptlonalNoluntary Investment - Indicate the amount 01 your investment and send it with your check or money order to Registrar and Transfer Company, P.O. Box 664, Cranford NJ 07016. All payments must be in U.S. dollars and payable to Registrar and Transfer Company. No interest will be paid on funds held pending investment. W"hdrawals - You may withdraw some or all of your Plan shares, in accordance with the Plan provisions, by completing and signing the appropriate section of the tear-off form and returning it to Reinvestment Department at the address below. Pleasa Note: We are unable to sail shares you hold In certificate form. If the Plan provides, you can deposit and sell your certificate shares. All sales are processed as promptly as possible, and a check will be mailed for the net proceeds. We cannot accept standing Instructions to Issue or sell shares at spaclfled Intervals or prices. IMPORTANT TAX INFORMATION Where appropriate, paticipants will receive once a year, a report 01 dividend and reinvestment income on Form 1099-DIV or 1042S and a report of all shares sold through the Plan on Form 1099-B. When withholding takes place, it will occur lor either non-resident participants (N) or lor those participants who are not in compliance with all IRS regulations(B). When Initiating a transaction or address change, please use the transaction form on the last paae of your statement. Transaction Form Important - PIAB"" send OptlonalNoluntarv Investments to: Registrar and Transfer Company Alln: Dividend Reinvestment Department P.O. Box 664, Cranford, NJ 07016 All other correspondence or transactions, including withdrawals, change 01 address and transfers should be sent to the address above. For a Change of Address or a Share Transfer, pleaSB chBCk the appropriate box on tha reverse sIde. Change of Address Participant Name: Share Transfer: Transfer shares as lollows: Transfer _ Plan shares into the following name. Account name Address Account Taxpayer I.D. Signature(s) (All joint owners must sign) Daytime telephone number Medallion SI9nature Guarantee' New Address: Date . If you are transferring shares to another registered shareholder, you must otoIn a Medallion Signature Guarantee from an eligble financial institution or a member of a registered national securities exchange or the NASD pursuant to S8alrltles Exchange Commission Rule 17acf-15. Acc:ountTaxpayer 1.0. FORM 1099-8 2004 STATEMENT FOR RECIPIENTS OF PROCEEDS FROM BROKER AND BARTER EXCHANGE TRANSACTIONS 1701511018 I TAXPAYER IDENTIFICATION NO. (REQUIRED BY LAW) ACCOUNT NUMBER 20-6200435 PAYER'S NAME WAYPOINT FINANCIAL CORP COMMON 10 COMMERCE DRIVE CRANFORD NJ 07016-3572 25-1872581 ROBERT J BURCHFIELD EXECUTOR ESTATE OF JEANETTE F KELLY 325 PINEWOOD DRIVE SHIREMANSTOWN PA 17011 1b) CUSIP NO. 946756103 INDIVIDUAL TRANSACTIONS 18) DATE of SALE 7) 2) 4) FEDERAL INCOME LAX WITH-1lELD DESCRIPTION GROSS PROCEEDS 07/08/2004 LIQUIDATION 3,343.75 Instructions for Recipient Brokers and barter exchanges must report proceeds from trans- actions to you and to the Internal Revenue Service. This form is used to report these proceeds. Box 1a. shows the trade date of the transaction. For aggregate reporting, no entry will be present. Box 1b. For broker transactions, may show the CUSIP (Committee on Uniform Security Identification Procedures) number of the item reported. Box 2. Shows the proceeds from transactions involving stocks, bonds, other debt obligations, commodities, or forward contracts. Losses on forward contracts are shown in parentheses. This box does not include proceeds from regulated futures contracts. The broker must indicate whether gross proceeds or gross proceeds less commissions and option premiums were reported to the IRS. Report this amount on Schedule D (Form 1040), Capital Gains and Losses. Box 3. Shows the fair market value of nay trade credits or scrip credited to you account for exchanges of property or services as well as cash received through a tarter exchange. Report bartering income in the proper part of Form 1040. See Pub. 525, Taxable and Nontaxable Income, for information on how to report this income. Box 4. Shows backup withholding. For example, persons not furnishing their taxpayer identification number to the payer become subject to backup withholding at a 31% rate on certain payments. See Form W-9, Request fro Taxpayer Identification Number and Certification for Information on backup withholding. Include this amount on your income tax return as tax withheld. Box 5. Shows a brief description of the item or service for which the proceeds or bartering income is being reported. For regulated futures contracts and forward contracts, "RFC" or other appropriate description may be shown. Box 6. Shows the profit or (loss) realized on regulated futures or foreign currency contracts closed during 2000. Box 7. Shows any year-end adjustment to the profit or (loss) shown in box 6 due to open contracts on December 31, 1999. Box 8. Shows the unrealized profit or (loss) on open contracts held in you account on December 31,2000. These are considered sold as of that date. This will become an adjustment reported in box 7 in 2001. Box 9. Boxes 6, 7 and 8 are used to figure the aggregate profit or (loss) on regulated futures or foreign currency contracts for the year. Include this figure on your 2000 Form 6781, Gains and Losses From Section 1256 Contracts and Straddles. REV-l508 EX+ (6-98) .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHIDULI I CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF JEANETTE F. KELLY FILE NUMBER 21-04-0437 ITEM NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All praperty jointly-owned with right of survivorship must be disclosed on Schedule F. 1. 1973 CADILLAC DEVILLE DESCRIPTION 2. 2000 BUICK CENTURY CUSTOM SEDAN 3. WAYPOINT BANK - ACCOUNT NO. 0108148701 4. PSECU - ACCOUNT NO. 0172XXX 5. PNC BANK-ACCOUNT NO. 5001116737 7. AFLAC INSURANCE BENEFITS 6. WAYPOINT BANK - ACCOUNT NO. 0560001333 A 07/07/04 $ 400.00 $11,240.00 $ 5,540.00 B.06/14/04 C.07/08/04 D.07/08/04 $ 8. IRS TAX REFUND CHECK (TAX YEAR 2003) 9.41 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) VALUE AT DATE OF DEATH 3,300.00 5,695.00 4,228.56 16,542.07 3,492.41 135.19 17,189.41 6,937.68 y---- NADA Appraisal Guides - Get a Val~e- Page 1 of2 NAD_~sl"'----'''' Free Vehicle PriCIng & Information Buya Vehicle I Find a Dealer I Sell your Car I Get an Auto Loan I Free Insurance Quote I Vehicle Inspection I Check Your Credit Home I SutJ;;ccib~to Trade (3uiq,,;; I S'te Map I F J You are here: Category> Make> Year> Model> Vehicle Options> Vehicle Value Report> Get Another Price I Classic Car Consumer Prices 1973 Cadillac Deville 4 Door Sedan April 27, 2004 MSRP Original Manufacturer's Suggested Retail Price when new $6,500 Low Reta" Base Price $1,775 $3,300 $5,050 Total Price $1,775 $5,050 $3,300 Other Vehicle Information Model Number: Weight: N/A 4985 Value Explanations Low Retail Value This vehicle would be in mechanically functional condition, needing only minor reconditioning. The exterior paint, trim, and interior would show normal wear, needing only minor reconditioning. May also be a deteriDrated restoration or a very poor amateur restoration. Most usable "as-is". Note: This value does not represent a "parts car". Average Retail Value This vehicle would be in gODd condition overall. It could be an older restoration or a well-maintained original vehicle. Completely operable. The exterior paint, trim, and mechanics are presentable and serviceable inside and out. A "20-foDter". High Retail Value This vehicle would be in excellent condition overall. It could be a completely restored or an extremely well maintained original vehicle showing very minimal wear. The exterior paint, trim, and mechanics are not in need of reconditioning. The interior would be in excellent condition. Note: This value does not represent a "100 Poinf' or "# 1" vehicle *. * "100 Poinf' or "# 1" vehicle is not driven. It would generally be in a museum or transported in an enclosed trailer to concourse judging and car shows. This type of car would be stored in a climate-regulated facility. II Other Information You I Might Need... For this vehIcle Print Report . EtnaiL a friend . SelLYour Car Other services . !'Jew Car Q~.al~I Quote . Car Loans,A.24% APR . Insuranc;~CLLlQtEJ . yehlclEJ l-:Ii~t9JY . Extended Warranty . fREE VIN check . GEJtLoJack at a dEJalElLnear you. . Auto Transport . c;liI!>!>igcar.bLJyiog tip!> . DMV forms . Go ~c;kYQLlLC;I~glt . Part~ILAc.cEJ;;;;Qries . GarCarEJ GEJnter . Vehicle Inspection For a new car . Price a new car . CQmPaIEJsldEl,by,;;lde . New Car Reviews . Inc~otiYEJ;;.&-'3~tJate.s . Dealer Price Quote . lea'510ftLibI<3IY In other words Find out what you can afford with our "Lease or f".urcoas.e" caicuialDr c s I .. .NalueCategoryReport.asp?UserID=5308IAB IA0540&D1D=381 04&wSec=2&wPg= 1207cS04/27 /2004 Kelley Blue Book Used Car Values fA Kelley Blue Book . !!:!.~,T_~'!!!~"~_f!E~~~ ~/USEOCAR8' @) ~,!.;IJS;:K' . -.....". , ~ - REVIEWS & RATINGS ADVICE FINANCING I'. INSURANCE Page 1 of2 V6 luxury for under : o F_ Oe,II.., Price Ouot.. I:> Seatd1 UMd car Liillings ( BLUE BOO~UE ;.em Pennsylvania. April 27. 2004 2000 Buick Century Custom Sedan 4D . . . See Lpcal ListinQsotThis Car List Your Car FQrSale Online E3uy.a New car Free Lemon Check Auto Loans from 3.85% APR Insurance Quote Payment Calculator Current Model Features Engine: V6 3.1 Liter Trans: Automatic Drive: Front Wheel Drive Mileage: 26,000 Equipment Air Conditioning Power Steering Power Windows Power Door Locks Tilt Wheel AM/FM Stereo Traction Control Single Compact Disc Power Seat Premium Sound Premium Wheels Dual Front Air Bags ABS (4-Wheel) Consumer Rated Condition: Good "Good" condition means that the vehicle is free of any major defects. The paint, body and interior have only minor (if any) blemishes, and there are no major mechanical problems. In states where rust is a problem, this should be very minimal, and a deduction should be made to correct it. The tires match and have substantial tread wear left. A clean titLe histOry is assumed. A "good" vehicle will need some reconditioning to be sold at retail; however major reconditioning should be deducted from the value. Most recent model cars owned by consumers fall into this category. Trade-In Value $5,695 Trade-in value represents what you might expect to receive from a dealer for this consumer owned vehicle. Keep in mind that the dealer must then absorb the cost of making the vehicle ready for sale, advertising, sales commissions, arranging financing and insurance and standing behind the vehicle for any mechanical or safety problems. G_et" P"v"t~F)"rty V"Jy.!! Get Invoice & MSRP on New Cars http:.../kw.kc.ur?kbb.PA;300796;PA04I&170 11 ;+t&278;Buick;20000102OCentwy&5;BU;E 04/27/2004 5-07-2004 17;48':10 JEA1\JETTE F KELLY 325 PINEWOOD DR SHIREMANSTOWN PA Next display: ,0,5, 100009454 4-15-04 Checking Account Inquiry Current Statement for: Bal as of +Dep/CR: -Chks/DR: 9 " -Service charge: +Interest paid: Current balance: 17011-6528 Pst Dt Serial Number TC Description Amount X Eff Dt Str/Run/Bat/Seq# 041604 3814 081 CHECK 2794.00- 041904 3815 081 CHECK 5000.00- 041904 3804 081 CHECK 2406.00- 041904 3803 081 CHECK 2020.00- 041904 3801 081 CHECK 1186.00- 041904 3811 081 CHECK 24.60- 041904 3812 081 CHECK 3.24- 042104 3817 081 CHECK 78.39- F3=Exit F8=Recent trans F13=Inquiry window Fll=Fold/unfold F24=More keys F16=Print research stmt F15=Restart VIWayRQint BANK Way Better Banking only from Way point Bank Receipt - Acct. #: 0108148701 TLR #:0464 DDA Deposit TR #: 107 TR AMT: 4228.56 Date: 05/10/2004 Time: 10:56 ~., C Iosect/f _\ Wt<jfO'/l./ ele. Chec~s and other items rec~jved for deposit are sub'ect to the . . . deposIts are subject to delays in availability according to ~ank policy. provISions of the Un-iform- Commercial Code. Certain TEL.ol0(08I02) Thank You For Banking At Waypoint Member FDIC 20-0700-4 DSPBR00509 17,773.96 .00 13,546.02 .00 .00 4,227.94 Balance 14979.96 9979.96 7573.96 5553.96 4367.96 4343.36 4340.12 4261.73 More.. . Checking Account Inquiry Current Statement for: Bal as of +Dep/CR: -Chks/DR: 9 -Service charge: +Interest paid: Current balance: 5-07-2004 1 7 : 4 S.: 19 JEro'lETTE F KELLY 325 PINEWOOD DR SHIREMANSTOWN PA 17011-6528 Pst Dt X Eff Dt 042204 Serial Number TC Description 3816 081 CHECK F3=Exit F8=Recent trans F13=Inquiry window Next display: ,0,5, 100009454 4-15-04 Amount Str/Run/Bat/Seq# 33.79- F16=Print research stmt F15=Restart Fll=Fold/unfold F24=More keys 20-0700-4 DSPBR00509 17,773.96 .00 13,546.02 .00 .00 4,227.94 Balance 4227.94 Bottom PSEC.w. Account 0172XXXXXX KELLY,JEANETTE Document Number: 1989800 Effect: 05/10/04 Post: 05/10/04 Tlr: 0267 (See receipt for reference) ------------------------------------------------------------------------------ JEANETTE KELLY 325 PINEWOOD DR SHIREMANSTOWN PA 17011-6528 Account 0172XXXXXX KELLY,JEANETTE Document Number: 1989800 Effect: 05/10/04 Post: 05/10/04 Tlr: 0267 ------------------------------------------------------------------------------ (See receipt for reference) --------~--------------------------------------------------------------------- ',",'" ,'I'; NO STOP PAYMENT PERMITTED PSECU is obligated to pay this Cashier's Check according was issued. ' If the check is lost, stolen or destroyed pi 237-7328 nationwide or (717) 234-8484. ~C'_ ~2 ~ *!. '....,.,...; i,::,;,.:.i,i!i,'i'::';; PAY TO ':rHE , ~JmER ' " ',:OF', ESTATE ROBE ,3i?'S ,~'~R ,d "",.,.J ",:,,:':;,':.1.':,,0, ::,'\:,:,:r.::,':'i,',';:,'i/ R~~ ~~ ,~ ~! ~'?- II" ~ ~8 ~80QII" I" B n8~ ~ H,I: :;;~~"'.oc ','I,;,,'!'[,ii:,'::"', :,:I,I""",J,'i,ill,!,Ii",'11 'l'i'j,:I',i,i:':\'i',',i!ii:'i,I"'(!,';I"il,,:::,, i!'i',:i,',.',::,',:I,';:,:'"'i:;."i,,il'ii,l,',',':':i,i'i,',I'I':)!,:!I,I:',:":I; ';";"I,I . . . zi' ~~J,,~ PSE(i II11II111 P.O. Box 67013 (717) 234-8484 (Harrisburg) Harrisburg, PA 17106-7013 (800) 237-7328 (Nationwide) website - http://www.psecu.com Pennsylvania State Employees Credit Union DID YOU KNOW THAT YOUR IMMEDIATE FAMILY IS ELIGIBLE FOR PSECU MEMBERSHIP? THEY CAN APPLY AT WWW.PSECU.COM. 1",111",111"""11.,.11.11...1.1..,1,11,,1,,,1,1,1,1",1,11 JEANETTE KElLY 325 PINEWOOD DR SHIREMANSTOWN PA 17011-6528 JOINT OWNER PSECU Telephone Numbers Direct Inquiries to: (800) 237-7328 (Nationwide). (717) 234-8484 (in Harrisburg) TDD (800) 472-1967 (Nationwide). (717) 777-2100 (in Harrisburg) Member Service Telephone Hours 7 a.m. - 5 p.m. Monday through Friday 8 a.m. - 12 p.m. Saturday Self Service Telephone: (800) 435-6500 (Nationwide) (717) 236-9150 (in Harrisburg) Your ttiliing I1lghw - Keep tilill iIio1ice lor "utu... Use Thi. notice ccntaino impor1anl infDnnation about)'OU' riltdo and _noibililieo under the Fair ~BiUingAct. PIe_ write 10 uo at P.o. Box 87013, Harrisburg, PA 17108-7013. Send uo a oopy of your __nt. P_ keep al originals. In Can of Errors or Qu88llona About Your Bill . you lhink)'OU' biD ill ...-ong, or . )'Ou rwed mo.. irIormation about a _n on)'O", bill, write Ull (on a saparalo II-> at p.o. Box 87013, Harrisburg, PA 17108-7013, as 800n as poaoibla. We mual .r from )'Ou no _r than 80 day. _r _ &ant the firwt bill on which the .rror or plObIem ap..,.-.d. You can telephone Ull, bill by doing "" will not ___ your rigtto. In your _r, gi... uo the followire inlormalion: . Your name and acooLl'lt rumber. . The dollar amount of the auapocIIod arIOr. . Ducribe tM error and _plain, it you can, why you beliew theN is an enor. If you rwed mo.. infonnation, deecrie. ttw item you aN unaue about. You do not ha... to pay any amount in qUNtion while _ are imeatigatire, but you are atHI obligabodto pay the parte d your bill that a.. not in quaation. While we inW8ligalo your quNIion, _ cannot ..port you as dalinquent or taloo any action 10 oollect the amount you quaation. Spec181 Rule for CredltC.d Pur~ . you haw a problem with the quality d good. or --..iceo that you pu"'_ with a c_ caRl, and )'OU hi... triad in good faith 10 _ the problem lMth the ma",hlnt, you may not ha... to pay the ..mainire amount due on the gooda or ..-s. You haw thill protecIion only whoan ttw p&.R:hase price was more than $50 and the pUltlhaae was made in )Our home state or lMthin 100 mile& 01 )'Oil' mailire add_. (K _ own or oparalo the marchlnt, or H _ mailed )'Ou the advertiaoment for the plOperty or ,,_, an pu""- ... ~ regardlaao 01 amounl or location 01 p"""-.) Anance Chergee - 8IIIlmce Computation Pianoonol Service Loana and Horn. Equity Loana: We calclM18 the finance charge for one day by multiplyire the 'lJI1>8id loan balance' by the daHy pariodic ralo on your _. W. then calculala the .um of the finance chlrge for each day '--n paymenta. . the amount 01 tha payment or _ is not .<lficientlO pay the ...... calcdated finance charge, the ..maining "u.....ia~ tinance charge <*.rriH OWl'to N .....XI: payment or cl1Kit. The 'unpeid loan balance' _ 10 calculaM finance ""- ill the balanoa _ __ .re aubtrac:tad _ a~ or _ charga& are _. VISA Loana: You cen awid paying finanoa chlrgea by payire the New Balance of PlI'Chaoe& .ach month lMthln 25 daY" of yoU' _man! cIooire _. Otha_, the new baIanoa aI pll'Ch_ and aubaaquant chGrgaa from the daw they are poalod to your _nt are aubjacl 10 finance charge. Caoh.dvanoaa... alway. .ubject 10 finanoa chlrge from the day they are poalod 10 )'OU' acoount. Pu",-.: We O8lcUaw yourfinonce charge by mulliplyirethe __ edjuaIad daily balance, inducing new pll'Cha&as, for the biDing <:)'C1e bythl monthly periocIc pll'Chue raw. _: We celcUaw )'Our finance chlrge on caah acMoncaa by nUtiplyire the a...raga aq.-ddailybalanoafor caoh.dvanoaa during the billire C)'CIa by the monthIypariodic- ralo. The A_ Adjualied Deily Balance is 08_ by a...ragire .hI adjusted daily balanoa& d.nre the bilUre <:)'C1e. To colculata the Adjuallad DaHy Balance each dall _ teloo the followire olop.: We..... the oUlatanding balance (all amo......)'Ou owe) a.the atarI of the day. Than, in the _ in which amount.... poalod to )'Our aooount, we add the amounta of .. dabila and .ubtracl the amo...... of all_ which poat 10 your _nt that day. _ applyire payment. and oradHa, _ aubtract the amount of.ny unpaid Financa awg.. or Late awg... Then we aIoo aubtract the amount of any Cash Adwnca tranaaclion that poaW 10 )'OU' acoount on thet day or in any pravio.. day in the bilUre cycle. The reauft ill the Adjualed DeHy Balanoo for thai day. Note that Cash AdvAnce TransactiollE whch aAt posted to your aocourt are not included in the A__ Adjuallad Dfoily Balance calculation, and... therofora not.&J>jact k> the monthly pariodc rate for Pu_. The _rago Adjuallad Daily Balanca is calculated saparetely for Cash Ad..nca tranollcliona and ill .ubject 10 the Caoh Adwnce Monthly Periodc Rata. Rate Line: (800) 237-7328 (Nationwide) (717) 234-8484 (in Harrisburg) A, Complet8 thl. lI8Ctlon to balance your checkbookl 1. Errt.r 'ENDING BALANCE' amourrt from your 8latam.nt ..... $ (1) 2. Errt.r eny dapoaits you made that are not D8lad on thia atalaman~ include MAC deposits ......................................... +$ (2) ...............................................................................................+$ (2) ...............................................................................................+$ (2) ...............................................................................................+$ (2) (3) 3. Add Un.. 1 & 2 ........................................................................ $ 4. In part B. liat any checks you wrota that are not shown on your atatament. Include MAC withdrawals, SST tranat.... or auto transfers. (You identify theee by placing a check mark in your ragister n.xt to .1OCh check thai ia liatad on the atatam.nL) Place total on this line .................................. - $ (4) 5. Subtract line 4 flOm lin. 3 ..................................................... $ (5) The balance on lin. 5 .hould b. the balanc. you have in your checkbook. If you don't balanc., chack the following: 1. la your addition and aubtraction correct in your r&gister end in sections A end B1 2. Do.. the dollar amount of your check r.gister match the doHar amount on this staten..nt? 3. Are all d.posHa end withdrawals accountad for? B. Check8 and w1thdra_l. that are not on thl. etBtement Check Number Amount Total Pennsylvania State Employees Credit Union IIIIII111 P.O. Box 67013 (717) 234-B484 (Harrisburg) Harrisburg, PA 171 06-7013 (800) 237-7328 (Nationwide) website - http://www.psecu.com DID YOU KNOW THAT YOUR IMMEDIATE FAMILY IS ELIGIBLE FOR PSECU MEMBERSHIP? THEY CAN APPLY AT WWW.PSECU.COM. JOINT OWNER JEANETTE KELLY Savings Account Statement PNC Bank o PNCBAN< For the period 04/01/2004 to 04/30/2004 Primary account number: 50-0111-6737 Page 1 of 2 N umber of enclosures: 0 K JEANETTE F KELLY 325 PINEWOOD DR SHIREMANSTOWN PA 17011-6528 Q For 24-hour banking, customer service and interest rate information, sign-on to 'If Account Link @ by Web on pncbank.com or call1-888-PNC-BANK Moving? Please contact us at 1-888-PNC-BANK I2!SI Write to: Customer Service PO Box 609 Pittsburgh PA 15230-9738 a. Visit us at pncbank.com iii TDD terminal: 1-800-531-1648 For hearing impaired clients only PNC Investments Financial Consultants can help you prioritize your goals through a comprehensive financial portfolio. Whether you are saving for retirement, estate building, pUlling your child through college, or building a nest egg, goal setting is at the core of any investment plan. By taking the time to talk with you about your personal objectives and becoming familiar with your investment preferences, your Financial Consultant can find ways to make the most of your money and address each goal. PNC Investments Financial Consultants can be reached through our Customer Service Center at 1-800-762-6111, its website at www.pncinvestments.com or any local PNC office. * PNC Investments LLC is a subsidiary of PNC Bank National Association. Investment products are not FDIC insured, may lose value and are not gua,'anteed by PNC Bank or its bank affiliates. Savings Account Summary Account number: 50-0111-6737 Account Link @ number: 0172322347 Jeanette F Kelly Balance Summary Beginning balance 2,717.85 Deposits and other additions Checks and other deductions Ending balance 774.56 .00 3,492.41 Annual Percentage Yield Earned (APYE) 0.20% Number of days in interest period Average collected balance for APYE Interest Earned this period As of 04/30, a total of $1.52 in interest was earned this year. Interest Summary 30 3,466.06 .56 Deposits and Other Additions Date Amount Description There were 2 Deposits and Other Additions totaling $7711.56. 04/02 774.00 Direct Deposit- Soe See US Treasury 303 201183995D .56 Interest Payment 04/30 Daily Balance Detail Date 01/01 Balance 2,717.85 Date 01/02 Balance 3,491.85 Date 04/30 Balance 3,492.41 FOR M953R Savings Account Statement C For 24-hour customer service information, sign-on to Account Link (Bl L3 by Web on pncbank.com or call1-888-PNC-BANK Account number: 50-0111-6737 - continued For the period 04/01/200. to 04/30/200. JEANETTE F KELLY Primary account number: 50-0111-6737 Page 2 of 2 Get the Credit Card That Rewards You Every Time You Use It. Introducing the new PNC Bank \VorldPoints (sm) Credit Card. Earn cash, travel or other merchandise rewards for every net retail dollar that you spend. Apply now for your new PNC Bank WorldPoints Credit Can! at any PNC Bank office or by calling 1-888-PNC-BANK. If you already have a PNC Bank Credit Card, ask abollt appl}ing for a new \VorldPoints Canl. There's a Better Way to Pay your Bills Do you spend a lot of time each month sorting your bills, writing checks, bu}ing stamps and hunting down mailboxes to make sure they alTive on time? Give yourself a break-and more time-by pa}ing yoUI' bills the fast am! easy way--rigbt from your computer. Account Link@\Veb Bill Payment lets you pay virtually all of your bills at one time, from one place, through a source you can trust, PNC Bank. Best of all it's FREE. Visit pncbank.com for more information and to get started today. -< 0. 0 ~.g~ ;:; ~. ~ ~ - CJl ~ : 11) ~ m ~ ~g -.::> " " !l~ o~ 0.3 " '" ~~ '" ~ :'i"~. '" Ci ..... ~. a. ~ ~Q ~ ~ 0- ;x:-~~ cH~ c a. ~ "T\~'ro o -'" "> 0 " m g'* II ~ $l. ~-go :1" ~:.T IQ . " "0 ~ a < ~ ~. Dl " u::: '" "8 ?. S" ~ .... 0 0 0. ;:: ~ . 3 0 ~ " ~ ~. " " " 0::> -I -1 ;:Q QlAlr-(J) c+ :::0 () (J) '"' (1) ......#1-'. . . "0 o-JO<"1- U1W-4>- .". WI I-" -1--.,1 0:::0 :D .....,"- ("l N:DOOO 030> ,...- 0-1< . .po II II 1-'- :;; '"' -t ~ta 11111 ,...-WrJ) S U1 C> ([> . "U1 ....1-..........G'l WO C. I-- rJ) 0 cr, ([> 0 0....... N c::: W C) ("'"'t" lA) W c 3. D 3 o o 3 3 " o ~ C' \j)- ~~ <::. ~ -, <:0. ~>- ~ I ~ z-~ ",:3 ~ --- ~ -.l:' :s' (:) ~ IC: m ~ m ., m DI :J 2S: :J IC o 2- IC: .... ., o 3 ~ IC: 't:J 2. :J ~ m DI :J " - '" '" '" Z (/) m 0." go ClOJ ~ (/)0 ....>< ~~ .. ~~ ~ ~I~~ JJ" p- ~;R ZZ ~~~ ~~ 'h. ;;)>, :i:i Z::;- gti: ..... .::; n,..,. ::i~ ::::! '" '" '" ./. o ~ :<'to 0'" O1o-l to:>' ~t;j ,"0 01'>:1 ~~ Q~ '>:I to Ho-l tOo-l t'tO t:l '>:I to [;1t:i t' S; U1 --- -.l --- '" o o ~ " r m )> (fl m :0 m -l ~ Z -l ::I: Ui < o c o ::I: m :0 "'11 o :0 -< o C :0 :0 m o o :0 o (fl -<J> H W U1 H \D N W (!) o N (.J1 --J (.J1 (!) --- !!!!!!!!! --- - - --- - --- !!!!!!!!! --- - --- --- - - = --- !!!!!!!!! --- !!!!!!!!! ',...\_.......11::(""1( ~c Columbus, Georgia 31999 Toll Free 1-800-99-AFLAC (1-800-992-3522) MAILING ADDRESS POLICYHOLDER'S NAME AND ADDRESS o N ~ N o ~ ?l ~ 1,"111,"111,"",11,"11,11",1,1,"1,11"1.,,1.1,1,1,"1,11 JEANETTE F KELLY 6295 325 PINEWOOD DR SHIREMANSTOWN PA 17011-6528 JEANETTE F KELLY 325 PINEWOOD DR SHIREMANSTOWN, PA 17011 515001657 JEANETTE 000000000 070704 C030177434 01-18-04 01-30-04 $400.00 $0.00 $400.00 "LEASE FOLD AND DETACH CHECK --- !!!!!!!!! --- - --- - --- - --- - --- - --- --- - - = --- !!!!!!!!! --- !!!!!!!!! U3945 uI1 T':' ~~8~o'--~MC Columbus, Georgia 31999 Toll Free 1-800-99-AFLAC (1-800-992-3522) PAGE: 01 MAILING ADDRESS POLICYHOLDER'S NAME AND ADDRESS o 1".111,"111",",11,"11.11",1,1,"1,11,.1,"1,1,1,1",1,11 JEANETTE F KELLY 6295 325 PINEWOOD DR SHIREMANSTOWN PA 17011-6528 JEANETTE F KELLY 325 PINEWOOD DR SHIREMANSTOWN, PA 17011 :;; N o ~ o N ~ TREATMENT DATE: 01-18-04 - 01-30-04 PATIENT'S NAME: JEANETTE CLAIM NO.: 515001657 AGENT'S NAME: MAXWELL JAMES C GROUP NAME: AGENT NO.: J6251 GROUP NO.: GEO CODE: EXPLANATION OF BENEFITS POLICY NUMBER DESCRIPTION TREATMENT UNITS AMOUNT REMARKS AND PLAN DATE OD926495-EHIClJC REDUCED BENE 011804 2 400.00 021 033 053 *** TOTAL *** 400.00 PAGE TOTAL 400.00 American Family Life Assurance Company of Columbus (AFLAC) L1BEN3 IflEMc --. , Columbus, Georgia 31999 Toll Free 1-800-99-AFLAC (1-800-992-3522) TREATMENT DATE: 01-18-04 - 01-30-04 PATIENT'S NAME: JEANETTE CLAIM NO.: 515001657 AGENT'S NAME: MAXWELL JAMES C GROUP NAME: PAGE: 02 AGENT NO.: J6251 GROUP NO.: GEO CODE: CHECK ISSUED TO: JEANETTE F KELLY CK.NO. C030 177434 155. DATE 07/07/04 AMOUNT 400.00 BK. UP W/HLD. 0.00 REMARKS CHECK TOTALS: 400.00 A FORTUNE 500 COMPANY, AFLAC INSURES MORE THAN 40 MILLION PEOPLE WORLDWIDE. 021 THE FIRST DAY OF INTENSIVE CARE CONFINEMENT FOR AN ILLNESS IS NOT COVERED. 033 THIS INTENSIVE CARE POLICY COVERS CONFINEMENTS TO AN INTENSIVE CARE UNIT ONLY; OTHER HOSPITAL ROOMS AND UNITS ARE NOT COVERED. 053 ALL BENEFITS UNDER THIS INTENSIVE CARE POLICY ARE REDUCED AT AGE 70. American Family Life Assurance Company of Columbus (AFLAC) LlBEN4 --- !!!!!!!!!!!! --- - --- - --- ~ - == !!!!!!!!!!!! --- - iiiiiiiii - --- ~ --- - --- --- --- !!!!!!!!!!!! LCMCHECK ,. Ii1HAc Columbus, Georgia 31999 Toll Free 1-800-99-AFLAC (1-800-992-3522) MAILING ADDRESS POLICYHOLDER'S NAME AND ADDRESS a :" rn a a ~ ~ ~ 1",111",111",",11",11,11",1,1,"1,11"1",1,1,1,1,"1,11 ESTATE OF JEANETTE F KELLY 4660 325 PINEWOOD DR SHIREMANSTOWN PA 17011-6528 JEANETTE F KELLY 325 PINEWOOD DR SHIREMANSTOWN, PA 17011 478101629 JEANETTE 000000000 061404 C029936835 04-22-03 04-20-04 $11,240.00 $0.00 $11,240.00 PLEASE FOLD AND DETACH CHECK --- !!!!!!!!!!!! --- - --- --- ~ --- ~ - - !!!!!!!!!!!! --- - - - --- == --- - --- --- --- !!!!!!!!!!!! U3945 PA EO"1557 Sic Columbus, Georgia 31999 Toll Free 1-800-99-AFLAC (1-800-992-3522) PAGE: 01 MAILING ADDRESS POLICYHOLDER'S NAME AND ADDRESS a ~ 1",111",111,"",11",11,11",1,1,"1,11"1",1,1,1,1,,,1,II ESTATE OF JEANETTE F KELLY 4659 325 PINEWOOD DR SHIREMANSTOWN PA 17011-6528 JEANETTE F KELLY 325 PINEWOOD DR SHIREMANSTOWN, PA 17011 a; a :Ii ~ TREATMENT DATE: 04-22-03 - 04-20-04 PATIENT'S NAME: JEANETTE CLAIM NO.: 478101629 AGENT'S NAME: MAXWELL JAMES C GROUP NAME: AGENT NO.: J6251 GROUP NO.: GEO CODE: EXPLANATION OF BENEFITS POLICY NUMBER DESCRIPTION TREATMENT UNITS AMOUNT REMARKS AND PLAN DATE OD926494-CCAE2D SURGERY 042203 600.00 064 055 032 SURGERY 042203 4,400.00 -CCAI58 FRST OCC INIT 042203 1,000.00 FRST OCC PROG 042203 2,400.00 *** TOTAL *** 8,400.00 OD926494-CCAE2D CHEMO INJ 050703 1,500.00 141 *** TOTAL *** 1,500.00 OD926494-CCAE2D HOSP BENEFITS 031704 1 140.00 -CCAI58 HOSP BENEFITS 031704 1 100.00 *** TOTAL *** 240.00 OD926494-CCA158 HOSPICE 040904 11 1,100.00 *** TOTAL *** 1,100.00 PAGE TOTAL 11 240.00 American Family Life Assurance Company of Columbus (AFLAC) UBEN3 If1FMc , -. Columbus, Georgia 31999 Toll Free 1-800-99-AFLAC (1-800-992-3522) TREATMENT DATE: 04-22-03 - 04-20-04 PATIENT'S NAME: JEANETTE CLAIM NO.: 478101629 AGENT'S NAME: MAXWELL JAMES C GROUP NAME: PAGE: 02 AGENT NO.: J6251 GROUP NO.: GEO CODE: CHECK ISSUED TO: ESTATE OF JEANETTE F KELLY CK.NO. C029936835 155. DATE 06/14/04 AMOUNT 11,240.00 BK. UP W/HLD. 0.00 REMARKS CHECK TOTALS: 11,240.00 A FORTUNE 500 COMPANY, AFLAC INSURES MORE THAN 40 MILLION PEOPLE WORLDWIDE. 032 PLEASE SEND US A COPY OF THE ITEMIZED HOSPITAL BILL FOR THIS CONFINEMENT. 055 THE PROGRESSIVE BENEFIT CEASES TO BUILD ON THE POLICY ANNIVERSARY DATE FOLLOWING YOUR 65TH BIRTHDAY. 064 THIS PAYMENT REFLECTS THE MAXIMUM DUE FOR THE SURGERY BENEFIT UNDER THIS POLICY. 141 THIS PAYMENT REFLECTS THE MAXIMUM BENEFIT FOR CHEMOTHERAPY/RADIATION THERAPY. BENEFITS WILL RESUME ONE YEAR FROM THE DATE OF THE LAST TREATMENT PAID. American Family Life Assurance Company of Columbus (AFLAC) LlBEN4 ...... !!!!!!!!!!! ...... - ...... ...... - !!!!!!!!!!! - ...... ...... - iiiiiiii - ...... !!!!!!!!!!! ...... ...... - ...... ...... - ...... !!!!!!!!!!! I rMr.HFC':K ~c , ".....,.. Columbus, Georgia 31999 Toll Free 1-800-99-AFLAC (1-800-992-3522) MAILING ADDRESS POLICYHOLDER'S NAME AND ADDRESS o ~ m ro o o ~ ::I o 1",111."111",",11",11,11",1,1",1,11"1,"1,1,1,1,,,1,II ESTATE OF JEANETTE F KELLY 0457 325 PINEWOOD DR SHIREMANSTOWN PA 17011-6528 JEANETTE F KELLY 325 PINEWOOD DR SHIREMANSTOWN PA 17011 030001660 JEANETTE 000000000 070804 C030185068 01-18-04 04-08-04 $5,540.00 $0.00 $5,540.00 DI CAC:C 1:1"\1 n ^....n nCTAt"'u I"'uct""'1l' ...... !!!!!!!!!!! ...... - - - - - - ...... - - - ...... - ...... ...... - ...... ...... - ...... !!!!!!!!!!! U3945 PA E07557 ~c . "Columbus, Georgia 31999 Toll Free 1-800-99-AFLAC (1-800-992-3522) PAGE: 01 MAILING ADDRESS POLICYHOLDER'S NAME AND ADDRESS ro ill o 1",111",111",",11",11,11",1,1",1,11"1",1,1,1,1,"1.1I ESTATE OF JEANETTE F KELLY 0456 325 PINEWOOD DR SHIREMANSTOWN PA 17011-6528 JEANETTE F KELLY 325 PINEWOOD DR SHIREMANSTOWN PA 17011 :g ~ o TREATMENT DATE: 01-18-04 - 04-08-04 PATIENT'S NAME: JEANETTE CLAIM NO.: 030001660 AGENT'S NAME: MAXWELL JAMES C GROUP NAME: AGENT NO.: J6251 GROUP NO.: GEO CODE: EXPLANATION OF BENEFITS POLICY NUMBER DESCRIPTION TREATMENT UNITS AMOUNT REMARKS AND PLAN DATE -- f------. OD926494-CCAE2D HOSP BENEiTfs'- -"0118()"4-- --12 1 ,460.00 -CCAI58 HOSP BENEFITS 011804 12 1,200.00 *** TOTAL *** 2,660.00 OD926494-CCAE2D HOSP BENEFITS 032604 13 1,580.00 -CCA 158 HOSP BENEFITS 032604 13 1,300.00 *** TOTAL *** 2,880.00 PAGE TOTAL 5 540.00 American Family Life Assurance Company of Columbus (AFLAC) UBEN3 fJ1HAc --'- -.. Columbus, Georgia 31999 Toll Free 1-800-99-AFLAC (1-800-992-3522) TREATMENT DATE: 01-18-04 - 04-08-04 PATIENT'S NAME: JEANETTE CLAIM NO.: 030001660 AGENT'S NAME: MAXWELL JAMES C GROUP NAME: PAGE: 02 AGENT NO.: J6251 GROUP NO.: GEO CODE: CHECK ISSUED TO: ESTATE OF JEANETTE F KEllY CK. NO. C030185068 155. DATE 07/08/04 AMOUNT 5,540.00 BK. UP W/HLD. 0.00 REMARKS CHECK TOTALS: 5,540.00 A FORTUNE 500 COMPANY, AFlAC INSURES MORE THAN 40 MilliON PEOPLE WORLDWIDE. American Family Life Assurance Company of Columbus (AFLAC) LIBEN4 ~c Worldwide Headquarters 1932 Wynnton Road, Columbus, Georgia 31999-0001 1-800-992-3522 CHECK NUMBER: R003506610 DATE: 07/08/04 00926494 KELLY ESTATE OF JEANETTE 172322347 REFUND DUE TO DEATH $9.41 LRCHECK LOC SHJ PLEASE FOLD AND DETACH CHECK Qlttttm ~ <nmmn11! '~Z;O' ..(.~~\ ~ .:. ~ u , :> (I , .:. 0 ( Check No. . 03 04 05 19 AUSTIN, TEXAS 67526956 130 012020823KELL ANDOVERTAX 1",111",111"""11,"11,11",1,1,,,1.11,,11111.1,1,1,,,1.11 JEANETTE F KELLY 325 PINEWOOD DR SHIREMANSTOWN PA 17011-6528 2306 67526956 REFUND '<> :9- lEi '" .... '0 ~~102 $***6937*68 on .... l;; S ........._..""""" VOID ArnR ONI! YEAR 277.68 INTEREST ""2 :\0 b 711" ~0000005~B~ b?52bq5b2~ O~0305 t 'i ~ .:)-. 'I (\ ~ ~\'t)~ V\ "" '}.,. :' ~ . \~ ~ 't-- ~~ C"\ ~ ~\) ~ ~'h~ REV-1511 EX+ (12-99) *' SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JEANETTE F. KELLY FILE NUMBER 21-04-0437 Debls 01 decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION FUNERAL EXPENSES: W. Orville Kimmel Funeral Home Inc. Trinity Evangelical Lutheran Church (Cost Df Meal); Use of Nave; Honorabium to Paster Romberger Memorials - Lettering & Cleaning Monuments 1. 2. 3. B. ADMINISTRATIVE COSTS: 1. Personal Represenlalive's Commissions Name of Personal Representative{s) Robert Burchfield Social Security Numbe~s)/EIN Number of Persooal Representative(s) Street Address 325 Pinewood Drive City Shiremanstown State PA ZIp 17011 Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (n decedenfs address is not the same as c1aimanfs, attach explanation) Claimant Street Address City Stale . Zip Relationship of Claimant to Decedent 4. Probale Fees 5. Accountanfs Fees 6. Tax Return Preparer's Fees 7. COPY OF DEED (2118105) ADVERTISING OF LETTERS - LAW JOURNAL (CUMBERLAND) ADVERTISING OF LETTERS - THE SENTNEL DEED - FILING FEE 8. 9. 10. AMOUNT 8,740.68 601.12 90.00 0.00 7,805.00 325.00 125.00 1.50 75.00 122.63 39.50 TOTAL (Also enter on line 9, Recapitulation) $ (" more space is needed, insert addItional sheets of the same size) 17,925.43 STATEMENT ~ ,n ,ff r{/, [ U'LIJLLLE J\ r...mmE '7WlE.'LaJ dloo",:, [Inc. TIMOTHY A. HOBBS, SUPERVISOR 2001 MARKET STREET. HARRISBURG, PA 17103 (717) 238-2502 TO: FUNERAL SERVICES OF Professional Services ............................. $ Facilities & Equipment............................. $ \ '., Automotive Equipment .................................. $ TOTAL OF THE ABOVE ........... ......................... $ MERCHANDISE AS SElECTED......."............"...........".....~......... $ .-i SPECIAL CHARGES ....::.,...........,.;.;~_...._:....;;;.~...;.:.,;;..:, .~t.L:....... $ i_ L "1 'l~- " -1 n ~': 'r _ i~.' -, :f-,-.. ('_ CASH ADVANCED Opening Grave ............................................... $ Cemetery Equipment ..................................... $ Headstone Engraving .................................... $ lot & Deed ...................................................... $ Newspaper Notices-Loca1........................... $ Newspaper Notices-Out-of-Town...c::':":'" $ Telephone & Telegrams .............................:.. $ Airfare .............................................................. $ Clergy & Mass Offering ................................. $ Organist ........................................................... $ P~II'b~ar~rs ...................................................... $ Copies/Death Certificate................ $ Vault Service Charge..................................... $ Flowers ............................................................ $ TOTAL OF THE ABOVE ...................................... TOTAL OF ALL SELECTIONS ........................... {~::: (..:. .~,: ,~{ .. ~')( . '.._l_ $ / ,,- .. I '; . -' .:.-' ~ (0 $ c'fl -rC/. c? "-:.-1 f,/_ : ,. ~ SM ;;:;~ NCNlllC/IIlIS '..'.. "'." Yoou,Oc) ;pn'TLfo ' &W Yl DJ f&}uk D'. s !/O/ptj [Jrinity 'Evangelical Eutheran Church TWO THOUSAND CHESTNUT STREET CAMP HILL, PENNSYLVANIA 17011 717-737-8635 FAX 717-730-9297 SENIOR PASTOR J. STEWART HARDY, PH.D. ASSISTANT PASTOR NANCY R. EASTON, M.DIV. ASSOCIATE PASTOR JOHN H. BROCK, M.DIV. DIRECTOR OF MUSIC H. TIMOTHY KOCH DIRECTOR OF LEARNING MINISTRIES JAYNE E. COOVER, ED.D. YOUTH MINISTRY COORDINATOR PETER A. FOX, B.A. May 11, 2004 Robert Burchfield 325 Pinewood Drive Shiremanstown, PA 17011 r ~ sllV!6~,l0, \ ,\t,/ f')\~ ~ V INVOICE Charges for Jeanette Kelly's Funeral: Use of the nave $250.00 _ prClt/l't1S1~ fa; J h y ~/mllltf 'FV1/e,4{ /JI....' $201.12 $451.12 Cost of the meal Total amount payable to "Trinity Lutheran Church Honorarium payable to "Pastor J. Stewart Hardy" $150.00 --,f/"elA 'OIlS/,! J%,'J by k'#lt1lel/Wt;-.t/ If you have any questions about this invoice, please feel free to call me at the church. j#/HI' Thank you, V ~J J-! !f ~D 1}2. 10/ AL - ~ Paul Hensel Financial Administrator ------------------------j GRANITE MARBLE BRONZE ROMBERGER MEMORIALS 2395 State Street, Penbrook, PA 17103 Specializing in Lettering and Cleaning Monuments PHONE 232-1147 800-340-6744 Monuments, Markers. Mausoleums, Honor Rolls, Vases, Urns, Sandblasting Glass -Signs-Windows Order No. ............ .............. ...... To~$.l....~.....~::, ":.:"~ ~?.~........gls.~ Date .!/U':t.J?; ..?Y.'?Y Terms... / ..7I...... ./:<;.:e;.r,.,r .......... -. r C'd;,) ... ....jd~~... ...:;-:-):': (::~'':"::f..-~.:::./ :~)? >.l/I~(.':/~" DETAILED DESCRIPTION OF WORK .-/, ;-) , .!..::?..,...........:...:...:!../.... The Iollowing .......;)::1.,;7:........... ......... k?c . ,r'-- ........9..~.f:(.. ~.c:;.. ....l,..~<.<..~.?.,..r.. . ............. to be ..d..:?.P..t,.,;'....../!.:l....,...... .... He;;-. ..~/~,..::;;:..!.~::.i:-:......,.... Jj"<dC;TC /.... . ,..(... L --L Y ~~) '- ~/ / Lj I"~) '7 /-' "---, 6- ~Po ~~ Yo J.l2.- Total Cost $ .......ZQ.:..-:?S?....................... AbtNe order shall be tiUEld a$ stated therein unless unavoidably delayed by labor conditions or oftter confingencies beyond our contra. and then as ~ as practicable thereatter. Biffings shall be stbjad to the above nam&d teuns and conditions. <=: fj) ,. ,,<l"<.'" ..0iA<f:.,.i2)~~~\b~)W-.... .... ...... ....~...~7r::~~;;~;;ii9~~i~;~l.:;:-.,Ir.:.i.C::.Lj;) FOR PAYMENT ills Receipt Date: Receipt Time: Receipt No. : 5/05/2004 09:13:59 1036495 Estate File No. : Paid By Remarks: 2004-Uu'u f ROBERT J BURCHFIELD JA ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name PETITION FOR PROBA EXTRA PAGES SHORT CERTIFICATE JCP FEE Check# 13 73 Total Received.. ....... 270.00 6.00 24.00 10.00 ---------------- $310.00 $310.00 CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN BUREAU OF RECEIPTS & CNTR M.D fiLl CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, P A 17013 - JUNE 4, 2004 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: Paul Bradford Orr, ESQUIRE Jeannette F. Kelly, 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 following dates: May 21, 28, MAY 4,2004 Advertising Cost $ 75.00 Second Proof Request $ 0.00 $ 0.00 $ 0.00 Proof of Publication Payment received Total Amount Due $ 75.00 --------- --------- Payment received by .""<!.;;;t.,.~~_:l~i.l..u.., .,'".,'L'!,."O$' REMITT A~CE ADDRESS I BilL TO THE ENTlNEL .- LEGAL PAUL l%l\AbrORO on P.O. BOX 130, CAALISLE, PA 17013 .. illlllNd 'i5AtB"~ AD NUMBER I CLASS SALE 265088 10 PUBLIC NOTICES 29 OG/o9/04 .,,~'I!ll.i '. 9 . Y6At~" AD DESCRIPTION ESTATE NOTICE LETTERS TESTAME jJZ2l'Q~ . PUBLICATION INSERTIONS ~'ft..... .T OlJ 3 THE SENTINEL - LEGAL 3 LGL 116 .~ TOTAL AD CHARGE 116.2' 3 PROOF OF PUBLICATION o LflRt 6..3 DAYS RUN PURCHASE ORDER PAY THis AMOUNt' 12:2. 63 kelly estate RIl'tAIl\l fHI~ jlI0R'fIC>tI! FO~ 'vbUR RECORDS ""- It :",,",,",oiI .- LINES 34 * 2 , STOP DATE .. 06/05/04 ..1~ GROSS AMOUNT 147.16* · AFTER D7/09/04 ~ a ~ MESSAGE: Thank you for advertising with The Sentinel. Deadlines for in~column legal advertisements I Mondtiy lstriday at 11 a.m.; Tuesday is Friday at 4 p.m.; wednesday i~ Ronday At 12 Noon; Thursday is Tuesday at 12 Noon; Friday is WednasdbY at 12 Noon; Sunday is Thursday at 12 Noon. If you have any questions regarding your Legal bill pleas$ call Tammy Shoemaker 243-2611, ext 203. Fax your legals to 243-3754, attention Tammy Shoemtiker You can also EMAIL yourlega1toClassifiedads.btls@cumberlink.com. Please send a cover letter including your nama and address as an attachment FILE DETACH AND RETURN THIS PORTiON WliH YbU~ PAYMENT J.~~5xE1~Jlc~Hsi~f~~13 kelly estate AD NUMBER Cl SSo START DA 265088 PUBLIC NOTICES OS/22/04 AD DESCRIPTION BilLING DA ESTATE NOTICE LETTERS TESTAME 06/09/04 06/05/04 H 717~2Sa-a558 GROSS AMOUNT OF 147.16 DUE AFTER 07/09/04 TOTAL AMOUNT OUE 122.63 PAUL BRADFORD ORR 50 EAST HIGH STREET CARLISLE, PA 1.,,111,"111,,",,11.,11,1,,1.1 ENTER AMOUNT ENCLOSED 17013 20200000002650880000000000000001471600000122636 PROOF OF PUBLICATION State of Pennsylvania, County of Cumberland Tanuny Shoemaker, Customer Care Sales manager, of The Sentinel, of the County and State aforesaid, being duly sworn, deposes and says that THE SENTINEL, a newspaper of general circulation in the Borough of Carlisle, County and State aforesaid, was established December 13th, 1881, since which date THE SENTINEL has been regularly issued in said County, and that the printed notice or publication attached hereto is exactly the same as was printed and published in the regular editions and issues of THE SENTINEL on the following date(s): Mav 22, 29 & Tune 05, 2004 COPY OF NOTICE OF PUBLICATION DIAU:~ Lellers Testamentary for the Estate of JEANETTE F. KELLY. deceased, of Lower Allen Township, Cumbe~and County, Pannsylvanla, have been grantee:! to the undersigned. All persons Indebted to the Estate are requasted to make immediate payment, and those having claims against the Estate are requestad to present them for settlement without delay to: Robert J. Burchfield 325 Pinewood D~ve I Shiremanstown, PA 17011 or to: Paul Bradford Orr, Esquire 50 East Hi9h Street Carlisle. PA 17013 Affiant further deposes that he/ she is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statement as to time, place and character of publication are true. ~ om to and subscribed before me this 09 day of june, 2004 My commission expires: O NOTARIAL SEAL AWN M SH'JG . . ( HART, Notary Publi M Carlisle, Cumberland County C Y CommIsSIon Expires No..'::. 28. 2006 '~-"'--''''' PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16,1929), P. L.1784 STATE OF PENNSYLVANIA : ss. COUNTY OF CUMBERLAND : Lisa Marie Coyne, Esquire, Editor ofthe Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, VIZ: MAY 21, 28, JUNE 4, 2004 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter ofthe aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. \' Kelly, Jeanette F., dec'd. Late of Lower Allen Township. Executor: Robert J. Burchfield, 325 P1newood Drive, Shtrmans- town, PA 17011. Attorney: Paul Bradford Orr, Es- qutre, 50 East High Street, Carlisle, PA 17013. r SWORN'TO AND SUBSCRIBED before me this 4 day of JUNE 2004 NOTARI SEAL LOIS E. SNYDER, Notary Public Carlisle BolO, Cumberland County My Commission Expires March 5, 2005 Mentzer & Company, P.C. Certified Public Accountant 35 E. High Street, Suite 104 Carlisle, P A 17013-3052 BILL TO Estate of Jeanette F, Kelly C/O Robert J. Burchfield 325 Pinewood Drive Shiremanstown, P A 17011 DESCRIPTION Preparation of applicable Federal, State and/or Local Income Tax Returns for the year ended December 31,2004. l___~___._-----_..,----- -~----- -- -D ~ .llil} ,_ __ n_1.1 LAW OFFICES OF PAUL BANBFClRD ~R,^ OPERATING I EXPENSE ACCOUNT . PH. 7H-258-85j;8 5o...EAsT HIGH STREET CARlikE, PA 17013 .' ' ji..{J...", :~4- 0 60-8762/2313 A 062784~3 __ "t\ ~f . -, . fA $ ) J 5:F ." "~~ {I] i::oft7:" ~ Ir CORNERSTONE f.d. fa I. C t, d It Un I" n ... J(.1S1iO'~""'~f~~ ":;:1 UB?E. 2B1: DE. 2?B"'~00:1u. :11''''5 ... f\lE COP~ Invoice DATE INVOICE # l 4/28/2005 5760 j DUE DATE 5/28/2005 ...J AMOUNT ---1 125,00l I I i I I i j{ ~1q~ / i I I I $12~,00 j - - -. .-- ....___v vU~6V'" J-'UJ 1"'"'''' Ul~L UI:; 1'1:;\;1:;1 veu oy me Que aate above. A finance charge of 1 1/2% per month or 18% per annum will be charged on all amounts outstanding after that date, fflT Total WE GREATLY APPRECIATE YOUR BUSINESS AND WELCOME YOUR REFERRALS!! Phone (717) 249-6327 REV-1512 EX+ (12-03) *' COMMONWEALTH Of PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT OECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE UABILITIES, & UENS ESTATE OF JEANETTE F. KELLY FilE NUMBER 21-04-0437 Report debt. Incurred by the decedent prior to death which remained unpaid a. of the date of death, Including unrelmbursed medical expon.... ITEM VAlUE AT DATE NUMBER DESCRIPTICIN OF DEATH 1, COMCAST CABLE (01010 THRU TRANSFER DATE) 2. PENNSYLVANIA AMERICAN (WATER) 3, 4, 5, 6. 7. 8" 9. 10, 11, 12, 15, TOTAL (Also enter on line 10, Recapitulation) $ (~more space is needed, insert additional sheets of the same size) @omcast ACCOUNT NUMBER DATE DUE (. TOT AMOUr. Vis~ us on the web at www.comcasl.com 09547219569.01.4 OS/23/04 $42.24 News from Comcaiiit @omcast ACCOUNT NUMBER DATE DUE TOTAL AMOUNT DUE Vis~ us on the web at www.comcast.com 09547219569-01-4 06123/04 $42.24 How to reach us... How to reach us: 3800 Trindle Rd, Suite B Camp Hill, PA 17011 (717)540-8900 Tele h News from Comeas. @omcast. ACCOUNT NUMBER DATE DUE TOTAL AMOUNT DUE Visit us on the web at www.comcast.com 09547219569-01-4 07/23/04 $42.24 News from Com cast Thank-you, more. card. AcG6 ... @omcast. Visit us on the web at www.comcast.com. ACCOUNT NUMBER 09547 219569-01-4 DATE DUE TOTAL AMOUNT DUE 08/23/04 $42.24 News from Com cast Thank more card' . AcCol:lnlExeetl -~- -------- 1 09547219569-01-4 09/23/04 TOTAL AMOUNT DUE !t42.24 @omcast. flc!J ,/ V h--L <t'f' C('e5~'( Visit us on the web at WWW.comcast.com ACCOUNT NUMBER DATE DUE @omcast ACCOUNT NUMBER DATE DUE TOTAL AMOUNT DUE Visit us on the web at www.comcas\.com 09547219569-01-4 10/23/04 $42.23 @omcast. ACCOUNT NUMBER DATE DUE TOTAL AMOUNT DUE Vis" us on the web at wwW.comcast.com 09547219569-01-4 11/23/04 $42.23 @omcast. ACCOUNT NUMBER DATE DUE TOTAL AMOUNT DUE Visit us on the web at www.comcasl.com 09547219569-01-4 12/23/04 $42.24 How to reach us... How.to reach us: 3800 Trindle Rd, Suite B Camp Hill, PA 17011 (717)540-8900 T eleph 2,(h News from Comeast Thank you for your promptpaym~nt.Foryour c: more quick and ea~y payment optiClns, includjn card payments or direct debit paymenfs. p' . Account Executive and find out how you This bill reflects a change in the FCC Regulatory f~~ '!,.,;; vi\.> ;l_~~~i/~j'\l~); @omcast. ACCOUNT NUMBER DATE DUE TOTAL AMOUNT DUE Visit us on the web at www.comcast.com 09547219569-01-4 01/23/05 $42.24 @omcast. ACCOUNT NUMBER DATE DUE TOTAL AMOUNT DUE Visit us on the web at www.comcast.com 09547219569-01-4 02123/05 $42.24 @omcast. ACCOUNT NUMBER DATE DUE TOTAL AMOUNT DUE Vis" us on the web at www.comcast.com 09547 219569-01-4 03123105 $45.27 News from Comcast Thank'you for your. prompt ' it . more quick and 'easy pay . ptr card payments or dJrebt d9bit paym~nts. fir, , Account Executive and find out how you:clln's4'i ,,;\;>;,': . .~., @omcast. ACCOUNT NUMBER 09547219569-01-4 DATE DUE TOTAL AMOUNT DUE 04/25/05 $45.27 I "'U~IU"'C:' I"t""""U' n JlU""','A&"'",,' "'''''''::1 ...,W..'U,,,..~ For Service To: JohnM Kelly 325 Pinewood Dr Account Number: 24-0655910-0 Premise Number: 24-0387396 --------Prior Balance---------------- Balance from last bill Payments prior to May 13, 2004. Thanks! Total prior balance, May 13, 2004 --------Current Water Charges--------- Service Charge Water Volume ($. 005735 x 2,300) STASPAWC Water 0.04% DSI - PAWC Charge 0.25% Total water charges, May 13, 2004 ...-..-..Other Current Charges-.._.... Mthly Water Line Protection Total other charges, May 13, 2004 $33.79 -33.79 .00 Billing Period & Meter Information Billing Date: May 13, 2004 Billing. Period: Apr 12 to May 11 (29 days) Next reading on/about: Jun 09, 2004 Rate Type: Residential 11.50 13.19 .01 .06 24.76 Meter readings in current billing period: MeterNumberN000045083 is a5/8-ihChmeter. Present-actual 987400 Last-actual 985100. Gallons used ---------AMOUNT DUE --------------....-.. 5.00 5.00 $29.761 . ~16~ . I 4/~Jt ~t'\. t~. Water IJsag~Compariscln Monthly usage In hundred gallons. \,;lJ 101f\ o t3 y(j 2 MJJASONDJFMAM2 8 ;~~~~f~~~g~r;~ Messages to you from Pennsylvania American Any portion of the water charges wnich is not paid as of 6/07/04 will be subject to a 1.50% penalty. . Customers may use their credit card, debit card or pay by electronic check only by calling toll free: 1-866-271-552. Customers may also pay on-line at www.water.paymybi/f.com. A service fee will apply. . Approximately' 4.72 percent or $1. 16, of State taxes are included in your current bill. . Effective April 1,2004, the Distribution System Improvement Charge (DSIC) is now .25%. This charge funds the replacement of water distribution facilities. . Effective April 1, 2004, the State Tax Adjustment Surcharge (STAS) is now .04%. . When paying your bill in person, be aware that American Payment Systems (APS) is Pennsylvania American's only authorized collection agency. APS ensures your payment is credited to your account. Call 1-800-565-7292 for a list of payment centers. Customer Service & Emergencies 1.800-565-7292 (24 Hours) For Hearing Impaired Customers TOO 1-800-300-6202 (24 Hours) Visit us on the INTERNET: www.pawc.com @~ AIM 31014 L"U:tIU'IItill ,..cor~UU'" "IIUJIUClII"" U"""!I "'U"""5"~ For Service To: JohnM Kelly 325 PinewoodDr Account Number: 24-0655910cO Premise Number: 24"0387396 -.-.-Prior Balance--------.----- Balancefrom last bill Payments prior to Jun 11,2004. Thanksl Total prior balance, Jun 1.1, 2004 .----Current WaterCharges---- Service Charge Water Volume ($.005735 x 2,500) STASPAWC Water 0.04% DSI- PAWC Charge 0.25% Total Water charges, Jun1',2004 ---Other Current Chafges-.....- Mthly Water Line Protection Total other charges, JUn 11,2004 Billing Period & Meterlnf()rtnatlc)f'l Billing Date: Jun 11, 2004 Billing Period: May 11 to Jun 09 (29dllYs) Next reading on/about: JU112,2004 Rate Type: Residential Meter readings in currel1tbillingiperlod: Meter Number N000045083 isa:$/8-ineh,meter. Present-actual 989900 Last"actual 987400 Gallons used ------AMOUNT DUE ..--.-...-- 2 1 2 J J A S 0 N 0 J F M A M J 2 g u ~ u . c 0 . a ~ a r a u ~ n 9 p I v c n r y n $29.76 -29.76 .00 11.50 14.34 .01 .06 25.91 5.00 5.00 I $30.911 . ~- -- Messages to you from Pennsvtvania American Any portion of the water charges w!iich is not paid as Of 7/06/04 will be subject to a 1.50% penalty. . Customers may use their credit card, debit card or pai: by electronic check only by calling toll free: 1-866-271-5522 Customers may also pay on-line at www.water.paymybill.com. A service fee will apply. . ApproximateJr. 4. 72 percent or $1.22, of State taxes are Included in your current bill. . Effective April 1 ,2004, the Distribution System Improvement Charge (DSIC) is now .25%. This charge funds the replacement of water distribution facilities. . Effective April 1 ,2004, the State Tax Adjustment Surcharge (STAS) is now .04%. . When paying your bill in person, be aware that American Payment Systems (APS) is Pennsylvania American's only authorized collection agency. APS ensures your payment is credited to your account. Call1-BOO-565-7292 for a list of payment centers. . Arrangements to disconnect your.servicejust got easier. Log on to pawc.com and follow the Turn-Off Program link Customer Service & Emergencies 1 "800-565-7292 (24 Hours) For Hearing Impaired Customers TOO 1-800-300-6202 (24 Hours) Visit us on the INTERNET: www.pawc.com @~ A1M 28385 -!'--....'.::I'-_......~.., 11. 50 16.63 .01 .10 28.24 ...;;..-..Pr:ior Balance.;~~""l'-.-..~!. .-----. " . Balance from1ast.oilJ . , ~, ' "'" ,,', ", ',,' ",' ""''',,: . t~ prior to'.fuI14,' 2004; 7J!flnk$! r,ior ibalanc", ---;"';"'~Curr:ent WafE! Service Charge Wa:~c.Volume ($.'00513?x:-R,900) .$TA'S'PAWC Water o,pi$% 'D$I;PA WC Charge ojf1% . . Total)vl\ter charges,4Ul1i4,2004 .;------Other CurrentehatgEilS~-;"'---- Mth/yWaterLirie ProteCtion - . Total olher charges, Ju114,2004 _--.--_--AMOUNT DUE -.-.-----------. 5.00 5.00 $33.241 Messages to you from Pennsylvania American , Any portion of the water charges wFiich is not paid as or8/09/04 will be subject to a 1.50% penalty. . Customers may use their credit card, debit card or pai: by electronic check only by calling toll free: 1-866-271-5522 Customers may also pay on-line at www.water.paymyblll.com. A service fee will apply. . Approximately 4.72 percent or $1.33, of State taxes are included in your current bill. . Effective April " 2004, the State Tax Adjustment Surcharge (STAS) is now .04%. . When paying your bill in person, be aware that American Payment Systems (APS) is Pennsylvania American's only authorized collection agency. APS ensures your payment is credited to your account. Call 1-800-565-7292 for a list of payment centers. . Arrangements to disconnect your service just got easier. Log on to pawc.com and follow the Tum-Off Program link . Effective July 1,2004. the Distribution System Improvement Charge (DSIC) increases from .25% to .37%. This charge funds the replacement of water distribution facilIties. QustomerServlce& Emergencies 1"800-565.1292 (24 Hours) For Hearing Impaired Cu_s~omers TOO 1-800"300.6202 (24 Hours) Visit us on the INTERNET: WWw:pawc.com @ -= A1M 30150 ~u..""""rr;;;, ,..........v.....~ ......,....51~.V.. _......~ _........._.~ For Service To: John M Kelly 325 Pinewood Dr Account Number: 24-0655910-0 Premise Number: 24-0387396 -_......Prior Balance.-.-....-......-... Balance from last bill Payments prior to Aug 1:2, :2004. Thanks! Total prior balance, Aug 12, 2004 -...Current Water Charges._.._. Service Charge Water Volume ($.005735 x 2,300) STASPAWC Water 0.04% DSI- PAWC Charge 0.37% Total water charges, Aug 12,2004 ..---.Other Current Charges....-.--- Mthly Water Une Protection Total other: charges, Aug 12, 2004 Billing Period & Meter Information Billing Date: Aug 12,2004 Billing Period: Jul12 to Aug 10 (29 days) Next reading on/about: Sep 10,2004 Rate Type: Residential Meter readings in current billing period: Meter Number N0000450B3 Is a 5lB-lnch meter. Present-actual 995100 Last-actual 992800 Gallons used _.......-AMOUNT DUE -..--.-....-.. Water Usage Comparison Monthly usage in hundred gallons. 1 2 ASONDJ,FMAMJJA2 g~~f~~~~~r~~~~~ $33.24 -33.24 .00 11.50 13.19 .01 .09 24.79 5.00 5.00 I $29.791 . Messages to you from Pennsylvania American . ' Any portion of the water charges wFiich is not paid as or 9/07/04 will be subject to a 1.50% penalty. . Customers may use their credit card, debit card or pal by electronic check only by calling toll free: 1-866~271-552. Customers may also pay on-line at www.water.paymyblll.com. A service fee will appro . Approximately 4.7:2 percent or $1.17, of State taxes are. included in your current bil. . Effective April 1, 2004, the State Tax Adjustment Surcharge (STAS) is now .04%. . Arrangements to disconnect your service just got easier. Log on to pawc.com and follow the Tum-Off Program Iin~ . Effective July 1, :2004, the Distribution System Improvement Charge (DSIC) increases from .:25% to .37%. This charge funds the replacement of water distribution facilities. Customer: Service & Emergencies 1-800-565-7292 (24 Hour:s) For: Hear:ing Impaked Customer:s TOO 1-800-300-6202 (24 Hour:s) Visit us on the INTERNET: www.pawc.com @ Ibm A1M 30627 c;usromer Accounr tnTarmanan D"""Y wu"""a,y For Service To: John M Kelly 325 Pinewood Dr Account Number: 24-0655910-0 Premise Number: 24-03B7396 ......-..Prior Balance......-................ Balance from last bill Payments prior to Sep 14, 2004. Thanks! Total prior balance, Sep 14, 2004 ...-.....Current Water Charges-......... Service Charge Water Volume ($.005735 x 2,600) STAS PAWC Water 0.04% OSI- PAWC Charge 0.37% Total water charges, Sep 14, 2004 ...-.-....Other Current Charges..--....- Mthly Water Line Protection Total other charges, Sep 14, 2004 Billing Period & Meter Information Billing Date: Sep 14,2004 Billing Period: Aug 10 to Sep 10 (31 days) Next reading on/about: Oct 11, 2004 Rate Type: Residential Meter readings in current billing period: Meter Number N000045083 is a 5/8-inch meter. Present-actual 997700 Last-actual 995100 Gallons used ...._...-AMOUNT DUE ............--.--.... ;! ~ Liv \1 V ~~ (J 0 Water Usage Comparison Monthly usage in hundred gallons. 2 o g SONDJ ecoea p t v c n FMAMJJ ~~r~~~ A S 2 u . 0 9 P ~ $29.79 -29.79 .00 11.50 14.91 .01 .10 26.52 5.00 -- 5.00 1 $31.521 I. Messages to you from Pennsylvania American Any portion of the water charges wnich is not paid as of 10/12/04 will be subject to a 1.50% penalty. . Customers may use their credit card, debitcard or pal by electronic check only by calling toll free: 1-866-271-552, . Customers may also pay on-line at www.water.paymybt/l.com. A service fee will apply. . Approximately 4.72 percent or $1.25, of State taxes are included in your current bill. . Effective April 1, 2004, the State Tax Adjustment Surcharge (STAS) is now .04%. . A"angements to disconnect your service just got easier. Log on to pawc.com and follow the Tum-Off Program lin . . Effective July 1, 2004, the Oistribution System Improvement Charge (OSIC) increases from .25% to .37%. This charge funds the replacement of water distribution facilities. Customer Service & Emergencies 1-800-565-7292 (24 Hours) For Hearing Impaired Customers TOO 1-800-300-6202 (24 Hours) Visit us on the INTERNET: www.pawc.com @ IiiIGi A1M 35746 """...~.""""g. ,..,.___w... ....W'...._.._.. -......:;1 --~....._.." For Service To: John M Kelly 325 Pinewood Dr Account Number: 24-0655910-0 Premise Number: 24-0387396 --------Prior Balance--------------------- Balance from last bill Payments prior to Oct 14, 2004. Thanks! Total prior balance, Oct 14, 2004 ....---Current Water Charges------_.. Service Charge Water Volume ($.005735 x 2,300) STAS PA WC Water 0.04% OSI- PAWC Charge 0.82% Total water charges, Oct 14, 2004 -------Other Current Charges...----. Mthly Sewer Line Protection Mthly Water Line Protection Total other charges, Oct 14, 2004 Billing Period & Meter Information Billing Date: Oct 14, 2004 Billing Period: Sep 10 to Oct 11 (31 days) Next reading on/about: Nov 08, 2004 Rate Type: Residential Metor readings in current billing period: Meter Number N000045083 is a5/8-inch meter. Present-actual 1000000 Last-actual 997700 Gallons used .------AMOUNT DUE ------------------- Water Usage Comparison Monthly usage in hundred gallons. 20NDJFMAMJJAS02 R f~~~~~ry~p~~f ~ $31.52 -31.52 .00 11.50 13.19 .01 .20 24.90 9.00 5.00 14.00 I $38.901 Messages to you from Pennsylvania American Any portion of the water charges wnich is not paid as of11/08/04 will be subject to a 1.50% penalty. . Customers may use their credit card, debit card or pal by electronic check only by calling toll free: 1-866-271-5522 Customers may also pay on-line at www.water.paymybtl/_com. A service fee will apply. . Approximately 4.72 percent or $1.17, of State taxes are included in your current bill. . ~ffective April " 2004, the State Tax Adjustment Surcharge (STAS) is now .04%. . Arrangements to disconnect your service just got easier. Log on to pawc.com and follow the Tum-Off Program link . Effective October " 2004, the Distribution System Improvement Charge (OSIC) increases from .37% to .82%. This charge funds the replacement of water distribution facilities. Customer Service & Emergencies 1-800-565-7292 (24 Hours) For Hearing Impaired CustolT1ers TOO 1-800-300-6202 (24 Hours) Visit us on the INTERNET: www.pawc.colT1 @~ A1M 34B27 __n_~.__nn._..___'_ _ .._ ..,.._.... ... ..~... Customer Account Information For Service To: John M Kelly 325 Pinewood Dr Account Number: 24-0655910-0 Premise Number: 24-0387396 Billing Summary Billing Period & Meter Information Billing Date: Nov 11, 2004 Billing Period: Oct 11 to Nov 05 (25 days) Next reading on/about: Dec 09, 2004 Rate Type: Residential _____m.. Prior Balance---------------....--... Balance from last bill Payments prior to Nov 11,2004. Thanks! Total prior balance, Nov 11, 2004 ---.--.---Current Water Charges-----...-- Service Charge Water Volume ($.005735 x 1,700) STAS PAWC Water 0.04% OSI- PAWC Charge 0.82% Total water charges, Nov 11, 2004 --m..---Other Current Charges.....----- Mthly Sewer Line Protection Mthly Water Line Protection Total other charges, Nov 11, 2004 Meter readings in current billing period: Meter Number N000045083 is a 5/8-inch meter. Present-actual 1001700 Last-actual 1000000 Gallons used -....-...-AMOU NT DUE -.--....----.----..-- Water Usage Comparison Monthly usage in hundred gallons. 2 NDJFMAMJJASON2 o oeaearauuueco 0 ~VCllbr ynlgptv~ $38.90 -38.90 .00 9.58 9.75 .01 .16 19.50 9.00 5.00 14.00 I $33.501 '- -_._-~--- -- --....----..- - Messages to you from Pennsylvania American Any portion ofthe water charges wnich is not paid as 002/06/04 will be subject to a 1.50% penalty. . Customers may use their credit card, debit card or pay by electronic check only by calling toll free: 1-866-271-552~ Customers may also pay on-line at www.water.paymybill.com. A service fee will applY. . Approximately 4.72 percent or $.92, of State taxes are included in your current bill. . Effective April 1, 2004, the State Tax Adjustment Surcharge (STAS) is now .04%. . Arrangements to disconnect your service just got easier. Log on to pawc.com and follow the Turn-Off Program IinA . Effective October 1, 2004, the Oistribution System Improvement Charge (DS/C) increases from .37% to .82%. This charge funds the replacement of water distribution facilities. Customer Service & Emergencies 1-800-565-7292 (24 Hours) For Hearing Impaired Customers TOO 1-800-300-6202 (24 Hours) Visit us on the INTERNET: www.pawc.com ~~ . A1M 31000 CU$tamer AccountJnfarmation For Service To: John M Kelly 325 Pinewood Dr Account Number: 24-0655910-0 PremiseNllmber: 24-0387396 Billing Summary Billing Pel'iad&Metetlnfatmation Billing Date:Oec 13, 2004 Billing Period: Nov 05 to Dec 09 (34 days) Next reading on/about: Jan11, 2005 Rate Type: Residential .......---Prior Balance.....-...........--..-- Balance from last bill Payments prior to Dec 13, 2004. Thanks! Total prior balance, Dec 13,2004 ..........Current Water Charges-........ Service Charge Water Volume ($.005735 x 2,800) STAS PAWC Water 0.04% 051 - PAWC Charge 0.82% Total water charges, Dec 13,2004 ...._....Other Current Charges.......... Mthly Sewer Line Protection Mthly Water Line Protection Total other charges, Dee 13, 2004 Meterreadings.in'Cllrrentbillingperil)d: Meter Number N000045083is a5/8'inchrnefer. Present"actual 1004500 Last-actual 1001700 Gallons used .._......AMOUNT DUE ....-.............. Water Usage Comparison Monthly uSllge in hU{1dre9 gallons. 2DJFMAMJJASOND2 o e.e.r.uuuecoe~ ~cnbr ynlgptvc~ $33.50 -33.50 .00 11.50 16.06 .01 .23 27.80 9.00 5.00 14.00 I $41. 801 ... ... Messages to you from Pennsylvania American Any portion of the water charges wfiich is not paid as of 1110105 will be subject to a 1.50% penalty. . Customers may use their credit card, debit card or par by electronic check only by calling toll free: 1-866-271-552. Customers may also pay on-line at www.water.paymyblll.com. A service fee will apply. . Approximately 4.72 percent or $1.31, of State taxes are included in your current bill. . Effective Apri/1, 2004, the State Tax Adjustment Surcharge (STAS) is now .04%. . Arrangements to disconnect your service just got easIer. Log on to pawc.com and follow the Turn-Off Program lin . . Effective October 1,2004, the Distribution System Improvement Charge (DSIC) increases from .37% to .82%. This charge funds the replacement of water distribution facilities. Customer Service & Emergencies 1.800.565-7292 (24 Hours) Fbr Hearing Impaired Customers TOO 1-800.300.6202 (24 Hours) Visit us on the INTERNET:www.pawc.com ~ iII=I AIM 34724 Customer Account Information For Service To: John M Kelly 325 Pinewood Dr Account Number: 24-0655910-0 Premise Number: 24-0387396 Billing Period & Meter Information Billing Date: Jan 17,2005 Billing Period: Dec 09 to Jan 12 (34 days) Next reading on/about: Feb 09. 2005 Rate Type: Residential Meter readings in current l:Iillingperiod: Meter Number N000045083 is a 5/8-inch meter. Present-actual 1007400 Last-actual 1004500 Gallons used Water Usage Comparison Monthly usage in hundred gallons. FMAMJJASONDJ2 g~r;~p~~f~~~g Billing Summary _._......Prior Balance.........-...--......... Balance from last bill Payments prior to Jan 17, 2005. Thanks! Total prior balance, Jan 17, 2005 ..........CUrrent Water Charges..-....-- Service Charge Water Volume ($.005735 x 2,900) STAS PAWC Water-0.14% OSI- PAWC Charge 1.42% Total water charges, Jan 17, 2005 .-........Other Current Charges..-....... Mthly Sewer Line Protection Mthly Water Line Protection Total other charges, Jan 17, 2005 ...---...AMOUNT DUE ----...---.----...-.. ~\\ u"\~< $41. 80 -41.80 .00 11.50 16.63 -.04 .40 28.49 9.00 5.00 14.00 I $42.491 Messages to you from Pennsylvania American Any portion of the water charges wliich Is not paid as of2/14105 will be subject to a 1.50% penalty. . Customers may use their credit card, debit card or par by electronic check only by calling toll free: 1-866-271-552~ Customers may also pay on-line at www.water.paymyblll.com. A service fee will apply. . Approximately 4.72 percent or $1.34, of State taxes are included in your current bill. . Effective January 1, 2005, the Distribution System Improvement Cha1J!.e (DS/C) increases from .82% to 1.42%. This charge funds the replacement of water distribution facilities. . Effective January 1,2005, the State Tax Adjustment Surcharge (STAS) decreases from .04% to -.14%. . Arrangements to disconnect your service just got easier. Log on to pawp.com and follow the Turn-Off Program linl . Customer Service & Emergencies 1-800-565-7292 (24 Hours) For Hearing Impaired Customers TDD 1-800-300-6202 (24 Hours) Visit us on the INTERNET: www.pawc.com o~ A1M 36926 '._-_"'__'__'_'_'._.'_._:'~__"'~~',__"'l" ....,".-.-.',..~..~,.... -~.. Billing Summary Bi/lingPeriod & MeterlnfOitrtation l3illingDate: Peb 11,2005 aUlingPeriod: Jan 12t.o Feb08(27 days) Nextreading on/about: Mar09,20Q5 Rate Type: Residential .....-...Prior Balance....................._.. Balance from last bill Payments prior to Feb 11, 2005. Thanks! T6talprior balance, Feb 11,200.5 .._......Current Water Charges.......... Service Charge Wilter Volume ($. 0057:JSx 2,3(0) STA$ PAWC Water .0, 14% 0$1- PAWC Charge 1,42% Totitlwater charges, Feb.11 ,200.5 ..........OlherCqrrent Charges-........ Mtlily SewerLinePiote6tion Mthty WaterLine Protection Total olher charges, Feb .11, 2005 Meter readings in curtent Iiilling,petiod: Meter Number N000045083 isa 5/8-inchmeter. Present-actual 100.970'0 Last-actual 1007400. Gallons used ._.......AMOUNT DUE ..-..-........... Water Usage Comparison 3 Monthly ,usage in hundr~d gallons. fjl A M J J A s a N 0 J F 2 r r a u U U e. c 0 e a e g y n I 9 P t v c n b $42.49 -42.49 .00 11.50 13.19 -.03 .35 25.01 9.00 5.0.0 14.00 I $39.011 _.~."---- .- Messages to you from Pennsylvania American Any portion of the water charges wliich is not paid as 0(3108105 will be subject to a 1.50% penalty. . Customers may use their credit card, debit card or pay by electronic check only by calling toll free: 1-866-271-552~ Customers may also pay on-line at www.water.paymybill.com. A service fee will apply. . Approximately 4.72 percent or $1.18, of State taxes are included in your current bill. . Effective January 1, 2005, the Distribution System Improvement Charge (DSIC) increases from .82% to 1.42%. This charge funds the replacement of water distribution facilities. . Effective January 1,2005, the State Tax Adjustment Surcharge (STAS) decreases from .04% to -.14%. . Arrangements to disconnect your service just got easier. Log on to pawc.com and follow the Turn-Off Program Iin~ Customer Service & Emergencies 1 c800c565.7292 (24 Hours) For Hearing Ilnpaired Customers TOD 1-800-300.6202 (24 Hours) Visit us on the INTERNET: www.pawc.com ., II8a A1M 28292 C~rom~A~o~tmrorma~n For Service To: John M Kelly 325 Pinewood Dr Account Number: 24-0.855910-0. Premise Number: 24-0.387396 Billing Summary --.--Prior Balance--...--------.--.. Balance from last bill Payments prior to Mar 11, 2005. Thanksl Total prior balance, Mar 11, 2005 ----Current Water Charg!!s------ Service Charge Water Volume ($.005735 x 1,900) STAS PAWC Water -0.14% DSI. PAWC Charge 1.42% Total water charges, Mar 11, 20.0.5 ...---Other Current Charges--..-. Mthly Sewer Line Protection Mthly Water Line Protection Total other charges, Mar 11, 20.0.5 Billing Period & Meter Information Billing Date: Mar 11, 200.5 Billing Period: Peb 0.8 to Mar 0.7 (27 days) Next reading on/about: Apr 11, 20.05 Rate Type: Residential Meter readings in current billing period: Meter Number No.o.o.o.45083 is a 5/8-inch meter. Present-actual 1011600 last-actual 1009700 Gallons used -..---AMOUNT DUE .-...-.------ Water Usage Comparison Monthly usage in hundred gallons. 35 2 MAMJJASONDJFM2 ~ ~r~~r~~f~ggg~~ $39.01 -39.01 .00 11.50 10.90 - .03 .32 22.69 9.00 5.00 14.00 I $36.691 Messages to you from Pennsylvania American Water Any portion of the water Charges which is not paid as of 4/05/05 will be subject to a 1.50% penalty. . Customers may use their credit card, debit card or pay by electronic check only by calling toll free: 1-866-271-552.. Customers may also pay on-line at www.water.paymybill.com. A service fee will apply. . Approximately 4.72 percent or $1.07, of State taxes are included in your current bill. . ~tfective January 1,2005, the Distribution System Improvement Charfle (DSIC) increases from .82% to 1.42%. This charge funds the replacement of water distribution facilities. . Effective January 1, 2005, the State Tax Adjustment Surcharge (STAS) decreases from .04% to -.14%. . Arranf/ements to disconnect your service just got easier. Log on to pawc.com and follow the Turn-Off Program lim. . Attentions customers: as Pennsylvania American Water transitions to new company vehicles, you may notice a color change from white to pewter vehicles. For security purposes, all official company vehicles are clearly marked with the Pennsylvania American Water/RWE logos, despite the color of the vehicle. . Customer Service & Emergencies 1-800-565-7292 (24 Hours) For Hearing Impaired Customers TOO 1-800-300-6202 (24 Hours) Visit us on the INTERNET: www.pawc.com @- A1M 12128 11 I I ;. pp( Electric Utilities I Electric Service For: JOHN KELLY 325 PINEWOOD DR SHIREMANSTOWN PA 17011 Ouestions about this bill? Please contact us by May 27 at 1-800-342-5775 or 484-634-4900 01' write to: Customer Service 827 Hausman Rd. Allentown, PA 18104-9392 www.pplweb.com Page 1 ., : YouI..Bll1AocOilillNUilmi:j''c...:. ..... 01660-78002 .. 'OJ . ,,;,,,,rl.h,,,.,. ..: 'c Summary Page Balance as of May 6, 2004 Char~s: TotafrPL ELECTRIC UTILITIES Charges Total Charges 174 145 KWH - Average Per Day $0.00 $ 180.00 $ 180.00 Account Balance $ 180.00 ~ '-' . (\Ga ) ~t. ~ trl r 10'/')') It\r)'t. Electric Use This graph shows your electric use over the last 13 months. Types of Meter Readings: Actual II1II Estimated _ Customer D 116 - II I Meter Reading Information eter 4618474 May 6 Actual Apr 6 Aclnal 30 Da s KWH BIlled 25225 23316 ~ 2004 551' 64 87 58 29 o MJ J ASONDJ FMAM 2003 Months 2004 Average - May Temperature KWH Per Day Yearly Use: Jun 2002 - May 2003 Jun 2003 - May 2004 2003 56F 66 Total Use 30045 28296 Ave,'age Monthly 2504 2358 Otber important information on back ... ---------------.------------..---------------------------------.--------------------------------------------------------------_.---------------- r---- I ~ I I ; PPt. Electric utilities Electric Service For: JOIfNXELLY 325 PINEWOOD DR SHlREMANSTOWN PA 17011 Questions about this bill? Please contact us by Jun 28 at 1-800-342-5775 or 484-634-4900 or write to: Customer Service 827 Hausman Rd, Allentown, PA 18104-9392 www.pplweb.com 01660-78002 Meter Reading Information 4 1 4 Actual Actual KWH BlIled A vel'age - .Tun T emjJera ture KWH Per Day Yearly Use: Jul2002 - Jun 2003 Jul2003 - Jun 2004 2003 581" 55 Totlll Use 30318 27631 ppl Page 1 Summary Page Balance as of Jun 7,2004 Char~s: TotafrPL ELECTRIC Ul1LITIES Charges Total ~harges $0.00 $ 180.00 $ 180.00 Account Balance $ 180.00 Electric Use This graph shows your electric use over the last 13 months. Types of Meter Readings: Actual II1II Estimated - Customer D 174 145 KWH - Average Per Day 26163 25225 ~ 2004 68F 29 A verllge Monthly 2527 2303 Other important information on back ... ---~----_.~--_._---------- --- ---. -- ------------------------'.----- -- ---... ---------- - -------- --- - ...- -..". .---- ------ "'-- ....'"'-..-- --- --_.-..'....... ---- -- .--- -. . 116 87 58 - .- -- - --- -- -- -11 - -- ~-- I I 29 o J J ASONDJ FMAMJ 2003 Months 2004 I I I PPL EleGtric Utilities I Electric Service For: JOHN KELLY 325 PINEWOOO DR SHlREMANSTOWN PA 17011 Ouestions about tliis bill? Please contact us by Jul 28 at 1-800-342-5775 or 484-634-4900 or write to: Customer Service 827 Hausman Rd. Allentown, PA 18104-9392 www.pplweb.colll ppl Page 1 .....:.-;};.:.YQll(:BillA<;COUllfNumlil:f''i . 01660-78002 ~".am"".",........ Summary Page Balance as of Jul 7, 2004 Char~s: TotafPPL ELECIRIC UllLITIES Charges Total Charges $0.00 $ 168.00 $ 168.00 Account Balance $ 168.00 Electric Use This graph shows your electric use over the last 13 months. 'I'ypes of Meter Readings: Actual _ Estimated iii Customer 0 174 KWH - Average Per Day Meter Reading Infol'mation 8474 145 Actual 26831 Actual 26163 116 KWH BIlled ~ 87 Average-Jul 2003 2004 -- Te~erature 72F 72F KW Per Day 34 22 58 Yearly Use: Total A vera~e 29 Use Month y Aug 2002 - Jul2003 30189 2516 0 Aug 2003 - Jul 2004 27230 2269 J ASOND J FMAMJ J 2003 Months 2004 - ------- -------- - - - - - - ---- --.-- - - ---. -.- -- - - ----- - -- - - -. -- - ---- --- - - --- - -- -- - -- -- .--- ------- --- ------- - ------- -- ------ --- --- ------------ -------- Other important information on back ... ..,.,..... P;Pl.EI.eCltric 'Utilities Electric Service For: JOHN KELLY 325 PINEWOOO OR SHlaEMANSTOWN PA 17011 Questions about this bill? Please contact us by Aug 30 at HQo-3!fZ-5775 Qr 484-634-4900 or write to: Customer Service 827 Hl1us!lllln Rd. AllentoWll. PA i8i04-9392 www.pplweb.com . . . " ,. I' '............~:l.,,' <' . I ..' pp .!.~~~ " w Page I 01660-78002 Summary Page Balan~e as of Aug 6,2004 Char~s: TotarpPL ELECTRIC UTILITIES Charges Total Charges $0.00 $ 168.00 $ 168.00 ~:~l~!~i~~1~t!~t~}~;~~~~Jl;~;ItI~~t~~t~~~~i~;;l~rt~I~~lt1It;~;JJ;~~;;~~Jl~}i;~:1:1Z~;IU:n~~~~J~~~~~~~~~~~;:i~]~~~~~t~~~I~~~~~i~~~i~il~l~~ij~~i~:~i~:;~~~:~~~~U~ Accolmt Balance $ 168.00 Pd <?)lsJOIf Electric Use This graph shows your electric use over the last 13 months. Types of Meter Readings: Actual _ Bsti!llllted _ Customer 0 174 KWH - Average Per Day Meter Reading Information e r 145 Aug 6 27465 Jul 7 26831 il6 30 Da s -m 87 Average - Aug Z003 2004 TwrJmture 74F 73F K Per Day 34 21 58 Yearly Use: Total Avertie 29 Use Mont b III Sep 2002 - Aug 2003 30003 250 0 Sep 2003 - Aug 2004 26957 2246 I I I ASOND J FMAMJ J A 2003 Months 2004 Other important information on back .. PPL Electric Uf1iities Electric Service For: JOHN \CELL Y 325 PINEWOOD DR SHlREMANSTOWNPA t10tt Questions about t6is bill? Please contact us by Sl:J:l. 28 at 1-800-342-5775 or 484-634-4900 or write to: Customer Service 827 Hausman Rd. Allentown, P A 18104-9392 www.pplweb.com , . , , ,I, I , \. .... ( ~ ppi.~~~~~ " w Page 1 r"'~..:=::'..l ,::::::;~~O-78~2~::: Summary Page Balance as ofSep 7,2004 Char~s: TotarPPL ELECTRIC UTILITIES Charges Total Charges $0.00 $ 168.00 $ 168.00 ~~::~~i:;:~~~~~~:~~~~:~~:j~~:;+)t;:::~.::t;;.:~~~:~~~::~;:::t:;;~;~~;;:t~~:;.:.J:;;~~~~;~~ii;;~;;;~:~:;I::~t~:;~~:~~::;ii;;:~:;~:~:~~;~;:t~~;;~~~;~~~~~:~~~~~~~~~~~~~~:~~~~~ll~1~ifI:~~~~I~~~~~I~~~~~~~ ~~~I~Ji:~~I~~JXr~~ AccOlmt Balance $ 168.00 Electric Use This graph shows your electric use over the last 13 months. Types of Miter Readings: Actual _ Esti!llllted III Customer 0 174 KWH - Average Per Day Meter Reading Information 145 28075 27465 116 -om 87 Average - Sep 2003 2004 TwrJrature 74F 7IF K Per Day 32 19 58 Yearly Use: Total Averahie 29 Use Mont y Oct 2002 - Sep 2003 29928 249~ 0 Oct 2003 - Sep 2004 26529 2211 SONDJFMAMJJAS 2003 Months 2004 Other important information on back .. PPL EI~tric -:utilities Electric Service For: JOHN KELLY 325 PINEWOOD DR. SHIREMANSTOWN PA 17011 Questions about t6is bill? Please contact us by Oct 28 at 1-800-342-5775 or 484-634-4900 or write to: Customer Service 827 Hausman Rd. Allentown, P A 18104-9392 www.pplweb.com \ I I' , ,14 I '.....\....::././ .- . ".' ppl .;~~~~ , N Page 1 C~J Sunimary Page Balance as of Oct 7, 2004 $ 0.00 CharMs: TotafPPL ELECTRIC utILITIES Charges $ 140.94 Total Charges $ 140.94 Account Balance $140.94 Electric Use This graph shows your electric use over the last 13 months. Types of Meter Readings: Actual _ Estimated _ Customer 0 174 KWH - Average Per Day Meter Reading Information 145 Actual 28617 Actual 28075 116 KWH BIlled --ro 87 Average - Oct 2003 2004 Twmrature 62F 65F K Per Day 37 18 58 Yearly Use: Total Avera~e 29 Use Month ~ Nov 2002 - Oct 2003 30244 252 0 Nov 2003 - Oct 2004 25961 2163 ONDJFMAMJ JASO 2003 Months 2004 Other important information on back + PPL EleCtric E:ltilities Electric Service For: JOHN KELLY 325 PINEWOOD DR SHlREMANsroWN PA 17011 Questions about this bilI? Please contact us by Nov 29 at 1-800-342-5775 or 484-634-4900 or write to: Customer Service 827 Hausman Rd. Allentown, P A 18104-9392 www.pplweb.com , ' , \ ,I, ' " ~.... 4' , '...:.....~.,:', ppl J~~: " N Page 1 01660-78002 Summary Page Balance as of Nov 5, 2004 Cbar~s; TotafPPL ELECTRI0UTILITIES Charges Total Charges so.oo $ 140.84 $ 140.84 Account Balance $ 140.84 Electric Use This graph shows your electric use over the last 13 months. Types of Meter ReadiDgs: Actual _ Estimated _ Customer 0 174 KWH - Average Per Day Meter Reading Information e r 145 Nov 5 Actual 30182 Oct 7 Actual 28617 116 29 Oa s KWH Billed -----rID 87 Average - Nov 2003 2004 Temllerature 54F 53F KW Per Day 64 54 58 Yearly Use: Total Avera~e 29 Use Month y Oec 2002 - Nov 2003 29711 2476 0 Oec 2003 - Nov 2004 25674 2140 NO] FMAMJ JASON 2003 Months 2004 Other important information on back .. PPL Electric Utilities ppl Page 1 ,::::,:,:,:,:,:>",>X~WBUIA#i:i~i:tNijiilli.~if"",:,:,:::::::::. 01660-78002 ,:,:,:,:,:,:,:Hili,{"i1ien:)ia .. H. H H iii H:,::::::::::...:. Electric Service Summary Page Balance as ofDec 7,2004 S 0.00 CharMS: TotafPPL ELECTRIC UTILITIES Charges $ 40.85 Total Charges $ 40.85 Account Balance $ 40.85 For: JOHN KELLY 325 PINEWOOD DR SHlREMANSTOWNPA 17011 Questions about tliis bill? Please contact us by Dec 28 at 1-800-342-5775 or 484-634-4900 or write to: Customer Serviee 827 Hausman Rd. Allentown, P A 18104-9392 www.pplweb.com Electric Use 174 KWH - Average Per Day Meter Reading Information 145 Actual 32857 Actual 30182 116 KWH Billed 2m 87 Average - Dee 2003 2004 T~erature 42F 46F K Per Day 98 84 58 Yearly Use: Total A vera~e 29 Use Month ~ Jan 2003 - Dec 2003 30504 254 0 Jan 2004 - Dec 2004 25224 2102 D J FMAMJ J ASOND 2003 Months 2004 This graph shows your electric use over the last 13 months. Types of Meter Readings: Actual _ Estimated _ Customer 0 Other important information on back .. , ' , , ,I, I '......\...::l~/ .. ppl :;~~~:- . ~ Page 1 PPt.. Electric ~' Utilities 01660-78002 .w Electric Service Summary Page Balance as of Jan 7,2005 $ 0.00 CharMS: TotarPPL ELECTRIC UTILITIES Charges . $ 163.00 Total Charges $ 163.00 Account Balance $ 163.00 For: JOHN !CELL Y 325 PINEWOOD DR SHlREMANSTOWN PA 17011 Questions about this bill? Please contact us by Jan 31 at 1-800-342-5775 or 484-634-4900 or write to: Customer Service 827 Hausman Rd. Allentown, P A 18104-9392 www.pplweb.com Electric Use 174 KWH - Average Per Day Meter Reading Information f"!eter Actual 36570 145 Jan 7 Dec 7 Actual 32857 116 31 Davs KWH Billed jID 87 Average-Jan 2004 2005 TemlIerature 36F 36F KW Per Day 126 120 58 Yearly Use: Total Avera~e 29 Use Month ~ Peb 2003 - Jan 2004 28910 240 0 Feb 2004 - Jan 2005 25036 2086 JFMAMJ JASONDJ 2004 Months 2005 This graph shows your electric use over the last 13 months. Types of Meter Readings: Actual . Estimated _ Customer D Other important information on back ~ - PPL Electric Utilities Electric Service Por: JOHN KELLY 325 PINEWOOD DR SHlREMANSTOWN PA 11011 Questions about this bill? Please contact us by Peb 28 at 1-800-342-5775 or 484-634-4900 or write to: Customer Service 827 Hausman Rd. Allentown, P A 18104-9392 www.pplweb.com , ' , , "I' "';.~I::.~';> pp }::- ......., " ~ Page 1 _J:llln~:eQolliit; " 01660-78002 ""f""':,":i:;;,,' Summary Page Balance as ofFeb 7,2005 $ 0.00 CharMS: TotafPPL ELECTRIC UTILITIES Charges $ 163.00 Total Charges $ 163.00 Account Balance $ 163.00 Electric Use This graph shows your electric use over the last I3 months. Types of Miter ReadIugs: Actual . Estimated _ Customer CJ 174 KWH - Average Per Day Meter Reading Information 145 Actual 41129 Actual 36570 116 KWH Billed -:m9" 87 Average - Feb 2004 2005 T~erature 21P 30P K Per Day 172 147 58 Yearly Use: Total Avera~e 29 Use Month ~ Mar 2003 " Peb 2004 29031 241 0 Mar 2004 " Peb 2005 24780 2065 PMAMJJASONDJP 2004 Months 2005 Other important information on back .. PPl Electric Utilities Electric Service For: JOHN KELLY 325 PINEWOOD DR SHlREMANSTOWN P A 17011 QuestioDs ab\)ut this bill? Please contact us by Mar 30 at 1-800-342-5775 or 484-634-4900 or write to: Customer Service 827 Hausman Rd. Allentown, P A 18104-9392 www.pplweb.com . , , , ll, I '.............::l~./ "' . I '.- pp }=~ . '. " ~ Page I 1"'::=:"1 :=':~~~~~~-'::: ,"i;i!;;,.,;,;::::';;;'Zi:';:: ;",.;';,' 'iH:i''':;;:;,,,', Su.mmary Page Balance as of Mar 9,2005 $0.00 CharMS: TotafPPL ELECTRIC UTILITIES Charges $ 163.00 Total Charges $ 163.00 Account Balance $163.00 ( Electric Use This graph shows your electric use over the last 13 months. Types of Meter Readings: Actual _ Estimated _ Customer D 150 KWH - Average Per Day Meter ReadiDg IDformatioD l\'!eter Actual 45003 125 Mar 9 Peb 7 Actual 41129 100 30 Davs KWH Billed jffi 75 Average - Mar 2004 2005 TemlIerature 35F 34F KW Per Day 122 129 50 Yearly Use: Total Averi1fe 25 Use MODt y Apr 2003 - Mar 2004 28510 2370 0 Apr 2004 - Mar 2005 24738 2062 MAMJJASONDJFM 2004 Months 2005 Other important information on back ~ PPl Electric Utilities Electric Service For: JOHN KELLY 325 PINEWOOD DR SIDREMANSTOWN PA 17011 Questions about tJiis bill? Please contact us by May 2 at 1-800-342-5775 or 484-634-4900 or write to: Customer Service 827 Hausman Rd. Allentown, P A 18104-9392 www.pplweb.com , , , \ ,., I " \ &'. # I P P":..I...~~;:~ :-..... +,.'.. " ~ Page 1 ''''''''''''''''''''';'''. ,,,,,:::,,,,,,,,::,,,,,,,, .....................-.. 01660-78002 ,..".",.,,,:. "'.~"""~"::: - .. <:'::: ::.,. ~ Summary Page Balance as of Apr 8, 200S CharMS: TotafPPL ELECTRIC UTILITIES Charges Total Charges $ 0.00 $ 163.00 $ 163.00 Account Balance $ 163.00 Electric Use This graph shows your electric use over the last 13 months. Types of Meter Readings: Actual . Estimated _ Customer D 150 KWH - Average Per Day Meter Reading InforlUation 125 Actual 48162 Actual 45003 100 KWH Billed ~ 75 Average - Apr 2004 2005 Tej!Ierature 42F 40F KW Per Day 105 105 50 Yearly Use: Total Avera~e 25 Use Month y May 2003 - Apr 2004 28490 2374 0 May 2004 - Apr 2005 24846 2071 AMJ JASONDJFMA 2004 Months 2005 Other important information on back + ~ ver,Z2!1 Make progress every day MR JOHN M KELLY Account Summary Billing Dale 04/25/04 Page 1 of 5 Telephone Number: 717 7613064 Accounl 717761306418394 Y How 10 Reach Us: See page 2 $44.00 -44.00 $.00 OJ Manage Your Verlzon Account Online! View & pay bills, request repairs, place orders. It's quick and easy: Go to verizon.com Click "Sign in" under "Manage My Account". First time user? Get started with ... UserID:7177613064$ Password: DM94RT ... and customize your ID as you register. Then follow the step-by-step instructions. Previous Charges Payments Received Ihru Apr 27 Past Due Charges New Charges Verizon (page 3) Tolal New Charges due May 20 $38.13 $38.13 Total Due (Past Due + New) $38.13 Mail payments to: VerizDn, PO Box 28000, Lehigh Vly PA 18002-8000 Change 01 billing address? Go 10 verizon,comlbillingaddress or see page 2. '"0Zj To enroll in the Verlzon Direct Payment Option please read and sign the agreement on the reverse side of the payment form below. f\l>J ~ ,,~~L/ ~3 ~4y - - - - - - - - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ,!D.!',,!!!hlo~t'!!.nE.a~e.!)t:!!iPl"i!!:!Y2ur:.c~c~P!y~I'!...to"ye.!:!z~._ __ ~ ver.'nt1 Make progress every day MR JOHN M KELLY Account Summary Previous Charges Payments Received thru May 26 Past Due Charges $38.13 -38,13 $.00 New Charges Verizon (page 3) Total New Charges due Jun 21 $32 .,22 $32.22 Total Due (Past Due + New) $32,22 Mall payments to: Verizon, PO Box 28000, Lehigh Vly PA 18002-8000 Change 01 billing address? Go to verizon,oomlbillingaddress or see page 2. Billing Date 05/25/04 Page 1 of 5 Telephone Number: 717 7613064 Account 717761306418394 Y How to Reach Us: See page 2 CD Manage Your Verlzon Account Online! View & pay bills, request repairs, place orders, It's quick and easy: Go to verizon. com Click "Sign in" under "Manage My Account", First time user? Get started with .., UserID:7177613064$ Password: 6M5572 ... and customize your ID as you register. Then follow the step-by-step instructions, 'Y5ZJ To enroll in the Verlzon Direct Payment Option please read and sign the agreement on the reverse side of the payment form below, _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~D.!t'!9h~l!tu.!.n.e.aY..Te~t!!ip..!'i~y~ur:..ch~c~p~y~l~to"ye!!z~._ __ ~. verizlllt Make progreas every day MR JOHN M KELLY Account Summary $32.22 -32.22 Previous Charges Payments Received thru Jun 28 Past Due Charges New Charges Verizon (page 3) Total New Charges due Jul 21 $.00 . $29.66 $29.66 Total Due (Past Due + New) $29.66 Mall payments to: Verizon, PO Box 28000, Lehigh Vly PA 18002-8000 Change of billing address? Go to verizon.comlbillingaddress or see page 2. Billing Date 06/25/04 Page 1 of 5 Telephone Number: 717 761 3064 Account 717761306418394 Y How to Reach Us: See page 2 fd &~*"Ie IIUli( CD Manage Your Verizon Account Online! View & pay bills, request repairs. place orders. It's quick and easy: Go to verizon.com Click "Sign in" under "Manage My Account". First time user? Get started with ... UserID:7177613064$ Password: GYB568 ... and customize your ID as you register. Then follow the step-by-step instructions. . '7r:::-71 -L.:::.J To enroll in the Verlzon Direct Payment Option please read and sign the agreement on the reverse side of the payment form below. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ L_' _ '! D~t~h ~ ~!tu.!.n E.a~e!,l ~ip ..!-'i~ y~u':..ch.!c~ P!yc:?l~to 'ye!!z~. _ _ _ ~ yerlZSlD Make progress every day MR JOHN M KELLY Account Summary Previous Charges Paymenls Received Ihru Jul 27 Past Due Charges New Charges Verizon (page 3) Total New Charges due Aug 19 $29.66 -29.66 $.00 $30.17 $30.17 Total Due (Past Due + New) $30.17 Mall payments to: Verizon, PO Box 28000, Lehigh Vly PA 18002-8000 Change of billing address? Go 10 verizon.comlbillingaddress or see page 2. Billing Date 07/25/04 Page 1 of 5 Telephone Number: 717 761 3064 Account 717761306418394 Y How to Reach Us: See page 2 OJ Manpge Your Verizon Account Online! View & pay bills, request repairs, place orders. It's quick and easy: Go to verizon.com Click "Sign in" under "Manage My Account". First time user? Get started with ... UserID:7177613064$ Password: TS3F16 ... and customize your ID as you register. Then follow the step-by-step instructions. 'T5ZJ To enroll in the Verizon Direct Payment Option please read and sign the agreement on the reverse side 01 the payment form below. ./ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ,!~t~h~~tu!..ne.a~e~t~ip_wi!!:!y~u~~c~p!y~I~to"ye!!z~._ __ ~ . vertZllD Make progress every day MR JOHN M KELLY Account Summary Billing Date 08/25/04 Page 1 of 5 Telephone Number: 717 761 3064 Account 717 761306418394 Y How to Reach Us: See page 2 Nt), -C~S-k'{L $30.17 lJJ Previous Charges Payments Received thru Aug 26 Past Due Charges New Charges Verizon (page 3) Total New Charges due Sep 20 -30.17, $.00 $38.19 $38.19 Total Due (Past Due + New) $38.19 Mall payments to: Verizon, PO Box 28000, Lehigh Vly PA 18002-8000 Change 01 bllJlng address? Go to verizon.comlbillingaddress or see page 2. Manage Your Verizon Account Online I View & pay bills, request repairs, place orders. It's quick and easy: Go to verizon.com Click "Sign in" under "Manage My Account". First time user? Get started with ... UserfD:7177613064$ Password: TP38NG ... and customize your ID as you register. Then follow the step-by-step instructions. 7s::J To enroll in the Verizon Direct Psyment Option please read and sign the agreement on the reverse side of the payment form below. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ '! ~t~h ~ ,!tu!." E.aY.!"8.Dt !!ip ~i!b y~ut..ch!C~ p.!y~l!..to ~e.!!z~. _ _ _ ~ v8."ZIlD Make progress every day MR JOHN M KELLY Account Summary Previous Charges Payments Received thru Sep 27 Past Due Charges New Charges Verizon (page 3) Total New Charges due Oct 20 $38.19 -38.19 $.00 $41.06 $41.06 Total Due (PaSI Due + New) $41.06 Mail payments to: Verizon, PO Box 28000, Lehigh Vly PA 18002-8000 Change of billing address? Go to verizon.comlbillingaddress or see page 2. Billing Date 09/25/04 Page 1 of 6 Telephone Number: 717 761 3064 Account 717761306418394 Y How to Reach Us: See page 2 [0 IV\')IO~ Manage Your Verizon Account Online! View & pay bills, request repairs, place orders. It's quick and easy: Go to verizon.com Click "Sign in" under "Manage My Account". First time user? Get started with ... UsertD:7177613064$ Password: X8NTR4 ... and customize your ID as you register. Then follow the step-by-step instructions. I _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ,!D~t,!,h2~tu.!.nE.ay~'!!)I~ip~i!!:!Y.2u~h2c~p!y<pI'<.to'ye.'lz~._ __ ~ venZSl!1 Make progress every day MR JOHN M KELLY Account Summary $41,06 -41.06 Previous Charges Payments Received thru Oct 27 Past Due Charges New Charges Verizon (page 3) Total New Charges due Nov 22 $.00 $37.79 $37.79 Total Due I Pasl Due + New) $37.79 Mall payments to: Verizon, PO Box 28000, Lehigh Vly PA 18002-8000 Change 01 billing address? Go to verlzon.comlbilllngaddress or see page 2. Billing Date 10/25/04 Page 1 of 5 Telephone Number: 717 761 3064 Account 717761306418394 Y How to Reach Us: See page 2 [I] Manage Your Verizon Account Online I View & pay bills, request repaIrs, place orders. It's quick and easy: Go to ver/zon. com CriCK "Sign in" under "Manage My Account". First time user? Get started with ... Ussr ID: 7177613064$ Password: 6WH2NT n' and customize your ID as you register. Then /o/Iow the step-by-step instructions. Q ~ \\1 \ ~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ,!D~t,!,h2~t'!!."E.a~'!!)t~ip~I!!:!Y.2u~h2C~P!y<pI,<-Io'ye!.!l~._ _ _ .~ venzon Mskll progl'llss livery day MR JOHN M KELLY Account Summary Previous Charges Payments Received thru Nov 26 Past Due Charges New Charges Verizon (page 3) Total New Charges due Oee 21 $37.79 ' -37.79 $.00 $36.24 $36.24 Total Due (Past Due + New) $36.24 Mall payments to: Verizon, PO Box 28000, Lehigh Vly PA 18002-8000 Change of billing address? Go to verizon.comibillingaddress or see page 2. Billing Date 11/25/04 Page 1 of 6 Telephone Number: 717 7613061 Account 717761306418394' How to Reach Us: See page 2 [I] Manage Your Verizon Account Online! View & pay bills, request repairs, place orders. It's quick and easy: Go to verizon.com Click 'Sign in' under 'Manage My Account', First time user? Get star/ed with. UserlD: 7177613064$ Password: 959ZSS .., and customize your 10 as you register, Then follow the step-by-step instructions. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ,,!D.!t'!S'h~!:!!tu.!!'e.ay.!!'e.!)t!!ipl"i!!!y~u~h.!!c~P!y~I'!..to'y..!:!l~,_ _ _ ~. vet'mD We never stop workIng for you. MR JOHN M KELLY Account Summary Previous Charges Payments Received thru Dec 28 Past Due Charges New Charges Verizon (page 3) Total New Charges due Jan 24 $36.24 ' -36.24 $.00 $29.17 $29.17 T otaJ Due (Past Due + New) $29.17 Mail payments to: Verizon, PO Box 28000, Lehigh Vly PA 18002.8000 Change of billing address? Go to verizon.comlbillingaddress or see page 2. Billing Date 12/25/04 Page 1 of 4 Telephone Number: 717 7613064 Account 717761306418394 Y How to Reach Us: See page 2 OJ Manage Your Verizon Account Online! View & pay bills, request repairs, place orders. It's quick and easy: Go to verizon. com Click "Sign in" under "Manage My Account". First time user? Get star/ed with ... UserID:7177613064$ Password: YRNK7R ... and customize your 10 as you register. Then follow the step-by-step instructions. ~ ~ I \\0\\ t) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ '! ~1a.2h 1< ~IU.!!' e.aY.!!'B.!)1 !lip l"i!!:! y~u!:2h.!!c~ py~I'!..to 'ye.!:!z~. _ _ _ ~ verlZllD We never stop workfng for you. MP JHN M KELLY Account Summary Previous Charges Payments Reeeived Ihru Jan 26 Past Due Charges New Charges Verizon (page 3) Total New Charges due Feb 22 $29.17 -29.17 $.00 $34.52 $34.52 Total Due (Pest Due + New) $34.52 Mall payments to: Verizon, PO Box 28000. Lehigh Vly PA 18002-8000 .Change 01 billing address? Go to verizon.comlbillingaddress or see page 2. Billing Date 01/25/05 Page 1 of 5 Telephone Number: 717 7613064 Account 717761306418394 Y How to Reach Us: See page 2 rn Manage Your Verizon Account Online I View & pay bills, request repairs, place orders. It's quick and easy: Go to verizon.com Click "Sign in" under "Manage My Account". First time user? Get started with. UserlD:7177613064$ Password: M4XVHP ... and customize your 10 as you register. Then follow the step-by-step instructions. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ '!~t,!!,h1<'!tu.!.nE.a~e.!)t!lip.!'i!!:!y.!!u!..Ch.!!C~P!y~I'!..to"ye.!:!z'2!"_ __ ~ ver'7on We never stop wor~/ng for you. MR JOHN M KELLY Account Summary Previous Charges Payments Received thru Feb 28 Past Due Charges New Charges Verlzon (page 3) Total New Charges due Mar 23 $34. 52 -34.52 $.00 $33.82 $33.82 Total Due (Past Dua + Naw) $33.82 Mall payments to: Verlzon. PO Box 28000, Lehigh Vly PA 18002-8000 Change of billing address? Go 10 verizon.comlblllingaddress or see page 2. Billing Date 02/25/05 Page 1 01 6 Telephone Number: 717 761 3064 Account 717 761 3064 183 94 Y How to Reach Us: See page 2 [[J Manage Your Ver;zon Account Online! View & pay bills, request repairs, place orders, It's quick and easy: Go to verizon. com Click "Sign in" under "Manage My Account", First time user? Get started with, UserID:7177613064$ Password: 7DG8B5 '" and customize your ID as you register, Then follow the step-by-step instructions. Pd /(,'-': . ;3s r}c11 (' _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ !:O~t,!!,hJ<,!\u.!.nE.aY.!!'e.!)t!.!iP.!'I!!ly.!!u~h.!!c~P!y~J~to"ye.!!z~._ _ _ ~ ve"zon We never stop working for you. MR JOHN M KELLY Account Summary Previous Charges Payments Received Ihru Mar 28 Past Due Charges New Charges Verizon (page 3) Total New Charges due Apr 20 $33.82 -33.82 $.00 $31.56 $31.56 Total Due (Past Due + New) $31 .56 Mall payments to: Verizon, PO Box 28000, Lehigh Vly PA 18002-8000 Change of billing address? Go to verizon.comlbillingaddress or see page 2, Billing Date 03/25/05 Page 1 of 5 Telephone Number: 717 761 3064 Account 717761306418394 Y How to Reach Us: See page 2 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ !~ta.Eh}~tulnE.ay.!!''!!)t~ip_wi!!:!Y.2u':}h.!!c~P!y~l~o''yeL!z~._ __ Your AT&T Statement February 20-April19, 2004 -- --~ -_.,~-- -..-- - '=" USA ."---"~j~G' . ~"XY.'" I \..,," ,"'I' \... ATs.T 'BWNCJFM 110905029302001811 D 0006889A V20.503850A49703**5DGT 1",111",111"".,11",11,11".1.1",1,11"1,,.1,1.1,1",1,11 MR JOHN M KELL Y 325 PINEWOOD DR CAMP HILL PA 17011-6528 Customer 10: 717 761-3064 Page 1 of 7 Customer Service: 1 800 222-0300 Text Phone (TTY): 1 800833-3232 Internet Address: www.att.com Summary of chal"!~('s ~ Extra! Extra! GET LOCAL SERVICE YOUR WAY - ALONG WITH A $25 BILL CREDIT! With AT&T you'll find the right local plan for you. Cail1 800-383-6158 ex! 24687 Previous balance .............. ............... ...... ................. ... ......... ....29 .85 Payment received Mar 3 - Thank you............................... -29.85 AT&T direct dialed calls........................................p 4 ..........36.21 Other charges and credits ...................................;p 4 ......'.... 17.3,1 Taxes and surcharges .............................~............p 5 ............ 7.75 $61.27 May 14, 2004 Total amount due Date due This statement includes charges from the last two months. 101/'l,. V\Ll./ (1 '1 \ /1\ 1\ \ rJ '6 · Continues on back .jl Your AT&T Statement r>pril20-July 19, 2004 IBWNCJFM A 64"3DG 110905029302001811 D 0104279AT10.2928568 611 1",11I",11I" '" ,1111I11,11",1,111I1,11"1,,,1,1,1,1, "I,ll MR JOHN M KELLY 325 PINEWOOD DR CAMP HILL PA 17011-6528 Summary of charges Previous balance ..... ......... ............. ................................ ...... ...61 .27 Payment received May 17 - Thank you............................. -61.27 AT&T direct dialed calls ........................................p 3 ..........10.17 Other charges and credits ....................................p 3 ..........22.11 Taxes and surcharges ..........................................p 3 ............4.75 Total amount due Date due $37.63 August 13, 2004 This statement includes charges from the last three months. -,,-,_,"-'-~ -- -- _._" "'=' ATs.T Customer 10: 717 761-3064 Page 1 of 5 Customer Service: 1 800222-0300 Text Phone (TTY): 1 800833-3232 Internet Address: www.att.com ~ Extra! Extra! Traveling this summer? Just dial down the center with 1-800-CALL-A TT for collect calls. DiaI1-800-CALL-ATTfrom . anywhere in the U.S.A! Continues on back ~ Your AT&T Statement July20-~tober19.2004 ~tjAT.T '~~ #BWNCJFM tl09050293020018tl D 0017145AV10.278884A70t95"5DGT 1",111..,111"""11".11,/1",1,1",',1',,',,,1,1,1,111,1,11 MR JOHN M KELLY 325 PINE WOOD DR CAMP HILL PA 17011-6528 Customer 10: 717 761-3064 Page 1 of 4 Customer Service: 1 800222-0300 Text Phone (TTY): 1800833-3232 Internet Address: www.att.com 1"111111,,,,111,1,11..1111.1.1..11111.1,.1,1111,,1,.11111,1",111,1,111 Summary of charges ~ Extra! Extra! Plans change at the last minute? DiaI1-800-CALl-A TT for collect calls & stay in touch when someone is counting on you, anywhere in the USA Previous balance..... ...................... .......................... ............. ..37 .63 Payment received Aug 6 - Thank you ..............................-37.63 AT&T direct dialed calls ........................................p 3 ............ 6.33 Other charges and credits ....................................p 3 ..........22,36 Taxes and surcharges ..........................................p 3 ............4.14 Total amount due Date due $32.83 November 13, 2004 This statement includes charges from the last three months. Continues on back ~ Your AT&T Statement October 20-November 19. 2004 f.3WNC..\FM ~ 110905029302001811 0 00I6934AV10.278B90D72935 5DGT ""111",111.,,.,,11,..11.11...1.1...1.11.,1.,.1,1,1.1...1,11 MR JOHN M KELL Y 325 PINEWOOD DR CAMP HILL PA 17011-6528 1,,11I11I,., .111, I, 11,,1111.',1,,11I11 ,1,,1.11I1. .1, .11I11 .1.. ,III, I ,III Summary of charges Previous balance...... ...... ...................... ......... ...... ........ .......... .32 .83 Payment received Nov 2 - Thank you .............................. -32.83 Other charges and credits ....................................p 3 ............7.33 Taxes and surcharges ....................................:.....p3 ............ 1.06 Total amount due Date due $8.39 December 14, 2004 ~ v... ~ <! ~AT.T Customer lD: 717 761..3064 Page 1 of 3 Customer Service: 1 800222..0300 Text Phone (TTY): 1 800833..3232 Internet Address: www.att.com / 4J" Extra! F-nra! Give our troops AT&T CyberZone Holiday Gift Cards - the gift that helps bring them closer to their< familyanc\ friends this holid?y . season. Continues on h~lck 8 Your AT&T Statement November 20-December 19, 2004 #BWNCJFM 1109050293020011111 D 0017155AV10.278B92B75498~5DGT 1",111..,111."",11",11,11",1,1".1,11,.1..,1.1,1.1,..1.11 MR JOHN M KELLY 325 PINEWOOD DR CAMP HILL PA 17011.6528 I, .111111,...111.1.11.,1111.1.1..11111.1..1,1111,.1..11111,1".111,1 ,III Summary of chargl's Previous balance .................. ....................................... .............8.39 Paymenf received Dee 9 - Thank you ................................ -8.39 AT&T direct dialed calls........................................p 3 ............3.14 Other charges and credits ....................................p3 ......."...7.61 Taxes and surcharges ..........................................p 3 ............ 1.56 Total amount due Date due $12.31 January 13, 2005 ~AT.T Customer 10: 717761-3064 0293020 Page 1 of 4 Customer Service: 1 800222-0300 Text Phone (TTY): 1 800833-3232 Internet Address: www.att.com 4i'-- Extra! Extra! Plans change at the last minute? DiaI1-800-CALL-ATT for collect calls & stay in touch when . someone is coun!!ng 00 you, anywhere in the USA Continues on back ~ Your AT&T Statement December 20-March 19, 2005 IBWNCJFM .. 1I09050293020011lllD 0022583AV10.278B134A82937 500 1",111",111"",.11",11,11",1,1",1,11"1,,,1,1,1,1",I,ll MR JOHN M KELL Y 325 PINEWOOD DR CAMP HILL PA 17011-6528 1,.111"'",,1",',",,1'" .1.1,,11111,1. .1. "" ,.1,.11111,1",111,1,111 SummatT of Ch;ll"gl'S Previous balance ....................................................................12.31 Payment received Dec 31 - Thank you ............................. -12.31 AT&T direct dialed calls........................................p 3 ............0.68 Other charges anderooits ........................o........."p-3,...,.".. 22-.29 Taxes and surcharges ..........................................p 3 ............3'.31 Total amount due Date due $26.28 April 13, 2005 :~AT.T Customer 10: 717 761-3064 0293020 Page 1 of 4 Customer Service: 1 800222-0300 Text Phone (TTY): 1800833-3232 Internet Address: www.att.com 4i'-- Extra! Extra! Subscribe to USA TODAY and enjoy the convenience of home or office delivery for only $12.95 per month. Continued~ Continues on back ~ ,r1l7, . Received from ~1t;l4'- 20 flY I -rWO ~ o~ . Fi tE.tJ1AIr/ .- 'hi - 0 or" . . 5. J;;l. ? :I:: -f-' ,0; offars J /t-./. ~ (f $:htJ AM f!;~' c;-... ~ ~ ~ .~ ~ ,- ~ ~ .~ ~ LOWER ALLEN TOWNSHIP 1993 HUMMEL AVENUE Telephone CAMP HILL, PA 17011 717-975-7575 -ACCOUNT NO. BilLING DATE 1084760-0 07/01/04 ~ ~ ~ SEWlla CURRENT 2 4 . 0 0 ARREARS PENAL TV ADJUSTMENTS CURRENT ARREARS PENAL TV ADJUSTMi:NTS Total Sewer Total 24.00 Refuse 49.35 W. DATE 08/01/04 A 10% Penalty on Sewer AND a 10% Penalty on Refuse are added if full payment is NOT made within 30 Days of the Billing Date. Adjustments include Lien Fees. NSF );'1~rges, etc. _' i~fz{k . tj(;f1Iulo:!Vj LOWER ALLEN TOWNSHIP 1993 HUMMEL AVENUE Telephone CAMP HILL, PA 17011 717-975-7575 CURRENT ARREARS PENALTY ADJUSTMENTS 2 4 . 00 CURRENT ARREARS PENAL TV AWIJSTMENTS 49.35 Total Sewer Total 24.00 Refuse 49.35 11/01/04 73.35 A 10% Penalty on Sewer AND a 10% Penalty on Refuse are added if full payment is NOT made within 30 Days of the Billing Date. Adjustments include Lien Fees, NSF charges, etc. LOWER ALLEN TOWNSHIP 1993 HUMMEL AVENUE Telephone CAMP HILL, PA 17011 717 -975-7575 , CURRENT ARREARS PENALTY ADJUSTMENTS 2 4 . 0 0 CURRENT ARREARS PENALTY ADJUSTMENTS 49.35 Total Sewer Total 24.00 Refuse 49.35 if:) .U.TE 02/01/05 73.35 A 10% Penalty on Sewer AND a 10% Penalty on Refuse are added if full payment is NOT made within 30 Days of the Billing Date. Adjustments include Lien Fees, NSF charges, etc. lOWER ALLEN TOWNSHIP 1993 HUMMEL AVENUE Telephone CAMP Hill, PA 1701 i 717-975-7575 P ... ACCOLJNl"NQ. ----t- B1LLlN\sQAr~ l__~_~~~~~-=~J_~_ 0410 l 105 -----' SERVICE ADDRESS ~-:~~::~~~~J~;~~.. i CURRENT 30 . 0 0 r CURRENT 4 9 . 3 5 A.RREARs i ARFiCjl,F1S PENALTY I PENALTY ADJUSTMENTS ! ADJUSTMENTS I i i I Total I Total Sewer 30 . 00 I Refuse DUE DATE 05/0l/05.-l A 10% Penalty on Sewer AND a 10% Penalty on Refuse are added if full payment is NOT made within 30 Days of the Billing Date. Adjustments include Lien Fees, NSF charges, etc. 79.35 B.3670.F381 F H RENEWAL CERTIFICATE __~,_,"___'___~___'_._'.'.,.._'"__A"___'__~_~_'__~ _PO.lICY NUMBER _____}~f'Q.7:m:L_____._.._._.______. Homeowners Policy NOV 18 2004 to NOV 18 2005 ~ STATE FARM iNSURANCE COMPANIES State Farm Fire and Casually Company One State Farm Dr. Concordville, PA 19339-0001 KELLY, JEANETTE F 325 PINEWOOD DR SHIREMANSTOWN PA 17011-6528 PLEASE PAY THIS AMOUNT "~..__.'~--_._- .~- $486.00 DATE DUE NOV 18 2004 1...111,.,111"".,11.,,11.11.,,1.1,..1,11,,1,.,1,1.1,1,.,1,11 Coverages and Limits Section I A Dwelling Dwelling Extension B Personal Property C Loss of Use Up To $165,800 16,580 124,350 Actual Loss Sustained Deductibles . Section I All Losses 250 Location: Same as Mailing Address Loss Settlement Provisions (See Policy) A1 Replacement Cost - Similar Construction B1 Limited Replacement Cost - Coverage B Section II L Personal Liability Damage to Property of Others M Medical Payments to Others (Each Person) $100,000 500 1,000 Fonns, Options, and Endorsements Homeowners Policy Amendatory Endorsement Increase Dwlg up to $33 160 Ordinance/Law 10%/ $16,580 Policy Endorsement Fungus (Including Mold) Excl Jewelry and Furs $1 ,5001$2,500 FP-7955 FE-7269 OPT 10 OPT OL FE-5320 FE-5398 OPT JF Annual Premium Amount Due $486.00 $486.00 Premium Reductions Your premium has already been reduced by the following: Claim Record Discount 51. 00 Inflation Coverage Index: 186.3 The State Farm replacement cost is an estimated replacement cost based on general information about your home. It is developed from models that use cost of construction materials and labor rates for like homes in the area. The actual cost to replace your home may be significantly different. State Farm does not guarantee that this figure will represent the actual cost to replace your home. You are responsible for selecting the appropriate amount of coverage and you may obtain an appraisal or contractor estimate which State Farm will consider and accept, if reasonable. Higher coverage amounts may be selected and will result in higher premiums. TkLs>b.-M;l(9,fJS~F-'-- /I;e,~tk.II< ~tuIH~~. Agent ~ALE Dd'BAN Telephone (717) 737-4117 D'~~M~'" CCD "0 """A h 503333 9569 See reverse side for important information. Please keep this part for your record. N ~I'UJ~~ u :0:: 0 !z ;<'1<'1N ~I:~'; ci Ad>' -::.;,. r<l z ('1 :O::OI...:l -....;..,. E-< ... \0 P-.IZ ~...:t:.r<l 00 ....l 0I~0l>< . "I( )U1 0 or-.,) '..r. DJ r<l iii ...:l . f2,O ('f") _~1\:::.,...:l ::> . J: ,I 01 II000Z .1-1 i',: .... ..., Nl><O . ~ IN Nj r~J =- ....:I r<l :0:: .0: . o. I "---_ H 0: >- 0 p-'f.!)0E-< I r- :3: z LO ~::>OOZ 0 00 w I- ---.-.--j :E LO .o:1l:;r<l f.!)E-< I OOU E-< (J) CI) ::>:0:: . 0 i:il r<l p-. (J) 0 w \0 O:O:r:E-< 'ffi ::>UE-<I > >:0 H (J) LO ::>r<lE-<Z .o:OU H .o:Z r<l (J) o. <t rl :r::3: H l!l 0 0: E-<.o: U E-< ZO . r I I I 0 0- ...:l I'zl ~OA, ... ~~ r:: ""0: Il:; ~ p-. !i 0 ..-1 Or<l :0:::0::.0: ii: 0 '0 .......~ ...:l "" 00 A, A, " ::>r<lrz.. 0 rl 10:0:: _ 0 0 r<lMOIl>< ~ -.-':l :3: ..-1 rl::>'O 0 ::>1 I~ i:il 0: ;:l .......U::>O N E-<rl~ Z 0 ~ N .0:.0: rl H Z rlOr<l rl rlUlE-< E-< p-. .0: rl E-<O:O: w .......Il:;U> Z l>< :0:: III >> ::>0 lot>> 01::>00 ::> E-< ..-1 ~o:~rz.. Q...:l :r: Z o. 0 ...:l ZOI+-> r<l ::> OE-<~ "#- Ui:il.o: .o:1r:: 0>:E:r<l t:l E-< 0: OOUZ 10 :E:OCV HOHr<l OE-<r<l :::~~ N r<lN'O .0: .o:rz.. rlUlP-.E-< ..~ <'1 0: ..-1 P-.O...:l " ..........:lr<lrz.. :I' HE-Irn :Z;r<lUO " ~.o:OO.o: I :r:OCV ::>:z; 0 I 00...:l0: 0: >: . ...:l _....._11....'.. rz..::>"':rl 0 HE-<E-<<Il- 0 :r:E-I 0- J UU "#- I Cl)H Ilr---I 0: rz.. "E-< l>< "Ul r<l :z; H E-< .0: 0 E-< rl 0.. r<l III i i:il rl :0:: U...:l :z; 0 0 HO ...: ~ U E-<O I~I I r<l r<lrl O:r: t:l > r<l :Z;U H.o: f.!) Ul E-<rl I I <'1 ~ O:P-. ...: >: r<lrlM ._--~ ~ 0 ,f.!) .0:.0: r<l00l :;1 0 :0:: Z E-< E-<r<l O:t"-rl I I 0:3: 0: 0: E-<rlN I I LO Z 00 0 r<l"': Ul 1 01 :r: OE-< :0:: E-< .o:~ I t"- O :3:00 .o:f.!) ...:lE-lP-.<'1 0 t:l r<l:Z; Il:; E-<O: ...:l::> t"- o. J :z;...: ::> CI)::> r<l:Z;Z "#- I "" H:O:: 0 I'zl~ :3:E-<:3:~ I N l>< o..r<l l>< Ul OUlO~ 1 ...:l 0: ...:lU O:r<lE-<rl ro ...:l IOH 0 "':H A,:r:CI)~ ""~ "" i:il N:r: E-< r<lZ~ UZ~ <'1N :><: <'100 O:"':w ...: ...:l :t:~ U.==:.. 0 ...:l U')U~ r<lrilril Z H a: Oti:1Q,. l>< Il:;Z ~ ~ 1:E:12 OrlHO E-< >o:;tt ~ ::>rl:r::r: U 00 ><0 " t:lNUlo.. U H ~O i .0: rz..:r: N HE-< 7 $print@ Monthly statement: May 4, 2004 10f 4 Customer service 1-800-829-8009 Internet address sprint.comJIocal Customer number 717-243-3356-679 Summary of Current Charges Local Long Distance Total Other Charges and Usage .00 7.76 7.76 Taxes and Surcharges .00 1.10 1.10 Previous charges Payment April 16 - Thank you! Balance 3.24 -3.24 .00 .. \J tyY"-t'. ~VJ"S~ \~l1 ~ \ 1l~ _ * Please recycle - _~_ _.<1..... ___ i ~ ~ .."",0 ll.' ,Q ~e~a z o?~\Lo :a == ,.. ... iii ,., \ l- t ! o - () ,~o " ttk ~'$1~ I- ,",0 Ii; 1~~ ~ l ",,,, ~._::~ . ~, C~;~-::::::/ rtjO OCOOO~O("lOM ('t'I Ol..OOt'"" 0.,-\.01$> .....\il"'Oi"'.o.o.o. ~~ o ",*,(1) I.PCOC"lOOO _ r-- at-,-I 1fi''<t~\.O~ o (""I C'l a ~ <:> o Cl 0- 0 .0 o 0 0 '1.01 00 ,;, r . I~' . ~. ~ '" '"~ '" ~~ '" ';j~ '" ~ e ~ \\li"'" t:'l" u" to "'C. Q)::l OJ 4l~ q)H Q)f-'. 82~ 1& 1&8 1&~1&~ w => <i. a:'" ~~ gd; ;;l\!l "'~ w.:J. ~~ \f~ ,,- ~::i, oil! u.i @g ~. oi g~ uJ::i \liS "Ul w<a. r~ ...\i \!:~ .)P,CO""'" ~o;~~. ,.. ..., ,.. ..., ..., '" '" ..., ... ..., ~...."'....,., ~r-.M,N. '" 0 '"' '"' '"' owe' t-I~ri"; '" '" '" '"' <<> o ..., '" "' '" ..., '" o'"f'oC'l o 0'\0 rl. \0 .0 . ococo<O:t" o\,O".-tM ",,,,0 o 0 o 0 ooo~ cd'" 00 o .0. . or-Ot"'- -<t'coatl\O ,.,,.,0 o 0 o 0 III " :) (J) ~ ~Ul\R f-:)';' ,,'m C; Ul>l"- :1" :( -m(l. ::<.::<::1 ~::<- Ul:):I: Z:I:a. Z"'::< 0$<( CD.....() i. 1(~ .. '" '" '" <<> , uJ & 'i \ ~ '"' '" qUl 'a\~ " ~O~~ ~ "'~ .<( '5.-l ,hCS ::< CD'" ..~ Z - ..W <(O~'Z O"7<f):::<'>"C:Ul Z"'UlUl'c<l"'O 0..: 0:"0- ~,&5~'O'~$ ::<",<((Il;;l"" u... Ul \~ ..,a O<lC ::<' Z< :I:! ~ ~ u: ::. % " "lWay~qi!1J Member FDIC 12/16/04 I!II'fATE OF.aEMETTE F. ICEI.1.Y --... aHIIBMNIlDWN, M 1l'Dl1 << ..~ ~ ... 149 ;;;;i:l.~ 11; 701 t .---1 S f,:f".lg ESTATE OF oIEAIETTE F. KEl.LY --... ~'''1701' ~~ ~,<I........ ~ - Jd ~ J A";./~K , W~__.___._. ... lhv. ?/7J /Py~1t!' - O:BU?Ba?O:O~OU~a?O~; O~ ..0 000&500.. ~..~ml5a.':" 12/15/04 149 UTATE.OFJEANETTEF.KEU.Y ~... 150 ::.,~...=-"'" IJIlII ~tl, '~JlO'f ~-fL.vr.,I. . o. ,. ,,~I7..tt. 1$ ""-"~-C--I 0 I Wing W~4 00016 4065:9100 .- Z'f-fJt~<!i"'-A r;j,/k.//./J--,!: ':,UHB8?':OlOu~a OI5;;~~~ao... 41.80 ~ \Y POO"S03 (2/02) Account Page # # 108148701 2 _ MAlIvT. - Sf! ~ 1~ Go ~iJ~ ~ 11"\... ~~ POD-S03 (2J02) "lWay~qint Account # 108148701 Page # 3 Member FDJC .. r" -MJ'~ l;,. f:M --", Oal~a?OI~ 01, '00 000~01?" 8/06/04 120 ESTATE OF JEANETTE. F. ICEU.Y ..."""""""" "_*,~""IJUll 8/09/04 121 ..,. ... 122 ;;;"It'9." (,; 'lQ1I{ I S 7o.~ ~Iil= ... f1IVlv-r ~;'~j~;!'- " .WW"'.......w. ' ...-.:::::~. /J J J. .J;. 6:f _.IJv.l." d, ~_ 'k ' ", l:,H;UBa?l:OIOal~a?OI~ 01,$1 '0 00007000.. 12 7 ~ ESTATE OF JEANETT1:: F. KElLY ~ :us PMWOOD DR. _ $HIREW\NSTO\lflol,Plll1'l111 .tIa:r ~~tJtE~.ry~ IhM.hq k;:;LU~-~_ V/~ ~J.Jt!fl =-OIW -71i{(I~ ,~/t~~ ~~3.~7~~a?co.o 8?O.~ a..? ~OO~.'800' '5 1& 123 ,;;;t'J,,)..,t~<p'r ~ ", 4".'t'{ T~l>-C.,,~" .tJ~yt,," ,',.,~ flJ =- W . / ~J'~' ~Ii -~S&rt# ~ ~.; . .:i!I&:J7lI8V':OioOSio..a 1'- O~~ 0000..Z2..... 117 168.00 8/12/04 123 42.24 ,11:01\:;-" ~ -'4, .W~/ -~""fLM'- ~U"_Jl..!;1__,, .:'~13?"a?o:o~oBi..C1I?01;. ~~~ooooo.. -YX \~ 7/22104 118 ~_....._._._.__w___.. 119 157.00 172-32-2347 4 Your first name, initial. and last name 1,475. Jeanette F. Kelly If a joint return. spouse's first name, initial. and last name Home address (number and street) Apt no. 325 Pinewood Drive City. town or post office State ZIP code Shiremanstown, PA 17011 BAA ------------------------------~~~~-~~~------------------------------ ;. Detach Here and Mail With Your Payment and Return ;. Make your check payable to the "United States Treasury" and mail Form 1040-V payments with your return to: Internal Revenue Service P.O. Box 80101 Cincinnati, OH 45280-0001 ----------------------------------------------------------------------------------------- File only if you are making a payment with Form 1040. Return this voucher with check or money order payable to the "United States Treasury." Please write your social security number, daytime phone number, and "2004 Form 1040. on your check or money order. Please do not send cash. Enclose, but do not staple or attach, your payment with this voucher. REV-1513 EX+ (9-00) .. COMMONWEALru Of PENNSYLVANIA INHERITANCE TAX REnJRN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF JEANETTE F. KELLY NUMBER I NAME AND ADDRESS DF PERSDN(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)} ROBERT BURCHFIELD - 325 Pinewood Drive, Shiremanstown, PA RELATiONSHIP TO DECEDENT Do Not list Trustee(s) 1. Nephew FILE NUMBER 21-04-0437 AMOUNT OR SHARE OF ESTATE 212,589.85 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON.TAXABLE DISTRIBUTIONS: A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (ff IOO/e space is needed, insert addnional sheets of the same size) 0.00 07-18-2005 KElLY 04-20-2004 21 04-0437 CUMBERLAND 101 APPEAL DATE: 09-16-2005 ( See reverse side under Objections) Aaount R..ittedl I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS +- REV:is47-EX"AFP-coi:osj-NOTicE-OF-iNHERiTANCE-TAX-APPRAisEMENT:-ALLOWANCE-OR--------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX JEANETTE F FILE NO. 21 04-0437 ACN 101 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ,....,...(\("\,...,"r" (\,....,,".\:-- ,.,~ NOTICE OF INHERITANCE TAX BUREAU OF INDIVIDUAL TAX~\./0:'L,=',; ,,,~c",~PJlAISEMENT, ALLDHAIlCE OR DISALLORAIlCE INHERITANCE TAX DIVISION c' "'! Of DEDUCTIONS AND ASSESSKENT OF TAX PO BOX Z8D6Dl HARRISBURG PA 17lZ8~D6Dl L:',~5 ,y~'~_ 2:~ 2:27 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN F:] C:=;~' ,". PAUL BRADFOR~ ORR ESQ P BRADFORD ORR LAW OFC 50 E HIGH ST CARLISLE PA 17013 ESTATE OF KELLY *' REV-1547 EX AFP (06-05) JEANETTE F TAX RETURN HAS: I X) ACCEPTED AS FILED I ) CHANGED DATE 07-18-2005 I~ an assess.ent was issued previously, lines 14, 15 and,or 16, 17, 18 and re'flect ~igures that include the total o'f AY.. returns assessed to date. ASSESSMENT OF TAX: \ 15. Aaount of Line 14 at Spousal rat. (15) 16. Amount of Line 14 taxable at Lineal/Class A rat. (16) 17. Aaount of Line 14 at Sibling ~t. (17) 18. Aaount of Line 14 taxable at Collateral/Class Brat. (18) 19. Principal Tax Due A C S' RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R..l Est.te ISchodule A) 2. Stocks and Bonds ISchedule B) 3. Closaly Held Stock/Partn8rship Interest (Schedule C) 4. Hortgages/Notes Receivable (Schedule D) s. c.sh/Bank Daposits/Hisc. Personal Property (Schedule E) 6. Jointly Owned Property ISchedule F) 7. Tr8nsfers (Schedule Q) 8. Total Assets (1) (2) (3) l'l) (5) (6) (7) 169.000.00 12.945.70 .00 .00 57.520.32 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. FU"terel Expenses/Au. Costs/Hlsc. EXP8llS85 (Schedule H) 10. Debts/Hortgage Lll1bll1ties/Liens (Schadule 1) 11. Tot.l Deductions 12. Net Valu. of Tax Return 13. Cheritable/Govern-.ntal Bequests; Non-elected 9113 Trusts (Schedule JJ 14. Net Value of Estate Subject to Tax (9) (10) 17 ,925.43 8.941.74 Ill) (12) (13) Il'l) NOTE: .00 X .00 X .00 X 212.598.85 X 00 = 045 = 12 = 15 = + AMOUNT PAID 30,000.00 2,400.00 DATE 07-20-2004 04-20-2005 INTEREST/PEN PAID 1-) 1,578.95 3.83- _BER CD004181 CD005228 ~. TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE NOTE: To insure proper credit to your account, sublll t the l4JPBr portion of this form with your tax payJlent. 239,466.02 ?/a.R/a7 17 212,598.85 .00 212,598.85 19 will (19)= .00 .00 .00 31,889.83 31.889.83 33,975.12 2,085.29CR .00 2,085.29CR IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. I IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FDHN FOR INSTRUCTIONS.) BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX Z8060 1 HARRISBURG PA 171Z8-D6Dl COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE Co ,~,rcn["f,,~~ITANCE TAX ,"C'J'JUSTATEMI;NT OF ACCOUNT ,-,-",-, .' *' REV-1607 EX AFP (03-05) ",...r- ....'D I 3 !')\:~ "'J", I'" ,~. ,... ,t, I L ,,-~, ,~' ...: ,..1 ' I 1: 45 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 08-22-2005 KELLY 04-20-2004 21 04-0437 CUMBERLAND 101 AltOunt R..i tted JEANETTE F {"\j ce'( ,r., \."'L'..! '.:\ '. QT , PAUL BRADFORD ORR ESQ". ' P BRADFORD ORR LAW OFc', 50 E HIGH ST CARLISLE PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax pa~t. CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS - ---------------------------------.-------------------.--------------------- REV-1607 EX AFP (03-05) ~~~ INHERITANCE TAX STATEMENT OF ACCOUNT ..~ ESTATE OF KELLY JEANETTE F FILE NO.21 04-0437 ACN 101 DATE 08-22-2005 THIS STATE"EHT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE HA"ED ESTATE. SHOWN BELOW IS A SUHNARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAY"EHTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-11-2005 PRINCIPAL TAX DUE: 31,889.83 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 07-20-2004 CD004181 1.578.95 30,000.00 04-20-2005 CD005228 3.83- 2,400.00 08-04-2005 REFUND .00 2,085.29- TOTAL TAX CREDIT 31,889.83 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 . SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU "AY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. I ~t Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 3/07/2006 ORR PAUL BRADFORD 50 E HIGH STREET CARLISLE, PA 17013 RE: Estate of KELLY JEANETTE F File Number: 2004-00437 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 4/20/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~ ~-'J J&.-L.__.P Glenda Farner strasb;~ Clerk of the Orphans' Court cc: File Personal Representative(s) ~r cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 3/07/2006 BURCHFIELD ROBERT J 325 PINEWOOD DRIVE SHIREMANSTOWN, PA 17011 RE: Estate of KELLY JEANETTE F File Number: 2004-00437 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 4/20/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~~~J~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel (7f .. " Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: .T p::t n p r r p F K p 11 Y Date of Death: A D r i 1 20. 2004 Estate No.: 2004-00437 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. . State~ether administration of the estate is complete: YesA! No 0 2. lfthe answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. lfthe answer to No.1 is Yes, state the following: a. Did the person~presentative file a final account with the Court? Yes 0 No ~ b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes W' No 0 ~o East High Street. Carlisle .........:r~dress S,[\J:j~~id801'~ (717) 258-8558 Telephone No. -, 11t C \1'.:i~1 nnn7 0.... Z. :rri::-p' ~r:'1.~!;- (ntj...;~...,.,l D.,.~....,.("t.,......+...+.;"(r~ \....1 ____ ""'- ry. .&....-L .1. yJ.i:>VJ.J.Q..l .1.'\..y!-'J.y.;:)yJ.J....u....J. V v ~Counsel for personal representative ~1/'