Loading...
HomeMy WebLinkAbout09-01-091 1505607121 06 05 ' REV-1500 EX ( - ) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number PO BOX 280601 2 1 0 9 0 4 3 8 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 8 3 1 2 1 1 6 7 0 4 3 0 2 0 0 9 0 4 0 8 1 9 2 3 Decedent's Last Name Suffix Decedent's Firs t Name MI B E A R R A Y M O N D F (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ^X 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) © 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number R O G E R B I R W I N E S Q U I R E 7 1 7 2 4 9 2 3 5 3 w.~ Firm Name (If Applicable) I R W I N & M c K N I G H T P C- First line of address 6 0 W E S T P O M F R E T S T R E E T Second line of address City or Post Office C A R L I S L E State ZIP Code REGIS OF WILLS U~ONLY ~ ~ r ~ ' v ' ~ n ; ~r :; ~7 r _ ~ , -'c,~~ ~. - -.. ~ _~ v rJ~_ DATE FILED, P A 1 7 0 1 3 Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any kno ledge. SIGNAT E OF PERSON BESPOISfSIBLE FOR FILING RETURN D r. n n SIGNATURE PREPARER OT ER THA EPRESENTATIVE D PLEASE USE ORIGINAL FORM ONLY Side 1 1505607121 1505607121 J 'C22Z09SOS'[ 'I22Z09SOS'I Z ap!S 9 E 'h Q 9 6 1N3WA`~/d213A0 Ned dO aNfld321 d ~JNI1S3f1b321 3?1H flOJl dl lt/AO 3Hl NI llld 'OZ 66 ................................................ and xel'66 0 0 ' 0 8~ 0 0 ' 0 a • aull }o }unowy algexe; bl g 1. 0 0' 0 ~~ 0 Zl• X a}e~ 6uligis }e 0' 0 • algexe; bl, aull;o;unowy ~~ 9 E' h S 9 6 s~ Z O' Q 0 2 5 2 2 sbo' X a;e~ leaull }e • algexe; b~ aul~;o;unowy gl, 0 0' 0 9~ 0 0 0 ( g ~ ~g •oag ~apun spa;su ea} ~o 'a;e~ xe; lesnods ay};e algexe} b~ aull;o }unowy '96 S31V2i 319V~IlddV 21Od SNOIl~f1211SN1 33S - NOIlb~lfldWO~ X~dl Z 0 ~ Q 0 2 S '[ 2 'b6 ... .... ........... (EL aull snulw ZL aul~) xel o;;aafgng anleA ~aN 'bl 2 0' 2 2 6 E 2 gl, ' •• ~••• (f I P y S P q;ou se xe o uol;oaa ue ~~•••~•~••• an a o a ewuaa y }; l • g ~ yolynn ao} s;sn~l E L l6 oag/s;sanbag le}uawwano0 pue alge}uey~ Q 0 ~ 0 2 '[ 6 E 2 •Z6 ' • (LL aull snulw g aull) a;e;s3;o amen;aN •Z~ Q 2' 6 h Z h 2 ' L L ... .... .................... (0 L '8 6 scull leioi) suol;anpaa le3ol ' L L ' Q •OL ... .... ..... (I alnPayoS) suai~ ~ 'sal}l~lgell a6e6}~oW `}uapaoad;o slgad 'Ol 9 E 2 h 6 2 8 '9 O B S 2 •6 • • • • • • ~ • • • • • • • • • (F.l alnpayog) s;sod and;e~;slulwpy ~ sasuadx3 ~e~aun~ •g 9 2 ' 6 9 Q E 9 2 .g ... ........................ (~_ ~ scull lelol) s;ass~r ssa0 le3ol '8 e 2 ' h Z L Z Z ~~ ~ ~ ~ ' ' ' ' Pa;sanbab 6u11118 a}e~edag ~ (O alnpayoS) ~adad a;egad-u N snoauepaoslW ~ SJa;sued sonln-~a;ul •~ 2 Q ~ E 6 S '[ 2 '9 ' ' ' ' ' ' ' pa;sanba~{ 6ulll!8 a;e~edag ~ (~ alnpayoS) ~(~adoad paunnO ~l;ulo f •g ~ '~ ~ '~ 0 S 6 '[ .5 ~ ~ ~ ~ ~ ' ' (3 a~npayog) ~(}~adad leuos~ad snoauellaoslW ~ s;lsodaa ~lue8 'yse~ •g .b ... ..................... (d alnPayoS) algenlaoaa sa;oN g sa6e6}~oW •b 'E ' ' ' ' ' (~ alnPayoS) dlys~olaudad-slog ~o dlys~au}~ed 'uol;e~od~o~ plaH ~(lasol~ 'E .................................. (e alnPayoS) spuog pue s~loo}S 'Z 'Z 0 0 0 O O S h 'I ~ ~ ........................................ (y alnPayoS) a}e3sa lead • t. NOll~dlfl11dV0321 21 tl 3 8 '~ Q N O W A d 21 :aweN s,~uapa~aa Z 9 'C 2 2 't E Q 2 ~agwnN ~t;unoag leloog s,;uapaoap X3 009 L-/~32i 'I22Z0950S'C REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 09 0438 DECEDENTS NAME R/~YMOND F. BEAR STREET ADDRESS 836 W. NORTH STREET CITE' CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments 9,000.00 C. Discount 473.67 3. Interest/Penalty if applicable D. I nterest E. Penalty (1) 9,684.36 Total Credits (A + B + t;) (2) 9,473.67 Total InterestlPenalty (D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (3) 0.00 (4) 0.00 (5) (5A) (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ...................................................................... ^ ^X b. retain the right to designate who shall use the property transferred or its income; ............................... ^ Q c. retain a reversionary interest; or ................................................................................................ ^ d. receive the promise for life of either payments, benefits or care? ....................................................... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... ^ Q 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. 210.69 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. 210.69 The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX + (6-98) SCHEDULE A ~ COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER RAYMOND F. BEAR 21 09 0438 All real properly owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real roe which is ' intl -owned with ri ht of survivorshi must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 836 W. NORTH STREET, CARLISLE, PENNSYLVANIA 145,000.00 TOTAL (Also enter on line 1, Recapitulation) I S 145.000.00 (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) w SCHEDULE F • COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER RAYMOND F. BEAR 21 09 0438 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PERSONAL PROPERTY -APPRAISAL ATTACHED 9,495.00 2. COINS -APPRAISAL ATTACHED 837.10 3. M&T BANK -CHECKING ACCOUNT 7,969.36 CHECKING ACCOUNT #9832815410 4. MEMBERS 1ST FEDERAL CREDIT UNION 5.93 REGULAR SAVINGS ACCOUNT #219430-00 5. MEMBERS 1ST FEDERAL CREDIT UNION 388.97 CHECKING ACCOUNT #219430-11 6. MEMBERS 1ST FEDERAL CREDIT UNION 804.81 INVESTMENT SAVINGS ACCOUNT #219430-05 TOTAL (Also enter on line 5, Recapitulation) I $ 19,501.17 (If more space is needed, insert additional sheets of the same size) REV-1509 EX + (6-98) • • COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF hlLt NUMIitK RAYMOND F. BEAR 21 09 0438 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME A. JOANNE L. BEAR ADDRESS 222 CHANDLER DRIVE WEST CHESTER, PA 19380 RELATIONSHIP TO DECEDENT B C JOINTLY-OWNED PROPERTY: DAUGHTER ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. 07/2008 M8~T BANK 5,548.56 50. 2,774.28 CERTIFICATE OF DEPOSIT #31003917741778 2. A. 06/2008 M8~T BANK 11,337.41 50. 5,668.71 CERTIFICATE OF DEPOSIT #31 00391 7741 794 3. A. 12/2008 MEMBERS 1ST FEDERAL CREDIT UNION 1,179.40 50. 589.70 CERTIFICATE OF DEPOSIT #219430-47 4. A. 12/2008 MEMBERS 1ST FEDERAL CREDIT UNION 2,399.67 50. 1,199.84 CERTIFICATE OF DEPOSIT #219430-48 5. A. 02/2009 MEMBERS 1ST FEDERAL CREDIT UNION 11,591.79 50. 5,795.90 CERTIFICATE OF DEPOSIT #219430-49 6. A. 04/2009 MEMBERS 1ST FEDERAL CREDIT UNION 11,130.76 50. 5,565.38 CERTIFICATE OF DEPOSIT #219430-50 TOTAL (Also enter on line 6, Recapitulation) I $ 21,593.81 (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS 8~ MISC. NON-PROBATE PROPERTY FILE NUMBER RAYMOND F. BEAR 21 09 0438 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIRRELATIONSHIPTODECEDENTANO THE DATE OF TRANSFER.ATTACHACDPYOFTHEDEEDFORREALESTATE. DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION (IFAPPLICABLE) TAXABLE VALUE 1. THRIVENT FINANCIAL FOR LUTHERANS 7,805.78 100. 7,805.78 FIXED ANNUITY #3706688 BENEFICIARY: JOANNE L. BEAR 2. ALLSTATE LIFE INSURANCE COMPANY 59,459.16 100. 59,459.16 ANNUITY CONTRACT #GA17245732 BENEFICIARY: JOANNE L. BEAR 3. WESTERN-SOUTHERN LIFE ASSURANCE COMPANY 10,509.34 100. 10,509.34 CONTRACT #W 20603585 TOTAL (Also enter on line 7 Recapitulation) ( $ 77,774.28 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (10-06) SCHEDULE H - COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER RAYMOND F. BEAR 21 09 0438 Debts of decedent must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. EWING BROTHERS 2,036.84 2. FUNERAL LUNCHEON 95.34 3. WESTMINSTER CEMETERY -HEADSTONE 190.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) SVeet Address City State Zip Year(s) Commission Paid: 2 AttomeyFees IRWIN 8~ McKNIGHT, P.C. 10,000.00 3, Family Exemption: (If decedent's address is not the same as claimanPs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees REGISTER OF WILLS 302.00 5 Accountants Fees 6. Tax Retum Preparers Fees PATRICIA A. ROSENDALE, CPA 350.00 7. ROY D. GOTTSHALL -APPRAISAL ON PERSONAL PROPERTY 60.00 8. THE SENTINEL -ESTATE NOTICE 187.54 9. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 75.00 10. REGISTER OF WILLS -SHORT CERTIFICATE 4.00 11. HARRY DONSON -APPRAISAL ON COINS 15.00 12. CERTIFIED MAIUPOSTAGE 25.97 13. T. RANDALL ADAMS -LAWN CARE 225.00 14. STEVEN W. BARRETT -APPRAISAL ON REAL ESTATE 325.00 15. REGISTER OF WILLS -FILING FEE 30.00 16. LEBO'S GARAGE -CAR REPAIRS (2003 CHEVY) 529.68 17. SOLLENBERGERS -FEES TO TRANSFER 2003 CHEVY 134.00 18. PENDER VETERINARY CENTRE, LTD. -OFFICE CALL (DECEDENT'S CANINE) 781.96 TOTAL (Also enter on line 9, Recapitulation) $ 15.806.82 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent RAYMOND F. BEAR 21 09 0438 Decedent's Name Page 1 File Number Schedule H -Funeral Expenses 8~ Administrative Costs - B7. ITEM NUMBER DESCRIPTION AMOUNT 19. ANIMAL INN -DOG GROOMING (DECEDENT'S CANINE) 20. FEE TO DISMANTLE CLOCK 21. STATE FARM INSURANCE -CAR INSURANCE ON VEHICLE 84.80 40.00 314.69 SUBTOTAL SCHEDULE H-B7 ~ 439.49 REV-1512 EX + (12-03) SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ~ ESTATE OF FILE NUMBER RAYMOND F. BEAR 21 09 0438 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. EMBARQ -TELEPHONE 360.31 2. SMITH RADIOLOGY -MEDICAL 1.70 3. SPRING ROAD FAMILY PRACTICE -MEDICAL 60.48 4. CARLISLE BOROUGH -REAL ESTATE TAXES 1,294.34 5. PENN NATIONAL INSURANCE -HOMEOWNERS INSURANCE 627.00 6. SARAH TODD NURSING HOME -NURSING 5,771.26 7. PP&L -ELECTRIC 236.79 8. WEST SHORE EMS -AMBULANCE 96.06 9. YORK WASTE TRASH -TRASH 45.45 10. CUMBERLAND GOOD-WILL FIRE RESCUE -AMBULANCE 13.66 11. NORTH MIDDLETON TOWNSHIP - WATER/SEWER 164.60 12. MILLENIUM PHARMACY -MEDICAL 29.55 13. EXPRESS SCRIPTS -MEDICAL 38.00 14. KOUGH OIL -HEATING OIL 199.62 15. CARDIOLOGY DIAGNOSTICS -MEDICAL 3.54 TOTAL (Also enter on line 10, Recapitulation) 15 8,842.36 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (g-00) SCHEDULE J ,COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER RAYMON D F. BEAR 1~ uy u4~ts RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and Vansfers under Sec. 9116 (a) (1.2)] 1. JOANNE L. BEAR Lineal 215,208.07 222 CHANDLER DRIVE WEST CHESTER, PA 19380 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. GRACE UNITED METHODIST CHURCH OF CARLISLE 23,912.01 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET S 23 912.01 (If more space is needed, insert additional sheets of the same size) J ~~ l' :~ ~'~ ~~ r ~ f ~ _~ LAST WILL AND TESTAMENT =`=-~ ~ ~ ~= , ==' :-;ice-n ~, - -,, ~, ~ N `~~ ~ ~ v I, RAYMOND F. BEAR, of North Middleton Township, Cumberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly revoking all Wills and Codicils heretofore made by me. 1. I direct my Executrix to pay all of my debts, funeral and administrative expenses as soon as maybe done conveniently after my decease. 2. I authorize and empower my Executrix to sell any realty owned by me at my death, and not specifically devised herein, at either public or private sale, and to give good and sufficient deeds therefor, in fee simple, as I could do if living. 3. I give, devise and bequeath all of my estate of every nature and wherever situate as follows: (a) 10% to GRACE UNITED METHODIST CHURCH of Cazlisle Pennsylvania; and (b) 90% to my daughter, JOANNE L. BEAR. 4. I nominate and appoint JOANNE L. BEAR to be the Executrix of this my Last Will and Testament; she is to serve as such without bond. 1 ACgNNOWLEDGEMENTRND AFFIDAVIT WE, RAYMOND F. BEAR, SHARON L. SCHWALM and MARTHA L. NOEL, the testator and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his Last Will and that he had signed willingly, and that he executed it as his free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the Will as a witness and that to the best of their knowledge the testator was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. RAYMOND F. BEAR SHARON L. SCHW~A7LM /~~~tU MARTHA L. NOEL COMMONWEALTH OF PENNSYLVANIA . SS: COUNTY OF CUMBERLAND Subscribed,.. sworn ..to and acknowledged before me by RAYMOND F. BEAR, the testator, and subscribed and sworn to before me by SHARON L. SCHWALM and MARTHA L. NOEL, witnesses, this s n day of February, 2003. ~J .~ Public Notarial Sea! Irwin, Notary Public Arta, Cumberland County don lsxpiros Oct. 3, 2004 S. W. Barrett Real F~tate & Appraisal Services File No. 09-0247 APPRAISAL OF -~: .. ~,, ~' ::.t:-t LOCATED AT: 836 West North Stn3et Carlisle, PA 17013 CLIENT: Irwin 8 McKnight 60 West Pomfret Street Carlisle, PA 17013 AS OF: Apri130, 2009 BY: Cassandra J. Crockett PA Certified Residential Real F~tate Appraiser S. W. Barrett Real F~tate 8 Appraisal Services ripe rvo. 05/28!2009 Irwin & McKnight 60 West Pomfret Street Carlisle, PA 17013 File Number: 09-0247 In accordance with your request, I have appraised the real property at: 836 West North Street Carlisle, PA 17013 The purpose of this appraisal is to develop an opinion of the defined value of the subject property, as improved. The property rights appraised are the fee simple interest in the site and improvements. In my opinion, the defined value of the property as of April 30, 2009 is: 5145,000 One Hundred Forty-Five Thousand Dollars The attached report contains the description, analysis and supportive data for the conclusions, final opinion of value, descriptive photographs, assignment conditions and appropriate certifications. Respectfully submitted, ~~~~~ . ~~ Cassandra J. Crockett PA Certified Residential Real F~tate Appraiser Summary Residential Appraisal Report File No. 09-0247 The purpose of this appraisal report is to provide the client with a credible opinion of the defined value of the subjea property, given the intended use of the appraisal. Client Namellntended User Irwin 8r MCl(nl ht E-mail Client Address 60 West Pomfret Street C' Carlisle State PA Zi 17013 ' Additional Intended Users The intended user of this re ort is the Client No additional Intended Users are rmitted without the rmission of the a raise s . . Intended use The Intended Use is to evaluate the roe that is the sub'ect of this a sisal to rovide the Client with an accurate and ode uatel su rted o inion of value. Pro Address 836 West North Street ci Carlisle crate PA zi 17013 Owner ofPUbticRecordBear Ra ondF. coun Cumberland L Descri tan Deed Book 254' Pa a 1008 " Assessors Parcel # 29-20-1794-015 Tax Year 08/09 R.E. Taxes $ 1 742.00 Ne' hborhood Name North Middleton T Ma Reference 20-1794 Census tract 0119.01 Pro R' hlsA raised X FeeSi M Leaselal0 Odler describe M research did X did not reveal an riot sales or transfers of the sub' ro for the three rbr to the effective date of this reisal. Prat SalelTrenskr: Date 10/25/2002 Price S1 Sources Courthouse records Analysis of prior sale or transfer history of the subject property (and comparable sales,'rf applicebk;) No further recent recorded transfers were found. Offerings, op[bns and contracts as of the enective date of the appraisal None known Nliphborhaod Characteristlcs One-UMtHOUSirg Trends One-Untt HOUSirp Present Land USS% Location Urban X Suburban Rural Pro Values Incre X Stable Declini PRICE AGE One-Unit 73 % Buitl-U X Over 75% 25.75% Under 25% DemandlSu Sho X In BaWnce Over Su 000 s 2.4 Uni[ 0 % Grawlh Ra id X Stable Sknv Markelin Time Under 3 mtl[s X3.6 mlhs Over 6 mots ~ Neighborhood Bountlaries Sub act is bounded on the north Pa.Turn ike• on the east 120 Low New 260 H' h 100 Muni-Farm 2 % Commercial 10 % Carlisle Borou h• on the south Rt.641 • and on the west McClures Ga Road. 160 Pres. 50 other Vadln: 15 % ~ Neighborhood Description Sub'ect ro is located in an ex ndin area of sin le Tamil hom es both detached and attached ad'acent to the Borou h of Carlisle. Sho in and other amenities are within welkin or short drivin distance. School s tam is Carlisle District and school tom lax is within .25 mile. SMSA 42-3240. Market conditions (including support for the above conclusions) Pro values are eurrentl stable in the Sub'ect ro s market area. Local multi-list data indicates an ovate a marketin time of 90-180 da .Economic trends and lendin rates have remained favoreble althou h sales concessions are occurln more uerdl .There are new homes under construction in surroundin develo manta as well as re-sales available in the nei hborhood. Dimensions 80 x 240 Area 0.44 Acre MIL S Rattan ular view Residential S ecific Zonin Classification R-1 2onin Desai ' n Suburban Residential Zoni Com Hance X Le of L Nancordormi Grendfadiered Use No Zuni II I describe Is the highest and best use of the subject property as improved (a as proposed per plans and specifications) the present use? X Yes No 0 No, describe. Utllities Public (kher describe Public Odrer describe ON-silelm cots-T a Public Private Electric' X 200 Am water X Street AS halt X Gas can' sewer X A To rear X sae commerns There are no a rent adverse easements encroachments or other adverse conditions. GENERAL DESCRIPTION FOUNDATION EXTERIOR DESCRIPTION materiels INTERIOR me0erials Unas X one Onew/ACC.una ConaeteSlab Crawl FoundationWaas Block/Av Fbors HW/Ca p # of Stor'~es One X Full Basement Partial Basement ExtedM waus Brick/Av walls Plaster/Av T X DeL An S-DetJEnd Unit Basement Area 1015 . n Roof Surface Shin Ie/Av TrirtVFnish Wood/Av Existin Pro UnderConst Basement Finish 0% Gutters&DOwn rsAluminUm/Av BathFkxu Tile/A-G ce' n s e 1 Sto X OulSideEn (Exit sum Pum WindowT DbIHn Av Bath wainscot Tile/A-G Year Buia 1955 Ex Bat3ement Sbrm Sashllnsuleaed Storms/Av Car Stor None Effective a rs 15-2 0 Screens Y es /Av X # of cars 2 Attic None Hea' X f1NA HW Radiant Am enRies WOOdSbve s # Dr' Surkce COrlCrete Dro Stair X Stairs Odier Fuel Oil X Fire laces # rence X Gar a #ofCars 2 X Fbor Scuttle Conlin X CentralAtrcondiuonin PatiolDeck X Porch EnclOSet Ca rt #ofcars Finished Healed Individual Other Pool Other An X Det Buia-in A liances Refri ereta X Ran Oven Disfwatsher D' Microwave WasherlD r Otlrer desaibe Finished area above rode wntains: 4 Rooms 2 Bedrooms 1 Bath 5 1 015 a Feet of Gross Livkr Area Above Grade Addaional Features See Attached Addendum comments on the Improvements Im rovements are in avers a condition with no h ical or functional made uacies a rent ~"~ .,~~~~M•, P ~•ld2 ""'"".°"m`A" iarmmiwynpnvmuazwe ra avsmaiw cwmesmwm. mc, MRIela RtlbVN. ace (pPAR^') Gererd Pup0.9tApprasal Reopl 17/20ae GPARSU 0/1l1]IIlor ADDENDUM Client: Irwin 8 McKnight File Na.: 09-0247 Property Address: 836 West North Street Case No.: SUMMARY REPORT City: Carlisle State: PA Zip: 17013 Additional Features Heating system, central air, electric service recently up-dated/replaced; 2nd floor is unfinished attic storage except for awalk-in cedar closet ~ top of stairs; hardwood on first floor, carpet in living room, vinyl file in kitchen/dining area, ceramic file in bath; partial basement with earth floor under detached garage [24 x 26]; enclosed porch; frame shed [12 x 76]. AdderWum Page 1 of 1 Summary Residential Appraisal Report File No. 09-0247 FEATURE SUBJECT COMPARABLE SALE N0.1 COMPARABLE SALE N0.2 COMPARABLE SALE N0.3 836 West North Street Address Carlisle 17013 803 West North Street Carlisle 17013 914 West North Street Carlisle 17013 712 Belvedere Street Carlisle 17013 Proxim' ro Sub' t 0.10 MI E 0.19 MI W 1.2 MI SSE sale Prfce $ $ 147 000 $ 160 000 $ 160 000 sale PdcetGross Liu. Arm $ 0.00 . ft $ 137.77 . ft $ 129.87 . ft $ 119.05 . ft Data source s verittcation source s MLS/Courthouse Records MLS/t:ourthouse RecoMs MLS/Courthouse Records VALUE ADJUSTMENTS DESCRIPTION DESCRIPTION - s DESCRIPTION - S awnent DESCRIPTION *-)S arml2rr sale or Finarroing Concessions FHAICC53000 DOM 182 -3,000 None, Conv DOM 243 None, FHA DOM 5 Date of Sale/time 5/09 5/09 9108 Location Suburban Suburban Suburban Suburban LeasehokllFee Sim le Fee Sim le Fee Sim le Fee Sim le Fee Sim le sire Lot/Av .44 Lot/Av .1 4000 Lot/Av .29 2 500 Lot/Av .38 0 view Residential Residential Residential Residential De'n S 1 Sto 1 Sto 1 Sto 1 Sto al' of Construction Avers a Avere a Avere a Avers e ACWaI a 54 Yre 54 Yre 47 Yre 37 Yrs = Condition Avere a Su erior 5% -7 350 Avers Avere e • Above Grade rod ama rod adrts rar eais rdd aWs . Room Count 4 2 1 5 2 1 6 3 1 5 3 1 F2H -2 000 Gross ' Area30.00 1 015 . ft 1067 . ft -1 560 1 232 . ft $ 510 1344 . ft -9 870 • Basement&Finished Rooms Below Grade Full Bsmt/ Unfinished Full Bsmt! Famil Room -3500 Full Bsmt/ Unfinished Full Bsmti Unfinished Functional util' 2 Bedroom 2 Bedroom Su rior -2 000 Su rior -2 000 - Heati oli OFHAICA OFHA/CA OFHA/CA GFHA/CA Ener Efficient Items T ical T ical T ical T ical Gar elCar n 2 Car Gare a OSP 10 000 2 Car Gare e 2 Car Gare e PorchlPatiolDeck Enclsd.Porch/ Porch/Shed/FP -1 000 Cvrd.Patio/FP 2 000 Enclsd.Poroh/ -2 000 FP/Shed Fenced Yard Poroh/2 FP's/ Fenced Yard NetAd'ustment o + X - $ 2 410 + X - $ 4 010 + X - $ 15 870 AdjusledSalePrice Net Adj. -1.6% of Com tiles Grote 20.7% $ 144 590 su of salescom isonA roach All com arebles are similar in util sales and are the best cumertti available. Sale #1 had been recen Net Adj. -2.5% Net Adj. -9.9% Gross 8.1% 8 155 990 Grote '. 9.9% $ 144130 and location to the sub'ect ro are verified closed ti remodeled/u -dated. Ad'usted ran a of value is 5144 000 to 5156 000. COST APPROACH TO VALUE site value comments Site value from current assessment data and recent local land sales. ESTIMATED REPRODUCTION OR REPLACEMENT COST NEW OPINION OF SITE VALUE ........................................ _ $ 45 000 Source of Cdsl data Dwelli S . Ft $ ............ _ $ al' redo tram cost service Elkctive date of cost data S . Ft $ ............ _ $ Comments on Cos[ A roach ross fnd area calculations, de reciation, etc. - Cost A roach from Marshall/Swift Valuation Service G elCar rt , FL $ ............ _ $ handbook and local cost anal is was considered but ToralEstimateotCost-New .......,. _ $ deemed not credible due to the a of the im rovtarrlertts. Less P ical wnctional ,,, E#ernal Site value from Market Data. De reciation based on a e/life De reciation = $ observed condition and Market Data Anal is. Estimated tx eciated Costof l rovemertts ................................ _ $ remainin Economic Life is 40-45 ors. "As-is'vahreafSiMlm rovemerns ................................ _ $ INDICATED VALUE BY COST APPROACH ...................... _ $ N/A INCOMEAPPROACH TO VAWE ~ Estimated Month Market ReM $ WA X Gross Rent Muti lier N/A = $ NIA Indicated Vakre Income A roach Summary of Income Approach (including support for market rent arW GRM) N/A McMOds and techni ties em I ed: X S•les COm arisonA roach CostA roach IncomeA roach Otlrer: Discusson of medrods and techniques empbyed, including reason for excluding an approach ro value: COSt A roach was considered but deemed not credible due to the a e of the im rovements. Income A roach not relevant to current use as a sin le famil residence. Recenciliation cemments: Market Anal is consistenti su its m o inion of market value. Cost roach and GRM were found ins ro riate for this anal is. Greatest wei ht is a lied to the Market Data Anal is. Su ortin file irtfortnation substantiates these estimates. Based on the scope of work, assumptions, limiting conditions and appraiser's oartirication, my (our) opinion of the defined value olthe real properrythat is the subject of this report as of 04/30/2009 , which is the effective date of this appraisal, is: QX Single point S 145 000 Range S to 5 ^ Greaterthan ~ Less than S This appreisal is made X "as is,' subject ro wmple~n per plans and specfirations on the basis of a hypothetical condition that the improvemems have been completed, subject ro the blowing repairs or akerations on me basis of a hypothetical condition mat me repairs or alteretions have been completed ~ subject ro the blowing: q~ei~al~,uipusE~l.In-,sal.el~o~t -' "~ Pepe2d2 ," ,~. N,m ~wngROnw~auenu u,.m •w c~nn semces. iz. w ~ aea•rea. tpPna^~ cererd AaPdsdsu~ar tvmoe GPM ar 171II00r S.W. Barrett Real Estate 8: Appraisal Services File No. 09-0247 Scope of Work, Assumptions and Limiting Conditions Scope of work is defined in the Uniform Standards of Professional Appraisal Practice as " the type and extentof research and anayses in an assignment" In short, scope of work is simply whatthe appraiser did and did not do during the course of the assignment. tt includes, but is not limited to: the exkntto which the property is iderfied and inspected, the type and extentof data researched, the type and extent of analyses applied to arrive at opinions or conclusions. The scope of this appraisal and ensuing discussion in this report are specific to Ute needs of the client, other identified intended users and rothe intended use ntthe report This reportwas prepared for the sde and exclusive tae of the clientand other identified inbended users fortite identified intended use and its use by any other parries is prohibited. The apprerser is not responsibk for unauthorized use of the report The appraiser's certification appearing in this appraisal report is subjectto the fdlowing conditions and to such otiter specific conditions as are setforth by the appraiser in the report All extraordinary assumptions and hypotltetieal conditions are statedm the report and might have affected the assignmentresutts. 1. The appraiser assumes no responsibilh for maters of a legal nature affeding the properly appaised or title !harem, nor does the appraiser render any opinion as m the title, which is assumed m be good and marketable. The property is appraised a5 (hough under responsible ownership. 2. Any skemh in this report may show approximate dimensions and is included arty m assist the reader in visualizing the property. The appraiser has made rro survey of the property. 3. The appraiser is na required m give testimony or appear in court because of having made the appraisal with reference m the property b gttestion, unless arrangements !rave been prevbusy made !harem. 4. Neither all, nor any part of the conknt of this report, wpy or other media thereat (including condutoons as m the property value, the identity of the appraiser, professional designations, or the firm with which the appraiser is connected), shall be used for arty purposes by artyone but the client anO otlter imended users as identified m this report, nor shall h be conveyed by anyone to the public through atlvertising, public relations, news, sales, or other media, witirord the wrgten wnsent of the appraiser. 5. The appraiser will not Oiscbse dre conmms of this appraisal report unless requked by applicable law or as specified in th Uniform Standards of Prohssonal Appraisal Pradice. 6. Information, estimates, and opinbns furnistred m the appraiser, and contained in the report, were obtained tram sources considered reliable and believed m be true and correct However, no responsibility br accuracy tN such items furnisfred m the appraiser is assumed by the appraiser. 7. The appraiser assumes that (here are no hidden ar unapparent conditions of the property, subsoil, or strudures, which would render it rare or less valuable. The appraiser assumes no responsbiliry for such conditbns, or for engineerktg or testing, which might be required m discover such faaors. This appraisal is not an ernironmenhal assessment of the property and should not be considered as such. 8. The appraiser special¢es in the valuation of real property and is not a home inspector, buildbg contractor, structural engbeer, or similaz expert, unkss otherwise noted. The appraiser did not conduct tite intensive type of field observations of the Idnd irdended m seek and discover property defeds. The viewing of the property and arty impraverrrerrCS is for purposes of developing an opinbn of dre defined vame of the property, given the intended use of this assignment Statements regarding condition are based on surface observations only. The appraiser claims no special expertise regarding issues including, but not limbed m: foundation seWemerrt, basement nroismre pro6kms, wood destroying (or other) insects, pest infestation, radon gas, lead based paint, mold or emironmenral issues. Unless dherwse indicamd, mechanical systems were not activated or tesmd. This appraisal report should not be used m discbse the condition of the property as i[relates m the presence/absence of defects. The client is im~ted and emmuraged m empkry qualified experts m inspect and address areas of concern. If negative wnditbns are discovered, the opinbn of value may be a0ecmd. Unless otlterwise noted, the appraiser assumes the components titatconsfilute the subject property improvement(s) are fundamentally sound and in working order. Arry viewing of the property by the appraiser was timi0ed m readity observable areas. Unless otherwise rroted, attics and crawl space areas were not accessed. The appraiser did not move furniture, fbor coverings or other items that may restrict the viewing of the property. 9. Appraisals imroNing hypothetical wnditbns related m campktion of new wnstrudmn, repairs or al~ration are based on the assumption that such crompletion, alteration or repairs wit be competently performed. 10. Unless the intended use of this appraisal Spedficelry indudes issues of property insurance coverage, this appraisal sfroukl n« be used for surh purposes. Reprodudbn or Replacement cost figures used in the coar approach are for valuation purposes any, given the irrterMed use of the assignment. The Definition of/alue used in this assignment is unlikely m be consistem with the definition of Insurable Vame for property bsurartce coverageNse. tl The ACI General Purpose Appraisal Report (GPAR"') i8 not intended for use in transactions that requve a Fannk Mae 100AIFreddk Mac 70 form, also known as the Uni(arm Residential Appraisal Report (URAR). Additional Comments Related To Scope Of Worfr, Assumptions and Limiting Condiflons ,mry,wr rnwF ew.~ vepe 1 of 2 gencraiou•posc::pp,~:,~~ni~r~,urc File No. 09-0247 Appraiser's Certification The appraiser(s) certifies that, to the bestof the appraiser's knowledge and belief: 1. The statements of fact contained in this report are true and correct 2. The reported analyses, opinbns, and conclusons are limited ony by the reported assumptions and IimNng condi0ons and are the appraiser's personal, impartial, and unbiased professional anayses, opinions, and concbsbns. 3. Unless otherwise stated, the appraiser has no present or prospective interest in the property that is the subjea of this report and has no personal interest with respect to the parties inwlved. 4. The appraiser has no bias with respect [o the property that Ls the subject of this report or to the parties imrolved with This assignment 5. The appraiser's engagement in this assignment was not contingent upon devebping or reporting predetermined results. 6. The appraiser's compensation for completing this assgnmem is not comingem upon the devebpment or reporting of a predetermined value a direction in valve that favors the cause of the client, the amount of the value opinion, the attainment of a stipulated recut, or the orxunence of a subsequent event directty related to dte intended use of this appraisal. 7. The appraiser's anayses, opinbns, and conclusions were devebped, and this report has been prepared, in coMOrmity with the Uniform Standards of Pro(essbnal Appraisal Practice. 8. Unless otherwise noted, the appraiser has made a personal inspection of the property that is the subject of this report 9. Unless noted below, no one provided significant real property appraisal assistance to the appraiser signing this certification. Significant real property appraisal assistance provided by: Additional Certifications: Definition of Value: X^lNarketValue ^OtirerValue: Source of Definitbn: USPAP The most probable price in terms of money which a property should bring in a competitive and open market under all conditions requisite to a fair sale, the buyer and seller, each acting prudently, knowledgeably and assuming the price is not affected by undue stimulus. ADDRESS OF THE PROPERTY APPRAISED: 836 West Notch Street Carlisle, PA 17013 EFFECTNE DATE OF THE APPRAISAL: April 30, 2009 APPRAISED VALUE OF THE SUBJECT PROPERTY E 145,000 APPRAISER SUPERVISORY APPRAISER Signature: Signaure: ~ ~~ I Name: Cassandra J. Crockett Name: Steven W. Barrett, SRPA, SRA, ASA State Certificaoon # RL001348L Staff Certfication # GA000298L or License # or License # RB026921A or Odler (describe): State #: State: PA State: PA Expirafion Date of Certification fir License: 06/30/2011 Expiration Date of Certfication or License: 06/30/2011 Gate of Signature: 05!28/2009 Date of Signaure and Report 05/28/2009 Date of Property Viewing: Date of Property viewing: 04/30/2009 Degree of property vbwmtg: Degree of property viewing: ^ Interior and Exerior ^ Exterior Ony ^X Did not personaly view ^ Interior and Exterior ^ F~derior Onty ^ Did not personalty view - Praaceaumq ~a fie. eoo.ze~.ernww..exm.mm msromi c<Ppgaomosaoorea oiwonaisoaan.sawra.inc.Mropnonwiwe. Pepe 2 a t (pPpp+h Gennd PuporeAppaiSBl Reopt 1LAD5 gene ni ~>u~yusc:rp,x~;,sni r,:l,uit. S.W. Barrett Real Estate 8 Appraisal Services GP a;oervma SKETCH/AREA TABLE ADDENDUM ,,~ ~,,, Fae rb oema7 i Address ti36 wear Wor03 street q$y Cy{yk County Cumbala3d State PA Zip 17013 Borrower RaymondF..BFARIEstate LerdedCramt Irwin a NlcKni~3t UC Address 60 wear Pomfret Street Appraiser Name AaPr ~~ e.a v ictehe~, Bam Bedroom Encbsad o; N ; Porch During Area 0 'r~\ ~~J l______ N Living Room Bedroom 35.0' Commeras: Srale: 1 = 10 AREA CALCULATIONS SUMMARY Code Description Siu Totals f3T.A1 First Floor lOlb.00 1015.00 p/p Bnclosad Porch 120.00 120.00 TOTAL LIVABLE (rounded) 1015 LMNG AREA BREAKDOWN Brealmowar Subtotals First Floor 29.0 z :35.0 1015.00 1 Area Total (rounded) 1015 ~rocaoF,wwea»asawse ~aowM.n FRONT VIEW OF SUBJECT PROPERTY Appraised Date: May 8, 2009 Appraised Value: $ REAR VIEW OF SUBJECT PROPERTY STREET SCENE COMPARABLE PROPERTY PHOTO ADDENDUM COMPARABLESALE#1 803 Wes# North Street Carlisle 17013 Sale Date: 5109 Sale Price: $ 147,000 COMPARABLE SALE#2 914 West North Street Carlisle 17013 Sale Date: 5/09 Sale Price: $180,000 COMPARABLE SALE#3 712 Belvedere Street Carlisle 77013 Sale Date: 9/08 Sale Price: $160,000 N tD 0 ~'1~ O 0 ~ o t `~ ~' d O 0 ~, 0 O O ..~ O O 00 0 ~~ N °D 241.00 co w N O .P ~ O ..~> ^~{ 240.00 o a ~ o 0 0.28Ac. ~ ° 240.00 0 o ~' o O ~ h O • 240.00 O o ~ o o° ~ 0 ~ ° . .P 240.00 A 0 0.22 Ac 'P w g O . 240. ° O o o 0.22Ac. b ° ~. 240.00 {V O .o. O O ° o.22A~. O ° 2ao.oo A p a o.2zA~. 24(1 nn v w 0 0 125. io 0 125.53 z O V O = O! d ~ -~ 125.00 0 io 0 925.00 LOCATION MAP Prepared by Steven W. Barrett R.E. Appr. Svc. (717)24&6646 dD =i .- -;gHdrsss .. :, .. - ;;gate ,. ,:,-:•., ;t.'P.iied:' . Y,..::•RNf:.:Bl~;?~'Balh. ~BCFk ..;•Pioidiuilf~ ... _= ~' :~, - S 836 N North St 9 2 1 1015 0.00 MI 1 803 N North St 5/09 197000 5 2 1 1067 0.10 !II E 2 919 N North St 5/09 160000 6 3 1 1232 0'.19 MI N 3 712 B~1v~dez• St 9/08 160000 5 3 1/2 1399 1.2 MI SSE ~* QUALIFICATIONS *****"*** The following checked items are SPECIFIC SPECIAL CONDITIONS that were identified by this appraiser during the inspection of the subject properly, the comparebles sales, and their neighborhoods and locations. Unless otfierwise noted, the conditions that apply to the subject property or the comparable sales used DO NOT AFFECT THE MARKET VALUE OR THE FUTURE MARKETABILITY OF THE SUBJECT PROPERTY BEING APPRAISED. This is not a home inspection service. This is an appraisal to estimate market value. _7. The subject is located in a rural area and is less than 25% built-up. _ x_2. Commercial/Industrial uses are located within the subjects neighborhood. These uses are typical of similar neighborhoods. _x_3. Vacant and undeveloped land uses are located within the subjects neighborhood. These uses are typical for the area. _4. The predominant value in the neighborhood is less than that of the market value of the subject property. This is due to the very wide range of value of properties in the area and superior quality of the subject property. _5. The subject property is located in a F.E.M.A. Identified Flood Zone. Flood insurance coverage is required and suggested. _6. Dampness is noted in the basement of the subject Standing or running water was not present on basement floor. This condition is considered typical in dwellings of this style. _7. The subject property is serviced by private well andlor septic systems which is common for the area. _x_8. The subject is older than five(5) years. All mechanical systems including the heating, electrical and plumbing systems appear upon a visual exterior inspection to be in working order. No warranties are implied in this statement. _9. Repair items were noted in the comments section of the report. These comments on repair items are for descriptive purposes only and are not required repairs. The items listed are cosmetic in nature. _10. The basement floor is a dirt floor. This condition is common and typical for the area. and does not pose a health or safety hazard. _11. The subject properly does contain functional obsolescence as noted in the report. This condition is considered typical and common for the area and this style dwelling. _12. The land value exceeds 30% of total value due to the high demand for vacant land in this neighborhood. Thia condition is considered common and typical for the neighborhood. _73. The land value exceeds 30% of total value. This is due to the large size of the site. This condition is considered to be typical and common. 14. Individual adjustments were required that exceed 15%. These adjustments were required due to lack of more similar comparebles on that individual reting. All comparebles used are the best available. _15. Total adjustments exceed 25%. This is due to the lack of compareble sales that were more similar in the subjects market area. All comparebles used are the best available. _x 76. One or more comparable sales are older than six(5) months. Although there are compareble properties in the subjects area, none have sold recently; therefore, sales in excess of six(5) months have to be used. All comparebles used are the best available. x_17. One or more comparebles used were in excess of one (1) mile from the subject property. Athough there are comparable properties in the immediate area, none have sold recently. Therefore, it was necessary to use comparable sales outside of the immediate area. All comparebies used are located in similar neighborhoods and within the same marketing area. All comparebles used are the best available. _18. The electrical system was not connected during inspection. _19. The water service was not connected during inspection. _20. The heating system was shut down during inspection. _21. Roofing_Plumbing_Electrical_Heating_certification(s) islare suggested. _22. Inground swimming pools out buildings are included .not included__according to lenders guidelines. _23. According to lenders guidelines a maximum of acres were considered for this valuation. Remaining acreage was given no value. ********* QUALIFICATIONS *''*'k**"** _24. The subject properly is located on a private road. _25. Wood infestation inspection is suggested. _x_26. Last recorded deed transfer: Date_10/25/2002 .Consideration: 51.00 _27. Proposed construction/renovation in accordance to plans and specifications to be completed in a workman-like manner. _28. Seller is paying part or all of closing costs. _x_29. All compareble sales are verified closed sales. _x_30. There are no special conditions or other requiremerrts that would affect market value or future marketability in the Appraisal Report. ********* QUALIFICATIONS ~** Confidentiality and Security Policy We consider privacy to be fundamental to our relationship with clierhs. We are committed to maintaining the confidentiality, integrity and security of clients' personal information. Internal policies have been developed to protect this confidentiality, while allowing client needs to be served. We restrict access to personal information to authorized individuals who need to know this information to comply with federal standards to protect your nonpublic personal information. We do not disclose this information about you or any former consumers or customers to anyone, except as permitted by law. The law permits us to share this information with our affiliates. The law also permits us to share this infomtation with companies that perform marketing. When we share nonpublic information referred to above, the information is made available for limited purposes and under controlled circumstances. We require third parties to comply with our standards for security and confientiality. We do not permit use of consumer/customer information for any other purpose nor do we permit third parties to rent, sell, trade or otherwise release or disclose information to any other party. Education As of the date of this report, land/or Steven W. Barrett, SRPA, SRA, ASA have wmpleted the requiremerds under the continuing education program of the Appraisal Institute. ~,~, ___ _ . . ~'~~ 7i°~ '' b~ ~~ A_ ,. ,. '' ~ = ~ - ~' .: _ ~-- ~. ~- ~; ._.~ .. ~.~~~,~ ~: ~~ - ~~ r ~., ~ ~ /J /~ ~.~. ,..~-- .: ~) ~ ~,,~;~ ~ J i, ~ ~ `~ ~~ ~~ ~~ ~ l~ ~ ~~ ,: ~~ r~' ~ ~~ ~' ~~ 0 ~\ ~\. 1~N , AAAv ~ ~ m ~~ ~o .. ~, o 0 0 00 . ~~~++ -~ ~~ ~~ ~~ ~~ G ~\ ~~ ~ ~. ~ ~~ c.~ ~ , ,~ ~'~ ~~ ~~~ ~~ `~ ~,, 1 I ,~ ~~ ~~ ~~•, ~'~ L ,~, ~. ~' ~~ ,~ ~` ~~ ~ ~ ~~ ~~ ~~ ~__ n ,' ' j ~ ~~ ~, ~~ ,, ' ' i'+ ~ ~~, ~ ~~ ~ f ~, ~,. ~a . ~ ~. ~~:;~ ~~ (~\\~\~' O h 'i v '\ ~ ;~ ~~ ~ ~_ °~ ;v °~ w ~ ~~\~ ~~~ ~ RAYMOND BEAR ESTATE d/o/d -APRIL 30, 2009 Appraisal by: Harry E. Donson 243-8943 CARLISLE COIN SHOP 25 Circle Drive ~ ~ ~ ~' Carlisle, PA 17013 C .eti ~ ~' ~~-~'~ 5 ~.~ off. ~- S' ~ ~ ~~-~`-~(3 ~ ,~' S r ~~-~-~ ~ ~ ''l` ~ ea` ~~.~• s ~ ~,,~ 61 ~~ ~ ~ L sl ~ ~~, ~T_____~ =a-- ~ l ~ 3 ~ ~. 2~ ~~~ ~~ ~ ~~ ~ s .,~ 3 3 - /'~ _~ ~ ~ G (~.,~~ ~'"~ ~ ~ 2 ZS ~~ ~ ~r~.~ ~~r~ ~~~~ _ ~~~ -srYc,~. /~ /~' 3, 'J ~'~5 -~'~ 4 ,j ~ ~j ~+~1 ~ 5~1~ j, 2~~~' ~.. ~ ~ ~- " ~ ~-° 9 ~ (~~-~-~ T'__.~ /~' ~ eau ~: ~~e~~-~ ~DG1a~s - T ~ 3~.'~ ~ ---- ~ ~ 3~ ~ /_~~ -~~ ~~~ ~,,/f o ,~- ~ , ~ ~ , vim, -~ arD t, ~- .~~s~~-~ 1 ~ ©y°v ~~ ~ ~~~~~5 ~ .~ ~ Si~~ ~ ~5 ~~~~ -~ ~Z7Y? ~ ~ ~ ~ ~~ t fl _ ~i ,~ ~ ~ r` ,~ ~~ ~~~~ ~ ~~- ~~~~ ~~~ ~ ~~ ' - ~ ~ M8T Bank _ .~. ` 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Phone (888)502-4349 Fax (302)934-2955 May I I, 2009 Law Offices Irwin & McKnight, P.C. West Pomfret Professional Building 60 West Pomfret Street Carlisle, Pennsylvania 17013-3222 :ft l~ ~ ~t .: ~l i l?~"j ~- - -i! - Re: Estate o~aymond F. Bear ' Social Security: 183-12-1167 Date of Death: April 30, 2009 Dear Sir or Madam: Per your inquiry dated May 7, 2009, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Checking Account Account Number 9832815410 Ownership (Names o~ Raymond FBear* Opening Date 10/17/02 Closed 5/8/09 Balance on Date of Death $ 7, 969.21 Accrued Interest $ 0.1 S Total ----------------------------------------------------------------------------------- $ 7, 969.36 2. Type of Account Certificate of Deposit Account Number 31003917741778 Ownership (Names o~ Raymond FBear* Joanne L Bear* Opening Date 7/3/08 Balance on Date of Death $ 5,419.79 Accrued Interest $ 128.77 Total $ S, 548.56 .~ 3. Type of Account Certificate of Deposit Account Number 31003917741794 Ownership (Names oj~ RaymondFBear* Joanne L Bear* Opening Date 6/19/08 Balance on Date of Death $11,000.00 Accruedlnterest $ 33741 . Total ~ $11,337.41 4. Type of Account Box Number/Location Ownership (Names o,~ Opening Date Safe Deposit Box 0003716/High Street- Carlisle Raymond F Bear* Betty L Bear, Co-Owner* S/12/98 * If upon reviewing the information above, you believe there are additional accounts not referenced, please provide us with an account number and/or name of any possible joint account holder. For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, etc., please contact our High Street Carlisle Oflice # 717-240-4536. Sincerely, ~..,~~c~ Tracie Hare Adjustment Services St MEMBERS 1St FEDERAL CREDIT tTPIION REGULAR SAVINGS ACCOUNT: Account Number/Suffix 219430-00 Date Account Established 06/19/2002 Principal Balance at Date of Death $5.93 Accrued Interest to Date of Death $.00 Total Principal and Accrued Interest to Date of Death $5.93 Interest Eamed 01/01/2009 - 03/31!2009 $.93 Name of Joint Owner None CHECKING ACCOUNT: Account Number/Suffix 219430-11 Date Account Established 06/19/2002 Principal Balance at Date of Death $388.97 Accrued Interest to Date of Death $.00 Total Principal and Accrued Interest to Date of Death $388.97 Interest Earned 01/01/2009 - 03/31/2009 $.00 Name of Joint Owner None INVESTMENT SAVINGS ACCOUNT: Account Number/Suffix 219430-05 Date Account Established 01/23/2008 Principal Balance at Date of Death $804.71 Accrued Interest to Date of Death $.10 Total Principal and Accrued Interest to Date of Death $804.81 Interest Earned 01/01/2009-03/3112009 $25.96 Name of Joint Owner None CERTIFICATES OF DEPO$R: Account Number/Suffix 219430-47 279430-48 Date Account Established 12/09/2008' 12/10/2008" Principal Balance at Date of Death $1,175.64 $2,392.01 Accrued Interest to Date of Death $3.76 $7.66 Total Principal and Accrued Interest to Date of Death $1,179.40 $2,399.67 Interest Earned 01 /01/2009 - 03/31 /2009 $11.60 $23.62 Name of Joint Owner Joanne Bear Joanne Bear Date Joint Ownership Established 12/09/2008 12/11)/2008 'Rollover from certificate 219430-40, originally established 12/10/2004 . "Rollover from certificate 219430-41 , originally established 12/10/2004. CERTIFICATES OF DEPOSIT: Account Number/Suffix 219430-49 219430-50 Date Account Established 02/09/2009' 04!27/2009" Principal Barance at Date of Death $11,561.48 $11,128.41 Accrued Interest to Date of Death $30.31 $2.35 Total Principal and Accrued Interest to Date of Death $11,591.79 $11,130.76 Interest Earned 01101 /2009 - 03/31 /2009 $53.12 $.00 Name of Joint Owner Joanne Bear Joanne Bear Date Joint Ownership Established 02/09/2009 04/27/2009 `Purchased by transfer of funds from 219430-00. ''Rollover from certificate 219430-45, originally established 5/27/2008 . ~+c~ ~b~~r 9 ~ l ~G~ fRWif~ ~ ~~~!c~(i~'iul-i s MBERS~1sT FE~R~ Cv"`UNI~ Danielle A. Kline \\I) Insurance Services Specialist May 13, 2009 Estate of: RAYMOND F. BEAR Date of Death: April 30, 2009 Social Security Number: 183-12-1167 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org vur~~-r.w~ iuu lY~GJ r,~.~ cliduGlluu 1lli~lVdlll, I'llliilll;liil ~UUL!UUL • ~ 1 Tf~r~ven~t ~Finar~c~al for Lufh~erans~ Death Benefit Information Flxod Annuity Contract 370fifi88 neceased: ttaymond F Dear Date of Death: 01/30/2009 Date Prepared: 05/07/2009 Claim Number. 427216 Death Benefit t;ost stasis $ 3,500.00 Taxable Gain $ 4,305.7$ Total Daeth Benefit ~ 7,1iU5.7B Beneficiary D~slgnation B2se coverage: Proceeds wal be paid to Joanne ~ Bear,10117 Oakton Terrace Rd. Oakton, VA, 22124, child, if surviving; otherwise to th® estate of the owner. Special Messages 1. IMPpRTANT TAX REQUIREMENTS: Each beneficiary will be eubject to federal income tax withholding for their share of the taxable gain. Each beneficiary needs to complete the substitute W-AP section on the Claimant's Statement. If NO withholding i3 desired, the first section in the substitute W-4P should be checked. If the benet7clary r]C1FS want whhhnldinrJ, the apprnt-ri2te section should be completed. 2. TO aSS1S[ rhP. l7P.nP.flr:iaty in sale?rring a riLsrribr.Rion method, you should refer to Non-qualified Tax Chart No. 3. This chart can be printed from ~ieldNet, Products & Marketing, Know Your Product, Annuities, l.laims, ueath I ax (:harts. ,ul MMRUOTrv~~1N7Wiev~~7cvigpq,MEPNAIVSEONIY. Page 3 Ofa I~Pr•PacPri~.r. C.:I,1$tQ~T~P,.C ICS: 5014542 uu~ ui r c,w~ iut.~ i3~~~ r,~ I11auG11uu llli'1V~llL rllldllCldl ,, r . y y ~Thriv~nt Finoncial for Lutherans $00 THgIVENT (800-817-18317 • wwtiv.thriventeom Facsimile I~UUI!UU~ 7o Fdut nwtdreri ;l,llurncy Itugrr Inyln 1-~17-149-d'3a4 From (name and designation) Phone Fax number Michael Collaghcr~ FIC 717-SOZ-1100 717-50?r1119 7iUr Uate N inauc-al (:oncult9et 05/07/00 llddreee ; City wlatt: ZIP codt: 101 S. 'US Ilighvray 15, Switc B bill~4ucg PA 17019 Problems with this transmt[tal, t:aii Phone Number of pages including cover Kay stone, office Professional 717.502-I r 00 2 Ifierc is the papcnvork from Miehae! Gallagher. TLauk yuu, IGay 6tonc Officc Professional Sontb Genteel PA Group 717-SDZ`1100 tnsurnnoc and retlrernent pnxJuds, whore available, ere indvidua) conaa~ts (nat yrouN wvr~ayrj wr~I urlarr~I Y~y Thtivrnl Fn~ancial fix Luthcrarrs, Apprelan, Vvt ~a19-vuUT. NAIL N0.15:iti•56o14. Products issued by 7'hdvrrtt Financial for Lutherans ~ available to applicants -vho meet membership, MEUrsblNry, lJ.S. ut4sonthip and rcoidency rcquircmcnts. Not aUpmduets described ere avartabk in alt states. SrnuNinc rnw nffPrrxl fhrnupA THriw•nt tnvPStmpnt Manegemenrlnc, 625 Fourth Avo. S, Mrnnaapolis, MN 55?JrJ665, a whoNy owned subsidiary of firiuentFtinsncialfar Lttthetans MembcrFINRA. MBmber SIPC. hank producde and lrvst eeru/eoe efl'orad Fhrough Thmnsrt Finaineigl 8anh 2000 !r Mi1aslens Or,, Appratnn, tM SI818-0Lltlt: (IHem6er rO1C, Equal Nous/ng LenderJ, a wnofry owned sttpstdtarY o/ 7rtrlverrc Financial for Lutneran5. kurrronea, JnvsshnerK products, severities, Mast and Lrvcafinent nlaHayeureat eervit:rs surd aceuwrla arc rrot dcpushs, arc not I'DIC Insured, ere not Insured AYanYlietlM81l7oVWfuaant a>renrs, and are no! yurenteed 6y TtrrJvan- Ftnanr:/at pank. Varishto insnr;+nr,.p coafrar•!9, lnvcsbncntptroducts, securities, bust, andinvestrrtonttnanagomant aaourrfs maygo down in value, These faxed documents are Irtl®ndetl for the use ai the addressee and may contain privileged or confidential infotmatioR If you are n~the addressee, you may not mpy or atstn[wte tnese documents, unless autnanzea w ao so nv the adnr~see. It you reoenrea Tats tax In error. olease as us immadiabty 1o arrange for the return of theca faxed deeumonte. 20113 R4-08 Allstate Life Insurance Company P.O. Box 94212 Palatine, IL 60094-4212 Telephone: (877) 499-6418 Facsimile: (866) 635-4523 May 14, 2009 Kathleen Nissley Invest Financial Corp. 1166 Walnut Bottom Road Carlisle, PA 17015 Re: Raymond F. Bear Contract No: GA17245732 Dear Mrs. Nissley: Allstate You're ~n good hands. We received a request to complete IRS Form 712 for the above referenced contract. The purpose of Form 712 is to provide an estate or donor with the value of a life insurance contract or its proceeds as of a certain date (usually the owner's date of death or date of transfer of the contract). Because this contract is an annuity, it is not reportable on IRS Form 712. I can, however, provide the following information for estate purposes: Date of Death: Apri130, 2009 Annuity Value as of Date of Death: $ 59,459.16* Cost Basis: $ 50,000.00 Named Beneficiary: Joanne L. Bear *The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender Charges. If you have any questions, please contact me at 1-877-499-6418 Ext. 86553. Sincerely, Jacklin Saro Sr. Claim Examiner Western-Southern Life Assurance Company Single Premium Deferred Annuity sso ~ ' ' • • Prepared on 12/08/2008 Owner BEAR RAYMOND F 836 W North ST Page 1 of 1 Western-Southern Ufe appreciates your business. Carlisle PA 17013-1743 Annuitant BEAR RAYMOND F Contract Number W 20603585 Contract Date 12/06/2001 Contract Type NON-QUALIFIED * * * INFORMATION ABOUT YOUR CONTRACT _ > Total interest earned during any contract year will be impacted by any withdrawals, including systematic withdrawals, from the contract during that year. For example, if you select the systematic withdrawal plan, the interest you receive will be less than the amount indicated by the effective annual interest rate because interest is being paid out rather than accumulated. SUMMARY OF ACTIVITY 12/07/2007 through 12/06/2008 Beginning Contract Value $ 10,034.41 plus Interest Credited' 356.21 less Systematic Withdrawals \ .00 Partial Withdrawals ~ .00 Surrender Charges ~ .00 Ending Contract Value ~ ~~ 10,390.62 Surrender Value` ~ ~ 10,110.07 ~~ .~~ ~ ~;~' \J " The effective annual interest rate for the contract year indicated above was 3.55% and is 3.70% for the current year. The Pacesetter guarantees interest rates each year for two 5-year periods. You are currently in the second 5-year guarantee period and the interest rate will again increase by .15%. The minimum guaranteed interest rate in years 11 and later is 3.00%. '~ Amount available after deducting any applicable charges if you cancel your contract. For further information about your PACESETTER Annuity contract, including interest rates, contact your sales representative or call Annuity Operations. ANNUITY OPERATIONS Western-Southern Life Assurance Company PO Box 2918 Cincinnati, Ohio 45201-2918 1-800-926-1702 Customer Service Hours: Monday -Thursday, 8 a.m. to 6 p.m., Eastern time Friday, 8 a.m. to 5 p.m., Eastern time *1W8LOOK7* 517 s May 12, 2009 Joanne L. Bear 10117 Oakton Terrace Road Oakton, VA 22124 Ewing Brothers Funeral Home, Inc. 630 South Hanover Street Carlisle, PA 17013- (717)243-2421 The Funeral Service for Raymond F. Bear We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. 1. PROFESSIONAL SERVICES Services of Funeral Director/Staff , $4650.00 FUNERAL HOME SERVICE CHARGES $4650.00 SELECTED MERCHANDISE: Batesville SS Blue Praying Hands , $3275.00 #5 OBC American, $1395.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED $9320.00 Cash Advances Newspaper Notices -Patriot, $201.92 Clergy/Mass Offering, $200.00 Certified Copies of the Death Certificate , $60.00 Flowers, $132.50 The Sentinel Obit, $117.42 ~` TOTAL CASH ADVANCES AND SPECIAL CHARGES . $711.84 Total Total Cost , $10031.84 SUB-TOTAL $10031.84 / ~~~~~~~~ INITIAL PAYMENT /DISCOUNT /CREDITS 7913.57 ~ ~ r e~a~l~~ TOTAL AMOUNT DUE $ 8.27 ~ Q The unpaid balance over 30 days is subjected to a 1.50 % service charge per month - 18.0000 % per annum. f ~ e ~e ~o~ ~ C ~.X~XQ~y ~~ ~i ~31' .~ o0 ~ ~<l.. ~y ,~ ~ • t Statement United Church of Christ Homes Sarah A. Todd Memorial Home 1000 West South Street Carlisle, PA 17013 Statement Date: 04/09/2009 Joanne Bear 10117 Oakton Terrace Road Oakton, VA 22124 Due Date: 04/25/2009 Re: Raymond F Bear Account Nr: 102000 Date Description Days Rate Charges Pa.jrntents Balance Quant BALANCE FORWARD 10,404.50, - 03/28/09 PAYMENT T0,404.50 03/26/09 Beauty & Barber 1.00 12.00 12.00 03/31%09 Cable Television 1.00- 19.50 19:50 03/31/09 COINSURANCE BILLED 133.50 267.00 03/31/09 Incontinence Suppli 1.00 47.52 47.52 03/31/09 Personal Supplies 1.00 29.66 29.66' 03/31/09 Medical Supplies 1.00 59.91 59.91f 04/01/09 Room & Board - Semi 30 238.00 7,140.00 4' 10,404.50 .00 12.00 31.50 298.50 346.02 375.68 435.59 7,575.59 NOTE: ***** PAYMENT IS DUE UPON• RECEIPT ***** BUT NO LATER 'THAN THE: 25TH OF THE MONTH ***** Please remit the LAST AMOUNT printed on your. statement. Include the ACCT# from the statement on the 1KEM0 LINE of your .check. Payments after 04/03/09 do no.t reflect on statement. NOTE: ** LATE PAYMENTS ARE SUBJECT TO A 1.25$ LATE CHARGE PER MONTH ** A $10.00 FEE WILL BE CHARGED for RETURNED CHECKS ** t • '~ .c; ~~ `~,J ~' PE~fVDER JETERINARY CENTRE, LTD. Account: 16854 The E~~argency Veterinary Clinic of Fair Oaks ~ Invoice: 595820 4001 Legato Road -Fairfax, Virginia 22033 (~~, Date: 06/15/2009 (703) 591-3304 V Time: 1102 Page: 1 ! Joanne Bear Patient: TEDDY Age: 10 ` 10117 Oakton Terrace Rd Species: CANINE Sex: MN Oakton VA 22124 Breed: Cocker, American Tag: I Color: Buff Weight: 27.60 I Doctor: Jody Clarke, DVM ~ Phone: (703)255-0583 .__~_-.--.--..________~__-.._ .._~. _______----_~~_ ._..r_.._...____i Service/Item Qty Price Amount ~ j Office Call 1.00 13.00 13.00 . Exam, Medical Progress 1.00 43.00 43.00 Fecal -Colon Cytology 1.00 40.00 40.00 Lab Request 1.00 0.00 0.00 CALLBACK 48 HOURS 1.00 0.00 0.00 PellitolOintment 1.00 ~~~ _ ___ 24.50 _.. ___.__..________.._ --- Tax 0.00 Net Invoice 120.50 ~, Previous Balance 0.00 Payment visa 120.50 Balance Due 0.00 ~ Reminders: Aug. 22, 2009 Rabies 3-Year Aug. 23, 2009 DHPPC Booster 3-Year Feb. 4, 2010 Bordetella/Dog Intranasal #2/B June 1, 2010 Fecal -Complete - The Emergency Veterinary Clinic of Fair Oaks is a department of Pender Veterinary Centre, Ltd. For your convenience, you can order therapeutic diets, most prescription refills, and flea, tick, and heartworm preventatives directly from our secure website. Order at WWW.PENDERVET.COM. _ _ _ _ _ __ _ Thank You -- _ Please call the clinic in 3 days for any lab results, or in 7 days for any biopsy results. Thank you. i r, ~ Services in P rogress PENDE:R VETERINARY CENTRE, LTD. Joanne Bear Account: 16854 Date: 06/01 /2009 Patient: TEDDY Page: 1 Date Service/Item Qty Price Amount 06/01/2009 Office Call 1.00 13.00 13.00 06/01/2009 0333Exam 2 -Prof. Service 1.00 55.00 55.00 06/01/2009 Medical Waste Disposal 1.00 3.00 3.00 06/01/2009 Anal Sac Express 1.00 24.00 24.00 06/01/2009 Ear Smear & Cytology 1.00 38.00 38.00 06/01/2009 Fecal -Complete 1.00 68.00 68.00 06/01/2009 Lab Request 1.00 0.00 0.00 06/01/2009 CALLBACK 48 HOURS 1.G0 0.00 0.00 06/01/2009 Superchem / CBC / T4 IH DX 1.00 13$.00 138.00 06/01 /2009 Lab Request 1.00 0.00 0.00 06/01/2009 Urinalysis -Complete DX 1.00 43.00 43.00 06/01/2009 Lab Request 1.00 0.00 0.00 06/01/2009 Interceptor 26-50# 12 dose 1.00 68.50 68.50 06/01/2009 Frontline Plus -Dogs 23-44# 1.00 T 74.99 74.99 06/01/2009 Otomax 30 gm 1.00 46.50 06/01/2009 Forti Flora - K9 (entire box) 1.00 T 40.00 06/01/2009 Metronidazole 250 mg 30.00 13.50 06/01/2009 Two week recheck appointment 1.00 0.00 0.00 Tax 5.75 Net Total 631.24 ~~ -~~..~ a~~ . ~~ ~1c~,xl