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HomeMy WebLinkAbout01-15-1015056051058 REV-1500 Ex Cos-D5) OFFlCIAL USE ONLY PA DepaMlerrt of Revenue Code Yeaz Fde Number t3ureau aI lrldividttal Taxes INHERITANCE TAX RETURN - -- ____. _ __ __- Posox 280601 21 ~ 09 0027 PA nlze-osol RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 222-18-9228 12/20!2008 i { 08!30/1925 DecedeM's Last Name Suffer Decedent's First Name MI ___ -_ Cox i Mabel ~ ! G _J (If Applicable) Error SurvNing Spouse's Information Bstow Spouse's Last Name Suffix Spouse's First Name _ ___ MI _-.~ ~~ ~ I i Spouse s Social Security Number,. _- THIS RETURN MUST BE FlLED IN DUPLICATE VYITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1.Original Return O 2. Supplements{ R81um O 3. Remainder Return (date of death prior tp 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death attar 12-12-82) O 8. Deoederrt Died Testate O 7. Decedent Maintained a living Trust __ 8. Total Number of Safe Deposit Boxes (Attach Copy of Wi6) (Attach Copy of Trust) O 9. L'rfigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Electbn to tax under Sec. 9113(A) between 12-31.81 and 1-1-95) (Attach Sdr. O) CORRESPONDENT - TFfiB 8ECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFlDENTIAL TAX INFORMATION SHOULD 8E DIRECTED TO: Name _ Daytime Telephone Number Cynthia L. White !; (717) 877-4324 Finn Name (If AppOCabie) _._ . ___ First tine of address 130 Pine Street Second line of address City or Post Office_ __ Dillsburg State ZIP Code ' r_ ~_ ~--. -- ---~ 4PA {17019' REGISTER OF WILLS USE ONE ~ E: s ~ 0 " ~ ~ C., cx~ r ~ l ~ C1 .> -.~:~ _~~~ ` ~?.7 G"I ~`,. ; t~% c..l "J t~-S ~ "i"i _... ...- cu ~~ ~ ~':' ~ ~ : , ~> c. ` ~: _ C". _ ~ .~ ' i~ _ ':. i ._ <,'~ t ~-> "1` T Cortespaxterrt's e-rrrail address: Un~d~~,i~~ar-altiea or perjury. I declare that I have examined its return, irrGuding aocomperrying schedules and atatemenffi, and to the hest of my knowledge and belief. it 7°r°, correct and complete. Declaratlon of preparer other than the personal represerHative is based on all infomratlon of wtrich preparer hag any WroMAedge. ~i nntRrt PERSON PONSIdLE FOR FILING RETURN , _ DA7Tr ~i31~~ ,~ ~t~' ~~~~`~ ~A 1 a 1 S RE OF PR ER THAN REPRESENTATIVE PpATE L ~ Dl /!Sl%1a/0 ~. Side 1 15056051058 15056051058 J 15056052059 REV 1500 EX Decedent s Social Security Number __ ___. - t~ecadenrs Nam: Mabel G Cox _____ _-_ 222-18-9228 RECAPIruunoN 1. Real estate (Schedule A) ............................................. Li 0.00 I 2. Stocks and Bonds (Schedule B) ....................................... 2. 0.00; 3. Ck~seiy Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. j 0.00 j 4. Mortgages 8 Notes Receivable (Schedule D) ............................. 4.:. 0.00 i 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ........ 5. I 10,454.16 'i 6. Jointly Owned Property (Schedule F) O Separate Baling Requested ....... 6. i' 0.00 j 7. (~- Y rvosG Wafers & Miscellaneous N Probate ProPertY '` e d , o to Billing Requested........ 7. ~ 420,278.55 '; 8. Total Gross Assets (total Lines 1-7) .................................... 8. i 430,732.71 9. Funeral Expenses 8 Administrative Costs (Schedule H) ..................... 9. 7,129.76 ;. 10. Debts of Decedent, Mortgage Liabilfies, 8 Liens (Schedule q ................ 10. ~ 308.56 11. Total Dsductlons (total Lines 9 & 10) ................................... 11. 7,438.32 12. Net Valw of Estate (Line 8 minus Line 11) .............................. 12. 423,294.39 13. Charitable and GovemmeMal Bequests/Sec 9113 Trusts for which r an election to fax has not been made Schedule J ( ) ........................ 13. , 0.00; 14. Net Valw Subject to Tax (Line 12 minus Line 13) ........................ 14. ' 423,294.39 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 -_ ___ - - _--- --__ ~ -- _- -__ _-- -- --_ -- (ax1.2) x .o_ ; 0.00 I 15. j 0.00 j 16. Amount of Line 14 taxable ;° at lineal rate x .0 45 423,294.39 '; 16. ~ 19,048.25 ~ 17. Amount of Line 14 taxable i -° at sibNng rate X .12 I 0.00 17. f 0.00 18. Amount of Line 14 taxable at collateral rate X .15 0.00 ~ ~a ~ 0.00 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 19,048.25 O 15056052059 REV 1500 EX Page 3 Decedent's Complete Address: 21 09 0027 DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER Mabel G Cox 222-1&9228 STREETADDRESS 130 Pine Street CITY Dillsburg STATE PA ZIP 17019 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19} 2. CreditslPayrnents A. Spousal Poverty Credit B. Prior Payments C. Discount (1) Total Credits (A + B + C) (2) 3. InteresUPenalty ffapplicable 315.95 D. {merest E. Penalty Total InterestlPenalty (D + E ) 4. ff Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. FIII in oval on Page 2, LMe 20 to requeN a refund. 5. ff Line 1 + Line 3 is grater than Line 2, enter the difference. This is the TAX DUE. A Enter the interest on the tax due. (3) (4) (5) (~) 19,048.25 0.00 315.95 0.00 19,364.20 0.00 B. Enter the total of Line 5 + 5q. This is the BALANCE DUE. (56) 19,364.20 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIAfiE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the properly transferred :.......................................................................................... ^ b. retain the right to designate who shah use the properly transferred or its income : ............................................ c. retain a reversanary interest; or ............................................. d. receive the promise for life of either paymer-ts, benefits or care? ...................................................................... ^ 2. ff death oocumed after December 12,1982, did decedent transfer property within one year of death without reosiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death? .............. © ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a benefiaary designation? ........................................................................................................................ © ^ IF THE ANSWER TO ANY OF THE ABOVE QUES110NS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART ~ 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 tp 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 10 or for the I1S@ of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)). The statute does not exempt a transfer to a surviving spouse from fix, 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 otter July 1, 2tX10: The tax rate imposed on the net value of transfers from a deceased gild 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 (O) 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 benefiaaries is four and one-half (4.51 percent, except as noted in 72 P.S. §9116(1.2) (72 P.S. §911ti{a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedents 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 cannarr with the decddert, whether by blood or adoption. REV-1508 EX+ (8-98) COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX I~TURN RESIDENT DECEDENT SCEIEp1~LE E CASH, BANK DEP'OSRS, & MISC. PERSONAL PROPERLY ESTATE OF FILE NUMBER Mabel G. Cox 21-09-0027 Include the proceeds of Idigation and the date the proceeds ware received by the estMe. All propsKy Jointly~wned with right of wrvMorship must tw disclasd on Schsduk F. (If more space is needed, insert additions sheets of the same s¢e) REV-1510 EX+ (08-09) pennsytvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT pECEDENT ~A~ OF FILE NUNBfpt Mabel G. Cox 21-09-0027 This schedule must 6e completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. iTEM NUMBER DESCRIPTION OF PROPERTY IMaIAE THE NAME OF TFIE TRANSFT~E, THEDt REfA71DrL~ TD DECfDBIT AHD THE DATE OF TRAHSRTL ATrAgi A coPr of THE DEED FDR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION tF APMICABIE TAXABLE VALUE 1. 405 Reservoir Road, Mer~anicsburg, PA 17055 Mabei G. Cox, Essel T. Cox 164,800.00 100 164,800.00 Uuslors,1011111999 Sold 03!2412009 Expenses including broker commission, Doc prep, Notary ~ Transaction Fees _15,072.23 ' 100 -15,072.23 see HUD 1 Settlement Sheet Adjustments for items pad by seller in advance 933.59 100. 933.59 See Settlement Sheet Real Estate Taxes paid up to sale -112.00 100 -112.00 Insurance coverage up to sale X1.76 100 -51.76 Utilities Expense uptosale -565.13 100 X65.13 Material for impravemenis to property required for sale -633.00 100 -633.00 Barry White Services for repair to properly required for sale -1,000.00 100 -1,000.00 Glenn White Services for repair to property required for sale _1,000.00 100 -1,000.00 Midland National Account #8500038183 IRA 79,463.39 100 79,463.39 Midland National Acx;ourd #850000381841RA 28,402.47. 100 28,402.47 Members 1st Federal Credit Union Account #205793 25.00 100 25.00 Members 1st Federal Credit Union Account 205793 12,556.15 50 6,278.08 Pershing Account # 58F006652 63,969.30 100 63,969.30 Franklin Money Market Aa~unt # 11118722599 20,363.48 100 20,363.48 Frankin PA Tax Free Aa~unt # 12911678117 21,574.23 100 20,363.48 American United Life Insurance Annuity 2453373280 54,118,88 54,113.88 TOTAL (Also enter on Une 7, Recapitulation) $ I 420,278.55 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (SO-09) SCHEDULE H Pennsylvania DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT EsrATE OF FILE NuwBEit Mabel G. Cox 21-09-0027 Qetedant's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Auer Cremation Services 1, 596.60 2 Wes Gunther (Clergy) 250.00 a Faye Haar (Custodial Services) 100.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 2,000.00 Name(s) of Personal Representative(s) Cynthia L White street Address 130 pine Street City Dilisburg gq~ PA ZIp 17019 Year(s) Commission Paid: 2009 ...0.00 z. Attorney Feels: 0.00 3. Family Exemption: (If decedent's address is not the same as daimant's, attach explanation.} .. Claimant Street Address 4. 5. 6. ~. a s ~o City State _ Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Return Preparer Fees: Federal Income Tax Obituary Notices Boyer Nursery Memorial Tree Brian T. Cox Reimbursment for Air Travel and Auto rents! 80.00 0.00 110.00 1,431.00 206.42 97.94 1,257.80 " TOTAL (Also enter on line 9, Recapitulation) I; 7,129.76 ZIP If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08) ~ Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX REruRN MORTGAGE LIABILITIES ~ LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Mabel G. Cox ~ 2-os-ooa7 Report debts Incurred by the decedent prior to death that remained unpaid at die date of death, Including unreimbursed medical expenses. If more space is needed, insert additional sheets of the same size. ~ Discover More Card Account Summary - Cardmsmbsr since 1987 Dosing Dam December 24, 2008 pogo 1 of 3 / ~ ~4ceouc~t number ending in 6239 Previous Baldgcs f 3025 Payment Dus Dale January 23, 2009 Paymerds And CredNs 30.25 `~ Minimum Payment Due 515.00 Purchases + 17.94 Credit Limit 514,500.00 Cosh Advances + 0.00 Credit Avaiksbls 514173.00 Balwcs Transfers + 0.00 'Cash Credit limit 57,300.00 Fiwnoe~arges •.: + 0.00 .Cash Credit Available 57,300.00 New 517.94 You may bs able b avoid Periodic Firwnce Charges, seethe reverse side for dstaik. ~~ ~ashback Bonus' ~~ Bo~s 5 12.99 New Caahback Bonus Eansd + 0.01 ~~ Ile~mua01- &ineo Anrrivcroary Nato _ .. _ cF Dezember 24: 55.79 ~ ;tCeep building your ravwrd: with .very ~purdws., slat redeeming once yea roach 's2o Carhbad: eonusptl. 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Past Dale Dale °•+ 'Payrnerrls and Gedis Dec 3 Dec 3 PAYMENT • THANK YOU ~y ~ ~ ~ -30.25 °_ ;Other/IMisoeMarwau Dec 23 Dec 23 IDENTITY THEFT PROTECT 800347-3089 iUi LltAW.LIt~ - 9.99 ~Servioes Dec 5 Dee 5 ~ SiCdVEBRIDGE IIVS 12/08 800527-0006 TX (~itOKGr 7.95 . ~ ;Information For You - _.. . _ . _ _ _ _ _ -_- _ _-- - - ~_ op dala,roe Tranafir of firs) for arnarrt bir:rg period: ~DaRy Periodic Rab: 0.00000%; coresponding ANNUAL PERCENTAGE RATE: 0.0096. Finish your hdiday shopping from home this year. Discover GTR Cads Dome in a variay of designs-many with matdring ~Groering Cads. Choose ary dollar amount from 520 b 5500-ond shipping is FREE! Good kr p:xrhoaa d mi~iors of ,k~ediorrs. Need b get it Nrers FastY Try the NEW Discover eGiR Card. Buy d DiscovwCiRGud.eom/holidoy looking For a leaf minuN hd' giRT Give tits Discover eGiR Cad. No driving arovrrd for dle pirlisct giR - a~~ERr .send Dolma inafarrlly. It's good puncirasss d mipiorrs of k~cdions, ankne and ov~ar 1M phone. Finish year ~..o ~PPinB bday d aooverCaiACard.oarrr/egiR ~ W wr... ~ T £] Lam` !~! !1l LTA ~ iW Y: r; T ,~ ~- >.S ~ F•a .~i t IX SJ ~ ~ ~ >~~~~ s~ ~ u~r~~ ~~V~ Q i-~ = b it: ~ L3 sn ;yj i.Y:UWCt, CEL~~];- = itl ~-+ 2 L`%t~Q itiJW~ ~ycT~~UZG ~~'~ 4 W .~ s :c W CC CC~+~ ~~ 7. 1- •?' tai i3.+ I's3 Q~a .1~iQi. ~FZ w 7K ~ ~~© ~ • ifs G~} . aL~~ t1 C ltl s.~~~ .~~~ ~ NOIIY~f 10: ~9~~1:61LS~$~IG: SI~OXY~13~A3: ~~11 P~P~ N~I9~~g~~t b00alO~Q lY GAS! ~ uti ~111d ~ .. ~ • . ~ ~ .. ~ i .. ~ ~~' r, i ff' ~ 6i ~ S 11,3 L • • ~ i .~ 0 rr }-~ LQ Q h N 3 w L] !f) ~ 5~ ~: ~. J ~~ ~ ~ ~~~~rr L ~L ~~ ~ ~~ iffl. O. 'j 7G ~1 LEI t:• { t[ :~ ~ ~. _~~ s ~~ }' ' .. z O •~ ~ ~ O :~ • ` v. ..:. .. ~ . ~ •=.u z .: ~ ~ ~ • ~: ~~ ~ ct! ~ ~~~~ .JL3~La Y s•~ ~ ~., Z ap d N w V .. f V ~ 5~ ~ ..v 4 i~ ~ L ow .. W ~.. ~~ W W ~ ~ Q ~ ~~ ra ss V { ~i,i t ~© ~ Q ~ 's !$C ~ '~' ,.4..._ S a ff ;•. H i~l s ~Q~~ ff E:t a] a h- tFl !~~ N~~~3J~a%+fi w~u~w>~~~ rox ACtQft}fUlffLRCtU ';' ~ . t~ x ti t_1 ~ ~ ~ . ~ x ~ ~ s .° t- ~a ~.4 ~ ~l Ifl '' ~~ ~ ~ ~ F- ~. ..., .., L~~., a $t 4F ~ . ~ g ~' ` ~ ~ , * ~ ..v ..i .:s £ T00~ ~IV~ 'IV~IZI~ B~IOH~ ~Z8ZOt9 %V,3 I~T~OT 6002/OT/ZO Upper Allen Township ~' 100 Gettysburg Pike Mechanicsburg, PA 17055 717-766-0756 Sewer Billing THIS IS YOUR 4TH QUARTER SEWER BILL. ESSELL COX 405 RESERVOIR RD MECHANICSBURG PA 17055-G147 Service Location: RESERVOIR ROAD 405 Account Number: 534018 Billing Period: 10/01/2008 to 12/31/2008 Balance Forward: $ Current Charges: $ 112.00 Consumption: gals /~~ ~~e9 /~~ . If Paid By: 02/10/2009 $112.00 Penalty of 5% on the current charges will accrue after 02/10/2009. Interest of 1/2% of the unpaid balance will accrue after 03/16/2009. "i ~ -LEA3E RETURN UPPER PORTION WITH PAYMENT, I 1 ACCOUNT NO. h h P.O. BOX 1745 3.Of{"'O;i.:l. 'H~f.~r FE~a'ER~CIT~i FiL7AD ~,;,„, HARRISBURG, PA 17105 7d5 PHONE (717) 232-4328 n G n i~r'S~G!?t7t?8` ~?iQ~i.~'-.5. i ~OL.b 8e1-v i ce ~' l~rt ! ! 4+ € i2l3fll:~GC7F~ i1b8f3b FUEL CIIL. ~~8.~ ; 2.3~90~ 348. ice'; ~ ~ 'y~ f ~ i +~ ! • 1 O ~ j ; JAt~tUA~tY PAY~iEt~fTS ASE TlOT C2E~'~ECf i'ED ©~t YHE ANNUAL CHARGE IS COMPUTED BY A PERIODIC RATE OF 5. S. !~'- % PER MONTH WHICH is AN ANNUAL PERCENTAGE RATE OF • {) +~~ % APPLIED TO THE PAST OUE BALANCE FROM WHICH CURRENT PAYMENTS ANONOR CREDITS HAVE BEEN DEDUCTED. 8TA'T'EMEt~[T 9.~ ~.. ~. _ __ _ _ _ _ _ t~; ,~ a~~ °a•"`R~~°`- Page 1 ®.- ~.._ ° - _ -- -- pp ®~__ ............:... APL Electric :°-~ ~ ~ ~~ °~ '- 41010-82002 Utilities Electric Service For. EssELL r cox 403 RESERVOIR RD MECHAHICSBURG PA 17035 Qae~stians aboat this bill? Please contact ns Dec 12 st 1-880-34 5775 (1~8®-DIAL-PPL) or write to: G~stom~ 3erv~e SZ7 Hangman Rd. Allenotown, PA 18104-9392 www.pplelectric.com Electric Use Summary Page Balance as of Nov 2b, 2008 ~PL ELECTRIC UTILITIES Charges Total Charges Accolmt Balance 36 30 24 18 12 6 0 KWH -Average Per Day Meter Reading Information This graph,shows your dectrlc use over the last l 3 months- Types of Meter Readings: Actual - Adjusted Estimated p customer p DJFMAMJJASOND 2007 Mombs 2008 Total Avers Use Mont 8729 6377 ` Other important information on back ~ 41010-82002 AV 01 015230 623306 81 A"5DGT ESSELL T COX 405 RESERVOIR RD MECHAIQICSBURG PA 17055-6147 $27.53 Meter #3&170904 Nov 26 Actual 4712 Oct 29 Actual 4687 28 s KWH Billed 24 verag A e -Nov 2007 2008 e a 4 ~ KWH P Deg ay 22 9 Yearly Uae: Dec 2006 -Nov 2007 Dec 2007 -Nov 20(18 .~::. •----- -.. - .: nor.:. ~...- ~:.. -- <r. - Auto Pay PPL ELECTRIC LR'ILITIES 2 NORTH 9TH STREET RPC-GENN I ALLENTOWN PA 18101-i 175 ~1~1~1~111111~~~1~i~~~111~,11~'~111i11~16~10~~11~1'~'lllll~~h $o.oo $27.53 $27.53 ,. ~gnnnnna~~a9nnnnn?~s~r~ 41.n1.nR~nn~ USAGE HISTORY Monthly usage in thousand gallons ti rn H A O Billing Date: 01/27/09 Account Number: 00200999527689 Previous Balance $14:-10 Payments Through 01/27/09 $0.00 Balance Forward - PAST DWE* $]:4.10 Current Charges Due 02/162009 $14.35 `~7Y~~ :f!~:c.~I'~~i~;~:"••:i#;:.:.:. .. .. r:>: ~.j:::%i?i`ii%i:'iis#:%`~•`~<•:: ~`:~•;r.: .~!,:::,::.r~::.: *1'ast ~e Balance may be subject to late chargies, collection and/or termination. *PAY BY 02/21/09 TO AVOID A 1.596 LATE PAYMENT CHARGE SERVICE TO: ESSELL T COX SERVICE ADDRESS: 405''RESERVOIR RD MECHANICSBURG PA 68281260 12/23/08 01/26!09 34 0014 0015 1 MGL ACTUAL EOU/VALENT 117 1,Q0'0 GALLONS SERVICE CHARGES $8.50 W-STAB SURCHARGE $0.03 CF WATER CHARGES $5.14 W-PEN DB $0.21 W-DSIC SURCHARGE $0.53 TOTAL CURRENT CHARGES $14.35 SEE REVERSE SIDE FOR IMPORTANT ACCOUNT INFORMATION :n . ......................................... .. -... .-- ........... .>:~r. iiF-: - :~-. -. .,.,}.:; ~v--•:. -:::: «:::::: v ............................................... .... .... ~......... v =' '? ": ~~~:LJi::+i?ii:: i::~::•iii::~ii:?iii: iiiiiiii':Ni;: iiii}iiiiv •: Uiiiii: :: ~:rv:yn...-:. t~:4 =:!v~iv:~ :.. .v.~:::.:::::iiii:i:?:v}i......,i:;4?i'f.•ii}: i:3i:'•:: i:~::~.......... v .... mini? n. n.:::4..: s+ - ._i?'I~.... ' t .:::jFii'iiif:;~i:~:j:'r::isi.;iiii:::::.',••:j:<:i::%f•;::i i'i:;-;iiiiiii: {•vn::i:•i.i-:.::::.::r~:.;.....:.:u ............................n......::::.~.y::..}i'•: ri0::^i}i}i.~:i `.. .. ... F:: .:x n..v n. ..nne.......x.: v.: .. If you would like to pay your bill online, please visit our web~site at www.unitedwater.com and click on the Western Union's Speedpay icon. Approximate state tax included on this bill $0.68. (~"'F`~ ~ /039 osoor~ Erna PLEASE DETACH HERE AND RETURN THE BOTTOM PORTN)N WITH YOUR PAYMENT IN THE RETURN ENVELOPE PROVIDED. taoew~noeotz+awo __~___-_---_-______~~__~_~_~_~~_____~-_~~ _ i~M WQfIRM97'IIWI Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Next meter reading date: on or about 02/25/2009 ....... STATE FARM INSURANCE COMPANIES' STATE FARM PAYMENT PLAN ,.....~. PO Box 830854 Bimtingham AL 36283-0854 AT1 0000-9572-i3 6350-F38i 38 oooaa COX, ESSELL T 8 MABEL 6 153 LOGAN RD DILLSBURG PA 17019-9501 ** POLICIES ON ACCOUNT ** HOMEOWNERS 38-56-7098-i CURRENT INSTALLMENT 24.58 ;24.58 ACCOUNT NUIYIBER 0000-9572-13 Monthly AooouM DATE DUE PLEASE PAY THS AMOUNT FEB 1, 2 009 SEE NOTE ** BILLING SUMMARY ** Last Amount Billed $26.18 Last Amount Paid -26.18 JAN 1, 2009 Difference p . 00 Current Installment 24.58 Service Charge 1, Op Tota! Amount Due By FEB 1, 2009 ;25.58 Changes completed after i -~ 4-09 will appear of the next notice. NOTE: Pre-autiwri#ed payment of x"15.58 wii be entered FEB 7, 2009 through your bank. w,za Py- Future rwtices will onty be mailed if your amount dus changes. Please continue to subtract this amowht from your financial records each month. ~oo< <o LeSn ~s ~ a6ea~w ,q~ea,.- ese~ene as sr ~, ;sat m ~«~ oN [~ sax (] 1-~++u~~a ~cloyesrgy y sel~od w~e~ sots ~ (~i~o ~a-~wd lT/ al sagddZ a6ueyo I! xoq ~~ (tue6e weed aielS nod ses eseald) aBu~eyo uolleml Q Huo a8uetp ssa~ppe 6yrye oN ~ SaA ~ ~ssaippe snanexl ~no~{ a1 wrge~ q veld rapt oa bs~RUOw ~tue<u Moy'Neiodwei p tiemdwal ~ ltlaueulaad ~ :aBi sgwtl ~O apslnp ~ skwll ~ ~ >tlw~ dly 'W~! a~4d ssa~lsn8 8AoJ Ielsod/dIZ aounO.Id~aielS wa auoud a~ueplsea .a.d x STATE FARM INSURANCE COMPANIES NOTICE OF PAYMENT DUE ^ i BTATE FARM PAYMENT PLAN <~ PO Box 830854 &mrngham AL 35283-0854 AT1 0000-9572-13 6350-F381 38 COX, ESSELL T &~MABEL G 153 LOGAN RD DILLSBURG PA 17019-9501 ** POLICIES ON ACCOUNT"' -10MEOWNERS 38-56-70~-1 CURRENT lNSTALt.MENT ** CURRENT CHANGES ** 1995 SUBARU 534 2740-D09-38S EiiHing through payment plan has been discontinued. AccouNT NuM13ER 0 -9 -1 MoMhty Aoawnt DATE DUE PLEASE THIS AMOUNT JAN 1, 2 009 SEE NOTE "BILLING SUMMARY *" Last Amount Billed $0.60 Last Amount Paid 0.00 Difference 0.60 Current insta>Iment 24.58 Service Charge 1.00 Total Amount Due By JAN 1, 2009 X26.18 24.58 $24.58 ~P~ Changes completed after 12-12-08 wi11 appear on the next notice. NOTE: Pre-authorized payment of $26.18 will be entered JAN 1, 2009 throughyour bank. Future notices wit! only be mailed if your amount due changes. Please continue to subtract this amount from your financial records each month. azooe to Ewen tprraxy eBee~u e8e,enea~ saw ;sei[ sr ~,x~ oN ^ mA ^ Ll~tp~i'~F~au waq Pys of uen!+P tyvey~en l~ruo ~d ~Alo4~s~o4 ~ ~~ ~~ tgap~ Till a segddia s6ueyap xoq kip ^ pueBe uuej A1e~ mob ees t-t~ld) ti6ueyo uopeoo~ ^ Nuo eBue~.p sse~ppe Buk~ au ^ set ^ asse~ppe snalneid mob of utnl8a a end nob op bstpuaw ~(uew Moo `~Ueiodwet u baeiadwaj ^ ~ueuew~ad ^ :ae H~ ~ 1, Flo o ^ talon, ~ tn~lsul ^ 'Wd twos t~eysng ePoJ Itn~od~d¢ e~l~dlt-~S r ~ ~~ ~~ 1I~~~ ~~ PA ~a~~~ 7 ~c In: ~I~ ~ • Pho,k pr,~, ,~6 ~ Entry Method: ~nua! 3 ; ~,~ ~ 14:9~;g~ Ohlinr ~°~' Code: II41~1 M Batc~i; ••~nc YOU! Mrs. Cindy L. White 130 Pine Street . Dillsburg, PA 17019 Dec 21, 2008 Mabel Givens Cox - Deceased SPECIAL CHARGES X Direct Cremation Nationwide Guarantee Program Worldwide Travel Protection Program TOTAL SPECIAL CHARGES PROFESSIONAL SERVICES X Services of Funeral Director & Staff Dressing/Cosmetizing Facilities & Staff for Memorial Service Staff & Equipment for Memorial Service Private ID Family Viewing Witnessing the Cremation Packaging/Forwarding of Cremated Remains Personal Delivery of Cremated Remains Scattering of Cremated Remains TOTAL PROFESSIONAL SERVICES AUTOMOTIVE EQUIPMENT X Removal Vehicle Lead Car/Clergy Car Family Car Service Vehicle TOTAL AUTOMOTIVE EQUIPMENT ~~- A,~ , ~~"T L~ AIFR CRF11A1IOH SLi.._. , OF M I PI PE g p(T17) 595-9801 "~°~ ~~: ~1~ ERVICES OF PENNSYLVANIA INC Phone Order • ~ , : ~~~~ ~1~ ) . i-800-720-8221 • Fax 717-541-9943 • Shawn E. Carper, Supervisor DISCOYfR Eby Ikthod: l~ua1 iotat; s i~s,~ ~a ~z;~;~ Imp: 966991 R~r Code: ~Z OnII1e ~ CIG Coar; !(~TCfI M 281242 c~~ cry 11iYI( YOUR 51,395.00 Included 51,395.00 50.00 Included 50.00 ~~~ jo3~ MERCHANDISE X Register Book .$45.00 6~ Tax $2.70 $0.00 X Memorial Cards 100 @ $55.00 6~ Tax $3.30 $0.00 X Thank You Cards 2 @ $15.00 6$ Tax $0.90 $0.00 X Remembrance Package $110.00 6$ Tax $6.60 $116.60 Alternative Container X Cardboard Container Urn Burial Vault Container Veterans Flag Case Grave/Memorial Marker TOTAL MERCHANDISE $116. 6b CASH ADVANCED ITEMS Grave Opening Cemetery Equipment X Dillsburg Banner- No Charge X Harrisburg Patriot $176.42 Newspaper Notice Clergy Church/Sexton/Organist/Soloist Flowers X Crematory Charge Included X County Coroner Fee $25.00 X 10 Certified Copies of Death Certificate $60.00 X 5 additional Death Certificates $30.00 TOTAL CASH ADVANCED ITEMS $291.4 SUMMARY OF CHARGES Special Charges $1,395.00 Professional Services $0.00 Merchandise $0.00 Automotive Equipment $116.60 Cash Advanced Items $291.42 SUB TOTAL $1,803.02 CREDITS $0.00 AMOUNT PREPAID Date $0.00 TOTAL $1,803.02 AMOUNT PAID Date Dec 22, 2008 -$1,686.42 BALANCE DUE $116.60 THIS STATEMENT MAY NOT REFLECT ALL NEWSPAPER GHARGES Concept Taz Services 113 North Crawford Road Grantville, PA 17028 (717) 469-7574 Mabel Cox Apri107, 2009 130 Pine Street Dillsburg, PA 17019 Forms Amount Federal Federal 1040A $30.00 SSA 1099 1@ $5.00 N/C Schedule B 1099 Int's 2@ $5.00 $10.00 1099 Div's 6@ $5.00 $30.00 1099R 4na $5 00 $20.00 Sub-total Federal $90.00 State PA40 $15.00 PA Schedule SP $5.00 Sub-total State $20.00 Local Total N/A $110.00 Please make checks payable to Ed Shirk. Thank you Federal 1040 Payment Due $1,431.00 State PA 40 No Payment Due $0.00 Local No Payment / No Refund $0 0 ~~ 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Cox Family Trust Cynthia L. White 130 Pine Street Dillsburg, Pennsylvania 17019 Re: Estate of: Mabel Coac Account Number: 9846799386 Date of Death: December 20. ZOOS January S, 2009 Dear Madam: Per a memo from Cheryl F~hrman at M&T Bank, dated January 2, 2009, requesting at the time of death, the balance on the above referenced account(s) was: 1. Type of Aaount Checking Account Ao3mutt Number 9846799386 Otunership (Names o~ Cox Famt7y T3usly Crnantor* Cynthia L White, ?lrustee* Opening Date 7/28/08 Balance on Date of Death $10,454. I6 Aorrued Interest $ 0.00 Total -- -------------------------------- $10,454.I6 -------------------------------------------- * For tbrther account information, regarding ownership, closures and/or reimlwurseme~ of funds, etc., please contact the Dillsburg Office # 71?-432-2860. M 8s T Bank DOD Unit /Adjustment Services My Yorttolio Summary Page 1 of 1 ~arx~ecerox sa~w,.T.orr. • r.~r sets Portfolio Details As of December 19, EaseB Cox Total A&uets S 541,937.71 2008 Non-retirement Accounts Franldin Peanaylvania Tu-Free Leome Fand - Claas A ESSELL T COX OR MABEL G COX TRST THE COX FAM TR DTD 10J11/99 153 LOGAN RD DILLSBURG PA 170198501 Plane 71795-3702 541,937.71 Fund-Amount number 129- 12911878117 Aom~t type VoNarfary IrrdividrJoint Tenants Valve S21,5T4.23 NAV S9.OB Shams 2,376.016 YTD purdwses 10.00 YTD rodemplbns 90.00 Account cost bas's 525,501.70 Average cast per sham 510.73 ~~ November 24, 2004 Franklin Mosey Fond - Cbma A ESSELL T COX OR tiMBEL G COX TRST THE COX FAM TR DTD tOJ11l'99 153 LOGAN RD DILLSBURG PA 170199501 Phone 717395-3702 FurM-,M1ooouM number 111- 11118722599 Amount type Vohartary IndividlJciM Tenants Vatae 520,363.48 war s1.oo Sheens 20,366A90 YTD purchases 90.00 YTD rsdernptions 53.280.00 Aooorrrt oust !teals - Averapecost per sham - Opened or- Fmnldin Tampiebn Dis9ibulas, Inc One FranMin Parkway San IiAs6so. CA 8440301906 8001632-2301 NovemtMr 26, 1999 https://www.frainklintempleton.com/retailrsp app/portfolio/fae~ortfolio detail~rinter&... 12!22/2008 Account -Holdings -Positions rats t tLttutt (:UX - 58F006652 12/22/2008 10:09:08 Name of Il': EDWIN SHIRK Account Summary Values LMV: 58,323.21 Net Bal: 0.00 Total Equity: 58,323.21 SMV: 0.00 Cash Avail: 0.00 M11tII+': 5,645.09 Tec: 0.00 Tdy Fed Call: 0.00 PCF: 0.00 Real Time Positions -- - ~~ Q~~~Y Security BtiseNptios _ _ Po~tios _ Security Type Positlos Aceoeat Traes. Last Value Held Type Type 1 FCR MMFFCR __ 5,645 FEDERATED CAPITAL RESERVES 5,645.09 MONEY FUND C h 2 ENR 292668108 320 ENERGIZER HLDGS INC COM as _ 15,164.80 COMMON STOCK USD C h Long 100 0000000 3 EXC 30161N101 _ 257.5220 E3tELOWN CORP COM as 13,504.45 COMMON STOCK USD C h Long 4739 -- 4 GIS 370334104 44.1662 GENERAL Mti"t 4 INC COM as 2,558.11 COMMON STOCK USD C h _ Long g2 44 5 RAH 751028101 122 RALCORP HOLDIlVGS INC NEW COM as 6,963Jb COMMON STOCK USD C h Long 5792 as Long 57.08 b WL 971807102 853.7272 WII-MIIVGTON TRUST CORD 19,413.76 COMMON STOCK USD C h - as Long 22 74 ._ Ciaige - '/G Today's Today's Bid Ask `Volume Market Y•Gais Geis USDE Position FX hate ISIN Hargis House Value Cumney Overt3de Type Req. Sy /Dollar Per Stare 1 2 -1.20 -2.470 _ 2.470 -384 4728 47.40 95,556.00 NYSE _5,645.09 USD _ 1.00000 I 15,164.80 USD 1.00000 US29266R1086 Not Available Stand d N/A e 3 -027 -0 512 -0 512 -69 531 52 42 52 ar 30 Ye . . . . .4b 146,255.00 NYSE 13,504.45 USD 1.00000 US30161N1014 Standard 3(-g, 4 5 -1.08 -1.831 -1.831 X7.699 57.91 57.95 427,673.00 NYSE 2,558.11 USD 1.00000 US3703341046 Standard 30% -0.17 -0297 -0297 -20.74 57.01 57.10 74,743.00 NYSE 6,963.76 USD 1.00000 US75102810I4 Standard 30•~ b -023 -1.001 -1 001 -196 357 22 69 22 74 . . . . 36,975.00 NYSE 19,413.76 USD 1.00000 US9718071023 St d d • an ar 3p /a Hoagie _ _... _ _ .. - -- - - - Rs4 S -- - - . 1 2 4,664.64 ---~- _ 3 4,07220 __ _ 4 781.74 5 2,09535 _ _ b 5,883.03 All Market Value calculations exclude open/unsettled FX trades. Real-Time price for domestic securities -stocks and options.Others are as of the previous trading day. 7hit reports a service at>o year Ltvmtesrt Praf~ooal, sat a suhatitae far stasesest 71ia repot men erormttioa aom aoraaea that r~ acoa~ arue~ and cadomaliotw. 'ILis repot is ptapated a ofttade date tauter thm seglemaa date sod 6a ao~aet Ltteatomt Ptatniosal. P°~°a befieva ro he toGabk bra Pastrm6 eaoeot auarmtee the soass~y ofihia io€etealioa ar the ~S' P~P~ed w a didermt date than yam O LOOS NUEacYsae Ro. Aa aiyas arxrved. ~r afthrx aoaee: tf yna 8dd ~ ®this nepott, Werra Page 1 St Send myukes to: soon ~a,~e ~ PO eox 40 MecheniCSbu~, PA 17065 www.msmborslaK.orp Yaln s~rna,ao.ra: (900) 2s3-232s ez c.~r~: (71'n ss~-4372 or (900) 283,a3rz TDD: (717) 697-6312 a (800) 286-2329 ata. 5312 ® TeleBranch: (804` 23?-7289 MEMBERS 1st . FEDERAL CREDIT UNION 7323 1 AV 0.324 7323-7323 * ~ 1~-.I{I...III....I~I~~I~I~~il~~~~~ll~l~~lf~~~lll~~~~l~l~i~l~~l ~~ COX FAMILY TRUST .. C/O MABEL G COX Nib 405 RESERVOIR RD ~ MECHANICSBURG PA 17055-6147 o~ *, Statement of Accounts Sep 25, 2008 thru Dec 24, 2008 Account Number: 205793 Balances at a Glance Checking : 0.00 Savings : 25.00 Certificates : 12,556.15 Loans: 0.00 Money Management: 0.00 Swipe 5 YTD Re+uvard : 0.00 Page : 1 of 1 Your aggregate balance as of December 1st is $12,581.15. An aggregate balance of 62,500 and having 3 products --- -- - _-- ._-- _--- _. __--- -_~e[tll glade you.ir~the Silv_~r IVlILR; level. _.__-- 1099-INTs are not included in this statement. !f you earned at least $1i0 in dividends on your account for 2008, you will receive your 1099-1NT in a separate mailin in early January 2009. 1099-INT information will also be avai~able on Members 1st.Online in early January. SAVINGS ACCOUNTS 00 -REGULAR SAYINGS Date Tranae~ort Description Additions Subtr,~ctions Be~,rxe Sep 25 6~nce Fonr~ard 25. i10 alas 24 9 6ral~nrae 25.00 CERTIFICATE ACCOUNTS. 40 -12 MONTH CERTIFICATE fVlaturrty Date -Jun 03, 2009 D~ete Trar>sacibn Desexbfjort Adt~tions Subtra~Ction s Balar~e Sep 25 ~nrae Fnv>w~rd 12 , 472.94° 3o)M Owner:. DAVID COX Sep 30 Deposit Dividend 2.670%0 27.37 '12,500.31 _ ____ - ...., yv -..-~~d<~ ~.^.:w -.~...a~rnc.. ~,.+-,q.. ne~n.e/p .,~~ec ~ f~/J~(''~I~ _- vVIY . v.• vV. v • ~ -.._...... .. _ -.._.-_. __.__.. ~ ^ Oct 31 Deposit Dividend 2:67096 28.35 12,528.66 Anr>~l Pert:ertfsgie 'Y~erid Famed 2.TlXrJlb fipm 70/0f12gA8 >O/31/2010i9 Nov 30 Deposit D'nridend-2.670% 27.49 12,556.:15.. A~ PlerrxArJ~e Yid Famed 2.7~JI0% firvn 11f©t/2gAB ~ 11!30/ZnIQB alac 24 F 6fa~ixae 12,566.15 YTD SUMMARIES TOTAL DNIDENDS PAID 00 REGULAR SAVINGS 0.00- 40 12 MONTH CERTIFICATE 375.58 Total Year To Date Dividends Paid 375.58 NOTE: Total includes closed shares Vatiet_>E'eus`.: ;:.;;:ilia»»»>< _>>>><<;",' ;1~. ~r Seru~ice C~ :.: laltos 1,?r~ve, HlaennlE+etsEvv>st, PA 17t?~f ~e 7'17` 564=3i&62 ::.... ,..;:::; iedwater.co ;:::::.. ;;::: s a H l~ a~ C] mar Apr Nlay Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Next meter reading date: on or about 03/26/2009 SERVICE T0: ESSELL T COX BILL SERVICE ADDRESS: 405 RESERVOIR RD MECHANICSBUR6 PA 68281260 02/24/09 03/24/09 28 0015 0031 16 MGL ACTUAL EQU/YALENT 7p 16,000 GALLONS SERVICE CHARGES $8150 WATER CHARGES $76.64 W-DSIC SURCHARGE $3.35 W-STAB SURCHARGE 0.17 CR TOTAL CURRENT CHARGES $gg,32 SEE REVERSE SIDE FOR IMPORTANT ACCOUNT INFORMATION 8.81 8.81CI 0.00 $88.32 you would like to pay your bill online, please visit our website at www.unitedwater.com and click on the Western Union's Speedpay icon. UWPA WILL CONDUCT ASEMI-ANNUAL FLUSHING ~' THE DISTRIBUTION SYSTEM IN YOUR AREA FROM APRIL 1ST THROUGH END OF JUNE. THIS MAY CAUSE TEMPORARY DISCOLORATION OF WATER AND TEMPORARY DECREASED WATER PRESSURE. FOR HYDRANT FLUSHING UPDATES, PLEASE CALL 717-564-3662. Approximate state tax included on this bill $4.25. ^cT~CH HERE AND RETURN THE BOTTOM PORTION WITH YOUR PAYMENT IN THE RETURN ENVELOPE PROVIDED. 1~0/MMROl pi~129[ Billing Date: Account Number: 03/25/09 00200999527689 Previous Balance Payments Through 03/25/09 rne~k ra, Balance Forward Current Charges Due 04!14/2009 I ~F o e /////// 2058 STATE RD. CAMP HILL PA 17011 717-761-0660 Fax 717-761-6428 SOLD TO: STEPHENSON'S EQUIPMENT 7201 PAXTON ST HARRISBURG, PA 17111 ~~~~~~~~~{~~~~r{~~~'~~~r~~ Ship Ticket 2a t1:~8L7/W1 Siia1D3T.i ORDER OATS ORDER M1hHfR 02/26/09 S1154037.001 f~ ~ OROER T0: PAGE H0. ~ ~ t~ j R. P. FAGER CO. ~ f 2058 STATE RD. CAMP BILL PA 17011 1 CiL91N 717-761-0660 FHX 717-761-6428 SHIP T0: STEPHENSON'S EQUIPMENT ?201 PAXTON ST HARRISBURG, PA 17111 CUSTOMER NUlBER CUSTQER PO ti1R8ER JOB NAME / RELEASE NUHBER ORDERED BY 2452 WHITE GLENN WIITER SHIP VIA YWtEt1OUSE SHIP DATE MITCH SHIMP PICK UP COUNTER Sh CMP Prc CMP 02/26/09 OROEIt QTY SHIP QTY DESCRIPTION Dnit Price Extension lpk lpk _ LENOX 20580 RECIP BLADE 8X10TH 14.000 pk 14.00 5/PK lpk lpk r LENOX 20564 RECIP BLADE 6X14TH 11.070/pk 11.07 5/PK loft loft 5366M10 PIPE PVC S40 1-1/2" X 10' 0.405/ft 4.05 tea tea 5145M2 PVC DWV 45 1-1/2 0.679/ea 1.36 Sea Sea r 5110M2 PVC DWV COUP 1-1/2 0.341/ea 1.02 ***** ******** ** ***** Credit Card Information **** *********** ******* * * Mer hart ID# 34270640882 TimeEST/Date: 1:49:06 26 EB 2009 * Car Number XXXXX3678 Card Type: DS * Car Holder ITE/GLENN E Auth Code: 026 80 * Cha ge Amoun 31.50 Charge Date: 0 /26/2009 * * * Si ature * * * I a ree to p y ove total amount according to car ' issuer agr ement.* ********** ORDER SUMMARY ********* Total Sales for Order 31.5 Payments to Date -31.5 Balance 0.0 ********************************** 02/26/09 31.50 Credit Card G * Applicable taxes extra 3ubtOt~a1 31.50 * Shipping and Handling charges may apply SSeH CI~GS 0.00 * Special order items are non-returnable. Sales R~ax 0.00 Amt Paid -31..50 Amount Dlue 0.0 0 a ~F. ~~~ ~~~~,~~ 3901 DERRY ST. HARRISBURG PA 17111 717-564-i166 Fax 717-564-6056 SOLD T0: STEPHENSON'S EQUIPMENT 7201 PAXTON ST HARRISBURG, PA 17111 ~~~~~~~~~~{~~®~~~~~~~~~~~~~ Ship Ticket 300cn3/t7 1T~YD4 P1A 81,6437,., ORDER GATE ORDER Nu~ER } 03/17/09 S1164371.001 n ~ J ~ ORDER T0: PAGE NO. b, ! J} ~ R. P. PAG&R CO. T , y 3901 DERRY ST. RARRZSSDRG PA 17111 1 717-564-1166 Fax 717-564-6056 SHIP T0: STEPHENSON'S EQUIPMENT 7201 PAXTON ST HARRISBURG, PA 17111 CUSTOMER NUMBER CUSTOMER PO NUMBER JOB NAME / RELEASE NUMBER ORDERED BY 2452 none MItITFR SHIP VIA MAREFiOUSE SHIP DATE TODD BEHNEY PICK UP COUNTER 5h HBG Prc HBG 03f17/09 ORDER QTY SHIP CITY DESCRIPTION Unit Price Extension lea lea r FLUIDMASTER 400A ANTI SIPHON 7.182 ea 7.18 BALLCOCK ********** ORDER SUNIIKARY ********* . Total Sales for Order .7.1 Payments to Date ~ -7.1 Balance 0.0 03/17/09 7.18 Cash ' Applicable taxes extra S'l7btOt~1. 7 .18 ' Shipping and Handling charges may apply S&H CHCs3 0.00 ~ Special order items are non-returnable. $81e8 TSX 0.00 Amt Paid -7.18 Amouat DTae 0.0 0 ~.. THE HOME DEPOT #4113 4200 MERRY ST HARRISBURG, PA 17111 ° YOUR SWATARA HOME DEPOT:717-558-8105 4113 00004 71029 02/23/09 D ~;~ SALE 11 CHAlAO 03:52 PM - ~~ LOME'S HONE CENTERS, INC. .~~~~ - 5500 CARLISLE PIKE `~~~ MECHANICSBUR6, PA 17050 ~`` ® (717)610-9230 -SALE- SRLES #: S2223EY1 664472 02-26-09 021709009149 CITRUS CLNR <A> 10.49 764666103702 21/2CSDWSC11t <A> 210155 TAPCO 3" NONOPOST 7'0"-7" 87.76 2Q14.37 8.74 2 i! 43.88 885911108652 T25 2°TORX <A> 2.9g 23832 2"X10'PVC SCH40 PIPE SOLI 4.18 764666564589 TAN 5# SCREW <A> 28.24 051411205119 ROMEX CONN. <A> 17203 tlAll TIE 100PER 228A BALV 12.58 21.54 3.08 1467 4X4%10 p2 .40 ACO TREATED 11.97 764666177925 3-1/2PDKNL5# <A> 13.62 46905 2%4X8 ACQ TOP CHOICE TREA 23.03 SUBTOTAL 67.16 7 Q 3 29 SALES TAX 4.03 TOTAL $71.19 23902 2" SCH40 COUPLINB 429020 1.74 XXXXXXXXXXXX3678 DISCOVER 71.19 2 i! p,87 AUTH CODE 023398/1045814 TA 11818 YEATHER ROOF CEMENT (TUBE 18.12 . .. 6 @ 3.02 ' X2522 ROLL ALUM FLASHINB 14"X50 30.75 ii 23338 2" PVC 45 ELBOY 321 1000 2.64 ~II~f~~I~ ~I~~~ I~~~~~~~I~~~~~ 2 it 1.32 4113 04 029 /23/2009 2637 SUBTOTAL: 192.77 RETURN POLICY DEFINITIONS TAX: 11.57 INVOICE 02221 TOTRL: 204.34 POLICY ID DAYS POLICY EXPIRES ON A 1 90 05/24/2009 BRLANCE DUE: 204.34 THE HOME DEPOT RESERVES THE RIGHT TO LIMIT / DENY RETURNS. PLEASE SEE THE RETURN POLICY SIGN IN STORES FOR DISC: 204.34 DETAILS. GUARANTEED LOW PRICES DISC XXXXXXXXXXXX3678 026237 LOOK FOR THOUSANDS OF LOWER PRICES STOREWIDE AMOUNT: 204.34 *~txxxs~*x~zxx*xxx~t:x*x:se***~r:x~r~r~txxxxx ~~~ ENTER FOR A CH oNOCE TO WIN A $5,0 HOME DEPOT G I FT 2223 TERMINAL: 02 02/26/09 09:44:39 CARD! Share Yam Opinion With Us! Complete # OF ITEMS PURCHASED: 2~ the brief survey about your store vi si t EXCLUDES FEES, Si:RUICES AMD SPECIAL ORDER ITEMS and enter for a chance to win at: www. hapedepot. cap/opinion ~~~~~~~~~~~~~~'~~~~~'~~~~ iPARTICIPE EN UNA OPORTUNIDAD DE GANAR • UNA TARJETA DE THANK YOU REGAL O DE T HD FOR SHOPPINB LOYE'S ~ DE $5,000! i Comparta Su Opi M brl! Complete 1 a breve RECEIPT REQUIRED FOR CASH REFUND. encuesta stbre su vi si to a 1 a ti ends y CHECK PUIlCCIMISE REFUNDS REQUIRE tangs 1 a opa'tunl dad de ganar en: 15 DAY YAIT PERIOD FOR CASH BACK. WWW . h0lNedepOt .cap/opi n1 on STORE MBR: JIM DUNKELBERBER User I D : HAVE A COMMENT OR FEEDBACK? LET US KNOH AT: 146460 142351 1ANI,LQMIES.COM/FEEDBACK Password : STORE CODE: 22130-22609-02221 9123 142347 __,- .~. CremO~ s 'CllEMOS- COM (111) 691-3361 02/26%2009 1U:54AM 0001 o0ooaof~3~~ 46 2 p X8.50 t ARP i tiUtwEE ~ ~ $17.00 ~$4.00 :~~:~~, ~ HAND 1001 $21 00 NOSE S1 du~se2 $1.26 1 Alt1 hod: S CNARuE1 X22- 26 ~265~2 thank Y°" 30 Day MarrantY 22.26 Save Receipt Mrrlc~vc:V C„=.lu~~,- Copv ~. d~E LOME'5 HONE CEN)I:RS. INC. 850 EAST HIBF STREET CARLISLE, Pf 17013 (717)258-1; tro -SALE-~ SALES It: S1710V8'1 1203109 02-27-09 260402 KOBALT 12" BRICK 11t0YEl - 19.98 SUBTOTAL: 19.98 TAx: 1.20 INVOICE 14210 TOTAL: 21.18 BRLRNCE DUE: 21.18 DIS[; 21.18 DISC XXXXXXXXXXXX387f 027104 - AMOUNT: 1'.18 ~~ ~ v 1710 TERMINAL: 14 OZ/177'09 20:07:48 ~ 01= ITEMS PURI:HASED: 1 EXCLUDES FEES, SERVICES ANt SPECIAL ORDER I1ENS i1NNIK Y[ll FOR S110PPIN8 t.OitE `S RECEIPT REQUIRED FOF CASH REFUND. - CHECK PURCHASE REFLtN>,S REQUIRE 15 DAY YAIT PERIOD FIIR CASH BACK. STORE MBR: RICK CROSS HAVE A COFRIENT OR FEEDBA[1;i LET US KNOY AT: MMMI . LOMES ~COM/F~EDBACf( STORE CODE: 17100-•22709-14210 YOUR DPQNI011: COUNT! RE8[STER TO VIN A S250t LOYE'S GIFT CARD iREBISTRESE PiNlA tsY1NAR UMA T1IRJETA lIf RE81N.O LOYE'S REGISTER ONLINE OR BY PHONE BY COMPLETING A GUEST SATISFACTION SURVEY ANYTIME DURING THE NEXT 3 DAYS: httv:i/~ebuiew4.isecorv.co~/loges ,_n,~_~e,_n~ca ~_ CARLISLE CEMENT PRODUC 510 E. NORTH ST CARLISLE, PA 17013 02J28J2009 07:38:41 Merchant ID: 000000001004&!7 Terminal ID: 01455990 601103003198797 CREDTf CARD DI5CVR SALE CARD ~ XXXXXXXX>Ci(XX3678 INVOICE 0001 Batch #: 000253 Approval Code: 028909 Entry Method: Swiped Approved: Online SALE AMOUNT $19,08 CUSTOMER COPY :nt Products, Inc. 17 Transaction #: Account #: Page: Date: Time: Cashier: Register #: Ship To: Store Customer Invoice 76775 0 3of3 2/28/2009 7:38:11 AM KEITH 1 Quantify Price _ _ :Extended. 16 60 $0.86 $51.60 ASON MIX 80LB 4 $5.75 $23.00 Thank you for shopping Carlisle Cement Products, Inc. Please come again! Sub Total $74.60 Sales Tax $4.48 Total $79.08 Credit Tendered $79.08 Changed Due $0.00 ,._,_ __ ~; '~% I + ~.. i ~'~" ] i? - - fa~E " ® ~ t r ,_ f 7 y ~ l~il -~f L~~ ~~'" . J ~ , ' j sfl rM ~~ ;?P~'~ cs~,,y 1" :s !~. ti/ . ~ ~~E - (/\ j I rt ~;~•~~~ t~}~r-,,'•1 t•~ +' ~ l~ ] } I~Ci~`i~~ ~~i~~~ _ _ . . . . l~ ~f~Ry~ ~i~~""~1tT ~.G `~~•3 "' _` ~` P~a~-^' ..~i.~ =er,rr ~atrij!a f _~~ Ir .., .~ I i V ~..~ - -- - _ ~1 ~£ ~.E~~.j~~ :., tiM ~~~ ~ ~; ._ VV ~ li e A ~`~~1 ## 11[aj~ t 4~~~i,ia~ 6 ^~ ' ~~ pCEil~~ r - rr:+ i; sii? ~`~ ~ 4 4a~7t'ip fi ZE< ` ~ ~ .. ~5~.':iQlt~ ~".C+11r` L ~ t~, .:ENS. _ '- -. 7 Ei! - ~~- , ii( ~~'~ age LL 'L. zi. r' tfli'yi~.. .:~.~ ivF.."a u ~U ~y.. ...~ %~i~' 4~a~1.&Ie~~EUti± $i?~ ~': E,~ ~4 '~ ;;' ~~1 i? ?5.:~?e`. ~" ~ ~~ .. 1f~:~~~Y Y. ~ ti?S 1 (7~ ~ ti/ ` ~-._~ ,_ ..__._._... _..__.. ~._~~ r-..__.,_..-_-._._--,--_---._ .. _-_.~-~-__._~.~_.... _.,.._`._-.~-_.. _ /`^, ._~~ ,_ __ BRAVG 1C~t_ DRIVE 451 JP eiARRISBUR6r PA 17111 BATCH: 12b S-A-I-E-S D-R-A-f-T ` t '- 181K932 352385281713 REF: 22~i Reference #: ~, ° ,, ;„ `.i. CD TYPE: DISCOVER " TR TYPE: PURCHASE DATE: FEB 23. 89 15:23:84 Cust #: Order Date: Gust P.O. #: Page Ship to#: ,. $126.94 TOTAL `~' ; "'t~ ;' ~i°, a ~ ~" Bill To: ACCT : 3678 EXP: fiJti anch ' " Branch #: _. ~: 8Z335b i. <~~J~l ~stx .., 11X1 . ai,. 11;. ri` NAME: GLENN E VAIITE >; ~ t :. ~ ~ . '; ~ . Salespersgn: Taken By: CAADMEMBER ACKNOifi.ED6E5 IrFCEIPT OF GOODS ~ }~ ,,q }u } ~ 1 ~ a }~ , , ; ; ' AND/OR SERVICES IH TIIE pMDUHi OF TIRi ~ y ~ - 10TAL "!~1?~ NEI~BN iMq AGREES TD PERFORM i f , _ , ~b~ 4~S ; ~ , ~ :;'i ~ ~" ~ ; ~1 ~ ~ ~' Ship To• • ?HE i1B~16ATIOHS SET FORTH BY TIIE tractions. Ship via. ,aR'rMEM@E~'S A6REEMEHT iUTH TIN: ISSIIEk • ,~ ,.. w.'..... ! .,~~, ~y ~- Ship bate: P'omise Date: CUS10lER COPY Une # Bin:_ Product and Description .. Quantity Quantity Quantity ~ ~ anount Location Ordered Picked Shipped ~ ~ pe ."~i'.!~11''i.~ .~ p,_~ri,__ ...L~1_' },t}~} .... i'i'u. _~.-7ai' r}{t. .., `Y'~1 .~.' ~ i _.. .. °~ } d ~. b i Q V ti c ~ 1. i • A S w w.yF ''(( jL_". i:V~~iS it~ysl ~ w, ~.~tGl ~~ ~~ f1 1 ~~ . itJ Driver: Checked By: HazMat Totai VYt• Rec ed t3y: j r , [rr ~ ,.! THiS ORDER IS'SUBJECT TO THE TERMS AND GONDITIO S Date Receive ON .FACE AND REVERSE SIDE OF THiS YARD TICKET r-•; r~-rr~nni~r~ rnpv A. v~.«av...v... ., ~._____. SETTLEMENT STATEMEN t _ L SETTLEMENT CHARGES PAID FROM PAID FROM 700. TOTAL SALES/BROItER'S COMMISSION broad en 1 800.00 7.000 =11 536.00 BORROVVER'S SEDERS ' Of FUNDS AT FUNDS AT t. 6 817.00 1 SET'REMENT tiETTIEMENT ~ 919.00 Rana Prahaionab nt 11538.00 175.88 . lfEMS PAYABLE IN CONNECTION YYITH LOAN ' F % ' Fae Ytllearlt nid ..C. 5.00 F Bad= Fee Badt: 1 . Tax F T Ban 6 LR T3.OD T eaan 6 LR T Bqn b LR 22.50 6t0 Price T Ban 3 LR 11. 900. KEYS REQUIRED BY LENDER TO ~ PAID 9i Fran 03RA12009 04!01 17 8 1 . H d In 1 .O.C. 163.00 901. 1000. RE S DEPOSRED FOR 1.H 1 1 .Cif Tax 1 . Cou Tax 1&23 1 t 151.64 .00 f 100. TITLE CHAR t1 t. 1 t a 11 tt . T10e' 11 tat 1 tt Tina L. 23' m ~• tt . 11 T' North Mardaln 1 No: 1101.1 tt 131 ttt . 1 •11 1t t. End 1 North LP. 1 711 -- _ ...,, 11 ~ 1200.OOVERNMENTREC0RDING AND TRAtl6FER t t. 48.50 72.50 121.00 t 1 .00 1 t T 1 t . t 1300. ADDtTiONAL CHARGES t . -vr Fee Natll LP. 20.00 t 35.00 t 20.00 1 F Maltrdain 5.00 1 . T t ~•~ 1306. T YarOn A. Y 73 1 . TemYte T Pawn hIC. '~ t AINn T 8aawr 112.00 1400.70TAL C 548.05 1 laic ~r.Anon a swee lwa eeLer Ta W P Trva wAwv+u:noAwemrwowMa.rwurtswasrATar~arrtsmnt nr~raawr Warr. raw.wrrasr,.m..+aer unnxosrw~asarnesaeiwreeaa~~ArA~ParLLPelNL7a9r11P0=f.ONVICrIOM YPUmnn lrrwaawtlv attn. r rewrsaruwwaat Ga INCUIOE A Pala Naf a1P'Ibada@/T. Fd10ETlele eeE !Titre 1t ue. coos aECmu imr Axo a~Tiox Iola _ ~~..~ ~, G`•. a~~9 February 11, 2009 Cynthia White (The Cox Family Trust) 130 Pine Street Dillsburg PA 17019 Dear Cynthia; Congratulations and thank you for a{kywing us to market and sell your home. During any part of the process, please do not hesitate to call us should you need anything at all. For your records, here is a complete copy of your contract. Furthermore, a summary of the contract follows: Sales Price: 1164,800.00 Under contract date: 2R/2009-Saturday Sellers assistance: ;0.00 Settlement date: 3124!2009--Tuesday Contingency dead-lines: Buyers mortgage application Insurance contingency Property inspection Wood infestation inspection Buyers mortgage commitment Z/17/09--Tuesday 2122109--Sunday Z/27J09-Sunday 2!22/09--Sunday 3H7/09-Tuesday ff you provided an email address to us, please monitor your mail at least once a day to ensure proper communication. However, we will certainly advise you on important issues via voice communication as well. Again, please accept our thank you for your business and please don't hesitate to call should you need anything. Gary Byers RFJMAX 1st Advantage ~'; 6375 Mercury Drive, Suite 101 Ar Mechanicsburg PA 17050 i Main - 717+691.6666x7734 Falx - 717.691-T273 gbyen>~so~rfastneasy.com http:!/my1 dvantage.com -P~ ~,~ ~ nvcn ~ --~- a~'~~ Rev sas ex (ors) 3 4 6 0 0 0 9101 ESTATE INFORMATION SHEET piennsylvariia FOR REGISTER'S OFFICE USE ONLY pEPl1RTNENT OF NEVENVE County Code Year File Number DECEDENT INFORMATION: El~ter data as it will appear on aU r'~ V (~ ~~ documerNs submitted to the Department ~ t v Decedent's Social Security Number Date of Death Date of Birth 222-18-9228 12/20/2009 08/30/1925 Last Name Suffix First Name MI Cox Mabel G TYPE FILING: Fill in oval to indicate the nature of the return to be filed with the departmerK. CsD Probate Retum O Joint Assets Only ONon-probate Assets Only O Litigation Purposes (ra other assets) LETTERS GRANTED: Fill in oval to indicate the nature of the praaeedings at the Register of Wills Office. (Attach additional sheets if explanatlon is necessary.) m Testamentary O Administration O No Letters O Other (Please Fxplain.) ATTORNEY/CORRESPONDENT INFORMATION: Enter all irformation for the attorney or indivrduai tp restive tax information and wrrespondence. last Name Suffix First Name MI White Cynthia ' L Supreme Court I.D. # Telephone Number Attorney/ Correspondent's a-mail address: (717) 432-3183 N ' First Line of Address ~' ~-' ; }, 130 Pine Street r~~ rn- .,-.. {'-- °_~ ' ~; rn r :; Second Line of Address + ~ ~ ~ Cpl r _ , ~ `. City or Post Office State ZIP Code c ' =~~ ! a , .' ~t Dillsburg PA 17019-9406 ~ c--s c:rt~ ~;-~ w PERSONAL REPRESENTATIVE INFORMATION: Enter all information for the personal representative(s) of the estate authorized by the Register of Wills. Executor/Administrator Social Security Number Telephone Number 202-46-6395 (717) 432-3183 Last Name Suffix First Name MI White Cynthia L First Line of Address 130 Pine Street OFFICIAL USE ONLY Second Line of Address TRANSACTION COUNT City or Post Office State ZIP Code Dillsburg PA 17019-9406 Complete general estate iMorrnatiion questions and indicate additional personal representatives on reverse side. PLEASE USE ORIGINAL FORM ONLY Side i 3460009101 3460009101 J REV-346 EX (03.09) Decedent's Name: Mabel C3. COX Co-Executor/Administrator Social Security Number Last Name First Line of Address Second Line of Address City or Post Office Telephone Number 3460009201 Suffix First Name State ZIP Code MI Co-ibcecutor/Administrator Social Security Number Telephone Number Last Name Suffix First Name MI First Line of Address Second Line of Address City or Post Office State ZIP Code General Instructions: This form should be filed with the Register of Wills of the county of which file decedent was a resident at death. Please be aware the correspondent identified will receive all correspondence from the department. It is the responsibility of the personal representative to notify the department if the wrrespondent contact information changes. The department is authorized by law, 42 U.S.C. §405 (c)(2)(C)(i), to require disclosure of Social Security numbers in connection with administering state tax laws. The department uses the Social Security number to identify the decedent and personal repre- sentatives of the estate. The commonwealth may also use the information in exchange-of-tax-information agreements with fed- eral and local taxing authorities. State law prohibits commonwealth personnel from disclosing wnfidential tax information except for official purposes. Decedent's Sodal Security Number 222-18-9228 Side 2 L 3460009201 3460009201 ~„J