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Home My WebLink About10-14-10 (2) i 15056101D1 EM (oi-tio) ~~~ ~~~ ~ ~ V V OFFICIAL USE OlIL Y PA Department of Revs>"rtue Pennsylvanta ""~"`"~°~"`~`"°` County Code Year Ffie Number Bureata of Individual T~ixes PO BOX28D6oi INHERITANCE TAX RETURN Z j ~ . 0 ©O 20(0 Harrisbu PA i u o6oi RESIDENT DECEDENT ENTER DECEDENT INFORMATION ELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 201-18-2770 ! 01/29/2010 ': 07/04/1926 _.. Decedent's last Name Suffix Decedent's First Name MI Hom Janet G (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 WI H 'SHE __ _ REGISTER OF WILLS FILL IN APiPROPRiATE OVALS BELOW ~ 1. Original Retum O 2. Supplemental Retum O 3. Remainder Re~um (date of death prior to 12- 3-~2) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal E te',Tax Retum Required dealFs after 12-12-82) O 6. Decedent Died Testate O 7, Decedent Maintained a Living Trust ~ 8. Total Num er of Safe Deposit Boxes (Attach Copy of III) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credft (date of death O 11. Election to x ' nder Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach . O CORRESPONDENT - THIS SECTION MUST BE CDMPLETED. ALL CORRESPONDENCE AND CDNflDENTiAL TAX INFDRMATiDN LD DIRECTED TD: Name Daytlme Telepho tuber Mark W. Alishouse, Esq. (717) 582-40 6 r,,, __ _ _ _ _ _ _ _ _ _ -o _... REGISTE LLS USE LY ' C7 -~ - First line of address t-' _ 4833 Spring Road ~' -~ Second line of address .. _ C > T 3 - . -Fi ~ -- State ZIP Code P t Off Cit - E ILED ice y or os Shermans Dale PA 17090 Correspondent's e-mail address:: mark CI COmCa3t.net Under peneMies of perjury, I declare that I have examined this Blum, including accompanying schedules and statements, and to the be d r}ry knowledge and belief, it is true, coned and compote. DedaBtfon of preparer other then the personal representative is based on all Information of which pro rer! has any knowledge. ATURE OF PERSON RESPON tBLE FOR FILING RETURN DATE . ~ ADDRESS 167 Overcash Road, Chambersburg, PA 17202 SIG AT E OF ER REPRESENTATIVE TE RESS 833 Spring Road, She ns Dale, PA 17090 PLEASE USE ORIGINAL FORM ONLY Side 1 15D5610101 1505610 107 t! ~3 _ r.~ ~? ~p ~ :.`7 ~C~ ;~ r~ --~ ~ J REV-1500 EX Name: 1505610105 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 125,000.00 2. Stocks and Bonds (Schedule B) 2. 2 078.39 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. __ 0.00 __ 4. 9a9 ( ) ........................... Mort es and Notes Receivable Schedule D 4. ~~'~ 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. ~ 26,$57.39 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property L I 0 00 ' (Schedule G) O Separate Billing Requested........ 7. ~ . , 8. Total Gross Assets (total Lines 1 through 7) ............................. i 8. I 153,935.78 9. Funeral enses and Admirnstrstive Costs Schedule H ............ Exp ~ ( ) ....... 9. 33,904.99' 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ....... ....... 10. ~ 9,491.53 11. Total Deductions (total Lines 9 and 10) .......................... ....... 11. j 43,396.52 12. Net Valus ~ Estats (Line S minus Line 11) ....................... ....... 12. I 110,539.26 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ~ an election to tax has not been made (Schedule J) ................. ....... 13. , 0.00 14. Nst Value Subject to Tax (Line 12 minus Line 13) ................. ....... 14. 110,538.26 ',; TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 _ 0 00 ' ~ 00 0 (a)(1.2} x .0_ . : 15. ' I . __ 16. Amount of Line 14 taxable _. at lineal rate X .0 110,539.26 16, 4,974.27 17. Amount of Line 14 taxable 0 00 ' 0 00 at sibling rate X .12 . 17. . 18. Amount of Line 14 taxable 0 00 - _ ' _ 0 00 at collateral rate X .15 . 18. . _ ... 19. TAX DUE ........................ ... ........................... 19. 4,974.27 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Decedent's Social Security Number 201-18-270 Side 2 1505610105 1505610105 J REV-1500 EX Page 3 []ar-erlent'A Cemelete Address: Flle Number DEC ENTS NAME Janet G. Hom i STREET ADDRESS 38 Hom Road ~ITy Shippensburg STATE PA ZIP 17257 Tax Payments and Credits: 1. Tax Due {Page 2, Line 19) (1) 4,974.27 2. CreditslPayments 900.00 2 , A. Prior Payments B. Discount 145.00 Total Credits (A + B) (2) 3,045.00 3. Interest (3) 0.00 4. if Line 2 is greater than Line 1 + Line 3, enter the didference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1,929.27 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPR(~P~tIATE BLOCKS 1. Did decedent make a transfer and: es No a. retain the use or income of the property transferred :.......................................................................................... b. retain the right to designate who shall use the property transferred ar its incorr-e : ............................................ c. retain a reversionary interest; or .......................................................................................................................... 0 d. receive the promise for life of either payments, benefits or care? ...................................................................... 2. If death occurred after Dec. 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? .............. 0 4. Did decedent own an indivxual retirement account, annuity or other non-probate property, which contains a beneficary designation? ........................................................................................................................ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE T ASS PART OF THE RETURN. For dates of death on or after Juty 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or fo the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of he surviving spouse is 0 percent [72 P.S. §9116 (a) {1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory require emts 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 21 years of age or younger at death to or f the use of a natural parent, an adoptive parent or a stepparent of the child is 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 .5 I percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116 a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ {t1-08) Pennsylvania SCHEDULE A ~ DEPARTMENT Of REVENUE REAL ESTATE I INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE N MBER Janet G. Hom 21-1?~- 0206 Ali real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defin a~ 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 k o wl ge of the relevant facts. Rea{ property that is joirrtty-a~rned with right of survivorship moat be discbsed en Schedule F . Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common, i I VALUE AT DATE OF DEATH NUMBER ' DESCRIPTION 1• 38 Hom Road, North Newton Township, Cumberland County, Shippensburg, PA 17257 - ! 125,000.00 appraised value I TOTAL (Also enter on Line 1, Recapitulation.) 125,000.00 If more space is needed, insert additional sheets of the same size. ~I REV-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT scN~du~ s STOCKS 8~ BONDS ~ __ ESTATE OF _ I, F14E NUMBIrR Janet G. Hom ' 21-12-0206 REV-1508 EX+ {6-99) scNEOU~ E BANK DEPOSRS, & MISC. CASH COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN , PERSONAL PROPERTY ', RESIDENT DECEDENT ESTATE OF FILE NUMBER Janet G. Hom I 21-12-0206 Indude the proceeds of litigation and the date the proceeds were received by the estate. All property jolntty-Dammed with right of aurvivonhlp must be dbclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. FS~M Trust checking account # 33-04957 4, 765.53 2. Adams County Electric Cooperative, Inc. -account # 41623350 -patronage capital aaount 535.07 3. Cumberland Valley Memorial Gardens - Cemetery Pbts (2) 2, 590.00 4. Warren Township Burial Assodation, Mercersburg, PA -check # 455 ($622) and check # 450 ($626) 1,246.00 5. PA Treasury -property tax rebate 250.00 6. CenturyLink, Inc. -customer refund 34.85 7. Conseco Life Insurance -premium refund 21.73 8. Federal Empbyee's Group Life Insurance -claim number 20100100118 4,527.93 9. Cash from sale of com shelter $5Q trailer $100, com grinder $50, plows $100, and suitcase w/books $1 00 400.00 10. Cash from sale of riding lawn mower 650.00 11. Martin check # 1947 - sale of John Deere 1010 Tractor 1, 000.00 12. Newcomer check # 511- sale of riding lawn mower 500.00 13. Washington dreck # 2064 -sale of antique dresser and cement flower planter I 225.00 14. Ride Foreman, Auctioneer -proceeds from two auctions at decedent's residence 9, 317.00 15. 2009 federal income tax refund '~ 436.00 16. State Farm -refund of homeowner's insurance premium I 356.28 TOTAL (Also enter on line 5, Recapitulation) 26,857.39 (If more space is needed, insert additional sheets of the same size} _. ._ _..____ _.. __ _...~_ _ _ ..__ T REV-].511 EX+ (10-09) ~ pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND ~ ~, INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT . ESTATE OF FILE N M ~R Janet G. Hom 21-1 -0206 Decedent's debts must be reQorted on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: I' Fogelsanger-Bricker Funeral Home, Inc. -staff services, facilities, and equipment 4, 950.00 Casket 2,970.00 Notices, dergy, and flowers 596.24 2. Cumberland Valley Memorial Gardens -burial and tombstone 1,595.00 3. Premier Events, LLC. -After funeral luncheon 824.25 a. Warren Township Burial Assodation -Assessment 1.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP _ Year(s) Commission Paid: _ __ ~_ 3,500.00 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address ___ State ZIP City _ __ _ Relationship of Claimant to Decedent 4. Probate Fees: 327.50 5. Accountant Fees: 6. Tax Retum Preparer Fees: ~~ ~• S.W. Barreff Real Estate 8 Appraisal Services -appraisal services 350.00 8. CIeaK-ing at decedent's residence to prepare forauction -Glenda Branthafer $4,758, Patsy Martin $4,620, Glen Hom, Jr. $1,740, and Janette Washtington $534 11,682.00 s. Cumberland Law Journal $75 and Central Penn Business Journal $115 -estate advertising 190.00 ~ o. Cumberland County Register of Wills -filling fee for Inheritance Tax Return 15.00 ~ ~. Ride Forman Auctioneer -auctioneer's costs for fr19-10 and 7-10-10 auctions at decedent's residenc e 6,904.00 TOTAL (A{so enter on line 9, Recapitulatlo ) $ 33,904.9 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX•t (12-08) ~~ pennsylvania SCH~©UL~E I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, '. 1NHERrrANCE TAX RETURN MORTGAGE LIABILITIES ~ LIENS RESIDENT OKEDENT ESTATE OF FILE N M HR Janet G. Hom 21-1 - 0206 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreim u rsi'Sd medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 • State Line Gas Service, Inc. - 213.8 gatbns of liquefied petroleum gas 448.98 2. West Shore Emergency Medical Services -ambulance 890.30 3. Shippensburg Health Care Center -Cable 10.00 4. DirecN -cable 32.67 5. CenturyLink -telephone ', 46.65 6. West Shore Emergency Medical Services -ambulance 194.39 7. Christian Lawyer Solutions-Inh. Tax Retum preparation for Glenn Hom (dod 12I6I09) (JaneYs spouse) 1,015.00 8. Lutheran Home Care & Hospice, Inc. -personal care aide 3,676.71 9. Prem~re Property Services - septic tank cleaning 135.00 10. Darlene Pittman, Tax Collector - 2010 Per Capita Tax 9.80 11 Darlene Pittman, Tax Collector - 2010 county and township real estate taxes 276.60 12. Darlene Pittman, Tax Collector - 2010 school real estate taxes 1,502.76 13. Adams Electric Cooperative Inc. -Electric utili6y January through July 2010 298.17 14. IESI PA Corporation Chamt~ersburg Hawling -trash - dumpster Fetxuary through June 2010 558.50 15. State Farm -Homeowners insurance 386.00 16. F&M Trust - bank fee 10.00 TOTAL (Also enter on Line 10, Retapitulatlon) 9,491.53 If more space is needed, insert addRional sheets of the same size. I REV-1513 EX+ (O1-10) Pennsylvania SCH~DUL~ ] DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DE{EDENT ESTATE OF: FILE NUMBER: Janet G. Hom 21-12-0206 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Glenda J. Branthafer,10306 Mountain Rd, Orrstown, PA 17244 daughter 25°/° 2. Janette L. Hom Washington, 929 North West St, Carlisle, PA 17013 daughter 25°10 3. Patsy A. Martin, 167 Ouercash Rd, Chambersburg, PA 17202 daughter 25% 4. Glen R. Hom, Jr,1033 Pine Stump Rd, Chamberstwrg, PA 17202 son 25% ENTER DOLLAR AMOUNTS FOR RISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, APPROPRIATE. II NON TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. If more space is needed, use addftional sheets of paper of the same size. o LAST WILL AND TESTAMENT OF JANET G. HORN I,.Janet G. Horn, of Shippensburg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish an~ d~claze this as .and for my Last Will and Testament, hereby revoking all other Wills and Codicils I~eretofore made by me. FIRST I direct the payment of my just debts and expenses of my last illness an~ Funeral from my estate as soon after my death as conveniently may be done. I direct my remains be buried in my prepaid cemetery lot in Memorial Cumberland County, Pennsylvania.. If none exits, I authorize my personal purchase a contract for perpetual care of my cemetery lot, using therefore in such amount as she shall consider necessary and desirable. Further, if none exits, I authorize my personal representative to expend estate, in such amount as my personal representative shall consider necessary the purchase, erection and inscription of a suitable marker for my grave. SECOND I give and bequeath certain articles of my tangible and personal property with a hand written list made by me during my lifetime and attached hereto. In such a list or designation on said list, said articles of my tangible personal added to the residue of my estate. ~ THIRD Carlisle, to from my estate from my 3 desirable -for '',accordance absence of y shall be I give, devise and bequeath all the rest, residue and remainder of my esta td my beloved spouse, Glen R Horn, absolutely and in fee simple if he survives me by thirty (3 ) days and he is not institutionalized in a health care facility or nursing home, or receiving b~nefits through the PDA Waiver Program or any otherpublic benefits program. ', FOURTH I! In the event that my spouse, Glen R. Horn, fails to siuvive me by rty (30) .days or in the event he shall be institutionalized in a health care facility or nursing ome, or receiving benefits through the PDA Waiver Program or any other public benefits pro , I hereby give, devise and bequeath my estate to my children, Glenda J. Branthafer, ow of Orrstown, Pennsylvania, Janette L. Horn Washington, now of Caziisle, Pennsylvania, atsy A. Martin, now of Chambersburg, Pennsylvania and Glen R. Horn, Jr., now o Chambersburg, Pennsylvania, equally, share and shaze alike, pro rata. Should any child pr e~ease me, their shaze shall pass to my surviving issue, pro rata. These provisions also appear on my spouse's Will and aze int reciprocal, each providing the consideration for the other. FIFTH '\ I direct that any and all inheritance, estate, and transfer taxes imposed u passing under this Will or otherwise shall be paid out of the principal of my res SIXTH In addition to the powers conferred by law, I authorize any personal rep under this instrument, in his or her absolute discretion: l by both to be ~n Amy estate waxy estate. (A) To retain in the form received, onto sell either at public or real or personal property; (B) To exercise any options to subscribe for stocks, bonds, or o~ investments; ve acting sale any 2 . (C) To join in any plan of lease, mortgage, consolidation, a change, reorganization or foreclosure of any corporation in which my estate or any trust may hold stocks, bonds or other securities; r 3 (D) To sell, transfer, convey, mortgage, pledge, lease or ex property, real or personal, which at any time may form part of my est. of debts or taxes, or for any purpose of administration or distribution, upon such terms as my personal representative, in his ar her sole disc wise, and to execute and deliver deeds of conveyance or transfer therE (E) To make settlements and compromises on such terms as representative in his or her sole discretion may deem wise without the r obtaining any court approval thereof; (F) To make distribution hereunder either in cash or kind, a: ainge any for the payment r .Such prices and ion, may deem r personal ~ssity of personal representative in his or her discretion may deem wise. SEVENTH I do hereby nominate, constitute. and appoint my daughter, Patsy A. Mai Executrix of this my Last Will and Testament. Provided, however, that if she is unable to act as Executrix, I direct the duties of Executrix to be performed by m 3anette L. Horn Washington. EIGHTH I direct that no personal representative, guardian, trustee or other fiduci under this instrument shall be required to give bond for the .faithful performance any jurisdiction. #O act as or laughter, appointed 'heir duties in 3 ._. IN WITNESS WHEREOF, I, Janet G. Horn, have hereunto set my h~nd and seal to this my Last Will and Testament, consisting of five (5) typewritten pages, the first'~three (3) of which bear my signature in the margin for identification, this ~Q~day of , 2008. -~ ! 1 .~ ' ~i ~ Janet G. Horn, Testatrix Signed, sealed, .published and declared by the above-named Janet G. H and for her Last Will and Testament in the presence of us, wha have hereunto names at her request as witnesses thereto, in the presence of said Testatrix and ~~ ~ ` ` R ~ ADDRESS ~ ` r ~~ ~ ~~~~ ~~~"~' ADDRESS i ~ ,~U, ~~l~m~ ~, Testatrix, as ~SCribed our ' each other. COMMONWEALTH OF PENNSYLVANIA COUNTY OF ~'~nbcr/a.~~ ~! We, Janet G. Horn, and ~O ~ I dt" L°/^, the Testatrix and witnesses, respectively whose names aze signed to the foregoin dar attached instrument,.being first duly sworn, do hereby declare to the undersigned authori l~at he Testatrix signed and executed the instrument as her Last Will and Testament and th~.t she signed willingly and that she executed as her free and voluntary act for the purposes the i expressed, and that each of the witnesses, in the presence and hearing of the 'Testatrix signe tl~e Wiil as witnesses and that to the best of their knowledge the Testatrix was at the time ei t~,en (18) or more years of age, of sound mind and under no constraint or undue influence. E Janet .Horn, Testatrix. ~~ r 1 /lr.n 1 Witness ,Witness 4 i i Subscribed, sworn to and acknowledged before me by Janet G. Horn, the :Testatrix, and su. b~scr"i`bed to and sworn or affirmed to before me by ~ , and j ~Q/G1S'` ~° . l~c°/""' ,witnesses, this ~ day of 2048. ' ,. - - a ,... ;. ~ . . ~ .. . »yas-woner a,+. aen +w.. wR w nM. u.d. ae«e. B!'"8~ ly YA6[JUi~ a.r, a.s. 1w. ,.Mn.. r.. ' ' ' ~~ ~~ ~I t ' .+ A[AU,Ii' TH1E c~~~• daq of April ~ ~ tea ~~ ? _ ~ of our lord one thouaao~d aixe hundrreal fifty-wino. . t ~Ufs'TWLJ~'IV FANNIE M, HORN and 1~ORGAN D. HORN, her husband, th pf . ~ R. ~]. ~ 1, Shipperiaburg, Pennsylvania, s ~ , ' and. GLENN R. HORN and JANET G. HORN, husband and wife, both of b. 1, Shippeneburg, Pennsylvania, Gr"~"` e, ,. i WITNES3FT'A, that in oonaidaratiow of One (~L. 00~---- oUars, ' ex head peed, the receipt whereof is hereby gaipeoioladped,.ths said pnsntor s do her yr~ant . i end coavair to the avid yrautase their heirs and assigns as tnaanta by the reties, ' ALL THAT CERTAIN lot of ground located on Township liosd A 305 ' I North Newton Township, Cumberland County, Pennsylvania, more parts v2airly ' { bounded sad described ae tollows: ' ~ BEGINNING at a pout in the canter of t1~e intersection of sa[d public road • + and a private lane leading to the p:operty of the grantors herein, thence ~6 Laid private lane South 53 degrees West Z93 feet to a gate post; thence N rt11 by other Lands of the grantor herein, North 28 1 /~ degrees West 619.5 to t'tq sn iron pan; thence by the same North 48 degrees West 540.8 fact to line f Lsade of Emerson Varner; thence a2oag said lands North 63 degrees East . 1~5 .feet to a point in the canter of said Township Road; thence by the center f the Township Road, Sossth 58 1l2 degrees East 75 toot to a point; thence by t e same, South 41 3!4 degrees East 1044 feet to the place of 8eginntng. THE ASOYE described lot of ground is part of a larger tract of land cort- veyed to the grantor herein by deed of Harold R. McCullough and Ella F. ' McCullough dated Marsh 22, 1947 and recorded in the Olfic• of the Reco dezt • ot. Deeds of Cumberland County, Pennsylvania, in Deed Book "M", YoI. 3, ' ~ Pagc 179. i i i .. i I i i ~, i i F . f i ~ I ', ANU, the said pra'ator s , do ~ hsrrGy coronae! and apiroe to end weth flea seed praxtx s they ,the p-aator s, their heirs, es,eautors sad adfnifhetrtttors, shell end wilt root gentrally oad Jorsesr.dslead the kerein 4boeo i presdsea, urith tM hereditaateseta ar~d'app>crbaa'nos+, uieto ihs said Orteutce s, their and . j aaeipae, 4paiatt the slid psalm s ,and against avert' other person lawJultg daineiny or rgho alurll i hsna/ter claitie the aafres or dng part tharaol. .. . i I~ s ~. t ` .i..•~w .. rl' a `•e ...ice ~ c. . I.. M . ,`.~~. • ~I• _' .~ .._.... n~Atr~ear o- enaai . AFFiDAriT OF raLr~ eroeem a oournr coats~nt>~ -- Y - '• a,. ~ •.11's`cpired ceder 6ecgLon 8 of the itetlt~ Traoafer tae Act • ..~ , of Deceaber 8'l, 1951. P.L. 294E; as mended. Lath; h, ~`TO /E FILED iR DiMLiCATE MIAI Tip RECOMEIt 9F DEEDS. ~_ . . ~~ CA!~1~11RAI.1N Ol P)atltBYLYANIA 1 f~11Ni1' ~~ I ss: ,-^ I }~a____~i 1YJ lWr,w.~ ._,.. being dull sro . hereby states he is the itgtAD'1'~tl tIiPAMllFrin the deed betaaaw t Hesse end eddrass of 1. . and ~ , . f ease ee- rase of (IitAM~l • Mich regard to aificll this Affidarit ~is gi~eas, gad Lbnt the true, tltll ' •cooplete market talus of seCti ne:l en ,liens • giber encuskrsncea is Doll tS ~d- f. Rtu hit~esL seed !glue of said real es for ocsl tax purposes is nf~ Dolls tS 'l. bill any mortgages be recorded cantesaporaraeonaly a+i.th or aubsegneeat to the recording of the deed4 „~_ Amau-t . t ~i yy I _ Property location: ~~....A, t~~3oS M ~a•. ~ 112.>_C: ~_,t -~,a ~i ~'Stree~and Number! !City or 7btnshipl ;L end subscribed before ae :'~~~~wwt~~-~ dqy of RRdd / 19,E ~N~l~ ~ aYY1• s ~;~''' rantar or rasa . O ~'~: Y ~.~ ~. NoLai74r~}!~~~ ~t,'•~.!r; Address t;t P-YyP*(,..~' IAyCumr: ~ aan Qv • •. . ; ,, • •••~••••• if trap ~i, ie no i ble, eu:plain• ~=.~++~ • ~,~.~ ~..1 w. „ 5.... . P.' 8 Aai~ Dopy to: Book No. Coaewnwaalth of Peenpriraaie Page No.._s.. DsperheacL of Retirn~e Aoo:ait of tae paid tes per Harrisburg, Pamaglranie cac,celled sterapal i ~~ ~K i .. ~~ ~~8~~ ~~~ 1N wtTN1CS8 WXSRBOF, aa£d Ora*to+a ltore,be+wnto set their l~aada ~ ~eed[ s . tki day eaui ina+' !~ moos wrlttea. Af•w~ ~atrA aai Rdlo+rrb ....._~!1.~.'-~=rYUJr,'!'Yl.`~f~;.:,!?/! ? _ . w qe ~Irnraer or ~ Farmie M. '3~oin ' ' orgaa"~'~"iT'orn ' ~ i State o1 'penstaylva~ia . ae. Coaaty of Cumberland M Oa tkir. thr o,}'/,~,~ doy 01 April , 1Y 54 , b ore,+ne, -tAs ~ardsn:oaed odtoer, personalty appeawd Fannie M. Horn and Morgan D. Ho n ,,.••~ •`~ ese for eatieJactorily prorsa) to bs W pereoa a wkors rams arsabeanbed to witb- ,'`,~~, ... s+1d sekaonoled0~ tkat thoy exsaated eta~t 1sr tbs pprpaeae tikereia tatted. ~d~. { MIJB3S A+ABRIPOF, l ksreaato est +aY, bmat aad o~felsl eeaL sr : ::~. .~1GSe6lNOTAR~ ce,gL~C t, i '~, r.~.,:'r. ._.........MMCoatr,+uo~rE,T~r.,.:.....,1 .:.....__ ...._~..... .,Ot~RtlLys~v; ~ L'AHLiSLE, PA. cTC~s M 0 i "'••.~,;;,rp~"'~• I, do ~+'eby eerttly tAat tke preafea rseldeaas aeut aoaiptets post oDtce !'as ~ o/ tke voitAia +ateted yraatse is R. D, Nl, Shippenabur~, Penns. ~. i A/ Spy ~ s ty. ............... ...._ ..._ ; Attorsay for..~'~ .~ ...... <• ~ H p q ~ O ~ ~ a. zz s ~ : ~ H xx ~r ~ ~ . ~ .Q o ~ ~ . C7 ~ ~ 'w ~ '- ~' 3 "` fL ~ , o a ~ z _- o~d Q~ r ~_ ,~ r • ~ V+ I . ~ALTB OF PENNSYI;9AN COIfXONW =~ :. I /f Conn o .. 11 ' ~, " r~ -"' eeca~saa.otFlet a . q ~~~LL,. d y q% ~^ ` ,. r r rw~ aesa ar caai~s s a ; 1P.13CORUSD oa tbte_._.~ _ = .._...-.. : < .a ;; . _.._... ~ ~ °~ : . A. D. IB~, in trle Recorder's oetee o1 ~e ssid7Sa -Y ; ~ nty,~ I)e ~• . k~ D: D ~Aaj Voi.._._..! . Pape._~~..... - cw+erxtMro coven Gteen larder to )taxed and the seal of tAe esid oetce, tTie date shoes w ' eK. +~ansnvMm vr~i+.~'+'r-atfl.l..~..y~rf~J.? da?G~~ dr. x w b S. W. BARRETT REAL ESTATE AND APPRAISAL SERVICES LOCATED AT: 36 Hom Road Shippenstwrg, PA 17257-8752 CLIENT: Patsy MaAin 167 Overcash Road Chamhersburg, PA 17202 AS OF: March 27, 2010 BY: Stan A. Skovrrorak PA CertiRed Residential Real Estabe Appraiser APPRAISAL OF 3. W. BARRETT REAL ESTATE AND APPW113At SERVICES Summary Residential Appraisal Report Fie No. 10-0076 The purpose a mis appraisN report is b provWe the tietdwim a aedibb opinbn of the dented value athe subject Property, ~ me 7raertded use a the appaisal. Gent ~ flay Martin E~rrrai N(A Ctierxaodrees 167 Overcph Rwd Chem Sous P Addworw lrrlended TM kriendsd User of lttk a kal rt k the Clknt. No addkionel irrtrrodad tlus katon of the s . uraerrdw the The leoleroded Uss k b waluaEe the that k the t of this a isat to 1M accurate su rted o nkm of valve. 17202 igsd wHhout wHh an Address 38 Flom Road Shi Stale P 17257-8752 UvmaraPubicfiecadGkusn R. 8 Janet G. Fiom Cou m nand Deed Book 788 305 Ar"S Parcel a 80-10-0818-005 Tax Year 06/09 R.E. T E 1762.00 t9ame Nortf6 Newton Townshi Rekrence 10-0618 censusr 028.00 X Fee t.easefroid Amer research did rid not revel sales a transfers ame br the mree ' b the eAectlye rise a this Prior SekRrons<er: Dre Unknown Prke Unknown s Cotutltotae ArxMis a prior sat a tarrsier hbbry a the suhjeet property (and wmparahb sobs, i appicaele} NO Or traMhra Of th4 withi moroths. Com rabk a1eZ last transtanad on 28 2009 for 1.00. 36 olbrsgs, opions and cartrads as a the eaecdve love a me apprafsrrl N!A 7 [snieurtax LoeaYar lhben X Suhwbn Rrxal Vaeres X Sp~le PRICE AGE 40 96 O+et 7996 X 25-7596 under 2596 b eakuxx Over 2~4 0 9i Growth S61bk Sbw Tare UMer 3 mms X 36 mms Over 8 mYrs Weiphbahood eaunderies The k lsour6ded on the north Er6ote Rd on the Best rout 74 on the so6etl6 Rltrosr and on the waet iNhk Run Rd. 00 Low 40 186 100 140 ProQ 50 096 096 Vac 60 96 rbignhodrooo Oeadipdon TMs k located in an area Of mixed raafeMrotlal and cultura l oMe wFafcis k ~ 1Absttrn CwnttMrland t,',ou K k wig9in reasonable drivi distance to ammenitles such as sch ools ant. Marloet Condtiorrs (mcludxrp support fa me above corvdusions) Sae Attached Addendum olnrensiorrs See daaxt Arco 4.88 Afros roll 1 kt vawr O C6~fration None known N!A L Use No desrxbe ffi the highest and hest use a rite sutyeet property as impro~ (a as proposed per pbras and specilkatlons) rite preseMuse? X Yes No d nw, Ndlltlea pubik Otlbr daecrlbs PuWk OeNr deeuibe OIP.tlre1T lnr8-T ~ Publk Prlvaee X Weer X IAlell Surest Macadam X Gas X ne F ces Sewer X None sie commems Private water and sanity s arc comma9 to ttee area and haw no adwres affect m are no a sent adverse easements encroachments or oflter advarae conditlons. 1 .There ~ ,,. , in~teilals urws X one OnewGtc.uni Caxede slab cxawl WYs SbonsJA Fbar9 A raslodes 2 wllsessraem X Pmdalt3esernerri ErOerbrwaie VYoodU wars nsYA T X Def. Atl. S~Oa~End Unk under Cam. 2 Sto easemerrtArea 448 . i. ReserneraRrrish 096 OunitleE Roa 5urh>ce MsbeYA Gwen & AlumirNerolA wlrrdow 1NOOd FramsJA t f9edr Boor ooddA A A Year flue 1830 Scam YeNA Car ~ taste Eerctlve 20-26 rrs YeslA rr Cars 2 Adk taore FWa WW RedbM Am aaies ear Grovel Stag sets Omer Furel r6e s e 2 Fence x 'Cars 1 X Floor Scuae Cemrcl Air PatldlDeCk Paeh a Cars Flydgrea t•letled R X hWitrtlrlal Direr Poe aa. Maaawave WashN r ()rifer Feiered Brea ar eve 6 Roruns 3 llemooms 1 7671 Faadf Area Abae Grade Addnoraa raxerres Front aoverod ximste a down small wooden outtsui wed as sto s sifts. Most of these outbuildin are old and wom and thw most are not even valve heroin. are on the Commerps on rite ~ Im rowmer~ are in av candifion with no ical or tunctbnal i uacks I '.~ Aoq[N UlgrgU.Vlgl eY.7HJRIMI~:•1gMD.0eT 1MIbgl Cepy~IMO]iSOwlLtpq~MgaO MA. MRWprtlpl~MnrYY .. PpridY UpAR"'1 Grard cnwuN_a6 I~ ADDENDUM Client Patsy IiAartin File tto.: 10-0076 Prapetty Address: 38 Hom Road Case No.: Cily: Shippensburg State: PA Zip 17~5T-9752 Nelghbort-ood Marken Conditions ~i list(Sale ratio approrrimately 969L. I haw Considered rolevant competitlve Ibtlngs andlor corrtraCt offers in the performance of this appraisal and in the trending infatuation reported in thin saetlon. ff a frond is i 1 have attached an addendum providing relevant compstftiw listingicontraet offering data. local muMi-list indieatrs stable market in itre past calendar year with no appreciation in the subjects rnartaet area, wltlr an awre nharkeUng time of 90-180 days. Economic trends and lending rates haw remained favorable. Saks coneessiars ro ~cwring more frequently; however, there is no known prewlance of unusua{ sslNr ffrrancirrg concessions or There are new homes under construction in surrounding dewiopsmerrts, as well as resales awilable in the neighboriwod. II I I l it i~ I I I I Adaand~m Pape ~ of r Summary Residential Appraisal Report ~-w.1o-Dora FEATURE SUBJECT COMPARABLE SALE N0.1 COMPARABLE SALE N0.2 ARABLE SALE N0.3 38 Horn Road Assess Sh 17267 i05 Shed Road Nswville 17241 267 Rotcbrtry Rosd Newville 17241 115 pOptNrs Gap Road CarNa 1 0 3 ' n 8.05 miles N 7.32 miles NNW 12.8! i ENE 5ek Prix S S 120 000 ' S 128 ; . . s 11 000 SalePtior~GtossLM.AIm E 0.00 .R S 79.68 R ' S 79.32 t. - S !2. 4 k Deresourcers) CPML310176702 CPMLS 10180498 CPM 10!188802 verikrion s 'COtri'$uCai+ = Courthouse Courlhouse VALUE ADJUSTMENTS DESCRIPTION OESCRWTION • s DES(:RIPTION - s • s Sak a Finanptg ratlrestaons 3U/F .: " Notes, Coco DOM 8 None, Priwte DOm 89 None. h DOM 1 Date as.aflTnte 04/3012009 09/3012009 Loaaat Subteban Suburban Suburban Su n LmseholNFes ~ Fee Sbn Fes Sim Fee Sim a For Si sNe 4.88 AT:JA 3.4 Ac/A 7400 4.26 AT:/A 3150 5.48 Av -T 900 11few cal O C O COU O 2 1.6 Sto 1.5 2 olCottslmcdon Aw A Aw A AqW . 80 Ywrs 70 YNrs 54 Years 100+ Y n ConmYat A Awn A A AbOOeGrede iaW 8rls Torl e~tls Tar &Yr Tqr Room Cowu 8 3 1 7 4 1 7 4 2 000 4 2 Gross Atm15.00 1 671 . R 1608 . R 2445 1 620 . R 786 1 24a' R 5465 tlasemera&Fatishea RaomsBebwGrade Partlal Bsmt Urdinishsd Full Bacot UrTflnitehed Full Bsmt Unfinished Partial t UMinis Func6ond ~ A Av Awn A FWA1None FWAMone FWAiNone E ElNcientNems T ical T 1 T eai T 1 Car Ga 2 Car Gan -5 2 Car Gan -6 000 None 5000 ~ Porch Porches -2 Porch Porches -500 2 Fi Nate 4000 None 4000 None 4000 Oufbufldi Sam Ba etBld -6 000 Outbuild Nel + S B 346 + X - S 6085 X * S 10 065 Ad~Tad sale Price Net Adj. 5.3x, Ne<AaJ. -4.796 Td tiles Gross 17.$16 E 12B 345 17.191 122 1 d sales n nlott of value ra is 122 000 fA 126 000. us dotes 000 sus. The Tali combittstlort of an old farmhouse vvittt a and ras ties search arw in order to find suitable similar eom hies. These are the best sales eom Net Ad} .8N Grow 1 .1 S 125 086 made at ulbd in to tiles tTi be awilsble. ~. TbH' 1rivAt.ue. `- - Sias value Commetas A rwisvlr of vacant land sales within the s s market teTrealed sa1T-s fs at a ce ra of 500 to 70 lore Of value for the site - 72 000. from 3.18 to 4.43 acne ESTaMTED REPRODUCTION OR REPLACEMENT COST NEW OPINION OF SITE VALUE ........................................ = S 7 000 sauce of cost data FL S ........... c $ 0 dare Co9t9enice Ei1e~+e sax a ~ era . k S ........... = S 0 con.naKSen Cost arm caiaamon ~ etc Coat deemed a indicator Of wise. Estimabsd . F't s ............ = S 0 RTtmaini Euxwmic Life -35-40 B Tomt Esdmme of cost-New ............ ~ 0 Less Ftatc>lonaf EtOe nmi 0 ' Caaot ownrlems .............. ................. = ' 0 'AS-14' Vabt of Sik .............. .................. = i INDICATED VALUE BY COST APPROACH ...................... = ' tUA rlcaaEevtr~eaiATxe ,. - Estlmeled MerNetReMi NIA XC.ross(~nl r N!A =S NIA t10ica9edvalue tlcorre SuretmryaralwnteApproach(aldudtpsupportfamadaetremandGRM) NIA rnaaaavmw . swacori 1126 000 coat i WA erroms • WA The MaA6st Data • w m of valor far ttw The Cost wars not indieabor ctf wlw and therefore vras not included herein. The Income A roach wiu also dearTled 1 r this afla Thisappraisal is made u Is.' sutyectb cangledon per plans aM specrcatlons on die basis of a Aypdaetllwl canditlon dlatrle hnpro+emsnls imye been tad. Oadjca b the bNelMnp rapatsar a on the basis ors hypoNetlcel oortditlon drat rte repots ar alleretlons have been caapkeed ^ subject b the b lowirib: The has been a in current condition. This is for the clients use on . eased on The mApe afwork, assrunpeorts, amisnp mrrmdons and epprahers certirkaaon, my (ottr) opNWn otThe da/Yted vatw tithe ra- tlutieThesubieetaftltisraportia3 125.000 riot 03/27/2010 ,whfchisMTea/kcaredtleoftlTh -."°~ wmu.sawrgxa eollwn, i0G.T3l.OTfwaW~.mm ninrm CaAMA1o700610urAa stereo awrnc. Nwaawr..a. ~~"~ PptlMi tGP'4t"'I Grrr/ MPaOg1~AM rt.: S.W. Birr'eti Real Estate 3 Appnisal3ervlees Fie Na. 10-0076 Scope of Mork, Assumptions and Limiting Conditions soop.dwork is deafttsd in fin tNtUornt Standards dPmNssrdrW Appraisal Predioe as ^ the type amt exarrtdrasaeeclt eetd aulysps roan asaigrrnarrt" tnahort,aoepedwaktssYnpy wMrBttheeppraisar~danaddnatdodurirgtlrecwusedthe. R bytbnd inriladtoc lheodrttbwlMMthepropertyisiderrtllledandkrpsefad, thetypeandaxlentddtlrtraea-tltad, tltatypeand analYseSapP~ toar-ive aaoptnions ar ~ondtesions. Ths stops dthts appraisal and ensuing dfsaasWrt in this reporters spscllk btlte tteeda dthe dent, dhar iderdNfad 6ttarwlad wer~tandaotlM irtlerrdedusadtxterepai TMisrepatwaaprapradtorthesoleandexelrolverwdthectlrttanddhsridsrNplsdirMrrdedusas tlteiderr>ibd breerwfeduseandksusetryaryotlrrxpsrtiasisprohWtled.ThetrppraberisnotreaporW6leforrarautlrorizedrnedthereport Thaapprabarscartl6eaYonappnringinMlsappraisYrapatlsaubjectbthetoNorAttgoortditlorntmdbsuchadrerspscilic sears setioMbytheappraiserinthereport Ali nroraadlnaryassumpGonaandhypotlraticalcondWonsareatlrledmtderapartand~Wiscbdtha ~- 1. The appraiser assrarres m ~n b rratlers of a Ieyd naaae alkttirrp dre property apprei9etl a title Atereb, nor ~esAte appraiser render any opin' as tD the title, whkn is assumed to be good and rtrerkef~le. The property h appraised as Haugh wrier responsible ownership. 2. Any siaetdr n des report may shay apprmdmNe dimensions end is McBded Dray b asset the rbder in visual¢Ing Are property. The appraiser has made no ptthe property 3. The epgaieer is not reglrire0 b gore tesbaany a appear in court because d havirtq made the appreisNwitit tetererlce aAle property h question. unless fens been previornty made Ar!rea. 4. tJeidrer ep, nor arty pertof the co~mm des report, copy a odrer made tirereoi (ra8d'sg corrc8rsbns as b the preperry value, dre idet+My d the appraiser, despnations, a Ate irnr web wiridt the apprai~erscarereged),shell be use0for any pwposes by erryone but the glerrtan0 otlrer Naerrded users as itletafed in Ass report, na stns h lx caneyed by anyprre m dre pubic throtgh aarerAsing, pubic remtions, news, sales, a other media, wrdata the wrieert conaem of tits eppaiser. 5. The appraiser wtil rat disclose the ro» of ins appt8iset ceport wtless b by appicabk law a as specsed in the Urebrm Ssrdards of Proiessionrd AbMa~e{ practice. 6. lnlwnretion, est'nnetes, end opinions tuntslred b the appraiser, and conmmwl in the repnR were dmatreo from sowrxs wrWdered refaDle errd believed a belatre and cones. i~brataret, m resparsbify fo! aawacy d such items tarnished to tits appraiser's assixned by the appraixr. 7. The appraiser asaares tltuAtese are no hidden a unepparem crorditlars al the properly, subsof, a stnrcbxes, which would render it mom a kssvsisbls. appraiser assumes no responsbifdy br such caditidfs, a for erpineerirp a testing, which mght be required to discover such tapes. Ties apprdsel is na en envirmnrerael df the properly and would nape catsdaed asnaAr. & The appraiser spedeitts in dre veYwtlmt of real properly and is note borne inspector, teridurp caaragor, stnrcwal ergYber. a slmiar e»erC ww~ The aptaaiser did not wrrdug the iraerr9He OrPe M field observa0bns dd+e idrrd imerrded a seek and d'scaver properly debGts. The vietMrtp d tits propery and tug' fe or purposes as deuebDinD an aptiriar otAre deFred value d the property,given the iularrded use dues asstpnnrent. Stetenrenls regadirrp corrdiforr are based on swtace Dray. fie eppreisereleims ro speaal e~srlise regerderg byres indud'n9, Ma rat iriled b: fourdatiorr setremerK besemem nai9frre probirtrs, wood deseoyirtg {a aAar ir>sedts. pat irdestetbrr, radar gas, Iead tared peiN, mdd a errvuonnrersnl tsares. Unless odrereese irdicekd, mecharrkd sysoems were rat acefualsd a tested. This appeisat report should na be rsAd a aiacbse Ins condtion ar the poperty as t rreflles t4 Ate presencrJabserrce otdetects. The diem is iairetl and b empty qualified r,~e+tsb inspect and address areas of corrrxm. M rrepative coraebns are discovered. the opetiorr of vafus may b alleged. UYtlessatlrervrtaerroeed,tMappraiserassumastlreoomponertbtlvtoonstluriethewbi~P~Y~pIs)are soundrrdin woridrtg order. Any viewing of the properly try dye appraiser was lirtried a reedit' ogservable area. Unless odrelvui5e noted, adds and rxaai space arts were rated. Tla appraiser rid rat move aunhrre, Poor couedrgs a other (ItensArat may restrict the vkwtq otd,e property. 9. Appraisals imgtuing hypodretical conditions related b completion of new carsmu6ort, repairs a afesation are based on tine essrsrrption drat such corrgkdon. a repairs wrl be tongetemy perbrmed. id. Unless Are iraertdad use otAtisaipprssef specificafy aatdes issues of property inswarrce coverage, This appraisal stauld not be used to such purposes. a Repleoementcostipuresusad anAte set approach am br vawatlon purposes oMy, given tine aaend W use of da a~iprunem. The DeAnifon of Value used in des hrem is unMadj a be mtsislemvrih Are deinetiorr of knrxable value br properly Ntsrrrance coverepeArse. 73. TNeApCareralPwVoseAPRaiaWFteirort(GPAR'"')ianotirNendedtoruwinLrgruaefiansAmtrequirsaFennieMae3l10MFreWReMeC7'ofam, also latown as the thtirorm ReaidaMMl Appnriisd Report(URAR). AddiUOrwl Cannnenfs Related To Srxrpe 4t Work, Asstarrptlau and t.NrrgYg Carrdidons None ..__..__..__~._._ ___-..r----- ~~ wpra: t - - Appndset'a Certifit~tiort Tn.+ppeai~«igo.rw.. ~ha, wtn.eaeafn.~ jYra w aad ur~k 1. The aeamena aNd oowsb[d b aic neat are tme eae cartete 2. The aPaMd ~R apabee, and azeM~aaeve ImMetl ary bylAe npotitl gssunptlons aae ~q condaue ana a+e the aPDraifer s peisdrol, Pn aryees, apYifoae, aiW aMtdwbns 3. UrAeb oltaMdse tYI1Bd, lie eppreher has eo gesent a paepedbe bletest kl Mie piopaty0rt m the wgatad~bagat end ttosno Yaaee brolwd. a. the+~po~ahernas~aaeawhpmpestaslevrov~flerttatheaugeuaoesreponabmsvrMSlnwNeaw~mwa~pmem. s. ~meeppraier'sapepea~enttnnsaaepmnentwssootoawhpentuOonAe~oW:garepatlaprauas, !ti ThetppraYerseaapenswbnbrcpnpleapakeseipeaengbnaoasYtpenttponaederebpmeaaropaYnpdapredwem~inedvwueaakecme ae tlaa,balhevNM Ophbn,>hB atriirneaaa nuuq a tlk oaunenoe as alOeepknleuelM'dtedyieWedbae YeenMA ux 7. rneagaaYe-'swMeu.oprYons.enuama,atan.~ereee~klo{+ed,anoaasrepatnasoeenprepena,noaponn~rrwneieu~fpmsmrMutbaPn & uneseaanweaaeA,IheappnixrhtsmWeaperspulitspecOboatlNprepetrytlrotisd~eaihjeetaONereporL 9. tlaWenoadbebw,eoaxpm~0eusgnM~ntr/Npfupenypppabelau1.96us:8bdleaPDra~q~bten~on. Slpn~ntroYpmDwHePI Ae1~p1a1 OerlNgrons: NOtN De1MtManafValnw ®AAM1ratValw ~OwwValue: 9oeroeaDei~MOa: !ldPAP TM moat praYabN ptlee be senna oi' motry',wltieft a propetiy sheteld 6rhq M cantpatltlve and. ~ ooredltloew trgteNlle to a talr aaN, the boyar and seNer, oath at:tleep pnedeedly, geoteAedpwbly and a allbasd by teetdtee stlmtttus. ~tDDAESSOF t#tE PRDPERtYAPPtZUS~: Ilorrt PA 17T8T~7l2 E~FECtIVE DATE DF THE AiPR/1Slll: 08f~T/2018 ~w+a~sEOVUUE oFT-tE st~ECraaoPF.>:tr s 125.000 svatutts®e ttnae: elan A. lhowroetak srtecealatfone ot~L o s'i2L a tiraroe>r aEaler(Obpbe): SWea: sate: PA EtipreaonoreorCrYlaitonauawe: Jtaie20.2o11 Derasiprarewartepac QIl55/2010 wearropagvrleF 03f27fT010 atmvabr+•~ inatioraaAEalnfor O~ pg0axdenaaywew soar ... ~~~./~ tt~e: st.wn w. SRP SRA Sotee Carwhabn s atiewees RBO A sane: PA Date a CertlAalbna t.teaae: Jesse 80.241' owe a sgiwee: 04ln0f2010 o de a P~o~vfewwq: v e ~ e Uwa~aE,aena ^~aroe-,r ®on twee a race Pre~ded by r all price ~ trot ~r.:.. ,. ...o.w~a.... w..wn..eawm. r rAetax S.W. eamu seal Esta6. i Appraigl services FLOORPLAN SUBJECT PROPERTY PHOTO ADDENDUM FRONT VIEW O SUBJECT PRO Appraised Date: M h' 27, 2010 Appraised Value: $ I ~I REAR VIEW OF SUBJECT PROP~RTj STREET SCENE - _ COMPARABLE PROPERT1f PHOTO ADDENDUM Fif COMPARABLE ALE #1 105 Shed R~ ~ u.17u1 Sale Date: Sale Price: $120, COMPARABLE S~4LE #2 Z5T RoxbwY Road ~rrifle 17?A1 Sale Date: 09t30-20 Sale Price: S 128,Sf COMPARABLE SAE ~ 11B W+p wP CatlisN 17013 Sale Dom- 1 000 Sale Price: S LOCATION MAP "'**"**"'~ QUALIFICATIONS'**"**"'* The following checked items are SPECIFIC SPECIAL CONDI710NS tfiat ware identified by this appre luring the irrapectlon of the wbjact properly. the comparablas sales, and their rteighborfiooels and locatrorrs. otiwrwkse rested, ftre corrditlora that appy td the subject properly w the comparable sales wed DO NOT AFFE y'I1E Y11RfCET VALUE OR THE FUTURE MARKETABILITY OF THE SUBJECT PROPERTY BEING APPRAISED. Thb not a home inspection service. This is an apprebal to esttmale market vales. _1. The subject is located in a rural area and is less than 25% built-up. ,i2. CommerciaUlndustrtal uses are located within the subjects rreighborirood. Those uses are ty'oicrMt of similar rreighbofioods. _ ff _x_3. Vagnt and undevebpsd land uses are located within the subjects neighborhood. These we# one typical for the area. 4. The predominant vales in the neighborhood is less than that of the market vales of the s property. This is des to the wry wide range of wlw of properties in the area and superior qualify of the subject _5. The subject property is totalled in a F.E.M.A. Iderttlfled Flood Zone. Flood insurance cowrag~ is Acquired and suggested. 6. Dampness is noted in the basement of the suf>jeCt. Standing or running water was not presar~ orb basement flow. Tide condition is considered typical in dwellings of this style. x 7. Tire subject property is serviced by pfinte well andlor sepde systems whklt is common for a~+aa. x 8. The subject is older than tive(5) years. All mechanical systems including ties heating, t a plumbing systems appeer upon a vlswl exterior inspectlon to be in working order. No warranties are Impaled i th~staternent. 9. Repair iMns wero noted in fire comments section of the report. Ttrese canmerrts on repair Mare for descriptive purposes only and are not required repairs. The items listed are casrrrsUc in nature. x 10. The basement floor is a dirt flow. This condition is common and typical for the area. and noR pose a healtlt w safety hasard. _11. The subject property does corMain functional obsolescence as noted in the report. Thls )a considered typical and common for the area and this style dwelling. 12. The land wtue exceeds 30X of total wlw des to ltre high demand for vacant land in the neigh .This condition is considered common and typical for the nelghborhootl. x 13. The land value exceeds 30% of total vales. This is des to the large sb~e of the site. This Is carsidsred to be typical and common. _74, individual adjtrstrnents ware required that exceed 15%. These adjrrshrrerrts were required des t p lack of more similar comparables on that individual rating. Ali companbles wed are ttw best awllabls. i _15. Tatai sdjwtments exceed 25%. This is des to the lack of comparable sales that ware more sin subjects marital area. Ali comparables used are the best awilabb. x 1B. One or more comparable sales are older than slxi6) morrtlrs. Although there are comparable p subjects area, Hare have sold recently; therefore, sales in excess of shg6) montlrs haw to be used. , used are the beat awilable. _x 17. One or more comparablas used were in excess of one (1) mlie from the subject property. Altf>I comparable properties in the immediate area. oats haw sold recettly. Ttrstefore, it ores necessary to sales outside of the immediate area. All comparebles used are boated in similar neighborfioods and i marltetirrg area. Aq comparables wad are the bast available. _,18. The eleetrieal system was not connected during inspection. ,19. The water service was not connected during inspection. _20. The heatlng system was shutdown during inspection. ,21. Roofing__Plumblrrg_li7ectrical_Heating_certifltretlort(a) iaJare suggested. yin the m the pantrNr i ttrere are comparab4 h the same _22. Inground swimming pool_~ out buildings are included .not inGuded according ~ lartder's guidelines. _23. Atxa+ding to lenders grddelirws a maximum of acres were considered for this valuation. acreage waf gkvM no wiw. ___ ,.,. '"*"'*"'*'""' QUALIFICATIONS ~*~*""~' Confidentiality and Security Policy We consider privacy to be fundamental to our relationship with clients. YYe are commkbd to mai hqp the confidentlality, inbgrity and security of client' personal information. Internal policies haw been opsd to protract this corMidsntiality, while a{iawing client needs to be served. We r+estrtct access to personal Information to authorized indhridwls who hied to know this f ~ comply with federal sbtMards tD protect your nonpublic persorgl irrfornation. We do not disclose tlds 1 about you or amy former eonsumrers or customere to anyone, except as permitted by law. The Isw permNs us to s ra% this information witlr our afRliabes. The lavv also permit us to share thb information with companies peRforn marketing. ' When we share nonpublic information referred tD above, the inNormation Is made avafiabN for Iim putpoass and under controlled circumstances. YYe require tirird parties to comply with our standards for security a goMientiality. We do not perrrrit use of corrsranodcustomer intornation for arty other purpose nor do we permit thl peVrtles to rent, sell, bade or otherwise release or disclose intornation to any other party. Education As of fire dab of this report, l andlor Stewn W. 9arrett, SRPA, SRA, have complsbd the requirems under the continuing education program of the Appraisal Institute. Calculated Value of Your Paper Savings Bond(s) Calculated Value of Your Paper Savings Bond(s) Calculator Results for Redemption Date 01/2010 Page 1 of 1 I Total Price Total Value Total Interest YTD~ItAterest I X306.25 $2,078.39 _ $1,772.14 0100 Bonds: i-16 of 16 Issue Next Final Issue Int r Serial # Series Denote Interest R t g6091852146e. E g6091850596e E g6091848921e E g6082173808e E g6082167099e. E g6082172256e E g6056682694e E g6056684352e E g6091847359e E g6056677696e E g6056681023e E g6043682077e E g6043683702e E g6042926718e E g6056676110e. E 1515662451ee EE Date Accrual Maturity Price $25. 08/1976 __ 08/2006. $18.75 $117.57 _. $25 08/1976 _ 08/2006 $18.75 _ $117.57 $25: 07/1976 07/2006_. . $18.75 $117.57 $25; 06/1976 06/2006 $18.75: . $117.59 $25 05/1976 05/2006 $18.75, $117.29 $25. 06/1976 06/2006 $18.75 $117.59 $25. _01/1976 01/2006 $18.75 $116.01 2 $ 5 2 1976 0 / 02 2006 / _ 18.75 - $ 116.01 $ _ _._ . $25 07/1976 :,. 07/2006 $18.75 ...__$117.57 $25 12/1975 12/2005 $18.75 $116.00 $25 01/1976 ' 01/2006. $18.75. $116.01 $25 11/1975 ' 11/2005 $18.75; $115.71 $25; 11/1975 11/2005; $18.75 $115.71; $25. 10/1975 " _ 10/2005, $18.75" $114.40: $25 12/1975 12/2005 $18.75 _$116.00 __ $50; 09/1993 .03/2010 09/2023 $25.00. $23.54,. 1. 5 Totals for 16 Bonds 5306.25 $1,772.14 Notes NI `Not Issued NE .Not eligible .for payment _ P5 Includes 3 month interest penalty MA Matured and not earnin interest Value $136.32 MA $136.32. MA ' $136.32 _. MA $136.34.. MA $136.04 MA $136.34 MA $134.76; MA $134.76: MA $136.32. MA $134.75 _. MA $134.76 MA $134.46' MA $134.46 MA ' $133.15 _ MA __ $134.75 MA $48.54 _ __._ ~z_e~A_39 l+t4n•//~srtanir lraac~irv~ira~rt an[7~~~QRrPr1(:P. 3~S~ZUlU S...- !~ e i~~~ u ~~ SS Q. ,+,.:( ~' r .~~ 4kW7EPE J~ .,;, BALL e, n y` ++1\w~~nc.~ n~~ '~ AT 2HS OtiiG#NAL NATV?.(7Y N6REOF WILL PAY ~~ ISSUE DATE WNiLY iS 7}iF F!R57 GAY OF iJ J l ~. .I. i v ~4MOl~T'N) _ _ ~ ~ :. YEAP t _ '~a'~~~"`~it~~SU w!., ~~ 3~ 2i~ A , r ~ MlF j. ~,`.i {.~li :3 'J ~~ ,~~~~~ p t ~,~ f ~JFLBIG1tSlc-' adc~'~SJ ~~ ~ ~~ .. ~ ~ V it ---- I ~MOOIOY{D Vf0[~aAO VII RTM 10110 aT. •S ~MOn1W.~gO0'+0- "_ nt-mm~ *ulru aeconwrioa sixce . R ~ma ~c wuo enr n o1.t in- a r Q _xwro~lua wOM. aoxur[1mw~ nsY1R nmtrt Tlm0'1M~. ^.-y.- arcASiR'recRlRrutR'r ~ ~ -. CI _. .. _ } ~~~~ ~ ~~~../~,/ti-,,~,~J'~ AT T11t OR1O#NAL MATURTY NRIItOP WILL Mr. ~ ,,_ .-, ~~i~~~~~~.~ ~ ~~ .,cssu~FnA pe of ~, 185-12-5665 Ta ~R GLEN R N~i7,N ~7' _ 197.5 ,: (~ n --- - - V ~VX ~~J ~(NOti'TNl _~~ lYEAR7 °~ SHI~'PER#S£SURG PA 1725? .'`5 ~A1f~N~S Ohm ~~S•U P~~ yG~fi(ryy35T-127 14 L~V *.STA~~ ~~. .;., ?~~ ~'a~, ; '~ - - I~`i~ nsw~oraamwnwmamer ww~e+,a.+erw~l+estw. ~, ~ t"ti'EPE"7De! .~ HALL ~,, rx ~;:. y' bp'"~ saao m raM''~« Ieuoww lneo.e~°1~ni ! r ~ ~~ 1 ~ ~~~ ~ u S._ ~ i> 0~. ' y '~+5 t-.,.,.r-/'~/` A7 T~NtP~fO7~'IAIWNAL MATURITY NtRtpF W~I1L^~LSP~AtY~ ~~.;~ _ ,~:.'~ .. ~Q .gg~~g~~}i.~LL cc~`~^ CFI 1,9 NE fR5 0 ~ OF ,4't ~ ~•'~r ~~~~~r'V ~L7 ~~~ ~~i..~~ f~.A3'.w7 A~k ~.iY~ ~~ t.~ t :z, '~ MSS .~~,tiET ~ ±ap~~ ~ UDC 397,E !~° p ~T. ~~~_ F` h .'. - ~. z ! 4EPEkD £ NACL ?_ ~~evnw°~Oi MOr~.wsniai~ ~. ~ ~ y .~ ~' ret .,r ''1 . ~ wYwtlOO>wR+sU1t • . ~.. #M+aM1~i Mon ~irnu. _ ,:_~ .a';.., :.d'i ?...i ~:~ F.lr. - sc+~us.no o.su..ws e[wwen ~..,~ _.'l ~ ... ± ,~ ~ .._ -< _~,! - ~ ~"sue AT THE ORIGINAL .MATURITY NEREOF WILL PAY ~~„/~~,,,~~~1 ISSUE DATE wlalcrl Is 7Hc FIRST DAY CF To :.~v-~12-5bCa ~ Q ~3~~ 15? St!iF~~~S~URG ?~ 3.7,~~? ti .I'S SA112~vt~~ P J ~, Ei I(~ 3 ~~I~~~ ~9~5 ~#A~v~~' s ~~~6~i 2~;,Nt3U 19~~ . - MIaaOM049101ta OMDA YIMOI~T'M a0M0 )R.MlMAO)D, •Ma4)Oa~ ~i. ' }q ',. HRIP TMt TtMMl MDtO~an~plf )MT[O R wLL at wW0 OMIT iI 0.N ~M _.:. . - .. arnaa..e oacs..Mea)urtlnaar ralanw lNCO.rgr wrNU.+sNmea. (,_ w .. . + 4 e /1N'Aa{111'/ OOMM(OT ':.... h//_//" _ . IIAfMINOTON :i II AT TMe ORIWRA4 MATURITY NERLOF 1MLL ~MY [ ~,~~ ~ ISSUE DATE ~ ~ ~ ~ ~ 2 ~ ~ ~ ~ ~ iCF( IS THE F!RST DAY OE Ta #'~°~: Gi.~~ P, ~!~t?P9 Jl~i~ 197E ~ €~ ~CX 253 -~ ~Fr-___~-;r~I-- ..7'31+~~'G~1J~:V R; !3 ~. 1'7 Z~"~ vRl~ll~~~~'.~~3++A Yli~I V'.,~- ' ~' ''~hb~edY.ly Ac~lil~ r~L A, y 3"i?~ -- - _- -- ~~^'q ~~ f C ~~~ ~ ' A7A~7 .7NE ORtOtNAI MATURITY HEREOF YVILL PAY ~`~ ~.F3f3'-12~M5666 ~° h~z~L~~y.~~kicc~2 Ht~-~P.i 4 ^ ..{. 1 ~~~ ~"~ ~ ~ ,, S ~s ~!i ~. ~ v 4'~ ~ err $..~~,, swaowelnwa+oneAVMNnnvar, ;, mrw>tTUnu.MatoManTOlq ante, "Srn 1CbtY •MO OKt0. MOaWKtlb Maly ~'+~,.Y'~n 71KMfR/OLMUOM[IIT ipONIMOtON . n ala~it w.,~e a«<~r Klo~aalNa_. ISSUE DATE ICH IS THE ft457 DAY OF ~~ ~ ~ ~~? ~(M~o~TN:.~~~~~~ ~lTJlR7__ ~+fl 3a~LvSYl~t fi' ~~,~qq~~~qgl~~~~~~ 3R ~'.~ JH~IV a.r~~ l ~+.' I ---- ~~,, )NraaMesgso omta NliNOalnea eow Aer.uaNC+etgaNasaua. nerTe nltTta.rrroceMarlge) .nwuae.AUaewrveuar..- ...- ~~~ f sewo~Na awm..weatinw wvur. .ew)nr *rawa. Y'S..:°'t' ~ -. Y '"~ '`-k F ~"~- wawMOOaRr~tNr - ~_- _ ~_~ A7 THE ORIGINAL MATURITY HEREOF W:l~ RAY 188-12-~~b~ ': c~ ~ P C3 I~~ X. .15.E i :. p c i~ r ... a' 2` ~ir~l.ly ~~ ; a~ ~..- ~~~ yC l~ %1 ~ ~~ V~"9 ! Z `ai .gyp y~ /~' T^ .~AN~~ ~ ~fi~~ e , ,awnvor••uno.r. or w-+am:~•e+~asaa.. ea rs.u y~~ ~ C. [ af.~^3 nwy Cd~O„gN5 f••1[e Or / , fie!, ~!a nc ec ••o oa:o. a.o awrtaoe+• rou K ~. « '~^' was.ms-nv ~/~_ 1. 7 _ _. ~ Y _. 1 V.vmiw.rug+ . AT THE OR161NAL MATURITY MERIGOF WILL PAY ~ ~~ ~.~~"~.~`^ 666 Ta M~ G~.Et R ?~G~A v 2C~ 15'3 s~zF~~~s~~~ ~ ~:~ z~~~~ HOC i~RS ~~~~~ ~ ~p=P~; R, neaeaNOn,remoeml•oinoerr.ee earo Ne+aa Mae+eo[O.awowe- S'~~F JRfAMIatlYaa aNetO.ellleea l[Nl0 .Rarpy e[.aw OKT •eaaT ~.y _ etlaep Mee..m..«D mnweer•N R[caH [Nolan AtaAeR 1RfAfYR'f Ol1eRIMirt[ r ' S SNDefc~QElNtE hAL4 ~- > > d _ i ..t-, AT TNt OR1611+AL. MATVRITY NEREOP W14. PAYa ~~-liiR~ 1£s~-12-7~b5 To ~~ vL~.ty c; *~.Q?P P U ?Cyr 3.53 ,I-'~~~.~P~f~a~~;~l~ Ala Pty ~,~G?~ 7 f ~~ ~.7 ~/ N ~ i. #'.7 ~ ~D r ~V ^, :ssv~ c~,Y~ tirEic a .._ ~, - , .: ~s _ ~I t3;~ JRNI1?dtiS z ~~'~~~ 4C £i 1~-: AtaUL -~: X376 I a r x~~ ISSUE DATE VYNtC4E iS iHF..F(~ST DAY OF a ~'~ V aa~6 AQpijt".p V } C~GT 3~°1?7 1~.~ ~"~ ~Ai 97'6 ISSUE DATE 11YFItLH IS THE FIRST OAY OF k~ 1 ~?~Es U~rs SQVI~~3S lase ~"'~.?~ ow- N c~:z~•r t'r`p 71peD11Dla'RevmbNp[Il alrRlown Ot eoNe ,aec YaYn101p. afle6ale• :,IQE~~V <.E tiD. L ,~-„- r~'^'. x[rae+neluaw•eeeo.omewsa ao..n+,wea.weo.aTRwu III eaelm aro oNrm. Nre e[wa.meT aca.r llw[a wmvoR. -y .. '^' J ^~ - 1F,f ~ "~~ VLA}IRteWInMiNT ~[..r~' •..• •. '~, tel:{ t ~ '~q *>,, ` w•wvHroR ~.a !+C" AT THE ORIGINAL MATURITY HEREOF WILL hAY ti ,^ f~-, 4 ~ rr~~ `a +~`~+: '~.~: *~ .-~ WHI_HiS THE :~IN.ST DF.Y OE ~` !~ { ~ (MONTFN) ~~~ :YLARI~r G ~~~ ~ .. a- INREPE DENCB HALL ~' ~. ~ C ,~,~ ~`' Iii ~ tt U 1'4 i~ ~: ~'• J~/ illlsrMNalRNm nnesN AVIIgRIIT OS ~wloAn,AtA.tNam.ANenaw- ~'-`~a mrlo Ta,~ nNNa Awoeisngns snore ~wu ~s vAUe owar n oua A senAm ANO O.t[e.ua eunae~rw wwlNS Ntttror rma+r drwroN -~.~.. t iEAtYRP 0[NaRtN[NL trASllmaton ~~_ ~L' n_ ~~ ct>~a AD?r~ ~'T AG~'~ z..12'° ~ a sT~+r .~ I~~~ AT TN[ ORIGINAL MATURITY HEREOF Will PAY TO i~((~~ (v~'~yCi.9~i ~ ~~?~l~i i' i1 ~ V X Z. r s=~I~~r~si3~.li;u Pk 17.257 ~~u taswwnruoto urgtn AVnloNmer Belle wer. AS AwNem.ANeawr lYDEPEM HCE HALL ~ '~ RT'O TMe+tns Aweenomeet tTAne rt Mu. nt rAUO Mar n Dear ~+ iCNreLD NO OAHp. Ann e[UVtM.nMAN IpNMI~(t~p~yyMtN{iNARpN, ! '°-'•^~ -^' ,:h ~~ TMAfeRY OtwInMtNT !/v'///~ ~^ '" G "J1 ~~~ AT THE ORIGINAL MATURITY N[REOF WiLL /AY J.8G7'12-566V To P'!iZ 6LEf+j R N(3RN ~ a snx ~~~ S~I~'PEiti~~Ui2~ €~A 17257 P+3 #~ ~ S ~i A N 1E ~' u H (~;~~i INpEPE DENCE HALL ~.,~ {'~~~',,Iy MWNOKIYbW WINAYNI0wN01 sONf1 ACT. UAMOIOm.AW S/O-~ AlAlO nlt iU111{MOCdWNNlq mete Rtwk ei vAYO Mar li elR'I INS 3 aeNRw Ano owno. Ano onntNroniw no ~lur,a rnweM rxenelow. i~~. Tl4Nf17 DLRIIITMtNT WA4NINOTpN ~ .., _. _. ISSU''E DATE WHICH IS THE E1P.5T DAY OE hlAY '' ?76__ ~, SA Y~~'i 13Q E,b N It~~7 ~; A~GT ~ 312? 2t )~8,~~7 ,~ ~' -- IS SUE DATE WBlCH S THE FIRST CAY CF ]]i'N .~~ __ 76 ~ ~ H 11-~~~ ARI~.. ( ~;'s s~vzr~~,s ~a ~ AE57 w7~i A Gi' 3- 2~ ~ ;` 0'2 .9Ti~P9 7,-~ ---- ~ ?` ,.~ ''J~~- I4`4 ' '-~ AT THE O IGINAL R MATVRIT M F W[ RE O • ... . ~ ..~ LLp P,{A~Y ~,g x ~ p '° ~. y ^F~y g j.,q '~E~i~~.7['r~r~,Yli~~I_:,1 ~~IIJ~a171~+L7e`A i~ ~ ~ ~ ~ r /. -... ~ $$^~ E IDe4 , t -~c ~ .. . ..,:- ~F 7 I r 19kC F if O : ~r ~, 'S EST J N H) ,~_-~ P• r' `'. .F+ 4 ~ ~.._ rt ~ V ~~L' A~~~~~ ~ :1 ~ r .' .wW I l.A ~/ ~ f. J ~ T.J ,* - ~ - '~i'' ~. ~.E F+? ~~ a'"`5 T'N g^q ~^cr tln)ODNDK~)T )D VNDIa w'JrYOYrv Or '•WnD nCf, A4 •arN9Tl, •.D P. Sf~!- F'y'~ [ .«[*eaea •NO eommow )rno rwnl .e .. o! nuo ~",y~ )c la.NO D•rYD.InD a:wcam lr• ~ol:o+,na rcn ~. :r.. A '1r[rsu.. a[wNr.[NS ~^ ~ . ' _ ' ~ <~, AT TM[ OR161NAL MATURITY NEREOP WILL PAY ~^~, _ ~i^~-. ~yy~'~} [~~Ey~ t'. "Ir IS LFE DATE ~.+1.'~~~~ ~~~1`l~'~~~~ ~.a~ WH1~H l tHE FIRi; <1FY D~ .~ i ~ 3 _.. ... , K ffi32V _~i~7..~._ ~ y e'6~ ~~ry~~~~~, R ~Q~ ~ T f ~.II. .~ ~ ,S ~! ?Y ti i~ ~~ i? ~.' sJ 1 7~~' :l /i Is1n` F Jc\GF A ~, .,,~ r.x)eonewnwco uaocN w-NDNrtr olr. ar.e.n. w.NC DCe o)+u~- Y• ~, y~111~~~~' J[DrM'N[Tfeq •wO CONDnRR fr.RD [lOr.nw:l !)•M•D i~ 5,~,~b ,cNflco•nootto..NDOtIn[amw• ralo+.i.=v 3•~w.l .w%m. - ~L. S raAwF+DCmNr.cnr // ^ ;r^,. -- I i r W.SM~~9rOY F•f ~ •. ~ /' ...r^' -.. -+e ~ 1 ~ _ 4 ~.r i~~ ... -~J:~ rr~inm y ~ q~•o,F y,.~, a a .t'A ~i w.n.•rarrw•••awimn•••wRSSRr ~'.. 4 ' / ~/ _~~../~J - `~.~~ ,,,s a; _ ..~,.<<; :~,~ s" AT THE OR161NAL MATURITY HEREOF WILL FAT ~, ~ °`~y ~~ ~q~~~ r~l~ t ~~ ~~~.~~~ ' ~ n Iss uE DaTE . _~ 'a v ~"` ...a.,,,'•• -.~.w,~. r .. ~r r WHICH ISI .~N[FIRS; [~P,Y Or ~' To 18ti-32--56x,6 it ti S ~; x P i' ~~ #~ ,i:~ ~.rt G ;~._~ ~. ? 2 5 7 l1 .S a4 ~t I £V G~ !-~~ f ~9~Ni3 ~~~-~~s~ar~~; t' U A n~ ~ ~1 s~n~ `. J -. eA Inro ry;. A f F iV!pE!' ~OFNCE HALL ,1q rpS lpfO ii ~f)VID VNp "~ nnro r«c nN.!lNOa f s<m)D •rD ewro..Nl -'. ~'~R x yF TN[nwyar 0lMN>M[Nr -. a... is .f.M i~l +Y,.l. ..~ T1rfY ~ G ~ _ ___ _ _ __ ..,:: _ _._._..___--. -._- us~N Nc •.cN ~o. •ao n loo- _ n~wu is :use o a~ • ~N- .QpNaiN.Yt~~Ck. M i o9/oa/solo Tgv e: a9 FAx ,.~ ~oozioo3 F & M Ti'uSt CO, STATEN N O F ACCOUNT CIOSSif1$ 33-04957 ~~ ~6>111'llf~is`tQY C1~1f0 . '+~~ ~ 1~$ STA E NT PERIOD FRO THROUGH 01-1 1 ~ 02.15-10 """""""'AUTO"5-0IGIT 17257 ' 1703 0.7150 AV 0.335 81 112 PAGE 1 of 2 1 ~- GLEN R HORN JANET G HORN 38 HORN RD ENGL U ES 3 SHlPPENSBURG PA 17257 9752 5 GO CLUB t~GULAR CHEGKING ACCOUNT: 33-04937 BEGINNING DEPCs31TS/ CHECKS/ SERVICE BAtANCE NUMBER CREDffS NUMBER DEBITS FEES 4,004.43 1 992.59 4 231.49 .00 ACTMTY DATE DESCRIPTION CREDITS DEBITS 01-14 BEGINFRNG BALANCE O1-s9 DEP05IT 003003.03616 992.59 PYNR OX-20 2 00077900000 56.76 2 45 01-20 CHECK 2z4z 00400002474 4.00 O1-Z]. cKECic 2246 00500407085 160.73 01-26 CHECK 2247 00300406674 10.00 02-15 ENDING BALANCE CHECKS * - derwtes miS6ing check number in sequence R -denotes returned check CHECK NO AMOUNT CHECK NO AMOUNT CHECK NO 7142 4.00 2246 160.73 2245 ~ 56.76 2247 1 D.00 TOTAL NUMBER OF CHECKS 4 TOTAL AMOUNT OF CHECKS SERVICE FEE BALANCE INFORMATION FROM 1-14-10 THROUGH 2-15-10 AVERAGE L.EDC3ER BALANCE 4,863.92 AVERAGE COLLECTED BALD MINIMUM LEDGER BALANCE 4,004.43 MINIMUM COLLECTED SALAI ENDING BALANCE 4,765.53 BALANCE 4,004.43 4,997,02 4,936.26 4,775.53 4,765.53 4,765.53 AMOUNT 4,683.92 4,004.43 DIRECT F&M TRUST - NEWVILLE OFFICE fNQU1RIE5'f0: 9 W 81G SPRINQ AVE NEIIWILI.E, PA 17241-1301 TELEPHONE: 717-776-2242 Adams Electric Cooperative, Inc. A Touchstone Ene tative ••--_ August 20, 2010 Patsy Martin 167 Overcash Rd. Chambersburg, PA 17202 RE: Glen R. Hom, #41623350 Dear Patsy: 1338 Biglerville Road, P.O. Box 1055 Gettysburg, PA 17325-1055 717/334-9211 www.adamsec.coop This letter is regarding the above estate and the status of patronage capital derived d>~rirhg the years in which electric service was received from Adams Electric Cooperative, lnc. The Cooperative has made special retirements of patronage capital to estates on a dis o~.lnted lump sum basis. Both the general and special retirements are subject to annual authorization by the C operative's Boazd of Directors. The special lump sum early retirement of an estate's patronage capital discounts the tired patronage capital for each year that such amounts are paid in advance. Applying the process to this est tee's patronage capital yields an approximate lump sum amount of $535.07. In order for the Cooperative to provide the special retirement, please: 1. Complete the enclosed Legal Statement (s) and sign in the presence of a 2. Return the Legal Statement (s) in the enclosed postage-paid envelope. 3. Provide proof of death, example copy of death certificate(s). If you have any questions, please let us know. Sincerely, r A e E. Smith Billing Coordinator Enclosure ~tlblic. I ~, D1strlCt Off1CeS - I 1380 Biglerville Road, P.O. Boz 1055 204 West King Stteet I 200 Trinity Road Gettysburg, PA 17325-1055 Shippensbwrg, PA 17257-1126 York, PA 17408-8964 717/334-2171 7171532-2214 II ~t~no~_z~ ~d 9e~ ~f~;a~ ~ 1921 Ritner Highway Carlisle, PA 17013 717-243-3541 Fax:717-243-4495 r~l 1, 2010 Deaz Mr. Allshouse, In reference to your letter regarding the remaining lots that were owned y 'IGlen and Janet Horn. We aze strictly prohibited from "buying back" cemetery prope .!, However, the family is free to sell these spaces privately if they so wish. As it stands, these two remaining spaces aze owned equally amongst all remaining children. Each nmust sign offin order for them to be sold. Sign offpaperwork will be provided by o o ce when an actual buyer is found. The two remaining lots in The Last Supper, Lot #119C, #3,4 currently re per space. My best advice would be to privately advertise them in the local for sale if no one in the family is interested in owning them. If you have any additional questions, please do not hesitate to contact S' erely, Ginny A. Weller Administrator for $1295 STONEMOR PARTNERS, L.P. OSIRIS HOLDING of PENNSYLVANIA, INC. so-,eeo/s,3 4 5 5 WARREN TOWNSHIP BURIAL ASSOCIATION DATE ~ ~ '~ PAY TO THE y~ ' ORDER OF a~.Sa 1 l \CLR~ ~ ~ ~ ~ . O O C GG 5 ~fycY ~ ~~ ~-~~ ~ 1 A,~fL,LY~.~ ".~ i c7 ~' a 0 LLARS L! ' ~ WER _! ~ -iANK- ~i ApY01O1QW17f[OR 1NQ t~o6iSSm~' /Ga/ ur ~~:0313i890.?~: 0000508462' 0455 ~Ulc-~ c-~ ~lSS ~. ~ec„It ~}~,~- 4,Ro c c` ~- ~ a~. ~'J-e-l c~ ~ c ''~~ J~ 31 "1_:.~~. C.~„~-e. Wes. II so-~~3,3 4 5 0 WARREN TOWNSHIP BURIAL ASSOCIATION °D0°5°~ t DATE ~ y ! ~ ^ I C3 II e / . ,... ~ PAY TO THE -^v~ „ ,~,1~.~„~ ~ ~ ~.A ~ ~G ~ C' G ORDER OF C e ~ > >Li[. < ~ M ' ~ ' ;,gin ~,~ 4 ~..~-~ ~Y.s~~= t -" ~Z X C~ DOLLARS e..-, ~ . eat+aa. .. the ~ 4 M~uo Q s 4m~ ~ ~ ~ -_----------r~ - --~~'---- •r ~:O 3 i 309440+: 0000 50846 2n' 04 SU.~ ', COMMUNITY OFFICES IN FRANKLIN, CUMBERLAND, FULTON AND HUNTINGDON COUNTIES www.fmtrustonline.com ~**AUTO*'S-DIGIT -17202 1534 0.7150 AV 0.335 6 1 136 i~~~lll~~~i~~l~lll~~~~~l~ll~l~~~~l~lll~~~l~l~~~ll~~i~~~i~l~l~l 2 8 5 0 JANET G HORN ESTATE PATSY ANN MARTIN EXECUTRIX 167 OVERCASH RD CHAMBERSBURG PA 17202-9209 ACCOUNT: 11-29864 DEPOSITS/ CHECKS/ CREDITS NUMBER DEBITS 25U.00 1 45.84 5 STATEMENT OF ACCOUNT 11-29864 ESTATE ACCOUNT BEGINNING BALANCE NUMBER 10,815.81 1 ACTMTY DATE DESCRIPTION CREDITS 07-02 BEGINNING t3i~LANCE 7-01 PA TREASURY DEPT 00077900000 2.,.0.00 REVENUE 100701 188125666011180 07-21 CHECK 111 00400000587 07-31 ENDING BALANCE CHECKS * -denotes missing check number in sequence R -denotes returned check CHECK NO AMOUNT CHECK NO AMOUNT CHECK NO 111 45.84 TOTAL NUMBER OF CHECKS 1 TOTAL AMOUNT OF CHECKS SERVICE FEE BALANCE INFORMATION FROM 7-01-10 THROUGH 7-31-10 AVERAGE LEDGER BALANCE 1.1,049.54 AVERAGE COLLECTED MINIMUM LEDGER BALANCE 11,019.97 MINIMUM COLLECTED AVG. INVESTABLE BALANCE 11,049.54 A~'EMENT PERIOD OM THROUGH 01-10 07-31-10 1 of 2 1 ENDING BALANCE 11,019.97 BALANCE i0,8i5.8~. 11,065.81 11,019.97 11,019.97 45.84 it ~j I DIRECT F&M TRUST -CARLISLE CROSSING OFFI E INQUIRIES TO: '214 WESTMINSTER DR CARLISLE PA 17013 TELEPHONE: 717-263-2215 DEBITS 45.84 AMOUNT 11,049.54 11,019.97 ~~ ~':~' ,_,.~ ~-.~ 000 Property Tex or ReM Check your IabN for arxwacy. rr ~~ Your Social Security Number t ~ ~ l •• / .'~ ' Last Name ~1 0905010013 .~~lry- 6009 rnct, do not ese tM hbet. CompNte Part A. Spouse's Social Security Number r ., ti, First Name ~~ ~~wrowwn ff 8pwu:• is Deceased, till in the oval. t= [T.D -~~ t xis ~ ~ 38RHORNERDR ~ ~~ SHIPPENSBURG PA 17257-9752 i ~ ~ ~~ ~ y Spouse's First Name MI County Code School DiaMct Code Qv Ciaims~t's BkUrdate spouse's Birthda/e Daytime Telaptwne Number TOTAL INCOME received by you and your spouse during 2009 ~ ~~ ~ ~ 4. Social Security. SSI and SSP Income (Total benefits $ i , ,~ ~ ~ ~ divided by 2) .......... 4. 5. Railroad Retirement Tier 1 Benefits (Tolal benefits S ~ ~ ~. divided by 2) ............ 5. • 6. Penaton, Annuity, IRA Disu~utions and Vegans' Disability Benefits (Use 10896 of ZOQ9 Raihoeci Retirement Tier 2 BerrefiW) ........................................................... 8. an< '*~eecSen. 1. 1 am 1Minp far a rebels as a: P. ~-Sse R Ranter-See ~ B. ~ -See 2 t Certify that as of Dec. 31, 2009, t era a: A. claimant aye Os or older +~ B. CWnant under aye ~, with a epeua aye OS or alder who rasWed ~ the same household C. YYkbw or widower, age sa~~ ,~ o. P.rm.nenay disabNd and aye 18 /o W 3. 'i have you ntceived Properly TadRant ftabalae to Ole peat? 1; Yes ® 2. No (see iratrucdons) • Jtuts 30, ZD10. Dollars Cents ~ ~, • ..~- -. T. Interest and Dividend ir-corrre ...................................................... 7. 8. t3ain or Loss on the Sale a Exchange of Property.....:... tf a loss, fiN in this Duet. ... , woes p 8. 9. Net Rental lnoor-w3 or Loss ........................... If a bss, fill in this Duel. ...: Loea O 9. 10. Net Business Income or Loss ......................... if a loss. fiN in this oval. .... joss p 10. t~Ltt~in .Itemize the amounts received from each of the sources listed below. ~ 11a and estate and heat ir~oorrre a b as ~ i 11 S h ...................... . e, omr , , aa, way ~ a. a r ~ 11b. tiattrbllrrg and Lottery whrdrge, tnGNrdirp f+A Loldry wbxrkrys, Prize wMninys and Are value 11b. of oNter prizes .... . ............................................................ 311c. Value of lMraritangs, atirnorry and spousal euPpaL .................................... 11e. g 11d Cash pWsrc asaistanoNtsOsf. UrarrrploymaM corapernadon and workers' comperaafion, ~ exoeptfleeAon mac)beryls ....................................................... 11d. O ~ 11e. t3roes anaant of lose of time &arrrance btrreA6s and dWbiNly Maunnaa beneiks, 11s d ! d th b fit f I l h is 000 ! . s........... ene paynar o a ea e Ant t o t- arrd Ns iraunrroe banaRb, exppt t , mae flan 1300, except yiRs between 3 11f. .............................................. 11f. rnenirers of hotgehoW. ealhneous insane thst ie not Hated above........... ................................ 11g. 11y. ~ 11. Other Income. Enter the total of lines 11a through 11g . ............................. ... 11. 12. TOTAL INCOME. Add only the positive income amounts from Unss 4 through 11. ff your total income exceeds i3S,000, you may not claim a nababe .................. ... 12. s II~iPOIiTAAIT: You must submit proof of the income you reported -See the Instrucfions on Pages B and •.:~ ~;3 • '~ ~ ~'~ f~ "i `a ~, • •; a ~ ~'`b'~.a D905010D13 D905D7~0~113 J ~-. ~ o0o soo9 Your Social Security Number f ~~ ~ PROPERTY OWNERS ONLY 0905120010 You' Name: ~ z '~ t `t ',Y - t ~ r - - 13. Total 2009 property tax. Submit copies of receipbed tax bNls. ........................... 13. 14. Property Tax Rebels. Compa+e Line 13 to fibs maxhrtum rebate amount determined by your income level in Table A and enNr the lesser amount . .................................... 14. RENTER8 ONLY 15. Tota12009 rent paid. Submit Rent Certlilcab and/or rent ~Pa ......................... 15. 16. tiAtrlt~ly t.irte 15 by 20 peroartt (020) ................................................ 16. 17. Rent Kebabs. Cornpen+e Line 16 fi the maximum r+ebabe amount determined by your income level in Tabb B and enter the lesser sertotmt . .............................................. 17. OWNER -RENTER ONLY 18. Properly TaotlRent Rebaba. Add Lines 14 and 17. then compare total to the maximum rebate amount determined bIl your inoonte level in Tattle A and enter the lesser amount .............. 18. DIRECT DEP08R in order tD comply with new baMdrlg rules, direct deposits d rehabs chedks ere not for rebates going bo beMk accounts outside the U.S. Da not complete the dtred deposit Lines 19, 20 and 21 in a chalk ham the Department. ff your rebate roll be going to a beutk aaxturtt within the U.S., you have tl~e option to have your rebate check ff you want the Dsparhnent ~ dkectly deposit your rebate check into. your checking or savings account, complete Litres 19.20 and 21. 19. Plaos an X in one box to authorize the Department of Revenue to direc0y deposit your rebate i9. into your . ...................................................................... Z0. Routing number. Enter in boxes to the right ................................... 20. 21. Aaount number. Enter in boxes to the right. ......... 21. QtWFiERS QNL~: If ytatt are ailglble for a suppfementai payment above the trta.:ilnutxl rek-ats, tl-e i)apatirrtartt vviti calculate it for you. c-::~ ~:. and you will receive r~tly deposited. cnec~r>g -. Savings TABLE A -OWNERS ONLY ~ M TABLE 8 - ONLY lflfAME LEVEL Mttxirr~ i N~CONIE LEVEL 'Rebate $ 0 to $ 8.000 $650 $ 0 to $ 8,000 ' $650 $ 8,001 to $15,000 $500 $ 8,001 to $15,t>~ $500 $15,001 b0 $18.000 $300 $18,001 to $35,000 $250 M soccessiws clNnt vdtlt Mrletrt to tisfrattd is a nr>aiarreanor ptati:Mble a tnndmtart line of $1,OOe, antNor for up be one year upon corrvidion. TM cithtarR it ako wbject is a paswNy d xf pataat of tits ~nr amount dninMd. CI./-tMANT OAT1f:1 tMelare tlat this ddut k trite, correct and oorrrpielo to the ite~t d my Iatowledge and betNf, and is tits only ciwbn tiled by mambas d my ltattsehotd. t augrorhee tM IM Dap~rbaent d iletialtte access to writ federal and stall Persaal Mwottre Tax my PACE neords, my tyoc>•1 8etxsNy AdrnNthbabort woorrie anrfbr my Depabnatt d PubBc taWNae recorAe. This arxese b for bulb, corrst~+ees aid d the 3nbnnstlort h this dein. ;~ PREMRER: ~ daelere tnt 1 pnpaed s-is ietwr-, end that x is to the best or my la~ovrlaelps and bs~esf, true, correct and complete. Preparer's t3ipnahrre, if olMr than the dahraM rate Name of dalmarrt's power of attamey or . fMSae Qrint. Prapatars Name - pleeae print Teleplwne number or claim~K's prover of nearest rslaeve. pie nunWor IiDrtM eddrees or daMnerK's power d aMorney relstlwe. Pleeee print. CMy or post Orrice 3tsMe i 21P Code Cali 1-888-T2&2937 to check the status of your claim or to update your dr~s. 0905120010 090512 q10 ~~ ~~ I~ ~~ CenturyLink~ Cffi~1TURYT$L, INC . ATTN: Coatroller~s Group P.O. BOX 4065 MONRO$, LA 71211 1-877-386-7151 Document /Date 2000251618 / 03/08/2010 Your vendor nwmber 5oaooo ATTN: Coatroller's Group 00.026304~19y, ~'~~~ P.O. BOX- 4x65 JPMORGAN CffASE BAfJK, #~~ MODFRO$, LA 71211 SlMt RNGELO 88'88/1113 1-87?-385-7151: CenturyL~nk~ Void 'after 90 days 03/08/2010 *** THIRTY-FOTYR USD and 85/100 *** LTSD ******~*****34_85,~ Pay to the order ef: ESTATE OF JANET .HORN 38 HORN RD SHIPPEbTSBLIRG PA 3.7257-9752 ~ ~ Protected by positive pay n'000 26 30;. l9~' !; l Z l 3©Q88D; -iMp 58£]O~l ?9~i ?++' x'0000 14 2 2 28~' ~:0 3 i 1000 4 ?~: 2~ 900 ? 5 iM CONSECO LIFE INSURANCE COMPANY 0 12 2010 11825 N. PENNSYLVANIA ST., CARMEL, IN 46032 VENDOR: PAYEE: ESTATE OF JANET G HORN POL/AGT~: REFUND OF POL>11~ This refund check has been issued as a return of premium due to the death of the insured. If you have any questions, please feel free to contact our Customer Service Department. RFLT02P ~~ DEPOSIT TICKET g° JANET G. HORN ESTATE ~~ PATSY ANN MARTIN EXECUTRIX 167 OVERCASH RD. _ CHAMBERSBURG, PA 17207 - f V DATE ~ ~ -.. _° ° 5 DEPOSITS MAY NOT BE AVAILABLE FOR IMMEDIATE WITHDRAWAL IE 8 m ~ 81ON HERE FOP CA9q gECENED (IF gEO111RED) # cs ~~ ~vww~;~ ~:0 3 1304 306: i 1~ 29864~~• ®CASH - saa~ ~ 313 1~10~K~ SUB 70TA1 - * LESS CASH RECEIVED - 20 CLICA /ASPMA/ ASP / ;..: ,. 0142228.... 18o53o2A ~t.~ 3 i i _.. ~. .. ... --yy I ~y } ~73 _ _ _ .., ,, OFFICE OF FEDERAL EMPLOYEES' GROUP LIFE INSC~R~4NCE STATEMENT OF CLAIM PAYMENT FOR LIFE INSURANCE Claim Number Date of Death and/ or Dismemberment Date of Birth j Name of Insured X0100100118 12-06-2009 02-OS-1924 GLEN R HOR 5R Name of Payee Life Insurance interest I Total Estate of Janet G Horn de $ 4500.00 $ 27. 3 $ 4527.93 THE OFFICE OF FEDERAL EMPLOYEES' GROUP L{FE INSURANCE CANNOT 91ST YOU IN NEGOTIATING THE CHECK. YOU SHOULD CONTACT YOUR LOCAL BANK IN OUR COMMUNITY. We have enclosed a check for your Federal Employees' Group Life '~,lnsurance (FEGLi) claim. If you have questions or need further help, please call the OFEGI~.I customer service toll-free number at 1-800-633-4542. To ensure the timely receipt of year end tax information,. pleas) Fall the OFEGLI customer service toll-free number or write the Office of ~ederal Employee's Group Life insurance to report any change of address.'~Written notification must include the insured's name and. Social Security's ot- C l a i m Number,... -06-2010 Iz~sctsEro~roat 11~11~~~~~~ DETACH HERE Otfitt3 of Fetbral Employees' Qroup Lit@ P.O. Boot 6512 Utica, NY 1350-6512 Claiw Na. Newta at IeamrN 20100100118 GLEN R HORN SR PAY TO THE ORDER ~: oo2es THE BANK OF NEW YORK (DELAWARE) Newark, Delaware 17~ Group No. If Payment lnchides Settlent~tt c Interest It IS Subject to Federal 0017000 and Loci Income Tax Laws. Dete of Bird Date of DaetM lets 02-05-1924 12-06-2009 $ Estate of Janet G Horn decd Patsy A Martin Administrator 167 Overcash Road Chambersburg PA 17202 62-35/311 001222203 Not Vaud Before 1.93 MAY/06/2010 Amount Oallan Ceeta ***4527~t93 ~~ swwm~ i Rick Foreman Auctioneer Au1163L 38b Springfield Rd. Shippensbnrg Pa 17257 (717)776-4602 SETTLEMENT STATEMENT Sale for ~~.~ r,.~., ~ a.,K;~~: ~~ j., z~,. Date ~~ t ~ ~ :~~-~~E Advertising Lanc .Farming ~ i <-~ Guide ~~~~ ~ ~~ V.T.S _~~~ ~4: All other Adv. ,~ ;~s~m ` ` ~~ „~~ k ~ I Sale Flyers y~ ~~.A Total Adv. ,~~,1~ ; .~ ; ~;~s~ ~~1~, ~~~~~~~ Auctioneer Percentage Port a Pot All other Charges Total Adv. Total Expenses SALE TOTAL TOTAL EXPENSES NET SALE Notes Vii! ~:-~ ~~ ~-~ ~-~ ~ ~~ ~ ~ ~'. ~K J .~ ~ / ~ ,-.. C C .~, ~~~ l~-1.3 : ~ c". rs .~:~ ~: ~~:~ ,~S'`C:~ f:3: ~~ ~' 'l ~'" ~' C `~_._..... ~,F~ ~~~~ ~ ~ ~ '~~ ~ _~, , ~a.ck: foreman Auctioneer Au116~I.~ ~~~ Springf~e~d Rd. S~~~apensburg 1'a 1257 ~'~1 "7~~7~~-4602 SE~'LEE~~ STATEN EI~T 1`~~~v~~~"~.5~ '- ~ a ~ ~~ ~ _ ~; ~ ~' S ._._._. z Auctioneer Perce~ntag~ Fort a P'ot Ali other Charles SRt~.~ ~~`P Total Adv. ~ota~ E~~1criSeS SALE T~TA.L TC)TAL ~~~~~~ ?~7ET SALE '~ otes ~ ~ R .. m ~~~~ ~,,. ~~. !- ~~ ~~, :~ Ll ~ u c~ C : ~. s ~, 7~5 ~ $1~. a~ ~q,rc~r- ~~` ~ I a ~,5 ~/Oo . .~ .2F~0 ~Q~ C~~ ~~~~~ ~~ ~ Cvt2.~ ~5~.~~1c r ~ 5~}Y a~ ~~ C~~ Q~~- r-~- ~~` DEPaSIT TICKET ®cASHI- ~~ JANET G. HORN ESTATE ~~~ 3t3 ~ ~~ PATSY ANN MARTIN EXECUTRIX ~ 167 OYERCASH RD. ~ CHAMBER56URG, PA 17201 I~ ~~ 'g~ DATE ' 1~ ~ ~ K DEPOS7S NOT BE AYA! FOR /MNEOUTE WtTHDRAWAt =$ Iomm~~RwoRas „~ SUB TOTAL SRNI HERE fOR CAM1 RECEIVED RF REOWREOI w ~~ * L~S~ CASH IYED ~~ E E `~ '• ~ ~ ~'{ '' c 1 f ~V ~ 1 w~ww.imau~MM.cOm ~oo,p B 4 .0 t? i:0 3 1 304 306: 11p(29864x" 20 w~ DEPOSIT TICKET r~/=~cnss+- ~~ JANET G. MORN ESTATE 60=4301 ' ~p PATSY ANN MARTIN EXECUTRIX 313 167 oveRCASH RD. ~ (a s V ~ a O __~______ CHAMBERSBURG, PA 17201 _ ` x e~§ DATE = j ~ DEPOSITS MAY NOT B AfLABLE FOR IMMEDIATE WITHDRAWAL ~ 8 ~ ICR MfN.RWYMI6RlOEI `~ SU8 TOTAL - `~. `~ 8168 MERE ROR CABN RECEIVED pF REQUIRED) M '. ~ ~~ ~ LESgg CCASH ~S RECEIVED - I ~ : 3 •r~w. S~ www.lmWgonrnicom V~ ~ .7 . S ~ n u x:03 L304306~: i i~E(29864n' 20 U 1 ~ ~ ~ 1~a1 1 Ct, ~1 ri, ~~ ~,v-e, ~ t ~~so, C~ ....-~ ~ ~ 1 4 ~ ~ r r4~C3 ~ ~v~ ~ a i ~1 I w-C ~~e C~e ~ G o~ ~~. 1 ~ w~ i ~,a,~ ~~w~ ~~~ X650. ~~~ ROBERT LEE MARTIN, JR o2-~ lb7 OVERCASH ROAD CHAMBERSBURG, PA 17202 s _ .. s~,s °2 19 4 7 ,~ -3 ~-~ a I _ ~. $ (~~, ~~U~~~ t 1~ ~ `~` Freedom ~~ ~a ~ FhBt _ ~ RV~71 ~ ~o ~ J ~ ~-~2 ~~~/~ ~ ~:03L304306~: 32~5390~~' L9ti? ~a~~ C~c~; c-t... 1b 1 b --~r'-a.~-~oc- C'o~ S~.a-~ ~ ,~ ~~'~~%~ '" 1 ~ ~ ~ ~ 1. ~~w,(,(,~ 1. ` ~ *1,::~~ (y ~SOL? CHRISTINA K NEWCOMER oalu so-~eso/s~3 I J 11, 9266 GAP ROAD WAYNESBORO, PA 17268 DATE ~ L ~ y 4C r / (" J/ ~ IAYTOTfiE ~F ~~ ~-~ ~ ~ ~U f / ORDER OF e t .-~ ~ c ~~ ~ j ~~ J ~ ,. ,,,,• ~'"7U'~= ~1.1.z.',~1':.,~' !(.J~l~.~ '//"~L' ~ DOLLARS pp W ~„~ ~ W E R /^ ~~~J '~~~[/~ ~j~'~'~ pp AVNIIO~Q WfIIG~[7DA1 M11[ ~j ~ ten, MEMO ~ ~~~ M ~:03L3i8907~: 36i000i392~~' OSii JANETTE L~AS~IN~T 929,N. WEST STREET ` , CARL15Lf, PA 17013 •~'' ~~: ~- '~~ ;f,/~ ~J DEPOSIT TICKET ® y ~€ ~g JANET G. BORN ESTATE 631 ' ~° PATSY ANN MARTIN EXECUTRIX ~ 3 ~ •t, [;_ 167 QVERCASH AD. ~~ CHAMBERSBURG, PA 17201 • Y =s`= DATE =By€ DEPOS-TS MAY NOT 8E AYA/LABLE FOq 1MMEDlATE N7THDAAWAL S~ (OR IOINFlpIO11QA ~g SUB TOTA - • 910111tlnE son dlfM REC6YED (~s REOUREGI +t se - gg * RECEPVE - 20 F 2 ,~ ~-~ .~ ~~, ~, ~~ It ~ ~~ v , ~~~ Z~, d o -~---~_~~}~-._.~.,.__..w_.__--~_- _ ~ ,~.. ~•- 2064 60.13?, 24!?313 op.n~+t «nis Tn.ury-i,wrNi Rw~nu. senefos ! J ~ 1 U.S. individual Income lax Return ~,~~~ iRS t)seorey-DO net vrrite cr~tapls„„~,~. ^ ^ For the vrr Jan. t-Dec 31 _' 006. a oMie-tax veer haoirifo _2009. aryirn ?0 nun w ~ cwcmve iI.,CIL7t;•r1 ~ Yaur first name and initial Last nartre l ~ our sooW saaa9gt raariber e ~ ' ~ '' fig; ~~ S~ 6(~ On papa 14.) rehar-, spouse's first nerve and irdtlal E If a last Patna ~ • ewdM ssourlty number Use life IRS ~ ~ ~ /+, ) } ~~~14' / ~~ ~~ ~L~ ~. H Homo addra~ (rwrrtber and stresq. ff you have a P.O. txnc, see page 14. Apt. -to. I '' You rrttiet enter Oth811Ni9@. E ~-..- ' your SSN(s) above. leeae ~nt R ~ E City. town pr posYof0oe, state. a~nwd ZIP cpocb. q you have a foAroigr- address, see papa 14. type ~ a !~ below wNl not ~ S ~ M •~T :..) Prrteklerrtlal your teX or refund. 9eCtiort ~ Check here . or if .want X3 to t0 this fund 14 - You ^ spouse ~~ ~$ 1 ^ Single 4 ^ Head of household (whh perstx>y. (3ee page 15.) if the 2 ,~. Married filing jointly (even if only one had irxxxrte) qusti(yNrg person b a cd~pd nbt your dependent, enter this Check only one 3. ~ Married filing separately. Enter spouse's SSN above child`s name here. - box. end fuY rrsrrte here. - 5 ^ t]veRiyhtg widorr(er) with c~lhd (see Page 16) do rat check tx»c 6a . f3a ~ Yotarsalf. if swrteorte can cairn you as a dependent ~ ~ , ~~~~ b ~ 1 c ~ -(Yl Dependent's . •(tl) DependarR's . N ~ ~ No. or cttgdren ta chid t~ilO social secur0y rtrartbsr relaiortaltq to you (1) Fret name Last name ~ YQU • did not aw rnlat ^ a ff more than four ^ (se. pave ta- dependents, see e 17 a nd ^ a- ec rwt enMrsdaabovs a p g Check here - ^ ~ ^ Add rrtsnbers on Q d Total number of ciairrted tens atwre - ~ wages, salaries, tips, etc. Attach Form(s) W-2 I 7 ncome ~ ~ Taxable interest. Attach Sc~adule B if required t3a , G b Tax-~osrrtpt interest. Do not irtr4uds on tine tie 8b Attach Form(s) 9s Ordinary dividends. Attach Schedule B if required ~9a' W-2 hero. A!w b f]ualifled dividarbs (see page 22) 9b ettsctt Forms W-2G and 10 Taxable refunds, credits, ~ offsets of state artd local income taxes (see page 23) t0 109]i-R tf tax t 1 airrtorty received : . _ 11 was 12 Business income or peas). Attach Schedule C a GEZ _ 12 13 Capital gain or pose). Attach Sctredttle D if required. M not required, check here - ^ 13 if you did not 14 Other gains or posses). Attach Form 4797. 14 get a W-2, 15a 113A distributions 15a 22 b Taxable antotu~t (seepage 24) . see page . 16a Pensions and annuities 18a b Taxable amount (seepage 25) db'~ 17 Rental real estate, royalties, parbterst>ips, S corporations, tntsts, etc. Attach Schedtde E 7 Erxiose, but do 18 Farm income or pose). Attach Sr~edule F . ti not attach, any 19 Urtem m er ass of 400 per recipient (see page 27) ~ ' nt Als 9 ~ payme . o, p~ us 20s Social security berrerits 20a ~ ~7~~J b Taxable amount (see page 27) Fofm 100-V. 21 Other income. List type and amount (sea page 29) 22 Add the arrtounts in the far cohxrat for Mrtee 7 21. This is todai itoorrra - 23 Educator expenses (see page 29) 23 Adjusted i ' i \~ ~ ?J Certain lwshwss of reservists, performing artists. and ~ - fee-basis gtr++arnrrtetd ofCtcbis. Attach Farm 2106 a 210tt-EZ 24 t v income ys ~~ savings account deduction. Attach Form sss9 Z6 I` gyp` ~ 28 Moving . Attach Form 39003 28 I ~ ( ~ v 27 One-half of self~mpioyrnent tax. Attach schedule SE 27 ' ~' ; ~, i 28 Self-empbyed SEP. SIMPLE, and quaNfied plans Z8 29 Self-employed health inst,a arcs deduotiort (see page 30) 29 I ~. 3o Penalty on ~h- witlldravval of savings . 30 '~ 31a Alimony paid b Recipient's SSN - 31a C" 32 IRA deduction (see page 31) 32 ~, 33 Student k>an interest deduction (see page 34) 33 34 Tuition and fees deduction. Attach Form $917 34 ~ ~ Domestic production activities deduction. Attach Form 890;1 ~ 38 Add {roes 23 through 31 a and 32 through 35 . 37 Subtract ire 3f3 horn line 22. This is income - For Disdosuro, Privacy Act, and Paperwork Redudiort Act Nottos, sate page 97. Cat. No.1132~ ~n 1040 Rif ~~ r Form taot~oo91 i~eae 2 36 Amotmt from line 37 (adjusted grioss irtcorrte) . 38 TeX 811d 39a ~ You were born before January 2.1945. ^ Btinci. ~ Toil boxes ~~ '~ Cit@d~S ~ ~ if: ~ was boat befcre January 2, ,945. ^ Blind. a»cked P ~ g b tF yout spouse Rerrtites on a eepera6~ tetutt or you was a a~eri,see page 35 and check here> Dsductlort IOa ibarrdned dedtwKiorts (from Sd>aduie A) ~ your standard deduction (see left man8in;- for- s y~ b if you are irtcreasirrg yau' standard deduction by certain real estate taxes, new motor cfiecsk aryl vehicle taxes, or a net disaster loss, attach Schedule ~ and ohacdc here (sea page 35) . ®40b® box on line 41 Subtract line 40a from late 38 40b or who 42 13tetnptions. ti tine 38 is 5125,100 or less and you did not provide housing to a Mklwestem `{. as a displaced individual, 53.650 by the number on line 6d. Otherwise, seepage 37 . 43 Taxable ir>corrre. lirb 42 from line 41. ff line 42 is more than line 41, enter -0- . ~ • AA others: 44 Tax (see page 37). Check if any tax is iram: a ^ Form(s) 8814 b ^ Form 4972 . Single or 45 Albentative mkrimlmt tax (see papa 40). Attach Form 6251 Marred ~9 48 Add lines 44 and 45 D ~ 55 47 Foreign tax giedit. Attach Form 1116 if required . 47 Martfed ~S ~ 48 Credit for chid and dependent care expenses. Attach Form 2441 48 ~ 40 Education credits irorrl Form 8863. tine 29 49 51 ~ ~ .Retirement savings conMbttlorts credit. Attach Form 8880 t°i0 Head of S1 Child tax credit (see page 42) Si ~ 52 Credits from Form: a ^ 8396 b ^ 8839 c ^ 5695 b2 ~ ss Diner aea~ from Form: a D 3800 b ^ 6601 ~ ^ ss 54 Add lines 47 through 53. These are your fated cx'ec~a . S5 Subtract line 54 iron line 46. A tine 54 i$ more than tine 46, enter -0•- D ~ C !S6 Self-errrploymerrt tax. Attacfi Schedule SE @ '~ unreported soaal securlly and Medicare tax from Form: a ^ 4f 37 b ^ 8919 Tax@s 58 Additior-ai tax on IRAs, other qualified netiranlent plans. etc. Attach Form 5329 if required !y9 Additional taxes: a D AF..lC payments b [] Household empbymeM taxes. Attac~t Schedule H a30 Add tines 55th 59. This is toRaf tatx - Pey~tg 81 Federal income tax withheld irorr- Forms w 2 and i 099 61 .~ ~ ~ 82 2009 estimated tax payrnerrts and amount applied from 2008 rt~um 62 + 83 Maldng work pay and governrtlent retiree credits. Attach Scttedt4e M 6S M you have a 64a Eerrfsd atcotrle credit (pCj 64fl d b Nortaxabie combat pay election 64b ` Schedule DC. 85 Additional child tax credit. Attach Form 8812 86 , 66 Refundable education credit from Forrn 8863, tare 16 66 87 Fret time hornebuyer credit. Attach Form 5405 67 _ - i 88 Amount paid with request for extension to fife (see page 72) BS 1 N F.xoess social secxutty artd tier 1 RRTA tax withheld (see page 72) 80 ~ TO Credits from Fonn: a ^ 2439 b ^ 4196 c ^ 8801 d [] 8885 70 ~' is 71 Add times 61,62.63, 64a, and 65 70. These are our tot al pay merrEs - 71 ff ~ 1. Refund 72 If line 71 is more than line 60, subtract Nrre 60 from line 71. This is the amount you overpaid 72 Direct depose? 73a Amount of line 72 you want r~eNs'Ided to You. ff Forrn 8888 is attached, check here P ^ end ~73b, t' b Routing number l ~~~~ - c Type: Cheddrrg ^ Savatgs - ;. , 73c, and 73d, P d Accourrt number ~ r ' i ,'~ or Fomt 8888. 74 Amount of {ate T2 want to 201 ~tg4sd tax - 74 ~I Ar110tA1t 7S ArrtOlatt you owe. Subtract time 71 from line 60. For details on haw to pay. see page 74 . - 7b ~ YOU t~M-e 76 Estimated tax see 74 _ 76 T~ P>>rl'h/ Do you want to allow another person to discl~s this return with the IRS (see page 75)? ^ Yes. t#te fdlowing. ~{ No ~ne@ DesiDnse's Phone t~eraonal iderNiRca ~for1 ~'~-"'~'-1-"i - rw. - i- 1 .~f 1 under p~rnlties of parjuy. ! declare urrt I tmre ~orarntrNd tMS return and aocortiprryinp schedules and sfatamaMc, and to the a my lviorrledps and bepef, !'t@l @ t1+aY are true. correct and oompbte. DecNradon or pia~eror (ottier then taxpayer) to hwed on sit tMO~simtlon or which anY ~+o~led7e- Joht rsltan? Your signaRwe Date Your ooarpation pta rre rKrinber Sea page 15. iC . `'~ ~ ~ '.3 ~ b ' ~~rrr t ~ n . ~o+u,~. ~~`t eep a copy ' for your records. SPX's . ff a ioirrt return, both must sign. Date Spouse s i Paid a ~ oar ~-ematcyed ^ ~ ssN o- Pnty t~.,e..e.~.fe :: ,,, Fam`s name (or ~, ~ EIN it '. Date February 15, 2010 No. Funeral of Janet G. Horn Mrs. Patsy Martin To 167 Overcash Road Chamberburg, PA 17202 Personal, Staff and Professional Services Funeral Home Facilities and Equipment $4 , 950.00 Automobile Equipment Casket $2 , 970.00 Interment Receptacle Monument Engraving Total `A' $7,920.00 I3ewspaper Notices $ 301.24 Clergy Honorarium $ 100.00 Certified Copies $ 36.00 Flowers $ 159.00 Total `B' $ 596.24 Total `C' Complete Total $8 , 516.24 Due March 16 , 2010 Amount Paid -p- Balance $8,516.24 No. Cumb~a~la~nd Vatl+~~* 1V~embt"ti~t G~rd~>ui;: .1921 Itiril~r Highway Carlisle, PA 111113 711-243 3541. INTERMENTIENTOMBMENT AIITHORIZATIdN ANU 1Np1;MNiFICATION Burial No: CONT~tACT N0. ~38~ ` ~~ ~«d ND ~aayr z9 - DATA ON IIECEA9ED - NAME: 1~ ++ ..Jhr~E b.O.B. D.b:D. TIME OF DEATH SEX M F ~p D~ M ~tI'tAL3TATU3 ~I ADDRESS: V YE9 / 34 i~DF,.I ~i.p wARRE RU h ~5. PLACE oa DEATH: ~± NJJ '1'. I' d - INTERMI~NT/ENTOMBMENT/INURNMLNT DATA CAL CEIVED GATE: - T[ME: BY: ~ 1 ~~~ F'UNERALH ADDRESS: PHONE: FUNERAL HbME NTACT: FUNERAL DIRECTO • - ..tt .y L' Yi ~ t DA Y DATE OF 9URIAL: . PUNERAL __~~ FUNERAL HOME. y-CHURCH _„_ CEMETERY: EST. ARRI~ EME AL C T ERY : " // ~~ ~~ cc 1.JWJG ~'~,iD SBItVICE A7: 71ME: `I ~Vt~Q~• y~~~o ~ ) ,y V~1'° -MAUSOLEUM- TEMP:. MAUSOLEUM NAME: - SECTION NO. LEVEL tJO. RYPTMICHE N0. ~ LEt'tERIN : CRVPT PL PERM: _ PSl. INCISINGlSCROLL 6EATH bATE NEEbED: YES 1 NO RELIGIOUS A PII ATIONlOTHEk:. - BURIAL - GARDEN NAME/ SECiI(~N1~. ((-~~ LOT NQQO//1t I~.I.L ~URAVE(S) ~~ S]NGLE/REO TRIPLE ~ TYPE OP OUTER BURIAL CONTAINER: "~..,... "OUTER BURIA CO AINER CO.: _CHAPHLSERVICE ,_,~CRA. - $ ~OTHEk OTHER SPECIAL INSTRUCTIONS/SPECIALEQUIPMEN?: - PN MEMORIAL [N3•fALLEDt YPS l I ` ~~ ~ SCROLL DEATH bATE/ENGRAVINd NEEDED: PS O ~J ~I U F" ~ - ~ I O ' -CURRENT CHARGES AND PAID INFORMATION - PRENEED CONTRACT:. PATE NUMUER 56LLING PktCE AMbUN'f p9.1 OPENINGlCLOSING ~ 1$j -I D --"'-"' '* , Q VAULTNAULT INSTALL. ' `~ " i ~ I '~ i CASKET '~;;~'~ ,. ~ ;. •I_ ,; MARKEA/flASE .. .. PROPERTY 2~ "2-3.-f~fl ~~ .r ~ ~ ~~.: OTHER . ~ ~ ~.' -...* a~ AMOUNT DUE TO.BE RECBIVED FROM: ~_ PAMILY PUNBRAL bIRECFOR TOTAL DUB: !.~ 'ihe undersigned hereby certifies they have the fufl legal authority to direct the Inttttnent~ 6nlombment, or Inwnnxnt of the remains of the deccascd, and hereby author ~~ itt the cemetery to make diepasition of theremaina o[ the deceased as indicated, The undersigned hcroby f4rther certify and teptts~nt fiat they are bwnet~s) or authd ittd representative(s) of the ownerCa) of the above described Intetmmt Rlghta and hereby authorize use ofsaid Internhient Righis of tfle lnlerrixnt. ~ntombtnent, or fnumrrtertl of the remains of the herefrt named deceased. The atnetery is hereby directed to supervise inaiallation or install any outer btrtrsl conhirrer, W the oxtmf requited by law, Purchased in crntnection with this Interrttrnt and the Interment Rights described herein. The undersigned IiMeby sgnee fe ihdenmify and Ftold harmless the cemetery, its agents and amployees from any and al{ LIA9ILtTY, including'; ble atsomey's ' tau, and against arty iaas It a they may sustain in ContlEO)[on with the Internment, $niambnbnt, or tnymmGnt suthdriEed trereundei..The takCa gnsat eae avoid errors, but in the event an inadvertent error d8ea oceitr, the ixmetery shali.have the light td. correct anyerror in the Intemrrtertt,. BnWrrtbritaht In•trrtment, at its own ezpenu, without any liability Cor such error i NOTES: I Pbsren t-iII removed 2 days f m boH~ri. ', - ~„_,--. ` rgnaturo of Faritily Se`rvtee Ctnrnse SigttalutQ.' of Lot Aat 1ttp~dttativo I OFR)I E USE O Y -AUDIT ANb ORDKt16iHVG- SPACE VERIFIC O1V Interment (inkiil slier h caoPletetn Check Namlly VerlRed: INTETUrq<T C)RDti/t CHECKED fi~l•1'BRUiENT I:ARb COMPLETEFI AND FILED L S . 5nweyed fly: MASTER CARb UPDATED It"lip x e PLAT BbOKAND LOT MAPS UPDATRD -I Chetkedflyt (3t#1tiALPERMttRHCgNEDANIPILED .. ATE , _. ---- -- --- _TT ..~ .-•--..~,~..s Premier Evens, LLC 429 East Qrange Street Shippenstwrg, PA 17257 Voice: (717) 532 2279 Fax: (717) 532-2279 1NVO~CE Invoice Number. X721 Invoice Data: treb 3, 2010 Page: 1 iB~ Ta9 Ldp tis: Patsy Martin Patsy MarSn ~_-+ t.Lt~n~r D C'~l10o~1aBi~'Pp R~rymwtt'F ~>rtrrs Patay Martin C.O.D D ~tipp~rg,~etl,tott D~ibf Clw tJalr Airborne I ~ 2/3/10 -- Nlinti Ds~cNPlbn t)nt# Frbt rMnotint 54.00 Food After Funeral Lund~eon ~i'ai d e,l~ #~ bt~~ 12.00 848.00 Subtotal 648.00 Salsa Tax 38,88 Total Invoice Amount 686.88 Check/Gedit Memo No: PaymsnGCredft Applbd TOTAL ~~ ~`,~ - ~ 13"7.3"1 ~ 8~~. ~S _ _ _ _ _ ~~` ~ ARRE~TOWNSHIP BURIAL ASSOCIATION ` ~ Tats is To ceRTlFr chat ~ ...~.,: -, a member, is deceased, and your assesttmmettt of One ISoller (;1.00) is now due to the War- ren TorritsLtp Bnrial Association, payable within ten days to the Secretary. Your extra assessment of ; each is due at this time. ' Briny tLis card alone to 1N receilptad, or, if receipt is to M retnrnaa by mail, sand stamped envelop. aad this Cara. _ _ _ _ -_ _- Annual meeting of this Association will be held on the first Friday in April, at which tune officers will be elected to serve during the year. Non-beneficial if ~t paid within ten (10) days from the date of this notice. Make checks payable to WA1iREN TOWl4SH1P B1/1t1tAl. ASSOCIATIOIi 8531 Little Cave Rd., Mercersburg, PA 17236 or at Residence 6 pm. to 8 pm. Assessment No ~` ,~ .~~ ,Secretary Received the above dues: _ ~.>.~ y ~~ v Cif- ~ ~-s ~...M ...,~.,. _..,_ p ,,.. _ ~. _ _ RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Receipt Date: ~ 3/02/2010 Cumberland County -Register Of Wills Receipt Time: , 11:09:23 One Courthouse Square Receipt Nq.: 1060173 Carlisle, PA 17613 I HORN JANET G Estate File No.: 2010-00206 APET Paid By Remarks: S HORN A ------------------------ Receipt Distrib ution ------------- Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 260.00 CUMBERLAND COUNTY WILL 15.00 CUMBERLAND COUNTY SHORT CERTIFICATE 2 IO D ~ JCS FEE 3.50 EIPTS RE BUREAU AUTOMATION FEE 5.00 ------- ------ --- CUMBERLAND COUNTY Cash 5327.50 Total Received......... $327.50 E RAL E~~jjERAL I FUN FUN ENERAL FUN & NTR M.D E RAL FUN S. W. 9ARRETT REAL ESTATE AND APPRAISAL SERVICES '"""~' INVOICE *""'*""'~* File Number. 10-0076 OIJ06~2010 JNnetOe 5larlln V -1~. n4-k ~ ~~ Paley Martin .7 167 Overceeh Raad CAernbsrsMrcy, PA 17202 ~ypt~ # ; 10-0070 Orde(Date : OS/2112010 ReferelkelCese # PO Number ~8 Hom Road 8hlppenaburp, PA 17267.8762 ApptaMal Senkes S 360.00 Invoice Total S X60.00 State Saks Tax ~ S o.06 Deposd (S 860.00 oeDosit (S ) Amomtt Due E 0.00 Terms: Paid Receipt Please Make Check Payable To 3. W. EiarrHl Real Fatale 3 Appraisal Servkes 506 South Hanover Street CarltaN, PA 17013 Fed. I.D. #: 225555.801 YOUR SINGLE SOURCE..Protwsional, ERIekM Service THANK YOU ° "~ ~ ~ '.; ~~ ~, a ~CQ ,~ ~~ J J ~~~ S , ~.~ ~ ~ ~ ~ ar \ S ~ ~ . t3 ~-L-.c-~._ -~ ~ Q. ~L ^~:', ~ ~ rte-} '~ ti ` ~~~ ~~ _~~ ~` ~~~5 ~~ ~..w ~, r ~3 ~~ 1~>~ /64 ~+.h ~= ~ ~ ~~,. 3S ~ ~~ c ~~4 / / ~f5 CUMBERLAND LAW JOURNAL 32 SOUTH BED~ORO STREET CARLISLE, PA 17013 Tsh: (7171249.4188 Fax: (71 ~ 249-2Q68 April 23, 2010 Cumberland Law Joumai is published every Friday by the Cumberland o~ Bar Association and is designated by the Court of Common Pleas as the offici Ile publication for Cumberland County and the legal newspaper for publication of I gE notices. TO: Matic W. Allshouse, Esquire Janet G. Hom Estate RE: Legal advertisements must be received by Friday Noon. Alt Legal must be paid in advance. Make all checks payable to: Cumberland Law Advertisement inserted on following dates: April 9, April 16 and April 23, 2010 Advertising Cost Proof of Publication Second Proof Request Payment received Total Amount Due $ 75.00 $ 0.00 $ 0.00 $ 75.00 $ 0.00 Becky H. Morgenthal, Executive Director i 506 Paxton Street ~~ Harrisburg, PA 17104 717-236-4300 711-23b-6803 FAX P U B l I C A T l O N S www.jaurnolpub.wm INVOICE TO Christian Lawyer Solutions,. LLC Attn: Mark W. Allshouse, Esq. 4833 Spring Road N V O t C E arssuzoso ORDER #: TO$53 TERMS: Net 3o Days I ADVERT}SEIt --- Christian Lawyer Solutions, LLC Rick Foreman Auctioneer Au1163L 386 Springfield Rd. Shippensburg Pa 17257 (717)776-4602 SETTLEMENT STATEA~IENT Sale for ~,~, ~~~ Date ~ • ~~ ~ a~rn Advertising Lanc .Farming ~ i s' • ''-" Guide '~~'• '~= V.T.S 3~~ ~« All other Adv. / /.s =~` ~ "~`' ~~ / Sale Flyers ~Q Total Adv. .~1~~~ ,(k;~s~ ~~id r Ar~~~~~ Auctioneer Percentage Port a Pot All other Charges Total Adv. Total Expenses SALE TOTAL TOTAL EXPENSES NET SALE Notes ~?uf-s~~~~~+~p ,, fi ~ ~. z~ rte, is ~~ ~ ~_ ~~~~~ ~~ ~~ ~ (,~ ..~tn..3: 02 ~~S ~.i~ Rick Foreman Auctioneer Au1163L 386 Springfield R.d. Shippensb~~rg Pa 1725.7 (717)776-4602 SETTLEMENT STATEMENT Sale for _~,~...~ C~~cu~~ Date 7 /e^ • ~~~ Advertising Lanc .Farming f y ~~ ~n Guide _ /.~y.So V.T.S 18ra "-' All other Adv. Sale Flyers ~-- Total. Adv. ~~/: s~ ,3c k r ks e'~u~ ~- ~~'J~' Auctioneer Percentage Port a Pot All other Charge ~~ P Total Adv. Total Expenses SALE TOTAL . TOTAL EXPENSES /~, ~/~ S"o NET SALE __ ,~~~~ . ~..~ Notes : ~ ~~~ D {'Y~i3h~ ~Oy • v C7 ~c,~~ ~~~'~~~' S ~ 7s -~~~ / y a s_ ~. ~~ `= ~ '/,_c'Q _~_~ ~,~ CERTIFIED METER DELIVERY ~ ~+~. ~ ~ ~ . T P VIO SA L NO E GALL R NG -~ TA j' sp R 1 ~ ~ j, ? } - ~ ( ~ i... U J ~ ~ ~..~ ~~ ~? ~ ~ .8 YOUR 541E NO. GALLON READMK3-flNISN fLAMYABLE COM/RE75fB - TEMPBRATlNiF Cpy/E/~/SATEO A760° F. ~TAT'E LSE ~rA~ ~EF~YICE ,1NC. aa ~~ ~ ~Q~v ~`r ~~~ C.O.D. U CHARGE l.l~~ DATE ~ .f1 ~~ _ SOLD TO ~-- - ~ '.ADDRESS CITY PAOD!lCT GALLONS PAlCE AMO!!N L.P.GAS ~~-`"~ ~~ ~~ ~ BEG1 G % END SALES ~~ TAX NO TAN j K . --- TOTAL' +Tt-!!S TS ~"C7d.1~7 dlVt~'C7fCE ""°''°` I # RECEIVED / y 0 :ABOVE GALLONS 1~ _ LUSTO TORE l-1 CASH +RECENED ':PAYMENT ; CU CHECK DRIVER LIQUEFIED PETROI:,EUM>GAS SEE GtFVERSE SRi,YE Y~OFB PRVPANE SAFETY INFORMAT108eB WSEMS - Chambersburg ALS 205 GRANDVIEW AVE SUITE 211 CAMP HILL, PA 17011 ~~Frw71 ~Q~ Phone #: (800) 367-0512 Federal Tax ID: 23-2463002 etn,~Fi~zc;F:wc.v nay-:n~c ~,t st,r.~ x rs PATIENT NAME: JANET HORN PATIENT NUMBER: 87451 ~~ HIGHNON CALL NUMBER: C1000851 EHGM INSURANCE: C1000651 JANET HORN C/0 PATSY MAR71N 187 OVERCASH RD CHAMBERSBURG, PA 17201 BATE OF GALL: TIME OF CALL: CALLER: FROM: TO: REASON(S) FOR TRANSPORT ilYVOICE 01 /14!2010 Pofice/Firef911 SHIPPENSBURG H LTH CARE CEN' CHAMBERSBURG H SPITAL ALTERED MENTAL TALUS DEHYDRATION Sepsis URINARY' TRACT IN ECtiON OESCgIPT10N OF CHARGE QUANTITY UMT PRICE A OUNT ALS EMERGENCY LEVEL 1 S0207 1.0 879.65 g7g,~5 EKG ELECTRODES (1) A0396 1.0 1.30 1.30 GLUCOSE BLOOD A0394 1.0 7.08 7.08 NSS 0.9% t000cc Bag A0394 1.0 2.27 2.27 5~~~ ~~ 1...1' ' Total Ch 890.30 DESCRIPTION OF PAYMENT RECEIPT PAYMENT BATE AMO NT ZERO MEDICARE PAYMENT 02/0812010 0.00 Total Crodits 0.00 PLEASE PAY THIS AMOUNT -INVOICE DUE UPON REGEIPT --- ~gp,3p RETURNED CHECK FEE - 531.00 Shippensburg Health Care Center 121WALNiTr BOTTOM ROAD SHIPPENSBURG, PA 17257 (717)530-8300 Janet Horn 01608 Patsy Martin 167 Overcash Road Chambersburg, PA 17201 01/01/10 Balance Forward 01/25/10 Payment O1/O1j10 CABLE Ol/O1/10 Feary 12, 2010 Balance e: 10.00 Payments/ Charge Credits --------- ---------- 10.0 0.00 10.00 1 10.0 ` ~,1~" ~~ c-4 2 4s February 12,.2010 ~ Janet Horn 01608 Please Remi Please send payment within 15 days. We accept Visa & MC. 10.00 __ __ ~ ACCOUNT NUMBER RATE DUE AMOUNT DUB - 193D8019 Due Upon Receipt $32.67 Pay online today at d~ectv.comlmyaccoum ' 1 Summary ~ Statement Date: 02!06/10 Previous Balance 78.30 Page 1 of 1 fo r. Payments 0.00 GLEN HORN Currorn CherOes A Fees 0.00 I For Service at: Adjustments & Credits -41.76 38 HORN RD Texas -2.47 SHIPPENSBURG, PA 17257-9752 } ~ i At:'t1Vtfi! S Start End Description Arrwwrt Previous Balance 76•~ ' Payment 0.00 ~- _ _ _ ... ___ __ ~_ _ I Adjustments & Crarits To contset w call ~-804331-5000 01!30 02117 TOTAL CHOICE Partial Month Credk -34.18 Crod'it 01/30 02/17 STAR2 Super Pack Partial Month Credit -6.87 Credit Entertatumeut ua Br'om DIRECPV. - Please Batt ns to ate your services ~ Sales Tax -2.47 mday. .. AMOU •~ I ~ I ~ ~ I , '~ '~ ~y ~ ~~ ~ ,' ~ ~~ ~, '~ ,I .m..$;' v,fAz CenturyLink- MarAhly Statement Fetxuary 4, 2010 Payment Options 8t Comact htfo Cunbtrt Charges At A-t3larws Rata~l Store in Yax Arse CARLISLE 202 Westminster Drive in The Carlisle Crossings Center Efesrrttd Hems PMons -page 3 Pay Online ~ Local end Optional Services -Page 3 CEN7URWNK.wm/myaccount ~' ~ One ~ Long Dis/enos -Page 3 1-877-813-7804 Custwmr Sarvloe Taws and Surcharges -Pape 5 t-8D0-829.8009 Repair Serdes e~-~ ' r 100-798-3800 .,, y1 '~C u, _ ~~~. Pegs t of 6 Account Number 777-776-5t04-9t8 P 4 N Total 2a.9s 2.67 8.85 11.88 ~_ e.• WSEMS - Chambersburq ALS/BLS 205 GRANDVIEW AVE SUITE 211 CAMP HILL, PA 17011 Phone #: (S00) 367-0512 federal Tax ID: 23-24630Q2 PAnENT NAME: JANET HORN INSURANCE: C2010631 JANET HORN C/O PATSY MARTIN 167 OVERCASH RD CHAMBERSBURG, PA 17201 PATIENT NUMBER: 87451 CALL NUMBER: C2010631 ii DATE OF CALL: 01/19/2010' TIME OF CALL: 01:43 PM CALLER: CHAMBER; FROM: CHAMBER TO: 38 HORN F REASON(S) Pneumonia FOR URINARY 1 TRANSPORT ROUTINE 1 DISCHARC INVO/ CE ~~ ~~ WCS NONE HOSPITAL HOSPITAL INFECTION DESCRIPTWN OF CHARGE QUANTITY UNIT PFIICE AMOUNT INVALID COACH NON-MEMBER A0999 1.0 76.58 76.58 MILEAGE INVALID COACH A0999 21.0 5.61 ~ 117.81 . J~f~i~ ~~ ~ ~ ~ ~ "~ ' ~:~ ~~ i I I To I Qharges 194.39 Christian Lawyer Solutions, LLC 4833 Spring Road Shermans Dale, PA 17090 Lutheran Home Care & Hospice, Inc. 2700 Luther Drive Chambersburg, PA 17202-8131 (717)264-8178 Patient Name: Horn, Janet Patient Acct #: 000000000018078 Bill to: Janet Horn 38 Hotn Rd. Shippensburg, PA 17257 Billing Date Range: 1/IS/20i0 - 1/31/2010 Bill Print Date: 02/05/2010 ~~ Patient Address: 38 Horn Rd. Shippensburg,~PA .17257 Admit Date: 1 / 19!2010 Discharge Date: 1/29/2010 Page 2 of: Date of Service Service Description Units Agency Charge 1 /26/2010 Personal Care Aide 8 154.00 1/26/2010 Personal Care Aide 8 154.00 1/27/2010 Personal Care Aide 7 134.75 l /27/2010 Personal Care Aide 8 V 154.00 1/27/2010 Personal Care Aide 8 154.00 1/28/2010 Personal Care Aide 8.25 158.81 1 /28/2010 Personal Care Aide 8 153.99 1/28/2010 Personal Care Aide 8 154.00 1!29!2010 Personal Care Aide 8 154.00 Total Billing for Page 2: 71.25 1 371.55 Invoiced to Other Payors: $0.00 Total Billing for All Pages: Balance Carryforward: Total Due from Patient: 1191.00 ~ 3,676.71 ~ 0.00 $3 676.71 Premiere Property Services Sept/c Setv/ce, Portab/e Resti+oom Rentals, Water Ue/ivery 1695 Bedfiord ltAad Shippensburg, PA 17257 I~ 717-530-0582 Date .~ ~~~ Name - - - -~--- -~ Address ~' ~ ` "~' ~, (~ f t t !~Y f ~N f 1~. ~~ ~A" SUBTOTAL TAX TOTAL ~' ~un~i °~ot~i.~ Cum nand County Pennsylvania TAX COLLECTOR COPY -RETURN WITH PAYMENT FOR PROPER CREDIT Bill No: 590 JANET HORN Control No: 30-000358 38 HORN RD ', SHIPPENSBURG, PA 17257-9752 Payable To: DARLENE PITTMAN, TAX COLLECTOR 903 BIG SPRING ROAD SHIPPENSBURG, PA 17257-9753 Phone: (717) 7765779 OCC COUNTY OF CUMBERLAND Discount ace Penalty COUNTY PC $4.90 $5.00 $,5,50 TWP OF NORTH NEWTON MUN PG $.4.90 ~ $5,00 85,25 MUN OCC TAX AMOUNT DUE If Date Of Payment Is On $p.Op $9.80 3/1 /10 thru 4/30/10 5/1 N $0,00 $10.00 thna 6!30/10 $0,00 $10.75 7/1 /10 or later Payable To: DARLENE PITTMAN, TAX COLLECTOR 903 BIG SPRING ROAD SHIPPENSBURG, PA 17257-9753 Phone: (717)778-5779 51.00 FEE FOR ADDITIONAL RECEIPTS Tax Payer: JANET HORN 38 HORN RD SHIPPENSBURG, PA 17257-9752 Offk;e Hours: SECOND & LAST WED 11AM-7PM LAST SAT IN APRIL & JUNE 9-11AM APRIL 3010AM-2PM PHONE (717) 7785779 Bill No: 590 Bill Date: 3/1/10 Control No: 30-000358 OCC COUNTY OF CUMBERLAND Disc•,ount Face Penalty COUNTY PC 34.90 $5,00 $5,50 TWP OF NORTH NEWTON MUN PG $4.90 $5.00 55.25 MUN OCC TAX AMOUNT DUE If Date Of Payment Is On $0.00 $9.80 3/1/10 thru 4/30/10 5!1/10 50,00 .310.00 ru'6/30/10 30,00 310.75 711/10 ~ Later TAXPAYER'S COPY -KEEP THIS PORTION FOR YOUR RECORDS DARLENE PITTMAN, TAX COLLECTOR 9Q3 BIG SPRING ROAD SHIPPENSBURG, PA 17257-9753 RETURN SERVICE REQUESTED e-r~ ~o - asses JANET HORN 38 HORN RD m SHIPPENSBURG, PA 17257-9752 Cumberland County Pennsylvania TAX COLLECTOR COPY -RETURN WITH PAYMENT FOR PROPER CREDIT HORN, GLENN R 8 JANET G 38 HORN ROAD 38 HORN RD Acxes 4.880 Dsad: 00198-00306 SHIPPENSBURG, PA 17257-9752 LAND APPROX 5 ACRES Residential Building Payable To: DARLENE PITTMAN, TAX COLLECTOR 903 BIG SPRING ROAD SHIPPENSBURG, PA 17257 9753 Phone: (717) 778-5779 I~'~~ Bill No: 370 Bill Date: 3/1/10 Control No: 30000878 MAP NO: 30-10-0818.005 Assessed Value: Land: 37,490 Improvenwnt: 64,240 Toad: 101, Discour>t Faoe Psnaky COUNTY R/E 2.39900 3239.17 3244.05 3268.46 COUNTY LIB .18000 517.94 318.31 320.14 MUNIC. R/E .14000 513.96 514.24 614.95 TAX AMOUNT DUE If Date Of Paymsrrt la On 3271.07 3/1/10 thru 4130/10 5/111 t 5276.60 hrU 8/30!10 5303.56 7NN0 or Later Payabk To: DARLENE PITTMAN, TAX COLLECTOR 903 BIG SPRING ROAD SHIPPENSBURG, PA 17257-9753 Phons: (717) 7765779 MAP NO: 30-10-0618-005 Deec: 38' HORN ROAD Aoras 4.880 Deed: 00198-00306 LAND APPROX 5 ACRES ~~,~~ ~~ 31.00 FEE FOR ADDITIONAL RECEIPTS Tax Payer. HORN, GLENN R 8 JANET G 38 HORN RD SHIPPENSBURG, PA 17257-9752 OMios Ho~a: SECOND 8 LAST WED 11AM-7PM LAST SAT IN APRIL b JUNE 9.11AM APRIL 3010AM-2PM PHONE (717) 776.6779 BHI No: 370 BNI Date: 311/10 Control No: 30000678 Asssaed Vettu: Lead: 37,490 Improvenwrd: 64,240 Tota1:101, Dieoount Fsos Penally COUNTY R/E 2.39900 52.17 '3244.06 3288.46 COUNTY LIB .18000 317.94 318.31 320.14 MUNIC. R/E .14000 513.96 514.24 314.95 TAX AMOUNT DUE If Dane Of Payment is On 5271.07 311 M 0 thru 4130/10 5/1 N 0 $278.60 8130110 5303.55 7/1 /10 or Later TAXPAYER'S COPY -KEEP THIS PORTION FOR YOUR RECORDS DARLENE PITTMAN, TAX COLLECTOR 903 BIG SPRING ROAD SHIPPENSBURG, PA 17257-9753 RETURN SERVICE REQUESTED a~~ ~o - ~ooa HORN, GLENN R 8 JANET G 38 HORN RD SHIPPENSBURG, PA 17257-9752 87110~R-10004 PAYABLE ~: DARLENE PIITMAN 903 BIG SPRING ROAD SHIPPENSBURG, PA 17257 oesc: ASSESS.NO-30000878 MAP NO: 30-10-0618-005 38 HORN ROAD ACRES 4.880 DEED 00198' 00305 LAND APPROX 5 ACRES Resid~ttiai :8uiiding RESIbENTIAL 2010 Statement Of Rssl Estate Tsaas (`nntrnl Nn• nRn - nrx1R7A icrm ~~ .Yb'J Bill Date' 7/n1/2n10 Assessed Land Improvement Mineral Total Values 37,490 64,240 0 101,730 Homestead Exclusion 8 228- Diicount Fees Rates .01607200 .01607200 2 t 10 t SCHOOL R B 1 635.00 Homestead Credit 132.24- TAX AMOUNT DUE -> ~~~o 51.6~.~ ;1,66S.OA I$ Paid On or fitter 7 01 2910 9 O1 2010 11 O1 2010 _! Paid Oa or aelase 3 '2010 10 31 2010 12(31 2010 TAX HORN. GLENN R ~ JANET G PAYER 167 OIVERCA3H RD CHANIBEA;SBURG, PA 17202-9249 oFFlCe SECOND & LAST WED 11AM-7PM r+ouas: LAST SAT OF AUG & OCT 9-11AM AUG 31 10AM-2PM rv~ vraa w ~ rruw uw zi, tF TA7tES ARE M-1T~CAOYII ~ 91LL ~ OE CO. RE11lRM BIIJ. MRTH PA111191T: ~~~ __ __ ~~ ~~ `` _~~~ FOR A RECBPT SDiD BIL19 AND ADq BTAMPF.D ENt/EL.OPE NOTICE OF PROPERTY TAX ~2E IfEF Your enclosed tax bill includes a tax reduct(on for your omestead andJor farmstead property. As an eligible homestead and/or farmstead p rty owner, you have received tax relief through a homestead and/or farmstead exalus fi which has been provided under the Pennsylvania Taxpayer Relief Act, a law F-a by the Pennsylvania General Assembly designed to reduce your property taxes. PHONE (717) 776-5779 _J_J, $ m BiN with Payment. For a Recut, Tax Collector Signature Date Paid Amount Paid lose a self-addressed stamped enveN M p1ryNg ; use tln carpals bslar >3o submit peyma+bs. H pat-Irg la lhtil; submit 11M ranltt~nee copt- oboes. TAX HEAR 2010 BALL DATE 7/01/2010 BILJ. # 369 PAYAHLETO DARLENEPITfMAN 903 BIG SPRING ROAD SHIPPENSBURG, PA 17257 CONTROL # 030 -000678 NAP # 30-10-0618-005 SCHOOL BIG SPRING S.D. TAX f>AYER HORN, Gi...~tN R & JANET G 38 HORN, ROAD Sii1PPENS$URG PA 17257 3rd Fleets Ifd~tB11 ~~ tl~it m~ra . tl6oo.~ ow oR ®e=oRE ocTOeER 31 solo $661.01 AFT'LA thCCTOBHi 31, 2010 10 x _!'/^ $ Tax Collector Signature Date Paid Amount Paid TAX YEAR 2010 BILL DATE 7/01!2010 BILL # 369 PAYABLE TO DARLENE PITTMAN 903 BIG SPRING ROAD SHIPPENSBURG, PA 17257 CON'iR01.# 030 -000678 YAP # 30-10-0618-005 SCFIOOL BIG SPRING S.D. TAX PAYER HORN, GLENN R & JANET G 38 HORN ROAD SHIPPENSBURG PA 17257 NiSTALJ.ilEN18 CAMiOT START AFTER OCTO~R 31, A010 1 St pisses IfdblfR aot~pott,l~nn flrlYt petyrrtsrtt. oN oR a Auc,A~T s1 solo :ss,.al AFTER AuausT s1, 2mo 1o x / / TAX HEAR 2010 891 DATE X101 /2010 BILL # 369 PAYABLE TO DARLENE A~1 903 BIG SPRI R,014D SHIPPENSBU A 17257 OON1tROl. # 030 -000678 YAP # 30-10-0618-005' SCHOOL BIG SPRING S.b. ', TAXPAYER HORN, GLENN.R ~ JANET G 38 HORNf~OAi~ SHtPPENSBUFXi PA 17257 it Z nd Pisses ~ ~ tltifle~ second peymettt Jig 0 oR BgPraweER solo X661.01 AFTER a1, 201o io x i ~ s rtease getach the above portion and return with your payment. Account #: 2090900300 Meter Type Previous Rea ' Pressrrt Multiplier KWH'', U ed' Reading T Name: GLEN R HORN JANET G HORN KWH 22846 23384 1 538 Actual Reading Dates: 12~ao20os To ot/3o2ot0 Rate: RSW31 RESIDENTIAL W(WTR HTR SERVICE Service Loc: 38 HORN RD SHBG ~ILLING`D~~'i~11~~ BASIC CHARGES NON-BASIC C~iA~i~ ES Energy supplX prices and charges are set by your electnc generation supplier. Adams Electric Cooperative Inc. 888/232-6732 1338 Biglerville Road Gettysburg, PA 17325-1055 ENERGY SUPPLY: i Energy charge 538 kwh @ .061 32.82 Load control credit -5.00 TOTAL ENERGY SUPPLY 27.82 DISTRIBUTION: Access charge 25.75 Distribution charge 538 kwh @ .019 10.22 TOTAL DISTRIBUTION 35.97 TOTAL BASIC CHARGES 63.79 Your participation in Project Helping Hamd awy be tax deductible. ff you contributed in 2009, th a punt of your donation will show in the 2009 Round-U~D n',ation total in the Account Summary section below. Than, s or your help! 1~.1 ~ ~/ ran ~~ ~0 `x~'' Rav Month 1 JAH 2010 Previous KWH for past 12 months Aw month r KWH for past 12 months Payments F Balance Fk 7882 Total Basin: Total Non-~ Sales Tax:'' s56 ACCOUN'tt 66.76 -66.76 0.00 63.79 0.00 0.00 63.79 ,cove cortion and return with your payment. r , ~~~~ ~~drn 2090900300 ~ GLEN R HORN JANET G HORN .eading Dates: ot/aoRolo To o2~ts2olo Rate: RSW31 RES~ENTIAL W/WTR HTR SERVICE Service Loc: 38 HORN RD SHBG BASIC CHARGES Energy supply prices and charges are set by your electric generation suppiler. Adams Electric Cooperative Inc. 888/232-6732 1338 Biglerville Road Gettysburg, PA 17325-1055 ENERGY SUPPLY: Energy charge 259 kwh @ .061 Load control credit TOTAL ENERGY SUPPLY DISTRIBUTION: Access charge Dishibution charge 259 kwh @ .019 TOTAL DISTRIBUTION TOTAL BASIC CHARGES star type Previous Presets Multipli. Roa in • din KWH 23384 23643 1 Actual NON-BASIC C~iA,~i~aES 15.80 -5.00 10.80 25.75 4.92 30.67 41.47 proud partner of the 2070 U.S. Census. Visit www2010.census.gov for mare details. Rev Month FE® 20t0 Previous Payments forty rKW Balance F~ H past 12 7441 Total Bass: months Totai Non-~ Awra~e Sales Tax: ~'j ~ 62o ACCOUNII ~ for past 12 months 63.79 -63.79 0.00 41.47 0.00 0.00 41.47 .L/LO/LV IV I V VJlJV/LV IV ° ,ESIDENTIAL W/WTR HTR SERVICE 38 HORN RD SHBG BASIC CHARGES nergy supply prices and charges are set r your electnc generation suppler. Adams Electric Cooperative lnc. 888J232-6732 1338 Biglerville Road Gettysburg, PA 17325-1055 NERGY SUPPLY: Energy charge 275 kwh @ .061 Load control credit DTAL ENERGY SUPPLY ISTRIBUTION: Access charge Distribution charge 275 kwh @ .019 DTAL DISTRIBUTION DTAL BASIC CHARGES ~S ~~ ~` ~~ NON-BASIC CHAJRC~ES 16.78 -5.00 11.78 25.75 5.23 30.98 42.76 proud partne- of the 2010 U.S. Census. Visit www.2010.census.gov for more details. _ . _ACCOUNT' SUMM~A~tY _. Rev Motrth MAR 2010 Previous Bal~nde: 41.47 P t R ~' i d 41 7 aymen ~c ve s , : - .4 oral yearly Balance Fotiward: 0.00 KWH for peat 12 8989 Total Basic: ' 42.76 months Total Non-Balsic°, 0.00 Av®rage Sales Tax: ' 0.00 monthly KVI/H 5s2 ACCOUNT I~AL1AiNCE 42.76 or past 12 months PAYMENT DUE 04/21 J~0~10 42.76 ~~ Tease detach the anove ponion ana return w~ui your payment. Account #• 2090900300 Mater Type Previous Prosont Multiplier KWH Name: GLEN R HORN KWH 23918 2x168 1 250 Reading Dates: 03!30/2010 TO 04/30/2010 Rate; RSW31 RESIDENTIAL W/WTR HTR SERVICE Service Loc: 38 HORN RD SHBG BASIC CHARGES Energy supply prices and charges are set by your electnc generation supplier. Adams Electric Cooperative Inc. 888/232-6732 1338 Biglerville Road Gettysburg, PA 17325-1055 ENERGY SUPPLY: Energy charge 250 Icwh @ .061 Load control credit TOTAL ENERGY SUPPLY DISTRIBUTION: Access charge Distribution charge .250 kwh @ .019 OTAL DISTRIBUTION TOTAL BASIC CHARGES Detach here lading ra Actual NON-BASIC C~fAIRIGES 15.25 -5.00 10.25 25.75 4.75 30.50 40.75 Your 2009 cooperative and generation s~nd'tr~ansmiasion (G&T) alloaationa bolow are subject to tkrtu~e rotirements (normally in Decemt~ar) as financial conditions permit. Co-op: 137.34 G&T: 523.86 ACC4l,~NT :~~ A`I~ Rev Month APR 2010 Previous ~al nce: 42.76 Payments ~Re~ceived: -42.76 'otal yearly Balance F{,orv~-ard: 0.00 KWH for past 12 6ti41 Total Basir: ' 40.75 months Total Non-~a$ic: 0.00 Avoraga Sales Tax:' ' 0.00 monthly ACCOl1NT B,~ILANCE 40.75 KVYH 545 for past 12 months PAYMENT QUE Q5/2~/20'1,a 40.75 Detach Here Please detach the above portion and return with your payment. Meter Type Provious Present Multiplier ea ing Account #: 2090900300 Readin Readin Used TYPe Name: GLEN R HORN ICVNH 24188 24438 1 2 0 Actual Reading Dates: oa/3o/2oio To os/3o2o10 Rate: RSW31 RESIDENTIAL W/1NTR HTR SERVICE Service Loc: 38 HORN RD SHBG IL iD ;,AIL BASK CHARGES NON-BASIC QHI~ GES Energy supply prices and charges are set by your electnc generation supplier. Adams Electric Cooperative Inc. 888/232-6732 1338 Biglervilfe Road Gettysburg, PA 17325-1055 ENERGY SUPPLY: Energy charge 270 kwh @ .061 16.47 Load control credit -5.00 OTAL ENERGY SUPPLY 11.47 DISTRIBUTION: Access charge 25.75 Distribution charge 270 kwh @ .019 5.13 OTAL DISTRIBUTION 30.88 OTAL BASIC CHARGES 42.35 protect sensitive electronic equipment troln power surges. Contact Adams El ectric for a complete',lin~ of affordable surge protection and uninterruptible power supply'(UPS) equipment. Call 888832-6732 ACCOUNT S M ARY ev Month AY 2010 Previous ~ nce: 40.75 Payments''Rgceived: -40.75 oral yearly KWH tibr Balance F'oriNnlyd: 0.00 past 12 s149 Total Basil: 42.35 months Total Non-~a$ic: 0.00 Aversge Sales Tax: '~ 0.00 monthly 512 ACCOUNt B~4LANCE 42.35 KWH r past 12 months PAYMENT DUE Og/7?/21,010 42.35 Energy charge 246 kwh @ .061 15.01 ' Summer energy charge 246 kwh @ .022 5.41 Load control credit -5•~ 70TAL ENERGY SUPPLY 15.42 DISTRIBUTION: Access charge 25.75 Distribution cha a 246 kwh @ .019 4.67 OTAL DISTRIBUTION 30.42 OTAL BASIC CHARGES ,4„y,84 Let Adama Eloctric sand you back to s h ' I! Go to ~ ia oirer how you can adamsac.coop or call888832-6732 to apply for one of tha 51000 adult scholatsh available to co-op momb~ra. Your acholarahip appllce oh moat ba postmarked by July 31, 2010. iav Moult JUN 2010 Previous Eal rtice: Payments] R slued: tor1Y WI Balance Fo rd: I H past 12 5691 Total Basil: months Total NonaBa~ic: Awngg~s Sales Tax; morttltly ACCOUN~ B~ILANCE K1NH 474 or psai 12 months 42.35 -42.35 0.00 45.84 0.00 0.00 45.84 uetacn Here Please detach the above portion and return with your payment. Account #: 2090900300 Meter Type Pnvious Present Multiplier KNIT ea rig Readi Read Ue Type Name: GLEN R HORN EST KWH 24684 24746 1 62 Actual Reading Dates: os/3oRo1o TO o7Rsrzolo Rate: RSW31 RESIDENTIAL. W~WTR FITR SERVICE Service Loc: 38 HORN RD SHBG >. BASIC CHARGES .: . .. . ,. NON-BASK gIiATRGES Energy supplx prices and charges are set by your electric generation supp{rer. Adams Electric Cooperative Inc. 888/232-6732 1338 BiglerviAe Road Gettysburg, PA 17325-1055 ENERGY SUPPLY: Energy charge 62 kvvh @ .061 3.78 Summer energy charge 62 fcwh @ .022 1.36 Load control credit -5,00 TOTAL ENERGY SUPPLY 0.14 DISTRIBUTION: Acoess charge 24.89 Distribution charge 62 kwh @ ,019 1.18 TOTAL DISTRIBUTION 26.07 TOTAL BASIC CHARGES 28,21 M you are an Adams Electric rental proI~ owner or tenant, please complete and return the enclosad f r1n. This ~ information will help us update our menhbe records to serve 1 your property Heads more atticienty. Rev Month JUL201o Previous I ce: 45.84 Payments R eived: -45.84 r~H ~~ Membership~1~Th~"epositnnt -5.00 past 12 5077 Balance i$olliwtrd: -5.00 months Total Basil: ' 26.21 Awn~~ee Total Non-~,Ba$ie: 0.00 mortddy 423 Sales Tax:. 0.00 for p~st 12 ACCOUNT B~ILANCE 21.21 morphs ~1 r-,r--~ IESI PA CORPORATION P.O. 80X 399 LD. NO: 52-2175834 SCOTLAND, PA 17254 717-709-1700 • $77-709-1700 (TOLL FREE) FAX 717-264-2285 PURCHASE ORDER REQ. 1(ES' NO P.O. # NAME G: ~--r_ BILLING2 _ ~ . ADDRESS ~~'t~~- ~ i ~ I 4" CITY, ZIP=__~a'~ Ii f-MAIL TEL # F :CONTACT. NEVUS ^ PRICE INCREASE `'~--:-~---~°`~~ SERVICE SfiART ATE CONTAINER DEt~V~RY DATE ^ SERVIGE INCREASE ^ PRICE DECREASE ^ SERVICE DECREASE ^ OTHER s .. ACCOUI~tT , ~ r- i NAME -y ' N ~ t i t ' ,, ~._ ~ ~ ?tit ~ ; ~ ~ `',~ `, `~._'~'E:... ., SERVICE '~ ~ "~ } t-%` Y I ~ ~`"``~~ ADDRESS 1-- ...~ CITY, ZIP r ~ _~.i i tai } +, ~ ,~, . f (I, t {- ~ ..<°~~~ i -_I ~~f l COUNTY {~ ~~ f ..~, ~~~ - `-..+~7 -'` TEl # " FAX # CONTACT ~0 t '~ ~'"~ CUSTOMER ACCOUNT NO. ~ ~j ~~ '-~ ~. 3 ~~ 1 EQW~PMENTI:~CRVtCE SPECIfICATIQIdS ~~ r" F Duantity Size Uds Wheels Locks F envy Sehedule & Route No. Charge(s) Tues. Wed. Thurs. Fri. Sat. $ , a t :;{: LifF Tues. Wed. Thurs. _ Fri. Sat. Month ~ $ Lrft - ~rqy. Mon. Tues. Wed. Thurs. Fri. Sat: ..Month ^ $ Lift on. Tues. F` ..Wed: TPttir5:° Fri. I Sat._ $ liknth ORIGIN OF WASTE {COUNTY AND TWSHP) g Total Mftnth ~ TYPE OF WASTE SPECIAL INSTRUCTI 61LL TO ACCT # DISPOSAL SITE AMEX MASTERCARD VISA DISCOVER CREDIT CARD # EXPIRATION DATE CARD HOLDER NAME CARD HOLDER ADDRESS CB ~000~. SERVICE AGREEMENT NON-HAZARDOUS WASTES 1 ~~ SCHEDULE' O~"CHAR GES SERVICE CHARGE PER MONTH ``CASTERSILOCKS $ EXTRA PICK-UP CHARGES PER LIFT $ PER YARDlTON $ HAULING PER LOAD .DISPOSAL PER LOAD ', $ TOTAL PER LOAD. '~ $ DELIVERY CHARGE ' ~~ THE UNDERSIGNED INDIVIDUAL SIGNING THIS AGREEMENT ON BEHALF OF CUSTOMER~ACKNOWLEDGES THAT UNDERSTANDS THE TERMS AND CONDITIONS OF THIS AGREEMENT, ON REVERSE SIDE, AND THAT HE/SHE HAS HI BEHALF OF THE CUSTOMER. CUSTOMER CONTRAIC~'C ' \ ~ ~ I ~, .rl ~ °.~ ? %.,I ~ ; ~ ~' :~ , t" t it AUTH RIZED SIGNATURE REPR SE ATIVE'S SIGNATU ! TITLE DATE SALES ID CUSTOMEp 4D AND `TO SIGN ON . ryh ,~.~1 y c DATE r ~~ IESI -CHAMBERSBURG `~~~~ PO BOX 399 - ' SCOTLAND PA 17254-0399 717-709-1700 . ^:.~, ~° 717-264-2285 -FAX Page 1 of 1 INVOICE DATE CUSTOMER ID 2300046472 /01/2010 105042041 BALANCE FWD PAYMENTS FINANCE CHARGE ADJUSTMENTS NEW CHARGES AMOUNT DUE 122.00 125.00 0.00 0.00 97,.00 94.00 GLENN R HORN ESTATE GLENN 38 HORN RD SHIPPENSBURG PA 17257-9752 RETURN CHECK FEE X35.00 BLANKET PO # SERVICE REF DATE 11CKET # NUMBER QTY DUE UPON t#E~EIPT CURRENT 1 - 30 DAYS 31 -160 DAYS 61+ DAYS 94.00 0.00 ' 0.00 0.00 DESCRIPTION 02/24/10 Payment # 3385 001 - GLENN R HORN ESTATE 38 HORN RD Service Order #: 0004057556 04/01/10 - 04/30/10 0000259244 1.0000 COMMERCIAL 10YD CONTAINER SE~tVICE Site Total The Address below is for PAYMENTS only. Please use the Address and Telephone Numbers above for any outer borrespondence. IESI -CHAMBERSBURG PO BOX 399 SCOTLAND PA 17254-0399 CHARGE 125.00 ai.w Customer iD 105042041 'Date 04/01/2010 Invoice 2300046472 A ~ Due 94.00 Amount Paid with this Coupons use this coupon to make yolur ~ayments by check or... ~,a'~ ~NLII~lE:~i ~isat us at wvuxr.iesi.c~m~i:"paymar=.ts vs, you still have the option >la parr by phone via ACH o RETURN SERVICE RE VESTED . ~.. , GLENN R HORN ESTATE GLENN 38 HORN RD SHIPPENSBURG PA 17257-9752 N~~~LI~I~~~LLIL~~ILJI~~~~iI~~~M~LhILI~~LI IESI - PA CORPORATION ' ~, CHAMBERSBURG HAULINIG PO BOX 660655 DALLAS TX 75266-0655 ]~05042041230004b4~200000094009 IESI - CHAMBERSBURG PO Box 399 SCOTLAND, PA 17254-0399 717-709-1700 FAX: 717-264-2285 Page 1 Invoice Date Customer ID 2300053018 5/1/2b1 105042041 lance w Payments finance arges Adjustments Amount Due 94.00 94.00 0.00 0.00 9$.00 97.00 Attn: GLENN GLENN R HORN ESTATE 38 HORN RD SHIPPENSBURG, PA 17257 Blanket PO # Service Date Ticket ~ Ref Number 4/27/2010 001-GLENN R HORN ESTATE 38 HORN RD May-2010 0004139550 PAYMENT IS DUE UPON RECEIP'Tr O INVOICE LATE PAYMENT MAY RESULT IN AN INTERF~U ION OF SERVICE. ANY PAYMENT NOT RECENED WITHIN 30 A SiOF THE INVOICE DATE ~ WILL BE CONSIDERED PAST DUE. PAST D E I ~ OICES SHALL BE SUBJECT TO A LATE CHARGE OF 1 1J2% f R CH MONTH OR PART THEREOF THAT THE INVOICE IS PAST DUE4 DUE UPON REC~IP~' Current 1~0 Days 31-60 s 61+ Days 97.00 0.00 0. 0 0.00 Qty 'Description ' ' Charge Payment # 102 ' -84.00 1.00 COMMERCIAL 10YD CONTAINER $E~ 97.00 Site Total ~ 697.00 IESI PA CORPORATION CHAMBERSBURG HAULING PO BOX 399 SCOTLAND, PA 17254 (717) 709-1700 Fax: (717) 264-2285 Paae 1 of 1 {nvoice Date Customer ID 0000982749 Q6/ 1/2010 105042041 Balance Fwd Payments Finance Charge Adjustments New i,Charges Amount Due 97.00 -97.00 0.00 97.00 97.00 ~1CEll~-t ~. CsLGNN~fiLHORN ESTATE 38 HORN RD SHIPPENSBURG, PA 17257 RETURN CHECK FEE: 535.00 Blanket PO # DUE UPON RECEIPT II Current 30 Days 80 Daays 6?+ Days 97.00 0.00 .00 0.0!? Service Date Ticket # Ref Number Qty Description ~~ Charge 05/17/10 Payment - #106 -87.00 Site 0001 GLENN R HORN ESTATE 38 HORN RD 06/0'V10 -06/30/10 1.00 COMMERCIAL 10YD CONTAINER SEiRV~ICE 97,00 Site f l'mtal 5 97.00 IESI PA CORPORATION CHAMBERSBURG HAULING PO BOX 399 SCOTLAND, PA 17254 (717) 709=1700 Fax: (717) 264-2285 Paae 1 of 1 Invoice Date Customer ID 0000988753 / OJ2010 105042041 Balance Fwd Payments Finance Charge Adjustments Now har+ges Amount Due 97.00 -97.00 0.00 1 X4.00 194.00 .;tf c' ,r ~y,r,,© GLENN R HORN ESTATE 38 HORN RD SHIPPENSBURG, PA 17257 RETURN CHECK FEE: X5.00 Blanket PO # DUE UPON RE~E~P!T Curt~ent 30 Days ¢0 ' ye 61+ Days 194.00 0.00 .00 0.00 Service Date ~ Ticket # ~ Ref Number ~ Qty ~ Description , Charge- _~ 06/29/10 Site 0001 GLENN R HORN ESTATE 38 HORN RD 06/16/10 0002099215 1.00 07/0'Y10 - 07/3V10 1 •~ Payment - #110 -97.00 10YD FRONT LOAD EXTRA PICK UP ' 97.00 COMMERCIAL 10YD CONTAINER SE~tVI~CE 97.00 Side Total ~ 194.00 ~.~~.~-k. ~.1 t - I yS S ---__. St? r.at -~ •~ ~ ~.a ~P/ ~~ ~ s .~ ~m Cdr P S~~,k~~.~ , ~'~. ~~ ~sy The Address bebw is for PAYMENTS on Please use the Address and Telephone Numbers above for r correspondence. IESI PA CORPORATION CHAMBERSBURG HAULING PO 80X 660855 DALLAS TX 75266 Customer ID 105042041 06/30/2010 Invoice 0000988753 o nt Due 194.00 Amount Paid with this Couporc Please use this coupon to make >~ r payments by check. If you would like to pay via ACH~~or ~rgdiflDebit Card, please call Customer Service at : 717) 709-1700 GLENN R HORN ESTATE 38 HORN RD SHIPPENSBURG, PA 17257 IESI PA CORPORATION CHAMBERSBURG HAULIf~G PO BOX 660655 DALLAS, TX 75266 105042041000098675$0~0'D00194002 i State Farm Fire and Casualty Company ~--r ~ iDO State Farm P/aoe Ballston Spa, NY f2020~•8(!00 P-13-6212-F382 H HORN, GLEN R, ESTATE OF 38 HORN RD SHIPPENSBURG PA 17257-9752 Location: Same as Mailing Address Important Message(s) ~~~~='~ TODD WEST ~Te;e;i~o,.e (717) 532$409 oH~Kn~c uvt Nu ~ ~L~ POLICY NUMBER 38-03-3957-8 Homeowners Policy JUL 01 2010 to JUL 01 20i 1 j DATE DUE PLEASE-PAYtkIRS AMI3UNT F JUL 01 2010 $386.00 ~= 50 3176 6598 See revelrse side for address changes, Please keep this part far your record, COMMUNITY OFFICES IN FRANKLIN, CUMBERLAND, FULTON AND HUNTINGDON COUNTIES www.fmtrustonline.com "*****'***"*AUTO"*5-DIGIT 17202 1524 0.7150 AV 0.3't35 61 147 ~~ (111~~'11{~1{II~Illllli'{~11'Ili{II~II111~1'Illlllllllllllllll 2 ~ ~ ~ JANET G HORN ESTATE ~~ PATSY ANN MARTIN EXECUTRIX ~~ 167 OVERCASH RD ., ~ CHAMBERSBURG PA 17202-9209 "`; '~ 4~.~, STATEMENT OF ACCOUNT 11-29864 STI~T~MENT PERIOD FRAM' THROUGH I 03-02-10 03-31-10 PAGE ~~ 1 of 2 1 5 I I ESTATE ACCOUNT ACCOUNT: 11-29864 ~I BEGINNING DEPOSITS/: CHECKS/ SERVIC~ BALANCE NUMBER CREDITS NUMBER DEBITS FEES .00 4 8,476:08 2 943.92 .00 ACTMTY DATE DESCRIPTION CREDITS DEBITS 03-02 BEGINNING BALANCE 3' 03-02 DEPOSIT 0030000785$ 1,596.9 ' 03-02 DEPOSIT 00300007871 2,078.77v" 03-02 DEPOSrr 00300007872 4,765.53./ 03-12 DEP RET 00600102696 03-12 DEP ITEM RET FEE 10.00 1 AT 510,00 ` - DEPOS 200101743 34.85' 03-31 ENDING BALANCE SERVICE FEE BALANCE INFORMATION FROM 3-02-10 THROUGH 3-31-10 AVERAGE LEDGER BALANCE 7,$15.44 AVERAGE COLLECTED BALA~JC MINIMUM LEDGER BALANCE 7,497.31 MINIMUM COLLECTED BALLgAIN-CI AVG. INVESTABLE BALANCE 7,744.98 ENDING BALANCE 7,532.16 BALANCE .00 8,441.23 7,497.31 7,532.16 7,532.16 7,744.98 6,362.46 DIRECT F&M TRUST -CARLISLE CROSSING OFFICE '' INQUIRIES TO: 214 WESTMINSTER DR CARLISLE PA 17013 TELEPHONE: 717-263-2215