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HomeMy WebLinkAbout10-29-10 (2)i ~ 1505610101 REV-1500 Ex `01.1°' enns lvania OFFICIAL USE ONLY PA Department of Revenue P Y County Code Year Fil~a Number nr~~nniw.~r~r of Hevrnut Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 28o6oi ~ ~ r ~ L~ ~ ~~ Harrisburg, PA 1'7128-0601 RESIDENT DECEDENT / r ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 183-12-3703 02/17/2010 08/25/1921 Decedent's Last Name Suffix Decedent's First Name MI CABA GEORGE (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O O 4. Limited Estate O ~ 6. Decedent Died Testate O (Attach Copy of Will) O 9. Litigation Proceeds Received O 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) O 3. Remainder Return (date of death prior to 12-13-82) O 5. Federal Estate Tax Fteturn Required 0 8. Total Number of SafE: Deposit Boxes O 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Numb~ar G CRAIG CABA (717) 732-3204 First line of address 2520 LAMBS GAP ROAD Second line of address City or Post Office ENOLA Correspondent's a-mail address: State ZIP Code PA 17025-1129 Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct an lete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATUR~.k7~ SON R NS LE FOR FILI E RN f//ry DATE r ~ /O /V A RESS C. 2520 LAMBS GAP R ENOLA, PA 17025 SI RE OF PREPARER OT ER TH REPRESENTATIVE DAT i P~ L~ 1l7 AD S 7 ST MAIN STREET SHIREMANSTOWN, PA 17011 PLEASE USE ORIGINAL FORM ONLY L 1505610101 Side 1 1505610101 J 1~~ J 1505610105 REV-1500 EX Decedent's Social Security Number Decedent's Name: GEORGE CABA 183-12-3703 RECAPITULATION 1. Real Estate (Schedule A) ........................................... .. 1. 2. ..................................... Stocks and Bonds (Schedule B) 2, .. 7,080.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 4. Mortgages and Notes Receivable (Schedule D) ......................... .. 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 172,706.04 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested...... .. 7. 8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. 179,786.04 9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9. 3,123.43 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............ .. 10. 11. Total Deductions (total Lines 9 and 10) ............................... .. 11. 3,123.43 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 176,662.61 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. 176,662.61 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 45 176,662.61 16, 7,949.82 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE ....................................................... ..19. 7,949.82 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610105 1505610105 J REV-1500 EX Page 3 File Number Decedent's Complete Address: Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 7,949.82 2. Credits/Payments A. Prior Payments - B. Discount Total Credits (A + B) (2) __ 3. Interest (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) ___ 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 7,949.$2 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.......................................................................................... ^ b. retain the right to designate who shall use the property transferred or its income : ............................................ ^ c. retain a reversionary interest; or .......................................................................................................................... ^ X^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 0 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? .............. ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ........................................................................................................................ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for 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 the 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 requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 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 4.5 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)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX+ (6-98) Y SCHEDI~ILE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER GEORGE CABA 21-10-0400 All property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (6-98) } SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER GEORGE CABA 21-10-0400 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 CAPITAL FINANCIAL SERVICES -ACCT #: N8T-007713 -MONEY MARKET ACCOUNT 1,581.56 2 CITIZENS BANK -ACCT #: 610068-935-2 -CHECKING ACCOUNT 65,313.49 3 MEMBERS 1ST FCU -ACCT #: 335593 -SAVINGS ACCOUNT 2,759.31 4 MEMBERS 1ST FCU -ACCT #: 335593 -CERTIFICATE ACCOUNT 100,000.00 5 ROBC LIMITED PARTNERSHIP -REFUND 1,209.00 6 PA STATE EDUCATION ASSOCIATION PENSION AGENCY 173.49 7 COMMONWEALTH OF PA -DEPOSITS 1,288.35 8 COMMONWEALTH OF PA -DEPOSITS 380.84 TOTAL (Also enter on line 5, Recapitulation) $ 172,706.04 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-09) SCHEDULE H ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER GEORGE CABA 21-10-0400 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' FUNERAL DINNER 762.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City __ State __.. _.. ZIP . __ Year(s) Commission Paid: 750.00 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City _ _ _ _... State _ ZIP _ . Relationship of Claimant to Decedent 4. Probate Fees: 327.50 5. Accountant Fees: 500.00 6. Tax Return Preparer Fees: 150.00 ~• RENT EXPENSE 588.00 s MILTON S HERSHEY MEDICAL CENTER-PHARMACY 10.00 s ALERT PHARMACY SERVICE-PHARMACY 28.93 ~ o ALERT PHARMACY SERVICE-PHARMACY 7.00 TOTAL (Also enter on Line 9, Recapitulation) I $ 3,123.43 If more space is needed, use additional sheets of paper of the same size. • ~ REV-1513 EX+ (01-10) pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: GEORGE CABA 21-'10-0400 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. GEORGE CRAIG CABA 2520 LAMBS GAP ROAD ENOLA, PA 17025 SON 50% 2 PATRICK LOUIS CABA 2520 LAMBS GAP ROAD ENOLA, PA 17025 SON 50% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS 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. I $ If more space is needed, use additional sheets of paper of the same size. REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA No . 20 ~ 0- 00400 Estate Of : GEORGE CABA PA IVo . 2 ~ -- ~ 0- 0400 (First, Middle, Lastl Late Of : HA MPDEN TOWNSHIP CUMBERLAND COUNTY Deceased Social Security No: CERTIFICATE OF GRANT OF LETTERS 183- ~ 2-3 703 WHEREAS, on the 14th day of Apri 1 2 010 an _ins trumen t da tf=d October 6th 1998 was admitted to probate as the last will of GEORGE CABA (First, Middle, Las11 late of HAMPDEN TOWNSH/P, CUMBERLAND County, who died on the 17th day of February 2 010 and WHEREAS, a true copy of the wi 11 as probated .i s annexed hereto . THEREFORE, I, GLENDA EARNER STRASBAUGH _, Register of Wi 11 s in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, i~ereby certify that I have this day granted Letters TESTAMENTARY to: G CRA lG CABA who has duly qualified as EXECUTOR(R/X) and has agreed to administer the estate according to law, al.Z of which fully appears of record in my office a t CUMBERLAND COUNTY COURT HOUSE, CARL /SL E, PENNS YL VA NlA . IN TESTIMONY WHEREOF, I have hereunto set my hand and af:~ixed the seal of my office on the 74th day of April 2070. * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAS'T') S i `t S 1 t ~ '~ ~~~:~ i~> ~ ~ ~ ,. ', V ,'a i , tie©rge Cuba, row or formerly of X211 Dcfver ~.oad, I~arrisburg, Lower ~axten Towrsh:~p, Dauphin County, Fer~nsylvan~_a, being of sound and disposing mind and memory, do mane, publ.i.sh and declare this to be my Fast ~i11 a.rd Testament, hereby rev©}~ing a1~. Wills and CeGic:a.~.s by mE at any time made . T direct that all ir~heritan.ce and es~:ate taffies b~comin~r due by reason of my death, whether such taxes may be payable by my ,state or by any recip~.ent of any property, shall be pa~.d by my Executer out of the pr©perty passing under this twill., which zs not specifically devised er bequeathed, as an expense and cost of adm~_ni~tra tiers of my Estate . My Executo.~ 9ha2 ~~ have no duty a~: t~bligation to cbta~:n re~.mbursement for any such tai: paid by my ~';h~ci~i for ever though on proceeds of insurance or ether prQ~ert1r ~d~~<<, passa.n~ under this X11.. ~~~.~~.~.: ~ hereby exercise al:~ ;powers of appontrner~t wh~.ch l may ha•~e at the time cif my death in. favor e~ my ]~'xecutor, and ~l.l r.~roperty sub~iect to ~~.1 such po~aPrs ah~~.~. be in~,lt~dea a.n my Estate. ~r~~M Imo,,;.: i give and. bequeath. all lily household zux_nt~~:r_e end fu~-~zisy~ ~ nr~s, a~.~totnobs~.;.es, hc~o~s, p-~ ~~:tt~r~~, -j~w~-~1.~}~,~, china, linen; sil~.rerware, ~~earing apparel, a:-:d ~l? otter 1 ke art,i.cles of ~.ouseho? d or pex-srnay ~a:~e and ad©r_n~nent tc~ my children, ~. Craig Caba and T~atr~.ck. ~,ou~.a ~a~a, if they surv;~ve me, or if my chs.ldx~Pn coo not surva.~Te me, to mgr th~ar~ living gra.ndrYii l.t~ren , per qt irpes ,~',,~~: ~ give, devise and beques.th ali. Qf tree rest, residue and remainder of: m-~ property, real, xaersorlal and mixed, to my chi.l~lrerl, a.f they ,survive me, ter, if they do rot survive me, tc ~- my then :l.~ri.rg g:rand.chi.l.dren, perµ^ystirpes : ' '<' '; Trl the settlement of my Est~.te, my Executor shall possess , among others , the f o:1lo~ang powers to ~~e executed for t~'~P rest i.~~tarest:. of the benef~.c~.i.ax'i,es (ai 7'o sell, either at publics or pr:i.vate sale and upon such terms and conda.ti©i~s as my Execu for may deem ac~vant~ageous to my Estate, any ©r all read. or persona estar.e or interest: ~.h:eren, whether o~,mec~. by me severally or i.n cox~j unct ion with other pears©ns car acqua.red after my death by my Executor; and to consummate sa:;.d sale car salas by sufficient deeds or o~,~~er anstrument.s to t~~e purchaser car pu~~cha~~ex's, con~re3ri.ng a fee simple L-it1e, fyee and c~.ear of alb. tr~ast and ~v_ithout ok~lgation ox lakail.ity of the pure}~.aser or purchasers to see wo tlZe appi;ic?t~.on of the pu~"C~:iasF money or t~ ma}~e :i..:irui.ry into the valc~.~:ty ~f n~.'~C~.~.~~...+''~~(W o:~ Fc~~~~ j c`3.~~~~, 4 ~ ~!~G f €~t,'_~~~~.~ 1;.~, 7 ~~C7~ ~ ~? ar,know:l cage anti del.vex' any and a1.1 deeds ; a~signl~pr~t opt~.cxiti or rather writ~i.ngs wh~,ch may be nec~e~;s~ry or. d~~,irak~l..e in carryi.rig cut any of the p©wrrs conferred up~~n ;ray ~'kc~cutc~r in this ~~ragrap~~ V (~) o.r ea_~~cti~t'1~`~" :~. ~-,. ~iy ~V ~ ~ x (~) To p~Y a1.1 ~~sts, taffies, expenses a:r1d rha.~ge 1 ~ . +.> ~-, ~~on~:~~tpn with the a~m~.n~.stx-atiaxi of zny F~~tate , my }~~~Rcutr~:r shal~_ p~~. ~pt~ns~s of my l~.st i1:3..ze~~ a.~ (G) ~o a~.~tr~u~.~ m}r .~ ~ta~e in. ~;i~~ o~ .n. tYE~nt~y ~~y assets art t~i~fix~s.hutiLd. ire k~:nd, they sha~[:l be d~.st:?~ik~uter~ at ~hei.~ respeet~~~ ~alu~ (~) ct~ the date ~~} ~~, 1c~ ret~t~ ~.t~y i~ue~tm~n~:~ ~: mad h~~tr~ ~t myy de~t.h ~a ~.ang as my E~~eta~t~~r s~~y diem ~:t ~~~; ~.~~~:~.~ to x~i~ ~st~~~ so tc~ d~. t~) To vax~~}r ~..ri~re~tmen~Ws, ~•hen d~emer=t dESira~~e by try ~~~~uEwor end ~C~ :1.Tl~.~e~w in ~u~h bands, St~if~~r notes, *r:c~n~y Markets, real ~st~.te mortgages car oth€ €ecur:it~ e~ or ~.n s~ac~~ ~L-her property, real. or personal, a~ he sha1.~_ deem w~_ae, without being restri:ctE~d to s~- celled ".~ga ~.z~v~s~ments . ~~ (~) To mor. tgage real estate end to make :leases cf. r ~'~1 ~~1>~te? . ~~~~= °~ c (g ) To borrow money f tom any part`r to pay indebtedness of mine or of my Estate, expenses cif administration ox inheritance, legacy, estate and other taxes. (h) To vote any shares of stack which form a part of the Estate and to otherwise exercise al1_ the powers incident to the ownership of such stock. { ~. ) ~:n the discretion ©f my Executor, to unite with other owners of similar property in carrying out any plans for the reorganization of any corporation or company whose securities form a part of the Estate. (j) T'o distribute my personal property directly t© the Guardian of the person of any minor beneficiaries hereunder. (k) To elect such settlement options as deemed m©sr_ appropriate by my Executor with respect to any pension, profit sharing or other retirement plan in which ~ am a participant. {1) To do all other acts in the judgment of my Executor necessary or desirable for the proper and advantageous management., investment ~.nd distr:i.~7ution ref r~iy ~st.ate. ,~'~;~'~.1 ~~TI: A.s~.y pets®n who shall rave died at the same time as Testator. or in a common disaster wa,th h=i.ni, ox: u?~der such ~a~~ ~ o circumstances that it i_s difficult or impossible to determi.rle who c~{ied first, sha11 be deemed to nave pred:~ceased him. ~ VIi: I nominate, constitute and appoint my son, G. Craig Caba, to be my Executor (1-ierein referred to as "Executor") . In the event of the death, resignation, refusal or in.abiJ_ity of G. Craig Caba to serve as my Executor, I n©minate, constitute ~~nd appoi~zt my son, Patrick Lewis Caba, to serve as Executor. My Executor is specifically relieved from the duty ar obligation cif f_ i i ing arly bond or bands . IN WITNE~~ WHEREOF, I have set my hand and seal to this my Last Will and Testament, consisting of this, the next three (3) pages and the p7~eceding four (~) pages this ~-'``-day of ~~`~- ,.~~~~ ~~- , ~,r~~~3. r~ r~ f-..~ ~... - 4-- ~_p ~-.~~: ~,~. ~..r.j ~..... ~..~.. ~,: ~.. f T~ ~. ~ Page ~ of €3 SIGNED, SEALED, PUBLISHED AND DECLARED b~.t the above named Testator, Ge©rge Caba, as and for his Will, in the presence of us, who, at his request, in his presence and in the presence of eac~~ other, have hereunto subscribed our names as witnesses s_n attestat 3,on thereof . 1.420 North Second Street Harrisburg, PA 17102 72 South Pin Cak Drive Boiling Springs, PA 17007 l28 East Liberty Avenue Carlisle, PA 17013 Pac~`~e 6 ©f f~ ~GW~ED~~~ COMMCJNWFAL,TH OF PENNSY~,VAN~~ SS.. COUNTY CJ~ CUMB~RZ,AND ~, George Caba, the Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that T signed anc~ executed the instrument as my ~,ast Will; and that r signed it willingly and as my free and voluntary act for the purposes therein ex~>ressed. Sworn to or affirmed and acknowledged before me by Geor.c~e Caba, the Testator, this Cv~C day of d~,,c~~ 1Q9~ . ;~ ~+ .r; ~` ~' ~- ;~ ~~ . ~~ ~ Not ublac - ._._- My Camm.i s s i on ~xp ~. re s (~~~) t~pTARiAL SEAL C©t~t~iE R. S~ittl.TZ, Ncw+ry Pubic Mechar~fa*~9, Cue~he~elsr~d Gne~tY M Gvrt-mi~ts+art E s A: , 1 ~. 2()42 F~c~Ct~ i n f 11I'FSnAVST CUMMCT~k1~~IaT~-I t~F ~ENN~YLV,~'~TI~1 SS.: We, Mark ~. Emery, Robyn Cronin and David A. Tones, II, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the instrument as his Last Will; that the Testator signed wi~_Zingly and executed it as his free and voluntary act for the. purposes therein. expressed; that each subscribing witness, irs the hearing and sight of- the Testator, signed the Will as a witness; and that t© the best of our knowledge, the Testator was at that tame 1~ or more years o.f ar~xe, of. sound m~.nd and under no constr~.int or. undue inf.~uer~c~ . Sworn to or affirmed and subscribed to before me by Mark R . Emery, Rob n ~r~in and Da~T~.d A . Jones , x ~ , 'Vt1i the S ses , thws ~~~~ day of c, ~ ~' ~' 1.998 . ~~ ~ ~ ,-- Witness ~ ~ Witrsese .... ~ W ` tl'~ess ~ ~ ~ Public My Commission expires: (5 EAL ) ~y~TAR~AL SEAL C:ONNIE R. SHULT2, Notw~ Public M~ch~nicsbtxg, Ct~r~birelahd C.exr+ty tw Comm~~sion Ex ' . ~ A . 13; 2f~1'I2 . ..:,, ~~ge 8 of f~ 10/21/2010 L.~ ;~,~ PFE Historical Prices ~ Pfizer, Inc. Commo... ~-- ,,,L,~ ~ j ~~ Q~ ~-G' c? Hi, Joshua Sign Ou# Help Make Y! Your Homepage Yahoai Mail H~~Q, F ~ h! A N C E Search Web Search Dow 17" 0.06% Nasdaq; 0.32% HOME NEWS ~ OPINION PERSONAL FINANCE MY PORTFOLIOS TECH TICKER GET QWTES , . Pfizer Inc. (PFE) ~C ~~ ~~ (,~ ` Z ~~• ~i Amtwadr, TRADES r E . '~" At 2:46PM mT: 'I 7.60 10.06 (0.34%) ~~~~~ ~N mw AdC~~CiUfJT e . E~kTRRDE~SECURIflES LLC Historical Prices Set Date Range Start Date: Feb ~ 17 2010 Eg. Jan 1, 2010 End Date. ""Feb i ~ ' 17 201~0 Get Prices '~ Prices Date Open Feb 17, 2010 17.85 '! Download to Spreadsheet t..r~.~. I"`~+ t f~ r .s Please providE High Low Close 17.86 17.53 17.67 Gose price adjusted for dividends and splits. Daily Weekly Monthly ;Dividends Only Get Historical Prices for: ' I GO AdChoices r't VTa~l~ Fuza;a ~vnnpsng, First ~ Previous ~ Next ~ Last Volume Adj Close' 58,254,100 17.29 First ~ Previous ~ Next ~ Last online Services Guarantee Yc-~az c~o~xorzr',Part WWII de~ ca~tr~czri CapyrightC~~201Q Yahaof tnc Ail rights reserved. Privacy Policy-About OurAds-TermsofService-Copyright/IP Policy-Send Feedback-YahOal NeWS NetWOrk C~uotesare real-time far NASDAC,1.. NYSE, and Amex.See also delay times for other exchanges. All information provided "as is" for infonnatronal purposes only; not intended for trading purposes or advice. Neither Yahoo' nor any of independent providersisliable for any informational errors. incompleteness, or delays, orforany actianstaken in reliance on information contained herein. By accessing the Yahoo! ste, you agree not to redistribute the information found therein. Rea!-Time continuoussireaming yuotesare available througtm our premium service. 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"n!eT+~r!s^w'e!!. ~^irei~ Uotd ~urnrr~ary Account Atepunt Number 6al~+nEe Balatlc~s ~f~iRGlr CAE3A cast staturr-ent this Stat•m~r:t %, CRAIG C1l(3A aEPQ5ZT BALANiE Circle Geld CEi~CE41nC~ w/Il~tsC~S't Checking ~. , ~ - „~(}0{?~3-.1i~ ~ Ci:-cl~ mould Cheekiijg v~fXnt~r~~t ~1~E)68=5:~5-2 fra, 342. ~~ ~~~~, 370. ~~ Cirelt: Geld CE~eek{ng ~u/zt~i;at~ast N ~I~ 61UG7~.-~g2-S 1,~a~G.t~~ ~r~.~. ~~,4t;~.n6 Cis ~ti~ ;~.Cc?~;±~i c+-iC rtl~rzt`tt C~ t2~~~ f~~3~G~ , Ali . (~~ P,~t~Eti.lt~y cc~rnb~ir~~ci ~alat~~r:~ t.~ t~aii~~ rs~~tikftly fay i~ Your rriot~~hly c~m~ined bvlar~Ge tE~is st~~err«tj~ per'trzci is 1'~t~t i~~~~»it b~~9!~~~ S~:i, :s~r,.1C 20, OQO. Q~ Totat K~laai~rt~3itp C~~i~cycr; S ; 3 ~.~ 2. ~ ~. l~7 ,,3 E'3.~~ . ~~ I ~~,E i i`i E:~:>" ~i ~;C".rtt, :~c'~alC~3~L~ c,c,;i!~ CrU:.;Gtll~( rE'tYlw;: l?I7~ >tti~~ ??I~i!; 1;27 3tl~t~ii: ~ if 11'.i;nr'IUiI, CLiii~?17r frl}@8, dll~ d{1`-4V~.t~ kU U~tlt W?1@~r.tpl9~. tit?iltr?i"ltntj l ~'k~)'Ct~t)y . ta, ~~ll~ (1 f.l~?r~ctt;t~{,i f~tE?rI`.it ,L~ 2(~d`It~ Ch~ckir~~ _ _. SUMMARY c,lCtl;c~f~ Ct~' L~r~ C_x E~i1,<~i~l ~.~1~1~r~ ~~~c~i1~@ ~3~CU~.a~1Ci1 ~~AfIC1t7~'~ Eir~~~ ~t~ld ~i~~kirig LvJ~rat~r~~# f~r~Vit)il; L~al~sist't_' (i'~,3~a2,42 f~~et(tt{~' f~Cdt(lf f~tilflt)i:f? ~~~~,ttCitf..li i;~t.(lf~'#-`_+?`_~~i? ir.IrC!1.~`i ~4! OG~`c~. #~ .. ~`ttf~res~ 1~?ithcirawals .~~ L)frpt~sits ~ t~dr~itit:F~ra :i,0~i1.~~ .+. Inteiti~st ('zti=.! `i.O + ,~nttuctf f~€?r~~.'tr~tcftz 1`€~(tl ,.~'tt€j~~t{ .lf~`:~~ Cu~r~n~ 8~.~;~~~ r+~ti, 37~). 24 = Nunt~~~r~ cif ~~x~s ~ttter~st~f_~crr,i~r~ ~'7 Ii~~st~sf ~~ar€t~ts `r.C)7 Inte€~~t F'c~ir~~ this ~`c'~r ~U,15 prat ias+;~ 6atartee TRANSACTIQN UETAIt.S C`~,3~;~.4~ Checks* Tfrerc is n ureuk in check ses€u~nr.~~ Check ~ Amount pate Check ~ Anrou~rt Efate 120 ~~. J3 03/~~ I7. f,8 10,+)0(). o~) ~r2 j~7 12G7" I~,JQ0.0~ 02/2? Total f i,aSkS 1.EQr'~1~,~i~ 4~ L7K l'i44~~ L~Q~~t? ottn )~srr~p Apa t t tiott path p { j n p g / ()37'1 .),0~) l . ~)Ci I.~'.~?)?(t ~ _, ir7tai flepnta#es & btiditirarCS a °"'~"' ~ ," . ~ , ~~r7 ~ t"yid pats Atttg!:rtt he~asri~tEor7l lief Sri 3.~7 int"t'.t~5f sac:pl T;rx~C~S~.:?itci .n. ,.... . ..., ._.. ~~~~ ... .. ... .~.. ... , ., . .~ ~ , , ~ - . -. . e r. .,, e- , [~ t,J) ! C-~ttent Eai~t~r`Q .~ . - r~u, :jiE;. ~'~+ ~a~iy ~atarr,c~ Date B~ta9lce Oate BaEance Oafe BaEatsce 02/17 `•5, 3~+~,4~ t~3~(?~ <r3, ~23.~t) 0~~'i5 ~4 ti, 3Ii).2.`+ 02/2? ~3,3~?..t;~ 0;~/~,~ 4h,:~~5.17 ..NEWS ERQM ~ITI~ENS --Looking for hir,~h yielda <aixi easy aceess to your cash savings~f Look r?o furtffer'. Citizens E3ank off~~r~s savinrfs and muur~y market accounts witL~r rarcat races arui the peace of rrrind uf~ Fl1%C insurance:. Whether you are just starting out ur looking tti preserve your Liquid rash deposits, we have an account to suit your needs. We also have nE~w prc~duets twat rew~~rd yr.~u for saving fur r:ulli~ge or a nr:w borne! Fur rTaure infc~riYtatiurt, to open an accrl?.rr~t., tar and t.t~ your existing bal~~nct~~, visit your (t7cal branch today ur eaLL 1.800-773-737 . Mernbr,r i-DIC..See a k~~anker fc~r FTC cuv~raye amounts arrd txan;ar~tioll lirnit~tic~trs. --Citin~r~rs Bank is !~rert~ fur ail yt;ur harrowing r-rc~eds. Whetht?r yon art~~ cunsolidat~incf dent:, r7takiny bur?a~.~ impravemer?ts r~r paying ofif student Loans, Citizens (3ank has cjrtaat fates t{Tat - t.an help you witfr ,~ variety afi borruwinc~ neer.}s. Take advantage ui flexible rep~+yrrrer?t. t<:rr?~s ~3nd na closinr~ costs on lu~i1?e equity Lilies ter loans. r~r, fur rhr?se of you i.~hr~~ gale purch;asintii - a borne ur refinant irtt~ yurtr r7rartc~aye,get 1/8°/o aff your rate wren yl~tr havt? a Cit+_le f~nLi Chet.kiny account and youur paytnL nt aut;an~?atiratty deducteri. Sc~e ~3 banker today ar call 888-71f-4824 and discuss your barruwir~g optinn. -~-Start pratec.tint_i hour identity today. Ntanitur any inquiries ur chanz~es mane to yaur credit report, view your credit. scort= and receive your first r~unth of Privar.y(;utardfar just. $1. i or d(,'iails or tr, ~nrcil call. 1 86~-9~~7-4019. i'rivacyt;uard is offered by Trilet~iant r, .. __ . t _ ;~ .. . ~~ _ .~, ~ .: ~~_~~ ~~ i Galt ('~ti~e~3~' ;p~ciat, de~icaz~~ ~ol~ i~uston~et~ ~~EVie+b tir,+° an}~ Cir~~~ for aE~.~ui~t ~a armature, c~r!~nt rates, af~s~ al~~vr+irs i~ yauv qu+astjanz:. ~rn~ut=~ ~ or ~ctctitrit n3~~~i8-y35-~ ~~ GF ~i~:gi~~E~rry F~~~ru~r3t 1~, Z(l1J fi.:~rattgft nl~rcit 15, ~0°l~ ~ . ~ ~..~..,,_, a~oRa~.cwa,• ~~~ O. CRAIG CA6F,, riJA 12th c-----~ _ ~_.... _.__ ~ c~~eoac~~tsxna Q. GR1i,ID`CAPfx, pQA - _..T... ~--------~ 12'7 ",'""" 7020 4AtK.+B ctAe ftg iigt)1J1. f+A 190k4 >•Tlekifo CtltC ~ t~ iH 3szo LAwt~ 6Ar wn 7N61~ I'A 17D!'J , i~ , .~ _ l~G~-~-~•firu+iio ()pfi i0T r a ~ , .R,..~'c,-~.+~-t.~.C--~~'° ' -____....,1 $ ,~. g. ~.3 ty in tM nrir ~,r :ti J ~ ~~ . r~,.7 ;',~'. ~ . ~~ pT _ •..~..~,~~.~.tr ._:°F°'~'°"_'t1u11Ari ~ ~ 1`~ ~yfi ......."'°,tdn;t~rc ~ ~.~w iu Ck l A ~~ ~Z@1~5E~ii1~C Gufnxt:sd~Aeso R CItI~C~19 ~s"1~k h . .~~i ~ r:nc • r uamt ~ r~~~l~t cf~~"'` .,°'~F ~edLP Vnf '~^Z-~~.. ~. ~ e ~ ~~ V r r •, ftar ... -.__._itr ~..._.. ~... ~ . __._..._... . . t: 6L[706f3R~~~n° ~:a~6U?6i5C __. y ...... _..... .. • ' i:p36r77~,35C]i. 4'a3pUrti8'~35 ~ ~1+"' ~r• iP6r i I (J3 ~ 124: ~}3~ 08.20 () $28~.~3 12~i7 r___m.__~r~.._____.__.-~._..__~__._____ ~~:;~ p~sgna~ e~ax, 126 Q. CR,#16s CxlRA., pCK 0?+A9 LAiAE!$ can aq '? ) a.n,Kaa BTJfitA, rA r~3 (,yam •,,, ~~?C~ DoT Pry tpcM ~.-y ~f~ ~f f~ y~ yy} 4° ~ otdwol **--- ..... F_,~ ~~ • ie't :.5.._-^c, ..,,_._..~.,,r,....J ~ ~j~ (A~ rf Citottns CitrJ~ Ac9wnt CittZetts ~~nic p1nPi~r4WN~ ~,C'136137~15t3t: ~lLUC7~ ~~~~~' ~w'6~ /Q'''~°"`~.'- 12h8 ~)2i 9 7,201 D $1 tJt3[)C?.tit) Send Inquires to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.membersl st.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 TeleBranch: (717) 795-6049 or (800) 237-7288 GEORGE CABA 2520 LAMBS GAP ROAD ENOLA PA 17025-1129 Your An a We have oncE SCHE~54~ St MEMBERS 1St FEDERAL CREDIT UNION Katie Clement ATCrrIb~'r S~~r.~icc Kcprc«~rrt~~~il~e Statement of Accounts Dec 25 , 2009 thru Mar 24 , 2010 Account Number: 335593 Balances at a Glance: Checking: o . 00 Savings: 2,759.95 Certificates: 100, 07s . 71 Loans: o . 00 Money Management: o . 00 ~~•~~^~ ~ "TD Reward: o . 00 ,Carlisle Pike Branch 6230 Carlisle Yikc Mechanicsburg, PA 17O5O Tel: '717.097.4432 Pax: 717.097.5274 clen~entk(c~memberslst.org Page: 1 of 2 fu with a SAVINGS ACCOUNTS 0000 - REGULAR SAVINGS Dato Transaction Description _ ~ ` Additions Subtractions v Balance Dec 25 Balance Forward 2,757.67 Dec 31 Deposit Dividend 0.350% 0.82 2,758.49 Annual Percentage Yield Earned 0. 350% from 12/01/2009 through 12/3112009 Jan 31 Deposit Dividend 0.350% 0.82 2,759.31 Annual Percentage Yield Earned 0. 350% from 01/01/2010 through 01/31/2010 Feb 28 Deposit Dividend 0.300% 0.64 2,759.95 Annual Percentage Yield Earned 0. 300% from 02/01/2010 through 02/28/2010 Mar 24 Ending Balance 2,759.95 CERTIFICATE ACCOUNTS 0041 - s MONTH CERT Maturity Date - Jul 29,2010 Date Transaction Description Additions Subtractions Balance Dec 25 Balance Forward 100,000.00 Dec 31 Deposit Dividend 1.740% 147.78 100,147.78 Annual Percentage Yield Earned 1.750% from 12/01/2009 through 12/31/2009 Dec 31 Withdrawal by Check 147.78- 100,000.00 Jan 28 Deposit Dividend ~ .740% 128.71 100,128.71 Annual Percentage Yield Earned 1. 750% from 01/01/2010 through 01/27/2010 Jan 28 Withdrawal by Check 128. 71- 100,000.00 Renewed at 1.000% to mature 07/29/10 Jan 31 Deposit Dividend 1.000% 10.96 100,010.96 Annual Percentage Yield Earned 1. 010% from 01/28/2010 through 01/31/2010 Jan 31 Withdrawal by Check 1 q . 96- 100,000.00 Feb 28 Deposit Dividend 1.000% 76.71 100,076.71 Annual Percentage Yield Earned 1. 000% from 02/01/2010 through 02/28/2010 Mar 24 Ending Balance 100,076.71 ~ ~19r6by C@I'G~l that the 14 a t~~s and exact y~,ot tie aimed 1 ~~ 1st Fede!"al r~dit U~1,p~ ~~`~,(~P Jv~ e ,~, -~ 1, n ~~ ~~ ~~.~- - - - Continued on following page - - - ~ _ ..~. _~ ~_ y ,~ ~~. ~ ~--- ~~ a G ~- ~ ~ ~ ,~ Page 1 of 1 SCtI t l7J ROBC Limited Partnership Nations! peon Bank 3200965060-e7a~a, 3 Va The Bridges at Bent Creek Boyertown. pA 202 Black Matt Road Douglassville, PA ,95,8 - - *'** ONE THOUSAND TWO HUNDRED NINE AND 00/100 DOLLARS TO THE DATE AMOUNT ORDER OF 02/23/10 $1, 209.40* ** George Caba c/o G Craig Caba 2524 Lambs Gap Road Enola, PA 17025 u'3 2009650u~ 1:0 3 1 308 7841: N' 215855043-1' CItIZEMS T5~B/4A/938/814 ~ RIVERSlE1E Rl @3]?2934 ~'7 -O 1 15001207 `"`~F~~-------------- -=; ~~_ _ _ ~`~ ~~ ~ `~ Posting Date 2010 Mar 12 Posting Seq No 42535067 Account Number 215855043 Check Number 32009650 Amount $1,209.00 http://wiismab0003 5008/inquiry/page/itemprint.j sp?BEANNAME=ArchiveItemListdetails..,. 9/21 /2010 + (~~,9. ~~~~:~ r~~~~~t ~~~~r~ ~~~ugl~~sviile, ~~~ ~ ~~ €~ ~~~r~~+ 41~ ~r~~r~ ~~~ ~5~~ i~~~~a~ C~~ ~s~~ S ~ N c ~~.J £~1JK~e4s~;~! tl.. ~~~{~e. ~"'~~Cfi~~lt: ~~~~~~~ ~~r~~~ -~ ~~ ~~ ~ hca~~~~ ~~i~~'1Ct' Fu~~r'f;~ -~,73~~~f~ G1 fa5/1 ~ ~e~uty ~,~~.~ _ ~;ut ~r~ty ~ ~/~~ ~ ~.r~a ~ ~.at~ 1121 ~~ Q ~hk~ 1 ~~5 ~,1 a~.t;t~ ~4;1~~.~t3 Q21t~1/1~ Rrr~t 4,139.~~ ~+.~~ t}/011 f~ ~e~uty~ i-ia - fut. ~aniy 1 /1 ~ 16.~~ 1 ~.C~~ 02/23/1 t) C;redii F~er~t t~~!20/1 U-~J212$/1 ~ -1,~2~.~Q ~1,~~~.f3~ t~2f;~3/1 c7 ,~~~tt~urtt to be refundad 1,20~.G0 U.C~c~ ~i2/23/1 d (ir'~y~ 11 f~4~) Move out refund -1,2C1~.Q0 -1,Z~l~.Q~ ~12f2311 ~ ~i`~ef~k # 320GJ65a laid out ~1,2G~,i~J f3.fi(3 t;~sr~r~r~t ~~ i~~~s ~~ ~~~ ~.~.:~'? t1.U C'~ >~ ®. PVC _" PAYABLE BATE HOT vnuo 03/1/30 BEFORE Pay to Tt~e Order Ot GEORGE CABA 2520 LAMBS GAP ROAD EHOLA PA 17025 W1~ Bank, N~rtronW AswcuGon ApbbueQh, Partsylvania S~ i~ 355221ZZi PENNSYLVANIA STAtE EDUCAtION ASSOCIATION PENSION AGENCY p'00 2 4 z 3 ?0 4 ?ii' ~:0 ~+ 30[]00 96~: 0^ ]. Z 1 ? 30 i fin' CITIIDIS T528l9A/836l919 RIVERSIDE R1 83122A14 -41 I SC<O 12~~ Posting Date 2010 Mar 12 Posting Seq No 42535065 Account Number 11173011 Check Number 24237047 Amount $173.49 Page 1 of 1 0024237047 e_s ` ~o •- AldEOt~ N T ~ - $*****~**173.49 4MC Bank, Nauonat Aafecubon Pa~.r ~ G AUTHflRiZED TURF ~$~a~~ g g ~~~;~ -~ m S ~~~ ~ ~ Sr ~ z ~z y ~ 3 ~ 33 g .~~3 m $ ~~~ ~g~ m ~~~ ~~ O ~ ~ ~~A u3m ~~~ g r' ~~ .$ o 111 A~~P'~ z ~~ http://wiismab0003 5008/inquiry/page/itemprint.j sp?WINDOWID=1285092687818&count... 9/21 /2010 ,.-.- Page 1 of 1 ' v%'' ~~ '^'=" 'tfOLD DOCUMENT TO LIGHT 70 VERIFY YVATERMARKS 002873 00000 062 072 020510 97230051 355004 ~! 203 CCC FUND DEPT PREP DATE VOUCHER WARRANT ~D ` ~ Northwest Savings Sank + ,.a ~, No ~ VERIFICATION AVAILABLE -'POSITIVE PAY' PROTECTED `' , _ ' o PAY ~ ~~3 ~3 . '~' ONl w CTS CPS 84 02183832 CHECK N'JMUER 02/26/2010 DATE ~ ~,•~ 70 TKE ORDEFI OF VOfD AFTER 780 CAYS o ~ GEORGE CABA ~ *****~*##*1 288'35 N ~- ~ ------ 2520 LAMBS GAP RD ~ >~ ENOIA PA 17fl25-1 T29 ~ cc ~.. .~_ 8 111111 i[11f~IJI[11~1 ~1i1~1[illll ll~~1[ll ~~1~11[1~1'~1[[1~111/~ EA$URER OF PENNSYLVAfJ1A W'02i8383~11' ~:~ti33?ti2i8~: 10 2 6 0 288 6811' ~,-.,t~.~,,.-, 2 7 6 2 518 8 F-~ CITI,ZI:iiS r.~e~938/61~ RJi~ERSIDE RI A31T2A I8 -O 1 2 5K~0120~ =- - --- = _~ h~.J ~~ Posting Date 2010 Mar 12 Posting Seq No 42535066 Account Number 1026028868 Check Number 2183832 Amount $1,288.35 httn://wii~rrtahn(1n~5(1nR/inrn~irv/nanP/itemnrint i~n~RF.ANNAMF.=ArchivPTtemT.i~tdetailc.._ 9/21 /2n1 O C..~ Page 1 of 1 HOLD DOCUMENT TO LtGNT TO YERlFY WATERt1+1ARKS 002874 00000 062 072 020510 97230054 355007 607421 CDC FUND DEPT PREP DA'E VOUCHER WARRANT iD , ~ 24 3 ' ~ Northwest Savings Bark ~ 1'1~ f ~ ~ l p„R•rn ° R.u, ~ ~ VERJFICATION AVAILABLE -'POSITIVE PAY` PROTECTED •• -z p --- ~ ~ ~ ~~ M •` a CT$~ 84 02203615 CJiECK NUt~S6ER 02/26/2010 DATE ~ ~ TO THE ORDER OF VOtD AFTER 180 GAYS o'a ~,, . GEORGE CABA 2520 LAMBS GAP RD c ENOLA PA 17Q25-1129 _~_ ~ '~ 8 A ~ -_ • ~ ~i~s~~~~u~~~an~~-t~~~~uulR~u~~ut~~~s~uu~<<~~as~~ti~•~ Y~_._~~~- ~ ~ ------- TAEJSUAEA OF PEN~75rlVA.N to p'0 2 2036 1St+' ~: 243 3 74 2 i8~: 10 260 2BB6811' 2 7 6 2 518 8 :; CiTI1E}IS i528/9A/638/Of9 Rf~ERSt[~E RI 831?2974 /•O 1 15G0 i[ 2Q~f ~~ ~v Posting Date 2010 Mar 12 Posting Seq No 42535064 Account Number 1026028868 Check Number 2203615 Amount $380.84 ~'11fT1'//vviictl~ahnnn`~SnnR/innnir-t~/t~a~P/;tPmr~rint ;cry`~RFO1~T1~TA1~~1F=~r~~h;~~ATtamT ;~t~r~t~ilc o/7~ ~7n~ n x e S N O S Tip'.. ~1 1C.r.-~~G'c~ Page 1 of 1 ~ .~ v~ SCE ~ .~ ~r~~-- ~(~ ~~ Citizens Bank CheckinglMMA peposit HuMBERT ~ ~ ~j ~ ~~ ~,~J•~ !F OVER 3 CNFCKS LIST CHECKS OM THE REYERSF SIDE PRINT /; /f _~ NAME ~~ / ~ DATE SIGN HERE tF CASH RECEIVEQ FRQM OEPO5IT ti_fl. ta~riK use flritr) DOLLARS CASH ~ CI:IVTS CHECKS -LIST v~RrtT r r CHECKS - ToT~t FR 1M RFV RS SUBTOTAL r--- 1 tE55CA5H TOTAL $ ~^,..C ~-"~~~ ~" ~: 5 9 9 D ~~~ ~ 1~ 5 5 ~: I' ~' ~` p~ Q ~D OD V a Sn A W N -+ O CI~'I,~S ~/ ~11D e1i ~U/~L. ~ ~ ~ ~~38~ 1 D'~A N -+ L V b n 0 ~ ~~ ~~ ~ _~ ` S ~ G ~ ~ L ~ ~~V~ i ~ ~~ ` i O I O I ~ ~~ 1 i O O v f ~ ~ r D ~ 1~ I !~ ~ ~ ~ 7 r1 ~ Posting Date 2010 Mar 12 Posting Seq No 42535063 Account Number 6100689352 Check Number 0 Amount $3,051.68 f ~ ~ r r Y ~ Y T ~ .*. s ~ r~.~ Ln N T A 1'~ M N P~1 ~ ~o ~ "' a Z Q ~ y ~ Y r~*+ C ~ Q "' C~ m ~ 70 G D x ~,/'1 moo; a a r ,~~, ~ ~ ; r ~ 00~ r1 ^` Z =~ ~ _ r- N rn ~ v~ c = f1 ~ ~ D m ~ 7t ~ ~ t./1 http://wiismab0003 5008/inquiry/page/itemprint.j sp?BEANNAME=ArchiveItemListdetails... 9/21 /2010 r2E'CE ~ P T FC~R P,~-~~''M~~;N'?ry G±,ET~3D1~ FAR.r1ER. STRASBAUG?~ ~'uin~~'+r1_an1d Cc~tlntY -- Register Of ~~i1_ls ~'~F~ CYO=~,:~?~:~, R C: ~ ~' l p ~. i~ ci ~: E'_ : ~ / .I.4 / ~ 01 C Recea_pt 'rimE : 12 : ?6:20 -- -~ ~ state Fi~_p Nom.: 20~.0~00~00 %'~a.c~ By F.~~~ar1~,:s : G CRAG CAPA k~ _..-_~___.~______~.r_w_ _..___. RecP~.pt Distr_:ib ution ------_ _~._____._ _.~_~__-~ .___ Fee/"i.'ax Descri_ptic~n Payment Amount Payee I~1ame PET S T Z ON L T RS TE 5'3' 2 ~ 0 . 0 0 CUMBERLAND C'OUZVTY GENERAL FL7N t~i~LL 15.00 CUMBERLAND COUNTY GENERAL FUN Si~ORT CERTI FI CATr.., ~ 4 . 0 0 CUMBE~tLAND COUNTY GENERAL FUN TCS FEE ~ 2 3 . 5 0 T3UREALT OF RECE Z PTS & CNTR M . b . A?7TCMATIGN FEE 5 . 0 0 CUMBERLA.~~1D COt~TITY GENERAL ~'UI~fi c ; ~ ~~~ c~r~~~ ~~~ . 0 ~ ryy y,~1~ C~ ~ v ~ ~' ~a ~ ~ c H ~ ~~~ JAM'S ~. f~~3L.~..~i~11b, ~P~ 7 West Main street ~.hiremanstov~rn P~ ~7C1 Phone: 777-763-6890 Fax. 717-7636889 TriElr~day, starch 18, X010 ~a~a, Gearge /t~ Cram baba ~~~~ Lambs Gap f~©ad ~nc~la ~r^, 1i0~5 ~,tt~ntlr~r,: client No: 80120 Invoice Na: 318 01 ~ Fc~r prEparatinn of the 2CC9 Individual income Tax Returns: ~ 150,0© ~~.,,. H~ ~r~ r... ~'~ ~er~~o~e~ Irdivid~~l Income Teat t~eturns ;~~~~!~C1 ~J 1 ~(JC &sse~b!~ i~~x i~eti~rt~s ~~~~!a1~ ~.~~ scary ~~r~port ~~cui~n~nts ~'i~ :l~Ca~t~ 0 ~% ~~,~ df ~c~ck~t ~~pense I~`~st~~e for ~CC~ Tax l~et~arn ~;~~~~C1 ii x,50 ~wQ, a Finance charges assessed ~ 1 °lo per month on aE{ open amQ~nts. Please it~clt.~d~ y4t~r ciient nurnE~er on ~~ur chc~~l~. ~'I~~an~ you; $rTAT'EM~rJT t)F RHY:~ICIAN SERVICES ~.342~OS5 PERFt~MED BY: ~.ATHLEEN L SEM~'ELES ~ PENN STATE FAMTLI~ PLACE OF SVC: SATELLITE CLINIC ~ ~.1f25f04 3b~15 Ste. 9 ROUTINE VENTPUNC COLLECT 22 ~ t10 12,'14~f09 t~DTCARE PAYMEN'T~ 3.OD~ ~ 1z/14rf09 MEDICARE CONTRACTUAL A 14.Oq- D.00 11125/09 904x71 Vd3.B2 ADMIN DF PNEI~ " ' AL 12fI4tf09 MEDICARE PAYMENI'~ ~ I2f 14Ef 09 MEDICARE CONTRACTUAL AD.~ Ilf25f09 99214r 12f14f09 i2f14f09 12f31f09 5~.9 OUTPATIENT VISIT EST MEDICARE PAYMENT MEDICARE CDNT'RIICTUAL AD.!* INSURANCE PAYMENT 31.00 y19.B7- 11r13~ ~.QQ 21~.da 71.b2- ~.Z3.47- T.91- 1,0.00 11f25f09 90732 V03.#f2 PNEUM'DCOCxAL 23 VALENF 53.00 12f14/09 MEDICARE RAYMENT~ 37.61- 12f14Ef09 MEDICARE CONTRACTUAL AD.1~ L~.39- 0.00 BALANCE: ~EOR6E CABA X10.00 INQICATES NEi~ FINANCIAL ACTIVITY SINCE LAST BILL. PAYMENTS DF 10.00 APPLIED TO YDUR CHARGES t+nT INCLUDED ON THIS BILL. IF YOU HAVE ANY f~IESTiDNS ADCyUT THE i" YOUR INSURANCE COMPANY PAID, Cq+Ii'ACT THEM DIRECTLY. FOR ANY OTHER QUESTIONS REGARDING YOUR BALANCE, PLEASE CONTACT OUR OFFICE. TF PAYMENT HAS BEEN MADE, THANK, YOU AND DISREGARD THIS BILL. PLEASE NDTE; TO ~CEEP YOUR di:t" CURRENi'~ OllR PDL.TCY IS TQ r .,. ` ~" k ~ .~.t"TSVa.TY FAR C.~$.7~, ~EQFc.G~ -CA~.~G - ~- ~, td ~ r ... ~ ~{ .^t 1.1 ~~. ~ ~.~ E ...3 .~ ~ ~ ~:: J ~ ~ ,~ 5+ A .~~.1{~~~. N?~A Y f ~~ 't .~'a.~ L~ .l 3 .. ~ i.. ~~ AI+...~N _ R Ji~ ~ ~ r'~ e i# ~ i.~ { .. ~,.ti :~ ~ . ..i' ~ w2 ~ p ~~ f i i .:> ~ ~ a~ F ~. 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