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HomeMy WebLinkAbout11-02-10150561,0140 REV-1500 EX (°'-'°' PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 0 0 7 9 1 Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 4 8 1 6 6 2 7 7 0 6 2 8 2 0 ], 0 0 1 1 0 1 9 2 4 Decedent's Last Name Suffix Decedent's First Name MI M O O R E W I L L I A M F (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name M O O R E Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW Suffix Spouse's First Name R O S E M A R Y THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS MI E 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) Q 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Wifl) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHVUt_u ~t ulKtc: I to I v: Name Daytime Telephone Number R O G E R B I R W I N 7 1 7 2 4 9 2 0 5 0 First line of address 6 0 W E S T Second line of address City or Post Office C A R L I S L E State P A ZIP Code 1 7 0 1 3 REGISTER ~ WILLS USE Y .~?~- ~ ~~ ' Via' rl ~~ t ~~~r t r ~; I :~ `~ ~ : ~.~ ~ (c / f ~ r ...td.. y~l AT~ FILED ~:";~ _~._7 _ 7 k.. ' { ~ .l _ _v . I i ~~ Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, Corr ct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATUR F PERSON RESPONSIBLE FOR FILING RETURN dDA E ADDRESS 3 WHITE OAK CT- ~- _ BOILING SPRINGS PA 17007 SIGNATURE OF~PJR PARER OTHER THAN PRESENTATIVE iDA E ~' C1 ~ ~ _ %! / ~ ADDRESS h^ WEST POM RET STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY 1505610140 P O M F R E T S T R E E T Side 1 1505610140 J 1 .* r Oh20'[9505'C Ofi20'C950S'C 1 Z aP!S 1N3WAdd213n0 Nd 30 dNfld32~ d JNI1S3f1D32! 3?~b' f1OJl 31 lb'AO 3H1 NI ~~I~ 'OZ 6 S •6 S S 'I .6~ ...... ................................................ 3f1CIX`dl '6l 0 0 ' D ~8~ 0 0' 0 ~ n xe ~ c ~ aui }o;u nowy alge ; ~ g~ 0 0 ' 0 L ~ 0 0. 0 z ~' }; a~e~ suilgis ;e ' algexe; ~,~ auil }o;unowy L~ 6 Q ' 6 S S 'I 'g~ h 2' fi 9 9 fi E 5~0' x a)e~ leawl }e ' algexe) ~ ~ aull }o ;unowy g ~ 0 0 ' 0 'S ~ 0 0' 0 , o' x (z' ~)(e) g ~ ~g ~oaS ~apun spa}sues) ~o `a~e~ xe; lesnods ay;;e algexe; ~~ aull }o;unowy ~g~ S31~ft1 3l8bOllddb 2103 SNOIl~f12l1SN1 33S - NOIlH~fl~ld~ Xyl fi 2 ' fi 9 9 fi E 'ti L ...... . ......... ' . ' ' ' . (£ l aull snulw Z ~ aull) xel o~ ~oafgng anleA;aN 'b r. • '£ ~ ...... ................ (f alnpayoS) apew uaaq ;ou sey xe; o; uol;oala ue yolynn ~o} s;sn~l £ 6 66 oaS/s}sanba8 le;uawuaano0 pue alge;uey0 ~£ ~ h 2 ' h 9 9 h E 'Z L ...... ...................... (L L aull snuiw g auil) a;e;s3 }o an1eA ~aN 'Z L 2 2 . 2 6 fi h 2 ' l 6 ...... ......................... (0 L pue g scull le3o;) suol;onpad Idol ' 6 6 I E • Q E ~. 'L 'OL ...... ....... (I alnPayoS) suall pue `sal~lllgeil a6e6}~olN `;uapaoa4 }o s;qaa 'OL I 6 • 2 S Z 2 I .6 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ (H alnpayog) s}sod anl)e~}siuiwpy pue sasuadx3 le~aun,~ .6 9 h ' S S 'L 6 h .g ...... ..................... (L y6nwu; t. scull le;o;) s;assd sso~0 Idol '8 • .L ...... . pa~sanba~ oullll9 a~eaedag (~ (O alnPayoS) ~(}~adad a;ego~d-u N snoauellaosllN'8 spa}sued sonln-~a;ul 'L . 'g ...... . pa)sanba~ oullll8 a;e~edag ~ (~ alnpayoS) ~(}~ado~d paunnO ~l;ulo f 'g ~. ~ • Q 2 0 0 2 ~5 ~ ~ ~ ~ ' ' '(3 alnpayoS) /(~adwd leuosaad snoauellaosiw pue s;isodaa ~lueg `yse~ 'g .,~ ...... .................... (d alnPayoS) algeniaoa8 sa;oN pue sa6e6}~ow ~~ • .£ ' ' ' ~ ' (~ alnPayoS) dlysao)al~do~d-clog ~o diys~au~ed 'uol;e~od~o~ plaH l~lasol~ '£ 6 S ~ 9 2 2 6 2 ~Z ...... . .......... ... ............... (e alnPayoS) s~puo8 pue s~loo;S 'Z . ~ ...... ..................................... (d aInP~3y~S) a;e3S3 lea2l ' L NOll~dlfllldb~32! Z Z 2 9 9 'L Q h 't 3 N O O W •~ W d I 11 I (Ti :aweN s,;uapa~aa ~ag wnN ~(;ianoaS leio oS s,;uapaoaa X3 005 L-/~3b Oh20'C9505'[ r REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 10 0791 DECEDENT'S NAME WILLIAM F. MOORE STREET ADDRESS 227 AVON DRIVE CITY CARLISLE STATE ZIP PA 17013 Tax Payments and Credits: ~ ~ Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3, Interest 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. (1) 1,559.89 0.00 (3) (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1, 559.89 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 : ...................................................................... ^ Q b. retain the right to designate who shall use the property transferred or its income; ............................... ^ c. retain a reversionary interest; or ................................................................................................ ^ d. receive the promise for life of either payments, benefits or care? ....................................................... ^ Q 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ Q 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? ......... ^ Q 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? .................................................................................................. ^ 0 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 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, undE Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Total Credits (A + B) (2) 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 WILLIAM F. MOORE 21 10 0791 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. SOVEREIGN BANK -SAVINGS ACCOUNT #2894018387 10,024.50 2. (SOVEREIGN BANK -CERTIFICATE OF DEPOSIT #2895380232 ~ 10,004.37 TOTAL (Also enter on line 5, Recapitulation) I $ 20,028.87 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER WILLIAM F. MOORE 21 10 0791 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. EWING BROTHERS FUNERAL HOME 2,395.01 2. FUNERAL LUNCHEON/DINNER 1,412.15 3. ROYER'S FLOWERS 190.78 4. BUNKY'S CHARPTER 250.00 5. JENNIFER McKENNA AND JEFF GEBELIUS (PASTORS) 350.00 6. DEBRA BRANDBURG (SEXTON/COORDINATOR) 100.00 7. MARK ROMIG (PIANIST) 150.00 B. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: State ZIP 2, AttomeyFees: IRWIN & McKNIGHT, P.C. 3, Famiiy Exemption: (If decedents address is not the same as claimant's, attach explanation.) Claimant ROSEMARY E. MOORE 4. Street Address 227 AVON DRIVE City CARLISLE State PA ZIP 17013 Relationship of Claimant to Decedent SPOUSE Probate Fees: REGISTER OF WILLS 5. I Accountant Fees: 6. 7. 8. 9. Tax Retum PreparerFees: PATRICIA A. ROSENDALE, CPA REGISTER OF WILLS -FILING FEE ROSEMARY MOORE -REIMBURSEMENT OF LAZY BOY CHAIR SOVEREIGN BANK -DATE OF DEATH VALUATION 3,250.00 3, 500.00 145.50 350.00 30.00 609.47 20.00 TOTAL (Also enter on Line 9, Recapitulation) I $ 12.752.91 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LiABILITiES, & LIENS ESTATE OF FILE NUMBER 1/VII 1 IAM F MnnRE _ 21 10 0791 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. CARLISLE BOROUGH TAX ACCOUNT -REAL ESTATE TAXES 1,718.31 2. IHARTZELL EYE MDS -MEDICAL I 20.00 TOTAL (Also enter on Line 10, Recapitulation) I $ 1, 738.31 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) pennsylvania ~ SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: WILLIAM F. MOORS ~~ ~n may 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).j 1. ROBERT MOORS Lineal 34,664.24 8520 PINE MEADOWS DRIVE 1/~- 25% REMAINDER ODENTON, MD 21113 2. WILLIAM C. MOORS Lineal 6000 SOUTHWARD WAY 1~- 25% REMAINDER ALEXANDRIA, VA 22315 3. SAMUEL R. MOORS Lineal 2574 WOODLAND PLACE 1/1~- 25% REMAINDER CHESAPEAKE BEACH, MD 20732 4. TERRY ROBERT MOORS Lineal 8520 PINE MEADOWS DRIVE 1/ - 25% REMAINDER ODENTON, MD 21113 5. WILLIAM SCOTT MOORS Lineal 5124 RIVER CHASE RIDGE 25% REMAINDER. WINSTON-SALEM, N.C. 27104 6. SUSAN M. YEINGST Lineal 3 WHITE OAK CT. 50% REMAINDER BO[LING SPRINGS, PA 17007 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 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 additional sheets of paper of the same size. ~/ ) ~ ~ LAST A'ILL AND TESTAMENT I, WILLIAM F. MOORS, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly revoking all Wills and Codicils heretofore made by me. 1. I direct my Executrix to pay all of my debts, funeral and administrative expenses as soon as may be done conveniently after my decease. 2. I authorize and empower my Executrix to sell any realty owned by me at my death, and not specifically devised herein, at either public or private sale, and to give good and sufficient deeds therefor, in fee simple, as I could do if living. 3. I devise and bequeath all of my estate of every nature and wherever situate as follows: a. 25% thereof to ROBERT MOORS, WILLIAM C. MOORS, SAMUEL R. MOORS and TERRY ROBERT MOORS, equally; b. 25% thereof to my son, WILLIAM SCOTT MOORS; and c. 50% thereof to my daughter, SUSAN M. YEINGST. 4. I nominate and appoint SUSAN M. YEINGST to be the Executrix of this my Last Will and Testament; she is to serve as such without bond. Should she die before my death, renounce or refuse to serve for any reason, or die leaving any of my estate unadministered, I nominate and appoint DENNIS E. YEINGST as substitute Executor, also to serve as such without bond, with the same powers as are given herein to my Executrix. ~79s ;~~ , 3 lira a 5. I hereby suggest that my personal representative retain the services of Irwin & McKnight as attorneys in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 27th day of December, 2005. (SEAL) WILLIAM F. MOORS Signed, sealed, published and declared by WII.LIAM F. MOORS, the above-named Testator, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence and in the presence of each other have subscribed our names as witnesses hereto. ;~ ~,~ ~a9s ACKNOWLEDGMENT AND AFFIDAVIT WE, WII..LIAM F. MOORS, MARTHA L. NOEL and CHERYL L. CLELAND, the Testator and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament, that he had signed willingly, that he executed it as his free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as a witness and that to the best of their knowledge the Testator was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. .~ WII..LIAM F. MOORS 1 ' ~ ~~ ~ THA L. NOEL ~ ~ ~ ~- YL L. CL LAND COMMONf WEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS: Subscribed, sworn to and acknowledged before me by WILLIAM F. MOORS, the Testator herein, and subscribed and sworn to before me by MARTHA L. NOEL and CHERYL L. CLELAND, witnesses, this 27th day of December, 2005. 3~ CO MO 1NEAL~'H OF PENNSYLVANIA Notarial Seal Roger B. Irwin, Notary Public Cartiste Boro, Cumberland County My Commiss'wn Expires Oct. 3, 2006 Member, Pennsylvania Association Of Notaries 3 ~~ n~---. j.Jiil4L~tC~l ~. tatvci.7t,u1~tt1..7 t r .tai [.v1V ,L .L G! ;)+.~ !-4.'•1 t'NI.tG 1C~! VLV CdX E'Jtil VCl • ~ Delaware lnvestments~ ' ~~ '1`Ei"~I /l' ; :S `; ,~~ "1 Cl F '.~d':~~,^ suc.7 /Ar WILLIAM F MOORE 227 AVON DR CARLISLE PA 17013-4297 Investment Update January 1, 2D1D -June 30, 201D Page t of 4 Your Faancisl Advisor TROY H LANDtS AMERICAN PORTFOLIOS FINC'LSERVS INC 74 W POfJlFRE7 ST CG~Hl15LE PA 17013-3216 t7396t77 Account Services Branch Office Code 0003929111 C68 Account Service 800 523-1918 t?a.r-r. - Ip.nr. ETMan. ~ Fu: Web site vvww.delawareinvestrnt;nis.com Qalephona 300 362-FUND (3863! 2Jhours,7daysa tiveek Regular Mait Delaware Investments Sae Rsvcrse fonilsbucdons. P.O. Sox 219691 E-mai! service®delinvest.com Kansas City, MO 64121-9691 Portfolio Summary Year to Date Regular Account Activity Summary Fund tYeme + Investments/ Withdrawals/ Reim-esmd Change in _ FundCodelAccaunttdo. BeginningVelue Additfans Reductions Earnings MarketValue EndingYalue f)elaware Tax-Free USA Fund A Class Q11I51173312fJ4 527,9$1.&9 0.00 _ 0.00 r 664.&1 180.29 _ r 529,128.59 - Regular Total 527,981.69 10.00 0.00 664.61 480.29 S29,12fi.59 Ye ar to date Tots I $Z7 , 981.68 + $0. t30 50. ~ 5664.61 5480..29 = $29,126.59 Qu a rte r t0 D ats Iota t $28, 492 Q:3 + 50.00 50. DO . , X3.54 5;305. t}2 = 529, t 26.59 Yom Persona! Portfolio Rate of Rearm is Year iA Oate 4.09 % Inception ° 113/1495 5. D9 °lo Your personal rate of rehrrn represents the perfarmitnce of alt the investment(s) you have selected for your portfolio, ineAiding hoih your Regular Investment accounttst and Retirement accounttsl. The catcniatiail includes any front-end sales charges and all activity in your portfolio {such as contributions, exchanges among investment options, etc.) using daily share price in effect wheel the activity occurred. IDue to applicahle sates charges and the timing o1 your investments and withdrawals your personal iirrestment results will generally oat he the same as the investment ret-ans quoted for the individual funds y°u have chasert tf you have questions, please call onr sharehoMer service center at 9005-19f8 or a-mail service~deliiivest.com. "For accounts established prior to 1995, a January 3,1995 inception date will he used t° calculate indlvldual performance. Perfoiraance since inception is annualized. ~~~. -- 3tW •0!100. 0612536606 lfil l) !6)~' C~SOt N/01 OG aE~ 0013'S93] ~- ,3. - . Delaware ' investments° iw,.'T':1' ;.1 t.".;i '.IA:r!? . ti'.ti,~ wKd.•AR WfLL1AM F MOORE Delaware Investments News Investment Update January 1, 2010 - Juna 30, 2010 Page 2 of d ACCOUnt Sarvics 800 523-1916 Q a nr_ - l a. rrr. Fr boon ~ F.,: Delaphone 800 362•Fl1ND 13863} 2arrvurs,7daysa wedk Srre roverss hrr+irsoucaorrs. Delaware I nvestments is now a member of Macquarie Group, a global provider of banking, financial, advisory, investment, and funds management services, f~eadquartered in Sydney, Australia, with more than 70 offices in 28 countries. investing involves risk, including the possible loss of principal. Carefully considerthe Funds' investment objectives, risk factors, charges, and expenses before i~~vesting. This and other information can be found in the Funds" prospectuses, which may be obtained by visiting www.delawareinvestments.com or calling 80a 523-1918. Investors should read the prospectus carefully before investing. Asset Allocation & Portfolio Summary R ce ular AcCfOf11fi1tS Allocation of MerNetValua i cur~sntAssets or>~r2mo .~-~~ ~~-~~ . h•, ~ Fixed Income 100 00°l0 126 ~Z9 59 ,, . , ; ~ ~.; . , . - ,~ ~~ ' '~`~ ` ~ ~ .,. ~' ~ ' `' ~` Delaware Tax-Free U5A Fund A Class 1(10.00°,~0 529,126.59 ~" `~l ^ ~ "~`'~~; ^- ~ R uhr Accounts Sutbiotal 10D.0096 529,126.58 \/./ / ~ . v / K \~\ /1 \.; K.L. ?rt.,J J - Total Portfolio 529,126.59 Investment Earnings Summary as of 6/30/010 Long-Term Fund Narneil'ype FumfiAcconntNumber Qrdinary tncame" Capital Gains f)elAtivare Fax-Free U5A Fund A Glass 011J5117331204 9~fiEi4.61 50.0() - Totals 5664.61 SQ.QO •`4icfudes D+v+dends and ShortTern Caprta4 Gai,ys (T3ken in cash or reinvastedl. ~:;= - ,`~~: ~i :'. -?;;;~i~.,„D'art JtW -O7Z00. 7G!]53~004147 rP 1P!17 ;Y,1SDlW01 OC ~:El OO~l?643a Delaware • Investmentsr . rv~fi~1'r,f',', :,,ic':re '.'rl,~ w•c,>t.v+r. WILLIAM F MOORE Transactions Investment Update Jant~ry 1, 2010 -June 30, 2010 Page 3 rrf ~ Account Service 800 523-1918 S 3.0r. - ~ p.1rl. ~,ti9on ~ i-r; Delaphone 800362-FUND X38831 14hours,Idays:rf.veak See reverse Porinsoucriars. Delaware Tax-Free USA Fund A Class Incepton• REGULAR INVESTMENT ACCOUNT Year to Door !/3!1495 Symbol DMTFX YaurPersarta!Rate o1 Retum for This Fund is 4.09 % 5.09 °la Fund Code/Aeeour-t Number 01 11511 7 331204 •For accounts established prior to 1995,a January 3,1995 inception date wilt ba used to cafculata performance. Pario-rttance since incepiar is annualized. W 1LLIAIJI F MDOHE For yourconsideretioa: Go papetisss. Sign uptar e0e1"asry service, a secure and eomrenient way to access a{I materiels nelatsd to yourDelawaro Invasbtreats aceonats. To get ahrrted, call us at 69Q 523-1918. Shares This Price Oate Transecdon Oescri~tion ___,~ Dollar Amount " _ Share Price = Transaction Total Shares 01/01!2010 OQening 6alanre $27,981.69 $11.14 2,511.821 01!21!2010 Div Reinvested $11i .79 $11.22 9.963 2,521 .734 07122!2010 Div Reinvested $112.14 $11.21 10.004 2,531.788 03/22!2010 Div Reinvested 5101.14 $11.26 8.982 2,540.770 04122/2010 Div Reinvested $113.34 $11.30 10.030 2,550.800 05121/2010 Div Reinvested $110,09 $11.38 9.674 2,560.474 06/2212010 Div Reinvested $118.11 $11.30 10.275 2,570.749 fl6/30/2010 Ending Bslence 529,126.59 S11.33 2,570.749 Historical Fund Performance Totef Return Monthly Since Inception Fund Nauee Dist.Reta SECYield• 1 Year SYear 10Yaar Inception Data Delaware Tax-Free USA Fund A Class 0.04375817 3.61 ~ 7.690 °;6 2.630 % 4.900 9G &.890 °Io 01!1 U1984 All perfnrma-rce shown is at full offer, which includes the effect of sales charges and a:ccumes reinvestment °f d'eridends and capital gains. Past performanre is not a guarantee of future results. Investment return and principal value fluctuate so that shares, when redeemed, maybe worth more or less than the originat gust. Performance for other classes will vary due to different charges and e>penses. Expenses have been subsidized for some funds. Without the subsidy, performance would be {aver. Please refer to the fund prospectus for mote detailed inf°rmati°n tegardng charges and expenses. 'A 7-day YirlA ac °f quarter end is calculated fnr money market funds. A a0-day SEC Yield as of quarter end is c:alou{ated fora-I daily dividend ftf~.nds. ~.~~~~ 3L V! •0!?00. 06`25?600A,B!i91B719 [:NS DI NlDI JD :EL C01?!59]2 ., r .~ ~ - '' ,~.- Change Qf ~~ . ~ Address ', Please marl rri th© onvolnpo pravrdrtd. Page 4 of 4 ',i~iLLIAM F MOORS Address Change? ?27 AVt?N 7R please indicate any addross Chengaa or corrections in the space below. CAAUSyE PA 11013.4297 ~'} Checkhere t0 change Obe address o-r al/alyour r~ccourrrs. ~,lJ (Please listanyexcepoorts art Me r ave+sa sine nfthis caupnra). Name G~:~laev~ue I ~ ? 0. Ba+c2i9691 Narne _______~ h~~•dstr=lens• ~ Kansas City, MO bt121.9691 ____ Addross ______ J_ .,_~ Address ____.___.___ ~.-_ i Phono ~ ~f~ll~ 4 lll~ l~ I~~ ~~R ~ 1~ ~I~ ~ AIM ICI I~1 I~~ ~~ I 111~~I~INI~l~Il~l~lll~lg11~11~(~~~~I~I~li~ll~ 0000 00000000 51173312043 0000011 Invest by Magi UVtIUAMEM04RE Delaware Tax-Free USA Fund A Class Pluase mail in the urwelope provrded 211 AVON DR CAR11SlE PA 17013-a297 REGULAR MVES'PMENTACCOt1NT Please anier date. fuad/Account Number 01115117331204 / Chsck Number Amount Minimum invosvnent S10000 uNr:~wares hr:esinients• I '~ P 0. Box 219656 S - • Y ..,v ~•.ri Karrsas City, MO 64121.9656 s Total invaslment ~ P ease do rrot sand cash 0000 00000000 51273312043 000001], _ _ __ _ . _ __.__ _.__._.~.. ___-_ ____ __.__._ ___ __ _._ _......._.__ -. r _ -.---.....___ _ _ _ ,~_~: ~', W •0±d10.06:2516004/877078770 CMSOl W01 CC 6EL X0{7759)2 ~' overei ~ . ~ .~S ~ ,~ Court Ordered Processing \ Decedents - MA 1-MB3-02-10 - P. O. Box 841005 - t3oston, MA uLLU4 August„ 10, 2010 Roger B. Irwin ' Irwin & McKnight 60 West Pomfret Street Carlisle, PA 17013-3222 RE: Estate of William F. Moore Date of Death: 6128/10 Dear Roger B. !twin: ~ECEIV~~ ~AUG 16 2010 IRW{N ~ {~c~(IVIGtI~ lAW OFFICES Per your request, enclosed please find the account information as of the date of death for the above-named decedent. For your information, accrued interest is not included in the date of death balance. Please feel free to contact me if {can be of any further assistance. Very truly yours, f - ~ ~ y~~`.y v Laurie DiGiandomenico Team Manager 617-533-1789 .~ 0 0 a A :~ :~ .~ a 0 r 0 s 3 a m .d Sovereign Bank ESTATE OF William F. Moore SOCIAL SECURITY #: 148-16-6277 DATE OF DEATH: June 28, 2010 Account #: 2891027809 Type: Checking Open date: 1 /411984 In the name of: William F. Moore or Rosemay E. Moore (Susan M. Yeingst POA) Date of Death Balance: $867.20 Int.(YTD) from 1/112010 to 6/13/2010 $Ct.05 Accrued interest to date of death: $0.00 Other Info: Account #: 2894018387 Type: Savings Open date: _ 8/15/1991 In the name of: William F. Moore (Susan M. Yeingst POA} Date of Death Balance: $10,021.20 Int.(YTD) from 1/1/2010 to 3/31/2010 $3.25 Accrued interest to date of death: $3.30 Other Info: Closed 8/4110 Account #: 2895380232 Type: In the name of: William F. Moore CD Open date: 3/16/1995 $10,000.00 to 5/31 /2010 $4.37 $38.08 Date of Death Balance: Int.(YTD) from 1 / 1 /2010 Accrued interest to date of death: Other Info: Page 1 of 1 93ECEI~~ AUG :L 8 2010 1'RUf-lt-1 & l~C~tN~GH~ SAW OFFICES PAYABLE TO CARLISLE BOROUGH TAX ACCOUNT PO BOX 100, 53 WEST SOUTH STREET CARLISLE PA 17013 oESCRIPTION ASSESS.NO - 04001787 MAP NO: 04-23-0600-048 227 AVON DRIVE ACRES .410 DEED 0022M/ 00098 CHAPEL HILL LOT 99 Residential Building RESIDENTIAL ~""~" TAX PAYER ~ M RE, WIWAM F 227 AVON DRIVE CARLISLE PA 1701 297 TAX PAYER COPY 8111 No: 9882 Control No: 004 - 001787 ~u7v ~eoe menc:or ii~9 1 Esraiae Taws Bili Date: 7/U7r1o1a Assessed band Values 40,130 Homestead Exclusion Improvement 86,860 1Kineral 0 Total 126,990 8 ~58- CARIJSILEAREA S.DI. DlKOUat Faoa Rates 14.83000 SCKOOL R B 14.83000 14.83000 2 ~ 1.883.26 10 ~ Homestead Credit 129.88- TALC A1110UHT:DUE. -~--~ ~I,T1as1 #1,78 i1,ti-~.7z If Paid Oia or. ~:aftier. I# said O>a or:~lEtoforo 10 8 31 2010 9 01 2010 .10 3'1 2010... 11 01 2010 12 31 2010 +~~~1~~ AUG -~ ~ ~3i0 OFFICE HOURS N7R5fl6AY=FRIDAY :30 RNh__e._M_e_._..._..__, PHONE (717) 24 22 ~Or~OUGH pF CARLISLE CLOSED SAT, SU ~ HOLIDAY( k~ ~ ~: t F; I ~T iv1 E tv T CASH ONLY AFTE ~--~--°---~---~--•~~---~ NOT PAID BY 1?l8tUI0.'Ri1S 81I.L WILL BE RE'iURNED TO TAX JtIM BUREAU FOR COLLECTION. .00 DUPLICATE TAX 81LL fEE • NOTICE OF PROPERTY TAX RELIEF Your enclosed tax bill includes a tax reduotion for your homestead and/or farmstead property. As an eGgibte homestead and/or farmstead property owner you have received tax relief through a homesteadand/or farmstead exclusion which has been provided under the Pennsylvania Taxpayer Relief Act, a law passed by the Pennsylvania General Assembly designed fi reduce your property taxes. CARLISLE BOROUGH TAX ACCOUNT ` ` CARLISLE BOROUt~H TAX ACCOUNT CARLlSt:E 80ROUGH TAX A LINT PO BOX 100, b3 WEST SOUTH STREET PO BOX 100, 53 WEST SOUTH Sl'REET PO.BOX;100; 53 WEST SOUTH STREET CARLISLE PA 17013 CARLISLE PA 17013 CARLI$LE:PA 17013 ~ 7 7 ~BSfiY$7 r _ X13-0600-048 ice-0600-048 ~ ~~ r tl~IOOL SCHOOL ~ SCHOOL ~:A~CI$LE AREA S.D. ALE AREA S.D. Z`A~LT$lE AREA S.D. TAX PLAYER TAX PAYER 16fb~•E, ~i1VILLIAM F lOf8~W1LL1AM F PLEASE RElzJRN COiIlPQ141. 1ST WITH Flil~r+oRlFt1LL:RAYYENT PLEASE RETURN COUPON 2ND wrrH~sEC0111D PAYMENT $584.46 ON OROEPOgE. #i/3:1/2Q1:0, $584.46 ONOR6EPORE 9/30/2010 1N8TILLLY~118CANNaTB'f'I1RT'.AF11~R:: -8/31/2010 $642.91 AFTWi 9/30/2010 t!R TAXPAYER. 1G~L'~IIWAM F PLI~IISE RETURN OQUPON 3~Q Wll'niTlflRD PAYI[1ENT $5.84...46 ON OR BEFORE 10/31/2010 i r $642.91 AF~Bt10j31/2010 r wY~erlT -A~ou~ .PwYeY o~scotiiKr 1,,718:31 ` = ., a. 31 2oio FACE 1 :753 :3.8 :: .._ 10."::3fi 2010 PENALTY 1,928:72: ::12 3:1 2010 Jul 6 2~ '° Y Rosemary E. (Eb rly) Moore 227 Avon Drive Carlisle, PA 17013 Ewing Brothers Funeral Home, Inc. 630 South Hanover Street Carlisle, PA 17013- (717)243-2421 The Funeral Service for William F. Moore We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. 1. PROFESSIONAL SERVICES Services of Funeral Director/Staff , _ - $1120.00 3. AUTOMOTIVE EQUIPMENT Vehicle to transfer remains to Funeral Home, $275.00 Death Cert. filing/Retrieva) etc., $125.00 C. SPECIAL CHARGES Direct Cremation , $320.00 FUNERAL HOME SERVICE CHARGES $1840.00 SELECTED MERCHANDISE: Acknowledgement cards , $10.00 Register Book(s) $40.00 Memorial folders , $75.00 . . . . . . . . . . . . . . . . . . . . THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED $1965.00 Cash Advances Certified Copies of the Death Certificate , , Coroners Authorization fee , , Cremation pouch , , The Sentinel obit , , The Patriot Obit , TOTAL CASH ADVANCES AND SPECIAL CHARGES . Total Total Cost , , SUB-TOTAL INITIAL PAYMENT /DISCOUNT /CREDITS TOTAL AMOUNT DUE The unpaid balance over 30 days is subjected to a 1.50 % service chazge per month - 18.0000 % per annum. $30.00 $25.00 $20.00 $165.74 $289.27 $530.01 $2495.01 $2495.01 .-- )'~~ 100.00 = ~ ~ti/~'r~ ~dL~~~ t~ $2395.01 --~~`2N ~~~f ,~" Date: ~~ r~°~D Dear ~ U~xni ~2-'''Jr~S~ Thank you for booking your burial a-t sea with BUNKY'S CHARTERS LLC. You have our condolences and the Bunky's family is sorry to hear the loss of your loved one. We have confirmed your reservation on ~/ /~/ /off, for burial at sea service board the " pf~~6.~~ ". Our services will begin at ~~:~~ and will end at ~:~. Our company and the boat's crew will follow your scheduling and special directtons such as location of the final resting place, ceremony aboard, prayers, etc. There is a bathroom on aboard for your convenience. The contact person for the family will be~tLSanl ~!.-~'~I a~,S°~' and their cell phone number is For last minute changes or special request, please contact Brian. Cell phone is 443 53 -414 Please find your receipt of the non refundable deposit in the amount of $ DSO • ~ Q +~d . 1'he cost of this service is $ ,bpd • ~ for the first two hours and $65 for each hour thereafter. Times are recorded as port to port. We provide a captain and a deck hand. We provide all safety equipment including life jackets and fire extinguishers in order to provide a safe service in the event of an emergency for you and your guest. Our boat aad crew are United States Coast Guard inspected and certified. The inclement weather does not affect your obligations. It is the judgment of the CAPTAIN to decide if the weather will not permit a safe trip. In this case, your deposit will be applied to another date of your choice within this year. If the weather can be judged by the CAPTAIN unfit or unsafe at an earlier time, we will contact you by phone to make other arrangements. You have 48 hours after the date your reservation was made to cancel in order for your deposit to be refunded. Any damages incurred by you or your guest to vessel or equipment are your responsibility. You will be charged for any expense. Our tackle store offers an ATM machine, ice, soda, beer, snacks, bottled water, etc. All parking is free at Bunkys. If you need additional information, please call or visit our website at w~vw.BunkysCl~arterBoats.com. Bunkys Charters LLC Thank you, Operating Management BUNKY'S CHARTERS LLC ~~~ P.O. Box 379 ° 14448 Solomon's Island Rd. ° Solomons, Maryland 20688 ° Phone: (414) 326-3241 ° Fax: (410) 326-0779 -- www bunkyscharterboats.com ~'' ~~ :a~^~ STONEY' S SQLQP70N8 PZ 145?5 80LOh10NS I3LAtJ SOLOt90NS. MI} 20688 BATCH: Dfi0 S-A-L-E-S D-R-A-F-T 741113D0 100B59435DBD SERUERs 54 REF: 8028 CD 1YPE~ VISA TR TYPE• PURCHASE IIIV: 4417 DATE AUG 14. 1D 2934:59 At•10UNT ~8~9.29 TIP ~~ TOTAL ~~~' Z~ ACCT: 1J~Ioi~4477 . ERP: ~Ic1~k AP: D3544C tIRHE~ SUSAII H YEIH6ST TRAIL. DBD22?02D999490 CARDh1EHBER ACKHDW1EDfiE5 RECEiPi DF 600DS AHD/OR SERVICES IN THE AHOUiIT OF iNE TOTAt SHObRI HEREON AHD RBREES TD PERFORH THE QBLIGATIOIIS SET. FDRTH BY THE CARDMEHBER'S ABREEi~tli WITH THE I55UER THAHKS FOR USIt1G UISA CUSTOP>ER COPY can `~~s~--~ `1'e~1~ s-~ s UtS~~~-~~ a~'~~ T So1amons Pier 14575 Solomons Island Rd Order 8068 Solomons MD 20688 Tel. 410 326 2424 08/.._:1.4/:10.< 9:36 PM table loo Gust 2s Waiter 54 TINA 4;***********~**~***~~**~**~**~*****~*~** 1 ROCKFISH BITES 1 DOZ CLAMS 1 CRAB LEG CLUSTERS 2 SHRIMP & CRAB DIP 1 1/2 DZ FRIED OYSTERS 1 Seared Tuna Appetizer 2 1/2 DOZ EXOTIC OYSTERS 2 Baby Cake 4 Softshell Sandwich 3 Crab Louis 1 FRENCH FRIES 2 YUENG BTL 2 YUENGLING 4 GUINrSS 4 DOGFISH 1 BLUE MOON 2 MANHATTAN ROCKS 4 sada 2 MILK 3 TEA 2 COFFEE 3 Crab Cake Dinner 1 Baby Cake Dinner 1 SEAFOOD BASKET 1 OYSTER BASKET 1 PIER FRIED PLATTER 1 GROUPER DINNER 3 PATUXENT BROILED PLATTER 1 MARGARITA PIZZA CHEESE PIZZA 1 Key Lime 1 Grilled Cheese 1 MAC & CHEESE - 2 Cof f ee 14.00 8.00 25.00 28.00 8.00 13.00 16.00 33.00 72.00 48.00 3.00 7.00 8.00 18.00 18.00. 4.OU 15.00 Taxable; 8.00 4.00 6.00 4.00 85.50 19.50 22.00 17.00 26.00 24.00 90.00 8.00 Sub-total: Tax: Total: Gratuity: 671.00 40.26 711.26 128.03 6.00 5.00 4.00 4.00 To-t~l Due: 839.29 671.00 i 1'~ W W .-3 O d =~7 V • • ~~ a°.T~ ~-. ~~~ Z O ~ m ~ 1~ ~i eL y~ ~Efi W~~6 ~~~W ^w W LA ~ .o 3 cv -.. N ~~~ W . ~- G y,~ ~p n y Q^t~~ ~~ ~.r' M a~ m r WO. ~~ J N ~a c=a N ~U ¢~ `_ O IL Of ~~~/y~j~'~_ aON U ono 4Om z~a WLL a ¢~ ~ Quality,gelectlon,Bavings. Every Qay. ~' Visit us an the Internet www.GlantFoodStores.co~n N y soal !s to ensure your satisfaction very time you shop with us. If there N s anythins more I can do to improve -our experience please call or write. Chad Hoch, Store Nlanaser ¢o Giant Faod Store #112 <~ 255 S. Sprins Garden Street °~~~ Carlisle. PA 1?013 G.O N OTC Store Telephone: tT1?) 249-2323 ~`LL'o Pharmacy Telephone: t?1?) 249-8836 ~ O?/03/10 09:04AN ~~ THANK YOU 4800?404999 PLANTERS PEANUT HC 2.79 F --o SC 80NUSHUY SAVINGS .29-F Price you pay 2.50 2 @ 2.99 CHINET PLATTERS 5.98 1 • 3 @ 2.36 i~ CHNET CUPS 18CT 7.08 T 2 @ 4.99 UTZ CHIPS 16 02 9.98 F 2 @ 2.99 UTZ PRETZELS BC 5.98 F SC BONUSBUY SAVINGS .40-F Price for 2 5.68 COKE CLASSIC 2LT BC 1.59 B SC BONUSBUY SAVINGS .26-8 Price you pay 1.33 2 @ 1.59 COKE DIET 2LTR BC 3.18 B SC BONU5BUY SAVINGS .26-H SC BONU5BUY SAVINGS .26-8 Price far 2 2.6? BARQ'S 2LTR BC 1.59 B SC BONUSBUY SAYINGS .26-B Price you pay 1.33 COKE DIET 2LTR BC 1.59 B SC BONUSBUY SAVINGS .25-8 Price you pay 1.34 CANADA DRY67.6FZ BC 1.69 B SC BONUSBUY SAVINGS .50-B Price you pay 1.19 CANADA DRY67.6FZ BC 1.69 B SC BONUSBUY 5AVINGS .50-,B Pelee you pay 1.19 4 @ 1.27 GNT FORKS 24CT BC 5.08 T 4 B Z? SC 80NUSBUY SAVINGS 1.08-T Price for 4 4.00 LONGHORN 4.39 F TURKEY :HILL TEfl ~- 2..59-;F..:_ T HILL LEMONADE 2.59 B 2 @ 2.59 TURKEY HILL TER 5.18 F 15 CT BROWNIES B.99 F BREAD/CAKE TRAY 19.99 F 3 @ 10.99 SHRMP RING 1602 BC 32.97 F 3 / 4.00 .SC BONUSBUY SAVINGS 12.00-F Price for 3 20.9? TOTAL BEFORE SAVINGS 129.92 YOUR TOTAL SAVINGS 16.05 TOTAL AFTER SAVINGS 108.87 TAK PAID 1.73 ***+~TOTAL 110.60 VF CREDIT CARD 110.60 GIANT FODD # 0'112 255 SOUTH SPRING GARDEN ST. CARLISLE, PR 17013 VISA PAYMENT Card XXXX XXXX XXXX 4977 Payment Amount 5 ****110.60 AUTH# 00573C ~~ ~~~ 7/03/10 09:07 0112 19 0006 11:3 CHANGE .00 TOTAL NUMBER OF ITEMS SOLD = 31 7103!10 9:07 AM 0112 19 0006 113 y _. • ~ ~ .~~ -T .. Quali4y,Belecfiain,.Savings. Every Ray. Visit us on the Internet www.GlantFoodStores.com Mw goal is to ensi~ire your satisfaction every tl-ne you shop with us. If there is enythins more I can do to l~nprove ' your experience i~lease call or write. Chad Hoch, Store Manaser Giant Fond Stare 11112 255 S. Spring Garden Street /r' Carlisle, PA 17013 . 1.' . Store Telephone: 1717) 249-2323 .~harr~acy Telephone: 1717) 249-8836 07;03110 09:26AM THANK YOU 48007404999 . 2 @ .2.99 'SLRAW. GELATIN 5.98 F lOL°OGNA CHUBS 4.99 F 'SALSA JACK SICK 6.20 F PARTY TRAY 39.99 B ! I 2 @ .6.99 MACARONI SALAD BC 13.98 F 2 @ 2.11 SC BONUSSUY SAVINtiS 4.22-F Price far 2 9.76 RELISH GOURMET 36.99 N FRUIT TRAY LG 35.99 F TOTAL BEFORE SAVINGS 194.12 YOUR TOTAL SAVINGS 4.22 TOTAL AFTER SAVINGS 139.90 TAX PAID 2.40 ****TOTAL 142.30 VF CREDIT CARD 142,30 GIANT FOOD 1t 0112 255 .SOUTH SPRING GARDEN ST. CARLISLE, PA 1T0~3 UISR PAYMENT Card XXXX XXXX XXXX 4477 Payment Amount $ ****142.30 RUTH1t 02578C 'i/03/10 09;27 0172 16 0043 160 *********~f**~******+~*******ff***~**** CHANGE .00 TOTAL NUMBER OF ITEMS SOLD = 9 7/03110 9.27 AM 0112 16 0043 160 I'm clad you shopped here today. Your Cashier -- BRANDON ****** BONUSCARD SAVINGS SUMMARY ***** BONUSCARD SAVINGS 4.22 TOTAL SAVINGS 4.22 2010 BONUSCARD SA!riNGS 709.32 ~e.~***+~ REWARDS PAINTS SUMMARY *****+~* Earn Redeem Bal Expire ExtraRewards 14U 0 249 08/21 *************+~**f~~ff***f*f**********x GAS EXTRA REWARDS! 100 POINTS = x.10 PER GALLON DISCOUNT YOU HAVE EARNED R DISCOUNT OF 50.20 PER GALLON! NO CASH BACK. VALID FOR ONE VEHICLE FILL-UP. POINTS EXPIRE ON 8/21/10. x~tx***f~r**~rxf**~~tx~~r~r~xx~xf~rf~~*~rf~ra*f* ~LITY.rSELECTION. OPEN 24 HOURS y1GS. EVERY DAY. EVERY DAY ~(~ ~~L~ i i ~+ a 1 _ 4 kr~~rt . BIG KMART STORE 7746 1180 WALNUT BOTTOM ROAD Karns C,~ua 1 i -tom Foods CARLISLE, PA 17013 4i3 Forge Road ( 717 )243-3233 Boiling Springs,PA ~` Paul Hoover Store Manager 258-1458 Keith Meck Meat Manager 258-1658 *~ WELCOME TO YOUR *~ Store:6 *~ KMART STORE 7746 ~* Cashier: Megan WCASHIER: DENNIS GENERAL MERCHANDISE 07/03/10 10:06:14 49111365440 PRESCRIPTION H 5.12 15 MARZ RANCH DP 3.79 FD 8 # ICE BAG 1.49 FD ~~** TAX .00 BAL 5.12 20 # ICE BAG 2.99 FD Cash 5.12 suBTOTAL 8.27 TOTAL TAX .00 TOTAL NUMBER OF~ ITEMS = 1 ~J~.;...g t;.~-~. flowers ~.!. g!,('ts 525 Mt, Rd 80TLING SPRINGS, C'A {717)25$-6436 Clerk#: 107 STEVEN Ob/1.9J?010 TranSactian: 575$1 REG #1 1:06prr~ ~_n# Pn Descr r~ty Amount Ext Amt 1 491 LUVING T 1 99.99 9g,gy 2 4$6 GARDEN U 1 79.9J 79,99 Tax: 10.50 Tata 1; 19c1.78 S.C. VI Tender; 180,/8 XXXX-XXXk-XXXX-4477 7/11 Authorization# 005540 Thank-You For Your Patronage i~w~~ . royerti , com Urder Number; 13445 Delivery Da~ke: 07/03/2010 Recipient: MUORF Address; 525 GARLAND DR City/S~tal:e: CARLISLE ~'A - 0 rde r Nurr'be r : 13446 -'~ Delivery Date; 07/013/2010 ~~ ~ RP.Clplent; r+I0U~1~ Address; 528 GARLAND DR i~e~~~r~~~~~~~~~ere~ pill tEB N9E m5M 5V6 N9a RECEIPT# 07746 062710 031 51797 06/27/10 3.21 iPM 7746 31 5179 9050 HEALTH CARE ITEM TOTAL; 5.12 THE ABOUE TOTAL INCLUDE5 ITEMS (AND TAX) THAT MAY BE: ELIGIBLE FOR REIMBURSEMENT FROM YpUR FSAIHRA/HAS PLAN. PLAN RESTRICTIONS MAY APPLY, CHECK WITH YOUR PLAN ADMINISTRATOR FOR MORE DETAILS. Merchandise included .in today's transaction may be returned or exchanged before 09!25/10 with this receipt, The complete return & exchange Policy is available at the Service Desk, ~~~1~~i~~~~~~~~i4~~E~~~~~i~~~4~~E~;~r~~~~E~ Tell us about your exaerience and you could wln a $4,000 KR~art gift card visit our website within 7 days. Do not use a search engine, but type into browser address bar: www.kmartfeedback.com You will need your 19 digit receipt number. denos sus comentarios y podria ganar una tar,ieta de regalo de $4,000 de Kmart v i a i f a ~.it.e.i kmar+~aa~r~harlr rnm oars vor I ac ,~ ~_ Y .~, ~ii~~ `~~ OfficeMax #746 650 E. HIGH ST. SUITE 600 CARLISLE, PA 17013 1;717) 243-2764 Te 11 us about your shopping experience and enter to win 1 Of 5 prizes. Visit www.officemax.com store surve to enter and to view the terms and cond i ons ~ ~of entering the -survey , 079946129915 $6.29 Blue Foamboarci 20" X 30" SubTotal $6.29 Tax 6.00096 $0 , 38 TOTAL $6.67 VISA $6.67 Card number: XXXXXXXXXXXX4477 Autharizatian ~J3581C MaxPerks Number 001834216629 91442556 '~ 0746 00001 74250 2 06/30/10 00386074 02;38;34 PM OADEP BY PNpNE 1-Bli-0FfICEMPN ~i~i~i~u~~i~i~i~i~~hi~~m n ~~ FoodStaa FoodMe~luts CATERING ORDER FORM Name Address Home # ~' ~ Work # • 't ~ ~,~ F Pick-up bate: Pick-up Tune: -' ~./ ~a LA-Z BOY FURNITURE GALLERIES 1484 HARRISBURG PIKE .LANCASTER PA 1 713-396- 5 27400000064801 :rchant ID: 27400000054801 Sale ~kXKXXXXXXkX5230 jltant ~ <~~ ~: . ti • , ~,. 5 x 4525 ~_ ~;~, ,,.-' ypa.com urg Pike I'M R ~ '! ~ ,.~ ~ . ~ ~ ~ ; 17601 .com ~: 1484 Harrisburg Pike, Lancaster PA, 17601 (717) 396-9535 ~ Fax: (717) 293-9887 IISR Entrv @ethod; 3vliped total: $ 609,4 Sales Ticket Page 1 02/10/10 12;2Z,0B Inv; 000001 Rppr Code; 620922 AA~rvd; Qnline Batch: 002007 Ticket Number 5-69400 Customer COPY THANK YOU! PLEASE COME AGAIN! sherry Smith Date Written Vendor Stock Number DescriptionlAdd-ons 2010-07-10 010437 C957507 RECLINA-ROCKER CHAIR FABRIC CHAIR CHAIR FABRIC ULTRASHtELD 2010-07-10 3000 LEVER EXTENDER ID Delivery Method Delivery Date LAZB-09121700670220041 Customer Pickup 2010-07-14 Customer Pickup 2010-07-14 Subtotal Tax STN-000014159 ~~~ (place C,h~:~ r ~hc~ (~1~ L[i a~~. Ticket Total 2010-07-10 Visa Payment/Refunds Total Balance Due Sales Notes '' FABRIC PROTECTION # 372598. CHAIR fS AVAILABLE FOR PU THIS WED. THANK YOU ROSEMARYI ENJOY -SHERRY [20i 0-07-10] ~' \ ,~~, (1 ~~ Date 2010-07-10 Amount $ 474.99'` 59.99 39.99 574.97 34.50 609.47 -609.47 -609.47 0.00