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Home My WebLink About11-24-10 1 1505610101 REV-1500 Ex `01 _,°' . ~ OFFICIAL USE ONLY t i PA Department of Revenue van pennsy a ____ Bureau of Individual Taxes OEP~NTMENI Of REVENUE County Code Year INHERITANCE TAX RETURN "~"-~ I ~ File Number "~_~~:~ ~"~~~ PO BOX 280601 ` f 3 _ Harrisburg, PA iyi28-o6oi RESIDENT DECEDENT ; :'~ 1 V ~ ! ? ~ ~' ENTER DECEDENT INFORMATION BELOW Social Security Num ber Date of Death MMDDYYYY Date of Birth MMDDYYYY _ _ 176-34-9231 ~ _ 11/23/2009 01/23/1945 J 2 ~ .__._ ~ Decedent's Last Name Suffix Decedent's First Name MI ~Gouse ~ ~ ~ Dell ~ ~ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M __ ~ ~ _ _,._...._ _. __ ----.. _ _ - __ ________ ~ _. ___ ____. _..._ _ _ ..._.__ -__ __ _ ~_____~ ____-_~ - --._ L_.. J Spouse's Social Security Number j____-~~~-~__._~_________~..___~-_______i THIS RETURN MUST BE FILED IN DUPLICATE WITH THE i ____---______.___..._.._ ~___ __~ REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death O 4. Limited Estate ~ 6. Decedent Died Testate (Attach Copy of Will) O 9. Litigation Proceeds Received O 4a. Future Interest Compromise (date of deatft after 12-12-82j O 7. Decedent Maintained a Living Trust (Attach Copy of Trustj O 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ZIP Code CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name _ .~__~____ ~~ _____ Daytime Telephone Number ,Paul Bradford Orr -------___._,______~_.__~ I ~7~---------258-8558 ~ _~~~ First line of address 50 East Hlgh Street _ ___ Second line of address City or Post Office State Carlisle ~ PA _.. ___. _ ._._ __ ._.______.___ ___~__.._._____..._...____. ___.i Correspondent's e-mail address: SIGNA RE OF P ON RESPONSIBLE FOR FILING RETURN DATE 11/19/10 e nRFCc prior to 12-13-82) O 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes O 11. Election to tax under Sec. 9113(A)~ (Attach Sch. O) REGISTER (7F WILLS U5E QNI.~, C~ L~ ~-~ cam. : =; I ~ tl- ~ C~ '~ ,, f -.r ~ ~) i„~.7 .. _ ~; _ _-~ . : DATE Flt<ED : __ _ 17013 r_ ~~ ~.,.. _,...~, ,. ~~ ; r=-;- - E i 1 ;~ -:_ ,,. ,, Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. 1526_P~ne Rd., Carlisle, PA 1701 ~ ~ivrv i vrst v YKtYHKtK V I - CK I t1A ~rKt - N iAyrvt DATE - , L. 1. ~ ( _,~-~ ' ~~ _ _ . _~ ~l ~~ ~ J 11 /19/10 823 Windy Hill Rd., Shermansdale, PA 17090 PLEASE US L Lsos61oLO1 GiNAL FORM ONLY Side 1 1505610101 REV-1500 EX Page 3 Decedent's Complete Address: File Number Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments B. Discount 0.00 3. Interest 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fifl in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) Total Credits (A + B) (2) (3) (4) (5) 1, 524.54 0.00 ~1~.~~ 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 :................................................................................... ....... ^ 0 b. retain the right to designate who shall use the properly transferred or its income :.................................... ....... ^ c. retain a reversionary interest; or ......................................................................................... 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? ............................................................... X 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 properly, 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. y. .-,yam ~ r~ ~.:?C"S .,~: ,.. z't :e.f`:~ ~ .srF 3.. r - ,.°uxti ,r F~fi. . "C'L"V~y ~~i~f. j~ ~`~Sh s.'` 's~~x~4'~F' 't` .. r.. .;, ~.k •~~`~:~~~3`. ,. r: .~_ ' .,.~~ v ~~ G-t5`,±t., r.l::y~.n; .n~,a.. .. o.~ ,..1 ... ^s''~a~s -:'_ For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the lax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. X9116 (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. 1 1505610105 REV-1500 EX Decedent's Social Security Number Decedent's Name: ~ 176-34-9231 r RECAPITULATION ~. 1. Real Estate (Schedule Aj ............................................. 1. i 65,000.00 j 2. Stocks and Bonds (Schedule B} ....................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) .................... . 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E). 6. Jointly Owned Property (Schedule F) O Separate Billing Requested . 7. Infer-Vivos Transfers 8~ Miscellaneous Non-Probate Properly (Schedule G) O Separate Billing Requested. . 8. Total Gross Assets (total Lines 1 through 7) ...................... . 9. Funeral Expenses and Administrative Costs (Schedule H) ............ . 4. ~. -..~....,-.~..._ .... 5. ~ 16,236. i 1 l 6.~ i ~_..._........_.., r._.._......_...._-..~~...,_.__.._..__,-........-~. ___-~- 7. s. ~ 81,236.71 9. i 9,139.83 10. Debts of Decedent, Mortgage Liabilities, and Liens {3chedule I) .............. 10. 38,218.29 j I 11. Total Deductions (total Lines 9 and 10) ................................. 11. ~ 47,358.12 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 33, 878.59 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ~~ - ~--~-~-~~--~-~-° --+---~-~--~-----• __ an election to tax has not been made (Schedule J) ........................ 13. 3 ~ 14. Net Value Subject to iax (Line 12 minus Line 13) ........................ 14. ; 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 16. I 1, 524.54 ~ -~ ~~~'Y`' .~--- 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable 1----~-----~-~~W-~-~-a-a-~.__._... ..............._.,~__.m__~..-w.~.~.,.....~ at collateral rate X .15 18 1 ' 19. TAX DUE .........................................................19.' 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 1505610105 Side 2 1 ~ _ ----.-- O 1505610105 J 1 REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA No. Estate Of : DELL H GOOSE CERTIFICATE OF GRANT OF LETTERS PA No . 2 ~ - 09- ~ 119 (First, Middle, Lasil Late Of : LOWER ALLEN TOWNSH/P CUMBERLAND COUNTY Deceased Social Security No : 176-34-9231 WHEREAS, on the 3rd day of December 2 0 09 an instrument dated September 20th 2007 was admitted to probate as the last will of DELL H GOOSE /First, Middle, Lastl for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: JOHN H GOOSE and REBECCA S PERRY late of LOWER ALLEN TOWNSH/P, CUMBERLAND County, who died on the 23rd day of November 2 0 09 and WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Register o:f Wills in and who have duly qualified as EXECUTOR(R/X) and have agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CA RL lSL E, PENNS YL VA NlA . IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the ~~eal of my office on the 3rd day of December 2009. Register o l is ,~/~ Deputy * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) ZI - Z~~~~ _j/~ Last 'Will And Testament Of DELL H. GOUSE I, DELL H. GOUSE, of the TOWNSHIP OF HAMPDEN, COUNTY OF CUMBERLAND, COMMONWEALTH of PENNSYLVANIA, being in good bodily health and of sound and disposing mind and memory, and not acting under duress, menace, fraud, or undue influence of any person whomsoever, merely calling to mind the frailty of human life, and being desirous of disposing my worldly goods while I have the strength and capacity so to do, I do make, publish and declare this my LAST WILL AND TESTAMENT. I hereby revoke, cancel and annul all my former Wills and Testaments, including codicils thereto, by me at .any time made, and declare this alone to be my LAST WILL AND TESTAMENT. AS TO SUCH ESTATE IT HAS PLEASED GOD TO ENTRUST ME WITH IN THIS LIFETIME; I DISPOSE OF THE SA11~IE AS FOLLOWS, VI?_: ITEM 1. I direct that my Executors hereinafter named, pay and discharge all of my just debts, funeral and testamentary expenses. ITEM 2. I order and direct that my bodily remains be cremated. ITEM 3. All the rest, residue and remainder of my entire estate, wheresoever situate i and whatsoever it may consist of, I give, devise and bequeath, absolutely and in fee, to my dearly beloved children, REBECCA SUE PERRY AND TORN H. GOUSE to share and share alike, per stirpes. ITEM 3. I hereby nominate and appoint JOHN H. GOUSE and REBECCA SUE PERRY as Co-Executor and Executrix of this my Last Will. I order and direct Executor to retain and appoint James M Bach, Esq. for legal services. ITEM 4. I direct that my personal representatives, as well as their. successors, shall not be required to give bond for the faithful performance of their duties in any jurisdiction. ~'`~ N G W ~ ~i r~3pWge.pO ~OW~~Q ~~~~z-* ~~A~~~ ~~o x~ '-' U ~~`"~~~' ,~~ ~ ,., / " ~`Li' DELL H. GOUSE 9/20/2007 1 ITEM 5. I direct that all estate, succession, legacy, inheritance or other transfer taxes, however designated that shall become payable by reason of my death in respect of all property comprising my gross estate for tax purposes, whether or not such property passesunder this Last Will, shall be paid by my Executor out of my residuary estate. ITEM 6. I grant to my personal representatives herin named, in addition to but not in limitation of those powers vested by law, to be exercised without prior application to or approval of any court, the power and authority to retain indefuutely any property, to invest and reinvest any assets or the pxoceeds derived from the sale of assets, although said investments may not be of the character prescribed by law, to sell, convey, assign, transfer and encumber any property, to pay, settle or compromise all claims, to make distribution or divisions in cash or in kind, and in general to exercise all powers in the management of any property hereunder which any individual could exercise in the management of similar property owned in his own right, and to execute and deliver any and all instruments and to do all acts which may deemed necessary and proper. ------------------------------------END------------------------- ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA ) ss COUNTY OF CUMBERLAND ) I, DELL H GOUSE, the TESTATRIX, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instnunent as my LAST WILL; that I signed it willingly; and that I signed it as my free and voluntary act for the purpose therein expressed. Sworn to or affirmed and acknowledged before me, by: the TESTATRIX this 20TH day of SEPTEMBER 2007. ~~~~~ DELL H. GOUSE NOTARIAL SEAL J S . BACH, ESQ IRE JAMES M, i3ACH, Notary Public NO Y PUBLIC Hampden Twp., Cumberland County Me h icsburg, PA 17050 My Commission Expirss May 13, 201 ~ My mmission Expires: 05/13/11 2 The preceding instrument consisting of this and three (3) other typewritten pages, identified by the signature of the TESTATRIX, was on the date thereof signed, published and declared by DELL H GOUSE, the TESTATRIX therein named as and for his LAST WILL AND TESTAMENT. Residing at 352 S. Sporting Hill Road hristina L. Jensen ~Viechanicsbur$, PA 17050 /~~ GtJ ~ ~.~~.~._. Residing at 352 S. Sporting Hill Road Thomas W . Fleckenstein Mechanicsburg, PA 17050 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) ss COUNTY OF CUMBERLAND We, Christina L. Jensen and T h o m d S W . Fleckenstein , 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 TESTATRIX sign and execute the instrument as her LAST WILL; that the TESTATRIX signed it willingly and that he executed-it as her free and voluntary act for the purpose therein expressed; that each witness in the hearing and sight of the TESTATRIX signed the ~Y/ILL as witnesses; and that, to the best of our knowledge, the TESTATRIX was, at the time, 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn to or affirmed and acknowledged before me, by: Christina L. Tensen and Thomas W . Fleckenstein ~ witnesses, this 20th day of September, 2007. ~- ~~r~TA~(AL SEAL ~'+`injF~ 14i. ~~`;C:f~±, ~uolary Public i'-d1~'.~l~f?F1 ~~j~„ ~Ntr~beriand County ~:Y ~0~-:~14~~(Pri'i ~~~ir~s May 13, 2011 Y PUBLIC anicsburg, PA 17050 Commission Expires: ,~ REV-1502 EX+ (11-08) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Dell H. Goose 2009-01119 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on 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. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1. } i „~~~ ,. I '5016 ERBS BRIDGE RD., MECHANICSBURG, PA 17050 ' 65,000.00 ~: ::~ ..ie -.~.,y ,..., ,.... ~ _~.n ..nmfna.etamane'carnmw+.xw.ws_+amew.w+am.'-M.MUwm`w+eascamv~lio'wxaaevroxsvr-.. ..._ s--.. ..wr ~-...-. _, s~'p:.mnwmw++rmav+m'hwaw.ca~„-mn ~ ~ •• ~ u ~{ ~~~ a ~ f i t ` 1 S e ~ .. n..««.u.nzs~rvnimavv#E -.. .Y.a.. . cxi-.»t.mkm. wr.n±nra..~wru,,~ewaavwo;.L'r:reCa~.swm..bra~um~,~,._r.~,w~.m.+akmwnmwru.:aarv.'c. anvaezw -.w .. _. -, w.~rr m " M +' ~ 3 ` ' ~ . w .w.c cx.m ,mrroa~.Y-sr.. w w.w,zuwrsa+n'am.+NCUw.we~r.vw.aaet'rvpsnar - a .. .. ..~ i . ~_T_ ?.. It j ` )~ f < r'a'x . _. y,...- ! ~~ +.u a:f.s ,...-~w... _.. .ux+ a..rs. i.n.,,u.- roamxe~.;.5-x.t. cn-am~x.4A-rrvam /vvrb_:J'N.nroruw+ro*'va,.rscs.'asxa <m:.wxaaevir. iY~z.vv,-x~re .wov-.mmw.~z~.~.uca.. wms»s:~..~am,'~w...,w.w.-roWnwmus»uvs<.., p.~:a.- ~ .._ , - . .. { ,,.[a.~. w,.w . .a~n:.,, m.v:sma. . ~www ,w... +~a . ,. ~ ` ~ . . y .. : . ,. .. x-.sseewna. fiuN,,.M:w~a..+iwxrx.,naa.:n>.n-.w.m9*k L ,. ° ~ ~ ~,~ . ~«~,~..,,,.~,.~.a~..~,~.«~„,„, p _,.~,x.,~.~~....»w,.- .~«~.~,M»x.,~~,.k.....~G,,...~F ,~,x,.~,~«a.<. ,~„~»..~~d,.,~.~e~~~.,,,m, ,.K~ ~ ,~:Ft.~a~~r'!~'• _^x } i ~.__ __ -__ ...... . . ......m_ . _.....µ ~ ...~ v...... _ . ~ ~, TOTAL (Also enter on Line 1, Recapitulation.) $ 65,000.00 If more space is needed, insert additional sheets of the same size. OMB N0.2502-0265 r B. TYPE OF LOAN: ,~~ ~ 1.QFHA 2.QFmHA 3.QCONV. UNINS. 4.QVA S.QCONV. INS. U.S. DEPARTMENT OF HOUSING 8 URBAN DEVELOPMENT 6. FILE NUMBER: 7. LOAN NUMBER: SETTLEMENT STATEMENT 1o-57s 8. MORTGAGE INS CASE NUMBER: C. NOTE: This form is furnished to give you a statement o! actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked (POC)" were paid outside the closing; they are shown here for inlormational purposes and are not included in the totals. 1.0 3198 (JDINES.ALLEN.PFD/ta576I8) D. NAME AND ADDRESS OF BUYER: Allen R. Joines 5016 Erbs Bridge Road Mechanicsburg, PA 17050 E. NAME AND ADDRESS OF SELLER: Estate of Dell H. Gouse F. NAME AND ADDRESS OF LENDER: G. PROPERTY LOCATION: 5016 Erbs Bridge Road PA 17050 Mechanicsburg H. SETTLEMENT AGENT: 68-0510988 Community Land Transfer, LLC I. SETTLEMENT DATE: November 12, 2010 , Cumberland County, Pennsylvania PLACE OF SETTLEMENT 2331 Market Street Camp Hill, PA 17011 J. SUMMARY OF BUYER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BUYER: 400. GROSS AMOUNT DUE TO SELLER: Contract Sales Price 101 65,000.00 401. Contract Sales Price 65,000.00 . 102. Personal Pro ert 402. Personal Pro ert 103. Settfement Char es to Bu er Line 1400 1,590.88 403. 104. 404. 105. 405. Ad'ustments For Items Paid 8 Seller in advance Ad'ustments For Items Paid B Seller in advance 106. Ci /Town Taxes to 406. Ci /Town Taxes to 107. Coun Taxes 11112/10 to 01/01/11 43.53 407. Coun Taxes 11/12/10 to 01101/11 43.53 108. School Taxes 11/12110 to 07/01/11 709.58 408. School Taxes 11/12/i0 to 07/01/11 709.58 109. 409. 110. Sewer 4th Qtr. 11/12/10 to 01/01/11 81.52 410. Sewer 4th Qtr. 11/12110 to 01/01/11 81.52 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BUYER 67,425.51 420. GROSS AMOUNT OUE TO SELLER 65,834.63 200. AMOUNTS PAID BY OR IN BEHALF OF BUYER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. De osil or earnest mone 1,000.00 501. Excess De osit See Instructions 202. Princi al Amount of New Loans 502. Settlement Char es to Seller Line 1400 6,622.87 203. Existin loans taken sub'ect to _ 503. Existin loans taken sub'ect to 204. 504. Payoff of first Mortgage to Goldbeck, McCafferty & 29,229.90 205, 505. Pa off of second Mort a e 206. 506. 207. 507. De osit disb. as roceeds _ 208. 508. 209. 509. Ad'ustments For Items Un aid 8 Seller Ad'ustments For Items Un aid B Seller 2i0. Ci !Town Taxes to 510. Ci !Town Taxes to 211. Coun Taxes to 511. Coun. Taxes to 212. School Taxes to 512. School Taxes to 213. _ 513. 214. 514. 215. 515. 216. 516. 217. 517. Escrow Inheritance Taxes to Communi Land Transfe 2,430.00 218. 518. Sewer to Ham en Townshi 515.27 219. 519. 220. TOTAL PAID BY/FOR BUYER 1,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 38,798.04 300. CASH AT SETTLEMENT FROMITO BUYER: 600. CASH AT SETTLEMENT TOIFROM SELLER: 301. Gross Amount Due From Bu er Line 120 67,425.51 601. Gross Amount Due To Seller Line 420 65,834.63 302. Less Amount Paid By/For Buyer (Line 220) ( 1,000.00) 602. Less Reductions Due Seller (Line 520) ( 38,798.04 303. CASH (X FROM) ( TO) BUYER 66,425.51 603. CASH (X TO) ( FROM) SELLER 27,036.59 The undersigned hereby acknowledge receipt of a completed copy of pages 182 of this statement & any attachments referred to herein. Buyer ~ ~~~ Alle R. Joines ._~ Seller Estate of Dell H. Gouse _.Ay. ~'~ -- ,fit /1 / L. SETTLEMENT CHARGES 700. TOTAL~COMMISSION Based on Price $ % 4 195.00 PAID FROM PAID FROM Division of Commission line 7OO aS i=OiiOWS: BUYER'S SELLER'S 1. $ 4,195.00 to THE HOMESTEAD GROUP, INC. FUNOSAT FUNDS AT 7 2. $ t0 SETTLEMENT SETTLEMENT 703. Commission Paid at Settlement 4,195.00 704. Buyer Commission to The Homestead Group, Inc. 295.00 800. ITEMS PAYABLE iN CONNECTION WITH LOAN 801. Loan Ori ination Fee °k to 802. Loan Discount % to 803. Appraisal Fee to 804. Credit Repoli to 805. Lender's Inspection Fee to 806. MoR a e Ins. A .Fee to 807. Assumption Fee to 808. 809. 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to @ $ /day ( days %) 902. MIP Totlns. for LifeOft.oan for months to 903. Hazard Insurance Premium for 1.0 ears to 904.. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance months $ er month 1002. MoR a e Insurance months $ er month 1003. Cit /Town Taxes months $ er month 1004. Count Taxes months $ er month 1005. School Taxes months @ $ per month 1006. months $ er month 1007. months @ $ per month 1008. months $ er month 1100. TITLE CHARGES 1101: Settlement or Closin Fee to 1102. Abstract or Title Search to 1103. Title Examination to 1104. Title Insurance Binder to 1105. Electronic Document Pre to 1106. Closin Service Letter to 1107. Attorney's Fees to includes above ifem numbers: i 108. Title Insurance to COMMUNITY LAND TRANSFER Reissue 583.88 includes above item numbers.1102, 1103 8 1104 1109. Lenders Coverage $ 1110. Owner's Coverage $ 65,000.00 583.88 1111. Endorsements 1D0, 300, 8.1 1112. Notary Fee Community Land Transfer 1113. Notary Fee _ to Community Land Transfer 5.00 1114. Overnight Fees & Handling to Community Land Transfer, LLC 15.00 1115. 1116. Deed Prep. to Paul Bradford Orr Law Offices 175.00 1117. 1118. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 62.00; Mortgage $ Releases $ 62.00 1202. Cit /Coup TaxiStam s: Deed 650.00• Mort a e 650.00 1203. State Tax/Stam s: Deed ~ 650.00; MoR a e 650.00 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Surve to 1302. Pest Ins eclion to 1303. 2010 Count ffownshi Taxes to Michael Lan an, Treas. 10-20-1844-079A 349.55 1304. 2010/11 School Taxes to Michael Lan an, Treas. 10-20-1844-079A 1,233.32 1305. 1400. TOTAL SETTLEMENT CHARGES Enter on Lines 103, Section J and 502, Section K) 1,590.88 6,622.87 Community Lan ransfer, LLC Settlement Ag t Certified to be a true copy. (10.578 1 10-578 / 8 11/08/2010 16:12 FAX 7177307366 REAGER & ADLER, PC J l al~ll ~~~b~~~~C,G V7 i ~YJ DEED, oUftOEp~ANU OOUNTII-PA. ~ ~,_ ,~ - !~ In rk year of ow Lo~~OnQ3~t Rar~if~ n ne 3 MAU1: T/t~ - ~ - day of ~~.,.- hundred ninety (1 y90) DI;TW~~'N DELL 11_ COUST sad LORI ANN ALMEr:~ now by mar~ia o, LORI ANN t. () U S tt. husband and wife, of 5016 6rbs Btidgge Rood, Natnpden ~ownahip, (Merhnnicaburg, PA 17055),. tLbrnborland ~krunty. t'ennsytvMlin . Orontvrj, arts DELL 11, COU3E and I.OR1 ANN COUSE~ husband and wife, of 5016 &bs Bridge Rood, l (ampdt:n Township, (Mcchenlt:6burp. PA 17055). tatntberlsnd Couery , PennerlYonta G~anrees W/TNrSS15Tt/, rl+ar In cnnrldcrartu/n /{y/'~ One dolfor pnQ nollOU-••••••••---•----••••--------••••••• ••••--.--.••.•-.~~~~vw•.•w-~.ww• ,~I.W)'-~.N••••••w-+•.h-A••M•Y•W~--••\••N••Yw•~rors. r„ harttl rxrrrl, rho ~recr,IPr wl,anof !s harohy acknnwfadged, the sold gronrots do hereby a-aar arrc! t:wtvey rn rite suid t;ronrars. their heirs and aretd„s, ar tenants by i oadrery. AI.L TIIQ$6 TIIRBQ CBitTA1N troets or lord of ground rituero In liotttpoan Township, Gumberland County, Pannsylvnttie, tTtoro particularly bounded end dessribt:tl es followz, w wit; TItn4T NA. 1: lsIrGINNtNC of en iron pin on the side of a I;ny feet wide Public Alley; tltt;nc;c rlong the lino of wld Street ttouth thltor (37) daarea thirt2- (30) ntlrwtn «tee eltsry (b(I) fcot ~o n point; thcneo notlh filtytwo (92) dtgr~ees thing (30) rtunutas east oao hundt+ed rrt~n cl 1 fCet to s point on oshee funds now ot•Inrs of t'sarl N. Ready •nd Dorothy M. Ready; th ~ ~ mo nonh chinYy-fovea (37) do t:a thlrry (30) minuteA wcat dxty ~ feet to e poinl oi~ 1ho •Y6lor y lino of o Ihirty fps{ W1dC ~QCG[; manta along sal0 5aeot route ~[~-tW0 (52) d~gn;c:b thirty (30) minutc9 wear (ineortzctlyy referred to in prior deed as ''ntmh'7 ono hundred . ftfte~n (115) 1'cct n~ a point, rite placo of DW1NNlN0. ' ~ t3EfNCi a rtion of l.otR Noy. 2 and 3 0~ Plan No, l of Bun&alow Shoe, as laid out by f-~' Churl~y !:burly bad ru:ordcd In rho Cumberland County Reeorder'c dffic~ In Dlru, Book 2, pg6G 71. IIAVING TIIEREON erected a dwelling house also partially situate on Trnct No. t hvroinuftcr. TttnC'~ No. 2; 8>EGINNIN(; At a point on the Pasterly lint of a 30 foot. sncct, said ppooint being at u dlRtunee of one hundred fiflecn (1 IS) foot meaeumd to en ?Jorthoax~arlr dlrootton frtau thr Inter~cc;tlon of Rnld 30 fbot street tend a 50 foot BtrtCt, nA Ahown on the Plan of Loll of Ch;trlas C.txrly, r~rnrdud in she Cumberland County RQOOrdo~ a tNftce in Plan Qook 2, pogo 71; thcnta attrnp~ the Goatorly lira of aald 30 foot etTaol North S2 dcatet:a 30 minulot Eelte, lwo hundr~Kl (~Ihh) root ro a point on fire bunk or rho Conodo ulnct creek; thence aloeg rho Conodo~~uinet Creek, in a Southeastcrl dMeecion, sixty (6A) ~ to a point; thanoe South 52- dcbrt:rs ;tt1 nrlttttteR weal. two huntuod (~00) feet tb a polnl; lhcnco along other lends of David S. Sltndcrson and wife, North 37 degrees 30 minuu8 West slxly (60) feet to a P°:ne, the plntte of HL•GINNINO. ll l? I N(. pans of LotF Nos, 2 and 3 on the ttbOvc mcntfonCC Plan, 'CI(A(:T NO, 3: DEGINNING t-t a point on the CpvtCm xlda p( Lot No. 1, on the nrtr~n;tft~r Itu'nllon~tt f l;tn of t.oiy, whlt:h point is two hunUrt:d ninety (290) fret, more or ICKS, dm~lh I~~un the norlhrasl c'omcr of r-nld tot; thcnco oxtondinr sc-uthwnrdly along thm wexwrn tine of a tttiny fcvt veldt; Public 5troct, twenty (?A) feet to a poiri~ dtt:nee extending westwardly olong the southern Ilne of soil La 1Vo. 1 trveety ('01 foal a n points eheneo vRtortdln` rtoNtwer0ly twenty (?0) fcot ro a point: thence extending eastwtudly twenty (x0) feet to a point, the place of B6CINNINC. DEINQ '1'l1E southcaattim t:OtAet of IAt Ivo. t in Plan No. 1 of 19ungelow Sires es laid out by Charles Eberly at'orosald end being imptvvod with tt double fretne aerOCc. The abovo thttee track of land now Known a9 and Ntunbped 5016 t3rbe 9ridge Rood. MechanitsburS. PA 17055, Having enctcd dretron a dwelllna house altuero vn Traocs Nos. 1 s,ttd Z utt not onh hernia and n doubb !tame gars ottvate ooeosa d>e ehirs~ rcor yublic street running along the twNt wcslarn boundary line of is Nos. 1 end 2 set [oft huein, aaocs fhom rho weao:ern covnQr otTr4ct na. t hetorn. 'R{E l~rl'Ii{IA3 Cortveyanca 19 !'ccm husband and wl,f6 l'A hubhar-9 and ~•Tife enc9 is cnererore exempt fz~vtt all realty rspr)ef~ tatooB. . .. ~ ~ ' ~] o~:iluu~t ~ ~ti°~ ~~~ ~~ r~oACOR & AoF_or~, r~ ~UU~,U~4 i~/oo/2oio ic: i2 ~A}( 7177~07~CC r . ~~ ..., BS1N(3, tho iomop~daa vhdcb David 9.9enda~oft. widQw~et_ , by deti4 daoed Dtodhber' L4. -9e'r and ~etod owvrncor 13~ 19~/ v- tic On'loe Of the i-eooo0ve ct DOEd~ irl arld [Or Cbrobe-iand Camgr~ CtdMle, Paouylwd~. in Deod Book "C" ~ YoL 33, Puto 309• p~ncee and • oomc~-od to bolt K Douce en0 tral Mn J-1mer~ CrnntOee h~al4 '11tc seld Lori Ann Alma hea oow tntarouuried with the Said DoU H. Cioaso and is aye and the game peaon ae trori Ann QOl1sO, AND fl+eaaidgronmrs hentbpaotre~ntandogreetAor t+ltey w1U~+arRa+M~s+terdb ~eor~rsr~-1,erv~by cavnvgsd, /N WITNESS WHBRBOF~ sold praneo~ hQue he~eearere hr rA.t. and anab d~ doy ondyea-,Rr~f Above wrltran. 81~r•~d, 8eaforl, •Rd D.rh-rnQ rra rw• ~nertte~ qJ •' SBAL) • Doq ~ Houle ~~ SBAL) Arta SBAL) nn Clouse Scare qt PennryfvanJa } fa, Cory of Cwnberlcar~d On tots, the > >'.r'~ day ~ ,1990, bgioro nre, the pridarstgned v,,~ictr pe.sa~alRy apps-td 'Dal! H. ab~~~ .ad' l~orl ~rur Gvuw, rormert~+ Mori ~-r~ IUr'r~. hufbt~rf~ end writ, known ro me (or sai~arxortb ptrovan) ro bs de persons wlrgta tmnkst ort subscribed ro the .rtrl-tn tascrwnenr, ttM trcrbwwtcit8ae rr<ar tlcey executed the dame for t-!e pwposaa nc~reln ntalned, '~ IN k'~'FNBS$ WK6Ri~OP,1h..~unroser„,q,l~anda~ec~oral~u+ar. '' ~~ '~~y' ~~~~,%'' '~ (~. r I~bow AM o, ~ . i ~ ~J T ;~ 'Qr~6vgfi~Cynq W00~auAl - '..n~ ~ ^ ~ +'~rr,`i •! orwww~ Wow ~ ~ h rr .~ ~ •1 do hereby ecru,~y thnr the precise restderc~s o„d c~lRre pas: c~gla. oddroaA~o~'~Nw~'+virlrlri nvmrd grantees 1rS0(d Erbs BNdBe Road, Meeha~luburg, PA /70SS, ~~~- •~`~ 1990 ~. // ~~•~ LLL , eoo~ 34 Mc~A48 ~i' r C~ • ~ REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Deli H. Gouse 2009-01119 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 ~~ _,~_..._..._,,.. _~_~_~_.m~._.~_ .-.~.._ ~ ~~~_ ~_~....,wo._,_ r_...__~....~_. ~„ ....~._.... ~. ..__ ~M & T Account -Checkin _. ~ . __ ,~~ ...~.~ .,......~, ., _. ,,, x __ g 2,8~G..~2 _ ~ - ,. ,_ ~.; ~ ~,:;.r v 2.~ f M & T Account -Savings 7,027.19 ~~ ~ , , ,..:..,-. _~. ..2ys.,: +.s-_.,.. .........,....:. c...,, u,t .., ,..a,»~,,~ws. ~>.,,.,,~rov«~Fac.~> `~'iq ~,~ ~ k^" r ~3 ~r^, ~ 3.~ ~ 1987 Chevrolet Monte Carlo LS 2,250~00 ., 4 . :.~. d. .. ~..~~«. ~ s~: ~„ _ .2003 Chevrolet Trailblazer LT Sport Utility 4D ,, ,. ~~,R~ ~:,~ „T.~ ~.,ti ,. ~~, ~ , 2,225.00 i1 5. 1987 Dodge Ram Charger AD 100 988.00 r 6. Utility Trailer 200.00 _ .:~r f. ~ .~:~:_ 7. Small Utility Trailer 150.00 ,~ _ _._. _.. _ . . .~ ,«~t t 8 fi ~ ~ Personal Property Sold at Yard Sale 500.00 ~,,:': -. I j . ;.. . , t•a.-~:t^:~a ase..- ,:,~e.+aaaxxxaaaiy.~^sj:.S#+s4 ... F:±b ~ n : ~aahv'.Y,= _." :aW•:;[ p. ... a ~ : r i _ ~ mod' t. At.q. ~.~1 • j z z >; ., i d t t - -.. .:.. & .. _ -e~eaa~~,~;~ra~ r..m~~arrc.~,z~ .~ r zw..~r~:ar.~- m . ,.e .,; M.=,,. _ c .. K !~S _ ~. . ~,r. aY 4_ < .. _'~r ~ <. e . ~z m -n < y Svs~nAe ~c~q^=~Yar2PWraa~~rss - m. a us n -- e... o . MlaereXHUi- r.wf ~ _ ~ht ~ ya..q l~ ~ -a N,~ry~ t~ C i K • Y x ~ . -. ~' ~ ~ ~:~amYSf?4&^az~5./M~ ~.+^u,.~.h'r„-rw~,?.^~-tat+wa%: Y~asanav [w::a!%c'R'q'~" .'H'3~ler-roYN'aroe#Mv:A'.5'Yb.P'H,gNfib[?Y6. 1 -:-wNaroaH.9:rxuR-•;asMY.Y.F.a'axfw~r:'r ~ rzuP» rn'eaw;~6-.s: RfiYSSaW:kbmlbn~.kc- .. w?''. "e~m~.OY A~ ~?~ ~ -':u`~w .r ~]~~.51~~ _ ~' N.:i'~~ 1 ~$ i yi s 44 E i.--'.~ w... ,.t .'. ' 8 ~ _ .. 3 s Ei TOTAL (Also enter on line 5, Recapitulation) $ 18,236.71 (If more space is needed, insert additional sheets of the same size) I~51 M&T Bank 00 0 06123M NM I17 4776 DELL H GOOSE 5016 ERBS BRIDGE RD MECHANICSBURG PA 17050-2430 STiATEMENT PERIOD PAGE - ---__.... -.~._.._~__..._..j NOV„14-DEC.15,2009 ]. OF 3 SELECTED ACC©UNT SUMMARY ..._____._..._.. ACCOUNT ACCOUNT INTEREST EARNED MATURITY ENDING; TYPE NUMBER YEAR-TO-DATE DATE BALANCE: DIRECT DEPOSIT CHECKING M8T PERSONAL SAVINGS 000000023520043 015004208556520 o.oo 2.66 a . o la a~.o~ ACCOUNT DELL H GOOSE DIRECT DEPOSIT CHECKING TITLE _____ _... ACCOUNT N0. 23520043 WEST SHORE PLAZA Af'f'f111NT SIIMMeRY BEGINNING BALANCE` DEPOSITS >sR: OTHER ADDITIONS CHECKS PAID OTHER SUBTRACTIONS CURRENT INTEREST PD ENDING BALANCE .,_._ N0. AMOUNT N0. AMOUNT N0. AMOUNT 4,341.26 1 1,482.20 5 1,208.05 5 4,615.41 0.00 _-N_ O~~1C errf111NT e['TTVTTY POSTING DATE> __ _ TRANSACTION DESCRIPTION DEFOSITS;INTEREST $ OTHER ADDITIONS CHECKS 8 OTHER SUBTRACTIONS DAILY BALANCE _„_,-M; 11-14-09 BEGINNING BALANCE 54,341.2~i 11-16-09 PP ELEC BILL 113.00 4,228.2.€h 11-18-09 CHASE CHECK PYMT 000000000006773 100.00 4,128.2ra ~, 11-19-09 CHECK NUMBER 6771 110.00 4,018.2~'o 11-20-09 CHECK NUMBER 6774 200.00 11-20-09 VERIZON ARC CHECK PYMT 000000000006772 23.69 3,794.5' 11-25-09 US TREASURY 303 SOC SEC 1,482.20 5,276.77 11-27-09 CHECK NUMBER 6777 500.00 4,776„7'7" 11-30-09 REVERSE DIRECT DEPOSIT 1,482.20 3,294.57" 12-02-09 CHECK NUMBER 6776 46.05 3,248.5". 12-03-09 CHECK NUMBER 6775 352.00 2,896..52 12-04-09 CLOSEOUT 2,896.52 0.00 ENDING BALANCE 50.00 _._ L008A {6/07 tic F S "~ `. ' - r~~f''L~(~ Tai a#, ~ ~. _. a . _ /~1 M~cT ~3a .~ DELL H GOOSE CHECKS PAID SUMMARY _~ ~.A~ 6771 11-19-09 110.00 6774 11-20-09 200.00 6775 12-03-09 °~~-_^,+:90 6776 12-02-09 46.05 6777 11-27-09 500.00 ACCOUNT DELL H GOOSE r _..I M&T PERSONAL SAVINGS - TITLE .. ACCOUNT N0. 15004208556520 WEST SHORE PLAZA nrrnllNT CIIMMeRY BEGINNING BALANCE DEPOSITS & OTHER ADDITIONS <WITHDRAWALS 8 OTHER SUBTRACTIONS CURRENT INTEREST PAID ENDING BALANCE _ N0. AMOUNT N0. AMOUNT 7,027.01 0 0.00 1 7,027.19 0.18 _ nrrnllNT erTTVTTY INTEREST TS OS W/DRAWAiS 8 OTHER DAILY .POSTING DATE TRANSACTION DESCRIPTION , I DEP & OTHER ADDITIONS SUBTRACTIONS BALANCE S7, 02 11-14-09 BEGINNING BALANCE 12-03-09 INTEREST PAYMENT 0.18 7,027.19 12-03-09 CLOSEOUT ENDING BALANCE ANNUAL PERCENTAGE YIELD EARNED = 0.04 EFFECTIVE MARCH 1, 2010, THERE WILL BE A 525 FEE IF YOU REQUEST EXPEDITED DELIVERY OF A NEW OR REPLACEMENT M8T CHECK CARD OR M8T ATM CARD. EXPEDITED DELIVERY MAY TAKE 1-2 BUSINESS DAYS. IF YOU REQUEST EXPEDITED DELIVERY OUTSIDE THE CONTIGUOUS UNITED STATES OR THE DISTRICT OF COLUMBIA, SUCH FEE WILL BE 550, AND DELIVERY MAY TAKE LONGER THAN 2 BUSINESS DAYS. THERE WILL BE NO FEE FOR EXPEDITED DELIVERY IF THE PRIMARY ACCOUNT LINKED TO YOUR CARD IS A POWER CHECKING ACCOUNT, OR THE REQUESTED CARD IS A PORTFOLIO MANAGEMENT ACCOUNT CARD. ** END OF STATEMENT ~* ~ooaa ~s~a7} p {'~ C~ 7 , ~:-:h 0 '!fl ~U ~i , l) D .i. a s~z.r ti;t~lY;'~ +i a'i~ ai ~Il ~I}' ~} die °i ..~~t X' ~~?t ~Ii~ I t' 1987 Monte Carlo I,S LS 2 Door Coupe price report atNADAguides.com http://www.nadaguides.com/default.aspx?I,I=1-22-1-5013-0-0-G+&1... ~~~~ ~~ C~ t ~~ S ~ The Power of Yeh+cle tnfarmation Y ~~..yyyy~~ .4 Mt.~• Autos Cfassiic Cars Motorcycles Boats Recreation Vehicles Manufactured Homes Buy a Price G Free Insurance Quote ~ See Your Credit Score $0 ~ Buy a Vehicle ~ Sell a Vehicle ~ Get Pricing 1987 Chevrolet Monte Carlo LS LS 2 Door Coupe Collector Car Financing Free Loan Quote wooos~os cnsorr ett«e.,~ e.. ~rth..~dNs PRICING Free Insurance Quote Original iMSRP: $11,306 October 22, 2010 print this page ~ email this page Free Insurance Quote ~~ ~ ~~~~ Base Price Know your Credit History TQTAL PRICE Free Online Credit Score '~ = ~~ ~ ~ ~ m NEXT STEPS Find Your Classic Chevrolet Z1P 17013 . • Goiwad ry AutoTrader Classics Trusted Partners Car Care Center Vehicle History Classic Car Resources Collector Insurance Guide Classic Car Buying Tips Car Care Center Law Retail $2, 250 $2,250 were e Retail $4,650 $4,b50 High Retail $7,225 $7,225 Insure Your Investment Looking to Buy a Classic? See Your Credit Score $0 Looking to Sel! Maur Classic? Monthly Payment Calculator New Car Prices, Reviews & Info Low Retail Value This vehicle would be in mechanically functional condition, needing only minor reconditioning. The exterior paint, trim, and interior would show normal wear, needing only minor reconditioning. May also be a deteriorated restoration or a very poor amateur restoration. Most usable "as-is". Some of the vehicles in this pubNcation could be considered "Daly Drivers" and are not valued as a classic vehicle. When determining a value for a daily driver, it is recommended that the subscriber use the low retail value. Note: This value does not represent a "parts car". 1 of 2 ] 0/22/201011:15 AM Body Style > Make > Year > Model 8 Trim > bons > Used Vaiuss 1987 Monte Carlo LS LS 2 Door Coupe price report atNADAguides.com http://www.nadaguides.com/default.aspx?LI-1-22-1-5013-0-0-0&1... Average Retail Value This vehicle vwuld be in good condition overaN. tt could be an older restoration or a well-maintained original vehicle. Completely operable. The exterior paint, trim, and mechanics are presentable and serviceable inside and out. A "20-footer". High Retail Value This vehicle would be in e~acellent condition overall It could be a completely restored or an extremely well maintained original vehicle showing very minimal wear. The exterior pairrt, trim, and mechanics are not in need of reconditioning. The interior vuould be in excellent condition. Note: This value does not represent a "100 Point' or "# 1" vehicle *. * "100 Point' or "# 1" vehicle is not driven. It vwuld generally be in a museum or transported in an encbsed trailer to concourse judging and car shows. This type of car would be sb~red in a cpmate-regulated facility. 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Copyright ~ Privacy Policy ©2000-2010 Chrome Systems Corporation. 2 of 2 10/22/2010 11:15 AM 2003 Chevrolet TrailBlazer -Trade In Value, blue book value - Kelle... http://www.kbb.com/used-cars/chevroledtrailblazer/2003/trade-nn-v... _ ~ ~. • ,A, r, .~~ ~~ ~~I~e B~u~ Bork _ __ Y THE TRUSTED RESUURCE ---- Horne New Cars Certified Pre-Owned Used Cars Research Reviews 8c News Dealers & Inven~ Used Car Values ~ Search Used Car Classifieds ~ Certified Pre-Owned ~ Compare Vehicles ~ Perfect Car Finder ~ Most Researc Wei!oome Badc ~ Sign In ~ Create Account ~ My KBB ZIP Code: 17013 Recently Viewed Home > Used Cars > SUVS > Chevrolet > TrailBlazer > 2003 > LT Sport Utility 4D 2003 Chevrolet TrailBlazer LT Sport Utility 4D Trade-In Value Private Party Value BLUE BOOK®TRADE-IN VALUE ;`f,r"~ Suggested Retail Value ---------.-___~. cPO value Condition Photo Gallery ~-rr° Excellent Cars For Sale ~~~~~~~ ~ . Compare Vehicles ..~ Good Blue Book Review ~ ,4 ~ r '~ Fair Consumer Ratings More Photos Find Your Next Car Specifications ,~ Price New Cars For Sale Near Carlisle 2003 Chevrolet TrailBlazer Local Listings: Total Ustings Near - Carlisle: a Search Chevrolet TrailBlazer Search all Cars For Sale near 17013 Find a i3eai *Suggested Retail Value ~: ~.~ Shopping Tools CARFAX Record Check Auto Loan from 3.79% APR Compare Insurance Rates with Progressive Payment Calculator Find a Dealer Fnd The Right Car Compare Used vs. New Under $5,000 Sa Finan Get a Ne Value 3.79% A Get a PrE $3200 3.99% A $2,675 Get Your Get a FrE ~2~~~~ ad SEARCH News, Reviews ~ Top 10s i 10 Most Comfortable Cars Under $30,000 ~ KBB Video Contest: Best of the Old Cars i ' Best October Finance Deals - AOL Autos 1 S Great Car Deals Why Your Next Car Will Have Turbos (And That's Okay) - AOL Autos ~ Read More __ _ - _ _ __ Average Consumer Rating (1264 Reviews) Read Reviews ' n ~ ~~~r .,f S Review the 2003 Chevrolet TrailBlazer 1 of 2 10/22/201011:19 AM Cars for Sale: 1987 Dodge Ramcharger AD 100 in Norman, OK 7307... http://www.autotrader.com/fyc/vdp jsp?ct~&car_id=28;8784755&d... Engine Transmission Drive Type Fuel Type Doors Vehicle Description Seller's Description and Comments Stock No. 5984A Okay here it is, yes, this has a bt of miles and is a few years old. ViN View VIN But just bok at the pies and you have to know this baby has a lot left in her sweetheart. and for this kind of price should just be unheard of. Make NO mistake, we are NOT fi~ang anything on this ~` Top vehicle. Normally we vwuld wholesale these vehicles at the auction but the owner feels vue should give our customers first dibs. You're vuebome. -The Buzz www.bigredsports.com Disclaimer Sales Tax, Title, License Fee, Registration Fee, Dealer Documentary Fee, Finance Charges, Emission Testing Fees and Compliance Fees are additional to the advertised price. t Top Own this Dodge Ramcharger AD 100 Find out the next steps to making it yours. Car Loans Rates as low as 6.15% APR* for this Dodge Powered by LendingTree® Car Insurance Get a free insurance quote for this Dodge Want an Instant Otter on Your Car? Get a free, ir:;~,tar,t offer ors your trade-in New from AutoTrader.com. T Top . ~ ~ ~~ ~, $14,988 3~~e-€ ~" Top 8 Cylinder Gasoline 3 Speed Autiomatic 2 wheel drive -rear Gasoline Tvw Door Used 20019 Dodge Journey Red 6 Cylinder Gasoline Get a free insurance quote for ~~~~'~ this Dodge Check your Credit See your free credit score Vehicle Pricing Check used car pricing on NADAguides.com Sell or Trade In on AutoTrader.com Post an ad or get an instant Trade-!n Offer e~ '~ +~ <' $988 Used '199 Dodge Dynasty wnite 6 Cylinder Gasoline ,~~ ,, ~,,. - . $4,988 EJ T 3 of4 11/4/2010 1:41 PM Cars for Sale: 1987 Dodge Ramcharger AD 100 in Norman, OK 7307... lrttp://www.autotrader.eom/fyc/vdp jsp?et=u1&vcar id=286784755&d... 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"AutoTrader.com" is a registered trademark of TPI Holdings, inc. used under exclusive licei 4 of 4 11 /4/2010 1:41 PM Big Red Sports ~ Imports Utility trailer http://harrisburg.craigslist:.org/for/ 198!~208b60.html harrisburg craigslist > for sale /wanted > genera! far sale email this posting to a friend Avoid scams and fraud by dealing locally'. Beware any deal involving Western Union, Moneygram, wire transfer, cashier check, money order, shipping, escrow, or any promise of please flag with care: transaction protection/certification/guarantee. More in o miscate~,orized Utility trailer - $200 (Mechanicsburg) Date: 2010-10-04, 8:33PM EDT Reply to: sale-3zm5t-1989208660~a,crai slims st.org ~Er~°rs Whe"rep~"'gtoaa~?t prohibited ~im/overpost best of crai~slist heavu duty Utility trailer from the 70's with 15 inch tires rebuilt in 2001.7 feet long 4 feet wide. Leaf springs need work. one good tire, the other is dry rotted. have a title and it is road legal. have a spare tire off the rim too. make an offer. No use for it anymore. • Location: Mechanicsburg • it's NOT ok to contact this poster with services or other commercial irrterests -,~;~q ~" _ ~ ~. X~ 1 of 2 10/22/2010 11:34 AM PostinglD: 1989208660 Small trtility trailer (great for deer) http://harrisburg.craigsRist.org/p~/2018568059.htm1 harrisburg craigslist > for sale /wanted > auto parts email this posting to a friend Avoid scams and fraud by dealing locally! Beware any deal involving Western Union, lease fla with care: Moneygram, wire transfer, cashier check, money order, shipping, escrow, or any promise of p -g transaction protection/certification/guarantee. More in o miscate org ized Small utili trailer (great for deer) - $150 prohibited (Carlisle) ~am/overpost best of crai~slist Date: 2010-10-21, 5:30PM EDT Reply to: sale jhhmv-2018568059(a,crai~slist.or~ (Errors when replyin t~ aa~?l Like new, 54" x 40" flat bed, 1000 max gross weight, tow with truck, car, cycle or ATV. Great for hunting season or use with small car. ~~, _ ~ ,a ~. ;~ ~ ,, .: ,~, r- ~f ,~ ~° rte. _„~;;«s:M, '~ *Kucv~,.: y PostinglD: 2018568059 1 of 2 10/22/2010 11:33 AM • Location: Carlisle • it's NOT ok to contact this poster with services or other commercial interests ~ REV-1511 EX+ (10-09) ~ pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Dell H. Gouse 2009-01119 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' _ Ewing Brothers~Funeral H.-_sH._ _ .w~F ~v.n~~ . ...T.~,~~.~_., ~~...., ....R~. ., d.....,._e_~. ......... ...._ . ........,..~. ... ome _ __ ,, 4 ,07.97 ..K, ~ { B. J e 3 -...~.. -...,. ,_W.. .. ..v.- .,.. ~.. ...._ ...~~....,.. .. ........ .. ... ,,... _ . .. ....... .. .. ....... ... i ADMINISTRATIVE COSTS: .. .. 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP _ Year(s) Commission Paid: ?.. Att~~rrcy Fees 4,061.84 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Slrcet Address City State ZIP _ Relationship of Claimant to Decedent 4. Probate Fees: 345.00 . S~ Accountant Fees 6. lax Return Preparer Fees: ~• ~Robm Starner Notary Fees ~ 20 00 , a~-~ , _,_ n . , _ _ ,. 8 _..._...... _ .... _v...._ _ _..... _..._ ..., .__ _ ___.,M .~, . ~.., Cumberland Law Journal A...._._ _ ..~.~. ..~..._ ~. ..._,..,4. A.~ ..._ ...~..._.. ,.__.__. a_....._ _.. _ _. , ._~._e_ _ .,......_ 75 0 ., , .~.. ~~:_ -, s t ..~..___~ ~w u~., IThe Sentinel ~ ~__ ___.u ...~._~ _. __.__..._ _ _~~m o_~___~__,_.m____...~..__~_~.__ w ,..._.__.__ ~.~-_ ..._.. ___ .. _ _~_ ... ... .. .. . ~ 230.02 ~ ,. - -, . _ ,..~.. ~n } .. .... .. _ ...._.._~ ¥. ~ _ f _.. ._ ..___ ~._ _ m..~.__._.. .__ _._ ...._ ~._ ~, ...._._ ~~. _..~ ....m _ ~,._ ... _ _.._.. _ , ~ x. _ ~` a -__. _ ...,..~ . _... _ _.__.~_. .~..__..__~~.~_~_._-___._ ..~~e_ ..w_~...a.__.~... ~ ,~ , .~r ~ ~,~~~ ~.W.,..~ >~~ TOTAL (Also enter on Line 9, Recapitulation) $` 9,139.83 - - ~* , .. If more space is needed, use additional sheets of paper of the same size RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Receipt Date: 12/03/2009 Cumberland County - Register Of Wills Receipt Time: 09:33:35 One Courthouse Square Receipt No.: 1059141 Carlisle, PA 17613 LOUSE DELL H Estate File No.: 2009-01119 Faid By Remarks: PAUL BRADFORD ORR SAP ------------------------ Receipt Distribution Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 260.00 CUMBERLAND COUNTY GENERAL FUN WILL 15.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 40.00 CUMBERLAND COUNTY GENERAL FUN JCP FEE 10.00 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5.00 CUMBERLAND COUNTY GENERAL FUN Check# 2337 ---------------- $330.00 Total Received......... $330.00 Ewing Brothers Funeral Home, Inc. 630 South Hanover Street Carlisle, PA 17013- (717)243-2421 December 3, 2009 Rebecca Sue Perry ~ ~ / 823 Windy Hill Rd. Shermans Dale, PA 17090 The Funeral Service for Dell H. Gouse ~';~ 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 , $1250.00 Embalming, $875.00 Dressing, Casketing, Cosmo, $290.00 2. FACILITIES AND SERVICES Viewing (Visitation/Wake) , $495.00 3. AUTOMOTIVE EQUIPMENT Vehicle to transfer remains to Funeral Home, $275.00 C. SPECIAL CHARGES Direct Cremation , $315.00 FUNERAL HOME SERVICE CHARGES $3500.00 SELEC'T'ED MERCHANDISE: Solid Oak Rental Casket, $540.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT 1'OtI ITAVE SELECTED $4040.00 Cash Advances Certified Copies of the Death Certificate , $72.00 The Patriot no photo , $ ] 70.97 Coroners Authorisation Fee, _ _ $25.00 Register book/Memorial Folders $100.00 TOTAL CASH ADVANCES AND SPECIAL CHARGES . $367.97 Total Total Cost _ $4407.97 SUB-TOTAL $4407.97 INITIAL PAYMENT /DISCOUNT /CREDITS 0.00 TOTAL AMOUNT DUE $4407.97 The unpaid balance over 30 days is subjected to a 1.50 % service charge per month - 18.0000 % per annum. ;1 q3~; ~;~3~~, ~~.. ~I f CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717) 249-3166 Fax: (717) 249-2663 February 26, 2010 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Paul Bradford Orr, Esquire RE: Dell H. Gouse Estate Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on the following dates: February 12, February 19, and February 26, 2010 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 0 .00 Total Amount Due $ 75.00 Payment received by, PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County ar~d State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, viz: February 12, February 19, and February 26, 2010 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. .- ,--- __ ~ ~ _- isa arie Coyne, Edit =~ SWORN TO AND SUBSCRIBED before me this 26 day of February~2olo `~ ~`~ ~ ` . ~~ Notary Clouse, Dell H., deed. Late of Lower Allen Township. Executors: John H. Gouse, 1526 Pine Rd., Carlisle, PA 17015, Re- becca Sue Perry, 823 Windy Hill ~ °- °•~-~ ~'-r» ~~~3~- Rd., Shermansdale, PA 17090 and , Paul Bradford Orr, 50 East High ~ f~c ~C);?AI~i /~, f„C;s± ;!,! Street, Carlisle, PA 17013. ~ fi>~?~~ry ~c.,~;lic. Attorney: None. C,.: Fk~,s3i..r L^~?~,~, CU`Cl':?"1",!_<il~t~ CC?~JSvT`l ~f;,r i.GCilr~l~r;~,iFi r',•;fil`?S 1~~i ~~, ~'Q10 ..; _ . :~,:y:~ _.-~-: mow,. ~r_-,~~-:~~s~~:r:-~s~ -n A 4° °~ov~ ~m 0 T o ~, a r ~ ~ ~-. 'N ~ i~ © a b/~ ~ ~~ ~. '' `~ 0 r , r O w r ^ r O O ! -r~ -~ w !r ~- a, s 4 .. c ~c r o ~ :~ m t'-1 o~N N~Q ~, -~ q -o rn~oG ,,, G ~' (AZr ~ ~ '0~ gmo~ w~qv -n O v m U~ C~ C~ ~ o-~ ~_ ~~ o ~ f~~- ~ THE SENTINEL P. 0. BOX 130 CARLISLE, PA 17013 LEGAL (717) 243-2611 Statement Date: 03/25/2010 Page 1 Type Ad-No Date Amt Due lass/Bal First-Words Ad 380213 02/23/10 230.02 10 EST TE NOTICE LETTERS TESTAMENTARY 230.02 ~~ G~oc~. J~ ~° '~ Message: Your account with The Sentinel is PAST DUE. Please make payment as soon as possible. Any questions call the classified dept at 240--7130. Current Over-15 Over-30 Over-60 Over-90 Over-120 Total Bal .00 230.02 .00 .00 .00 .00 230.02 PROOF OF PUBLICATION State of Pennsylvania, County of Cumberland Lames Kleinklaus, Director of Sales and Marketing, of The Sentinel, of the County and State aforesaid, being duly sworn, deposes and says that THE SENTINEL, a newspaper of general circulation in the Borough of Carlisle, County and State aforesaid, was established December 13,1881, since which date THE SENTINEL has been regularly issued in said County, and that the printed notice or publication attached hereto is exactly the same as was printed and published in the regular editions and issues of THE SENTINEL on the following day(s): February 9,16 and 23, 2010 COPY OF NOTICE OF PUBLICATION _ ESTATE N TI L"attars Te"st'amentary for the Estate of DELL H. GOtiSE, doceased, of Lower Allyn `township, Cumborland County, Pennsylvania, have been granted to thel~ndersigned. AIt persons indebted to the,Estate are requested to make immediate payment, and those having claims against the Estate afe requested to present them for settlement without delay to John H. Douse 1526 Pine Road Carlisle, PA 17015 Rebecca Sue Perry 823 Windy Hill Road Shermansdale, PA 17090 Paul Bradford Orr` 5b East High Street ` Carlisle, PA 17013 _ __ Affiant further deposes that he/she is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statement as to time, place and character of publication are true. ~4 Sworn to and subscribed before me this a5~ ~n~~ ~ ~.~~~~ Notary Public My commission expires: LNQTARIAL SEAL BAMB! ANN HECKENOORN Notary Pubtic CARLISLE 80ROUGH, CUMBERLAND CNTY My Commission Expires Jan 27, 2014 ~ REV-1512 EX+ (12-OS) r pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Dell H. Gouse 2009-01119 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~ ..:........-... _.,,..._..e ... .>.>. ~...,e+ ..... ....:. a,, e... ~ ,,., .....n .«. n,.....-.. aun+n«..-.w.».ro..ra.:..xa.rswv....vawx.,..:.w,.w.vnr.n~..... .-s.. ,.. x.-n.-,.........: . a~a~...:...:r x<. .n.u,...:.... ..~<.. ..,e..«.. .<..wr.~..-. xv..~ .Ohio Casualty i p.f ..... 398.00 2 ~ Verizon ~ _ 63.83 ~ .~.. 3 ' .. Slate from Chase 41.41 .. ~ .. M.. 4. ` Hampden Township Trash and Sewer 165.01 3 5. Pennsylvania American Water i 3G.20 6.' `Comcast Cable 201.36 - ~. 7. z ABC Fuel Oil Company, Inc. _ 300.93 .., _t~ ,, 8. ~ Boiler Repair 139.68 9. t Health South Special Services 150.00 _.. __._ ,:a:. .. ... ~ o. Holy Spirit Hospital 110.00 11.='; °Medical Supplies ? ~ 27.24 12. County and Township Taxes I 9.8G 13.~ Pinnacle Health Hospitals 250.00 7 4. PPL Electric 3 7 2. U6 15. .?Mortgage Liability (See HUD 1) 29,229.90 16. ~ Sale of Real Estate _ _~ _ __ __~ ._ 6t_ ,_ 622.87 3 4 a 3 .«... . ... ._. ... .... ...... .. ... .~. .. ~ 5 ~.; ,;.. ...:::~.[.t:11J..+~:,a ._~tii. it v~;IF" s < g 4 a, F . .. 4 I ' s .. P ~ ,. .. ..., ~Y .._.... ~, I ,••,• 9${#{g .. en. »-~~..:.u. ..urrn »:..~ru.e.,.....„nirrcmm.F.urw. «..war.ei ra ..r.:wrti..nr...b..v.<:v-au.u ...v~we>....., x....ie. TOTAL (Also enter on Line 10, Recapitulation) i 4. .... ~:.. µ...i .t.. .. . $ 38,218.29 If more space is needed, insert additional sheets of the same size. INSURED COPY ~~ .~ ~~ ~~ ~~ ~~ ~~ s .~,~ ~ ~~~ o ~~ o ~~ 0 N ~~~ °' --_ N A ~~ m x _ Ohio Casualt~M Member of Liberty Mutual Group CBC 08692 DHO-02624886 97•-CHR 12/23/09 9450 SEWARD ROAD FAIRFIELD, OHIO 45014-5456 INSURED: DHO 02624886 CBC DELL H GOUSE 5016 EBBS BRIDGE RD MECHANICSBURG PA 17050-2430 I~~~lil~~~ili~~~~i~l~li~~~~~l~l,l„I~~Ii~ll~~~~~~ll~ll~~~~~lll AGENT: 37-01-1600 ~ _-~ BLACK DAVIS & SHUE AGENCY INC Pt7 BOX 2747 HARRISBURG PA 17105-2747 i .. ____ 0 ~ ~..` o o 0 N r~ Of N ~~ A ~~ m i~ m ~~ W _._... INSURED COPY CBC 08692 DHO-02624886 97-CHR 12/23/09 The Ohio Casualty Insurance Company 9450 Seward Road, Fairfield, Ohio 45014-5456 POLICY NUMBER DHO 02624886 ST. TERR. AGENT 37-01-1600 INSURED: DHO 02624886 CBC DELL H GOUSE 5016 ERBS BRIDGE RD MECHANICSBURG PA 17050-2430 I~~~III~~~III~~~~I~I~II~~~~~I~I~I~~I~~II~II~~~~~~II~II~~~~~III AGENT PHONE NO. (717) 233-8461 BLACK DAVIS & SHUE AGENCY INC PO BOX 2747 HARRISBURG PA 17105-2747 12/28/09 BILLING iNO.UIRIES: 800-543-1953 Dear Customer: We appreciate the opportunity to provide insurance for your protection. As of the date above, we have not received your insurance premium payment. We are obligated to release a "~lotice of Cancellation" at this time but rr~alize that non payment may r;ot have been your intent. There is still time to avoid loss of coverage by sending the required paymen# to us. As long as we receive the payment before the cancellation date and time mentioned in the "Notice of Cancellation" attached, we will be pleased to reinstate your policy with no lapse in coverage. For coverage to be reinstated, your payment of $199.00 is due by 02/0112010 . In the event you have decided to discontinue coverage with our company, your coverage will cease on the date and time noted on the Notice of Cancellation. If you have questions or would like to confirm your payment history on this policy, you are encouraged to contact your Agent or the Customer Account Service Unit. Due to mailing time, payments sometimes "cross" in the mail. You are a valued customer and we thank you for choosing to place yolrr -~--~ •--'~~*^~ •~~~*h ~ ~~ Fold and Detach - INSURED COPY CBC 08692 DHO-02624886 97--CHR 12/23/09 NOTICE OF CANCELLATION PENNSYLVANIA LAW REQUIRES THAT YOU BE GIVEN A COPY OF THIS NOTICE. READ IT CAREFULLY. POLICY NUMBER ST. TERR. AGENT DHO 02624886 37-01-1600 .~_ .~. . ,~ 0 ---_ o ~.. 0 N ~~ N ~ A ~~ ~ ~~ W ~~ cn ~~ a ~~ ~~ ~~~ ~~ ~~ INSURED: DHO 02624886 CBC DELL H GOUSE 5016 EBBS BRIDGE RD MECHANICSBURG PA 17050-2430 I~~~III~~~III~~~~I~I~II~~~~~I~I~I~~I~~II~II~~~~~~II~II~~~~~III DATE OF NOTICE: 12/28/09 LOCATION: 5016 ERBS BRIDGE RD MECHANICSBURG PA 17050-2430 DHO 02624886 HOMEOWNER POLICY CANCELLATION WILL TAKE EFFECT AT 12:01 A.M. STANDARD TIME ON 02/01/10 REASON FOR CANCELLATION -NONPAYMENT OF PREMIUM AGENT PHONE NO. (717) 233-8461 BLACK DAVIS & SHUE AGENCY INC PO BOX 2747 HARRISBURG PA 17105-2747 YOU ARE HEREBY NOTIFIED IN ACCORDANCE WITH THE TERMS AND CONDITIONS OF THE ABOVE POLICY, THAT YOUR INSURANCE WILL CEASE AT THE HOUR AND ON THE DATE MENTIONED ABOVE. YOU HAVE, THEREFORE, 30 DAYS FROM THE DATE OF MAILING TO GET NEW COVERAGE IF YOU WANT TO DO SO. YOU ARE HEREBY ADVISED THAT THE AMOUNT OF PREMIUM DUE IS S 199.00 ON 12/ 17/09 PAYABLE TO YOUR AGENT OR OUR COMPANY AT THE ADDRESS SHOWN ABOVE. IF YOU HAVE ALREADY MADE PAYMENT OF PREMIUM DUE OR WILL MAKE PAYMENT PRIOR TO THE EFFECTIVE DATE OF THIS CANCELLATION, PLEASE CONTACT OUR COMPANY OR YOUR AGENT IMMEDIATELY. ~_~ ~/~~ 0 AUTHORIZED REPRESENTATIVE SEE REVERSE S1DE FOR IMPORTANT NOTICES The Ohio Casualty Insurance Company 9450 Seward Road, Fairfield, Ohio 45014-5456 oooa Page 1 of 2 OC 70 41 04 04 INSURED COPY CBC 08692 DHO-02624886 97-CHR 12/2:)/09 NOTICE OF CANCELLATION PENNSYLVANIA LAW REQUIRES THAT YOU BE GIVEN A COPY OF THIS NOTICE. READ IT CAREFULLY. POLICY NUMBER ST. TERR. AGENT DHO 02624886 37-01-1600 4 6 ~~ O ~~ 9 N i~ N ~ A ~ m ~ ~~ ~ - fD ~ i ~~ ~~ ~~ ~~ INSURED: DHO 02624886 CBC DELL H GOUSE 5016 EBBS BRIDGE RD MECHANICSBURG PA 17050-2430 DATE OF NOTICE: 12/28/09 LOCATION: 5016 ERBS BRIDGE RD MECHANICSBURG PA 17050-2430 DHO 02624886 HOMEOWNER POLICY CANCELLATION WILL TAKE EFFECT AT 12:01 A.M. STANDARD TIME ON 02/01/10 REASOIL' FOR CANCELLATION - NONPA~!MENT 01= PREIVIIUII/I AGENT PHONE N0. (717) 233-8461 BLACK DAVIS & SHUE AGENCY INC PO BOX 2747 HARRISBURG PA 17105-2.747 YOU ARE HEREBY NOTIFIED IN ACCORDANCE WITH THE TERMS AND CONDITIONS OF THE ABOVE POLICY, THAT YOUR INSURANCE WILL CEASE AT THE HOUR AND ON THE DATE MENTIONED ABOVE. YOU HAVE, THEREFORE, 30 DAYS FROM THE DATE OF MAILING TO GET NEW COVERAGE IF YOU WANT TO DO SO. YOU ARE HEREBY ADVISED THAT THE AMOUNT OF PREMIUM DUE IS $199.00 ON 12/ 17/09 PAYABLE TO YOUR AGENT OR OUR COMPANY AT THE ADDRESS SHOWN ABOVE. IF YOU HAVE ALREADY MADE PAYMENT OF PREMIUM DUE OR WILL MAKE PAYMENT PRIOR TO THE EFFECTIVE DATE OF THIS CANCELLATION, PLEASE CONTACT OUR COMPANY OR YOUR AGENT IMMEDIATELY. ~.._~ ~/.~.Il AUTHORIZED REPRESENTATIVE SEE REVERSE SIDE FOR IMPORTANT NOTICES The Ohio Casualty Insurance Company 9450 Seward Road, Fairfield, Ohio 45014-5456 0004 Page 1 of 2 OC 70 41 04 04 v ~~ D p ~~ u ~~ n ~~ V ~__ n ~~ ---- ~_ s ~,~ b ~~~ ~~. .= ~- ~_ ~_.s.. ..~ ACCOUNT NUMBER 850002624886 - 1110 9450 Seward Road, Fairfield, Ohio 45014 BILLING DATE ' ' www.ohiocasuaity-ins.com/services 02/2212010 Casualty,. Member of Liberty M1lutnal Gmup ~ Homeowners Insurance Bill ACCOUNT BALANCE $587.00 DUE DATE 03/18/2010 MINIMUM DUE $199.00 PAYOR AGENT AGENT'S PHONE N0. DOLL H GOUSE BLACK DAMS & SHUT AGENCY INC (717 233-8461 5016 ERBS BRIDGE RD PO BOX 2747 MECHANICSBURG PA 17050-2430 HARRISBURG PA 17105-2747 ~~~i~~~~~r~~~~~i~~~~~~~i~~~r~~~~~~i~~~~~~~~~i~~~i~~~~~i~~~~~~~ Dear Cusfomer, We appreciate the opportunity to service your insurance needs. You may pay the current payment due by the due date onto avoid further service charges you may pay the account balance in full at anytrme during this billing cycle. If you need assistance, contact your agent at the above number; or see the'Need Assistance?' section of your billing statement that follows. LAST PAYMENT RECEIVED __ ___ DATE AMOUNT o~/2s/zolo ;199.00 Account Detail for DELL H GOUSE ____ __-- ~ HOMEOWNERS 12/14/2009 - 12/14/2010 QUARTERLY INSTALLMENT S~a2.oo 5194.00 DHO 02624886 SERVICE CHARGE* * s. o o s. o 0 Total $587.00 $199.00 * *Service Charge is added for the installment payment plan. For goer Records: Amount Paid Date Paid Check No. COltttltllC[I OTt bQCk pllg8 i Manage Your Account Phone Number Account Number Billing Date ver~,~oin My Acca lnt at ve\~o-1.com/billview 717-761-2939 .717 761-2939 5.10.84Y ` 11/25/2009 Verizon News ick Bill Summary for D L GOUSE VZ Wireless & FiOS Togethe . Call 1-877-299-7271 by 12/31/09 to et $150 back, via prepaid card, when you n Previous Balance up for Verizon FiOS TV, Internet, & home Payments Received Nov 19 p one. d erizon fireless get a 4 svcs Balance Forward on ONE-BILL® starting ~ $134.99/mo. w/ term agents., saving you $14.99/mo. Subj. to avail. terms & taxes. Limited time offer. TV, Internet, Phone - $99.99 Get stunning TV, blazing fast Internet & unlimited Natl, calling for $99.99 per mo. for 1 yr. Experience FiOS 100% fiber optics straight to your home. Call 1-877-299-7269 today and get $150 back. Sign up by 1/16/10. Install by 3/16/10, w/1 yr. agent. Taxes, fees & terms apply. Get the Best of FiOS TV Call 1-877-299-7279 for a great value with the FiOS TV Essentials package. Only $47.99/mo w/1-yr. agrmt. Get Over 255 all-digital channels. Optional packages avail. with access to 115+ HD channels for addtn'I cost. It's the best value in entertainment. Subj. to aV2':lahllltl,.~ ~ reStriCtlOnS. Direct Payment Enrollment ~ Online Billing & Payment ~ Questions about your bill? ~verizon.comlbillpay ~ ~ ~ ^amlbillvew ~~ ~ verizon.com or 1-800-VERIZON (1800-837--4966) New Charges $23.69 -$23.69 $.00 Voice Services (See pg 3) $12.63 Taxes, Fees & Other Verizon Charges $8.80 Other Providers (See pg 4) $42.40 -- -- Total New Charges Due by December 22, 2009 $63.83 Total Amount Due by December 22, 2009 $63.83 CONSUMER ALERT! Check your bill this month for a new service provider. '~ ~-~ ° ~ Phone Number Aca~ ant INur~n~~~~l Date DuEr Page ~`~'",.~ Verb ~ 717-761 2939: 711761•-2939 51Q 84Y Dec 22, ~?OOt,~ 3 of 5 Questions'? Visit verizon.com or 1-800-VERIZON (1-800-837-4966) Breakdown of Charges Nov 25 -Dec 24 Voice Services Measured local Calling - Residt:nce 2.62 Sensible Minute 2.00 Dial Tone Line 7.87 Local Calls (see Call Detail) .00 Sensible Minute Play (see Call Detail) .14 Total Voice Services $12.63 Taxes, Fees & Other Verizorl Charges Voice Federal excise tax .50 PA Gross Raceipts Tax Surcharge .35 PA Relay Surcharge ,08 E911 1.25 State sales tax .01 Federal SuRascriber Line Charge 5.89 Federal Unwersal SE,rvice Fee .72 Total Taxes, Fees ~4 Other Verizon Charges __ _ $8.80 Call Derail Sensible t'"~linute Flan Date Time Place Number V1in_utes Amount Nov 22 1:~i9 PM MtliollySpg PA 777-486-3423 ,90 .14 Total Sensible Minute Plan 5.14 Local Calls Area Rate Calls Mirn tes Amount 01 D~~y 1 Untii 77ed .(17 NightM'ee~;end 1 Untii ied .(13 Allowance -. ~i 0 Total Local galls $,00 r ~~.,,.,,.,,, Phone Number ~i~e~~ 717-761-2939 Need-to-Know Information Account Nur~nhr~r Date Due Page 7177'61--2r339 ti10 84Y qec 22, 2008 5 of 5 Past Oue New Totals Credit Reporting Basic .o0 19 28 ___ 19.28 ____ _ This is a required legal notice. If you fail to pay your bill, Verizon may Non-Basic .00 44.55 44.55 submit a negative credit report to a credit reporting agency, which will Total .00 63.83 Ei3.83 negatively affect your credit report. Included on this por tion of your bill is approximately $1.19 f or PA taxes Important billing information on utilities When you provide a check, you authorize us either to use information from your check to make aone-time electronic fund transfer from your account or to process this transaction as a check. If you wish to be excluded from this process, please call 1-888-500-5358. When we use information from your check to make an electronic fund transfer, funds may be withdrawn from your account as soon as the same day we receive your payment, and you will not receive your check back from your financial institution. Closed Captioning Concerns or Complaints? If you are having a concern with closed captioning on a program you are currently watching, you may contact Verizon at 1-888-553-1555, via email at videoclosedcaption~e?verizon.com, or via facsimile at 1-888-806-7026. If you have a written closed captioning complaint, you may write to us at Verizon, P.O. Box 33052 821, 1st Ave N St. Petersburg, FL 33701 Aft: Valerie OeCastro, Manager, fax 1-888-806-7026, or via email at videoclosedcaption@verizon.com. Getting and Keeping Your Phone Service Connected Verizon PA offers four programs to help low-income Pennsylvania residence customers get or keep their telephone service. If you are a low-income residence customer, you may qualify for these programs. You can receive a credif on your regular rnonlhly bill for one telephone line at your primary residence up to $11.41 for Lifeline and up to $7.66 for Lifeline 135. With Lifeline 135 you can purchase optional services like Call Waiting. You may also purchase Verizon Local Package, Regional Essentials ar Verizon Freedom Essentials. Link Up America provides 50% off .your line connection charge. You can qualify for Lifeline if: No one claims you as a dependent on their Federal Income Tax unless you are 60 or older and you are in one of these programs: General Assistance, Supplemental Security Income, Temporary Assistance for Needy Families, or, your yearly income is at or below 100% of the Federal Poverty Guidelines. You can get Lifeline 135 if: No one claims you as a dependent on their Federal Income Tax unless you are 60 or older and you are in one of these programs: General Assistance, Supplemental Security Income, Temporary Assistance for Needy Families, Food Stamps, Low Income Home Energy Assistance, Medicaid, Federal Public Housing Assistance, Stafe Blind Pension, National Schools Free Lunch Program, or your yearly income is at or below 135% of Federal Poverty Guidelines. You can get Link Up A-nerica ii you qualify for Lifeline or Lifeline 135. UTAP can help you pay your basic telephone bill. You must be an existing or approved Lifeline customer to get UTAP funds. If you have Lifeline 135, you muss be approved for Lifeline to get UTAP funds. To apply, call your Verizon PA Business Office at 1-800-VERIZON. Restatement of Charges Regulations require Verizon to group your charges as shown below 10 make it clear which charges you must pay to avoid suspension of your local service. Basic includes charges for local calling, applicable tax and fees. Non-Basic charges include, but are not limited to, Caller ID, inside wire maintenance, regional and long-distance calling, Internet service, OIRECTV and applicable tax and fees. Non-payment of any past due basic charges could result in suspension of your basic local service after you receive a separate written statement. ~ M Statement Date: 11 /02/09 - 12/01 /09 ~ ~ Manage your account online: from CHASE ~ i ~ ~ www,ch~se.com/creditcards M inimum Payment: $10.00 P ayment Due Date: 12/26/09 Additional contact information ACCOUNT SUMMARY Account Number: 4366 1630 5127 5671 conveniently located on reverse side Previous Balance X139.91 Total Credit Line $20,200 Payment, Credits -$100.00 Available Credit $20,158 Finance Charges +$1.50 Cash Access Line ~A,040 New Balance $41.41 Available for Cash $4,040 ACCOUNT ACTIVITY Date of Transaction Merchant Name or Transaction Description Amount 11/17 ~ .Payment Thank You Electronic Chk -100.00 FINANCE CHARGES ____ Finance Charcge~ .Transaction Daily Periodic Rate Correst~. Average Daily Dire To Fee / Acc~.:mu!ated FINANCE Category 30 days in cycle APR Balance Periodic Rate Service Charge Fin ChargE: CHARGES Purchases V .03559°i° 12.99% $90.51 $1.50 $0.00 $0.00 $1.50 Cash advances V .05271 % 19.24% $0.00 $0.00 $0.00 $0.00 $a.oo Total finance charges $1.50 Effective Annual Percentage Rate (APR): 19.88% Please see Information About Your Account section for balance computation method, grace period, and other important information. The Corresponding APR is the rate of interest you pay when you carry a balance on any transaction category. The Effective APR represents your total finance charges -including transaction fees such as cash advance and balance transfer fees -expressed as a percentage. IMPORTANT NEWS Omaha Steaks exclusive offer to Chase Cardmembers! Save 52% on the Value Collection and get FREE SHIPPING, PLUS 6 FREE burgers! Cafl 1.800.960.8400, tell them you have a Chase card and ask for offer 45491 CDE or go to wwv<<.OmahaSteaks.com/statement. Stock up and SAVE, Order Now! 0000001 FIS33338 0 7 000 N Z 01 0912101 Page 1 of 3 06598 MA MA 78365 33510000070457836501 Y INS142351Ng139371NS13933 t~iGl UIUV 111r YV1i11Vi\ V'Y11t1 YAY1y11;1V l BILL INCLUDES JAN -MAR 2010 QTK SEWER AND/OR TRASH CHARGES. PAYMENT IS DUF, BY JAN.31, 2010 TN ORDER TO AVOID LATE CHARGES. DATE CONSUMPTION AMOUNT BALANCE FORWARD 10/01/2009 PAYMEN"f 10/] 3/2009 SEWER 0l /Ol /201 U ~TRASIi 0l /0l /2010 ADJ USZ'MENT PENALTY IN"fEREST DELL H GOUSE 5016 ERBS BRIDGE KD MECI~ANICSBURG PA 17050-2430 GROSS BALANCE: PAYABLE AI°I'EK 30 DAYS DIREC`T' WI'T'HDRAWAL AVAILABLE 138.65 -138.65 ~ ~ 105.75 , , ~ ~ r i 44.25 - f I ` !'~, 0.00 ! ~~ Imo...., 0.00 0.00 PROPERTY ADDRESS 5016 ERBS BRIDGE RD CN: 008174-000 LC: 10201844079A DUE DATL-; 01 /31 /10 AMOUNT DUB $ 150.00 AFTER DUI; DATE $16.01 RESIDENTIAL & COMMERCIAL PROPERTIES ARE REMINDED IF THEY HAVE A SANI'T'ARY SEWER BLOCKAGE OR BAC;K UP TO NOTIFY THE TOWNSHIP BEFORE CALLING A PLUMBER. CALL THE TOWNSHIP'S ROTH LANE TREATMENT PLANT AT 761-7963. s Customer Account Information Bfllin~ Summary For Service`To~ Gouse Dell --------Prior BalanceM4--------_.~~._. 5016 Erbs Bridge Rd Prior Water Balance Account Number: 24-0652639-8 ' Prior $alance Other Premise Number: 24-0385378 Payments prior to Nov 30, 2009. Thanks) Billing. Period &: Meter Information Billing Date:. Nov 30,.2009 Billing Period: C~ct 22 to Nov 20 (29 days) Next reading onlabout: Dec 23, 2009 Rate Type: Residential Meter readings in current billing period: Meter Number N0374302fi5 is a 5/8-inch meter. Present-actual 422100 Last-actual 421900 Gallons used 200 Water Usage Comparison Monthly usage in hundred gallons ,-- $14.87 $14.50 -29.37 .00 1.2.49 . 70 .76 -.O1 13.94 9.00 5.50 14.50 $28.44 Messages to you from Pennsylvania American Water Any portion of the water charges which is not paid as of 12/2&/09 will be subject to a 1.50 % penalty. ''Approximately 3.90 percent or $.54, of State taxes are included in your current bill. * Save time and money by signing up for Pennsylvania American Water's automatic payment program. Your bill will be paid directly from your checking or savings account. * Have you moved or changed your phone number? Please let us know, so that we can update our customer records. To update your information, call us toll-free, 24 hours a day at 800-565-7292. Effective October 1, 2009, the Distribufion System Improvement Charge (DSIC) increased from 4.6'8% to E.07%~. Customer Service & Emergencies 1-800-565-7292 {24 Hours) For Hearing Impaired Customers TDD 1-800-300-6202 {24 Hours) Visit us on the INTERNET: www.pennsyivaniaamwater.com Total prior balance, Nav 30, .2009 ----------Current Water Charges---------- Service Charge Water Volume. ($ 003500 x 200) Water Volume ($ 003800 x 200) STAS PAWC Water -0.15% Total Usage Billed o ----------Other Current Charges---------- Customer Protection Sewer Line Customer Protection Water Line Total other charges, Nov 30, 2009 ._.a-----AMOUNT DUE --------------------- i 003242/OO:i242 PCJZRH TAV01 123 RAW 100AM 1681AM211 I A t M 3569 Customer Account Information For Service To: Gouse Deli 5016 Erbs Bridge Rd Account Number: 24-0652639-8 Premise Number: 24-0385378 Billing Period & Meter Information Billing Date: Dec 29, 2009 Billing Period: Nov 20 to Dec 22 (32 days) Next reading on/about: Jan 26, 2010 Rate Type: Residential Meter readings in current billing period: Meter Number N037430265 is a 5/8-inch meter. Present-actual 423800 Last-actual 422100 Gallons used 1700 ,,~ ~~f~ ~~ r "" !~, Water Usage Comparison ~ Monthly usage in hundred gallons. :. +~ 'E E: ~. 2 0 0 8 Billing Summary ----_----Prior Balance----------------------- Prior Water Balance Prior Balance Qther Payments prior to Dec29, 2009. Thanks! Total prior balance, Dec 29, 2009 ----------Current Water Charges---------- Service Charge Water Volume ($.007890 x 1,700) Total Usage Billed o ----------Other Current Charges---------- Customer Protection Sewer Line Customer Protection Water Line Total other charges, Dec 29, 2009 1 ----------AMOUNT DUE --------------------- ~...~ s~ ~.: r r~ ^' w. ~ gip{ _ ~ ~>x rte'-'-• `i : ... 3 ~ r >. 4 : ~. , ~3 ~, '}ri r ~,S i ~'v } F =L' :Ji D J F M A M J J A S O N D 2 e a e a p a u u u e c o e 0 c n b r r y n f g p t v c 0 9 $13.94 $14.50 -28.44, .00 13.00 13.41 26.41 9.00 5.50 14.50 C $40.91 Messages to you from Pennsylvania American Water Any portion of the water charges which is not paid as of 1/25/10 will be subject to a 1.50% penalty. 'Approximately 3.90 percent or $1.02, of State taxes are included in your current bill. * Save time and money by signing up for Pennsylvania American Wafer's automatic payment prograrn. Your bill will be paid directly from your checking or savings account. '' Have you moved or changed your phone number? Please let us know, so that we can update our customer records. To update your information, call us toll-free, 24 hours a day at 800-565-7292. Take these simple steps to rotect yourself against utility imposters: Ask for proper identification. Check the service person's vehicle. All Pennsylvania American Water vehrcles have the company`s logo clearly displayed. If you are still unsure,don't hesitate to call us at 800-565-7292 to confirm service work is occurring in your area. * Have you winterized your home? For tips on how to protect your pipes and meters from freezing, visit us online at www, pennsyl vaniaamwater. com. Effective October 1, 2009, the Distribution System Improvement Charge (DSIC) increased from 4.68% to 6.07%. Customer Service & Emergencies 1-800-565-7292 (24 Hours} For Hearing Impaired Customers TDD 1-800-300-6202 (24 Hours} Visit us on the INTERNET: www.pennsylvaniaamwater.com 003940J003•~40 PCK6UD TAV02 123 RAW 100AM2101AM2381 A 1 M 1667 .Customer Account lnformation For Service To; Gouse Dell 5016 Erbs Bridge Rd Account Number: 24-0652639-8 Premise Number: 24-0385378 Billing Period & Meter lnformation Billing Date: Jan 28, 2010 Billing Period: Dec 22 to Jan 22 (31 days) Next reading on/about: Feb 23, 2010 Rate Type: Residential Meter readings in current billing period; Meter Number N037430265 is a 5/8-inch meter. Present-actual 424200 Last-actual 423800 Gallons use 400 .~ .. ~ E . ~r /r! ~ ~ Water Usage Comparison Monthly usage in hundred ~allons- ~~ ~. c 2 0 0 9 Billing Summary ----------Prior .Balance------------------------ Prior Water Balance Prior Balance Other Payments prior to Jan 28, 2010, Thanks! Total prior balance, Jan 28, 2010 ----------Current Water Charges---------- Service Charge Water Volume ($.007890 x 400) STAS PAWC Water 0.45/0 Total Usage Billed o ----------Other Current Charges---------- Customer Protection Sewer Line Customer Protection Water Line Late Payment Charge Totat other charges, Jan 28, 2010 ----------AMOUNT DUE --------------------- Y 'A .• ~a.y .NAS7~± •~W Y ~V "'1~ ~ :~, N "t•y .ail • ' F ]Ad " is ~,_: ~.. 1 ~`.; ~ t7 `.~:~i G= ~:. i~$.h. . )• vv ~~'S: y: .1 • .~ .rho 1 ?~ 1.. i ' J F M A M J J A S O N D J 2 a e a p a u u u e c o e a p n b r r y n l g p t v c n ~ 0 $26.41 $14.50 -40.91 .04 13.40 3.16 .07 16.23 9.00 5.50 .40 14.90 C $31.13 Messages fo you from Pennsylvania American Water Any portion of the water charges which is not paid as of 2/22/10 will be subject to a 1.50% penalty. '`Approximately 3.90 percent or $.63, of State taxes are included in your current bill. '` Residential customers, you can save time and manage your account when it is most-convenient for you. On My H2O Online, you can check your balance, pay your bill or even sign up for automatic bill payments. Sign up today at amwater.com/myh20. For rnore information, take a look at the informational insert included with this bill. * Got questions or looking for additional information about the July 2010 transition to chloramine? Visit PAChloraminefacts.coin or call our customer service center. Effective January 1, 2010, the State TaxAdjustrnent Surcharge (STAS) increased from 0% to 0.45i~. * ~ffactive ~ti'ovember i, 2009, the Distribution System Improvement Charge ("OSIC) was decreased to 0%. DS1C funds the replacement of water distribution facilities. * Pennsylvania American Water is now accepting applications for its Stream of Learning scholarship program. The deadline to apply is February 12. High school students interested in learning more can visit us online at www.pennsylvaniaamwater.com. Customer Service & Emergencies 1-800-5fi5-7292 (24 Hours) For Hearing impaired Customers TDD 1-800-300-6202 (24 Hours) Visit us on the INTERNET: wwHt.pennsytvaniaamwater.com RAW 100AM 1351AM t 781 003i89/0031A9 PCKDRH TAV01 123 AtM 1205:- i Customer. Account .Information Billing Summary For Service To: Gouse'Dell --Prior Balance---------------•------- 5016 Erbs Bridge Rd Prior Water Balance Account Number: 24-0652639-8 Prior Balance Other Premise Number`: 24-0385378 Payments prior to Feb 2&, 2010. Thanksl Total,prior balance, Feb 26, 2010 Billing. Period & Meter Information - - ---Current Water Charges---------- Billing Date: Feb 26, 2010 Service Charge Bitting Period: Jan 22 to Feb`23 (32 days) Wafer Volume {$.007890 x 1,000) Next reading on/about: Mar 23, 2010 STAB PAWC Water 0.45% Rate Type: Residential Total Usage Billed o ----------Other Current Charges---------- Meter readings in current billing period: Customer Protection Sewer Line Meter Number N037430265 is a 518-inch meter. Customer Protection Water Line " Present-estimate 42520Q fate Payment Charge Last-actual ` 424200 Tota( other charges, Feb 26, 2010 Gallons used 100.0 ---------AMOUNT DUE ---•----------------- l Water Usage Comparison , ,,,~ Monthly usage irrhundred gallons. a ~ > > ~ ~~ a ~ ~~ ' ;~ ~ I YJ 2 F M A M J J A S O' N d J F' 2 0 e a p a u u u e c o e a e 0 9 b r r y n I ~ P t ~ c n b o - $16.23 $14.90 -31.13 .00 13.00 7.89 .09 20.98 9.00 5.50 .24 14.74 C $35.7] ~=Estimate Messages to you from Pennsylvania American Water Any portion of the water charges which is not paid as of 3/23/10 will be subject to a 1.50% penalty. * Approximately 3.90 percent or $.81, of State taxes are included in your current bill. * Got questions or looking for additional information about the July 2010 transition to chloramine? Visit PAChloraminefacts.com or call our customer service center. * Effective January 1, 2010, the State Tax Adjustment Surcharge (STAB) increased from 0% to 0.45°i~. x Effective November 1, 2009, the Distribution System Improvement Charge (DSICJ was decreased to D%. DSIC funds the replacement of water distribution facilities. * IMPORTANT INFORMATION ABOUT YOUR DRINKING WATER --Availability of Monitoring Data for Unregulated Contaminants for the Greater Mechanicsburg System (PWS ID: PA7210029}: Our wafer system has sampled for a s~ unregulated contaminants. Unregulated contaminants are those that don't yet have a drinking water standard set by U. S. Environmental Protection Agency (EPA). The purpose of monitoring far these contaminants is to help EPA deci~ whether the contaminants should have a standard. As our customers, you have a right to know that this data is avail If you are interested in learning more about this required testing, please contact Water Quality Supervisor Jon Prawa at (717) 774-1404. Monitonng conducted during 2009 did not detect the presence of any of the unregulated compour Far Hearing Impaired Customers TDD -~ -800-304-6202 (24 Hours) Visit us on the INTERNET: www.pennsylvaniaamwatei-.corn RAW 10QAM 1351AM2581AM211 t Customer Service & Emergencies 1-800-565-7292 {24 Hours} UU1 b381UU 15d81'GKLJ7 I AV04 1234 AIM 24~ft a ~cdmcast. Account Number Billing Date Total Amount Due Payment Due by Contact us: ~~ www.comcast.com 1-800-COMCAST LA GOUSE For service at: 5016 ERBS BRIDGE RD MECHANICSBURG PA 17050-2430 News from Comcast Thank you for your prompt payment. For your convenience, we now accept regular and automatic monthly credit card payments and direct debit. Late Fee Change Effective January 10, 2010, the Late Payment Administration charge will be increased from $6.95 to $7.95, excluding applicable taxes and fees. o~~o ~ , ~+ 4d# k; `'k. ~^' Comcast Cable Television 92.95 Taxes, Surcharges & Fees 7.73 ; Total New Charges $100.68 M ~~~~c3 C 09547 198084-01-8 11 /14109 $100.6$ 12/07/09 Page 1 of 2 N O O~ 0 • • Comcasto Contact uS: d wwH,.comcast.com 717-5~4~0-8900 Account Number Billing Date Unpaid Balance New Charges Total Amount Due 09547198084-01-8 12/14/09 $100.68 -Due Now $100.68 -Due 01/07/10 $2o1.3s Page 1 of 2 LA GGUSE , . 1oo.ga Previous Balance For service at: Payments -received by 12/14!09 0.00 5016 ERB5 BRIDGE RD Unpaid Balance -Due Now 100.68 MECHANICSBURG PA 17050-2430 New Charges - :Due by01/07110 100,68 NeWS ff011"1 ~QmC~St see below for move.Infarmation Our records indicate your account is past due. If your Total Amount Due $201.36 account is not paid in the next seven (7) days, a $6.95 late fee will be assessed. if payment has already been made, please disregard this notice. ~_ u F .: .~ y#y{ A ' ~~ Comcast Cable Television .92.95 T ~ r ', Taxes, Surcharges & Fees 7.73. o Total New Charges $100.68 --~L '~ ~ .,~ ~ ,~ m ~. 4' D TE r ~ ~// ~. ' ~~ .. ~~ ~~ r ~ '--1~~7Cn~~ ~ ° ~ ~' ~ ~ FUEL OIL COMPANY INC. ~ ~ 4 ~~ ~ ~ ?:~R,~ t ~ ,~~,, ~ CA ~ ~ ~.•-•~ 25 N. LOCKWILLOW AVE., HARRISBURG, PA 17112 ~ ~. ~ ~ ~ HARRISBURG: (717) 545-4758 • YORK: (717) 843-3897 • LEWISBERRY: (717) 938-1.411 k ~ ~ ~ ~ -' Q ~- .. ~' FAX: (717) 545-4750 ~ • '~ ~. o n ~? ~ ~~ ' abcfueloil@comcast.net • www.ABCFUELOIL.com ~ ~ m -nC n DELIVER T0: TO: SOLD ~ 1 rF t '} y r ° ~ '•. 7 ~ 11l11111l1l11111111111111111//111111111111111~11~~~ ~.«, 11~. ~a1/ ~~!l.11 col ~1 ,~~1~1'11~1~~~~!"1~~~ `-"` 111~11~~111~~~1, 1/ ~11i1~1~1`• i111i /i 011111111111/ ''.'~.' /11111111111, .. /~~.~.«5~:~~~.x«.1111/111111111111111111/0 /111111111/111~~11111111111111111/1000000000000000000000000 ~~~11111111010000100/0100111111/0001000000000000000000001000 `! - ( )FULL ( )NOT FULL GALLONS PRODUCT ~ ~. _i. a r y~•~ ~ ~ `, t~as~, F~ ,i4..F i.. 'a,"Y:' ~s't` F.`ie~°S`,F. ~ ~~:` ~.`''411P :d.' 4j.. , . ,. ~ ~'~. ... . 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S • cp ~, fD O ~ N A -~;; 1 ~ • O ~ CD A r n ~ p ~ ~ °: in' ~ ~ ~ ~'*, rt ~ 0 ~ O ~ O X C~ ~ O ~ ~ ~ ~ ~ a m v + O ~ ~ ~ ~ ~" ~ V r-r 3 ~ `° o ~ ~ C p O ~ C1 O O', ~ p O < n N O ~ o ~D ~, m Q ' 3 O ~ a a ~ ~ c ' v n Q ~ ~ ~ fD -` ~ O ~ ~ ~ ~ y ~ e ^~"'~ ~ ~ n ,,,* rn cv ~ r~-r O n ~ ~ ne y 3 ~ ~ , ~D a 3 ~ O ~. A ~ m ~ ~ ~ ~ ~ ~ c ~ _ '; ~'. ~ vii ~ r-r fD to ~ ~ r~-t ~ i ~ ~ ~ ~^ Q A O d ~! ~~}}-~~ :~ ~~s ~ = ci:. T Z V W (D ~ y ~ L~ C~. ~' t .- `"° C X Q 3 ~ ' s` ~.,; " m ~ can ~ : sv ' ~` ~ a- ~ ,,,,, D ~ ~.>. ~' z_ ~. O ta~-' ~M Y ~ }, ' i' / i>+ \ ~. ~ ~. ~~~~ ~ _ ~ , ~ ~ =, ',~~ ~ ~~' 1 II aLY H SPITAL The Spirit o f CarirO For Account Informa~i ~ fir. tS Y, < aU- } i''N to ~~ 1 Transaction Date 11/05/09 11/05/09 11/05/09 11/16/09 11/16/09 Holy Spirit Hospital r. 503 N 21ST STREET ~ ~~USE ~~LL, H CAMP HILL PA 17011 etuic~ ~!~~ 11ID5109 # Servire~~~~: _,: 717-763-2138 ~.~ss~ ~r~+~t~# Date. ~1AASw~i~r1?1yy~4Qlyd/~y/0~~ -~ i~+lrsn 4~ ~ ~•YR MVI M~: lease Call 717-763-2138 z.:. Description PREVIOUS BALANCE CT PELVIS W CONTRAST CT ABDOMEN W CONTRAST CT ABD PEL W C CMBO ADVANTRA HMO PYMT Q49 ADVANTR/HEALT ADVANTRA HMO C/A Q49 ADVANTR/HEALT ~ Estimated Insurance Due: .00 Total Patent Cteditsc YOUR INSURANCE HAS BEEN BILLED.THIS IS YOUR CURRENT BALANCE. YOUR PAYMENT IS DUE UPON RECEIPT. THANK YOU. Q49 ADVANTR/HEALT .00 r N PLEASE DISREGARD THIS STATEMENT IF YOU HAVE PAID. . ~ ~~ ~~ Amount .00 2,834.00 2,737.00 .00 -493.13 -4,967.87 Account Balance: 110.00 your L DATE OF TRANSACTION SERVICE DATE QTY 07/21 /2009 3 2 08/12/2009 10!13/2009 10/13/2009 11 /14/2009 YOUR MEDICAL SUPPLY ~s.~.~. SUPPLIES & TRANSACTIONS 1727364 WAFER PRECUT 5/8" CONVEX 2PC 1727364 POUCH UR 1-1/2" 2PC TRANSPARE COPAY Contractual Adjustment COVENTRY HEALTHCARE Payment Patient Payment DEBITS, ~ PAYMENTS & TRANSFERS ADJUSTMENTS BALANCE 295.80 143.20 439.00 6.86 439.00 234.20 163.84 13.72 27.24 :.\ t-~ CURRENT OVER 30 DAYS ~ OVER 60 DAYS ~ OVER 90 DAYS OVER 120 DAYS Patient Responsibility $0.00 $0.00 ~ $27.24 $0.00 $0.00 STATEMENT DATE PATIENT NAME ACCOUNT NUMBER PLEASE PAY ~ - 12/03/2009 DELL GOUSE 324980 THIS AMOUNT $27.24 DUE UPON RECEIPT IF YOUR ADDRESS HAS CHANGED OR IF YOU HAVE ADDITIONAL INSiJRANCE INFORMP,TlON, PLEASE COMPLETE THE I;EVERSE SIDE. FOR BELLING INQUIRIES, CONTACT 888-240-7700. IMPORTANT MESSAGE REGARDING YOUR ACCOUNT Thank you for your recent payment. PAGE 1 OF .~2~soo • Payable To: MICHAEL LANGAN, TREASURER 230 SOUTH SPORTING HILL ROAD MECHANICSBURG, PA 17050 Phone: (717) 737-4822 $1.00 FEE FOR ADDITIONAL RECEIPTS Tax Payer: DELL GOOSE 5016 ERGS BRIDGE RD MECHANICSBURG, PA 17050-2430 Office Hours: MARCH-APRIL: M, T, TH 9-4:30 AND THURS Bill No: 6021 6-8PM; MAY-JUNE M, T, TH 9-4:30 Bill Date: 3/1/10 CLOSED WED, FRI 8 HOLIDAYS Control No: 10-008698 PHONE (717) 737-4822 OCC COUNTY OF CUMBERLAND Discount Face Penalty COUNTY PC $4.90 $5.00 $5.50 TWP OF HAMPDEN MUN PC $4.90 915.00 $5.50 MUN OCC $0.00 $0.00 $0.00 TAX AMOUNT DUE if Date Of Payment Is On $9.80 3/1/10 thru 4/30/10 $10.00 5/1/10 thru 6130110 $11.00 7/1/10 or Later •~ - ~ ~~ • TAXPAYER'S COPY -KEEP THIS PORTION FOR YOUR RECORDS MICHAEL LANGAN, TREASURER 230 SOUTH SPORTING HILL ROAD MECHANICSBURG, PA 17050 RETURN SERVICE REQUESTED OFFICIAL COUNTY MUNICIPAL TAX BILL DELL GOOSE w 5016 ERGS BRIDGE RD N~ MECHANICSBURG, PA 1705D-2430 87110 - 37235 87110-P-37235 J DELL H GOUSE 5016 ERBS BRIDGE RD MECHANICSBURG PA 17050-2430 d~ Pl NNACLE HEALTH HOSPITALS YOUR ACCOUNT IS PAST DUE. PLEASE CALL OR PAY IMMEDIATELY. For Account Information, ~"~' Please Call Jane (717)230-3419 or 1-800-603-6064 for Out of Area Calls. If payment has been sent, please disregard. 0 o, •~' ~~~ Patient Name: Gouse ,Dell Statement Date: Service Date(s): Account Nunnber: Primary Diagnosis Code: Ins. 1: ADVANTRA FREE Ins. 2: MEDICARE A Ins. 3: Ins. 4: 12131 /09 09/21109-10/09/09 10079789 1 fi2.5 .oo a~`' .oo ,~~~~~6 ~~ Total Charges: $~86, 588.90 Payments/Adjustments: X86, 338.90- Account Balance: S 250.0 0 Patient Balance: ~25Q . 00 Please Pay This Amt; $250.00 For questions, call our Billing Help line at: 717-230-3717 for local calls or 1-800-603-6064 for Out of Area. Customer Service Hours: Mon-Wed-Fri 7:00 AM to 4:00 PM Tues-Thurs 7:00 AM to 6:00 PM Please Note: Your physician wi11 bill separately for professional services. 1 PPL Electric Utl~ltle5 Electric Service For: DELL GOUSE 5016 ERBS BRIDGE RD MECIiANIC5BURG PA 17050 Questions about this bill? Please contact us by Dec 28 at 1-800-342-5775 (1-800-DIAL-PPL) or write to• Customer Service 827 Hausman Rd. Allentown, PA 18]04-9392 www.pplelectric_com Electric Use This graph shoves your electric use over the last 13 months. Types of Meter Readings: Actual . Adjustcxl Estimated Customer ,~, ~ t ~ d ~ • sss i +•~o~ ^ as.+P~ , i ~--_ pp ^sd- :®~~ .,~e 9 ` `TM Summary Page Balance as of D ec 4, 2009 Page 1 86840-84015 -:: aa:~rakl:.. ~:> $0.00 Char es: Tota~PL ELECTRIC UTILITIES Charges $51.45 Total Charges $51.45 -: Account B ance $51.45 1 V ~ K1~1] -Average Per I)ay 24 20 1G 12 8 4 0 Meter Reading Information Meter #46482461 ____ Dec 4 Actual 34450 Nov 4 Actual _ 34120 30 Da s KWH Billed 330 A~-erage -Dec 2008 2009 Tempperature 42F' 47F KWH Per Day 1 ~ 11 Yearly Use: Total Average Use Monthly Jan 2008 -Dec 2008 543 ] 453 Jan 2009 -Dec 2009 481 ] 401 Other important information on 6~ack ~ D J FNIAMJ J A S C)ND 2UU$ Nlonilis 2vG> 1 PPL Electric Utilities Electric Service For: DELL GOUSE 5016 ERB5 BRIDGE R.D MECHANICSBURG PA 17050 Questions about this bill? Please contact us by Jan 27 at 1-800-342-5775 (1-800-DIAL-PPL) or write to: Customer Service 827 Hausman Rd. Allentown, PA 18104-9392 www_pplelectric_com Electric Use "I~his graph shows your electric use over the last 13 months. Tyypes of Meter Readings: Actual Adjusted Estimated Customer ,~, ~ ~ ~ . ~~~~i , .®__ •r~I .;., pp 'e"~ . ;~ Pagel 7~~,~ .: _.~dtlff $il~}~CGpt3~~~1~~1ff1~' 86840-84015 .: Summary Page Balance as of Jan 6, 2010 $0.00 Char es: Tota~PL ELECTRIC UTILITIES Charges $34.63 Total Charges $34.63 Account Balance 1 l ~,~~ ~ 5a~ KWH -Average Per Day 24 20 16 12 8 4 0 $34.63 Meter Reading Information Meter #46482461 Jan 6 Actual 34755 Dec 4 Actual 34450 33 Da s K'Wtt I3illcd _ 305 Average -Jan 2009 2010 Temperature 34F 31 F KWH Per Day 16 9 Yearly Use: Total Averagge Use Monthl}~ Feb 2008 -Tan 2009 54:17 45l Feb 2009 -Jan 2010 4568 381 Other important information on back ~ JFMAMJJASONDJ 2009 Months 2010 PPL Electric Utllltle5 Electric Service For: DELL DOUSE 5016 ERB5 BRIDGE RD MECHANICSBURG PA 17050 Questions about this bill? Please contact us b Feb 25 at 1-800-342-5775 (1-500-DIAL-PPL) . or write to: Customer Service 827 Hausman Rd. Allentown, PA 18104-9392 ~'~"'~'- pPI el ec tric. core Electric Use This graph shows your electric use over the last 13 months. Types of Meter Readings: Actual . Adjustc~cl rsti~nated Customer ~~, s ~ ~ . ~ ^ • ~.- ..-- ~~` ~~ pp ,` TM Summary Page Page 1 .~'"r,~-r Bill ~1~~~ 86840-84015 t7~e'~e~cal)' Balance as of Feb 4, 2010 $(1.00 Charges: Total-PPL ELECTRIC UTILITIES Charges $30.34 Total Charges $30.34 .... ~bn~_ ~l~#~i~ Via; ~~te~, ~~~a, ~ ~ ~[~ ..:.....::.... . .. . ... . ... (~3:, Account Balance $30.34 Y 2,Z~ ~J C~ KVdH -Average Per Day 24 20 16 12 8 4 0 Meter Reading Infarmatic~~^ Meter #4G4824G1 Feb 4 Actual 34975 Jan 6 Actual __ 34755 29 Da s K~'I~ Billed 220 Average -Feb 200!) 2010 Te~mpperature 251 ~ 31 F KWH Per Day 15 8 Yearly Use: 'Total Avers e Use Month~y Mar 2008 -Feb 2009 5381 44$ Mar 2009 -Feb 2010 4362 364 Other important information on sack ~ FMAMJ T A S ()Nl~ J P 2009 Iv1on~Iis 2u i ii 4 ~ ~ '`.'.~%~o°: ~ Page 1 ... ~~]if ~$i~~ }~Giblltit :~lfftl~3CT .. ~.. ... s.-- PPL Electric p p .;=.;` 86840-54015 -: ...:: Utilities ~' ~" :.. ~;r~~a~iY qr~i~ Electric Summary Page Service Balance as of Apr 7, 2010 X32.77 For: Char es: DELL GOUSE Tota~PL ELECTRIC UTILITIES Charges $37.68 5016 ERBS BRIDGE RD MECHAIVICSBURG PA 17050 Total Charges $70.45 :: Account Balance $70.45 Questions about this bill? Please contact us by Apr 28 at 1-800-342-5775 (1-800-DIAL-PPL) or write to: Customer Service 827 Hausman Rd. Allentown, PA 18104-9392 www.pplelectric.com E- lectric Use This graph shows your electric use over the last 13 months_ Types of 1Vleter Readings: Actual - Adjusted >slimatcd Customer 24 20 16 12 8 4 0 KWH -Average Per Day Meter Reading Information Meter #464$2461 Appr 7 Actual 35488 Max 8 Actual _ 35214 30 Da s KWH Billed 274 Average -Apr 2005- 2010 Tent erature 44F 51 F K~v> Per D ~y 1 _S 9 Yearl~~ Use: 'Total Average Use Monthly May 2008 -Apr 2009 5397 450 May 2009 -Apr 2010 3992 333 t~nn nn ~~~k •~ A M J J A 5 0 N D J F M A 2009 Mot~tl-s 207 0 1 PPL Electric Utilities Electric Service For: DELL GOUSE SD16 ERBS BRIDGE RD MECHANICSBURG PA 17050 Questions about this bill? Please contact us by Nov 24 at 1-800-342-5775 (1-800-DIAL-PPL) or write to: Customer Service 827 Hausman Rd. Allentown, PA 18104-9392 www.ppleiectric.com Electric Ilse This gaph shows yoiu electric use over the last 13 months. Types of Meter Readings: Actual - Adjusted Estimated Customer ~~ } ~ Yr Page 1 . _Ycivr Bbl :~ni ~u~-frex 86840-84015 ,~, Summary Page Balance as of Nov 3, 2010 $165.08 Char es: Tota~PL Electric Utilities Charges $20.11 Total Charges $185.19 .:'~~~. ~-~~~ ~: ~~t~~: ?~~a~ Gov; ~~, ~U.~.#~ .:...... ..: ~.~5~~.: Account Balance $185.19 24 20 16 12 8 4 0 KWH -Average Per llay N D 7 F MANI 2009 Monde Meter Reading Information Meter #46482461 J J A S G N s 2010 Other important iaformation on back ~ Nov 3 Actual 36777 Oct S Actual 36646 _ 29 Da s KWH Billed 131 Average -Nov 2009 2010 Temperature KWH P D 52F 54F er ay 9 5 Yearly Use: Total Average Use Moathly Dec 2008 -Nov 2009 4946 412 Dac 2009 - No~c~ 2010 2657 22I Page 3 ..<. Yam Bid _,~c~tn~:I'3~#>x ... ~_ ... PPL Electric p p 86840-84015 Utilities ... ~~.,~~~~ _ .~~~~~ ; ~._ . Electric Total from Last Bill ~Y65.0$ Service Billing Details For: DELL GOU5E Amount You Still Owe as of Nov 3, 2010 $165.08 5016 EBBS BRIDGE RD MECHANIC5BURG PA 17050 Current Charges Charges for -PPL Electric Utilities Residential Rate: RS for Oct 5 -Nov 3 PPL Electric Utilities Distribution Charge: Customer Service man Rd 827 H Customer Char e . 8.44 81 3 . aus 0600000¢ per KWH 131 KWH at 2 . Allentown, PA PA Tax Adj Surcharge at 0.10300000% 0.01 18104-9392 800-342-5775 1 Transmission Charge: 41 0 - 131 KWH at 0.31600000¢ per KWH . 1-800-DIAL-PPL) ~ Transition Charge: www.pplelectric.com 131 KWH at -0.66800000¢ per KWH -0.88 Generation Chargge: d Ener Capacity; an 131 I~WH at 10:13300000¢ per KWH 13.27 Total PPL Electric Utilities Charges $25.06 Other Charges for PPL Electric Utilities e ment Char t Pa L 91 1 g y e a Late Payment Charge . 0.06 Phase-In Option Credit -6.92 Total of Other Charges $--4.95 :'~lti~ Am~-ua#- n Late Thal ~~v ~4,~ a~ 4 .::......::.....::.... ~~.~~~~.; Account Balance $185.19 General Your account is overdue. If you do not pa in full or call our office to a ent in 10 days your electncity maybe shut off. Call us arran e Information p g weekdays Sam to Spm at 1-ADO-358-6623. Next meter The $165.08 balance includes $4.85 in prior late payment charges. readingg on or about Generation prices and. char es are set by the.electric generation supplier ates distribution M Cominlssion regg Pubic Utilit Th h h Dec 3 ~ -- y e ave c osen. you pprices and services. The federal Energy RegulatoryZ'ommission regulates i d i ces. serv ces an {ransmission pr PPL Electric Utilities uses about $0.90 of this bill to ppay state; taxes. Ia ts Tax s the PA GrossRecei a t $11 f thi bill 33 dditi b . p y p . o s on, a ou a For your convenience, you can now pay your bill using your Visa, MasterCard, Discover, or ATM Card. Call BillMatrix at 1-8'00-672-2413. BillMatrix will charge your credit and ATM card a service fire for making this payment. Before diggin around your home or property, you should always call the state's One Call notification system to locate any underground. utility lines. You can do this by simply dialing 811, which will connect you to the One u di ll 81I b f t f d ll B C g. ore yo e e an ca e sa a em. sys With pa~perless billing, you can receive and pay your PPL Electric Utilities l T d earn o secure. bills onrine. The process is free, quick, convenient an more or sign up, visit www.pplelectnc.com. Save postage and late charges -sign up for Automated Bill Payment. OMB NO.2502-0265 -j'~~- ~~'~ 8. TYPE OF LOAN: i DEPARTMENT OF HOUSING 8 URBAN DEVELOPMENT U 1.QFNA 2.[]FmI1A 3.[]CONV. UNINS. 4.QVA 5.[]CON~. INS. r SETTLEMENT STATEMENT 6. FILE NUMBER: 1a57s T. LOAN NUMBER: 8. MORTGAGE INS CASE NUMBER: C. NOTE: 7hls loan is furnished to give you a statement of actual settlement costs. Amounts paid fo and by the settlement agent are shown. Items marked (POCJ" were paid outside the closing; they are shown here lorinlormalionalputposes and are not included in the totals. 1.0 3/98 (JOMES,ALLEN.PF0110-568) D. NAME AND ADDRESS OF BUYER: Allen R. Jofnes 5016 Erbs Bridge Road Mechanicsburg, PA 17050 E. NAME AND ADDRESS OF SELLER: Estate of Dell H. Gouse F. NAME AND ADDRESS OF LENDER: G. PROPERTY LOCATION: 5016 Erbs Bridge Road Mechanicsburg, PA 17050 H. SETTLEMENT AGENT: 68-0510988 Community Land Transfer, LLC I. SETTLEMENT GATE: November 12 2010 Cumberland County, Pennsylvania PLACE OF SETTLEMENT 2331 Market Street Camp Hill, PA 17011 , J. SUMMARY OF BUYER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BUYER: 400. GROSS AMOUNT DUE TO SELLER: 101. Contract Sales Price 65,000.00 401. Contract Sales Price 65 000 00 102. Personal Pro ert 402. Personal Pro ert , . 103. Settlement Char es to Bu er Line 1400 1,590.88 -403. 104. 404. 105. 405. Ad'ustments For /terns Paid 8 Seller in advance Ad'ustments For !tams Paid B Seller in advance 106. C /Town Taxes to 408. C" /town Taxes to 107. Coun Taxes 11/12/10 to 01!01/11 43.53 407. Coun Taxes 11H2110 to 01101/11 43.53 108. School Taxes 11/12/10 to 07/01ii 1 709.58 408. School Taxes 11/12/10 to 07!01!11 709.58 109. 409. 110. Sewer 4th Qtr. 11/12/10 to 01/01/11 81.52 410. Sewer 4th Qtr. 11/12/10 to 01/01/11 81.52 111. 411.. 112. 412. 720. GROSS AMOUNT DUE FROM BUYER 67,425.51 200: AMOUNTS PAID BY OR IN BEHALF OF BUYER: 420. GROSS AMOUNT DUE TO SELLER 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 65,834.63 201. De osit or earnest move 1,000.00 501. Excess De osit See Instructions 202. Princi al Amount of New Loan s} 203. Existin loans taken sub'ecl to _, 502. Settlement Char es to Seller Line 1400 503. Existin loan s) taken sub•ecl to 6,622.87 204. 504. Payoff of first Mortgage to Goldbeck McCalfert 8 29 229 90 205• , y 505. Pa off of second Mort a is , . 206. 506. 207. __________ ____.___~ _~ _ _ ~ 507. (Deposit disb, as proceeds) 208. 508. _ 209. 509. ~ _"-`--, Ad'ustments For Items Un aid 8 Setter 210. Gi /Town Taxes to Ad'ustments For Items Un aid B Seller 510. Ci !Town Taxes t 211. Count Taxes to o 511. Coun Taxes to 212. School Taxes to 5i2. School Taxes to 213. «~---- 513. 214. _ 514. 215. 515. 216. 516. 217• 218• 219. 517. Escrow Inheritance Taxes to Communi Land Transfe 518.: Sewer to Ham eri Townshl 519. 2,430.00 515.27 220. TOTAL PAID BY/FOR BUYER 1,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 38,798.04 300. CASH AT SETTLEMENT FROM/TO BUYER: 600. CASH AT SETTLEMENT TO/FR 301. Gross Amoun( Due From tau er Line 12~ 302. Less Amount Paid By/For Buyer (Line 220) 67,425.51 ( 1,000.00) OM SELLER: 601. Gross Amount Due To Seller Line 42~^_ 602. Less Reductions Due Seller (Li 520 .65,834.63 3~3. CASN (X FROM) ( 70) BUYER 66,425.51 ne ) 603. CASH (X TO) ( FROM) SEDER ( 38,798.04 27,036.59 t rte unaerstgnea nere~y acknowledge receipt of a completed copy of pages 182 of this statement & any attachments referred to herein. Buyer , ~~,b Alle R. Jofnes Seller Estate of Dell N/Go~us~e ..-- L.•~ ,-- L. SETTLEMENT CHARGES . 700.TOTAL OMMISSION Based on Price $ % 4 195.00 PAID FROM PAIOFROId fAvision of Commission I%n6 QUO 8S FOIIOWS: BUYER'S SELLER'S 7 . S 4,195.00 to THE HOMESTEAD GROUP, INC. FlAJOS AT FUNDS AT 702. S t0 SETTLEMENT SETTLEMENT 703. Commission Paid at Settlement 4,195.t>0 704. Buyer Commission to The Homestead Group, Inc. 295.00 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori ination Fee °,6; to 602. Loan Discount °~ to 803. Appraisal Fee to 804. Credit Report to 805. Lenders Inspection Fee to 806. Mort a e Ins. A .Fee to 807. Assumption Fee to 808. ' 809. 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to @ $ lday ( days %) 902. MIP Totlns. for LifeOtLoan for months. to 903. Hazard Insurance Premium for 1.0 ears to 904.. 905. .1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard insurance months $ er month 1002. Mort a e Insurance months $ er month 1003. Cit /Town Taxes months $ er month 1004. Count Taxes months $ er month 1005. School Taxes months @ $ per month 1008. months S er month 1007, months i per month 1008. months S r month 1100. TITLE CHARGES 1 i01: Settlement or Closin Fee to 1102. Abstract or Title Search to 1103. Title Examination to 1104. Title Insurance Binder to 1105. Electronic Document Pre to 1106. Closin Service Letter to 1107. Attorney's Fees to includes above ifem numbers: 1108. Title Insurance to COMMUNITY LAND TRANSFER Reissue 583.88 includes above item numbers.1102, 1103 8 1104 ' 1109. Lender's Coverage $ 1110.Owners Coverage $ 65,D00.00 583.88 1111. Endorsements 100, 300, 8,1 1112. Notary Fee Community Land Transfer _ to Community Land Transfer 1113. Notary Fee 5.00 _ 1114. Overnight Fees & Handling !o Community Land Transfer, LLC 15.00 1115. 1116. Deed Prep. to Paul Bradford Orr law Offices 175.00 1117. 1118. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed ~ 62.00; Mortgage 5 Releases g 62.00 1202. Cit 1Coun TaxlStam s: Deed 650.00• Mort a e 650.00 1203. State 7ax/Stam s: Deed - 650.00; Mort a e 650.00 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Surve to 1302. Pest Ins ection to 1303. 2010 County/Township Taxes_ _____ to Michae! Lan an, Treas. 10-20-1844-079A 349.55 1304. 2010/11 School Taxes to Michael Lan an, Treas. 10-20-1844-079A 1,233.32 1305. 1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K) 1.590.88 6,622.87 ny sigrong page i or ws statement, vie srgnatones actutowieoge receipt or a comptetea copy or page [ or vtrs two page statement. Certified to be a true copy. Community Lan ransfer, LLC Settlement Ag t t ~as~e r +o-see r e i +~' REV-1513 EX+ (Oi-10) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE BENEFICIARIES ESTATE OF: FILE NUMBER: Dell H. Gouse 20C-9-01119 REL-ATIONSHIP 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 1. .. _ __ ~ 2. ~.:~~.ra...,r; } _i s 4 II 1. 1. E s t .~. _.~___. _._. __._~.._ . v_ ~ . _.___.. ___,...._ _._..___~__.~_~.__~._~__ .._.._ _._.____._ _....__.._ ~r._~___. ~.~...___n___. ___~.~ „~_ 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.