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f 1505610148 J REV-1500 ex (°'-'°' PA De artment d` Revenue OFFICIAL USE ONLY p County Code Year File Number Bureau of individual Taxes INHERITANCE TAX RETURN ~~ Po sox zso6o~ 21 10 D 4 9 7 ,, Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYY'Y 190-12-2163 04102010 12231926 Decedent's Last Name Suffix Decedent's First Name MI SMITHSON ROSS W (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE IWttH THE - - REGISTER OF WILLS '' FILL IN APt'fiVYKW 1 E t3V1lE.•i t3ELVYY ® 1. Original Return ^ 2. Supplemental Retum ^ 3. Remair•der F~etum (date of death prior to! 12t 1 8-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 5. FederaN Es~a tle Tax Retum Required death after 12-12-82) ® i3. Decedent Died Testate ® 7. Decedent Maintained a Living Trust ~ 8. Total NUmI~ eF of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) j ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date of death ^ 11. Election to t ax under Sec. 9113(A) k>etween 12-31-91 and 1-1-95) (AttachiSc . b) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMA I time Tele l~on Da 4tOULD t3E DIRECTED TO: Mlumber y p Name CRAIG A • HATCH, ESQ • 717-731- 600 w. REGI8 /f LLS USE Q~LY,.r , ,~ ~' 1Z n ~ t,. First Ikle of address ~ , ~ ~ .r~" ~.~ ` s K.i~ ~ ~.. 1013 MOMMA ROAD ~~ "t' ,' a n ~ Second line of address ~ ~ N ~ ~ ~ SUITE 100 ~ ~ ZIP C d St t FILED e o e a City or Post Office LEMOYNE PA 17043 Correspondents e-mail address: C• H A T C H a G A T E S L A W F I R M• C O M ~~ Under penalties of perjury, I declaro that I have examined this rotum, induding accompanying schedules and statements, and to th t bf my knowledge and belief, it is true, correct and complete. Declaration of preparer other then the personal roprosentative is based on all information of which rear hes any knowledge. SIGrW P R NSIt3LE FOR FILI RETURN -- DA Fz-a.~~ ADDRESS 5 CARRIAGE ROAD NEW CUMBERLAND, PA 1'70 T0 SIGNA OF P ER THAN REPRESENTATIVE DATE a ai d ADDRE 101 MOMMA ROAD, SUITE 1D0 LEMOYNE, PA 17043 ', USE RI I AL F LY Side 1 ' ~! i.~n~L.i.ni.uia 15056110 148 LM4V9/ 4.UVV Estate of Ross W. Smithson Executors (Page 1) Name Kelly A. Frey Address 424 Spring Hollow Drive New Holland, PA 17557- Tax ID 191-46-1271 Name Todd H. Smithson Address 5 Carriage Road New Cumberland, PA 17070- Tax ID 191-46-1263 190-12-2163 1505610248 REV-1500 EX Decedent'8 S~ci~l Security Number 190-12 ~C163 ~«xdanraNpmr SMITHS4N ROSS W RECAPITULATION 1. Real Estate (Schedule A) 1 D . D D 2. Stocks and Bonds (Schedule B) . 2, ' D • D D 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3_ ' (] . D (] 4. Mortgages and Notes Receivable (Schedule D) q, D . D D 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5, 61, 9 9 3.21 s. Jointly Owned Property (Schedule F) ~ Separate Billing Requested , , , , g, 17 , 5 6 0.4 8 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) ~ Separate BiNing Requested .... ~. 2 6 D , 7 41.5,8 8. Total Groas Assata (total Lines 1 through 7) 8. 3 4 0 , 2 9 5.2 7 9. Funeral Expenses and Administrative Costs (Schedule H) , , g, ' 11,17 2.4 6 10. Debts of Decedent, Mortgage Liatrlities, and Liens (Schedule I) , 10, 1, ? 7 5 • D 3 11. Total Deductions (total Lines 9 and 10) , . 11. '' 12 , 9 4 7.4 9 12. Net Value of Estate (Line 8 minus Line 11) , 12. ' 327 , 347.78 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) , , 13. D • D D 14. Net Vslue Subject to Tax (Line 12 minus Line 13) , 14. 3 2 7 , 3 4 ? • 7 8 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICAI~.E RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers un~r Sec. 9116 (a)(1.2) x .o ~ 0.00 15. 0.00 1 s. Amount of Line 14 t~xabie at linealrateX.O- 327,347.78 1s. 14,730.65 17. Amount of Line 14 taxable at sibling rate X .12 D• D D 17 D• D D 18. Amount of Line 14 taxable at collateral rate X .15 D• D D 18. D' D D 19. TAX DUE 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1505610248 Side 2 9M4848 4.000 14,730.65 15056101248 ~. REV-1500 EX Pape 3 Fik Number Decedents Com lets Address: 21 1 ^ ^ 4 9 7 DECEDENTS NAME STiiEET ADDRESS CITY STATE ZIP Tax Payments and Credits: ~, 1. Tax Due (Page 2, Line 19) {1) 14 , 7 3 0.6 5 2. Credits/Payments A. Prior Payments 14 , D 0 D• D D B. Discount 7 3 6. 5 3 Total Crodks (A + B) (z> 14 , 7 3 6.5 3 3. Interest (3) ~ ,~ 0.0 0 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Pag• 2, Line 20 to request a refund. (4) ~ 5 • 8 8 i 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) D • D 0 i Make check payable to: REGISTER OF WILLS, AGENT. I PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIAITE~ BLOCKS 1. Did decedent make a transfer and: Yes II, No a. retain the use or income of the property transferred; .. .... .. .. ... ~ ' b. retain the right to designate who shall use the property transterred or its income; c. retain a reversionary interest; or .................................. ®, d. receive the promise for life of either payments, benefits or care? .. .. ... .. .. II 2. If death occurred after Dec. 12, 1982, did decedent transfer property wfthin one year of death ^ without receiving adequate consideration? . . 3. Did decedent awn an "in trust for" or payable-upon-death bank account or security at his or her death? ^ 4. Did decedent own an individual retirement account, annuity, or other non-probate property, which ® 'I ^ contains a benefidary designation? ......... .. .. IF THE AN8WER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE BCHEDULE G AND FILE It A PART OF THE RETURN. !I Fa dates of death on or after July 1, 1994, and before Jan. 1,.1995, the tax rate imposed on the net value of transfers to or for the ~ of the surviving spouse is 3 percent [72 P.S. §911 B (a) (1.1) (i)J. II 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 s~nAving spouse is 0 percent [72 P.S. ~11t3 (a)'(1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requlremlent fbr disdosure of assets and filing a tax return are still applicable even if the surviving spouse is the only benefidary. ' Far 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 ftx th~ use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9118(a)(1.2)]. ' • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal Lx3nefidaries is 4.5 relent, 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. §9118(a)~1.3 ].'A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 9M4671 2.000 REV-1502 EX+ (Ot-10) Pennsylvania OEPART6EN'f l]F REVENUE NJIiERITANCE TAX RETURN RESIDEM I~CEDENT ESTATE OF: FILE NIJA~BER: Rosa W. Smithson 21 10',0497 All roal property owned solely a as a bnant In common must bs reporbd at fair market value. Fair market value is defined asithePPrice at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, bath having reasonable knoVrleaae d ttre relevant facts. Real props-ly that is Jointlyowned with right of survivorehip must be dlsclossd on t3cl»dub F. I__ Attach a copy of the seltkmerrt sheet ff the property hat been sold. ~ ITEM InGude a copy of the deed showing deoedem's interest if awned as tenant in commas. ~' VALUE AT DATE NUMBER DESCRIPTION '' OF DEATH 1. None 9W4895 2.000 SCHEDULE A REAL ESTATE TOTAL (Also enter on Line 1, Recapitulation.) I S', I If more space is needetl, use additional sheets of paper of the same size. -_ 0.00 ,~___ __ REV-1503 EX * (6.98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN Ri=SIDENI' DE(~DEAff SCHEDULE B STOCKS 8 BONDS -- • - - • - -• FILE NUNIBE~t ', Roas W. Smithson 21 Q497 All property jointly-owned with right of survivorship must be disclosed on Schedule F. NUMBER VALUE AT DATE DESCRIPTION 1. None ~ ~`TM TOTAL (Also enter on line 2, Recapkulation) S 0.00 3W4698 1.000 (If more space is needed, insert additional sheets Of the same size) i i REV-1504 EX+ (698) COM~AONNVEALTH OF PENNSYLVANIA INhERITANCE TAX RETURN SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP Schedule C-f or C-2 (including all supporting information) must be attached for each dosaly-held corporationJpartnership interest or the geaedent, other than a sde-proprietorship. See instructions far the supporting information to be submitted for sde`proprietorships. VALUE AT t~eER DESCRtPl10N i DATE OF DEATH ~ ~ None 3W4697 1.000 TOTA4 (Also enter on line 3, Recapitutaltion) I $ ~I more space is needed, insert additional sheets Of the same size) I I 0.00 REV-1507 ES(+ (&99) SCHEDULE D C.ONNAONWEALT1i OF PENNSYLVANIA MORTGAGES 8 NOTES ~~M TOC-(~'.EDEN1' N RECEIVABLE FILE AN property Jointly-owned with Hght of wrvivorship must 6a disclosed on Schedule F. 3w4tSAC t.00o (n moro space ~s neeaea, insert aaanona aneas a same aze) REV-1508 EX + (698) GOM~AONVVFALTH OF PENNSYLVANIA INFERITANCE TAX RETURN RESOENTDECEDENT re of SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. PERSONAL PROPERTY REV-1509 IX+ (Oi-10) ,pennsylvania SCHEDULE F DEPARTMENT OF REVENUE INHERITANCE TAX RETURN JOINTLY-OWNED PROPERLY RESIDENT DECEDENT ESYATE OF: FILE NUMBpt: Ross W Smithson 21 10 0,4917 K an asset became jolMy owned wghln one year of the decedent's date of death, it mat be reported on Schedule G. SURVNNG JOr(rTENANT(S) NAIoE(S) ADDRESS REL/1TIOI~ISF~TO DEC87B~ff A Smithson, Todd H 5 Carriage Road, New Cumberland, PA 17070 So#~ JOINTLY OWNED PROPERTY: ll~ NLMBEi't ~ErTEa FOR JDINf TENANT DWTE MADE JOM DESCRpnotr of PRDFezrv RICLUaE NM,E OF FNIANCY1l INBTITUTICN AND MIUt ACCOUNT NUMBER CRSwU1R CEMKYINDMABE0. ATTACH DEED FaR JgMIY NEID REAL E67ATE. DP`TE OF DEATH VALIE OF ASSET % OF DECEDBIfPS T DOTE OF DEATH VALUEOF S MB~EST 1 A 8/1/2006 Integrity Bank checking ~ account 23,391.78 50.0000 ~ Iii 11,695.89 2 A .4/27/200 Integrity Bank money marks 'i account 11,729.18 50.0000 !. 5,864.59 i i ~ 1 ~i II '~ i TOTAL (Also enter ~ Lina 6, Recapitulation) t I 17 , 560.48 evweAE 2.00o M more space is needed, use addftional sheets of paper of the same size. REV-1510 EX +(OB-09) Pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENTDECEDENr ESTATE OF FILE U R Rosa W. Smithson 21 10 4 7 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of tha REIV -1500 is yes. DESCRIPTION OF PROPERTY ITEM NCL4AE7FEWIMEOFTFEiRMBFEREE,nfIRRELATIOrsr+PTODECEDEMAro DATE OF DEATH %OFDECD'S EXCLUSIO;d TAXABLE NIgNBE TIEDATEOFTRAFBFERATTA:FIACOP'loFTFEDEEDFORREALESTATE. VALUE OF ASSET INTEREST FAPPLICABL VALUE f• Allianz annuity policy number 70734508 88,741.58 100.0000 ~.~ i I 0 88,741.58 2 Real estate located at 510 I~ Susan Road, Camp Hill, i Cumberland County, Pennsylvania ~, 17011 172,000.00 100.0000 Q.t# I I ii ', II ~~ 0 i ii l 172,000.00 TOTAL (Also enter on line 7, Recapitulation) $ 260 741.58 8W46AF 2.000 It more space is needed, use additional sheets of paper of the same size. REV-1511 EX+(10-09) SCHEDULE H Pennsylvania OEPARTIYENrOFREVENUE FUNERAL EXPENSES AND P~ERITANCETAXREruRN ADMINISTRATIVE COSTS RESDENrDECEOENT ESTATE OF FILE NUMBER Roas W . Smithson 21 10 014 97 Decedent's debts must be reported on Schedule L ITEM NUMBER DESCRIPTION ' AMOUNT A. FUNERAL EXPENSES: ~, Elephant and Castle - funeral luncheon 751.16 Total from continuation schedules . B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) ~ j Street Addr+~s I City State ZIP Year(s) Commission Paid: ', 2. Attorney Fees: i 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address i City State ZIP i Relationship of Claimant to Decedent ~'I 4. Probate Fees: 5. Accountant Fees: ', 6. Tax Return Preparer Fees: I' Iii 7. ~I 1 The Sentinel -estate publication ' ~, ~, 2 Cumberland Law Journal -estate publication I 3 PP&L Electric ~, Total from continuation schedules TOTAL (Also enter on Line 9, 968.92 4,000.00 218.50 240.64 75.00 228.67 4,689.57 172.4 awaanc 2.000 If more space is needed, use additional sheets of paper of the same size. Estate of: Ross W. Smithson Schedule H Part 1 (Page 2) Item No. Description 2 Auer Cremation Services of Pennaylvania, Inc. Total (Carry forward to main schedule) Estate of: Rosa W. Smithson Schedule H Part 7 (Page 2) 4 UGI Gas Service 5 Pennsylvania American Water 6 East Pennsboro Township 7 Rumberger's BP - gas for UHaul 8 Home Depot - replace light fixture 9 UHaul - rental for moving furniture 10 Erie Insurance Group - homeowner's insurance 11 Free Flow - Drain cleaning for property located at 510 Susan Road, Camp Hill 12 Susquehanna Valley Tree - tree trimming for 510 Susan Road, Camp Hill 13 Chamberlin Inspections - house inspection for 510 Susan Road, Camp Hill 14 Crystal Clean Maids, LLC - house cleaning for 510 Susan Road, Camp Hill 15 Debbie Lupold, Treasurer - school taxes for 510 Susan Road, Camp Hill 16 Al's Tender Lawn Care - yard clean up at 510 Susan Road, Camp Hill 21 10 0497 219.87 140.48 345.00 8.14 102.79 66.48 394.00 145.00 300.00 350.00 235.00 2,117.81 265.00 Total (Carry forward to main schedule) ~, 4,689.57 ~I IL ~I aEV_,s,zdc•c+Z-oe, SCHEDULE Pennsylvania oEPARTMENrOF REVENUE DEBTS OF DECEDENT, NHERITANCE TAX RETURN MORTGAGE LIABILITIES ~ LIENS RESOENTOECEOENT ESTATE OF FILE NUMB Ross W. Smithson 21 10 4 7 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreim u medical expenses. ITEM ~ ', VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1• PP&L Electric I 15.98 2 Loyalton of Creekview -nursing home 898.26 ~I 3 Capital One - credit card owned. by decedent ~ 507.21 4 West Shore EMS -BLS Iii ~~ 116.23 5 Federal Employees Health Benefits -health care coverage II 175.08 i 6 Camp Hi11 Emergency Physician 12.16 7 Holy Spirit Hospital i ' 50.11 III i it I II i ~' ~' i I ~~ I i i TOTAL Also enter on Line 10, Reca tulation S I' 1 775.03 8W48AH 2.000 ,. ,,....., oro.....a ...... ............_......._. _..__._ _...._ __..._ _.~_. `~~_151~~`+~~,_,~, SCHEDULE J pennsylvania t)EPI~RTMENiOF REVENUE BENEFICIARIES INIfR17ANCE TAX RETURN RESIDENT DECEDENT NUMBER: Ross W. 3mi son 1 0497 RELATIONSHIP TO RECEDE AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY Do Not List Trustee(s) ' OF ESTATE I TAXABLE DISTRIBUTIONS [Indude outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] ', ,, Todd H. Smithson ', 5 Carriage Road ~ ~, New Cumberland, PA 17070 Integrity Bank checking account Inventory Value: 11,695.89 ' Integrity Bank money market acoount Inventory Value: 5,864.59 !, ~i~ 0~ of Residue: 154,893.65 i Son i 172,454.13 2 Kelly A. Frey i 424 Spring Hollow Drive ~ New Holland, PA 17557 0~ of Residue: 154,893.65 Daughter ~, I 154,893.65 EMER DOLIAR AMOUffT5 FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 '. 8 OF REV-1500 COVER SHEET, AS AP RDPRIATE. 11 NON-TAXABLE DISTRIBUTIONS A. SPOl1SAL DISTRIBUTIONS UDDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. I ~ I I ~I B. CHARfTABLE AND GOVERNMENTAL DISTRIBUTIONS: L TOTAL OF PART II • ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. S' 0. 0 0 __ _. _ _ _ _ ___ If more space is needed, use additional sheets of paper of the same size. TI ~D HE DER ~ 'pF T TE '~~ ~. TC3~~'~ TIFI~A ~ , DEAT ,, ~~, ~~ ;. ~~ ~~ ~~ ~~ jrk t ~Y ~~~' ~'rfFp~.x~;~4.-#~- ~a6i~..~. ! F~eF~Tt G ~V.,-Len. '#''-$ F^yFEf ~ ~.E~~~ S ~-.r.# ~,.~ f .. 5 . _ _ . C t. I i E F, c _- ~ u.-. ~Etaa--ddfl F ~i t r. r k '-. [I F -;; .r, ii t!i~rla t~. -ef" C~ ;t F;• ,cd-~ f-;'r , L , .. -.. _ ~~uj. ilk .. L I'll CCi ~.' (~. .J IC„._ ul. ~~~?L?'~~rc'~(Jti. ~~ .. a REV sagO06 [ : FRYar w wr ii!>. I5 'O C:?'I;t\' 11~C: ""~Il,~i!ic 1!1}C1rielfll?CA7 h~:'f: ~'1\'t it C>r_[C?}l; l0~??C'li }il'+il? :!?`. C`l; t!??:II ~L'1'l]tIC1IC Oi DC?l iii\- {.}eC} ''•'tilli a1~'.. ''~LOI'31 R?~i~:rar. The crl°3il ~.tii?C.ili: Pa'!i' 1cEiu;:i!'UC'i~ i(} the SISIE ~~'!I ~.C~//;i;!'tl' ~ (. 'l 1. pcil{,!ii21?leiii Fl~if!`~. t~ ~!/ l~ - r- a_.._3} k2~":i,'... ' L~Aie I~SCIC{I COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See instrucdona and examples on reverse) erarF FrF arueER t. Nawa deanfYe Wn aama. Yr. ssftaz) 2 Su l.~SooY Sranq NneY l a Uwe. `I'- YW Ross W. Smithson riale 190 - 12 - 2.163 A r 1 10. 2010 s ha W aeeemtl liner a Unar ~ e Data a e+n T. at>e wr a 4 Ptaer r Doan ssrw O•r+ tan sanau trapat Ones: 83 Yti Dec. 23. 1926 York. PA Oltowr DEn,oaonw OooA ®taw DtreYe. ^aY•sp,a,F t Core/ a Oaan R VY, 9os4 TYp a Dann !ti FaoLp Natsr AI naerrt~an, Sir srra asd+arerl ~ OnpN ®+a !. ~D ~ Y i0. ~A'rsaa Yafrs Bhel Yiiaa, at G Cumberland Cam Hill Manor Care of Cam Hill 1MtOR0'"'n'~°""~t White t t:OananRa l1asY J4m arw m na rma fr Doer sar ~ et Wr Oaoeant war n M el Doneaara EnteRew ISFdY •^M ~~ 9++~ nni MM u. ~b ~ 9Yvnrq SpY ra M rK 9•• "~" nrml twawm wraarttra+aerap LLS Anaae FYaaT FJlntaselary, Ia+A ealaYl IH a S•1 WUOarel fSOao+i/ Salesman Trans ortation ®Ya D No 4 Widowed lc o. wr: trrrn+~ ts.«~ ar, n.a sqt.. an+=a.t o«.eYr. oa o.cwa AoYlRriersca ,Tt $Iw Pennsylvania ~ t;rn, nc ®Yr,OaweYe thaUn ~ E st Pennsboro T,y. 510 Susan Road C be l d TOOT °d^ ' ^"0 Cast Hill, PA 17011 ,n~OYey um r an ~~ d ~ ~,+~ to Faf/s i4nr IFess soar. uss wM.t to taalwaNrr iF•St mesa. nreaet sanwri Ross Smithson Viola Hea s zoa,Yawrsl:urli,ye+vae, lmarnweswrit'AmarlSow.oq+nn.Star,sooath i Mr. Todd H. Smithson 5 Carria a Road New Cumberland, PA 17070 2sa wnoaanav°wo^ ®Gansrw ^DYrmt 21o OwdOevr+rtlwsw. d`I•t•Y) 2sc'Rrad DepaeenlNanaa n•rwY. ueruwy YOnre+ral to IrJlpitM.ssYa. jp nnl ^ BunY ^ RYno.Y aM $Un . Wrs Caasrbn r Donavan AuYpthw - O - tgwawEarwe++eYwtrT ®Yrpea A ril 14 2010 Cremation Societ of PA a risbur PA 17104 m afa.Y~ ,Y acrgrsuUq m~camaH.pr ncworanaAmrsaFaaq Au Cremation Services of ~~ en sylvani ~nc. 1~ - - FI?-013376-L Jonestown Road, Harris 41 ur PA 1 U 2bc 13a Toter ra tno.aoopo.Oaan am•ne Y h aYO, oW anoplaer sotan ISquYto atn tool s. tanoY 73D tran '"Z1e Dw Sgre IwM. rr. 1•ael a oww. r onn n ~ ~~ `~Q,.~ ~`-w~ / ~ v Q /'~ " ~ ~ s V / W term rill met r arvwa q anwn M Twr a Doao n Dw Ptanuraa Due Itbtet eaY• Yarl 26. was Caw NY.mq n lnrot t b a Wawr Ow GYtur. a Oww~T - "'° n°°"rs ewn J ~ /t S M. k 3 p (,L ^ rr ew CAUSE OF OEATH ISoo ImbuctlMa cold nrnpiry ~ A,goaamr nrrvat van x EnY anY ~ 2l 0a Toraoa Uu CarOiaa Y OaanT trr Ti vans Ent ar mtoaL.rosma - oe.r.a. +lae. Y so•or+aar ~ w eaq~ ua.e r awn 00 NOT watt tYl+Yrl ..Yes soot r osoac Ylrc Onwe r Own sw oa nYrsq n er rnYy+q fas. r t ' I{/{p~7 ^ v rep•awy amfe. a .crew Irraoon rMa Yarq.r aaYOQj. aY aM Yruw on can W. '~i i ry ' LJ Np ^ Wrtwr WEDIAIF CAUSE iinY ...".._a t ^ L~ asteoa+nvegoaewt -~ ~ a ~N ~16 ~ /nyO 4iAl~ 2,. riei.Jr/.s~. ~ I T BefYaala: ^ taY r sra w.t v >r Duo n Ib as a aonaarrta al. I 0 f t v ^ Name Y am• a arR 5.~,rr.~ aY ~r a a11. ° + ~ ^ 4~6~rit os. mw Y~wa 6o b UYDERLYNG GUSE Dw n IY a a mragrna all. - enenq~ra eA nw~e+~^~dr+ a aaan Isrua a ryVt nY aratw M ~ l r Q n ^ i awr ewaeq s eaaey LLST. Du. n la r a areaprraa aA: ,• aY prayrle W vrgrn p n erne eaaw e ^ VrrY~r aOr9we wn.r GaY,v 7r Wr r Aiaopy ~. wY• AunyaY FrWgs 7s. wroY a Dun ]h AY a MryY IlM~kt W7.1•Y) 7m. D.vnos IW sNY Omr~q ~. ~ ]LC Ran aY~Yy. ebna FYSM1 S.rl fassrM. 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OIiY SFaray m cnaaY teum ayr art ono raY a • 6NM•q Mnr+wsv^ss.aw nNa•q mwaeaan.twe anon yrysaarwaam•oeaun am oaMY•r rmtOl ewaoaam.a owner cw.elslw.wYraw T•orl.asaY ,asr.re . ~ ~{ /-.~ , q , _________________________________ ]Y Lawns. ta,.ron Sgrl labnn. oaY. r•YI • wonaYOnl •w a•seYYl yryaacw,PtgisoYS ros pYwnmgeaau Yr rNpq n nw a ounl mr ute pay re orbn. w.yalaM mYnY rYane araa re m axrswrurfiY. ^ T n n e ~ ~ rL-/~ ry . __________ • e w. q., r • Y•e1cYEaarr+ta•nr -------- ~ . /! oGG ~ a( 'I M ne ern a uaarruat anal a tnarYgYnn' . wan r<rMY er Wtw, eua, one 0tan• one eua w Yr oaurlq aaq rrw r swae_ ^ H Nr.e ~A° Amos a vr>as wtr a Drn /.war .C ~~~ i z T,~as vnr b R,grals ]6 M.IrYs ... c1 ~ OepurertFYneNO. 0490267 ~• i ~l ~I ~~ ,i I ~~ .r-E,ST A. ~, , L ~~D ~~~ 5T ~yYL ~~~~° ~ , ~ • ~~ oss ~, LAST WILL AND TESTAMENT OF ROSS W. SMITHSON I, ROSS W. SMITHSON, now of 510 Susan Road, Camp Hill, Cumb 1 d County, Pennsylvania, 17011, dopublish and declare this to be my Last Will and Testament, er by revoking all other prior wills and codicils made by me. FIRST: Family Background and Appointment of Executor. (A) Fai u'ly and Background Information. I am married to NINA H. SM T SON. The children of our marriage are KELLY A. FREY and TODD H. SMITHSON. Throu wt this Will, NINA H. SMITHSON will be referred to as "my wife" or "my spouse" and KELL . ~'REY and TODD H. SMITHSON will be referred to as "my children". The word "issue" '1 include my children as well as my other descendants. (B) Appointment of Executor. I appoint as my Executrix and successo xecutors (all hereinafter referred to as Executor) under this Will, the following named persons t s e without bond and without being required to account to any Court: ' ~I, Executrix: My wife, NINA H. SMITHSON. ', ', Successor Executors: My children, KELLY A. FREY and TODD H. SMITHSON, to act jointly or individually. SECOND: Funeral and Last Illness Expenses: Taxes. (A) Expenses of Funeral and Last Illness. Notwithstanding that my i e', NINA H. SMITHSON, survives me, I direct my Executor to pay my funeral expenses and the ex ~nses of my last illness from my estate. (B) Taxes. I direct my Executor to pay any and all estate, inheritance, su a Sion, legacy, transfer and other death taxes or duties, by whatever name called, including any an al interest and penalties thereon, imposed under the laws of any jurisdiction by reason of my dea ion or with respect to any and all property included in my gross estate for the purpose of such t ~s, whether such property passes under or outside of this Will, out of my residuary estate, withou b i~g prorated or apportioned among or charged against the respective devises, legatees, beneficiar~e ,transferees, ~~ '~ LAST WILL AND TESTAMENT OF ROSS W. SMITHSON PAGE 2 I or other recipients of any such property or charged against any property passing or passed to any of them. The Executor shall not be entitled to reimbursement for a~ such taxes from any such person. THIRD: Tangible Personal Property. Except for those items excluded items enumerated in the Letter of Instruction, I bequeath to my wife, NINA H. ; tangible personal property, including but not .limited to clothing, jewelry, heir] personal effects, motor vehicles, and all other similaz articles, which I own, a thereon, if my spouse survives me by sixty (60} days. Tangible personal property ; (l) any and all property used by me in any business, (2) cash on hand or on dep. stock or securities, (4) any type of evidence of indebtedness, and (5) any life, h insurance policies. If my wife, NINA H. SMITHSON, does not survive me, I bequeath such t property to my children, KELLY A. FREY and TODD H. SMITHSON, living death, to be divided among them as they may select in as nearly equal shares as is spouse and my children do not survive me, I leave such tangible personal property t children, per stirpes. If there is any disagreement as to distribution, I direct my E such distribution. The decision of my Executor shall be final and binding. Any it or any items which my Executor considers unsuitable for my children maybe distz the sole discretion ofmy Executor and, if sold, the net proceeds therefrom shall residue ofmy estate. Any such article allocated to a minor may, as my Executor c either be delivered to the minor or to any person to safeguard on behalf of the min Notwithstanding any other provisions in this Article THIRD, I may leave and unsigned Letter of Instruction, which I shall place with my Wili, containing dir ultimate disposition of certain of the property bequeathed under this Article THIRD of Instruction shall determine the distribution of such items. FOURTH: Family Home. [THIS ARTICLE IS INTENTIONALLY LEFT BLANK.] FIFTH: Residuary Gifts. may have ion of any ~w and those THSON, all ls, furniture, he insurance t not include: in banks, (3) i or accident ible personal e time of my ctical. If my e issue ofmy utor to make ;not selected ted or sold in added to the ns advisable, gate, dated nsastothe such Letter ~c _i_. ~ LAST WILL AND TESTAMENT OF ROSS W. SMITHSON PAGE 3 (A) If my wife, NINA H. SMITHSON, survives me, I give, devise and begs residue and remainder of my estate, of every kind and character, real, personal and and intangible, and wherever situated, including any lapsed or renounced legs residuary bequests (and including any property over which I may have a Power of ~ my wife, NINA H. SMITHSON. (B) If my wife, NINA H. SMITHSON, does not survive me, I give, devi: all the rest, residue and remainder of my estate, of every kind and character, re< mixed, tangible and intangible, and wherever situated, including any lapsed or ren or devises (and including any property over which I may have a Power of Appo. children, KELLY A. FREY and TODD H. SMITHSON, per stirpes. If either predecease me, then the predeceased child's share of the residue of my estate shall l the predeceased child's issue, per stirpes. (C) Distributions During Administration. Prior to final distribution Executor, in his discretion, may make partial distributions to one or more benef As a consequence, the Executorship and any Trusts created under this contemporaneously. A distribution may be made subject to any indebtedness estate. SIXTH: Spendthrift Provision. No beneficiary shall have the pow encumber or transfer his or her interest in the estate in any manner other than by tl of a power of appointment. No part of the estate shall be liable for or charged contracts, liabilities or torts of a beneficiary or subject to seizure or other process b a beneficiary. SEVENTH: Powers of Executor. In addition to the powers and duties granted elsewhere in this Will, but subject to any limitations stated elsewhere Executor shall have and exercise exclusive management and control of the Estate a with the following specific powers and discretion, in addition to the powers as conferred from time to time upon him bylaw: (A) In the management, care and disposition of the Estate, the Exe power to do all things and to execute such deeds and instruments as may be c proper, including the following powers, all of which may be exercised without ~ ~~ all the rest, d, tangible devises or ntment), to nd bequeath »rsonal and ced legacies Went), to my my children listributed to estate, the or Trusts. may -exist ility of my anticipate, d exercise any debts, creditor of 3y have been Zis Will, the call be vested be generally tall have the necessary or f or report to LAST WILL AND TESTAMENT OF ROSS W. SMITIISON PAGE 4 ''~ any Court: (1) To sell, exchange or otherwise dispose of any property, real, p o al or mixed, at any time held or acquired hereunder, at public or private sale, for cash or o t s, without advertisement, including the right to lease for any term notwithstanding a ~riod of the Estate, and to grant options, including any option far a period beyond the d ation of the Estate. ~ (2) To invest ali monies in such stocks, bonds, securities, mortgag otes, choses in action, real estate or improvements thereon, and any other property as th xecutor may deem best, without regard to any law now or hereafter enforced limiting in estments of fiduciaries. (3) To retain for investment any property deposited with the Exec~to>E hereunder. (4) To vote in person or by proxy any corporate. stock or other sec and to agree to or take any other action in regard to any reorganization, merger, consolida o , liquidation, bankruptcy or other procedure or proceedings affecting any stock, bon , ate or other security. (5) To use attorneys, real estate brokers, accountants and other a nts, if such employment is deemed necessary or desirable, and to pay reasonable comp s Lion for their services. (6) To compromise, settle or adjust any claim or demand by or again$t t~~ Estate and to agree to any rescission or modification of any contract or agreement aff ti g the Estate. (7) To renew any indebtedness, as well as to borrow money, and to a ure the same by mortgaging, pledging or conveying any property of the Estate, includi g e power to borrow at a reasonable rate of interest. i (8) To retain and carryon any business in which the Estate may a i e'an interest, to acquire additional interest in any such business, to agree to the liquidatio i !kind of any corporation in which the Estate may have an interest and to carry on the bus n s thereof, to join with other owners in adopting any form of management for any busine s r property in ~' ~. _.,_ T ~__- f ~ .._.._ LAST WILL AND TESTAMENT OF ROSS W. SMITHSON PAGE 5 which the Estate may have an interest, to become or remain a partner, gene regazd to any such business or property and to hold the stock or other investment, and to employ agents and confer on them authority to manage business, property or corporation, without liability for the acts of such agen~ liability or indebtedness of such business if the management is selected c reasonable care. (9) To register any stock, bond or other security in the name of a the addition ofwords indicating that such security is held in a fiduciary cap records shall be maintained showing that such security is a Estate asset shall be responsible for the acts of such nominee. (B) Whenever the Executor is directed to distribute any Estate assets person who is then under twenty-one (21) yeazs of age, the Executor shall be authe property in Trust for such person until he/she becomes twenty-one (21) years ~ meantime shall use such part of the income and the principal of the Estate as the E: necessary to provide for the proper support and education of such person. If such before becoming twenty-one (21) yeazs of age, the property then remaining distributed to the personal representative of such person's estate. (C) In making distributions from the Estate to or for the benefit of an' person under a legal disability, the Executor need not require the appointment of a gt be authorized to pay or deliver the same to the custodian of such person, to pay or to such person without the intervention of a guazdian, to pay or deliver the same to of such person if one has already been appointed, or to use the same for the benefi (D) In the disbursement of the Estate and any division into separate tru; Executor shall be authorized to make the distribution and division in money or i regardless of the basis for income tax purposes of any property distributed or divi the distribution and division made and the values established by the Executor shat conclusive on all persons taking hereunder. The Executor may in making sucl division allot undivided interests in the same property to several trusts or shares. (E) The Executor shall have discretion to determine whether items s credited to income or principal or allocated between income and principal as the -r limited, in ~rities as an t' operate the for any loss, stained with nee, without but accurate he Executor : simple to a to hold such :, and in the may deem n should die ust shall be inor or other ian, but shall vier the same gal guazdian such person. r shares, the ~d, or both, in kind, and binding and ~tribution or charged or mayd,~eem G ~~~ LAST WILL AND TESTAMENT OF ROSS W. SMITHSON PAGE 6 equitable and fair under all circumstances, including the power to amortize or fail o ortize any part or all of any premium or discount, to treat any part or all of the profit resulting fr the maturity or sale of any asset, whether purchased at a premium or at a discount, as income o principal or apportion the same between income and principal, to apportion the sales price of an het between income and principal, to treat any dividend or other distribution of any investm t ~ income or principal, or apportion the same between income .and principal, to charge any ' se against income or principal or apportion the same, and to provide or fail to provide a re o able reserve against depreciation or obsolescence on any assets subject to depreciation or obsoles ¢e, all as the Executor may reasonably deem equitable and just under all the circumstances. j (F') If at any time the total fair mazket value of the assets of any trust est 1 shed or to be established hereunder is so small that the corporate Trustee's annual fee for admini t ~ng the trust would be equal to or less than the minimum annual fee set forth in the Trustee's re ly published fee schedule then, in effect, the Trustee in its discretion shall be authorized tot in tie such trust or to decide not to establish such trust, and in such event the property then held in or o ~ distributed to such trust shall be distributed to the persons who are then or would be entitled t ~ income of such trust. If the amount of income to be received by such persons is to be de a fined in the discretion of the Trustee, then the Trustee shall distribute the property among suc of ithe persons to whom the Trustee is authorized to distribute income, and in such proportions, t ~ Trustee in its discretion shall determine. (G) Unless the context clearly states otherwise, when the authority and pow u der this Will is vested in two (2) or more Executors, the authority and powers are to be hel j ~ntly by the Executors. A majority of the Executors may exercise any authority or power grant der this W ill or granted by law, and may act under this Will. Any attempt by one such Executor o ~t under this Will on other than ministerial acts shall be void. The action of one such Executor c~er this Will maybe validated by a subsequent ratification of the act by a majority of the Execu~o EIGHTH: Rights and Liabilities of Executar. No bond or other security h 11, be required of any Executor. This instrument always shall be construed in favor of the valid ty o~,f any act or omission by any Executor, and any Executor shall not be liable for any act or omissio except in the case of gross negligence, bad faith or fraud. Specifically, in assessing the p o riety of any investment of the estate, the overall performance of the entire estate shall be tak 'nto account. Each Executor shall be entitled to receive reasonable compensation for services a ly rendered to my estate, in an amount the Executor normally and customarily charges for perlfo ing similar LAST WILL AND TESTAMENT OF ROSS W. SMITI3SON PAGE 8 ' (F') Captions. The captions set forth in this Will at the beginning of the hereof are for convenience of reference only and shall not be deemed to define or lip hereof or to affect in any way their construction and application. (G) Powers of Appointment are Exercised. By this Will I Appointment which I may possess at my death. IN WITNESS WHEREOF, I, ROSS W. SMITHSON, the Testator, Will and Testament, typewritter~on nine (9) pages, including the set my hand and seal this a~ day of August, 2005. RbSS W. SMITHSON Signed, sealed, published and declared by the above-named Testator, as and for h: Testament, in the presence of us, who have hereunto subscribed our names at witnesses hereto, in the presence of the said Testator, and in the presence of each o~ further declares that he or she believes the Testator to be of sound mind and memory instrument consists of this and eight (8) other consecutively numbered typewritten the Acknowledgment and Affidavit. ,. ,. (print name) residing at residing at '~ chi ~i ~Gj S ~ s divisions provisions Power of this my Last id Affidavit, ast WiII and request, as . Each of us e preceding ~s including ~~ s X4.2.0 ~ L - i=' l2 <7N ~ L-,a al (~ (print name) ACKNOWLEDGMENT AND AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ~ ~/~~ SS: COUNTY OF~(~%~~Y~~~.~~ ~,~,,ti'I~~i~ : The Testator and the witnesses whose names are signed and subscribed to foregoing instrument, being first duly sworn and qualified according to law, do hereb depose and say to the undersigned authority, that the Testator signed and executed as his Last Will in the presence of the witnesses; that he signed it willingly or wi another to sign it for him; that he executed it as his free and voluntary act for the p expressed; that each of the witnesses were present and saw the Testator sign a instrument as his Last Will; that each subscribing witness in the hearing and sight signed the will as witnesses; and that to the best of their knowledge the Testator eighteen years of age or older, of sound mind and under no constraint or undue inf. Testator Witness ~ . ~_~ Witness ;attached or ;knowledge, instrument gly directed uses therein execute the the Testator ~t that time Sworn to or affirmed, subscribed to, and acknowledged, before me by th above-named Testator and witnesses, this ~ day of August, 20~ Notmiad Seal ~- - Teri L Walter, Notary P~bNc ~err-ayna t3o%q~rnbertand Cointy My C.ortxrNS,sion Expires.l~. 20, 2007 Notary Public My Commission Expires: _.._. _. CERTIFICATE of GRANT of LETTERS REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA No. Es to Late Dece Soci CEIRTIFICATE OF LETTERS WHEREAS, on the 13th day of May 2010 an instrument d~ August 24th 2005 was admitted to probate as the last wily ROSS W SMITHSON tad ~~ 97 !First, Middle, Last) 1a to of EAST PENNSBORO TOWNSHIP, CUMBERLAND County, who died on the 10th day of Apri 1 2OI 0 and, I ~' WHEREAS, a true copy of the will as probated is anne ell hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Registe ~f WiI1s in and for CUMBERLAND County, in the Commonwealth of Pennsylvan" a~ hereby certify that I have this day granted Letters TESTAMENTAR t~o KELL Y A FREY and TODD H SMI THSON I' who have duly qualified as EXECUTOR(R/X) I' and have agreed to administer the estate according to Ia all of which fully appears of record in my office at CUMBERLAND COUNT l ~OURT HOUSE, CARLISLE, PENNSYL VANIA. ~' IN TESTIMONY WHEREOF, I have hereunto set my hand an ~ffixed the seal of my office on the 13th day of May 2010. '~, -, * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, i L~ST) I j !. i T S THE SMITHSON FAMILY TR DATED DECEMBER 3, 200 ~~ ~,, ~~ ~ 1 ~ -- _ - THE SMITHSON FAMII.Y TRUST ~.~ TffiS TRUST AGREEMENT is executed in triplicate on this ~ day 2009, by and between ROSS W. SNIITHSON, now of 510 Susan Road, Camp l Cumberland County, Pennsylvania, 17011 (hereinafter called "Settlor") and ROS SNIITHSON, now of 510 Susan Road, Camp Hill, Cumberland County, Pennsy (hereinafter called "Trustee") who shall serve jointly or individually in the capaci with his children, TODD H. SMITHSON and KELLY A. lq'REY. ARTICLE I. TRUST ESTATE 1.01. Initial Principal. Settlor, desiring to establish an irrevocable trust, irrevocably transfer, assign and deliver to the Trustee and its successors, and assig listed on Schedule A, attached hereto and made a part hereof. As further evidence assignment, the Settlor has executed or will execute or cause to be executed such c instruments as may be required for the purposes of completing the assignment or t to such property to the Trustee. The Trustee accepts such transfer and assignment Trustee, and undertakes to hold, manage, invest and reinvest the assets of this Tru distribute the income and principal of the Trust in accordance with the provisions Agreement. 1.02. Additional Principal The Settlor and any other person or person: consent of the Trustee, shall have the right at any time to make additions to the co Trust or any share thereof hereby established. All such additions shall be held, go distributed by the Trustee in accordance with the terms and conditions of this Agri Trustee, in its sole discretion, may require, as a prerequisite to accepting property, transferring party provide evidence satisfactory to the Trustee that (i) the property contaminated by any hazardous or toxic materials or substances; and (ii) the prope used and has never been used for any activities directly or indirectly involving the use, treatment, storage, disposal, release or discharge of any hazardous or toxic m, substances. a, 17011 'Trustee as hereby he assets such • of title if as to h the of this ~d, and .nt. The the vs not being or 1.03 Disclaimer. The Trustee shall have the right to disclaim, in whole) or in part, prior to its acceptance by the Trustee, any interests in property for any reason, including Ibujt not limited to a concern that such property could cause potential liability under any federal, state,', or local environmental law. ARTICLE II. IRREVOCABII.ITY OF TRUST 2.01. Irrevocability: Settlor has been advised of the consequences of an trust and hereby declares that this Trust shall be irrevocable and shall not be altere~ revoked, or terminated by Settlor or any other person or persons. ARTICLE III. LIFE INSURANCE POLICIES 3.01. General Provisions. If any insurance policies aze transferred into t ' Trust, the Trustee shall be vested with all right, title, and interest in and to the transferred po ic' s of insurance, and is authorized and empowered to exercise and enjoy, for the purposes f the Trust herein created and as absolute owner of such policies of insurance, all the options, be efits, rights and privileges under such policies, including the right to borrow upon and to pled a em for a loan or loans. The Trustee takes all rights, title, and interest in and to the above s to ,insurance policies subject to any prior split-dollaz life insurance agreement and assignments, w ich may be in effect at the time of transfer. The insurance companies which have issued police afire hereby authorized and directed to recognize the Trustee as absolute owner of such policie o~ insurance and as fully entitled to all options, rights, privileges, and interests under such poli fie ,and any receipts, releases, and other instruments executed by the Trustee in connection wi uch policies shall be binding upon all persons interested in this Trust. The Settlor hereby relin uishes all rights, title, interest and powers in such policies of insurance which Settlor may o and which rights, title, interest and powers aze not assignable, and will, at the request ofthe ru tiee, execute all other instruments reasonably required to effectuate this relinquishment. 3.02. Payment of Premiums. The Trustee shall be under no obligation o ~ay the premiums which may become due and payable under the provisions of any policy of insurance which may be transferred or assigned to this Trust, or to make certain that such pr iums aze paid by the transferor of such policy, or to notify any persons of the nonpayment f s ~h premiums, and the Trustee shall be under no responsibility or liability of any kind in case such premiums aze not paid, except the Trustee shall apply any dividends received on s c policies to the payment of premiums thereon. Upon notice at any time during the continuanc f this Trust that the premiums due upon such policies aze in default, or that premiums which it become due will not be paid, either by the transferor or by any other person, the Trustee, withi i s sole discretion, may apply any cash values attributable to such policy to the purchase f aid-up insurance or of extended insurance, or may borrow upon such policy for the pa n of premiums due thereon, or may accept the cash values of such policy upon the policy s forfeiture. In the event that the Trustee receives the cash value of such policy upon its forfei for nonpayment of premiums, the amount received shall be added to the corpus of thi rust, and shall be administered according to the terms of this Agreement. If the insured un a such ~ .. _. _- policies of insurance, becomes totally and permanently disabled within the meanin~ cif any policies and because thereof the payment of premiums, or any of them, shall durin a pendency of such disability, be waived, the Trustee, upon receipt of such knowledge, shall p~o ptly notify the insurance company which has issued such policies, and shall take any and all ste s necessary to make such waiver of premium provision effective. 3.03. Duties of Trustee With Regard to Life Insurance Policies. The stee shall be under no obligation or duty whatever except with respect to the safekeeping of u h policies of insurance and the duty to receive such sums as may be paid to them, in accord c with the requirements of this Trust, by the companies issuing such policies, and to hold, m ge and disburse such proceeds subject to the terms of this Agreement. Upon the death of th insured, the Trustee shall make reasonable efforts to carry out the provisions of this Agree a t, including. the maintenance or defense of any suit, provided, however, the Trustee shall be a no duty to maintain or enter into any litigation unless its expenses, including counsel fees an c sts, have been advanced or guaranteed in an amount and in a manner reasonably satisfacto t the Trustee. The Trustee may repay any advances made by it or reimburse itself for y such fees and costs from any corpus or income of this Trust. ARTICLE IV. TRUST DISTRIBUTIONS 4.01. Tract Pr®cipal. The entire corpus of this Trust, including the asst initially transferred to this Trust, subsequent additions to this Trust, and the proceeds of y ale, exchange or investment of such Trust assets, shall be used for the purposes herei c retained. 4.02. Income Distribution. During the Settlor's lifetime, the Trustees ali distribute ail of the net income of the trust to, or for the benefit of the Settlor, ROSS W. S C?N. The Trustee shall make no distributions of principal to ROSS W. SNIITHSON. Upo a admission of ROSS W. SMITHSON to a long term caze facility for a period of time in exc ss of thirty (30) days, the Trustee shall cease the distribution of income from this Trust to ROSS SMITHSON and such income shall accumulate to the principal of this Trust. A 1 n term care facility shall be defined as either an assisted living facility or skilled nursing facil ty where the delivery or availability of medical care is the basis for the admission of the Settlo . 4.03. Principal Distributions. Upon the death of the Settlor, ROSS 11YIITIiSON the Trust shall terminate. Upon termination of the Trust and the payment of all n c gsary and appropriate debts, taxes fees and costs of the Trust administration, the remaining T st estate shall be distributed in equal shares to the Settlors' children, TODD A. SNIITH and KELLY A. FREY, per stirpes. Unless otherwise designated, if any of the Settlo 's children or issue predecease the termination of this Trust or their subsequent Trust, the peed c ed individual's share shall be distributed, unless otherwise stated, equally to the pre e used individual's issue, per stirpes, provided that if any named individual predeceases h termination of this Trust without leaving issue, then such predeceased individual's share shal b distributed equally to the surviving issue of the Settlor, per stirpes. 4.04. General Power of Appoiintmenk Settlors' children, TODD H. S SON and KELLY A. PREY, aze hereby granted the general power to appoint some or a~l f the principal of this Trust to themselves. as they may jointly deem advisable upon writt n'~~notice issued to the Trustee. The Trustee shall present such written notice to the Settlor w o upon receipt, shall have a period of time not to exceed ten (10) business days to veto the pr posed exercise. If and in the event that a veto is not received by the Trustee as described v~e, then the proposed exercise shall be deemed valid. This power shall not be exercisable and r eir Wills and shall terminate upon the death of the Settlor. ~,, ~ ARTICLE V. POWERS OF TRUSTEE 5.01. General Powers. In addition to such other powers and duties as m y ave been granted elsewhere in this Trust, but subject to any limitations contained elsewhere 'n is Trust, the Trustee shall have the following powers and duties: i~ A. In the management, care and disposition of this Trust, the Trustee shall a the power to do all things and to execute such deeds, instruments, and other documen may be deemed necessary and proper, including the following powers, all of which may a ercised without order of or report to any court: I ', (1) To sell, exchange, or otherwise dispose of any property, real, F or mixed, wheresoever located, at any time held or acquired hereunder, at or private sale, for cash or on terms as may be determined by the Trustee, advertisement, including the right to lease for any term notwithstanding th of the Trust, and to grant options, including an option for a period beyond duration of the Trust. (2) To invest and reinvest all or any part of the Trust Estate in any ',, common or preferred stocks, shazes of investment trusts and investment companies, bonds, debentures, mortgages, deeds of trust, mortgage partici at ons, notes, real estate, or other property the Trustee, in the Trustee's discretion, se ects; provided that the Trustee may not invest in any stock or securities issued b t e corporate Trustee or issued by a pazent or affiliate company of such Truste ; n the manner that, under the circumstances then prevailing (specifically includi g, ut not limited to, the general economic conditions and the anticipated needs f t e Trust and its beneficiaries), persons of skill, prudence, and diligence, actin i a similaz capacity and familiar with those matters would use in the conduct f enterprise of similar chazacter and similaz aims, to attain the Settlor's goal u der this trust agreement. (3) To retain for investment any property deposited with the Trust~e hereunder. ii ii I ~ 4 !, I, __ _ _ ~__ __ __~, l,f (4) To vote in person or by proxy any corporate stock or other secu~it} and to agree to or take any other action in regard to any reorganization, me~?~g-e~, consolidation, liquidation, bankruptcy or other procedure or proceedings affe~'ting any stock, bond, note or other security held by this Trust. ' (5) To use lawyers, real estate brokers, accountants and any other if such employment is deemed necessary or desirable, and to pay reasonal compensation for their services. (6) To compromise, settle or adjust any claim or demand by or ag ns~t the Trust and to agree to any rescission or modification of any contact or agree nt affecting the Trust. i, (7) To renew any indebtedness, as well as to borrow money, and t the same by mortgaging, pledging or conveying any property of the Trust, including the power to borrow from the Trustee (in the Trustee's individu~ capacity) at a reasonable rate of interest. (8) To retain any business interest transferred to the trustee, as ~ shazeholder, security holder, creditor, partner or otherwise, for any period f 'me whatsoever, even though the interest may constitute all or a large portion o e trust principal; to comply with the provisions of any agreement restricting sfer of the interest; to participate in the conduct of the related business or rely others to do so, and to take or delegate to others discretionary power to tak y action with respect to its management and affairs which an individual coul e as outright owner of the business or the business interest, including the vo 'n of stock (by separate trust or otherwise regazdless of whether that separate st '11 extend for a term within or beyond the term of the trust) and the detennina io of all questions of policy; to execute and amend partnership agreements; to participate in any incorporation, reorganization, merger, consolidation, sal o assets, recapitalization, liquidation or dissolution of the business, or any c ge in its nature, or in any buy-sell, stock restriction, or stock redemption agreem n s; to invest in additional stock or securities of, or make secured, unsecured, or subordinated loans to, the business with trust funds; to take all appropriate adtions to prevent, identify, or respond to actual or threatened violations of any II environmental law or regulation thereunder; to elect or employ with 'i compensation, as directors, officers, employees, or agents of the business, an~ persons, including a trustee of any trust held under this instrument, or any i ector, officer, employee, or agent of a corporate trustee of any trust held under t isl instrument, without adversely affecting the compensation to which that st e would otherwise be entitled; to rely upon reports of certified public acco is as to the operations and financial condition of the business, without indepen e t investigation; to deal with and act for the business in any capacity (includi gin ~~T. T ,_ the case of a corporate trustee any banking or trust capacity and the loaning oft money out of the trustee's own funds) and to be compensated therefor; and ~o ell or liquidate the business or any interest in the business. ~I ', (9) To register any stock, bond or other security in the name of a n m nee,. without the addition of words indicating that such security is held in a fidu i capacity, but accurate records shall be maintained showing that the stock, b n or other security is a trust asset and the Trustee shall be responsible for the acs f the nominee. (10) To set aside as a separate trust, to be held and administered L same terms as those governing the remaining trust property, any interests property, for any reason, including but not limited to a concern that such could cause potential liability under any federal, state, or local environm~ B. Unless otherwise designated, whenever the Trustee is directed to distril principal in fee simple to a person who is then under twenty-five (25) yeazs of age shall be authorized to hold such property intrust for such person until he becomes (25) years of age, and in the meantime shall use such part of the income and the p~ trust as the Trustee may deem necessary to provide for the proper support and edu person in the standazd of living to which he has become accustomed. If such pers~ before becoming twenty-five (25) years of age, the property then remaining in tru: distributed to the personal representative of such person's estate. C. In making distributions from the Trust to or for the benefit of any min person under a legal disability, the Trustee need not require the appointment of a shall be authorized to pay or deliver the distribution to the custodian of such pers deliver the distribution to such person without the intervention of a guazdian, to ~ distribution to the legal guazdian of such person if a guardian has already been al use the distribution for the benefit of such person. D. In the distribution of the Trust and any division into separate trusts an~ Trustee shall be authorized to make the distribution and division in money or in k regardless of the basis for income tax purposes of any property distributed or divi the distribution and division made and the values established by the Trustee shall conclusive on all persons taking hereunder. The Trustee may in making such disc division allot undivided interests in the same property to several trusts or shazes. E. If at any time after Settlor's death the total fair mazket value of the asse established or to be established hereunder is so small that the corporate Trustee's administering the trust would be equal to or less that the minimum annual fee set Trustee's regulazly published fee schedule, then the Trustee in its discretion shall terminate such trust or to decide not to establish such trust, and in such event the any trust Trustee my-five pal of the ~n of such Would die X11 be other Sian, but pay or deliver the ;d, or to ,azes, the or in both, . in kind, and blinding and ution or any trust a fee for in the then to 6 held in or to be distributed to such trust shall be distributed to the persons who are ~ nor would be entitled to the income of such trust. If the amount of income to be received by s c persons is to be determined in the discretion of the Trustee, then the Trustee shall distribute t)~e roperty among such of the persons to whom the Trustee is authorized to distribute income,) din such proportions, as the Trustee in its discretion shall determine. i ~~~ F. The Trustee shall be authorized to lend or borrow, including the right tole d to or borrow from the Settlor's estate, at an adequate rate of interest and with adequate a urity and upon such terms and conditions as the Trustee shall deem fair and equitable. G. The Trustee shall be authorized to sell or purchase, at the fair market v lu as determined by the Trustee, any property to or from Settlor's estate, the estate of Se tl is spouse, or any trust created by Settlor or Settlor's spouse during life or by will, even thou a same person or corporation may be acting as executor of Settlor's estate or the estate of a lor's spouse or as trustee of any other such trusts and as the Trustee of this Trust. ~, I, H. The Trustee shall have discretion to determine whether items should be c arged or credited to income or principal or allocated between income and principal as the T tee may deem equitable and fair under all the circumstances, including the power to amorti a or fail to amortize any part or all of any premium or discount, to treat any part or all of the ro it resulting from the maturity or sale of any asset, whether purchased at a premium or at a dis o t, as income or principal or apportion the same between income and principal, to appo io the sales price of any asset between income and principal, to treat any dividend or other dis ution on any investment as income or principal or to apportion the same between income o p 'ncipal, to charge any expense against income or principal or apportion the same, and to pro id or fail to provide a reasonable reserve against depreciation or obsolescence on any asset su 'e t to depreciation or obsolescence, all as the Trustee may reasonably deem equitable an j st under all of the circumstances. 5.02. Actions and Voting by Trustee. When the authority and power u d r this Trust is vested in two (2) or more Trustees or Co-Trustees, the authority and powers are to be held jointly or individually by the Trustees or Co-Trustees such that any or all of the T sees may act to bind this Trust. 5.03. Trustees Power to Deal witb Environmental Hazards. The T to shall have the power to use and expend the trust income and principal to (i) conduct enviro tal assessments, audits, and site monitoring to determine compliance with any enviro ental law or regulation thereunder; (ii) take all appropriate remedial action to contain, clean u o remove any environmental hazard including a spill, release, discharge or contamination, eithe o its own accord or in response to an actual or threatened violation of any environmental la rxegulation thereunder; (iii) institute legal proceedings concerning environmental hazards or o test or .settle legal proceedings brought by any local, state, or federal agency concerned with a vi onmental compliance, or by a private litigant; (iv) comply with any local, state or federal a n y order or 7 court order directing an assessment, abatement or cleanup of any environmental hazards; and (v) employ agents, consultants and legal counsel to assist.or perform the above undertjak~ngs or actions. Any expenses incurred by the trustee under this pazagraph may be chazgeld ajgainst income or principal as the trustee shall determine. ARTICLE VI. SPENDTHRIFT' PROVISION 6.01. General Provision. No beneficiary shall have the power to anticip~at~, encumber or transfer his interest in the Trust Estate in any manner other than by the valid ex rc'se of a Power of Appointment. No part of the Trust Estate shall be liable for or charged any debts, contracts, liabilities or torts of a beneficiary or subject to seizure or other process y y creditor of a beneficiary. ', ARTICLE VII. CONSTRUCTION OF TRUST 7.01. Choice of Law. This Trust shall be administered and interpreted with the laws of the Commonwealth of Pennsylvania. 7.02. Code. Unless otherwise stated, all references in this Trust to secti n d chapter numbers aze to those of the Internal Revenue Code of 1986, as amended, or corres o cling provisions of any subsequent federal tax laws applicable to this Trust. 7.03. Other Terms. Unless the context otherwise requires, the use of o e r more genders in the text includes all other genders, and the use of either the singulaz or h plural in the text includes both the singulaz and the plural. 7.04. Captions. The captions set forth in this Agreement at the beginni ~g f the various divisions hereof are for convenience of reference only and shall not be de m d to define or limit the provisions hereof or to affect in any way their construction and applic ti n. 7.05. Sites of Trust. The Trust shall have its legal situs in Cumberland Pennsylvania. ARTICLE VIII. COMPENSATION OF TRUSTEE AND APPOINTMENT OF SUCCESSOR TRUSTEE 8.01. Compensation. The Trustee shall receive as its compensation for h ~ services performed hereunder that sum of money, based on an hourly chazge or percentage ra a which the Trustee normally and customarily charges for performing similar services during a time which it performs these services. 8.02. Removal of Trastee. Settlor may remove the Trustee, at any time Ibr times, with Ii 8 or without cause, upon thirty (30) days written notice given to the current Trustee., Upon the death of the Settlor, a majority of the current beneficiaries may remove the Trust, ~t any time or times, with or without cause, upon thirty (30) days written notice given to the ru tee. Upon the removal of the Trustee, a successor Trustee shall be appointed in accordance v}~it~i the terms set forth in Paragraph 8.03. ', i 8.03. Appointment of Successor Trustee. The Trustee may resign at y ime upon thirty (30) days written notice given to the Settlor if Settlor is living, or in the evaer~t f Settlor's death, upon thirty (30) days written notice given to the current beneficiary or bene 'a-ries (including a beneficiary's natural or legal guardian or legal representative), hereon a .Upon the death, resignation, removal or incapacity of the Trustee, a successor trustee may pointed by the Settlor during Settlor's lifetime, or, after Settlor's death, by a majority of the c nt income beneficiaries. A Trustee may be any individual appointed by the Settlor or, after t e death of the Settlor, by any then-currently serving Trustee. Any successor trustee thus appoint d, off, if the Trustee shall merge with or be consolidated with another corporate fiduciary, the s ch corporate fiduciary, shall succeed to all the duties and to all the powers, including discretio powers, herein granted to the Trustee. Unless otherwise designated by the Settlor during h's 1 fetime, the successor Trustees shall be the Settlor's children, TODD H. SMITHSON and II.Y A. FREY. 8.04 Ezoneration of Trustee. No Trustee shall be liable for any loss o d preciation in value sustained by the Trust as a result of the Trustee retaining any property up n hich there is later discovered to by hazardous materials or substances requiring remedial acti n p~w~suant to any federal, state, or local environmental law, unless the Trustee contributed to th 1 ss or depreciation in value through willful default, willful misconduct, or gross neglige c . 8.05 Indemnification of Trastee Upon Distribution. Notwithstandir provision in this Trust Agreement, the Trustee may withhold a distribution to a b receiving from the beneficiary an indemnification an agreement in which the ben to indemnify the Trustee against any claims filed against the Trustee as an "owne under the Comprehensive Environmental Response, Compensation and Liability from time to time amended, or any regulation thereunder. ARTICLE IX. PERPETUITIES CLAUSE 9.01. General Provision. Notwithstanding anything to the contrary in ti disposition I have made here, legal or equitable, to the extent it can be referred in postponement of becoming a vested interest to a duration measured by some life c at the time of my death is definitely to vest in interest, although not necessarily in later that twenty-one (21) years after such lives (and any period of gestation invol extent it cannot be referred in any such postponement to such lives, is to so vest n twenty-one (21) years from the time of my death. ,~ contrary ciarv until ary agrees "operator" of 1980, as rust, each ;s in being ;ssion, not or, to the ~r than 9 ARTICLE X. ', ACQUISITION OF UNITED STATES TREASURY BONDS' ELIGIBLE FOR TAX PAYMENT; PAYMENT OF TAXES, FUND EXPENSES, AND EXPENSES OF ADMINISTRATION ', 10.01. Acquisition of Bonds. The Trustee may, at any time, without the ri t approval or direction of the Settlor and whether or not the Settlor is able to manage Settlor' o affairs, acquire United States Treasury Bonds selling at a discount, which bonds are redee tale at their par value plus accrued interest thereon for the purposes of applying the proceeds t ~ payment of the United States estate tax on the Settlor's estate; and the Trustee may borrow o 'any lender, including itself, with or without security, to so acquire these bonds. 10.02. Payment of United States Estate Taz by Bond Redem 'on. Thee Settlor directs that any United States Treasury Bonds which may be redeemed at their paz~ v lie plus accrued interest thereon for the purpose of applying the proceeds to the payment o e United States estate tax imposed on the Settlor's estate, and which are held by the Trustee s all, to the extent of the amount determined to be required for payment of the estate tax, be d's 'buted to the legal representative of the Settlor's estate to be used by the legal representative ah cif any other assets and to the fullest extent possible to pay the estate tax. ~ ~, 10.03. Payment of Death Tazes and Other Estate Settlement Costs. A e the Trustee has complied with pazagraph 10.02, above, and ascertained from the legal represe to irre that alI such bonds have been redeemed in payment of the United States estate tax, the T st shall also ascertain from the legal representative whether the legal representative has suffici nt assets to pay the remaining legacy, succession, inheritance, transfer, estate and other death ~ or duties (except the additional estate tax imposed by Section 2032(c), or corresponding pr vi ions of the Internal Revenue Code of 1986 applicable to the Settlor's estate and imposing the ) !levied or assessed against the Settlor's estate (including all interest and penalties thereon), 1 f',which taxes, interest and penalties are hereafter referred to as the death taxes, interest an tpalties. If the legal representative advises the Trustee that insufficient funds exist to pay all a death taxes, interest and penalties, the Trustee shall then pay to the legal representative from t st property, an amount equal to all the death taxes, interest and penalties in excess o th funds available to the legal representative for this purposes, which payments are to be m d without apportionment. In making the payments, the Trustee shall use only those assets or th ~r proceeds which aze includable in the Settlor's gross estate for purposes of the United States s ~e tax and shall not impair the marital portion without first exhausting the entire non-marital o ion. If the Executor of the Settlor's estate, in such Executor's sole discretion, sh~ll determine that appropriate assets of Settlor's estate are not available in sufficient amount top y (l) the Settlor's funeral expenses, and (2) expenses of administering the Settlor's estate, t e rjustee shall, upon the request of the Executor of the Settlor's estate, contribute from the p i opal of the trust estate the amount of such deficiency; and in connection with any such action Trustee shall rely upon the written statement of the Executor of the Settlor's estate as to th v l~dity and 10 correctness of the amounts of any such expenses, and shall furnish funds to such ~ to enable such Executor to dischazge the same, or to discharge any part of all there making payment directly to the person entitled or claiming to be entitled to receive thereof. No consideration need be required by the Trustee from the Executor of S~ for any disbursement made by the Trustee pursuant hereto, nor shall there be any c such Executor to repay to the Trustee any of the funds disbursed by it hereunder, 2 disbursed by the Trustee pursuant to the authority hereby conferred upon it shall b without any right in or duty upon the Trustee to seek or obtain contribution or reir, from any person or property on account of such payment. The Trustee shall not b• for the application of any funds delivered by it to the Executor of the Settlor's esta the authority herein granted, nor shall the Trustee be subject to liability to any ben hereunder on account of any payment made by it pursuant to the provisions hereof IN WT1'NESS WHEREOF, the Settlor and Trustee have hereunto set seals as of the day and year first above written. WITNESS: _ i .._.... ! ~} 9 4 ~~- w. COMMONWEALTH OF PENNSYLVANIA ' / /' SS: COUNTY OF ~'I! L~ ~~ ~~L ~- ~ On this, the ~ ~ A day of December, 2009, before me, a Notary Public, officer, personally appeared ROSS W. SNIITHSON, known to me (or satisfac be the person whose name is subscribed to the within Trust Agreement, and ac he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have set my hand and official Seal. COMMONWEALTH OF PENNSYLVANI Ncp~tid Seer Terl L Wllpox, Nckaay Pubic Lemoyne Sao, Cumberland Cou14- MyOoerninion E~Yes Jan. 24, ffiI~ Maa~bsr, PeansyAmnia Aaootatlon of NoMeNs cutor so as itself by yr's estate gation upon all amounts to and ~) to that ll The foregoing Trust Agreement was deli Pennsylvania, on December 3 , 2009. WITNESS: ~° ~d-- ''~- . v~ \ 7 1~ _~_-. ~ _. SCHEDULE"A" SCHEDULE tRED TO IN THE ANNEXED TRUST AGREEMENT DATED: DECEMBER ~ , 2009 FROM ROSS W. SNIITHSON, SETTLOR TO ROSS W. SMITHSON, TODD H. SMITHSON, and KELLY A. FREY, each as PROPERTY DESCRIPTION: 13 PA REV-1500 SCHEDULE E ''~~~~ CASH, BANK DEPOSITS ~ MISCELLANEOUS PERSONI PROPERTY Q.~~r~vNB~~:~. A 7radit.ion of E~eller~ce ', June 11, 2010 Gates, Halbruner, Hatch & Guise, P.C. 3 West Monument Square, Suite 304 Lewistown, PA 17044 Attention: Valerie Long, Paralegal Shirley Wescott Orrstown Bank PO BOX 250 Shippensburg, Pa 17257 Phone 717.530.2515 Re: Estate of: Ross W Smithson Date of Death: April 10, 2010 IT IS HEREBY CERTIFIED THAT THE ABOYE NAMED DECEDENT, ON THE A~ FOLLOWING ACCOUNTS WITH OR~tSTOWN BANK: CERTIFICATE OF DEPOSIT Account # Title of Account Date opened Principal Accrued Interest 4000033227 Ross W Smithsan 6/01/49 57,140.40 47.20 Best re ards, ;~-~~~ S14irley Wescott Receptionist East King Street ~oaensbura. PA 17257 ATE, HAD THE al YTD Int ~, X7.60 $630.13 Editors' Rating ==%13ot Yet Rated {Read the Model Review 8.3 `, _.. Consumer Rating 51~Rjeviews ~Wri1e a Review `D Fuel Economy 21 mpg YENiCLE iP0713GiT SPr~r>rd5 caxm:~ " AIr10-IOIIIE rIE7WOPJC gEW6LET11Bt: Shor.M• the CARFAXi ........ 3..._ ... lion lle Today! itnd out hOr msry °' '~"', Oet inc•ndws. nco.ds exixt on '= d' -: " fi•e Woos. road • used Carr .,~~° - ~..~+~' t•ses, sPY ghats a ~. '111< .,.r:~ auto rMrs. Buying 6 Selling AFWR~iIY CIILCIB.llTtllt Find oa! hor mr,~vou on alrord - ~: TRUE MARKET ..Find Out ItNlat I T•/ us your d.si..d For The Car Ya VYitll Edmmnds T mortldY DaYmamt 8 " ~! price estimate W get • Prba ranq• for car. and your de your n•xt wr. ., novsKr:ae,:cw. t1Lllg a custom/zed ~``~ >;p Code, yourf f• • VIB1N AN Stykta • s~rcn Usk BWCk Listings • Aute Loans sa bw L as 3.95% APR • Appraise YOUf C.af • Sati Your Car Online • a•t a Bad [r~di[ r Lean • Prices in Yotu Area . Resale vak,ea . 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Search 2002 Buick Century Listings Near You Zip Code: 17011 11~ Ratsli 54,087 50 S-t e 515 i ~~~ ~ ~~'. ' 51.059 , Crr QHaatio+ta 8 ietp tlhad So ! '~ISlI I Cr11YY ' ' ! Sa,143 wa 'i Aak a-Vttiar1011 _ 11 Truck MMiyan /Van Luxury Hybrid TIPS R ADVICE Latest News br Car S Edmunds Daily 70 Steps W Buying a ar Browse try Make: Now Car Buying s New Car BuILvtg_Guides: Select a Make A Smart Look at WhaYs New for 2009 Best Cars Inskler Sets ~~ ;Flow Muds Car Can Y `s'~,~,,,,,,'r ~NerRo BANK 3801 Paxton Street Harrisburg • PA • 17111 mymetrobank.com 888.937.0004 l December 2, 2010 Gates, Halbruner, Hatch & Guise PC 1013 Mumma Rd Suite 100 Lemoyne PA 17043 RE: Estate of: Ross W. Smithson Tax identification Number: 190-12-2163 Date of Death: April 10, 2010 i To-Whom It May Concern: This letter is in reference to decedent account information you requested for the individual listed ab ve. We are able to provide the following: Account Type: Checking Account Number: 32073959 Date Opened: 04/07/1997 Primary Owner: Ross W. Smithson Secondary Owner: Nina H. Smithson (deed) Date of Death Balance: $310.61 Please feel free to contact me at (717) 412-6127 if I may be of further assistance. Sincerely, Diana Reynolds -- Metro Bank Research Associate/Deposit Services PA REV-1500 SCHEDULE F JUINTLY OWNED PRUPERr i Integrity ,./ Fnday, June 18, 2010 s A N K Law offices of Gates, Halbruner, Hatch & Guise, P.C. 1013 Mumma Road Suite 100 Lemoyne, PA 17043 RE: Estate of Ross W. Smithson Date of Death: April 10, 2010 Valerie, My name is Ronak Patel and I am a customer service representative with I am writing back in response to your recent request for date of death. infi above mentioned estate. Below you will find the requested information. 1. The account is titled Ross W. Smithson 2. The joint owner on the account is Todd H. Smithson 3. The customer had two accounts a checking account and a money marl The checking account was established on 08/01/2006 and the money ~ account was established on 04/27/2009. 4. No changes were made to the account within the last year previous to customer's death. 5. The checking account had a date of death balance of $23,391.78 and ~ market account had a balance of $11,729.18. 6. The interest earned on the checking account from January 1 to April $74.85 and on the money market the amount is $48.50. 7. The customer had no credit or loan accounts. If you have any other questions please do not hesitate to contact me at (717) extension 233. Sincerely, ~` G%~~~/`' Ronak R. Patel t `~ Customer Service Representative Integrity Bank 3345 Market Street Camp Hill, PA 17011 (717} 920-4900 ext. 233 Bank. for the account. money 10 is ~~ ~~ ~,- ~, 1345 Market Street, Camp Hill, PA 17011 • Rhone: 717-920-4900.877-1-HAVEIT • Fax: 717-920-4904 • www. PA REV-1500 SCHEDULE G INTER-VIVOS TRANSFERS MISCELLANEOUS NON-PRO. PROPERTY d .TE Allianz Life Insurance Company of North America PO Box 59060 Minneapolis, MN 55459-0060 800/950-1962 JULY 7, 2010 ESTATE OF ROSS W SMITHSON C/O GATES, HALBRUNER, HATCH & GUISE PC 1013 MUMMA ROAD #100 LEMOYNE PA 17043 Re: Ross W Smithson, deceased Dear Executors}: Alliar~~ ~ti This letter is in reference to your request for information on policy nur~ 70734508. • Title of Account: Ross W Smithson, annuitant and owner ~I • Names of Beneficiaries: Todd Smithson and Kelly Frye, equall}~ • Effective Date of Policy: 5/1 /09 • No Change in Ownership from the effective date • Date of Death Value as of 4/10/10: $88,741.58 • No interest accumulated until distribution is taken -tax deferrer • Not a credit or loan account. Should you have any questions, please feel free to contact our office. you. Sincerely, Cindy Drawert Sr. Claim Examiner Allianz Annuity Claims r(s) nnuity. - ~ r ~ _ _ _ f ~ ~r_-} ~'. L~_. . F Prepared Uy and Return tu: Craig A. Hatcf~, Esq. Gates, Halbruner cC Hatch, PC I U 13 Mumma Road, Suite 1 I UU Lemoyne, PA 17U43 TAX PARCEL NO. U9-20-1850-U55 EAST PENNSBORO TOWNSHIP DEED THIS DEED is made the 3'~ day of December, in the year two thousand nine BETWEEN ROSS W. SMITHSON, now of 510 Susan Road, Camp Hill, Pennsylvania, l 7011, party of the first part, GRANTOR, AND County, ROSS W. SMITHSON, widower, now of 510 Susan Road, Camp Hill, Cumb 1 d County, Pennsylvania, 17011, TODD H. SMITHSON, married man, now of S Carria e Road, New Cumberland, York County, Pennsylvania, 1707fl, and-IfELLY A.-FREY, married o an, now of 424 Spring Hollow Drive, New Holland, Pennsylvania, 1757, Trustees of THE S ITHSON FAMILY TRUST, parties of the second part, GRANTEES. WITNESSETH, that said party of the first part, for and in consideration of the sum Dollar, lawful money of the United States of America, well and truly paid by the sai second part to the said party of the first part, at or before the sealing and delivery of the receipt whereof is hereby acknowledged, has hereby granted, bargained, sold, alie released, com~eyed and confirmed, and by these presents does grant, bargain, sell, release, convey and confirni unto the said parties of the second part, theirs heirs, assigns, ALL THAT CERTAIN piece or parcel of land, situate in the Township of East P~ of Cumberland and Commonwealth of Pennsylvania, more particularly bounded follows, to wit: BEGINNING at a point on the Western line of Susan Road which point is at the between Lots No. 67 and 68 on Plan of Lots hereinafter mentioned; thence South s degrees, thirty-seven (37) minutes, thirty (30) seconds West and along the dividing lin Nos. 67 and 68 on Plan of Lots hereinafter mentioned, a distance of one hundred tw sixty-two hundredths (123.62} feet to a point at the extreme northwest corner of Lot of Lots hereinaftermentioned;thence Souththirty-seven (37) degrees, forty-three (43} ne($1.00) 'ties of the presents, enfeoffed, r~, enfeoff, ~ssors and County -ibed as riding line -eight (68) wveen Lots -three and 70 on Plan cites, thirty (30) seconds East and along the dividing line between Lots Nos. 68 and 7U, a dist~n~e of seventy- five and seventy-seven hundredths (75.77) feet to a point at the dividing line between Lots No. 68 and b9 on Plan of Lots hereinafter mentioned; thence North seventy-nine (79} d~gilees, five (US) minutes East and along the dividing line between Lots Nos. 68 and 69 on the Plan o L is hereinafter mentioned, adistance ofninety-two and zero hundredths (92.00} feet to a point on h Western line of Susan Road; thence North ten (10) degrees fifty-five (55}minutes West and al n the Western line of Susan Road; adistance offorty-two and thirty-six hundredths (42.36) feet t a point; thence continuing along the western Iine of Susan Road and on a curve to the Left who a adius is two hundred fifty (250) feet adistance offorty-eight and zero hundredths (48.00) feet to pint, the place of BEGINNING. BEING Lot No. 68 on Plan of Lots known as Part of Country Club Park which PI n is recorded in the office of the Recorder of Deeds in and for Cumberland County in Plan Book 1 age 12. HAVING THEREON erected a dwelling house known and numbered as 5 ] 0 Swan Road. UNDER AND SUBJECT NEVERTHELESS, to restrictions, conditions and eas~rr~ents of prior record pertaining to said premises. I~ ~ BEING the same premises which Scott F. Fones and Ruth P. Fones, by deed dated ay 24, 1979, and recorded in the Recorder of Deeds Office in and for Cumberland County, Penns lv ia, in Deed BookL28, page l 74, granted and conveyed unto Ross W. Smithson and Nina H. Sm'th on, husband and wife. Nina H. Smithson departed this life, thereby vesting complete title under pe~ration of law to Ross W. Smithson, Grantor herein. THIS IS A TRANSFER FOR NOMINAL CONSIDERATION TO A TRUSTEE OF AN O I ARY TRUST WHERE THE TRANSFER OF THE SAME PROPERTY WOULD BE EXEMPT IF THE T SFER WAS MADE DIRECTLY FROM THE GRANTOR TO ALL OF THE POSSIBLE BENEFICIAR E THAT ARE ENTITLED TO RECEIVE THE PROPERTY OR PROCEEDS FROM THE SALE OFT E PROPERTY UNDER THE TRUST AND IS THEREFORE EXEMPT FROM THE PAYMENT OF RE T~ TRANSFER TAX. TOGETHER with all and singular the buildings and improvements, ways, streets, a passages, waters, watercourses, rights, liberties, privileges, hereditaments and whatsoever unto the hereby granted premises belonging, or in any wise apper reversions and remainders, rents, issues, and profits thereof; and all the estate, rig: property, claim, and demand whatsoever of the said Grantor, as well at law as in e~ to the same. TO HAVE AND TO HOLD, the said lot or piece of ground above-described, with the buildings and improvements thereon erected, hereditaments and premises her mentioned and intended so to be, with the appurtenances, unto the said Grantees, assigns, to and for the only proper use and behoof of the said Grantees, their he forever. driveways, urtenances, ig, and the le, interest, ,'of, in, and end singular granted, or it heirs and end assigns AND the said Grantor, for himself, his heirs, executors and administrators, does cov~na~nt, promise and agree, to and with the said Grantees, their heirs and assigns, by these presents, Grantor, and his heirs, all and singular the hereditaments and premises hereby grants and intended so to be, with the appurtenances, unto the said Grantees, their heirs and him, the said Grantor and his heirs, and against all and every person and persoi lawfully claiming or to claim the same or any part thereof, by, from or under him,1 of them, shall and will, subject as aforesaid, SPECIALLY WARRANT Ar DEFEND. IN WITNESS WHEREOF, the said party of the first part has hereunto set his day and year first above-written. SIGNED, SEALED AND DELIVERED IN THE PRESENCE OF --~ .~9 Gl"'-`z CE'SMMONVi~EALTI~ OF PENN/SYLVA~NIA COUNTY OF ~• ~'z~, 1 } ~'-~~~,~ ~"~.~ 1 C{'`' vkL'1 ~ /• ROSS W. SS: a4 he, the said r mentioned ss~gns, against homsoever r, them or any OREVETL d I d seal, the r. '4 ~ .~ ~~ On this, the J~~day of December, 2009, before me, a Notary Commonwealth of Pennsylvania, the undersigned officer, personally appearE 5MITHSON, known to me (or satisfactorily proven) to be the person whose name i tl~e within instrument, and acknowledged that he executed the same for the p contained. IN WITNESS WHEREOF, I hereunto set my CONgNONWEALTH OF PENNSYLVANIA Notarial Seal Teri L WaAcer, Notary PubYc lr3rrtoyrre eoro, Qrrriberland catxity Mr forrxniesion E>~ires Jan. a0. 209 t Member, Pennsylvania Association of NOtades mud-official seal. ~. (~?. Commission Expires: CERTIFICATE OF RESIDENCE 1 hereby certify that the present residence of the Grantees herein is as follows: The Smithson Family Trust Ross W. Smithson, Trustee 510 Susan Road r ~ -~' Camp Hill, PA 17011 ~ --; `'.~~~~`~'~`-~ Attornev'for Grantees lic for the ROSS W. bscribed to ase therein ROBERT P. ZIEGLER RECORDER OF DEEDS CUMBERLAND COUNTY 1 COURTHOUSE SQUARE CARLISLE, PA 17013 717-240-6370 d Instrument Number - 201001003 Recorded On 1/12/2010 At 11:03:09 AM * Total Pages - 5 * Instrument Tyke -DEED Invoice Number - 59166 User LD - JM * Grantor- SMITHSON, ROSS W * Grantee - SMITHSON, ROSS W * Customer -GATES HALBRUNER ET AL * FEES STATE WRIT TAX $0.50 Certification P STATE JCS/ACCESS TO $23.50 JUSTICE DO NOT DET. RECORDING FEES - $12.50 RECORDER OF DEEDS This page is nova PARCEL CERTIFICATION $10.00 FEES of this legal docu AFFORDABLE HOUSING- $11.50 COUNTY ARCHIVES FEE $2.00 ROD ARCHIVES FEE $3.00 EAST PENNSBORO SCHOOL $0.00 DISTRICT EAST PENNSBORO TOWNSHIP $0,00 TOTAL PAID $63.00 I Certify this to be recorder in Cumberland County PA ~~ t. a * - Information denoted by an asterisk may changedn~ing the verification process and may not be rellcct o this page. IIUIIINNIYIIII~~ PA REV-1500 SCHEDULE H FUNERAL EXPENSES and ADMINISTRATIVE COST wmm.~wvrciu~n ~r rrnnarwwnr~ REV-11H2 EX~11-96) OEPARTMBdT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. ~~ 013033 SMITHSON TODD H 5 CARRIAGE ROAD NEW CUMBERLAND, PA 17070-2302 ESTATE INFORMATION: SSN: .190-12-2163 FILE NUMBER: 2110-0497 DECEDENT NAME: SMITHSON ROSS W DATE OF PAYMENT: 07/08/2010 POSTMARK DATE: 07/08/2010 COUNTY: CUMBERLAND DATE OF DEATH: 04 j 10/ 2010 REMARKS: SEAL CHECK# 495 TOTAL AMOUNT ACN ASSESSMENT CONTROL NUMBER ~I 'MOUNT ~, _____ 101 ~ S dl•, 000.00 i I PAID: GLENDA EARNER S $ ~ R 4,000.00 '~ SBAUGH REGISTER OF WILL I'~ li I~ II~ ~, INITIALS: DM RECEIVED BY: TAXPAYER 0042 Server: AM BAR A (#753) Rec: 13 04/18/10 15:57, Swiped T: 72 Tere: 4 ELEPHANT AND CASTLE CHECK OUT OUR. ENTERTAINMENT SCHEDULE (717)774-2721 MERCHANT #: CARD TYPE ACCOUNT NUMBER DISCOVER XXXXXXXXXXXX4650 NaNe: TODD SMITHSON 00 TRANSACTION APPROVED AUTHORIZATION #: 018785 Reference: 0418010000042 TRANS TYPE: Credit Card SALE CHECK: 640.69 TIP : C). ~"? TOTAL : 2.~ _. ~6 X PHONE: ( ) - ***Duplicate Copy*** CAR~iOLDER WILL PAY CARD ISSUER ABOVE AMOUNT PURSUANT TD CARDHOLDER AGREEMENT Sign ~ Copy & Keep a Copy for Your Records ~~ NtIER CNQNiTIQI SERYIGES OF Pq HIWR(SBI/ui. PA 17369 PIM~E N(7173 546-4681 4~6. ~ ,~1ER CREMATION SERVICES OF PENN~S'~'LVANIA, INC. Ikrchani ID: 89617866 ~~ ~~ 0 Jonestown Road • Harrisburg, PA 17109 • 1-800-720-8221 • Fax 717-541-994 haan E. Carper, Supervisor ~~ ,~~~~~ Dlsco~ ~ ~ C`u~ ~ ^~ ~ tote s ~ss~ ~~ ~- ~~~.~-~ ~:~:~ ~: ~ coat: ~PPMd: Unllat CID Cody: l~1CN M tare( you! Apr 11, 2@10 Mr. Todd H.~Bmithaon 5 Carriage. Road. New Cumberland, PA 17070 SPECIAL CHARGES X Direct Cremation Nationwide Guarantee Program. Worldwide Travel Protection TOTAL, SPECIAL CHARGES 100411 SP-5 ~. ,. ; 51,4~5~.00 ', PROFESSIONAL SERVICES X Services of Funeral Director & Staff Other Preparation of the Body Facilities & Staff for Memorial Service Staff & Equipment for Memorial Service Witnessing the Cremation Private Faaily Viewing/Witnessing Cremation Packaging And Forwarding Cremated Remains Personal Delivery of Cremated Remains Scattering of Cremated Remains .. Medical Documents./Courier Fee TOTAL PROFESSIONAL SERVICES AUTOMOTIVE EQUIPMENT ~ ~' X Removal Veh i c 1'e Inc ~ u~ied Lead Car/Clergy Car ~ ', Family Car ~~ Service Vehicle TOTAL AUTOMOTIVE EQUIPMENT lil ...-- - z~ .~~Z -- -,~~ '~ '~~ "7 Z U ~~ R l~Z ~~z . .. ._...... $0.@0 MERCHANDISE Register Book Memorial Cards Thank You Cards Remeabrance Package Cremation Container % Cardboard Container Urn Burial Vault Veterans Fiag Case Grave/Memorial Marker TOTAL MERCHANDISE CASH ADVANCED ITEMS Grave Opening Cesetery Equipaent X Harrisburg Patriot News X York Newspapers Vault Service Charge Clergy Church/Organist/Soloist Flowers X Crematory Charge X Cumberland County Coroner Fee X 22 Certified Copies of Death Certificate $0.00 '~ $1> i .,22 $1 .7$ i Inc l ded $ .00 $1 .00 TOTAL CASH ADVANCED ITEMS _-:+ c -.. SUMMARY OF CHARGES Special Charges $1,495.00 ~~ Frofessional Services $0.00 _ ~-~:~:• -~ ~,~i, Automotive Equipment -$®~.00 Merchandise $0.00 ~j Cash Advanced Items $413.92 ~ - - -. ~~ _ .h SUB TOTAL ~ $1, 908.92 :~ -r ;~~ ~~ ;. ~, ,~~. CREDITS -:$640.00 --.,1 AMOUNT PREPAID Date Oct 28, 2002 -$.940..00. _ _ . ~_~ ~ :~'~ TOTAL $328.92 - - ~• ~i AMOUNT PAID Date Apr 15, 2010 -$328.92 I~ BALANCE DUE $0.00 ,. _.~ $413.92 THIS STATEMENT MAY NOT REFLECT ALL NEWSPAPER RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 SMITHSON ROSS W Receipt Da e, Receipt Ti el, Receipt No ~~ I Estate File No.: 2010-00497 Paid By Remarks: T SMITHSON JN ------------------------ Receip t Distribution ------ ---- Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 135.00 CUMBERLAND COUZ WILL 15.00 CUMBERLAND COUZ SHORT CERTIFICATE 40.00 CUMBERLAND COUZ JCS FEE 23.50 BUREAU OF RECE: AUTOMATION FEE - 5.00 CUMBERLAND COUI -------- Check## 487 $ -------- 218.50 , Total Received......... 218.x0 5/13/2010 13:28:18 1061104 GENERAL~FUN GENERAL FUN GENERAL FUN & CNTR M.D GENERAL FUN ayU,~~i PROOF OF PUBLICATION State of Pennsylvania, County of Cumberland q~vn,ucnbegand, PA t7070-2302 i ~'~~ A. ,HATCH, fSflU1RE :'Hal6runer & Hatch; P.C. " eys for Nu Estats Mumm~na Road, Suite 100 e, FA 17t>x3 Notary James Kleinklaus, Director of Sales and Marketing,, of The Sentinel, of the Co State aforesaid, being duly sworn, deposes and says that THE SENTINEL, a ~ of general circulation in the Borough of Carlisle, County and State aforesaid, established December 13,1881, since which date THE SENTINEL has been issued in said County, and that the printed notice or publication attached hey exactly the same as was printed and published in the regular editions and is~ THE SENTINEL on the following day(s): Tune 5, Tune 12 and Tune 19, 2010 COPY OF NOTICE OF PUBLICATION ESTA'€t?~NOTiCE ~ ~ ~~ r ~ ~~ Affiant further deposes that he/ interested in the sub'ect matter c #+X for the Estate of Rt95S W. SIA~, - em"s~°ro Tewnshlp, conterland-C,' aforesaid notice or advertisemel ~aitia, htGih' en granted tgthe undersigned on M~~Oto. ~;,nd~ed t°-the E's~ ~re reer,est°d tq rriake imr„e~~tf~QQymeAt all allegations 1n the foregoing s ~s Neving ciao 8ya~nst the Estate are requestai)sfb pres'~nt ttieri5 t0 time lace and Character Of iBment wi~a,t aeCay~tp: _ , P P soK end are true. /~ / »w; Co-Ezectitors . ~ .~ eta I and is of is not that nt as Sworn to and subscribed before ~e Ithis My commission expires: dAMrl t'~CIOENOORN NoUry PrrMlc CMLISIE BOROUGH. CUMBERtJWD C My Commission ExphES Jan 2T, 201d CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (71 ~ 249,3188 Fex: (717) 249-2863 ~, June 18, 2010 Cumberland Law Journal is published every Friday by the Cumber Bar Association and is designated by the Court of Common Pleas as the publication for Cumberland County and the legal newspaper for publicatic notices. TO: Craig A. Hatch, Esquire Ross W. Smithson Estate RE: Legal advertisements must be received by Friday Noon. All legal must be paid in advance. Make all checks payable to: Cumberland Law ------------------------------------------------------- ------------------------------------------------------- Advertisement inserted on following dates: June 4, June 11, and June 18, 2010 Advertising Cost $ Proof of Publication $ Second Proof Request $ Payment received $ Total Amount Due $ County al legal legal Becky H. Morgenthal, Executive Director PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of i State aforesaid, being duly sworn, according to law, deposes and says that the C! Journal, a legal periodical published in the Borough .of Carlisle in the County an~ was established January 2, 1952, and designated by the local courts as the officio periodical for the publication of all legal notices, and has, since January 2, 1952, issued weekly in the said County, and that the printed notice or publication attar: exactly the same as was printed in the regular editions and issues of the said Cure Journal on the following dates, June 4, June 11, and June 18, 2010 mty and !red Law aforesaid, n regularly hereto is •land Law Affiant further deposes that he is authorized to verify this statement by th C~linberland 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 fore oing statements as to time, place and character of publication are true. ~ ~, •- Marie Coyne, SWORN TO AND SUBSCRIBED 18 dayof June, 2010 me this Smithson. Ross W., deed. Late of Eaat Pennsboro Town- ship. Co-Executors: Todd H. Smithson and Kelly A. Frey, 5 Carriage Road, New Cumberland, PA 17o7o-a3oa. Attorneys: Craig A. Hatch, Es- quire, Gates, Halbruner 8~ Hatch, P.C., .1013 Mumma Road, Suite 100. Lemoyne, PA 17043. Notary NOTARIAL SEAL DEBORAH A C Notary- Public CARLISLE BOROUGH, CIDER Cat~l7lr MY Commission Expires 28 21D14 r ro a° '~~_ P,~L~E~ectl~ic ,E,°°- ~~ Utitifies Electric Service For_ ROSS W 5MI'CHSON slo sllsAx RD LOT 68 CAMP HILL PA 1701 S Qaes~s moat this bill? Please contact us ~ 21 at 1-~0-34~-5775 (1~N-DYAL-PPL) or write toz C®atomer Service 827 Htatsman Rcl AlIerttywn~, PA I8104-9392 www.pplelecenic.cam Electric Use This gisph shows your electric use ova the last l3 months Rea~gs: Actual - AdNsted . Estimated ~` Customer Q Page 1 53830-82009 ~ lam= Sammary Page lial:ace ~ of Mry s, solo Sooo ~PL ELECTRIC UTII.ITlE5 Charges 519.13 ~I '', Total Charges 519.13 ~ Accaant Balance KWIi - Aveaage Pea Day 24 20 16 12 8 4 0 Me4r lteadi~ Wora>atioe A~pc 6 Actual 29 KWH Billed Aevler~asae -May 2009 KWFI P Day ~7 Yearly Use: Total Use Juu 2008 -May 2009 z86s Jun 2009 - Msy 2010 2008 M37ASONDJFMAM 2009 Moatls ZOlO .7S.it'31 ~ ~~ 11 ~ ~ ' ~f ~; i~i`v 53830-82009 AY 01 008373 75410E 40 A'"5067 ROSS W SMRHSON 510 SI3SAN RD LOT 68 CAMP HILL PA 1 70 1 1-2059 Auto Pay PPL ELECTRIC IJ'TII 1TIES 2 NORTH 9TH STREET RPC~~rENN l I ~~! ALLENTOWN PA 18101-1175 dnll~ll~~n~l~~"~~Itilll~tdldllli~di.y~ili~l~il'II~U~IIIN 'i ~, 1 38DD0001913800D0019130 5383082009 I sl~.l~ I, ~i _. I~ Other important information on back a1 PL Electric _ ~ -~= pp~ Page 1 -~Sr: - ...~~.... .~._:.:_:~ . ~ s:Y :: tY~C ? Utllitl@5 ~ 53830-82049 Y •- Electric Summary Page Service Balance as of dnn 4, 2010 $0.00 For. 1~ Z ( ROSS W SMITHSON ~BTPPL ELECTRIC UTII.iTIES Charges $37.78 510 SUSAN RD LOT 68 CAMP HILL PA 17011 Total Charges $37.78 ', K ~ : <r ~sr~=r~r z~«~ i ~-$ ~_ r t .~. Account Balance $37. 8 Ii Questions about this biD? Please contact ns by Jun 22 ' at I-80Q342 5775 '', (1-006-DIAL-PPL) '~ er write to: Customer Service _ _ .. 827 Hausman Rd Allentown, PA ', 18104-9392 www.pplelectzic.arm Electric Use yon ele~ctn'c use over the last 13 myyoppnteehsss. Meter Readings: Actual - Adjusted Estimated customer 24 20 16 12 8 4 0 KwH -Average Pea Day Meter Readieg Information Meter 1184571963 Jun 4 Actual May 5 Adnal 3o xwH Billefl 28~ 28G z Average -Jan 2689 2A10 T tote x D 62F 7 65F 8 ~ ay Yearly Use: Total Avea Use Moe Ju12008 -Jun 2009 2857 Jul 2009 -Jun 2010 2033 3JASONDJFMAMJ 2009 l~nins zolo 16~ I Other important information on back '~ ', 53830-82009 AV 01 010404 85107E 41 A" 5D6T ROSS W SMITHSON 510 SUSAN RD LAT 68 CAMP HILL PA 17011-2059 Auto Pay ' PPL ELECTRIC LTIIIITIES 2 NORTH 9TH STREET RPC~'iENNI ALLENTOWN PA 18101-1175 "~IIII~I~III'~II'111'1~~1'II{l'1~1p11~61.lllll'INl~ll'lll~itl 1 76DDDD037786DDDOD37780 5383D82009 +<r '~ ~.~ PPL Electric Utilities Electric Service For. ROSS W SMITHSON 510 SUSAN. RD LOT 68 CAMP HILL PA 17011 Qnestlms about this bill? Please contact us Ju122 at 1-$M- 5775 (1~D!-DL~IrPPL) or write to: Castor Servi©e 827 Hauso~an Rd. Allentown, PA 18104-9392 www.pplele+cltic.oom EZeCtrlC Use This graph show yoir electric use over the last 13 eM -ter Readings: Acdisl - Adjusted . Estimated Customer PPS Summary Page Balaace as of dal 6y 2010 50.00 T~L ELECTRIC UTa,ITIES Charges $35.33 ToW Charges $35.33 Accamt Balance 24 20 16 12 8 4 0 RWH -Average Pa Day ~. __ T ~ .. _ _ Page 1 - .>== € 53830-82009 Meter Reading Wat>mtioa Meter #84571963 1 Julio Actual 1 Jun 4 Ac~aal 2 32 KWH Billed 22 Average - dul 2N9 2i1 Ted lure 70F 74 ', KWIC Per Day 8 "" LI 77 Yearly Use: Total Av Use M Aug 2008 - Jn12009 2873 Aug 2009 - Jn12010 2035 I 0 JASONDJFMAMJJ 2009 Mo>~ths 2010 Other important information on back ~ 1 53830-82009 AY 01 009477 97239C 38 A"5DGT ROSS W SMITHSON 510 SUSAN RD LOT 68 CAMP HILL PA 17011-2059 s_.._... Auto Pa~ PPL ELECTRIC UTILITIES 2 NORTH 9TH STREET RPC-GENNI Ai.LENTOWN PA 18101-1175 r441~rhI~rllPrrr~rrrbrllr~rl~r,rhrnL~~rnP~ilrlrl~rrl~r 1 90000003533fl000©035330 5383082009 e PPL Electric Utilities Electric Service For_ Ross w slvnrxsoN 510 SUSAN RD LOT 68 CAMP Ii1LL PA 17011 Qaestioss abort this bill? Please contact ns 20 at 1~A0-345 (1=S9Q-DIAL,-PPL) or write to: Customer Service 827 Hausmaa Rd- Alle,~own, PA 38it)4-9392 www_ppleiectric.com Electric Use This g~ shows your electric use over the last 13 myopntehss. Meter oReadings: Actual - Adjnsted Estimated customer - Page I `•`e?`?'f~.;-`ems. 1'i1 ~~~ .` P ~ 53830-82009 .~t ~ - Summary Page Balaecc ss of Aug 4, ZO10 50.00 Cbar es: '' Tota~PL ELECTRIC iTTILITIES Charges $43.44 ', Total Ci~rges $43.44 '~ Account Balance 24 20 16 12 8 4 RWH -Average Per Day Meter Reatl~g Lformatioa Meter #84571963 ' Aug 4 Actual Z 3 Ju16 Actual 2 29 Da s KWH Billed Aever~agae - Ang 2009 ZO1 KWIJ Per Day ~ 79 Yearly Use: Total Av Use 0 IE E i E ~ ~ t i ~ ~ ~ ~ tl ~ 2~ -A~ io00o aog6 ~'~~ 1 ~~ ASONDJFMAMJJA 2009 Months 2010 ' ' Other important information on back ~ ~' 53830-82009 AV 01 007890 072808 35 A"5DGT ROSS W SMIfHSON 510 SUSAN RD LOT 68 CAMP HILL PA 17011-2059 PPL ELECTRIC UTB,ITIES i 2 NORTH 9TH STREET RPGI'iENNI ~' ALLEIVTOWN PA 1 81 01-1 1 75 ' li ~'1~L.1111..`..1.,11'~'I~~II"11`I'11~"~Ili~~lll"~'II~I~II~~iI II 1 1400000434440000043440 5383082009 ~, 't ,_, ~_ ~0 0 ~ ~ 4 Q'f ©o . -' PPL Electric n4 pp °°-- O ^ ar o Utilities a electric Service For ROSS W SMTTHSON 510 SUSAN RD LOT 68 CAMP HILL PA 17011 Qa~stims abeat this bill? Please contact us 20 at 1-8~A-34 5 (1-DIAIrPPL) or write to: Customer Service 827 tisnausan Rd_ Alleadown, PA 18204-9332 www pplelectric_com Electric Use This gzaph.shovvs your elecfinc nse over the last l3 months. Typ~c of Meter Readings: Adjusted Estimated Customer ~] Summary Page Page 1 53830-82009 .r~~ r« Bsdaace as oi5ep ~, 201o Soon T c~aTP L Elednic Utilities Charges $32.29 Total Clnrges $32.29 rrr:rf: rr. r:rrff:frr fffffr:ffir -: ACGU1311t Balance 24 20 16 12 8 4 0 KWH - Avetage Per Day SONDIFMAMIJAS 2009 Months 2010 Meter Weramtion Meter X4571963 Aug 4 Acxual 2 3 29 s RWH Billed Average -Sep 2AS9 Z®1d~ T 74F 75R Per Day 7 Yearly Use: Totat Av Use M Oct 2008 -Sep 2009 2714 ~ Od 2009 -Sep 2010 2079 ' 1 3' Other important information on back ~ 53830-82009 AV 01 007154 16827E 32 A..SDGT ROSS W SMTfH&OPt 510 S[JSAN RD LOT d8 CAMP HILL PA 1 70 1 1-2059 ~f`f _ -_ ~ fff° PPL ELECTRIC UTII.ITIES 2 NORTH 9TH STREET RPC~.rENN l ALLENTOWN PA 18! Ol -1175 ~„1,~l~lll~la~al~ll,,~~„1,lll~.~l~~~~~~ni,~,~,,iili~i~,~,i., - ~ ?E]DOQQ03229DOODQD3229Q 5383Q~2Q09 1 PPL Electric .;,' ..:._- pp Utrt~hes Electric Service For. Ross w sMrrxsorr SIO SUSAN: RD LOT b8 CAMP H1LL PA 1701 I Summary Page Bahuce as of Oct 4, 2414 ~PL Electric Utilities Charges ToW Charges ~!L~i ihlOHt this bil!? Please ODntaCt.ll$, UCt 20 at 1-8M-3~5 (1-i0A=DYAIrFPL) 'or wtlte to- Cattoas~ Service 827 Aaus+man Rd Allerdovvn; PA 181049392 ' . www_ppleiectcic_oosl Electric Use Tlus graph shows your electric nse over the last 13 months_ ''~~rrpp~~s of Meter Rea~ngs_ Actual - Acl~usted Feted Customer 0 Account Balance KWH -Average Per Day 2~ 20 16 12 8 4 0 Page I 53830-82009 - - . ~f bT st- o0 $24.04 $24.04 Meter Reading Wor~tion Meter t184571963 Oct 4 Actual Sep 2 Actual T verage -Oct Z~ 268 8 R Pea Day Yearly Use: Total Ar~ Usc M Nov 2008 -Oct 2009 2705 ~ - Nov 2009 -Oct 2010 l 971 ~ 1 ~4' OND7FMAM77AS0 ,,~ 2009 Mnrnhs 2010 i 53830-82009 AY o1 009919 28715E 47 A"5DGT ROSS W SMrrHSON 510 SUSAN RD LOT 68 CAMP HILL PA 17011-2059 Auto Payj PPL ELECTRIC UTII,TfIES 2 NORTH 9TH STREET RPGGENNI A1.I,ENTOWN PA 1 81 01-1 1 75 .~..d~tlttillttt'lll"111tltttl.{.pnlt~l{......{t.n1411~f1tll ~I 1 9100000240410000024040 53830x2009 ~i -~--- '~I Other Tumportant inf©rmatioa on back ~ '' I! ._~ _. ~_ .~--- PPL Electric U#lities Electric Service For. ROSS W SMITHSON SID SUSAN RD LOT 68 CAMP HILT, PA 17011 PPS '' Summary Page BslaHCe as of Nov 2, 2010 es: Tot PL Electric Utilities Charges Total C>nrges Account Balance Qnet~ioea abort this bell? Please contact us Nov l8 at 1~0-34~-5775 (1~ll~DTAIrPPL) or gtiite t C~Stamer Service 827 Hausman Rd. Allentoam, PA 181049392 www.pplelectric_com Electric Use This g ~cshows ova the last l 3 months. Tyyppeess of Meter ReaBings: Actoal Adjusted Estimated Customer 0 KWH -Average Per Day 24 ZO 16 12 s 4 0 Page 1 53830-82009 $eoo $20.23 $20.23 .. ~,, i Meter Reading Iaformatioa Nov 2 Actual 298 Oct 4 Adual Z97 29 Da s KWH Billed l Average -Nov 2009 2018 Tea>petxhtre 52F 54F K Pa Day 9 4 Yearly Use: Total Aver Use Mo' Dec 2008 -Nov 2009 2787 Dec 2009 -Nov 2010 1790 NDJFMAMJJASON 2009 Months 2010 Other important information on back ~ 53830-82009 AY 01 008923 392026 39 A"5D6T ROSS W SMIrHSON 510 SUSAN RD LOT 68 CAMP HILL PA 1 701 1-20 59 -:1?It~' f --- Auto Pay'~i PPL ELECTRIC LTfILITIES 2 NORTH 9TH STREET RPC-GENNI ' ALLEIVTOWN PA 18101-1175 ~Ilil~il~l•loll,~A~lPlilih„lfll,••ltlll~llhlllllll,ylq„q 1 36DC10~~2D236U~00020230 5383>182Da9 _ _. _ __ _ _ _ _ _ _ _i. _r PPL Electric ... PP Utl~ltle5 Electric Service For_ ROSS W SMITHSON S IO Si15AN RD LOT 68 CAMP FIIi.L PA 17017 Summary Page Balaace ~ orDec ~, 2010 ~PL Electric Utilities Charges Total Charges QHeati0~6 abeat this bill? Please ODnta4t ~ Dec 20 at 1-8ii~- ~ (1-$~=D)~PPL) or write to: C^domer Service 827 Hawn Rd_ Alleatown, PA 181049392 www_ppleleetric.arm Electric Use This graph shows you: elecQic use over the last 13 months- Types of Meter Reae~gs: Ach~ar . Adjusted Estimated Customer Q ACCOIIIIt Balffi1Ce KVVH -Average Pet Day 24 20 16 12 8 4 0 DJFMAMIJASOND 2009 Months 2010 Page 1 53830-82009 •~~=r: soon I $16.43 ', $16.43 Meter Readia8 Iaformation Meter #845719b3 Dec 2 Acnial 2 Nov 2 Aetuai 2 8 30 s KWH Billed 7 Average -Dec 2099 201 i ~ T P 47F 5 , 44 ~ ~ i a Day K ~ Yearly Use: Total Av Use M Jan 2009 -Dec 2009 2.ti89 ~ 41 Jan 2010 -Dec 2010 1726 ' 1 Other important information on back ~ 53830-82009 AY 01 008921 502556 39 A"5DfiT ROSS W SMTTHSON 510 SUSAN RD LOT 68 CAMP HILL PA 1 70 1 1-2059 Auto Pays ~~ i PPL ELECTRIC UTILITIES ~, ' Z NORTH 9TH STREET RPGGENNI '' II ALLENTOWN PA 18101-1175 hrlhl•1••rrl•r•rlnlllr•rr•r•Gd•!•rlrrl•r111P•r•hr•rlihrrl ~I 1 3100000164310000016430 5383082009 -~ --- i ~, _ _ _ _ ~ ,. _ H lwl lElricE Ilhg ~rrarear~l tier snip ~ iA N SMMTI~SON MP }~MI.L ~ 17011 Heating-OC NMg Psris~ •/01!2010 bo 05/03!2010 (32 days) Rerrrabe Device Read it @00-27ti-2722 or writs Uo tlGl at ~ BOD(13009 adirrg. PA 19612 3009 ur current 1161 irrcluds ih tarns totaling about 5 0.43. Past BNI Isdsrssa0oa - U61 Uliltty The arxount balance an your last biU was ~_M__ ;13.00 Thank for t of ._....__........_______ ~ ~ 1 Your b rrp as ~ Ot0 _____________._. - !ld Utflilr . Customer Charge astribufiar Charrggeesa (First 11 CCF at 50.35182) _ 3.87 Nigtation Rider Srrr~arpe _..._.__ 1.02 PA State Tax Setcharge .~_.w.._______~.._..____. - - Total Current Charges -1161 tldNiy _______....__...._... i~4b ing Anioent __________._~w 1300 ~ 1161 elrae~pgs awed Mb bUt .._...._ __ Peat 8Nt hrtonestlar - tq#PI.EY EIER6Y ' ~, The accaeart balance on your loot bill waa ...__..~. 5 28.17 Thank you far your pp~~mmerrt of __________..~..__._~_~~_~~7 Your batanp as of 055/2010 _~__~____~.._.....~:b~ I~~ Carraat Blq hrforara6oa -11HIPLEY EM6tBY 5rrppCbr Cuabomer Charge ________ 1.00 Tolal~ t~g(sa-lSHIPLEY~RGY )._...._~__. ii6P4EY EI~Y owed this hill 0. 7ofsd Awwaat Dee her t06/Z6/2010)._.. ...._ 5 Mohr h~toresaBo~ - Nsort Rpd gah Jrrae 2, T010 Mohr Ibrssber Preeieas Readfp Praeeat 6sasral laienatierr ^ S1flPL.EY H~E{1G11 CtIWPAWY 550 E KNY6 STREET P.O.6E11t 946 ' Y'OR1( PA 17405 or Phorrs 800-839-1849 I~'~ I ^ GAY prtpa and are aet by the natural pea supplier you have droserr. i14e Public Utility Commis~on rogulahs diatribetion gripe and services. inperhat Messages iraar 1161 ^ Your current price b compare is 5 0.85410 lCCF. • Yore total annual uaape is 466 CCF. Your average mantNy usage is 38 CCF. ^Your anrruai budgetyear began with 5epbern6er 2009. Last This To dabs yoe have been biNed 5 265.00 'w~ Year ~~~ Year To data you have used 5252.39 ~/day 2.06 ty fsmpsrature 54' 0.34 8°F Keep tlris part for your records. l lnfe~tlen ~ en itre baclr trt ffii: bNl. UGI Utilittea. Inc. Customer Numbec ~ amarnt due PO Barr 71203 217 562 1621 30 PA 19176 Philadel hia dederJed ~" y accour p . May 26, 2010. ~ TAE lEf -!CE 2175623623300526D1000~,~2790000280OOOOQDOOOOOOD00000003!~ 1 ~ _ z» ssz ~s13o i 1 AMJJA=ON0IFMA 2009 MonOrs 20'}0 oooorxr H sryAS aESrrtE ItDSS w SI~p"rF190N ~ ~ce~ t0: NNIA N SMITHSON 510 SUSAN RD CAMP Hql PA 1701 t Rafe ~: Residential Fiea6rrg-CC _ BiMNg Perfed: 05/03/2010 to' 08/02/2010 (30 days) Remote Device Read Qaesliias? CaR 800-276-2722 or writ to IiGI at PO BOX 13009 Reading, PA 19612 3009 Yorx current UGI charges include State saxes totaling about = 0.38. 4 Past Bin Iafetaratlea - t1Gl tNitity The account balance on your last bill was _ ~~5-11300~0Q Thank you for your 0120 0. ~~"~""~~"'~ Your balatrce as of OE --_..-.._-.. 217 562 1621 30 Ctrneat Bin blbrrplbrr -1J61 tNltily Customm Charge __..~..........._...._.... ... 8.55 I, Diatritrrrtion Charges (First 9 CCF at 50.35111 j _. ~~~g~3~p16~3 ~'i T~I~C~urres~-tgCAarges~ UG{ Iltitity ...._._..»~~~_... ~. ~1~ ~Mr cMaross~awad tAb bill -M. -........»~_ 8.00_ Y... ~ 8~ Past Bnl brierwMioa - SInPLEY EMER6Y , The accoont balance on your last bill vras ._..._... S 9.79 Thank u for pey of ..._....__~._..._.~__ 9~7 Your ba~rrce as~of 06JpM2010 ..........._...._......__...~ Careeat Bnl laleraatba - 8HfPLEY BIER6Y Surlier Customer Charge ._____ 1.00 ' Commodity Charge (9 OCF at s0.T9889) .......___. 7 t Total Current Charges -SHIPLEY Et+IERGY ......_._... aNtPUEr tamer cbaraes ewes this an I >d ails Tole) Aarormt Dae by (06/25/2010) ._»_..........___.. MJJAStINDJ FMAM 2009 Mbatlrs 2010 Last This Average Year Year CCF/day 0.74 0.30 Daiy terrgrerature 62°F 65°F tllder lafertaatloa -Meat Read Dale Jay 1, 2010 tNeler Naarber Peatrioas fbadgrg Preeant Readlag CCF 1178870 1624 (rewrote) 1633 (remote) 9 6eaeral birwattoa ^SHtPLEY ENER&Y CONB'ANY 550 E. KING STREET PA. Bt1Dl 946 YORK PA 17405 or Phone B00-839-1849 `Commodity prices and charges am set by the natural gaa suppler you have Nrosen.~, Public ntRiy Commission regulates distriturtion psicea and.services. bispor~at tll~yes lroei IIGI `Your currerd price to compare is S 0.85410 /CCF: 'Your tMal annual usage is 452 CCF. Your average monthly usage is 37 CCF. `Based ort the amount of your. usage ~ date and/or changes in energy costs. we haael, changed your Budget Bitting amount to ~ 8 . Please cats ifi you have any questions. Keep #his part for your records. tiGl lltilties, Inc. Customer Number The amount due ~rFg be H PO Boot 71203 217 562 1621 30 ~~ ~O1A y~ur Philadelphia. PA 19176 checking aoceu fAf fEf Y/LE June 25, 2010. 1N7 I June 25.2010 ROSS W SMITHSON ABCt~LAl1 NINA H SNLTHSON 510 SUSAN RD CAMP HILL PA 17 011 A8C PL~11 - 282 21756216213006250100001619000020000000000000DOD00000~12 I sus sssrier li~~~~'iorservkot« INA N SM11190N 10 SI)5AN RD 7MP wLL PA 17D11 ate pas~aNoa: ssidential liea6rrg-oc ilUrrg Period: 6/02/2010 b 06/3(!!2010 (2B clayey Remde Device Read alt 800-276-2722 ar write to 06l at D BODC 13009 ending, PA 19612 3009 wt currant U61 d+argas include fate fazes (dating abort S 0.36. your cast a was ________ S B.OD ',~""~s' ThaMc you for your t of _________..___.W...,_ 8.00 Yoru balance as of 7!0612010 -"ti7~ t ,. _ ,,~ ".' ., __._._____......_.~ 217 562 1621 ~ Carrerrt ~ bdorsatloa - trst tlulrty Distn"lnrtion Cf (First 9 CCF at 50.35000) ._... 280 PA Slate Tax Surtirarge _______ ld C t Ch T Uhl UtiQl o urran arges - p _,._.._ tip Amount ~_~__~__ 8.00 U671MNi~r~Mchry.. owed wls blrl ___._~.~________ _ ___.~__....~. : ar,.04t Pmt efirr Merrrrauoa- striPi.rr t1Y Tha arxoerd balance on your blot bill was ._.,~_.. S 8.19 'i balms as d 07 0 0 _.._..~~ _ .. _ - Crrrrsat MIl leaongtioa - SrNPlEY BIIER6Y ~Pt~ Customer Charge .._....~_.~_ _.._..__.. i.00 Commodity (urge (B CCF at l0.798R7G5Y) 9 TSHIPI.EY t9~YcMr+posi owed leis 6tii ~.____r______ li 7 trolor MrisrrrallUoo - (!text ((lead t3Ne ArypraE Z. Y8t8 Last This verage Year Year CF/day 0.33 0.29 airy ternperature 70 F 74°F 1178870. 1633. (rertra~e},.. ,:.;1641: {tsrr-aba} $ secure! lalenrratlen ^ slrrr~Y ter col~ANn 550 E KMl6 STREET PA. 80D(946 YORK PA 17405 or Phone 800-839-1849 ', ^ Commodity prirxa and r~rarges are set by the natural gas supplier you !rase cd+osnn. l~+e Public Utility Commission tegWabea distribution prices and services. Inrpordnt Nsssagss ~ U61 ' 'i ^ Your curtest price to compare is S 0.85410 /CCF. II i ^Your total annual usage is 450 CCF. Your average martidy usage is 37 CCF. I~ ~I ^ Your annual budget year began with September 2009. ~ To date you have been billed S 281.00 To date you have used ! 275.39 !, Keep this part for your rer~rds. '' II Important M~orn~bn is on the barrrk of ibis bNl. .~ _ _. _ ._.... _ --1----~--~-- UGr utilities, tnc. Customer Number ~ amountdusvd H PoBooc 71203 217 5621621 30 fr01Yt PMladerphia. PA 19176 checkirrp ~~ r~r saner duly 27, 2010. Ni~ ~ .. _ _ 27, 2010' Ju AV Oi 005242 97493!3 18 A**SD9T ~.r~~.r ~~i~~rr.~.~~l~tlrl~~i~l~lrrrlrn~~ri~t~ir~~iftrrrrrl[rrr ROSS W SMITHS©N ~~'~ ' NINA :H Sh'ITH:50N _ ~ ~ 51 D SUSAN RD . - _ .. ~ _ CAMP HTLL.PA 17D11.2Q59 AtTC PLAN ~ _ _ 280 1 _ _. _217.562162130072703~D000Z539000019000000000000000000000`~ ~~ Past tf1NI Merrrralieo -1~r rx~ity~ The arxxarmt balance on JJASONDJFMAMJ 2ooe rtleatha 2o1a H ~= ass fE/Y/CE may ~~r~ ter Service to: 510 SU6A CAMP HILT. PA 17011 Rate Cam: ResdeMia{ Fleatirg-CC, g Q8/02l2010 to 0813tl2010 (29 days) Remote tTevice ReOd Catt804276-2722 or ws~e b (1G{ at PO BW(13009 Read'ng, PA i96i2-3009 ' Your currre-t tlGl charges include State ta~aes totaling about; 0.35. Pad WH lafararatba- 1161 udl The account balance on yarrlast -tt was _._..__. s 6.05 Thank you for your of ___..._..._____._... Your baF~nce as of 0212010 ...._..._____........__. Carreat t1M lal~eflaattall- IMiI til{Ii1y Distdbutia- Cf ges (F~st 7 CCF at tQ34857) ~ 244 PA State Tax Sunrhatge .___..___....______ 0 3 w. Total Current Charges - I{6t Ikitity ..~________ 10.96 Budget Billing Amount __........_____.._..._.._.........._. 22.00 2175621621 Past 9iN lafonlatfatt - SHH'LteY ENER6Y - The arxourrt balance on your last bill was ___...._. s 8.19 ThaNc you for your payment of Your balance as of D~102/2010 ._.....~..._.__..r....... 0.00 Carseat ~ hrtarraMfea -SHIPLEY EIIBtGIf Suppker Guatotner Ct-arge ._.... __.._... 1.00 ~i CorrMrrodity Charge (7 GCF at 10.79857) ....._._... Total Current Charges -SHIPLEY BIERGY _........... ~LI:Y B~t6Y a ewai this biN Tetal Aarouat Due a (09/23!2010) .__..__..w._..__________._.___......_.._________ I tj -- Maler lataraeatfoll - Nerd Bead Dsle tiepteraber 30, 2@10 Maier Nrreetrer PrerMas ileadiwg Pneraat MaAiap CCF 1178870 1650 (remote) 165? (rslrloYe) _ 7 6eaeral hterweRisu •SFIIPLEY ENERGY COMPANY 550 E I(frG STREET P.0 BOX 946 YORK. PA 17405 or Phone 800-839-1849 Last TMs Average Year Year CCF/day 0.35 0.24 oaity temperatun: 74°f 75~'f 'Commodity prises and charges are set by the nature{gas suppNer you {rave choaea. i Th~ Public utility Commission regulates distribution prices and services.. i larporfarrt Messages frara 1161 'Your current pace to compare is S 0.81555 lCCF. 'Your total annual usage is 448 CCF. Your arnerage monthly usage is 37 CCF. 'This is your first Budget Bi{lirg bi0 for tt-e new season. The amow-t is S 22 Please ~0 tiGi before t{-e due date 4 you have questions. K this part far your recoNs. Irrruortant irrlarenatbn b on tiw.b~k.af t1110_b15,_-- _-----------.__-_---,-----~ ~- uGt lltdi6es, h+c. Customer Number PO Bmr 71203 2175621621 ~ Philadelphia, PA 19176 6~s strr/eE ~f~ The amount due deducted from y checking arxan September 23, 2 September ROSS W SMITHSON ~`I ~~ NINA H SNITHSON 510 SUSAN RD CAMP HILL PA 17 011 AaC PLIiN 280 2'1756216213009230100002b59000036000000000000000000000 ASQNDJ fMAMJ.{ A 2009 MoMlrs 2010 . _ , ._ _ ,F _ - . ,. ~>~ ~ ~ tltili~ H The arxaourrt batanc:e an yow last II was ____.___ t _ - S 2200 """" ~~ '°` .= IA• lfrllCE Your' 1>~nCe as d 1~/~412Q .._ .............._ 1Q ..M~~_.._ ~ 217562162130 irr~ ~ for tlervice to: (atrrsat BUI is~adoa - IIW tldUlY ' i 1H~s~rt~so~+ a3 6ahonCharges (F'aat 9 CCF at 50.33778) ,~ 3.04 iP I~iL PEA 17ott PA State Tax SUrt~ge .~.~...,..~~.~....._ 1161 tttikty ___~_~_______ Total Cur reot t ~ s gaeef~oa: N t ~~0 c~ s+rred ~b 411t S 7~2 0~ idetrtiat Heating-OC ______________ . ;~,~ ~ P 1 ~ 31 /20 0 bo 09130/2010 {30-days) TM aocau~t yl ~ bit S 6.59 Remote Device Read Thank you for you payment of __________...._r retloast W Yoer balance as of 10104/2010 _.... I ~-27ti-2722 or write to UGi at 9W(13009 p~ ~i lptsr~n -SHIPLEY Eg19;6Y ~ ding, PA 19612-3009 t U61 d d i d _ _ p y~ ~ ~ g at 50.79889 _.____._ Y H 11~ 7.19 _~ e r aurea t >argsa n u _.._......___ IPLE f3 Total Cirrent t3rarges -S . b taxes totaling about 5 0.37. SHPLEY ENERSY ciawyas a~wad ~b btU .._... 6.4 5 Told Awesat Das by (10125/2010) ____.._.._.._.. ~...~..._____.~. S 7 I M~ilr lafsre~lies -itliort: tlad Dale Oclob~r ?9, 2010 Last This crape Year Year 1:lday 0.33 0.30 ily berr-peratiure 64°F 69°F Ildar Nsiwbar Prev~ses Rsadia0 _ PewMt OCF Chad ~ ~ Bnsrti Nderwnliea 'St~l.Elf EItHt6Y t;0111!'ANY 550 E K~ STREkT P.O~ Bm(946 YORK PA 17405 arPhone 800-839-1849 ^ibmrrradity prices and are act by the natural gas auppkar you have rdrosetr. Thle Pabtic Utility Commiaabn regulates distritnrtion prices and servirxs. Lperfant Messages freer U61 ^Your current pace b compare is 3 0.82458 ICCF. ^Your total aararal usage is 445 OCF. Your average monthty usage is 37 tX'T. ^ Your emus/ budget year began with September 2010. To dab you have been t>lNed S 44.00 7o date you have used S 2252 Keep this part for you records. Imliort~nt bfiorr~on is am the back of this bDi. N b 8 ~ UGl Utiaties Inc. Customer Number ~ amount des wi be , PO soot 71203 217562162130 deducbd f 1On' y°"r clreckrrrg a ~ ~ H Phila~lphia, PA 19176 October 25, 2010. _ •AS rterreE . ...G. _ ~Ni _ ' _ __ _ October 25, 2010 AV .01 OU5721 286288 ~9 A**5DGT ~~idi~ll~I~'~'Ilf~l~~~~l~hu~:hrllr~~lilLl~ll~l~~r~l1~rf111111 -ROSS W SMITHSQN ABC RJW _ NINA .H SMITHSON ~ ~.,,s ~._ .. ,~~~g .. RD 510 . SUSAN "F .::., . . CAMP. >+ILL . PA _ 271)11-2059 - . ABC PLAN _. 280 - 217562#b213Q1025010000303900003800000[10000000000©OOOQ81 ''~ ~~ SDNDJFYANJJAS ?009 Marrtlrs 2510 ~ =~lH ~ ~swrys tESrice S VY S~MtTF160f~I ter s~evi~ f0: S WAIN ~i9011 iP INII PA 17011 flag PaMod: '0 ~ 10129 da») 1800-27276-2722 or write to UGI at ' BOD(13009 rdirrg, PA 112-3009 rr currant 1161 rdtarpes include to faxes totaling about 5 0.45. Past BiN HMeewatloa - u61 UYlily - _ The aawuM balance on your last bill was ._...._.._... S 2200 ° -- Thank you for year payment of _......-_...._..».~__._.~ =~04 .., _ Your bahance as of 11/02/2010 __._..._.._.. - --0~ ~ ~2i75621 B2130 Carraot BNI iatoraafion - Uq Utility Customer Charge .~~._...._~...»~...___.___ 8.55 ~ Distribution Charges (Post 16 CCF at 50.33813) . 5.41 PA 5fate Tau 9lrrduage .___.._-__.._........_..________ ~Q4_ Trial Garrett Charges - IIGt Utilty ___.._.-..-_______ 8'i inp Anrourt _._r...,_..~ 2200 ~~g r~argss owed lhis bllt ~ _ ~Z.~O Past >~ NrSerrsatba - >g11PLEY EIERGY The atxonnt balance an your last biU urea ..._ S 8.19 ', i ThaNc you fcr your payment of ________.. ...... -8.19 Your hatiance as d 11/112/2010 _~.-......____.~:~ Current Ali lotonaalbn • tliiiPLEY B19t6Y Supplier Customer Charge ~._-.._-~...._______ 1.00 ' ~~ Commodity Charge { 16 CCF at 50,79875) ___.... 1 78 ~I Telal Crrrant Charges -SHIPLEY ENEi~Y ___~___.. BHPLEY EitIl:N61r claryos owed this bNl i ~5.~8'', Last This Year Year ~~~ F/day 0.52 055 ~ih terrrparabrre 5 5 °F MMor grtonatiarr - ilsert tieid DMe Ooeaa4sr 1, 2010 Yo1K Maober Prsstoas tfeddiog Pre~t ihsdi~g - d:F lber~ ^ SFNPIEIf ENERGY COtiIPANY 550 E KING STREET P.0. BOD(946 YORK PA f 7405 or Pfrare 800-839-1849 `Commodity prices and cirarpas are set by the natural: gas suppNer you have ctresen. Public Utility Canmiaaiaa regutafes distribution prices and satvpx~s. UPorfaat Yesagss Hare U61 •Your current price tocompare is S O.B2458/CCF. ^Your tots annual usage is 446 CCF. Your average monthly usage is 37 CCF. •Your annual budget year began with September 2010. To date you bave been billed 566.00 Ta date you have used 5 36.44 Keep this part for your records. 1rwp~rfarrf IMormaUon is on the back of this bill. ~. -` I1G1 Utilities, tnc. Customer Number ~ amormt duewiM ;',~ Pomoc 71203 2175fi2162130 ~"~'°d f'01" your Philadelphia, PA 19176 ~~ ~~ d sws stwneE NDVetnber23,2010' 4Sq$N O ONDJFMAMJJA:O 2089 Months 2810 ~_ H sus sESrieE Iles ~~ for 8sryies hoc I'14a~lAH~ NP HILL PA 17011 s*'wlenba Irian Psried: /29/2010 to 12/01/2010 (33 days) Rands Device Rsad II 800.276-2722 ar writs 6o IIGI at ~ 801(13Q09 sling. PA 19612-3009 ur currant UCl include ? abs tares totaling about 6 0.90. last This Year Year ~~ 7CF/day 0.55 1.82 `any terrrparatrnre 4 °F Pad BfU'latw~atisa -1l6! 1l01tty The accord balance on your last bill was ._~........_ 0 2 20 l ,~ ~ ~ Thank yartar your paymart of __.~.....__------_ ~ f 12103!2010 l Y ~ ~ - ~? ~ - ~ ~~ ' -•- ance as o _.___._____......_ our ba Csrrsst Biq hriorraa6oe - U61 lltllity • - - 2 i 75621621 ~0 ~ Cbg ss (Fkat 50 CCF at 60.33840) _ Diafdbution 1&92 Distribution Charges (Neoct 10 CCF at 60.27300) ._. 2.73 PA Mate Tax 9rrcharge _~______.... Total Ccrrrart Charges - UGI Utility ~.._.__......_..~ iil'e~g Amount.~.._..________~......~.. 22.00 drsryee owed this 6Ig _____..__ =~22.~ Pad Mtl IMsraratiaa - i1MPii.EY E1IEAQY ~ T The account balance on your leaf bill was _.~.._.. 6 f 3.78 Thank you for yore payment of ______~___ _t 3•L ~ Your balance as of 12103/2010 0.00 ~, Csrreat tiiR Ia/ersMios -SHIPLEY 61Bt6Y '' ~~ Supplier Cuataner Charge ._w_________~____.. 1.00 Commodity Charge (60 CCF at 60.79900) ._._._...r_„~47.94 46 944 TtiHPL.EY darses owsd~thb bM -_._.... . . __ L s~.#4 _ _. _ reisr brtormaUan - ttlnat M.+ DNs or;..b.r s, tote IleisrNasibsr . Prssisrrs Prswrt R.arNag fxF Ihe~ _~.Nwrv .,ww.pve~~~ ....:a-w.pw.w.wj,-.. _ v.... ^S4RPLEY HERGY COMPANY 550 E KING S7REET P.0. 80)(946 YORK PA 1740.5 or Phone 800-839-1849 ^ Commodity prices and drargea an: set by the neutral gas supptisr you hays chosen. 'i~e !, Public irtitity Commission reputataa distribution prices and services. Irapsrbad Metiages hors 1161 ^ Your current price to compare Rs 6 0.72778 lOCF. ~! •Your total annul reaps is 488 GCF. Your average monthty usage is 40 CCF. ^Your annual budget year began with 5eptariber 2010. To date you have been bi0ed 6 88.00 To date you have used S 64.54 Keep this part for your records. Impart intormaliort i+s or! tbb back-Of tfiie bDl __ _ - _ .~ UGI utilities, inc. Customer Number The amount due a H PO Banc 71203 217562162130 d°'l'"~°d t'D"' ~ Philadelphia, PA 19176 ~ amt December 27, 201 sss ssrrres RH '-~- . December 27 2 1p AV 01 005268 506376 18-A**5DGT 1ai11r~~thhu~~ilrlHlr~~l~~rtEl~flpl.~~r~:rllrl.r~~.~~~g1 ~ ROSS W -SMITHSON. ASCPLAN '' - ~- _.__, NINA H SMITH50N ; -~ 51t3 SUSAN. RD _ ~~s I ?' ~ ~ CAMP : riILt PA 17Ui1-:2Q59 _ _ MiCPIJW ; 1 _ . - . .... 280 i '~ 2375621621.3012270100007D940Q00890000000QOOQDOQQ,QQO.Q00 ~ ', , NQJ FMAMJ J AS QN 2118! Heaths 2010 000240660D4020000000000002100035 Pennsylvania American Water PO Box 371412 P~tsburgh, Pa. 15250-7412 For Service To: 510 Susan Rd 025938 t AV 0.3351938/25938pp1938 089 t PCL5J2 L..IIL..IIL.....ILalit.Llp....LLI.I.....lIII.....ILI ROSS W SMITHSON 510 SUSAN RD CAMP HILL PA 1 701 1-2059 24- 0660ti4~ Pennsylvana American Wa~e PO Box 371412 Pittsburgh, Pa. 1 5250-74 1 2 I' h..il.6L..61.LIJL..L..LL.L..IL.LL.IIat woas9 check here to ade H2la~to on.ars caibrH.rron ro y«u mona-y vir a to dwtge yoer address a number, and prht inlbrntetinn an reverse side Cbtll8l` ~~ ~t71I" BflHltg St!/nlit8ry - For'3erYit:@ To• Ross'Vlt SrrtiEtistth Prior $alence 5 i 0 Susan Rd Ac~rmt Ntat~er: 24-061;0840-2 Prior Wate- Balance $1 ' 9 Pretnise t~xrtbet: 24-0390183 Prior Salar-ce Ot~-er Payrnertfs prior to May 24 2010 Thankst` $ 0 , B/iIl/!~ P~l'/Od & b~~ 1/~f01-t?8t1011 , . Toil prior balance, f11ay 24, 2010 -2 .7 0 Biglrtg DaEe: May 24 2010 ---~urrertt YNater Charges i , (3llling Period: Apr 2i to May 19 (28 days) Next d Service Charge War Volume (~ 007830 x 300) 131.0 ~ 3 0 7 rea ing oMabotrt: -Jun 21, 2010 Rail Type; Residential STAS PAWC Water 0.45% . . 0 7 DSl - PAWC Charge 0.40°/ .0 #Aater readings in crurertt W"fling periodz Total Usage Bided 0 ------Other Curr~tt.Charges---. 1 .5 Meter Number N087152544 is a 5Y8-inch meter. Customer Protection Water tine i ' Present actual 7500 Last-adua! 7200 Total other charges, fiAay 24, 2010 5 . 5 5.5 GaAons used 300 AMOUNT -DUE $21'~ . 0 Do not ssrrd payment Total AmounYl3u tttriq be deducted ~ from Yom' bank account on Jun 14, 20 ', i D0024066084020000000000002b000~5 Pennsyhvania American Water PO Box 371412 Pittsburgh, Pa. 15250-7412 For Service To: 510 Susan Rd oaooso ~ av ass oosa2oosooooo~ ae2 i x~cEA I~r.lll~nlllnrnrllurllulrlllnul~lrlrlnrr,llllnu~ll~l ROSS W SMITHSON 510 SUSAN RD CAMP HILL PA 17011-2059 24-066Q840-2 AMOUNT DUE ~~1 ~ ~0 DUE DATE Jul 14, ~01iQ AMOUNT PAID E~ PA Pennsylvania American W~tf PO Box 371412 Pittsburgh, Pa. 15250-7412 I~~~ILLL.~LL1~61L~~6~~LI~~I~~~IL~LL~~IJ _D ease check hereto add H2'O~b Others ow-9i6utlon to your rnaodNy biN -- --_---- -- a"Y~ aaHrass art e-rwmber, and prht nrormetiwe on-rep erne sib -. cusrorner Acac~,rit h>!#ormaao-n -------~---------------- W~_ ~~1/tri~gr Swmmary For Service To: ' Ross: W Sr~tt~so~ Prior' t3alerk~_ 5i0 Susan Rd Account Number: 24-066Q84~1-2 PriorWai+sr i3alance Premise Number: 24-0390183 Prior Balance ether Pa eats ym prior to Jun 24, 2010. Thanks! BifUng Pr3clOd ~ Ailetel' lnfOrmBtlon Total prior baiartce, Jun 24, 2010 8iilling Date: Jun 24, 2010 ~ ~ der Charges-----._ BiMirrg Periods May i9 to Jun 21 (33 days) Next re adirag on/about: Jul 21 2010 ~ Water 4/olume ($ .OQ~890 x 300 ~ , Rate Type• Residential STAS PAINC Water 0.45% DSI - PAWC Charge 0.40% .:Meter reai~hgs in current biging period: Total Usage Bided 300 Meter Number N087152544 is a<5/8-inch rrtieter. °---~~her Current ChaFgess-- Customer Protection Wafer Li Present-actual 7800 Last-actual 7500 ne Total other c ham. Jun 24, 2016 Gallons used. 300 AMOUNT DUE.. Do t>at sane ~yrnertt. Tofaf /4mount fht horn yarr tank account on Jui 'tA, 2010 Water Usage Comparison ~ ~~' ~, twr-dred sleMons: mop! 10 %g'L Paaoxa iou ur- II!4 . q, 31 'palalduroo x~on~ atA uo". paseq syivotu earyl ~(rana aBuey~ puK D(ld atp ~4 panardde a6~ey~ s!41 _'oia 'saMen 'siue~p~ty and `s~aiaw $11,5 . ~50 -2~. 0 • 0 1~.~0 ,~ . 7 X 1 0 ~0 ~-~ ~l be avow ~~ c~(crr- ~.. ~ ~o~ n n..,. ,„ ~eP 59 Uey3 YYYV ~YYYYY ~YL.YYY YYYYYYYYYLYL IYJIO Pennsylvania American Water PO Box 371412 Pittsburgh, Pa. 15250-7412 For Service To: 510 Susan Rd 018861 AY0.3352166Ii8A88l002A86 067 1 PCLJQO I~~~III..~IIi~~~~~~ll~~~ll~~l~lll~~~~l~l~l~l~~~~~llll~~~~~il~l ROSS W SMITHSON 510 SUSAN RD CAMP HILL PA 1 70 1 1-2459 Pennsylvania American Water' PO Box 371412 Pittsburgh, Pa. 15250-7412 ~J1~1~1~~~1~1~IJJh~~L~~LL~I~~~ll~~l~6~llrl ~~ Custorr~er Accoernt ~#O~na>i~on Blllfng :Summary For Service To- Ross W Srrrithson Prior Balance 510 Susan Rd Prior Water Balance Account Namber: 24-0660840-2 Prior BaJ~cse Other Premise Nrmnber: 24-0390183 Payments pricy to Ju126, 2010. Titanksl Total prior balance, Jul 26, 21110 Bf/Ung PIBl10d d~ Ai~Bt@I' fRfOlmBlffOA Currerrt Water Charges---- Riling Date: Ju126, 2(110 Service Charge Bii~g Period: Jun 21 to Ju121 <(30 days) ''Water Volume ($.0(?7830 x 200) Next reading cnlabout::Aug- 20, 201b STAS: PAWC Water 0.45% Rate Type: Residential DSI -PAWC Charge 0.96% ToEai waiter charges, JuF26, 2010 illeter readings in current biil~g period: ---her Current Charges--- Meter Nurt>ber N087152544 is a518-inch meter. Cusiamer Protection Water Line Presets-actual 8000 Total other charges, Jul 2ti, 2010 Last-actual 7800 Gallons used 200 AMOUNT DUE ------------ Do not send. payment Total Amount Du from your: bank account on Aug 16, 204 Water.Usage Comparison Mpntidy-usage in hundred gaYons: ~~ t E: ~ it $1S.~Q $5.~q -21. 13.bp 1.5$ .~~ 14.E 5. wiu be deducted uuucYUdduo~tucuuuuuuuuuuuuya~auya PeninsylvanNt American Water PO Box 371412 Pittsburgh, Pa 15250-7412 For Service To: 510 Susan Rd 011621 AY Q3~ 91621191&2182 077 t PCI.pJ6 I..1i11..1111......11...1I..I.III..1.1/i.l.l.....llilr....ll.l ROSS W SNITHSON 510 SUSAN RD CAMP Hill PA 17011-2059 Pennsyhrania AmerWart Water PO Box 371412 Pittsburgh, Pa. 15250-7412 Ir/.il.LLr.IILLLIL..L.rIJ.rL..H..LIrrILI Please chearc Here ro add F~?~N~ro ohs oonv~ion ro ya. monUMy Her aroahanperaradaraesa number, andP-~tnlbrnwOfonanre~rerseseie. pistomer AC~count lntbrmat/on BJg-Summary For Service Ta: Ross W Smithson Prior Ba a:...o- 510Susan Rd Prior Water Batra-oe Atxountlwhnrrber:24-06'60844-2 PriorBa~nce (~fher Premi.e t~r0bec: 24-a~solaa Payma~r~:~,a~,y2s, 200. n-ar,~r Total prior balance, Aug 25, 2010 $/~NI1g PRt'fOd dr A~tel MfOftlf8tf0lt Cwrent Water Charges---- BiNing Dom: Awg 25, 2010 Service Charge sitting Parlor!: Ju121 tD Hug zo (~ days srAS PAwc water 0.4596 Next read'erg oilr~bOlelt: Sep 21, 2010 -DSl--PAWC Charge 0.96% Rate Type: Resic,':+ntial Totat water char 9~, Aug 25,:2010 ---Atlrer CExrent Ct~ges------- flleter r~dir~gs ~ cwrent AiNfig .period: Cusdemer Protediort Water Line Herter Phurtl~r N087152544 is s 5/8-inch meter.. Total otlierr charges, Aug 25, 2010 Presets-actual b~900 Lass-actual 8000 AMOUNT DUE Gallons used 0 Do not ss~wl payment ToW Amwmt kom year txmlc accgmt vn Ssp 14, 201.., Water Usage Coimparison 2 ~ Monlhy Visage in hundred gaNons. 1S ~2 .._.. $14.,9 $5.~0 _2 0 13.~q .be 1--~$ 5. 4 $18. vriM be de1e1¢ted uuu~~uooua~u,_uuuuuuuuuuuuy ,~rou~o Pennsylvania American Water PO Box 371412 Pittsburgh, Pa. 15250-7412 For Service To: 510 Susan Rd 0115501 AV 0.335 4560f1466U~002r50 081 1 PCLVaB I,,,111,,,111,,,,,,II,,,II„I,111,,,,I,i,l,l,,,,,llil,,,,,li,l ROSS W SMZTHSON 510 SUSAN RD CAMP HILL PA 17011-2059 Pennsylvania American Wader PO Box 371412 Pittsburgh, Pa. 15250-7412 I„MILLI,~.I,I,LI,Ih,.b,J,1,.L„IL,LI„III orto yon- aa~a-ass a num6a., and p-:,r irbrmeEian an,~re-se skle. - -- Cnte,r Accost art.' - ------ ---------- -------- ~ -------- ,iili~ tn~ary Foir Ssrvias To: Russ W Sm~tson ...-~-.,^p~r~ Bilshcs ~..,.-...r ' 510 Susan Rci Prior Warr Balance $13.18 A iair~atbet: 24-066fl8~i0-2 Prior 8alarace Ud~~er 5 . ~~ Preeise Nmrelrer: 2d-0:390183 Payments prior A~ Sep 24, 2111 Q: TFrarrks 18 . & , Tout prior baEac~ce, Sep 24, 2010 ~ , d Big Plerk~d & itey' ~xi~~nat~an --~;iern wager Ctysrges=- 9 t)ede: Sep 24, 2010 Service Charge 1~ . t~tY ' e~r91: ~ 20 ~ SeQ 21 (~ ~i i+YF,Eer ~~ame (~.007E9Q x rood . 79! Meat ~9 ar~~aboltc: C3ci 2t. 2L}1i3 STAS F,4iNC 1Na~+r 0.45% . (~(~ R~aOe Type: DSt - PAWC Charge 0.95% Td~ rimer ct~ge~s, Sep 24, 2010 13 lre~et n r~sreiit ~~ peci~: ---Other Ctfrent Charges----- i t~,taer lrOB7` ~~ as a 5~B-~d~t ~e~ec_ t~~stxr+erProtedion Water Line 5 . q #'reseaE-act 810Q Taml offer charges, Sep 24, 2010 5 . d t~si-~acb.~aE 800Q C~aibres usec# 10A Dt~ $i9. Ibsetseed ~e~L Taiai A~oleit Due rn7 be deduded~ iei ~~ back aiocv,~nt a Oct tal, 2eti __._ .~ -.___ _ -_..__. ___-____--- _. _ _ _ ~._...~ __ _~ .._.,,__-a _~ Water: tsage ~ampartson ~ "" ~ ~ ~a~r v u, nt,nd,~+ ins. .. ~. _ - ~ _ = Sit ~ V ~- _ ~ ~ i z ~ a e ;, J _ - - - y z s7 A~I<es:~agsa to you from PennsylvaMa Amertcan Wafter ' ~iv~.:F-ate =. yQ percent ar $.54, of State taxes are rncJuded in,~avur aerrrent bill. ' ~,~ _~'~^. '. 210, the State Tax Ar/n~ctr.+n.,• c..__~__ - - . _-~_ -- uuu~4uebun4u~uuuuuuuuuuuuyy6]101:6 Pennsylvania American Water PO Box 371412 Pittsburgh, Pa. 15250-7412 For Service To: 510 Susan Rd 013747 1 AV 0.335 17471137471001747 060 1 F'CAAOU4 I..tIII...IH.....tilt..Il..1.111....I.I.I.I.....tili.....li.l _ ROSS W SMITHSON _ 510 SUSAN RD CAMP HILL PA 17011-2059 Pennsylvania American Wager PO Box 371412 Pittsburgh, Pa. 15250-7412 L.JLLL..I.hLLIL..I...LL.L.,IL.LL.IL U Please dlecAc here to add H2a- ro others contnbutlan to yorx neonth/y diN .. _....__ar ~O_ ._1'?w address ar torrenembar, areall~ irllbm-atbn are reverse side _ _ .. ,_.. .. - . ~ r Cus#orner Account MtormaUan SNNng :Summary .._-. , , ~,. For Service To: Ross W Smithson Prior' Balance - - 510Susan Rd Prior Water Balance $13 . ~'8' Account ~tutnber: 24-0660640-2 lprior Balance Other $5 . ~'0 i Pretnise Nuttlbat': 24-0390183 Payments prior to Oct 25, 2010. Thanks! -19.4~g Toil prior balance, Oct 25, 2010 . qp $l/[flTg'Plee-k)d & 1liietEr /nfQ/f1?BtIOR Current Water Charges-+--- Billing Elate: Oct 25, 2030. Service Charge - 13.010 Baling Period: Sep 21 to Oct 20 {29 days) Wafer Volume ($ (I07~4O x 100f , 7~9 Next reading oNabout: Nov i 7, 2010 STAS PAWC Water 0.45% , p6 Rate Type: Residential DS!- PAWC Charge 1.85% .216, Total water cdtatges, Oct 25, 2010 14~ .11' Meter readings in ct~rent billing period: ---~-_Ott~er Current Charges Meter Number N087152544 is a 5/8-indt meter.. Cusbmer Protection Water Line 5.510 Present-actual 8200 Tout other charges, Oct 25, 2010 S .510' Last-actual 8100 Galbns used 100 AMOUNT IIUE $19.62 Do tort send. PaYmont. Total Amount Due 'N bs deducted trom your bank account on Nov 15, 2070. uuuc~tueduo~ucuuuuuuUUUUUU~U4~Uj`) Pennsylvania American Water PO Box 371412 P~tsburgh, Pa. 15250-7412 For Service To: 510 Susan Rd Oi3918 1 AY 0.396191fiH931B100i3(~8 0t6b t PCA45pO I1/11~'111'~III1111"IIiI~11'f'"IIIIIIII'I~IIt11~1'I11//1"II _ ROSS W SMITNSON _ 510 SUSAN RD CAMP HILL PA 17011-2059 AMOUNT DUE DUE DATE PAID 24-0660840-2 ~Z'Q ~~ [)ec 13 201U ELECTRONIC PAYMBiT i Pennsyhrania American Water ', . PO BOx 371412 `` Pittsburgh, Pa. 15250-7412 'IIIIII'1111'1~1'1'1'~t0't11'1'U'111~~U'1'U'I1~ D Please cYieck Ge1e w adN ro ~ conNixtEiori ro yar mwdlNr eir ______°_r~_°_l^0fi1-addrems~C~~F____.____ num6ar, and prht hldrltaUon on nwsrsosde. ------------ - --------- - ---- -- ------------------- L'!lS~alllel A4GOt~/tt 8>~tlli Far Serv#ce TO' ROSS. W Smithson Prbr t3~tisllc° 510 Susan Rd P-iior Wai~ir Bak~r>ce Ac~ourrr [~lutrrber: 24-0860840-2 Ptnr Batarrc~e ~frer Prltnise, Nufriber: 24-0390183 Payrrr~tts prier k~ Nov 22, 2010.' 7hartkst Billing Perlod ~ Ilileiter Mformstlon TOE t~ balance, Nov 22, 20~ 0 -- ~r BlNing Date: Nov 22 2040 --~Cf rern ureter charge------- . t38iir~g Period: Oct 20 to Nov 17,(28 days) Service Cliargre Water Volume [007890 x 200) Next reading onlabout: Dec 20.2010. ST,4S PAWC Water 0 45% tote Type: ResideMiat . DSI - PAWC Charge 1.85% Total water charges, Ho+- 22 20't0 Meter readings ~ txlrrent billing period: , -----char Currant Charges----.- Meter. Number N087152544 is a 5/8-inch meter.. CLSbrne~r Protection Water Lure Ptesertt-actual 8400 Total other charges, Nov 22 2070 .Lass-actual 8200 , Gallons used 200 AMOUNT DUE -------- Do not send peymeM. Tohl Antou "=- _. .--___ _ nt troal rourt>aMc account on Dec i3, $14.1 $5.5~, -19.6 0 13.Ob 1.5$ .0~ 2 14.9 5.5 5.50 ~ v r-~v~aLr rrntP,:_rY CHAR~~'3 PAY BY MAY 7, 2t710 ~~~"~"- Telephone 732-0711 SEWER/ u.s PosT~ ~ orou-, ~ Olfioe Hours 8:0010 4:Of) Mon thru Fri SANITATION PI-D. a rae.au~ osss ~~r: HsAdi,g P,~o,,, +~a,~ c~„t~ ~K _~ 2 01 f 11500 :?1 151 -1 f 5{}0 X5301 4 ab30 f R 6550 4650 i i u~ ~l ~~~, ROSS ~ SM I THSOi~f 510 Sl1SA~i PQAII GAPSP HILL PA 1X111 i--,lii,--i1L.---~(1--,i1„i~iit-~--i~i,l,1-,---1111--,-,)l,i BILL DUE BY AUG b, 20f~? D YARD WASTE PICK UP 2ND & 4TH ~~` u.s. aosrACS Palo Telephone 732-0711 M©NDAY sewEw ~ ~^ Ofeice hours B:00 ~0 4:00 Mon tlxu Fri SANITATION ~~ ~. s Fleedrg DaM Presets #taadng Previous ReacRnp Coro~aription Amoixit X401 i o a 11 soo X41310 Y -11500 )93010 W 6850 ?93010 R 4bS0 i i r~ie Aber Dees ~MZT'HRWt3Q11 s 151`0 ~U~Al4# ROAIS RQSS W SMITNSON S10 SUSAfV RQAD CAMP HILL PA 1?011 1,,,11t,~,lli..,,~.ti,,,If., i,111.,,,1, l,f,l,.,~,tlll,,,,,i1,1 BILL DUE BY Ni3V 5, 201© QED TRICi~ OR TREAT NIGHT QGT 28TH use Teleptwne 732-o7t ~ +~-8 PM sEWER~ . as olfioe Hours a~oo ~ a:oo Mon Uuu ~ snrarnno~ No. e r~trti ` ` ~aaarg c«~ur,~ ,~moux 370110 A 11500 ,)7231 d Y -1 i Sp0 1231f0 W b850 L23110 R 4b50 ~ ~ naK h,wu ~ ~ A~ ROSS #~J SMIT#-iSflN 510 SUSAN RUAD CAt"1P NILL PA 17C}i i !-„lii,.,lit,~,,,.IL~,li„!.!!!„ t-l, i,l,i,,,,~!!li~,,,,!!,i Rueberger's 48440id6ettysburg Plech, PA 17035 43f28/10 13:58 MECt1AlIICSBilR6 ~A iT4S5 Self Pwip~46 - _ BLU 6aiione ` 2.951 A 42.7591~GAL Fuel 58.14 TVNo?ax 58.14 Tax Pd 40. ~ rota l 48.14 D [SCOYER ~_ --- ~' Ruth #: 02 8396 Ref: 96639 008 Reap Code: 0~0 Stan: 0064 8x608 5l`TE ID: 6955629 Earn a 5~ reeate pith the ~ visa Take application asul Apply Today 'thank You Fo r Choosing BP!!! ~~,~- ~: h,~1 ~~ ~tip~-~e ~~t- a~ ~~r~ t ~~~ ~«~~. More doing: 6000 CARLISLE PIKE, MEt~ P:, 1;055 STORE MANAGER CHEt KEELEY (717?795-9602 4120 00059 57634 05/29!10 01:18 PM CASHIER SELF CHECK OIfT - SCOT59 _._ . 046335841536 ~ CFN10 PM ~A> _.~(i.97_ .. SALES TAX 5.82 TOTAL $102.79 XXXXXXXXXXXX3900 MASTERCARD 102.79 AUTH CODE 029682/1593519 TA / 1 RETURN POLICY DEFINITIONS POLICY ID DAYS POLICY EXPIRES ON A 1 90 08!27/2010 THE HOME DEPOT RESERVES TFIE RIGHT TO LIMIT t DENY RETURNS. PLEASE SEE THE RETURN POLICY SIGN IN STORES FOR DETAILS. GUARANTEED LOM PRICES _ LOOK FOR FEEDS OF ~~_ - -----r ~ ~ i iL EQUIPMENT CONTRACT ' rage t of t - - ~ .. r-f~i ,l i - : No.: 82453806 4 U-HAUL MECH.,•:==_? ~~ 4725 GEfTYSBURG RD 3/28/2010 2:04 PM II (811055) MECHANICSBURG, PA. 17055 (717)763-7677 :i• Name: : ust Ph -Emil: thson 727-495-7464 ge Rd i nberland, PA 17070 ~ Rena: ~a a ~r-e: 3.'28; 2010 9:446 AM i Return Date/Time: 3>28/2010 2= PM ) ' ,~ _ ~ ~ + CharyeaWe Rawl Periods: 1 t 4 ~ 'r _.,.,,., _..__. ~ i 9 magd_ ~ .:: _. i rtE - I Cut ~H In I Rate.. -. I Cha a-. ~ ' ° _ issin or Da ~ arge _ .~Ctual Charges . - :K192520.0 Ii92545.0 0.99 X 25.0 24.75: fe~ivve $~ 0 ;' ,- •. , 9: i 519.95 ;58.70 - ~. I 469673 t ,: ,{ Envirgnmlemai Ree: ;1.00 E ~ 'la ~_ ~/2 ~ ~a : - f s~bTotai: #59.70 ~ (~ ~ ~ (~ [ ~ (t ~ 1 ! t MoRor v ' Tax: Sz.oo Reti aryes: #66.48 Plre Paid: ;0.00 3e: Account: ~: Gredit C#rd P~naeat: #75.00 - XXXXX)O(XXXXX4455_ 028838 ~e: Account: Aunt: XXx70O00CX)OCX44650 No Ruth Credit ~~ ~~ -58-52 Net Pa4i~ Today: #66.48 3 immediately issues and processes debit and credit card refunds. Federal reputations allow banks up to five days to process refund requssts~ Ctedit proce~istg delays :ed by a customer' s issuing bank that takes advantage crf this regulation. ~rrt that during the term of my rental there was not an acdderrt involving the rented U-haul equipment and no incidence where this equiplner~~truck or otherwise ~nege to any person or property either while on a public road or private property. There was no injury or damage sustained by me or any o @r drivers or passengers quipment. , ---- °-. _. - - f ~._~----_~- - - __ ~ ., __ - - - - - = - -- 'NICHOLAS BRINSON -- -- ^-- .~--- Cu~omer Signature - (todd smithson) rare we doing? Please go to www.uhaul.com re. a a_, dfe~ ~ know if received the level of quality nd service you expect fre~ri~:~ ; s -~iul 1~ocation. ~! : ~ 1 i . ~~ i ~1 ~~' - a ,1~ ~ - ,; ~; ,, ~~~ ~ r~ !~ - ~~--. G 1 . !~ ~ I'I j ,,~ , ::; - ~ , ,: k ~; '` } 4 ~~ ~ '. , ~ i iz /webbest.uhauldeaier.com/ContractPrin ing/receipt.a~x?source--printing_ot~~ 'cti~u , _~ ~ 1 ~?.~B_... 3/28/2010 tsit t t. t l1SUR1RNCi BBCHANGS HOMBPROTECTOR POLICY Gsurance ULTRACOVSR ~ CONTINUATION NOTICE ,oo~.~a ~~ AA7685 STROCIC INSURANCE AGENCY 05/23/10 TO 05/23/11., ,Q53 2302055 H ROSS W SMITHSON 510 SUSAN RD CAMP HILL PA 17011-2059 AGENT - STROCR INSURANCE AGENCY 401 SOUTH 32ND ST~,EIT ***** AGENT PHONE - (717) 737-5405 CAMP HILL PA 17011'S137 COVERAGE BEGINS AND ENDS 1~T 12.01 AM STANDARD TIME AT THE LOC~TIiON OF TH8 INSURED PROPERTY. UNTIL TERMINATED, THIS POLICY WILL CONTIN(1EI'IN FORCE. LOCATION OF RESIDENCE PREMISES IF OTHER THAN STATED IN ITEM 1 O~t',IF SPECIFIC DESIGNATION IS NEEDED. ZIP CODS - 17011 EPNSBO~T~, CUltBB CO PROPERTY INFORMATION -PRIMARY RESIDENCE, YEAR OF CONSTRIICTIO~tI',1969, MASONRY VENEER, PROTECTION CLASS B. PROPERTY IS WITHIN 1000 FSST OF A FIRS HYDRANT AND WITHIN 5 MI~$S OF A;.RESPONDING FIRS DEPARTMENT. AUTOMATIC ADJUSTMENT OF COVERAGE WAS APPLIED TO DWLG. * THB AMOUNT OF INSURANCE APPLYING TO THS DWELLING IS THS RSP$.A $ltBNT COST AT THS TIME OF THS LOSS, SUBJECT TO POLICY CONDITIONS AND RSQI71~S. THS ESTIMATED REPLACEMENT COST OF THS DWBLLING IS $ 277,000. SECTION I - PROPERTY PROTECTION AMOUNT OF INSURIIN ~ PREMIUMS DWELLING *GUARANTEED REPLACSItENT ~0 ~ $ 396.00 OTHER STRUCTURES $ 55,400 PERSONAL PROPERTY $ 207,750 LOSS OF USE LOSS SUSTAINED NOT ESCESD 12 CONSECi1fi I'~S MONTHS SECTION II - HOMlB AND FAMILY LIABILITY PROTECTION PERSONAL LIABILITY -EACH OCCURRENCE $ 500,000 ~DICAL PAYMBNTS TO OTHERS -EACH PERSON - $ 2,000 PREMIUM CHARGE FOR INCREASED LIABILITY LIMITS $ 23.00 FULL TERM PREMIUM FOR THIS RESIDENCE - - - - - - $ 419.00 FULL TERM ADDITIONAL COVERAGE PRSI[IUM - - - - - I $ 25.0001 TOTAL PREMIUM FOR THIS POLICY - - - - - - - - - ~ $ 394.00 I IBLB 500. SECTION I DEDUCT $ APPLICABLE FORMS - 2005 02/01, HP-PA 09/08, HP-FP 02/03, HP-Gl~ X1/09, UF2106* 04/08*, UF2733* 01/09*, UF2743* O1/10*, HP-AAN 01/97. ', eve ne~~snnea n+wos .,..••., •• • ~•• •• •~ •• ~~ Drain Cleaning Specialists "Family owned and operated" 30 Years Experience r n 6;, Mileage '" ` - P n N~- ~t Job <sd~~ ~:.'<-.-f:~,~ Bill -ftf ~:.iSc. 1~C €1 ~J~'"` 7 LENGTH C+F LINE_ ": ~ LENGTH OF LINE GLERNED. 3.~ DIAMETER t,,. ~ , , i BLOCKAGE , AREA" `'o ~r,~ n?; r> CAIiSE OF ROOTS DIP RAGS OTHEf~ SLUDGE GREASE POSS BLCICKAGE . ' • 1- M.S. H.S. K:S. B-T B:S. ' L.D: L.T. TA. U.R. ` F~ D.SVDTHER-- - BLADES GLEANOUT MACHINE S.J. S_ MR ROOT CUTTER ~ USED - ° '. LOCATION Pt GPP , PB CAMERA LOCATOR CONDI~JNCONfl1TlONAL ~.. ::.MONTHS GIfARANTEE ~ FOLLOW UP ^ SERVICE CONTRACT COMMENTS - f , c .- . ~'. __ a` _ - - _ +r ~ E ... _ Ir_ _ - a~ -- _ ,. . < . ~-, . , .° ;~ L. . 1. t.. _. - v ;. f TIME p AM TIME J~ AM SERVICE -. !N ^PM '.' ~::} OUT ^ PM `w' `` '::, _ MAN - CUSTOMER'S SiGNA.JURE° ; - - - PRICE - PAYMENT TERNS: ~~pUE UPON RECEIPT ^'NET 30 Administrative %e 1.596 per month for past due balances PAYMENT _ ~-, TI~ITAL ©PAY ONLINE SOURCE ~ PHONE `-~' -- 7 r_{ %r t_ vanr~~ran rv~~y~r 486 Levvisbetry Road- New Cumberland, PA 1.7070 West: 717-774-4571 -East: 717 232.7290 Carlisle: 717-245-9879 Fax:. 717 774-7861 email: info@treeflowpa.com web: vrww.freeflovrpa.com Date ~-~I~ i F FOR PROPER CREDIT PLEASE WRITE INVOICE NtfMB~ECt.4~NCNI~K X535 Charge on Atl Returned Checks* - - ~ ~ __ - _ _ 1~4oti~; (7~7} 4'T9=3299; ~'~ Blt£ ~~?.- 1 . R~ ~c r1p...e,c~P.tr' . 4II-~oi~L~.- ~~ ~~ -~. . .rte E =~ ~~ a,t ~~ ~~ ~!.~ ' ~ k 5 l r ~~ii~~ ~~~ i~.~ '', i Ch,~: ~ aP 5- 8" /D II ~ 1NVOI~E Chamberlin ir~spectlons 393 Chestnut Drive BoNing Springs, PA 17007 717-443825 Inspected By: Ben Chamberlin, AIA Inspectlge: 6/5/2010 1D: 2410-Oi 5 Customer Into: Mr. Todd Smithson 510 Sus~t Road 5 Carriage Road Camp HiN PA 17011 ' New Cumberhautd PA 17070 f~l Estrtte Professional: inspection Fee: Service Heafied Sq Ft 2,001 - 2,500 Payment ihod: Check Payment Status: Invoice Sent Note: Prompt payment is appreciated, thank you! Price Amount Scrt~Total 350.00 1 350.00 Tax;0.00 Toter, ice X350.00 file•//C:~Docwnents and.. __ ~Home1M Documents~HomeGau e1Re _ 12010-01 . Settings Y 8 P~ _ ... 6J21/2010 •.! Z D 4 ~ ~ L,.) v ~ d N T L .~ t[3 _. ~.. ¢~ W t _ ` C C1 \ Q r4 G .~ 4..~ Z D O ~ ~ Q, 1 Q r O J ut N °:' 0 zn Jr ~,~~~ .3 J ~ Q ~ Q ~ W O m o a ~N {fl ~+ C! ~ i Z ~` 'L• ~~~ .~ 3 ~~ ~ ~ ~- ~~ ~~ \~ ~~ ~ ~ o ~ `ti ~~~ ~ e~ d z d ~ Q .~+ ~ N ~ N C N ~ ~ '~ m a ~ ~ N. y n ~ ~ C ~ w ~ `` W D V ~ c~ a ~ ~- :~ -F' X V J d 0 y.., ao m ~n a°o .o N ~ Y C o ... .7„ ,~Q N 1~- ~ ~ 0 N y„ M Q~ ~}" 1`.. t31 '!" N d a t = r ~; a o O U -~ '8 ~ o`r ~, -~ c s p N u d C.U N o 0 a t U 0 a L y C Y d N A ~ ^~. \~•` F~~ I i 1 1 ~. .~ .`'' ~~. N ~,~ ca ~+-- 0 Z ~ ~ 0 N r+ o ~ ~ ~'+ o ~ N O Q ~ O 8 ¢~ ~ ~ ~ ¢ ~ ~ ~ ~~ a ~ ~ ~ ~ ''>& ~ m N ADO r Z ~ d~ ° ~ ~ ~ ~ d ~ ~ ~ ~ M O p ~ .~ s o 3 ~ ~ ~ ~~ c o ~ ~ ~ ~,•~ o N g c _ o d h W ~ '~ ~ e~•1 Q j ~ ¢ ~ g ~~~ ~ ~ ~ >~ °~ ~ ~• ~ ~ ~ LL o C Q r r Z N O1 N ~ Q ~ ~ r ~ N 3 F L ~ ~ 1" .O N . _ .. ......... ..--~-- d O O ~O ~ N CI ~ ~ $ ~ ~;; s ~~~ £S o p N W C N ~ r ~$ a ~ g ~ 6 Q~4 ~ ~ ~ ~N O ~ ~ JQ~ r p Z LL d ~ t ~,i=,'~ SENDER DAWN CARE (717) 856-3628 ALVn~ Hn:s'rER 1470 Yoxx Roan CART 7tr F~ PA 17015 Bill To: Todd Smithson Weekly visit: $11.00 Extra duties: Clean-up & Mulching Hourly Rate: $0.980 hr. Bushed all trimmed op Beds Weeded Ivy cut back from hoase and walkways Removed walking stick tree and planted grass plant at back of hot~s{~. Laid Dyed Brown Mnkh in aii Beds Original Bid - $65.00 Your #otal bill = SZ6-50t! Thank you for choosing me to give your lawn a little TLC, Sincerely, ~, Billed ply ZOi© Alvin Hiester Bill (Please Make Check Payable to Alvin Hiester or Al's TLC) j ,~:~2~.c~ ~ Sao Sus,~/,~C~ PA REV-1500 SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES and LIENS ~' ~ e Page 1 PPL ~~eC!'!"It <" n_ S 830-82009 {~ ... Pp ~ 3 ~ Utllltles ~ Electric Serve FOr. ROSS W S1~ON 510 SU3~kN RDIOT 68 GAMP Hlll. PA 1701 I QQsuestiq~ps ~t this biIl? lease . at 1~3+i~~3 (1-IAN-DIAIrPi'i~) or:~rrite to: C Scrvicc 827 Harlsulen Rd. Alleflrtown, PA 181049392 www_pplelectri~:com Electric Use This graph shows yore electr~ nse Overthe-last 13 months. ReadmgR: Actaal - Fs~ated s:•,- CUStOmel Summary Page Bslaace ~ of Apr G, ZO10 TPL Ej FCTRIC UTILI'T'IES Charges Total CMrges ACCO12Ilt $a18IICC 24 20 16 1Z 8 4 0 KWH -Average Per Day sooo $15.98 $15.98 1Vlster Ra[it>ag htormtion -Meter X4571963 p~ 6 Adnai 2858 Mar 5 Adnal 28 1 32 s KWFi Billed 7 Average -Apr Zt1t19 2tt1® KWH Pet D 43~ 50~ ay Yearly Use: ToW Av Use Mum May 2008 -Apr 2009 2841 - May 2009 -Apr 2010 2136 1 AMJJASONDJFMA 2009 Monti~s 2010 Other important information oa back ~ 53830-82009 AV 01 007982 640546 28 A"5DGT ROSS W SbIITHSON 510 SUSAN RD LOT 68 CAIN ffiLL PA 17011-2099 .'SS~~i tf s~_ ~s. ~~J ~J ~0 Auto Pay PPL ELECTRIC UTII.ITIES 2 NORTH 9TH STREET RPC-GE1VN i II ALI,Z:N'TOVYN PA 18101-1175 {}lib{la{abpniaiillplaiulllalalnl{{{l{}{llill}{abplilhi 1 5800000159880000015980.5383082009 Loyalton of Creekview ~~~ ~~T T 1100 Crandon Way U Mechanicsburg, PA 17050 -----Sea.rar Lwur,~ o~~y~.ca~Y~. May 25, 2010 Invmice: S000026240 Ross Smithson 503 c/o Todd Smithson 5 Carriage Rd New Cumberland, PA 17070 .~g _- ~ ____ _ _ ~ _. ,.__~ _ _ _ ._ ___ _ ___ Billin for: 04j01i201'~Qto06j30j201U Charges Current Prior Charges Total AL Rent $nq Resident 0.00 898.26 898.26 Late Fee 0.00 150.00 x.09`"` Total Ihie and Payable 1116.26 . _ ;. ~v~ * Includes Sales Tax if applicable Payments are due on the first of the month. Late fees are assessed after dse ~~. You may either mail your payment to the address bebw or drop it off at thet o~ilce. Thank you for malting Loyalton of Creekview your home. K::l/[v9 KYWM. ' . _ _ ., -i2RH.•-Y.~y..'.K~+/mid/e9!.7AOldT/~FfP~27lClR*:l/a~'/~/X~/~/.'~':b~9/F~ If smaller monthly payments would be more convenient, especially if you are working o~ selling a home or waiting for benefits to arrive, we provide a senior living line of credit through our reLatio~s6ip with Flderlife Financial Services. For more information please call Elderlife at 1-888-228-4540 and let the counselors know ~ f you are inauirin¢ about our community or visit Elderlife on the web at www.elderlifefinanagc~iaLcom. _ _ _ _ _ _ _ Loyalton of Creekview 1100 Crandon Way Mechanicsburg, PA 17050 (717} 730-4033 s~ f a t ~-ewaAa~iriv 1nllillw~epitslDhetom ~ Rlar.14 -Apr. 17.2019 31 Days in eiiiy Cyde tAiE rAt4lONr rM1141~14c ~ ~d~ not wa~ire pw i~ brl~~ ~.) } 7oDOC-l0ooc~oooc n47 1°d ^'~'~tMt1D,"y'~~ao Ire ter ana,A.-ApRS rtry Ee rx~.a up b die P~~gr APeaI~.4on. tErrw~wcE ~r-tnrR£t~tr ouE ow>E ssnst s~s.~ ~- t~, zoo r;•. neeeeynrar~nesaesouMr ~I CsadltlieiC 52R00O00 Cae1s Gedit liaiC 51Q00000 Ayeielle CsediE Si9,492.79 AvaYehle Credfllot Cas1~ 510,000.00 p1l11~0~ ~ p19~ 4s1~ C1MI4 k!4 ~ b101llit L7llll~d T~iO~004 R~ ~i11MO! 5907.44 - f507y1 • f0~00 ~ .~. 550721 x 559721 TRANSAwtT1OMS Omens ~ Aailsnli>~rs FQII R06S w SRMFit90il s17247 1 31 UMR PAYMBIi I5507.84y TNR115ALTgMS FOR N06S w SMRISON sT~T247 1 31 WWONNNCAR6877~66~40i640H 550721 ~ Tad Traesad~ns This Mind 550721 Fi~S Tod Fees ibis P~diod 5000 Tod Faes'It~is Year 50.00 Mi~ST C1i11RGED Tohl hleest This Pariod 5000 Tad kMnast This Yeet 50.00 PREV10115 AVANADtE 1~IMARDS MIANCE (35.29 REWARDS fMfFD TIRS PERIOD f5.07 6eAeds>rswdions posted duhgd~is biig cytle- AVARAIHf lfAIANCEAS OF OV17j2010 540.E hr ey-M~a4a aear~Neariia*, wielt ~ ~~ IrMl~l~' oraiwplr dl l-tN,~iJOM Yat AsMMeel Panaeuh/a RaAa (A?R'- is ~e ~ sale an yar soffit. Type of 9ala~o! RMa (MIS ltsla ~ kNn~eet ~ 24.90'!< D ! D.00 ~ 50.00 PLEASE RETUR91 PORTION BELaN 1AIITH PPIYIUENf OR LOG ON TO WNMV.GRPITALOI~E.tIOM TO RMIQF YOUR PII1YrYENT OIiI14E. WEST SNORE EMS -BLS _ E ~ ~t :.. 205 GRANDVIEW AVE ~ ~~` ~, SUITE 211 ~~ -° CAMP HILL, PA 17011 `'~~ Phone ~: (800) 367-0512 Federal Tax ID: 23-2463002 E~~(ERGE~Cl' ~!Ef~IC L SE32\Jl~ ±: < PATiEN7 NAME: ROSS SMITHSON PATIENT NUMBER: 85153 WCS CALL NUMBER: 201888W .NONE INSURANCE: DATE OF CALL: 03/28/2010 ~ t T{ME OF CALL: 04:42.AM GALLER: HOLY~SPIRIT HO~f~iTAL 2O188SW FROM: HOLY SPIRIT HO$4~ITAL TO: MANORCARE H TH SERVICES ROSS SMiTHSON 1700 MARKET ST REASON(S) FEBRILE CAMP HILL, PA 17011 FOR ' TRANSPORT INVOICE DESCRIPTION OF CHARGE _ QUANTITY UNIT PRKE ~~~ ,AMOUNT :~ STRETCHER One Way 7sar-sport 72005 1.0 108.75 -_- 108.75 Transport Van Mileage 50209 2.0 3.74 7.48 Total C 116.23 DESCRIPTION OF PAYMENT RECEIPT PAYMENT DATE ! MQUNT __ __ __ - _ _ _ - iota! ~ __ __-0.00. __.. PLEASE PRAY °~~S ~!.P<<tatl~l E - Ilt~~rr~IC~ Dtl~ 1,1!~O~f ~~~CEI~' _, ~ si1s23 USDA, Office of the Chief Financial Officer, National Finance Center FE E"{ Q DPRS Billing Unit DPF~S P.U. Box 61760 New Orleans, Louisiana 70161 FORM DPRS-28 71/08 NOTICE OF UNCOLLECTED PREAUTHORIZED I~EBtT MAY 07, 2010 Indllmllln~ndludlnl~llln~~l~l~l~lii~lull Ross w. sMiTFISON Acct. Number. 1~Oh221Q3 s1o susAM Rn CARP HILL PA 17011-2059 Your preauthorized debit for coverage under the Federal Employees Health ~nefits (FEHB) program has been returned by your bank as uncollectible. We request that ~i~u immediately send in a replacement check. ~ If we do not receive the amount past due within 15 days from the receipt ~' df this letter, your enrollment may be .canceled. The effective date of the cancellation w~ll` be the last day of the month that the United States Department of Agriculture`s National Finance Center received full payment. Please mail a'repiacement check to: USDA, National Finance Center DPRS Collections P.O. Box 790341 St. Louis MO 63179-0341 AMOUNT PAST DUE $75.0$ if we continue to receive advice of uncollectible funds, your preauthorized debit privileges will be discontinued ' Please understand that once your enrollment is canceled, you: ', • May not enroll again, unless you first qualify for FEHB as a federal ~rhiployee • Wiil not be entitled to the temporary extension of coverage for conversion, and • May not convert to an individual contract If you have any questions regarding this notice, please contact us at 1-800-{2#2-9630. ~I DRinD ivoe Ca~IiTCE01 R100100fUDtUtlZ00f'TCE' DAMP HILL EMERGENCY PHYSICIA , PO BQX 136$3 PHILADELPI=IIA, PA 19101-3693 .~..~~~,.~..f,.~lr~lhd~~~l~~I1~NN~H~IlrlflF~lhE~11~~ Ilb~p ~Qfl0368©04 ~t 9-{]6 HYP3530163~ R©SS`.i{f'SMITHSON ~70t~ MARKET ST CAMP HILL PA 1.701 t-4817 Account Detai/ t>9rz7no ~ : i3rtezce~cw EvAt. a MCMr sa34.ao 0.3? s ~. ODC~eBtiO DR: 9iIRKhIOt.Y$PIRrT HOSPITAL OYT3f10 I~IGAREC.ONTRACTUAIALLOV1NtNCE ~~ .. 1W23f10 hEEMGCRE PAYM9~IT -03pi~6- -- N[SM16~DCkdUMPE1iB~.B-LA61G3----- -- -- -- _ INFO NEEDS FOR AD.IUOICATION STATEMENT OF ACCOt,~[j (2) ', Sfa6emept E~ate:.kfne 20,.2010 ACCOt1INT:(yllMBE(R: H-YIP,~6a0e44# Patient Name: ROSS W 3 Tax IQ:#: 20-4667340 Accoufft Relatx:e: 512.16 Amount Penang- Insurance; SO.oo :.Amount Due From _Patieht (Curn~M): 10.00 Amount Due From Patient Past nue : st 2:y s fa~...= t 5+~ +g x YE~I2'A000UNTI&I~A8~r t PLEASE i~M17 PAYi~N~r THANK YOtf. Ptsase raker to cou t-elow toc PaYrnent Amount E'ot Yrc. oth.r urn Patient Inaner,ce i } . .: .~, :.:.,., .w ..: y . I, ~.~ :5-473.18 ~ • ~ ~ TOTALS: ~ s~t33a.ao ~ s-os.es ~ sooo ~ saao ~ s-373.ia ~ so.oo ~ s~2~s -mporta-rt Messages; This staisrnerd is for the Brea erestrrart andlur ai care you recently teoeivea tnxn an F~ arrt~ed saperaeey inxn arty hospital «othei polrresiona Mec for v~areh gQ"6y P"' a< Hoy Split Hospital The lees for this privam physidans far duiges in oorrrection wih vsi, i vri not indude the Tema 6elod ~ ~stalertienLr~ Thetelore, shout you nsceive a Wl from the hospital « . "Payme~rt Plans" Accepted ~, Questions about this statement? / Dame de :Cones a Yiemes? CaN ~-E00-356-247t11111+Drrday thr h Friday 9:30AM - 4:OOPM. .Your automated system access code is 08-368p0449, or you can-send email~to bil6ng_questiorrs~emcare.com. Please detach and return bottom portion with your remittance. ~ ~ I! UHoLY AL Tl~c Spbic of CariAg Rar AecoaaR lleare Cat 717 763-213s - - _ ._. _. _ - -~. ~ ` - ' ~ta~t` off Acct iD ll l . n..~ PREVIOUS sA1.ANCE ~ ~~~ 00 03/27/10 VEMIPINiCTURE , . 03/27/10 03/27/10 URIN, (NO MICRO.) ', ' 18.00 35.00 03/27/10 URIN, (NO MICRO.) LEVEL III FC , i -35.00 -- -- -83{28~/i8 - --- -- Z3~iiR0lIAIf -=3t50118--~ _ , -_ . _- - -- _ ~ --.:_ _ 561.00 -- 10Q:9'S _ -__= 03/28/10 METAOOLIC PANEL C ~ . 03/20/10 03/28/lt , URIN, (NO MICRO.) CfC,AUTO RIFF ~ j 157.00 35.00 03/28/20 CHEST 2Y i 107.00 06/03/10 06/03/10 MEDI PYMT-HOSP OP M10 MEDICARE OP A 352.80 -167.19 06/16/10 MEDI C/A HOSP-OP M10 lEDICARE OP A I -1,021.46 09/Z1/1• 09/21/1• M®I PYMf-HOSP ~ MEDI P1rMT- N10 M®ICARE OP A ~I -41.35 167.19 09/21/10 HOSP OP M®I C/A HOSP-OP M1• N1• MEDICARE OP A 'i MEDICARE ~ A l -166.77 1 OZI 46 09/21/10 10/20/10 MEDI C/A N04P-OP )tC PYMT OP M1• i MEDICARE ~ A ' ' , . i 1,t21,91t 10/20/1• SC PYIR OP i99 1699 1LUE CROSS 3i •LUE CROSS S+i~ I 41,5 -41 33 10/20/10 sC PYMT OP •99 OLUE CROSS 3~ . -50.84 YOUR INSURANCE HAS BEF_N BILLED.THIS IS YOUR CURRENT BALANCE YOUR PAYMENT IS DUE UPON RECEIPT. THANK YOU. M10 MEDICARE OP A .00 899 BLUE CROSS 36 .00 p PLEASE DISREC,ARD THIS STATEMENT IF YOU HAVE PAID. INVENTORY REGISTER OF WILLS OF Cumberland COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland } SS File Number 21-10-0497 Keliy A. Frey and Todd H. Smithson Personal Representative(s) of the Estate of Ross W. Smithson deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the pereo~al assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation planed ~~posite each item of said inventory represents its fair value as of the date of the decedent's .death, and that Decedent owned no',real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventor}. I verify that the statements made in this Inven- tory aze true and correct. I understand that false state- ments herein are made subject to the penalties of ~-! 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities. Attorney -- (Name) Craig A. Hatch, Esquire (Supreme Court rl~. No.) 76361 (Address) Gates, Halbruner, Hatch & Guise, P.C., 1013 Mumma Road, Suite 100, Lemoyne,:PAi 17043 (Telephone) 717-731-9600 DATE OF DEATH LAST RESIDENCE L71ECE Et~T"S SOC. SEC. NO. 4/10/10 510 Susan Road, Camp Hill, Pennsylvania 17011 190~1~-2163 FIGURES MUST BE TOTALED Orrstown Bank certificate of deposit account number 4000033227 57,187.60 2002 Buick Century 4 495.00 Metro Bank checking account number 32073959 310.61 r., ~_ ~ ~ u'<~~ '--?t ~ y~ ~i~~Ti`1 t~ (Attach addlttonal sheets as needed) ', 61,993.21 NOTE: 'T'he Memorandum of real estate outside the Cornmonwealth of Pennsylvania may, at the election of the personal representati~/e include the value of each item, but such figures should not be extended into the total of the Inventory. (See 20 Pa C.S. § 3301(6)) Form RW-09 ree 10.13.06 _, ~ ~ - - LAW OFFICES OF GATES, HALBRUNER, HATCH & GUISE, P.C. 1013 MOMMA ROAD • SUITE 100 • LEMOYNE, PENNSYLVANIA 17043 (717) 731-9600 • FAX: (717) 731-9627 ~~~ R• ~-T~. u• M• GORRESPONDENCE ADDRESS: BRANCH OFFICE: LL. M. in Taxation Lemoyne ONice 3 WEST MONUMENT SQUARE, SUITE 304 Also AdmfUed ro Messaohusatts Bar LEWISTOWN, PA 17044 MARK E. NALBRUNER WEB SITE: (717) 248.8909 ~p A• ~~ CELA www.GatesLawFirm.com Cerdlkd ea en Elder Law Attorney by 9ITACEY L NACE the Nadorrd Elder Lew Foundation ParalegaVOtflce Manager " ~ IIRACI L SEPKOVIC A~ ro P,a~ babra d,a January 3, 2011 ~~~ U.S. Patent & Trademark Olfice 1!RACI L HILFERDIN(i JAIME Q BLACK Paralegal OF Counsel VIA U.S. FIRST CLASS MAIL Office of the Register of Wills Cumberland County Courthouse n' One Courthouse Square ~ ~ Cazlisle, PA 17013 ~' c~ ~ ,_.., ~.'. ~ t ~~,°~ f 1 7C r~ .. ~..~ RE: Estate of Ross W. Smithson ~ ~ ~ ~`~ -~-~ Estate No. 21-10-0497 b , ~? ~~ ~ w ~I Dear Sir or Madam, Enclosed for filing aze the Pennsylvania inheritance tax return (in duplicate) aa~d Inventory for the Estate of Ross W. Smithson. There is no tax liability due on the tax return. Please time- stamp the photocopy of each document and return them to our office in the enclosed envelope. Please also find enclosed a check in the amount of $30.00 as payment for the ding fee of the Pennsylvania inheritance tax return and Inventory. If you have any questions or need additional information please feel free tq contact me or Attorney Craig Hatch. Thank you. Sincerely, • ~~ Traci L. Hilferding, Paralegal tlh Enclosure cc: Todd H. Smithson, Co-Executor Kelly A. Frey, Co-Executor