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01-28-11
15D561D143 REV-1500 Ex (o,-,a, OFFICIAL USE ONLY PAD rt fR epa ment o evenue pennsylvania County Code Bureau of Individual Taxes DEPARTMENT OF REVENUE Po Box.2soso~ INHERITANCE TAX RETURN 21 Harrisburg, PA 1712s-0601 RESIDENT DECEDENT Year File Number ~$~8- 00486 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 213 56 1066 05 04 2010 Decedent's Last Name GILDER (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Spouse's Social Security Number Date of Birth 08 19 1956 Suffix Decedent's First Name MI MICHAEL D Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return ~ 2. Supplemental Return 4. Limited Estate n 4a. Future Interest Compromise /rf~4n of rln.~fM .~Hnr ~ 7 17 C'I~ ti Decedent Died Testate ~ ~ Decedent Maintained a Living Trust (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 1 p. Spousal Povert Creditl(date of death between 12-31 X31 and -1-95) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number BRUCE J WARSHAWSKY 717 238 6570 First line of address 2320 NORTH SECOND STREE Second line of address City or Post Office State ZIP Code HARRISBURG PA Correspondent's a-mail address: bjw@cclawpc.com -: _~., i ,~ .._, ;~~ ~::::> _.., .7 Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE Q Natalie Geiger / - ~ 5 -11 ADDRESS O u 11 Kingswood Drive, Mechanicsburg, PA 17055 ~- ,Z ,~- / I SIGN F REPARER O~.J~IER TEPR~NT~yikE~ DATE J. Warshawsky 2320 North Second Street, Harrisburg, PA Side 1 155610143 1505610143 J '~ REV-1500 EX Decedents Name: Gilder, Michael D. Decedent's Social Security Number 213 56 1066 RECAPITULATION 102,900.00 1. Real Estate (Schedule A) ....................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................................................ 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 38,590.21 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous fin; Probate Property Se arate Billin h Re e S d l t d G p g qu ............ ( c e ) ^ s e u e 7. 8. Total Gross Assets (total Lines 1-7) ..................................................................... g, 141 , 4 9 0 .21 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 22,529.27 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 76,333.78 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 9 8 , 8 63.0 5 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 42,627.16 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ............................................... 14. 42,627.16 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 0 , 0 0 16. 17. Amount of Line 14 taxable at sibling rate X .12 42 , 62 7.16 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 . ~ 0 18. 19. Tax Due ................................................... .............................................................. . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 15D561D243 15D561D243 15D561D243 0.00 0.00 5,115.26 0.00 5,115.26 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-08-00486 DECEDENT'S NAME Gilder, Michael D. STREET ADDRESS 711 Old Silver Spring Rd. CITY STATE PA ZI P Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 5,000.00 255.76 3. Interest 4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. Total Credits (A + B) (1) 5,115.26 (2) 5,255.76 (3) (4;1 140.50 (5;1 Make Check Pa able to: REGISTER OF WILLS, AGENT. a 1 r PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :............................................................................... ^ ^x b. retain the right to designate who shall use the property transferred or its income :.................................. ^ ^x c. retain a reversionary interest; or ............................................................................................................... d. receive the promise for life of either payments, benefits or care? ............................................................ ^ 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without [] ^ receiving adequate consideration? .................................................................................................................... x 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ^ ^x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................. ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. - ~;~;. For dates of death on or after July 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0 percent [72 P.S. §9116 (a) (1.2)]. . The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1 )]. . The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Rev-1502 EX+ (~ ~ -08) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF I FILE NUMBER Gilder, Michael D. 21-08-00486 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 11-08) (If more space is needed, additional pages of the same size) Rev-1508 EX+ (6-98) ' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Gilder, Michael D. 21-08-00486 All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 American Express Refund 2.74 2 April Disability Payment reed 6/3/10 1,531.00 3 IRS Tax Refund 156.12 4 Metlife refund (not yet received) 1.38 5 PA Property Tax Refund 250.00 6 Tax Refund (not yet received) 39.10 7 Travelers Insurance Refund 80.00 8 XM Satelitte Radio refunds (44.29+4.50) 48.79 9 PSECU Checking 27,665.34 10 PSECU Regular 263.37 11 2004 Chevy Malibu-for Sale through 8/31/10. Distributed to Beneficiary, Natalie Geiger on or 6,050.00 about 9/1 when no sale occurred 12 Household Goods, Printers, CDs, LPs (91+80+215.77+30+47.60) 464.37 13 Scrap Gold 1,008.00 14 Watches (2) 380.00 15 Liquidation value of Credit Plus-see attached letter (not yet received) 650.00 TOTAL (Also enter on Line 5, Recapitulation) I 38,590.21 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV-1151 EX+ (10-06) COM IN~~~IDENT D CEpN~N$.R4YANIA SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Gilder, Michael D. 21-08-00486 VYN~.7 V~ Y~iV~iYii.l 1L ~~~Y~16 u6 ~~. ~./VI ~GIJ V11 ~7VIICNUIC 1. ITEM DESCRIPTION AMOUNT A. FUNERAL EXPENSES: B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(sl Commission said 2. Attorney's Fees Cunningham & Chernicoff, P.C. 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. ~ Probate Fees 8,700.00 328.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 300.00 7. Other Administrative Costs 13,201.27 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 22,529.27 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Gilder, Michael D. 21-08-00486 ITEM NUMBER DESCRIPTION AMOUNT 1 Other Administrative Costs Appraisal of watches on Schedule E 42.40 2 Car Insurance-for period while car was for sale 69.00 3 Electricity-PPL for Real Estate on Schedule A 240.47 4 Escrow, recording fee and convenience fee to payoff mortgage from HUD-1 65.50 5 Interest paid on Real Estate on Schedule A until sale 279.52 6 Law Office Costs 6.10 7 Legal Advertising 172.00 8 Maintenance Costs for Real Estate on Schedule A-Capital Area Carpet Cleaning 117.66 9 Maintenance Costs for Real Estate on Schedule A-Crystal Clear Window Cleaning 106.00 10 Maintenance Costs for Real Estate on Schedule A-Dehumidifier 137.79 11 Maintenance Costs for Real Estate on Schedule A-Lightbulbs 6.34 12 Maintenance Costs for Real Estate on Schedule A-Lock set 9.51 13 Maintenance Costs for Real Estate on Schedule A-Old Maids cleaning 148.40 14 Maintenance Costs for Real Estate on Schedule A-PJ Flooring/Carpet 425.80 15 Maintenance Costs for Real Estate on Schedule A-Repairs/Mark Lauver 410.00 16 Monthly Condo fees for Real Estate on Schedule A 495.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) ' SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Gilder, Michael D. 21-08-00486 ITEM NUMBER DESCRIPTION AMOUNT 17 Oil Change for Car while for sale 21.15 18 Real Estate Taxes for Real Estate on Schedule A (1021.94) less mount reimbursed on HUD-1 186.48 for taxes paid in advance (835.46) 19 Reserve for Costs 250.00 20 Settlement Charges on sale of real estate On Sched. A (see HUD-1) 9,811.00 21 Sewer charges for Real Estate on Schedule A 140.00 22 Water-United water for Real Estate on Schedule A 61.15 H-B7 13,201.27 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ (12-08) ' SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Gilder, Michael D. 21-08-00486 Report debts incurced by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Chase Card 48.79 2 East Shore Oncology 6,366.35 3 First Horizon Mortgage-balance on DOD-see attached 11,815.09 4 Hospice 56,440.00 5 Outstanding check # 1905 on date of death for Payment of PA Income tax for years 2004 1,242.91 -2009 6 Outstanding check # 1908 on date of death for payment of Federal Income Tax to IRS 105.00 7 Outstanding check # 1911 on date of death for United Water 15.87 8 Outstanding check # 1912 on date of death for Local Occupation Tax 26,77 9 Outstanding check #1902 on date of death for Condo fee 95.00 10 Outstanding check #1909 on date of death for payment of Local Income Tax 178.00 TOTAL (Also enter on Line 10, Recapitulation) I 76,333.78 (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) REV-1513 EX+ (9-00) SCHEDULE J COMM_QN~,IDE~NT DECEDEN~RNANIA BENEFICIARIES ESTATE OF Gilder, Michael D. FILE NUMBER ~~ _nst_nndAa NUMBER NAME AND ADDRESS OF RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE PERSON(S) RECEIVING PROPERTY (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 a 1.2 Natalie Geiger Sister Half 11 Kingswood Drive Mechanicsburg, PA 17055 Neal Gilder Brother Half 3811 Summerlin Dr. Buckner, KY 40010 Tota I En r II o f i ri i n n lin 1 thr h r r i n v 1 y r he II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FO R WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA No. Estate Of : MICHAEL D GILDER CERTIFICATE OF GRANT OF LETTERS PA No . 21- 10- 0486 (First, Middle, Lastl Late Of : MECHANICSBURG BOROUGH CUMBERLAND COUNTY Deceased Social Security No : 213-56-1066 WHEREAS, on the I 1 th day of May 2 010 an instrument dated October 8th 2009 was admitted to probate as the last will of MICHAEL D GILDER (First, Middle. Lastl late of MECHAN/CSBURG BOROUGH, CUMBERLAND County, who died on the 4th day of May 2010 and, WHEREAS, a true copy of the wi 11 as probated i s annexed hereto . THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wi 11 s in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY ta: NA TALiE GEIGER who has duly qualified as EXECUTOR(R/X) and has agreed to administer the estate according to law, a.Il of which f u11 y appears of record in my office a t CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNS YL VAN/A . IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 11th day of May 2010. egis t/Ier o ills y L i ,- ~-t- ~ .~.- eputy * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) hJ Q •--- _~ ~~ o _~~ ~ ~~ - ~ ~~ ~ -T-. t-~- ~^C .. , ;~ ~~ _ LAST WILL - - -~~' _ _..., MICHAEL D. GILDER T,=°~ ~ ~ = -~~~ ~~ I, Michael D. Gilder of 711 Old Silver Spring Road, Mechanicsburg, Cumberland County, Pennsylvania, being of lawful age, sound mind and memory, and under no restraint, do publish this as my Last Will, revoking all other Wills or Codicils previously made by me. FIRST: All expenses, fees, costs, and taxes related to this estate shall be paid from the probate estate assets, including but not limited. to funeral expenses, grave mazker, the costs of my final illness, Inheritance, Estate and Fiduciary Taxes; apd all gifts and bequests shall be paid from the net distributable estate. SECOND: I have two (2) siblings: Natalie S. Geiger and Neal M. Gilder, my father, David Gilder, predeceased me and my mother, Barbara Gilder is living, but my Will does not provide for a distribution to her so as to not adversely impact her own Estate plan. THIRD: (a) I give my furniture, household and personal effects, and other tangible personalty of like nature, other than cash or securities, together with any existing insurance thereon to my brother and sister, Neal M. Gilder and Natalie S. Geiger only, in equal shares, if they should survive me by 30 days, per stirpes. (b) I give, devise and bequeath the rest, residue and remainder of my estate, of every kind and nature, wherever situated, which I may own, or hereafter acquire, or have a right to dispose of at my death ("Residuary Estate") to my brother and sister, Neal M. Gilder and Natalie S. Geiger only, in equal shares, if they should survive me by 30 days, per stirpes. FOURTH: I nominate and appoint my sister, Natalie S. Geiger to be the Executrix of my Last Will, granting to her authority to sell and convey any or all of my estate, real and personal, or mixed, upon such terms and prices as she shall deem proper, without obtaining any prior order of the court therefor. I also grant her full power and authority in the settlement of my estate, to compromise, adjust, and settle any and all debts and liabilities due to or from my estate, for such sums, and upon such terms and conditions as she shall deem best. In the event that she shall for any reason decline to serve, or fail to qualify for any reason, or having C-tip ~.. qualified and been appointed, fail to complete the administration of my estate, then I nominate my niece, Melissa Geiger, the Alternate or Successor Executrix. FIFTH: I direct that no bond or surety shall be required of any guardian, trustee, executor, administrator or fiduciary named herein.. IN WITNESS WHEREOF, I have hereunto subscribed my name, and acknowledge and publish this instrument as my Last Will in the presence of the undersigned witnesses, on this ~ ~ `' day of C~ ~ ~ ,,1 ~ , , 2009 Michael D. Gilder The preceding instrument consisting of four pages, including this page, was on the date thereof signed, published and declared by in the presence of us, who, at his request, in his presence, and in the presence of each other, have subscribed our names as witnesses hereto. f/ 7 of Harrisburg, PA Bruce J. arshaws of Harrisburg, PA i berly .Peterson Commonwealth of Pennsylvania County of Dauphin ss I, Michael D. Gilder, the Testator, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will, that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein expressed. Michael D. Gilder SWORN or affirm to and acknowledged before me by the above named Testator this ~ day of , 2009 ~ ~ otary Public [y commission expires: Commonwealth of Pennsylvania ss County of Dauphin We, the undersigned witnesses whose names appear above, being duly qualified according to law, do depose and say that we were present and saw Michael D. Gilder, the Testator sign and execute the instrument as his Last Will; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses and that to the best of our knowledge the Testator was at the time eighteen (18) or more years of age, of sound mind and under no constraint..ar undue influence. Bruce J. Warshadv PC.• K>t berly .Peterson SWORN or affirmed to a Testator this '~'- day of before me by the above named .2009 ~n.c~l~t~f,c F: \Home\B1W\DOCSIG ILDER.MICHAEL\Will. wpd btary Public y commission expires: COMMONWEALTH OF PENN Y VA NOTARIAL SEAL JULIEANNE AMETRANO, Notary Public City of Harrisburg, Dauphin County My CAmmission Ex 'res February 22, 2011 (~~~ ~.. uMe A SETTLEMENT STATEMENT (HUD-1) ••"""''* Select Platinum Settlement Services, LLP ~ • ~ 3912 Market Street c ,1`'•~.,.~.~~''~~ Camp Hill, PA 17011 (717) 737-0884 8, TYPE OF LOAN -t~i~ _ _ _ 1. fHA 1 RH5 ~. W CONY. UNINS. 4. ^ VA 5. ^ CONV. INS. 8. ESCROW FILE NUMBER' 00102160-001 MAW 7. LOAN NUMBER: 00962o38a1 8 MORTGAGE INSURANCE CASE NUMBER: r -IVA~ I _ ---------- C NOTE. (TMs bnn is firmisf-ed to give you a statement of actual seClement Costa Amour>ls peld to snd by the settlement spent are shown. Ilgms marked (P O. C )' were paid outside the c-asulg; they ere show~r- hers !or rnbrma6orlaf purposes and are no! included in the totals __'__ o -r+nwlE of BoRROwER. Svend D. Sheppard IV ADDRESS OF BORROWER 4 Bayberry Court _ Mechanicsburc;f PA 17050 ____._ _ _ _ _ - __ - -- E NAME OF SELLER: EStat@ Of MlChael D. Glld@r ADDRESS OF SELLER: F NAME OF IENDER SOVerelgn Ban!( ADDRESS OF LENDER' 1130 13Etfk5hife BIVd. Wyomissing, PA 19610 ~oPERTY LocATION 711 Old Silver Spring Road Mechanicsburg, PA 17055 Cumberland County 18-22-0519-001 B-U-A711 Parcel #18-22-0519-0018-U-A711 __ _ ___ ___ _ _ _ JI+_ serTIEMENTAGENr Select Platinum Settlement Services, LLP (717) 737-0884 o. nr.E nF sETnEMENr: 3912 Market Street. Camp Hill, PA 17011 I SEITLEr~AENT DATE 10/28/201Q PRORATION GATE' 10/28/2010 (NSBURSEMENT DATE 10/29/2010 K. SUMMARY OF SELLER'S TRANSACTION 400. _GROSS AMOUNT DUE TO SELLER: - _~_~ 101. Contract Sates Price 102,900.00 401. Contrail Sales Price J_ _ _ 102. Personal Property 402. Personal Property 103. Settlement charges to Borrower (line 1400) 5,041.23 403. i oa. - ------- -- 404 105 405. _ _ _..__._-.__ ___ .~ ................~.. ~., .., .......~~~. sn ~~ icru~utc cna i rr~uc PAIn nv SEl 1 ER IN ADVANCE 102,900.00 108. Cky/Town Taxes 408. Ck ITown Taxes _ 107 County Taxes 10/29/10 to 1Z/31/IO 80.00 407. County Taxes 10/29110 to 12131/10 80 00 108 Assessments 408. Assessments __ . 109. _ _ School Tax 10/29/10 to 06/30/11 _ ~ 897.10 409. _ __ _T ___ -_ _, School Taz 10/29/10 to _08/30/11.___ _ _ _ _ 697.10 110. HO Assn 10/29/10 to 10/31/10 8.58 410. Fi0 Assn 10/29/10 l0 10!31!10 6.58 111. Sewer 10/29/10 to 12/31/10 _____ 51.78 411. Sewer 10/29!10 to 12/31/10 51.78 112. 412. ~ J 113. 413. 114 414. 115. 415. 120. GROSS AMOUNT DUE FROM BORROWER: 200. AMOIldTB PAD BY OR IN BEHALF OF BORROWER 108,778.89 : 420. OR089 AMOUNT OUE TO SELLER: 600. REDUCTIONS N AMOUNT DUE TO SELLER: 103,735.46 f _____ _ ___~ 201 Deposit a eamsst money 2,000.00 501. Excess de osil see instructions) ____ _ 202 Principal amount of new loan(s) 82,320.00 ~ 502. Seltlemsnt chat eQ s to Sslter line 1400) 9,811.00 203, Existing loan(s) taken subleil to 503. Exist' loan(s) taken sub ect to -_ 204 504 Pa off of tat mt .loan to First Horizon Home loan _ 9,477.81 205. 505. Pa otf of second moRga ban 206. Application Fee Credit 399.00 508. _ 207 507. _ 208 508. ____ __~ 209. 509. 210 CllylTown Taxes 510. Cky/Town Taxes ___________ ___,_ 211. County Taxes St 1. Count Texas _~_~__ 212. Asaesttments 512. Assessments 21 ~ 513. .~ - --~ 214. 514. -------_._____ 215. 515. 216. 518 -----.._---- 217. 517 ------ ----- 218. 51 B. !-- --` 219. 519 220. TOTAL PAID BYIFOR 80RROWER: 84,719.00 520• TOTAL REDUCTIONS IN AMOUNT OUE SELLER: 19,288.81 100. CASH AT SETTI.E]w1ENT FROWTO BORRt7YYEli: rwo. ~wsn w I x I r LCNICIV r rurnure xu.rr~ !-- 301. Gross amount due from Borrower (line 120) 108,778.89 601. Gross amount due to Saker Sane 4201 _ 103,735.46 302. Less amount paid by/tor Borrower (line 220) 84,719.00 602. Less reduction In amount due Seller (line 5201 - _ 19,288.81 303. CASH ( ®FROM) ( ^ TO l BORROWER: 24,057.69 803. CASH (^ FROM 1 (~ TO (SELLER: 84,446.65 The Public Reporting Burden br this cdlection d information is estimated at 35 minutes per response for collecting, reviewing, and reporting the data. This agenq may rat collect this information, and you aro~not roquired to complete tt>ia bnn, unless it displays a currently valid OMB contrd number No confidentleNly is ~sured; this disclosure is mandatory. This is designed to provide the parties to a RESPAcovered tansaction with information during the settlement process. r 1. SETTLEMENT CHARt3E3 ESCROW FILE NUMBER: 00102180001 MAW 700. TOTAL REAL E.`i t A t C nnvnsax r cw' PAID FROM PAID f ROM DMSION OF CONwi15S10N (LINE 700) AS FOLLOWS: t30RROWER'S FUNDS SELLER'S 701 i~,118.001o RelkAax RssNy Select AT sETTIEMENT FUNDS AT SETTLEMENT 702 f3,087 00 to ERA NRT Inc. -- 7,203.00 703 Commbaron gab at Seltlernetlt NRT LLCJ RekAex ~ - - -- 195.00 ~ t 55.00 704 Additxx,al Broker Fee to ERA- - _ _ _ _ 10.00 ._ . 705 Tax Receipts to ReMax RaaNy Select tI00. ITEMS PAYABLE N~1 CONNECTION WfTH LOAN: 949 00 (Iron GFE Nrl P.o.c. =~ -~ , - ~ ~~t~ ~~ 801. 0 - - _ Your cradN or charge (pomta) for the speclt-c Interest rate chosen- 802 __ f0 00 (rrom GFE N2) _ __ - - ---- . 803 Your ad)uslsd orrginadon charges to Sovereign Bank _ Thom GFE A) __ . 949.00 raisers A P Irram GFE a3f 348.00 _ ~_ enn pp 804. Appawsal tae to Central _ ___ 805 Credit report to CBC Irxrovb - (kam GFE N3) -- _ --- _ -- 18.33 - erican l A F T (tom GFE N3) 63 m rn 806. ax service to 807. Flood prlMcallon to LPS National Flood __` (ham GFE N3) _- - -- - - 5.75 _~~ - 808. - _ _ _ --- - -_ _ _ 809. - _ - ------- 810. --- - 1100. ITEMIf REQURED BY LENDER TO BE PAlD OJ ADVANCE: _~ o P.o.c. ~ --- - 16 29 901. Dally interest chxgaa ) (kom GFE n --- . hom 10/29/2010 l0 11/1lZO10 ~ aft 71 e3 /day 'Ai (3 days) -- -- - 9p2 Mortgage Insurance prurnlum for 0 monlf,ls) (kom GFE M31 g03 ilon,aowrler'a insurxrce for t year(s) b Penn Nalbrwl Insurance (from GFE Nt,) (381.00)8 _- 905 - - -. ~ - ~ - __- loos RESERVES o~osREO YNTH LEwER: 11X)1 Wltal daposN tot yolx escrow account (ham GFE N9) 627.61 i __ _ - _ 1002 Norl,eownNr's rnsurance months ~ f per month 1003 ~rW+Oe ktwnnu months ®f per month 1004 City property taxes months ®f per month ~ T.~------- 1005 County property taxes 9 months ®f 38.83 per month 5347 B7 - -- __ _.._~._ _ •___- _ __ _ __ _-_ - 1008. Annual asNaamenls months ®f per month 1007. Schod Taxes ---- S months ~ f ~ 90 per rrlortlh f434 S0 ------- 1008. months ®f per month 1009 Aggregate Acct. Ar>f. months ®f per month -(154.58 - - -- _ 1100, TITLE CHARt;ES: P,o.C. 1101. Title services end tender's tins inau-ancs Ihon+ GFE >NI 1,071, 08 __-- - 1102. SelllerrNnt or GoskW he 1 t 03. Owner~a M11e ktsurance to Seect Platinum 5elriemenl Services. LLP (kom GFE NS) 105.30 1104 Lerxlsr'a UNe insurance • to Select ~lahnum Sdtlerr,ent Services, LLP f681.0a 1105. Ler,der'a Urie poMcy limit f82,320 00 1106 Owmer's 1Nte pdiq Iimi1 f 102,900.00 1107. Agent's portion d 1M total title msurance premium is3r>.42 1o Sebd PleUnum Settlement Services, LLP _ -_____ . _._ _. i 1108- Ur,derwrllsr's poAan of the Iotal Utle inwranu premium (222 96 to OW Reputriic National-Title Ins. Co. 1109 Ends. 100, 300, !. t, condo • b Seleq Pladrrxn Settlement Services, LLP (200.00 _~ -_ ___-_- __._ _-•_ _ 1110. Insured Closing Latter • b Old RepudiC National Tide Ins. Co. (75.00 1111. Nolxy Fees • b Settlement Oftiuiur (45.00 _~._ _ 10.00 - 1112. '•Ses altnched to txeakdown (70.00 15.00 -~ ~ ~9M rJN/CDUaaCAR mrnonrsxn sun tsa!augGCR r^NSR[`.F4• P.O.C. ~ 1201, GovemmeM recording charges Rrom GFE NT) 158.00 _ 1202. Deed 182.00 Mortgage (68.00 Release f0 00 --•--~-- -- 1203. Transfer taxes Ifram GFE Nel 1,D29 00 1204 CNy1CouMytax/slamps Deedf1,020.00 Mortgageli0.00 _ -'- 1,029.00 - --- 1205 Stale Iaxlstemps Deed f1,029 00 Mortgsge 10.00 ____ _ 1208 -- ----- - - ------ 1207. 19M AIHLTIHWI Q6TT1 caacAtT r{JAQrIQ• Y.U.V. 1301. Rsquked services Mat you can shop for (6om GFE Net ~_ 1302. Resale CertlBcale to Helene Dougherty 150.00 1303. lnltietion Fee to WaUtut Villas Cando Assn. _ 300.00 _ 1304. Special Termite Assessment b Walnut Wlea Cando Assn _ ___ 44.00 4.00 1305. November Assn. Fee to Walnut VAlas Gondo Aasn. 100.00 ----- ~-T- _ ------ 1306. "See attactred for breakdown 1,235.00 1400. TOTAL SETTLEMENT CHARGES (Enter on line 103,SecUon J • and - Nr,e 502, 5ectbn K) _ , _ 5,041.23 _ 9,911.00 have arelvey reviewed lM HUD-1 Settlement Statement and b the beg d my knowledge and ballN, Il Ice a true and accurate stalemenl of aA receipla end disbursements made on my accotalt or by me in thin trensacnon. 1 Curtner oerdry ttlat t have received o mpy of tl,e HUo-t Battlement Statement. . ,r _ Svend D. Sheppard iV Estate of Michael D. Gilds / Borrowers Sellers The HllO-t Saltlemar,t Statement which I have prepared is a true and axurale aocaunl of this trenearllon. i have mused or Mrrl cause the funrN b be disbursed N accordance Wih Mrls statsrnent. ! _ r ( I ~' I ~ ~' Settlement Agent ~ ~~ ` -~~ ~ /1 Oate Select atinum Settlement Services, LLP WARN)NG: II is a cane t0 krlowingty make false slalerrlenls to the United Slates on this or any simlx form. PenaNies upon convlctlan can hcluae a ins and mprhanmerit. Fvr detak see. Titb 1tl U.S. Code section toot and Sediat Coto. t=ecraw Number. 00102160-001 MAW Comparison of Good Fslth Estimate (GFE) and HUO-1 Charges Charges That Cannot increase HUD-1 Llne Number Our origination charge 1801 Your uedit or charge (points) for the speciNc interest rate chosen M802 Your adjusted origination charges X803 Transfer taxes X1203 _, _ Charges That in Total Cannot Increase More Than 107E t;,overnment recording fees +1201 Appraisal fee M804 Credit report >r805 Tax service ar806 Flood certification _ Jf807 S M Total 683 08 591 08 increase between GFE and F1UD-1 Charges ~ S -72.00 or -10.8584°~ Charges That Can Change Good Faith Estimab HUO-i Initial deposit for your escrow account *1001 4~~_ 1,835.00 ~ _ 627 6t Daily interest charges x«901 S 9.7183 I day 58,31 29 16 Homeowner's insurance ~ M903 0 00 381 (K1 Titb services and lenders title insurance 81101 -._____.-~-___ 1,091.00 _- __. _ 1,071 OS Owners tide insurance _~----~ (11103 135.00 ___ _ 105.30 a ----- -- Loan Terms Your initial ban amount is _ S 82,320.00 Your loan term is i ~ yew I Your initial interest rate is 4.2500% Your irrtial monthly amount owed far principal, interest, and any S 404.97 Includes mortgage insurance is L^.J principal J-X~ Interest Mortgage Insurance Can your interest rate risel l X~ No. ~~ Yes, it can rise to a maximum of 0.0000%. The first change will be on and can cturrge again every alter .Every change date, your interest rate can increase or decrease by 0.0000%. Over the lice of the loan, your interest rate is guaranteed to never txe lower than 0.0000% or hgher Than 0.0000% I Even if you make your payments on lime, can your loan balance rise? ~Xl No. ~_~,J Yes, it can rise to a maximum of s 0.00. Even if you make your payments on tkne, can your monthly amount ~ No. U Yes, the first incre~e can be on and the monthly amount owed can owed Ior principal, interest, and mortgage insurance rise9 rise to S 0.00. i i The maximum it can ever rise to is S 0.00. Does your loan have a prepayment penaKy7 J X.J No. J~_3 Yes, your maximum prepayment penally is Z 0.00. Does your loan have a balloon payment9 J%) No. G~ Yes, you have a balloon payment or S 0.00 due in 0 years on Total monthly amount owed including escrow account payments ~~ You do nd have a monthly escrow payment for items, such as property taxes and homeowners insurance. You must pay these items directly yairaetf ~x ~ You have an additional monthly escrow payment of i 157.28 !fiat results in a total Initial monthly amount owed of S 562.25. This indudes principal, interest, hecked below: c any mortgage insurance and any ibms tt r~- 1.^ l Property taxes I^1 Homeowner's insurance r .} Fbod Insurance r~ `~ ~_.~ Note: If you have any questions about the Settlement Charges and loan Terms listed on Ibis form, please contact your lender. Good Faith Estimate HUD-1 949.00 949.00 p.00 J 0 00 949.00 ~~ ~ 949.00 1,029.00 1,029.00 Hood Faith Estimate 230.00 346.00 HUD-1 ~ 158.00 346.00 18.33 fi3 00 18.33 ~ 53.00 5.75 5 75 pr~~wn,.~ ~Ai/in..• ~r~ nM~l~ Escrow Number 00102180-001 MAW BREAKDOWN OF PAYOFF ON HUD LINE 504 First Horizon Home Loans Daecrlption Amount Principal Balance 9,369.94 Interest 42.37 toantt 0041791591 Recording Fee 50.50 Convenience Fee 15.00 Total Payoff 9,477.81 Total as shown on NUD line 504. 9,477.81 e~ow ~~r~ 001021 saool MAw HUD 1112 DETAILED BREAKDOWN OF ADDITIONAL TITLE CHARGES Detsll Seller Descrl ption Amount Amount 1113. Doc Trans/Wire Fees • to Select Platinum Settlement Services, LLR40.00 1114. Overnight Fees • to Select Platinum Settlement Services, LLP 530.00 15.00 Total as shown on HUD page 2 Line #1112 15.00 HUD 1200 DETAILED BREAKDOWN OF GOVERNMENT RECORDING AND TRANSFER FEES Buyer Seller Amount Amount City ~ County TaxlStarnps City Tax/Stamps: Deed $1,029.00 Total as shown on HUD page 2 Llne #120A 1,029.00 Buyer Seller Amount Amount State Tax/Stamps State Tax/Stamps: Deed 51,029.00 Total as shown on HUD page 2 Line #1205 1 029.00 HUD 1306 DETAILED BREAKDOWN OF ADDITIONAL SETTLEMENT CHARGES Description 1307. Radon Mitigation to Enviroquest 1308. Home Warranty to American Home Shield 1309. Sewer 10/1110-12/31/10 to Mechanicsburg Borough Seller Anwunt 725.00 435.00 75.00 Total as shown on HUD page 2 Llne #1306 1,235.00 PSEC~ January 14, 201 1 Account # 0213XXXXXX Correction to June 15, 2010 letter E3RUCE J WARSHAWSKY CUNNINGHAM & CHERNICOFF PO BOX 60457 HARRISBURG, PA 17106-047 Dear MR WARSHAWSKY: the following is the status of MICHAEL D GILDER's account with PSECU as of the date of death. Joint Owner's Name NONE Date of Death OS-04-201 U Date of Birth 08-19-1956 Share Description Opcn date Balance Accrued Dividend S 0 I Regular Shares 06/23/ 1995 $ 263.36 $ 0.01 S 04 Checking 07!26/ 1995 27,665.09 0.25 "The dividend earned.fi-om January 1, 2010 through the date of death was $1.43. The decedent had no loans with us. We do not have safe deposit boxes far our members. The executrix has provided instructions for closing the account. If you have any questions, please call 234-8484 in Flarrisburg or our toll-free number, (800) 237-7328. At the menu prompt, enter 6 and then extension 2227. Sincerely, ` ~.~ ~ ~ r' C Y1 ~1 Sue Walter Member Service Representative Finance Support Unit Pennsylvania State Employees Credit Union Main Address: 1 Credit Union Place, Harrisburg, PA 1 71 10-2990 • 71 7.~?34.8484 • 800.237.1328 Mailing Address: PO. Box 67013, Harrisburg, PA 1 7106-7013 • 71 7.777.2100 (TDD) • 800.472. 1967 (TUD) psecu.com This credit union is federally uuu~ed by !he. Notional Credit l lnion Adnuni,bofinn Fyual Opportunity LEnxjei TRAVELERS ONE TOMER SQUARE - 0000 PBPZA HARTFORD, CT 06183 MICHEAL D GILDER 11 KINGSWOOD DR MECHANICSBURG PA 170552761 DATE: CHECK NUMBER: AMOUNT: OFFICE: 675 ACCOUNT: REFUND DUE TO CANCELLATION 11/12/10 883A 04567581 s8o.oo*** AGENT: OI1809 949219188 949219188 NAMED INSURED MICHEAL D GILDER AND ADDRESS 11 KINGSWOOD DR MECHANICSBURG PA 170552761 ** IF YOU HAVE ANY QUESTIONS, PLEASE CALL 1-800-841-3005 ** GEICO INS AGENCY INC ~~•n ~ ~ ~ ~ ~A i~~~ ~~n ~ i inn an 4~~ ~A ~ i ~ ~. ~ ~~~~ Detach Chick Detach Ch~cl~ CJe.~2~e ,IOSEPIi JAMES ~EWE~ERS TO WHOM IT MAY CONCERN: This is to certify that we tie engaged in the jewelry business, appraising diamonds, watches, jewelry and precious stones of all descriptions We herewith certify that we have this day carefully examined the following listed and described articles, the property u( NAME: Instate of Michael Gilder ADDRESS' c/o Natalie Geiger I I Kingswood Drive Mechanicsburg, PA 17055 We estimate the value as tisied for insurance or other purposes at the current retail value, excluding Federal and other taxes. !n making this Appraisal we DO NOT agree to purchase or replace the The following items are evaluated for estate purposes DESCRIPTION One gent's quartz Concord Mariner SC wristwatch. The band is stainless steel with 18K yellow gold bars; three are missing. The dial is gold with diamond markers encircled with a diamond bezel. This watch has a quartz movement. The case number is 1150810115 V 14. The band number is 7035 ] 9. Value: $200.00 !~ dK. .~'' 1 • ~ ~a~:' ~r. ~ ~ iD4 A i:.4 yy Al~~ t' t... ,. k ~ ; : .. ti w; `~. h: ~ •. s ~~;. t~tl ~. `:" ~I~p v,~My, xr'ia ..tit ~~ Yt ~ ~4• y, ~ ~;: u ~A~~~. .~ K.. t' _.. ~' ' ~t ;r,~ • ~ t :. t 1 r 1 ~'~ s1.,~ry a , 1 i"; i ,• '~' ~ i One gent's manual wind Omega wristwatch. The case and lugs are 14K yellow gold. "the silver dial has stick markers. The case back is engraved To Sam Love, Jessie 1973. This watch has a Raymond Weil black leather strap. There are minor scratches on the crystal. Value: $180.00 - ~-: ~ - `- _. ~..,_._.~=---~.~=~ -~ May 19, 20 ] 0 ,~ ~.._.~---~ ~~~a es D. Davis P.G. The foregoing Appraisal is made with the understanding that the Appraiser assumes no liability with respect to any action that may be taken on the basis of this Appraisal 301 East Msin Street Mechanicsburg, PA 17055 (717) 795-y224 n I I C~z--i~v --~~mva ~ I 1 mm~~cn ro-n---~c~ i D~ZCO ~ m O o n i - -1 v ~ ~ n ~ •- c~mc i vrn - o -~~~ ~ I I r 3ar+ CJ7o•• r+ rn I •I aor- orn m n 1 I z- r+ .~• ~ o cn OD ~ r-= ~~ ~ W N\a i i I O ~ i i m ~Nmx t D ~ i C O~ i O X O T1 1 1 a X I 1 I ~ x 1 ~ 1 (/) a 1 1 ~ I I m 1 1 1 1 r-r I I O 1 1 I O 1 ~ I N N I ~ Q~ I I 1 ~ ~ ~ i i O N ~a Q -A 1 1 W CJ1 I I v O (,l1 W O I I CJ1 O O O m _, r-• m TI n V ~ n ~g~ ~~ v A V~ r ACA ~ A~3 :] XM SATELLITE RADIOS Inc. ` JPMorBan Chsfa Bank, N.~ No 2781.84 Xv f1A0~OLfTf[ 1500ECkingtonPfec.~•,NE:: 8yracwft.NY ' ~~c Washington, DC 20002 so-e37/213 202-380-4000 PAY 05/14/10 Forry+-Fo~rrAnd 19/100 Dollofz ~~*••••*gq,29 TO I~Nchaei Gilder Not vffsfi ~ttf~ tzo o.y s THE 11 Kingswood Dr ORDER Mechanicsburg PA 17055-2761 OF United States A Ms~d 8loastufn ii'0000 2 ?8 184i~ ~:0 2 L 309 3 ? q~: 8 i i i04 2 ? iii' . ~ • _. Check No. • ~~=-- - - 06 03 10 12 PHILADELPHIA, PA 2049 95786439 ~ ~~'~ ~ •~~. _ ~- -~~~ 2049 95786439 28045300 S2 B P r. • - ~-PaX to ~r~ :.,; ~~~ ~-'~~~ ° ~~ ~ ~{~¢eara~cot NATALIE GEIGER 39 VOID ASTER ONE YEAi SOC SEC ~' '`~~ FOR THE ESTATE OF U FOR INS ~~~~° * ~ ~ _ MICHAEL GILDER DEC' D ~***1531 *00 - °'""~ ` • 11 KINGSWOOD D R r:,~ ~'-~~ MECHANICSBURG PA 17055 ~" ~" 1 51 P 277,116,316 ~.~r:y .1a ;~ , - ,. ,, ~.- i. .N•:.~E~.~R~~~N' ~;, . f.. .a~wo..~.o.~. x:000000 5 i8~: 9 5 ?8 6 4 3 9 1M' 0 90 6 10 /r_`~ ~7 .. .`•. $.. ` S { '• ... r :~. >::..:' d .. ... ..3.~ .~'*: '' ~ ~: O~y . .. ~:~';;..:;:: (~~"~ ~° <~~rQm~ v O. ~.~~~ ,.,.!~.. ...:: :, ~ij n ::~ Y ,.,.Y i is f ~~: ~ yT w ,~.R,.. .. .. ... ~ w >}.•; `;' ~ ...;: -- r- W • ~... • • .-~ ~ ~ ~ ~ ~ N to "" tt'1 O ~ n w ~, ,~ ~ d -' a c~ ~ ~- o~- a°~ = m~ ~~~- ~ cn z ~~Q= O'YU~ W W ~+ ~ ~~~~ •^ ~L PA O •• rtJ LJ7 .a c~- .a ru O 00000 002 018 052210 02040015 446871 ~pp FUND DEPT PREP DATE VOUCHER WARRANT ID WACHOVIA BJ1NK'; PHILADELPHIA, PAS VERIFICATION AVAILABI-! -"POSITIVE PAY" PROTECTED PAY OO ONL~~i irTSCrS TO THE ORDER OF MICHAEL D GILDER DLN 097010232553 REV REBATE 11 KINGSWOOD DR MECHANICSBURG PA 17055-2761 IIEII~IEIE~IIEEEEIEIEE'.'tEEIEiIEEEIEI~EEEEEIIEEE~IEEEIIEIEEII Q2~i38 iii <- 7 15192167 ;''CHECK NUMBER o?/o~/2orc DATE a~~ o~~sn ~' /~ ptoK~UQ N,ltf ,~ Q VOA AFTER 1 a0 DAYS ~_ ~~`' ~ ?REASURER OF PENNSYLVANIA la i 5 L 9~ i 6 ?~' ~:0 3 i X00 2 2 5~: 20 ? 9 9 50008 60 2~' ~ ~ • ~ • • Pennsylvania DEPARTMENT Of REVENUE REV-s6~g EX (2-so) Enclosed, please find your Property Tax/Rent Rebate check, funded by the Lottery and revenue from slots gaming. Some homeowners may receive a larger rebate than requested. Based on where you live, income and/or property taxes, you may have qualified for a supplemental property tax rebate added to your regular rebate. In addition to funding the expansion of the Property Tax/Rent Rebate program, revenue from slots gaming will provide general property tax relief again this summer, further cutting school property taxes for millions of homeowners across the commonwealth. The Property Tax/Rent Rebate program is one of many benefits the Pennsylvania Lottery provides to older Pennsylvanians. Ours is the only state lottery that designates ail proceeds to programs that benefit older residents. You may be familiar with other programs the Lottery funds, including: PACE and PACENET, our low-cost prescription drug programs; free and reduced-fare transportation services; long-term living services; senior centers; and Area Agencies on Aging. All of these services are part of our commitment to ensuring a healthier, happier life for you and all Pennsylvania's older residents. If you have questions about this check or your rebate claim, please call, toll-free, 1-888-222-9190. G` Edward G. Rendell Governor P i AM •~•••~~~ *~_ ~~~~~~ Note: You will automatically receive a Property Tax/Rent Rebate application in the mail early next year. '""'M-~ ` PROCCESSED DATE CHECK NO. RATE ACCOUNT BATCH /SEQUENCE 07/06/ 10 ! = 72089931 X}OO~QaCOOQ{S 1005 2865 192 ___... REFERENCE GR45S DISCOUNT NET AMOUNT TOTALS s2.7a American Express TRS Company Inc. REMTlTANCE ADVtce Phoenix, Arizona 85027 M DETACH BEFORE DEPOSR'lNC3 '~' K 734, 283, 091 4;••~- =_ • ~ ~~~ _ Check No. ~ •a ~ ~'" ~ 07 23 10 13 AUSTIN, TEXAS. 2310 41163447 *~ r,, . 2310 41163447 20090900 I30 OGILD KANS CYTAX REFUND ~ Pay to ~~~~~~~~~~~~~~~~~~~~~~~~~ii~~~~~~i~~~~~~~~~~~~~~~~~i~~~~i~~~~~ theordaof MICHAEL D GILDER 12/;0 .; 11 KINGSWOOD DR 47, MECHANICABURG Pa 17055-2761 ~****156*12 ~, VOID AFTER ONE YEAR ~e~anK r~~sroonru~ %~ ~? ,~~~ .30 INTEREST u' 2 3 LOON' x:000000 5 LBO: 4 ~ L 6 3 4 4? 6N• 0 40 ? LO llepartment rf ~he'1'reasury lur~rn:~l }jr~•rntteSrr~'ire 1'.C1. lies lti??6 1'hila~lelphi:i, 1':1 1!)11-C~??G 17111; 1KS 1_'SL' O~i1Y 000199.755752.0001.001 2 AT 0.'392 1090 f*' MICHAEL D GILDER 11 KINGSWOOD DR MECHANICABURG PA 17055-2761 000198 «'h~• «'e Arc S~•~-itit>t~ 1'„u '1'l~is notice 1.1'1!!1-I~J-~ib!!-ll ~L1111!n (.:.1': ti13 ~~~ 1.1 Il Ij~) r~>t-aas~sl;-„~~. eau: 1-811U-K2~)-i'ii7=l Your (':Illri• II): 7275~~) ~ulice \ umber: (:'P1G 1)ute: July 2G, ~!i-I(I '1'uxpu}•rr I~Ie111ilira1io11 ~ 111111-er: l :i-~G- t h(i(i "I'a\ I'tll'lli: 111=t~U X1:11 ~~eal': L)~tiallltl~f 31, ~(11.I~i C .'~Illllllllt 1-Cltl't'llllll S l 5S.K2 ~V~ ch:r11~'l'll the u~~~rpayluciit altlollllt oIl your 2t)()~ lax return hecausc ~v~ ti)un~l one or lllor~ nlistakcs th.rt ~h:rn~~c~) yi-Irr ti~tal tax ;rncl'or i),iynla;~nt`. Yl)u Holy h:r~•i~ ~~~cpi•~t~•ri .r dil'ti•rcnt rctiuli) rlrnc)Irrlt I)r ni) r~liurcl at all. fhir r~•curds show you owe other l~e~l~ral tax(es). ~Ve applied part or all ~)Cthe ot~erpayn~~nt to tll~ ullcl-:rpaid ac~c)unt(s). «'L ha~•~• li~t~•~i the explanations ol•tllc chall~~~•(s) and the anluullt(s}applied Ull tll~• 1•Qlluwlll~ na~~~•(s). • ~Vt cunlput~•d your reco~•ery rehate credit t'or you. «'1>I:It 1'ou Should 1)0 !f Y~-u At;ree ~1'itl>I'1'he ('1>ta>«t;e • Yi)u ilo llc)t n~lr•~i to du anytllin~. Il•you t)wo no oth~•r anl~)ulats that w~ aro r~•t.luir~~l t~) ~ull~•ct, yinl should rec~•i~•e your corr~ct~•d refund within six weeks. «'hal 1'~lu Shout~l I)o If 1'ou !)is~t;rcc «'ilh "I'llc ('I>t~tlt;e • ICyou dis~l~ree with th*v change wo maiio or you ha~•u addlllunal lnti)Cnlalloll (flat c~)rr~rts the ~•rrur wu ti)und, please call lls at 1-8i)t)-82~)-8374 to discuss your account. • C)ur representati~•e will explain the chan`e we mado. You can explain why yolt disagree with the changly alld pr~)~•id~• th~• r~•rr~•eerltati~•c with auy cc)rr~•rti~•o illli)rnlati~)n you ha~•o. ~V*v will c~)rn•c:t any II11~t:Ila;S 1111 y'(lllr al'COUlIt. • Y~nl also ran llandlo 11115 lllatl~'r by mall. You may write to us at the address i)n the stuh at tho end oi~ this n~~tice. 1'ltase attach the stub to your corrtspondonce. "1'he stub will help us process yo11r inquiry cluirl:~r. I':,,~c 1 1'hil.ui~lphia S~tvic~ Czntzr 2l ~-~fi-I OGfi 'l'ax 1'~ri~x1: 1)~ctmh~r 3 t, 2(1(- (~)tir reecu•el~ shr-w yuu ~~«~e i~tlirl• F~drr.~l tax~•s. Y~-iu• c~t~etpaymcnt ~~~as applied as 1~i~llc~~s~s: 'l'ax I~untt(s) Tax Period(s) Amount Applied Balance 1O=1O I)ererllher 3 1, 2OO7 S 144.1 K S.OO ()tllcr IiiCurm:~tiun • In general, you mint tilt a Maim fur rchtnd within three years after you Bled your retunl ur two years alter you paid the tax, whirhe~•er is biter. _000198 Your refiu~d may include interest. Please he aware that interest you recei~~e un tax refunds is taxable income to you in the year you recci~•c it.. Please retain this notice for your records. "the following inli~rmation may pertain to you il'you sire currently married iir were pre~•iously married. 1)id we use your reiiuld to pay liir inciulle tares that you and a tornler (or current.) spouse owe'? Ii'you lilt a claim, yot- may be eligible to recei~•e relief ti•om ha~~ing to pay your f~~rnler (or current) spouse's income tax deht. A successlirl claim liar reliel'coul~i change the t~tr you 1><t~~u tip pay. You may nit owe anything Ott all. You could recei~~e your reiiuid or other payments hick. Yi~u only ha~~e two years to lile your claim. Z'he two-year clock starts ruluiing Crorll tlw lust, time we collect on this deht. Taking your relitnd and using it to pay hack taxes is an example of an el~l~~ri to collect. Il'we look yuttr relitnd to pay liar your current or limner spouse's past. clue deht, such as child support, a student loan, or taxes your spouse owes separately or with a pre~~ious spouse, do not respond by tiling an iilnucent spouse claim. Instead, please use ronn X379, lrrjrrrc~cl.Sjr~~rrsc~ C'luinc uncl:llTncativrr, to got your looney hark. \i-tc -- [king your relinl~i from t11is year's lllrt)rlle lax CC1uCi1 Illay nut. he the lust art to collect that we'~•~ talon. You otlly ha~~e two years lrurn the date of our first efl'c~rt to collect. nrI earlier art, such as our issuing a notice tellinL you of your right to a collection due-process hearin~- and our intent to levy, miry ha~~e already started UIe cluck ruluiing. (_htr 1'uhlirutiurr 971, Irrrrc,cc-r7t S'pcu~c> Relic-r ll~is specific dotails on eligihility reduirements and on how to re~luest this sort ofrelieC. You ran get. it at our web sift www.irs.go~• or by calling t-fitOO-K2~)-tt374 to urcler it. roc t~tx li~rtns, instructions anti illli~rmatiotl ~•isit «•~~•«~.irs. ~~~~~. Access to this sift will nut pri~~•id~ yuu with any taxpayer account inl~~nnation. I':~ s;~ 3 xl'hila~izlphia S~rvicz ('~nt~t 2 { i-~6- I (166 Tax 1'~ri~~~i: 1)~c~mh~r .~ 1.2(1t1K L ~1.~. OU0198 ~~ ('l;'I' lll~:ltl~: fL~~urn this ~~c~u~h~i-~~~ith }'i~ur ~ayrn~nt c-r ~r~rc~sE~und~nc~. Y~~ur'I'~I~•~h~~n~ \umh~r: };~st 7~iin~ icy ('all: 7, i~( 0 ill G~~ 5~~ ?I.1~li?~ 16 Iut~in;~) ]t~t~~nu~ S~i~ic~ I'.t=). lox 1 h??G i'LilaJ~lphia. I'.1 1 ~-l 1 ~-(.-??G f lti)? ~ - - ~ ~ ~)-~t.~h i -~.1 D ('~-rresl~uu~lc~~icc ruclr-srtl: • ~1'riiryrur'1'acp;~}~erl~lenli(i~;itirn \umiu r, tub ~cri~~~l un~l t:,x li~rm munl~cr on your inquiry ~~r crrr~sprn.lence ~11:('11:1~1t':~131'lt(i 1':1 I i(-~;-~'fil 213561066 JZ GILD 30 0 200812 ~. } F _. ~`~ ~tJSE~t~ .~AM~~,~L~N'~.~R ~~~ H ~ ,r..q~~ ,~ r ;ti `~ k^ , i ::'~ v . ~r .~ , MECNJ~V ~~ ~~~ i' ~' r e C~~ ~9s• ~'~~ * ` ~-, ,#= . ~ ,. , . ~ p ~~ ~ ~ ~~JT ~ ~~ F>~~{ f t ~ ` A ,. R : } '~, r ~Y y .$. ~i° FC • r.* . ~~ . , ~ ~ ~ _ Y+ `.. 'r'~'R ~' ' Sn ,K ~. ' A' !. m-' l 1 P .k. ~~. t `l~tic ^ se~Ixnj4^ , ! eE < ..~, 5, tY,~, ;"~"` .,.,..s r w~fYr~; '~ j ~. ~, P l t y~'~it ,. .. ~a,,~ fL ~. y~ ~ i 't '~ . ~/lC11/1t x K ~, . M . ~ Y ,~ A~ ~ ~?~ a }~ ` ~ r ~ ~ ~~' 4' ~ gT + ~"'+`~ `~ ; -~~- `l+ti-- :-?T~ p R«~..wJ,;-tyi y. '.u.~p~. .rF y ~k~ yy ~ '~i y ~ fi., Q ~ ~rM•4Vr...~,~.a~1 ' ~~~~~~ ~-~~ K. {Y {~ d~~. ~ OLD losep6 Mmes Jewelers Estate of Michael Gilder 401 • Materials Scrap Gold Cash In Bank - PNC C ,~ , 06/08/10 01:18PM W430058 ~ I 5175 E TRINDI_E R[) MECI~ANICSBURG NA MEMBERS 1ST FCU xXxX~~xX9973 9138 31,008.00 CHECKING UEHOSIf AVAIL. BAL. 8.1,685.69 BALANCE 31,736.09 THANK YOU s~r~olo 505 1,008.00 1,008.00 Date ~ /Z' Z (L O ~ ~ s~~..~~~ Reg. No. Clerk Account Forward 1 2 4 iv 3 4 ~ 5 6 7 8 9 10 11 12 13 1a 15 Your AcCOUnt 512t@a to uate • ~- Crror is ruww, neswn~ ai v~n.v ~n N ~~ !'~ 7~ r 0 0 0 w r J 3 ~j ~>l 1 C ~~ ~p = ~d ~ ~ ~~ ~ ~ ~ ~, t 7.._/ ~~ www. haars. com Sett 1 ement Seller: E~iSS HAAR' S AUCTION NATALIE GEIGER CK TO EST MICHAEL GILDER l 1 K I NGSWC]OD DR MECH FAA 170JJ 717--43`--8~4E F~ a g e Item Description F~rice Qty Total - Sectional sofa 1 ~~• ~~ - Recliner 1 7~. ~~ - Golf clubs 1 ~- ~'~ - Walker 1 ~• ~~ - Red frame 1 1~. Q~~ - Coffee table i ~~• ~'~ - Snack trays 1 1. Q~Q - Headboard 1 1. ~~- - Dining room suit-end 1 1~~. ~~ - Pox lot - electronics i Q'• ~~~~ - Record player END 1 1. ~~ - Hox 1 of s - books. 1 i ght 1 ~• ~~~~ - Pox lots - plates, tool bag 1 ~• ~~ - Hooks, box lot 1 ~='•'r~ - Hooks, frame 1 ~• ~J~~ - Jewe 1 ry 1 1. 5~ - Box 1 of s - books, pots, 1 17. ~~ pans END Items: 17 Amo~_~nt : 3~Zt8. ~5 Gomn~ission at ~. ~~~'~ 9L.. 48 Less adjustments: -S .48 Net d~.~e to seller: X15.77 www. haars. com HAAR' S AUCTION 717-43c:-8~4f~ S ~ ~,a ~~ ~~ ~ ~v°~ ~ ~ ~ ~9~ ~~~ w r w ~, ~ ~~~ ~ ~T r r +~''Q C7 ~~ r n~ ~ ~ ~ ~ r -.7 ~ ~ (0 ~ O r 0 Dd w - ~ O '~ s ;f~ d ~ ~ 3 ~ t0 ~ ~ ~ V ~ ~) ~) ate : r~5-:~8--`t~ 1 ~ www. h aars. co m HAAR' S AUCTION 717--43:~-4~4~ Settlement NATALIE GEIGER F'age: Seller: 6~~5 MICHAEL GILDER 11 KINGWOO~ DR MEGH FAA 17~~5 Item Description F~rtice Qty Total -- Lexmark 1 r~.~ ~.~. 0 - Cd' s 4. 5~ 6 ~7. ~a - Records 1 17.~~ - Recoryds 1 ~=- ~~ Items: 4 Amo~_~nt: 68.~~ Commission at 3~. ~~~~ `~• 40 Less ad.j ust ment s : --~~. 4~ Net d ~_~ e t o s e l l e r : 4 7. 6yZ- www. haars. com HAAR' S AUCTION 717'-43`-846 ~~4 ~3`Q~~~~1~ ~L~ 1 ~'~~' ~~~ i~3 50~ 2DD~ ~M~1~tflL~T 59651953,01 ~~ >•3> UMBER YEAR .~ MAKE OF VEHICLE TITLE NUMBER ... e ~. ,...., .. ... .- ... ... _.., .. .,, . __._....... .... .. .,. . s ... .. .. P^;"BOpY TYPE OUP SEAT CAP PRIOR TITLE STATE DOOM. PROCD. GATE ODOM MILES oooM sTAT'US . ..ca , .,. .... ., .. .., .. .... .. .. ... .. _, . ,. .. ..... ...... ... '. / .. .. DATE PA TITLED ~ DATE OF ISSUE UNLADEN WEIGHT GVWR GCWR TITLE BRANDS ODC>Al1~TER STI1T~b 0 • ACTUAL tulq,8liff>)E t F MILEA4E f7R~S THE ~CNa~I~ a . Not aNg TAAAP@Alfw RIFIEQ1. ~ . El(EMPT FROM OOOftETER WSCLOSURE 3 TRlE BRANp6 A . AgT10{IE t/EHICLB .~+ C a Ct/18aIC Vf91IClfl; D . COLLECII~E V6HIp F . ouT of OOIBITRY O G . ORIGINNIY MFap. l O .~ OItltRwurwN O H H . AORI011LT17RAl V~Ij 1 L LODONG VEHKXI ~ ~ H P . 13/WA8 A POLICE VE ttf~ ~ O y R -RECONSTRUCTED ~-~ o t-' s . STREET Roo ~ ~.+ C T .RECOVERED T}I~'T ! V . VEFIICLE CONTAMIS w .ROOD VEhIICIE ~ O O x . ISJWAS A TAXI ~..~~ M a eaoond gerlllolder a Ibtsd upon glisrctiprt at ifs tIM ,' Penholder must forward Yllss T1W to ihs Bureau Molpr, FiR>iT LI@I RELEASED ~ ~ aPProP-~ form and Me. ~~ ~. nVB D i-~ ' ~. f~-STER[O OWNiSR(B~~ `,~ti~ 3-d" ~: 1. }~ f~ r Gr~, 1 .,"c ~ ~, ~~ V V~~DNEr\ ~~+. fJy~rrr~nc~~l<,f 7tanr)rurrptluil: ~.-~, G . \ ~~~ 7~'R„ Ole SYLVf~R SPG '. R ~;,~~~ ~~c~AwlCSauKc~ PA 17055 4 FII~TLi~ld FAVOR OF: ~~~ 6ECONtJ UEN FAVOR OF' a GMAG BY _ _ AUTM Z PRESENTATIVE MAIUNGI ADDRESS GMAc P O BOX b1141 CUCKEYSVILLE MD 21030 ~ O N s O Q ~ O 1 u° o ^ w ~ j J ~ ~ ''d W t I '.~ W ~1 H ~ b ,p ~D ~ O f.. O E O N ~ N x~ °~ ~~ ~o o ~ SECOND UEN RELEASED DATE BY AUTHORIZED REPRESENTATIVI 1 oenPy es a the date a lseue, tfN onlcial records a the Pennsylvania Department A L I E N D 8 I E H l E R a TnulsponaUon reftact that tree person(s) or company named frrein to the lawful owner a the edd wh1eM. SecMary of Tnmportation ~ ~" ~ 1 i' ~ 1 1' ~ 1 $U88CRIBED AND 6WORN M a f7o-pure:hfafa•r other theft your t3pouse is (feted end yal IAterlt the title to t E: be listed Y 'Jokrt Tenertts With Right of Sutviyorehip• daa one ' 'I'~r:, owner, tiffs pons to survivirp otAmsrwj GHECf~; ^. wik be issued ore 'Tenants in common' (4r~ , I ~~~1; ~ deceased owner yogic to hilJllsr hWrs or etfwle) ",~~, •, w ~ A " ~fSF ~ AOAIM118TEWNp OATH .. ~~.M.+. ,~ ~~ , II' 1ST LIEN DATE: +~ iF, 1ST LIENHOLDER .;; •e ,.e'~w,; •. CITY ~ STATE IfP ~ 9... '~' :c y~,, FINAN~IAL INSTITUTION NUMBER - -, N 2ND UEN DATE: ..• IF No LIEN CHECI( r N 7>ti. ~.awagrwo Iweey elslss t« c.rxlbn. a rw. b Mw .s11kN antcribW y ~~ '^~"!! ,.etw», lul~aa b sr elrumeearba .ne anw best awns r1 bm Irw ~ 2ND LII:NHOLDER ~V' ~ '' !„~«~' ~ M w STfiEEi' ~ ' ~r"~' aIeNATUNE OF APPLICANT OR AUTHORIZED SIGNER ' ^ V 1 CITY ..~--+.. STATE LIP "(~ ' ; M w SIGNATURE Or IY)•APPLICM1TmTLE OF AUnaRIZED sx)NER FINANCIAL INSTITUTION NUMBER W ?044 Chevrolet Monte Carlo -Trade In Value, blue book value -Kelley Blue Book Fage 1 of 4 ~ -.. * :... .. :'s,:; .. ~ `rs ~:: :y,.qi GrvL6b.. ...:. .i .... s .. s.: :~: , yrsAs~w:".t?a. l:F ndf .d.::r.:y. ~ f "~ ,,.....: i ,W,Y.!<err ~ ,,';'s:s! x:.i:. .. ,. .. ... . . ~~~ . . .KIe :,;~ _„ - e I Blue Book y THE TRUSTED RESOURCE N~~me Neva C~rrs Certified Pre-Owned Used Cars Research 12eviF~vvs & News; ~}~~~~t~ rs & Crt~ Used Car Values ~ Search Used Cars for Sale ~ Certified Pre-Owned ~ Compare Vehicles ~ Perfect Car Finder ~ Most Resear Welcome Back ~ Sign Ir} ~ Create Account ~ hty KBB ZIP Code: 11055 Rc'c ~t~it!y Vic:•.~c~d 2010 CHEW I~AAIlBU - r NOT Y04A Dtr'1 2010 CHEVY MALIBU click to ~rre:v ~,,,;,~- IN. Y r Chei;y -.aalibu offers ?3t~.aPG hc~y-better than a othrrr angt~s ~~...,~,~ VIEW c arable T ota Ca r;si _ omp oy nay mPg} a i lon da c ca d i1 .~ ' ~. IOCA' mpQ1 tiurne > Used Cars > 2004 > Chevrolet > Monte Carlo > SS Coupe 2D ~ S 2004 Chevrolet Monte Carlo SS Coupe 2D Trade-In Value Private Party Value BLUE BOOK TRADE-IN VALUE ;';;;"` Suggested Retail Value ' f't? `M'~-il,,f: ~ ~" Condition Value Photo Gallery ~ ,~~~~- Cars For Sale ~j~~~-~' ~ ~ . ~ ~ Excellent $6, S,SC~ Compare Vehicles GOOd $6,050 E:~ii.;i` `,iOtik F2,t~vlr'bV - Fair $5, 225 Consumer Ratings More Photos Find Your Next Car Specifications • Price New Cars ~a Shopping Tools Local Listings: Free CARFAX Record Check Auto L.orur from 3.85°i, APR (? Search Chevrolet Monte Carlo Compare Insurance Rates (' Search Certified Pre-Owned Chevrolet Monte Carlo with Progressive Payment Calculator (' Search all Cars For Sale near 17055 Find a Dealer FIND fHE RIGHT CAR Compare Used vs. New $5,000 to $10,000 ~~ Both New and Used Coupe ~~ To View List, Click ~IfE411 ANOTHER WEHItIE http://www.kbb.com/kbb/UsedCars/PricingReport.aspx?Yearld=2004&Mileage=63 000&... 6/ 17/2010 2004 Chevrolet Monte Carlo -Trade In Value, blue book value -Kelley Blue Book Select Year... • -. ~ Average Consumer Rating (593 Reviews) Read ~teviews - ` ~~`"~~'"_~'"'~y~~~~ 4.7 out of 5 ReviE~w this Vehicle Cir 5~~~~rc:h by C~t~ec)ory Check Out Our 10 Most Researched Coupes U~ Change ZIP Code 2011 Chevrolet Camaro 2011 Ford Mustang 2010 Honda Civic 2010 Honda Accord 2010 Dodge Challenger 2010 MINI Cooper 2010 Nissan Altima 2010 Chevrolet Corvette 2010 Hyundai Genesis Coupe 2010 Nissan 3702 Check out New Vehicles From Chevrolet Vehicle Highlights Mileage: 63,000 Engine: V6, 3.8 Uter Transmission: Automatic Drivetrain: FWD Selected Equipment Standard Traction Control Power Door Locks Air Conditioning Tilt Wheel Power Steering Cruise Control Power Windows AM/FM Stereo Blue Book Trade-In Value Change Equipment Cassette Dual Air Bags ABS (4-Wheel) Rear Spoiler Kelley Blue Book Trade-In Value is the amount consumers can expect to receive from a dealer for atrade-in vehicle, assuming an accurate appraisal of the vehicle's condition, mileage and features. This value will likely be less than the Private Party Value because the reselling dealer incurs the cost of safety inspections, reconditioning and other costs of doing business. Vehicle Condition Ratings Check Vehicle Title l~~i~~tory Excellent $6,550 • I_.OQIC`i il(".~% f5 Ifl t,',XCt:,'ll('.IIT !'pl?!;r~l<)111C~~1! ~ai('.''IC_if}(. '~ ti ,'i,l+, la'; Page 2 of 4 http://www.kbb.com/kbb/UsedCars/PricingReport.aspx?Yearld=2004&Mileage=63000& ... 6/ 17/2010 2004 Chevrolet Monte Carlo -Trade In Value, blue book value -Kelley Blue Book Page 3 of 4 ~E'a_.~~ ~cl;t~~.~~~ri~rl:a • ~i~'vi'r hdd art', UdiRt ~)r l)c3Cty ,~.'r;rri ,ir+<; ,, f';,c~ ;t rr:.~~,t • C~~t',ir! titlt:~ history ar)ct ..'til i1<:~4 •, ;r;,~:,f , .~: .,t~_±. ~ .~;, _ • ': !:•;~Irl!' i'!'IITI{)-irt .'lt('rlt 'If"'.1 1 ~.':~~ ~?i) !;i~ :( ~(':t..<;, .tai..;? !I Y • "'t't~(~I( ti:' 3f'L~ :,<~t tf:;.~1 it •~-~; ~;; t r; ~.-~•. I (-, ., `: ``1.111 7 ~ ilt if '.i`~.~'Ct ~:l'~•,. i;". ~,',tt ,.;s `•.ri,~. "('~''~ . Good • `„ ; $6,050 • Free of any major defects. • Clean title history, the paints, body, and interior have only minor (rf any) blemishes, and there are no mayor mechanical problems. • Little or no rust on this vehicle. • Tires match and have substantial tread wear left. • A "good" vehicle will need some reconditioning to be sold at retail. Most consumer owned vehicles fall into this category. Fair $5, 225 ~ `;~C~rT)t' IT)~'( ti~9rllr X11 ur t ~_ "irrit'! 1~_ 1i'i('t t`; rl.~il '~~,~ ,~~<, `+~~~' ,1~;._1 !il~ , <ittii :;'1 !`f.'c~`+(ir):'jr}iC' rU111)f11C) ; :)r'C111'I:ili ~ `_iG'<3f~ tilt' ilt`;t(1r"j~~ till? f)i~l)lt, f70(1y ,1r1~t,'t';r ii?'(,r:~l~ !'.i 'i_! ., ;'k: f<x rfr)r rued EJy a pr~;t'~;51r1i~r~tl • TIreS n):9y 11i't~rj !~~~ lac: rt~pld:.r't1- • f~hc'r+,' may tit:' •:r;nr' r~;'(id~r.iV,lt', ru°~a ~!:+~n~u;~. Poor IN /` A • '7l":c't'~• 111{fli;irlfi~.9i <1rl~i; (7T t.'•-i'II't~l: .f•:''~l•tI'; .1+1.1 ~~.- ~ , ~ ia.. ~;tl~ttf;.~n . • i~`f ~~~/ 't c:l ~,.: r~ ft t ~~r{l'.(T1> tll<it C~~lrl I.i ~Sitf~:'y :"ih( .4 ,~..!, ,.. ~ .t ,~? .) ir;~trlr' ii!~ r7 r!.ISti't~t:i1l~7~iC)rf t1C)!I'; • E'•rdnClt:C1 talc' !Salvdt~ac~, flbocJ, ~~tc ~, ru ;~ ~ `t17`_t-tr:t~<rC,<~:? rrt i+.,;,y; Kr llt>y E:34t.r%- E~c,ok dcx°~; nt,)t ~;~tte'rllt~t t~> rr>;~t,rt ::) ~ ~) ,..c n1r ~:, "i,.;~~1 ` i~i~ ~!:.° t)f'(,iill`i ~? t"i~11' 'l clillf' ()f rtlt:st~' Vf'114(. ft'`._ 'v <SrR~~:' ,.j{'+,:',i t.ly f~. '; ('. P"t tr (~,' i11 }.,s;~,>~" `.G(iClltl(?(1 Ill~~y' IE'llt.fll"i~ :~11 Ill(~(~G~)t:'r!,i('rlt. <)(?i.)I•:31:iiili t.; !.iC'~t Y?I~t.~ 11.5 '~~tltk '' Pennsylvania 6/17/2010 Accurate Condition Appraisal Change Condition Accurately appraising the condition of a vehicle is an important aspect in determining its Blue Book value. Taking our 16 question condition quiz will ensure you know the correct condition rating. http:/Iwww.kbb.com/kbb/UsedCars/PricingReport.aspx?Yearld=2004&Mileage=63000&... 6/17/2010 2004 Chevrolet Monte Carlo -Trade In Value, blue book value -Kelley Blue Book Page 4 of 4 Prtc:e New CGtrS • ~: X010 Kelley Blue Book ~o., Inc. All nyhts reserved. 6;"1 L.'010-F,~17,•~010 td~fron. The specific irrtormation required to deterrrnne the value for this particular vehrcle was supplied by the person generating this report. Vehicle valuations arc' opinion; and may vary from vehrcle to vehrcle. Actual valuations wN! vary based upon market Cond.+trnrrs, specifications, vehicle condition or other particular circumstances pertirrenf to this particular vehrcle or the transaction or fhe parties to the transaction. Thrc report rs intended for the individual use of the person _yenerafinq this report i?nly and shall nc~t be sold or transmitted to another party. Kelley Blue Book as~urnes no rr_~sponsrbr;lty tar errors or ornlssrons. (v.10061) Orr KBEi.t_c~m ,~{ ,r cl ;r~~1 r:r ., :~ ~ •:< ~ ., ~ ~ . . Featuring New vor"k Auto ~hf)w NeW C~:trs Fc~r Si)Iet Usrad Cars P or Sala New L.;3r ('I'IC:f?s :, C:,,-c?af (:<jr I.~cials ;_1:tr Re,vlf'ws (:ar AbOUt KBB At.)i)uT US (;ontt]ctt lJs Cr)reters i /iQ Media Ac'lvr~rtisinCa t.nrk~ncJ F'nv,:?c:V Sete Map CrtGiy; ~ghr t?, i rtdi~ri?arks © 1995-2010 Kelley Blue Book Co., Inc. f3us~ness lnyuirres http://www.kbb.com/kbb/UsedCars/PricingReport.aspx?Yearld=2004&Mileage=63000&... 6/17/2010 RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17613 Receipt Date: 5/11/2010 Receipt Time;; 09:23:38 Receipt No.: 1061066 GILDER MICHAEL D Estate File No.: 2010-00486 Paid By Remarks: NATALIE S GEIGER SAP ------------------------ Receipt Distribution ----- Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 260.00 CUMBERLAND COUNTY GENERAL FUN WILL 15.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 24.00 CUMBERLAND COUNTY GENERAL FUN AUTOMATION FEE 5.00 CUMBERLAND COUNTY GENERAL FUN JCS FEE --- 2 3 . 5 0 BUREAU OF RECE I P7:'S & CNTR M . D Check# 2876 ------------- $327.50 Total Received......... $327.50 CUMBERLAND COUNTY RECORDER OF DEEDS RECEIPT Inv Number: 65334 Invoice Date: 05/11/2010 9:24:07 AM RECEIPT Reg/Drw ID: 0101 Customer: Last Change: Receipt By: COUNTER By: AF CASH Chg # Charge / Payment I Fee Description Amount Inst # / Inst Date Municipality 1 COPIES $0.50 Fee Detail COPY FEE $0.50 TOTAL CHARGES $0.50 PAYMENTS CASH $0.50 TOTAL PAYMENTS $0.50 AMOUNT DUE $0.50 PAYMENT ON INVOICE ($0.50) BALANCE DUE $0.00 Date: May 11, 2010 9:25:05 AM Page 1 J u I 1 ~ ~~~~ 1 ~i ~ ~ ~4rm ~~~a iru, cuuY ~ , c CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STaEET CARLISLE, PA 17013 Tele: (71 ~ 240.3166 Fax: (74 ~ 24~-2663 July 27, 2010 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Attention: Julie Bruce J. Warshawsky, Esquire RE: Michael D. Gilder Estate Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on following dates: May 28, June 4, and June 11, 2p10 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 75.00 Ck #47606 Total Amount Due $ 0.00 Becky H. Morgenthal, Executive Director N V O I C E 1500 Paxton Street Harrisburg, PA 17104 ~, 711-236-4300 C A T I O N S >>> 23b-6803 FAX P U B L www journalpub.com -------------- INVOICE TO ------------ Cunningham 8 Chernicoff, P.C. Attn: B.J. Warshawsky P. O. Box 60457 Harrisburg, PA 17106 ' INVOICING: Advertiser DESCRIPTION OF CHARGES - COST -- CREDIT = BALANCE = PUBLICATION: CLASSIFIED/CENTRAL PENN BUS. JRNL COVER DATE: 6/11/2010 THEME: CLASSIFIED AD/CENTRAL PENN BUSINESS JRNL RATE CARD: DESCRIPTION OF AD: Legal listing: Estate of Michael D. Gilder REP(S): MARK SUNDAY 6/23/2010 ORDER #: '11507 TERMS: Net 30 Days -------------- ADVERTISER ------------ Cunningham &Chernicoff, P.C. SIZE: LEGAL LISTING, COLOR: 68W PAGE: 97.00 0.00 SPACE SUB-TOTAL: 97 " BALANCE DUE: 97.00 '~~~~~ • FAILURE Tn RECEIVE 81LL DOES NOT ENTITLE CUSTOMER TO NET RATE ~ccourt No- ~uwo oat 7244-0 04/15/10 711 OLD SILVER SPRING RD 04/01/10 06/30/10 0.00 1.00 70.00 -26-ZOLO t 2 0.00 1000 ~ 70.00 05/17/10 77.00 5-a~-~o CK.. ~ i o ~. - TS ~-4 h PPL Electric Utilities Electric Service For: MICHAEL GII,DER 7l 1 OLD SILVER SPRNG RD MECHAIVICSHURG PA 17033 QQu~estions about this bill? Please contact us Ma 28 at 1-809-342-3773 (1-800-DIAIrPPL) or .Price to: Customer Service 827 Hausman Rd Allentown, PA 18104-9392 www.pplelectric.com Electric Use This graph shows your electric use over the last 13 months. Types of Meter Readings: Actual - Adjusted - Estin3ated Customer (~ / 1 , ~ , ~ , / '~~~~:::,~;~.~ Page 1 ^~ ~ ~ '~~• p p ......... ... . ~~'~ 49610-86013 ,, :~: Summary Page Balance as of May 7, 2010 $0.00 Char es: Tota~PL ELECTRIC UTILITIES Char es S ~1~0.71 Total WASHINGTON GAS ENERGY ~RVICE `a ges Total Charger $18.62 Account Balance KWH - Avetage Per Day 36 30 24 18 12 6 0 $7.91 P$. s-~_ZOr~ ~ i oif Meter Reading Information Meter #84572176 May 3 Actual 52834 Alx 1 Actual 52749 3Z Da s KWH Billed 85 s g r e -May Ave 2009 2010 m p e ra D ~ 523 573 FTH Per ay K Yearly Use: Total Averagge Use Montlily Jun 2008 -May 2009 7610 634 Jun 2009 -May 2010 5287 441 Other Important Information oa back ~ MJJASONDJFMAM 2009 r Months 2010 ' 1 ~ I 1 ~ ~ I ' ~ , ~ / '•;••''~.•;. - Page 3 ctric PPL Ele ''~~ `~~ ~~~ p p : .. :::::~ :: ' .;• ; 49610-86013 Uti I ities '~ " E IeCtr1C Total Jmiw Lost BiU 53.01 Service Pay~ne~rt Receival A~ 19 -Thank Yor! X34.01 Billin Details MICHAEL GIZ,nER g 711 OLD SILVER SPRNG RD MF,CHAI~IICSBURG PA 17055 Babace ss of May 7, 2010 $0.00 Current Charges WASHII~TGTON GAS CES R Charges for -WASHINGTON GAS ENERGY SERVICES C~ ~ S~1r vl~ General Service Rate: WGESD for A r 1 -May 3 Total U 85 K h At $0 093 P ~ 7 K 91 13865 SUNRISE VALLEY DRIVE w se: w . er . Cross Receipts Tax X0.47 ~O , Va Total WASHINGTON GAS ENERGY SERVICES Charges $7.91 20171- -~ 1-888-884-9437 Current Charges PPL Electric Utilities C°st°mer Se^'ue Charges for -PPL ELECTRIC UTILITIES 827 Hausman Rd Residential Rate: RS for Apr 1 -May 3 Distribution Charge: Allentown, PA 18104-9392 Customer Chaarrgge 8.44 85 KWH 2 6 (i-S00-D~IAL~-PPL) at .9D 00000¢ per KWH 2.47 PA Tax Adj Surcharge at 0.10300000% 0.01 www.pplelectric.com Transition Charge: 85 KWH at -0.25200000¢ per KWH -0.21 Total PPL ELECTRIC UTILITIES Charges $10.71 •.~~: Account Balance 518.62 General Generation prices and chargges are set by the electric generation supplier .you have chosen. The PubCc Utility Commission re area distribu- lion Information ricer and services. The Federal Energy Regulatory~ammisslon regulates ~ransmissuon prices and services. Next meter reading PPL Electric Utilities uses about X0.05 of this bill tod~aay state taxes. In on or about addition, about X0.63 of this bill pays the PA Gross Kecelpts Tax. Jun 2 For your convenience, you can now pa your bill using your Visa, MasterCard, Discover, or ATM Card all BillMstriz at 1-800-672-2413. BlllMatriz will charge your credit and ATM card a service fee for making _ this payment. Before digging~ around your home or property, you should always call the state's One CaIl notification system to locate any, underground utility lines. You can do this by simpl dialing 811, which will connect you to the One Call system. Be safe andyca1181I before you dig. With ~~aa~~eerless billing, you can receive and pay your PPL Electric Utilities bills ~nFine. The process is free, quick, convenient and secure. To learn more or sign up, visit www.pplelectnc.com. Save postage and late charges -sign up for Automated Bill Payment. New refrigerators use about half the energy as models made before 1979. If you buy, a new refrigerator, get rid of the old one. It's costly to keep two units running. ceo~) ars wood 1,8a e~g8p~ad III III 1 IIIllllllllillil IIII IIIIi ~ 3 ~~~~~~ ~~ ~ ~ ~ ~ r •woa•~tyaalaldd' ~e Ssajiatl8ti O~ •~'JaQ, daipoil8 ~ l~(u, lY1 a~~ so ~Qaa~Bd 8 ss~a ia~a~ . ~~~ `~~ ~~1'~~,, .~...... r ~~ ~ I • _ I t*~, . 1 . ~ ~- 1 Natalie Geiger 11 Kingswood Drive Mechanicsburg, PA 17055 May 24, 2010 PPL Electric Utilities Two North Ninth Street Allentown, PA 18101-1179 Re: Account #49610-86013 Amy, Attached is a copy of the Short Certificate that you requested. My brother's account can be changed to an estate account and the mailing address can be in care of me, as ezecutriz, at 11 Kingswood Drive, Mechanicsburg, PA 17055. Thank you for your assistance. Sincerely, Natalie S Geiger M FIRST ~ ~~~ way, Dula i w IMng TX 75063 , ~ HORIZON. - HOME LOANS ,, 5'-'13... I o --~ rv..p ~- ~,~,~~., t . ~~ ~~ i, r ~,~,a,l` ~ ~.E . 1-Qd3-~160000~07-001.1-OOa 100.004000 ~A~~ MICHAEL D C~II.DE 11 KINC33WOOD Dlt MECHATiIC38tJR0 PA 17033-2761 ~u ~ Pa-~rn,~-~ ~ 1 b~"~ Zl s MORTGAGE ACCOUNT STATEMENT For mortgage account information: Pay online at: 1-800-364-76b2 Monday -Friday lam - 7pm CT www.flrsthoriwn.com Account Number: 0041791591 Home Phone: 717-697-5235 Work Phone: 717-236-8061 For additional Anancial servtca: First Horizon 1-800.615-0822 w W w. firsthocizoit. cam Q,.dc n... i,~ar.dbs.t, phon. r~.,,e.i. cn.a~ h...r aompiM. ~ ~, upon reeatpt oI peyman~ you- starwnam w1N ba maNad ACCOUNT INFORMATION PAYMENT SU~IVIlVIARY Account Number 0041791591 Property Address: Principal ~ Inteccst 5536.46 Current Statement Date 05/03/10 711 OLD SII,VER SPRG Total Amount Due .46 Interest Rate for 6/01/10 5.25000°~b MECHAICSBURG PA 17035 Payment Due Date 06/01/10 Current Principal Balance' 511,815.09 Interest Paid Year-to-Date 5230.28 Taxes Paid Year-to-Date 50.00 ~ ~ ~ ~~~ ~,~` ~ ~~ l ~ 5 'T1~b b yiou- P-Anc~l eMrr~ ony, nd EAe amount rsqulred to P.y your aovount In full. NbAR: feM~Ot au6nNMrd Mtagl- your onAlne banldnp may be ie/scMd N fAe Iwrds belnp sent eti not sufNc/ent to psy tha monfh/Y PaY~nent~ lrour lo~en la In a dellnqusnt sA~hr~ a- yvu MaMr lMrd a ber~fat cart Mat b sdlM actlw, W fs wlll aulat~sdcNfy be rstwned Ao dw re+rW[~r o/ tha lunch. You cannot make a p~c/pN only paynNnt or nmr~ tl1M ona p~I1rAt~ one QankAnp as ~ l~nda wNl not proceaa ass Mtanded. ACCOUNT ACTIVITY De~cripdon Dw Date Date Paid Amount Principal Interest Escrow Fees Other Payment Applied OS/i01/10 OS/03 536.46 482.38 54.08 .00 .00 ,00 Principal Reductioa 06/01/10 OS/03 63.54 63.54 .00 .00 .00 .00 IT 18 VERB( IMPORTANT THAT YOU REPORT ANY POSTING ERRORS TO FIRST HORIZON CUSTOMER SERVICE WITHIN 30 DAYS OF THIS BILLING. IMPORTANT MESSAGES For Mortgage Account Informatioe: Our customer relations team is available Monday -Friday, lam - 7pm central time to answer questions you may have about your current mortgage account. You may call our toU &ee number 1-800-364-7662 or visit our secure website. T6inkins Aboat ReAnanctng or Purchasing a New Home? In this changing economy, a home is still your greatest asset and we are here to help. If you are planning to purchase a new home or want to take advantage of low rates and refinance your existing mortgage, please visit www.firsthorizon.com or call us at 1-800-615-0822. PLEASE DETACH AND RETURN 80TTOM PORTION W1TH PAYMENT IN THE ENCLOSED ENVELOPE Number Account Number Date Due 6 H4250-00-711 JUN 1, 2010 MICHAEL GILDER If RECEIVED After MMu chick phnbM to: Walnut Villas Condominium Association JUN 6, 2010 ~~~III~~~III~~~~I~~I~~11~11~~~~11~~~~1~1~~1~1~~1~1~~1~1~~~ PROPERTY MANAGEMENT, INC. WALNUT VE.LAS CONDO ASSOC. PO SOX 622 LEMOYNE PA 1 T043-0622 5'~-~~ G~ rod mount Due 595.00 Pay This Amount 5104.50 ~},~so ~iv Ma^~ , ~o I ~ i ~~~~~~ yI-~ ~,o cat --~1 a {~idP~ ~ S~j~h,.~ ~ /~ i~o a,,~,,a,,,, f - ~'~C.-~t1,~c~ ... .. . :.;; . ~.: <~~ ~: . .:.. > . kl .. ,~,~~.. :,:: .. ~. , . , .. ~~ ~9d s. ~fvE,``Nwmisl<a~wn, pli 'I ~~~~ ~r""J ~ ~~~~ f~ '~`gt~phbi~.t Tip`;~6~4~3~~~ .:. .: :: .::. :.... USAGE HISTORY Monthly usage in thousand gallons 0 0 Billing Date: 05/14/10 Account Number: 00200999115167 Previous Balance $0.00 Payments Through 05/14/10 rna~k you $15.87CR Balance Forward $15.87CR Current Charges Due 06/03/Z010 'PAY BY 06/08/10 TO AVOID A 1. ~% LATE PAYMENT CHARGE SERVICE TO: MICHAEL GILDER SERVICE ADDRESS: 711 OLD SILVER SPRING RD MECHANIC58URG PA ~''~ ttitl~~d- .; '~~~ ~. ~ K ~' ~i'I ~ .: ..:. 5979401 T 03/15/10 05/13/10 59 0084 0084 0 MGL PRORATED ACTUAL EQUIVALENT TO 0 GALLONS SERVICE CHARGES 20.50 TOTAL CURRENT CHARGES $20.50 SEE REVERSE SIDE FOR IMPORTANT ACCOUNT INFORMATION UWPA will conduct asemi-annual flushing of the distribution system in your area from April 1st through end of ]une. This may cause temporary discoloration of water and temporary decreased water pressure. for hydrant flushing updates, please ca11717-564-3662. If you would like to pay your bill online, please visit our website at www.unitedwater.com and click on the Western Union's Speedpay icon. Save a stamp and ggo paperless today! log on to www.unitedwoter.com or call Customer Service to find out more information and to enroll in eBilling. Approximate state tax included on this bill $0.99. K 0 0 00 RE 1 ~6eY! PIEIISE DETACFI HEi1E ANO RETURN THE BOTTOM POIITION WITH YOUR PAYMENT IN THE RETURN ENNEIOVE VROVIDED. 102 1 ~ MAR00 W2Y2010 Mar Ap- Mar Jun Jul Auk Sep Oct Nov Dec Jan Msr May Next meter reading date: on or about 06/12/2010 n ~ Dtn cpC n~na- d°c ~~ ~ uCi~u+ ~ vi a O O A N C ~ Q ~. D ~~ ~ ~.~~ 3~1/1A 3 r. 0 ~ ~D ~ d rn~ ~ ~a o~C C ~ »D ~ x ~~ ~ ~n D ~ D '+ ~ ~ ~° v ~~ ~ z c w+ c • ~ ~ ~ J ~ c ~. C o` ~ ~ ~~C AQu~+~• r3> >~. ., d ~+ w~0 c~ ~a O c . O '"~ O~ '' D ~ CC N ~ ~fOAD a r+ ~ O ~ A D G f0 D ~1D ~pDN O ~ ' p ~ p~ O +DO ~ O ~ ~A nnryA i _n c~zo O1 VI ~~ ~~ A ~ ~~~ ' E 1 ~ ~~ ~ > > ~ ? a o T ~-> c c C ~o c ' , ;~; D ~ o` ~ : ~~ re~~C o ~~ c~~3 v' o ~ p ,., O D Q• D `t '~ : ~ i A Q O ~C ~ G ~ ~~ Oc•A ~D ~~~ ~ ~` n ,~,~ tOn D ~ A~ ~ ~ as oAA ~3 ~3~ ~ ~N ~~O ~ ~~ 30~ . ~ Q{Q N ~ '1 N O ~ ~~ DDS • ~ D D c h 1 G ~ ~ ~ o ~ °'~ °33 ~ ~? f0°~ D C t0 ~ D A o ~ n ~ ~~ c O ~ O hm ~ ~ v ~° ~o n ~n c :. n n m ~ ~„ :::. +~ ~ c = ~ rn n~ D Z ~ _ D ~'*~ w ~ '~c 3. G~1 ~ , rn v ago 0 0 ~~~ 4 11f O V1 ~ ~ J 00 ~n w ° o 0 ~ "` . s ~~ o ~ '~~. v O ~o m O D ~~ , n ,t. c D r m C n T n r c~ 6 ~o m c m z -- a ~ a A 0 Q d g ~ rt C -r h•~ C 1•r \ 00 N o R DbGK12 1 3 0 C ~c y ~ m ~ _ H o c v ~ ~ ~O O N a0 ao ~-~1 n oo ~ ~ ncD Ca:: ~oD~ ~• ?A C ;. ~ ~~~~ ~~ .. ~~ N ~ D C O ~? Z~ ~ o ~ o. ~ 0 ? ~ 1 T :.. ~ J .. ~ ~ O -.~ ~ n ~ ~ W - ~ N O j ow o O N O tD t0 ~ ~O O ~ \ ~ ', N :; -~ O W Q1 J 00 O ~ ~1 O ~o m g~ ~ b ~~~ ~~ ~ T 7D v ~o z 70 v 3 m n a z C 70 G1 a C Z' r~'~ ~~~ N 4 ~ '' ~' „« ~. Mack Gerberich & Associates, P.C. P. O. Boa 6595 Harrisburg PA 17112-0595 P6oae: (717) 652-9692 Faz: (71'n 652-7368 MICHAEL GILDER c/o ED GEIGER 11 KINGSWOOD DRIVE MECHANICSBURG PA 17055 Irrvoice #: 12533 Date: November 02, 2010 Date Due: December 02, 2010 Client ID: 3992 For professional services rendered: 1040, PA40, LOCAL - 2010 -Preparation dt Review Please pay this amount 5300.00 rxl,- ~ ~-~-zo co c~ r~ A 1.S% per month, 18% per annum, interest charge will be applied to all invoices over 30 day. Mack Gerberich & Associates, P.C. paw 1 ~ ~~ ~~ 1 ~ PPL Electric Utilities Electric Service For: MICHAEL GII.DEA ESTATE 711 OLD SILVER SPRNG RD MECHAMCSHURG PA 17035 Final Bill Qo~stlms about this bill? Please contact ua Nov 22 at Y-s®a-34 s77s (1-300-DIAI~PPL) or write to: Customer Service 827 Hausman Rd. AUeDtown, PA 18104-9392 wrww.pplelectric.oom Electric Use This graph shows your electric use over the last 13 months. Types o[ Meter Readings: Actual - Adjusted . Estimated customer 0 $0.00 $13.08 a13.ua ~.. 1~iD ~~ Meter Reading Wormation 572176 Oct 26 Actual 54469 3 Actual 54261 2 Da s KWH Billed 208 Average -Oct 2009 ZO10 T mpetat~re K1~~VH P r D 52F 23 56F e ay 8 Yearly Use: Total Avera e Use Mont Nov 2008 -Oct 2009 8340 69 Nov 2009 -Oct 2010 4540 378 Other important information oa back ~ P~ ~ :::X#sat::~i: ........ :.. i~tpitw~ 49610-86013 AV 01 014212 387998 64 A"5DGT MICHAEL GII.DER-ESTATE C/O NATALIE S GEIGER 11 KINGSWOOD DRIVE MECHAMCSHURG PA 17055-2761 ~1111~1~I~111~1~I1~11111111~~ ~ i ~~~1"~~I'1'~I'il'1111111111~~~11~ . ~~, . ~~ ' ~ ~ i s~~ ~•:•'"~.'.•' Page 1 ........ :•-' p p :........... .~=:: •., „ 49610-86013 - ~~ ~~: Summary Page Balance as of Nov 1, ZO10 es: To PL Electric Utilities Charges Total Charges Account Balance KWH -Average Per Day 36 30 24 18 12 6 0 NDJFMAMJJA50N 2009 Months 2010 a c eck oavable to :::Ffl~lME::Pi::::::::::: :::p. • :::. . Nov 22, 2010 $13.08 Amount Enclosed .~ ~ PPL ELECTRIC UTII.TIIES 2 NORTH 9TH STREET RPC~rENNI ALLENTOWN PA 18101-1175 1 0900000130890000013087 4961086013 .' t' ~, ~~~ ~ ~~~ i ~`.~.•^•:~.~,- Page 3 ..:...:::..:..:::. .................. PPL Electric :::jr::°~:~~::::~`i::::::::::: •~~:: pp ..__ • 49610-86013 Utilities '~ Electric Tota~ from Last B;u ~ sas 83 Service PaYnrent Received Oct 2S -Thank Yow. ,843:83 For: $illinpp Details Ni1CHAEL GILDER-ESTATE b 711 OLD SILVER SPRNG RD Balance as of Nov 1, 2010 $0.00 MECHANICSBURG PA 17055 Final siu Current Charges Wsshington Gas Energy Charges for -PPL Electric Utilities Services Residential Rate: RS for Sep 30 -Oct 26 Customer Service Distribution Charge: 13865 SUNRISE VALLEY Customer Charge 8.44 UITE 200 200 KWH at 2.90600000¢ per KWH 5.81 8 KWH at 2.64000000¢ per KWH 0.21 20H> ~RNDON, VA PA Tax Adj Surcharge of 0.10300000% 0.01 1-888-884-9437 Transition Charge: 200 KWH at -0.66800000¢ per KWH -1.34 PPL Electric Utilities 8 KWH at -0.59200000¢ per KWH -0.OS Customer Service Total PPL Electric Utilities Charges $13.08 827 Hausman Rd. Allentown, PA 18104-9392 1-800-342-5775 ......::::::.~ ~_. ~~~ ~ ~ :::: ~ ~~:-~: ~ :::~:::::....:... ,;:..:::: ~ :::::..........:.;..._ ...:......:.:......_ ..., ..........:..........,...........................,............... . (1-800-DIA.L-PPL) ..... . T~~a: ~~ioa~t 1'~#. Witter>~:~~..... ~..... . ~~.:~'. www_pplelectric.com Account Bslance $13.08 General Your Supplier Charges for Generatioa and Transmission were not available- fo be included in your bill. The charges will be included with Information your next month's billing. Generation prices and charges are set by the.electric generation supplier you have chosen. The Pubic Utility Commission re Mates distribution ~nces and services. The Federal Energy Regulatory~ommission regulates ransuussion pnces and services. PPL Electric Utilities uses about $0.06 of this bill to pay state taxes. In additioa, about $0.77 of this bill pays the PA Gross Keceipts Tax. For your convenience, you can now pa your bill using your Vise Mas}erCard, Discover, or ATM Card all BillMatria at 1-800-672-2413. BillMatria will charge your credit and ATM card a service fee for making this payment. Before digging~ around your home or property, you should always call the Y te's One ~aIl notification system to locate any underground utility lines. ou can do lus by sunpl dialing 811, which wall connect you to the One Call system. Be safe andyca1181 I before you dig. With pa rless billing, you can receive and pay your PPL Electric Utilities bills onI-ine. The process is free, quick, convenient and secure. To learn more or sign up, visit www.pplelectnc.com. We appreciate the opportunity to have served you. Because you have paid your bills within 30 days over the past year, you have established an excellent payment record with Pennsylvania-Power ~ Light Company. Heating your home is the biggest part of your winter every needs. Check your heating system filter(s) monthlyy. Clean or change fibers as needed You can save money since your sysfem will use less energy. Information about appliance energy use and tips on saving energy are available through the-Energy Library on our Web site, www.pplelectnc.com. ,Make a Payment turps://seliserv.pplelectnc.comrrU~eli~ervl aecured/Urte~l~imeraymen Payment Co nfi rmati o n Thank you for using myPPL to make your payment Your confirmation number is: 10110SS4 Please print this page for your records. Wb will apply a payment of 513.08 on 1116/2010 against a total balance of 513.08 on account 4f up to three business days for this payment to appear ~ your PPL Electric Llfilities account sumire K you wish to cancel this payment, you may do so from the payment. history page. ff you have questions, please call PPL Customer Service at 100-DIAL-PPL (1.800-342-6775). C representatives are available from 8 a.m. to 5 p.m. Monday to Friday. 1 of 1 11 /4/2010 10:26 Ply ~` ~ Vl~~shington Gas Energy Services A Washington Gas AAiliated Company November 01, 2010 Michael Gilder 11 Kingswood Dr Mechanicsburg, PA 17055-2761 RE: PPL Electric Utilities Account Number 4961086013 WGES Electricity Supply Service Agreement Dear Michael Gilder: This letter confirms that WGES received and processed your request to cancel your WGES Electricity Supply Service Agreement. Please retain it for your records. Your WGES service ends on the applicable meter reading as determined by PPL Electric Utilities. At that time, your electricity will be supplied by the utility or another supplier of your choice. If cancellation charges apply to your WGES account, they will appear on your bill and will be due in accordance with our standard billing policy. If you are cancelling before your WGES service was scheduled to begin, you should not experience any changes on your bill and you will remain with your current supplier. We are sorry to have lost your business. Since we are committed to providing quality service to our customers, we would like your feedback. If you were not satisfied with our WGES Electricity Supply Service Agreement please tell us why. We would appreciate an opportunity to improve. We have provided apostage-paid envelope for your convenience. If you have any additional questions, please call our customer service specialists toll free at 1-888-884-9437 from 7:00 a.m. to 7:00 p.m. weekdays, except holidays. Sincerely, WGES Cancellation Processing Center Please tear here and return. ~ ~.7as November 01, 2010 E~er9Y~erV~e8 Michael Gilder 4981086013 WHICH OF THE FOLLOWING REASONS BEST EXPLAINS WHY YOU CANCELLED? Not enough savings with WGES. Preferred to stay with the Utility. Preferred another supplier's offer. Had a problem with the WGES sales Interaction. YOUR ADDITIONAL COMMENTS ARE APPRECIATED: Had a customer service problem with WGES. Letter from PPL Electric Utilities concerned me. Had a billing problem. Other PPL. 33. WEB. 18245 ~ 1738 North 3~d Stroet ' ~ Suite A •~ ~ ~~ ~~ d Harrisburg, PA 17102 E N V I R O Q U E S T ~+ ~~„ ~ ~,,, ~ „~ Phona (717) 233.8144 Fax (717) 233.2699 www. ovghar rlsburo. c one svq~comcast.nat ~ro~o~ar AC;REEMENT made fn Harrisburg Pennsylvania, between Enviroquest, a Pennsylvania Corporation, and the homeowner of the address shown below, hereinafter called "Homeowner": 711 Oki Silver Spring Road Mechanicsburg, PA 17055 TO WIT; WHEREAS, Enviroquest is engaged in the business of providing environmental services; and WHEREA8, Homeowner desires to contract environmental services from Enviroquest; NOW THEREFORE, in consideration of the mutual promises made herein, the parties, intending to be legally bound, hereby agree as follows: 1. 8ERVICE8: Env~oquest agrees to provide and install a radon mitigation system in a good and workmanlike manner delineated as folbws: a) Sub- slab depressurization radon mitigation system with one to two suction point(s) as necessary. The suction point(s) will be connected by 3" radon piping and exit property at ground level. Fan will bs located at ground level. System will vent above roof level using downspout similar to existing. b) A Dynavac GP, RP or XP series fan will be installed. The fan most suitable for this job will be determined at the time of installation after sub slab diagnostic procedures. (see page 2 for fans & specifications) c} A condensate bypass will be installed for all exterior installations. d) Caulking, sealing of major radon entry points, and installation of retrofit sump and floor drains as necessary. Marine plywood sump lids will be fabricated and instal{ed as needed. Crawl space will also be mitigated, if necessary. e} One vacuum gauge (u-tube) will be installed to monitor system performance. f) One on/off switch or plug with all necessary electrical hookups done in accordance with NEC (National Electric Cods). g) One post test kit with complete instructions to be performed by the owner, or a DEP certified third party on behalf of the owner, within 2 to 30 days of installation. h) Site cleanup and disposal of any and all wastes created by installation to be performed by contractor. Foam used during installation is easily cleaned up after curing which can take several days. i) Backdraft testing will be conducted, if there are any combustion appliances. j} We design our systems for maximum radon reduction efficiency and minimum aesthetic impact. The work will take approximately one day to complete. '** PlEA8E MOPE PER80NAL ITEMS 24" FROM WAlL81N BA8EMENT IN UNFIN18HE0 AREA8 ONLY *** 2. C08T: The contract price of this ob is: 725.04 8.OUARANTEE8 and WARRANTIE8: Enviroquest will reduce radon levels to 3.9 pCUI or below for 5 years. To reduce the radon level, Enviroquest reserves the right to modify the system ss necessary. There is a five year warranty on all system components, with the exception of the fan which carries a 6 year limited manufacturer warranty, and the system pressure Indicator, which carries aOne-year manufacturer's warranty. For warranty related repairs there's one year free labor. This warranty does not include treatment of radon in water. Enviroquest Inc. shall not be liable for failure to reduce airborne radon concentrations due to building material conternination. The warranty doss not include malfunction due to present or future elevated water levels under the slab. This warranty is void if structural, or other modifications are made to dwelling which would affect the function of the radon reduction system. The warranty does not include damage to the system resulting from an act of God, accident or misuse during the Five year period. This warranty is transferable from owner to owner of the above listed property. This warranty is not valid unless the contract price is paid in full. This radon mitigation agreement must be signed and dated, and the post test must be completed within 2.30 days after installation, or any subsequent modification, for the warranty to be valid. ff Enviroquest uses pre installed radon piping and the radon level does not come down to below 3.9 pCi/I after installation, additional work to correct the condition will be on a time and materials basis. Areas concealed by personal items, (i.e. boxes, carpet, finished areas etc.) that need to be sealed after system is installed, will be treated on a time and materials basis. 4. REFERENCES: Refirsnoes awvallable upon request. OYNAVAC FANS We use the Dynavac GP series where possible. ff we ere unable to fit a GP, an XP series (not shown) is used. We carry several sizes of fans and determine the appropriate size after performing diagnostics at tha time of inatallatbn. The following table illustrates power usage assuming that the fan runs continuously and your electricei costs are 9 cents per kW-Hr. Power Consu Month Cost Power Consum Month Coat 40 w 2.59 100 w 6.48 50 w 3.24 110 w 7.13 80 w 3.88 120 w 7.78 70 w .54 130 w .42 8Ow 5.18 140w 9.07 90 w 5.83 150 w 9.72 A~sth~tiwlly Pl~aaln8 Outside QP 601, 201 8~~iN Fsns Neat, Chan, Quality CrsKsmsnship 6. COMPANY BACKaROUNO: Enviroquest Inc. has been in business for over 20 years. We have performed thousands of successful mitigations. Enviroquest, Inc. holds DEP Mitigation Firm # 1725. John Staz, the president of Enviroquest, holds OEP Mitigation Individual # 1512. We are a certified DEP contractor. Enviroquest is fully licensed and insured. d. REQUIRED MAINTENANCE: The radon fan should be kept on at all times. The system pressure indicator should be checked periodically to make sure that the liquid levels are not at zero. ff levels are at zero, check the on/off switch to make sure it is in the on position. If the switch is on, and the system pressure indictor reads zero, call Enviroquest immediately. T. HAZARDOl18 MAT'ERlAl.8: Enviroquest uses PVC glue, polyurethane sealant, and other materials, which may produce strong odors. The odors will usually dissipate within 24-48 hours. If you have an allergic reaction to volatile organic vapors, please let us know prior to installation. The MOS (material data sheet(s)) are available upon request from Enviroquest. 8. POST MITI~3ATION TESTING: Enviroquest will provide you with one post mitigation test kit with complete instructions that should be started no sooner than 24 hours after installation, and no later than 30 days after installation (see warranty section). The homeowner, the buyer of the prospective property or a state certified neutral third party on behalf of the homeowner, may complete this teat. It is recommended that the home be tested every two years to confirm proper function of the radon system. Free post mitigation radon test kits may be obtained from the DEP at 1.800-23-RADON. 9. PAYMENT: Homeowner will pay: ~ Seven Hundred Twenty Five Dollars and Zero Cents (725.00) for its services provided under this Agreement. Homeowner shall pay said amount at the time of the service, unless otherwise provided for in writing by Enviroquest. (We accept Visa/ MastsrCardtPersonal Checks) 10. DEFAULT: In the event Homeowner does not pay the amount specified in Paragraph 0 of this Agreement to Enviroquest at the time of Enviroquest performance of services, or by any other due date agreed to in writing by Enviroquest, then Homeowner will be in default and in breach of this Agreement. 11. REMEDIES: If Homeowner shall default pursuant to Paragraph 10 of this Agreement, then Enviroquest Inc. may seek all remedies legally available to Enviroquest to collect the unpaid debt, including but not limited to: turning said default over to a collection agency, reporting the default to various credit bureaus and credit reporting companies, and filing suit In a court of law of proper jurisdiction. 12. LEGAL FEE8 and C08T8: In the event Homeowner default shall cause Enviroquest to seek legal action, then Homeowner will pay an attorneys' fee of 6525.00 in addition to the amount owed Enviroquest, if the action is filed in a District Magistrate Court. Said attorneys fee shall be included in the Magistrate's judgment. ff the action or an appeal is of a type properly filed in a Court of Common Pleas, then Homeowner shall pay reasonable attorneys fees in addition to the amount due Enviroquest. The court's judgment shall reflect the addition of said attorneys' fees. Regardless of the judicial forum in which Enviroquest seeks legal redress, Homeowner shell also pay, and any judicial Judgment shall reflect, all court costs, service of process fees and all execution costs and fees as well as interest upon the unpaid debt equal to the maximum annual percentage rate allowed by law. 18. RELEA8E and INDEMNITY: Homeowner agrees to assume all risk of loss, and to indemnify and hold Enviroquest harmless from and against any and all liabilities, demands, claims, suits, losses, damages, causes of actbn, fines or judgments, including costs, attorney's and witnesses' fees, and expenses incident thereto, whether direct or indirect, for injuries to persons (including death) and for loss, breakage, damage or destruction of property or chattels arising out of or in connection with this Agreement unless caused by the negligence of Enviroquest, its officers, agents or employees. 14. DI8CLAIMER: Enviroqueat is not responsible, and Homeowner will hold Enviroquest harmless, for any loss, inconvenience, delay of settlement or actual, consequential, delay or expectancy damages which may result from any negstive finding(sj made during installation by Enviroquest. (Example: excessive water under slab, which would delay job). 16. INTEGRATION and 8UPER8EDE8: This Agreement represents the entire understanding of the parties with respect to the subject matter of this Agreement anti cancels, supersedes and terminates all prior agreements, contracts, understandings, negotiations and other arrangements between the parties whether written or oral or partly written and party oral. 1 d. A881GNMENT AND DELEGATION: This Agreement shall not be assigned without the expressed written consent of Enviroquest. This does not apply to the warranty, which is transferable from owner to owner of the subject property. 1 T. EXCEPTIONSIFORCE MAJEURE: Enviroquest may suspend, cancel or terminate this Agreement at any time because of fire, flood, natural dissster, strike of its personnel, war, insurrection, riot, the declaration of a state or national emergency, acts of civil or military authorities, acts of God or the public enemy, or other cause beyond the control of Enviroquest by giving the Homeowner written notice of such suspension, csncellation or termination and the reason for the same. 18.OOVERNINO LAW: This Agreement shall be construed and governed pursuant to the laws of the Commonwealth of Pennsylvania. Any choice of law issues shall be deemed to utilize the choice of law rules of the Commonwealth of Pennsylvania. 19.8EVERA8ILITY: All sgreements, provisions and covenants contained in this Agreement are severable, and in the event any of them are held to be invalid by any competent court, this Agreement will be interpreted as if the invalid agreements, provisions or covenants were not contained in this Agreement. 20. AMENDMENT end MOOIFICATIONB: This Agreement may be amended, modified or supplemented only by the written agreement of the panes hereto. 21. FAX AUTHENTICATION This agreement and any amendments thereto, may be executed in multiple counterparts by the parties and delivered by way of transmission through a facsimile (FAXj machine and such counterparts shall have the same Legal enforceability and binding effect as though it were signed by all parties in original form. 22. NOTICE TO CLIENT8: The Radon Certification Act requires that anyone who provides any radon related service or product to the general public must be certified by the Pennsylvania Department of Environmental Protection. You are entitled to evidence of certification from any parson who provides such services or products. You are also entitled to a price list for services or products offered. All radon measurement data will be sent to the Department as required in the act and will be kept confidential. If you have any questions, comments, or complaints concerning persons who provide radon-related services, please contact the Pennsylvania D. E. P., Rachel Carson State Office Building, P.O. Box 8489, Harrisburg, PA 17106 -8469, (71 T) 783 - 3594 or (800) 237-2366. BY SIGNING, ALL PARTIES HERETO AFFIRM THAT THEY HAVE READ, UNDERSTOOD ANO AGREE TO ABIDE BY THE TERMS ANO PROVISION8 OF THIS AGREEMENT. TO ACCEPT THIS AGREEMENT, SIGN, DATE, ANO FAX OR MAIL THIS PAGE ONLY. PROPOSAL DATE;- September 21, 2010 -~ I understand that the radon test kit that will be left at the property must be completed within 2-30 days, and that payment in full must be received for any warranty to be valid. I understand that Enviroquest does not complete the radon test and that I will be responsible for completing the test. I further understand that Enviroquest must receive a signed copy of this page of the agreement prior to the installation date. Please move all personal items a minimum of 24 inches from the perimeter of foundation walla and any other obvious openings prior to the commencement of the job. Radon travels through soil gas. Enviroquest needs to evaluate and seal these areas (as necessary). Please call if you are unsure of what to move. A service charge will apply if we cannot complete the job due to personal items that are in the way. Please Sign end Date. (' ~', Date: ~j_..~ ~ - ~,t-v- Sign Name Above ~ f~~~~i~L S C=1/d L-~ ~EC:L.CTQ.U~[ Print Name Above r Rain down spout color: -white, _wlcker, -clay, -brown, -cream, _ light gray T11 Old Silver SpNng Road Mechanicsburg, PA 17086 The contract a is: 726.00 at Settlement date 0 Check ^ Invoice 0 Visa/MC - Name on Card: Exp / Billing Street Address: City/State2ip: ATTESTED: Enviroquest Incorporated 1738 N. 3"' Street Sufte A Harrisburg, PA 17102 Ph.717.233.6144 Fax 717.233.2699 evq~comcast.net Telephone ~: • `~ ~ ~ ~ TRAVELERS INSURANCE.COM 29000 AURORA RD SOLON OH 44139 MICHAEL GILDER ESTATE 11 KINGSWOOD DR MECHANICSBURG PA 17055 Automobile Account Bill Account No. 983906881 Please refer to this billing account number °~~~ when calling or making payments. 670 Billing Date: MAY 21, 2010 Due Date: JUNE 10, 2010 QUESTIONS? CALL US: clam servic,. 1-800-CLAIM-33 Policy Gluestions a Change of Address 1$00-a4Z~50T5 To pay online visit mytravelers.com Save money and have the peace of mind of knowing your policy premiums are paid automatically. Simply enroll to pay automatically by credit card or bank account. The two easy ways to enroll are to complete and return the form on the reverse side or go to www.amp.travelers.com. Policy Pavmertt llnformation Minimum Unpaid Policy Name Policy Number Policy Period Amount Due Balance Automobile 983906881 101 1 06/01 /10 to 12/01 /10 $ 5 2.16 S 313.0 0 Service Charge This Month X5.00 Total X57.16 X313.00 ~.~ l 0 $ Please read importan information on reverse side. Please detach and mail the lower portion of this bill with your payment in the enclosed envelope to TRAVELERS, ONE TOWER SQUARE, HARTFORD, CT 06183-1001. Thank You. TRAVELERS Previous balance s313.o0 Total $313.00 Our installment plan is designed to make it convenient for you to pay for your coverage over the policy term. If you do not pay an installment on time, you may no longer be eligible to pay by installments and we may require payment of the total unpaid balance to continue your coverage. You must pay at least the minimum amount due by the due date to avoid a $10.00 late charge. A $20.00 fee will be assessed for payments returned by your bank. Insurer for policy 983906881 101 1: THE TRAVELERS HOME AND MARINE INSURANCE COMPANY We offer three payment options. You may pay: 1. The Minimum Amount Due - includes a $5.00 service charge. 2. The Unpaid Balance -eliminates further service charges. 3. More than the Minimum Amount Due but less than the Unpaid Balance - includes a $5.00 service charge. Account Bill Account No. 983906881 Please refer to this billing account number when calling or making payments. ~~ TRAVELERS .J Account No. 983906881 INSURANCE.COM 29000 AURORA RO MAY OS, 2010 SOLON OH 44139 oo~as e~ ~ ~ ""' ~ ` ` ~~-~- MICHAEL GILDER ,~ ~, ~~,• 711 OLD SILVER SPRING RD ~ ~ ~ ~'~ ~,(, MECHANICSBURG PA 17055 ~ ~i. For Policy chanyss or gwstio~s call: 1-800-342-5075 For clsies call: 1-800-CLAIM-33 IMPORTANT BILLING NOTICE This letter is to inform you of a change to your Recurring Credit Card payment plan. The amount rte Trill charge your credit card has changed because of the following activity: BILLING ACTIVITY POLICY NUMBER AMOUNT Renewal(06/01/10) Automobile 983906881 101 1 +313.00 AS A RESULT, ON MAY 10, 2010 YOUR CREDIT CARD WILL BE CHARGED $.00. All charges trill be made to your credit card on the 10th of the month. If this date is on a weekend or a holiday, the charge Mill be made on the following business-day. If you make a change to your policy that results in additional premium due, we will send you a notification before we charge the amount to your credit card. I! there are no changes, your next charge Mill be made when your policy renews. If your card is declined, you trill be billed directly for the entire balance on your account. Any refunds for thia policy/account will be credited to your credit card where permitted by law . See the reverse side for a breakdown of your charge. Insurer for policy 983906881 101 1: THE TRAVELERS HO!!E AND MARINE INSURANCE COMPANY Thank you for insuring with us. Please contact your insurance representative if you have any questions concerning this letter. 004638/00635 F3116D70 7105 05/05/10 YOUR PREMIUM TO BE CHARGED TO CREDIT CARD ACCOUNT XXXXXXXXXXXX5S11 POLICY TYPE NEN pNp POLICY CHARGE EFFECTIVE DATE POLICY NUMBER BALANCE AMOUNT Automobile (06/01/10) 983906881 101 1 S313.00 50.00 CREDIT CARD CHARGE DATE OS/10/10 S0.00 YOUR SCHEDULE OF CHARGES TO YOUR CREDIT CARD. CHARGE DATE CHARGE AMOUNT OS/10/10 $0.00 06/10/10 $313.00 NOTE: This schedule Mill vary if changes are made to your policy that affect your premium. If the deduction asount changes, we Nill send you advance notification of your neK deduction amount. TRAVELERS] INSURANCE.COM 29000 AURORA RD SOLON OH 44139 00635 MICHAEL GILDER 711 OLD SILVER SPRING RD MECHANICSBURG PA 170552882 Thank you for trusting Travelers with your auto insurance. We're always available to assist you with questions, additional insurance needs, or claims. The enclosed, personalized policy package was created just for you. Please review these materials for accuracy: • Your auto renewal ~,olicy • Your auto insurance identification card(s) • Other important notices May 5, 2010 Policy Number 983906881 101 1 Policy Period 06/01 /2010 - 12/01 /2010 12:01 AM STANDARD TIME AT THE RESIDENCE PREMISES Thank you for your business! QUESTIONS? CONTACT USI Policy questions or changes. 800.842.5075 24 hour claim service 1.SOO.CLAIM33 1.800.252.4633 Online service . mytravelers.com • Identification Cards. You may need these cards as proof of insurance so keep them in a safe place in your vehicle, such as your glove box. • Claim Cards. Use the handy claim cards below if you're ever in an accident. Simply break the card in half and give the right side to the other driver. Please see reverse side for important information relating to Pennsylvania law. On behalf of INSURANCE.COM, we thank you for your continued business. Sincerely, ~ ~~ "~~ ~ Gregory C. Toczydlowski President Personal Insurance PL-14511 R PA 06-09 TRAVELERS Call us immediately to report your loss 800.252.4633 (800.CLAIM33) We're here to help 24 hours a day, 385 days a year Break in half. (See other side.) } FOR YOU TRAVELERS Call us immediately to report your loss 800.252.4633 (800.CLAIM33) We're here to help 24 hours a day, 385 days a year f Break in haB. (See other side.) -- - FOR OTHER DRNER TRAVELERS Call us immediately to report your loss 800.252.4633 (800.CLAIM33) We're here to help 24 hours a day, 385 days a year Break in half. (See other side.) } FOR YOU TRAVELERST Call us immediately to report your loss 800.252.4633 (800.CLAIM33) We're here to help 24 hours a day, 385 days a year ~_ Break in half. (See other side.) FOR OTHER DRNER MLAA7/MAAR F11 1 Ar17n 71 nR nR/nR/1 n ~. ...waw iww wwww~ Please note the following: AUTOMOBILE INSURANCE IDENTIFICATION CARD INFORMATION • Your automobile insurance identification card indicates that your policy provides at least the minimum coverage required by Pennsylvania's Financial Responsibility law. • One ID card is enclosed for each vehicle on your policy. Keep the card in the glove compartment of your car. This card must be shown when requested by any law enforcement official. The ID card information may also be used for vehicle registration and replacing license plates. If your liability policy is not in effect, the card is no longer valid. • You are required to maintain financial responsibility on your vehicle. It is against Pennsylvania law to use the ID card fraudulently such as using the card as proof of financial responsibility after the insurance policy is terminated. If you suspect FRAUD on any policy or claim, call the Travelers 24-hour hotline (800)-6-FRAUD-0. Help us fight fraud. • Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. Thank you for insuring with Travelers. FOR OTHER DRNER _ _ FOR YOU FOR OTHER DRNER FOR YOU This insurance card has been provided by a Travelers customer. Please call us at •00.282.633 for claim service. Claim professionals are available to take your notice of loss 24 hours a day, 385 days a year. 9838068811011 nu-vetswe cuerora roucr ~arsei H you an In an auneo sccldertt 1 Snap this wrd in two and prande the right side to the other driver 2. Get the license plate number of the other drivers vehicle. 3. Call Travelers immediately at 800.232.1633. onew orevers uce,ra rues r+~a•t# 9838068811011 vouR roucr -a~sw This insurance card has been provided by a Travelers cusEomsr. Please call us at 600.282.d633 for claim service. Claim professionals aro available to take your notice of loss 24 hours a day, 385 days a year. 983906881 101 1 nuv~sia cwTOwu -aucr raae~ H you an in an auoo accklent 1. Snap this card in two and provide the right side to the other driver. 2. Get the license plate number of the other drivers vehicle. 3. Call Traveler immediately at 800.232.1633. or-ra anvsirs ucsws rum -eirsw 983806881 101 1 roue roucr r.~rrait 0 .- 'gi r 0 r A IL W ~, Q U ~ ~"' E `~' ~j Z ~ 1~~ N~ p ~ ~ ~~ ~ O ~ ~ e^~ 't3 ~ +"'~ t3 O'- N df 4 ~„ o ~ m ~ a V ~ 'L ~ o J Z ~ 7N ~ m ,~,. U -~'' Q V c ~ too ,. Z u. ~ r' ,~ v x c- ~, -- W ~ c ~ ~ per, ~ J ~ \M ~ ~ 1 ~ p~ ~" ~-' 7~ Zo r~ ~ O ,~, HNC Z ~-~ ~~ ~ •~ V ~ ~~U O W °~ ° oo+ o ~ ~' ~~ p 'a L~ ~ L1• Q~a E ~ ,~ ~O V 4 .fl ~~ ~ U~U m ZV NQo o To a ~„~Ndf Z ~-~• ~~ y w p'-=' ~~{ ~ ~ 3,~~ C~ ~ O ~ r~~ ~ ~- E> ~. •- s _ g .. •r 'a a c 3r ~ ~ ~ •~ ~ 3 ~ C ~ y ~ ~ ~ ~ ~ ~~ ~~ ~-•~~~.° ~. ~~, fig-' ~3 ~.dc ~ct~-ES~~ ~ o~ ~U C~ N~~ •~~°c~~w ~ oZ ~ ti oa. ~r $ " c c ° ~ 'S ~c E ,~ o ~ »-..- .i -oc cc~ • 3~ ~coai w .. • y v ~ T"" ~ t7 w •- tQi. • .- r ~ ~'~ • ~? ~~ Lam. ~~ ~ ~'~ $a$ ~ ~t ~ C .. ~ ~~ ~` ~~~ ~ Obi C ~'3~~~ ~•~ ~ ~ p~ Qb~ W~a~~~c~M''~ ~3~~c~ ~~p•~c ~+ v~~ gym=o~°~~ ~~~•'~ ~%'~c`,~'S~ Z .~ c r ~ .r c~ ..w ~L ~~ ~~"ioQZrg7~~p` ~ TRAVELERS Automobile Policy Continuation Declarations 1. Named Insured MICHAEL GILDER 711 OLD SILVER SPRING RD MECHANICSBURG PA 170552882 Your Agency's Name and Address INSURANCE.COM 29000 AURORA RD SOLON OH 44139 Your Policy Number 983906881 101 1 Your Account Number 983906881 For Policy Service Call 1.800.842.5075 For Claim Service Call 1.800.CLAIM33 2. Premium Your Total Premium for the Policy Period is 6313.00. The policy period is from June 1, 2010 to December 1, 2010. 3. Your Vehicles 1. 2004 CHEVR MONTE CARL Identification Numbers 2G1 VVX12K049191501 4. Coverages, Limits of Liability and Premiums Insurance is provided only where a premium is shown for the coverage. "IF COLLISION COVERAGE IS PROVIDED UNDER THIS POLICY, COVERAGE EXTENDS TO VEHICLES WHICH YOU RENT FOR 30 DAYS UNDER A RENTAL CAR COVERAGE AGREEMENT. PLEASE REMEMBER THAT COLLISION COVERAGE DOES NOT PAY FOR LOSS OF USE. PLEASE CONTACT YOUR TRAVELERS AGENT OR REPRESENTATIVE IF YOU HAVE QUESTIONS. IF YOU DO NOT CARRY COLLISION INSURANCE, THIS POLICY DOES NOT PAY FOR DAMAGE TO RENTAL VEHICLES. VEHICLE 1 04 CHEVR MONTE CARL A. Bodily Injury x100,000 each person ............. 6 48 6300,000 each accident B. Property Damage 6100,000 each accident........... 6 60 Continued on next page 670/oWG834 PL-7782 Rev. 08-07 Page 1 of 4 004e40/OOe36 F3119D70 7106 06/06/10 TRAVELERS~T 4. Coverages, Limits of Liability and Premiums (continued) 04 CHEVR MONTE CARL D 7. Uninsured Motorists (Bodily Injury) Non-Stacked $50,000 each person .............. $ 9 $100,000 each accident See Endorsement A37043 D9. Underinsured Motorists (Bodily Injury) Non-Stacked $50,000 each person .............. $ 19 $100,000 each accident See Endorsement A37043 E. Collision Actual Cash Value less........... $ 122 $250 deductible F. Comprehensive (Other than Collision) Actual Cash Value less........... $ 23 $250 deductible G. Extended Transportation Expense $50 per day/$1,500 maximum....... $ 17 QB. First Party Benefits Coverage Full Tort Option ................. $ 15 See Endorsement A37021 Subtotal for your vehicle ............... $ 313 Total Premium for This Policy: 670/0WG834 ~ 313 Continued on next page PL-7782 Rev. 08-07 Page 2 of 4 TRAVELERS? Named Insured MICHAEL GILDER Policy Number 983906881 101 1 Policy Period June 1, 2010 to December 1, 2010. Issued On Date May 5, 2010 5. Information Used to Rate Your Policy Discounts and Advantages Travelers Homeowners Customer Anti-Theft Discount 04 CHEVR MONTE CARL Passive Restraint Discount 04 CHEVR MONTE CARL Drivers DATE OF SEX MARITAL BIRTH STATUS 1. MICHAEL 08-19-56 Male Single Vehicles USE OF LOCATION VEHICLE OF VEHICLE 1. 04 CHEVR MONTE CARL Pleasure MECHANICSBURG PA I t is important that the above information is correct to ensure that your policy is properly rated. If there are errors or changes to this information, please notify your Travelers representative immediately. 6. Other Information Loss Payees 04 CHEVR MONTE CARL GMAC VIN # 2G1WX12K049191501 PO BOX 5378 TIMONIUM,MD 21094 Your Insurer The Travelers Home and Marine Insurance Company 6081 East 82nd St, Indianapolis, Indiana 46250 One Tower Square, Hartford, CT 06183 670/OWG834 Continued on next page PL-7782 Rev. 08-07 Page 3 of 4 n~a~a+inn~aR F~11Af~7ff ~~nli n~sm!~i~n TRAVELERST 6. Other Information (continued) Policy Endorsements A37013 Amendment of Policy Provisions - Pennsylvania A37021 First Party Benefits Coverage - Pennsylvania A37043 Uninsured/Underinsured Motorists Endorsement Pennsylvania Policy Edition 8 Policy Form 101 Issued on 05105/10 Thank you for insuring with Travelers. We appreciate your business. If you have any questions about your insurance, please contact your Travelers representative. FOR YOUR INFORMATION Children 8 air bags. it's as easy as 1 1. Never put a child seat (those used with of a car with air bags. 2. Make sure all children are buckled up no Unbuckled children can be hurt or killed 3. The rear seat (those with seat belts) is of any age to ride. - 2 - 3 infants) in the front seat matter where they sit. by an air bag. the safest place for children For information about how Travelers compensates independent agents and brokers, please visit www.Travelers.com or call our toll free telephone number 1-866.904-8348. You may also request a written copy from Marketing at One Tower Square, 2GSA, Hartford, Connecticut 06183. YOU MAY PURCHASE UNINSURED AND/OR UNDERINSURED MOTORISTS COVERAGE AT ANY AVAILABLE LIMITS FROM :15,000/:30,000 UP TO YOUR BODILY INJURY LIABILITY LIMITS. YOU MAY REJECT THESE COVERAGES ENTIRELY. 670/OWG834 PL-7782 Rev. 08-07 Page 4 of 4 IMPORTANT BILLING NOTICE This notice contains important information about our billing options and fees. You have chosen to pay your insurance premium in full by Recurring Credit Card (RCC). In the event that your payment is returned by your bank, it may result in the automatic conversion of your Recurring Credit Card (RCC) account to Bil'1 by Mail. If your billing needs change, we offer several ways to pay your premium: Bill Plan ~ Mon h Luam Suai Electronic Funds Transfer (EFT) $ 1.00 No Charge Recurring Credit Card (RCC) $ 1.00 No Charge Bill by hail $ 5.00 No Charge Late Charge: $10.00 per occurrence Payments returned by your bank: $20.00 per occurrence If you have multiple policies with us you may be able to combine those policies into a single billing account. If you have selected one of our monthly billing options, and you combine your policies into a single billing account, you will be charged just one service charge per installment, and not per individual account. To add this policy to an existing billing account or if you have other questions about this notice, please call your insurance representative at 800-842-5075. PL-14216 09-08 AAAOAO//111AOR Cg11/1117R 7111.1 AR/AR/111 .~ { ( 1\~ ~• )(~.~ t~~ ~~~ (~ ~ <,~ 1a" ~ .; 4-~~~ i1. ." V`~ --~ ~ C =~ ~ a3i'aa~3bd ~p ~~ ~~ 0~9~1~~/ G~ ~~ ~\ 1 ... ~, r ... .~... ...~ • ..~. .~+~ .+~ ...Y r --- r •... ~- r ..+ n ~~ a TRAVELERS INSURANCE.COM C 0 TRAVELERS P 0 BOX 6075 GLENS FALLS NY 12801 MICHAEL GILDER 711 OLD SILVER SPRING RD MECHANICSBURG PA 17055 Account No.g83906881 NOVEMBER 04, 2009 For policy chances or questions call: 1-800-842-5075 For claiMS call: 1-800-CLAIM-33 IMPORTANT BILLING NOTICE This letter is to inform you of a change to your Recurring Credit Card payment plan. The amount we Trill charge your credit card has changed because of the following activity: BILLING ACTIVITY POLICY NUKBER AMOUNT Renewal(12/01/09) Automobile 983906881 101 1 +310.00 AS A RESULT, ON NOVEMBER 10, 2009 YOUR CREDIT CARD WILL BE CHARGED x.00. All charges Mill be made to your credit card on the 10t1t of the month. If this date is on a weekend or a holiday, th• charge Mill be made on the following business day. I! you make a change to your policy that results in additional premium due, we Trill send you a notification before we charge the amount to your credit card. If there are no changes, your next charge will be made when your policy renews. If your card is declined, you Trill be billed directly for the entire balance on your account. Any refunds for this policy/account Trill be credited to your credit card where permitted by law. See the reverse side for a breakdown of your charge. Insurer for policy 983906881 101 1: THE TRAVELERS HOME AND MARINE INSURANCE COMPANY Thank you for insuring with us. Please contact your insurance representative if you have any questions concerning this letter. c-~,9~ra ~ -~' l O 004029/00590 F3116D70 6979 11/04/09 YOUR PREMIUM TO BE CHARGED TO CREDIT CARD ACCOUNT XXXXXXXXXXXX5511 POLICY TYPE NEW AND POLICY CHARGE EFFECTIVE DATE POLICY NUMBER BALANCE AMOUNT Automobile (12/01/09) 983906881 101 1 S310.00 S0.00 CREDIT CARD CHARGE DATE 11/10/09 50.00 YOUR SCHEDULE OF CHARGES TO YOUR CREDIT CARD. CHARGE DATE CHARGE AMOUNT 11/10/09 $0.00 12/10/09 $310.00 NOTE: This schedule Mill vary if changes are made to your policy that affect your premiums. If the deduction aiaount changes, we Mill send you advance notification of your new deduction amount. a 0 r Crl tL ~_ ~_ a~ W ct Q Z 2 4 .. ~ ; ~+ Z° m o o''"r A ~ A ~ O O ti ~- ~ H u p ~ , ~ N o -t~ ~ 7+ "'' ~ ~ ~` ,~ > ~~ ~, 3 ~ jN p ~- "~ ~ Q i o ~ o W ~ c ,~ ~ ~ E ~ ~ ~ ~ N ~ Zo ~ ~~ r ~' Cp m a ~ a a+ o E o ~ „~ ~ ~ b ~ a ~ ~ ~ v ~ ~, ~3 ~ a v O a 7 Zv NQp Z H W ..~ W Q ~" N A~ N W~ v xo '~ ~ ~ N ~a _ ~p~ ~ ~ O~..t11 ~~~ y.~NW ~ ~~~ ~ ~ .~ v ~Q, Q HVa~ ' T G ~ ~_ ttl m m m 0 a v O 2 0 E m O 0 rn m • '~ .- a G ~, ~3 • i~~c o~ At' ~E Sgui 3~ ~~~ •~SE-cam 3 oz 7~C`a~ ~ tea:: ~~~~53 ~ ° ~O ;~~$_~~ r .. 3 .- ~ ._ o '- asc s~ ~C•~'~~C t~Cr~C~O~7Rf ~e ~ E~~ ~'~ c'~~3 0~ ~'4•v4ra .,..~.- .. o ~ d •o~ ~~~g a•~~ c~. ~~..'~i off' $$~ 3'~ • ~ ~ c~•~ r z$ - ,. y- TRAVELERS Automobile Policy Continuation Declarations 1. Named Insured MICHAEL GILDER 711 OLD SILVER SPRING RD MECHANICSBURG PA 170552882 Your Agency's Name and Address INSURANCE.COM C\O TRAVELERS P O BOX 6075 GLENS FALLS NY 12801 Your Policy Number 983906881 101 1 Your Account Number 983906881 For Policy Service Call 1.800.842.5075 For Claim Service Call 1.SOO.CLAIM33 2. Premium Your Total Premium for the Policy Period is 2310.00. The policy period is from December 1, 2009 to June 1, 2010. 3. Your Vehicles 1. 2004 CHEVR MONTE CARL Identification Numbers 2G1 VVX12K049191501 4. Coverages, Limits of Liability and Premiums Insurance is provided only where a premium is shown for the coverage. *IF COLLISION COVERAGE IS PROVIDED UNDER THIS POLICY, COVERAGE EXTENDS TO VEHICLES WHICH YOU RENT FOR 30 DAYS UNDER A RENTAL CAR COVERAGE AGREEMENT. PLEASE REMEMBER THAT COLLISION COVERAGE DOES NOT PAY FOR LOSS OF USE. PLEASE CONTACT YOUR TRAVELERS AGENT OR REPRESENTATIVE IF YOU HAVE QUESTIONS. IF YOU DO NOT CARRY COLLISION INSURANCE, THIS POLICY DOES NOT PAY FOR DAMAGE TO RENTAL VEHICLES. '' VEHICLE 1 04 CHEVR MONTE CARL A. Bodily Injury $100,000 each person ............. $ 49 $300,000 each accident B. Property Damage $100,000 each accident........... $ 58 Continued on next page 670/OWG834 PL-7782 Rev. 08-07 Page 1 of 5 004031/00590 F3118D70 8876 11/04/09 TRAVELERS) 4. Coverages, Limits of Liability and Premiums (continued 04 CHEVR MONTE CARL D 7. Uninsured Motorists (Bodily Injury) Non-Stacked $50,000 each person .............. $ 9 $100,000 each accident See Endorsement A37043 D 9. Underinsured Motorists (Bodily Injury) Non-Stacked $50,000 each person .............. $ 19 $100,000 each accident See Endorsement A37043 E. Collision Actual Cash Value less........... $ 120 $250 deductible F. Comprehensive (Other than Collision) Actual Cash Value less........... $ 22 $250 deductible G. Extended Transportation Expense $50 per day/$1,500 maximum....... $ 17 QB. First Party Benefits Coverage Full Tort Option ................. $ 16 See Endorsement A37021 Subtotal for your vehicle ............... $ 310 Total Premium for This Policy: 670/0WG834 ~ 310 Continued on next page PL-7782 Rev. 08-07 Page 2 of 5 TRAVELERS) Named Insured Policy Number Policy Period Issued On Date MICHAEL GILDER 983906881 101 1 December 1, 2009 to June 1, 2010. November 4, 2009 5. Information Used to Rate Your Policy Anti Theft Device Travelers Homeowners Customer Drivers 1. MICHAEL Vehicles 1. 04 CHEVR MONTE CARL 04 CHEVR MONTE CARL DATE OF BIRTH 08-19-56 SEX MARITAL STATUS Male Single USE OF LOCATION VEHICLE OF VEHICLE Pleasure MECHANICSBURG PA It is important that the above information is correct to ensure that your policy is properly rated. If there are errors or changes to this information, please notify your Travelers representative immediately. 6. Other Information Loss Payees 04 CHEVR MONTE CARL GMAC VIN # 2G1WX12K049191501 PO BOX 5378 TIMONIUM,MD 21094 Your Insurer The Travelers Home and Marine Insurance Company 6081 East 82nd St, Indianapolis, Indiana 46250 One Tower Square, Hartford, CT 06183 Policy Endorsements A37013 Amendment of Policy Provisions - Pennsylvania A37021 First Party Benefits Coverage - Pennsylvania A37043 Uninsured/Underinsured Motorists Endorsement - Pennsylvania Policy Edition 8 Policy Form 101 Issued on 11/04/09 Continued on next page 670/OWG834 PL-7782 Rev. 08-07 Page 3 of 5 004032/00690 F3118070 ®979 11/04/09 TRAVELERS~J 6. Other Information (continued) Thank you for insuring with Travelers. We appreciate your business. If you have any questions about your insurance, please contact your Travelers representative. FOR YOUR INFORMATION Children 8 air bags. it's as easy as 1 1. Never put a child seat (those used with of a car with air bags. 2. Make sure all children are buckled up no Unbuckled children can be hurt or killed 3. The rear seat (those with seat belts) is of any age to ride. - 2 - 3 infants) in the front seat matter where they sit. by an air bag. the safest place for children For information about how Travelers compensates independent agents and brokers, please visit www.Travelers.com or call our toll free telephone number 1-866-904-8348. You may also request a written copy from Marketing at One Tower Square, 2GSA, Hartford, Connecticut 06183. The laws of the Commonwealth of Pennsylvania, as enacted by the General Assembly, only require that you purchase Liabliity and First Party Medical Benefits coverages. Any additional coverages, or coverages in excess of the limits required by law, are provided only at your request as enhancements to basic coverages. The premium for the mandatory coverages at the limits required by law and the tort option you previously elected are as follows: Coverage Veh 1 Bodily Injury $30.00 $15,000 each person/ $30,000 each accident Property Damage $52.00 $5,000 each accident First Party Medical $16.00 Subtotal $98.00 Total Amount $98.00 Continued on next page 670/OWG834 PL-7762 Rev. 08-07 Page 4 of 5 TRAVELERSJ+ Named Insured Policy Number Policy Period Issued On Date MICHAEL GILDER 983906881 101 1 December 1, 2009 November 4, 2009 to June 1, 2010. FOR YOUR INFORMATION (continued) YOU MAY PURCHASE UNINSURED AND/OR UNDERINSURED MOTORISTS COVERAGE AT ANY AVAILABLE LIMITS FROM 615,000/x30,000 UP TO YOUR BODILY INJURY LIABILITY LIMITS. YOU MAY REJECT THESE COVERAGES ENTIRELY. 670/OWG834 PL-7782 Rev. OS-07 Page 5 of 5 004033/OOS80 F3118D70 8878 11/04/08 Your privacy.. . Is our concern WHAT WE MEAN WHEN WE TALK ABOUT "PRIVACY" Your privacy is important to us. When we sell an insurance polic}• to a person w~e need information about the person or property that we're insuring. We consider this private and have taken steps to keep it confidential. We want you to know about our privacy policy. The privacy polic}• tells you the kinds of information we get about }•ou, where we get it, and with whom, if anyone, we may share it. This brochure describes our privacy polic}•, procedures and practices for individuals who seek or get auto, home and other personal liabilit}• and property insurance for personal, family or household needs. WHAT KIND OF INFORMATION WE HAVE AND WHERE WE GET IT You give us most of what we need in the application process. To make sure what w•e have is correct we may need to check with you by phone or mail. You may be asked to give us more details in writing or over the phone. Plus, we may receive and check your past insurance claims from insurance support organizations or your former insurers. As allowed by law, we may ask for credit and other consumer reports from consumer reporting agencies concerning your application for insurance or any renewal of insurance. Information given to us by an insurance support organization, including consumer reporting agencies may be retained by them and disclosed to other persons. For auto insurance, we often get a report of accidents or convictions from your State Motor Vehicle Department. We get these reports through an independent reporting company. We may also check information from govenvnent agencies or independent reporting companies. This helps us correctly rate and price your policy. For home, building, or boat insurance, we or an inspector from an independent company may visit the property to inspect and report on its condition. In some cases, pictures may be taken. This allows us to check the estimate we have of your property's value. If we need more details about the property or the alarm you've installed, we may need to enter your property to finish the inspection. We would contact you before entering your property. As a part of our application and underwriting process, in most states, we also order an Insurance Score based on credit history. We use the Score, information you give us, and other consumer reports for underwriting and the price we will charge. If we receive corrected personal information from a consumer reporting agency, we will re- evaluate you. Once you're insured with us, your file may contain details about your policy(ies). This may include bill payments or claim history. A claim representative may comment, for example, on the condition and use of the insured property. We may also keep a police report if one was issued. Sometimes we need to know about your health. For example, if we need to know whether a physical limitation will affect your abilit}• to drive, we would ask you to sign a form allowing your personal doctor to answer any question we may have. WHO HAS ACCESS TO THIS INFORMATION We keep what we collect about you in our files. Our policies and procedures protect your personal information. We have physical, electronic and procedural safeguards in place. We do not give or sell our customers' personal information to others for marketing purposes. You don't have to ask us to keep your information private because we do not give it, unless allowed. We will use information about you to sell you insurance, service your insurance and settle claims. We may give the information to other persons or companies to help us manage or service our business. When we do, we require them to use it only for the reasons we gave it to them. We may give, without your past permission and only if allowed by law, information about you held in our files to certain persons or organizations such as: • Your agent or broker • Our affiliated property and casualty insurance companies • An independent claim adjuster or investigator PL-11952 Rev.6-07 004034/00390 F3118D70 8979 11/04/09 • Persons or organizations that conduct scientific research, including actuarial or underwriting studies, provided that no individual may be identified in the studies • An insurance support organization, including consumer reporting agencies • Another insurer in order to prevent or prosecute fraud Also, on rare occasions, we may be required to share this information: With a State Insurance Department or other governmental agency, if required by federal, state or local laws • If ordered by a summons, court order, search warrant or subpoena • To protect our own legal interests, or in case of suspected fraud or other illegal activities. HOW TO FIND OUT WHAT INFORMATION WE HAVE ABOUT YOU If you have any questions about what we have in your file please write to us. When we receive your written request, we will respond within thirty (30) business days. We will let you know if we've given any information about you to anyone in the past. If we asked for a consumer report we will tell you the name and address of the consumer reporting agency. You may also see and copy your file (except for certain documents about claims and lawsuits). If you believe any of our information is wrong,we'll check it out and if we agree there was an error, we'll correct it. If we don't agree, you're still allowed to file a letter with your comments. We'll send the correction or letter to anyone who received or will receive the original information. If you have any questions about the right of access to or correction of your file, we'll be happy to review our procedures with you. Please contact: Privacy Coordinator AFFINITY MKTG P.O. BOX 6075 GLENS FALLS, NY 12801 WHEN YOU WRITE, PLEASE BE SURE TO TELL US YOUR: • Name • Address • Policy number • Phone number and the best time of the day for us to call you Please include a copy (not the original) of personal ID, such as your driver's license. WE THANK YOU FOR LETTING US SERVE YOUR INSURANCE NEEDS. This notice is effective Iuly 2006 and is given by Travelers [ndemnity Company, and its property and casualty insurance affiliates, members of the Travelers group of companies. This notice applies to current and former customers and may be amended at any time. The amended notice will be sent to customers and will also be placed on Travelers web sites. A statement concerning our use of Insurance Score is available upon request for Oregon residents. PL-11952 Rev. 6-07 IMPORTANT NOTICE Pennsylvania Surcharge Disclosure Statement Notice of Tort Options Notice of Premium Discounts Pennsylvania Surcharee Disclosure Statement: In accordance with Pennsylvania law we are providing you with the circumstances and conditions under which a surcharge would apply, the estimated increase for the surcharge per policy period per policyholder, and the number of years a surcharge would be in effect, if applicable. Driver points, during the experience period, are accumulated for each operator in the household.. Driver points are then used in con junction with other driver variables to determine the highest ranked drivers. The highest ranked drivers equal to the number of eligible vehicles are then used to determine the average driver factor for the policy. For a Named Non-Owner policy or a Miscellaneous Vehicle only policy, we use the highest ranked driver only. The experience period is the three years immediately preceding the effective date of application, or the preparation of the continuation or renewal. The average driver factor is applied to the following coverages: Bodily Injury, Property Damage, Single Limit Li- ability, First Party Benefits, Increased First Party Benefits, Extraordinary Medical Benefit, Medical Payments, Comprehensive and Collision. Points are accumulated for Convictions and At Fault accidents as follows: Convictions: Points are accumulated for convictions occurring during the experience period for motor vehicle violations of the applicant or any other resident operator. Violations are categorized as outlined below: A) Major Convictions for which points are assigned for each conviction: 1) Driving under the influence: driving while intoxicated or under the influence of drugs 2) Refusal to take a sobriety test 3) Attempting to elude officer: eluding or attempting to elude a police officer 4) Failure to stop and report an accident when involved in an accident 5) Gross negligence/manslaughter: homicide or assault arising out of the operation of a motor vehicle 6) The accumulation of points under a State Point System or a series of convictions requiring the filing of evi- dence of Financial Responsibility under any Financial Responsibility Law as of the effective date of the policy 7) Illegal use of license/driving while suspended: driving while license is suspended or revoked; using stolen license 8) Operating a motor vehicle without the owner's permission 9) Loaning a license to unlicensed person 10) Failure to stop for a school bus: failure to stop or yield for a school bus as required 1 l) Reckless driving: driving a motor vehicle in a reckless manner 12) Racing: engaging in a speed contest 13) Suspension/Revocation: suspension or revocation of a license as a result of a conviction unless the suspen- sion is the result of a single 1535 violation. PL-12323 06-08 Page 1 of 4 004033/00590 F3118D70 Q979 11/04/09 14) Single incident requiring a Financial Responsibility filing We assess a surcharge of approximately 59% for each major conviction. B) Conviction resulting from any other moving traffic violation not assigned a point value elsewhere in this rule, and such conviction is the second or subsequent conviction by any one insured recorded under the policy that has not been assigned a point value above. These include: 1) Lesser speeding convictions 1-5 miles per hour over the posted speed limit 6-10 miles per hour over the posted speed limit 11-15 miles per hour over the posted speed limit 16-20 more miles per hour over the posted speed limit We assess a surcharge of approximately 22% for each lesser speeding conviction. 2) Minor convictions Illegal turning Stop Sign/Red Light: Running through a red light or stop sign. Passing violations Other Miscellaneous Minor violations We assess a surcharge of approximately 31 % for each minor conviction. 3) Major convictions Careless Driving Speeding 21 or more miles over the posted speed limit. We assess a surcharge of approximately 59% for each of these major convictions. C) At Fault Accidents Points shall be assigned for each accident that occurred during the experience period, involving the appli- cant or an}~ current resident operator, while operating an auto. 1) Points are assigned for each auto accident that results in a paid claim for: a) $1,050 or more damage to property, bodily injury or death if such accident occurred on or after July 1, 2002, but prior to July 1, 2005, or b) $1,150 or more damage to property, bodily injury or death if such accident occurred on or after July 1, 2005, but prior to July 1, 2008, or 2,000 or more damage to property, bodily injury or death if such accident occurred on or after July 1, 2008. 2) Points are assigned if, during the experience period there were two or more accidents that result in paid claims and the accidents have not been assigned a point under 1) above and the accidents in total re- sulted in damage to property, bodily injury, or death of: 1) $1,050 or more, if at least one accident occurred on or after July 1, 2002, but none occurred on or after July 1, 2005 or 2) $1,150 or more, if at least one accident occurred on or after July 1, 2005, but none occurred on or after July 1, 2008 or 3) $2,000 or more, if at least one accident occurred on or after July 1, 2008. PL-12323 06-08 Page 2 of 4 We assess a surcharge of approximately 39% for each at fault accident above the threshold and fora com- bination of minor at fault accidents once they in total pierce the threshold. EXCEPTIONS: 1. No points are assigned for accidents incurred by an operator demonstrated to be a named insured or a principal operator of an auto under a separate policy; and 2. No points are assigned for accidents occurring under the following circumstances. a) auto lawfully parked (if the parked vehicle rolls from the parked position then any such acci- dent is charged to the person who parked the auto); or b) the applicant, owner or other resident operator is reimbursed by, or on behalf of a person who is responsible for the accident or has judgment against such person equal to at least 60% of the total amount of the paid claim; or c) auto is struck in the rear by another vehicle and the applicant or other resident operator has not been convicted of a moving traffic violation in connection with this accident; or d) operator of the other auto involved in the accident was convicted of a moving traffic violation and the applicant or resident operator was not convicted of a moving traffic violation in con- nection with the accident: or e) auto operated by the applicant or any resident operator is struck by a "hit-and-run" vehicle, if the accident is reported to the proper authorities within 2~ hours by the applicant or resident operator; or f) accidents involving damage by contact with animals or fowl; or g) accidents involving physical damage, limited to and caused by flying gravel, missiles, or falling objects; or h) accidents occurring when using auto in response to an emergency if the operator of the auto at the time of the accident was a paid or volunteer member of any police or fire department, first aid squad, or any law enforcement agency. This exception does not include any accident occur- ring after the auto ceases to be used in response to such emergency; or i) accidents resulting in an amount being paid on behalf of an insured under a First Party Medical Claim only incurred on or after July 1, 1990; or j) accidents, incurred on or after July 1, 1990, resulting in an amount being paid on behalf of an insured only under Basic, Added or Combination First Party Benefits coverage, or under Ex- traordinary Medical Benefits coverage. D. At Fault Accident With Bl: an accident meets the criteria in C.1) above and there was bodily injury dam- ages paid as a result of the accident. E. At Fault Accident Without Bl: an accident meets the criteria in C.1) above but there was no bodily injury damages paid in the accident. F. If two or more accidents meet the criteria in C. 2) above, we will count the accidents starting with the old- est accident in the experience period. Once the dollars paid or reserved for two or more accidents equal or exceed the threshold, we will use the characteristics of the most recent accident in the group to determine if the accident is an At Fault Accident With BI or an At Fault Accident Without BI and apply the points to the point accumulation for the driver involved in that accident. We will then repeat the process for any re- maining accidents under the threshold. PL-12323 06-08 Page 3 of 4 004038/00580 F3118D70 9878 11/04/09 G. Months Since Most Recent Incident: for each driver the number of months prior to the effective date of the new business policy or continuation that the last at fault accident occurred and the last conviction oc- curred. H. Refund of Surcharged Premium If point(s) have been assigned in accordance with one of the following situations, the Company shall refund the insured the increased portion of the premium generated by the point(s). All such refunds shall be the portion of the premium due to the surcharge for all policy periods since the inception of the surcharge. 1) If points are assigned as a result of an accident and it is subsequently learned that the accident falls un- der one of the exceptions enumerated in this rule. 2) If points are assigned as the result of a conviction and the conviction is ultimately reversed. 3) If points are assigned through mistake, carelessness, misinformation or other error. Notice of Tort Options T1~te laws of the Commonwealth of Pennsylvania give you the right to choose either of the following tw•o tort op- tions: 1) "Limited Tort" Option -This form of insurance limits your right and the rights of members of your household to seek financial compensation for injuries caused by other drivers. Under this form of insurance, you and other household members covered under this policy may seek recovery for all medical and other out-of-pocket expenses, but not for pain and suffering or other nonmonetary damages unless the injuries suffered fall within the definition of "serious injury", as set forth in the policy or unless one of several other exceptions noted in the policy applies. 2) "Full Tort" Option -This form of insurance allows you to maintain an unrestricted right for yourself and other members of your household to seek financial compensation for injuries caused by other drivers. Under this form of insurance, you and other household members covered under this policy may seek recovery for all medical and other out of pocket expenses and may also seek financial compensation for pain and suffering or other nonmonetary damages a result of injuries caused by other drivers. If you wish to change the tort option that currently applies to your policy, you must notify your agent, broker or company and request and complete the appropriate form. Notice of Premium Discounts [f your vehicle is equipped with passive seatbelts or airbags, you are entitled to a discount of the First Party Bene- fits Coverage portion of your policy. Passive seatbelts are those which automatically fasten without any action by the driver or front seat passenger. If your vehicle is equipped with a passive anti-theft device you are entitled to a discount on your comprehensive coverage. Passive anti-theft devices are systems installed which are activated automatically when the driver turns the ignition key to the off position. This does not include an ignition interlock provided as a standard feature by the manufacturer. If all named insureds age SS or older have successfully completed a driver improvement course approved by Penn- DOT, you may be eligible for a premium credit. If you have property coverage insured with us, you may be eligible to receive a premium discount. Please contact your agent or insurance representative for information on these premium discounts. PL-12323 06-08 Page 4 of 4 IMPORTANT BILLING NOTICE This notice contains important information about our billing options and fees. You have chosen to pay your insurance premium in full by Recurring Credit Card (RCC). In the event that your payment is returned by your bank, it may result in the automatic conversion of your Recurring Credit Card (RCC) account to Bill by Mail. If your billing needs change, we offer several ways to pay your premium: Bill Plan Monthly Luny Swn Electronic Funds Transfer (EFT) $ 1.00 No Charge Recurring Credit Card (RCC) $ 1.00 No Charge Bill by Mail $ 5.00 No Charge Late Charge: $10.00 per occurrence Payments returned by your bank: $20.00 per occurrence If you have multiple policies with us you may be able to combine those policies into a single billing account. If you have selected one of our monthly billing options, and you combine your policies into a single billing account, you will be charged just one service charge per installment, and not per individual account. To add this policy to an existing billing account or if you have other questions about this notice, please call your insurance representative at 800-842-5075. P 1-14216 09-08 004037/00580 F3118D70 8879 11/04/08 r~ ~'RAVELERS~ INSURANCE.COM C\O TRAVELERS P 0 BOX 6075 GLENS FALLS NY 12801 00590 MICHAEL GILDER 711 OLD SILVER SPRING RD MECHANICSBURG PA 170552882 Thank you for trusting Travelers with your auto insurance. We're always available to assist you with questions, additional insurance needs, or claims. The enclosed, personalized policy package was created just for you. • Please review these materials for accuracy: • Your auto renewal policy • Your auto insurance identification card(s) • Other important notices November 4, 2009 Policy Number 983906881 101 1 Policy Period 12/01 /2009 - 06/01 /2010 12:01 AM STANDARD TIME AT THE RESIDENCE PREMISES Thank you for your business! QUESTIONS? CONTACT US! Policy questions or changes. 800.842.5075 24 hour claim service 1.800.CLAIM33 1.800.252.4833 Online service mytravelers.com • Identification Cards. You may need these cards as proof of insurance so keep them in a safe place in your vehicle, such as your glove box. • Claim Cards. Use the handy claim cards below if you're ever in an accident. Simply break the card in half and give the right side to the other driver. Please see reverse side for important information relating to Pennsylvania law. On behalf of INSURANCE.COM, we thank you for your continued business. Sincerely, ~ c- ~~ ~ Gregory C. Toczydlowski President Personal Insurance PL-14511 R PA 06-09 TRAVELERS Call us immediately to report your loss 800.252.4833 (800.CLAIM33) We're here to help 24 hours a day, 365 days a year Break in haR. _~ (See other side.) TRAVELERST Call us immediately to report your loss 800.252.4633 (800.CLAIM33) We're here to help 24 hours a day, 385 days a year { Break in half. (See other side.) TRAVELERS~T Call us immediately to report your loss 800.252.4633 (SOO.CLAIM33) We're here to help 24 hours a day, 385 days a year Break m half. (See other side.) _~ TRAVELERS Calt us immediately to report your loss 800.252.4633 (800.CLAIM33) We're here to help 24 hours a day, 385 days a year ~ Break in half. (See other side.) FOR YOU FOR OTHER DRNER FOR YOU 004028/00800 F3118D70 8678 11/04/06 FOR OTHER DRNER DI -17i~T7 //Y~.rJfY101 Please note the following: AUTOMOBILE INSURANCE IDENTIFICATION CARD INFORMATION • Your automobile insurance identification card indicates that your policy provides at least the minimum coverage required by Pennsylvania's Financial Responsibility law. • One ID card is enclosed for each vehicle on your policy. Keep the card in the glove compartment of your car. This card must be shown when requested by any law enforcement official. The ID card information may also be used for vehicle registration and replacing license plates. If your liability policy is not in effect, the card is no longer valid. • You are required to maintain financial responsibility on your vehicle. It is against Pennsylvania law to use the ID cans fraudulently such as using the card as proof of financial responsibility after the insurance policy is terminated. If you suspect FRAUD on any policy or claim, call the Travelers 24-hour hotline (800)-6-FRAUD-0. Help us fight fraud. • Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. Thank you for insuring with Travelers. FOR OTHER DRNER This insurance card has been provided by a Travektrs customer Please call us at 500.2s2.4633 for claim service Clam professwnals are available to take your notice of loss 24 hours a day, 385 days a year. 98390688 TMYKEiq ctwtorpt raLKV wwEw FOR YOU If you an in an auto accident 1 Snap this card in two and provide the nyht side to the other driver. 2 Get the Incense plate number of the other drnrors vehicle 3 Call Travelers immediately at 500.2s2.4s33. 0T1E1! 011NER'f LKEI~NE KATE fiArEll 9838088811011 rout, ~a.Kr ~ FOR OTHER DRNER This insurance card has been provided by a Travelers customer Please call us at 500.232.4633 for claim seance. Claim professionals are available to take your notice of loss 24 hours a day, 385 days a year. 983806881101 1 T1tAVELE1tS CUlTOMER -OIICr IrU1rER FOR YOU K you an in an auto accident 1 Snap this card in two and provide the nyht side to the other drver 2. Get the license plate number of the other drivers vehicle. 3 Call Travelers immediately at 500.2s2.4s33. OTFeII DMIER'! LICE/NE -UTE fit~lfl 983906881 101 1 rotes roucr wur>Ea '' ~i=~iX~'~n-o ~ ~ , ~ygCJ'-' C~ N C~CP - 3 p.- ~; ,.~ ~-(L ", r1. S~N$SN N :~:~ s~;t~~a lsai~ ~73121US32ld ~~ o ~ ~~~ ~ ~~~~~ ~.Z i~~ ~ a ~, ~~~~ ~~~ ~~~ 1J1 ti~ ~~.. .,.~ .,.. t*? (11 r..y ::• ra TRAVELERST INSURANCE.COM 29000 AURORA RD SOLON OH 44139 00592 May 11, 2010 Policy Number 983906881 101 1 Policy Period 06/01 /2010 - 12/01 /2010 12:01 AM STANDARD TIME AT THE RESIDENCE PREMISES MICHAEL GILDER ESTATE . 11 KINGSWOOD DR MECHANICSBURG PA 170552761 Thank you for your business! QUESTIONS? CONTACT US! Thank you for trusting Travelers with your auto policy questions or changes. . insurance. We're always available to assist you 24 hour claim service . with questions, additional insurance needs, or ' claims. The enclosed, personalized policy package was created just for you. • Please review these materials for accuracy: • Your auto change policy • Your auto insurance identification card(s) • Other important notices Online service 800.842.5015 1.SOO.CLAtM33 1.800.252.4833 mytravelers.com • Identification Cards. You may need these cards as proof of insurance so keep them in a safie place in your vehicle, such as your glove box. Please see reverse side for important information relating to Pennsylvania taw. On behalf of INSURANCE.COM, we thank you for your continued business. Sincerely, ~ ~~ c~ ~ Gregory C . Toczydlowski President Personal Insurance PL-14507C PA 06-09 oo22ezooeoz Fat t eeHJ ~~ ~ o oar i~~ o Please note the following: AUTOMOBILE INSURANCE IDENTIFICATION CARD INFORMATION • Your automobile insurance identification card indicates that your policy provides at least the minimum coverage required by Pennsylvania's Financial Responsibility law. • One ID card is enclosed for each vehicle on your policy. Keep the card in the glove compartment of your car. This card must be shown when requested by any law enforcement official. The ID card infornnation may also be used for vehicle registration and replacing license plates. If your liability policy is not in effect, the card is no longer valid. • You are required to maintain financial responsibility on your vehicle. It is against Pennsylvania law to use the ID card fraudulently such as using the card as proof of financial responsibility after the insurance policy is terminated. If you suspect FRAUD on any policy or claim, call the Travelers 24-hour hotline (800)-6-FRAUD-0. Help us fight fraud. • Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. Thank you for insuring with Travelers. PL-14507C PA 06-08 page T) TRAVELERST Automobile Policy Declarations 1. Named Insured MICHAEL GILDER ESTATE . 11 KINGSWOOD DR MECHANICSBURG PA 170552761 Your Agency's Name and Address INSURANCE.COM 29000 AURORA RD SOLON OH 44139 Your Policy Number 983906881 101 1 Your Account Number 983906881 For Policy Service Calt 1.800.842.5075 For Claim Service Call 1.800.CLAIM33 2. Premium This is change number 1, which is effective June 1, 2010. * This change causes no additional or return premium for the policy period. * The policy period is from June 1, 2010 to December 1, 2010. * Your address and your name have been changed. * These declarations replace all prior automobile policy declarations on the date on which this change is effective. 3. Your Vehicles 1. 2004 CHEVR MONTE CARL Identification Numbers 2G1 WX12K049191501 4. Coverages, Limits of Liability and Premiums Insurance is provided only where a premium is shown for the coverage. "'IF COLLISION COVERAGE IS PROVIDED UNDER THIS POLICY, COVERAGE EXTENDS TO VEHICLES WHICH YOU RENT FOR 30 DAYS UNDER A RENTAL CAR COVERAGE AGREEMENT. PLEASE REMEMBER THAT COLLISION COVERAGE DOES NOT PAY FOR LOSS OF USE. PLEASE CONTACT YOUR TRAVELERS AGENT OR REPRESENTATIVE IF YOU HAVE QUESTIONS. IF YOU DO NOT CARRY COLLISION INSURANCE, THIS POLICY DOES NOT PAY FOR DAMAGE TO RENTAL VEHICLES. VEHICLE 1 04 CHEVR MONTE CARL A. Bodily Injury $100,000 each person ............. $ 48 x300,000 each accident B. Property Damage x100,000 each accident........... $ 60 Continued on next page 670/OWG834 PL-7783 Rev. 08-07 Page 1 of 4 00226M00602 F3116CHJ 7110 06/11/10 TRAVELERSJ~ 4. Coverages, Limits of Liability and Premiums (continued) 04 CHEVR MONTE CARL D7. Uninsured Motorists (Bodily Injury) Non-Stacked $50,000 each person .............. ~ 9 x100,000 each accident See Endorsement A37043 D9. Underinsured Motorists (Bodily Injury) Non-Stacked x50,000 each person .............. ~ 19 x100,000 each accident See Endorsement A37043 E. Collision Actual Cash Value less........... a 122 X250 deductible F. Comprehensive (Other than Collision) Actual Cash Value less........... a 23 $250 deductible G. Extended Transportation Expense $50 per day/1,500 maximum....... $ 17 QB. First Party Benefits Coverage Full Tort Option ................. ~ 15 See Endorsement A37021 Subtotal for your vehicle ............... S 313 Total Premium for This Policy: 670/OWG834 ~ 313 Continued on next page PL-7783 Rev. 08-07 Page 2 of 4 TRAVELERSJ~ Named Insured MICHAEL GILDER ESTATE . Policy Number 983906881 101 1 Policy Period June 1, 2010 to December 1, 2010. Issued On Date May 11, 2010 5. Information Used to Rate Your Policy Discounts and Advantages Travelers Homeowners Customer Anti-Theft Discount 04 CHEVR MONTE CARL Passive Restraint Discount 04 CHEVR MONTE CARL Drivers DATE OF SEX MARITAL BIRTH STATUS 1. MICHAEL 08-19-56 Male Single Vehicles USE OF LOCATION VEHICLE OF VEHICLE 1. 04 CHEVR MONTE CARL Pleasure MECHANICSBURG PA It is important that the above information is correct to ensure that your policy is properly rated. If there are errors or changes to this information, please notify your Travelers representative immediately. 6. Other Information Loss Payees 04 CHEVR MONTE CARL GMAC VIN # 2G1WX12K049191501 PO BOX 5378 TIMONIUM,MD 21094 Your Insurer The Travelers Home and Marine Insurance Company 6081 East 82nd St, Indianapolis, Indiana 46250 One Tower Square, Hartford, CT 06183 670/OWG834 Continued on next page PL-7783 Rev. 08-07 Page 3 of 4 00226d/00602 F3113CHJ 7110 06/11/10 TRAVELERSY 6. Other Information (continued) Policy Endorsements A37013 Amendment of Policy Provisions - Pennsylvania A37021 First Party Benefits Coverage - Pennsylvania A37043 Uninsured/Underinsured Motorists Endorsement - Pennsylvania Policy Edition 8 Policy Form 101 Issued on 05l 11 / 10 Thank you for insuring with Travelers. We appreciate your business. If you have any questions about your insurance, please contact your Travelers representative. FOR YOUR INFORMATION Children b air bags. it's as easy as 1 1. Never put a child seat (those used with of a car with air bags. 2. Make sure all children are buckled up no Unbuckled children can be hurt or killed 3. The rear seat (those with seat belts) is of any age to ride. - 2 - 3 infants) in the front seat matter where they sit. by an air bag. the safest place for children For information about how Travelers compensates independent agents and brokers, please visit www.Travelers.com or call our toll free telephone number 1-866-904-8348. You may also request a written copy from Marketing at One Tower Square, 2GSA, Hartford, Connecticut 06183. YOU MAY PURCHASE UNINSURED ANDiOR UNDERINSURED MOTORISTS COVERAGE AT ANY AVAILABLE LIMITS FROM s15,000/s30,000 UP TO YOUR BODILY INJURY LIABILITY LIMITS. YOU MAY REJECT THESE COVERAGES ENTIRELY. 670/OWG834 PL-7783 Rev. 08-07 Page 4 of 4 F. ~owARO o~A iu /Olo 1 l,~~ 2876 NATAIi~e 8. GEIGER Pa. n~-~-~'~ ,~ ~sw+ooo o~n~ aa~~vrn~ MECMAI~MCS9UR8. PA 17'066-Z7i1 ' $ 3a?, So ~ 8~ ~~ ~~ nu »»a~e -+~uew~a , ~r.wMaw~.. r+oR ~, , ~: 2 3 i 38 i i i 6~: 28 7 6 0 ~. 501080 ? iw r 8 '~T =-5•+210 4~t•4~ >031315036< Orrstvwn Bank Shipp~nsburq, P11 17257 Phones: 717-53Z-611! Bus Dates: 05/12/2010 Branch/T~ll~r 0008/0127 05/12/2010 10:!!:53 i 3a~.so 13~1~~ ~.d9 ~d. ~,~-~~zoto ~K-~ I 0 ~ ~o T n ~ a ~. r~ ~~m ~~~~ ~ ~~~ ~~~~ V~ O T BJ'S WHOLESALE CLUB 3805 HARTZDALE DRIVE CAMP HILL, PA. 0025 005 8307 05t29tti CASH-1 11? 1 19:18:0 aaa+~s+pass#srss~rsasrarrsssrrrsraaaa~rs~ sia MEM8ER9NIP I0. OTS~01?6116 **+ sa• MEM8ER5HIP E><PIpE5 OM OZJ11 •*a ar~arsras*~r+~as~rrsrss+r~r~rrs~rsrss*+~~raar+~a i 68756856195 DEHUMIDIFIER 129.99 ITEM TOTAL 1 SUBTOTAL 129.99 PA STATE TAX 6x 7.80 TOTAL l3?.79 « ELEC SIGNATURE CAPTURED 8307 1 » VISA CRRO X37.79 XXXXXXXXXXXX8061 RUTH 097388 THRNIt YOU FAR 5HOPPING AT BJ'S i~u~l~l~l~!!!uu The Me~bership That Pays You Back Upgrade to a BJ's Regards he*bership and earn 2x Payback an post in-Club and all BJs.co~ purchases r, Details at the Meatier Services Desk ~ or visit BJs.co~/rewards I ~~:. ~~ ~a*aa Shop BJs.co~ For savinss an 'ands of other great products! n ~t' piss out an e~ails with sperla offers: sign uP at BJs.coa. I~~ I JOSEPIi DAMES JEWELERS 3O1 E. MAIN STREET MECNANicsbuac,, PA 170SS 717.795.9224 Sold To: s0~001-01699 EDWARD and NATALIE GEIGER 11 KINGSWOOD DRIVE MECHANICSBURG, PA 17055 USA 720-1371 RECEIPT #001-23949 I~IIII~t~1Nt~11 6/7/2010 3:55 PM Joseph James Jewelers (717) 795-9224 You were assisted by Jamie Davis (~1) Ellen Augusterfer (~6) Appraise Appraise: 56738 -Written document X40.00 reflecting values of GTS Omega and Concord watches for estate purposes SubTotal... x40.00 Pennsylvania Sates Tax... 52.40 Total... 542.40 Charged to Visa Card #9873 Auth ;015541... 642.40 x Please Sign Store CoQY~ _ __ _ _ ___ NATALIE S GEIGER EXEC I agree to pay the above amount according to the card issuer agreement. M Thank you for shopping Joseph James Jewelers C~ Phon• (717) 5545897 CAPITAL AREA CARPET CLEANERS P.O. Baoc 255 Mechanicsbut~ PA 17055 M~chsnicsburE (717) 766-3242 East B~Iin (717) 637.7400 CUSTOMER'S ORDER NO. I PHONE I DATE ~ ~ ~ / (r 1 ~ NAME ~ !.~ ~~~r ADDRESS ~[ l o(~ S~, lK.~-~~ iZ~ INl.a.1.~ l'7' S3 SOLD BY Z CASH C.O.D. CHARGE ON ACCT. MDSE. RETD. ~ PAID OUT .. ~ '7. ~;,, l ~ ~v Cti~ l3 s ~- / 1 ~. -~t~ C~~b1- 1 l r' ,~.~~ ~ - M TAX RECEIVED BY s30 FEE FOR RETURNED CHECKS D waoucr e~or All CtaN1q anA nhlm~d pooa mwt be accompanied TOTAL ~ ~ ~ ~ ~ by thls biH. 16378 ~.• ~.-r~- ~~~ THANK YOU • Cry' It D II ~~ ~ ~ ~ 1 M •, ti PJ FLOOR/NB ~ - aces ~ ~ . i~:r ~~~ - ~, K Pjer Grbavac ~ i ~ i t. . 1. ' 4, fir' ~! ` ~ ~ 'y' .'M ~ •i "' ~ ~ ~ Floor Covering _ -~ • Carpet • Vinyl • Tile • Pergo ~~ Free Estimates ._ 717-576-4907 or 717-737-5297 N- =... ~i/ ^ v wow. c,.. neon..-, Style/Color: TORRENT -WARM SAND Product Sku: 372-ass Fiber: 100% Nylon To rc-order this sample ple:.se use sku 626-003. ~ 4 v . _r__. Please visit www.homedepot.com to view all your flooring options. __ _ D~ loe mrr lark r w ~_ ; I ~. ~ , f _..._ ~ • , ~, -{ .. n ~ ~~ t "V S / ~~ ~ O• ~ . f a g® 5"8'a k, t r 1 ; n~ ~ ~ t. N • fir, b ~ ~ ~ ; ~, -, _. ; ~ f -- = 4, ~ ~ , ~ i • ~, 4 1 'r ' .~ ~ ' } ~ Axr y~ed Yet~q ~, of ~._ ~ M i ..,~.,-........~.~.....r......,,..~,..~..~ ,.~,,. _ . 3 • I C Oh~'E .+ DETACH AND RETURN UPPER PORTION WITH PAYMENT EST' tifAl{A~ C!~#/4RLi~S REEEtPTS I3i4LA>~tC$ ~ 03!23/09 ETOPOSIDE, 10 MG 460.00 21 .87 J9i81 162.8 03/22 t0 GENERAL WRITE-OFF 18.25 04/1 6.10 CHECK PAYMENT FROM PATIENT 100.00 04/16;10 GENERAL WRITE-OFF 100.00 05/2810 GENERAL WRITE-OFF 121.88 05/28/10 CHECK PAYMENT FROM PATIENT 100.00 03%23!09 PIATINOI tOMG 880.00 330.00 J9080 182.8 05/28/10 GENERAL WRITE-OFF 330.00 03/23/09 INITIAL CHEMO INFUSN UPTO tHR 225.00 t 12.50 9841 8 1 ~~~ ~~`~ ~~ / ~~ 05/28!10 GENERAl WR E-OFF / t 12.50 03/23/09 CHEMO INFUS EACH ADDL 1-8 HRS ~ , ~p ~~~~ 111 li 80.00 30.00 05/28;10 98415 182.8 GENERAL WRITE-OFF w1 1_ ~1(,~7~ `S U t `I ~ ~+ ~ 30.00 03/23/09 CHEMO INFUS SEQUEN UPTO 1HR 93.00 48.50 98417 182.8 ~O ~ ~ 1 05!28/10 GENERAL WRITE-OFF r ~ ~ (~ J 48.50 03/23/09 ALOXI 25 MCG ~ ~ ~~~~~~ l• ~ 450.00 226.00 J2489 182.8 ~ 05/28/10 GENERAL WRITE-OFF ~ 225.00 i 03!23!09 DEXAMETHASONE 1MG ~'^y~~ ~ ~~-` 25.00 12.50 J 1 100 18 2.8 l' "`'" I r l~ y 05/28/10 GENERAL WRITE-OFF ~~ ~;1~1 /„n~ UCH y 12.50 * * * *CO-PAY DUE AT TIME OF VISIT* * *BAL.ANCE DUE UPON RECE~pT* * * • EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # (717) 558-7350 EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG, PA 17111 PHONE: (717) 558-7350 MICHAEL GILDER ESTATE 1 1 KINGSWOOD DRIVE MECHANICSBURG PA 17055-2761 . L' ~ 7 -~~ ~~ ~ l~ ;~ ~ ~ . Q'0 2 ACCOUNT NUMBER: 59079 BILLING DATE: 06/01 /10 DATE OF LAST PYMT: 05/28/ 10 p AMOUNT NOW DUE: 6266.35 AMOUNT ENCLOSED: CHARtiE AMOUNT DUE TO MY: MASTERCARO _ VISA _ EXP GATE CHARQE ACCT t: PRINT NAME: SIGNATURE: DETACH ANO RETURN UPPER PORTION WITH PAYMENT 03/23/09 MANNITOL 2596/50ML 10.00 5.00 12150 182.8 05/28/10 GENERAL WRITE-OFF 5.00 03/23/09 IV INFUSION SEO UP TO 1 HR 50.00 25.00 98387 182.8 05/28/10 GENERAL WRITE-OFF 25.00 03/23/09 IV INFUSION CONC UP TO 1HR ~ 32.00 18.00 98388 182.8 05/28/10 GENERAL WRITE-OFF 18.00 03/23/09 IV HYDRATION EACH ADDTI HR 84.00 32.00 98381 182.8 05/28/10 GENERAL WRITE-OFF 32.00 03/23/09 NOR.SAL-STERL 5000C 30.00 15.00 17040 182.8 05/28/10 GENERAL WRITE-OFF 15.00 03/24/09 OV EST PT W/O MD 30.00 16.00 9921 1 182.8 05/28110 GENERAL WRITE-OFF 15.00 03/24/09 ETOPOSIDE, 10 MG 480.00 230.00 19181 182.8 05/28/10 GENERAL WRITE-OFF 230.00 03/24/09 INITIAL CHEMO INFUSN UPTO 1HR 22 5.00 112.50 98413 182.8 05/28/10 GENERAL WRITE-OFF 112.60 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* cctx ~>G~aa t~Y~ aa9v aRr~a ~t~,~~c an~ru pv~ tx~ onacs. Tarim ; c~ rr~MS ~, <, .. ,: . .. : _ : ~ 4~: : ~s ~I: EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # (717) 558-7350 EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG PA 17111 PHONE: (717) 558-7350 3 ACCOUNT NUMBER: 59079 BILLING DATE: 06/01 /10 DATE OF LAST PYMT: 05/28/10 AMOUNT NOW DUE: 6266.35 AMOUNT ENCLOSED: MICHAEL GILDER ESTATE 1 1 K I N G S W 00 D DRIVE CHARGE AMOUNT DUE TO MY: MASTERCARD _ VISA _ EXP PATE / CHARGE ACCT ~: MECHANICSBURG PA 17055-2761 PRINT NAME: SIGNATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT »~~ t~,~~rr NA~~ R Rle~ar~s e~~... ~- 03/24/09 KYTRIL 100MCG 254.00 127.00 Jt828 182.8 05l28~70 GENERAL WRITE-OFF 127.00 03/24/09 IV INFUSION SEQ UP TO 1 HR 50.00 25.00 98387 182.8 05/28/10 GENERAL WRITE-OFF 25.00 03/28/09 OV EST PT W/O MD 30.00 15.00 99211 182.8 05!28/10 GENERAL WRITE-OFF 15.00 03/28/09 ETOPOSIDE, 10 MG 480.00 230.00 J9181 182.8 05/28/10 GENERAL WRITE-OFF 230.00 03/28/09 INITIAL CHEMO INFUSN UPTO 1 HR 225.00 1 12.50 98413 182.8 05/28/10 GENERAL WRITE-OFF 112.50 03/28/09 KYTRIL t OOMCG 254.00 127.00 J 1828 182.8 05/28/10 GENERAL WRITE-OFF 127.00 03/28!09 IV INFUSION SEn UP TO 1 HR 50.00 25.00 98387 182.8 05!28/10 GENERAL WRITE-OFF 25.00 04/13/09 OV EST PT W!O MD 30.00 15.00 9921 1 182.8 05/28/10 GENERAL WRITE-OFF 15.00 ' * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* * * * Ctti~ • ; 3t~atl't~Yll;. '` 51-~10!pAY~, '. Rt•1iCR'paY~ gVR1~ 1.'~~IAYi _1C0?itt: i:~ff:k'I'~i:; '~ ~` ~~CCQW!1~` eA#,Mlti~. ~ii3#~A[!~CB , h1t~VK'17#~E' EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # (717) 558-7350 EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG, PA 17111 PHONE: (717) 558-7350 MICHAEL GILDER ESTATE 1 1 KINGSWOOD DRIVE MECHANICSBURG PA 17055-2761 4 ACCOUNT NUMBER: 59079 BILLING DATE: 06/01 /10 DATE OF LAST PYMT: 05/28/10 AMOUNT NOW DUE: 6266.35 AMOUNT ENCLOSED: CHARGE AMOUNT DUE TO M1/: MASTERCARD _ VI8A _ EXP DATE / CHARGE ACCT •: PRINT NAME: 81GNATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT OJt; ... . E .: Oaf : , RfO~ BAkA$;~ ~$: 04/13/09 VENIPUNCTURE 10.00 5.00 38415 182.8 05/28/10 GENERAL WRITE-OFF 5.00 04/13/09 CBC 13.75 8.87 85025 182.8 05/28/10 GENERAL WRITE-OFF 8.88 04/20/09 OV EST PT EXP FOCUS 70.00 35.00 99213 182.8 05/28/10 GENERAL WRITE-OFF 35.00 04/20/09 VENIPUNCTURE 10.00 5.00 38415 181.8 05/28110 GENERAL WRITE-OFF 5.00 04/20/09 CBC t 3.75 8.87 85025 182.8 05/28/10 GENERAL WRITE-OFF 8.88 04/20/09 ETOPOSIOE, 10 MG 480.00 230.00 J9181 182.8 05/28/10 GENERAL WRITE-OFF 230.OC 04/20/09 PLATINOL t OMG 880.00 330.00 J9080 182.8 05/28/10 GENERAL WRITE-OFF 330.00 04/20/09 INITIAL CHEMO INFUSN UPTO 1HR 225.00 112.50 98413 182.8 05/28/10 GENERAL WRITE-OFF 112,50 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* * * * ~f J?~8rDA1~~ „ 81+80 PAYS ` , 9T=t A4 f7AY~ C~V~a~Q QJ~1': , 1'tiT~k J~C~7W~k7>aAi+iR~Yt7l. E~&6 #T~ Q aNitl#IAI!1C6 MONI' 088' EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # 1717) 558-7350 5 EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG, PA 17111 PHONE: (717) 558-7350 MICHAEL GILDER ESTATE 1 1 KINGSWOOD DRIVE MECHANICSBURG PA 17055-2761 ACCOUNT NUMBER: 59079 BILLING DATE: 06/01 /10 DATE OF LAST PYMT: 05/28/10 AMOUNT NOW DUE: 6266.35 AMOUNT ENCLOSED: CHARGE AMOUPiT DUE TO MY: MA8TERCARD ~- VISA , E7tP GATE / _ CHARGE ACCT •: _ ~ _ _ ~ _ ,_ _ _, _ _. _ -_ _ vf11NT N4YE SIt3NATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT Jt'F~ ,, I~~T I~Ac~L } - .. .. #~Rt~ RIeOdPT~ St14: . . ;: , G€Lt~EI~ ES'I'~4T~ MECt~A~... , . 04!20/09 CHEMO INFUS EACH ADDI 1.8 HRS 80.00 30.00 98415 182.8 05/28/10 GENERAL WRITE-OFF 30.00 04/20/09 CHEMO INFUS SEOUEN UPTO 1HR 93.00 48.50 98417 182.8 05/28/10 GENERAL WRITE-OFF 48.50 04/20/09 ALOXI 25 MCG 450.00 225.00 J2489 182.8 05!28!10 GENERAL WRITE-OFF 225.00 04120/09 DEXAMETHASONE 1 MG 25.00 12.50 J1100 182.8 05/28/10 GENERAL WRITE-OFF 12.50 04/20/09 MANNITOL 2596/50ML 10.00 5.00 J2150 182.8 05/28/10 GENERAL WRITE-OFF 5.00 04!20!09 IV INFUSION SEQ UP TO / NR 50.00 25.00 98387 182.8 05!28110 GENERAL. WRITE-OFF 25.00 04!20109 IV INFUSION CONC UP TO 1 HR 32.00 18.00 98388 182.8 05/28/10 GENERAL WRITE-OFF 18.00 04/20!09 INITIAL IV HYDRATION UP TO 1H 115.00 57.50 98380 182.8 05/28/10 GENERAL WRITE-OFF 57.50 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE ~ (717) 558-7350 EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG, PA 17111 PHONE: (717) 558-7350 MICHAEL GILDER ESTATE 6 ACCOUNT NUMBER: 59079 BILLING DATE: 06/01 /10 DATE OF LAST PYMT: 05/28/10 AMOUNT NOW DUE: 6266.35 AMOUNT ENCLOSED: 1 1 K INGSWOOD DRIVE CHARGE AMOUNT DUE TO MY: MASTERCARO _ VISA ` ExP DATE / CHARGE ACCT I: MECHANICSBURG PA 17055-2761 - - - - - - - -- ~--- - - - - PRINT NAME: SI~iNATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT Qht'~'E PlRTI~tT tif0~M£ q~RQ~$ REI~dM!7S B~UtB ;`- ~5.. 04/20/09 IV HYDRATION EACH ADOTL HR 32.00 18.00 98381 t 82.8 05/28/10 GENERAL WRITE-OFF 18.00 04/20/09 NOR.SAI-STERL 500CC 30.00 15.00 J7040 182.8 05/28/10 GENERAL WRITE-OFF 15.00 04/21 /09 OV EST PT W!0 MD 30.00 15.00 99211 182.8 05/28/10 GENERAL WRITE-OFF 15.00 04/21 /09 ETOPOSIDE, 10 MG 480.00 230.00 J9181 182.8 05/28/10 GENERAL WRITE-OFF 230.00 04/21 /09 INITIAL CHEMO INFUSN UPTO 1 HR 225.00 1 12.50 98413 182.8 05/28/10 GENERAL WRITE-OFF 112 50 04/21 /09 KYTRIL 100MCG 254.00 127.00 J1828 182.8 05/28/10 GENERAL WRITE-OFF 127,00 04/21 /09 IV INFUSION SEO UP TO 1 HR 50.00 25.00 98387 182.8 05/28!10 GENERAL WRITE-OFF 25.00 04/23/09 OV EST PT W/O MD 30.00 15.00 99211 182.8 05/2810 GENERAL WRITE-OFF 15.00 i * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* * ~1f'. 31~•df~' R~4Y~ , 61 ~>~O ttltV'a :: 91:;.1: t'~41r~ 4V~ 1 ~8 #7RY~ YOT~ C~R& k'~M~ ~lI~1Q' . G~FT:;aA~.AIlyli~" ,, t1~#AIrC~" ; N01+K 8!##8~ EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # (717) 558-7350 EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG, PA 17111 PHONE: (717) 558-7350 MICHAEL GILDER ESTATE ACCOUNT NUMBER: BILLING DATE: DATE OF LAST PYMT: AMOUNT NOW DUE: AMOUNT ENCLOSED: 7 59079 06/01 / 10 05/28/10 6266.35 1 1 K INGSWOOD DRIVE CHARGE AMOUNT DUE TO MY: MASTERCARD __ VISA _ ExP GATE CHARGE ACCT is MECHANICSBURG PA 17055-2761 - - - - - - - -- ---- - - - - PRINT NAME: SIGNATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT I~A~ .: > ,.; p`A'~~#'1' t1fhM~ ~ OI RE~EEfM1T~ ~L~~ EIS. I~E~#~A.E~ ,~IE.l~~l~ ES~~4T~ 04/23/09 ETOPOSIDE, 10 MG 480.00 230.00 J9181 182.8 05!28/10 GENERAL WRITE-OFF 230.00 04/23/09 INITIAL CHEMO INfUSN UPTO 1 MR 225.00 112.50 984 t 3 182.8 05/28/10 GENERAL WRITE-OFF 112.50 04/23/09 KVTRIL 100MCG 254.00 127.00 Ji828 182.8 05/28/10 GENERAL WRITE-OFF 127.00 04!23/09 IV INFUSION SEO UP TO 1 MR 50.00 25.00 98387 182.8 05/28/10 GENERAL WRITE-OFF 25.00 05/1 1 /09 VENIPUNCTURE 10.00 5.00 38415 182.8 05/28/10 GENERAL WRITE-OFF 5.00 05/1 1 /09 C8C 13.75 8.87 85025 182.8 05!28/10 GENERAL WRITE-OFF 8.88 05/19/09 OV EST PT EXP FOCUS 70.00 35.00 99213 182.8 05/28/10 GENERAL WRITE-OFF 35.00 05!19/09 VENIPUNCTURE 10.00 5,00 38415 182.8 05/28/10 GENERAL WRITE-OFF 5.00 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* * * ~i.;AO tin~Y~ R1~•~! ~AtY~ 9:1:-1Atii tkAY~. q~t~ 1~#~N1'1'8 '' YflT,iit,, l~!tT~Mi~R1p!!0 Idkif~illt'I`:. `: ;;.. ACC~W~FT ~A~+AIMR~ ~itill:A[!CR >. ~~~< EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # (717) 558-7350 EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG, PA 17111 PHONE: (717) 558-7350 MICHAEL GILDER ESTATE 1 1 KINGSWOOD DRIVE MECHANICSBURG PA 17055-2761 8 ACCOUNT NUMBER: 59079 BILLING DATE: 06/01 / 10 DATE OF LAST PYMT: 05/28/10 AMOUNT NOW DUE: 6266.35 AMOUNT ENCLOSED: CHARGE AMOUNT DUE TO M~: MASTERCARD _ VISA _ EXP DATE CHARGE ACCT !: PRINT NAME: SIGNATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT QItTE: PA7T` NAME. . ,..-_......__~ Rti£$ REOpPT~::: 8l4LAN~ ~+ • I:CMA ~ G~~.D~~fi ~B'1'1~T~ 05/1 9/09 CBC 1 3.75 8.87 85025 182.8 05/28/10 GENERAL WRITE-OFF 8.88 05/19/09 ETOPOSIDE, 10 MG 480.00 230.00 J9181 182.8 05/28/10 GENERAL WRITE-OFF 230.00 05/19/09 PLATINOL 10MG 880.00 330.00 J9080 182.8 05/28/10 GENERAL WRITE-OFF 330.00 05/19/09 INITIAL CHEMO INFUSN UPTO 1HR 225.00 112.80 98413 182.8 05/28/10 GENERAL WRITE-OFF 112.50 05/19/09 CHEMO INFUS EACH ADDL 1.8 HRS 80.00 30.00 98415 182.8 05/28/10 _, GENERAL WRITE-OFF 30.00 05/19/09 CHEMO INFUS SEOUEN UPTO 1HR 93.00 48.50 98417 182.8 05/28/10 GENERAL WRITE-OFF 48.50 05/1 9/09 ALOXI 25 MCG 450.00 225.00 J2489 182.8 05/28/10 GENERAL WRITE-OFF 225.00 05/19/09 OEXAMETHASONE 1 MG 25.00 12,80 J1100 182.8 05/28/10 GENERAL WRITE-OFF 12.50 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* cc~+F~ ~~:~sdr:axY~ . ~t't sp d~Ma~t e1-a ~o~ aw~~rs~ Qv~ ~~o ~e~xs ~~n~: ~r~ ~s a . • INi4~FAtrCG I!!~q!U i~` ! ~~~~~~ : 3 . EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX IDS 23-2937659 PHONE ~ (717) 558-7350 EAST SHORE ONCOLOGY T50 EAST PARK DRIVE SECOND FLOOR HARRISBURG, PA 17111 PHONE: (717) 558-7350 MICHAEL GILDER ESTATE 1 1 KINGSWOOD DRIVE MECHANICSBURG PA 17055-2761 9 ACCOUNT NUMBER: 59079 BILLING DATE: 06/01 /10 DATE OF LAST PYMT: 05/28/10 AMOUNT NOW DUE: 6266.35 AMOUNT ENCLOSED: CHARGE AMOUNT DUE TO MY: MASTERCARO _ VISA _ EXP DATE I CHARQE ACCT I: PRINT NAME: SIGNATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT L?ATB ; PA?SET ilfkMl - ; CF#ARt~$ > fiE~EtP~S 6r4lhNOL , : iNB. I~I:CHAh~. 4ILl~EI~ EST1~~`~ 05/19/09 MANNITOL 25%/50M1 10.00 5.00 J2150 182.8 05/28/10 GENERAL WRITE-0FF 5.00 05/19/09 IV INFUSION SEO UP TO 1 HR 50.00 25.00 98387 182.8 05/28/10 GENERAL WRITE OFF 25.00 05/19/09 IV INFUSION CONC UP TO 1 HR 32.00 18.00 98388 182.8 08/28/10 GENERAL WRITE-OFF 18.00 05/19/09 IV HYDRATION EACH ADDTL HR 84.00 32,00 98381 182.8 05/28/10 GENERAL WRITE-OFF 32.00 05/19/09 NOR.SAL•STERL 5000C 30.00 15.00 Joao 182.a 06/28/10 GENERAL WRITE-OFF 15.00 05/20/09 OV EST PT W/O MD 30.00 15.00 99211 182.8 05!28/10 GENERAL WRITE-OFF 15.00 05/20/09 ETOPOSIDE, 10 MG 480.00 230.00 J9181 182.8 05/28/10 GENERAL WRITE-OFF 230.00 05/20/09 INITIAL CHEMO INFUSN UPTO 1 HR 225.00 1 12.50 98413 182.8 05/28/10 GENERAL WRITE-OFF 112.50 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* * * ~r . ~i-ego rxaYS~. a~~•9o c~i~rs:. ~~ •~ ~o aAY~I c~~l ,!~a ~ucxs Tvr,~:. ` u~ ~T~s o :I~ . I#ii EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # (717) 558-7350 EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG PA 17111 PHONE: (717) 558-7350 MICHAEL GILDER ESTATE 1 1 KINGSWOOD DRIVE MECHANICSBURG PA 17055-2761 10 ACCOUNT NUMBER: 59079 BILLING DATE: 06/01 /10 DATE OF LAST PYMT: 05/28/10 AMOUNT NOW DUE: 6266.35 AMOUNT ENCLOSED: CHARGE AMOUNT OUE TO MY: MASTERCARD _ VISA _ EXP DATE / CHANGE ACCT S: PRINT NAME: SI<iNATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT >i~~'I<'~kY l~ti~fll8. #~#. NEI~gR~B. @A~E: MfS: ~CI~1~~: ~IE~ ~~T~kT~ ; ... . 05/20/09 KYTRII t00MCG 254.00 127.00 J1828 182.8 05/28/10 GENERAL WRITE-OFF 127.00 05/20/09 IV INFUSION SEO UP TO 1 HR 50.00 25,00 98387 182.8 05/28/10 GENERAL WRITE-OFF 25.00 05/21!09 ETOPOSIDE, 10 MG 480.00 230.00 J9181 182.8 05l28i10 GENERAL WRITE-OFF 230.00 05/21 /09 INITIAL CHEMO INFUSN UPTO t HR 225.00 1 12.50 98413 182.8 05/28/10 GENERAL WRITE-OFF 112.50 05/21/09 KYTRIL t00MCG 254.00 127,00 J1828 182.8 05/28!10 GENERAL WRITE-OFF 127.00 05/21 /09 IV INFUSION SEO UP TO 1 HR 50.00 25.00 98307 182.8 05/28/10 GENERAL WRITE-OFF 25.00 08/09/09 OV EST PT EXP FOCUS INSURANCE COPAY 70.00 5.00 99213 182.8 07/20/09 CHECK PAYMENT FROM INS MCARE 25.00 07/20/09 3 RIVERS HLTH MA ADJ 35.00 05/28/10 GENERAL WRITE-OFF 5.00 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* I Lai!lltll~- 1l~~~a7A1r~' . , i1-lQ DAM#. Rt •1 ~Q ftXYR ~1VQ!`1.ZQ AI[Yi Tti'~Xl. ~ #T~INi !R : /# EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # 1717) 558-7350 EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG PA 17111 PHONE: (717) 558-7350 MICHAEL GILDER ESTATE 1 1 KINGSWOOD DRIVE MECHANICSBURG PA 17055-2761 11 ACCOUNT NUMBER: 59079 BILLING DATE: 06/01 /10 DATE OF LAST PYMT: 05/28/10 AMOUNT NOW DUE: 6266.35 AMOUNT ENCLOSED: CHARGE AMOUNT DUE TO MY: MASTERCARD _ VISA _ EXP DATE / CHARGE ACCT t: PRINT NAME: SIdNATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT ~A~'TE PST 11fA::AiI~ tRL3~$' ' R~~~I~*~- 8i4LAa11G~. ~~~~f E~~~~E~ ~'1'AT~ 08/23/09 AIOXI 25 MCG 450.00 .00 • J2489 182.8 05/20/10 AGING ADJ 120+ DAYS 450.00 08/23/09 NOR.SAL-STERl5000C 30.00 .00 J7040 182.8 05/20/10 3 RIVERS HLTH MA ADJ 30.00 07/28/09 VENIPUNCTURE 10.00 .00 38415 182.8 05/20/10 3 RIVERS HLTH MA ADJ 10.00 07/28/09 C8C 13.75 .00 85025 182.8 05/20/10 3 RIVERS HLTH MA ADJ 13.75 07!28/09 INITIAL CHEMO INFUSN UPTO 1HR 225.00 .00 98413 , 82.8 05/20/10 3 RIVERS HLTH MA ADJ 225.00 07/28/09 IV INFUSION SEO UP TO 1 HR 50.00 .00 98387 182.8 05/20/10 3 RIVERS HLTH MA ADJ 50.00 07/28/09 IV INFUSION CONC UP TO 1 HR 32.00 .00 • 9838e 1e2.e 05/20/10 3 RIVERS HLTH MA ADJ 32.00 07/28/09 INITIAL IV HYDRATION UP TO 1 H 115.00 .00 98380 182.8 05/20/10 3 RIVERS HLTH MA ADJ 115.00 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* * ~T 3~~A4 [iAYs~. . , i9.90'DA~fa} ~~-1i[!! tTi41t~ ' q:Y!!~ 1.'C@l~14Yi: .. „ . TO!'J~kt, :. . J~%~~#Ii~l" a!4~J4M~iR t~Mi ~ ` ;, :ONCE:.. : ,~ N~~. ~ EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # X717) 558-7350 EAST SHORE ONCOLOGY T50 EAST PARK DRIVE SECOND FLOOR HARRISBURG, PA 17111 PHONE: (717) 558-7350 MICHAEL GILDER ESTATE 1 1 KINGSWOOD DRIVE MECHANICSBURG PA 17055-2761 12 ACCOUNT NUMBER: 59079 BILLING DATE: 06/01 /10 DATE OF LAST PYMT: 05/28/10 AMOUNT NOW DUE: 6266.35 AMOUNT ENCLOSED: CHARGE AMOUNT DUE TO MY: MASTERCARD _ V18A _ EXP DATE ~ CHARGE ACCT t: PRINT NAME: SIGNATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT QJ~'['E ;, I~~RT'' lSf/tNf>ff :: qR~ : ~NT~. >4h~1~E. lS~ECHA~:, ~~LI~EB' ~S:'i`1~4"~'E. ' , : .. 07/28/09 IV HYDRATION EACH ADDTL HR 32.00 ,00 98381 182.8 05/20/10 3 RIVERS HLTH MA ADJ 32.00 07/28/09 ETOPOSIDE, 10 MG 280.00 .00 J9181 782.8 08/31 i09 CHECK PAYMENT FROM INS MCARE .45 08/31 X09 3 RIVERS HLTH MA ADJ 227.83 05/20/10 3 RIVERS MLTM MA ADJ 31 .92 07/28/09 PLATINOL 10MG 880.00 .00 • J9080 182.8 08/31 /09 CHECK PAYMENT FROM INS MCARE 2,32 08/31 /09 3 RIVERS HLTH MA ADJ 830.87 05/20/10 3 RIVERS HLTH MA ADJ 47,01 07/28/09 ALOXI 25 MCG 450.00 .00 J2489 182.8 08/31/09 CHECK PAYMENT FROM INS MCARE 178.30 05/20/10 3 RIVERS HLTH MA ADJ 273.70 07/28/09 DEXAMETHASONE 1 MG 25.00 .00 J1100 182.8 08/31 /09 CHECK PAYMENT FROM INS MCARE 1.80 08/31/09 3 RIVERS HITH MA AOJ 18.80 05/20110 3 RIVERS HLTH MA AOJ 4.40 07/29/08 ETOPOSIDE, 10 MG 480.00 .00 J9181 182.8 08/31 X09 CHECK PAYMENT FROM INS MCARE .90 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* a1tF' ~t~Al=#J4Y~ : iF4~~f0 C~i4~fa!' :: I~t~t~[t1 pAYSR ~ i'~N~ 1.44l1IKKl~ '~tIT/kt, ~ ,tom ~T~Mi.. ,_ ., ~ l ,.., ~cc>QU~r~ v>~vclE. ,,.: . a~~u+ca Mt~1lK ~: EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # 1717) 558-7350 EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG PA 17111 PHONE: (717) 558-7350 ACCOUNT NUMBER: BILLING DATE: DATE OF LAST PYMT: AMOUNT NOW DUE: AMOUNT ENCLOSED: 13 59079 06/01 / 10 05/28/10 6266.35 MICHAEL GILDER ESTATE 1 1 K I NGSWOOD DRIVE CHARGE AMOUNT DUE TO MY: MASTERCARD _ V18A _ txP DATE / CHARGE ACCT •: _ _ _ _ _ _ _ _ _ _ _ MECHANICSBURG PA 17055-2761 - - - _ - PMNT NAME: Sit3NATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT ~LtTE: ' PATI~ItT liflllfif~ C~#I4Rq~S> RIE:~pPT~ BAUt1~: ~S. . EC~iAEL. GII»I3ER EB"Tl~'~>~ .. 08/31 !09 3 RIVERS HLTH MA ADJ 402.73 05/20/10 3 RIVERS HLTH MA ADJ 58.37 07/29/09 INITIAL CHEMO INFUSN UPTO 1 HR 225.00 .00 98413 182.8 06/20/10 3 RIVERS HLTH MA ADJ 225.00 07/29/09 KVTRIL t00MCG 254.00 .00 J1820 182.8 05/20/10 3 RIVERS HLTH MA ADJ 254.00 07/29/09 IV INFUSION SEO UP TO 1 HR 50.00 .00 98387 182.8 05/20/10 3 RIVERS HLTH MA ADJ 50.00 07/30/09 THERAPEUTIC INJ S0/IM 25.00 .00 98372 182.8 05/20/10 3 RIVERS HLTH MA ADJ 25.00 07/30/09 INITIAL CHEMO INFUSN UPTO 1 HR 225.00 .00 98413 182.8 05/20/10 3 RIVERS HLTH MA ADJ 225.00 07/30/09 iV INFUSION SEO UP TO 1 HR 50.00 .00 • 98387 182.8 05/20/10 3 RIVERS HLTH MA ADJ 50.00 07/30/09 ETOPOSIDE, 10 MG 480.00 .00 • J9181 182.8 08/31/09 CHECK PAYMENT FROM INS MCARE 10.35 08/31 /09 3 RIVERS HLTH MA ADJ 402.73 05/20/10 3 RIVERS HLTH MA ADJ 48.92 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* * 1~" 31 X42 pAYi. i'1 ~90 D~kV'8~ st , i ~ WIYi. gv~lt 1 xQ: ~K~i TOTAL; _ is~t-aT~IMi iQlpMrQ , ~4` ;: AST R~-~,14~N3E ,. tI~C~, ~~'I» EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # (717) 558-7350 EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG PA 17111 PHONE: (717) 558-7350 MICHAEL GILDER ESTATE 1 1 KINGSWOOD DRIVE MECHANICSBURG PA 17055-2761 ACCOUNT NUMBER: BILLING DATE: DATE OF LAST PYMT: AMOUNT NOW DUE: AMOUNT ENCLOSED: 14 59079 as/o1/10 05/28/10 6266.35 CHARGE AMOUNT OUE TO MY: MA8TERCARO _ VISA _ EXP DATE I _ CHARGE ACCT 1: _ _ _ _ - _ _ - - PRINT NAME: SIGNATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT QhfiE :. _ ; : PAT'f' t~k;Mg . ' ; C~Rt3~ REI~E~I~$:: sAll~ fly: I~ECI~Ah~:..: ~~E.DE~t:~~:'~~T~ 07/30/09 KYTRIL t OOMCG 254.00 .00 J1828 182.8 08/31 /09 CHECK PAYMENT FROM INS MCARE 23.40 05/20/10 3 RIVERS HLTH MA ADJ 230.80 08/18/09 OV EST PT EXP FOCUS INSURANCE COPAY 70.00 5.00 99213 182.8 09/21 i09 CHECK PAYMENT FROM INS MCARE 25.00 09/21 /09 3 RIVERS HLTH MA AOJ 35.00 05/28/10 GENERAL WRITE-OFF 5.00 08/31!08 OV EST PT EXP FOCUS INSURANCE COPAY 70.00 5.00 99213 182.8 09/28/09 CHECK PAYMENT FROM INS MCARE 25.00 09/28/09 3 RIVERS HLTH MA ADJ 35.00 05!28/10 GENERAL WRITE-OFF 5.00 10/09/09 OV EST PT MOD CMPLX INSURANCE COPAY 95.00 5.00 99214 182.8 11/10/09 CHECK PAYMENT FROM INS MCARE 44.42 1 1 /10/09 3 RIVERS HLTH MA ADJ 40.58 05/28/10 GENERAL WRITE-OFF 5.00 10/30/09 OV EST PT W/0 MD 30.00 .00 99211 182.8 05/20/10 3 RIVERS HLTH MA ADJ 30.00 10/30/09 VENIPUNCTURE 10.00 .00 38415 182.8 05/20/10 3 RIVERS HLTH MA ADJ 10.00 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* ~~: ~ a~~6o ~rs~> ~c~r~>s-o uRr~s ~~~»o r~~r~l:. c~+r~ ~~ t~ax~l Yos~.: uE~ s.sEr~s A .... ~ ...: ~:call~~ e~ +~t~MCS EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE ~ (717) 558-7350 15 EAST SHORE ONCOLOGY 59079 750 EAST PARK DRIVE ACCOUNT NUMBER. SECOND FLOOR HARRISBURG PA 17111 BILLING DATE: 06/01 /10 PHONE: (717) 558-7350 05!28/10 DATE OF LAST PYMT: AMOUNT NOW DUE: 6266.35 AMOUNT ENCLOSED: MICHAEL GILDER ESTATE 1 1 K INGSWOOD DRIVE CHARGE AMOUNT DUE TO M11: MASTERCARD _ VISA _ EXP DATE / .. CHARGE ACCT f: _ _ _ _ MECHANICSBURG PA 17055-2761 - - - - _--- - - - - PRlNT NAME: SIGNATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT _ I~hTE.. ` P ~ _ ,,. . CI`f/4Rti~E$ RIE=1~txlPTS ..-- >3AL/tNC>ff.~ » MICI~:~. 4~LDEr~ ES'1'Jat'7E 10/30/09 THERAPEUTIC INJ S0/IM 25.00 .p0 • 98372 182.8 05/20/10 3 RIVERS HLTH MA AOJ 25.00 10/30/09 ARANESP 1MCG 879.00 .00 J0881 182.8 05/20/10 3 RIVERS HLTH MA ADJ 379.00 05/20/10 3 RIVERS HLTH MA ADJ 300.00 10/30/09 ARANESP 1MCG 42.00 .00 • J0881 182.8 05/20/10 3 RIVERS HITH MA ADJ 42.00 10/30/09 TOPOTECAN 4MG 2100.00 .00 • J9350 182.8 05/20/10 3 RIVERS HLTH MA AOJ 2100.00 10/30/09 INITIAL CHEMO INFUSN UPTO 1 HR 225.00 .00 98413 t 82.8 05/20/10 3 RIVERS HLTH MA ADJ 225.00 10/30/09 ALOXI 25 MCG 450.00 .00 J2489 182.8 05/20/10 3 RIVERS HLTH MA AOJ 450.00 10/30/09 DEXAMETNASONE 1 MG 25.00 .00 • J1100 182.8 05/20/10 3 RIVERS HITH MA ADJ 25.00 10!30/09 iV INFUSION SEO UP TO 1 HR 50.00 .00 • 98387 182.8 05/20/10 3 RIVERS HLTH MA ADJ 50.00 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* rs~tr s~.•an an~rsR '; ~s~rstc a~,~re ea-~:~.t~~r~ :: a~rra~ txa~ax~l .....: .............. : .. ~~r~ . . r ~~ cl~t.o ~... :;ARII~lN7:. : Ni~~lY: ~~3~ . ; : . EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # (717- 558-7350 EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG PA 17111 PHONE: (717) 558-7350 MICHAEL GILDER ESTATE 16 ACCOUNT NUMBER: 59079 BILLING DATE: 06/01 /10 DATE OF LAST PYMT: 05/28/10 AMOUNT NOW DUE: 6266.35 AMOUNT ENCLOSED: 1 1 K I N G S W O O D DRIVE CHARGE AMOUNT DUE TO MY: MASTERCARO VISA _ EXP GATE / CHARGE ACCT #: MECHANICSBURG PA 17055-2761 - i - -~- - - --~---~- ` ` - PRINT NAME: SIGNATURE: ' DETACH AND RETURN UPPER PORTION WITH PAYMENT I~/ti'.>x6. .. PltT~lkT 11tAM~: _ C1f~4R<iE$ • 11t~I:CI~A:, G~k.D~i~ ~S"I'4~~ . 10/30/09 IV INFUSION CONC UP TO 1 HR 98388 182.8 05/20/10 3 RIVERS HITH MA ADJ 32.00 ,,rrr r ~. e~ut:~~.. ~; .00 32.00 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* * * * 59079 EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE ~ (717) 558-7350 825 Market Street ' Lemoyne, PA 17043 Sold To Natalie Geiger 11 Kingwood Drive '~ Mechanicsburg, PA 17055 Sales Receipt __ .+. Date Sale No. bnlnolo 3287 Check No. Payment Method Check Serviced Description Qty Rabe Amount 6/ 18/2010 cleaning service 2:00 PM to 4:30 PM 2-person team Lucy and Glenys 140.00 140.OOT Thank you for your busincas. SUb'~O~I S 140.00 Phone # E-mail Sales Tax (6.0°i6~ ~a.4o ? 17-761-?300 ddmaidmaids(u~ad.com Tota ~ S 148.40 i 6416 CARLISLE PIKE MECHANICSBURG, PA 17050 (717) 791-4500 06/19/10 OPR 301647 60WT GLtIBE 3.99 T 60WT CANDLE BASE 1.99 T !AX 0.36 ~**~ k1ALANCE 6.34 v1~A PURCHASE ACCT. *~****~~**~+~9973 AurN: 014215 KCPi: ~iS7U CODE: 0000 l:RI=OIT CARD 6.34 CFIANGE 0.00 06/19/10 02:22P~n 45 21 145 301647 CUSTOMER COPY r • ,, 1 S~.ES I-R~f ~n~ h w-I - tam, i -~1 I~rn~ 1, 1,, . ~a ~ ~1-- ".v~.u~~il w~ tiU\ ~.•i ~~'hl r . 1 ~ ' '.F• ~ r! .. ~ ~ j i JLu~ '.. . ~. :,"11 „ 'nL'~ I"Vliln :'iltt"V ~ w "fir ; ~~'! i 1 I I N 1 h~l .. •• 11~ 1 l~li li~~~l 1~~ rl~~ ~t,T: u:~.rf' n'I 'lic MtkIF~FUI ,~ I X ' • _1MEA/C14/V 3809 TRINDLE RD CAMP HILL PA 17011 PHONE: (717)781-2821 A ppp~ n/E TAX fTATW CIR ID w.o.# ~ 21168491 21 08/23x10 08/23/10 •• INVOICE'' CRT: 545 ID: 3 W.O.N 54535857 21 13:08 15:01 CU>iTOMEII P.O. N0. TERIN >{INP VIA VQNCIr,! DElCIMPfION LJCENN AELEAGt siLi11. ASH 04 CHEVROLET MONTE CA FME3478 83315 3 889 w, , . ~ ~ ~ CUSTOMER SERVICE: 1-80o-833-6051 S NATALIE GEIGER H:(717)802-2119 S NATALIE GEIGER O T 11 KINGSWOOD DR H T 11 KINGSW000 DR L O MECHANICSBURG PA 17055 I O MECHANICSBURG PA 17055 D P WHEELS MUST BE RE-TORQUED AFTER 50 MILES WHEELS MUST BE RE-TORQUED AFTER 50 MILES ITEM N0. slzE Ptr D~CRIPTION P111C~ EXTEI+EIOK TAx 1 1 LOF OIL CHANGE LURE, OIL ANO FILTER CHANGE 27.95 887 27.95 • 1 PZ9A OF OIL FILTER PENNZOIL 50 QS59752 5W20 QKRSTATE 5W20 BULK /10TH 1 CFF S CHECK MOST FLUID LEVELS 1 ENV1 ENVIONMENTAL ENVIRONMENTAL CHARGE 1 LURE LURE LUBRICATE CHASSIS 1 1 CCQ CHECK QUICK COURTESY CHECK 0.00 887 .00 • 1- 1- PROM010LOF COUPONI O PROMO 810 OFF LOF 8.00 8. • • NOTE: • 1) SUGGEST TIRES 3 ALIGNMENT • d 2) OIL DRAIN P~U ST iP~ED ;~ '~~ ~ :~ :! ?_i:~Mii~ ~'1A•jd5 ~Y ••~ ••, ••• •sq ••~ • '. i-~"E FEt '~1F: '~'.":it ~,irUf,. .. 1 1 1 VIN:2G1WX12YC043 5 50 VISA/MC 21.15 AUTHORIZATION CODE: 015000 THANK YOU VERY MUCH 3 HAVE A NICE DA 21 TSA ANDREW DEPALMA ORDER p 545358 UNIT: YVEKiFfT tYlRDI~ML~ LAS011 FREIGHT AMIC. EXp9E TAX TAxAM.E TOTAL NONTA7I TOTAL SUB TOTAL: t9•~ 1 0 8.00 27.9b .00 .00 .00 19.95 .00 -wwr. DIIE DATi GRON AMOIJKf AeO~~ CASH DIr1Q- NET 1 1 08/23/10 21.15 .00 .00 21.15 PA SALES TAX 1.20 TM18 At~UNY> 21.15 TOTALS 21.15 .00 .00 21.15 ~hersby M t+ hodze tM above repelr woAc to be darN yonq with CUSTOMER NAME (PRINT) USTOMER SIGNATURE , d~ ins «r • ~ ~aY ~erM •xpr~vih 1~Cnr~pu~o.i e• 'dl~M~ibov vM to sec~rsf b the ~m~ dm~soeirs~~~~ t ~t~ nen~ ou a~kn o wr Ibp~ f t d =a M q ~ ~ e e o « oa ao~~Mr o y«,r c«,tra. ve hide in pie a~ r. A seovrit~Mer~st in {h~r-erec~ w has bMn bn this sales l~+f1 f-fRf i W ~OPIf ~{~ff1- /- .A M 11/1}{~ f1V1~ {/1 11Y ~0I[~ WHEELS MUST BE RE-TORGIUED AFTER 50 MILES ,w~p .a •' -~~ ooj trr~~er m~ Pa~'L~'r « RA~ 8% to prwious sncs~ A FINANCE CHARGE OF .00 % PER MONTH ( •~ °~ PER ANNUM) WILL BE ~~ eroe t~ ~+V~++ w~~+~r~°t~ ~~ ~e CHARGED ON ALL PAST DUE ACCOUNTS. PLEA8E REMIT TO: I LIAMS TIRE CO., INC. '~A,~ CUSTOMER COPY -CASH PPL Electric Uti 1 iti®s Electric Service For: MICHAEL GII.DER-EST'AT'E 711 OLD SILVER SPRNG RD MECHAMCSHURG PA 17055 Questions abort this bill? Please contact us Jun 28 at 1-808-34 5775 (1-S00-DIAIrPPL) or w~te to: Customer service 827 Hausman Rd. Allentown, PA 18104-9392 www.pplelectric.cam Electric Use This graph.shows your electric use over the last 13 months. Types o[ Meter Readings: Actual - Adjusted . Estimated Customer Q I '~•~~:::;~;~,. Page 1 ;,.- ....................... pp :...: ..........:....... ..__ :. .: •''~: •,, ~ 49610-86013 ~ ~,~; i Summary Page Balance as of Jun 7, 2010 50.00 Char es: TASHINGTON GAS ENERGY SERVICES Char es Total PPL ELECTRIC UTILITIES Charges ~ 11 ~5 Total Charges $20.16 Account Balance 36 30 24 18 12 6 0 KWH -Average Pet Day ~~a~~z~cb -IS JJA50NDJFMAMJ 2009 , Months 2010 Meter Reading Information 59.11 Meter #84572176 Jun Z Actual 52932 May 3 Actual 52834 30 Da s KWH Billed 98 ra g Ave e - Jun 2009 2010 m ~ a 6 ~ K~~VH Per Day 13 3 Yearly Use: Total Avera e Use Mon Jul 2008 -Jun 2009 7831 65 Jul 2009 -Jun 2010 4979 415 Other (n>lportant lnformanon on back ~ 1 ' I ~ ~ ~ ~ `~ • ~ , ~ / •~~~...,.' -' Page 3 ;,.- ~ ~~~`~ `~~~ ~~ ~~~~ ~ ~ ~~ PPL Electric •~'~ . - 49610-86013 Utilities , ' :::~ ~~: Electric s1~62 Total fro~w La.4t a~a Service - Pay~e~rt x~eiveid May 27 Thank YoN. ,f1~62 For: Billing Details MICHAEL GII.DEA-E5TATE 71 ~ oLD stLVER sPRNG ItD Balance as o(Jun 7, 2010 $0.00 MECHAMICSBUAG PA 17053 Current Charges WASHINGTON GAS ENERGY SERVICES Customer Service 13865 SUNRISE VALLEY DRIVE SUITE 200 HERNDON, VA 20171- 1-888-884-9437 PPL Electric Utilities Customer Service 827 Hausman Rd A1letrtown, PA 18104-9392 1-800-342-5775 (100-DIAIrPPL) www.pplelectric.com Charges for - WASHIIVGTON GAS ENERGY SERVICES General Service Rate: WGESD for May 3 -Jun 2 Total Use: 98 Kwh At $0.093 Per Kwh 9.11 Gross Receipts Tax $0.54 Total WASHINGTON GAS ENERGY SERVICES Charges $9.11 Current Charges Charges for -PPL ELECTRIC UTILITIES Residential Rate: RS for May 3 -Jun 2 Distribution Charge: Customer Charga 98 KWH at 2.9600000¢ per KWH .44 2.85 o PA Tax Adj Surcharge at 0.10300000 /0 0.01 Transition Charge: 98 KWH at -0.25200000¢ per KWH -0.25 Total PPL ELECTRIC UTILITIES Charges $11.05 Account Balance SZ0.16 General Generation prices and charges are set by the electric generation supplier you have chosen. The Public Utility Commission re area distribu- lion Information pnces and services. The Federal Energy Regulatory~vmmission regulates i d transmiss on prices an services. Next meter r~~g on or about PPL Electric Utilities uses about $0.05 of this bill to m~aay state taxes. In addition, about $0.65 of this bill pays the PA Gross Keceipts Tax. Jul 1 For our convenience, you can now pa your bill using your Vise MasterCard, Discover, or ATM Card all BlllMatriz at 1-800-672-2413. BiIIM~Mz will charge your credit end ATM card a service fee for making this payment. Before diggin around your home or property, you should always call the state's One Call notification system to locate any underground utilit lines y . You can do this by simpl dialing 811, which will connect you to the One Call system. Be safe andyca1181I before you dig. With ppaappeeriess billing, you can receive and pay your PPL Electric Utilities bills onrme. The process is free, quick, convenient and secure. To learn more or sign up, visit www.pplelectnc.com. Save postage and late charges -sign up for Automated Bill Payment. Air conditioning is probably the biggest part of your summer energy needs. You can save money while keeping cool. Check air conditioner filters monthly. Clean or change filters as needed. You 11 stay cool and your system well use less energy. ~yi~a ~d k ~,uavP /L ~Jvis~ ~ ~`- ~+aK c ~~ui ~Hirl.~ ~~ l~0~~ INVOICE NO. 2 513 9 6 ~lz~~~~ INVOICE SOLD TO / / ~ ~~ p SHIPPED TO VIA ADORES ADDRESS CITY, STA E, ZIP CITY, STATE, ZIP .R'8 ~ ~, .. ~; . ~.i ~.., ,.~, ~.;jk s+.~` ,~ _ ~ _ y ,~, ..k51M ,e ~< .3 .4!' s;-~1 'f:. w.l } ~:~r ~~ t~. ~y~ ~~ I4' . '..~:~ ~i ~t. 'Vi'i^-, T • f IOC' i.>t ..~ kS~d >~ .--+_ rr- ~a ~//a~ p~ O ~~ k r ,1~~~'~.1, S~ ~ ~s ~ i~ Y OdC i`KS~ i ~ a ~ 7 l C ` 7 C'~Nt n r~ 1v~ iQd hr ~ l O ;O ~~r~ T 8740 n FIRST ``~0°° Horizon Way, Suite 100 Irving TX 75063 ~ HORIZON_ HOME LOANS 1-663-47125-0001155-OQ1-1-10Q-100-000-000 '.~1ICHAEL D GILllER 1 1 KINGSWOOD DR 1rIECNANICSBt'RG Pa 17055-2761 MORTGAGE ACCOUNT STATEMENT For mortgage 1-500-364-7662 accouet information: Monday -Friday lam - 7pm CT Pay online at: www.firsthorizon.com Account Number: 0041791591 Home Phone: 717-b9?-5235 Work Phone: 717-236-8061 For additional financial services: First Horizon 1-800-615-0822 www, firsthorizon. com Ct+eck Nero ~ your add-eaa, phone numbers Check here and oomplels the torte a Soaal SewxRy number(s) are arcanxt on the rereraa side if you woule ^ and cample0s the form on tl» reverse sde. ^ 11ke M» aubrnaoc payment option. Upon ncNpt oI payment, your statement will be mailed. ACCOUNT INFORMATION PAYMENT SUMMARY Account Number 0041791591 Property Address: Principal 8t Interest 36.46 Current Statement Date OS/28/10 711 OLD SILVER SPRG Total Amount Due $536.46 Interest Rate for 7/01/10 5.25000% MECHAICSBURG PA 17055 Payment Due Date 0 Current Principal Balance" $11,330.32 Interest Paid Year-to-Date $281.97 ~ ~_ 2,5', ~ ~ Taxes Paid Year-to-Date $0.00 ~ ~w~oe 'Trils Is y+nur P-incipa/ Balance onty, not the amount required b pay your account In full. Nbte: Funds sudNMsd thrgph your online bsnking may be fed If tt-e /unds be/ng sent ere not sutirlclent b pay the monthly payment, your loan is /n a defMquent status, o- you hatr~a 1Ned a bankruptcy case that Is still acehre, payments wJN aubmaticelly be returned b tl-e -enMtter o1 fhe funds. You cannot make a p~inclpal only payment or morn than one payment through on/Me banklnp as tFia ttrnds will not process as tntindad. ACCOUNT ACTIVITY Description Due Date Dste Paid Amount Principal Interest Escrow Fees Other Payment Applied 06!01/10 05/28 536.46 484.77 51.69 .00 .00 .00 IT IS VERY IMPORTANT THAT YOU REPORT ANY POSTING ERRORS TO FIRST HORIZON CUSTOMER SERVICE WITHIN 30 DAYS OF THIS BILLING. IMPORTANT MESSAGES For Mortgage Account Information: Our customer relations team is available Monday -Friday, lam - 7pm central time to ans~vcr qucstions you may have about your current mortgage account. You may call our toll free number 1-800-364-7662 or visit our secure website. Thinking About Refinancing or Purchasing a New Home? In this changing economy, a home is still your greatest asset and we are here to help. If you are planning to purchase a new home or want to take advantage of low rates and refinance your existing mortgage, please visit vvww, firsthorizon. com or call us at 1-800-615-0822. PLEASE DETACH AND RETURN BOTTOM PORTION WITH PAYMENT IN THE ENCLOSED ENVELOPE Number Account Number Date Due 7 H4250-00-711 JUL 1, 2010 MICHAEL OILER If RECEIVED After M~It~ Ch~Ck pry~OM to: Walnut Villas Condominium Association JUL 6, 2010 itttlil~ttlli~~~~l~~l~tli~ll~~~~ll~~~tl~l~~i~ittl~l~tl~itttlll PROPERTY MANAGEMENT, INC. WALNUT VILL/48 CONGO ASSOC. PO BOX a22 LEMOYNE PA 17043-0a22 . ~- zS -- ~ r d ~~- ~Ig Amount Due 5100.00 Pay This Amount sllo.oo ~~ ~. 3- 2- s ~ 1- 0 o- UNITED WATER USAGE HISTORY Monthly usage in thousand gallons 2 2 2 i i 0 0 0 0 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Mar May Jun Next meter reading date: on or about 07/14/2010 SERVICE TO: MICHAEL GILDER ~1#!fl'iF1a<# tom''' ~~rsirtwm. c~A '~z4~6 ~~~z '. Billing Date: 06/15/10 Account Number: 00200999115167 Previous Balance $4.63 Payments Through 06/15/10 T-tar,k rc~ $4.63CR Balance Forward $0.00 Current Charges Due 07/05/2010 $10.25 *PAY BY 07/10/10 TO AVOID A 1.596 LATE PAYMENT CHARGE SERVICE ADDRESS: 711 OlD sIIVER SPRING RD MECHANICSBURG PA Mir ~t>~r~ Slirvi~ ~ .. f ~. q€ ,~.~, ~t~iE~' ~~~ U t~n~t t~ i#~t~# 1~ l+rc~: > .Ta . .,. 5;r~e.:., .:.. Pr~o~~. ... ..:;;f~N~~ ..: ... :.., ~s~ ..... ;. y3>~e ~ .. 59794017 05/13/10 06/14/10 32 0084 0084 0 MGI. ACTUAL EQUNAIENT TO 0 GALLONS SERVICE CHARGE5 $10.25 TOTAL CURRENT CHARGES $10.25 SEE REVERSE SIDE FOR IMPORTANT ACCOUNT INFORMATION _.. UWPA will conduct asemi-annual flushing of the distribution system in your area from April 1st through end of Lune. This may cause temporary discoloration of water and temporary decreased water pressure. For hydrant flushing updates, please call 717-564-3662. If you would like to pay your bill online, please visit our website at www.unitedwater.com and click on the Western Union's Speedpay icon. Save a stamp and ggo paperless today! Log on to www.unitedwater.com or call Customer Service to find out more information and to enroll in eBilling. Approximate state tax included on this bill $0.49. • 0 0 0 o pE ~ aot 34 ClEASE DETACH HERE AND RETUi1N THE BOTTOM PORTION Wmi YOUR PAYMENT IN THE RETURN ENVELOVE VROVIDED. 102 1 ~0! MApOS W2l2010 ~rrsta/ il~ar Window Ckan~ieg d~ Pressure Cleaieing Spec~al3sls Commercial d~ R~sldentlol CUSTOMER INFOI~~MATION: Date ~ 3 a ~_, Name Address: INVOICE: X ESTIMATE: Pboee Number: Description Total f ~ Da111e1 Brown, Owner ~~~ • Q~ lOZ Foz Street Taz ~ DO Harrisbnra, PA 17109 "~~~~_~ ~ l06. 00 ~xl! . ~-S za a ~.~r lzv ~~~ ~ __~ • f ~ _ ` ~ 1 DETACH AND RETURN UPPER PORTION WITH PAYMENT E~ItTE . W~kT~EI~kT E . _ Cl#Aa~$ ' HI~OE.IPT~ 13l4LA,NCE tlx: t~~~~~R ~~~I'~4T~ l~E~#~fiAE~. , 03/23!09 ETOPOSIOE, 10 MG 480.00 .00 J9181 182.8 03/22 10 GENERAL WRITE-OFF 16.25 0416 10 CHECK PAYMENT FROM PATIENT 100.00 04,18 10 GENERAL WRITE-OFF 100.00 I 1 0528 t0 GENERAL WRITE-OFF 121 88 05 28~~0 CHECK PAYMENT FROM PATIENT 100,00 0824 10 CHECK PAYMENT FROM PATIENT 21 87 03'23;09 PIATINOL tOMG 680.00 251.87 J9080 182.8 05/2810 GENERAL WRITE-OFF 330.00 08124;10 CHECK PAYMENT FROM PATIENT 78.13 II 03/23/09 INITIAL CHEMO iNFUSN UPTO 1 HR 225.00 t t 2.50 98413 182.8 05/28/10 GENERAL WRITE-OFF 112.50 03/23/09 CHEMO INFUS EACH ADOI 1-8 HRS 60.00 30.00 98415 182.8 05/2di10 GENERAL WRITE-OFF 30.00 03/23/09 CHEMO INFUS SEOUEN UPTO 1 HR 93.00 48.50 96417 182.8 05/28/10 GENERAL WRITE-OFF 48.50 03/23/09 AIOXI 25 MCG 450.00 225.00 J2489 182.8 05/28/10 GENERAL WRITE~OFF 225.00 P~_ ~-.Z-Zolo C1~~ ~ ~-l ~i u-~ . o-a * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* * * * ~c-rrr ~a ~-: r~Ye +~~-so; v~Ya1 ~~;r.~ a~Y~ ;. ovae ts~ oar ~<n~ u~ >t~lac:~lva~~o > J4AItt~I,iIY~'' A~~OW~kT'aA1,ANQ~ :nMi~F#NC~ AIQ~ I~~~' EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # (717) 558-7350 CUIVNINGHAM d~ CHERNICOFF, P. C. 2320 N. 2nd Street, P.O. Box 60457 Hamsburg, PA 1 7 1 06-045 7 Ph:(717) 238-6570 Estate of Michael Gilder c/c~ Natalie Geiger 1 1 Kingswood Drive !utechanicsbur`~, PA 17055 Fax:(717) ?33-4309 Attention: Re: Estate Administration DISBURSEMENTS Postage May-21-10 .Journal Publications - Proof of Publication - Michael Gilder Estate Jun-21-10 Cumberland Law Journal -Publication - Michael Gilder Estate Totals ~'~tal Fees, Disbursements Previous Balance Previous Payments Balance Due Now We Accept Visa & Mastercard Jul 12, 2010 f' i I~' tz~ (,O~71 O Inv #: 47780 Disbursements C~. I O 97.00 75.00 $178.10 $0.00 SEE SUMMARY: Lawver Hours Effective 12ate $178.10 $0.00 $0.00 $178.10 ~ ~. Amount ~~ ~ PPL Electric Utilities Electric Service For: MICHAEL GII.DER-ESTATE 711 OLD SILVER SPRNG RD I~iCHANICSBURG PA 17055 Questions about this bill? Please contact us Ju127 at 1-800-345775 (1-500-DIAIrPPL) or write to: Customer Service 827 Hausman Rd Allentown, PA l 8104-9392 www.pplelectric.com Electric Use This graph shows your electiric use over the last 13 months. Types of Meter Readings: Actual - Adjusted - Estimated Customer 1 ~ I `~ ' , / ~ / ;~.- :~-- pp •._- .; , ,~ Summary Page Page 1 49610-86013 ~:~ ~~: Balance as of Jul 6, 2010 50.011 Tc~tarPPL ELECTRIC UTILITIES Char es 16.75 Total WASHINGTON GAS ENERGY ~RVICES urges Totsl C barges $46.79 Account Balance d• `1-z3-'zaio ~~ Iz3 36 30 24 18 12 6 0 Meter Reading Information X30.04 $46.79 Meter #84572176 Jul 1 Actual 53255 Jun 2 Actual 52932 29 Da s KWH Billed 323 Average -Jul 2009 ZO10 T mpera~ure 69F 75F K~NH Per Day 11 l l Yearly Use: Total Avers c Ude Mont Aug 2008 - Ju12009 7915 Aug 2009 - Ju12010 4984 415 JASONDJFMAMJJ 2009 r Months 2010 Other important information on back ~ KWH -Average Per Day '~' ,~ ,~, ~ ~ . ~~~ . . . - Page 3 '•;•~' ~•.% , „. ~~~- :............. . ......:......:.. ~~~~~~ ~ ~~ ." PPL Electric .~•:: . pp 49610-86013 Utilities , ric Elec t Totarf~ last Bia ,~a16 Service ~ P~v,~en~ x~eN~+Jrn lS -Thank Yow. a2~16 Biding Details MICHAEL Ga.DER-ESTATE 711 OLD SILVER SPR1vG RD Bahuce sat of Jul 6, 2010 $0.00 MECHANICSHUItG PA l703S Current Charges WASHINGTON GAS ENERGY SERVICES Customer Servict 13865 SUNRISE VALLEY DRIVE SUITE 200 1-IERNDON, VA 20171- 1-888-884-9437 PPL Electric Utilities Customer Service 827 Hausman Rd Alletrtowa, PA 18104-9392 1-80®-34Z-5775 (1-500-DIAL.-PPL) www.pplelectrie.com Charges for -WASHINGTON GAS ENERGY SERVICES General Service Rate: WGESD for Jun 2 -Jul 1 Total Use: 323 Kwh At X0.093 Per Kwh 30.04 Gross Receipts Tax $1.77 Total WASHINGTON GAS ENERGY SERVICES Charges $30.04 Current Charges Chsrges for -PPL ELECTRIC UTILITIES Residential Rate: R5 for Jun 2 -Jul 1 r g e : Distribution Cha a r g e WH m KWH 5 81 a t 2.90600000¢ per K 00 . 123 KWH at 2.64000000¢ per KWH 3.25 PA Tax Adj Surcharge at 0.10300000% 0.02 Transition Charge: 200 KWH at -0.25200000¢ per KWH -0.50 123 KWH at -0.22300000¢ per KWH -0.27 Total PPL ELECTRIC UTILITIES Charges ~ 16.75 Account Balance 546.79 General Generation prices and charges are set by the electric generation su lier you havo chosen. The Pub is Utility Commission re aces distribu~iarl Information prices and services. The Federal Energy Regulatory~ommission regulates transaussion prices and services. N ~g~~ PPL Electric Utilities uses about ~-0.07 of this bill to ppaay state taxes. In on or about addition, about $0.98 of this bill pays the PA Gross 1Zecelpts Talc. `A~ 2 For your convenience, you caa now pa your bill using your Vi _ MasterCard, Discover, or ATM Card all B1llMatlriz at 1-800-672-2413. BIIIMatriz will charge your credit and ATM card a service fee for making this payment. Before digging~ around your home or property, you should always call the state`s Oae CaIl notification system to locate any underground utility lines. You can do this by simply dialuig 81 1, which will connect you to the One Call system. Be safe and ca1181 I before you dig. With ppaa~~eerl billing, you can receive and pay your PPL Electric Utilities bills onIme. "I'he process is free, quick, convenient and secure. To Learn more or sign up, visit www.ppleiectnc.com. Save postage and late charges -sign up for Automated Bill Payment. Close drapes, blinds and shades an the sunny side of your home during the hottest part of the day. It eases the load on your cooling system and saves energy. FI n CT 4000 Horizon Wary, Suite 1 QO j~ 1 Irvine TX 75063 ~ HORIZON_ HOME LOANS 1~ . 2-663~7328.OOOOW6-001-1-10a-100-000-000 ESTATE OF MICHAEL D GILDER 11 KINGSWOOD DR MECHANICSBURG PA 17055-2761 MORTGAGE ACCOUNT STATEMENT For mortgage 1-800-364-7662 account information: Monday -Friday lam - 7pm CT Pay online at: www. firsthorizon. com Account Number: 0041791591 Home Phone: 717-697-5235 Work Phone: 717-236-8061 For additional financial services: First Horizon 1-800-615-0822 www. firsthori2on. com a,.a~ n«o ~ yar r~«is, t~ ~«,~ ct~dc nw and oanpiM~ tiw Ihnn a SodM ~kY rKrnb~r(sy a~.:,ooR.ct on tiw ~w ad. R yvu world D ~a oa,~w. a+. ~a,,, «. ~,. ~.r.r.. ~.. D ~. aw. t ~. upon ,ecsrpt of p~ymen[y your statement wtN be maned ACCOUNT INFORMATION Account Number 0041791591 Property Address: Current Statement Date 06/28/10 711 OLD SII.VER SPRG Interest Rate for 8/01110 5.25000% MECHAICSBURG PA 17055 Current Principal Balance* 510,843.43 Interest Paid Year-to-Date $331.54 Taxes Paid Year-to-Date $0.00 = ~o~ PAYMENT SUMMARY Principal & Interest 36 6 Total Amount Due 536.46 Payment Due Date O8/O l ! 10 ~~ ?!~~ ~ f~~r "Thfa /s yar PrlnclpN Balenve oMy, not the amount requln~d tb pay your account /n lull. Molts: Funds subnUt[rd eArou~h y~r on/!ne banktrp maybe reacted K the funds helnq sent are not su8'ktent M pay the monthly payment, your loan !s /n a delinquent stetw, or ynu haw fJNd a bsniwptoy case that !a at~l acdw, Pa Fs will aWanatka/ly be relumed lu the rerNMsr of the funds. You urrnot make a pMnc/pN only payment or moro than one psrnent dtroupH onlMne baiekkq as a t~unds wlil not process as Intended. ACCOUNT ACTIVITY Description Due Date Date Paid Amount Principal Interest Escrow Fees Other Payment Applied 0?/01110 06/28 536.46 486.89 49.5? .00 .00 .00 fT IS VERY IMPORTANT THAT YOU REPORT ANY POSTING ERRORS TO FIRST HORIZON CUSTOMER SERVICE WITHIN 30 DAYS OF THIS BILLING. IMPORTANT MESSAGES For Mortgage Account Information: Our customer relations team is available Monday -Friday, lam - 7pm central time to answer questions you may have about your current mortgage account. You may call our toll free number 1-800-364-7bb2 or visit our secure website. T6inlting About Retlnancing or Purchasing a New Home? In this changing economy, a home is still your greatest asset and we are here to help. If you are planning to purchase a new home or want to take advantage of low rates and refinance your existing mortgage, please visit www.firsthorizon.com or call us at 1-800-615-0822. t~[.tasE DE7a~}+ .,A~~ ate,., .~.. _ IN ~ ORMATION CHANGES: ADDRESS * PHONE NO. * SOCIAL SECURITY NUMBER Account Number Name Flnt Nana MI Last Nana New Mailing Address SEraat aktnsa Cltp Sbh Lp New Home Phone Borrower Social Security No. _ Borrower's Signature Required AUTOMATIC PAYMENT AUTHORIZATION AGREEMENT New Other Phone Co-Borrower Social Security No. _ Co-Borrower's Signature Required This will authorize the financial institution indicated on the enclosed check to honor monthly withdrawals from the account shown on the check, which are initiated by First Horizon. To ensure proper implementation, please allow 45 days to pt•ocess the request. Tltis will also authorize First Horizon to initiate monthly withdrawals for monthly payments due on the account number indicated below. This authorization is to remain in force until First Horizon has received written notice 30 days prior to cancellation, payoff, or assumption. Cancellation will automatically require that subsequent mortgage payments be made according to the terms of the note and mortgage or as instructed by First Horizon. This authorization does not change the terms of your mortgage. First Horizon reserves the right to revoke this authorization in the event of a stop payment on a draft without prior notification; the account closed without prior notification; two or more insufficient funds drafts in one year. Reinstatement in this program will be considered after a period of six months. Account Number Borrower's Signature Required Name Please complete this form and return It, ALONG WITH A VOIDED CHECK, to: P.O. Boa 630327, Mail Code: 6102, Irving, TX 75063. *** Please continue to mall your payments until we notify you of your first draft date. *** CONVENIENT PAYMENT OPTIONS AutoDraft -Payments automatically withdrawn from your bank account. Fill out the authorization form above to take advantage of this convenient service. Just in Time (JIT) -Make your payment by phone using funds directly from your checking account. Call 1-800-364-7662 to authorize immediate payment from your account for a nominal fee. Pay Loan On-line -Make your payment while viewing your monthly statement at our website. Log on to www.firsthorizon.com and make your payment today. Opciones Convenientes Del Pago AutoDraft (Giro Automlitico) - Pagos que se realizan automaticamente desde su cuenta bancaria. Llene el formulario de autorizacion en la parte superior del page[ pars aprovechar el beneficio de este servicio. Justo A Tiempo (JIT) -Haga sus pagos por tel6fono usando su cuenta corriente. Llame el nitmero 1-800-364-7662 pars autorizar el pago inmediato desde su cuenta, aplica urea cuota fija por transaccibn. Pago de Pr~stamo On-line -Haga su pago mientras observa su estado mensual en su sitio web. Entre a www.firsthorizon.com y realice su pago hoy. FIRST HORIZON GENERAL FEE SCHEDULE Property Inspection $0 to $30.00 Wire Fee $0 to $15.00 Demand Letter Fee $0 to $30.00 * Reconveyance Fee $0 to $45.00 '" Payoff Quote Convenience Fee $0 to $15.00 * Non-Sufficient Funds (NSF) $0 to $30.00 * Additional Ways to Pay Home Loan Online Payment Fee $11.00 JIT Automated Phone Payment Fee $13.00 JIT Representative Assisted Payment Fee $15.00 'Vsr/ss by Stab and loan Type This fee structure !s sub/ect b change without notice. Th/s schedul. does not include all fsea that may apply. These fees miy not apply If proh161ted by federal or stab law, federal regu/adons or mort8ape documents. CONTACT INFORMATION Correspondence First Horizon Mail Code 6412 4000 Horizon Way, Suite 100 Irving, TX 75063 Payoff Information* First Horizon Attn: Payoff Department Mail Code 6108 4000 Horizon Way, Suite 100 Irving, TX 75063 'Please nob: For payotls, only Cerdfled Funds will be accepted. ' Nots: • Para pa~os solo se aceptar>jn Fondos Certlflcados. Overnight Payments First Tennessee Bank 3451 Prescott Road IMZ 3453 Memphis, TN 38118 Payments Only First Horizon P.O. Box 809 Memphis, TN 38101-0809 Property Tazes Mail Stop 6308 First Horizon Home Loans P.O. Box 630148 Irving, TX 75063-9987 Hazard/Flood Insurance 1-866-49?-0529 (toll free) Documents First Horizon P.O. Box 7481 Springfield, OH 45501 PAYMENT PROCESSING Consumer checks received by First Horizon via the U.S. mail or at our drop box location may be electronically presented for payment. This debit transaction uses the check only as a source document for pertinent information. Consumers need to refer to their monthly bank account statement for the check serial number. Checks which have been presented to First Horizon for payment and returned due to insufficient funds or uncollected funds may be electronically re-presented for collection. Los cheques de los consumidores recibidos por First Horizon via correo (U.S. mail) o en nuestros buzbn podran ser presentados pars su cobro electrbnicamente. Esta transaccion de debito usa Ios cheques sdlo como medio pars su informacion pertinente. Los consumidores necesitan referirse a su estado de cuenta bancaria mensual para obtener el numbeo de serie de su cheque. Cheques que hayan sido presentados a First Horizon pars pago 0 regresados por fondos insuficientes o fondos en tr~nsito podran ser electrbnicamente re-presentados para su cobro. New Work Phone '~ UNITED WATER eriid~ylva>~isr C~ ~er#L~>t' ~w~. i~ummelst~wl~r~ Pit 11q~6 -SS~y~~6 ~x~ca Billing Date: 07/15/10 Account Number: 00200999115167 H O 1-H 0 T May Jun Jul Aug Sep Oct Nov Dec Jan Mar May Jun Ju Next meter reading date: on dr about 08/13/2010 Previous Balance $10.25 Payments Through 07/15/10 rha~k rou $10.ZSCR Balance Forward $0.00 Current Charges Due 08/04/2010 $10.25 •:: •PAY BY 08/09/10 TO AVOID A 1.596 LATE PAYMENT CHARGE SERVICE TO' MICHAEL GILDER SERVICE ADDRESS: 711 OLD SILVER SPRING RD MECHANICSBURG PA 'liERt ~ ~I~+iWI ~ ~ R~'' ~G~tt~ ~fqt 0# . >~rarrl::: > ...::.::.::~'.~:::. •:.:.::.~.,~....#'~, ~ . .::. pre~i~i~l:;:::.:::>;:~.: ~t±as~t>:tt~'< ......~` M~e~st~!#~. ~cr~~l4'~~!#~ 59794017 06/14/10 07/14/10 30 0084 0084 0 MGl ACTUAL EQUIVALENT TO 0 GALLONS SERVICE CHARGES $10.25 TOTAL CURRENT CHARGES $10.25 SEE REVERSE SIDE FOR IMPORTANT ACCOUNT INFORMATION If you would like to pay your bill online, please visit our website at www.unitedwater.com and click on the Western Union's Speedpay icon. Save a stamp and ggo poperless today! Log on to www.unitedwater.com or call Customer Service to find out more information and to enroll in eBilling. Approximate state tax included on this bill $0.49. 0 2 0 0 RE 1 t/4402 VlEASE DETACH HERE AND fiETURN THE 80TTOM POFTION WITH YOUR CAYMENT IN THE RETURN ENVELODE PROVIDED. t 02 1 ~ MARW 07022010 • .. , EMERGENCIES 717 564 3662 888 Z99 8972 Available 241 for reporting disruptions or other water emergencies. a BY TELEPHONE 717 564 3662 (Harrisburg, Mechanicsburg, Newberr , Grantham, Center Squarel 888 Z~9 8972 (toll-freel Monday through Friday (except holidays) 8:00 a.m. to 4:30 p.m. BY FAX 717 920 6066 IN WRITING United Water Customer Service Center 8189 Adams Driue Hummelstown, PA 17036 P/eose register any question or complaint about the trill prior to the due date. Always remember to include your account number on any correspondence to us. BY E-MALI UWPAquestions@unitedwater.com FOR MORE INFORMATION, VISIT US ONLINE www. unitedwater.com/uwpa PENNSYLVANIA PUBLIC UTiUTIES COMMISSION United Water is regulated by the Pennsylvania PUC Customers can contact the Bureau of Consumer Services at: P.O. Box 3265 Harrisburg, PA 17105-3265 800 692 7380 www.puc.state.pa.us ...; . , ;: BY TELEPHONE To pay your bill by phone, call us at 888 608 6690. A convenience fee applies for this service. BY DIRECT DEBiT E-Pay is our free direct payment program that automatically deducts your bill payment from your bank account. Call or e-mail us for an application form, or download the form from our website. IN PERSON Pay by cash, check or money order at athird-party payment center in or around your neighbofiood. Contact us or visit our website for locations. You can also leave a payment (check or money order) 24 hours a day in the drop-box at two different locations: 4211 East Pork Circle, Harrisburg, PA 8189 Adams Driue, Hummelstown, PA ,~1 BY MAiI LrJ For your convenience, a return envelope accompanies this statement and should be used to make payments by mail. Please include your bill stub to avoid a delay in processing your payment. DO NOT SEND CASH. ONLINE To pay your bill online please visit www.unitedwater.com and click on the Western Union SpeedPay link. A convenience fee applies for this service. EMPLOYEE IDENTtfICATION All company employees are uniformed and wear identification badges with the company logo, the employee's picture and name, and the dote the card was issued. Please ask to see it, or call us to confirm on employee's name. .._ .. RATE SCHEDULE A rate schedule and explanations of the various charges and how to verify the accuracy of a bill are available for review on our website. CONSUMPTION UNIT OF MEASURE MGL: One thousand gallon units PRORATED BILLS We prorate your bill when it is for a partial billing period or when more than one rate is in effect during the billing period. ESTIMATED BILLS We estimate your bill when we cannot obtain an actual meter reading. ' TRAVELERS INSURANCE.COM 29000 AURORA RD SOLON OH 44139 MICHAEL GILDER ESTATE 11 KINGSWOOD DR MECHANICSBURG PA 17055 Account Bill Account No. 983906881 Please refer to this billing account number 03229 when calling or making payments. 670 Billing Date: JULY 14. 2010 Due Date: AUGUST 10, 2010 QUESTIONS? CALL US: claim service 1-800-CLAIM-33 Polley Questions or Change of Address 1$00-84Z-5075 To view or pay your bill online visit mytravelers.com Minimum Unpaid Policy Name Policy Number Policy Period Amount Due Balance Automobile 983906881 101 1 Cancelled $11 .84 $11 .84 Prior Service Charge Due~~ ~ $ 5 Total r`~ ~l~:f~' t 1.~~{- ~ I.B~- 1z~ Please read important information on reverse side. Please detach and mail the lower portion of this bill with your payment in the enclosed envelope to TRAVELERS, ONE TOWER SQUARE, HARTFORD, CT 06183-1001. Thank You. Policy Payment Information i TRAVELERST INSURANCE.COM 29000 AURORA RD SOLON OH 44139 MICHAEL GILDER ESTATE 11 KINGSWOOD DR MECHANICSBURG PA 17055 Automobile Account Bill Account No. 983905881 Please refer to this billing account number ass when calling or making payments. 6T0 Billing Date: JUNE 21, 2010 Due Date: JULY 10.2010 QUESTIONS? CALL US: claim service 1-800-CLAIM-33 Pocky Cuestions a Change of Address 1-800-842-6075 To pay online visit mytravelers.com Save money and have the peace of mind of knowing your policy premiums are paid automatically. Simply enroll to pay automatically by credit card or bank account. The two easy ways to enroll are to complete and return the form on the reverse side or go to www.amp.travelers.com. rvttcv rayrn~nt ~r~rv«rra~iur~ Minimum Unpaid Policy Name Policy Number Policy Period Amount Due Balance Automobile 983906881 101 1 06/01/10 to 12/01/10 a52. 16 $260.84 Service Charge This Month X5.00 x5.00 Total g`~ =57.16 6265.84 ti o~/2 i Please read important information on reverse side. Please detach and mail the lower portion of this bill with your payment in the enclosed envelope to TRAVELERS, ONE TOWER SQUARE, HARTFORD, CT 06183-1001. Thank You. ---------------------------------------------------------------------- Make checks payable to: Travelers Indemnlty and af171/ates ego ~ 004218/04162 F3116D01 T 1ST 06/21/10 owce3a INSl1RANCF C(~M MICHAEL GILDER ESTATE Billing Account No. 983906881 Please do not staple your check to this stub. TRAVELERS REMITTANCE CENTER ONE TOWER SQUARE HARTFORD, CT 06183-1001 III~~~~II~~~~~III~~I~~~II~~~~IIII~~~II~~~~~~IIII~~~I 0039383339303638383140393939391400000571600002658465 AMOUNT ENCLOSED UNPAID BALANCE ssss.8a MINIMUM AMOUNT OUE 657.1 s DUE DATE JULY 10. 2010 PL-9837 DETACH AND RETURN UPPER PORTION WITH PAYMENT Qlt~7E ~~' PAT#~ET ICE C.kGRt pl@CEiRT~ 6AlA1~tCL fNS. !~#~HAEL ~~~~El~ ~~`I'f~~'~ 03/23/09 05/28/10 08/24/10 07/1 6:10 03!23;09 05/28'10 03r23~09 05128 10 03/23/09 05;28110 03!23/09 05/28/10 03!23/09 05/28/10 03/23/09 05/28/10 PLATINOL 10MG J9080 182.8 GENERAL WRITE-OFF CHECK PAYMENT FROM PATIENT CHECK PAYMENT FROM PATIENT INITIAL CHEMO INFUSN UPTO 1 HR 98413 182.8 GENERAL WRITE-OFF CHEMO INFUS EACH AODI t 8 HRS 98415 182.8 GENERAL WRITE•OFF CHEMO INFUS SEOUEN UPTO 1HR 98417 182.8 GENERAL WRITE-OFF ALOXI 25 MCG J2489 1ez.e GENERAL WRITE-OFF OEXAMETHASONE t MG J1100 182.8 GENERAL WRITE-OFF MANNITOL 25%/50ML J2150 182.8 GENERAL WRITE-OFF p~d• 5--3-~io cK~ ~Z9 ~ ~6n.o~ 880.00 151 .87 330.00 78.13 t 00 00 225.00 1 t 2.50 t 12.50 80.00 30.00 30.00 93.00 a8.50 48.50 450.00 225.00 225.00 25.00 12.50 12.50 10.00 5.00 5.00 .. .. .. .. ~~ .... ~.... ~ ~ ~^..~ w~ •,~,-,~r,a rA w ~ w ~~/~c ^1~ ~c ~ ~DA~~ scf'~C~~T~F • i ~ EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 r TAX ID# 23-2937659 PHONE ~ (717) 558-7350 a EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG, PA 17111 PHONE: (717) 558-7350 MICHAEL GILDER ESTATE 1 1 KINGSWOOD DRIVE MECHANICSBURG PA 17055-2761 2 ACCOUNT NUMBER: 59079 BILLING DATE: 08/02/10 DATE OF LAST PYMT: 07/16/10 AMOUNT NOW DUE: 6066.35 AMOUNT ENCLOSED: CHARGE AMOUNT OUE TO MY: MABTERCARD _ VISA _ EXP DATE CHARGE ACCT ~: _ _ _ _ - _ _ _ _ • _. - - - ' .___ _ _ _ PRINT NAME: SIGNATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT ., a~ I~e~~T~~ ~ .. .. . . G€~D~t~> ~ST~4TE l~E~H.: ; , 03/23/09 IV INFUSION SEO UP TO 1HR 50.00 25.00 98387 182.8 05/28/10 GENERAL WRITE-OFF 25.00 03/23/09 IV INFUSION CONC UP TO 1 HR 32.00 18.00 98388 182.8 05/28/10 GENERAL WRITE-OFF 18.00 03/23/09 IV HYDRATION EACH ADOTI HR 84.00 32.00 `, 98381 182.8 05/28/10 GENERAL WRITE-OFF 32.00 03/23/09 NOR.SAI-STERL 5000C ~ 30.00 15.00 J7040 182.8 05/28/10 GENERAL WRITE-OFF 15.00 03/24/09 OV EST PT WIO MO 30.00 t 5.00 99211 182.8 05/28!10 GENERAL WRITE•OFF 15.00 03/24/09 ETOPOSIDE, 10 MG 480.00 230.00 J9181 182.8 05/28/10 GENERAL WRITE-OFF 230.00 03/24/09 INITIAL CHEMO INfUSN UPTO 1 HR 225.00 112.50 98413 182.8 05/28!10 GENERAL WRITE-OFf 112.50 03/24/09 KYTRIL 100MCG 254.00 127.00 ,11828 182.8 05/28/10 GENERAL WRITE-OFF 127.00 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* * cuter : ~>I:.~a ~YS~,: : s~~~o a~~l} ,~i,r~o a~YS : c~rra~e ~~ ~x~:,, sari, ,, cry ~ AhlkOtf .<. .. ,, ;: EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # (717) 558-7350 t 3 EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG, PA 17111 PHONE: (T17) 558-7350 MICHAEL GILDER ESTATE 1 1 KINGSWOOD DRIVE MECHANICSBURG PA 17055-2761 CHARGE AMOUNT DUE TO MY: MA8TERCARD VISA _ EXP DATE / _ CHARtiEACCTI: _ _ _ _•_ _ _ _-____• PRINT NAME: SIGNATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT Qh't'E : . .. R~~'#~kT l~fhML~ CHl4. . , . REC~PT~ . M#~I~~~ . 03/24!09 IV INFUSION SEn UP TO 1 HR 50.00 25.00 98387 182.8 05/28/10 GENERAL WRITE-OFF 25.00 03/28/09 OV EST PT W/O MD 30.00 15.00 99211 182.8 05/28/10 GENERAL WRITE-Off 15.00 03128/09 ETOPOSIDE, 10 MG 480.00 230.00 J9181 182.8 05/28/10 GENERAL WRITE-OFF 230.00 03/28/09 INITIAL CHEMO INFUSN UPTO 1HR 225.00 112.50 98413 182.8 05/28/10 GENERAL WRITE-OFF 112.50 03/28/09 KVTRII 100MCG 254.00 t 27.00 J1828 182.8 05/28/10 GENERAL WRITE-OFF 127.00 03/28/09 IV INFUSION SEn UP TO 1HR 50.00 25.00 98387 182.8 05/28/10 GENERAL WRITE-OFF 25.00 04/13/09 OV EST PT W/O MD 30.00 15.00 9921 1 182.8 05/28/10 GENERAL WRITE-OFF 15.00 04/13/09 VENIPUNCTURE 10.00 5.00 38415 182.8 05/28/10 GENERAL WRITE-OFF 5.00 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* * * * cal ~t~.~~r~< : srso:v~~r~ .. ~~1txa>~YS~.:> ~r~::~xQ~xs~ rcxi~tt, ~~MS:a : ~rv«tQu. a~: a~RCm~NCIS > NQI~; ~i~3~~ ACCOUNT NUMBER: 59079 BILLING DATE:. 08/02/10 DATE OF LAST PYMT: 07/16/10 AMOUNT NOW DUE: 6066.35 AMOUNT ENCLOSED: EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # (717) 558-7350 EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG, PA 17111 PHONE: (71T) 558-7350 MICHAEL GILDER ESTATE 1 1 KINGSWOOD DRIVE MECHANICSBURG PA 17055-2761 4 ACCOUNT NUMBER: 59079 BILLING DATE: 08/02/10 DATE OF LAST PYMT: 07/16/10 AMOUNT NOW DUE: 6066.35 AMOUNT ENCLOSED: CHARGE AMOUNT DUE TO M~: MASTERCARD _ VISA _ EXP GATE I _ CHARGE ACCT ~: _ _ _ _ • _ _ _ - • _ _ _ _ - _ ~ _ PIUNT NAME _ SIGNATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT Ci~LiE$ ~ R~C~PT$ @~~: 04/13/09 CBC 13.75 8.87 85025 182.8 05!28/10 GENERAL WRITE-OFF 8.88 04!20/09 OV EST PT EXP FOCUS 70.00 35.00 99213 182.8 05/28/10 GENERAL WRITE-OFF 35.00 04/20/09 VENIPUNCTURE 10.00 5.00 38415 182.8 05!28110 GENERAL WRITE-OFF 5.00 04/20/09 CBC 13.78 8.87 85025 182.8 05/28/10 GENERAL WRITE-OFF 8.88 04/20/09 ETOPOSIDE, 10 MG 480.00 230.00 19181 182.8 05!28/10 GENERAL WRITE-OFF 230.00 04/20/09 PLATINOI 10MG 880.00 330.00 19080 182.8 05/28/10 GENERAL WRITE-OFF 330.00 04/20/09 INITIAL CHEMO INFUSN UPTO 1HR 225.00 112.50 98413 182.8 05/28/10 GENERAL WRITE-Off 112.50 04/20/09 CHEMO INFUS EACH ADDL 1.8 HRS 80.00 30.00 98415 182.8 05/28/10 GENERAL WRITE-OFF 30.00 * * * *CO•PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* * cc,~ a~•s~ an~r~l:< ar;w>~~s ~>k~xr~ crxY~: ~v~:~xe:.u~cx~ ; ;:jmr~ c~~~~r~ ~wvnr~ 1#hlrly EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # 1717) 558-7350 EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG PA 17111 PHONE: (717) 558-7350 MICHAEL GILDER ESTATE ACCOUNT NUMBER: BILLING DATE: DATE OF LAST PYMT: AMOUNT NOW DUE: AMOUNT ENCLOSED: 5 59079 08/02/10 07/16/10 6066.35 1 1 K I NGSWOOD DRIVE CHARGE AMOUNT DUE TO MY: MASTERCARD _ VISA _ ExP DATE CHARGE ACCT I: _ _ _ _ _ ,_ _ _ _ _ _ _ _ _ _ _ MECHANICSBURG PA 17055-2761 PRINT NAME: SIGNATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT ~/t'~B PAT~T ~ . CH141i RI~I~E.tP?~ SAlA:1~t0>~: ~, ~~L~~l~ E~raT~ ~~~~aE~ 04/20/09 CHEMO INFUS SEOUEN UPTO iMR 93.00 48.50 98417 182.8 0512810 GENERAL WRITE-OFF 48.50 04/20/09 ALOXI 25 MCG 450.00 225.00 J2489 182.8 05/28/10 GENERAL WRITE-OFF 225.00 04/20/09 DEXAMETHASONE 1 MG 25.00 12.50 J1100 182.8 05/28/10 GENERAL WRITE-OFF 12.50 04/20/09 MANNITOL 2596/50M1 10.00 5.00 J2150 182.8 05/28/10 GENERAL WRITE-OFF 5.00 04/20/09 IV INFUSION SEQ UP TO 1 HR 50.00 25.00 98307 182.8 05/28/10 GENERAL WRITE-OFF 25.00 04/20/09 IV INFUSION CONC UP TO 1 HR 32.00 18.00 98388 182.8 05/28/10 GENERAL WRITE-OFF 18.00 04/20/09 INITIAL IV HYDRATION UP TO 1 H 1 15.00 57.50 98380 182.8 05/28/10 GENERAL WRITE-OFF 57.50 04/20/09 IV HYDRATION EACH ADDTL MR 32.00 18.00 98381 182.8 05/28/10 GENERAL WRITE-OFF 18.00 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* * * * ~:: 31-MQ ttJ1YS~> ET.~O {?14'll'I!~ '~ta~!! ffXl'~. C:~Y~;t;b~l~M~, :.. 'Tfi~'~l, ; i.~&a~Mili3; ~ h1E31~fN'~: ~'~ .~... ~~ roam ~~~ EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # (717) 558-7350 EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG, PA 17111 PHONE: (717) 558.7350 MICHAEL GILDER ESTATE 1 1 KINGSWOOD DRIVE MECHANICSBURG PA 17055-2761 6 ACCOUNT NUMBER: 59079 BILLING DATE: 08/02/ 10 07/16/10 DATE OF LAST PYMT: AMOUNT NOW DUE: 6066.35 AMOUNT ENCLOSED: CHARGE AMOUNT DUE TO MY: MASTERCARD _ VISA _ EXP DATE I _ CHARGE ACCT I: _ _ _ • _ _ _ _ • _ _ _ _ PRINT NAME: SIGNATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT ~kT~ . > R~TT 1~k~~ ... ~ CRt .` RiBI~NPT3 lA1~Cg .. 04/20/09 NOR.SAL-STERL 5000C 30.00 15.00 J7040 182.8 05/28/10 GENERAL WRITE-OFF 15.00 04!21 /08 OV EST PT W/0 MO 30.00 15.00 99211 182.8 05/28/10 GENERAL WRITE-OFF 1 5.00 04/21/09 ETOPOSIDE, 10 MG 480.00 230.00 J9181 182.8 05/28/10 GENERAL WRITE-OFF 230.00 04/21 /09 INITIAL CHEMO INFUSN UPTO 1 HR 225.00 1 12.50 98413 182.8 05/28/10 GENERAL WRITE-OFF 112.50 04/21/09 KYTRIL 100MCG 254.00 127.00 J1828 182.8 05/28/10 GENERAL WRITE-OFF 127.00 04/21 /09 IV INFUSION SEO UP TO 1 HR 50.00 25.00 98387 182.8 05!28/10 GENERAL WRITE-OFF 25.00 04/23/09 OV EST PT W/0 MD 30.00 15.00 99211 182.8 05/28/10 GENERAL WRITE-OFF 15.00 04/23/09 ETOPOSIDE, 10 MG 480.00 230.00 J9t81 182.8 05/28/10 GENERAL WRITE-OFF 230.00 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* * * * If1~FW~V/~~~~~'ii-~. I~/~I~ EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # (717) 558-7350 EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG PA 17111 PHONE: (717) 558-7350 MICHAEL GILDER ESTATE 1 1 KINGSWOOD DRIVE MECHANICSBURG PA 17055-2761 7 ACCOUNT NUMBER: 59079 BILLING DATE: 08/02/10 DATE OF LAST PYMT: 07/16/ 10 AMOUNT NOW DUE: 6066.35 AMOUNT ENCLOSED: CHARGE AMOUNT DUE TO MY: MASTERCARD ~ VISA _ EXP DATE f CHARGE ACCT I: PRINT NAME: SIGNATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT ~1/k'FE PS~~IE~E1' ~FA>1~11' ~ CtR RE~EtI~Tg S/~LAl HAS. I~I:C~A GlER E~'FJ~TE 04/23/09 INITIAL CHEMO INFUSN UPTO 1 HR 225.00 t 12.50 98413 182.8 05/28/10 GENERAL WRITE-OFF 112.50 04!23/09 KYTRIL 100MCG 254.00 127.00 .11828 182.8 05/2810 GENERAL WRITE-OFF 127,00 04!23/09 IV INFUSION SEa UP TO 1HR 50,00 25.00 98387 182.8 05/28/10 GENERAL WRITE-OFF 25.00 OS/1 1 /09 VENIPUNCTURE 10.00 5.00 38415 182.8 05/28/10 GENERAL WRITE-OFF 5.00 05/t 1109 CBC 1 3.75 8.87 85025 782.8 05/2810 GENERAL WRITE-OFF 8.88 05/19/09 OV EST PT EXP FOCUS 70.00 35.00 99213 182.8 05/28/10 GENERAL WRITE-OFF 35.00 05/19/09 VENIPUNCTURE 10.00 5.00 38415 182.8 05/Z8/10 GENERAL WRITE-OFF 5.00 05/19/09 CBC 1 3.75 8.87 85025 182.8 05/28/10 GENERAL WRITE-OFF 8.88 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* * * * Cv ~1 ~6t1 DAYS: sr•g-o t>~trs >~~~~E- f~XYS4 OV1~ 1+'~ ff7U4~i ~ Tti»~1: i:~dk #T~ 4 . Alh~ EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # X717) 558-7350 8 EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG, PA 17111 PHONE: (717) 558.7350 MICHAEL GILDER ESTATE 1 1 KINGSWOOD DRIVE MECHANICSBURG PA 17055-2761 ACCOUNT NUMBER: 59079 BILLING DATE: 08/02/10 DATE OF LAST PYMT: 07/16/10 AMOUNT NOW DUE: 6066.35 AMOUNT ENCLOSED: CHARGE AMOUNT DUE TO MY: MASTERCARD _ VISA _ EXP GATE CHARGE ACCT ~: _ _ _ _ • _ _ _ • _ . - - ' - _ . PRINT NAME: SIGNATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT Q1kTE P'~L'~T ~ifAlfllE ' ` GR .. ::' gIEEpPT~t QALAI~E. ~11~5: 05/19/09 ETOPOSIDE, 10 MG 480.00 230.00 J9181 182.8 05/28/10 GENERAL WRITE-OFF 230.00 05/19/09 PLATINOL 1OMG 880.00 330.00 J9080 182.8 05/28/10 GENERAL WRITE-OFF 330.00 05/19/09 INITIAL CHEMO INFUSN UPTO 1 HR 225,00 1 12.50 98413 182.8 05/28/10 GENERAL WRITE-OFF 112.50 05/1 9/09 CHEMO INFUS EACH ADDL 1 -8 HRS 80.00 30.00 98415 182.8 05/28/10 GENERAL WRITE-OFF 30.00 05/19/09 CHEMO INFUS SEOUEN UPTO 1HR 93.00 48.50 98417 182.8 05/28/10 GENERAL WRITE•OFF 48.50 05/19!09 AIOXI 25 MCG 450.00 225.00 J2489 182.8 05128!10 GENERAL WRITE-OFF 225.00 05/19/09 DEXAMETHASONE 1 MG 25.00 t 2.50 J1100 182.8 05/28!10 GENERAL WRITE-OFF 12.50 05/19/09 MANNITOI 2596/50ML 10.00 5.00 J21 50 t 82.8 05/28!10 GENERAL WRITE-OFF 5.00 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* * * * CtitF > , . ~t~~Q ft~lY>~ ' tl~1-0<pik~f~ . 9~=12Q tt~Y~:. OY~ 1.'CQ~~aY~: . 'Ct~'~kh ? t.CdiS tT~11i l0 ALfNT' ,, :.: l~-CG~it~t1'..~A~AN~i~. INRti~A1rC.. R (~~~ ~3WE' EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # 1717) 558-7350 EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG, PA 17111 PHONE: (717) 558-7350 MICHAEL GILDER ESTATE 1 1 KINGSWOOD DRIVE MECHANICSBURG PA 17055-2761 9 ACCOUNT NUMBER: 59079 BILLING DATE: 08/02/10 DATE OF LAST PYMT: 07/16/10 AMOUNT NOW DUE: 6066.35 AMOUNT ENCLOSED: CHARGE AMOUNT DUE TO MY: MASTERCARO _ VISA _ EXP DATE f CHARGE ACCT I: _ _ _ _ - _ _ ._ _ - _. _ - - ' - - - PRINT NAME: SIGNATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT ; ' ' 4'!#14R H~CEtPl'S >31~LA q~S. QA,?~`E. NAME ' f PX?l~ 05/19/09 IV INFUSION SEO UP TO 1 HR 50.00 25.00 98387 182.8 05/28/10 GENERAL WRITE-OFF 25.00 05/t 9/09 IV INFUSION CONC UP TO 1 HR 32.00 18.00 98388 182.8 05/28/10 GENERAL WRITE-OFF 18.00 05/1 9/09 IV HYDRATION EACH ADDTL HR 84.00 32.00 98381 182.8 05/28/10 GENERAL WRITE-OFF 32.00 OS/1 9/09 NOR.SAL-STERI 5000C 30.00 15.00 J7040 182.8 05/28/10 GENERAL WRITE-OFF 15.00 05/20/09 OV EST PT WIO MD 30.00 15.00 99211 182.8 05/28/10 GENERAL WRITE-OFF 15.00 0520/09 ETOPOSIDE, 10 MG 480.00 230.00 J9181 182.8 05/28/10 GENERAL WRITE-OFF 230.00 05/20/09 INITIAL CHEMO INFUSN UPTO 1 HR 225.00 112.50 98413 182.8 05/28/10 GENERAL WRITE-OFF 112.50 05/20/09 KYTRIL 100MCG 254.00 127.00 J1828 182.8 05/28/10 GENERAL WRITE-OFF 127'00 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* * * R:<< ~~ EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # (717) 558-7350 ~ ~ EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG, PA 17111 PHONE: (717) 558-7350 MICHAEL GILDER ESTATE 1 1 KINGSWOOD DRIVE MECHANICSBURG PA 17055-2761 10 ACCOUNT NUMBER: 59079 BILLING DATE: 08/02/10 DATE OF LAST PYMT: 07/16/10 AMOUNT NOW DUE: 6066.35 AMOUNT ENCLOSED: GRANDE AMOUNT DUE TO MY: MASTERCARD _ VISA _ EXP DATE / ~_ CHARGE ACCT !: ,_ _ _ _ - _ - - PRINT NAME: SIGNATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT QrhTB: ; P~T~kT t~AMl; :; ~4R0~ R~~Eip1'S S14LA~C$ 05/20/09 IV INFUSION SEA UP TO 1 HR 50.00 25.00 98387 182.8 05/28/10 GENERAL WRITE-OFF 25.00 05/21 /09 ETOPOSIDE, 10 MG 480.00 230.00 J9181 182.8 05/28/10 GENERAL WRITE-OFF 230.00 05/21 /09 INITIAL CHEMO INFUSN UPTO 1 HR 225.00 1 12.50 98413 182.8 05/28/10 GENERAL WRITE-OFF 112.50 05/21/09 KYTRIL t00MCG 254.00 127.00 J1828 182.8 05/18/10 GENERAL WRITE-OFF 127.00 05/21 /09 IV INFUSION SEO UP TO 1 HR 50.00 25.00 98387 182.8 05/28/10 GENERAL WRITE-OFF 25.00 08/09/09 OV EST PT EXP FOCUS INSURANCE COPAY 70.00 5.00 99213 182.8 07/20/09 CHECK PAYMENT FROM INS MCARE 25.00 07/20/09 3 RIVERS HLTH MA ADJ 35.00 05/28/10 GENERAL WRITE-OFF 5.00 08/18/09 OV EST PT EXP FOCUS INSURANCE COPAY 70.00 5.00 99213 182.8 09/21!09 CHECK PAYMENT FROM INS MCARE 25.00 09/21 i09 3 RIVERS HLTH MA ADJ 35.00 05/28/10 GENERAL WRITE-OFF 5.00 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* * * Cttt~' ~1~~0 t7~1Y~> ;'~9~90 ClIkY>~ fft<t3E0;t~A1~li OVE~``1R~flX'~ : TUT~C,.:., ! tai*~li.lQ ~I~I~~':. .,, ..:., ACC~7UF!~1' ~~I#:A~!la~ INi{:F~fAMCR> ~~~,~~~,`: EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # (717) 558-7350 ~• ~ EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG, PA 17111 PHONE: (717) 558-7350 MICHAEL GILDER ESTATE 1 1 KINGSWOOD DRIVE MECHANICSBURG PA 17055-2761 11 ACCOUNT NUMBER: 59079 BILLING DATE: 08/02/10 DATE OF LAST PYMT: 07/16/10 AMOUNT NOW DUE: 6066.35 AMOUNT ENCLOSED: CHARGE AMOUNT DUE TO MV: MASTERCARO _ VISA _ EXP DATE I _ CHARGE ACCT I: _ _ _ _ - _ _ _ _ • _ PRINT NAME: SIGNATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT £~jt''~'E I~JRTi~t' >~fk~>~ ~ " "q:~14Rt~. R~~~NtS B~4L/E NHS. 'IVIIC~A ~#~~DE~ ~STA'~~ 08/31 /09 OV EST PT EXP FOCUS INSURANCE COPAY 70.00 5.00 99213 182.8 09/28x09 CHECK PAYMENT FROM INS MCARE 25.00 09/28/09 3 RIVERS HLTH MA ADJ 35.00 05/28110 GENERAL WRITE-OFF 5.00 10/09/09 OV EST PT M00 CMPLX INSURANCE COPAV 95.00 5.00 99214 182.8 11!10/09 CHECK PAYMENT FROM INS MCARE 44.42 1 1!10/09 3 RIVERS HLTH MA AOJ 40.58 05/28/10 GENERAL WRITE•OFF 5.00 a PPL Electric Utilities Electric Service For: MICHAEL GII.DER-ESTATE 711 OLD 5ILVER SPRNG RD MF,CHANICSBURG PA 17055 Questions about this bill? Please contact us Auk 27 at 1-SOO-3~1 S77S (1-500-DIAIrPPL) or write to: Customer Service 827 Hsus~man Rd. Allentown, PA 18104-9392 www.pplelectric.com Electric Use This graph.shows your ele~nc use over the last 13 months. Types of Meter Readings: Actual - Adjusted - Estimated Customer 0 ~ ~ i ~•:•!"~.•'.-' Page 1 :--' p p •-- •'~:: • 49610-86013 •, ,~ ~~: Summary Page Balance as of Aug 6, 2010 $0.00 Chaar~es: Tota~PL ELECTRIC UTILITIES Cha~ es 17.93 Total WASHINGTON GAS ENERGY SERVICES urges Total Charges $54.01 Account Balance 36 30 24 18 12 6 0 ~d . ~ -,~ 3 -- Z~ I D G~~ ~ 31 KWH - Average Per Day Meter Reading Wormation $36.08 Meter #84572176 2 ~ 25 Actual 1 Ju1 5 53 32 Da s KWH Billed 388 Avenge -Aug 2009 2010 T mpeta~ure ~ 72F 12 78F l2 NH Per Day K Yearly Use: Tots! Avers Use Mont Sep 2008 -Aug 2009 7958 66 Sep 2009 -Aug 2010 5008 4l 7 ASONDJFMAMJJA 2009 .- Months 2010 Other importaat information oa back ~ +; 1 ~ I 1~ ; ~ ~ ~ i ~•:•"'•.•;-' Page 3 PPL Electra ~~~- pp ..:.::..:.......... .... , : ; Utilities , . • ~ 49610-86013 '~ n :: i~ . ~ ~. Electric Totem fro,,, L~ B,u a~~,9 Service Pay~~nt x~ceivcd Ja! Z7 - Tlwnk Yow ~ s4~ 79 F°r: Billingp Details MICHAEL GII.DEA-ESTATE b 711 OLD SILVER SPRNG ItD Balance as of Au 2010 g ~ $0.00 MECHAIVICSBUAG PA 17055 Current Charges WASSII~tGTON GAS ENERGY SERVICES Customer Service DRIVE LJNRISE VALLEY SUITE 200 HERNDON, VA 20171- 1-888-884-9437 PPL Electric Utilitlea Customer Service 827 Hausman Rd. Allentown, PA 18104-9392 1-800-342-5775 (1-800-DIAI.-PPL) www.pplelectric.com Charges for -WASHINGTON GAS ENERGY SERVICES General Service Rate: WGESD for Jul 1 -Aug 2 Total Use: 388 Kwh At $0.093 Per Kwh 36.08 Gross Receipts Tax $2.13 Total WASHINGTON GAS ENERGY SERVICES Charges $36.08 Current Charges Charges for -PPL ELECTRIC UTILITIES Residential Rate: RS for Jul 1 -Aug 2 Distribution Charge: Customer Chazge 8.44 200 KWH at 2.90600000¢ per KWH 5.81 188 KWH at 2.64000000¢ per KWH 4.96 PA Tax Adj Surcharge at 0.10300000% 0.02 Transition Charge: 200 KWH at -0.35600000¢ per KWH -0.71 188 KWH at -0.31525000¢ per KWH -0.59 Total PPL ELECTRIC UTILITIES Charges $17.93 ...... .. ..................:......... Account Balance 554.01 General Generati~ prices and charges are set by the electric generation sup~lier have hosen The Pubic Utilit Commissi n t di trib i y Infornlati n O . y o re e as s u on nc p es and services. The Federal Energy Regulatory~omnussion regulates transmission prices and services. Next meter reading on or about PPL Electric Utilities uses about $0.08 of this bill ropey state taxes. In addition about $1 05 of this bill pays the PA Gross Recei ts Tax Aug 31 , . p . For our convenience, you can now pa your bill using your Vi Mas~erCazd, Discover, or ATM Card all BillMatriz at 1-80072-2413. B111Matriz will charge your credit and ATM card a service fee for making this payment. Before diggin around your home or property, you should always call the state's One Ca~ notification system to locate any underground utility lines. You can do this by simply dialing 811, which will connect you to the One Call system. Be safe and ca1181 I before you dig. With pa less billing, you caa receive and pay your PPL Electric Utilities bills onI-me. The process is free, quick, convenient and secure. To learn more or sign up, visit www.pplelectnc.com. Don't set your thermostat lower than normal when yyou turn on your air conditioner. It will NOT cool faster. It WILL cool fo a lower temperature than you need and waste energy. Save postage and late charges -sign up for Automated Bill Payment. .are --- 4()t>V MOn2on Way, Suite 1 W FIRST Irving TX 75063 . HORIZON_ HOME LOANS 5-863-47550-0000953-001-1.100-100-000-000 ES?ATE OF MICHAEL D GILDER 11 RINGSWOOD DR \,tECHANICSBL'RG PA 17035-2761 MORTGAGE ACCOUNT STATEMENT For mortgage 1-800-364-7662 account informatioe: Monday -Friday lam - 8pm CT Pay online at: www.flrsthorizon.com Account Number: 0041791591 Home Phone: 717-697-S23S Work Phone: 717-236-8061 For additional financial services: First Horizon 1-800-615-0822 www. firsthorizon.com c~aclc n... r your addAaa, ~ rumbas c~,.d~ n... and oanp.n a,.Ibnn «socdsl s.axNy ixnib~(:) ar..,ooi~cx «, n+. i.v~a. pia. if you woua ^ and oomplda the lbrtn on the n~vaas aids. ^ NNi u,s auanatc ~K ~~ upon recMpt or payment, yow statement rvtlt be mNNd ACCOUNT INFORMATION Account Number 0041791591 Property Address: Current Statement Date 07/30/10 711 OLD SILVER SPRG Interest Rate for 9/01/10 S.2S000% MECHAICSBURG PA 170SS Current Principal Balance' 510,354.41 Interest Paid Year-to-Date S378.98 Taxes Paid Year-to-Date 50.00 ~ PAYMENT SUMMARY Principal 8t Interest SS36.46 Total Amount Due X36.46 Payment Due Date 09/01 / 10 Q-.~7-Zo to C~-~ 13~ "Th/s Is your Princ/pa/ Balarae oMy, rat tl-o amount required to pay your account !n lull. Mats: Fur-~ subnWted Ehnxph y~ow oMIVM bank/np msy be re~c~ed i! the lands be/rp sent are not suA7clent to pay d-e monthty peyn~ent, your bsn la In a delliKlusnt status, or you hew filed a bankruptcy case drat r: stlN ectws, payn~enfa w!H autornsdcMly be retuned b the rerrNfMr o/ the lands. You cannot make a prtnelpM only piymeni or macs then orn payment th;~onlMa bankMp as • fonds wtl/ not process as Intended. SandMy mon than one bsnsectlon In the same day ror your monthly oerirnant wlN Gauss aN ban not sawt m a aey-nant m be n/acttd. ACCOUNT ACTIVITY --- --- Description Due Date Date Paid Amount Principal Interest Escrow Fees Other Payment Applied 08/01/10 07/30 536.46 489.02 47.44 .00 .00 .00 IT IS VERY IMPORTANT THAT YOU REPORT ANY POSTING ERRORS TO FIRST HORIZON CUSTOMER SERVICE WITHIN 30 DAYS OF T~iIS BILLING. IMPORTANT MESSAGES For Mortgage Account Information: Our customer relations team is available Monday -Friday, lam - 8pm central time to answer questions you may have about your current mortgage account. You may call our toll &ee number 1-800-364-7662 or visit our secure website. TbinWng About Refinancing or Purchasing a New Home? In this changing economy, a home is still your greatest asset and we are here to help. If you are planning to purchase a new home or want to take advantage of low rates and refinance your existing mortgage, please visit www. firsthorizon.com or call us at 1-800-615-0822. PLEASE DETACH AND RETURN BOTTOM POR770N W/71`l PAYMENT IN THE ENCLOSED ENVELOPE ;; < ~1>~ite~t a~fat~~: P*~n~yl~~h~d: Cu~stgrt'irr ~~e Center Q~' : xr: $~$$ >l~>!~t's.l}~'i~. k1>;~~1~lelst>aimt~, PA '~T>~36 Trlsp#~rte. l~l t-~~~-~66Z :. .: - _ u.uttfteesr cro~rt USAGE HISTORY Monthly usage in thousand gallons m 0 3 2 1 0 0 0 0 0 0 0 Jun Jul Aug Sep Oct Nov Dec Jan Mar May Jun Jul Aug Next meter reading date: on or about 09/14/2010 SERVICE TO: MICHAEL GILDER Billing Date: 08/16/10 Account Number: OOZ00999115167 Previous Balance Payments Through 08/16/10 Tnorlkvou $10.5 510.25CR Balance Forward Current Charges Due 09/05/2010 $0.00 $10.25 'QT~4~ ~4ME~UNT ©IJ~ , ~-- $1 a~5 'PAY BY 09/10/10 TO AVOID A 1.596 LATE PAYMENT CHARGE SERVICE ADDRESS: 711 OlD SILVER SPRING RD MECHANICSBURG PA Miter tdumb+~r 5+rrvic~ ; I~+y~ t~f:` I'~~r Realr~f>ng ; #Jsd ~ L o~ f~Ee~adi T~pe .. i, ~. 59794017 07/14/10 08/13/10 30 0084 0084 0 MGI. AC 1 UAl EQUIVALENT TO 0 GALLONS SERVICE CHARGES 10.25 TOTAL CURRENT CHARGES $10.25 SEE REVERSE SIDE FOR IMPORTANT ACCOUNT INFORMATION Go Green. Win Green. See important insert for details or visit www.unitedwater.com/ebillingprize. It is very important that United Water has your correct contact number. We moy need to inform you of an emergency or discuss your b>Ill for services. '=Please be aware that United Water may deliver these messages v~o an automated calling system to the contact number listed on your account''. In the event that your contact number changes, please contact our customer service group to ensure we have your current telephone number. UWPA will conduct asemi-annual flushing of the distribution system in your area from September 7th through the end of October. This moy cause temporary discoloration of water and temporary decreased water pressure. For hydront flushing updates, please ca11717-564-3662. Save a stamp and ggo paperless today! log on to www.unitedwater.com or call Customer Service to find out more information and to enroll in eBilling. Approximate state tax included on this bill $0.49. a 1 0 0 0 RE 1 oY16o PLEASE DETACH HERE AND RETUfiN THE BOTTOM PORTION WITH YOUR VAVMENT IN THE RETUFN ENVELOPE VAOVIDED. 102 1 ~0! UAl1 qa 07022010 PAYAlLE T'O Bpi ~L HECKARD SR 806 SOMERSET DRIVE 717-788-8206 MECHANICSBURO, PA 17066 oExRIPTIar A~NO • 18000088 MAP NO: 18-22-0619.0018 U-A711- P 711 OLD SILVER SPRING ROAD DEED 00265 a' fG 1 WALNUT VILLAS U UNIT 711 BLDC3 A P8 48 PQ 29 Reside~tlal Bulidiny TAX PAYER COPY Bill No: 1052 Control No: 018.000098 ~v of RNI I T Bill Data: 7/01/2010 AsBESSe Land Values 0 Homes ea Exclusion Improvement 79,520 M Hera! 0 Total 79,510 8 581- RO AREA S.0. Rates 1!.70000 L R 8 1!.70000 1!.70000 2 1 168.9! 10 s ead Credit 126. !- TAX A~AOUNT DUE -> sh,o~.s~ >r,o~.~o sh,~s~.a ii t Oa os altos ! lsiS Oa o >Ntoso 7 O1 2010 8 31 2010 9 O1 2010 10 31 2010 11 O1 2010 12 31 2010 RESIDENTIAL B A R R Y TAxPAYER TAX COLLECTOR IL , MICHAEL D X1.00 FEE FOR EXTEIA TAX BBL 711 oL.D SILVER SPRING RoI~E C N a N ~ ~ S A t 1 R G. PA . REtuRN ~ wiTFi PAYMENT, EHC~ osE s~ Aoo~ss sTAi~ anr. MECHANICSBURO PA 17065-2882 IF TAXES ARE IN ESCROW, FORWARD BX.L TO MORT. CO. OFFICE MOORS ~OCY-'AQ~'i TOES d~ THUR 10-4PM SEPT-DEC TOES 10.4PM CLOSED ALL HOLIDAYS CLOSED AUG 6-20 & ELECTION DAY NOTICE OF PROPERTY TAX RELIEF Your enclosed tax bill includes a tax reduction for your homestead and/or farmstead property. As an eli ibis homestead and/or farmstead property owner, you have received tax relief through a~omestead and/or farmstead exclusion which has been provided under the Pennsylvania Taxpayer Relbf Act, a law passed by the Pennsylvania General Assembly designed to reduce your property taxes. • r FAILURE TO RECEIVE BILL DOES NOT ENTITLE CUSTOMER TO NET RATE ~ccaurr nog N.uw oaE 7244-0 07/15/10 711 OLD SILVER SPRING RD 07/01/10 09/30/10 0.00 1.00 70.00 0.00 1000 70.00 08/16/1 77.00 C ~ I.~~ DETACH AND RETURN UPPER PORTION WITH PAYMENT phtTE PST' i~fANl~ '.. ; Cf~ARLi~:: R~~i:IPTS. Bl~lki~g . ~tS: N((~NAh~. ~#~~R ESTATE - 23/09 05/28!10 08/2410 07/1 8/10 08/18/10 23/09 05/28/10 23/09 05/28/10 23!09 05/2810 2 3109 05/28/10 X3/09 05/28/10 13109 05/28/10 PLATINOL IOMG J9060 182.8 GENERAL WRITE-OFF CHECK PAYMENT FROM PATIENT `'(~~ CHECK PAYMENT FROM PATIENT , \\Jv r CHECK PAYMENT FROM PATIENT ` .~\ ~~j INITIAL CHEMO INFUSN UPTO 1 HR ,-~~ ~) ` 98413 182.8 GENERAL WRITE-OFF CHEMO INFUS EACH ADDL 1-8 MRS 98415 182.8 GENERAL WRITE-OFF , CHEMO INFUS SEOUEN UPTO 1HR 984 t 7 182.8 GENERAL WRITE-OFF ALOXI 25 MCG J2489 182.8 GENERAL WRITE-OFF DEXAMETHASONE 1 MG Ji 100 182.8 GENERAL WRITE-OFF MANNITOL 25%/50ML J2150 182.8 GENERAL WRITE OFF 880.00 330.00 78.13 i 00.00 i 00.00 51 .87 225.00 1 12.50 112.50 80.00 30.00 30.00 93.00 48.50 48.50 450.00 225.00 :t 2 5.00 25.00 12.50 12.50 10.00 5.00 5.00 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* * * * Ci+lii 31~8Q pr1Y~~ . ~? !i!: lltY~; A1:~f~t0 tYKYi~ ~. QV~!`l~Qi:#~X~' . *tiX'1~1, L~~>t'~IIpEIQ . /#A~Oiil~. , ,. EAST SHORE OIV~OLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # (717) 558-7350 PPS. El~tric Utilities Electric Service For: MICHAEL GII.DER-ESTATE 711 OLD SILVER SPRNG RD MECHAMCSBURG PA 17053 Q~eatiooa about this bill? Please contact us 24 at 1-500-34~S77s (1-S00-DIAIrPPL) or w-clte to: Customer Service 827 Hausman Rd. Allentown, PA 18104-9392 www.pplelectric.com Electric Use This graph, shows yota electric use over the last 13 months. Types of Meter Readings: Actual - Adjusted - Estia~ated Customer Q ~ I ~ , 1 ' / :•-' ... _ pp •--_ .; . ,, ~~ Summary Page Page 1 49610-86013 ~ r ~~:~ Balance ~ of Sep 3, 2010 ~•~ Char es: Tota~PL Electric Utilities Charges 14.82 Total Washington Gas Energy Services Charges 27.16 Total C~rges $41.98 Account Balance KWH -Average Pet Day 36 30 24 l8 12 6 0 4-z~ - zoro A« X3'1 Meter Reading Information Meter #84572176 Aug 31 Actual 53935 Aug 2 Actual 53643 29 Da s KWH Billed 292 Average -Aug 2009 2010 T a~at~re 75F 75F K\NH Per Day 11 ! 0 Yearly Use: Total Aver e Use Mon Sep 2008 -Aug 2009 8103 67 Sep 2009 -Aug 2010 4957 413 SONDJFMAMJJAS 2009 ~ Months 2010 Other important information on back ~ PPL Electric Utilities 1 ~ ~ `~ ' , . ~/ rr- ... _ p p ~-- _ .; . ~ ry Page 3 { Y ~ .13i#1. 49610-86013 Electric Total jro~n Last Bia ss~ol Service Pay~went Received Awg 24 - Tbank Yow. ~S~OI For: Billin Details MICHAEL GILDER-ESTATE 7l 1 OLD SILVER SPRNG RD Balance as of Sep 3, 2010 $0.00 MECHAMCSBURG PA 17055 Current Charges ~~a~O° ~"s E°e~' Charges for - Washtn~t on Gas Energy Services ' Customer Service VGESD for Augg 2 -Aug 31 General Service Rate: ~ Total Use: 292 Kwh At $0.093 Per Kwli 27.16 13865 SUNRISE VALLEY Gross Receipts Tax ~ 1.60 DRIVE SUITE 200 Total Washington Gas Energy Services Charges $27.16 HERNDON, VA 20171- •~ 1-888-884-9437 Current Charges PPL Electric UtiUties Charges for -PPL Electric Utilities Customer Service 827 Hausman Rd Residential Rate: RS for Aug 2 -Aug 31 . Allentown, PA Distribution Charge: Customer Charge 8.44 18104-9392 i-800-342-5775 P ~ 200 KWH at 2.9()600000¢ per KWH g2 KWH at 2,64000000¢ per KWH 5.81 2.43 ~~ ~D ~~p PA Tax Adj Surcharge at 0.10300000% Transition Charge: 0.02 200 KWH at -0.66800000¢ per KWH -1.34 92 KWH at -0.59200000¢ per KWH -0.54 Total PPL Electric Utilities Charges $14.82 Account Balance $41.98 General Generation prices and charges are set by the•electric generation su lier you have- chosen. The Public Utility Comrrussion re Mates distribution Information nces and services. The Federal Energy Regulatory~omrnission regulates ~tansmission prices and services. Neadu~g~~ on or about PPL Electric Utilities uses about $0.06 of this bill to~ppaay state taxes. In addition, about $0.87 of this bill pays the PA Gross Keceipts Tax. Sep 30 For your convenience, you can now pay~your bill using your Vises _ MasterCard, Discover, or ATM Card L;all BillMatriz at 1-800-672-2413. BII1Matriz will charge your credit and ATM card a service fee for making this payment. Before diggin around your home or property, you should always call the state's One Ca~ norification system to locate any underground utility lines , . You can do this by simply dialing 81 1, which anll connect you to the One Call system. Be safe and call 81 I before you dig. With pa rless billing, you can receive and pay your PPL Electric Utilities bills oni-me. The process is &ee, quick, convenient and secure. To learn more or sign up, visit www.pplelectnc.com. Save postage and late charges -sign up for Automated Bill Payment. Dish washers use about 13 allons of hot water per load That's less than washing dishes by hand Algways use fiill loads on the shortest cycle When . washing dishes by hand, don t let the hot water run continuously. FIRST 400° "°~°~ Way, Suite 100 Irving TX 75063 ~ HORIZON. HOME LOANS ~ 3-663-47733-0000951-001-1-000-100-000-000 ESTATE OF MICHAEL D GILDER 11 KIVGSWOOD DR '~iECHANICSBLRG PA 17055-2761 MORTGAGE ACCOUNT STATEMENT For mortgage 1-800-364-7662 account information: Monday -Friday lam - 8pm CT Pay online at: www.firsthorizon.com Account Number: 0041791591 Home Phone: 717-697-5235 Work Phone: 717-236-8061 For additional financial services: First Horizon 1-800-b 15-0822 www. firsthorizon.com cn.dc n«. R your addrw, p-+aw nun,b~s Ct~acic hens and axnpNla tha tam a SociM ~M nurt~(s) ~ Kioortacx on tM rs~s~ side ~ you would and oort~IMa ttw tam °n 1M iMrs~ side. ^ like fM aubmfOc p~ymarx op0on. upon r•cNpt of paymn~ your:btm•nt will b• -nalld. ACCOUNT INFORMATION PAYMENT SUMMARY Account Number 0041791591 Property Address: Principal & Interest 5536.46 Current Statement Date 08/30/10 711 OLD SILVER SPRG Total Amount Due 536.4 Interest Rate for 10/O1/10 5.25000% MECHAICSBURG PA 17055 Payment Due Date 0/01/10 Current Principal Balance* 59,863.25 Interest Paid Year-to-Date 5424.28 Taxes Paid Year-to-Date 50.00 ~ 9 •' Z7 - 2.0 ~~ uNOas "This Is your Principal Balance only, not the amount required /o payyouraccount /n full. Note: Funds subnMtt•d thraph your online banklrp may be tad JI the funds belnp sent are not sutl7cient to y the monthly payment, your loan Is In a dell--quent status, or you have R/sd a bsMwpAcy case that Is st/ll ecGMs, payments will aut+ornatkelly tie refumed to the renMfler of the /urMa. You cannot rnalce a pdnelpN only payrnpnt or mon Lhan one payment throuoh online batkMp as tfi• funds will not process as Intended. Send/np mon than one transaction in the same day for your monthly Payment will caus• all tfa/l oni not •qusl to 1 paym•nt to b• rif~•ctd. ACCOUNT ACTIVITY Description Due Date Date Paid Amount Principal Interest Escrow Fees Other Payment Applied 09/01/10 08/30 536.46 491.16 45.30 .00 .00 .00 IT IS VERY IMPORTANT THAT YOU REPORT ANY POSTING ERRORS TO FIRST HORIZON CUSTOMER SERVICE WITHIN 30 DAYS OF THIS BILLING. IMPORTANT MESSAGES For Mortgage Account Information: Our customer relations team is available Monday -Friday, lam - 8pm central time to answer questions you may have about your current mortgage account. You may call our toll free number I -800-364-7662 or visit our secure website. Thinking About Refinancing or Purchasing a New Home? In this changing economy, a home is still your greatest asset and we are here to help. If you are planning to purchase a new home or want to take advantage of low rates and refinance your existing mortgage, please visit www. firsthorizon. com or call us at 1-800-615-0822. .« Pl FASF AFTACH AND RETURN BOTTOM PORTION WITH PAYMENT IN THE ENCLOSED ENVELOPE i 80-x111/2919 t DATE u ~ ~S ~ 1 .....~ ~~ -.«.... r"~, DOiIARS ~ ~ .. ~~~ wu~Rrseusic3, w- »~1o-2wo ~ • FOR ~: 2 3 L 38 i ~ ~6~:0 L 39 X04 58 346 2 LOW' ESTATE OF MICHAEL D GILDER NATALIE S GEIGER EXECUTRIX 11 KIN(3SW000 D9 r MECHANICSt3URa, PA 17065 PAY TO THE S~ ~ ORDER of ~_` l,U I I~LI\L r Rzturn this ~~c~ucher ~~-ith your payment or corres~undence. Amount you owe: 282.66 ~'uur Telephone Number: Best Time to C~~II: ( ) - AM Ph~l Amount enclosed: `7'7RU [ 9,830 0 Make payable to United State Treasury • Write Taxpayer ldentitication Number, tax peri~xi and tax term number nn payment O Correspondence enclosed SB 20t0~~ 0107 5922[-170-~1I15-0 l4 [eternal Revenue Service MICHAEL D GILDER Kan~s City, 1~~[c~ G=1999-U20? 11 KINGSWOUD DR MELNANICABURG PA 17055-2761 I~il~~~l~~li~l~~l~l~~l~l~~ll~~~~~l~lli~~~~~l~ll~l~~l /~~ 213561066 JZ GILD 30 0 200412 670 00000028266 ,_~i._ ..,~~- ~~~ c Aq c ?~~ .~,E; °~o 17U~~ IRS r!SE ONt_1' SB 11' !) O ~~) ., ' ['or assistance. ,:;~[I: D~~p;inmant ut` thr ~'r~s;urv (-tiOfi-~?9-~ i ~.1 1 ntrrnal Re. enue Seri ice Philadelphia. P.~ l~)I~~ 1'c-urCullerlO: 7_'7~5~) \~rtice \crnrher: CPI.1 Date: SzPt~•crih~r f.~. 'tl I (J 079349.777523.0305.00? 2 MB 0.507 1120 I~I~~IIII~I~~~~I+I~~I~I~Ill~lll~~~~~l~lltl~'lll~t~~~~~~~lll~lll~l ~•. s c~ MICHAEL D GILDER 11 KINGSWOOD DR MECHANICABURG PA 17055-2761 079349 Anlcrunt Yuu O~~~~ :~s of September 27, 2111 II S2R2.(~6 :~ccurdin;~ to our records, 4ou lla~'e lln :1mUUtlt due o[I Ytlttr 1T1COn1t' tax. PIeaSC CUlnparc' ~oUr' tai relurtl a~aUlst tart' ti~ur~~s belo~~•. lfyuu'~e already paid your tax in till( ur arrangt~d tier all installment a`_rt~tmcnt. pt~~a>~~ disr•~~`,ard this Ilt)ltCc•. 1'ucr r ? 00~ "t'~t x Record Description On lour tteturn Total'Cax~)n Rc'tuc'tt 51,7~~.0(J Lc ss: Tax ~L'ithhe[ct S l.,'?.U(J- k:~timated ['a~mc:nts S.t-U ()they C'rrditr ~.(-t:- C)ther Pa} nlc nts ~? ~~),(Ju- ~[ oral Na~~ctlents ~~: C'r«lits '~ 1,7~?.(.1f.)- t_)~~c~rpaid Tax S.UU I'ena[t~ S [ ~7.2~ nterest (?,, 'I'ota( Amount Yuu Owe ,. _ , ` ~r~~.>~ r~, \1`~ ~~ f ~~~e recei~"e your payment by September 27, 2010, ~r~e «~ill not clitar;;e additic-nal penalt•" and interest. If you agree please: • tiiake the check payable to "United States Treasury." • write your "1';rxpay~~r ldrntitication Number oll ~-our check. • Clse the enclosed en~~elupc•. • Include the tear offstub at the end of this Holier alld make ,ore the l1ZS address sho« s throu;~~h the ~~~indo~~-. tf you disagree please: C'atl tlua eustirnler sere ice nurnber abode. • 1-~a~~e your -ha~payc~r Identification Number a~~ailable. • [t'you ~~~ish to discuss a pa~~ment that you tllade h}, check, lla~~~~ til~ Intcn•rnattorl trorn the front and hack of your cancrlled chuck ~r~~ailal~le. r _~ ~ ~, _ ~ o ' ;? ~ a i ~ .~'.~I~,t~ ~ 1J ~~- '1'a~pa~er I~ientiliratir~n \urnber: ~I ~-~6-IO66 7`ax 1~ urm: I l?fit) 'Tax 1'e:rr: I)~•ccmhcr 31. 'Ot-~ F30~9~?~ Philadelphia Sen~ire Center 13-~G- I OGG ~ Penalty and Interest Tax P~~riud: December ? 1, 200~t .~~bout Your Notice -The penalty and/or interest charges on your account are explained on the following pages. If you want a more detailed explanation of your penalties and interest, please call the telephone number listed c>n the tc~p of this notice. You may call your local IRS telephone number if the number shown on y~x~r notice is a ~~~~ long-distance call tier you. All days mentioned in the paragraphs below are calendar days, unless specifically stated otller<vise. 079349 01 Penalty fur Filing Return Late 5100.00 Penalties: 5157.25 We charged a penalty because you tiled your return late. tVe use the number ot~ months the return is late to determine the penalty. If you tiled more than GO days late, the mitlimuln penalty may apply. Clle [111nlltluill penllly is the lesser of S I OU or 100°io ot~ the tax due, for returns due before 12/31 /2008, For returns due after 12/3 I'2008, the minimum penalty is the lesser of S l35 or 100°% of the tax due. I fyou disagree with this penalty, see "Removal of Penalties" in this notice. "fo avoid this penalty in the future, yi~u should file your returns by the return due date. (/-ttc~rr~crl Rc~~~c~ncrc~ G>cfe .cc~c•tivn fib? I 07 Pen~t[ty for Paying Tares Late 557.25 We charged a penalty because you paid your tares late. We count part of a month as a full month. I F you disagree with this penalty, see "Removal of Penalties" in this notice. To avoid this penalty in the future, you should pay your taxes by the due date. Even if you have an extension to file your tax return, you do not have additional time to pay your tar. (Ir~terr~ul Rel~entre Cede section bb S I The table below shows how we figured your penalty. We multiplied the number of months times the monthly rate (1 /? percent) times the principal. (nut to exceed 25%). Date No. Months Rate/Month Principal Penalty 05/15/2010 50 0.50 229.00 57.25 Total Penalty: 57.25 Removal of Penalties The law lets us remove or reduce penalties if you have reasonable cause or receive erroneous written advice from [RS. Reasonable Cause [f you believe you have an acceptable reason why [RS should remove or reduce your penalties, send us a signed explanation. after we review your explanation, we will notify you of our decision. In some cases, we may ask you to pay the tax in full before we reduce or remove the penalty for paying late. p.v~a Z tau-+v,~,.~ Philacirlphia S~n~irr Center 13-~G- I (1(~(i ~(~.ix P~°ricxi: ~~ Additional Interest Charges T f 079349 I t the amount you once is S 100,000 or more, please make sure that «~e recei~~e your payment ~rithin I U work days from the date of your notice. [f the amount ~~ou o~ve is less than S 1 OO,UUt), pl~~ase tl~ake ;ore that we recci~~e your payment ~~~ithin ? 1 calendar days from the date of vuur notice. if ~~ e don't receive titll payment «~ithin these time frames, the law requires us to charge interest until you pay the full amount you o~~~e. r i,., .. , . . , Philadelphia Sen•ice Center ~13-~G-IOhG C: [': Tax Period: December 3 t, ~i10=~ CUT OUT AND RETURN THE VOUCHER l1~[M1tEDIATELl' BELO«' IF ~'OU ONLY HAVE AN INQUIRY. DO NOT USE 1F YOU ARE 1~1Ah1NG A PAYMENT. CUT OUT AND RETURN THE VOUCHER AT THE BOTTOM OF TH[S PAGE [F YOC- ARE i~[AkING A PAYI~~IENT, EVEN 1F YOU ALSO HAVE AN INQUIRY. ~ 079349 4 d`' ('U7' tIERF Return this ~ Quebec ~c ith }our inquiry or correspondence. 1~'c~ur "i'el~~phone Number: Best Time to Call: 1 ) - Av1 PM ?7.75O ! 9,~3~ 0 SE3 201U3~ 0107 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~4~~~~~~~~~~~~ 213561066 JZ GILD 30 0 200412 670 00000028266 Q~~ ••..'r ~IG'D~ --- - O Correspondence enclosed: • Write your Taxpayer Identitiratiun Number, tax period and tax form number un your inquiry ur rurrespundence 5922 1-1 70- ~ 1 118-0 1-); Internal Re~•enue Sen~ice h11CHr1EL D GILDER P.(?. Box I C,22G I 1 KINGSW'UOD DR Philadelphia, P~~ 1911-1-~2?6 NtEC}IAN{C.AEil1RG PA 17Q~~-?7fil Internal Revenue Service t7nircd States L~rp~rune~t of ehe Trrasury This Product Contains Sensitive Taxpayer Data Request Date: 09-20-2010 Response Date: 09-20-2010 Tracking Number: 100078801601 Account Transcript FORM NUMBER: 1040 TAX PERIOD: Dec. 31, 2004 TAXPAYER IDENTIFICATION NUMBER: 213-56-1066 MICHAEL D GILDER 11 KINGSWOOD DR MECHANICABURG, PA 17055-2761-114 00183` --- ANY MINUS SIGN SHOWN BELOW SIGNIFIES A CREDIT AMOUNT --- A000UNT BALANCE: 282.66 ACCRUED INTEREST: 0.00 AS OF: Sep. 06, 2010 ACCRUED PENALTY: 0.00 AS OF: Sep. 06, 2010 ACCOUNT BALANCE PLUS ACCRUALS (this is not a payoff amount): 282.66 ** INFORMATION FROM THE RETURN OR AS ADJUSTED ** EXEMPTIONS: O1 FILING STATUS: Si~gl• ADJUSTED GROSS INCOME: 27,780.00 TAXABLE INCOME: 19,830.00 TAX PER RETURN: 1,752.00 SE TAXABLE INCOME TAXPAYER: 0.00 SE TAXABLE INCOME SPOUSE: 0.00 TOTAL SELF EMPLOYMENT TAX: 0.00 RETURN DUE DATE OR RETURN RECEIVED DATE (WHICHEVER IS LATER) PROCESSING DATE TRANSACTIONS CODE EXPLANATION OF TRANSACTION CYCLE DATE 150 Tax return filed 20103408 09-06-2010 89221-170-51118-0 806 W-2 or 1099 withholding 04-15-2005 610 Paya~e~t with return 05-02-2010 166 Penalty for filing tax return 20103408 09-06-2010 after the due date 276 Penalty for late payment of tax 20103408 09-06-2010 196 Interest charged for late paya~e~t 20103408 09-06-2010 971 Notic• issued 09-06-2010 This Product Contains Sensitive Taxpayer Data May 02, 2010 Sep. 06, 2010 AMOUNT s1,752.00 -s1,523.00 -1229.00 s100.00 s57.25 5125.41 so.oo ~ Internal revenue Service ['nitcd Stara D~parnncnt of the Treasury PHILADELPHIA, PA 19255-1498 001834 Tracking ID: 100078801601 Date of Issue: 09-20-2010 Tax Period: -~ecember, 2004 Information about the Request We Received 001834.777551.0007.001 1 I~iH 0.3BZ 540 ~~~~~~~~~~~~~~~~~~~~~~~~~t~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ MICHAEL D GILDER 11 KINGSWOOD DR MECHANICABURG, PA 17055 In this latter, we'll report the status of the request we received. Ws'vs enclosed the transcript or transcripts that you requested on September 20, 2010. A transcript of account shows a summary of your tax return and subsequent actions taken. Thes• actions could include payments, amended returns, and corrections we made to the original return due to math mistakes. Information for current tax years is available immediately on our computer systems. Delivery time to you depends on how you submit your request and the delivery method you select to receive the information. If you have any questions about information contained in the transcripts or other enclosed information, please call us at the IRS telephone number listed in your local directory or at 1-800-829-8374. Sincerely Yours. 6eth Jones, Director Electronic Products 8 Svcs Support Enclosures: Account Transcript RCA -Adjustment Print Page 1 of 1 PIP#1117411447 TC161 -100.00 BL1C05 INPUT-DT 09/27/2010 sEQ#1 271 -57.25 Reasonable Cause Summary TIN: 213-56-1066 MFT: 30 Name Control: GILD Tax Period: 200412 Category Conclusion: First Time Abate FTF First Time Abate FTP Module Conclusion: First Tlme Abate FTF Flrst Time Abate FTP The penalty(s) for Failure to File (FTF) and/or Failure to Pay (FTP) can be removed because this is the first time the taxpayer has filed a return. Any explanation provided by the taxpayer has not been considered as a basis for reasonable cause. In a similar situation in the future, the taxpayer could be penalized for non-compliance. Letter 3503C should be sent to the taxpayer explaining this one-time-only removal and informing them that they should receive a notice of penalty adjustment within the next few weeks. https : //amsrca.enterprise. irs. gov/rca/AutoPrint. j sp 9/27/2010 tF1~ - - .Qtr s~tt~sy,>~grt; ~~ ~uStoA:er 56~icB Cetlter X189 Ad~e1~s * hlt~~trnelstvwn, pA t 7f33r~ ,. ,, ..; .... . .. u-,uttft8~ltilla~'rt USAGE HISTORY Monthly usage in thousand gallons O Jul Aug Sep Oct Nov Dec Jan Mar May Jun Jul Aug Sep Next meter reading date: on or about 10/14/2010 Billing Date: 09/15/10 Account Number: 00200999115167 Previous Balance $10.25 Payments Through 09/15/10 Tnc-Ik rcu $10.25CR Balance Forward $0.00 Current Charges Due 10/05/2010 $10.25 TOTAL 1~ME~UN~' DUB - ..~~~ ~ ~ $1 t~.2~ •PAY BY 10/10/10 TO AVOID A 1.59b LATE PAYMENT CHARGE SERVICE TO: MICHAEL GILDER SERVICE ADDRESS: T11 OLD SILVER SPRING RD MECHANICSBURG PA M~111~ kwr~ber Ssrw~e,; ~ Mir Rradi~~ ; ~~ U~ . ~tarage Rea~19r~ Typs . ~.;: ,~tlE ..... S:t.: 5979401 T 08/13/10 09/14/10 32 0084 0084 0 MGI. ACTUAL EQUIVALENT TD 0 GAItONS SERVICE CHARGES $10.25 TOTAL CURRENT CHARGES $10.25 SEE REVERSE SIDE FOR IMPORTANT ACCOUNT INFORMATION It is very important that United Water has your correct contact number. We may need to inform yyou of an emergency or discuss your bill for services. "Please be aware that United Water may deliver these messages vio an automated calling system to the contact number listed on your account". In the event that your contact number changes, please contact our customer service group to ensure we have your current telephone number. UWPA will conduct asemi-annual flushing of the distribution system in your area from September 7th through the end of October. This may cause temporary discoloration of water and temporary decreased water pressure. For hydrant flushing updates, please ca11717-564-3662. Save a stamp and ggo paperless today! log on to www.unitedwater.com or call Customer Service to find out more information and to enroll in eBilling. Approximate state tax included on this bill $0.49. r 0 0 0 0 RE 207~G4 PLEASE DETA[H HERE AND AETUIIN THE 9GTTOM POnT10N WITH YOUN PAYMENT IN THE NETUitN ENVELOPE PROVIDED. 102 1 J00 MAROe 07022010 • More saving. More doing:" 6000 CARLISLE PIKE, MECH PA 17055 STORE M~ANIIGER CFET KEEI.EY 1717) 795-9602 4120 00002 61248 06/12/10 12:22 PM CASHIER QOREEN - DR54NF1 060134870017 KEYLOCK <A~ 8.97 SALES TAx 0.54 TOTAL X9.5 xxxxxxxxxxxx8061 VISA RUTH CODE 071248/7021667 ~tA 1 RETURN POLICY DEFINITIONS POLICY IO DAYS POLICY E~IA£S ON A 1 90 09/10/2010 ThE HOME OEPOT RESERVE5 TFE RIGHT TO LIMIIT /DENY RETURNS. PLEASE SEE TFE RETURN POLICY SIGN IN STORES FOR DETAILS. GUARANTEED LON PRICES LOOK FOR H OF LONER PRICES STOREMIDE ~. io-~~-~~o ~-i ~~, a PPL Electric Utilities Electric Service For: MICHAEL GILDER-ESTATE 71 l OLD SILVER SPRNG RD MECHAMCSBURG PA 17055 Questions about this bill? Please contact us Oct 25 at 1-500-34 -5775 (1-500-DIAI.-PPL) or write to: Customer Service 827 Hausman Rd Allentown, PA 18104-9392 warwr. pplelectric. com Electric Use This graph shows your electric use over the last 13 months. Types of Meter Readin s: g Actual - Adjusted - Estimated Customer ,~, ~ ~ ~ '~~~~:.:.~.~.- Page 1 ^.. _ : Y'' p p ....:. ........... ~i;~ - ., ,~ 49610-86013 ~~.~ Summary Page Balance as of Oct 4, 2010 $0.00 Char es: Tota~PL Electric Utilities Charges $15.51 Total Washington Gas Energy Services Charges $30.32 Total Charges X45.83 :.. .:`~'~I~ fd>~If~ Ala', f ~t>~, ~~ .~~~~ . ;..:....... :.::> .....< . , . -. Account Balance $45.83 36 30 24 IS 12 6 0 KWH -Average Per Day Meter Reading Information Meter #84572176 Sep 30 Actual 54261 Aug 3l Actual 53935 30 Da s KWH Billed 326 Avemrpaegtae -Sep 2009 K1~~I Per Day 659 2010 69F Yearly Use: Total ~ Aversge Use Monthly Oct 2008 -Sep 2009 8139 678 Oct 2009 -Sep 2010 5014 418 ONDJFMAMJJASO 2009 Months 2010 Other important information oa back ~ Return this part to address below with a check payable to PPL Electric Utilities Corporation >::;:< ::>:X~i~ta~:~iica~pit~e~::::<:::>::: ~ ::::::::::::::::::::.FT~=:~i~: ~ : ' ::::::::::::::::~>`::: ::::::::::: P' ~ '.:'t:A~ai~t:::::::::: 49610-86013 Oct 25, 2010 $45.83 AV 01 016669 287168 69 A`•5DGT ,~ MICHAEL GILDER-ESTATE };~ C 1. `~~~` C/O NATALIE S GEIGER \ r ~i,;~`L 11 KINGSWOOD DRIVE In MECHANICSBURG PA 17055-2761 ~ ~ r,~- [~~ `' Ill~~ll~l~lllil~~~tll~~~~~~ll'II~~~~~~I~II'~II~~I~'I~~~Il~ill~l~~ 7D^0^0^ PPL ELECTRIC LTfILITIES 2 NORTH 9TH STREET RPC-GENNi ALLENTOWN PA 18101-1175 1 8600000458360000045837 4961086013 re.~.~lh5 1 ~ ~ ~ ~ ' ~ , r~~ ,~':•"'•:'.-' Page 3 ; -~ PL Elettr~t . pp :.__ : ' .. Y~~ B~ii: ~: ~:~ :::::::::::::: Utilities •;• '~ " 49610 860 13 Electric Totalfroin Last BiU .541.98 Service ~ payment Rtceived Sep ll -Thank Yow. ,541.98 For: $~ ~ 4 Details g MICHAEL GILDER-ESTATE 7I 1 OLD SILVER SPRNG RD Balance as of Oct 4, ZO10 00 $0 MECHAMCSHURG Pa 17055 . Current Charges Washington Gas Energy r Charges for -Washington Gss Energy Services Cus tourer Service General Service Rate: WwGESD for Aug 31 Total Use: 326 Kwh At $0 093 Per Kwli -Sep 30 30 32 13865 SUNRISE VALLEY DRIVE . Gross Receipts Tax S 1.79 . SUITE 200 HERNDON, VA Total Washington Gas Energy Services Charges $30.32 20171- 1-88884-9437 Current Charges PPL Electric Utilities a ' t Charges. for -PPL Electric Utilities 82 ~ Hs~ Rd Residential Rate: RS for Aug 31 -Sep 30 Distribution Charge: Allentown, PA 1 8 1 04-9392 Customer Charge 5.44 i-800-342-5775 200 KWH at 2.90600000¢ per KWH 126 KWH at 2.64000000¢ per KWH 5.81 3 33 (ww~w pplel~ectriPPcLom PA Tax Adj Surcharge at 0.10300000% . 0.02 Transition Charge: 200 KWH at -0.66800000¢ per KWH -1.34 126 KWH at -0.59200000¢ per KWH -0.75 Total PPL Electric Utilities Charges $15.51 . lit. ~ =. Account Balance 545.83 General Inform ~ ' anon Generation prices and charges are set by the electric generation supppplier yric have chosen. The Pubic Utility Commission re ales distribu3ion es and services The Federal Ener Re t l ~ l . gy gu a ory omuussion regu ates transmission prices and services. Next meter reading on or about PPL Electric Utilities uses about $0.07 of this bill topay state taxes. In addition about $0.91 of this bill pays the PA Gross Kecei ts Tax Oct 29 , p . For your convenience, you can now pa your bill using your Vises Mas}erCard, Discover, or ATM Card all BillMntriz at 1-800-672-2413 . BiliMatriz will charge your credit and ATM card a service fee for making this payment. Before digging~ around your home or property, you should always call the state's One CaIl notification system to locate any underground utility lines. You can do this by simply dialing 811, which will connect you to the One Call system. Be safe and call 81 I before you dig. With pa~perless billing, you can receive and pay your PPL Electric Utilities bills oni"me. The process Is free, quick, convenient and secure. To learn more or sign up, visit www. pplelectnc. com. Keep light bulbs and fixtures clean. Dust and dirt absorb light and can reduce right output by as much as half. Save postage and late charges -sign up for Automated Bill Payment. Make a Paymert ,..~,.~.,, ~.,.,~.,...rr._.__..._.__--- _---------- ~ ~ - - - - - -- - -- - ----- -~ Pa Thank you i>Iar askp nryP~i b make year payment Your conAmatbn number is: 10102Sit Please print Mis page for your records. We will apply a payment d:45.i3 on 10/2s/2010 against a total balance of f4.S.i3 on account 4f010~013. Please allow up to three business days for this payment to appear on your PPL Electric lJClities account summary. K you w+sh 1b cancel this payment you may do so from the pe~meM histor~r pegs. If you hays questrorrs, phase call PPL Customer Service at 1-t00-0IAL~I (1-100~342~775-. Customer service representatives aro available from 8 a. m. to 5 p m Monday to Fr-day 1 of 1 10/25/2010 11:34 A] __.. Uaite~ wte~ter Pertnsywonu~ Customer 5ervic+t CeflteF; J~ x,, ~ ~~ ~ ~: ~ t /~~~ ~ 81$9 .Adams Drive,. Hu~nrleigtau-rt. PA 'l lfi3fi ~ ,~ ~ Teteptiane T17-564-36f~' www.urtitedwater.com USAGE HISTORY Monthly usage in thousand gallons 0 s 2 ~ 1 1 1 0 0 0 0 0 0 0 0 0 Aug Sep Oct Nov Dec Jan Mar May Jun Jul Aug Sep Oct Next meter reading date: on or about 11/12/2010 Billing Date: 10/14/10 Account Number: 00200999115167 Previous Balance Payments Through 10/14/10 rhank roe Balance Forward Current Charges Due 11/03/2010 $10.25 $10.25CR $0.00 $10.34 T4TA~ AM~UN~' DUE , (~-,~- 510.34 'PAY BY 11 /08/10 TO AVOID A 1.596 LATE PAYMENT CHARGE SERVICE TO: MICHAEL GILDER SERVICE ADDRESS: T11 OLD SILVER SPRING RD MECHANICSBURG PA Metet Number Service Qays ~ Meter Rs>Dding Visit of ~i Measur~a Readln~ Type Fronts To. Service: ist~ewious. Pcr~erst _. 59794017 09/14/10 10/13/10 Z9 0084 0084 0 MGL ACTUAL EQUIVALENT TO 0 GALLONS SERVICE CHARGES $10.25 W-DSIC SURCHARGE $0.09 TOTAL CURRENT CHARGES 10.34 SEE REVERSE SIDE FOR IMPORTANT ACCOUNT INFORMATION IMPE}RTAN~ MESSAGES It is very important that United Water has your correct contact number. We may need to inform you of an emergency or discuss your bill for services.'*Pleose be aware that United Water may deliver these messages uta an automated calling system to the contact number listed on your account**. In the event that your contact number changes, please contact our customer service group to ensure we have your current telephone number. UWPA will conduct asemi-annual flushing of the distribution system in your area from September 7th through the end of October. This may cause temporary discoloration of water and temporary decreased water pressure. for hydrant flushing updates, please ca11717-564-3662. Save a stamp and ggo paperless today! Log on to www.unitedwater.com or call Customer Service to find out more information and to enroll in eBilling. Approximate state tax included on this bill $0.50. -~ ~~ r'-~:-f~Gll 'T"jw,tr~S . ~} t nc~ ~ - ~~I -tot o .~,~r\ ~~ Sct~l-~~~rt~ ~i ~ha Wo~~ u.~+~.1. qtr cca.~ ~ f1 , 0 0 0 0 RE 207270 DLEASE DETACH HERE AND RETURN THE BOTTOM PORTION WITH YOUR PAYMENT IN THE R!1 URN ENVELOPE VROVIOED. 1 ' ~HA5E ~' Manaps your account online: www.chase.corn/creditcards ACCOUNT SUMMARY Account Number: 41t)S SS2S 11390 0021 Previous Balance $0.00 Purchases ~+ New Balance 548.79 Opening/Cbsing Date 03125J10 - 04J24/10 Total Credit Line $11,500 Available Credit $11,451 Cash Access Line $t 1,500 Available for Cash $11,451 r~-- s~Zb-~co~ ~ ~n3 Additional contact Information conveniently located on reverse aide PAYMENT INFORMATION New Balance $48.79 Payment Due Date 05J21/10 Minimum Payment Due $10.00 Lets Payment Warnlnq: If we do not receive your minimum payment by the date listed above, you may have to pay up to a $39.00 late fee and your APRs will be subject to increa~ to a maximum Penalty APR of 29.99%. Minimum Payment Warnln9: If you make only the minimum payment each period, you will pay more in interest and it will take you longer to pay off your balance. For example: If you make no You will pay off the And you will end up additional charges balance shown on paying an estimated using this card and this statement in total of... each month you about... pay... Only the minimum 5 months $50 payment If you would like information about credit counseling services, call 1-866-797-2885. FLEXIBLE REWARDS SUMMARY Previous Points Balance 6,710 Thank you for using the credit card that earns Points Earned on Purchases This Period 49 rewards that can be used for travel, gift cards, Points Earned Through Chase Rewards Plus 0 cash, or merchandise. Remember, you can New Total Points Balance 6,759 redeem a wide selection of $50 gift cards for 5,000 points. Simply go chase.com/rewards 5,382 Points to expire on statement on or after FEBRUARY, 2014 and use your rewards today) Your Chase Flexible Rewards credit card earns 1 point for every $1 you spend on purchases. Earn up to an additional 10 points while shopping online through www.chase.com/rewardsplus. Add authorised users, and sign up to have your monthly bills charged to your card, too. Why not get rewards for all those purchases tool It's that simple. Simply go chase.com/rewarda to choose your reward today! Redeem your points anytime, or just check out new offers at www.chase.com/rewards. ACCOUNT ACTIVITY Date of Transaction Merchant Name or Transactkm Description $ Amount 04/05 XM 'SATELLITE RADIO 800-XMRADIO DC 48,79 Total fees charged in 2010 $1.50 Total interest char ed in 2010 $0.00 Year-to-date totals reflect all charges minus any refunds applied to your account on or after January 31,2010. I 0000001 FIS33338 D 13 000 N 2 24 t0~01i24 Psye 1 of 2 05888 MA MA 29174 11310000130482917401 x ~~ DETACH AND RETURN UPPER PORTION WITH PAYMENT DATE PaTtEi~T i1FAM1" Ct#ARGE~ R~~EtP1'~ g~4LE I~~CI~aE~ ~~~~~~ ~~~~~~ 10 30%09 ARANESP 1MCG 42.00 .00 ' JU88t 1628 05 20'10 3 NIVERS HITH MA ADJ 42.00 10.30 09 TOPOrECAN 4MG 2100.00 .00 ' .19350 162.8 05!20%10 3 RIVERS HITH MA ADJ 2100.00 10,30.09 INITIAL CHEMO INFUSN UPTO 1HR 225.00 .00 ' 984 t 3 162.8 05~20/t0 3 RIVERS HITH MA ADJ 225.00 10,30-09 ALOxI 25 MCG 450.00 .00 ' J2469 162.8 05 20, 10 3 RIVERS HLTH MA ADJ j.1 ~ ~ h 450.00 103009 UExAMF~HASONE iMG ~~,00 ,62.9 1iJ ~,/ 25.00 ~` ~ ~~~~~~ C .00 ' ~ U5;?O 10 3 NIVERS HITH MA ADJ ~1 V ~ i 25.00 1030;09 ~V ~NFUSIUN SEO UP TO 1HR ~ I„~ ~ I 50.00 V 1 ~ .00 ' 96367 t 62.8 ~ J ~" l ~~ Uo~LU~ IU d AivcRS n~;H MA ADJ f'~ ~ C~ ~ ~ t 50.00 10/30/09 IV INFUSION CONC UP TO iHR o 32.00 ~ c J .00 98368 t 62.8 3 RIVERS HLTH MA ADJ D 3 ~ ~~1 ~ ~ 32 00 05/20/10 , - /~ ~ . I G~-~~ r ~ i r~.~ j * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* * * * 59079 ----- Ct-RiI~t7" 31.=6E? pAY'd 81.90 DAVE Yt~al xfl:Ct~IYR ` `. C1~Y~!! t~A: Q/~1"~ , 1'4TAk . '. `, t~Si ~f~ IQ . ~~~ ~-CCO~NtT OA~,pn1lJr~~. 9#R~1-yC~". ., N~V~ ~~~, .:: .00 .00 .00 .00 12732.75 12732.75 .00 12732.75 EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE ~ (7171 558-7350 Account #: 59079 PAYMENT DETAIL [GILDER ESTATE) --- - --------------------------------------------------------------- Ref # Dt Post Type Source Method Voucher Ref Dt Amount -- ---------------------------------------------------------------- 1 11/09/10 PMT PATIENT CHECK 146 11/09/10 5866.35 open Auth: [Payment Application Detail]---------------------------------------------- Date/Service Patient -- ---- Dr # -- Proc Code Voucher Amount 08 / 18/09 - MICHAEL ------ 2 --------------- 99213 --------------- 190178 ---------------- 5.00 04 / 23/09 MICHAEL 2 J9181 188454 230.00 04 / 20/09 MICHAEL 2 J2150 188364 5.00 04/13/09 MICHAEL 2 36415 188241 5.00 05/19/09 MICHAEL 2 85025 1$8863 6.87 04 / 23/09 MICHAEL 2 J1626 188454 127.00 04 / 23/09 MICHAEL 2 96413 188454 112.50 05/19/09 MICHAEL 2 96367 188863 25.00 04 / 20/09 MICHAEL 2 96360 188364 57.50 05/ 19/09 MICHAEL 2 96361 188863 32.00 05/ 19/09 MICHAEL 2 J2469 188863 225.00 05/ 19/09 MICHAEL -- 2 -------- 96417 --------------- 188863 ---------------- 46.50 --------------- East Shore Oncology 750 East Park Drive Harrisburg PA 1711 ~ r~^~ ~ ~ Q~,~ ~ ~~~~ ,~ ~~ vJ ~ ~~\ D x ~'F N W 1 N w V ~O S Z T V W ~J1 O m N V• O Z O r O V t~'1 m D 7C v m n N C ,o D ..~ J W W W lOii (Oil ~ 4 O ~ N W a ~p O ~ Nm N W a i0 O ~ ~ NQI N W a ~ O U ONO N W a ~ O ~ ~ V O ~ N OO N W a ~ O ~ ~+ v O m a) O Q O ~ N A O ~ N m N W a 1p f' p O O O O O O O O O O td J i j a s n O ~ ~ G7 O o x ; m = ~ N A ~ D O x N ~ 1 01 j v n m O T 7 Qt j ~ ~ m O T 7 '1 ~ A W Z 1 r f'1 m 7 7 ") 1 l 10 0 O ~ i Z O ~, .= 4 D D C T D ~ rn Z m D ~ ,,, ~ N ~ m m O D ~' 2 m ~ m Z m S ~ ~ ~ T O ~ N m n ~ m z m D ~ D =1 m O ~ N ~ C v, ty/1 In C Z C ~ O rn z m ~ ~ ~ ~ o T ~ N o C `" m D 2 O p r ° N = '" f7 7t ~ 3 m ~ T ~ m m 9 ~ ~ -~ p T T N co ; o 2 T Z C ~ O 2 ~ ~ ~ ~ m ~ T s 2 ~ 7t ~ ; rn ~ T n 2 n ~ v ; m Z T ~ I ~ 7t ~ ; rn ~ T ~ ~^ m S ~ ~ ~ p T T N m O 3 ~ w ~~ K{ .. ~ '~ *- m rn m m n+ m O ~ ~ ~ ? ~ C ,~ N ~> ;::' :>' `. • s _ , ~ W D r D Z m "'~ ~ ~ :.: `` ~ o c m ~. .~ ~ C ~ Z a' ` ~ I m c7~ 8 p O 0 W 8 O 8 N t7~ 8 A O 8 ; . * ~ i i ~,.: N N Vt A Oi W O A m .+ N ~ Q O Q O ~ W O O O O p S W O my O O ~ W p S ~ i N O P ~'* - .~ N O U i O all O O v !14 G EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG, PA 17111 PHONE: (717) 558-7350 MICHAEL GILDER ESTATE 1 1 KINGSWOOD DRIVE MECHANICSBURG PA 17055-2761 2 ACCOUNT NUMBER: 59079 BILLING DATE: 10/01 /10 DATE OF LAST PYMT: 09/17/10 AMOUNT NOW DUE: 5866.35 AMOUNT ENCLOSED: - - C:I~~k- ~ ~'~'~O CHARGE AMOUNT DUE TO Mtl; MASTERCARO _ VISA _ EXP DATE / CHARGE ACCT t: PRINT NAME: SIGNATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT .:: :. .. : :. 0 . ~#:: RI~I«~RT~ 13AlkIIL:. ~+ - ECG:. C~~E.C~~~,:~5'1'1~4'>"~ .., 03/23/09 MANNITOL 2596/50ML 10.00 5.00 J2150 182.8 05/28/10 GENERAL WRITE-OFF 5.00 03/23/09 IV INFUSION SEO UP TO 1 HR 50.00 25.00 98387 182.8 05/28/10 GENERAL WRITE-OFF 25.00 03/23/09 IV INFUSION CONC UP TO 1 MR 32.00 18.00 98388 182.8 05/28/10 GENERAL WRITE-OFF 18.00 03/23/09 iV HYDRATION EACH ADDTL HR 84.00 32.00 98381 182.8 05/28!10 GENERAL WRITE-OFF 32.00 03/23/09 NOR.SAL-STERI 5000C 30.00 15.00 J7040 182.8 05/28/10 GENERAL WRITE-OFF 15.00 03/24/09 OV EST PT W/0 MD 30.00 15.00 9921 t 182.8 05/28/10 GENERAL WRITE-OFF 15.00 03/24/09 ETOPOSIDE, 10 MG 480.00 230.00 J9181 182.8 05/28/10 GENERAL WRITE-OFF 230.00 03/24/09 INITIAL CHEMO INFUSN UPTO 1 HR 225.00 112.50 98413 182.8 05/28/10 GENERAL WRITE-OFF 112 50 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE D UE UPON RECEIPT* 31-~X ttl~Y~ ; ~1;SO DA~'~ ..: ~1 ~1 Aft lXi1Y~ Q~k4xl .1~ D/~1t~ • ~'fltlrl:. tES& #T~t ~IpMIR:; : I~R~1~~` .. ~-CCk~tiRkT ... aA~rw~e EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # (717) 558-7350 EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG, PA 17111 PHONE: (717) 558-7350 MICHAEL GILDER ESTATE 1 1 KINGSWOOD DRIVE MECHANICSBURG PA 17055-2761 3 ACCOUNT NUMBER: 59079 BILLING DATE: 10/01 /10 DATE OF LAST PYMT: 09/ 17/ 10 AMOUNT NOW DUE: 5866.35 AMOUNT ENCLOSED: CHARGE AMOUNT DUE TO MY: MASTEACARD _ VISA _ EXP DATE / CHARGE ACCT ~: PRINT NAME: SIGNATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT t?I1.. P~tT~kT 11fllE Ct#~4Rt~; ' gIEI~E,li-'~3 B4L~tG~` ~5:, . .: ~#~~fA~. O~E.DE~'~S~T~TE ;. , 03/24/09 KYTRIL t00MCG 254.00 127.00 J1828 182.8 05/28/10 GENERAL WRITE-OFF 127.00 03/24/09 IV INFUSION SEO UP TO 1 HR 50.00 25.00 98387 182.8 05/28/10 GENERAL WRITE-OFF 25.00 03/28/09 OV EST PT W/O MD 30.00 15.00 99211 182.8 05/28/10 GENERAL WRITE-OFF 15.00 03/28/09 ETOPOSIOE, 10 MG 480.00 230.00 J9181 182.8 05/28/10 GENERAL WRITE-OFF 230.00 03/28/09 INITIAL CHEMO INFUSN UPTO 1HR 225.00 112.50 98413 182.8 05/28/10 GENERAL WRITE-OFF 112.50 03/28/09 KYTRIL t OOMCG 254.00 1 Y7,00 J1828 182.8 08/28/10 GENERAL WRITE-OFF 127.00 03/28/09 IV INFUSION SEO UP TO 1 HR 50.00 25.00 98387 182.8 05/28/10 GENERAL WRITE-OFF 25.00 04/13/09 OV EST PT W/0 MO 0 .00 3 15.00 9921 1 182.8 05!28/10 GENERAL WRITE-OFF 15.00 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* * * * cuRa : a~ •awl- ax~r:~ ~~irv;~r,~rr~ ~k~,k~ a~x:. t~v~la~ t~~cx~:.. . ~rox~t,:~ c.ar~s s _ A ., . .. ., EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # (717) 558-7350 4 EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG, PA 17111 PHONE: (717) 558-7350 MICHAEL GILDER ESTATE 1 1 KINGSWOOD DRIVE MECHANiCSBURG PA 17055-2761 ACCOUNT NUMBER: 59079 BILLING DATE: 10/01 i10 GATE OF LAST PYMT: 09/ 17/ 10 AMOUNT NOW DUE: 5866, 35 AMOUNT ENCLOSED: CHARGE AMOU(Y>t DUE TO MY: MA8TERCARD _ VISA , EXP DATE PRINT NAME: SIGNATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT QA't~'C P'iRT)i~fi'' i~F/~M~ • !?; _ CNARti~ HfODPT3 BALIW~B:. lilW3: l~ECAh~;. G~~DER ~7AT`~ 04/13/09 VENIPUNCTURE 10.00 5.00 38415 182.8 05!28110 GENERAL WRITE-OFF 5.00 04/13/09 CBC 13.75 8.87 85025 t 82.8 05/28/10 GENERAL WRITE-OFF 8.88 04/20/09 OV EST PT EXP FOCUS 70.00 35.00 99213 182.8 05/28/10 GENERAL WRITE-OFF 35.00 04!20109 VENIPUNCTURE 10.00 5.00 38415 182.8 05/28/10 GENERAL WRITE-OFF 5.00 04/20/09 CBC 13.75 8.87 85025 182.8 05/28/10 GENERAL WRITE-OFF 8.88 04/20/09 ETOPOSIDE, 10 MG 480.00 230.00 J9181 181.8 05!28110 GENERAL WRITE-OFF 230.00 04/20/09 PLATINOL 1OMG 880.00 330.00 J9080 182.8 05/28/10 GENERAL WRITE-OFF 330.00 04/20/09 INITIAL CHEMO INFUSN UPTO iHR 225.00 112.50 98413 102.8 05/28/10 GENERAL WRITE-OFF 112.50 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* * * ~T :: ~1 ~ ttAY~ fit: 80 gr4~f~' A~,1 ~t1 aiJrtY~ . QY18E .1~8 ~Y~ ` : '-QT~: - ~ tF~i8.1'f 1~N1<`. _ •• ., . EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # 1717 558-7350 EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG, PA 17111 PHONE: (717) 558-7350 MICHAEL GILDER ESTATE 1 1 KINGSWOOD DRIVE MECHANICSBURG PA 17055-2761 5 ACCOUNT NUMBER: 59079 BILLING DATE: 10/01 /10 DATE OF LAST PYMT: 09/17/10 AMOUNT NOW DUE: 5866.35 AMOUNT ENCLOSED: CHARGE AMOUNT DUE TO MY: MA8TERCARD _ VISA _ EXP GATE / CHARGE ACCT R: - PRINT NAME: SIGNATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT . . : 04!20/09 CHEMO INFUS EACH ADDL 1-8 HRS 80.00 30.00 98415 182.8 05!28/10 GENERAL WRITE-OFF 30.00 04/20/09 CHEMO INFUS SEOUEN UPTO 1 HR 93.00 48.50 98417 182.8 05/28/10 GENERAL WRITE-OFF 48.50 04/20/09 ALOXI 25 MCG 450.00 225.00 J2489 182.8 05/28/10 GENERAL WRITE-OFF 225.00 04/20/09 OEXAMETHASONE 1 MG 25.00 12.50 J 1 t 00 182.8 05/28/10 GENERAL WRITE-OFF 12.50 04/20/09 MANNITOI 2596150ML 10.00 5.00 J2150 182.8 05/28/10 GENERAL WRITE-OFF 5.00 04/20/09 IV INFUSION SEO UP TO 1HR 50.00 25.00 98387 182.8 05/28/10 GENERAL WRITE-OFF 25.00 04/20/09 IV INFUSION CONC UP TO 1HR 32.00 18.00 98388 182.8 05/28/10 GENERAL WRITE-OFF 18.00 04/20/09 INITIAL IV HYDRATION UP TO 1 H 1 15.00 57.50 98380 182.8 05/28/10 GENERAL WRITE-OFF 57.50 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* c~r~ a~~ a~YSx us.»'o o~~ra~ ~~~~~a rrx~r»~ : c~r~ 1'~0: o~cxs ~or~w,~ u~:mEMS:~awo ;:~k 'Itl~Vl~`~ ,, #cccnu~r'e~a~c~ ; p~c~u+c~. ` M!~i+K`F~#~E EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE ~ (717) 558-7350 EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG, PA 17111 PHONE: (717) 558-7350 MICHAEL GILDER ESTATE 1 1 KINGSWOOD DRIVE MECHANICSBURG PA 17055-2761 6 ACCOUNT NUMBER: 59079 BILLING DATE: 10/01 /10 DATE OF LAST PYMT: 09/17/10 AMOUNT NOW DUE: 5866.35 AMOUNT ENCLOSED: CHARGE AMOUNT DUE TO Mb: MASTEACARD _ VISA _ EXP DATE / CHAR<3E ACCT #: PRINT NAME: SIGNATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT f~A~'r ' P :'I'mo' Nfk~fllE CF#I~R¢I~'. RECpP7S~. $I~L.Iti iNS.. 04/20/09 IV HYDRATION EACH ADDTL HR 32.00 18.00 98381 182.8 05/28/10 GENERAL WRITE-OFF 18.00 04/20/09 NOR.SAL-STERL 5000C 30.00 16.00 J7040 182.8 05/28/10 GENERAL WRITE-OFF 15.00 04/21 /09 OV EST PT W/0 MD 30.00 15.00 9921 1 182.8 05/28/10 GENERAL WRITE-OFF 15.00 04/21 /09 ETOPOSIDE, 10 MG 480.00 230.00 J9181 182.8 05/28/10 GENERAL WRITE-OFF 230.00 04/21 /09 INITIAL CHEMO INFUSN UPTO 1 HR 225.00 1 12.50 68413 182.e 05/28/10 GENERAL WRITE-OFF 112.50 04/21 /09 KYTRII 100MCG 754.00 127.00 J1828 182.8 05/28/10 GENERAL WRITE-OFF 127.00 04/21 /09 IV INFUSION SEO UP TO 1 HR 50.00 25.00 98387 182.8 05/28/10 GENERAL WRITE-OFF 25.00 04/23/09 OV EST PT WIO MD 30.00 15.00 9921 1 182.8 05/28/10 GENERAL WRITE-OFF 15.00 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* *"* Dt1tF': ' 311t~t1 liJ1Y~'. , ~: ~'~+li0 RAi1ft~ : ; ~~*1;X12! ~~~ Q1~~ 1:'~Q !Ml'i: • ' 'F'U!'!t{., ' :; tE8& t~Ewti pQ1iMNQ` :'~} ,. .. .. ,, •: . `; .. .. ACC~#~kT:aIC~. INii~t#-NC6 ~:Ig011l~<E' , EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # (717) 558-7350 7 EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG, PA 17111 PHONE: (717) 558-7350 MICHAEL GILDER ESTATE 1 1 KINGSWOOD DRIVE MECHANICSBURG PA 17055-2761 ACCOUNT NUMBER: 59079 BILLING DATE: 10/01 / 10 DATE OF LAST PYMT: 09i 17 / 10 AMOUNT NOW OUE: 5866.35 AMOUNT ENCLOSED: CHARGE AMOUNT DUE TO MY: MASTERCARO ~ VISA EXP DATE 1 CHARGE ACCT ~: _ _ _ _ _ _.., ~ .- . - -- -- - .- PRINT NAME: SIGNATURE: _ DETACH AND RETURN UPPER PORTION WITH PAYMENT I~J~'i`E' ;; . `:a4~ . .. RE~t~PT;IK 8;. 04/23!09 ETOPOSIOE, t0 MG 460.00 230.00 .19181 182.8 05!28/10 GENERAL WRITE-OFF 230.00 04/23/09 INITIAL CHEMO INFUSN UPTO 1HR 225.00 112.50 98413 182.8 05/28/10 GENERAL WRITE-OFF 112.50 04/23/09 KYTRIL t00MCG 254,00 127.00 11828 182.8 05!28!10 GENERAL WRITE-OFF 127.00 04123/09 IV INFUSION SEA UP TO 1 HR 50.00 25.00 98387 182.8 05/28!10 GENERAL WRITE-OFF 25'00 05/1 1 /09 VENIPUNCTURE 10.00 5.00 38415 182.8 05/28/10 GENERAL WRITE-OFF 5.00 05/1 t /09 C8C 13.75 8.87 85025 182.8 05/28/10 GENERAL WRITE-OFF 8.88 05/19/09 OV EST PT EXP FOCUS 70.00 35.00 99213 182.8 05/28/10 GENERAL WRITE-OFF 35.00 05/19/09 VENIPUNCTURE 10.00 5.00 38415 182.8 05!28/10 GENERAL WRITE-OFF 5.00 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* * * * EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # 1717) 558-7350 EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG PA 17111 PHONE: (71T) 558-7350 MICHAEL GILDER ESTATE 1 1 KINGSWOOD DRIVE MECHANICSBURG PA 17055-2761 8 ACCOUNT NUMBER: 59079 BILLING DATE: 10/01 /10 DATE OF LAST PYMT: 09/17/10 AMOUNT NOW DUE: 5866.35 AMOUNT ENCLOSED: CHARGE AMOUNT DUE TO MY: MASTERCARD _ VISA _ EXP GATE / CHARGE ACCT ~: - PRINT NAME: SIGNATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT QA~'~'E.:. ?IEI~ET NEE - . < . ; . tRG~B,.<. ,REOEIP'~~ Sl.~h~.. . ~~Iw~#.. G~ED~~ `~5. "T~4~`~. 05/19/09 CBC 13.75 8.87 85025 182.8 05/28/10 GENERAL WRITE-OFF 8.88 05/19/09 ETOPOSIOE, 10 MG 480.00 230.00 J9181 182.8 05!28/10 GENERAL WRITE-OFF 230.00 05/19/09 PLATINOL tOMG 880.00 330.00 J9080 182.8 05/28/10 GENERAL WRITE-OFF 330.00 05/19/09 INITIAL CHEMO INFUSN UPTO 1HR 225.00 112.50 98413 182.8 05/28/10 GENERAL WRITE-OFF 112.50 05/19/09 CHEMO INFUS EACH ADDL 1-8 HRS 80.00 30.00 98415 182.8 05/28/10 GENERAL WRITE-OFF 30.00 05/19/09 CHEMO INFUS SEOUEN UPTO 1 HR 93.00 48.50 98417 182.8 05/28/10 GENERAL WRITE•OFF 48.50 05/19/09 ALOxI 25 MCG 450.00 225.00 J2489 182.8 05/28/10 GENERAL WRITE-OFF 225.00 05/19/09 DEXAMETHASONE 1MG 25.00 12.50 J1100 182.8 05/28/10 GENERAL WRITE-OFF 12.50 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* * * aim .. , ' 31 ~O ftA1'S i'~sfQ: Rllt~f~ ~; 9k 1;iCQ ftKYSi: C~~ t.'!~! #M~ : ~. >: ..: T4Tltt,. > . . , <; `EJF~aTTsMZ Pli~i' .. :1~MIY~ ;. EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX IDS 23-2937659 PHONE # (717) 558-7350 EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG, PA 17111 PHONE: (71T) 558-7350 MICHAEL GILDER ESTATE 1 1 KINGSWOOD DRIVE MECHANICSBURG PA 17055-2761 9 ACCOUNT NUMBER: 59079 BILLING DATE: 10/01 /10 DATE OF LAST PYMT: 09/ 17/ 10 AMOUNT NOW DUE: 5866.35 AMOUNT ENCLOSED: CHARGE AMOUIYr DUE TO MY: MASTERCARD _ VISA _ EXP DATE f CHARGE ACCT I: PRINT NAME: SIGNATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT Q~tT A: - . ,. ... .---- IrI~I:~AE~: ' %' ~(E~l` ESTATE. 05/19/09 MANNITOL 25%/50ML 10.00 5.00 J2150 182.8 05/28/10 GENERAL WRITE•OFF 5.00 05/19/09 IV INFUSION SE0 UP TO 1 HR 50.00 25.00 98387 182.8 05/28/10 GENERAL WRITE-OFF 25.00 05/19/09 IV INFUSION CONC UP TO iHR 32.00 18.00 98388 182.8 05/28/10 GENERAL WRITE-OFF 18.00 05/19/09 IV HYDRATION EACH ADOTL HR 84.00 32.00 98381 182.8 05/28!10 GENERAL WRITE-OFF 32.00 05/t 9/09 NOR.SAL-STERL 5000C 30.00 15.00 J7040 182.8 05/28/10 GENERAL WRITE-OFF 15.00 05/20/09 OV EST PT W/O MO 30.00 15.00 ss211 182.e 05/28/10 GENERAL WRITE-OFF 15.00 05/20/09 ETOPOSIDE, 10 MG 480.00 230.00 J9181 182.8 05/28/10 GENERAL WRITE-OFF 230.00 05/20/09 INITIAL CHEMO INFUSN UPTO 1 HR 225.00 1 12.50 98413 182.8 05/28/10 GENERAL WRITE-OFF 112.50 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* ccx~~ . ,, ~t~ anx: ~~>to Q~~s: ..: .:. '< <' ~~~>t~atr>,c~r~:.. ~~ ~~s~cYS :.~: ror~tt: ..:.. ;Ri`GT` RAf,AI!IE1>E u~ss s sera. p!ISU~AI!~C~ `~1 ~~~: ~~~ i EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # (717) 558-7350 ' ~ ~ EAST SHORE ONCOLOGY 750 EAST PARK DRIVE SECOND FLOOR HARRISBURG PA 17111 PHONE: (717) 558-7350 MICHAEL GILDER ESTATE 1 1 KINGSWOOD DRIVE MECHANICSBURG PA 17055-2761 10 ACCOUNT NUMBER: 59079 BILLING DATE: 10/01 /10 DATE OF LAST PYMT: 09/ 17/ 10 AMOUNT NOW DUE: 5866.35 AMOUNT ENCLOSED: CHARGE AMOUNT DUE TO MY: MABTERCARD _ V18A _ EXP GATE / CHARGE ACCT •: PRINT NAME: 81GNATURE: DETACH ANO RETURN UPPER PORTION WITH PAYMENT fltlt'E'E ~ P'At'!' #~FR1i~E . ~#.~3: q~CE~PT~ ~~~. :. I~ECI~,,.. E~~~D~~ E'i'A'~~ >. . .. ` .: , . 05/20/09 KYTRII 100MCG 254.00 127.00 J t 828 182.8 05/28/10 GENERAL WRITE•OFF 127.00 05/20/09 IV INFUSION SEO UP TO 1 HR 50.00 25.00 98387 182.8 05/28/10 GENERAL WRITE-OFF 25.00 05/21 /09 ETOPOSIDE, 10 MG 480.00 230.00 J9181 182.8 05/28/10 GENERAL WRITE-OFF 230.00 05/21 /09 INITIAL CHEMO INFUSN UPTO 1 HR 225 00 1 12 50 98413 182.8 08/28/10 GENERAL WRITE-OFF 112.50 05/21 /09 KYTRIL 100MCG 254 .00 127.00 J1826 182.8 05/28/10 GENERAL WRITE-OFF 127.00 05/21 /09 IV INFUSION SEQ UP TO 1 HR 5 0.00 25.00 98387 182.8 05/28/10 GENERAL WRITE-OFF 25.00 08/09/08 OV EST PT EXP FOCUS INSURANCE COPAY 7 0.00 5.00 99213 182.8 ' 07/20!09 CHECK PAYMENT FROM INS MCARE 25.00 07/20/09 3 RIVERS HLTH MA ADJ 35.00 05/28/10 GENERAL WRITE-OFF 5.00 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* * EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # (717) 558-7350 ~ ~, r 11 EAST SHORE ONCOLOGY T 50 EAST PARK DRIVE SECOND FLOOR HARRISBURG, PA 17111 PHONE: (717) 558.7350 MICHAEL GILDER ESTATE 1 1 KINGSWOOD DRIVE MECHANICSBURG PA 17055-2761 ACCOUNT NUMBER: 59079 BILLING DATE: 10/01 / 10 DATE OF LAST PYMT: 09/17/10 AMOUNT NOW DUE: 5866.35 AMOUNT ENCLOSED: CHARQE AMOUNT OUE TO MY: MASTERCARD _ VISA _ EXP DATE CHARQE ACCT +f: - - ---- ---- ---- ---- PRINT NAME: SIGNATURE: DETACH AND RETURN UPPER PORTION WITH PAYMENT p11~'E'E:: ~ ?'I~l4T~'f E <> ,,.: ,, . ,, CfIR ; RE E1, ~S>. ': , 08/18/09 OV EST PT EXP FOCUS INSURANCE COPAY 70.00 5.00 99213 162.8 09/21 .09 CHECK PAYMENT FROM INS MCARE 25.00 09/21 /09 3 RIVERS HLTH MA ADJ 35.00 05/28/10 GENERAL WRITE-OFF 5.00 08/31 /09 OV EST PT EXP FOCUS INSURANCE COPAY 70.00 5.00 99213 182.8 09/28!09 CHECK PAYMENT FROM INS MCARE 25.00 09/28/09 3 RIVERS HLTH MA ADJ 35.00 05/28/10 GENERAL WRITE-OFF 5.00 10/09/09 OV EST PT MOO CMPLX INSURANCE COPAY 95.00 5.00 99214 182.8 11/10/09 CHECK PAYMENT FROM INS MCARE 44.42 11/10/09 3 RIVERS HLTH MA AOJ 40.58 05/28/10 GENERAL WRITE-OFF 5.00 * * * *CO-PAY DUE AT TIME OF VISIT* * *BALANCE DUE UPON RECEIPT* * * * 59079 ~~.~ :' . ~t~A~ tw1Y~ ;: : i'k~i1Q QA*~ I!>E<1 A'O.E7~41!'~ ' .. QY~ 1.'E~ DKY~R'' ; T1D~'~1,: #~%C~#W~T' ~+~ CWT tTE~ ~IDMiIf~ !~43RANCR: .:~~~`' I~Q~ ~~~ .00 .00 .00 .00 5866.35 5866.35 .00 5866.35 EAST SHORE ONCOLOGY 750 EAST PARK DRIVE HARRISBURG, PA 17111 TAX ID# 23-2937659 PHONE # (717) 558-7350 Hospice of Central Pennsylvania 1320 Linglestown Road Harrisburg, PA 17110 Voice: 717-732-1000 Fax: 717-234-0375 Account Of: Michael Gilder C/0 Natalie Geiger 11 Kingswood Drive Mechanicsburg, PA 17055 Date Due Date T Reference ! Paid Description i ~1~1/30/09 ,12/15/09 3650 esidential Care - November 17-30, 2009 12/31/09 1/15/10 ;3734 I esidential Care - ~ December 1-31, 2009 .1/31/10 ;2/15/10 3771 esidential Care - ~ i I January 1-23, ~ I 2010 and January , i 27-31, 2010 2/28/10 3/15/10 13827 ~ ~ esidential Care - ! ' ~ I February 1-28, I ~ 2010 3/31/10 14/15/10 13873 Part esidential Care - ! i March 1-31, 2010 i 4/30/10 5/15/10 13927 Part Residential Care - ; j ;April 1-30, 2010 5/31/10 '6/15/10 4088 Part Residential Care - May 1-4, 2010 6/9/10 X546 ~Pld INV# 4088 -MAC 6/9/10 CD11 597 G~ Apld !INV# 3927 ~ ~pRIL 6/9/10 ' 5481 ~D~T Dtl~u-`I Apld ~INV# 3873-~~I~N ~.q.T~ 70 ~ ~0 • ~ Statement Statement Date: Jun 9, 2010 Customer Account ID: Gilder Amount Enclosed S _ -_._ _. Amount Balance 4, 760. 00~ 4, 760.00 10, 540. 00~ 15, 300.00 i 9, 520. 00~; 24, 820.00 9,520.00 34,340.00 10, 850. 00~ 45, 190.00 ~ 10, 500. OO 1,400.001 55, 690.00 ~ 57,090.00 ~ -40.00: -300.00 -310.00 57,050.00 56,750.00 56, 440.00 56,440.00 ___ Tota 1 ~. ~I-i~-2o~~ CYO 14~ .- Hospice of Central Pennsylvania 1320 Linglestown Road Harrisburg, PA 17110 ~OICe: 717-732-1000 <w Fax: 717-234-0375 ~I~ 1~~, n- uxrrt~t wr~+rm v. ,~ ~~ ~c:/~ Credit To: ~~"'~'!~ Michael Gilder C/O Natalie Geiger 11 Kingswood Drive Mechanicsburg, PA 17055 ---r- . Customer ID _ ___ _i___ ____ ____ Gilder- ~ - _~ Quantity Item ~ Description ~tesidential Care - May 1-4, 2010 I~ i i Invoice No: 4088 Credit Memo Credit Memo Number: 546 Credit Date: Jun 9 , 2 010 Page: 1 Unit Price -T Extension ---- - 90.00' TOTAL 9 0.0 0 Thank you for choosing Hospice of Central Pennsylvania. Hospice of Central Pennsylvania 1320 Linglestown Road Harrisburg, PA 17110 Voice: 717-732-1000 Fax: 717-234-0375 Credit To: Michael Gilder C/O Natalie Geiger 11 Kingswood Drive Mechanicsburg, PA 17055 Customer ID, Gilder Quantity Item t i t i i i i I .~ ~~ 1C'~~: ~t1 ~iLYf'11A1. Ptil~k'~IW Y r~;. Description esidential Care - April 1-30, 2010 Credit Mem o Credit Memo Number: 547 Credit Date: Jun 9, 200 Page: 1 ~~ Unit Price Extension - - ----~ ----- --- - -~ 3 0 0. 0 0 j i I ~~ I Invoice No: 3927 TOTAL 300.00 Thank you for choosing Hospice of Central Pennsylvania. ~, Hospice of Central Pennsylvania 1320 Linglestown Road Harrisburg, PA 17110 Voice: 717-732-1000 Fax: 717-234-0375 Credit To: Michael Gilder C/0 Natalie Geiger 11 Kingswood Drive Mechanicsburg, PA 17055 Cu_ stomer ID -~ Gilder_ - - --__-_ ~_ i ~~ icy w u~rra~u. ~i _ tr. --~-- ~~ ~.~ ~~. Quantity ~ Item ~ Description -~es~idential Care - March 1-31, 2010 i I~ i i i I i I i I Invoice No: 3873 Credit Memo Credit Memo Number: 548 Credit Date: Jun 9 , 2 010 Page: 1 Unit Price ! Extension -----1--- -- 310. 00~ i TOTAL 310.00 Thank you for choosing Hospice of Central Pennsylvania. y~1,-IJ'IV ~~•iaMn~ r~~nrnsi~irG nvNG canna i-soi r•YNI/VVJ r'ilw Fax F~RSr HORIZON. HOME LOANS To: Bruno Wt+rshawsky From: Custon»r Resolution w~i~~i. Fax: 717-238-480 onto: 12/10/2010 Loan Numb: 0041781 S81 BorrowQr's Nsmo: Gilder Document Typo: P~ymant History .~,. Comrn~snts: First Horizon Home Loans Customer Aesolutian Dept. Mail Code 6412 4000 HOf120r1 Way Irvin, YX 750fi3 XSB Confidentiality notice: The facslrnile transmission (and/or the documents accompanying lt) may contain legally privileged and/or confidential information. The information is Intended only for the use of the Individual or entity named above. If you arc not the intended recipient you are herby notifiod that any disclosure, copying, distribution, or the taking of any action In rQliance on the contents of this information is strictly prohibited. !f ypu have received this transmission in error, please immediatay notify us by telephone to arrange rotum of the documents. Dtc-13-1D u4:I~pm tram-lai~irt nuue `unna t-vai r.vutrvv~ r-~+g ~ F~~ HORIZON_ December 10, 2014 Estate Of Michael D Gilder 1 1 Kingswood Dr Mechanicsburg, PA 17055-2761 RE: Loan Number 0041'791591 Dear Estate Of Michael D Gilder Attached is a copy of your loan history. The transactions are identified under "TYPE/IRAN", meaning the type of transaction. The Cransaction number identifications are as follows: DISBURSEMENTS REFUNDS 310 FHA/Private Mortgage Ins. 162 FHA/MIP Insurance 312 County Tax 163 Hazard Insurance 313 City, Borough, or Township Tax 164 County/City 'Y'ax 334 School Tax 165 School Tax/Special 3 15 City/School Tax Assessment 320 Special Assessment 351 Hazard Insurance LATE CHARGES 3 52 Flood Insurance 152 Assessed REVERSALS 132 Waived 146 Misapplication or Reversal APPLICATIONS o f Fund s 148 Reversal of Funds/Payment 171 Coupon payment returned by bank 172 Modified payment 147 Misapplication or Reversal 173 Payment of Funds 174 Short Payment 1.5o Deposit of interest on escrow 175 Additional Principal Payment We hope your inquiry has been satisfactori ly answered. However, should you have further questions, ple ase send written iMquiries t o First Horizon Home Lonna, P.4. Box 6303 87, Irving, TX 75063 or call Customer Service at our told. free number, 1-800-364-7662. Sincerely, Customer Service Department C5012-016 X5B Fi r~ct Hhrixon 4ut)0 Hc~~iia7~i Vc%y, ~uirc i'iV Irvii~~. 'l'X 7Sc)f; i D~c-13-10 04:13pm From-YETL I FE NODE LOANS LOAN ADMINISTRATION 4000 HORIZON WAY IRVING, TEXAS 75063 REQ BX X5B CUSTOMER ACCOUNT ACTIVITY STATEMENT ESTATE D GILDER 11 KINGSWOOD DR MECHANICSSURG PA 1.7055 T-oAT P'. 073/00!3 F-71'4 ~3ATE 12/10/10 PAGE 1 LOAN NUMBER: OQ41791591 •*~Irt~*~**,k~www+rw*tt*ir***w+4wwr*,r,e~t*xtttt**~*ww+r~ryrr,r,t~******w~krr*x*~•k,ttt~www,rwwwww ---------------------~---- CURRENT ACCOUNT INFORMATION ----------•--~----------- DATE TOTAL PRINCIPAIa LOAN CURRENT PAYMENT PAYMENT & INTEREST XNTEREST PRINCIPAL ESCROW DUE AMOUNT PAYMENT RAT$ BALANCE BALANCE 11-O1-10 53b.46 0.00 5.25000 0.00 0.00 rrwww.r~rw*ttt**t*wwwww+r**ttt*tw****t**wwwwww,r,r*ttt*t**w*w****tt****www+e+rtt**trr*t* ACTIVITY FOR PERIOD 05/04/10 - 11/O1/10 PROCESS DLJE TRANSACTION TRANSACTION EFFECTIVE DATE DATE DAT$ CODE DESCRIPTION OF TRANSACTION TRANSACTION ---- -~ PRIN. FAIR/ SCROW PAID/ ------~------OTHER------------- AMOUNT BALANCE YNTSREST BALANCE AMOUNT CODE/DESCRIPTION 11- O 1-10 11- Z O 181 LOAN PAID IN FU X.+ ~ .,,~ (-} v D - ~ S ~ t.~ ~ 9,412.31 9,369.94 40.99 1.38 0.00 1.38 NE3W PRINCIPAL,/ESCROW BALANCES 11-01-10 11-10 173 PAYME T X15.00; ^ 0.00 0.00 ! 0.00 15.00 8 CONVENIENCE FSS 11- 0 I -1 p ~~ 11 -10 17 3 PAYME T 50.50 > 0.00 0.00 i, 0.00 50.50 V RECORDING FEE o~-2e-~.o io-lo 17z PAYM 09-a7-1o 536.46 493.31 43.15 0.04 9, 369.94 NEW PRINCIPAL.,/ESCROW BAL?~NCES 08-30-10 09-10 172 PAYM 08-29-10 536.46 491.16 45.30 0.00 9,863.25 NEfR PRINCIPAL/ESCROW BALANCES 07-30-10 08-10 17~ PAYM 536.46 489.02 47.44 0.00 10,354.41 r NEW PRINCIPAL/ESCROW BALANCES 06-28-10 07-10 172 PAYMEN~' 536.46 486.89 i 49.57 4.00 10,843.43 ~ 0 5- 2 8 -10 Q 6 -10 1_ ~---~YMEN'~' ~ NEW FRINCYPAL/ESCROW BALANCES 535.46 r~48 4.77) ! 51.69 0.00 11,330.32 NEW PRINCIPAL/ESCROW BALANCES 3~0~ i3~~ah~ ~~ ~ ~ ~ ~~ ~ `-~ ~r c~ , ' ~ ~ , F .. ~,- r ~ ~ ,,~i, ~ ~ r ~~ ~ n - ~ ~~ ~ Vic? ~ / y - - .. ~"~ xr- t ,,~" (,. i i ~, `F ~ ~ ~ I GREEN IS A BEAUTIFUL THING(S11> APPLY TODAY FOR A HOME EQUITY LINE OF CREDIT 800.LOAN.555 PSECU.COM.%LIFE. EQUAL HOUSING LENDER. 00002734 1 AV 0.335 MICHAEL D GILDER 11 KINGSWOOD DR MECHANICSBURG PA 17055-2761 JOINT OIM~ER MEAGER NUM6ER 0213XXXXXX BTAlEMENT PERIOD FT0f1r1 ~ 0S0110I053110 PAGE 1 P p ~a ~ ~p~~~ L TR/WS/1~T10N 0~6CRiPT10N ~ CRiD1Tt0R I CNARCiE ~ C~~g _ ~ ~ A~~T710N ~_ _B N E -- ~ ~~c 05/01 ID 01 REGULAR SHARES BEGINNING BALANCE __ 263.36 ~ 05/13 WITHDRAWAL TRANSFER 6.00- 257.36 TO GILDER,MICHAEL D XXXXXXXXXX SHARE 01 05/13 WITHDRAWAL TRANSFER 252.36- 5.00 TO GILDER,ESTATE OF XXXXXXXXXX SHARE 01 05/31 PAYMENT: DIVIDEND 0.4001 0.04 5.04 ANNUAL PERCENTAGE YIELD EARNED 0.45r FROM 05/01/10 THROUGH 05!31/10 BASED ON AVERAGE DAILY BALANCE OF 105.01 05!31 ENDING BALANCE 5.04 DIVIDEND YTD: YEAR TO DATE 0.39 c.~;=...,..-...==...xa=-sxx----=~aaxsaaaa=sxxaa.--xsa._-_a;a=-a---------~---=-°-=-=----=-===-====- 05/01 ID 04 CHECKING BEGINNING BALANCE 30905.05 05/03 CHECK 001904 .~ ~ 464.04- 30441.01 05/04 CHECK 001903 v 600.00- 29841.01 PROCESSED CHECK - METLIFEHL TYPE: CNECKPAYMT ID: LOO0Q00809 05/04 GHECK 001906~~.' 229.00- 29622.01 05/04 GNECK 001907 339.00- 29273.01 05/04 CHECK 001910 1600.00- 27673.01 05/04 WITHDRAWAL CHECK CARD 7.92- 27665.09 03 2416407GB SGBWOKY 9 9 521100482 MEC _ _ _ _.___ -_ ""~ -' 05/05 CHECK 001911- ~`~~ tI ~~G//^y Fh~'C k1 ~- ' 15.87- 27649.2 05/05 05/06 CHECK 00190$ ~•' . CHECK 001905 -' ~<~k° ~ ~ ~ ' - /~ 105.00- 27544.22 r 1 G 1242. 91- 26301.31 05/07 CHECK 001912 - ~Cl~~ ~~C~C'l/f'~? ~`f " 26.77- 26274.54 05/07 ~ t T CHECK 001909. 178.00- 26096.54 05/10 CHECK 001902 ~" 95.00- 26001.54 05/13 WITHDRAWAL TRANSFER - 0.00 TO GILDER,ESTATE OF XXXXXXXXXX SHARE 04 05/31 PAYMENT: DIVIDEND 0.100r, 0.90 0.90 ANNUAL PERCENTAGE YIELD EARNED 0.10% FROM OS/O1/10 THROUGH 05/.31/10 BASED ON AVERAGE DAILY BALANCE OF 10,646.97 05/31 ENDING BALANCE 0.90 DIVIDEND YTD: YEAR TO DATE 1,72 NUMBER AMOUNT NUMBER AMOUN? NUMBER AMOUNT NUMBER AMOUNT 001902 95.00 001905 1242.91 001908 105.00 001911 15.87 001903 600.00 001906 229.00 001909 178.00 001912 26.77 001904 I 464.04 001907 339.00 001910 1600.00 ~ _.~:.._=xam=ssas~=xas~mszxca~s=axssx=~:c==x;~x :a= =xaxaxssas::sasx=zFS=sx=xx= s=xxa_xasstxrsezamc=a=s 0201 000 065 0 --- 110809 4116275 t ~~~ -~ \\~ ~ 4 t ~ ~ ,. 1 ~ -.~. \• ,~ is 4 ~. k MICHAEL D GILDER GREEN IS A BEAUTIFUL THING(SM> APPLY TODAY FOR A HOME EQUITY LINE OF CREDIT 800.LOAN.555 PSECU.COniLLFE. EQUAL HOUSING LENDER. ~________._------ -._._.- _l JOINT OWNER MEMBER NUMBER 0213XXXXXX sn-Tr~FJaT ~cnoo ~ From To 050110(053110 '. PAGE 2 ' TT~~ 11 ~ 1 FINANCE FEES OA TRANSACTION -- - NEW - _. CNAROE CNAAGE8 i AMOUNT BALANCE ~~ a I ~ ~~E .~~ . .. 'T~Mx3~IC71oN DF.vC~tIP'f1oN ......_ .. _ ~.c~°~~ I TOTAL DIVIDEND YTD: YEAR TO DATE 2.11 0202 000 065 0 110809 4116276 m UNITED WATER USAGE HISTORY Monthly usage in thousand gallons m i 0 vanZa~ ter srhthetstflwn, PA 17Q3$,. 3~-6Z Billing Date: Account Number: 04/15/10 00200999115167 Previous Balance $2.95 Payments Through 04/15%10 mock rcu $2.95C1 Balance Forward $0.00 Current Charges Due 05/05/2010 $15.87 TAT; ANT l~U ESTIMATED BILL •PAY BY 05/10/10 TO AVOID A 1.596 LATE PAYMENT CHARGE SERVICE TO: MICHAEL GILDER SERVICE ADDRESS: T11 OlD SILVER SPRING RD MECHANICSBURG PA Mel iV~lrnbi!!~ S!i'ttfc~~ ~~ M~~ I~ Urtifi ~~ i±taf~.:< t'Q . ~le~~: E~sc~e i~ec~#tfg ~'y~prt~. 59794017 03/15/10 04/14/10 30 0084 0085 1 MGL ESTIMATED EQUIVALENT 7l7 1,000 GALLONS SERVICE CHARGES $10.25 WATER CHARGES 5.62 TOTAL CURRENT CHARGES $15.87 SEE REVERSE SIDE FOR IMPORTANT ACCOUNT INFORMATION ,; A ~~+~ ,, ~~~~~~+~ # ~E~~~~~~;. UWPA will conduct osemi-annual flushing of the distribution system in your areo from April 1st through end of tune This may cause temporary discoloration of water and temporary decreased water pressure. For hydrant flushing updates, please coil 717-564-3662. if you would like to pay your bill online, please visit our website at www.unitedwater.comond click an the Western Union's Speedpay icon. Save a stamp and ggo poperless today! Log on to www.unitedwater.com or call Customer Service to find out more informotion and to enroll in eBilling. Approximate state tax included on this bill $0.76. nea- npr May Jun Jul Auk Sep Oct Nav Dec Jan Mar Apr Next meter reading date: on or about 05/14/2010 ~ WEST SHORE MECHANICSBIIRG BOROIIGH Local Earned Income Tax Return r ZQQs Taxpayer's name and address MICHAEL D GILDER 11 RINGSWOOD DRIVE MECHANICSBIIRG PA 17055 Township MECHANICSBIIRG BOROIIGH Your social security number Spouse's social security number 213-56-1066 ~ ~.~; ~ '~ ~ ^n10 LU Complete this section if you moved during the year Time Period TO TO ~ F , ~ ~ ~ ~ Address Income Tax rlJoint S uss RESIDENT 1. Gross eamings reported on W-2's 1. 9 , 6 4 7 2. Allowable nonreimbursed employee business expense 2. 3. Other income/loss ....... ... .... ........ . . 3. 1, 0 4 3 . . ... . ...................... 4. Losses from a business, profession, faun, etc . .... 4. ......................... 5. Taxable W-2 eamings (Total of lines 1.thru 4~ ..... 5. 10 , 6 9 0 6. Net income/loss from a business, profession, farm, etc 6. .................. 7. lnformationai Purposes Only: S Corp Profits/(Loss) as reported on PA-40 ..... 7. $. TOTAL TAXABLE EARNED INCOME . . .. . . . . 8. 10 , 6 9 0 •1 . . ............ ........... . Tax Computation 9. Tax rate ... .. . . .... 9. 1.7 0 0 0 0 . . .. ................................................. 10. TAX LIABILITY ............... ..... . . .. . . . . . . ..... . . 10. 1$ 2.O 0 , . . ..... .... ... .. .. . . ... Payments and Credits 11. Tax withheld ........ ....... . . . . . . .. 11. 10 8 . 0 0 q /U ~ J / . . . .. .... ........................ ... 12. Estimated tax payments ........... .. .. . . . . . .. . . . .. ..... 12. . ... .. . . . . . . .. .. . .. 13. Credit for prior year overpayment ..... 13. ...................... 14. Credit for tax paid to Philadelphia ..... 14. ..................................... 15. Credit for taxes paid to other states ..... 15. .................................... 16. Other Credits: ..... 16. 17. TOTAL PAYMENTS AND CREDITS 17. l O B . O O ................................... Refund or Amount Due 18. Tax due .................................................. ......... ..... .... 18. 7 4 . 0 0 ,~/ ~ 3 ~ ~ / . 19. f nterest .................................... .. . .. .. .. . . . . . . 19. . . .... . . . . .. 20. Late Penalty . .. 20. 21. Amount Due 21. 7 4 . 0 0 22. Overpayment ........................................ ....... . .. . . . 22. . . . . 23. Amount applied to next year's estimated tax .. . . .. . . . . . .. 23. . .... .. ....... . .. . 24. Amount of refund to be transferred to spouse's current year return ..... 24. 25. Amount due with return AMOUNT YOU OWE .............................. 25. 7 4 . 0 0 26. Amount to be refunded REFUND 26. MAIL THIS RETURN TO: WEST SHORE TA1C BIIREAU IISE APPROPRIATE LABEL Under penalty of perjury, I declare that I have examined this return and that to the best of my knowledge and belief, it is true, correct, and complete. ~~" ~, 'Z H ~o ~ Taxpayer's signature ~ Date Spouse's signature DWIGHT E. SMITH 3/16/10 717-652-9692 Pre ared b other than tax a er Date Paid re avers tele hone number - Date P ~ I Calculations Date Tax Due Date Received 41 2 Tax Due . # Months Late Penalty Due 13.38 Interest Due 13.39 Other Charges u o Total Amount Due 100.11 ~~/AAA !~ A / Date Tax Due Date Received Tax Due # Month L t ~; s a e . Penalty Due 0.00 Interest Due 0.00 Other Charges u oa Total Amount Due C 0.00 MICHAEL D. GILDER 1909 PH.717-697-5235 80-8111!2313 711 OLD SILVER SPRING RD. MECHANICSBURG, PA 17055 ~ 1 „ _ ~ ~ r, ~ m r n DATE PAY TO THE ORDER OF_ J . ~ 17g. u~ Yn PSEC~ HARRISBURG~,~"PA 1 71 1 0-2990 ~ ,~ FOR `~'~`~u>ta~-T-?~f17~~ ~`~~ ~-j-~--=_ x:23 L38 L L i6~: X909.10 4 5 1 3 3 508 711' ~ J 7 /' MICHAEL D. GILDER 1912 PH.717-697-5235 60-811112313 711 OLO SILVER SPRING RD. . MECHANICSBURG, PA 17055 ! ~ QQDATE // ORD R OFE ~ ~J ~ ~~C.. ~(~1JY~~lllt ~,ll_ ~ ~P O~ ~O . / ~..._.._.. 8 l~cw.,v ~ i S ~ r~~w.•, D~~u~. o. VN PS C~ FiARRiSBURG, PA 1 71 1 0-2990 _ FOR 21'2- JaLL - .~1~~-}~ 1 ~:23L38LLL6~:L9~2 ~~1045~33508711' FORM 531 -FINAL EARNED INCOME TAX RETURN WEST SHORE TAX BUREAU PHONE: 717-761-4900 WEB SITE: WWW.WESTAB.ORG TAX YEAR YOU ARE RE(]UIREO BY LAW TO FILE THIS RETURN ON OR BEFORE APRIL 15th E' FULL YEAR RESIDENT YES O NO O MUNICIPALITY MECHA D 76927 -- GILDER MICHAEL D ' . ------ __ 711 OLD SILVER SPRING RD +~,~ MECHANICSBURG PA 17055 ~~~~*' i,,,iii,,,iii,,,,iti„i-i~„i,ii,.~,i„~,,,~,i,,,i~.,,iru,~ -~--- - - ,. IF YOU MOVED DURING THE TeX YEAR COMPLETE THE FOLLOWI: Moved in 1/1 Address Moved in 1 / Moved Out Moved Out Moved in Moved m Moved Out Moved Out Mo~eed m Moved in Movsd Out 12131 Moved Out 12/- YOU MUST Taxpayer A SS COMPLETE Taxpayer B SS 1. Gross Eamings from Employment: Enclose w-2s 2. Other Earned Income Enclose 1099-MISC / 1099-R Excluding CODES 3, 4 b T t 1099-C 3. Allowable Non-Reimbursed Employee Business Expenses Enclose PA Sch UE 4. Taxable Eamings Add Lines 1 & 2 Subtract Line 3 5. Net Loss Attach PA Sch C, F, RK-1 and/or NRK-1 NOTE: PA Sch C-F is not acceptable. 6. Subtotal Subtract Line 5 from Line 4 T. Net Profits Attach PA Sch C, F, RK-1 and/or NRK-1 NOTE: PA Sch C-F is not acceptable. 8. Total Earned Income Line 6 + Line 7 DO NOT ROUND past this p e 9. Tax Liability Line 8 multiplied by tax rate ~' ~ (See back of Retum for tax rates) 10. Quarterly Estimated Payments/Credit From Previous Tax Year 11. Earned Income Tax Withheld Generally the amount is shown in Box 19 of attached W-2s 12. Misc Credit See worksheet on back of form for calculating Phitadelphia/Out of State Credit 13. Total of 10, 11, 8 12 14. REFUND/CREDIT Subtract Line 9 from Line 13 NOTE: NO Refunds under 51.00 15. CREDIT TO NEXT YEAR/CREDIT TO SPOUSE Next Year ~ Spouse ^ 16. TAX DUE If Line 9 is greater than Line 13-Subtract Line 13 from Line 9 17. Interest + Penalty (1% per month after April 15th) 18. TOTAL AMOUNT DUE line 16 + Line 17 NOTE: Amounts Liss than S~.oo nNd not be paid. MAKE CHECKS PAYABLE TO WEST SHORE TAX BUREAU. A FEE OF 520. -~~ I declare under penalties of perjury that I have examined this return and to the best of my know atE Signature-Taxpayer A Date Occupation Signature-Taxpayer B ,~ U ~ Date Occupation P((r~~eparer's Name/Address (Please Print) -J c.,, ~ q~n~ S •.r , r~ , C P ~ S 7 G 4 L ~ '` 5 `rf f -~ :r •- ~ ~ ~ {-I• bg, ~ ~} f T- 00'0. anQ ;unowd ~e~ol eo n sa6~ey~ ~ayl0 00'0 anQ ~sa~alu~ 00'0 anQ ~~~euad a}e~ sy~uow # anQ xel SL'6S ~ enQ ~unowd le~ol o n sa6~ey~ ~ay~p 89'S anQ ~sa~a~u~ L8'S anQ ~~euad a~e~ sy~uow # anQ xel paniaoa~ a~eQ anQ xel aleQ 800 S ~ t~- I~daSSM paniaoa~ alea anQ xel alea suoi;e~n~~e~ ~ '8 d J t MICHAEL D. GILDER 1909 PH. 717-697-5235 60-8111/2313 711 OLD SILVER SPRING RD. MECHANICSBURG, PA 17055 ' I DATE . PAY TO THE '~~~ ~ ~ "''r ~ ORDER OF~-~,~_~L-`'(3-J~-.-~-~ ~-Ll~.~.LaL _ I ~ ~ / ~ , (: C-J Yc.'~~ PS~C~ HARRISBURG. PA 17110.2990 FoR~~~-S~- I C~fc~~.__.~_~-~ ?rn1 ?1b4 -Ye-.~ ____~._._ _ ~D~ -T--.--r --~- ~: 2 3 i 38 i i i6~: i909 ••~04 5 i 3 3 508 ?~I• J l_' MICHAEL D. GILDER 1912 PH. 717-697-5235 711 OLD SILVER SPRING RD. so-8111/2313 MECHANICSBURG, PA 17055 D~~ DATE G ,~i„ Me. HARRISBURG PA 17110-2~99~0~ FOR. 213 -~Z_ ~p(~_T1L~~.S'~ 'ZC bG~ ~,,,P ~:23138iii6~:i9i2 ••1045i335087~1' F WEST SHORE MECHANICSBIIRG BOROIIGH Local Earned Income Tax Return 2008 Taxpayer's name and address MICHAEL D GILDER 11 KINGSWOOD DRIVE MECHANICSBIIRG PA 17 0 5 5 ~. Township ~ ` ~ MECHANICSBIIRG BOROIIGH ~•.~' ~ , '~ •. . Your social security number Spouse's social security number 213-56-1066 f, ~'~ ~' ~~ ~~~~ • '':~`' 3 Complete this section if you moved during the year Time Period ~ ~:; To To \ ` `~' Address Income Tax a r/Joint S use RESIDENT 1. Gross earnings reported on W-2's .......................................... 1. 2. Allowable nonreimbursed employee business expense ....................... 2. 3. Otherinc°melloss ........................................................ 3. 2 , 2 6 9 4. Losses from a business, profession, farm, etc ............................... 4. 5. Taxable W-2 earnings (Total of lines 1 thru 4~ 5. 2 , 2 6 9 6. Net income/loss from a business, profession, farm, etc ....................... 6. 7. Informational Purposes Only: S Corp Profits/(Loss) as reported on PA-40 7. 8. TOTAL TAXABLE EARNED INCOME 8. 2 , 2 6 9 Tax Computation 9. Tax rate ................................................................. 9. 1.7 0 0 0 0 10. Tax Liability .............................................................. 10. 3 9.0 0 11. Flat Tax/Occupational Tax ................................................. 11. 12. TOTAL TAX LIABILITY ................................................... 12. 3 9 . 0 0 Payments and Crsdits 13. Tax withheld ............................................................. 13. 14. Estimated tax payments ................................................... 14. 15. Credit for prior year overpayment .......................................... 15. 16. Credit for tax paid to Philadelphia .......................................... 16. 17. Credit for taxes paid to other states ......................................... 17. 18. Other Credits: 18. 19. TOTAL PAYMENTS AND CREDITS ........................................ 19. O . 0 O Refund or Amount Due 20. Tax due ................................................................. 20. 3 9 . 0 0 21. Interest ................................................................. 21. 22. Late Penalty ............................................................. 22. 5 . 0 0 23. Amount Due ............................................................. 23. 4 4.0 0 24. Overpayment ........................................................... 24. . 25. Amount applied to next year's estimated tax ................................. 25. 26. Amount of refund to be transferred to spouse's current year return 26. 27. Amount due with return AMOUNT YOU OWE .............................. 27. 4 4 .0 0 28. Amount to be refunded REFUND ............................... 28. MAIL THIS RETURN T0: WEST SHORE TA]C BIIREAII IISE APPROPRIATE LABEL Under penal of perju I declare that I have examined this return and that to the best of my knowledge and belief, it is true, correct, and complete. ~D Taxpayer's signature l Date Spouse's signature Date COLLECTIONS Occupation Occupation DWIGHT E. SMITH ~ 1~ c 717-652-9692 Pre ared b other than tax a er Date Paid re avers tele hone number P ~ I Calculations WSSD P & I Date Tax Due 4 2009 Date Tax Due Date Received 4 / Date Received Tax Due . # Months Late Tax Due # Months Late Penalty Due 2.43 Interest Due 2.44 Other Charges u oa Total Amount Due 03.87 Penalty Due 0.00 Interest Due 0.00 Other Charges -__ , ~STo a . Total Amount Due 0.00 _, s MICHAEL D. GILDER 1909 PH. 717-697-5235 60-8t t t /23t 3 711 OLO SILVER SPRING R0. MECHANICSBURG, PA 17055 ~ ~ t ~ I X1.1 DA~1E ORDER OF~t ~~ .~~ ~Q AC ~1~1~ It - ~J ~ ~ ~ ~ , U~ ~~ ~ ~ 8 D~ ~~~~ a~ Yn<~ PSEC~ HARRISBURG, PA 17it0-2990 R~, x:23 X38 ~ ~ ~6+: X909 ~~~045 X335087++' _~ -. r i7~" 1909 6Q-8tti/2313 ~ . u'v Q e•c~~„r o~,~„~ o ws~ ~~~ HARRISBURG. PA 17110-2990 [1 FOR ~( ~' ~- f [~.~~.~-~.:~ 7 4 'i"d,r ----- ~.` _ ~J~ x:23 L38 L L L6~: X909 ••~0~.5 L33508711' J l MICHAEL D. GILDER 1912 PH. 717-697-5235 711 OLD SILVER SPRING RD. 80-8111/2313 MECHANICSBURG, PA 17055 ~~ ! ~'j~ , DATE ORDER OF ~ ~J t~~ ~ j1t w{, E~~A/ C~ M l ~ _~ $ a b ' F1~1u~.• D~1~~1, or Met ~~ HARRISBURG, PA 17110-2990 FOR 2l 3 -~Z- /aL .~35"~~LXo ,,,~ x:23 l38 L L 16~: L912 ••045 L33508711• ~ MICHAEL D. GILDER PH. 717-697-5235 711 OLD SILVER SPRING RD. MECHANICSBURG, PA 17055 I DATE ~^~ o~ p~ ~~ N ~.` ,~ ~C ~~. ~ ~'~ n `_ ~ N ~~ ~ ~ u? ~ G ~~~ ~mr U ~~ ~C ,° X ~ 2 v O q rn `~- v ~ Z ~ O Z 3 rt` rn 3 - rn ~ N rn 7~ . .,, ~ ~ ~ ~ ~ ~ °' ~ a ~• ~~ ~ N -~ 0 °v s w .,.a 3 ~ A n j 0 ~. a ~ ~ g~ d A A d 3 rn N Z Z C i ~ rn z ?~ rn ~ ~ r b ,~' o~ c ,.. '2 o~ ... N rn 1 7 p C n -~-~ o ~ -~~ C ~! r.~ ~ p cD ~~ ~ r ~_ ~ G ° m~ -_y---~ cn ct~ ~~ z ""i (~ ~` N G^^ L' q i l s o n J ~~~ M Q'~ C1 n o= 8 ~ , ~ r -.~ _ ~. ~~ ~ v , A Z~~m ~r ;'r ~ m N ~ A i '' c m "'~ ~c .S3 -,.... 4f} v ~ ~, ~, ~ O C~ --5~ w tr+ ._,. ~, rg,'~ ~: 9r '~S ~ ~ ~ t" ~ ~" 3992 Filing Instructions Form 1040 and Form 1040-V U.S. Individual Income Tax Return and Payment Voucher Taxable Year Ended December 31, 2008 Name: MICHAEL D GILDER ~, Z,p ~ O Date Due: AS SOON AS POSSIBLE p~.. ~~ lq n~ 1 Remittance: A check in the amount o $105 hould be made payable to the United States Treasury and included with t e voucher. Write "S.S.N. 213-56-1066, 2008 Form 1040" and your daytime phone number on the check. Mail To: Internal Revenue Service P.O. Box 37008 Hartford, CT 06176-0008 Signature: You should sign and date the return on Page 2. Other: Initial and date the copy, and retain it for your records. Do not attach your payment or Form 1040-V to your return or to each other. Instead, put them loose in the envelope. 7 V4V U.S. Individual Income Tax Return zoos 99 tRSUseO not write or ate )nthls For the ar Jan. 1-Dec. 31, 2008, or other tax ar Innl , 2008, endl , 20 OMB No. 1545-0074 Label L A Your first name and initial Lest name Your social stcurity number (See B MICHAEL D GILDER 213 - 5 6 -10 6 6 instructions on page 14.) E fl a joint return, spouse's first name and iniliad Last name Spouse's social security number Use tho IRS L tab~l. i H Home address (number and street). If you have a P.O. box, see page 14. Apt. no. You must enter • se, otherw a 11 1CINGSWOOD DRIVE your ESN(s) above. • please print R Or type. E City, town or post office, state, and ZIP code. tf you have a foreign address, see page 14. Checking a box bebw will not Pnsidantial MSCHANICSBIIRG PA 1? 055 than your tax or refund. EI®ctio~ Campaign - Check here if you, or your spouse if filing jointly, want S3 to go to this fund (see page 14) - You Spouse 1 a Si le 4 ea se wt qua rag pennon . page n9 the quaNfying person is a child twt not your pendent, enter Filing Status 2 Married flNng jointly (even if only one had Income) this child's name f-ere. - Check Only 3 Marred flNng separately. Enter spouse's SSN above 5 ~ DuaNfying widow(er) with dependent child (see page 16) one box. and fuN name here. - 6a do not check box 6a YourssN. If someone can claim you as a dependent, . . Boxes checked ..... . ... . ...... . . .. . ... . . ~ ~ and ~ , Exemptions b s use No. of c t+wrn c Dependants: (Z) DeperWent's (3) Dependern's (4) ~ ~ ~ ~ o. uat~ . Nwd with you social security number relationship to • did not live with tax a. see 1 First name Last name u i ~ du (see P~ 1B) If more than four ~ ~ ~ ~ dependents, see n~e ttbr sd a bov e gage 17. d Total number of exem lions claimed . ................................................................. 7 Wages. salaries, tips. etc. Attach Form(s) W-2 7 t1COf11@ 8a ........................................................ Taxable interest. Attach Schedule B if required . ...... . ... . ... . . . . .. . .. . . . . . . ..... . .... . .. . . . ... 8s ttach Form(s) '-Z hen. Also b 9a Tax-~xompt interest. Do not include on line 8a . , , ........ Bb Ordinary div' ~ ch S ~ r it 9s lath Forams -TG and 99-R ff tax b 10 . , . .... ...... ... .. . t]uaNfled divi s (see 21) ..... .. ...... .. 8 8 .. Taxable refu di t nd ~ 1 i me tax pa 0 is withheld. 11 . . .. . . . . . .......... Alimony received 11 did not o 12 ............................................................................ Business income or (loss). Attach Schedule C or C-i.2 . .. . ....... . .... . ... . . . . . . . . . .. . . . . . . . 12 u a W-2 13 ~ Capital pale or (bas). Attach Schedule D if required. ff not required, check here - 13 , page 21. 14 .................................. Other gains or (losses). Attach Form 4797 14 15a IRA distributions 15a . _ .. , ... , , 7 , 0 0 0 . ........ . .......... . ....... b Taxable amount (see page 23) 1 tab 1t8a Pensions and annuities 16a 1, 0 8 0 b Taxable amount (see page 24) 16b lose, but do 17 Rental real estate, royalties. partnerships, S corporations, trusts, etc. Attach Schedule E 17 attach, any 18 Farm income or (bss). Attach Schedule F 18 Went. Also, se use 19 ...................................................... Unempbytnent compensation 19 n 1040-V. 20a .. ............ ................ ........... Social security benefits ~ 20a ~ 7 , 2 3 5~ b Taxable amount (see page 26) 20b 21 PA RSTAIL FLO~PSRB - IIS Other income. List type and amount (seepage 28) 21 22 .. .... , .. .. ..... Add the amounts in the far right column for lines 7 through 21. This is your total income - 22 23 Educator expenses (see page 28) 23 ............................... ' USt@C~ 24 Certain business expenses of reservists, performing artists, and egg fee-basis government officials. Attach Fom- 2106 or 2106-EZ 24 p~@ 25 Health savings account deduction. Attach Form 8889 23 ...... . ....... Z6 Moving expenses. Attach Form 3903 26 27 One-half of self-empbyment tax. Attach Schedule SE 27 161 28 Self-empbyed SEP, SIMPLE, and qualified plans 28 29 Self-employed health insurance deduction (see page 29) 29 ' 30 Penalty on early withdrawal of savings 30 ......... . ................. 31a Alimony paid b Recipient's SSN - 31a 32 lRA deduction (see page 30) 32 ................................... Add nu on Ilnee above C 26E 2, 66s' 1,236 1, 08a 0 2,269 7 , 517 33 Student loan interest deduction see a 33 33 ( P !~ ) .................... 34 Tuition and fees deductbn. Attach Form 8917 34 35 Domestic produt~ion activities deduction. Attach Form 8903 35 ' 36 Add lutes 23 through 31a and 32 through 35 ......................................... 36 . 161 37 Subtract line 36 from line 22. This is ur ad usted ross income - 37 7 3 5 6 ...... .......... cclosure, Privacy Act, and Paperwork Reduction Act Notice, sea page 88. Form 1040 (2008) .,~ . . , ~ ;, ~+, r.. ,..~ ~,7".•~A,,M._ ~ ;...,"t. .. ±f:k~~`a ~t.~ r'~'' p 'e!~~?!' ,~c,"Y."l~S"{k ;Y~"~6F.'d`.' s~,.'"'~.` eq,-.'~t' sr,~ ~'$`a:~~_}z~`~-.`:~3~'~F'"aS9r±~,;,4~"~W; ~t'.~r ~~. <r-<., ~orrn 1040 2i aX and Credits Standard Deduction for- • People who checked any box on Nne 39a, 39b, or MICHA$L D (~ILDBR 38 Amount from line 37 (adjusted gross income) . . ............ .... ....................... . 39a Check You were born before January 2, 1944, Blind. Total boxes Spouse was born before January 2, 1944, Blind. checked - 39a b K your spouse itemizes on a separate return a you were adual-status albs. sx page 34 and check mere - 39b _ c Check ff standard deduction includes real estate taxes or disaster loss (see page 34) - 39c 7 _ 40 Itemized dieductions (from Schedule A) or your standard deduction (see left margin) ...... , . 41 Subtract line 40 from line 38 .................................................................. 42 If line 38 is over 5119,975, or you provided housing to a Midwestern displaced individual, see page 36. Otherwise, multiply 53,500 by the total number of exemptions Gaimed on line 6d 43 Taxable income Subtract line 42 from line 41 n kne 42 is more than tine 41, enter -0~ 213-56-1066Pa e: ~- 7,356 40 5 950 41 1, 406 42 3 5 0 0 0 39c or vrtw ~ .................................. . ... 44 can be 44 Tax (see pope 36). Check it any tau is from: a ^ Form(s) 8814 b ^ Form 4972 .............................. . claimed as a 45 Alternative minimum tax (see page 39). Attach Form 6251 dependent, ..................................... .............. - 46 see page 34. 4tB Add lines 44 and 45 ........................................................ • Aa others: 47 Fore' n tax credit. Attach Font 1116 ff r wired 47 t9 ~ ................... S'ng~ °f 48 Credit for child and dependent care expenses. Attach Form 2441 48 Married filing separately, 49 Credit for the elderly or the disabkt3d. Attach Schedule R 49 55,450 50 Education credits. Attach Form 8863 ............................. 50 Married filing 51 Retirement savings contributions credit. Attach Form 8880 51 jointyor ~~•~••••• ~uaNfying 52 Child tax credit (see page 42). Attach Form 8901 ff required . • .. • • . • t32 ', widow(er), 510,900 53 Credits from Form: a ^ 8396 b ^ 8839 c ^ 5695 , . • • . • • , • . 53 Head of S4 Other credits from Form: a ^ 3800 b ^ 8801 c ^ 54 '< household, 55 Add lines 47 through 54. These are your total credits 58,000 ........................................... 56 Subtract line 55 from line 46. If line 55 is more than line 46, enter -0- ~ 0 Other 57 Self-employment tax. Attach Sdtedule SE ....................... .......... ................. 57 3 21 TeXeS ~ Unreported social security and Medicare tax from Form: a ^ 4137 b ^ 8919 ss 59 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required • .... • • ..... 59 60 Additbnal taxes: a ^ AEIC payments b ^ Household employment taxes. Attach Schedule ii ....................... 60 61 Add lutes 56 th h 60. This b r total tax - 61 3 21 62 Federal income tax withheld from Forms W-2 and 1099 • .. , . • • . , , . , 62 216 Pa manta 63 2008 estimat a ants i~ftt 1 7 re ---L_ Ii you have a 64a Earned lnc credit ( C) . _ . , , , . • , . , . """ qualifying b Nontaxable a child, attach Schedule EIC. 65 Excess social security and tier 1 RRTA tax withheld (see page 61) tiiS 66 Additional child tax credit. Attach Form 8812 ~ 67 Amount paid with request for extension to file (see page 61) , • .... • • .. ~ , . , , 67 68 Credits from Form: a ^ 2439 b ^ 4138 c ^ 8801 d ^ 8885 68 69 First-time homebuyer credit. Attach Form 5405 • • .. • • • ... , • • .. • , . • ... , • . 69 70 Recovery rotate credit (see worksheet on popes 62 and li3) ....................... 70 71 Add lines 62 through 70. These are your total paymttMs - 71 216 Refund 72 If line 71 is more than line 61, subtract line 61 from line 71. This is the amount you owrplid • , , , , , 72 Direct deposit? 73a Amount of line 72 you want refunded to u. If Form 8888 is attached, check here . , .. • . • , , - ~ 73a _ See page 63 - b Routing number - c T ^ Checking ^ Savings and fiN in 73b, 73c, and 73d, - d Account number or Form 8888. 74 Amount of line 72 u want a Ibd to ur 2009 estimated tax - 74 : ' . Af110Unt 7S Amount you ovw. Subtract line 71 from line 61. For details on how to pay, see page 65 . _ • ...... - 75 10 5 ............................. YOU OWe 76 Estimated tax pena see pa 65 76 Third Party ~0 you want to albw another person to discuss this return with the IRS (see page 66)? a Yes. Complete the folbwi No Personal identification number (PIN) - Designee I~esig"ee's Phone no. - name - PREPARSR Under pe~al~ies of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowl Sign belief, they are true, correct. and complete. Declaration of preperer (other tlwn taxpayer) is based on tip information of which preparer has arty k Here Y signature Dat~ Your occupatbn a ~ ^~"~?' ~ OLLSCTIONS See page 15. copy Spouse's signature. If a joint retu bo uat n. Oate Spouse's occupation Preparer's Date Paid signature , Preparer's Fim,~s ~~ (~ MACK C3ER8$RICH ~ ASSOCZAT$ Use Only yours nself-empbyed), , P . O . 8070 6 5 9 5 address, and z1P code HARRI SBIIR(3 and phone number Lq?-~~S~S 7 .... r Check if Preparer's SSN or PTIN self-employed ^ P 0 0 211215 S, P.C EIN 25-177636! Phone no. PA 17112 717-652-9692 Form 1040 (2oc DAA