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HomeMy WebLinkAbout04-18-11March 31, 2011 PA Department of Revenue Bureau of Individual Taxes Inheritance Tax Division-EXT PO Box 280601 Harrisburg, PA 17128-0601 Re: James W McClaferty Casty: Cumberland File: 2210-00697 DOD: July 1, 2010 SSN: 193-20-7348 To Whom it May Concern: I am representing the above named estate and am requesting an extension of time to file the Dorm REV- 1500, Pennsylvania Inheritance Tax Return. Additional time is needed to complete the return due to the following circumstances: Mr. McClaffferty owned a 1957 T-Bird and we are unable to obtain a current value. Efforts were make to sell it but we have had no one interested. It was offered at a auction but received an unrealistic low offer and was not sold. I have retained an appraiser to value this asset of the estate, but the appraiser has informed us that he will not have the appraisals ready and needs additional time to complete his valuations. We respectfully ask, that based upon the above facts, an extension of time be granted to file tl~e REV- 1500, Pennsylvania Inheritance Tax Return for the above named decedent. Should you have any questions, please do not hesitate to contact me. Thank you for your consideration. Very truly yours, Carol A. Sabine Exectrix ,,..~~ 15056101D5 REV-1500 EX (o2-u) (FI) ~ ~1 PA Department of Revenue Pennsylvania OFFICIAL USE ONLY - Bureau of Individual Taxes OEMRTNENTOFREVENUE County Code Year File Number PO BOX 28o6oi INHERITANCE TAX RETURN Harrisburg, PA 1128-o6oi RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW - Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 193-20-7348 07012010 12201926 Decedent's Last Name Suffix Decedent's First Name MI MCCLAFFERTY JAMES W (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return O 2. Supplemental Retum THIS RETURN MUST BE FILED IN DUPLICATE WITH THIE REGISTER OF WILLS O 3. Remainder Retul-n (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of Q 5. Federal Estate Tax Return Required death after 12-12-82) ® 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE: DIRECTED TO: Name Daytime Telephone Nurnber CLARENCE E ASBURY 717-766-9544 ~ ... First line of address 1355 ARMITAGE WAY Second line of address City or Post Office MECHANICSBURG State ZIP Code PA 17050 Correspondent's a-mail address:CASBURY@COMCAST .NET 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 gf preparer other than the personal representative is based on all information of which ereoarPr n:~c anv Irnnu.ln'I.,e ........-.~ v,~,~2 yr rcR.7 Kt.~-YVNSIti - ----°-' .~ ING RETURN DATE ADDRESS ~ f ~~ ~~ 4 / 18 / 2 011 109 CLEMSON DR, CARLISLE, PA 17013 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY - Side 1 1505610105 15056101D5 REGISTER O~~S USE OILY _ -:.~ ~~ ;,,~_ ~. .~?-j f> - ~...+- DATE FILED - ~~ (' „ ~ .~ r ,_: 1 ~i J 1505610205 REV-1500 EX (FI) Decedent's Social Security Number decedent's Name: JAMES W MCCLAFFERTY 193 - 2 0 - 7 ~~ 4 8 RE CAPITULATION 1. Real Estate (Schedule A) ............................................ . 1. 1 ~) 5, 0 0 0. 0 0 2. Stocks and Bonds (Schedule B) ...................................... . 2. 5 7 , 6 9 4.8 8 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .... . 3. , 4. Mortgages and Notes Receivable (Schedule D) .......................... . 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)...... . 5. E> 3 , 4 51.7 0 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ...... . 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. ~, 3..0, 410.32 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 6 6 6 , 5 5 6.9 0 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 18,335.26 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I} .......... . . . . 10_ 4 ,, 5 9 3.0 8 11. Total Deductions (total Lines 9 and 10) ................................. 11. 2 2 ,, 9 2 8.3 4 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 6 4 3 ,, 62 8.5 6 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. 6 4 3 ,. 6 2 8.5 6 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0- . 15. 16. Amount of Line 14 taxable at lineal rate X .0 - . 16. 17. Amount of Line 14 taxable at sibling rate X .12 . 17 ~ 18. Amount of Line 14 taxable at collateral rate X .15 6 4 3, 6 2 8. 5 6 18. 9 ~o , 5 4 4.2 8 19. TAX DUE ......................................................... 19. 96,544.28 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 J REV-1500 EX (FI) Page 3 Decedent's Complete Address: JAMES W MCCLAFFERTY_ _ _ STREET ADDRESS 109 CLEMSON DRIVE cITY _ _ _ __ _ CARLISLE Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments ___ B. Discount Fite Number STATE PA 50,350.00 2,650.00 (1) Total Credits (A + B) (2) 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3) Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) Make check payable to: REGISTER OF WILLS, AGENT - - - ----------- -- ___-- - ZIP ;17013 96,544.28 53, 000.00 - 127.13 43, 671.41 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.......................................................................................... ~ ^ b. retain the right to designate who shall use the property transferred or its income : ............................................ ~ ^ c. retain a reversionary interest .......................................................................................................................... ~ ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................ ^ .. ............................ X 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? .............. ^ ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ........................................................................................................ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the rase 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 notf;d in [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+ (01-10) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE "'~~" "~ FILE NUMBER JAMES W MCCLAFFERTY 2010-00697_ All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as 1:he 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 knowleclge of the relevant facts. Real property that is iointly-owned with right of ~~~~,~~.,~~ti;~ ~„~.~+ ~e a:~..~..,...a __ ~_~_~__~_ . -• •••~•~ .,r~~~ ~~ iiccucu, nwai~ auuiuonal Sf1eeLS Of Lne Same SIZe. FROM: Bonnie Myers, Office Manager Central Penn Appraisals, Inc 24 West Main Street Shiremanstown, PA 17011 Telephone Number: 717-737-4600 Fax Number: 717-737-9123 T0: MR CLARENCE ASBURY 1455 ARMITAGE WAY MECHANICSBURG, PA 17055 Telephone Number: Fax Number: Alternate Number: E-Mail: ~ UNIFORM RESIDENTIAL APPRAISAL REPORT INVOICE INVOICE NUMBER CLEMSONDR109 DATE 7/23/2010 REFERENCE Internal Order #: Lender Case #: Client File #: Main File# on fo rm: CLEM:SC-NDR109 Other File # on form: Federal Tax ID: 25-1733269 Employer ID: DESCR~PTtON Lender: PRIVATE Client: PRIVATE Purchaser/Borrower: N/A Property Address: 109 CLEMSON DRIVE City: CARLISLE County: CUMBERLAND State: PA Zip: 17013 Legal Description: DEED BOOK 00278 PAGE 00333 FEES AMOUNT 109 CLEMSON DRIVE, CARLISLE ~ 350.00 SUBTOTAL 350.00 :.PAYMENTS AMOUNT Check #: Date: Description: Check #: Date: Description: Check #: Date: Description: SUBTOTAL TOTAL DUE $ 350.00 Form NIV5 - "WinTOTAL" appraisal software by a la mode, inc. -1-800-ALAMODE Central Penn Appraisals, Inc. (717) 737-4600 E7 (lnininn of \/oliin c ~ o~ nnn } ~ Central Penn Appraisals, Inc. (717) 737-4600 Uniform Residential Appraisal Report Main File IVo_CLEMSONDR109 Page #~ Gilcif ~^I ~~/ICrlAln~~nn The purpose of this summar a praisal report is to provide the lender/client with an accurate, and ade uatel su orted, o inion of the market value of the subject property. Pro ert Address 109 CLEMSON DRIVE Cit CARLISLE State PA Zip Code 17013 Borrower N/A Owner of Public Record ESTATE: JAMES MCCLAFFERI Count CIJMBERLAND Le al Descri tion DEED BOOK 0027 PAGE 00333 _ Assessor's Parcel # 21-16-1090-025 Tax Year 2009 R.E. Taxes ;$ 2 015 , Nei hborhood Name MIDDLESEX TOWNSHIP Ma Reference ADC MAP 16 E-2 Census Tract 0118 03 " . Occu ant ^ Owner ^ Tenant [] Vacant S ecial Assessments $ ^ PUD HOA $ N/A ' [ ] ~er year ^ per month __ _ Pro a Ri hts A raised ®Fee Sim le ^ Leasehold ^ Other describe - Assi nment T e ^ Purchase Transaction ^ Refinance Transaction ~ Other describe This a raisal is for private use and not mortgage purposes Lender/Client PRIVATE Address -- Is the subject roe current) offered for sale or has it been offered for sale in the twelve months rior to the effective date of this appraisal? j Yes ®No ~_ Re orf data sources used, offerin rice s ,and dates . - I ^ did ^ did not analyze the contract for sale for the subject purchase transaction. Explain the results of the analysis of the contract for sale or whey the analysis was not erformed. N/A Contract Price $ N/A Date of Contract N/A Is the roe seller the owner of ublic record? ~ Yes ^ No Data Sourc;e~s TXCRD/CONTRAC- Is there any financial assistance (loan charges sale concessions gift or down a ment assi t t b , , p y s ance, e c.) to e paid by any party on behalf of the borrower? ^Yes [] No If Yes, re ort the total dollar amount and describe the items to be paid. N/A Note: Race and the racial composition of the neighborhood are not appraisal factors. ...Nei hborhood Characteristics One-Unf Houain Trends:.. One-Unit Housing Present Land Use °/o Location ^ Urban ®Suburban ^ Rural Pro ert Values ^ Increasin ®Stable ^ Declinin PRICE AGE One-Unit 60 ~ ° Built-U ^ Over 75% ®25-75% ^Under 25% Demand/Su I -- - ^ Shorta a ®In Balance ^ Over Su I $ 000 r~ 2-4 Unit 0 Growth ^ Ra id ®Stable ^ Slow Marketin Time ®Under 3 mths ^ 3-6 mths ^ Over 6 mths 120 Low 0 Multi-Famil 0 ~° _ Nei hborhood Boundaries The home is located Between Routes 76 and 944 West of North 450 Hi h 100+ Commercial 0 ~° Middlesex Road in Middlesex Townshi 200 Pred. 20 Other V-40 ~° Nei hborhood Descri tion The sub~ect ro ert is located in a rural area where a substantial ortion of the land surrounding the home is farm land -- Market Conditions includin su ort for the above conclusions The market is still relative) pod in this area with lower than average unem to ment rates and continuin low intrest rates. -- Dimensions SEE LEGAL DESCRIPTION Area .61 ACRES Sha a IRREGULAR Vie~N AVERAGE S ecific Zonin Classification R1 RESIDENTIAL Zonin Descri tion SINGLE FAMILY RESIDENTIAL __ Zonin Com liance ®Le al ^ Le al Nonconformin Grandfathered Use ^ No Zonin ^ Ille al describe Is the hi hest and best use of sub~ect roe as im roved or as ro osed er lans and s ecifications the resent use? ®Yes ^ No If No, describe Utilities Public Other (describe) Public Other (describe) Off-site Improvements -Type __ Public Private Electricit ® ^ Water ^ ®WELL Street ASPHALT ___ ® ^ Gas ^ ^ NONE Sanitar Sewer ^ ®SEPTIC Alle NONE ^ ^ FEMA S ecial Flood Hazard Area ~ Yes ^ No FEMA Flood Zone qE FEMA Ma # 42041 C0231 E FEMA Map Date 3/16/2009 _ Are the utilities and off-site im rovements t ical for the market area? ®Yes ^ No If No, describe _ Are there an adverse site conditions or external factors (easements encroachments environmental conditions land uses etc )~ ^Yes ~ No If Yes, describe General Descri ion Foundation Exterior.Descri tion materials/condition Interior materials/condoion Units ®One ^ One with Accessor Unit ^ Concrete Slab ^ Crawl S F ace oundation Walls CONBLK/AVE Floors __ CARPET/VINYL/ # of Stories 2 ®Full Basement ^ Partial Basement Exterior Walls BRICK/ALUM/AV W ll a s _ DRYWALL/AVE T e ®Det. ^ Att. ^ S-Det./End Unit Basement Area 1 168 s .ft. Roof Surface SHINGLE/AVE Trim/Finish WOOD/AVE ® Existin ^ Pro osed ^Under Connt Basement Finish ' . 50 9 ° Gutters & Downs outs ALUMINUM/AVE Bath Floor CERAMIC/AVE Desi n S le SPLIT LEVEL ®Outside Ent /Exit ^ Sum Pum Wi d T n ow e DBL HUNG/AVE Bath Wainscot CERAMIC/AVE Year Built 1964 - Evidence of ^ Infestation Storm Sash/Insulated INSULATED/AVE Car Stor~~e None Effective A e rs 18 ^ Dampness ^ Settlement Screens YES/AVE ®Drive~way # of Cars 3 Attic ^ None _ Heatin FWA HWBB Radiant Amenities Woodstove s # Drivewa Surface ASPHALT ^ Dro Stair ^ Stairs ^ Other F -- _ uel OIL ®Fire laces # 1 ^ Fence ~ Garay e # of Cars ^ Floor ®Scuttle Coolin ®Central Air Conditionin ^ Patio/Deck ~-- 3 ~ Porch ^ Car t # f C or o ars ^ Finished ^ Heated ^ Individual ^ Other ^ Pool ^ Other ~ Att. [ ~ Det ^ Built-in . _ Appliances ^ Refri erator ®Ran a/Oven ^ Dishwasher ^ Disposal ^ Microwave ^ Washer/Dr er ^ Other describe • Finished area above rade contains: 6 Rooms 3 Bedrooms 1 Bath(s) 1168 Square Feet of Gross Living Area Above Grade Additional features s ecial ener efficient items, etc.). REC ROOM DEN AND POWDER ROOM IN THE BASEMENT REPLACEMENT WINDOWS _ -- Describe the condition of the ro ert includin needed re airs, deterioration, renovations, remodelin ,etc.. These im rovements are ~of avers a unlit frame construction and fl t -- re ec average maintenance Are there an h sical deficiencies or adverse conditions that affect the livability soundness, or structural integrity of the property ^Yes ~~ No If Yes, describe Does the roe enerall conform to the nei hborhood functional utili , s le, condition, use, construction, etc. ? ~ Yes ^ No If No, describe Freddie Mac Form 70 March 2005 Page 1 of 6 Fannie Ma.e Form 1004 March 2005 Form 1004 - "WinTOTAL" appraisal software by a la mode, inc. -1-800-ALAMODE Main File IVo. CLEMSONDR109 Page #] Uniform Residential Appraisal Report File# CLEMSONDR109 "'~~~ u~~ I l+Vlll pIAUIG IU CIIICJ currenu There 3 orrerea for sale m the subect nei hbor hood ran in in rice from $ 179 900 to $179,900 are com arable sales in the subec FEATURE SUBJECT t nei hborhood within the past twelve mo COMPARABLE SALE # 1 nths ran in in sale rice from $ 190 0 COMPARABLE SALE # 2 00 to $ 197 500 COMPARABLE SALE # 3 Address 109 CLEMSON DRIVE CARLISLE PA 17013 Proximi to Sub'ect Sale Price $ N/A Sale Price/Gross Liv. Area $ s .ft. 7 BEAGLE CLUB ROAD CARLISLE PA 17013 0.82 miles N $ 199 000 $ 123.60 s .ft. 406 WOLFS BRIDGE ROAD CARLISLE PA 17013 0.74 miles N $ 190 000 $ 130.49 s .ft. 2 ROE3ERT LANE CARLISLE, PA 17013 1.53 rniles SW ~ $ 197 500 $ 167 94 s ft Data Sources Verification Sources VALUE ADJUSTMENTS DESCRIPTION ASMT RECORDS/MLS/AGEN SETTLEMENT DEPT. DESCRIPTION + - $ Ad'ustment ASMT RECORDS/MLS/AGEN SETTLEMENT DEPT. DESCRIPTION + - $ Ad'ustment . . . ASMT' RECORDS/MLS/AGEN SETTILEMENT DEPT. DESCRIPTION + $ Ad' t Sales or Financing Concessions FHA SLRHL$703.0 CONVENTION NONE KNOW VA NONE: KNOW - us ment Date of Sale/Time Location Leasehold/Fee Sim l AVERAGE 12/22/09-99D AVERAGE 11/6/09-33DM AVERAGE 5/21/10-80DM AVERAGE e Site Fee Sim le .61 ACRES Fee Sim le 1.33 ACRES -3 600 Fee Sim le 1.84 ACRES -6 200 Fee Simple 26 AC:RE S +1 80 View Desi n St le AVERAGE SPLIT LEVEL AVERAGE RANCH AVERAGE RANCH . _ AVERAAGE BILEVEL 0 Qualit of Construction Actual A e Condition Above Grade Room Count Gross Livin Area AVERAGE 46 YEARS AVERAGE Total Bdrms. Baths 6 3 1 1 168 s .ft. AVERAGE 36 YEARS AVERAGE Total Bdrms. Baths 7 3 1.5 1 610 s .ft. 1 000 -6 600 AVERAGE 46 YEARS AVERAGE Total Bdrms. Baths 6 3 1.5 1 456 s .ft. _ 1 000 -4 300 . AVER~4GE 35 YEARS AVERi~G_ E Total Bdrms. Baths 6 3 2 1 176 s ft 4 000 Basement & Finished Rooms Below Grade Functional Utili . Heatin /Coolin FULL BMST REC/DEN/PR AVERAGE HW/CA FULL BMST REC ROOM AVERAGE EBB/CA +3 000 FULL BMST UNFINISHED AVERAGE EBB/HP/CA +g 000 ^ . . PART BMST REC/DEN_/PR AVERAGE EBB/C A Ener Efficient Items Gara a/Car ort ' T1'P FOR ARE 3 CAR GARA TYP FOR ARE 1 CAR GARA +10 000 TYP FOR ARE 2 CAR GARA +5 000 , TYP FO_R, ARE 2 CAR GARA +5 0 Porch/Patio/Deck PORCHES PORCHES PORCH +1 000 PORCH /DEC 00 ' • • Net Ad'ustment Total Adjusted Sale Price of Com arables I did did not research t 1 FIREPLACE NONE NONE e sale or tra f hi t 1 FIREPLACE NONE NONE ®+ ^ - Net Adj. 0.9 % Gross Ad'. 12.2 % 1 800 $ 200 800 1 FIREPLACE NONE NONE ®+ ^ - Net Adj. 1.3 % Gross Adj. 13.4 % 2 500 $ 192 500 _ 1 FIREPLACE NONE ___ NONE_ ~ + _ ^) - Net Adj. 1.4 % Gross Adj. 5.5 ~° 2 800 $ 200 300 ns er s or of the subect roe and com arable sales. If not, ex lain M research ^did ®did not reveal an rior sales or transfers of the subect ro ert for the three ears rior to the effective date of this a raisal. Data Sources LOCAL TAX ASSESSMENT RECORDS -- Mresearch ^did ®did not reveal an rior sales or transfers of the com arable sales for the ear rior to the date of sale of the com arable sale. Data Sources LOCAL TAX ASSESSMENT RECORDS --- Re ort the results of th h d e researc an anal sis of the rior sale or transfer histo of the subect ro ert and com arable sales re ort additional rior sales on page 3). ITEM SUBJECT COMPARABLE SALE #1 COMPARABLE SALE #2 _COMPARABLE SALE #3 Date of Prior Sale/Transfer NO PRIOR TRANSFER It NO PRIOR SALE OTHER NO PRIOR SALE OTHER NC)_PRIOR SALE OTHER Price of Prior Sale/Transfer THE PAST THREE YEAR THAN ABOVE THAN ABOVE THI_AN ABOVE Data Sources TAX RECORDS TAX RECORDS TAX RECORDS TA_X RECORDS Effective Date of Data Sources 7/14/10 7/14/10 7/14/10 7/14/10 Anal sis of rior sale or transfer histor of the subect roe and com arable sales There were no unusual characteristics observed in the prior sales histo of the subect ro ert or com arable sales. -- Summar of Sales Com arison A roach All four sales are considered to be reliable indicators of value and are wei hued similar) in the final reconciliation. All four com arable sales are located in the same market area as the subect ro ert and would_be considered b the same ers ective urchaser if all were on the market at the same time as the subect. Com arables sales used are all closed sales. In order to find com arables sales it was necessa to use sales over 6 months ofd. Indicated Value b Sales Com arison A roach $ 195 000 -- Indicated Value by: Sales Comparison Approach $ 195 000 Cost Approach (if developed) $ N/A Income Approach (if developed) $ N/A --- f This appraisal is made ®"as is", -- ^ subject to completion per plans and specifications on the basis of a hypothetical condition that the improvements have been completed, ^ subject to the following repairs or alterations on the basis of a hypothetical condition that the repairs or alterations have been com leted, or ollowin re wired ins ection based on the extraordinar assum tion that the condition or deficienc does not re wire alteration or re air: p ~_~ subject to the --- Based on a complete visual inspection of the interior and exterior areas of the sub1ect property, defined scope of work, statement of assumptions and limiting conditions, and appraiser's certification, my (our) opinion of the market value, as defined, of the real property that is the subject of this report is $ 195 000 , as of 7/1 /10 _ which is tha r~atc „s ;AQNAA~rAw ....,, .~_ _~__.:.._ ~_._ ... __-_ __-. _.. ....~. ...v v..vv~I~~r NGI~i VI 11117 Q iai~br. I Freddie Mac Form 70 March 2005 Page 2 of 6 Fannie Mae Form 1004 March 2005 Form 1004 - "WinTOTAL" appraisal software by a la mode, inc. -1-800-ALAMODE ' Main File No._CLEMSONDR109~[ Page #4~ Uniform Residential Annraical Rpnnrt .. ,,, ~.. . __ ^ ^ - - --- - --~- -- - ~ i~cn VLL~vIVVI~IUII IV.7 AMENDMENT TO SCOPE OF WORK: THE INTENDED USER OF THIS APPRAISAL REPORT IS THE LENDER/CLIENT. THE INTENDED USE IS TO EVALUATE THE PROPERTY THAT IS THE SUBJECT OF THIS APPRAISAL FOR. A MORTGAGE _ FINANCE TRANSACTION SUBJECT TO THE STATED SCOPE OF WORK PURPOSE OF THE APPRAI;S AL REPORTING _ REQUIREMENTS OF THIS APPRAISAL REPORT FORM AND THE DEFINITION OF MARKET VALUE AS. DEFINED BY FANNIE MAE OR FREDDIE MAC. THE REPLACEMENT COST IS USED FOR NEW CONSTRUCTION _ THE INCOME APPROACH IS USED ONLY WHEN THE SUBJECT IS TO BE A SINGLE FAMILY RENTAL PROPERTY. -- -- -- -- -- COST APPROACH TO VALUE (not.... ulred b Fannie Mae) _ Provide ade uate information for the lender/client to re licate the below cost fi ures and calculations. Su ort for the o inion of site value summary of comparable land sales or other methods for estimating site value) ESTIMATED ^ REPRODUCTION OR ~ REPLACEMENT COST NEW OPINION OF SITE VALUE _ _$ = . Source of cost data MARSHALL & SWIFT COST HANDBOOK - ---- DWELLING S .Ft, @ $ _ _$ ' Qualit ratin from cost service AVE. Effective date of cost data 06/2008 ___ Sq.Ft. @ $ -$ -_. Comments on Cost A roach ross livin area calculations, de reciation, etc. - -- __ _$ • __ Gara a/Car ort Sq.Ft. @ $ _$ __ __ Total Estimate of Cost-New _$ Less Ph sical Functional ____ External De reciation ___ =$ ------ De reciated Cost of Im rovements -$ - = -- - "As-is" Value of Site Im rovements _ _$ stimated Remainin Economic Life HUD and VA onl 42 Years -- INDICATED VALUE BY COST APPROACH _ _ . _ _ _ _ -g INCOME APPROACHfiO VALU E (not r aired b Fannie Mae) • _ Estimated Monthl Market Rent $ X Gross Rent Multiplier = $ __ _ Indicated Value by Income Approach Summar of Income A roach includin su ort for market rent and GRM ---- PROJECT INFORMATIQN FOR PUDs.(if a livable) Is the develo er/builder in control of the Homeowners' Association HOA ? ^ Yes ^ No Unit t e s ^ Detached [] Attached ' _ _ Provide the followin information for PUDs ONLY if the developer/builder is in control of the HOA and the subject property is an attached dwelling unit. Le al Name of Pro~ect - ---- • Total number of hases __ Total number of units Total number of units sold __ Total number of units rented Total number of units for sale Data source(s) Was the ro~ect created b the conversion of existing building(s) into a PUD? ^ Yes ^ No If Yes date of conversion • Does the ro'ect contain an multi-dwellin units? ^ Yes ^ No Data Source ---- Are the units, common elements, and recreation facilities complete? ^ Yes [] No If No, describe the status of completion - --- Are the common elements leased to orb the Homeowners' Association? ^ Yes ^ No If Yes, describe the rental terms and options. Describe common elements and recreational facilities. - --- Freddie Mac Form 70 March 2005 Page 3 of 6 Fannie Nlae Form 1004 March 2005 Form 1004 - "WinTOTAL" appraisal software by a la mode, inc. -1-800-ALAMODE Main File No. CLEMSONDR109 Page #5~ unirorm Residential Appraisal Report File# C;LEMSONDR109 This report form is designed to report an appraisal of a one-unit property or a one-unit property with an accessory unit; including a unit in a planned unit development (PUD). This report form is not designed to report an appraisal of a manufactured home or a unit in a condominium or cooperative project. This appraisal report is subject to the following scope of work, intended use, intended user, definition of market value, statement of assumptions and limiting conditions, and certifications. Modifications, additions, or deletions 1:o the intended use, intended user, definition of market value, or assumptions and limiting conditions are not permitted. The appraiser may expand the scope of work to include any additional research or analysis necessary based on the complexity of this appraisal assignment. Modifications or deletions to the certifications are also not permitted. However, additional certifications that do not constitute material alterations to this appraisal report, such as those required by law or those related to the appraiser's continuing education or membership in an appraisal organization, are permitted. SCOPE OF WORK: The scope of work for this appraisal is defined by the complexity of this appraisal ;assignment and the reporting requirements of this appraisal report form, including the following definition of market value, statement of assumptions and limiting conditions, and certifications. The appraiser must, at a minimum: (1) perform a complete visual inspection of the interior and exterior areas of the subject property, (2) inspect the neighborhood, (3) inspect each of the comparable sales from at least the street, (4) research, verify, and analyze data from reliable public and/or private sources, and (5) report his or her analysis, opinions, and conclusions in this appraisal report. INTENDED USE: The intended use of this appraisal report is for the lender/client to evaluate the property that is the subject of this appraisal for a mortgage finance transaction. INTENDED USER: The intended user of this appraisal report is the lender/client. DEFINITION OF MARKET VALUE: The most probable price which a property should bring in a competitive and open market under all conditions requisite to a fair sale, the buyer and seller, each acting prudently, knowledgeably and assuming the price is not affected by undue stimulus. Implicit in this definition is the consummation of a sale as of a specified date and the passing of title from seller to buyer under conditions whereby: (1) buyer and seller are typically motivated; (2) both parties are well informed or well advised, and each acting in what he or she considers his or her own bust interest; (3) a reasonable time is allowed for exposure in the open market; (4) payment is made in terms of cash in U. S. dollars or in terms of financial arrangements comparable thereto; and (5) the price represents the normal consideration for the property sold unaffected by special or creative financing or sales concessions* granted by anyone associated with the sale. *Adjustments to the comparables must be made for special or creative financing or sales concessions. fVo adjustments are necessary for those costs which are normally paid by sellers as a result of tradition or law in a market area; these costs are readily identifiable since the seller pays these costs in virtually all sales transactions. Special or creative financing adjustments can be made to the comparable property by comparisons to financing terms offered by a third party institutional lender that is not already involved in the property or transaction. Any adjustment should not be calculated on a mechanical dollar for dollar cost of the financing or concession but the dollar amount of any adjustment should approximate the market's reaction to the financing or concessions based on the appraiser's judgment. STATEMENT OF ASSUMPTIONS AND LIMITING CONDITIONS: The appraiser's certification in this repoirt is subject to the following assumptions and limiting conditions: 1. The appraiser will not be responsible for matters of a legal nature that affect either the property being appraised or the title to it, except for information that he or she became aware of during the research involved in performing this appraisal. The appraiser assumes that the title is good and marketable and will not render any opinions about the title. 2. The appraiser has provided a sketch in this appraisal report to show the approximate dimensions of the improvements. The sketch is included only to assist the reader in visualizing the property and understanding the appraiser's determination of its size. 3. The appraiser has examined the available flood maps that are provided by the Federal Emergency Management Agency (or other data sources) and has noted in this appraisal report whether any portion of the subject site is located in an identified Special Flood Hazard Area. Because the appraiser is not a surveyor, he or she makes no guarantees, express or implied, regarding this determination. 4. The appraiser will not give testimony or appear in court because he or she made an appraisal of the property in question, unless specific arrangements to do so have been made beforehand, or as otherwise required by law. 5. The appraiser has noted in this appraisal report any adverse conditions (such as needed repairs, deterioration, the presence of hazardous wastes, toxic substances, etc.) observed during the inspection of the subject property or that he or she became aware of during the research involved in performing the appraisal. Unless otherwise stated in this appraisal report, the appraiser has no knowledge of any hidden or unapparent physical deficiencies or adverse conditions of the property (such as, but not limited to, needed repairs, deterioration, the presence of hazardous wastes, toxic substances, adverse environmental conditions, etc.) that would make the property less valuable, and has assumed that there are no such conditions and makes no guarantees or warranties, express or implied. The appraiser will not be responsible for any such conditions that do exist or for any engineering or testing that might be required to discover whether such conditions exist. Because the appraiser is not an expert in the field of environmental hazards, this appraisal report must not be considered as an environmental assessment of the property. 6. The appraiser has based his or her appraisal report and valuation conclusion for an appraisal that is subject to satisfactory completion, repairs, or alterations on the assumption that the completion, repairs, or alterations of the subject property will be performed in a professional manner. Freddie Mac Form 70 March 2005 Page 4 of 6 Fannie Nlae Form 1004 March 2005 Form 1004 - "WinTOTAL" appraisal software by a la mode, inc. -1-800-ALAMODE Main File No_CLEMSONDR109~ Page #6] UIIIIVI111 RC5IUCIILIdI H(J~fdlSal I~epOr[ File~# (;LEMSONDR109 APPRAISER'S CERTIFICATION: The Appraiser certifies and agrees that: 1. I have, at a minimum, developed and reported this appraisal in accordance with the scope of work re~auirements stated in this appraisal report. 2. I pertormed a complete visual inspection of the interior and exterior areas of the subject property. I reported the condition of the improvements in factual, specific terms. I identified and reported the physical deficiencies that could affect the livability, soundness, or structural integrity of the property. 3. I performed this appraisal in accordance with the requirements of the Uniform Standards of Profess>ional Appraisal Practice that were adopted and promulgated by the Appraisal Standards Board of The Appraisal Foundation and that were in place at the time this appraisal report was prepared. 4. I developed my opinion of the market value of the real property that is the subject of this report based on the sales comparison approach to value. I have adequate comparable market data to develop a reliable sales comparison approach for this appraisal assignment. I further certify that I considered the cost and income approaches to value but did not develop them, unless otherwise indicated in this report. 5. I researched, verified, analyzed, and reported on any current agreement for sale for the subject property, any offering for sale of the subject property in the twelve months prior to the effective date of this appraisal, and the prior sales of the subject property for a minimum of three years prior to the effective date of this appraisal, unless otherwise indicated in this report. 6. I researched, verified, analyzed, and reported on the prior sales of the comparable sales for a minimurn of one year prior to the date of sale of the comparable sale, unless otherwise indicated in this report. 7. I selected and used comparable sales that are locationally, physically, and functionally the most similar to the subject property. 8. I have not used comparable sales that were the result of combining a land sale with the contract purchase price of a home that has been built or will be built on the land. 9. I have reported adjustments to the comparable sales that reflect the market's reaction to the differences between the subject property and the comparable sales. 10. I verified, from a disinterested source, all information in this report that was provided by parties who have a financial interest in the sale or financing of the subject property. 11. I have knowledge and experience in appraising this type of property in this market area. 12. I am aware of, and have access to, the necessary and appropriate public and private data sources, such as multiple listing services, tax assessment records, public land records and other such data sources for the area in which thE~ property is located. 13. I obtained the information, estimates, and opinions furnished by other parties and expressed in this appraisal report from reliable sources that I believe to be true and correct. 14. I have taken into consideration the factors that have an impact on value with respect to the subject neighborhood, subject property, and the proximity of the subject property to adverse influences in the development of my opinion of market value. I have noted in this appraisal report any adverse conditions (such as, but not limited to, needed repairs, dei:erioration, the presence of hazardous wastes, toxic substances, adverse environmental conditions, etc.) observed during the inspection of the subject property or that I became aware of during the research involved in performing this appraisal. I have considered these adverse conditions in my analysis of the property value, and have reported on the effect of the conditions on the value and marketability of the subject property. 15. I have not knowingly withheld any significant information from this appraisal report and, to the best of my knowledge, all statements and information in this appraisal report are true and correct. 16. I stated in this appraisal report my own personal, unbiased, and professional analysis, opinions, and conclusions, which are subject only to the assumptions and limiting conditions in this appraisal report. 17. I have no present or prospective interest in the property that is the subject of this report, and I have no present or prospective personal interest or bias with respect to the participants in the transaction. I did not base, either partially or completely, my analysis and/or opinion of market value in this appraisal report on the race, color, religion, sex, age, marital status, handicap, familial status, or national origin of either the prospective owners or occupants of the subjE~ct property or of the present owners or occupants of the properties in the vicinity of the subject property or on any other basis prohibited by law. 18. My employment and/or compensation for performing this appraisal or any future or anticipated appraisals was not conditioned on any agreement or understanding, written or otherwise, that I would report (or present analysis supporting) a predetermined specific value, a predetermined minimum value, a range or direction in value, a value that favors the cause of any party, or the attainment of a specific result or occurrence of a specific subsequent event (such as approval of a pending mortgage loan application). 19. I personally prepared all conclusions and opinions about the real estate that were set forth in this appraisal report. If I relied on significant real property appraisal assistance from any individual or individuals in the performance of this appraisal or the preparation of this appraisal report, I have named such individual(s) and disclosed the specific tasks; performed in this appraisal report. I certify that any individual so named is qualified to perform the tasks. I have not authorized anyone to make a change to any item in this appraisal report; therefore, any change made to this appraisal is unauthorized and I will take no responsibility for it. 20. I identified the lender/client in this appraisal report who is the individual, organization, or agent for the organization that ordered and will receive this appraisal report. treadle Mac form 70 March 2005 Page 5 of 6 Fannie Nlae Form 1004 March 2005 Form 1004 - "WinTOTAL" appraisal software by a la mode, inc. -1-800-ALAMODE Main File No_~CLEMSONDR109 Page #7] Uniform Residential Appraisal Report Filed C;LEMSONDR109 21. The lender/client may disclose or distribute this appraisal report to: the borrower; another lender at the request of the borrower; the mortgagee or its successors and assigns; mortgage insurers; government sponsored enterprises; other secondary market participants; data collection or reporting services; professional appraisal organization:>; any department, agency, or instrumentality of the United States; and any state, the District of Columbia, or other jurisdictions; without having to obtain the appraiser's or supervisory appraiser's (if applicable) consent. Such consent must be obtained before this appraisal report may be disclosed or distributed to any other party (including, but not limited to, the public through advertising, public relations, news, sales, or other media). 22. I am aware that any disclosure or distribution of this appraisal report by me or the lender/client may be subject to certain laws and regulations. Further, I am also subject to the provisions of the Uniform Standards of Professional Appraisal Practice that pertain to disclosure or distribution by me. 23. The borrower, another lender at the request of the borrower, the mortgagee or its successors and assigns, mortgage insurers, government sponsored enterprises, and other secondary market participants may rely on this appraisal report as part of any mortgage finance transaction that involves any one or more of these parties. 24. If this appraisal report was transmitted as an "electronic record" containing my "electronic signature," as those terms are defined in applicable federal and/or state laws (excluding audio and video recordings), or a facsimile transmission of this appraisal report containing a copy or representation of my signature, the appraisal report shall be as effective, enforceable and valid as if a paper version of this appraisal report were delivered containing my original hand written signature. 25. Any intentional or negligent misrepresentation(s) contained in this appraisal report may result in civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Section 1001, et seq., or similar state laws. SUPERVISORY APPRAISER'S CERTIFICATION: The Supervisory Appraiser certifies and agrees that: 1. I directly supervised the appraiser for this appraisal assignment, have read the appraisal report, and agree with the appraiser's analysis, opinions, statements, conclusions, and the appraiser's certification. 2. I accept full responsibility for the contents of this appraisal report including, but not limited to, the appraiser's analysis, opinions, statements, conclusions, and the appraiser's certification. 3. The appraiser identified in this appraisal report is either asub-contractor or an employee of the supervisory appraiser (or the appraisal firm), is qualified to perform this appraisal, and is acceptable to perform this appraisal under the applicable state law. 4. This appraisal report complies with the Uniform Standards of Professional Appraisal Practice that were adopted and promulgated by the Appraisal Standards Board of The Appraisal Foundation and that were in place at the time this appraisal report was prepared. 5. If this appraisal report was transmitted as an "electronic record" containing my "electronic signature," as those terms are defined in applicable federal and/or state laws (excluding audio and video recordings), or a facsimile transmission of this appraisal report containing a copy or representation of my signature, the appraisal report shall be as effective, enforceable and valid as if a paper version of this appraisal report were delivered containing my original hand written signature. APPRAISER A S ATE E FED RESIDENTIAL APF Signature Name Ro rt K. Banzh ff ~' Company ame CENT ENN APPRAI L INC. Company Address 24 West Main Street, Shiremanstown, PA 17011 Telephone Number (717) 737-4600 Email Address bonnieCa~paappraisers.com Date of Signature and Report 07/23/2010 Effective Date of Appraisal 7/1 /10 State Certification # RL001231 L _ or State License # or Other (describe) _ _ State # State PA Expiration Date of Certification or License 6/30/2011 ADDRESS OF PROPERTY APPRAISED 109 CLEMSON DRIVE CARLISLE. PA 17013 APPRAISED VALUE OF SUBJECT PROPERTY $ 195,000 LENDER/CLIENT Name Company Name Company Address PRIVATE Email Address Freddie Mac Form 70 March 2005 SUPERVISORY APPRAISER (ONLY IF REQUIRED) Signature Name Company Name _ Company Address Telephone Number Email Address _ Date of Signature _ State Certification # _ or State License # State Expiration Date of Certification or License SUBJECT PROPERTY ^ Did not inspect subject property ^ Did inspect exterior of subject property from street Date of Inspection ^ Did inspect interior and exterior of subjecl: property Date of Inspection COMPARABLE SALES Did not inspect exterior of comparable sales from street ^ Did inspect exterior of comparable sales from street Date of Inspection __ Page 6 of 6 Fannie N1ae Form 1004 March 2005 Form 1004 - "WinTOTAL" appraisal software by a la mode, inc. -1-800-ALAMODE Main File No._~~LEMSONDR109TPage #B] Uniform Residential Ao~raiSal Rpnnrt FEATURE SUBJECT ' '" ~ ~ Address 109 CLEMS ON COMPARABLE SALE # 4 COMPARABLE SALE # 5 ~OMPARABLE SALE # 6 DRIVE CARLISLE PA 17013 931 ENOLA ROAD CARLISLE PA 17013 Proximit to Sub'ect 2.72 miles NW -- Sale Pric e $ N/A $ 214 000 $ $ Sale Price/Gross Liv. Area $ s .ft. $ 145.78 s ,ft. $ s .ft. $ ~ s ft Data Sources ASMT RECORDS/MLS/AGENT/ ___ __ . , Verification Sources SETTLEMENT DEPT. VALUE ADJUSTMENTS DESCRIPTION DESCRIPTION + - $ Ad'ustment DESCRIPTION + - $ Ad'ustment DESCRIPTION + - $ Ad'ustment Sales or Financing Concessions CONVENTION NONE KNOWP -- Date of Sale/Time 3/26/10-35D0~ --- Location AVERAGE AVERAGE _ ---- . Leasehold/Fee Sim le Fee Sim le Fee Sim le --- Site .61 ACRES 1.29 ACRES -3 400 View AVERAGE AVERAGE ---- Desi n S le SPLIT LEVEL SPLIT LEVEL --- Quali of Construction AVERAGE AVERAGE Actual A e 46 YEARS 45 YEARS Condition AVERAGE BTR AVERAGI -5 000 'Above Grade Total Bdrms. Baths Total Bdrms. Baths Total Bdrms. Baths Total __ Bdrms, Baths Room Count 6 3 1 6 3 2 -4 000 Gross Livin Area 1 168 s .ft. 1 468 s .ft. -4 500 s .ft. __ s .ft. Basement & Finished Rooms Below Grade FULL BMST REC/DEN/PR PART BMST REC/DEN/BAT -1 000 ___ Functional Utili AVERAGE AVERAGE ___ Heatin /Coolin HW/CA HP/CA Ener Efficient Items TYP FOR ARE TYP FOR AREA Gara a/Car ort 3 CAR GARA 2 CAR GARA +5 000 Porch/Patio/Deck PORCHES PATIO +2 000 _____ 1 FIREPLACE 1 FIREPLACE ___ NONE NONE NONE NONE Net Ad'ustment Total ^ + ®- $ -10 900 ^ + ^ - $ ^ + [^ - $ Adjusted Sale Price of Com arables Net Adj. 5.1 % Gross Ad', 11.6 % $ 203 100 Net Adj. ~o ~ Gross Ad', % $ _ Net Adj. ~o Gross Ad'. % $ Re ort the results of the rese arch and anal sis of the r ior sale or transfer hist or of the sub'ect ro ert and com arable sales re ort additiona l rior salt;s on a e 3 . ITEM SUBJECT COMPARABLE SALE # 4 COMPARABLE SALE # 5 COMPARABLE SALE # 6 Date of Prior Sale/Transfer NO PRIOR TRANSFER It NO PRIOR SALE OTHER Price of Prior Sale/Transfer THE PAST THREE YEAR THAN ABOVE _ ___ Data Sources TAX RECORDS TAX RECORDS __ ___ Effective Date of Data Source s 7/14/10 7/23/10 __ __ Anal sis of rior sale or transfer histor of the sub'ect __ roe and com arable sales ___ Anal sis/Comments • - -- Freddie Mac Form 70 March 2005 Fannie Mae Form 1004 March 2005 Form 1004.(AC) - "WinTOTAL" appraisal software by a la mode, inc. -1-800-ALAMODE Main File No_~CLEMSONDR109TPage #9] Supplemental Addendum File No. CLEMSONDR109 Borrower/Client N/A - Pro a Address 109 CLEMSON DRIVE _--- Cit CARLISLE County CUMBERLAND State PA Zip Code 17013 Lender PRIVATE This appraisal assumes a reasonable marketing period for the subject property of three months. The Market Approach reflects recent activity in the market place. The Income Approach is inappropriate because few single family houses are rented in this market. In view of the age of these improvements, the Cost Approach cannot be considered an accurate indicator of value. THIS IS A SUMMARY REPORT OF A COMPLETE APPRAISAL. APPRAISER ACKNOWLEDGEMENT: APPRAISER ACKNOWLEDGES AND AGREES, IN CONNECTION WITH ELECTRONIC SUBMISSION OF APPRAISALS, AS FOLLOWS: THE SOFTWARE UTILIZED BY THE APPRAISER TO GENERATE THE APPRAISAL PROTECTS SIGNATURE SECURITY BY MEANS OF DIGITAL SIGNATURE SECURITY FEATURE WHICH LOCKS THE REPORT WITHIN OUR OFFICE AND CAN NOT BE: ALTERED BY ANYONE OTHER THAN OUR OFFICE. APPRAISER CERTIFICATION: APPRAISER STANDARDS: I acknowledge and certify that (I) my appraisal of the above referenced property may be used in a federally related financial transaction subject to requirements of Title XI of the Financial Institution Reform, Recovery and Enforcement Act of 1989 (FIRREA"); (ii) the appraisal must comply with FIRREA and the applicable regulations implementing Title IX of Firrea; and (iii) the appraisal vvas completed in accordance with USPAP. APPRAISER COMPETENCY: I certify that I am fully qualified and competent by training, knowledge, and experience to perform this appraisal. APPRAISER INDEPENDENCE: I represent and certify that (I) the appraisal assignment was not based on a requested minimum valuation, a specific valuation, or the approval of a loan; (ii) my employment was not conditioned upon the appraisal producing a specific value or value within a given range; (iii) my future employment is not dependent upon an appraisal producing a specific value; (iv) my employment, compensation, and future employment are not based upon whether a loan application was approved; (v) neither me nor any person with an ownership interest in the company employing me, is related 'to or has any ownership or other financial interest in, either the builder/developer, seller, buyer, mortgage broker, or real estate broker/salesperson (or any person related to any of them) involved in the transaction for which this appraisal was requested, or with the most recent sale or refinancing of any property used as a comparable property in this appraisal, and (vi) I am not aware of any facts which would disqualify me from being considered ari independent appraiser. Form TADD - "WinTOTAL" appraisal software by a la mode, inc. -1-800-ALAMODE Main File No. CLEMSONDR109 Paae #10 Subject Photo Page Subject Front 109 CLEMSON DF;IVE Sales Price N/A Gross Living Area 1,168 Total Rooms 6 Total Bedrooms 3 Total Bathrooms 1 Location AVERAGE View AVERAGE Site .61 ACRES Quality AVERAGE Age 46 YEARS Subject Rear Subject Street Form PICPIX.SR - "WinTOTAL" appraisal software by a la mode, inc. -1-800-ALAMODE - - - -_ i Main File No. CLEMSONDR109 Page #11 Photograph Addendum Borrower Client N/A Pro a Address 109 CLEMSON DRIVE -- C~ CARLISLE Coun CUMBERLAND State PA Zi Code 17013 Lender PRIVATE Form GPICPIX - "WinTOTAI" appraisal software by a la mode, inc. -1-800-ALAMODE ~ " Photograph Addendum /Client N/A Address 109 CLEMSON DRIVE CARLISLE County CUMBERLAND PRIVATE Main File No. CLEMSONDR109 Page #12 State PA Zip Code 1 Form GPICPIX - "WinTOTAL" appraisal software by a la mode, inc. -1-800-ALAMODE Main File No. CLEMSONDR109 Paqe #13 Photograph Addendum Pro a Address 109 CLEMSON DRIVE -- C~ CARLISLE Coun CUMBERLAND State PA Zi Code 17013 Lender PRIVATE Form GPICPIX - uWinTOTAL" appraisal software by a la mode, inc. -1-800-ALAMODE '' Main File No. CLEMSONDR109 Paae #14 Comparable 1 7 BEAGLE CLUB ROAD Prox. to Subject 0.82 miles N Sales Price 199,000 Gross Living Area 1,610 Total Rooms 7 Total Bedrooms 3 Total Bathrooms 1.5 Location AVERAGE View AVERAGE Site 1.33 ACRES Quality AVERAGE Age 36 YEARS Comparable 2 406 WOLFS BRIDGE ROAD Prox. to Subject 0.74 miles N Sales Price 190,000 Gross Living Area 1,456 Total Rooms 6 Total Bedrooms 3 Total Bathrooms 1.5 Location AVERAGE View AVERAGE Site 1.84 ACRES Quality AVERAGE Age 46 YEARS Comparable 3 2 ROBERT LANE Prox. to Subject 1.53 miles SW Sales Price 197,500 Gross Living Area 1,176 Total Rooms 6 Total Bedrooms 3 Total Bathrooms 2 Location AVERAGE View AVERAGE Site .26 ACRES Quality AVERAGE Age 35 YEARS Form PICPIX.CR - "WinTOTAL" appraisal software by a la mode, inc. -1-800-ALAMODE Comparable Photo Page Main File No. CLEMSONDR109 Paae #15 Comparable 4 931 ENOLA ROAD Prox. to Subject 2.72 miles NW Sales Price 214,000 Gross Living Area 1,468 Total Rooms 6 Total Bedrooms 3 Total Bathrooms 2 Location AVERAGE View AVERAGE Site 1.29 ACRES Quality AVERAGE Age 45 YEARS Comparable 5 Prox. to Subject Sales Price Gross Living Area Total Rooms Total Bedrooms Total Bathrooms Location View Site Quality Age Comparable 6 Prox. to Subject Sales Price Gross Living Area Total Rooms Total Bedrooms Total Bathrooms Location View Site Quality Age Form PICPIX.CR - "WinTOTAL" appraisal software by a la mode, inc. -1-800-ALAMODE Comparable Photo Paae • ~ - -- Main File No. CLEMSONDR109 Pa_ae #16 Building Sketch Client N/A Address 109 ~~• lr/1RLIJLC Coun CUMBERLAND State PA Zip Code 1701 Lender PRIVATE Form SKT.BIdSkI - "WinTOTAI" appraisal software by a la mode, inc. -1-800-ALAMODE Location Map Main File N~. 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Kwk tt'.,n 4 .~ ~e.a`~adr, ' ~ .~ R,aarn r., Car19P Arrpon 74 ' W svt n F AilY1C ' ~ Ur ~ ~ ~ 3 Hor,aerl. .. rt p ~ yQy~ ~ -IetltueY D` ~~~~ ti~ S W kkxr+er Rd A ~~ t.o„;~~ .641', ~ .HN' uo ,~. n C ~f~ra B.~mr7cs N Form MAP.LOC - "WinTOTAL" appraisal software by a la mode, inc. -1-800-ALAMODE REV 1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JAMES W MCCLAFFERTY SCHEDULE B STOCKS & BONDS FILE NUMBER All property jointly-owned with right of survivorshiu must be disclosed nn Schadu~a F (n rnvre space is neeaea, insert adtlitional sheets of the same size) Calculated Value of Your Paper Savings Bond(s) Page 1 of 2 . ~ ~,. r~ • Calculated Value of Your Paper Savings Bond(s) Calculator Results for Redemption Date 07/2010 °~t~~ ~a~i~ ~~t~l '11~1ue Totat nt~r-~~t "~°~ r~~~~-~~t $7 087.50 __ $48,531.64 $41,444 14 $0.00 Bonds: 1-40 of 40 s~ria~ Issue eves 0ee~r~m Dade N+~x F~r,al Accrual IHatur~it°y su 'rice ne~°~ t~~erest ~1ue NA E $1,000 11/1976 11/2006 $750.00 $4,756.00 $5,506.00 M NA E $500 05/1973 05/2003 $375.00 $2,222.80. $2,597.80 M NA E $500 05/1973 05/2003 $375.00 $2,222.80 $2,597.80 M NA E $500 05/1973 05/2003 $375.00 $2,222.80 $2,597.80 M NA E $500 05/1973 05/2003 $375.00 $2,222.80 $2,597.80 M NA E $500 05/1973 05/2003 $375.00 $2,222.80 $2,597.80 M NA E $500 05/1973 05/2003 $375.00 $2,222.80 $2,597.80 M NA E $500 05/1973 05/2003 $375.00 $2,222.80 $2,597.80 M NA E $500 05/1973 05/2003 $375.00 $2,222.80 $2,597.80 M NA E $200 08/1978 08/2008 $150.00 $705.76 $855.76 M NA E $200 07/1978 07/2008 $150.00 $705.76 $855.76 M NA E $200 07/1978 07/2008 $150.00 $705.76 $855.76 M NA E $200 06/1978 06/2008 $150.00 $705.52 $855.52 M NA E $200 06/1978 06/2008 $150.00 $705.52 $855.52 M NA E $200 03/1977 03/2007 $150.00 $954.32 $1,104.32 M NA E $200 03/1977 03/2007 $150.00 $954.32 $1,104.32 M NA E $200 07/1973 07/2003 $150.00 $901.68 $1,051.68 M NA E $200 07/1973 07/2003 $150.00 $901.68 $1,051.68 M NA E $200 07/1973 07/2003 $150.00 $901.68 $1,051.68 M NA E $200 06/1973 06/2003 $150.00 $891.60 $1,041.60 M NA E $200 09/1978 09/2008 $150.00 $705.76 $855.76 M NA E $200 07/1975 07/2005 $150.00 $915.20 $1,065.20 M NA E $200 07/1975 07/2005 $150.00 $915.20 $1,065.20 M NA E $100 11/1976 11/2006 $75.00 $475.60 $550.60 M NA E $100 11/1976 11/2006 $75.00 $475.60 $550.60 M NA E $100 11/1976 11/2006 $75.00 $475.60 $550.60 M NA E $100 11/1976 11/2006 $75.00 $475.60 $550.60 M NA E $100 03/1975 03/2005 $75.00 $451.28 $526.28 M NA E $100 03/1975 03/2005 $75.00 $451.28 $526.28 M NA E $100 03/1975 03/2005 $75.00 $451.28 $526.28 M NA E $100 03/1975 03/2005 $75.00 $451.28 $526.28 M NA E $100 02/1975 02/2005 $75.00 $451.28 $526.28 M NA E $100 12/1973 12/2003 $75.00 $438.92 $513.92 M NA E $100 12/1973 12/2003 $75.00 $438.92 $513.92 M NA E $100 12/1973 12/2003 $75.00 $438.92 $513.92 M NA E $100 12/1973 12/2003 $75.00 $438.92 $513.92 M NA E $100 08/1978 08/2008 $75.00 $352.88 $427.88 M NA E $100 08/1978 08/2008 $75.00 $352.88 $427.88 M NA E $75 12/1976 12/2006 $56.25 $357.87 $414.12 M http://www.treasurydirect.gov/BC/SBCPrice 7/12/2010 . ~r r~ ~~ ~J • Calculated Value of Your Paper Savings Bond(s) Page 2 of 2 NA E $75 12/1976 12/2006 $56.25 $357.87 $414.12 M Totals for 40 Bonds $7,087.50 $41,444.14 $48,531.64 ot~ NI Not Issued NE Not eligible for payment P5 Includes 3 month interest penalty MA Matured and not earnin interest http://www.treasurydirect.gov/BC/SBCPrice 7/12/2010 Calculated Value of Your Paper Savings Bond(s) • Calculated Value of Your Paper Savings Bond(s) Calculator Results for Redemption Date 07/2010 • • Total ra~~ ~`otal t~atu~ Total Irtt+~r°st "~°° It~•~st $1,331.25 $9,163.24 $7,831.99 $0 00 Page 1 of 2 Bonds: 1-36 of 36 5~~°lal 5~°is r~orra I~~t~e ~xt Elnal ate ~+~r~at aturlt NA E $50 07/1972 07/2002 NA E $50 07/1972 07/2002 NA E $50 07/1972 07/2002 NA E $50 07/1972 07/2002 NA E $50 03/1972 03/2002 NA E $50 03/1972 03/2002 NA E $50 03/1972 03/2002 NA E $50 03/1972 03/2002 NA E $50 10/1971 10/2001 NA E $50 10/1971 10/2001 NA E $50 12/1968 12/1998 NA E $50 12/1968 12/1998 NA E $50 11/1968 11/1998 NA E $50 11/1968 11/1998 NA E $50 11/1968 11/1998 NA E $50 07/1967 07/1997 NA E $50 07/1967 07/1997 NA E $50 07/I967 07/1997 NA E $50 07/1967 07/1997 NA E $50 07/1967 07/1997 NA E $50 07/1967 07/1997 NA E $50 07/ 1967 07/ 1997 NP. E $50 07/1967 07/1997 NA E $50 07/1967 07/1997 NA E $50 07/1967 07/1997 NA E $50 07/ 1967 07/ 1997 NA E $50 07/1967 07/1997 NA E $50 07/1967 07/1997 NA E $50 07/1967 07/1997 NA E $50 07/1967 07/1997 NA E $50 07/1967 07/1997 NA E $50 07/1967 07/1997 NA E $50 07/1967 07/1997 NA E $50 07/1967 07/1997 NA E $50 07/1967 07/1997 NA E $25 10/1971 10/2001 Totals for 36 Bonds ! r~~~~ nr~t ~ri~~ at $37.50 $218.04 $37.50 $218.04 $37.50 $218.04 $37.50 $218.04 $37.50 $214.88 $37.50 $214.88 $37.50 $214.88 $37.50 $214.88 $37.50 $215.22 $37.50 $215.22 $37.50 $237.06 $37.50 $237.06 $37.50 $233.38 $37.50 $233.38 $37.50 $233.38 $37.50 $219.40 $37.50 $219.40 $37.50 $219.40 $37.50 $219.40 $37.50 $219.40 $37.50 $219.40 $37.50 $219.40 $37.50 $219.40 $37.50 $219.40 $37.50 $219.40 $37.50 $219.40 $37.50 $219.40 $37.50 $219.40 $37.50 $219.40 $37.50 $219.40 $37.50 $219.40 $37.50 $219.40 $37.50 $219.40 $37.50 $219.40 $37.50 $219.40 $18.75 $107.61 1,331._25. $7,831.99 ! dote ot~~ NI Not Issued http://www.treasurydirect.gov/BC/SBCPrice $255.54 $255.54 $255.54 $255.54 $252.38 $252.38 $252.38 $252.38 $252.72 $252.72 $274.56 $274.56 $270.88 $270.88 $270.88 $256.90 $256.90 $256.90 $256.90 $256.90 $256.90 $256.90 $256.90 $256.90 $256.90 '$256.90 ;$256.90 :$256.90 :$256.90 :$256.90 :$256.90 .256.90 !256.90 !2,56.90 l~256.90 !126.36 9,163.24 MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA ' MA MA MA ; MA ~ MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA , 7/12/2010 REV-1508 EX+ (11-10) r pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER: JAMES W MCCLAFFERTY Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. it more space is neeaea, use additional sheets of paper of the same size. :~ 1-88$-910-4200 Calt Citizens' Phone:Bank anytime for account a»formation, current rates and answers to your questions. U5259 BR289 7 ~. JAMES W MCCLAFFERTY 109 CLEMS~N DR CARLISLE PA 17013-8891 Circle Acco~~n1: Statement GF 4 Beginning June 04,:2010 throughi .Italy 06, 2010 Con e~nts $UmmaCy Page Checkin~"y Page 2 Check Tma~~es Page 4 Circle Summary Account Account. Number DEPOSIT BALANtE Checking Circle Checking 622362-445-8 Savings Circle Savings &255-9&4650 Monthly combined balance to waive monthly fee is Your monthly combined balance this statement period is Balance Balance. JAMES VV MCCIAFFERTY fast Statement This statement circle Checking 622361-44'a -8 7,298.78 7,426.75 .00 .00 _ Tatat Deposit BatantE T 426.76 5 , 000.00 _ Total. RetaNonshtp Balance 6,672.32 ~ ~ 4 7, 26.76 ~ ~ ~ g ~~ ~¢ ~ ;ar ;~ ...... 1-8$8-91Q-/+100 Cade Citizens' PhoneBank anytime for account: inforrnatiotr, current rates and answers to your questions. Circle Account Statement` aE 4 Beginning June 04, 2010 through July 06,.201:0 Checking SUMMARY .Balance Calculation Previous .Balance Checks Uithdrawals Deposits & Additions Current Balance JAMES Ut- MCCLAFFERTY Circle Checking G223G1-44.5-8 7,298.78 959,44 - 160.58 - 1,248.00 + 7,426.7E = TRANSACTION DETAILS Checksx TlTere is a break in c%eck sequence Check # Amount Date 119 90.00 OG/0$ 120 .119. GO OGJ09 121 204.65 OG/15 122 38,39 OG/18 `~"rithdrawals ether Withdrawals .Date Amount Description OG/04 108.58 Embar Bilt Pymt 100603 Check ~# 040000011.7 06/18 52.00 Patriot News Check Pymt 461710 Check ## 0400000123 _ Total Checks ~P 959.44 Total Witfidrawats -- 160.58 Deposits & Additions Date Amount pescription 07/02 ~ 1,248.00 Treasury 3.03 Soc Sec 070.210 - ~~~ Daily Balance Date Balance Date Balance Date Balance OG/04 7,190.20 06/15 6,775.95 OG/22 G,178.7G OG/08 7,100.20 OG/16 6,582.95 07/02 7,426.7E -0G/09 G, 980.60 OG/18 G, 492.56 iVfWS FRt3M CITi2EtV5 --Citizens Bank is here for all your borrowing. needs, Whether you are consolidating debt, making home improvements or paying off student loans, Citizens Bark has great. rates that can help you with a variety of borrowing needs. Take advantage of flexible repayment terms and no closing costs on home equity tines or loans_ Or, for those of yUU who are purchasing a h©me or refinancing your mortgage, get 1/8°l0 off your rate when you have a Circle Gold Checking account and your payment automatically deducted. See a banker today or caul 88.8-716-4.824 and discuss your borrowing options. --We all have savings goals. Whether it's a new home, a child's education, retirement or being prepared for unexpected expenses, Citizens Bank makes it easy and rewarding for you t:o start saving. Creating an emergency savings account can prepare you for unexpected events and help you reach your savings goals. Na matter what you`re saving for, we have. a great savings solution. Ask your banker about what savings accounts and programs are right for you. We also offer money market accounts and CDs with competitive rates and the peace of mind of FDIC insurance. For more information or to apes a new account, visit your focal branch today or call 1-888-821-3900. °Ylf.'(i3tSc( E+.iiC 'h_'r ~`~".:i i'{;~i:=!ti '; ..,.. ~i?~,. Previous Balance 7,298.78 Check # Amount Date 124* 193.00 06/16 125 123.00. 06/22 126 190.80 OG/22 Total Deposits & Additions '~' ~- 1.,248.00 ~_ torrent Balance ~•. --N 7 426.76 ~' .~ ~ ~~ ~ ~; ~ : T-~ Circle a - - Account Statement 1-$88-91Q-41Q0 ~ uF 3 Ca{t Citizens' PhoneBank anytime far aceotmt information, current rates anrJ answers to your questions. Beginning July 07 2010 through Au~~ust 04~ 2010 Checking su aiMaav Balance Ca{culation Previous. Balance 7,426.7b Checks ,00 Withdrawals 7,426.76 - Deposits & Additions .00 + Current Balance . QO TRANSACTION DETAIL5 Withdrawals Date Amount Description 7 08 1,248.00 Return SSA 07/02j10 07/12 b,178.7b Clvs~ng i hdrawal Daily..Balance Date Balance Date Balance Date Balance 07/os b,178.~~ 07/12 .ao MEMO --Reminder: As of August 15, 2010 a new federal regulation will change the way your account works today. As detailed in the insert you received in your Juty statement, with current Standard Overdraft Practices, Citizens Bank, at our dt'scretion, may authorize and pay transactions that cause overdrafts including AhM and everyday debit card transactions. However, effective August 15, 2010 we will decline your ATM and everyday debit card overdrafts unless you ask us to include them in the Standard Overdraft Practices. an your account. If your account was opened July 1, 2:010 or later, your Standard Overdraft Practices preference was made during account opening and is effective immediately. At .Citizens Bank you have a choice for how you would like us to handle your ATM and everyday debit card transactions. If you haven't already. done so, and ;rnir wish to give us the authority tc~ pay ATM anri debit card overdrafts an your behalf, you .may provide your consent by using one of these three convenient options: call us at 1-8G6-221-?_921, log On to online banking or visit your local branch. While you can make andJor change your decision at any time, to retain this service without. interruption we must have your authorization before August 15th. If you prefer that the bank does not pay ATM and everyday debit card overdrafts an your account, there's no action you need to take, Beginning August, 15tk~, any overdrafts on ATM and everyday debit card transactions will be declined. For more :information on this new regulation visit citizensbank.cam/overdraft-regulation. By providing you with information about this new federal regulation and how it impacts your account, Citizens Bank remains dedicated to helping you bank on your terms. NEWS FROM CITIZENS --Citizens Bank is here far all your borrowing needs. Whether you are consolidating debt, ~-.. making home improvements or paying off student loans, Citizens Bank has great. rates that can help you. with a variety of borrowing needs. Take advantage of flexible repayment terms and no closing. costs on home equity lines or loans. Or, for those of you. who are purchasing a home nr refinancing your mortgage, get 1 j8°lo off your rate when you have a Circle Gall Cher_king account and your payment automatically deducted. See a banker today or call 1-88&5G7-1518 and discuss your borrowing options. --We alt have savings goals. Whether it's anew home, a child's education, retirement ar being prepared for unexpected expenses, Citizens Bank makes it easy and rewarding for you to start saving. Creating an emergency savings account can prepare Vou for unexpected events and JAMES W Mf.CLAFFERTY Circle Checking f223b1-445.-8 Previous BaEance 7,42b.7b TotaE Withdrawais ~. 7,426.7b _ Current Balance ~~ .Oo _.~ __ CUStOCYt2!" ReC@i(3t Please be sure to enter this transaction in your records. Transaction Date Amoun~ Description Account Number ~<i :' :"~ ~t' ;i f s r f~rlt"~ 4 '~ ,r7r- (` f rl ~ ~{ ^ ~' r tlt;~ S`i<f 1'h' ~Ey;~.~ }~Vlty~r~J~,/ a?iy/r ~~; ~'it"a~igl'1! •1ih e_111 '. 4.-.}~e ~1Si+.itlt7l• Jt_"/•y ,.. 7 S '!:.Z '.~. Funds from your deposit may not be avaiEabie for immediate withdrawal. Att transactions are subject to 22089-BUNKER 8106 iMIPK verification as outlined in the rules and regulations of the Bank. Member FDIC ~+ • f e ~~ , ~ ~ ~d~~ • i' yn Mawr Road • Carlisle, PA 17013 • ii' `~ ~ ~ ~~,L {717) 243-7855 • FAX (717) 243-0255 www.carlisieevents.com SALE DATE _ LOT NO. YEAR MAKE TYPE AS/WHERE iS TITLENO. SERiALNO. ANNOUNCED CONDITIONS SELLER - ODOMETER DISCLOSURE STATEMENT Fed~erai and state laws require that you state the ;mileage of the vehicle described herein an this certificate upon transfer of BUYER -' ownership. Failure to da so or providing a false statement may result in fines andlorimprisonment. 1, ..._.~INTEd NAME SELLER that the odometer-now reads miles {no tenths) and to the best of my knowledge that it reflects the actual mileage of vehicle described herein, unless one of the following is checked. {1) I hereby certify o the best of my knowledge the odometer reading reflects the amount of mileage in excess of its mechanical limits. ____ (2) i hereby certify that the odometer.reading is NOT the actual mileage -WARNING -ODOMETER DISCRERANCY. 1, by use of authorized signature, hereby agreeto pay the indicated sales price for the vehicle described in this voucher UNDER THE TERMS AND RULES OF THE - ABOVE AUCTION AND SUBJECT TO THE TERMS OF' THIS BUYER'S ORDER. I For the value received J hereby sail, assign ar transfer the vehicle acknowledge receipt of odometer disclosure statement and must return a signed described on this document to the purchaser named .herein. copy to Seller of be subject#o civil and criminal :penalties, including tines and jail. X ~ X SIGNATURE OF S G 7URE OF BUYER --- x ,' X PRINTED NAME OF SELLER 'PRINTED°NAM OF BUYER --- FEES 131D PRICE . , BUYER FEES ;` BUYER TOTAL SELLER FEES NET DUE' SELLER. ~ - gag - _, .~' ~ ;~ .& ___ Estate of James W. McClafferty DOD July 1, 2010 Household items Bedroom bed, dresser, night stand 150 Living room One chair, one coach, end table and tamp 75 dinning room Table and chairs 75 Family room Coach, two chairs, lamp, and old tv 125 office Deck and chair 125 550 WIIh"am H. Smith 2083 Schoolhouse Rd. Middletown, P14 17057 (717) 948-0935 March 30, 2011 Clarence Asbury 1355 Armitage Way Mechanicsburg, PA 17050 RE: 1957 Ford T-bird Vin: D7FH393727 Color: Metallic Grey with Red Interior VEHICLE CONDITION: This vehicle is in # 1 Condition. Qual'if'ications 1979 & 1980 President of the Antique Automobile Club of America National lodge with more than 150 judging credits Executive Director of the Antique' Automobile Club of America for 17 years AACA Library & Research Center past director and past president AACA Museum Board Member and past president Former member of SEMA and ARMO 2005 Meguiar's Person of the year Certified Appraiser with International Vehicle Appraisers Network (1-VAN) This certifies that on July 12, 2010, William H. Smith has hereunto appraised the above-mentioned 1957 Ford Thunderbird in the range of $50,000.00 (Fifty Thousand Dollars). This appraisal was based upon the overall condition of the vehicle with the knowledge that the motor was started. ThE; value of this vehicle is subject to change due to the fact of deterioration, repeated use and any damage resulting from theft, effects of nature andlor damages out of the control of the owner. This 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. The appraisal of this vehicle is intended to remain valid until such time as the above-mentioned causes may affect the vehicle in any way. Upon such time, this appraisal i> subject to change. Wherefore, the appraisal made the day and year first above written is made to the beast of my knowledge and belief and is subject to change in accordance with the facets previously listed. Date: ~ ' ~ ~ -- I f Certified by: ~~ tit,~~ William .Smith Name: Clarence Asbury Address: 1355 Armitage Way Mechanicsburg, PA 17050 Phone: Ce11:717-514-2600 Date: 3 -3 0-11 Overall Vehicle Condition 1 Re: 1957 Ford T-bird Appraisal Amount: $50,000.00 • Paint Color & Condition Excellent, 1958 Metallic Gray • Interior Color Red, Excellent • Vin No. D7FH393727 • Plate No. 509B • Miles 16,555 • Engine 312 V-8 Ford Started: Yes • Transmission Automatic • Trunl~ Excellent • Tires_ Good • Hubcaps. Verv Good • Glass Very Good • Trim Excellent • Undercarriage Very Good • Runningboards/Doorsills Ve Good • Air Conditioner: No Additional Notes: • 2 Tops add $ l , 800.00 • Restored in 1982-won all Antique Automobile Club of America aw~~rds REV-1510 EX+ (08-09) SCHEDULE G ~ pennsylvania INTER-VIVOS TRANSFERS & DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER JAMES W MCCLAFFERTY This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV 1500 COVER SHEET is vPc ~n mvre space is neeaea, insert aadit~onal sheets of the same size) W N (V11 cr o ~ ~ ~ ~ m u s~ n Z~.n ~ m ° , w O _ ~ Z rn ~ z O ~ ~ Z ~ ~ m .~ rn N o r m w -.~ ~ o ' V 1 ~r~\ O p N O N ~ V W .1 N CJ1 ~ N ~ CO N O O O ° ~ ~ O ° o ° o cs nNi cNi, v N N O O ~1 O O p O O O U7 -~ W o ~., v zw~ Ohm Z r -I T C r D O ~~m m ,~+z ~ 0 0 -- ~ D - O co o ~ rn O'a m~c~n O ~ o O ,A rn J ~/ ''' N OWO O O_ O O o °o m_ ~ COT1 O 00 O u 0 0 0 0 o° o Z n Z ~ ? cmn Z ~ n ~ Z N ~ ~ /Nw V 1 I\ p ~ ~ O C 0 cc> QD C71 O O o° o° 0 0 D n n rh O ~, 0~0 a~ N o° ~ vi y D ~ ~ °~° ~ ~ c r = ~n ~' ,~' r _r m c ~ ~ O Ca N /W W O O ..~ 0 ~ Z ~' ~ ~ 3 a~ c~ 1 PF ~' ~i N 0 y ~. ~ ~ ~ a N ~ .-r O ~ n C ~ ~ O p C O O ~D .~ O ~ n fD ~ `_~ o' ~' ~ ~ Q N ~ ~N o N N 0 0 -' O c m ~ -~ (7 ~ O ~ ~ ~ ~ Z D ~ ~ m 0 c ~~ ~ "//--~~ l JJ o y -,, ~ ~ ~ ~ cn m ~~ ~ m c L D m W v 0 D C ~ c `~. 01 !D ~ S ~ C7 ~^ ~ ~ ~ N ai ~ ~ 3 n ~ ~ rt n O N c~ O v y+ rn O N. ~ ~ v ~ rn N N 2 ~ ~ cn L ~ ~L O O O O M i M M M ~ ,oj ~-. ~ ~ RS > O O r M O O ~ O O O `~ ~ _ O G1 CD CO ~ N ' ~ ~ .~ r .~ c ~ Q _ ~ ~ CV l1') N i O O O X ~ ~ N j ~ ~ ~ v .~.° ifs IL ~ 6 9 ' ~ ~ ~ ~ c ya _ ~ ~ ~ L = fA O O ~ ~ ° N ~ lf3 ER ° o 'Q C L ° ~.N ~ a~ ~ ~..> ~ V ~ ~ c m c> ~ Q o ay -a ~ ~ y - m "~ X y ':- a °i N ~ c ~? ° ~.. 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L = 1 N ~ d O O N ~ C ~, fa L L Q ? ~ ~ r C • . ~,,, _ - O ~ ~ C Q1 - N _ Q~ ~ 3 O ~t C p O ~~ d I C ~ K V C6 a. ~ L ~ _ R ~ ~ ~ t ~" ~ L ~ O cLa O 1 O C p C O la ~ ~ U C.1 1 I i ' eC N C N N B C ~ d ~ ' ' LL . -p ~~ ... caw d ~ 1 a :: a ar H cad U~ 41 C 0 t R l4 ~L ~ d ~ o • ~ I ~ c ~ a ~ 'a L ~ , ., J . ~ ~ E N _ ~ co ~; E O O C O „_, ~ N V •N d ~ ~ w '„ ~ ~ ' ~ d1 ~ ~ ~ ~ C 7 ~ ~ ~ .F+ N L !a ' UJ U) N N ~ ~ N "O ~ i d1 d C d R _ 7 U U O~ ~ .> I ~ 3 ~ C C~ N G1 ~ d 3 - > 3 d d ~ ~, ~ 3 c9 N ~~ 'O o i C ;- a ~ a~ N N~ ~ O N ~ Q. Q V ~. V d ~ y 0 U 0 O ^ '~ 'C Q ca O • • d >. J ~+ C J L ~ ~ ~ z O ~ C1N ` R :c~ ,~ o - 0 0 ; j~ d d C = c •c ~ ~ a.. ~ ~ ~ z c. M REV-1511 EX+ (10-09) SCHEDULE H ~ pennsylvania FUNERAL EXPENSES & DEPARTMENT OF REVENUE INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER JAMES W MCCLAFFERTY Debts of decedent must be reported on Schedule !. ITEM NUMBER DESCRIPTION __ AMOUNT A. FUNERAL EXPENSES: ~• MALPEZZI FURNERAL HOME 13,403.76 2 HEADSTONE 125.00 B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) CAROL A SAB I N E StreetAddress 10 9 CLEMSON DR ~;ty CAROI SLE Year(s) Commission Paid: N /A State PA zIP 17 013 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant 4. 5. s. ~. Street Address City State Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees ZIP TOTAL (Also enter on line 9, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) 3,058.00 323.50 975 450 18,335.26 Malpezzi Funeral Home 8 Market Plaza Way (717) 697-4696 Mechanicsburg, PA 17055 www.lrialpezzifuneralhome.com Jeremy J. Shartzer, FD Michael J. Malpezzi, Owner, FD Kyle C. Knipe, FD July zo, zo ~ 0 Clarence Asbury 13 S 5 Armitage Way Mechanicsburg, 1'A 17G5~ The Funeral Service for James W. McClafferty We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FtINERAL ,4RRANGEMENTS. 1. PROFESSIONAL SERVICES: Services of Funeral Director/Staff $4,(125.00 FUNERAL HOME SERVICE CHARGES $qG,~>5,04 SELECTED MERCHANDISE: Pecan Casket $3,5E5.00 Clark 7 Ga. Vault. $2,835.00 Natures Tranquility Register Package $g5.00 Flag Case $g5.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED $11,215.4(1 AT THE TIME I~'t1NERAL ARRANGEMENTS WERE MADE, VdE ADVANCED CERTAIN PAYMENT`S TG OTHERS AS AN ACCOMMODATION.. THE FOLLOWING IS AN ACCOUNTING FOR TI-IOSE CHARGES. CASH ADVANCES: Opening Grave ~;EsI Q.00 Cemetery Equipment S~ i Ei5.00 Certified Death Certificates $10.00 Newspaper Notices -Patriot 9s2:~~6.52 Newspaper Notices -Sentinel ~> 14~ 1..84 Clergy/Mass Offering ~;2C~0,00 1Vlilitary Honor Guard $50.00 Flowers $445.40 TOTAL CASH ADVANCES AND SPECIAL CHARGES $2,188.76 sUS-TOTAL $I;,4c-;.7s INITIAL PAYMENT 1 DISCOUNT I CREDITS ~;O,pO TOTALAMOUNT DUE $13,403.75 r°"'"_' c K ~-y~Qt -~~ 29/~D Malpezzi Funeral Home 8 Market Plaza Way Mechanicsburg, PA 17055 Gingrich Memorials 5243 Simpson Ferry -Road Mechanicsburg, PA 17050 tr717~ 766-5622 ICI VD/C~°1 12-20619 9f 16/2010 1 Cemetery Inscription ~?t~i0~ y0'uf ~r/to?~QrOT' GB~II~.'t~~ inscription is~'snisjiec~ 1/18/2011 James McClafferty Rc-n Colvin Qrder Tatai: Payments: Balance Due: m ~ rn ~c ~ ~ ~ ~;~ -to ,~,~, ~ ~, ti,,.s U,;~ ~.,. a s n~ did ,~+ ~,~ ~ ~~ . $125.00 $0.00 $125.00 ~~ ~~ ~ ,r ~/ ~ LAW~OFFICE~~~/S/ FRANKEBERGER PLACE 219 EAST MAFN STREET P.O. HOX 230 MECtiANiCSBURG, PENNSYLVANIA .17055 7 t 7 69 T -7770 FAX 69 1 -7772 March 2, 2011 Estate of James W. McClafferty Carol A. Sabine, Executrix c/o Clarence E. Asbury . 1355 Armitage Way Mechanicsburg, PA 1705.0 For Professional Services Rendered 1. Office Consultations with Mr. Asbury (7/8/10; 9/16/10; 10/1/10; 2/23/11) 3 . ~?5 hrs. 2. Telephone Conferences with Mr. Asbury (7/6/10; 7/8/10; 7/13/10; 7/15/10; 8/12/10; 10/4/10): 1.50 hrs. ~~ 3. Probate (Preparation and. Drafting Probate Documents; Probate Will; Preparation and Drafting Notices to Beneficiaries; Preparation of Notice to Beth Aulthouse; Advertisement of Grant of Letters;. Preparation, Drafting and Filing Certification of Notices; Letter to Department of Welfare; Short Certificates; Preparation, Drafting and Filing Family Settlement Agreement)(?/8/10; 7/9/10; 7/12/10; 7/14/10; 7/15/10; 7/21/10; 9/17/10; ,/ /11): 5.5G hrs. 4. Preparation and Drafting. Promissory Note for Travis; Notice and Certification (9/1/10; 9/l i/10; 9j27j10) 2.75, hrs. 5. Review Cumberland County Land Records (10/7/10): 0.50 hrs. 6. Review File (7/6/10; 8/9/10; 9/29/10; 9/30./10; 2/23/11): 1.75 hrs. Total: 15.25 hrs. Balance: $3,050.00 Costs Advanced: Register of Wills, 2 Short Certificates: B,.OG Total Due: $ 3,058.00 ~~~ ~~~``1 RECEIPT FOR PAYMENT' GLENDA EARNER STRASBAUG~-i. - Cumberland County - Register Of Wills One Courthouse Square Yarlisle, PA 17013 MCCLAFFERTY JAMES W Estate File No.: 2010-00697 Paid By Remarks: CLARENCE ASBURY Receipt Date: 7/12/2010 Receipt Time: 14:10:47 Receipt No.: 1061829 SAP ---------------------- Receipt Distr ibution ----- _ - Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST WILL 260.00 CUMBERLAND COUNT'Y' GENERAL FUN SHORT CERTIFICATE JCS FEE 15.00 20.00 CUMBERLAND CUMBERLAND COUNTY' COUNTY' GENERAL GENERAL FUN FUN AUTOMATION FEE 23.50 5.00 ----- BUREAU OF RECEIPTS CUMBERLAND COUNTY & CNTR GENERAL M.D FUN Check# 2096 Total Received......... ---32----- 323.50 ~ 3.50 - t~ '~~' ~~~~~NL~ ~~,SB~ CERTIFIED PUBLIC ACCQUNTANTS ESTATE OF JAMES W. MCCLAFFERTY C/O CLARENCE ASBURY 109 CLEMSUN DR CARLISLE, PA 17013-8891 Invoice Date: 4111/11 Invoice Number: 00150295 Client Number: M1000 001 & Preparation of the 2010 Income Tax Return for Estates and Trusts PA Fiduciary Income Tax Return $ 975.00 ~ 975.00 DUE UPON PRESENTATION A FINANCE CHARGE OF ONEAND ONE-HALF (1 ~/2} PERCENT per month (ANNUAL RATE OF 18%) wilt be added to any account balance which remains. outstanding for more than THIRTY (3O} DAYS from the date such balance is first invoiced. ~ BEST PLACES G~~ F= to work i n t i> w I~ E LLP M £ M B Ei R ~®E~'I~®L'1III MEMBERS AMEF2ICAN AND PENNSYLVANIA INSTITUTES t)F CERTIFIED PUBLIC ACCt)UNTANTS REMITTANCE ADDRESS: 415 Fallowfield Road .Camp Hill, PA 17011 1.800.569.5199 . www.macpas.com .Fax: 717.761,7944 NicKornx 0d CERT(FfED F~L1~L#C ACC~U'JNTAIVTS JAMES W. MCCLAFFERTY C/O CLARENCE ASBURY 1355 ARM/TAGE WAY MECHANICSBURG, PA 17050 E~9* EMEiERS :'+;iv';~=~I~:,>:t;l ,`;lvt7 PE(~r1SY~V~F~Ir? ttif ~~ i ~-i !J ? Fe C?r CEO (IFIE[3 P~.!6LIC Invoice Dafe: 2/21/11 Invoice Number: 00149398 Client Number: M100D 0016 Preparation of individual tax returns for the year ended $ 450.00 December 31, 2010. $ 450.00 DUE UPQN PRESENTATIQN /-~ FINANCE CHARGE QF 1}fz PERCENT per month {ANNUAL RATE flF ~~ F~ERC:Ef`~T1 wvil be ac~dee~ to any account bafance which rerT3ains outsta;ncinc~ €fl:~- m€~re than THIRTY (3Q) DAYS from the date such bafance is ~irSt ~nvo~cec, RE1~9ITTANCE ADDRESS: 415 Fallotviiel~ Rr~ad • Ca!np i-~f#i, ~A 17~J11 1.8flG.569.5199 • wwti~~.macpas.corr~ F~.~x: 7~ r.7~1,7~?~.4 Assu~~ ~~ ~4 a~ ~~~ FI~f~S ~~ ~~~ 1 r# r.+E!'~1E€R TGLVORKf-OR E'.t~ t~~ ~v r~. ~s ~t• REV-1512 EX+ (12-08) ~ pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER JAMES W MCCLAFFERTY Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH i. PPL ELECTRIC BILL 155.8 2 VERIZON PHONE BILL 65.1 3 Central Penn Appraisals- home appraisal 350.0 4 CUMBERLAND COUNTY LAW JOURNAL 75.0 5 PATRIOT NEWS LEGAL NOTICE 137.2 6 MEDICAL BILLS 1,012.0 7 J & B BUSINESS - PREPARE CARS FOR SALE 577,7 8 CARLISLE EVENTS - ENTRY FEE FOR CARS 800.0 9 AUTO DRIVE - REPAIR CAR FOR SALE 90.0 10 WILLIAM SMITH - CAR APPRAISAL 150.0 11 FINAL FEDERAL TAX PAYMENT 82.0 12 FINAL PA INCOME TAX PAYMENT 1,098.00 TOTAL (Also enter on Line 10, Recapitulation) $ 4 , 5 93.0 8 If more space is needed, insert additional sheets of the same size. 8 9 0 0 4 7 0 0 0 0 0 PPS, E1e+etr~c Utilities Electric ~erV1Ce For: JAMES W MCCLAFFERTY 109 CLEMS(JN llR CARLISLE PA 17013 pp~ Page 3 .=~ ~~~~~ 994t~9--4501 s Total_from Last Bill $II9.60 Payment Received Jurr 8 -Thank You! ~II9.60 Billing details Balance as of Jul I, 2010 Current Charges PPL Electric Utilities Charges. for -PPL ELECTRIC UTILITIES Customer Service 827 Hausman Rd. Residential Rate: RS for Jun 2 -Jul 1 Distribution Charge: Allentown, PA 1.8104-9392 Customer Charge 200 KWH at 2.90600000¢ per KWH $ 1-800 342-577 (1-gOp-DTAI., ppf,~ 600 KWH at 2.64000000¢ per KWH 330 KWH at 2.48700000¢ per KITH S. g l 1 S. 84 www.pplelecirc_com PA Ta~c,Adj Surcharge at 0.10300000%, Transmission Charge: 8.21 0.04 1,130 KWH at 0.31600000¢ per KWII Transition Charge: 3.57 200 KWH at -0.25200000¢ per KVVI-I p _0 50 330 KWH at -0.20600000¢ er KWH p Generation Char _1,34 0.68 ~ ge: Gap04 ty and. Energy ZZ T~WH at 10. I3300000¢ per KWF-I " 600 KWH at 10.13300000.¢ per KWH 330 KWH at 10. I3300000¢ er KWf I PA T ~ 20.27 60.80 3 3 q.~} ax Adj Surcharge at -0. 1400000°f° . _0.02 Total PPL I LLCTRIC UTILITIES Charges Other Char es for PPL e'le'ctric Utilities Operation IIaP Donation 2 00 Total of Other Charges Account Balance $o. 00 $153.88 $2.00 ~ _~ General Generation prices and charges are set by the electric generation su lier • you have. chosen. The Public Ufility Cornrni sion re Mates di;;tribuption InfQrmatlQil nces and services. The Federal Ener Re ato ~rartsrrnssion prig-and s~tvie~. ~ ty omm2sslon regulates Next meter .._ ,. ~.., . readin ,. g PPL Electric Utilities uses about. $0.72 of this. bill to~~ppaay state taxes. In on or about addition, about $9.07 of this bill pays -the pA Gross I~ec Aug 2 etpts Tax. For your convenience, you can now~pa your bill. using your Visi MasterCard, Discover or ATM Card. ~a11 BiliMatrix at 1-800-~72-2413. BlMatrix will charge your credit and ATM card a service fees for making this payment. Before digging~ around your home or property, you should always call the state's C?ne Call notification system to locate any underground uti11 Tines. You can do this by simply dialin 811, which w111 connect you to the One Call system. Be safe and ca11 81 ~ before you dig. With pa erless billing, you can receive and pay your PPL Electricr Utilities bills onlPine. The process is free, quick, conven2ent and secure. To learn. more or sign up, visit www.pplelectnc.com. 11'11 ~ Qt ~Wf~~ PO BOX 4003 ;Manage: Your Account ' Account Number Date Due .~ t ACWQRTH, GA 317101 ,, -~ ~, q _ , .. ~ ~ - ,~ ~ ~ ~ r ; r, ~ .~~ ~ ~ . ~,. ~ ,~r _-„a .~. ~;~ Invoice Number 64443496 t 000026 i D7 AT 6.357 '"AUTQ T2 0 1 T42 17413-889tU9 1 E PH[L0204 -- ., f<<~lfl<<~{lf~~~~~~f(„ff~I~~I-I~zl~f,f~<<~~(III,~~I~f,~~~ll~f JAMES W MCCLAFFERTY 109 CLEMSON DR ~ ~'.':~s~. `3 i~^' ~~ {see back for derails) $19.38 CARLISLE, PA 17013-8891 ~-- - --~------_--- No Payment Received $.00 Adjustments -$76.44 Credi# Balance }"- -- - ----------- -$57.U6 Monthly Access Charges --$6.50 Usage Charges Voice $46.35 Verizon Wireless' Surcharges and Other Charges & Credits $75.49 Taxes, Governmental Surcharges & Fees -__ __~__ ___ $6.91 !t's never been easier to enroll In Auto 8111 Pay. See back of Payment Coupon below for details. Total Current Charges Total Charges Due by Juiyr 28, 201 Q $122.25 $65.19 • ..~.~ !~ ~. 1/e/Y` 'oAWilt9lBSS PO aax 4003 ACWOf~Tii, GA 30101 :Manage Youf Account !, Account Number Da#e Due .- _ . .~ Y s ~' ~ t F b _ ..~ ~" . . i Y ~~, j M fnvaice Number 6437115084 1000``31t21 3 01 AV 01t.335 "AUTO T9 0 1615 17013-889tttQ9 i 3 E PH(U504 ~rra~llrrtl~~rrrrrrt~rr`~r~rr~ilrr~r~r~trrrr~f~irrrir~rrrr~~rl JAMES W MCCLAFFERTY 109 CLEMSON DR CARLiSi_E, PA 170f3-8891 ft's never been easier to enroll in Auto Bif! Pay. See back of Paymen# Coupon below far details. °~,r~,~ ~ ~;f~ ~~:~ (see back fOr details) $19.38 Payment -Thank You _ _~ -------- Balance. Forward i Monthly Acce~ Charges Usage Charges _ -.'-- Voice _ Verizon Wireless` Surcharges v and Other Charges. & Credits -$19.3$ -- T_ $.OQ $15:Q0 $.00 $2.35 Taxes, Govemmentai Surcharges & Fees $2..03 Total Current Charges ---^ ~-~- $19.~ -~,~~ Total Gharges due ay J ly i 0, 2010 ~ $i 9.38 c~~ ~~~ _~ _____ -____._ .m____.._ ..~A__._W~.~._~._ _..._..__ ...r... ...~w_~. __ Mv...~..~ W_.:..~ _._ _~ Pa;~ from Wireless Pay on the Web Questions: ^'~ ~ar-. -.~ ...-. ., , FROM: ' Bonnie Myers, Office Manager Central Penn Appraisals, Inc 24 West Main Street Shiremanstown, PA 17011 Number: 717-737-4600 Fax Number: 717-737-9123 TQ: MR CLARENCE ASBURY 'l455 ARMITAGE ViJA,Y MECHANiCSBURG, PA 17055 ?elepirane Number: Fax Number: Alternate Number: E-Mail: UNIFORM RE5IDENTtAL APPRA[SA~ REPQRT RAYENT~ ='~ ~ - INVOICE 1~T~".. 41C~ ~~~R Cl_EMSQNDR109 ~AT~ 7l23l2i71 !~ i~~RtsNtE Internal Order #: Lender Case #: Clieni Fiie #: Main File# on form: CL.EMSONDR109 Other File # on form: Federal Tax I[}: 2.5_17.33269 Employer ID; Check #: Qate: Description: :.;~~~ Check #: Ua#e: D~~ ~ .^y ~. 7 t .~~~ LAW OFFIGES~ , '~...LL-- FRANKEBERGER PLACE 2.19 EAST MAIN STREET F? O. BOX 230 MECHANICSBURG, PENNSYLVANIA 17055 Estate of James W . McClaf f erty 717 691 77,o August 2 10 c / o Caro 1 A . Sabine , Executrix -- ------ -- -- ------ 20 109 Clemson Drive Carlisle, PA 17013 FOR PROFESSIONAL ~,F_RVIC:.t-S REN'JERf=G Costs Advanced: Cumberland Law Journal, Advertising: $ 1'5.00 b/~ ~v ~~ ~ r ~ ~a ~~ The Patriot-News Co. 2020 Technol©gy Pkwy Suite 300 Mechanicsburg, PA 17050 ---~ Inquiries - 717-255-8213 c~he~latriot News NOw you know MARLIN R. MCCALEB, ESQUIRE 219 EAST MAIN STREET P.O. BOX 230 MECHANICSBURG PA 17055 INVOICE ACCT # NAME AD ORDER # DATE EDITLON ADDTL. 1NF0. I~,LL CHARGES ARE NE" TYPE OF CHARGE AMOUNT 32231 MARLIN R. MCCALEB, ESQUIRE 32231 MARLIN R, MCCALEB, ESQUIRE 32231 MARLIN R. MCCALEB, ESQUIRE 0002082257 07/30/10 METRO WEST 0002082257 08/06!10 METRO WEST 0002082257 08/13!10 METRO WEST BASIC AD CHARGE $44.08 BASIG AD CHARGE $44.08 BASIC AD CHARGE $44.08 AFFIDAVIT CHARGE $5.00 TOTAL: $131.24 REMITTANCE ADDRESS The Patriot-.Neves. Co. 2379 Network PL Chicago, !L 60673-1237 ~r ~-~ ~ ~= ~~ ° ~~ Please include the Account # or Ad Order # (above with your remittance-~-Thank You NOTE: This Invoice replaces the Order Confirmation which we previously sent with Proofs afi Publication Estate of James W. McClafferty Dr. Bills Lung, Asthyma and Sleep Associates in Kidney Diseases Yellow Breeches Family Carlisle regional Medical center Moffitt Heart Dr Phelan Dr Chemicoff Kinetic imaging ~ , g3 307.86 173.70 43.98 - 220.00 14.09 151.13• 46.36 - 53.12 . 1-8~'9-~~4-- T~ ~~ ~ « I ~~ ~ yoc~~ .-v o .:: ~- r. ocno ~ OOO ,~ oooro ~ r a~~ ~~3 o ~ ~ ;~~~ -D cu su ~ Q x_ ~~ ~ ~~ a ~~•' -' ~ a ~- AOC~Tt ~ O O cD 1t1 worn ~ c~ ' J ~ ~ s..,.,. ~~ ~~ r~ r ~ ~ r~, ~ t r" fi y, ~~ r F ~ ; ~S C~ ~.. ~ ~~ ~ ~ ` ' W (t _ f `~ 't l ~~~ ~ ~ .~ mom, ,~ c~ Q ~~ ,~ Q o ~ a~ ~ a r'' c m ~, ~ ~ c ~ ~ ~ ~~ a ~` o g' ~~ ~~ ~~ ~~ ~~ ~. ~~ °: ~ ~O ~ ~ ~ m ro. ~' ~' ~' C/1 ~ m p' x ,c .~ N ~ ~~ ~~ ~° ~~ ,~ o ~ ~ ~ J ~ tD O _~ 3 ~ O rn c~ a cn su ~ n. ~ Q. c~ ~~ 0 0 ~ ,< m o ~ ~ ~ cpn o O ~ 0 Q ~~ 0 a m rn ro cn ~~ ~ ~ < ~' I ~' I r c~iy ~ _ ~ ~ °~ n i ~~ ; o CD ~ ~' ~ o ~ i ! o o~v n~ o ,a' ~~ ~ N .1 0 0 o ~ a~ ~ ' -~ c N .... O n ~ ~ (~ 0 °-° 3 ~a C W ~~ OI n D~ ' ~ cn ~ ~ < ~ Q ~ 'S , ~ ~ a ~D ~ GJ c~ ~ tD N ~~ ~ tD S ~i ~y. ~ a ,~ n tD y ~ ~ ~ It? N _ Q' ~ ~ 'U O O ~~ ~ ..« ~ G O ~ N ~ ro A ..~ ~~ ~ _) n a ~~ 'Z ~O ,~ I~ IZ 'Q ~~ p+ ,TI ~ 1,'J') ^* 'Z n +Q O ~~ C ITI _. .~ v, .2 N ~~ IA ~Z (~ ;D 1~ [" r- d 3 {~ O .~ O C C' l~ O W O 0 J ~~ ~~ ~ ~~ 3 w~ n N o ~ C~ 3 w ,.1 w 0 O m ~ mmz~~m 3 3 0, m, c~ 3 ~v~~3~a d O cD ~ ~ O ~ ~ ~~~ ~fD zz~ c as 'i ~, ~ a ~,' a, ,, ,--, N ro ~ N m m V ~ ~ i ~? ~ ~ ~~ ~ V ~ ~ f'' 1-~ SD N ~ ~--~ d N N -{~ V 1l ~ ~ v ~q p ro "' N z D~ n .l lD D wTV ~ .vv n6/24/I0 Critical Care, First Ho $407.00 ;~,~,,6/25/ 10 Critical Care, First Ho $407 00 06J26/10 Critical Care, First Ho $407.00 06/27/10 Critical Care, First Ho $407 OQ 06/28/10 Critical Care, First H° $407.00 07120/10 Medicare Payment $1,131.58 07/20/.10. Medicare Adjustment $1,309.5.6 07/2012 0 Medicare Transfer 08126110 Commercial Insurance Tr $307.86 This represents the Co-Insurance amount due. Please remit payment. Ending Balance: $307.86 Your prompt payment is greatly appreciated. ~,,~--''~! .~-° ,. V C~ 1 BALANC.E~ DUE:. $307.86 `~" Account Number: 27300 ~* -- Due Upon Receipt ~* Lung, Asthma.& Sleep Associates, PC 2497 S. Queen Street York PA 17403-3:851 LASAPC01-0249337 0007126 17t6S0~-001-000020•#001276-0006 Phone: 717/335-2021 2RS# 20-319273 I - 4 0 o_ m m A .l .1 ~1 .l ~1 .l ~- to cn cn cn to cn cn ~ h ~ ~~~ ~ ~ ~ ~ O o - P - P ~~ ~ O ~~ ~ C ..~ W o ~ --- cc _« ~« --Z sp ~~ ~< s /~ ~ c ~ ~ ~ ~ ~~~ o 'V P P P P ~ WWWWWGJW ~ ~_~ ~~ r- n ~. {~ ... O_ Z c 3 .1 0 N N W W Q~ 3 3 o m~~ l v~v~~3~ oo~~a'o ~. ~, ~ ~ ~ m c ~ ~ vR ~ a ~ ~ H~ {[~ ro N V h H ~~ V W p3j 3 3 i fi n {7 ~~ n J v ° o ~ ~ ~ J Oo n, r~ cv V F--~ "~ ~! -fi t,p ~ ~ ~ p CD N S C7 N O~ ~ A ~ p -o •~ ~~ n O C. t~ ~tc.rr.+v r vu..r ti.,~r .. , ~ REFE~~~~~ '~ 13. 3~ CO ItYS, NOP~ CROSS ClvEa ~ 1013$5 !05/281201 99232 !SUBSEQUENT HOSPITAL CARE ~ 80.00 -55.70 0.00 -10.3 13.9 3~E~E°~~3'~G~ '~ 1 ~ . ~ CO INS, MON CRC)SS O~AER ~ X389197 ;Ofi/22i2010 9929i GRITICAL DARE, FIRST HOUR 400.00 -t75.94 0.00 -180.0 43.9 0389197 p6/23/201t~ t~E~Es'~c~'~dCE 99232 `6~3, 9$ CO IBS, NaN CROSS OVER SUBSEQUENT HOSPITAL CARE 80.00 -55.70 0.00 -10.3 13.9 JJ iREF~~~C~IC~. ~~~C~. ~~ ~tl IBS, $99.59 OED CROSS i t?~IER i I ' ~ ~~ ~~ ~~ ~ __ _ _ ~ ~ - _ _ _ I I I ----~ _ ~ - ~. - 4 ----~TM^ 08 18/2010 1 f 588 JAMES W MCCLAfFERTY ~. ~ 10 DaYS from Receipt -~ / -~ ~/ ;~j/sfl/fr• % 1~i // - %'I'r~Ilr rf r, r.. ,J,/,./~f~//: ~4ssvciates in Kidney Diseases, 1-typer~ention lrstensi~e Care lillec~icine, L.LC $9t3 Poplar Church Rd ate ~0~13 Camp Niil l~A ~7p91 Billing Questions: {866) 263-0121 Billing Fax: (941) 355-5280 Appointments: (T17) 695-0394 O_ m ~,: ~~~ ~~l~'e~ Tease ~em~t ~`$ ~ 7 ~ a ~ Thank you for selecting Associates in Kidney Disea, es, Hypertention & Intensive Care Medicine, LLC for your recent health care need . nt represents your most recent charges, aswell as the balance now due. Patient balance is due in full upon presentation of this statement. As a courtesy, we have billed your insurance company. Any charges deniedor not paid by your insurance company will be transferred to patient responsibility. Ifyou have questions as to how your insurance paid or elected not to pay, p{ease call the insurance company directly. For questions regarding your account not related to insurance,. please call our business office (assi 2s3-o~a9, Monday - >=riday bet~rreen 9:00 am and 4:30 pm. Thank you! p1.DY5F 'a 'a Cf• <D ~ `~ C7 ooc~~uo ~ ~ ~~ . ~ +° ~ ~ cm~ ~ m ro ••r . O Z 3 a~ •` G ~ L d ~ ~ ~ N ~ v ,~+ ti v, a, ~ ~ .~ -s g D y N ~ W v o n J m ~ ~ O w d fD tD " ~ m o rti o 0 v ~ N ~ G ' ~--, fD ~ f'h FV r',' vt s ~ ~ ~: ~~ ` * ° ' a ~ YEL~OtJ BREECHES FAMIL~_.-..._._...~..__ ...... __.._.~...____ ~ - - - -. ~ PFF°itilf~T"Fii YELLOId BREECHES FAMIL ...-T-.__w_._ ,...~ _ ~, .__~.. 'f~1~~` i tCF Nfifz~F: __ ~ FnH ~~, ~ N~f'?;~ 717-258-.3274 __ _,.. .._M. _.~ _.. _ _ .__..._ .. ~ ....... ...:....~.,._~_. j IN~UfHlE*~, t 'fit C __ Ft ~ iC~-1i K F1Fai F 'tE tea C?I! 1 Rt "C at i, +T ,__,~.,_...~., ._.. __ _. _. _ .~.._.~_,_._.__~.._. a`;1 ~~ ~ F[l ~>~ F (>~ Itd^tl~~>~tit"! ~ r.llJf~f tF .; MCCLJA 00 ! r~~1v~AEh.1" it*~**~** I '~ _~ PaY4v1ENT H6EE®P{DN _._.__,.. . u... _,_ _ _.... . _._. __._....__ .. ~ i~tl~: DATE { ..__ -...u. ~_v.._..._ _-... .__:~ti_.._~..~__-.i-_ -r-- }}--------- ( 08 17 10 43.98 T-~.__ _...__ __._._. __ ~ ~ ! 0.00 f 0.00 ~ ~_ ~ + Over 30 ..Days Over 60 Da s 0'd0 ~ `43.98 ! ~ r , r ~ r R~ „ ~ c u~fi~€ >; ~ _._.. , ,.l..,_,.._,_.~_. ~.___...e_ I _ _ _ Y i Over 90 Days ~ Over 120 Days ! rt~ASE SAY ~rHis nr~'r0ur3T _ ... _ .. ... - ~.- ___,___..y.»_~~.,. TRANSACTIONS AFTER THE CLOSING DATE WILL APPEAR ON YOUR NEXT STATEMENT ~IIIII II IIIl~ III VIII IIII IIII VIII Ilil ~ III II(II Illu VIII ill Ill llil ~~u TOTAL 240.00 219.92 .00 .DO 43.98- .00 20.08- .00 PROVIDER TOTAL 240.00 219.92 .00 .00 43.98- .00 20.08- .00 CPX07 0200026992 CF0038 06-04 .00 43.98 .00 43.98 ~~~~~~ ~a,,,,,e rce~,una, ~vieuitca~ renter .:: P. a. Bi,~ ~ s6 ~ g VlTiirnington DE 19850 ii~~~~~ i~~~iii~r~~~~r~rr~i 1~~r~~ir:~~~r~~ri~~~~~~~~ii 82.2513688.8883 FOR RETURN MAIL ONLY SEP 20 2010 s 257,3688 JAMES W f1CCLAFFERTY ^' ~oi~ 109 CL.EMS~N DR CARLISLE PA 17Q13-8891 Dear JAMES W MCCLAFFERTY, ~RUSLE R~EG~ONAL. lvtEDiCAL CENTER PU F3ox 4100 Carlisle, PA, 17(115-3661 Phone: 800-381-91 f 0 Statement: 2513 F 8 f~ Account: 50 ] 49~~ 23007-36 Patient ~ . S e~ ce Date: 07/0 1 1 1 a.lance: X220.00 W M C~CLAFFERTY Thank you for choosing Carlisle Regional Medical Center for your healthcare needs. We value 'our. us facilities- y e of our It is unfortunate that eve have to inform you that your account is now past duel .Please help us keep the healthcare costs down b a 'in y p g your balance in full, promptly within the .next ten { l o) days. To ensure proper crediting of your account, please return your payment in the envelo e enclose with the to«!er portion of this ietter. For your convenience, we also accept Mastercard, Visa Disco - d alang American Elpress. ~ er and If you have any questions regarding your bill. or you have additional insurance information, which w~~s not __ previously proti=~ided, please contact us at the telephone number listed above. Tf you have paid this account in full rv-ithin five (5) days of the date of this letter, lease disr request....and thank you. p egard ilhis PAY ONLINE 7 DAYS A 'W'EEK 24 HRS/DAY AT www.carlislermc.com ~~ r~~3 PT.FACF. RFT7TRN T (l`7U7:i? DlIA'PTllA7 ~z~rr-u viz m T, ~ ~.,, .T,~,.„ - ~ ~. r ~~~ Thank c~u i., % F *,~,~~ y ,~.>> ], a: omit: payment. If it becomes necessary that ppour ~*~ unpaid teal ~":' s, ~,~.'~-a~d~~d o the collection rocess you wi11 be ~*~ ~~~; charged a i`s ~ 1. ] C,c: - pp ~~~~*~~:~c~,c,',,:::;_~~, ;;~ -,,., ~. ~oc°c ee. Please call 717-731-$31~ ~~,ti "- "ti~:':c3 c;'c~'c;c:~sF~ti:csL~c;c~:3c~'c~'e~'r~'c~'c;c~F:'c~;s!~~'c~'t:cx~ts~~Qs't~~'C~ ~r:c~sti~e'r$-t~rOC1S~'c~tsk~t'cs'cs`c~'c~Y~: 06/24/10 1 10 L ::::]i~ ~ (~ r I -) t~OMPL]TE, HOSPI 93306 786.05 160. 48/09/10 , ~,;,,,~..~ ,: sx e PaSnnent 00 ~~4/10 ~,~~-'- ~ f= t As s i ~n Ad j . 56.35 I fa•1.1,,,.C BENE~c Payment -89.56 0.00 14.09* V ~ I ~~ ~~ .~ '" L-The 'PLEASE PAY' inc::]. ar,{e.~ :~czpad co-pay or co-ins. Please make:. payment. yy''uu II~~ aarE ~.asr P~uo an,tot~nrr ;~i~~~~ ~I ~V~~i~~ i~~ - F • - . ~ • - , • r . - - 00/00/00` 0..00 c ~ .. . .l. ~a . (; a ~) . 00 0.00 0 , 00 0.00 0.00 0.00 14.09 MOFFITT HEA~t.'l~ S~ 'V~"-,; -1',U1~AR GROUP - ~~.... , , , f,], ,, . J .~ ~ 1000 NORTH ~"1'ECa~~ (~ a~r~~~.~ ro: WORMLEYSBIJRC~~„ ~~ ^ ~, ~ ~` 14 09''t PAT~~ 1-JAMES W IrJC;'~~l,.c~~~:F~'k l3,TY PR~I~~ 10=-LINE, DENNIS E, I'iD, ]'ACC ~~ Ph: (717):-733-0101 Ac,c1:~~: _ 199165 Date: Q9/24/10 Page 1 of 1 ~iC Comm Ins . ENT - WILLIAM PHELAN, M.D. 2 TYler Court CARLISLE, PA 17m ~ -~ ..,~ rvvrsACCOU~T -~_.,.., nv,rnSCOWMN -~. AS lTAPP~ARS ON Ypuq ~pG~R CARD DATE `PATIENT 1 DOCTOR ~ CPT4 DE.. _,41PTION CHARGE RECEfPT FROM INS. RECEfPT FROM PAT . ,4DJ. INS. PAT. BAL BAL 06/22j10 06/23/10 James James Question Chernicoff Chernicaff ?? Pleas 9922.3 99231 CaN INITIAL HOSPITAL CARE SUBSEQUENT HOSPTTAL CARE 17-6:57-2599 $225.00 $65.p0 $154.65 $30.79 $,11,63 r^~ .~~.6.51 $4,00 $0.00 $38.$6 $7.70 b~Y i ~ ~Q t~/' CURRENT 30-60 DAYS 60-90 DAYS `90-120 DAYS OVER 120 DAYS TOTAL ACCOUNT BALAN s4s,36 ~o.oo so.oo so.oo so,o© 546.36 Fuff Balance Paid? Please Disregafid ~ Thank You For Your Prompt Payrnent~ SUE FROM PATI T II 546.36 3838-MEIRa *S 1 J 106XDN000228 r,~ ~ ^~t+~T ~~,~:-~~-r~ rE~.'~'~IF'tiTSiC=:oRRESPOI\'DE_~vcc :ro: `,3 K.ir~c;tic ~r+ ~~;ine - I~ep ` l 3 ~~~ I P+~+ E3u~: 129 yak:;, P.~, '~ c-4`~ti I Illy VIII Ili! Illll IIII l Ill! Illlll VIII hill !I'll Illll IIII IIII For billing qu~esti{~In ~ call: 717-652-fi105 =ax: 717-652-21 fi5 C)ffice Hours: Mon ~~ i=ri ?:OOam to 7:OOpm ADDRESSl.E: ..,~ ESTATE OF~ JAMES W MCCLAFFERTY A ~ ATTN~ CAROL A. SABTNE w 109 CLEMSON DR CARLISLE PA ],701,3-8891 1>,~~III~nlllu('~~~Il~tll~l~~l~l~~l~l~L~~~~rllll,~~I~I~~~~IL~I IF PAYINQ 8Y V18A OR lY1AS'TEACARD, Flt1, pUT BEIAYM ._ _" ---- I /t~Y1~, BfONAll1FiE ~ MUSC !NCI.{J()E 3 DN;1T St_f.1JRITY CODE FNOM 8i41;K OF CARD STATENiEfvT DATE PAY THIS AMC~URiT ACCOUNT NQ. II/5!2010 Conti:n>~ed 39~~8 . ~ SHC7W AMQUNT ~ PAID HERE ®MAKE CHECKS PAYABLE / REMtT TO:~^s Kinetic Imaging =Ia20 Union Deposit: Rd Harrisbtjrg, PA 1711.1-2910 It>,IIII,~>,I~~~lI„>,II,~~II„1sIIJ~~1;~,1111~~~~~1~lII„„~I~i~l ^ Please check box it above address is incorrect ar insurance ~~r!~•~.~® information has changed, and indicate changes} on reverse side. `~1~~ PLEASE DETACH AN© RETURN TOP PORTION WITH YOUR PAYMENT IN ENCLOSED ENVELOPE ..Patient: JAMES W MCCL,4FFERTY Account: 39848 Services Rendered At: Carlisle Re i«nal Medical Center Date Proc ,~ Code Description Payments 6/26/2014 71010 XR CHEST 1 VIEW Charge Ad-ustm8nts 8/16/2Q10 PMT MEDICARE HGS,t#DMINISTRATORS ~ 40.OU 6/29!201:0. ,. ~i/16/2t310 6/28/2010 8/16/2010 6/27/2010 8/16/2010 6130!2010 8/1:6!2010 6/23/2010 8/16/2010 BALANCE DUE PAY BY 40.00 7., 34 30,133 40:00 7.34 3Q:83 40.00 .7.34 30.$3 40.00. 7. ,34 30:83 .~. 135.00 12.62 119.23 ~ - `l~( Co~ainued ease call with :your insurance. coverage ar For billing questions call: 717-052-61:05 ..nit the balance due today to: 4520 Union Deposit Rd Fax: 717-052-2165 Harrisburg, RA -17111-2910 Office Hours: Mon -Fri 7:OOam to 7:OOpm CR Adjustment MEDICARE HGS ADMINISTRATORS 7.34 Message: NIEDiGARE HGS. ADMINISTRATORS CONTRACT FEE ! 30.8.3 ACCEPTED ASSIGNMENT ~ $~` - 71010 XR CHEST 1 VIEW PMT MEDICARE HGS ADMIN[STRATORS CR Adjustment MEDICARE HGS ADMIIISTRATORS Massage: MEDICARE<HGS ADMIN`ISTRATQRS CONTRACT FEE ACCEPTED ASSIGNMENT 7110 XR CHEST 1 VIEW PMT MEDICARE HGS ADMINISTRATORS CR Ad}ustment MEDICARE HGS ADMINISTRATORS Message: MEDICARE HG5 ADMINISTRATORS CONTRACT FEE 1 ACCEPTED ASSIGNMENT 71010 XR CH:EST '{ VIEW PMT MEDICARE. HGS ADMINISTRATORS CR Adjustment MEDICARE HGS ADMINISTRATORS Message: MEDICARE HGS ADMINISTRATORS CONTRACT FEE t ACCEPTED ASSIGNMENT 71040 XR CHEST 1' VIEW PMT MEDICARE HGSADMiN1STRATORS CR Adjustment MEDICARE HG'S ADMINISTRATORS Message: MEDICARE HGS ADMIN'fSTRATORS CONTRACT FEE I ACCEPTED ASSIGNMENT 76937 US GUIDANCE VASCULAR ACCESS PMT MEDICARE HGS ADMINISTRATORS CR Adjustment MEDICARE HGS ADMINISTRATORS Message: MEDICARE HGS ADMINISTRATORS !CONTRACT FEE / ACCEPTED ASSIGNMENT I~IIIN~I~I~M~IIIN~~IIIIIIIhII~ SEE REVERSE SIDE FORTMPORTANT BILLING INFORMATION _ F_ ~)t~ '~t~^'1~ ~ R'.'~'n ~'::~''~1~;'V'1'~,i~'ORRI+'S~ONDI?~iC'~. `I'O: ~~:,~ [~u~t;t c , n~~~g~n~ ~. ~.. ~: r, elks. }~,~a y'-~:~f) I Illlil VIII IIIIi IH8 IIIIi Icll IiIIII ICIII VIII IiIII IIIIIIIII IIII For balling questions call: 717-652-6105 Fax: 717-652-2165 Office Hours: Mon -Fri 7:OOam to 7:Oflpm ADDRESSEE: III~,I,II~,II~.I..I{I"111111{I'Illt'11111{1'LI"IL{'ll'llll1zl-il ,rte-3 $ ESTATE OF JA[1ES W MCCLAFFERTY A ~~ ATTN= CARflL A. SABINE 1D9 CLEMSflN DR CARLISLE PA ],701,3-8891 ^___._. iF PAYlN(i BY VISA OR MA'STE3iGARD, flLL O!!T' 9ElAW __.~..T ~--l~ _1~ DYISA ii ^ MA$7ERCARD l~!~' ciao au~aEA ~~ ~. a~~ ~ounrr ~~~~ I.AIIST INf.1.t1DF 3 DIG1' 5[ CUR17Y CdDE FRdM BACK Ur CARD STATl=NIENT QAT~ PAY THtS AMOt1NT ACCOUNT tVC1. 1 ~1/~/2010 Continued 384& - SHOW AMOUNT ¢ PAtD HERE `A ~^~ MAKE CHECKS PAYABLE /REMIT T4: ~ Kinetic Imaging 452() Union Deposit Rd Harrisburg, PA 1711.1.-2910 l...III.~~(~~~il„~.ll.„il,.1.!l,N~~,~~llll~~~<<L!Il~~~~l,l~l ^ Please check box if above address is incorrect or insurance ~'~1T~ " PLEASE DETACH AND RETURN TOP PORTION WfTH mformatian has changed, and indicate change(s) on reverse side. YOUR PAYMENT IN ENCLOSED ENVELOPE PatiQnt: JAItAES:'ll~' 1~1CCt.AFFERTY Account: 3.9848 Services Rendered At: Carlisle R tonal' Medical Center Date Proc Pa merits r:["fI'IP nASC.Ylt'11'IAI'f !'rh~r.•.~ * _ .. ~ . CI22t2010' 71010 XR CHEST 1 VIEW _----- ~- 40.00 rrv ua~~ticrrca 811612010 PMT MEDICARE HGS ADMiNISTRATCaRS '~.~ 7.34. CR Adjustment MEDICARE HGS ADMINISTRATORS 30.83 Message:-MEDICARE HGS ADMINIS~FRATORS CONTRACT"FEE / _ ACCEPTED ASSIGNMENT 612112010. 71020 XR CHEST 2 MEWS ~,~ 50.00 $!'(6/2010 PMT MED(CARE HGS ADM:INISTRATC)RS- g Og CR Adjustment MED[CARE HGS ADNIIN[STRATURS 38.65 Message: MEDICARE HGS ADM N[STRAT4RS CONTRACT FEE t - ACGERTED ASSIGNMENT ~~,~ fi/2212010 71250 CT CHEST 50 00:, 811 6120 1 0 PMT MEDICARE HGS ADMiNISTRATC~RS . 47.74 CR Adjustment MEDICARE HGS ADM'tNISTRATQRS 1gp.32 Message: MEDICARE HGS ADM1NlSTRATORS CONTRACTFEEJ _ ACCEPTED ASSIGNMENT ~';'~ 6!2312010 3fi589 INSERTION QF PICC LINE - 5 YRS-AND ALDER. '~'` 400.00- 8/1812010 PMT MEDICARE HGS ADM`INISTRATC~RS 77.15 Message: MEDICARE HGS ADMfNISTRATORS CCNTRACT FEE / ACCEPTED ASSIGNMENT 8/16/2010 CR Adjustment MEDICARE HGS ADMINISTRATORS 303:56 6/24/2010 7101fl XR CHEST 1 VfEW ~,,~ 40.00 ,~t 8/16/2010 PMT MEDICARE HGS ADMLNISTRATQRS 7.34 CR Adju~tmenfi MEDICARE. HGS'ADMNIS T f~ATORS ~J.83 Message: MEDICARE HGS ADMINISTRATORS CONTRACT FEE / _ ACCEPTED ASSIGNMENT 6/25/2010 71010 XR CHEST 1 VIEW ~'~. 40.00 8/16/2010 PMT MEDICARE 'HGS ADMiNlSTRATORS 7.34 CR Adjustment MEDICARE HGS ADMINISTRATORS 30.83 Message: MEDlC;ARE` HGS ADMINISTRATORS CONTRACT FEE 7 _ ACCEPTED ASSIGNMENT BALANCE DUE Continued PAY BY base cal! with your insurance coverage or For billing questions call: 717-652-6105 ..:mit the ba{ante due today to: Fax: 717-652-2165 4520 Union Deposit Rd Office Hours: Mon -Fri 7:OI~am to 7:OOprn Harrisburg, PA 1?111-29:10 IItNlIIllill![illllllllllll~I~j(~lII11Illflllllilil'll114111 SFE REVERSE SfDE FOR MPORTANT BILLING INFORMATION 16605 - 5 __ _ _ _ _ - - - `>!~atrent:.~~nrtts ~ nn~:ca~rr~~~~r r Account: ?9848 _ Services Rendered At: Carlisle R~:~anal Medical Center Proc Date t`nrip [)esr_rintinn r~~.....~.. _ Pa t7'tents 6123/2010 71010 KR CHEST 1 VIEV1/ _------~- r`- 40 00 rr~u~u~e([(~(([ 8/16/2010 PMT MEDICARE HGS ADMINISTRATORS . r 7 34 CR Adjus#ment MEDICARE HGS ADMINISTRATORS 30 83 Message: MEDICARE HGS ADMINISTRATORS CONTRACT SEE / . ACCEPTED ASSIGNMENT BALANCE DUE $53.12 PAY BY December ; 2'0 Please call with your insurance coverage or For billing questions call: 717-652-6105 remit the balance duetodaY o: Fax: 717-652-2165 4520 union Deposit Rd Office Hours: Mort -Fri T:OOam to 7:OOpm Harrisburg, PA 17111-2910 (Illililllillilili1111IIN1~1~~~1111iillllilll lllll~lll~l) SEE REVERSE SIDE FOR.IMPORTANT BtLLiNG INFORMATI N 0 16605 - 7 J & B Business Services, Inc. 324 N. Middlesex Road Carlisle, PA 17Q 13 Description 1957 Ford Thunderbird -Detailed inside, outside, engine compartment, trunk, inner fenderwalls & door.jams 1992 Lincoln Towncar -Detailed inside, outside, engine compartment, trunk, inner fenderwalls & door jams Sales Tax ~~-- ~ o ~ ~~~~ cl~~Y/~° Thank you for your business. Invoice Date Invoice # > ~~9,2o1a 3z~ Amount 240.OOT 30~,f)OT 32..70 Total x;77.,0 CARLISLE EVENTS 1000 BRYN MAWR RD. CARLISLE, PA 17013 717-243-7855 PAID RECEIPT #12351 TO: CAROL SABINE 109 CLEMSON DR CARLISLE, PA 17013 DATE: 09/29/la 02:11 PM AMT PAID: $800.00 COLLECTED E3Y : Val PAYMENT METHOD: CHECK 1005 $800.00 09/09/10 ENTRY FEE W69 F10 INV # 2632 1992 LINCOLN (NY65' $ 400.00 09/09/10 ENTRY FEE W68 F10 INV # 2631 1957 FORD (FH393727 $ 400.00 DUE: $800.00 PAID IN FULL c (~ ~ -- ~~`~ ~e ~u~anLee whit We SFi/ NAME A~ITQ Dl9CIY;~ - _ __---__ used cars, Inc ADDRESS , ~feS_ar~d SeM~e `_~ CITY 1130 Harrisburg Pike • Carlisle PA 17013 ~'~ atsr.otrao. '~~`P'f' Phone; 717-245=2322 ~ _~-_ ___~ ...~~~~__ -------- _ TIRE TAX SALES TAX _, TOTAL PARTS ~ auzHO~~zEa BY TOTAL ~ ^ ESTIMATES ARE FOR LABOR; ah~ o Nhor¢e tha above repsF work to be done abng wlh necassery msterels. You arx) your emplpyaes -nnY operates above~ ONLY, MA~'ERtAL ADtJ1TtONAL ~"''°°s°~°~`°~""s~~~~~ardefneryatnyri~,go.$~y~~ AMO HIS secuts the amount of repairs tttere-o. it ie wrdarsfood that this gad on above vehiete to fire to vehicles placed with Them for storage, aeb, y ass>Anes AO ~~ Tor tads. or derr+dgs by then a UNT repair orwhite road testir+p. GVilh"an1 H. smith 2053 Schoolhouse Rd. Middletown, P14 17057 (T17) 948-0935 July ~ G, 2010 Clarence Asbury 1355 Armitage Way Mechanicsburg, PA 17050 Invoice No. 3$7 Qn2difiratiorrs 1979 & 1480:1>resident of the Antique Automobile Club of America- NatiOna# ludgea with mare than ISO fudging chedits Executive Direti~tor of the Antique Automobile ("l+ub afAmerica for 17 years AACA library 8~ Research Center past director a+nd past .president AACA Museum Board iNember` and past president Former tnembe~r of SEMA and ARMO' 2OUS Meguiar's Per~scrn of the year Certif}ed Appraiser with )rrterna#ona# Veshicie Appraisers Network li-VAN) Appraisal of 1957 Ford T-bird .........................................................................$10.00 Balance Due ............................................ .......$150.00 ~ ~~i~ ~ ~~ 9~~ ~ r< 2010 TAX RETURN FtL1N~ tNSTRUC710NS U.S. INDIVIDUAL INCOME TA,X RETURN Prepared for Prepared by Amount of tax -- -overpayment Make check payable to ltllail tax return and check (i# applicable) to reeturn mus malted on or before Specr`al lfilStrUCtlOt1S FOR THE YEAR ENntNG . _D~.C.~MB:ER_ 31, 2 01 C J'AME S W . N.tC CLAP EERTY ESTATE 113 5 5 ARMT TALE G~TAY MECHANICSBURG, PA 170.50 MCKOIJLY & ASBURY, LLP 415 F.ALLQWFIELD ROAD CAMP HILL, PA 17011 Total tax Lass- payments-and credits $ ~ ~ ~ ~ ~ 411 Pius: 'cnterest and ~enaities $ ~ ~ BALANCE `DUE ~ ... :. :........:. ...:.....:.. ..~.......: 82 MisceiianeQUS Donations ~ ~ Credited to your estimated tax ~ efunded to you $ ~ K~ ~a /~ UNITED STATES TREASURY THIS RETtJR.~1'.: ~A,S B~~N~ ~~.A~i.~A ~_': _ - ~ > ., .~~L~~T.R~}~S C . ~`F~~~ =;~D 'THE ; PRA~CT~~T~~~T,E~ PI''~.PROO~ ~A.S ,++i.EN B`L~~TE~i f FL+_f~3~- 1~,~,~1 ..~F RE~`URN F~~ 88'79 ~0= ~tfiR OFFICE., fnxE. WSLtL 'I'HEI~T TR.A.NSM~T ~O RE'T`URN EI,~CTRC}N'ICAi;~,y TO'; THE SRS , NOT APPLICABLE DO NOT MAIL, THE PAPER COPY OF THE RETURN TO THE IR-3. YOUR CHECK FQR- X82,. PA.YABZ}E TQ THE UNITEF} STATES T~tFASURY MUST BE SAID BY;=, APRIL 1$ , :.~.0:~.3 . _ BE SURE TO z~IC~UDk~ YOUR PAYMENT WITH FORM 10 4 0 - V , FORM 10 4 0 PAYMENT ~1"OUCHE~t . YOUR SOCIAL ~SEC:~TR.I~~"Y ~F~3MBER DAY'TII~SE PHQNE NL?3~S~3ER , . ' INCLUDE Y~t3RDS ' " 2.0..1.0 F`OR~ 14,4 0 ,~ ON YQUR CHECK . AND '~'~iE MAIL TO - INTERNAL REVENUE SERVICE CENTER P.O. sox 37oos HA~tTFORL7, GT 06176-0008 os_rt-~n 2010-TAX RETURN FtL1N~ tNSTRUCTtONS PENNSYLVANIA INCQME TAX RETURN -FOR THE YEAR ENDI[t#D DECEMBER.. 31,.. 2,410 Rrepared #or -~ JAMES W. MGCLA,FFERTY' ESTATE- 11355 ARMITALE WAY MECHANICSBURG, PA 17050 Prepared by ~. MCKQNLY & ASBURY, LLP 415 FALLOWFIELT3 ROAD GAMF RILL, PA 17011 Amount of tax __ Total tax $ ~; 1 , 074 , . ... ..................... Less: payments and credits $ . ' Plus: interest and penalties $ 2 ~ 4 ,, f ,~; ;BALANCE D`TE ~ _- 3 ~ 9 . '+ ~ . 8 , .:. ~ .... Miscelfaneaus Donations $ 0 Overpayment Credited to your estimated tax $ 0 Refunded to you $ Q Make check PA DEPARTMENT OF REVENUE ~~ payabte to Mail tax return THIS R:E'~'URN RAS BEEN PFZEPA;RED FGR EI,ECT:RaNSC FSLING . ~?~;~-~; , and check (i# . ~.~~~. . SIGN , D~~~ ~ . ADD ,.RETtTRN F(~~ ~.A . 8,4 ~ 3 TC~ 4L~ ~'}~`~'1 C~ . ~; ZI<- applicable} to . SI1BMiT~ :'Yflt7R E~~-~CTI{QNIC `RET~ TO ` ~" I~T~`t7R:. Return must be malted on NOT ,APPLICABLE or before Special Instructions YC}UR CHECK- F4R 1 ~ 9 $ , $ PAYABLE TO PA DEPARTMENT C)F REVE~13E ~ ~ BE PAID BY APR.SL 18 , 2 X11, .BE SERE TQ INCLrJL?E FC)RM PA-V WITR - Y{~UR PAYMENT . MAIL T4 - PA DEPARTMENT 4F REVENUE PA-V PA~'MENT ENCLQSED l REVENUE PLACE RARRISBURG, PA 17129-04©1 TNCL~TDE YatIR SOCIAL SECURITY ~fUMBER AND. THE. WQRD.~.~ -- 2010 PA 2'.fi. CaN YC?UR CHECK ~v~~ . 05-01-i0 ~ ti. LAST WILL AND TESTAMENT I, JAMES W. McCLAFFERTY, of the Township of Middlesex, County of Cumberland and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void all former ~JVills and Codicils by me at any time heretofore made. FIRST . I order and direct that aii my just debts and funeral expenses be paid by my Executrix or Executor, as the case may be, hereinafter Warned, as soon as conveniently may be done after my decease. SECOND. If my friend, CAROL A. SABINE, is residing in my home at 109 LAW OFFIC=E`S I ARLIN R. McCALEB Clemson Drive, Middlesex Township, Cumberland County, Pennsylvania, at the time of my decease, then and in that event I order and direct that my E=xecutrix or Executor, or my Trustee, as the case may be, hereinafter named, shall permit her to continue to reside therein as long as she desires, provided that she shall pay and be responsible for all normal household and utility expenses, including but not necessarily limited to heat, electricity, telephone, cable TV, gas, water, sewer and refuse (but not including real estate taxes, insurance and repair and maintenance, all of which shall be paid by my Executrix or Executor, or my Trustee, <~s the case ~, may be, hereinafter named). At such time as my friend, CAROL A. SABINE, shall no longer reside in my said house, then my Executrix or Executor, or rr,y Trustee, as the case may be, hereinafter named, shall proceed to liquidate the property by ,r ~ . public or private sale or otherwise and the net proceeds thereof shall be distributed in accordance with the terms and provisions of Item FOURTH, hereinbelow. THIRD. If at any time my Executrix or Executor, or my Trustee, as the case may be, hereinafter named, shall decide to sell my 1957 Ford Thunderbird automobile to anyone, he or she shall first give to BETH AULTHOU;SE, of Lancaster, Pennsylvania (daughter of Ken Aument, of the same plac;e;) the right to purchase said automobile for the sum of Forty-Five Thousand and No1100 ($45,000.00) Dollars in cash. Notice of said right to purchase shall be given by my Executrix or Executor, or my Trustee, as the case may be, hereinafter named, in writing to the said BETH AULTHOUSE and she shall exercise said right to purchase by notice in writing delivered to my Executrix or Executor, or my Trustee, as the case may be, hereinafter named, within twenty (20) days after her receipt of the aforesaid notice of the right to purchase. In the event of her exercise of said right, final settlement thereon shall take place within twenty (20) days thereafter. If she fails to exercise said right as herein provided, said right shall lapse and become null and void. FOURTH. I give, devise and bequeath my home at 109 Clemson Drive, Middlesex Township, Cumberland County, Pennsylvania, subject to the provisions of Item SECOND, above, and my 1957 Ford Thunderbird automobile, subject to the provisions of Item THIRD, above, and all of the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever sil:uate, unto LAW OFFICES MARLIN R. McCALEB -2- p • ~~ Agreement of equal date herewith of which I am the Settlor, to r~old, manage, invest and reinvest the same and the income therefrom for the uses and purposes set forth in said Trust Agreement or any amendments of supplements thereto or any subsequent trust agreements in replacement thereof. LASTLY. I nominate, constitute and appoint my friend, C:AROL A. SABINE, Executrix of this, my Last Will and Testament, but if for any rea:>on she shall fail to qualify as such Executrix or cease so to serve, then I nominate, constitute and appoint my friend, CLARENCE E. ASBURY, as Executor, to serve in her place and stead, each to serve without bond in this or any other jurisdiction,. IN WITNESS WHEREOF, I, JAMES W. McCLAFFERTY, have hereunto set my hand and seal to this, my Last Will and Testament, which consists of three (3) typewritten pages to each of which I have affixed my signature this /'~ day of ~~U~~ , A.D., Two Thous nd Two (2002). (SEAL) The preceding instrument, consisting of this and two (2) other typewritten page, each identified by the signature of the Testator, was on the date thereof signed, sealed, published and declared by JAMES W. McCLAFF~ERTY, the Testator therein named, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence, and in the presence of each other, have subscribed our names as witnesses heret . ~. ~F2~ ., o ~~ ~,~ f -- LAW OFFICES MARLIN R. McCALEB -3-