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05-06-11
~c j . J 15056051058 REV-15 0 0 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes ~. County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 20 10 00549 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 180-34-2438 05/19/2010 08/02/1944 Decedent's Last Name Suffix Decedent's First Name MI Davenport Dale A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Davenport Sherry L Spouse's Social Security Number 185-36-9377 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW • 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 4a Future Interest Com d promise ( ate of 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Nurnber Luther E. Milspaw, Jr. (717) 236-3141 Firm Name (If Applicable) ~-~ '_ .. f t .~ First line of address - _ _ _ -; ; 130 State Street - ^~ c.,l-, _ Second line of address ~' r ~> - ~ .. {, '--> ,~ _ _ ~ . , ~ ---- City or Post Office State ZIP Code '~ ~~ -_ .- i ~' ~ ~=J r. , Harrisburg PA 17101 _~~ Correspondent's a-mail address: luthermilspaw@milspawlawfirm.com Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of ray knowledge and belief, it is true correct and complete Declaration of r th h , . p eparer o er t an the personal representative is based on all information of which oreoarerlh,as ariv knnwlarina - ---~-~ SIGNATUR~~~OF~ PERSON RES~f FOR FILING RETURN ' _ ~ AaE ADDRESS ~ 22 C ~ ish rive mp ' I, PA 011 - _. SIGNATU Ed' ' OTH R MAN R RE NTATNE DAl"E ADDRESS. ~ ~ ~ !~ ~ ~..,~ , ~~ 130 State Street, Harrisburg, PA 710. PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 ~ • ,~ 15056052059 REV 1500 EX Decedent's Social Security Number Decedent's Name: Dale A Davenport 180-34-2438 RECAPITULATION 1. Real estate (Schedule A) ............................................. 1. 0.00 2. Stocks and Bonds (Schedule B) ....................................... 2. 167,609.96 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0.00 4. Mortgages & Notes Receivable (Schedule D) ............................. 4. 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. 17,925.10 6. Jointly Owned Property (Schedule F) Separate Billing Requested ....... 6. 1,984.55 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested........ 7. 0.00 8. Total Gross Assets (total Lines 1-7) .................................... 8. 1$7,519.61 9. Funeral Expenses &Administrative Costs (Schedule H) ..................... 9. 11,087.14 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. 6 639.16 11. Total Deductions (total Lines 9 & 10) ................................... 11. '97,726.30 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 169,793.31 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. 169,793.31 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0 0 169,793.31 15. 0.00 16. Amount of Line 14 taxable at lineal rate X .0 _ 16. O.OO 17. Amount of Line 14 taxable at sibling rate X .12 17. 0.00 18. Amount of Line 14 taxable at collateral rate X .15 1g, 0.00 19. TAX DUE ......................................................... 19. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 1505605X159 R*~V-1500 EX Page 3 Decedent's Complete Address: File Number 20 10 00549 DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Dale A Davenport 180-34-2438 --- STREETADDRESS - - - -- ------ --------- 22 Cherish Drive CITY STATE ~ ZIP ----------- --- . Camp Hill PA ~ 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 0.00 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable - D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.......................................................................................... ^ b. retain the right to designate who shall use the property transferred or its income : ............................................ ^ c. retain a reversionary interest; or .................................................................. d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................................................ .................................................. 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. ^ ^ a 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................... ................................................. ^ ^ x 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 January 1, 1995, the tax rate imposed on the net value of transfers to or for they use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (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 twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (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 four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling isdefined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. r + LAST WILL AND TESTAMENT of DALE A. DAVENPORT I, DALE A. DAVENPORT, of 22 Cherish Drive, Camp Hill, Cumberland County, and Commonwealth of Pennsylvania, having a date of birth of August 2, 1944 and a social securit Y number of xxx-xx-2438, and being of sound and disposing mind, memory and understandin , do g make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void all former wills and codicils by me at any time heretofore made. ITEM I: I direct that the expenses of my burial and all my debts be paid as soon after my death as maybe convenient to my Executrix or Co-Executors hereinafter named. ITElYI II: I give, devise and bequeath all the rest, residue and remainder of my estate, whether real or personal, of whatsoever nature and kind, and wheresoever situate, unto my wife, SHERRY L. DAVENPORT, provided that she is alive on the 90`~ day following the date of my death. ITEM III: ~ In the event that my wife, SHERRY L. DAVENPORT, is not alive on the 90`h day following the date of my death, I give, devise, and bequeath to each of my grandchildren who survive me, the sum of $5,000.00. Thereafter, the rest, residue, and remainder of my property, real, personal and mixed, shall be divided in equal shares per stirpes to my twa sons, BRIAN PAUL DAVENPORT, now or formerly of 6009 Marilyn Drive, Alexandria, VA 22310 and MARK ALLEN DAVENPORT, now or formerly of 328 11`b:Street NE, Washington, DC 20002. ITEM IV: I nominate, constitute and appoint my wife, SHERRY L. DAVENPORT to be the Executrix of this, my Last Will and Testament. If my named Executrix does not survive me, or is unable or unwilling to serve for any reason, I nominate, constitute and appoint my two sons, BRIAN PAUL DAVENPORT, now or formerly of 6009 Marilyn Drive, Alexandria, VA 22310 and MARK ALLEN DAVENPORT, now or formerly of 328 l lc'' Street NE, Washington, DC 20002, as Alternate Co-Executors hereof. ITEM V: I give to my Fiduciaries the following powers which are to be: construed in the broadest manner consistent with validity and their duties as fiduciaries. I give the powers stated herein, in addition to those granted by law, and I give them to Administrators and Trustees who succeed the fiduciaries I have appointed. a. To retain any or all of the assets of my estate, real or personal, without regard to any principle of diversification or risk. b. To invest in all forms of property, including stocks, common trust funds and mortgage investment funds, as they deem proper without regard to any principle of diversification or risk. c. To sell at public or private sale, to exchange or to lease, for any period of time, any real or personal property and to give options for sale, exchanges or leases;, for such prices and upon such teens or conditions as they deem proper. d. To allocate receipts and expenses to principal or income or partly to each as they from time to time think proper. e. To borrow money from any person or institution, and to mortgage or pledge any or all real or personal property as my Executors or Trustees, in their sole discretion shall choose, without regard for the dispositive provisions of this instrument. , f. To register securities in street name or in the name of a nominee or in such manner that title shall pass by delivery and to vote, in person ox by proxy, securities held hereunder and in such connection to delegate discretionary powers. g. To compromise any claim or controversy. h. To choose the optional valuation date for federal estate tax purposes. i. To exercise any law-given option to treat administrative expenses either as income or as estate tax deductions, without regard to whether the expenses were paid from principal or income. j. To exercise any law-given option to pay death taxes in instal:lments, the payment of interest due on such installments to be a charge against principal. k. To make distribution in cash or in kind, or partly in cash and in kind, and in such manner as they may determine, and at valuation finally to be fixed by them. ITEM VI: All federal, state and other death taxes payable on the property forming my gross estate for those purposes, whether or not it passes under this Will, shall be paid out of the principal of my probate estate just as if they were my debts, and none of those taxes shall be charged against any beneficiary. This provision shall not apply to any property over which I have a general power of appointment for federal estate tax purposes. ITEM VII: To the extent that such requirements can be legally waived, I: direct that my Executrix or Co-Executors shall not be required to post bond or give any security in connection with their duties hereunder, whether in the Commonwealth of Pennsylvania or any other jurisdiction. IN WITNESS WHEREOF, I, DALE A. DAVENPORT, have hereunto set my hand and seal to this, my Last Will and Testament which consists of four (4) typewritten pages, this ~ `~ day of January, 2006. t'L{,' ~t~i.JV' Dale A. Davenport Signed, sealed, published and declared by the above-named, Dale A. Davenport, as his Last Will and Testament in the presence of us, who at his request, in his presence and in the pr~sence of each ot~.er have hereunto subscribed our names as witnesses. .. . ~-, A WITNES WIT ESS of ~I~ II~IIS'l~~ ~~~f~/ v~-~i -eft ~1 I oy orl`{ lervnce Blvd. Etwi~kw~n ~'A I164`~ SELF PROVING AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ; COUNTY OF DAUPHIN ss: We, D E A. DAVENPORT, Luther E. Milspaw, Jr., and . ,the Testator and witnesses, respectively, whose names are signed to the attached and foregoing instrument, being duly qualified accordin to law declare to the undersigned authority that the Testator signed and executed the attached~ins hereby as his Last Will and Testament and that he signed it willingly, and that he executed it as his fr ent and voluntary act for the purposes expressed therein, and that each of the witnesses in the ee presence and hearing of the Testator, signed the Will as witnesses, and that to the best of our knowledge the Testator was at the time eighteen (18) years of age or older, of sound mind under no constraint or undue'influence. 'and . ~ L~ r ~` Dale A. Davenport . ~ j ~.., . fitness x (`~ , Witness Subscribed, sworn to and acknowledged before me by DALE A. DAVENPORT T tator, and subs 'bed and sworn to before me by L Cher E. Milspaw, Jr. and ~~uvitnesses, this _ day of January 2006. ~~ ~) ary Public NOTARIAL SEAL My commission expires TEA L EBRIGHT is LEWISTOWN BOt20UGH. MIFFLIN COUNTY My Commissbn Expires Oct 1 a ~ 2008 ., ` ~ REV-1503 EX+ (6-98) y ., ~. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Dale A. Davenport FILE NUMBER 2010-0549 All property jointly-owned with right of snrvivnrchin mnc4 A~ .::~,. L...,..J .... @_L_J..1_ ~ SCHEDULE B STOCKS & BONDS ~~~ ~~~~~~ J~a~~ W IICCUCV~ ulsen aaaaionai sneers of the same size) ~ ~ r.r (Jl ~ n' f n` Z v ~• • n o' ^ ~ ',~ O ~ . p _ p .~ ~ R s V c• , ` ~ ~ ~ "y • O ~ ~ ~ ~ ~ m ~ _ . 0 ~ ~ ~r ~~ tai O d~ ~ u ~nN n 0 ('D ~-' a~ ~• ~• ~'- rr ~. r r n CT' M n zzz ~o~''~ Ff +" ~ ("E ~ ~ UQ a °' n ~~. ~. H ~^'~^^ VI o°wv N N rn^ rn N {jq N ~- O ~i w ~\ ~i O W V 1 V 0 rn d• • C ^ fD N t1 'O ,.. m ~ .~ ~ 1 S ^ 0 f`f p' to -~ Q. ~ ~ N N~ ~ p' O C7 c7. O ~p C1 '''~~ w w C7 N 'r1 Z ~ ~-- DNtbT1 `d N.~•~ 3 n ~ ~ ~ ~ 0 = d -n ~ a '-'; cn =mD3 ~~ ~ ~ H~r~ ~~ .. rHmn ,~ r fA p N _~;~ U~ a d d n o~~ +i r ~ ~-+. ~ A ,.._, ~ to ,_ H r+. S~„o to p-ji:~i,'i r1. ~ c-~ l~ ~' n H ~ i~:; i~f~~j~ o ~;: ;, ~;;:.... ;; o o ~ . y ,.+ j ;~'~ ~ o ;: Cr j~ .1 O A. O ' '''~ 'J O) ffl:. ~ o~ o w N;:;3:~i~i : J~ (71 QO (fl;'{ H p ~ 1 ~I c0 t O ,: :~ ti~~:~~ . I~ I ~y _ ( 01 ~ -~ CO;t;~' ~ ////~~ W / O ~i .......... . ~ 0 7 O a~ c a~ 1 O. 0 01 y. ~~ ~ ~ a ~ ;~ ~ ~~~ ~ ~ c C (7ro ~ ~, ^ IH ~ (~ C ~ z En ~ , . ~~ L ~~ y, G7 j I . ...i . V ~; w ~Q o'~~ ~'. O z o ~ w V O O V ~ 1' N W G1 W ~ ~. V lh ~ ~ ~ . O ~; yO 4 • 1 .. REV-1508 EX+ (6-98) !. t ~.~~ ^ 1 ~~~. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Dale A. Davenport FILE NUMBER 2010-0549 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivnrshin mncf ho rlic~~~~e.a ,,., c,.a„,~..~,. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ~•• •••~•~ ~N~~~ ~~ ~iccucu, uiacit auunwnal SneelS Oi Ine Safne 51Ze) ~Mass,Mutual~ June 23, 2010 Sherry Davenport 22 Cherish Drive Camp Hill, PA 17011 Re: Policy Ntunber 19 19601862 Dear Mrs. Davenport: Please accept our sincere sympathies over the passing of your husband Dale. Enclosed is a check in the amount of $149.34 that refunds the unused premiums for your late spouse's long term care coverage. This policy is now cancelled as of May 19, 2010. Once again, please accept our condolences for your loss. Sincerely, - ~ .~~~-- Alison Pomerantz-Garcia Long Term Care Administrator cc: Becker, David 037 Massachusetts Mutual Life Insurance Company Long Tenn Care Administrative Office 21600 Oxnard Street, Suite 1500 • Mailing Address: Post Office Box 4243 Woodland Hills, CA 91365-4243 (888) 505-8952 • (818) 887-4436 • Fax (818) 887-4595 2002 Toyota 4Runner -Private Party Pricing Report -Kelley Blue Book Page 1 of 2 ,.. 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The final sale pnce may vary depending on the ' ... vehicle s actual condition and local market conditions. This value may also be used to derive Fair Market Value for insurance and vehicle donation purposes. Vehicle Condition Ratings ~Jr S<arr_i~ of t~<,tuyory Check Vehicle Tiile Nsta-y C:l' Chcl",4C LIP CC('!~_ _„`eil2nt • Looks new, is in excellent mechanical condition and needs no http://www.kbb. com/used-cars/toyota/4runner/2002/private-party-value/pricing-report?core... 3/28/2011 .. ~, ~~ USAA Federal Savings Bank 10750 lblcl7ermott Freeway San Antonio, Texas 78288-0544 USAA® 03790.59X1.JSS136405305.01.01.8 EST OF DALE A DAVENPORT 22 CHERISH DR CAMP HILL PA 17011-1025 ~~~ November 23, 2010 Reference: Estate of Dale Davenport Dear Mrs. Davenport, ' As you requested, we're providing the balance of Mr. Davenport's account on the date of his death. Account Type Account Ending in Interest Accrued Balance Checking account 9517 $0.05 $1,245.76 If you have questions, please call a member service representative at 1-800-531-USAA (8722). Thank you, USAA Federal Savings Bank DM-03790 BKDATEDEATH 66072-0408 "' F~~Ci L ND6R INSURED ... - ; ' REV-1509 EX+ (6-98) y t :~. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY OWNED PROPERTY ESTATE OF FILE NUMBER Dale A. Davenport 2010-0549 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A• June Davenport 20 N. 12th Street, Apt. 334 Lemoyne, PA 17043 Mother B. C. JOINTLY-OWNED PROPERTY: ~~~ nwiC aNace is neeaeo, insert aaainonal sheets of the same size) '= <~ ~' ..s,~,.1 ~0~~~~a~)i~f ~~DI ~ ~.T~IOf~T March 24, 2011 To Whom This May Concern: On the date of death for Dale Davenport May 19,2010 on account xxx926 with June Davenport the ending balance in the Savings Account was $2744.62. Also, the Checking Account balance was $1224.48. The date the account was opened with Dale Davenport as a Joint owner on May 25,2006. Thank You, Sonia Hoffman, Belco Community Credit Union Teller MSR Ir?elca C~aE~;f~u~~ii~ Credit U~~fc~ 8~~~ 1`~~i~ppole~ i~oa ?{. K'. `'x ~, h ' ~ ;. y4 R,' [y. ~" ~..~; , r - S >:` b - t^ ~ ~~. ,4 .yl x..Je~. ~~!. 7'~1 ~v I'~ IvIGn~.lyi1Cn .I;f~ t ,.~8~t ~'~~ ~q,. ~. L. y' t ~ +. .Q ,~~~~~ ~s ~~t, -'~e a J' ~a ~.~,!i <- '~~. ~ ~_! eS f..,~ ,-~~ - ~'.1~.~.- ~~~~ ~ ~ ~.'`~- `.~v,.rfiE'!'{-y'2 ; .L'~~4k.~ ~ .~ J~~'.rti SAef~+a "~ T ~,s ~,~ ~~a-lsn ~~: ~ ;;o-opt ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF Dale A. Davenport Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION A• FUNERAL EXPENSES: 1' ~ Neill Funeral Home, Inc. 2. The Columbarium for Mount Calvary Episcopal Church (burial niche) 3. Dukes Bar & Grille (funeral refreshments) 4. Booms by Vickrey (flowers) B. 1. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City - -- ------- Year(s) Commission Paid: State - ZIP z• Attorney Fees: 3• Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant 4. 5. 6. ~. s. 9. 10. 11. Street Address City _ State Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Return Preparer Fees: The Patriot-News (legal publication) Cumberland Law Journal (legal publication) Cumberland County Register of Wills (filing receipt and release) U.S.P.S (stamps) Cumberland County Register of Wills (filing IT Return) FILE NUMBER 2010-0549 ZIP TOTAL (Also enter on Line 9, Recapitulation) I $ If more space is needed, use additional sheets of paper of the same size. 4,680.00 750.00 1,541.45 359.34 2,500.00 323.50 500.00 304.41 75.00 10.00 28.44 15.00 11,087.14 Neill Funeral Home, Inc. 3401 Market Street Camp Hill, PA 170114428 (717) 737-8726 Supervisor: Kevin J. Shillabeer The following is a detailed bill for the professional services and/or merchandise arranged for Dale A Davenport Date of Service :May 23, 2010 Sherry Davenport Statement Date May 24, 2010 22 Cherish Drive ~~ Contract Number 741101000174 Camp Hill, PA 17011 Arranger Name Kevin J Shillabeer Initial Selection Final Selection - Difference Package Offerings Direct Cremation Basic Professional Service Fee Refrigeration Transferring Remains ~to Funeral Home Transfer to or From Crematory Service Vehicle Total Package Offerings Use of Facilities and Related Services Church Memorial Service Visitation Total Use of Facilities and Related Services Transportation Limousine Total Transportation Other Goods and Services Crematory Memorial Package Total Other Goods and Services Merchandise $2,055.00 $2,055.00 __ Incl Incl ___ Incl Incl ___ Incl Incl ___ Incl Incl ___ Incl Incl ___ $2,055.00 $2,055.00 --- $495.00 $495.00 --- $495.00 $495.00 --- $990.00 $990.00 --- $395.00 $395.00 --_ $395.00 $395.00 ___ $395.00 $395.00 --- $150.00 $150.00 ~ ~ --- $545.00 $545.00 --- ~ ~- Initial Selection Final Selection Difference Cardboard Container $95.00 $95.00 ___ Total Merchandise $95.00 $95.00 ___ Cash Advance Certified Copies $90.00 $90.00 ___ Permit $25.00 $25.00 ___ Clergy /Religious Facility $150.00 $150.00 ___ Musicians or Singers $150.00 $175.00 $25.00 Newspaper /Bloomsburg/estimate $160.00 $160.00 ___ -- Total Cash Advance $575.00 $600.00 $25.00 Total Services, Merchandise and Cash Advance $4,655.00 $4,680.00 $25.00 Total Charges (Total Services +/-Allowances + Taxes) $4,655.00 $4,680.00 $25.00 Less Cash Received $0.00 Unpaid Balance Due $4,680.00 Page 2 of 2 PJE(LL ~UNEF~AL H~i1lIE 74~i '~ `~~.~~~~~~~ 301 i~lARKET STREET ~:AN1P HILL, Pfd '170'1'1 / 17.7x7 8725 INDIV:IDUAL CASH RECEIPT DATE ~ ACCOUNT NO. ~ ~ ~ ~oi ~~ ACCT/CONTR. NAME ~ CCT/CONTR. NO. _ $ RECEIVED FROM 1 ~ CK # / C.C. APPR OVAL # ~ 1 -~ r C.C. TYPE DESCRIPTION - TRUST NO. ~ G2 ACCT. BY ~ CHECK ~ CASH ~ ~CREDT CARD ~ DEBIT GEN 8001 (3/08) White -Customer Copy Yellow -Contract File Pink -Control Copy TOTAL ~~ ~ THAl®TI~ YOU I{1Rt{'S GARllCN The Columbai-ium for Mount Calvary Episcopal Church Camp I-Iill, Pennsylvania APPLICATION FOIL 1NT1JL2M1~NT LICrNS.C NAME a v etJp o ~R, ADDRESS o2 ~l C I~1e ft ~ S I'~ D ~-' ~ a ~'` p~,~ I I ~ la- I'7 0 1 1 TIaLEP [-ION.I; N tJM 13 f? R. 7 ~ ? 3 03 ~ ~~DATF, Or 13IRTI-I - _ ~ ~ ~{ I RI?QUEST TO BE INTERRED DIRECTLY INTO TIIE MEMORIAL GARDEN I REQUEST TO BE INTERRED 1N A NI " CHE APPLICATION FEE: '` ~ `Jf ~ $50.00 ~ LICENSE FEE: ~~ ~ ~~ $700.00 _~- DATE OF APPLICATION (o , ~ ~, -020 1 v SIGNATURE OF APPLICANT AI'PLICAI'ION AI'PRO VED ~L~ ~ (Signature acid Date) WHEN THIS APPLICATION IS SIGNED, DATED AND SEALED WITH THE SEAL OF TIIE CHURCH IT WILL SERVE AS A LICENSE FOR INTERMENT IN KIRK'S GARDEN FOR A PERIOD OF FIFTY YEARS FROM DATE OF APPROVAL. This approved and sealed Application will be given to the Licensee for their records. A copy will be kept by the Church. ., 1 .w ~^ ~ ~ 1l ~ ~ ~--- ~~ ~ ~ ~~ .~ ~~,~~~' ~'~ ~J j~~,~~, ~~e~cac~~ts: ~. .~,-1 r ~• = w+• ~~' f J 3 ~i I @~*~ F per per~u ~ 4 ~i C1' ) F « t ~4 ~- ~~e~~ dFXS'~~'41C~OgS: ~ y w date ~f ~~a~a~~: ,~.~~...f ~~~a~ '~ ~'°. ilTumber of ~~e,~~; Name: ~~~-~re~~/ ~,s ~y~~''t~~- }~~s ~i ~1a1C'C103a ~~III: ~i ~~ ~ ct ~~.'.. ~7CiS11: ^aioure //77 _ '`~f/{y ~~ ~~ l~ ~ ._ 77 / j pp~~}w qty ~g py~ yy- {~ ^' {~y*~~y f~q(~ O~ gLIVCi ~.s PJ;L~~V ~Vi ~eivJ®iY ~yAaY~ ~~~irC.~Y y ~~ '~ , ~ ~4RiiL~ ~®~M.L C~ 0 ~ ~ ~ ~•~~ t=j food tc~~~ V ~sw~ E ~T ~ ~K1 ~aY ~ { ~`~~ • ~ ~~ ([tot app'~3eci to sates ta~L) l' ~~ ~ ~-~'~ ~[aOn[€ Cbt~tzge (tf applies) ~ti ~~ ~' ~ tCT~ci( ~i -~ leeSS ~@~1EAS~t` ~ ~ `t I . ~~ ~~,~.rre~ ~uE ~.~,- .~ ~':r~~9~:7i7-~~~-1~i3 fax: 7i7-7~7-g~~ [_l ~..~ I~ C _ y ~ ~C 1 ~' ~ f~' :~ :t i_3 E_ _._. ~~R ~'; uE~:~.: L_L~. U.~ SC~a TBL # 185 #Party tJ JEN C SvrCk: 5 17:20 05;23/10 1 O'DOULS, l o'douls, 1 o'douls 9.00 14 Gl_, CHARDONNAY 63.00 5 TANr~UERAY, 1 /tonic, 1 ,/tonic, 1 /tonic, 1 /tonic, 1 /tonic 30.00 1 DEUlARS 5.50 1 JACF; DArdTELS, 1 ~u~at:er, 1 water 10.5() Gl_, F'TNOI- GRTGIO 31.50 ~ GL. sHIRAC 1$.00 3 GL. CABERNET 13.50 4 YIJE~fGLING/DRAF1 12.00 ~i BLUE MOON/SCHOONER 5.50 1 GLENLP~ET 7,00 1 MAKER'S MARK 5.50 1 DEFl1ARS, /ginger 6,00 d BLUE h1O0N/(7RA.FT 32.00 4 GL , F'T NOT fdOTR 19 , 00 1 KETEL ONE 5,50 3 GUINESS/DRAF=T 15,00 1 BANQUET FOOD, amount? 897.50 897.50 1 ROOM CHARGE, arilGllrlt? 50.00 50 , 00 2 GL. MERLOT 9.00 1 h1ILLER LITE BTL 3,00 Sub Total; 1248.00 (TAX 891.50, Othr 350.50) 1~AX: 53.85 20% GRAT 239.60 05/23 19:59 _~ ~~ ~(- ,~- L_ : 1 ~ ~ ~1 . ~~ ~'~ BAR T07~AL 30CJ.50 ~~~ ~~~s ~~~~_~~ur~ ~~:~.r ~rr ATMOSPHF.~~I : 1 2 3 4 5 G 7 8 9 l U FOOD: ? 234567$910 SERVICE: 1 2 3~ 5 h 7 8 9 10 03/21!2011 15:34 3024580090 visa~GNA7UR~ BAC DEBT MANAGE1~1Eh~T PAGE 05108 T.~•~ ~:~ ~.31V.A4~.~, ~IVII7rET~~ ~~x,.&~~ dkLt; A f~AV1:N1~~1RT Account Number: ~14T ~gbr~ x.408 t~7~7 May ~~ - .tune ~$, ~~a.Q A I aaount n4brmetl~n: vV'ovt4.bt~t9l:aft~mt~~icr~,aom ' _ ~ IVlall bllllrig inqu~rTea tom: T3ANKt?t! AlUf;RTtJA grew r~alal~~e Total .......,..,..,...,.-,,.,.,$8,87,$4 ...........~...,,...,......,.~.,~.,.,. Pi'aVloa~a Balance .............~~ 711 86 .,..,,..,,. P,O. BQ~X x.6028 fiurrent Payment Duo .. ~ fiB.QQ .................. .,...,.,~ .............................,.......... ., . Rayments and +Dtrter Credts . ,•1,71..86 ...,.,,.,, ~Vli',,MTN(~~'i"jN, T~F+~ Purchases and l~djustm~nts .............6,875.34 1.986p•60aF3 Tvta( Minimum Payment aue .................:....................................:~...,:~68.Q0 Pae:a ~harr~eel.,.,...,......,..,...,. . ............................O.C6 iVlell peyrr~en$~ Qd: ,~ ............. ,...,...,.,,,.. Payment Duo dato. ..,,,.,..,,. ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7/1G/1a tit®r~t ~h~r~®ri.,....~,b...~... ~.O.~iO ............k.......s......a. RANi~ ~~ ~~lta~rcn P.O. T3{3X 1501f3 ~~~ ~I~y,~,®~:t anr~r-,r-,~; it ova clo not r~caiva your minlmum psyrrrent by tt~e Ivaw Balance Total ................ . , .....,~6,875.&;G WII,MTNt~`T(~1+f, T11; date listed above, you may have to pay a I~'te ~~•~ ~~ tca ~~~.~pO. i.l~BBQ-1itll.i~ Mlnln~um Peyrrterrt W~rain~: if you ~'r7~Re only file rninimurr- payment each Credit Line ..................... ~ifi df1d 00 ~t~~torr,®r s®rvl~: perrad, yt~u w+A ps~y mere in interest end It will take you I~n~r tr3 grey ~y4ur , . Creellt Avelieble ................... ~g ~ ~4„ l 6 ~~..Bav,r~s.ts2a balar~oe. i-~r cxarnple: . , , , ~ ~tateenertt Cls~sin ~ ~~~ ................,,.,~~~s/a.~ r;a.,soa..~:~.~ °rm~ Days irr I~lna~,g cy~r~ ..................................~~ Tignex~~lnn f'~stlrt~' ~P~is G~agfe Qr9 ~eNpiJon R~ti~~~rtce Accoernf Number Nyn9bar ~Jmount Tdre/ Peymseaits ~n~ otha~r c:rcdt~~ Q~/:~.B BA ELECTRONIC PAYMF{Vr -1,711.8 -~1,7~.~,.Sfi 6~LPrCh~®s® end Adaelstment~ QE/2~ O8/~4 Bt.(~OM~ BY VICKREY, INC 7~,7-7B7-O~~,2 PA dO~ ~ Q7O7 , 1+OQ.00 X5/22 .~.:~.. 05f 2~, gI.OQlV16 BY VPCKREY, INC 717-~~7-0~a,~ pa d0~4 c77~7 ._.~: _~._.__-=- dQQOOQO3r~27737d~;fs~ ~~3.34 D~/R~ Qfi/~fi [~uK~~ R1vEi~SIDE BAR G vVt7RMLtiY~f3U0~~ FAA 7a5C]~ O7~T ._._..,..r~~-.s..--.-- - ~onunua~ on ne~2peQe_.. . ~,106.~5 ~~ 006~~5~4~~C]Dh~~I®CI®1~~,ZD6D®047,47~~0®Z~ft]~®73? BI~Nt{ OF AMERiC~I P,U, BrJ}C 15Q1 ~ i1GVV~ant Nc~mbc~r: X247 ~6001dt7d ~~~7 WILMIhrt~T~N, D~ 1BBfifi-6079 iVaw Br~lattve'Total ...........................................................6,875.84 Mfnirnum 1~Frymenx 1~ue . .......................................... ..,. ~ ~„~ ..~ ~. ~.fi8.00 p~,yrnant Due dsto ........................... . ..................07116110 PEA A T7A p~ •p ^~.~ I i~+' ~.ao ..:~41r~:..tl~"~~;, ": :.'+~,-,,r.,•.:.r.•:..y ~ dHER18F~f [?R Ewrr#er payment amount ••~r~ ;, $ ~; ~• ' ~ :a CAMIa HILL PA 170'14-? ~~~ ~: ~ ~'_,~ - ~ }.,~.i ~!:,",,.-,°-- ~r .'.:,'; ~r ,.7 °'.i © C1~r~nk lf~ro 1f9r~ E~har~ aPms!!lr~+sddns!~~ pr/7/fOn9 riLa't~b®r~ ' ~ lesae pr~r~lo49 ?~N r7d/1t~Ct/dltS dr7 the row9rae sloe. Me~i1 thl® ooupon mfan~ with ynur ah~Qk p,<,y~brs to: BAtdFC ~F fii11g1=RfC,A If you would like anfarmati~n about credte caunseling sorvlcea, pair 7. ~a~QO.528>3. USPS, ENOLA ENOLA, Pennsylvania 170259998 4134870025 -0097 07/14/2010 (800>275-8777 12:59:06 PM Sales Receipt Product Sale Unit Final Description Qty Price Price Cushion Mlr 1 $1.39 $1.39 8.5x12-RP EDISTO ISLAND SC 29438 $5.05 Zone-4 Priority Mail 6.20 oz. Issue PVI: $5 05 2009 Forever 1 $8.80 $8.80 Stamp PSA Dbl-Sd Bklt 2009 Forever 1 $8.80 $8.80 Stamp PSA Dbl -Sd Bkl t $4.40 U.S. 1 $4.40 $4.40 Flag PSA Bklt Total: $28:44 Paid by: VISA $28.44 _ Account #: XXXXXXXXXXXX0737 Approval #: 05581C Transaction #: 4 23 903110047 Order stamps at USPS.com/shop or call 1-800-Stamp24. Go to USPS.com/clicknship to print shipping labels with postage, For other information call 1-800-ASK-USPS. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~r~~~~~~~~~~ Get your mail when and where you want it with a secure Post Office Box. Sign up for a box online at usps.com/poboxes. Bill#: 1000303247356 .Clerk: 04 All sales final on stamps and pastage Refunds for guaranteed services only Thank you for your business HELP US SERVE YOU BETTER Go to: https://postalexperience.com/Pos TELL US ABOUT YOUR RECENT POSTAL EXPERIENCE YOUR OPINION COUNTS Customer Copy ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Dale A. Davenport 2010-0549 Report debts incurred by the decedent prior to death that remained unpaid at th e date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 ~ Scott's Lawn Service 108.67 2. Mount Calvery Episcopal-Church (pledge) 2,340.00 3. ADT Security Services 77 22 4. Comcast 146.25 5. PPL 96.43 6. Pennsylvania American Water 40.17 7. AT&T Wireless 261.00 8. Bank of America (credit card) 1, 300.43 9. City of Pittsburgh EMS (medical bill) 50.00 10. East Pennsboro Ambulance Service Inc , . 100.00 11. Highmark Freedom Blue (insurance premium) 138.00 12. East Pennboro Township (sewer/sanitation) 241.50 13. U.S. Airways (credit card) 1, 711.86 14. Macy's (credit card) 27.63 TOTAL (Also enter on Line 10, Recapitulation) I $ 6,639.16 If more space is needed, insert additional sheets of the same size. • • • • SERVICE INVOICE 1000 Kreider Dr Suite 100- (717)944-6800 ~~ Middletown, PA 17057 ($$$)$72-6887 PLEASE STAY OFF TREATED AREAS UNTIL ~ DRY OR UNTIL DUSTS HAVE SETTI Fn Invoice # 21348663 Gol rnerts: ~~~ ~_~ ~ urf Builder Pro Rnd 2 - ~s'~® Please see insert for service details. ~G&~~iz How are we doin ~ g . Tell us what you think at www.researchhq.com/SLSsurvey and enter for a chance . ~g-~~ ~_ to win $100 $44.50 SAVE 5% when you prepay today! Take advantage of our prepay discount and you will save an additional 5% when you prepay for your services today. Call your local branch today for more details. Fertilizer Product s) Code(s) ~~ Analysis /~ D • ~'~ Control Product(s)* City. Applied ~ gal Ibs Product Code(s) ~ • ~ Treated Area at9 ftz Area [ ]Front [ ]Back QtY• Applied /•~IbS gal /Ibs Treated [ ]Side - L / R [ -All Treated Area `~ ftz z SERVICE ADDRESS: Dale Davenport 22 Cherish Dr Camp Hill PA 17011 CUSTOMER ~: 65669334 oda~s Serv{c~ Charge 44.50 i V ~-I ~ S ~ /~ Pa Sales Tax 2.67 C Today's Total 47.17 Prev. Balance as of 0.00 Please Remit 47.17 Payment is due upon receipt. Pay by phone is available at 1-888-872-6887. ft "For more information regarding control products Area [)Front [ ]Back [ ]Front [ ]Back [ ]FOR BEST RESULTS, ~~~~ applied, see table on reverse side. Treated [ ] Slde - L / R -All [ ] Slde - L / R [ ]All WATER-IN THIS ~ PPLICATION. / TRUCK #: Weather ; I Sun Wind Direction ,Wi~ed Equipment Used _ Conditions (]Overcast A /' ~ =~ [ ] S reader ~~•- .G~~e°-.~.- [ ] R~a~in~ W ~v~ E 5-10 Power Sprayer/Rate ~ gpm OPERATOR LIC Temperature-~~~--- g 10-15 [ ]Hand Sprayer/Rate gpm DATE _ The end use dilution applied to your lawn has a maximum pesticide concentration of 2.5%. For more information see reverse side or call the number above. ` /~ X2010. Scotts LawnService. World Rights Reserved TIME Start Stop f ~,~~~ '- - - - - - - - •• - •• - _ ' - - - - - ~Orf4?kI ~ S/J{?~lB!}iQ,gCsEL S@~1'~I£A sQt~ti~ss f!'@!~1f,2dSC#f}-t~`-$$~S4Flr - - - - - - PLEASE RETURN THIS PORTION WITH YOUR PAYMENT - DO NOT include correspondence with payment L~wwnSea~ice® Davenport, Dale 22 Cherish Dr Camp Hill, PA visa card number exp. date _ INVOICE NUMBER:21348663 Please Remit: $47.17 Make Payments Online with ~S~/ . If paying by check, please make yourcheck by going to rriyseottslawnserViCe.COrn payable to Scotts LawnservicE; - Include your account number on your check . If utilizing a third party bill paying service, please verify the Scoffs mailing address and reference account # 889-65669334 17011 Amount Remitted $ ~~ I~I~~I~I~I~~~I~II~„I~I~~I~~I~I~I~I~I~~I~~I~I~I~~I~~I~I~~I~I~I Scotts LawnService PO Box 742585 Cincinnati, OH 45274-2585 amount$ ^_ 889 65669334 0513],0 000477,7 101,00 0 8 • • • - • ~ 1000 Kreider Dr Suite 100 (717)944-6800 + l .L Middletown, PA 17057 (RRR1R77_6887 PLEASE STA Fertilizer Product(s) Code(s) Analysis Y OFF TREATED AREAS UNTIL DRY OR UNTIL DUSTS HAVE SETTLED. Ortho® Double Barrier $64.50 Today I applied your Ortho Home Defense Insect Control treatment to the foundation and the area around your home. This service will help to protect your home from the invasion of nuisance insect pests. For your convenience, service continues from season to season. SERVICE IIWVOICE Invoice # 21348664 SERVICE ADDRESS: Dale Davenport 22 Cherish Dr Camp 'll PA 17011 ~~.~ V~s~ . CUSTOMER #: 6569 34 Today's Service Charge 64.50 After Multiple Service Line 58.05 Pa Sales Tax 3,48 Today's Total 61.53 Control Product(s) Prev. Balance as of 0.00 Product Code(s) Please Remit 61.53 ~ s Payment is due upon receipt. Pay by Qty. Applied _ Lj~S gal i bs /o.-~ ga ~ phone is available at 1-888-872-6887. Treated Area f "~~..~ ft2 ,~ ft2 *For more information regarding control products Area [ ]Front [ ]Back [ ]Front [ ]Back ( ~ FOR BEST RESULTS, f ~ `~.7 applied, see table on reverse side. Treated [ ]Side - L / R [ ]All [ ]Side - L / R [ ~ All WATER-IN THIS `-~°"~ / Weather APPLICATION./ TRUCK #: Sun Wind Direction Win _ ed Equipment Used Conditions N ~ .- [ ]Overcast ~ ~ o- [ ]Spreader - ~ ~ ~~ ~'` Rain OPERATO [ ] ~ vv~-~-~ E 5-10 [ ]Power Sprayer/Rate gpm LIC #: ,Temperature g 10-15 i -Hand Sprayer/Rate gpm ~-~ a The end use dilution applied to your lawn has a maximum pesticide concentration of 2.5%. For more information see reverse side or call the number above. DATA J 2010. Scotts lawnService. World Rights Reserved TfM~ Start `~ ~~ ---__________..____..___..__-------far,~'o~~c,orwen.ie'ar~serasiceco~atinatss.fr®m-seas~fra~ea~..------- - sto PLEASE RETURN THIS PORTION WITH YOUR PAYMENT - DO NOT include correspondence with payment - - - - - - - - - - - - - - - - - - - - ,. b~Fi~l~S~&FTdC~'® INVOICE NUMBER:21348664 Please Remit: $61.53 Make Payments Online with . If paying by check, please make yourcheck by going to myse®ttslawns~rVjce,~®~ payable to Scotts Lawnservice • Include your account number on your check . If utilizing a third party bill paying service, please verify the Scotts mailing address and reference account # 889-65669334 Davenport, Dale 22 Cherish Dr Camp Hill, PA 17011 Amot.lnt Remitted ~ visa card number exp. date _- ~. $ ~~J amount S 'IIIIIII1111111~'IIIIIIII~IIIIIIII'1111111~111~11I11111111111I Scotts LawnService PO Box 742585 Cincinnati, OH 45274-2585 889 65669334 05131,0 00061,53 10100 0 4 Mount. calvary Episcopal Church rage: ~ ~- i L5 ortli 25th Street Plain Paper Statement 1.7011, PA CampHill - Reflects 2010 Gifts 01 /O l /2010 to 12/31 /2010 dges, 2010 Pledges, Bishop's Descretion. Fund, etc.,. Envelope #: 19 Ms. Sherry Davenport 22 Cherish Drive Camp Hill, PA 17011 Date Fund Description Gift Descri tion Amount Check )1/03/2010 2010 Pledges )1/03/2010 Initial Offering $60.00 003866 )1/03/2010 Ton of Love Income $1.00 $10 00 003866 003866 )1/10/2010 2010 Pledges )1/24/2010 2010 Pledges . $60.00 003868 )1 /31 /2010 2010 Pledges $120,00 $ 60 00 001249 003 8 81 )2/14/2010 2010 Pledges )2/21/2010 Holy Days -Ash Wednesday . $120.00 001251 )3/07/2010 2010 Pledges $10.00 $60 00 003874 )3/07/2010 2010 Pledges )3/14/2010 2010 Pledges . $120.00 001254 )3/21/2010 2010 Pledges $60.00 $60 00 003878 003882 )3/28/2010 2010 Pledges )4104/2010 2010 Pledges . $60.00 001255 )4/11/2010 2010 Pledges $100.00 003883 )6/13/2010 2010 Pledges $60.00 $240 00 001256 001262 )6/20/2010 2010 Pledges )6/27/2010 2010 Pledges . $360.00 001263 J7I04/2010 2010 Pledges $60.00 $160 00 1)01270 001273 J8l15/2010 2010 Pledges J8/22/2010 2010 Pledges . $360.00 001286 J9/12/2010 2010 Pledges $120.00 $180 00 C-01289 001295 10117/2010 2010 Pledges 10/17/2010 2010 Pledges . $120.00 001300 10/24/2010 2010 Pledges $120.00 001310 11 /07/2010 2010 Pledges $60.00 $120 00 001313 001040 11/21/2010 2010 Pledges 11 /21 /2010 Ton of Love Income . $120.00 001305 12/05/2010 2010 Pledges $20.00 $120 00 12/12/2010 2010 Pledges 12/19/2010 2010 Pledges . $60.00 001422 $120.00 001424 $3,301.00 X02 j 3 ~~ ~ ~ ~,~~ Unless otherwise noted, the only goods or services provided are intangible religious benefits. .~- ~ ~.~~~ar~~ Episcopal Church i25 North 2~th Street 1701 1, PA CampHill tits. Sherry Davenport 22 Cherish Drive Camp Hill, PA 17011 Fund Summary Page: 2 Plain Paper Statement Reflects 2010 Gifts 01/01/2010 to 12/31/2010 dges, 2010 Pledges, Bishop's Descretion. Fund, etc... Envelope #: 19 Fund Description 2010 Pledges _ Total YT Total Pledge _ Pre ~ -.~7~ents 1 e Balance Holy Days -Ash Wednesday $3 260.00 $10 00 $3,120.00 00 $0 $0.00 $0.00 Initial Offering Ton of Love Income . $1,00 . $0.00 $0.00 $0.00 $0.00 $0.00 $30.00 _ $0.00 $0.00 $0 00 $3,301.00 $3,120.00 $0.00 . $0.00 Unless otherwise noted, the only goods or services provided are intangible religious benefits. Previous Current Payments '- Total - Pay nme t P00001-0026995 Balance Charges Received Adjustments Balance Due Due Date $0.00 $77.22 $0.00 $0.00 $77.22 ~ ~ . O6/03/10 Current Account Activity: Invoice Date: 05/12/10 Current Charges: 06/03/10 to 09/02/10 Quarterly Security Services Amount: $77.22 Tax: $0.00 Total Balance Due: ,~~, l ~ G ~ v ~~ ~~~ ~ ~~ / G r-e ~ , --r $0.00 Wi / ~ ill 16 C~ ~ $77.22 $77.22 ~ Please remember to include the payment coupon belotiv with your payment. it paying by check, please write your customer number on the check. iA-^ Customer Number: 1 b~012:330 Account Name: DALE DAVE',NPORT Service Address: 22 Cherish .Drive Camp Hill, Pt~- 17011 Billing Questions: (800) 238-2455 Moving? Call: (800) 600-5145 Monitoring/Service: (800) 238-2727 How to Read Your Bill: www. adt. com/bi 11 info It's fast and even more important -it's easy! You can s~.ve tune and money paying your bill by using your Visa, MasterCard, Discover® or American Express® card. Please see the back of your invoice for instructions on setting up your account for automatic payments. Late Fee Policy: A late fee of 1.5% (or highest rate permitted by law, if To pay this invoice and/or future less) per month will be assessed on the unpaid Statement Total Balance or bank debt, follow the dit card Due when more than 30 days past due. instructions on the back of this _ invoice. TES_r YOUR ALARM[ SYSTE:vf ~~fONTHLY TO CONFfKM YOUR S~'STE~~t [S OPE(Zf~T[ON~~L Page 1 of 1 ------------------~ozSRE----------------- 03 ---------------- _ - ---004-------------- -------------------------------------- ~ayment Coup®rl __ ---------- Please detach and enclose this coupon with your payment. Do not Due Date: 06/03/10 send cash. Please write your customer number on your check or money order and make payable to: AoT security Servioes. Customer Number: 01100 168012330 ^ If you have any changes to your billing or monitoring account information please check here and enter the new information on the back of this invoice. To ensure timely, accurate application to your account, PLEASE INCLUDE THIS STUB WITH YOUR PAYMENT. 22965 1 AB 0.360 0022965 S1 T96 Please Pay ~~ This Amount ` $77.22 Amount Enclosed: ~~ :;~`: #BWNJYCW ~'•~~ #0332 1 0861 001 1 09# DALE DAVENPORT 22 CHERISH DR CAMP HILL PA 17011-1025 '~~Illlllll~lllll~~~~l~lll~l~~llll~llllll~~~~~~l~~lll~l~ll~l~~~ll '~' MAIL PAYMENT TO ADT SECURITY SERVICES P.O. BOX 371490 PITTSBURGH, PA 15250-7490 ~Il~ll~~l~~l~i~l~l~~~ll~~~~~ll~~~~l~l~l~~l~~l~l~tl~ r~l~~~ D01,68D],23300DOD0000000006031,OD000ODDOOD000077224 4 , : comcast~ Account Number Billing Date Total Amount Due Payment Due by Contact us: ;'~c~,~~ www.comcast.com `I~° 717-540-89Q0 09547 245002-01-2 05/07/10 $146.25 06/01 /10 Page 1 o f 3 DALE DAVENPORT For service at: 22 CHERISH DR CAMP HILL PA 17011-1025 News firom Comcast Thank you for your prompt payment. For your convenience, we now accept regular and automatic monthly credit card payments and direct debit. Hearing/Speech Impaired Ca11711 Parents: Do you know you have options to help determine which programming is appropriate for your family? Visit www.comcast.c~m/uarentalcontrots to learn more abou# parental control features that are available as part of your Comcast Gable service. ~IGl~~flSh',,it~~id (~'~r,V{=~.lt~~:)~{ ~{+j~~1~1lif~V J' '.a __ ,... Previous Balance 146.25r Payment- 04/30/10-thank you -146.25 New Charges -sea belovlr 146.25 To#a~ Amount Due $.146.25 Rayrnent Due by O6fO1/1Q Ir~'~ lv~r (ui ~. ~~~~'~ ~ ' ~1t~~'a r~ li~r l-Y ~~~~; i- L xFINITY @und[ed Services 139.95 '~ -~ ~__ ~ Additional XFiNITI~ TV Services 30.34 ~~~. ~~~ ~ ~:: Additional XFINITY Internet Services 5.00 Additional XFtNFTY Voice. Services 2.9t} Other Charges & Credits -40.00 Taxes, Surcharges & Fees 8,42 Total New Charges $146.25. _, Detach and enclose this cou n with our `"-""""'°"'""""°""""-°~--•-- Po y payment. Please write your account number on your check or money order. Do not send cash. - + .. Comcast. 1555 SUZY STREET LEBANON PA 17046-8317 l---II---l!- maniftest lim!e - tt tiflllll~lt11~i11~I11!'Iilllt'llifllll'~i!'i1~111I~1l~i~lfl~l DALE DAVENPORT 22 CHERISH DR CAMP HILL PA 17011-1025 Account Number Payment Due by Total Amount Due 09547 245002-01-2 06/01/10 $146.25. Amount Enclosed $ Make checks payable to Comcast 1.,,11iJ,~.JhIJ~~L.I,,.11,11~~~11~~„I,I~11,~,~I,L1~~.11 COMCAST CABLE P 0 BOX 3005 SOUTHEASTERN PA 19398-3005 09547 245DO2 01 2 0 014625 ~ ~ i e . a • '•'~~~'•~~;,: Page 3 ... ~ • ;.. Util~t~es ~ TM 01560-70003 cE~E'.C~~'1G Total from Last Bill ~7~~1C~', $96.43 For: g 4tal..IS DALE DAVENPORT Amount You StiD Qwe as of Jun 23, 2010 22 CHERISH DR $96.43 CAMP HILL PA 17011 Current Charges Charges for -PPL ELECTRIC UTILITIES PPL Electric Utilities Customer Service Residential Rate: RS for May 24 -Jun 23 Distribution Charge: 827 Hausman Rd_ Allentown, PA Customer Char e ~8 ~WH at 2.0600000¢ per KWH 8 ~ 5 81 18104-9392 WH at 2.64000000¢ per KWH . 11 83 2-800-342 5775 (1-S00-DIAL-PPI,) www lelectric PA Tax Adj Surcharge at 0.10300000% Transmission Charge: 648 KWH at 0 31600000¢ e KWH . 0.03 _pp _com . p r Transition Charge: 2.05 Z00 KWH at -0.25200000¢ per KWH 448 KWH at -0.22300000¢ per KWH -0.50 Generation Chargge: C it d -1.00 a~0ac0 y an Energy WH at 10:13300000¢ per KWH 448 KWH at 10.13300000¢ per KWH PA Tax Adj Surcharge at -0.01400000% 20.27 45.40 -0.01 Total PPL ELECTRIC UTILITIES Charges $92.32 Other Char es for PPL Electric Utilities Late Paymen~ Charge 1.21 Total of Other Charges $1 ~' 1 •: i•f • ...~... •:•Y^ ~ -~ '.. ~~` ~. . 'Y: •• ^ ~+r ~• +• ~Q#~ ... ...•_ _.: r:. Account Balance $189.96 ~iirellePs~.l Information This bill includes a previous balance. If you have aid this amount accept our thanks and pay only the current charges ,Please Next meter di Generation prices and char es are set by the electric generation supplier you have chosen. The Pub~c Utility Commission regulates distributi rea ng on or about on nces and services. The Federal Energy Regulatory Conunission regulates transmission prices and services Jul 23 . PPL Electric Utilities uses about $0.89 of this bill to ppay state taxes. In • addition, about $11.20 of this bill pays the PA GrossReceipts Tax • For our convenience, you can now pay your bill using your Visa, MasterCard, Discover, or ATM Card Call BillMat i t 1 8 . r z a - 00-672-2413. BillMatrix w111 charge your credit and ATM card a service fee for making this payment. Before diggin around your home or property, you should always call the state's One Ca~ notification system to locat e any underground utility lines. You can do this by simply dialing 811, which will connect you to the One Call system Be safe and ll 81 b . ca I efore you dig. With paperless billing, you can receive and pay your PPL. Electric Utilities bills online. The process is free, quick, convenient and secure To learn . more or sign up, visit www.pplelectric.com, Save postage and. late charges -sign up for Automated Bill Payment. • d OOOc43,OpZ00p9000000000000401701], Pennsylvania American Water PO Box 371412 Pittsburgh, Pa. 15250-7412 _~_~__ For Service To: 22 Cherish Dr 013927 1 AV 0.335 1927/139t27/G01927 048 1 PCKYZW I1!lllllllllllllllillll111llllllllfl1111111111l1111111EIIIY111 DALE DAVENPORT 22 CHERI;;H DR CAiVIP HILL PA 17011-1025 AMOUNT DUE DUE DATE AMOUNT PAID 1 24-1001302-9 X40117 May 13, 2010 Pennsylvania American Water P4 Box 371412 Pittsburgh, Pa. 15250-7412 I111111111111l11111111111111111111111111111111111111 Please check here to add H2O-Help to Others contribution to your monthly bill _____-___ or to change your address or to/ephone number, and print information on re Customer Account Informatio verse side. n Billing Sum-~ary For Service To: Dale Davenport ----------Prior Balance--------------- 22 Cherish Dr Account Number: 24-1001302-9 - -------- Prior Water Balance $29.70 Premise Number: 24-0579431 Payments prior to Apr 23, 2010. Thanksl -29 70 Total prior balance, Apr 23 2010 . BIIIIn ' ' g Perioel & Mefer Informafion , ----------Current Water Charges---------- .00 Billing Date: Apr 23, 2010 Billing Period: Mar 19 to Apr 20 (32 days) Service Charge Water Volume ($.007890 x 3,400) 26.83 Next reading on/about: May 18 2010 STAS PAWC b'Vater 0.45% . 18 , Rate Type: 13esidential DSI - I'AWC Charge 0.40% 16 Total Usage Billed c~ . 40.17 Meter readings in current billing period: Meter Nurnher lJ044159346 is a 5i6-inch met _______ ----------AMdUNT DUE - $40.17 er. Present-actual 6091300 Last-actual 606400 Gallons used 3400 ~• t; .: -- } } _ __ __ ,~ ~ `~t, . __ __ ~: _:; Page: 1 of 8 Billing Cycle Date: OS/l4/10 - 06/13/10 Account Number: 464012374475 How To Contact Us: .1-800-331-0500 or 611 from your cell phone • For Deaf/Hard of Hearing Customers (TTY/TDD) 1-866-241-6567 Wireless Numbers with Rollover -'~ 717-439-5030 ,~ 717-571-4054 /1 :. ~ h~~ ill ***This Bill Includes A Past Due Balance**X If payment has already been made, thank you, please disregard. If not, payment must be made immediately. Please send your payment, including current charges, in the enclosed envelope. You may also pay 24 hours a day, by ma~or credit card or electronic check at 1-800-331-0500, or att.com/MyWireless. If' your service is suspended, a reconnection fee will a ply. If you have questions regarding your account, contact us at 1-800-947-506. Return the portion below with (srOUI3 1~eta11S _ _ ~ _ _ _ _payment only to AT&T Mobility. Note: The following information summarizes only the shared plan services for your account. For additional information and details relating to all other services for a subscriber, please refer to the subscriber's indi id l . FT NATP 450R UMMSKNW v ua pages. Shared Minutes Used Wireless Period Numbe-• Monthl Y Rollover Service Minut Other Shared Billed Billed 717-439-5030 05/14-06/13 es Minutes n'Iinutes Char es r 717-571-4054 05/14-06/13 : <~ :.::: 19.99 281 39.99 101 280 0 0.00 :;;. : : : _ _:;::;;::::::;:>:::;:>: _::>::>::>:=: >:;:::::;::::~:_:::::~::::<>::;.::.:::.: »:;:: ;;: ,.Total:::::: ~>::::::::::>:::::= ~::>:>:::::::<:::>;:;: >::-:.;:.>:;;.:; ~ ~. _:. ~>::::>:;:;:.: ~;>::: ...: ............. :>;:::;. . ~::. ~:: .::.<.::>::-:.;:.::.:. ~;;>...,...:.. ~.:...:::::: .... ,......: 382;: ....:: ....................... .: 136 ..: ................. : :.: :>;:: 41 6 0 ~... . 0.0 ......... : Shared Data Used . ; : . .: : Shared Wireless Monthly Text Number Service Ms s Shared M gS S Kr ed M Billed Text Billed MMS Billed Bi g 717-439-5030 0 00 B s s Msg Msg KB lled Charges . 0 Period 05/14-06/13 0 0 0 -- 0 11 0.11 Summary of Rollover Minutes for the Grou Previous Rollover Balance 1,835 ~' . ~ } } - ~ . ~~~ ~ `~ ` Page: 8 of 8 Billin C cle Date: `',~--= ' g y 05/14/10 - 06/13/10 Account Number: 464012374475 .:::.:.....:::.:.,......................:::.,::,.._...::::,:::,.::.:.:.::~:~::.._.:......:: _.>:;:.:..:Yp._.~:.._.::...rovider ID Date Cost Tax :>~:<::1:;..>:(I6(OS #?taYp}ione 5uki~c~iptf 74777:::::: MT ~~PlayPhone )ne~ otals 1:3Q88..:; D7/051201.a ~~:14:g4:~ n~`nri. Mobile Purchases & Downloads: Communication Charges 717-571-4054 User Name: DALE A. DAVENPORT Get help and manage your purchases several ways: • Check your purchases anytime on your mobile phone by accessing My Account in MEdia Net and click the My Purchases link • Go to att.com/MobilePurchases • Call AT&T Customer Service by dialing 611 from your mobile phone or 800-331-0500 Type: MT=Multiple Types Monthly Subscriptions To stop a subscription, text STOP to the Short Code using the mobile phone associated with those charges. Subscription Code T e P ontent Renew # Date Name rop~te..rurcnases:B:I]ownloadsi Communication Guar ~es:> ::.::::~:::::::::::~.;;.:::;.:.::::::;: Add a Line with Family Talk from AT&T FamilyTalk plans start at 'ust $69.99/month including 700 Rollover Minutes. Ad'd up to three additional lines for only $9.99 each. Sign up now by calling 800-449-1672 or visit ATT.COM/ADDALINE Go Green! Sign up for Paperless Billing Today Sign up for paperless Billing and join AT&T in its efforts to be more earth-friendly. Going paperless is safe, secure and easy...and will save you time and money each month. View and store your monthly bills online (for up to 12 months) instead of receiving paper bills in the mail. Visit att.com/actgreen to learn more and enroll today. It's free, it's easy, and it's green! 14.99 I 8920.004.028022.04.04.0000000 YYNNNNNY 230467.230467 ~' . -- ~;'; ~. . - - - _ vvww.FlACardS~rvices com ESTATE OF DALE A DAVENPORT 22 CHERISH DR CAMP HILL, PA 170111025228 October 18, 2010 Account No.: 4147360014080737 Dear Estate of Dale A Davenport: ~ ,_ , "` We have recently been informed of the passing of Dale A Davenport and offer our condolences. Please be assured that this account has been closed. Dale A Davenport was a valued FI.A Card Services customer since January 5, 1999 and we greatly appreciate the past business with us. While we certainly understand this is a difficult time for the family, we do require the necessary information regarding the financial affairs since there is a balance of $1,300.43 remaining on the above referenced FIA Card Services account. The information requested on the following page will enable us to take the appropriate action and contact the personal representative handling the financial affairs of the decedent. Please complete the enclosed Estate Status Form and return it to us using the postage paid return envelope provided in this package. If you Have access to a fax machine please feel free to fax the form to 1.302.458.0679. You are not obligated to send us a death certificate unless the above referenced account was enrolled in one of the credit insurance, cardholder security or credit protection plus products. Should the family or legal counsel determine that opening an estate is not the best course of action, please have the Personal Representative of the decedent take a moment to call one of our senior associates at the number below to discuss the various options available to satisfy the remaining balance of $1,300.43. As a reminder, whether or not, you are the personal representative, executor or attorney handling the affairs of the decedent, you are not personally responsible for this debt. Subject to the above, if you are in a position to mail a payment in full, please mail it to FIA Card Services, PO Box 15409, Wilmington, DE 19850. For overnight mail, please use FIA Card Services, 1000 Samoset Drive, Newark,. DE 19713 When sending a payment to our office, whether through the U.S. Postal Service or via overnight/express, please do not forget to write the account number listed above on the face of the check to ensure the payment is correctly credited to the account. Again please accept our condolences on the loss of Dale A Davenport. If you should you have any questions with regard to the above referenced account, payment options, or how to answer the questions on the Estate Status Forrn attached, please don't hesitate to contact one of the senior associates in our Estate Department at 1.877.767.9383. Our hours of operation are Monday through Thursday, 8a.m. to 8p.m. and Friday, 8 to 5 Eastern. Sincerely, The Associates of FIA Card Services Estate Department Enclosures City Qf Pittsburgh EMS PO Box 2480 Pittsburgh PA 15230-2480 (412) 655-0437 Patient Name: Dale A Davenport Time of Call: 20:16:00 Run Number: 10-27107 Date of Call: 04/19/2010 Dale A Davenport 22 Cherish Dr Camp Hill PA 1701 1-1025 Description A0427 ALS Level 1 Emergency A0425 Mileage A0422 Oxygen A0392 EKG Total Revenue Adj ustmer~ts Payor: Freedom Blue From: To: Primary Payor: Secondary Payor: ~~~3 I~ o 121 Grandview Av 12, Mount Washington, PA 15211 Shadyside Hospital Freedom Blue Contractual -- Qty Price Allowance Amount 1 650.00 260.48 389:52 7 70.00 21.91 48.09 1 50.00 50.00 0.00 1 70.00 70.00 0,00 -$13.01' Dep. Date: 05/10/2010 -$374.60 BALANCE: $50.00 /J4 Please Remit Payment To: ~ ~ ;~i..~-(~C,~---~C` East Pennsboro Ambulance Service Inc Billing Office P.O. Box 726 New Cumberland, PA 17070 QUESTIONS ABOUT THIS BIi.L? Phone: 877-214-6018 Espanol: 866-724-4114 Fax: 717-214-6020 Email: info@ambulancebillingoffice.com Date of Service: 5/13/2010 15:32 Patient Name: DAVENPORT, DALE A. Please visit our website to provide insurance or make payment, and From: 22 CHERISH DR. for additional payment options and frequently asked questions: To: Holy Spirit Hospital weivv~.ambulancebilling®ffi~e.com Medica~"e has paid their poi"tion of these chap°ges. The bula»ce dcre is yoan" ~"esponsibilr'ty. Please rernrt pay117E?nt o~" the ~"en~aiT~i»g bala»ce. Tha»k yoz~. .f . _ _ _ -- _ ,. ~ ,~.. ;:. -- e~,.., _ ~ _ ~ ~ ,. _ _ _ _ _ ;. ~~ __ _. _ .._ _ __ __ __..,_ 5/13/10 Basic Life Support/Emergency A0429 1 630.00 630.00 5/13/10 Mileage A0425 5 9.00 45.00 5/13/10 Adjustment -Insurance 6/07/10 Adjustment -Insurance -312.63 6/07/10 Payment -10.84 Total -301.53 675.00 -323.47 -301.53 t• . Please Remit Payment To; East Pennsboro Ambulance Service I. Billing Office P.O. Box 726 `~-~~~~~~ New Cumberland, PA 17070 QUESTIONS ABOUT THIS BILL? Phone: 877-214-6018 Espariol: 866-724-4114 Fax: 717-214-6020 Email: info@amSoul'ancebillingoffice.com Date of Service: 5/17/2010 16:19 Patient Name: DAVENPORT, DALE A. ~ ~ ~ ~ From: Holy Spirit Hospital ,~ ~~ To: RESIDENCE ~~ Please visit our website to provide insurance or ma!<e payment, and for additional payment options and frequeni:ly asked questions: ~rww.amfaula~~ebillir~c~c~~:.i;i~:~.c®~ Medicare has paid them poz°tion of these charges. The balance dzie is youz° responsibili I ou have supplemental insurance which covers this co pay amount, please complete the back of the invoice or contact our billin o rce. Thank g ff you. ~ , _ __ - -- _ ~,. ~. ~ ,._qq _... __~.~_.~.._ .._ _ _ .i- .'.i. _. _ .. 5 ~: - - _ - --_. _.. 5/17/10 Invalid Coach One-way A0130 1 84.00 84.00 5/17/10 Invalid Coach Mileage S0209 4 1.60 6.40 8/11/10 Adjustment -Insurance 8/11/10 Payment -30.40 Total _ -10.00 90.40 -30.40 -10.00 z' . ~IIGHMNZK. Ff~E~oMB~uEPPC?~ en~~eamrgrPo 120 5th Ave Pittsburgh PA 15222-3099 I~~~III~~~III~~~~~~II~~~IIII~~~II~~~II~~~II~~~~~I~I~~I~I~II~~I DALE A DAVENPORT 22 CHERISH DRIVE CAMP HILL PA 17011 P.O. Box 382054 Pittsburgh PA 15251-8054 Invoice 01-1-03050 Date Group 05/07/10 01998215 Company Code Billing ID 09 600128369 ~' _____ V .1,,~ --- ~~~ Coverage Period Account Status Member ID Beginnin Ending Previous Balance 138.00 1028450040010 06/01 /10 06%30/10 Payments Received CR (13 8 . 0 0 ) Adjustments o . 00 Coverage: FreedomBlue PPO ~ - Prior Balance Due 0.0 0 Coverage Period Premium 13 8.0 0 Total Balance Due 13 8.0 0 Look for important information in this space on future bills. We will provide updates on your benefits, health tips and other information. If you have any questions about your coverage, please contact our Member Services department. The address and telephone number appear on the reverse side of this a~ . ~ ~ ~ ~ ~~ ~ L..9._. ~~~: ~ ~' ~~i~,J~ ~~ ~~• PRESORTED . . ,. FIRST CLASS MAIL _ '1'~4"t~t ~~ .~',~~; ~ ~,~ ~ .~ ~~`! ~.JI~ G~'1.~7 ~: ~ ~•~; ~"'~ U.S. POSTAGE PAID Telephone 732-0711 ~'"~CM~~i~g~,~ SEWER/ ENOLA, PA Office HolarS-8:00`'to 4:00 Mon thru Fri SANITATION PERMIT N0.9 Reading Date od Present Reading Previous Reading Consumption Amount 4~j~~~'t .~. ~i~ ~!~~' 7~ I 1 ti ~ I V 1 4Pay this Amount '~ ~ C5 After Due Date -> ,-- ,s•,, '`'} ~ ~ ~ ~:~ ~. '~ ~ !''t ~ r}F~~,~~~n {fit) Address ~''^ d .~-ti 1F ~~t1i~~i~t1~lr~~t~t~~tir~~~t~~1t~~t~t3aJt~i~i~itr:~~~s.,,.~~;~•~,..~.:~ ~ i _ _ _ _ _ 03J 21 J 2011 15: 3~ 302580090 BAC DEBT MAh}~GEMEhdT P~4GE 03J 08 ~~ . • ~a~>I>aEr~>a ~x~~ DALE A E?AVENPO>~r • Account Num-aer: ~41+~7 8fiad 1408 v7~7 April 2Q -May 19, 2t]10 • Aaaaur~t Irafvren~tmn_ wv~rhant~f~ericr~.com ~ Man biFling Tuuulries to: ' New Baf,~nce Tcat~~l ~ ~ ~ a i3ANFi' OE' AM]! ltit~A P' 0 13t~X 1fs0~ET ............................/.1./,..,.........,,........, $~, 7:[3..66 ............ Ct~~'rerrt Paymer-t ©ue ............. ..................... Previous Balancca .......,....,.. (] /~~ +..,1,...~3,~95,~9 . . WTLMINQTON T)T; .............,...........,.. .....,,,17.00 Peymonts and (7ther Ct~dita......... f./•~,695.~9 , t.9$15t~ti0~A T~#al Minimum Payment 1bus. Purchases and Ad}uatm~:rrt~ .............g,~SS.~ fi Mall ~3sp:svgnt9 to ~ ..........................................................~~,7.0a ayrnerrt Due Date ................. ................... P~~s Gharr~ed.. //~~~/f+..[[~~ ; 'F3AN:~~T+' AMrTi.TCA ........................:.....1111.1/56/50 Intur®~t G6~r e ~ ~...,............ ..........................:.... ~. ~ a PIO. D(7X 11101.9 ~AT iT 1UlINC~'~C?N ~~#e Paaymant ~14farrflhg: fftiov~ d4 not receive date Nsted ab~v~, y~~, may have m pay a late ~e of „t ~ $he Nt~w B~iance 7'atel ...............~........~So711.~6 . 1 , D>C up tv ~8~,00 1088fi•50.19 Mlnlrs~urn Payrrran! V4-areying: If you make ~n0y the minirviu ~tastt:resep ~~rvlca: rn perlad, Xau Will pay mare in interest and i wffl to ~~ent each t ka yvu l~Fti~er to pa cYff ou Credit Lane ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,~16,0d0.®(~ G ` 1.,~t~.883 1820 y y r balanc®. Foe exArnpfe: t cdit Available .................,..,., i/,,~;~4,~~~.~4 . r (.1..800.~22.'77~~~y `i'7""'i'}} 8tate~tv~ent Closing Date ..................~ a/~,8/y0 - - gays fn Billing Cycle ar~ly the minimum .53 years ~~11.Z~~.32 payrnt~nt X57.94 ~6 tnv~h~ ~2,Og5.$4 (Savings = ~1,097.~48) If you would lidty ir~farmatlan about credit r~7ur7selirt~ scrvlcvs, call 5-86600-5~$$, ' Trsnse~tlarr ~xtln~r Data rl+tfi Descrlp~'an l~sfesr~r~e~ .4~ootr»t ~ayenents and Other tdlt~ Nurrrbnr N~rrrber rrnraur:i T~f~f . fifi'/1~ PA ~~.FCTRQNIC PIIYMLNT 024 v4/~s Puvch~sas and Rc0)wstm®nta Ct7 GO'S 2$id D4/2fi ~' 0~/~T PITTS~URfifi PA GIANT FOaD 91t~69 CAMP hllt ~ ~A ~~'~ 07D7 44.24 , C1+035~ 890~t 08'7 St'~4.5~-. • Q4J29 D5/01 CVS PHARMACY #2321 ~0~ ENOLA pA cont~aued an ncze papa.., I~~'5~ 877 X1.77 ~~ ®Q~,73,1860~~[]~°~^^QQ339549®®0~8y~7~6[IC3~~®~®73`~ BA~~ ~F AMERICA f'.C. ~QX 45019 At:caune Number: 41,47 3600 5408 07~? WILMINfi:TCiN, 1~S 19088.6019 ivaw•F3s~ls~nce Total .................. ................................... „...,:~~, 73.1.86 Mirtii-riurn Paymorrt Du® ................ ...17.fl0 Payment Due Ore ,.~ ................. ..........I..,.I~fi/~.k5~50 ~~.r...~_ .._ _ ._.. r.~ bAL~ A f3f11lEi~PC)RT "'{~• • • , ., ~~ ~~~~,~ ,: . „ ~ ~~~~~~° '";J•• ~ • 22 CHERt~H QR ~ntar tasYmen# amc~a:n# ~`~` .. ~ ~; ,,; ; CAMP 1-~fLi, PA 17011-1©2fi ~' ;.L,,...~. ,:~__.., .:. _.. •_..._..:......:~_~,.,.,:~'.,.._ - • ® ~.~J~Gk ltdlt~ 7f?r' 8 ah~ry~e of m~/1lr~d ~ddrr~~,~ r~r jplrt7~ ~it,Mbera. lip®sse prov~da A/lao~not/o1f:: v17 the9 rse~raa s/o+a, Ma11 this aeaupon e1on~ wt4h vavr ahw~4c pray~ble t~; 8AN64 ~F Af4nE~~c~ ~3/~112~11 15:34 3Q~4580O90 BAG DEBT MAh~IAGEM1Eh~~T PAGE 1~410~ ~. ,~ . ~I~gI7rE~T~i ~T~G~~ 4~.~7 380i} 108 O73'~ Aprll 20 - M~3~ ~.~, 2Q~.0 p~~3v~6 TrAI~~rGtloR Ababrl7g - D~te Dais L~®scfilPtlon Rnifbrsnrs mb~f Nr~Rlb+~~ Nu ~4r»ermr ~p~' 1 f~'urohias®s arr1 Adjustments OBE/Sd C75/Q~. GIANT FC1EL#~58 EiVOLA PA X992 d7S7 0~.0O01 30.tJ0 0~/Sd d5/Qi O5fO3 '0~ 05 AMt=BEGAN Ai.>: H4l~8EAND STATE COLLEGERA ' X883 d7~T G7 ~3 ~ ~ HE TAVERN RCSTAURANT S7gT5 Oc~LI.EdF Pq ~~~ . d5/d~ 05/03 , NITTANY LION IiV1V LODGE STATE COLLEIs~PA ~ 8824 0737 0787 54,~,r~ 7790 8G9,78 AR1~1VA1.4ATE 4/30/10 . Q5/0~ 05/45 P1~NERA BREAD X759 NARR18F3UI~Q PA 029 p737 27 45 g1~d50i~9 T5~V~, 5Y7t?fJ0OO67 79 . 05/U4 05/04 05/05 C15/p~ 13~i.I.A UNQ SALON CAMP HILL i~q CVS i3i~PARMAC~ #232, QO3 ENOLA EPA 5202 U737 29,22 05/0 05j08 STALIFFERB OF f~ISSF1 MECHANfU$BLIRf~PA 8551 $5G9 0797 0737 4~i155B1OOp;~V1 RY70O(7454320 318,87 0*~f07 05/08 GIANT F[9EL#26S ENt7LA PA 125 Q7~7 010074 3®.~3 05/07 d5/0~ CfANT F0O1] X253 f;N~L11 PA ~4.~5 0737 O1d2b9 35O.t7D d5/d7 O~Ja.v ~~/08 05/12 9NINE ~C SPIRITS ~~,1.~, ivfVOLA PA CVO ~HARMACY;~2321 Qd3 ~IOIA p 4 45/13 d5/~ 3 Q5/14 Q5 1~ , BELLA UNb SAI~gN GAOVIP HILL PA X8245 59~3ra 4737 0737 2~,,gg , / a L1~1nf~TY FORQt~ QOLFCQU MECWANICS~UR~PJ~t 2 834 47 ~ , 37 .00 ~~.,~9.i..~~ Interest Charged 05/18 05/39 interest Charged ort ~Is~n~e Tr~rrsfers 05 f 19 45/19 Interest Charged are Cash Adv~np~~ Q,OQ 05/~,~ 05/x.9 Interest chAt~ed C71 PUrchasv~ 0.00 ~®TAL IN1'ERE~T F017 Tf~fC fPL~2t~~ Q.Q¢ $~.~~ i r ~ ~ ~- T~$~I fees ch~rg~d !r! X01.0 ~D.DD i ataf IRt~I'~&t ch~af~ed its 2010 ~0.0(l Your,4nn~ret Psree~p$r~~,~ beta (APR) Is the artrrt1t31 ittre~t rate on your accaurre. Anrfasel f~r~rr+a~lar~el I~ramatiaevel Rst~n~s 8r9~r~~ ~er~erllt~~q~ Leta Tree~~~att~s, ~tfer Id ,~uf~f~dt tee ~4~~r~~rs by Tb 1a~4~r~rst Tr~me~~ea~lae~ R~$m ° ~~1ar~ae T~ai7a~e?~~ ~i~.24~sv ry~~ Ca!ah Ae~~ltfi~a~ ~~. ~~~biP ~0 . ~Q $d . b~ ~~~~~~~ i~.24~v ~0. l?O ~~, ~~ l4PR Type Definitlan~; I~aIIY in4gre~t~R~t® Type: V= V.9d~bia R~Q~ {~t~ rn~y vaeyj ~Q ~ QO ~~ ~ $~ t' • I H x.1..4 I ~,._~ ~ rw_ T.____ ~~~~,~ ma cs ~~ ~ _ -,-- Red Star Rewards account-statement For the period ending May 4, 2010 • Days in billing cycle: 30 DALE A DAVENPORT Questions orlost/stolen card? Call Customer Service 1-866-593-2543 Account number: 41-474-677-220-0 Go to macys.com/mymacyscard to mans a and a Page:1 of 4 9 p yyouraccountonline. Summary of account activity Payment Info Previous Balance Payments Other credits/adjustments Purchases Fees charged Interest charged Total New Balance Past due amount Account Type summary New Balance Minimum Payment Due rmat~on -$2.00 Total New Balance $27.63 .~ $0.00 M~n~mum Pa ment Due $5.00 ~....~. $0.00 ~ - - Payment Due Date Jun 4, 2010. ~ - +$29.63 Late Payment Warning: If we do not receive your minimum payment •~..~. $0.00 by the date listed above, you may have to pay a Late Payment Fee of _ $0.00 515.00. ~.~~,. Minimum Payment Warning: If you make only the minimum .~..~.. $27.63 payment eac h period, you will pay more in interest and it will lake you longerto pay off your balance. For example: $0'~ Ifyou mate no You will pay offthe Md ou will additional durges balance shown on y '~~~ using this card and this Statement in end up paying ~.~... ead~ month you pay--• about._. an estimated total of... ~~" Only the minimum ""~ payment 9 months $44 If you are experiencing financial difficulty and would like information about credit counseling or debt management services, you may call 1-877-337-8187. m r-+ Rev= Total $27.63 $27.63 N $5.00 $5.00 N . m 0 0 4 R~',i-1513 E:~C+ ;11-Q3) ~ pennsy[vania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Dale A. Davenport SCHEpV~E J BENEFICIARIES NUMBER FILE NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [Include outright spousal distribu ' 2010-0549 RELATIONSHIP TO DECEDENT Lions and transfers under ~0 Not List Trustee(s) AMOUNT OR SHARE 1. Sec. 9116 (a) (1.2),] Sherry ~, DaVenpprf OF ESTATE Wife 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOV I iI NON-TAXABLE DISTRIBUTIONS: EON LINES 15 THROUGH 18 OF REV-1500 COVE A• SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH R SHEET, AS APPROPRIATE. ~ • AN ELECTION TO TAX IS NOT TAKEN B• CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 TOTAL pF pgRT II -ENTER TOTAL NON-TAXABLE DIST RIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET, If more space is needed, insert additional sheets of the same siz ~ e. am r~ G w `~ ~ ~ 0. O P ~ k ~,~ ~, E yJ~6 `mom'" ~SQ311Nn r }~. Jj ~_ 1 `' ~ ~ .~ ~.,, ~~ R y... ~~ Z~ Q J W W F- O V O Q J O ~ ~ an W ti ~ W ~ `~ ~ a n W ~ ~" a~ Q ~ ~ N y ~d M ~ ~ ~ Q C7 U ~ ~ o a~ ~~ ~ U ~1--d ~ ~ o a U ~ o ~ U ~ ~ ~ o U 0 U ~ ~ ~ M ~ M a~ ~ .---~ ~ ~ ~ a U ~ :~ O U