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08-31-11 (2)
15056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes Po sox 26oso1 INHERITANCE TAX RETURN NT /~ ~ ~z ~ L !~ ~ ~ G~ Hanisburg, PA 17128-0601 RESIDENT DECEDE ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 177-24-8396 12/03/2010 10/09/1930 Decedent's Last Name Suffix Decedent's First Name MI Gaul Doris H (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED MF DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return 2. Supplemental Return 3. Remainder Retum (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Retum 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 Number Robert A. Quigley (717) 774-4002 - .., n _._, Firm Name (If Applicable) ~ -- -~ REGISTER OF~Plltsl~ USE ONLY- T~ ~-t QUIGLEY LAW OFFICE, P.C -~° " `' L {"7 t First line of address -% ~ ~ ~ j ,~ --_ 1553 Bridge Street - ~ ~ " ;- c'~ _ Second line of address ~ "' ` I A ~' ` '3 ~~ City or Post Office State ZIP Code DATE FILED _~ New Cumberland PA 17070 Correspondent's a-mail address: 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. Declar n of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGryEITI:IR PE ON R SI E FOR ING RETURN ~ /~ ~~~~ DATE ~ ,"! - - - '[ 1 ADDR S 31 Kirkby T ~ , air NY 14 0-4106 and 393 Lincoln Way . C_h_a_m__bersburg, P_A_ 1720.2-1_930 SIGNAT~J$j; P O TI~i~RE ATIV DATE r~- ~- ~ __ - ~~~ 1= ADDRf=SS ~f ~ ~ .. - - - ORIGINAL FORM ONLY Side 1 15056051058 15056051058 15056052059 REV-1500 EX Decedent's Soaal Security Number DOri$ H Gaul 177-248396 Decedents Name: RECAPITULATION 1. Real estate(ScheduleA) ............................................. 1. 0.00 2. Stocks and Bonds (Sr3~edule B) .... . . . . . . . ............... . . . .......... 2. 258,647.39 3. Cbsely Held Corporation. Partrrership or Sole-Proprietorship (Schedule C) - - - - - 3. 0.00 4. Mortgages & Notes Receivable (Schedule D) .... - - - - • . . . . ................ 4. 0.00 5. Casty. Bank Deposits 8 Misoelleneais Personal Property (Sr~edule E) . • - - . - - - 5. 12,886.13 6. Jointly Owned Property (Schedule F) Separate Biting Requested .. - - - - - 6. 0.00 7. Inter-~lrvos Transfers & ~ Non-Probate Property (Schedule G) Separate BiAing Requested........ 7. 0.00 8. Total Gross Assets (total Lies 1-7) . . .................................. 8. 271,5$3.52 9. Funeral Expenses 8 Admirrstrative Costs (Schedule H) .......... . . . . . ...... 9. 13,314.06 10. Debts of Decedent, Mortgage Liabilifies, 8 Liens (Schedule I) ................ 10. 4,288.02 11. Total Deductions (total Lines 9 & 10) ................................... 11. 17,602.08 12. Net Value of Estate (Line 8 rrrnus Line 11) .............................. 12. 253,931.44 13. Charitable and Govem-nental BequeslslSec 9113 Tnu1s for which an election to tax has not been made (Sdredule J) ........... . . . . . . . ...... 13. 1,756.55 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. 252,174.89 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (ax1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate x .0 45 252,174.89 16. 11,347.87 17. Amount of Line 14 taxable at soling rate X .12 17. 18. Amount of Line 14 taxable at coNateralrate X .15 18. 19. TAX DUE ......................................................... 19. 11,347.87 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Fpe NwnDer Decedent's Complete Address: oECEOENTS NAME oECEnarrls socuu. sECx~Rm rrrtMaER Doris H Gaul 177-24-8396 sTREETAODRESs 1418 Carlisle Road -- - -- - -- ------- - - r STATE ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 11,347.87 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 9,000.00 C. Discount 567.39 Total Credits (A + B + C) (2) 9,567.39 3. Interest/Penalty if applicable - D. Interest ___ ___ __ E. Penalty - _-_- ____-- ----- Total Interest/Penalty (D + E) (3) 0.00 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) 1,780.48 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) Make Check Payable fo: 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 properly trar~sfa-red :......................................................................................•-- - ^ b. retain the right to designate who shah use the properly transferred or its income :........................................... . ^ G retain a reversionary or ...................................•-----................................................................................ . ^ d. receive the promise for fife ~ eiltrer payrrrerds, benefits or care? ..................................................................... . ^ 2. If death occurred after December 12,1982, did decedent transfer properly within one year of death without receiving adequate oor-sideratron? ............................................................................................................. . ^ 3. Did decedent own ~ n fn>,st fa" or payable upon deaM bank account or secrrity at his or her death?......-•---.. . ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which cordairs a beneficiary desg-ratan? .................................................................................................•----•--.............. . >r 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 the 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 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-1503 EX+ (6-98) scNEOU~ s cotuMONwEALTH of PENNSr~vANU1 STOCKS & BONDS INh~RITANCE TAX RETt1F~J RESIDENT DECEDENT ESTATE OF FILE NUMBER Doris H. Gaul 2010-01209 All property joiMty-owned with right of survivorship must be disclosed on Schedule f. ITEM VALUE AT DATE NUI~ER DESCRIPTION OF DEATH ~. M8~T Bank 23536268 (transferred into an Estate Account) 9,000.86 2. Savings Bond 0106436546 EE - t)ertorrlinatan 5100 18920 3. Travelers Stock Account 3100875134 -224 shares/ 54.86 per share 12,288.64 4. Travelers Stock Account 3100875135 -100 stlaresl54.86 per share 5,486.00 5. Wells Fargo Advantage llhTdy and T Fund Arx~ount 667-1009377020 6,76628 6. Pioneer Investments - 24-700534383 103,188.91 7. Pioneer Investments -Account #9200325336 (IRA) 103,217.00 8. Pioneer Investments - Aaount # 11-70053483 13,140.12 9. Pioneer Investrnenis - Arxalnt #77-70053483 3,059.37 10. Pioneer Investments - 7-70053483 2,311.01 TOTAL (Also enter on ine 2, Recapitulation) I t 258,647.39 (If more space is needed, insert additional sheets of the same size) Q M~~' ~3~:r~ L~ilderstanding what's impor~u~ Highland Park Office If you have any questions, please call our Telephone Banking Center at 1-800-724-2440 Today's Date: 12/10/2010 Time: 01:03 PM Checking Deposit ~**~9132 Total Balance: Available Balance: Business Date: 12/10/2010 $9,000.86 $9,000.86 $0.00 6113 /04 51 Thanks for visiting us today. We are happy to assist you! Calculate the Value of Your Paper Savings Bond(s) ~rectz. Home > Individual > Tools > Calculate the Value of Your Paper Savings Bond(s) Calculate the Value of Your Paper Savings Bond(s) SAVINGS BOND CALCULATOR Value as of: ~~~~ ~ j UPDATE `~'Ir Series: Denomination: Bond Serial Number: Issue Date: EE Bonds 100 CALCULAT~ f HOW TO SAVE YOUR INVENTORY CalcuNator Results for Redemption Date 01/2011 i Instructions _-- -_,-- Hqw to Ilse the Savl:gs Bond ~! C_alculator Notes Descriptiz+n NI Not Issued NE Not eligible for payment PS Includes 3 month interest penalty MA Matured and not earning interest Page 1 of 1 Total Price Total Value $50.00 $189.20 Total Interest $139.20 YTD Interest $0.00 l3onds: 1-1 of 1 Serial # Series Denom Issue Next Final Issue Interest Interest Value Note Date Accrual Maturity Price Rate 0106436546EE EE $100 11/1985 05/2011 11/2015 $50.00 $139.20 4.00 % ;159.20 REmovE ~ C.=~.LCULF,TE ANG~HcR Bt~t~C ~ Survey - - ------- How would you rate th Excellent Good _' Fair I'-' Poor ~ SUBMIT F~-eedum of irifixmation Act I law Za Guidance ~ Pn racy. t~_L eyal. Notice ~ tdeb_sltr fE-~ris f4 nor cations I Ai yes>,_U ut~ ~U~t@_C~alit}~ J,S Uepar_t_i7_ert ~f thg. Tre~_sur ~_Bureau of the Public Cebr. http://www.treasurydirect.gov/BC/SB CPrice 1 / 16/2011 August 9, 2011 Rob A. Quigley Quigley Law Office 1553 Bridge Street New Cumberland, PA 17070 Dear Rob: Attached are the two Financial Confirmation letters from Shareowner Services for the two Travelers stock accounts in my mother's name. I was informed by Shareowner Services that, as more than 60 days have passed since my mother's death, I would have to resubmit proof of my status as executor of her estate in order to receive the date of death values for her Travelers stock in writing. Rather than do this, I chose to request the values over the phone. They are documented below. Note that, since Mom was receiving her dividends each quarter as a check, the number of shares in the attached letters is the same as those she owned on 12/03/2010. Account number 3100875134 224 shares $54.86 per share Account number 3100875135 100 shares $54.86 per share Sincere regards, ... / 1 1 r~~ ~~~~~ `- ~~ti~ Mark R. Gaul 31 Kirkby Trail Fairport, NY 14450 585-781-4379 cell mark.gaul@rit.edu Enclosures Shareowner Services February 19, 2011 Mark Gaul 31 Kirkby Trail Fairport NY 14450 Regarding: Financial Confirmation Dear Mark Gaul, Account Number: 3100875134 Registration: DORIS H GAUL & CHARLES R GAUL JR TEN ENT Creation Date: 12/15/1998 Issue Name of Stock: The Travelers Companies, Inc. Total Share Balance on 02/18/2011: 224.00 Certificate Shares: 224.00 DRS/Book Entry Shares: 0 Dividend Reinvestment Plan Shares: 0 Dividend Amount Paid YTD: $ 0 PO Box 64874 St. Paul, Minnesota 55164-0874 www.wellsfargo.com/shareownerservices Request Number: 8817443 ID Number: FAX WFType: CO Dividend Rate: .36 Closing Price per Share on 02/18/2011: $ 60.92 Ticker Symbol for the Company is: TRV It is exchanged or traded on: NYSE Please note that as a transfer agent, we are not directly connected to the stock market. The above price is given as an estimate and is not a guarantee of a specific price. If you have any questions, please call our Shareowner Relations Department at 1-888-326-5102. Sincerely, Shareholder Communications Enclosures: Shareowner Services PO Box 64874 St. Paul, Minnesota 55164-0874 www.wellsfargo.com/shareownerservices February 19, 2011 Mark Gaul 31 Kirkby Trail Fairport NY 14450 Regarding: Financial Confirmation Dear Mark Gaul, Request Number: 8817443 ID Number: FAX WFType: CO Account Number: 3100875135 Registration: DORIS H GAUL & CHARLES R GAUL JR JT TEN Creation Date: 12/15/1998 Issue Name of Stock: The Travelers Companies, Inc Total Share Balance on 02/18/2011: 100.00 Certificate Shares: 100.00 DRS/Book Entry Shares: 0 Dividend Reinvestment Plan Shares: 0 Dividend Amount Paid YTD: $ 0 Dividend Rate: .36 Closing Price per Share on 02/18/2011: $ 60.92 Ticker Symbol for the Company is: TRV It is exchanged or traded on: NYSE Please note that as a transfer agent, we are not directly connected to the stock market. The above If you have any questions, please call our Shareowner Relations Department at 1-888-326-5102. Sincerely, Shareholder Communications Enclosures: ~, ~~y,~ ® , ;: , ~~ . ~~ P.O. sox 8>.c6 acs+c., Cv1assachus~its OZZ66 v:n:~~w.~~ue~!siaryacom/advaneaq~furds August 5, 2011 Mark R. Gaul 31 Kirkby Trl Fairport, NY 14450-4106 Reference: 01424014 Dear Mr. Gaul: Thank you for requesting adate-of--death account value for a Wells Fargo Advantage Funds° account. Doris H. Gaul held an individually registered Wells Fargo Advantage Utility and Telecommunications Fund account #667-1009377020. The account value is provided in the following table as of the date that she passed away, December 3, 2010: Share Balance Share Price Account Value 569.073 $11.89 $6,766.28 Information in this letter is historical and may not reflect the current balance in the account. Please refer to statements for actual holdings and detailed information. Investment values may fluctuate. If you have any questions or require further assistance, please call us at 1-800-222-8222. Representatives are always available to assist you. Sincerely, l~ Abigail Becker Client Service Consultant Wells Fargo Funds Management, LLC, a wholly owned subsidiary of Wells Fargo & Company, provides investment advisory and administrative services for Wells Fargo Advantage Funds®. Other aff liates of Wells Fargo & Company provide subadvisory and other services for the Funds. The Funds are distributed by Wells Fargo Funds Distributor, LLC, Member FINRA/SIPC, an affiliate of Wells Fczrgo & Company. ®PIONEER I~lvestlY~e~~ts August 4, 201 1 Mark Gaul 31 Kirkby Trl Fairport NY 14450-4106 REFERENCE: CORRO# 00412701 Fund# 2 Account# 9200325336 PIlVI IRA Cust For Doris H Gaul Fund# 7, 11, 24, 77 Account# 70053483 Doris H Gaul Dear Mr. Gaul: I am writing in response to your recent telephone inquiry concerning the above referenced accounts: We appreciate the opportunity to be of service to you. The values of the accounts on December 3, 2010, were: • Account 2-9200325336: $103,217.00 (9,282.104 shares @ $11.12 per share). • Account 7-70053483: $2,311.01 (117.549 shares @ $19.66 per share). .--• Account 11-70053483: $13,140.12 (528.140 shares @ $24.88 per share). • Account 24-70053483: $103,188.91 (10,267.553 shares @ $10.05 per share). ~' Account 77-70053483: $3,059.37 (3,059.370 shares @ $1.00 per share). This information maybe needed for tax reporting purposes and does not necessarily reflect the values of the accounts upon redemption or transfer. Shares are redeemed/transferred at the net asset value in effect at the time the request is received in good order. If you have any questions, please contact our Retirement Plans Department at 1-800-622-0176, 8:00 a.m. to 7:00 p.m. Eastern Standard Time, Monday through Friday. Sinc ely, Jesse pencer Shareholder Corresporiderit Pioneer Investment Management General Inquiry Shareholder Services, Inc. 800-225-6292 P.O. Box 55014 Retirement Plans Boston. MA 02205-5014 800-622-0176 Member ofthe UniCredit Banking Group, Register of Banking Groups. REV-1508 EX+ (6-98) SCHEDVLE E COMMONWEALTH OF PENNSYLVANIA CASI'I, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUN~ER Doris H. Gaul 2110-01209 Inckide the proceeds of IAigation and the dale the pr~eeds +xere rewi,~e~± ~~ ~,Q estate. All property joiMtyowned with right of survivorship must be disclosed on Schedule F ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Mrs. Gaul rented her home had few personal property items that were of any value. 4,288.07 2 2004 -Dodge Stratus -Sedan 4D SE 4,475.00 3 Highmark Healthcare Premium Refund 12/30/10 31.74 4 Long Term Care Insurance Refund 03101!11 962.70 5 Metlife Auto -Deductible Reimbursement 04!16/11 250.00 6 Metlife Auto 8~ Home Renters Refund 04122/11 32.00 7 Metlife Collision Payment -deductible waived 12130110 2,495.62 8 Metlife Auto 8~ Home Insurance Refund 04/11/11 30.00 9 Federal Tax Retum Refund 05!27 321.00 TOTAL (Also enter on line 5, Recapitulation) S I 12,886.13 pf more space is needed, insert adddanal sheets of the same size) 00 H ~ n ~o C ~ ~ ~ 3 ~ o ~ ~ o 1 H a m ~ ~ ~ 0 ~ c) Gl ~ nNi oNi uri ~ cn (~ O aooo -v nn --~ ~ ~ • n N .~ ~ O Q (p .. fA O- ~ 7r V/ of Vf to fA N ~ ~ n n 00 lD ~ 7C (<D -t ~ lD ~• 7r G h N ~ fD ~ n 0 ~ N = ~ N r+ t ~ (D fD y N (D C p~j vNi cNi~ ~ 7 7 ?~ lD lD ~ ~ dq D7 < ~ O A ~ ~ ~ 7 ` ~ ~ ~ O ~ O ~ rr ~ ~ ~ N ~ 04 N ~ N ~ (D ~ ~ n '-h ~ 'C a = O ^• N ~ W m ~ m ~ ~ Q 3 ~ ~- fD ~ < m ~' ~ N ~ c 7 i1. ~ < f7 ~ N -s N ~ _ C ~ _ ~ 7 UU (D ~ W N ~ N O ~ v ~' N ~ N F ~ 1--~ I--+ 00 I-~ I--~ F-~ i-~ 1-~ I-~ 1~ F-~ I-~ ~ ~ 00 00 M~ {--~ F-~ N i-~ lJ7 F-' ~P O O I~ F-' W --~ F~ F-~ W .A O O N 1-~ Ql .A N N W pmj ~ Ul O V 00 lD Cl7 lD Ul V l0 lD Q1 ~ 01 l0 Ul N lD CD Ul 00 V V lO N N .P W In F-~ V 00 n = O V V O O N fD Ul F-+ ~ ~P O I~ N W F ~ F~ I--' W ~ 00 N V F-~ ~ ~ N .A W ~ ~ < ~ ~ ~ ~ O O V 00 t0 U'1 l0 U1 V l0 l~ d1 l0 O) tD In N l0 l0 111 V O l!1 ~' V ~ ~ ,A Ol ~ O O i--~ fD _v, H 0 N o' ~ ~ fD o ~ 3 o ~ ~ o ~ 3 , 0 3 ~ °' m .'^+ cn oo cn cn to cn p p ~ m 'v r ~ cn cn -I N N - f~ p O p 7 'v cn cn n Z ~ ~ w A A ~ ~ : ~ ms s ~ ~ ~ rn v v o a, ~- ~ c m ~ o m ~ ai ~ co - = 3 n: m ~ v o ~ c - ,rt o o ~ m m ~ r* ~; ~ ~ o o ~ r m o '^ m o v m ~ a: = x m m . ~ N rt ~, N ~, N ~ ~ ~ ~ N ~ '+ ~ N ± lD N ~ r-h r+ ~ 3 3 fl- ~ - n ~ h m s N ~ ~o fD fD ~ V1 i ~n ~ fD ~• y ~ O v N 7 N ~ O '?. 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O 3 .-+ O C r-r Dodge Stratus 2004 -Car Standard Equipment - NADAguides.com Official Site Page 1 of 3 N,ADA GUIDES The Power of Vehicle Information NADAguides.com ® Close Window 2004 Dodge Stratus 1/15/2011 Sedan 4D SE NADAguides.com Price Report - - - Rough ~ Average Clean Clean Trade-In ~ Trade-In Trade-In Retail Base Price $2,000 $2,775 $3,400 $5,375 Mileage: 33,000 miles $1,700 $1,700 $1,700 $1,700 Options: TOTAL PRICE ~3~700 $4,475 5,100 $7,075 Standard Equipment Standard Equipment Details Engine Specifications Type: Gas 4-Cyl Size: 2.4L/146 Horsepower: 150 @ 5500 RPM Torque: 160 @ 4200 RPM Drive Train Drive Train: Front Wheel Drive Transmission: 4 speed Automatic Safety Air Bag-Driver-Front Air Bag-Passenger-Front Air Bag-Side-Body-Front Air Bag-Side-Head-Front Air Bag-Side-Head-Rear Alarm System Brakes-ABS-4 Wheel Brakes-Type-4 Wheel DISC Brakes-Type-Front Disc/Rear Drum Engine Immobilizer/Vehicle Anti-Theft System Headlights-Daytime Running lights Locks-Child Safety Rear Door Traction Control Comfort & Convenience Air Cond-Front Cruise Control Keyless Entry Locks-Pwr Mirrors-Pwr Driver Mirrors-Pwr Passenger Mirrors-Vanity-Driver Mirrors-Vanity-Driver Illuminated Mirrors-Vanity-Passenger Mirrors-Vanity-Passenger Illuminated Reading Lamps-Front Seat Trim-Cloth http://www. nadaguides. com/cars/2004/dodge/stratus-4-cyl/sedan-4d-se/standard-equipmen... 1 / 15/2011 Dodge Stratus 2004 -Car Standard Equipment - NADAguides.com Official Site Page 2 of 3 Seat-Pwr-Driver Seat-Rear Pass-Through Seats-Front Bucket Steering Wheel-Adjustable Steering-Pwr Trip Computer Tru n k-Release-Remote Windows-Pwr Music & Entertainment Audio-AM/FM Stereo Audio-Cassette Player Audio-CD Player Interior Auxiliary Pwr Outlet Floor Mats-Front Floor Mats-Rear Exterior Defogger-Rear Window Roof-Generic-Sun/Moon Roof-Sun-Pwr Tilt/Sliding Wipers-Intermittent Wipers-Variable Speed Intermittent Tires Front Tire Size: P205/65TR15 Rear Tire Size: P205/65TR15 Wheels Front Wheel Material: Steel Rear Wheel Material: Steel Back to too Rough Trade-In: $3,700 Rough Trade-in values reflect a vehicle in rough condition. Meaning a vehicle with significant mechanical defects requiring repairs in order to restore reasonable running condition. Paint, body and wheel surfaces have considerable damage to their finish, which may include dull or faded (oxidized) paint, small to medium size dents, frame damage, rust or obvious signs of previous repairs. Interior reflects above average wear with inoperable equipment, damaged or missing trim and heavily soiled /permanent imperfections on the headliner, carpet, and upholstery. Vehicle may have a branded title and un-true mileage. Vehicle will need substantial reconditioning and repair to be made ready for resale. Some existing issues may be difficult to restore. Because individual vehicle condition varies greatly, users of NADAguides.com may need to make independent adjustments for actual vehicle condition. Average Trade-In: $4,475 The Average Trade-In values on nadaguides.com are meant to reflect a vehicle in average condition. A vehicle that is mechanically sound but may require some repairs/servicing to pass all necessary inspections; Paint, body and wheel surfaces have moderate imperfections and an average finish and shine which can be improved with restorative repair; Interior reflects some soiling and wear in relation to vehicle age, with all equipment operable or requiring minimal effort to make operable; Clean title history; Vehicle will need a fair degree of reconditioning to be made ready for resale. Because individual vehicle condition varies greatly, users of nadaguides.com may need to make independent adjustments for actual vehicle condition. Clean Trade-In: $5,100 Clean Trade-In values reflect a vehicle in clean condition. This means a vehicle with no mechanical defects and passes all necessary inspections with ease. Paint, body and wheels have minor surface scratching with a high gloss finish and shine. Interior reflects minimal soiling and wear with all equipment in complete working order. Vehicle has a clean title history. Vehicle will need minimal reconditioning to be made ready for resale. Because individual vehicle condition varies greatly, users of NADAguides.com may need to make independent adjustments for actual vehicle condition. Clean Retail: $7,075 Clean Retail values reflect a vehicle in clean condition. This means a vehicle with no mechanical defects and passes all necessary inspections with ease. Paint, body and wheels have minor surface scratching with a high gloss finish and shine. Interior reflects minimal soiling and wear with all equipment in complete working order. Vehicle has a clean title history. Because individual vehicle condition varies greatly, users of NADAguides.com may need to make independent adjustments for actual vehicle condition. Note: Vehicles with low mileage that are in exceptionally good condition and/or include a manufacturer certification can be worth a significantly higher value than the Clean Retail price shown. http://www.nadaguides.com/cars/2004/dodge/stratus-4-cyl/sedan-4d-se/standard-equipmen... 1 / 15/2011 ~MNZK. Date: 12/14/2010 This Month Gross payment amount 31.74 Net payment amount 31.74 ~~ ~ at ~ ~N-~P ~ ~ l ^~ X331 b53 ' WASHINGTON NATIONAL INSURANCE COMPANY P.O. Boz 64739 St. Paul, MN 55964 Telephone:9-877-452-5824 March 1, 2011 Wa~nington na[ionai• ESTATE OF DORIS GAUL C/O MARK GAUL 31 KIRKBY TRAIL ROCHESTER NY 14450 Policy Number: PL1241109A Insured: DORIS H GAUL Dear Estate of DORIS GAUL: Please accept our condolences for your recent loss. A refund check in the amount of $962 70 is enclosed as ovemayment for DORIS H GAUL's long-term care olio Should you have any questions please contact Customer Service at 877-452-5824, Monday through Friday, 8:00 a.m. to 6:00 p.m. Eastern Standard Time. Sincerely, Washington National Insurance Company Customer Service Enclosure(s) O C ~ 7 N O p t Q i!Y d tt O O O 'y O .-1 O O C N C ~ ~ ~ CO O a N ~ N _ ~ ~ Z O Y U N a„I L U ~ 0 N 01 C ~Y 7 O Q N 7 Z v s u 7 --i . ~ ~ 7' U1 O O O O O .--~ ~ .--i ~ O ~ ~ M ~ N N O J Q U C Ur ~ a i + .fl ~ o z ~ w N Q U ~ W j U ¢ .~ ~ ~ ~ ° w M IO n N l0 V} C O tR- c N lC Q1 J Understanding what's importarn~ Perinton Office If you have any questions, please call our Telephone Banking Center at 1-800-724-2440 Today's Date: Business Date: 12/30/2010 12/30/2010 Time: 10:40 AM Checking Deposit $31.74 ~**~9132 0186 / 10 27 Thanks for visiting us today. We are happy to assist you! N CO ..~ 0.1 L RI ++ OJ C d U ., m O r ~ .- O ~ O ~ N O \ O O M . ~.C7 07 ~Y ~ O Y d' a--~ ~ N • m O w' N ~ N ~ T C ~ Z O UJ U ?.~ C O. W g ~ O ~ ~ d O Ql ~ >~++ ~ L ~ O O r~--i U N t~'00 D ~ N\ FO- N ~ O 1--- Q D ~~ U ~ pn~s~ Understanding what's important Perinton Office If you have any questions, please call our Telephone Banking Center at 1-800-724-2440 Today's Date: Business Date: 03/12/2011 03/14/2011 Time: 11:57 AM Checking Deposit $962.?0 ~~ *~**9132 0186 / 10 49 Thanks for visiting us today. We are happy to assist you! 00 N ~ ~ O O O +~ >. fn ~--~ 3 ~ . ~ ~ tp O • O O ~"' • > 7~ \. Q CD L ~ ~ ~ O O N ~ ~ ~ E 3 0068 PO BOX 410200 CHARLOTTE NC 28241 0068 WFE305420 ESTATE OF DORIS H GAUL 31 KIRKBY TRAIL FAIRPORT, NY 14450 MetLife Auto & Home MetLife Auto & Home is a brand of Metropolitan Property and Casualty Insurance Company and its Affiliates, Warwick, RI INSURED: DORIS H H GAUL CLAIMANT: DORIS H H GAUL CHECK NUMBER : 003496110 CHECK AMOUNT: $2,495.62 Two thousand four hundred ninety five and 62/100 Dollars COLLISION PAYMENT FOR LOSS OF 12-03-10 DEDUCTIBLE WAIVED Our number one goal is to ensure that you are COMPLETELY SATISFIED with your claim experience. If you have any questions or concerns about your claim, please call us at 1-800-854-6011 and we would be happy to assist you. We realize that you have a choice when selecting an insurance company and we thank you for choosing MetLife Auto & Home. Access your MetLife Auto & Home policy, billing, and claim information online at www.eservice.metlife.com XS BP 0944895 MetLife Auto & Home° DORIS H H GAUL 1418 CARLISLE RD CAMPHILL, PA 17011 CANCELLATION INSUREDS REQUEST MetLife Auto & Home is a brand of Metropolitan Property and Casualty Insurance Company and its Affiliates, Warwick, RI Undersruuiv~g what~s impor~u~ Perinton Office If you have any questions, please call our Telephone Banking Center at 1-800-724-2440 Today's Date: Business Date: 04/09/2011 04/11/2011 Time: 10:18 AM Checking Deposit $30.00 ****9132 1(~vw.c ~G~ , 0186 /02 68 DETACH STUB BEFORE CASHING Q ~~~ t7nd~ersranding what importar~ ton Office If you have any questions, please call our Telephone Banking Center at 1-800-724-2440 T^~'°~~'s Date: Business Date; /2011 04/22/2011 ~'~`'. Checking Deposit $32.00 ***~",~, ~,~ -~ o ~~°~ ~~sc~ ~~ 0186 /07 35 Thanks for visiting us today. We are happy to assist you! L n fd ~ .~ ~ ~ p. U n ~ fn _~ O ~ ~ N ~ r ~ N m N ~ O O ~ N ~ ~ T~ OHO ~O N T! .~ N SU ~ ~ O F~ ~ ~ ~ r 70+.- L d H U ~~s~,x Lhiciers~~ cvhat~ important Perinton Office If you have any questions, please call our Telephone Banking Center at 1-800-724-2440 Today's Date: Business Date: 04/16/2011 04/18/2011 Time: 10:06 AM ~~ Checking Deposit $250.00 ****9132 .~ .~ ~~' 0186 /O7 35 Thanks for visiting us today. We are happy to assist you! 0 0 p) N b ~ (~ ~ Q O fn \ d. a ~ ~ C ~ ~ O O ~--~ 7. ~ O `, m 1~ ~ N .N tp ~ O Q ~'' 1 '~ -~--+ O ~ O .~ ~' CO D. ` d +' N N (.O O tn0 td ~ O O OO 4- ~ O p ~N ~ ~ N O r7 ~ ~ O Y >~ _ ~ ~ ~ ~ U O ~ ~ ~ t ~ ~ ~ ~ 3 1-O-- O F- U iE MetLife Auto & Home` Subrogation -Warwick Mail Processing Center PO Box 1503 Latham, NY 12110-103 800-63~-9740 04/08/2011 Doris Gaul 1418 Carlisle Rd Camphill, PA 17011 Our Customer: Our Claim Number Date of Accident: Responsible Party: Dear Doris Gaul: Doris Gaul WFE30542 12/03/2010 Margaret Marche MetLife ~~, ~'~ 1. (, (~ t(, Enclosed please find your deductible reimbursement $250.00. I would like to take this opportunity to thank you for insuring with us and hope that your claim was handled to your satisfaction. We appreciate your patience and cooperation during the claim process. Sincerely, CCS Metropolitan Group Property and Casualty Insurance Company Collection Agency Ext: 6038 Fax: 866-314-9382 THE COMMONWEALTH OF PENNSYLVANIA REQUIRES US TO NOTIFY YOU OF THE FOLLOWING: "Any person who knowingly and with intent to defraud any insurance company or other person tiles an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, infornation concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties." MetLife Auto & Home is a brai~tl of Metropolitan Propernj and Casualty Insurance Company and its Affiliates, Warwick, RI 0001 PO BOX 1503 LATHAM NY 12110 0001 WFE305420 DORIS H H GAUL 1418 CARLISLE RD CAMPHILL, PA 17011 MetLife Auto & Home MetLife Auto & Home is a brand of Metropolitan Property and Casualty Insurance Company and its Affiliates, Warwick, RI INSURED: DORIS H H GAUL CLAIMANT: DORIS H H GAUL CHECK NUMBER: 003808119 CHECK AMOUNT: $250.00 Two hundred fifty and 00/100 Dollars AFTER COLLECTION, THIS IS YOUR SHARE OF YOUR DEDUCTIBLE FOR LOSS OF 12-03-10 Our number one goal is to ensure that you are COMPLETELY SATISFIED with your claim experience. If you have any questions or concerns about your claim, please call us at 1-800-854-6011 and we would be happy to assist you. We realize that you have a choice when selecting an insurance company and we thank you for choosing MetLife Auto & Home. Access your MetLife Auto & Home policy, billing, and claim information online at www.eservice.metlife.com Al Y2 BU 1024683 J REV-1737-6 EX + (6-08) REVERSE Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN NONRESIDENT DECEDENT SCNEpULE N FUNERAL EXPENSES +c Use Schedule H ONLY for proportionate method of tax computation. ApMINISTRATIVE COSTS ESTATE OF FILE NUMBER Doris H. Gaul 2010-01209 Debts of decedent must be reported on Schedule 1. fTEM Nll~ DESCRIPTION AMOUNT A. FUNERAL EXPENSES: f ~ Guss Funeral Home 8,246.7' 2. Organist -Carol Houck 80.OU 3. Pastor Arthur Grake -Conduct Funeral Service 150.00 4. Geratd Seiler - Sobist for Funeral Service 80.00 B. ADMINISTRATNE COSTS: 1. Personal Representative's Commission(s) Name(s) of Persorgl RBpreser~Yve(s) Mark R. Gaul L and Timothy N. Gaul (Submit requested information for additional personal representative's on additional sheets) Social Searityy Number(s) ar EIN Number(s) of Personal Representative(s) 166-46-4388 162-48-1096 ~) 31 Kirkby Trail ~;~) Fairport s~1s) NY ZIP(s) 14450 Year(s) Carnmission Paid 2011 2~ Attorney Fees 3• Probate Foes 4. Accountant's Fees 5. Tax Return Preparer's Fees 6. t~scelarreors Experres Escrow -Accounting Fee for Final Fiduciary Income Tax Return Mark Gaul -Postage, Boxes, Faxing, Copies and Mail Tax Return Mark Gaul -Check Register Car Quest Auto Parts -Battery replacement for vehicle PPL Electric Utilities -final bill 3,aoo.oo 393.50 745.OG 300.00 95.12 12-89 88.00 122.83 TOTAL (Also enter on Line 9 Recapitulation) I s 13,314.06 (If more space is needed, use additional sheets of paper of the same size) Guss Funeral Home 20 South Third Street Mifflintown, PA 17059 Karl E. Guss, Funeral Director Barbara Guss Partner, Funeral Director (717) 436-2149 Funeral Expenses for Doris H. Gaul Date of death: December 3, 2010 Professional Services, Use of Facilities, and Equipment $4,452.50 20 Gauge Spartan Bronze Metal Casket Monarch Concrete Vault 1,810.00 1,125.00 Cash Advance Items: Lewistown Sentinel Obituary Harrisburg Patriot Obituary 10 Certified Death Certificates Cemetery Charges: Grave opening Headstone engraving (in the spring) 120.00 229.22 60.00 350.00 100.00 Total amount due Guss Funeral Home 8, 246.72 f~ ci.`~ //~/~ ~ GC,a~t,1L ~ / psi This statement is net and payable in full on or before January 9, 2011. A late charge of 1.50% per month (18.00% annum) will be added to the unpaid balance. The friendship and good will you have accorded us is worthy of our most heartfelt thanks. We appreciate the confidence you have placed in us and will continue to assist you in every way we can. We sincerely hope that our service has been in every way satisfactory and comforting to you. Most Respectfully, Barbara Guss Partner Page 1 of 1 t ~~ ~ '~ 1 ~ ~ ' F~t4 b thG ~~dCr ~ „ .~ 1 ~. ~- i ~ 1~1M&Td3 60-295/913 1)af~ G $~. ~ 1}ol}orb ~ ~ .. 95 i ~~ I mcn~o~%fl~101iY,~~v~~ - r~ r .. x:03 i30 2955~:J~'~~'9854009 i3 2ii'00 ~~~ >031301846< Metro Bank Hub #01 2010-12-27 019316329 ~- -..n 39 10:13 12/27/2010 626769$97 TIrFnCkCash $80.00 S#ore: 114 Telle~:6629 Till: 1403 Posting Date 2010 Dec 27 Research Seq # 8100653972 Account # 9854009132 Check/Store # 0 DB/CR DB Dollar Amount $80.00 Bank # 096 Branch # 06113 Deposit Acct # 0 Record Type # O1 :..~ S ~. ~. c al ~i ,' http://afresh/inquiry/servlet/inquiry 8/22/2011 Page 1 of 1 `~ . - 60-~55/Jt3 96 • ~ ~ ~~~ g~~at~or irar- /~1M8zTBantc ~~l ~ /Sv. ~ +:D 3 1 30 2 9 5 5+: 98 S 400 9 13 2~i'00 4 ,'00000 L SDOO,~' - __ _ ~ ..' METRO Bl-3NK >03i30i3a6 ~ - = NARR LSBURG PPj - " ~ - .22449058 02-i6-11 1035 i035 02 _ ~ - : - -•'~ - _ _ - _~_ _ _ _ r Posting Date 2011 Feb 17 Research Seq # 8007272490 Account # 9854009132 Check/Store # 96 DB/CR DB Dollar Amount $150.00 Bank # 096 Branch # 06113 Deposit Acct # 0 Record Type # O1 http://afresh/inquiry/servlet/inquiry 8/22/2011 Page 1 of 1 f ~ 60-295/313 (~ 'T ~~ ~:: ~~~ ~- ~ nay C[Yt~.KC~ ~~~y-~i- ~ I ~ ~` . F ~ { t :w 333• 1~1M&T ank ~ -~ ~~---: _ . - M ~J ~ ,, f~ ~~:03L30 2955: 98 54009 1 3 2u'0097 - __ _. -- ~~ ~ - _ - -- ~, _ . ~. _= 9 _ - ~ f ` _ ;f ~ ~; - ~ ~: K ,_ .t b ._ U _ ~ ~ C - -- ' - = C r - - _ - _ - _ _ = _ - _ - - - ... ~; - - ~ ~~ - 3 _ - ~. . ~ - _ n- i } h J _. 2 ,., ti c J ~ J .,~ ~~ ni l r . __ .? Z ~ '~i ~~ r t m 9 Posting Date 2010 Dec 20 Research Seq # 5900789219 Account # 9854009132 Check/Store # 97 DB/CR DB Dollar Amount $80.00 Bank # 096 Branch # 06113 Deposit Acct # 1016121009 Record Type # O1 m z .A m m http://afresh/inquiry/servlet/inquiry 8/22/2011 REC~TPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Sqquare Carizsle, PA 17ff13 GAUL DORIS H Estate Fi7.e No.: 2010-01209 Paid By Remarks: MARK R GAUL SAP Receipt Distribution * DUPLICATE '* Receipt Date: 7.2/10 2010 Receipt Time: 10: 7:03 Receipt No.: x.063632 Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 310.00 CUMBERLAND COUNTY GENERAL FU WILL 15.00 CUMBERLAND COUNTY GENERAL FU SHORT CERTIFICATE 40.00 CUMBERLAND COUNTY GENERAL FU JCS FEE 23.50 BUREAU OF RECEIPTS & CNTR M AUTOMATTON FEE 5.00 CUMBERLAND COCJNTY GENERAL . FU Cash --- -----393.50-- Total Received......... 393.50 Date: April 15, 2011 DENK & ASSOCIATES, PC CeYtified Public Accountants 4755 Linglestown Road, Suite 207 Harrisburg, Pennsylvania 17112 (717) 652-495> Estate of Doris H. Gaul 31 Kirkbv Trail Fairport, NY 14450 TO PROFESSIONAL SERVICES RENDERED: Final 1040 & Fiduciary Tax Return ......... $ 745.00 P~zd 4(LG~I~ tL~c~ tz3 YOUR PROMPT PAYME.'VT /S .APPREC'/ATED '4 n ~i ~~. ~~ '~I HENDON POST OFFICE HENDON, New York 145069998 3510280506-GU96 04%18/2011 (716)624!3441 11_37 23 AM-- - - Sales Receipt -- Product Sale Unit Final Descri~~ion Qty Price Price H~KRi~uuRG PA 17128 $0.64 Z or~a- 3 First-Class Letter 1.40 oz. Expected Delivery: Wed 04/20111$2 85 Certified Label #: 70091410000012227198 Issue PVI: $3'49 ;;aF;"?C6URG PA 17129 $0.64 Zone-3 First-Class Letter 1.20 oz. Expected Delivery: Wed 04/20/11$2 85 Certified Label #: 70091410000012227174 Issue PVI: $3.49 CINCINNATI OH 45999 $0.64 Zone-4 First-Class Letter 1.60 oz. Expected Delivery: Wed 04/20/11$2 85 L'ertified Label #: 70091410000012227204 Issue PVI: $3.49 KANSAS CITY MO 64999 $0.84 Zone-5 First-C1?ss Letter 2.10 oz. E,,~ected Delivery: Thu 04/21/11 Cer+ified $2.85 Label #: 70091410000012227181 Issue PVI: $3.69 Total: Paid by: Debit Card Account #: Approval #: 'T ~~....~n~inn ik~ $14.16 $14.16 XXXXXXXXXXXX7142 187962 ~~F _-- q~9 - - ~ t~ ~ ~ II u-+ a ~ ,.. .. ~- r, ~ - ~ ~i . .. ~! s9 Q J .. I I :'y 7 O ~ U '~ ~ ~ C.~ r ~ " x s '!' r v - ~ ~ m z .-, < 1 .[ z ~ <: m cn O ai r x `^ ~ 1 y :.~. x~ " d ^~ M 'r" ~ r Y cl; ..J -~ O cC ~~ r ~ 1 ~ 7- ~ ~' ~ ~ ~ ._ ~ ._ - w S Q ' O e~ 5 4 -~ C1 " - :L CD 1 O W~ C f ~~ .-' '~ C N . f .~ ~ O N .. ,... 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NO. sales N INTR. SHIP VIA TERMS . o. No. , .. 1 ,. ,. , f~I'tiEa t! ~ k.y .. 1~~ ,~ i ~ ~ , MFG. -PART NUMBER - ORDERED SHIPPED BKO LIST PRICE NET NET CORE EXT.AMOUNT 1 ~ . ~ - I:~.: ~~_ . • ~,_ T. ,:.. - , ~ . r. r. ,. 2 t . ' t.. - '. .. 3 ;.. . .... _ , e, ~. ., .. ,, , , , 4 5 6 7 8 9 10 11 z ,~~~~, ,~~z ~~,~ 14 FREIGHT LABOR SHOP TOTAL CORE TAXABLE AMT. SALES TAX SUB TOTAL 1: RECEIVED ? ~' BY ~ TOTAL ~ PAY THIS AMOUNT ' , ~ .. ~ 0 ~~t~ ~i ~' ia~~ r~ .:I .;! PL Electric Utilities Electric Service For: CIIARL,ES GAUL 1418 CARLISLE 1tD CAMP HILL PA 1701 I Quesfions about this bill? Please contact us by Mar 1 atl-800-342-5775 (1-800-DIAL-PPL) or write to: Customer Service 827 Hausman Rd_ Allentown, PA 18104-9392 www.pplelectric.com Electric Use This graph shows your electric use over the last 13 months. T3~pes of Meter Readings: Actual Adjusted Estimated Customer a ~` R I~ '.°'°'•.;~' Page 1 •y - • „ p p ~~® •'~~ ., Summary Page Balance as of Feb S, 2011 Char es: Tota~oininion Enemy Solutions Charges Total PPL Electric Utilities Charges Total Charges Account Balance 72 60 48 36 24 12 0 ~i~i~$>lt:~l~iii~~~ 42860 77016 »t Iaec.Q cslliii ~ ~~.~i~il;~a ::=; >: $0.00 85.79 37.04 $122.83 ~~~z~~~ ~~~~~~ KWH -Average Per Day F M A M J J A S O N D J F 2010 Months 2011 122. Meter Reading Information Meter #17220936 Feb 7 Actual 85112 Jan 7 Actual 84147 3l Da s KWH Billed 965 Average -Feb 2010 20Lt Temperature 30F 26F KWH Per Day 45 3 t Yearly Ilse: Total Averagge Use Monthly Mar 2009 -Feb 2010 14717 1226 Mar 2010 -Feb 2011 76635 1386 Other important information on back ------------------------- reading PPL Electric Utilities uses about $0.04 of this bill to ppay state taxes. Ia on or about addition, about $2.38 of this bill pays the PA Gross Keceipts Tax. Mar 9 For your convenience, you can now pay your bill using your Visa, MasterCard, Discover, or ATM Card. Call BillMatrix at 1-800-672-2413. BillMatrix will charge your credit and ATM card a service fee for making this payment. Before diggin around your home or property, you should always call the state's One Call notification system to locate any underground utility lines. You can do this by simpl dialing 811, which will connect you to the One Call system. Be safe andycal181I before 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 team more or sign up, visit www.pplelectric.com. Save postage and late charges - sign up for .Automated Bill Payment. v ~ ~.. Comparable ~~~ to Dome® Item #210 ~, a ~~. .` ,A , ~. ~_~~ ~~ ~ r oo.~ ~.... ,..... , .._~, , _ ,.,. ~~M~~~ ~IIP~~ OfficeMax #107 80 COBBLE STONE COURT VICTOR, NY 14564 (585) 223-7680 SALE 087958022605 $11.99 Check Payment/Deposit Regi SubTotal $11.99 Tax 7.500% $0.90 TOTAL $12.89 VISA $12.89 Card number: XXXXXXXXXXXX0924 Authorization 00630C 62447556 0107 00001 78616 7 06/28/11 00410862 07:23:40 PM Tell us about your shopping experience and enter to win 1 of 5 prizes. Visit www.officemax.colstore~surv_~ to enter and to view the terms and conditions of entering the survey. ORDER BY PHONE 877.OFFICEMAX (633.4236) VISIT US ONLINE officemax.com ~I~INI~I~I~I~IMIN~I~NIIAIW __ - a ~1 ~ (n ~ ~ I OD ct~ C'"J O C'7 O N i-c) CO7 T VJ ~ ..i.. d ~ L i E O I ~3 d4 ~ 6~9 ~ 604 ~ ~ i ~ '- ~ O ~ CO r, O (.O O ~ i ~ I Ql +~ f " .~ .L7 O ~ ~ LL• +Y~fO O U ~ OD D_ OIL m 1 ~ i O C') °a O ~ r+~rr~ ~k Z ~ f~ t1 ~ VII .0-- I C'1 ,~,~ ~ CL ~ "~'T ~ C/I Z N O O U ~ ,y +-~ ~ *t ,- ~ ? ~ o ~ ..~ r- .i"r'r`O r ~y `F m~ u7 _ 3 N~'D O i C/J J O 'J 2 s'C~ O O ~ ~ ~ fl •~I rU CA O ~ ~ -JY~ E 4- .~++~.P'M Ll 4- ~ L O U <U 3)O O I OOm~OLi 64 ~tO0C7 ~ ~ ~ ~ ~ rJ ~~~ _ O ~ +r U I O C/7 O O f~- J CJJ ~ J~, /~ J ~ ~`~ _..~,,.o F- RJ i ~ r-' ~ F- Q t ~ O ' ... J W CO p X H- VI VI RS ~1` W C/7 t- I- U U U ~ ~ ~~ ~ ~ ~ ~ A I O Cn V' C`'] I CO \ p ~~ b O I V V u"l O_ O t11 O O U'I ~~~ a p~ •L f- ~ Ql 7IE O I ~ ~~~ ~~ ~0 ~ O~ -CA CC N N V)~ N I •• _ ~~O www. ~ O CEO ~ .~ ~'+-~ ~ I ~ 7 ~~ V t+ U ~~~0 O O o aI +.~ a I r` ~-+ O r O VI O X I 0.?W O 0 O G7 Z N V) O~. 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'f~ ~( /~ ~~^~ ~ ~-~ ~y~,/~ 7 Payment eir~% Cie _ ~''1.~ `V ~.. _ ___ State (,__1. r, __ZIP ~C~ h ~53J ~ - Errter FedEx M;ct No. or Credit Cesd Np. low. // A ecc NCf Sectior r __~~r ^ 1Mlmemiiea ~ _1 Recipient [_'' Third Party ~ CredhCard ^ Cash/Check FeaF,n=n No ~. creaaramNa Day _ Total P ckages Total Weigh[ Total Declared Vafue' o~'~~ - Iba ~g L L yy~,~$. r_,~ ~• ~ 10 I bl I aed[ Sllq I youdeclere eh gher value Sce backf dem'I By usnglhsAirbdlyuu 60LJ say'l1T~l ~~{~F}Tf'Qi1~~~1f1`t'B ~Q~It lw{~}~jj~jl~.. 9eemh -ce conditions on the backofdtsAirbill and'n the curtain FedExS MCe Guide, nclud ng terms I that rmrtourl'ahlrty t Rav. Date 2'10 • Part?158281 •61994-2010 FedEx • PRINTED IV U.S.A. SRY ~ Pennsylvania SCHEDULE I DEPanTMENT OF REYENUE DEBTS OF DECEDENT, eN~n~N~E TAX RETURN MORTGAGE LIABILITIES 8k LIENS RES]D9iT DECEDENT ESTATE OF ~~ tdUMBER Doris H. Gaul 2010-01209 Report debts marred by Me decedent prior to death that remained unpaid at the date of death, including urreimbursed medical ems. Ip~,I VALUE AT DATE NUMBER DESCRIPTION OF DEATH _ 1• PABSMghmark 15.00 2. Penn State Milon S. Hershey 250.00 3. Kevin Gasswint - ReM Payment on 1418 Carlisle Road 950.00 4. CCS Medical 7.20 5. Eugene Ktmore MD, PC -Eye Care V'~sit 15.00 6. Sun Motor Cars, Inc. - RepaK of Vehicle 2,495.62 7. PPL Electric Utilities Corp. - December 2010 145.04 8. Comcast Cable 62.82 g. ~y 212.50 10. Penn State Milton S. Hershey - oopay 15.00 11. PPL Electric Utility Corp. - January 2011 119.84 TOTAL (Also enter on line 10, Recapitulation) i; 4,288.02 It more space is needed, insert addAional sheets of the same sae. PENNSTATE 2nd Statement Milton S. Hershey Pa e 1 of 2 Medical Center i. PO Box 643291 This bill represents the portion remaining after your Pittsburgh, PA 15264-3291 insurance company has processed your claim. You are responsible for any amounts not covered by your insurance. Do not delay taking care of this matter any longer. Please send your payment for the full amount. DORIS GAUL ivoosi5 1418 CARLISLE RD CAMP HILL PA 17011-6103 I~~~III~~~lll~~~~~~ll~~~ll~ll~~~~~llll~~~~~ll~~~~lll~~l~~~~lll Patient Name GAUL DORIS H DATE DESCRIPTION AMOUNT Statement Date 12/02/10 Service Date(s) 10/13/10 - 10/16/10 11/10/10 **BALANCE FORWARD** 250.00 Type of Service INPATIENT TOTAL 250.00 - _- ---- Account Number 15086628 New Charges/Adj $ 0.00 New Payments/Adj $ 0.00 ~„,~.Q ~' / /~q~ Account Balance $ 250.00 ~ ' ~~ ``'' ~~ K /~~~ Amount Pending Insurance ~~ ~~ __ ~I~LGG~ `~ Amount You Owe $ 250.00 I This new statement has been specially designed For billing questions or insurance changes: with you in mind. Let us know what other Para preguntas acerca de su factura o cambios de seguro contamos con improvements we should make. representantes disponibles para asistir a la comunidad hispana. Phone: (717)531-5069 or (800)254-2619 Please a-mail your ideas to: Available Hours: Monday, Tuesday & Wednesday 8:00 am to 5:30 pm Statementideas anhmc psu edu Thursday & Friday 8:00 am to 4:30 pm or write to us at: Written Correspondence: Penn State Milton S. Hershey Medical Center Penn State Milton S. Hershey Medical Center Statement Ideas, PO Box 854, MC A410 Patient Financial Services Department Hershey, PA 17033 PO Box 854, MC A410 Hershey, PA 17033-0854 Please Note: Yoair pltt~sicians will bill separately for their professional services. ....... ................ .... ........ ... .... ERSHEYST-01 ..... .................. ... ................... ............. .... Page 1 of 1 60-295/313 GJ 8 r / 9S~- /c~IM&T Banlc o , i:0 3 130 29 S S~: 98 54009 13 2~~'0098 ~ ~m N - v WK-~~ ~. ~~ ~ ~ , ~~~~ ~ ~~_ } 1~.Et ~k~ ~ i %~i' ~ .lb~~~~~~ '' - p ~• 4 G, iP Posting Date 2011 Jan 07 Research Seq # 8104189081 Account # 9854009132 Check/Store # 98 DB/CR DB Dollar Amount $950.00 Bank # 096 Branch # 06113 Deposit Acct # 0 Record Type # O1 http://afresh/inquiry/servlet/inquiry 8/22/2011 Questions? Call us toll free, 1-800-557-8568 M E D I C A L® Monday-Friday, Sam-9pm ET. ti`s DORIS GAUL 13322 1418 CARLISLE RD CAMP HILL PA 1 701 1-61 03 I.,~III~~~III~~~~„II~~~II~II~~~~~IIII~~~~~II~~~~III~~I~~~,III After receiving an explanation of benefits from your Insurance Provider, you have a balance due on your account. The total due is detailed on this statement. Shipment detail shows only the most recent charges. Payment is due within 30 days of invoice date. If you have any questions, call us toil free at 1-800-557-8568. Our billing department is available Monday - Fridayfrom Sam - 9pm ET. LGG ~p~ DATE OF _ SERVICE COPAYMENT DEDUCTIgI.E OTHER BALANCE 10/07/2010 1.80 11 /01 /2010 0.00 0.00 5.40 0.00 1'80 0.00 5.40 Total Due 7.20 AMOUNT DUE: $7.20 ., 2212727 11/25/2010 IMPORTANT MESSAGE FOR OUR PATIENTS Please remember to keep us informed! Complete the reverse side of the form with any changes to your information and mail it back to us so that we may update our records. Work Phone: Email: Treatment: Frequency: - 14255 49TH STREET NORTH, SUITE 301, CLEARWATER, FL. 33762 • 1.800.726.9811 • WWW.CCSMED.COM Patient: DORIS H. GAUL Case Descrip: OV/VF/FREE Primary Ins. PABS/HIGHMARK 11/22,'2010 Amount Paid by Amount Paid By IDates Procedure Procedure Description Charge Insurance Guarantor Adjustments Remainder 09/29/10 92083 VISUAL FIELD, EXTENDED MEMBER EFFECTIVE DATE ERROR 100.00 -60.74 0.00 -24.26 15.00 ~ 9~ PLEASE NOTE THAT THE BALANCE DUE MAY NOT INCLUDE RECENT PA YMENTS RECEIVED ON YOUR ACCOUNT. 1F YOUR BALANCE INCLUDES AMOUNTS FOR OPTICAL MATERIALS ON ORDER, PLEASE DISREGARD THIS BILL. LAST PATIENT PAYMENT 10/20/2010 -$35.00 "* Before you are billed, charges are submitted to any insurance carriers you provided. This balance is now the patient's responsibility. Payment is due within 15 days from the statement date. We Thank You for paying your account promptly! V. EUGENE KILMORE, JR. MD. PC. Amount Due 15.00 CUSTOMER #: 32154 DORIS GAUL 1418 CARLISLE RD CAMP HILL, PA 17011 HOME:717-761-5231 CONT:N/A BUS: CELL: 7541 *INVOICE* PAGE 1 SERVICE ADVISOR: ~ ~ 4 n Mercedes-Benz SUN MOTOR CARS, INC. 6677 CARLISLE PIKE MECHANICSBURG, PA 17050 PHONE: 717-691-3333 TOLL FREE: 877-316-3030 www. s u n m otorca rs. c om MTCNART~ C1RT,F.TTTIF.R L R YEAR MAK DEL VIN LICENSE MILEAGE IN/OUT TAG BLUE 4 D D E TRATU 1B AL4 R 4N2 4 25 3 25 5 DEL DATE PROD. DATE WARR. EXP. PROMISED PO NO. RATE PAYMENT INV. DATE OlJAN04 D 52.00 CHG 21JAN11 R.O.OPENED READY OPTIONS: DLR:67267 ENG:2.7 Liter MPI 16:36 16DEC10 11:27 21JAN11 LINE OPCODE TECH TYPE HOURS LIST NET TOTAL A REPAIR PER ESTIMATE REAR END COLLISION DAMAGE; METLIFE AUTO CLAIM RPE REPAIR PER ESTIMATE 3534 CPBO 19.20 844.80 844.80 1 5152003AA NAMEPLATE 80.95 80.95 80.95 1 5303637AA NAMEPLATE 69.50 69.50 69.50 1 4806063AA DECAL 41.20 41.20 41.20 1 4574904 LAMP 15.25 15.25 15.25 1 USED DECKLID 156.25 156.25 156.25 1 5019528AE PANEL-DECK OPENING 515.00 515.00 515.00 1 5073328AA FASCIA 355.00 355.00 355.00 PPE PAINT PER ESTIMATE 226 CPBO 6.50 286.00 286.00 PPE PAINT PER ESTIMATE 911 CPBO 10.20 448.80 448.80 MISC PAINT & MATERIALS CPBO 213.10 213.10 PLEASE COLLECT 2495.62 FROM ******************************************* CUSTOMER AT PICK UP. (250 * j ] CASH CHECK CK NO. [ ] DEDUCTIBLE & 2245.62 INS * [ ] VISA ] MI~STERCARD [ ] DISCOVER CHECK) A SUPPLEMENT IN THE * [ ] AMER EXP ~S~ ~._, OTHER [ ] CHARGE AMOUNT OF 711.79 HAS BEEN SENT * ~_,=-z_`- +? ~ .~ ~~ TO DAVID MAXEY OF METLIFE INS CLAIM# WFE30542-1 TELE## ******** **#*~*~*" * *~**************** :~ ~"~# 610-212-9968 M.W. f - ..~.... cl~kK ~E~'n ~ l~~'r- ~~I •-~~ O~~ ~~ ~~ Sun Motor Cars IriC STATEMENT OF DISCLAIMER DESCRIPTION TOTALS , . OUR POLICY The factory warranty constitutes all of the warranti ith t t LABOR AMOUNT 15 7 9 , 6 0 ~~ es w respec o the sale of this itemlitems. The S l PARTS AMOUNT - 12 3 3.15 HIIZ We believe Strongly in fast, ~-]j~Z courteous efficient service and e ler hereby expressly disclaims all warranties either express or GAS, OIL, LURE _ 0 0 0 , pride ourselves on repairing your implied, including any implied warranty of merchantability or SUBLET AMOUNT 0 , Q 0 car properly the first time. fitness for a particular purpose. Seller neither assumes nor MISC. CHARGES _ 213.10 We try sincerely to handle all service work honestly, and at a f i i ! authorizes any other person to assume for it any liability in TOTAL CHARGES _ 3025. 5 a r pr ce Should you ever have a question regarding our work, please feel free to bring it to us. connection with the sale of this itemiitems. LESS DISCOUNT SALES TAX - Thank You! CUSTOMER SIGNATURE PLEASE PAY THIS AMOUNT 3207.40 SUN MOTOR CARS IS DOING ITS PART TO SAVE THE ENVIRONMENT BY RECYCLING. CUSTOMER COPY CUSTOMER NUMBER: 32154 NAME: GAUL,DORIS ADDRESS: 31 KIRKBY TRL PHONE: 717-761-5231 E-MAIL: SO DATE REFER AMOUNT CURRENT 317UL BAL FWD 711.78 56 19AUG 27994 -711.79 TOTALS FOR 32154 -.O1 -.O1 AGING DATE: ACCOUNT BALANCE: CREDIT LIMIT: FINANCE CHARGE: OVER 30 OVER 60 0.00 0.00 317UL2011 -.O1 100.00 0.00 OVER 90 0.00 REPORT INCLUDES ALL REFERENCES view "Not yet in accounting" detail (Y/N)....N: PPL Electric Utilities Electric Service For: CIIARI.ES GAUL 1418 CARLISLE RD CAMP HILL PA 17011 Questions about this bill? Please contact us by Dec 29 at 1-500-342-5775 (1-S00-DIAI,-PPL) or write to: Customer Service 827 Hausman Rd. Allentown, PA 18104-9392 www.pplelectric.com Electric Use This graph shows your electric use over the last 13 months. Tvpes of 1Vleter Readings: Actual . Adjusted. Estimated Customer t pp~ Summary Page Balance as of Dec 8, 2010 Page 1 ,. YaurBt:i4~cnunt:-~Iu~6~r.:_.;>_;:. 42860-77016 1J~e:ufic~i esxi.::_ Q~~i .: $0.00 Chargges: Total~Dominion Energy Solutions Charges Total PPL Electric Uh-Iities Charges 7z 60 48 36 24 12 0 KWH -Average Per Day D J F M A M J JASON D 2009 Monihs 201() $112.08 $32.96 Meter Reading Informafion Meter #17220936 Dec 7 Actual 83215 Nov 5 Actual 82023 32 Da s KWH Billed 1142 Average -Dec 2009 2010 Temperature 46F 42F KWH Per Day 46 =47 Yearly Use: Total Average Use Monthly Jan 2009 -Dec 2009 14454 1205 Jan 2010 -Dec 2010 17674 1473 Other important information on back ~ NexC metes reading on or about .Tan 7 YYL t;tectnc UC111t1es uses about ~U. Jt5 of thls ~bili to ppay State taxes. In addition, about $2.35 of this bill pays the PA Gross 1Leceupts Tax. For your conveiuence, you can now pay your bill using your Visa MasterCard, Discover, or ATM Card. Call BiI1lVlatrix at 1-800-~72-2413. Bi1lMatrix will charge your credit and ATM card a service fee for making this payment. Before digging arolmd your home or property, you should always call the state's f)ne Call notification system to locate any underground utility lines. You can do this by simply dialing 811, which will connect you to the tine Call system. Be safe and call 811 before you dig. With paperless billing, you can receive and pay your PPL Electric Utilities bills online. The process us free, quick, convenueni and secure. To team more or sign up, vusrt www.pplelectric.corn. Save postage and late charges -sign up 1c>r Automated Bill Payment. ~Yf CO, , i~q5~, _ _ _ _ Account Number _ _ _ _ 09547 218911-02-6 Billing Date 12/14/10 Total Amount Due $62.82 Payment Due by 01/07/11 Page 1 of 2 Contact us: www.comcast.com 717-540-8900 _ _ _ __ CHARLES GAUL Previous Balance 62.82 For service at: Payment - 12/03/10-thank you -62.82 1418 CARLISLE RD CAMP HILL PA 17011-6103 New Charges -see below 62.82 Tota! Amount Due $62.82 News from Comcast Payment Due by .01107/11 Thank you for your prompt payment. For your convenience, we now accept regular and automatic monthly credit card payments and direct debit. HearinglSpeech Impaired Call 711 Have you had your XFINITY On Demand today? Watch a huge selection of movies, TV shows, kids programming and music, many at no additional charge! Just click On Demand on your remote and choose from thousands of programs! XFINITY TV 59.45 Taxes, Surcharges & Fees 3.37 Total New Charges _, $62.8 ,~G~~X ~ll~/?mil/ f.... _, ~~J{ ~~~~~ ~(z~~r • C ,~ ~mcast au~.~ ~s l ~~. A _ _ __ C~ , ~ ~(,~F,~ ccount Number Billing Date 09547 218911-02-6 01/14!11 ~ /~~ ' • ~~ /~@y~ C ' Unpaid Balance N $62.82 -Due Now C / ~C Q '- ew Charges $63.00 -Due 02/07/11 -~ " ~ Total Amount Due $125.82 Contact us: www.comcast.com ., 717-540-8900 ,...-.~.........F Page 1 of 2 CHARLES GAUL F Previous Balance ~ 62 82 or service at: ~ ~ 1418 CARLISLE RD Payments -received by 01/14/11 ~ 0 CAMP HILL PA 17011-6103 News from Comcast Our records indicate your account is past due. If your account is not paid in the next seven (7) days, a $7.95 late fee will be assessed. If payment has already been made, please disregard this notice. For your convenience, we now accept regular and automatic monthly credit card payments and direct debit. Hearing/Speech Impaired Call 711 Have you had your XFINITY On Demand today? Watch a huge selection of movies, TV shows, kids programming and music, many at no additional charge! Just click On Demand on your remote and choose from thousands of programs! Comcast has conducted an internal review of your billing statement. This statement reflects a correction in your state sales tax. Unpaid Balance -Due Now 62.82 New Charges -Due by 02/07/11 63.00 see below for more information Total Amount Due $125:82 XFINITY TV 59.45 ' Taxes, Surcharges & Fees 3.55 Total New Charges $63A0 Detac-h and enclose this coupon with your payment. Please write your account number on your check or money order. Do not send cash. ( (,(~m~as"`~ Account Number 09547 218911-02-fi Payment Due by Due Now 1555 SUZY STREET LEBANON PA 17046-8317 AV 01 007361 251588 19 A**SDGT n~ll~lllinll~ln~llulr~ull~~~ll~lll,~l~lllt~l,~llll~llln"~ CHARLES GAUL 1418 CARLISLE RD CAMP HILL PA 17011-6103 Total Amount Due $125.82 Amount Enclosed $ Make checks payable to Comcast ~Il~nnllllllllfllnll~l~lllnlllllllll~llllllnl~~llll~l~ll~ul COMCAST CABLE P 0 BOX 3006 SOUTHEASTERN PA 19398-3006 0 09547 218911 ^2 6 4 012582 ~~- r 0 r rn r w ~~HCJLY IRIT H O S P I T A L The Spirit of Caring 38542627 DORIS H GAUL 31 KIRKBY TRL FAIRPORT NY 14450-4106 Patient Name: Gaul ,Doris H Statement Date: 01/11/11 Service Date(s): 1 1 /25/1 0-1 2/0311 0 Account Number: 38542627 Medical Record Number: 083359 ~, Insurance Information Ins. 1: HIGHMARK SECU Ins. 2: Ins. 3: Ins. 4: •• - - We have received the explanation of benefits from your insurance company(s) and have applied whatever payments and/or adjustments are appropriate. Please make payment for the balance due $250.00 OR take advantage of a 15% prompt payment discount and remit $212.50 on or before 02/10/2011. Here are two convenient ways to make payment: 1. Call Customer Service at 717-763-2138 to make payment by credit card. 2. Mail tear-off coupon below with payment using the enclosed self-addressed envelope. Previous Balance: 5250.00 Total New Charges: 5.00 Payments/Adjustments: 5.00 Account Balance: Please Pa This Amount• y _ ~ ~__ , ~ _ Discounted Art-~c~unt ~ Z~S~~~~-i--r~asis~r__~ r__y_r before 02!10!2011 Please call Customer Service at 717-763-2138 ~~<!,C/~~ to add or make corrections to your insurance ((z~~~~l.~ j` p information, or to make arrangements for a payment plan. If you are unable to make payment, please contact the Financial Counselor's Office at (717) 763-2885 to discuss financial assistance options. Please Note: Your physicians will bill separately for professional services. PENNSTATE Milton S. Hershey Medical Center PO Box 643291 Pittsburgh, PA 15264-3291 1st Statement Pa e 1 of 2 This bill represents the portion remaining after your insurance company has processed your claim. Please send your payment for the full amount due. If you have any questions concerning how your insurance company processed your claim. please call them. DORIS GAUL rvoiar 1418 CARLISLE RD CAMP HILL PA 17011-6103 I~~~III~~~III~~~~~~II~~~II~II~~~~~IIII~~~~~II~~~~III~~I~~~~III Patient Name GAUL DORIS H DATE DESCRIPTION AMOU Statement Date 03/09/11 NT Service Date(s) 09/20/10 09/20/10 BLOOD GAS PANEL Wl02 SAT 218.00 Type of Service OUTPATIENT ~ 02/26/11 BLUE SHIELD PAYMENT HOSP -48.50 Account Number 14978809 02/26/11 BLUE SHIELD CONT ADJ HOSP -154.50 New Charges/Adj TOTAL $ 0.00 15.00 New Payments/Adj $ 0.00 Account Balance $ 15.00 ~~i~ ~~~~~ Amount Pending Insurance A t Y O $ . ~ ~ moun ou we $ 15.00 ~-LLC'~ E~l~ I This new statement has been specially designed with you in mind. Let us know what other improvements we should make. Please a-mail your ideas to: Statementideas@hmc psu.edu or write to us at: Penn State Milton S. Hershey Medical Center Statement Ideas, PO Box 854, MC A410 Hershey, PA 17033 .For billing questions or insurance changes: Para preguntas acerca de su factura o cambios de seguro contamos con representantes disponibles Para asistir a la comunidad hispana. Phone: (717) 531-5069 or (800) 254-2619 Available Hours: Monday, Tuesday & Wednesday 8:00 am to 5:30 pm Thursday & Friday 8:00 am to 4:30 pm Written Correspondence: Penn State Milton S. Hershey Medical Center Patient Financial Services Department PO Box 854, MC A410 Hershey, PA 17033-0854 Please Note: Your plrysiciarrs will bill separately for their professional services. .................................. . . .............................................................. ........ HEYST-O1 PPL Electric ` Utilities Electric Service For: CHARLL;S GAUL. 1418 CARLISLE, RD CAMP HILL PA 1701 L Questions about this bill'? Please contact us by Jan 31 at 1-800-342-5775 (1-800-DIAL-PPL) or write to: ~~ Customer Service 827 Hausman Rd_ Allentown, PA 18104-9392 www.pplelectric.com Electric Use This graph shows your electric use over the last 13 months. Types of 1Vleter Readings: Actual . Adjusted Estimated Customer 0 ~'"~~y Pagel ~~._ ~,. pp~ Summary Page Balance as of Jan 10, ZOl 1 Char es: Tota~PL Electric Utilities Charges Total Dominion Energy Solutions Charges Total Charges Account Balance 72 60 48 36 24 12 0 KWH -Average Per Day JFMAMJJASOND7 2010 Months 201t ~i$~t~~~~ :: 42860 77016 >:: LJ~e~uliea ~aklati ~ 4~~tiitiir ` ~ `_=::: $145.04 .13 86.7 $264.88 $261.88 Meter Reading Informaflon Meter #17220936 Jan ? Actual 84147 Dec 7 Actual 83215 31 Da s KWH Billed 932 Average -Jan 2010 20:11 Temperature 31F 29F KWH Per Day 50 i0 Yearly Use: Total Average Use Monthly Feb 2009 -Jan 2010 ]4459 120 Feb 2010 -Jan 2011 17061 1422 Other important information on back ~ Generation prices and chargges are set by the electric generation supplier Next meter you have chosen. The Pubric Utility Commission re Mates distribution reading ~nces and services. The Federal Energy Regulatory~ommission regulates on or about ransmission prices and services. Feb ? PPL Electric Utilities uses about $0.21 of this bill to ppay state taxes. Li addition, about $10.71 of this bill pays the PA GrosslZecelpts Tax. For your convenience, you can now pay your bill using your Visa MasterCard, Discover, or ATM Card. Call BillMatrix at 1-800-~i72-2413. BillMatrix will charge your credit and ATM card a service fee for making this payment. Before diggin around your home or property, you should always call the state's Chie Ca~ notification system to locate any underground utility lines. You can do this by simpl dialing 811, which will connect you to the One Call system. Be safe andycall 811 before you. dig. Pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE INHERRANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Doris H. Gaul 2010-01209 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Mark R. Gaul Son 50% Timothy N. Gaul Son 50% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 16 OF REV-1500 COVER SHEET, A S APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. Goodwill Donations 1,756.55 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed, insert additional sheets of the same size. DONATION RECEIPT ~'o~ur donation is important. The money earned from your donation will fund programs that promote employment and self-sufficiency for individuals with iisabilities and gth~er barriers to indepe ence. ~! ~A,TE 6~~~~ (,, LOCATION ~~ ~ ~ REP C VAME OF DONOR ADDRESS BAGS PC CTNS. DESCRIPTION CLOTHIrJG FURr~ITURE _~ HOUSEHOLD ~.-1ISCE~LANEOUS fhe donor is responsible for assigning value to donations. STIMATED VALUE OF DONATIONS $ goodwill has not furnished goods or services to the donor in exchange for :his contribution. lour donation is important. The money earned from your donation will fund programs that promote employment and self-sufficiency for individuals with iisabilities and other/barriers to independence. r SATE ~~ ~ t l LOCATION~_~_ REP ~ l~ ~JA,ME OF DONOR ADDRESS BAGS PCS. CTNS. DESCRIPTION C;L_~~:~THIrJ~ -- ~ / 1( iLJS-F IOLD L.P I r.~i~~~L~r_aNEOUs fhe donor is responsible for assigning value to donations. .STIMATED VALUE OF DONATIONS $ COMMENT CARD Tell us about your experience. At Goodwill KeystonE Area, we value and welcome your opinions and comments. DATE LOCATION NAM E ADDRESS EMAI Please rate today's donation experience: (1 being poor and 5 being great) 1 2 3 4 5 COMMENTS: I I 1 I 1 i Please detach and return by mail. COMMENT CARD Tell us about your experience. At Goodwill KeystonE Area, we value and welcome your opinions rind comments. DATE LOCATION _ NAME ADDRESS EMAI Please rate today's donation experience: (1 being poor and 5 being great) 1 2 3 4 5 COMMENTS: Please detach and return by mail. DONATION RECEIPT goodwill has not furnished goods or services to the donor in exchange for :his contribution. ;~ QONATION RECEIPT Four donation is important. The money earned from your donation will fund programs that promote employment and self-sufficiency for individuals with ~isabilities~jnd othelr barriers to independ ce. SATE t / " ~ `LOCATION ~ ( ~ REP SAME OF DONOR ADDRESS B,gGS I PCS._ I CTNS. I DESCRIPTION I CLOTHING PJRNI-TURF ~-'OUSEHOLD MISCELLANEOUS COMME111T CARQ- Tell us about your experience. At Goodwill KeystonE Area, we value and welcome your opinions rind comments. DATE_ LOCATION NAME ADDRESS EMAIL_ Please rate today's donation experience: (1 being poor and 5 being great) 1 2 3 4 5 COMMENTS: Please detach and return by mail. the donor is responsible for assigning value to donations. STIMATED VALUE OF DONATIONS $ goodwill has not furnished goods or services to the donor in exchange for his contribution.