Loading...
HomeMy WebLinkAbout09-21-11 (2)15D5610105 '-'~ REV-1500°"°z-">tFil ~ OFFICIAL USE ONLY PA Department of Revenue PennsylvaEMa County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN ii PO BOX z8o6Di ~ ~ ~,, i' ~ ~ RESIDENT D Harrisbu PA i~iz8-o6oi ECEDENT 1 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY Decedent's Last Name Suffix Decedent's First Name MI =S i~ t/ ~ L i C ~- 2 ~ ~. ~- (If Applicable) Enter SurvivlMtg Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~, 1. Original Retum O 2. Supplemental Return O 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 8. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number ~... ~ncd scz~~ ~ 4~~ fry ~ ~ s ~ ~~- a~c~ (~ ~ ~ ,_ First Line of Address I ~ S~-.;~...~ ~~-, >~ Second Line of Address City or Post Office Sft~ate ZIP Code REGISTER OF 1j1L1~.LS USE ONLY v- ~ --- _,.~ , , .. _ . ~ ~7 C_' i - r-l - Y i fi-i , _ .=~ ~_ -> :~. _~ ,: ~- ', ~_ DATE Fltfi~ ~r~ Correspondent's a-mail address: Under penalties of perjury, I deGare that I have examined this return, including accompanying schedules end statements, and to the nest or my Knovneage ano oenei, is true, correct and complete. peclareti of prep er other than the personal representative Is based on all intormation of which prepay/er has any knowledge. SIGMA RE OF P SDSP S E F IWNG RETURN / / D~7 `~ n Q ~ t ADD~E`?S ~ ~~ ~ `l 3 ~ .'` d t l rl Q LLi t/1 ark /'~ SIGN RE O PARER O NREIirRESE TATIVE DATE ,/1r 1~ t AD RES ~t ~ S~ ~~ / ~j 3 a~ieesE uSE ORIGINAL FORM ONLY -~-, r- , '~ .-r, `-`' G --r- Side 1 1505610105 1505610105 REV-1500 EX (FI) P Decedents Name: (~ fG1' ~ , ~~ `r? 1505610205 Decedent's Social Security Number RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. c :! 2. Stocks and Bonds (Schedule B) ....................................... 2. ~ ~ ~~ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. ~ ~~~ ~' 3 ~ ~"::.3 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. ~~ ~~ `J S / tt C~ 9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9. 1.~ 3.~~ ~~ 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............. .. 10. ,~ ~ '~~~, 11. Total Deductions (total Lines 9 and 10) ............................... .. 11. ~ r V 7 ~ , t~~ 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. ~ ~ ~ ~ ,~ ~ „ Cl~ 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. ~ ~ ~ "7 "7" ~ ~ l,? TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15 (a)(1.2) X .0_ . 16. Amount of Line 14 x e ~f at lineal rate X .0 ~ ~ ~`'~ I Ls ~ 16. C -~ '~ ~ ~ ~ / , ~ ~ 17. j Amount of Line 14 taxable 17 at sibling rate X .12 • 18. Amount of Line 14 taxable 18 at collateral rate X .15 • 19. TAX DUE .........................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~, 30~:~~ O Side 2 1505610205 1505610205 ,J REV-1500 EX (FI) Page 3 Decedent's Comalete Address: Fite Number DECEDENTS NAME ~c~ ~d ~ ~--oS 11 x'21 t~ ___ -- -- ------ - ---------------- - - STREETADDRESS ------------- --- CITY ;STATE ZIP C«~ II sIe ~ ;~ ~-~~ - 3 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments _._ B. Discount ___ 3. Interest 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. (1) ~ ~ c~ ~'. ~S -~ (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) ~S ~ C% ~ ~ S 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 .............................................................................................................................. ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after Dec. 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" orpayable-upon-death bank account or security at his or her death? .............. ^ Q 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ........................................................................................................................ ^ '~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)j. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefiaaries is 4.5 percent, except as noted in [72 P.S. §9116(a)(1)), The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)J. 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. Total Credits (A + B) (2) (3) REV-1503 EX+ (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Ail orooertv lointlwowned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert aaamonai sneeus or me same s~ce~ REV-i5o8 EX+ (u-io) ~ Pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. 5~ If more space is neetletl, use atltl¢ionai sneers or paper ui uie same sicc. REV-1511 EY.+ (10-04) Pennsylvania !i~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Decedent's debts must be reported on Schedule I. REM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: I. ~, --z3~ G i B. 1 2. 3. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) ____ --_____._ - ------ Street Address - ------- ------------------------ -- Cit ____-_ -_-__ State __-. ZIP __-__ _ y ------- Year{s) Commission Paid: _-_----___-_----------- Attorney Fees: ,j~~ Irv l ,~ ~' C!3 c J Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) ri~t~,~„t ---- -- `~~,~ . ~ ti Street Address __ -__---------------- City _-__ _ _-. State ZIP _- Relationship of Claimant to Decedent _ -_ _. _-_--__--- 4. Probate Fees: ~~~~; ~i c,., ~ ~ ~ . ~ ~ ,~ j 3 , J, a 5. Accountant Fees: 6. Tax Return Preparer Fees: ~, ~~J ~ nc!~~-iccs ° ~ ~Jc~,-nom ~e ~ ~ ~ S ~; . ~..> ~ ~ 3 . -~ b' `~. ~itccks 1cr ~5'~~~ ~xcc'c~~~~' /a ~i SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS TOTAL (Also enter on Line 9, Recapitulation) $ '`7`~ ~~~ If more space is needed, use additional sheets of paper of the same size, REV-1512 EX+ {12-OS) ~ Pennsylvania SCHEDULE I DEPARTMENT Of REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER o...,,~ d.tir~ incurred 6v the decedent arior to death that remained unpaid at the date of death, including unreimbursed medical expenses. c~ If more space is neeaea, inser< aomnonai sneew ~~ .~~~ ~a~~~= ~~~_, REV-1513 EX+ (O1-10) ~ i'1 Pennsylvania SCHEDULE ] ~ DEPARTMENT Of REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: 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).] / C ~S' Yr ~-, ~ n i ~ C.L;~, ~ /l ~ s (,~ ~ Pra J.~ ~ c Y, , ,. ~. 1~ r C ti CLe l ~.. ~. i1 c?~z~ ~~. 1 i~"cam-, ~c:~ t ~ ~n f '~ / ~ /) ~~.,~`,~~ ~ ~~ i c ~ ~'"'' !~~ = ,~G~, ~`I 3 . G l~ cl~, i/q ~3~~5 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS 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. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $ If more space is needed, use additlonai sheets of paper of the same size. N n (~] C q _ LAST WILL AND TESTAMENT ! ~ ~ r, - _;., p _; OF ~ '~~ `~ s~ - r,_J -~~i - i-~ CAROL A. SHOLLY ~ `~ t_~ -~ ~~ KNOW ALL MEN BY THESE PRESENTS, that I, Carol A. Sholly, 113 Amy Drive, Carlisle, Cumberland County, Pennsylvania, being in good health and of sound and disposing memory, do hereby make, declare, and publish this as my Last Will and Testament, hereby revoking all former Wills and Codicils heretofore made by me. FIRST: I direct that all my just debts and expenses of my last illness and funeral expenses shall be paid by my Executor, hereinafter named, from my estate as soon after my decease as shall be found convenient. SECOND: (a) I give personal gifts of the item named and to the individual listed on the Listing of Personal Gifts attached to this Will. ~~~ `~ ~:~, (b) I give, devise, and bequeath all the rest, residue, and remainder of my estate, whether real, personal or mixed, of any nature whatsoever and wherever situated, including any lapsed or void legacy, to my three children, Michael Lee Sholly, 2221 Vantage Point, # 101, Virginia Beach, ----- irgmia o en o y, $~oswell Trail, Foster, Rhode Island 02825; and Donald ,V Eugene Sholly, 108 Virginia Avenue, Carlisle, Pennsylvania, if they survive me by 90 days. If any of the devisees listed in paragraph (b) predeceases me, the percentage share that would otherwise be distributed to that predeceased devisee shall be distributed to his or her biological issue, per stirpes, and should no issue be available to receive, then such share shall be added to the share for my other named children. THIRD: I hereby nominate, constitute, and appoint Donald E. Sholly, as Executor of this my Last Will and Testament. If my Executor fails to serve, or for any reason fails to continue to serve, I then appoint Michael L. Sholly to serve as Executor. FOURTH: I direct that my Executor, or his successor, shall not be required to furnish any bond or other security for the faithful performance of his duties, notwithstanding any provisions of law to the contrary. FIFTH: My Executor shall have, in addition to the powers and authority conferred upon him by law, the following additional powers and authority: ~Fy LAST WILL AND TESTAMENT OF CAROL A. SHOLLY KNOW ALL MEN BY THESE PRESENTS, that I, Carol A. Sholly, 113 Amy Drive, Carlisle, Cumberland County, Pennsylvania, being in good health and of sound and disposing memory, do hereby make, declare, and publish this as my Last Will and Testament, hereby revoking all former Wills and Codicils heretofore made by me. FIRST: I direct that all my just debts and expenses of my last illness and funeral expenses shall be paid by my Executor, hereinafter named, from my estate as soon after my decease as shall be found convenient. SECOND: (a) I give personal gifts of the item named and to the individual listed on the Listing of Personal Gifts attached to this Will. (b) I give, devise, and bequeath all the rest, residue, and remainder of my estate, whether real, personal or mixed, of any nature whatsoever and wherever situated, including any lapsed or void legacy, to my three children, Michael Lee Sholly, 2221 Vantage Point, # 101, Virginia Beach, Virginia 23455; Todd Allen Sholly, 18 Boswell Trail, Foster, Rhode Island 02825; and Donald Eugene Sholly, 108 Virginia Avenue, Carlisle, Pennsylvania, if they survive me by 90 days. If any of the devisees listed in paragraph (b) predeceases me, the percentage share that would otherwise be distributed to that predeceased devisee shall be distributed to his or her biological issue, per stirpes, and should no issue be available to receive, then such share shall be added to the share for my other named children. THIRD: I hereby nominate, constitute, and appoint Donald E. Sholly, as Executor of this my Last Will and Testament. If my Executor fails to serve, or for any reason fails to continue to serve, I then appoint Michael L. Sholly to serve as Executor. FOURTH: I direct that my Executor, or his successor, shall not be required to furnish any bond or other security for the faithful performance of his duties, notwithstanding any provisions of law to the contrary. FIFTH: My Executor shall have, in addition to the powers and authority conferred upon him by law, the following additional powers and authority: 1 1. To gift, sell at public or private sale, exchange, lease, mortgage, or pledge any property, real or personal, constituting a portion of this estate, at any time, and upon such terms and conditions as he shall deem wise. 2. To invest any money at any time in such bonds, stocks, notes, real estate, mortgages, life insurance, annuities, or other securities, or such property, real or personal, as he shall deem wise, without being limited by any statute or rule of law regarding investments by the Executor. 3. To retain, without incurring any liability, as investments, any property owned by me at the time of my death, as long as he deems it wise, and even though such property is not the kind of property he would purchase as an investment, and even though to retain such property might violate sound diversification principles. 4. To cause any security or other property which may at any time constitute a portion of my estate to be issued, held, or registered in his own name, or in the name of a nominee, or in such form that title will pass by delivery. 5. To consent to the reorganization, consolidation, readjustment of the financial structure, or sale of the assets of any corporation or other organization, the securities of which constitute a portion of my estate, and to take any action with reference to such securities which, in the opinion of my Executor, is necessary to obtain the benefit of any such reorganization, consolidation, readjustment or sale; to exercise any conversion privilege or subscription right given to him as the owner of any securities constituting a portion of my estate; to accept and hold as a portion of my estate securities resulting from any reorganization, consolidation, readjustment, sale, conversion, or subscription. 6. To pay all costs, taxes, charges and expenses in connection with the administration of my estate. 7. To determine what is "Income" and what is "Principal" hereunder, and his decision thereon shall be final; and to purchase securities at a premium or discount, and to apply or charge said premium or discount against income or principal as he may determine. 8. To gift, transfer, sell, exchange, partition, lease, mortgage, pledge, give options upon, or otherwise dispose of any property at any time held by him, at public or private sale, or otherwise. 9. To borrow money from any person, firm or corporation, for the purpose of protecting and preserving or improving my estate or to execute promissory notes or other obligations for amounts so borrowed. 2 10. To employ legal counsel, accountants, brokers, investment advisors, custodians, managers, and other agents and employees and to pay them reasonable compensation out of my estate or out of any fund held hereunder to which said compensation is attributable. 11. To do all other acts in his judgment necessary or desirable for the proper and advantageous management, investment, and distribution of my estate. SIXTH: I direct that all transfer and inheritance taxes, state or federal, assessed because of my death, whether the funds, property, or insurance proceeds to which such taxes are attributable pass under this Will or not, shall be paid out of my residuary estate just as if they were my debts and none of those taxes shall be charged against any beneficiary; that my Executor pay, or provide for payment of all such taxes at such time or times, and in such manner as my Executor deems best. SEVENTH: All questions as to the validity of this, my Last Will, or the administration of the Will shall be governed by the laws of the Commonwealth of Pennsylvania. EIGHTH: Should my children, and the issue of my children, all fail to survive me, then I give, devise, and bequeath all the rest, residue, and remainder of my estate of whatsoever nature and wheresoever situate to The Waggoners United Methodist Church, 1271 Longs Gap Road, Carlisle, Pennsylvania. NINTH: Except as otherwise provided in this Will, I have intentionally failed to provide for any other relatives or other persons, whether claiming to be an heir of mine or not. Insofar as I have failed to provide in this Will for any of my issue now living or later born or adopted, such failure is intentional and not occasioned by accident or mistake. IN WITNESS WHEREOF, I, Carol A. Sholly, the Testatrix to this, my Last Will and Testament, typewritten on three (3) sheets of paper which I have identified in the margin of each page by my signature, hereunto set my hand and seal this 5th day of May, 2009. Carol A. Sholly The preceding instrument consisting of three (3) typewritten pages, each identified by the signature of the Testatrix, Carol A. Sholly, was on this day and date signed, published, and declared 3 by her, the Testatrix therein named, as and for her Last Will, in the presence of us, who at her request, in her presence, and in the presence of each other have subscribed our names as witnesses. COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF CUMBERLAND ) I, Carol A. Sholly, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will on the 5th day of May, 2009; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Carol A. Sholly Sworn or affirmed to and acknowledged before me, by Carol A. Sholly, the Testatrix, this 5th day of May, 2009. Notary Public COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF CUMBERLAND ) We, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Carol A. Sholly sign and execute the instrument as a codicil to her Last Will; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of Carol A. Sholly signed the codicil as witnesses; and that, to the best of our knowledge, Carol A. Sholly was at the time eighteen (18) or more years of age, of sound mind, and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me by the above-named witnesses, this 5th day of May, 2009. Notary Public 5 > ., J~~?~~1° 9t ~~ ~il~~l t~ ~i~lpl~~at~ this ~~a~ ~y t~~tostat ~r p~totOgr~tt. f `~^i - -- - ,_ ttt,,t? 12_vc',i' ~ihl~ l~ t(.` ti.'.I-tl`,l' %lalt tllk' I?lit~rCTlatiOR iiv;•('e °lti"ei? I.~ ccx'r~~tl~ ct rl~iec s c~? ;} an original Certificate cif Ih t;l citt~~' #ilur~ ~y,ith tll° a* I..o~al Regictl•ar. The ori~~tlTt'. l'^~i t]t1C:a`' il'l l' ':?c ~i?'s ~t"arCjL:CI. l.C) the ~t211~ ~`;la? I`*.~ei~r(i~> (-)itlt:l.: ~.." (?C'Ciltatlcdlt tl~I114J. z~isvt ~~t'~~'~~,n~.-r~ X14.1 ' ~ $ ~~"'f'- 1,ocu1 [~*~<<,ititt-.sr 7~It' I~;:;ueci 3> i O N1os faT REV Ivzoo6 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS TYPE/PRINiIN CERTIFICATE OF DEATH PERMANENT BUCK INK (See Instructions and examples on reverse) STATE FILE NUMBER J O J Q 2. Sax 3. $adal SeWrily Number 4. Dale of DeeN (Manlh, day, year) '' Name of Dacebnl (Flrsl, midde, teal. wf6xl F 186 - 34 - 1090 6 17 2010 Carol Ann Sholly 5. Aqe (Last Birtlbayl UM« 1 ear Under 1 b 6. Date M Binh MmM, b , 7. BI a CI and slate or fore munl Ba. Place d Death Check one Hospital' Other: AlarAw DAYS llaxs Mkwln 10 26 1943 Harrisbur PA ®Itpetieal ^ ER / OuplaaeM ^ DOA ^ Nursing Honer ^ Resid«xa ^ OIMr - Spedly • 66 vr6. Twp. d DeaM Btl. Fadely Name III nd'nsaNtion, gK'e sheet and number) 9. Was Decedent of Hispanic Odgn? ~{ryo ^ Yes 10. Race: American Indan, BWCk, WNIe, etc. Boo m & CM (SVar'+M f , . . Dea Bb. County o (d yes, spatlN Cuban, Cumberland South Middleton Ztap Carlisle Regional Medical Center Mexican, Puerla Rican, etc.) White r Marred, 75. Survirinq Spouse (ll wih, give msitlen name) ta Was Decedent ever n Ure 13. pecedeM's Education (Specify onN taghesl grade conpleted) 1A. Mam ' 12 t d l ' - • ~d . e re kla. Do ri s a a cad !sa 11. DeceeenYS Usual Inn Klnd of work done most d wo hl Kindd Busiasslintllutry U.S. Armed Faces? Elementary !Secondary (1}12) College (t~ a 5+) Knd d WoA Administrator PA of Health ^ vea f~Na 12 Divorced - • ,sDecebnraMaangAeeresslsheet,dryltown,atate,zipaxle) Dec•denl's pA L°,~d,~in°~~"t rn. North Middleton T t~ Yes. DecebM Lived in w>' Actual Residence t7a Slate 113 Amy Drive Toxi9h°? 17d. ^ No, DecetleM Ihred wanin lBwo Ci Cumberland ry 17h. County Adual knitsd • Carlisle PA 17013 rg. MdMrs Name lFrst midda, msNarl eanara) 18, Father's Neme (Pint, middle, IasL aNbx) Floy Christina White James 0. Creel 206. InlamaM's Mating Aeeress (Street, ckY /lam, state, zip axle) 20a. InlortnenYS Name (Type / Plnlj 108 Virginia Ave., Carlisle, PA 17013 Lbnald E. Sholly p~.~ 21 b. Dale of Dispaitlm (MOnm, daY, Year) osabn lgn ^ Donation th d of tTS 1 M 21c. Place d Disposbbn (Name of amelary, cremalay w other place) 21 d. L°°eaon (City Ilavn, stale, zip axle) o p ~M,renla e _ 2 a. ^ Burin ^ Removal Irom State i Was cremetkn « Donedon Adhaized ^ 201 0 Leola , PA Evans Cranation Services No 6 1 8 I W Medkal EnmhwrlCOroner7 ~Ves ^ ONe r ~ 22a, Signature d F Ixernee (a persan~eX~;s suYp1"') 22b. License Numhw 22c. Name and Address of Faciliy y FD 012633 L Doing Brothers Funeral Hone, Inc., Carlisle, PA 17013 / / • ~ ( ~ G Carplek eerrs 23a< oral' when cedgy'alg 23a: To knowkege ~cuf(~ at Te lime, bte ant place staled. (Splature and ellel 23b. License NlsMer 23c. Date Slgrwd (Mmh, daY. Year( Z O /O 0O ~ ~~-' L J w~lC" ~ ~ l ~ I Q S ~ / I - q~yu an rs nM avaaable al tkna °I balk ro Q ~' arNy Huse of bam. eay. year) 26. Was Case Relerred to Algdical Examiner I C«oner fw a Reason Ollrer Uan Gemation a Donation? Date Praiaa:ed Deed (Month 25 , . . I o am Items 2426 must b axripleted by person -7 / ~I ~ r ^ Yes Cm~ N/o ronounces bam ~Z' Z(o /IM. (MSG ( 2-Q ~ 0 • who . p CAUSE OF DEATH (See Insarucrlona entl sxempba) , Approximate nleaM: PM II: Enter o1Mr y x~• .,an hm antd+~aN„ to bem 26. Dq Tobacco Use D«IxibUN to Deam4 obaM~ Yes m hul not msdOrg n me wlbrhying cause 9nen n Pad I. ^ ^ t I D ^ ~ ~ _ e ee Item 27. Pan I: Enter db pule, d cents - du,eases, injuries, a mmpnauaw ~ Nat erectly caused tl?e bent. DO NOT enter lemanal evenb suds as cardiac artesl, Onse ~~~ A le ' a. el ally one rouse xm eae resgrat«y artest, a ventrkuler YAMledon wktoul stwwing ale eaobgy. L 29. a Female: IMMEDIATE CAUSE ffFnM 6aease w rn 1 II 11 1 N.~ ~~ Irk/ t VI ^ Nol Ixegnent with Pass year wndtion resuaing in peaty( 1' At t0. fR1 L l VA _~ a, . ^ Pregnant al lime d death / ' - ~ Oue b u( e cemequerlce op: ~ j ^ Nat pregnant but lxegnaM witnm a2 daye ~ ~ ~ f IFV lest ceri9lbns, d anY~ b. tQ .. -i ' ' M d h M eat ~ the cause kaetl on rote a. pue a (« as d c°nsequerce WIC' Eller UNDEPLYING CAUSE ^ Nd pregnant but pregnant d3 days to 1 year - (disease a njury Thal inaialM the events resdtirg n death uST. c. Due m I« as a axwquence o0: Opl«B death ^ Unkmm a praglanl wain Vre pall year d. ~ 30e. Was an AdapaY 306. Were AulapsY F xFgs 31. Mem« M 32a. Date d In Month. day, Year) Nry l 32b. Oescri0e How Irryury 0«urted J2c Place d Iryury' Nana. Farm, Street, Pettey, Office Builtlng, etc. (Speay) PMOm d? Available Prior b CanpleMn N~ ^ rypmicitle ~ of Cause of Deets? D't,(/ ^ ^ Accident ^ Pendkq Iaeslgefion Sze. Tone d Injay 32e. Injury at Wolk? 321. It Transpowtion Inpay (Speciy) ^ DrNerlOperela ^ Passenger ^ Pedestrian 32 Locatron d Irpury Isveet, dN I lows, stale) 9~ ^ Yes Y•s a~ ^O ^ Sdcib ^ Could Not b Detemmned M, ^ Ves ^ No Omer - SpedN: 33a. Cenaler (deck anti ~•) 3 36. axe an sician ulMpng rouse d barh when arodlar physician tw promalced tleaM BM axripleletl Ilem 23) h skfen (Ph dn CMB {/~ - ~ y y y g p Toth MNdnry kngwledga, death oeeumddue so tM esuegsjeM manrrru stned_________________________________ 33e. Lieme NU 33d. Data S' (MO^al~d•Y. Year) • Proiwuneing end arraying phYakMn (~Y~ n boll Ixawurn^9 death ell °aMym9lo uu%°I tleelh) Torts brit of my kxwwledgs, death otturted MtM Ume,dek,aM plea, and due to rM ewagal area msnroras stated------------------^ D d • Wdial ExalMnar/Cermx On 1M basis d examnarion end I a InvNligetion, in my opinion, Ifetlh occurred al tM time, dale, end plan, ant due to rM ausele) ant manor aE etarad_ - 3a. Name arts Adtlress d Person WM Complelad Cause °! Death (Item 27) T I Pnnl ~ •o. ~-t ~ - UI~,-k T q 36. Begetter lure ant DsNcl yumtan I •yi I ~ I + I t I U ~. eta Rlad (Harm, my, Yaarj ~ x , Dispositim Permit No: ~" ' `~- `°~ 1~ U REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA 7 ~ ,,~ __, ~ _ ~'~. ' ~ - J No . 2010- 00658 Estate Of : CAROL A SHOLL Y (First, Middte, Lastl CERTIFICATE OF GRANT OF LETTERS PA No . 21- 10- 0658 Late Of: CUMBERLAND COON ~WNSHIP Deceased Social Security No : 186-34-1090 WHEREAS, on the 30th. day of June 2010 an instrument dated May 5th 2009 was admitted to probate as the last will of CAROL A SHOLL Y (First, Middle, Lastl late of NORTH MIDDLETON TOWNSHIP, CUMBERLAND County, who died on the 17th day of June 2010 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wi 11 s in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: DONALD E SHOLLY who has duly qualified as EXECUTOR(R/X) and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 30th day of June 2010. ~° ~ , f ~ ~. ~ ~ , ,-- ~ ,> 1'~„~ir f'~ rirJ ' i;'ty >ti -,{': ~ .. ,.~`~f / .fir re1,~f+~9. ~~ V"1 r 'Y ~ - „TT R~ ister of Wills - '~. r ;; eputy **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) LINDSAY D. BA1RD, ESQUIRE 100 Strawberry Drive Carlisle, PA 17013 (717) 240-6575 STATEMENT FOR LEGAL SERVICES RENDERED DATE: July 4, 201 1 To: Donald E. Sholly RE: Estate of Carol A. Sholly UNITS OR DATE SERVICE RENDERED HOURS RATE TOTAL 7.50 '' 200.00 1,500.00 7/20 1 0-7120 1 1 ~ Probate, Notice preparation, DPW claim letter, Form 5.6a, ~, Inheritance Tax Return, Family Settlement Agreement, Form 6.12 _ __ _ - _ __ _- - - ---- 0.00 -- __ - - -- -- -_ __ - -_ - ---_ _- - _- .-- -- -- ----_ - _- - __-- -- ~, -_ .- - __ -- - _ -_ 0. -- - -- Thank you, Mr. Sholly. - - ~' `'- _ - -_ ~I- 0.00 - - _ - _ - 0.00 ~ _ --_ __ -- - _- -- - -- - - __ __ 0.00 --7 _. -.--. _, _- - __-. _-.. -- -. _ _.- -.. - -- I _- 0.0 - - --. - -- _ - --._.-. -_-I-. - _. --_ -- _-_ - t 0.0 _ __ _ -_._ _. - _- _. __-_ -i.--_..-_ _--- - -. -.- - _ -- - - 7.50 TOTAL UNITS OR HOURS ' ~ SUBTOTAL 1,500. Less Retainer paid 7/2010 750.00_ BALANCE DUE $750.00 ~~ ~ ` /1~5Cx C_ ESTATE OF CAROL A SHOLLY DONALD E SHOLLY, EXECUTOR PH. 717-422-5731 108 VIRGINIA AVE CARLISLE, PA 17013-1072 PAY To 'LHG ORDF,R OF 60-822M7313 104 DATE /~ `1J ~~ ;r-~ 1 $ ~-515, ©d E ~ !J~_ ~~ D ~ DOLLARS 8* ~ „~, A'iM1 ~ it rn.~ St v ~M E~v.g~ r~i • www.membmteug 6P MEMO___ ~:23~38224L~: 28389090 ~~ OL04 ~~r~~ /~ J~~_ /d ti~~a~ k ~ Gsa.c ~~ ~~~er Cd ~ `S ,`.~ ~~. ~~ Ewing Brotllers Funeral Home, Inc. ~~"'~ ~ ~" ~~ 630 South Hanover Street Carlisle, PA 17013- (717)243-2421 June 26, 2010 Donald E. Sholly 108 Virginia Ave. Carlisle, PA 17013 The Funeral Service for Carol A. Sholly We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. 1. PROFESSIONAL SERVICES Services of Funeral Director/Staff , _ $1120.00 3. AUTOMOTIVE EQUIPMENT Vehicle to transfer remains to Funeral Home, $275.00 Utility Car for DC retrieval/filing $125.00 C. SPECIAL CHARGES Direct Cremation , _ $320.00 FUNERAL HOME SERVICE CHARGES $1840.00 SELECTED MERCHANDISE: Acknowledgement cards, $10.00 Register Book(s) $40.00 Memorial folders , $75.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED $1965.00 Cash Advances Certified Copies of the Death Certificate , _ _ $60.00 Cumb. County Coroners Fee, _ $25.00 The Sentinel Obit, $154.62 TOTAL CASH ADVANCES AND SPECIAL CHARGES . $239.62 Total Total Cost , _ $2204.62 SUB-TOTAL $2204.62 INITIAL PAYMENT /DISCOUNT /CREDITS 0.00 TOTAL AMOUNT DUE $2204.62 The unpaid balance over 30 days is subjected to a 1.50 % service charge per month - 18.0000 % per annum. f- ~- ~ -~ S ~ ~ C a2 a3 y. ~ ~ 103 Pnv To ~ W r`•N6~ ~cv JhefS 1-cati er-~~ ~~e»tt _ -L 3G, ( ~ 023 `(• ~o e~ THE ORDER OE ~ Tr,.IO ~ SGinI~ lt.9p ~d~ 7~1t+~~-Tt.l Tt~~E~O~Id~t`s~ ~C~r-s~cv L!J ~a~, St tt rEOM BE~ca~ [liruoer MEMO 'GPG s@,M~L~„ - -- --- -- ----- --- -- ------ - _------- ___ ~: 2 3 i 38 2 24 i. 2 i8 3890900~i LO 3 ~ ~~ ~j~-o s . ;~~/ ~ ~~~ ~, rG~ ~e~,~ ESTATE OF CAROL A SHOLLY w-e~~zl~s DONALD E SHOLLY, EXECUTOR PH. 717-~22-5731 108 VIRGINUI AVE `~ ~ y ~ j CARLISLE, PA 17013-1072 DATE ~ Deluxe OrderPro -Order Confirmation C)eluxe ClyderPrt7~ ..:u:.l Order Search Order Confirmation . The order has been submitted. You may print this screen for your records then either place another order for this account, access another account or Exit. Order Contents Continuation X: 7 1 0 4 7 6 0 6 4 0 _.. _. _... Routing N: 23138224 Account p: 2183890900 Estimated Order Total: $13.95 '',. Order Date: 06/30!10 Item 1: Product Description $peGalty Blue - Single/Wallet Imprint: ESTATE OF CAROL A BROLLY DONALD E BROLLY, EXECUTOR PH. 717-022-5731 108 VIRGINIA AVE CARLISLE, PA 17013-1072 shipping Method: Standard Delivery - 14 Days '. Shipping Address: ESTATE OF CAROL A BROLLY 108 VIRGINIA AVE '.. CARLISLE, PA 17013-1072 ....__......... . Important Update: Look for the New Packaging for Personal Checks. Look for the new packaging with this check order. To meet changing U. S. Poslal Service requirements, the Deluxe personal check box has been replaced with a flatter, more sVeamlined mailing package. If you have any questions, call Deluxe Vew Large..r Irpage of New..~heck toll free at 1-877-984-4146. Pack~ca e Page 1 of 1 Help ~ Tutorial. i Ex .. _. -. .~ ,w tot r•W096 )d4lr; 127156 )ar eip: .` l E r .r-""'-....-.-~'r"- - - - ~ - Search for Another Account Record [Pont This Screen] ~ Search Current Account Record' Exit' -- , ~-- i r.. ~~ ~ ., r~<f 4r_R€rSr4stssrLficaS Vn I ~i r,..~:,: rr;t„rn ~ ~~c, ire.... i vi .. w~~r~.:, ~i. <~.rn ._...i >.~.n. V ~~-~ J G~j~cl~i ~ https://orderpro.deluxe.com/webapp/blueiceberg/deluxeport/DLXportServlet 6/30/2010 ESTATE OF CAROL A SHOLLY DONALD E SHOLLY, EXECUTOR 6D~~~13 11 l PH. 717-422-5731 108 VIRGINIA AVE CARLISLE, PA 17013-1072 pq~~f~~, ~~ ,r" l~ P.~Y TO ~ ~'~fS~ ~ THE ORDERrOF ~~ t ~ `~'"' ~ Q wv You ~VV o~0 ~ . ~~ ~ a~~r ~8 ep DOEEARS 8 ~ ~.~~, tt 1~~~ .~ ~i MEMO L}----~3~ ~' '~'~ ~ 7~ ~:23138224i~: 2183890 ili ~e ~ y~ ~~ ~~ ~ Se,~~`~t ~~~ ~~ ~a~ ~~~~~~~ 5 ~~ ,~L The Sentinel www.cumberlink,com t/~~~~/~ j/"~~/irC.3fi' AD NUMBER 387478 Publication 3 THE SENTINEL -LEGAL TOTAL AD CHARGE 3 PROOF OF PUBLICATION g Y 3 k~ ATTY. AT LAW LINDSAY DARE BAIRD 37 SOUTH HANOVER STREET CARLISLE, PA 17013 717-243-5732 AD NUMBER PAGE NO. 387478 1 of 1 BILL DATE SALESPERSON 08/24/10 robik START DATE STOP DATE 08/10/10 08/24/10 CLASS LINES NOTICE LETTERS TESTAMEN 10 PUBLIC NOTICES 38 ' 2 cols Insertions I Rate I Net Amount I Gross Amount 3 LGL $201.78 $201.78 01 PRF $7.00 Dp `ATE pF N cAR SRC 2 ~ E ~~ ~ ~ S~OL . L1SLE~ 1j 73,107 ExEC~TpR AY T(, ~~ 2 (.. , ~`e224~23~3 St `' v ~ DATE -C ._ 11 . M °E~Rs 1 ' ~ 1 j ~~ 8! Purchase order : ~ 3 j 3 ~ 4 ~g _ ~v 8 B ~ ii; y lD~DO`LARS ~ ~`. ~183g9O __~ 6 __ __ __ _ j j ___ _ __. Thank you for advertising with The Sentinel! Lt.: j ~ -. ... , in-column legal ads is 4:00 p.m. two business days prior «, ~ _ -,., date of insertion. For questions, call (717) 240-7130. ~" nn THE SENTINEL c/o LEE NEWSPAPERS PO BOX 540 WATERLOO IA 50704-0540 Rc~arn rms pomon wnn your payment Check #~ ~ Credit Card ~®^~^®^ Acct #: Ems. Date: m m Name on credit card Signature Please make checks payable to: 000363 ATTY. AT LAW LINDSAY DARE BAIRD 37 SOUTH HANOVER STREET CARLISLE, PA 17013 ~"".~d Leaal 9 4* /10 4-0540 Ad Number 387478. Billing Date 08/24/10 Amount Due $ 208.78 Amount Enclosed $ ~° ~ pj ~ ~- THE SENTINEL c/o LEE NEWSPAPERS PO BOX 742548 CINCINNATI OH 45274-2548 ~~~n~i~~~u~~~~~u~~~~n~u~~~i~~~n~u~~n~n~n~~n~~~ui~~ 215402000000038747800000000000000025D5400000208782 CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717) 2493166 Fax: (717) 249-2663 August 27, 2010 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Lindsay Dare Baird, Esquire Carol A. Sholly Estate RE: Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on the following dates: August 13, August 20, and August 27, 2010 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 0 .00 Total Amount Due $ 75.00 Payment received by ESTATE OF CAROL A SHOLLY ~~~13 113 DONALD E SHOLLY, EXECUTOR PH. 717-422-5731 108 VIRGINIA AVE DArE ~1 !~- ~ -~ ~~ CARLISLE, P//A 17013-1072 `~ _~(~ Jg s PAY TO C...(~y-1 ~P{"~~CX GG cJ J 1~U~'-yl3. \ I TtiE ORDER OF n aD~ a _ ~~ e.-~ ~1~~1 ~ ~ olta~--5 CJ1fi~~ J , D (/ DOLLARS +~ ~ ~ St s ~~ MEMBERS 1" ~>~.~~ MerLmiabma,YA t7~5 MEMO t-' ` /~.S~o1 GS '(^~ ~ -- -------------- - ------ -_--~- ~--_wr ~: 2 3 l 38 2 24 i~: i8 38909 O i i 3 /`-) ~ D ~~ ~~ `~~ ~~ C~ ~~ \ ~ ~,~ ~~- ~~ J `~` "; Document Number: 2519126 Account 8604XXXXXX SHOLLY,CAROL A Effect: 06/30/10 Post: 06/30/10 Tlr: 0306 ID DUE DATE PRINCIPAL INTEREST FEES NEW BALANCE IRAN AMOUNT SEQ ----------------------------------- Withdrawal from REGULAR SHARES Prev Bal• 32,126.53 01 32,126.53- 0.00 0.00----------0_00 32,126.53 1603664 ------------------------------------------- Check Disbursed ESTATE OF CAROL A SHOLLY 32,126.53- CAROL A SHOLLY C/O DONALD E SHOLLY, EXEC 113 AMY DR CARLISLE PA 17013-8810 Document Number: 2519126 Account 8604XXXXXX SHOLLY,CAROL A Effect: 06/30/10 Past: 06/3060 Tlr: 0306 ID DUE DATE PRINCIPAL INTEREST FEES NEW BALANCE IRAN AMOUNT -SEQ Withdrawal from REGULAR SHARES Prev Bal• 32,126.53 O1 32,126.53- 0.00 0.00 0.00 32,126.:53 1603664 eck Disbursed ESTATE OF CAROL A SHOLLY 32,126:53- C~~~~ /c~ ~~ ~ ~ NO STOP PAYMENT PERMITTED PSECU is obligated to pay this Cashier's Check according to its terms at the time it was issued. If the check is lost, stolen or destroyed please contact us at (800) 237-7328 nationwide or (717) 234-8454. AMERICAN HONDA FINANCE CORPORATION P.O. Box 2713 TORRANCE, CA 90509-2713 ~ o~~/~ ~ ~~ wv l ~j 0000557 01 MB "AUTO T2 O 6114 17013 C05 Iu~II1n~111nn~~11u11~1u1~iulnu~~nnnnnnnnnn~ CAROL BROLLY 113 AMY DR CARLISLE PA 17013-8810 RE: Account Number: 124689609 2009 HONDA CIVIC VIN: 2HGFA16619H539469 Dear Carol Sholly: Thank you for financing with us. HONDA Financial Services 0108 Attached is a check for $13.27 which represents a refund resulting from an overpayment on your account. If you have any questions regarding this refund, please contact us at 1-800-916-9939. We appreciate your business. Regards, American Honda Finance Corporation Honda Financial Services is a dba of American Honda Finance Corporation. DETACH AND RETAIN THIS STUB FOR YOUR RECORDS VENDOR #: 1003797607 CHECK~M 0052801164 ATTACHED BELOW ~~ EKES 1~` FEDERALCI~LEDi7 UNIUAt North Middleton 1711 Spring Road Carlisle PA 17013 Inquiries Call: 717-258-5504 Acct XXXXXXX090 SHOLLY,ESTATE OF Eff: 06/30/10 Date: 06/30/10 Tlr: 0670 Time: 11:23am Deposit to REGULAR SAVINGS 0000 Prev Bal : 0.00 Amount: 20,000.00 New Bal: 20,000.00 Seq: #303121 Deposit to CHECKING 0011 Prev Bal: 0.00 Amount: 12,126.53 New Hal: 12,126.53 Seq: #303125 Chk hld rls 07/02/10 4,750.00 Chk hld rla 07/12/10 15,000.00 due to Large Deposit Chk hld rla 07/12/10 12,126.53 due to Large Deposit Check Received 32,126.53 Authorized by ID Source: ^ Div Lic ^ SigCard ^ Known ^ Other Got 3.99$ APR on your VISA Credit Card? Here's how you can: Get our VISA Platinum Choice Rewards Card. Ask for details. os, ~ J~ %G~~'s ~~ ~~e ~ L S `~ ~ ~v 1 l n ~~ ~~ ~~ ~~ A-CC©J+`, ~ ~ cj ~v~QQU~~ ~~D /~~~ ~~ ~ . ESTATE OF CAROL A SHOLLY North N:iddletan 171A Sprir:y Road Carlisle E+A 17013 Inquiries Call: 71"1-258-.5504 Acct XXXi~XXY.090 SHC7LLY ,ESTATE OF Eff: 06/30Ji0 Date: 06/30/10 Tlr: 06 i0 Time: il:"23am , Deposit to AG!CU.L•AR SAVINGS 0000 0.00 Freer Bal: Amount.: 20,OOG.OCi Ncw Bai: 20,000.00 Seq: #303121 Deposit to CHECKING OCiil 0.00 Prev' Bal: 12,126.53 Amount: 126,53 New Bal: 1"' ~ \ Seq: X303125 CYek hld rls 07/0`1!10 x,750.00 Chk hld rls 0'Xi=2110 15;000.00 dae tc Larye 7eI;:%sit Chk hlr. rls G/; i2/10 12,126.53 due to Large Dei:osi.t Check Received .32,126.53 ____.~ _ __ ,~ ~ 5~1 F ;'..:aori2ed kay TD Sou... . - Dru Lie . _._.._._-.-- _' Si~7Card -- '-' Known ~, Uther _.___ _ -.---___ dISA Credl_ `"`' .,ow you Get o . VISA -_ _~um Ck~,oioe, ~awarda idbd. Ask fo~ ,a,ls. ES'PATE GF CARflL A SHCLLY K~arsk.rtn~.~~~r?r~~.r, urrtci~x tdorth Middleton 1711 Spring Raad Carlisle PA 17013 Inquiries Call: 717-258-5504 Acct XXXXXXX090 CAROL A SHOLLY Eff: 03/16/11 Date: 03/16/11 Tlr: 1843 Time: 11:17am Deposit to REGULAR SAVINGS 0000 Prev Hal: 20,038.52 Amount: 9,300.00 New Bal: 29,338.52 Seq: #308447 Check Received 9,300.00 Authorized by ID Source: _ Drv Lic _' SigCard 1, Known ~', Other cIISA Platinum Select Credit Card Rates as lac, as 8.25~e APR! Ask an associate for details. CARCL A SHOLLY ESTATE Addendum A "AS IS" Condition. By signing this Agreement, uyer represents that he has inspected the home and is satisfied with the same in its present condition. This sale is made "AS IS" with the presentation by Seller as to quality or condition, and Buyer accepts title to the mobile home with this eacpress understanding. Buyer can cancel this contract at any time until the closing with no penalty whatsoever. Buyer shall make no claim against the Seller for any damages to the home or any other claim whatsoever after accepting title at closing. . ~ . ~ S . ~ ~ Buyer: ~~~./t~Y= Date. Buyer: ~~ i+~•i ~y - - sr ~ ~ ~ N O N [~ ,°a~ ~ o a ~ ,~ air 'i moaoao +*~ o ee o 0 0 ~ ~~,.~ ooe.~n-# n1 N sLO~ Od0101 ~ r .• ® O O p N N O1 . -1 ~ ~ .V 'JL ~ Q ~. H a ~ 7 ,~ o ~ '° • r+ yam e °` ~ a ' rii O~ R V ~ ~ ° a ° x ~ v j'.4 .. d '~ . ~uoi x a o ~m ~~ ~mo''s+ xo ~ + ~ x .,~ -.i a p a u -. r0 ~ ~ i ° ° D ~ ~i ~ ° o w e ~ is . ~2zm x ~ V z°` ~,v H ~ wH caa. '~ 6 s. 0 t s~ -• n 'o s°+`~vso o H ~ e y to A fA 'fi 0 C~C7L m B O q a OG U v a a y U d 6 ~ O (R ~ N ~m ~ -.~ .-. N • M A • M °i o ~ H M O > ~w 61 E N W N a a 0 x :n d a °a a UMH SALES AND FINANCE, INC. 3499 Route 9N, Suite 3-C Freehold, New Jersey 07728 (732)577-9997 BROKERED TRANSACTIONS DATE: ~ 1 I ~ ~ 11 Buyer(s) ~~^^~~ ~~r~Q Phone: ~1~7- J I ~- i ~~~ Social Security No. ~ Address: UMH Sales and Finance, Inc. Representative: l S ~ ~~~ ~~~ ~~~~r~-~'" Community: \ ~ ^~ ~~~~ iL~A~ ~ Make & Model: ~~~h Serial Number: ,1. ~C`~(~ C~ Purchase Price: ~,9 ~o ~~ Less Deposit: Commission: ~ ab U C:J Balance Paid to Seller: ~t .3~®~ ~ The undersigned hereby agree and acknowledge that they have read and understood the terms of this document. The UMH Sales and Finance, Inc. representative has simply facilitated the sale from Seller(s) to Buyer(s) and shall not be liable for any representations made by Buyer(s) or Seller(s), nor for any damages or injuries that may result from this transaction. _.., r !__ A Date Seller Date Buyer Buyer Date UMH Sales and Finance, Inc. Date r By. ~- ~ Year ~ ~~} ~ Bedrooms Size: J+~ > Carpet Color Form of Payment: Form of Payment: Form of Payment: (' ~r# I'~`(~O~ Form of Payment: ('~,~~t 13y~~~7 Seller Date UMH SALES & FINANCE, INC. BROKERED SALES PURCHASE AGREEMENT THE BUYER (S) ~ CL~1~ DATE II f t OFFERS AND AGREES TO PURCHASE THE FOLLOWING MANUFACTURED LOCATED AT: ~ `~ ~ ~ ~~ t ~~ ' p ~ MAKE; MODEL: SIZE: ~.~-~ BEING A YEAR: ,~ 1 - SERIAL # ~ ~ ~~'' ~ ~Q FOR THE AMOUNT OF $ OS ~ t?C~ .00/100 BUYER: SIGNA BUYER: SIGNATURE SELLER(S) HERBY ACCE TS TIE ABOVE OFFER: SELLER• . ri~ ~ ~ f d ~ ~~.~- ~_.•-•~"SIGNATURE SELLER: SIGNATURE CLOSE DATE BY: ~ ~ "~ I I ~. DATE• ~ ` ~`~ _ DATE: DATE: ~ ~~~~ ~ ~ `i DATE: UMH Sales and Finance 3499 Rt. 9 N. Suite 3-C Freehold, NJ 47728 AGREEMENT OF UNDERSTANDING ~-Y I/W ~ ~- ~ ~ L ~ `~- ~ ~~~x ~~ ,agree e, .~,,~; that the following documents be verbally translated into m /our native language. I/We understand and agree that y the contents of said documents were read and explained tlZOroughly and completely. I/We have signed said. documents with a clear Agreement of Understanding as to content and intention. ~~ --.- Y-~ Signer ,~ Date Date Signer T nsl Date Date Manager Date Witness No. pl PATTTLE NUMBER (AS SHOWN ON ATTACHED TITLE) MAKE OF VEHICLE felb6El YEAR PUR p ~ CHASE PRICE (See Noce on Reverse.) .. J vQ w v VEHICLE IDENTIFICATION NUMBER CONDITION ~ a _ O GOOD O FAIR O POOR LESS TRADE-IN g. LAST NAME (OR EULL BUSINESS NAME) FIRST NAME MIDDLE NAME ~ w J .. ... _ .. .. _ TAXABLE AMOUNT w CO-SELLER °1 1. SALES TAX DUE x s~ (.os) x ~ ( a~ oR `` LAST NAME (OR FULL BUSINESS NAME) FIRST NAME MIDDLE NAME PA DL7PH0T0 FDA DATE OF 662TH . , e a OR BUS. IQA * (Se N m on Reverse.) i .. ? tA. EXEMP'r1oN , °' - _ .. .. " REASON CODE (must Z CO-PURCHASER LAST NAME FIRST NAME MIDDLE NAME PA DL/PFIOTO !DA DATE OF BIRTH be a number Gan 1 to ~ m ~ 23 or O) i 16. FIRST ASSIGNIM1ENT i6. SECOND m ~ STREET COUNTY CODE ASSIGNMENT a ~ EXEMPTION NO. EXEMPTION NO. 2. TITLE FEE CITY STATE ZIP CODE DATE ACQUIRED! REFER TO COUNTY CODES PURCHASED.. LISTOiG ON REVERSE SIDE .. '._._ OF YELLOW COP`( 3. LEN FEE D LAST NAME (OR FULL Bt1StNESS NAME) FIRST NAME MIDDLE NAME PA DLIPFLOTO IDA DATE OF BIRTH OR BUS. ItJA 4. REGISTRATION OR PROCESSING FEE ~,. O•PURCHASER LAST NAME FIRST NAME MIDDLE NAME PA DLIPHOTO ID# DATE OF BIRTH z W FEE EXEMPT NUMBER AS ASSIGNED BY THE DEPARTMENT STREET COUNTY CODE £ DUPLICATE REG < p a p - . FEE NO. OF h H CARDS CITY STATE ZIP CODE DATE ACQUIRED! PURCHASED REFER TO COUNTY CUES & TRANSFER FEE LISTING ON REVERSE SLDE OF YELLOW COPY E MAKE OF VEHICLE VEHICLE IDENTIFICATION NUMBC-R T. INCR1J15E FEE j p - - _. Up W ~ DEL YEAR BODY TYPE (CP, TK, ETC.) CONDTION > ~- 8. REPLACEMENT FEE GOOD O FAIR rJ' POOR TOTAL PAID B. 70. ~'_ O PLATE TO 8E ISSUED BY O TRANSFER OF PREVK)llSLY ISSUED PLATE (ADD i THRU 8) DEPARTMEI'FT (PRA OF O TRANSFER & RENEWAL OF PLATE INSURANCE MUST BE O TRANSFER & REPLACEMENT OF PLATE 19. GRAND TOTAL SEND OtVE CHECK IN ATTACHED. O EXCHANGE)PLATE TO BE ~ TRA3SFER OF PLATE & REPLACEMENT ~ STtCKER (ADD 9 & 10) THIS ~~ ~ - ISSUED BY DEPARTMENT PLATE NO. -': - REASON FOR REPLACEMENT CJ TEMPORARY PLATE ISSUED ~z. ~ [:DST O DEFACED ~ STOLEN O NEVER RECEIVED Lost in M il ( BY FULL AGENT (Note: This a ) plate vrili expire 90 days Erarn EXPIRES Morph Yew ~ NOTE: tt `NEVER RECEWED' bkxk is checked, applicant must complete Form MV44. ~ dam ~ ~~) ~ O TRANSFERRED FROM TITLE NO. V W O ... < ,. tQi N SIGNA URE OF PERSON FROM WHOM SKIN HERE a w TEMP. PLATE NO. PLATE LS BE#NG TRAWSFERRED {IF arc OTHER THAN APPLICANT) VEHICLE PURCHASED WEIGHT GVWR UNLADEN ~h'EIGHT RED. REG. GROSS WT. INFORMATION (IF APPLICABLE OdCLUDlNG LOAD INSURANCE COMPANY NAME POLICY NO. (OR .. ATTACH BWDER) ..- RTE .. DATE - I CERTIFY THAT ON MONTH DAY YEAR ~ ISSUING AGENT{PRINT NAME) - AGENT NO. ISSUING I HAVE CHECKED TO DETERMWE THAT THE VEHICLE LS INSUREDAND - ~~ `~" ` ~' `°' _ AGENT ISSUED TEMPORARY REGLSTRATK?N TO THE ABOVE +A.P?LLCA.WT, 4N ISSUING AGENT SIGNATURE TELEPHONE NO. INFOftAAAT70N COMPLIANCE WITH ALL APPLICABLE PROVISIONS OF THE VEHICLE CODE AND DEPARTMENT REGULATIONS. ( G, LANE CERTIFY THAT uVJE HAVE EXAMINED AND SIGNED THIS APPL".CAT30N AFTER (TS COMPLETKNF. itV+rE FURTHER CERTIFY THAT ALL STATEMENTS HEREIN ARE TRUE AND CORRECT AND MAKE APPLICATION FOR CERTIFICATE OF TITLE FOR THE VEHICLE DESCRtBED IN SECTION A. !F ANY EXEMPTION fS CLAIMED, THE PURCHASER FURTHER CERTIFIES THAT HE/SHE IS AUT!-IORIZED TO CLAIM THLS EXEMPTION. LANE ACKNOWLEDGE TiiAT LWE 2SAY LOSE !AY?OUP. OFERATM7G PRN4LEGE{S) OR VEHICLE REGISTRATION FOR FAILURE TO MAINTAIN FINANCIAL Z RESPONSIBILITY ON THE CURRENTLY REGISTERED YEWCIE FOR THE PERIOD OF REGISTRATION. ItWE ACKNOWLEDGE THAT UV4E MAY BE SUBJECT TO A FINE NOT EXCEEDING 55.000 AND O IMPRISONMENT OF NOT MORE THAN TWO YEARS FOR ANY FALSE STATEPdENT THAT I,~NE *AAKE ON THfS APPLICATON. U 1ST oI Fast Purchaser or Authored Signer - ' ~ Telephone No. ~+- ASSIGN- .' MENt Signature of Co-PurchaserfTiOe of AuHrcx"¢.ed Signer ( j~ w O ~y Signature of SecorW Purchaser ar Auttarized Signer ~ Telephone No. ASSIGN- MENT Sgnahae ale AWhot¢ed ( ) H. ~ z NOTE: IF A CO-PURCHASER OTHER THAN YOUR SPOUSE 15 LISTED AND YOU WANT THE TTTLE TO BE LISTED AS'JOINT TENANTS WITH RIGHT OF SVRVNORSHIP' (ON DEATH OF ONE O z w < OWNER. TITLE GOES TO SURVNLNG OVrRdER) CHECK HERE O. OTHERWISE. THE TITLE wttJ. BE tSSLfED AS `TENANTS IN COMMON' (ON DEATH OF ONE OWNER, INTERESt OF DECEASED f g OWNER GOES TO HISMER HEIRS OR ESTATE-) f ~ o ~ NOTE: IF THE VEHICLE tS TO BE IiSED AS A DAILY RENTAL OR LEASED VEHICLE, CHECK THIS BLOCK D. IF BLACK IS CHECKED, COMPLETE AND ATTACH FORM MV-t L. a = MESSENGER NO. 3. APPLICANTS COPY !TEMPORARY REGISTRATION (VALID FOR 90 DAYS) _>`~~ i' ~ ~ S ° ~ F. ~ Gi ~, 1 -L ~ S ~Oy"l ~ S ~Q~1G~ b lC L%-~ 1XG~rs-~ -`' I I 1 c~ R I(I I ~` ~ • ~~~~ ;~~> ` ( ~ nom' I ( ~ !11~. t?~ ,~~~ ~> ~: V I D !. C ~ ~ y4. C'` ~' C ~ t' ti. _ i ~ ~ I I ~ ~-~r ~g ~a7~9o o~ yb E ~-----I- I I , I If?Y I ~?d~Y'8'4'~3700 E I " ,-~-I l-2~IA>4~o~F~`~os-g E I I I i T I _ I -- ~- - ~-_--- ~ ___--I ~~~ s s~G ris~,~ -. _i _ _ _-. ___I_ _ 1 x-j i it_.J l J IrTYX Yom] h~l ,_ „ ~ ... ~ _ „I ,, ~ _ I ~. - ~ i. ~~ i~ ;~-FI ,. It r ir' c ~ ~-y I p os, - ~ , 7~iJ~ -LY~_ - - -f -- ~ y o .-~ c , ., ., ~. ~ ~ ~ ~? ~`~l GG3~/~GO,r ~ ~~~,oo. "( ~ ~~~ ~~~,~ rots Ll YP I GG ~s~zG b 33oE~ I ~6~ i ~ ~ K1~ I~ ~ n ° t I-~ .--~-_-" I~ I~~iC-~Ys3 ~ooss-~~ :, j4~f%t~~~ i~ ~o~ I i-1 i -~ (--~- ~ } --}---a C i f ~------} --I---~------~--j IIDD~I i i I i ~~v, ~~ I ~jaD ~ i ~ ~ ~- - L------ - -- ------------' ~- _ l LtUO ~ ---- - I ~ ~ ---- ~ __ LL_ ~ fj~ ~ I j i L__.___.~~.___.___.._.___. ..... _......~.....~ ,...._..~..-____-_._~_ ~ loa G Y3 ti~ 33 ~5~15 d~ ~ 50 LDa3~81~~ 1 T ~ 5 v L.o za-3 ~-5 ~-~tS s ~ ~o Lb3~~. ~30~ $ T. ~ 5o L a ~~ a~ ~ z~~ T ~. ~J ~-~j~j 2.6~~5b i D 51~ o~~~ ~l lt~a ~ ~ I ~ 3 3(~~S z{lv t~~l~ ~ rJD L o 2G'~5 1,231?' 5o L.o~S ~~i3~1 ~5 7` 51~ G,o33 sod- 5~~ r ~ ~a~ c~9~~~ 3~3~L~ ~o~ G fi~-~~~~y19 ls~~ ~~~~`~(13~~5y~1~6~ ~Zg~ G 558~~g~f~$l~~ j,. o~~ /~f.~,v 1,,~a: -~- 7-o carol ,4,~~ 5 I~~l\.~ G ~~~ ~- ~~o~(~ l wc~ ~~ fry C~~I o~ ( s~~t~ ~ ~ a~ ~~~~ l l~-t'~~ G ~ ~ ~ 5~5',e ~ CCc,/~ ~~~~ ~~o ~~a~y~iz3a= ~~v ~ ~2z x-63 Sl3 X50 ~~~g~-~'3Y~~ ~5(~ C,~33~~~sy~.: ~~~~,4~~ ~~~ ~- ~ I ~5U L~3~~1y3648 t~ ~~ iR1.L.s~,A/'.A~ Sd FEb~EtALC:lTEt31'i' UMt']T North Middleton 1711 Spring Road Carlisle PA 17013 Inquiries Call: Acct XXXXXXX090 Eff: 06/30/10 Tlr: 0670 717-258-5504 SHOLLY,ESTATE OF Date: 06/30/10 Time: 11:37am Withdrwl from CHECKING 0011 Prev Bal: 12,139.80 Amount: 313.00 New Bal: 11,826.80 Seq: #308456 Deposit to REGULAR SAVINGS 0000 Acct XXXXXXX194 SHOLLY,DONALD E Amount : 313.0 0 New Bal: Seq: #308458 Comment for CHECKING 0011 REPAYMENT OF ESTATE START UP Authorized by ID Source: ^ Drv Lic ^ SigCard ^ Known ^ Other Got 3.99 APR on your VISA Credit Card? Here's how you can: Get our VISA Platinum Choice Rewards Card. Ask for details. ~(~~' I ~~ i `~~ ~ Gov~`~ c°~~ ~~ Gl. ttLL ~ ~~~- D ~ p~L~t~ l ESTATE OF CAROL A SHOLLY ~~ E~v1~3E.5 Est FHI~ERAL(:ItEl7!'1' UNtUTi North Middleton 1711 Spring Road Carlisle PA 17013 inquiries Call: ACCt XXXXXXX090 Eff: 06/30/10 Tlr: 0670 717-258-5504 SHOLLY,ESTATE OF Date: 06/30/10 Time: 11:26am Deposit to CHECKING 0011 Prev Bal: Amount: New Bal: Seq: Check Received 12,126.53 13.27 12,139.80 #304434 13.27 Authorized by ID Source: ^ Drv Lic ^ SigCard ^ Known ^ Other Got 3.99 APR on your VISA Credit Card? Here's how you can: Get our VISA Platinum Choice Rewards Card. Aak for details. ~~ DS` ~ t C~ GNP,. 3~3"~(~ ~~(~ !~ ~~~y~ ~ l ESTATE OF CAROL A SHOLLY ESTATE OF CAROL A SHOLLY so-ezza/z;,s 10 2 DONALD E SHOLLY, EXECUTOR PH. 717-425731 ~~~1 ~ O 108 VIRGIrTIA AVE DArt 1 CARLISLE, PA 17013-1072 -_ PnY ro ~c 1~5<< Qcti~a,~c,~ iM ~~~ ( ~S•J~"t~ -__1 ~ j ~ • ~O rl{E /O~I2D~F.R OF t _ ,,~ ~ Q ~ p, /...t ~('C ~i~ ~0~~1 ~ Q/~'~l ~/ ' ~ DOLLARS U `~'„f°~ z t u. w~ St a MEN ~' uNlor ,YA 17055 • www.memleelq.wb NtEh,o ~~ ~ ~ Iq 8~ o ~ --- ---- --- --- -- ------ ---- "" ~: 2 3 L 38 2 24 ~~: 2 l8 3890-9$~T' O L0 2 r~~ /~~,+k~ ~,;t~ ;q-7,s-~ rF~~ _ `.~/-1I`aL.t~J 45 Sprint Drive M E D IuuC ••AGL !i(~C`JE LA T E R Carlisle, PA 17013 ADDRESS SERVICE REQUESTED PAYMENT DUE-BY ~~,- , ~ ° ~; °"' Carol A Sholly 113 Amy Dr Carlisle PA 17013 '111'~'Ii1~lllflf11~~11„iIt111'11'Ifll""fiifil"ff"I'111" 007852 858HMA 000054R IF PAYING BY CREDrT CARD, FILL OUT BELOW AND SEE REVERSE SIDE CHECK CARD USING FOR PAYMENT ^ ^ _ ^ ^ MASTERCARD DISCOVER `"'? VISA AMERICAN EXPRESS ACCOUNT NO. STATEMENT DATE BALANCE DUE e • 1 7998602 06/21/2010 515.00 MAKE CHECKS PAYABLE TO: CARLISLE REGIONAL MEDICAL CENTER P.O. BOX 281442 ATLANTA GA 30384-1442 '/1"i"i1111~'Iii'if'If'lfl~~l'i-~1~11'fl'i'i'il~ll'1~1'1'1~ 000007998602000000D1500CAROL A SHOLLY 2 _ „~,__ , -t_'-, i~ ~ ~,.~ Qa~rres~ ~ Y~c~ o.. Sri 7dicate change cr redsrse side. TO IiVSUR6 PRCfPER CREDIT. DETF=.CH RND FE7t,R^; 7f i~ ~C~RTICN RJ THE c ~...OSED EitV_L~?E. PATIENT NAME PATIENT ACCOUNT N0. DATE OF SERVICE TYPE OF SERVICE Carol A Sholly 7998602 03/31/2010 OUTPATIENT DATE DESCRIPTION PAYMENT/ADJUSTMENTS IV THERAPY/CHEMO 06/16/10 ADJUSTMENT 1,941.70- 06/16/IO INSURANCE PAYMENT 620.49- PAYMENTS AND CHARGES RECEIVED AFTER THE STATEMENT DATE NRLL BE REFLECTED ON THE NEXT STATEMENT. t F $15.0 0 MESSAGES FOR BILLING GIUESTIONS, PLEASE CALL: The amount shown an this statement is outstanding at this time. Your prompt payment will be greatly (71 77 960-1 680 appreciated. Bills can be paid online at our hospital Internet web site www.carlislermc.com PON RECEIPT ESTATE OF CAROL A SHOLLY DONALD E SHOLLY, EXECUTOR so-an4lx~'s 10 8 PH. 717-422-5731 108 VIRGINIAAVE Dare '~-(~j 7'1 ~~ CARLISLE, PA /17013-11072 ~I I tE ORDf:•R OE [l, { i ~ I D - ~'C~ _1C~c/ ~o l ~Cv''S ot•~ c~\ ~tO lO C~ ~-- DoLLA>~ 8 q~ st ~~.~~~.~ 1~1E~~~ >•~~ ~: 2 3 138 2 24 L~: 2 18 38909001' `~,~ Customer Service ~~'` 7-SOO-829-8009 CenturyLink~ Internet Address Account Number CENTURYLINK.comlresiderrtial 777-243-4624851 Do not send payment Your bank account will be drafted $10.76 on or after August 13 AV 01 031815 044578134 A**SDGT ~rl~lll~l~lllllllll~~~ll~l~l+Irlll~l~llnl~llrll~l~lllnllr~l ESTATE OF CAROL A SHOLLY 108 VIRGINIA AVE CARLISLE PA 17013-1072 We appreciate your business. CenturyLink P.O. Box 1319 Charlotte NC 28201-1319 l~i~lllllll~l"I~fll~lflll~lu.~lll~llrlllllf~l~lifhllrll~hli 12 71724345248519 OODDODODDDZ076 ODD010762 1D26615 /a~~~ ~~ ~=,N~1 ~h~e r3, ~~ Detach and enclose this coupon with your payment Please write your account number on your check or money order. Do not send cash. C~1'Y1CgSt_ Account Number 09547 374543-01-0 - Payment Due by 08/01/10 1555 SUZY STREET Total Amount Due $12.77 LEBANON PA 17046-8317 AV 01 006838 341448 21 A"5DGT Amount Enclosed $ lO~,~~ I'11111111111'llllhrlll'r'III'rlrlh'rilrll'lIN'lllllllln'n Make checks payable to Camcast CAROL BROLLY 113 AMY DR CARLISLE PA 1 701 3-881 0 IIII,ILII,II,~111`IIIIIrIr11J1111111'1111'11""11"iilllllll'1 COMCAST GABLE P 0 BOX 3005 SOUTHEASTERN PA 19398-3005 ^9547 374543 01 ~ 4 X0],277 ESTATE OF CAROL A BROLLY DONALD E BROLLY, EXECUTOR so-ezzaix~'3 10 6 PH. 717-125731 lOBVIRGINIAAVE _~~ V Jl CARLISLE, PA 17013-1072 DAVE PnY ro ~i~j itJ~ ~~{ ~ '~"~ THE ORDLR OF ~ ~ J a ~ -_ ~. `~ ` -___~ ~ D DOf LARS 8 St: R 1~ MEMO/~-e~ p ~~- 3~-~~L(3-OI -o __ w - -- -- ~: 2 3 i 38 2 24 l~: 2 i8 3890900~~' -106 ,~~ ~~~ ~ v /, ~~ tic~.~ G~~C~51 ~' ~~ ESTATE OF CAROL A SHOLLY ta~2319 1 ~ 5 DONALD E SHOLLY, EXECUTOR PH. 717-422-5731 108VIRGWIAAVE CARLISLE, PA 17013-1072 ~D ~J)_f 1n DA 9'I c y (- '' -- `` } - Pnv To 1Qp ~ `~J yi ~ `J 6 ~ (~r~ ~D P_!`GP_~ i ~4?~ ~'o l~fL-~ i' 1 ~ j q , ( THE ORDER OF f _ ~ ~ GG/L~ <<G-'f S t 1 GGJ DOLLARS y p, L!J St ~1 E~ ~a rr>mHHAr. CBFD[P UHION s rjs ~ . Q `~y MEMO t 1 y .7~'~ 3~j (f g __ __ _ ~ I:23L38224LI: 2L838909 L05 ~n~ PAYABLE TO ROBIN K_ SOLLENBERGER, TAX COLL 5 HILL DRIVE p17)249-0747 CARLISLE, PA 17013 DESCRIPTION ASSESS.NO - 29001376 MAP NO: 29-15-1251-014 TR03021 113 AMY DRIVE PINE RIDGE MOBILE HOME PARK LOT 113 Mobile Home - No Land MOBILE HOME -LEASED LAND TAX PAYER SHOLLY, CAROL A 113 AMY DRIVE CARLISLE PA 17013-8810 TAX PAYER COPY BNI No: 9688 Control No: 029 -001376 ~7p ~ OI lS~ r ~a 1aZQ8 om vatC: nv ucu Iv Assessed Land Improv~aent Mineral Total Values 0 10,110 0 10,110 Homestead Exclusion 8 758- ISLEAREA S.D. CARt Dhoount Face . Rates 14.83000 SCHOOL R B 14.83000 14.83000 2t 149.93 10~ Homestead Credit 129.88- TAX AMOUNT DUE > uses s~oos i~2.oa I! Paid On or altar 7 O1 2010 9 O1 2010 11 O1 2010 I! Paid Oa or !alora 8 31 2010 10 31 2010 12 31 2010 IF NOT PAN3 BY 1?l9tN0 TENS BN1 WILL BE RETURNED TO TAX CLAIM BUREAU FOR COLLEC TION AND FN.IN(i OF A LNG! AGAINST YOUR PROPERTY. IF TAXES ARE IN ESCROW FORWARD TO YOUR MORTGAGE COMPANY.;7.00 FEE FOR ADD'L COPIES. OFFICE HOURS ~JUL-AUG TOES 10-4 &THUR 10-6; MAY-JUN-SEP-OCT THURS 10-6 APPT ONLY JAN-FEB-NOV-DEC NOTICE OF PROPERTY TAX RELIEF Your enclosed tax bill includes a tax reduction for your homestead and/or farmstead property. As an eligible homestead and/or farmstead property owner, you have received tax relief through a homestead and/or farmstead exclusion which has been provided under the Pennsylvania Taxpayer Relief Act, a law passed by the Pennsylvania General Assembly designed to reduce your property taxes. ~J~. ~ ~ ~~ ~r~~es~~ I r}~!C~ ~Jo1~ e..~~~~~e~S TAX INSTRUCTIONS -READ CAREFULLY 1. If serviced by a mortgage company, forward entire bill to company immediately. 2. If you require an official receipt; send your check, both copies and aself-addressed, stamped envelope. 3. If not paid by 12/31/2011 this bill will be returned to Tax Claim Bureau for collection and filing of a lien against your property. 4. Failure to receive a bill does not relieve you from liability for prompt payment. 5. No partial payments or postdated checks will be accepted and payment must be received or U.S. post marked by the due date. 7~ ~~f Payable To: ROBIN K SOLLENBERGER, TAX COLLECTOR Office Hairs: MAR,APR,JUL,AUG TOES 104 8 THUR 106 Bill No: 3758 5 HILL DRIVE MAY,JUN,SEP,OCT THURS 10-6 t3iA Date: 3/1/11 CARLISLE, PA 17013 APPT ONLY JAN,FEB,NOV,DEC; Cootrd No:29001376 Phone: (717) 249-0747 PHONE (717) 249-0747 MAP NO: 28-1tF1261-014-TR03021 Dear: 113 AMY DRIVE Acres .000 Deed: PINE RIDGE MOBILE HOME PARK LOT 113 Mobfie Home - No Land Tax Payer. BROLLY, CAROL A C/O DONALD BROLLY 108 VIRGINIA AVE CARLISLE, PA 17013-1072 Assessed Value: Land: 0 Imprvverner~ 11,300 Total: 11,300 Discount Face Penalty COUNTY R/E 1.90200 521.06 521.49 523.64 COUNTY LIB .14300 51.59 51.62 51.78 MUNIC. R/E .69400 57.66 57.84 58.62 TAX AMOUNT DUE 530.33 530.95 tf Date Of Payment Is On 3/1/11 thru 4130/11 511/11 thru 6/30/11 534.04 7/1/11 or Later ESTATE OF CAROL A BROLLY DONALD E BROLLY, EXECUTOR PH. 717-422-5731 108 VIRGINIA AVE CARLISLE, PA 17013-1i}72 6Q-8224!2313 DAIS Cl ~ -i R'~ C/ 1 PAY TO ~D~ofi/J i~ . ~ OlLu' ~ rJC,{'LI~L~{ ~ ~ ~ C`_8 ~~t'CTQ ~ ' THt ORDER OP J` 128 L1 I J~ ~o~c.ARS 8 ~~ MEMBERS 2" . ~°~, MEMO ~ ~~ ~ ~ ~ 3 ~ -~_ -- ---- ~ ~------ -_ _ M! ~: 2 3 l 38 2 24 i~: 2 i8 38909 ~ i 28 fff . .f f...,~t .ei ~~~'~p..~. to ... ., .. Tf~µ)1~y ... ... •~ r ,_, _. -, ... ,.. r . ~. _^ I ~. ~_~C _. »..:. °... .. .. ~ ~ e._... ESTATE OF CAROL A SHOLLY gp-gy14/2313 101 DONALD E SHOLLY, EXECUTOR PH. 717-422-5731 ~ ~~ ~d 108 VIRGINIA AVE DATE CARLISLE, PA 17013-1072 ~ F ~y3~.r~a - PAY TO ~ ~ ~ ~ THE ORDER OE 1 [~O ~~ v v st ~~ MEMBERS 1ffi ' `~~~ ~y MEMO G~ ~~ r t ~ ~r~O i7O [ ~---- ---- -- -- -- -- ----- --- ~:23i38224i~: 21838909 OiOi r~~ ~~1~ )~lh ~f ,~e~ j - d ESTATE OF CAROL A SHOLLY DONALD E SHOLLY, EXECUTOR PH. 717-~I22-5731 108 VIRGINIA AVE CARLISLE, PA 17013-1072 Y70 ~~ ~~~ 60-8224/2313 1 0 () DATE ~~ •7 ~ $~~pp.~~~~y~~^^~va B 67I6.r1.f.ARC ^ ~~F°""` ~ U 1 ~~8 ~ ~ rs»s ?vtEMO~~/j~ ~j dy1D1 ~: 2 3 i 38 2 24 i~: 2 i8 389090 0 109 -__- __-__ -_-_~_~__ --~ ___ _ --_ _ __ --- ~~rv~~ ~~~~~>>o ~' ~;r;,v5i D. ~ ~~ I ESTATE OF CAROL A SHOLLY DONALD E SHOLLY, EXECUTOR PH. 717-422x8731 108 VIRGIlVIA AVE CARLISLE, PA 170131072 - PAY ro ~ ~ ~ ~ i - THE ORDER OF ~~ ~ ~~ ~~ ~, ~'-° M F.NtO ~D~ l ~L~ ~~ ~: 2 3 L 38 2 24 ~~: 2 L8 3890 ~4,~,3 112 DArE '-` ~ D iCS I $~~~. b~ A}(~ Sa'J\IQ~ P"V- (/ DOLLARS u o~~~. n^ O~L2 ~~~~ ~ ~v/ ~~~~- _ ESTATE OF CAROL A SHOLLY ~_~4i~t3 115 DONALD E SHOLLY, EXECUTOR PH. 717-422-5731 INIAAVE ~ N ~/ ~) DATE 1~--- CV 108 VIRG CARLISLE, PA 17013-1072 5 `-~~-~ ~ i ~ ~ 3 ~ ~ - ~r-o r~ (~ ~M ~ - , o PAY TO THL QRDF'R O1: J} St MEMBfiRS 1" ~M $iei ~ •,n..,m®6mw.as ~l~~ ' ~ ~ ~d~~~ ' ~ t T - Mr:MOL.6 L ~:23L38224L~: 283890'90 ~~' O L15 ~' r~~ 1 ~C / ~L 1 ~ ~~~i ~l ~7 v~G~ _ v I~ ~~~f ESTATE OF CAROL A SHOLLY DONALD E SHOLLY, EXECUTOR PH. 717-~22r5731 108 VIRGINIA AVE CARLISLE, I'A 17013-1072 ~o"~4~f,~~'3 117 DATE (,~' ~d V~ ~~r rA~~ ro ~` a'~ '~'~.. '~-`'' `-~-' c". = THE ORDER Of ~ ~; /~ ~ L t /~ ~_~~ \ ~~.~Y„- C.7~ ~ vft . '3'~'~` .i,__'..,'_JV \~Q'1~~ ~t''~"l. ~`' ! 6I.AKS ej G%~r.w.a 5t w.,. ~M~ ~ [ MON ~ PA 17055 j - - ~. - -- ----_ ~:231382241~: 218389O~.Q.u!-- 17 _ _ - --- ~ti'c~~ f~/~~ ;yeti, ~,~, f ~~,- /~~~-~ ESTATE OF CAROL A SHOLLY DONALD E SHOLLY, EXECUTOR PH. 717-325731 108 VIRGINIA AVE CARLISLE, PA 17013-1072 l~/~t t~ `r'roG'~~' ` ~ e OF yy~ ~ 60-8224/2313 119 ~~~,~a _.. _ I~LLARS 8e ~~sax, St MEMBERS 1# PPDEAAL CflFDIC UPIION ~ fiahauiobo~,PA 17056 ~wwrm®6ml~toq , /7 MLM() G..l~1 ~//3 PYLf f~ ~1~~ .~ ~ / ~/ M, ~:23L38224L~: 2L8389d~Q~~' OL19 L (' ~ ~~~ lG~e ~~~-~~J Pine Ridge Village Date: 11/23/2010 100 Oriole Drive Account: 113 Carlisle, PA 17013 Amount enclosed: Carol Sholly Pine Ridge Village 113 Amy Drive Carlisle, PA 17013 Please enclose this portion with your remittance. Dear Resident: Our records indicate that there is a balance due from you as noted on the statement below. Charges for water and sewer or court/attorney fees, if applicable, will be shown on a separate statement. If this is correct, please enclose the top portion of this letter with your remittance and send it to the Community Office. If you have already paid this balance, please disregard this notice. If you have a discrepancy, please send information regarding this discrepancy to the following address: UMH Properties, Inc. Attn: Dept. AR12 3499 Route 9, Suite 3C Freehold, NJ 07728 All special arrangements must be in writing and signed by the park manager. Thank you for your cooperation in this matter. Very truly yours, ANNA T. CHEW Vice President Statement for: Carol Sholly Pine Ridge Village 113 Amy Drive Carlisle, PA 17013 Unit Due Date Description 113 11/08/2010 Late Charge Statement date 11 /23/2010 Amount 40.00 Balance: 40.00' ESTATE OF CAROL A SHOLLY DONALD E SHOLLY, EXECUTOR PH. 717~I22-5731 108 VIRGII~tIA AVE CARLISLE, PA 17013-1072 ~-~4~~,3 118 DATE ! s~ - PAY TO ~~ ~ ~W~C+ '~ ~~ ~ ~ ~~~rp `_ THE ORDER OF ~j Q - r'' /i.r l'I.J ~ t ~' A._ / • r 1 ~` `' ~`~ ~~ !'~. 4'r-~ ~G•` ARS I!~ ~~~.~~ St ~~ MEMBERS 1~ FEDEYAL C8EDI5' UHION L5r~6ag,PA 11056 ~ wrw.memhmisteg ~~ f' > ~: 2 3 i 38 2 24 i~: 2 i8 3890900~~~6~i i8 ---_. ~_~ ~~ L~; ~~,~ ~ ~e~ 123 rf~~ t QL~ ~m~~ ~ °` ~~y~U~N10N _-. _____ INxhodn6~S PA 17055 ~ ` / ' ~ •wwamemiealsLnB ~~ ~' ~( _____ P :~.. _ ~ __ ~' 2 1 8 3 8 9 0 9 9-Oar'- 1 2 3 ~. 2 3 L 38 2 2 4 L. ~~r«~F l/ >Ir~ %?~ l/~vi ESTATE OF CAROL A SHOLLY so-8224/2313 DONALD E SHOLLY, EXECUTOR 3 , ~~ ~ ~ PH. 717-422-5731 DATE lOS VIRGINIA AVE CARLISLE, PA 17013-1072 ~ ` w. ~ 4 ESTATE OF CAROL A SHOLLY w-an,~z~,3 12 5 DONALD E SHOLLY, EXECUTOR PH. 717-425731 ry ,p 108 VIRGINLI AVE DATE / r~~[) ~~ CARLISLE, PA 17013-1072 ° PAY TO ~,./ / (LT ~~I}.Df~'~~,~C ~ ~ ~ ~3~ , OCR 1 'PHE ORDER OF 1( p (Jsl~ J.hJ~'~'~ ii,i.., :. I" llG~` N ~ t~C~ DOLLARS U ~ e.. $t ~r~ NtEn~oL-t~' it'll 3 r~l ~D~J! -- - - .. ~~vj~`" _ ear ~:23i38224i~: 2L83890~0~~' OL25 ~~~' ~ / -/ V ~. ~~ l ESTATE OF CAROL A SHOLLY eo-s~~xs,s 12 7 DONALD E SHOLLY, EXECUTOR PH. 717-425731 ~ aJ ~ L, ~~~_ 108 VIRGINIA AVE DATE '~ CARLLSLE, PA 17013-1072 A, ~ ~~ ~a~ ~ i" •.....~~ ~~ `~"~ /~ ~ ~ ~ ....2.---.--- ----------- MEMO ~1/~ f•YP.! ~~ ©~ - - --~ ---- ~:23L38224L~: 2L838909 I~ OL27 ~~~ ~~~r ESTATE OF CAROL A SHOLLY DONALD E SHOLLY, EXECUTOR PH. 717-422-5731 108 VIRGINIA AVE CARLISLE, PA 17013-1072 PAY TO ~ ~ ~( Txr: oRDeR of - `J ~~T'../ l~ 1~1: so-:~aizl,s 10 7 DA'i Z7 v (~`~ ,pp QN~ ~ ~ 8 D DOLLARS u ~ ~ ~. ~~~ --- ------ ---- ------- ----------- t:23138224i~: 2L83890 0107 Return this part to address below with a check payable to PPL Electric Utilities Corporation 87730-70007 AV 01 008738 02849E 37 A"5D6T CAROLSHOLLY 113 AMY DR CARLLSLE PA 17013-8810 luu,.~Ilriv~tllll~rlllll~~1~~~~tlNll~~iiui~~lillllli~lhl~ ~,~P:~v $x :$ . :.: ~ :=his-sit:= .' Aug 11, 2010 $164.96 Amouat Enclosed ^, ^. PPL ELECTRIC LTTILTTIES Z NORTH 9TH STREET RPC-GENNI ALLENTOWN PA 1 81 01-1 1 75 1 1200001649620000164960 8773070007 ~~ i0 Ci `~ ~----- ~~~ J J~ ~~ ra ~ J J~~ ~/~ ble to PPL El~tric Utilities Corporation Return this part to address below with a check pays ., ::: - X `==F _ ... . _~-~..= ~~ $17.28 87730-70007 Aug 23, 2010 Amount Enclosed AV 01 008871 065456 37 A•'5D6T ~,^ y ^ CAROLSHOLL 113 AMY DR CARLISLE PA 17013-8810 PPL ELECTRIC UTILITIES 2 NORTH 9TH STREET RPC~iENN 1 ALLENTOWN PA 18101-1175 I~if~ll`II'1'~Id~llt'1~11~1~~~~1~11~1~,~"~11~~1~111111~~~~~1111 1 99~~~0~1728900001717280 877307~pU7 ESTATE OF CAROL A SHOLLY DONALD E SHOLLY, EXECUTOR PH. 717-422x5731 108 VIRGINIA AVE CARLISLE, PA 17013- 72 ~ PAY TO _~ _ THE ORDFK OF - ~ld P.n~ T~-C.n) ~ p1 ~~~i a $f o 110 ~ 1~,aS ~~.° -t3oLLARS ~.,~.~„~. st x~,.w..g`R~ioss MEMOKLf !l TT~~~ -~""~~ -- ~:23L38224L~: 2L83890 l O ~r~~ G`/ ~ `~~ 1 LCG~~c ~,4 I 6p-BTZM2313 DATE . f0 /~JG~ /~ Return this part to address below with a check payable to PPL Electric Utilities Corporation 87730-70016 AV 01 009512 217398 42 A"5QGT CAROL SHOLLY-ESTATE 108 VIRGINIA AVE CARLISLE PA 17013-1072 ~h~lifil4~lil~lii~..ii,~„~il~~lliilumpii.,i~ui~~ih~i~in Oct 8, 2010 $6.48 Amount Enclosed n ^, ^ ^ . ~--F--~ PPL ELECTRIC UTILITIES 2 NOKTH 9TH STREET RI'C-CrENNI ALLENTOWN PA 1 81 01-1 1 75 1 9000OOOCI648~0~~0006484 877307016 ESTATE OF CAROL A SHOLLY DONALD E SHOLLY, EXECUTOR PH. 717-422-5731 108 VIRGINIA AVE CARLISLE, P 013-1072 - PAY TO 7 & THE ORDEK OF 3 S' K ~ Ar'-S a„y ~ ~ S v ~ 7 1~ so-e~2aixl,s 114 DATE j V $~.~5 `~-~ DOLLARS L+J ~ ~ FEDSIAL(F~I7NION 1..~~ - MEMO>~~~ ~~'JD'~DD ~(p / ~: 2 3 138 2 24 l~: 2 L8 389090 O L 14 c' ~ ~ .~ ~' ~-!1 Return this part to address below with a check payable to PPL Electric Utilities C:orparation '~€oia 33~t'ff rtccoant 3~ithnhce . =: ; ` :: _ .... ~~+C:$` :..- . •- -E!ait ~'tjii& #3;~o#Ersi_ .::: 87730-70016 Nav 8, 2010 $18.78 Amount Enclosed AV 01 009410 342768 37 A"5Q6T (~ CAROL SHOLLY-ESTATE ^ ^ ~ ^ ^ J ^ t ^ i~~ -I F~~--}) 104 VIRGINIA AVE ' rr u ! CARLISLE PA 17013-7072 PPL ELECTRIC UTILITIES 2 NORTH 9TH STREET RPC-CiENN I ALLENTOWN PA 1 8101-1 1 75 li~ullil~ih~ll~l~,ii~l~~i~~l~nuulnllll~ilu~rnl~lll~ulh 1 71D00007~8781000D018784 8773071716 ESTATE OF CAROL A SHOLLY DONALD E SHOLLY, EXECUTOR PH.717-422-5731 108 VIRGINIA AVE CARLISLE, PA 17013-1072 _ ~ ~ - NAY" TO - THE ORDER OF t '/ lAV 6d-8224h313 116 DArE I NDv 1 C' ~/ U Cf DOLLARS 8 0'~'~,~. ~gMEMBERS 1~ ` FpDEBAL C$tDR't7N10N ~ / ~~ RYA 77055 •wrw.nm6misLaE ~: 2 3 L 38 2 24 L~: 2 L8 3890900~~ O L L6 F^J D ~' - Return this part to address below with a check payable to PPL Electric Utilities Corporation ~~(-TIjC ~l~C~.D.fHIL.~I;ID7I~f,F'::...:'. 87730-70016 AV 01 008985 444256 43 A"5DGT CAROL BROLLY-ESTATE 108 VIRGINIA AVE CARLISLE PA 17013-1072 Dec 7, ZO10 $18.78 Amount Enclosed ^, ^ ~ ®- PPL ELECTRIC iTI'ILTfIES 2 NORTH 9TH STREET RPC-CrENNI ALLENTOWN PA 18101-i 175 Irlliln~~~l~llll~~i~~h~li~h~lu4hlllmlfnl~~nlli~~l11~<< ], 710a00~18781000D~18784 877307~~16 ESTATE OF CAROL A BROLLY DONALD E BROLLY, EXECUTOR PH.717-422-5731 108 VIRGINIA AVE CARLISLE, PA 17013-1072 ~~, ~ 60-8224!2313 ~ ~ O ,r~ F~ D;.TE ~ 1~i ~-~ ~-~1, ~~ .__._-- >~~.LARS e ~~mR.~~ ;, st ~ ~ j' "~y"EgN, QpDII'UNION , ~7f~~~` ryY YA 17055 _ YTVV • w~ww•memYe°41m6 -- ,~ , . ebb (~? , . -~r~ MEMO ~ 2 2 ~ 8 3 8 9 0~ 0 ~ ~-~ ~:~= ~:23L38224L~: -. ~G? ~rirspr~Ittt~ad~CS~~oapsiibP~L,E~~ _._. Y~.`O ~~ ~'~~* ~ r~ rn~r~-~na ~MM~I~r'ti~~~"r1~~~Nlr~~~ahh~"'N~~~ » 1 920000023682000002368q 8?7307001t~ _-- ESTATE OF CAROL A SHOLLY DONALD E SHOLLY, EXECUTOR PH. 717-~22-5731 108 VIRGINIA AVE CARLISLE, PA 17013-1072 !~ ~ % (r THE ORpEP. OF ~ ;; f I r J .r~.~ J ~1 ~Y ~7 C.- G~Z~t~\ ~~ ~ ~~ 121 `~ 8 ~a ®Gr DOLLARS + ~~.~,. ~ ti~ ~~ MEMBERS 1' ,>~a6mg,PA 117055 N •w~w.membmislo+b ~~,~~ NP r.~ 30 ~_ Qo t~ ~ _ _- ~ ~ ~' l --- -- --- - ------------------ - Mti..~TO ;~ i ~: 2 3 L 38 2 24 L~: 2 L8 3890906~~' ~ L 2 L un ,J ~,l G C , ~~ll 60-ffi24/2313 D~Tti s~ ~ ~!JL~ G J~ Return this part to address below with a check payable to PPL Electric Utilities Corporation 87730-70016 Feb 8, 2011 $28.17 Amount Enclosed AV 01 008803 688058 40 A"5D6T ^ ^ ^' ^ ~ ^ ^ ^ CAROL BROLLY-ESTATE 108 VIltGIIJIA AVE CARLISLE PA 17013-1072 PPL ELECTRIC UTILITIES Z NORTH 9TH STREET RPC-GENN i ALLENTOWN PA 18101-1175 ~h411~lIl~lI~111111~~PlllUl~llll~l~rdlll~~l~111~~~1~11~~~11 1 910000D2817100D0028174 8773070016 ESTATE OF CAROL A BROLLY DONALD E BROLLY, EXECUTOR PH. 717-422-5731 108 VIRGINIA AVE CARLISLE, PA 17013-1072 _ t PAY TO ~ ~ THL ORDFR Ol- .. 1 ji`'> tr''q~ _ ~ th~ / 11/'1 ~/:l~C d S 1 0 ~~'/D~ DOLLARS ~ o."°~.me~ St'- 1 Bats r »>~~~ MEMO~j ~ T~J(~ Z"VVl(It . i _ L~~-_1 .._~ _ _ -- ~ ~. 2 3 l 3 8 2 2 4 i ~: 2 18 3 8 9 0 9 u' 0 1 2 4 -_ _'- - -_- ~-~- ~r f ~~ 60'8224/2313 124 DATE / ~~~ f j !~c F, ,L J~: ~( Return this part to address below with a check payable to PPL Electric Utilities Corporation 87730-70016 AV 01 009156 79935B 37 A"5DGT CAROL SHOLLY-ESTATE 108 VIItGINIA AVE CARLISLE PA 17013-1072 -- --- Maz 9, 2011 $25.49 Amount Enclosed ^, ~ ~ ~- PPL ELECTRIC UTII,ITIES 2 NORTH 9TH STREET RPC-CrENNI ALLENTOWN PA 18101-1175 ~IHrur,Inrr,~,rrpr,n,ur,rr,ur,r,r„rgr~llPll~~urrr„rrr 1 78~000025498000~025494 877307016 ESTATE OF CAROL A SHOLLY DONALD E SHOLLY, EXECUTOR Px. n7-'1~~7s1 108 VIRGINIA AVE CARLISLE,~PA.j\~1\7013-10`72 }r PAY T(1 I ~ -l 1r'~ ORBEK OF ' ~~~Q a - ~~~ ..~5 DOLLARS 8 St ~~ ~ la isv HIE-naoR~ ~ 3~"'~_~L~ - ~------- --------'-"' ~:23i38224L~: 2L83890 OB' OL26 , ~l~rl~. tCc~. ~,~\ 60-8224/2313 126 DATE ~ ~ 7~ ~ U L Return this part to address below with a check payable to PPL Electric Utilities Corporation --- - -~- ..::~...s= -:' ---~ ~ >- ---- ~-- - ---~~ -mac -::: 87730-70016 Apr 8, 2011 $23.91 Amount Enclosed AV 01 009430 925558 41 A"5DGT ^ ^' ^ ^ ^ ^ a CAROL BROLLY-ESTATE ^ 108 VIRGII4IA AVE CARL.LSLE PA 17013-1072 I~i~l~ll'~ill~'~'1~~1",I,I,II~d~lh~,~,,,Idy~~lli"11'1"~1~ PPL ELECTRIC UTII.ITIES 2 NORTH 9TH STREET RPC-GENNI ALLENTOWN PA 18101-1175 1 9600000239160000023914 8773070016 ESTATE OF CAROL A BROLLY DONALD E BROLLY, EXECUTOR Px. n7-~z srai 108 VIKGINIA AVE CARLLSLE, PA 17013-107? PAY TO THE 60-822M2313 129 DA ~ Y"l -4"1C. ~t J $~,~ , ~( ~~'-DOLLARS 1~! BLi`~~ QffiiA~ON •. .g • ~ f DEMO ~ ~-~ ~ ~ as ~ ~ , ~ -- --- ~.~_ ~:23L38224L~: 218389 L29 ~~, ~~ n~ ~ ~~'~~ , GAS