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HomeMy WebLinkAbout10-20-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE REV-1162 EXI11-96) BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 015085 STONE DUANE P 8 N BALTIMORE STREET DILLSBURG, PA 17019 ACN ASSESSMENT AMOUNT CONTROL NUMBER fold ESTATE INFORMATION: SSIV: 174-36-0042 FILE NUMBER: 2110-0744 DECEDENT NAME: MILLER THADD A DATE OF PAYMENT: 10/20/201 1 POSTMARK DATE: 10/20/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 07/ 13/2010 REMARKS: RECEIPT TO ATTY CHECK#116 SEAL 101 ~ 54,155.20 TOTAL AMOUNT PAID: INITIALS: WZ RECEIVED BY: REGISTER OF WILLS REGISTER OF WILLS 54,155.20 GLENDA EARNER STRASBAUGH -~ REV-1'SQO~`~°'•'°' Lsas61o143 PA OspartmsM of Revenue OFFICIAL USE ONLY Bureau of Indhddual Ta1ros o ~unK rar Po I9W(.2el0801 INHERRANCE TAX RETURN 21 10 0 0 7 4 4 Harrblw~p, PA 17128-0801 RESIDENT DECEDENT ENTER DECEDENT INF~tAMTtON BELOW Social Security) Number ate of Death I~` Date of Bidh 174 36 0042 0713 2010 02 18 1944 Dsoadant'e Last Name Suffix Dsoedent'a Firot Name MI MILLER THADD A (N AppNpbNl Enbr SurWvMg Spoues'e InfomlaNon BMorv use a last Name Suffbc Spouse's Ferot Name MI Spouse's Sodal Securely Number THIS RETURN MUST 0E FILED IN DUPLICATE tNRH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS 6ElOW ® 1. tklplMl Rebwrl Q 2. 9upplsmantel Re41m (] 3. Relrlalnder Retunl (date of deelh v~ b 1s•1a.e~ Q 4. LImN~d Eabta Q 41. edit: of ~ 1~ 2.12~.~ (~ 8. Fsderol EWaOe Tau R~tun Ii~quked Q e, t>~o~rr ONd Tewa (i1M~~PYd W44 Q 7. ~ a 1MIne Tnn~ a. Toth Number of Sete Oapotll 8ooaes Q . • Y. utlOsNon Pnx~du Reaelwd ~ _ -Q 10. ~~d ~ Q 11 • EIeOMon to hK under Sea a1 t 9(ly (Aloecn Ban. O) COMEBPONOlNT • THIS SECTION IIAp<!ST 0E COMPLETED. ALL CORRESPONDENCE ANO CONFIDENTIAL TAX INFOIIMATI~1 ailOULD 9B OftECTED T0: Noes laaytlrrw Telephone Number • DUANE P STONE 717 432 2089 REGISTER OF~MALt.B USE ONLY ~ ~_, RMeI Ilne of address ~_ p aL ~7 8 l~1 BALTIMORE BTttEET `zn ~ ~?~ r ~ ~`~ - _ SaCOnd Ilse of addnua r ~~ ~ r 5 Cky or Peat OMIa Stab LP Code -- `:_ c= ~~ ~ DILL9HIIRa PA 17019 ~:~ ~ ~ ~ , conwpond.M~a.-malladar...: Duane~Stoneatlaw.com v ~~ and h Iii °fuue,"'ao i~ anidoon~pii~. ro ~ on~evrs~perer~aner Ihsn~"t~iea I romp a ~ well . n 01 w d~vn~pene- nee biny"'~°°knoMA d p.bolel, Helen 8. Miller • ~ ~ T613 Leuralin Piece, 8pl-IngeAeld, VA 22180 150561~D143 1.505610143 J 8 N. 8eltlmot+e Steroet, Dlllebuerg, PA 17019 Sida 1 J 1505610243 REV-1500 EX Decedent's Social Security Number °'SN~,e: MILLER, THADD A 174 36 0042 RECAPITULATION 1. Real Estate (Schedule A) ......................................................................................... . 1. 4 5 , 8 1 7.12 2. Stocks and Bonds (Schedule B) ............................................................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3. 4. Mortgages & Notes Receivable (Schedule D) .......................................................... 4. 5. Cash, Bank Deposits 8~ Miscellaneous Personal Property (Schedule E) ................ 5. 2 9 , 4 6 5 . 3 9 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property . (Schedule G) ^ Separate Billing Requested ............. 7, 3 3 , 7 $ 1 . 4 0 8. Total Gross Assets (total Lines 1-7) ....................................................................... g. 1 O 9 , 0 3 3.91 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 13 , 21 1 . 0 6 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 4 , 9 0 1 . 5 4 11. Total Deductions (total Lines 9 & 10) ...................................................................... 11. 1 $ , 112.6 0 12. Net Value of Estate (Line 8 minus Line 11) ......................... . ................................... 12. 9 0 9 21 31 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. 9 0 , 9 21.31 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 15. 16. Amount of Line 14 taxable at lineal rate x .045 9 0 , 9 21.31 17. Amount of Line 14 taxable 16. 4 , 0 91.4 6 at sibling rate X .12 17 18. Amount of Line 14 taxable at collateral rate X .15 18 19. Tax Due ................:.................................................................................................... 19. 4,091.46 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 15D5610243 1505610243 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 10 - 00744 Total Credits (A + g) (2) 0.00 3. Interest (3) 63.74 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 4 15 5.2 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 :.............................. ^ .................................................. retain the right to designate who shall use the property transferred or its income :.................................... c. retain a reversionary interest; or .................................................................................................................. ^ ^ d. receive the promise for life of either payments, benefits or care?............ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without x receiving adequate consideration?............ ^ ^ ................................................ . ........................................... 3. Did decedent own an "in trust fora or payable upon death bank account or security at his or her death?......... ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate praperty 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. §9196 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax reffum 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 ars of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0 percent [72 P.S. §9116 (a) (1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. • sibfrig is defined under Sectiont9102 as anrindividual who has at least one padrent inscolmmon withthe decedent wfiether by ti ood or adoption. Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Pa (1) 4,091.46 yments A• Prior Payments B. Discount SCHEDULE A COMMaJWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Miller, Thadd A FILE NUMBER 21 - 10 - 00744 All real property owned solelyy or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be excF~anged between a willing buyer and a wilting seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must tie disclosed on schedule F. Attach a copy of the settlement sheet if the property has been sald. Include a copy of the deed showing decedent's interest if owned as tenant. in common. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 40 Camelot Drive, Carlisle PA 17013 (assessed value $88,740 x 1.25% Common Level Ratio=$110,9250) 45,817.12 TOTAL (Also enter on Line 1, Recapitulation) 45,817.12 SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEILLTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Miller, Thadd A FILE NUMBER 21 - 10 - 00744 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER 1 From Orrstown Bank Accounts 2 Highmark Blueshield refund 3 Auction of Personal belongs 4 Century Link Refund DESCRIPTION VALUE AT DATE OF DEATH 16, 564.11 82.80 12,724.50 93.98 TOTAL (Also enter on Line 5, Recapitulation) 29 465.39 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT INTER-VIVOSD RA-NSFERS 8~ MISC. NON-PROBATE PROPERTY ESTATE OF Miller, Thadd A FILE NUMBER 21 - 10 - 00744 This schedule must be completed and filed if the answer to any of questions 1 tht"n~~nh a .,., ..,..e ~ :....__ ITEM NUMBER DESCRIPTION OF PROPERTY Include the name of the transferee, their relationship to decedent and the date of transfer. Attach a copy of the deed for real estate. DATE OF DEATH VALUE OF ASSET DECDFS INTEREST EXCLUSION (IF APPLICABLE - -- ~ --• TAXABLE VALUE ) 1 Edward Jones Account # 37712008 2,oo~.9a 100% 0.00 2,007.98 2 DC Pattern & Tooling 401 K with Ascencus Ac t # 3~ c 208666 ,7a3.a2 100% 0.00 31, 743.42 TOTAL (Also enter on line 7, Recapitulation) I 33,751.40 SCHmULE H COMMONWEALTH OF PENNSYLVANIA • `~' ~+ is Q INHERITANCE TAX RETURN ~ w~-~ RESIDENT DECEDENT ~'~LJI.w ESTATE OF Miller, Thadd A FILE NUMBER 21 - 10 - 00744 Debts of decedent must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. 1 Hoffman-Roth Funeral 2,860.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees Stone, Duncan & Associates 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 5,102.87 Claimant Street Address City State Zip Relationship of Claimant to Decedent a. Probate Fees Register of Wills Register of Wills 316.50 Register of Wills 15.00 5. Accountant's Fees 15.00 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Bond-Cincinatti Insurance 100.00 TOTAL (Also enter on line 9, Recapitulation) 13,211.06 Sdied~,ie H COMMONWEALTH OF PENNSYLVANIA "~ ""'~ D[ INHERITANCE TAX RETURN A.i.~: RESIDENT DECEDENT ~"~/ ~ ~ ESTATE OF Miller, Thadd A FILE NUMBER 21 - 10 - 00744 2 Executor travel expenses (gas and food) travel from Virginia to conduct executor business 166.50 3 Administration Expense Holdback 150.00 4 Executor lodging 5 days throughout year travel from Virginia to conduct executor business 594.45 5 Auctioneer Fee -Little Ike Eichelberger 3,890.74 Page 2 of Schedule H SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES, & LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT tsIATE OF Miller, Thadd A FILE NUMBER 21 - 10 - 00744 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1 Members 1st FCU checks for estate account 2 Cumberland Goodwill EMS 3 Carlisle HMA Physician Mangement 4 Bronstein Jeffries PA 5 South Middleton Township Municipal Authority 6 CenturyLink 7 PPL Electric Utilities 8 Robert C. Cairns, Tax Collector 9 Interstate Waste Services 10 PP&L 11 Robert Cairns, Tax Collector Local taxes (March Payment) 12 S. Middleton Township Municipal Authority 13 Baymont on Call (Tree fell and ripped electric of house) 14 Ed Crum (lawn service) 15 Interstate Waste Services 16 Embarq TOTAL (Also enter on Line 10, Recapitulation) AMOUNT 13.95 50.00 129.00 11.01 119.13 58.35 163.33 993.52 297.25 243.52 243.34 379.89 1, 266.41 120.00 55.80 148.52 4,au ~.~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Miller, Thadd A SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS continued FILE NUMBER 21 - 10 - 00744 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, inrluding unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 17 Ed Crum (lawn service) 200.00 18 Robert C. Cairns, Tax Collector (April payment) 243.34 19 A to Z tax Service (final returns) 90.00 20 Tractor Supply to fix vehicle 9.52 21 Home Depot (door shoe) 8.98 22 Lowes (key) 1.89 23 VA Tire & Auto 20.00 24 Postage 31.01 25 Lowes (duplicate keys for auctioneer) 3.78 Page 2 of Schedule I REV-1513 E7(+ (11-08) COMMONWEALTH OF PENNSYLVANIA SCHEDULE J INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF Miller, Thadd A NUMBER ',' NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I~ ;TAXABLE DISTRIBUTIONS [include outright spousal distributions and transfers under Sec. X116 (a) (1.2)] 1 !Helen B. Miller 7513 Lauraline Place Springfield, VA 22150 FILE NUMBER ~ 21 - 10 - 00744 RELATIONSHIP TO SHARE OF ESTATE i' AMOUNT OF ESTATE DECEDENT (Words) Do Not Liat Trusteelsl ~ (~~) daughter ONE HUNDRED PERCENT Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 coverlsheet, as appropriate. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 ~~. ' ~~~ .1~ 'i'i3f3Ei~lAt.C;lit~lli'(' M;Jp1'kf'~N Dills~~:rq 5 Tz n Driv Dillr_..rg PA 17019 Inquiries Call: Acct XXXXXXX842 Eff: 09/22/10 Tlr: 0157 717-502-9992 ESTATE OF THADD Date: 09/22/10 Tiros: 11:35am Deposit to REGULAR SAVINGS 0000 Prsv Bal: 0.00 Amount: 5.00 New Bal.: 5.00 Seq: #279325 Deposit to CHECKING 0011 Prev Bal: 0.00 Amount: 16,559.11 New Bal: 16,559.11 Seq: #279328 Chk hld rls 09/24/10 4,750.00 Chk r'~ rls 10/01/10 11,564.11 duc rLarge Deposit Check Raceivod 16,564.11 Authorized by ID Source: ^ Drv Lio ^ SigCard ^ Known ^ Other Take advantage of our 3.99 APR for VISA Balance Transfers or Cash Advances far six months.* Ask for mora details. Hurry - Offer. ends 10/31/10 ESTATE OF THADD A MILLER a Y U V ~. ~i O O ~ O ~ ~' ~ ~ O N .~ ,~ H ~ ~ (~ ~ ~ O ~ ~ N ~ O N ~ ~ ~ \ ~ ~ a o ~' a ti N O ~z o N A O BUYER _r: - ` " ' BUYER ITEM ~ _ ~ `~ `~~ ' ' ITEM LOT # ~ LOT # t ! = f~ 1 ' Q~ ~._~ ~ i -------------------W-----~----~-~--------- ~ -------- ~---• -- 3 BUYER "`-~~~~~~' s 4 BUYER ..; , ~ ~ ITEM t r~ F , ~-~' y ; ' -,~ i i i ITEM LOT # ' f LOT # a ~ 1 ,... _.. ~ ~ i _~ _ • _.._ _ r---_- ------------- - -_ __ -- - - _ - -- -- - _ BUYER ~ 6 __ -__ . BUYER ITEM ' ' ITEM 9 LOT # e LOT # ® _ ~ ~ _ ~ $ ~ - -- -- --- --- o - _. _ --.- - 7 , $ BUYER ~ BUYER ITEM i ITEM LOT # ; .LOT # ~ _ ~ ® _ $ ~ - - - --- -- -- ---- -- --- --- -- --- --- - - -- -- -- -- --- 8 , __ 10 -- --- -- -- --- -- - -- - - - -- BUYER ; BUYER f ITEM ~ ' ITEM 0 LOT # ~ ~ LOT # Ca3 ~ ~ ® - ~ ~ _____ - 1BUYER ~ 12 _ -- ~ BUYER ITEM i ITEM i LOT # _ ; LOT # ~ _ $ ' ~ _ - ---- ---- - - - - - -- - - -- - 13 -----~----------------------------~---_ 14 BUYER ; BUYER i ITEM ' ' ITEM LOT # LOT # C~ _ Q ~ • ~ _ W ' i ~ ~ • _- - - - - - - - - - _ - - - - - - - - - - - - - - - - - L - -, - - - - - - -- - - ~ 15 ~ -------------- BUYER ' 16 BUYER ITEM ~ LOT # ~ ITEM ' LOT # i ® _ ~ ~ ~ - MEET # .-°~f`- ~ .SHEET TOTAL $ /• J~'' ~ ' ~ RUNNING TOTAL $ ~ ~`~ ...`~~} 7 ' BUYER ~'~- ~` ~ ITEM ~ ~ '`r ~ +;, ~ .~ . ~ ~ ; . ; LOT # ..m.~ ,> ® _ . t.~ ~'..~ ~ B BUYER _ ~,,,..,~, i 10 _.. - ----. i ~ BUYER'~_ ,,' ~~ -,~ F # .. ITEM ~, ~ .`~ i .,_ fi ~ . ~ _ ~ ,~ ~ . t ~ +-~ ~w~, ~ ITEM 1 E ' ( £ ~- LOT # ~ LOT # ~ ~ ~ ...• --- - _ __ _ -- --- --- 1 BUYER , , s .. , ,~ ~k fi~ ! 1 BUYER `+ -.._ __ - -- - - -- --- -~ ITEM ,~ <"f ; T ~ .~ ~s ~ ~.•~ ~ ITEM $ I ~,~ fit..- s .k LOT # ! LOT # . ^'Y A - ,,,~ ~ I ~. -. I ----r----------------- ' 13 ~:, ~~~# ~ 14 , - v ` ~ BUYER = „~'r ~ BUYER ITEM ; ,~ ~' ~ ~: ~ ~~' ~ - ITEM ~ " _ ! ~ f ~~ ~ LOT # ~ LOT # ~ $ ~' ' _ _., _------------------------ ` I 15 ------------------ BUYER ~ 16 - ~ ' BUY 3 r-~ r ER ' ,. . ,a I ITEM ~ : ', 1 , ~ , ...~ ' _ ~ ITEM t ' ~ ~ r~ ~ ~ _ ... '~ ~ '' ~ ~~ ~ LO # ~•, ~ ~ ~ -~ . _ ~ _. , - ~ LOT # ~ _ ~ ~ ~ • ~ ~ e ~ ~~ ~ .. SHEET TOTAL ~ ~ ^ r r - tHEET # '. `~~ ~~ ~ ~~ ~ RUNNING TOTAL $ !' ~.~ ~ ~ ~. p BUYER 9 BUYER - M .q ITEM-L _ ° ~~ $-----~ ° ITEM 4 ' LOT # 3 ~ ~ LOT # ',• i ---- ! - i ~.-_---- L ° ~ ~P 3 ---------- ----- -3------- --------------------------- BUYER ,•-~ i 4 _ '-' ~ BUYER 3 ITEM _ `^ :~ ~ _ ! ~ ~ . _,p z , ITEM ,.. LOT # .,_ m LOT # ~ .:.-{ ._., ,. __. ... _ ..._ - --- _. _ _ _.._ _. - _ 6 BUYER ~ r _ ' BUYER ~ ' ITEM ~ ~ I ~ _ k ~ ~ ~l ' ,' ~` . ~ ° .°'` `"" ~ ; ~ ~ ITEM ~ i . ,-'' ~ ,~. ~ ! ~ LOT # ~ ~ ~ ~~ ° ~ ~ ~ LOT # ~ ~ o i • $ , _ ! - - -- -- -=-_I BUYER `~ _`. ° 8 _ ~~. ,: _.~- f~ ~ BUYER J {` v,~.,~ ~` .f ~ ITEM ~ ~ ~~~'S ° i r` 1,~~ ~ ~ ITEM I x ' ~ , LOT # ' ~ O°# i //~~ 3 f /~ , } ~. I 'V' _ ~ i. ~ 9.... ~ ~~° ..t I ' i ® - i ~~ ~ ~-------- 1 ~~ ~ -- --- -- 9 r - - -- -- BUYER_ _ b. ':' F 10 ~. _ . .,_ ,-.. ~ ,~..,., i "' ; BUYER ~ a ITEM ~~ °~ ~ ~ ~ _ ~ ''~"' ~ ITEM LOT # ~ ~+ ~ LOt# ~ i s''.` _ _ ____ - - ------ 11 - -- - _ _. __ - :, BUYER ~° ~ .'' i 12 , . ~_i ~ = BUYER ~,i'' ~ n ~ ~ .~ ~ - # ~ _ 4~ ~ ~ EM _ ~~ f l r ITEM ~ t ~ ' ~ ''~ ~ ,~ + LOT # ® - ~ F~ ~ ~{ ! ~ 4 - - i -_ -' - _- -_.. __. 1 13 - -----+ ---------------------------- _ __~ BUYER ~ ~_ ;, ~ 14 ., .._ BUYE . ITEM - - ~ -~-,~+ . ~~ ~ ITEM ,~ ~!____ , r ~ ~ .y~' LOT # ~ ~ f LOT # j _ F ~ ~ ' _ $ 1BUYER - ----- -w f ~~ ' 16 _ - -- --- ~, ,~ ~~ BUY -------- -J --__- i~ ER ITEM - ~ 3 - "~, LO # ~ ITEM ~ ~ ~ .: ..._, --~. ; LOT # h t i _ $ •HEET # L SHEET TOTAL $ /~~ ~~ ' ~ • ` - RUNNING TOTAL $ .'j-~ ~ ` e~~,° ~~. BUYER _ - _ - - - BUYER =' u t_ ITEM ~ ~ LOT # ~ ITEM 4 .~ ~ ~ ~ . F LOT # ~ .-. ~, s -_ ~ <"' ~ ! 1 f BUYER 4 - i z " ~t d i BUYER -.,.-~ ITEM ~ 1 ~ ~ ,~~ ~~ ~ ~ t ~~ ,~ ~ ~ ', : Y F ' - ; ITEM ~ ~ ~ ~' ~ ,' ~~ r ; °. a LOT # ~ ~-~' - ~ -- LOT # ~a ~~t ~ i ~ -.. -_ __-_ _.- --_. - W v, 5 -- -; _ ----- -- _ ~,, f 6 __ ___ - - _ - -- -__ BUYER `"'~ ~y,, ~ ~ BUYER - ~ `:~ ITEM t r ' ' _ -~ ~ ~ ~ ITEM i ' ~ ~ . ~ . ~ x ~t LOT #~ -'~ ,~ ~ LOT # ~ F ~ _ ~ --- - _.__ __. __ .-- -- -. ...- -- - -- ~ I i - -. - _._. _. _. - -. -- - i - - ' BUYER -~'~ I 8 ,--- "~ ' F BUYER ~-~ , ' ~ ~ ~ ~ ITEM _ ~ ~ ' ~ i ~ ~ ~" LOT # ~ ITEM ~~~`; LOT # - ~ ~. ~. ~ , - $ s Y- ---__- - - - -- , .- 9 _- - - ~ - -- -- - - --- --- -- -- - - BUYER "'•~ .._ ~ __ = ' BUYER ~~ i•.- f ~.1 ~'~ fi ITEM _ ± ~ ~ ' ~ , ~ ITEM ~ i ; ~ r ~ ~%~-~ I, LOT # ; LOT # ~~ f _...z _ `s - a ~ - - -- -------.__------ -- 1 11 , - I BUYER ~ ; 12 - - - - ~ BUY __ ` -~ ~ ~~ ER f ITEM ~ Y ~ b~ `° t ~ ~~~ `~ ~.,.r.. i ~. ~ "., -,. °~~,~ ~-~F ---=-~ ~ _ ~~ ~ LOT # ' ITEM ~~ } ~~ ~ ~~ ~~ LOT # `~;} • ~~ = , ..~ $ ~ r ~ 13 ,------- ---- -------- $ BUYER ,~~ i 14 _ -- - ~- 1 ,, `~ ; BUYER ~t` -• -~ ITEM ~~ ~r , ;~.. ((' ~` ~ i ~ • I~ ~ °p ~ I ~ ITEM _ E. `~ ~~ LOT # , ~-=-~- j ~ LOT # 15 '------------------------- -- BUYER ~, ~ 16 -- ~ : ~ ~ ; BUYER ~ ~ _ ~ ITEM _ ~ . s,. _ '; ~ ~' -~~ i i - r -~ ,~ `~ .:~. t LOT # i ' ITEM ~,.~~ • ; ~_~ LOT # j $ •. ~HEET SHEET TOTAL ~--~f - ' - _ - ~ RI INNINr T(1TAI $ t''}`' ^ ~~ j _ _ UYER - ..' ~' BUYER ~T - ,._ ITEM '~~ s ~ i ~ ,. ITEM _ .k ~ ' t.`~ LOT # ~ LO # ., t ,~ ~ ~ ~ ~ ~. ~ ~ _~ ,_ ; 3 -----------------~------- ------------------- ...~:~ ~, 4 BUYER _ ~ _ - , -- - r. BU t ,y,~~ _ , ITEM I ~ ~ } #° ,~ ', i ITEM ~ ~~ ~ ~ _} ~ '~ LO # ~ ~,..,k ; LOT # • ~ ~~ "+ i v. i ,~ f -- - __ - - - -_ - -- - -- -- -- ' $ ~ ~Y --- - - ---- r _ -. -- __ -- . 5 - -- ~ r, ~ _--___. -- - - _-_ -- - _; BUY ~ t.. _ ~ ~ ,~ ~ B ER E ~ ITEM , ~ ~ . i s ~ it ~~ ~ .ri..g ~'~.- 7 ~ ~ -~, ~ ~ ITEM ~ ~ ¢ ~, ~ ~.,~ f,r` ' `'~ LOT` # ~ `-~~• `~"°`~. i ' LOT # s~ - P a t t ~ ~ $ ~ `°. ~ i BUYER ~ `~- ~~ i BUYER ~ : ~ ,~ i ITEM ~ - ~ _~ ~°°~ ' ~ - ~ ~'~, ~ ' i-i ~ ~ .~~~ i ITEM .~ ,. '-_°- LOT # 1 ' E - ~ L. f r ~` ' _ $ r',. 1 ~ a - -- -- - - .._ .. -- -- -- -- -- -- ----- -- ------r -_ ------ --- -- --- - i 9 ~,:~ ~,~ ~ - - - _ _ -- - - -- -- - - -y BUYER Y ~ """~ ' 10 .~.' y% ' ~ .BUY ITEM .~_~ ~ _ ~ xf ~ ~ ' ~ '~ ' ITEM ~ ~~~ .~~~ ~ ~ ~ -~~ }> ~ LOT # ~ _-_ ~ LOT # -_ , .._~ ---.-.-_ ... ~ ~ r C~ - $ •. -- - -- ---- --- -- -- -- ---- ' 11 ~ -- -- - - - -- - - --- --- -- i' R .: •, ~- LOT # -~ ~ - ti ; ~ ITEM , ~L~ - ~ ~ , t .J ~~~ LOT # ,._ -1 .~° ~y' ya. ~. -~-------------- f s 13 -------------- ~----- --r--------------------------------- ~ ~ 14 t~~~ -'~ BUYER ~°"~•^~, i .~.~ ~, ~ ~..-= , BUYER ~ FY ITEM _,~ ~~ t -r, ~' t ~ ~ ~ t i ~' s ~ ~ _'~'- ' t ~' •_ ~-~ ate, ~-=- ~; ; ITEM! ~.t. ~~ ~ ~1 °~~~ i LOT # ~ i LOT # I ;_,. --- ---------------- .- - ~ F~ ``_ " .~.: t , BUYER - i. , , ITEM ~ °- . ~` g ~ „s , ~ ~ ~-- LOT # + '-°"`-~-----~=1_~.~ , i ITEM - ~ f ~! ~ ~ ~ j ' LOT # p' ~ ' I -~~y- _ ' HEET # cam'` SHEET TOTAL ~-~ ' ~ '7 ~ ~ RUNNING TnTAI $.~~ 2f'L~C., y~' f ----- - F 3 3 , ------- --}---- t:,, '~ ' 4 BUYER i BUYER ITEM •.,. ,; ~. ~, _.., > t _ i s ITEM ~ r ~ ~~ ~ ~~e ~ ~ , ~ F ~ ~=""t LOT. ~? , - .. ~ ' ` ' L # x ' ,. ., _ a ,~ ~ _ s ~ `~,--~, - __--- _ __ _... - - BUYER ~ ° ' 6 '" ' BUYER ._LLs ° -~ °--r-- r._. , ITEM _ ~ ~ ~ 1i i P ,r~ ~~ ~ ITEM ~ ~ %' LOT # ; LOT. # °w,.d .: ` r - ~ j ;.~' s - - - -- - - - _ - _. __ - _.__ _.. _ 3 -. -- -- -- - __ - -- -- _ - _.. __-- " - E- _ __ __ _-...._ 7 ~ y I ~ - -- -- -------- ~ -- __- BUYER ~~ --' ; 8 BUYER ~ ~ ITEM ~ ~ ~ i i t~ ~ f"~ - }r , s 1 LOT # r + ITEM .~.~ ~ ~'~: LOT # ,- , ,-, _ ... $ ~ ~_ - ~~.~ ~a , ~ -_-- -- -- -- -- -- --- -- I - - -- --- - -- r- - --- - - --- -- -- - -- - - - 9 y , -- -- -- -. BUYER ~- ,- ' 1 ~ a ,. _r . ' BUYER .._~~ ~... ~,: ~ ITEM .~ ~ ~ ~~ , ~ ~.t'"--~- ' ITEM ~`~..$, r` '. ~ (` ,~ LOT # i _'g-~'-""' ' ~~ ~ ~ LOT # ~ ,. ® ~~..,' , ;~ t , :- _.. -- -- __ _ __ _ _ _z__ _ 11 y , - -- -- - - - --- -- i~ `: r `~ ' 12 BUYER -~ -- i BUYER ~` `' ITEM ~ t ~, .P {~ ~ ~f ; ,~ ~ t ~ ~ , . ~: , .`'` ~ ~ '~~. -'_"_"f_" ` ' , ITEM ~T~~: { r ~{ ~ ~ ,~' ~ ~ ~ ~ L # i ; LOT # ~ 13 r------------ ----------------------------~ , BUYER _ ~ i 14 :` ~~ ~ -- . ~ , BUYER ~~_ t -,~ j __ ITEM ~ r, ~ . ~ , ~ ~ t ~ ,~ ~ r I ' ITEM ~ ( ' ~ ~~..~~ ~~, , LOT # i LOT # £ ,,. ~ r - r 15 i --------- __ ___~ -- -- - I~'``' ' BUYER {{ _ ' 1 BUYER ~'.'~"~ ~° ITEM t { ~ ~~ ~ t ,~.1 r 1 ~ ~~ ~ ~ ~ LOT- ~ ITEM ~', s x _ ~ ~~ t ~ LOT # ,F ~ - ~ ~ st , ) ~~ff %%~~__~~ ~ C~- _ ~ ~ SHEET TOTAL ~ ! RUNNING TOTAL $L~CJ1,_ BUYER 4. BUYER ITEM -~ - 1~ ~ r ITEM ,I ~ ~ ~ LOT # 1 `- ~ ~~ LOT # ~ ~ _ 1 @ t k _.. 1 - ., ~ _ ,~ ,.,, W • 1 ~ k ~ 1 _~_ - ~ j • -....._._. 1 3 - ------------------ 1 4 - - -- f BUYER ~` ~.._. ~ i BUYER 1 j . , ~ 4 ITEM __ ~ ~ I ,. ~ 1 ITEM _ ~ ~~ ~ ~ ~ ~ ~ ~1 ~ ~~,..~ LOT # ' LOT # _x _ _____ - --------- 5 a~~ ,~'"'t,` BUYER ,,,~`,...... ---~ i ITEM. t :° ..}; ,,} ~ ~ ~ ~ T'y~' LOT # $ ~_ - ~ .~ BUYER µ.~ ~ '~ } k _ tir .-. r ~ _.~. ~ ~ ~ ITEM _ ~ ' ' j ' ~ ~ ~~ ` LOT # 1 C~ _ $ f ,.~ . ~ _.~ 1 ___. -.. __..- - -_. - -i g 1 BUYER r ~ i s ITEM _ i~...~ ~~: ~ ~ LOT # .~ ~~; ~°~ ~ ~ _ $ 1~. ; 1 1 BUYER ~ 1 1 " j+ % ~ ~~ i ITEM ~-. ~~ : j ~ ~ 1 r LOT # r 1 f ~ 1 -------- -- -- 1 ----------------------t- 13 ~ BUYER -~ ~ ~ ITEM ~ ~- _ . ~ ~ .~ ~ ~ 1 ~ "i~ ,.. ~~ ~ 1 Ofi # ~ ~ >. ~„--] 1 ~ 1 ~,f ., `~ ! 15 1 BUYER ' ~,~ 1 ,_:, _, 1 1 ;. .~ t J'v'"'.~'""" i ITEM ~ ' "` ~ , 1 LOT # ~ ' P _ ~ ~' ~` ~ y , a I 1 HEET # _ SHEET TOTAL ~ a 3. BUYER - ~ _ '.~" i~ BUYER .. - ITEM ~ ~ ~~ ~ ~ ' F ITEM ,~ i ~ ~~.. a ~ z ~ f,, LOT # ; LOT # ~ ~` ~ $_ ~ ' ------- 3 ~ --------- ---- - BUYER ~~~ i ~ 4 ~ ~"~'' - + BUYER ~,,,.`,~ E ,~ ~ , ~ + r ITEM... s , i ~~f ~ , ' ~~'" j s f ~ ~ ~ ~:, ITEM C r € t I : ~ ~~~ LOT # ~ LOT # ,, ~ , i - ~ . - -• _ -. _ +_ _. _ _ _ - - --- BUYER ~ r.~; ~ 6 _ - - `,~ -_ BUYER ~ „, ~ ITEM r ~ .:'a~ ~ ! ~ ~ ~ ,~.,, i ~ ~ ,-,~, ! 3 `. ~ f i ~ ITEM , ,. ~ r ~,. .~ + l - LOT # ; LOT # L.~~~ ~ , __ ~ t ,.. ~ ~, _ ~ ~ `~~ ~ y, ` I d -- - - - -- --- -- -- ® ~ ~_,~f - ------ ' - -- + -- - - - _ 7 BUYER ~~ ' $ BUYER ,_. + :~ ~~ i ...f. a , _~ ..,, ~ + ITEM _ .. s ~ 3 ~ ~ : ! ~ ! ~ , ,-., F 8 E ~ ~ i ITEM _,' ~. ,'~. ~ ~~ , ~t ~ .,~ _ s ~ ~~ ' ! LOT # ~ LOT # ~~ ;~ ~' ~~ I .. ' , ~+ i ® - . ;~ ~ ~ ® ~ I~ ~ ` -- -- - - f 9 _ _ ~ . r. i ~~ ~~ ~ 1 BUYER - --- - - -- - -- ~ -- - BUYER ITEM .~ '~ ` ~'" ; , ~ ~~ i _,. ` r ~-~=~ ~ s ITEM ~~ `, ~ ~ ,,,-~ f ,.,2 LOT # ~ LOT # ~~ ' ~ i ~wP ! . ~. ~~• __ _ 11 - + i 12 _ - - -.~., a BUYER { F • + BUYER -~ i r ' -. ~ ~'"'~ t ' a,~ + ' e~ ITEM `~ ~ +'. ~ I ;~ ~ ~ ; ~~ ~ ~ t" -`- 1 r" t ~ t 1-~ i i ITEM i t ~; LOT # ~ , - " ~ € 1 ~ ..~. = i LOT # $- ,-- ~ $ C~3 .~ ~ + _ ....~f ------ - 13 -- k----------- -------- ------ BUYER ' 14 ~ t , BUYE ~ ; , _ ~. - ~ ITEM fi~ }-' ~' =T ~ ~ € ..~ ~ i ITEM •, ~r ~ i ' ~+ :; .: t , ` I LOT # i t ,; ~ `` + LOT _ _~ ... , _ t • `15 -----------=--+--------------- - ---j BUYER 16 9 __ ; BUYER ~ E~ .! ITEM _ ~ ~ i : , F , , ~ d ~ ~ , 5~ ~ ~ g i ITEM ~ ~ : t 7 ~ ;~ ~• LOT # - ~ i f ' ~ ,.. ,~ ; LOT # __ ~- _ e - _._.. iHEET # SHEET TOTAL $ ~ ~"~~ i $ ` ~~ ~~' _ RUNNING TOTAL BUYER ~.., ' "` ' r BUYER - ITEM ~ <! ~'~ ~ ' ~ ITEM ~ t3 f .~ 7 { L0T # ,~ ~a . ~ .. j ~ ~ `~ ,~ '. ; LOT # r f ~ ~~~ ~ - $ a ~ _p _ ~ -~ ~ 5 _ , 6 - ------a BUYER ~Y ~ ~` ITEM ~ _$~ i " ~~ ~ ITEM ~ ~:~A,{ LOT # ~ .~ ; f~K, ~ ~•~_ ~ ~' ,-~. ~~, ~. - _ » t ' LOT # t .. ,- ~, ,. ~ ~< .,-~ -_ . ,,.. ® _ ~ f,,f,, ~ ,, - -- - - -- ,p.. -- ----- - --- I - - - -- - BUYER ~T ~ BUYER ~, J~~ t I ITEM ~ t ~` ~ ~` ~ ~~ ~ ~'.: s ITEM ~ ~ `} " ~ ~8 ' d LOT # ' ~ ~ ~~ ~ .. ,,~ LOT # ,,. ~.~ .`, ~. ,,1 Y! ~ ® _ ~' + .:max • __ , c ~ s - --- g .~"; I - - -- -- ---- BUYER '-'~ i 10 '` ~ A~ --r- , BUYER ~.,d -~ tl ~ a ITEM ~ ~ .~ ~ ~ ~ k ~ ` ' ' ; ~ ~ o _ ~, :~ r ~ ~ ~' -,=-==,--°~-~- ~ t ' ~ ~ ITEM ~ ~ ~f ~ ~~ _ " ( ., ~ ; LOT # I ' ~ LOT # .-a -, I _- - 11 BUYER =~,~ G ~ 12 ---- - - --- ---- s~ ---_ ~, ~ BUYER ` - ~'` 4 __ - .. _, , -I- ~; - ITEM ~ # ~ i ~ ' i ITEM ~ tt ~},. ~y` „ ~ i ,4 ., ~;e» LOl' # i -i LOT # I ~ - $ .~..-~ ,~ . . 13 -r--------------------------------- -_ BUYER ~`~ ~', ~ 14 ,,~~ „_ p ; BUYER ,~,,, ;~ F~ 5 ' i ITEM ~ ~ ITEM {~ ~ ~ - ~ ~ s ,t~ ~ `, i "~~,~ - LOT # ~ ~ ; LOT # ~ ~ ~~~ a ~_- .. ,_ ------------- r-------------- 15 ,~ ,~ - - - __ :~,- 16 BUYER ; BUYER- ;, ~., -.a ITEM ~--~ +` ~, ~ ITEM :is ~y: ~ ~,•- ~ _,\~ ~ r~ , ~ ..ar ~ w ~ '~ ° i' ~ LOT # `` LOT # `~''° ~:~ ry I , f ~J HEET # ~ SHEET TOTAL $ ~ 1~.~' ~ ' RUNNING TOTAL $ (' /j~/ ~ a~~ - - _ ~ l3UYtH - ~`'~ '' BUYER ~ ' ITEM ~ ~ f ~ -~=~ " ~ ITEM LOT # ~ ' 3 ~) f + LOT # + Q__ . $ ~ - _ ' _ BUYER ~ ~ ,;,=.. ~ + 4 --- ` ~ i BUYER ~ ;` + ITEM _- '' ~ ` ' + ~° ~ _ LOT # ~ ITEM LOT # s 1 yx ,.5 C~__ _ $ ;mod' .- ,....- + - -- __ - - _- -- - 5 r-- - - -- - -- - - ---- -- --- __s BUYER ~ '` ' ; + 6 ' BUYER ITEM a I ~ ~ .~ ~~ j =x , ~ F i ..1 ~ ~ ,~ ~ 8 ' ~j+~'~ a ITEM LOT # _' ' --~ ~ _,: ,...,. ~ LOT # aF ; __ _' I ~- _ $ ~ ~ - ! -- -- - -- - 1 - - --- - _-- - -- -- - - BUYER ~; ,,.-.«, ~ 8 - - -- -- - - ~ -- - _--- . ~`' ~ BUYER I ITEM ~ i LOT # ~ ITEM ' .LOT # 1 i ® ~' -- -- -- -- -- - • 9 - - ~-- -- --- - - -- BUYER x 1 10 ~ ,i i ' BUYER ~ 1 ITEM '~ ~ ~ y i ! ~ ITEM LOT - ; LOT # j z:.- ~ ' --- - --- -- - - ~ i 11 _ _ - 1 - - -- -- -- -- - - ---- - - - - - - -- BUYER ; 12 __----_ ------------ - z.,-°i + BUYER r ITEM ' LOT # ~ ITEM i LOT # ® _~ 13 -----------r------ ----------------- 14 ---------- -_.~ BUYER ' BUYER ~ ITEM ~ ITEM LOT # ; I + LOT # 1 ® - $ --- ~ 15 ---------a--- --------------------- BUYER ~ 16 --- --- --_I BUYER ITEM LOT # ~ ITEM s LOT # ~ + 9 ® _~ I -IFFY # SHEET TOTAL $ r ,~- o RUNNING TOTAL $ ~"'~ $ • 3 ~ BUYER r~"' w"'? ~ i `~ ' ITEM t-~ , ,~ ~ - ~~ ~~~., ~~~ ,_~ ~ .., l , .~=-~- , LOT # ~ -- --- ----- - - -- -- - - `. BUYER~_ _~ ~°`~}"" ,, . ~ - - ITEM ~ 6 ~; _ ~ ~ ~- ~ ~~ ~ ~• 5 ----;~~ -~, ! LOT~# BUYER ~ `°' i 6 ~~-~ ~~ ~' f ;-a 4 ._. , BUYER _. ~ ~ .- ~ ~ I t ~ ~. ITEM 3 ~ ~_ 4? ~ ~ ~ ~~ ' ITEM i ~ ~ ,`•-, ° ._; I ~ - ,=~.~..,.zl LOT # ' ' LOT # .--; , ~ 7 BUYER.` :~ . ~ ~ i 8 BUYER - -- -- -- - - - - -- -- -- - -- --- --- --i - ~J- --_ ITEM ~ ~' .~. ~ _ _~~ l ~ ~ ~ ITEM I ~ ~t'' ~~"{ ., # ~,~ .~,~_ {: ~,- _,.. i ~== ,I LOT # ' LOT # r ~~ . I ~a - -- - --- --- --- - - -~ - t r-------- ----- -------- - ---___I ~ ~ BUYER - - ~ BUYER 1 ~ ~-~. ITEM a,~. ~- ,j I rr ~-~-~ ' ITEM r t 5'~ ~ ~ `' 4~ ~ ,~ t I ,, ; LOT # ~ LOT # _ ~ i 1 BUYER ''~ ~~'"~ ~ 12 f **°~ I ~ BUYER ~ ..~ i ~ ~ rs ITEM ; ~ ~ ~ ~ _ i ITEM ( ~~t ; ,..~._.~- .,, .. i LOT # ; LOT # ~ , ... i '1 ~ ,. _ ------ 13 ; 14 - ------------==-1 BUYER ~ ' BUY v ITEM 'r i I ~ ~ ~ ~ ~ ,t r t F~ ~ t ITEM '~ ', ~' ~ ~ }.. _.._ . ' ~ - d ~ ~ .-~~ LOT # ~ - LOT # . ` ~ € ~ .- , ~.... F ~: e ~ i c. _ _ t ~- • 16 -, BUYER `~'..~} ; BUYER ~ ,# j w ~, ITEM : ~ ~ f ~` , E' ~~ F ITEM ~ ; ` ! ~` . ~ I L T # 3 LOT # _ ~ i' ,P' `~ ~ y. ® _ ~` >'' ~ `~ , s~. i ® = Q~,~' - 't - Yom' A `1 f f ~ ~ ~_' ,HEFT # ~`%~ SHEET TOTAL $ /i~~ ~' RUNNING TOTAL $ ~~~~1 ~` I BUYER _. .. - ~ BUYER ITE LOT # ~ ; ITEM ~ ~~ ~ ~° ~ '` ~ ~ LOT # -~ ~ a ~ _ ~ _ _~ - ~ ~. -- - ------------------- ------'----z------ 3 ~ BUYER ~ ~ „ a ITEM [ ~,' . ~~f ~ ~ ` ~ t ~ ~~? ~~ ~f f`'a - ;, A, 4 LOT # A ~ r' ® - }' `~ i $ ~ . -.~; ~ 'S ~ ~ BUYER M i ITEM ._.~ ~~ ~ _ ~ x ~ `~ II ~~~E ~ ~' ~ r° t r LOT # F .~~, ~ ITEM I ./~ ,, ~~~ ; ~ ~ , a~ LOT # ~ _ ~:, ~- $_ BUYER f `-- ~ $ ,~ ~ _ ~ ~ BUYER , ~..,,~,~ ~--~ 3 ~ ITEM ~. ;, ~ ~~ LOT # t ; LOT # ~~ ~ ~. - --- - - - - - -- --~ - - - - ~ ~ $- t ~ ~ ~ ,~ 9 -~------ -_------- ----- -- -- - - BUYER ~~ t~ ~ 10 - - - --~A ~ _..-_. ~ t ~` BUYER ITEM ~~L ~ ~ ~" ~7_ ~ '' ' ~ r ~ ITEM ;~ .. ? i r ,,~ ~ ~ '~; r '.. f LOT # _~ ~ ~~ ~ ~ ~ LOT # '` s =~ ' '"`Z) ° r ~- -- -- - - - -- f - --- ------- - - - --- -- 11 - - ------ -- ----- -- -- ------- -- - BUYER ~"° - ~ F~ i 1 BUYER ~~~ ~ ~~ _ _' ~ e - a .~....~ ITEM _ , :~ . _ ~ ' 6 - ~, ITEM ~ , i ~'~ ~ ;,-,,# ~ ~. ~) ~ ~ ~ .~{'`... LOT # ; LOT # ' ~ .; ~ ~ ` 13 -----f-- ~~ - ~ 14 -------------- - BUYER , BU {~ ,~' YE ITEM '~ f `. ~ ~ %~~ ,3 t ~~~~: ~ ~l`''~i `;,•'~ ~ ITEM R ~ i~ ~ s'/ , '- J x 3 . € ~ ~ ~ -~ LOT- # ~ i s ~ t ~ ~, .s,-s.., ! ~ '~ ,_ ° ° . I' ~~_. t~ , ~ ~ _- ~ LOT # o ~i r '~,r'"~. ~ )y s.' i t ~ ~ i z1• •4 '' $ '' ' I = S. ~'..^" t' __-___ ~___ _-_-__-_--_-_---_- f 15 __ BUYER ' 16 - _ ~, ; BUYER ITEM ~` ~ a~ ~ '~ ~': ! ~-~ , ; ~ .. ~ LOT'# _'~ .r ; ITEM ~ f~._ , ice: -~ sl ;~ &:~~ ~.~._ ; LOT # ~..r ~ ~ i ~ ~ ~ _ ~ i HEET # SHEET TOTAL $ ~ ;, $ ~` ~-- RUNNING TOTAL -- BUYER t ,; BUYER. - _ ~~ ITEM ~ ~ ~ ~~ c ~ ~ ~ ~ ,~~ ~ ITEM l f` j ~ ~ LOT # r LOT # ,, ~ ~ ~ _ $ ~ ,~~ 3 + - - ---- ~` '~ '~ 4 BUYER "" ~ - ` `" ~ -°°~ i BUYER ~ °'i°" ITEM ,i i~~ ' . ~ i .~•f`- i ~ fit` ~v P .,,~ "~-~ , ITEM ~ - ~., ;i LOT # ' LOT # ~ =~~ ,~ -~ --- -- --- --- --- - ---_ - ~----- - -- -- - - 5BUYER ~...,,,~ ' 6 - ~ - -- r-•, ~ t '' ~ BUYER ~~r _~ ITEM ~ ' it (~.~ _; ;" ; ~ ~ ..,4 ----,~ t ITEM f LOT # i LOT # -- -- - 4 : , 8 BUYER '~-~-'`' i BUYER ~"~~ ! ITEM ~ '~'~. s '~`~ ° ~ k ~ -k I i ITEM _,, t s ~ ~ ` - ,r > LOT # ' ~ ' ' LOT # F $ ~ i ~ _ $ ~as,.,,.,,~ ---- ------------- - I - -- -- -- --- - BUYER -F 10 ~"' ; BUYER ITEM ~~ ~ ( _ ~ ITEM ~ ~. ~. ` " LOT # --' _ i LOT # ~ i ~~ _ ~ v e 11 ,~-- - - ~ ------------------ ------- ------ BUYER ' 12 + BUYER :._.- ITEM ! ~~ t~ f`"' r,•-E ~ , ,...._ . - ~ ~ ~ i` .~~... ;. ' e . t ~ I i i ITEM --_> ~~-..•':~ ~, '' ,~ l LOT # ''~ ' _ ; LOT # - ~ ` : _ ------ P I 13 ~ ----------------- ------------- --_- BUYER - _- - - - `""~~ .,-~ ~ 14 - ~ ~ _~~ I .- , BUYER ITEM I `-t---~ ~ ITEM ~..~ ~, -~_ {~,., ~ i ~ " ;~ ~ ~ ~ .~~ q,'r~: LOT # + ' -- + LOT # ` : + N. - ~. 15 + ------------- ---a- .-- ,, -, ~ ~ ~ ' BUYER ' ~ ITEM ~=._,~ ~ '"~~ ~ , ~~->~ ~'~'°` , •~~ i + ITEM ®'~`~ , a LOT # + a LOT # _ __ + f' _~ ; ' SHEET TOTAL ~ ~~" ' RUNNING TOTAL ~ ~~7 f`-~~ ~ BUYER ,; a .= BUYER - _ .. ~ - ~.. ITEM r z f ~ ~ p .z - ~ ~ ITEM i t-~--_ - ,~ ~` ~~ LOT # ,~ _ a LO # ,~ -~ - ~ -------------------------------a- --------------- ~ - - BUYER ...,~ , 4 - ` ~ BUYER ~,_~ ~~." ~-.a i ~ (y ~ - ~ ~, ~ - ITEM ~ ~~, r ~"~ i ~ ~ `,~' ~ ~ "' .. .~,~ , - ~ - ..~ ~. ~ ITEM ~ ~.:. ,. 4 LOT # ; LOT # l'~f = t • ~ ® _ ',. W f ~ _,.~..~~ _ __._-._. __ t ___- ___ -. _. --.- - _ _ 5 _-- - -____ ---- -_ _ ,., , 6 BUYER ; ~ ~-~ ` .- , ~ .-~-- ; BUYER ~,.'•~ ~ n ~ .~- ~ ~ ITEM ~~. ~•-' ~ ~ ~ i ~ _,,~ :. ~ _~ } , ,-, ~ } ~~.: -. _- ~ ITEM ....- i t ~ ~ ,f (_ LOT # ` ~ LOT # ~- ~r.~._ ~ ` ~ -$ ~~.~ -- --- --- - -- -- -- --- -- _ -_ ~~ J, __ _ . _ 7 BUYER - t ~../~"~ E $ -. "_ __ __ - -- --- --- - - -- -- ---, - _ ===i f~ r.,g ~ BUYER "'~° -.. ITEM ~ - ti ~ ~ ' ,~~ .,~ ~ .... ~ ITEM ;~ _ , ~'" ~ ~ ~ ~ ~- ~ LOT #~w, ' I ` LOT # _t~.~, ~ , ..... t k `x `D .~ . ~~ ~~ -- -- --- -- -- - -- -- - -- --- ~ I i BUYER f j "' ~ 1 BUYER ~' ~ ' ITEM ~ ~ _ ~~ i ~ ~ ~ _ ' ' `5. ''s _. ~ ~ ' ITEM ) ~ :~_ II ~~ g " LOT # ~ ~ LOT # ~~ ~ e Q -yi ~~`._ . t _ ____ _ _. __ _ _. __ .__ __-. __ . _ __ ___ ___ ___ _-_ _.._ _ __. _."_ -_ __. _._ __e _.- _ -_ __-.. i __ __. _.- _-_ -_ ._._. -_ ___ _- _. __- W 11 i i .-+ BUYER ~ _- , ~_ ~ ITEM ..,~ ~ j +~ i,, - ._ .~~ LOT~# ~ ~ ',. ,.~ ; ~ $ i ~ ------- 13 -~- -----~- -------- --------- ~ 14 _ _I BUYER , ", `~---= ; BUYER ~"• ~j ~~ ITEM F~ ,~ i ~` ~ ~~,+ ~... ~~ ; ITEM ~ - )~~ ~ • -~ ...... " ~~ ~ ~ ~ .j~" s, , LOT # ~ -'-~'-6 t'.~ - t t ~- ~ LOT # .~' ~. t ...~-°7' I _ ~ f, Q la.,_, ,f ~ __ 15 -- --- `-'-- ~ _ ------------------- _-' BUYER ~ <--%{ ; 16 3 , BUYER ~'~~ ~'~ I~ ITEM ~+~ ~~ }! }~,,,,__~ ~~ ~ ~ ~ ~ °~, ~ `t~ ' d~ _' ~ ~ 'a ~ I ~~ --~--r- ~ ~ ITEM ~ y~ ~ I ~~ ~ : :' F ~ J 7'`t' ~% ~ ~ LOT # -~ ~ ~ i R,.....,,` LOT # ~ .. ~ ., f HEET # SHEET TOTAL $_ ~~ ~ i ~ -'" -'-~ i - - - - _ RUNNING TOTAL $ ~ ~- ~. BUYER ,. ,'. ..,_= i~ BUYER _ _ - _ .. _ ITEM F ,' ~ t F ITEM ~~..p '' LOT # ` ~ ~ ~ LOT # -- --------------------------- -----i------------- -- 5 BUYER s .,.r~ ~ 6 BUYER °~ ~ .v..~ ... ,, _ a. ITEM i ~F ~ ~ i ` ', ~ ~ l ~ ITEM ? ~ i ~~~'.{ , LOT # o ~ ,~ x ~ LOT # --t------ ------------------- _ ____ 7 - , --- -- --- __- BUYER ~ I ~~ ~ ~ ~ $ ,~. ~ ~ ~ BUYER , ITEM - - `til E ~ 1 F (_ - r ~ "~ t ~. ~ i ~ ~ _ f < , ITEM ~ ~~~..~ r . ! ~ LOT-~~' ~ LOT # ,' ,~~.. ~ t. ~, ~ i / -- ----- -- --- --- -- - --- --- -- ---- -- - -- ---- _ --- s ~~ r~, i - 10 -- - -- -- --- --- - --- -- - - - BUYER ~ ~~ ' BUYE ~ ~~ ITEM ~ ~ `;;'t ~ ~ '`~ ~ 1~~ ` ~ ~ E ° ~ ITEM t i ~ 3 i , ,_- i -- LOT # ~ ` ~.-i i f ~ ` LOT # ~._._ , ~ ~ 1 ,- , - _, ,._ w _ n `--- - -------------- _ I1 ~ _ _ . - -- - - l _ BUYER ' ,-> ~ ~~ .~~ ~ 1 BUYER - - - .~ - - -L ITEM G ~ ~~~h~~ ~ `'~ i ITEM '` '~ j ..~J ~ ~,r.,~ LOT # ; LOT # ,.- j r t ® _ ~ c ~ ~ ~`~ 13 ~------------ ----- -- - ---------- -----~- BUYER _ ~ ~w ~ 14 -~ ; " E ~ ~ '~ ~.} ,-; ~-- ~ BUY r ? ~s ~ ~~ b_~ R;_ - ~ ~`a,~ r ITEM t ~. _ ,1, ~ s ~ d F ~ ~ ITE ~ ~ ~ ~` ~., t ,} .~ ~ ' ``' LOT# r ' M - *~ i` ~ ~ LOT # ~ s i~ - $ t ~ -------------- - ---- - ----- 15 _ , ---------- BUYER. '~ ' BUY s Z -~_ - i ~ t e. 4 i. ~t ~- ,, ~ r' :'~ ~ ~ ITEM ...~. ;. ~ , ~, ~ ~; ~ , i , _ , ~ ~ ~` = ITE LOT #~ ~ , ~ ,~ ~u ~ ~,' ,~` LOT # ~ -~--- e ,~ ~, ~ .~ ~.~ ~- ' ~ I ~-° I SHEET # ~' SHEET TOTAL ~ ' - _~ " RUNNING TOTAL ~ ~ -~ ,' _ _ tsuvtn __,. _ ,- BUYER - - ~,_.. i r~ ITEM ~ ~ I _ r ~ ITEM ~~ + ~~ , r---_ LOT # ' _ ~ LOT # ~-_ `f d °`~ ~ ~"'s~ ~ 1 e `°~ 4 _~_ f -} < ... 5 ; ~, _~ p BUYER_wf~::~ `y P ITEM E' a~ ) .~~'~ `~ r~~~~J~ ~ ~ ~ ~ LOT # ~ { ~ ; _., , 7 ~ ~ s BUYER -_ ~ r- ~ ITEM _ ~ ~~ ~~ t .'~ ~ i LOT # _ ~ ~.:~ t $ , a , _---- --- ----- --t-- BUYER. ~~__.~ ITEM _.~, ~, ,'t ~.~ '"l. LOT # -® - $ s~t~ ,~.~ BUYER ~..~.,~ ~~ ~ ~ ~~, ITEM ~ x~' ~ ~ ~~ ..-~- $ ~{w... 8 - ------------__---------------------- BUYER ~ 10 '~°' ; BUYER ~ `'_~ . _ ... ~ ~ ITEM ~ ....n, ~" ~' ~ i? ~'` , ' o `•~ t; ,~1 f ,- ~~. t "- -"~.. 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ITEM ~ ~l~ ~~ , ~ ~ ° ITEM ~~_~~ ~ { ~, ~ .. ~ 3 / LOT .# ~ LOT # '~ ~ ~ F ~ j _~ a ~ ® $ s ..,, ° - ~•-~ f SHEET # ~-~ SHEET TOTAL $ ~~--•`' ~`~~, ;0 $ '""~! _ _ RUNNING TOTAL BUYER ~ 1 BUYER ~ R ~ , ITEM t ~ ~ s ;~.-~.,_.,,5 } ~~ , .~` " ITEM _- ~ ~,: ( ~ f ; , ~ LOT # ~ LOT # ` ,° ., Q = $ ~ ~ • 3 w__ , ------- ------------ - - BUYER ~ ' ° 4 ' BUYER ~ ITEM f ` ,~' ~ :' ~, ~y ~" ,~' ~~ j ..,~.-.~~ ~ f "`.,:~`; i...< i ITEM _~,.~ ~` ~ ` d ~ ~. ,~~-~-; `'tea. -~-' LOT # ' LOT # ~ ~ o ~ ~ ~ , 7 ' $ --_~ BUYER ' °~ s ~ BUYER `' ~~ " ~ `F` - L ,. i i1~ d 4 i ITEM ~ _ ~ ~ .i ~ :$ ~~. ~~ ig r i a ~' ~ ~ ~ ~ .~.,. i ,~-~ ¢' t a , ITEM m ' tiE [, ~ ~~ " ~ I ~ i ~ LOT # ' LOT # I I ~ - ~~ ,~. v (~ jJ _- ___ _ ~ _. ___ __ __ t_ ___ _._ __ .._ ..__ ___ _.._ -___ __. _- - _ ~ ~~ ~ 10 -~---, _ BUYER _ ~''~ ; BUYER ~ F _~ _, -- ITEM t a ~ ,~ ~ ~ ~.,~ ' ~ ~' t: - ~, ~ ,,. s ~ ITEM I1 +~ ' ~ ~.-..' LOT # ' ,.t..~ ~ LOT # .- 11 ,~~= ~"" i "1 BUYER :`~-"`~j ' 1 ` _. , I --~.. r.4 ~, f% _ -..- ITEM s - ~ LOT # r ~ $ ~~ -+- -- - - 13 ,. ~_ , ---- -~ BUYER :.,...t -~" ~ 14 - - - -- -- -- - -- - ~.I ITEM ~ - ~ ~ j S~ ~ ITEM ~Ca , I ... ~ ~ , ~ ; ,; ~. A ~ r .~ ~~ LOT # ~ ~ LOT # _- -~ ~ :_ --------------------------------1 ----------------------- ~ 1 BUYER `~ ,.,,~ / ~ 16 ,~ ~ i ---, BUYER f ~ -~' -~ ' .._t 1 ITEM f ~ ~ _ ~ I LO # ~~ ; ITEM ~ ~ } `_. ~ ' ~ .>,: , ' LO # ~-' i ` I ~ - $_ ~ ,,. ' -' / 1 .---- iHEET # /f SHEET TOTAL $/ p = `~' ~ RUNNING TOTAL $ ~~~ ,~ ~ I3laYtFt BUYER. ITEM ._ _.i: f __.._ r~ ~~ -~ ~ '~~ ~ ITEM ~ ~~~ ~ ~~ t t { }~~: _r 1 f :.,.. LOT # ;l ~~ ~ -''_~ ' LOT # t.f ----- z ------------------ 3 ------------ BUYER r ~~ i 4 BUYER -- ~ - - - - -- ~ - ITEM ~ ~.' ~ ~ ~3 ~ ~ ~f',:~-~ $ ~-~ `~ . i __~-.... ,;-- "~ ~ „s ' ~ ,~ < , ITEM ~ # r ~ - ~ ~ ~ .~ LOT # ' ~ ' LOT # r ~ ~ ~a =a- -- _-- -_ _.. _._ ~- _ -- - 1 _- __ _ - -.~ 5 BUYER ~"'.~ ~ "''~ ~ 6 ~ .`' ,f ER_ t s z ; BUY ~ ,, t t ~+ . ,. ,, _... ~ r ~ ~ , ~ -. ~ ITEM - . ~' ` ° ` < : ~ ~ - ~ _ •~ ~ ~"+ _ , _ ~ ._, E j ~,,<~ ' ~ ° i "" ~ ~~~. ~ ITEM _ 1 } x ~ ~ ` i LOT # ~ ; LOT # -"~~ , i BUYER ~ `""°`~'° ~ r ~ ; BUYER ~ ~"`'• ... ;{j 4 ~ ITEM ' ~~ t y .~ 1 i ITEM ~ ~ ~ ~ i ~~ ~ t ~ ~ ~ f ,~ ~ ~°°~.,# s LOT # .~ ~ LOT # --- --, - '9 ~ BUYER ~ ~~~ ~ ' 1 BUYER ' ~'~"~' f ~ t,,,l f ITEM ~ ~ ~ ~~ ~ ;~ ;~ ~ { ~# ~I ~ i ..,~ , , ~". ' ~ ~,~ ~ ITEM f ~ ~ ~ / , ,'~;,~"` LO # } ; LOT # ~..., , .-_ ; -~ $ ' _ { -- - -- - 11 ' 12 ~ ~ BUYER ~~---,~ '` f i BUYER ITEM ~_~ t ~ r ~ ~ ~~ ,~ ' ITEM -~- ~ ~~ ~ ~' ~ ~ ; ~. R 5 ~ ~ L ~ ~~ ~ ~~ ~' LOT # ~ ~ LOT # e ~ ~_ ___ - - __ - _ - 1 ~P ._. 13 ~` BUYER ~~ ' 1 BUYER ~. `: _ s -.--- ~ ITEM ! ~-~ s ~ ~ ~° ~ ~` ~~ ` ~ E 'f'"_ ~ '~` ; ' „ ~ ~'' _ _' t s ~ ITEM ~~ i f ~ ~-~,~ ~ ~~ ' `~_~.`r LOT # i LOT # ~` F i i4ei ~d,_. f 15 ~ '`~ ~ 16 ---------- BUYER pp _ „f' ~ BUYER -- ~,,,,,f 3 ' a e t ~ '' ITEM ~m t l ? ,T~° ~ ~ ~ L - ITEM ~ ~ I; - .~ r~ : t LOT # _ ~ LO # ' ~ ® _ $ ~. i SHEET # =' SHEET TOTAL $ '__-~~ ~ RUNNING TOTAL $ ~ ~' ~' DIJl CI1 _. _. __ _. _. _ _ _. _ _ - - FjU YtFi ~ ~ ~ ' ITEM ' ' ITEM ~ LOT # _ ~ LOT # i •~ rt ` ~ ~ ± _ ~ ~ # ~ ~ - • -------------------------------1--~- -------------------- --- --, 3 ~ , _, _ BUYER _ ~ l i 4 BUYER ~}! "" €^ _: , - : ITEM ! t ~ `~ _.. ~-- t ;_~ ~ i ITEM k {,.,~ f ~ 1 t ?.t~ "' 1 a ~~ .: ~ , . ~ ~. _, LOT # ; LOT # ~;~ , fa, :,~, ~ ~ ' ~ ~. ... , _ ___ _ _ - - -- __ _ --- - BUYER ~ ~ ' BUYER .~. ~, :~ ITEM ~ ~ ' `~ , ; ~" ~ ~ s ~ .~ ' _~~~- ~ f ITEM ~ q`4~=¢~ ~ ~ ~~+" , LOT # ~ LOT # ~`~~ ,,., "'~" ~ ~ ~ ~ _ $ ~ _ _.. i 7 ~ ~ 8 # - BUYER -F ~ ~~ ' BUYER ' ~~ .. .y ITEM ~ ''7~`' '' ~ ~ t ,~~~ ~',,` ~ i ITEM <~ #~ ~~ t 1 ~' , LOT.a# ~ ~ ' LOT # Cam? _ $ • `, ~ ~ _ $ ~.. ~~ .y Y--- _ ----- -- ~ -- -- - -- - _-1___ -___ ___ ___ ___. __ __ -_._ _ _ BUYER _ ~~ ; 1 BUYER r ` .~. , ITEM ~_ ~ ~~ ~ ~ 1=,;., °`~.°" ~ ~ ~ , ,~ ~y ~^, ,_~...... f ~... r `'^.,~' ~ ITEM ~' ~ ; ; `~ ~ LOT # ' T~ ~ LOT # 1 ~ -__.. ____.. _..__ _ __-__.1 _.__-______. 11 _ --- -- - -- __ __- - . --_ _ BUYER - ~~-~~ ~ i 1 BUYER ;"' °° ~_~ ITEM ~`~ '; ~ ~ .~.._ ; ITEM ~ t ,~;.>,~ ~ .,~. _. _ ..~,~j~ { ~v,..,.~s ~ E> s~ ~, -H ,=i LOT # _ ; LOT # - $ ~.;. - ---------- ----------------------1-------------------- ~' 13 --- ------------__ ~ ~ 14 w. BUYER -. ; BUYER _ ITEM t ..a , ~ , °~ i ,~~ ' ITEM °~.,, ~ ,~ > > LOT # ` LOT # ~ ~ - ~, .~ ------------------ a- , , -------------~--_ 1 BUYER +'°~.+~'~ ' 16 : ~ ~ BUYER _ _ -. -.~_- ~ i L- ~, ITEM ~ ~,.. ~ ~ ,_ - 3 , ii,~~ ~ ~~j;~~~Y ~ ~ ITEM ( '~ ~'~° ~ ,_; I~,~_ LOT # ' LOT # ~`~-, ' __ ® - ~ a ~..~ ~ ~ ~t ~d~ BEET # SHEET TOTAL $~~~~ ' y RUNNING TOTAL $ - - i ~ -~ ITEM ~ ITEM _ ~ ;" r ' f ~~~ t ~ LOT # ` LOT # -- --- - - ---- - - 3 r ~ ' 4 BUYER i BUYER_ _ r ~' i ~ _. ITEM ` ,}f ~ ~ ~~ r ` ; ITEM _%~ k~'j LOT # ~ LOT # i 3 ~ Y ~ ~ 5 BUYER f ~ ~ 6 BUYER "°"~""? ,~ ~ --. „ ! ~, ~'" ~-, _ ITEM '" ~~ ` ~ ITEM _l_.. ~ ~ ~° LOT # ; LOT # ;M.. , __ _ _._ _ - -- -- - -- - 7BUYER ~ ~ ~ 8 _ _ _ . 4 ~` ~`,~ i BUYER ~~~ d _ z ~~ a ITEM - ~ ` i ~ ITEM t LOT # LOT # 9 Z ~~ # BUYER ~~~~ ~ ' 1 BUYER {~ ~~ I r ,~ i ITEM ~ ~.. ~ ~~ ° ~: j ITEM ~( ~t ~ " ,; ., ,~ ~ ' ~ '~ ~ ~ d~ LOT # ~ LOT # ~ ~ 11 ~ ~- BUYER ( i 1 BUYER ~ ~ ITEM - _ ` } fi -_~~ ~~ ~ ~~ 3 ~ ITEM ~ ~' ~ ~~ ~, '~ ~~. LOT # I ~ LOT # ~ ~ ~ ._.> I ----------- 13 '° BUYER s € jt ,i.v ~ ITEM ~ ~ k~ ~ 'f i i` ~~ .~ ~~ i F j LOT ; -- 15 ~ ` BUYER ~~ i I _ ~ ~ R •; ". i ITEM _.'~ I t ~ ': ~ •...f ~% ~ ~ ' LOT # ~.., ~ r i ® _ $ • _ >HEET #~,_ ~ SHEET TOTAL $ --~[~'J ~.1' ,a i BUYER `~- ~ i o ITEM t_ € s .fi{ ~ ;%~ ~ 6 1 LOT # E ~.,.~ ~ 4. a -_ _ _ -- - - --- - _-____, ITEM ' ' ±` LOT # ~ - ~~ `~ 5 5 4 ~ _ .-__ - - - - --- BUYER~ i 6 --,~; °°i _ t ~ -' , BUYER ~ , x~ ~ r /'~, ITEM '•- _ i ~ : ~' ~ ITEM ~ a' ? t ~ ;'`'- `~ _N LOT # ~ LOT # t ~ ~ _ ~ ~ ~ _ ~ - ---- - -- -- ----- 7 ~ , BUYER ~ s ' P ' ITEM .~.. _.~ ~ s E LOT # ~_~ F, , ® _ ' -- -- -- ,- ITEM -;T~ ~--. ~ t, ~ ~ ~` LOl"t# 1 ~, _~ F ~ 10 R '~ BUYER ~ ~~ ~"~ ~ ; BUYE e ITEM ' k ~ ` ~ I ,'~ °.`~. -~ ~r~ , ITEM I ~ t ~ _ - ~ ~ ~ } '.~ (, ~_ - - , ~ r r ~ t ~ ~ ~--i ~-- LOT # j - LOT # .__. _ 6 _. $ ~~-~' ------------- _E------ -- -- , 11 w, , BUYER- ~ ~S ~~ ~ ~. ~i `"" 4 `>`t ` i ITEM ~_ ,, ~ ~ i L T# .~' ~ , _ $ r _ ----------------------- - - ---- -- - -F-- `~ ~ 4 [[ f'. ITEM f . ~ ,~,° `~ '~ 1 ~. ~ ~ ~ LOT # a BUYEF? ~ ~~,,,~~ , BUYER ~ ~.~ -~' ' ~- ~ ~ i ~~ ~ ~~,,_~_~ r ITEM ITEM ~~~:~~ , ~. •` LOT # ~ _- ~ LOT # $ '°~ ~. - ~ 15 w --------------------_-, BUYER-_ ~ ' 16 ~ ~ ' BUYER ~-~~~ ''~`' ' ~° ITEM ,~ # +~ ~ s `} ~ ~ h ITEM t, t ~ ~ LOT # ~ LOT # I .,.• h,,, ~ r ~ 7 i_. -IFFY # - SHEET TOTAL ~~' • ' -'" c'~ o" RUNNING--TOTAL $ _ ~~ ~'" ~ ~ ~ I~UYtFi ~ ~ ~._. ITEM ~ , ~ ITEM - ~ " '` r~ s 7 LOT # LOT # $ f ~ -~ ~~ t r _ _a ~` • ,'~€ y --. - .. __- -- 5 ~ ) ' BUYER '`""~""~~'•~ ~ ~ ' ' ~ ' ~ z ~'~` ITEM ~ p i L T # ~~ ~7 ~ BUYER ' y ``` ' ITEM ~_k`~~~ ._, ~ty° ,~, -~`, LOT # ~, ~ $ r` - ~`'' _ '~..~'' i.....~'° ' f i BUYER ~~~- ~--'`~ ~ ~ "~ .-. ITEM _~ ' ~ * _. . ~~, ,~ ~ 5r ' K~ ,' _~ ~ LOT # ~ _ $ ' ~ ~~ ~ BUYER ~,.M-°' T--Y' ITEM ~ t ~ ~- ~ 4i ti., t ;.~ .~; °~ $ ~. - ----------------- g ~-~°. ~ BUYER ~~ 1 ~ ~ ~ ' ~ ;, a ~ i L # # ~ ' 4 ~{' ~ i ~ i ~ ~ry. BUYER ~ ~ - .. ITEM IL~ ~ `"_.tF`~....~ $ • ~ ~ 11 ...._ ~, ~ _ .~ , 12 ~ ~ BUYER ~-~ ~ ~ BUYER ,~~~._ ~. ffEM ~ " -~'~ ; ITEM #~.:•~'~' t~ ~ ;~~.. . ~a I LOT # ~ LOT # ,.~ ~ r -- 13 -~ ' BUYER ~ "~' ~ 1 BUYER +t„ ,, ITEM ..T c ~ -~r~ ~ ITEM _ LOT # i LOT # s ~ ~ ~ ~ i-.. ~ .. i 15 BUYER ~ ' 1 BUYER fir. / ~' ITEM "~ ~ ~ " ._ ~~ ~ ~ ~ !1 i ITEM 'r . ~.t~ ~ LOT # f LOT # ` i HEET # SHEET TOTAL $_~- _-- i RUNNING TOTAL ~ ~ •~ tSU T tFi - - 1 tfU'Y'tFi x ITEM # ! ~ ITEM ~ i ~' ~ ~ } LOT # , ~ •~ ~ .LOT # ,. __ --------------- ------------1-_------- ~_.,. p - - - - - - „~' t 3BUYER ~ ' s:~ ~ ~ i ITEM •' ~ t; ~ LOT # _f~ .~; ~ r ® - $ - ~~ 7 ~ • ~ 5 -_- ; 6 BUYER _ ~ r t ~ ~~ „~ ; BUYER r L°~`; : a ~ • ITEM ~ ~ ~ -~ i ITEM ~~ ~ ' ``, i ti. LOT # i LOT # ~ _ ,'` ~ ,~, --_-- 7 - -- - - --- -- -__ __ BUYER -_ ITEM 4 .,, ~ yr ~` t LOT # ~ ~- - - -- --- --- -- - --- -- - --..-- --- -- __ t -- -- --- -- -- -t-.--- -- - -- -- --- - -- - -- -- - ~ -_ 9 BUYER " 1 BUYER- - ~ ITEM ~ F i~. ~- i a~ ~' ~ ~ ;~~f ~ ~ ITEM ~ tf .:~ .. __ E LOT # i LOT # '~." , ~ f t ~ . ~.; ® _ ~• ~ $ ~ - ~' - -- ---_-- --- __--- - - - -------1--------------- ------ 11 ~ - -- - -- _ -_ -- BUYER ~ ~ ; ITEM =___',~f if ~ `~ `~ ~ f~ ~ LOT # ~ ~ _,..._~ ~ ~_~~~ ~ ;._ ..~~ ~ _ $ ~ 13 ~ i 14 I~ --• BUYER ~ ; BUYER ITEM ~~~j~ ~ ,. ._~ ~ ~ # _ } ~ .~ ~ ITEM 'x°~ #..~-~ i-`~(/ LOT # ~ ~• LOT # - - ------------ -wT---~ 15 r r' --- 16 i BUYER r ~ ~ BUYER ~ 1 ., ..~ ~•~ ~ s ~ei~ ~ ' ~ - ITEM 3 .1_. ~ ITEM ~,.,~ € !}. ,Y ~ -~~ , ' ~ ~ • i `- LOT ~ LOT # ® ~~ ~ i ~ ~, 5,f - ~~'~. a ~~~~ CenturyLink~ i~~~ P.O. Box 1319 Charlotte, NC 2820 1-1 31 9 Accoutrt Name: THADD A MILLER Page: 1 of 3 Account Number: 313965286 Bill Date: Aug. 25, 2011 Contact Numbers Current Charges Summary Detail Page Product, Services and Billing Total Current Charges o . 00 1-800-201-4099 Customer Service Hours Mon-Fri 8 a.m.-7 p.m. High Speed Internet 24/7 Tech Support 1-800-809-1410 Dial-up Intemet 24f7 Tech Support 1-888-872-7313 Fnancial Services/PaymentAaangements 1-888-646-0004 Repair Service 24/7 1-800-824-2877 Payment or Account Batan~ 24R 1-800-201-4099 Yrsit ua online www.centurylink.com rrevaus ua~anoe Paym~ts S Adjs Credit Balance Current Charges Amount Due Date Due 93.98 CR I 0.00 I 93 , 98 CR I 0.00 I 93,~ (~`R I ~, '~~ 2011 The Due Date On This Bill Applies to Current Charges Only "`PLEASE FOLD, TEAR HERE AND RETURN THIS PORTION WITH YOUR PAYMENT"' YOUR ACCOUNTCONTAINS ACREDIT - DO NOT PAY R io121o II~~~IIJ1~'~I~1~111~1'Il'~~~~~I~~~I~~IJIIII~1~„I~I~J'~'IIIJI CenturyLink Account Number: 313965286 P.O. Box 1319 Charlotte, NC 28201-1319 AV 01 046632 424496199 A`•5[)GT THADD A MILLER 40 CAMELOT DR CARLISLE, PA 17013-9268 ~~n~n~lulllll~i~lll'III'~~I~"'lllll~lhli~~lnil"11'nlll~~~ FOR CHANGE OF ADDRESS OR PAYMENT AUTHORIZATION: Please check here and complete reverse. Thank You. 00313965286700D000OOOOODOD0000000008251100DOOOI, - - - _ _ _ . _ OO,D009000000 ~~ ~~ ~~'; CenturyLink~ P.O. Box 1319 Charlotte, NC 28201-1 31 9 Account Name: THADD A MILLER Account Number: 313965286 Allocation of charges: Service Categories Past Due Basic Services 93.98 CR Other Services 0.00 Page: 2 of 3 Bill Date: Aug. 25, 2011 Current Month Total Due 0.00 93.98 CR o.oo o_on All Services 93.98 C R 0.00 93.98 C R Failure to pay Basic charges may result in the disconnection of those Services. Basic Service consists of local phone service, interstate access charge, telecommunications relay surcharge, emergency 911 surcharge, installation and other fees. Please contact CenturyLink regarding any questions or problems with your bill before the due date. A rate schedule, an explanation of how to verify the accuracy of your bill and an explanation of specific charges can be obtained free of charge by calling the customer service number listed on the first page. Notice about electronic check conversion When you provide a check as payment, you authorize us to use information from your check to make aone-time electronic fund transfer from your account or to process the payment as a check transaction. If you do not want to have your check payment converted to an electronic transaction, please call 866-375-1153. CenturyLink offers convenient alternatives to mailing your payment each month. Simply go to cerrturylink.com/myaccount to make a one time payment or to set up recurring payments from your bank account. CenturyLink shoukf be notrfied within 90 days after the CenturyLink Bill Date of any billing discrepancies on your statement. Immediate Billing Address Changes Call 1-800-201.4099 313965286 THADD A MILLER 40 CAMELOT DR CARLISLE, PA 17013-9268 Address Information Changes Effective Date New Address City State Zip Work Phone ( ) Home Phone ( ) MONTHLY AUTOPAY AUTHORIZATION FORM I authorize CenturyLink to charge my MasterCard, Ysa, Discover, American Express, savings or checking account monthly for any accrued balance on the billing account listed below. (We reserve the ~ to revok®this it bank approval is denied) Checking Account # (Write your billing account number on a voided check or copy of a voided check and attach.} Savings Account # (Wrte your billing acwunt number on a voided deposit slip and attach.) Credit Card ^ Debit Card Exp Date: MasterCard ~ Visa ~ Discover American Express S>gnature required Date Please continua to pay your bill until notified on your statement that autopsy is active. Akxount Number ~, /~ ~~~~ CenturyLink~ P.O. Box 1319 Charlotte, NC 28201-1319 Account Name: THADD A MILLER Account Number: 313965286 Page: 3 of 3 Bill Date: Aug. 25, 2011 Customer Rights -Pay-Per-Call Services Your CerrturyLink bill may include charges for pay-per-call services (for example, 900/976 calls) on behalf of other service providers. You can dispute pay-per-call charges separately from other charges. Todispute apay-per-call service charge, call the CenturyLink customer service number on this invoice. The FCC classifies pay-per-call services as non-communications or information services. COMMON CARRIER MAY NOT DISCONNECT LOCAL OR LONG DISTANCE TELEPHONE SERVICE FOR FAILURE TO PAY DISPUTED CHARGES FOR INFORMATION SERVICES. The pay-per-call service provider, however, may employ other entities to seek to collect those charges from you. Also, failure to pay legitimate pay-per-call service charges can result in terminating access to pay-per-call services. ff you want to block access to pay-per-call services, just call CeniuryLink's customer service department. Phone Number Disclosure when Calling 800- and 900-type Numbers Per-line orper-call blocking does not prevent transmission of your telephone number when you call a company using an 800, 888 or 900 number. Therefore, your number may be available to that company's service representative before your call is answered. SCHEDULE G 00016565 01 AT 0.357 01 TR 00070 EJADD021 010100 ~ THADD A MILLER 40 CAMELOT DR _~ CARLISLE PA 17013-9268 !~ I...III~~~lll~~~~~~ll~~li~l~l~~~~l~l~ll~~l~~l~~l~~llt~~~l~l~~l $2,007.98 Value on Sep 25 $2,107.98 Value One Year Ago $0.00 Account Holder(s) Thadd A Miller Account Numher 377-12008-1-7 Account Type Single fP"` R+r Flnsnda! Advisor Art Amundsen, 717-258-4688 0` ~ 21 West High Street, Carlisle, Pi417013 °+~ .~•°: ~MMU NICP Statement Date Sep 25 -Nov 26, 2010 Page 1 of 2 A Time to Say Thank You At this time of year, many of us look with gratitude at our friends and family. We also may be looking with anticipation toward the year to come. At Edward Jones, we want to take this time to thank you for your business. Our No. 1 priority is always to serve you, and we thank you for your trust and confidence. We look forward to working with you for many years to come. Beginning value Assets added to account Income -- Assets withdrawn from account Change in value Thhi Porlod ---- Thls Year 52,107.88 --- -----50.00 - ------- 0.00 --- 2,131.14 0.00 ,-- 0.00 0.00 __ 0.00 .~nnnn ,~ ---•~~ -iGJ.iV ._ .--.. . Ending Value $2,007.98 Cash do Money Market Ending --- --- _ Balance_ Cash _ _. _ _ -----~-- $2,007.98 al unt Value $x,007.98 Date Description -- ------- Quantltlr Amount 11/01 Estate Services - - ---- ------- - -5100.00 Aocaunt Holder(s) Thadd A Miller Account Number 377-12008-1-7 Account Type Single ~''`~ °'~,. a Wnandsi Addsor Art Amundsen; 717-258-4688 _ 21 West High Street, Carlisle, PA 17013 ~'c,~M „,~ot`° Statement Date Jun 26 -Sep 24, 2010 Psge 1 of 2 y •. 00013481 01 AT 0.357 01 TR 00060 EJPDD011 011001 ~ THADD A MILLER ®40 CAMELOT DR _~ CARLISLE PA 17013-9268 I~~~III~~~I11.~~~~~II~~II~I~I~~~~I~I~II~~I~~I~~I~~III~~~I~I~~I $2,107.98 Value on !un 26 $2,107.98 Value One Year Ago $0.00 Make sure we have cost basis for securities sold If you have sold or are planning to sell securities this year, make sure we have complete cost basis information. (Generally, cost basis is the original amount paid for a security, including commissions and fees, and adjusted for reinvestments of income and sales.) You may need your cost basis to calculate capital gain or loss for tax purposes. If we have this information on a sold security, we can include it in your year-end Consolidated 1099 Tax Statement, simplifying tax season for you. Contact your financial advisor today for more information. Ending Cash 8 Money Market Balance Cash 52,107.98 Total Account Value 52,107.98 This Period This Year Beginning value 52,107.98 50.00 Assets added to account 0.00 2,131.14 Income 0.00 0.00 Assets withdrawn from account 0.00 0.00 Change in value 0.00 -23.16 Ending Value 52,107.98 u ur Retirement A statement of your account for the period October 1, 2010 to December 31, 2010 \~ ascensusSM D.C. PATTERN 8t TOOLING, INC. KURT GRIGG 4450 SUNSET DRIVE CHAMBERSBURG PA 17201 0013975 O1M60.382 "AUTO T301S7522150 C01- Division: 0001 0001 ~u~i~n~~~u~~~i~i~~~~uii~n~ni~~ni~~~i~nm~~n~~ini~~~ THADD MILLER 7513 LAURALIN PL SPRINGFIELD VA 22150-4119 10/1/10 Balance Activity This Period Investment Gains/(Losses) Net Change 12/31/10 Balance D. C. PATTERN >li TOOLING, INC.401(K) PS PLAN PLAN ID: 208666 PLAN STATUS: Terminated DATE OF BIRTH: 02/18/1944 DATE OF HIRE: 08/13/1998 531,742.47 DATE OF TERMINATION: Contributions By Source This Period $0.95 50.95 Total 531,743.42 12/31 /2006 50.00 icio ~, ~v aarance vested Percent 12/31/10 Vested Balance EMPLOYEE 401(l~ $26,271.06 100'/0 EMPLOYER PROFIT SHARING $26,271.06 EMPLOYER MATCH $0.53 100% $0.53 $5,471.83 100% $5,471.83 Total $31,743.42 531,743.42 c~10 to December 31, 2010 Page 3 of 4 THADD MILLER Your Personal R t f R a e o eturn for the period 10/1/10 through 12/31/10 is n/a. Total Returns are for the Period Ending 12/31110. Asset Class / Inception Current Quarter Year to Date 1 Y 3 6 10 Years Fund Name Date % ear Years Years or Life of % % % % Fund Income JPMorgan Government Bond Fund C 03/99 (2 73) 6 01 JPMorgan Core Bond C 03/99 . (1 05) . 6 36 6.01 5.07 4.83 4.83 Balanced . . 6.36 6.08 5.52 5.25 / American Century Capital Preservation 10/72 Growth 8 Income - - 0.01 0.01 0.54 2.05 1.94 BlackRock Balanced Capital Fund Inc. 10/94 6.45 10 77 10 77 Ivy Core Equity Fund C 09/92 12.25 . 19 39 . 19 39 (2'07) 2.53 2.37 Eaton Vance Dividend Builder Fund CI C 11/93 9 . (1'91) 3.86 0.52 American Century Equity Income C .54 8.17 8 17 (9.10) 3.15 4 22 Growth 07!01 6.87 11 99 11 99 (0.45) 3.29 . 5.21 BlackRock Capital Appreciation Fund A 12197 13 98 19 13 BlackRock Global Growth Fund Inc. 10/97 . . 19.13 0.96 4.76 1.67 BlackRock Healthcare Fund -nc 9.53 11.11 11.11 (6.03) 6.69 2 36 . Eaton Vance Worldwide Health Sci C 10/94 2.98 3.36 3.36 ( . Ivy Science and Technology Fund C 01/98 1.46 10.31 10.31 3'48 3.05 1.50 Pioneer Emerging Markets 07/97 9.00 10.01 10.01 2.98 7.37 4 50 Ivy Mid Cap Growth Fund C 01/96 5.81 15.18 15.18 ( . 1 Other 07/00 14.37 28.89 28.89 5 27 7.04 4.23 Federated Money Mkt Mgmt Eagle 01/74 Large Cap Value - - 0.04 0.04 1.18 2.35 1.85 JPMorgan Mid Cap Value C SmaltlMid-Cap Equity 04/01 11.75 22.17 22.17 0.60 3.79 8,25 Ivy Small Cap Value C Large Cap Equity 12/03 16.55 24.96 24.96 5.67 5.11 6.78 Oppenheimer Main Street Fund A 02188 10.81 15 78 15 78 Asset Allocation . . 2 98 ( ) 1.80 1.48 BlackRock Global Allocation Fund Inc. 10/94 Specialty 5.78 9.85 9.85 2.01 7.51 8.73 BlackRock Science & Technology Opp A 05100 11 83 17 99 Invesco Select Real Estate Income C 05/02 . . 17.99 3.48 7.2g 0.1 g 3.38 17.85 17.85 1 91 -- (1.98) / = Funds in which you have a balance ,.. _.: Your Personal Rate of Return is an approximate rate of return for your account for the investment period shown. It is influenced by the timing of your contributions, withdrawals, investment changes and fees throughout the calculation period and may differ from the fund's overall Investment Pertormance provided on this statement, reflected on the participant website or heard on the IVR. Past performance is no guarantee of future results. Shares of Mutual Funds are not deposits or other obligations of, or endorsed or guaranteed by any Bank or any affiliates. Such shares are not federally insured by the FDIC, Federal Reserve Board, or any other government agency. Investments in the funds involve risks including possible loss of principal. Past pertormance does not insure future pertormance. The investment return and Net Asset Value will fluctuate so that an investor's shares, when redeemed, may be worth more or less than the original cost. An investment in the Money Market Fund is neither insured nor guaranteed by the U. S. Government. Yields will fluctuate, and there is no assurance that the fund will be able to maintain a stable NAV of $1.00 per share. International investment involves risk and volatility. Portions of the mutual fund pertormance information contained in this table was supplied by Lipper, A Reuters Company, subject to the following: Copyright 2006 ®Reuters. All rights reserved. Any copying, republication or redistribution of Lipper content, including by caching, framing or similar means, is expressly prohibited without the prior written consent of Lipper. Lipper shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Diversification SCHEDULE H ORIGINAL 2861 ACCT. NO. = F ' AMEF~~' /1 eaeavec~~ixom.: ~/ C~ax Funeral Services ~~~~• - ~~'~~^ a CREDIT CARD ^ OTHER LAST BALANCE $ ~/ Q ~ V !ll~~~"' INTEREST ^ LATE PAy11A~ scI~B.Si)i. ~S OTAL CREDITS LESS PAYMENT ~ C/ ~(~ NEW BALANCE $ .~ ~ ~/ 15061, Y //' ~` ;~ FUNERAL HOME ~ CREMA?ORY, INC Helen B. Miller 7513 Lauralin Place Springfield,, VA 22152 219 North Hanover Street Carlisle, Pennsylvania 17013 717.243.4511 toll free 1.866.451.4511 fax 717.243.3723 www.hoffmanroth.com info@hoftmanroth.com August 24, 2010 Statement of Funeral Expenses for: Thadd A. Miller Date of Death: July 13, 2010 Account Id: 15986-160 PACKAGE: Immediate Cremation, Memorial Service of Funeral Home OPTION 3 -Cremation $ 2,290.00 MERCHANDISE: Sub Total: $ 2,290.00 Register Book Memorial Folders $ 25.00 Acknowledgement Cards $ 25.00 $ 20.00 Sub Total: $ 70.00 TOTAL FUNER AL HOME CHARGES: CASH ADVANCES: ~ $ 2,360.00 25 Certified Death Certificates at $ 6.00 each $ 1 Newspaper Notice -Sentinel 50.00 Newspaper Notice - Wmspt Sun Gazette $ 92.70 Clergy $ 132.30 Coroner's Fee $ 100.00 $ 25.00 Sub Total: $ 500.00 Total Funeral Expense: $ 2,860.00 Payments Made: Total Payments Made: $ 2,860.00 Helen Miller Check 458 Aug 13, 2010 Balance: 2,860.00 Please return this portion with your Remittance. $ Amount Enclosed Thadd A. Miller Service ID#: 15986-160 SERVING OUR COMMUNITY SINCE 1907 a ~ ~ ~~ 219 North Hanover Street Carlisle, Pennsylvania 17013 yy //~~ 717.243.4511 ~~/r~~ toll free 1.866.451.4511 t ~ .~ '1?2~ ~- -~. ~ fax 717.243.3723 ,, ,% FUNERAL HOME ~ CREMATORY, INC. "'"^"''r1O~'anroth.com info@hoffmarxoth.com August 24, 2010 Helen Miller 7513 Lauralin Place Springfield, VA 22152 Dear Miller, 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. Enclosed you will find ati itemized bill for your records, showing that the bill for the funeral service of Thadd A. Miller is paid in full. SERVING OUR COMMUNITY SINCE 1 907 RECEIPT_FOR PAYMENT * DUPLICATE GLENDA FARMER STRASBAUGH Receipt Date: 7/23/2010 Cumberland County - Register Of Wills Receipt Time: 12:45:03 One Courthouse Square Receipt No.: 1061995 Carlisle, PA 17613 MILLER THADD A Estate File No.: 2010-00744 --- Paid By Remarks: STONE DUNCAN ASSOCIATED DM ------------------- ----- Receipt Distribution ----------__________ ____ Fee/Tax Description Payment Amount Payee Name PETITION LTRS ADM SHORT CERTIFICATE 260.00 28 00 CUMBERLAND COUNTY GENERAL FU JCS FEE AUTOMATION FEE . 23.50 CUMBERLAND COUNTY GENERAL BUREAU OF RECEIPTS & CNTR FU M ------_ 5_00 CUMBERLAND COUNTY GENERAL . FU Check# 3568 Total Received . --- - 316.50 .. .. .... 316.50 RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse S uare Carlisle, PA 1713 MILLER THADD A Receipt Date: 8/25/2010 Receipt Time: 15:02:39 Receipt No.: 1062392 Estate File No.: 2010-00744 Paid By Remarks: STONE DUNCAN & ASSOCIATES SAP ------------------- Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name BOND -------_-15_00- CUMBERLAND COUNTY GENERAL FUN Check# 3541 15.00 Total Received......... 15.00 Grill & Bar Carlisle #828 BRENT T062 O1J08/11 16:19:00 #01113 CHE~~ #008 YOUR OPINION MATTERS We invite you to complete our GUEST EXPERIENCE SURVEY YOU COULD WIN $1,000 A WINNER EVERY DAY! Te i~witamos a completar nuestra encuesta. TU PODRIAS GANAR $1000 From browser address bar type: www.chilis-survey.com Your persons~l code: OY~x A7~~~ ~d1_GS Please enter within the next 4 days No purchase necessary. Must be 18 or older. Void where prohibited. See website for rules/details. CHICKEN FAJITAS 11.49 BEV-RAGE 2.09 Subtotal 13.58 SALES TAX 0.81 Tory ~ ~ ~ . ~~ SHANK YOU!!! W~ welcome your comments. (800) 983-4637 www.chiis.com ***** YOU MAY BE A WINNER ****** * To complete a Guest Survey & * enter a monthly drawing for ~ your chance to win a * Cracker Barrel Rocker... * CALL: 1 X00-300-3010 ~ ACCESS CODE: 431-009-531-610 * Enter access code above to * take survey. Access Cade * expires 7 days from today. * For Sweepstakes rules visit * www.CrackerBarrel.com **************** I! I 0531 Cracker Barrel Store #431 -a,,.,;~,; „.. 128F~49 Kim N 1 TBL 15,/1 ~ 3 1 6 GST 1 JAN~Q' Q•19AM 1 COFFEE 1,69 1 TWO EGl~ F:ASG~ . 3.99 EASY 1 HBR 2.?~~ Subt~. ~a E >r3 135 CASH :~: Change Due --4 3286 CL05t. 9 :.. , ~.• Thr Please m~ , www,~~, eI.COf' i~uer~t li)I"I~, caur~~ents ur ci;~-kerns please cal 1 1-Btid :t':34--BU03 or email us mcricma 1 i:is_mi:duna 1 ds~ yahoo . Grin w 6tfB EAST HIiaH SIf~EEI raR~ Tsi_E , f'A 1 r~t13 THANi~ YOU Mt:DONALU'S 1I31G i~:L#t•IT}249-f1~I I3 KS#l14 c)~ Jarr.()t3' l i(Sat)i19:4'f STURE# 181h 0 r~~ r #~~ 1 ~ SAT ~ N 1 SAUSAtxE BISL'UI ~ i uil 1 HASH BROWN I . t i(1 1 :,ML COFFEE ~ t;i, SuB TaTai ~ rin EAT IN IAx. ,a. iH 3.18 CASH TENL)L1~'ED S.OU CHANGE i,p; Visit.us on the_internet www:GiantFoodStores.'coM l~, Hpa l i s to ensure. ~ro~r sat i sfact i an every iee Y~ -iwrth ~. If there ~' ..is anytfiinb Nar`e: can da, to ilNprave your experience please gall or write. Chad Hoch, Store Manater , Giant ~ocy! Stoke it ~i11 255 S. S~pr,'int` Garden Street +e Carlisla~ PA 17013 Store T,olephone: 5:7.17 249-2.32'3. `Phar~racy.Telephone:. -((717 149-$83Fi' °,~ PEPFARM sTIGK$Z - BC 3.49. F STN BCH BARB. 84Z q, q~ F YOGI GRNL CRSP ~ q,gg F METRO WATERI6FZ 1.59 B TAX PAtD *~##CQ~ z0. X66 CHANGE 6.Op TtITAL NUMBER OF ITEMS SOLD = .,; q 1/b8/11 3:58 PM 0112 89 010g 472267 I'm glad you shopped here #oday. Your Cashier -- EASY-SCAN #*####~##>«~##~################~k####### 'You could have saved . .50 today! Stop by the Customer Service Desk to sign up for your o~n-'.BONUSCARD gUALITY. SELECTION. OPEN '_ ~ K1lNtS SAVINGS: EVERY DAY. EVE(. JAY I a Welcome to Chick-fil-A Germantown Toam Center FSU (#01044} (240) 686-1110 Operator: Dave Martin r Guest: CUSTOMER COPY 4/9/2011 3:55:17 PM DRIVE THRU Order Number: 1250777 1 Meal-Nugg Bet 3.96 1 BTL Water 1.49 Sub. Total: $5.45 Tax: $0.33 Total: $5.78 Change $14.22 $20 $20.00 Register:2 Tran Seq No: 1250777 Cashier:Bob It was a pleasure serving you! Have a wonderful day. Follow us on Facebook! www.Facebook.comICFAGermantowntowncenter ***** YOU MAY ! ''!INNER ****** * To compete a Survey & * enter ~~ mont awing for ~ yc,~r _~ a * Cracker ~~ ~r... * CALL: 1-800- ;j AGGrSS UuDE: 431-;.:~i-447-31~ * E-+er access code above to * ' ~Ke survey. Access Code a expires 7 days from today. * For Sweepstakes rules visit * www.CrackerBarrel.com **************** II II I ~I I I I II o ~ Cracker Barrel Store #431 Carlisle, PA 1257100 Kait)yn M 1 TBL 131/1 ---~4~ 3 ----GST 1 -JAN07'll 6:lOPM ------------------------ 1 ICED TEA UNSWEET 1,gg 1 BLT SALAD 7,79 1000 ISLAND 1 POTATO CUP 2.•99 Subtotal 12,67 State&Local Tax 0.76 Total 1 3 .43 CASH 20.00 Change Due 6.57 --1266208 CLOSED JAN07 6:45PM-- Thank You Please Come Back www.Cracker8arrel.com r ._ .._1'EtMHK. 'r'C1J FOR I~~I~i HCOOh1AL.DS ~~ f',4CKLICK RD ;x'1150 ~ ! ~ TFl4M( YOIi TE.1_K TCI,'3 4C~'i 8879 5'tore# 20514 K"lt •' F~~r'.16"11 (S~3t! 06:33 'a'~ 0 ° ~ ~,r ~,3 p''r ~:Tl~h T3TAL 1 :I;~ 1 N1: 4L 1 ~IA:;E 3R]'h~N 1.99 1 00 1 :~I~II_ I ]F:=LE . 1 00 '4C1) CRE4h' . S. k:~t : ~ t~~i 1 3 99 Tax T:~k~•O~.it Total . 0.20 4.19 Ga~,~i i~~~na_r~=d 10 00 G ~ ,~ r. o:~ . 5.81 ~I~C~CIJeI_DS # 20514 TfL4NK. YC1U F~CIR I)FIOOSII~G NCDONAI.DS --~ ~ C+4C~(L.ICK. RD ~~'iINL1=IFl.D , VA ;2150 ! ! ! T>`d4hK YOU ! ! i TE1.K 703 4':•'i X879 Storms ;ZO',i14 K':lt '~' Ahr.09'11 (S~~t! 06:03 Mf~'~ ;~)7)E: 1 K'V;i C:~~dar 5F p ~ 'i : tI~ M 1 ; ;71„I~,~,aE 1374:;I_.IT TO'iAL 'I •I~~::~F 3R;1~~JN 1.00 'I :,htl_ I:_IF-CC 1.00 ,•',CI_~ ~ CRE 4h'! 1.00 3 .40 S. Lit: ~ t,a 1 _=_ Ta,< 3 . ~ 5 T:~k=• O~.It Tota 1 C~ 4j ~:Ir,; CO . ~ '6.85 ~ICUCIJ~I_GS # x'0514 Ouestiur~~is, comments or concerns f-~ 1 ease ca 11 1-888- 334--8003 or email us mcrJona 1 ds_iru:dor~a 1 r ls~ yahou . c~ii~i p 608 LAST HIGH ~,IkEEr CAf2l.I:S~E, r~A 17018 THANK YOU MCi:iUNHI_D'S 1816 rLl.# (717)~~9-71~c' 4J K#04 ~~~ Apr.30'11(~:;atl'~.Uf:) STOf2L# 181fi ~ ~C~~ ~" ~~~~ ~~~ ~ ~ L'PY CKN 5 VdL`ar (AU GJ i SOUIHNIL-SI UhESSI~:; . 1 Lf`i; I iN;;WE f T "L'LU ~ i:A ~ . 00 ~il1H ? , i y 5 . ~9 EA1 IN laX 0,35 6.04 CASH fLNUL12Ll) , ~!ri CHANGE 1;.y~ r,. y~ THIN( ' QR (NOOSING H(NONAL ~ ~, 1 TIN FtN2RACE RD NT , !N) 21788 ! ! !THANK YOU ! TEL# 301 271 3003 Store# 5 787 KS# 12 A~.3O~11 f~at > 08:29 IfY SIDE 1 KV5 Order 45 qTY ITE 1 MC ITO STK ML TO L 1 S F DD C M ~.OQ~ ADD 4 SPLENDA Subtotal 4 49 Tax Take-Out Total . 0 27 4.76 Cash Tendered 10 00 Chance ~. . 5.24 MCDONALDfCoS 5767 ;~,; W v sheetz #299 Eat In W 428 M Church st ~~ Thurmont, MD 21788 ts9~~ 21 Order #200197 WENDY'S 416/2011 12 OLD FASH ~ :00:25 PIS _3279 IONED HAM BURGERS Un i eased Ca 94 ~2.799/G V l Carlisle 0402 store #00000402 Name: Samanth M ~ m o ume. 14.391 Ga i a ------ ---- REG Gas Tata 1 ; X49 , 93 Tata i ------ 1 LG Chi li -------- ------~-- ~4g . 93 1 Bottle Water 2.29 ApPravai SubTotal 0'99 Debit xxxXXXxxxXxx 2 2 7 e Tax 3.28 0.20 94/11/2919 18:99:29 r+ 1 I~la l Cash Tender ~' 5 Change ' 1. W N How was your visit? Call us at 1-888-624-8140 Total Items 2 ee 0 - 3 Sheetz #232 420 N Baltimore Ave Mt. Holly Springs PA 17065 (717) 486-4439 4!9!2011 8:02:45 AM '! ~ ~ T erm i na l ~~ ~~ yy Order Nu~r: 7UJ Register:3 Prepay Pump NUnsu~r 1 Amount of PreFuy $20.00 Prepay Fuel Fuei Amount Sub. Total; $20.00 Tax: $0.00 Total: $20.00 Discount Total; $0.00 Exact Change - C;a $20.00 Change $0.00 Sheetz #232 420 N Baltimore Ave Mt. Holly Springs PA 17065 X717) 486-4439 1/9/2011 11:36:09 AM Fuel Destination Order Nu~ber: kegister:100 , Pay at Pump Sale Pump Number 8 Unleaded (87) G~?lons 7.951 Price/Gal $3.139 $24.96 Sub. Totai: T~ x : Total: Discount Total: Visa: Change Visa XXXXXXX.XXXXX2270 '~~?J09/2011 11:36:02 $24.96 $0.00 $24.96 $O.GO $24.96 $0.00 SALE STARDUST MOTEL 102 HOLLY PIKE CARLISLE. PA 17013 f717) 243-6058 ~ THANK YOU MERCHANT ID: 267235032880 DEVICE ID: KKKN ' Itei•: 001 VISA SALE i SWIPED Rcct; ~X%%~0453 INVOICE: 2001 SALE ~ 34.88 TOTAL $ g4,S8 I AGREE TO PqY ABOVE AMOUNT ACCONDING TO CARD ISSUER AGREEMENT [MERCHANT AGREEMENT IF RETURNI DATE: 12i11i10 TIME: 09:14 RESP: AUTH/7fST 024196 E iID: 080345512539290 ACI: E B07TOM COPY-CUSTOMER Registration Card st~r~~st hotel Ty-Ara Inc, Phone;(717)243-6058 • Fay 1502 Holly Pike NAME _ k~ ~= .~ ~ s vl a ~~ ADDRESS ~`S 1 3 t.-ttiv ~~ ~ I ~,,, CITY ~-. ~ -:- t ~G--~ ~~ f.b COMPANY NAME No 20473 (717) 243-5782 Carlisle, PA 17015-9103 ~'L-- _ STATE its' CAR LICENSE . l~ I ~w '7 7 STATE MAKE N0. OF CAR l~'. t.4-:~_ ~ ~V `{ _r ~„ ,-„~_ PERSONS ^ casn ^ Room N~. ~ Rate $ Date In ~ .~ 'Date Out ~^ /~ DAYS OCCUPIED (circre days) Mon. Tu. Wed. Th. Frt. Sat. Sun. TOTAL DAYS TOTAL 'A STATE TAX ;OUNTY TAX ems Property Is privately owned and the management reserves ~- TELEPHONE service to anyone, and will not be responsible for accklents or in u to ~9M ~ ~~ of money, Jewelry or valuate of any kind. ~ ry 9~ts or for loss TOTAL DUE _-~ i • AMERICAS BEST VALUE INN -CARLISLE 1460 HARRISBURG PIKE CARLISLE, PA 17015 717-249-7775 abvicarlisle@gmail.com Printed: 7/10/2010 - 4:32pm Page #1 MII.LER HELEN Guest #5212 7513 LAURALIN PLACE SPRINGFIELD VA 22150 US Room: 209 ND1 Daily Rate: 85.99 + Tax Check-in: 07/10/10 4:32pm Out: 07/11/10 Nights: 1 Guests: 1/0 Date Room Phone Misc. Tax Total Credit 07/10/10 85.99 .0.00 1.00 7.74 94.73 0, TOTAL 85.99 0.00 1.00 7.74 94.73 0, AMOUNT TENDERED : $0.00 CHANGE : $0.00 PA f3ti1 Total .73 0.00 94.73 .73 0.00 94.73 Balance MISCELLANEOUS REPORT: SAFE: 1.00 Check-out time: 11:OOam Check-in time: 2:OOpm Guest Signature: 0. THE MANAGEMENT ASSUMES NO RESPONSIBILITY FOR ACCIDENTS, INJURIES, THEFT OR LOSS DUE TO ANY CAUSE. THANK YOU FOR STAYING HERE WE HOPE YOU HAVE ENJOYED YOUR STAY. PLEASE CALL AGAIN ANY TIME TO MAKE RESERVATIONS HERE. ~ f i Rodeway Inn (PA128) Account: 159455679 1239 Harrisburg Pike Date: 8/8/10 „ Carlisle, PA 17013 Room: 221 eaR t3 Y C H O t C£ ti 0 fi£ t. 5 (717) 249-2800 Arrival Date: 817/70 gm.PA128@choicehotels.com Departure Date: 8/8/10 Check In Time: 8/7/10 6:43 PM Check Out Time: 8/8/10 7:01 AM MILLER, HELEN- Rewards Program ID: X You were checked out by: rsheth.pa128 Springfield, VA 22150 You were checked in by: GM.PA128 Total Balance Due: 0.00 Post Date Description Comment 8/7/10 Visa Payment Amount (143.19) XXXXXXXXXXXX0453 8/7/10 Room Charge #221 MILLER, HELEN 8/7110 129.99 State Tax 8/7/10 7.80 City /County Tax 8/7/10 Safe w/ltd Warranty 3.90 1.50 Folio Summary :8/7!10 - 8/8/10 Room Charge 29 9 State Tax 1 .9 City /County Tax 7 80 Safe w/ltd Warranty 3.90 Visa Payment 1.50 This rate is eligible for partner rewards. If this rate is changed, you (143.19) may no longer be entitled to partner rewards. Balance Due: 0.00 Thank you for your business! Book your next reservation on www.choicehotels.com for the best intemet rates guaranteed. 07/24/10 3:22 AM BEST WESTERN CARLISLE 1155 HARRISBURG PIKE CARLISLE, PA 17013 717-243-6200 Folio: 49267 Miller, Helen SPRINGFIELD, VA 22150 Company: NiteVision 2009 SP1 HF1 P1 Room: 166 Arrival: 7/23/2010 Departure: 7/24/2010 Trans # Date Description Charges Payments Balance 210723 7/23/2010 Rm: 166 Less Disc. $14.00 $125.99 $0.00 $125.99 210724 7/23/2010 PA Sales Tax $7.56 $0.00 $133.55 210725 7/23/2010 Local Room Tax $3.78 $0.00 $137.33 210950 7/24/2010 Visa $0.00 $137.33 $0.00 Credit Card Information * Already Processed Balance: $0.00 Trans# Type Card Holder Card Number Amount Date/Time *31488 VISA MILLER/HELEN ... 0453 $137.33 7/24/2010 3:22:33 AM Membership: Method of Pay: Credit Card Signature: "Each Best Western hotel is independently owned an Folio Summary Previous Balance: $0.00 Room Charges: $125.99 Other Charges/Credits: $0.00 Phone Charges: $0.00 Tax: $11.34 Less Payments: $137.33 Total Amount Due: $0.00 d operated" _. _ Page 1 of 1 ~ ~ ~ ~ Rodeway Inn (PA128) Account: 157301328 1239 Harrisburg Pike Date: 7/18/10 Carlisle, PA 17013 Room: 118 enR B Y C H O! C E H 0 Y E t. S (717) 249-2800 Arrival Date: 7!15!10 Departure Date: 7/18/10 gm.PA128@choicehotels.com Check In Time: 7/15/10 6:36 PM Check Out Time: 7/18/10 8:19 AM MILLER, HELEN Rewards Program ID: X You were checked out by: cwaltz.pa128 Springfield, VA 22150 You were checked in by: GM.PA128 Total Balance Due: 0.00 Post pate Description Comment Amount 7/15/10 Visa Payment (122 88) XXXXXXXXXXXX0453 7/15110 Room Charge #118 MILLER, HELEN 54.99 7/15/10 State Tax 3.30 7/15/10 City /County Tax 1.65 7115/10 , Safe w/ttd Warranty 1.50 7116/10 , Room Charge #118 MILLER, HELEN 54.99 7/16/10 State Tax 3.30 7/16/10 City /County Tax 1.65 7/16/10 Safe w/Itd Warranty 1.50 7/17/10 Visa Payment (61.44) XXXXXXXXXX)CX0453 7/17/10 Room Charge #118 MILLER, HELEN 54.99 7/17/10 State Tax 3.30 7/17/10 City /County Tax 1.65 7/17/10 Safe w/ltd Warranty 1.50 Folio Summary.. T/15/40 - 7h 7/40 Room Charge State Tax City /County Tax Safe w/ltd Warranty Visa Payment This rate is eligible for partner rewards. If this rate is changed, you may no longer be entitled to partner rewards. 164.97 9.90 4.95 4.50 (484.32) Balance Due: 0.00 Thank you for your business! Book your next reservation on www.choicehotels.com for the best Internet rates guaranteed. Little IKE Eichelberger, Auctioneer Dillsburg, PA 17019 Phone Number (717) 432-0006 PA License # AU. -001954-L Statement of _P,~i61ic Sale Held For EXPENSES / ~J Advertising .............................................................................. Co ~ J _ ~~ Insurance ...................................... ........................ 0 Auctioneer's Commission...r~~,., a .......................... r Real Estate Commission. ~-~ . ~ ~~ ~ ~ U~C~f1 pz~ Clerk's Commission............ °"~ ......................................... Runners Pay..~.~~.~..~eo~.~~.~...`:........ ~~d ~ Miscellaneous xpe es. ^'~.~ ~~o' ~G~O Total Eape . <: ....... lQb .~° ................................................ .~ a RECEIPTS Gross Sale............ Less Expenses...........: ,~ ~~~ . Less Uncollected Amount........... Total Net of Sale ................................................... ~O .3~ . 7 I received $~0.3 ~ ~ fronn proceeds of the listed sale on ~ `"~ " ~~ ~~~ Signature Date . ~ _ _ Send Inquires to: St 5000 Louls' ^rlve PO Box 4 Mechanlcs.._.g, PA 17055 www.membersl st.org Maln Swltchhoard: (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 ® TeleBranch: (800) 237-7288 MEMBERS 1St FEDERAL CREDIT iJNION 2136 1 AV 0.335 2136-2136 I~~~III~~~III~~~~~~III~I~~~~~II~~I~I~~~IIII~~~II~~~I~~I~II~~~I ~~ ESTATE OF THADD A MILLER 8 N BALTIMORE ST DILLSBURG PA 17019 Statement of Accounts. Sep moo, 2010 thru Oct 24, 2010 Account Number: 397842 Balances at a Glance Checking : 16 ,545.57 Savings: 5.00 Certificates : 0.00 Loans: 0.00 Money Management : 0.00 Swipe 5 YTD Reward: 0.00 Page : 1 of 1 We make it easy to transfer between financial institutions. See the enclosed insert for more details. CHECKING ACCOUNTS 0011 -CHECKING Date Transaction Description Additions SubtracY~ns Balance Sep 25 Balance Fo~wa~d 16,559.11 Sep 28 Withdrawal ACH DELUXE CHECK 13.95- 16,545.16 TYPE: CHECK/ACC. ID 1410216800 CO: DELUXE CHECK Sep 30 Deposit Dividend 0.100% 0.41 16,545.57 Annual Percentage Yre/d Eame+d 0. 100'6 firom 09/22/2!1 f0 through 09/30/2090 Based on Average Dai/y Balance of 16, 554.46 Oct 24 Ending Balance 16 ,545.57 SAVINGS ACCOUNTS 0000 -REGULAR SAVINGS Date Transaction Description Additions Subtractions Balance Sep 25 Ba/ante ForwaM 5 • ~ Oct 24 Ending Ba/ante 5 • ~ YTD SUMMARIES TOTAL DIVIDENDS PAID 0000 REGULAR SAVINGS 0.00 0011 CHECKING 0:41 Total Year To Date Dividends Paid 0.41 NOTE: Total includes closed shares Don't forget about our new Member Loyalty Rewards .Program. The more products you have-with us, themore benefits you'll receive. Ask an associate for details or visit our website at www.members1 st.org for details. Cumberland Goodwill EMS PO BOX 12910, PHILADELPHIA, PA 19176-0910 (800)369-7544 Patient name: MILLER, THADD A. THADD A. MILLER Cumberland Crossings Retiremen 1 LONGSDORF WAY CARLISLE, PA 17013 Run number: 10-58099 Date of call: 7/10/2010 Time of call: 11:37 Caller: From: Carlisle Regional Medical Center To: Cumberland Crossings Retirement Community Primary payor: highmark FER102359790001 Secondary payor: Patient Pay Description BLS Non-Emergency Mileage CIA Medicare Payment-Check PAY THIS BILL ONLINE AT WWW.EMSBILLPAY.COM OR CALL THE NUMBER ABOVE TO PAY BY PHONE d il'~~/b `Pr~ ~ `~ ~r 101 C K- e.....,. ~.,~ $475.00 $23.00 ($266.83) ($20.82) PLEASE PAY THIS AMOUNT: $210.35 DETACH AlONO ABOVE LINE AND RETURN STUB WITH YOUR PAYMENT. THANK YOU. Patient name: MILLER, THADD A. Remit to: Cumberland Goodwill EMS PO BOX 12910 PHILADELPHIA, PA 1 91 76-091 0 Check # Quantity Unit price Payment date 1 $475.00 2 $11.50 1 9/27/2010 11865249 1 9127!2010 Run number: 10-58099 Current date: 11/29/2010 Amount $ enclosed: Due on: 12/29/2010 DOS: 7/10/2010 This is the 3rd invoice that we have forwarded to you. Your account is now delinquent 8 due immediately. Failure to respond could result in your outstanding balance being forwarded to a collection agency. Please contact us today or send payment. 12910 ACRI DO HOSPITAL CARE II3V#s3 1dILLER,THADL 129..00 Insurance Balance: O.AO Patient Balance: 129.00 -+ /~/ j u+ ~, i V iJ !' ~`~ ~" 1 ~~ itement PLEASE INDICATE YOUR ACCOUNT NUMBER WHEN CALLING OUR OFFICE: te: 07/29/10 767472 _- - -= PATIENT BALANCE Current 31-fi0 Days 61-90 Days >90 Days Total In8 Pending PAY THIS AMOUNT o.o0 129.00 0.00 0.00 129:00 0.00 129.00 ND tNgUtfltES /PAYMENTS TO: CARLTi$LS ~[A PHYSICIEH Dfi$>~ PO ~JC 381fiZ9 All unpaid balances will be ATL1lN'~']-, t~A 303s3416~9 sent to a aolleotion agency 717 519-0753 and all coliectian/legal fees will be your responsibility. 684 7659688 001685 001685 OOOOi100U01 520966902 - -_ NOTE: Charges and payments not appearing on this statement will appear on next month's statement. s2oss5t io2e a RECEIPT ~~CEIPT INS. PAT. DATE PATIENT DOCTOR CPT4 ;CRIPTION CHARGE FROM INS. I A PAT. ADJ. BAL BAL 01/22/10 Thadd Hotchner M J1200 Benadryl Up To SDmg $2.50 $0.82 $1.68 $0.00 $0.00 01/22/10 Thadd Hotchner M 96375 TR/PRO/DX INJ NEW DRUG AD $180.00 $61.98 5118.02 $0.00 $0.00 01/22/10 Thadd Hotchner M 96417 CHEMO IV INFUS EACH ADDL $15D.00 $64.71 $85.29 $0.00 $0.00 01/22/10 Thadd Hotchner M J1453 Emend lmg injection $345.00 $162.49 $18.06 $164.45 $0.00 $0.00 01/22/10 Thadd Hotchner M 96415 CHEMO, IV INFUSION, ADDL $120.00 $28.56 $91.44 $0.00 $0.00 01/22/10 Thadd Hotchner M 85025 COMPLETE CBC W/AUTO DIFF $32.00 $11.14 $20.86 $0.00 $0.00 01/22/10 Thadd Hotchner M 99211 OFFICE/OUTPATIENT VISIT, $45.00 $9.69 $18.19 $17.12 $0.00 $0.00 01/22/10 Thadd Hotchner M J9171 Taxotere lmg $4,000.00 $2,820.80 $1,179.20 $0.00 $0.00 01/22/10 Thadd Hotchner M J2150 Mannitol 12.5gma $10.00 $0.82 $D.09 $9.09 $0.00 $0.00 01/22/10 Thadd Hotchner M 96367 TX/PROPH/DG ADDL SEQ IV I $200.00 $61.12 $138.88 $0.00 $0.00 Ol/22/1D Thadd Hotchner M J9062 Cisplatia SDmg $975.00 $61.84 $0.00 $943.77 $0.00 -$30.61 01/22/10 Thadd Hotchner M J2469 Aloxi 25meg $475.00 $175.10 $299.90 $0.00 $0.00 01/22/10 Thadd Hotchner M J7050 NSS 250cc $12.50 $0.28 $iz.za $o.oo $o.oo 01/22/10 Thadd Hotchner M J1100 Dexamethasone lmg $7.50 $0.90 $0.10 $6.5D $D.00 $0.00 01/22/10 Thadd Hotchner M 96366 THER/PROPH/DIAG IV INF AD $100.00 $19.52 $80.48 $0.00 $O.DO 01/22/10 Thadd Hotchner M 96413 CHEMO, IV INFUSION, 1 HR $250.00 $131.14 $118.86 $0.00 $0.00 01/22/10 Thadd Hotchner M J3480 Potassium chloride 2meq $20.00 $0.18 $0.02 $19.80 $0.00 $0.00 04/27/10 Thadd Hotchner M J2353 Saadoatatin LAR $7,500.00 $2,991.97 $241.79 $4,229.70 $0.00 $36.54 04/27/10 Thadd Hotchner M J9062 Cisplatin SOmg $975.00 $26.76 $2.97 $945.27 $0.00 $0.00 04/27/10 Thadd Hotchner M J2150 Mannitol 12.Sgma $10.00 $0.93 $9.07 $0.00 $0.00 04/27/10 Thadd Hotchner M 96372 THER/PROPH/DIAG INJ, SC/I $40.00 $20.17 $19.83 $0.00 $0.00 04/27%10 Thadd Hotchner M 96366 THER/PROPH/DIAG IV INF AD $100.00 $19.52 $80.48 $0.00 $0.00 04/27/10 Thadd Hotchner M J3480 Potassium chloride 2meq $20.00 $0.20 $19.60 $0.00 $O.DO 04/27/10 Thadd Hotchnez M J7050 NSS 250cc $12.50 $0.29 $12.21 $0.00 $O.OD 04/27/10 Thadd Hotchner M J1453 Emend lmg injection $345.00 $186.30 $158.70 $D.DO $0.00 04/27/10 Thadd Hotchner M J1100 Dexamethasone lmg $7.50 $0.81 $0.09 $6.60 $0.00 $0.00 04/27/10 Thadd Hotchner M J9181 Etoposide lOmg (VP16) $500.00 $8.82 $0.98 $490.20 $0.00 $0.00 04/27/10 Thadd Hotchner M 99211 OFFICE/OUTPATIENT VISIT, $45.00 $38.11 $1.81 $0.00 $5.08 04/27/10 Thadd Hotchner M 96417 CHEMO IV INFUS EACH ADDL $150.00 $64.71 $85.29 $0.00 $0.00 04/27/10 Thadd Hotchner M 96375 TX/PRO/DX INJ NEW DRUG AD $120.00 $41.32 $78.66 $0.00 $O.DO 04/27/10 Thadd Hotchner M 96413 CHEMO, IV INFUSION, 1 HR $250.00 $131.14 $118.86 $0.00 $0.00 04/27/10 Thadd Hotchner M 96367 TX/PROPH/DG ADDL SEQ IV I $200.00 $61.12 $138.88 $0.00 $0.00 04/27/10 Thadd Hotchner M 96415 CHEMO, IV INFUSION, ADDL $120.00 $28.56 $91.44 $0.00 $0.00 CURRENT 30-60 DAYS 60-90 DAYS 90-120 DAYS OVER 120 DAYS TOTAL ACCOUNT BALANCE ~ DUE FROM PATIENT ~~ S 1 1.01 50.00 50.00 50.00 50.00 S 1 1.01 ~ 511.01 i~ ~~ Full Balance Paid? Please Disregard **Thank You For Your Prompt Payment** 3838-MBRO•SOLOW05Z9000128 RECEIPT '~CEIPT INS. PAT. DATE PATIENT DOCTOR CPT4 SCRIPTION CHARGE FROM INS. ~ PAT. ADJ. BAL BAL 04/27/10 Thadd Hotchner M 85025 COMPLETE CBC W/AUTO DIFF $32.00 $11.14 $2D.86 $0.00 $0.00 04/27/10 Thadd Hotchner M J2469 Aloxi 25meg $475.00 $158.67 $17.63 $298.70 $0.00 $0.00 Question ?? Pleas Call 17-657-2599 (,~ V ,~ ~i~ 3 Z ~ , ~1 .°1 CURRENT 30-60 DAYS 60-90 DAYS 90-120 DAYS OVER 120 DAYS TOTAL ACCOUNT BALANCE ' IDU $FRO M PATIENT 511.01 50.00 S0.00 50.00 50.00 $~~ 01 ' O I) n ~~ Full Balance Paid? Please Disregard **Thank You For Your Prompt Payment** 3838-M~tO•SOLOWQ5Z9000128 sERwcE aoDRESS 40 CALOT DRIVE, CARLISLE ,---accr. No. 009055 BILLING PERIOD COVERED FROM / / To 06/30/2010 SERVICE WATER FIRE SEWER TOTAL 30.80 88.33 KEEP THIS PORTION OF THE BILL FOR YOUR RECORDS. 09/03/2010 - - ' ' " ' ~ ~ ~ PLEASE SEE ADDITIONAL 119.13 IMPORTANT INFORMATION ON THE BACK OF THIS BILL *~*******************************REMINDER NOTICE*****************«************ We have not received your 2nd Quarter Water/Sewer PAYMENT IN FULL. Second quarter net charges were due by Aug. 3, 2010. Please remit the total amount shown by the final due date of September 3, 2010 to avoid additional charges. If you have already sent your payment, PLEASE ACCEPT OUR THANKS. +++++++++++++++++ADDITIONAL NOTICE+++++++++++++++++ THIS NOTICE MAY INCLUDE AMOUNTS OLDER THAN 60 DAYS. Amounts more than 60 days past due will be processed for collection and can result in termination of service at any time. ~~-i .,~~ CenturyLink~ IZE: (717) 243-2084 458 Dear Customer: REMINDER NOTICE FROM CENTURYLINK September 3, 2010 This is a reminder that payment for your telephone service is past due. Payment is due by the date shown on your telephone bill each month. If payment has been made, please accept our thanks and disregard this reminder. Convenient Ways to Pay On the web: www.centurylink.com/myaocount By Phoae: 877-813- 604 Your nearest CenturyLink retail store Any Western Union quick p8y location Thank you for your prompt attention to this important matter. If you have any questions about your account, please contact CenturyLink at (877) 386-0217. Sincerely, CENTURYLINK f L ~~S ~, 3 5~ ~d s_' ~~ m m 8 6 PPL Electric Utilities Electric Service For: THADD A MILLER 40 CAMELOT DR CARLISLE PA 17013 Questions abort this bill? Please contact us by Sep 22 at 1-500-342-5775 (1-800-DIAL-PPL) or write to: Customer Service 827 Hausman Rd. Allentown, PA 18104-9392 www.pplelect<ic.com Electric Use This graph shows your electric use over the last 13 months. Types of Meter Readings: Actual - Adjusted Estimated Customer 0 ~a a e i9 5 a' ~_ pp m~ ~~ f ~~ ._ ,~~a ~R ',,, Summary Page ^`Page 1 34420-85004 ~:~ Balance as of Sep 1, 2010 $130.41 Char es: Tota~PL Electric Utilities Charges $32.92 Total Charges $163.33 .--, ---: :..:. :.:.. ..:.r.: ...::.::. r '~ .- Account Balance ~~ $163.33 ~ 63 `~; ~ 1Q~ . ~f~ _ d ~.~3 ~ .. l~ KWH -Average Per Day 36 30 24 18 12 6 0 SONDJFMAMJJAS 2~9 Months 2010 Meter Reading Information Meter #16748462 Sep 1 Actual 44028 Aug 3 Actual 43848 29 Da s KWH Billed 180 Average -Sep 2009 2010 Tempera~'e 74F 75F KWH Per Day 17 6 Yearly Use: Total Avera e Oct 2008 -Sep 2009 4460 Mon 37 Oct 2009 -Sep 2010 5108 426 Other important information on back ~ PPL Electric Utilities Electric Service For: 1TiADD A MII.LER 40 CAMELOT' DR CARLISLE PA 17013 ~s a f, •~s'~ .o§ . `,, ,M 34420-85004 ~_: Total from Last BiU $I jp 41 Billing Details Amonnt Yon Still Owe as of Sep 1, 2010 $130.41 Current Charges Char s for -PPL Electric Utilities e PPL Electric Utilities Customer Service Resid ntial Rate: RS for Aug 3 -Sep 1 Distribution Charge: 827 Hausman Rd_ Allentown PA Customer Charge 180 KWH at 2.90600000¢ per KWH ' 5.~ 18104-9392 PA Tax Ad Surcharge at 0.10300000% T~~ssion ur e 0.01 1-800-342-5775 g : 180 KWH at 0 31600000¢ er KWH 0 57 (1-S00-DIAIrPPL www.pplelectric.co~ . p Transition Charge: . 180 KWH at -0.66800000¢ per KWH -1.20 Generation Charge: C i apac ty and Enemy 180 KWH t 10:133000 a 00¢ per KWH 18.24 Total PPL Electric Utilities Charges $31.29 Other Char es for PPL Electric Utilities Late Paymen~ Chaz e g 1.63 Total of Other Chazges $1.63 .... Account Balance $163.33 General Information Next metea reading on or about Oct 1 The $130.41 balance includes $1.06 in prior late payment charges. Generation prices and charges aze set by the,electric generation Suppppl~ier you have chosen. The Pubic Utility Commission re ates distribu3ian pricer and services. The Federal Energy Regulatory~ommission regulates transmission prices and services. PPL Electric Utilities uses about $0.76 of this bill topay state taxes. In addition, about $9.63 of this bill pays the PA Gross Receipts Tax. For our convenience, you can now pa your bill using your Visa, MasterCard, Discover, or ATM Card all BiBMatrix at l -800-fi72-2413. BiIlMatrix will chazge your credit and ATM card a service fee for making this payment. Before diggit 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 sunpl dialing 811, which will connect you to the One Call system. Be safe andyca1181I 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 learn more or sign up, visit www.pplelectric.com. Dish washers use about 13 allons of hot water per load That's less than washing dishes by hand Algways use full loads on the shortest cycle. When washing dishes by hand, don't let the hot water run continuously. Save postage and late charges -sign up for Automated Bill Payment. PAYABLE TO ROBERT C CAIRNS TAX COLLECTOR PO BOX 40 BO!lJNG SPRINGS PA 17007 0040 DESCRIPTION ASSESS.NO - 40002331 MAP NO: 40-22-0485-009A 40 CAMELOT DRIVE ACRES .340 DEED 00326! 00413 LAND LESS THAN 1 ACRE Residential Building RESIDENTIAL TA% PAYER MILLER, THADD A 40 CAMELOT DRIVE CARLISLE PA 17013-9288 OFFICE HOURS 1GR51TTQE-WED 9:OOAM-3:OOPM 4 FORGE RD: SCHOOL ADMIN OFFICE CLOSED JULY 16-23 AND HOLIDAYS PHONE:717-258-6484 EXT 2010 TAX PAYER COPY >-:+•~`I~o: 3980 __ _ Control No: 040 - 002331 r. zu~u anep msn[ 'ae r e*[e~e i ~ nm vara: nv I rw ~ v Assesse Land Values 18,000 Homestead Exclusion Improvement 70,740 Mi 1 U _, Total 88,740 10 546- SOUTH UIDDLETON S.D. Diacoura Faea Rates 11.55070 SCHOOL R 8 11.55070 11.55070 1 025.01 10 Homestead Credit 121.81- TAK AMOUNT DUE -> ~.~a ~9oaao ~D8.52 I! Paid Oa or 11ltas I! Baid Oa or 8alosti 7 01 2010 8 31 2010 9 01 2010 '10 31 2010 11 O1 2010 12 31 2010 IF TAXES ARE IN ESCROW FORWARD TO MORTI'3ADE CO IF NOT PAID BY 12/31/Z010 Ti~S BILL WILL BE RETURNED TO TAX CIAIIA BUREAU FOR COLLECTION G 1, ~ 0 -~ ~ ~~ 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. NT R TS ATE PO BOX 553916 DETROIT MI48255-3916 w'""`"~~" (717} 423-5383 Address Service Requested 353DDD0132 <B> Ill.t~~~I...dl~rllhllhhlllm.l.luti~lrilllui..ul~~q~u THADD MILLER 40 CAMELOT DR CARLISLE PA 17013-9268 Description Service Addross: Account Number. 060109 Previous Balance: 0.00 0001 - 40 Camelot Dr Invoice Date: 09/15/2010 Current Balance: 297.25 Carlisle, PA 17013-9268 Invoice Number. 0002236216 Please Pay: $297.25 Blanket PO: Due Date: Due Upon Receipt INVOICE DETAIL Date Reference Stbe 0001 - 40 Camelot Dr Csrtbls, PA 17019-9268 09/10/2010 0000194722 20 YD Open Delivery 09/15/2010 0000195746 20 YD Open Pull & NJR-Trash 09/15/2010 0000195746 Dump/Trash Important Messages Submit payments and remit coupon to the Detroit PO Box address listed on the coupon below. Ali other corresluondenoe must be mailed to: Western Md Waste Systems, LLC Customers: PO Box 2421, Cumberland, MD 21503 IWS of PA Customers: 354 Alexander Spring Rd Ste #3, Carlisle, PA 17015 IWS Western PA Collection Customers: 7095 Glades Pike, Somerset, PA 15501 PO # Quantity Amount Totals IO~id-'/O 1.00 50.00 1.00 200.00 50.00 200.00 ~-'_ 1.05 45.00 47.25 ~s Current Charges: Taxes: 297.25 0.00 Invoice Totals: $297.25 i~ To expedite processing, please detach and return below po-tlon with your payment PPL Electric Utilities Electric Service For: THADD A MILLER 40 CAMELOT DR CARLISLE PA 17013 Estimated Bill Questions about this bill? Please contact u5 b ]un 28 at 1-800-342-5775 (1-S00-DIAIrPPL) 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 Meter Readings: Actual . Adjusted Estimated Customer 0 a ; '.4kA~s '-5~~~~~~3 ,.-- Page 1 pp~ § ~:: _~ :.. :..: 34420-85004 ~:~ ~~~:~ Summary Page Balance as of Jun 7, 2011 Chargge~s: Total-PPL Electric Utilities Charges Total Charges Account Balance 36 30 24 18 12 6 0 KWH -Average Per Day JJASONDJFMAMJ 2010 Months 2011 $137.51 $106.01 $243.52 $243.52 Meter Reading Information Meter #16748462 Jwn 6 Estimated 45241 May 3 Actual _ 44474 34 Da s KWH Billed 767 Average -Jun 2010 2011 Teemmpperature 65F 65F KWH Per Day 23 23 Yearly Use: Total Average Use MontWy Jul 2009 -Jun 2010 5562 464 Jul 2010 -Jun 2011 2262 189 Other important information on back ~ PPL Electric Utilities Electric Service For: THADD A MII,LER 40 CAMELOT DR CARLISLE PA 17013 Estimated Bill PPL Electric Utilities Customer Service 827 Hausman Rd Allentown, PA 18104-9392 1-800-342-5775 (1-800-DIAL-PPL) www.pplelecttic.com ppl Page 3 _ 34420 85004 Total from Last BiU $137.51 Billing Details Amount You Still Owe as of Jun 7, 2011 $137.51 Current Charges Charges for -PPL Electric Utilities Residential Rate: RS for May 3 -Jun 6 Distribution Charge: Customer Charge 8.75 200 KWH at 3.30405800¢ per KWH 6.61 567 KWH at 3.30405800¢ per KWH 18.73 0 09 PA Tax Adj Surcharge at -0.27600000% . - Transmission Chazge: 767 KWH at 0.20846900¢ per KWH 1.60 •• Generation Chazge: Capacity and Enemy 200 KWH at 9.00064600¢ per KWH 18.00 567 KWH at 9.00064600¢ per KWH 51.03 20 0 6 0 % 00 00 PA Tax Adj Surcharge at -0.28 . - Total PPL Electric Utilities Charges $104.43 Other Char es for PPL Electric Utilities ~ Charge Late Paymen 1.58 Total of Other Charges $1.58 Account Balance $243.52 General The $137.51 balance includes $11.66 in prior late payment charges. Information Generation prices and charges are set by the.electric generation su lier you have chosen. The Pubic Utility Commission re~~((ates dlstribu~ion Next meter prices and services. The Federal Energy Regulatory`~ommission regulates readin srnission prices and services. J~oi about ppL Electric Utilities uses about $0.29 of this bill to ppay state taxes. In addition, about $14.36 of this bill pays the PA Grosslteceipts Tax. For your convenience, you can now pa your bill using your Vise Mas}e~tCard, Discover, or ATM Card ~aU BillMatrta at 1-800-672-2413. Bi1lMatr3a will charge your credit and ATM cazd a service fee for making this payment. Before digging 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 andyca1181 I before you dig. We were unable to read your meter this month. We estimated your bill based on your normal usage. With pa~~ppeerless billing, you can receive and pay your PPL Electric Utilities bills onIme. The process is free, quick, convenient and secure. To learn more or sign up, visit www.pplelectric.com. Save postage and late charges -sign up for Automated Bill Payment. Payable To: ROBERT C CAIRNS, TAX COLLECTOR Office Hours: MON-TUES-WED 9:OOAM - 3:OOPM Bill No: 3984 PO BOX 40 4 FORGE ROAD; SCHOOL ADMIN BLDG Bill Date: 3/1!11 BOILING SPRINGS, PA 17007-0040 CLOSED HOLIDAYS Control No:40002331 Phone: (717) 258-6484 EXT 2010 PHONE (717) 258-6484 EXT 2010 MAP NO: 40-22-048fi-009A Desc: 40 CAMELOT DRIVE Acres .340 Deed:00328-00413 LAND LESS THAN 1 ACRE Residential(NNUnder 10 Acres) $1.00 FEE FOR ADDITIONAL RECEIPTS Tax Payer. MILLER THADD A Assessed Value: Land: 31,500 Improvement: 80,600 Total: 112,100 Discount Face Penalty COUNTY R/E 1.90200 $208.95 $213.21 $234.53 COUNTY LIB .14300 $15.71 $16.03 $17.63 MUN FIRE PROTC .17000 $18.68 $19.06 $20.97 TAX AMOUNT DUE If Date Of Payment Is On ;243.34 3/1/11 thru 4,'30/11 $248.30 5/1111 thru 6,'30/11 $273.13 711/11 or Later 40 CAMELOT DR CARLISLE, PA 17013-9268 ~d ~~ 11~q $~ a ~ ~ ~'~ ~ y~a~ ~~l TAXPAYER'S COPY -KEEP THIS PORTION FOR YOUR RECORDS sERVICE ADDRESS 40 CAMELOT DRIVE Acct No. 009055 BILLING PERIOD CQVERED FROM / / To 03/31 /2011 SER1/ICE WATER FIRE SEWER TOTAL 111.41 268.48 KEEP THIS PORTION OF THE BILL FOR YOUR RECORDS. 06/02/2011 ~ ~ ~ ~ PLEASE SEE ADDITIONAL 379 89 IMPORTANT INFORMATION ON THE BACK OF THIS BILL *********************************REMINDER NOTICE****************************** We have not received your 1st Quarter Water/Sewer PAYMENT IN FULL. First quarter net charges were due by May 3, 2011. Please remit the total amount shown by the final due date of June 2, 2011 to avoid additional charges. If you have already sent your payment, PLEASE ACCEPT OUR THANKS. +++++++++++++++++ADDITIONAL NOTICE+++++++++++++++++ THIS NOTICE MAY INCLUDE AMOUNTS OLDER THAN 60 DAYS. Amounts more than 60 days past due will be processed for collection and can result in termination of service at any time. INVOICE #: ~=~ t/~'~ i~ ~~ DATE: ~ ~~ BSN #: ~~~~~ ~ ~ ~ ~ ~ a ~ I I _.~ _~_ ,__..~._ I _ _._. agyMONr ~ ° _-.. - JOB ONT CT N ME ,. _ ~ ;_ ;CUSTOMER NAME (Financ`ially Responsible Party) CALLER NAME _ - ~~ F- i .. ... _. _. _ ~.. a__.. _ .. _ _ ~~ .. ~._._._..,..~.,.:_ :~_:. ...~ n._u.~_:.,~~.~~~....,., ,t.__. _..___..~___~-- STATE ZIP ' 10B-PrB8Rf55 }_.> i 1 ~ ~ `~ CITY i One Cal! Does It Alf ! I _ I :k'' ~ ~ ~ ~' ) ;- 's- 1 j Y"Y ~ ~ ~;~ ~ ~ ~ ~ 11 t... ..~.... _. , ..... 1'~ .,. 243-2749 432-8727 697-6706 ~-- ~ . ,fi'r` ~ ~. PH1 PH2 Carlisle Ddlsburg Mechanicsburg € Ifferent) _.~" .-. , ., _ _ , ~ . r_ _~-_ ~ .F~~.~~ Member of $ ~ hE-MAIL ADDRESS ~ ~~ ~ ~. ~~~ ~ ~} ~-~ ~ ~ ~ ~ ~ ~ ,: -..~ ~.e' ~~ ~ _.,. PA030595 .. _ ._. _. ~ .. __ {ORIGINAL REASON FOR THE CALL ~ ~ 1 4 ~C 1 r ~ } ~` 0~ __. .. __~ ~ -- _ __ ~,__ e . - --~ - - ....._ I ~, I c j SUMMARY: _.,__ _... ---__._._. __ __ _ __ _ _ _... _ - ~ See Summa of Fmdmgs sheet _._. ... .._ _..__.. .. ry - for additional m ormation w_.._~ -__ - _. _ - I WORK AUTHORIZATI ON: 4 the undersigned, am owner/authorized representative/tenant of the premises at which the work above is being done. I hereby authorize you to I For your peace of mind, !, perform the above recommendation, and to use such labor and materials as you deem advisable Unless prior-authorization for billing, payment for all work done is due upon ~ ~ should the repair amount letion C.O.D.). A $10.00 BILLING CHARGE is due thereafter An office billing charge and/or finance charge of 1.75% per month (21 % per annum) will be added after 10 days ' ex ~ee~acement valueyourm's I mmp ( i past due. I agree to pay reasonable attorney's fees, court costs and collection fees in the event of legal action. I have read this contract, including the terms and conditions on the ~', to hnician is required to ~ reverse side hereof and agree to be bound by all the terms contained herein. All of parts will be removed from premises and discarded, unless otherwise specified herein. i inform you of options for I IHEREBYAUTHORIZEYOU (~}~~-Ai{`~~ ~j'r.[?.r 'r5n~.^,~ ~''~~ ,~~~Su~ I~~"i ;~ ;~+ jibothrepairingandreplacing TO PROCEED WITH THE ABOVE } the equipment. i } f {~ Si nature Pnnt Name: __ }{ .--- ~---- --- ~- IWORK AT THE UPFRONT FEE OF $~,~~~ r 1 -.... g ._~ _ _ _ ~.___._.._ _~ _.,__ - -..-.-..-__.____. _ __.. _ t_.._.... ---_ -___ .__ .......... ~... ._ ~.; ~..~~,...~....n..~~ Qty Task# Description Sarongs ate _.~ __,~ ~ .~~. a _~.~ ~ ..~. - ,;, _ ,... ,..,,__ ...tir .-~ cr-- Dispatch Charge ~ Service Partner Membership !' ~ ~ =~ ^Prc-Approved financing Terms: V# PAYMENT 1 Cash ^ Check ^ MC ^ Visa ^ Disc ^ AmEx ^ Card #: PAYMENT 2 Cash ^ Check ^ MC ^ Visa ^ Disc ^ AmEx ^ Card #: SUBTOTAL ^ Please pay from this invoice -Work performed C.O.D. Check #: _ ..- Auth #: My Service Technician presented me with a Service Exp: C~ C~ Partner Program and explained the benefits Initial ONE .Check #: I want to save money and ~~ Auth #: become a Service Partner OR ~~ Exp: m m At this time 1 decline the offer ACCEPTANCE OF WORK PERFORMED: I acknowledge satisfactory completion of the above described work and that the premises has been left in satisfactory condition. I understand that if my check does not clear, I am liable for the check and any charges from the bank. I agree to pay 1.75% per month for past due contracts (minimum charge $15). In the event that collection efforts are initiated against me, I shall pay for all associated fees at the posted rates as well as all cost of collection fees and reasonable attorney fees. I agree that the amount set forth in the space marked "TOTAL COST" is the total flat price I have agreed to. SIGNATURE I decline to have the recommended work performed at this time. SIGNATURE SERVICE TECHNICIAN ACKNVVVt.tuut,rwtty r Prior to the customer entering into the contract, I have discussed the nature of the service and cost and I have given a copy of the contract to the customer. All work I have done has been in compliance with company standards in a workmanship manner, to building codes when applicable. SIGNATURE ~:y..- DISCOUNT ~;I l ~:~ ~ir TAX - TOTAL COST ~ ,~~ ~`~ DEPOSIT - - AMOUNT DUE f ~ ~ ~.~~ i ~' `err ~ k ~ *i` ~ ~ r ' Y'1 ~a-~~ >c~ ~ t n~ ~ _i,. '~~s z CUSTOMER SERVICE IS OUR #1 FOCUS If you are not completely satisfied for any reason, please call and ask to speak with the Customer Service Manager. Your feedback is very important to us. THANK YOU FOR CHOOSING US FOR DATE - YOUR SERVICE NEEDS!. ... `~-'"G`a~ow* ~~~ Customer: ~~:~~ .. ~~ ,~~, ~ ~~;~. Date: _~ One Call. Does It All ! ~rf ~ ' +`~ 243-2749 432-8727 697-6706. ~~; ;a~; Carlisle ~ Dillsburg Mechanicsburg:" ,: Observations I r ~.~: ~ . a -..~ u ~' dam' ; °;.- ... -,xJ i ~ --f" `~~;'' 1~ ~~ , "~`` r'` "' i" t 1, Findin s ry ~~ Baymont On Call • P.O. Box 697 •Dillsburg, PA 17019 • Phone: (717) 243-2749 • (717) 432-8727 • (717) 697-6706 J PA030595 Smmm~srv of Finelinea V s~ ~~ rP ~_ ., , _ , ,_ HELEN B. M~I~1 FR _ _ ~~..~~..- 1175 751 3 LAURALIN PLACE 68-782812580 SPRINGFIELD, VA 221 50 __ __~~''~~_~C- i ^~` ,i:e the _- ? --- --J (~ v ~ ~'v [~~,/ _ L3 ~_~ ° , I ; '.~'1oiLar~. __. •~ --~~ - . , w i1ycL> .EDIT UNION TRi/~ , vieciNU xxisa v. ~ ~, ~~ _ ~: 560 78 ~8~4~: L L 700000 2468 211' L L 7 5 P.O. Box 25084 Lehigh Valley, PA 18002 '121 DG00100021101" T Miller 7513 Lauralin PI Springfield, VA 22150411 I~~I~I~~I~I~~~II~I~I~II~~~~I~~I~~~II~~~III~I~~~~~I1~~11~~~~111 ~ l ~~~; ~E•.~i t.:.: .~ ~ .~ May 1, 2011 Past Due Amt: $55.80 Current Amt: $0.00 Total Amt: $55.80 Account #: 032406 *****NOTICE OF POTENTIAL INTERRUPTION OF SERVICE***** Dear Customer: According to our records, your waste removal account has a past due balance totaling $55.80. As of the date of this correspondence, your account is in a state of delinquency. As a reminder, our payment terms are due upon receipt. You have been granted ample time to pad your account. To avoid interruption to current or future services, please pay the balance in full vv~thin 10 days. Please remit the outstanding balance along with the tear off portion provided below. If you have already sent payment or believe an error has been made, please call us immediately toll-free at 866-516-2768. If payment is being withheld for any reason, please contact us to discuss concerns or questions regarding your invoice. We highly value your business and thank you for your prompt attention to this matter. For your convenience, and no additional fee we do accept check by phone payments, MasterCard, Visa and American Express. Sincerely, Accounts Receivable Department Interstate Waste Services, Inc. NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION /~ 20R1644U' AveW Lyrmwood, WA 98036 Dear Customer: Your account, listed below, has been assigned to Receivalles Performance Management for payment processing, on behalf of Embarq, for your LTD (Local Telephone Division) account. If youu have any questions or need assistance, please call TOLL FREE 1-866.212.7408. , Reference Number: 7172432084458 Creditor: CenturyLink formerly EMBARQ Date: I 1-13-10 Amount: $148.52 Amount Due: $148.52 (U.S. FUNDS ONLY) Please make payments payable to: Embarq PO Boy 96064 Charlotte, NC 28296-0064 Unless you notify this office within 30 days after receiving this notice that you dispute the validity of this debt or any portion thereof, this office will assume this debt is valid. If you notify this office in writing within 30 days from receiving this notice, that you dispute the validity of this debt or any portion thereof, this office will: obtain verification of the debt or obtain a copy of a j udgment and mail you a copy of such judgment or verification. if you request this office in writing within 30 days after receiving this notice, this office will provide you with the name and address of the original creditor, if different from the current creditor. This communication is from a debt collector. The purpose of this notice is to collect a debt. Any information obtained will be used for that purpose. Estimado Cliente: Su cuenta, que se senala mas adelante, ha sido enviada a Receivables Performance Management Para procesar el ppago a nombre de Embarq, pare la cuenta de LTD (Local Telephone Division). Si tiene alguna pregunta o necesita evade, silvase llamar GRATIS al nutnero 1-866.212.7408. Numeo de referenda: 7172432084458 Acreedor: CenturyLink formerly EMBARQ Fecha: 11-13-10 Cantidad: $148.52 Cantidad adeudada: $148.52 (MONEDA DE EE.UU.SOLAMENTE) Sivase hater el pago a: Embarq PO Boy 96064 Charlotte, NC 28296-0064 Este oficina asumira que la deuda es valida a menos que a mas tardar 30 dies despues de recibir esta notification, usted avise a esta oficina de que mega la validez total o parcia~ de esta deuda. Si a mas tardar 30 dies despues de recibir esta notification, avisa a esta oficina de que mega la validez total o partial de esta deuda; haremos to siguiente: obtendremos verification de la deuda u obtendrernos una copia de la sentencia de ley y le enviaremos una copia. Le daremos el nombre y direcci6n del acreedor original, si es dtferente al acreedor presente, si usted asi to pide por escnto a esta oficina a mas tardar 30 dial despues de recibir este aviso. Este comunicado es de un recaudador de deudas. La finalidad de esta notificaFion es recaudar una deuda. Cualquier information obtenida se utilizara con este fin. To ensure ro credit, lease detach the bottom onion of this notice and return with our a V i P~ P P Y P yment. Para gazant~zar qua se aeredite el pago, torte la parte inferior de esta notification y enviela con su pago. ~` .~ ,; ,~ W J ~, m a z . _ • ~i z °< W ~ ~ Wo ~ W , ~o q ~ m ~ _. ., ~- _ N ~ ^ ,. l~ ~ L~ - m y~ ~ * - ~ a _ mx Y s ~ ~ p ~ _. o ~ E =J ~~=JW - _~^ $ ... t m o L ~ °m - - LL _ ~ m ~: ~~ ,•r , ,t ~ ~ r •a '~ ~ +r ; ~ ~ ~ ~; -- 0 ~.. r' z ~~ ' ~ - JLl W ~- W ~S ,~ y..j ~'~r; . 5~ ~, ~ ~ o ~~ ~ S ~ ~~ i ~~ `! _, ~`'+ { t ~ - ~ v ` I~~ _ ~ ~ .. 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L ?~ h Ji ~i 5 L L ~~ 4 {~;± w ~ 6 ~ yr ~ ~ r } ~' ` ~~ f ,'~`' ` Y i > ' '.L ~ k` .. `r ' 1 °Y tH ,Fi-.~ _ tic q !f V ~ 4y i-. ,. y.. ; ~ ' ~, ; ..r ` , ~ ° ~ , s ae ;:; _ `~w a .=_ to ~, ;r ~-7 a A to z Tax Service 321 Second Street, New Cumberland, PA 17070 7744068 ~° ~ ~,<~ 249-8166 _ ~ ! Name ~' ~ } ; ~~: ~~ --- Phort~ ~~`~ j - ~ ~'~' `~-~ ~ ~ Pickup Date Oto Copy FORM FED ST F/ST LOC ~ CLI Total ~~~ .~ ~ .sue ~~ ~ ~. ~~ ,; ~ ~. ~. r ~~~ SPECIAL INSTRUCTIONS: s` ~`° ; PREPARED B1F COST Tax Consultant'~y ti ~ j~ ti4r ~ (~ ~ ~~~~~ Trattor5upply.com ,, 10 NOBLE BLVD. CARLISLE, PA 170'13 717-245-2334 Ticket: 39131 Date: 12/11/10 Time; 1:37 PM Store Z64 Register: 3 . Cashier: 00203239 Item Qty Price Rmount TRRV RV ANTIFREEZE 823026 1 4.49 4.49 TRAY RV ANTIFREEZE 823026 1 4.49 4.99 Subtotal 8.98 Tax 0.54 ,? Total 9.52 .Deb Card 9.52 XXXXXXXXXXXX2Z70 Bank Reference ><:000018666333 Chansa. 0,00 I agree to PaH the above amount according to my card issuer agreement. ****~t***+t+t~~~****~t*~~***~r*~aE**+r****~~*~ 0 ai Mire saving. Mor~* doing:" 1013 S. HANOVER ST, CARLISLE PA 17013 WE NOW INSTALL HOME SOLAR POWER UNITS 4149 0005$ 33306 09/18/10 03:44 PM CASHIER SELF CHECK OUT - SCOT58 077578015712 DOOR `.>HOE <A> 8.47 SALES TAX v 0.51 TOTAL $8.3$ CASH 20.00 CHANGE DUE 11.02 1 1 1 RETURN POLICY DEFINITIONS POLICY ID DAYS POLICY EXPIRES ON A 1 90 12/17/2010 THE HOME DEPOT RESERVtS THE RIGHT TO LIMIT /DENY RETURNS. PLEASE SEE THE RETURN POLICY SIGN IN STORES FOR DETAILS. GUARANTEED LOW PRICES LOOK FOR HUNDREDS OF LOWER PRICES STOREWIDE x ~~~ LONE'S HONE CENTERS, INC. 850 EAST HIGH STREET CARLISLE, PA 17013 (7177 258-7700 - SALE - SALES 8: 51710CR2 1538446 04-09-11 71920 ARAON-SE6AL KEY 9102-7- 1.78 SUBTOTAL: 1.78 TAX: 0.11 INVOICE 10304 iOTAI: 1.89 CASH : 2.00 CHANGE: 0.11 STORE: 1710 TERMINAL: 10 °04/09/11 10:13:42 # OF ITEMS PURGHASED: 1 EXCLUDES FEES, SERVICES AND SPECIAL ORDER ITEMS THANK YOU FOR SHOPPING LONE'S. SEE REVERSE SIDE FOR RETURN PGLICY. STORE MANAGER: RICH TROSS HAVE A COMMENT OR FEEDBACK? LET US KNON AT: 41MW. LObIES . COFIJFEEDBACK STORE CAE: 171-40911-10304 NE HAVE THE LONEST PRICES, GUARANTEED! IF YOU FIND A LONER PRICE, NE HILL BEAT Ii BY 10;;. _ :: ;~ -° ', . y .. ;i :, ... ,i ~ `;ai. _ i ~ t's~ itt~,, ...._,. .'1 ~: 1 f '.. l!li '; _: - _ ~-~: _.ti~,y ~~~t~~ w.y ~t rt: t~~+i inii i1j,'°? /'. ~. ~"~~~s ';j' 1 :': '.S.U .. - ~ . ;, ~ '. . _ ' i 'fir;. v```~. i1~ __...._'... ._ ^~: ~.__._.... 0 SPRINGFIELD M 0 7051 BROOKFIELD PLAZA SPRINGFIELD, VA 22150-9995 NORTH SPRINGFIELD BRANCH SPRINGFIELD, Virginia 221519998 5165430222 -0096 04/14/2011 (703)321-1069 09:05:24 AN Sales Receipt Product ''Sale Unit Final Description Qty Price Price Utility 1 $0.99 $0.99 Mailer 10.5x16-RP KANSAS CITY NO 64999 $0.61 Zone-5 First-Class Letter 1.30 oz. .:.==_a~ Issue PVI: $0.61 HARRISBURG PA 17129 $0.61 Zone-2 First-Class Letter 1.20 oz. sas=aams Issue PVI: $0.61 Forever 1 $8.80 $8.80 Holiday Evergreens PSA Bklt Total: $11.01 Paid by: Cash $20.00 Change Due: -$8.99 Order stamps. at USPS.com/shop or call 1-800-Stamp24. Go to USPS.com/clicknship to print shipping labels with postage. For other information call 1-800-ASK-LISPS. wwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwww w.~wwwwwwwwwwwwwwwww,rwwwwwwwwwwwwwwwwwwww Get your mail when and where you want it with a secure Post Office Box. Sign up for a box online at usps.com/poboxes. wwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwww wwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwww Bill#: 1000403668451 Clerk: 11 All sales final on stamps and postage Refunds for guaranteed services only Thank you for your business wwwwwwwwwwwwwwwwwwww~wwwwwwwwwwwwwwwwwww wwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwww HELP US SERVE VOU BETTER Go to: https://postalexperience.com/Pos TELL US ABOUT YOUR RECENT POSTAL EXPERIENCE YOUR OPINION COUNTS wwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwww wwwwwwwwwwwawwwwwwwwwwwwwwwwwwwwww*wwwww 09/20!2010 07:33:53 AM Sales Receipt Produrt Sale Unit Final Description Qty Price Price DiLLSBURG, PA 17019 $4.9t. Zone-2 Priority Mail® 0 lb. 12.20 oz. Expected delivery Weds. yr, September ?_2. Delivery Cu;ifirmation"' serv~i ce $ . 70 Label #: 0496 9010 2430 2608 3892 Issue Postage: ;U Total: •- __-_-- $5.60 Paid by: Debi tCard F' Account #; XXXXXXXXXXXX~ Approve/ Jr: 373231 Transaction #: 708 23-902320316-99 Receipt #: 026971 APC Transaction #: 5 USPSO # 51872-9550 To check on the delivery status of your Delivery Confirmation'" article, visit our -Track & Confirm website at www.usps.com, use this Automated Postal CenterTM (ar any Automated Postal fenterTM at other Postal locations) or call 1-800-222-1811. Thanks. It's a pleasure to serve you. ALL SALES FTNAL ON STAMPS AND POSTAGE. ~:EFUNt 4 GUARANTEED SJ:RVICE :JNLY. Customer Copy NORTH SPR NC;FIELD BRANCH SPk;NG'iELD, Virginia X71519998 '.i i,; Sa 30222'` -0096 11/2212010 (7il:i)321-1069 04:04 :25 Ptd a ----- Sa 1 a°. Recei ut -- --- Product '=;~:.ie Unit Final D..cription icy r'~ ,~e Prue DILLSBURG PA 17019 r4.9~; Zone-2 Priority heal l 10.60 oz. Expected Delivery: Wed :x'10 Delivery Confirmation :!:r J Label #: 030312~~.;lUi! t~~;!; ~ ~ ~-! Issue PV:: -$5 60 t~or•ever 1 $8.80 $8.90 Holiday Evergreens PSA Bklt Total: $14.40 Faitl by: Cash $15.00 Change Due: -$C.60 Order stamps at USPS.eomishop or call 1-80U-Starnp24. Go to l.1SP~.com%elicknship to print shipping labels with postage. For other information call 1.800-ASlt-LISPS. *******ak***k*f~**~4+hat*ik****+F+4 M+t****aF ~r#*Jr.fr* ********'at******,tat*******# k*,t**vt*at**st**ir* Get .sour mai 1 when and ~rl,er•e s'oir ',rant. i t witty a secure Post Office Box. Sign u;~ for a box online a.t usps.com,poboxes. **atie*at*~k****~**1r.4*+k+t*it *e4 ile ek ar at*,t******~k,t,k +t i. drka4k*k*A*4***M'*****kk*k*~ni:**k***n~k4kt:*ir* Bill#: 100020.'605977 Clerk: 12 All sales fi i nag on staurps and postage Refunds for• guaranteed services only Thank you for your business **ir***a4*******at***Yr***************k**+tx* k.:i***k~rr*****+k atat****,t ak ~w~ir*~k****at at-k k**ak*k* HELP' US SERUE YOU BITTER Go to: ho ps:,~lpostal~xperiance.camlPos TELL-U~ ABitU? `,~u~,~ ri~ttrJl Ps: fAL E?iPERIENCE '10UR UPIi1TOtd COUNT`: *********:kk**#**xY.M*ak1.~kl.~*1r**wxkaskk**h** *.h*at***irc is*k:=rxw A~~k at***~kla4 n~*kir.l****is**t:k is.t& Customer Copy R au~E LDWE'S HONE CENTERS, INf.. 850 EAST HIGH STREET CARLISLE, PA 17013 (717) 258-7700 - SALE - SALES A: S1710JG3 1514762 03-05-11 71891 MASTER PADLOCK KEY 9102- ' 1.7fl 71912 NRTIONAL KEY 9102- 1.78 SUBTOTAL: 3.56 TAX: 0.22 INVOICE 09665 TOTAL: 3.78 CASH : 5.00 CHANGE: 1.22 STORE: 1710 TERMINAL: 09 03/05/11 14:45:29 # OF ITEMS PURCHASED: 2 EXCLUDES FEES, SERVICES AND SPECIAL ORDER ITEMS ~~~~~~~ THANK YOU FOR SHOPPING LOWESS. SEE REVERSE SIDE FOR RETURN POLICY. STORE MANAGER: RICH TROSS HAVE A COMMENT OR FEEDBACK? LET US KNOW AT: 4~lMI . LOWES .CON/FEEDBACK STORE CODE: 17100-30511-09665 ,.~ HAVE THE LOWEST PRICES, GUARANTEED! IF YOU FIND A LOWER PRICE, WE WILL BEAT IT Ei 10$. SEE STORE FOR DETAILS. * YOUR OPINIONS COUNT! * REGISTER TO WIM R 55,000 LOW1:'S GIFT CRRD! ~ * ~ ~ REGISTER BY COMPLETING A GUEST SATISFRCTION SURVEY * WITHIN ONE WEEK Ai: uww.lomes.iWrsuruey.co~a Y O U R I D N 09665 1710 064 ~ * ~ ~ NO PURCHASE HECESSHRY TO ENTER OR WIN. ~ * VOID WHERE~PROHIBITED. MUST BE 18 OR OLDER TO ENTER. ~ * OFFICIAL RULES d WINNERS AT: wWW.lowes.iWrsuruer.coe ~ STORE: t710 TERMINAL: 09 03/05/11 14:45:29