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
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Helen 8. Miller •
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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
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~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
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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 ******
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ACCESS CODE: 431-009-531-610
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****************
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
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* To compete a Survey &
* enter ~~ mont awing for
~ yc,~r _~ a
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* 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
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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~
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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
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sheetz #299
Eat In W
428 M Church st ~~
Thurmont, MD 21788
ts9~~ 21 Order #200197
WENDY'S 416/2011 12
OLD FASH ~
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_3279 IONED HAM BURGERS
Un i eased Ca 94
~2.799/G
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l Carlisle 0402
store #00000402
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14.391 Ga i a
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Gas Tata 1 ; X49 , 93
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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
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How was your visit?
Call us at 1-888-624-8140
Total Items 2
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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~. __. •~
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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: $148.52 (MONEDA DE EE.UU.SOLAMENTE)
Sivase hater el pago a: Embarq
PO Boy 96064
Charlotte, NC 28296-0064
Este oficina asumira que la deuda es valida a menos que a mas tardar 30 dies despues de recibir esta notification, usted
avise a esta oficina de que mega la validez total o parcia~ de esta deuda. Si a mas tardar 30 dies despues de recibir esta
notification, avisa a esta oficina de que mega la validez total o partial de esta deuda; haremos to siguiente:
obtendremos verification de la deuda u obtendrernos una copia de la sentencia de ley y le enviaremos una copia. Le
daremos el nombre y direcci6n del acreedor original, si es dtferente al acreedor presente, si usted asi to pide por escnto
a esta oficina a mas tardar 30 dial despues de recibir este aviso.
Este comunicado es de un recaudador de deudas. La finalidad de esta notificaFion es recaudar una deuda. Cualquier
information obtenida se utilizara con este fin.
To ensure ro credit, lease detach the bottom onion of this notice and return with our a V i
P~ P P Y P yment.
Para gazant~zar qua se aeredite el pago, torte la parte inferior de esta notification y enviela con su pago.
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Trattor5upply.com
,,
10 NOBLE BLVD.
CARLISLE, PA 170'13
717-245-2334
Ticket: 39131
Date: 12/11/10 Time; 1:37 PM
Store Z64 Register: 3 .
Cashier: 00203239
Item Qty Price Rmount
TRRV RV ANTIFREEZE
823026 1 4.49 4.49
TRAY RV ANTIFREEZE
823026 1 4.49 4.99
Subtotal 8.98
Tax 0.54
,? Total 9.52
.Deb Card 9.52
XXXXXXXXXXXX2Z70
Bank Reference ><:000018666333
Chansa. 0,00
I agree to PaH the above amount according to
my card issuer agreement.
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1013 S. HANOVER ST, CARLISLE PA 17013
WE NOW INSTALL HOME SOLAR POWER UNITS
4149 0005$ 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;;.
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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.
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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.
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a box online at usps.com/poboxes.
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Bill#: 1000403668451
Clerk: 11
All sales final on stamps and postage
Refunds for guaranteed services only
Thank you for your business
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HELP US SERVE VOU BETTER
Go to: https://postalexperience.com/Pos
TELL US ABOUT YOUR RECENT
POSTAL EXPERIENCE
YOUR OPINION COUNTS
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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.
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witty a secure Post Office Box. Sign u;~ for
a box online a.t usps.com,poboxes.
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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`:
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Customer Copy
R
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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