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Home My WebLink About10-19-1115056041114 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Couniy Code Year File Number Bureau of Individual Taxes PO BOX 280601 INHERITANCE TAX RETURN ~~ I Q Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 574-10-8230 10262010 Decedent's Last Name Date of Birth 08081911 Suffix Decedent's First Name KLAIBER DOROTHY (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ® t. Original Return 0 4. Limited Estate ® 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS Q 2. Supplemental Return 0 4a. Future Interest Compromise (date of death after 12-12-82) Q 7. Decedent Maintained a Living Trust (Attach Copy of Trust) Q 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) MI T MI 0 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 0 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ANN OPDYKE DEELEY, EA 717-901-3392 Firm Name (If Applicable) H&R BLOCK PREMIUM First line of address 4811 JONESTOWN ROAD, STE 125 Second line of address City or Post Office State ZIP Code HARRISBURG PA 17109 REGISTEF?~F WILLS US~ANLY -~ ~ - t - ~ raa - -- ~7 G - .~T '~. <= - - DAtLE FILED ~ ~' t'-;: z~ ~~-e i_ .i _ T~ 7 Correspondent's a-mail address: ANNOPDYKE .DEELEY@TAX . HRBLOCK . COM Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is 4811 JONESTOWNI~D,STE 125 HARRISBURG, PA 17109 PLEASE USE ORIGINAL FORM ONLY Side 1 15056041114 15056041114 312 LA SMITH RD CAMP HILL, PA 17011 SIGNA P E~OTHER TFfpN REPRESENTATIVE / „~AJE 15056042115 REV-1500 EX Decedent's Name: DOROTHY T KLAIBER Decedent's Social Security Number 574-10-8230 RECAPITULATION 1. Real estate (Schedule A) ........................................... 1 2. Stocks and Bonds (Schedule B) ...................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. NONE 4. Mortgages & Notes Receivable (Schedule D) ............................ 4. NONE 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. 6. Jointly Owned Property (Schedule F) Separate Billing Requested ........ 6. NONE 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested ........ 7 NONE 116000.00 91175.00 35571.00 8. Total Gross Assets (total Lines 1-7) ......................... ......... 8. 2 4 2 7 4 6. 0 0 9. Funeral Expenses & Administrative Costs (Schedule H) ........... ........ 9. 5445.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............... 10. 11. Total Deductions (total Lines 9 & 10) ................................. 11. 12. Net Value of Estate (Line 8 minus Line 11) ............................. 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 20450.00 25895.00 216851.00 an election to tax has not been made (Schedule J) ...................... . 13, 0 . O O 14. Net Value Subject to Tax (Line 12 minus Line 13) ....................... 14. 216 8 51.0 0 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0 0 15. O. 0 0 16. Amount of Line 14 taxable at linealratex.o 45 216851.00 i6. 9758.00 17. Amount of Line 14 taxable at sibling rate X • 12 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X , 15 18. 0 . 0 0 19. TAX DUE ...................................................... . 19. 9758.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056042115 15056042115 J REV-1500 EX Page 3 574-10-8230 File Number Decedent's Complete Address: 21-10-1177 DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER DOROTHY T KLAIBER 574-10-8230 STREET ADDRESS 11 ELMHURST ROAD CAMP HILL PA 17011 CITY STATE ZIP CAMP HILL PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 9758.00 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 9800.00 C. Discount 490.00 Total Credits (A + B + C) (2) 10290.00 3. InteresUPenalty if applicable D. Interest E. Penalty Total InteresUPenalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 532.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT rt ~ - ~ . , . PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ....................................... ^ ^ b. retain the right to designate who shall use the property transferred or its income : ................ ^ ^X c. retain a reversionary interest; or ...................................................... ^ ^X d. receive the promise for life of either payments, benefits or care? ............................. ^ ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................. ^ ^X 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .. ^ ^X 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which ^ ^X 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 January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 277 REV-1502 EX+ (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER DOROTHY T KLAIBER 21-10-1177 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which properly would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real propertv which Is Jointly-owned with r(ght of survivorship must be disclosed on Schedule F. ITEM I I VALUE AT DATE 11 ELMHURST ROAD CAMP HILL PA 17011 ~ 116,000 TOTAL (Also enter on line 1, Recapitulation) I $ 116 (If more space is needed, insert additional sheets of the same size) 217 REV-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE B STOCKS & BONDS FILE NUMBER DOROTHY T KLAIBER 21-10-1177 All property Jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM 1. 725 SH ATT X28.40 2. 124 SH COMCAST ~ 19.735 3. 192 SH EXXON MOBIL ~ 66.19 4. 65 SH FRONTIER C~ 8.735 5. 200 LOCKHEED MARTIN 071.595 6. 43 SH MET LIFE ~ 40.305 7. 272 SH VERIZON X32.56 8. 757 SH WEIS MARKETS X39.57 9. 20 SH GENERAL MOTORS ----WORTHLESS (If more space is needed, insert additional sheets of the same size) VALUE AT DATE 20,590 2,447 12,708 568 14,319 1,733 8,856 29,954 z~~ REV-1508 EX+(6-ss) SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER DOROTHY T KLAIBER 21-10-1177 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with rtcht of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 AUCTION PROCEEDS - S BRIAN MAGARO AUCTIONEER 07/31/2011 16,705 2 NCFCU ACCOUNT 001707 6,103 3 SUSQUEHANNA VALLEY FEDERAL CREDIT UNION 7377 REGULAR SHARE 2,245 4 SUSQUEHANNA VALLEY FEDERAL CREDIT UNION 77 REGULAR SHARE 5,142 5 SUSQUEHANNA VALLEY FEDERAL CREDIT UNION 7378 REGULAR SHARE 353 6 1996 BUICK VIN 1G4AG55M7T6476591 1,808 7 METRO BANK 50 PLUS CHECKING 0513244442 1,672 8 2009 FEDERAL INCOME TAX REFUND 422 9 ~ 2010 FEDERAL INCOME TAX REFUND ~ 1,121 TOTAL (Also enter on line 5, Recapitulation) $ ~ 35,571 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+(10-06) SCHEDULE H FUNERAL EXPENSES 8~ ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER DOROTHY T KLAIBER 21-10-1177 Debts of decedent must be reported on Schedule I. ITEM A. B. 1 2. 1 FUNERAL EXPENSES: MUSSELMAN'S FUNERAL HOME 451 FUNEAAL FLOWERS 184 FUNERAL STIPEND 300 MINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(s) Commission Paid: State Zip 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 409 5. Accountant's Fees 1,000 6. Tax Return Preparer's Fees 731 7. ESTATE ADVERTISING 342 S. 9. 2010 SCHOOL REAL ESTATE TAXES 1,316 10. 2011 CUMBERLAND COUNTY AND LOWER ALLEN REAL ESTATE TAXES 702 11. 2010 SCHOOL PERSONAL TAXES 10 TOTAL (Also enter on line 9, Recapitulation)_ $ 5 445 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+(12-03) SCHEDULEI COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, ~ LIENS ESTATE OF FILE NUMBER DOROTHY T KLAIBER 21-10-1177 Repoli debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. SETTLEMENT EXPENSES FOR THE SALE OF 11 ELMHURST RD CAMP HILL PA 9,616 2. AUCTION EXPENSES S BRIAN MAGARO 7/31/2011 7,278 3. METRO BANK CHECK S CASHED AFTER DEATH 973 - $60,974- $68.81,975 - $56.00, 185 4. HOMEOWNERS INSURANCE $260.00 7/15/10 $154.25 8/2/10;$111.00 11/10/10 525 5. LAWN CARE/SNOW REMOVAL 1,115 1115. UTILITIES -ELECTRIC $634; GAS -$545; WATER - $142; SEWER/TRASH -$420; 1,320 7. ALERT PHARMACY 411 TOTAL (Also enter on line 10, Recapitulation) $I 20,450 more space is needed, insert additional sheets of the same size) 217 REV-1513 EX+ (9-00) SCHEDULE) COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN ESTATE OF FILE NUMBER uvrty i n r i nvliccrt RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)) HENRY A KLAIBER 6516 DORNACH DR GREENSBORO NC 22410 SON ONE-HALF 2 DONALD A KLAIBER 312 BLACKSMITH RD CAMP HILL PA 17011 SON ONE-HALF ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR OUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET I I. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ ~ (If more space is needed, insert additional sheets of the same size) ESTATE OF DOROTI~~ T I~AI~ER 2110-1177 IJAST WIlLL AND TESTAMENT COMMONWEALTH OF PENNSYLVAN~~ COl~NTY OF G=.~MSERLA!~~? estate of DOROTHY T KLAIBER SHORT CERTIFICATE I, GLENDA EARNER STRA.SBAJG Register for the Probate of Wi11s and Granting Letters of Administration in and for CUMBERLAND County, do hereby certi f-v that nn the 30th day of November, Two Thousand and Tel, Letters TESTAII/IENTARY ir_ common form were granted by the Register of said. .County, on the late of LOWER ALLEN TOWNSHIP (First Middle, Lastl ili saicz county, deceased, to DO/VALD k"LAli3ER (First, Middle, Last) and that same has not since been revoked. InT TF'ST'TMQjUV rnTHEREOF, I have hereunto set ~-ny hand and affl~ed the seal of said office at CARLISLE, PENNSYLVANIA, this 30th day of November Two Thousand and Ten. File No. PA File No. Date of Death S.S. # 2010- 01177 21- 10- 1177 10/26/2010 574-10-8230 NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL ~~ ;, / / Register f Wills LR$T h'Il.L AIdD TESTAt~EE~IT C3F Dt~RQTHY T, I~LFiISER I, Dt3ROT~IY T. K~AIBER, Social Security Number 574-IO-$~3f3, of the Commonwealth of Pennsylvania, declare that this is my T I+~r's~+ AHD TES'.EAME:NT and I revoke all other wins arc codicils previously made by me. FTRS2: I appoint my sons, HEHRIt A. I~LAI88R and DQNAffD A. KLAIBER as my Co-Personal Retaresentat~.ves concerning this T~sTill. a. I request that my Personal Representatives be permitted to serve without band ar surety thereon and without the intervention of any court, excegt as required by law. I direct that my Personal Representatives act in unsupervised administration so as to administer my estate with a minimum of court supervision. If it becomes necessary to have ancillary administration of my estate in any jurisdiction where my Fersonal Representatives are unable or do not desire to qualify as ancillary legal representatives, I appoint as such ancillary legal regresentative such individual or corporation as my Personal Representatives sha11 designate, in writing. b. I direct my Personal Representatives to pay the expenses of my last illness, the expenses of a funeral appropriate to my station in life and custom of living {including a suitable monument or marker for my grave), and written charitable pledges which I have made. I grant my Personal Representatives the power to extend or renew any debt for such time as my Fersonal. Representatives shall deem appropriate. c. All estate, inheritance, succession and other death taxes with respect to all property passing under this my Will shall be paid from and borne by the principal of my residuary estate, without regard to reimbursement, as if such taxes were administration expenses. My Personal Representatives may pay such taxes at any time deemed advisable, whether or not then due and payable. d.. My Personal Representatives are requested to settle my estate as soon after my death as may be practicable, and to pay or deliver every legacy or bequest to my beneficiaries without waiting any time that may be believed to be customary in probate matters. FOURTH: If there ~s a c~...piete f~ ~:~re of makers L~er ~~~e preceding paragraphs, the property undisposed of shall. go to my ~'?°irS determined at the time of my death, pursuant to the Statutes of Descent and :J~Stri,rur...~.~ia ii. Bii.EC~., iia ~.axc Sx.n~.c vi. .Tcy uGTiiCi.ic, dt.. ~rI@ t.1ITt~ O! my death. FIFTH: If any beneficiary to any share of my estate ,which is nat subject to the provisions of any trust which may be created by this will is at the time of distribution of his or her share,, a ,mirror :.~~ the laws Of his Or her domicile, ~ direct that tLe n~'~~,r~°~-'rr ~3,a?-m ;des Y+a~teti into .quaff ifving proz~erty and dei? vere~t to ~he ~, ~ s ~ia~ as Gustodian f€sr ehe .nor under the Uniform Gifts to Minors ~,=.t __ _ e ti'~.fo~~ ~~_s~.sfers vc ~;inors Act as may then be in effect in aithe,r the state in which the beneficiary or the Custodian resides, or a::~y other state of competent jurisdictior_. a. The Uniform Gifts to Minors Act or The Uniform Transfers to Minors Act, as may then be in effect in the state concerned, is hereby incorporated by reference. The property affected by the Act shall be managed, held, and distributed in accordance with the provisions of the Act. b. The financial custodian will serve without bond or surety and without intervention of any court, except as required by law. c. The receipt by the Custodian, for the minor, of any principal or income transferred pursuant to this paragraph shall be a full acquittance and discharge of my Personal Representative or Trustee, as applicable, from liability with respect to such transfer and from further accountability for the principal or income so transferred. Si~TH:> Except as-otherwise provided in<this Will, I have i.n~entionally failed to provide for any oi.:her relatives or other p~rsaas, whether claiming to be an heir of mine or not. Insofar as I have failed to provide in this Will for any of my issue now living or later born or adopted, such failure is intentional and not occasioned by accident or mistake. SEVENTH: Any beneficiary who fails to survive until one hundred twenty {120} hours after my death shall be deemed to have predeceased me, and the gift to that beneficiary shall be disposed of accordingly. PAGE 3 ~~°r~ d-~`` OF 5 PAGES ~T 4* T T C~C)l~.t)~1'YC:~1A i!t' ct.I~ilr l.uwrur.iri CQtTFtTY C3F CiTMBERI~AND a C~C.~TQWLE1~Gt+TT I, DUR~THY T. KLAIBER, testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary oat for the purposes therein expressed. .. ;~Cf'G~~ C_:r r a (SEAL ) DURQTHY T RLAIBER~ AFFIDAVIT 'vie , ~S~ l' ~~~ ~ ~ ~i ~j -- ~ ~v". S ~ a'-=d t !~ i 4(( f ti.1(~t~n ~ M fl~Q~' , the witnesses, sign our names to this instrument, bung d~.Ty qualified according to law, do depose and say that we were present and saw the testatrix sign and execute the instrument as her .Vast will; that the testatrix signed willingly mr~d executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testatrix signed the will as a witness; and that to the best of our knowledge tha testatrix was at that time 18 or :Wore years of age, of sound mind and under no constraint or undue influence. Wztn s Witness Viit ss _ ;. Subscribed f s~br€~. to and acknowledged before me .by D~~ ~'_ tie teestatrix, and subscribed and sworn to before me say r~ S7 ~~°. ~r~-~ ~ ~~ r ^~t r lk. y- 2_ ~ t ~2 ~ and ~D~ n F. ~1~~~,~' , the witnesses, this 16th day of August, 1994 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX~11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 260601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX uFFiCiAL RECtiP i N0. CD 013912 KLAIBER DONALD 312 BLACKSMITH ROAD CAMP HILL, PA 17011 ACN ASSESSMENT AMOUNT CONTROL NUMBER fold ESTATE INFORMATION: ssN: 574-~o-szso FILE NUMBER: 2 110-1 1 77 DECEDENT NAME: KLAIBER DOROTHY T DATE OF PAYMENT: 01 / 1 9/201 1 POSTMARK DATE: 01 /1 9/201 1 coulvrY: CUMBERLAND DATE OF DEATH: 10/26/2010 REMARKS: SEAL CHECK#113 101 ~ 59,800.00 TOTAL AMOUNT PAID: INITIALS: CJ RECEIVED BY: 59,800.00 GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER A. Settlement Statement u.s. Dspattment oP Housing OMB Approval No. 2502-0265 and Urban Daveloptnent (expires 1t73Q12009) B • Ty ps of Loan ~~~ e. Rls Number: 7. Loan Number. a. MprtOage lnsuranCa Case Number. V' I ~ ~~ j t. ^ FHA 2. ^ FmHA 3. ^Conv. Unins. ( ( ~ jj~ ,~ / . l; 4. ^ VA 5. ^Conv. Ins. ^ / ` /"f F ~ ^'~ e a~ M r .+~. i w mm~(Inre ryrN(1 In Anre [IV 11!R ,Sgetiwnwnr wewni wm Ailnwn IIP.mi markeA ~' /l 111111. C. t4ete: Th)s form s furriahsd to give } c^te7*~.,, o ew,,.a. se..remenf ^es!s °(p,o.c.)" were paid outside Gosin9; they are shown here for informational purposes and not inGuded in the totals. __ ~ '~ C. Ne« ssb AGGrass ci scHCaar. , E. Name any Address of 9e0er. i F. Name and Atltlress of Lender. ~ ~ _ "~ i HSF Really.. LLC ~ Estate of Dorothy T. Ktafbar ,. -'"'` IDOneltl A. Klaiber, Executor I G. Property tACetian: SehlerneM Apenf: Ronald D. Butter, Esquir~+ ti EMltatratROad Ir'uweOi~en1PnC I~ C>mlpHYl pp 17n11 ~S007MummaROed, Suite 101 {'9f7M1 _LOt: 81ork: I1_gmgyt!e, PA 17Q43 ~a0amarsfro!eM•Uelar J. Summary of Borower•s Tranttactlon K. Summary of Seller's Transedion 100. Grawa Amount Qua Frnm Berravvwr don Amcs emrt:.nt n... Tn awuw. tot. Canradeabsprlo• - -I ti6,000.O D~aOt. Comredsatesprlne ~ i160000~ 102- Perseus{ properly 4112. Perscnel property 103, setdamem dlsr9es to txxrow~ {fx!g 1400) ' 3 430.75 r403. _ 104. I _ __ t404. ~-_~ tos. 405. __ L AdJusfinente for items paid by sailer in advance Adjustmanfs for items paid by seller in advance 100. G Aoamfaxes 917/tt ip 12731/11 221.30 400. C /tovntaxes $17/11 ro 12(31/11 ~ ~ 127.3Q 107. taxes ~ rd07. Ca taxes b r 108. As•••srronic m ~ 409. AeeadsmerNS ` toe. School taxes 9?!11 to 6/30/12 1 226.22 408. School taxes 9!7!11 to 6130!12 f I 1226 22 i m Rwumr 9_1711 t is 9/30/1 9 ~ 25.99 410. Sewer 9r7li l to 9/301 i 1 2~ 99 111. _ t0 414. ~ b - -.- t 12. to 412. to _ 113. fe I t41S 18 114. to )414. to ~ ii5. do _ 415. W _ 'r 20. Gross Amount tfiia Fram Borravrvr j 120.904.26 420. Grass Amount Dus Ta Seiler t 17.473.51 206. Amounts Paid By Or In Baha{f Of Borrower 500. Reductions In Amount Due To Seller <~,. DepssO~earnestmtxiay 1 6ape.ee ~~x~eed ~O raeelnstrutlioru+ ~ 6a00.op 202. Prindpal amount of new loan(s) 562. 3et0emertt cheroes ro seller rl Ina 1400) t 616 10 203. Existing !Danis) taken wbiea l0 I t 503. Hxieart0 bents) taxen subsea b t 204• - 604. Pe Oft od fist a ban _ ~- 205. 505. P oa or seeaW rno a town ~^ 205. -.__-_ 1 • 500. 207. 507. 209. _ __ 508. ~ 2!+9 509. Adlu9lmema for Items Umpald t1y Seller _ Adtuatmenta for iMme unpaid by seller _ ~--_- 210. CINAowrt saxes b 1 510. ClNfinwn taxes to 211. Counytaxas 10 _ 57 t. Coun faxes ro 1 - . 212. Asseasrnsrlts ttl _ 57T. Assessments to _ ~ 213, b 513. to ----~- 274, l0 5f4, to 215__ m 575. t0 ----- -- 278. t0 555. ~ _-_-__._.... 217. 1• 617. b 219_ Ic 518. Ia _- - 219. b _ Ste. io 220. Total Peid BylFor Borrotsar 8,000.00 620. Total Reduetlon amaurtt Due Seller I 9 615 t0 3Q6. Cash At Settiement F-omlTo Borrower 606. Ceeh At Sdtiemerli Toirrom Seller 301. Gross Annum tlue from borrower he 120 120 904.26 5 01. Gross amount due b s•Iler ins 420 117 473.51 302. Loss amounb Hof borrower lure 22D 6 000.00 5 02. Lees reductions k! amt, due wiles 7nQ 5 9 616.ip) 903. Cash ©From ^ To Borrower tt2 .26 6 03. Cash ®To ^ From Seller 167.657.81 Spetion 5 of the Reai Fslale Sehiemm!t Praoadwes Ad (RESPA} requires the following: • HUD must develop a Speekl Information 9ooklal to help peraom borrowing money to 6nanee the purehaae of msiden4iel real estate to tretter untleratand the nature end txsls of real estate aettlemeM BefL Ices; • Each tender must prrnide the boektel to all applicants from whom h receluea or for whom tt prepares ^ written application to borcow money to (manes the purohase Ot tasiderstal rea! estate; • Lenders must preparo and distrtbtile wdh itie BooWbt s Good Faith Ea6mate of fha aettlerrreat COatB that the borrower la bxey to incur in connection with the settlement. These disclosures are mandatory. Section 4(s} of RESPA mandates that F4UD develop and prescdba this standard -orm to be used at the ame of ban oetttemeM to provide tuu disclosure of ell charges imposed upon the borrower and seller. These ere third party dlachsurea that are desigr5ed to provide the borrower with peNnent Information tluring the settlement process In order to be a batter shopper. The Public Reporting Burden for this ea0edion of information is estimated to average one hour per response, trtcluding the time for reviewing in9trut.. lions, searching existing data soureea, gathering and meinlaining the data needM, end completing and reviewing the collection of Information. Thin agency may not collect this information, and ypu are not required to wmplete this form, unless it displays a currently ve0tl OM8 control number. The information requested does not lend itself to wnfidanliebfy. Previous edttiona ere obsolete paw t o{ 2 form HUD-1 (3!66) ret Hen~lodc 4305.2 L. SsM1tlement Cho 700. Ttlfal aWtdBrokara CemmNSbn baaM an rlaa t 11 t3 QOOAO 'k ° 0.00 Patd From Paid Fmm DhdslonrOt Commisalon ne7 es toHOwa: BGrtowera Sellers 701. f t0 Funds At Fantle Al - SelOament Settlement 800. Items Pavabis in Connection tlrltk Loan _ ROt Loan OnplnaWn Fea 802. Lcan Oiaccunt h ._ ,..~ R03- ApOraisal Fee W ROd. CtatlR Report ____. _.. _.Y? ._..__._~_~_._..~_~_.._ RRR. Letldrrs ~Mapeetbn FaB ~______. 80R. Mortgage InauranCeApptlcati0n Fee to - 807. Assumption Fee Y~,m,.,~_ - 806. ROB. _ _ __ 870. "- -~-----`-`_ 7001. Hat:ard ineunnGB t monMS~S per mOnM 7002. a e Insurance 1 moMR S er rtronth + _ ___ t0a3. CRy property texas 1 rrwmhe{'~t per monM t I SO04. Covflty pfepeity laKaa i rriGryG78~8 _, _,____ pat mcnLh _ ~ _,, ~~ 1005. Arvlual tnseaemenls 1 morlMS r monM 1000. 1 t7tordlls®S 1181 moMn 7007. 1 rnortlhs~3 per month 7000. Aggregate Artpunllnp Atliustment I I !lfln ?lira rhArnrr~ 1101. Soleamantordoau,groa b Butler Law Firm 100.00 ttoz. Abstredoralleasandl a T- hat. rdteeKerlvnauae b _~~ I ~ -- 1104. TRte insurence binder to ; 1m5. Dowrnent eoerebdn m Butter Law Pirm 100.00 ii00. NotaNtees io CaBk i i i0.00 5.00 1707. A'a 1888 t0 _ __ IIn7ltrde8 above ItemB men6de: --.` t~OS. TKieinsuranre to CommomxaaRh Land TiQe Inauran0e n .75 tlndudas above Rems numbers I _. 1 tea. Lenders ooverege s - - _ t t 10. Owners cove E t i6 000.00 - ^~ tnt. - - - _ 172. _ ^ 1 ~ -- tt73. ~ 52n0_ GnVa1TmA,11 Rafnroinn ann Trnnera. ChnMan 1201. RaGOrtlinp fees: Deed S 62.00 ; tdOnOaga S • Releases E 82.00 1202. CllyleounN hrlstampe: Geed S 1,160.00 ; Mort0a0e E t 180.00 1207. Sots taxratampa: Deed S t 160.00 ;Mort 3 1 '.60.00 told. ---- 12x5. ~~ Zaua waamonal aememenr cnaroea 7301. Sufyalr !D 1302. Pest kle e00n ro t3oa. 201f-12 $OhOatreatostata tax _ _ 5.511.1 730x. trios. 7309. ~ tsx7. 73oe. 1400. Total SeMlament Charges (enter on Ones 103, 5action J and 602, Section K) 3 430 TS I 1 61610 ,rra,n 1 rvrv f have wretuly reviewed the HU0.1 Settlement Statement and to Ore bast of my knowlsdoo and belief, i1 is a We and axurate staternenl of ail reriipts and disbumemeno on my account or by rns In this frensadiah. 1 hlrMar certify that I have rewtvetl a GGpy of I s HUD-t Sa70arteem Statement. Seller _ Borrower Estate of Dorothy T. Klaiber HSF Realty, LLC SNbI Befrewer Donald A. KlaIDer, Executor TO MB baal of my knoMattge Ina NUD.t Setdemenl $fatement wnull 1 Mve preparc0 6 a We antl accurate account of the tuntls whlU were reGeivetl antl have been or will ba tlisbutsed by the untlerslgned as pare of the settlement of Mia uansaaton. SeroetrentAgent __ pale Ronald D. Butler, Esquire iNARNIN(i: N Is i r:blla to Imowingly make Klee il8tnrrelde 1D the tMiled Stabu en Mia Orally OMIx aIryNIN t0fnl. Peneitirn dpGry OGryviCGOry Gan iflGlNde a (irye and I err nme 1 F >• rs - t1 18 1 q ode on 1x01 and Sedicn 1010. .~}~ form HUD-1 (3/86) Previous edHiOns are obsolete Page 2 of 2 ret Handbook 4305.2 •nrvn e~~,,... rte.....rre.r uual. l .°.re. ESTATE OF DO~OT~i~~ T ~A1BER 2110-1177 SC~IEII~ULE ~ A l dl;, l lI1C., 1 rilstoricai tluote - (iv i ~~ j i , ri 1 dL 1 Inc. aiocx i~ric;c - til~~na i5.c;uiu r arc ~ u;< ~ WSJ WSJ Mgrk~tW~tl;.h MarketWatch rR CtB~ AIIThi~gsDfgi~ta~i t~ AIIThingsDicl;&1 FINS RSOuotee Neva Indwtriea Markets Historical Ouotee BlpReports vtnaat-stocx exctrange--_.._..._~ _..__,.~ _._.... .___..,.... ~,. __. .._ __. FIIDB@Ouot~ tool albws you to bok up a secudry's enact closing porn. W6idl/1181fipe in the symbol and a hisbrical dare b view a quote and mini chart for that sectuiry. WSJ India W$J-GtSU1a_ Ines edti n WS~~~~~~0_,1=----------°'---'---, EnterDate: 10/26/10 ', ~~ ~ W5J Eutope -..... Sponsored Links Your 10 BAGGER is here! Stock tools, news, social feeds, charts & insider tips! Free offer! .:,.._ ,r azn=tenor ,.;.cm Penny Stock of the Day Penny Stock Pick of the Day Emailed to You. Huge Gains for Traders! ~+.wm Pen rn~Stock Ater Iszcrr. Big Penny Stock Returns Rated #1 Penny Stock Newsletter on the nst -~ „~e,i~srr~ck~,~nm VELA could be *BIG* Read why VELA could be the hottest Penny Stock of 2011! ..a:olr;F.vromirrreying~um Get starttid wRb a broker ~~ ~,. Why Pay Morel Switch Scottrade: $7 Trades, Trade with F'Meliry M OptionaHouse. Fast Executbns Ernier Symbeis or Ke';yworas ~ SEARCH P,g. ,5~ ©~~ ~~ . ~~ ~~ ~ ~~ e~ ti:lrs3+takfi Emker ~m'r. F . ~. Home I About I Job.DpP.ortunnies I Coglact Us I Feedoack I Heb Copyright 2011 MarketWatch, Inc. All rights reserved. By uanp this site, you spree to the Tetms of Usa and privacy Polipv (updated 4/aPoSI~ Intraday Data provided by St%Telekure entl subject W }ermeot.use. Historical and current entlof4ay data provided by SIX Telekurs, bl2day data delayed per ezchanpe requirements. Dow Jonas Intlezes (SMI Iron Dow Jones 8 CAfnpanY, Inc. All quotes are in local exchange time. Real time last sab date provldetl by NASDAQ. More nformetbn on CIASDAGLtratled.symbols~nd their eunent Onaneial status. Inuaday data delayed 15 mMNas for Nasdaq, and 20 minutes for other ezthanpes. Dow Jones IndazasSM from Dow Jones a Company, Inc. SEHK ntraday data k provided by SIX Terekurs and k tl least BO+nnWes tleWyed. All quotes are in bCel exchange ame. http://bigcharts.marketwatch.com/historical/default.asp?symb=T&closeDate=10%2F26%2F... 09/28/11 at&t ~ ~,omputershare ~~ Comoutershare t`.U. pox 43U/tf Providence, RI 02940-3078 (n~i*hj~ i is^ Oc ±~ .i+~.ip~ P raa„ice onn oGi ~~~, - - - . to ...,,,., c. rte., a,t.. -rn~ r~~ n-r~n V UI_iIIUG VJf1, VJ t.i irtVir'v.r r.r v.r .t, u. iui J. ri.' vvww. computershare. com%att IIIVtP(SRTti,IVT 7VA!X ~cT"txl~N C'C1t`:f,"11h,~h:T FiwP:i ~i;~Fi~~ ~- *******'*****AUTO**3-DIGIT 170 00022010077226 0 7 7 2 2 6 °illllllll°rl~!lIIII~II~:!!::ilia!:;!ii~iE`iiiiil!Er:~l~:clll~li° -` Recipient DOROTHY T KLAIBER 312 BLACKSMITH RD CAMP HILL PA 17011-x^21 h~ ~ '~s`~ _ ~} ... ~~ ,'~~ ~~ Holder Account Number 03003624560 16v Record Date OB Oct 2010 Check Number 0011002251 SSNITIN Certified Yes 0(11 CS007R.DOMLNGEQS_PGLA7T.073514_19F/07722fi/1177226/i AT&T Inc. - Combined Dlvldend Payment / 2010 Tax Form 1099-DIV ® Corrected (if checked) Account Number 03003624560 ~I Recipient's ID No. ending in *• ~*'-6230 Form 1099 •DIV -Dividends and Distributions 2010 Copy B -For Recipient payer's Federal ID No. 43-1301683 This is importard tax information and is being famished to the Internal Revenue Service. If you are required to rile a reiurn, a negligence OMB No. 1545-0110 penalty or other sanction niay be imposed on you h this Ncome is taxable and the IRS determines that it has not been reported. DeuaNnent of the treasury - tmemai Revenue Service Recipient DOROTHY T KLAIBER 312 BLACKSMITH RD CAMP HILL PA 17011-8421 to Total Ordinary to Qualified u Nondividend Dividends ($) Dividends ($) I Distributions ($) 4 FEDERAL INCOME TAX WITHHELD ($) s Foreign Tax Paid ($) ~ Foreign Counlly a Cash Liquidation a U.S. Possesson I Distri. ($) Payer's Details 1118.88 1118.88 0.00 0.00 0.00 AT&T INC. CIO COMPUTERSHARE ~~~ P.O. BOX 43010 PROVIDENCE RI 02940-3010 Form 1099-DIV (Keep for your records) Confirmation of Dividends Paid in Cash Participating Dividend Gross Dedu ction Deduction Net Payment Date Class Description Shares I Rate I Dividend ($) I Amount ($) Type Dividend ($) 01 Feb 2010 COMMON 666 $0.42000 279.72 0.00 NIA 279.72 03 May 2010 COMMON 666 $0.42000 279.72 0.00 NIA 279.72 02 Aug 2010 COMMON 666 $0.42000 279.72 0.00 NIA 279.72 ov 20 COMMON $0.42000 279.72 0.00 NIA 279.72 Year-To-Date Paid ~ 1,118.88 0.00 1,118.88 ..h., ® 46UTX ~~~•~~ A T T "~' OORX6A•PP-(AF2NU) corneast Corp. ca A, (,MESA Historical (loots - ( ~ C;11~1C;15A, t;omcast Corp. L... age 1 of 1 Ws~ WSJ Enter Symbols Or Keywords ;SEARCH MarketyQatch M2rkEtVVatch II ' ~ AIlThingsDlgitai ~akh AIIThiogsDigi!n FINS _ ______ F air 5 ar.r~~:: -- '__-- ~ 1 I ~ 11 '-5 CMCSA tie Bl~iie-~"ouotea News Industries Markets Historical Quotes BlpReporta Vtnu_a_rsTOrl excnarrgc.. _.________.._ FjIP6@iFdkdllPd'Ymuotes fool albws you ro look up a security's szact cbsing price. W~dyfysltpe in the symbol and a hisbrical date b view a quote and mini chart for that security. WSJ Intlia W~f~tf~a_ fines a 'ti n EnterDate: w~,tafzan _ _ o CMCSA.. _ 10/26/10 _ __ ~~ WSJ EutQpe .., ,.. Sponsored Links Pro Market Stock Tips The next BIG stock tip is HERE. The righi place, the right time... vn urncniainers ::^rr: .... Penny Stock of the Day j~ Penny Stock Pick of the Day Emailed to You. Huge Gains for Traders! w:nsPOnrgrS ku;P.Aic~riscom Big Penny Stock Returns ~ 1 Rated B1 Penny Stock PJewstetter or. the net x~.,,u. nir~dtl=Str:r.i:e :-nn: ~~ 1 ~/? / r-~ ~ VELA is a HOT Penny Stock ~ . / yr b 3 ~ r Check it Out NOW, The First True 4G Company in an Emerging Market .vNa~.Tc+k>~;ornlnvestian room Get starf:ed with a broker (M,,,,,,,(,,,,,,~ qi'"~~ +174U/rF-' ^ JI ~ /$~. ~~W/ _. __ kLY'r-+iti I t iLY~t+.+YW t ~ ^c. .: ' .. er ,hc E ~t® Why Pay More4 Switch Scomade: $7 Trades. Trade with Fidelity to OptbnsHouse. Fast Ezeeutbrre Hpme i About ! Joq Opportunities ~ GcnWCt U5 ! Feedgack ~ Help Copyright 2011 MarketWatch, Inc. All nghla reserved. By using Mis site, you e0roe to Me ~rrtygyl_Use end P_liyanyPaLW (updated are/pel. Inlratlay Data provided try SIX Telekurs and subject ro terms gloss. MisroriCel and current entlaf4ay data provbed W SIX Tebkura btroday data delayed per ezManpe requirements. Dow Jones Intlexes (SM) /rom Dow Jones & Company, Inc. All quotes aro b bcel exchange time. Rea1IMe lest sale data providetl by NASDAD. More inlormatbn on [{A~pAO traded_sym¢p.4s antl their current financial status. tmraday data delayed 15 minutes for Nasdaq, end 20 minutes for other exchanges. Dow,bnes IntlaxesSM from Dow Jones & Company, Inc. SEHK btradey dab p provided lry SIX Tekkure and is at bast 60anbutes delayed. AN quoMS ere b bcal exchenpe lime. http://bigcharts.marketwatch.com/historical/default.asp?symb=CMCSA&closeDate=10%2F... 09/28/11 comcast® Llft9F'UR1`AlYT TAX RETURN QQCUMENT ENCLt?SED~ _- HU ~ l)''~-Ullilf t %0 UOU1 y4/lll)b6t364 I_I h h tl 6 4 =! r ii li I er fili i it ElleC,l ireE r ie Yiic ~ rc @ r v i i i it i iE I t i6 61 I iiiill I"I 1 tilt Recipient DOROTHY T KLAIBER n_~,~~ . ~ `~~ ~,omputershare ~" ~~ ~ Computershare PO Box 43078 or0.•dd~.,,.e of rrosnn arn~ 1 VIIV , 1 VL -tV-JV/ 1M1/:~L:.. Ilan Iln ._....t. /uruini u~H, u,: tCriitQfiE~ :t t.df18:)0 ~tlt1 tlOJ ~uGl;,i Outside USA, L'S territories & Canada 781 575 4730 www_r.omoutershara rnmirnmr•a~r = 312 BLACKSMITH RD Holder Account Number CAMP HILL PA 17011-8421 = 03011016412 I N D Record Date O6 Oct 2010 Check Number 0007685304 SSNlTIN Certified Yes 001 CSOOOS.DOMLNGEQS_PG LCMCS.105916_$39(2/0((RG4/fNi(R64li Comcast Corporation `-.Combined Dividend'Payment /.2010 Tax Form 1099,DiV . ~~ ~® Corrected (if checked} --------...----- Form 1099 -DIV -Dividends and Distributions 2010 Copy B -For Recipient This is important tax Mformation and is being famished to the Internal Revenue Service. If you are required to file a return, a negligence penalty or other sanction may be imposed on you h this income is taxable and the IRS determines that it has not been reported. Recipient DOROTHY T KL4IBER 312 BLACKSMITH RD CAMP HILL PA 17011-8421 Account Number 03011016412 P.ecipient's ID No. ending in ""-*~-8230 Payer's Federal ID No. 27-0000798 OMB No. 1545-0110 Det>Trhnenl of tl>P Traaeury • Internal Revenue Senate 18 Total Ordinary to Qualified J Nondividend < FEDERAL INCOME s (Foreign Tax ~ Foreign Country a Cash Liqudation Dividends {$) Dividends ($) I Distributions ($) TAX WITHHELD ($) Paid ($) a U.S. Possession Dis6i. ($) I Payer's Details 46.88 46.88 0.00 0.00 0.00 COMCAST CORPORATION C/0 COMPUTERSHARE P.O: BOX 43010 PROVIDENCE RI 02940.3010 Form 1099-DIV (Keep for your records) Dividend Confirmation Payment Date Class Description Participating SharesNnits I Dividend Rate I Gross Dividend ($) I Deduction Amount ($) I Deduction Type Net I Dividend ($) 7 Oct 2010 CLASS A COMMON 24 Year•To-Date Pald $0.09450 11.72 46.88 /' ~ ~ .~ 0.00 0.00 N/A 11.72 46.88 46UTX CMCS 'i' I01CD70006 / R OORX6A-PP•(F2) _ __ _ _ m. txxon Mobil Corp., XOM Historical Quote - (NYSE) XOM, Exxon Mobil Corp. Stock P... Page 1 of 1 WSJ WSJ fddrls~t9!-etch MarketWatch r~ rte' AllTtirrigs igila A~IStliegs'~igftat FINS F~•a mn ,x z~n_ .~rp~OM r r .• ~. .. 6d5puotes News Industries Markets Historical Quotes BIDReports vinuaL~t_oca_t^trcRang~..,...._..._,.. .......,. ~,.. , ...,_.._ .. EIIP9Sti18Fd1181Rmtates tool Mows you b bole up a securay's exact cbsing price. LN~dtlflk8l~e tit the symbol and a hisrodcel date ro view a quota and mine chart for tfial security. WSJ India ~~ i es e~o XOM EnterDate: X10/2-6/10' Wti nr• e s Enier Symbols or Keywords 'SEARCH 1t~1t~lQhi! Corp. P,cp~6l+~~010 ____ ~ sssa ~,.~ ! ! es.a6 ~.______ N;.7h~ ! be..57 _._....._...__ ......._... __ .............____. _...___ __. _.._..._..__ _.~...__ .y_.._~._.... ~~_____ _-_._ ._.__ __.___...___.~.__ 14on. ~ i . ._..._. - - BS.Bt E _.._ _,._........._.,,.. ..__._.~ .... ~~ ! ; No Splits I L~.___- 1 _.~__.. _.._.. Sponsored Links 5000°k+ Gainers Inside... Stoic tools, news, social feetls, charts & insider tips all in 1 spot! v~°o-.Green ;n Iners.com Penny Stock of the Day Penny Stock Pick of she Day Emailed to You. Huge Gains for Traders! w++v-. PennyS iockAiads.ccrn XOM: Buy, Sell, or Hold? Don't trade XOM until you get our trusted free weekly trading advice! Big Penny Stock Returns Rated ftt Penny Stock Newsletter on the net nsv, r in+bhsk+rks rti»tt Find a broker Why Pay Morel Switch Scottrede: 57 Trades, Trade with Fidelity ro pplbnsHOUSe. Fast Executions ~ , ~~ 7 1~ t r (~ ~ ~~ r ~~ ~ /~ HOme I Atnut ! Jpb (PplMdunirie5 ! Cpnlact US ! Feedback I H91p Capyripht 2011 MarketWatch, Inc. All fights resenetl. ey using this ails, you agree W the TSS1r15~1 !sa end PliydclLQoliGY (wdated 4/BNB). InuadaY Date previdetl by SI%Telekun aM subject b terms 01 use. Historical antl current entlcf~day data provided by SI% Takkum. Intraday tlata deayed par exchange requvemenls. Dow Jontu indexes ($M) from Dow Jones 8 Company, Inc. All quoes are k1 kcal exchange tkne. Real time last sale date fxovkled by NASDAQ. More hlOrmation on NAS4AQtraded_gyrl7bpl_s and Meir Cueent financial status. Intraday tlata tleleyed 15 min Wes for Nasdaq, end 20 minutes for Other exchanges. DowJnnea IndexesSMfrom Oow Jones 6 COmpenY. Inc. SEHK htradey date a Drovide0 W SU! Tebkure and is at least 60-mhNeS delayed. Ak quotes ere in local ezcharlpe time. http://bigcharts.marketwatch. com/historical/default.asp?symb=XOM&closeDate=10%2F26... 09/28/11 E~onMobil ~,omputershare _. iffdrr~fyfiFFLffvT T.4X r~~T'uF"rfu fa C`~~:~~tilf~n(T- ~Arrr nccnl ""`"""""AUTO"'3-DIGIT 170 000033/0012310 012 31 ~ rilllllilieel~llllli~ii~rlieeiiEllrrE~ir~iaiii~~liiu~l~rrili~~lr Recipient DOROTHY T KLAIBER 312 BLACKSMITH RD CAMP HILL PA 17011-$4?1 Computershare PC Box G3u7is Providence, BI 02940-3078 1f~fiiinn ~ ~,ji.~ i rorrii~n red k ~~amLJ? s~('tf~ i~o •i i((Ifi vuwfue u~H, u~ terrliones a t;anada /ii1 :i75 ZU58 www. com putershare.com/exxonmobil Holder Account Number 00005997151 I N D Record Date 12 Nov 2010 Check Number 0002993376 SSNITIN Certified Yes 1101 CSODUS.DOMLNGEQS_PGt.XOM.1 I0823_347I0/012310/012310/i Exxon Mobil Corparatloin ~ Go~nbined Di~ider~d Payment /2010 Tax farm 1Q99~DIV Conected (If Checked) Account Number 00005997151 Recipient's ID No. ending in *"= `•8230 Form 1099 -DIV -Dividends and Distributions 2010 Copy B -For Recipient payer's Federal ID No. 13-5409005 This Is important tax infomtation and is being famished to fhe infemai Revenue Service. if you are required to file a return, a negligence OMB No. 1545-0110 ~ penalty or other sancdon may he imposed an you if this iisome is iasaLla anu Uie IRS determines drat ii has not been reported. Departrnent of the Treasury - mlemai Revenue Service Recipient DOROTHY T KLAIBER 312 BLACKSMITH RD CAMP HILL PA 17011-8421 i a Total Ordinary m Qualified u Nondividend 4 FEDERAL INCOME s Foreign Tax 7 Foreigrt Cotmtry (eJ Cash Liquidation l Dividends ($) Dividends ($) I Distributions ($) TAX WITHHELD (S) Paid ($} or U.S. Possession I Distri. ($) Payer'S Details 334.08 334.08 0.00 0.00 0.00 EXXON MOBIL CORPORATION C/0 COMPUTERSHARE P.O. BOX 43010 PROVIDENCE RI 02940-3010 Form 1099-DIV (Keep for your records) Dividend Confirmation Payment Date I tion I Participating I Class Descri Dividend I Gross Deduction Deduction Net p ShareslUnits Rate I Dividend ($) Amount ($) I Type I Dividend ($) 10 Mar2010 COMMON 192 $0.42000 80.64 0.00 NIA 80.64 10 Jun 2010 COMMON 192 $0.44000 84.48 0.00 NIA 84.48 10 Sep 2010 COMMON 192 $0.44000 84.48 0.00 NIA 84.48 10 Dec 2010 COMMON 192 $0.44000 84.48 0.00 NIA 84.48 Year•To-Date Paid 33 4 08 0.00 334.08 // / ~~ 1 J F 4 6 U T X V r X O M "~"' ~ ~/ )1CD70006/R '1 rronner Lonununications Corp., FTR Historical Quote - (NYSE) FTR, Frontier Commun... Page 1 of 1 WSJ WSJ MarketWatcll M~rketWatch. :~. n pliThmgsDig !111ThingsD~q;•~! RNS rr95 ---Fr ,> I FTR ~ .:. . r , ar t~r,~: hs0uotes News Induatrias Markets Hiatorleel OUMes BlgReports VlrttldlStdCiC'EXChange.'. _..,, ._.,.,____.,,.,...... .... ...... .......... .. .. .. ........ ... .......,,_.., .. _..... Fiq~wg~+~ryptates tool albws you b look up a security's enact cbsing pace. W~l~slgde in the syrtgwl and a historical date b vrew a quote end mint chart for Mat seruriry. WSJ Intlia WSJ /phi _3 ~i~'Se~~ !N~! Jda~n ~R - - EnterDate: 10/26/10 WSJ El~iope _.._.> Sponsored Links 5000%+ Gainers Inside... Stock tools, news, social feeds, charts & insider tips all in 1 spot! vre.-v~.3n;erGntreus ~ nrn Big Penny Stock Returns Rated H1 Penny Stock Newsletter on the net a. nv„mnbks7n'ks. cum Penny Stock of the Day Penny Stock Plck of the Day Emailed to You. Huge Gains for Traders! VELA could be `BIG` Read why VEIA could be the hottest Penny Stock of 2011 ! u~wx. 1 FIar;Onrinv'•g!in(J.f:tl~n Fjnd a broker aNIiMETW0E5< Why Pay More? Switch Scothade: 57 Trades, Trede wiM Fidegry W OpsonsHOUSe. Fast Executions Eni,-;r Synlb:;is ar it~~ysvurUS i SEkRCH (~ ~,~ ~ ~ r ^~, j _ CV/Jr ~ 9 % ~- I ~~ ~ --r r r .. ~.mr:- .~. Npme I Aboet I Job OppOnuneies ~ C.oolaCl.US I Feedback I Help Copyright 2017 MarketWatch, Inc. All rlpMS reserved. By using Mis 8ke, you agree to Me Ie~915_2 Slse and Pl1v3CY._pylicY (updated d/oNe). Intraday Data provided oY SIX Telakurs antl aubjecl to fem!sgl. Use. Historical and current endroldey data provided M SIX Tekkurs. Intraday data delayed per exchange requirements. DowJOnes Indexes (SMI from Dow Jones 8 Company, Inc. All quotes are h bcat exchange time. Real time Wst sale data provided by NASDAQ. More information on _t{ASDga rtASlatl.3y1n4,245 and their current financial status. Intraday tlate delayed 15 minutes for Nasdaq, antl 20 minutes br Wher exchanges. DowJOnea IntlezesSM from Dow JOnes 8 Company, Inc. SEHK intraday dale d provWetl by SIX Tebkurs and is at least e0+ninutes delayed. All quotes are in brat exchange time. http://bigcharts.marketwatch.com/historical/default.asp?symb=FTR&closeDate=10%2F26... 09/28/ 11 ~~~~® Communications ~,omputershare ~' %t)ITllli rferghara PO Box 43078 ~~G+h ., imp n ;~, r - ~~ n...,. ... ,.... ~'' - ., ~..,..... ~.. ~ i V v'tJU ~utsiue USA, US territories a Canada r'81 575 2382 www.computershare.cominvestor '1 1 1 I'r11 111 i1 f111i r1 iri Inlfilt ~~~ X111 1~f1r , _._. ~- Recipient ' ~. DOROTHY T KLAIBER ; i 312 BLACKSMITH RD ,;-' ,:^~ , .? + Molder Account Number CAMP HILL PA '7011-8421 ;' "~;" *,/~, ~ ~~,~` 00003868869 I N D ~ ~' -'. ;: . •r:D LL-PY :fti fY i ir+I~ It.G t l/Rt!W k~'Er":~:,''t~~C".1: .~-'~"1r~~iLV J~u1 -_ i <"*«:«***«*«.AUTO'«3-DIGIT 170 000051/0019808 Q ], 9 8 Q ~ 11111 1111 11 fl 1 ! 6 i "1 'i f Record Date 09 Dec 2010 Check Number 0000513401 SSNITIN Certified Yes UOICS(1D(15.DOMLNGFQS_PG 1.F[20N.1U4T4x_3539R/019Nex/(119x(fRii FRONTIER COMMUNICATIC3~iS GC3RPORATi ~aN = Com~inerd:Divd~nd Pay~ent 12a'!Q Tai Form 1Q9~3-Df~! .. Corrected (~ checked) Form 1099 -DIV -Dividends and Distributions 2010 Copy B -For Recipient Tttis Is important tax information and Is being fumfshed to the Internal Revenue Service. if you are reGufred x fife a return, a neyligeuce penalty or other sanction may be Imposed on you 4f this income is taxable and the IRS determines that it has not been repo.~ted. Recipient DOROTHY T KLAIBER, 312 BLACKSMITH RD CAMP HILL PA 17011-8421 r.' `4 1 /%~ ~~ t !~. Account Number 00003868889 Recipient's ID No. ending in ~*••'-8230 Payer's Federal ID No. 06-0619598 OMB No. 1545-0110 I~ Department of the Traasury - internal Revnmre Sarvice ~.ITotal Ordinary tb Qualified L3J Nondividend a FEDERAL INCOPAE a foreign Tax ~J Foreign Country a Cash liquidatan Dividends ($) Dividends ($) Distributions ($) TAX WITHHELD (S) Paid ($) I or U.S. Posses~on I Distri, ($) I Payer'S Details 7.17 7.17 17.21 0.00 0.00 FRONTIER COMMUNICATIONS CORPORATION Cf0 COMPUTERSHARE P.O. BOX 43010 PROVIDENCE RI 02940-3010 Form 1099-DIV (Keep For your records) Dividend Confirmation Payment Date I Class Description Participating ( ShareslUnits Dividend ~ Rate Gross I Dividend ($) Deduction I Amount ($) Deduction Type I Net Dividend ($) 31 Dec 2010 COMMON 65 50.18750 12.19 0.00 NIA 12.19 Year-To-Date Paid 24.38 0.00 24.38 .~ ^ 46UTX FRON '~' CD70006 / R OORX6A-PP•(F2) LocKtleed Martin t;orp., LMT Historical Quote - (NYSE) LMT, Lockheed Martin Corp. 5... Page 1 of 1 ~^1SJ WSJ C_vl~rkkQlWatCh MarketWatch ~ _ i't8" pll7hngs gita V/ir<n A11_Things_Digita! FINS Ft~,'a anxr'neyr, r;r- t LMT .. , .. , • .. Vf~lt~~~~r~uotas Newt Industries Markets Htstoncal puotea BlgReports F~Gt81dIt289~uotes tool albws you ro bok up a security's exact cbsing price. w6tftl~lppe in the symbol artd a hisrorical date ro view a quote erd mini than for that security. WSJ Inpia W$,I~K^~_ loss edti n WS1 Jd1 an~q_ LMT......... '~'""~"` EnterDate: ..., VtSJ Et r~Re 10/26/10 W ~ .. ._. ~_.._ __ e e crer yrn;icAS Gr 4<cywurtis ~_EpRCR 'lL~k14L~¢ Martin Carp. ~kf7~~c.u ~Nyts.::: 1.`_...._____.___-._._.._._.~_..._......-....___~~.~~.._..___...~..~.___._....~--_...........__. 7t.ao .._............_..____...._.._......_.. ___ i Nign' _.__. _. _..... ___. _.... _~~__-.~ 72.7 3 ___W_._........_..-------_-_.~_._ _..W__.___M.._.~. v-._____~~~ vniurne: ^` l 2,23e,79D .~.~ ..............~.._..~._~..~.. _._........_._... ....,._.~...,..,,~...._.__.___.ui ....._.._~._ _~. ~ _.- No Splits Sponsoretl Links 5000°/a+ Gainers Inside... Stock tools, news, social feeds, charts & insider tips all in 1 spot! rwH. ,r,; ,: ~[„inners Caro 850°~ Penny Stock Gains Our last pick jumped 850% -Join our 100% Free Newsletter Today ~x:v:,PennySia:kscLzpe, Lcer,. DAILY Penny Stock Picks My email alerts may cause Insane gains for active traders! The "HOTTEST* Penny Stock of 2011 could be VELA. Read why a Fox Business Anatyst picked VELA! .rax IeIP.r,.'.,;urc,arncilnycom Find a broker °F ,:: JRJlIr Why Pay More9 Switch Scottratle: 57 Trades, Trade with Fidelity b OptbnsHOUSe. Fast Executions r i' ,~ ~e ~ ~ , ~ ~ `~ ~' .~ rl r ~ / l J~ i.~~ ,x.~rrs:;::~c~r"„d. AA~3~t'atrh 9rc.*e .c Hone I AbOyt ~ Jpb_DRpgnMttbs I CpnklGt US ~ Feedback I HeID Copyright 2011 MarketWalch, Inc. All dgMS reservetl. By using this sae, you agroe to the Iermssl Uss and PSrv~7.cyP_DJicy (updated 4/6rb6). Intreday Data provbed by SIX Telekurs and subject to tagns.01_use• Hisbrbal and current entlof<iay date provided M SIX Tebkura. Intraday date tlebyad per exchange requirements. Dow,bnes Indexes (SM) from Dow Jones a Company, Inc. All quotes are in Nicel exchange time. Real t"ene last saki data provided M NASDAD. More Mormetion on d_gSQAt] tradep.c~yr~ls antl mek cunent linanciai status. Intraday date delayed 15 mnutes for Nasdaq, and 20 minutes for other exchanges. DowJOnes IndexesSM Iron Dow,bnes 8 Company, Inc. SEHK imratlay data b Drovided M SIX Telekurs and is at best 60+nnules tlebyed. All quotes are b bcal exchange time. http: //bigcharts.marketwatch. com/historical/default. asp?symb=LMT&closeDate=10%2F26... 09/28/ 11 L O C K N/ f D ,ar w a r e ,w ~,omputershare rc°r~~r, r.+~w. E~ x Nc? F.'!':t' ....~v~v~tfdT cfvGLllS~bl __. _..~_-_ I 004056 eilllllitini~ltttttiiii~llrriii~luilt'~l'I!l~itlln(I~nitli~lr Recipient DOROTHY T KLAIBER 312 BLACKSMITH RD CAMP HILL PA 17011-8421 r.....__..~ t,un~jJUt(-`IJ lalf; po BGX 4~o;s ~i(lyjlionrp iai ~l'//Oq~l. ~~~~,lo ,.,, ~;, ~„ ltniiuiies Q l.aflaga tiJ/'498 B$61 Uutside USA, US terntaries 6 Canada 781 575 2879 www.computershare.com/investor !colder Account Number C~ay0p0y0p266ry~~0p~1~y ~ y{IyyND~yq~ ~ ~ IIWCMI INIMWI IIMIY YNII ~i OO1CS(bOS.DOMLNGHQS=PGI.LMT.154R14_;i~049/004055/004055/i __ _ ._ ~,ockheed Martin Corporation -:Combined Dividend Pay~tel!~it!12l31Q Tax Forth 1099-Div Corrected (if checked) ~ Account Number, '' 00000286701 kYk 4i Form 1099 -DIV - pividends and Distributions 2010 Copy B -For Rent ReciPierit's ID No. ending in - •8230 -~.._.._..__.-•--•~-`Payer's Federal lD No. 52.1893832 , This Is important tax Mfonnation and is being fumished to the Internal Revenue Service. Iryou are required ro flle a return, a negligence i OMB No. 1545-0110 penalty or other sancrion may be imposed on you>t this Income is taxable and the !RS determines that it has not been reported. Deperjment or the Treasury - Internal Revenue Service Recipient DOROTHY T KLAIBER 312 BLACKSMITH RD ! CAMP HILL PA 17011-8421 1 ' ~ ~` + to Total Ordinary to Qualified (3.i Nondividend 4 FEDERAL INCOME 6 Foreign Tax ~ Foregn Camtry ~ Cash Uquidation Dividends ($) Dividends ($) I Distributions ($) iAX wITHHEI.D (SI Paid ($) a U.S. Possession Disfi, ($) I Payer's Details 528.00 528.00 0.00 0.00 0.00 LOCKHEED MARTIN CORPORATION CIO COMPUTERSHARE P.O. BOX 43010 PROVIDENCE RI 02940.3010 Form 1099-DIV (Keep for your records) Dividend Coni'trmation Payment Date' Class Description I Participating ShareslUnits Dividend I Rate Gross I Dividend ($) Deduction I Amount ($) Deduction Type I Net Dividend ($~ 31 Dec 2010 COMMON 200 $0.75000 150,00 0.00 NIA ~/ 150.00 Year•To-Date Paid 528.00 O.QD• ,C'~i9 .I ws~; ~ ~.,~,-' 528.00 ~ ~~ ,• ~~~ ^ 46UTX ~l LMT "~' :070006 / R OORX6A-PP•(F2) MetLife inc., MET Historical Quote - (NYSE) MET, MetLife Inc. Stock Price - BigChart... Page 1 of 1 WSJ _ WSJ Eraer Syrnbcls cr Keywords :SEARCH MarketWatyh MarkelWatch z+ ~ -~$~.. AIIThrig9 ,.. AIIThingsDigital FINS FIB 1, r ara; ,~ ~ MET r r.. 1~.. _1;_ ~r,_-9uotas News Induatriee Merketa Historical !)notes BlpReports th 71121 '~YgC1t Excnatlge .......... ...... , ,.._ , ....._ .,. _.,...:..., ._ _. ..._.._ .,... _. _.... .,:.. „ ,._. _.:.......... _.......„. .........:.. Fltr~aliy@tates tool elbws you b bok uP a securhy's enact cbsirg pdai. WJSt~I$14pe M the symbol anti a historical date M view a quote aM mini chary Mr that security. WSJ Intlia Penny Stock of the Day t r ~ a 1 a, Penny Stock Pick of the Day Emailed to You. Huge Gains for Tradersl t /.~ f(/ ~:vn•:. Pnn rrr a io:;kA!erl,.curn Big Penny Stock Returns ~ ~ ~ Rated #1 Penny Stock Newsletter on the net _~-+ B50°k Penny Stock Gains .~~'J- /~ ~Q,'~ "~" Our last pick jumped 850°k -Join our 100°k Free Newsletter Today ~(~ ~ (X ~ ~ wr,v, Penro±Str,::ksFyl>encom (J ~- Find a br°kcr~,r ~~ ~ Ov _.~.- `---_.-__- ,~.r~ ~,a` rw«t~a, art kar cuu~: L . r Why Pay More9 Swdch Scomade: $7 Trades, Trade wim Fidelity to OptionsHOtrse. Fast Executbns - r~ra . .. Hpma (About I Job Opportunities I Contact Us I Feedback I Help Copyright 2011 MarkNWatch, loc. All rights reserved. 6Y using this cite, you aprae to the Terms of Use and PriyacY_POlicy (updated a/a,U81. Intraday Data Provided W SIX T°lekurs and subject to tennsot use. Hiabrical entl currant endcl4ay data provided M SIX Tebkurc. Intraday tlate tlelayatl per ezchanpa requirements. DowJOnec lntlezec (SM) Irom Dow Jones 8 Company, Inc. All qudes are b local emhange time. Real thne bat eab tleb provided oy NASDAD. Mora kdormetion on NA$DAD.treded symbols and thek current tinancbl status. Intraday data delayed 15 minutes for Nasdaq, entl 20 minutes for shay exchanges. Dow Jones IndezesSM Iran Dow,bnes 8 Company, inc. SEHK imreday data b provbed M SI% Tebkuro and Is et best e0+ninutes tlebyed. As Ouolea are in local ezchanpa time. http://bigcharts.marketwatch.com/historical/default.asp?symb=MET&closeDate=10%2F26... 09/28/ 11 Sponsored Links Your 10 BAGGER is here! SPOCk tools, news, social feeds, charts R insider tips! Free offer! ..nz. rdrnenGaurers corn a amen RETAIN FOR XOUR RECORDS- DOROTHY T KLAIBER Account Market Value i Stock Price as of i i otai iJ~arkei 11/0?!2Ct1Q Value , $40.530 - -~ - $1,74-- 2~ 7~ Then a~~f2laat° art:ct+nt ^v6iu ,u eiii Trust Beneficiaries of= this dlst~ Ibuti:lri is $185,573,185.12. Investor ID ~ 8063 8984 3424 2010 Dlvldend Summary ~ ro - ` Total Tff:St Divide;,d ear ~ ~ Current ~ tit Rannrrf-.R • ~-~--- - ~ interests ~ Trust Interest ~ ~ Distribution i ^yi~/nil/?rl1 •} I Q„y,(lr~r7ti ?2P.in h x$1.52 j ~~ _ _ _ ' Payabie Date Tax "tiifithhefd ! ~ Nei Distribution I Prior `,'sar Distribution 12/14/2010 $0,00 I $31.82 ~ $31.82 For inquiries about year account, you may visit www.bnyrnellors.corns/stlareowner/equityaccess, or call 1-800-649-5593. Trust Beneficiary Infonnetion You may purchase or sell shares of MetLife, inc. common stock through the MetLife Policyholder Trust (the `Trust"), free of any commissions or other fees, under the MetLffe Purchase and Sale Program, as amended. A copy of the brochure describing the program is available on the Internet at www.metlife.com by selecting Investor Relatiohs and then the Shareholder Services Information page, or by calling the number listed above. You ars permitted to transfer your Trust Interests only in the circumstances described in the brochure. You may also instruct that all (but not less than all) of your shares of MetLife, Inc. common stock held by the Trust be withdrawn from the Trust. Information regarding your withdrawal rights may be found in the Purchase and Sale Brochure or by calling the number listed above. 0052050 G3 An annual shareholders' meeting to elect members of the Board of Directors of MetLife, Inc. and for the transaction of other business is expected to be held on April 26, 2011. The deadline for submitting shareholder proposals for consideration at this meeting is November 23, 2010. A copy of MetLife, Int.`s annual report and proxy statement will be available free of charge on or before March 3i, 2011, along with other MetL'rfe, Inc. and Trust filings under federal securities laws, (i) on the Internet at www.Metlife.com by selecting About MetLife, Corporate Governance, under Related Links, (iij by writing to MetLfe, Inc., c/o BNY Mellon Shareowner Services. PO Box 358447, Pittsburgh, PA 15252-6447 or (iii) by calling the number listed above. These and other SEC filings by MetLife and the Trust are also available on the Internet at www.sec.gov. Please Note: Important 201 D Tax information ~~~ _. Metl~fe li FORM 1099-DIV. U.S. TAX INFORMATION FOR 2010 OMB NO.1545-0110 DIVIDENDS/DISTRIBUTIONS COPY B FOR RECIPIENT RECIPIENT'S TOTAL ORDINARY IDENTIFICATION NUMBER DIVIDENDS QUALIFIED DIVIDENDS FEDEPIALiNCdMETAXYVITHHFID BOX to BOX 1B BOX 4 57410.8230 $31,82 $31.82 $0.00 PAYER'S NAME PAYER'S FEDERAL IDENTIFICATION NUMBER BNY MELLON SHAREOWNER SERVICES AS CUSTODIAN OF THE METLIFE POLICYHOLDER TRUST 51-6516987 SECURITY DESCRIPTION TO WHOM PAID TRUST INTERESTS DOROTHY T KLAIBER 312 BLACKSMITH RD CAMP HILL PA 17011-8421 IMPORTANT 2010 TAX INFORMATION FOR_I REPORTED BY THE BANK OF NEW YORK MELLON 480 WASHINGTON BOULEVARD JERSEY CITY, NJ 07310 REGARDING THE ABOVE, CALL 1-B00-649-35 is Is Important tax informatlon and is being furnished to the Internal Revenue Service. you are required to file a return, a negligence penahy or other sanction may be posed on you if this income Is taxable end the IRS determines that k has not been >orted. x 1A -Shows total ordinary dividends that are taxable. Include this amount on line 9a of rm 1040 or 1040A. Also, report tt on Schedule B (Form 1040) or Schedule 1 (Porto 1040A), equired. The amount shown may be dividends a corporation paid directly to you as a parti- ant (or beneficiary of a participant) in an employee stock ownership plan (ESOP). Report it a dividend on your Form 1040/1040A, but treat it as a plan distdbution, not as investment ome for any other purpose. Box 4 -Shows backup withholding. For example, a payer must backup withhold on certain pay- ments at a 28 % rate 'rf you did not give your taxpayer identification number to the payer. See form W-9, Request for Taxpayer Identification Number and Certification, for information on backup withholding. Include this amount on your income tax return as tax withheld. Nominees. If this form includes amounts belonging to another person, you era considered a nominee recipient. You must file Form 1099-DIV with the IRS for each of the other owners to show their share of the income, and you must famish a Form 1099-DIV to each. A husband or wrfe is not required to file a nominee return to show amounts owned by the other. See the 2010 General Instructions for Forms 1099, 1098, 3921, 3922, 5498, and W-2G. x 1 B -Shows the portion of the amount in box 1 A that may be eligible for the 15 % or zero ~Ital gains retes. See the Form 1040/1040A instructions for how to determine this amount. - port the eligible amount on line 9b, Forn 1040 or 1040A. Verizon Communications Inc. VZ Hist _ orical Quote - (NYSE) VZ, Verizon Communicati... Page 1 of 1 vysl WSJ Mark t~W~1S_h MarketWatch ~~~~~~+ nvt~ttitJ,~ xnmir;gsr3lgi a AilThui9s~~~n^a' 1=1NC ~FpI~~4~ly~~'~r"'n lKezuvtJt ~- .••• A"f rt`quotes News Industries Markets Historical Quotes BipRepor[s VYnual'SYOCk-FXi;hange......_. ,,.,.:. .... _. .... .._. . ....,.,,,_...,....... F!49S416tdllPdYf-uotes tool allows you b look up a secunN's exact cbsing price. W6ttl~i~Je in the symbol and a hLtorical date to view a quote and mini char, for that sscuriy. WSJ Intlia WS.1~~'iPaq.. ed'ti n~ W':*1 Jay-,t o ~ -- EnterDate: 10/26/10 WSJ Er.;:,1,e __.~. r Sponsored Links EMBA Hot Penny Stock Pick Why Smart Investors Think This is The NEXT MAJO_ R Penny Stock Of All erx~.~.ftmr,niiairicr's.c ,^i[r~t^d. . Penny stocks soaring 900% Come experience penny stock gains with our free & accurate newsletter :~ aro~, Panrry'J+U':k'iljnrt;t?rSr, ~: )m 850% Penny Stock Gains Our last pick jumped 850% -Join our 100% Free Newsletter Today w:+u.l'P,I:II)':ii;:f.+5:`_YIJ~I i.C'n'!i 1000°k+ Penny Stock Picks Join our 100% Free Newsletter today and get picks that skyrocket! .t.~:-Ave>om¢Perun~5n,ck,~ =;um Get started wlfha broker E:nier Syml;ols or Keywords :SEARCH ~ ~,~~ ~~~ / ~ ~r Pr d~lL/ ~~~ J rr.._L ~ I~iWO~ ~..••.a.~•~ e,=fc,: .~?».-:....x=.::. A1ahM.s;+Oc~ _. Why Pay Morel SwRth Scomade: $7 Trades. T2de with Fidelity b OptioreHouse. Fast Fxecutbns -vrs ._=.awwrs.. Home I About I Job Qaportunrties I CpnWGt Us I Feedtzack I Help CopynpM 2011 MarketWatch, Inc. All npMS reserved. 6Y usn0 this site, you spree to Me TBrr~ls_pltJae entl PacY.P_glicy (updele0 x/9/09). Intaday Data provkled by SIX Telekurc entl aublect to terms p1 use. Historical and current entlof4ay tleta provided by SIX Telekurc. Intraday data delayed per exchange requirements. Dow Jones Indexes (SM) from DowJOnes 8 Company, Inc. All quotes ere it bcal ezchanpe time. Real Ime last sale date provided by NASDAQ. More infortnatbn on HASAAattadedsymho~ end their curtent financial status. Intraday tlare delayed 15 minutes for Nasdaq, and 20 minutes for oMer exchanges. DowJOnea IndaxeaSM from Dow Jones 8 Company, Inc. SEHK intratlay date h provided by SIX Tebkurs entl is at least 90+nkl Nes tlelayed. Ap quotes are in ktcal exchange time. http: //bigcharts.marketwatch. com/historical/default. asp?symb=VZ&closeDate=10%2F26%... 09/28/ 11 ver-~n IlMP(~R7"dAlT rn X o.Pcr'rcA,r L?~!.`(El"J!~l~fT ~~~;~L,~,~~~,~ °"~"""`"`"`AUTO""3-CIGiT1;f1 (l~fii1210ildinud (Iu~~i.lla rillillilirri~iliiliiitlrit,rili~l~rl~i°~i'IIiE~ilirril~rrliilil' Recipient DOROTHY T KLAIBER X12 BLACnSNiTH RD CAMP HILL PA 17011-8421 ~omputershare Computershare //J PO Box 430?8 ~ i'rrnlirlon~o ul n?nan ~~~~ Within USA. US territories b Canaria S00 631 2355 ~~li ll till l._ .11 L1 ~ lulllltlllu~' t} I;%{(1~11 }+ ~t{ 1'i I`~l S S'4C1 vv vv vu.Gui 1INurCi si Idl G.l;tll I1/VeI17On ~, l~ Holder Account Number 00006441637 t N D Record Date 08 Oct 2010 Check Number 0002592819 SSNITIN Certified Yes 0o I c'snuns.uon-n_Nreps_rc~ .vzN.I I oa I4_:7?pie Tina I aaarua I eaaii lferizon Communications inc. -Combined Dividend Payment / 2010 Tax Form X1099=DIV ® Corrected (If Checked) Account Number 00006441637 Recipient's ID No. ending in ***-**-8230 Form 1099 -DIV -Dividends and Distributions 2010 Copy B -For Recipient payer's Federal ID No. 23-2259884 This Is important tax information and Is being famished tc the Internal Revenue Service. If you are required to file a return, a negligence OMB No. 1545-0110 penalty or other sanction may be imposed on you if ibis income is taxable and the IRS determines that it has not been reported. Department onhe Ueasory - Intnmal Revamle Sarvicn Recipient DOROTHY T KLAIBER I 312 BLACKSMITH RD CAMP HILL PA 17011-8421 iJalTotalOrdinary to Qualifiedl3J Nondividend 4 FEDERAItNCOME a ForeignTax u ForeignCountry~CashLiquidationl Dividends ($) Dividends ($) I Distributions ($) TAX WITHHELD ($) Paid ($) I a U.S. Possession Distri. ($) Payer's Details 520.20 520.20 0.00 0.00 0.00 VERIZON COMMUNICATIONS INC. CIO COMPUTERSHARE P.O. BOX 43010 ~~1 ~ PROVIDENCE RI 02940-3010 Form 1099-DIV Dividend Confirmation (Keep for your records) P t D t Participating Cl D i ti I Dividend I Gross Deduction I Deduction I Net aymen a e ass escr p on ShareslUnits Rate Dividend ($) I Amount ($) Type Dividend ($) 01 Feb 2010 COMMON 272 $0.47500 129.20 0.00 NIA 129.20 03 May 2010 COMMON 272 $0.47500 129.20 0.00 NIA 129.20 0 COMMON ~... $0.47500 129.20 0.00 N!A 129.20 1 Nov 2010 COMMON 27 $0.48750 132.60 0.00 NIA 132.60 Year-To-Date Paid 520.20 0.00 520.20 U: - _ _ 46UTX ~~~ >L V Z N '~" OORX6A-PP{F2) ~~ 10 7 0 070006 1 R Weis Markets Inc., WMK Historical Quote - (NYSE) WMK, Weis Markets Inc. Stock Pri... Page 1 of 1 Ws.f W$,1 Enier Syrnbois ar Keywords ;SEARCH MArkgtWWWWW~t_ch _..____~._~.____....._...__ MarkeiWatch r14 All. (ngs igi areas :.IITh~~~igi;ai ~FiNS n .. st r,ca•x~ mod: "~ : WMK.......... ~~ " ' " EA , v _ _-- Blp~anspuotes Naws Industries Markets Histoirce10uotae BigReports Fimifil@61A1a11E~Nmuotes tool allows you ro bok up a security's a:act cbsing price. W~'d~slfpe in Ute symbol arxi a historical date ro view a quota ar/' mini chart foi Glat security. WSJ.India W$J Chftia. Ines ed'ti n EnterDate: waRan~~~~o WMK.... _ 10/26/10 WSJ lydtope _ _ _ W .. e - 1~4~ft'~rkets Inc. ....~...,_._.....,~..,_...._._._._...~ ~~071i ,..._,,.~..,.,._....,,.........._..........._....,.~ ~ 4g4y rx,.,n: 39.41 t{qn 39 ?e tow~_ 39.36 ~ volur,7e. 2(Y,t t i Siwnstxed Links #1 investor Hub for 2011 Get news feeds, stock charts & the best stock tips all in 1 spot! XOM: Buy, Sell, or Hold? Don't bade XOM until you get our trusted free weekly trading advice! ~+rv=w.7h&BSntNewsigrye~e ?:pm Penny Stock of the Day Penny Stock Pick of the Day Emailed to You. Huge Gains for Traders! ww~,., PennyS!orkAiorts.cam Big Penny Stock Returns Rated #1 Penny Stock Newsletter on the net ..w,...nmtbl?sWrk,;;mn find.a. broker Why Pay More? Switch Scottrade: 57 Trades, Trade with Fidelity ro OpibnsHouse. Fast Ezecufioro !/ ~~ a , ~~~° ~ ~~ .~ ~ ,.. ~~ //~~G ~ ~ ' - 1 t u r -ran-- :.tn.~ - ..... ,; ..:_.~,~„ :.~-fas. 81a..erNret, 6c .ks'r..era! Home About I .bb Opppnunkies I Conlacl_Us I Feedback I Help Copyright Tot f MarketWatch, Inc. All dghts reserved. eY using this We, you agree to Me TamaotStae and Plivacvpolisy (updated aeJ061" Intredey Data providW M SIX Telekurs and subject ro tam!.s.pt_uae. Hisbrical and curtest endoi~day data povidetl M SIX Telekurs. btreday data delayed per exchange requkemenle. DowJOnes Intlezes (SM) from Dow Jones 8 Company, Inc. All quotes ere b bCel emhanpa time. Real time last sale data provided M NASDAQ. More intortnation on yg$QAD traded wrnt29JS antl their curtest finanelal status. Intraday data delayed 15 minutes for Nasdaq, antl 20 minutes for other exchanges. Dow Jones IndezesSM Irom Dow Jones 8 Company, Inc. SEHK btraday data b Orovitletl by SIX Tebkurs antl Is at least 60mbtnes delayed. All quotes are h kraal ezcharge lime. http://bigcharts.marketwatch. com/historical/default.asp?symb=WMK&closeDate=10%2F26... 09/28/ 11 240755415 name, street a~ CORRECTED (if checked) RECIPIENT'S identification a ota o inary ivi ens OMB No. 1545-011 number * * * * * 8230 $878.12 ~~ 1 Q state, ! WEIS MARKETS It.IC ~ C/O Amryerican Stoclk Transfer & Trust Company; LLf~.• i ~ 'VBW ,Y fJf~,. RVX rpt~.~. irrlone: dtati-ti68 9cix4 ,~,w,~ DOROTHY T I(LAIEER 11 ELMHUFdST RD CAMP HILL, PA 1?f211-6013 no. ,~n,R%S4 9~ ~ cam.;,, lnue_~n! pain distr. 12b UnrecaG. See. ' ., I ~ I ~ .- .__,,..,_`'j -_~ i I 2c Section 1202 gain ' 2d Collectibles (2v %) gain ___I 3 Nondividand disfribUtiuns 'n Federal income tax wtt thel I ~ $0.00 5 Investment expenses i Foreign tax paid I7 Foreign country or U.S. possession 8 Cash liquidation 19 Noncash ligi distributions ~ distributions 06729 0000012192 Form 1099 DIV (Keep for your records) .~ I ..~.-- i i ~ r r-, O ~ 1 i /~. C-.f ~~t c.. t4' ~„C..,.~ I .y~,,~ ,~.-~,. i i 1 ~ 1{,, i G' ~. f ~-, N- t l r~~w,xr' } r ~~ la V~"'~ it ~~' V 1 06729 OOOOD12192 Instructions for Recipient Recipient's identification number. For your protection, this form may show only the last four digits of your social security number (SSN), individual taxpayer identification number (ITIN), or adoption taxpayer identification number (ATIN). However, the issuer has reported your complete identification number to the IRS and, where applicable, to state and/or Iocai governments. Account number. May show an account or other unique number the payer assigned to distinguish your account. Box ia. Shows total ordinary dividends that are taxable. Include this amount on line 9a of Form 1040 or 1040A. Also, report it on Schedule B (Form 1040) or Schedule 1 (Point i040A), if required. The amount shown may be dividends a corporation paid directly to you as a participant (or beneficiary of a participant) in an employee stock ownership plan (ESOP). Report it as a dividend on your Form 1040/1040A but treat it as a plan distribution, not as investment income, for any other purpose. Box 1b. Shows the portion of the amount in box 1a that may be eligible for the 15% or zero capital gains rates. See the Forrn 1040/1040A instructions for how to determine this amount. Report the eligible amount on line 9b, Form 1040 or 1040A. Box 2a. Shows total capital gain distributions from a regulated investment company or real estate investment trust. Report the amounts shown in box 2a on Schedule D (Foram 1040), line 13. But, ff no amount is shown in boxes 2c-2d and your only capital gains and losses are capital gain distributions, you may be able to report the amounts shown in box 2a on line 13 of Form 1040 (line 10 of Form 1040A) rather than Schedule D. See the Fonn 1040/1040A instructions. Box 2b. Shows the portion of the amount in box 2a that is unrecaptured section 1250 gain from certain depreciable real property. Report this amount on the Unrecaptured Section 1250 Gain Worksheet-Line 19 in the Schedule D instructions (Form 1040). Box 2c. Shows the portion of the amount in box 2a that is section 1202 gain from certain small business stock that may be subject to a 50% exclusion and certain empowerment zone business stock that may be subject to a 60% exclusion. See the Schedule D (Form 1040) instructions. ,a, t' ~ u ~~~ ~-- " =.Z. ~ ~ !~ r~ ;''S f P~ Box 2d. Shows 28% rate gain from sales or exchanges of collectibles. If required, use this amount when completing the 28% Rate Gain Worksheet-Line 18 in the instructions for Schedule D (Form 1040). Box 3. Shows the part of the distribution that is nontaxable because it is a return of your cost (or other basis). You must reduce your cost (or other basis) by this amount for figuring gain or loss when you sell your stock. Butrf you get back all your cost (or other basis), report future distributions as capital gains. See Pub. 550, Investment Income and Expenses. Box 4. Shows backup withholding. For example, a payer must backup withhold on certain payments at a 28% rate if you did not give your taxpayer identification number to the payer. See Form W-9, Request for Taxpayer Identification Number and Certification, for information on backup withholding. Include this amount on your income tax return as tax withheld. Box 5. Shows your share of expenses of a nonpublicly offered regulated investment company, generally a nonpublicly offered mutual fund. If you file Forrn 1040, you may deduct these expenses on the "Other expenses" line on Schedule A (Form 1040) subject to the 2% limit. This amount is included in box 1 a. Box 6. Shows the foreign tax that you may be able to claim as a deduction or a credit on Form 1040. See the Form 1040 instructions. Box 7. This box should be left blank if a regulated investment company reported the foreign tax shown in box 6. Boxes 8 and 9. Shows cash and noncash liquidation distributions. Nominees. If this form includes amounts belonging to another person, you are considered a nominee recipient. You must file Form 1099-DIV with the IRS for each of the other owners to show their share of the income, and you must furnish a Form 1099-DIV to each. A husband or wife is not required to file a nominee return to show amounts owned by the other. See the 2010 General Instructions for Certain Information Returns. Dividends and Distributions copy 1 v1 t~Glr1 Fll Ctt6 This is impo~ant tax information and is being furnished to the Internal Revenue Service. If you are required to file a return, a negligence penalty or other sanction may be imposed on you if tis income is taxable and the IRS deter- mines that ii has not been reported is i~ ~J .~-'' ilia > TRUgT cQMPAHREG157RAR ,,. ~H~ No~,THERN .-,~..~ ~_~ ..---..~ FILER B'[ :~~ ~ U71,Ipµ1ZEp pF ' A ~ - _~ ~~ ~ i_ ~ ~ ~; ~ ~ ~ ~~~~~ s F\ ~ k ?~~- ~ 1~ rs ~ ~ ,ti ~~ ~ ~y~ ~ ~« - J ~ v ~K .,,,.:~ z. ~ ..~ ~~~" -,. ~" "., ct7 ~`~ ~~'~ ~ , ~ I/~ '` % ~ r f ~ ~ f ~ ..._ ., ~ ~~ p F ~ . ~ ~ ~'` '~ h `'~. ~ ~ .,; ~ z ~~ ~ ~, Vii; ~ ~. ` ~ m c 1 ~1`~ ~ v ~; ~. - fi r ~ 'A ~. ~\ G ~ '~_ r`` -~ ~. m `s~ ~ ~ ~. e z~~ 1;,. ~ ''~ ~ icy ~ ~ ~ ~ ~/f/9~1fJ r~~^~ S ~; '' iu ~, ~~ ~~ ~~ ~.f~. Q y~ H ~~F~~ t ~ ' ~ ~. Z ~~5~ N /~~ `~% ~ I ~+ z ~- i ~, f f5~, ^..~ ac ?. 1 4~ ~. C ''"~ ~ ~~a ~~~ ~ ~E nytl NplS 63214lOH1CIY 6 - ~ AE4 4~ `l ~° ~ ~ tl731 oao xrr+avfo xs~xl'a`a~~~915tl31Nn03 w y tl y3~5N Downs ~~,7Jif+~T~ ;p3N n 1N3D ,~~1s,ONYTM1N••L~ ~, .. ~,..tiz'a..> iq ~`t `_~'' "` o ~,~~~~~~ .. ~~ ~„ ~~ ~~ .~~~ t~ ~„ a ~ ~ ~, _ f .vii ~ '~~ h ~ ~ mow. ic, I ~h~~41 ~~ a ~. °C: o r' ,1` `~ V~ o t i ~t nMk "~~,~~' r " ~ ~ C, ~ ~ ~ ~ ~ I I a ~~ ~' \` a ~~ ~~ ~\ - ` ~~ i ~ ~ ~ ~~~~ 1~ ~ f" ~ \ 7~ N , ~~ ~ +l :, ~ ;.~ ,V $8513.N0 03x~a OyZAb ! ~ II ~. I ~ry ~i~, ~~ . ~: abaLSl~~a u 1lV3E)y M HMV Q r WSJ rQ lSn'Jt S3~lAtf3S `~' Aa ~ ~ '~ ~ a y m ~~ ~{ ~ '. - _.~ ~, oa~3 S~~ ~Hc ~b a~w~isa~~w oa y z m +r'.L#'~ i 1{~`~ v~ _ ti \~~ ...\ ~. \ ~~ ti~ ,;r ~~ < ~ , r c m N I g: :+.' '~~I t >•~ ;,, ~~ ~~ ~t, 'l; ti ~r . ~tl 0 H f' $ m D 0 0 ESTATE OF DOROTHY T KLAIBER 2110-1177 S~HEDIJLE E c,~ ~~~~; ~ ~~ P o ~~ ~~ctis~~~~° ~~~ ~~~~s ~oa~ 11nol:af Pennsylvania 1'7Q~5-~~:~~ `7~`'T-'7~2-`79~ exraail: ~a~aroaucfionta~ol.ao~s ~.#,4is0.0t~ 52.175.13 >>•, r``, tA1~T~ 11[li~l~ 5~~~~~t~'1~t~1~ ~~~~~ Settlement for: Donald A. Klaiber Sate Date: 07.31.2011 `Fatal pracee~s from the sale a* yea! M state ~5 i €~,~~s~!.1,~~! .Deposit of received Total proceeds from the sale of Personal Propertty dash reco~=zred Boring auctao~ set-~. Tatal E'Bpens~: ~ommissian Pram ideal Estate of 3.t1°i° commission from Personal Property of 25°10 ~d~.fert~ia~~• Fast Signs 5 53.00 r^ y z.vui~uiiiSTili'=arrvit~ 4vtiEu~l .a rs~Qr'.v+~ Pa~tt3n Dei aid n i~~r.b~ Total Advertising $ 967.60 went»l ~T e:2t} Auction set-up 49 l~rs ~ 515.00 ~;135.00 " (contract amount 5500.00} Auction personnel day of aucti€~n 5625.00 (contract amount 5 0} I`otai Expenses Total amount due Seller Date of Settlement: ~ ~, i ~ ~ 1 i ~s~ravT check m: Qt~~- $ 967.60 S 155.49 $ 500.00 ~.~ { ,a. ~~ t~ ~ ~ 1 ~~~~ 4i ,~ ~. '^ t ¢, ~ ;l rte , ~,UOU.UU_ r y' ~•~Q y 516,705.00 5 0 ~~ - X ~- 9,426.78 Thank the o rtunity to serve you and pour auction needs. S. Arian 1`~agaro AuctianeEr NEW CUMBERLAND FEDERAL CREDIT UNION J ~ Nr ~vii~i-iiY.Y.r~-i/~~~ i.~i~vwl'.~"- ~ui'"i-~vr,"~i. -LO. Box 658 • New Cumberland, PA 1707(1 • www.ncfcuonline.oro (7111 7%4-7706. (8001 716-2325. Nax: (7171 774J99G STATEMENT OF ACCOUNT IMPORTANT TAX RETURN DOCUMENT ENCLOSED PAGE ACCOUNT NUMBER 215 2 A T 0.4 8 2 Joint Owners ~ 0 017 0 7 IIIII~EIII~I~IIIIIIIEIIIE~~IIIII~IIEII~IYIIIi~111E~11~l~llllil I SOCIAL SECURITY DOROTHY T KLAIBER 312 B L A C K S M I T H R D STATEMENT PERIOD CAMP HILL PA 17011-8421 F~ ro 100110123110 TRANSACTION DATE EFFECTIVE PATE DESCRIPTION AMOUNT FINANCE CHARGE FEES/ FINES BALANCE 1001 PREVIOUS BALANCE Sl-PRIMARY SHARES 6101 7 1031 DIVIDEND 1 0 6102 7 THE ANNUAL PERCENTAGE YIELD EARNED IS 0.2 . 1130 DIVIDEND 1 5 6103 2 THE ANNUAL PERCENTAGE YIELD EARNED IS 0.2 1201 WITHDRAWAL CHECK 098 2 ~~ 5 0 P-ESTATE OF DOROTHY T KLAIBER 1217 SHARE LIFE INSURANCE 1107 3 I 1112 3 1227 WITHDRAWAL CHECK -5 0 1107 3 P-ESTATE OF DOROTHY T KLAIBER 1227 WITHDRAWAL CHECK -553 7 553 6 i P-DONALD A. KLAIBER 1227 CLOSE ACCT WITHDRAWAL CHECK -553 6 0 P-HENRY A. KLAIBER 1231 MEW BALANCE CLOSED: 122710 0 RJSING A DAILY BALANCE METHOD. ------ ----- OVERDRAFT AND RETURNED ITEM FE -------------------------------------- S SUMM - R TOTAL FOR ----- ~ - --- -- TO --- AL - ------ - I THIS PERIOD ~ YEA -T -DA E TOTAL OVER RAFT FEES ~ S 0.00 ~ S 0.0 TOTAL ------ RETU ----- NED ITEM FEES ~ S 0.00 -------------------------------------- ~ ------ - S --- -- 0.0 --- - ------ - TOTAL DIVIDEND YEAR-TO-DATE TOTAL FINANCE CHARGE YEAR-TO-DATE for an savings except fRA savings. Dividends shown, if over $f 0, will be reported for an bans to the Internal Revenue Service for this 16 .9 5 0 . 0 0 a.nronua~ ynar. INDICATES EFFECTIVE DATE NOTICE: See reverse side for important information necnc~z SUSQUEHANNA ALLEY F E D E R A L C R E D I T U N I O N 3850 HARTZDALE DRIVE C F,Mr~ n l i.~i, ~ r %a 7 i. + i - 7 ^n i,^, (1111 ~I II IIII111111"IIII~I11~11'llllill~llll~lll l'IIIIIII'll~ ~.~ 00000153 1 AV 0` 335 DOROTHY T KLAIBE~ 312 BLACKSMITH jfD CAMP HILL, PA ,'17011-8421 y J. ~, 000153 000153 1-000153 _..~ Member# ~ 377 s ~~ i Statement Date: '3-zti1'31/2010 Page#: 1 iinil ~~..G ~c: Tran Eff Transaction Tran Fee Finance Loan Date Dzte Description Amount Amount Charge Principal ~alance ----- ----- ------------------------------ ----------- -------- --------- ---------- - --------- 10/01 Type: 00 - REGULAR SHARES - 00 PREVIOUS BALANCE X2244.45 :~'~ 11/18 11/18 Dividend Credit .74 245. 11/18 11/18 Withdrawal to close account 2245.19- .00 11/18 11/18 Close a member .00 .00 12/31 NEW BALANCE .00 Member Year-to-Date Totals YTD Taxable Dividends: 4.93 YTD Interest: 0.00 YTD Charges: 0.00 This New Year, we'd like to thank you for trusting SVFCU to meet your financial needs. We know you have many choices in the financial industry and we appreciate the confidence you place in us. Happy New Year! ~7USQUEHANNA ALLEY F c r1 E 4 A, ~ !_ R F r'1 I T I I AI I h hl Tran Eff Date Date 10/01 Type 12/01 12/01 12/01 12/01 12/01 12/01 12/31 3850 HARTZDALE DRIVE ~~t'H~'lY [~'i. Y.il~~ Yh~1 1 ~~ i.-7 nii r'i ` / 1 / I - / J / - "2 1 J L ~•~ 00000002 1 AV 0.335 ~ DOROTHY T KLAIBER ~ ~• 312 BLACKSMITH RD j~ CAMP HILL, PA 1701,1-8421 Transaction Descrigtion 00 - REGULAR SHARES - 00 Dividend Credit Withdrawal to close account Close a member 000002 000002 ~^ ~~ ~-oooooZ Member#: 77 Statement-•-Da~tec 12/31/2010 Page#: 1 Mai 1 ~o.~o; Tran Fee Finance Loan Amount Amount Charges Principal Balance PREVIOUS BALANCE 5140 26 2.15 5142.41 5142.41- .00 .00 .00 NEW BALANCE .00 Member Year-to-Date Totals YTD Taxable Dividends: 154.23 YTD Interest: 0.00 YTD Charges: 0.00 This New Year, we'd like to thank you for trusting SVFCU to meet your financial needs. We know you have many choices in the financial industry and we appreciate the confidence you place in us. Happy New Year! SUSQUEHANNA ALLEY C F D C R /• 1 ~ D F A I T I I nl I n Af 3850 HARTZDALE DkIVE 000154 ~ \ ~mber#:_737 Statement D~ e 12/31/2010 Page#: 1 _, '~;a ~ , Cody-: 'Inelllus~~lnssss~~ess~~~es~ss~ss~srlelses~~sss~~es~s~ss~s~~ J. 00000154 1 AV 0.335 DOROTHY T KLAIBER i 312 BLACKSMITH RD i CAMP HILL, PA 17011-8421 Tran Eff Transaction Date Date Description ----- ----- ------------------------------ 10/O1 Type: 00 - REGULAR SHARES - 00 11/13 11/13 Dividend Credit 11/13.11/13 Withdrawal to close account 11/13 11/13 Close a member 12/31 000159 1-000159 Tran Fee Finance Loan Amount Amount Charge Principal Balance ------- -------- --------- ---------- ----------- PREVIOUS BALANCE 35Z`:~3-, .10 352.57'• 352.57- .00 .00 NEW BALANCE .00 Member Year-to-Date Totals YTD Taxable Dividends: 0.75 YTD Interest: 0.00 YTD Charges: 0.00 This New Year, we'd like to thank you for trusting SVFCU to meet your financial needs. We know you have many choices in the financial industry and we appreciate the confidence you place in us. Happy New Year! _ ~3 _._ ...,.... ~~ V ~~ BILL C1rF SALE ~'s-4-+~~ e, off" Stiller; ~c,r~~zt~,~? ,-, 4{~,~? ~$3f - l~ f_1~~~r,~"~S~ ~c~ ~ ~r~a,~ l~f~~~(t B'a. l Zc~(t in C~rtsider~tiu!'t of ~T.~!~.~T~? ~=~~'~-= r~{c~ti~y~ZEf~ (~,~ :~tsCYi :~~> __-- r~r411~r~, i'~~.eipi .~th[~r~u€ is hArR r arknn~nilPrlnarl rln~¢ hPrah ~PII; a~~inn tr~n~fs'r. artc~l ~,P.t ttt~P,r t0 Bl1VP_r,_____ .~, ......~~~, ...., . .,...v...,,.. __ --_ . _ _._~ . _ ~ ., ivijc~ Ly t'U Ivy o4v c _ is --- a~Q..~~ s-~srL-~--{--P ~ ; the f091owin~ r~?scriLie~! personal property, to-wit: ---_._.,Y,. I ~ ~ rc _ _ ~ (~~~t~ G'lfc.. ~ 1 4v ~. ~'C1 ~. ("t fSG`t rl ~ ~ I~hC k. t` ~ tv 'r--'j ~:'_ !C. :.~r'~ t~ S C It c ~ F E~ tT> : G l t t~ i-e~ .> -~ j l~~'~ i; ~tL~C EL u5 C, ~p 1;,~:.: ~ C k .. ~~t~ 4`t~ 2~.r ` ~ i~C~n_ ~C_ `3 ~ Oa-1~1 ~ t~ v S"',`~' ~.r~, Z~~I ~G' ~ ~ ~/~`~. °~,~ I, t~ ~ lrs ~ r~ ~ SS 1~1 '`~ i ' ~ ~( 7 (~ .Sg I f,,,, ,~:.~ ~_F i .~~ ~ 4 ~ ~' ~ t~ i $~ ~ //y/c/~ ~i '`fJ ~ s f+'- SSA 1 ~ 1 1 .~ w e ~ i~ ~ OEPARTMEhiT OF TRANS20RTATION II :_ ~~-- `-ER`rEEICATE OF 'T`ITLE FOR /~ ~EHIC! E ~'"3 ,~ s #~-+' - ;t i p ~~Tr~~~~~~T~9~O~ 7~ - r ~ f ~ ~ -t"Y ~ f" !!+l~: _ VEHIC 4 .- s I .. a w ~ ~FJ'#3F~riCf a'i 31 1 3f ~. , ~ LE IDENTIFICATION NUMBER I YEAR ~ MAKE OF VEHICLE . TIT LE NUMBER ~F va. ~ ~~ ~~~ __ ~ ~ ' _ 11 60D1 ~ t, f I ~~~~Ir ~~~ ~~~~I I - Tt FE CUP E oEAT CAP i - PRIOR TITLE STgrE t vG.;.A. °?;OCC. DATE ODOA!. rJILES II ODOh; 57ATUS ... 'i7c o+. Tl cp ~ nr cK;;~ m: nn=u v r,_~r I. ~ cv~''O _-.~ rcura -nn _ .o.,._nc ~.1 I~.:) ~~I I l# l3 i ba'~ ~ .~' 9 ~ ! ~jr~<c~. v~4~t~~\~: lS ~C ~.vct ~'t~~a~~~E't12~'~ 1 ~•J II ,~5 (S ~l Co~Ud~ 1`r 1©ril; i. Seller hereby represents and warrants to Buyer that Seiier is the absolute owner of said prop- erty, that said property is €ree and clear of all liens, charges, and encumbrances, and that Seller has foil right, power, and authority to sell said personal property and to make this bill of sale. Ali v~varranties of quality, f:tness, and ~~~erchantability are hereby excluded. If this bill of sale is signed by more than one person, all persons so signing shall be jointly and severally bound hereby, IN WITNESS WHEREOF, Seller has signe and sealed Ehis bill of sale at ~~la ~-~ 1 ~~ this ____ ~ da of (.mc~.} c u „ , (yr.) ~ c~ ~-, wom and sumac. tad #o t-tom,,,.-` ~"X~ - [SEAL] ~N ., Y / ~~C9"~ ~~ ~1~:5~~ C~ 2bc~~~ o~_________ _,..~ ~L .U'~t-.~- ~~2 (SEAL] VANi~t ~ ~ /< ~~-~ NOTARIAL SEAL ~ ~~u~~~ UNDASAWYER, Notary PubAc Camp HiN f3oro, Cumberland Camty My Commission Expires February t2..~ o_~~ _ .-~,~ _ ~ NAMEfADDRESS - .< ~, <, f HOME PHOtJE ~ WORK PHOfdE I 1 . ~ .. .. , ~ , ~ ~. YEAR 1 MAK£ 1 MGDEL ~ DATE LICENSE NO. M1l.EAC,E r. _ _ "'~, I i I t -1 i I- I I 1.- 1 1 1 ,. f I 1 ! I I 1 ENGINE T RHNSt:AiSSIOh! KE'>' TAG h70. ~I - - I i - _~ -- i ~ OISOLAIP4ER OF WARRAFmcc ANY tNARFUNTIES :?hi THr-. P^n~7C~~^TC SOLD ARF TF C`SF !-.~1~E E?1'THF, s-fANUFACTtIF?EF: THE =ELLER FtEREE~r EXPHES9LY DISC! AiF,U ALL WARRAN'°+E~. EfFHeti tsPRESS OR IMPLIE[ IhJCLUUING ANY IMPLIED WAHRAFyTY i1F MEHI.HANTABIIITY If :-i iNtaa rvH n, NAMTiBULAN Purirl75E.:.idv J- i FEi; ti 'duiar_S +J~ U ~ H~n~L a a~y\ uT:iE., 7ERSv±: TJ ASSUME FOn {; ~i 7YLtABtuT kJ CONNECTION tirT THE SALE OF SAID PRODUCTS. dl1YER SHALL NOT BE ENflTLEU TU RECOVERFROM THP SELLER ANY CONaEOUcF•1TWL DAMAGES, DAL1AvE5 n7 PROPERTY, aAMAGE FOR LOSS OF USE, LOSS OF TIME, LOSS OF PROFIT O •." J.dc Jn ~S.`; CTi t~F. INCiOr?iTAL C.;9:;,'.G~~. .."AART PRICES SUEtJECT TC L`11+C?1~P"'. Oancellalbrt after aWhmlra8otl slgnapaia of esUmaM maybe subleC! to 20'%. paAS mstocMng Charge: Italrtom6l711e Is retumecJ Fo customer before ,5ervi~e is c=rfahmzd, a diagr>QStic aM handling charge. linduditq reassembling), wM 6e made. ~ LA~OI~ PANS & O~'HFPS 1 ""~ ~ ',,` l ... _ <<. ~' II Environmental Surcharge for the Disposal:of: Used Oil Oil Filter Antifreeze Tires ~.....,.,...... ~., . ~..~„ ..~. PARTS ~ y r v r P F / STICKER NO. LF LF LABOR `' i' i:: ra L-' LR LR MISC OLD STICKER NO . RF RF ~..:.. RR RR SUBTOTAL ~, ~:, ~ NOTES/COMMENTS TAX +, -U ~_ `j~ TOWING TOTAL ~ ' ' r ~d ~.. ~ c f,..,~ 'METRO BANK >Q6124 6632566 Qi71 Q9214Q DOROTHY T KLAISER OR DONALD A KLAti3ER „ c~ ti~uHRcr ont~n i i LL ~ CAMP HILL PA 17011 Metro Bank 3801 Paxton Street Harrisburg PA 17111-1418 'I-888-~J37-0004 mymetrobank.com ~~ We're here T days a week, 24 hours a day at 1-888-937-0004. ~~ '~~ 5d PLUS CHECKING Q543244442 Statement Balance as of 09/28110 51,22©.21 ~"' Plum 4 peposlf4.and Other Credits 578.391.70 ~r Lees ~. 7 Ghacixs anQ Other i]ebtts ,: 58.998.76 _ ~,~ plus - InterestPaiQ _. , .. _ 50.37. $tat9tit9fl# i' ~ ~lahce as of 10t28I10 _ 58,533.52 Transactions By Date _ - _--- .---- - Date Description Debit Ceedit _ Salance 09/3Dh10- ~ . ; A"C YDEP~991i~1tlUfIANT.. ,, - - ___ . ,_ ._,.._ 57,28.51 _ . ,- _ _. S2A~~ 10/04/10 CHECK # 968 590.00 52,348.72 10 ,CHECK #859 5102.81. - . _ $2,245.91 .. 10107/10 CUSTOMER DEPOSIT 53,940.19 56,186.10 ~8/1~t'~~, -. ~ ~.~.K # 9'111 .. _ ;- 54,34$.RO ~~, ~~. '`~ 1 51. .10 770 10 51 10/15!10 UGI UTILITIES UTIL PMT $70.00 , . ~i ~ ~ SERIAL NUMBER: 0972 218487745002 ;....._ Cl~~#C~71 ~ -_ . ~ ~ 597.95 _ ,~: ~: .~~` S1,fiT1.75~~ 10127 0 CHECK # 973 '~ ----- 560.00 ~ ------ ~ - --- 5 ~~ ; , ~~ :: ~~~VlE}{ t3EPC-SIT~;- . .:_ __ ~32~688.00 ; :. __ ~ . ~~0.~~;.: _ _. 10/28/10 , CUSTOMER DEPOSIT 58,465.00 512,765.15 1.01~%i f~.HIC,# 577 . .~ ', S~#,232.0~1 " ~ S@~;,15 8 10/28/10 . INTEREST PAYMENT $0.37 ,533.52 $ Check Transactions Number Date Amount Number date Amount Number Date Amount w ~. .. 1010 j80.00 969 10/04 $102.81 970;: i.- ?-~°,.'. ~~-UQ_~ . :~.. 971 --- 10118 $97.95 ~73`, 10/27 Sfi0.i1~ 977• 10/28 $4,232.00 Items denoted with an "E"are electronic entries and will not have a check image. items denoted with an °" indicate processed checks out of sequence. Interest Summary t~aginnfn~ Interesf Rate_ _ t~unr~{ae}• of days In this Statement Perigd 1ntx,Ea-r~ed dils Statemoht Period -~ Annae`},et-taQe~ Yield, Fsrrred this S~te-teent Period (APXj _ i - ~ ~Yto Da~e_..., 5 .. R K ~ . 0:~15~`- "_ 3Q 50,~~:: - ~ 0.15% - _ ~ ~~ n b O lit Q n cr n 0 I'1 cr r• ~• A a rt 0 F~ ro a~ 0 w 0 cr p hh 0 n A N N 0 r~ n 0 th a a a H I 1. ro II 0 1~ F' 11 r li E ii W II `a 11 ~' 1". h11 II 0 u li u ~ 11 W II it p ii au . 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F- _ ~ a ' ! -,~, Cc7 IT1ti_1 t-i Z ? ~ , r"r~`i ~ r v 1 i .~. .. ~ ~`~r tea;c ~.ot covered ~_n pre-need contrs.ct ) ' ~~ i '. l~ll~~~~~>~~; Copies of death certificate (25 to $o'. Gu ) -- - - ~ `' ~ Newspaper obit w/color pi.ct~~r~ n th i ti ' u~u ~~~ or za o Coroner s au ~QDiCICIit~. llL-1~+t~". ! - ~_. ~, TOTAL Established 1895 Brian t;. (viusselman, F.D. - Supen~isor \ `~ William 0. Penan, F.B. ~~, P.0. Box 137 324 nun7n~iei AverMUe ~ ~ ~ \ , ' ~' ' ~ ~ ~ ~~ ~ ~ t_eiriayne, PA 17043-0137 .~ ,~ ;; i 1t (717) 763-74~D _ ~ ~ ~,~ ,. tr ~-- s ~~ r ' ~ 'Z .~' Nov,1 7, 2010 $1 X0.00 276.07 25.00 $451.07 FOR APPtlIr~Th~Ettr pun~;~ ; j, -7G3-74~ii ~~`~ ~~ ~~~~ ESA, ~ ~ ~- ..:'t F S''r~'f 4r 1~. :'liLf t ~.a.'. ,; 4'?~~ !- i!.% •"-GEC? t7 n-7 ~'iftli .f Cheek frxtage~ Account: 50 PLUS CHECKING (*4442) ~ Check Number: X84 ~ Date Posted: 12/2/2010 ~ Amount: $408.50 Zoom In ~, Zoom Out ~. Print " t DOROTHY 7.KIAIBER f~-tll~::~~f'vl f 984 I I 11 taMHURST ROAu I CAMP HILL, PA fTOtt !f`~ >~!~ ~-Itt6/313 GY ~2 PAY i0 THE / ~~~~ CATf I ~~ ~~ ORDER OF -j-~p I pp,, .. ~~~~rRO . ~l ::^3?:3~~i3k S1: 51 ~' _ - 3?IR~L ?II" 09B4 ~--` >0.31315036< Orrstown Bank Shippensburg, PA 17257 Phone: 717-532-6219 Bus Date: 12/01/2010 i Branch/Teller 0008/0127 121 0112010 20:39:92 Technical Support: 800-204-0541 Copyright 02009 Metro Bank Online Banking. Member FDIC All Rights Reserved. -Metro Bank is a wholly owned subsidiary of Metro Bancorp, Inc. and is not affiliated with Metro Bank Ltd, Great Britain Invoice 10/17/2011 FROIUl: H&R BLOCK PREMIUM 4811 JONESTOWN RD, SUITE 125 HARRISBURG, PA 17109 BILL TO: DOROTHY T KLAIBER 11 ELMHURST ROAD CAMP HILL, PA 1701 i For the preparation of PA-1500, 1041, 2009 - 1040 and 2010 1040 Statement of Charges Tax return preparation fee 1,731.00 TOT~-L 1~7~3 i~00 ~R ~.~ ~: ,,,.., 2 Viv u~ivvl Dui uStut2 Tul: Tax Collector: Bennie FC. Miller, Treasurer 717-97~-7~,7~ KLAIBER, FRANCIS A & DOROTHY T 11 ELMHURST ROAD CAMP HILL, PA 17011 2010 School Real Estate Tax for West Shore School District Account Number: 13-23-0547-068 Property Location: 11 ELMHURST ROAD HIGHLAND PARK LOT-9 Residential Building Land 112,768 Improvements: 0 Total: 112,768 ~t1~~1'~~~~ lC~~~`l~~ v ~OlVl~~iE K. Pv9i~LER, ~reas~ ~~ R1ler~ ~®w~ship Bill Number: 21925 Discount Face Penalty Jul 1 2010 to Sep 1 2010 -------------- School 1,172.54 -------------- Total 1,172.54 ------------------------ Paid in full at the pen Sep 2 2010 to After Nov 1 2010 Dec 31 2010 -------------- -------------- 1, 196 .47 1, 316 . ~``` 1,196.47 ,316.12' ~lty amount Date Paid: 12/14/10 Amount Paid: 1,316.12 ~~_. t + ~ ~ ~ i ~ ~ ~ ~ ~ ~ ~ i • ~ Payable To: BONNIE K MILLER, TREASURER Office Hours: MON,TUES & THURS 9-4 i3lll No: 2823 2233 GETTYSBURG ROAD CLOSED VVED; FR! P.ND ALL t~ivLivAYS Bill Date; 3!1/11 CAMP HILL, PA 17011-7302 BONNIE_MILLER LOWER-ALLE, ~, Phone: (?t7) 9,'S-7575 EXT 1701 PHONE (717)975-~ 75 EXT 1701 ~ PA.US Control Na:13000764 MAP N0: 13-23-0547-068 Desc: 11 ELMHURST ROAD ACrF,S i ~~~ Tige;N. nn• ~., .,. vvi i r-UV024 u~~t~~nitiu YHKK LOT-9 Residential(Under 10 Acrel~)~ !!{{I{Ilf{{{ilill{{fff{{li!{{flili{f{{Ili!{I{IfI{f ~,:~.R:. , . . $1.0 EE FOR ADDITfON LA R~~~~ IFS, lax Payer; KLAIBER, FRANCIS A 8 DOROTHY T~ {i '? Fn 11 ELMHURST P,D CAMP HILL, PA 17011-6013 ~~~~~ ,//3 ££ G ~. tltl11C ~ ~°. AssessedVelue: L4~ a 33,«.u --- - , ;;;;prw~n~enti:~i$4.50Q T.,+~r.c~^^^ -..... v, ,uVV Discount Face - _ Penalty COUNTY R!E 1.90200 $312.96 $319.35 $351.29 COUNTY LlB .14300 $23.53 $24.01 826,41 MUNIC. RIE 1.23000 $202.39 $206.52 $227.17 ,MUN,F{RE SRVS .41000 $67.46 $66.84 $75.72 IGHT 1.00000 $2.60-°--.- $28.60 $28.60 MUN DEBT 5VC .41000 ,,~ $67.46 $68.84 $75.72 ' 1;'~~X AMOUNT DUE If Date Of Payment Is On $702.40 3!1 11 thru 4/30111 ~ $716.16 5!1/11 thru 6!30111 ~ $784.91 711!11 or Later dr atc ~ i ~+f li~.d TAXPAYER'S COPY -KEEP THl5 PORTION FOR YOUR RECORDS ~ • • - ~ ~ • . ~ BONNIE K MILLER, TREASURER _ - 2233 fETTYSBt7Ru' ROAD CAt1P HILL, Pa 7,7011-7302 TEMP - RETURN SERVICE REQUESTED OFFICIAL COUNTY MUNICIPAL TAX BILL ll~lltl'Mullin"i`l~il~~lll`~~{~lllt{~~ttl~'ll~l'lll{{l~{~lll~l 87110-34384 ~+~ ~ I:LAIDER, rRANCIS A & DOROTHY T 17, ELMHURST RD CAMP HILL, PA 17D7,],-6D13 0 Q ~, .n d a 2 v i v ucho.^ii i er~.~iinai ~~ax Tax Collector: Bcrlnie K. Miller, Treasurer 717-97S-7S7S KLAIBER DOROTHY 11 ELMHURST ROAD CAMP HILL, PA 17011-0000 2010 School Personal Tax for ~nu~ rrlest Shore School District ~~ n""~' ~k ~ 5 Account Number: 013002383 Bill Number: 3567 Discount Jul 1 2010 to Sep 1 2010 -------------- Schl P/C 4.90 Schl RES 4.90 -------------- Total 9.80 Face Sep 2 2010 to Nov 1 2010 -------------- 5.00 5.00 -------------- 10.00 ~~~~~_ Penalt~`O,~f~~ ~ ~ ~~~ ~~i~~,. BAs ~,~~~~-;; , fj.,,; _ After ~ ~+'~~~s,~,~~`'~,~. Dec 31 2010 -------------- 5.50 5.50 -------------- 11.00 Make Checks Payable to: Bonnie K. Miller, Treasurer 2233 GETTYSBURG ROAD Camp Hill, PA 17011 717-975-7575 ESTATE OF I~OI~OTH~ T ~AI~E:~ 2110-1177 SCHEI~IJLE I ALE1~T SC~~' A FINANCE CHARGE OF 1.50 ~ PER MONTH PHARMACY SERVICES INC. (AN ANNUAL PERCENTAGE RATE OF 18 . 0s) OR A 219 North Baltimore Ave MINIMUM SERVICE CHARGE OF $ 1.00 WILL BE CHARGED Mt Hally Springs, PA 17065 800-266-9954 (717) 486-8606 ON ALL AMOUNTS 3 0 DAYS OR MORE PAST DUE www.atertpharmacy.com ~TATEl4+~ ENT QF I~~G~ lJ NT ----- --_--------_----- - IF YOU RECEIVE A NEW INSuF.ANCE CA:DD FOR YOUP, -- _-- JRG'~('RTDT'T(1T?C ~~ crru~ mn cr?nnrv rrc rarmv r r»nnv Date =~~ GG;~~C1~ - PMT DUE..11/15/10 _ _.`._.___.___ j KLAIBER, DOROTHY T KLAID 3O DAYS. 143.04 j~ WOODS AT CEDAR RUN GRP-57 I 60DAY5. 92.35 ~~ 824 LISBURN ROAD PAGE 1i l i CAMP HILL PA 17 O l l ~ ~ Amount Paid PLEASE DETACH AND RETURN TOR PORTION WITH YOUR PAY_ _MENT ALERT PHARMACY SERV. INC.219 NORTH BALTIMORE A.VE. MT.HOLLY SPRINGS, PA 17065 • ~ • ~ a e I I ~ ** ACTTVIT__Y FOR KLATBER, DOROT_HY_ T_ _ _ -KLAID - -57 09/08/10 7710032 2 --J_ rANTOPRAZOLE 40MG __ ._ 01---.___.____ - ----.. g.-26,_ -_____------.,----..00 .__ 9. 26.f.. 09/08j10 7709988 4 FERROUS SULFATE 3 01 * 2.63 .00 2.63 09/08/10. 7709993 28 LISINOPRIL 10 MG O1 12.68 .00 12.68 09/14/10 7740928 21 PREVACID 15 MG SO Ol 146.78 .00 146.78 PAST t}t1E YOUR ACGOUl~IT Is coI`tsIDERASLY PAST DUE, PLEASE REMIT ...... TOi}AY 235.89 ~ 171.35 ~' 3.54 = --1~ 8~- LEGEND FOR MONTH 410.78 NON-LEGEND FOR MONTH Totat Payment & Credits .00 nn nt t oweonRnrv oci n'rtn ~-.rn4 uccc of cncc f-ni r nt...+ o~.........,... ~,,.,,:,.,,,, rte., ~, ,, onn „~~ ~„~„ AMOUNT DUE - 410.78 ..~_ _ _ . . ALE ~ SC ~ ~~~ ~~ '~A FINANCE CHARGE OF 1.5 0 ~ PER MONTH PHARMACY SERVICES INC. (AN ANNUAL PERCENTAGE RATE OF 18.0°s) OR A 219 North Baltimore Ave MINIMUM •SERVICE CHARGE CF $ 1.00 WILL BE CHARGED Mt Holly Springs, PA 17065 800-266-9954 (717) 486-8606 ON ALL AMOUNTS 3 0 DAYS OR MORE PAST DUE www alertpharmacy.com i1rA~E~E~~ taF ~~CQ!!I~!'t' ! IF You RECEIVE A rrEw INSL7RANCE c_~RD FOR YouR ----' - D13'G'C('l?TpTT(1TTCT RL' CTTDC T(~ CFTLSPT.V fTC TnTTTiT T~ nnnv ~ i... ... .. __-..._.~. ...._ ~..-._. _.... ~..-___ .. -., .,_~.- -,. `...tea. t .- Date 1~f~;~;f~0i0 PMT DUE..11/15j10 ~~~ KLAIBER, DOROTHY T •~ KLAID 3O DAY5. 143.04 j~ WOODS AT CEDAR RUN GRP-57 50 I?AYS. X2.85 I~ 824 LISBURN ROAD PAGE 1, CAMP HILL PA 17 011 i Amount Paid __ PLEASE DETACH AND RETURN TOP PORTION WITH YOUR PAY_ _MENT ALERT PHARMACY SERV. INC.219 NORTH BALTIMORE AVE. MT.HOLLY SPRINGS, PA 17065 ** ACTSVTTY FOR KLAIBER, DOROTHY T -KLAID - -57 09/08/10 7710032 2 PANTOPRAZOLE 40MG O1 9.26 .00 9.26 09/08;/10 °7709988 4 FERROUS SULFATE 3 O1 * 2.63 .00 2.63 09/0$/10 7709993 28 LISINOPRIL 10 MG O1 12.68 .00 12.68 09/14./10 7740928 21 PREVACID 15 MG SO Ol 146.78 .00 146.78 PAST DUE YOUR ACCOUNT fS COtJS1DERABLY PAST DUE, PLEASE REMIT ...... TOE?AY .00 i LEGEND NON-LEGEND ` TOTAL TAX FOR MONTH FOR MONTH evious Batance Charges thfs month finance Charge TOTAL CHARGES Total Payment 8 Credits j AMOUNT DUE 235.89 ~ 173.35 ~" 3.54 - 410.78 - .00 - 410.78 ><nca nt ~ ewe~nanrv oc~ nrcn inrnt ttacc.oi once t~ni i ni...+ oti,.'..,,,,,.. c.,.. .:...... F.,,, .~. ~ onn ncc n~cw Customer Account Information For Service To: F A Klaiber ~ 11 Elmhurst Rd Account Number: 24-0631620-4 Premise Number: 24-0373250 Billing Period & Meter Infc~rmatiQn Billing Date: Aug 04, 2011 3iliinq_ Period: uui u5 to Hua u3 rz~ aavsi Next rPadir~g on!abou#; Aug r,,5; 2011 bate Type: r~esidentiai Billing Summary _----.--__prior Balance---------------____.__ Prior Water Balance Payments prior to Aug 04, 2011. Thanks! Total prior balance, Aug 04, 2011 ---------Current Water iharaes---------- Sert~ice Charge y Water Volume ($.007890 x 800) ~TA,S' PAVI/r', Vt/atar () .R7~/ Total water charges, r",ug t;Y, 2^11 i~Mnxor rnoriin na in ICI IrYOn11 I~Illlnn nnrtnri• v r-. _. _______. AIIP}PJ' nljffTt {?^r_ ~'Q,1d 1_SR~Q~_~~ a_ F/R =inrh_matar_________ Customer Account Information Far Service T:.: F A Klaiber 11 Elmhurst Rd Account Number: 24-0631620-4 Premise Number: 24-0373250 Billing Period & Meter Information Billing Date: Jun 09, 2011 Billing Period: May 04 tc Jun 06 (33 days) Next reading on/about: Jul 05, 2011 Rate Type: Residential Meter readings in current billing period: Meter Number N044158293 is a 5/8-inch meter. Present-actual 311000 -----------Last=act~~,aL,---- -------------- ?~-1 ~_n11--------T------ Customer Account t„f~rr ratio;. For Service To: F A Klaiber 11 Elmhurst Rd Account Number: 24-0631620-4 Premise Number: 24-0373250 Billing Period & Meter Information Billing Date: Jul O8, 2011 Billing Period: Jun 06 to Jul 05 (29 days) Next reading on/about: Aug 05, 2011 Rate Type: Residential Meter readings in current billing period: Meter Number N044158293 is a 5/8-inch meter. Pre s e nt-actual 311100 Last-actual 311000 Gallons used 100 Water Usage Comparison Monthly usage in hundred gallons. .J ~• L a t ~± . ~,; ;. ~: ~A . .__.~Ni1fYi iAY`T i'll Yu _.. _____.. .. ___. ------ -------------------------- 8illing Summary ---------Prior Balance------------------------ Prior Water Balance Payments prior to Jun 09, 2011. Thanks! Total prlor balance, Jun 09, 2011 ___.__Current Water Charges--------- Service Gharge STAS PAWC Water 0.32% DSI -PAWC Charge 3.51 Total water charges, Jun 09, 2011 ----------Other Current Charges---------- Late Payment Charge Total other charges, Jun 09, 2011 --------AMOUNT DUE Bi1li~ig Surrr;ary ----------Prior Balance----------------------- Prior Water Balance Payments prior to Jul 08, 2011. Thanksl Total prior balance, Jul 08, 2011 ----------Current Water Charges---------- Service Charge Water Volume ($. 007890 x 100) STAS PAWC Water 0.32% DSI -PAWC Charge 3.83 Total water charges,.Jul 08, 2011 AMOUNT DUE ~\~~\`, $14.36 -14.36 .00 13 00 ~ I 6.31 i n~ ~ ~ r, 2v i i i I ~i c~Yri l i I r-----~i $15.97 I I .00 ~ 15.97 I 13.00 ~ .04 ~ .46 13.50 .24 .24 $29.71 Customer Account Information For Service To: F A Klaiber 11 Elmhurst Rd Account Number: 24-0631620-4 Premise Number: 24-0373250 Billing Period & Meter Information Ojlling DatC. VOIi V7, Lv i U Billing Period: Nov 02 to Dec 02 !30 days) Next reading on/about: Jan 05, 2011 >?ata Type: Reside;~tial Meter readings in current billing period: Meter Number N044158293 is a 5/8-inch meter. Present-actual 310800 Last-actua! 310800 Customer Account Information For Service To: F A Klaiber 11 Elmhurst Rd Account Number: 24-0631620-4 Premise Number: 24-0373250 Billing Period & Meter Information Billing Date: Apr 07, 2011 Billing Period: Mar 07 to Apr 04 (28 days) Next reading on/about: May 04, 2011 Rate Type: Residential Fvteter readings in current biiiiiig perir~u: Meter Number N044158293 is a 5/8-inch meter. Present-actual 310 8 0 0 Last-actual 310800 Gallons used 0 Water Usage Comparison Monthly usage in hundred gallons. 0 1 0 0 1 1 $14.90 .00 14.90 , I 13.00 ~ Vv j i .~4 i 13.30 I 22 $28.42 $40.92 .00 40.92 13.00 .04 I .46 ~ 13.50 .61 .b~ ~ i $55.031 I \~ Messages to you from Pennsylvania American Water Any portion of the water charges which is not paid as of 5/02/11 will be subject to a 1.50% penalty. The due date per[ains to current charges only. Any past due balance should be paid immediately. 'Approximately 3.90 percent or $.52, of State taxes are included in your current brll. " Effective Apnl 1, 2011, the Distribution System Improvement Charge (DSICJ has increased from 3.11 % to 3.51 %. This charge funds the replacement of water distribution facilities. Billing Summary ---------Prior Balance------_._~___......_ Prior Water Balance Payments prior to Dec 07, 20 i0. Thanksl Total prior balance, Dec 07, 20?0 ----------Current Water Charges---------- Service C~h,~arg~ee y ST AS PAfYC YY a`lt7/ V.Y/'io DSI -PAWL Charge 1.85% Total water charges, Dec 07, 2010 ---------Other Current Charr~ea-------- ~aic i -uyii,vut vuctryc Total other charges, Dec 07, 2010 ----------AIAOUNT DUE Billing Summary ----------Prior Balance----------------------- Prior Water Balance Payments prior to Apr 07, 2011. Thanksl Total prior balance, Apr 07, 2011 ----------Current Water Charges---------- Service Charge STAS PAWC Water 0.32% DSl -PAWC Charge 3.51 °ro Total water charges, Apr 07, 2011 ----------Other Current Charges---------- Late Payment Charge Total other charges, Apr 07, 2G ~ 1 ._.__._AMOUNT DUE -----------------°° ~~ c A M J J A S O N D J F M p P a n l y e t v c n b a Y 9 P L0~11iER ALLEN TOiNNSHIP 2233 GETTYSBURG ROAD CAMP HILL, PA 17011 TELEPHONE:717-975-7575 ~~~ 1.010 „, ,n, no /n, „, „ )1V-lJ U/ ~U1/ 11 ZU QJ/ ~V/ 11 ll/ / V1/ 11 V(7/ Vl/ 11 11 ELl.l f'YURJ I f'lV . l _. ~ _. _ _. _ ... ' n«-r rv ^n ~=fr;c s•r;7 hr- ~r,~,^ar,' r _ ' t AI T^ Ivan ...._. "., _. .... _. _ _._.. .'__1 1!7lld z;7T ! . _ F ~ }1CC1^T9 4'1T1/'1FI ~.__ __._._._ ___._.__-____ - ._-_ _- __1 . ,~ -. _ . Sewer Previous Balance 5.00 , ,,,, , , Refuse Previous Balance 5 .40 ~ =`" ~= '- == -' 1.00 RO1 SEWER-RESIDENTIAL .5^,0^ I ^,`;..~.~f~ r`~~ ,3. °:n~n ~:nn j 1.00 RRl REFUSE-RESIDEIVTiAL Total Due By 08/01/11 Total Due After 08/01/11 53.95 j ~ ~s ~ ~, ~\ i ~ 1 ~ ~ ,; , -----, ~ \ ~~ ~ ~~,~ ~~ ~~ ~ X114. 33 5~,.°~ ~ 1Z~7~ I i ~ _ _. _ _. :1d;CJR1N B 1010810-0 i DUE D~,-E r W~ZCURIT ~ ! 08/01/11 114.35 I IF PAID AFTER AMOUNT 08/01/11 124.75 ~u.~~~'~~ .~~ l.:~C,;., e s.~J~d :~.ar~ ~ G~~~W .r~~~~~ a^aa'~?~~~1P, ~da-rs.e ?•+~5,9,9~G+ ~A~,i/~~~~lf DOROTHY KLAIBER CAMPBHILLSPAT17011D8421 ~II~IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 11 ELMHURST RD I LOE ALLEN ~ ONSI~I 2233 GETT~'SBURG ROAD CAMP HILL, PA 'i7011 TELEPHONE: 717 -975-7575 SEEP T~~~ P~~~'~~~ F~f? ~'~C~~ ~'~C®~~~ '~, ACGOUNT. BILLING PERIOD BILL DATE DUE DATE SERVICE LOCATION 1010810-0 04/01/11 to 06/30/11 04/01/11 05/01/11 11 ELMHURST RD UNITS CODE DESCRIPTION AIVIOUNT sewer Previous Balance 0.00 Refuse Previous Balance 0.00 1.00 RO1 SEWER-RESIDENTIAL 50.00 1.00 RR1 REFUSE-RESIDENTIAL 53.95 ~\~~\~ A 70% penalty on sewer and a 70% penalty on rer'use will be added if full payment is not received by the due date. Township Office Hours: Monday -Friday 8:00 to 4:00 v LOWER ALLEN TOWNSHIP 2233 GETTYSBURG ROAD CAMP HILL, PA 17011 PLEASE RETURN THIS STUB WITH PAYMENT L_ _ ACCOUNT NUMBER i -t t» nR~ ~-n i L-- I e;~~,~,~e nr~~gSr~ ~..,. rtii//.. i 111 ELMHURST RD I ~ 4AN®UNT DUE BY J 2 x`01/ 11 i~ 1i7~-w; ~~, AmUUN-UUtAl:~il:lt uz;°v1i ~~ 314.35 TOTAL AMOUNT PAID > ~ MAIL TO: ,- ^ r ` DOROTHY I<LAIBER 312 BLACKSMITH ROAD CAMP HILL PA 17011 /~• 1 LOWER ALLEN TOWNSHIP 2233 GETTYSBURG ROAD CAMP HILL, PA 17011 TtLEPHC7NE: 7 i7-~75=1575 ACCOUNT NUMBER BILLING DATE i ' i ~ i ~ 1V1uESiv-v I ivj vs./iv ~ i ccrnnrc nnnoccc ~ ~ u~r,"- n :311_I_;~.1~t; ~E~107 , --- i 10/01/ZU - 12/31/10 5eWEit REFUSE I CURRENT 44.00 I CURRENT 5 3. 9 5 ARREARS ARREARS PENALTY PENALTY ADJUSTMENT S ADJUSTMENTS TOTAL TOTAL SEWER 44.00 REFUSE 53.95 • •~ • ~ • o 11/01/10 ~ 97 95 _ _~__ \ A 10% Penalty on Sewer and a 10°% Penalty on Re se are added if full payment is not made within 30 Days of the Billin ate. i - Past Bill Information -UGI Utility =_ The account balance on your last bill was .................. S -37.85 -• ~, ~- - Payments .............................................................................. 0.00 d~ LIStOITIer ~ItIf11C _' BAd SEBV/CE Your balance as of 08/05/2071 .............................-......~'l~5 ~ - ---~ Current Bill Information -UGI Utili 218187745002 Billing Summary for Service to: Customer Char e ~ ..................... 2.57 DOROTHY T KLAIBER g ..........- ............................... 11 ELMHURST RD Commodity Charge (2 CCF at $0.75500) ................... 1.51 CAMP HILL PA 17011 Distribution Charges ...._ .................................................... 0.93 PA State Tax Surcharge ..................................................... -0.02 Rate Classification: PA Sales Tax ......................................................................... 0.30 Re ' " I Heating Total Current Charges -UGI Utility ................................. Credit Balance ..........................._.........._............................ -32.56 ! it Per d: UGI Utility charges owed this bill _ ........................_.............._......._..a:.......................-. S 0.00 ° /26/2011 08/04/2011 (9 days) Final Read Current Blll Information -UGI Services ations2 Tum On/Shut Off Fee ...:........................................._.......... 37.00 ; Ca -2 -2722 or write to UGI at Total current UGI Services Charges ................................ ~'Tba PO BO 09 UGI Services charges owed this bill ..........................................................._.........._....... S 57.00 Reading, PA 19612-3009 Total Amount Due, Please Pay by Due Date (08!26/2011) .................._................... S 87.00 "'Your current UGI charges include State taxes totaling about S 0.46. ° C ~, ~ ,~ ~ 2.90 2.61 2.32 2.03 1.74 1.45 1.16 Meter Reading Information Meter Number Previous Reading Present Reading CCF Used 1204453 2605 (remote) 2607 (final) 2 Messages from UGI ^Your current price to compare is $ 0.77347 /CCF. ^UGI will refund your credit balance within 30 days, provided there are no outstanding UGI service charaes at this address. Bps sess/eE Billing Summaryry for Service to: DOROTHY T KLAIBER 11 ELMHIIRST Rp CAMP HILL PA 17011 !fiats C3aWsi:icv4:cr.: nesiderliiai rieaiifYy 'tilling Period• X2/28/2011 to 0~/yam/~~ 11 (~~ ~a~a; Remote Device Reaa ~oAQStiolrls? r+..ll qr1 f1 r17 P_ n'fnn ,. .- idrl .,l p~"saxs`oos" _._ ~, ...._~ _tr _._..._ Reading, PA 19612-3009 + Vpl'r rl~rrnnt IIr_I rharnoc inrl,~`io _.~~~ State taxes totaling about $ 3.14. 00001 ss _~~ ~ ,' GAS SERV/L'E Billing Summary for Servic o: ~~ DOROTHY T KLAIBER 11 ELMHURST RD .~ 1 CAMP HILL PA 17011 Billin Period: \ 9 04!27/2011 to 05/25!2011 (28 days} Remote Device Read Questions? Call B00-276-2722 or write to UGI at R~ Rnx 13009 - --.nn 'Y __ S ~_ .._ 64Y dEBY/CE Billing Summary for Service to: DOROTHY T KLAIBER CAMP HILL PA 1D7011 Rate Classification: Residential Heating Rate Classification: Residential Heating Billing period: 05/25/2011 to 06/27/2011(33 days) Remote Device Read Questions? Call 800-276.2722 or write fo UGI at PO BOX 13009 Reading, Pq 19612-3009 x Your current UGI charges include State taxes totaling about $1.46. 2.1 2.; 2.0 1.7 1,4; Past Bill Information -UGI Utili ~--- - ,~ ~ -~- -~--- The account balance on your last III was ......._....... $ 46.00 ll~f et . Un1~}eF. Payments ............................................................................ 0.00 0.58 2 .~ . Late Charge ...................................................................... 18187745002 Your balance as of 03!31/2011 (due now} ...............~b~$ -1.: Ae.P 11t `Ili il':':.^i: iiu«i: iii.' Ir~Ji :.~+::'h: • ••: ~uswulcl vIlQr~e .............................................................. o.~~ %tlmnlt~dity f;h~rno ~~ i ^_ r , - .•~ Distribution Charles {Firt 22 CCs= at $0.~;46ss} ... 9.82 ?A State Tax Surcharg? ............................._....,_. _ _. -0 13 PA Sales Tax .......................................................:......:..:..: 2,04 i oiai Curren Cnaraes - ~~~i uriiiw ................................ 3o.u~ Budget Billing Amount .................................................... 20.00 UGI Utility charges owed #his bili ..................................................................................... $ 66.5ii Total Amount Due, Please Pay by i3ue rJate (04121!201 i 3 ....................................... 3 66.56 n 1`1 E ~ st Bill Information -UGI Utilit ~ ....~ ~ _ ~, I account balance on your last ill was ................ $ 87.41 :, n , a nk you for your payment of ..................................... -112.58 ur balance as of 06/01/2011 ................................... =2~ 218187745002 Current Bill Information -UGI Utility Customer Charge .............................................................. 8.55 Commodity Charge (4 CCF at $0.71750} ................. 287 Distribution Charges (First 4 CCF at $0.44250) ...... 1.77 PA State Tax Surcharge .................................................. -0.05 PA Safes Tax ...................................................................... 0.79 Totai Current Charges -UGI Utiiity ............................... i 3.93 Budget Billing Amount .................................................... Credit Balance to be applied to next bill .................... 20.00 -5.17 UGI Utility ch®rnes awed this bill ..................................... ..................._..,,......, ._.. $ OAO - -~_nt Due - No Payment Requircd ................................................................. $ 0,00 Current Bfll Informati on - UGt Utility Customer Charge.. .... CommodityChar a ~~~•~.."""""°" Distribution Cha g (6 CCF at $0.74667) ~,~•~~~~~~""""' r 8.55 (eirst 6 CCF of $0.45167)•~~~~~~~ PA State Tax Sur ahar 4.48 g PA Sales Tax '""" .• .. 2.71 Total Current Char ~ es ........... " .........° y •°......_........ UGI ty ..,..,•.•.........•,..-... -_, ~~ ~ Ufili ~~~ ' °° Budget Billing Amount '~~" -0.05 ~ 0.95 .••. . UGI Ut,li ty charges awed ~~•~"~"""""""""• this bill """""""" ~ 10.00 Total Amo ......................_......... unt Due, Please Pa ".......° ....................-.. Y by Due Date (07/21/2011 ................. c ~'~~ ~\~ Meter Information -Next Read Date July 28, 2011 Meter Number Previous Readin 1204453 g Present Reading 2595 (remote) CCF Used 2601 (remote} Messages from UGI 6 • Your current price to compare is S n »v,,~ ,....~ 4.88 i Past Bill Information -UGI Utility The account balance on our I Payments ........ y ast bill was .....,.....•.•._, $ _5.17 Your balan .......................... ..CUStp ce as of O6/30/20t1 ~~~~~~~~~-°"""""°°°°°•••• mer NUnlbrr ...................................._"~•-1~- 218187745002 ~~ ~~ ens see vice Billing Summarryy for Service ta: DOROTHY T KLAIBER 11 ELMHURST RD CAMP HILL PA 17011 mate Classification: Residential Heating trilling Perioa: :!3129; 2011 to 04; 27/zt+~i ; 30 mays; Remote Device Read y'WbbNVllbf :;alt 8UU-276-2i 2~ Or YY`(ilc ~0 U~l di PO BOX 13009 Reading, PA 19612-30139 "'/our current UGI charges include State ±axes totaling abcut W 1.86. ~ 0000886 ~ ~ , cas sEev;ce Billlllg Summary for Service to: DOROTHY T KLAIBER 11 ELMHURST RD CAMP HILL PA 17011 Rate Classification: Residential Heating Billing Period: 01!26/2011 to 02/28/2011 (33 days) Remote Device Read Questions2 Call 800-276-2722 or write to UGi at PO BOX 13009 Reading, PA 19612-3009 'Yourcurrent UGI charges include State taxes totaling about $ 7.31. Past Bill Information -UGI Utili~ u.. .. , ,, ...~.. The account balance on your last ill was ................. $ 66.58 CuSt®R1A>~~,{„~e~ __ „ .. aymen s ............._.............................._.............._......__.... 0.00 h Late Charge ................_...................................................... 0.83 218187745002 Your balance as of 05/02/2011 (due now) ................ ~~ %urrent mitt information - uui ur~~Mty Customer Charge ............................................................... 8.55 ~Sriuirudity %haiye (i u %%~ ai pu. i i i u~1 ............... 1',1 ? Distribution Charges (First 10 CCF at $0.~~?DL) .... 4.4? PA SW,te .ax our~har^a ^ ^^ y -u.u>y ^A Sales Tax . ........... ....................'.........................,.... ,..., ^'n. .. nr Budget Billing Amount ................................................ 20,00 "~!' GI Utility charges owed this bill ..................................................................................... $ 87.41 Iota! Amount Due, P;sase Pay by ..aa 5;23;21;) $87.x1 Past Bill Information -UGI Utility ! !,~~~,~,~,P1, The account balance on your last bill was ................ $ 46.00 .' ,°~,"°~ Thank you for your payment of ..................................... -46.00 '~ i Your balance as of 03/02/2011 ...................................~"b~ 218187745002 Current Bill Information - UGi Utility Customer Charge ........................................._................... 8.55 Commodity Charge (62 CCF at $0.71694) .............. 44.45 Distribution Charges (First 50 CCF at $0.43960) ... 21.98 Distribution Charges (Next 12 CCF at $0.37500) .... 4.50 PA State Tax Surcharge ..............._................................. -0.30 PA Sales Tax ...................................................................... 4.76 Total Current Charges -UGI Utility ......_ .............._....... 83.94 Budget Billing Amount .................................................... 46.00 UGI Utility charges owed this bill .................................... ........_.................................... $ 46.00 Total Amount Due, Please Pay by Due Date (03/23/2011) ..................................... $ 46.00 `~1~ L h 10 Average CCF Per Day 79 48 17 0. FMAMJJASONDJ F 2010 Months 2011 Last This Average Year Year CCF/day 2.43 1.68 Daily temperature 29°F 32°F Meter Information -Next Read Date March 29, 2011 Meter Number Previous Reading Present Reading CCF Used 1204453 2497 (remote) 2559 (remote) 62 Messages from UGI ^Your current price to compare is $ 0.73453 /CCF. ^Yourtotal annual usage is 266 CCF. Youraverage monthly usage is 22 CCF. 'Your annual budget year began with September 2010. To date you have been billed $ 394.00 To date you have used $ 324.08 • Help prevent pipeline damage, accidents and service disruptions. Call 611 before you dig. ^Sign up to view and pay your future UGI bills online at www.ugi.com. If you pay at a payment agent please take your entire bill. Make check payable to UGI. Keep this part for your records. Important information is on the back of this bill. ~ ~ ~' ' , .. ~`.L~'~. ~ ~ Page 3 . f ;.~:_ ~ ~ _ _ Y«nr:~l3 ,Accavu.I3umbrar PPL Electric .; :'' 53300 73003 Utilities ~' TM - Ixsc-c~~~ ~IFzarta 3i ~'~'~~~~~~ Tota! from Last isi Moir. ~s' ~er'~C~ Pt~yrstent Receivn~l Jrrl 77 - ~'3+r~*+k Vn_.sl ion ~.~ /•J•.n~r7r7~ r~r r?rr+ ~il~lil~- ~L~1Li~li~ cR„ ~ .. r T ,.~,.~~~.. lp~. E'lec$ric Utilities ~~°~' ` = ,, ~ 53300 73003 ~ 1 i 1'i~eCtlK°1C Totatfrom Last Bill xzl~2.sZ C~.! E•rV1Ce Payment Received Aug 18 -Thank You! ~I02.52 For: Billing Details DOROTHY T IiLAI~E.R i I Er~I-IUItsT RD Balance as of Sep 13, 2!111 $0.00 C?.M~' HILZ PP_ ? 70'. I _ Feral ~~ Current Charges PPL Electric Utili*ies Charges for -PPL Electric Utilities Residential Rate: RS for Aug 12 -Sep 1~ Customer Service Distribution Charge: R27 Hausman Rd. Customer Charge 8.73 Allentown, PA 18104-9392 491 KWH at 3.32300000¢ er KWH °• PA Tax Adj Surcharge at - .27600000 ~° 16.32 -0.07 1-800-342-5775 (1-800-DIAL-PPL) Transmission Chargge: 491 KWH at 0.T200000¢ per KWH 3.69 www.pplelectric.com pA Tax Ad`1' Surcharge at -0.28600000% C -0.01 hargge: Generation d Energy Ca achy an ~91 KWH at 7.89912400¢ per KWH 38.79 PA Tax Adj Surcharge at -0.28600000% -0.11 Total PPL Electric Utilities Charges $67.36 Account Balance $67.36 General Generation prices and charges are set by the electric generation supplier you have chosen. The Fabric Utility Commission re ~ ates distribution Information pprices and services. The Federal Energy Regulatory~ommtssion regulates transmission prices and services. PPL Electric Utilities uses about $0.08 of this bill to ppay state taxes. In addition, about $3.97 of this bill pays the PA Gross Kecelpts Tax. For your convenience, you can now pay your bill using your Visa, MasterCard, Discover, or ATM Card Call BillMatrix at 1-800-672-2413. Bi1lMatriz will charge your credit and ATM card 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. PPL Electric Utilities R`~~CIR~~'~fl; C4 iY~~ Y'4l (~ i IJ'V 11 1 l~ L Fer: ... ~...,~ir~.~ ~r . ...-,.__,_ i 1 ELNLHURST RD CAP~iP HILL PA 170 L1 PPL Electric Utllitie5 Electric Service Tor: DOROTHY "r ~T.ATRER 1 I ELMHLTRST RD r_nivzP x1I,L PA ~ ~o> Questions about this bill? Please ~~ PPL Electric Utilities Electric Service For: DOROTHY T KLAIBER 1 I ELMHURST RD CAMP HILL PA 17011 Questions about this bill? Please contact us by Ma 4 at 1-800-342-5775 (1-800-DIAL-PPL) or write to: Customer Service 827 Hausman Rd. Allentown, PA 18104-9392 www.pplelectric.com tide, ~e u~3 t.~ti~„~ao~ ~>- Page 1 .' YaurBl A,ccnuritNurnEur; ~~., pp ~m=~ `®¢° 53300 73003 ~, n :.. F ..:.. ..::. .. _. ~: ~+'gv,~_ CA. G.8117I1 ~42L'Y1Yt~lii ~'~....:...:~ vwrmm~r~,~ ~~~sa Balance as of bets I l.; 2aii ~ ~~,n,,~ ; ~'ll~r~?e'5- _ _ il.°!tY i i L i.Yi:LL.S~, ~~'L55±L±L~ ~.ly(gA~7y,~t Yy~,l3.v_, ~~9ta1 Cl~ar~~s ~5a.~~ y L X ,' Page 1 '~ . ~ v ~ .. _ ~e ~_ - p :-~<TU£ }31?~_~u't1lYLId: 1~d34YYbk.I ::. 53300-73003 rt:~ ~; Summary Page L.'Si y.~nc,W ~s of i~v~:3i ~~, 291. ya'sl(,~11 FA~ Char es: TotaJgPPL Electric Utilities Charges $44.6 Total Charges $44.65 :. ~>~s ~~~#.1~}ei:~,at~er t~a>~ .fit .~ ;?~T1 : ~: Account Balance $4x.65 Page 1 pp~ Summary Page Balance as of Apr 13, 2011 :;Yaut~ B~i1 ~b~r. F,,,,, 53300 730031, :::.:....:::l.=.[~.CYO'~E?~~I}~S6`C)F~!F~Lt~''`:'::::: -:~:~ $0.00 Charges: Total-YPL Electric Utilities Charges $30.33 Total Charges $30.33 . ~m~ r~flto~~~ Z~v L~~ter; aa, lea w ~r ~ ~ ... Account Balance $30.33 T` ~nn4's•in ~>~~„~ _ ,., Meter Reading Information i;i ~ sau a '~,~,.®°4°,,'d Page 1 ' PPL Electri e -- ®_ ~A~ .. :=i Yetur.:Bili~ectiiiu~~iiimtiorr .: c LIt111t1e5 -~ ® °' ~, ` 53300-73003 • ectric ~u~,a,.4,1'age `~ ~~i3~~~~ wu :~i i`lr~.. i 2 '7947 7 .. y .r, .rare s LL'64 /F.i4 J>•V.~IMV ~'or: Cllar~~s: DOROTHYTK~4TBFg T t T7 ~ T7i'1= i_ ~,~., „ 1 1 N 1 1\il ~ [u \~( Ik 1 1 - - CAMP HILL PA 17011 Total CllaraQS ~~3.0~ ..~~5.`~, .~i~3~E~~.'6'J ~af~ ~]f4~~:'~aia+4 ..:~~ '~fAl 1.:: .: _.. . y..r„r i':;w A ~-~nI?nt R,ala, ,nrP mc~ n< Questions about INJJ. VV this bill? Please contact us by Jun 3 at1-500-342-5775 ~ (1-800-DIAL-PPL) ar write to: ~r, aa1 ~ ~ ~' CllStomer Service ~~ - Page 3 ~~~. Elsctr~ic ~ =-- ~- ..53300 73003 ~ltilitie~ '~ ~ . :L~~ rrli~ti ~al~t~ ar~~~~r~ E 1CCtrlic Total f rom Last ~3¢~ ¢~~ ~ 5bR s1 Service payment Received a~ Z7 - Th~c~z!s voss! For: Billi>!1g De~a~s DOROTHY T KLAIBER 11 ELMHLJRST RD Ralanre ac of Nnv 11.2010 ~0'UU CAMP HILL PA 17~ Page 1 Ye~uc Bail _r5~catani h~iiit~,lier P ~. Electric ~ ~~ 53300 73003 ... TM Utvl~tles _~~ ~~-~~ Electric Summary Page SerVlce Balance as of Dec 13, 2010. $50.59 For: DOROTHY T KLAIBER Char es: Tota~PL Electric Utilities Charges $27.78 11 ELMFILTRST R.D CAMP HII.L PA 17011 Total Charges $78 37 :: .. . Account Balance $78.37 Questions about this bill? Please contact us by Jan 3 at 1-800-34Z-5775 (1-800-DIAL-PPL) or write to: ~~ Customer Service 827 Hausman Rd. Allentown, PA 18104-4392 www.pplelectric.com 6 ~/ Iwn ~n~~r SOLD TO SHIPPED TO VIA f"n r ~ ~ `~' ~C ~,~ ~ ~c~ h ~ADDftESS iADDRESS _ I ~~: ~',o~ l~%'~ I iCITY, STATE, ZIP - - .r c ~CiT , TATti, Z1P ., ~_ ~-' , - ,, .,, t c-n _ . ~ .ro i (.~ nrrj nA~ ~ ~._. I~Trr,F (~ _~ - _.__--_-- -- -LL- ---- -- I Cn O _.- i r-r ATC ... I _ - - -- ---- ~ i . , r.. ----~ , ._. _ ._ _..____,.- { d .. ___._ .. _ ...._.._. ._ _ ~ ~ I ' i N _ __ .-..__ _. ._...r ~ i ~ 1 I~ ~ ~ - - ~,-a ~ ~ y ~ ,~ ~ ~^ I ~, ~ I ~ r ~ J ' a I ~ , IlvvolcE No. _~~a.~ ,7~rC p C ~~~~~~~ SOLO TC? ~ ~ ~ I SHIPPED 70 VIA ~AUDRESS I (ADDRESS ~ .°Y ~ a ~~ ~ ~ f v ~~v; STATE, ~fP ClTY, STATE, Z!P l~j t~ Ji' ~°~ i ? ~ ~ $CUSTOMER'S ORDER 1 SALESPERSON ITERNiS ! FO:& KATE J c ..~ ; v /~_ (~ / INVOICE NO. - ,sue ~ w ~ ae, ~ I C...- .~---. ~. ~ .--' ~~ ~~~ ~N® SOLD TO ~ ~2 ~ ~ \~~ ~~ ~~ SHIPPED TO Q ~ i~.~k~ VIA ADDRESS ADDRESS ~G ~ lam` CITY, STATE, ZIP CITY, STATE, ZIP /I,w~ ,, CUSTOMER'S ORDER SALESPERSON TER<v1S F.O.B. DATE kNVCiQE NCS, !~' ~~`~~[~~ il~VOIL'~ NF~t. ~ . ~'x ~ -`" N '~ ,.. ., .,~ ~°. SE.~ F lZ r, ~._.,. ~.,e..~,....~ ~..~~....~. __ _ l ,. F"!i'F'~J lIJ~ , ,f r ! ! ~I~ 4 ! ~1 ~ d " ~~G6T' ; ., lro c~, ,`E(-` - ~__ ~ i18 u Y, 4 ~.`3,e _. -': ~' ~ ~ r i ._ l_:` .. ~ ~ ~ f_._~_.~.~, p~ ! ._ ! ~ E i g tl ~~ ..J y _ , _.__-,_. ~~ ~ i ~~i L . _.._ ~ i! ~ i _ ._- ____. ..~.. --~ ~ Y -- ~~ (_ ~~~- PNVG°°t.^.E ilQ. , ~~~~Q I~~~~C~ St7l.Q TO ~S~a{ ~ P~ rS K1t~be~ ep..lY~pcu TO VIA A~QL'RLSS _ ~DC~E3S p V- U ~a~ I 0 ~vlTY, ST~iT~, cP~ vi1; STi~TE, ZI? GL'ST A ' ~ W C (~/~ (.?a~0 " - Qi,~cR ~ _ ^tn- SA~~S: ~~SL l~} at ?rUIS FO:B. ~~iATr= ~ ~ ~ .,...._..~ ~ ~ t ~ //~ e iMew ,,n S ~~~~e~\~ ~~'~r~~i a.t~LU 'v `` SH;P?f~D Tte ~ ~ + ~ ~'y ~.-. Cf"^! STATE, ~:P _ ~.~~ lw.=" ! Si':if E, GaH' ~ ~ ~ !f ~~ ~ ~ ~ -,e.~....e-. ,.~.~...~..~.. .. - i ... ~ - i ;~ ~~ i L - -- .~ti ~,,.,e,~,__.. y-----.. ._.. _ _ ~r t tX t ( f f~ ~ ~" C ~ i- ~ 5 \~ y n i .1, c. ~ c'~- i' ~ r'1 ~a ~ tld .~ d t ~ ~ ivy' ~ ~L ~ t--I ._.._______ _ ~ ~ T-- .~._ INVOICE NO. ~~~ ~ ~~ ~~~10~~.p ~ .~ &~ E SOLD TO ~~ ` ~`1 ~ i~i~~-~' SHIPPED TO ~ ~ ~ ~ [/' ~ ~ VIA ADDRESS ADDRESS CITY, STATE, ZIP CITY, STATE, ZIP t` ~"~ I ~ G 'j C CUSTOMER'S ORDER SALESPEgSON'' TERMS F.O.B; DATE ~ "`~ ~ '~ ~ ~' 1 ~ Z ~"' Z U~ ~? Erie ~\ Insurance 100 Erie Ins. Place • Erie, PA 16530 NpTICE QF ?4YI4!IE!R~T DI.~E FAlSILY AUTO POLICY NUMBER AGENT NUMBER • ` fili / 3 / J i j DOROTHY T KLAIBER C%O DON- KLAIBER ~ 312 BLACKSMITH RD ~ CAMP HILL PA 17011-S4Z1 P~LFQ~' TI~~;~A~Tl41tTS. 07-12-10 PREMIUM $ 619.00 CURRENT BALANCE $ 619.00 BILLE!riG QATE vv^7-2 i - i G J P WOLFE INSUR TNC 717-7Z7_/,ova PAST DUE AMT MUST BE RECEIVED WITHIN 15 DAYS TO RETAI~J PLAPJ A DISCG'UNT & AVQID LATE FEES #I~T~'ILIVIE~t~`5 NDNE r' ! ! / 1 /' ,/~ I ~r _ i P~ Y; l ., ~-, r~ ~`~ ~ ;'~ ~ r ,/ ,. ~/ r i t, ~.r s -: i i i:! .. r..i - . i ~t s^"~ I ~, ~: .r.. TRANSACTIONS OCCURRING IN THE LAST 10 DAYS MAY NOT APPEAR ON THIS STATEMENT. ~ TF TH~2E IS AN ERP.OR, PLEASE CONTACT YOUR AGE^!T OR THE HOME OFFICE. 06936 RETURNED PAYMENT FEES WILL BE ADDED TO VDUR ACCOUNT. I KEEP THIS PORTION FOR YOUR RECORDS BLGRP Erie ,~ ERIE~„I-N'~r~ic@ivc~..x.~-cnt~ -~OMEPROTECTOR POLICY ~~%~ i~lij Group Ce AMENDED DECLARATIONS O 1 * EFFECTIVE 08/05/10 ATTACH ~ * EXT OVER ,~' THIS TO YOUR \\ 100 Erie Ins. PI. Erie. PA 16530 i,. REASON FOo HAIFr;i~i•~F_fiTv-.iS'g' - 3~NiENiu'ED ADDRESS &/OR LOC OF PROPERTY AGENT ITE~tlI 2. EGi~iVY rcRti~v FC~~CI' "J!)PJ~BE° ~'il~l ~ .7 ~ .7 .,.~.,,-. .*rr- ll r W V L l.' L 1 1. i.Y V i • ~ a r. ~. nain~i~ri mr) i~rsiii5iii Goo uJULV7J ri ~> - - ~ - - ~ __ ~ _ I ~~\ \ ~`. DOROTHY T KLA I BER ~•. d ' ~ '~ ' ` ~ „ 312 BLACKSMITH RD ~ ~ ~`R ~~ ,.~,r ~ ~~;' ~, ~ CAMP HILL PA 17011-8421 ~~`` ~ ~ ~I p ~~\.•. ~,~, ' ~ `~" ~~ ~, jy ~, i`~ t AGENT - 3 P WOLFE INSUR INC AGENT PHONE - (717) 737-4981 23 WEST MAIN STREET SITYREMANSTOWN PA 17011 6327 COVERAGE BEGINS AND ENDS AT 12.01 AM STANDARD TIME AT THE LOCATION OF THE INSURED PROPERTY. UNTIL TERMINATED, THIS POLICY WILL CONTINUE IN FORCE. LOCATION OF RESIDENCE PREMISES IF OTHER THAN STATED IN ITEM 1 OR IF SPECIFIC DESIGNATION I S NEEDED . Z I P COI;E - i 7 011 LALLIIv* T6~'P , CU1~BF CQ 11 ELMHURST RD CAMP HILL. PROPERTY INFORMATION - PRIMARY RESIDENCE, YEAR OF CONSTRUCTION 1950, MASONRY, PROTECTION CLASS B. PROPERTY IS WITHIN 1000 FEET OF A FIRE HYDRANT AND WITHIN 5 MILI+;S vF A RESPONDING FIRE DEPARTMENT. COVERAGE IS PROVIDED ONLY IF A SPECIFIC AMOUNT OF INSURANCE IS SHOWN. SECTION I - PROPERTY PROTECTION AMOUNT .OF INSURANCE DWELLING $ 175,500 ~''`, OTHER STRUCTURES $ 17,550 ~ PERSONAL PROPERTY $ 112,125 LOSS OF USE LOSS SUSTAINED NOT TO EXCEED 12 CONSECUTIVE MONTHS SECTION II - HOME AND FAMILY LIABILITY PROTECTION • PERSONAL LIABILITY - EACH OCCURRENCE $ 300,000 / ~~ MEDICAL PAYMENTS TO OTHERS - EACH PERSON $ 1,000 i/ NO DIFFERENCE IN PREMIUM DUE TO THE CHANGE $ .00 SECTION I DEDUCTIBLE $ 500. AUTOMATIC NO-DEPRECIATION SETTLEMENT APPLIES TO DWELLING AND OTHER STRUCTURES. APPLICABLE FORMS - 2003 02/01, HP-PA 09/0$, HP-FN 02/03, UF2106* 04/08, UF2743* O1/10, HP-AAN 01/97, HP-BD 02/01. NO BUSINESS PURSUITS ARE CONDUCTED AT THE PREfhIISES, EXI,C.Px el5 CVL+LU^~J " ADDITIONAL COVERAGES YOUR PREMIUM RE~°LEC'TS SAVixti'+GS iuE iv^ n i~iCia;~i :.:::%~"i•":.-~..•E PREMISES ALARM SYSTEM - TYPE 2 REPLACEM.P.Ai'a• COST SETTL.E?+fENT -- PERSONAL- PROPERTY AUTO/HOME MULTI POLICY DISCOUNT APPLIES ncm aF (17/OS/10 Erie L.. y ..a i 1. n.I V LEAN ~„r V LILa V..a •.. V L T Insurance \11~~--~~,,F,~,A~~M~~I ~~LY AUTO POLICY `" ~ Group CONTINUATION NOTICE ?.~ L.:~"' ~.~,i) ~`~~ \\ 100 Erie Ins. PI. Erie, PA 16530 f.'rq ~` /" / ~ t,r_PR~- ,i' IT~~A ~ pt t(_1~:Y PFRI(~i_~' PpLIGY fVU.MBPR '~ ~ - / J % 1 ~ - ~'• - - _1~_~ !~ - / /~ .ter / ~.~. /1 I'y rs / 1 n / l l.. I"~ /~ ^I 1 ~1 /1 /1 ^/ c / / J V ~ V~I~r.r ~i 11W `'I_V `~`v' f 11 // 1 ~; !1 11 1 / DOP.OTHv T ur,Ar $Ep 11 ELMHURST RD CAMP HILL PA 17011-6013 AGENT - J P WOLFE INSUR INC 23 WEST MAIN STREET ***** AGENT PHONE - (717) 737-4981 SHIREMANSTOWN PA 17011 6327 ************************************************************ * CONGRATULATIONS! A PIONEER EXPERIENCE RATING CREDIT HAS * BEEN APPLIED TO YOUR POLICY PREMIUM. ************************************************************ !'~JldR C~LLISI~f~~ CvV~R~~~ 1~rD ~~~UCTIBL~ 4PPL~/ TV PRIV~T~ P~lSSFN~FR ~ ~ a4UTU5 Yc~E3 UR A R~SIvCtvi RCLATIVC RcivT r~R ~~ D~i~Sv'R LFSS. THIS IS ~ SUB.IFCT Tv LIMITS, TERMS ANU CUA~t)ITIVI~S IN THE P~JLICy. ITEM 4. ALTTOS COVFPED A[iTQ Y_R. MAKE ViN ST TER PHY LIOTCMCL RATINGCLASS DDP 1 96 BUIC CENTURY SP 1G4AG55M7T6476591 PA 4D 7 0912 ALAS F590 ITEM 5. INSURANCE IS PROVIDED WHERE A PREMIUM OR INCL, IS SHOWN FOR THE COVERAGE COVERAGES; LIMITS AND ANNUAL PREMIUMS ARE AS FOLLOWS- M EQUALS THOUSAND $ #1 *****GOOD DRIVER RATES APPLY***** - THE FULL TORT OPTION APPLIES TO ALL PRIVATE PASSENGER VEHICLES. --- LIABILITY PROTECTION- PROPERTYNDAMAG~2$~OOM/ACON $500M/ACC 199 FIRST PARTY BENEFImS- MEDICAL EXPENSE $100M 114 ACCIDENTAL DEATH $$5M 2 FUNERAL BENEFIT $2.5M 2 EXTRAORDINARY MEDICAL BENEFITS $1000M 30 UNINSURED MOTORISTS COVERAGE- ~, BOD INJ 250M/PERSON $500M/ACC-UNSTACKED 17 UNDERINSURED MOTORISTS COVER GE- BOD INJ g250M/PERSON 500MA/ACC-UNSTACKED 91 ~~ PHYSICAL DAMAGE COVERAG~S- COMPREHENSIVE - $100 DED 33 COLLISION - $250 DED 110 .1.-n - - •-- - ..,... ~~. r, .., ,.. .. E'1U°1'11 0 L ANNUAL POLICY PREMIUM^ $ 619 ITEM 6. APPLICABL ORSEMENTS EXCEPTIONS TO DECLARATIONS ITEMS ALL AUTOS - FAP 03/07, AF~FO1 03/07, AF~A03 10/08. nr,Tmn i - nFnrlnl n~in7, ANTI-THEFT DISCOUNT APPLIES-PASSIVE DISAB AUTO 1 AUTO HOME MULTI POLICY DISCOUNT APPLIES PASS VE RESTRAINT DISCOUNT APPLIES - SINGLE AIRBAG AUTO 1 ANTI-LOCK BRAKE DISCOUNT APPLIED AUTO 1 PAY PLAN DISCOUNT APPLIES 02025611 ~ YD WFS 06/12/10 Erie ' PERSONAL CATASTROPHE POLIC ~ j ~ Insurance Group I~ RENEWAL CERTIFICATE \\ 100 Erie Ins. PI. Erie, PA 16530 I _-_ AGENT. ' '!TEM-2• POLICY PERIQD POLICY NUMBER I li7i/3/3 V L~_ WQLF~ 1IrSLF aiv~, a.~j ,.j yr ~.. ~.../ ?~j t. x;35 1.51+~~~ k''a _ _ b -ITEM t. NAMED ft~SURED At~D ADDRESS ITEM 3. OTHER (h;TEREST~ DOROTH i~ T KLA I BErc `~ C/O DON KLAIBER 312 BLACKSMITH RD '~ CAMP HILL PA 17011-8421 i AGENT - J P WOLFE INSUR INC 23 WEST MAIN STREET ***** AGENT PHONE - (717) 737-4981 SHIREMANSTOWN PA 17011 POLICY PERIOD BEGINS AND ENDS AT 12.01 AM STANDARD TIME AT THE ADDRESS OF THE NAMED INSURED. THIS INSURANCE APPLIES TO THE COVERAGES FOR WHICH A LIMIT IS SHOWN. THIS INSURANCE IS SUBJECT TO THE TERMS OF THE POLICY AND ITS FORMS. COVERAGE AI3Y~ L I Wi I TS _ ------------------- 1 ~`'; h PERSONAL CATASTROPHE LIABILITY COVERAGE ~\ ~'- ~~~ I ~.:' ~ L I M I T OF L I AB Y L I TY $1, 0 0 0, 0 0 0. EACH OCCURRENCE ~,~ ~if `;~~` ~,~~, SELF-INSURED RETENTICyIS $ NONE. EACH OCCURRENCE .~ ~~ MAINTENANCE OF UNDERLYING INSURANCE - SUBJECT TO THE MAINTENANCE OF UNDERLYING INSURANCE CONDITION, YOU AGREE THE UNDERLYING LIMITS OF INSURANCE SHOWN ON THE DECLARATIONS AND/OR AMENDED DECLARATIONS, WHICH IS PART OF THIS POLICY, ARE IN FORCE AT INCEPTION OF THIS POLICY AND WILL BE MAINTAINED AS LONG P.S PERSONAL CATASTROPHE LIABILITY COVERAGE IS PROVIDED. UF6415* 05/95*, UF4810* 03/08*, PCAT-61 06/09, PCAT13 07/91, PCAT14 07 1. ~ ~ ~ ~` FULL• TER*I PREMIUM FOR TH I S POLICY - - - - - - - - - - - ~ $111.0 0 1 l+ f, FORMS AND ENDORSEMENTS- PCL 09/98, PCAT-27 03/95, UF2106* 04/08*, PCAT57 3, SEE REVERSE SIDE WFS 10/02/10 n v f ~ /~~ *` ~ r, k !s ~ ~ /. rj f rI;HAKI~iG~ rRi~iC n PO BOX 149 NEW CUMBERLAND, PA 17070 PHONE 774-1449 OR 215-6885 fasickmaintenance@comcast.net Invoice Submitted To: Realty Services Group, Inc. 422 Bridge Street Ne~v Cumberland, PA 17070 Attn: Donald Klaiber ~~ ~.~ ~:~. 1 Date Dec ~, 2Oi0 Invoice is submitted for Don's Mom (clean out spouting] Sew y~iee C :11 ~ Tabor $30,00 Painting ~ Parts ~ CleanIlnb Shampoo Carpets ~ Pay~;~er~t due when ,fob is eomplete. Thank You, Charles Fasick Total $30.00 ,c~~ .w } si: ~ INVOICE FOR SALE OR SERVICES RENDERED Date:117-19-11 Sold to, or performed at; Riil ~"a; 11 Elmhurst Rrl. '`lion ~i'ZafLer Camp Hill Pa X717-856-7530 ~° 717- 774-3404' ~i 1 ~. ~~~ n ..:.. __ . m ..,.,. n ~ , , J~ LeJ'L'ri~luvrr. i rcri~ (~ic r~reed ~ j~~~ ~~ I "~ ~~ Trim Bushes around house. ~~eed all beds.• ~I/fow Lawn. Edge all walks & driveway Total Cost; $260.00 Total p~~naent is due within 30 dcrvs of invoice date. 1.3 ~b yrrorzthly if~teyest otz all balances over 30 days, Arry costs incurred in collecting unpaid balances including, but not limited to; attorney, fee 's, court costs, and lost wages will be charged. Cash or checks payable to: Joe Swartzell o ~ r ;,. a,~ ~..;..,. r~,.., u` ~.ireuu ~~ivc ~v.n...v Mechanicsburg, PA 17(ISU Cell 717-802-6543 Fax 117-697-7512 PQ T irvf~ cn # P,4 (171723 F-mail jswartzell~omcast. nei °o y~l ~ ~~~ ~ 1 KV ~6~^ ~G y~ BAN K ~sf 9 X04, O rd~s ~f~~? Ar ~ ~. 06~~~~ O Q^ 7. t?~ ~G ~~ ~~ lSTA7E OF DOROTiiYTIMIBER n-tom ~'~' ~+.o,...~... •.145 ' 7ta RAplAOtN ItD ---1/ n f CA171fILM n70i1 ~ rte= / / ' /,!/~ ' ~~~ETRO 1:0313038461: 28 3 2 53 2 29 Sw Oi45 #145 20110822 $100.00 lRTATE OF 00110THTTIMIUIER "tt•w ~ ~ ~ .. - .. 147 s1:elAaawmlw ~~ ~~=J~ GYPNLL.M f7w1 ~A _ I / ^' `! wl~' n7 tune - /` -~ _.. ... _.I $ GR 8 ~. ^`~~NO -. _. 403130 846. 28 3 25 3 2 29 Sr 0147 -.... .. ... #147 20110804 $159.00 esrAreaaooeoTenTlo.AmeR ,1-lom,>..4m...., ~~~ _,,,-,z 150 ma elAr+aluln m CI1110I011.,M /7011 .y ~ i rlW'ii Lea-( -1~-4C6 y Z ~'~ oae~.n ~ •~.w- j~ ETRO ~ - BANK 40 3 1 30 184 5+: 283253229 Sr O15^ ~'00000 10 2 5 2,f #150 2832532295 20110822 $102.52 lSTAre OF DOROTRYTq.A1U1lR tt•le ats IrACaswtn IU1 146 CA1r FULL PA 17071 ~~ Mµ111 u omwa. $ ~ ~ ~/ ~ ~ n~ }} E Yt0 JVtl ANK 4031301846. 283253229 5w ^145 #146 20110809 $200.00 lBTAT! OF DOROTNYT IO.AIYlaI it-w fne lAAdtWfMao 148 . GVYPHI~ M 17011 . .. rnwn / limn p ~ Nd olws O ~- + E -aBANK ~~ ~~ Sc...~.r7G,..~ 1:0313018461: 283253229 5r 0148 #148 20110808 $38.38 E6TATH OF OOROTNTTIO,AIOBI tf•lo - 161 srr!tlLAaa1rt11w CA1P16LMifU11 +/' ~ Wyly bT 1011! ~/~~•/ omeea l~G __~____ I $ .~0." '~/ETRO ~,~,j 00IIf3 c ~4o6sIS2b4 BANK -; 1:0313038461: 283253224 Sr OLSi F000000201i1- #151 20110822 $20.11 Page 3 of 4 92740 ROLL 07/11