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HomeMy WebLinkAbout05-08-121505610148 REV-1500 EX(°'.'°' OFFICIAL USE ONLY PA Department d Revenue County Coda Year File Number sureau orlndiNdual raxea INHERITANCE TAX RETURN 21 11 1333 PO BOX 260601 Harrisburg, PA 17126-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social SBCUrIIy NUmber Dale Oi Death MMDDYYVI' Dale Of Binh MMDDVWI' 193-12-9209 11162011 09251923 Decedent's Last Name Suffix Decedent's First Name M I TEZAK, JR FRANK J (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW ® 1. Original Return ^ 2. Supplemental Retum ~ 3. Remaintler Return (date of death prior to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Return Required death after 12-12-82) ® 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust ~ 6. Total Number of Sate Deposit Boxes (Attach Copy of WIII) (Attach Copy oT Trust) ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date of death ^ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECf10N MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number CRAIG A• HATCH, ESQ• 717-731-9600 First line of address 1013 MOMMA ROAD Second line of address SUITE 100 City or Post Office LEMOYNE Slate ZIP Code PA 17043 REGISTER OF WILLS USE gN4V ~::o ~ CJ r-3 - P 7• rt ` ~ `'' rn I ~- ~ co v~ .~, , r,J correapondant'se-magaddresa: C•HATCHaGATESLAWFIRM•COM Under penalties of perjury, I declare that I have examined this return, inGuding accompenyin9 schedules end statements, and to the beat d my knovAedpe end belief, it is true, correct and complete. Declaration of preperer other than Ne pereonel representative is based on all information of which proparer has any knowledge. O 8 A ENOLA, 10~ MOMMA ROAD, SUITE 100 LEMOYNE, PA 17043 PLEASE USE ORIGINAL FORM ONLY Side 7 1505610148 sfnasa~a.ooo 1505610148 J T~ _~ -~ _-_~ _~-~ ,~i'~j 1505610248 REV-1500 EX Decedent's Social Security Number 193-12-9209 oecedanrs Ham TEZAK JR FRANK d RECAPITULATION 1. Real Estate(ScheduieA)•••••••••••••••••••••••••••• 1. 155,965.03 2. Stocks antl Bonds (Schedule B) ..... ...... 2. 4 , 311.9 7 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3. Q • Q Q 4. Mortgages and Notes Receivable (Schedule D) 4. Q • Q Q 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5. Q • Q Q 6. Jointly Owned Property (Schedule F) ~ separate Billing Requested 5. 23, 884 • 90 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested .... 7. Q • Q Q 8. Total Gross Assets (total Lines 1 through 7) ........... g, 184 ,161.90 9. Funeral Expenses and Administrative Costs (Schedule H) , ,g. 2 Q , 9 7 4 •09 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ip, 952 • 26 11. Total Deductbns (total Lines 9 and 10) , ....... 11. 21, 9 2 6.3 5 12. Net Value of Estate (Line 8 minus Line 11) . 12. 162 , 235.55 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to lax has not been made (Schedule J) , .. 13. Q • Q Q 14. Net Value Subjeet to Tax (Line 12 minus Line 13) . 14. 16 2 , 2 3 5.5 5 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the Spousal tax fate, or transfers under Sec. 9116 (a)(1.2)X.0- Q•QQ 15. Q•QQ 16. Amount of Line 14 gable 4 S 60 300 at linealrateX.0 - 162,235.55 ts. 7, . 17. Amount of Line 14 taxable at sibling rateX.12 Q.i]Q 17. Q'QQ 18. Amount of Line 14 taxable 1 Q Q Q al collateral rate X . 5 Q. Q Q 18. ' 19. TAX DUE .. .... 19. 7,300.60 x^ 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15Q5610248 1505610248 ernasae a.ooo REV-1500 EX Page 3 ~wradanY.¢ Cmm~le}a Address: Flb Number DECEDENTS NAME T K J FR NK SFREET ADDRESS Cf1Y 0 A STATE PA ZIP Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 7,3D0.60 2. Credits/Payments A. Prior Payments 7, DDD • DD a. Diswunt 36 5 • D 3 ' TotACradits(A+B) (z) 7,365•D3 3. Interest (3) D•aa 4. If line 2 is greater than Line 1 + line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) la 4 • 4 3 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a Vansfer antl: Yas fJo i h i ^ a, reta n t e use or ncome of the property transfened; b t i th i t d i h h l t ^ l y I . re a n e r ght o gnate w es o s a l use he property transferred or its Income; ..... u ~ c. retain a reversionary interest; or ................................. ^ ~ J, 1 d. receive the promise for life of either payments, benefits or care? ................ ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................... 3. Did decedent own an "in trust for" or payable-upon-death bank account or secudty at his or her death? 4. Did decetlent own an individual retirement account, annuity, or other non-probate property, which contains a beneficiary designation? ................................ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND Fa.E IT AS PART OF 7NE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) O]. Far tlates of death on or after Jan. 1, 1995, the tax rate imposetl on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse h~om tax, antl 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 Trom a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)j. • The tax rate imposed on the net value of transfers to or for the use of the decedent's Ilneal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9118(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1,3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood ar adoption. aM9871 Z.oOa REV-1502 EX t (01-10) Pennsylvania DEPPAIFEMOF REVENUE INHERITPNCE TAX RETURN RESIDEM DECEDEM SCHEDULE A REAL ESTATE FILE NUMBER: Frank J. Tezak, Jr 2111 1333 All real properly ownetl wlely or as a bneM In common must 6e reported at hlr market value. Fair market value is definetl ea the pace al which property would be exchanged between a willing buyer and a willing seller, neither bang compelletl to buy or sell, both having reasonable knoMedge Uth~ relevant hcta. Real properly that Is joiMlyowned wiN right of survivorehlp must De dlwlosed on SchsduN F. ewasas z.ooo It more space is needed, use adtlltialal sheets M paper M the same size. REV-1 W0 EX ~ (698) CAMMOMNEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP ORSOLE-PROPRIETORSHIP Frank J. Tezak. Jr ~ 21111333 Schetlule C-1 or C-2 (inUUtling all supporting information) must be attached for eam dosdy-hdd colporetion/pennership imerest Uthe decedent, IXher than a sole-proprietorship. See instruMions for the supporting iMOrmetian to be suhmitted for sdo-propdelarships. AEV-150] EX ~ (G98) SCHEDULE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE 7AX RETURN ~._,.~., .. ~... ESTATE OF FILE NUMBER Frank J. Tezak, Jr 21 11 1333 All properly )ointlyownetl whh right d aurvivonhip mwt lr d4cloaad on Schatlule F, s Wa6AC taco (If more space is neetled, inwn additional sheets d same aze) REV-1508 F!X+ ry 1-10) pennsylvania DEPPATA~ENr OF REVENUE INMERITPNCE TPX RETURN RESIDEM DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Frank J. Tezak, Jr 21111333 O WdaAD Y.00o I(more apace is needetl, use edddional sheets d paper d the same e¢e. REV-1509IXH (Ot-00) . pennsylvania SCHEDULE F DEPGRTMENT D£ REVIIIl1E INHERITANCE TAX RETURN JOINTLY-OW NED PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Frank J. Tezak. Jr 21111333 H an asset became )ohnly ownetl wIM(n one year of the decetlem's tlate of death, N moat ba reportetl an Schetlule G SlR/NNG,gM TBJAM(S) NAAFjS) AOOF~E6S RHATIONSHIPTO t]ELID[3Jf A Mahoney, Diane 605 Via Chris Court, Debary, FL 32713-5426 Daughter 8 Tezak, III, Frank J 8 Annette Drive, Enola, PA 17025 Son JOINTLY OWNED PROPERTY: RBA MRaEH~ IkTTER FCR JgNT TEN{NT tWTE MA[JE ,IOMI I7ESCRPIION OF PROP[iilY INLLULE NOFE6EIINNCML INSTITUIIGNNNO B/.HHNµWXlHM4EP Ui 81M1AR ,pENI1Fl'!M'iMLMY0./.iTALXpEEOfgiJpHILV HELRRE~L FBTPTE. ~ATE~~p'TM VALUE OF A$SE7 %OF OEC®ENfS N1Bi~T QATEI]F OEATFI VALI~()F DECH.BdI~S Wi6l6T 1 B 3/21/2011 Citizens Bank checking account number 6100710955 36,268.93 50.0000 18,134.47 2 BA 6/17/200 Members let Federal Credit Union Savings Account Number 265483-00 2,541.48 33.3300 847.16 3 BA 6/17/200 Members let Federal Credit Union checking account number 266483-11 14, 709. B1 33.3300 4,903.27 TOTAL (Also enter on Line 6, Recapitulation) 5 23 , 884.90 eweaAE z o0o M more space is needed, use additional sheets of paper of the same size. REV-1510 EX +(0a-09) pennsylvania DEPARTMENT l7f REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENr SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY Frank J. Tezak Jr 21 11 1333 This schedule must be completetl and filetl if the answer to any of questions 7 through 4 on page three of the REV-1500 is yes. ITEM NUMBE DESCRIPTION OF PROPERTY irrunEr~w.ueorr~raA~sn=nee r~ia aeuriorsnv ro oECeoEnrnw raoareorraw~aa n**ecMACCV+orr~oeEO FOna~ESrn*e DATE OF DEATH VALUE OF ASSET o /o OF DECD'S INTEREST EXCLUSION IFaawJG4BLE TAXABLE VALUE f None TOTAL (Also enter on line 7, Recapitulation) $ It more space is neetletl, use eddRlonal aheela of paper of the same eBe. 9W48AF ].000 REV-1511 EX+(1608) ' Pennsylvania OEPPAR+EM OF REVENUE INHERITANCE TN( RETURN RESIDENr DECEDENT ESTATE OF Decedent's debts must be reported on Schedule I REM NUMBER DESCRIP110N AMOUNT A. FUNERAL EXPENSES: ~_ None B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paitl: 2. Attorney Fees: 3. Family Exemption: (If decetlent's address is nol the same as GaimanTS, attach e~ylanalion.) Claimant Street Address City Slate ZIP Relationship of Claimant to Decedent 4. Probate Fees: 5. Accountant Fees: 6. Tax Re[um Preparer Fees: 7. 1 Settlement Charges for real estate settlement of S Tommy Lane, Enola, PA 17025 2 PPSL Electric (utility) Total £rom continuation schedules . 4,000.00 340.50 13,578.64 108.82 2,946.33 9W46AG ].000 TOTAL (Also enter on Line 9, Recapil If more space is needed, use additional sheets of paper of the same size. SCHEDULE H FUNERALEXPENSES AND ADMINISTRATIVE COSTS Estate o£: Frank J. Tezak, Jr Schedule H Part 7 (Page 2) 3 4 5 6 7 8 9 10 11 12 Tare's Cleaning Service (house cleaning) Commonwealth Corporation (carpet cleaning) Roberto Ortega (house painting) East Pennsboro Township (sewer charges) UGI (utility) Pennsylvania American Water (utility) H6R Block (preparation of decedent's final tax returns) Sherwood Court Homeowners Association Cumberland Law Journal (estate publication notice) The Patriot Newa (estate publication notice) 21 11 1333 120.00 252.77 1,600.00 138.00 166.56 70.83 175.00 200.00 75.00 148.17 Total (Carry forward to main schedule) 2,9G6.33 REV-1512 EX+(II-W) Pennsylvania CEPPAIhEMOF REVENUE MMEPoTPNCE TaX RETURN SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES 8 LIENS ESTATE OF FILE NUMBER Frank J. Tezak, Jr 21 11 1333 Reporl debts Incurred by the decedent pr(or to death that remained unpaid at the date of death, including unreimbursetl medkal expenses. ewasaH z.ooo If more space is needed, insert additional sheets of the same size. REV-151$ EX+ (01-10) Pennsylvania OEPARIi.EM OF REVENUE INHERRANCE TAX RETURN RESIDEM DECEDEM SCHEDULE J BENEFICIARIES t5TA1E DF: FILE NUMBER: Frank J Tezak Jr 21 11 13 3 RELATIONSHIPTO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS (Indude ouMgM spousal distdbutions end transfers under Sec. 9116 (a) (1.2).J 1. Frank J. Tezak, III 8 Annette Drive Enola, PA 17025 Citizens Sank checking account number 6100710955 Inventory Value: 18,134.47 Members lot Federal Credit Union checking account number 266483-11 Inventory Value: 2,451.64 Members 1st Federal Credit Union Savings Account Number 266483-00 Inventory Value: 423. SS 0~ of Residue: 69,175.32 Son 90,185.01 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHDWN ABOVE ON LINES 15 TW20UGH 1 8 OF REV-1500 COVER SHEET, AS APP ROPRIATE. II NON-TAXABLE DISTRIBUTIONS A SPOUSAL DISTRIBUTIIXJS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHgRRABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. S 0.00 9W46AI 2.000 IF more space is neetletl, use additional sheets of paper of the same size. Estate of: Frank J. Tezak, Jr Schedule J Part 1 (Page 2) 21 11 1333 Item No. Description Relation Amount 2 Diane Mahoney 605 Via Chris Court Debary, FL 32713-5426 Members lat Federal Credit Union checking account number 266483-11 Inventory Value: 2,451.64 Members lat Federal Credit Union Savings Account Number 266483-00 Inventory Value: 423.58 09 of Residue: 69,175.32 Daughter 72,050.54 nas.eos aEV mvm~ LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. ~ee for this certificate, $6.00 P x.8032589 Certification Number This is [o certify that the information here given i correctly copied from an original Certificate of Deat. duly filed with me as Local Registrar. The origins certificate will be forwarded to the State Vita Records Office for permanent filing. _~_ ~~ ~ ~~~abl Local gisVar Date Issued ,nrw rMV ttNae CONMONWEAL7H OF PENNSYLVANU • nEPAH7MEM OF HEILLTN • VRAL nECORDS rne~~r CERTIFICATE OF DEATH vm rx (Sea Inabuctbm aM anmpM on taeetae) arse Fxt MIIIBFA g~ 3 vmraorrnrtM•ra. rtraq FrankJTB2sk Jr s.w,~y1 sera ea.p M.ar naw aoan arr<a.M l l , I • r o V em 183- 7}- 9208 L Der / V A /l aM WBaan laa l IbEr l noaaaa l'. r4,wr r.Pbao,a 88 "•• °r "°" ~" geptetnbsr26, 1823 SkaMWn, W ~ ^~ ^oat ~ x ^ara ^a r e a ^E r b m , „ m n . ~ p r: n aM . w aurya orb ROr.mar<an.n enHSlwm.Pmaaa+Mwar<a~M awr o,we.+a rptuMS w ra mwzwrkw ~anewkrae.m Perry Penn Klnkon Pytlilan Home wP.o~r,~ ~ rei ~f Whke r.mirr awn0.n isn a a ttooba. m to Wr owa.wnnb npown Farb (q,s/oy Myw PS mgYp to ~~ s~W~M~ 1YnYl~ 15 mMtaN®P.a. Pa aMn nn+) p y ~ u~Ay~.~~ r FeOear~~ ~r l eb"biW /eves lnt9 a4 U~ws.1 WI l e me p^•11••nmw r oYVad C~r.O taonlaewa~WrWrMap/bn+a/vane ~• tl00in0i" t:itl PenMb0f0 PA. u.e. tm Braarw.uaeb ry re i a M m m ~7 LiI1e eaMA . r . .n . Y h TOMS' tM^ ^+/ End 77028 eAand ~~d ^ ~,/~ tmm.M Cum mrarrrarr+aaba.bMrap Frank J Terak Sr nabnMwrYn,rmanrrnraml: EtMI Wakas ao.lmnrY•MriFp•/md Frank Tazak III ab rrraiworssP~rtab/anwr:+rrrl 8 Annetb Dr. Enola, PA 17026 zt. ~e°aarrar ^a,mtla ^m.w nnaraororerprr,ry.M sm gra4raarrrarrry.rraY•bMr) nnmbWb/bw aa, aprM ~ m77 Ro81ng Gnun Mamor1a16aMens Camp HIII " °i"' ^ IaW OOran ~ rov PA 17077 r ~" "~°d° ^ , e aM. w P rr meyr••a aaarrp ura Mani Mrwua..arrr/ F0.13&6~ Sullivan Fansral Hama 67 N. Enoh W. Enola, PA 77026 miilranaw Wriraapa 9darom0rla•rarr4p.warrrwrFn,rwpnar4Pawwwry NY IbnMnn,r rc oa•Faa ran, na.M tM~lwYwrra[nabaJrbb sM~arw r8wa arlr aaaYY00yparn %Traarn as as nrrrwarpoa, M.M YablFVrrlLwrb, a,an olr MparmrmWi rOw IYMrb r.pssa.n !0 pw ev mb r W ~Oll m uu[aroumlm•nr,Marr rr msYq ern. wn~eraeaugbaoa-arr.ova..aer+w-rs.ar.earwmxorwwmn4.oMwn.ae....a ~ o.ano.n err w.ati+anaaaMUra. M~ean~ a arrw b ^w.. ^na,w ra+nw.....Mrrra~..raM=+amaaae.man~r.r..m.0.~r m ^una.. k5 ~'O~O ; T SI D; 6 '~~ ~ f rO o ae 4 c a , waora.aaParr arba 41~ ^ngr.araarM y~ yy ~~ M a /q[lu l~ a, I..re ~to lMriVC f-I~tnr,-~[n5tan Wn ~ • ^xarsr4wr~a•aar~urt. y~ y ~ r i . Ba UleeaT/eCMae orbpr4morn at w awn .~r°.rata{, 4d~+i~iaata C ^M+rn+4mrgrn4rYi ar arbor r. w.Mrn ak ~~ 4 ^ UYOiwn MP4rIMMn,P41r l.tln r ,a a„n A.aYa M•Y~na~M Sa shah Mx hS/YOanM .Y.WrnMIePY a4 YM n4aImnP i ffi~ ataY eaa Fray. W - ~ ~ MwWf MYtl,/bbCSMr /`'~ ^mnW • acaraw.m ~ ~M4n ^ ~( ^ ^ ~ mnnaFlrv s. Mnaw4t aa.. nrrwMmiHaRirb/ rn~ama NrrPraa braa..aa vr xe rr w ^ ~anr iar o,neae ^ rr ^ Mo ^ o4r~oprbr ^ arrP ^ P,arha M pix-~. ry~ arcrrlwarhwl m.ear..r4na 'M • fre1M11nMarwrbrMMnnar,n•narrraan4alnperaeAerb rnrrWaXral rrrb.tru.~y.ar.rr.w r wr wM ^ a an ~ • r•. •mr ______ ___________________________ a w ~.~~ a4oararaNrnar,M «e~ ee -w ~ a w ~ r~r ~w r n~n~ ~ ..yq . a . s,arM ___-_______ n prar . .r -----' ,~yti/u OS OUOF084'C. Nov cr.+ber 17 X011 ~ lla.w4NyYa ~NbbwruO~YJwn,rb,L ^ QtM4.YaWwN/rMYrm,Ygnliw4 wnrmnrw %WM1y.ra~c aWgiale Cwgay CQrwaaO~~l,m YliT/p/flM YY~t4 ~I AA L u r g ^ mywn ua.r. ra ~ OC. Y2 ~ !. Mr aY. ' ~ AI PI nB frJG l ; dSY~ ' t- 011 '! t 7go a.•;sbv~ PA I ~~~~ THE LAST WILL AND TESTAMENT OF FRANK J TEZAK JR !, FRANK J. TEZAK JR„ of Enola, Cumberland County, Pennsylvania, declare this to be my Last Will and revoke any Will previously made by me. I. 1 bequeath my motor vehicles and remaining household and personal effects, and other tangible personalty of like nature (not including cash or securities), together with any existing insurance thereon, to my wife, Nancy Jane Tezak, if she survives me by thirty (30) days. Should my wife, Nancy Jane Tezak, not be living on the thirty-first (31St) day after my death, I bequeath such tangible personalty and insurance thereon to such of my children, Frank J. Tezak III, my son, and Diane L. Mahoney, my daughter, as are living on the thirty-first (31St) day after my death, to be divided among them by my executor in as nearly equal shares as practical. II. !devise and bequeath the residue of my estate of every nature and wherever situate to my wife, Nancy Jane Tezak, providing she shall ~(~ survive me by sixty (60) days. Should my wife, Nancy Jane Tezak, predecease "~\ me or die on or before the sixtieth (60"') day following my death, I devise and bequeath the residue of my estate of every nature and wherever situate to my issue, per stirpes, living on the sixty-first (61St) day following my death. ~~ III. I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. IV. I appoint my wife, Nancy Jane Tezak, executor of this my Last Will. Should my wife, Nancy Jane Tezak, fail to qualify or cease to act as executor, I appoint my son, Frank J. Tezak III, and my daughter, Diane L. Mahoney, co executors of this my Last Will. Should either co-executor be unable or unwilling to serve, then the other should act abne as executor. V. The executor or co-executors shall receive a reasonable compensation for the ordinary and extraordinary services rendered by them in the performance of their duties and responsibilities. Page 7 of 5 VI. 1 direct that my personal representative and her successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. VII. My executor shall have the following powers in addition to those vested in her by taw and by other provisions of my Will applicable to all property, whether principal or income, including property held for minors, exercisable without court approval, and effective until actual distribution of all property: a) To retain any or all of the assets of my estate, real or personal, without restriction to investments authorized for Pennsylvania fiduciaries, as she deems proper, without regard for any principle of diversification or risk. b) To invest in all forms of property, without restriction to investments authorized for Pennsylvania fiduciaries, as she deems proper, without regard to any principle of diversification or risk. c} To self at private sate, to exchange, or to lease for any period of time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms or conditions as she deems proper. d) To allocate receipts and expenses to principal or income or partly to each as she from time to time thinks proper in her sole discretion. e) To compromise any claim or controversy. IN WITNESS WHEREOF, I have hereunto set my hand this !day of ~~- 2004. SANK J. TE C JR Page 2 of 5 The preceding instrument, consisting of this and two other typewritten pages, each identified by the signature of the testator, was on the date thereof signed, published, and declared by FRANK J. TEZAK JR., the testator therein named, as and for his Last Will in the presence of us, who have at his request, in his presence and in the presence of each other, subscribed our names as witnesses hereto. WITNESS Pape 3 of 5 _ COMMONWEALTH OF PENNSYLVANIA) )SS COUNTY OF CUMBERLAND ) I, FRANK J. TEZAK JR., the testator 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 act for the purposes therein expressed. ..~~ _~' FRANK J. TEZA JR. ,~ Sworn and subscribed to before me this / ~ day of ~L,2+~+,I 2004. il~u.~ ~• d~ l.~t~_ Notary Public r~ai seat AAary L f32idys, Notary fhbl'~C cayawr;a~~=;,~,, ~yo~,~~co~y My Com.:iissror £xpi93 QC. 27, 2005 Nk.+r~Uer, Penrsrylvenie Asyociadai Ot Notaries Page 4 of 5 COMMONWEALTH OF PENNSYLVANIA) )SS COUNTY OF CUMBERLAND ) We, the undersigned, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the testator sign and execute the instrument as his Last Will; that he signed willingly and that he executed it as a free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testator was at that time IS years or more of age, of sound mind and under no constraint or undue influence. WITNESS WITN Sworn and subscribed to before me this /S~ day of ~6~~-irrJ 2004. /i~/~R~~, L. ~itr.~~~-~ Notary ublic NoMariat Seal Mary L Batdys, Notzry PubPC City Ot yJltiarnsport, Lycaning County My Cortvnission 6cpires Oct. 27, 2006 Me~nCer, Pennsylvania Kssociaticn Of Ndz^tM Paga 5 of 5 REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE OF GRANT OF LETTERS No . 2011- 01333 PA No . 21- 11- 1333 Estate Of: FRANKJTEZAKJR lfing MidCk, [esU Late Of : PENN TOWNSH/P CUMBERLAND COUNTY Deceased Social Security No: 193-12-9209 WHEREAS, on the 14th day of December 2011 an instrument dated February 1st 2004 was admitted to probate as the last will of FRANKJTEZAKJR IFirsp Mid~k, Lest/ late of PENN TOWNSH/P, CUMBERLAND County, who died on the 16th day of ,November 2011 and WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STRASBA UGH Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: FRANK J TEZAK 111 who has duly qualified as EXECUTOR(R/Xl and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 14th day of December 2011. A. SETTIEMENi STATEMENT (HU0.1) °e8e8d8"MMM`~~-°'t~ Select Platinum Settlement Services, LLP ~ , , a 3912 Market Street tg t '+.,",,,.~ Camp Hill, PA 17011 (717) 737-0884 TYPE OF LOAN INS. RJ:II:FY 00122349-001 MAW 71240113958 a. MORTGAGE INSURANCE CASE NUMBER: D. NOTE: This ronn is han/shsd b gi"a you a atelemeM o/eduel settlement costs. Amounrspe/d fo erMby the settNmenl spent ere shown. hems medmd'(P.O.C.)' were patl ouGSde the dosirp; they ere sham here rot Mormeb'anel puryows erMere nol,YrcNdad h the blots D. NAME OF BORROWER: Stephen J. $tank0 ADDRESS OF BORROWER: 9 Richland Lane Apt. 218 Camp Hill PA 17011 E. NAME OF SELLER: EState Of Frank J. TBZak Jr. ADDRESS OF SELLER: F. NAME OF LENDER: ERA Home LOanS ADDRESS OF LENDER: 1 Mortgage Way Mount Laurel, NJ 08054 - G. PROPERTY LOCATIOk 8 Tommy Lane Enola, PA 17025 Cumberland Caunly 09-15-1288-313 Lot(s) ~-1 of Sherwood Court N. sETnEMENrncENr: Select Platinum Settlement Services, LLP (717) 737-0884 PucE OF SETTLEMENT: 3912 Market Street, Camp Hill, PA 17011 I. SETTLEMENT DATE: M122012 PRORATgN GATE 4/122012 DISBURSEMENT DATE: 4/1212012 J. YOF BORROWER'S TRAM CTION K SUMMARY OF SFILER'S 7FNNSAC710N iIIIU' y.. ~ .. ~.. -e~a2 ".L ,. :::r'~=a k'.aiu!4dO:~aRL1eF'ASA Ei..••8 ;,.°.i ~ •..r,.'!' p';;. 101. ConbaM Sobs Prbe 155,000.00 401. Contrecl Saba Price 156,000.00 102. Personal Property 402. Personal Property 703. Sedbmanl charges to BortovJer (Arse 1400) 7,255.75 403. 104. 404. 105, 405. ADJUSTMENTS FOR ITEMS PND BV SELLER IN AWAN CE: ADJUSTMENTS FOR REMS PNO SY SELLER IN ADVANCE: 105. /Town Taxes 406. Cil /Tew'll Taxes 107. Coun Taxes 04/1 12 to 12/31/12 410.87 407. Court Taxes OU1y12 fo 12/31/12 470.61 tOB. Astlassmsnts 408. MamemeMa 700. SWOd Taz 01/7y12 to 06130/12 105.38 408. Schml Tax 0//ty12 to OBI30I12 405.38 170. Sewer/Troah OM1y12 to OM30/12 119.47 470. SewedTnah 0411y12 to 06130/12 119A7 171. A M HOA D 0417y12 to 04130172 28.58 471. A dI HOA D OM1y12 to 09/30/12 29.58 172. 412. 773. 413. 174. 414. 115. 416. 120. 2 ' OR083 AMWNT DUB FROM BOR0.0WER: /1 PNR9Y-' 183,220.78 +•k4 sr ;,.-.3~tI~'~ 420. GROSS AMOUNT DIR! TO SELLER: ~ pT~liG11 9(18.. BELL[k . . 755,tifi5.03 .. .. 201. Oepostl a earnest money 1.500.00 501. Ezass de B sea InslMdbna 202. Principal ammM of new bon(a) 105,000.00 502. SeRMmeM cha es to SeAer Ina 1400 12,028.44 203. Exbtlrlg ban(s) Mken subject to 503. Exbtln loan a taken su 'ed to 204. 504. Pa R of Ant mo a ban 206. 505. Pa or aemnd mo a Imn 208. 508. 207. Seser poMm o/Tnnabr Tax 1,550.00 5m. Sslbr portionaTronafer Taz 1,550.00 208. 508, 209. 509. ADJUSTMENTS FOR REN6pNPAID BY SELLER: ADJUSTMENTS FOR RQAS UNPAID BY SELLER T70. CAy/Tawn Tezes 510. CH Ram Tazas 211. County Taws 517. Count Taxes 212. Asaeasmenb 512. AsessamenM 213. 513. 214. 51d. 215. 515. 276. 578. Z1 ]. 517. 218. 618. 219. 518. 220. TOTAL PNO BYIFOR BORROWER: 108,050.00 520 TOTAL REDUC1gNS IN AMOUNT DUE eELLER: 700:~CA141A7 E•..~.. 60RpgNH;t';i%1„x s;~ny ;:: +n..~600.~~ A 8 ~., ' .861!42° is*x 301. Gross amount due from Borrow( (line 120) 163,220.]8 601. Groaa amount due to Selbr (line 4201 302. Less amount pert by/for BortovJer (line 220) 108,050.00 602. Leas reductlon In amount due Salbr (Ilne 5201 13,578.44 :;.r^,.,,.~," 165,965.03 13,578.49 303. CABM (®FROM 1 ( ^ TO I BORROWER: 55,170.]8 803. CA9N (~ FROM I I ®TO I SELLER: 142,388.58 TM Publc Repomnp Burden torthls colbGion of iMonnatlon h eetknaletl at 35 minutes per reeponae /a mlbgkq, roviewing, end reportkp the data. TMe agency may na mlbct Mb iMOnnalion, and you are na requted t0 canpleb thb form, unbp It tllapbys a curzantly wlltl OM8 eoMrol number. No mnMentlaltly le emoted; this discbsure b mandatory. Thb is dee~nerl to provide the pertbs to a RESPA mwretl tranactlon wtlh FfomgtNg7 w........ e.~.~aw.Y. _•_____ _ _ - I L-SETTLEMENT CHARGES ESCROW FIIE NUMBER: 0082a1a-Wt MAW .,,... «.~.r acer 2i5vTe e~iZESEFiuk,. ... ... --P:D:6. a. ,.:::`1 DMSN7N OF COMMISSION (LINE ]00) AS FOLLOWS: 701. E1,916.OOb ReRASa Reeky NmdaM PND FROM BORROWERSFWOS AT SETTLEMEM PNO FROM SELLER'S FUNOS AT 702. f1.e50.00 b EM NRT Inc. SETTLEMENT 703. GOmmbebn pak al aekkmenl 9,595.00 7pq_ ACOItlOdI COmmleabn to EM-NRT Inc. 195.00 705. '•See albtlwtl M beekdavn 78.80 8D r~T18ABP _N 011N6¢. ;NA lktMFk:~'(^ . I : : T'lI 801. Our oripbatlpn Wat9e 5685.00 man GFEHI 802. Your ruedkarMUrpe(poinla)tor ins apetlbc inlwast nk chden (51,12b.00)(han OFE F2) 803. Your e0luekd ollplnatlon cneryes b ERA Home Loans loan GFE N 804. AppraWl Neb STARS Oran GFE Fat 805. crodl repalb OBC lnnwis, Ina man BFEw1 -540.00 410.00 8.20 506. TsN aervid man OFE NI 807. Fbotl ceMMSOd morn GFE Y3) BOB. ScainO Fes b FNMA 15.95 808. 810. ;:972.LiBA6.. ...: L8 ..'TOB..FAI N 3 ., ..:: ~ ..: ^ :...:,., ~P.O.C, 901. paint innnat tlulga man GFEF1o1 .;,.... t'., 235.80 ^ -' v':f^i kmn /1122012 b M12012 ®512.1000 l daY % (19 tlays) 902. Morlppe bwnnce pmmlwn br 0 month(s) INan GFE Y3) 803. Hpdownefe kwrMlce brl ysRs)bNbbb kwnnce man GFENIt) 380.8/ 904. 905. ~e..e..~nr..u,k-curse. .._ za ... ;r :: ~.:. -. _.~, _.. _..., 1 1001. 1002. IMtlM tlepollby0u eeaw amount HomeaAnela Mastics 3 monlha ®i 90.07 per monm Inan OFE F% 590.21 1,804.91 1003. MmtWpa MManm mNMaQt per monb 1004. City property laaea moMha®3 per month 1005. County property bona 31rbn91a®f 17Ap pN monm 511217 1ppg. Amrw1 sasesameMa mOnbs ®i r momh 1007. Sciwd kaee 11 monM ®i 16295 r month i1,e52A5 1008. monMS®f Per moron 1009. A99re9ab Aat Atll. moMha~s per montlr 391e22 rnwri''~rve.eMlatsraQ. .:-5 PA.G. ,.:I 1101. 1102. Title asrvkas orb bn0efs tltle kwnnd SMONnaMmtloYnp Fee (rvem OFE;Yk) 1,283.75 1103. Owrrfa flk MUrMbsb 5eMCl PMtlnum SakbmeM SarNCea, LLP man GFE FS) 250.00 1104. LarMeM1 the kaunnoe • b Sabcl PWlnum Ssdanwrl SaMda, LLP iBe3.]6 1105. L«Mefs tltle po0c/NmN 5105,000.00 1106. Omwh IMS OoIMM IYnk 5155,000.00 1707. Apenye Pa00n atlre ldel tltla baunrce pmnlum f1,1aJ.eB bSeled Pletlwm SatlbnNM Sendda, LLP 1105. UnOerutlUr's Pmtlar W tl1e bW tltle keuranca Pmnium 5276.05 b Ob Repudk NaOaMI TNb be. Co. 1109. EMS. 100, 300, e.l, pW • b SeNM PIaMMm Satlbment SaMOx, LLP 5200.00 1710. Inwed Cbakq teller • b OM Rapubkc Na1bnN 7116 M. Co. 5]6.00 1111. Nohry Fase•b Setllanan101Mw SIS.00 1112. "Sae albcMtllm Oreakdown iB0.00 35.00 'tm4: . ,, r L I° :1j .. r. PA,C: 'If.h 'Ir. 1201. Govemmanl recadbp Nrar9a (1mn GFEN]) 164.00 1202. Daatl 55200 Mplpapa 5102.00 itebaae 50.00 1203. Tnnaler tune Orom OFEFa) 3,100.00 1204. CltyyCourlty tavhlampa Dastl 51,550.00 Morgape f0.00 1205. Stele kr/Wmps Oee0 N,550.00 Mortpepe 50.00 1208. 1207. q OrAT]BIA ,. 'c... ESS' I::. ,.:.,.: .. ..' ; .;; ., .: -..: P.0.0. _ :. 1901. RsOrkred aFrvlcaatMyw dnatbp br man GFEM) 19.50 1302. 2012 Codty2wp Tua b Detl01e Lupdtl 569.88 1303. PaaOHamaAatlon kupectlarR b Envkomwal (430.00)B 1304. Hama WaeaMyb FlnlAmnimn HOms BUyen Pralectlon 480.00 1305. Replace Oryx OUCIb FM CMI Remotlebn 226.86 1306. •'Ses aOarAatlberaakdaxn 519.50 150.00 1,063.00 1400. TOTAL SETTLEMENT CHARGES IFnkr on Oct 109,Seclbn J -wd - Mne 502, Saabs IO 7,256.75 12,028A4 I Mve eanhM m(avetl the HUO-15aiemaMSbtameMandblM OSpa ny knOwbdpe and 0e5e1, kls else and amurale Nabment aaA remlpb mOtlbbolaemanls matla on my smwlm0 re in role tnnatllon. IbMwr cerN~ Ihallhava rxeneda copy alhe 1k1613e0emeM Slalamant. _- - y~ ~•t!~ C 'Y~ I Cam-- ~___~~ 5 ephen J. Sknko Eakte of Frenk J. Tezak Jr. BOrrw,en Sellm The MU0.15alament SlelemeMV,hitlLLhrve pepretlb ue en0 eccurab amwnl of lhb innsedbn. Ihave mu.e0 ar nitl uucethe MMab ne tliahunetl In emortlance wBk Nle q1 y+ /a 6 I' sl Penf 7.~1 A~LLC-C~.- ~~r~ ? sereamemA9eM '7~/l..~i ~/•'~ D.y Select lalinum Sellkment Servkxe, LLP WARNWG: kb acrimelo bbvfrgly rrelw hlae abbmeMa bUla Untied SlMn on Yde onrry tlmllarlorm. PenMBea upon mmktbnean include ailne end knptlmnmenl FmtlaWa see'. T41e 18 U.B. pOtle Saakn 1001 eM Scalps 1010. ' Eecfow Number: 00122349-001 M4W LOm ularM rM GooA:FYflh E~gai$i.: 6F and HU0.Y Ohn ~ .::.: ~,.., ~ &ood F.IN, s.amd. - xuD.t . Charpea Tnn Canna Irrcnwss HUO-t Llna Number Our origination Marys 6607 565.00 565.00 Vour uetlk or Marge (pofnte) /or Ma apecNc interest rete chosen 6602 -1,125.00 -1,725.00 Vour Mjuewtl orpination charges 6e03 -540.00 -540.00 Tronawrlazes 67203 3,710.00 3,100.00 Ohalgas Thft In 7ohl.GaltM lmnra6 Mpre Than,'~1Gy... ":.~ ~.~. ~.~000d FaINFatlmlHe ,.. ::,HUD•1 ' Govemmenl recording tees 67207 279.00 164.00 Approbal fee 6604 470.00 410.00 Credk report #805 6.20 6.T0 Swarlg Fce 6808 15.95 75.85 Flood Certlficatbn 61372 79.50 19.50 6 Total increaw beN/een GFE and HU0.1 Char9ae 730.65 675.85 E -715.00 or -15.7394% -CMrgw That CJrtO rgt • "`' ~. OOOdFalgrEaamab ..:: HUbt ` . inilkl depoak for your esuow eceounl 61001 1,360.92 1,604.91 Daily interest Merges 6901 E 12.40001 day 235.80 235.80 Homeovmers Insurance 1903 707.45 360.84 TMa wrvbes and kMers title insurenw 61101 365.00 1,283.75 Owners Mle Insuronw 61103 1,209.75 250.00 6 Loan Terrna Vour bklal loan amount is E 705,000.00 Vour loan term is ~ Y°~ Your Initial Interest role is 4~2`~°~ Your Irdlwl momhy amoum owed to principal, interest, antl any E 516.54 Ylcludw mortgage Inwrerwa b Q prindpal ^X Inwroal Mortgage Insurance Can your interest rote ase7 ^k No. ~ Yeq R ®n rbe to a maxknum o/0.0000%. The /bat change wiB be on antl can Marlpa again awry soar . Every Merge Oaw, your interest rate ®n inoaew or tlsaease by 0.0000%. Over Me lire o/ the Icon, your Interest rate Ie guereMeed tc never be laver than 0.0000% or hgher Man 0.0000%. Even M you make your peymeMa on time, on your ban balance awl ^% No, ^ Veq M ran rbe to a maximum of E 0.00. Even N you mate your paymema an tine, wn your monMly amoum x^ No. ^ Yeq tlw lxet Incroeae can be on end Me montltly amount owed owetl for prilcipal, irMrest, end mortgage insuronceawl can riw bE0.00. The maxhnum k ®n ever rise to is E 0.00. Does your ben have a prepayment penaky7 0 No. Q Yeq Your rtw:dmum PrePaymem penaky Is E 0.00. Dcea your loan have a balbon payment? Q No. ^ Yeq you have a balloon payment o1 E 0.00 due In 0 yeah on . Total monthly amount owetl hdutlirg ewrow amount peymeMe ^ Vau do not have a ngnMly escrow payment for Items, aw:h as progeny taxes end homeowners Inwranra. You must pay Mew kema tlireay youroek. x^ You have en edditlonal monthy escrow payment of E 230.51 Owl rowks In a fowl Inkial monNy amoum owetl of E 747.05. This includes prlndpal, Irdereet, any mortgage insurance erM any kama chadretl babes: ^x Progeny fazes ^k Homeovmers insurance ^ Fbotl Insurance ^ ^ ^ Nae: I/ you have any quastlons about tlw Seabment Charges end Loan Terms Ostetl on Mls /orm, please tented your lender. Exmw NUmEer 0017234}001 MAW HUD 705 DETAILED BREAKDOWN OF ADDITIONAL REAL ESTATE BROKER CHARGES Seller Descrip0on Amount 706. Notary fee to Judy Palm 15.00 707. Appliance Repair Reimbursement to Dave Smolizer 63.60 Total ac shown on HUD page 2 Line #705 76.60 HUD 1112 DETAILED BREAKDOWN OF ADDITIONAL TITLE CHARGES Dahl SeINr Dwcdptlon Amount Amount 1113. Doc TrenslWire Fees • to Select Platinum Settlement Services, LLR50.00 25.00 1114. Overnight Fees • to Select Platinum Settlement Services, LLP E30.o0 1115. Tax Cert Fee to Select PlaOnum Settlement Services, LLP 10.00 Total ae shown on HUD page 2 Line #1112 35.00 HUD 1200 DETAILED BREAKDOWN OF GOVERNMENT RECORDING AND TRANSFER FEES Buyer Seler Amount Amount City b County TaxlStamps City Tax/Stamps: Deed $1,550.00 Total as shown on HUD page 2 Line #1204 1,560.00 Buyer SelErr Amount Amount State Tax/Stamps State TaxlStamps: Deed $1,SSO.DO Totalas shown on HUD page 2 Line #1205 1,550.00 HUD 1306 DETAILED BREAKDOWN OF ADDITIONAL SETTLEMENT CHARGES D.r.r Boyar Seller Dascriptlon Amoum - Amount Amount 1307. Radon MiOgation System to Enviroquest 750.00 1308. May HOA Dues to Shenxood Court HOA 50.00 1309. Initiation Fee to Sherwood Court HOA 100.00 1310. Resale Cert to Sherwood Court HOA 75,00 1311. SewerlTrash 4N112-6I30N2 to East Penn Consumer OKce 139.00 1312. Flood CeAificetion • to STARS E19.5D 1313. Ice Maker Credft to Stephen J. Sfanko 100.00 Total as shown on HUD page 2 Line #1306 160.00 1,063.00 n W W\~Ne.ea!-t1\9-si y . ,. . ;L ~qy 0 raze assn N11D= T8s / ~ ~ day of C2GTljXil/ in the year of our Lord twa thousand one 12001). 8NT'fPYSlP RUSSELL C. GOODLING and JANET D. DOODLING, husband and wife, Grantors, and FRANTC J. TSZAIi, JR., and NANCY J. TSZAK, husband and wife, Grantees 1flTlbj83YTH, that in consideration of One Filuidred Thirty-sine Thousand Nine Sundred and NOl100----------t$139,900.00)------•~--------Dollars, in head paid, the receipt whereof is hereby acl~owledged, the said Grantors do_hereby gzant and convey to the said Grantees, their heirs and assigns, ALL T1AT CNJtTATN piece or parcel of land situate in 8aet Penneboro Township, County of Cumberland, sad Commonwealth of Pennsylvania, bounded and described as follows, to wit: ggGINN1NQ at a point oa the Southwest right-of-way line of Tommy Lane, a 50-foot right-of-way, 35 foot eartway, said point being at the aortheaetern corner of Lot Nd. Q-2 on the here£aafter mentioned Plan of Lotsi thence by the aouthweatern right-of-way line of Tommy Lane, South 41 degrees 27 minutes 51 seconds Bast, a distance of 61.92 feet to a point at Lot No. L-1 on the hereinafter mentioned Plan of Lots; thence by Lota Noa. L-1 through L-5, South 60 degrees 30 minutes 00 seconds 1Peat, a distance of 160.48 feet t0 a point st Lot No. IN-4 on the hereiaaftar mentioned Plan oP Lotst thence by Lot No. 1d-4, North 41 degrees 27 minutes 51 seconds West, a distance of 28.65 feet to a point at Lot No. Q-2 oa the hereinafter mentioned Plaa of Lots; thence by Lot No. Q-2, North 48 degrees 32 minutes 09 seconds Seat, a distance of 157.00 feet to a point at the southwestern right-of-way line of Tommy Lane, the point and place of BSGINNINO. -1- BUUK ,~ PACf¢,¢~ r• ~.. 3lSt$17 Lot No. Q-1 on a Final Re-Subdivision Plnn for Sherwood Court Lots L-i through L-6, M-I through M-4, and Q-1 through Q-4 sad recorded in Cumberland County Plan Book 83, Page 33, and containing 7,109.75 square feet. H7lVIliO TAgAlQDt erected a townhouse dwelling known and numbered as 8 Tommy Lano. ~&R A'!ID BOHJRCT to a certain Declaration of Bherwood Court, a Planned Community, recorded in the Office of Recorder o! Deeds of Cumberland County in Miscellaneous Book 626, Page 383, as amended by Amendment to Declaration of Sherwood Court, a Planned Community, recorded in the Office of Recorder of Deeds of Cumberland County in Miscellaneous Hook 638, Page 826, as nmended by Second Amendment to Declaration of Bherwovd Court, a Planned Community, recorded in the Office of the Recorder of Desch of Cumberland County in Miscellaneous Hook 653, Page 51, as amended by Third Amendment to Declaration of Sherwood Court, a Planned Community, recorded in the Office of the Recorder of Deeds of Cumberland County in Miacellaneoua Book 673. Page 457. SSIND a part of the same premises which Ronald R. Sgrignoli and Mark R. Sgrignol3, Co-Partners, t/d/b/a F M& T Sgrignoli, a Partnership, by their deed dated July 28, 1998, and recorded July 29, 1998, in the office o! the Recorder of Deeds in and for Cumberland County, in Record Hook 182, Page 296, granted and conveyed unto Russell C. Doodling sad Janet D. Doodling, husband and wife, grantors herein. AND the said Orantora hereby covenant and agree that they will warrant specially the property hereby conveyed. -2- gouts 2~3 ~44i9 ZN NI1'N3BB 1oDR8oF, Bald arantora have hereunto set their hands and seals the day and year first above written. 8i~ssd, Bealed, and Deliwrad in the Presence of _ (SEAL) R S88LL C. GOOD (saAL) D. oOODL NG COJAMON9P$ALTH OF PENNSYLVANIA: . ss: COI]6TPli OF CIJNIBERI.AZdD . on this, the 11.= day of Q~e~J 2001, before me the undersigned officer, a Notary Public, personally appeared, RUSSELL C. GOODLING sad JANET D. DOODLING, husband and wife, known to me (or satisfactorily proven) to be the person chose names are sub- scribed to the within instrument, anal acknowledged that they executed the same for the purposes therein contained. IN WITNfiS8 9PIiER~F, I have hereunto set mY hand and official seal the day and year first above written. ~ 52. bQ:~•., Notary ublic -3 ~~~ Z-,~006 aou~ 248 P+~44~0 I hereby certify that the precise residence and complete poet office address of the within named Grantee is: B Toamy Leae, Enala, Peaaeylvaa#e 17025 ~Tga; Octo6ez 17, 2001 TE&IU~iCE J. RERWIN, Attorney Eor Graateee r eertir, ~ ~.~;is to be recorded rn CtuI1L::rland Cownty PA Recorder of Deeds t': C7 .:. +-' :[ rn ;~ o ~` c, ~ -` ~ m~,,ta N b '~ ~.~ W ~.. s .~;~.. o ~ . 3 ~ ~ ~~ r. G V ~_ N -[ O~~t y,>± ~ ~ .d v 3~~~~~~~~ ~ a ~ ~ ~ ~ ~ ~ ~ ~ +~ a ~~~ ,,,,llll,,,, ~ ~ r _g_ ~i' ~ ~ ~A ~ II~..._Y~~~E o :S 8 $ ~ ~ ~S 8 ~ ~ ~ y~',~ BSrGI( ~ PdGE4Qi~L PRU Historical Prices ~ Prudential Financial, Inc. Comm Stock -Yahoo! Finance Page 1 of I Nnw User1 Reyis!er Sign In Help Make YI My HOmepage Ma,l My Y! Yahoo! Search lbaeah WN HOME I INVESTING ~ NEWS PERSONAL fINANCE MY PORTFOLIOS EXCLU$WES FANTASY FINANCE WtQ1701N ~ N4M, Mey 2, 2012. 2'Oapm E. DT- US MarkoM cbao in 1 hr antl $2 mitts Dow L0.15%Nasoaq 10.37% -. _.___._- •ue, raa roewrnvs TRADE p FftEE~ AYS PRu an.lra.,mrc ua PruAentiapl Flnanelal, IOC. (PRU~- NYSE Antl to PoMolio ''. Like !38 60.98 fO.~~~~.~6%1 2:OBPM EDT-NeWp Real Tlme Prke Historical Prieea Set Dab Ranae G Daily Sbr1 Dab: Nov ~ 16. _ „011... E9. Jan 1, 2010 f Weekly Etta Dab: Nov ~ 16 011 r Monthy !- Dlvidentls Only t3et Prkas Priua Date Open High Law Close Nov 16, 2017 52.55 53.36 51.61 51.80 pose pace s~uMetlior dvlaeMa antl eplaa. Osl HbtoHnl PHps br. 1... .. ' AtlChalces Flrst ~ Previous ~ NaXI ~ last ! i Volume Atlj Close• 5,1>65,600 50.41 When. it'S on your mind. li'$ On ei3oy: +61DOwnloatl to Spnatlsheet Curronq in USD. J ~ ~J s~ ~~,n S~, ~~ Firsl ~ Prov)nus ~ Next j Last auy tn.W.tli,,r N mw• S ~4~ Copyran1O2pR Yaaao! Inc. All rphls nurwb. Prlwoy PoACy ~ Aaoul our Atls-loran oraervke -LOpyrlphNP Policy -&aM f-eetlp¢ck - Vah00! - AHC NEWS NatWOfk Quotes for NYSE, Nastlaq and NYSEAmeX an Reei-Hme aM solacetl M1om Nastlaq Leat Sale when available. If not avalbde hom NLE. qumes will appear tleleyatl from primary listing ¢bLKl. Sae slap oaby gmfls fa mhflr ezchengos. Quotas entl omor IMOmwtinn 6upplletl by intlaperWflM pfgVWbfa itlentifiatl on the Venool Finanro pemWr page Uugn are uptlehq aNOmatigally, bul w111 ba Wmetl oR attar 25 minuted b inechvty. quotes a:e tlelayoa fll least f5 minutes FJI inforn:etian prctitlntl "aa I¢" br iMOrmehonel purpo¢es only, rpt IMaircetl for Crating purpoaee a atlvice. Ne.mer Yatwo! nor any M IrMflparltlent prgWtlere,a iiabin /or any infonnetlonal wrora, IncnrtryNetene¢¢, or ONays, ortor any &:hprl6 taken in rNianrs on IMamation contnneo rareln. fiy eo;essirg tl1a Yahoo! sib, you agree nol ro radietnbme the in;ormaHal fam0 theleln. FurdamaMai company tlata proYinetl by Capital Iq. Historical then tlele eM tla•ly uptletoe pmvidTtl by Commotliy Sy6bms, inL. ICSI). Intema;ional hiafonrnl than aam, Dairy uptlabs, NM summmy. hmtl par/aimanrR, tlivitlontl tlata ono Mamingstor IntlpX ^ob provitlan by Mmningsbr. Inc. ~, M ~ s Q f 7 (h ~ ~ m N ~ pp Z t~ ~ 00~~ N C a °°~~ ,, r~ t n°mppo~F~ " ~ 0. ~b 5 is Yn °' ~ ~ r ~~ ~ ~~ ~~ N 6 U ~ ~ N m U ~~ >> 6 N 7 7 30 ru m m Q 0 u '~ N is 0 o U .j F3 r Z [L LL N W j W ~ R' O O .~'- i` J W 4 k~ a Yz~ = ~~Z LLmW ~~ Y~ Y V 0D 4~1 ~ p~~ A~~ 1#~I t a° a`o~~ F ' N ° ~ c. P 0 7 S O N < V J G ~ N C Z ° a O U' 8 N o ~ d C' 0 ~ N W G N ~/ r ~ ~ lL 3 ~,, w m t.. ~ ~ v ~ ~ ~ ~ ,v ~ ~ ~ C N L ~ f.3 G O ~ ~ r w _ i d' N A t a „ r fii ~ m ~ ` 0 __~ ~ N m `~! m c~ a O ~ N C N r ZZ c) G ~ f ~ ~ i 1=' N - d O ~ 4L Q r :3 4 N Z uJ J m , N ~ ~ OG r C O ae '~ ~ 7 N N E `O !Q.. W ~ ~ ~ ~ ~ ~ ~ W J O. - 7 m V , r'' U i uJi C o a ~ _~--- ~ ~d Z • . .r ...: • ~ ie . ~ ~. N C ~ N ~ ~ ~ j~ i~ U ~ N O It( c~6 • ~ N p d r d ~ 'O „ 6 m ' ~ V N o ~ N N O. r 8 ~i~~zens B~n~,° Account Number 6100710915 Account Title FRANK J TEZAK JR/FRANK J TEZAK III Date ened 11/9/1984 Account T e Checldr- Princi al Balance as of DOD $36267.63 Interest from Last Postin to DOD $1.30 Account Balance as of DOD $36268.93 Y'TD Interest to DOD $10.80 ~% Citizens Bank January 26, 2012 GATES, HALBRUNER, HATCH & GUISE, P.C. ATTN TRACI L HILFERDING 1013 MUMMA ROAD SUITE 100 LEMOYNE PA 17043 Estate of FRANK J TEZAK JR Date of Death: Nov 16, 2011 SSN: 193-12-9209 Dear Sir/Madam: One Citizens Drive ROP112 Riverside, RI 02915 In accordance with yow request, the attached information sheet has been provided in the above decedent's name as ofhis/her date of death. As per yow request, there was a title change made to the decedent's account on March 21, 2011. Nancy J Tezak was removed as a joint owner and Frank J Tezak III was added to make the account titled as shown on the attached worksheet. There was no loan or credit account located with ow institution. For all other inquiries, please call 1-877-579-2667 xun t3aager Decedent Account Processing REF#: 521246 SC e MEMBERS 1't PBDHRALCaSDTT UNION REGULAR SAVINGS ACCOUNT: Account Number/Suffoc Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established Name of Joint Owner Date Jaint Ownership Established CHECKING ACCOUNT: Account Numbar/Suffix D-ate Account Established Princpal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Aarued Interest Name of Joint Owner Date Joint Ownership Established Name of Joint Owner Date Joint Ownership Established 266483-00 06/17/2005 $2,541.22 $.26 $2,541.48 Diane L. Mahoney 06/17/2005 Frank J. Tezak III 12/13/2006 266493-11 O6N 7/2005 $14,709.21 $.60 $14,709.81 Diane L. Mahoney 06/17/2005 Frank J. Tezak III 12!13/2006 MEM RS 1~ FEDERAL CR IT U I Danielle A. Kline Lending Insurance Support Specialist January 4, 2012 Estate of: FRANK J. TEZAK JR. Date of Death: 11/16/2011 Social Security Number: 193-12-8208 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 2$3-2328 wwwmembexslst.org PA REV-1500 SCHEDULE H FUNERAL EXPENSES and ADMINISTRATNE COSTS RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARMER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17613 TEZAK FRANK J JR Estate File No.: 2011-01333 Paid By Remarks: FRANK J TEZAK III HEA Receipt Distribution Receipt Date: 12/14/2011 Receipt Time: 09:54:44 Receipt No.: 1068079 Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 260.00 CUMBERLAND COUNTY GENERAL FUN WILL 15.00 CUMBERLAND COUNTY GENERAL FUN RENUNCIATION 5.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 32.00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 23.50 BUREAU OF RECEIPTS & CNTR M D AUTOMATION FEE --- 5.00 ---------- CUMBERLAND COUNTY GENERAL . FUN Check# 3369 --- $340.50 Total Received......... $340.50 C/ FRANK J TEZAK, JR ~©~ 3369 ~A FRANK J TEZAK IH 26 COPE ROAD ~ antigen , DUNCANNON, PA 77020.%14 ),2.'"I ~~ II aa~ rwcoc,,e Register of Wills I $ 3 yc~ ~- - order of ,~j j,, ~/ ~ ~ CitixensBank / ctizeniGrckA«o~~c ~.~/~-/RM~i,.A~~~ For/rr~u~ r."'.G•lX1Q ~C¢ _~e~~r~~ w 1:036076 1501: 61007 i0955p'"~~3369 ~.M,~.. w 1 q. SETTLEMENT STATEMENT (HUD-1) I Tre yr ~ `„r„r~ 1. FHA ~ 2. RHS ~. Select Platinum Settlement Services, LLP ~. p Vq s, ^ corrv.INS. 3972 Market Street e. ESCROW FEE NUMBER: t A ~~ 00122349-001 MAW ''w... Camp Hill, PA 17011 (717) 737.0934 B. MORTGAGE INSURANCE CASE NUMBER: C. NOTE: T7es mna is Ium/aMd 10 pAro pa a 8fefemellf dedwl aBftleabnf cOSfs. Aerountdpsitl fo Nltl by fM selrbmMl epem ere NUwa. Nems mrfmtl "(P.O.C.Y were pep orrtaOS N1e tlwdnp; Mey ere Hawn IMre lorhbrmeflorMl pwpOaea arltl ere not hcluded h flM fOfek o. NAME of eoarsowER: Stephan J. Sfanko ' ADDRESS OF BORROWER: 9 RfchWnd Lane ApL 219 Camp Hill PA 17011 E. NAME OF SELLER Estate Gf Frank J. Tezak Jr. ADDRESS OF SELLER: F. NAME OF LENDER: ERA HOme LOanS ADDRESS OF LENDER: 1 MOrlgage Way Enofa, PA 17025 Cumberland County 0&15.1288-313 PucE aF sErtLEMExr: 3912 Merkel Street, Camp Hill, PA 17011 I SETTLEMENT N1TE:eM2/JM2 PRORATION GATE dM22r112 01S6URSF]AENT OAtE: 4M 22012 J. 101. OF BORR STRANSACTION CoMred Sant Prke 155,000.00 K 401. SULa4ARY OF SELLERS TRANSACTION ., ConSad Saks Prla ,>„'''iii.. 155,000.00 102. Po[soMi PraPertY 402. Personal Property 103. SeRbment duryae to gormwer (Ibe 1100) 7,255.75 103. 104. 404. 105. 405. AD1U871BENTB Fqi nEMS PAID BI'SELLERMADVAN GE: ADJIISTMENfa FOR ITEMS PA~In'SELL~R IN ADVANCE : 10e own Tams 108. CA /fawn Tema 707. C Tmn 0471 12 l0 1 1112. 110.81 A07. Cou Tap 04/11M2 to 12731H2 N0.81 1%. AesasemeMS 4%. a.e..mem. 108. SdwOl Ttu( OU12H2 to /18f7W12 405.98 409. Scholl Tax OM72112 k 08130712 405.38 710. SewerrtraM OM72/12 to OBp0112 116A7 470. SawarrtneN 0//12/12 to 0&90/12 719.47 111. HOAD OM72H2 to 01/30772 29.58 411. NFIOAO OM12/12 to (MI9W12 29.59 112. 112. 113. 119. 111. 411. 116. 416. 120. OROtE AMOUNT OUE FROM BORROWER: 189,220.76 420. BROaa AYOUM OUE TO alL1ER: 155,%5.03 201. DaPoeN Orarneetmaley ~ +d~F:,y{r r, tiw 1,500.00 • +: 501. i Exaaa de aN lmtruc6wta 20T. Pdncipal a1n0uM d new ban(s) 105,OOD.00 502. SatllemeM CRe to Sslbr Ina 1100 12,028.M 203. EudtBM bang) taken wbjed to 503. E+k6n bans Wmn a to 204. 504. Pa o/IMt ban 203. 505. P d aa0md ban 2%. 508. 207. Saber porOOn dTnukr Taz 1560.00 507. lielkr rtbn otTnmrer Tax 1.50.00 208. 6%. 209. 509. 270. Clly/rown lama 510. C Rown TMme 217. County Taxes 511. Court Tams 272. Awmmenta 512, Muesmenb 277. 513. 214. 514. 275. 515. 216. 516. 217. 517, 216. 518. 219. 516. 220. TOTK PAM) BYROR 90MOMIER: 7%,050.00 520. TOTAL REDUClIONa W AMOINIT DUE tELIFA: 73,576.41 701. Grose amount Oua from Bonowar (line 120) 183,220.78 601. Gross amount tlua to Sepsr fline 1201 ~ 155,%6.03 302. Lase amount Peb by/lor gortower Oirro 220) 1%,050.00 802. Leas reducdort k amount dw SeBsr OMe 5201 13,578.44 303. CASH (®FROM) t ^ TO) BORROWER: 55,170.78 803. CASH 1 ~ FROM) (®TO) SELLER: 112,3%.59 Tha Pubic RepcAiny garden brlhfs cdkdlon dlMortnaBOn k ecdmated al 35 minutes per nteporwe for mlkdkp, revkwyq, end reponYq Ua dek. 7Ne e0enaY may not mllsctt~IrdamaUOn, end YOU are ndreouked to eexndd.rr.I. A..... ....r.-w.,-~..___._~.___ .,. "-.._. _.. L. ~SETTL. EN7 CHARGES ESCROW FRE NUMBER: 00123949-pO11MW .. TOTAL HEAL. A. )., _. :. .::.:. ... .. ..: I .. , 701, mvrsnm Or cww4isslurv (LmE 7a9)ws FOLLOWS w,w6.p9b Ra5Ye Reelry Aewtlehs PNOFROM BORROWERS FIMO$ A7 E PNDFgOM SELLER'S 702. w,66D.0ob EM NRT brc S TTLEISEM FUNDS AT SETTLEMENT 703. 704. Convnwbn pk1 e1 NHement MtlitlorMl CanmhMmbERA-NRTIrc 195.00 9'S~'~ 705. 600: ••SN epemed MeraMaOwn , ;r: :,~., .~ .. . ,,.. .. . 76.80 --.,,_„-- . _ .. I _ ~ 801. 802. Oa alpbetlm tlmrye vOUruMn«tlrr8e (pabb)brlM epetlOC inWeelnh rAMen f666.00 (NmGFE F11 (i1,12s.00)(eom OFEe21 803. YOUr adjwlM On81M00n cbsryeeb ERA Nome LmM Oam r#E AI 540.00 804. AOaebY beb STARS (eon GFEw1 410.00 805. LroGrrep9db CBC brwWS, lrrc. (from OFEw) 6.20 BOB. Te%NMN pmm GFE N) 807. FbOtluMlotlon IemrGFEwI BOB. Scakq FN b FNIM 13.95 BOB. 810. ':IRON. 901. ;....... -. ..'lp. PN 7 :;i ~ DeOylnbmltllerge ,: ,. ,...r '. .,.: . ' Ieom ME not .. P,94C1 ,... .., ,~ i~' 275.60 ,.. s•' .(: t1; FOrli 4/t2I3MTbl412012 ®512.40001 tleY X (19 tlei'a) 802. Mamepe lnsaerce pramlum br0 mcnlh(e) Pam OFEp) 903. Hana9.mNSlnwrrlm brlY9rr(slbNlms beuxre Omm GFE wtI 380.81 904. 905. ~,iw,m•,ecmmsmB M ' rRr~uwn tu• Iran ~ .. ... .. .:....:. 1007. YINel OeppMbyaraeO9e'ee9pwq (eFrn GFE N) 1,501.91 1002 IlOrnePAyleye bleleellee ]mwOM®5 90.0] p«mmb 59G,2t 1003. kbd8epe bRrence madMmS px mOMn 1001. Lqy pngrry lesN maMn®7 per m9nm 1005. County PmPrb YASe 9ma9M®S 47.45 Iw montll 5113A7 1006. MnNl eewsmenh monON ~.i p«mOMh 1007. Sclgd bNa 11 maWn ®i 16295 per maM 51,e62A$ tooe. matll. m 5 11M nbnlh 1008. A9prepeh AOCt Ado nbnnH~i pmrrvWl aSt0.22 . ,.. . . ., . . .r-. .1100.:: . 1701. Tdb saMON erb lsntlsh tlM bsurerru feern OFE w) 1,283.75 1102. Setlbmada tloWpM 1103. OFAMfs tlSS brurrA bSehd Phonon SMnaMMServku,lLP Omm GFENI 250.00 1101. LerrdMe SlN enaMbe•b S9Md PWlnum SeHerMnI BMHNt, LLP SSe5.76 1105. LMltleh tltle pol0/inp 5105,000.00 1106. OMMh b'tle pp4ySIIIn 7165000.00 1107. ABNye Pern9n atlb eMel Slh MIeWYI9e peMUm 51,1A1.e9 bSebd PleBeen SBltlemenl8eMrea, LLP 1108. Ibtlerrnlhfe per6an 91tlr bM IM beaMea praNUm 5276.06 b Ob RapuSYC NPIbMI TMh b. Co. 1108. EMe. 100 ]OO, e.1, putl • b Sebcl Phtlmsn Semerrwll BerMNe, LLP 1200.00 1110. kMaetl Lbstp L4Mr• b Otl Repubnc NeSaW T9b W. Co. 576.00 1111. Nohry FNS•bbeplrrwn OekM 546.00 1112. '•See elhehM /a breYWpeR 560.00 1-_ - ~,~ ... -"`. 1201. Gorsnsrurlt remMki9 FJrarBee pem OFEq) ~ 161.00 1202. Daetl 562.00 Moryepe N02.00 ReWN50.W 1203. TMeM Ie9N Pmn OFENj 3,100.00 1201. ClyiCOUny lbdalMrlp. Deetl 31,550.00 Morbepe 50.00 1205. Sbb teFhlenBe DNdS1,560.00 Mapepe 50.00 1208. 1207. ~. .~ 1901. RequNetl 4sybatlutypu cHl Mwp br learn OFEN) 19.30 1302. 2012 Coudy/Twp Tesesb OWde LOPcb 1]03. PNONOrrRrRe00n IneAdbM b flnec00eel 568.06 (130.00)6 1901 IIOnN WemM b FlM Anedc N B . y Ml am uyers PraeNOn 1305. RepleN Dryer OUdbFYq Cell Ramotlelve 480.00 1908. ^See etledHd brGNMtlovm Si9.s0 228.86 1400. TOTAL BETTlB.1ENT CHARGES (Enteron5M 109,Swgm J-entl- svi Sedbn p 150'00 1,08.7.00 , 7,256.75 12.07S.M Ikrva aroY rMerwtl IM NIA-1 Bet5emeM SIe1N19MeM btMbeYd my knowbtlps 1114 DeIW,84 etrve enU e¢unts atebmeM ale6 recelpY entl0lrMrMmanlemetle mmy acmuMab eh Wsimptlbn. INrOrer Mrtl betlMw roceMtle copy WtM MIGt SMlemenl SYtemeM. /~~,y4... ~7L 8 p0en J. SronkG ~ ~ ~ "' - EslNe at Fronk J. Tezek Jr. TM NU615e11ement-ShhmeMMii ~irvep md'a/y/~~ueNdsccurak eccounl Mtlris lnMWbn. IhNe auNd Or wll csueethe hndsb Mtliebusetlh sscordsnce wlUll Nis aWameM .. L(.~ /~f•LH~..1~7 Sa dflalinum Sellkment Services, LLP SeNemNlAgm Dab WARNING: 61s a crime to ImOWrNly meb hhe atohmen6 b the UMletl Stehe On bie ar eiry simllerlam. PenelhF upon mmlcdon cen include a 0na entl MpdbnnHnt PordMels see: Tek 16 U.S. Catle Seelbn 1 OOLntl SeCbn 1010. Eraow Numbs 00122349-001 MAW 'Q001 ~ 011~Cipp~FdI~IF E8H10a~a'. OP6 ~jId MU0.1CM .,.j':~ ~ `. .' GOOdFWrtSatlmak NUO-0 _,.. CMrpea Tnat Cannot Inoreaaa HUD-1 Llne NumMr Ow orlplnatlon ohage - a001 585.00 585.00 Your cr.tle or chage (poink) kr the apedfic Inlereat rate cnasen M802 -1,725.00 -1,728.00 Your edjuslatl oriplnatbn eharpss aB03 -540.00 340.00 Tnnakrteea a7203 3,H0.00 3,100.00 DIN,~N7fMt IA 7oWDannot inan~a Mora than'.10!/{ :, ^yI ,e ,.: ~ ~::.Oaod PaMIrE7Mpmb -'.:.NDD7 GovemmeM ncordinp kea 11201 279.00 784.00 Appniaal fee 1'804 410.00 410.00 CredB n:pon 1'805 6.20 8.20 Scednp Fee a808 15.95 15.94 Fbod CeMflcatbn 17312 19.50 19.50 a Total Incrsau bekeen GFE and HUD-1 CMryes _ 730.85 613.BS ~ i -115.00 a 16.7394% .M TIrMb4Pn,C aPga "~: !-5:_:. `.~. ~< ..'- ;.:: ~ ~..BOOdFaNlr.Fatllrnb ...HUC1 ::;:i . In8ial depos8 brywresuow aeceunt (1001 1,380.82 1,804.91 Dally 9derast chagss N907 S 12.4000 /day 235.80 235.80 Homeowners lnaunnce Y903 707.45 380.84 T8b servbes and lenders tme inaurence tl1101 385.00 1,283.75 Owrefa tab Imunnce a1103 1,208.76 250.00 a Lawn Terms Yow balal Iwo amount b S 105,W0.00 Vour ban brm b 30 years Your mXW inbreat Me b 92600% Vour IMIW maMty amount owed for pdnapa4 inkrest, and any =516.54 bcludee mortgage lnaurericeb ^x Prlnapal Q Interest Mormape Inaurerke Can your Inkrest role dae7 ^a No. Q Vea, 8 cen n9e to a rrlaxynlan of 0.0000%. TM feat charge wiA M on and can Uranpe again every atkr . Every aiarge dab: Yow Interest rob an inaacae or deaere by 0.0000%. Over Me IBe atM loan, your Interest rate la guanMeed k never M lower loan O.000D% or Idpter man 0.0000%. Even 8 you make your payments on tgne, un your ban balmce dae7 x^ No. Q Vea, 8 cen rbe to a mazMUm a S 0.0Q Even Y you male yow peymerae on terse, can your monthly amount ^X No. ^ Yes, 1M flnt IncrcYe can be on entl iha monlMy amount owed owetl br Dnc~il7al, iMerea4 and moripape Insurance rbe7 can nee to S 0.00. TM mavinum y on ever Aae k Is S 0.00. Does your ben Mve a prepayment penalty? ~X No. ~ VeA Yow netdmum prepayment penalty Is i 0.00. Does your loan Mvs • balloon payment? Q% No. ^ Yaa, you hew s Mlloon payment of E 0.00 due In 11 years on . Total monthly amount owed Indutling escrow aoaount paymeMa ~ Vou do nG hwea monmly eacraw payment brlleme ouch as property , nxee entl homaownera ~arance. Vou must pay these kern Gnat' yauneY. ' Q You Mee an adGBOnaI mon8dy eeerow Deyment of S 230.5'1 Brat rewh in a toW inhbl monthly mount weed a3 747.05. TM inclMen prlnapel, 1Mercs( any rronpape Naunnce and any dame checletl bebw: Q PropedY tasea ^% Homeowners Insurance ^ Flood Inaunnce ^ ^ •~°~ ^ +°° ~••._ •.:r ~wa.•+:u. •wur aw xnarmen[ crerpee eno roan Tarma Ilated on mb form, please tooted your lender. Exmw NUmeer 001223L9-001 MAW HUD 705 DETAILED BREAKDOWN OF ADDITIONAL REAL ESTATE BROKER CHARGES Description SNbr Amount 706. Notary Fee to Judy Palm 15.00 707. Appliance Repair Reimbursement to Dave Smolizer 83.60 Total as shown on HUD page 2 Llne #705 7g,gg HUD 1112 DETAILED BREAKDOWN OF ADDITIONAL TITLE CHARGES Deccrlp0on ~r r eater Amount 1113. Doc TranslWire Fees • to Select Patinum Settlement Services, LLRW.00 25.00 1114. Overnight Fees • to Select PlaOnum Settlement Services, LLP E30.00 1115. Tax Cert Fee to Select Platinum Settlement Services, LLP 10.00 Total as shown on HUD page 2 Line #1112 35.00 HUD 1200 DETAILED BREAKDOWN OF GOVERNMENT RECORDING AND TRANSFER FEES Buyer SNkr Amount Amount CIty b County Tax/Sfamps City Tax/Stamps: Deed E1,550.00 Total» shown on HUD page 2 Line #1204 1,550.00 Buyer SeINr Amount Amount State Tax/Stamps State Tax/Stamps: Deed $1,550.00 Totalas shown on HUD page 2 Line #1205 1550 gg HUD 1306 DETAILED BREAKDOWN OF ADDITIONAL SETTLEMENT CHARGES dm Descriptors Buyer Salkr Amours ~ Amount Amount 1307. Radon Mitgatbn System to Enviroquest 750.00 1308. May HOA Dues to Sherwood Court HOA 50.00 1309. Initiation Fee to Shervrootl Court HOA 100.00 1310. Resale Cert to Sherwood Court HOA 75.00 1311. Sewer/Trash 4/1/12/30/12 to East Penn Consumer Office 1312. Fkxxf Cerdficafion • to STARS $18.50 138.00 1313. Ice Maker Credt to Stephen J. Stanko 100.00 Total as shown on HUD page 2 Llne #1308 150.00 1,063.00 C m A o- wu o~ a S7 ~~6 (7 J tP y7 y, n E ~s ~i u~i d d ~ ~ N Y ~" N C3 ~ A O 1cY ~~~~F N ~ ~ ~ N d Y I t U y N bP N i 3 ~ ~ ..V~ ~ G y ~ 0 3, Z ? Gi 0 0 0 J1 mg Fj ~ U n~~ ~ 0 • V ~;~1 i _ ~~ :~ //1~~ i7~ 6 ~~lill~ii{~iI~INt~lnia~u.,.~ / 3 days u7ece~ ~',~a G~7 u bC~ 7 ~~ rm °' o c N~o$ ,p 7 7 u,y yc~ p~ p p~'"~d ~ J T p ~a,~o ~~ ° ~, o~i c'b~i Nd ~~~ v~ ~~ u~ yy~Nd CL ~~_"~ }O~ C'~ E ~ d O.~'}S p 43' ,o orc ~$ $u u~ d d y E oc~ m ia$~1 ~~~ ~°-s"- Edc~c OA~,p} ~~F^ d~~y{~ LO W~~ d Oe~ N~d ud'G ~~p~~d yW.~i66 7 O~ N~ T C C £r, Qj.~ r~ ~ A>~$~ = d 7 N uN~ ~ ao~NG aAQ ~~~'p Ay 7.37 ~~A ~G ~N~~ 3pdG t0 Vy_~1~ ~s'+J _~ 9~ y ,O ~~ C~rrv'a ~~ ~~ 6N1 r,~Q m ~Y~~ Oy 7! ~~ ~~QQTG~~!! ,p ~ ut, {N~j~y'-'" ~ ~~p~„ d'O E'er V L^ ~e °~ G s W~ -. • C d~ y~ b d Y ^.' •. jp 7 N b ~ W ~' r N O ~C .d R O ~~ r M t O d~c'j ^' C G ~~ ~ d N ~ ~~~ .~a~~ o; ~ C4 W~~ W ~> ~ d~ ~~ O Z I6 i~ N ~ N (yr(JIl A~ ~d'8~tl Y a 0 a ~£+wo~ ~ du°G< C Z ~d d d v 'o `^ E >~ o`d~~ d ~~ ~~~~ O .-t 4 v1 ~° ~z~ ~~ U~ V ;~ T s 0 o ' ~n I ~ r ~ 0 N j j 7C' _ ~ t + I O V a v ..: 0 m ~, , s~ w w m w n ~~~fi s ~~ M .,, d s N w ~~ m ~ x €~~ ~~ ~ Questians7 Please Visit us online at Page 1 contact us bV Jan 9. ~ ppkkctric.tom 1.800-DIAL-PPL ppl ~~ ,1-800-342-5775) 27067-36014 tan 9, 2012 ~ ~1$.~• ~ ~~,,,,, M-F: Sam to 5pm Your Electric Usage Pile Billing Summary {Billing detsiht on back) Service to: Ba~nte as of Dec 19, 2011 50.00 FRANK! TEZAK JR Charges: 8 TOMMY LN Total Dominbn Energy Solutions Charges $6.95 ENOIA, PA 17025 Total PPL Electric Utilities Charges $11.44 Meter: 80625000 Your next meter readnng is on or about Jan 18, 2012. Total Charges $18.39 This section helps you understand your year-to-year M ~~ §+ elearfc use by month. Meter readings are aduai unless Account 8atance $18.39 otherwise noted. PPL Electric UtliRies' price to compare for your rate is 7.769 cents per kWh pro ~ prr effective 12/1/2011 to 2/29/2012. For a list of supplier offers visit ao zs zo is c ~ io ~ s 0 Dec 2011 30 8Z 3 43f Dec 2010 30 510 17 37F Dec 16 Actual 56140 Nov 16 Actual 56058 30 Days. kWh 8111ed S2 Jan 2011- Dec 1011 2766 231 Jan 2010 -Dec 2010 7044 587 papowerswRch.com or www.owstate.pa.us. Your Message Center • With paperless biifinB, u can receive and pay your PPL Electric Litilities biiis online, The process is free, quick, convenient and secure. To learn more or sign up, visit ppkkclrfccom. . Information about appliance energy use and tips on saving energy are available Hlrough the Energy Library on our Web site, ppkhxtrlccom. 8 • Before digging around your home or properly, you should always call the state's One Call notification system to locate any underground utility Tines. You can do this by simply dialing 811, which will connect you to the One Cali system. ee safe and calf 811 before you dig. Payment Methods ,/~ OnNne at: - ®8y phone: i-800.342.5775 ~ U ppkkctrk.com or p118i11Matrix lservice fee applks) i 800 672 2 5 at - . . 41 to pay using Visa, mm MasterCard, Discover or debit card. ® ey Mall: Correspondence should be sent to: 2 North 9th Street Customer SerWces CPC-GENNi 827 Hausman Road A{lerrtown, PA 18101-1175 Allentown, PA 181049392 ~ s Other GnportaM Information on the bade of this bill -~ s%.Sf'u`P.s~'$Li•G'~s~ipf ' 0.'4961!'11li+ r+.,.Y,MbYT.!.itCSAffi!11`k6'+'x°~`k!i:s"{+S£ K1':F.{ a- FRi1MK J. ~1LK dR. 3371 ~: F1t1WKJ.tE,iAK.W. 2¢t7dvENOAD srtNxo 0(ir~p1NNON.PA 17ozaeers,'°~«~•. ,2 7 2.01_aoa tr y~ Do(tars a+ ~rJ: ~l~izens Bank cro=em Cirdg Accamt for - d ,~.: c'.~.c ~ ~,.~ _~ e ..Lf-.aG~~~ _~ t:036O7~i5Dt: 610O71O955w 337; ` - ,.~,~.. J F M A M 1 J A S O N D Mantle ~~~.~i ~' ~~ r~ °m z I j ~.a ~~~ ~ h O ,° a~ ~~ $~! ~ ~ ~ ~ ~ ~ ~ ~ }. ! ~ ~ ~ n ~ Y ` } I ~~ fn ; ~~ ~: U-~ cIl ~~ m d~ .;: r u wa ~¢ 00 ad 0 Y w o ~.. ~a ~I :: c~ ~; 0 a 0 T n 10 ~ m ~ C `D• ~~~~ m ~ a '$.3'$ ~ ~ ~~ o w~ w ~~ Am m ~~~« m c $=~ N F ~ p. ~i+~- i . ~ rr® T ~~. 3~ ~~~ N q w" ~i~ 3`° 3 ~ ~" ~--'L~ „~ n ~t ~~ ~~ r~ g, ?. .Sr + m 3 r, O~ 'n m .~ . ~~~ ~ ; ~ ~ o ~~n_ NN ~O ~ C~ ~ o~ ~, ~..~ ~ r~`m ``` w $ ~< a s,~ ~~ ov ~~ ~~ ~x~ ~ ;~: 4~ 4~+. .~? S Questions? Please ,fry Visit us online at Page 1 ~~°6"P•'~ contact us by Apr 10. _ t,J ppkledrk.com ,; 1-800-DIAL-PPL .;.: - PP , „ (1-800-342-5775) 27067-36014 Apr 10, 2012 sY4`' rvt.~.a,+~wwu.. M-F:8amt0Spm Your Elect'it: Usage Prtrfile Servke to: FRANK J TEZAK 1R 8 TOMMY LN ENOLA, PA 17025 Meter: 80825000 Your Held meter reading Is on or about Apr 18, 2012 This section helps you understand your year-to-year electric use by month. Meter readings are actual unless otherwise noted. 2011 ~ 2012 za zo 16 r B lz ~ a Q a J F M A M 1 J A S O N D Months Mar 2012 32 56 2 44F Mar 2011 30 499 17 39F Mar 19 Actual 56405 - Feb 16 Actual 56349 32 Days kWh Billed 56 Apr 2011- Mar 2012 1495 125 Apr 2010 -Mar 2011 6851 571 Billing Summary (Billin8 details on back Balance as of Mar 2A, 2012 $0.00 Charges: Total Dominion Energy Solutions Charges $4J5 Total PPL Electric Utilities Charges $10.59 Total Charges $15.34 Account Baiance $15.34 PPL Electric Utilities' price to compare for your rate Is 6.935 cents per kWh effective 3/1/2012 to 5)31/2012. For a fist of wpplier offers, visit papowenwkch.com or www.oa.state.pa.us. • With paperkss billing, you can receive and pay your PPL Electric Utilities bills online. The process is free, quick, convenient and secure. To {earn more or sign up, information about appliance energy use and tips on saving energy are available through tfie Energy Library on our Web site, ppklectrlc.wm. • Before digging around your home or property, you should always call the state's One Calt notitication system to locate any underground utility lines. You can do this by simply dialing 811; which will connect you to the One Call system. Be safe and call 811 before you dig. ~Z413 to pay using visa Discover or debk card. ® By Mail: 2 North 9th Street CPC-GENNS Allentown, PA 18101-1175 Correspondence should be sent to: Customer Services 827 Hausman Road Allentown, PA 18104-9392 Other important Information on the back of this bill -~ s ;~ s~ '~ ((I~~~.. ~ 91 }I~~~^ i _T M ~~ ~. i ~' ~ ~ m O ~' !, ~ d ~ m N r lf~ i~ Q m O a O ~w Y ~ ~A } \$ fi ~ ` ~~ r~J N M r' 4 ya 'm Ff' a ' ; n~ N m ~. ? C d v yy`~. .~ N ~` $~ _~ +~ t i~ _~~i :'~ Y ~> ~~~ ~ >~ ~'~7 ~ yZ~ <~ ~ ~ A ~3'~ m ~~ v ~ C ~ ~ a. ,~ "d ^ ^ S `~ ~ o N "~ ~pp C NG~ R N m~ ~ a N C~ N B~ ~~~ ~' ' ~ ~~ ~-, m $~F v 3 ~ ~ ". N A O {A~ ! '+~m ~o N~ R ~~ Vii. ~~ A N ~~ M n ~~ r+ ~~~"y`'. ~.4` ` '~}`~. . q~ ~~~3~ :!' h~i d~ ~~ y$~yyA ..33 eeee~~TT''" ~ N ~ tV O ~~N~ v ~ 9 ~ ~ i ss '~. ~?? N V ~^y 1O `~` e~ 3 3~ BZt t' c0 ~~~ a a ~ ~ Z _ h- N V o ~W mow? ~~ ~Na G F z w~ j -'z aa~6 ,,, !~. fla J II a a a ~ =~~~ ~ = ~z 4 LLcoW 7 ~s 1~f ~ ggg~g b'X ~~ W W ~. ~ ~g. ! J _ ~ 'Q ~ U fa '11 ~ ~~, s f A .71 w 1 r' ~_ 0 Y ~~''. 0 9, ~ ~ N ~ ~~ m ~~ ~ N G ~ ~ M ~ ~ Q :. ~~ O ~, ~ m ~n m r~i I + ctl ra ` o- a ~ ~ o ~ c ~++ 0 m O .. J ~~ § ~, ~~ o. 1 Y ~ ~" 0. 0 . ~ ~~ zo 0 ,H~: t-¢c w r (J V ~QF w o 01/01/1999 00:80 7179328764 ORIAN SiQF PAGE 81 Tars's CINOinB Ssrvio~ rte. ~a 1~s1e (T17}~A~-1098 IIWOICE Mroio~ IWxrrbr: 0100 Inrol0~ OMM:12/211~011 Cswrr. ~ Mrwe Nr~s ~dw~c 8 T Laos ~~+•~ 8 T CaMN Enoh PA Oidr tdbrnrlbit ~. tlAk'~'[F'6Yd'Y~%° .~CA6 M1ffiieT1E~tMr7aLXW~C.`i[`iA«F'b 43'ftb v:'FA'A^i'"~"s^.~1~:.+. -:,. Fe~iac.~. reuK, fin. - 3373 °_ FRII~IIC d, TE~11K1N ~~-__~ ./ ~coirEteowo dJNCANAIDti, PA 17020~Y814 J ~ u`~'~ .'~.G' j l &ni ~ / ~. u_ 1/ Pay to Yhe~ ~,/,/ ~11'~ ~ .. ~ , $. ~ ~~~.. orckrof~ ~/' k~1~-r£~-..c-~,r `'c..,.., ,-~c.~r::..- ~! ., :.' irorrars ~ ,„:~,: +~ Gtizens Bank crow cap Accowt For ~`'`- ,;, "'~^a._ ~.,~ ~_~y Doc-22-11 02:18P C.OMNONMIEAL7H CORP r 1 nave srioLtzEa RHNAX REAIA'>f,atASSOCIATSS l 8 TO!!MY LA ~+s BNCILN~ PA 17025 Cf1Y ;TI17F TCeM 7177700606 ~ P,p2 O1ti1ntOAW@~~1 Corporation l • ('ORfheHfpl • Reuomaiorl 784 GOl~gtaes COGS. LinidriN Catstttee;; Park NYw Cwn61rYn11, PA f 7070 I RlG. R/dI' lUB. P1eCeE f/1!-l. w v vwcti tw[~ ws. tb. S[rwa tsin; r awn ass . ~~ W? _ 1 1Ki {p~; ..... p/c chew ~ L ~ auw r atw. f7p[s ' I ~aew _ DESCRIPTION OF SERVICES Ccd.4.ESS ~ Ep6ELCARPET CLEANING OF: SHOMCA88 8 .38 s£ .._~._ Q~a~ ._,.32/sf . ... _. ......_.. -. `LIV R!!/AIN RM COM80 ~,~ X ll _ } Z /~~ - -~ 1 ~~ ... ---- HIiARM~Xj.Z * /LIX~Z, __ l SnNR~.~ x.9 y~ ..._ lo`~~ .-....... ~-' lax.a~. _._ ~-~- NOTE: SPECIALISSn CLSANING OH HEAVILY L" BAST s x e HATE ~ TSCH fExcL EDCS cLSap), c CORP ~ GOARAI . _ ._..... RSt60VAL oa ANY" ne, ~ _ - _I '"'w -- s. i o~cr SERNCES SERVICES, p~-- ~~J ~/ 7(.~ . 3~.... . I_~_ G-~ CAINS,OR ~r HR PER ....--- -... 1Olll nOwu rROlxrcrs /VrD10R SB1VN2:5- ; . _ CtINlY-YG ST/t`CAG7E .. _. ... ~~ asuw. aatsnaiYa Lr 1wenM a.~rtas. ti+...wM ~........, aaa/a~4M~rMras W ~ ~ ~ ~ ~ ~ mra ~oaxis AWfOR SERVICES Kf aYSiI Y.-' M p. iW w ;mtl I ~A~E vnat0~ V w ,~.~.~.~~.;~~w:~t~~~:~~„~.~, ,.~:, P.,t~~:~w~, ~.~,%~:~~.~~.$~-a.>~U,, .:,~:~: TOTAL ~~ r~ 3~ .. F7tANK r. T~tAlc, tom. 3372 ~...• 26feCfVFROAD _ ~? >„~s,~ ----- I WiNCANNON,PA t70¢0~6f4 - ~/ .~ti. ~~ ~~~C-~~ 7xi ~ j n ate erof -~r.. ;.c"i+.1.4-f'~'.~titi! ~; ~ .~ ~.t 4.~ti~r:~ .. ~D :~. STS .,...~.-- .~ R~JN• T •.+r" ~N LZ'y"~"FPf/ '.?'+~,FL_•i { .-+r'. _._._,:.,._..., ,13 : • .~ Ilr awe. Mnarn ~ ~Yn n tut YM' 4 ~ '~' ~ZdDollafs 8. '~'. ,.•.• .b.i. 1N tw. r w t;- a• aorM. CitixensBank ~'' c~`"`c;"~~"°""` ~ ~ a n u llNl pFt7C C;NI OIlQ !,~ '+ ~ C A ~` :id [ ~x~.',C ~ , .. - fns h' ~< iC" ~,~__~ z'"-~-, v • C-' ,y°' ~: r~ w _~ - _ - - .-.~ inn .rr..• e~•nnntr~nr r_. _ '+~f not -. CA1 t1_aePU. eur PROPOSAL From: Roberto Ortega 210 Tall Oak Dr New Clunberland PA 17070 To : Dave Smolizer 8 Tommy Lane Enola PA 17032 INTERIOR, TO PAINT WALLS ALL ROOMS INCLUDING CLOSETS $800 PAINT ALL CEILINGS $4S0 PAINT ALL WOODWORK $3S0 EXTERIOR-NONE. *Licensed and Insured *Prep work incluc~d *Paint and Labor indtrc~d Total $ 1600 Dep S 600 Bal $ 1000 If you would Irke us to she you work please forward a signed copy of This proposal along with you deposit. Deposits are due at least 4wks prior to the start da'be and the balance is due the day the job is completed. Fates are good for 60 days. PA #019426 Thaalc You Signature Date Page 1 _. FxnNK J'rszntc, Rt. FxnNxJTSZnxni DIANE L MAHONEY zscovExn. xM2io v,wirrnnA `M'HiAN HOMEPH.717$34-SS21 ,~~„~,3 14 0 9 DnTE ~ ~ % f p{TpICANNON,YA NAr ~, l $ ~ UG' PAY7O p{{p OP ~~ p e y LLA&S' L'1 :: xa S~3 MEMO • ~~~~~ ~~~~~~~(c~~- -~ M ~:23i3p224i~: 2i82664835~~' L409`" / ~,~. .~PSYttP.`.s~¢ctr;lXSi?agMH!aYAia£'+]F.<E;-C•~3itleW~4Y6tty W.+ti.WW~FY.",rJ~Yf~i49:1ffiaC+l4"oy iFBt.SM'.iit'itSgts'..1M.bl .SvT?"~. •.'-.::v R °-~-~ ~tuwK ~. ~wc, .x~. 3387 ~---~~ FrtMUC r. xeu~ nr ~ex~venoao >•n,vno DUWCANNON, PA 777lO~Y611 '. ~~. '° ~ Z.. ^ ~ [ ~ Date ~~~ JJ,~ r G.~- .J-z' -~ v r.' c~. ilars Q ~~~::~ ~~ i`o~ Cttjzens Bank c c~ Aix For ~% J .-•;.~~~~~~--"~ ~:d3f~076i5~i: 6100.710455' 3 Jh,`L~ t~"~~~~ U ~ 1~ G N ,~ ~Is ~_ ~ ~ ~ ~ CtJ ~ ~ ~ ~ ~ ° `~ ~ `~ ~~~a= p d ~ 1 YI W ~~~ y 4 .~\ i W J ~ ,~ ~ Z ¢o ~ 1 ~ ~ 3r - ..~ ~ wz FT Q T .~.,~~ N N {~. 'G .~ ::WT .~~ y r `Qd ~o p ~G6 4$ .. 5 ~ W T ~; f _- ~ ~ r ° g2 ~o ~ m ~ ~ _ I ~~ '~ ~ C' ~g~~~ t! ~~ ° 2~~ ~. ~ g <o ~~a~~ '~ ~ ~1 ~~ u ~ ~~ ~+ r~~ . ~i~ aaoo O -~~. -m:.~-_ re~=x+ur+wa~ ..iaies4wwumo 0 v~- o ~ o I oo~~:n m M ~ {~} ~ Q' C N M H W . ~ _ -~. N .F.- 4=Zo g O ~ Y ~ •ni q $ ~ ~ ff O ~ a s ~ * ~ZZg g pQ~ Q O 2 . 6 LL W W 'i ce 4 FW- . ~ Q 7 h W ~ ~ ~ t'~ -+.~+ F .. ~ 60 i ~ C7 (7 . 11 .. ti ,-~ Q..... ... _ _ _--- ooa~ _ o.~ .~. ._ .-. OON~ O'O N ~ d ~ ~ ~© ~. ~ C Yt IA~ . i BY O ~. ~~ > ~ w ~~ i ~' ~ ~C ~ ~~ ~~ • C - c ~ soa ~.- . . . =w a a°c~w a3 ~~ ~~ J 1 i f r. ~ ~ ~ €~ 0 ° o N O O D p ice: O ti RI i- 0 O O O N O r 0 v n 0 ', a m N 0 N N ~R ~fi z ~~9 H ~~ Q :.~-,.., pp ~~. ~; ~. VI ~: a:a G1 ~ v N N a !~ J .1 t"V ~ 69 S O Y "x C m h N ~ ~O u k °o >~ MY a o t a~ , • N td rfi N ti ~~w iii ~ ._• ~. .a ~~ ~i p~ -i Q ~ , ~, p g~ I o Y~ y 0 5 o O I w ----.__.._-. w.~~~ H IJJ JU rK! BII~IIapJ ~NKrr1r ter 8srvica to 8 7pMMY LN JR Ea04A PA 17026 pets t5eaeMeaBm: pesidsnbalHsaNnp BlNiet Peeled: ouo9/zo12 to p1/31/2o1z (26 soya} gmpeny Rsad 8276-2722 a wrifi to UG1 at PO t10X 13009 IMading. PA 19612-3009 ' Your currant U01 eharyes inducts State laNea tstalirp atawt 51.84. Past 9m lnterwatlon-u011U81Hy r..,~ ';~ The aecourd balance on year Last bill was _,..__.. 5 A3.55 w Thank yar to your ppaayymmentot ._____..__._..._..._.~-4 8 220443851017 Your baland an of 02/03f2012 ._....._..._.......__. IatarmaDelr-tM0• IWtily s (47 t:CF at 50.83892! .._..... sa drat 47 CCF at 50.40468} . MaM' Inlorwatlan • Msat lisad Dad 1369988 9298 (cvmparyg 3945 (coropemr} 4T Msppss Mow •Yow eurrent price to tempera is 5 0.68010 /CCF. •Yow tMal annual use !s 304 CCF. Yaw avsr~gs monUdy Maps is 281X±r. •Wa can make your soapy costa aaisr on yaw budpst wffA ow 12 month Budpat Billing plan. Ywr nioMhly payment would be approdmatNy S 36A0 . For mare intamadan about this plan wN UGL •Hslp prevent pigsties damage aeddade and aen4ce d'mrupNona. qIl 811 bstora you dig. 'tlid you racantty mob the switch to natant peal Sham yew story with ua at www.ficebook.can/ugfuBNties. •Save time. Sane the planet Sign up fo viewand pay your UGl bibs onNns at wanvupf.can. Last Thia '° Avaipe Year Year CCF/day 3:81 1.6 N you pay at a payment spent Abase take yda entire hN4 Make eheck payefes to UGt. DeNy bmPersturo eF Keep Chia part for your records. ImpoRant IMormNlon la on the back of thh blll. JFMAMJJASOMDJ 2011 MosMs 2012 1! ~~ i~a ~~ ~ 4 J Z ~aa ~ O r~ ~ ~~ M -} ~ ~ ~~ W a 0 ~~ .~ to li, ~~ `p; H ~~~ ^`s !. !~. Yom: ,. ~i, r o- sD ~" rM ,~ aC a N . 'ey~_ N ~ ~-Sj Ln ~. ~"~ •• r ~. III .. ~ cD N ' i~ Q NI D u+ D C A ~ W N ~~ ~ Q ~ ao ~~ ~. ttl ~ O ,/1 ~ LL _-- ~ m Q< c m ~; ~ -i ` ~ ~.. ~ m =~ T o ~ ' ` i1 o ~$~ < tf1 O ISI $ S 1qaq ~ F~ w a r t] :. ~~.~ ..r. ~ e fV '. ~. ~~se.,y N m' W t~A p+ a' a' ¢r c -R i i v~ ~•~~ 4 n ~A ~3 N , D m ,I ' w l `~~ ~ D O , ~ r r v, Z O D ~ m k t31 6~~ _g ~$ J~ f _ ~_'_ ~.___~ '~ ~ ~m "= p C~'~~ ~ ~ O ` nOO x. c _ $ ~ ~ ~ ',~~ ~•~ Zfnx'^ ~' f~ ~ OOO' o m ?' ~ d ~'~: Si :~~ ;N= ~3 ~ y=r ' o yN ~$y+ S+ -p "' J` ^ p ~ ~ U+ 8" :mom =m ~ Q s' r Q c A ~ ;'~~ ~ ip =~ a' N ~~ ;~~ ~ -~ ~Ty' ,~ ~ m ~ , ? -- ~€ '.•' :~. J. ~prn ~ ; ~ D t" c w O r a> y a rn q m ~z v .9N~ N F a ~ ~ \~.. ~ ~ a i W ~ - o ' y r y Z ro ~ V., ,:+ V N ~ ~ i Y . m.. c C G n 1 t u k J a z C 1 C C G G G G 0 a c c C C :° 0 w `^ O r j ~ .. :r I O A Q ~M1`,\` Q ~il'~ Ii ui ~ ~ i ~r w u. m ~a 0 ~ ~ ,w ~ '•' ~~ ~~ ~'+' ~ y ~`~ 3i ?~ 1 r ~t~ C1 .... Q, ..~€e~ y00 W r (~ (y~~ iib Qw~ W p~~ Dm Z ~a r 2# `" ~ n O (p \ ~ ~ iN0 b z ~ ~~ ~ N _~ ~ ~ k=~ d ~ ~ ~~ k ~ 1 •^~ ~.~~~ a .• ' ~ '~ ~' ~'a ~~ ~ ~~ • ,°, ~ ~• ~~ ~i~ yam, ~ 'T '~ m "'~ ~! w ~. ~ ,,; ~. ~ r ° ~ _ r ~ m ~ ~~ ~'~ ~ -- .__ . ° N ~ ~ G°'O~ ~o~- ~ymx'^+ z~o~°~- z°~z~. m a ~ym , '' qN o Z~ > m $ 0 0 K 7 s'i .0 ~y 'O Og ~ppp ~N y N 'v -Tp ~ ~ G ~9.{{ a "{ to d o '~ "' c ~ ~ w w r- `° ~ ~~ ~~ ~ a ~~- 0 F Y'~ Customer Account Intormat/on For Service To: Jr., Frank Tezak 8 Tommy Ln Q 1 Account Number: 24-1319640-9 Premise Number: 24-0596648 Blll/ng Period & Meter information Billing Date: Mar 20, 2012 Billing Period: Feb 14 to Mar 15 (30 days) Next reading on/about: Apr 16, 2012 Rate Type: Residential Meter readings in current billing period: Meter Number N074642206 is a 5/8-inch meter. Present-actual 283500 Last-actual 283500 Gallons used 0 Water Usage Comparison _ _ Monthly usage In hundred 1 2 M A M J J A S O N D J F M 2 D a ~ y n 1 9 P t v c n b a 0 7 2 $13.75 -13.75 .00 13.75 13.75 $13.75 Messages to you from Pennsy/van/a American Water ' Anyportion o/the water charges which is not paid as o/ 4/1&/12 will be subject to a 1.509 penalty. Aqpppproroxrmate/y 4.57 percent or $.62, of State taxes are included in yow current 6111. 'ENec6ve Notrembar 11, 2011, the Distribution Sys[em Improvement Charge (DSIC) decreased from 5.449 to 0.009. This charge /unds the replacement of wafer distribution /aal~ties. 'Have you recently changed your primary phone number? Il you have, please update your account information using My H2O On 'neat www.amwateccom/myh2o or call us at the number below so that we can update our re Customer Service & Emergencies 1-800-565-7292 (24 Hours) For Hearing Impaired Customers TDD 1-600-300-6202 (24 Hours) Visit us online at: www.pennsylvaniaarttwater.com RAW100AW1361 B/l/ing Summary -----Prior Balance--_____-----. Pno~ Water Balance Payments prior to Mar 20, 2012. Thanks! Total prior balance, Mar 20„ 2012 ------Current Water Charges------- Service Charge Total water charges, Mar 20, 2012 --------AMOUNT DUE 00003?JOOOW2 NCOMDV TA81015 A1M 36056 _. .. -_- (mll D m 0 ro p{ o O -i -. m CJ 9~ flm a~ ~' ~` c fl s ~ ~i O ~ ~ t'~+~ 1~~ ~~ 1 I `' Q a ~ a m r Q n, `'~ r -~ i i~ . y... N ~. ~` r T ~~~ ~~ ~ s ~.~ a ~ ~ ~ ~ Q Yom` ~~ ~~ ~'wF tttyy9fffjjj111 J ~ pSMN 3'. ~II' ~ ~ J x i ~ 1a p ^J n~~ ,~ ~~ ~ ~.. ~~ ~ ~ i O' r D 71 N ~5 g ti O ~,~' y.a B~ ~~ ~~ ~$ ~~"~~ &~~~~ g ~~ ~ ~ n~~ -. ~~ ~~N Li ~. 1 N f'' `+ W W I , y J C ~I. v p tl~U UU ~" 'g „~,8 ~ . ~~: S ~"~ r 'rt A ~, I~ C a ,.. ,}vet O1~ t' ..a o C' ;> n ~, 1~' ~,~ ~~~ ~: ~~:, ~rl ~'~, ~ ~ ~ ~'' c '~. ). tl ~~' ~ ~ ~. ~•~ ~" ~ :~... 1~c ~~ ~~ i 1 } ~~ ~, ~' '< ': i~; ~, ~ O ~~ ~ N~ .'' J 1~! N ~ ~ Na • 7 h `~ '9 ~A m N ~ p ~ ~ n O ~m 7 N ~^ ~ .~~~~ o ~ ~ °* 'o d ~ ~~ O e ~ r O ~' ~ ~- r uti O .. .. ..,. tf' ru , r. w ,. tb ': ~ . a . a \`'\./ ~i m m '~~' =t b ~,;. s f -T °,__, DY, 1' ~i m l 1 6 ~4 #~ ~ ~ ~ O P m ~ ~CP1 ~~ {~~LL PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Cazlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, viz: January 6, January 13, and Januazy 20 2012 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and chazacter of publication are true. r , ~~~ Lisa arie Coyne, Editor SWORN TO AND SUBSCRIBED before me this 20 of January. 2012 Notary Tesak, Ftaak J., Jr., deed. Late otthe Township of East Penns- boro. Executor: Frank J. Tezak, nI, 8 Annette Drive, Enola, PA 17025. Attorneys: Craig A. Hatch, Es- NOTARIAL SEAL quire, Gates, Halbruner, Hatch i$ DEBORAH A COLLINS Guise, P.C., 1013 Mumma Road, Suite 100, Lemoyne, PA 17043. Notary Public CARLISLE BOROUGH, CUMBERLANDCOUNTy My Commission Expires Apr 28, 2014 CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717) 249-3188 Fax: (717) 249-2683 January 20, 2012 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Craig A. Hatch, Esquire Frank J. Tezak, Jr. Estate RE: Legal advertisements must be received by Friday Noon. Ail legal advertising must be paid in advance. Make afl checks payable to: Cumberland Law Journal. Advertisement inserted on following dates: January 6, January 13, and January 20, 2012 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received Total Amount Dus $ 75.00 $ 0.00 Becky H. Morgenthal, Executive Director The Patriot-News Co. 2020 Technology Pkwy i' Suite 300 ~ Mechanicsburg, PA 17050 Inquiries - 717-255-8213 GATES, HALBRUNER & HATCH, PC 1013 MUMMA ROAD SUITE 100 LEMOYNE PA 17043 ~e atriot~~'ews Now you know THE PATRIOT NEWS THE SUNDAY PATRIOT NEWS Proof of Publication Under Act No. 587, Approved May 16, 1929 Commonwealth of Pennsylvania, County of Dauphin) ss Holly Blain, being duly sworn according to law, deposes and says: That she is a Staff Accountant of The Patriot News Co., a corporation organized and existing under the laws of the Commonwealth of Pennsylvania, with its principal office and place of business at 2020 Technology Pkwy, Suite 300, in the Township of Hampden, County of Cumbedand, State of Pennsylvania, owner and publisher of The Patriot-News and The Sunday Patriot-News newspapers of general circulation, printed and published at 1900 Patriot Drive, in the City, County and State aforesaid; that The Patriot-News and The Sunday Patriot-News were established March 4th, 1854, and September 18th, 1949, respectively, and all have been continuously published ever since; That the printed notice or publication which is securely attached hereto is exactly as printed and published in their regular daily and/or Sunday/ Community Weekly editions which appeared on the date(s) indicated bebw. That neither she nor said Company is interested in the subject matter of said printed notice or advertising, and that all of the allegations of this statement as to the time, place and character of publication are true; and That she has personal knowledge of the facts aforesaid and is duly authorized and empowered to verify this statement on behalf of The Patriot-News Co. aforesaid by virtue and pursuant to a resolution unanimously passed and adopted severally by the stockholders and board of directors of the said Company and subsequently duly recorded in the office for the Recording of Deeds in and for said Gounty of Dauphin in Miscellaneous Book "M°, Volume 14, Page 317. PUBLICATION COPY This ad # 0002186955 ran on the dates shown below: January 06, 2012 '--uary 13, 2012 uary 20, 2012 A.D. COMMON 7t10P PlNNBYLVAIytA Na4Net SeN Sherrie 4 Owena, Ndary Publk ~ •, DeuplUn CquMy rbv. 26, 2015 MEMBER PeeiBYlVAI/lA ASSOQA'rIOM Of MOTAIUES ~IJe ~latrivt-1~ews Order Confirmation Now you know Ad Order Number Customer 0002186955 GATES, HALBRUNER & HATCH, PC Sales Reo. Customer Account aieeds 2374 Order Taker Customer Address aleeds 1013 MUMMA ROAD,SUITE 100 LEMOYNE PA 17043 USA Order Source Phone Customer Phone 717-731-9600 PO Number Ordered By Traci Customerfax Customer EMail s. nace@gateslawfirm.com Pavor Customer GATES, HALBRUNER 8 HAT Pavor Account 2374 Pavor Address 1013 MUMMA ROAD,SUITE 100 LEMOYNE PA 17043 USA Pavor Phone 717-731-9600 Special Priclno None Tear Sheets Proofs Affidavits 1 0 1 Invoice Text Blin Bo Promo Tvoe M to als Net Amount $148.17 Paymeni Method Payment Amount $0.00 Tsx Amount $0.00 Amount Due $148.17 Total Amount $148.17 Ad Number Ad 7VD8 Ad Sixe 0002186955-01 Legal Liners : 1.0 X 19 Li Production Method Production Notes Ad Booker External Ad Number Ad Attributes Ad Raleasetl Fick Uo No Color <NONE> 12/28/2011 9:08:SOAM 1 Ad Preview LETTERS OF TESTAMENTARY for Me Estate o1 FRANK J. TEZAK, JR.. deceased late of Me TowOShip of Easf Pennsboro, Cumberlantl County. Penn- sYlvanlD, hdvlnD been DrWted b Me un- OerslDnetl on GlCember L, ]011, all per- sona Intlebietl to the Eatdfe are reauesi- etl to make ImmetllDie poYmeni an0 1hOZe hDV109 CIOIT4 Oflp1n51 MG Ezipte OfG repUezted tO prGSGnf 11,em Inr se11e- mentwithout tle IDY to: FRANK J. TEZAK, I11, Executor 8 AnneMe Drive EnolD, PA 1]0]5 or fo: CRAI G A. HATCH, ESG. Gpfes, HDibruner, Hdfch & Gulse, P.C. 1013 Mumma Rood Suite 100 Lemoyne, PA 11OC0 Product Information PlacemenOClassification Run Uates Run Schedule Invoice Text Sort Tezt PNCO::Full Run 840W -Metro West Legats 1/6/2012, 1/13/2012, 1/20/2012 LETTERS OF TESTAMENTARY for the Estate LETTERSOFTESTAMENTARYFORTHEESTA # Inserts Cost 3 $135.67 Online::Full Run 640W -Metro West Legals 1/6/2(112, 1/13!2012, 1!20(2012 LETTERS OF TESTAMENTARY for the Estate LETTERSOFTESTAMENTARYFORTHEESTA' # Inserts Cost 3 $7.50 12/28/2011 9:08:50AM 2 PA REV-1500 SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES and LIENS WEST SHORE EMS -BLS jwscovlx ~ ' 205 GRANDViEW AVE SUITE 211 ,.__. _..__ _ CAMP HILL, PA 17011-1708 ON REVERSE SIDE .~~~ ~Q~ Phone #: (800) 367-0512 Federal Tax ID: 23-2483002 PATIENT NAME: FRANK TEZAK Jr INSURANCE: MEDICARE B REJ FEP NONE CALL NUMBER: 222742W DATE OF CALL: 10!04/201'1 FROM: HOLY SPIRIT HOSPITAL TO: KINKORA PYTHIAN HOME ACCOUNT SUMMARY FRANK TEIAK Jr 25 COVE R0.KINKORA TDTAI- C-IAROE3: 250.06 DUNCANNON, PA 17020 PAYMENTS/ADJUSTMENTS: 0.00 pLEA$E PAY THIS AMOUNT. 250.0E nrrenu e, nun OFQMRdTIAN dN0 RETURN STUB WITH PAYMENT ______ DESCRIPTION OFCHAROE QUANTITY - - t1Nn'PRICE AMOUNT STRETCHER VAN -1 Way Transport T2005 1.0 108.75 100.75 Trensport Van Mileage S0209 20.4 3.74 78.30 OXYGEN ADMINSTRATION A0422 1.0 85.01 05.01 ToGI Cha ea DESCRIPTION OF PAYMENT ~ ~ RECEfAT .PAYMENT DATE ~ AMOUNT Denied by Insurance -FEP (electronic) 01/03/2012 0.00 Denied by Medicare 11/04/2011 O.DO Total Credits 0.00 PLEASt~ PAl' T}iiS AMOUNT -INVOICE DUE UPON RECEIPT -"~` orre,euen r:.a~rst ccc _ 4~~ nn 5250.0E 7 - U..... JIENT NAME: TEZAK, FRANK J CALL NUMBER: 222742W ~ AMOUNT PAID; ~ ~~~ olslsnol2 IPORTANT MESSAGES: A claim for this Invoice amount was denied by your Insurance carrier. Balance is your responsibility -please remit payment to our office. WEST SHORE EMS -BLS 205 GRANDVIEW AVE SUITE 211 CAMP HILL, PA 17011-1708 ~„y~>r~-- i ~ ~ ~ ~' R ,m o~ ~ N ~. ~ ~ „~ s ~~ ;;~ ~ ~, .~° ~, ~ a~~ ~ ~ ~ -, ~~ ~~, ; ~ ~. ~ ~ ~ ~ . ¢~ . w _ ~' a ~ ~" ~ ti ~ , ~ m .~ i_ ~ O 4, j •.f l.; .. ~~ ~, L ,~J ~V ~Q -~ ~: '~~ t_ ~ ~~~~ ~ ~~1 r -=$ N s~ WG. ~ PATNOLOG 9FNEY~ AOf CENTRAL Dept i38g4 POnBox 1 59~~oxDrravcETO: Oaks, PA 19456 For billing questions call: 717-652-8105 Fax: 717-552-2165 Office Hours: Mon -Fri 7:OOam to S:OOpm Yaa msY WY Y~ '{{('I{{11,1,IL~{,{I{..I{,{'11{I'L{,i,le{{{II{I{.{Ilnldlla{II tewsts FRANK J TEZAK 8 TOt111Y LN ENOLA PA 17025-1947 _12128/2011 I $48.50 I 106518 SHOW AMOUN7 A - ~ -~ - ~ PAID HERE W ~~~ MAKE CHECKS PAYA6LE / REMIT TO: r Pathology Associates of Central PA 4520 Unwn Deposit 12d Harrisburg, PA 17111-2910 IndlLnlmllod4,ad6ddLLun111LnnLllbnddd Please check boz tt above address rs incorrect or insurance , PLEASE DETACH AND RETURN TOP PORTION WITH inPormaaon has changed, antl indicate change(s) on reverse side. VDUfl PAYMENT IN ENCLOSED ENVELOPE PatleM: FRANK J TEZAK Account: 106818 Servbas Ren At: Pinnacle Hoe 1 REF Dife n~ _.. DNCMOf10e Ckaeeae ~ .ae..j__..._ ua.....r 11[11/2011 $8305 811R©ICAL PATH LEVEL 4 127;00 - _ 12/12/2011 Measeg®: MEDICARE HGS ADMINISTRATORS PATIENT - EMROLLSD 1N HOSPICE 12l27/2011 t.R AdJugtmenl F~ftAL BLUE SHIELD AFTER 78.60 MEDICARE. Menage: FEDF_RAI: SLUE SHIE{.D AFTER MEptCARE GOVT(L4CT FEE / AGCEP.TEpASS1GNMENT ,M, Y u may ay our bill online at hops://pay.instamed.co A7HOL0 AS$OCIA ES BALANCE DUE ~,8p PAY BY Janus 27, 2012 aloe call vrrih you- insuranos ooverape or For billing questions call: 717.852-8105 ntt the balance due today to: Fax: 717852-2165 M union Deposit Rd Office Hours: Mon • Fri 7:OOam to S:l>Opm rrNbury, PA 171173910 STATEMENT ~~~®~~~®m~~ SEE REVERSE SIDE FOR IMPORTANT BILLING INFDRMATIGN _ ~~ C ~ ~ G®3 ~ b\~~ ~ Ww ff V Q J 1 C 4 ...: ~~` ,:~~~ m ~~ _., ~`~ ~~ 9' ~ v. O a~'~ ~ ~s~_ r ~z NEW BLOOMFIELD EMS TRANSPORT P.O.Box 313 New Blommfield, Pa. 17068 1 ~e-zaaL Last: T~k First: Frank Street: Kinkora STATE: Pa - ZIP: 17 0 2 0 DATE OF SERVICE: l 0 / 7 / 2 011 d CITY; Duncannon FROM: Above Address T0; 879 South Arlington REASON FOR HAUL: apPt MILES: 17.8 atS2.00: $35.60 BASE RATE: S 4 0.0 0 OXYGEN: SUPPLIES: wAITiNG: RETURN TRIP: $ 7 5.60 ~yIO>~'r; $151.2 0 DATE BILLED: 11 / 18 / 2 011 STAT: DATE PAID: Ins. Number: Ai410UNT PAID: r3+~~~. rv~i.sr ~3E PLEASE FORWARD FRANK TEZAK III 8 ANNETTE DRIVE ENOLA, PA 17025 Secretary of NB EMS Rosie Campbell 582-7471 ~~~ ~s _ ts9x Last: Street: Kinkora STATE: Pa • ZIP: 17020 NEW BLOOMFIELD EMS TRANSPORT P.O.Box 313 New Blommfield, Pa. 17068 Fit; Frank CITY; Duncannon DATE OF SERVICE: 10 / 14 / 2 O 1 I FROM: Above Address q'0;879 South Arlington RBEA30N P'OR HAIIL: appt MII.ES: 21.3 at 52.00: $ 4 2.60 BASE RATE: 570.00 OXYGEN: SUPPLIES: WAITING: RETURN TRIP: $112.9 0 AMOUNT: 5225.00 DATE BILLED: 11 /18 /2 011 STAT: DATE PAID: Ins. Number: AMOUNT PAID: Secretary of NB EMS Rosie Campbell 582-7471 ~'~" f[[~` d5~ ~. °~~, ~ ~ 4 ~~ '. ,~~ ~ o ~ ~; ~ -~, f: ~ . ~~ o- .~ ~ ~ a: e; ~"> o ~~ ~ _ ~, 7 ,,,, -4 ~ ~ ~,~ }+ ,C7 ~~~, ~ ,~ ~ ~. ~ ~ c^ -.., C' ~~y~ 4 ~~ ~~'w~ ~ ~~ ~v , i ~ tii a p. ~ ~.~ -_ ~ ~ ~, '~ ? ~~ ~ ~ .iii ti3 ea.w • , _,,..i "s' ~...~-.^". ~y- o LL ~: .r A O N ~ A a _ .~~ x ,~ a ~- <p H r E ~ e~1 ~ ~ .~ C M d ~ C rl O a urn 0 °& as O ~ oo~~°no° !~ ~ O ~ t~N H N ~ w w c4i~ioob ~f) Y! y 1ff N N ~ V N m p p m 0 ~I ~ ~ ~ 0 O 3 ~ ~ .. .. 0 _..._ O F p ~ }}0o lA S a rn c F ~ E ~ 2 LL C O V1 Y C ~ n H Y o p y O O ~ .. - _.... ~.... .. O ~ 0 0 ~ N O r a d E x Y z ~ i a ~ ~ LL LL ~~~}c~~~ O ~- U ~ 2 LL ~ N ~ LL ~ Q w ~ ~ ~ d Q m J J N a~ a .~ ,~i O ~Ij U LL h a c n ~ as r a ~ . L !~ .~ a 3 7 Y C i ~R '\ t`Yl ~ '~" ~.1 T`'~ Z NN ~ R IfA 4 a `` ~, `~ ci ~~I ,c i~: ;;S ~i~ N 4 J G m. N d i V J S ~ ~a Yom. O Q aO w a ~~..