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HomeMy WebLinkAbout04-30-12 (2) _ _ • 1505610143 -"'~ REV-7 500 ~"°'-'°' OFFICIAL USE ONLY PA Department of Revenue ~ n ~y~va~nia~ cour~tr code veer Flle Numoer Bureau of Individual Taxes Po Box,2soeD1 INHERITANCE TAX RETURN 21 11 0970 Harrisburg, PA 1712&0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 199 34 9504 08 07 2011 O1 23 1945 Decedent's Last Name Suff°t Decedent's First Name MI WOLF ROGER A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL INAPPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 1. Original Retum ~ 2. Supp{emental Retum 4. Limited Estate ^ 4a. Future Interest Compromise (date of death after 12-122) ® g. Decedent Died Testate (Attach Copy d Will) ^ ~, ark M~i~a~ned a Living Tnnt Att COPY of Trust) ^ 9. Litigation Proceeds Received ^ 10. usal P2-31 Si and t-d -951 death 3. Remainder Retum (date of death prior to 12-13.82) 5. Federal Estate Tax Retum Required 8. Total Number of Safe Deposit t3oxes 11. Election to tax under Sec. 9113(A) (Attach Sch. 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number JOEL O SECHRIST ESQ 717 938 3396 First line of address 568 OLD YORK ROAD Second line of address City or Post Office ETTERS State ZIP Code PA 17319 correspondent's a-man address: Secnnstlaw(a~gmau.com REGISTER OF WILLS USE ONLY C7 ~~ ti m -~7~r~ n. c,-3 ~ W :'+3 ~' _i f-7~ ~7 1~ 1 Under penalties of perjury, I declare that I have examined this return, indudtng accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of proparer other than the personal representatlve Is based on all infonnatbn of which preparer has any owledge. SIG € OF PERSON~~RyESPONSIBnLE FOR FILING RETU ppTE /t Phili Bracken WoN Z ~ Z ~) L ADDRESS 124 r Avenu Co fatten PA 17728 31G F ER ER T REP ESENTATIVE '~ DATE '~ Joel O. Sechrist Esq. 2 y (~~ L ~8 Old York Road, Efface, PA Side 1 L 1505610143 1505610143 ' ' 1 1505610243 REV-1500 EX Decedents Nams: Wolf, Roger Andrew Decedent's Social Security Number 199 34 9504 RECAPITULATION 1. Real Estate (Schedule A) ....................................................................................... 1. 145 , 718.52 2. Stocks and Bonds (Schedule B) ............................................................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages 8 Notes Receivable (Schedule D) ........................................................ 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 10 , 073.53 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous -Probate Property (Schedule G) ~ Separate Billing Requested............ 7. 18 6 , 698.30 8. Total Gross Assets (fatal Lines 1 Z) ...................._...._..-.._.................................. 8. 342 , 490 _ 35 9. Funeral Expenses & Administrative Costs (Schedule H) ...................................... . 9. 16 , 009.50 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule t) ............................. . 10. 65 , 8 98.45 11. Total Deductions (total Lines 9 8 10) .................................................................. . 11. 81 , 90 7.95 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 260 , 582.40 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) .............................................. . 14. 2 60 , 5 82.4 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 .00 15. 0.00 16. Amount of Line 14 taxable 0 00 16 0 00 . at lineal rate X .045 . . 17. Amount of Line 14 taxable 24 0 4 at siblingrateX.12 - - y- 39.84 17. 28,852.78 18. Amount of Line 14 taxable at collateral rate X .15 20 ,142 .5 6 18. 3 , 021.38 19. Tax Due ................................................................................................................. . 1s. 31,874.16 20. FILL IN THE OVAL IF YOU ARE REQUESTINCa A REFUND OF AN OVERPAYMENT. 1505610243 Side 2 1505610243 1 REV-1500 F~( Page 3 File Number 21-11-0970 Decedent's Complete Address: DECEDENT'S NAME Wolf, Roger Andrew STREET ADDRESS 22 s. 29th street: CITY Camp Hill STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments 20,554.12 B. Discount 1,045.20 3. Inlerest q, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund g, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) 31,874.16 Total Credits (A + B) (2) 21,599.32 (3) (4) (5) 10,274.84 Make Check Pa able to: REGISTER OF WILLS AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a, retain the use or income of the property transferred :............................................................................... b. retain the right to designate who shall use the property transferred or its income :.................................. z c. retain a reversionary interest; or ......::....................................................................................................... x d. receive the promise for Iffe 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?....... ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which wntains a beneficiary designation? .................................................................................................................. ~ ^ IF THE ANSWER TO ANY OF THE A80VE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)J. The statute does not exempt a trensfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even 'rf the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0 percent ]72 P.S. §9116 (a) (1.2)]. . The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. . 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)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common wdh the decedent, whether by blood or adoption. 1 , ~ Rev7502 EXt (71-09) CDMMOMVFALTH OF PENNeVLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE IrILC rvUMCCK Wolf, Roger Andrew 21 11-0970 All real epropsrty ed bat~r~a or ae a tenant in camlon must be nrywrted at fair market vNus. Fair market value ie damned as the price at which prop9ny would be ng ng buyer arxl a willing cellar, neNhar belrg compelled to buy or sell, both having reawnable krwwtedge of the relevant fasts. RaN propMy which is jolrMy~wned whh dgM of wrvlvorship must W disclosW on aehedule F. Attach a copy of the settlement sheet H the property has been sold Include • copy of the deed showirp deeedard'a interest H owned as tenant in common. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Real estate at 22 S. 29th Street, Camp Hill, PA as sold 145,718.52 TOTAL (Also enter on Line 1. Recapitulation) I 145 718 52 (K more space is needed, additional pages of fhe same size) Copyright (c) 2009 form software only The Lackner Group, Inc." Fonn PA-1500 Schedule A (Rev. 11-08) Rev-1lG0a E%+(8-98) COMMONWEALTH OF PENNSYLVANU. INHERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Wolf, Roger Andrew 21-11-0970 Include the Proceeds of rilipaU'on erXf the date the proceada were received by the estate. All property joiMlyowned w~ktlh~ IM dpht or survivorship must he diaelosmd on fcheduls F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Caah 112.00 2 2010 federal income tax refund B28.00 3 Citizens Bank account 1,618.18 4 Income tax refund 459.00 5 Proceeds from sale of 2003 Vibe automobile 5,000.00 6 Proceeds from sale of personal properly 2,256.35 TOTAL IAlso enter on Line 5, Recapitulation) I 10,073.53 (If more apace is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedub E (Rev. 6-98) , Rer-1510 DC+ (8.99) SCHEDULE G INTER-VIVOS TRANSFERS t& MISC. NON-PROBATE PROPERTY coea+uoNwEALTH of rENNSnvANu INHERITANCE TAX RETURN REBIDENT DECEDENT ESTATE OF FILE NUMBER Wolf, Roger Andrew 21-11-0970 This schedule must be completed and filed if the misvrer to any of questions 7 through 4 on the rovarse aide aF tha REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION Of PROPERTY T E DATES O~TRANSFER.SATTACIi A COPY OFTTHE DEED OR CREAL ESTATE. DATE OF DEATH VALUE OF ASSET 55 of DECD~s INTEREST Exct.usloN (tF APPLICABLE) TAXABLE VALUE 1 Ameriprise account -Marjory Dengler, Philip Wolf and 49,876.72 49,876.72 Frederick Wolf, siblings of the decedent, are equal beneficiaries 2 Ameriprise IRA -Heather LeBlanc and Held1 Wolf -9:278.64 - 9;270.64 Davis, nieces of the decedent, are equal beneficiaries 3 Commonwealth Annuity -Jana Dengler, niece of 10,871.92 10,871.92 decedent, is the beneficiary. Her address is Stone Harvtast Fann, 60 Hardwick Road, Petersham, MA 01366. Please bill Jana Dengler. 4 John Hancock annuity -Marjory Dengler and Philip 104,947.48 104,947.48 Wolf, siblings of the decedent, are equal beneficiaries 5 Sovereign Bank account -Philip Woff, brother of the 11,731.54 11,731.54 decedent, is the sole beneficiary TOTAL (Also enter on Line 7, Recapitulationl I 186,698.30 (K more space is needetl, addiGOnal pages Of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc." Forrn PA-1500 Schedule G (Rev. 6-98) ' REV-1151 Ex+(10.05) gCHEDULE H FUNERAL EXPENSES 8~ co~.~~a ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Woff, Roger Andre 21-11-0970 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Yearfsl Commission paid 2. Attomev's Fees JOeI O. SechriSt ESq. 3, Family F~remption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address '~ City State Zio Relationshio of Claimant to Decedent 4. Prohate Fees 5. Accountant's Fees 6. Tax Return Proparer's Fees 7. Other Administrative Costs 10,671.00 5,000.00 338.50 TOTAL (Also enter on line 9, Recapitulation) I 16,009.50 Copyright (c) 2009 form software onty The Ladrner Group, Inc'. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF F{LE NUMBER Wolf, Roger Andrew 21-71-0970 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Baughman Memorials stone 2,815.00 2 Minister, music and food for funeral reception 625.00 3 Stone and Murray Funeral Home 7.231.00 H-A 10,671.00 A Copyright (c) 2002 form software only The Lackner Group, InC. Form PA-1500 Schedule H (Rev. 6-g8) Rsv-1512 F.X+112-0a) cowwNwEA~m of vENNSnvANw INHERRANGE TAX RETURN REeIDEM DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8~ LIENS ESTATE OF (FILE NUMBER Wolf, Roster Andrew 21-11-0970 RapoK dents Ineuerad Cy em decedent pAor to dsadl ttNrt rsmainad unpaid rt the dab of dNth, Including umeimburead msdkal eXpenaaa. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Electricity 304.00 2 Expenses associated with safe of real estate 53,715.98 3 Fee for income tax preparation for 2010 and 2011 740.00 4 Heating oil 788.00 5 Janet L. Miller, Tax Collector check cleared after date of death 1,935.73 6 Mortgage payments prior to sale of house 4,410.00 7 Retum of pension payment 3,051.74 8 Sewer 300.00 9 Supplies 132.00 10 Trash collection 46.00 11 Water 340.00 12 Yard work 135.00 TOTAL (Also enter on Line 10, Recapitulation) I 65,898.45 {If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Forrn PA-1500 Schedule 1 (Rev. 12-08) SCHEDULE J coler~~i7S`o~~~nNV, I D N BENEFICIARIES ESTATE OF FILE NUMBER Wolf, R erAndrew 21-11-0970 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal • distributions, and transfers under Sec. 9116 a 1.2 Philip Bracken Wolf Brother entin: estate 124 Rader Avenue Cogan Station, PA 17728 Total Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 150 0 cover sheet as a ro riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS r TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright (c) 2009 form so}tware only The Lackner Group, Ind' Form PA-1500 Schedule J (Rev. 11-08) LAST WILL AND TE5Ta*~*~'~' OF ROGER ADTDR&W WOLF HB IT RBMBI~ERED that I, ROGER Ab7DREW.WOLF,~aow residing at 142-144 Pearl Street, in Somerville, County of Middlesex, in the commonwealth of Massachusetts, beiaq of sound mind and memory, but ;;saw:=; ~e '~=a=-__i =_ -_ Wis. s sac: -_s my LAST S4TT.T. AND TESTAriBNT, hereby reva3r3.ulg all former wills by me at any time heretofore made. After the payment of my jest debts and funeral charges, I bequeath and devise as follows: FIRST: Z give, devise, and bequeath, to my ]~elovad brother, PHILIP BRACS~DT WOLF (born April 2, 1941}, all my property, real, personal, and mixed, wheresoever situated, of which I may be possessed, or over which I may have Hower of disaosition at the time of my death: PBOVIIISD, ltoraver, tLat wy' s.; .s brother shall have survived me. e S~OND- In the event that a4' said brother. PHILIP BBACICSN WOLF. shall have predeceased me, or should we die at the same tine, or as a result of the same accident or disaster, o. ~-= a joint last illness, or u_ncer cicnzs-~xs : `ar a_^e s:~ ~= 'the order o= ou=. cea=~ ca~c= ~e as`ti °'~'°~ v'=~ =B°~-?s certainty, or under such cirr-ars*a^^°s that tLer~e is m yes- sumption, in law, of surYivorship, then„ in such event, I give, devise, and bequeath all my property, real, personal, and mixed, to ~Y nephew, CRAIG LOUIS WOLF (bor; September 24, • jf~-' 1950); the said CRAIG LOUIS WOLF being the s ~ of qty brother, TODD LOUIS WOLF (born September 18, 1926), f~~~y j1 i -~ i I Rage Oae o£ Five Pages. THI~2D In the event that. bath my said brother, PHILIP BRF~CFCs1 WOLF, and my said nephew, CBA=G LOUIS SpbLF, sha11 predecease me, then, in such event, I give, devise, and bequeath all m9 Property, real. personal, and mixed, to my sister, MAR~7gRS£ JEAN DENGLBR (borne January 21, 1928). FOURTH: In the event .'=t =S ~;,; _,~-~'_-. Fr_-; ~ ~. and my said nephew, CRAIG LOUIS WOLF, and vY said sa.stcr, biA12JORIE '3FsA~T DE6GLER 3haTl predecease me, then, in such event, I give, devise, and bequeath all my property, real, personal, and mixed, to those of my Brothers and Sinters only who aha11 survive me; my said Brothers sad Sisters who shall survive me to participate in all my property i.a equal shares. ~= in the event that my said Brother, PHILIP BRACISEN WOLF,t and my said Nephew, CRAIC- LOUIS WOLF, ~d _: s== S:s =e= , lSAR.TORIE JEAOi DI807GGER, aa~d all pf, ~q said Szot6erss aid 5istexs shall predecease me, then, in such event, S give, devise, sad bequeath all ttiy property, real, personal, and mixed, to the }seas vhp shall survive me of my said Brother, PHILIP BRACKEN WOLF; the said issue of my said Brother, r Philip Bracken Wolf, t0 participate in all my pronerty, zeal, personal, and mixed, by Right of &earese=$a__a`. SIXTH- In the event that my said Brother, PHIL $FACL~T IiDLF, and my said Nephew, CRAIG LOOIS WOLF, and my said sister, lSARJORIE .7F AN IIE'kQsE.Z• ~d =I? 0= _,' =a== ~=C~.~9 ;-d J L'd 91C~LZE(OLS) ~a~IW~~I d40~L0tlOldsS PAGE TWO of three poag~es.~ / • J 6isters, and ail of the issue of my said Brother, PHILIP SRACICE3v W(A.F, sha11 predecease me, theft, in such event, I give, devise, and bequeath all n1P property, real, _ Sep 1011 01:O5p Lyco Micro (57D~27-5376 p.1 l perso~aS, and mixed, to those persons who would have i~lerif~d ry personal estate as if I had died intestate, amd ~--~, ~~- a = ~=~~,t of ,.-.e r.+~-..~^^rrealth of xassaczsetts; the said persons to participate in all mY ProPertY, real, personal, and mixed, in the proportions provde3 'Eor by and under the said Laws of said Commonwealth_ SEVENTH• I hereby nominate, constitute, and appoint my said Brother, the said PHILIP HT2ACEa$I Wl1LF, to be '-..z~-'-=_ =f '.=s 1(32? a*id 4estacent. I request that .o sureties on hi.c bond as Executor be required. In the event that my said Hrother, PHILIP HRACgFaT 140LF, shall have predeceased me, or shall not be available to perform the duties as Executor, then, in that event, I norniaate, constitute and appoint as Eaecator o£ this Will and Testament, my said n7ephew, the said CRAIG LOUIS WOJ,F, I request that no sureties ..^ his bond as Executor be required. I t~3GE TfFREE of five pages. ~ l~ lr ~ J~~ ~/~ I a e ~ P, I hereunto set. my hand end in the ==ass^_ca of tG.ree witnesses declare this to be my last will tais 26th day of February, in the year one thousand nine ^'.xrored eighty-two. BO ANDREW AULP _- =s 23~ tel. o. 2e~rsary, 1982. ROGER ANDREW WOLF. of Somerville, Massachusetts, signed the foregoing instrument is our presence, declaring it to be his last will; and as witness thereof, we three da no at his request, in his presence, sad in the presence of each other, hereto subscribe our names. c ~n~ nr. ~uTO, _ F&At~$ a_%l~s~snmmio COML~SONWEALTS OF MASSA.CHIIS&TTS, County of Middlesex, before me, the undersigned authority on this day personally appeared ROGER ANDREW ioOLF sad FRANK N. 1]AR4EN0, JR. and FRANK AI. D?iRDffid0 ,mown to me to be the testator and the witnesses, respectively, ~isose names are signed to the attached or foregoing instrument, azd, all of these persons being by me duly sworn, the testator Heclared to me axed to the witnesses in my presence that the in- strument is his last will and that he had willingly signed the said instrument as his last will, and that ho executed it as =~_ wee z:.H roluntary act of the purposes therein expressed; and ea._ a° ~e s+i^..esses stated to me, in the pxesenae of the testator, ~= 3e s=.~.ec Te will as vitaess and that to the best of his ~.ar_a5ca, we _era_or ~.2s eighteen years of age or over, PAGE FOUR of five pages. of sound mind and under no constraint or nadae itszZueaces. ~_ ADTDFEW WOLF i I]ARDF~TO, ~. y FRADTK : ~ n~n~o The within will and testament of ROGER ARDxEi9 WOLF, comprising with this sheet five (5) pages. has been executed before me by said ROGER A19DREW WOLF. Further, the said will and testament has been subscribed anfl sworn to before me by tha said Testator, ROGEtt AL3DREW WOLF, and by the said witnesses, this 26th. day of February, 1952, L'd 8L£9-LZ£(OL4) oao~y~oo~(l dZL~406LOLd®S ~_ C;-~'1 A. Settlement Statement (HUD-1) z -s'> OM8 Approval No. 2502-0285 ESTIMATED 1. ^X FHA y, ^ RHS 3. ^ Conv. Unins. 12-00~GC mbar. 7. Loan Number: 8. Mortgage Insurance Case Numher: 4. ~ VA 5. ^ Conv. Ins. C. Note: Thb form b fumishetl m give you a statement of sooret settlement coam. Amouma paid to snd by the settlement agaMa ere drown. Rama marked 'IP~a.L)' was pab oubide the dosing; tMY era shown here for infametbrel purpacee and are rwt Ndudad b fire totals. D. Name & Address of Borrower: E. Name d Address of Seller. F. Name & Address of Lender. David L. Sprowls, Regina A SpraNC The Estate d Roger A WoM, PN1ip &adcen Wdf, Gamey Fundtg Diversi6M Malgage Svcs 18 Hazelwood Path, Medtaniaburg, PA 17050 Eseator 300 Welch Road, BklgS. Horsham, PA 19044 22 S. 29N Street, Camp HM, PA 17011 G. Property LocaMOn: H. 5et0ement Agent: I. Settlement Date: 02/28/2012 22 5.29th Street Guardian Trsnskr Coryora0an OlsbursemeM Date: 0212812012 Camp H81, PA 17011 4075 Market St, Camp HB, PA 17011 Camp Hill Borough 7174)094700 PWce of Settlement: TitleFxpreas 4075 Markel SEreeL Camp HM, PA 17011 Printed 0272412012 at 1:44 pm by SLC A 100:. _: paeAequttDashaoBonawr . 458. .. ... : GrasAnwunfOw to Be6er '. 701. Cadract cabs prior 145.000.00 401. Corbaet BebS price 145.000.00 102. Peradrd 402 Persaw 703. ' Satllarrent~dwg6e mbatower pkre140p) ~ 4,056.7d 403. 104. 404. 105. 405. for Mang b se6er h adrana to Ibma sNbr in advance 7os. c5ytroam tmles m 406. ciryMwn tines ro 107. Couny magic b 407. cowry mass m 708. sohod rases 02128/2012 m o8r3012012 65{.72 408. Schad lazes 02R8/L012 m 08/30/2012 tMi4.12 709. sewer 01/2812012 m 03/3112012 54.40 409. sower 02/2872072 m o313ti201z 54.40 110. 410. 111. 411. 772 ate. 710. Gress Mratad pus Sam BorroaNr 146,775.26 425. Gross Amount Due to SelNr 145,718.52 .280. Awtamts PaM orb8dta0of8arotwr .550: Mdud0oirhMiwrdWeto Se6er 701. DepoeB a eemat money 1,200.00 501. Fuss dposM (see InsWClians) 201. Pdndpal etnaml o7 new ban(s) 141,299.00 502, Setllenem dergeamsdbr (One 7400) 21,113.00 203. ErisB s taken b 503. s taken 'actin 209. 504. 205• 505• Payalf ohnongage kran m C6f2em Bank d Penis aNa 33,774.51 206. Soft. 207. 507. zo6. Se6ersASSbt e,7oo.ao roe. seMasASeist e;7aa.ao 209. 509. faf Merrre b N6M ualnrarrts far Mere6 Se91f 270. C4ty/town fazes m 510. Cltylmwn Saxes m 217. Count' fazes 01/0112012 m 01/28/2012 128.47 511, County taxes 01Poi12012 m 02128/2011 128.47 272 Sdad taxes m 572. Scholl taxes m 213. 513. 21d. 514. 215. 515. 216. 518. 217. 517, 218. 518. 219. 519. 2m, Tobl Paid Borrower 151,327A7 5M. Told Redugion Anises Ow Be6s 63,775.66 300. CaahM7~Weorent tYOadWBarowx .. OW. -Cash dSeltlanent taMroru 8e9er 301. Gross arrant due hom tbnoaar plea 720) 149,775.26 607. Grass amoud due m se6er I6rte 420) 145.716.52 302. Less amounb DWd byllor lwrrower pine 220) 151,327.17 602. less rsdudbrN in amoum due ae0er pine 520) 63,715.98 303. Cuh ~ Fran ~ To Bonewer 7,552.27 603. CaM ^X io ~ From Behr 02,00254 ~~~: .a....r,e.,~mo,..,... ,o ®..~...r.m.~.....o-,...,,-ter ,,..+.....e,.n.... w..n..ew.es,..avw.u.,.., u+.,,,.w,aw,o n Drevtous edatons are obsolete 'u HUO-1 A rw.. tanlReat6uh Broter Fep Se,a7tl.9o DM~ondwmmiseionine700 as flows Paid From Borrower's .Pafd.From. Sell r. 701. S4,0B9,gg N KdlarVAWems of Central PA 702. f4,3B9A0 N ColdwaM Banker FbmesNad Group 703. Cammisebn paid at satlNnernl :Funds at :.. Settlement 300.0 e Funds at - .Settlement.. 0 8,178. 000. Menu N:Comtedtlan w9h Loan i. 801. qur origination Marge (IMudea OAglnaUOn Point 0.000% or 50.00) S (tram GFE 01) 802. Ywr aedtl a charge (palnN) for the spedfic interest rata Masan S (from GFE 02) 803. Your adjusted adginetion Maryes (hom GFE A) 804. rehd (ee N from GFE 03 ~ Crodt to from GFE #3 808. Tax aervbe N from GFE 93 807. Flood rx+rtlfiratian b from GFE 03 ~• b 900. Mme Under to M Paid M Adeann ~ 901, DeOy inNreel Merpea fran from 02/28/2012 N 03/01!2012 ~ SO.OO/day (from GFE O10) 802. Morlgege insurerloe premium br monhs N (from GFE 03) 903 . Homeowners insurance for ~ m (from GFE 917) 904. momhs N from GFE 911 1000. Retrv.s.. nA9lUnder 1001. Nltld deposit for your escrow accwnl (from GFE 09) /81.83 1002. Homeowners inwe'anoe 2 monhs 5 O.OOlmomh S 1003. Mdlgage imurenae 2morMs 5 0.00/month 5 1004. Property taxes 2 months 5 O.OOlrronlh S 1005. Coumy taxes 2 months 5 B1S6/nantli 5138.72 ~~ 1006. Schod faxes 2 merdis 163.35lmoMh 5328.71 1007: Aggregate Adjustrnent ~ 5 11001: TON -. 1101. TiIN sarskros and NMers title ineurarla GFE O4 1,273.80 40. 1102. 3etllemed or doming fee m 5 1103. pwnefs title inwrance -Title Reswraea Guarertly Company from GFE OS 111.03 1101. Lender's title inwrance-TAN Rewvras Guaranty Company 1961.88 1106. Lenders title pdiq Omit 5741,298.00 Candela Pdiq 7106. amarstitle pdiay timd5145,ooo.og t3wrrele Pdicy 1107. Agenrs por8on olthe flat the inelnna Dremkm 5911.97 N Guardian Trarrder 1108. Underwriters partlon of the bhl tltle insurance preniun 5160.94 N 71tle Resources G Cam 1109. 1200. f,ovarrnrertl and Tranfw ~ 1201. Govenxnem mcordirg Merges 5 (Irom GFE #7) 140.00 12oz. Dead uzo9 hw se6.w Release 5 7203. Transfer taxes 5 (from GFE 08) 1,450.00 1204. Cirylcwnry Nxlslamps Deed 1,4so.00 M 5 12116. SNN Taxlslemps Dead N,450.00 5 7,450. 7206. Dead S Mo S Release 5 1207. 5 4510_ AOtlNienal .. 1307. Requked aervkes Md you cart stop Nr 1302. Home Irwpedion fee N TM CenNr (from GFE 98) 1303 AIeNAeI 6 Labor 320.00 . to Peak CareWdion ~. 1304. Painting N John CNmmer ~. 7305. IdwriNrrce tax aeaow b C+wrdNn Transfer Inc. 10,000. I nK ]I 7~ ~~1 M 'Paid ouNide M tbsing bl (B)orrower, (s)ekr, (L)ender, (Qnveator, Bro(K)er. "Credtt q' lender drum w papa 1. "'Credt Dy eater aMwn an page 1. PreWoua tMitlons arc obsolete '+ Page 2 of 4 MUD4 dQobd FdtlrEWraaM andNW-7C l3obdFallh EadmW HUD-1 'fhtiittCmot lncreaee HU0.1llne Number . OOR.....rmtlon '`. .. .~ ~.. ,i=30t" '' 0.00 0.00 Yovcaddaeh brtlM/-. knereslrale dneen y:802 0.00 0.00 YowadjuaNda~na6mi charges :~ * 803 0.00 0.00 Trglretxbxes ~! 1205 D.00 7,450.00 That Can. . ~ .' ~ GoodfafOr Edimide ~ -HUD-0 ' lyd5ol depoatt tarycureeoowaamunt,: ~ ;F'l4at, D.00 461.53 DgFy lnbreal chPr9~ horfr ~ sot, S o.oo o.oo ;flonieowna(s frpuredres Y:B0.7 6.00 0.00 Y !~. N' - '.' ':S ;. .. M , , .. ,,. ',.. s A YarlaNW inlerae<rsMja % YaalNml moMd[y amount owed brPMnrlpai, krbreA,. arp sNrro~gagp' S intlWes iuuraiuab ^ Prn¢iipal , ', Q lmeren ^ Mortgage Inwrarrce Can yotsiMarem rau rise? ^X No. ^ Yes, n can nee to a maximum of 9(r. The fast charge ;. wM be on I f and can large again every years after I I . Evary charge date. yma interest reb can increase a decease q' X. Over are gk of : the ben. your Interear reb b guarertteed b never be Imasr then % ar hlgha ~' ttan %. Event you make paymeMe on ine, can you hen Oelrree rae? 7(^ No. ~ Ves, n wn nsa to a maximum of 3 Ewhgyou make pganenb on tlmo, ari year monthy amourdawd fa ' ~ '.. ~ No. ~ Yes. the fast bcease ran tb on / f and the monody . prmtipat, ifwest,aM.mortgage in9aaice dse? - annuntowed an neemS The maximum npn aver nsePoisS pow yea bn haw a prepaymmdpemlly'J ''., QX No. ~ Yes, your mmdmum prepayment penalty is S Does yea ken have a taatlom payaieMl. QX No. ~ Yea. you haw a bdlaon Paymerd dS due in years m I I Toptmonady amourd oared induArgewow axocrc paymenh ~ %~You do nottawartantNy esacw paymenttor Gems, such as properly nixes and txxraownefs Inwrence. You must pay mesa Hems dhecayyoureed. ^ You have an add'Nonel mouthy asaav payment nt S -~ amt resuka n e bpi ktitlal mouthy anaunt ovred oy S . Thb indwlea prindpel, interest :. any mortgage insurena and arty items drecked bebw: ;. ^ PmpanY taws ^ Honbamwts nsuranca Flood insurmice Nde: N you have any quesgdns about the Settlement Charges and Loan Terms listed on this form, please contact your lender. Previous editions arc obsolerc w Page 3 ar 4 XUD-1 THE ESTATE F ROGER A. WOLF ~ PNIp 0recken Wop, Executor The HU0.1 SelgenleM StNemeM which I haw prepared b a true and accurate account of fhb irenaecdon. I have caused or will cause lha funds to be dlebureetl In accordance wkh fhb statement S M NT DATE WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 1B: U.S. CODE SECTION 1001 AND SECTION 1010. Previous a dons are obsolete Page 4 0 4 HUD HUD CERTIFICATION OF BUYER AND SELLER ~ carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge end pellet, R Is a true entl accurate statement of all recelpte end ouraements mods on my account or pY me In fhb treneactbn. I further certiry that I have recebed a oopy of the HU0.1 Settlement Statement. /24/12 ~~ ~~~~£CIS ~~i~~ ROP.460 CiY~ Provideme RI 02940 ~'"`!` AB 07 018927 80901 B 7SA hlrllr~IPllua4rungt7itelrtrlrrllrt99rilrri•791rppri ROGER A WOLF 22 629TH ST CAMP HILL PA 170111515 attachment(1662x2t47) a-soo-n3-7373 Circle Gold %ece nl! w a~ae frr amen la year aoesdns, amunt iriforcation. arn~rt sates Account Statement or tp up~ela your aedRr 4 phurie number. o OF 2 8eginnSng August O5, 2011 through September 07, 2011 Contents Summary pay, 3. Checking raga 2 ~~ . ..v '> r Circle Gotd Summary u s o o z Ae~ t un ASgmt Negfrar faWw falanw ROGFR A. My0tF Coat sesawnt ihk ~`~ DCCOSIT fAIANCE Circle bald Checkl rlg W/IMNrost [heck{ng X%%XXXX544-3 Circle Gold Oreddrrg w(Interest %%%700(X544-3 1, 6]8.10 S, 618.18 (_l Toffi oyeert Wane t~~ 1,678.78 Lo AN fALAMCE. - EquityUneotGedit• as of pg/osjtr %XXXXX%5053 37,366.48 37,366.48 ~ 'A stoteoent wnioJnisq detaib of tMs actvunt rriU b¢ esamW m yosi sepamtr(y If3ars Aaw questions a5out pwr bdanw, Abast srfer fn,yow detailedsiotemeni ayran it wows. fdryan bmt oaounu do not rxeiw ownth7 stotaments ~ iaaY tw } s y : 37, ~ i Monthly combined balance m waive monthly ree is 20 000 OO ~ Your moMllly combined balance this statement period is , . 38,984.58 Toffi YlatleNhOa ~ ~.~ `~ A wrmc ~ par+rra!.r Exhibit to Schedule E ~ttps://mail-attachment.googleusercontent.com/attachmenV7ui=2&ik=b9e4b7d9c5&view=att&th=136c6... ~/ '/24/12, attachment (1381 x1333) ~ ~ J S f r .a. ~'~~ . s.-~ ~. ~ .. . "'i :T1 ~, L~ °~ `f my +t t u 3; f tt ~ t k;-' a.rt i~.. £ r' i. '"+ ~. x:'P { 5 fr ..n ~ .. E _ i 'i ~, ~ ... qe.'~i S .., w yY'"~"b /^... Y r {~ 9eu_ ~ ~ ^i ~.'rt a:i . m ff~~ ~' PS?j r ,~f u.. w ~ 2 12.~ F ~ .« V-Y.m 3 :+i a e. . ~ - ' ... 4 F j ,~ l SR.i ~ 'Y? ....Y ~ " ' ~ ~ ~Y '"CY ~~ - r t;'i e.~ C rt ~~ i I.1 i'~ °" a.4 .d., ~.y _ E~~ NA ~v~ .. ,,y' ... ... k,., v'^a -_ `. ... t '= C. ' -a k.4.: ,%.' ~ ~ rt^ y. ~ .. .__. r.°~ '~'. ~- "'~ i i i N - ~, ~~, ~, ~r, i ~ , ; fµ ~ _~. ~ ~~ ~ p y~ ,.... _ -.s? a v c, ~..~. ,~ ~.r Exhibit to Schedule E ~ltps://mail-attachment.googleusercontent.com/attachment/?ui=2&ik=b9e4b7d9c5&view=att&th=136c6... 1~ Holdings by Net Worth ~ Mr Roger A Wolf GEORGE S MASTROGIORGOS Combined Account Partfolb Ameri rise ~ii~ ~ S°""' 2s"'st~et cF''® aete: oero7r1o11 P Camp Hill, PA 17011 Finanaal Advisor Created: 11H5/2011 Financial with the practice of JOSEPH A RONZANO Assets Asset: Non-Qualfied ~. 't1©D74232448021 Non-Qua6lied 08fp412p11 ~ _ 49.878.72 Non-0ualified Total: 549,876.72 Asset: QrraiOed _~~~ ?.~" Exhibit to Schedule G Please See the end of ttas report for important diadowre inbrmation. M~erlprise Finenaai Services. ice. - aege ~ or 3 CblvtNto>~Ir u~,,A,,,~.. P.o. eoX 758550 ,o,,,,,,,,,,,,,,,,,, Topeka. KS 66675-655U December 5, 2011 I~~~Ill~e~ll~~~l~~lell~~l~~l~l~l PHILIP WOLF 124 RADER AVE COGAN STATION PA 17728 - ----- Re: ContracYNnmber. JG100016052 Dear.Mr. Wn)f: is writing to you regarding the above referenced contract. We have received the request to send you a letter including the account value as of 08/07/2011 date of death of Annuftant/Insured Roger A Wolf. Account value as of 08/0712011: $10,871.92 ff you have any questions regarding this letter, or ff we may assist you with other questions or information, please contact an AcxouM Service Representative at . Our Account Service Represerrtatives are available between 7:30 am and 5:00 pm Central Time. Sincerely, Service Operations Commonwealth cc: JOAN H SALTZMAN bcs Exhibit to Schedule G Commonwealth Annuity and Lrfe Insurance Company. Epoch Securities, Inc. P.O Box 758550, Topeka KS 66675-8550, Phone (800) 533-7681 John Fiencxk Lice Insurance Comperry (U.S.A.) Jahn HenoodcAmuNiee Service Gaoler 189 Carporefe Drive, Pertrmoulh, N103801~8H15 MafNng Address: PO Box 9505. PanerrnWi, NF10380Z~505 (800) 3N-1029 vnr+w.jlwnnuNiee.cam November 1, 2011 Philip Bracken Wolf 124 Rader Avenue Cogan Station, PA 17728 ~icor~ the futurc is yours Dear Mr. Wolf: RE: CONTRACT/CERTIFICATE #: 2097216 This letter is in response to your request for information concerning the above referenced annuity contract The value upon death (8/7/201 I) of contrail 2097216 is S 104,947.48 if you have any questions about this letter or the contract, please call us at 80U-344-1029. Our Client Services Representatives are available on weekdays from 8:00 a.m. to 6:00 p.m. EST. Sincerely, A Exhibit to Schedule G li& nrwuxa amu0iec. NdatrR Pao am~efies ue podwtis useed M lasn Hwmek Li& Lwaexe CaoP~YN-EAY. HbaoDrW Hills, MI 'not&enw;d m New Ycvk J ~' STMS ~.N~,~ ~~~ .oC 7~+'~l 1~ R°eER A WOLF 17F Account # 2331024669 PHILIP WOLF BENEF Balances _Bs$inning 8alens;e ` . S1L8B'133. CurraiM Balanca SG 782 0T Depos+L°ICredAS ; S3 826.24 Average Daily Balance 111,288 50 1KdhdrawaielDebils -55,74550 .....:. -.. - Interest Paid tlsic Period • ,- : S 0.98 Annual Parosntage Yield F_imad _ 010% Eamod thrs Penod S 0.99 Paid Last Year 113.54 Paid Ysar-To-0sde' ; ,.56:76 , '"ft~ inlerrst earned and the interest Paid may differ depending on when kMrest is crodNed to your sooount. Checks Posted Chock if Date Palo Amomt Reieranee Check * Date Pafd Amount Refennee 'Y175 ' 0720 -`'550.00 " 990810225 1182 08103 515.00 985186240 _1176 0726 552.00 983484825 '1183'`: 0727 ~ 515.00 989753570 1:177 0727 •:.535500 ~'~' 1184 OB/10 21.935.73 886596075 1178 0727 51.41319 971523755 ,. 1186 08104 5150.00 985538020 118Y : 0727 585.00 983897200 _ _ 1188' 08105 564 49 _. 985611 . ~i 1 o check(s> Posted =14,11 s.41 An asterisk t7 ind>ce<es a skip in sequential dredc mant,ers. An ~ irrdtuu~ check was concerted to an eiectraric item. AcrouM Activity Dsse Daacripflon Addltiorra Sraw ractiorw Bad 07-14 f3aginninp Balance 511,681.33 07-15 ` CFIK CARD PUR 56/817 KARNSPRI KARNSPRIMEB - , i31J5 =511,650.18 ,LEMOYNE PA - 07-15 CHK CARD PUR 580408 YYINEd~SP WII+IE3SPIRTTS ,_ 525.42 ... 571,624.76 LEMOYNE PA LEMOYNE PA 07-22 "CHK EARQ PUR 396205 ASPCA-PS ASi?CA.PS -- ; - S18 00 . ; ~ 511.533.69 - ._ 80082$0028- #AD - `. ~._..~ .~ 07-25 COMCAST CENTRAL CENTRAL PA 072511 5139.41 S71,39428 18545703 07-25 , CHK CARD Pl1R 783481'CAMPHILL CAMPHII,LANI : 550.29; .511,343.99 CAliAP HILL PA""' OT-26 CHK CARD Pt1R 052534 PROGRESSI PROGRESSN yt11.00 510,93'1.99' soa~6s-n6a off 07-26 ' . CHECK <.1178., -. ..: ~s~:m s~nnnnm 8004tINGRCN NJ CAMP HILL PA yr cr:: w~ec~ : 1183 , :.::: 515.00 -.. M~,001.41 07-28 CHK CARD PUR 241044 AMTRAKTEI,EP 573.95 58,927.46 08008727245 DC 07-29 COMM OF MASS TRESRBPEN 110721 , 53,751.30 512,678.76 001089926 Exhibit to Schedu'ie G /'"~ a °~~a 233/42x669 lysooazz~z43 oc .717-2.5r~8750 PA ~lo,• VI..V 0&14 6tdbtg Balutce 19,762.07 IN CASE pF ERRORS OR QUESTIONS AHOUT YQUR ELECTRONIC TRANSFERS CALL YOUR CUSTOMER SERVICE CENTER AT THE NUMBER SHOWN ON THE TOP OF YOUR STATEMENT OR WRITE TO THE BANK FOR DEBIT CARD ISSUES: FOR AIL OTHER ISSUES: _ _ _ _ --_ __ _ _- SO1~~Cud i~epu&.4 Teain At6ii M l 1 .. _ _ B $O~. ~' 'ALn: -Relaliia~s _ - - ~ - _ 1 5 A M 3 02 10-421~R1 P.O. Box 831002 P.O. BOX 12646 Bosom MA02283-1002 READING, PA !%12-2646 Pkase caotarA us if you tltiek your statertaent or razipt is wrong or if you hoed addRioirl infornrdioa about a transfer oa the steternertt or tecapt. We must her front you no htta tltan 60 days after we seat you the FIRST sutemerK on whidt We error eppearod. • Tell m yattr rrme and rccotun number. • Descn'be the error or dte trarnfer that you aro rtnstae about and explain as c~Y m you • Tdl us the do1Mr aatamt of the stapecled error. can why you believe them is an error of why you need fisdKr iaformatian. If you tell us Dolly, we may r•9•~ you b send your complaint or question in writing within !0 bussms days. We wall promptly inv~igae We nutter and call or wrioc p you wph au a~sw~er within !0 binroess ders (10 adeadar days et ~). If wt neat mere tiers, we~y Ike ~ b 45 days b ' your eomphint a question. If we do we wdl aodi[ sera aocouM wAhhi tltis 1 lnr the amaaat you tltidc is is error, so you wi0 ~ the ere of tke naney du[ing the time it ta~aes to b oompkle o~c irves~ion. if we ~ you oho put your cwnpitint err quatioa iu waiting and we do oat teoeire tt witlan l0 bustrKSS days, we ar!' chose not b cedit your socoant Far errors crvdving nsw aeeotet~, poim of sde ouMuxos or fae~ vansactions, w+e Wx b 90 b ' question. For ttaw accounts, weary take up io 20 busbesa drys b credit your socoum~for ibe ar~nouut ~. m~~ ~ bt ~ you ihrk is b error. We wtll odl yon the tosxlls of our investigation within 3 bmioms days after oompbting ore ' too. if we decide them was ao error, we w~71 sad you a wretert expMalioe. You may ask for avpics of the docuntaN.s we used r oar i ~r. Iwportaut bfernat;Nw aboat year Sovereisa Debit Grd The tatvrorks thrwgh which sane of sovereign Debit Card purchases tue~ true begun albwing metdrnts b Y~ 1•s without either a sigrrhrre a a PIN. Ifyou re oat rreeqquucd b amer your PM you mdce s purchax, may lie dtlt~ throtrglr Ure Visa network or tluougM the STAR or NYCE networks. If your orci~ase is i~roaeasad thrpAR err NyCE dittams apply and you will Dot be elig~ie Wr the rigtus and protectiarrs awikrMe through tae. flare sx your Pasoeal Depaak Acrount Agraatratt Por mote hrformrrm. '~: ~ Q~~ t ~ a:.e cl~~ tin c7~niRr ~Z~ page 3 of4 233/024669 5... -~ stab~it7ent P!~21od o7n~n1 m oen4nl nirirsII _~ ~' _,.: w" 1176 e.r .. ~7Ni~ ~ .. -J S3~- r -~.. p ~~ 0~K .. -__- ~C2333Tii iC ' 233 L024CC9r L315 A ~{ °'~° 1176 • tiros 7N /TNI' i .--+ ~°' ~I ~ r,23.337269 iC 233 t0246E9r 117E 736 A.w A I °'°n" 1177 ' ~ I 4'+Y MA~ii w ZQ ~ ~" s3 ~ ~ ~ / ~ ~~ ~ . _ ~ J / ~~~.. r, 3H7 69 LC 2333024EE9r yiT ~ 933,024669 - # 1177 07n7/11 5355:00 ~~~ 1181 ~+ S.y1t MINI °" wrwN ~ 'G/ •. ~ H f ~ 6! ~ ~~ / ~ . Y /)` ~ /s~jJ, W ~ ._ 8i 1:213;7'e6933 - 233rD 248E 2331024869 # 1181 07CL7111 565.00 ,3 "°"" 1183 a.,,~ a„~„ f ~ p.~OlIY' d„ 5. /~~~1V C23L 2331024E~iL83 ---_ ,~ ~^ 11as ~`~r11L~ '~ R Tea /S'D--" '~` ~. ~. 023137269 iC 233 LD 24E69r 385 331024669 # 1185 08104111 5150.00 pnge 4 ojd ~~~~ -*~ , 1178 .~ r Sig13-(9 ® ~- I 023 139269 iC 233 LDi4E4 2331024689 # 1178 07n7h1 51,413.19 ~ars~ '°0" 1182 a.,..~3,.,~„ -~ .~ Ia ~ '~.[ D/s CC IYL - ~ sJ3 A' ? ~e..~ ,/ l 'Z~~~ o ~ ~ ~ 7 eE9K 3 C 233 2333024E49~ L182 1 515.00 ~yl..,~A. ~'"° 1164 1 _s.y~n+rTr~~ ~ '~ H5.~17f „i{ SI '~ I 0233372L9 iC 233b24EE9r 1 4 2331024889 # 1184 08/10/1'1 s~.usa.2s -- ~^ 33ea ~ 1 '1I _ ~,,.,, a..~...._ sr~~- ~ N~- s~~ yy -_~ y e ~e~r ~ ~~a--~ '- ' = C 2313726930 233 i024669r ii # 23310:d6~9