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06-18-12
1505610101 REV-1500 ~`°"°' ~ PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes Ee~a~,,.. Countg Code Year File Number Po Box zao6ot INHERITANCE TAX RETURN Harrisburg, PA 1'7128-o601 RESIDENT DECEDENT ~ ~ ~ I ~~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth NIMDDYYYY Decedent's Last Name Suffix Decedent's First Name MI CUTCHALL BEVERLY K (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI N/A Spouse's :iocial Security Number THIS RETURN MUST BE FILED IN DUPLJCATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW Ob 1. Original Return O 2. Supplemental Return O 3 Remainder Return (date of death prior to 12-13-82) O 4. Limitetl Estate O 4a. Future Interest Compromise (date of O 5 Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 0 8 Total Number of Safe Deposit Boxes (Attach Copy of Wil1J (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11 Election to tax under Sec 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TA%INFORMATION SHOULD 8E DIRECTED T0: Name Daytime Telephone Number Andrew H. Shaw (717) 243-7135 First line of address 200 S. Spring Garden St Second line of address Suite 11 City or Post Office Carlisle State ZIP Code PA 17013 ti W r 0 Correspondent's a-mail address: andreW~aShaW18W.COr11 Untler penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, antl to the best of my knpWletlge and belief, it is true, correct antl complete. Declaration of preparer other than the personal representative is based nn all information of which preparer has anY knowletlge. 1933 Sterrets {IGNATkI(2 OF P le, PA 17013 REPRESENTATIVE 200 S. Spring Garden Street, Suite 11, Carlisle, PA 17013 PLEASE USE ORIGINAL FORM ONLY REGISTER OF WILLS USE ONLY n.a o Q ~ C t ~r- ~ . ~~• rr ~~~., ,,..2e,r~ ~ _ m S r/~.'~Da ~'u '.J c~ t Sri n C7 i", t-" _„ ~~~ Side 1 L 150567;0101 1505610101 J REV-1500 EX Decedent's Social Security Number Decedents Name: Beverly K. Cutchall RECAPITULATION 1. Real Estate (Schedule A) .......................................... ... 1. 2. Stocks and Bonds (Schedule B) .................................... ... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 4. Mortgages and Notes Receivable (Schedule D) ........................ ... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. 6. Jointly Owned Properly (Schedule F) O Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested..... ... 7. 8. Total Gross Assets (total Lines 1 through 7) .......................... ... 8. 9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........... ... 10. 11. Total Deductions (total Lines 9 and 10) .............................. ... 11. 12. Not Value of Estate (Line 8 minus Line 11) ........................... ... 12. 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. TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (aJ(1.2) X .0_ 0.00 15. 16. Amount of Line 14 taxable at lineal rate X .0 5 70,130.76 ig. 17. Amount of Line 14 taxable at sibling rate X .12 0.00 17 18. Amount of Line 14 taxable at collateral rate X .15 0.00 16. 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505610105 1!i05610105 15D56101D5 71, 008.71 0.00 0.00 0.00 8,282.47 0.00 0.00 79,291.18 3, 905.39 5,255.03 9,160.42 70,130.76 0.00 70,130.76 0.00 3,155.88 0.00 0.00 3,155.88 O OMB Approval No. 2502-0205 A. Settlement Statement (HUD-'I ) 1. ^ FHA 2. ^ RHS 3. ^Conv. Unins. 8. File Number: 7. Loan Number: 8. Mortgage Insurarice Case Number: 11-91 507446 10-10E{1625231 4.®VA 5.^Conv. Ins. C. Note: This form Is famished to give you a statement of actual settlement coats. Amounts Faltl to and by the aedlament eganta are shown. Items marked "(p.ao)"were paid outside the closing; they are shown here /or informational purposes and are not included in Iha totals. D. Name 8 Address of Borrower: E. Name d Address of Seller: F. Name & Address of Lender: Grady 1 Klein The Estate of Beverly K, Catchall, Cuk:hall, CaNinai Financial Company, L.P. 346 C Street, Carlisle, PA 17013 ExecutoNeBrey L P,O. Box 2697, Warminster, PA 10974 100 Fisher Road, York Haven, PA 17310 G. Property Location H. Settlement Agent: I. Settlement Date: 1'V28/2011 346 C Street The Law Office of Andrew H. Shaw, P(% Disbursement Date: 1 Y28/2011 Carlisle, PA 17013 200 S. Spring Garden Street, Suite 11, Carlisle, PA 17013 Telephone: 717-243-7135 Place of Settlement: TitleExpreas 200 S. Spring Gallen Street, Suite 1 t, Carlisle, PA 17013 Printed t Y28@011 at 3:23 pm by SDC r , r 00. Grose Amount Duelrom BOrcovrer_ Oi. Contrad sales price 96,500.00 400. Grose Amount Dua to Boller 1. Contrad sales prce 96,500.00 1 02. Personal 402. Personal art ~~ 03. SetBemenl charges to borrower (line 1400) 6,259.50 403. 04. 404. 05. 405. A d uatmenb for Ifema old seller In advance O6. City/lawn taxes to 07. Canty taxes 11282011 to 11/31/2(111 O8. School Taxes 1128.2011 to 0613012012 09. Reimburse GaslElectric 46.58 620.52 85.00 Ad ustmenta for Noma paid by seller In advance 406. Citydawn taxes to 407. Counry~ taxes 11/2812011 to 17/3112011 408. Schoa Taxes 11282011 to 06130/2012 409. Reimburse Gas/Eleddc 46.58 620.52 65.00 10, 410. i 11, 411, 1 2 12. 20. Groaa Amount DUe from Borrower 103,511.60 OD. AmouMa Pald b or In Behall of Borowrer 1. Deposit or earnest money 02. Pdndpal amount of new loan(s) 99,684.00 412. 110. Grose Amount Due to Seller 87,252.10 300. Reducllona In Amount Due to Seller 501. Excess deposit (see insbudions) 502. Setlement charges to seller (line 1400) 8,555.10 3. Existin lea s taken su 'ed to 503. &istin~ loo s taken sub~ed to 504. PayoB of first mortgage loan to M & T Bank 17,860.69 2 5. 505. PayoB of second morlgage loan Seflefs Assist 3,827.60 506. Seller's Assist 3,827.60 7. 507 2 508. 9. ueMenta br kema un old b seller 509, Ad ushnenh for Rema unpaid b1l seller 2 0. Cityttown taxes to 510. Cityttovrn taxes to 2 1. County taxes to 511. County taxes to 2 2. School Taxes to 512. Schod Taxes to 2 3. 513. 2 4. 514. 2 15. 515. 2 16, 516. 2 7. 517. 2 8. 518. 2 2 3 30 9. 0. Total Pald /For Borcovmr 703,511.60 0. Ceah al SeldemeM lromho Borrower 1, Gross amount due horn bortower (line 120) 103,511.60 2. Less amounts paid bytta borrower (tine 220) 103,511.80 519. 520. Tatel Reduc0on Amount Due Seller 30,1A3.39 800. Caeh at Settlement tollrom Seller 601, Gross amount due to seller(line 420) 97,252.10 602. Less rerludlons In amount due seller (line 520) 30,243.39 303. Caeh ^X From ^ To Borrower 0.00 803. Cash ^X To ^ From Seller fi7,008.71 ..nxb.M v«.m Pre lous editions are obsolete Page 1 of 4 HUD-1 700. Tohl Real Estate Broker Fees Paid From Paid From Division of commission (Iine700)as follows. _ Borrower's Seller's 701. $0.00 to ~ Funds at Funds at 7D2. $0,00 _ io Settlement Settlement 7D3. Commission paid al settlement 800. Items Pa able in Connection with Loan 807. Our orginafion charge (Includes Origination POint for $000 $2,492.10 (from GFE#1) 802. Your credit or charge(points)for the specific interest rate chosen $-3,364,34 (from GFE#2) 803. Your adjustetl origination charges _ (from GFE A) -872.24 804. Appraisal fee to Central Penn A ./FCOte Ca ital (from GFE #3) 375.00 805. Credit repod to Credit Plus $13.58 P.O.C. B' (from GFE #3) 10.99 806. lax service to (from GFE #3) 007. Flood certifcation to Core Lo is (from GFE #3) 9.00 008. VA Funding Fee to (from GFE #3) 900. Items Re aired b Lender to be Pald In Advance 901. Daily interest charges from from 11282011 to 1210112011 @ $11.6070/day (from GFE #10) 34.82 902. Mortgage insurance premium for months to (from GFE #3) 903. Homeowners insurance for ears to State Fann lnsurence (from GFE #11) 66100 904. VA Funding Fee for months to CaMinal Financial Com an , L.P. (from GFE #3) 3,184,50 1000. Reserves De osltetl with Lentler 1001. Initial deposit for your escrow account (from GFE#9) 558.55 1002. Homeowners insurance 3 months (u1o. $ 55.081month 516524 1003. Mortgage insurance months no. $ O.OOlmonih $ 1004. Properly taxes months $ OOOlmonth $ 1005. County taxes 10 months $ 41.67Imonlh $416.70 1006. School Taxes 6 months $ 09.41Imonih 5536.46 1007, Aggregate Adjustment $-559.85 1100. Title Cha ea 1101. Title services and lenders title insurance to The Law Offce of Andrew F ham GFE #4 1,103.75 180.00 1102. Settlement or dosing fee ip $ 1103. Owner's title insurance _ from GFE #5 1104. Lenders title insurance g85875~ 1105. Lender's title policy limit $99,684.00 Lenders Policy 1106. Owner's Lille policy limit $96,500.00 Owners Poicy 1107. Agent's portion of the total the insurance Dremium 5607.00 1108. Underwriter's ponion of the total title insurance premium $171.75 1109. to $ 1200. Govemment Recordin and Transfer Cha es 1201. Govemment reoxdlnq charges $ (from GFE #7) 1202 Deed $fi2.00 MorM a e $98.00 Release $ 160.00 1203. Transfer taxes $ (hom GFE #8) 1204. City/County tax/stamps peed $965,00 Man e$ 965.00 1205. State Taxlstamps Deed $965.00 Mort e $ 965.00 1206. UPI Fee peedS Mo e$ 1207. $ 1100. Atltlhlonal Settlement Chardee __ ~ 1 01. Required Services that you can shop for from GFE p6) 1 2. Survey _ to 1 03. Pest Inspection to Sudden peach Termite & Pest Control 1 04. 2011 CountylBOrough Taxes to Borou h of Carlisle 50, 550,1 1305. Release and Tracking to R uire, Inc. $ 35. 1306. Repair Invoice to ATFAB 2,775. 1 07. Final WatedSawer io BOrou hot Carlisle 1308. Escrax for Inheritance Tax !o The Law Office of Antlrew H, Sha, 69.13 4,000.00 t r 6,259.50 8,555.10 Pala outside of Dosing by (B)onower, (S)eller, (L)ender, (I)nvestor, Bro(K)er. ^Credit by lender shown on page 1. "'Credit by seller shown on page 1. Previous editions are obsolete Page 2 Of 4 HUD-1 Com arlson of Good Faith Eatimate (GFE) and HU0.1 Charaea Good Fa1M Estmate HU0.1 Cha ea That Cannot Increase _ HUG•1 Line Number _ Our odginatlon charge q 601 '• 2,492.10 2,492.10 Yourcreditacharge(points)for the spedfic interest rate chosen g 802 -3,364.34 -3,364.34 Your adjusted origination charges g 803 Transfer taxes g 1203 A72.24 965.00 -872.24 965.00 Cha es That in Total Cannot Increase More Than l0% Good Faith Eatlmate HU0.1 Government recading charges q 1201 150.00 160.00 Appraisal fee _ p 804 475.00 375.00 Cretlit repot g 805 60.00 24.57 .Flood certificetion # B07 9.00 9.00 VA Funding Fee p 904 3,184.50 3,184.50 p a 3,878.W ,753.07 $ -125.43 r -3.2340% ha es That Can Change _ ~• ~ ~~ Gootl Felth Estimate HU0.1 nitial deposR fa youresaax acount q 1001 oily interest charges from "' #901 11.8071llda ' "' 1,851.72 348.21 5 .55 .82 omaowner s insurance q 903 __ It a services and lender's title insurance ~ p 1101 480. 1,086.0 61.00 1,103.75 p Loan Terms Nour initial loan amount is $99,684.00 Nour loan term is 30. years Nour initial interest rate is 4.2500°h Nour Initial monthly amount owed fa pdncipai, interest, and any mortgage $490.39 includes iasurnce is ^X principal ^X Interest ^ Mod9age Insurance don your interest rate rise? ^X No. ^ Yes, it can rise to a maximum d %. The frst change will bB on I I and can change again every years aher I I .Every change date, your interest rate cer increase a decrease by %. Over the life of the loan, your interest mte is guaranteed to never be lower than %or higher Uan %, E;'Nen'rf you make payments on time, can your ban balance doe? ^X No. ^ Yes, II can rise to a maximum of $ ENen it you make payments on lime, can yar monthly amount owed for ^X No. ^ Ves, me first increase can be a / I and the monNly pdndpal, interest, aM mongage insurance dse? amount owed can dse to $ The maximum it can ever rise to is S your loan have a prepayment penalty? ^X No. ^ Yes, your maximum prepayment penalty is $ Dpes your ban have a balloon paymen@ X^ No, ^ Yes, you have a balloon payment d $ due in years on 1 I Total monthly amount oxed induding escrow accent payments ^ Vou do rrot have a monthly escrow payment for items, sued as property taxes and homeowners insurance. You must pay these items directly yourself. ^X You have an additlonal monthly escrow payment d $186.16 that results in a total Initial monthly amount owed of $676.55. This includes pdndpat interest, any mongage insurance and any items checked below: ^X Property taxes Q Homeowner's Insurance ^ Flood insurance ^ ^X Annual Assessments ^ Note: If you have any questions about the SelBement Chergas and Loan Terms listed on this form, please contact your lender. PreNloua editions are obsolete Page 3 of 4 HUD-I HUD CERTIFICATION OF BUYER APJD SELLER I nave carefully reviewetl the HU61 Settlement Statement and to the best of my knowletlge and belie(, it is a true and accurate statement of all receipts and tlisbursements made on my account or by me in this transaction. I further certify that I have receivetl a copy of the HU61 Settlement Statement. /lX-/ ~ /~itil Grady J. KI s n K oath E. G c~l, Executor r deNfey L ut all, ulor i disbursed in accgrdance with this a True and eccurete atcqunl of this i ~~ ~ ~ ,~ ~,.~ _~`i ~~-( ~ AGENT ~~ ~ DATE WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED S7ATES ON THIS OR ANV SIMILAR FORM. PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18' U.S. CODE SECTION 1001 AND SECTION tOt0. Previous editions are obsolete Paqe 4 of 4 HUD-1 .. I Name of Borower: Name of Seller File Number: Grady J. Klein Kenneth E Cutchall, Executor 11-91 Jeffrey L Cutchall, Executor Prepared 11YLSY1011 al 3:22 pm Note: This page tlisplays an itemization of the charges shown on Ilne 7107 of the HUD-t Settlement Statement Thla page accompanies but Is not a part of the HUD-1 Settlement Statement If a discrepancy exists, the Information on the HU0.1 Settlement Statement applies. 1 00. TPoe Charges Bortower Seller 101. Title services and lendefs Otle insurance to The Law Office of Andrew H. Shaw, PC 1,103.75 160.00 ~ PreP~ to The Law Office of Andrew H. Shr$ 150.00 Seller Notary to Sarah D. Dieckman $ 20.00 Borrower Norery to Sarah D. Dieckman $ 10.00 Seller Overnight to fie law Office of Andrew H. Sh;$ 20.00 Seller 100 No VIo11100 to Law Office of A. H. ShawISTGC($ 10,00 Borrower 300 Survey1300 to Law Once of A. H, Shaw/STGC($ :10.00 Bortoxer 900 EPL-Res18.1 to Law OfOce of A. H. ShawISTGC($ Ii0.00 Borrower ClosingSvcUr1CL M Law Office of A. H, ShawISTGC($ 75.00 Borrower Subtotal $ 425.00 1102. SetOement or closing fee to $ 0.00 1 04. Lender's title Insurance to Law Office of A. H. ShawISTGC($ 8;1875 109. to $ 0.00 elledLender credits shaven on e 1 POC • Pald Outside Clasin Prev us editions are obsolete Page i o 1 MUD-1 REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY w ~n~ ~ ~r FILE NUMBER Beverly K. Gutchall 21-11-0711 Include the proceeds of litigation and the date the proceeds were receNed by the estate. All property IoIMty-ownetl with right of survlvonhip must be dlsdosed on Seheduk F. ITEM 1. M&T Bank, Accourht #98386896 2. M&T Bank, Account#15004200896536 3. Certificate of Depo~it with M&T Bank, #31003915939036 4. Certfcate of Depo it with M&T Bank, #31003915939028 5. Rersonal Effects TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1,018.93 1, 334.98 2,191.97 2,236.59 1,500.00 8,282.47 M&T Banic ACCOUNT N0. ACCOUNT TYPE. 98387868911 MBT SELECT NZTH INTEREST 00 0 04344M NM 017 BEVERLY K CUTCHALL 346 C ST CARLISLE PA 17013-1874 39073 INTEREST EARNED FOR STATEMENT PERIOD 0.00 INTEREST PAID YEAR TO DATE 0.02 wnrn~~ur STATEMENT PERIOD ppg MAY.25-,IUN.24,2011 1 OF 1 SPRING GARDEN BEGINNING DEPO I 5 B •---~~~ ~ v~~ ~" ~ :.:OTHER CURRENT ENDING BALANCE OTHER DDITIONS LNECKS PAID SUBTRACTIONS INTEREST PD ' BALANCE N0. AMOUNT N0. AMOUNT N0. AMOUNT 241.93 1 777.00 4 631 08 2 387 85 0 00 0 00 wrrnnur POSTING ---- ~ EPQS TS,INT R T C ELKS B O: NER DAILY: DATE TRANSA ION DESCRIPTION 8'0iHER AObITIONS . "SUBTRACTIONS $ALANCE 05-25-11 BEGINNING BALANCE 5241.93 06-07-11 DEP0SI1' 777 00 . 1,018.93 Ob-15-11 CHECK NUMBER 2795 134.61 06-15-11 CNECK NUMBER 2794 06-16-11 UGI UTILITIES UT$L PMT OOOOOOD00002796 98.57 785.75 85.00 700.75 06-20-11 CHECK NUMBER 27% 325.00 06-20-11 CHECK NUMBER 2797 72.90 302.85 06-24-11 CLOSEOUT 302.85 0.00 ENDING BALANCE 50.00 CHECKS PAID SUMMARY 2794 Ob-15-11 98.57 2795 06-15-11 134.61 2797^ 06-20-11 72.90 2798 06-20-11 325.00 ANNUAL PERCENTAGE YIELD EARNED = 0.00 COULD VOU R SOMEONE VOU KNOH USE ADDITIONAL RETIREMENT INCOME? M8T CAN HELP. HHETHER IT•S FOR DAV-TO-DAY LIVING EXPENSES OR TO ENJOY A BETTER L.IFESTVLE, HOME ONNERS AGE 6~ AND OVER CAN CONVERT A PORTION OF THEIR HONE EQUITY INTO CASN KITH AN M8T REVER E MORTGAGE. 70 LEARN MORE CALL 1-888-253-0712, OR VISIT N41N.MTBREVERSEM0RTCAGE.COM j LOO6A (6/07) I ACCOUNT NOI. ~- ACCOUNT TYPE. 1500420089653E~1 RELATIONSHIP SAVINGS 00 0 04344M NM 017 13523 _ BEVERLN K CUTCHALL - 1933 S~TERRETTS GAP AVE CARLISLE PA 17013-1063 INTEREST EARNED FOR STATEMEryT PERIOD 0.01 INTEREST PAID YEAR TO DATE ', 0.36 wrrnnur STATEMF,NT PERIOD PAGE '.. JUN.14-JUL.13.2011 1 OF 1 SPRING GARDEN BEG NNING. D STS 6 M TNpRA LS &'0. NER CU RENT <EN IN6 BALANCE -OTHER ADDITIONS .SUBTRACTIONS INTEREST PAID :BALANCE ' N0. AMOUNT N0. AMOUNT 1,334.98 1 137.50 1 16 98 0 O1 955 51 wrrnnur wrt..•.r.. POSTING DATE TRANSAC ION DESCRIPTION DEPQS T ,INTEREST BOTHER ADDITIONS NfgRAN LS R:OTN SUBTRACTIONS pA Y. `.BALANCE 06-14-11 BEGINNING BALANCE '~ . 61.334.98 06-24-11 INTEREST PAYMENT i 0.01 Ob-24-11 CUSTOMER NITlIDRANAL 516.98 818.01 07-01-11 FELRA PENSION FU PENSION-[K ~ 137.50 955.51 ENDING BALANCE ~~' 5955.51 ANNUAL PERCENTAGE YIELD EARNED 0,01 __ ~~~ M&T Banlc i © One M g T p~eyx. 6uttala~ Ne- w yoek ~yZAO Spring Garden June 24, 201 1 649 - BEVERLY K CUTCHALL 34 C ST CAPoLISLE PA 17013-1874 Re: CD Accou~t Closing Notice Account ~ 1"v03915939v36 Dear Beverly K ~utchall, We are writil At that time, We'd like to rf all your financ those needs, si Center at 716- www.mandtba Thank you for Sincerely, MtehePe CoQe Michele Cole- Customer Ser confirm that on 06/24/11, your CD account was closed or transferred. balance was $2,191.97. nd you that M&T Bank is committed to providing you with solutions to needs. To find out more about the many ways we can help you with ly stop by any M&T Bank office or call the M&T Telephone Banking -1900 or 1-800-724-3222. Or if you'd like, visit the M&T website at with M&T Bank. Manager SMACCL AT.RC51 © One M & T Plaza, BuRalo. Ne Spring Garden June 24, 2011 - sas - BEIYERLY K CUTCHALL 34~ C ST CA LISLE PA 17013-1874 Re: CD Accou t Closing Notice Account }31003915939028 Dear Beverly K Cutchall, We are writing t confirm that on 06/24/11, your CD account u~as closed or transferred. At that time, th balance was 52,236.59. We'd like to rem 'nd you that M&T Bank is committed to providing you with solutions to all your financia needs. To find out more about the many ways we can help you with those needs, sim ly stop by any M&T Bank office or call the M&T Telephone Banking Center at 716-62 -1900 or 1-800-724-3222. Or if you'd like, visit the M&T website at www.mandtban .com. Thank you for banking with M&T Bank. Sincerely, M~.ehe2e Michele Cole-He for Customer Servic Manager SMACCL A'LRCSI r REV-1511 EX+ (10-09) ~ ` Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAx RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Beverly K. Cutchall 21-11-0711 Decedent's debts must be reported on Schedule i. TEEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSE 1' Hollinger Funeral ome 8 Crematory, Inc. 2,120.89 B. ADMINISTRATIVE C STS: 1. Personal Represen [ive Commissions: Name(s) of rsonal Representative(s) Jeffrey Cutchall and Kenneth Cutchall Street Add s City _ J'I State ZIP Year(s) Comrhission Paid: Z• Attorney Fees: III 3. Family Exemption: aIf decedent's address is not the same as claimant's, attach ezplanationJ Claimant 4. 5. 6. 7. SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS Street Addre~s City ~ State AP Relationship If Claimant to Decedent (Probate Fees: ~''i Accountant Fees: ~~ 'fax Return Prepared, Fees: i TOTAL (Also enter on Line 9, Recapitulation) ~ If more space is needed, use additional sheets of paper of the same size. IIL 0.00 1, 500.00 0.00 284.50 3,905.39 Hollinger Funeral Home & Crematory, Inc. Eric L. Hollinger, Supervisor June 16, 2011 Kenneth Cutchall 100 Fisher Rd. York Haven , PA 173 The Funeral Service f'pr Beverly Cutchall: We sincerely appreci to the confidence you have placed in us and will continue to assist you in every way we can. Please f el free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS ASV ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE HAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. Professional rvice CremationP ckage-Direct Cremation $1750.00 AT THE TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN ACCOMMODA ION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES. Cash Advanc s Newspaper N tices -Sentinel 82.22 Newspaper N tices -Patriot 143.67 Certified Copi s of Death Certificate (20 @ $6) 120.00 Cumberland aunty Coroner's Authorization 25.00 Total Charges I $ 2120.89 Current Balance: I'i $ 2120.89 ~~E%~ive~ C-.C ,fY`//may' ~?~.~?(. ~ c.IC~4i~ y~/ ~,,y~,, f/ ~~ ~/ate/.~ ~~`~~. soI NORTH BAL'CIMORE AVEC7HE • MOllNT HOLLY SPRINGS, P NNSYLVANIA 17065 • ;7I7) 9s6-3x33 • FAX (717) a86-3215 www.hollingerfuneralhome.cam rr~ i si ~. ra, ,.;-on; jil pennsytvania SCHEDULE I f~..i'~77 °EPa"T^'E"T OFfE0EN0E DEBTS OF DECEDENT '""EmT"NCE T^x "ET°a" MORTGAGE LIABILITIES & LIENS F'.ESIDENT DECEDENT ESTATE OF FILE NUMBER Beverly K. Cutchall 21-11-0711 Report debts Incurred by a decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. 1. 2. 3. a. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Comcast Central PA Pulmonary Assoc. LLC Carlisle HMA Phys~iaan Management Carlisle Regional Ntedical Center, Account #9496831 Kinetic Imaging, Acount #32121 Century Link II Subway Auto Body Deluxe Checks li Sloop Service Cen~er, Inc. Borough of Cadisl~-Real Estate Taxes PPL Electric Utilitie~ UGI Gas Service M&T Bank Borough of Retum of PI 134.61 1,297.46 131.41 340.00 144.35 136.17 500.00 13.50 37.10 1, 051.44 367.59 104.11 786.89 72.90 137.50 TOTAL (Also enter on Line 10, Recapitulation) I ~ 5,255.03 If more space is needed, insert additional sheets of the same size. ~omcast~ Contact us: www.comcast.com ~ BEVERLY CUTCHALL For service at: 346 C ST CARLISLE PA 17013-1874 News fronn Account Number 09547 362546-D1-8 ' Billing Date 06/14/11 j Unpaid Balance $134.61 -Due Now ' New Charge;; $75.26 -Due 07/07/11 I Total Amount. Due $209.87 717-243-4918 1 __ Page 1 of 2 _ Disconnect Warning: Paym nt for services received is now seriously past due. All p st due charges must be paid immediately. Failure to mply may result in disconnection of services wit ut further notice. Thank you for your prompt payment. For your convenience, we accept regular and automatic monthly credit card payments and direct debit. Hearing/Speech Impaired Call'f11 CORRECTION: The actual d~te NEW subscriptbns to the Sports Entertainment Pa age (SEP) will require a subscription to Uigdal Starter r MuttiLatino Max is 06/23/11. i Did you know that 23 percent f American children do not have regular access to th Internet? Comcast and Boys & Girls Clubs of Ameri are working to change that with Club Tech. Learn m re on how you can get involved at www.facesofthefut re.om_ >~,r ,~ '~~ ~ t a 4 ~g: ~ ; E i ~ ~ ~' ~' ' Y'~ '~~ r~j~F pia, ee! r~ ,. ,+T, r. s,<^,e, .*, wW rr ~ f ra , ? ~. . ; Previotas Balance 134:61 Payments -received by 06/14/11 0.00 Unpaid Batanca • Due Now 134.61 .New Charges -Due by07/07/11 75.26 see trelow for more info7maUon 7'otai Atn©unt Due $209.87 XFINITY TV ~ 63.50 Other Charges & Credits 7:95 Taxes, Surcharges & Fees 3.81. Total N Charges : $75.26:. "< Detach and enclose this ~comcast. your payment. Please write your account number on your check or money order. Do not send cash. 1555 SUZY STREET I LEBANON PA 17046-8317 Account Number 09547 362546-01-8 Payment Due by Due Now Total Amount Due $209.87 AV 01 009428 p43936 31 I'hn'I'llll'llllll"III'llll'lll'I BEVERLY CUTCHALL 346 C ST CARLISLE PA 17013-1874 •SDGT Amount Enclosed S I'ill'Illlll'I'Illllllll'I Make checks payable to Comrast nllhll'Id"mldlu'bl'I'IPI'lll'hhdr"ulhurl'Illll COMCAST CABLE P 0 BOX 3006 SOUTHEASTERN PA 19398-3006 09547 362546 D1 8 6 020987 ~omcasta Service Details Contact us: !%1 www.comcast.com 717-243-4918 r w,a~iV~.Yi '~ a 5 , n +j~ i i a YS~, i ~i '~,i ~~~:, u.~ ..,. ,. ~~ . Limited Basic 06/24 - 07/23 19.95 Expanded Basic 06!24 - 07/23 43.55 Total XFINITY TV ~ $63.50 '. fi5 1Y/~~ Y ~~~~ ~ Late Fee ~ 05/23 7.96 Total Other Charges $ Credit $7.95 F, } ,p~h y~~ M4Z h ik . 3 kr a~e.,°.;k~x+'aa,~k..dY^"'~1~feuvir^m.'v ~"y+"~"y.~l~.n TV I Franchise Fee I' 06/24 - 07/23 3.55 .......Sales Tax........_......._ ...............!L.............................................................. 06/24 - 07/23 0.18 i .............................................................. FCC Regulatory Fee 06/24 - 07/23 0.08 Total Taxes, Surcharges & Fe s $3.81 On July 4, 2011 you will recei~ programming under Viendo M Hispanic channel line-up. Ven change its name to Viendo Mt committed to offering you the most choices and will update ` Movies to your channel line-ul Venemovies ies as part of your tovies has chosen to es. Comcast is st programming with the nemovies with Viendo Lobby Hours 339 Baltimore Rd Ship Mon-Fri gam-Spm, Sat PA 17257 4601 Smith St Harrisburg, PA~17109 Mon-Fri gam-6pm, Sat 8:30a -4pm Franchise Authority: PA0543 Carlisle Borough 53 W South St Carlisle, PA Account Number Billing Date Unpaid Balance New Charge;; Total Amount Due 09547 362546-01-8 06/14/11 $134.61 -Due Now $75.26 -Due 07/07/11 $209.87 Page 2 of 2 Closed Captioning Customers: For assistance call (800)266-2278 or go online for email or live chat at www.comcest.com/suoport Forwri[ten concerns contact NW. Patel, Comcest Closed Captioning Office, 1701 John F. Kennedy Blvd., Phila., PA 19103-283$ email: Closed Captionina(@Comcast.com fax:(215)286-4700 or mll our closed captioning line (215)286-8000 An administrative late fee of $7.95 will be assessed on accounts not paid within 38 days of the Billing Date of the invoice, and additional later fee will be assessed day 68 of the billing cycle. To ensure proper credit, refer to the due date on the invoice and allow 5 to '7 days for mailing and processing. If your payment is not reflacked on the invoice, ft may not have been received by the date the statement was printed. ~omcasta Contact us: •~~~, www.comcast.com .~ 717-243-4918 Account Number 09547 362546-01-8 ' Billing Date 05/14/11 Unpaid Balance $67.30 -Due Now i New Charges $67.31 -Due O6/07/11 Total Amount Due $134.61 Page 1 of 2 ~ ~__ BEVERLY CUTCHALL For service at: 346 C ST CARLISLE PA 17013-1874 News from Our records indicate your aca account is not paid in the next late fee will be assessed. If pa made, please disregard this rn For your convenience, we nog automatic monthly credit acrd debit. is past due. If your ,n (7) days, a $7.95 nt has already been aa~pt regular and payments and direct Hearing/Speech Impaired Call 711 This bill reflects a change in th Regulatory Fee from $0.07 to monthly FCC ~x w xu frv p,r~~.k~~ ?? ^^ , ~ 5 "n'~ifi~i tW '~"' r•4 1 ~~1 " ! ! 6c,'u'fluhf{+~M;~+ vsx AiN`KAW(ikJ Y?3+~Y~AF'«YF Y~'~YM1H..y ~n Vj tY B'. ~,~~~r'. Previous $alance 67.30 Payments -received by 05/14/11 0:00 Unpaid Balance -Due Now 67.30 < New Charges -Due byD6/07!11 67.31 see below for more Information Total Amotmt Dtte X134.61 %~r ~ ~' ~~~' XFINITY TV 63.50 Taxes, Surcharges & Fees 3:81 0 0 Total New Charges $67.37 (comcast~ Service Details Contact u3: ~a www.comcast.com 717-243.4918 Account Number 09547 362546-01-8 Billing Date 05/14/11 Unpaid Balance $67.30 -Due Now New Charges $67.31 -Due O6/07/11 Total Amount Due $134.61 Page 2 of 2 . t I Ll 5 .~'~~d '@ ~4, i't3 c d f x ~ ~ ~"; y'~~7.'~tx ~ . Limited Basic 05/24 -06/23 19.95 Expanded Basic 05/24 -06/23 43.55 Total XFINITY TV $63.50 vat C, {,?a r TV Franchise Fee I 05/24 -06123 3.55 Sales Tax ~, 05124 -06/23 0.18 FCC Regulatory Fee 05/24 - 06!23 0.08 Total Taxes, Surcharges & Fe s 53.Rt Do you know you have option to help determine which programming is appropriate fo your family? Visit htta://www.comcast.com/Co rate/Customers/Parents ontrols.html/ to team more about parental control featun available as part of your Com st Cable service or call Customer Service. ~~ ~ _~ ~ ~ j ..__m ~_...._...~/~ ~~ ~7~~ ~omcastm Contact us: ~ tNww.comcast.com "~ 717-2434918 Account Number Billing Date Total Amount Due Payment Due by 09547 362546-01-8 07114!11 -$24.68 No Payment Due Page 1 of 2 _, F._._._.._...a._..,......_..._. .-,. BEVERLY CUTCHALL ~ ~ . ~ ~ ~'~° e ~ ~ t+~ ~" ~~~ ~ ~~ ~ ~ ~i~ ~ ~~~ Previous BalahCe 209.87 For service at: Payment= 06/15!11-thank you -134,61 346 C ST CARLISLE PA 1'7013-1874 New Charges -see lteYOw -99;94 Total Amount Due -$24.68 NG'WS ft'Om COtTiCB~t Payment Due by No Payment Due You have a credit balance of-24. 8. Make no payment ! -fl'~~` °~ Our records indicate that you ave a credit balance. All PaRiaf Month Charges & CredRs -86.79 credit balances of $L00 or re will automatically be Effective O6H2/f 1, you made changes to your refunded to you. If your credit balance is less then $1.00 acxount. See the following pages formore details. and you would like us to send you a refund, please OtherCharges 8 t"redits -7:95 contact our office by mail or p ne with your forwarding ~ ° address. However, ff you are till a customer, this Taxes, Surcharges & Fees -5.20. balance will be transferred to our new account Total New Charges X99.94 HearinglSpeech tlmpairad Call ~'11 Detach antl encaose this coupon with your payment. Please write your account number on your check or money order. Do not send cash. ~comcast~ 1555 SUZY STREET LEBANON PA 17046-317 ~w AV 01 011015 211626 32 '*SDGT ndll°1hill~hlurl^I~hl°IiP~~~r~hrl^Ilnldllhlulll BEVERLY CUTCHALL ' 1933 STERRETE'S GAP AVE ' CARLISLE PA 17013-1063 ' Account Number Payment Due by 09547 362546-01-8 No Payment Due Totat Amount Due $24.68 Amount Enclosed $ Make checks payable to Comcast Inlhlhhhdlhul~liillrlhlh~l.ludrllPhllPlhdl~~ll COMCAST CABLE P 0 BOx 3005 SOUTHEASTERN PA 19398-3005 i 09547 362546 01 8 I 8 002468 ('ccomcasta Service Details Contact us: www.comcast.com 717-243-4918 it ~ ~°. „~"<~ ~~ p~,~,+a "~i ~,gNt ... , ,. , ,, a r i ~.~y DVS i 7 rSl ~~n , r M Pao ~ Y ti~ W'p ~ 9r1 'A'~~b.,,('1~m. Because we had already billed you when the latest changes were made to your ar~count, we have adjusted this bill. Listed in this section are credlts and/or charges for these changes. Effective 06/12111, you remov~rl Limited Basic at $19.95 per month and Expander-d Basic at $43.55 per month. Adjustments for previously bided services removed 06/12/11 Limited Basic ', 06/12 - 07123 -27.27 41 days @ $0.6651/day bas~d on a monthly rate of $19.95 _ ___ Expanded Basic ~ 06/12 - 07/23 -59.52 41 days @ $1.4517/day bas~d on a monthly rate of $43.55 I FCC Regulatory Fee 06/12 - 07/23 -0.08 Sales Tax _ __.........__ ............._, 06/12 - 07/23 -0.26 Lobby Hours 339 Baltimore Rd Shippensbur~, PA 17257 Mon-Fri gam-5pm, Sat gam-1p~tt 4601 Smith St Harrisburg, PA '7109 Mon-Fri gam-6pm, Sat 8:30am~4pm Franchise Authority: PA0543 Carlisle Borough 53 W South St Carlisle, PA 17013' Account Number 09547 362546-01-8 i Billing Date 07/14/11 ', Total Amount Due -$24.68 Payment Due by No Payment Due Page 2 of 2 1 lr t r n p;,. ' ,. n. ~ .. 1 6 d 1 rz Yk ~ .~ .. 1 ~ ~~~1 ' V , Franchise Fee 06112 - 07!23 -4.86 Total Taxes, Surcharges B Fees .55.20 Information on upcoming I>rogrammer contract expirations can be found at www.xfinitvtv.cnm/contractrenewals Closed Captioning Customers: For assistance call (800)266-2278 or go online. for email or live chat at www.comcasLcom/suoport. For written concerns contact NW. Patel, Comcast Closed Captioning Office, 1701 John F. Kennedy Blvd., Phila., PA 19103-2831} email: Closed Captionina(a~Comcast.com fax:(215)286-4700 or o311 our closed captioning line (215)286-8000 An administrative late fee of $7.95 will be assessed on accounts not paid within 38 days of the Billing Date of the invoice, and additional late fee will be assessed day 68 of the billing cycle. To ensure proper credit, refer to the due date on the invoice and allow 5 to 7 days for mailing and processing. If your payment is not reflected on the invoice, it may not have been received by the date the sta[em~nt was printed. W E ACCEPT Masterord, Visa & Discover Please see back of form ~ ~ ~. ~~~. C~ I' STATEMENT Central PA Pulmonary Assoc. L.L.C. 2250 Millennium Way, SUIte 400 ACCOUNT NUMBER: CUTBEV0001 Enola, PA 17025 STATEMENT DATE: 10/11/2011. AMOUNT DUE: $1,297.46 AMOUNT ENCLOSED : W _ Bevedy K Cutchall Inv # Patient Balance 346 C St 55095 CUTBEV0001 $212.02 Carlisle, PA 17013 65111 cuTBEVooo1 $z1z.o2 '~, 55112 CUTBEV0001 $212.02 ~~, 55113 CUTBEVlN701 $212.02 ' 55114 CUTBEV0001 $212.02 I ^Please mark box and indicat any change in address on reverse side - -'_- -~ _______.______________j..(pLcpSE DETACH AND RETURN TOP PORTION WITH PAYINENT}---------------=-- Central PA Pulmonary Assoc. Bevedy Cutchall Inv # 55095 (HHA) PaOent Uue 05131111 $311.00 Statement Inquiries Number: (717)724-2791 ext 230 This is your final staten(ent. Please remit payment to avoid being sent to our collection agency. I Beverly Cutchall (CUT~EV0001)-- Inv # 55111 (HHA) ~ $311.00 Patient Due ''~. This is your final statem~nt. Please remit payment to avoid being sent to our collection agency. I Beverly Cutchall (CUTB~V0001) Inv # 55112 (HHA) $311.00 Patient Uue I This is your final statem~ant. Please remit payment to avoid being sent to our eolledion agency. Beverly Cutchall (CUTB~V0001) Inv #.55113 (HHA) $311.00 Patient Clue I This is your final stateml;nt. Please remit payment to avoid being sent to our collectio i agency. Bevedy Cutchall (CUTB~V0001) ~I ~.. Inv # 55114 (HHA) ~, $311.00 PaOent Due This is your final stateml~nt. Please remit payment to avoid being sent i o our collectio i agency. Bevedy Cutchall (CUTBEV0001) , Inv # 55197 (HHA) I, ~ $311.00 Patlent Clue This is your final statem~nt. Please remit payment to ai oid being sent Ito our collectio i agency ly'r` ~ ry, if~iiil 10/11/2011 CUTBEV0001 PENDING INSURANCE $212.02 $212.02 $212.02 $212.02 $212.02 $216.06 $1,297.46 $0.00 Please make che<:ks a able to entrdl Penns Ivania Pulmona Assoc. ACCOUNT y ry BALANCE $1,297.46 p y 4 ~-- - - __~_ ___ CARLISLE HMR PHYSICIAN MANA@1553144 STATEMENT ?h~kN#-OPTIONS A>nt $ PO BOR 28162.9 , - - ATLANTA, G1! ,903891629 v1ao1Q o70 539aD W810 RETURN SERVTf~ REQUESTED >25339 8001313 OU1 0920~b6 BEVERLY K CUTCHALL 1933 STERRETTS GAP AVE', CARLISLE PA 17013-1063 Please Include Secuntv Code From Back Of Card CNECKCARO USING FOR PAYMENT 0 V/SA a ® O STERC:ARD V ISA D ISCOVER CARD NUMBER EXP. DATE CARDHOLDER NAME SECURITY CODE SIGNATURE AMOUNT REMIT TO: CARLISLE HMA PHYSICIAN MANAGEM PO BOX 281629 •: ATLANTA GA 30384-1629 ~u~lt ~~~uui~~~~u~n~u~m~~~~~nu~~~~~~uu~~~~~~n u~~t~ '~ I` F',_~r .t ~,.il-{I I i~; I'~"~E,TI.7Pd ~.^/ili (, YfA1-Nl_ Office Phone Number S.atement ate your ACLOUni Number Page No_ '~ ~>~~ ~ e SHOW AMOUNT 717 519-0753 08/10 11 853144 1 131.41 PAID HERE $ _ ------------------------------ ARGES APPEA ING ON THIS STATEMENT ARE NOT INCLUDED ON ANY HOSPITAL BILL OR STATEMENT 13111 CHERNICO!! HOSPIT CARE INV4'el CVTCRALL, BEVERLY 960.00 ANOONT PLIED TO DEDUCTIBLE $Y31.41 061311 H THANERICA NED PNT 0.00 C045-C CiES EXCEED YODA CONTAACTEDAEE ARRANQENEN PA1-DED CTIHLE 061311 H THl1NERICA NEDICARE A -128.59 Insurance B lances 0.00 Pat:lent Balances 131.41 ement -- _ 08/10/11 PLEASE INDICATE YOUR ACCOUNT NUMBER WHEN CALLING OUR OFFICE 853144 Current 31•-60 Days 0.00 131.41 i 61-90 Daya 0.00 >90 Days 0.00 Total Ins Pendin g 131.41 0.00 ?ATIgN~~hALArIC,P b°AY I HIS AMCJtiT 131.41 K11NQUlHIE87iMYMEN7S llrr taaaootrlaa2s~vaoxa~aaooD~~ooooy r: Ail unyaid balanase will be sent to a onlleotion ai~sacy and ali colleation/1e~ 1 fees will be your reepon~ibility. • ~ 0 ~ 007852 858HHA 000102E 1'~lJ~~l V/lL 45 Sprint Drive MEDICAL CENTER Carlisle, PA 17013 ADDRESS SERVICE REpUESTEO 1 UPON RECEIPT Beverly K Cutchall 346 C Street ro Carlisle PA 17013 N L,rIIh,,111r,r,,,IL,llr,..III„hLr,~,LdJ„LILJr,IJ IF PAVING BY CREDIT CARD, FILL OUT BELOW AND SEE flEVERSE SIDE CHECK C/1RD USING FOR PAYMENT ^ - ^ ICI ^ ^ MASTERf,AFD DISJOVER Y~ VISA it - AMERICAN E%PRE55 ACCOUNT NO. STATEMENT DIrTE BALANCE DUE ~ A • . , 9496831 07/18/2011 S340.00 MAKE CHECKS PAYAEILE TO: CARLISLE REGIONAL MEDICAL CENTER P.O. BOX 281442 ATLANTA GA 30384-1442 Ir,llrlll,r„Ilrll,Ir,l„I,r,ll,ir,lrl„Ir,l,l,lr,l„I,I,Irl,l II 00000949683100000034000BEVERLY K CUTCHALL 0 Please checrc If above address Is Incorrect and Intllcate change on reverse sitle_ TL INSURE PROPER CR1-01T, DETACH AfJD RE?URN THIS PORTION IN THE ENCLOSED ENVELOPE A l A IE T ACC UN ND. ATE OF S I f P tl Beverly K Cutchall 9496831 05/27/2011 LNPATIENT DATE DESCRIPTION PAYMENT/AOJU8TMENTB 07/14/11 ADJUSTMENT 167,151.32- 07/14/11 INSURANCE it I I 11 ~i I II AYMEN7 36,185.84- PAYMENTS AND CHARGES RECEIVED AFTER HE STATEMENT DATE WILL BE REFLECTED DN THE NEXT STATEMENT. r 1 : ~ r 1 $340.00 A The amount shown on his statement is outstanding at FOR BILLING QUESTIONS, PLEASE CALL: this time. Your prompt ayment wiA be greatly (717) 960-1680 appreciated. i i Bills can be paid online at our hospital internal web site www.carllslermc.com i ' r PON RECEIPT ***Detach Upper Portion and Return With Payment*** Patient Name: BEVERLY K CUTCHALL Services Rendered At: Carlisle Regional Medical Center ~~ )f~ Account#: $2121 ~ ("~ BALANCE: 144.35 PAY BY: AST DUE , ***IlVIPORTANT*** Your account is PAST I UE. Perhaps you have overlooked this balance? Remember credit is one of your most valuable assets. To prole t your credit, send payment in full, or, contact our office immediately to make satisfactory payment a~Tangements. PLEASE CALL: 717-652-61.05 Kinetic Imaging 4520 Union Depos>It Rd '~, Harrisburg, PA 171].1-2910 P~case contact our office for further details on your account. ~aeoe - z ..~ .~ -"" Cent:uryLin~C~ P.O. Box 1319 Charlotte, NC 28201-1 31 9 Account Name: BEVERLY K CUTCHALL Accoum Number: 31432766 Page: 1 of 4 Bill Date: Jul. 25, 2011 COM8C1 NUrilb@rS __ CUrr@rlt Char@@S $Ummary Detail Page Pay Online ~ -- ~~- --- www.cenlurylink.com/myaccourot D Centurylink local Services 3 1 .Do Pay by Phonte 1-666-712-1996 Account Charges 4 0. n cR Customer Service '~. 1-800-788-35Cq Late Fees 0.43 Customer 3ervtce Hours '. TOtal Current Charges 1 .26 Mon-Fri 8 a.m.-7 p.m. Repair Service 1-800-788-3600 ' Visit us onlirua ~I www.centurylink.com '~, Previous Ralanra Pavh,enr< u nd~~ P~~r rn,e n..___...~_____ ._.--.__ ..__ _ _ - _ - -a-- vaaao vue 100.81 I ~, 66.71 CR I 34.10 I 1 ,28 I (~,~ ( AUg. ~~ 2011 Just a hiendty reminder that your account is past due. If yo~ have already made your payment, thank you for bringing your account up to date. The Due Date On This Dill Applies to Current Charges On'y 6 . -. CenturyLink° Page 1 of 5 Monthly Statement Account Number JUne 25, 2011 717-243-9399-017 Payment Options & Contact Info Current Charges At-A•Glance Rstail Store in Your Area a CARLISLE 202 Westminster Drive in The Carlisle Crossings Cent$r Pay Online CENTURYLI NK.com/myaccount Pay by Phone 1-877-813-7604 Customer Service i-800-829009 I Repair Serv„ce ' 1-800-788-31300 '. Internet Address CENTU RYLIN K.com/residential CerduryLink Services Local and Optional Services -Page 3 Taxes end Surcharges -Page 4 n Total w 24.89 9.27 Previous Balance Paymen}s & Adjustments Past Due, Please Pay Now Total Current Charges Total Amoum Due 136.71 I .00 I 66.71 I 34.10 I S7 ~_$.' `, I~ ~I 1` CenturyLinkry Current Charges Due By: 07/19/11 ' If received after July 25: $102.05 ' = e ®Please Recycle ', Please return this portion with payment Customer Service Internet Address Account Number ', 1-800-829.8009 CENTURYLINK.rom/residential 777-243.9399.077 '~... Please pay past due amount of ' $66.71 lmmedtately Total Amount Due: $100.81 $102.05 if received after .July 25 r' ', Amount Enclosed: s ~ ~ ~--- AV 01 022895 091618 97'A**SDGT ~IIL~1~~~111~~~1~11111~~~1'~~1~'1i111'~I~'I'~""~'II'~'Ill~ll~~ Make checkspayable~to:berona,eck BEVERLY K:CUTCHALL 346CST ~ POtBoxl1319 CARLISLE I A 17013-18744 Charlotte NC 28201-1319 1111111'1~~11~~I'I'11111"'~I~i'Ir~~~rIIILL~ILIhP~I„111111~' 12 7172439399017011 00000000003410 000100812 1120504 I ~~ 1 __ _ __ Fum%c ^m a~ ~ ' n v g n $ , .m c v o 0 RO+ON~ Z 2 ~. OC~dN ~ ~ 3 ~ ~ • ~oaa~° n `\ ~ _ .\ ~ ~ ad"sa~ ~P n ~ l.c " , 1y^,~ c ma ~ V ~_ F.or~° ~ ' ~ 111 ~ mc ~ D md ~ r D v ~~~' ~ ~~ n _ o m IUJ x o ~ r ` a a~ L ` °~" ~ Rd > \ ~p A OA 'q ~ T W ` _ ~ _ °m ~ ~ ~1 a .op¢ ~J fn ~~ ~ ~ va ga i ~ ~ m n v _. _. _ _ __ __ -- __. _ . _ .___ . . ~mSm ~a'cu m T _ ~ 's o ~rvv ', nr A Do nmD n zv~mv-~ - S O m Q D O Z D ~ < rO~m r m y W O C < n < n ~nomn~ m a m m a -1 D Otim~< < ~~ ~ ~ c~ ~ O_ r Ga o ~ q m .- A Cm < i ~ • O m r m m cr rv,m ti m ~ D o ~ r m~mmF O o ~. r t m r O y~pnr m -~ a ~,/~ _ ,1 1 y~ m ~zammm m l ~ a ° ~ (n °<m ~'~~ " '-' m ~ ~ n (~ mop v ~ m O ~ozm~c .a p~ ' ~~ ' ~ ~ ~ ~ Cry _ ~ ' m ~ `~i ~ I ~ ~ n Aim mm ~ ~ D I I ximnOZ O.. - i ~ [ u 3 ~\~ (\ m C'p ny ~ r _ si n~ in • ~7 a I .~v,om~ ma z~ o s ~ C] o ~ N / ~ m a ~mza i ~ ~ ~ ~A m~v_ ~ O (!1 Gy ti o Snn-r/l - O Om y m~~ p~6 ~~ <~m cn '7 '~ , , D~zm< m ~ , j .~ ~ nmip-m o z[o ~ p A - m 77 V ~ ~ p r rlp O • r~ ~j ~ A ys°ooo m ~ n C~ ~ d ~ V p ~ N m p< o z ARI~~<31 ~ ~ ~ ~ ~ ~ Z J] °r T m ~ I -i (l1 ai "x n LJ In '~ ~ t n +F y ~ m ' ~~ S r O r r,. ~ O ^ .. m .\y, c 3 a o ~ . m D ~ JJ y 7J .< v j g c i m ~ ~ ~ ~ ~ n I 3 .S e \~ x ~' z "' • D rD- ~ y . ]J v ~ ~ '1 o 4 J ~ ~ ~ ~ A p Rl D 3 3 ~ { y = Z Lr ~ m CI '~ ~ Z Cr ~ ~ . 1 _ N ~ m ry~ ~ Y ~ •i~• /' T O P m ~I 1 1 ! n ~ S Apo-65f-? uHINTFf ~ IN i JR ~ PPL Electric Utilities Electric Service For: BEVERLY CUICtIAL,I:. Sac c sr CARLISLE PA 17013 Questions about ttus bill? Please contact us by Jul ] at 1-800-34b5775 (1-800-DIAL-PPL)i or write ta• Customer Service 827 Hausman Rd. Allentown, PA 18104-9392 www.pplelectric_com Electric Use 'this graph shows your electric use over the last 13 months. Types of Meter Readings: Actual - Adjusted Estimated Customer 0 Page 1 pp ~ Yme ' 1' tai 68070 78008 .. Summary Page B~lance as of Jun 1Q 2011 C r~ es: T taFPPL Electric Ufilities Chages T tal Dominion Energy Solutions Chages Charges ................... gi mt Balance II KWH -Average Per Day za 20 16 12 8 4 0 JJASONDJFMAMJ z to Months 2011 $98.57 16.87 18.67 $134.11 $134.11 Meter Reading Information Meter #68224773 Jun 9 Actual 30668 May 10 Actual 30458 _ 30 Da s KWH Billed 210 Average-Jun 2010 2011 Temperature fi7F KWH P D 11 68F er ay 7 Yearly Use: Total Average Use Month)y Ju12009-Jun 2010 3581 298 Ju12010 -Jun 2011 41542 379 Other important information on back ~ PPL Electrir. Utilitie,i Electric Service For: BEVERLY CUTCFLALL 346 C ST CARLISLE PA 17013 Questions about this bill? Please contact us by Aug 31 at 1-500-342-5775 (1,800-DIAL-PPI:) or write to: Customer Service 827 Hainan Rd. Allentown, PA 18104-9392 www.pplelectric.com Electric Use This graph shows your electric use over the last 13 months. Types of Meter Readings: Actual - Adjusted Estiatated Customer Summary Page Balance as of Aug 10, 2011 Clbar es: Tgta~PL Electric Utilities Chazges Total Dominion Energy Solutions Charges Total Charges count Balance w look coming soon October, we'll debut a new bill design r customers. The new bill will make it u need. Please check out Connect, the ur bill, for more information. $0.00 $13.36 $11.87 $25.23 $25.23 based on feedback pprrovided by easier to find the inlbrmation monthly newsletter included in Meter Reading Information KWH - Avetage Per Day 24 Meter #68224773 Augg 9 Actual 30942 20 I, Julll Actual 30802 _ 29 Da s KWH Billed 140 16 1 Average -Aug 2010 2011 ' 2 Temperature 78F 79F KWH Per Day l6 5 8 Yearly Use: Total Average a Monthly Se 2009 A 2010 p - ug 3943 9 Sep 2010 -Aug 201 I iS885 324 0 A S O N D J F M A M 7 J A O1~ MOIlt118 2011 ', Other important information on back ~ -----1------------------------------------------------------------------------- ~I I PPL Electric Utilities Electric Service For: BEVBALY CUTCFiALL 34C C S7 CARLISLE PA ]7013 Questions about tbis bi117 Please cnntad us b Sep 30 at 1-800-345775 (100-DIAL-PPL) or write to• Customer Service 827 Hausman Rd. Allentown, PA 18104-9392 www.pplelectric.wm Electric Use This graph shows your electric use over the last 13 months. Types of Meter Readings: Actual - Adjusted Estimated Customer Sammary Page Balance as of Sep 9, 2011 $p,00 C r es: To al YPL Electric Utilities Charges $12.11 TI Dominion Energy Solutions Charges $8.65 To~al Charges $20.76 Balance $20.76 Ne look coming soon In ctober, we 11 debut a new bill design based on feedback pprovided by o customers: The new bill will make It easier to fmd the information yo need. Please check out Conuect, the monthly newsletter included in yo bill, for more information. 24 20 ld t2 8 4 0 KWH -Average Per Day Meter Reading Informatiou Meter #68224773 Sep 8 Actual 31044 Aug 9 Actual 30942 30 Da s KWH Billed 102 Average- Sep 2010 2011 Temperature 74F 71F KWH Per Day 11 3 Yearly Use: Total Use Average Monthly Oct 2009 -Sep 2010 3940 328 Oct 2010 -Sep 20] 1 3647 304 OND J FMAMJ ] AS Months 2011 Other important information on back ~ ~KVz~ i~~ Questions? Please Visit us online at ~~ ~/0"s ~ Page 1 ® contact us by Nov 1. `~ pplelectric.com 1.800-DIAL-PPL ~ ~ • ~~~ ''~~ (1-800-342-5775) ~1 w~L w.awo ~num•. M-F: Sam to Spm 68070-78008 Nov 1, 2011 f ~ ``~' ; ~` Your Electric Usage Profile Service to: BEVERLY CUTCHALL 346 C ST CARLISLE, PA 17013 Meter: 68224773 Your neM meter reading is on or about Nov 8, 2011. This section helps you understand your year-to-year electric use by month. Meter readings are actual unless otherwise noted. za r 20 3 = 16 ~ 12 a 8 t° Q A Oct 2011 32 270 III I I 8 62F Oct 2010 29 316 it 64F Oct SO Actual 31314 Sep 8 Actual 31044 32 Days kWh Billed 370 Nov 2010 -Oct 2011 3601 300 Nov 2009 -Oct 2010 4013 ' 334 details on Balance as of Oct 11, 2011 50.00 Charges: Total Dominion Energy Solutions Charges 522.90 Total PPL Electric Utilities Charges $17.68 total 540.58 Account Balance $40.58 PPL Electric Utilities' price to compare for your rate is 8.411 cents per kWh effective 9/1/2011 to 11/30/2011. For a list of supplier offers, visit papowerswitch.com or call 1-800.684-6560. Your Message Center • Your bill has a brand new look,. To learn more about how we changed the bill to better serve you, check out the enclosed brochure or pplelectric.com/samplebill. • Wlth paperless billing, you can receive and pay your PPL Electric Utilities bills online. The process is free, quick, convenient and secure. To learn more or sign up, visit pplelectric.com. • Information about appliance energy use and tips on saving energy are available through the Energy Library on our Web site, pplelectric.com. • Keep light bulbs and fiMUres clean. Dust and dirt absorb light and can reduce light output by as much as half. /~ Online at: By phone:l-800-342-5775 ~~ U pplelectric.com or call BIIIMatrix (service fee applies) at 1-800-672-2413 to pay using Visa, MasterCard, Discover or debit card. ® By Mail: Correspondence should be sent to: 2 North 9th Street Customer Services CPC-6ENN1 827 Hausman Road Allentown, PA 18101-1175 Allentown, PA 18104-9393 Other important information on the back of this bill -~ ~ 200 ~ ~m~ ., m a L L °E cu C O ~d «. u in a '> a 0 m ~+' o ~n E d~aui o VI N~~ _O ~11GM tEp to mYB ~ ~ .O u49 a0 ~i ~I v /_~ ~~~~ ~~v y ~ e\ v 4 ~ O ~F a V 0 ~,«a,~ __ „m ~ '- ^' _ 3 lA Y Aj ~" Q ++ tr? ~ ~~ C 8 Ol N N ~~' u` O C O O N O N N N N ~ /.. N ., v rl~ . J C r 10 ~ .. 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UN yW > J~ l0 >~~ 0pN ~ O1 ° ~y °o m _ : y ~ C J c ~ a i ~ n . nv •o a m_t c y ' ~ ' ~ N O d N of ' u N w N aoE d V y ~ ~- '" +-'gC a0~ X10 u m_OT'~' N u i ~~C , A>yi •a , n TUE v~ _C p p Z w 'C .' c N p ~ ~ ~ m~'OU W r~'oN~ 'Cm~Dy d 0 , m s u0` ; ~ua c JdNO N R a O rp N r m + ~ i L+ 0! y > 41 ~. y d J v~ 3 p 0 ~r (>p C O ~L T}j'".0= 40 y N t0 t• # L ~ y _ o a v> C N O fG N VI'O Y~O c m o ~ o ~ ~ o ~++ ~ ~ma ~' ~ • m uI o~~;a dvn y~. a i ~ e4 C ~ O N Ti6 I J o ~ Y h N f0 Ol d ~ T(p O O C I a >~- v i o ~ ~ ~ v ~ ~ 'm ~ ~ ~ c J a Jt ~ ti N N O O _ ^o ~ nEc Ri ~ N N to ~ Q O a E ~ v c c J G! } + N u d N V ~~ ~ ~ ~ J ° { , ~ V ai L ~nm ~ ga Sao (4NW) heQ gad •8ny ° z 0 Q f a F LL II IIII I I I ICI I1BI I Ilill I III I Intl II 11 111 111 T n> m •• nmu O C ~ ++ a N'IAa nv- ~O Ol IA ~ N N w T m 1~ umo i O -O m O IA'` O. aN v ,0,a ' p1 O .S Y u M HMO Nvi N"'~ xv`~ ~ ~u~.ti d r ~N~ C~ ~" c'm o ~ oa,~; o aE e _ v n m ~ ° n ;,, u.y~ Y n w E _ e Y C N ; 6 E H . o '~ ~ .~ v ~ u t ~ 01 g u ;;•° vr' L ' "~z c -Lwo w C C O~ . d ~ C (~ O1 Oa mNCJQ a LL LL N N V 1 ~ m ~ °m m .+ .-~ m M m N N -a ?~ `° m ~ m a m ~ a ~ L m 3 Y H O N ~ m H O N O Z Z N O 2 N O Z 00 Z 0 O ~ M N O O ~ N ~ O G l0 N [Q ~ O N N '1 ei _~~ ~~ uer acsrect ~~/ enp Summary for Service to: V 9ERLY K CUTCHAILL r~ d46 C ST CARLISLE PA 17018 ~,. l) Rate gssNRcaUan: Residential Heatinig I Billing Period: O4/19/2011to 05/19!2011(30 days) f Remote Device Read C puestlonsy P Call 500-276-2722 a write to UGI at R PO BOX 13009 yi Reading, PA 19612-3009 SY Your current UGI charges include State taxes totaling about $ 0.57. Past Billlnfirmatlon-UGIUUIRy ~' The aarount balance on }rear last bill was ................ S 51.50 "~ ~ ~~ ~ ~ -~. ~.,,~i Payments........._ ............................................................._. 0.00 218776408040 Late Charge .............._....................................................... 0 74 Your balanre as of 05/24/2011 (due now) ............... ~d Currant Bill Information -UGI Utility Customer Charge .............................................................. 8.55 Commodity Charge (8 CCF at $0.71625 ................. 5.73 Distribution Charges (First B CCF at $0.4750) ...... 3.50 PA State Tax Surcharge ......................._......................... -0.07 Total CurrentCharges -UGI Utility ......................:........-i7~4 UGI Utility charges owed this bill .............._...______. Average CCF Per Day Meter Information - Nexl Rsad Oats Juns 2t, 2011 e 4.70 Meter Number Previous Reading Present Reeding CCF Uead 4.23 1225663 7872 (remote) 7880 (remote) 8 3 3.76 2 3.29 ~~ Maasegas Iron UGI 2 2.82 1 2.35 1 1.88 g., 1.41 O.e 0.94 O.G 0.47 MJJA140NDJ FMAM 2010 Months 2 1 rerag~ Last This ,F d Average Year Year fly tai CCF/day 0.36 0.27 Daily temperature ,62°F 61°F",'- • Your current price to compare is $ 0.73453 /CCF. •Your total annual usage is 473 CCF. Your average monthly usage is 39 CCF. • Halp prevent pipeline damage, accidents and service disruptions. Call 811 before you dig. •Sign up to view and pay your future UGI bills online at www.ugi.com. .,~ U N 6~~ -~~~ If you pay at a payment agent please take your entire bill. Make check payable fo UGI. Keep this part for your records. Important Inlormatlon_le on the beck of this 6111. - ' ~°~°~~s. important Information is on the bark o/rthlsiblll. ~lH ers rss risr Ilingg Summary for Service lo: VERCY K CUTCHALL 6C5T RLISLE PA 17013 ite ClassiflesUon: sidentfal Heating (ling Period: /20/2011 to 07/20/2011 (30 days) Remote Device Read esUona7 II 600-276-2722 or write W UGI at BOX 13009 ading, PA 19612-3009 ur currant UGI charges include rte taxes totaling about $ 0.27. ~~" 1 a `f ~~ ~~~ y~ ~ ;. The aByount h~ancPn~o our last bill was ................. $ 1.55 2 f~r~ y 18776408040 Thank ou for ur a ment af .................................... 1.55 Your balance as of 07/25/2011 ..................................- BIII Informalfon -UGI Utillly r Charge ........................................._...._....,.......,. 8.55 Tax Surcharge ................................................... -0.03 rent Charges -UGI utility .........._ .................... -~ ly eharasn owed this 6111 ........................................................ 3.52 !~ Meter InkrmaUon -Next Reed Date August 19, 2017 ~I Meter Number Previous Reading Present Reading CCF Uesd 1225663 _ _ 1880 (remote) 7680 (remote) 0 !, Messages (mm UGI Your current price to compare is $ 0.77347 /CCF. Your total annual usage is 473 CCF. Your average monthly usage is 39 CCF. F We can make your energy costs easier on your budget with our 12 month Budget &Iling '~, plan. Your monthly payment would be approximately $ 53.00. For more information '~, about this plan call UGI. F Help prevent pipeline damage, accidents and service disruptions. Call 811 before you dig ~ Show your patriotism with UGL Lika us on Facebook in the month of July and we'll donate $ i to the USO. Visit www.facebook.comlUGlUtilities today for more details. Last This xage Year Year =/day 0.00 0.00 ly temperature 76°F 77°F F Sign up to view and pay your future UGI bills online at www.ugi.com If you pay at a payment agent please take your entire bill. Make check payable to UGI. Keep this part for your records. Important Information Ie on the hack o/ this bill. J ASONDJ FMAMJJ 2070 Months 2011 •. , 3i11 Ouestiora? f you have a question aboutthe bill, please call UGI before the bill's due date. UGI's phone number, yoiur due date rnd billing rate can be found on the front of the bill. A detailed rate schedule can be requested. You may also con- :act UGl atour web sitla, www.ugi.com searing or soeech imoaired customers TDD only call 1 800 654 5988 Tc dic an overd .n rnnnr 8ca 1.800_ ?76-2722 weekdays BAM to 5PM 3111 Payments 'eying your bill by mail is convenient. Simply use the envelope provided with your bill. You may also pay at one of our :ayment centers. A list of the payment penters is available upon request UGl offers a plan where your bank deducts your payment automatically from your ghecking or savings account Please call us if you are interested irl this service. fo pay by phone, please call 1-877-503-Q956 Ysed Your Natural Gas Service Turned Oft? fo ensure thatyour natural gas service is fumed off on the daythatyou want, pibase contact UGI seven days in advance. third Party Nntfication -Budget Billirhg Plan -Operation Share -Customer Assistance Program (CAP,) Cab us to iiscuss these UGI Programs. :cf -100 cubic feet of g as. Mcf - 1,00f :ommodity Charges -The charges for seating value (dekathermsl. gas supply service which is sold either by volume Iccf ar Mcfl or :ustamer Charge - A monthly charge to jcovernatural gas distribution company INGDCI costs such as maintaining the las lines, meter reading and billing. )istribution Charges -The charges for~the delivery of natural gas from the point of receipt into the NGDCs system. :atimated Bill - A bill based on your pr sous use and weather conditions. UGI may need to estimate your bill due to extreme weather conditions, emergencies, or any other circumstances that prevent UGI from taking a meter reading. .ate Payment Charge -Fee tfiat UGI charges if you do not pay your bill on time. It is a fixed monthly percentage of he amount owed. 'rice to Compare -The dollar amount~harged by the NGDC, used by consumers to compare prices and potential savings with other natural gas supplier. state Tax Surcharges -Charges approved by the PUC. It is a special charge to recover state taxes UGI pays cubic feet of gas. This is a measure of gas usage. FM~flGENCIES: t0 report a Gas Leak call t_ggp_z7~~ 9e hmrt n As lH •.rr ruritr IIIap Summarryy for Service le: VERLY K CUTCHALL 6C5T .RLISLE PA 17013 rte ClaaslflcaUon: ~sidential Heating Iling Period: y2o/2D11 m oene/2on ~zs aaye) Remote Device Read reationsP ;II 600-276-2722 or write to UGI at iBOX 13009 jading, PA 19612-3009 ur current UGI charges include ate taxes totaling about $ 0.27. Last This Year Year F. 0.00 D.00 :h' ~. ~ F 77°F Pasl Bill Information -UGI Utlllty The acrnunt balance on your last bill was ................. $ 6.52 Thank you for your payment of ...................................... -6.52 Your balance as of D8/23l2011 ....................................-b~0 Curronl BIII Information -UGI Utility Customer Charge...__ ........................_....., PA State Tax Suroharge ........................... Total Current Charges -UGI Utility ........ UGI Utility charges owed fhia 6111...... 6.55 :~~ ~M. ~~ r ~~~ 216776408040 S ~~ ~~ f / S 8.52 Meter Information - Nsxt Read Data 8eptsmbsr 20, 2011 Meter Humber Provloue Resdlnp Preesnt Reading CCF Uaad 1225663 7680 (mmote) 7660 (mmota) 0 ', Messages from UGI hYour currant price to compare is $ 0.77347 /CCF hYour total annual usage is 473 CCF. Your average monthly usage is 39 Ct:F h We can make your energy costs easier on your budget with our 12 month Budget Billing '~~~ plan. Your monthly payment would be approximately $ 58.00. For more informaGan ~, about this plan call UGI. t Help prevent pipeline damage, accidents and service dismpticns. Call 611 before you dig. ~ Like us on Facebook at www.facehook.com/UGIUtilities for energy carsenatian tips, ~, exclusive offers and tasty summargdlling recipes. f Sign up to view and pay your future UGI bills online at www.ugi.com. If you pay at a payment agent please take your entire bill. Make check payable to UGI. (Keep this part for your records. Important Information Is on the back of this bill. ASONDJFMAMJJA 2010 Montha 2011 IIIrr~~qg Summary for Service to: VERLY K CUTCHALL 6CST RLISLE PA 17613 i7e Classlticatlon: sidential Heating (ling Period: U19/2011 to 10!1812011 (29 days) Remote Device Read ieeQons7 11800-276-2722 or write to UGI at 180X13009 ading, PA 19612-3009 ur current UGI charges include ate taxes totaling about $ ~D.27. Psal811i InformaQon -UGI UUlily The account balance an your last bill was ......... ........ $ 8.52 - r ~~ ~'E^i Payments ..................................................................... ........ 0.00 21!!776408040 Late Charge ................................................................ ........ 0. 1 Your balance as of 10/24!2011 (due now) ........ ........ J L,•Jll // ~ J Current Bill InkrmaUon -UGI Utllily C y ~~~t~7 L, ~ (7iy ustomer Charge ..................._.................................. ......,. 8.55 PA State Tax Surcharge ...........:.:............................. :....... -0.03 - Total Current Charges -UGI Ubhty ........................ ....... ~?'~ UGI UUlily charges owed this bill ...................... ........ .............. . ........................... $17.15 Meter Informa0on - Nsxt Read Dste November 17 2011 , I 4 70 Average CCF Psr flay ! Meter Number Provlous Reading Present Reedin CCF Used i g 4.23 1225663 7980 t 789 t (remo e) 0 (remo e) 0 3.76 3.29 I Messages from UCI 2,g2 Your current price to compare is $ 0.77347 /CCF. 2'35 1.98 Your total annual usage is 466 CCF. Your average monthly usage is 39 CCF. 1.41 ~ Help prevent pipeline damage, accidents and service disruptions. Call 91'I before you dig. 0.94 (1 A9 tSign up to view and pay your (atom UGI bills online at www.ugi.com. ONOJFMAMJJASO 2010 Months 2011 Last This erage Year Year F/day 0.16 0.00 ily temperature 60°F 62°F ', If you pay at a payment agent please take your entire bill. Make check payable to UGI. IKaep this part for your records. Important Information Is on the back of thla bill. Y r \~ -_ y "'y ~ O 7 "N jQ,~N C ~N O tl 6 O 7 ~ ~ a ~1O °'~p'~ m~3 ~a 'f - O.F F} N ~ 1(] O Gi0 N m V v `~ Gg. ~ ~ ~ i ^11 F ~ ~ v .S p i ~ i O a ee e"Tn~ ~ ~ !gip w .o§ 4 9 W ~ ~tl~~ O i~ ro tl 6 ~Gtlq ~ ~~L .+ 7 ~~~ 'o ' @ E ~ E 2 . E~c, 9 ~ p ~ ~ a~ ~ tl ~ m ~ L : = f 0 A U 4, '=:, . g 0 ~ ~, a ~ V 0 % ~J i [O t _ ~^ ~ 8~ Eu a ~ { iflfl 1 }~»w V ~ N 91 J ~W p>io¢ LO~~Q T m 1O a ~ N ~J ~ N O ~ m N N9p ~. o ~° 8 ~ 0 O M ~ N Ol ~ N N_ L O C OI N U W m O ~_ N f0 {' m u tl $ ^ t Nm'1 3 p.1~.04 ~ tl m ~ ^ p tlN(71 q FO SN`OC 9 GmC~m~'O VaR. 'pp ~_ .~ Opp (~ pmp -~= d'm0 ~fJSG}~ gC pY Ot i ml m E' t+f IG 10 Y] N e m n tl .~ E ~s 'a o psi Y = E >° =~ m~ m ~~ m'm s o E N Yom. O O O S~ ~ _r ~~ a E e g^ O r8 A ffi~ qtl 0 -~j g c Tp~ tl d 'm't~ 60 T. ~~II c Y E ~ pc ~5 U C ~ 0 N Sam N N GO Q 1~ O m m m v m e o N N ~ ~ 0 0 0 i W m p a ~. m i 6 G N w~ ,~ S ~' tl ~_ W 0 O~ M .o ~ ° s: tl, ~a n a L u C y ~ C O a w ~E m€ 4, C m m w ~ „ n N 0 . 6 C 9 W ~~ ~~ m r m ~ T a¢ T O LL L lpp O r`r OfC 00 ~p 0 J T O i0 m 6 ~ ~ ~ a v~ ~~~_ F~ ~. °> ~ N u~fa ^^ (A' _~~ € ~ ~~ o N m ~ 7 0 ~v~N O ~ 6 ~ qq~~ mg." a~'Y =~e~ m~~~ mom.. a~~i N n N N m N ~ ~C a` C mppg UI m s ~ s V ~ G r ~ Ol ~ ~ M ~, ~ p O ~ C y ~2 o m 0 ~ 1~~10 ~j ~ ¢$O Sm O g~ tOOm I~~' ~~ w q~ y b Qo~a .„,~ IN ~~I €~~~ ~~ ~ € mss I~ q m o ~~m'm~ CK m ~ ~BSz m S ~ C M t~~ U k~ ~ygg~ S ~~ N ~k yE S 8 9 ~I ~~ A O) = 9 O } € V d Y a ,p~ ~ _ ~° fJ ~m E m L ..~ ° ~ « mb ~ 3 ~ _ ~ 5 ° '- OO m ~ ~ a m E~ U A ~ C c y y~ Y o ~ O 6 j = m O ~ p n w i4e l ~~ ~ GO '~' g L E m~ $ ~ m ~ @ E ti m $~' a m E m ., ~ 8 ~ m o ~ gg ~ ~~ ~ ~a ~ E ~ m c q ~ ~ ~ ~ E « m ~ ~ ~ $ m} m ~ ~ A '~ e t0 R ~ S ~ C ~ W 40 • } ~ ~ N C 'O m m ~ ~ ' { Q ~ a .B OI ~p ~p C7 6~ Op C m S ~ {p m C ~ S N ~ .t.. ~~ p n 'c c m ~~ g q LL'«n " m ~ ~ m i" ~F Q m .r E~ m g ' ~ c5 a ai g a E ~ 19 0 }~ br o c 14 = a ~S > 3 ; ~ c m m S n n ~~ m ~A c ~ o O ~} O y 3Gm m S Y C Jm STY ~9 m fn $ _y • • ^ • • ^ ^ _~ W m q O e t ~ Y ~ Q ~a ~~ C ~ ~ m N J d'LL Y ~ O 7 w O r Z Ri ti N m M YmY Q N~ 0 m F } E 9 Q CJ O r:z< ;~ ~ ~~ ~ ~ m ~ . k~ ~ ~ i P~~~ [< N i Y] N ev N ~T OI Oi vmmo oim ? Q ~ mvoeo r fA i i~ .~ - ~ "po e i a en ,.~_ ' t7 D ~ ~ S '~. ~ LL ' ` ~ ~ ~ o Ego ,, rd ~ ~ ', m q ~ ~ ~ ~'~. C m ~~ ~ Em$,R ` etc `m $~A ~~~~ t ' m"~8~~8' m ~.xa ', gg~ Ea ~~ ~ a°'OO E p e- n.~~} ~ LiU~Gdh~--~ ~` A 3 v N m vi = a W 9 ~ S ~. ~ ~ C K ~ , y pJ ~ O ® y ~ 4 ~J I. N ~ C G O M y~~N N ~ l ~ ~ p ~'~. ~H ~ ap:mO r 8Q ° 2 O Y N _ Nm~ ~.N. f00 Q ~ ~ L ~A~~~ . ONm6 ~~ N ryNNry J III pll J J J ~ ~~N t~. 0 g1O C Cmy9 p p it ~l I C _J WUK ~0~ ~5 ~n ~C\ ~~m~LL _Omm GN ~q `~Sz $ L . ~i C C 0 n £3 °v 0 m a S a a u ~ } a o m A na Y G ~ u ~ (Y~(QQ ~ ~2 ~ a a ~E mQ c ~W `'g o ya ~+ E 6 v Do ~~ ~~ m ~ m n$ Y O ~' _~ ~ mLL ~ ~ ~v t b ~~ C ~ { p n n of ~ q J '} N M W ~ oR ~ LL ~ Q {p V O a~~ RATE 1 BASE $ 4.73 $ 0.00 $ 4.73 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 STATEMENT PERIOD ACCOUNT NUMBER 07/05/11 08/04/11 12044440755544998 Home Equity Line of Credit Account Summa 11030 BEVERLY K CUTCHALL 1933 $TERRETTS GAP AVE CARLISLE PA 17013-1063 LINE OF Previous Balance (07/04111) +Advances & Debits -Payments & Credits +FINANCE CHARGE + Life Insurance Charge + Late Charges + Other Charges New Balance Periodic Rate ~~. Corresponding ANNUAL PERCENTAGE RATE (Average Daily Balance FINANCE CHARGE i, Due to Applica6oa of Periodic RATE 2 LOAN 400] $ 18,364.90 $ 0.00 $ 236.89 $ 108.46 $ 18,236.47 0.0121917% 0.0191780% 4.4500%(") 7.0000%(+ ) $ 0.00 $ 18,244.79 $ 0.00 $ 108.46 Page 1 of 4 Billing Date 08/04/11 Current Due Date 08/29/11 Days in Billing Period 31 AmourR Billed This Statement $ 236.89 Over Credit Limit Amount $ 0.00 Past Due Amount $ 0.00 'T'e~tal:Pa3~meui Du¢ $ Z3b$9 Draw Period Expiration Date 06/05/12 Credit ]Limit $ 35,000.00 Availat~le Credit $ 0.00 b'inance: Chazge YTD $ 771.23 ANNUM, PERCENTAGE RATE 7.1336% TOTAL $ 18,369.63 $ 0.00 ,~s $ 241.62 ~ ~ ~ ~ ,~ $ 108.46 $ 0.00 $ o.oo ~~~.-~nt1 (3 1( $ 0.00 $ 18,236.47 ~r^~ / v, r L5 ~~vz_ p~s~,x BEVERUV K CUTCHALL 1933 STERRETTS GAP AVE CARLISLE PA 17013-1063 Page ] of 4 STATEMENT PERIOD ACCOUNT NUMBER 08/05/11 09/05/11 12044440755544998 Home Equity Line of Credit Account Summary Billing Date 09/05(11 Current. Due Date 09/29/11 10994 Days in. Billing Period 32 Amount Billed This Statement $ 236.89 Over Credit Limit Amount $ 0.00 Past Dtre Amount $ 0.00 Tztlal,l'ayrkacAtl~ue 23&9 Draw Feriod Expiration Date 06/05/12 Credit ]~imit $ 35,000.00 Available Credit $ 0.00 Finance Chazge YTD $ 879.69 ANNUAL, PERCENTAGE RATE 7.3639% I~ _ HOME EQt~JTTY LINE OF CREDTI' FINANCE CHARGE, ANn RAr,A1VCF. crrMMeuv ', RATE 1 RATE 2 BASE LOAN 4001 TOTAL Previous Balance (O8j04jll) ', $ 0.00 $ 18,236.47 $ 18,236.47 +Advances & Debits ''. $ 0.00 $ 0.00 $ 0.00 - Payments & Credits $ 0.00 $ 250.00 $ 250.00 + FINANCE CHARGE ! + Li $ 0.00 $ 110.92 $ ] 10.92 ~ / ~ ~ ~ ~ ~u fe Insurance Charge $ 0.00 $ 0.00 ~ ~ / / + Late Charges ', $ 0.00 $ 0.00 / +Other Charges I $ 0.00 $ 0.00 New Balance ' $ 0.00 $ 18,097.39 $ 18,097.39 ~'3v~ Periodic Rate 0.0121917% 0.0191780% C[xresponding ANNUAL 4.4500%(") 7.0000%(+ ) PERCENTAGE RATE - - Average Daily Balance $ 0.00 $ 18,074.93 FINANCE CHARGE $ 0.00 $ 110 92 Due to Applica6oa of Periodic Rat . p~~ 10850 BEVERLY K CUTCHALL 1933 $TERRETTS GAP AVE CARLISLE PA 17013-1063 Page 1 of 4 STATEMENT PERIOD ACCOUNT NUMBER 09/06/11 10/04/11 ~ 12044440755544998 Home Equity Line. of Credit Account Summa Billing Date 10/04/11 Current Due Date 10/29/11 Days in Billing Period 29 Amowit Billed This Statement $ 236.89 Over Credit Limit Amount $ 0.00 Past Due Amount $ 0.00 '1'Atallkaytuent Due $ 23C,.8t3 Draw Period Expiration Date 06/05/12 Credit Limit $ 35,000.00 AvailaUle Credit $ 0.00 Finance Chazge YTD $ 990.tii ANNUAL PERCENTAGE RATE 6.6736% BARGE AND B4LANCE SUMMARY -- ~ -- -~. I RATE 1 RATE 2 I I BASE LOAN 4001 TOTAL it Previous Balance (09/T15i71) '. $ 0.00 $ 18,097.39 $ 18,097.39 +Advances & Debits -P & C di $ 0.00 $ 0.00 $ 0.00 i ~ ` ayments re ts $ 0.00 $ 300.00 $ 300.00 / ~.~ + FINANCE CHARGE ~ $ 0.00 $ 99.74 $ 99.74 /// ',: + Life Insurance Charge $ 0,00 $ 0.00 + Late Charges ~~i +O ' $ 0.00 $ 0.00 C„ ~~ I /f ~} "' i ther Charges I $ 0.00 $ 0.00 ~ iNew Balance ', $ 0.00 $ 17,897.13 $ 17,897.13 I P i di R yy}} // /41 ~~ 7 / l er o c ate (Correspondin ANNUAL 0.0121917% 4 " 0.0191780% ° j ~t g iPERCENTAhF,RATE .4500%( ) 7.0000 /a(+ ) i Average Daily Balance $ 0.00 $ 17,934.31 FINANCE CHARGE. $ 0.00 $ 99 74 Due to Application of Periodic Rath . REV-1513 EX+ (O1-10) pennsylvania SCHEDULE ] OEPARTM FNT OF REVENUE INRERITnrvcE Tax aETUarv BENEFICIARIES RESIDENr DECEDENT ESTATE OF: FILE NUMBER: Beverly K. C:utchalt 21-11-0711 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME ANq ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. TE;rry R. Cutchall, 732 Forge Road, Carlisle, PA 17015 child 13,389.95 2. Daniel L. Cutchall, $0 Greenmeadows Drive, Carlisle, PA 17013 child 13,389.95 3. Susan C. Momison,i22 Brian Ddve, Carlisle, PA 17013 child 13,389.95 4. Kenneth E. Cutchall, 100 Fisher Road, York Haven, PA 17370 child 13,389.95 5. Jeffrey L. Cutchall, h933 Sterrets Gap Road, Carlisle, PA 17013 child 13,389.95 ENTER DOLLAR NGN-TAXABLE I A. SPOUSAL D 1. i i STS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES IS THROUGH 18 OF REV-1500 C(IVER SHEET, AS APPROPRIATE. TONS TIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: B. CHARRABLE AND QOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ',, If more space is needed, use additional sheets of paper of the same size. __ ~__