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Home My WebLink About05-30-12~. REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 1505607122 INHERITANCE TAX RETURN RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Securit Number Date of Death _ _ 36I0~18~09.5L4~ ~2~272~10~ Decedent's Last Name Suffix - ------ -- --- ,, ~ -K ~P_I P E. I ~~ M1A N ____ _ ~__; ___ ~_ _ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix ~I f ~ i i- ~__ _ ~ i__I OFFICIAL USE ONLY County Code Year File Number - -i - -- 2 1 1 1 0 0 0 3 6 Date of Birth __ - --- l (-08021927 Decedent's First Name MI - -- IL O,U I S.E.. ~ i I ~ iFi Spouse's First Name MI ( 1 ~ l l l~ ~ i i t I Spouse's Social Security Number- THIS RETURN MUST BE FILED IN DUPLICATE WITH THE ~ i i- -~ ' ~- ' ~ REGISTER OF WILLS ~ __ _ I ___ ~ _._ __ FILL IN APPROPRIATE OVALS BELOW • 1. Original Return c~ 2. Supplemental Return c~ 3. Remainder Return (date of death prior to 12-13-82) c~ 4. Limited Estate c~ 4a. Future Interest Compromise (date c~ 5. Federal Estate Tax Return Required of death after 12-12-82) • 6. Decedent Died Testate c~ 7. Decedent Maintained a Living Trust p 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) c~ 9. Litigation Proceeds Received c~ 10. Spousal Poverty Credit (date of death c~ 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 TAX INFORMATION SHOULD BE DIRECTED TO: - I I I ' N~umber~ ~ - - Name _ i (-- ' ~ . i I _ . _~. __ ~ ~ _ _ I I-- ~ -I ~_ _ i ~ IDaiimelT~ phone-~ I , ; _'~ ~ ~ -~„~ (WII-L~L~_I~A M -- RI K ABU F!M A N I 7 1.7 _ __~t6~ ~7~[~>~-, L_ !- - - Firm Name (If A ~licable I _ I I `~ T ~' i _. _ _-- I i i I - I. _.--_ i i REGISTF~Q WILLS U ~~ NLY ' , l I -- - ~--- - - _ ___ _ First line of address -' ~- --- ~ -- _ ----- - -----, --i .. --~ a. ~_ 940 CENTURiY (DRIVE ~ I ~ I "~~~ ~~ ~ ~~ ... Second line of address --_-- - - -___ __-- __--- ___ __ _ , _-- - ~ ~- t.,-, ~ __ ~ I( i i j .~: I SUITE B I i ~ ~ __ ~_ I I ___ I_ ~ I DATE FILED City or Post Office State ZIP Code ___ ---- j- I i- --- - II i j 1 ~ i I ~ I M E~C-H A N~I;C_SB U~R-1-~~ __ ~__ I ~P A..~ ~1_7i~_-5'_54-~1.? 61 Correspondent's a-mail address: wrkaufman.wrklaw@comcast.net Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNA~RE OF PERSO O IBLE OR FILING RETURN DA E r-~.-)ti, a,yiA ') .EXECUTOR ~~-I /~- ADDRESS 6113 CHARING CROSS, MECHANICSBURG, PA 17050 SIGNATURE q~F ~gf ~ OTH THAN REPRESENTATIVE ATE ..7/'1 ~~+//,~/f.1~,G~[./t ~~' ,ESQ. __ 5'~J~/~~ Zs _ 940 CENTURY DRIVE` SUITE B, MECHANICSBURG, PA 17055-4376 PLEASE USE ORIGINAL FORM ONLY Side 1 L_ 1505607122 1505607122 _~ REV-1500 EX Page 3 Decedent's Complete Address: File Number 211100036 ' DECEDENT'S SOCIAL SECURITY NUMBER S NAME DECEDENT LOUISE KOPPELMAN 360-18-0954 STREET ADDRESS 1004 JENKINS GROVE CITY STATE ZIP ENOLA PA __ 17025 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) $74,181.49 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments $75,000.00 C. Discount 3,709.07 Total Credits (A + B + C) (2) $78,709.07 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) $ 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) $4,527.58 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) $ 0.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) $ 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ^ 0 b. retain the right to designate who shall use the property transferred or its income; ^ ~ c. retain a reversionary interest; or ^ 0 d. receive the promise for life of either payments, benefits or care? ^ 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ^ ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ~ ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1500 EX 1505607222 Decedent's Social Security Number ---- f j I I - (- --- _~ Decedent's Name: LOUISE KOPPELMAN 3E6 O;18~I0~915~4j RECAPITULATION 1. Real estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) c~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c~ Separate Billing Requested 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 8 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) TAX COMPUTATION --SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 ! ' ' i i f ' 16. Amount of Line 14 taxable ! ~ i ~ ~ ~ ~~ ( i~ ~ at lineal rate x 0.045 i 1 i 6.418 4~ 7 7 i 6~ 5 ~ !_.._~__ I'~.~_. i_.... 17. Amount of Line 14 taxable ~ I ' I ~ at sibling rate X .12 ~ j i•i 18. Amount of Line 14 taxable I !. at collateral rate X .15 ~• 19. TAX DUE z.l ~ '1~3~8~54 415'.~9j2 -__ . 3.I i.. ~ ~ 0~.~0 0~ i ' i ,0;.'0;0 4.' , 5. ~ !3 4';5 9i0j.~1 3 i - ~. I ' i sJ I Oj•!00' 7.' 4,7 3 6;3~3~0 ;1 7 3 3! 2 9 _9_!_ ~ 3_I.5_! ' ~ 6~2~0'5 1~'4~1 i i ' 212,7 710;.'219_ ,_ 8;48,2;1;.'7~0~ I I i~ ~~.1'~~~6~!4~~~8~4~7~7~;~651 0 0j0j 11 6;_4,814 ? 7;,6!5_ s' i 10. 11. 12.' 13.E 14.E 15. , ,; 16. i , 17. 18. ' 1 s. ' i I O, ~_p; 0I ._ _ , ~ ~ i t-__I 7~4~1;8i1 '49 -__ _ ~ '0~ 010 IO 0~0~ j I .- ; 7 411~8;1;.4~9j 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT • Side 2 1505607222 1505607222 'REV-1502EX + (6-98) R. ~~ '~ COMMONWEALTH OF PENNSYLVANIA SCHEDULE A INHERITANCE TAX RETURN RESIDENT DECEDENT REAL ESTATE LOUISE NUMBER 211100036 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH PRINCIPAL RESIDENCE, 1004 JENKINS GROVE, ENOLA, PA -SEE ATTACHED SETTLEMENT SHEET I $265,900.00 TOTAL (Also enter on line 1 Recapitulation) ~ $265,900.00 (If more space is needed, insert additional sheets of the same size) REV-1503EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF LOUISE KOPPELMAN FILE NUMBER 211100036 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. UBS BROKERAGE ACCOUNT, NO. 7N 19539 88 -SEE ATTACHED 12/31 /10 STATEMENT $923,248.74 2. UBS BROKERAGE ACCOUNT, NO. 7N 19537 88 -SEE ATTACHED 12/31/10 STATEMENT 315,943.27 3. UBS BROKERAGE ACCOUNT, NO. 7N 19536 88 -SEE ATTACHED 12/31/10 STATEMENT 146,253.91 TOTAL (Also enter on line 2, Recapitulation) $1,385,445.92 more space is needed, insert additional sheets of the same size) O U ^~ W ^~ ~/ C~ ~"1 0 N O -Q Fl V M ~m C ~[ ~ N ~^ J ~ X V J Z O ~a ~ 9; z z Q O m ~go~ ~ mpNZ N EZ~~ o i+~owp o mi°n~~ a X00 Vlm Q ~ ~ O U O O O_ O 0 m °m m O O O H N ~ O ~ z ~ O v Q O r" O ~ ~ ~ J V' N a~`^° oOY~ ~ 1 Z a w ~ ~ ~ Q 000 o O o Z O J ~ W z Q 00 J 00 W ~ °' m o_ ~ O ~ Y w N z 7 ~ C C c c a a m ~. n 00 N m Q 1~ _ T .p ~ O C ~ rp ~ N N -O ~ =0 ~ W N rp OD 01 ~ f~ N N O ~O a' N ~ O ~ ~ L ~ C > O '~' n ~ N O1 M N p 1 O~ L 01 O~ O w ~ vi v+ M ._ C Y tFl ~ C O- ~ ~ 'O C m O N +~ N ~ C h 0 ~ pl Ol n p) 7r L pl ~ N ~ r ~ r0 r ° ~ t 0 j r g~;p T L ~;?3a> o ~ c p~ ' "' Y 7 0~ C ~ ~ ~ ~ O O O~ vOi >. v ~, L ~ 7 Y V vii O O a, v ~ p O O1 ,~ o ~ c v c -o E 7 m p w t0 O ~ O .C r0 ~ Or ~ O ~ Ol O H ~ ~ C rn Y AO ~ ~- O 7 N T ~ H 0! C ~ ~ ~ C > N C a 7 C ep 7 N O pl l~ .C ~! o_ C °O N 0 7 f0 ~ 0 0 N ~ O a ~' C N N O a m 'O w C H . r N O > ~ T ~ w P'1 i V 0 N N V C U `- ' p! ~ .C "O' C~ V C w W d~ Q r p ~ O N C 'O ~ C~ ~ C Y O V d d O m ° m r O ~ ° m c ~a m O~ m T 'D ~ m~ o o .~ t v 'o t ro v E ? o m c ' Qua t. 7 5 S i m wan v N 'O > m Z ?i } > O M O1 .o E V 0 O O m Ol 0 z 0 U U CCS 4-I 0 emu', N m N ni O ~O- rn O 0 O a~'i rn I '«~ N N I rp to } } ~ V O Cp m C O d v v Y ~ V A O 'a is O ~ O O 0 ~ N W j ' ~ 0 0 ip '> o° ;, Q `O of c Q ~ ~ j _m c umi ..p+ .c ~ • p ~ ~ ~ p N ~ Y ~ C LL D ~ O C m ~ p~ v ,~ z ~ 7~ p 7 - O ui i ~ a+ O T Q O p s ~ l N } ~ o_ c rp d U p ~ ~ ~ n ~ frl N ~ ft'1 N Ol ~ m ~^ lfl 0 VT O o~ v- p, c o a, v 10 ~. .E ~ ~ N C c N v ~ u > a v ~~ N O ~ O N ~ ~ ~ ~ C v °- c 0 .v -O O > c d ~ ~ ~ ~"'+ _c r0 O a Z ~, i O ~'~ v u O m7 p107'^ a A ~oo_~c ~ O'- N C O T ~ = N V w ~ ~ p ~ .~vZ~ ?~i U V CCS ^~1 ~W.~ r r+ N N . r..r ~ ^i N V ~ O [~ L ' ~ V rl T v O ~, ro ~o m O O °o N V O d D• A a O V N N O 0 0 v v 0 0 0 v n. w .n E a J SL . }~~ ._,~f~ O '~ _ O O o -' t0 ~ O '~ LL _ O '~ to [D ~ _ ~ _ O p O '~ F ~ p ~ ~ ` O N Z > W N = ~ ~ 0! L!1 J ~ J N 0 ~ -~ aaz~ U ° U ~ w~ _ ~ Qi v _ a`n~g 0 000 o°°w = ,ssa N ~ ~ m o um v ~ ~~ ~ J ~ U_ J z ~ Z 0 vi Z ~ a .U~p~ m N ~ N ? ~ cZ~~ o LLpwp i°o mi°j~ a ~ 00 V1 a0 V ,, GA ~~ 0 7 > ~ O Y C_ O 7 a u o `0 T ~ 7 ~ T U O •C uN ~~ m v rn ~~ m w 0 v v 0 z 0 +~ U U c~ 0 ~1 Q N 01 L('1 M m 0 0 0 m d N 7 N °? N ~ ~ M 0 O N .~ m 0 a J 00 DO p 0 ~ p ~ r ~ C O O w `^ rn ~ v ~ EYa ~ `o ~ v ~ , Z ~^ ~ z ~ ° ~ ~ a o ~ ~ ~ ~ ~ ~> ~ ~ ~o ~ ~ Q ~ ~ ''' m c vmi ~ .c E E ~ ~ ~ O1 ~ ~ t0 7 'q W m ~ ~ ~ ~ o C C C C C H N Y m ~ ;~ ~ ~ Q O ~ v L N 7 ~ C LL. j a i H c >> C 0 o O v L ~ N T a_a'o U N Q Q p >°~a ~ - O'uz ~ '> ~ °~ N ll'1 n 'a N ` . ^ m '~ a o w ~ w w W M w ~ 0 01 C ~ O c C 0 ~ 0 ~ 'O ~ U O~ O ~ O 'O d ~'' ~ N C N 7 ip ~ d V Ip ~. C ,- ~ ~~ 7 N TC T vi Ip O E ~ C N >~ .C C 7 C~ 7 N T, r NN D ; c rnw rn •..m o~~ ~. ~~ o o.= v o v E ~ ,n -o > A z 3 ~ o O m m~ I I o ~~ M m ~ ~ o ~ m ~ ~ V U o ~ m v ' +~ o C 7 v V ~ ~ ~ ~ ~ ~ ~ c {..~ W.~ ~ ~ ~ ? .v.. ~ n c d > ` w > U ~ u s F `u a r t 1 d mi ~~ ~' rl M N Z O 0 N 0 O ~~p N N 0 m D~ as N O O N st 0 0 0 V d IA d E w J ,~.~` -~ 0 0 0 tN0 0 ~°o m t0 OO O F.-. /^] O O W O ~ V / ~ 0 ~ W ~ ~ Lfl ~ U ~ -O o ~w aaz~ a° U ~ z~ v a~,g ~ W W 0 0 0Q0 O J ~ W ~ ~ > m o "m v ~ c ~ ~ ry ,~ J ~ X Z O ~O ~ vii ZQ OZ my .u~o~ m m mONZ ,,~, cZag m~?~ ~oov,m V V J +~~~ ~ O ~ ~ ~ ~ ~ 01 O ' 01 ~ ~ M 01 ~ w 01 N M N m m m m w m `'~' W w O Y ~ w ~ w c O o ~ o ~ pi ~ ~- `v C 7 ~ ~ m u E >` N A 7 ~ O v 7~ ; V p~ .O m N 7~ u q 0 C 0 q p Q .T~ ~ ^~ p ~ d C O 7 d E '0 c .5 .S ~ j j 0 .S > r ' °~ rn m 0 0 ~~ q ~~ N ar O 3 ~ ~ a v ~ ~ m H rn v r w o+ a p m i 2 u d ono ~ ~ c per' ,~,2 ,~c~ m~ ~ 7~ ~ ~. ~ _,r_, o O. E V m V E N Q ,,, vOi 'o > ~ z 3 Y ' 0 ;~ O r ~ o _~ ~- O~ O 01 m o i+1 fY1 111 O M Ill tm0 t7 V v N N a+ o E ~ u r ~ d~ C O ~. _ O O r" d ^ ° - m ui N O iri N m V z _ v ~ ~ ~ V _ ~ ~ ~ ~ ~ ~ M o ~ ~ - 0 0 _ ~ ~ O O ~ rn O U ~ ^ N U '--i ~ CC3 01 ~ c ~ ~ 7 ~ 0/ ~ v ~ +~ ,~ ~ ~ c ~ O v . ~ ~, H ~, ~ ~ C ~ ~ v, r0 O v U 'o ~ rn Q ~ Gil ~ ~ N Z Q ~ w ~ 00 ~o 0 ~ :: o C o ~L ~ ~ N " ~ u V ~ O K 'S ~ ~ Z ^ O O ~ N O O 0 vii m ~ ~ .> o j • ~ 0 0 p T Q ~° c dl p o Q~ ~ ~ a'' m e umi +d+ c ~ , Y ~ p 't~ ~ m ~~ ? 1 0 7 •~ w rn ~ ~ ~ u0i ~ O C C C C C F- N Y rn N LL O ~ O vi 7 c ~ v +~ ~ O O LL~ c T i• o~ j O V V p~ t 7 m~ ~ H ' a Q >~a a~~ ~ > N N O m m a O O O 0 v v 0 0 0 0 V a d E d J ~~ _~; REV-1508 [X + (6-98) ~'~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF LOUISE KOPPELMAN FILE NUMBER 211100036 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. METRO BANK CHECKING ACCOUNT, NO. 0536580673 -SEE ATTACHED STATEMENT $1,423.33 2. PREPAID 2010 FEDERAL INCOME TAXES -SEE ATTACHED COPY OF 2010 FORM 1040 9,172.00 3. CUMBERLAND COUNTY VA DEATH BENEFIT 100.00 4. REIMBURSEMENT AT SETTLEMENT OF "ITEMS PAID IN ADVANCE BY SELLER" -SEE LINES 407 - 411 OF ATTACHED SETTLEMENT STATEMENT 1,206.80 5. CLOTHING AND HOUSEHOLD FURNISHINGS -ALL DONATED TO CHARITY -VALUED AT "THRIFT SHOP VALUE" FOR INHERITANCE TAX AND BENEFICIARY INCOME TAX DEDUCTION PURPOSES -SEE ATTACHED LIST OF DONATIONS AND ITEMIZED LISTS OF PROPERTY DONATED 22,688.00 TOTAL (Also enter on line 5, Recapitulation) ~ $34,590.13 (If more space is needed, insert additional sheets of the same size) ~" ,~ETRO BANK 00421 6770557 001 09214^ RAY KOPPELMAN OR LOUISE F KOPPELMAN 1004 JENKINS GROVE ENOLA PA 17025 Transactions By Date 01/03H 1 TARGET VISA ONLINE PMT Metro Bank 3801 Paxton Street Harrisburg PA 17111-1418 1-888-937-0004 mymetrobank.com 01105!11 UNITED INSURANCE PREMIUM ,g. ~ KOPPEI:MAN R ~~~5~~-~~°'' 01107/11 PENN AMER WATER ONLINE PMT `iiL'~~3'~ HARRIS,DENISE ~'" ~ , 01/12/11 BON TON ELDER ONLINE PMT 01113!11 DISCOVER E-PAYMENT KOPPELMAN LOUISE ~' 01l18H1 TIAA-CREF,DISTR. RECLAIM LOUISE F KOPPELMAN ~- ~. 0 • ~ x3,844.94 1 Cl.~ ~n.~~~ 18 Cycle Page 1 of 6 NOTE :SEE REVERSE SIDE FOR IMPORTANT INFORMATION Member FDIC We ie here 7 days a week, 24 hours a day at 1-888-937-0004. 50 PLUS CHECKING 0536580673 Debit Credit Balance . ~ - e~ can ~~ c~ W C ~ X O O O O O O O O O O O O O O O O O ~ ~ 0 0 0 0 0 0 ~n 111 O O ~1f 11) O O O O O H O M M i-i to O M N ci O O N ~ I~ LO N 00 O M t0 M O lD Ct I~ N 00 M r-I r-1 ~ Q1 . -1 I~ 00 ~ 111 rl 1~ to W M lD 00 N 00 ~ O a-i t!'1 N ll'f t0 ~ O t/1• V? 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U C7 U U U C7 U O O O ~ ~ ci ~ r-I r-1 ~ c-I rl rt ri ~ N ci ci e-i r-I c-I ci c-i r-i ri r-1 c-I ri r•i r-I c-I ~-i 0 0 0 0 0 0 0 0 0 0 0 0 O O O O ~ ~ N \ N \ N \ N \ N \ N \ N \ N \ N \ N \ N \ N \ N \ N \ N \ N \ ~ 0 00 r•i O ~' W l0 00 C}' 00 i--I 00 M Lf1 M e-I N y_ N \ m \ M \ N \ ~--1 \ ~ u•f ~ t!1 N \ N \ ~ 00 ~ 00 ~ 0l ~"~ \ N \ ~ O `~ \ ~ N N N i-1 M 111 I~ O Q1 `'i ~ y a-1 a--I r•1 ++ !0 Y ,,~~;. F 1 Y 2010 Tax Year Item YTD by Charity i __ ~~, Donated Items Donation Date Quality # Items Community Aid 4833 Carlisle Pike, Mechanicsburg, PA 17055 Donation Date: 1213112010 Clothing, Footwear & Accessories Footwear Shoes -Casual -Adult high 1 Clothing, Footwear & Accessories Footwear Shoes -Dress -Adult high 2 Clothing, Footwear & Accessories Outerwear Ear Muffs -Adult high 1 Clothing, Footwear & Accessories Outerwear Jackets -Adult high 1 Clothing, Footwear & Accessories Outerwear Mittens or Gloves -Adult high 1 Clothing, Footwear & Accessories Footwear Slippers -Adult high 1 Clothing, Footwear & Accessories Outerwear Stocking Hats -Adult high 2 Clothing, Footwear & Accessories Outerwear Winter Coats -Adult high 1 Clothing, Footwear & Accessories Outerwear Winter Scarves -Adult high 1 Clothing, Footwear & Accessories Women's Clothing Shirts -Jersey high ~ Clothing, Footwear & Accessories Women's Clothing Suits -Sets -Skirt Suit high 1 ~~, ~~ 1 , r 2010 Tax Year Item YTD by Charity Donated Items Donation Date Quality # Items Community Aid 4833 Carlisle Pike, Mechanicsburg, PA 17055 Donation Date: 12/28/2010 Clothing, Footwear & Accessories Footwear Shoes -Casual -Adult high 6 Clothing, Footwear & Accessories Footwear Slippers -Adult high 1 Clothing, Footwear & Accessories Footwear Slippers -Adult high 5 Toys, Hobbies & Gaming Dolls Baby Doll high 1 Toys, Hobbies & Gaming Classics Plush/Stuffed Toy high 1 Toys, Hobbies & Gaming Classics Plush/Stuffed Toy high 1 Clothing, Footwear & Accessories Women's Clothing Undergarments -Bra high 6 Clothing, Footwear & Accessories Women's Clothing Shirts -Dress Shirt high 3 Clothing, Footwear & Accessories Women's Clothing Sleepwear -Nightgown high 2 Clothing, Footwear & Accessories Women's Clothing a Sleepwear -Pajama Set high 8 Clothing, Footwear & Accessories Women's Clothing Sleepwear -Robe high 2 Clothing, Footwear & Accessories Women's Clothing Undergarments -Slips -Half high 2 Clothing, Footwear & Accessories Women's Clothing Suits -Sets -Pant Suit high 1 Clothing, Footwear & Accessories Women's Clothing Shirts -Turtleneck high 1 Clothing, Footwear & Accessories Women's Clothing Undergarments -Underwear high 21 case adult diapers high 1 ~ 7 a ~!;.R. ~ f i , ~ 2010 Tax Year Item YTD by Charity Donated Items Donation Date Quality # Items Purple Heart Foundation Hertisburg , PA Charity Donation Date: 12/3012010 Clothing, Footwear & Accessories Footwear Shoes -Casual -Adult high 2 Clothing, Footwear & Accessories Footwear Shoes -Dress -Adult high 2 Clothing, Footwear & Accessories Footwear Slippers -Adult high 2 Clothing, Footwear & Accessories Men's Clothing Shorts -Cargo high 2 Clothing, Footwear & Accessories Men's Clothing Shirts -Dress Shirt high 10 Clothing, Footwear & Accessories Men's Clothing Pants -Dress Slacks high 3 Clothing, Footwear & Accessories Men's Clothing Pants -Jeans/Denim high 2 Clothing, Footwear & Accessories Men's Clothing Jogging Suit high 1 Clothing, Footwear & Accessories Men's Clothing Pants -Chinos/Khakis high 3 Clothing, Footwear & Accessories e Men's Clothing Sleepwear -Pajama Set high 2 Clothing, Footwear & Accessories Men's Clothing Undergarments -Socks high 4 Clothing, Footwear & Accessories Men's Clothing Suits -Individual Pieces -Sport Coat high 1 Clothing, Footwear & Accessories Men's Clothing Suits -Sets -Three-Piece high 2 Clothing, Footwear & Accessories Men's Clothing Suits -Sets -Two-Piece high 3 Clothing, Footwear & Accessories Women's Clothing Suits -Individual Pieces -Blazer high 1 Clothing, Footwear & Accessories Women's Clothing Suits -Individual Pieces -Blazer high 1 Clothing, Footwear & Accessories Women's Clothing Shirts -Dress Shirt high 1 Clothing, Footwear & Accessories Women's Clothing Shirts -Dress Shirt high 1 Clothing, Footwear & Accessories Women's Clothing Pants - JeanslDenim high 2 Clothing, Footwear & Accessories Women's Clothing Pants -Jeans/Denim high 2 Clothing, Footwear & Accessories Women's Clothing Shirts -Jersey high 1 Clothing, Footwear & Accessories e p Women's Clothing Shirts -Jersey high 1 Clothing, Footwear & Accessories Women's Clothing Jogging Suit high 1 Clothing, Footwear & Accessories Women's Clothing Jogging Suit high 1 Clothing, Footwear & Accessories Women's Clothing Sleepwear -Nightgown high 1 Clothing, Footwear & Accessories Women's Clothing Sleepwear -Nightgown high 1 Clothing, Footwear & Accessories Women's Clothing Swimwear -Two-Piece high 1 Clothing, Footwear & Accessories Women's Clothing Swimwear -Two-Piece high 1 ItsDeductibleOnline.com Home Personal Info 2011 Donations Eslimnletl Savings ®® Item Donation Summary Here's the list of items on This donation so iar. Community Aid Date of Donation 01!24,!2011 Total Items Donated 36 Page 1 of 1 Ycu are':or.µled in. as Cienise I-1;:1ris -Lag Oul Fr. erlbacb: f Ir.;;Ip 201D Donations 2009 Donations ~i `' All O8A ~ Explain this I ^adar m::rd DESCRIPTIOfJ QUANTITY 4UALITY VALUE DONATION Adult Jacket 1 Fllgh $25,00 each 525.00 Fondu Set 1 High $Z00 each $7.00 GlassiCeramic Vase I High $9.00 each $9.00 Men's Dress Slacks 4 High $6.OD each 524.00 Men's Jeans 4 Hlgh $17.00 each $44.00 Men's Sult: Two-Piece 2 HIgY+ $59.00 each $118.00 Men's Sweatshirt 1 High $9.00 each $9.00 SlatueiFigurlne 1 Hlgh $8.00 eacfl $8.00 Women's Dress Shirt ._ High $6.00 each $12.0(1 Women's Nightgown 1 High $6.00 eactl $6.00 Women's Nightshirt 1 Hlgh $5.00 aach $5,00 Women's Pajamas: Pajama Set 1 High $5.00 each $S.OC Women's Pajamas: Pajama Set 1 Nigh $5.00 each $S.OC Women's Polo Shirt 2 Hlgh $7.00 each $14.OC Women's Robe 1 Hiyh $6.00 each $6.OC Women's Strapless Shirt 2 Higf1 $8.00 each $16,OC Women's Tank Top 9 Higl1 $7.00 each $63.OC Antique shoes circa 1860 1 Medium $t 25.00 eactl $t25.OC Total Value: $501.OC • If you have more items to add to this donation, selec[ Add More Items. • If you are finished, select Done With this Don ation. Back Add More It ems Done Wiih This Donation tic<:nse Agr,~t91 ', Prl'•:;~a Promise ! L~wl !1_;,.Fe~ ~L+agt~ .__ _._1 t;>p11 Intait Intr. HII rirJhls regorvt d. View Popular Answers Oo I nerd : re:;elpt ?n: drop-hox ~ior:aiic:ns'?? Is there a way to che.r:ye ItsU=ductible Donations ~ntcled L°Je''•i:~ don=rted a Int of h:acs or !terra to Goodvri!I on a turn... Clcdhlry Uonalior, Is there a lirnil to [tie TOTAL ::mount ::f d~d;lMlons ~~ou cn. Wha ::ar: I not r.;e: fc;d !iste:d ar. , category h1r item dona_. Is there a limit on flow many senarnte donations that the o e td,r: Answer a Question When I add donation In lira the se:r.FOn wo:i t upd~tc kaa.. l~ttrerr~nn ~~ 201'1 Tax Year + : r i , Item YTD by Charity Denise Harris Suits -Sets -Two-Piece high 5 Clothing, Footwear & Accessories Men's Clothing Suits -Sets -Two-Piece high 5 .»S7w ~~ 2071 Tax Year ~; , , , Item YTD 6y Charity 1tsDeductibte0nline.com Page l ot~ 3 ~ I , . , ~:,~ ~>> ,_ .: , , - ~; . . __;.~.~ `! n.;,,~:, ... ~ ,n;;, 2011 Donations ),, r . ~.... ~~ ~...,,~. ~. . :n; ~.g; Item Donation Summary g ~ g, Here's ih,+ li;t of gems nn Ilti; cien;+hun su far 8 s~ Liac• Conuuunity Community Aid Date of Donation 05/D8/201 1 View Popular Answers Total Items Donated 'LG1 , . ,_,~ ,,, i , ,, . ~ , ..~ ._ , _:~,r:;a,~;icr. ~ i!:av:~; :~°.!nlu ~,r,ui::. u:~~ '~11f.:1 „I .~...,.,_..,, r I :. ~ ~ Adult Baseball CaP .. linlh :It:%OV esiti $11).00 ~. ..... ~~; i,; e . ,. Artificial Trre I High 5.'1 Onear.h $21.00 "'I' -' ' ~ -~ i, Cell Phane Headset I Higi; :E SD :;a;:h $2.50 '~J I': !~ ~~~ Chalk Baard I flq:!h 'FU).It(1 arch $10.00 ~ ~ ' .. - i Coffee CuP 4 liulh '6I DU i:acJ-~ $4.OU Answer a Question Colander I Fllr~h $9 f'U :=ach 89.00 ~"' - '' I P.' .. p I Cookie Cutter I Hlylt :F:r')0 ea:;l; $2.50 Carksa~e+N I f6gh :F(i OD oar•.P~ $f..00 Cross Cut Paper Shredder i Iig1h 'I. 15 00 each $15.00 antinyBaard ) lli~h 1'.: roe;~rh $r.oo DVD Movle 2 I-ligh :i+3 On :rr~.a~ $fi.00 Desktop Charyiny Statirn, t F1i01' :F2~' un -'a:-h $2G.00 Uinncr Napkin; (Set) I-luah II'A OU r;li.li $12.011 Dish Urainet' 1 Flirlh T I FO ~rarh $1.50 Dish Towel G High :Ff00,:a:h $it+.t10 Dumbbell Set I tlgah ~f.l ~ nU e?r.~.h 51100 Fabric Wall Hanyin9 1 Hu,1h :I'.IS VO aar;h $1S.(1t1 File Bnx ;i FGyh $'. ~!AO is i<h $39.00 Food Scale 1 I-liyh 'F1P DU i+:~ih $10.00 Framed Ari Print !+ fiulli :F I:?.I,(i e'+:-I. 5104.00 FuIlfQueen Bedspread I Nledunn '!. id u0 zaeli F14 00 FuIVQueen Bedspread ,. High 9~_•LOI, o1V,1, $12.00 Funnel 1 I-hyli $3 00 2a:'.h $1.00 Garment Slcanutr. Standard I I-h(71~ :P(l Oi? r:acl~ SO.OU Glass Measuring Cup ) Huth (.I i~~i) each $1.50 Glass Tumhler E'~ lia~h '41 00 ~•2r:h $6.00 Glass/Ceramic Vase ,. High P8 u0 ,~a :h $)7.00 Golf Bay: Stand I High a?a 00 es~::h $14.00 Golf Bag: Travel 1 High '1.1C: UO e:,CI; $1ti.00 I1aYdr,OVrr Book I1 hhylt :ES OU!?~Ch 89f3.00 Flarmonica I Higl~ G4t10 eadi $9.(10 Hat Rack t Hiiih 'F1300ear1i $1g,U0 Total Value: $1,G73.50 'ItsDeductibleOnline.com Holiday: Christmas: Tree Ornament 12 Fligh $2.50 each $30.00 Hot Pad I Hiyh $2.00 each $2.00 HumidifierNaporizer: 13 Gallon 1 High $16.00 each $16.00 Ice Cream Scoop 1 High $2.50 each $2.50 Ice Cube Tray t Higti $1.00 each $1.00 Image Projector I Hiyh $5.00 earh $5.00 Jello Mold 3 Hiyh $'3 OD each 89.00 Ladle 1 High $6.00 each $6.00 LetterlMail Holder 1 Nigh $10.00 each $10.00 Magazine 4 High $I.00 each $4.00 Magazine 4 High $1.00 each $4.00 MantellShelf Clock 1 High $14.OU each $14.00 Measuring Cups 1 Hiyh $3.OG each $3.00 Measuring Spoons 1 High $5.00 each 85.00 Men's Dress Shirt 14 High $6.00 each $84.00 Men's Palo Shirt 8 High $8.00 each $64.00 Men's Socks 10 Hiyh $1.50 each $15.00 Men's Sweatshirt 2 High $4 00 each $16.00 Microwave Egg Cooker 1 High $2.50 each $2.50 Mouse Pad 1 High $6.00 each $6,00 Oil Lamp 1 Hiyh $14.G0 each $14.00 Organizer/Day Planner 2 High $5 00 oath $10.00 Oven Mitt 1 High 83.00 aach $3.00 Paper Towel Holder 1 High $7.00 oath $7.00 Photo Album I Hiyh $6.00 each $6.00 Placemats (Set) 3 High $9 OD each $27.00 Plastic Hangers (10-20) 3 High $250 each $7.50 Plastic Hangors (10.20) i Medwm $1.00 oath 81.00 Queen Bed Skirt I Hiyh $7.00 each $7.00 Queen Bedspread Sat 1 Metlium $23.00 oath $23.00 pueen Sheet Set 3 High $14.00 each $42.00 Roading Glasses 2 High $4.00 each $8.00 Rolling Pin I Hiyh $4.00 each $4.00 Salad Shooter 1 High $'IU.00 each $10.00 Salt 8 Pepper Shakers 1 High $2.50 each $2.50 Serving Dish 1 High $9.00 each $9.00 Serving Tray I Hiyh $H.00 each $8.00 Sowing Pattern 6 High $0.50 each $3.00 Softcover Book 14 High $5,00 each $70.00 Spatula 1 High $3.00 each $3.00 Spice Rack I Hiyh $9.00 each $9.00 Total Value: $1,673.50 Page 2 of 3 • x r.tine=e[litc4~rlnnatinn=~4~R95h9 5/'i(l/2011 «~..~uu~«t„cvu;<ine.com Page 3 of 3 ., . Spoon ~ High $2.00 each $2.00 Suitcase 4 High $10.00 eaGi $40.D0 Tablecloth 1. high $G 04 aach $12.00 TaperCandle,Holcter f, Mediu m $~.OOeach $36.00 Textbook ~ High 162:f 00 aa.-.h $4G.00 Tissue Box Cover 1 Fliyh $5.00 each $5.00 Toile) Seat t Fligh $1 % 00 each $17.00 Tongs 1 Hicli 1 $2.00 each $2.00 VHS Movie 3 I-kgh ;63.00 each $9.00 Vanity Case ~ Hiyh $9.00 each $9.00 Vanity Case 2 High $9A0 oarh $18.00 Votive Candle Holder 6 Higl i $ci 00 each $54.00 Wedge: Pitching 1 High $24.00 each $24.00 Welcome Mat 1 tligh :6:.00 each $7.00 Wine Rack 1 hliglt $9.00 earh $5.00 Women's Purse ~ High :620.00 each $56.00 Wamen's Sundress ~ High :68 00 each $56.00 Wood 'I Hiyh S2•L00 eeclt $24.00 Wreath ~. High $~ 00 each $14.00 Gift bags and cards 25 High $0 50 each $12.50 Total Value: 51,673.50 • II ynu have more items to add In )his donation, select Add More Items • If you are finished, sele ct Done With this Donation Ba,: k rstid Mor~: Items Uone t4;ifh ?'itii= L~r.ration Li-er.cF •,~ra. ncnl .ng; Lf ~;.isr Fr ::)'. F••~•dl;,ri. . `~-.f1: nfui`Ir I ~. r;hlsr .ad. https://itsdeductibleonline.intuit.com/secured/Item.htul?action=edit&tinnar;nn=~zanQ~s~o ~i:ni~nt t ~ Goodwill ~ Qonation Receipt Goodwill', a qualified SOtlcll3l charitable organization, gratefully acknowledges anon-cash donation from: Donor Name: Address: City: State: Zip Code: The donor recenred no goods or services (in I,vhole or part) in return /or this contribution. Goodwill can provide this receipt as substantiation for contributions only on the date of the donation. This document will serve as confirmation of your donation. See your tax preparer about requirements for donation tax deductions. Goodwill may not establish or confirm value, amount or inventory of donated goods. Goodwill only accepts merchandise in good used condition. u.~lr•,.r~ ,+rr.no~+kugra ,+nd ag,ees that GOOdwall shall nor be responsible for removing or m~iping m,p data. ~~,, la;uuu ~ i,nhdr~nral ,nrnumm~n or personal identJrable rnlorn,afion, that might be stored on Customers ,.r,~; y~,nr~ ~, nlhri rlerhon¢ equ~pmenl haing rlnnared Customer releases Goodwill, its emplo)~ee-c and ~r„~,n~~< non: an. enrr,all clannc arrsmg burn the rel2dse or potential release of persona! idenliliaUle or r ~ ~ ~ r•~~tral nl~nnew„n/sr_oretl on qra rompurer or other electronrr, equipment being [lasted bl, Customer RECEIVED BY: ~~ DATE; ~ °~~"` ( Gnndwm vnenmer. ul Saull~cauem WKCnncin. Inc., Goodwill Industries of Mnlmpolllan Chicago, Inc, and Goodwill Pelail Services. Int.. Bedding Descriphar Books/Tapes~deos Descnptton: Clothing Descnpuon: Cookware Description: _ Electrics &~lectronic Description: Furniture Description: _ Shoes, Purses & Accessories Description:: _ Sporting Goods Description: Toys Description: Other Description: Qty x Value =Total Grand Total',_, `t) - v,l~.., ... ~.e ~tise ............. ,. ~., elm.........;.. rl.... o.t.....e~o,.......n.,o7 Ira e~~..l Purple Heart Foundation Charity Date of Donation Total Items Donated 07/28/2011 25 DESCRIPTION Adult Casual Shoes Adult Dress Shoes Adult Sandals Men's Cargo Shorts Men's Jeans Men's T-Shirt Women's Jeans Women's Jersey Shirt QUANTITY QUALITY VALUE DONATION 2 High $25.00 each $50.00 2 High $8.00 each $16.00 2 High $16.00 each $32.00 2 High $8.00 each $16.00 2 High $11.00 each $22.00 5 High $7.00 each $35.00 5 High $13.00 each $65.00 5 High $9.00 each $45.00 Total Value: $281.00 ~! Community Aid 4833 Carlisle Pike Mechanicsburg, PA 17055 Date of Donation 08/01 /2011 Total Items Donated 1061 DESCRIPTION QUANTITY QUALITY VALUE' DONATION Adult Jacket 5 Medium $11.00 each $55.00 Adult Jacket 26 High $25.00 each $650.00 Adult Mittens/Gloves 4 Medium $6.00 each $24.00 Adult Winter Coat 6 High $17.00 each $102.00 Adult Winter Scarf 5 Medium $5.00 each $25.00 Duffle Bag 1 High $4.00 each $4.00 Men's Dress Slacks 2 High $6.00 each $12.00 Men's Pajamas: Pajama Set 2 High $8.00 each $16.00 Men's Sweater: Pullover 10 High $21.00 each $210.00 Men's Sweatpants 4 High $11.00 each $44.00 Men's Sweatshirt 1 High $9.00 each $9.00 Men's Underwear 16 High $3.00 each $48.00 Women's Blazer 31 High $19.00 each $589.00 Women's Capri Pants 15 High $6.00 each $90.00 Women's Corduroy Pants 3 High $7.00 each $21.00 Women's Dress Shirt 59 High $6.00 each $354.00 Women's Dress Slacks 11 High $7.00 each $77.00 Women's Formal Dress: Evening 3 High $12.00 each $36.00 Women's Girdle 2 High $7.00 each $14.00 Women's Jeans 3 High $13.00 each $39.00 Women's Jersey Shirt 63 High $9.00 each $567.00 Women's Jogging Suit 22 High $12.00 each $264.00 Women's Jumper 11 Medium $4.00 each $44.00 Women's Jumper 6 High $8.00 each $48.00 Women's Khaki Pants 96 High $5.00 each $480.00 Women's Khaki Shorts 3 High $6.00 each $18.00 Women's Pajamas: Pajama Set 2 High $5.00 each $10.00 Women's Polo Shirt 18 High $7.00 each $126.00 Women's Purse 26 Medium $13.00 each $338.00 Women's Robe 2 High $6.00 each $12.00 Women's Skirt: Full-Length 28 High $8.00 each $224.00 Women's Skirt: Knee-Length 31 High $6.00 each $186.00 Women's Slip: Half 7 High $6.00 each $42.00 Women's Socks 4 High $1.25 each $5.00 Women's Suit 10 High $28.00 each $280.00 Women's Suit 84 High $26.00 each $2,184.00 Women's Sweater: Cardigan 54 High $7.00 each $378.00 Women's Sweater: Pullover 112 High $6.00 each $672.00 Women's Sweater: Vest 25 High $3.00 each $75.00 Women's Sweatpants 23 High $6.00 each $138.00 Women's Sweatshirt 58 High $7.00 each $406.00 Women's T-Shirt 79 High $6.00 each $474.00 Women's Turtleneck 88 High $5.00 each $440.00 Total Value: $9,830.00 Goodwill Industries Keystone Area Date of Donation Total Items Donated 08/08/2011 52 CsESCRIPTION Adult Athletic Shoes Adult Baseball Cap Adult Dress Shoes Adult Hiking Boots Adult Jacket Adult Sandals Adult Slippers Adult Slippers Adult Stocking Hat Dish Towel Full Bed Skirt Full/queen Bedspread Men's Thermal Pants Men's Thermal Shirt Pillow Sham Pot Holder Women's Corduroy Pants Women's Dress Shirt Women's Jersey Shirt Women's Nightgown Women's Pajamas: Pajama Set QUANTITY t]UALITY VALUE DONATION 2 High $14.00 each $28.00 1 High $9.00 each $9.00 1 High $8.00 each $8.00 1 High $23.00 each $23.00 1 High $25.00 each $25.00 1 High $16.00 each $16.00 1 High $8.00 each $8.00 2 High $8.00 each $16.00 1 High $5.00 each $5.00 1 High $3.00 each $3.00 1 High $10.00 each $10.00 1 High $24.00 each $24.00 1 High $6.00 each $6.00 1 High $3.00 each $3.00 1 High $6.00 each $6.00 1 High $2.50 each $2.50 5 High $7.00 each $35.00 2 High $6.00 each $12.00 5 High $9.00 each $45.00 2 High $6.00 each $12.00 1 High $5.00 each $5.00 Women's Polo Shirt 2 High $7.00 each $14.00 Women's Robe 3 High $6.00 each $18.00 Women's Skirt: Full-Length 1 High $5.00 each $8.00 Women's Sweatpants 1 High $6.00 each $6.00 Women's T-Shirt 3 High $6.00 each $18.00 Women's Turtleneck 9 High $5.00 each $45.00 Total Value: $410.50 `t Community Aid Date of Donation 09/03/2011 Total Items Donated 117 DESCRiPTiON QUANTITY GIUALITY VALUE DONATION Adult Athletic Shoes 1 High $14.00 each $14.00 Adult Baseball Cap 1 High $9.00 each $9.00 Adult Belt 20 High $9.00 each $180.00 Adult Dress Shoes 8 High $8.00 each $64.00 Adult Mittens/Gloves 1 High $11.00 each $11.00 Adult Sandals 9 High $16.00 each $144.00 Candy Dish 1 High $4.00 each $4.00 Electric Skillet 1 High $13.00 each $13.00 Fashion Scarf 40 High $7.00 each $280.00 Faux Flowers 1 Medium $11.00 each $11.00 Fleece Blanket 1 High $14.00 each $14.00 Hardcover Book 5 High $7.00 each $35.00 Men's Lounge Pants 2 High $9.00 each $18.00 Men's Pajamas: Pajama Set 1 High $8.00 each $8.00 Men's Swimsuit: Trunks 1 High $8.00 each $8.00 Microwave Oven: Countertop 1 High $41.00 each $41.00 Tablecloth 1 High $6.00 each $6.00 VHS Movie 10 High $3.00 each $30.00 VHS VCR 1 High $22.00 each $22.00 Women's Nightgown 1 High $6.00 each $6.00 Women's Pajamas: Pajama Set 1 High $5.00 each $5.00 Women's Suit 1 High $26.00 each $26.00 Women's Sweater: Cardigan 3 High $7.00 each $21.00 Women's Sweater: Pullover 1 High $6.00 each $6.00 Women's Swimsuit: One-Piece 4 High $9.00 each $36.00 Total Value: $1,012.00 ItsDeductibleOnline.com r 1Y ~P - ars ES!mrat_d ssvm3, Page 1 of 4 Flume FersrnZal Into 2012 Donations ZU i1 Conrtions 20 i0 t:onatinns Item Donation Summa o~ .>'-. `, t ~C so far. Here's the kst of dems on this donati Y OO1117UlII LiVe. an oaa ~ see r,~y Qsa -~. ~....~, Community Aid - _ ~ ` Date of Donation 05!12/20 12 View Popular Answers Total Items Donated 388 Vy<~,o ecnared a'c c; vacs ct items !e Gnod:=?.I on a Harr: (1G !1~^.d 2'r: ~?.iVI f0f drOl~.~b^~ ~ic+calions%~ DF.Si:RIPTIOF; DU ^~N'!1Y gl!N.11Y VAI-UF. [1c?*:;, ~IO:a I> There t~ lend to the rn itii_ Adjustable Wrench 4 High 55.00 each 524.00 amo~.r.~~' o* deductions yo;: ca ~:yhy..-ai ~ I not say food hs!2G a= e. Adult Baseball Cap 2 Hiyh 59.00 each $10.170 ce~iegory fc~r iiei+~. dc1?~. Ash Tray 2 High 512.00 each $24.00 V+;HFi2 E. DCl I KECORD cacl? donction in 1ts'vrdu^12b1e:^ Bath Spa 1 High 515.(10 each 516.OD I ; cm ata 1 vU Icy c( i;;cd .. (h-.. 'ooi. , ta:nl.. 'e'driahl Vvatciiar Bathroom Scale 1 Hiyh 50.00 each $8.00 ,,, ,,, Bowl 1 High S1 00 each $1.00 Answer a Question Bowl a High S1 00 each 54.00 ~'^'aho:: c;uals~.on. Bracelet 5 High 54.00 each $20.00 Cake Plate 1 High $0.00 each $6.00 Casserole Dish 1 liryh 56 GO each $6,00 Casserole Dish 1 Madamr S4.C0 each S4.00 Casserole Dish 1 hligh 56.00 each 56.00 CassettelCD CaselRack ~ Fligh 53.00 each $3.00 CassettelCD Travel Case ~ High 5:i 0(7 each $5.00 China (Set} 1 High 575 00 each $75.00 Corded Telephone: Multi-Line 1 Medum 55.00 each $5.00 Corded Telephone: Multi-Line 1 High $9 00 each $9.00 Cordless Tefophono 1 High 513.00 each $13.00 Curtain Rod 2 High 510.00 each $20.00 Cutting Mat 1 High 54.(70 oath $4.00 Dinner Napkins (Set) 12 Nigh 54.00 each 548.00 Drip Coffee Maker 1 High 511 00 each 511.00 Earrings 3 Madium $1 50 each S4.50 Earrings 4 High 53.00 each 512.00 Electric Jack 0 Lantern ? High $0 00 each 516.00 Electric Make-up Mirror 1 High 517.00 each $17.00 Electric Toothbrush 1 High 512.00 each 512.170 Fashion Scarf 12 High 57.00 each 584.00 Faux Plant 1 Medium 510.00 each S10.00 Faux Plant 1 Hiyh $17.00 each 517.00 Film Camora 1 high S46.00 each 546.00 Film Camera 1 Madium $21.00 each $21.00 Total Value: $2,572.00 https://itsdeductibleonline.intuit.tom/secured/Item.htm?action=edit&donation=37647276 5/28/2012 ItsDeductibleOnline.com Full Fitted Sheet 1 High 5~ 00 each $7.00 Full Flat Sheet t High $7.00 each 57.00 Fu111Oueen Bedspread t Medum 37a.C0 each $14.00 Garden Hoe t Hi^yh 510 00 each 510.00 Garment Bag 2 High 511.00 each 522.00 Garment Bag i Medium $8.00 each 88.00 Glass Tumbler 36 Higlt 57 00 each $36.00 Glass Tumbler 11 High $1.00 each 511.110 Glass/Ceramic Vase Medium $5 00 each 535.00 Glasses Case Z High $8.00 each 516.00 Hammer 1 Hiyh $6.00 each $6.00 Hand Mirror 1 High $4.00 each $4.00 Hand Saw 1 Hiyh $Z00 each $7.00 Holiday: Christmas: Tree 10 High $2.50 each 525.00 Ornament Holiday: Christmas: Tree 10 High $8.00 each Seo.DD Ornaments (Boxed Set) Hot Glue Gun I High $3.00 each 53.00 Iced Tea Maker 1 High $7.Q0 each 57.00 Jewelry Box t Hiyh 810.00 earth 510.00 Laser Printer 1 High 857A0 each 567.00 Level t High 55 00 each 56.00 Loaf Pan 2 High 511 00 each 522.00 MateriaUFabric _ High 5500 each 510.00 Ma[eriallFabric 2 Medium 83.00 each S6.00 Nail Care Kit 1 High $4A0 each 84.00 Neck Tie 26 hligh $4 00 each 8104.00 Necklace 2 Medium $2 50 each $5.00 Necklace 3 I~iigh $5.00 each $15.00 Oil Lamp 5 Hiyh $14.00 each 570.00 Open-End Wrench ., High SGAO each 518.00 Pendent Fixture I Hiyh 520.00 each 520.00 Picture Frame 2 High 510.00 each 520.D0 Pillar Candle Holder 1 Hiyh 511.00 each 511.00 Pillow 2 Fligh 52.00 each 84.00 Pillow Sham 2 High 58.00 each 512.00 Pillowcases (Pair} 5 Medium 85.00 each 530.00 pin 5 High 54 00 each 520.00 Pin 2 Medium ¢2.50 each 55.00 Pitcher 1 High 85.00 each 59.00 Plant Stand ~ High 818.00 each 518.00 Plastic Hangers (10-20) 5 High 5250 each 512.50 Plastic Pumpkin Bucket i High $2A0 each 52.00 Total Value: $2,572.OD https://itsdeductibleonline.intuit.tom/secured/Item.htm?action=edit&donation=37647276 Page 2 of 4 5/28/2012 ItsDeductibleOnline. com Pliers 1 High 56.00 each b6.00 Printer Cable t hligh 55.00 each 55.00 Pruning Saw 1 High 57.00 each $7.00 Puzzle: 10-999 Piece 1 I~igh 52.50 each 52.50 Puzzle: 1000 or More Piece t Hiyh 52.00 each 52.00 Rake 1 Fligh 35.00 each 55.00 Roast Pan 1 High $9 00 each $9.00 Saucer 1 Medium $tu 00 each 516.00 Serving Dish 1 Medium $5.00 each 56.00 Serving Tray t High 38AU each 56.00 Sewing Pattern 3 Medium $0.50 each $1.50, Sewing Pattern 5 High $0.50 each $2.50. Shears t High $5.00 each $5.00 Shovel 1 I~ligh 56.00 each $6.00 Shower Curtain I Hiyh 58.00 each $6.00 Snow Shovel t High 57.00 each 57.00 Soap Dish 2 High SS UO each $10.00 Statue/Figurine 2 Fligh 58.00 each 5'16.00 Storage Tote 1 laledium 54.00 each $4.00 Storage Tote t High 5 OD each SZ00 Straight Edge Scissors 1 Fligh 53.00 each 53.00 Taper Candle Holder 1 High 52200 each 522.00 Taper Candle Holder 1 fvtedwm $6.00 each. $6.00 Thermal Blanket 1 High 59 00 each $9.00 Tissue Box Cover 2 High 55.00 each 5'10.00 Toothbrush Holder 1 High $4.00 each $4.00 Torque Wrench 1 Hiyh 59.00 each $9.00 Twin Duvot Cover 1 High $1 H.UU each $18.00 Twin Quit 1 High 51'I 00 each $1 L00 VHS Movie 20 High 53.00 each $60.00 VHS Movie 23 Medium SI 50 each 534.50 VH5-C Camcorder 48 Medum S1G.00 each $768.00 Wall Mirror 1 High S1 % 00 each $17.00 Wash Cloth 2 Hiyh ;1.50 each 53.00 Wicker/Wooden Basket _ High 5.00 each 514.00 Wine Rack 1 High S9 00 each 59.00 Women's Mock Turtleneck 2 High 58.00 each 516.00 Woman's Polo Shirt 1 High S7.OU each $7.00 Women's Skirt: Knee-Length 1 High 56.00 each 56.00 Women's T•Shirt t Wgh 56 00 each 56.00 Women's Turtleneck 2 High $5.00 each $10.00. Total Value: $2,572.00 Page 3 of 4 https://itsdeductibleonline.intuit.com/secured/Item.htm?action=edit&donation=37647276 5/28/2012 ItsDeductibleOnline.com Wooden Wall Shelf 2 High $400 each $8.00 Wreath 2 High $7.00 each 514.00 Yarn 2 High $0.75 each $1.50 Yarn 1 Medium 50.50 each $0.50 Glass Water Pitcher 1 High $4.00 each $4.00 Total Value: $2,572.00 • If you have more iterns to add to this donation select Add More Items - I. you zre finished select Done With this Donation. @ack ~~dd More !re;ns Done Vditn This 7unztion I,icensu_ F~grsununt ; Privacy Prq;nix I Seim i!s ~eeghac ~(I ni ~: Inc I f ; ~ ?v=d Page 4 of 4 https://itsdeductibleonline.intuit.com/secured/Item.htm?action=edit&donation=37647276 5/28/2012 ~_ :: CommunityAid - NEIGHBORS HfiP1NG NEIGHBORS RECEIPT OF DONATED 600DS We are a 501 tCI t3) Registered Charity To: ~ ~S ~ ~ ~~'is Date ~ ~ i ~ ° ~ ~ ~`" This will acknowledge with many Thanks fur donation of the listed articles of goods we thank you for helping us serve "Our Community Description of Articles Valuation of gifts are the privilege and responsibility of the donor. A Valuation Guide is included on the rear side of this receipt. Contributions are deductible for income tax purposes to the extent allowed by law -_.., ~~ *Signature of "Community Aid" Representative ~--~~ 'Note: Due to the record keeping and reporting requirements imposed by the Internal Revenue Service. Community Aid requests all donors who will require us to execute a Form 8283. 'Non-cash Charitable Contribution.' For contribution over $5,000 to present such forms for execudce at the time of the donation. Community Aid will not be able to execute such forms at any time thereafter if the donated property cannot be traced. Community Aid is required to report the International Revenue Service the sales proceeds of any single item for which the donor clairned a deductions of more than $500 and or when the donor has contributed more than $5,000. Community Aid, Inc 4833 Carlisle Pike Mechanicsburg, PA 17055 REV-1510 EX + (6-98) F '~~ ti~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ATE OF LOUISE SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY NUMBER 211100036 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1. UBS TRADITIONAL IRA, NO. 7N 22957 88 -BENEFICIARIES $47,363.30 100% $47,363.30 DENISE K HARRIS, 50%, LINDA L BLACKBURN, 50% -SEE ATTACHED CORRESPONDENCE TOTAL (Also enter on line 7, Recapitulation) ~ $47,363.30 (If more space is needed, insert additional sheets of the same size) O U O = O O O Q ~ U m = U m o _ ~ ° ` _ - ~ N ~ O ~ N z > / N J ~ ~ o ~ J a o_ Q ~ z s~- +_/ ~ ~ Q V OZa v~ . ~ vv~ -~Q ~ Q ~ ~~<to0 ° o O ~ o z = O J F- W Ul ~ ~ m ~m ~ n ~ J ~ X U J cZc O ~ Q G N vii Z Z n Q O o C ~ C 7 ~ ~ N O N z m ~ Z # ~ O LLou,a o m°~° a ~ao~nm Q "' a~ bR ~ ~ i O M n, m m o ni m ~ ~ ~ u o o O m E 0 z 0 '}~ U U C~ ~{"'~ ~-~y C~ O ~I ~I O O O tD O ~o N ~ ~-+ } }- +• C O V O O W 0 V U Q z a ~ ~~ ~ ~ ~ ~ o ~ o :° o ~ W J Z ~ T ~ M ~ Q ,c o O C. ~ N v ~ ~ C v a c O .~ -~ o w ~ = v ~+ m v i ~ 0 - o ? z ^ L oo °N' d ~ °' ~- h ~ Q ~ ~ O ~ .~ o is ' ~~,, . c r o ~ vi t0 Z T u Cl ~ ~ o Q ~ ~ ~ c O ~- ~ p ~ ~ ~ . 3 N ~ Y z ~ N~ T~ c o ~ c +~+ C ~ ~ u, m ~ ~ o ~' ~ . . o G ~'~O v c a+ C ~+ C ++ C u i C N p~ 7~ 0 N~ m`,o~ 7 O 7 O 7 v LL O N c O ~ T'm ro c O c~vu V a u V a V a 70 O -~ r }~a ~-^ > ~ ~L mo.n -u~z~ lfl N 01 ~ lff O N O n M ~ m N Il'1 tD N 1~ N ~ ~ d ~ w O L C O V C ~0 7 i O ~ V ~ ~ j, `0 °o m O N. ~ y. ~- 7 ,n 00 ac ~~ m W p~ p ~ o- m V .C N N 'd0 'O 7 V 7 j, L vOf'D > m Z 3 V U CC3 ~F1 ^~ W cLi ^~ W ~l~/ .~ V m C V ~ o C 7 N a c v E v C ~ 7 E `OC.Sm ~, v ~ > c ~, ~ ~ ~ ~ C Y C 'D ~ t ~ 0 0.~ u E } v ~} n C O V a O a 0 /N M M n w N C 7 V A O ~ O 7 N 0 T w O ~ ~O > O 0 0 `; 0 0 s 0 z rn O ri O 0 0 N 0 n 0 0 N 0 O O d 0 0 0 N 0 O O N O m O O N 0 0 r d d N N O 0 0 ~. O O O V a W .n E m J ,.~~ ~~ REV-1511 EX + (10-06) h'F'. ~~ COMMONWEALTTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF LOUISE KOPPELMAN FILE NUMBER 211100036 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HOFFMAN-ROTH FUNERAL HOME & CREMATORY, CARLISLE, PA -SEE ATTACHED INVOICE $798.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 5,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS 788.50 5. Accountant's Fees DeMUTH & KAUFMAN MANAGEMENT CONSULTANTS - 2011 FORM 1041 995.00 6. Tax Return Preparer's Fees 7. SELLING EXPENSES, 1004 JENKINS GROVE, ENOLA, PA -SEE LINES 502 AND 1400 OF ATTACHED SETTLEMENT SHEET 20,577.97 8. ADDIT-ONAL SELLING EXPENSE -CLOSING COSTS PAID BY BUYER -SEE LINE 506 OF ATTACHED SETTLEMENT SHEET 8,900.00 9. AMOUNT PER SCHEDULE H CONTINUATION PAGE 1 7,731.38 10. AMOUNT PER SCHEDULE H CONTINUATION PAGE 2 7,317.16 11. AMOUNT PER SCHEDULE H CONTINUATION PAGE 3 9,943.40 12. 13. TOTAL (Also enter on line 9, Recapitulation) $62,051.41 (If more space is needed, insert additional sheets of the same size) r r '" '~ ' ~ ~'. ~,~ FUNERAL HOME ~ CREMATORY, INC 219 North Hanover Street Carlisle, Pennsylvania 17013 717.243.451 1 toll free 1.866.451.451 1 fax 717.243.3723 v~,wv.hoffrnonroth.com info~;hoffmanroth.com January 7, 2011 Denise K Harris 6113 Charing Cross Mechanicsburg, PA 17050 Statement of Funeral Expenses for: Louise Florence Koppelman Date of Death: December 27, 2010 Account Id: 16116-290 $ 750.00 Sub Totals ~ ~sn nn OPTIONAL SERVICES: Humanities Gifts Registry/Body Donation $ 750.00 ea ertlflcates at $ 6.00 each $ 48.00 Sub Total: $ 48.00 Total Funeral Expense: $ 798.00 ~ v i H~ runtKAL NOME CHARGES: CASH ADVANCES: 8 Certified D th C ' Balance: $ 798.00 Please return this portion with your Remittance. ~' ~ ~~ L., f ~-, C .. $ ~8.0~ Amount Encloseii Louise Florence Koppelman Service ID#: 16116-290 JAMES W. HARRIS DENISE K. HARRIS 6113 CHARING CROSS 717-790-0473 MECHANICSBURG, PA 17050 60-7269/2313 7 ~ ~ 8 - o, f a~~a.e •~ :,,•.- _y7?h'it_,~,_ ------- _ _ ,--J' -,~/ Jo ~ ~ !~`~w~YC/'~t~- _ `_-tU~ _ .._ ICJ Sovereign Bank t PART OF THE SANTANDER GROUP (\``~~~ ~~ ~ ;M~„t~ ~:23~37269~~: L68L7L5L7L11'7808 WILLIAM E. HOFFMAN, PRESIDENT CHRISTOPHER H.NoFFnnnnl c~wtiFC o..~~.,r „ ~.._.._.. ,.,_ DEMUTH & KAUFMAN PROFESSIONAL MANAGEMENT CONSULTANTS 940 CENTURY DRIVE MECHANICSBURG, PA 17055 (717)790-9001 FAX: (717) 790-9031 DONALD L. DEMUTH, C.H.B.C., M.B.A., C.P.A./P.F.SJA.B.V. WILLIAM R. KAUFMAN, C.P.A., J.D. Apri19, 2012 Denise K. Harris, Executrix Louise F. Koppelman Estate 6113 Charing Cross Mechanicsburg, PA 17050 Fee for preparation of 2011 income tax returns: 995 CONTINUATION PAGE SCHEDULE _H__ ESTATE FILE NUMBER 2111 ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. POSTAGE -MISCELLANEOUS ESTATE CORRESPONDENCE SENT VIA CERTIFIED MAIL $19.50 2. IRS -ONLINE EIN REGISTRATION FEE 9.99 3. PA AMERICAN WATER -SERVICE FOR 1004 JENKINS GROVE, ENOLA , PA - PD 1/7/11 40.58 4. PA AMERICAN WATER -SERVICE FOR 1004 JENKINS GROVE, ENOLA , PA - PD 2/7/11 53.22 5. PA AMERICAN WATER -SERVICE FOR 1004 JENKINS GROVE, ENOLA , PA - PD 3/7/11 19.76 6. PA AMERICAN WATER -SERVICE FOR 1004 JENKINS GROVE, ENOLA , PA - PD 4/12/11 32.00 7. PA AMERICAN WATER -SERVICE FOR 1004 JENKINS GROVE, ENOLA , PA - PD 5/6/11 31.29 8. PA AMERICAN WATER -SERVICE FOR 1004 JENKINS GROVE, ENOLA , PA - PD 6/7/11 37.03 9. PA AMERICAN WATER -SERVICE FOR 1004 JENKINS GROVE, ENOLA , PA - PD 7/11/11 28.83 10. PA AMERICAN WATER -SERVICE FOR 1004 JENKINS GROVE, ENOLA , PA - PD 8/2/11 43.69 11. PA AMERICAN WATER -SERVICE FOR 1004 JENKINS GROVE, ENOLA , PA - PD 9/8/11 45.33 12. COMCAST -TELEPHONE & INTERNET - 1004 JENKINS GROVE, ENOLA, PA - PD 12/23/10 148.73 13. COMCAST -TELEPHONE & INTERNET - 1004 JENKINS GROVE, ENOLA, PA - PD 2/1/11 149.15 14. COMCAST -TELEPHONE & INTERNET - 1004 JENKINS GROVE, ENOLA, PA - PD 3/1/11 149.15 15. COMCAST -TELEPHONE & INTERNET - 1004 JENK-NS GROVE, ENOLA, PA - PD 4/1/11 149.15 16. COMCAST -TELEPHONE & INTERNET - 1004 JENKINS GROVE, ENOLA, PA - PD 4/29/11 149.07 17. COMCAST -TELEPHONE & INTERNET - 1004 JENKINS GROVE, ENOLA, PA - PD 6/1 /11 149.09 18. COMCAST -TELEPHONE & INTERNET - 1004 JENKINS GROVE, ENOLA, PA - PD 7/1 /11 149.08 19. COMCAST -TELEPHONE & INTERNET - 1004 JENKINS GROVE, ENOLA, PA - PD 8/1/11 149.08 20. COMCAST -TELEPHONE & INTERNET - 1004 JENKINS GROVE, ENOLA, PA - PD 9/1!11 156.71 21. COMCAST -TELEPHONE & INTERNET - 1004 JENKINS GROVE, ENOLA, PA - PD 9/26/11 156.71 22. UGI -SERVICE FOR 1004 JENKINS GROVE, ENOLA, PA - PD 12/28/10 189.11 23. UGI -SERVICE FOR 1004 JENKINS GROVE, ENOLA, PA - PD 1 /28/11 189.11 24. UGI -SERVICE FOR 1004 JENKINS GROVE, ENOLA, PA - PD 2/24/11 193.43 25. UGI -SERVICE FOR 1004 JENKINS GROVE, ENOLA, PA - PD 3/28/11 155.37 26. UGI -SERVICE FOR 1004 JENKINS GROVE, ENOLA, PA - PD 4/26!11 142.00 27. UGI -SERVICE FOR 1004 JENKINS GROVE, ENOLA, PA - PD 5/26/11 97.10 28. UGI -SERVICE FOR 1004 JENKINS GROVE, ENOLA, PA - PD 6/27/11 39.84 29. UGI -SERVICE FOR 1004 JENKINS GROVE, ENOLA, PA - PD 7/27/11 21.81 30. UGI -SERVICE FOR 1004 JENKINS GROVE, ENOLA, PA - PD 8/25/11 25.46 31. UGI -SERVICE FOR 1004 JENKINS GROVE, ENOLA, PA - PD 9/23/11 24.22 32. EAST PENNSBORO TOWNSHIP -SEWER & TRASH SERVICE FOR 1004 JENKINS GROVE - PD 2/25/11 151.80 33. EAST PENNSBORO TOWNSHIP -SEWER & TRASH SERVICE FOR 1004 JENKINS GROVE - PD 5/2/11 138.00 34. EAST PENNSBORO TOWNSHIP -SEWER & TRASH SERVICE FOR 1004 JENKINS GROVE - PD 8/4/11 138.00 35. CARPET MAGIC -CARPET CLEANING - 1004 JENKINS GROVE, ENOLA, PA - PD 9/15/11 603.84 36. PATRICK MURPHY, NEW CUMBERLAND, PA - MISC LANDSCAPING AND LAWN CARE EXPENSES -SEE ATTACHED INVOICES 3,441.08 37. FREEFLOW -PLUMBING REPAIRS - 1004 JENKINS GROVE, ENOLA, PA - PD 2/10/11 145.00 38. R. F. FAGER -NEW FURNACE FILTER - 1004 JENKINS GROVE, ENOLA, PA - PD 9/8/11 25.58 39. LOWES -MISCELLANEOUS HOUSEHOLD SUPPLIES 23.49 40. WHELAN CROSSING HOMEOWNERS' ASSN DUES - 1004 JENKINS GROVE - PD 2/12/11 120.00 TOTAL $7,731.38 --~ .-~ ~`~ 1 ~- ~rv~ c.Je,..s `~ ~ ~~ ise, '"" '.4 5~n7 F.oi:~oF ,- ~ ~ ,~ ,~I _ ~ ~~ ~ ~U 33 ~~° 7u J ______ ~ pri I l ~ ~ i i a A~ to 125 . w~ ~ U,-~` r,,,,~ ~ ~ ~YaSs~ ~C , ~u.m~, : ~U c~,a~'S , ~~rl~ ~ ~Q ~1 ~ ~ ~ t t.'„LV` C~J.s /ha 3 Z~U -~o X33 c. - ~ ~ ~~ ~~, ~ ~ ~_o ~`~a'~ ~ ~~~ ~~ '71~~ ~/tA.'Y~ttLC-1J CL g~~ s ~ ~ . e~ ~, f Gov, I ; '~"r~ ru, ~ ~ 1ea.r u~ , m ~.LCN ~o ~fi ~~ r'y1~ ~ ~ ~s ~ ~~ s~~~s~.. ~~ ~ ~ 5~ v •v~u~c~l ~ 5~e . C ~~~ j ~ i ~ ~ ~a ~-~ f ~ 3•~,~ °~ ~ s~. o ~~ ~ ~~ -~,~ ~cl~ (-y~,aZ 1 ~ ~ 1~.~mr s~.(~ ~-~-~ 3~ , ~ J --- -- ~~~. .,~•vo l9UHY11Y 717 ?74 520 7 F. 02.'05 ~ f S ~~~, yn,~ 27 t Z~ -ro v~~`7 ~ (~ectn r.~.P fir'ee 1~,~6.s -~~~m. ,~a rrh . ~,~ 5 roes' ~. .~ ~ r"a~ W e~ S. 2~ S ~r~. v w~2, ~ ~ 2.~'~ - ~{LI 9 ~ 1~~-~fi 2. ~..~.~s v t,Jc~ . . ~S ~. ~~~ w-~ne I ~ ~ t3 a ~~ s~'°'7 (~. ~,~Lc~ C 2 sad s~ ,~ 5 ~ ~ c~~ 5r~ss _ .,n~uc:~~ ~~~ ~~d~ ~ ~~ ~~ , ?~ V c~ tti~Y1~ 2.~ l0 3 ~ f'o 32 L~ LI c~ e.. ~ ~ 2~ - f -0 51 ~ ~t~., -'r~') u.l...t i~l C 3 ~c oa~.S~ ~ ~ ~~L~' I ~3~ fio 135 ~%k ~wi~~ ~ ~ scc~~~, muL~,~ ~ i S JUL-II-GU11 1`J:OB MiJRPHY 717 774 5201 F.0:3::'05 -~ ~~ .~~ ~ S ~ ~~~ ~~ ~~s~ ~~ ~ ~~ ~; r ~ s ~ .~~r~ ~ ~ ~~- ~ -y~~~, ~ ~~ . 2..L ~~~ ~ ~o • ~~ ~ cal ~~ C ~ ~~, ~ ~ ~~Y 13 j Gr~.e ~a~fi~ I b5o -F ~{g3. ~2 + 1b = ~a~43. ~2 SaYY~ ~ L1~ ~~ ~j of?X ~ N~ ~~iz. ~, ~~ 'r'1'r 774 ~2Q7 F'.U1 ,OF, c ' /~ C jlacx'-iv C~ 5S ~ ~e ~.a.~ i c.s ~b~. ~~' ~~ 7 ~~ ~~ ~ ~~ 1 3 J ~' ~r~a~ !l~.~~ a~~ ~/~~~~, 2Y :, ~~ckl.4~ 2 s~~b~~' c~~f~u,tC~d 3. s ~y~s. Ejl ill.. ~, ; 3~ ~~~ x+2rq~.ea~.s' ~ Rl~a~~es, ~~1b ~°-~°r~ ~ ~ ~~s L..vi~l2~s ~~~ ~ D ~r~ S'-~©Yr-1 . cwt' ~u~~~-f~S FRb~r-~t c~~A~~~ _ ~R.G~ 1 U~ F3~' CN 1 ~ N~~ dG aa~J ~.nlc-z a ~ 1 /~! J~ C ~`~ S .1 y~ ,~~13 ~C~`?'~ i_ AUG-03-2011 17:54 MURPHY 717 774 5207 P.02i05 r ~-~ a ~L~ ~5 _.~ .- al~~l~z~ ~ wes~-s' ~~LC~ ~4N~~' -~ ~~~,t~''~ s ~' t • . ~ ~.~ ~ . _~ ~,~,(,~ ,~,~,, Ilea. ~~ar - ~ ~'~~' ~' ~ . ~ ~1 rs . ~~ ~ ~ ~ ~~arn~ ~8'•$'~ {N ~~~~ ~ h~ P ~~~ ~~~~ ~ ~a ~. -~s DSO ~'~ ~~ ~ ~ ~ ~ ~ ~:~ ~ Pry, ~..~" ~~~ yF,v«, l~'~` ~.~,~r~~. ~~ n~~~~s -. ~~~~,, ~, o ~,~~ c. n1Uf2 ~Y1u.Z~Q t~~ ~ ~, i3 ~' ;~ we~~ ~ ~ ~~~~~ - is ~ ~!~ la~,~ ~ .~ AUG-03-2011 17:54 MURPHY ~~~ ~'w~.Y ~ ~ i Pte, ~ G3o ~~ r l ~ ~'~,~ ~~~~~~ J ~~~ ~ ~u~ ~ ~~ ~ P ~'~'!,~ r1 ~ tom. ~a"''~~{ - ~ Q,p ~~,,,p ~~cu.N~ s~R~Fs /~Kcw~~~ ~ 717 774 5207 P.03i05 S, 5 ~~-- c~1,~ NRS- `~ . G~ ~ ~..~('IGJ 6~ ~l ~'~~~~ ~ ~ ~ S ~~, w ~ ~ `~ U 1I.G~~`l . ?- J~1 ~1~ 5 ~ ~' arS ~' ~ ~ ~~c 1~ ~..~~ ~~~~ ~j~1-ate ~~r'e ~ ,,~ ~s i2- s~~ //'' ~~ ,~,, a ~aC~~Ci~ ~' ~s8' ~~. ! ~ ~~ la~oOr ~0'~ 'ids' ~g~s G~r.s~ ~ a~a.Y~" ~3zz. 9 ~ ~~~~.. ~ 12`1 ~'~ 6 ,~,, ~ ~ ~~~ ~ f --~-~ ~~-9Z-~ AUG-03-2011 17:54 R ~~~ LORE'S HOME CENTERS, INC. 5500 CRALISLE PIKE NECHANICSBURO, PA T?r150 (711) 610-9230 ._ *aALE - SALES A: 52223CH1 66353i 01-Y9-it 201596 4%4X8 ACO .40 TDP CNUICE 5.41 tO3B5 CONCRETE NI1( fl0# OUIgAET 3.46 MURPHY l4eist Hardware Ins.. 1512 6r~ldye Street New Curnberiand Pa rf o70 SUBTOTAL: 9.43 TAY: 0.57 INVOICE 07999 TOTRL: 10.00 NERCH/GIFT CARDS : iD.OO SNIPED MERCHlf,IFT CARD 7404 RUTNCOQE x00064 BEQIN BAL TRANSACTION ANT ENDING 8AL 1o.ea 1a.aa D.84 STORE: 2223 SERNINAL: 07 07!29/11 13:51:45 >F [IF ITEMS PURGFOpSEp : 2 EXCLUDES fEES, SERVICES ANO SPECIAL ORDER FTENS . •nifi!~•' •^^akrU.w~..~^.•~rN1:119}w'^,~iI~11T91~Dk~k"~d'IRI g~}"~~ C_ i~~ F= ° 8 IOWE'S NOME r'f.NTERS, INC. 4000 UNiON DEPOSIT RC. HARRISBURf,, PA 1?189 (717) 540-0610 -• SAk•E: - SALES N: FSi1.aNEt 17 08-01-ti 402]0 4K4 PLASTIC POST CAP PCP4 1.33 I2t3u REBRR 3/S" H I0 (A3J lt!.10 2 @ 5.05 SUB(~ifiL: ''' 43 ,,.. tAli: 0.75 INVOICE. 12?OB TOTAL: i'. t8 19ERCH/GIFT CARDS : 0.54 VISA: 1:'.54 SWIPED MERCH/GIF [ CARD 7404 AU(NCOOE p000UO BEGIN BAL. TRANSACTION AM'i ENDING BAL 0.64 0.64 D.uD ViSA:R}Ull0i1(1(1(KX1IX75? i AMUUNI: i?.54 Al11NCU:80tD1B 5141PED REFT0:8T139I05gI 08/01/11 09;51:42 , STORE : 0522 J[kRMI M1IAI.:..12 08101 I i 1 09:51:51 # f1F' IT'E:MS PURCHASI;C7: 3 EXCLUDES FEES, SERVICES AHD SPECIAL ORUEk TiEHS ~j~ THANK YOU FOR SHOPPING U)uc'~ SEE REVr°o' • .- .. ,-• I;LtRK: SALES IN!1il[Cl: t)gjL)1/~i.11 lU:iO +la, Op2fi3920 ~k.U N0. E!ti DESI:RI?`! lUN (~~I Y AMOUNT ;:'4 5c;401602 1 4 , i3:T ("tilt U-ll...E:LK 5PRr1Y PAINT ;~ l~- ioT~;L "kalGs Tax lir~AL ~.1~ ~t~YMENT VISA ~ 757i S~T~ 8A1A14i~E UUE [tern count-l ' -~ Y. -: _. ~-.- i -. F ~ :` ~~_~ ~-: ~i •~ 'T 4 BJ !) : 25 ~.f3 .g _,,. , [1,00 717 774 5207 P.04i05 NIGHLRND 'lip GARDENS s TWANKj YQU ,~ 07/26/?0111:3?PM O1 T«w OODOQOAB123 CLERIt01 ~!'~~ 0.9 (~ $29.99 ANNUAL S2B.99 ~~~ 0.9 ~ 51.49 SiDRE ~ 94 'r'ISi d p.9 N S1 STDR ~ 51.34 a~~( ~;~r. o.~ ~ $T.49 STORE 4 t1 ~n,J d9 D•9 ~ s aDRf RE TA1( $1.94 late ~~~~r~~ f~'` ~~~ v N P~ s ; ~, j nryu.i.cq , fp0 9 STORE 1n ~'L ~~ x19.9 5 N $2.59 STARE S sv $12.95 iAii $3.92 tTEns r_~a CA~E-i 9x69 '? 1 ~.Y: ~:: ~ .. :. `r: ..- ~ .. M v-, ~ . AUG-03-2011 17:54 MURPHY 717 774 5207 P.05i05 ``~~ , Z~ HIGHLAND 710 ° . t0 ~? ~ ~ ~ S' 1 ~ ~ ' GARDENS THANK YOU heist iitir~lt•rarc In+~. 07!25/2011 1:55PM 01 1~ I~ B r i a~~~ ~ c r e;~ c oooooa#eoa5 cLEAS<o t New Cuii;t+~rln~1i1 -'N ~tA,S?~111,3 PlNa ~ IVY 17~+'il 2 @ 51.49 '` " STORE 52.98 0.8 @ 329.99 +;r;:'!i!~'U11 1:}.0:! No. 002u;14i~;: NORSERY :~' 823:99 TAfi '~ 51.62 st ~;+•;tt Plil . E, I r~ f ~,, ITEMS QO i il-;ir't~ to ! l liN U (Y APt~.+U,; l / 1- ~ CASH $29. 59 ~, c 13., fi~~ll}:'•ilU + i::_ Iii . ;,r,-~ -•l}Kc (1'L 1!_U HIGHLAND 710 • ~ ~ ,; ~ ~ ~ ~ ,; , GARDENS :~.;~' ' ~- I i L;! .~ St'Ni;t i'hI N I THANK Y U ~: ',Ull lf.il~l ~,~ 11.'.:. 07/25/POl! 1:56PM Oi ;a1e~ Tax 000000#8047 CLERI(Ot STORE 537.98 1~4+M[ NT - 'JT:iG -1 i.i6 TAX $2.28 ~ 75ri ITEMS 3Q di~l.ANi;F Dl1F, i; ~!i~ CASH $Q~O. 26 Ism Ci}i.nit_. U_l ;.~ , 5 ~`~ c.wt I nrT P <~ -_ 06/24/2011 3:53PM . ° ~ ~ ~ ~ ~ ~ ,~,. , „ ooaaoo#a57t cLER1l0 . - o;. , ~ g ~ ~ N I GHI..RND GARDENS ~~ ~~~- 2 ~ $$379 ~x ~of~r-~~~ K S10RE ~ i' vim' fir: a-"'a."'r= dog ~, a TAX 52' . s~ z= ~H ~`~,~~ ow ~~ 07/1'1/2011 12:31PM 01 ^11~'f,X~ r= d Z °ti g~ 000000#699P CLERK01 V;Sa ITEMS 30 rms W'D °''< a 1 3 ~ 0 4fa CASH ~4()- d x ~ o ~ • 0.9 @ $14.99 ~. ;,, 6--. 7~C a STORE 513.49 J6~24~t o ~ c,) ,~~ ~ r ~ ,~ 1AX S0. Bt lna ~: 4 HIGHLAND '110 ),., ~ ~ N ~ ~ ~ Q- '^ ~ p APprv~: GARDENS a C ITEMS 20 THANK YOU ~ -+~A ~ ~ ~ ~'° 4- CASH 9~ i 4- 30 ?otal; ~~. c„s,~~~z, r.~„•. C U ~ „~,,, ?+ I NgNK IOU! -+~+ •~ r~i ra;E canc. ~G~11N' rn X ~ p ~ ~ :: 11 ~nINM ud N H -^ ~ ~ ~'v.. ~T'}' m 2 y ~ ~Q ~ ~ ... 94: w m zmi: N} S7 1 ~r~n? Q ~% 1~ 9 zo~e N ~ ~ wr~~ N ~, ~. a z a c o a V A M "Hi~~ .x ~ 1 p°rD O .i '~` !~ ~~ W ~ ~ ~ ~ ~ ~~ m N V E u N ~ ~ 2 TOTAL P.05 CONTINUATION PAGE SCHEDULE _H__ KOPPELMAN FILE NUMBER 211100036 ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PAY 1040 SERVICE FEE -FEE CHARGES TO PAY 2008 TAX BALANCE DUE ONLINE -SEE DISCOVER CARD STATEMENT 29.89 2. DISCOVER CARD FINANCE CHARGE -SEE DISCOVER CARD STATEMENT 68.98 3. LOWE'S OF MECHANICSBURG -MISC. HOUSEHOLD ITEMS -SEE DISCOVER CARD STATEMENT 8.94 4. 2011 REAL ESTATE TAXES - 1004 JENKINS GROVE -SEE ATTACHED TAX BILLS 3,345.81 5. PA AMERICAN WATER -SERVICE FOR 1004 JENKINS GROVE, ENOLA , PA - PD 10/11 /11 33.83 6. PA AMERICAN WATER -SERVICE FOR 1004 JENKINS GROVE, ENOLA , PA - PD 11/14/11 30.10 7. PA AMERICAN WATER -SERVICE FOR 1004 JENKINS GROVE, ENOLA , PA - PD 12/6/11 2837 8. PA AMERICAN WATER -SERVICE FOR 1004 JENKINS GROVE, ENOLA , PA - PD 1/5/12 35.63 9. PA AMERICAN WATER -SERVICE FOR 1004 JENKINS GROVE, ENOLA , PA - PD 2/16/12 32.90 10. PA AMERICAN WATER -SERVICE FOR 1004 JENKINS GROVE, ENOLA , PA - PD 3/20/12 39.68 11. PA AMERICAN WATER -SERVICE FOR 1004 JENKINS GROVE, ENOLA , PA - PD 4/10/12 70.76 12. PA AMERICAN WATER -SERVICE FOR 1004 JENKINS GROVE, ENOLA , PA - PD 5/14/12 51.47 13. COMCAST -TELEPHONE & INTERNET - 1004 JENKINS GROVE, ENOLA, PA - PD 11/1/11 156.76 14. COMCAST -TELEPHONE & INTERNET - 1004 JENKINS GROVE, ENOLA, PA - PD 12/1 /11 156.76 15. COMCAST -TELEPHONE & INTERNET - 1004 JENKINS GROVE, ENOLA, PA - PD 12/30/11 156.76 16. COMCAST -TELEPHONE & INTERNET - 1004 JENKINS GROVE, ENOLA, PA - PD 2/1 /12 156.93 17. COMCAST -TELEPHONE & INTERNET - 1004 JENKINS GROVE, ENOLA, PA - PD 3!1/12 156.93 18. COMCAST -TELEPHONE & INTERNET - 1004 JENKINS GROVE, ENOLA, PA - PD 3/30/12 156.93 19. COMCAST -TELEPHONE & INTERNET - 1004 JENKINS GROVE, ENOLA, PA - PD 5/1/12 156.90 20. UGI -SERVICE FOR 1004 JENKINS GROVE, ENOLA, PA - PD 10/26/11 26.67 21. UGI -SERVICE FOR 1004 JENKINS GROVE, ENOLA, PA - PD 11 /23/11 65.31 22. UGI -SERVICE FOR 1004 JENKINS GROVE, ENOLA, PA - PD 12/28/11 121.18 23. UGI -SERVICE FOR 1004 JENKINS GROVE, ENOLA, PA - PD 1 /26/12 135.73 24. UGI -SERVICE FOR 1004 JENKINS GROVE, ENOLA, PA - PD 2/26/12 137.12 25. UGI -SERVICE FOR 1004 JENKINS GROVE, ENOLA, PA - PD 3/30!12 130.90 26. UGI -SERVICE FOR 1004 JENKINS GROVE, ENOLA, PA - PD 4/25/12 69.91 27. UGI -SERVICE FOR 1004 JENKINS GROVE, ENOLA, PA - PD 5/7/12 103.34 28. A & D REISMAN -SNOW REMOVAL - 1004 JENKINS GROVE - PD 2/17/11 40.00 29. A & D REISMAN -SNOW REMOVAL - 1004 JENKINS GROVE - PD 3/3/11 45.00 30. A & D REISMAN -SNOW REMOVAL/LAWN CARE - 1004 JENKINS GROVE - PD 4/18/11 140.10 31. A & D REISMAN -LAWN CARE - 1004 JENKINS GROVE - PD 5/13/11 153.75 32. A & D REISMAN -LAWN CARE - 1004 JENKINS GROVE - PD 6/13111 155.67 33. A & D REISMAN -LAWN CARE - 1004 JENKINS GROVE - PD 8/4!11 155.67 34. A & D REISMAN -LAWN CARE - 1004 JENKINS GROVE - PD 8/12/11 155.67 35. A & D REISMAN -LAWN CARE - 1004 JENKINS GROVE - PD 9/15/11 155.67 36. A & D REISMAN -LAWN CARE - 1004 JENKINS GROVE - PD 10/14/11 155.67 37. A & D REISMAN -LAWN CARE - 1004 JENKINS GROVE - PD 12/30/11 155.67 38. EAST PENNSBORO TOWNSHIP -SEWER & TRASH SERVICE FOR 1004 JENKINS GROVE - PD 11/2/11 138.00 39. EAST PENNSBORO TOWNSHIP -SEWER & TRASH SERVICE FOR 1004 JENKINS GROVE - PD 2/3/12 151.80 40. WHELAN CROSSING HOMEOWNERS' ASSN DUES - 1004 JENKINS GROVE - PD 2/1/12 50.00 TOTAL $7,317.16 Payable To: DEBBIE LUPOLD, TREASURER Office Hours: MONDAY THRU THURSDAY 9:00-4:00 Bill No: 3645 96 S ENOLA DRIVE; ROOM 101 PHONE (717) 901-9392 Bill Date: 311111 ENOLA, PA 17025 Control No:00504224 Phone: (717) 901-9392 MAP NO: 09-14-0837-052 Desc: 1004 JENKINS GROVE Acres .210 Deed: 00260-02122 WHELAN CROSSING LOT 49 PH XIP885PG41 Res(dential(Under 10 Acres) I IIIIII VIII VIII VIII VIII VIII (IIII VIII IIII IIII $1.00 FEE FOR ADDITIONAL RECEIPTS T P Assessed Value: Land: 52,700 Improvement:213,100 Total: 265,800 Discount Face Penalty COUNTY R/E 1.90200 $495.44 $505.55 $556.11 COUNTY LIB .14300 $37.25 $38.01 $41.91 MUNIC. R/E .95700 $249.28 $254.37 $279.81 TAX AMOUNT DUE If Date Of Payment Is On 781.97 3/1/11 thru $797.93 5/1/11 thru 6/30!11 $877.73 7!1111 or Later ax ayer. KOPPELMAN, RAY & LOUISE F 1004 JENKINS GRV ENOLA, PA 17025-3504 TAXPAYER'S COPY -KEEP THIS PORTION FOR YOUR RECORDS ' ~•' ' ~ • = • DEBBIE LUPOLD, TREASURER 98 S ENOLA DRIVE; ROOM 101 C~ n., ENOLA, PA 17U25 ~/ P TEMP - RETURN SERVICE REQUESTED ~~ 3I~I~I' [ ~ 1 . 1'OY~ D OFFICIAL COUNTY MUNICIPAL TAX BILL it " i"II~I~1~1'~il~l'~I~II~II~~~~II~I~~III~IIII~IIIIII~I~I,l~l~l 87110 -15774 ~;;' KOPPELMAN, RAY & LOUISE F ''~~f 1U04 JENKINS GRV ENOLA, PA 17025-3504 87110-R-15774 PAYABLE TO DEBBIE LUPOLD, TREASURER 98 S. ENOLA DRIVE, ROOM 101 ENOLA PA 17025-2704 DESCRIPTION ASSESS.NO - 00504224 MAP NO: 09-14-0837-052 1004 JENKINS GROVE ACRES .210 DEED 002fi0 / 02122 WHELAN CROSSING LOT 49 PH XI PB 85 PG 41 Residential(Under 10 Acres) RESIDENTIAL TAX PAYER KOPPELMAN, RAY & LOUISE F 1004 JENKINS GROVE ENOLA PA 17025-3504 OFFICE HOURS 111-OITDAY-THURSDAY 9:OOAM - 4:OOPM CLOSED FRIDAYS & HOLIDAYS PHONE (717)901-9392 TAX PAYER COPY 2011 Statement of Real Estate Taxes Bill No: 3665 Control No: 009 - 504224 Bill Date: 7/01/2011 Assessed Land Values 52 700 ~ improvement 213 10D Mineral 0 Total 265 8(10 Homestead Exclusion 12 025- '' EAST PENNSBORO AREA S.D. Discount Face Penal Rates 10.30900 SCHOOL R/E 10.30900 10.30900 .2~ 2 740.13 10~ Homestead Credit 123.97- TAX AMOUNT DUE --> ~,~ $2,616.16 $2,877.7 If Paid On or After If Paid On or Before 7/01/2011 8 31 2011 9/01/2011 10 31 2011 11/01/201: 12 31 201: RETURN ONE COPY WITH PAYMENT""NF TAXES ARE ESCROWED FORWARD TO MORTGAGE CO.~'" $1.00 FEE FOR EACH ADD'L COPY OR RECEIPT 'IF NOT PD BY•12/31l11 THIS BILL WILL BE RETURNED TO TAX CLM BUREAU FOR COLLECTION & FILING OF A LIEN AGNST YOUR PROPERTY ~~ic C~~ ~0~20 NOTICE OF PROPERTY TAX RELIEF Your enclosed tax bill includes a tax reduction for your homestead and/or farmstead property. As an eligible homestead and/or farmstead property owner, you have received tax relief through a homestead and/or farmstead exclusion which has been provided under the Pennsylvania TaxpayerRelief Act, a law passed by the Pennsylvania General Assembly designed to reduce your property taxes. if paying in installments use the coupons below to submit payments. If paying in full use ONLY the 1 ST coupon below to submit payment. rTAXYEAR 2O1t DATE 7/Ot/2011 BILLS 3662 TAX YEAR 2O1I DATE ~/O1/ZOI1 BILLS 36E PAYABLE TO DEBBIE LUPOLD, TREASURER 98 S. ENOLA DRIVE, ROOM 101 ENOLA PA 17025-2704 ~CONTROL# 009 504224 MAP# 09-14-0837-052 SCHOOL ~PENNSBORO AREA S.D. PAYABLE TO DEBBIE LUPOLD, TREASURER 98 S. ENOLA DRIVE, ROOM 101 ENOLA PA 17025-2704 CONTROL# 009 504224 MAP# SCHOOL EAST PENNSBORO AREA S.D. TAX PAYER TAX PAYER PRb PE~fVTAN, RAY & LOUISE F PPE MAN, RAY & LOUISE F PLEASE RETURN COUPON PLEASE RETURN COUPON 2ND WITH SECOND PAYMENT ' 3RD WITH THIRD PAYMENT $872.05 ON OR BEFORE 9/30/2011 ' $872.06 ON OR BEFORE 10/31/2011 $959.26 AFTER 10/31/2011 $959.26 AFTER 10/31/2011 CONTINUATION PAGE SCHEDULE _H__ ESTATE OF LOUISE KOPPELMAN FILE NUMBER 211100036 ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PP & L -ELECTRIC SERVICE - 1004 JENKINS GROVE, ENOLA PA - PD 1/14/11 $107.01 2. PP & L -ELECTRIC SERVICE - 1004 JENKINS GROVE, ENOLA PA - PD 2/11!11 104.38 3. PP & L -ELECTRIC SERVICE - 1004 JENKINS GROVE, ENOLA PA - PD 3/14/11 91.55 4. PP & L -ELECTRIC SERVICE - 1004 JENKINS GROVE, ENOLA PA - PD 4/13/11 86.57 5. PP & L -ELECTRIC SERVICE - 1004 JENKINS GROVE, ENOLA PA - PD 4/20/11 52.39 6. PP & L -ELECTRIC SERVICE - 1004 JENKINS GROVE, ENOLA PA - PD 5/13/11 56.23 7. PP & L -ELECTRIC SERVICE - 1004 JENKINS GROVE, ENOLA PA - PD 6/13/11 59.52 8. PP & L -ELECTRIC SERVICE - 1004 JENKINS GROVE, ENOLA PA - PD 7/12/11 101.08 9. PP & L -ELECTRIC SERVICE - 1004 JENKINS GROVE, ENOLA PA - PD 8112/11 156.27 10. PP & L -ELECTRIC SERVICE - 1004 JENKINS GROVE, ENOLA PA - PD 9112/11 136.34 11. PP & L -ELECTRIC SERVICE - 1004 JENKINS GROVE, ENOLA PA - PD 10/13/11 83.50 12. PP & L -ELECTRIC SERVICE - 1004 JENKINS GROVE, ENOLA PA - PD 11/29/11 65.69 13. PP & L -ELECTRIC SERVICE - 1004 JENKINS GROVE, ENOLA PA - PD 12/28/11 119.81 14. PP & L -ELECTRIC SERVICE - 1004 JENKINS GROVE, ENOLA PA - PD 2/t 5/12 83.69 15. PP & L -ELECTRIC SERVICE - 1004 JENKINS GROVE, ENOLA PA - PD 3/19/12 82.68 16. PP & L -ELECTRIC SERVICE - 1004 JENKINS GROVE, ENOLA PA - PD 4/16/12 7238 17. LAWN DOCTOR -LAWN CARE - 1004 JENKINS GROVE, ENOLA, PA - PD 1/30/11 190.44 18. LINDA BLACKBURN, REIMBURSE FOR VARIOUS CLEANING & MAINT EXPENSES 1,134.08 19. ERIE INSURANCE -HOMEOWNERS' INSURANCE - 1004 JENKINS GROVE ROAD, ENOLA, PA 580.00 20. PATRICK MURPHY, ADDITIONAL YARD WORK, PAID 12/1/11 2,044.59 21. CAPITAL SELF STORAGE -BOXES TO PACK REMAINING PERSONAL PROPERTY IN RESIDENCE 503.39 22. CAPITAL SELF STORAGE -STORAGE RENTAL -SEE ATTACHED INVOICE 2,730.04 23. ON THE MOVE TRUCK RENTAL -VACATING 1004 JENKINS GROVE PROPERTY 36.57 24. LET'S MOVE IT, INC. FINAL CLEANING & MOVING PERSONAL PROPERTY FROM RESIDENCE 860.00 25. NEXT GENERATION FURNITURE -WOOD REFINISHING AT RESIDENCE IN ADVANCE OF SALE 180.20 26. WINDOW PAINS -WINDOW REPAIR AT RESIDENCE IN ADVANCE OF SALE 85.00 27. 4 D'S HANDY SERVICES - MISC REPAIRS AT RESIDENCE IN ADVANCE OF SALE 140.00 TOTALI $9,943.40 MOVE-IN RECEIPT Unit #Ol -ON017 4/ 14/2012 09:06:06 Receipt #238,119 Capital Self Storage Mechanicsburg Rent .................................... $2,852.63 Use Tax ................................. $154.81 Admin. $20.00 Prelease Deposit ($25.00) 12 Mth Discount ......................... ($272.40) Total $2,730.04 PAID BY: Card: $2.730.04 Auth No.: 247270 Paid to Date: 5/1/2013 Balance due: $0.00 James W. Harris 6113 Charing Cross Mechanicsburg, PA 17050 717-790-0473 Card #: 3016 Expiration: 02/ 13 X 1 agree to pay die above amount according [o the card issuer We value your business! REV-1512 EX + (12-03) ~~ ~.•~~ SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN RESIDENT DECEDENT MORTGAGE LIABILITIES, & LIENS ESTATE OF LOUISE KOPPELMAN FILE NUMBER 211100036 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, include unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 2010 FEDERAL INCOME TAX LIABILITY -SEE ATTACHED 2010 FORM 1040 $10,809.00 2. 2010 PENNSYLVANIA INCOME TAX LIABILITY -SEE ATTACHED 2010 FORM PA-40 1,210.00 3. ADDITIONAL 2008 FEDERAL INCOME TAX LIABILITY, PLUS INTEREST -SEE ATTACHED IRS NOTICE 1,272.00 4. DISCOVER CREDIT CARD ACCOUNT, NO. ENDING IN -9817 -SEE STATEMENT & RELATED RECONCILIATION 2,067.15 5. TARGET PHARMACY -MEDICATIONS -SEE ATTAHED LIST -PRESCRIPTIONS LAST FILLED IN DECEMBER '10 BUT WERE CHARGED ON A TARGET CREDIT CARD AND PAID AFTER DATE OF DEATH 347.36 6. 2009 REAL ESTATE TAXES - 1004 JENKINS GROVE, ENOLA, PA - PAID ON DECEDENT'S BEHALF BY DENISE HARRIS AND NOT REIMBURSED UNTIL AFTER DECEDENT'S DEATH -SEE ATTACHED INVOICE AND CANCELLED CHECK 3,242.78 7. HOME CARE COMPANION, LLC -PAID ON DECEDENT'S BEHALF BY DENISE HARRIS AND NOT REIMBURSED UNTIL AFTER DECEDENT'S DEATH -SEE ATTACHED CANCELLED CHECK 2,277.00 8. MESSIAH VILLAGE -PVT -LEVEL 1 NURSING CARE -SEE ATTACHED INVOICE 1,545.00 TOTAL (Also enter on line 10, Recapitulation) I $22,770.29 (If more space is needed, insert additional sheets of the same size) a r3~~-~0 ~~ 1,~~ ;~~~~ f~ ~ Department of Treasury / ~ ~(~, y3 tnterna[ Revenue Service P PO BOX 9038 ffs j ~~ G~~7 ANDOVER, MA 01810-4544 0 ~/o y~2o~l ~~~ /p~0 _____, 018515.614D95.0167.004 3 AB 0.610 2188 I~i~ll~~~~~llf~i~~rrl~l~~{lui~~~li<<I~I<<i~l~~lllll~~~l~ll~,~{I .~~~ 018515 RAY & LOUISE F KOPPELMAN 1004 JENKINS GRV ENOLA PA 17025-3504049 AUR Control: 50081I~2054 Notice: CP2000 Notice Date: December O6, 2010 Social Security Number: 322-18-9638 ;~'~'. Form: 1040 Tax Year: 2008 To calf for assistance: 1-800-829-3009 Toll Free between 7:00 AM - 8:00 PM To FAX information: 1-877-477-9485 Fax Contact: Office of Mark Conway January D5, 2011 1 Why are you getting this notice? The income and payment information (e.g., wages, miscellaneous income, interest, income tax withheld, earned income credit, etc.) that we have on file does not match entries on your 2008 Form 1040. If this information is correct, you will owe S 1, 27 2 The proposed changes to your tax are listed below. 2008 Tax Increase S 1,188 g 0 Payment Increase 0 Penalties -may not include all applicable penalties $ 2011 5 84 Interest - if paid by January 05, Proposed Balance Due $ 1, 272 2 What steps should you take? Following these steps can help you understand this notice. t . Review your 2008 tax return. 2. Compare your return to the information in the Explanation Section -- page 7 . 3. Decide if the information in the Explanation Section is correct. 4. Check the answers to i=requenfly Asked Questions -- pa a 2. 5. Compete and return the nstallmen Ag eemenf Requestl (enclosed) if you need to set 6. Comp up a payment plan. 7. Review your rights in The Examination Process Booklet (enclosed). 3 What happens if you don't respond by January o5, 2011? We will send you a final notice, followed by a bill. During this time, interest will increase and certain penalties may apply. {SP1A} CP2000 (Rev. 11/2004) ~~. =, ' ' ~~r~scover Card: Printable Statement ~~ / 4 CARP LOUISE KOPPELMAN ~ Acct. Ending 9817 Cardmember since 1991 1004 JENKINS GRV, ENOLA, PA 17025-3504 (717) 732-7742 Page 1 of 2 Opening Date: Dec 19, 2010 -Closing Date: Jan 18, 2011 Discover Card Account Summary Cardmember since 1991 Account number ending in 9817 Previous Balance ~ $ 1,973.82 Payments and Credits - $ 100.00 Purchases + $ 1,404.16 Balance Transfers + $ 0.00 Cash Advances + $ 0.00 Interest Charged +$ 68.98 Fees Charged + $ 0.00 New Balance = $ 3,346.96 See Interest Charge Calculation section following transactions for detailed APR information. Credit Line $ 16,000.00 Credit Line Available $ 12,653.00 Cash Advance Credit Line $ 7,300.00 Cash Advance Credit Line Available $ 7,300.00 Cashback Bonus Summary Anniversary Month: May Opening Cashback Bonus Balance $ 31.62 New Cashback Bonus This Period + $ 4.49 Cashback Bonus Balance = $ 36.11 Payment Information New Balance $ 3,346.96 Minimum Payment Due $ 89.00 Payment Due Date Feb 13, 2011 Late Payment Warning: If we do not receive your minimum payment by the date listed above, you may have to pay a late fee of up to $35.00 and your purchase and balance transfer APRs for new transactions may be increased up to the Penalty APR of 29.99% variable. Minimum Payment Warning: If you make only the minimum payment each period, you will pay more in interest and it will take you longer to pay off your balance. For example: If you make You will pay And you will no additional off the end up charges balance paying an using this shown on estimated card and this total of... each month statement in you pay... about... Only the minimum 13 years $ 10,376 payment $ 5,114 $ 142 3 years (Savings = $ 5,262) If you would like information about credit counseling services, call 1-800-347-1121. Payment Address Create a Plan to Reduce Your Balance Discover Financial Services For more options on paying down your balance, use P.O. Box 6103 the Paydown Planner online tool at Carol Stream, IL 60197-6103 Discover.com/paydown Transactions Category Trans. Date Post Date Description Payments and Credits 01/12/11 01/12/11 INTERNET PAYMENT -THANK YOU Su ermarkets 12/17/10 12/19/10 GIANT FOOD #263 ENOLA PA p 010065 Amount $ -100.00 $ 30.70 /cardmembersvcs/statements/app/stmt?date=current&printV... 1/23/2011 Discover Card: Printable Statement Page 2 of 2 .~^o ~, Transactions Category Trans. Date _.. Post Date Description A $ Amount 63 2 37 12/19/10 12/19/10 GIANT FOOD #263 ENOLA P . 010089 . _. GPA $ _. 00 Z 25 12/19/10 12/19/10 WEGMANS #45 MECHANICSBUR . 01/04/11 01/04/11 _ __ PAY 1040 SERVICE FEE 888-PAY- $ 29.89 Government Services 1040 DC ......... . _.. __ ~ 00 272 1 01/04/11 01/04/11 US TREASURY TAX PYMT 888-PAY- $ ~ . , ~ 1040 DC ......... _..._ ....... .. . ..... _ ~ ' 01/03/11 01/03/11 ........................ . LOWE'S OF MECHANICSBURG, $ 4.18 Home Improvement MECHANICSBURGPA Q o 76 4 01/04/11 01/04/11 LOWE'S OF MECHANICSBURG, $ . MECHANICSBURGPA TOTAL FEES FOR THIS PERIOD Fees $ 0.00 INTEREST CHARGE ON PURCHASES $ 68.98 Interest Charged INTEREST CHARGE ON CASH $ 0.00 ADVANCES ...._ . . _ INTEREST CHARGE ON BALANCE $ 0.00 TRANSFERS TOTAL INTEREST FOR THIS PERIOD $ 68.98 2011 Totals Year-to-Date TOTAL FEES CHARGED IN 2011 $ 0.00 ................. ...... _ _..__. TOTAL INTEREST CHARGED IN 2011 $ 68.98 Interest Charge Calculation Your Annual Percentage Rate (APR) is the annual interest rate on your account. Current Billing Period: 31 Days Annual Percentage Rate (APR) Balance Subject Interest to Interest Rate Charge Purchases Cash Advances V=Variable Rate ©2010 Discover Bank, Member FDIC. Rja ~ ~ 2/27/10 P~~ ,~,,~„"e ~~,~ .~ ~ ~22 D oD ~~ ~ t Ze~ 2'7 (cQ 29.99% V 29.99% V ~, 973, 8'~ 9 3, 33 $ 2,708.27 $ 68.98 $ 0.00 $ 0.00 https://www. discovercard.com/cardmembersvcs/statements/app/stmt?date=current&printV... 1/23/2011 Page: 1 M E D I C A L E X P E N S E S a KOPPLOI Patient: KOPPELMAN, LOUISE F. Pharmacy: TARGET PHARMACY #2202 RespPty: 6416 CARLISLE PIKE STE 1900 1004 JENKINS GRV MECHANICSBURG PA 17050 RPh: PILOYAN, MARIA ENOLA ~A 17025 3504 NCPDP#: 3988411 Birth: 08/02/1927 Prescriptions: Dates: 12/01/2010 to 12/31/2010 Last Fill Rx # Drug Name DAW Qty Days Price Written Tx # Drug NDC RPh RefAut/Rem/# Physician 12/02/2010 6635383 SYNTHROID 125 MCG TAB 1 30 30 21.14 05/06/2010 1118204 MJG 11/4 / 7 Dr. TECAU, ROBERT Dr.NPI: 1750374682 Insl: MRX Card:0022662631 Prov#: Plan:9999 Ref#:103362218654008999 Group:PDPIND PrAuth: 12/07/2010 6646490 METOPROLOL 200 MG E TAB 0 30 30 60.46 12/07/2010 1119073 MJG 2 /2 / 0 Dr. LOWE, CHARLES Dr.NPI: 1841253119 Insl: MRX Card:0022662631 Prov#: Plan:9999 Ref#:103416306362041999 Group:PDPIND PrAuth: 12/12/2010 6640219 SEROQUEL XR 50MG TAB 0 60 30 253.88 08/17/2010 1119682 LAT 5 /1 / 4 Dr. LOWE, CHARLES Dr.NPI: 1841253119 Insl: MRX Card:0022662631 Prov#: Plan:9999 Ref#:103463181081048999 Group:PDPIND PrAuth: 12/19/2010 6637117 CITALOPRAM 20MG TAB 30 30 2.88 06/10/2010 1120708 LAT 5 /4 / 1 Dr. TECAU, ROBERT Dr.NPI: 1750374682 Insl: MRX Card:0022662631 Prov#: Plan:9999 Ref#:103532527911012999 Group:PDPIND PrAuth: 12/21/2010 6639771 ALENDRONATE 70MG TAB 0 4 28 9.00 08/06/2010 1121019 MJG 5 /0 / 5 Dr. LOWE, CHARLES Dr.NPI: 1841253119 Insl: MRX Card:0022662631 Prov#: Plan:9999 Ref#:103552113492073999 Group:PDPIND PrAuth: 12/26/2010 6645927 OMEPRAZOLE 20 MJ ~'P 0 11/26/2010 1121695 r / 1 Dr. TECAU, ROBERT /2 Dr.NPI: 1750374682 Insi: MRX Card:0022662631 Prov#: Plan:9999 Ref#:103602415770015999 Group:PDPIND PrAuth: Page : 2 M E D I C A L E X PENS E S ' c KOPPLOl Patient: KOPPELMAN, LOUISE F. Pharmacy: TARGET PHARMACY #2202 RespPty: 6416 CARLISLE PIKE STE 1900 1004 JENKINS GRV MECHANICSBURG PA 17050 ENOLA RPh: PILOYAN, MARIA ~A 17025 3504 NCPDP#: 3988411 Birth: 08/02/1927 Prescriptions: Dates: 12/01/2010 to 12/31/2010 Last Fill Rx # Drug Name DAW Qty Days Price Written Tx # Drug NDC RPh RefAut/Rem/# Physician Report Date: 01/26/2011 $347.36 Attested To By: Registered Pharmacist ~''~Sovereigri .- JAMES W. NARg15 ~~ DENISEY HARRIS y„iy„~ 7345 6,t~CMMMG Cross y,'.rsoall MECHAVILS~B(U//R~yOjP~A oso~(~ ` ,y „~la~~~oy / ~ s ~. ~ ]S~ ~~aJ ..._ U oo~uns fi :: Sovereign Bank y~23f 69 i1: 6a 17-Si7L"7345 .'0000005000' A /_. tll~ ..... , ~~ y, 1 ~ 1.. n i o4o u[lu3/l U $50.00 JAMES W. HARRIS -.. - .. _. .. .._ . -DENISE K:HARRIS - r !7 •rw~n , 7 S96 PAYABLE Assessed ro DEBBIE LUPOLD, TREASURER Valuee xomestea 98 S. ENOLA DRIVE, ROOM 101 ~~ p~ ENOLA PA 17025-0769 states DEec: ASSESS.NO -00504224 FCHOOL E xomestea MAP NO: 09-14.0837-052 1004 JENKINS GROVE ACRES 210 DEED 0026Q' 02122 WHELAN CROSSING LOT 49 PH Xf PB 85 PG 41 Residential Building - RESIDENTIAL TAX KOPPELLMAN AY & LOUISE F ~R.tp~ 1004 JENKINS~ PAYER ROVE ENOLA PA 17025 ~~ ~ tom, orrice MONDAY-THURSDAY 9:OOAM - 4:OOPM Hougs: CLOSED FRIDAYS 8 HOLIDAYS CLOSED SEPT 21-25 & DEC 21-25 PHONE (717}901-9392 _~raremenF-Perrod 01!11/10 TO 021 ..~_ -, - JAMES W. HARflIS yo-,~y~y 7594 DENISE K. HApflE: Ay a CfUMNO cross mreoo.n t ELIIAlhCSBUN(y, PA~1ps0 ~ A~ -^ p, ~ r: PP a= cblu~,~ ~- d, T - - -- - y ~ .. ,~ ~~, -,n4~~A1. $ Via. ~7 f ad, ~r: ~Soverefgn Banl~ ~~~ I .n.~.>•_~eaf-.Sefbd~8~~1f3~~.yul ?a CB3i37269iy: L68L7i5i7i~~'?594 1681715171 # 7594 01/12/10 $3,242.78Y f-: ! y _. 1 - ~ ~-~--- -- ~ ~....,.1 ' nowceW'H.~e;e oarnu 759E I '.,? ~.~.»r Bill No: 36'32 D09 -504224 '1008 Stwtwment et Rwwt Ewtwtw TwYww Bill Date • 7/07/2009 Land ~ improvements Minerals ~ Total ~ 3.8,000 1 200,3201 01 1 238,320 1 elusion I J I I 777 t BORO AREA S.b. .01289900 1 .01289900 1 1 D~mu2rr~ ~ Face 1 ~~~ TAXAM©E1K6DUE--> i s2,e~.o2i Sz,947.ee~~ ~~~~'`~e_ ___ if Pasd On or After ~ 7/01/20091 9/01/2009 ~ 11/01/2009 If Paid On or 8 fore I 8/31/2009 1 1D/31/2009 112/16/2Qg~ RETUAN ONE COPY WITN PAY(IIENT"'IF TAXES ARE ESCROWED FORWARD TO l10RTgal~ CO.•••• i1.00 FEE FOR EACH ADD'L COPY OR RECEIPT 'A= NOT PD BY 1?11610Y TIIIB BELL WILL BE RETURNED TO TA% CLM BuREau FoR couECTION ~ R~Lnnw/c+~oF(A~L~r~EN aoNSr rouR PROPERTY ~IYI~1 V® NOTICE OF PROPERTY TAX RELIEF Your enclosed tax bill includes a tax reduction for your homestead andlor farmstead property. As an elr'gible homestead andlor farmstead property owner, you have received tax relief through a homestead and/or farmstead exGusion which has been provided under the Pennsylvania Taxpayer Relief Act, a law passed by the Pennsylvania General Assembly designed to reduce your property taxes. ~.r./ S Return Bilt with Payment. For a Receipt, Fax Collector Signature ate Paid Amount Paid Enclose aself-addressed stamped envelope. ~ _. a emen eno JAMES W. f1Aq RIS DENISE K. HARRIS ~ ~'r 7548 c, aucxwnc woss nr.;~oan S MFQVlIICSBWC. PA i>MU rt._O7/°r~~0/ m °' N 0 000 ~ ' ° ° Soecrcign Bank ° ~ ,,,C//64~3/-060 GC1oR/coy , 4 23 137 269{4 L60i? LS L7LM7548 ,+000OOL3865r+ 1681715171 # 7548 08/10/09 $138.65 JAMES W. NAgg15 7$51 DENISEK HARRIS gnlpnr sluclunrta moss rv.reoorn K as lad/„~ ° MECWWILEBMG PA traso ~~ a .~.m«E 7,r I~I ~~~a~.,~tl~~~~ I $ G30. v0 o i e~tlL T1Jt~il~~, YLy~-~/dD-^- - nouAno a =_ H / N ° ° - .SovereignBanlf ~~Y1•«~*b ° 42313726914 i6017L517La7551 1681715171 # 7551 JAMES 9V. HARRIS o~rsvnn 7552 DENISEKlURgIS wrnm ent clannuro cross rnaroan g +~ O 4ECgWICSA1Mfw PA IN~II Q' ogre ._((1_ ,Nj MrtOTIE ° ° ° ~Soveroign Banlt ° - L 1: 23L37269U: L68L?15L71cr7552 1681715171 # 7552 08/17/09 $75.00 JAMES W. HARRIS m.ryyyir 7554 DENISE K. HAi1RIS romm~ 61U CHANNG woss ) T.r86aTJ MECIan'IC58Un0, PA bozo oAa D8 ~~~~q ;8overelgn Bang ~aP~l.~.~C`'Iz(~~~~7~~'ti'~'o-.. +:2313?2E4 U: ~ 16817 L517 Lr~755: 11681715171 # 7554 08/25/09 X25 nn `T. -J 08/10/09 $630.00 JAMES W. HARRIS m.rJauu 7553 DENISE K HARRIS em ceAnac roost nrvrBOan MECHANICSBMGFA Iip50 O~~E OS/fir/o~ __~~~/~ ~~ ~ ~/~ .~/VDLlAPS ltd i^.. ~9overeignBRnk 1:23L37269L1: 168L71Sl7Lnr7553 1681715171 # 7553 ,r,_ 08/21/09 _ $25.00 .~'~'~ C JAA.sES.ri. WIgg13 i ~7•SbS ~`~ DENISE KHARRIS ~ - ,~, ilu r crnntwrroroots nrrosan ~ LECwwksauna PA Imto M209 r r... [; ~ ~ o tea:: T r~ v» ~~e I$~a»6fl ~ ".;9 f~ ppi~nn J _~ 00 °m ~ ~j~~-J ~LJtA ~ "771-'7s4 de dA~ l9` ~ ~ ' ks: ~:;< i $ ~, ~; °° $O ercign B~.~rn,i{ ''j~ ° t - 1:23L372691C 1L31715171c'Tccc •:. 1681715171 #7555 08/20/09 $2,277.00 ~~' ,, , C._ page 8 of8 1681715171 y~ [~~ ~~sY~a~. u - ~/ t L_ !~_ AC" ~ 100 MOUNT ALLEN DRIVE, MECHANICSBURG, PA 17055 DENISE HARRIS 6l 13 CHARING CROSS MECHANICSBURG, PA 17050 DATE DESCRIPTION Balance Forward 12/3]/2010 PAYMENT RECEIVED -THANK YOU! 12/31/2010IPVT - LEVEL 1 -MECHANICSBURG ,coq ¢~~~ Form PB-01 QUESTIONS? CALL: (717) 697-4666 RESIDENT # UNIT t2M31/20 0 7473 RESIDENT(S) Ms, LOUISE KOPPELMAN TOTAL AMOUNT DUE $780.00 DATE DUE 01/30/2011 RATE Daysl CHARGES CREDITS BALANCE units 765.OC 765 0.0[ 52.00 15 780.00 l ~ 780.0( OVER 60 OVER 90 OVER 120 TOTAL AMOUNT D~ OVER 30 0.00 $780, RESIDENT # CURRENT 0.00 0.00 7473 780.00 0.00 Farm PE RESIDENT NAME Ms. LOUISE KOPPELMAN p 1'%, finance charge may be assessed if balance is not paid by the due date. Thank You! Please contact the Business Oft'ice directly at 717-790-8220 if ,you !lave questions or concerns about your shitement. REV-1513 EX + (g-00) ~: r ;~, SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LOUISE KOPPELMAN FILE NUMBER 211100036 RELATIONSHIP TO DECEDENT arnourrroRSl-wRE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) oFesrA~ TAXABLE DISTRIBUTIONS [include outright spousal distributions, and t transfers under Sec. 9116 (a) (1.2)] 1. DENISE K HARRIS DAUGHTER 50% 6113 CHARING CROSS MECHANICSBURG, PA 17050 2. LINDA L BLACKBURN DAUGHTER 50% 4155 KITTATINNY DRIVE MECHANICSBURG, PA 17050 (INTEREST HELD IN TRUST UM/, DENISE K HARRIS, TRUSTEE) ENTER DOLLAR AMOUNTS FOR DISTRIBU110NS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ 0.00 (If more space is needed, insert additional sheets of the same size) U. S. DEPARTMENT OF HOUSING and URBAN DEVELOPMENT OMB No. 2502-0265 SETTLEMENT STATEMENT TITLEPRO '"' LIBERTY LAND TRANSFER, INC. 8. TYPE OF LOAN 4660 Trindle Road, Suite 201 Camp Hill, PA 17011 ^ 1. FHA ^ 2. RHS ®3. CONV.UNINS. ^ 4. VA ^ 5. CONY. INS. Phone:717-975-9915 FAX:717-763-7460 6. FILE NUMBER: 95785 7. LOAN NUMBER: 6800496532 C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts p Items marked "(p.o.c.)" were paid outside the closing; they are shown here for inform MORT. INS. CASE NO.: aid to and by the settlement agent are shown. ation purposes and are not included in the totals. D. NAME AND ADDRESS OF BORROWER: Linda G. Hirsch E. NAME AND ADDRESS OF SELLER: Louise F. Koppelman Estate F. NAME AND ADDRESS OF LENDER Members 1st Federal Credit Union 5000 Louise Drive Mechanicsburg PA 17050 G. PROPERTY LOCATION: 1004 Jenkins Grove Enola, PA 17025 H. SETTLEMENT AGENT: Liberty Land Transfer I. SETTLEMENT DATE: Apr 18 2012 Wednesday East Pennsboro Township Cumberland County, PA J. SUMMARY OF BORROWER'S TRANSACTIO PLACE OF SETTLEMENT: 3803 Cedar Avenue Camp HIII, PA 176011 N K. SUMMARY OF SELLER'S TRANSACTION 100. Gross Amount Due From Borrower 40D. Gross Amount Due to Seller 101. Contrail sales price 265,900.00 401. Contract sales price 265,900.00 102. Personal Property 402. Personal Property 103. Settlement Charges (line 1400) 9,506.79 403. 104. 404. 105. 405. Adjustments for items paid in advance by seller(s) Adjustments for items paid in advance by seller(s) 106. City/Town tax to 406. City/Town tax to 107. County/City tax 4/18!2012 to 12131!2012 560.30 407. County/City tax 4/18/2012 to 12/31/2012 560.30 108. Assessments to 408. Assessments to 109. School Tax 4/1 612 0 1 2 to 6130/2012 521.80 409. School Tax 4/1 &2012 to 6/30/2012 521.80 110. SewedTrash 4/18/2012 to 6!30!2012 110.70 410. Sewer/Trash 4/18/2012 to 6/30/2012 110.70 111. Assn. dues 4/18!2012 to 4/30/2012 14.00 411. Assn. dues 4/18/2012 to 4/30/2012 14.00 112. to 412. to 120. Gross Amount Due from Borrower 276,613.59 42D. Gross Amount Due to Seller 267,106.80 00. Amounts Paid By Or In Behalf Of Borrower 500. Reductions In Amount Dua To Seller 01. Deposit or earnest money 1,000.00 501. Excess deposit (see instructions) 02. Principal Amount of new loan(s) 212,720.00 502. SetBement charges to seller (Ilne 1400) 20,727.97 203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to D4. Credit for Amount Paid 375.00 504. PayofF of First Mortgage Loan 05. 505. Payoff of Second Mortgage Loan 206. Closing Costs by seller 8,900.00 506. Closing Costs for buyer 8,900.00 207. 507. OB 508. 209. 509. Adjustments for items unpaid by seller i; Adjustments for items unpaid by seller 210. City/Town tax to 510. CitylTown tax to 11. County/City tax to 511. CountylCity tax to 212. Assessments to 512. Assessments to 13. School Tax to 513. School Tax to 14. to 514. to 215 to 515. to 16. to 516. to 217. 517. 18. 518. 219.- 519. 220. Total Pald by/for Borrower 222,995.00 520. Total Reduction in Amount Due Seller 29,627.97 300. CASH AT SETTLEMENT Fromn'o BORROWER 600. CASH AT SETTLEMENT TolFrom SELLER 301. Gross amount due from borrower (line 120) 276,613.59 601. Gross Amount due Seller (line 420) 267,106.80 302. Less amounts paid by/for borrower (line 220) 222,995.00 602: Less reduillon In amt. due seller (line 520) 29,627.97 303. Cash ®FROM ^ TO Borrower 53,616.59 603. Cash ®TO ^ FROM Seller 237,478.83 ~. ~-~ ~~~~cl~ _~ ~ ~ Buyer or Borrower's Signature a is Srgnat ~-Ui~2_ `~ L. SETTLEMENT CHARGES Case # 95755 700. Total Real Estate Broker Fees $ 16,179.00 Paid From Paid From Division of commission (line 700) as follows: Borrower's Seller's 701. 7,977.00 to Century 21 - Walak Funds At Funds At 702. 8,202.00 to Prudential Homesale Service Graup Settlement Settlement 703. Commission paid at Settlement 16,179.00 704. Broker Fee to Walak/Wallz 150.00 800. Items Payable in Connection With Loan 801. Our origination charge 830.00 (from (GFE #1) 802. Your credit or charge (points) for the interest rate chosen $ (from (GFE #2) 803. Your adjusted origination charges to Members 1st Federal Credit Union (from (GFE A) 830.00 O.OD 804. Appraisal Fee to (from (GFE #3) 805. Credit Report to (from (GFE #3) 806. Tax Service to (from (GFE #3) 807. Flood certification to (from (GFE #3) 808. to 809. to 810. to 811. to 012. to 813. to 814. to 900. Items Required by Lender to Be Paid in Advance 901. Daily interest charges from 4/18/2012 to 4/30/2012 @ $ 22.5833 /day (from (GFE #10) 293.58 902. Mortgage insurance premiurt for 0 months to (from (GFE #3) 903. Homeowners insurance premium fo1 years to USAA (from (GFE #11) 794.51 904. to 1000. Reserves Deposited with Lender 1001. InRial deposit for your escrow account Members 1st Federal Credit Union (from (GFE ff9) 2,216.82 0.00 1002. Homeowners insurance 3 Months @ $ 66.21 /Month 198.63 1003. Mortgage Insurance 0 Months @ $ /Month 1004. Property taxes 3 Months @ $ 65.16 !Month 195.48 1005. School 11 Months @ $ 213.65 /Month 2,350.15 1006. 0 Months @ $ !Month 1007. Aggregate Adjustment - 525.44 1100. Title Charges 1101. Title services and lenders title insurance (from (GFE fl4) 1,623.38 0.00 1102. Settlement or closing fee to Liberty Land Transfer 1103. Owners ti0e insurance to Liberty Land Transfer (from (GFE #5) 238.50 1104. Lenders title insurance 1,481.38 1105. Lenders title policy limit $ 212,720.00 1106. Owners lifts policy limit $ 265,900.00 1107. AgenFs portion of the total title insurance premium 1,491.90 1108. Underwriters portion of the total title insurance premium 227.98 1109. Tax Cert. to Liberty Land Transfer 10.00 1110. Deed Prep. to William R. Kaufman, Esq. 150.00 1111. to 1200. Govemment Recording and Transfer Charges 1201. Govemment recording charges (from (GFE #7) 164.00 1202. Deed $ 62.00 Mortgage $ 102.00 Recorder of Deeds 1203. Transfer taxes (from (GFE #8) 2,659.00 1204. City/County tax/stamps Deed $ 2,659.00 Mortgage $ Recorder of Deeds 1205. State tax/stamps Deed $2,659.00 Mortgage $ Recorder of Deeds 2,659.00 1206. to 1300. Additional Settlement Charges 1301. Required serv(ces that you can shop for (from (GFE #6) 535.00 1302. Initiation Fee to Whelan Crossing Homeowner100.00 1303. Resale Cert to Whelan Crossing Homeowners Assn. 50.00 1304. Home Inspection to Homespec 435.00 1305. Radon to Homespec 760.00 1306. 2012 Co/twp Taxes to Debbie Lupold 781.97 1307. Sewer/Trash to East Pennsboro Twp Auth. 138.00 1400. Total Settlement Charges (enter on lines 103, Sections J and 502, Sections K) 9,506.79 20,727.97 Panies agree that no liability is assumed by Settlement Agent Tor the axuracy or intonnauon lurnlsned by others as shown on the HUD-t Sedlement Statement. HUD CERTIFICATION OF BUYERS AND SELLERS I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account by me in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement. ~~~~ ~ Buye roc Bono~~lwe S ers 3 gnatu Buyers Atldress 8 Phone: Seller's New A dress 8 Phone: The HUD•1 Sehlement Statement which I have prepared is a true and accurate account of this hansaction. I have caused or will cause the funds to be disbursed in accordance with this statemen ~-/~' iz Settlement Agent ~ ~~ Date WARNING: It is a cdme to knowingly make false statements to fhe United States on this or any similar form. Penalties upon conviction can include a fine and imprisonment. For details see Ttle t e: U.S. Code Section 1001 and Section 7070. ~ O~O Depa~r+tment of the Treasury -Internal Revenue Service //~ 1 O O Form V.J. Individual Income Tax Return L. 1 (99) IRS Use Only - Do not write or staple in this space. N For the year Jan 1 -Dec 31, 2010, or other tax year beginning , 2010, ending , 20 OMB No. 1545-0074 ame, Vour social security number Address, Your first name MI Last name and SSN Louise F Ko elman 360-18-0954 If a joint return, spouse's first name MI Last name Spouse's social security number t See separa e instructions Home address (number and street). If you have a P.O. box, see instructions. Apartment no. Make Sure the SSN(s) . above and on line 6c 1004 Jenkins Grove . are correct. City, town or post office. If you have a foreign address, see instructions. State ZIP code l not oelo fwil b ch Presidential Enola tl tax ange Sou PA 17025-3504 Election Campaign ' Check here if you, or your spouse if filing jointly, want $3 to go to this fund? ........ ...................... ~ ^ You ^ Spouse Fllln Status g 1 X Single 4 ^ Head of household (with qualifying person). (See h ld i i ng person is a c instructions.) If the qualify 2 Married filing jointly (even if only one had income) but not your dependent, enter this child's Check only 3 Married filing separately. Enter spouse's SSN above & full name here . ~ one box name here ~ 5 ^ Qualifying widow(er) with dependent child Exemptions -~ e h ked 1 ren If more than four dependents, see mStrUCtlOns and check here ... ~^ 6a X oxes c ec Yourself. If someone can claim you as a dependent, d0 rlOt Check box 6a ............ on 6a and 6b b $ OUSe ............................ ............ No. of child (2) Dependent's (3) Dependent's (4) if ~ 6c who: c Dependents: social securit y relationshi p chilgdeunder lived with you . . al i ig f number to you or ity r qu chiltld tax cr ~ did not (1) First name Last name (see instrs) live withyo~ due to divor or separatio (see instrs) Dependents on 6c not entered abo ^ Add number :e r re . s d Total number of exemptions claimed ............................ .above ..... ~ etc. Attach Form(s) W-2 ....................................... tips salaries 7 Wages 7 , , , Income 8a Taxable interest. Attach Schedule B if required .. .. 8a 7, 028 . bTax-exempt interest. Do not include on line 8a ..............I 8bI 7, 245. 9a Ordinary dividends. Attach Schedule B if required ....................................... 9a 18, 632 . Attach Form(s) W-2 here. Also b Qualified dividends ........................................ I 9bI 7, 082 . attach Forms 10 Taxable refunds or offsets of state and local income taxes ....................... credits 10 45. , , W-2G and 1099-R 11 Alimony received .............................................. .................... withheld if t 11 . ax was 12 Business income or (loss). Attach Schedule C or C-EZ .................................. 12 If you did not 13 Capital gain or (loss) ck here .......................... ~ ^ Att Sch D if regd. If not regd 13 -3 000 . , . get a W-2, ..... 14 Other gains or (losses). Attach Form 4797 ....................................... see instructions 14 . 15a IRA distributions ............ 15a : bTaxable amount 15b 2,683. 16a Pensions and annuities ...... 16a 46, 411. bTaxable amount ........ .... 16b 45 858. partnerships, S corporations, trusts, etc. Attach Schedule E .. royalties 17 Rental real estate 17 , , 18 Farm income or (loss). Attach Schedule F ......................... .................... b t d E l 18 o ose, u nc not attach, any 19 Unemployment compensation .............. 19 ...I 20aI 22, 650.1 b Taxable amount ............. payment. Also, 20a Social security benefits 20b 19, 253. ........ please use 21 Other income Form 1040-V 21 . -------------------------------------- 22 Combine the amounts in the far right column for lines 7 through 21. This is your total income ............. ~ 22 90, 499 . 23 Educator expenses ....................................... 23 Adjusted 24 Certain business expenses of reservists, performing artists, and fee-basis GPO55 government officials. Attach Farm 2106 or 2106-EZ .................... 24 Income 25 Health savings account deduction. Attach Form 8889 ........ 25 26 Moving expenses. Attach Form 3903 ....................... 26 27 One-half of self-employment tax. Attach Schedule SE ....... 27 28 Self-employed SEP, SIMPLE, and qualified plans ............ 28 29 Self-employed health insurance deduction .................. 29 30 Penalty on early withdrawal of savings ..................... 30 31 a Alimony paid b Recipient's SSN .... ~ .. 31 a 32 IRA deduction ............................................ 32 33 Student loan interest deduction ............................ 33 34 Tuition and fees. Attach Form 8917 ........................ 34 35 Domestic production activities deduction. Attach Form 8903 ............... 35 .......... .............. ... . 36 Add lines 23-3laand 32-35 ..... . .................... 36 ..... . 37 Subtract line 36 from line 22 This is your adjusted gross inco me . . .................. ~ 37 _ 90, 499. BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. FDla,oiiz i2~22no Form 1040 (2010) Form 1040 (2010) Louise F /man 60-18-0954 Page 2 38 Amount from line 37 (adjusted gross income) .................................. ........ 38 Tax and Credits 39 40 a Check X You were born before January 2, 1946, Blind. Total boxes If: -~ 8 Spouse was born before January 2, 1946, 8 Blind. checked ~ b If your spouse itemizes on a separate return, or you were adual-status alien, check here ........ ~ Itemized deductions (from Schedule A) or your standard deduction (see instructions) ............ 39a 1 39b ........ 0 41 Subtract line 40 from line 38 .................................................. ........ 41 42 650 by the number on line 6d .......................... Exemptions. Multiply $3 ........ 42 43 , Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41 enter -0 . ............. ....... . 43 44 , .............. Tax (see instrs). Check if any tax is from: a b .. B ................. Form(s) 5814 Form 4972 ....... ........... ........ 44 45 Alternative minimum tax (see instructions). Attach Form 6251 ................... ........ 45 46 Add lines 44 and 45 .......................................................... ...... ~ 46 47 Foreign tax credit. Attach Form 1116 if required ............. 47 78. 48 Credit for child and dependent care expenses. Attach Form 2441 .......... 48 49 Education credits from Form 8863, line 23 .................. 49 50 Retirement savings contributions credit. Attach Form 8880 ... 50 51 Child tax credit (see instructions) .......................... 51 52 Residential energy credits. Attach Form 5695 ............... 52 53 Other crs from Form: a ~ 3800 b ~ 8801 e ~ 53 54 Add lines 47 through 53. These are your total credits ........ ..... .............. ........ 54 55 Subtract line 54 from line 46. If line 54 is more than line 46, enter -0 . ............ ...... ~ 55 Other 56 Self-employment tax. Attach Schedule SE .................................. ............... . .. . Taxes 57 Unreported social security and Medicare tax from Form: a ~ 4137 b ~ 8919 ...................... . 58 Additional tax on IRAs, other qualified retirement plans, ete. Attach form 5329 if required .................. . 59a ~ Form(s) W-2, box 9 b ~ Schedule H c ~ Form 5405, line 16 .... . 60 Add lines 55-59. This is your total tax ...................................................... ~ P t 61 Federal income tax withheld from Forms W-2 and 1099 ...... 61 9 172. aymen s 62 2010 estimated tax payments and amount applied from 2009 return ........ 62 _ If you have a ~ 63 Making work pay credit. Attach Schedule M ................. 63 0. qualifying 64a Earned income credit (EIC) ................................ 64a child, attach Schedule EIC. ~ b Nontaxable combat pay election ..... -~ 64b~ 65 Additional child tax credit. Attach Form 8812 ................ 65 66 American opportunity credit from Form 8863, line 14 ......... 66 67 First-time homebuyer credit from Form 5405, line 10 ......... 67 68 Amount paid with request for extension to file ............... 68 69 Excess social security and tier 1 RRTA tax withheld ......... 69 70 Credit for federal tax on fuels. Attach Form 4136 ............ 70 71 Credits from Form: a ~ 2439 b ~ 8839 c ~ 8801 d ~ 8885. 71 72 Add Ins 61-63, 64a, & 65-11. These are your total pmts ......................................... ' Refund 73 If line 72 is more than line 60, subtract line 60 from line 72. This is the amount you overpaid ........... . 74 a Amount of line 73 you want refunded to ou. If Form 8888 is attached, check here .. ~ b Routing number ........ XXXXXXXXX I - c Type: I I Checking ~ Savings Direct deposit? • d Account number ....... XXXXXXXXXXXXXXXXX See instructions. 75 Amount of line 73 you want applied to your 2011 estimated tax ........ ~ 75 Amount 76 Amount you owe. Subtract line 72 from line 60. For details on how to pay see instructions . .............. ' 78. 10,809. 10,809. 72 9 172. 73 74 a 76 YOU OWe 77 Estimated tax penalty (see instructions) .................... ~ 77 Do you want to allow another person to discuss this return with the IRS (see instructions)? .......... ~ Yes. Complete below. ,637. X^ No Third Party Designee Designee's Phone ~ Personal identification ~ name ~ no. number (PIN) Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and Sign belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Here Your signature Date Your occupation Daytime phone number Joint return? , See instructions. Retired Keep a copy ,Spouse's signature. If a joint return, both must sign. Date Spouse's occupation for your records. PrintlType preparer's name Preparer's signature Date Check if PTIN Paid Preparer's Firm's name Self Use Only Firm's address' Firm's EIN ~ Phone no. Form 1040 (2010) 90,499. 25,212. 65,287. 3,650. 61,637. 10,887. 0. 10.887. FDIA0112 12/22/ 10 360180954 KOPPELMAN LOUISE 1004 JENKINS GROVE ENOLA 717-790-0473 1000118171 PA-40 - 2010 Pennsylvania Income Tax Return ENTER ONE LETTER OR NUMBER IN EACH BOX. Do Not Use Your Preprinted Label N Extension. N Amended Return. F Occupation RETIRED R Residency Status. PA Resident/Nonresident/Part-Year Resident Occupation from to S Single/Married, Filing JointlylMarried, Filing Separately/Final Return/Deceased Date of death N Farmers. PA 17025 School District Name CUMBERLAND VAL 2116D 1 a Gross Compensation. Do not include exempt income, such as combat zone pay and qualifying retirement benefits. See the instructions. 1 b Unreimbursed Employee Business Expenses. 1 c Net Compensation. Subtract Line 1 b from Line 1 a. 2 Interest Income. Complete PA Schedule A if required. 3 Dividend and Capital Gains Distributions Income. Complete PA Schedule B if required. 4 Net Income or Loss from the Operation of a Business, Profession or Farm. 5 Net Gain or Loss from the Sale, Exchange or Disposition of Property. 6 Net Income or Loss from Rents, Royalties, Patents or Copyrights. 7 Estate or Trust Income. Complete and submit PA Schedule J. 8 Gambling and Lottery Winnings. Complete and submit PA Schedule T. 9 Total PA Taxable Income. Add only the positive income amounts from Lines 1 c, 2, 3, 4, 5, 6, 7 and 8. DO NOT ADD any losses reported on Lines 4, 5 or 6. 10 Other Deductions. Enter the appropriate code for the type of deduction. See the instructions for additional information. 11 Adjusted PA Taxable Income. Subtract Line 10 from Line 9. PAIA0412 11/23/10 N EC Page 1 of 2 FC 1a D 1b D 1c 0 2 12409 3 20017 4 0 5 6171 6 0 7 0 8 D 9 38597 10 0 11 38597 1000118171 ~ ~ 1000118171 PA-40 - 2010 Social Security Number 360180954 1000218187 Name(5>Louise F Koppelman 12 PA Tax Liability. Multiply Line 11 by 3.07 percent (0.0307). 13 Total PA Tax Withheld. See the instructions. 14 Credit from your 2009 PA Income Tax return. 15 2010 Estimated Installment Payments. 16 2010 Extension Payment. 17 Nonresident Tax Withheld from your PA Schedule(s) NRK-1. (Nonresidents only) 18 Total Estimated Payments and Credits. Add Lines 14, 15, 16 and 17. Tax Forgiveness Credit. Submit PA Schedule SP. 19a Filing Status: 01 Unmarried or Separated 02 Married 03 Deceased 19b Dependents, Part B, Line 2, PA Schedule SP 20 Total Eligibility Income from Part C, Line 11, PA Schedule SP. 21 Tax Forgiveness Credit from Part D, Line 16, PA Schedule SP. 22 Resident Credit. Submit your PA Schedule(s) G-R with your PA Schedule(s) G-S, G-Land/or RK-1. 23 Total Other Credits. Submit your PA Schedule OC. 24 TOTAL PAYMENTS and CREDITS. Add Lines 13, 18, 21, 22 and 23. 25 TAX DUE. If Line 12 is more than Line 24, enter the difference here. 26 Penalties and Interest. See the instructions. Enter code: E If including form REV-1630/REV-1630A, mark the box. Y 27 TOTAL PAYMENT DUE. See the instructions. 28 OVERPAYMENT. If Line 24 is more than the total of Line 12 and Line 26, enter the difference here. The total of Lines 29 through 35 must equal Line 28. 29 Refund -Amount of Line 28 you want as a check mailed to you. Refund 30 Credit -Amount of Line 28 you want as a credit to your 2011 estimated account. 31 Amount of Line 28 you want to donate to the Wild Resource Conservation Fund. 32 Amount of Line 28 you want to donate to the Military Family Relief Assistance Program. 33 Amount of Line 28 you want to donate to the Governor Robert P. Casey Memorial Organ and Tissue Donation Awareness Trust Fund. 34 Amount of Line 28 you want to donate to the Juvenile (Type 1) Diabetes Cure Research Fund. 35 Amount of Line 28 you want to donate to the PA Breast Cancer Coalition's Breast and Cervical Cancer Research Fund. Signature(s). Under penalties of perjury, I (we) declare that I (we) have examined this return, including all accompanying schedules and statements, and to the best of my (our) belief, they are true, correct, and complete. Your Signature Spouse's Signature, if filing jointly Preparer's Name and Telephone Number Self-Prepared Date 12 1185 13 0 14 0 15 0 16 0 17 0 18 0 19a 00 19b o0 20 0 21 0 22 0 23 0 24 0 25 1185 26 25 2 7 1210 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0 E-File Opt Out Y FIRM EIN Preparer's SSN/PTIN L 1000218187 Pa~e2of2 1000218187 J PAIAO 12 2/15/11 v ~~~~ ~F ,' = OF LOUISE F. KOPPELMAN I, LOUISE F. KOPPELMAN, of Cumberland County, Pennsylvania, declare this to be my Last Will and Testament. I revoke all other Wills and Codicils that I may have previously made. Article I My just debts and expenses of my last illness, funeral, and administration of my estate shall be paid by my Executor from the principal of my residuary estate as soon as practicable after my death. Article II All inheritance, estate, and succession taxes (including interest and penalties thereon, but not including any generation skipping tax) payable by reason of my death shall be paid out of and be charged generally against the principal of my residuary estate without reimbursement from any person. This provision is not a waiver of any right which my Executor has to claim reimbursement for any such taxes which become payable as the result of any property over which I have the power of appointment. LAST WILL AND TESTAMENT Article III I give, devise and bequeath in accordance with any memorandum which I have either handwritten or signed, located with my Will or with my valuable papers and found within 30 days of the probate of my Will. Gifts may only be to persons who survive me or to organizations which exist at my death, and if there is a conflict, the memorandum having the latest date shall govern. Article IV All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, I give, devise and bequeath to my husband, RAY KOPPELMAN, of Cumberland County, Pennsylvania. In the event that RAY KOPPELMAN predeceases me or fails to survive me by thirty (30) days, I give, devise and bequeath the remainder of my estate, of whatsoever nature and wheresoever situate IN EQUAL SHARES, to my daughter, DENISE K. HARRIS, of Cumberland County, Pennsylvania, per stirpes, and IN TRUST for my daughter, LINDA L. BLACKBURN, of Cumberland County, Pennsylvania, to be held and administered according to the following terms and conditions: 1. I direct my Trustee to disburse the entire net income of the Trust to LINDA L. BLACKBURN at least on an annual basis throughout her lifetime. 2. My Trustee shall have full discretion to disburse principal to LINDA L. BLACKBURN throughout her lifetime. 3. Upon the death of LINDA L. BLACKBURN, any Trust funds remaining in the Trust, including income and principal, shall be distributed IN EQUAL SHARES to LINDA L. BLACKBURN's natural-born heirs, per stirpes. -2- g 1 £~~ ~~ ~ r~ ~ ~ r if _ f n.4.;. p ` 4. , No beneficiary arremainderman of this Trust`shall~ have any nght to alien t~,-~~~,' ~'`, , '~~ encumber, or hypothecate his or her interest in the principal or income of the Trust in any manner, nor shall any interest be subject to claims of his or her creditors or liable to attachment, execution, or other processes of law. If any of my beneficiaries predecease me or fail to survive me by thirty (30) days, I give, devise and bequeath his or her share to his or her natural-born issue who survive me, per stirpes, or if he or she has no issue, the share(s) are to be added equally to the other shares. Article V If a beneficiary under this Will has not attained the age of thirty (30) years, the share of the beneficiary shall be placed in a separate trust, for the benefit of that beneficiary according to the terms in Article VI. Article VI In the event that a Trust, other than the trust for LINDA L. BLACKBURN, is created by or as a result of any part of this Will, the terms and conditions of the Trust shall be as follows: A. To expend and apply so much of the net income and so much of the principal of the Trust as the Trustee shall consider advisable for the support, health, care and education (including college, trade school, or other similar training or education) of the child until the child attains the age of thirty (30) years. B. Upon attaining the age of thirty (30), the remaining principal and accumulated income of the child's share shall be distributed outright to the child. C. No beneficiary or remainderman of this Trust shall have any right to alienate, encumber, or hypothecate his or her interest in the principal or income of the Trust in any manner, -3- . ,~ ~~ ,_ '*' not shall any interest be subject to claims ofhis or her creditors or liable to attachment, execution, or other processes of law. Article VII I hereby appoint my daughter, DENISE K. HARRIS, as Trustee of any Trust(s) created in this Will. In the event of the renunciation, death, resignation, or inability to act, for any reason whatsoever of DENISE K. HARRIS, I nominate and appoint myson-in-law, JAMES W. HARRIS of Cumberland County, Pennsylvania, as Successor Trustee of any Trust(s) created in this Will Article VIII In order to carry out the purposes of the Trust(s) established by this Will, the Trustee, in addition to all other powers granted by this Will or by law, shall have the following powers over the Trust estate, subject to any limitations specified elsewhere in this Will: (a) to retain in the form received and/or to sell either at public or private sale, any real estate or personal property except that which I specifically bequeath herein, (b) to manage real estate, (c) to invest and reinvest in all forms of property without being confined to legal investments, and without regard to the principal of diversification, (d) to exercise any option or right arising from the ownership of investments, (e) to compromise claims without court approval and without consent of any beneficiary, (f) to file fiduciary/income tax returns and pay the tax due for any year for which such a return is required, (g) to make distributions in cash or in kind, or in both, and to determine the value of any such property, -4- '(lj ~ to employ any attorney, investment advisor, or other agent deemed necessary by my Executor; and to pay from my estate reasonable compensation for all their services, (i) to conduct along with or with others, any business in which I am engaged in or have an interest in at the time of my death, and (j) to receive reasonable compensation in accordance with their standard schedule of fees in effect while their services are performed. Article IX I nominate, constitute, and appoint my husband, RAY KOPPELMAN, Executor of my Last Will and Testament. In the event of the renunciation, death, or inability to act, for any reason whatsoever of my Executor, I nominate, constitute and appoint my daughter, DEPTISE K. HARRIS, successor Executrix of my Last Will and Testament. In the event of the renunciation, death, or inability to act, for any reason whatsoever of DE1vISE K. HARRIS, I nominate, constitute and appoint my son-in-law, JAMES W. HARRIS successor Executor of my Last Will and Testament. I direct that my Executor or successor Executors be permitted to serve without bond and in addition to those powers granted by law, I grant them power to distribute in cash or in kind in like or in unlike shares and to file any qualified disclaimer I could have filed if living. My Executor and successor Executors shall receive reasonable compensation for services rendered to my estate. Article X In addition to the powers conferred by law, I authorize my Executor and successor Executors, in his/her absolute discretion: (a) to retain in the form received and to sell either at public or private sale, any real estate or personal property except that which I specifically bequeath herein, -5- ._ (b) to manage real estate, (c) to invest and reinvest in all forms of property without being confined to legal investments, and without regard to the principal of diversification, (d) to exercise any option or right arising from the ownership of investments, (e) to compromise claims without court approval and without consent of any beneficiary, (f) to file any federal income tax return for any year for which I have not filed such return prior to my death, (g) to make distributions in cash or in kind, or in both, and to determine the value of any such property, (h) to employ any attorney, investment advisor, or other agent deemed necessary by my Executor; and to pay from my estate reasonable compensation for all their services, (i) to conduct alone or with others, any business in which I am engaged in, or have an interest in at time of my death, and (j) to receive reasonable compensation in accordance with their standard schedule of fees in effect while their services are performed. -6- v /. IN WITNESS WHEREOF, I, LOUISE F. KOPPELMAN, hereby set my hand to this my Last Will and Testament, on 2005. LOUISE F. KOPPEL In our presence, the above-named LOUISE F. KOPPELMAN signed this and declared this to be her Last Will and Testament, and now at her request, in her presence, and in the presence of each other, we sign as witnesses. Name Address _845 Sir Thomas Court. Suite 12 Harrisburg PA 17109 845 Sir Thomas Court, Suite 12 Harrisburg, PA 17109 -7- I, LOUISE F. KOPPELMAN, Testatrix, who signed the foregoing instrument, having been duly qualified according to law, acknowledge that I signed and executed this instrument as my Will, and that I signed it willingly as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by LOUISE F KOPPELMAN, the Testatrix, on ~-~~ ,2005. ~. otary blic COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL bICOUEI.INE A. KELLY NOTARY PUBLIC LOWER PAXiON TWP., DAUPHIN COUNTY MY COMMISSION EXPIRES DEC. 17, 2007 LOUISE F. KOPPEL We, the undersigned witnesses who signed the foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the Testatrix sign and execute this instrument as her Will; that she signed and executed it willingly as her free and voluntary act for the purposes therein expressed; that each of us in her sight and hearing signed the Will as witnesses, and that to the best of our knowledge, that she was at that time eighteen (18) years or more of age, of sound mind, and under no constraint or undue influence. Sworn to or affirmed and subscribed to before me by ~a~~ll~-!C I,~~ ~Q~-~~C-~ and ~ -L~ Witness witnesses, on --~~ , 2005. ~ Q p / 'mess C ,~p~ ~- otary blic COMMOnwEALT-I OF PENNSnVANu NOTARIAL SEAL 1ACOUELINE A. KELLY, NOTARY PUBLIC LOWER PAXfON TWP., DAUPHIN COUNTY _ g _ NIY COMMISSION EXPIRES DEC.17, 2001 _-