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07-12-12
1505610140 REV-1500 EX (01-10) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 1 1. 0 4 1 0 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 0 3 1 4 2 0 1 1 1 1 0 2 1 9 2 4 Decedent's Last Name Suffix Decedent's Firs t Name MI M O U N T Z F R A N C E S S (If Applicable) Enter Surviving Spouse's Information Below Spouse°s Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ^X 1. Original Return 4. Limited Estate OX 6. Decedent Died Testate (Attach Copy of Will) ® 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE VWITH THE REGISTER OF WILLS 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estal:e Tax Return Required 8. Total Numbeir of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number R O G E R B I R W I N' , E S Q U I R E 7 1 7 2 4 9 2 3 5 3 First line of address I R W I N & Second line of address 6 0 W E S T City or Post Office C A R L I S L E .,> _ REGISTE SILLS USE~ILY 'JD ~ ~ c... m 4 ~I T ~ ~ 5,:__ ~ ~ ~ r„t M c K N I G H T P C I ~J rv ~~-` `~' s.r'~i C7 ~~ .-- r-. ~ . _; P O M F R E T S T R E E T ~~ ~? ~. ~-' State ZIP Code _ L?rR'f_E FILED ,~- -~-- P A 1 7 0 1 3 Correspondent's a-mail address: 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 tr rrect and plete. Declarat' o preparer other than th.> personal representative is based on all information of which prepare~r has any knowledge. IGNATUR OF R ESP I OR FILING RETURN ~~ D TE ~-'" ~ ~Q ~ ADD S 645 HIGHLAND AVEN E MT• HOLLY SPRINGS PA 17065 SIGNATU ~~R~(E~ARER O HER T N REPRESENTATIVE DAT rf~IC~~i - v ~ i , ~ -- - +r~'`t~~ is 60 WEST PQ-MFRET STREET CARLISLE PA 17013 PLEASE JSE ORIGINAL FORM ONLY Side 1 1505610140 ],5056101,40 J ;.= Oh20'C950S'I Oh20'C950S'C Z ap!S 2~ ~h~- 1N3WJlb'd213A0 Nb' dO aNfld321 d JNI1S3f}D321 321`d flOJl jl lt/AO 3Hl NI llld ~OZ 61 ...................................................... 3f10 Xb~l 6l 0 0. 0 g ~ 0 0. 0 5 ~ X a}e~ ~e~a}el~oo }e a~gexe} qi, auil;o }unowb gt 0 0. 0 ~~ Z L X a}ea 6upgis }e 0 0 0 aigexe}q}auil;o;unowy Ll Z 5-i ~T![~ 96 ~h, U(a ~ 'O~~ SV0 X a}ea leaull }e a~gexe} q~ auil;o }unowy gL g ~ ~g oaS ~apun spa;sues} ao `a}e~ xe} lesnods ay} }e algexe; q} auil;o }unowy 5L S31b21 3l8`dOllddt! 2104 SN0IlOf1211SN1 33S - NO11111nO1~d0 Xt/1 ~~ ~~ ~4l . ..................... (£ L aull snulw Z ~ auil) xel o;;oafgng an1eA aaN ~bl £ ~ ~ ~ ~ ' (~ a~npayog) apew uaaq }ou sey xe} o} uoi}oala ue yolynn ~o; s}snag £ l L6 oaS~s}sanbag ~e}uawwanoO pue a~qe}uey0 £;. ~° .Z` . ........................... (L L auil snuiw g auol) a}eas3;o an1eA }aN Zl (~ ~ hh SL. L L ... .. .. .. (0 b Pue g sauil le}o}) suol;onpa4 leaol l L 5 S 9 E Z 6 E Ol ~ ~ ~ ~ ~ ~ ~ (~ a~npayog)'suail pue 'sal}l~lge1l a6e6~oW `}uapaoad;o s}qa0 p~ ~ly ~ ~ L~ S E .6 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ (H alnPa4oS) s}so0 and}e~;slwwpy pue sasuadx3 le~aund .6 L, . ~ }°/ 7 c., (~ .g . .......................... (L 46na4} l scull le}o}) classy sso~J Idol '8 ~ pa}sanba2{ 6u1~1~8 a}e~edag ~ (J alnPa4oS) ~(}~adoad a}egoad-u N snoaue~~aosiNl ~ spa;sueal soniA-ya}ul ~ g pa}sanba21 6uy~i9 a}e~edag ~ (~ a~npayog} ~(uadoad paunnO ~l}u~o(` 'g ~• ~ ~ n ~~ l~ g (3 ainpayog) ~(}~ado.id ~euosaad snoaue~~aosiW pue s}lsodaa ~lue8 'yse~ c . y . ........... ' ' . ' " " .... ' ' ' . (4 alnPa4oS) algeniaoab sa}oN pue sa6e6uoW ti '£ ~ ~ ~ ~ ' (O alnPa4oS) dlys~o}alldad-clog ao dlys~au}~ed 'uol}e~odao0 p~aH ~(lasol0 £ Z . ..................................... (8 alnPa4oS) spuo8 pue s~loo}S ~Z 00°00006 ................................... (b' alnPaUoS) a}e}s3 1ea21 i NOllylfllldb~3321 Q h E 2 Q 'I 2 0 2 Z .L N f10 W' S S 3 J N d ?J ~ aweN s,luapa~aa ~agwnN ~(}unoaS leioog s,}uapaoaa X3 0091-A321 Oh20'C9SOS'C REV-1500 EX Page 3 File Number C~ecedent's Complete Address: 21 11 0410 DECEDENT'S NAME FRANCES S. MOUNTZ _ STREET ADDRESS 57 E. SOUTH STREET CITY STATE ZIP CARLISLE PA ~ 17013 Tax Payments and Credits: ~. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments - B. Discount 3. Interest Tota{ Credits (A + B) (2) (3j 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. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (4) (5) Make check payable to: REGISTER OF WILLS, AGENT (1) 746.52 0.00 0.00 746.52 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 : ................................................................ ...... ^ ^X b. retain the right to designate who shall use the property transferred or its income; ......................... ...... ^ X^ c. retain a reversionary interest; or .......................................................................................... ...... ^ X^ d. receive the promise for life of either payments, benefits or care? ................................................. ...... ^ 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................. ...... ^ X^ 3. Did decedent own an "intrust for" or payable-upon-,death bank account or security at his or her death? ... ...... ^ 4. Ditl 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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requiremE:nts 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 21 years of age or younger at death to or for the u,se of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, undE Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1562 EX+ (01-10) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: FRANCES S. MOUNTZ 21 11 0410 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 that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1. 57 E. SOUTH STREET, CARLISLE, PENNSYLVANIA 23,000.00 STATEMENT OF VALUE ATTACHED 824 PETERSBURG ROAD, CARLISLE, PENNSYLVANIA I 67,000.00 SOLD -SETTLEMENT SHEET ATTACHED TOTAL (Also enter on Line 1, Recapitulation.) ~ $ 90.000.00 If more space is needed, use additional sheets of paper of the same size. REV-1508 EX+ (11-10) • pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER: FRANCES S. MOUNTZ 21 11 0410 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1, SOVEREIGN BANK -SAVINGS ACCOUNT #1674303142 50.07 2. SOVEREIGN BANK -CHECKING ACCOUNT #2891030893 1,580.53 3. COINS/JEWELRY -APPRAISAL ATTACHED ~ 406.84 TOTAL (Also enter on Line 5, Recapitulation) l $ 2, 037.44 If more space is needed, insert additional sheets of paper of the same size REV-1511 EX+ (10-09) ' pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER FRANCES S. MOUNTZ 21 11 0410 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HOFFMAN-ROTH FUNERAL HOME 9,630.86 2. FUNERAL LUNCHEON 128.93 3. MINISTER DONATION 140.00 B. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) DONALD E. MOUNTZ Street Address 645 HIGHLAND AVENUE City MT. HOLLY SPRINGS State PA ZIP 17065 4,500.00 Year(s) Commission Paid: 2. Attorney Fees: IRWIN & McKNIGHT, P.C. 5,350.00 3. Family Exemption: (If decedent's address is not the same as claimants, attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: REGISTER OF WILLS 257.50 5 Accountant Fees: WAGNER'S TAX SERVICE 80.00 INCOME TAX PREPARATION 6. Tax Return Preparer Fees: 7. REGISTER OF WILLS -FILING FEE 30.00 8. CLOSING COSTS ON SALE OF REAL ESTATE - 824 PETERSBURG ROAD 6,736.45 9. THE SENTINEL -ESTATE NOTICE ' 187.54 10. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 75.00 11. SOVEREIGN BANK -DATE OF DEATH VALUATION 20.00 12. PECK'S SEPTIC SERVICE -PUMP SEPTIC TANK 198.75 13. S.W. BARRETT REAL ESTATE -APPRAISAL ON REAL ESTATE (2) 650.00 14. M&T BANK -DRILL SAFE DEPOSIT,BOX 150.00 15. DONALD E. MOUNTZ -REIMBURSEMENT OF HOUSE CLEAN-UP/SUPPLIES 168.34 16. LAWN CARE 760.00 17. WASTE MANAGEMENT -TRASH REMOVAL 4,102.35 18. LINDA M. MOUNTZ -REIMBURSEMENT OF CLEANING SUPPLIES 35.74 TOTAL (Also enter on Line 9, Recapitulation) $ 35.711.46 If more space is needed, use additional sheets of paper of the same size Continuation of REV-1500 In~neritance Tax Return Resident Decedent • FRANCES S. MOUNTZ 21 11 0410 Decedent's Name Page 1 File Number Schedule H -Funeral Expenses 8~ Administrative Costs - B7. ITEM NUMBER DESCRIPTION AMOUNT 19. LINDA MOUNTZ -HOUSE CLEAN-UP 800.00 20. REBECCA MOUNTZ -HOUSE CLEAN-UP 400.00 21. RICH KENNEL -HOUSE CLEAN-UP 770.00 22. SOUTH MIDDLETON TOWNSHIP -PERK TEST 540.00 SUBTOTAL SCHEDULE H-67 ~ 2,510.00 REV-1512 EX+ (12-08) pennsylvan4a DEPARTMENT OF REVENUE INHERITANCE TA>: ~ETJRN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8~ LIENS ESTATE OF FILE NUMBER FRANCES S. MOUNTZ 21 11 0410 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursedl medical expenses, ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. SOVEREIGN BANK -LINE OF CREDIT 24,686.01 2. DONALD E. MOUNTZ -OUTSTANDING NOTE 1,530.00 3. YELLOW BREECHES EMS, INC. -AMBULANCE 79 90 4. WEST SHORE EMS -AMBULANCE 1,216.59 5. CARLISLE REGIONAL MEDICAL CENTER -MEDICAL 229.58 6. HOUSEHOLD RECOVERY SERVICES/BENEFICIAL -CREDIT CARD 2,459.57 7. STOKEN OPHTHALMOLOGY -MEDICAL 67.52 8. UGI -UTILITY 406.35 9. OPAL MASON -OUTSTANDING LOAN 400.00 10. M&T BANK -SAFE DEPOSIT BOX PAYMENT 39.00 11. PP&L -ELECTRIC 99.54 12. ALLSTATE INSURANCE COMPANY -HOMEOWNERS INSURANCE 378.73 13. TAX CLAIM BUREAU OF CUMBERLAND COUNTY - 2009 REAL ESTATE TAXES 1,473.00 824 PETERSBURG ROAD 14. TAX CLAIM BUREAU OF CUMBERLAND COUNTY - 2009 REAL ESTATE TAXES 1,161.00 57 E. SOUTH STREET 15. BOROUGH OF CARLISLE -WATER/SEWER 616.48 TOTAL (Also enter on Line 10, Recapitulation) ~ $ ~a ~,~~ ~F If more space is needed, insert additional sheets of the same size. ' Continuation of REV-1500 Inheritance Tax Return Resident Decedent FRANCES S. MOUNTZ 21 11 0410 Decedent's Name Page 2 File Number Schedule 1 -Debts of Decedent, Mortgage Liabilities, ~ Liens ITEM NUMBER DESCRIPTION AMOUNT 16. SOVEREIGN BANK -LOAN PAYMENTS 899.54 17. TAX CLAIM BUREAU OF CUMBERLAND COUNTY - 2010 REAL ESTATE TAXES 824 PETERSBURG ROAD 18. TAX CLAIM BUREAU OF CUMBERLAND COUNTY - 2010 REAL ESTATE TAXES 57 E. SOUTH STREET 19. ~MARILYN DEWALT -OUTSTANDING LOAN 1, 542.05 1,251.69 1,200.00 SUBTOTAL SCHEDULE I 4,893.28 GRAND TOTAL SCHEDULE I $ 39, 736.55 REV-1513 EX+ (01-10) pennsylvania I SDHEDULE J DEPARTMENT OF REVENUE I BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: FRANCES S. MOUNTZ 21 11 0410 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. CHILDREN OF GARY MOUNTZ, DECEASED Lineal 2,764.90 'I/6TH REMAINDER 1. DANIELLE HILTON Lineal PO BOX 1394 SPRINGDALE AR 72765 2. TRACY MOUNTZ Lineal 425 MORRISON ROAD ARKADELPHIA AR 71923 3. CHRISTINE HARDIN PO BOX 1711 SPRINGDALE AR 72765 4. JUDITH ELLIOTT Lineal 1352 B POLLISON LOPT SPRINGDALE AR 72765 CHILDREN OF LEO MOUNTZ, DECEASED Lineal 2,764.90 'I/6TH REMAINDER 5. SANDY LOWE Lineal 4081 EARLY ROAD ELLESBURG PA 17024 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. [], NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS. 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ IT more space is needed, use additional sheets of paper of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent FRANCES S. MOUNTZ 21 11 0410 Decedent's Name Page 3 File Number Schedule J -Beneficiaries - 1 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE [ TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 6. DOUGLAS MOUNTZ Lineal 478 MEADOWS ROAD NEWVILLE PA 17241 7. JEFF MOUNTZ Lineal 35606 CRESTVIEW DRIVE YUCAIPA CA 92394 8. DONALD E. MOUNTZ Lineal 2,764.90 645 HIGHLAND AVENUE 1/6TH REMAINDER MT. HOLLY SPRINGS, PA 17065 9. RICKY L. MOUNTZ Lineal 2,764.91 62 KERSEY ROAD 1/6TH REMAINDER VIOLA DE 19979 10. RANDY MOUNTZ Lineal 2,764.91 30 APPALACHIAN TRAIL ROAD 1/6TH REMAINDER GARDNERS PA 17324 11. MARILYN DEWALT Lineal 2,764.91 203 NORTH BALTIMORE AVENUE 1/6TH REMAINDER MT. HOLLY SPRINGS PA 17065 n ~z ~, U ~.. ~~ ~ m ~- C7 ~ _~ ~~ f~ri N LAST WILL AND TESTAMENT OF ~ J~~ Lt3 FRANCES S . P40UNTZ ~~ r =' O 7 -i ~) r~ -T-1 . ,J c= _o --~ D w cn KNOW ALL MEN BY THESE PRESENTS, that I, Frances S. Mountz, _ of South Middleton Township, Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this to be my Last Will and Testament and revoke all Wills and Codicils previously made by me. ITEM 1. I direct my hereinafter named Executor to pay my just debts, funeral expenses, and costs of the administration of my estate, as soon as may be convenient after my death. ITEP4 2. I give, devise, and bequeath all of my estate, be the same real, personal or mixed and wheresoever situate, to my husband, Leo F. Mountz, providing he shall survive me by thirty (30) days. ITEM 3. I appoint my husband, Leo F. Mountz, the Executor of my estate. "~ IT_EM 4. If my said husband should predecease me or die on or before the thirtieth day following my death, I devise and i Q G~ d h ~ w erever s tuat~ ~~eC bequeath my entire estate of every nature an C in equal shares amo"aig my six (6) children, Leo Robert Mountz, Gary F. t4ountz, Donald E. Mountz, Marilyn F. r4cBride, Ricky L. Mountz and Randy Mountz. ITEM 5. In the event my said husband predeceases me, I appoint my son, Donald E. P4ountz, the Executor of my estate. ITEM 6. I grant unto my Executor the pocaer to sell, pledge, mortgage, lease or exchange, or to grant an option for a purchase, lease, or exchange of any real estate which I own at the time of my death. Page 1 of 2 Pages /~nlror,~J" ~+~ r a~ ~; _~ r _ - ~'~ O ~~ a ITEM 7. I direct that my Executor, as well as his successors, shall not be required to give bond for the 'faithful performance of his duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ day of June, 1977. p ~ii Leo ~1. ~i ~~.~~SEAL) The preceding instrument consisting of this and one other typewritten page, each identified by the signature of the Textatri:x, was on the day and date hereof signed, published and declared by Frances S. Mountz, the Testatrix herein named, as and for her Last Will and Testament in the presence of us, who, at her request, in her presence and in the presence of each other have subscribed our names as witnesses hereto. ~o f~' Page 2 of 2 Pages ronn nuv--~ ptddl rm nanOnOOx aaw.e A. Settlement Statement U.S. Departmen[of Housing and Urban Development OMBADDrova1~2502-0265 __~ 1. ^FHA 2. ^FtnHA 3. ^Conv. Uains. 6. File Number 7. Loan Number 1 B. Mortgage Insurance C:aseNttmber a ~Jvs_ 0 ~ 012-124 --- This torn is fumisned to glue you a statement of auYUal sea0ement costs. Amounts paid to and by the setdement agent are shown. j C. Note: Items marketl •(p.o.a)' were paid outside the dosing; they are shtwm here lorildormadon puryosa and are not Indudetl In the totals. TigeF~cpress Selgement System WARNING: Il is a crime to knowingly make false statements l0 tiro United Slates ort this or an other simper tmm. Penallles upon I D. NAME of BORROWER: Thomas A. Fries and Amy L. Fries 412 ine R a Mount oll s PA 17065 _- E. NAME OF SELLER: The Estatevf Fiances S. MOUntz 24 etersbur oad i le 1 O1 -- F. NAME OF LENDER N/A - G. PROPERTY DRESS: 824 Petersburg Road, Carlisle, PA 17015 South 'ddl t n o x. sEI-rLEMENT AGENT: PA Real Estate Settlement Services, LLC, Telephone: 717-249-6333 Fax: 717-2419-7334 354 e er li t A 17 5 _ O1 J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF.SELLER'S TRANSACT ON: D R --- 67 000.00 _ 67 000.00 1 r - 1 708.63 __~ 'us ri d' i i set ri v_a~rce s OS 30 12 12 31 12 244.91 05 30 12 12 31 12 ~ 244.91 OS 30 12 06 30 12 146.22 OS 30 12 06 30 12 _ 146.22 ~ D F 69 099.96 _- 67 391.13 2 A NT P R I I T L _~ 1 320.00 _- __ 6 736.45 _.A~j me r i id r A ' r' b el _- 22 A P B F W 1 320.00 T D _ 6 736.45 3 0 A T F R _- i 69 099.96 _ 67 391.13 1 320.00 _- 6 736.45 sns. CASH FROM BORROWER 67 779.96 CA _ 60 654.68 SUBSTITUTE FORM 7099 SELLER STATEMENT: Tha Infomtadon rAnlalned herein is important tax Inlprmation and Is being famished to Ne Internal Revenue Service. If you are required to file a return, a neOII enpe penalty or aNer sandtpn will be Imposed on you H this Item Is requiretl lobe reportetl and the IRS determines Thar II hes not been reported. The Conlrad Sales Price described an tine 401 ebpva constltutes the Grass Proceeds of this transacgon. you are requlretl bylaw to provide Ne seblement agent (Fed. Tax ID No: ) wIN your correct taxpayer IdenUflcalion number. M you do not preNde your correct taxpayer itlenUfiwtlon number, you maybe suhjea to civic or criminal penalties imposed by law. Un3er pena~t as orpe+1ury, 1 certify that the number shown on This statement is my rroned taxpayer IdenUfiption number. TIN: ~- 1 _- SELLfR(S)SIGNATURE(S): 1 _ SELLER(S) NEW MAILING ADDRESS: -- SELLER(S}PHONE NUMBERS: (R) ~} ..,...... ..............,,.awauvvruvuutUSnlvllCVIrWYM!_:N"C File Number. 201?-'24 PAGE St1ILtMtNI JIHI MtNI L M N A _ PAID FROM PAID FROM 7 Q T~Tr?L.~!\i~S1BROKER'S COMMISSION based on Drice $67 000 .00 @ 4 .500 = 3 , 015.Op BORROWER'S SELLER'S _ FUNDS AT FUNDS AT to _ SETTLEMENT SETTLEMENT 3 015 00 to Real Estate Excel _ 7~ - ,_ ~ 707 Commi ion oaid -t cemem nt _ _ 3 .015.0 I __. ~_____~__,-__ .,, Roal tr.atara F.xcal _. 250.00 250.0 1 IVI 802 Loan D 804 r dit 905 H HD I taunt ~ R Dort + - - - - I _~ _+ ~ - _~ 0 - _ - - 85 A 1 1 i 9 T RE Y L r -+-- 1 .R S F - ura l - . ns ace 1 0 0 55 0.00 0.01 IT S - - ! Stewart Title Guarant PA RE SS 726.8_1 N' - ~ t ~ ~~t r p Iiy~ 67 000.00 - 726.83 _ - - - 1 00. O RNMENT RE ORDIN AND F R HA ES 62.00 _ 62.0(1 670.00 670.00 _ 670.00 670.0( 13 . AD IT A Tax Claim Buearu 2,381.4_' Robert Cairns Tax Collector ~_ S.Ot Robert Cairns Tax Collector ~ 415.0( ~ nnn TnTel cFTTI CGAFAIT CND,RRFR tenter nn linee 103. Section J and 502. Section. K) __ - ___ __. 1 708. 83~_ 6, 736.4°. HUD CERTIFICATION OF BUYER ANO SELLER 1 have caretutly reviewed the HU0.1 Settlement Statement and to Ne best o(myy knowledge and beliel, it Is a true a a le statement o(all rec nd tlisbu ents matle on my account or by me in this iransaeUOn. I further hal I ha re d a copy M the MUD-1 Selllemenl Slalement. Thomas A. F' Amy L Fries WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE The HUD-1 Settlement Statement which I have prepared is a We and aaurate account of tats transactlon. UNffED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION I have causetl or will cause Ne funds to be disbursed In accordance with this statement. CAN INCLUDE A FINE AND IMPRISONMF1dT. FOR DETAILS SEE TITLE 1a: U.S. CODE SECTION 1007 AND SECTION 1070. aY - ~ 3c~rZ f " ~ A REAI. ESTATE F.~CEI. 1224 Ho11y Pike Carlisle PA 17013 (?17~ 258.8934 Fax 166.590^5236 EXceedin Your EX stations R~~~r~~l~s 9 Pe Faa~ Trar~r8mrt~acl Form To: ~ ~ ~ - ~~-x Nt~~~a: a ~{ g_~ 3 s Y AAZE & T>z~: ~ 1 ~ 3 j~~ i~~ s~ ~ Ste,., # OF PAGES INCLUDING COVER PAGE: ~~ T"J~ GoLLUr~S, 717 386-0226, J1M@SEEJIM.COM JON CoLLrnts, 717.3860367, coLinasJor~~GMAU..COM () ~1'AYNE UT.SH, 717-25&8934, PA_RF.AL_ESTATE_GUY@YAHOO.COM () DAOVN CoLr_nvs, 717-385-4772, Dcou.I1vs412@HOTMAII..COM Message: EXceeding Your EXpectatians June 13, 2012 sx~,TE~v.~ Q~ va~u~ RE: 57 E. South Street, Carlisle PA 19p13 To Whom It May Concern, I fast listed this property on 9!26/2011 at a list price of $39,900. During that time, we had. multiple showings and had 2 v$ezs on the pzoperiy... one at $15,000 and one at $20,000. Due to the pzoperty's current poor condition, i estimate its value to be $23,000. Please do not hesitate to contact me if you need anything further. Thank you. Sincerely, James J. Col1.i'oas, $rokez REAL ESTATE E~CEI.~ 1224 Holly Pike, CaxUsle PA, 1701:3 • office: (717) 258-8934 • fag: (866) 590-823b www.ReslEstateE.gcel.us ' S~r~~ri Court Ordered Processing \ Decedents - MA1-MB3-02-10 - P. 0. Box 841005 -Boston, IYLA 02284 April 18, 2011 ~~~~~~ APR 2 3 ~01~ Law Offices IRWiN ~ iJlcf(NIGH~ Irwin & McKnight, P.C. c,AWOFfICES 60 W. Pomfret St. Carlisle, PA 17013-3222 RE: Estate of Frances P. Mountz Date of Death: March 14, 2011 Dear Mr. Irwin: Per your request, enclosed please find the account information as of the date of death for the above-named decedent. For your information, accrued interest is not included in the date of death balance. Please feel free to contact me if I can be of any further assistance. Very truly yours, .'~D~-~_.-~ ~ i Linda Spavento Team Leader 617-514-5189 Sovereign Bank ESTATE OF Frances S Mountz SOCIAL SECURITY #: 201-18-2348 DATE OF DEATH: March 14, 2011 Account #: 1674303142 Type: Savings Open date: '/19/2010 In the name of: Frances S Mountz Date of Death Balance: $50.07 Int.(YTD) from 1/1/2011 to 2/11/2011 $0.01 Accrued interest to date of death: $0.00 _ Otherlnfo: Account #: 2891030893 Type: Checking Open date: 11/28/1988 In the name of: Frances S Mountz Date of Death Balance: $1,580.53 Int.(YTD) from 1/1/2011 to 2/28/2011 $0.03 Accrued interest to date of death: $0.00 Otherlnfo: Account #: 6819066317 Type: Line of Credit Open date: Ei/18/2004 In the name of: Frances S Mountz Balance Due at Death: $24,686.01 Page 1 of 1 FRANCES MOUNTZ ESTATE d/o/d -MARCH 14, 2011 Appraisal by: Harry E. Donson 243-8943 CARLISLE COIN SHOP 25 Circle Drive Carlisle, PA 17013 ~`' u 5 ~G~~J ~ ~,~~~~,~,. L~ ~ ~, ~ ~ .~ ') r ~ ,~ ~.O~~l _ ~~l -~_C.l c.v'- '~~. `~ l 1.~ c~v`~) 1 ~l~ ~,~G l ~ ~ ,~- -,. CI ~~{, ~G~ ~ ~~ ~ a.,y~ 4:~~ ~~ ~ ___._ r ,~ ~' /~.~ ,R',1 ~ ass ~'~ ~ ~ ~~~~ ..~-, ,~..e- ~v~~ t/~'d~?.5 .<- C ~'~` ~l~>7~ VS~~~ ~ `.~- ~! . f c ~ f' 1.~~1 _ ---~""' _ J_ f~ ~ ,..- r~ ~'~ ` r. i ,~, :t ~~ ~ ~t.~` ~lr ~ ~~} s i . ~' ~ FUNERAL HOME ~ CREMA?ORY, INC Donald Mountz 645 Highland Avenue Mount Holly Springs, PA 17065 219 North Hanover Street Carlisle, Pennsylvania 17013 711,243.4511 toll free 1.866.451.451 1 fax 717.243.3723 v~rnnv.hoffmanroth.com infoC~hoffmanroth,com March 21, 2011 Statement of Funeral Expenses for: Frances P. Mountz Date of Death: March 14, 2011 Account Id: 16194-069 PACKAGE: Traditional Funeral Service TRADITIONAL FUNERAL SERVICE PACKAGE $ 4,550.00 MERCHANDISE: Sub Total: $ 4,550.00 Casket: Christian ll $ 2,890.00 Outer Container: Monticello $ 1,420.00 Sub Total: $ 4,310.00 TOTAL FUNERAL HOME CHARGES: $ 8,860.00 CASH ADVANCES: St. Peters Lutheran Church Cemetery $ 600.00 12 Certified Death Certificates at $ 6.00 each $ 72.00 Newspaper Notice -Sentinel $ 105.06 Flowers $ 159.00 Additional DC's 2 ~ $ 12.00 Sub Total: $ 948.06 Total Funeral Expense: $ 9,808.06 Balance: $ ~9~ -~ ~ I `7 ~ . as (~~~ s~ ~.~.t) ---------------------------------------------------------- --- .Please return this portion with your Remittance. ~ ~ b 30 °~ 6 Amount Enclosed Frances P. Mountz Service ID#: 16194-069 ~ M ~'' - `~ ©~ l~~- ~c ~ _ ~ ,° 6 ~ n ~ , ~ °®,.~ e~ '~9f~ SERVING OUR COMIVI NITY SINCE 1.907 DONALD E. MOUNTZ so-iso36 91$ LINDA M. MOUNTZ 313 645 HIGHLAND AVE. PH. 717-486-7675 MT HOLLY SPRIl~IG, PA 17065 DATE a, O II ~ PAY TO J $ 9~ 3 6 8 THE O D OF g rl.,..~ ~ K rw~- ~ ~"`-~+C~~~ OLLAAS L! J °b "~"' w.~~~ 5 o ~'7Ch ATsaditionafEsallma MEMO ryp ~:03L3L5036~; 106 002297ii' 09 L8 ~~r~.. TrueEarnings° Card AMERICAN EGRESS LINDA M MOUNTZ o Closing Date 04/08/11 \rV p. 3/5 I Account Ending ~ i i Payments and Credits :.`Summary - Total - n Payments -$150.21 r Credits $0.00 a Total Payments and Credits -$150.21.. ~ . ' D@tAl~ "Indicates posting date ~ Payments _ Amount a 03/25l11* LINDAMMOUNTZ PAYMENT RECEIVED-THANKYOU -$150.21 -- o 0 n N- :~ 7 V Total _ _LINDAN{TVIOUNTZD-71003 - - - - - - - - - - - - - - - - - - - - .. $228.79 DONALD E MOUNTZ 0-71011 $25.50 Total New Charges $254.29 Detail. LINDA M MOUNTZ ® Card Ending 0-71003 Amount 03/12/11 COSTCO WHSE #0327 OOHARRISBURG PA $29.35 7174122053 03/17/11 COSTCO WHSE #0327 OOHARRISBURG PA $70.51 7174122053 f r~~ y 03/17/11 ~ ~61SJi~RA~"". F~,~ G ~ t' (~ "i~ "V (~ 1" , ,..Ij 7174122053 DONALD E MOUNTZ ® Card Ending 0-71011 Amount 03/12/11 £OSTCO GAS #0327 OOOHARRISBURG PA $25.50 7174122050 Fees a Amount N o Total Eees for this Period $0.00 a Interest Charged m 0 Amount c Total Interest Charged for this Period $0.00 o a Continued on reverse IlPeck,s Septic service~~ ~~ 68 Pine School Road ~~ ~~Gardners Pa. 17324 ~~ II -(717) -486-5548 ~~ i n r ~~ ~~ CUSTOMER BILLING (~ ~~ ~~ ~~ '~ ~~ ~~ ~5~ G~~ 2 O ~ FRANCIS MOUNTZ I~ 824 PETERSBURG ROAD ~I ~~ CARLISLE PA 17013 ~~ ~~ ~~ ~~ ~~ ~~ ~~ ~~ BILLING INFORMATION I) ~I Ii u n it I~Previous Date Pumped: II ~i -~~ I~Date Pumped: 10/20/2009~~ ~IBilling Date: 10/29/2009I~ ~~Pumping Charge: $165.00~~ Labor Charge: $33.75I~ Material Charge: $O.OOII ~~ Service Charge : $ 0 . 00 ~~ ~~Total Due: 10°s Added After 30 Days) $"198.75II I' WORK DONE " 'I II*************** (PUMPED SEPTIC TANK, LOCATED AT) *1**y****~**~` I) ~I*************** (824 PETERSBURG ROAD, CARLISLE)*********** II ~ILOCATED AND DUG OPEN SEPTIC TANK, SOUTH MIDDLETON TOWNSHIP II II INSPECTION . II IITANK WAS LEFT OPEN IF YOU ARE INTRESTED ON RISERS TO WALL UP TO II I~SURFACE,PLEASE CALL, IF NOT WE WILL CLOSE TANK UP. II II***************** THANK YOU, PLEASE CALL AGAIN *************** II ~~ ~~ ~~Next Scheduled Pumping: ~~ ~~ ~~ I~ ~I r-~ ~~ I~ (~ PECKS SEPTIC SERVICE, SERVING THE COMMUNITY SINCE 1968 (, II II ~ THANK YOU FOR LETTING US SERVE YOU. ~ '~ ~~ ~~ II ~~ ~~ Gagner°s 't'ag Service 340 E. Loather St., Suite 1 Carlisle, PA 17013 (717) 243-8314 'I`axbiz39t~a aoLcom May ~, 20I I Frances S. Mountz 57 East. South St. Carlisle, PA 17013 Statement of Charges for Services Rendered: Per Form Charges: See forms listed below -Federal 70A~D See forms listed below -Pennsylvania 40.00 Subtotal before discount $ I10.0~0 Discouni 3.Q..QQ Total fee $ 50.00 Summary of Federal Form Charges: Description Charge per Form Count Charge Foi7n 1040 Individual Income Tax 45.00 1 45.00 Form 1099-R Worksheet 5.00 1 5.01) Schedule C-EZ Net Business Profit 10.00 1 10.00 Sch M ll~faking Work Pay & Retiree Cr 5.00 1 5.01) Schedule SE Self-Employment Tax 5.00 1 S.Of) Summary of Pennsylvania Form Charges: Description Charge per Form Count Charge Form PA-40. Income Tax Return 25.00 1 25.00 Schedule SP, Special Tax Forgiveness 10.00 1 10.00 csntai 5.00 1 5.Oi0 Mowing Petersburg Road Property 2011 and 2012 Donald E. Mountz Date Time and Gasoline to Mow 5/5/2011 $ 40.00 5/20/2011 $ 40.00 6/3/2011 $ 40.00 6/13/2011 $ 40.00 6/23/2011 $ 40.00 7/7/2011 $ 40.00 7/15/2011 $ 40.00 7/23/2011 $ 40.00 8/9/2011 $ 40.00 8/25/2011 $ 40.00 9/15/2011 $ 40.00 9/26/2011 $ 40.00 10/10/2011 $ 40.00 10/27/2011 $ 40.00 3/16/2012 $ 40.00 3/29/2012 $ 40.00 4/16/2012 $ 40.00 5/3/2012 $ 40.00 5/17/2012 $ 40.00 $ 760.00 Mowing Petersburg Road Property ~n~~ .,.,~ .,,..,, THANK YOU FOR SHOPPING AT SURPLUS L'ITY CARLISLE (717) 243-800'0 THANK YOU ;'11 10;59AM KBH 590 SALE 1 EA 4.49 EA `I~_ IA,SK 50RC 4.49 'i!~'AL; 4.49 TAX, .27 TOTAL: ~cND: 20.00 CHANGE: 15.21E 1111~~II~1~~~~~~~~1~~~11~1~~~~I'~I ~= __ » JRNL#A78549 «__ . CU~'~r L yC lr ^• •~ SHERWIN'WILLIAMSm CARLISLE Store 5949 823E HIGH. ST CARLISLE PA 17013 261(1 (717)243-2400 Fax (717) 243-4355 www.sherwin-williams.com ALE 11:' .` ,ran # 3892-2 03/3" .'13/10501 •(INALD D.I.Y. Account 1 Job 1 D.I.Y. ;`1 To: .r.Y. ~,2-0681 9010-00 EACH DIS LATEX GLOVE-100 1.00 @ 13.99 1.~.~~~ ._1-9071 76395-XL EACH GEN PROT COVRALL-XL :ale No Tax 1.00 ~ 6.9T (TOTAL ~ i.000X SALES TAX:1-391701300 ~. .H TENDERED -2:' , (, ~NGE DUE 'AL $;, us know how we're doing. Log onto Erwin-williams.com/reviews, and sha it thoughts about our products. We ~reciate your feedback. ., 1 ------- Thank You --------- receipt required for refund ~~~~I~~IIII~II~INI~ N~II~IIIIIIIh~~~~~~~I~I ~N X10501/38922 03 31 2011 More saving. More doing: 1013 S. HANOVER ST, CARLISLE PA 17013 WE NOW INSTALL HOME SOLAR POWER UNITS 4149 00056 95812 04/17/11 11:33 AM CASHIER SELF CHECK OUT - SCOT56 045899394991 10X14 FSBO <A> 3Q0.70 2.10 045899350423 SIGN <A> 400.97 3.88 ~i iwi~i~~iiu~~~iuu~u ~~ip 4149 56 95812 Oq/17/2011 0251 RETURN POLICY DEFINITIONS POLICY ID DAYS POLICY EXPIRES ON A 1 90 07/16/2011 THE HOME DEPOT RESERVES THE RIGHT TO LIMIT /DENY RETURNS. PLEASE SEE THE RETURN POLICY SIGN IN STORES FOR DETAILS. GUARANTEED LOW PRICES LOOK FOR HUNDREDS OF LOWER PRICES STOREWIDE a ~, L U r HL O '` O N . C ~ O e i ot }, ,~ ~ ~ 7 ~ Q ~C7 N 3 > 3 ~X- ~'i - _ i Iii ''More saving. More doing:" 1033 S. HANOVER ST, CARLISLE PA 17013 WE NOW INSTALL HOME SOLAR POWER UNITS 4149 00056.. 938&6 04/07/11 10:18 AM CASHIER SELF CHECK OUT - SCOT56 662909372:188+ 32P_K NI, GL <A> 9.88 073257132428`TRASH-BAGS <A> 15.98 SUBTOTAL 25.86 SALES°'TAX 1.56 - -TOTAL.... $27.42 KKXXXXXXKXKX8459 DEBIT 27 42 AUTH CODE 362924 +~ ~ a'~I>f,~.fl~I Ili ~ R'~; i~~ Ill1~,, ~ - ~ 1 , Ih ~~ii~~ ~ ~~ ~~11i1111t111111111 41;ti i~1i07/20118953 REI ~~~ ~`; ~ ~ ~ tFINITIONS POLICY I~ UAYa.' POLICY EXPTF;ES ON A 1 90:. 07/06!2U11 THE HOME DEPOT RESERVES THE RIGHT TO LIMIT /DENY RETURNS. PLEASE SEE THE RETURN POLICY SIGN IN STORES FOR DETAILS. GUARANTEED LOW PRICES LOOK FOR HUNDREDS OF LOWER PRICES STOREWIDE O ++ MAD N 0 0 ~ ~` L L V ~ M O. 0 0 ~x 0001Jr ~ O ~ O.L (0 E 3 ++ 0 0- NOD ~ * ~ O) Q» ~ N ~~ i ~ ~ NH O d L CR 3c'"~ X~~O ~ O N ~ O X r. " f~0 ~.~ ~ r'~iNrMi NN R ~ X~O) is fp . 0 7 O JO ~ Qk CQ f`n ~yt - ~k~ ~ ti X ~ ~ L 'O U Z -. N+-~ ra rt t- ~ c~ ~~ - ~ Ot O.~ v r ~e Z X ~e Jt ~t ii Z WX ~% It i~ Ci ~~ _ + C m N T+-fCNL L L OcOsL . i ~ W ~ ~ ~ ~ . m 3 v m+0+ Nc~a ~ o >x r.: ... N~ d JZ ~ O C O 0 0 ~' - N O~ C70 'O 7~ 3 + ~. C lq L L ~~ O-L N .C ~ N ~ x Z1~ L O O O O. O O H CS ~ +N L ~ ~ 4 U ~~ ~~ U¢¢¢ ari~. 1r A 61 O}~-p + C IC fC tAU 0>:'m' HF-- > ¢ a 4 n O d ~I!- it Cn a. 1-• O) Y CT O QN ~e p p C ! UtV i # 'ii • • is `"~ c N d C L t0 ~ C ~Y( q 41tnxF-m ~ 02 -D: N (0 JOi~ IXJ. ic c_ r~ ~x .a~ ,_ .~ mt C?tn d ?. - Z ~ GOW ~c OF-Wd E~Q00 ' ~, ~ IL7 ~ LO ti •Zt- *p 9c L.L~JU ~.ULI~ ri ~ L ~ ".? n C c%.. ~Ci: u.. t L1NU0 Q c~ i~c H. • _ _ ~~ My eBay Sell Community Customer Support ~" ~ -:i Hi, donm5879! (Sign out) You're Invited! Jain eBay Bucks. -- - - ,All Categories Advanced CATEGORIES FASHION MOTORS DEALS CLA551FIED5 eBayBuyerProtection Learn.n?arg _ __ _ _ _ _ _ Home > My eBay > Order details Order details Shipping details Payment details Don Mountz ~, PayPaf- ~ ~_~~-~~:~. 645 Highland Ave ~ Mount Holly Springs PA 17065 -~ ~ Q United States ~ _ . ~~ ~ ` Order details Item tale Available actions Seller: bemard3053 (164 ~) (~ Contact seller Paid on Mar-2411 via PayPal .... Breathable Disposable -... Protective Coveralls M Leave •.: 25/Case feedback - S $34.99 Quantity: 1 Having a problem with this purchase? We can help Shipping & handling (estimated price delivery;) Printer version Standard Shipping :FREE US $34.99 UPS Ground Estimated delivery: March 28 -April 1 Subtotal: Shipping & handling: Total: --U--S~$3~4E9~9 l US $34.99 http://payments.ebay.com/ws/eBayISAPI.dII?ViewPaymentStatus&transid=571878713005... 4/1 /2011 L ~ that was easy: Low prices. Every item. Every day. Store No:870 100 Noble Blvd Carlisle, PA 17013 {717) 243.1213 252575 XX 025 3;ttl82 Receipt #: 32882 Disc over #: XXXXXXXXXXXXIi170 OOf2Uf11 10:01 Uty Description Amount ~. BW SS PASS LtrfLgl•832551 2 45 SubTatal 2.~i STANDARD TAX u. t 5 Total Y 58 TI..: Cardholder agrees to pay the Issuer o1 the che, ~~ yard in accordance with the agreement between tl~,. la~uer and the Cardholder. Compare and Save with Staples•hrand products. 1 HANK YOU FOR SHOPPING AT S'fAPLESI 05700920113 88225 0$700820113288225 :tkki#*k9MMi.YY~k'k*kpkRM~,•kf/kkkkkkkkd~ The total charge on your card will include multiple transactions reflected on ttiis receipt. ~ d that was ease. Low prices. Every item. Every day. Store No:870 100 Noble Blvd Carlisle,.. PA 17013 (717) 243-1213 252525 XX 025 30570 Receipt #: 30570 MasterCard #: XXXXXXXXXXXX2259 05/03/11 11:26 Aty Description Amount 10 BW SS P@SS Lt... 0.90 Spoiled: 3 -0.27 0.63 SubTotal 0.63 STANDARD TAX 0,04 Total 0.67 The Cardholder agrees to pay the Issul:r of the charge card in accordance with the agreement between the Issuer and the Cardholder. Compare and Save with Staples-brand products. THANK YOU FOR SHOPPING AT STAPLES! `!iIkI~IpI~I~~I~IIINAI9AINkIIMI~q Mount Holly Springs MOUNT HOLLY SPRINGS, Pennsylvania 170659998 4134870065 -0097 01/30/2012 (800)275-8777 10:14:08 AM - Sales Receipt - Product Sale Unit Final Description Oty Price Price PROVIDENCE RI 02940 $5.25 Zone-3 Priority Mai l 2:80 oz. Expected Delivery: Wed 02/01/12 "" Insurance $7,05 Insurance Amount $500.00 Label #: VI138183442US Issue PVI: _ _$12 30 (Forever) 1 $45.00 0 ~ $45.0 Lady _ _ Liberty/Flag S ~,~ ~ ~~ Total ; ~,~ ;~ ~,o $57.30 Paid by: .9~"-G - o~0-/U Debit Card ,~ ~ $57.30 Account #: XXXXXXXXXXXX2259 Approval #; 308530 Transaction #: 670 23 903111565 Receipt#: 000798 "~ Save this receipt as evidence of insurance. For information regarding domestic insurance, visit our website at usps.com/insurance/postof~fice.htm Order stamps at usps.com/shop or call 1-800-Stamp24. Go to usps;com/ciicknship to print shipping labels wrth postage. For other information call 1-800-ASK-LISPS, rt K K rt % %YCYC It Y(1k Y(IK Y! 7r XYC 1t Yf Yf Y(Y(%7YYC'K Yf Y(1C Yf K IC Yf Yf 7C 1C fK Y(1K Yf K KKx'k%1Y Yi YfY(Y(YlYffk 7K yc 7K W ~K 7t Y(7C klY 7t'X ft X'1K k'7Y ;C fC 7C:Y W:t Yl YI:C Get your mail when and where you want it with a secure Post Ofifiice Box. Sign up for a bor online at usps.com/poboxes. rtXYCK*i1'~Yi Y(%K%YC:C;C%YC 1C K%%'K Y(%%'K Yf %.K Yf Yf 7C :t :K%%~Yt%YC K~t%'%rtK~~*YtYfY(~YlKYf y(%y(%%YfY(Y(Yf'k K1K YC %1C YC%KK1C Y(YlKit Bill#: 1000302164511 Clerk: 04 All sales final on stamps and postage Refunds for guaranteed services only Thank you for your business rtxxxx%KK7CY(YtYCYl1CXYtYfYCY(1tYCYlRK7CK7C7trt7CK7CX'%'~t7CK7Y:t7Y rtxxxrt\xXYt%Y(%YC%Y(%%%YC%YC%%%1C'K Y(Yf YC*Y(Y(%%YC YCYf 7K Y('X HELP US SERVE YOU BETTER Go to: https://postalexperience.corn/Pos TELL US ABU~I YOUR RECENT POSTAL Exi'ERIENCE YOUR OPINION COUNTS %Y(%7t%K%YC YC Y( iC%%%%%K %%Yc%%W~%'K Y(YC%%Y(%%%XYC %7r 7l Yt %%XXYlK%~K*%%7C%rtY(Y('X%rtK%%%Yl~'K%W%'X'1C Ir*~:t K;C M'X Y( .* that -was easy. Law prices. Every item, Every day. 100 Noble Blvd Carlisle, PA 1T013 (717) 243-1213: SALE 1519331 1001 16381 0870 03/22/11 12:19 QTY SKU PRICE 1 IN-STATE FAX'- FIR 381623 1.25 SUBTOTAL 1,25 Standard Tax 6.00 0,08 TOTAL $1.33 Cash 1.35 Cash Change 0.02 TOTAL Il"EMS 1 Compare and Sage with Staples-brand products, THANK YOU FOR SHOPPING AT STAPIES Shop online at wwl~~.staples.cOm The Weekiy Ad is always online! Simply click for Bonus Coupons and today's Top Deals. www.staples.com/weeklyatl GIINYII~IIIIWIIYI~IRIYIVIIMIIIIIpIIIVIII Customer Copy ` TRANSMISSION VERIFICATION REPDRT TIME 04/12f2011 11:57 NAME OFFICEMAX CARLISLE P FAX 7172434254 TEL 7172432764 SER.# 000G9N985425 DATE,TIME FAX N0.lNAME DURATIDN PAGE{S) RESULT MonF ~ ~~~~~ OfficeMax #746 650 E. HIGH ST. SUITE 600 CARLISLE, PA 17013 (717} 243-2764 Tell us about your shopping experience and enter to win 1 of 5 prizes. Visit www.officemax.com/store/survey to enter and to view the terms and contli ions of entering the survey. ~, _. 998100002423 $1.25 Fax Send Local 998100000689 $0.54 SS B&W LTR SS 24#Lsr/Clr ' 6 @ $0.09 SubTotal $1.79 Tax 6.000% $0.11 TOTAL $1.90 Cash ~ _ ,~~~ ~ _-$5_.00 Change $3.10 51449516 0746 00001 65415 3 04/12/11 00411104 12:07:59 PM ORDER ;BY ~Pat~ONE.1,~87,7-0FtFIC.EMAY~ IIII{{Illillll{Ililllllflllfllll({f11111l111111{II(I~Ililllllllll 074600165410001041211008 04112 11:56 18002508416 00:00:33 02 OK STANDARD ECM J~s~~~/~ i 9 Phone:J ~~ -?~ 7~S" ~~ ~ 7 650 E. High Street, Suite 600 Carlisle, PA 17013 Phone: 717-243-2764 Fax: 717-243-4254 Email: impress0746Qofficemax.com 0 0 fl 0 d °o 0 0 ~~~~ ~~~~ -1C $ ~ ~ ~ .. ~~~ fl.a c .Q~S~ via ~°~~ '" -as~g Cy ~~~ s~. ~_~o~ ~ _..~. ~~~~~ _~~ ~. °~ ~~~m ~m a ~~~~ ~_ ~~ 0 egg S.gg~ K ~ S ~ O .C ~ N ~' 3 G ~;~~ m~ m ~, ~ ~ 3 ~'~~ ~~~ ~ a .. g ~~ ~~ ~a K ~ '- 7 O. m~ ;i\ ~~ 1 m g~ 7 ~3 ~ ~ m m ~-^ ~go1 ~~~ ~~~ a ~o~ Q i f~i'^ ^-• ..-fir, ~ ~ c `o $ m mD+~~~~ 'D~Z~~ ~ ~ ~ c 3 m ~ ~ ~ e c •~ w d {yy i m d O ~ C ' ~' ~C v w ow~w~i~ "` $ O o i ~ °rn o > m --• .~ - 3/28 POS DEB 1333 03/26/11 393804 WAL-MART #2574 CARLISLE PA Card# 8459 3/28 POS DEB 1247 03/27/11 857632 SUNOCO 0956544101 CARLISLE PA Card# 2259 3/28 Check 67 AMERICAN EXPRESS 3/30 POS DEB 1546 03/30/11 056632 NST KMART 030062 CARLISLE PA Card# 2259 3/30 Bill paid-DISCOVER CARD SERVIC Confirmation number 330005274 3/31 PO5 DEB 1232 03/31/11 645749 WAL Wal-Mart Super 510011 37.80=' * 30':00- 150.21:- 21.49- 800.?90- 25.36- Date 4/11/11 I?age 4 Primary Account @XXXXXXXXXXX@297 Enclosures Donald E Mountz Linda M Mountz 645 Highland Avenue Mt Holly Springs PA 17065 Reward Checking @Xx;~;}~:~:KXXXXX@297 (Continued) Electronic Debits and Withdrawals Date Description Amount 4/01 CARLISLE ard# 84 9 DBT CRD 0200. WM EZPAY 66- ''- ' "80' PA 04/01/11 TX 769799 Card# 8459 4/01 ATM W/D 0916 04/01/11 008921 1 GIANT LANE CARLISLE PA Card# 2259 4/04 ATM Service Charge 4/04 ATM W/D 1839 04/02/11 405151 M&T Q20 NORTH BALT MT HOLLY SPRGPA Card# 8459 4/04 POS DEB 1738 04/04/11 327542 GIANT 6112 CARLISLE PA 4/06 DBT_CRD 0155 04/06/11 437705 WM~ EZPAY 66-834-2080 TX Car 4/07 POS DEB 1016 04/07/11 938601 THE HOME DEP OT CARLISLE PA Card# 8459 4/08 ATM Service Charge 4/08 ATM W/D 1722 04/08/11 880791 M&T 420 NORT H BALT MT HOLLY SPR GPA Card# 8459 4/11 POS DEB 1811 04/10/11 345759 GIANT 6112 47.4.00- 100:00- 2:.00- 200..00- 8.8,77- 474,00- 27-. 42'- `2:00- 200.A0- ~°~ 'fi'r ~y' a^~'~ Na~7' 9.90- Date 4/11/11 Page 5 Primary Account @XXXXXXXXXXX@297 https:/lwww.netteller.com/orrstown/hbStatementNoticeView.cfin 4/15/2011 Webmail Imbubbles3@embargmail.cort + Font Sze Your Payment Has Been Processed From : wmezpaynotice@wm.com Subject :Your Payment Has Been Processed To : Imbubbles3@embargmail.wm Reply 70 : " Payment Confirmation Mello don mountz MOUNrL, DON , (000092747243005). Fri, Apr 'e'2, 201103:33 PM A payment in the amount of $57.75 for your most recent Waste Management invoice was processed on 04/22/2011. This payment will be reflected on the payment method on file for your account (DISC). Please be aware it may take up to 5 business days'for your payment to be reflected on your Waste Management account. For questions regarding the payment process, please contact the Waste Management Senrlce Center at 866-834-2080 and select the option for WM ezPay. Please have this confirmation number - 9683882p0 -available when speaking with the customer service representative. For service or billing Issues, please contact your local Waste Management office at the number provided on your invoice. Thank you, Waste Management Service Center Use of WM ezPay constitutes acceptance of Waste Managements WM ezPay Terms and Conditions which may be reviewed at www.wm.com http://mdl4.embarq.synacor.com/zimbra/h/printmessage?id=126441 4/24/2011 }~fo~LV~R $3,239.92 I $65.00 ~~ ~~ ~ Payment Due Date May 18, 2011 1°nhlull'II''Ihil'ilr°n'r'nl°Iliil'llnihlunln'ill 00176120 01 AT 0.365 T3 23 SOS7 RA74~6 ~ DONALD MOUNTZ LINDA MOUNTZ 645 HIGHLAND AVE MT HOLLY SPGS PA~~/~fi5-1929 ~~~ Address, e-mail or telephone change? Go to vvww.Discovencom or print change in space above. Opening Date: March 24, 2011 - Closing`Date: Ap D450419864581336626490323992DOB0090DDD65DD I Discover More Card Account Summary = Cardmember since 1989 ~': Accourrt number ending in 6179 i.. Previous Balance $800.90 . Payments And Credits - 800.90 ~ Purchases + 3,2$9..2 ~_ Balance Transfers + 0.00 i ~ Cash Advances + 0.00 Fees Charged + 0.00 .Interest Charged + 0.00 New Balance $3,239.92 .~ See Interest Charge Calculation section Following hansactions for detailed APR information .' Credit line $12,000.00 ~•' CrediYLine Available -$8~703.CU • Cash Advance Credit Line $6,000.00 Cash Advance Credit Line Available $6,000.00 You maybe able to void Interest Charges, sae Additional ._ : Important Information For details. 0 A O ~""""""~ """"' Anniversary Month April Opening Cashback Bonus Balance $ 47.68 New Cashback Bonus This Period + 32.39 Redeemed This Period - 45.00 Cashback Bonus Balance $ 35.07 To team more, log in at www.Diseover.com ,, ........... .........o~ ..,,.....y ,.. ~.-.-_ Enter Amount Enclosed Below Please pay online at www.Discover.com or make check payable to Discover. Phone and intemetppaymentsrnust be made by S:OOpm ET for same day posting. Win Big in the Discoverm Everyday Give- away. Visit Discover.com/giveaway to see official rules and new prizes. PO BOX 71084 CHARLOTTE NC 28272-1084 tiilllrli,i.'uu(Ills(Irlyilii„lullydiill„tF'Iri°il"lu 23, 2011 page 1 of 3 Manage Your Account Online at vrww.Discover.com • Securely access statements and free online tools, pay bills online and frock and view all transactions simply and easily • Make your money worth moresM-find easy ways to earn _and.redeem_cash.rewards • NEWT Access your account securely through your mobile phone 3 Easy Ways to Contact Us 1. Access your account securely at www.Diseover.com 2. Call 1-800-DISCOVER (1-800.347-2683) Please have your Discover®card available. 3. Write to us at Discover, PO Box 30943, Salt Lake City, UT 84130 (Not a payment address) For payments, lease send to address on remittance or Discover, PO Bpox 6103, Carol Stream, IL 60197-6103 For TDD (Telecommunications Device for the Deaf) \ assistance, please call 1.800.347-7449. l' J((` J~ `^ ~. Transactions Payments and Credi-s Trans. Data Tvlar 31 Post Data Mar 3 T -PAYMENT-THANKYOU -800.90 Merchandise Mar 30 Mar 30 CA SOFTWAREt1CENSING 866.851-5273 FL $ 44.98 F5364786 Mar 30 Mar 30 CA SOFTWARELICENSING 866.8515273 FL 169.99 F5367289 Services pr b Apr 6 M EZPAY 866-8342080 TX 474.00 Apr 8 Apr 8 WM EZPAY 866-8342080 TX 570.00 Apr 11 Apr I 1 WM EZPAY 866-8342080 TX 274.00 12 Apr 12 WM EZPAY 866.834-2080 TX -r 422.OQ Apr 14 pr IPTION 888- AR I 18.95 Apr 15 Apr 15 WM EZPAY 866-8342080 TX -` ;~ Apr 20 Apr 20 WM EZPAY 866.834-2080 TX ._. Page 1 of 1 Manage your account online: KO ~ ~ ~ Click on My Kohl's Charge at Account Number ~ expect great things• www.kohts.com ACCOUNT SUMMARY PAYMENT INFORMATION Previous Balance $ 15.27 New Balance $ 7.20 Payments and Other Credits + 1 x•27 payment Due Date 5/10/2011 0 Purchases Minimum Payment Due 7.20 To Avoid Interest Charge Pay $ 7.20 + 0.00 Fees Interest Charges + 0.00 r New Balance $ 7,2p 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 Opening/Closing Date 03/13/2011 - 04!12/2011 and your APR may be increased up to the Penalty APR of 24,9%. Days In Billing Cycle 31 Minimum Payment Warning: If you make only the minimum Total Credit Line $1,500 payment each period, you will pay more in interest and it will take you Available Credit $1,492 longerto pay off your balance. Questions? If you would like information about credit counseling services, Click on My Kohl's Charge at Kohls.com or call 1-877-499-9467. Call Customer Service 1-800-564-5740 Sunday 10:00 AM to 11:00 PM (EST) Monday-Saturday 8:00 AM to 11:00 PM (EST) Automated service is available 24 hours. NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION ACCOUNT ACTIVITY Transaction Date Transaction Description Amount ...- .. ,::.... __. _ .: ~~m~rll~s. act~~3th~r ~lr~d~ts _. . _: 03123 PYMNT RECEIVED THANK YOU -$15.27 ._ _ ._ .._ 03!16 PURCHASE at the CARLISLE STORE ~~Q-- ~--' T ~01~ flL~~ili $7.20 Total fees charged in 2011 $0.00 Total interest charged in 2011 $0.00 INTEREST CHARGES Your Annual Percentage Rate (APR) is the annual interest rate on your account. ~~~'y_;aQ of Saiar~ a~~iraF #>ee~cen~~ gate ~AP~t~j 3a1~n~e ~raia~ert tc~ _ Isttereaf Gkearge"s ; .. ; . ;- ;; tttc~re t' Rate _ _ _o...:_ . _ . ._.... :- - Purchases 21.90 /o (V) $0.00 $0.00 (V) =Variable Rate ~ KOHL'S MVC SUMMARY Current Kohl's Purchases $22.47 LINDA M MOUNTZ To requalify for exclusive MVC privileges through February 2013 your Kohl's Charge purchases (Feb. 2011 •• Jan. 2012) must be $600. Your current Kohl's Charge purchases are $22.47. IMPORTANT NEWS Have you registered your Kohl's Charge account online? It's easy, simply go to Kohls.com and click on the My Kohl's Charge link. You'll have access to 12 months of statements and even be able to pay online free of charge. This Mother's Day celebrate Mom with a Kohl's Gift Card. Available in stores and online at Kohls.com, Kohl's Gift Cards are always the pertect fit. Don't forget, Mother's Day is May 8. {~E~sr-~~e~ww ~l~w~+,i'r ~~l~ir-+~ke+o- (M~RNSI•kN ~i z z N O N Ytxtr F f~~>5i 1 Previous Balance $0.00 Payments - $0.00 Other Credits - $0.00 PurchasesJDebits + $28.54 Past Due Amount $0.00 Fees Charged + 50.00 Interest Charged + 10.00 New Balance $28.54 Credit Limit $1,300.00 Credit Available $1,271.46 Statement Closing Date April 9, 2011 Days in Billing Cyde 25 Questions? Customer Service 1-000-942-0739 TDD/Hearing Impaired 1-000.365.0186 Bon-Ton Acrxwnt Statemenl Acxount Numb$~® From to Aorii 9.2011 Minimum Payment Due $25.00 Payment Due Date May 2, 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 $36.00 and your APRs may be incr~sed to the Penalty APR of 29.9996. Minarrum 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 no You will pay off And you will end additional charges the balance up paying an using this card shown on this estimated total and each month statement in of... you pay... about... Only the minimum 2 Months $29 Payment If you would like information about credit counseling services call in 1-866.569-2227. Payment Address: HSBC Retail Services, PO Box 17264, Baltimore MD, 21297-1264 Billing Inquiries: Retail Sen~ices, PO Box 15521, Wilmington DE, 19850-5521 Manage Your account online at vrww.hrsaccount.corUbonton As a rerrtinder. you may pay your credit card bill online or through our automated phone system for no tee. THANK YOU FOR OPENING YOUR ACCOUNT WITH US. YOUR APPROVED CREDIT LIMIT IS $1,300.00 THE BALANCE OF THIS ACCOUNT HAS BEEN TRANSFERRED TO YOUR NEW ACCOUNT NUMBER. Trans Date Post Date Description of Transaction Purchase Type Reference Number Amount or Credit 03!16!11 03l17N 1 PURCHASE, CARLISLE Reg - Punch PA 71107600100000800000 DTE 03162011 STR 0009 Reg -Punch REG 0109 TRN 03555 BETTER SEPARATES Reg -Punch BRIGGS-PETITES Reg -Punch Transaction Total Total Purchases For This Period Trans Date Post Date Description of Fees Description of Interest Charge y. ~/ IIiA l~ .pc~t3.64 Reference Number Amount Amount Detach end teWm bottom portion with your payment 211610 W 0265 108414 See reverse sltle for important IMormation ~IOU~S CL~4NINF Tit~PkSii OUT O~ ~i0U5E~ LINDA MOUNTZ ~~ `~~~ ~ ~ ~ w DATES ADDRESS HOURS TOTAL FOR DAY 4/1/2011 57 E South ST 10 AM to 3 PM 5.0 4/4/2011 57 E South ST 12 Noon 6 PM 6.0 4/6/2011 57 E South ST 10 AM to 3 PM 5.0 4/8/2011 57 E South ST 11 AM to 5 PM 6.0 4/11/2011 824 Petersburg Rd. 11 AM to 4 PM 5.0 4/12/2011 824 Petersburg Rd. 10 AM to 4 PM 6.0 4/13/2011 824 Petersburg Rd. 11 AM to 4 PM 5.0 4/15/2011 824 Petersburg Rd. 11 AM to 4 PM 6.0 4/19/2011 824 Petersburg Rd. 11 AM to 4 PM 6.0 4/20/2011 824 Petersburg Rd. 10 AM to 3 PM 5.0 4/21/2011 824 Petersburg Rd. 10 AM to 4 PM 6.0 4/22/2011 824 Petersburg Rd. 10 AM to 4 PM 6.0 4/25/2011 824 Petersburg Rd. 10 AM to 5 PM 7.0 4/26/2011 824 Petersburg Rd. 10 AM to 6 PM 6.0 TOTAL HOURS 80 K ~~ D fJ~b~ ~~~~~ CL£i4PIFfi OUT T~.~kSU ~tOM ~i0U5ES ~$~CC~ MOUATZ DATES ADDRESS HOURS TOTAL FOR DAY 4/2/2011 57 E South ST 11 AM to 4 PM 4/4/2011 57 E South ST 1 PM to 4 PM 4/5/2011 57 E South ST 11 AM to 4 PM 4/6/2011 57 E South ST 11 AM to 4 PM 4/9/2011 57 E South ST 10 AM to 3 PM 4/11/2011 824 Petersburg Rd. 10 AM to 3 PM 4/13/2011 824 Petersburg Rd. 11 AM to 3 PM 4/15/2011 $24 Petersburg Rd. 11 AM to 3 PM 4/19/2011 8~4 Petersburg Rd. 11 AM to 3 PM 5.0 3.0 5.0 5.0 5.0 5.0 4.0 4.0 4.0 TOTAL 40 K~l~! ~~ yl ~iC)~ '~ Z/(~U, ClC~ CLEAN TRASH OUT OF HOUSES RICH k r ~~'' ~2 `,1 DATES ADDRESS HOURS. TOTAL FOR DAY 4/2/2011 57 E South ST 11 AM to 4 PM 5.0 4/4/2011 57 E South ST 1 PM to 4 PM 3.0 4/5/2011 57 E South ST 11 AM to 4 PM 5.0 4/6/2011 57 E South ST 11 AM to 4 PM 5.0 4/7/2011 57 E South ST 10 AM to 4 PM 6.0 4/8/2011 57 E South ST 11 AM to 3 PM 4.0 4/9/2011 57 E South ST 10 AM to 3 PM 5.0 4/11/2011 824 Petersburg Rd. 10 AM to 3 PM 5.0 4/12/2011 824 Petersburg Rd. 10 AM to 3 PM 5.0 4/13/2011 824 Petersburg Rd. 11 AM to 3 PM 4.0 4/14/2011 824 Petersburg Rd. 11 AM to 3 PM 4.0 4/15/2011 824 Petersburg Rd. 11 AM to 3 PM 4.0 4/16/2011 824 Petersburg Rd. 10 AM to 4 PM 6.0 4/19/2011 824 Petersburg Rd. 11 AM to 3 PM 4.0 4/20/2011 824 Petersburg Rd. 11 AM to 3 PM 4.0 4/21/2011 824 Petersburg Rd. 11 AM to 3 PM 4.0 4/22/2011 824 Petersburg Rd. 11 AM to 3 PM 4.0 TOTAL HOURS 77 Y ~IU ~,izr'h(:~ ,~ 7 70. CJC~ ~.~- u- IRWIN, IRWIN & IRWIN 44 SOUTH HANOVER STREET • CARLISLE, PENNSYLVANIA 17013 v _ - _ (717) 249-2353 -_1_,5-30_.0------- - - - - -- -June ~' - . ,-- ------- -- -- 19 ---- I AS provided below after date, xnXe, the undersi ned, Xi~Xsi~iFe`4' g ~olCn'EU$+ ~I.Ky, promise to pay to the order of _ _ _ DOI~tA TAD E . MOUNTZ ~ ~ _ _1 , _5 3 0 _ o o_ _ _ _ ~, without offset, for value received, with/lnteie t xtKt~i ]s21t&t ~itX.XXXX°~~>}t~r~Ei14r3~. Pro- test waived. Any additional loans and advances granted to the undersigned AIrX~Xb~Xt75~itiK, with interest and charges, shall also be secui;ed hereby. AND FURTHER, >>~di $~)14~i11~lSa~l$, do hereby authorize and empower any attorney of any Court of record of Pennsylvania, or elsewhere, to appear for and to enter judgment against g~25i7C~XalfXlB,~diilif(iyKi me ~7ir&irXI~ 1 ~ the said sum of $~ ~~ 3 Q ~ n ~_ _ ith costs of suits, release of errors, without stay of execution and with _ _ _ _~;o added for collection fees; and ~eCl'b?C~+SUd7~18'?Calso hereby waive and release all re- lief from any and alt appraisement, stay or exemption laws of any state now in force or hereafter to be passed. This Note .~s- l:~ayab.le.__as a.greed• betwe~~ the_parti.es_ and_ will_ be due by the Estate of Frances S. Mourltz, if not sooner paid. 11ny payments on account will be marked on the back c:~f this Note . WIti1CSS: y,~ 1 /I' /~ ' j~ --i~~~>'_--1~.~_-,J'(/.~~lJs~~~----- _=s~rli3d_~.~Gi-~~ ---------fSEAL( FRANCES S. MOUNT - - ------------------------------------------- ----------------------------------------(SEAL( ------------------------------------------------ ----------------------------------------(SEAL ---- - ----- ---------- ------(SEAL 57 E. South Street, Carlisle, PA 17013 Address of Maker _ _ _ ~~~J~~ ~~ .w ~ .~•~ r 6. ~ ^~ ~ w CAREY, Notary Ilsle. Cumberland ~~~~ ~~ Yellow Breeches EMS Inc. Billing Office 11-119258 ~~, 6/19/2011 ~ $79.90 P.O. Box 726 '~ New Cumberland, PA 17070 QUESTIONS ABO' T THIS BILL? Phone: 877-214-6018 Espanol: 866-724-4114 Fax: 717-214-6020 Email: info@ait>Ibulanrebillingoffice.com Date of Service: 3/14/2011 15:07 Please visit our website to provide insurance or make payment, and Patient Name: MOUNTZ, FRANCES S. for additional payment options and frequent y asked questions: From: RESIDENCE To: Carlisle Regional Medical Center wwW.ambulancebillingofffice.com Medicare has paid theif~ portion of these charges.' The balancedue is your responsibility. Please remit payment for the remaining balance: Thank you. G. - S- • • • • s•- O - e •- 1 •• 3/14/11 BLS Emergency Transport A0429 1.0 650.00 650.00 3/14/11 Mileage A0425 6.2 13.00 80.60 3/14/11 Adjustment -Insurance -359.99 5/23/11 Adjustment -Insurance 28.88 5/23/11 Payment -51.58 5/23/11 Payment -268.01 Total 730.60 -331.11 -319.59 DETACH AND RETURN BOTTOM PORTION WITH YOUR PAYMENT. We accept payment in full by check* credit card or electronic Pleasd MakeCheck Payable To: check deduction. Please indicate your payment choicebelow Yellow Breeches EMS Inc. and fill in required information. If other arrangements are necessary, please call us at 877-214-6018. Y® ~ DISC©VER' Credit Card: ^ MASTERCARD _ - --- - --~I - ^ VISA ^ AMERICAN EXPRESS -~r --- - _ _ ^ DISCOVER i i ~ __ Card Number I ~' J; _--' - - Name un Cartl Ex OiraUOn Electronic Check Deduction Please send a voided check OR provide information below: •-~••~----•~~ [Sank Houtmg Number Checking Account Number Please make any corrections to address below. FRANCES S. MOUNTZ 57 E SOUTH ST CARLISLE, PA 17013 ~ rv FRANCES MOUNTZ • 6 WEST SHORE EMS -CARLISLE j,~sa~ IniseovER '' M°5te -a~d~ 205 GRANDVIEW AVE SUITE 211 __~_~ ~~ CAMP HILL, PA 17011-1708 ON REVERSE SIDE ® Pho ne #: (800) 367-0512 Federal Tax ID: 23-2463002 EVL•RGENCYME CALSERVICLS PATIENT NAME: FRANCS MOUNTZ INSURANCE: MEDICARE B ESTATE /,~ NONE CALL NUMBER: '~ ~rj~ ~ 2 DATE OF CALL: 03!14!2011 238 N BALTIMORE AVE= FROM: TO: CARLISLE REGIONAL MEDICAL CTR ACCOUNT SUMMARY FRANCES MOUNTZ 1216.59 57 E SOUTH ST TOTAL CHARGES: 00 0 CARLISLE, PA 17013 . PAYMENTS/ADJUSTMENTS: 59 1216 . PLEASE PAY THIS AMOUNT: .,~..+..... ~~rn_ nrocnvnrrnu enln RFTIII7NSTUB WITH PAYMENT DESCRIPTION OF CHARGE _.. QUANTITY UNIT PRICE AMOUNT ALS EMERGENCY LEVEL 2 A0999 1.0 1043.55 1043.55 20GTT TUBING A0394 1.0 14.72 14.72 ANGIOCATH (14-24) A0394 1.0 6.72 6.72 COMBO PADS ADULT A0392 1.0 80.00 80.00 EKG ELECTRODES (1) A0396 4.0 0.80 3.20 EPI 1 MG 1:10000 PFS A0394 1.0 7.12 7.12 ET TUBE HOLDER A0422 1.0 11.40 11.40 ETC02 (ADULT) FILTERLINE SET A0422 1.0 36.00 36.00 GLUCOSE BLOOD A0394 1.0 7.08 7.08 NSS 0.9% 1000cc Bag A0394 1.0 3.48 3.48 OP SITE A0394 1.0 1.92 1.92 SYRINGE CATH-TIP A0394 1.0 1.40 1.40 Total Charges 1216.59 DESCRIPTION OF PAYMENT RECEIPT PAYMENT DATE AMOUNT Denied by Medicare 03/30/2011 0.00 Total Credits 0.00 PLEASE PAY THIS AMOUNT -INVOICE DUE UPON RECEIPT -- $1216.59 e~-.~~ i-u~'AV LCC d'9~ AA _._ PATIENT NAME: MOUNTZ, FRANCES S CALL NUMBER: ~ ~ 05112 AMOUNT PAID: 08/16/2011 IMPORTANT MESSAGES: WE ARE AWARE THAT THE PATIENT IS DECEASED AND YOUR OFFICE IS HANDLING THE ESTATE. PLEASE FORWARD PAYMENT TO ABOVE ADDRESS AS SOON AS POSSIBLE. WEST SHORE EMS -CARLISLE 205 GRANDVIEW AVE SUITE 211 CAMP HILL„ PA 17011-1708 I„_ LyIYIIVSN J JJJIVYppQ]OCCUUUUUUb]-7U1~nbUUUUU Z~ti-ti8£0£ ~O eluelly ZtibI8Z xog 'O'd .ra;ua~ IeatpayN teuot8ag aisilie~ O.L .LI~I~WAdd'II~'IAi dS~'~'Id ~QIS ~S2I~l1~2I NO I~IOIZ~'Y~i2I031~II ~~N~'2IIISNI 2I0 SS~2IQQH d0 3JI~IdHO ~.LHQdf1 ~Sdd'Id 8S'6ZZ$ :aoueieg i I/tai/£0 :al~eQ aatniaS Z,LI~If10Y1t S S3~I~Id2Id :aureN tuarled 6S906fi6 ~#~~oaad LZb£-£ I OL I Fed d'ISI'I2I`v 7 .I.s xrnos ~ Lc zl.rrnoinl s s~ol~Ia FAOIOHOHtlO j0 3Hf11tlN01S 3400 dIZ SS3ki00tl L130lOHOdtlO 1Nf10WV 3WVN S:kl30lOHOHtlO 31V0 NOLLVklIdX3 #NIn H3HWf1N 5~H30lOHOkitlO ~ C~ M0~38 313'1dW00 a21V0 1103210 A8 JNIAVd dl .LI~idInIAb'd 2I[IOA H.LIM I~IOI.L2IOd 2Idnc10'I I~RIfI.Ld?I dSt/d'Id woa•awaa~sg.~ea•n~,tin~- .L~' AVQ/S2IH tiZ ?I~~AA ~' S~dQ L ~I~II'Il~iO ~~'d moiaq uuo~ atg ~u~ts pue Ino ~uiliB ~iq ssardxg u~eairauz~ .~o .~anoosrQ `ns~n `prealatsey~ q;im end ,iEUZ nod ~anoq~ iaquznu aut;~ aor~o 1no Ionluoo io i~ u[ ~Cnd o; st uoT;on s~yt pions of ~i~em ~ituo aqj, ~~~I.LOI~I'IdI~IId ~ sir{,I, '~oua~u uortoaiioo ieuoissa~oid ~ of paira3a.~ aq Iunoooe 1no~C;~er~; puauturooai Iiim am `seep (p I) ua; utrilim IIn3 u[ aaue~q aig aniaoar ;ou op am 3I i.LN~f1a1~II'IHQ ,~Isnouas sr Iunoaae .tno~ ;unoao~e anp Iced mo,S3o luaur,Ced io~ s;sanbar snornaid irto paiou~i aneq nod `Z.I.I~If10Y1t S S~~N~I3 reaQ 8S~6ZZ$ :aauel~g Z.LI~If10Y~t S S~~1`Id2I3 :aureN Iuat;ud 6S906ti6 ~#I~oaab' 0 £L i 8 S9 :Iuaura;~;S 09 i 6- i 8 £-008 :auorid i l OZ 9Z Nfll' A'Il~iO'lIdIAT I~RII1.Ld?I 2I~° Z088~0£Li8S9'Z8 T99£-SIOLI `~/d `alsTjieO b 3 1 N 3 J l V J t O 3 W 00 i b xog Od ~ ~~ I"I ~~" I~~II I'll I~I'~ ~'~') I'~~' ~'~~I'I'll I~I'III'~~'M~ ~~„/ 8I9SI xog 'O~d .~a;ua~ Iealpay~ Ieuo~ag alsgae~ Z2hE-E'COZ'C Vd 3lSI~~ld~ ~.S H.Lf10S 3 tS Z.LNf10W S S3~NV~ld OEL`CBS9 BEl-L006Z nu~ll~lllllnlll~lln~~llrrl~lrl~~llll~llllnl~lll~u~l~rll WELTMAN, WEINBERG ~ REIS Co., LPA ATTORNfiYS AT LAW Over 80 Years of Service. Brooklyn Hts zi 9 5ioo Chicago 3iz 76 Cincinn i3 7z3 zzoo ©eveland z16 b85 looo Columbus 6u{ zz8 7z7z 323 W. Lakeside Avenue, Suite 200 Cleveland, OH 44113-1009 (216) 685-1001 (800) 807-7796 (216) 363086 (faa) MON THURS SAM-6PM, TRI SAM-SPM, & SAT 8AM-12PM EST www.weltman.com lletmit zg836z6ioo 1Ft. Lauderdale 954 740 5zoo ~mve City 6u~ 8oi z6oo Philadelphia u5 5991500 Pittsburgh 41z 434 7955 June 8, 2011 To The Estate Of: FRANCES MOUNTZ 57 E SOUTH ST CARLISLE, PA 17013 Re: The Estate of FRANCES MOUNTZ Creditor: HOUSEHOLD RECOVERY SERVICES Client Account No.: xxxxxxxxxx6428 Balance: $2,459.57 File No.: 9238858 Deaz Personal Representative of the Estate: Please be advised that this law firm represents the above-captioned creditor with regazd to this account on which the Decedent was liable. Please accept our condolences during this difficult time. Our client has authorized us to accept 75% of the current balance as settlement of this account. Please be advised that you aze not personally liable for this debt. As the estate representative; please contact our office to let us know if the estate would be interested in taking advantage of this offer. Please also furnish to this office a copy of the death certificate, to the address or fax number at the top of this letter, for the Decedent. Our client may also consider an alternative resolution proposed by the estate regazding this matter. For your convenience, you may contact our office using the toll free number: 1-800-807-7796. Your attention to this matter is greatly appreciated. Sincerely, Weltman, Weinberg & Reis Co., L.P..A. Federal law requires us to advise you of the following information: This law firm is a debt collector attempting to collect this debt for our client and any information obtained will be used for that purpose. Unless you dispute the validity of this debt, or any portion thereof, within thirty (30) days of receipt of this letter, we will assume that the debt is valid. If you notify us in writing within the thirty (30) day period that the debt or any portion thereof is disputed, we will obtain verification of the debt and mail you a copy. We will also provide you with the name and address of the original creditor, if different from the current creditor upon your written request within the thirty (30) day period. 648/13372169 . STOKEN OPHTHALMOLOGY 338 ALEXANDER SPRING RD. CARLISLE, PA 17015 Return~rvice Requested 17769 FRANCES S MOUNTZ 57 EAST SOUTH STREET CARLISLE PA 17013-3427 12/30/11 ~ 4496 67..52~~ _MC VISA Disc Card~~ _ Sign STOKEN OPHTHALMOLOGY 338 ALEXANDER SPRING RI). CARLISLE, PA 17015 m ~' Security ~' Code _ Exp _/_ ''~'"` PAYMENT DUE ON 02/04/2012 FOR BILLING QUESTIONS CALL 249-6337. ''~''~'~ :c:~:~4c:'c:'c k4c:'c:c~c~c:'c4c~c:Y~c:'co'c:t:c:'c:'c~'c~c:'c x:c9cis:c:'i :: do o49c~c:ti:c:ti'.c:'c~cic4c~'c9c4c:'c;c:'c:'c:'c4c:~ :c :c :c :'::::': is is : d: is i; ~::: i; i::: is d: d; :: is isis;cis4c:'c 07/16/10 1 1 E OFFICE VISIT NEW LEVEL 3 99203 372.72 130.00 04/29/1.1 Medicare Payment 31.08 04/29/11 Accept Assign Adj. -31.40 67.52'' E-This bill applied against your deductible. You are responsible to pay us. DATE LAST PAID AMOUNT • - ~ • - . 1 • - • ~ • - 1 - . . . .. : . 00/00/00 0.00 0.00 0.00 0.00 0.00 67.52 0.00 0.00 67.52 MAKE STOKEN OPHTHALMOLOGY . , ., , CHECK 338 ALEXANDER SPRING RD. PAVaeLETO: CARLISLE, PA 17015 67.52" Ph:(717)-249-6337 PAT~~ 1-FRANCES S MOUNTZ PRV~~ 1-STOKEN, DREW J., M.D. Acct~~: 4496 Date: 12/30/11 Page 1 of 1 6-20-2010 i' Opal M Mason 10 E Front St Apt. A Shirtemanstown, Pa. 17011 Frances Mounrz 57 E. South Street Carlisle, Pa. 17013 `~ ~~ /'_, ~3 Received from Opal Mason personal loan check #5549 for $2,000.00 dated June 20, 2010 .I Frances Mountz promise to pay the sum $2,000.00 without ~: ~r~_>:_ s _ __ _, ;; per month for 10 months Starting July 3, 2010. "" -~ Upon default I Frances Mountz do authorize and empower any attorney of court of records of Pennsylvania or elsewhere to appear forme and to enter Judgment against my Estate for the sum of $2,000.00 ,-~~Opal M Mason \ Frances Mountz `. _ ~~ " ~ \'~ \~ ~~ Understanding what's important® High Street Carlisle Office Today's Date: 03/29/2011 Time r 09:22 AM Safe Deposit Fees General Ledger Credit GL Account Number Posting Cost Center Document Number Business Date: 03/29/2011 $150.00 30043190884319 4319 088431980 4319 /07 ~lAR 2 9 43i M r' `~ ~ ``s C Ztt S Understanding what's important High Street Carlisle Office If you have any questions, please call our Telephone Bankinp.Center at 1-800-724-2440 -~~- Today s Date: Business Gate: 03/29/2011 03/29/2011 Time: 09:22 AM Safe Deposit Payment $39.00 Box # 0000338 4319 / 07 6 M Thanks for visiting us today. We are happy to assist you! ~' -~meowners policy bill le!(rey pant 761 E High `~ Carlisle, PA 17013 lu'llllhl'II'III'In'I'I'I'IIIn1411111'll'I'hllrlulrlllh FRANCES MOUNTZ 57 E SOUTH ST CARLISLE PA 17013-3427 ~~ AI'a S a You're in good Information as of September 2, 2010 Policyholder Page 1 of 3 Frances Mountz Polic number 918191434 Your policy provided by Allstate Property and Casualty Ins Co Covered property 57 EAST SOUTH ST CARLISLE PA 17013.3427 To pay in full - $378.73 Policy period Effective August 23, 2010 through Minimum premium amount due 34.43 August 23, 201112:01 a.m. standard time Installment fee 3.50 Your Allstate agency is Minimum amount due by September 23, 2010 $37.93 C Jeffrey Conant (717) 258-4554 You may pay the minimum, or any amount up to the remaining $378.73 premium amount. !f you pay less than $378.73, we will charge the $3.50 installment fee. We will provide an updated schedule of _.., payment on your nextbill. Please seethe back of this bill for payment schedule and history. ~`-J`--"~`~ Ways to pay Automatic payment plans Your payments can be automatically deducted from your bank account, credit, or branded debit card. You can choose to pay monthly or all at once. Visit our online Customer Care Center or contact your Allstate agent to apply. Online banking Be sure to enter 9181914340823 as the account number and P.O. Box 3575 Akron, OH 44309-3575 as the payment address. Automated phone service (1-800.901-1732) or www.allstate.com Pay using your bank account, credit or branded debit card. Register to view your bill online at our Customer Care Center at www.allstate.com. See the "What you should know" section in this bill far additional payment information. Additional options You can also pay your bill by mail or at your Allstate agent's office. Return this portion with your payment °8'23 To pay in full $378.73 Minimum amount due by September 23, 2010 Amount enclosed Make check or money order payable to Allstate Property and Casualty Ins Co. Please include your policy number. Allow /ive days /or delivery. s2oss Policy number 918191434 Do not write addressor policy 1 1 1 1 1 11'III"I I I I II I' I I' I I I' I"I I I I' I1' I l l l l I' 1' I I"111 1.11111111 change requests on this retarn portion, contact your agency. ALLSTATE PROPERTY AND CASUALTY INS CO PO BOX 3576 AKRON OH 44309-3576 tiy~ /065070037000000091819143408238000379370000000000378737/ Say goodbye to clutter with Allstate Paperless Solutions. Lots of option's! Enroll in eBill today. allstate.com/ebill Detach bottom portion here ~~ Allstatem You're in good hands. $37.93 Policyholder Frances Mountz GARY EICHELBERGER CHAIRMAN RICHARD ROVEGNO VICE CHAIRMAN DENNIS MARION CHIEF OPERATIONS OFFICER EDWARD SCHORPP SOLICITOR BARBARAB.CRO55 TAX CLAIM BUREAU OF CUMBERLAND COUNTY STEPHEN D,TILEY SECRETARY One Courthouse Square, Room 106, Carlisle, PA 17013-3389 ASSISTANT SOLICITOR (717)240-6366 Printed: 5/02/11 C Receipt No.: 81481 12:57:10 Receipt Date: 5/02/2011 Control Number: 40-001375 **** RECEIPT **** Page: 1 Property Description: MOUNTZ, LEO F & FRANCES S 824 PETERSBURG ROAD CARLISLE PA 17015 Map No: 40-11-0286-045 Tax Year Description 2009 CTY-SOUTH MIDDLETON 2009 CLB-SOUTH MIDDLETON 2009 FIRE-SOUTH MIDDLETON 2009 SCH-SOUTH MIDDLETON 2010 BUREAU COSTS LAND APPROX 2 ACRES Residential (Under 10 Acres) Situs Information: - 824 PETERSBURG ROAD & AUTUMN DRIVE SOUTH MIDDLETON TOWNSHIP Penalty & Face Interest Costs Total 208.00 18.31 15.61 3.48 19.07 4.15 986.65 217.07 Received For Year Of 2009 .66 Received For Year Of 2010 226.31 19.09 23:22 1203:72 $1472:%34 .66 $.66 Tendered > Received By > Paid By > Remarks > CASH JC MOUNTZ, LEO F & FRANCES S * Continued Total Received $1473..00 _~~~ ,~ J ,~~1~~ "~k~ ~' G GARY EICHELBERGER CHAIRMAN RICHARD ROVEGNO VICE CHAIRMAN DENNIS MARION ' CHIEF OPERATIONS OFFICER EDWARD SCHORPP SOLICITOR BARBARAB.CROSS TAX CLAIM BUREAU OF CUMBERLAND COUNTY STEPHEN D,TILEY SECRETARY One Courthouse Square, Room 106, Carlisle, PA 17013-3389 ASSISTANT SOLICITOR (717) 240-6366 Printed: 5/02/11 C Receipt No.: 81480 12:56:50 Receipt Date: 5/02/2Q11 Control Number: 3-000321 **** RECEIPT **** Page: ~ 1 Property Description: MOUNTZ, FRANCES S 57 EAST SOUTH STREET CARLISLE PA 17013 LAND LESS THAN 1 ACRE Residential (Under 10 Acres) Situs Information: 57 E SOUTH STREET Map No: 03-21-0320-155 CARLISLE BOROUGH Tax Penalty & Year Description Face Interest Costs Total 2009 CTY-CARLSSLE BORO 2 2009 CLB-CARLISLE BORO 2 2009 MUN-CARLSSLE BORO 2 2009 SCH-CARLISLE AREA 129.96 2.91 132.87 9.86 2.11 11.`97 168.69 37.19 205.88 653.37 156.89 810.26 Received For Year Of 2009 $1160.98 . 02 ::02 Received For Year Of 2010 $`'02 2010 BUREAU COSTS Tendered > Received By > Paid By > Remarks > Total Received $1161.:00 * Continued * ~ ~ / l ~ ~~ ~~~ ~-- ~ ~ ~ ,~~ ~'~ CASH JC MOUNTZ, FRANCES S V V v `- '--' V y ~ V V po ~p ~O C O N N ~-- N ~ O n- N C O ~ N N O w ~ O t` ~ N oo v A - .-. O o0 N N N N N N N N N N N N O O O O O O O O O O O O O O O O O O O ~--' ^' '--' ^' '-' b b~ ~v a ~ b ~ b ~~ c~ b a p ~ Z ~ ~ co ~ z ~ Z ~ ~ m Z ~. ~ o ~ 0 0 0 ~ N U U ~ ~ v. w .r oo ~ w ~ ~ ~ d d d fD (D ~ a, a, ~ ~ ~ a, 0 0 0 ~ ~ o ~ o ~ ~ o 0 C \O O ~O cn ~O \O O ~ ~A O ~O o ~ o .A o ~ a o ~ ~ o ~ 0 0 0 0 0 0 ~ o ° 0 0 0 N ~ O O O O O O A v i O -A ~ to ? N N _ t1~ N 00 U O O O cn A O N O U Oo O O O O O oo D\ O O oo N O O O O O O O O ~-' O O ~O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O U O O O O D\ O O o ~o O o ~ ~ o 0 0 ~ o ~o O ~O O O lA ~O O O O A O ~O I O O O O O O O O O O O O O O C O O O O O O O O O O O C O O O O O O O O O ~~~ ~ n C "Rt A '~ w m b7 ~. 0 ~ i A N ~j ~ d ~ O u~ ~ `~ ~~ 7 _ 3 a ~ r. y M ui ~ f9 t -~, f6 -~ 7 ^' .+ 'n ~ lD ~ ~~ O C `r ~ 'a' G `? ' a d . ~Y ~ P~ ry °' C '.~ MTI ~ d w „y. ~/~J -t -t O ~--+ w .. ~ ~. ~ ~ o ~~ ,' ~no ` a ~ ~ ~ ~ ~ '-' v ~~f ~- m > PJ ~ ~~ < ~ W o O ~ O O W N O co ~ ~ "~ '-} h n " N O ~ a ;y O O O ~ ~ ~ . S. W ~ b ~ ~ O ;z N o d W J N ~ K ~ k .y rt A ~ ~ ~ S ' ~' fD a y ^~ A A z e B Q A - a "' 0 C 0 O U o 0 A O p O t! CC ~ 5 ~ ... fi ry ~ R ~ f7 O ~ r.l O J ~ W z O O C~ a z o a z o ~ 0 0 ~~ ~v a °z' o c d H C A ~ H ~~~yy H •• W .• ~ w 7 m C!i 7J O D\ J p~p~~ O [l7 p O ~ N OAO O ~+ yy ~' r~ ~ O .-. ~~, M A C O d y 0 0 0 Soverei~~i July 15, 2011 Frances S Mountz 645 Highland Ave. Mt Holly Springs PA 17065 RE: Account Number ending in: 6317 Dear Frances S Mountz: On July 15, 2011, Sovereign Bank exercised its right to offset and transferred $122.81 from your CHECKING account #X~C~~XX0893 to your loan XXXX~~X6317 to cure a payment delinquency. If you have any questions regarding this transaction, please call 1-800-207-8767, Monday to Thursday, 8 AM to 8 PM, Friday, 8 AM to 5 PM, or Saturday, 8 AM to 12 PM. Sincerely, Consumer Collections Mailcode: 10-421-MC3 P.O. Box 16255 Reading, PA 19612 Member FDIC Sovereign Bank and_its logo are registered trademarla of Sovereign Bads or its affiliates or subsidiaries m the Udted States and other cocmtries COL / RSMORI . SaJ53?65969-OCD Santander Strong- Be r an ing means giving you more. Sovereign I t ~ Checking, Savings, Loans one o~~f the"World's Safest Banks° 1.877.SOV.BANK sovereignbank.com CUSTOMER RECEIPT 'EMENT OF ACCOUNT ............................................................................................................................................................................................................................................... r1 6819066317 'From: 03/15/2011 _ Through: 04/ 14/201 1 it Period: 31 24,855.89 ~ ~ .~,~ ~ . ~ nt: 25 , 000.00 LC F'a`j Katie J,~!..: , 1 i. 11 ~ ~_ i 1 ~ ~ CiC i i~ 313.99 Aft 681'~G66~~1I Sara ~J25'J jJti"e° - F'iMti $~- .24 ant: 377.24 I te: 05 / 1 1 / 201 1 Q _ BR0008 7/70 Sovereign Bank is a Member FDIC Get some of our best rates on our new unsecured Personal L i-nes of Credi t and Loans°and -have greater f l exi b"i 1 tty"and - - - better financial control over your borrowing needs. Use your line or loan for just about anything: vacations, educational expenses, medical bills, home improvements and more! Plus, applying is easy and you can borrow up to $25,000. To apply or find out more, call 1.877.4.SOV.LOAN (1.877.476.8562) or visit sovereignbank.com. Principal Due $103.68 Beginning Balance $24,766.78 INTEREST CHARGE Due $89.11 Advances $0.00 Past Due Amount $184.45___ Payment Received $0.00 Late Char es Due $0.00 ~ INTEREST CHARGE $89.11 Total Minimum Payment Due $377.24 Ending Balance $24,855.89 RY OF VARIABLE RATE REVOLVING ACCOUNT BALANCE Periodic Rate From 03/15/2011 Periodic INTEREST CHARGE Periodic Rate Through 04/14/2011 ANNUAL PERCENTAGE RATE 4••:2'500 Daily Periodic Rate* .0001164383 Balance Subject to Interest Rate $24,686.01 Ending Balance $24,855.89 * The daily periodic rate may vary. TRANSACTION ACTIVITY SINCE YOUR LAST STATEMENT Posting. Date Effective Date Activity Description Amount Balance 03/15/2011 BEGINNING PRINCIPAL 24,686.01 04/14/2011 ENDING PRINCIPAL 24,686.01 **********************************************s** FEES ********************z*s************************x*** TOTAL FEES THIS PERIOD .00 ********s************************s********* INTEREST CHARGED ********s**s********s************x*********** TOTAL INTEREST THIS PERIOD 89.11 '~ ~~ %~~ *********************x******************2011 TOTALS YEAR-TD-DATE********s************************* **** TOTAL FEES CHARGED .00 G o.., ,...E.....,oEO ~,,~r'~ TOTAL INTEREST CHARGED 350.09 ~~^ ~ ., S®~er~i~ August: 12, 2011 Frances S Mountz 645 Highland Ave. Mt Holly Spgs PA 17065-1929 RE: Account Number ending; in: 6317 Dear Frances S Mountz: On August 12, 2011, Sovereign Bank exercised its right to offset and transferred $211.17 from your CHECKING account #XXX~G~X0893 to your loan ~~X~~XX6317 to cure a payment delinquency. If you have any questions regarding this transaction, please call 1-800-207-8767, Monday to Tlmrsday, 8 AM to 8 PM, Friday, 8 AM to 5 PM, or Saturday, 8 AM to 12 PM. Sincerely, Consumer Collections Mailcode: 10-421-MC3 P.O. Box 16255 Reading, PA 19612 Member FDTC. Sovereign Bank and its logo are registered trademarks of Sovereign Bank or its affiliates or subsidiaries N the Ututed States and other countries COL / RSMORT • S®~re~°~~~~ September 16, 2011 Frances S Mountz 645 Highland Ave. Mt Holly Spgs PA 17065-1929 Dear Frances S Mountz: RE: Account Number ending in: 6317 On September 16, 2011, Sovereign Bank exercised its right to offset and transferred $153.09 from your CHECKING account #XXX~~XX0893 to your loan XXX33~XX6317 to cure a payment delinquency. If you have any questions regarding this transaction, please call 1-800-207-8767, Monday to Thursday, 8 AM to 8 PM, Friday, 8 AM to 5 PM, or Saturday, 8 AM to 12 PM. Sincerely, Consumer Collections Mailcode: 10-421-MC3 P.O. Box 16255 Reading, PA 19612 Member FDIC. Sovereign Bank and its logo aze registered trademarks of Sovereign Bank or its at$lia[es or subsidiaries in the Uni[ed States and other comrcries COL /RSMORF S®~erei~i September 16, 2011 Frances S Mountz 645 Highland Ave. Mt Holly Spgs PA 17065-1929 Dear Frances S Mountz: RE: Account Number ending in: 6317 On September 16, 2011, Sovereign Bank exercised its right to offset and transferred $35.23 from your SAV STMT account #~OC~~~X3142 to your loan XXX~O~X6317 to cure a payment delinquency. If you have any questions regarding this transaction, please call 1-800-207-8767, Monday to Thursday, 8 AM to 8 PM, Friday, 8 AM to 5 PM, or Saturday, 8 AM to 12 PM. Sincerely, Consumer Collections Mailcode: 10-421-MC3 P.O. Box 16255 Reading, PA 19612 Member FDIC. Sovereign Ba»k and its logo are registered tademarks of Sovereign Bank or its affiliates or subsidiaries in the Uoited States and other countries COL / RSMORF BARBARA B CROSS DENNI5 MARION CHAIRMAN CHIEF OPERATIONS OFFICER '' RD SCHORPP JIM HERTZLER VICE CHAIRMAN GARYEICHELBERGER TAX CLAIM BUREAU OF CUMBERLAND COUNTY SECRETARY One Courthouse Square, Room 106, Carlisle, PA 17013-3389 (717) 240-6366 Printed: 3/12/12 C 12:02:45 Control Number: 40-001375 MOUNTZ, LEO F & FRANCES S 645 HIGHLAND AVENUE MOUNT HOLLY SPRGS PA 17065 Map No: 40-11-0286-045 Tax Year Description EDWA SOLICITOR STEPHEN D.TILEY ASSISTANT SOLICITOR MELISSA F. MIXELL T~4X CLAIM DIRECTOR Receipt No.: 86926 Receipt Date: 3/12/2012 **** RECEIPT **** Page: 1 Property Description: LAND APPROX 2 ACRES Residential (Under 10 Acres) Situs Information: 824. PETERSBURG ROAD & AUTUMN DRIVE SOUTH MIDDLETON TOWNSHIP Penalty & Face Interest Costs Total 2010 CTY-SOUTH MIDDLETON 2010 CLB-SOUTH MIDDLETON 2010 FIRE-SOUTH MIDDLETON 2010 SCH-SOUTH MIDDLETON 2010 BUREAU COSTS 207.99 42.64 250.63 15.61 3.24 18.85 19.07 3.87 22.94 1001.45 205.29 15.34 1206.74 27.55 27.55 Tendered > CASH Received By > JC Paid By > MOUNTZ, LEO F & FRANCES S Remarks > Received For Year Of 2010 $1542.05 Total Received $1542.05 Balance Due As Of 3/12/2012 Claim Year: 2011 2350.15 Claim Balance: 2350.15 Receipt Number: 86926 Total Received: $1542.05 „B•ARBARA B CROSS ` CHAIRMAN JlM HERTZLER VICE CHAIRMAN GARY EICHELBERGER SECRETARY TAX CLAfM BUREAU OF CUMBERLAND COUNTY One Courthouse Square, Room 106, Carlisle, PA 17013-3389 (717) 240-6366 Printed: 3/12/12 C 12:02:51 Control Number: 3-000321 MOUNTZ, FRANCES S 645 HIGHLAND AVENUE MOUNT HOLLY SPRGS PA 17065 Map No: 03-21-0320-155 Tax Year Description 2010 CTY-CARLSILE BORO 2 2010 CLB-CARLSILE BORO 2 2010 MUN-CARLSILE BORO 2 2010 SCH-CARLISLE AREA 2010 BUREAU COSTS Tendered > Received By > Paid By > Remarks > **** RECEIPT **** DENNIS MARION CHIEF OPERATIONS OFFICER EDWARD SCHORPP SOLICITOR STEPHEN D.TILEY ASSISTANT SOLICITOR MELISSA F. MIXELL TAX CLAIM DIRECTOR Receipt No.: 86927 Receipt Date: 3/12/2012 Page: 1 Property Description: LAND LESS THAN 1 ACRE Residential (Under 10 Acres) Situs Information: 57 E SOUTH STREET CARLISLE BOROUGH Penalty & Face Tnterest Costs 131.39 27.00 9.86 1.97 195.53 40.13 682.36 139.92 23.53 Received For Year Of 2010 CASH JC MOUNTZ, FRANCES S Receipt Number: 86927 Total Received Total 158.39 11.83 235.66 822.28 23.53 $1251.69 $1251.69 Balance Due As Of 3/12f2012 Claim Year: 2011 1160.76 Claim Balance: 1160.76 Total Received: $1251.69