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Home My WebLink About07-23-12ti • J 1505610140 REV-1500 ~` ~°'-'°~ PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po sox 2sosol INHERITANCE TAX RETURN Harrisbur PA 17128-0601 RESIDENT DECEDENT 2 1 1 1 0 7 7 5 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 0 7 0 2 2 0 1 1 0 1 0 5 1 9 3 0 Decedent's Last Name Suffix Decedent's First Name MI T H O M A S B E T T Y ~ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death 4. Limited Estate prior to 12-13-82) 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) ^X 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT -THIS 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 REGISTER OF WILLS USE O~L~r First line of address n `' ,~, ' c. ~ C 7 I R W I N & M c K N I G H T p C =:r"''=2 r ~ ~'^;_:? Second line of address _ ~- ~-' ; ' r-~-; Ca ~~ 6 0 W E S T P O M F R E T S T R E E T ~ -~ ~' ~fi' ~' City or Post Office c ~ _ , ~ ` State ZIP Code DA E ED c.~ i ~ rn C A R L I S L E P A 1 7 -~`~ D ~- ~n 0 1 3 i Correspondent's a-mail address: Under penalties of perjury, I deGare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true n'eCt and complete. Declarati of preparer other than the personal representative is based on all information of which preparer has any knowledge. SI RE ERSON RESPON LE FOR FILING RETURN DATE A DRESS ~~ ~" 412 FAIRWAY DRIVE MECHANICSBURG PA 17055 SIGNATURE OF PRE A R OTHER THA REPRE TATIVE DATE ADDRESS '" ~ ~ ~'' 60 WEST POMF STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 15D5610140 1505610240 REV-1500 EX Decedent's Social Security Number Decedent's Name BETTY L• T H O M A S RECAPITULATION 1 3 5 0 0 0. 0 0 ........................................... 1. Real Estate (Schedule A) 1 2. Stocks and Bonds (Schedule B) ................................. .... . 2~ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .... . 3. 4. Mortgages and Notes Receivable (Schedule D) .................... ..... . 4. 7 3 6 0 . 4 7 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E). ..... . 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested . ..... . 6. 7. Inter-Vivos Transfers & Miscellaneous N n-Probate Property ~ 3 9 4 1 5 9 3 Separate Billing Requested . (Schedule G) ..... . 7. . 8. Total Gross Assets (total Lines 1 through 7) ..................... .... .. 8. 1 8 1 7 7 6 . 4 0 9. Funeral Expenses and Administrative Costs (Schedule H) ............ .... .. 9. 2 4 3 0 0 ' ~ 7 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ....... .... .. 10. 7 5 ~ 6 ' 2 7 11. Total Deductions (total Lines 9 and 10) ......................... .... .. 11. 3 1 8 7 7 . 0 4 12. Net Value of Estate (Line 8 minus Line 11) ...................... .... .. 12• 1 4 9 8 9 9 . 3 6 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ................ .... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ................ .... .. 14. 1 4 9 8 9 9 . 3 6 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 0 0 0 15 0. 0 0 (a)(1.2) x.o _ . 16. Amount of Line 14 taxable 1 4 9 8 9 9. 3 6 16 6 7 4 5. 4 7 at lineal rate x .045 . 17. Amount of Line 14 taxable 0 0 0 17 0 • 0 0 at sibling rate X .12 . 18. Amount of Line 14 taxable 0 0 0 18 0 • 0 0 at collateral rate X .15 . 19 6 7 4 5 • 4 ~ 19. TAX DUE ............................................... ..... . .. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OV ERPAYMENT ^ Side 2 1505610240 1505610240 J Continuation of REV-1500 Inheritance Tax Return Resident Decedent BETTY L. THOMAS 21 11 0775 Decedent's Name Page 1 File Number Correspondents Name R O G E R B I R W I N, Daytime Telephone Number 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 & M c K N I G H T P C. Second line of address 6 0 W E S T P O M F R E T S T R E E T City or Post Office State ZIP Code C A R L I S L E 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 true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledoe. si~rv,v I URE OF PERSON RESPONSIBLE FOR FILING RETURf~L., Jl~~~~~~- DATE -7 °Tf~JP1{7~ilJr / ~ l ~ l ADDRESS 62 SUNSET DRIVE MECHANICSBURG PA 17050 REV-150Q EX Page 3 Decedent's Complete Address: File Number 21 11 0775 DECEDENT'S NAME BETTY L. THOMAS -- ----- - STREETADDRESS ---"-" ---- -- 9 HELEN AVENUE CITY _ _ STATE -- - -- - -- ZIP MECHANICSBURG PA 17055 Tax Payments and Credits: ~ • Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 7,200.00 B. Discount 3. Interest 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. (1) 7,228.19 Total Credits (A +g) (2) 7,200.00 (3) (4) 0.00 (5) 28.19 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; ......................... ...... ^ 0 c. retain a reversionary interest; or .......................................................................................... ...... ^ X^ d. receive the promise for life of either payments, benefits or care? ................................................. ...... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................. ..... ^ 0 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? ............................................................................................. ..... 0 ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ___~~ or dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after 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 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 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling 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-1502 EX+ (01-10) < pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: BETTY L. THOMAS 21 11 0775 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. 9 HELEN AVENUE, MECHANICSBURG, PENNSYLVANIA 135,000.00 TOTAL (Also enter on Line 1, Recapitulation.) I $ 1 If more space is needed, use addrbonal sheets of paper of the same size. REV-1505 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: BETTY L. THOMAS 21 11 0775 Include the proceeds of litigation and the date the pnx:eeds 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. PERSONAL PROPERTY -APPRAISAL ATTACHED 710.00 2. WELLS FARGO -SAVINGS ACCOUNT ENDING 8109 1,292.58 3. ~ M&T BANK -CHECKING ACCOUNT #2670030440 4 722 89 4. (CASH TOTAL (Also enter on Line 5 Recapitulation) I $ If more space is needed, insert additional sheets of paper of the same size 635.00 7, 360.47 REV-1510 EX+ (08-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER BETTY L. THOMAS 21 11 0775 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 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 pF naPL~caeLE) TAXABLE VALUE 1. BANKERS LIFE AND CASUALTY COMPANY 3,882.93 100.00 3,882.93 ANNUITY CONTRACT #7896836 2. BANKERS LIFE AND CASUALTY COMPANY 11,482.92 100.00 11 482.92 ANNUITY CONTRACT #7946458 , 3. BANKERS LIFE AND CASUALTY COMPANY 13,154.76 100.00 13 154.76 ANNUITY CONTRACT #7753046 , 4. BANKERS LIFE AND CASUALTY COMPANY 10,895.32 100.00 10 895.32 ANNUITY CONTRACT #7822560 , BENEFICIARIES: ROBERT L. THOMAS CHARLES E. THOMAS KATHY J. GARTNER JANICE M. DeTRAGLIA _ TOTAL (Also enter on Line 7 Recapitulation) ~ $ 39 415 93 If more space Is needed, use additional sheets of paper of the same size. REV-151.1 EX+ (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER BETTY L. THOMAS 21 11 0775 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. EWING BROTHERS FUNERAL HOME 5,176.81 2. FUNERAL LUNCHEON 275.16 B. 1 2. 3. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: AttomeyFees: IRWIN & McKNIGHT, P.C. Family Exemption: (If decedents address is not the same as claimants, attach explanation.) Claimant 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Street Address City State ZIP Relationship of Claimant to Decedent Probate Fees: REGISTER OF WILLS Accountant Fees: Tax ReturnPreparerFees: PATRICIAA. ROSENDALE, CPA FIDUCIARY TAX PREPARATION REGISTER OF WILLS -FILING FEE THE SENTINEL -ESTATE NOTICE S.W. BARRETT REAL ESTATE -APPRAISAL ON REAL ESTATE CUMBERLAND LAW JOURNAL -ESTATE NOTICE CHARLES THOMAS -REIMBURSE OF MISCELLANEOUS EXPENSE ROY GOTTSHALL -APPRAISAL ON PERSONAL PROPERTY DETRAGLIA EXCAVATING, INC. -SEPTIC SYSTEM BACKLIGHT FOR WELL CLOSING COSTS FROM SALE OF REAL ESTATE 7,900.00 311.50 375.00 30.00 200.16 350.00 75.00 128.29 55.00 5,995.00 750.00 2,678.85 TOTAL (Also enter on Line 9, Recapitulation) I $ If more space is needed, use additional sheets of paper of the same size. REV-159•L EX+ (12-08) Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, Ot LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER BETTY L. THOMAS 21 11 0775 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. VERIZON -TELEPHONE 140.23 2. MET-ED -ELECTRIC 356.51 3. BANK OF AMERICA -CREDIT CARD 1,700.14 4. CARLISLE REGIONAL MEDICAL CENTER -MEDICAL 100.00 5. MARY A. MURRAY, TAX COLLECTOR -REAL ESTATE TAXES 1,672.08 6. SHIPLEY ENERGY -FUEL OIL 240.54 7. PENN WASTE, INC. -TRASH 95.70 8. FOREST PARK HEALTH CENTER -NURSING 2,012.04 9. SUSQUEHANNA OIL CO. -FUEL OIL 779 70 10. STATE FARM INSURANCE -HOMEOWNERS INSURANCE 479.33 TOTAL (Also enter on Line 10, Recapitulation) I $ 7 576 27 If more space Is needed, Insert addltlonal sheets of the same size. REV-151:~EX+ (01-10) , pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: BETTY L. THOMAS ~, ., ~ ~»~ V I I J 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. ROBERT L. THOMAS Lineal 29,979 87 2 SUNSET DRIVE 1/5TH REMAINDER MECHANICSBURG, PA 17050 2. CHARLES E. THOMAS Lineal 29,979 87 412 FAIRWAY DRIVE 1/5TH REMAINDER MECHANICSBURG, PA 17055 3. KATHY J. GARTNER Lineal 29 979 87 163 HICKORY ROAD 1/5TH REMAINDER DILLSBURG, PA 17019 4. JANICE M. DeTRAGLIA Lineal 29 979 87 281 TEXACO ROAD 1/5TH REMAINDER MECHANICSBURG, PA 17050 5. KAREN L. THOMAS Lineal 29 979 88 C/O CHARLES E. THOMAS , . 1/5TH REMAINDER 412 FAIRWAY DRIVE MECHANICSBURG, PA 17055 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ~~ ---- - $ ~~ ~ ~ ~~~.. ~ruw is i icccvcu, ~~~ auunwi iai si ieeis or paper DT [ne same size. D- ~ ~3 RJ ~ ~~ ~'~ ~~~~ t~I ~~ ~ ~e~~~.mt~.~ c7°° ~ _ ~-. ~ t ~, ~.~ , ~ .. ` ~~ ~.. I, BETTY L. THOMAS, of Monroe Township, Cumberland County, Pennsylvania, declare this instrument to be my last will and testament, hereby expressly revoking all wills and codicils heretofore made by me. 1. I direct my executors to pay all of my debts, funeral and administrative expenses as soon as may be done conveniently after my decease. 2. I authorize and empower my executors to sell any realty owned by me at my death, at either public or private sale and to give good and sufficient deeds therefor, in fee simple, as I could do i.f living. 3. I devise and bequeath all of my estate of every nature and wherever situate to my five children, share and share alike, the child or children of any deceased child taking the share their parent would have taken if living. ~4. The share of Karen L. Thomas shall be held in trust by Farmers Trust Company, for the use of my daughter, Karen, for and during her natural life, and the income and principal of said trust shall be paid to her guardian for her support, maintenance and medical needs, as necessary. Upon her death, whatever remains of income or principal shall be distributed to her brothers and sisters, share and share alike. 5• I nominate and appoint Robert L. Thomas and Charles E. Thomas to be the executors of this my last will and testament, they are to serve as such without bond. 6. I hereby direct that Charles E. Thomas shall be the guardian of Karen L. Thomas. 7. I hereby suggest that my personal representative retain the services of Irwin, Irwin & Irwin as attorneys in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 'Z''[~ day of September, 1982.. " ~ ~ ( SEAL ) TTY L. THOMAS Signed, sealed, published and declared by Betty L. Thomas, the above named testatrix, 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. -2- +a ACKNOWLEDGEMENT AND AFFIDAVIT We, BETTY L. THOMAS BETZI A. MORRISON , and SHARON L. SCHWALM the testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix signed the Will as a witness and that to the best of their knowledge the testat rix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ~i !~-,~1 r~-a.~ BET Y L. THOMAS ~~ (~ !rl nj An BE I A M~ L . ~° ~~~ COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by BETTY L. THOMAS the testat rix and subscribed and sworn to before me by BETZI A. MORRISON and SHARON L. SCHWALM , witnesses, this 2'?~ day of September 19 82 . ~. ;' ~: .«~ , ~- CARLISL[ B 0, ~ vfiitRL~ND COllNTY MY' GQrI?NH N PIRES OCT. 3, 19E~ ^;- OMB Approval No. 2502-0265 y ~ ~f A. Settlement Statement (HUD-1) 1. ^ FHA 2. ^ RHS 3. ^Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number: BROWNE6-12 41!)443 4. ^ VA 5. ^Conv. Ins. C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agents are shown. Items marked "(p.o.c)" were paid outside the dosing they are shown here for informational purposes and are not included in the totals. D. Name & Address of Borrower: E. Name 8 Address of Seller: F. Name 8 Address of Lender: ERIC C. BROWN, LAUREN E. BROWN BETTY THOMAS ESTATE MEMBERS 1ST FCU 11 HELEN AVENUE, MECHANICSBURG, PA 9 HELEN AVENUE, MECHANICSBURG, PA 5000 LOUISE DRIVE, MECHANICSBURG, 17055 17055 PA 17055 G. Property Location: H. Settlement Agent: I. Settlement Date: 07/05/2012 9 HELEN AVENUE 18M REAL ESTATE SERVICES, LLC Disbursement Date: 07/05!2012 Mechanicsburg, PA 17055 West Pomfret Professional Bldg, 60 West Pomfret Street, Monroe Township Carlisle, PA 17013 Telephone:717-249-2353 Fax:717-249-6354 Place of Settlement: TitleExpress West Pomfret Professional Bldg, 60 West Pomfret Street, Printed 07/05/2012 at 4:47 pm Carlisle, PA 17013 by JMR :. . ~.., ;,, , 101. Contrail sales price 135,000.00 401. Contract sales price 1 j5,pp0,pp 102. Personal 402. Personal ro 103. Settkxnent charges to bortower (line 1400) 4,168.84 403. 104. 404. 105. 405, Ad uatmenb for items id b seler in advance Ad ustmerds for items id seller In advance 106. Cityftown taxes to 406. City/town taxes to 107. County taxes 07/05/2012 to 12/3112012 196.33 407. Counrytaxes 07I05/2012to 12131/2012 196.33 108. School Taxes 07/05/2012 to 06/30/2013 1,314.29 408. School Taxes 07105/2012 to 06/30/2013 1,314.29 109. 409, 110. 410. 111. 411. 112. 412. ~1y2y0~• Gross Amourd Due from Borrower fM1 f}~ ...v n - ": ~- x-rn ....>:,.. 140,679.46 420. Grosps~Amoarrt Due to Seller~~p~ ~ '+Redric~rnala/~~~~W~11p „ ~ 136,510.62 201 Deposfl or earnest money 1,000.00 501 Excess deposit (see instructions) 1,000.00 202. Prindpal amount of new loan(s) 128,250.00 502. Settlement charges to seller (line 1400) 2,678.85 203. Existin loa s taken sub'eil to 503. Existin loa s taken su 'ed to 204. 504. Pa off of first mort loan 205. 505. Pa off of second mort a loan 206. lender credit 375.00 506. lender credit 207. 507. 208. 508. 209. 509. Ad ustments for items un id b seller Ad'ustmeMs for items un b seller 210. Cityftowntaxes to 510. Cityftowntaxes to 211. Counrytaxes to 511. Counrytaxes to 212. School Taxes to 512. School Taxes to 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 2~• Total Paid Borrower 129,825.00 520. Total Reduction Amount Due Seller 3,878.85 300. Caihs~nt.Yrornffo9`Beirower '800: iCiah ' '" t16~f'r`oin'~MIgF'' 301. Gross artaunt due from borrower (line 120) 140,679.46 601, Gross amount due to seller (line 420) 136,510.62 302. Less amounts paid by/for borrower (line 220) 129,625.00 602. Less reductions in amount due seller (line 520) 3,678.65 303. Cash ^X From ^ To Borrower .,o a„. ,: „w, 11,054.46 803. Cash ^X To ^ From Seller 132,831.77 selnemml proce"ss~~m "'"m'"r vnn carne comet numplr. ,ro wnnGa,,,I.My ie uwraq INa „4UCfun h mrtlMON. Tl,la Is CafipneC la pmvMe tM p.,tlef to i REBPR enve,eE inM-tlen rN~ iniam„ticn Ouri,q Me Previous editions are obsolete Page 1 of 4 HUD-1 700. Tt,bl~R~hiErrtatie-Broker,E6es Paid'Frotn -PaYd From Divisiamofcommissioh Iine700:asfollowsc BOrrOWer'S Seller's 701. $0.00 tc Funds at fttndS at 702. $0,00 to Settlement Settlement 703. Commission paid at settlement 800;. Items . •In°Connacffon•.wNliLoan 801. Our origination charge (Includes Origination Point 0.000% or $0.00) $830.00 (from GFE #1) 802. Your credit or charge (pants) for the specific interest rate chosen $ (from GFE #2) 803. Your adjusted origination charges (from GFE A) 830.00 804. to (from GFE #3) 805. to (from GFE #3) 806. Tax service to from GFE #3 807. Flood certification to from GFE #3 808. to (from GFE #3) 809. to (from GFE #3) 'gOp, 'IEam^ _x;N.ee""de~lEo911etPa"IdI~+A`ii+iiiiee ` 901. Daily interest charges from from 07/0512012 to 08/01/2012 @ 14.49401day (from GFE #10) 391.34 902. Mort a insurance remium months to from GFE #3 903. Homeowner's insurance for 1 ears to STATE FARM INSURANCE $393.00 P.O.C. B' (from GFE #11) 904• months to from GFE #11 905. for months to ,...,.. ,. •wgh'd ", , 11000.: . , 1001. Initial deposit for your escrow account (from GFE #9) 1002. Homeowner's insurance 3 months $ 32.751month $98.25 to MEMBERS 1ST FCU 1003. Mort a insurance months $ (month 1004. Pro taxes months $ (month 1005. County taxes 6 months $ 33.271month $199.62 to MEMBERS 1ST FCU 1006. School Taxes 2 months $ 110.741month 5221.48 to MEMBERS 1ST FCU 1007. Aggregate Adjustment 5-519.35 to MEMBERS 1ST FCU 1100::;, .,, ... ~, ,. ,. 1101. Tftle services and lender's the insurance from GFE #4 1,365.00 1102. Settlement or closing fee to $ 1103. Owner's title insurance from GFE #5 30.00 1104. Lender's title insurance $1,470.00 1105. Lender's title policy limit $128,250.00 Lender's Paicy 1106. Owner's tide policy limd $135,000.00 Owners Policy 1107. Agent's portion of the total tide insurance premium $1,041.25 to I&M REAL ESTATE SER4ICES LLC 1108. Underwriter's portion of the total tide insurance premium $258.75 to STEWART TITLE GUARANTY COMPANY 1109. '1200.,.Goxeutmrlmt~Reciord tian~eF..._ ., _ .. . , 1201. Government recording charges $ (from GFE #7) 152.00 1202. Deed $62.00 Mort a $90.00 Release $ to Recorder of Deeds 1203. Transfer taxes $ (from GFE #8) 1,350.00 1204. CitylCounty tax/stamps Deed $1,350.00 Mort $ to Recorder of Deeds 1205. State Tax/stamps peed $1,350.00 Mort $ to Recorder of Deeds 1,350.00 1206. Deed $ Mort $ Release $ to 1207. Assignment of Mortgage to Recorder of Deeds 50.50 1301. R wired services that ou can sho for E ~) 1302. to 1303. to 1304. 2012-13 SCHOOL TAXES to MARY A. MURRAY, TAX COLLE $ 1,328. 1305. to ' r ~ `' ~ ~ 4,168.84 2,678.85 'Paid outside of dosing by (B)orrower, (S)eller, (L)ender, (I)nvestor, Bro(K)er. "Credit by lender shown on page 1. "'Credit by seller shown on page 1. Previous editions are obsolete Page 2 of 4 HUD-1 ~~ ii i ry~~ 830.00 830.00 0.00 0.00 830.00 830.00 1,350.00 1,350.00 t i 238.00 152.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 30.00 238.00 182.00 $ -~•~ or -23.5294% 1,051.93 0.00 453.37 391.34 0.00 393.00 2,755.10 0.00 1,533.75 1,365.00 0.00 0.00 Loan Terms $128,250.00 30. years 4.1250% note: it you have any questions about the Settlement Charges and Loan Terms listed on this forth, please contact your lender. Previous editions are obsolete Page 3 of 4 HUD-1 ' HUD CERTIFICATION OF BUYER AND SELLER 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 or by me in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement. ERIC C. BROWN LAUREN E. BROWN BETTY THOMAS ESTATE ROBERT L. THOMAS, EXECUTOR CHARLES E. THOMAS, EXECUTOR The HUD-7 Settlement Statement which I have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be disbursed in accordance with this statement. SETTLEMENT AGENT DATE WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: U.S. CODE SECTION 1001 AND SECTION 1010. Previous editions are obsolete Page 4 of 4 HUD-1 ~~ •. Name of Borrower: Name of Seller: File Numt~er: Prepared 07/05!2012 at 4:47 pm Note: This page displays an itemization of the credits shown in section 200 of the HUD-1 Settlement Statement This page accompanies but is not a part of the HU0.1 Settlement Statement If a discrepancy exists, the information on the HU0.1 Settlement Statement applies. Credits Credit • . . •. • Name of Borrower: Name of Seller: File Number: ERIC C. BROWN BETTY THOMAS ESTATE BROWNER-12 LAUREN E. BROWN Prepared 07/0512012 at 4:47 pm Note: This page displays an itemization of the adjusted origination charges shown in section B00 of the HU0.1 Settlement Statemen This page accompanies but is not a part of the HU0.1 Settlement Statement If a discrepancy exists, the information on the HU0.1 Settlement Statement applies. Your Loan Origination Charges Borrower Seller 801. Our origination charge (Includes Origination Point 0.000% or $0.00) origination charge to MEMBERS 1ST FCU $ 830.00 802. Your credit or charge (points) for the specific interest rate chosen to $ 0.00 803. Your adjusted origination charges 830.00 0.00 . r Name of Borrower: ERIC C. BROWN LAUREN E. BROWN Name of Seller: BETTY THOMAS ESTATE File Number: BROWNE6-12 Prepared 07/0512012 at 4:47 pm Note: This page displays an itemization of the charges shown on line 1101 of the HUD-1 Settlement Statement This page accompanies but is not a part of the HU0.1 Settlement Statement If a discrepancy exists, the information on the HU0.1 Settlement Statement applies. 1100~~T4me'iCt~arpes - 1101. Tkle services and lenders title insurance TopI:C ... .. ~ to 'Bortow~r Setler overnight and a mail to 18M REAL ESTATE SERVICES $ 50.00 50,00 notary to $ 30.00 30 p0 wire fee to SOVEREIGN BANK, FSB $ 15.00 15,00 1102. Settlement or closing fee to $ 0.00 1104. Lenders title insurance to STGC/18MREAL ESTATE $ 1,270.00 1,270,00 ... Salkr/Estid"ei~adilit~s"s'hown~on' e~1; Totals: S 1,365.00 0.00 1,365.00 p. ~ - .° °~ ,° ,. . . _., , ,~. . 6R~1Lktideltik Previous editions are obsolete Page 1 of 1 HUD-1 ,~ r ..LG ~: ~~ .~ ~ ~~~ ~=: ~ ... ' 'i ~' ~~ ~ ,~~-- ~. ~' ., .. I ;;!~~u~ - ~' d, . A ,~ f ~ -- -- ~~~Gz ~ ~~ .-.' ~~ ~..~ ~~~ ~~G~~~ ~ /~~"~ ~- °r~ ~~ /o .~ ~~ ~~ ~ ~ ~ ~~ 3-Z .I ~ i __ _.__ _._ _ __ ,. _. ___ ___ .. -- _ _. __ _ _ __- ___ _. ____ ~~G __. __ _ _.. _ _ _a~. _ ~ ____ __ __ __ _. ~ __ __. - ~..~~~~' ___- ~ _ .. G~~/CAF r _. i ~ _ l -" G ._ .rT ~ ~~ _----- _ A. _. _._ _ .._ r __ ._ . ....__ _. _ _.... _. _.. __ _----_ ___ _ _.._ w _ -- __ ._ _~ _ _ _ _ ~~ ' ` ~- ~-/~~ ;. _r _. _ _ __-__ . _ ___ __ _._ __ 414.00+ ~ _ ______ Via- _ _ ___ --- _~ 296.00+ ~._. ~~L-CMG!" L~! Gt'~ _ _. _ ___. 710 • * ~ ~ ~ ~ ~/~,4~~ / ._- _ __ ~~~ __ .~ -. _.___ ~' - / aN ------ -~ _ .- _ _ __.. ~ Q M~cTBank 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Phone 888-502-4349 F ax (302) 934-2955 July 27, 2011 Irwin and McKnight PC 60 West Pomfret Street Carlisle, PA 17013-3222 ~~~~~~~~ ~.iUL 2 9 2011 Re: Estate of Betty L Thomas 1kWIN & McKfVIGHT Social Security: 162-22-1734 LAiNOFFICES Date of Death: July 2 2011 Dear Sir or Madam: Per your inquiry on July 12, 2011, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Account Number Ownership (Names o~ Opening Date Balance on Date of Death Accrued Interest Total Checking Account 2670030440 Betty L Thomas 09/01/67 $4, 722.89 $ .00 ------------ _. - - - -- $4, 722.89 For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, please call the Spring Garden Olfice at #717-?AO-4525. We were unable to locate any safe deposit box for the above-mentioned decedent. This letter does not include any accounts in which the deceased may have been listed as Power of Attorney, Custodian of Uniform Transfers, Representative Payee, or Trustee under a Written Agreement Sincerely, Tammy Spencer Adjustment Services ~ ao ~ H p N ~ N ~ N A ~ N ~ ~~ O ,~ ~ ~ ff -- p ~ ~ a ~ ~ C ~ a ~~ ~ ~ b d ~~ A ~, C7 y ~ w' O v! -~ ~' O ~ ~ P4 r w n u~ Q d ~ '~ ~ ~ •~ A A a w ~ WvW A4 ~, ~ ~ w U x PQ ~ .~ ~ N ~ A N ~ ~ OC N ~ , O O ~ O ~ a A ~ ~o ~o U ~ q ~ ~ ~ q 00 A . N ~ ~ ~ H ~~ ~ ~ O ~ Z ~ ~ va.a ~ ~ q ;' ~ z 0 o ~ ~ ~ a ~ ~ A H : ~ ~ ~ c c . O N S ~ v~ Q7 ~ V O ~~ "~ - ~~ ~ y ~. 3 ~ ,~ ~" BANKERS LIFE AND CASUALTY COMPANY ,~ CLAIMS ADMINISTRATIVE OFFICE P.O. Box 1937 Carmel. IN 46082-1937 (800)621-3724 August 29, 2011 Charles E. Thomas 412 Fairway Drive Mechanicsburg, PA 17055 Insured: Betty L. Thomas Contract NumTer: 7896836 Dear Charles E. Thomas: We again wish to extend our deepest sympathy to you and your family for your recent loss. Your claim on the above mentioned contract has been approved and processed. The benefits have been calculated as follows: Death Benefit ~~''~`~'• Your Share $ 970.73 Taxable Amount $ 970.73 Federal Tax Withholding $ 0.00 Final Benefit Amount $ 970.73 A form 1099R will be mailed at the end of this tax year for the taxable amount. CR., N0: 8445340A PAYEE: THOMAS, CHARLES E CHECK NUMBER: 0086232590 DATE: DEC 09, 2011 AMOUNT: $2,681.75 EXPLANATION: 8445340 8445340 BETTY L THOMAS DEATH BENEFIT $10,727.00 - YOUR SHARE $2,681.75 BLC /LCVPA/ LCV BANKERS LIFE AND CASUALTY COMPANY 11825 ~N. PENNSYLVANIA ST., CARMEL, IN 46032 PAYEE: THOMAS CHARLES E UNAPPLIED CASH DEATH CLAIM PAY VENDOR#: POL/AGT#: 7946458 TOTAL 2.870.73 X <.~ , BLC /LP3LA/ LP3 / /t I/ ~~~ ~~ SRS LIFE AND CASUALTY COMPAI~TY CLAIMS ADMIlVISTRATIVE OFFICE P.O. Box 1937 Carmel, IN 46082-1937 (800) 621-3724 August 29, 2011 Charles E. Thomas 412 Fairway Drive Mechanicsburg, PA 17055 Insured: Betty L.Thomas _ __ Contract Number: 7753046 . Dear Charles E. Thomas: We again wish to extend our deepest sympathy to you and your family for your recent loss. Your claim on the above mentioned contract has been approved and processed. The benefits have been calculated as follows: Death Benefit X13,154.76 Taxable Amount $ 3,288.69 Federal Tax Withholding $ 329.03 Final Benefit Amount $ 0.00 A form 1099R will be mailed at the end of this tax year for the taxable amount. ~.-..dTr~RS LIFE AND CASUALTY COMPANY • CLAIMS ADMINISTRATIVE OFFICE P.O. Box 1937 Cannel, IN 46082-1937 (800) 621-3724 August 29, 2011 Charles E. Thomas 412 Fairway Drive Mechancisburg, PA 17055 Insured: Betty L.Thomas Contract Number: 7822560 Dear Charles E. Thomas: We again wish to extend our deepest sympathy to you and your family for your recent loss. Your claim on the above mentioned contract has been approved and processed. The benefits have been calculated as follows: Death Benefit `'; Your Share $~~2,723.83 Taxable Amount $ 209.15 Federal Tax Withholding $ 0.00 Final Benefit Amount $ 2,723.83 A form 1099R will be mailed at the end of this tax year for the taxable amount. Ewing Brothers Funeral Home, Inc. ~^ 630 South Hanover Street ' Carlisle, PA 17013- (717)243-2421 July 15, 2011 Charles E. Thomas 412 Fairway Drive Mechanicsburg, PA 17055 The Funeral Service for Betty L. Thomas We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANG EMENTS. i. PROFESSIONAL SERVICES Services of Funeral Director/Staff , $1840.00 Embalming, , $875.00 Dressing, Casketing and Cosmetics, $290.00 2. FACILITIES AND SERVICES One Day event (Discounted), , $790.00 3. AUTOMOTIVE EQUIPMENT Vehicle to transfer remains to Funeral Home, _ $275.00 Hearse (Casket Coach) , _ $275.00 Safety/L.ead car/Clergy $125.00 Utility Vehicle for Death Certificate Filing $125.00 FUNERAL HOME SERVICE CHARGES $4595.00 SELECTED MERCHANDISE: Acknowledgementcards, $10.00 Register Book(s) _ _ $40.00 Memorial folders , $75.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED $4720.00 Cash Advances Clergy/Mass Offering, _ $125.00 Certified Copies of the Death Certificate , $60.00 Flowers. $185.50 The Sentinel Obituary announcement , _ $86.31 TOTAL CASH ADVANCES AND SPECIAL CHARGES . $456.81 Total Total Cost , $5176.81 ~ '21c T ~~ ~ ~~ ~~- 5 SUB-TOTAL $5176.81 INITIAL PAYMENT /DISCOUNT /CREDITS 0.00 TOTAL AMOUNT DUE $5176.81 The unpaid balance oy r 30 days is subjected to a 1.50 % ervice charge per month - 18.0000 % per annum. *** THE GROSS-ERY *** 308 Cheryl Avenue Mechanicsburg PA 17055 (717}918-0138 07/07/11 9:50 OPER 85 60000 Valued Gross-ery Customer a227~~AnRT cuP~ a ~~s--Few-,~~- 1 C~ 1.05 }-A~.._ 1 @ 1.05 '.,..~ 8 1 C~ 1.05 ~}-$~, 8 F~ 1 @ 1.05 ~ ~y-AS 1 # 2.25 822305 DART CUP 8KY8 FOAM 8Z 1 @ .85 .85 822305 DART CUP 8KY8 FOAM 8Z 1 ~ .85 ,g5 32803 POC MARSHMALLOWS MINIATURE 1 @ 2.10 2.10 1144109 POC FRUIT COCKTAIL LS 1 @ 9.10 9.10 144109 POC FRUIT COCKTAIL LS 1 @ 9.10 9.10 ° Merchandise Total $28.45 ~ /~ Tax_ $.48 ~lD a Invoice Total $28.93 AMOUNT TENDERED $28.93 Credit Card $28.93 ORDER# 936979 60000 PIECES 10 Invoice #649935 Please Sign in the box below ~**THANK YOU~~* *ALL RETURNED MERCHANDISE MUST* *BE ACCOMPANIED BY THIS RECETPT~ Gianat Fo~~d 51•ora_ IIbu'J~ 65ti~0 C.®rllt~le Plke M~ec:har•rics~hurs, PA 17050 Store Te JI e~h~ane : (717) 796-6555 Pharnrec~ TellePh~~ne: ('T17) 796-044~V THANK Y(JU 480015519!72 12 @ 5.19 DIET PFF'SI 12P1( B(: n2 l~3 B 12 @ 1.zo SC BONUSBt1Y '.3AVIIVG5 14.40•-B 12 @ 1,49 I:'.P PEPSI 4/x110 ~~. 17.83-B Pr Lce f'or 12 39.00 ~¢ SB S~bl R~35P1( 7.9? F 70TAL BEFORE SAVINGS 72.?'! YOUR TOTRI_ :iAVINGS 32.2'.3 TOTAL AETI_R SAVINGS 3y.~17 7A?; PF'iID 1 . YO ~e**T01'AL 41 . "77 uF DEBIT CARD 4'1.77 GIANT FOOD # 6005 F.560 CARL.ISI.E Ptki: - SUITE 100 I~IECHANICSBUF:G, PA 1050 DEBIT CARD Pf1YMENT Card XXXX XXXX 4?!X,X 7031 Pasiment Amount ~ f}+r;~~~{ ~7 Purchase Amount 1~ ~xt~'+4 T Cashback Amor.in ! 9. ~ ~;~ x ~ x ~:. v0 AUTH# 50904.' 7/06/11 20:'5 6005 i19 0~~36 {34 1A i'rkjF jF?F if Yr i:t#ar jE jit ~~F i4*~..{R3 fiifx#\x~i.^;#;. „ CHANGE: .UO fi]TAL Nt1MBER OF CTEMS SOLD = 15 z/o6/1{ a:~5 PM X005 09 nz>6 {s4 I' m v 1 ad s:~ou shoNped here t ~,J.~- Your Cashier - JES5Ii;A er~~t~t~t 13OMUS(:ARI) SRVI:Nf;S Sl1MMAR1' t=-.- Pt~NUSCARD SAVINGS 14 , ~10 f:xTRA REWRRD!:~ SA'dINGS 17.:tb fOTAL SAVING:+ 32.:'F 9 Waimart : ;,. Save money. Live better. MANAGER STEVEN MYERS ( 717 ) 691 - 3160 ST% 1886 OPB 00008691 TE1 19 TR>t 00550 TC RAV RED 001117934143 0.97 X TC RAV RED 001117934143 0.97 X TC RAV RED 001117934143 0.97 X TC RAV RED 001117934143 0.97 X TC RAV RED 001117934143 0.97 X TC ELEC BLUE 001117950217 0.97 X TC LIME GRN 001117960215 0.97 X TC LIME GRN 001117950216 0.97 X TC LIME GRN 001117950215 0.97 X TC LIME GRN 001117950215 0.97 X PARTY CUPSIN 007874 207875 4.98 X FLY PAPER4PK 004107261161 0.98 X FLY PAPER4PK 004107261161 0.98 X FORKS 068113170247 2.68 X SPOONS 007874208942 2.68 K 96CT ASST 007874208902 2.68 X GV 150CT PLT 068113151328 3.72 X GV 7 LAT 0 7$74201 P 0 839 1.98 X GV LF MINIS 007874204409 F 1.q8 N GV LF MINIS 007874204409 F 1.48 N POTATO CHIPS 007493111109 F 3.68 N POTATO CHIPS 007493111109 F 3.68 N POTATO CHIPS 007493112109 F 3.68 N POTATO CHIPS 007493112109 F 3.68 N POTATO CHIPS 007493111109 F 3.68 N POTATO CHIPS 007493112109 F 3.68 N SUBTOTAL 60.88 TAX 1 6.000 % 2,15 TOTAL 63.03 VISA TEND 63.03 ACCOUNT >t 7031 APPROVAL ~ 000631 REF 1k 118800643318 TRANS ID - 0161188002831259 VALIDATION - XSRY PAYMENT SERVICE - E CHANGE DUE 0.00 # ITEMS SOLD 28 TC>t 6703 9690 2070 3624 036 ~~~~~~~~~~~~~~N~~~~~~~~~~~~~~~~ ~~ New -P l ck UP Todab . Or ~^ free sage-daa Pick uP atder,,.- 07/06/11 ?' ~ CLOSED CHECK ~ SOUTH SIDE DELI Y Server; Serve Check#: 42707 Date; 07/08/11 Time: 11:54am Guests: 1 LJCtl l J._ --- -.__ _. .-- 3 LG Meat/Chz Tray $120.iJ~ Subtota 1: $12L1 Ci0 Tax:: $7.20 Sub w/Tax; $127,20 Amt Due: $1 27 _20 Cash $127 20 Thanks. for dir~ins with us! ! ! ~ ~ C`. M M ` ~ N N L(S P ~ Q ^- M 7 Q 00 N ~O O \O t0 »c M y . O r to ~O ~p 0 0 0 0 »: p »e p BOO in Q 7M~ M O M ~ ~ 'K N ale ? 'P d ~ SO ~D O '- Ll7Q~ ~ to N N N N *'O X ~O \D O %K ~k . . C ~ It! O OAT O :K 00 X000 N ~K . _ ~ '" ~ O Y ! O O O d N N N OD U U ~ * ~p O X N SIC ~ ¢ ~ ¢ C 10 .Y ~ ...- ~ O [n ~ X ~ ~ ~k ~ M L77 U E 4 !f w r. ~.. O O ~# Ln x N N ,~K ~k ~~ O d ~-+ E C O. O O O N W X +K * He 'k :- ~ .k _ V ~ N O OI ¢ F- X SIC SIC ~k Z fn :K ~r LP r: N N Vi d i d O_ v V N t` Z X Ne ** f--i C7 ~ x C* ~ O L W D O O W X* ~c ~c > Z ~--~ ~e p ~t 7 Cri ~ m to Ltd E He He * ¢"-' * * ~ ~ orx = C ~~ v` ¢ te 10 a O ~A d U N W ?C+++ ~ ~ .n , r r m n O t] ~ t L !a * e--~ Q ~ 7 iL iJ ~~ O L.L. 9 N ~ J N L J ~ 3 L.L ¢ F- OC ~I O :K .~-. ~ c: - 7 d L N G E CO O J c d L O O O ~D ~k ¢ t _ .n • ~+~0 C .-t ,..~ p _ ~2M ~~ Z4~ C1O¢A UMC WC'3 U 'K LL 7 to 2 C to 4 01 V > Z O t-1 ¢¢¢ r-- ¢ * J~ O> >K O O~ O ~O ¢ !-~ L AiOt i-i- > d VT O ¢Wi-¢ t3 iU iz > O V J Jd.JH~K V1G +- dYN O* W -• *t7 O ~ U J > tti ~ i.l ii O ~ ~ 2 y '•.~ [n O~ 0 ¢ U 1 CA r ¢ ~ ¢ ¢ :-i ~ s7 .-. cq O C ui ii vw O ~ 2 W O ~ N ¢ O I f s 8i ~- c Z O 3 ~ V- LO a' L H G F_ X 1-- m * O J (n ~ Ol 10 i0 00 ~ ~c ¢ m .- L. .q 7 ~ H _z ~ ~_ ._ • G G G¢ CS iii ac u ii U u E i y iv rc = i Z ~ E ~ NON U' N h-~O y _ _ '. __ - _ ' ~ T M ^~t f/1 ( +O ~ • 3 ~ T ~ SIC ale U * ~ _ Z '- - _-~ _ ~ ¢ h I I_ ii 1 T fY fDl N K H ¢ F- ~ ~ ~ ~' \ SIC L NUS O LL mNS ALL ~K Mc ¢~D UCO f-- p # ¢ O t--i * = • d V V O \ ~1c H\ »c Q Z 1- ' y H LL* O ~O L O 7 ye ¢ t~ * ~ r' 'k O O ~ -- * m H r f ~¢Xica.9,G.a. ~xcasaxi.+uJ., ~+,,c 281 e~exaca J\,naa '~.ec~ia.+u.cc~.+a9., ~a. 12050 .one: 71 Z 554-14.1 Z `coax: Zl Z 6~J1-6Z9Z March 29, 2012 For The Estate of: Betty L. Thomas 9 Helen Ave. Mechanicsburg, Pa. 17055 Re: Estimate for a New Septic System Stone Material $1,375.00 Pipe Material $ 650.00 Tank & Pumps $2,260.00 Seed & Mulch $ 300.00 Fuel $ 500.00 Permits & Fees $ 910.00 $5,995.00 t • STATEMENT Forest Park Health Center Resident: Thomas, Betty (23181) 700 Walnut Bottom Road Location: - Carlisle, PA 1701 Statement Date: 9/1/2011 (888) 880-709 ALL TRANSACTIONS PROCESSED AFTER Aug 31, 2011 WILL APPEAR ON YOUR NEXT STATEMENT Betty Thomas 9 Helen Avenue Mechanicsburg, PA 17055 Amount Due $2,012.04 PLEASE DETACH AND RETURN 4'VITH YOUR PAYMENT Amount Enclosed $ Forest Park Health Center Resident: Thomas, Betty (23181) 700 Walnut Bottom Road Location: - Carlisle, PA 17013 Statement Date: 9/1/2011 (888) 880-7090 Effective Date Description Units Unit Amount Amount BALANCE FORWARD $0.00 1/31/2011 Todays options copay date of service 1/31/2011 1 $112.04 $112.04 2/28/2011 Todays opt Copay date of service 2/28/2011 1 $1,900.00 $1,900.00 BALANCE DUE $2,012.04 Please call 888-880-7090 Ext. 872 if you have any questions. Julie .~. ~. ~ BankofAmerica G~ BETTY L THOMAS Account Number: 5490 3306 9516 6303 May 7 -June 7, 2011 BankAmericard° ~~,~,1,~ Y vv.vv U99~ l ~ Account Information: www.bankofamerica,.com Mail billing Inquiries to: New Balance Total .............................. ...................................$1 .... 735.19 Bank of America, , Current Payment Due .................. ....................$43 00 P.O. Box 15026 . Wilmington, DE 19850-5026 Total Minimum Payment Due ................ ............................................$43 00 Mail payments to: . Payment Due Date ......................................................................... 7/5/11 Bank of America . P.O. Box 1.5019 Wilmington DE 19888-5019 Late Payment Warning. If we do not receive your Total Minimum Payment by , the date listed above, you may have to pay a late fee of up to $35.00. Customer Service: 1.800 421 2ll0 Total Minimum Payment Waming: If you make only the Total Minimum . . Payment each period, you will pay more in interest and it will take you longer to pay off your balance. For example: (1.800.348.3178 TI'Y) Previous Balance ........................$1,809.03 Payments and Other Credits ..............-100.00 Purchases and Adjustments ....................0.00 Fees Charged ....................................................0.00 Interest Charged ............................................26.16 New Balance Total ......... ..........$1,735.19 Credit Line ..................................$20,000.00 Credit Available .......:...................$18,264.81 Statement Closing Date ......................6/7/11 Days in Billing~yel~--~.,,~,,,,,,,,,,,,,,,,,,,,32 ~/ 7C0. ~ ~ (mod ~S~ ~CC~ Only the Total 14 years $3,718.90 Minimum Payment $61.96 36 months $2,230.56 (Savings = $1,488.3 ) If you woo'Id tike inforitlation atioUt credit counseling sei'wce§~-call 1-866-300-5238. Transaction Posting Date Date Description Reference Account Number Number Amount Iota/ Payments and Other Credits 05/18 PAYMENT -THANK YOU -100 ~ -$100.00 Interest Charged 06/07 06/07 Interest Charged on Balance Transfers 0 ~ 06/07 06/07 Interest Charged on Cash Advances 0.00 contlnuetl on next page... ., _ w, r' _. ~_ - 1 1,( ~ ( ~ ~ DATE / TRUCK NO. ~~~ ~' DRIVER ~ {'~ ~,~ ~ O. P.O. BOX 700 DILLSBURG, PA 17019 432-9711 766-1511 ,9A_a~a~ PRODUCT ZONE NO. TANK SIZE TYPE HEAT TAX CODE CUST. TYPE CUSTOMER NUMBER NA 1993 TERMS: ACCOUNTS OVER 30 DAYS WILL BE SUBJECTTO A FINANCE CHARGE OF PER MONTH. ANNUAL RATE of )VOLUME DELIVERY ADJUSTEDTO 60°F. ~ ~. SOLD .:' ~ + ,.,` „~ ~ 1,~ ~ ~ '~ ~ ~ • ~\ TO s ~~. ~-~ ~ ~~-~ 13 ~ ~rl- y ~~ ~s DELIVERY INSTRUCTIONS Via' `-~- ~-: , "~ ~ ` ~~~' `'T ^:~ DATE `- ' ` / ~` ` ••~ ') TRUCK NO. ~ C!' DRIVER ~.. ~~ ~ o. P.O. BOX 700 DILLSBURG, PA 17019 432-9711 766-1511 ~~~ A'7 A'f TERMS: AccouNTS ovER so Davs wiL~ se sus.lECT To A FINANCE CHARGE of ANNUAL RATE of )VOLUME DELIVERY ADJUSTED TO 60°F. °ER A10NTH. GALLONS 10'~ DOLLARS CENTS DOLLAR AMOUNT DELIVERED PRICE PER GAL. TOTAL I > ,-,. _. , ,{ . _._. ,. ^ CASH ~ CHECK ^ NOT FULL - _ ,_. :~5'-5-yam GALLONS 10'" DOLLARS CENTS DOLLARS CENTS AMOUNT DELIVERED PRICE PER GAL. TOTAL PRICE ^ CASH ^ CHECK ^ NOT FULL PRODUCT ZONE NO TANK SIZE TYPE TAX __ CUST. _ .. .. CUSTOMER - _ -T1A 19J3 . _ __ HEAT CODE TYPE NUMBER L I1 Vl~lllLl LVLVJ.il 1L111•U1.111LtILLt~l• Start Date: Jul-1 1 Monthly Budget Payment: $448.00 Customer #: 512837 N~~rlber of Months: 11 Statement Date: 7/25/11 ^Delivery Locations: "O1" 9 HELEN AVE, MECHANICSBURG PA Current Hea ' Sea cba es included in bud et: (since last statement) Invoice Date Posti ate Transaction Description 6/25/1 1 Previous Balance: BALANCE CURRENT HEATING SEASON BUDGET: AUGUST BUDGET PAYMENT DUE O8/10/11 ~~,,~ gt4 - ~Dk . ~~~~ Shipley Energy 550 East King Street PO Box 5006. York, PA 17405-5006 51285780219552180804485220118725 Form # 711082-0 (717)848-4100 or1-800-839-1849 or Visit our website myshipley. com Amount $240:54,. $240.54 $468.32 ~~ ~~,~ Page: 1 The services and products provided are subject to the terms and conditions noted on the back of this invoice/statement If payment was made within the last 10 days, please disregard this statement. Shipley Energy 550 East King Street PO Box 5006.. York, PA 17405-5006 (717)848-4100 or1-800-839-1849 or Visit our website myshipley.com Page: 2 51285788219352108884fiS228118725 ~ I ~~ ~ N ~i ~~~