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Home My WebLink About08-09-12 (2) 1505610105 REV-1500 EX (o2-u) (FI) OFFICIAL USE ONLY PA Department of Revenue Pennsylvania DEPARTMENT OF REVENUE County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN ~ ~~ ~ -~ PO BOX 280601 i ~ Harrisburg, PA 1'7128-06 01 RESIDENT DECEDENT ;' :~ I ~ I /J ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 178-16-5714 10/18/2011 , ~ 07/20/1922 Decedent's Last Name - Suffix Decedent's First Name MI 1 - - -- - DONSON _ -i --- I ~ HARRY ---~ ~I '~ - - - - _ _ - --- - - - - _ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI i Spouse's Social Security Number -- - --- -- -- -- - --_-- ----~ I THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - ----------------- _ --- --- --1 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW C~ 1. Original Return O 2. Supplemental Return C~ 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate p 4a. Future Interest Compromise (date of (~ 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number IRWIN & McKNIGHT, P.C. (717) 249-2353 - - ~~ First Line of Address 60 WEST POMFRET STREET --- _ - _ - Second Line of Address City or Post Office ', CARLISLE Correspondent's a-mail address: -- - _ State i i ZIP Code PA i ___: ~ 17013 ~_-_ REGISTER OFD USE ONL~ ~~ ~ ` ~ - - C ~ C % ~ ~,.~ ~~ N -~ ~ . . N DATE FILED ('~„~ ~~ ~-:r E~~ ..r. ~ ~. ~..~ !~ --r~ Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATU. PARSON ~N'SIBLE~OR FILJI,VG~''F1~1RN DATE 1849 W. LISBURN ROAD, CARIQ,$LE, PA 17015 SIGNATURF,.k~ PR PARER OTHER THANpRESENTATIVE DATE ADDRESS 60 WEST POM~R T STREET, CARLISLE, PA 17013 PLEASE USE ORIGINAL FORM ONLY 1505610105 Side 1 1505610105 J ,., ~ Continuation of REV-1500 Inheritance Tax Return Resident Decedent HARRY E. DONSON Decedent's Name Page 1 File Number Correspondents Name Daytime Telephone Number R W I N & M c K N G H T P C 7 1 7 2 4 9 2 3 5 3 First line of address 6 0 W E S T Second line of address City or Post Office C A R L I S L E Correspondent's a-mail address: P O M F R E T S T R E E T State ZIP Code P A 1 7 0 1 3 Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNAT E ~F P SON RES N E ILING RETURN DATE ~, ' .- .. AD ES 72 LADNOR LANE CARLISLE PA 17015 J 1505610240 REV-1500 EX Decedent's Social Security Number decedent's Name: HARRY E- D O N S O N 1 7 8 1 6 5 7 1 4 RECAPITULATION 1. Real Estate (Schedule A) .......................................... . 1. 1 3 3 0 0 0. 0 0 2. Stocks and Bonds (Schedule B) ..................................... . 2. 1 1 3 1 9 6 4, 6 4 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .... . 3. 4. Mortgages and Notes Receivable (Schedule D) ......................... . 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)...... . 5. 5 5 5 9 6 2 . 5 8 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ...... . 6. 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ...... . 7. 3 3 7 9 5 6, D 2 8. Total Gross Assets (total Lines 1 through 7) .......................... . g. 2 1 5 8 8 8 3, 2 4 9. Funeral Expenses and Administrative Costs (Schedule H) ........ ........ .. 9. 1 4 4 7 7 0 . 4 2 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ... ........ .. 10. 1 9 4 5. 1 4 11. Total Deductions (total Lines 9 and 10) ..................... ........ .. 11. 1 4 6 7 1 5. 5 6 12. Net Value of Estate (Line 8 minus Line 11) .................. ........ .. 12. 2 0 1 2 1 6 7 . 6 8 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............ ........ .. 13. 5 0 2 2 6 3 . 5 0 14. Net Value Subject to Tax (Line 12 minus Line 13) ............ ........ .. 14. 1 5 0 9 9 0 4 . 1 8 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0 0 0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate x .045 ], 3 6 3 9 0 4. 1 8 1 s. 6 1 3 7 5. 6 9 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 17. ^ - ^ ^ 18. Amount of Line 14 taxable at collateral rate X .15 1 4 6 0 0 0 0 0 18. 2 1 9 0 0. 0 0 19. TAX DUE ............................................. ....... .. 19. 8 3 2 7 5. 6 9 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610240 1505610240 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 11 01151 DECEDENT'S NAME HARRY E. DONSON STREET ADDRESS CITY STATE ZIP Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments 80, 000.00 B. Discount 4,163.78 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) 83,275.69 Total Credits (A + B) (2} 84,163.78 (3) (5) (4) 888.09 0.00 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ...................................................................... ^ X^ b. retain the right to designate who shall use the property transferred or its income; ............................... ^ X^ c. retain a reversionary interest; or ................................................................................................ ^ ^Q d. receive the promise for life of either payments, benefits or care? ....................................................... ^ Q 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .......................................... 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? ......... ^ X^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? .................................................................................................. ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN For dates of death on or after July 1, 1994, and before 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 INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: HARRY E. DONSON _ 21 11 01151 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. (25 CIRCLE DRIVE, CARLISLE, PENNSYLVANIA I 133,000.00 SOLD -SETTLEMENT SHEET ATTACHED TOTAL (Also enter on Line 1, Recapitulation.) I $ 133,000 00 If more space is needed, use additional sheets of paper of the same size. REV-1503 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF HARRY E. DONSON FILE NUMBER 21 11 01151 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. WELLS FARGO -ACCOUNT #2467-8175 1,130,864.53 i 2. PPL CORPORATION COMMON STOCK ACCOUNT #3099002099 (4 SHARES 27.64) 110.56 3. ING ACCOUNT #6620305879 989.55 TOTAL (Also enter on line 2, Recapitulation) I $ 1,131,964 64 (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (11-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF: HARRY E. DONSON FILE NUMBER: 21 11 01151 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. ORRSTOWN BANK -ACCOUNT #111000247 274,731.62 2. MEMBERS 1ST FEDERAL CREDIT UNION -ACCOUNT #040 7.37 3. PUBLIC SALE -NOVEMBER 2011 41,609.50 4. MISC. ERTLE BANKS, JIfJI BEAM BOTTLES, HOUSEHOLD GOODS, AND 178,448.90 COCA COLA COLLECTION 5. CENTRIC BANK -REFUND 407.86 6. HOFFMAN-ROTH FUNERAL HOME -REFUND 100.00 7. PUBLIC SALE -APRIL 2012 22,732.00 8. PUBLIC SALE -MAY 2012 12,938.00 9. STATE FARM INSURANCE -REFUND 219.63 10. PUBLIC SALE -JUNE 2012 14,333.00 11. PUBLIC SALE -JUNE 2012 9,641.50 12. PPL -DIVIDEND DEPOSITS 7.12 13. PAY PAL 760.26 14. STATE FARM INSURANCE -REFUND 5.82 15. PA DEPARTMENT OF REVENUE -REFUND 20.00 TOTAL (Also enter on Line 5, Recapitulation) I $ 555,962.58 If more space is needed, insert additional sheets of paper of the same size 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 HARRY E. DONSON 21 11 01151 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 (If APPLICABLE) TAXABLE VALUE 1. EDWARD JONES ACCOUNT #10895-1-1 115,956.02 100.00 115,956.02 BENEFICIARY: KIMBERLY HOFFMAN 2. PHILIP HOFFMAN -GIFT -OCTOBER 2011 50,000.00 100.00 3,000.00 47,000.00 COLLATERAL 3. KIMBERLY ANN HOFFMAN -GIFT -OCTOBER 2011 30,000.00 100.00 3,000.00 27,000.00 LINEAL 4. BARBARA ANN HOFFMAN -GIFT -OCTOBER 2011 30,000.00 100.00 3,000.00 27,000.00 LINEAL 5. BONNIE LOU DEWALT -GIFT -OCTOBER 2011 30,000.00 100.00 3,000.00 27,000.00 LINEAL 6. FLOYD FAHNESTOCK, JR. -GIFT -OCTOBER 2011 50,000.00 100.00 3,000.00 47,000.00 COLLATERAL 7. ELEANOR KLING -GIFT -OCTOBER 2011 50,000.00 100.00 3,000.00 47,000.00 COLLATERAL TOTAL (Also enter on Line 7, Recapitulation) I $ 337, 956.02 If more space is needed, use 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 HARRY E. DONSON 21 11 01151 Decedent's debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HOFFMAN-ROTH FUNERAL HOME 2,464.48 2. WESTMINSTER CEMETERY 2,321.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) FLOYD FAHNESTOCK, JR. 24,731.00 Street Address 1849 W. LISBURN ROAD City CARLISLE State PA ZIP 17015 Years} Commission Paid: 2, Attorney Fees: IRWIN & McKNIGHT, P.C. 53,591.00 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 915.50 5 Accountant Fees: 220.00 6. Tax Return Preparer Fees: 400.00 7. REGISTER OF WILLS -FILING FEE 30.00 8. CUMBERALND LAW JOURNAL -ESTATE NOTICE 75.00 9. THE SENTINEL -ESTATE NOTICE 200.16 10. REGISTER OF WILLS -SHORT CERTIFICATE 20.00 11. NOTARY FEES 35.00 12. PUBLIC SALE -AUCTIONEER, ADVERTISING, STAFFING, TOILET RENTAL 19,695.30 13. UTILITY BILLS TO JULY 10, 2012 8,065.19 14. 2011 INCOME TAXES 2,003.00 15. CLOSING COSTS FROM SALE OF REAL ESTATE 3,209.44 16. BAD CHECK AND CHECKS 11.25 17. REAL ESTATE TAX REFUND 2,052.10 TOTAL (Also enter on Line 9, Recapitulation) $ 144 770.42 If more space is needed, use additional sheets of paper of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent HARRY E. DONSON 21 11 01151 Decedent's Name Page 1 File Number Schedule H -Funeral Expenses & Administrative Costs - B1 ITEM NUMBER DESCRIPTION AMOUNT B. ADMINISTRATIVE COSTS: Personal Representative Commissions: 2• Name(s) of Personal Representative(s) PHILIP V. HOFFMAN 24,731.00 Street Address 72 LADNOR LANE City CARLISLE State PA ZIP 17015 Year(s) Commission Paid: SUBTOTAL SCHEDULE H-B1 ~ 24,731.00 REV-1512 EX+ (12-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER HARRY E. DONSON _ 21 11 01151 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. WEST SHORE EMS CARLISLE -AMBULANCE 112.86 2. MIDDLESEX TOWNSHIP MUNICIPAL AUTHORITY -WATER/SEWER 157.50 3. NATIONAL REHAB EQUIPMENT -MEDICAL 30.02 4. COMCAST -CABLE 242.80 5. CAPITAL ONE -CREDIT CARD 443.43 6. PPL -ELECTRIC 539.13 7. LIBERTY MEDICAL SUPPLIES -MEDICAL 20.65 8. YORK WASTE DISPOSAL -TRASH 48.75 9. CHURCH OF GOD HOME -NURSING 350.00 TOTAL (Also enter on Line 10, Recapitulation) I $ 1, 945.14 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) pennsylvania ~ SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: HARRY E. DONSON 21 11 01151 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. PHILIP HOFFMAN Collateral 52,000.00 72 LADNOR LANE $5,000 & OCTOBER CARLISLE, PA 17015 2011 GIFT 2. FLOYD FAHNESTOCK, JR. Collateral 47,000.00 1849 W. LISBURN ROAD OCTOBER 2011 GIFT CARLISLE, PA 17015 3. ELEANOR KLING Collateral 47,000.00 306 SHUGHART AVENUE OCTOBER 2011 GIFT BOILING SPRINGS, PA 17007 4. KIMBERLY ANN HOFFMAN Lineal 454,634.73 2365 HUME LANE 23 1/3% ENOLA, PA 17025 5. BARBARA ANN HOFFMAN Lineal 454,634.72 1402 BRADLEY DRIVE APT 1113 23 1/3% CARLISLE PA 17013 6. BONNIE LOU DEWALT Lineal 454,634.73 301 W. JAMES ST. APT 308 23 1/3% LANCASTER PA 17603 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 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: B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS; 1. BOROUGH OF CARLISLE (MAINTENANCE & UPKEEP OF LETORT PARK) 5% 83,710.58 1236 FRANKLIN STREET CARLISLE, PA 17013 2. THE SALVATION ARMY 10% 167,421.17 125 S. HANOVER STREET CARLISLE, PA 17013 3. AMERICAN CANCER SOCIETY 10% 167,421.17 PO BOX 897 HERSHEY, PA 17033 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 502 263.50 If more space is needed, use additional sheets of paper of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent HARRY E. DONSON 21 11 01151 Decedent's Name Page 3 File Number Schedule J -Beneficiaries - 2B II. ~ B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 4. MASONIC CHILDRENS HOME OF ELIZABETHTOWN, PA 5% 83,710.58 ONE MASONIC DRIVE ELIZABETHTOWN, PA 17022 SUBTOTAL SCHEDULE J-2B ~ 83,710.58 LAST WILL AND TESTAMENT ~ E[ARRY E. DONSON, of Middlesex Townshi p, Cumberland County, Pennsyivanxa, being of sound mind, dispos~g memory and full le al g age, do hereby make, publish and declare this to be my Last Will and Testament, hereby revo ' all ~g Wills and Codicils heretofore made by me. 1. I direct my Co-Executors to pay all of my debts, feral and administrative expenses as soon as convenient after my decease, Furthermore, I direct that all state, uiheritance, succession and other death taxes imposed or payable by reason of m y death and interest and penalties thereon with respect to all property composing of m os Y ~' s estate for death tax purposes, whether or not such property passes under this Will, shall be aid b p y the Co~Executors of my estate. 2• My Co-Executors may, at their discretion, compromise claims bo crow money, retain property for such length of time as they may deem proper; lease and sell ro p perry for such pnces, on such terms, at public or private sales, as they may deem proper; and invest e state` Property and income without restriction to legal investments unless otherwise rovided P hereunder. . 3. I authorize and empower my Co-Executors to sell any realty amdlor o . pers nalty ~ owned by me at my death and not specifically devised or bequeathed here' at u ' m, p b12c or pnvate sale or sales and to give good and sufficient deeds and/or bills of sale therefore in f ee simple, as I could do if living. My Co-Executors are authorized and empowered to en a e ' g g in any business ul which I may be engaged at my death, for such period of time after my death as seems expedient to said Co-Executors. t~.f~ ~. ~~.t '~ 4, ff,.'~~ l~ ~: ;,+< 3` 4. I give, devise and bequeath all of my estate of whatever nature and wherever situate as follows: a. The sum of Five Thousand and no/100 ($5,000.00) Dollars and one-half (1 /2) of the Executors' fee to PHILII' V. HOFFiVIAN; b. Twenty-Three and one-third Percent {23 1/3%) of the balance to KIMBERLY ANN HOFFMAN, less any funds transferred to her after July 18, 2011; c. Twenty-Three and one-third PerceBt.(23.1/3%) of the balance to BARBARA ANN HOFFMA-N, less any funds transferred to her after July 18, 2011; d. Twenty-Three and one-third Percent (23 1/3%) of the balance to BONNIE LU DeWALT, less any funds transferred to her affer July is, 2011; e. Five Percent (5%} of the balance to the BOROUGH OF CARLISLE for the maintenance and upkeep of Letort Park; f. Ten Percent (10%) of the balance to THE SALVATION ARMY of Carlisle, Pennsylvania; g. Ten Percent (10%) of the balance to the AMERICAN CANCER SOCIETY of Harrisburg, Pennsylvania, for research; and h. Five Percent (5%) of the balance to the MASONIC CHILDREN'S HOME OF ELIZA.BETHTOWN, Pennsylvania. 2 •,,,,; ~r ~. ;; 1. %~ ;.;~~ ..:,'. ,~ ~:.~~`. ;,::: ``"'~ 5. I nominate and a '~~" ppoint PHILIP V. HOF~ and FLOYD A. FA,HI~IESTOCK, JR, to be the Co-Executors of this my Last Will and Testament. 6. No person(s) shall benefit hereunder unless such beneficiary shall survive me by sixty (60) days. 7. No Co-Executor acting hereunder shall be required to post bond or enter security in this or any other jurisdiction. 8. No beneficiary may assign, anticipate or pledge his, her or its interest in any income or principal held or distributable hereunder, and no beneficiary's creditors may levy, attach or otherwise reach any such interest. 9. I hereby suggest that my personal representatives retain the services of Irwin & McKnight, P.C. as attorneys in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~~~~ day ~of July, 2011. ~~m~-G~~sEni,~ AARRY .DONSON 3 .•!Ir ! ..?~ [,,e ,.r'. ~'' ~f: ~'~~ ;U ,~ Signed, sealed, publishes and declared by HARRY E. D ONSON, the above-named Testator, as and for his Fast W~ and Testament, in our presence, who, at his request, in his presence and in the presence of each other have hereunto set our names as subsc • . nbvng witnesses. 4 ~~ ~~RRY E. DONSON, I~; A.REN S. NOEL and MARTHA L. NOEL, the Testator and witnesses respectively, whose names are ~ ed gn to the foregoing unstrument, being first duly sworn, do hereby declare to the undersi Shed authority that the Testator signed and executed the instrument as his Last Will and that he bad, signed willin and gly, that he executed it as his free and voluntary act for the purpose herein expressed and tha teach of the vcntnesses, in the presence and hearing of the Testator, signed the 'Will as a witness an d that to the best of their knowledge the Testator was, at that tinne, eighteen years of a or older ~ , of sound mmd and under no constraint or undue influence. ~~~ HA,RR F T-(1~vcn~r COMMONV~rEALTH OF PENNSYLVANIA COUNTY OF CUMBEI~~LAND ~ SS: Subscribed, sworn to and acknowledged before me b Testator herein, and subscribed and sworn to before me b y ~A'RRY E' DONSON, the L. NOEL, witnesses, this r~" day of Jul , 2011. Y I~;AREN S. NOEL and MARTHA Y ~`~~~ ~j • C (~~ ~ otary Public @NUV 1`M OF PLNA1sYLVANIA Naar~i see Rclgar 8. Irwin, Notary Public ~ ~Cumberiand County OCt. 3, 2012 r' ~ iodation of Notaries L®CAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. 1=C~ I~ur this ~c~rtil~irate. 56.U~ P 1777079 Certification ~Ulllber This is to certify that the information here given is correctly copied from an original Certii~icate of DL;ath duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vigil Records Office for permanent filing. 1 ~ Local Registrar Date Issued "t0.i-t+3 REV ttrmDe COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS TYPE I PRIM IN Pt~Rr KNNK CERTIFICATE OF DEATH (See Instructions and examples on reverse) eTerc FII F All I,I000 ~I y v 0 w Z 1. Name d Decedent (Frsl. mrldle, last, sulbx) Harry E. Ronson 2. Sex Male 3. Sodal scanty N,~,6 5714 178 t. Daly of Death (Month, ~) -- G'% 5. Age (last Bvihday) Under 1 ar Under 1 da 8. Date d Binh Month, da , ar 7. lace Ci and crate or lor e n coon Sa. Place of Death Check acre 89 u~ °"' "~"' `W"°" July 20, 1922 Carlisle, PA Hospital: Other. Yrs. ^ Inpatlenl ^ ER I Oulpetienl ^ DOA raing Home ^ Residence ^ ONar - Spedly Bb. Canty d Death • Cumberland &. City, Born, Twp. d DeaN N. Middleton Twp Bd. Faakry Name (II hat ktctllutlm, glw ebaet and number) • /J 9. Was Decedent d Wspank prlgkt7 [~ I1e ^Yas (N yea specif ct,bar, 10. Roca: Amaricari Indian, Blaclt, White, etc s d • ~ ~ / L-~C~/-~i~ > Q~ ~~~ , y , Mexican, PueAo Rican, ere.) I v M White t t. DeceoenYS Usual Ibn KIM d work done most d Ne. Do rtd state reU 12. Wes Decedent ever n Ste 13. Decedenra EdupECn (Specify onry hi hest rade cort leted) 14 M l St ^ b M l d N i Kind d wont Owner/Operator tOnd d Btnkresallndustry Coln Store U.S. Amted Faced ®Yas ^ No Elements /Secondary (0-12) ~2 g g p College (td a 5*) . ar a a u: en a , ever Mon ed, Wkiowed, Diwrad (SpedlyJ W1doWed 15. Surviving Spouse (II wile, gNe maiden name) ' qq~g (street, city! town, sate. zip code) - t ircle ~rlve Decedents Did ply PA ActualResidertce 17a.Stele Llveina 17c.®Yes,DecedemUvadn-1vt1ddleseX Twp. - Carl isle , PA 17013 17b. County Cumberland T~~hip7 17d. ^ No, t)acedenl tJved vrithin Actual Umits d Ciry/ Bono t9. FaNels Name (First, middle. last, suffix) Paul M Ronso 19. MoNets Nana (First, middle, maiden surname) . n Helen M. DeLang 20a. Intanr>anl's Name (Type I Pant} 20b. Infonnanrs Malirq Address (SbeaL dry! town, stale, zip code) Flo d Fahnestock 1849 W. Lisburn Road, Carlisle, PA 17015 21 a. Metrtca of Disposioon I ®Cremekon ^ Dmalan ^ & nal ^ Removal Ir n sc r i 21 b. Dale of Disposltlon (ManN, day,Year) 21e. Piac~ d Disposition (Name of cemetery, aema~s~r a other place) Hof Lman-Roth Fun l H r & 21d. Loplian (City) tam, stale, rip code) , a a e Wu LYemaUon or t3onatlan Authorlxee ^ Omer - ' by kledkal Exeminsr/Caorar9 Yas^ No n pct . 18 , 2011 e a ome Carlisle , PA 17013 22a ore d Fu eral Service a (a ac6g as rich) 22b. Upnse Number 22c. Name ~ ~~ d F•~firy Hof fmari-Roth Funeral Home & Cremato - - a~.~ CJC ( 013144E rY Complete ' 23a< prey witch cerdryvg 23a. Ta tlx , death oeaured at the tlme, dale end piece Staled. (Signalwe and tlde pnyskxn is nd avakde a1 tlrtie d death to ) ~~ ~p• Nu'^b•r 23c. Dale Signed (Month, da ,year) ceruty cause d Beath ~ - Items 2x26 must ce mngleted M person 2 arts d ()eeN ~Q 25. Dale P Dead l0n~ day, year) 26. Wac Case Relerrad to Medical Examiner /Coroner la a Reason Other Nan Cremation a Datatlon7 - who pmarrrs death ~ ~ • . / M / ~.~ y i1 // ^ Yes ^ No /L•G~/ CAUSE OF DEATH (See Irsstruetlons and examples) i Approximate interval: Item 27 Pan r Enter die dram devents - dses5es, njrxies, a mrrtplicatierts - that dredly posed Ute deaN. 00 NOT enter lermtnel events SUCK as cardiac arrest, i Onset to Death res vata arres a v ui W fb yl li i Pert II: Enter ether sionificant ronditior~ mnlr~lino to dea h but rot resulting h the underlying cause gNen in Part 1. 28. Did Td,eao Use Contribute to Dealh7 ^ Yes ^ Pr ~' p y en r r cv a on w t daut sltowkq the a USI oNy one yore an each Gne. i ^ / / / / x ~ a~ ~~ / IMMEDIATE $E (Fvul disease a /- s ,~ / No Unkrown - ~ n ~ ~~~ G ' caNtion r n aN (~ /uC-..(9VCi YY (/(ir/~ Q/~~~" /~ ~ « ` // ,, {!/ ~ ~ 29 11 Female: ~_ a i - "" - "~- ' ~(, t4Y(/`~KIJ . ^ Due to (a asp d): ` ~ r S d U i ~ i ~ Not pregnant within past year eQuentlatly Isl ar i ons, J any, b. ~, / to the reuse fisted on Inca r ~ ~ (~ ^ Pregnenl al dme d death ~. i Enter UNDERLYING CAUSE Due b (a as a msepuerce oQ: i Idsease a njury Nat naialed the ' ! ^ Nol pregnant, but pregnant wiVun 12 days ' I c r events rewltng n death) LAST. I f of deaN Due to (a as a mnsequerw:e oQ: r pre ant, but Nd gn pregnant 43 days 101 year i d, i r belore deaN I, ^ Unknown N pregnant wiNn Ne past year 30a. Was an Autopsy Pedamed? 30b. Were Autopsy Fxi6ngs Avalkde Prior to CorttpleUon 3t. Nernst d DeaN 32a. Dale of Ir~ury (Monty, day, Year) 32b. Describe Now lnWry Occurted 32c Place of Injury: Home, Farm, Slroet, Factory, of Cause d DeaN? Natural ^ Hariidde Ofrice Building, etc. Isv~hl ^ Yes No ^ Yes ^ Na ^ Acddenl ^ Pend Inver' bm ~A ~ 32d. T~ of Injury 32e. Inltuy al Work? 321. II Transportation Injury (SpecilyJ 32 Loption d in 9• jurl (Street dry I town, stale) ^ SWdde ^ Could Na ce Deteminad ^ Yes ^ No ^ Dnverll~ereta ^ Passenger ^ pedestrian M ^ Other- Specify. 33a. CerSCert~ oNy acre) • dy 9 physician IPhyeidan certityng cause d r1eaN when ertodier has deaN and physkian pronar¢ed corrtpleted Item 23) 33b. Signature end le d Certlfi ~ ~~~ To the best of my knowedge, death occurred due to the ptue(s) and rtunner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ - . • Praauncing and cerdfying phyclclen (Physirien bdh prorwurxirg deaN and cerGlyng to pose d deaN) 33c. Ucense Number 33d. Date Signed (Monty, day year) ^ To the best of my knowledge, death oaurrod et the tlme, data, end place, end due to the puse(si and manner as stated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • Medlwl Exmminer/Caroner On the basis of esamirtallon end 1 or Inv sd tl I t t I~ ~ ~ ~ GJ V ~ ~ rJ C , I ~ ( I ~ I ~ l~ l I e ga on, n my op n an, death occurred al the time, date, and Platt, end due to the ceuse(a) and manner ea staled.- ^ 3q, Name and Address of Person~Who Completed Cause d DeaN (Item 27) Type I Prnt 35. Regsua/ hue and ' tncLll~6eT 36. Date FYed (ManN, day, year) y"'` 1~~~•E-~ 1d 2-~ ~ i CI ~ r 4VVJ - ~ X03 iJ . r~I~'l1`~>_pr~ ,(~ l'`'~' ~~I ~ ~ SJr 1 vt., c ~A I l n lrC-~ 1 Disposition Pennil No. ~ ~ ~'~ ~ ~~_ COMMONWEALTH OF PENNSYLVANIA dEPARTMENT OF REVENUE BUREAU Or" INDI':'iDUAL TAXES DEPT 23C6C1 nARF1S6~r,~, P:, 17128~C6C1 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 01 5454 FAHNESTOCK FLOYD A JR 1849 'v1/ ~ISBURN ROAD CARLISLE, PA 17015 ACN ASSESSMENT AMOUNT CONTROL NUMBER ESTATE INFORMATION: SSN; 178-16-5714 Fi~E NUMEER: 21 1 1 - 1 1 51 '~ DE-cEDEN-r NAME: DONSON HARRY E DATE OF PAYMENT: 01 / 1 3/201 2 POSTMARK DATE: 01 /1 3/201 2 cuuNTY: CUMBERLAND DATE OF DEATH: 10/ 18/ 201 1 TOTAL AMOUNT PAID: REV~1162 EX(11~96~ $ 80, 000, 00 F~EMARKS: FLOYD FAHNESTOCK CHECK~117 scA~ INITIALS: WZ RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER -: FY Ur---~,;~vuns aro oosoiztz form HUO-1 (3/Bti) rar Fiend UOdk 4305.2 ~~ St>=IlenlellL StateI71CI1t U,S.Department of Housing and Urban pevelopment __3 Type of Loan OMB A rovat No. 2502-0265 FINA_L_ ~Fr.A 2 ^FmNA 3 ~Conv Unins. 6. File Number 7. Loan Number 8. Mortyaye Insurance Case Number __`~ ~; 5 OConv Ins. CL12578 _ __ _-- -Tt~ worm is ufTnis e o give you a s a amen o ac ua a amen cos a. m un s pal o an y e sell amen agen are s own ---- -"'"-----_"" - ---~ ~.. f~Ole ~ zms mar,~od "(p.o.e.)" were paid outside Ina Gosing; they aro Chown here for inlormalion purposes and are not included in the totals ` I TI(12EX()reSS 521112 m2n1 5yS121?l Rh'~NG It is a crime to knowingly make false statements to the United Slates on This or any other similar form. Penalties upon _ ,. ~ ~cliun car. include a fine and imprisonment. For details see'. Title 18 U. S. Code Section 1001 and Section 1010. Pflnted u7/1 ~/2~12 at 09_31_:Y~L_ w,h.tE OF 60RROWER~ Harold Z. Swidler A~,CRESS ~~~r.~°.~tE of SE~~~ER Estate of Harry E. Donson ~'•~_'r~ESJ _ ~.t,tE of i_ENDER ~------ ~DRESS. ~,EOFERTY ADDRESS. 25 Circle Drive, Carlisle, PA 17015 Middlesex Township - =',~vr :,ETTLE141ENT _._... ___-IC-.T-,„T~ __ 10 _ __ 12 20 ~0 Cornerstone Land Transfer, Inc., Telephone: 717.730-9664 Fax: 717.730.9665 4705 E. Trindle Road, Mechanicsbur4, PA 17050 _ J. SUMMARY OF BORROWER'S TRANSACTION: K, SUMMARY OF SELLER'S TRANSACTION, - . GROSS AMOUNT DUE FROM BORROWER ------ - 400. GROSS AMOUNT DUE TO SELLER - tra~~ sales pace 133 000.00 133 401. Contract sales price i 1000.00 rc~s~na>I roPen`r - _ -- --- __ _ ____ __ ___ _ __ _ _ _ . 40'' Personal pr~ertY .__-- _ ~ - _ _ --- 2'r2fflent charges to borrower (line 1400 1,980.25 du i_ ~ - , . T _ ~ ^ --- 404. ------------- _ 405. __ __ _ _ _ _ Adjustments for items aid b seller i n advance ____ Ad ustments for items paid by seller_in advance __ _ _ __ - - c, ~ lazes _ 406. City/town faxes ~ :, _Xes 07110112 to 12131112 _ 332.67 07110112 to 12131112 3 407. County faxes 'i 32.67 ..; ax~_s 07110112 to 06130113 1 719.43 __ _ _ _ __ _____ . 408. School taxes 07110112 to 06130113 I 1 719 43 ------- - 409. -- --- 410. ----- - ---- - --- ------- -- ' -- --- 411. -- ---- --- --- --- 412. - ---------_ . GROSS AMOUNT DUE FROM BORROWER 137 032.35 420, GROSS AMOUNT DUE TO SELLER 135 052.10 . AMOUNTS PAID BY OR ON BEHALF OF BOR ROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER -~ rosy a earnest mone ~ _ ;= ~mwnt er new loans 10 000.00 _ 501. Excess De osit see instructions _ _ 10 000_00 1' 502. Settlement charges to seller (line 1400) r __-3,_209.44_1 - ~, :,~ ~ s'~ ay:en suoJect to __ _ __.__.__._________~._ i I 503. Existing loan(s) taken subiecl to 1 504. Pa off of Firsf Mori a e Loan ~ _ _ - --- ------ - 505. _____-!-_~ ~ 506. - -- -----------~ - 507. ------- , _ 508. ~----- ------- - - - - ~ - -i -- -- - --- -- 509 __ __ Adjustments for items un aid b - t ;town taxes ___ seller -_ ~ _ -_ _ _ _ _-_Adjustments for items unpaid b seller_______ _ _ i 51J. I,Ilown taXes rrv tales _--_ - _ _..~~,~_' :~.~~~ .____ ___ _- __. _-_ 511. Count' faxes.-- _.--- ,--- _~ 512_School taxes _ __ ~ _ - ~ ~ r~ ~''~ Taxes _ ._ i, 513 School Taxes ' ~ - -- -------- . ----- - 514. - - ------- -- _ -- - -- : - _ 515. -- ----- -- r - - -- - __ _ , 516. - ---- ------ ------__ r---- _. _.--._. _----____, 517, I _ 518. - - -- - -; --- - - --- - ' 519. -t--- --------- - -•'. --------- - -- - --------------- )._TUTAL PAID BYIFOR BORROWER 10 000.00 - 1 520. TOTAL REDUCTION AMOUNT DUE SELLER -_______ 131209.4.4_! ). CASH AT SETTLEMENT FROM OR TO BORR OWER 600, CASH AT SETTLEMENT TO OR FROM SELLER ~mcunt oue from borrower line 120 - --- - 137 032.35 601, Gross amount due to seller line 420 135 052.10 --- _ ~_ ~ r_ -~._~ _sra~q-oyitor borrower (line 220) - - 10 000.00 _ 602_ Less reduction amount due seller (line 520) - _ ,______13,_209.44 f - --- i_CASH FROM BORROWER _ ~ 127,032,35 , 603. CASH TO SELLER 1 - 0 _ O 0 - 121,842,66 ... ... _ .._ .- _. :.. tJsS :ic~_LER STi.TEMENT. The inlormaoon contained Herein is important tax Inrormatron and is being furnished to the Internal Ravenna Sernce. Ir you are reyu«eb w file a re turn, ,~ _~.~^er s:,nce-on will ba unposed on you it ;his item is reyuirad to ba sported and the IRS determines Thal it has not been reported. The Contract Sales Prico described on .. ~,_ __-.~ _~ -..... ~,es tnz Gress Proceeds ct this «ansacbon. . _ _ . a , . _ ~.ti Ic pro+~da the satuemant agent (Fed. Tax ID No 251751 821) with your correct taxpayer Identilicatron number. II you tlo not provide your correct taxpayer identilicat~on _ ,.~ , - :~;,, '.;r suc,ec; ~,~ civ~i or cr~minai panalbes imposed by law. Untler penalties or perjury. 1 certrfy that tna number shown on this statement is my correct taxpayer ~donut~cauun nunrua~ ------ --- - SELLER(S)StGNArURE(S) r-------------------------- ns are obsolete Iof1n HUD•1 (3/86) ref Handbook 4305.2 '~ U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number; CL12578 FINAL PAGE 2 SETTLEMENT STATEMENT TitleExDress'Settlement Svstem Printed 0711012012 at 09:31 KL _- - L. SETTLEMENT CHARGES PAID FROM PAID FROM __ _ 700. TOTAL SALES/BROKER'S COMMISSION based on price 3133,000.00 =T~ BORROWER'S SELLER'S Division of commissi n tin 7 0 f II ws: FUNDS AT FUNDS AT 701. tp SETTLEMENT SETTLEMENT 702. t0 703. Commission aid at Settlement 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori ination Fee °/v 802. Loan Discount °/a 803. A raisal Fee ~ I 804. Credit Re ors 805. -- r i 806. 807. - 808. ' 809. ~! 81G ~ _ _ 311. 90_0. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. interest From to Ida '' r 902. Mort a e Insurance Pr mium for 0 most t I 903. Hazard Insurance Premium for 0 Mont to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance mo.: Imo ^ I 1002. Mort a e Insurance mo. Imo '. 1003. Cit Pro art Tax ma Imo 1004. Count Pro art Tax m . Imo 1005. School taxes ma Imo r- ? 009. A re ate Anal sis Ad'ustment 0,00 0.00 '_ 1100. TITLE CHARGES t t 01. Settlement or Closin Fee to Cornerstone Land Transfer A ant for LTIC 125,00 t 102. Abstract or Title Search I i 103. Title Examination i t tu4 Title Insurance Binder 1 ? 05 Document Pre aralion _? tv6 Notar Fees to Nota Public 5.00 10.00 t 107 Attorne 's tees to Irwin & MCKni ht POC SELLER i __ includes above items No: ?tub. Titia insurance to Cornerstone Land Transfer A ant for FNTIC 443.25 _ incluoes above items No: I t 109. Lender's Polio t 1 t 0 Owner's Polio 133 000.00 •443.25 11111. i 1112. ~t 13. Reimb far tax cart to Cornerstone Land Transfer Agent for LTIC 20.00 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES _ _ ' t 201. Recordin Fees Deed 52,00 • Mort a e ~ Release 52,00 r t 202. Cit Count tax/stam s Deed 1 330.00 • Mort a e 1 330.00 1203. State Tax/stam s Deed 1 330.00 • Mort a e 1 330.00 I t 204. Deed • Mort a e 1205. Deed ~ Mort a e ~ Release r- 1300. ADDITIONAL SETTLEMENT CHARGES 1301. A lication Fee to MTMA 25.00 ~, ~ 302. 2012-12 School Tax to Frank Roberto 1 T62.90 303. Final Readin t MTMA 86.54 - 1400. TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section K 1 980.25 3 209.44 HUD CERTIFICATION OF BUYER AND SELLER nave carofuiiy rev eoG d the HUO- ettlema lateme t arW to the best o(my knowledge and ballet, it is a true and accurate statement of all receipts antl dis5ursemenls matla on my account ur oy r; fevi tni~act;gn. I lurlher certi al I haya~ived a copy of the HUD•1 Setllamenl Statement. /~~~~~~~ `..;RN~NG IT IS i, CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE The hIUD•1 Satllement Statement which I have prepared is a Vue and accurate account of this ~NiTEU STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION transaction. I have caused or will cause the lunds to be disbursed in accordance with this statame t C:,N INCLUDE A FINE ANU IMPRISONMENT. FOR DETAILS SEE TITLE 18' ., 5 COUE SECTIUN 1001 AND SECTION 1010. _// /J . ~ ~ i' I SETTLEMENTAGEIJy. , DATE:~~~ ., , ,,Fs Y ', _ ' • . , '.: ~ ~Y , : ,,.r ! . 1 ~ ~ .. JF~:f ~)+~,~` tF ~ E~ ri.~*w ;t r r~~j~~~#~t}(~~"~~ ) ~ 8~~ ""r0~ ~,~1 ~ M 'r r~ l ~t4f `{., rte ~! ~• Check Confl,rm~~ or~4Xf'~r ~ r~+? ,~ ~ f. t ,. .~iY r f1~tl,, ~ (v . , 1 ~ ~` ~ ~ ' ~~ ~ lS ~ 4 Confirm Date ~Dgc~rnbgr 14;~2 01a; .. +; ,-~ .~-.. r..: , ~ a~,,~ ,! ' Account Number. '6$2030879 ~ ~;;f+ ' .. , ~ ' +;~_ Account Type; , Regulai gccount - ' ~~., ~ t; broker/Dealer, •~ :ING )nvestments pistri4uto~• LLC , ' ~ •. 7337 E Doubletree Rarich Rd : -` ` ` ?' •' . Suite.100 , .. •. ~ ~ , i ~ ooos5 sH I NG1P001 ' 't _ . Scottsdale AZ.85~5$ ~ ...,'•.' ~. .. ' ~ ;~ + ,,~~rr I PHILIP V HOFFMAN AND FLOYD A FAHNESTOCK JR EXECS ~'~~~=•~ ~~~'~'~ THE ESTATE OF HARRY E DONSON ,, ;~, . • • ~ -~')-•~ •; •~ ~~ 72 LADNOR LN • .. . , .. CARLISLE PA 17015-9215 ING CONTACT INFORMATION ` ~ Shareholder Sgtvices~ ,.+ • ;800 99~-0180 ~ ' ` • ~ Websitec • ,, (. `vrww.ingfunds.com' `~ ' , ~ ' ~ , `', ~. A MESSAGE FROM ING -- _... .. ._ ...... _ ____ - - -..__--- .- ..._ _ _...._ .. _ .~..,~.. ;. __._ , ._. ,..._.. _... ... Did you know that ING Funds now offers electronic delivery of quarterly statements, annual and semi-annual reports, and prospectusest To leam'more visit'us on the ~ `:• f:+w_'~ -- w at www.ingfunds.com or call us at 800-992-0180. . .,.,•. , . :.,. ~.;•.,;,,, i~,~---~- . ...~... .. ~..~ FUND ACTIVITY ,` : , i. ~ + _ ING CORE EQUITY RESEARCH FUND-CLASS A Js ; ~--- , Fund Number: 1574. Fund Symbol: AAG I~v'` ~; ~~+~~ , Dollar.:. .. Share .. Shores Thls .. ` ,; ; ,Share ;` `~"""' Date Transaction Description , Amount '" Price '• • Transaiaion ''rt '' Galan<e "~ ~ '~ 12/19/11 NEW ACCOUNT TRANSFER IN _ ~ 5989:55'" `' ' '510,96'"°'' ~`•'" '" `''~`~90.287 " 90.281 ' 9933360673 lr,~..'',)~;••;a:~. ''~~~~'~''i; ! .. - . ~ , 12/19/11 REDEMPTION . •; _. ~~ ~ S989.55:. ~ t'S10.96` ~ ~ -•90.287 '' • ~ ' • 0.000 ~~~ ~-- Ending Balance as of 12/19/11 at a price of 510.96 was $0.00 ! ~ - , ~.,.,,; .:, Li. .:; , , ; , .;, ,,~ . Because the offering price is calculated to two dedmal places, the dollar amount of any applicable sales charge as a percentage of the offe~ng price and your~riet amount • invested for any particular purchase of Fund shares may be higher or lower depending on whether downward or upward rounding Was requ(red during the calculation - - process. • ,.. ~ .. ,•. ., i , .. .;,, ~ ~' n M c , ~ c ... ,~. n ~ , ~ , ,.. INVESTMENT SLIP ~ ~ ~ ~ :{~ ~.~ ^ Please check for address change, make corrections on the back, Account Number Account Registration• r ~ ~< have all owners sign, and return slip to address below. _ 6620305879 PHIIIP V HOFFMAN AND . FLOYD A FAHNESTOCK 1R EXECS ... . ~ THE ESTATE OF HARRY E DONSON 72 LADNOR LN CARLISLE PA ' 17015-9215 - ~ - .. - .. ~. Fund ~ •Tax Year- ,.:,~. , .. ~ :... ., ~ I ~ • Fund ~ Name (I A onlYj'''' :Investment Please mail in the provided envelope and make checks ~ payable to: 1574 ~ - r ING CORE EQUITY RESEARCH FUND-CLASS A - .S ING Funds .. .. . ' P.O. Box 9772 S • ~. Providence RI 02940-9772 ~ . ~ ' ~~ ~ ' " • S '• • Total Investment .. S .,.. ... 464 o000 6620305879 ~ ~ . , ~" 'Shareholder Copy . . Page t of 2 Account Holder(s) Harry Donson Account Number 889.10895.1-1 Account Type Single, TOD Financial Advisor Michael Cornfield, 717-249-1384 950 Walnut Bottom Road, Stonehedge Square Suited, Carlisle, PA 17015 ~"°"','' Statement Date Oct 1 -Oct 28, 2011 Page 1 of 4 ~~.~RRY Dotiscf~~ G'rVing Thanks %~ CIRCLE DRIVE CARLISLE P;, 1?G15-8894 The true meaning of the Thanksgiving holiday lies in giving thanks for all that we have. We value the relationship we have built with you and would like to thank you for the confidence you have placed in us. We'd also like to thank all those who have fought, and continue to fight, to protect our freedom and preserve our great nation, On Veterans Day, please remember to thank those who have served us so proudly, We remain dedicated to serving your financial needs and look forward to working together for years to come. 115, 956.02 ~ f:lonth Ago Year Ago Beginning value Assets added to account Income Assets withdrawn from account Change in value Ending Value Cash ~ Money Market -- - ~ . _'lcy Market 0.01 °'c = v •-e'y7- _:ai~ on the money market fund for the past seven days. Corporate Bonds ~...~, .;~^ 'NU Cap CGrp Sr NOIeS ,~_... ~~. ;'tr Cap Corp Sr Notes • ~~~~~:.,. ~Comm~~n~cations Inc Nt hi .;t;,ai Funds___ _"ccr ~~,;~r!CaTcnia! Gr1ti' Fo A This Period $11 1,807.28 0.00 979.80 0.00 3,168,94 $115,956.02 r Maturity ~ ~ Maturity I Amount Invested Amount Withdrawn Date Value Since Inception Since Ince ptlon 12/1;2038 17,000.00 19,818.45 ____ ' I 12/7/2038 ~ 15,000.00 16,654.95 ____ 4/1/2039 20,000.00 21,270.95 _ i Amount Amount ~ Price i Q Invested Withdrawn uantity Since Inception Since Inception 12.15 1,670.825 18,981.08 This Year $59,659.33 47,514.49 3,943.54 -244.43 5,083.09 Ending Balance $3,696.39 Value 1 9,230.06 16,472.25 27,236.80 Value 20,300.52 0 _~ NW O N f~0 Z 2 z z Z z 2 z 2 2 z z z z z P "0 c~ • ~ O ~ n , O ~ C C ~ m ~ 3 D rn ~ ~ ~ X O ~ ~ ~ ~ ~ ~ N ~ ~ ~ ~ c ~ ° a - < v ~ ~ ~ ~ a~~ v- N ~ ~ m ~ c~ ~ ~ N ~ ~ ~ ~ -~ ~~n N lA n N N ..a wO O i~ w W is N J W O it W M .a O ~ ~ . N -+ v :,+ ~ ~ ~- 8 i i H W~ C ~ Co c W ' ~.- 8~ M ..- w O ,~' N W H ...- W O N W ?c=i~dc~Dn~iO ~ ~t ~ ~ ,Q ~ ? N ~ ~ CD ~., , ~,. < ~ ~ 4.aN ~ ~~,~n~c~~:°' N N ~ •.; t, , ~ Q N ~ .-« C ~ ,sFr; '. ~ a ~ u, ~~1~ ~' ~ ~ } , ~,:,~,~ H -~ O ~ ~N OW ~ ~o ~ w m ODN0000 W ~ -+da0000 ca O U1V0000 -~ ~ N J i W O = N -' N i ~ U1O N O ,U0100N00 N (ll ~NO~~-00 b DZ7 C ~ C W ~ (a W CD ~ Z~ g O b g b ~ N ~ ~ p C JtN ~ .acaww m ~ _ ~ x1 OD a~cn~ ~ ~ m- O M JWN~1 ~O J prn~~ oCCi> ~ ~ DO o C~ n ~' ~JONN _~ O O C~ D OOD COJ1 .NA d~ ~ -~ ~ ~ Z -• C' ~' ~ O ~ ~o m J ~ O N J V Z~ _' N W (D 0y ~ ~ i ~~ p O (h .A ~ -~ N oo O (7 ~ -.• ...• ~ w ~ -~ ~ow w -gym oo- pp JWWO ~ ~ v0 -I .~ ~~ -~ aONN p A O O .Q ~ "'• J J Z m ` Z n v• ~ J R V -- w ~ ~ ~ O N ~ No°w ~m i c0 -~ v O cn m O -- ~° ° Z D Z TD N D O Z N 2 D rn C~ O C..~ c .. tf ~,{ ~-v ~~ `t.r YS ~.i:t I . ~ 1 1..• F 't. r 1!!` Jr -I 7 a Y' M4 j!1 ... ~v ~1. ~M`T~i~r'~i~. S k{ if'`'';,1 ~3v,:,1 {Y~Jy d ~..•l~ ~^Il±~}74S~ht)`#~ y r y i" y+'. • Tof authorize the direct deposit •of future deed • a men c ~ ~ ~~ 1 `' `f 4 " ,i ~ t'a it., f~ '~ <'~•3~''~rf'~~• ~ 'r ~' divi t ~; . ~ - , . .and mail P Y, is omplete form on reverao s(d w~ ~'a ~~>4t ~f.,~ d.,t ~ '~ J ~ _ .~ ~ ti ;~• this portion to: .' .. ~ t~:l ,~;fjr l ~~, 4~~i~~,~ t ~1, ~ ~ ,:, + ~~ ' yy ~ , artSi ~ r 1j11'~r'1k, y ~'{;e~i ~ rii`~~,~r(t I j''S. j ~r ` if~'~1vP+L~~I •. ri t..r 1 .I i dt17 Y~ v (ssI t~ 1,1 ~,1, t}t ~, y t, ~f •~ ~•~ t ,,~ 1, C'1J 'r/~ 1.`4 gPRt:~~A~cCC -t~u~nperi~``~099002099'::,~;~:`~~, PPI. Corporation .. .>< ( y,~' : ~.,~y' I!_f?tr fli y Srjynt;ll'y~ifrf.~~f Il'#~~/i{,ey It~~1 ~~'~'~~,~tF~ll,'t('~kr~~`r'i;~ h.~~. ~~r lk+{.it~ I r'••.t ~ ~) Jyy ~{~;ijau~',(r .Yd~. '' r~'Y ,r''.y, d {_r v. .r.• ,.t'" !; Investor Services, GENTWI3 ~, '. i• "~ ~ ' ~~~,~,• ~ ~~`°' ~lccouratgegl~tratiori and.Rrimary Address:it" Two North Ninth Street •~fr 11~' .• t r ~: n ~. , , r r Jy , ir,lfx'i~i~~ DQ ON'~6''''~nid 1, i ;'hd ' i 1 i t. y3l7~~S~1•} f~ . ;• f'J~ Allentown; PA 18101.1170 '' ' ti a, 1 orf{~,a r~•~ ~~6~D~~iku7~~-: i!(r< r ;;4 t if + 1 x i,1 r.Yl p ; , ~, r~.~it ftr~ r ~r f:. 5c1~. !7~ }1 .r.r(at. I ~Sv , C~~:'+,'1 'r~{: ',~. ' ' r ; CARt.13LE,'PA'17013;'~ ~J ' ,.; t ; a., f .f i~; ' ;~, t i.; t c t rjtyr J`~ r.. %7 fl ~},~}: ~1~'.!T N'.'~vti li ..: ..i:~, y)/•.r' Yi ~ ,.5.. HARRY DONSON ~ ;~ ~~,' Payee and 2 5 CIRCLE DR ~ •'• rl 1 '- t )~ „ r <. ,#~~~; Pa ent CARLISLE PA 17013 r ~'~' ' ,~f •. Address: ~. ~ ~ ... ,, r ,.:'' it• _ ~ ~ r `f`. ~:''~ .L M1 'r:Ir. + itJ"~ '' yy 1.d 1 ., .tip , ,!~5~~,,; ,1 t' . I• S ,. , .. ''~As'of ~record,date;'.yl~ rf . ;;~, , . ' ' • ~ , December 09, 2011 Receive your future PPL dividend payments quickly and safely,,, ; ~, r:r"~ ' "' ' ' "~ >r 1 ,yl, .i r. ~ r i•,. - .•, h4 ~:: 17 a.` vt `,~~~~''.. 1rLi ~l ty r r'IY J,' 1 ~ ill, ~'~iJi r`l,~'~J Yt ~~~f,~. !!rt Simpry complete the Authorization Form for Diroct Deposit of PPl Dlvidahd PaymRnts on reverso°sidq, de~l~h,and .mailrtq~PP4 Goryoration qt address• above.' ! ,1 f .~ .. r1 t., "I.',TJr 11l /fi r ,i•1 )7+~~'' Xr 1:,1 )d tijy, i{. ~r!/yI.Y~~•'~I I . ... ~' 1 1. 1 !. r ~:,1 4 i ~ / 1 •:f ~'rE}f~ti i ( ~f ', ; ly ~ :.y+'~'~Y{~~~1 ~+r...-....~.. 1w . sv...w...a w tt f.- v...:::. -.:.':.w~',i •: ~'. ~ ;Kr y; • . ,. ~ r~L(Y 1~ ~ s~' >, f ~. 'r r'3, ~ ~iG r,J r~.. '•; r ,; d r , IY .. f 1~ „ r r l o PPL Corporatton;~ , . ' ~~ ~~,~~~ ~ t ,: v fft': a ~ r r 1r l '~ vSv 1 r' l~ y.lYjtt«fi/ r,5' ~ ~ ~; .... tr ri1 i ~~~ , Jfh y~t:~i(~,~'f;. h~~y"lHp Wy rt ?y~, Two' North Nlnt{r~' Street ~:. ~ r .. ,'~;~; rt,, r~,,~; E, ,"-~f~l~r r;JJ~ 4~, • f. ' r ~i~1:1 ~ 7; r'~x; 1 , ''~~M~.~~j:r Ali +~{Y` ice' ~?f,. Allentown, PA 18101=1179. y ; 'riJ ,, i ,> f` ~,/(y ~; h, i' I Y t ')t ~ r' S lili.•lt ~, Jf' 4~ '',r' ~(+(~ ~,' www.ppiweb ~corr „ r `_` ; ,'$3.. ~, ~ ` '; r J k~I 1r Itd'•y~ ,~~'r _. ~ rr ~ y.4r~, r rrft, .fl'. ti r. )_t ri„a ~ r~~'1.,. PPL Shareowner Account Number: 3099002099 Account Registration and Primary Address: HARRY DONSON 25 CIRCLE DR ' CARLISLE PA 17013 Share Information: Certificate Shares: ORS (i3ook).Shares: __ ._ . Plan Shares: Total Record Dais Shares: 2.000 0.000•. 4.000 Year To Date Dividends: Gross Dividends Paid in Cash: Gross Dividends Reinvested: Total Gross Dividends: Total Taxes Withheld: 1.40 .00 1.40 .00 Change of address required? t . Cal(1-800-3.45-3085 toll-free. 2. Or change your address by accessing your account at www.shareowneronline.com 3. Or mail your change of address to: Shareowner Services P.O. box 64874 St. Paul, MN 55164-0874 Please be sure to include your account number. Changes must be auUioriz8d by au registered owner(s) or theft legal representatly®(s), .~. •~.i 1 '. ' .'(~ _ ~ M, , n,. Dividend Ch ~ ~ ` y : 1' r ~~ ''• I` k; mm , it r l-71 tr / r1 .~~ ~ ec Su ary : ,;, ~ ,; , ,~ , .~.; y, .Check Number: ' ` i' , ,. ~~~; ~~s ' II :~I`03Q'95226 , , ( Dividend Record Date~~ ~-~ ~ December ~ ~~~ ~ >v ; 09 2 ~` ~'~ ~(' r 011 ~ , 1 , . ~~ Dividend •i?ayment'~Date:rll~ 1 '~:'.J~ANUARI~,A~3 ?~0112~`' f~,~'r ~ is r,.~~Jr,, `~ ~ ( ~ V r : t ,., f, „~~r,1 f 11 ~ . 1 .., ( >>`~ ~r ill, Y ` t.l. , Net Amount X ~ , . . I r't ~J l ~,{,,i ', ,..,1~ ~ l~' ~~ I Jr 40 ~ ; ~1 •Y. .1 I .riv 411.r .}`• .., ~ '' '~: r ), ;;, , `Record:D~te T, r; :'DIYi~en~ , ~Y~': , .' fr a h s re: pa7~ ~y;~: . ` !~' S .y '~':• a~'~er, 1~'t Jr , s 4 ,~ .l .1 ., . -.Dividend' Class of Stock . 7't~'":Check ~~ 4~ •'~~~SFia'rQ~ y ~,i, . ~r;' ~' 'Amount PPL ~CORP COMMON '` ' ~ ~ 4000'{ ~ y ~ t r' 1 `,'3500,i'l~a y , ,,: , 40'' , 1 , . 1J, ~ f .T. , ~~~ ~Y~~ ~ pry( it I 1 (~ ,;. . .. ;~ ,: ~ . .,.q f ' ~ :~ ~~ i, ,: . .. ... , i . ti t_: _i Information on the Internet:. ..~ ~~' '~ ,:'>~. ,, ...'Account access and transactions:,www,shareowneronline,com ~, 1. . General inquiries: www.wellsfargo.com/s.~areownerservices ~', PPl News and Information: ~~ www.pplw~b.COm ,.. ~ ' .i Information.by phone: ~ , F ' ~ .~ 1 ,. 1-800-345-3085 toll-free ,within U.S. or 6b1-453-2129 from outside U S ' ~. ' Select Opt(on~ 1'at first menu for PPL's Nsws and •Informatlori Service Select; Optlorl; 2 at .first fienu for; account access and inquiries ' . 01 . r;:, y;; . > .,. r•1~1~J j.•Y,. .1. ~ . J - ,, ' J;', ,:~ J,~ ~ %• ''l ~~r.~}(.f. '~/tS'.. ~:~ld'~~'II! \I S r • ,t .. 'r,• i! J 1 t •' : , .d. i % .d! (( ~v dt f i.; l;~; ,,,r ; i i, l n t~.t 1<S/ iV;IiJ{1?1~~ ~t~\11\~`Lr't, R ,~ ~i J f 1\. !fv j,il~ f}r t51 ~`'~l~ .A''t11 1 t t '1 t.. I \il ~~ Jt yYVJdj„l~: tj dy,~'~l ill 1r'~11t~11 ti, ~Jr t~ .1. 1 ' ~ L•~ti . ``} ' .~ ti i y1 ,,~ , j ~ ~r~ , 1(d ~ ti 't 1.` 1' ~ 1 ~ 1 t r L ~ v .. ; T 1 l t .V .\~ .\'.~ 1 PPL Historical Prices ~ PP&L Corporation Common Stock Stock - Yaho... http://finance.yahoo.com/q/hp?s=PPL&a=09&b=18&c=2011 &d=09&... ~~~ Hi, Karen Sign Out Help Trending: 1 Mail My Y! Yahoo! _.. -__ _ _ _ _ Search Search Web __ ___ _ i _ - r-- -------------- --- HOME ' INVESTING NEWS PERSONAL FINANCE i MY PORTFOLIOS ~ EXCLUSIVES Get Quotes Finance Search Tue, Jul 31, 2012, 11:OOAM EDT - US Markets cbse in 4 hrs and 60 mins Dow •0.08% Nasdaq 10.24% E'~'TRA~t~.~ (t A:noritrade OPEN AN ACCOUNT .® CMTRADE SECURITIES LlC ~~i,.'.!!XZ~?J'~ PPL _ PPL Corporation (PPLj -NYSE Add to Portfolio Like ; 31 29. ~4 • 0.16 (0.55%~ 10:59AM EDT -Nasdaq Real Time Price Historical Prices Get Historical Prices for: ~- ~Q0~3 Set Date Range Daily Start Date: Oct 18 011 Eg. Jan 1, 2010 C' Weekly End Date: Oct 18 011 ~' Monthly C' Dividends Only "~Get~Prices First ~ Previous ~ Next ~ Last Prices Date O pen High Low Close Volume Adj Close' Oct 18, 2011 28.44 28.87 28.27 28.70 4,073,000 27.64 ' Cbse price adjusted for dividends and splits. First ~ Previous ~ Next ~ Last ~'~Download to Spreadsheet Currency in USD. Top 10 St These 10 stocks are set to crush the market in August 2012. 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All information providad "as is" for mforrnat~onal purposes only, not intended for trading purposes or advice Neither Yat~~uo~ nor ary of independent providers is liable for any informational errors, incompleteness, or delays, or for any actions taken m reliance on information contained herein. By accessing the Yahoo! site, ycu agrea not to redistnbuta tha mformatlon found therein F'undarr~~antai company onto provided by Capital IQ Historical chart data and daily updates provided by Commodity Systems, Inc. (CSI) International h~sioncel chart data, daily updates, fund surnnkry, lurid partorrnanca, diwaand data and fvbrningstar Index data pro~nded by Morningstar, Inc. 1 of 1 7/31 /2012 1 1:00 AM Nl ~` x ~.y~f+ir t ~~ , r ,R . ,a,. 5i;x iy3fa~ ~ ~:.~':."! Y'F`!~ ~~'IfQ,~ ~~~ 75'a'~iJ~i~ r'Gr '`off f !~ C~'l r 3f! < <K. _____. C~RRSTO'V4~N~•ANK , ~• ,~,, a. s~ ~ .- A Trar~ion of excellence '~• ~ , ~f .1~. o , P.O. Box 250 ~ •. ORBS 0 Shippensburg, PA 17257 ~' ~;r,' ,+ • '..• o )r rf Temp-Return Servic@ Requested Date 10/.1/11'. . • Page ;~; ,1 ., Primary Account 111000247 ~• Enclosures 8• ~F ~. .~.. 001200 0.8500 AV 0.340 TR00004 •~ "'~ Harry E Donson "'- 25 Circle Drive • Carlisle PA 17015-8894 ._. C H E C K I N G A C C O U N T S Account Title Harry E Donson 50+ Interest Checking Image Account Number 111000247 Previous Balance 276,658.73 1 Deposits/Credits 915.00 8 Checks/Debits 277,573.73 Service Fee .00 Interest Paid .00 Current Balance .00 Number of Enclosures 8 Statement Dates 10/03/11 .thru 10/31/11 ,~:": • ... Days In The Statement Period •~ •2g :. Average Ledger 227,841:79 Average Collected 227,841.79 ZO11 Interest Paid •~ 60.73 . Deposits and Additions Date Description Amount ~ • 0 10/03 XXSOC SEC US TREASURY 303 915.00 ~' P PD r o o N .-•~ O O o E.Zectroai.c Debits and WithdrawaSa ~ ~"~• •''~~~ Date Description Amoi~it 10/27 Close Account '~ 274,731.62- N O ~„ ~ ~ .. O ` ..~--_..-.. O N --- CHECK SUMMARY --- . ... Date Check No Amount Date Check No Amount ~ ~ 10/03 4238 168.84 10/0.5 4244 1,171.97 o ~ 10/03 9241* ~ 92.21 10/06 4245 50.00 ~,~ 10/09 4242 48.75 10/14 4246 1,000.00 ° 10/04 4243 310.34 * Denotes missing check numbers y _ v~ '' ,~ ~~ ~, ,. ~,. n' ~• %, ~,. r! f~ ~ ~~ `~`~\itYle\Ji~11 ,', ` j ~ ~ --° ~ ~ ?~ ~ ~, c{.~~ ".i.. ;~~~~<ii 1 ~ ;; rl~\ ~~i+~c t +`,i \~ ' ~ ~ ~'`~~ 'i~1~. ' 11 ': ~y .. ` ' rii ~~ ~~ r 1,i ,.J •~` ;, ~ ;;~~ `y~ ~; ~? ;~ ~; ,,if ~~ .,Y~ :~., C,=,rli.sle Giant 2!°.5 ;south Sprir,garden Sl:reet G,:~rli.sla PA 17013 I~'~qui.ries Call: 717-24J•-4f :140 A~::ct XXXXXXX04t:~ I)ONSON, FIA1.~FtY E E:I'f : 10/28/11 Date: 1()/:Z8J:L1 T:l.r : 0707 Time : 8 : 5!~~sm S,:,q: 571499 W:i.thclrHl from F:EGULI+.R a.A'VING:; 0000 P:~~ev F3a1: Amount : "~ . 37 N~:,N F-al : ~~ .:37 S~,,q: U .00 C,~ish Disbursed •_.~ ,37 F:i.va,: Disburse+:l Ones Disbursed 5.00 ~' . 0 0 Q+.iart:ers D i sbur•s ed () . ~5 Di.mac, Disburses( P~:,nni.es Disbursed () ~ 10 /~ O.U2 ;/ ~_.~•- -=-G.- ._ ' Crash Reae:miveei by IU :'%+~urc:e:: ~ +:: C v I~i.c f~:noNr~ }',i GChex~ _i E:?_1JNL' F':QL•C) .__-- VISA Aaa~ince ?':r•+snsfe+:: 1 , 90~ APR NO . t~al~~nca i:ransf~a:r fees . 3~a,k an associate for mor,y details . .__„ i _ - T BRICKERS AUCTION Buy & Seil on Commission -Complete Sale Service 93 Texaco Rd., Mechanicsburg, PA 17055 766-5785 Personal Property of Address Sold At Public Safe outstanding Total Sale _-____A ~", </ / ~ ~ ~ O C, ~ F~ ~ Total Checks ~~ '~' ' S v /~o~~ Total Cash J ,_ ~T ~~ ~ ~ Cash After Payout _ _.... _ ~ ~~, ~,~ -~~ ~-~-C/1------ - _' - '°f' T`^ ---~ ~------ ., __~ , '- ~--r~, /~ _ , _----- ~ - ~ ;'~ ~r~ ,_. ~~ ~- 1; , ~ --- - ~~ 1 ( 70 ~ ~~ Expenses ductioneer ~ Clerks ~~ ~ ~ Adv. Cost Property Fee C, ~ ~ ~ j~~ Sale Setup or Help V ~~, Total Expenses ,4/ C~ ~~ ~; , ; ~, ~ ; ~ ,' r ~ ~,~ ~~ ~, ~-;~~- ~ .4 '. `~. Y ~ !') 1 ~' 1 .~~t .y ~ ~ ~ ~-~ •' '~ .A U t;j ~ :..1 r. , f.4 ~ ~, l~ t„~ (~i ~ ~..J ~ r , .~ I f, ~i~ ~.) ./~. fl .. ..,1 NN ~~~ ~'~ ~.~ ~ .J 1 ~ ~~ U ~~ ,:~~ W :: , ~~ J ~ ~~ J „~ , r 4 - ' IGHMNZKm ~: ~. ~. Date: 11/01/2011 Gross payment amount Net payment amount 0369517 r~ :i' ,{k ' frr ~ ...:: ~~, , - .. f... J~ ,. ' ;.J +... ty 4 ,. ... ... .F .. Air.. 2 Y "~~ ?St.i 4rE y~v \.t w, !r fro u r r; 1 w~3;~ r r~ •+~ w~~ , r t ~,, a t~f# t 41 rx._ ryr,~tl,¢,~i~t. r e GG ~ sf ~ ,~.~ j ~ s,. ...r Y i :~~ y ~sit'~5 d r ' y..~f,sti i~ 4 :~~ ,,~ J~'~: - .,+ YYy , t • ~ _ ._ ,,_ .R _ . • r S ,Sfi .. -~^y _ _ .. r t ~ ! ~ J ~ \ ~ i \ i l rlrpp\1 ~ 4~~\' \ ~ 7 ~j\ jl} 5 ~ ( l \ \. ` r 1 yl ~ ` y r 1 r f ~ l ` ~\ ,~1 l tS~,llit ll \ ~ t Ni \`~ ~ f l ~ lyl Sl ~y1 lr\ t~~~~\i~ l~\\, r ,\~` \ i .. ~-- y y "~ ~r yl v l.. Jlti \ ~ `t 'i;L ~y f it; ;;J . c G rt \ } • `` , ; , ~ G~~ r'~ w:\. ':r ` \~ \ ~~li It \' ~~ C+,, . l ,17 y \; ' lx ; y ~ `• \l v\`54ti ~~ .. ~ . l y\ l l \\ 1. r ;i' 1 \ \ ~• 1 . ~ r\ ~ l l~\ ~.i1 1 .,ry ` 1 ~.\ r j1 , ~ t l l~ i •~~, \ ~ ~ l _ ~ \: \! ; 1 ...\ „~ ' •` \ .~~~ . ~" .. • ' ~ a ~ . i " 1~~ \ . \ \~ ';tip ,~ \ \ ` \,,~ i . r \ ~ ' ll ~; ~r \ ~ ;` tl \-, ~ 1 ` ,:~ ` 'a\ ~.,Y~„: ~,...~ ,,,, ,~w.... ~ „~ ,,,., oFF ---_... -ROTH FUNERAL HOME & CREMATORY, INC~`` ~ '~ ~ `' °`~~~ Floyd a~ hnestock ~ .~. 7 Reimb for Harry Donson funeral a 11/10/2011 xP 00.00 ,~ ~/~ ,. ~: ~ ~ - .~ C°C 1 ~ ~C Checking Funeral Ho Reimb for Harry Donson funeral exp 100.00 .. 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. ~~ Enclosed you will find an itemized bill for your records, showing that the bill' for the funeral service of Harry E. Ronson is paid in full. Therefore, we have enclosed a check~in the amount' of $100.00 as an overpayment of the funeral expense. Si , i1 ipp Office Manager $ERrVING `OUR COMMUNITY SINCE 1 907 .-. ~ ~ . ~ . Chuck Bricker Auc ' . #~oneer buy ~ ~e~i are C®mnn~ss~o~ ~ Gomp~lete~ date ~ef~v~ct~ ~~ Texaco ~ic~., -~#~~r~~~s~ur~~ ~A 'i X055 ~~f-5'~~5 ~~~~ ~f .,a ~~, ~ ~ ~~ n n ~ ~: ;) nJ ~~ ~ol~ ,At ~c f~arfs ~ ~ ~ I L `~. ~ 'zo ~ ~ l~utst~endur~ Ta-~af S~ !~--~ ~ ~ ~ L ., ~ ~ ~~ ~~ Tbtaf C:~ec~cs ~ ~ , C;( Cl (,~ r J~ ~.j ~' ~-~ J ~~ ~ - Totaf C~sfi 1 ~' `~ 5 ~ ~s~ j1f~r P~~-auct ~ Ex~a~ secs ~' . . ~ ~ l~+~t~ot~aes ~ t;EelkS ~ ~ ~ ~j r (;) U ~~r i/V~t ~ ~ ~ ~ ~ V '^ Safes Se#u~ ar f~sfp~ ~ ~ ~ ~ ~, ~. Tom ~~ ~ ~ a ~ ~ ~~; ~, ~« ~ l I~,~~B ~ __ ~'~D pU ~~ ~~- ~~ ~~-. .,~ . ~~ ~~ . s .~, -'~" s~ ~~, ~''"~` ~ . ~y ~~~ w, Chuck Bricker Au . ct~oneer E~uy ~ ~~~1 0~ conn~n~~s~or~ ~ comp~let~ ~at~ ~~rv~ce 9~8 Texaco Rc~., . ~~c~ar~ics~ur~, ~~ 170155 7f6-5785 #~arso~t P~~r~ of ~~~ ~~ ~~' ~s ., fold ~1t Pu~bt~c ~a~s 2~Cf ~ -y_ O~tat~ndis~g Tvtal Sams P i~.;~3~ ~-- ~ fl D C~ ~~ c~~s ~ ~- ~R 5~ ~ (U Go ~ ~~ ~~, ~ ~ Total cash Z_ 3 Z, SAO ~~ .' . . ~ ~+~t~at~ar ~ Clerks ~ ~ o~ ~~ I~l~Y. COSt ~~~ i v v' Safe Se#up~ or Help Y~~ ~~ ~ -l 1 U ~; ~ ~~~( 5~ ~`~~ Z ~ ~, ~f ~~ p l~i~ i~ ~~~~ ~~ ~ce / N F c%~- U~ . ~-. - ~ . ~ . Chuck Backer . ,Auctioneer - buy ~ ~e~[ can C~m~~~~~or~ - C~-mp~leta ~~t~ s~~v~c~ .. ~~ ~~r,A~C~ ~~w~ -~f~G~SI'ffCS~frff''~~ ~~ ~ 70~~ ~~~";~~~~ #~'ersa-ngf ~t~ of ,'--~.~~,'~`1 )~ ~~ /U ;SAN ,~~ l v41 Acf~~e*s ~vld At f'~blfC Ssrfe ~ j f~/ L ~ ?~~ Z„ Oe~tstandur~ Tv~f 3t~fe ~ .3 3 ~ ~ .~,~ ~ ~ ~ ~ v T+~f c:~s ~' © ~ ~- ~ -~, .,~ -~'~ Totaf C~sf~ ~ - ~~ ~~ - ~~ ~ v~ ~ 'Jw~ .5 ~3J~ l~ ~ts~ ~fike~r P~~It ~Ct ~- Z. , ~1 ~?. '~ }{ Zv~ ~ ~~ - ~ ~~es ,' - ~ ~ J~a~t#or~per ~ Cferfcs /.~1~ ~ ~ D ~ adv. Cast ~. °7 ~ ~ ~~ - ~~p~{j~-E~ Safe Se#u~ or Help ~ ~ ~ ~~ ~~ Tom ~~rpe~ses ` l.~ ~ l tic-, (~~L,~+~~L~~" ~J.v.. C`~\3 r . Chuck Bricker Au . ct~oneer buy ~ sett are C®nnnr~is~~or~ ~ Gomp~lete ~~t~ s~ru-~ce .. ~~ Taxaca ~it~., .~t~ani~s~ur~, ~A 1705 7~~~5785 #~ersanat e~ a-f ~-~ ~~ ~ Gl ~ l~' ~ S ~ ~ Ads ~a~dl At Pic e ~V~~ ~ 2a ~~- . a~t~t:~a„~ ~~t s~ , ~~~ ~~ ~ ~ ~ ,~ ~-~ U ~ T+~ta1 Necks '~~~ S C~ ~ U d ~ota~ ~tsh ~ c> ~ 5~ ~ ~s#~ ~1f~r Past . . ~ l~+~t~w~+-er ~E Clerks ~~ ~.~ ~ ~a~. cost ~v ~, ~ ~ ~r ~e~ ~22~; ~ ~ ~ . sa~~ sates or ~~~ ~ o ~ Tatal ~xpe~t~ ~~ ~.v~ 1~~~-mil ~~ ~~ .~ ____-- `~- ~ ~~' ~ ~ ~`~ v C~~ ~~~~,U ~W~• t -r`r. m+..7rYylXd ra{-lwnrtry~ .. ~:, ~. <~~ :( +s~~ajs:t~trhylh: ~ {l:il ";~, .y~t.~ 19+Y ~~ -,i C ` ~rti'''` r~, . ,~~~~i D&D Se tic & Toilet Rentals I nvo ice°~^~: ~:~~ p t 35 West North Street Carlisle, PA 17013 DATE INVOICE # :: ~" . ~ . , 11/28/2011 7707 ~, E n.~4 h ~. '~y• r P.O. N0. QUANTITY DESCRIPTION JOB: Estate of Harry Donson , 25 Circle Drive, Carlisle 1 Rental Fee 1 Standard Unit for a public sale PAID IN FULL Check # 106 State P~~c, ~p~~ ~~ a~ TERMS PROJECT - ; RATE .AMOUNT 5.00 SOOT 80.00 80.00 6.00% 0.30 "hank you for your business. Total Y ~ PO Box 45950 Omaha, NE 68145-0950 www.paypal.com S 1-000004 1 5 Harry Donson 25Circle Drive Carlisle, PA 17013 Page 1 of 1 Org Bank 041203824 Check# 11690070 Trace # 4759500739 ,rfw~ ,F ;; Make instant and online secure payments with PayPal -the Internet's first and largest online payment service. DATE TRANSACTION ID MEMO asy 12/3Q/11 =°!E p 1' ~ t ~ 5i'~.1'~ 'f Ynj fax C. '.1 1 ~~ ~ ~sl r y ~~ Y ~~ t ,~ ~~ i ~~/ ~i. ,i ~,••r t j' Y~ d ~a fi 1 Cody , ~ $786895 ` ~x~ ~ `" ~ :~~ ~ ,~ ~~ k ~ t ~ . x ~? ~ '~, ,. ,~ ti ~',`s t ~ ~ ~- i 't ~ 4 i ~ a ~% ~ ~ {~ e i'h ~} i1 t u v 't~.a r ~ ~ ~ ~r `n t ~ia~i ~`w~M1,S§F reytf ~~; vet ~ ~; ~ Jf ~ ~ ' 1 ,~}~;~~ F 'w7r? `f v j , W t~~t}t.~ ~7 r.Y h~f M!t ~ ,y, ! l ~ ~d G'~1,tt~' f~ , iC ta', l~ ~ j ; w ` ~ ~ i ~ + t ~' ~ 5 ~ ~ x'i t x i y~ ' "y rYlY}~~ S .t f j~xf~l.ffii',k ~d tj.]~r`~ i, i ~ irwi x .~ j z t ~ .~. "wi~ ,s . i' ~~t ;it4~s4 ~ ~1 r} 4 .~ .y ~1t ~~~ ~ ~~'~ , ` i,,Y ,j Y ) y ~~ say ;. 11 ~ ~, 9t_i t~ ylY: ~, ~ ~ z ~~~ ~"~ £y'L~"L ~ ~ _a ~r ~ 1~ t'~77 j i ' ~ T j 3 .„ 3 Y.S'~ t'+1A x~ ~ }'n .,, i~+ t~ r'~ i'.ek;~" ~ i .;Y .~~ t~' q'~ {i!,~p ~' 3r i t. ~a ~! d r 4~"' A a '~~ ~.a# ~,~ E ~ ~,Ivs~r zp~?- ~ ~ 7 ~~.~ ~ ~~ nn~"'A j ~t s~ ~ 'fix r .1 t..:t r't~'~~ ~ ~*~ ! ~;~ v}V ~ '' f~~Y ~f"~~~~ EASE DETACH BEFORE DEPOSITING CHECK AMOUNT 760.26 760.26 t; ;` '+~ '~~~' ;~;,,, a~"" .' ~ :' ;,,~.: {IAI{ IA{• STATE FARM FIRE AND CASUALTY COMPANY '"'J~"`° 100 State Farm Place Ballston Spa, NY 12020-8000 0006 B-13- 6271-F382 F L DONSON, HARRY E 25 CIRCLE DR CARLISLE PA 17015-8894 ACKNOWLEDGMENT OF CANCELLATION REQUEST Personal Liability Umbrella Policy POLICY NUMBER: 38-BR-Y870-3 DATE CANCELED; FEB 10 2012 RETURN PREMIUM: $5.82 To: ^X INSURED ^ MORTGAGEE ^ OTHER Dear Policyholder, As requested, this policy has been canceled effective 12:01 a.m. (or the time which is required by state law) as of the Date Canceled shown above. We thank you for giving us the opportunity to provide this insurance. Location: Same as Mailing Address Agent: GREG LUNDE Telephone: (717) 241-2341 524-127 04-01-2002 (01 t1223a) DATE PROCESSED YFEB 21 2012 Y~ ~~Q ~'~~~ .~ ~ a _~. Novem ner ~ ~~~~~ ~_ _ ~ ~ _. ._~~~ ~scs 'or ~~:,~, E Donson - - - , ~- - --- -~~ = ~~ ~ Account .a '~6>~.; _~ raCKAGE Sub Total: ~ 1,890.00 ~_ '. ...~~~~~~ ~ NL PROFESSIONAL SERVICES: - ~ ~ _ ._ ~ . ~~ ::~ ~e~. ice :. ~ 90 cJ0 Sub Total: ~ 190.OG ti1ER~rA~'~~DISE: Sub Total: ~ 180.0(;' "'~TA~~ r!~'NERAL 'NOME CHARGES: ~ 2,260.00 '~ASh ADVANCES: .- ~- ~ . • ~ ~ . tee... ~~e~t,?~~a'es at S ~ 00 each ~ 120 00 - „ ~ .. =. - , ~' ~_ - ~~'„ _ ~ 142.46 ~~_, ~.- ._ . ,_- _- -_._ _~ S 31 r 02 - = ~ 5 100 00 Sub Total: ~ ~oa.48 Total Funeral Expense: ~ 2,964.48 ~ Total Payments Made: ~ 2, 964.4d r_ ~,. _ _ _ T '~ i. ~. ~ L• --~:at~r~~~.7 ='r~~tr Of Eagles Check 4323 Oct 28, 2011 50U U~~~ ~~onsu~~. Check 9 Nov 4, 2011 2,464.ac Balance: ~-_ .-__ _Qy-Q~.~ ;ease return this portion with your Remittance. Amount Enclosed ^..~~ ~ ~~onson i y fa` .f - "~~~ - ~'i~~fr .~',`` r ~'~vt~~~ri*~Y~~'P'i~iDi'>w*'~~s7T~,YY. ` il,~'M~ . }} , \ ~>'~`(`rYA1+(} ,~ArrT:.~~(r",2F~ •~ ~ ~'+~~ ~f.''.,'~'c~..~J'.` i-:~4~ •,: Osiris Holding of Pennsylvania, Inc.:; ;,'~~ `''M~'i~l Y ; ~s~ ~' ~~ ';';;, . ~ ~ ~ ~ . Retail Installment Contract and Security Agre ent'"' ~~"'' ' "~ ~' "LLC") ^Tri-County Memorial Gardens LLC ("LLC") i'J Wcstminster;Cemete. LLC "LLC." '` 'Contr. C t"Con;pany") SconeMor Pennsylvania Subsidiary LLC ("Company") StoneMor Penrisylvariia Subsidiary LLC ("Company") (~~<~metery") Tri-County Memorial Gardens ("Cemetery") Westminster Cemetery ("Cemetery") . 1701= 740 Wyndamere Road, Lewisbeny, PA 17339 1159 Newville Road, Carlisle, PA 17013 717-938-3435 717-249-2029 ~ ~.•;; 1 ,., :o collectively in this Agreement as "Seller") are owners and operators of the Cemetery. THIS AGREEMENT is made by and between Seller and r-- ~ , ~' ~~ , t /~/,~ t ~'l~,.~"1 F' i , ~ . ~ hereinafter called the ", ~ buy and LLC and Company agrees to sell to. urc er, or his designated beneficiary in accordance with the temps hereof, the following items to be provided or used at the above check,° ITS. The Burial Rights covered by the Agreement are shown by the map Of such garden/building on file in the office of the CEMETERY, and are more particularly described below: Space(s) :+Mausoleum: ^ Chapel l7 Garden ^ Tandem ^ Side-by-Side q Single ^ Developed ^ Preco:::ruc Crti"pt: ^ Double Depth ^ Side-by-Side Niche: ^ Chapel 0 Garden ^ Single O Companion ^ Developed ^ Preconstruction 0 Single ^ Developed ^ Preconstruction +Maxirnu,n cocker dimen.ciau are: length 85", widrla 29 ", heigh116" 2nd Choice ~ 1st Cizoice Znd Choice Garden Section Lot Space(s) pt:r~hased for use at another cemetery. Vase; Y / N Granite Size X ~~~~ 1 /- ~ ~ ~ ~ '. Color: x p x p x p -Gauge: ` - Gauge: ' Building Building Section Section No.(s) No.(s) Level Level ~ . . 3. ITEMIZATION OF CHARGES .;_ LLC* ~ . " : ~ompar.~ (A) Burial Rights (as descr-bed in Para. 1 above) '°'"' $ ' • ' (B) Perpetual Care. $ ~• :~. (C) Less Certificate Discount $ (D) Second Right of Interment $ (E) Vault(s) $ ._ , ., (F) Urn(s). ` $. (G) Mausoleum Lettering/Crypt Plate $ ~ ~ ._ (H) MemoriaUMonument $ -•- ' ~~~ • (I) Granite Base(s) ~_ $ 7.__.11.:; ~ (J) Installation Charge __}______ $ .- $ ,- (K)Caskets .... $ : ~ ;:. (L) Initial Fee for Interment -. $ ; (M)Final Interment/EntombmenVInurnment Fee ~ ~ .~ -- . ('N) Permane~ Records & Processing Fee .. $ X336,88• $ - . ~ (P) Sales Tax $ ''" $ T .. • .,:, :: ; 4. TOTAL CASH PURCHASE PRICE (A THRU P) ' ~ $ ~, ,~~ -, ITEMIZATION OF THE AMOUNT FINANCED ~' ,~: ; (1) Total Cash Price ............... ~. , , ..... , . c .::.. ; . $ -~ `~ ~ C.. /~ (2) A. Down Payment O Cash O Check O Credit Card ..... $ 1~--• ~ t•/ ~'_. ~'> B. Trade In: ,,,.,,,.,$ ---- Old Agreement No. C. Total Down Payment (2A + 2I3) .................... $ ~~~' ~ `~ i ~1" (3) Unpaid Balance of Cash Price (1 - 2C) ....... . ....:... $ '-" (4) Finance Charge ................. . ........ ; ....~.. , . $ ----.. (S) Total Unpaid Balance (3 + 4) ...... . ................. $ --"'~ ,~ ~. rer.:::in secondarily liable to the ocher for the sales of items and services provided by one another pursuant to this Agreement; however, Purchaser shall not be require' :o exr ::~pany before proceeding against the other. ~~r ANNUAL PERCENTAGE RATS ------- ` =~~ ~ The cost of your credit as a yearly rate ` ~ ,, ~ ~~~' AMOUNT FINANCED ~ ~ TOTAL OF PAYMENTS '• • TOTAL SALE PR; :l: ~ . The dollar amount the credit:w1U cost you The amount of credit provided to you The amount you will have p~ld"after you The total cost of purchase on credit, inc • on your own behalf, have made all payme~• tis scheduled. ing down payment of $ ' ' Number of Payments Amount of Payments, , . First Payment Due Date Thereafter, Payments Are D;:a .- ~;' __ $ - OMonthly ' on the -- S , • :~~ in the gods or properp~ being purchased or in part of the fund~patd under this Agreement held in a Merchapdise Trust Fund. ~'•- :iii r•,~; have to pay a penaln• and you may be entitled to a refund'of part of the Finance Charge; .ert (i;;cluding General Provisions on the reverse side hereof) for additional information about nonpayment, default, delinquency charge, security interests, an ,.re,uired a ' etunds and penalties. Y q P Yment in full bef.:: the ~U~r OF ~ CONSUMER CREDIT SALE AND IS SUBJECT TO .THE`ADDITIONALCENERAL PROVISIONS C i altE a PART OF THIS AGREEMENT. - ~ ONTAINED ON THE IZ.EVEI :~E SII ., ion the heirs, executors, administrators, successors and assigns of the patties hereto. -. )~'a 11fTT V PA(lTR!`TTl11~i l~L~r~mrr.~rn ~ ..,.,. „~, . ,.~.._ _~ . __ _ _ ~ .. '~ ~."" '. i~i ,i ~ ~1 !~ .:.: .. ~~;C' + 4 (t jJ~i1/j~Tj",I~,C}1~~4f~ {J ~c~~'G Jy1kt,1 wi~~~i.'~~}~~~~%'' ~~. ~t{M1 !~~ ~ '~ f) ~,. , ~~ ~.~,~.; ~Oslris Holding of Pennsylvania, "Inc.. ~ ~ ' ~ ~ ~ '` " Retail Installment ~ ~ ~ ~~ ~ ~ ' 'f `` t' ' . Contract and Security Agreem ~ ~ ' "LLC"~ ^Tri-County Memorial Gardens LhC .'`LLC" '~ .C ("Company") StoneMor Penns lva ' .~) ~Jd'Westminster Cemetery LLC ("LLC", " C ("C~mett Y nta Substdt L~C (Company) StoncMor Pennsylvania Subsidiary LLC ("Company") ~'~~) Tri-County Memorial Gardens (" emetery") Westminster Cemetery ("Cemetery") 1'~~' 740 Wyndamere Road, Lewisberr~, PA 17339 ' 717-938-3435 1159 Newville Road, Carlisle, PA 17013 717-249-2029 ,. to collectively in this Agreement as "Seller") are owners and opg~tors of the Cemete .THIS AGREEMENT is made by.and between Seller and ~ bud- and LLC and Com an a ~ ~ I~"'" ~ hereinafter called,t p y grew to sell to Purch' er, or his designated beneficiary in accordance .with the terms hereof, the following items to be provided. or used at the above ch. iTS. The Burial Rights covered by the Agreement are shown by the m:~,Qfsuch garden/building on file in the oi~ice of the CEMETERY, and are more particularly described belo , Space(s) ' +Mausoleum; Crypt: ^ Double Depth ^ Side-by-Side -"=? ^ Chapel ^ Garden ^ Tandem ^ Side-by-Side . ^ Single ^ Developed ^ Prt ^ Single ^ Developed ^ Preconstruction -Niche: 0 Chapel ^ Garden ^ Single ^ Companion ^ Developed ^ Preconstruction. +Maximum casket dimensions are: length 85", width 19", height 16" ' 2nd Choice ~ 1st Choice Garden Building ~ 2nd Choice __ ___ Section -'~ ''' Building Lot Space(s) purchased for use at another cemetery. Section Section No.(s) No.(s) Level ~ Level ~~ ,.. 1r~: ,. ••~- , l,. ;, ;~ ;. ~. ...,, • j i f _ ~r.'• _! ~, . '~ _, 1 it 3. .,. `. Vase: Y / N -_____~ Granite Size X '. -_ _--, i.~ __ Color: _ x p -- X p ____ x p 4. ITEMIZATION OF CHARGES ~ LLC* (A) Burial Rights (as described in Para. 1 above) $ ~''' ~ ~~ " (B) Perpetual Care $ - . ,,~. ,; (C) Less Certificate Discount $ - .. , .. (D) Second Right of Interment $ ...~~,-,=- (E) Vault(s) ..,._. $ __,__ (F) Urn(s) $ .~ (G) Mausoleum Lettering/Crypt Plate ~ $ T (H) MemoriaUMonument ' ~ (I) Granite Base(s) ~ ~ ~ ~ S. (J) Installation Charge --" ~ $ _... - ~ $ (K) Caskets ...- $" (L) Initial Fee for Interment ____~_ $ ~a ~ ~ ~ . (M)Final Interment/Entombment/Inurnment Fee f~~ '"~~ n ~ $ ~Z (N) Permanent Records & Processing Fee $ -~~.9i1 v ~ L~ $ (P) Sales Ta - $ ..--- TOTAL CASH PURCHASE PRICE (A THRU P) $ ~^ 1 ~^ / ~~~: ITEMIZATION OF THE AMOUNT FINANCED (1) Total Cash Price . , .. , , , r $ ~ (2) A. Down Pa ment O Cash ~ '~`~ Y (d'C~heck O Credit Card : $/ ~" B. Trade In: ,,,..~~~ $ Old Agreement No. C. Total Down Payment (2A + 2B) ........... . . . . . . . . . $ ~ %-, ~ ~; `? Gauge: ~ ~ (3) Unpaid Balance of Cash Price (1 - 2C) ..... , , , $ _ Gauge: ~;: (a) FinanceChar a ..,..,,.,,,,„ ~~~~~~~~ $ ^~ ... ~' t (5) Total Unpaid Balance (~ ±. q) ....... ... ......... $ ~<< gain secondarily liable to the other for the sales_pf items and+st~iees provided by one another ursuant to thi .: ..n> before proceeding against the other. .~ P s Agreement; however, Purchaser shall not be requi: '' ~ 4 . ~~' ANNUAL ERCEN~AGE RarE c~.,~.,~ ,. ~:..,,:. ~~` ` The cost of your credit as a yearly rate. The do-lar amount the crgdil will cost you. The amou ~ oNcr diNprovided to you The amouC t youCwillphave Said after TOTAL SALE F: P . - you The total cost of purchase ~ ' on your own behalf ~ have made all payme gas scheduled. Ing down payment of S~_ ,tiumber of Payments / Amount of Payments F(rst Payment Due Date Thereafter, Payments Are __ $ - - S ,. nthly on the -~-==- :~t ~~~;:~ goods or property being purchased or in part of the iu s paid under this Agreement held in a Merchandise ust Fund. ,•.~~t h3~~e to pay a penalty and you may be entitled to a refund of part of the Finance Charge, ~ ~,~ y, (:n~luding General Provisions on the reverse side hereof) for additional information about nonpayment, default, delinquenc char e ~ , ~~ ~'.~~ and penalties. Y g , security intere~ts, y required payment to full b~ l U'I' 01~ A CONSU1v1ER CREDIT SALE'AND IS SUBJECT TO THE ADDITIONAL GE t :~Il-E :~ PART OF THIS AGREEMENT, .. ~~L PROVISIONS CONTAINED ON THE 1~E~'1: pon the heirs, executors, administrators, successors and assigns of the parties hereto. . F.a'~1ILY PROTECTION CERTIFi(`ATF. r>~ a vDT ,rr. nT „~.~,,..~.. __ _ , ~ __ ,. MIDDLESEX TOWNSHIP MUNKIPAL AUTHORITY ,`~ 350 NORTH MIDDLESEX ROAD, SUITE 2 CARLISLE, PA 17013-8422 PHONE (717) 243-0674 RETURN SERVICE REQUESTED METER READINGS METER READINGS PREVIOUS PRESENT PREVIOUS PRESENT 32 32 UNITS CHARGED CODE NET CHARGE 4 WA 31.50 ~~ •~4 ~ SE 47.25 ~1 ~~ P i D ~ ~ I O r or ue 0.00 LOCA1lON 2~ CIRCLE DRIVE SERVICE ~~ AFTER FROM~TQ,6/30/11 (J ROUTE ACCOUNT NO. )00 000 2 2 00 09/30/11 pp ~~ CC AMOIdI'CT.l7LLJt DUE DATE t . : ;;~;: ~ FIRST CLASS MAIL ~ •: ~ •' •,.,,; ~ AUTO ~~ ^;i U.S. POSTAGE PAID `'"~'~ CARLISLE, PA ;,~. ' PERMIT NO. 350 ~,;~~ ~ 1 i ,'` ;,,,}~ F PLEASE RETURN THIS STUB WITH PAYMENT: '~~~ ;~~ ~;~ . ;; . ****AJTOCR**R014 ~ ' HARRY E. DONSON ~ ,~ ~•;,~ 25 CIRCLE DR ~ ~~ ~ ~ ~ ~ ~~~'' `;t; CARLISLE PA 1701-8894 ` ~ ;~ . ~ ~; ~,. AFT~'ICUDLrijA~E 7A'htClV~JT DVE • - ItOVTE ACCOUNT NO. UUE DATE ;0004 p ~ ' ~ ,; ~. , i , ~,Y . I:,.. ,f , ' . I IIIIII VIII VIII VIII II~II IIII IIIII I G ,. UIII~I~III~IIIII s, ~S' ~:.~ ... „ - ,r.. ~ .. .. ... MIDDLESEX TOWNSHIP MUNICIPAL AUTHORITY ~ I ~~ ~`~"'~ MIDDLESEX TOWNSHIP MUNICIP S ITE 2 350 NORTH MIDDLESEX ROAD, U CARLISLE, PA 17013-8422 PHONE (717) 243-0674 ~ RETURN SERVICE REQUESTED h1ETER READINGS METER READINGS PREVIOUS PRESENT PREVIOUS PRESENT 32 ~ 32 UNITS CHARGED CODE NET CHARGE i Wp 31.50 1 SE 47.25 Prior Due 0.00 ~OCA710N 25 CIRCLE DRIVE SERVICE QQ~~ AFTER0674W~~ FROMrro12/31/ll ROUTE ACCOUNT NO. )00 00022.00 0~/30/l.. AMOVI`O ia[1J~ DUE DATE / ~ 350 NORTH MIDDLESEX ROAD, g AITJE 2 ORITY S CARLISLE, PA 17013-8422 PHONE (717) 243-0674 ` RETURN SERVICE REQUESTED ~ METER READINGS ; ' PREVIOUS METER READINGS i PRESENT PREVIOUS PRESENT }: • 32 33 32 33 UNITS CHARGED CODE NET CHARGE I WA 3].50 ,. tt ~ 1 SE 47.25 c ,:<., } I _ , ~ ~ F. ~ ± Prior Due r f 0.00 ' v LOCATION ~; , ,. ~ 25 CIRCLE DRIVE 6 I ' SERVIC 3 ~. I R AFTER 0 E DATE FROM/T~3/31/12 ~: ~`~~ 00~~~`.'~bNO. 06/29/12 ~' ~' ~. f. ! AMQOUNpT~1DUE ~ c ~ ~, ' G i' . ~ • - v. I ..,~~. {1 4 ,; ~ ~I ~. ~~ ~ '~~ 1 1 l ;; ~; ~~ ~' ~~ ti.'~1 .'.Il! l` .'. ,1Y ~~ ~\1~ '' 9 . 1~~ ;, i., •~~~ .;~ • ; `~ ~ ,, `, ,; \;~~, ,;;~: ~~ ,} ~~ '( ;;; ,, ~) ,i 'r ,. ,~ 1~ Comcasto Contact us: ~~~ www.comcast.com 717-243-4918 Account Number Billing Date Total Amount Due Payment Due by 09547 382344-02-0 01 /28112 $62.95 02!25/12 Page 1 of 2 HARRY DONSON For service at: 25 CIRCLE DR CARLISLE PA 17015-8894 News from Comcast Comcast has all the speed you need to do everything you want on the Internet --faster, including our Performance Starter tier, with speeds up to 6 Mbps, for $49.95 per month. Thank you for your prompt payment. For your convenience, we now accept regular and automatic monthly credit card payments and direct debit. Hearing/Speech Impaired Call 711 Previous Balance... 62.95 Payment- 01/11/12-thankyou -62.95 New Charges -see below 62.95 Total. Amount Due `` ..:$62.95 ~. Payment Die by 02125/12 ~ r ~~,' XFINITY Internet 62.95 __ Total New Charges $62:...95 0 ;, ~" ~ ~ i ~~~ i~~ y~~ 1 .~ `~,~ ~1 comcasto Ac o n c u t Number 09547 382344-02-0 Billing Date 12/28/11 Service Details Total Amount Due $62.95 Payment Due by 01/25/12 Page 2 o f 2 ' Contact us: H+ww.comcast.com 717-243-4918 .. Performance Intemet Svc 01/10 - 02109 62.95 , includes PowerBoost ' ............................................................................................................................. Customer Owned Modem 01/10 - 02/09 0.00 Total XFINITY Internet $62.95 4 ~~ \ ~\a\~ r~ :: .;,~ ~;; ~.~ r; ,~ .~.t ;i51 ;~ k\ .I ; ~`1 `11 . ~ ' rr~ .. ~ ~ - . 1 ,, ;{ ~~` ' 11 ~1 ,.yi ~~ ,~ ' ;i;! ~~ r i i ',5~ ~.\ ~;\ Comcasto •~ Account Number Billing Date Total Amount Due Payment Due by 09547 38234402-0 06/28/12 $62.95 07/25/12 Page 1 o f 2 Contact us: _~ wvvw.comcast.com 717-243-4918 ~~ ..............___..~.__________..~ __~~..__. _ ._.~ .. _. HARRY DONSON ,~ For service at: 25 CIRCLE DR CARLISLE PA 17015-8894 News from Comcast Thank you for your prompt payment. For your convenience, we now accept regular and automatic monthly credit card payments and direct debit. Hearing/Spaech Impaired Call 711 Comcast will be delivering some advertising in new and customized ways soon. To learn more and understand your choices, visit: http://www.comcast.com/adservicesor call 800-229-7150. ~~\\ rr ". .. •Y'. i; . ~ ,~~. ~~. ;~i '~ t, ... ,;~ ,4t . } _ ~,} •~ i .,~I ,~i , } ,.r, ' , `1 `i' ~; ;i, ~ 4, ,ii . - - .~. . , ,u, .~i~' ~~4t! ,~!ii ~t! ~\ ~.~~ ,~ '~~i ~.^A `{{' Q RQ a rQ ~q, fiyy~U,' ~j~ ,)~ +~y~,t 4try~,t ~1 //~ ~/.~(!~~! ~~~~rpp{i ~B I~ouM ~f.~/QtMn YY Y\ ~~~.A :) It Vf}`ry}t }'f~ 'f~~r~ f~ Y47;yw1,l~"~~15.~'F~~ t11" }i X41 ~~""I.- ~f.. Ygi(}1 } 11(( ~ ~r ~ aQ ~ ~ + ~y ~ ~ r 1 u k~~ Payment , 06/Q8i1 ~,; thank you ' ~ . ~4Y i,. -62 95 ,' ~ ~ . ~ ~ )r ., , . } i *u New Charges Spa below , ~~~, , 62 5 /~ e~ry~i;C.f,^f ~7 ":V I`li,~,.~.-~l ~ \l (i 1~1(~ ~~q~ 1 r ~,~,~~+4 i~~h ~j t1''-'.?t4\{YO ~'Qt~~ A.~'YIAt#11t'(~,U~{, r ~t ~fi~~~t~fbl~7~i'`Sx~~hrf++i hri~`tl~r~f~F! '4ti~y :'4{ 7~~~V~~i, 4 ).7. ~~ 11 (ryY~i~ ~~ Y ~~ i~n~nt ~U~ ~V 7~~,,~~,y14 ~~tit> qr~'.t,"%'faA,YT~~.VVI~~~ .~ ., ,~.., 7 if: , ~ ,,.:;T . , ~ ,., n u.,.'Ahtvv.tRA,~a~rM;~id ~rt~`sM(r1~f'ai4 pJ,iS~k ~41~~~'o"~!at .,.I "~~ ; ... ,J~~~dt~U~ Y i ~ ~~ ~XFINITY Internet `~ 62.95 '"" t ,~ ~A1C .r ~g\~Aai ~( M7 > ~ ))t4Tfyf (~ F~F ~_. ti~''QL~t1,~Sy4~,1fS1~ ~(~1~~ 11~ ,~,1~~[y~v~yl,,°{~~b~:iY~i~i'~4~{Yp~k~-~~~~fV~~~}~ ~1~1~~Fy~4gttil' ~(1yyj4'~ '~R/2 95 ~ '- .~~F~S1 ~t~d~l'.~i..n'atkk~W>S~d'lfAv }lt~+~ ~~tn!'.w.l~.,. ~G.U~~L'~S~'„7Pitxs~31Y~~~S.:,I~Y~~N1A'~F:07.~ h;hlaln'4Uf1,trt3'.~i1~;fr.~./.a.~w.«!. ,, ,..4.u~r...~~ p~j ~p ...aN1B91.4/iS1i~i0.gI41M~NY ' tgflfi~E ~ ~'S~tlYe~.. 8 m r Comcasto Contact us: _~ www.comcast.com 717-243-4918 Account Number Billing Date Total Amount Due Payment Due by 09547 382344-02-0 05/28/12 $62.95 06/25/12 Page 1 of 2 HARRY DONSON D '' {{~+ Q ' p` ~J I~~evlous 1..7alanCe i~'1i. `5 '~. ~i t~,'Y^ud~~4~~,4~y~ ~ ~~ ~~~-~"1P~r ~,,e ~,; ~r~ ~~~~ ~ ,~~ , ,, ~. ~~ 95~ For service at: Payment- 05/21/12- thank you ~ -62.95. 25 CIRCLE DR ,,,_, ~. CARLISLE PA 17015-8894 New Charges ~.s~ below " r ` {h ~2 95 iy r '. r~ J`v~.X 9~1 ~ ~)}~ 1 gyn. p r y{ ~ 11 d~'; ~ r ir~N/n f r ~ "'[~n~a e ~ I, ~, ii ~ ~ u art ~ ~~ t ~ ~ ~ ~s ~ S /n~CJ//~~j'~(~~!~r~7 ,~V ,1 MMw~R~ I~?-f,~M ~jt'~~~! I~'~j SQ '~C~li ~~qh~~~~ ~~~ + ~~~~'''7r MlIM, U/`h-~ News from Comcast ;.t~s,~x~.;r~ , ~~ .~~,~ ~ ~~ ~_ ,~,~~ ,~~~~,,,~~}~~ ~~~,~ ~~~~~~~~~~~,~,~ a~>> /~~{ ~(~~1}{, 1t{,-.~1'Up~j , +r i yI ~~ , is : r r!~ , ~ 2f. „~:!.U. ~~i:~r.: ~i~ v I.,:~;"i,~„'„ti ~:~ lit i,~,i~ ~~ a.'~vi, a~, ,aaf;ii I~~y.y~,S;+~~~~fiW~~tS.'~~~c:l~i~1~JV~~~~1~~~lA~J. ~/~,~_/~u"" Thank you for your prompt payment. ~ Y For your convenience, we now accept regular and ~ ~~~ ~XFINITY Internet 62.95 _' automatic monthly credit cam payments and direct ~~' ~~ip'~ ~~7 ~J~L1 r .~` debit. ~, w ~ w ~ ~~ ;~! ~ ~ ~ $62 95 ~; ", ~'lr7 ~~~~~ ~"fI •Y~) 'Gi~7 ~ ~, i f is~~ r 'ql h}J~ ~?~,~Qy f fv °( kF'' 1 (t...~ .. t i 'c , i ~ ~ s ~ ~ i.i ~ 1 ~ a'f~ ~dYi:~" ,~~~ 1~ ~:~~.:..Sq:.v.4~ -~i,r~tty '+"~~rXr.29b~.t:~1~ut~t~~~r? ia!`~~w~~/.,t~,.,.;. ad,~y,t.,,,w„w.~;gtiku4~w~~4F~,< a.w~~s~.a 3r' ti ~. Hearing/Speech Impaired Call 711 Q f i 4 :• 1 @ d t i :!i" ~~ l~ ~~/ ~~~~ ,1 m Comcast. Contact us: www.comcast.com 717-243-4918 ..Account Number Billing Date Total Amount Due Payment Due by 09547 38234402-0 04/28/12 $62.95 05/25/12 Page 1 o f 2 HARRY DONSON Previous Balance, • ~ ~; r , .1 ~ : ~ ~ ~62.95~~`;~ For service at: ~Paymer#t ~ Q4J27112= thank yQU .., ` ~ -62.95' 25 CIRCLE DR ~ ~~~ ~ ~ ,=~~~ CARLISLE PA 17015-8894 New Char gas ~ see below ~` 1 ~ g2.95~ ,; +(i~(~tra .~i:in'~,In~ 1. ~/~)te'A,'~ ~ Ittt~ e~YN (}ri~~a~i Y It / r'. ~J alt t7V off n ~ tl} yen. i Af~M~11~4~; A.~1'X~.If l1^~ wr' ~ ~ (R~.-~ /4~/!~~1 ~ ~ News from Comcast . ~ F i A 1~TT' ~.,. : ~ ;,. , , ~; ~ ~ ~~~~ „ ~ , t: F?ay b ' ~ " ~ ~ ~~`, .M ~# :' Y z ,;,: 05125/ 2 Y ~ • . .... ~,. Y.,~ ~ ... ~ :'~ ...'.°. . .. .,,. > • ; I Thank you for your prompt payment. , ', ~ r For our convenience, we now acre t r ular and y P e9 ~ ;, 1 XFINITV intemet 62 95 ~~ automatic monthly credit card payments and direct d bit ~~`j1~`; tlti~l~ '~~~~~~,,~,~t,,, ~ ~ {~ ~ y ~ : ,~~ ~~ ~~ r ,L~ h ~4~ ~ ~~ ~ ~ ~ , ~ ,~ ~ l~ ~ . e fF=~ ~~}'t'7,Yiry. p ~ ~~'4K~j~fp~q }~f)[1'T~i~~ ~ 1 ~6~F 9~ ~,. m 4 ,t~•i ~i( }~,~~~q~~Q+~~~~y*y p q ~{k~ +y ~ ~ ~~~ ) ~~ ~ ~ ~~ ~ ~~ ~~ •Y. .d N IL~W . 4' Jti Hlt 7n1.~~Ji 5 ! «IJ~Q I. 'i+f{Yi:.. a •t•..~ ~ .lU.E~i~):Z:'W IaJ. r: r.~~..~irn rl „ •.. ~. ,... • ... ~. .. ~ earmg/Speech Impaired Call 711 "' `° "~~,:,r ~~~.-, s ~ ~ ~ ~ ~~1- '~ r comcast~ Service Details Contact us: ~ www.comcas't.com ~ 717-243-4918 Account Number 09547 38234402-0 Billing Date 03/28/12 total Amount Due $62.95 Payment Due by 04/25/12 Page2of2 ~~ - Performance Internet Svc 04/10 - 05/09 62.95 Includes PowerBoost ~ ....... .............. Customer Owned Modem .............................................................. 04/10 - 05109 0.00 ~~, ~ Total XFINITY Internet $62.95 IMPORTANT INFORMATION: Effective May 15, 2012, H2 will be added to Digital Economy channel 116 and HD channel 876. Spike TV will no longer be available on Digital Economy channel 34 and HD channel 827. CORRECTION NOTICE: In the price adjustment notice included with this bill statement, we incorrectly state that Family Tier Additional Outlet Service will no longer be available as of 5/1/12 and will not receive a price adjustment on 5/1/12. Please be advised that Family Tier Additional Outlet Service will continue to be available and wilt increase from $2.35 per month to $9.95 per month effective on 5/1/12. rl fi COt~1CC~Sto ccount Number 09547 38234402_a ~. Billing Date 02/28/12 ~ Total Amount Due $62.95 Payment Due by 03/25/12 Page 1 of 2 Contact us: ~ www.comcast.com 717-243-4918 ,_.__..,,... _./ HARRY DONSON For service at: 25 CIRCLE DR CARLISLE PA 17015-8894 News from Comcast Thank you for your prompt payment. For your convenience, we now accept regular and automatic monthly credit card payments and direct debit. HearinglSpaech Impaired Cali 711 IMPORTANT INFORMATION: On Aprii 3, 2012, Disney Junior will replace SOAPnet on Digital Preferred channel 120. w r PreY'iQU~s Balance ;; ~ ,,~,~~~ ~~~~~ ..62.95 ~~ Payment - 02/15/12-,hank you -62.95 New Charges -see below ~ 62;95 Total rA.nnount Due .7. ~ ' ~, ~' ~' ~r:~ ~ ~ ~ ~ x$62.95 z i , 7r'~ 1 {p^ ; Payment Due by I r,• ~ • .nAll 4, ~ I I•.{J .h a..Y ~ ).UI„ n (I, r tM. ~ r. .. ...., .. 1• ~ I I I .. •,.. 03/25/.12 . . ,. ,~ . , , { ~; ~i~ 1N f TY I ntemet ~ T 62.95 ,.. ' ' ~ ~ 1 Total Nsw Charges ,~~, $62.95 Q .. M~ >1~Y~aw1 ~ f ~I~'~ ti~ 1v V :. ~ ti ....,. r it .- ' • ~z ^ash. ," Comcasto Contact us: ~~ www.comcast.com 717-243-4918 r Account Number Billing Data Unpaid Balance New Charge& Total Amount pue Q9547 382344-Q2-4 14/2$/11 $59.95 -Due Now $59.95 -Due 11/25/11 $119,94 Page 1 of 2 HARRY DONSON For service at: 25 CIRCLE DR CARLISLE PA 17015-$894 News from Comcast Our recorcls indicate your account is past due. If your account is not paid in the next seven (7) days, a $7.95 late fee will be assessed. If payment has already been made, please disregard this notice. For your convenience, we now accept regular and automatic monthly credit card payments and direct debit. Hearing/Speech Impaired Call 711 The first nationwide test of the U.S. Emergency Alert System occurs at 2:00 p.m. Eastern Standard Time on November 9, 2011, and it will interrupt programming for a few minutes. Visit http://www.comcast.com/nationaleastest/for more information Previous Halanc9 , r~ ~ ~~ ~'~ ~ ~°~'~ -~ °`~ '59.95 ~ Payments -'received by 10128!11 ~~~ ,°~ r 4:00 ~ ~ Unpaid Balance ~ l~~te Now, ,, 59.95 New Charges -Due by 11/5/7 7 ... , ~ 59.95 see below for. mode Information Total .A.mount Dui $119.90 .. J.YJ~~iI.. w.~~t4~:~rr1f.L%+,. ":+~11M%J!.(~I4W.iA41"M~:ilhil~fYlU7,rhK.~4~ld~....... ~ ~:J~ . i t~t.IJWUI+~~n4..r,, r ~. . r ~ ~ ~ .. . .. ,, . ..., J l1 y. ,:,-~. XFINITY In'i;::~ .~:_, ~ _; ,, r ~s ~ temet ~ ~. _ ,~ Ti 59.95 _ F _" ~ ~ Total,,,~~tt{{Ne~~I Gh~t~.es ~, ,~ ~ ~ ~' .-,W..a:A4~C{~.~l,~~µFl~d~15C~lNUYI, w~): i1~~,~v~Gll.yn YtdYA~,r1~rr. (.~~,~rt. ....i ~~.L..,.w~.x};~~S~Gry4~.9~~17.rt~Jti/~.~j .W $59 ~ 95 0 ...1;. ~.~~. .,. .. ,.. .~ A I _~ ~~ ~ ~I Al qo ~~9. ~~~L ~1 ~~ p s ~~~ ,;~'1 ~~~ ,~ ~ i ;~ ~, `~ i ~, ,. ~~ %~ ,. r •.` ,~ i '~ ~~ ~I ', ~~ ~j~ ~~ Comcast. Contact us: www.comcast.com 717-243-4918 ~~ Account Number Billing Date Total Amount Due Payment Due by 09547 3$234402-0 09/28/11 $59.95 10/25/11 Page 1 of 2 HARRY DONSON For service at: 25 CIRCLE DR CARLISLE PA 17015-8894 News from Comcast Thank you for your prompt payment. For your convenience, we now accept regular and automatic monthly credit card payments and direct debit. HearinglSpeech Impaired Call T11 This bill reflects a change in the monthly FCC Regulatory Fee from $0.08 to $0.07. .i r ~ r ~w.'rc ~ ~ , Previous B~li~nce ~ ''`~~ ~r~A ~ro 1~~, ~s'r~» ~'` X59.95 ~Paymerit- 09~26L11=thank you ~~ n~ ~,~ ~ ~, ~~~ ~ ~ ~~ T59 95" ~ ~~ ' r !7'FFf'k ff'{ ~,1{t '~ New Charges -see below ~ i 59 95 .,a h3 ~ . i 1' fG ~Gn~~ If ~~in,~ 1 r r ~ ., ! ~. Total±~A.motrnt~~es ~ , ,~,~~~,~~~,~.;,f~ f 5,95 . i~~' ~'~p'' tr'~ i,. sryy.,, t'~•li 'F ~~ `~h ~ 3nn~ "e~ ~}~ t r)~y P~y~nent (~u~ My +sf~4!~~~tn#±1 `, ~r ~i >~a ~i~V'j ~ X/~~/ 1 v:. u ...~.t~va, ~~ • ~ ,.. ~ ~ ~~r: , . ~ ~!,.n..hJ-. ~r~'.ihNiWlSi6r1~~~YVd~!tWN~d), !,. i .r,r+ .~ .. . ~. ..r:. '. . ~: ~ ~ XFINITY InfemQt ~~`~ '~~ ~~59.95 r ~, ~ u ,4 L i t t~ J ~ SR~i(I! yt~ ~,~ ``f(`hAa t~3 ~u~1~r f3\! 3'''l, i 1 r- T~ta~ ~eY~ Charges r~~,t ~,~r~~~, ~~~1~~~ °~1t~ ~~;~ ~ !,{ $59 95 , y ;: i~+:~:;~i„~u:YiU, 7,dUh/~~t~/1fAC'?,~tn,Heln~-.yk.b ,,w.+cs.lhY,. e.v~~Yb r, ~., :~+ +~+.)k ~lAli:3.t.~ntMi~S;~~.~Sr~'t~,C~~t~dt1~~/,. i; ur J, ~~:1. .r~. ~. ,. h O . ;S~I~u~mskoisin,.m _ o ~ ~~~ G~ D/3%/ r~ .rt SS ~l j ~ l t~ t j.\. REPUBLIC tlA..: f 9 3730 Sandhurst Drive York, PA 17406 HARRY DONSON Invoice Page 1 of 2 Payments/Adjustments Date Description Reference Amount 10/03 Payment -Thank You 4242 -X48 75 , Account Number 3-0611-1403893 Current Invoice Charles Invoice Date December 15, 2011 Harry Donson 25 Circle Dr (t_1) Invoice Number 0611-000825105 Carlisle, PA Previous Balance $48.75 Payments/Adjustments -$48.75 Contract: 9611015 (C2) Unpaid Balance $0.00 Current Invoice Charges $48.75 1 -Trash Cart (95/96 Gallon) Scheduled Service (S1) Date Description Reference Quantity Unit Price Amount 12/15 Residential Service 01/01/12-03/31/12 $48.75 $48.75 Current Invoice Charges $48.75 ~4~.75 Due By: 01/04/12 Customer Service (717) 845-1557 Customer Service (800) 210-9675 FOR YOUR CONVENIENCE TWO ALTERNATIVE METHODS TO PAY: 1NW1N DISPOSAL.COM OR PAY HY PHONF ~a 877-692-9729 BOTH METHODS r+AVE NO PROCESSING FEE. PAYMENTS PU~I EU UfvLINE OR THRU THE PAY BY PHONE SYSrEr,1 ~,^:iL~ APPEAR ON YOUR BANIVCREDIT CARD STATEMENT AS REPUBLIC SEf?~,~ICES;ALUED WASTE PHOENIX AZ Atterlion York County Residents-This invoCie may eflact a rate adjustment due to the tipping ee~Disposal Fee)irnplernented by the York County ~oi~a Waste Authority To pay on-line or sign up for convenient auto pay, go to: www.disposal.com 1 .~ ~.~. ~ ; // .~ ~~ ~~ 7 / / l:t.JtKfikN<_l ~-- -- 3a ~7AYS _ _~t? ~7~Y~ - =-~90~: GAYS-=--- 48 75 0 00 0 00 0.00 f M A Visit our website, www.disposal.com to make your payment electronically or to sign up for our convenient automatic payment plan. ~ Pln~ao nom.. ~~,.n..~n Ciri~ f..• }p~Ta onr{ rn.•iiiti~lna ~,'. ~ ; ,~ , '•'•~•'•'• Questions? Please ®cont t b J 1 ~ Visit us online at Page 1 ; ~ ac us un 1. Y pplelectric.com - ; ~ ~ 1-800-DIAL-PPL ~ • i ~ . ~ . ~ ; ~- ~~~~ uc,i+~~8 (1-800-342-5775 ) M-F: Sam to 5pm 03940-70001 Jun 11, 2012 $88.83 Your Electric Usag e Profile Billing Summary (Billing details on back) Service to: Balance as of May 21, 2012 $0.00 HARRY E DONSON-ESTATE Charges: 25 CIRCLE DR CARLISLE, PA 17015 Total PPL Electric Utilities Charges $gg.g3 Meter: 41421332 Your next meter reading is on or about Jun 19, 2012. This section helps you understand your year-to-year electric use by month. Meter readings are actual unless otherwise noted. '~ 2G11 ~ 2012 zoo 2Z5 = lso T 135 90 ~, `' 45 Months ~. ~ , ~. ~ •, ~. May 2012 ; 29 ! 61- 8~ ~~ 21 58F May 2011 '; 30 3552 118 59F :•~ „ .- • . ., I May 18 _, Actual ' 43057 Apr 19 ~ Actual 42439 29 Days ~ kWh Billed 618 ~. ~ Jun 2011 -May 2012 ~ 14239 ~ _ • 1187 Jun 2010 -May 2011 ~ 44527 3711 Total Charges $8$.83 Amount pue By Jun ~1, 2Q12 ~~~~ _ _~~____ ~T_^~ _$88.83 Account Balance $88,83 PPL Electric Utilities' price to compare for your rate is 6.935 cents per kWh effective 3/1/2012 to 5/31/2012. For a list of supplier offers, visit papowerswitch.com or www.oca.state.pa.us. Your Message Center • Budget Summary; We billed you $2,997.00 Including this bill, you used 51,146.96 After this payment, your budget is ahead $1,850.04 • Next month your budget amount will change to $10.00 • With paperless billing, you can receive and pay your PPL Electric Utilities bills online. The process is free, quick, convenient and secure. To learn more or sign up, visit pplelectric.com. • Save postage and late charges -sign r Automated Bill Payment. ~' ~" ~ s ~~ ~~ Payment Methods Online at: ~ By phone: 1-800-342-5775 pplelectric.com or call BiIlMatrix (service fee applies) at 1-800-672-2413 to pay using Visa, MasterCard, Discover or debit card. ® By Mail: 2 North 9th Street CPC-GENN1 Allentown, PA 18101-1175 Correspondence should be sent to: Customer Services 827 Haustrlan Road Allentown, PA 18104-9392 Other important information on~the back of this bill --~ 1 F M A M J J A S 0 N D •~'~+ Questions? Please ~ contact u b N 10 Visit us online at ~ l Page 1 s y ov . pp electric.com ~ ` 1-800-DIAL-PPL ~ ~ ~ r '~; • F'Pt Electric ut~i~uea (1-800-342-5775) M-F: Sam to 5pm 03940-70001 Nov 10, 2011 $539.13 Your_Electric Usage Profile Billing Summary (Billing details on back) Service to: Balance as of Oct 20, 2011 $0.00 HARRY E DONSON Charges: 25 CIRCLE DR CARLISLE, PA 17015 Total PPl_ Electric Utilities Charges $539.13 Meter: 41421332 Your next meter reading is on or about Nov 17, 2011 This section helps you understand your year-to-year electric use by month. Meter readings are actual unless otherwise noted. ~ 2oio ~ 20~ ~ zio L15 iso 135 yo 45 Months , , ~ ~ ~ ~ Oct 2011 - ' 30 t----- ; 729 -=-----~ 24 61F Oct2010 ~ 29 ; 2259 - 78 61F ~, ,- ., Oct 19 ~ Actual 35958 ` Sep 19 ~, Actual ; 35229 30 Days kWh Billed j 729 ~. ~ Nov 2010 - ,. Oct 2011 -- ~ 45277 - -- 3773 Nov 2009 - Oct 2010 T ! 36332 ~~3028 Total Charges _ $539_ .13 mount Due sy Nov 10, 2011 ~~ __.... ~ __~______$539.13j Account Balance $539.13 PPL Electric Utilities' price to compare for your rate is 8.411 cents per kWt~ effective 9/1/2011 to 11/30/2011. For a list of supplier offers, visit papowerswitch.com or call 1-800-684-6560. Your Message Center • Your bill has a brand new look. To learn more about how we changed the bill to better serve you, check out the enclosed brochure or pplelectrlc.com/samplebill. Budget Summary: We billed you $968.00 Including this bill, you used 5246.97 After this payment, your budget is ahead $721.03 $110.35 remains from last year's Budget Plan settlement. With paperless billing, you can receive and pay your PPL Electric Utilities bills online. The process is free, quick, convenient and secure. To learnr~ye~ e or sig -y~p, ,~ ~~ visit pplelectric.com. //~ ,~ ~~j Payment Methods Online at: ©By phone: 1-800-342-5775 pplelectric.com or call BiIlMatrix (service fee applies) at 1-800-672-2413 to pay using Visa, MasterCard, Discover or debit card. By Mail: 2 North 9th Street CPC-GENN1 Allentown, PA 18101-1175 Correspondence should be sent to Customer Services 827 Hausman Road Allentown, PA 18104-9392 Other important information o.n the back of this bill --~ J F M A M J J A S O N D ~,,`~,;;'.,~ , O Questions? Please ,~f~ Visit us online at ~.~' contact us by Mar 13. _ U pplelectric.com ;: 1-800-DIAL-PPL '~: (1-800-342-5775) ,F~~ E,o~<<~~ ut~~~t~,~s M-F: Sam to 5pm Your Electric Usage Profile Service to: nARRY E CONSC)N-ESTATE 25 CIRCLE DR CARLISLE, PA 17015 Meter: 41421332 'Four next r7~eter reading is on or about Mar 20, 2012 This section helps you understand your year-to-year ectric use by month, Meter readings are actual unless otherwise noted. 2011 ~ 2012 zoo zzs lao -- 13 S yo as 0 Months ~~ ~ r , Feb 2012 ~~ 29 1214 ! 42 34F FebZ011 29 '~ 6814 235 28F ' ~~ ~ ~ Feb 17 - _ -- - -- -_ ---- ------- Actual -------- 40784 Jan 19 t Actual ! 39570 29 Days kWh Billed j 1214 ~. Mar 2011 -Feb 2012 ~ 27004 2250 '~~1ar 2010 -Feb 2011 39697 3308 Billin Sum Balance a Charges: Tota I P P L eb 21, 2012 (Billing details on back) ~s ~""--- $425.73 Utilities Charges $431.32 Total Charges _ $857.05 mount Due By Mar ~3, 2Q12 ~ _ _ ~ ~ $857.051 Account Balance ~^ _ _ $857.05 PPL Electric Utilities' price to compare for your rate is 7.769 cents per kWh effective 12/1/2011 to 2/29/2012. For a list of supplier offers, visit papowerswitch.com or www.oca.state.pa.us. Your Message Center • Budget Summary: We billed you Including this bill, you used $2 730.00 _.851.84 After this payment, your budget is ahead . $1,878.16 • Next month your budget amount will change to $89.00. • This bill includes a previous balance. If you have paid this amount, please accept our thanks and pay only the current charges. • Information about appliance energy use and tips on saving energy are available through the Energy Library on our Web site, pplelectric.com. Payment Methods Online at: ~ By phone: 1-800-342-5775 U pplelectric.com or call BillMatrix (service fee applies) at 1-800-672-2413 to pay using Visa, MasterCard, Discover or debit card. By Mail: 2 North 9th Street CPC-GENN1 Allentown, PA 18101-1175 Correspondence should be sent to: Customer Services 827 Hausman Road Allentown, PA 18104-9392 Other important information on the back of this bill -~ Page 1 03940-70001 ( Mar 13, 2012 ~ .~ $857.05 w J F M A M J 1 A S O N D ' ~ ' Questions? Please Visit us online at Page 1 '`~^•~~ " ©contact us b Ma 11. ~:" Y Y pplelectric.corn p 1-800-DIAL-PPL ~ ~ ~ ~ . ~ r . (1-800-342-5775) 03940-70001 May 11, 2012 88,g PF'L Electric uti~ltle, M-F: Sam to 5pm $ 3 Your EI_ectric Usage Profile Service to: HARRY E DONSON-ESTATE 25 CIRCLE DR CARLISLE, PA 17015 Meter: 41421332 Your next meter reading is on or about May 18, 2012 This section helps you understand your year-to-year electric use by month. Meter readings are actual unless otherwise noted. 2011 ® 2012 zoo 225 3 lao 135 `` 90 ~ as 0 Months , , • ` ' ~ ~ Apr 2012 30 - 693 23 53F _-1----- Apr2011 29 -•,~-- ' 4862 168 45F - ~- .~ - Apr 19 Actual 42439 Mar 2G Actual 41746 30 Days kWh Billed 693 ~. ~ May 2011 -Apr 2012 ~ ~ 17173 - r--- _ 1431 May 2010 -Apr 2011 43128 3594 Billing Summary (Billing details on back) Balance as of Apr 20, 2012 $0.00 Charges: Total PPL Electric Utilities Charges $88,83 Total Charges $88 83 Amount Due By (Nlay i~, 2012 $88.83 Account Balance $88 83 PPL Electric Utilities' price to compare for your rate is 6.935 cents per kWh effective 3/1/2012 to 5/31/2012. For a list of supplier offers visit papowerswitch.com or www.oca.state.pa.us. , Your Message Center • Budget Summary: We billed you Including this bill, you used $2,908.00 ___$1 .11 After this payment, your budget is ahead $1,842.89 • With paperless billing, you can receive and pay your PPL Electric Utilities bills online. The process is free, quick, convenient and secure. To learn more or sign up, visit pplelectric.com. • Information about appliance energy use and tips on saving energy are available through the Energy Library on our Web site, ppielectric.com. ~~ ~~~ ~ Pa ment Methods ~G ~~ ~ / j--- Online at: pplelectric.com By phone: 1-8 -342-5775 ~ or call BiIlMatrix (service fee applies) at 1-800-672-2413 to pay using Visa, MasterCard, Discover or debit card. ® By Mail: 2 North 9th Street Correspondence should be sent to: Customer Services CPC-GENN1 Allentown, PA 18101-1175 827 Hausman Road Allentown, PA 18104-9392 t ~' .~ a 1 ' ~.f -* y k •y Tl~.' S.1 '.Y ^ - - t ' S +. ,' .M r , j. ,_~ 1 A ~r ~ :; ~'' r ~ tf !.' , i l .. ~• .i ~ ~' 7 _ ~~i' M ~ F M A M J 1 A S 0 N D ~,'• ~ : ~ , •''~~~'~'~' Questions? Please © ~ Visit us online at Page 1 " contact us b Jan 10. Y 1-800-DIAL-PPL pplelectric.com ~ `, .~ ' . (1-800-342-5775) • ~ ~ , ~ ~~ E~aw~~ ut,iiuos M-F: Sam to 5pm 03940-70001 Jan 10, 2012 $1,026.28 Your Electric Usag e Profile Billie Summa (Billi d t i ng e a ls on back) Service to: HARRY E DONSON Balance as of Dec 20, 2011 $539.04 25 CIRCLE DR Charges: CARLISLE, PA 17015 Total PPL Electric Utilities Charges $487.24 Meter: 41421332 Your next meter reading is on or about Jan 19, 2012. This section helps you understand your year-to-year electric use by month. Meter readings are actual unless otherwise noted. 2010 ~ 2011 zoo zzs Y lao ~ 135 yo ~ 45 Months ~. , ~. ~ •~ ~ ~ Dec 2011 32 ~ 1215 38 42F Dec 2010 T 30 5420 181 36F .. ~, .~ Dec 19 ! ~_ Actual _ _-- 38237 Nov 17 Actual 37022 i 32 Days '~ kWh Billed 1215 ._ ~ ~ Jan 2011__Dec 2011 38420 3202 Jan 2010 -Dec 2010 37906 3159 Total Charges ~ _ $1,026.28 Amount Due By Jan 10, 2012 ~~ ~--__.~. _______.. ___._.___r $1,026.28) Account Balance $1,026,28, PPL Electric Utilities' price to compare for your rate is 7.769 cents per kWh effective 12/1/2011 to 2/29/2012. For a list of supplier offers, visit papowerswitch.com or www.oca.state.pa.us. Your Message Center • Budget Summary: ~ T We billed you $1,878.00 Including this bill, you used 5533.21 After this payment, your budget is ahead $1,344.79 This bill includes a previous balance. If you have paid this amount, please accept our thanks and pay only the current charges. With paperless billing, you can receive and pay your PPL Electric Utilities bills online, The process is free, quick, convenient and secure. To learn more or sign up, visit pplelectric.com v~ C;~ ~~ y ~~ Pa meet Methods ~~ Y Online at: By phone: 1-800-342-5775 pplelectric.com ~ or call BiIlMatrix (service fee applies) at 1-800-672-2413 to pay using Visa, MasterCard, Discover or debit card. ® By Mail: 2 North 9th Street CPC-GENN1 Allentown, PA 18101-1175 Correspondence should be sent to: Customer Services 827 Hausman Road Allentown, PA 18104-9392 0 Q Other important information on the back of this b;~' 1 F M A M J J A S O N D ~.~ ~. t .. ~~ ~ ' :~~ ~ <~ a ~ ~ ~ ~ ~~ ti '.h ;{ / ~~. ~; yl~~. '''9 ~'.i ti~:~S1'k 1)i~i'u~a REPUBLiC .f ~~ sEw.1C7I ~ 3730 Sandhurst Drive ° York, PA 17406 Account Number 3-0611.1403893 .; Invoice Date March 15, 2012 ~~ Invoice Number 0611-000911533 ,'= Previous Balance $48,75 ~' Payments/Adjustments -648.75 Unpaid Balance 50.00 Current Invoice Charges ~n r :{ :; 548.75 i • $48.75 ~~ Due By: 04/04/12 lr • • 1 • `Customer Service (717) 845-1557 Customer Service (800) 210-9675 :~f-. ._ y. ~ . • • FOR YOUR CONVEMENCE TWO ALTERNATIVE ",1ETHODS TO PAY: WWW.DISPOSAL.COM OR _. PAY BY PHONE (c~ 877-692-9729 BOTH METHODS ~. HAVE NO PROCESSING FEE. PAYMENTS POSTED ONLINE OR THRU THE PAY BY PHONE ` SYSTEM WILL APPEAR ON YOUR BANK/CREDIT CARD STATEMENT AS: REPUBLIC SERVICESlALLIED V'JASTE PHOENIX AZ ,; HARRY D ONSON Invoice ,~:;. ,,~ Page 1 of 2 ~,~,; ~~ „~, •,, ; Payments/Adjustments :;~< ,,~,, ~~.~ Date Description Reference Amount 12/31 Payment -Thank You 113 -$48.75 ----- Current Invoice Charges Harry Donson 25 Circle Dr (L1} Carlisle, PA Contract: 9611015 (C2) 1 -Trash Cart (95/96 Gallon) Scheduled Service (S1) Date Description Reference Quantity Unit Price Amount 03115 Residential Service 04/01/12-06/30/12 $48.75 $48.75 Current Invoice Charges $48,75 ~~ ~~ , ~~I~ ~ 48.75 I 0.00 I 0.00 ,_^_~ 0.00 ". To pay on-line or sign up for f convenient auto pay, g0 t0: M A Visit our website, www.disposal.com to make your payment electronically V1/VNW. d is posa I. COm or to sign up for our convenient automatic payment plan. • Please see reverse side for terms and conditions ~.'~ ~ ~,~, Questions? Please Visit us online at Page 1 ~'~~~~'"••'~ ®contact us b A r 11. :•- Y p ~ pplelectric.com ~~ f •.~, 1-800-DIAL-PPL ~ • ~ r ~ • ~ '+~' ., (1-800-342-5775) PPL Electric ut~~~t,os M-F: Sam to 5pm 03940-70001 Apr 11, 2012 $$$,83 Your Electric Usage Profile Service to: HARRY E DONSON-ESTATE 25 CIRCLE DR CARLISLE, PA 17015 Meter: 41421332 Your next meter reading is on or about Apr 19, 2012 This section helps you understand your year-to-year electric use by month. Meter readings are actual unless otherwise noted. 2011 ~ 2012 2~0 225 3 lgo 135 90 ~ 45 Months , ~ ~ • Mar 2012 32 __ __ 962 30 45F Mar 2011 i, 32 6624 207 40F .. • ,. .. .~ ar 20 __ Actu a I 41746 .---- Feb 17 ~ Actual 40784 32 Days ~ kWh Billed 962 ' ~- Apr 2011 -Mar 2012 21342 1779 apr 2010 -Mar 2011 i 41404 3450 Billing Summary (Billing details on back) Balance as of Mar 21, 2012 $0.00 Charges: Total PPL Electric Utilities Charges $88,83 Total Charges $88.83 Aunt,Rue ~y Apc 11, 2012 ' ' 588 83 Account Balance ~~~ $88 83 PPL Electric Utilities' price to compare for your rate is 6.935 cents per kWh effective 3/1/2012 to 5/31/2012. For a list of supplier offers, visit papowerswitch.com or www.oca.state.pa.us. Your Message Center • Budget Summary: We billed you $2,819.00 Including this bill, you used $ 79 4.39 After this payment, your budget is ahead $1,844.61 • With paperless billing, you can receive and pay your PPL Electric Utilities bills online. The process is free, quick, convenient and secure. To learn more or sign up, visit pplelectric.com. • Information about appliance energy use and tips on saving energy are available through th rgy L' r on our Web site, pplelectric.com. Pa ment Methods /~ ~ ~ Online at: ~ By phone: 1-800-342-5775 pplelectric.com or call BiIlMatrlx (service fee applies) at 1-800-672-2413 to pay using Visa, MasterCard, Discover or debit card. ® By Mail: 2 North 9th Street Correspond nce should be sent to: Customer S~rvices CPC-GENN1 827 Hausman Road Allentown, PA 18101-1175 Allentown, PA 18104-9392 Other important information on the back of this bill ~ J F M A M J 1 A S 0 N D . ~-.~~ ' ~~ Sg~~ E`IERGENCI' I~IEQIC,~L SERVICES PATIENT NAME: CALL NUMBER: ~: 1 r~ .~ ?• 4 .~ i i, i r r , by ~ .; ,~y~ .+~ ,~7~ ~iT ti f~,,~~ v,~.+rt4~{~~J 1ye ~~ef.~n,~i•(f r !1.~~'1. u , ;.t( "%~~~11~ 1 .~. WEST SHORE EMS -CARLISLE Y,,,~,;'.~ ~ Fi.~ ~ rJYV~SA'•+1 •. ~ISCOV~R `3, 205 GRANDVIEW AVE SUITS 211 •= ~"~~~~~••~~~ ` t ~~••'•~ CAMP ILL, P 0 1 1708,,. , ~,;, .. '.:; t ~~~ ~~ ~~}.,R ;.',~, ,' . H A 17.1 ~ `'' ~ Y '~ 'ON'REVERSE SIDE `~' ~i y;~~~•rt Phone #. (800) 367-0512 Federal Tax ID: 23-24630Q2 . . ;~~ ' t ; - - +;~ HARRY DONSON INSURANCE: HIGHMARK FREED OM 6~.U IBAL ~ '~`, ~ ¢ ~yy rr~. ^^ c ~~' ' > '' tJ l , 1 ~ (~ 1 y~1 14i~`.~ I FdAL '-ey''X ~vk v r ' ` ~ ~ ~ ' ' 219768W DATE OF CALL... ,07/12/2011 : ~-,.,+...C,... ,~y~j i~r j~~j.~ '` ~~. F:• ,. ,f''r, ,~~Y •,i,'' ;:' r ~c~.a'. FROM: HOLY SPIRIT HOSPITAL TO: MANORCARE HEAhTH SVGS/ - y(~~AR~I; '( ~( `.~ ~ ~ ' .. ~ ' .~~. ,J ~ ~~,~r...'~ariv:~~`~..iU. t~r~i:~ VJ tJ~,1~..." '~I }'~t { ~~ ~ Sf ~ I 'v ' ~h '~J1 ~ ~ HARRY DONSON "• ' ' ~ a~,;,; F%'.~ 4s ~ 25 CIRCLE DR TOTAL CHARGES: 185.79 ; ` -~> , CARLISLE, PA 17013 PAYMENTS/ADJUSTMENTS: 77.04 ; ~: PLEASE PAY THIS AMOUNT: ~'' r~ / ~(f/ ~ d CO. J% ., - ~ . ~ s DETACH ALONG PERFORATION AND RETURN STUB ~;~. ,, WITH PAYMENT ~ - ? - . DESCRlPTIONOFCHAR~~~':Y~,'~~r`•p;E'~i,~~ 'A~z';~~Q~ n STRETCHER One Way Transport T2005 1.0 108.75 108.75 ~:~ ~^ Transport Van Mileage S0209 20.6 3.74 ~ :77.04 ~ !;~' r , r+ f t ~i ~ :. ,_, ' . I O . ~ I _ - _ Total Char es 185.79 9 ,~~'~±, :~;+ DESCRIPTIQN OF PAYMENT . ,t ~.RE~EIPfT ~~;~~ t ~c;P~1~( ,~ Medicare Assignment Adjustment 07/28/2011 23.49 Insurance Payment -HIGHMARK -FREEDOM Bl 13302224 07/28/2011 53.55 . _. ~ _ _... T I.Credits.:.__._~:.r:~.7.7.04 PLEASE PAY THIS AMOUNT -INVOICE DUE UPON RECEI T ~ ~ ~ iil ; ' RETURNED CHECK FEE - $31.00 .ti r ~ ~`' t ;~ ~ a ~ ia: ~~~ n ~, .1 1 :,,,r `. ~;-; t'i ;~~r>> '; ,~+~ • ~f ,, ~; •'•+, i,, i l .'r ~. ,..,f i ~; ,~ ~:ti r ~t~ 1 ~f ~.~~ ; `' e .~~,C ~ . ' k r,-. '.~;,u ~;~ ~ rr, ' . i~; ~~~ _ t. ._ ~. ~« •.f.'r ./f .~ -, , . ~ , r,.:,w%. 'F: Q rr `,1 ~~ `. .~ T ~~~~~, ~' ',~ ~~ ,f V wF.f~y1J~ H. 1 -'JY y 1? r ~ E:~„~:. PATIENT DONSON . '~CALI: NUMBI;R~-r HARRY 9 $. P ~~ ,; ~~. ~ 1. •. U~V~ ~ •-~ •: _~jj .. ~4Yi~,c t~~a;j~, ~ ,!. l~ ~ 7ia`J~ ~. ~ - r ~ . O r41 ']~'~~+°r~~~~~ ~~ , , ~ 1 y } f~y~~ r n 1' , t t :i. ~ , 4. ~~ ./</.'a ZF~_. ~~ w . 1`. ~.~T W' tt~v ~ y l1 .'yFl. .J..h .:! ~ ~~\ V~,'ti •~'.~~ .~ . IMPORTANT MESSAGES: This is the amount due of r your Insurance Carri is ~ ; . payment. '.. ; _~~'. „~. ~ ` ~; i •'t ' ` 1 .i ..~ % ~~ . ~ I,: ~,. WEST SHORE EMS -CARLISLE 205 GRANDVIEW AVE SUITE 211 CAMP HILL, PA 17011-1708 ~~. ~'{ ~~ • ~,,. ;'} lf', r ~~, ~~: i~~ ~;tii i~ C ~'4~iZ'S''Cti\ i~ili ~'ytliY~\dv~h~`.C'.'~~Z~V~~?~ YA~:y~Cr~~~~~ ~jj r~ ? h ~~`~r~ , r ~ ~ ~ i. ~~ 1 t~~~ 1 ~) ri:,~~) i ~ ~' •~ {1 ; 1..~1 MIDDLESEX TOWNSHIP MUNICIPAL AUTHORITY ? ,,~;; 350 NORTH MIDDLESEX ROAD, SUITE 2 CARLISLE, PA 17013-8422 PHONE (717) 243-0674 RETURN SERVICE REQUESTED I METER READINGS METER READINGS PREVIOUS PRESENT PREVIOUS PRESENT 32 32 I UNITS CHARGED CODE NET CHARGE 4 WA 31.50 .__..4,.. SE 47.25 I ~1 ~D P i D ~ ~ (D r or ue 0.00 LOCAI"ION 25 CIRCLE DRIVE SERVICE QQ AFTER(7d~ FROM/TQ~~/ ~J JO/11 ~ ROUTE ACCOUNT NO. . )00 00 0 2 2 00 09/30/11 p ^~ ~ 7~ A M Odd IQ. Dl1Y OUE DATE ,i'; .,~ ,`11~ ;,.,~~ ;;r .~:lr . i~~ -;: ~i~. ;,~)1 ?.~Ji ~4' ~~ ~1 ~Z \,; r .,,, ~;c ;~;~ ~, r 'r' ;~ ;;, ~~ ;, ~), ;j,r r. r, ~ri ,~~~ `.'irti ,'~ ~~ ~~ .,~ ;~ ~'` ~; ;;~; ,rj i;~ ;~ `' E ~} . ;~j}"1 ,r~ . ~:~I~ ;,~, ; ,;; ,1~ c ;;,; ; ,,, "~ I ~ 1 ~,. `s , ~ ~ ~ ~ ':~ ~.. ~ ~ -.~.; i .:(~ -;. F W`~F n;yrt ~~1.;:,. ~ y~yRtb4 a~ .:.°:r: ~ _; ;'r r riff-~~ ~ Item Date Invoice ~ Item Description of Product (s) Balance ~ `~' e., 05/31/11 V107890 25-M5C1500 SURE PREP SKIN PREP ~~ 14 .0 0 ~ ~"' Current Account Balance: 14.00 ~,`,~ -- ~ ~: .'::''r~ ,w, 4 F f.~ 4 'L G~ ~~. ~ ~~ /1 ~ •~'~ ~ ~ Current 31 - 60 61 - 90 91 - 120 $l4.0o s.oo S.oo S.oo .y Over 120 AMOUNT DUE ~~'~~~ $14 . o o -~~: ~ i ~'~' ~.~_ ::.K This balance represents either the amount that your insurance PATIENT; HARRY DONSON assigned as patient responsibility or the amount not covered by an ~ ~`` 1~ insurance plan for the products you received from National Rehab. If National Rehab Equipment Inc. ~ ~~ you have any questions regarding this bill please contact us at 1-800- AIRSIDE BUSINESS PARK ~~ 451-8510 or at billing~nationalrehab.com PO BOX 1135 STATEMENT MOON TQWNSHIP PA 15108-6135 I~IIIIIIIIIII~IIII~IIIIIIII I II1 SEE REVERSE SIDE FOR IMPORTANT BILLING INFORMATION 111 IIIIIIIIIIIIIIIIIIIIIIII 88307-3210 - 1118612 ~,~ .~y. i)a comcast. ~ , ~ i ~ , ~~ { t~ ~.~.~ .. ~, P ,•. ~ ~ Account Numbelr 0954 :3382344-02-0 ~ `r~:~ ' ~' .,.. Billing Date ., .,,: -~ 09%28/1.1 ° , '- ~' ., h~~ ; F~'. Total Amount Due ~' .~' ` `~ $59.95 _, ` , ,~~~~y , Payment Due by 10%25/11 ~ +~ ~~~ ~ ~ ~~` ~ ~'~% ~ }~; <~ ~ ;. Papa 1 of 2 ~ `~~~ I?•" Contact us: ~' www.cQmcast.com T1T-243-4918 :; ~,:.' ~., ~.~~ uLr ,r HARRY DONSON ` 1~ ~~"'.~'• . ..~ :% ~'r << ~~ !; ~: For service at: 25 CIRCLE DR CARLISLE PA 17015-8894 News from Comcast Thank you for your prompt payment For your convenience, we now accept regular and automatic monthly credit card payments and direct debit. HearinglSpeech Impaired Call 711 This bill reflects a change in the monthly FCC Regulatory Fee from $0.08 to $0.07. f/ r.~ 1 ,)s { f ~ i + ~ ~, rr,ti 1i1~+~`l, e~eLLi~i~1l~~.~r}?~~~t t t 1,i1 - ~ r i t Cllr ,}+~ ) \~ r\ .Y ~ r ~` Ali;` iV~~`~}h~~~y~Q,~~v C , 1 ' r ~ yr t .. ~ ~~,;)\)~. V~~~{rat<~ ~i V~' ' ` '~I1~ rir•wf3 ,t '~\~ a fa 4ir1~~i+i`1~1~ 14YR~~~',r y.r,r~ r.~.„";.ri .Kk~,~f r r,ti r ~ .. 1 It `~~ ~~s 5 r ~~ r r. .~, l7, . ~ s • r.~~ppr ~r ;!r .~. s r;:~•C4y.({,t~\i~~~f`r: •f,Jrfji,'i ,, • ?mow SiY ,; .I'.~ r 1 \ y\~'1;~~~~•~~ r'~ ~ w 1. , v r ,. ... .. (: ')' ~ ` r tiV 1 r r \• \,~st ~ ~f,; r s ~ ' r )~~. ~~~7'; `l~r+.t~•s. sir r ~ / ~ .s l ' ~ t ~ _ r .f ` utC4}t~~ iN~tti+'.i ~ !r\ ~' i 1 :r r ~ t, l r~ll~ \lrr(v~~i\\,~,{,y ~~+r C~~ • it•. ..\~~~ ~tY tip;'. i rrC .r i c.l ~ ';, ' '~` ; %; r, ;~~ .' + .) r r ,r` ) ` ~i~1 ,~ r lri i ,r. ~ji{~, }~. ~' 1 Page 1 of 1 1-E00-955-7070 Capita~1 i WWW.CapftaiOn@.COm Sep. 10 - Oct. 09, 2011 30 Days in Billing Cycle ~' j MINIMUM PAYMENT WARNING: If you make only the minimum payment each period, you I i Vksa ~ nature 9 will PaY more In Interest and It will take you bnger to pay off your balance. For example: XXXX-XXXX-XXXX-5722 NEW BALANCE MINIMUM PAYMENT Payment Amount Each Period If No Approxlmato Tines to Pay OH Estlmatad DUE DATE Additional CharyQS Aro Made statort,Qnt Balanco Total Cou 5260.27 $15.00 Nov 06, 2011 Minimum Payment 20 Monthts) 5297 r f ~. If you would Ilke In ion about credit counseling services, call t •888-316.8055. PLEASE PAY AT LEAST THIS AMOUNT Rewlvi Credit Umit: 530,000.00 n9 ~ i ; Cash Credit limit: 515 000 00 ~ , . - ' !Available Revolviny Credit: 529,739.73 Available Credit for Cash: 515,000,00 (~ ~ S 0 ~ ~ ` Previous Balance Payments and Credits Fees and Interest Charged Transactions New Balance - 51,189,56 i - 51,189.56 i _ -F' S9J8 .}. S250.49 - 5260.27 ~ TRANSACTIONS REWARDS INFORMATION `- PAYMENTS, CREDITS & ADJUSTMENTS FOR HARRY E DONSON #5722 PREVIOUS AVAllA6LE REWARDS BALANCE 107 691 1 Z9 SEF PAY~,IENT , (51,189.56} REWARDS EARNED THIS PERIOD 313 TRANSACTIONS FOR HARRY E DONSON #5722 (reflects transactions posted during this billing rycle) 1 30 SEP EEAY INC.888-749.3229CA 5106.02 AVAILABLE BALANCE AS OF 10/09/2011 108 044 2 O1 OCT AUTOPAY/DISH NTWK$04-894-9131 CO , Sg4,7g 3 03 OCT DLN`EASY WING DL866-241-2496W 524,99 4 03 OCT VONAGE'PRiCE - TAXES866-243-d357W 534.69 - Total Transactions This Period 5250.49 For up-bo-date rewards tracking, vlsift ~ www.capltalone.com ~/NOHaSSI@ rewards- or simply call t-800-22&3001 ~• FEES Total Fees This Period Total Fees This Year So.oo INTEREST CHARGE CALCULATION 50.00 INTEREST CHARGED Your Annual Percentage Rate (APR) is the annual interest rate on your account. INTEREST CHARGE PURCHASES Annual Percentage Balance Sub echo 59.78 Type of Balance j Total Interest This Period Irrterest Charge 59,78 Rate (APR) Interest Rate Total Interest This Year 544.29 Purchases 15.6596 D 5159.81 59,78 I I Cash 24.90% D 50.00 50.00 -~ ~' .,, PLEASE RETURN PORTION BELOW WITH PAYMENT OR LOG ON TO WWW,CAPITALONE.COM TO MAKE YOUR PAYMENT ONLINE. ';; ;~ 'See reverse for Important Wscbsures rapardinp thle Offar, .,~,,;; :; ~ , ' ~ • Questions? Please ~ contact us b N 10 ~ Visit us online at l Page 1 . ~~~ y ov . pp electric.com - f pp 1-800-DIAL-PPL ~ ~ ~ ~ , , . F~ E,~n~ uU~~uv6 (1-800-342-5775) M-F: Sam to 5pm 03940-70001 >, , ..,,__, Nov 10, 2011 ~, `~;Y''~ ~;~~9.~~. .Your Electric_Usa~e_Profile ____ Billing Summary (Billing details on back) Service to: Balance as of Oct 20, 2011 $0.40 r•7ARRY E DONSON Charges: ~5 CIRCLE DR CARL ISLE, PA 17015 Total PPL Electric Utilities Charges $539.13 Meter: 41421332 ~~c~ur next meter reading is ~~n or about Nov 17, 2011 ~~~,s section neaps you unCerstano your year-to-year ciectric use oy month. Meter readings are actual unless :.~nerwise notea. ~~o _ ~z5 so -- ? 3 5 90 as Months ~ , ~. ~ ~~ ~. ~~~ 0ct 2011 30 729 24 ~, 61F Oct 2010 29 2259 78 I 61F ~~ ~ Oct 19 i Actual ~ ___ 35958 Sep 19 Actual 35229 30 Cays kWh 6illea ~ 729 ~. ~ ~. ~ , Nov 2010 -Oct 2011 45277 3773 Nov 2009 - Cct 2010 36332 ~ 3028 Total Charges $539.13 iAmount Due 6y Nov 10, 2011 ~ $53g,131 Account Balance $539.13 PPL Electric Utilities' price to compare for your rate is 8.411 cents per kWh effective 9/1/2011 to 11/30/2011. For a list of supplier offers, visit papowerswitch.com or call 1-800-684-6560. Your Message Center • Your bill has a brand new look. To learn more about how we changed the bill to better serve you, check out the enclosed brochure or pplelectric.com/samplebill. • Budget Summary: We billed you $968.00 Including this bill, you used ~~46,97 After this payment, your budget is ahead $721.03 $110.35 remains from last year's Budget Plan settlement. • With paperless billing, you can receive and pay your PPL Electric Utilities bills online. The process is free, quick, convenient and secure. To learn e or sig p, visit pplelectric.com, ~a ~ ~ ~ / Payment Methods Online at: By phone: 1-800-342-5775 pplelectric.com ~ or call BiIlMatrix (service fee applies) at 1-800-672-2413 to pay using Visa, MasterCard, Discover or debit card, By Mail: Correspondence should be sent to: 2 North 9th Street Customer Services CPC-GENN1 827 Hausman Road Allentown, PA 18101-1175 Allentown, PA 18104-9392 Other important information on the back of this bill -~ ('J i ~ r M ., M 1 1 A S 0 N D .` " !} T ~~ Date 10/17/2011 Statement ° ~' .L11 e ~ - ~~ ,. ~. ;~ ~ f '~b ) l1r Deliver Better Health• - , Patient HARRY L DONSON Questions or Payment:' ' xf rx `~.~ ~ ~ ; Account - 985473 Toll Free 1-888-716-3943 :, ;,. ~. ;~~ Important Notice -Please review the reverse side of this statement for your rights and privileges. ,. Order Date Invoice Num er Dru Name Balance 6/15/2011 5318555 AVIVA TEST STRIPS 50 $17.03 MULTICLIX LANCET 102/BX C $2.50 AVIVA CS $1.12 Total Amount $20.65 I~ . ,. ~~ ~~ r .,~ .y. ~_ WEST SNORE EMS - CARLISLE . , ,,, , y,~. oscovER , \ 205 GRANDVIEW AVE SUITE 21.1 - ~ :~~ CAMP HILL, PA 17011-1708 oN REVERSE sIDE - ~ ,'' ~gO~ Phone #: (800) 367-0512 Federal Tax ID: 23-2463002 ;11~~ EMERGENCY !~IEI~ICAL SERVICES ~ '• PATIENT NAME: HARRY DONSON ~ INSURANCE: HIGHMARK -FREEDOM BLU IBAL •``~ l A. ` : 4 CALL NUMBER; 220300W ` DATE OF CALL: 07/28/2011 \ ` r,• l ~~; FROM: MANORCARE HEALTH SVCS - CARLI; ~ l TO: 25 CIRCLE DR . - ,., ,. . . ~f q t F} HARRY DONSON ', „~~:. ~ ~ \x, :~~~G,~..~~~~~.~~~. R-..t~:~3er . ,:~yr~~<ti; ~,~ , . -;~:; :. 25 CIRCLE DR \ TOTAL CHARGES: 74.57 • CARLISLE, PA 17013 \Q PAYMENTS/ADJUSTMENTS: 57.77 1 PLEASE PAY THIS AMOUNT: 16.80 DETACH ALONQ PERFORAT/nN 4Nn RFT~ IRIV cry iR wire ceve~~~~r -, j _ DESCRIPTION OF " `'~, .: ~~,~~ ~:vy ~,,r~ CHARGE ~`,~ti,,~~; ~ ~.~~~ v~;:~. ~ ; Qu~T,~T~(. ~ n~~ :~~~; ~~: Transport Van Mileage S0209 7.5 3 74 Wheelchair One Way -Member A0130 1.0 . 46.52 28.05 ~ •' 46.52'.`;:::•' Total Charges 74.57 DESCRIPTION OF PgYMEIyT y ~'~> _~~`~Y~Y , ~°, 'RE >.~ ., , v, ,Y ;:. , , ~ ~ ; .~«~~,, :,~ Medicare Assignment Adjustment 08/11/2011 7 65 Insurance Payment -HIGHMARK -FREEDOM Bl 13399949 08/11/2011 . 50.12 Total Credits - . 57.77 PLEASE PAY THIS AMOUNT -INVOICE DUE UPON RECEIPT -~ T, r r YS' w 2 :it i.~ :: , of RETURNED CHECK FEE - $31.00 :~~:,. ,,;r_ ~ ~,~6.,:+80,~r ~, ... :~~' • y ~ ~ t ~~ l~ 5C~ ~ r .~ ~S y. r'St~ ' ,. ) ~ it ~ w ~~ •~ x ;r'~; ~ x': ~\ fi ~~ fw~. Y i~ .1 i y. 1 .~''he~ (- ~ n PATIENT tyAME. DONSON, HARRY ~ ~~~\~' n ~h'CAt,L:IyU ~ '~ '~* ~ . Jy~ Y \r. ,~naj !i •,ti iy~ t .c. 1'.{~S 1R~ ~v~ ~.rSAlr ~' IMPORTANT MESSAGES: This account is now PAST DUE!! Payment must be received WITHIN 10 DAYS. Collection process will begin. ;~+ WEST SHORE EMS -CARLISLE 205 GRANDVIEW AVE SUITE 211 CAMP HILL, PA 17011-1708 ~~~ Y :-, ;k Comcasty Contact us: www.comcast.com 717-243-4918 0/28/11 ~. , . ~ :~~' X59.95 -Due Now $59,95= Due 1.1/25/11;1~~,;; ~:4~, S~l~niYf .f! y'Ntk" it i,.~~ ~ y ~}js,n.~r. ..~„R ~' ~ ..r ,. ~, .~ 119.90 ~ ~; ale 1 of 2 ;,, '.~ p I HARRY DONSON For service at: 25 CIRCLE DR CARLISLE PA 17015-8894 News from Comcast Our records indicate your account is past due. If your account is not paid in the next seven (7) days, a $7.95 late fee will be assessed. If payment has already been made, please disregard this notice. For your convenience, we now accept regular and automatic monthly credit card payments and direct debit. Nearing/Speech Impaired Call 711 The first nationwide test of the U.S. Emergency Alert System occurs at 2:00 p.m. Eastern Standard Time on November 9, 2011, and it will interrupt programming for a few minutes. Visit http://ww~v.comcast,com/nationaleastest/for more information ,.,j .±rr .~.t;, r~ ;-,~-; ~: ~~> i' .~ .. .~ - - `v`r7 , ~rrr ~l."t ~ ( ,.. i ~ t 4 E11{ ;114 ~~ 1 }, i ~\~ `.` \ L/~.. i1~~`~rt1 J -:'` ` ~ti < 1 . J ] \ ~~~\t`1`~'~V`! it lti ! ~ . ~ ~.~ 1 ` ~ , t to `` ; \ . \13~.f .\ ~t l ~~ 4\ ~, ~ , ~ ht1 ~5 e~ \,. ~ , !, 1'14 1 ~ ` , ~ 1, 1,~1 J , r ., \,11t/~t11~..~. - r ~~ ,.ti 5 r~,1 +, „,. , ( r1` `\ ~,\y,Y, 1 `^t, y I ii ~: i1 1y,~~~; ~i,~ ~.. ~. ~'~,`~ •r ,: ~~~e~~ . ,•. eft ~; 1 < 1 ~ ~\L'~1R1~1 , ~ ~ • 1 ~i 1 1~~1 l ' ~ 1 ~ ~ { I~ I 1' `; 1~ ~i'f~ } ~ 3.11 ~~ 'i. ~~ 1 •~~~ ~' 3 \ i~\ X111 ~ ` .. ~ ` .. 1 ~ ~ \ 111 +~ ~` \L ^~ ~ ~ ;~,ti ; ~ ; ~ ~~ ' i ,~ ~, ~ y ~\ ~ \ `~ j~1 Account Number 0 B(Iling pate 1 Unpaid Balance New Charges Total Amount pue $ P y ~g Item Date Invoice Item Description of Product(s) ~~~!31/11 V129990 25-1530-2 PAPER TAPE 2" X 10 YDS .,_.'~1/1'_ V107890 25-MSC1500 SURE PREP SKIN PREP Current Account Balance: 19.UU 16.02 ~ i °`~ ,. ~~ ~~ ~Y ~,~ ~~. . i ;~:1 'i i,' 4i • I ~I r. ~~: ti t k ~. ,` For your convenience, you can now pay your bill online at www.nationalrehab.com/billpay This balance is due 15 days from the statement date. If payment is not received within 15 days and we have a payment method on file for you, such as a credit card, we will utilize that method to collect payment. Current 31 - 60 61 - 90 91 - 120 Over 120 ._ _._ , _ ...-~,~ $.oo ~.oo AMOUNT DUE ~' $.oo $16.02 This balance represents either the amount that your insurance PATIENT: HARRY DONSON assigned as patient responsibility or the amount not covered by an insurance plan for the products you received from National Rehab. If National Rehab Equipment Inc. you have any questions regarding this bill please contact us at 1-800- AIRSIDE BUSINESS PARK a51-6510 or at billing@nationalrehab.com PO BOX 1135 STATEMENT MOON TOWNSHIP PA 15108-6135 '~~ j' i I II I II ~ III ~~ ~ I + ii I i "i I I ilk I~I I I ~j I (I I ; IIII ~~ I I II I SEE REVERSE SIDE FOR IMPORTANT BILLING INF II ORMATION 88307.3271 -1160608 , I i i i ~ I ~ I i 1 ~r ,. Balance A~'~"~ON CAa SHO~~~ SHIFT ~V'NAl' YOU'RE DOS ~: rl~~'rE's ~ !~~trl;~r ~w~,y C~~ get a luw car payment at v~ww.capitalor7e.curl?/autDluan5ll„?:~ ~~ ~r~ ~~~~ ~{~~~~ I :tip i~Y7` ;~S ii 1.~~`%~, h,r'f~' 'I _t~j .>; ,i~;tc~ i-ii;ari~~~~ ..: " ,- ~, ~ n`",- fib.. .~~t .M~. _t.:.. ~C,3t'1~;.., t 'f et sP,.,~ ,;~.. 4 - .;~-~` ~X~~ - x 9+~ 4 , r ,~, i - _ .+.+ v,,~r ; ;,~ ~ i-aac,-ass-~o~o _. --- _ ti~ww.capitalone.corn on ~o -Nov. oy 20~ 7 ~! ~~.~,> ~~~~ -„~~.~~; . _ ~i~~~~'~C~~~- ..~5~;'~;'?~~P ~r a AdINIMUM PAYMENT WARNING: i1 yvi, nk3Ke 0rtiy Itle inn itw i ,,:~~ ~K r:,.r ~ _ rVl~i pdy (I1prE '~n iflleftKl af1C II Vila; idKr ~Ou '~Onyr( I~ N~) Ohl yC~, .;a ~r~~~ :r ~~.~ .. ,,,;,~ ;,~~~i~t~,;; ~ ti;~~X~XXXX XxXX-5722 Payment Amount Each Penoo If No Apprvxirr~ste Tines co Pay Cr! cst.n~..a~~ ',i,'r ~:>.,_•~,:,_ r iYifNIMUIVI PAYFriEht7 DUE i7A7E AdUitionaiChargesAr~rModr Stawn>snttraianu lut~,_:;:; ,.'t . ~15.U0 DtC Obi, 2011 M~r~~,rn~~:~~~Payrrrent '6?~0 ;nos; ..: . ~~ YUu w0~,,iC I~k,e 'i10rf7'~f!',OI' atX>~? C'r(71i :UJf ~r~irl! ',c. .. ~ r_ ~ - _ ~- '~cr~; ~:~ ~.!;~;I:~~ Nc3~y(Ilz'f1C~ dn(3 CIC'L~iLS fE'eS i~IlCj IntereSl Q1dfyE~ Tfd(1SaCYJ0111 !4e ti.. ES;11_,~ICc -- S %ciU., -r SU.UU .fi S? 11.14 ~ i:. ~ ~. ~ -, ==rh_"~'~ __. ~ ~;,~;;~,,~~'IriLNiS (OR NARRYE JUN~ON :x5722 5~~.; . . -7"' -- . -,_:~~. t~ ~~',:1:'.~ r~5 ~, I'euUu ;':.~ ; .~ ,~~ . Si`4'9 _ . > :, ., . ;, - ----- ---~.___T----..___ _- --- - --- REWARDS INFORMATION PRE'~iOUS A~;~~iIABLE kEWARCS 6AlAFv~~_E . _ _ _ RE',^dARDS ~Ai<.~;E.; ?r7 S ~'tRJ;:' . . (iP~IFCSS !(d'tSoCi OrlS ; CiSfE'U dvrlny' If S DiiiifK~ _r~itl ,.. y ~- v." ~ L.< < f. % ~/ ~/ ~/~ / /' ~ ~ _. For up~~tu-date rewards ~raticiriy,~ visit wvyrW.capitalonr.com (~~1~14Cy~Iii.~.~f~ revr~:r~.~: or simply call 1-800-72&3Wi INTEREST CHARGE CALCUTATIUN Your Annual t'ercentoye Rate (APR) ~s t?~r ~nuu~3i ~nlrlr5! i_:t~ ~_,,~~ ;,.~~.:~ .,~_~___. ~. Ar7nual PercentacUe Ei~~l~ncc Sut;j.-~t tc~ Type of BUlaxe Rate (APR) interest fiatE Interr,~ ~~I~~r;. .asr ~~; 70`k C ).. .. ' - ~ , ' `!~Jt~ SFL~~V~,"rVITFI PA',^.~tNf OR LOG UN f0 4VWVV CAPIIALONc_COM IU w1~KF YUuiir'~YMLr`:I .~~;! '~;'_ 1.. ~~' T° -- -i . :i \ ~~ _. .C~JJ r~ - r .t ~'nr ~ ~ ~ .{r 1'~I'`",,~y~~~'\M~t{~Y~~IY~,fyZ`i~~• \ y ,, ,. ,. .. r.5 t.! , ,. °, ~~ ,~~ \ -- - - 1 FIRST CLASS MAIL. AUTO U.S. POSTAGE PAID CARLISLE, PA ' PERMIT NO. 350 ,5, PLEASE RETURN THIS STUB WITH PAYMENT: I.,.III,~~111~~,~,~II~I~1,I~~I~I„I,1~1,,,1,~1„I,I,I,I,II,,,I ****AUTOCR**R014 HARRY E. DONSON n, ~ ~J 25 CIRCLE DR V ~~ ~ ~ CARLISLE PA 1701 ~-8894 _ ~ a, AFTpi~"bt}{.~bATE ROUTE ACCOUNT 0004 ~~~?2 t7(l f\yr ~`!\U{; 1{li\`itjt i`~:r \ ~, t,t\\ `t '\ t\Y\ti~y `'ti1 :S `•;~i~ ' ~ ~ ! ~} try ~'. \t.\t \~ ,. y;.4 ;~ ttir y\yy ~,.~'. \ u~ \r t, ~ ., \,y~y1r \ ~ . Y. ~~rt ~ r t •-V ~ \\\ qtr\\ ~yI'\i {,\ ~\ , t\ t ~. 1~, \ (t \1t\ ,y \) c , \~, , ,., ; .,, t \ i; . \ ,, , y . f . I' ( S~ l ~ l \ \r\ \.\ ;>; ,y.,,,, , ~ ;~ ,, ::,,, \ ,.. \•, ''~I i ,~ ~: ~ ,, r 1 , 7leMCfUf~IT OUE ~ N0. DUE DATE ~ ~' r , \ `; ~ , \ ~: ,~. ~ (\ ~ ~tC' ,~~~~y4ryy~\a II~IIIIVIIII~NIIINIIIII~IM~IMYI~lJIIIMI•II ~ ~r ` ;~ \ ` ;~`I 1~ \~ ``\~\ i t ' ti ~ ti',' 1' ... - .. .. ... I'\ fit` \\,1\`;\~,~~.~ti ~ \ M1\\ ~•.\' \; filer` li((`(1'1 ~ ~~~ . \ r \ ~ \ ~~t{ ~~. • - ~~~. =a _ ~ '`'\t~ ;~l•1 \ ti 1^ ~ V\hy~ ~ ;~ t aj \ ,,r C .\ i ~:t :t ~, ), ;;~' ~ ti ~ t~ ~ ~~ .' \ A e,l . r ~' 1 y t. ` r \. , \) t ) \.~\\\ j ' ~ l] \ )~\~ , l \ \\ \,. .. „ • 1 fit. t' ~ ; J,\r\ \ \ tv. ~\~~ ~'~ y~y 4 t~ \ r , ~ j ~ \t a ',` r ,, t \ Y t t ,, y. r . ~ ;, 4 \ ,~•., ,; ;:~ , : ,~' - - ,,,~. ,~~ 1~ ~~ 1 f _ ~,~ \ \ t \~ ~1I l t 1`\` 1 1 ' •. 1 t i .1~'t~ t+ -. ___ . , ~' ~~ l` I t 1~ I~ i'U.~ 1 I~ ~' ------- ---- HARRY DONSON '` ~aruec,c Invoice f 3730 Sandhurst Drive Page 1 Of 2 York, PA 17406 Payments/Adjustments Date Description Reference Amount 10/03 Payment -Thank You 4242 -$48.75 Account Number 3-0611-1403893 Current Invoice Charges Invoice Date December 15, 2011 Invoice Number 0611-000825105 Harry Donson 25 Circle Dr (L1) Previous Balance Carlisle, PA x48.75 Payments/Adjustments -548.75 Contract: 9611015 (C2) Unpaid Balance 50.00 Current Invoice Charges 548.75 1 -Trash Cart (95/96 Gallon) Scheduled Service (S1) Date Description Reference Quanti Unit Price Amount 12/15 Residential Service 01/01/12-03/31/12 $48.75 $48.75 Current Invoice Charges 548.75 • r. -- - - $48.75 Due By; 01/04/12 Customer Service (717) 845-1557 Customer Service (800) 210-9675 FOR YOuR CONVENIENCE Tti'v0 ALTERNATIVE METr1QDS TO PAY ',ti^,1~,ti, DISPOSAL_COM OR PAY BY PHONE ~~ 877-0929729 BOTH METHODS - MAVE NO PROCESSING FEE. PAYMENTS POSTED ONLINE OR THRU THE PAY BY PNONE SY$TE~.1 ~^~iL~ APPEAR ON YOUR BANK/CREDIT CARD STATEtitENT AS REPUBLIC // ScR•:'iCES,=,~~_UEC'~`~,;STE PHOENIX AZ ~n~nnor, iorr, ~:~~,;nry Rcs,oents-This invoc~e may 7.S'r reii~c; a race a~i,,sunen, oue io the lipping ~' ((~ tee~O~s;.~sal Fer cn,,iemeniea oy the Yor}~ County Sviir~ ', `rci51E .=,uitlcr;Cy ;Cl1Rfi~NT ~- ~~~<~-_ .;:~'~ ..,I~ . Y'$ : ~~3;. ~ ; , ~~~.-s: 3 ~ ~ < Y u ~ ;~3AY~~:~, 48.75 0.00 0.00 0.00 To pay on-line or sign up for - ~ --------- convenient auto pay, g0 t0: M A Visit our website, www.disposal.com to make your payment electronically wvvw.disposal.com or to sign up for our convenient automatic payment plan. n Dln+eo w~.. ..~„nr+n Clr{n inr }prmQ onrt rnnri i}ulna .1 ,9 .{ ~. vllllllLlllJ ~,_.~: a:~..;~ ~~;~~~; 0~~ fer care of service 9/2-30111 is the members co pay amount = - - - X350 00 $0.00 $0.00 $0.00 $ 350 0! Date Description Days/ Rate Charges/ Payments Balance Units '~ (Credit) - . ~ ~ '. ~ ~ ~~~ '~ ~~ ~~~-ins Room & Board 1 $350.00 $350.00 ~ -~~~~ ~~ TOTAL BALANCE DUE: ;350.00 C~ C~ /~ ~~~~~~~ ~ 5~~ . ~z~ r _ ~ - ~~' ^- RESIDENT NAME ACCOUNT NUMBER := : -. ~ _=,_ ~:`f~.1 NC HARRY E DONSON ~ 803121 ---~ --- - _.__.-, _ -- -- ----- ~ I t V ~/ 1 1 1'~'L1 ~ ~,~ Service Details Account Number 09547 382344-p2-p Billing Date 12/28/11 Total Amount Due $62,95 Payment Due by 01/25/12 Contact us: C~ Page 2 of 2 ~ www.comcast.com 717-243-4918 _ T m Performance Intemet Svc 01/10 - 02/09 62,95 Includes PowerBoost ............ .................... .................................... ................. Customer Owned Modem ~~~~~~~'~~~~~""'~"~~~' 01/10 - 02!09 O,pp Total XFINITY Internet $62.95 4 ~1t~ VV r yi i - ~. - ..: - ,~ ~ 5~~ ... ~1 `~ 1\ ~( j• ~_ `,;. ~d ~. ', !r ~' .( ;~' I ~. 2 ;," . ~.ii. . Fa' ~'~;: