HomeMy WebLinkAbout08-16-12 (2)~ 1505611184
REV-1500 EX (o2-ii) (FI)
~••~1 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 21 - 2 011 - 013 3 5
Harrisburg, PA 1128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
199-07-6668
Decedent's Last Name
11222011
05011919
Suffix Decedent's First Name MI
SR GILBERT E
Suffix Spouse's First Name MI
MAURER
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
® 1. Original Return
Q 4. Limited Estate
Q 6. Decedent Died Testate
(Attach Copy of Will)
Q 9. Litigation Proceeds Received
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
Q 2. Supplemental Return
Q 4a. Future Interest Compromise (date of
death after 12-12-82)
Q 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
Q 10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
Q 3. Remainder Return (date of death
prior to 12-13-82)
Q 5. Federal Estate Tax Return Required
~ 8. Total Number of Safe Deposit Boxes
Q 11. Election to tax under Sec. 9113(A)
(Attach Schedule O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
JOSEPH F. MAURER (717) 712-0973
First line of address
208 SENATE AVENUE, APT 403
Second line of address
City or Post Office State ZIP Code
CAMP HILL PA 17011
REGISTER OF WILLS USE !)NLY
~ ~? ~~ -
~'
-,
``U --
-
r
~ ~ .
~`'- ~
_ ~;
~+
;
L -
,
~:: ~.~ ~'
~
~ ~, -.
R.
UAT~ ILED t,p
D ~.~
V..~
'~
Correspondent's a-mail address:N~A
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 beliet,
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.
S~I NATURE O~PERSON RESPONSIBLE FOR FILING RETURN DATE
n D
DRES
SIG ATURE OF PREPARER OTHER THAN REPRESENTATIVE D TE
8 ~ c .~ ~ s iz
ADDRESS
176 CUMBERLAND PARKWAY, MECHANICSBURG, PA 17055
PLEASE USE ORIGINAL FORM ONLY
1505611184
Side 1
1505611184
r
C~,,9
J
1505611284
REV-1500 EX (FI)
Decedent's Name: GI LBERT E MAURER SR Decedent's Social Security Number
19 9- 0 7- 6 6 6 8
RECAPITULATION
1. Real Estate (Schedule A) ............................................. 1. •
2. Stocks and Bonds (Schedule B) ....................................... 2. •
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. •
4. Mortgages and Notes Receivable (Schedule D) ........................... 4. •
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 5 , 8 7 6.91
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. •
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested........ 7. •
8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 5 , 8 7 6.91
9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 2 , 6 3 0.5 0
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. 2 , 0 94 .71
11. Total Deductions (total Lines 9 and 10) ................................. 11. 4 , 7 2 5 .21
12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 1 , 151.7 0
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ........................ 13. •
14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. 1 , 151.7 0
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_ . 15.
16. Amount of Line 14 taxable
at lineal rate X .0 4 5 1 , 151.7 0 16.
17. Amount of Line 14 taxable
at sibling rate X .12 • 17.
18. Amount of Line 14 taxable
at collateral rate X .15 • 18.
19. TAX DUE ......................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
51.83
51.83
O
Side 2
1505611284 1505611284 J
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
Gilbert E _._ Maure_r_ , Sr . _ _
STREET ADDRESS
208 Senate Avenue, Apt. 403
ITY ~ - - ~ STATE ~IP - _-
Cam Hill PA 17011
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
3. Interest
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
Total Credits (A + B) (2)
(3)
(4)
(5)
51.83
0.00
51.83
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 :.................................................................................... ......
^
b. retain the right to designate who shall use the property transferred or its income : ....................................... .....
c. retain a reversionary interest .................................................................................................................... ...... ^
^ 0
0
d. receive the promise for life of either payments, benefits or care? ................................................................ ......
If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death
2
.
without receiving adequate consideration? .......................................................................................................
h? ....... ^
^ 0
^X
........
3. Did decedent own an "in trust for" orpayable-upon-death bank account or security at his or her deat ......
Ditl decedent own an individual retirement account, annuity or other non-probate property, which
4
.
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(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)]. A sibling is defined,
under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1508 EX+ (11-10)
~ pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Gilbert E. Maurer, Sr. 21-2011-01335
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. Metro Bank - Checking Account 756.30
P.O. Box 4999
Harrisburg, PA 17111
2. Members 1st Federal Credit Union - Checking Account 1,402.60
P.O. Box 40
Mechanicsburg, PA 17055
3. Members 1st Federal Credit Union - Savings Account 3,284.01
P.O. Box 40
Mechanicsburg, PA 17055
4. Apartment Complex Security Deposit Refund 434.00
Susquehanna View Apts.
208 Senate Avenue
Camp Hill, PA 17011
TOTAL (Also enter on Line 5, Recapitulation) $ I 5 , 8 7 6.91
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 &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Gilbert E. Maurer, Sr. _ 21-2011-01335
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
~~ Woodlawn Memorial Gardens, LLC 2,113.00
2. ~Christmans Funeral Home, Inc.
B.
1
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
StreetAddress
City
Year(s) Commission Paid:
165.00
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
StreetAddress
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees Cumberland County Register of Wills - Document Fees 97.50
5. Accountant's Fees Hami 1 t on & Musser , P . C . 2 5 0 . 0 0
6. Tax Return Preparer's Fees
7, Notary Fees 5.00
TOTAL (Also enter on line 9, Recapitulation) $ 2 , 6 3 0 . 5 0
State ZIP
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX+ (12-08)
~ pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gilbert E. Maurer, Sr. 21-2011-01335
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (01-10)
pennsylvania SCHEDULE ~
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF:
Gilbert E. Maurer, Sr.
FILE NUMBER:
21-2011-01335
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).]
i. Deborah A. Maurer Daughter 1/4 of Residue
150 S. Revere St.
Harrisburg, PA 17109
2. Joseph F. Maurer Son 1/4 of Residue
208 Senate Ave., Apt #403
Camp Hill, PA 17011
3. Gilbert E. Maurer, Jr. Son 1/4 of Residue
2658 Morven Parkway
The Villages, FL 32162
4. Jack R. Maurer Son 1/4 of Residue
24900 Hilltop Road
Trinidad, CO 81082
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN;
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed, use additional sheets of paper of the same size.
J ~ ' ~~~~'
1, 4 •~
a ~: ,
~, ~ `~ f
Send Inquires to:
5000 Louise Drive
PO BOX 40
Mechanicsburg, PA 17055
www.membersi st.org
Main Switchboard: (717) 697-1161 or (80Q) 283 2328
BZ Call: (717) 697-~1 72 or (800j 233-4372
TDD: f717) G97-5312 or (SOOj 233-?_328 e~xl. ~>312
TefeBranch: (717) 736-6049 or (800) 237-7288
GILBERT E MAURER SR
208 SENATE AVE APT 301
CAMP HILL PA 17011-2345
Statement of Accounts
Oct 25 , 2011 thru Nov ?_4 , 2011
Account Number:
Balances of a dance:
Checking:
Savings:
Certificates:
Loans:
(V~oney Management:
Swipe 5 YTD Reward
416270
1,402.60
3,284.0'9
o.ocl
0.00
o.oa
o . 5~i~
Page:
Your aggregate balance as of November 1st is $5,152.58.
An aggregate balance of $2,500 and having 3 products
will place you in the Silver MLR level.
Enter for your chance to win PENN STATE sporting event ticketsE
Visit any branch location or www.members1 st.org to enter.
~~~~~~~~ A~~®~~~~
0011 -CHECKING
1 of 2
Date Transaction Descri}~tion additions
__ _ _ _ .Subtractions
_ _ Balance
Oct 25 Balance Forward 1,202.87
Oct 25 Deposit Transfer From Share 0000 300.00 1,502.87
Oct ?_5 Withdrawal 100. 00- 1,402.87
Oct 27 Withdrawal POS #624969 280. 00- 1,122.87
AFFORDABLE DENTURES HARRISBURG PA
Oct 31 Withdrawal POS ;f~634557 54.35- 1,068.52
GIANT 6269 CAMP HILL PA
Oct 31 Deposit Swipe 5 Rebate 0.05 1,068.57
Nov 02 Deposit by Check 1,301.00 2,369.57
Nov 02 Withdrawal 100. 00- 2,269.57
Nov 02 Check 000116 Tracer 0001175403 792. 00- 1,477.57
Nov 09 Withdrawal Adjustment Debit Card Credit Voucher 119.95 1,597.52
1 1/07 888- 829- 2430 TNC NJUSIN0002
Nov 10 Check 000117 Tracer 0026120502 44.32- 1,553.20
Processed Check - VERIZON ARC
TYPE: CHECK PYMT ID: 2005022221 DATA: DATA
Nov 13 INQ MEMBERS 1ST FCU 6280 CARLISLE PIKE MECHANICSBURG PA
Nov 13 Withdrawal at ATM ##004?_37 100. 00- 1,453.20
MEMBERS 1ST FCU 6280 CARLISLE PIKE MECHANICSBURG PA
Nov 13 Withdrawal POS #929477 50.60- 1,402.60
GIANT 6269 CAMP FiILL PA
Nov 24 Ending Balance 1,402.60
CHECK SUMMARl'
Check # Amount Date Check # Amount Date
000116 792.00 Nov 02 000117 44.32 Nov 1 U
2 Checks Cleared for 836. 32
- - - Continued on following page - - -
- ,~ m
~
~ " ;~. Sand Ingi.iirns Ire.
r Main Switchboard: (7' 7) E>97 1161 or (8O0) 283 23?_8
X000 Louise Drive _
~
~
3
~~ ~ EZ Call: 117 697 4372 or "00 283-4372.
Po E3ox ao ( ) (~~ ~ ~
Oct 2~, 2011 thru Nov
24, 201'
-
ti Mechanicsburc , PA 17055 TDD: (717) 697-5312 or (800) 283-2.328 ex!. 5312
3
Account Number:
4162'70
wF.~~tlir!It
I" Tele3ranch: (717) 795-6049 or (800) 237-7?_8£;
~~,,,~~.~~,.~~,,,~,,,,., www.niembers1st.°rq
Page:
2 Of 2
~A~"II®1~~7 A~~®~ 1
0000 - REGULAR SAVINGS
Date Transaction Description. ____.__ _ Additions Subtractions Balance
Oct 25 Balance Forward _.
4,383.09
Oct 25 Withdrawal Transfer To Share 0011 300. 00- 4,083.09
Oct 31 Deposit Dividend 0.250%~ 0.92 4,084.01
Annual Percentage Yield Earned 0. 250% from 10/01/2011 through 10/31/201 ~
Nov ?..1 Withdrawal 800. 00- 3,284.01
Nov 24 Ending Balance 3,284.01
~~~ ~~MMA~~~~
TOTAL DIVIDENDS SAID
0000 REGULAI•~ S/~VINGS 8.48
0011 CHECKING 0.34
Total Year To Date Dividends Paid 8.82
NOTE: Total includes closed shares
Add dour Photo For Security
Your personal safety and financial security are top priorities at Members 1st. As a result of
increased scams and fraudulent activity throughout the entire country, we are strongly
encouraging members to have their photos added to their account records. When visiting our
branch offices, you may be asked by one of our Associates to allow us to take your photo. T[~is
member identification program will assist in our fraud deterrence initiatives and will take our
identity theft prevention program to the next level. We are experiencing an increasing number of
attempted fraudulent activeties and as a result, we need to be able to verify your identity
immediately upon retrieving your account information.
In addition to having your photo in our files, you may be required to show additional forms of
identification based on the type of transaction you are seeking. This is for your protection and
security and we appreciate your ongoing cooperation and understanding.
,..
( ~ •,;~
rlr r ~-r
., 1 .y ... ........,. ~... ....~ .',.l ~.1--. ,~1
~~ . 4
~~1~?Lrr) Esar'~~
f Jf;3rrl.`.>IJl.lrr:; ~+C~ ~i 7' i 1 - i :1 ~,.
~~S°-S ";i-OO~r}
ill7~!!,'1 ~;':?r.','l~~`1r': iiill~ f'1'li'., .,
~~.~ii_r>i-r.i F: i~>,~nl.~!i:_i~: si< ~ ~ ~~~
C)fl (IL.C3E~~!Z1~ E~ MAUf?FR JF;
?O~; SE~_Nnl-E- ~~VF: AP i ~~1 i
'1Ve'rc here 7 days a week, 24 hours a day at '1~-888-037-0004.
50 C €~_~S CE~~:CKING 0537f31257E~
Statc'ment,E3alance as of 1112011 1 ', ' ,' J`.. 1 ' +' ','~ ' ~; ~JI ;ti +" ,$756 30 '~
'~~ ~~' 1.; 1' i ,1,:. ~I r( I V - ~:,1 I, 1.
,~; Plus' Deposit> and~Other~Credrfs ~ ~+ ~ ~~ !:, ', I, ~ ,~"ii,~ Dili, ~+I+' $0 00~„
Leis 1 'Checks and Other~Debrts i ' ' I, 'i' ,' +" ~ $756 30.,
,! 1 I `I i ,
Plu Interest Pard 1' ~ ~ ~ ~ `~ ' "' ;~ ' . ~i~ I~ r, ' ; 0 00 ,~
Statcmcnf E3alancc, as of 12/20/11 ~ ~~ '' ~~'I+; ~', ,~ ~ " ~0 00 i
~~?3as~a~~:a,o~s ~y ~~~~
late _ Descri~tior~ __ Debit Credit E3alr.3nce
- -- -
11123/11 ~,, CHECK !t 7„ . ,, '
...~ ,. ~' ' d - `6.30 `-~ I ~ ,., ~ ,, G" . i., ! $0 00 ~'
2 $7~ ,
~~~~c~ ~r~~~~s~crL~~a~s
Nr.rmbcr Date Amount Number Date Amount Nunrbcr Date Amount
,
72 . ,.,: - 11!23 , . $756:30 ~ ~ ._, __ -_ r
,; .i„
_.-~..--_.._.__-__-__ ~ r ~~ ~ ;_
I(rim>; rli~nptU(I wilPl Zln ' f, ~ arc r;lecir(mic cnt~iq;~, ,end ;vill nr~l I~i/rir. _I r;^+:~cK im~p~: toms i7r.l r~lefa ~n~ith ,~n "" ir'ICIiCEIt,) ~~rnc':e.,s~,cri ChgCls out ul sequc~:nr,r,_
1~6~tS'~'eS~ 7P..1B~J~"3c~
[3equ~ning Interest Rate - f i, , ' r ', 0 15% ~,
N~imbcr of D~ys.in this Staternc'nt Penod ~ ~ ~ J, ~'' ~' ~' ~ ,30
Iritcr~st E~rnetl;thr5 Statement Period '~ $0 00
Annual Pcrcent~nge Yield Earned this-Statement 1?enod (APY) ~' ~ (' J ~~ ~0 00%;~-
,
'Int~e'r'e~t 1?aid,Yca~r to~bate :' ,~ ~ ~,~ ' ~ ,';~,~ i' j '~$~~II6
,., , . ,,:
i
i~':: 4' S ~ 3.t If ~;3 f'~ ~ ~~
__.
Lota! Overdraft Fees this Statement Per(od - ;,, ~, ._ ~ . ~:; ~ _;~ ..'', .} ;'I~ ~ ',~ ,,' ~ ~~' +:,~ $0 00'I
,..
Total Overd-aft Fees Year to D~.3tr' $37.00 i
.~, - ,
Fota] Retirrnrd ItQm Fees thrsStaternentPenod ., ~ a - ,!. ' i' ~' S „, . u ,~,Ir ,, ~
„„ ,I,~,,. „~~,~ ~~.. ;:
Total Returnr'd 9tcrn 6-ees Year to Date II $p 00 ',
.___.___.--- -~ ._. _._ . _ .1- _. - - - - -----
f r)r yrn,r cr~nvenicnrc, a ,~irr,h~ary r;` ovr:rdr:~(I ,and roturnecr irern fe~c~~; ~pF~ca~s on your rnon(I'lly slalcmcn(. I'I~;,ISC Holt: Unit the ovcrdrilt fc~:
~~,ulnri,rry int:IUdus non-s,LlifiCiCnl (antis `a~es.;, uni:pllaCled fund;, foes sand unavai!~ble funds fees. i~he ~~,un~m<(ry r.iocs nol reflect rcfun<1cr1 or wruvcd
ilr_;n~, crcd~;ed to yo'"r ,~a;oun;.
A ME.tro F3ank Uisa'=' Gift Card makes the perfect holiday gift. Recipients can buy what they want, when they wanQ,
whc~rc~ver 1/isa debit cards are accepted. !t even comes wrapped in a signature red box with a white satin ribbon!
~'urchase without a fc:e at ,you! nearest iVlotro Sank store today.
2q Cyc:~c' Page 1 of 4
P.IO~f~E ~F_E: I'!~_~\/f~:l~ `~F: `>II~f: FC)R IN1F'O'? i~/'+fJ ~ INFORR,IATIC.~)N Mr~n(i~er J~I:)IC;
' ~,;
f_'
~~
-
~
i ~
j
~ ~ ~
i ~ ~;I
1 I ,
i ~ ~ j
~
I
<,
(~
M ~J
_
,~
~
i
'~
ii j
I
i i
i I i
~
J
J J
~
,
.f~'
~!1 fa Cam. ' I '.
::!'1 ~' I ~
I
~
' J .S ~ ~ ~ T i i i
,i i
_
,/
I ~
~
~ i
I
~ .)
,. i ~
~
. ..a r
,' .-.
_..
~,.r 1J
~
~ w'n ~'~ I
..., ~ 1
o ~/
a .1..
hIJ
'''
:'..
"..
J
'_. t..t
Y.. y ~
I~
~~ ~ I
.~~ ~~' ~~I ...
~~..~ i ~^ .~
i r:
i ...
;~
~_ C.,.
.
~
-
I -
J •-•
I~
~
,
_• J S_ Il ~-
r-. J ! _ gyn. ~~~ j
~' I ~../ =~ j 1 ~ L. ..
~ .
. a_ ~ ~ ~
.~ ~~,, ~
~~ ,~, _;
--
- . ~ ~
~ ~ by :.. fir, _ r ~ 4.~ I ~ I ~ r_.. -
:
~
._
.
~
I
ra
,r
-
~
,'
'~~
a
_ -r
~~
_.„
..
.
_
. . ,._
~. .._.
~
.^
~
~,/
i,.rk ~'". i i
j 1 ~
_
'. J .
~ - a ~ ~ - ~~
.4.,t
,q
1+~ .rod _ "J ~ -~.
''
~ ~
~,y ~
„ I :;1 I ,
p
i
•
~-
~
i i
'sue ~~ ~
~._, "7 ( ._ ~ i ~~ i ,
i
~ z u r t~ ~ ~ I :' ~. ._.. i '~ ~ : I
^,,. ~ F:~ ~ rtl .:, .: ran I, , ' '.. I (~ -. ..
-:r
Ci ~ ;. n
~ J
_, C
I ~.J _
~ ~ ~
I I I I I
~
,
_ r
,
I
a~
r
•-~
~
I, `.:]
'~
I
l ~ ,f_ ~ ~ it ', ~. I
~ I '
i
i ' -- a` w y' ~ ~~ _ ~ ~ ~ ~ ~
N '~ I .w i
'
-_ ~l~
r"
~,
is
~ _
._" ^~ _' w
r'";
rr~~+
I i ~ I ~
.
,., '~ i
i-W I I i
M1 -J ^J ^J
- I,
~, J r
. ~x,. r- ~
~
~, ,,, -+' ...~ ~
.,~ i j I,
C: I `J~ ~ ."mob ~.J %! ~ ;J; '~' 'J ~+' ~ t ! ~' ~~ sr ~" ~ti ._~ .I ~' .~... ,
j•
..
-~ 3
_ gi
f
l .,
~.l
,rJ
! ~~ v
j rl
'J
I
_•
~ i, r.
! ~-)
~i
~v
_7
I !
:.i _.
~! `_
(~
I ~ J a-
I r)
~ i r
~ ....~
I Il -~
I I
~I
i ~ J ~.
~ r'..
I J
i I ~:
7 (!;I , n
t~
I ! ~ .i
! i r
! ~~
,I i
I ~
~ i„C..
~ ~
,.. -~ t~
~ j 1 1J J
... .:
1 _
1
i , . +'~
a J
l
f ~.
~ -
~' -
~ _ r
~ ~
~ti
f ~ /' r~i
.~ ~ ._,
r ~ r^
~J --~ ~;y
Iwwl ./Y~ -/~ '~ ~ /~
:~1i nzi M. ~~, ~ ~ ~~ ~i
~~"+ ~~~
~ V. tu.,
a
• .rr
~
m.
~ .
.
A
ri
r^~ ~' ~ j ' ~
~a ~~
.~
~
~~ pew f ~~
-,
~(J .
_
w
`
'~,' 1 Na'F~ ~
r .,,.,.
1 j
:;~
, ~
w
,.
'
~
+?''
er .. ~i
~- C~~ .r. C
w~i
,..,~ ~! ra. ~.~ .J Nl; ~~
~. ~*.' --
`per' y .....- ~..~.... ,
~ J.a ~r r"``I
vM alp T
r
r,
(~' '...r ~ l Tom.
ear
pP±
~ is
ti
i ~ .., ~ ^ = i
T
~
~ (:;:~ ~i
Cor
`(vw+
l
_ 7r+ ~
rv.(1 _ ~~~ w.
~
~ ..' +mJ r„,, yl ~ Y'urll r., A~ ~•77 -.- ~ml ~+I an+w+
pa.e :~ 1~J r+~.r !
-d .i <
+m
r,. ~•i art ~ f, i
`""" rya `-V' ''I '~.°' ~., ~^~' =""~ ~. ': _ r' `°"~
4.,..1 .; '~ Y^~ ~ ...,. .y,,.r !wMtll ,..~ fir' a ~ '^ ~nYI r
t" r. i
~ G~
M'+'' ' .e..sl wtA d nA
I _ . ~~! :. ~.) r~i ~:I '~
EM
,r. r ,
"~
ti~a ~ ~, .~.~ ~/I ... r~~' .tom., ,~~
,-', w~-+I •C.: ~~
.
Merl +kN
rJ a • ... ~ ~ y M .;~
~M!
r
i {.r
~ (, ~..e r '.1.-' ter' c ...
~ ~ , ~'~~n
'~
L
.
,, `~,~ ~,.~ ~ ._;
./
(
r ~
te _ n~ .~ V
~ ~
I
. br.
,
~ ;!'~1 ~
~ .e~ a
..' .Su 1 rye
- :~~~
'
i r»~ ~
.=r+. l . r
~ '•
r ~ ,,,
.~, ~ iY ~
...N
v ~"~ ~
r
-~:; ,-, r} .J J
N~ .~
,
ig
..p~ 1'M 0.1 'd•,w -~ ~
' AN ~ wy .a
..w ~.d ~J "~
w .~.r Ill I J'I
~
..~ J
~" ~
;~ ~'~ M "=; "~ - "„tea
~, ~' '~ i
~ _. , ~
~ ~ ~ rY ~ I' ~PM ~ ~r /ill ~ a'.J v.U rte-, ~ ^
. I
~ i-
'
1o-n.y ..7. I~'v r~'1 ~~"1 .~ Yr~.a, ~... ~' ..J ^~ 6h~y ,~..r I.
~' ~ µdnl ~°I~ V 1 "1~ ~ ..L~.. ~ ~ f~~ ..~ rM~ ~~
~ r~ smd .+~
r ~~ ~ >..i ..r. :r.
.
'e.,,,p rr'' ~..a.r _s*~ ~ 'rte .~ Ir.~-
~I
i
[...
~...
`+ J
S -W rJ
a)
^• 4
r , .._.
V
_ ~ /~
II r j
~''~ +
.~
r cr
.1C ^' )
~J ~ ...
•.: :~.
'~...
J N.
~~
't""'
r ~ ~, 1
.-a ~.~
:.1 1 i
.. i
~'w
-J ~ '-~ _.
!'
./
f.
~~~urcc~ Ili.n~l~>~~scri~)(i~~n.l'aii(:i~~l~l(~i).'.')
~l~l~rr<.~/t~n~rcli.v~~-
;::::1'~lrli~ll llrn V,IIIII ........................ _..
'` K~~~I)~,ll:c• urn ............................... ...
( ~cL~'~1 .1C~1'il~ll'('.~'
N~;\\~;Irll~~r- I I,1rri:;hur~~ .............................
~'I~~r~~v ..........................................
C~~)unt~~ ~~~)runrr :'\tl(Ilurir.~Iliun ......................
l(ts1~,r1~
>. ,
~1~(.~~~~.`~~,f~Y'"~'ti'9~~~9?~'~~~; 93:~3,:yti't~.,.:~~ C9s'~~ frerclntltr ~, ?+;': r
. ~ t '~ ~;'~ . a. ~>
f~,iv?,
,, .tu!
,.: ~ a .~ :1 ,°,~ ~. 0.11 L~ .~ ~4 .J r d C. ~ ~ \) a
RECF I P`:I' F'0_~'- P'';Y ~vl:~~l`J`~'
c.fLE_,~!I:); I~'11R:L~IL;R SrI'RASI~AUUI1
,_`~!rri~:~c~~~!_<:~r~_d Co~~an~ty __ Rec~i.ster C~~ ~~_~_1:1~
c>>1,,-~ C~'~~t:1rLr7o~lse Square
C' ~:~ r~~ 1_ i : ~ -1 E~= , 1?A 1. % 013
N(1~1:J12L?I~ C:TTT~I3~~R`I, 1=, SR
',..>t:.al:~~ F'i1_e Nc~. ?_.011.-01335
1?~z-c~ I3y Remarks : JOSEP~II F' MAURIJR
Lc ~:~ ..~C ~v~~~ . ~! ~,. (i
} .
HMW
_. __ _ _ _ _ _- .-- -- _ .-- _ ._ _ _ -. _ _ _ -- _- _ _ _- .- - K e c e i p t I-) i s i= r -i_ b u r. ~_ <:~ rl _ __ __ _ ._ -_ _ . _ _ _. -- -_ _
I~'c~~/`['a~~ Description Payment ~lmourlt P~:~v~.E_ l'~T<~me
P:E~'TI`I:'TON LTRS ADM
~
~ 30.00 CLi1~II3LR.L,AND C'G1-:111'-i'Y C~.1~~1`Jl,~'%`~.i~ ~~'i:~~~!~
l_~I=~I~]
U
~I~fCI:~~TION 15.0 0 ~'UMI-?1=~~I1!._,~~i~1D C~'UI:JI~~'1'`C ~ ;! Iv~I ,I'.'~'~. ~ ! ''~ -~i~,
._,
~_' HC)R.'~l-' C~I~R`I' I: F I CA`I'IJ ' n
~ x . 00 r-~T ,-, -
~~~JM~I-~:F-1=,~1.~1_~ ,-, . ,-
~-.~.>~JI~,~ J '~~C , ~ ~~ ,
~ ~~
~iJ~ ~~ :~~.~. ~~'~,
I~~,
J~C:'S' L~'L~i~~ 2.3.50 h'~.J~i~1~'A~., C)F~' f l~'C'L~;1. i~ 1_'~=> _
-
.~ ~~~~
~: ; ~I ~
I~U'I'OMA~1-'7:ON F'EI~ 5.00 '_'Ui~1L:~1~i~~! ~~1~1h C:'~)~77~T 1 ~~,' _
~r1;~~I~11,!~.'.! ~ J~~I'~~~~
~ ~' <~ ~~ r-1 ~ 9 I y ~~ 0
'-Total 1~eceived. . . . . .. . 9'7 50
r...;--
r ~ . ,;
,~.~
_... 1
`. ~ ..
~,,....'
_ ~i~..r
5-, a`'
~, °E
1
~, 9 ~ `
/ ~\1
;,\~~~ U~ ,`,
~~~
;,
Joseph f'. Maurer
208 Senate Avenue, Apt. 403
Camp 1-~ill, ~'A 1701 1
"I~IKMS: Due upon receipt
HAM ILTOI'~ & 1VILJSSFIZ, I'oCm
C'I.;IZT1/•~lliU PURLlC,~1C'C~(:)U.~'"1~.4~~l~.~'
176 Cu~l~bcrland ParF:wtiy
Mcchanicshurc, P~1 170>>
717 (,07.358
INVOfC[-: NU : 1144089-IN
nn~ri: Au~~ 08, 2012
C1,Il:N'1' C~~ui~. ; UU--MAU[ZI;IZ.I
Pa~c I <~ f- I
For Professional Services Rendered: Amount
"I~a~ Services
2>(D.OU
Preparation oi~l~orm RI?V-100 anti v~trio~~s schedules
(1'.1 [nheritancc'l~ax IZctiirn I~or Gilbert l;. Maurer, Sr.)
SALES "hA\ UUI~;: `t;O.OO
~r~~~I'AI_, An~c~~~l~"r no,~I~.: ~~s0.o~)
CURRIN"I' 30 DAYS 60 DAYS 90 DAYS I20 DAYS I3AI,ANCI_~. I)UP;
$ 20.00 $ 0.00 $ 0.00 $ U.00 $ 0.00 ~ 250.00
~~~~~ OYVi~UICARI= OF VUILL9A~/iSPORT
-~ .~~ 6J9UB SNOWf:)R1Fi f~OAD
'~~~s~'/'~~~~`~ ALLENTOWN, I',^~ 181 U6
•~, •q Y
'~r~ f~E:-I URN SERVICE RFC~ULSTEU 3 ~•~.
.'Y"~'..L . J ~i
~~
1101
PHONE: 877-670-6323
You may also view/pay your bills at:
htt;~s://myornniview.on~~ni~care.com
~~9e~e~s~aa~li~t~(1~ellle,oi~od~3~d~~9~~i~~~~~r9~~~~~~yj~~a~o,,~i
GILLBERT MAURER
GiLBERT MAURER
208 SENATE AVE
APT 403
CAMPHILL, PA 170'! 1-23~~
~~ ;.
-,
~,' 1
,_. !~ ~i .
I J'~. /\ ,
,).~`i
. :,
~; ~ II`~
_;l__, .'JA'Y".:'r I
_.. ~ . ~ ~ t ~.i ~, ~/ ~ ~1 ~v' J ~ .. =. ~..>-.~. , , L»J :. ~~ . , .. .. _ ._ i i.l' ~t Illy ~l '! ~ Ill Gi ill r I ~I NJCI G~ ~`il ul' '; '.I i~ I I I i~.
MAURER, GILBERT S}R 3'; 3:T 5,~, ~~j~`r=iiiv;C` .
..
X
. ,
~_
r
3184-.529 ~~
_, _ _... _
,- -
I
_ _._ ---- -~ -----1-_ __ _ _ ._ __.__._._ _. . __. _.
I
~~ i
I
I! ~
I
i '~
..~.,si~~)~a
PREY?OUS GALANCE CHARGES r?N?.NCE CNF.RGc
'i.81 0.00 0.00
i,
I ~ ~,
I -.
i. J~J ~~ (f~~~~~~'.~i'~~ h,. i^~7 ~,: ) r ~ ~~i:l f,. i 1,;(711 :I. ~ ':1 !i '~~I'li~l_
TOT~;~ CND^-.RGFS r=',Yf~lt~r!~I~.~ ~. ! `.._C. `~ , :~iC_.~~J
'I .c ~ U.'i~J _
Addus Healtf~Care
1029 Momentum Place
Chicago, I~ 60689-5310
(8 77) 244-5411
rB'~uoice T®.
MAUfZER, GILBERT E
2oa s~NA-rE AvE
APT 301
CAMP HILL., PA 17011
CL9Ef'~T SEf~V9CE If'~VOICE Page 2 or' 2..
-- ~aYe _~~.~~_ _
1 ~1W3/1 1 I--come Care Aide Hourly Private:
11/09/11 Home Care Aide ~-sourly Priv~~t~~
11/10/11 f--come Care Aide f•-lourly Private
~i 'I /1 1 /11 Home Care Aide Hourly Private
'I 'I /'14/11 Home Care Aide Ho~irly Private
i'I/~15/11 Horne Care Aide Hourly Private
Total:
,~r000~y~~: ~\~:t7~C)E~. ~J~) I..il):jiiU
II:JC~~I-,Cpp~_G~~C3:CC~l I
SF~~voc~;s f=ot~:
203 SE~~!~!,~`,TE:. ,;~~F
~,` r~ -,- \J J, ,
Service Err~~9oyce
VVA T F~ R S
WATEPS
VVAT ERS
VVA?-F= R S
WF,TERS
V`JATERS
~~tai'ts i~~Ee: ~t<<o~y~~l
:' 00 ~~ ~, (U 3~:~ U,~
~~ 00 , . ':!(~; ~~: Cis
CJIJ I ', ~JLJ _'~J '_~'~;
-,
PLEASE ~ETACHI A~~ RETURf~ THE PORTfO~i ~E~`~ y'~~~p ~~.~fTl~ ~ 1~'O~C~' `~J~~~;`~~~~IEp'~-!,~
Uell Preferred Account
~~°' ~ Accot,nt tJurr,ber 6879 4501 2904 6150 168
,~~~ I.~~.I
,, ~„ .~ ~ ~, ., ., ~~ ~, ,. ~~
~~..~I~•a try wla,r,~l,<< For the billing ,
ending March 08, 2011.
pc riod
`~.`~:':~'__ .'~~~ ~`",~~
':.:~~
'
"
'
'
'~'"
~~`"
~..__._._.._ ,
-_
_
_.
.
.
_
.
_~.__
`" Special Messages for GILBERT L MAURER SR
__ __
~okinr, fur a rrtorF~ convenient way to pay your bill? Call 1
~6F~-509-9319 anti use our cit~~r:acc ~~ EJayi>>~~n[ sy~ l~ ni
.
......__ .__.._._ _________.~..~_.___._~_.~_ .____..
Summary of Account Activity
h I
_ _.._.. ~ _ ... _ .._ _... _ _.. _ _
Payment lnforrnat[on ~
_ __ __. ------_
~l'\'I(Ill`~ Clcl loll l(_l'' 1t ~Cj~.GJ i,l.W ri 'll]IIC: (,'
~
';tyntcnts
-51,781.6.`' 'aym,tnt plx- Jl,
,Mlninnnn r
PaylnenC Due [7a[h ;.p~l! Oc,, :';..1
lt_iu_r Credits 50.00
'llrCll,);cs 50.00 ~ - ._-__ ... _. _._ __ _..___ j
---- -- _ _
;trlcv Uvi>its 50.00 -. y. .~
~~ ~,
Late Pa ment W~rniny It tic. ilu no[ ter I yinJl nl'~niln I r,;~rn~ t I~I; lii
~ l'E'i Cl'lafC~l'd 5r~.()t) (1 ~1t1' 115 t1. C~ i]bU+e, )/Ull 'llcl/ Ilil Vi_ iJ ply ~~ I,ll~' ,t l' UI ll~) .J ,.~~7 ~fl l,, yUlll /-~t~l; ~
it'ttt'ft=5l C~fl~f~l'C, JU.UU Itt<]y ,~(' II,Cf (.'i:5(.'Cj CO C~I~ i~~•;, :I ~I Cy .~.N IJ. 'v~~,il:,l CU~~ICI !)C:~ Ji ~.; _:, "!~l.~J ~);~,_
_..__.. _. ___-.._._.._.._.._._.__. -_.___._.__..~.. __.. _._..~-_..... _,_._..__._ -~ ~ Jynlelii ~vvui I,C~: ii v..) ~. ~. ,., ...
~
a
I
•
'k~w (i,ilance 50.00 ,,;ul
~ ~. 1, ,,:r ul ~t_r ~ ; lal,~ I f
< <,vlll pay rnorc inti-~r ,. ,u d
>C rIU~`
yQU
i'd;I. DUV An1UUnt SO-UO ~)21l~lnCe.
For exarnplc:
~'dl
~'~~~lilt Lilnil
able Credit SI,000I.U~
SO.OU 1-~addltl~O not l'll"r1~1r1UeS ~, ii l~?IICi'lShCi rIi,JGnCtlll l'i
t
it
~`II`tl ll{~)ia
(i"Eels l.,i l!I,; ~'1 CC.IC, ~~~~
{~' 'y
)lcrn~~nt Closinr U~~tc~
March 08, 2012 l
c
ustnc; tM
ard ar bout
.
statrn,cnr to 1
.
ic,~~
l a'
I
I) !y~> in l3illins~ C t lc
._--. _ Y'___..._.- 1 J
._____ -----.--_~_-. _.__.`_ y
y
f
~
each ntoni, OU pa .
_ .
a -
-_
._.-_ _._.I
;.l,ntac[ Dell Fln ancial Services Custom.~r Service al
1 80028.) 2210 or vi;i[ us online at www dell corn/Clf s.
~'lrtuc send billirx~ inqulrlcs Co (illlint; Inquiry Dep~°rtnl~nt:
.i~•ll Prt~f~~rlcd AcaJUnt, P.U. Eux 8158, Austin, i~X 73708-1`i85
~'il:ir~e send r.orrespcxulencc other Umn billing inquiries to
J!.'ll Fin~rn~.,i,.ll Sr.~(vicc,, c/u DFS CustomCr Care Depl.,
r'.(_). [>ox 01577, Autitin, lX !8108.1577.
F'lc,tsi~ In,iil ptrymcnts to Chc oddness on your pitymcnt coupon
~rluw.
Only I~hc minurnnr. ~~ U n,nn:lls ! :U t;-,
p~lynn_n~ __~
II you would like more in(urni,~!iun abvul cl•dit co~,;nst_~ ,'r~l_,-;, ~_,:[i
1-1100 28i-?210 or t;o to
hCCp://vnvw.)~,ISLC~~.t,v.'!t/~~u;l~rlpli;,-~CUi~/r~C :;,~~nu"_,'.I~tln
'LEASE NOTE: ~1~0 AVpID ADDITIOrJAt~ INTEREST CHARGES, PAY ~iliE NEW GALArdCE BY THE" F°AYr/~E-rlT DUE' Ul~~iE
Transaction Detail
Reference Number Trans Date Post Date Uescri lion of Transoctivn or Credit ~~II ~J~„~ii
02•"L6-17. 0'L-?.6-1Z PAYPAE.NT ~ THAFJK YUU! [ ~ ~~'~ ~'~~''
2012'1"otatts Year-to-Date
_ _ . _. __... _-~ _.-
.
. _.~
-.
l
.
_
_
-- ------------~------.....---
iot,)l (c>c~; Cll~(rt;c'cl 2011 5i1.0U
~(otal interest chor.;ud 2Q12 `,U.`.i3
.Interest Charge Calculat,on
(nltr Ann ual f''erccnt );r~ It~ li~ (AP{+j i~ the anl~uul nt. e5t I,:[~_ ul uu .ccr~ullt, ~
._..
f _..__... _.
I--'A-
_..~_..___ .
PrUfnOtlOn
--
__.._
l3illitllf (;
._._...y...__
Dilll
.__.. ..-- ----
Allnll ill
-
_ ~
~' _ _.r~ ....~~
F rtJn ()t I,:1I1 r l ill l)c'' IIIC~ l ~Il ill I I j
f''~
Finn type
E.xpiraUun „
Sub~u,t to J
[ c.rlodit.;
r r.rct_nt~x'`~ In ere t , ,
.~,II n[~ I~..,l
i ry,ln; !.u~.~ ~
[)` ["``~`~
[Z ,tC~
t
~ncl-
i ~,l ,l
~n lC'l 1. L c~rl~~l
_ _ - -_._ - __._ _,
I
i I'. [:_r L,~i1? F'l Ar~ r,
>u c
V u.ot,.)1 fix, _.~ --f~-'~~__ (~~,~. ......._.. ~ ~...... ~ -._ _ I .- _
I I; _
_..._ '._ __.__.._. __ . _. _.
_._._._
------ ._ ____.--- .
-- -
-- -------- - - ...
I'lr..i~~~~ lilt iii II~~~ '~ilx~ililC E:nc to~(:d ~tiid i~•fllin tltr•li,lVl~ii~„[ ~;t~11E>ilrl wllll yuui ~ I~, ,~E. iii ll ~: Cr,i lu',i rJ i~. luiii i ._,.~,~_, i) ~ ,.;~ ',t I!;i',, i ,~,: i ,. ~ , t .j~~ ~ i~r„ ,i:
Want eo pay now? ,, ~, ,~, )~ I ~ ~.
Visit www dcrLcom/dfs Co make your payrnc~nt online,, ACC:~oUn! ;;~ ur>IJ )J, ... J I, )U 11: c•
... ---
__ _.. rlev, P°,lontr_ l r,(1
C~uptperh ~I
. . Vt ttwww tit ll r,om/G~P~lp°~Itr~,stu !corn rune. Minilrn°In Pity II ,C l:r.le: (.OU
_ _
r'ayment Dun IJd~C•: ;',pill ~.li~ 1U11
UY, ..
4~..'.
f'I!~,IS I,i iL. yc Ilr r ~ •i:b; I i li~li t, U~.I! ~'I! ~~ ,<<7
Account Inrl,l I /c , r 1 i r l ~,i! ,, c, ~lt Ill;ili, i ~ lln ;~r),;I -
Cl,c-'~k or iiil~ni"~~ c~rc;r~l f.' ~,~.I,~• :I,i~ ',:ni~)i:iil f iii I~~;~ cl'
.~ . ~~~ ~~ ~„ ~~.~~,,,.-. .i~,.,~.,~.~i~~., ~,in:~,n~n„~nn ~~,, „~~M~n~.~.~,iu~.ui~,•,n~:n ~~ ailll[i~i1 0!~ ;I,c~ r_ou~JC)i~. ~•ct~„<iIS Clir.• ~~ii~..r:~<;~ili~i~.llir,.
!il"it""fiiifllll'fflf'fl~IffIIII~~If ~~V~III~1111Jllllllll'll °lil"iliili'1'i'ii'i'i'iiiiiifileililf°lili`h`I'liiif'iio°ii(i:l
G1l f I:ftl f. MAURFf~ iR ~!'!
~09 !:;(NAIEi AVfi APl' 4~3 ~•'~i C. l I F'Nt i P("U ",CC.(i t'~
irAMr Ill! l_ f'A 1101_L 1.373 1~ F Y~•1l'Ni P J(i >>7C:C, _ha;,G
~1.G_u"~tiur;nl.a~-~r,u~.~,.~f11,1-,~,(~17~1nr111(ln~(lflllllfl~llf1flfl~lilf~lf7l7(~0[70CJ'-;O~;~L~.LC!.]~1C'1;!,F;1~(~~
Ac~uuui I'Jul~~bur
717 761 I~)4~J 4~UG i;/~i'
Ship °, B,~1% P;~y K ~1r;cl~rJ~yl CPr,vr~r/vs
~7u>'`op~y ~,~'.rp~w Fro~uv'i7v" ~:;;a<>ir
Grp gl~:utl,Yo~i.,y ~- C;u f':~,3ed ~rcC ~~t
Vt:~ i2p11,COIII~IIIyVt,'Y12U17
'Vl~rix~r~ ~e~vs
l~r;al art w~i~ll Spaacl Ir~tartrrJt
Gel Uerizt.m lliyh Spcerl Internet aI .;~ iv 1 IVlbps for
UIVLY ~ 141.~)E)/mo. for I yr with NO TERM CUNIlZACf
RL(]UIRf l). Call I -t3t38 -328- t3O8q ur visit
veriron.coln/iht:moslspeed. Subject to taxes and tei;s.
fernls and restrictions apply.
what IVar~ ~1~ers
Call I t3t)f3 3a J-ts~ll)5 and tale advania~~l; of this
nionih's hot oilers. Asl< about all the great NE:W bundle
options available.
~aIY l~~a~~t ~crr ~r/uty ~3r~r~csllc;~~
Call 1-&ti(i-(i7t3-.tS000 10 letirn about our gICaI, nl:w
special buniile otters for Verizol~ customr-rs. We'll
assess your needs and make sure yuu have tht; h~~~l
Ct)nll)InallUn (it Illlelnel 111 A ~"
best value. Uun't wail. i
~,
~~~ ~ ~ ~~~
~-j,~°
~i:t;C~~IYIlI ~Cl~~~r"Yrtic~EB~I~N
UIL(3EIZ1 r41NURE:FI
Pt~rolle: 77~/-761-1~3~'~
~cc;aar~t ~~~r`rr~rYr~~~
Previous (balance
Payment Received IVrv ~J
~alarl~e 'Fryu'vuar'~
'~I;II
Neuv Charges
Current J1cti~niy
taxes, f=ees arn.l l1li~u;~ l;litilOus
7uf~uV i~auv C;ltiarilr::; wr1~ i,y l)~~~:<<~,'I;c! ?'t, ;~U~~-t
,E1r~~Grtlr~i f!)e~r; ~~ ~~;crrr~a~r 'y.E, ; :yu~~[ ~
'UtC~grdt J~ry~aorbaYuc M'~yrrlr;J uc :.,~e't,~i~i7
`G~l~i :S?
`j~~! ~i .'3?
,,
y;.~l,u
;;>'.;~.~.'.~-1
i': :'.
t-nroll belovu ur al Verizon.con - on.col~~l of cell 1 JiUU VI_:13ii (lf~l l I ~ t3UU E.is/ ~141t;(~).
in.tilutiim to deduct the alnou ~ If~J i(~.i l llsr; 4~U6 it ,;sl<<.;~J lul fh~~ Iflrce ili~Jlls
tic account associates vvilh yc ~ ~~
~ '
semi payn~enl dileclly to Verizs .. ~ '~:acti u~, ~, ~1~
Aulumatlc Paynlenl, call Verizc ~(~ ,~. ~~
li~isaulhoriralion. VVV ~~~ ~~~,;~ ~,
CV
..:
~~~.-•-'J~ V E R I Z O I~ C F~ C~
it~~'ar>Y~1!"~ tfi5 f=F~AN{<l_IN ST
Teltl>tioris-: Nurnbs:r
7~~7/~'61-19~~~6
'VERIZC7iV P~
f='LOOFA 6 siG"~f01V Ivir'~, U:'11U-1`_? 1 '~~~iJC1.~ci`~~~c~~i
Uc,ticr i pti ors
~~ZE~ Y T 13AL~~N~~t` It E:t-(~~f~
D !a T E T E L E P li U Nil E a'J ll PSI ~ ~ it ~_ E~ -d t~'i~ f ~ ~ t" l ~ l'Y C>
~1f30/~2 ~"1776119~1-i :i.l.~V~
4=C3~.' d1Y~'`! ~Slylf='ST~t71~IS Y~~ iFtl~~ d'`al~ r 53f-d'irl'UlR'~~~d111dy
hllOne NUnlbe! l+Cl;U~lnt f~Lillll~;l !i;:1C f)Uti I~~,,,,~,.
111 -161 - 1911
~. ~',~ ~E:::~ ''~ X11 /t>i.. Ica;,l1 (1U~ rii': i'~? !;'i I
~~~
~ttr~r~err~ ~ciivity
Ciirrr:nt Charges
11/2 l2/24 Regional f_ssenli~~ils :32 ~q
11/2 12/'l.4 Uireclury /lssislancf: Chargt;s l.',>U
Currerit C~iarges Sutitotay `~:s3.5
Lt7ftl`etti~ f1Ctl'V9fiif ~ iD~~~ ~a33.;i
taxes, G=ees ~nQf Other ~~ro:~~c~~~
~~axe~s, Governrnent:~~ Surcharges anal Fa;~;s
t edi:rjl l:~xcise Tax ~~
I'l1 Slate and I Deal Salr;s Tax 1.92
lelecornrnunicalions i~clay Serviai U8
i_4~ I 1 1.?:~
Verozori ~u~rcharyes and Utlier C~iarg~;s aria Cr~:uixs
PA Gross Receilils fax Surclr~rgc 2.O.S
1-ederal Subscriber Line Charge 5.(t2
f edt;Ial !)IIIVerSal SerVICi; I Cc tS4)
~~t:~l ~T~xes, Fees at~c~ O~tier C~~rges ~y2.23'
flch;rence IU l:SYCYNJ/G I
iF~estaterg7er~a of Charges
fiegulations rerluire Vernon to ip~otrp your charges as shown bt;low lu
irrake it cl~~;ar a hiclr charges you must pay 10 ,void suspt;nsiun of your
local service. Basic inclur.les chargr;s for local callinr~, applicable; lax and
ter;s.
Non-f3asu: charges include, but are not limited lu, Caller IC, inside vvire
nu3in(cnance, regional and long distance callinr~, inlernel service,
Ulf~il~C1U and applicable lax and fees. IVon--payrnr;nt of piny past due; basic
charges could resul! in suspension of your basic local service at(er you
receive a separate written slalernenl.
f'asl Uuc f~Ji;w lo(a1s
Nun-[3asic UU ;i6.(i5 36.U`..~
Iolal .U~ ~lJ.UI ~IJ.C)~
Included on this portion o! your bill is appruxirnaicly ti;2.5o (or PA saxes on
utilities
i.3t Y~S::;t; ul~~u' e:l iCt
(.ill ID ;'l'll['(lll.i:()Ill~~;,illlill;ill;i Li. III~;II 'lip
i'U tits;( .3:>vii>, `.~i i't;lt'I;;I71111j, l .. .:/.,,
_ ,
~~'~~~..
'Jvi~~~,YA~V.+~ S.1'~~~~A~9 L~~L.
,.~~~'rci..--.n~tr @_3:~. i~/lei(ah,8'.~®$"Ck~cl.~„`hY.'L,C31~ J~ 3 ~-;~-~tr.~-Z>J'tJi
~~~
....
.~.,~u ._~t, j~~;r_
,:~, .. ..
~;~~~;IIE011 TO IhE' ~(•ICi? c`3Cj~UStlT1F_-il~S ,nfOV1C7~?C: c,S ~iF?~% Ci ,:. fl !iiS;l! [C~ :t1i~ ., ~~.~~';I ~._.~~;~ .. ,. ".... _ _~ ~... _., ~:._. ..._ ..,. .,. !~
:c: ,~
"':~i;ji~~?mr1`i!r'~(;c;f1Cj Ot~~f ~tJS{t•l°.SS t:~OS~CS 2i~ic~(:I~V~ ..)c3i?U2~y ~, ~('~~t I ,..,~.`, ~il'.;:.._ v~~l,l ~ .., ~,'' ~_. ~.i._: i ~~ _ ... _-._~ .. . ..
r~ ~~;
''~C!i:(y;:S ~...1r1!i:~::C9 k~d~,IC ;~F,iV1C:-, I-,.fi~ti,;' ! {':i, _li~?i~.:~ "C)!11,r;;!T.~
+':f!'~r'SL i ~J"ai..~ fir'-~,~^~iC_.~= v~7~W ~~~~'vq ~:ii~'a f 3vi~r_. ..~~ti ~`~.-_ ~.'~ .-~?`;~
c,.,.i C{ C~ifCifici's :?E?`~~i't
'~%, %;'' ,:~ 'ice,
,:`' ~~ ..'"t `_~.r P 9'~4`C :~5 :~~v y., `J ?~L~r tiiLr".'.~). r'..y'~:. F.
1 ~~ ,
. ~~ t
_. ,
~. ,
„~,.-5 Jr~r~tfyil <~r„ 1~Gr iESi '~fiTfc~, 5."/ic;,. ~,r'~`~' c il~~ _~:` ?ii;. ..';C;i.]._.. f ... . .:,' _.'.._ .,i ._ .... ..::'-', ,.-, .. .. ~ ... :... .._
_,
:;c:o~i~r~,~ i~:.5 or oir~c:, relai c~ cosis . ~;;cE;~ s:~t~~,.".:~ ..-~c ~..~.._~. ., ;:°....... ~ _... ~ . , . ~! .. ~ -,..,
r
~~~~~~
~~5~ SUZ~I STIZEIGT
<S~.i'TN : LEJ~~NON SU]PPOTZT SLIt~S1I t;ES
u •~;B1-~N~N, I>~~ x.7046
Nl3a
~fzILBLRT ~LJR~R z.~922 0930-'?2-2y--:?~.~~;
_ .._ 208 ~ENI-~'I'I/' ~?VI~ '~Pm 3~"~
_-..._. __.~__.__. L~~ BTLL, RA ?.701-:?3~L
_-'__ ~~~i~ndY~uu~~~~nY~IuBS~~n~1~~99~'J~9~~tlun~r~~~~~~~~~~~~~ya~u~~ns~~
Ch9ECK NO: 0008~.`J~; ~ .~
~~ccouiv-rr~o: 09517-:18928803 c'~;-r_cr<::~~~.~r_ '~.~~~_ ! :._
~:..~ a- ~; I ~,~3F I~:'I' 1VT1-~UR9.; J~. ,
_, ~ e d ~: ~i ~. c lk ~-
.. ~' L ~ C `a ~ #'2 t : e. 3. L. r L3 ~- - ~. . ~ .'".~P C: _ y~ ci? ~:i c~ J .'`i ;: ~ <; ' ~ I_.
C) ~:
r~ yr~~u <~~~~: ~~ ~Olllrvc~S3: .YI:INITY c~I:~~~oI~I~:r ~.I3d ~~~~avc ~~P~.s~:ie~r_~, _~_~<ti.~__3t1 ~c~c~,_ _-c:°i',.~~.~:~ :.~~:r:Cc, y~d~.
~:~rl ln,YT'?'i:f' tip.-; cl~ ~h~ ~.idd:~-~5:~ d~t~V~~ ~Cil'1i 'L'GP43~C:.~S~' S i. t:•°~ 1 6~;L::l~ :1._>1~..!lt:~?- '-,i_`:T `r: lti_c.:~4r-y~_:i.
-888-~1:Ui~iCHS'r (1-888-26b-227 8 ~ , r~3:- ~~z3uL 1>~~i ~s~ us _~~ .~~c~~ . cc~w~.~:-~ 1~ .. :. , ~ .
~; ~.. ! / ~.;1 ~ ~.. , i ~i i
~'.Y"I"~:SCygl~:cA'~.i.Vt?S c13:'Z <-3V~31~c-1-IJj.~: ~.G c"P5„3.~-'.~: ~JOLP ?!r '-aGtP, ~ ~. C:a`ji ~).:?ti _, ~.. ~,~-r: J.- .
1- j7~tf ~il'L Ci ~®ICaC<-1St: 5 ®t~ i1 ~1'1: ~C.'~ 1~'.71~ ~3" c-i~E'.I3i_ ~ { . - - k ~ ~ ~; ~.~._
P ~ 17~r ~ ci;:C_ C_~}~: t; :a t. T~. ~ C,~.._ _ u~. ~.._ ,. i~.1~~~ . -. `•yY <