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10-15-12 (2)
1505610140 REV-1500 EX ~°'_'°' OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 9 Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 1 2 0 5 8 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYW 1 9 8 3 0 1 5 7 1 0 5 2 0 2 0 1 2 0 2 1 7 1 9 3 8 ,. Decedent's Last Name Suffix Decedent's First Name MI S H A N N O N R I C H A R D C (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) 0 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number D O U G L A S G M I L L E R 7 1 7 2 4 9 2 3 5 3 First line of address I R W I N & Second line of address 6 0 W E S T City or Post OfFice C A R L I S L E M c K N I G H T P C- P O M F R E T S T R E E T State ZIP Code REGISTER CO„F~WILLS USE Q'~Y x'1-1 (~ z:., -~ ~ -+vr , . C ~ _: E~WILED '~ `-' _~ P A 1 7 0 1 3 Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. 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SHANNON STREET ADDRESS 2058 W. TRINDLE ROAD CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: ~~ Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 18,500.00 B. Discount 1,077.44 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) 23,896.66 Total Credits (A + B) (2) 19, 577.44 (3) (4) 0.00 (5) 4, 319.22 __ Make check payable to: REGISTER OF WILLS, AGENT L. ~.'ei+.. ~. _ .-_~..._ [~?y' ? :_._-~i._.~1~;~~.~ '~xr~,F'. ._'_^ -":N``i~ tit _ 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; ............................... ^ Q c. retain a reversionary interest; or ................................................................................................ ^ 0 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? ....................................................................................... ^ 0 3. Did decedent own an "intrust for" or payable-upon-death bank account or security at his or her death? ......... ^ Q 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: RICHARD C. SHANNON 21 12 0589 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. 12058 W. TRINDLE ROAD, CARLISLE, PENNSYLVANIA I 178,900.00 TOTAL (Also enter on Line 1, Recapitulation.) I $ 178,900 00 If more space is needed, use additional sheets of paper of the same size. REV-1503 EX + (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER RICHARD C. SHANNON 21 12 0589 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. WEALTH MANAGEMENT SERVICES 200,920.51 EATON VANCE INDIVIDUAL ACCOUNT VALUATION ATTACHED 2. 101 SHARES OF PRUDENTIAL FINANCIAL, INC. STOCK 4,656.10 101 SHARES X $46.10 PER SHARE _ $4,656.10 TOTAL (Also enter on line 2, Recapitulation) I $ 205, 576.61 (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (11-10) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS, ~ MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: RICHARD C. SHANNON 21 12 0589 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. PARTNERSHIP -1,000 UNITS IN FUND IV SERIES 26 AND 10,000.00 FOR 1,000 20,000.00 UNITES IN FUND IV SERIES 29 2. PERSONAL PROPERTY -APPRAISAL ATTACHED 4,198.00 3. M&T BANK -CHECKING ACCOUNT #1111930 4,057.14 4. M&T BANK -SAVINGS ACCOUNT #15004204273384 66,753.65 5. M&T BANK -SAVINGS ACCOUNT #15004200-915427 78,524.76 TOTAL (Also enter on Line 5, Recapitulation) I $ 173,533 55 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 RICHARD C. SHANNON 21 12 0589 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.ATTACHACOPYOFTHEDEEDFORREALESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IFAPPLICABLE) TAXABLE VALUE 1. WEALTH MANAGEMENT SERVICES 13,299.90 100.00 13,299.90 ROTH IRA BENEFICIARY: RICHARD C. SHANNON, JR. TOTAL (Also enter on Line 7, Recapitulation) I $ 13,299 90 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 RICHARD C. SHANNON 21 12 0589 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HOFFMAN-ROTH FUNERAL HOME 9,978.30 2. CARLISLE MEMORIAL SERVICE, INC. 348.00 B 2 3 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: Attorney Fees: IRWIN & McKNIGHT, P.C. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant 20, 500.00 4 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Street Address City State ZIP Relationship of Claimant to Decedent Probate Fees: REGISTER OF WILLS Accountant Fees: Tax Return Preparer Fees: PATRICIA A. ROSENDALE, CPA FINAL FIDUCIARY RETURN REGISTER OF WILLS -FILING FEE CUMBERLAND LAW JOURNAL -ESTATE NOTICE THE SENTINEL -ESTATE NOTICE ROY G. GOTTSHALL -APPRAISAL ON PERSONAL PROPERTY CHARLES BARNETT -REPAIR - 99 FORD POSTAGE PERSONAL TOUCH CARPET CLEANING RECORDER OF DEEDS -FILING FEE 469.50 375.00 30.00 75.00 189.54 65.00 115.14 2.44 163.77 63.00 TOTAL (Also enter on Line 9, Recapitulation) ~ 32,374.69 If more space is needed, use additional sheets of paper of the same size. ,f2EV-1512 EX+ (12-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER RICHARD C. SHANNON 21 12 0589 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. MILTON S. HERSHEY MEDICAL CENTER -MEDICAL 4,802.58 2. YORK WASTE DISPOSAL -TRASH 99.46 3. COMCAST -CABLE 294.16 4. UGI -UTILITY 34.08 5. NORTH MIDDLETON AUTHORITY -WATER/SEWER 164.60 6. PP&L -ELECTRIC 231.33 7. CENTURYLINK -TELEPHONE 15.10 8. ROBIN K. SOLLENBERGER, TAX COLLECTOR -REAL ESTATE TAXES 2,041.77 9. AERO ENERGY - REC CHARGE 215.40 TOTAL (Also enter on Line 10, Recapitulation) I $ 7,898.48 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: RICHARD C. SHANNON ~~ ~~ nano .,~ 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. RICHARD C. SHANNON, JR. Lineal 531,036.89 4 HOMESTEAD LANE REMAINDER CAMP HILL, PA 17011 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. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ It more space is needed, use additional sheets of paper of the same size. i ax~rs nesui~ Le~aiis Yage 1 of 1 Detailed Results for Parce129-21-0316-024. in the 2010 Tax Assessment Database DistrictNo 29 Parcel ID 29-21-0316-024. MapSuffix HouseNo 2058 Direction W Street TRINDLE ROAD Ownerl SHANNON, RICHARD C C/O PropType R PropDesc LivArea 1520 CurLandVal 35000 CurImpVal 143900 CurTotVal 178900 CurPrefVal Acreage .28 CIGrnStat TaxEx 1 SaleAmt 1 SaleMo 09 SaleDa 26 SaleCe 19 SaleYr 91 DeedBkPage 0035I-00078 YearBlt 1950 HF File Date 12/30/2004 HF_Approval_Status A http://taxdb.ccpa.net/details.asp?id=29-21-0316-024.&dbselect=l 5/24/2012 -. 1404 East Chocolate Avenue Hershey, PA 17033-111 S 717-533-3020 office 717-533-3021 fax ir~~ J7/V ~ ~ I prom: Fax: Pages: Attn: Date: ~ Z~ Re; r n CC: Q Urgent Q For Review ^Piease Comment ^Piease Repiy ^ please Recycl® The Inforrnallon contained In this facsimile fransmisslon Is privileged and conndanlial and is Intended only for the use of the recipient listed above. If you are neither the Intended recipient or the employee or agent of the intended recipient responsible for the delivery of this inlormatian, you are hereby notified that disdosure, oopyfng, use ordistribution of this Infomlatlon fs strictly prohibited, If you have reaelved this fn error, please notify us at 717-533-3020. Securities offered through NATIONAL PLANNING CORPORATION, (NPC), Member FINRA. Wealth Management Services and NPC are separate and unrelated companies. ~~ rte ~~~ ~ ~ n n ~ ~' UV~ .~~, ~~~ i~iwr~ cis cult 7~7u~iri rr~ai~ii IYId,IId,~CIIIC(ll LAW OFFICES - IRWIN ~ 1V1cKIVI G1~7', P. C. WEST POMFRET PROFESSIONAL BUILDING BO WEST POMFRET STREET ROCrER B. IRWIN CARLfSLE, PENAISYLVAN/A 97013.3222 ~1aRCUSa..~~r~xNrG~rr, rr! DOUGLAS G MILLER (717J 249-2353 S7'EPNENL, BL00.41 FAX(r17) 249-6359 b1ATTl•IEWA. b~c1~NlONT WWW.lRW/NMCICNrGHT.GOM May 25, 2012 'Y'011~ ~EVVE 'WEALTH 1VIANAGEMENT 1404 E. CHOCO~,ATE A'~1E. HERSHEY, ~A 17033 RE: THE ESTATE Off' RYCHARD C. SHANNON DATE OF DEATH: 1VYA`Y' 20, 2012 SOCIAL SECURITY NUIV,IBER; 198-30-1571 Dear Sir or Madam: iuo, ~~yo r, L N.1RUI.AS: /RW/N (19as-l9~rJ ~]AROLOS.IRW/N,JR (/95.1-19b6) 1R13'1N, /RW/N&!RW/N (1956-19B6J !RW/N, !RW/N8 dlcKNIGN!" (1986-1991) IRWIN, A~lcKNlGNT 8 NUG1Y'CS ()991?003) /RW/N & A(C1rNlCHr (1003.200&) We represent the above referenced Estate. 'VV'e believe Mr. Shannon died with interests in accounts at Wealth Management. por tax purposes, we would appreciate it if you ~v'ould provide us with the following information for each account or certificate. 1. The registered owner or owners (enact title of account): 2. The date on which the account rnras established, 3. If there was a change of or~-nership or registration of the account ~rithin one year prior to the date of death, please provide the date of such change and the title of the account prior to the change. 4, Yf there were any accounts closed within one year prior to the date of death, please provide the date, title and balance of the account closed. S. Any interest accrued to date of death for the calendar year. 6, The date of death_balance (principal plus accrued interest, if any). Thank you for your cooperation in this matter. 'Very truly yours, 1~.'VU'fil~ & Mc~1~YG~T, P.C. Douglas ,Miller, Esquire DC~M/ksn Enclosure i~~µy• ci. Lv i L 7 Tui iri YYGO, I l 11 IYIaIItl,~CIIICII l Wealth Management Services 1404 E Chocolate Avenue Hershey, PA 17033 717-533-3020 1-800-555-45$5 beth@yourwm.com Roth IRA: 1, 1Richard C Shannon 2. 02/20/1998 3. N/A a. N/A 5. N/A 6. $13299.90 Eaton Vance Individual 1. Richard C Shannon 2. 02/20/1995 3. N/A 4. N/A 5. N/A 6. $200,920.51 IV U, J`t70 ~• ~ Prudential ~,omputershare i' (IMPORTANT TAX RETURN DOCUMENT ENCLOSED( ~ **i******** ** - = AUTO 5 DIGIT 17013 00055810187770 18 7 7 7 0 ~~I~Ili~li~illli~~liii~li~llili~iill~ili~l~l~i~i~~i~li~~i~~i~~~il Recipient RICHARD C SHANNON 1005 TRINDLE RD ,.: , ~~~ CARLISLE PA 17013-2628 ,~ .. ~~~~: e~` ~ ~c~ ~ Record Date Nov 22 2011 Check Number 0013282890 SSNITIN Certified Yes 001 CSO 107.DOMLNGEQS_PG l ,PRU.03 1630_ 114/ 187770/ 187770/i Prudential Financial, Inc. -Combined Dividend Payment 12011 Tax Form 1099-DIV Corrected (if checked) Form 1099 -DIV -Dividends and Distributions 2011 Copy B -For Recipient Thls is important iax information and is being famished to the Intemal Revenue Service, If you are required to file a return, a negligence penalty or other sanction may be imposed on you if this Income is taxable and the IRS determines that It has not been reported. Reclplent RICHARD C SHANNON 1005 TRINDLE RD CARLISLE PA 17013-2628 Account Number 00020480505 Recipient's ID No. ending in ***= *•1571 Payer's Federal ID No. 22.3703799 OMB No. 1545-0110 Deparhnent of the Treasury -Intemal Revenue Service ~a Total Ordinary tb Qualified (~ Nondividend a FEDERAL INCOME s Foreign Tax 7 Foreign Country s Cash Liquidation I Dividends ($) Dividends ($) I Distributions ($} TAX WITHHELD (S) Paid ($} or U.S. Possession Distri. ($) Payer's Details 146.45 146.45 0.00 0.00 0.00 PRUDENTIAL FINANCIAL INC CIO COMPUTERSHARE P.O. BOX 43010 PROVIDENCE RI 02940-3010 Form 1099-DIV (Keep for your records) Dividend Confirmation . Payment Date I Class Description I Participating Shares/Units Dividend I Rate Gross I Dividend ($) Deduction Amount ($) Deduction ( Type Net Dividend ($) 16 Dec 2011 COMMON 101 Year-To-Date Paid $1.45000 146.45 146.45 0.00 0.00 NIA 146.45 146.45 46UTX PRU ~' Computershare PO Box 43033 Providence, RI 02940-3033 Within USA, US territories ~ Canada 800 305 9404 Outside USA, US territories & Canada 732 512 3782 vuww.computershare.com~nvestor Holder Account Number 00020480505 I N D OORX6A-PP•(F2) 002CS7000h rnv niswricai races ~ rruaential r financial, lnc. l:omm Mock -Yahoo! r><nance Yage 1 of 1 Hi, Karen Sign Out Help Preview Mail w/ Y! Toolbar Mad 1 My Y! Yahoo Search Search Web HOME INVESTING NEWS PERSONAL FINANCE MY PORTFOLIOS EXCLUSIVES ' Get Quotes Finance Search Fri, Hug 10, 2012, 2 22pm EDT - US Markets close m 1 hr and 38 mans i ___ -~ Dow 10.12% Nasdaq •0.25% No platform fees. . - - -- - -- _-_ _ - Trade free far 60 days. ! ~~Q~ES E~TRADE l~ am.~ltrad. o PRU t= Prudential Financial, Inc. (PRU)- NYSE 53.53 ~ 0.22 X0.41 %~ 2:21 PM EDT -Nasdaq Real Time Price Add to Portfolio ~ Like ~ `86 Historical Prices Set Date Range O Daily Start Date: May 20 2012 Eg. Jan 1, 2010 O Weekly End Date: May 20 2012 O Monthly O Dividends Only Get Prices Prices Date Open May 18, 2012 46.35 High Low Close 46.50 45.79 46.10 `Close price adjusted for dividends and splits. r~~Download to Spreadsheet Currency in USD. 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Lip L v i C i ~ I V ~ ni n ~w i ~ ii ni ~, ii v, (j ~uiV II l Ivv~ J-f/V ~ ~ 7 May 23, 2012 Re: Richard C Shannon To Whom It May Concern: The above referenced partnership had an original issue value of 510,000.00 for 1,000 units in Pund 1,V' Series 26 and $10,000.00 for 1,000 units in Pund Y'V' Series 29. As there is a very limited secondary market for this Partnership, it is difficult to place a current value on the account. In turn, Boston Capital does not place a current value on the account. In order to attempt to obtain a fair market value, you Fill need to contact a secondary market. Boston Capital does not participate in the secondary market, has no affiliation with any of these forms and merely provides this information as a. courtesy to our investors. Boston Capital Pt~nds are designed as long-term investments and secondary market prices generally do no reflect the current value of the fund's assets. The secondary market is an "Informal" market and therefore transaction prices can vary for any given fund based on number of units sold, number of firms active, credits received and time held. The following firms have been known to make a marl~et in limited partnerships: American Partnership Board (S00) 736-9797 Advantage Partnership Board (866) 735-5579 Frain Asset Management (800} 6546110 Alliance Partnership Services (soo) s9o~s6o4 Partnership Marketing Company (888) 8248600 If you wish to transfer ownership of the above referenced partnership please contact Investor Services (800) 955-2733, Yf you have any ful~thea~ questions, please do not hesitate to contact me (800) 955-2733, Our goal is to provide you with the best possible service. Sincerely, Anne Maranville Ynvestor Services ~/ f v iV[ •~1..~ I ' A ~ ' ~ 1/ C n f L..~ 1 ~ \ ._.~ 0 J ,,:% .~` r- - M1 ///~//~~, ~ 1 ,~,; i;~/ ~ ~ j /J ~ ~ di n ~. .~ t~ ~ ~ .,~ .r . ~' r F .! t i ~r ~. ( ~ .~ • ~i~:~/'"1~-='fi'r ~-,. ."/ `-.,._.1.. - -l .~" `^*`_-'' I / ~~ ~s: - ~__~ i•, ~:.(~ ---.- -----___..__r__._..._~._w ~ _~ _ ___. ~-^~ ~,f ,. .:~ '~' " ~ ! ~ f~ ter' " ~ ~/~i .- .- ._ i ~~r- ~.a ~,.r ~,. ~ :. h ._ ~._......._ j..___'_-.-.- ,, ~ ~ n r y / ,,>J' ... p~-w- - _~,. ~~ . ,~,r~ ,' - /r~ 6, f ,'f ~ '~ ~~-~ - ,, !~ n r i ~y~ /', ~~,~7 ~~ . I r v _ ~J/~~~ _ --.. _ -- - .. - - - - t _ ~ ~ ~ ~ ~; ~ ~~. -= ~ ~ . rZ~~l s ~ Cam' , ~~ _~ a~: ~ ~ _ "-'`~~~-.--- - _ _ _ . _... _ . _ _ _ - - - -~ - ~ " --- - ///pJ~ // R/ ~~~. , ___. __.._. _. __ ._. ___. /.- /.. - __... _ _.___. ..__ ..__. __.__ J ~ . .. r L..d~~°~~.~ ~_ ~''~sf _ r ~ ~--r~-=-_ ~ r ,- ~,„ l ~ ~, - r . - . . - _ ,. -- - ~ _ ~~ / >~ / ~ `~' , f ' ~ ~ .. ~ ~ ~~.. .// ' _' CJ ' •' .. C r. ; l ,, -- ~ r _ .. _ _~_i /`fl///'. rim-'~dn ~ff~ ~ f~~ -.... r _ _ _.._. _.. _~_ __. 1 .....~ ~~~ ~ _ ..._. __ ___.. _ _. _. __. _..__ . .. ..... ..... __-__. _ _ _ _... J~/~z~~~-r j~J/ L ~ // ~ / L G~~~ ~F ~ /~/~ .. / * .. i" /J ~~~/'~~ ~i~-7 /`} //y ''A r{/~ ~. ~ ~ ,~A ,. ~' ~ .~ ~~ ..~ `C..~ F '' ~ _- h ~ •~ ~ f~_..r1 foo J ~C~ ~~.n ._, .._, ~ 3 f. ~ _ _ ' ' .. °''''~ ~ •.. _.~~"'. ~__.~ __. _ _ -.... ~;:T..: .ate-- _. _. __...--~--- --- --.._--- -------- _ _' _ - / --- --- .,~... - - - '' 1 _-- - -- ___ - _ -- -- -- -- _ __ --._. ,.,, l ~d F y~ ~ a,i .t ' ,~~ .. 1 ~ ~.i~:fi'E. .. _ . i . . d t- . ._ _. ... _. _ _ _ . _ ' ~i J -~ ° ~ r i «~ ! .~ `~' ~~ .. ~ ` ,.r ` y / ~f' ~y "°l' d , . !' r ~ ~.~ J r~ '~ •_. .' ~ ') ~ ~ 4r r .,J " )V r -r_j 7;• ~. _ . ~-~ -~ 1 ~~J F 1''_~.a:~ ~- i"'J ~.C~~'.. ~'v°`°"6r G°"-~..H~G,''~<7Z/ C..-~~1~.,~'CY"./ ~.~r G~.~~ ,, s~~; .~=¢-_.s~"~ /!,c"t.'-~~ - .. ~ f / ~ I G '~ ~r . ~ . '~ d f ~ ...._._ _ _.______..-.------___ ____~.__.__.___.____._. __.___ -_...___.~___...___.__...~__._......_.._.__ G%f~ ~ ~F ~~1 ~ ~~~~ ~~.. _ , ~' ,~ ~~ F ~'~- ~~.J- ~ ~~ _ ~ ~~ .~.~ : > ,. 1 ' ~ ~ `~'~ ,~ _ _ _ -~ - ,~ ~~ ~ - ~ f ~ ~.~ ________._..__ _ ~ f~ -~__ ______.____----------_-----~~________._ ____________..__-___.__.-___----.,__--.---_._..~.-_.___.._ ___.__._ _____ r ~ ~ - -., - - /G' C ~ o• * '~~`~` // r. (.% ,.; _ ~ ~ 9 -------333 ° 00 + ~____~~____---_.----------________._. ~ ~ --3006°0.0+ ,, P. ..--859.00 + ~ ~~~ ~ 4 ~ 198 ° * ~= _ _ `-~- .-_.---- >= ~-u~"~/ ~ BOA • Q ~ ~/ - 0 219 North Hanover Street Carlisle, Pennsylvania 17013 717.243.4511 toll free 1.866.451.4511 fax 717.243.3723 www.hoffmanroth.com info@hoffmanroth.com Rick Shannon 4 Homestead Lane Camp Hill, PA 17011 ~~~~ ~` ~~ ~`~~~ June 15, 2012 ~~ Statement of Funeral Expenses for: Richard C. Shannon Date of Death: May 20, 2012 Account Id: 1655.1-117 PACKAGE: ~' Traditional Funeral Service TRADITIONAL FUNERAL SERVICE PACKAGE $ 4,650.00 Sub Total: $ 4,650.00 MERCHANDISE: Casket: Sterling $ 2,660.00 Outer Container: Monticello $ 1,620.00 Sub Total: $ 4,280.00 TOTAL FUNERAL HOME CHARGES: ::~_ : ~ . $ 8,930.00 ~I~S~J,,ADVAN~~S p ~:. . Letort Cemetery $ 850.00 1~0 Certified-Death Certificates.at $ 6:00 each $ 60.00 Newspaper Notice -Sentinel $ 131.88 Newspaper;Notice~-Patriot ~ $ 247.42 Clergy $ 100.00 Flowers $ 159.00 Sub Total: $ 1,548.30 Total Funeral Expense: $ 10,478.30 Total Payments Made: $ 500.00 Payments Made: Fraternal Order Of Eagles Check 4349 Jun 15, 2012 500.00 Balance: $ 9978.30 CARLISLE MEMORIAL SERVICE INC. 41 SOUTH BEDFORD ST. CARLISLE, PA 17013 BILL TO RICHARD SHANNON 4 HOMESTEAD LANE CAMP HILL, PA 17011 Invoice DATE INVOICE # 8/8/2012 32-080 ~ Terms ~ Due Date ~ Net 15 ~ 8/23/2012 DESCRIPTION INSTALL GRANITE GOVERS~TMENT MARKER FOR RICHARD SHANNON ON A CONCRETE FOUNDATION. IN LETORT CEMETERY . CEMETERY FOUNDATION Thank you for your business. i~ ~ ~~~~'_~ ~ w ~~~ Tota I AMOUNT Payments/Credits Balance Due 190.00 158.00 $348.00 $0.00 $348.00 ter..- vrti - ...+ ti- Carlisle Memorial Service, Inc. DESIGNERS AND BUILDERS OF Cemetery Memorials 41 South Bedford Street Carlisle PA 17013 "",~ rf`1 O~'C1 n C3 f 1 ~ ~ ~ ~~ ~Q~ ~~ Telephone: (717) 243-5480 . . .: Total Price . ~Z ~ ~ ~ ~ . . Please design and build the following memorial, ~~ ~ -. Date ~ ~ ,`'~+. +Ip For .~~~~, 4-.r~~~~ ~ ~ .. ` ~~-.,c~. r~ r~ ~~, ~-~ ~ ~~ -- ~-'1 ©1:s Address ~~ ~- c~~~?.. '=-~ ~- ~ c~ ~~ `'~,,,,~ ~~~ ?~, ~, ~ ~.1 ~ cx. \ 7 ~' ~ ! ~ Design No. Material Die Base Markers Posts Vases Price ~~ ~?, , ~u .~ Deposit '~ Balance Due 3 ~ ~~ 0 0 Style of Letters ,~._ C.~.~~ C1 C~ ~ 1 Foundation to be-furnished by -~ro.~ ~~~ ~C~ ~~.~ ~ c,,,,`. Material to be best selected monumental grade and to be free from imperfections and first class in every way. Work to be finished in a workmanlike manner. This memorial to be erected in ~ ~~~ `.~ Cemetery in or near during the month of unless unavoidably delayed by labor troubles and other contingencies beyond our control and then as soon as possible. Additional lettering and other work on this memorial in the future is not included in the Contract Price. Title and right of possession and removal of said stone, monument or appurtenances shall remain for all purposes in Carlisle Memorial Service, Inc until work and materials ordered are fully paid by purchaser or purchasers. In consideration of the acceptance by Carlisle Memorial Service, Inc. of this order, the undersigned (hereinafter known as the purchaser) agrees to pay Carlisle Memorial Service, Inc. Dollars on or before the 15th day following the billing of the work or job upon completion thereof by Carlisle Memorial Service, Inc. Thirty (30) days from date of invoice a 1-1/2% finance charge will be added to the unpaid balance. Said billing to be notice of completion thereof, this order shall become a contract between the purchaser and Carlisle Memorial Service, Inc. upon acceptance thereof in the space below by a duly authorized representative of said Carlisle Memorial Service, Inc. It being understood that this instrument upon such acceptance covers all of the agreement between the purchaser and Carlisle Memorial Service, Inc. and that no agent or representative of Carlisle Memorial Service, Inc. has made any statements or agreements, verbal or written, modified or adding to the terms and conditions herein set forth. It is further understood that upon the acceptance of this order the contract so made cannot be cancelled, altered, or modified by the purchaser or by any agent of Carlisle Memorial Service, Inc. in any manner except by agreement in writing between the purchaser and Carlisle Memorial Service, Inc. and it is hereby understood and agreed by all parties involved that in case of default by purchaser or purchasers, twenty-five per cent of the total original cost of the work or work and materials ordered, as the case may be, shall be a specified correct sum as liquidated damages which purchaser shall owe Carlisle Memorial Service, Inc. less any payment on account made prior to such default, this specification of damages to be due regardless of removal and taking possession of stone, monument or materials from purchaser or purchasers by Carlisle Memorial Service, Inc. upon following such default. r`ti. t '`Ea ~-f.~ ~ r 20 Carlisle Memorial Service, Inc. Approval By White: Office Copy; Canary: Custc (SEAL) Copy; Pink: Salesman Copy; Gold: Deposit (SEAL) ~ ~ i a ~ ~ ~'' N ~ ~~` ~;' ~ ,s<:-~~ t~--~ `-h* ~ W ~ p , 4 1 - 0 ~ O ~ W ~y ~ X .,~ O W W W d ~ = s H s ~ ~~ ~ O Yl ~ ~ W y ~ H 1-. ~ t = ~ W y W 3 Z ~ S ~ ~ ~ O Z ~ YI W ~ a O ` U a p U y ~ a r W ^ ~ ~ Z T ~~~ ~ o ~ ~ s 3 ~ ~ ~ ~Qe%~ ~ ~ w' O OC a N //~/ V• ~ W W ~ ~ ~ p~~Ce 1 ~~ a ~ Z O \".~ A ~ O'F ~ a O ~ r `~ aaougm° Q V .-. ~ m T i ~ N ~ d W ~O ~ = ~~ ~ o m mvt c vEm> °a. °p ~~ °~ ~ ~ ~°"~ ~ r am9me°o 4 {\ ~ W ~ `nO°°~~ ""~ ® W `-~nooao ~ ~ ~ W ® W ~ o~5owe° ~v o°-°t ~ '~^ , ~ '_ • ~ t ~ eem~ _ ~ .~ +' w o t~ - p.. - :~ O ~ Q ~ m}oo~o~ .. o , ~ t !~ o~ o° a w ^ Q~ c W ~ fi~T `'' "d S ~ m ~ E ~ o ° O ~ O > ~ r5~'`as ~ . e p ° m v :omm ~ ~ 2 p < H U < ~ j • °r a r° ~ c > o a Z v ~ ul 1`~`~ U ~`' a ~~ ~~ ~ ~ o a w o a a Q ~ o N _ ~ ~ ~ W U N O U Q W j Q O H Q ~, ~' O , h 2 4~~! F a in s ~ ,~ , ~ 0 Y'ti~. ~ ~ LL r '.,~ L1 Ca ~ J ~ - i t `~J ~+_ a~ ~ y+.. ~d l' ~ err.. ~~,:,~: i Z ~' O ~ W ~y O ~ X Z W 2a_ ~ ^ ^ ~ ~ y ~ ~ W 0 W (D 'moo W~ ~ ~ H ~ v = W 0 YI k ^yI 1 ~ F ~." W ~ ~ ~ w ~ ~ O ~ Z W ~ N ~~ ~ ps ` F~ ~ ~~/ ~` O tl ! ' O o ~ W ~ y~ n F- u a o ~ a- W ^ ^ Z ~ ~ ,` ~ O (~ ~ ~ _ S ~a,~ a Q o~~ Y ~ 3 ~~~ ~ ~ m~, Q ~ °~ ~ = ~~ ~ `Fr ~ > ~ ~ ~ ~ /A ~7 VN/ i l > ~ ¢ O Z Y ~ y ~? m v a.- c t ~ o~ o ~.. ` E T i ~~ ,vi ~ , ~ ' 4 ~ is = : W ~ ~ ~`~ J 't c... ~ ~'~ ° o' ~ o a. v •~~yq C ` "'~ i~ '~, 1 o ~, ,,_ ~ W = v W W o~ ~ ;: ~ ~ c c o y p~ c 'Yno~~o~ . 7 ~ ~` ~ ® ~ oo~oeEcei ,~ u..~ '''~ ~ 17 ~ _ ~ < J ~ W ~ ~ ~ C ~ t occYpo« ` ` ^ ~ ~ ~ "~^~ . ~ ~ ~ ~~~ ~ ! y ~~~ ~ `~~ ~~" ~ O O « O 4 ~ O.O. O O ° O .~ O Z ,'' k ~• '~ ~ t ~ m O« '~ , ``=- W m ~ ~ Q L E s« a~ W ~ O•o ~ ~ W G ~ ;~4 J ~ ~ ~ O ae _oe De 4 ~ ~ 1- ~ < O > ~ °v °C Z W U a ~ ~ ~ ~ ~ o a ~ o N ~ J ~ N U ~ 0 U U Q ~ Q H O ~ ~ Q O a ~ ~ a > 3 ~~~ ~~~ ' CARLISLE htPO CARLISLE, Pennsyl~°an iz. 1701399c8 4134870013 ~•009i; 04/14/2011 (800}275-8177 i.' ~ :~}i);94 Pr~1 Sala: Rac.t~i;.;, .--~..-.--.--____..`_.. Product Sale Unit rir+al Description Qty Pry ca F'r•i ce HARRISBURG PA '17129 $1.05 Zone-1 First-Class Large Env 1.60 oz. Issue PVI: $I>05 HARTFORD CT 06176 $1>39 ` Zone-3 First-Class Large Env 3.50 oz. Issue PVI: $7.x'9 Total: $2.44 Paid by: Cash $L.50 Change Due: -$0.06 Order stamps at U:;PS.:.t~~:. SYiup +.-~~~ ..ai 1 1-800-Stamp24 . Go t.o `.~: r~~~: > cniri c ~ r ~: ~:1'ISh1 p to print shipping 1 abel s ~r i th j~u~taye. For other information c:~ ~ l i-S00-R:7I{-(l5P~. ~r•k•h dr dt*tk +k'+k*s4 tk:It dlr*•k •***~k ~kx r: :, d; **rs h:t*~k ~k ,t 1: .1 :'::~..k* trt tk lk ~e •h t4'k:k*tk****tk'k is*•hN**•n k. -.~**krl••n-**Fr: :: :v is .•f~k Get your mai 1 +„hen and ;~+~r•? yo:~ :4E!fi~ i -: with a secure Post Offi~~~; Bux. Sign ~~;~ for a box on i i ne at usK~s> c~~ +~,:• ~:.ohoxi:s . •**•k*****~fr ro':**-Y*Jr*7k -h k*~r •.~~ .. •. a'•..k •kt ~; ~:~n it :'c :k :•: ~n•x * •* vk ~4t * * * >c rr'k h * /r * * *'it * * ~k is ;.~ i:::.. -k ~A- * .T ~h ~: r~ ~r. ~.~~ r :1. r..t: * Bill #: 'l00020455506s C1 erk: 09 Al 1 sales final ~~r; si~.~::~: ~ 3.rci ~,ostayu Refunds for- guar-Gr~t~.:;.t :~.er;iti.es onl~~ Thank 1`oLi for :io:.. ~ i•,us ; ~ ~e5s ~r~k9lrrk*.k*•k~1r•:k~k**~t~c*>t****:4i:-., .. ..a.., ,., . HELP US SER•.'E •!'Uu 5E i i•Cn Go to: https://postal ex;.~~~,~iencN.couiiPus TELL US ABOUT YOUR kE(:EN•( POSTAL EXPEk1cNLE YOUR OPINION COl1NT5 **t4tk'k'ik~tye4r*~t*t4vlr~lrekir*•hsk•M*k•kd`h****k*isn,t~•h~4*~tk• ••k**4t•h•kdr~Itir~rYr~rJeiee4~k~rkh*~le•k~k**•*~A:•.MYrX '•d.+,•ktkh;•k:kir Customer l.opy York :717-848-2064 Carlisle: 717-249-6914 Fax: 717-846-2641 PersonalTouchcc verizon.net _ __ Date: 9/28/2012 Order #: 120731 ~ ) e rs o n a l to U e h. fX~ Invoice carpet c l e a n i n g ^ Estimate 376 Tri Hill Dr. York, PA 17403 Bill To: Job Location: Rick Shannon 4 Homestead Ln. 205 8 W. Trindle Rd. Camp Hill, PA Carlisle, PA 17013 717-319-5706 "Perms: Duc Upon Rcccipt Description Linit Price Total ~ : G,~. I Ll~ ~' ~ T ~t,sr~ ~ '' ~-rec L,l ~~ _ ~' y ~~ _~ Subtotal ~;T.{ ~ ~~ Payment Cash: Check# t, ~..~ Tax ~ ~ ~ Information Total 1 ~ ~ . 7 Visa/MC: Gift Cent: Ttrms ane! Conditions: All laymcnts arc. clue upon rcceilt unless otherwise note<I on the invoice. A fee of $ 35 will be charberl fin' any returned checks. Payments that arc 30 clays last clue will be char~crl a late layrncnt fee af' I ..5% and an annual percentage rate of 18`%n compounded monthly. Any and aU concerns of duality workmanship must be reported within 72 horns. , - PEIVNSTATE N~R~N~v jvu~.ton ~, tiers~ey Medical Center RICHARD C SHANNON 2058 W TRINDLE ROAD CARLISLE PA t70t3~26Q~4 ~ ACCOUNT # 7506979 IF AMY QUESTIONS, PLEASE CONTACT: MSHMC PATIENT FINANCIAL SERVICES STATEMENT ~` OWTE: 05Jt t/t 2 LAST STATEMENT DATE: 0410611 Z FED TAX ID #251857035 BALANCE Sl~4ARY RESPp~{SIBLE PARTY POLICY # TOTAL HLM HEALTH AMERICA 85DOOb771019100DD1001 ~ q~~7.Dp t~P NOVITAS SOLUTIONS IFIC 19B3QL5711i5 ~ 3078.00 ~eeE 6UARANTDR RESPOtA3IBItITY ~ 90.D8 ~~q~~ C~ v '~'` °v ~~aoo R /QPART~NT! Pf_~/,l~~F A M ~uA PF1'I/P~- AA'rT~R+ oAprl~lu ~c ~Tar~ya~.r .y.ru vnr•v o.v4.lo* PEl~F~I~IED~ BY: T THt~IAS ZACNARIA MD DIV OF DIAG RADIOLOGY 03/13/12 705512b 437.1 MRI BRAIN t~ENIIANCED b75.OD 03/2L12 I~DICARE PAYMENTS O.QO ~ D~/09/12 HEAI.THAMERICA PAYMEM~ 0.00 * 04~!09/12 HEALTHAMERICA CElI+R ADS 5~r,r,~gf- ~ D4~/30l12 TNANC YOU FOR PAYMENT 28.b0- 110.8b PERFORMED BY: .10.SEPH A GASCHO MD IMAGING 03/13/12 9330b2b 427.84 TTE iiVDOPPLER A COLOR FLO 1175.00 03/21!12 - MEDICARE PAYMENi~ 0.00 Db/04N12 HEALTHAMERICA PAY14ENi~ O.DO D~tlO~/12 HEALTHAMERICA CONT AD,J~ 10~5.3b- 04~104t112 H~ALTHAlRrRICA DEDUCI'IBlE~ 124.b4~ PERFORMED BY: RONALD E DOMEN MD DIY CLINICAL PATIDLOGY 03!13/12 8b3342b 780.97 IFIdOIOFIXATxp+l SERA 110.00 03/28/12 MEDICARE PAYMENI~ O~~ ~ 04/23112 HEALTHAMEItICA PAYMFJ+If~ 50.Ob- ~ 11b/23/12 HEALTHAMERICA CONT AD.~ 51.11- L.J CHECK BOX AND ENTER ANY ADDRESS OR INSURANCE CORRECTIONS ON $ACK STATEMENT OF PHYSICIAN SERVICES 'ENNSTATE HERSHEY RICHARD C SHANNON ?A58 W TRINC~LE ROAD 11 of 11 ~'~ M11~Q11 S. Hershey CARLISLE PA 17+013-2644 ~e~G11 ~~~~ ACCOUNT # 7508978 iF ANY QUESTIONS, PLEASE COIiIi'ACT: MSHMC PATIENT FINANCIAL SERVICES STATEIAENT uaTE: 06115112 LAST STATEMENT DATE: os~11/12 FED TAX ID # 251857~D35 BALANCE SU~lIARY RESPONSIBLE PARTY POLICY # TOTAL HLM HEALTH AMERICA 85000b771O1~1Q0D01001 ~ 2b ~BeE 6UARANfOR RESPONSIBILITY ~ 138.65 ~~ ~~~``° .~ n - .4~pgn~r e.~Y. n. e!.[~T gr,~,~wai •uw /..+Tre~...~I!~T-~-~. ~..e~-1~`Y ~.. .. .~w.~~.w •.w~.• ~-•..~ r • .-.-..~ . 03/13/12 8~4EI6526 780.47 PROTEIN ELEC1~fPlnR SERUM 108.0D 03/28/12 MEDICARE PAYMENTS 0;00 04/23/12 HEALTHAMERICA PAYMENTS Y4~,D8_ 04/23112 HEALTHAMERICA CONT AD.H~ 7g,7D_ ~ Oi5/25J12 THANC YOU FOR PAYMENT r(,2,y.. 0.00 PERFOI~IED BY: ERICA PEM1Y PETERSON MD ELECTRDPHYSIOL06Y 03!13!12 93227 427.89 tIOLTER F~IITOR~l6 TO 98HR gFgE8.00 04-/x9112 MEDICARE PAYMENTS 0.00 ~ 05/2x!12 HEALTHAMERICA PAYMENTS ~,;,gq~_ ~ 05/21112 HEALTHAtR:RICA CDNi' AD.1~ 39b.31- ~ 05!251x2 THAN YOU FDR PAYMENT 7.75- 0.00 PERFORMED BY: AIESHA AH4ED MD DIVTSIdd OF NEURDLO6Y ~ D3/13l12 99232.60 239.b DAILY iNSPITAt CARE NLM 229.00 ~ 06/13/12 MEDICARE PAYMENtB 0.00 PERFORMED BY: TIt~pTNY J MIDSiIER MD DIV OF DIA6 RADIDLO6Y 031x112 7417726 X1.9 CT ABD/PELVIS W1 CONTRAST 522.00 ^ CHECK BOX AND ENTER ANY ADDRESSOR INSURANCE CORRECTIONS ON BACK STATEMENT OF PHYSICIAN SERVICES , PENNSTATE HERSHEY RICHARD C SHANNON 2058 W TRINDLE ROAD ~"" ~~ ~~ ~' ~~tey. CARLISLE PA 17015.2604 ~~.C~ ~~ ACCOUNT # 7506979 1F ANY QUESTIONS, PLEASE CQNTACT: MSHMC PAT1~~rr r~~watr~w~ ~eo~s~n~~ 05/20/12 31500 OS/3~112 D 06!27/12 D 06/27/12 n Db/27112 518.81 INTiA3ATION ENOOTRACHEAL MEDICARE PAYMENTn HEALTHAMERICA PAYMENTn HEALTHAMERICA CHIT ADJ~ BALANCE TRANSFER 15015 STAT6IAENT -"'""" DATE: o7r2or12 LAST STATEMENT DATE: osr15r12 FED TAX ID # 251857035 567.00 0.00 175.4~1- 360.64- nALar~a: ~~naRU C StIAN+RXf ~ 51956.25 n INDICATES NEW FINANCIAL ACTIVITY SINCE LAST BILL. c qE HAVE NQT RECEIVED YOUR PAYMENT IN FULL.. YOUR ACCOt91T IS PAST D1~. PLEASE SEND PAYMENT II~lEDIATELY. IF PAYMEM' HAS BEEN MADE, 'THAN(. YOU AI+01 DISREGARD THIS BILL. . PLEASE 181TE: Tn KEEP YOUR ACCDWT CURRENT, ~ OUR POLICY IS TO APPLY YOUR PAYMENT TD THE OLDEST OUTSTAi~1N0 BALANCE. ,. THANC YOU FOR t1SING MSI1~4C PHYSICIANS 6AOUP FOR YOUR PHYSICIAN SERVICES. IF YOU HAVE ANY QUEST'TONS R,EGARDII~6 THIS BILL,$PLEASE C~tt'ACT IIS AT 717-531 50b9 OR 800=25~-2614, ~ BETWEEN B:00AM AND 5:30PM l~AY THROUGH MIEONESDAY ~ BEIiiEEN 8:0DAM AND 4:30PM THURSDAY AND FRIDAY. vw..~w.r..~+r'nruu R,w1'YIp,1,pLC PAKI T PDI,.~CY ~ TOTAL `~~ ~ HLM I~ALTH AFRICA 85000677I01~100001001 ~ 2 ,~- ~ ~~ ~eee GUARANTOR RESPa1SIBILITY ~ 1956.25 n n __ ~.. ~~. ~,- IMPORT4N7': P,LE4SE,p~,~'A~lr~„g~J~((~~~ATTAY PAR~'fAAf AR RTaTFYJC~Ip H/fTM VAIIO naYYCAfT ~i~..w 03J15/12 99232.GC 234.6 DAILY INSPITAL CARE 224.00 Q6/13/12 MEDICARE PAYMENi~ 0.00 ~ O7/16~112 HEALTNAMERICA RAYM~IrT~ lOB.91- n O7/lb/12 HEALTHAMERICA CONT ADJn 1QD.BT- D 07/16/12 BALANCE TRANSFERS 19.22 03/16/12 99232.GC 239.6 DAILY I~SPITAL CARE 228.00 Ob/13/12 MEDICARE PAYMENI~ 0,~ n D7/1b/12 ~ALTNAMERICA PAYMENTS 108.91- ~ O7/lb/12 NEALTNAf~RICA CONT A~ 100.87 D 07!16/12 BALANCE TRANSFERS 19.22. PERFORMED BY: YI1~l1TA J ACHARYA MD DIVISION OF NEUlQLOGY D3/17/12 94232.GC 239.b DAILY ID6PITAL CARE 229.00 06/13/12 MEDICARE PAYMENI~ 0.00 ~ 06/27112 HEALTNAMERICA PAYMENi~ 108.91 ~ 06/27!12 NEALTHAMERICA Cp~i' ADJn ~lOD.67- n 06/27/12 BALANCE TRANSFERn 19.22 []CHECK BOX AND ENTER ANY ADDRESS OR INSURANCE CORRECTIONS ON BACK 30.95 ~~=~~~1~ , ~3.i~1'OS,'11.` RICHARD SHANNON Invoice ~ pusuc 3730 Sandhurst Drive Page 1 of 2 York, PA 17406 . Payments/Adjustments .. ~ . . Date Description Reference Amount • 03/31 Payment -Thank You 2025 -$ Account Number 3-0611-1410241 Current Invoice Charges Invoice Date June 15, 2012 Invoice Number 0611-001003362 Richard Shannon 2058 W Trindle Rd (L1) Previous Balance $49.73 Carlisle, PA Payments/Adjustments -$49.73 Contract: 9611020 (C2) Unpaid Balance $0.00 Current Invoice Charges $49.73 1 -Trash Cart (95/96 Gallon) Scheduled Service (S1) Date Description Reference Quanti Unit Price Amount 06/15 Residential Service 07/01/12-09/30/12 $49.73 $49.73 . ~ Current Invoice Charges 49.73 . ~ $49.73 Due By: 07/30/12 Customer Service (717) 845-1557 Customer Service (800) 210-9675 FOR YOUR CONVENIENCE TWO ALTERNATIVE METHODS TO PAY: WWIN.DISPOSAL.COM OR PAY BY PHONE @ 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 SERVICES/ALLIED WASTE PHOENIX AZ To pay on-line or sign up for convenient auto pay, go to: www.disposal.com ~. i ~~ ~~ ~.~-~i~ 49.73 0.00 0.00 0.00 A A • Visit our website, www.disposal.com to make your payment electronically or to sign up for our convenient automatic payment plan. • Please see reverse side for terms and conditions -~....~r__,_ ~ aEpuauc ~.,5 ~~ 3730 Sandhurst Drive York, PA 17406 ' e • • e Account Number 3-0611-1410241 Invoice Date September 15, 2012 Invoice Number 0611-001078564 Previous Balance $49.73 Payments/Adjustments -$49.73 Unpaid Balance $0.00 Current Invoice Charges $49.73 - s $49.73 Due By: 10/30/12 • e Customer Service (717) 845-1557 Customer Service (800) 210-9675 • . . • FOR YOUR CONVENIENCE TWO ALTERNATIVE METHODS TO PAY: WWW.DISPOSAL.COM OR PAY BY PHONE @ 877-692-9729 BOTH METHODS HAVE NO PROCESSING FEE. PAYMENTS POSTED ONLINE OR THRU THE PAY BY PHONE SYSTEM WILL APPEAR ON YOUR BANIVCREDIT CARD STATEMENT AS: REPUBLIC SERVICES/ALLIED WASTE PHOENIX AZ To pay on-line or sign up for convenient auto pay, go to: a Www.disposal.com RICHARD SHANNON Invoice Page 1 .of 2 Payments/Adjustments Date Description Reference Amount 06/28 Payment -Thank You 104 -$49.73 Current Invoice Charges Richard Shannon 2058 W Trindle Rd (L1) Carlisle, PA Contract: 9611020 (C2) 1 -Trash Cart (95/96 Gallon) Scheduled Service (S1) Date Description Reference Qum 09/15 Residential Service 10/01/12-12/31/12 Current Invoice Charges Unit Price Amount $49.73 $49.73 $49.73 49.73 0.00 0 00 A Visit our website, www.disposal.com to make your payment electronically or to sign up for our convenient automatic payment plan. • Please see reverse side for terms and conditions o.oo a- O N ~ N M y- e~ N N O n ~ ~ ~ O ~o~oa .a ~ ~~ E ~, ~, z~? ~o 0 o~~ °' ~~o~ 4mE--a ~+ V U ao N r n v 0 Lr `':J V C V O Z 2 V '~ ~ M 0 '''-'~Q co Z a V ~ J .O~J y ~ LL N U .~-+ tt~ U 0 U 0 ~1-- Z L!4 b000 ~~ (Ci ~ ' ~ ~, c0 ~ 7 C to : L ~ a~ a~ ~. c m as ~. ~ a ~- °- c ~ R a ~~ v ~ ~~ a c ~ ' . ~ U v o °-' :c E L O ~ ~ o ~ ~ d °' ~+ L ~ Y C Q ~, ~ .C C 'rr P gy ~ I-- L L c p 0 ' = 1 c, 9 ~ I N t f 4/ 4 498040 ~I IIIIIIIIII'~IIIIi~"(IIIIIIIIIIIIIIIIIIII 9 Z 4 r r O N ~O ~ N M w- M N N O ~ ~ ~ ~ N r oo~oa ~ ~ .a ... ~ Z ,~ ~ p 0 o~Q °' rn ~ c ~ v -- amHa N V U ~ ~,_ v ~ ~ ~~ 0 ~ c °~ a~ ~ ~ ~ c c '- ° Z ~ o-~ rn m .~ ~~, „~ ~! C O E U ~ V A ~a ~ ~ N la ° a° ~ ? , n c c~ ~ ~: U Cz ~ ~ e~ m O ~ ~~ m y°~ z Z o M ~ r- 4 V ~ a ~~ " .~ rn ~~ ,~ ° c ~, c o, ~~ ~ ~ a~ ~ ~E t ~ ~ ~ D ~'~w ~ a .~3_~ S vo,~-~ ~ Y ~ o ' ~ c ~ y ` y°' o (~ aoa ! ~ N U ~ z ~ am ~ , o~ '~ o G ; 2 .~N ~ `~ ° o° . l - L L c 0 ' U c~ c' S o0 a~ ~- ~- yv W 0 tIJ 0 V ~. ~ C~ ~(comcastm Account Number Billing Date Total Amount Due Payment Due by 09547 373562-01-1 09/14/12 $73.54 10/07/12 Contact us: ~j www.comcast.com 717-243-4918 Page 1 of 2 RICHARD SHANNON ~ • - - Prev~ous~`Balance ~~~ ~~~~ ~ ` ~ ~~ ~~ ~~ ~~~ 73 54 For service at: 2058 W TRINDLE RD - Payment, 09/04/12-thank you _73 ~ `; CARLISLE PA 17013 ~ Ne~n~Cfiarges ~= see,~below ~ ~~ ~ ~ ~ ~ ~73 ~,:~`~ News fro C `Totat',Amognt Due ~ i`~~ `A ~` :.' ~ ~ ~ ,_ ~. u ~~3.s~~ Y~ ~ ~ m omcast ~ r~~y a ~ e Parten~~{D~Se~~ ~ ~4 s . ,, , .~~ a,:r ~o~o7r~ ~ . ~ ~ ~~ ~' Thank you for your prompt payment. _.. n, ~.~ . . r...... .,~. _ r .......r..> .fR: ,~,.'t''t .x~~:i~uti'i.3,d,.cn;wL. ~zr.~ ,.F4,:.'- For your convenience, we now accept regular Ond automatic monthly credit card payments and direct debit. HearinglSpeech Impaired Call 711 ~'~ l.J`~ ~'~4~- N Q 0 0 .~comcast. Account Number Billing Date Total Amount Due Payment Due by 09547 373562-01-1 08/14/12 $73.54 09/07/12 • Page 1 o f 2 Contact us: www.comcast.com 717_2q.3-4g1g -_-___~ RICHARD SHANNON For service at: 2058 W TRINDLE RD CARLISLE PA 17013 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 Cie +zi .4. °Prevous Balance ~ ;73 °54' Payment- 07/27/12-thank you . ~ -73.4' ., :'New Charges see tie%w x'3.54 Total ~Amoun~ Due' r ~, ~ ~ ~>~~7 ~ ~ ~u ~~r stl~`~il ~, u~~a a. '.l r .,.Yp., i -• ~ , ,;T7 r t~'`5u~•r~~a/'"lr.:%: -,I~ ~ uv.~.v, ~~,.~.dF.cF~µ+,i~iar ~a~i11 ~. ~ .. ., ~ ...,...+~Va+,..3+at:JyMtt~ a.l w.fk.J, ~ v _ .... t ~1z~~~L s - rtrti . ~s~~ ~ ,~ ~ .~3.84~ ,: ~'+SSi '~ ++ "-` .i,ittr ~x"r^i<~ .w',Cris ~ rj~- 1 tiKr^ ~ ~ ~.Y it t r' ~f a~ ~,.:~ ~ h ~ ~ ~ ttww i:! o L'c~ 52ei: I .i 7~ ~F f4 O m "~Than~€ you fc~r being~ a~ ~. valued C+~mcast~ustomer! ~' ty~ Iii t 7 M ~ ~ O ~~ N 0 N N N O O,M 47 it] O tF! O ~OOC COO • N N ~. h O 0 lQ • N C9 O CN `~ •__~ d ~ am4~9 ~ 'O C ~_~. ~~OO ~ ~QIN O v 4 O ~ p ~ ~ ~ lO~pOO Elm~cvO1 ~ O~iO C~OV~ ~ r.. '~' ~O . t ~x 'a~ = C »~ CUID~O D BOOR m~~`~ O 'Ea R~ `ENC>> 4 ~'~~-- ?, 'r'' ca 1° 0 0 = m r~ W v v .° ~ o V Y ~ w C ~ a o o •c m '~, ~, y ~ N~ ~ C O.O p. N~ ~ M ~O °j ~' ZO G cv O~ ~ N r V C 0 ~,ZWp ~ C O ~ ~ O OV~d v1,O st O..r IONMd d 47 N VJ N W X0+'3 ~ O C r ~.. •~~~II ~11 IIII ~~~ L!~ c ~' ~ ~~O•oo v .~ I' ~~mJ ~ ~ N ~ Ohm ~ = w ~_ W~ fntL'NL..~ O; Q: m O dC)a fr `~O- -- ~ ~~ Z/L 808000 g ~ ~' n ~ O ,~„ ° w ~ n= y t ~ ~°i _G v •O. '~ -D10... O ~ .® ,w '''' . O m. ~m y O C O: h D O:: r O N M N 7 0 oe ~. Z O E i L ~ ' R O .C D1 h R .D O ~ O • ~ C ~ G ~ 0 d w .~+ O ~ . .G v ~ •~ i V ~ ~ ~ N M W //~~ W ~ C ea m - • o (~ ~ ~ ~, C C o ' °' z H O ~ ++ ~ O . ~ ~ N o~ v, ) `- ~ ~ ~ m ~ . r U y ~ ~ m U ~ c ~ ~• ~ ccv O ~ t7' R ~ ~ c ~ N ~ .~ C O N _m •~ t a O f O ~° ~ _ ~ m a ~ on m = • ~ c ~ N O G7 ~ E ~ m °..' R ~' O ~ C to ~ m ~ E a ' O ° ' ~ d = "'~ O ' ~ c n m ~ O ~i c ~ O O ~ ++ .a are m O n + ~, ~ -~ m ? .. O - ^ ^ ^ ^ ^ .fl ~ ~ s ~ ~' ~o a R W a •p Y ~s V ~ O C O la •O ~ O ~' E C ~" O F O C A `~ m C AY w m O ha _a E ~ ~ ^^'' ~~ ` o a a ~° lQ ~'' .~ R d a a~ ~a ?, Y .= s.es sEavicE Billing Summary for Service to: RICHARD C SHANNON 2058 W TRINDLE RD CARLISLE PA 17013 Rate Classification: Residential General Billing Period: 06/20/2012 to 07/23/2012 (33 days} Remote Device Read Questions? Call 800-276-2722 or write to UGI at PO BOX 13009 Reading, PA 19612-3009 Your current UGI charges include State taxes totaling about $ 0.27. Past Bill Information -UGI Utility The account balance on your last bill was .................. $ 8,52 Thank you for your payment of ...........................................__8,52 Your balance as of 07/25/2012 ..................................... 0.00 220778221003 Current Bill Information -UGI Utility Customer Charge ..................... 8.55 ... ........................................ PA State Tax Surcharge ..................................................... - Total Current Charges -UGI Utility .......„ ......................... 8. UGI Utility charges owed this bill . ... ............................................ .............................. Total Amount Due, Please Pay by Due Date (OS/15/2012~ ....................................... $ 8.52 Meterlnformation -Next Read Date August 21, 2012 Meter Reading Information Meter Number Previous Reading Present Reading CCF Used 1405759 8 (remote) 8 (remote} 0 Messages from UGI Your current price to compare is $ 0.60244 /CCF Help prevent pipeline damage, accidents and service disruptions. Call 811 before you dig. Save time. Save the planet Sign up to view and pay your UGI bills online at www.ugi.com. Your bill does not display a usage graph because your average daily usage is too low. If you pay at a payment agent please take your entire bill. Make check payable to UGI. - - - Keep this part for your records. Important information is on the back of this bill. ~C s.as sEevicE Billingg Summary for Service to: RICHAf~D C SHANNON 2058 W TRINDLE RD CARLISLE PA 17013 Rate Classification: Residential General Rifling Period: 07/23/2012 to 08/20/2012 (28 days) Remote Device Read Questions? Call 800-276-2722 or write to UGI at PO BOX 13009 Reading, PA 19612-3009 "`Your current UGI charges include State taxes totaling about $ 0.27. Past Bill Information -UGI Utility The account halance on your lasf bill was ................. $ 8.52 Thank you for your payment of ...................................... -8.52 Your balance as of 08/23/2012 .................................... 0.00 r n~.~~ .'n,~.:s •:.~i',:,t~~4;?a°trrlxasati.~,.,:.'^~.uS'1 220778221003 Current Bill Information -UGI Utility Customer Charge ............................................................... 8.55 PA State Tax Surcharge ...................................... . ~~ . ........... Total Current Charges -UGI Utility ............................... UGI Utility charges owed this bill ........ .... ................................................... Total Amount Due, Please Pay by Due D eat 3/2012y ....................................... 5852 $ 8.52 Meter Information -Next Read Date September 20, 2012 . Meter Reading Information Meter Number Previous Reading Present Reading CCF Used 1405759 B (remote) 8 (remote) 0 Messages from UGI ^ Your current price to compare is $ 0.60244 /CCF. 'Help prevent pipeline damage, accidents and service disruptions. Call 811 before you dig. 'Save time. Save the planet Sign up to view and pay your UGI bills online at www.ugi.com. ~~~~ ^ Your bill does not display a usage graph because your average daily usage is too low. ~~ f~ ~~ t.J ~ ~V ZJ' tf you pay at a payment agent please take your entire bill. Make check payable to UGI. Keep this part for your records. Important information is on the back of this bill. a r~ ens aasvicf Billing Summary for Service to: RICHARD C SHANNON 2058 W TRINDLE RD CARLISLE PA 17013 Rate Claasitlcation: Residential General Billing Period: 08/20/2012 to 09/18/2012 (29 days) Remote Device Read Queatione? Call 800-276-2122 or write to UGI at PO BOX 13009 Reading, PA 19612-3009 "Your current UGI charges include State taxes totaling about $ 0.27. Past Bill Information -UGI Utility ' CUStOtY~~C~NU ~,'beC ~. , :._, ~ . The account balance on your fast bill was ................. $ 8.52 220778221003 Thank you for your payment of ...................................... ~ -8.52 Your balance as of 09/24/2012 ............................. 0,00 Currant Blll lnl'ormation -UGI Utility Customer Charge ............................................................... 8.55 PA State Tax Surcharge ................................................... -0.03 Total Current Charges -UGI Utility ............... „`~?~' UGI Utili charges owed this bill ~ ~ ~~~~~~~~~~~ -------- Total Please Pay by 0/15/2012) ....................................... ~~ ~~ti Meter Information -Next Read Date October 19, 2012 Meter Reading Information Meter Number Previous Reading Present Reading CCF Used 1405759 8 (remote) _ 8 (remote) 0 Messages from UGi 'Your current price to compare is $ 0.60244 /CCF ^ Help prevent pipeline damage, accidents and service disruptions. Call 811 before you dig. 'Save time. Save the planet Sign up to view and pay your UGI bills online at www ugi.com. ~ Your bill does not display a usage graph because your average daily usage is too low. If you pay at a payment agent please take your entire bill. Make check payable to UGI. Keep this part for your records. Important information is on the back of this bill. NORTH MIDDLETON AUTHORITY 240 CLEARWATER DRIVE CARLISLE, PA 17013-1100 (717) 243-8269 DT Ti` A CTi Cri Ti UTi ~TTi i?CTi crn~ Servlce 2058 W TRINDLE RD >...~. w BillxOa 9/1 /2012 ~~.., r'~Account ~ F om r ,,~ tT>o`~ ~~ 15002860 0 06/11 /2012 08/18/2012 '`Pre; oUS C r~®n~ ~ Usa9e . ~TYt~~~' 191000 191000 0 Actual Previous Balance 82.30 Payments -82.30 Adjustments ~ 0.00 Penalty 0.00 Sewer Service 56.55 Water Service 25.75 Pay Before 09/30/12 82.30 Pay After Due Date 86.42 v ~~~~~~ NORTH MIDDLETON AUTHORITY 240 CLEARWATER DRIVE CARLISLE, PA 17013-1100 (717) 243-8269 Sei~'i,~; ~.`,~ X2058 RINDLE RD ail ~Da ~ ,- 7/1 /2012 'v' st'a :i4.Y.eyr• 15002860 0 * 04/13/2012 06/11/2012 a ~,~.n "~Pr`evrous, 4n'en~'` ` ~"`~ ~"~~'~ Cu M ~ ~ ~ s~ge~: `T .x 190000 191000 1000 Actual Previous Balance 82.30 Payments -82.30 Adjustments 0.00 Penalty ~~ 0.00 Sewer Service ~ 56.55 Water Service ~ \~L~~~/ 25.75 ~~ - Pay Before 07/30/12 82.30 Pay After Due Date 86.42 ~~ri~~~~~~~~ e-1 N h0 co a °E N cv c . o ~, ~d d '^ a. >a N e-i O N O N C ° 0 0 N 0 N n 00 O N vOi C ^ N ~Jn Q °'~o„~~n M ~ ~''n o N `~ a ~' ~ o~Cn' ca ~~ooo 00 ~ c ~ a~ `~ C7 ° .~ ~' ~ e ,~ ~'~•. -: `oppe~oo.~. -e „ate '. i~~P .j V N .Q ~_ C m O 00 00 VCf, ~ ,N v 00 L m t U N ~ o ~= N ;~., ~ M v C •C N L w ~ o -i ~ ~ a ~ °- u a ~ ~ ~ F°- ~a m m U LO a~ m ro t U H N e-1 O N 00 N c +~ 0 ~a 0 C O m c z o m m N a~° ° ~, r-i M ~ =J ~ ~ VOa p^p{~~ ~r ~ ? 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C ~ ~, o ~- o. ~ ~ c°v a~ ~ .Q p C O C O V1 N ~ ~ a•`3 ~ ~ ~ m~ Iwo t4M~l) Aea gad •~ny Z 0 a r 0 a LL ~ ~ Q> ~ O ~ ~~ C C ._ GJ '~ .Q aJ cn ~ a N ~ L ~~c0o • a -Q Q '1 a m ` L ~~~> ~ ° ~ M ~M O i~ '^ ~ .-i t O ` d' ~^ u v p~ `-~ 00a-'N~ ~~^a C ~ CQ .DN roa -~L CL~C OmQ~ ~'~cuO Q.~ , ~ V e-1 ago=c L t+''/1 I~ N ~ m Lo o~ to~u oQ d Ly 0 u u ~~ a~ c~ ca oa n ~ o v ~ N Q ~„~ a. ~Z c ~~~ ~ZU w m N U Q T H t ~+ O Y u ~o s ~+ C O C 0 E c +• c eo O E as t ~+ N N e~-i eN-1 00 i}' O '~ ~' ' ' ' ~~~~~eaave~ ~, ° p ~ Questions? Please Visit us online at Page 1 op.- : f contact us by Aug 20. 1 800 DIA pplelectric.com ~ ~ ~~ q ~, - - L-PPL • °a ~ '" Ppl. ~lectrlc UHlitleo ~ (1-800-342-5775) M-F: Sam to Spm 87201-26007 ~ 11(~1'f ~5~ ~ (,0 ~ ,S~ +j1T ~ Aug 20, 2012 {'{yn ~~~7~1'!'f$~ , ~~;~~r}~;~w: Your Electric Usag e Profile Billin Summa (Billing details on back) Service to: Balance as of Ju130, 2012 $39.01 RICHARD C SHANNON 1005 TRINDLE RD CARLISLE, PA 17013 Meter: 15870367 Your next meter reading is on or about Aug 28, 2012. This section helps you understand your year-to-year electric use by month. Meter readings are actual unless otherwise noted. 2011 ^ 2012 z4 3 zo ~-- 16 12 ~, a 8 m a' • ~Ju17012 32 Months 351 11 78F Ju12011 30 331 11 79F ~ • • Jul 30 Actual ~ 37918 Jun 28 Actual 37567 32 Days kWh Billed 351 Aug 2011- Jul 2012 3273 • .273 Aug 2010 -Jul 2011 3386 282 Charges: Total PPL Electric Utilities Charges Total Charges Account Balance PPL Electric Utilities' price to compare for your rate is 7.993 cents effective 6/1/2012 to 8/31/2012. For a list of supplier offers, visit papowerswitch.com or www.oca.state.pa.us. $88.03 Your Message Center 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. • Information about appliance energy use and tips on saving energy are available through the Energy Library on our Web site, pplelectric.com. • Don't set your thermostat lower than normal when you turn on your a1r conditioner. It will NOT cool faster. It WILL-cool to a lower temperature than you need and waste energy. ~~~ l.~ `^` ~~~ Pa ment Methods YJl v Online at: ~ By phone:1-800-34Z-5775 pplelectric.com or call BI11Matrix (service fee applies) at 1-800-672-2413 to pay using Visa, MasterCard, Discover or debit card. ® By Mall: 2 North 9th Street CPC-GENN1 Allentown, PA 18101-1175 Correspondence should be sent to: Customer Services 827 Hausman Road Allentown, PA 181049392 $49:02 $88.03 Other important information on the back of this bill ~ J F M A M J J A s O N D ,, . ~ ; ,, ,' .. ..-~ ~~ •w.. .. • ~'' .- •~' ,. ~~ ~~~~ uauuea Questions? Please ~ Visit us online at Page 1 ® contact us by Sep 18. pplelectric.com 1-800-DIAL-PPL ' ~ ~ • ' ~ (1-800-342-5775) 87201-26007 Sep 18, 2012 ~ ~ ~$57:49'~~~ M-F: Sam to 5pm Your Electric Usage Profile Service to: \~~`~ RICHARD C 5HANNON 1005 TRINDLE RD . CARLISLE, PA 17013 , ~~,~ Meter: 15870367 Your next meter reading is on or about Sep 28, 2012. This section helps you understand your year-to-year electric use by month. Meter readings are actual unless otherwise noted. 2011. ~ 2012 24 ~ io 3 v 16 ~ 12 a s m a ~ s •. ~ •t Aug-2012 2g Months 430 ,. i. ~ 15 73F Aug 2011 31 275 9 74F • • Aug 28 .• Actual - 38348 Ju130 Actual 37918 29 Days kWh Billed 430 ~ ~ . Sep 2011- Aug 2012 . . 3428 j 286 Sep 2010 -Aug 2011 3394 283 Billing Summary (Billing details on back) Balance as of Aug 28, 2012 $0.00 Charges: Total PPL Electric Utilities Charges $57.49 Total Charges $57.49 mount Due`By s~ep~~18;2012 Account Balance $57 PPL Electric Utilities' price to compare for your rate is 7.993 cents per effective 5/1/2012 to 8/31/2012. For a list of supplier offers, visit papowerswitch.com or www.oca.state.pa.us. Your Message Center • 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, pplelectric.com. Before digging around your home or property, you should always call the state's One Call notification system to locate any underground utility lines. You can do this by simply dialing 811, which will connect you to the One Call system. Be safe and call 811 before you dig. Pavment Methods Online at: ©By phone:1-800-342-5775 pplelettric.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 Other important information on the back of this bill ~ J F M A M J J A S ~ N D '~ ~' ' ' ' ~ Questions? Please ~ Visit us online at Page 1 '`'~~'`•;;~- contact us by Oct 19. pplelettric.com , ~~~ ~-__ 1-800-DIAL-PPL • i i • ' i •~'~ (1-800-342-5775) ~` ~ ~ 87201-26007 Oct 19, 2012 '$56.92 wx ei~a~a uai+aee ~ ~ M-F: Sam to 5pm Your Electric Usage Profile Billing Summary (Billing details on back) Service to: Balance as of Sep 28, 2012 $0.00 RICHARD C SHANNON Charges: 1005 TRINDLE RD Total PPL Electric Utilities Charges $56.92 CARLISLE, PA 17013 Meter:158703fi7 Your next meter reading is on ar about Oct 29, 2012. This section helps you understand your year-to-year electric use by month. Meter readings are actual unless otherwise noted. 2011 ~ 2012 24 r zo 3 16 ~ 1z a s m Q Months • •. C Sep 2012 31 428 • i. 14 67F Sep 2011 31 267 9 67F Sep 28 Actual 38776 Aug 28 Actual 38348 31 Days kWh Billed 428 Oct 2011- Sep 2012 . 3589 ~ • 299 Oct 2010 -Sep 2011 3418 285 Total Charges $56.92 !Amount Due By' Oct 19, 2ti12 ($56.92 ~ Account Balance PPL Electric Utilities' price to compare for your rate is 7.907 cents per kWh effective 9/1/2012 to 11/30/2012. For a list of supplier offers, visit papowerswitch.com or www.oca.state.pa.us. Your Message Center • 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 ppielectric.com. • Information about appliance energy use and tips on saving energy are available through the Energy Library on our Web site, pplelectric.com. • Before digging around your home or property, you ~ ~j should always call the state's One Call notification ~ Q~~1~ system to locate any underground utility Lines. You can V'' ~ do this by simply dialing 811, which will connect you to ~~~ the One Call system. Be safe and call 811 before you ~ dig. 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. ® 13y 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 F M A M 1 J A S O N D . ®~~-- CenturyL~nk ~- P.O. Box 1319 Charlotte, NC 28201-1 31 9 Account Name: RICHARD G SHANNON Page: 1~ of 3 Account Number: 314142085 BiII~.Dat~e: ~ Jul. 13, 2012 >~ CQrttact`N~Imbers~.` ' ' ~ Current Ctarges Summary ~ ~ Detail wage Pay Online www.centurylink.com/myaccount Late Fees . ~ - p ~ g Pay by Phone Total Current Char es ~ o .19 1-866-712-1996 g Customer Service 1-800-788-3500 Customer Service Hours Mon-Fri. 8 a.m.-7 p.m. , Repair Service 1-800-788-3600 Visit us online www.centurylink.com (1~f i'~ 11~~ Previous Balance Payments & Adjs .Past Due Current Charges Amount Du Date Due 32.72 I 17.81 CR 14.91 0.19 1) rJ.10 Aug. 09, 2012 I:. I ( I . Just a friendly reminder that your account is past due. If you have already made your payment:, thank you for bringing your account up to date. The Due Date On This Bill. Applies to Current Charges Only ~ 2 3 4 s Bills now due and payable To: Robin K. Sollenberger, Tax Collector 5 Hill Drive Carlisle, PA 17013 Office Hours: See Reverse Side Phone: 717-249-0747 I 1012-2013 CARLISLE AREA SCHOOL DISTRICT REAL ESTATE IAx BILL. Tax Type Millage 2% Discount Face 10% Penalty School ' 12.3706 $2,041.77 $2,083.44 $2,291.78 TOTAL $2,041.77 $2,083.44 $2,291.78 ~~/~-1~ 9/1 -10/31 11 /1 -12/31 Owner: "Tax Assessment Reduced (Homestead/Farmstead) Bill # 003706 Parcel 29-21-0316-024. SHANNON, RICHARD C Issue Date 7/1/2012 Land use 101 2058 WEST TRINDLE ROAD Location 2058 W TRINDLE ROAD CARLISLE, PA 17013 ~ Beginning Assessment $178,900 Homestead Exclusion $10,481 III I II I'I~ ` ~ Adjusted Assessment $168,419 ~` n ~ti ME OWNER COPY ~ Tax Reduction $129.66 ~\ V IF PAYING INSTALLMENTS, START WITH COUPON #1 AT THE BOTTOM --------------------------------------------------------------------------------------------------------------------------- Bills now due and payable To: Robin K. Sollenberger, Tax Collector 5 Hill Drive Carlisle, PA 17013 Office Hours: See Reverse Side Phone: 717-249-0747 2012-2013 CARLISLE AREA SCHOOL DISTRICT REAL ESTATE TAX BILL Tax Type Millage 2% Discount Face 10% Penalty School ' 12.3706 No Discount $694.48 $763.92 TOTAL $694.48 $763.92 Installment 3 (Discard if paid in Full) Before 10/31 After 10/31 Owner: `Tax Assessment Reduced (Homestead/Farmstead) Bill # 003706 Parcel 29-21-0316-024. SHANNON, RICHARD C Issue Date 7/1/2012 LLocation 2058 W TRINDLE ROAD 2058 WEST TRINDLE ROAD CARLISLE, PA 17013 ~ Beginning Assessment $17s,9oo Homestead Exclusion $10,481 IMPORTANT! • Tax Reduction $129.66 II I I ~ ~~ ~~ I II ~ ~ II ~ II II I II I II ~ ~ II II ~ ~~ I II I ~ II I II I II I II I II II II II III Adjusted Assessment $168,419 HEAD INSTRUCTIONS ON BACK TEAR HERE -----------------------------------------------------------------------------------=--------------------------------------- Bills now due and payable To: Robin K. Sollenberger, Tax Collector 5 Hill Drive Carlisle, PA 17013 Office Hours: See Reverse Side Phone: 717-249-0747 2012-2013 CARLIS LE AREA SCHOOL DISTR ICT REAL ESTATE TAX BILL Tax Type Millage 2% Discount Face 10% Penalty School ' 12.3706 No Discount $694.48 $763.93 TOTAL $694.48 $763.93 - - ----- --- Installment 2 (Discard if paid in Full) Before 9/30 After 9/30 • Tax Assessment Reduced (Homestead/Farmstead) Bill # 003706 Owner: Parcel 29-21-0316-024. SHANNON, RICHARD C Issue Date 7/1/2012 Land use 101 Location 2058 W TRINDLE ROAD 2058 WEST TRINDLE ROAD CARLISLE, PA 17013 Beginning Assessment $178,900 Homestead Exclusion $10,481 IMPORTANT! • Tax Reduction $129.66 IIII~IIIII~~~~II~IIIII~~~III~~~III~~IIII~IIIIII~~I~~III~IIII~III AdjustedAssessment $168,419 READ INSTRUCTIONS ON BACK TEAR HERE AE~to eae~~y 1-800-998-4311 www.AeroEnergy.com RICHARD C SHANNON JR 4 HOMESTEAD LN CAMP HILL, PA 17011 i~~~~~~ Customer #: 151746 _ Payment Terms: Net 30 Invoice #: 6428722 Invoice Date 2012-10-02 Total Due $215.40 Make Check Payable to: Aero~Energy Amount Enclosed: $ Remit To: Aero Energy 230 Lincoln Way East New Oxford, PA 17350 0000151746000642872200000215400000021540 5 Customer Name : __ _ ,~ ~ - ~ ~ ~ - Delivery/Semce~Address •_ = ~ Cusf # ~ :Invoice:#~ : Inv Date RICHARD C SHANNON JR 151746 6428722 2012-10-02 ,' ;Quantity .'Item Number:, ~ ; , ,_ ~ ;_ ~ ,-:. Description:. . ~ .. '-Unit Priee ; ,: "TOTAL - 1.00 REC CHARGE ~ $215.4000 $215.40 Sub Total $215.40 Charges $0.00 Tax Total $0.00 ACCOUNT BALANCE $215.40 TOTAL DUE $2f5:40 Scheduled Recurring Charge: Service Contract Renewal Aero Energy 230 Lincoln Way East New Oxford, PA 17350 1-800-998-4311 www.AeroEnergy.com t'd~C 1 ul 1 Detailed Results for Parcel 29-21-0316-024. in the 2010 Tax Assessment Database DistrictNo 29 Parcel ID 29-21-0316-024. MapSuffix HouseNo 2058 Direction W Street TRINDLE ROAD Ownerl SHANNON, RICHARD C C/O PropType R PropDesc LivArea 1520 CurLandVal 35000 CurImpVal 143900 CurTotVal 178900 CurPrefVal Acreage .28 C1GrnStat TaxEx 1 SaleAmt 1 SaleMo 09 SaleDa 26 SaleCe 19 SaleYr 91 DeedBkPage 0035I-00078 YearBlt 1950 HF File Date 12/30/2004 HF Approval_Status A http://taxdb.ccpa.net/details.asp?id=29-21-0316-024.&dbselect=l 5/24/2012 LAW OFFICES IRWIN F~ McIQV ~I GHT, P. C. ROGER B. IRWIN MARCUS A. McKNIGHT, III DOUGLAS G. MILLER STEPHEN L. BLOOM MATTHEW A. McKNIGHT WEST POMFRET PROFESSIONAL BUILDING 60 WEST POMFRET STREET CARLISLE, PENNSYLVANIA 17093-3222 (717) 249-2353 FAX (717) 249-6354 WWW.IRWINMCKNIGHT. COM HAROLD S. IRWIN (1925-1977) HAROLD S. IRWIN, JR. (1954-1986) IRWIN, IRWIN &IRWIN (1956-1986) IRWIN, IRWIN & McKNIGNT (1986-199x) IRWIN, McKNIGFIT & HUGHES (1994-2003) IRWIN & McKArIGHT (2003-2008) July 9, 2012 Richard C. Shannon, Jr. 4 Homestead Lane Camp Hill, PA 17011 Re: The Estate of Richard C. Shannon Costs Advanced Roy D. Gottshall, Appraisal on Personal Property .....................................................$65.00 Register of Wills, Probate Fee ..................................................................................$469.50 Cumberland Law Journal, Estate Notice ....................................................................$75.00 The Sentinel, Estate Notice .......................................................................................$189.54 TOTAL BALANCE DUE :..............................................................................$799.04 Please pay the above sum to Irwin & McKnight, P.C. and send your payment in the envelope provided. Thank you. Douglas G. Miller DGM/ksn MaTBank 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Irwin & McKnight, P.C. West Pomfret Professional Building 60 West Pomfret Street Carlisle, PA 17013-3222 Re: Estate of Richard C. Shannon Social Security: 198-30-1571 Date of Death: May 20, 2012 Phone 888-502-4349 F ax (302)934-2955 June 4, 2012 ~~~~ ~,i~lNiiv ~ ~lc~{~V!Ct~` ~_AVd OFF!CF Dear Sir or Madam: Per your inquiry on May 25, 2012, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Checking Account Account Number 1111930 Ownership (Names o~ Richard C. Shannon Richard C. Shannon, Jr (POA) Opening Date 10/01/1991 Balance on Date of Death $4, 057.14 Accrued Interest $ .03 Total $4, 057.14 2. Type of Account Savings Account Account Number 15004204273384 Ownership (Names o~ Richard C. Shannon Richard C. Shannon, Jr (POA) Opening Date 03/142003 Balance on Date of Death $66, 750.46 Accrued Interest $ 3.19 Total $66, 753.65 r 3. Type of Account Account Number Ownership (Names o~ Opening Date Balance on Date of Death Accrued Interest Total Savings Account 15004200915427 Richard C. Shannon Richard C. Shannon, Jr (POA) 10/02/1991 $78,514.54 $ 10.22 $78, 524.76 For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, please call the Spring Garden at 717-240525. We were unable to locate any safe deposit box for the above-mentioned decedent. This letter does not include any accounts in which the deceased may have been listed as Power of Attorney, Custodian of Uniform Transfers, Representative Payee, or Trustee under a Written Agreement. Sincerely, Valarie Mercer Adjustment Services