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HomeMy WebLinkAbout02-08-13 (2) 1505610105 EX (02-11) (R) ~ REV-1500 I OFFICIAL USE ONLY PA Department of Revenue pennsytvania Bureau of Individual. Taxes County Code Year File Number PO BOX 28o6oi INHERITANCE TAX RETURN , Harrisburg, PA 17128-o6oi RESIDENT DECEDENT I l I J ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYW Date of Birth MMDDYYYY 205-03-0914 05/09/2012 10/22/1921 Decedent's Last Name Suffix Decedent's First Name MI Danish Andrew T (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW CID 1. Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Andrew G. Danish (716 770-0545 ° m 6_08TER OFAj LS U191 Y rn m cn ~ c7 x First Line of Address M t C;~ ;a 00 506 Terrace Drive z o C> C7 C? r1 Second Line of Address _ C7 Cs <J City or Post Office State ZIP Code DA RILED( Ea7 New Cumberland PA 17070 Correspondent's e-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. SIGN RE OF PERSON RES SIBLE FOR FILING RETURN DATE G - -13 ADDRESS 506 Terrace Drive, New Cumberland, Pa 17070 SIGN AT AR OTHER THAN REPRESENTATIVE PTA B ADDRESS 549 Bridge Street, New Cumberland, PA 17070 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 I°~ 1505610205 REV-1500 EX (A) Decedent's Social Security Number Decedent's Name: Danish, Andrew T 205-03-0914 RECAPITULATION 1. Real Estate (Schedule A) 1. 104,231.59 2. Stocks and Bonds (Schedule B) 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 3. 0.00 4. Mortgages and Notes Receivable Schedule D 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 32,407.53 6. Jointly Owned Property (Schedule F) O Separate Billing Requested 6. 94,243.39 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 323,786.82 8. Total Gross Assets (total Lines 1 through 7) 8. 554,669.33 9. Funeral Expenses and Administrative Costs (Schedule H) 9. 18,022.54 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule 1) 10. 10,797.96 11. Total Deductions (total Lines 9 and 10) 11. 28,820.50 12. Net Value of Estate (Line 8 minus Line 11) 12. 525,848.83 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) 14. 525,848.83 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 45 16. 23,663.20 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.I 23,663.20 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Side 2 L 1505610205 1505610205 J REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENTS NAME Andrew T. Danish STREET ADDRESS 504 Brandt Avenue CITY STATE ZIP New Cumberland PA 17070 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 23,663.20 2. Credits/Payments A. Prior Payments 20,000.00 B. Discount 1,000.00 Total Credits (A + B) (2) 21,000.00 3. Interest (3) 0.00 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. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 2,663.20 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred ❑ 0 b. retain the right to designate who shall use the property transferred or its income ❑ 0 c. retain a reversionary interest ❑ 0 d. receive the promise for life of either payments, benefits or care? ❑ M 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ❑ 0 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? ❑ 0 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(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-1502 EX+ (01-10) ki pennsyLvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Andrew T. Danish 21-12-0615 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 1 504 Brandt Avenue, New Cumberland, Pa 17070 Property sold on September 10, 2012 for $112,000.00 (Settlement Sheet attached) Less closing costs of $9,034.47 Plus refund on countylboro taxes & refuse of $1,266.06 104,231.59 TOTAL (Also enter on Line 1, Recapitulation.) 104,231.59 If more space is needed, use additional sheets of paper of the same size. OMB NO. 2502-0265 9F A. B. TYrc OF LOAN: U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.QFHA 2.QFmHA 3. []CONV. UNINS. 4. []VA 5. []CONV. INS. 6. FILE NUMBER; 7. LOAN NUMBER: SETTLEMENT STATEMENT MILLER.504 8. MCRTGAGE INS CASE NUMBER: C. NOTE: This form is furnished to give you a statement of adual settlement costs. Amounts pail to and bythe settlement agent are shown. Items marked 'TPOC]" were paid outside the closing; they are shown here for informational purposes and are not Included in the totals. 10 3W (MRIERM4.PF0lA4UZ9.W4M D. NAME AND ADDRESS OF BUYER: E. NAMEAND ADDRESS OF SELLER: F. NAMEAND ADDRESS OF LENDER: Judy K. Miler Andrew G. Danish, Executor of the Estate of Andrew T. Danish G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 23-2402316 1. SETTLEMENT DATE: 504 Brandt Avenue PURITY ABSTRACT COMPANY New Cumberland, PA 17070 September 10, 2012 Cumberland County Pennsylvania PLACE OF SETTLEMENT Century 21 Really Services 3315 Market St, Camp Hill, PA 17011 J. SUMMARY OF BUYER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BUYER: 400. GROSS AMOUNT DUE TO SELLER: 101. Contract Sales Price 1 112,000.00 401. Contract Sales Price I 112,000.00 102. Personal Property 402. Personal Property 103. Settlement Charges to Buyer Line 1400 2,148.00 403. I 104. I 404. 105. 405. Adjustments For Items Paid B Seger in advance Adjustments For Items Paid 8 Seger in advance 106. Count Borer Taxes 09!10!12 to 01/01113 1 260.09 406. Coun /Boro Taxes 09/10112 to 01/01/13 ' 260.09 107. CI Tax to I 407. C' Tax to 108. School Tax 09/10/12 to 07/01113 I 997.16 408. School Tax 09110112 to 07/01/13 i 997,16 109. 3rd Qtr Refuse $38.60 09/10/121010101/12 I 8.81 409. 3rd CXr Refuse $38.60 09110112to 10/01/12 1 8.81 110. 410. I 111, I 411. I 112. 412. j 120. GROSS AMOUNT DUE FROM BUYER 115,414.06 420. CROSS AMOUNT DUE TO SELLER I 113,266.06 200. AMOUNTS PAID BY OR IN BEHALF OF BUYER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201, Deposit or earnest money 1,000,00 501. Excess De ostt See Instructions I 202, Prlnd alAmount of New Loans 502. Settlement Charges to Seiler Line 1400 I 8,975.32 203, Existin bans taken subject to 503. Existing bans taken subject to I 204, I 504. Payoff of first Mortgage 205. I 505. Payoff of second Mortgage 206. I 506. 207, I 507. (Deposit disb. as proceeds) I 208. I 508. { 209. I 509. i Adjustments For Items Un aid Seger Ad stmentsForItems Un ak! Seger 210. Count Boro Taxes to l 510. Coun /Boro Taxes to I 211. City Tax to € 511. CI Tax to ! 212. School Tax to f 512. School Tax to 7 213. 3rd Qtr Sewer a 07/01/12 to 09110112 f 59.15 513. 3rd Otr Sewer a 07/01/12 to 09'10112 I 59.15 214, j 514. 215. 1 515. 216. I 516. 217. 517. 218. I 518. 219. 519. 220. TOTAL PAID BYWOR BUYER 1,059.15 520. TOTAL REDUCTION AMOUNT DUE SELLER I 9,034.47 300. CASH AT SETTLEMENT FROMITO BUYER: 600. CASH AT SETTLEMENT TOIFROM SELLER: 301, Gross Amount Due From Buyer Line 120 115,414.06 601. GrossAmount Due To Seller Line 420 I 113,2fi6.06 302. LessAmount Plaid /For Buyer (Line 220) ( 1,059.15) 602. Less Reductions Due Seger (Line 520) 9,034.47, 303. CASH ( X FROM) ( TO) BUYER 114,354.91 603. CASH ( X TO) ( FROM) SELLER 1 104,231.59 The undersigned hereby admowledge receipt of a completed copy of pages 1 &2 of this statement & any attachments referred to herein. Buyer J! L Mae Seller Andrew G. Danish, Executor Judy K. 1 r G to- BY. Ngo 2 L. SETTLEMENT CHARGES 700. TOTAL COMMISSION Based on Price $ 112,000.00 6.0000 % 8,720.00 Rvo FROM RAID FROM Division of Commission ffino 700 as Follows: BUYERS SELLERS 701. $ 3,555.00 to ERA NRT, LLC FUNDS AT FUNDS AT 702. $ 3,360.00 to CENTURY 21 REALTY SERVICES sETnEWNT SETTLEMENT 703. Commission Paid at Settlement 6,915.00 704. ADD'L COMMISSION to CENTURY 21 RS WAIVED Note: Une 701 In dudes Adjustment of 195.00 For 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801, Loan Origination Fee % to 802. Loan Discount % to 803. Appraisal Fee to 804. Credit Report to 805. Lender's Inspection Fee to 806. Flood Cart Fee to 807. Tax Service Fee to 808. Document Prep Fee 809. 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to @ $ /day ( days 902. Mortgage Insurance Premium for months to 903. Hazard Insurance Premium for years to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001, Hazard Insurance $ per 1002. Mortgage Insurance $ per 1003. CDun /Born Taxes $ per 1004. City Tax $ per 1005. School Tax @ $ per 1006. 5 per 1007. 5 per 1008. AGGREGATE ADJUSTMENT 5 per 0.00 1100. TITLE CHARGES 1101. Settlement or Closing Fee to 1102. Abstract or Tale Search to 1103. Title Examination to 1104. Title Insurance Binder to 1105. Document Preparation to ERA NRT, LLC DEED 100.00 1106. Notary Fees to NOTARY CLERK 5.00 15.00 1107. Attorneys Fees to includes above item numbers: 1108. Title Insurance to PURITY ABSTRACT COMPANY 960.00 (includes above item numbers: 1101, 1103 - SALE 1109. Lender's Coverage $ 1110.Owner's Coverage S 112,000.00 960.00 1111. 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 83.00; Mortgage $ Releases $ 63.00 1202. City/County Tax/Stamps: Deed 1,120.00• Mortgage 1,120.00 1203. State Tax/Stamps Revenue Stamps 1,120.00; Mortgage 1.120.00 1204. RECORDER OF DEEDS 1205. RECORDER OF DEEDS 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Surve to 1302. Pest Inspection to WAIVED 1303. 2012 SCHOOL TAX/ 2nd & 3rd to ROSIN GASPERETTI, TAX COLLECTOR 825.32 1304. 1305. 1400. TOTAL SETTLEMENT CHARGES Enter on Lines 103, Section J and 502, Section K) 2,148700 8,975.32 8Y slgdng page 1 dthls statement, Ore sig atwies a0no ledga receipt of a complated COPY d papa 2 d Ws W page slatemsrL Rx), t%' V tY ~1 PURITY ABSTRACT C MPANY Settlement Agent Certified to be a true copy. ( MILLERSOS! MLLER.SW f 7 ) r REV-15o8 EX+ (ii-io) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS &MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY 1 i RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Andrew T. Danish 21-12-0615 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. Personal Property (Miscellaneous Donated & Yard Sale) 500.00 2. 2002 Chevrolet Malibu #693373 500.00 3. 232 Shares of MetLlfe Trust #8064 2385 3829 7,869.44 4. Savings Bonds - See attached sheets 22,286.09 5.' Federal Income Tax Refund for 2012 1,252.00 TOTAL (Also enter on Line 5, Recapitulation) $ 32,407.53 If more space is needed, use additional sheets of paper of the same size, PETE'S BRIDGE STREET MOTORS j 717-774-7233 8853 219 BRIDGE ST 60-1878/313 NEW CUMBERLAND, PA 17070 3 I ~ I '~CHF~CK ~lIM~9 Date Pay to Order of the D i' w A *i) 6° is ~ $ JC tl v ~~~i~r pve F., . Dollars o Camp Hill, PA 17011 www.inhprhyMrAconnm.eom 0 • N N II For- W N ,-v 14 4 l3 3E 1:0 3 13 18 76 71: 2 20 1000 5 201Ia88 5 3 MET Historical Prices MetLife, Inc. Common Stock Stock - Yahoo! Finance Page I of 1 New User? Register Sign In Heio Get new Yahoot Mail apps fvla:: My Y: Yahoo: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SearCl Search Web IT HOME INVESTING NEWS PERSONAL FINANCE MY PORTFOLiOS EXCLUSIVES . _ts case in 1 hr and 37 m ns ela 1w Get Quotes Finance Search nu Jan 31 2C0 . 2:2aor E,>T - I cz ; Dow 10.15% Nasdaq''0.11% TRADE R MET FREE 60 DAYS MET [+1Rfler. i[CUeIIUF. µc MetLife, Inc. (MET) NYS>W Add to Portfolio ike 5 37.2 V 1. 0.01 (0.03%) 2:24PM EST - Nasdaq Real Time Price I Historical Prices Get Historical Prices for: GO Set Date Range m Daily Start Date: May 9 2012 Eg. Jan 1, 2010 Weekly End Date. May w 9 2012 Monthly Dividends Only Get Prtces First P'eVIDLIS Next ~ Last ' 1 Prices I Dale Open High Low Close Volume Adj Close` Ma33.91 34.15 33.40 33.92 7,123,000 33.20 ' Close price adjusted for dividends and splits. First Previous I :"dent I Labt Download to Spreadsheet Currency in USD. copyi ght s9 201:, yaht: inc..M.il ::ght< Ee:atryad. Pnv. y Ptairy - aDowl .^,ur ids ~ Tv:rErs C%ryngntAP P:;iicy - :lend Fe::db:2;k - Ya'10o! - ABC News Network C uotes are real-time for NASDAQ, NYg., and i+YSP {a9 C°• See also delay times for other exchanges. A: infarmaticr. provided "as c" for informational purposes only, not intended `or;railing •n,t,„_ Of advice. Pd.eiit.:: :n..:.i: vi . =ii;y rr a• ,a . ; r; :a v :c lias 'ule for yry y iriiofrnationa errors Incompleteness or delays, cr for any , actioris tak ~n in rr:ii8orx on infoimatior: rormEMUd `•'ai._., p-.nF herein. Hy accessing trip Yahoo, site, you agree not to remF#ibute the i'tiorn'~at:cr: found thera:n. Reari irne wniim;ous euparning CU±)t?.S art, avaiiable Through our prP,.^:. urn erv:;.P.. You inay ;urii strern:ng quotes on or off. F''undamei tal ck.vr.,any d:a`a provided by Capita: :Q H:siorical cnart data and daily urx<ates provided by Commodity Systems, Inc. iCS:1. International historic,ai chart data, di::iy updates, furd surnmary, fund performance, dividend data and h'orningstar Index data provided by Morningstar, Inc http://finance.yahoo.com/q/hp?s=MET&a=04&b=9&c=2012&d=04&e=9&f=2012&g=d 1/31/2013 ANDREW T DANISH Investor ID 8064 2385 3829 Account Market Value 2012 Dividend Summary Stock Price as of Total Market 11/09/2012 value Record Date Total Trust Dividend per Current $32-020 $7,428.64 Interests Trust Interest Distribution 11/09/2012 232.0000 $0.74 $171.68 The aggregate amount paid to all Trust Beneficiaries in this distribution Payable Date Tax Withheld Net Distribution Prior Year is $150,581,457.14. Distribution 12/14/2012 $0.00 $171.68 $171.68 For account inquiries, you may visit www.cpushareownerservices.com or call 1-800-649-3593. When contacting us please have your Investor ID available, located in the upper right hand corner of this document. !1 IN 11111 111 11111 ! i i i ! f. f- i i • rt ! i - f i i•- i i i' *To 7 i - i i • i n Trust Beneficiary Information You may purchase or sell your shares of MetLife, Inc. common stock An annual shareholders' meeting to elect members of the Board of (represented by 'Trust Interests") held in the MetLife Policyholder Trust Directors of MetLife, Inc. and for the transaction of other business is (the "Trust"), free of any commissions or other fees, under the MetLife expected to be held on or about April 23, 2013. The deadline for Purchase and Sale Program, as amended. A copy of the brochure submitting shareholder proposals for consideration at this meeting is describing the program is available on the Internet at November 26, 2012. A copy of MetLife, Inc.'s annual report and proxy http://investor.metlife.com by selecting the Shareholder Services statement will be available free of charge on or about March 31, 2013, Information page, or by calling the number listed above. You are permitted along with other MetLife, Inc. and Trust filings under federal securities to transfer your Trust Interests only in the circumstances described in the laws, (i) on the Internet at www.metlife.com by selecting About MetLife, brochure. You may also instruct that all (but not less than all) of your Corporate Governance, (ii) by writing to MetLife, Inc., c/o Computershare shares of MetLife, Inc. common stock held by the Trust be withdrawn from Shareowner Services LLC, PO Box 358447, Pittsburgh, PA 15252-8447, or the Trust. Information regarding your withdrawal rights may be found in (iii) by calling the number listed above. These and other SEC filings by the Purchase and Sale Program brochure or by calling the number listed MetLife, Inc. and the Trust are also available on the Internet at above. MetLife, Inc. amended the Purchase and Sale Program Procedures www.sec.gov. in October 2012. As a result, you may no Iona r use a money order to ourchase_ additional shares of MetLrfe In common stock thro ueh the Purchase and Sal Program. W28599 G3 Please Note: Important-20012 Tax Information MetLife FORM 1099-DIV. U.S. TAX INFORMATION FOR 2012 OMB NO. 1545-0110 DIVIDENDS/DISTRIBUTIONS F COPY B FOR RECIPIENT RECIPIENT'S TOTAL ORDINARY 17- IDENTIFICATION NUMBER DIVIDENDS QUALIFIED DIVIDENDS FEDERAL INCOME TAX WITHHELD BOX 1b XXX00(0914 BOX 1a BOX4 $171.68 $171.68 $0,00 PAYER'S NAME PAYER'S FEDERAL IDENTIFICATION NUMBER COMPUTERSHARE SHAREOWNER SERVICES LLC AS CUSTODIAN OF THE METLIFE POLICYHOLDER TRUST 51 6516987 SECURITY DESCRIPTION TO WHOM PAID F TRUST INTERESTS ANDREW T DANISH 504 BRANDT AVE REPORTED BY NEW CUMBERLAND PA 17070-1834 COMPUTERSHARE P.O. BOX 43010 PROVIDENCE, RI 02940-3010 IMPORTANT 2012 TAX INFORMATION FOR INFORMATION REGARDING THE ABOVE, CALL 1-800-649-3593 This is important tax information and is being furnished to the Internal Revenue Service. Box 4 - Shows backup withholding. A payer must backup withhold on certain payments if yo, If you are required to file a return, a negligence penalty or other sanction may be did not give your taxpayer identification number to the payer. See Form W-S, Request for Tax imposed on you if this income is taxable and the IRS determines that r has not been payer identification Number and Certification, for information on backup withholding. Include reported. this amount on your income tax return as tax withheld. Box 1 a - Shows total ordinary dividends that are taxable. Include this amount on line 9a of Form Nominees. If this form includes amounts belonging to another person, you are considered 1040 or 1040A. Also, report it on Schedule B (1040A or 1040), if required. The amount shown nominee recipient. You must file Form 1099-DiV (with a Form 1096) with the IRS for each o may be dividends a corporation paid directly to ycu as a participant (or beneficiary of a panic:- the other owners to show their share of the income, and you must furnish a Form 1099-DIV tc pant) in an employee stock ownership plan (ESOP). Report as a dividend on your Form each. A. husband or wife is not required to file a nominee return to show amounts owned b, 10401 but treat it as a plan distribution, not as investment income, for any other purpose. the other. See the 2012 General Instructions for Certain Information Returns. Box 1 b - Shows the portion of the amount in box ta, that may be eligible for the 15% or zero capital gains rates. See Form 1040/1040A instructions for how to determine this amount. Report the eligible amount on line 9b, Form 1040 or 1040A. 1~11,'y Calculated Value of Your Paper Savings Bond(s) http://www.treasurydirect.gov/BC/SBCPrice Calculated Value of Your Paper Savings Bond(s) Calculator Results for Redemption Date 05/2012 Total Price Total Value Total Interest YTD Interest $1,950.00 $7,882.35 $5,932.35 $128.37 Bonds: 1-52 of 52 Issue Next Final Issue Interest Serial # Series Denom Date Accrual Maturity Price Interest Rate Value Note K51230011 EE $75,03/1985 09/201203/2015 $37.50 $116.10 4.00% $153.60 K51243584 EE $75 06/1985,06/2012 06/2015 $37.50 $113.10: 4.00% $150.60 K47428270 EE $75 05/1985 11/2012 05/2015 $37.50 $116.10 4.00% $153.60. K52390611 EE $75.12/1985 06/2012 12/2015 $37.50 $110.13 4.00% $147.63 K52390522 EE $75:12/1985;06/2012 12/2015; $37.50 $110.13, 4.00% $147.63 K52390523 EE $75.12/1985 06/2012 12/2015 $37.50 $110.13; 4.00% $147.63 K52390287 EE $75 12/1985 06/2012 12/2015 $37.50 $110.13 4.00%: $147.63 K52390288 EE $75 12/1985 06/2012 12/2015 $37.50 $110.13 4.00% $147.63 K52390048 EE $75 11/1985 11/2012 11/2015$37.50 $113.10 4.00% $150.60 K52390049 EE $75 11/1985 11/2012 11/2015 $37.50 $113.10 4.00% $150.60 K9183634 EE $75 11/1985 11/2012 11/2015 $37.50 $113.10 4.00% $150.60 K49784890 EE $75:11/1985 11/2012 11/2015 $37.50 $113.10 4.00% $150.60 K49784799 EE $7510/1985:10/2012 10/2015 $37.50 $113.10 4.00% $150.60 K49784798 EE $75 10/1985 10/2012 10/2015 $37.50 $113.10 4.00% $150.60 K49784566 EE $75,10/1985 10/2012 10/2015 $37.50 $113.10 4.00% $150.60 K49784428 EE $75 10/1985 1.0/2012 10/2015 $37.50 $113.10. 4.00% $150.60 K49784339 EE $75 0.9/.1..98.51.09/.2012'.. 091/210151 1. $37.50 $113.10 4.00% $150.60 1. .1 K49784206 EE $75:09/1985,09/2012. 09/2015: $37.50: $113.10; 4.00% $150.60 K47424725 EE $75:919/1985: 09/2012 09/2015 $37.50 $113.10 4.00%, $150.60 K47424724 EE $75 09/1985 09/2012 09/2015 $37.50 $113.10. 4.00% $150.60 K47424497 EE $75 08/1985 08/2012 08/2015 $37.50 $113.10 4.00%; $150.60 K47424358 EE $75 08/1985,08/2012 08/2015 $37.50 $113.10 4.00% $150.60 K47424271 EE $75:08/1985:08/2012 08/2015$37.50: $113.10. 4.00%. $150.60 K49784096 EE $75 08/1985 08/2012 08/2015 $37.50 $113.10 4.00% $150.60 K51455979 EE $75,08/.11985 08/2012 08/2015 $37.50 $113.10 4.00% $150.60 K51455859 EE $75:07/1985 07/2012 07/2015 $37.50 $113.10 4.00% $150.60 K51455757 EE $75:07/1985 07/2012: 07/2015 $37.50: $113.10 4.00% $150.60 K51455758 EE $75 07/1985.07/2012 07/2015 $37.50 $113.10 4.00% $150.60 K51243767; EE $75 07/1985 07/2012 07/2015 $37.50 $113.10 4.00% $150.60 K51243585 EE $75,06/1985:06/2012 06/2015 $37.50 $113.10 4.00% $150.60 K47428914 EE $75 06/1985:06/2012 06/2015 $37.50 $113.10 4.00%, $150.60. K47428842 EE $75:06/1985 06/2012 06/2015 $37.50 $113.10 4.00% $150.60 K51243378 EE 1$75.015/11985,111,111/2012 05/2015 $37.50 $116.104.90%: $153.60 K47428675 EE $75:05/1985 11/2012 05/2015; $37.50 $116.10 4.00%: $153.60; K47428426 EE $7505/1985 11/2012 05/2015 $37.50 $116.10 4.00% $153.60 K47428533 EE $75:05/1985 11/2012 05/2015 $37.50 $116.10 4.00% $153.60 K47428190 EE $75 04/1985:10/2012: 04/2015 $37.50 $116.10 4.00% $153.60 K47428067. EE $75.04/1985:10/2012 04/2015 $37.50 $116.10 4.00% $153.60 K47428066 EE $75 04/1985 10/2012 04/2015: $37.50 $116.10' 4.00% $153.60 K51230094. EE $75 04/1985 10/2012 04/2015$37.50: $116.10: 4.00% $153.60 . K49783859 EE $75 03/1985 09/2012 03/2015 $37.50 $116.10 4.00%: $153.60 K49783780 EE $75 03/1985 09/2012 03/2015 $37.50 $116.10 4.00% $153.60 1 of 2 1/31/2013 4:17 PM Calculated Value of Your Paper Savings Bond(s) http://www.treasurydirect.gov/BC/SBCPrice K49779114Ee EE $75 03/1985 09/2012 03/2015 $37.50 $116.10 4.00% $153.60 K49778948EE EE $75 03/1985 09/2012 03/2015 $37.50 $116.10 4.00%0 $153.60 K49778827Ee EE, $75 02/1985 08/2012 02/2015 $37.50 $116.10 4.00%; $153.60 K49778732EE EE $75 O2/1985:08/201,12..,..0.2/210,15 $37.50 _$116.10 4,00%, $153.60 K49772143EE EE $75 U/198508/12012,02/2015 $37.50 _$116.10 4.00% $153.60. K49772059EE EE, $75 02/1985 08/2012 02/2015 $37.50 $116.10 4.00% $1.53.60 K49771890EE EE . $75 01/1985 07/2012 01/2015 $37.50 $116.10 4.00% $153.60 K49771763Ee EE $75 01/198507/2012 01/2015 $37.50 $116.10 4.00% $153.60' K49771762EE EE $75 01/198507/2012. 01/2015 $37.50 $116.10 4.00/o ...$153.60......... K43517840EE.. EE $75.01/1985.07/2012 01/2015 $37.50 $116.10 4.00% $153.60 Totals for 52 Bonds $1,950.W $5,932.35: 7 882.35 Notes NI Not Issued NE Not eligible for payment P5 Includes 3 month interest penalty MA Matured and not earning interest 2 of 2 1/31/2013 4:17 PM it A II ; i1 la- _ f 6 D N tl : 1 1 _ tI : _ _ ' o n - 1 `6 D s ~ }IIY ! Cif J , e~aeaeRSaaaeee~wcm~aseeoea aeeeReneaeRSReaeRecga~ x1 „ T F F c., AT THE MATURITY HEREOF WILL PAY 711~ f~ - eiTnl~nsi t _ ISSUE DATE WHICH IS THE FIRST DAY OF 205-03-0914 To MR ANDREW DANISH PEN .J>AN__1985_ (MONTH! (YEAR) t 504 BRANDT AVE NEW CUMBERLAND PA 17070 4150 OR PROVIDENCE M DANISH UDD T I666C.I nnr / I 1 8 / J/ DATING STAMP HEis.~'~1?A . A lM' N SERIEs EE rv .rve„~uFET.oTrvEr Foeo..~Ee..WEwEOFNeE K49 771762 eFPae A EE Wa=rvr.~.IeFa=rve. ,OL R04040004090404140RiM909~F040104040p040p0 0y9i4evevevevevovew eve pve vep_4o~=0n°s®Ql4ipygeN3l40? vat®v p®v®vov®vcveo 07&vLeAR'4e8w - .S P wm 6iiiii'"i i"m-9 AT THE MATURITY HEREOF WILL PAV ISSUE DATE WHICH IS THE FIRST DAY OF 205-03-0'14 ToMR ANDREW DANISH E'EN ,T~'~Fz 504 BRANDY AVE (MONTHI (YEAR) - NEW CUMBERLANU PA 17070 41155, OR PROVIDENCE M DANISH UL)41 ISp ~cy OENT6 \r I 1 f3f65 DATING 6TAMP SERIES EE .N.. _TT.T. mervrrvF'AE'.1-P e K49 771763 EE Oev NHUI~ SAE aw OEPaeTMnIOP rrv rvF~ p} W rHGiON N4lRa9~PIl4v1494fP®pIlv®y®pgyQpERIL@4~R➢Ab?.4@pi4 ~v®ev®v®vop®9®O~pgpp~4&A0449'v,BmP@794fl4flglq O2 fl414®ROgop®voyevav®veq®41R08C4@9!A!4!R@4fl404@4t4p46gmo~4➢4®q@qqq®plORyp®vevmv®vooevea®pev®yeg.gpy®peq®pmo® ®ampmo®vevevovep v C0900R0 Ie~eeeeeAe~oM _ - 1 i! r l1 !fl _ AT THE MATURITY HEREOFWIL' PAY ad ff ISSUE DATE WHICH IS THE FIRST DAY OF 205-03-0914 TO MR ANDREW DANISH PJZN T~. - 04 bRANDT AVE (MONTH) (YEARI .x' NEW CUMBERLAND rPA 1707U 41I5 OR PRUVIDENLE PM DANISH L)Utjl I G1~GfFGENT6 `Ir Ilrc~ffiJ DATING STAMP -R IMAM SER-.'ES EE rv TOFTIC11 To:rvFT oeo~. Es .rvE.EOf~eFe. K49 771890 EE eF... rvo~eFa ~e. 3nFrtle~./IAr7 M O? 09iP040904140404040y0vev pepeR ev~p`g040pyve pepe0eaepepepe wun N0T aepeReoeoeoeoeoeoeo 0p0Q0g0Il08~q ~ O.l WIT to ~4-4 I, RIO------- a.e Form g6m AT THE MATURITY HEREOF WILL PAY ISSUE DATE ~~al Yom, 2 05 _yyyy WHICH IS THE FIRST DAY OF TO MR ANDREW DANISH fN F(MONI % (YEARI 1 504 BRANDT AVE J 17070 4,31 , 50 NEW CUMBERLANU PA ~dd .i 1~ T .i~:. LJ'LJ ~ 1n~'~74AGENT6 ``Ir OR PRERVIUENL' M UANI'-,Ft I/65 ..TING STAMP 4LI~.`~~„. M IMPN rv rF , Fmerve0rv-.WE Eo ave ErveEe. K49 77 2 059 EE SERIES EE eEPae w. r„~vE~TgY rvF Nr~![> T.0F.,T TE 3rmlrv allFn 7 p l,. 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K AT THE MATURITY HEREOF WILL.... ISSUE DATE WHICH IS THE FIRST DAY OF 205-03-0914 TOMR ANDREW DANISH PLN FLb I,V_85 504 bRANDT AVL. IMONTHI (YEARI-- NEW CUMBERLAND PA 17070 41: >U OR PROVIDENCE M DANISH t3DbIl IVLjFI, AGENT DATING STAMP VAW M, P 1.~ Txi„.xe,,. W... exm,., _UTllT"u xo e.".T..ex...T= .xe... K49 778 732 EE SEL IES EE e... rv^ x.. . .5 ~ ® wrwixcTox SmreT .(Ar7 G O!: ➢9l9➢OB9 eeePThceehe , Jilt, AT THE MATURITY HEREOF WILL PAY f - ' MMBev ig ISSUE DATE 205-03-0914 n WHICH IS THE FIRST DAY Of TO MR ANDREW DANISH F'N FEEa 1965 .f. 504 BRANDT VE IMONTHI (VEARI-- s: NEWT CUMBERLAND PA 17070 ~15G OR PROVIDENCE M DANISH uUti i 169u (~sGENTG 2/22/85 yj DATING BTAMP "`CT A l SEI~IES EE ......xe „rva..T,x..rv.T .EES° K 4 9 7 7& 827 EE ,D9 wasxirvCTOnxEp -0 &.nly e/Ihr7 •r~ oyo0P9v➢0.➢Y@P➢fl➢➢®4@➢B1.v08YRiv➢7➢4®vylvoP®POIlflq➢p➢p➢q➢AQ➢de0c ®vaynoeo 41. ➢II~➢90909 vv eo•ve •~ev➢4➢000tlOP0R0.9a¢0➢➢804➢4➢A09eRm9➢Il➢Il®9➢41P®y owaq wy ➢4®000040P@909➢40vAfl➢Afl4➢➢➢V➢¢iY➢~¢10.➢9➢C®A➢➢4➢. 1-',iu d.s a euu:eo = 07-T, = _ mriau-l ==e eo Gt"d h d AT THE MATURITY HEREOF WILL PAY ISSUE DATE CS~l~J~J WHICH IS THE FIRST DAY OF 205-03-0914 =r° TO MR ANDREW DANISH F' N Mzi_~Z$~______-- (MONTH) IYEARI 504 BRANDT AVE NEW CUMBERLAND PA 17070 415ti OR PROVIDENCE M DANISH wJ61IB1utoe..NT•6 4 V DATING STAMP t'IL s'`~A • d imp, N Tx~..o~e,,,ssx.orvxe.x.~Txm w.~..xT..xxe.~. ~.e.xw.x ~(4 9 778 948 EE Mims EE eEr. xx wwaxixcrox Jrmaq r/14 7 q, ',Ot ➢9➢9➢yevvmvv 9➢919➢9➢9➢i➢9➢9➢9➢A➢4➢9➢9➢9@?➢Ol. eeenaeeoaeaeadaeeca~enaeeaamenanweeeeeea~ aeee eeeeenenanaesaaeevae 3"1~. r I~~l+l~-'mil AT THE MATURITY HEREOF WILL PAY ISSUE DATE ~iall~J WHICH IS THE FIRST DAY OF r - 205-03-0914 MR ANDREW DANISH PEN MAb6iN i-1`~~'-?_-(YEAR)-- °i 504 BRANDT AVE NEW CUMBERLAND PA 17070 ~r15C? . OR PROVIDENCE M DANISH Ui36I16etFiGENT6 ~DATIRG'STAMP R IMAM » ,ss .x.xO E NToo ACCT.E Ea ENDED, --779114 EE 4, 9 SERIES EE eE.. »x. 'MR 'TON ^rE~~ MrAr 7ri4.p 'CL lan4nae a~veaw evaaayevevnananaLnsanin7ny v°" eveaevoaa➢iv 0._a _4v!v.a AB➢aYa76~aa .01, - - - l+ ,9 t> l~ 1 0 N d :1 1_ d 0 1 1 1 p } AT THE MATURITY HEREOF WILL PAV ISSUE DATE ~ WHICH IS THE FIRST DAY OF 205-03--0914 TOMR ANDREW DANISH PEN hfilk 19 5 _ ~ (MONTH) _ IYEARI 504 bRANUT AVE N((E~iEEW}} CU~~Mt •bERL.~AND PA 17070 ~{41'5 U{ wim ' OR Dy {~F R l+L.. 1 ✓ A N I S H 1 I.~V IJ ~ IBBWIilQ•AOENT•6 \\\I 311 /1 1 DATING 6TAMP J K49783780 EE SEAI.S EE °E.. ~»°„w.,E°rxx.»E. E4~!(7• ° ~ ITREIN .wwlxcmxf M'M, ,42 nan aca0o9aA0?a9icOfaPiWa - _ exsv aa_ evla_anIlnoeoeoeo! evsyev_v ,Di ~ enaeenaemsanaosaaeenaPeew _ AT THE MATURITY HEREOF WILL PAV ~ ISSUE DATE ' ,G 1e>• \i wY`~-~J WHICH IS THE FIRST DAY OF _ `'f = 205-03-0914 IYEARI-- 3 TO MR ANDREW DANISH fyE N M~~ON~ xb 504 BRANDT AVE. NEW CUMBERLAND PA 170 fit) 4, 5~< OR PROVIDENCE M DANISH t3C~tti 16Flx;AGENT$ Y ~iy n'., f d 3 /1 ~ 4ATUSTAMP RUMAN ° K49 7$3 859 EE x°r°»Irxxx»E.E .efs`EIAe~? SEAlES EE e.x..%x,or*x ,4I. xr oeao0.aaa9aVa4e8a9aaaaaaafla:aaa9f9a9aa ve evB4aCa➢a➢s0.la10a9Y9aaa9lvA4®a®~4®9a➢IDYa➢aFa9laa~9 veva0evev®a±a®v~9a7°-e-,02 na~n®oax®aa~aaaaa®envae~awia~aseaavacaas~sav~aacaceaaneeaoainrv_aasavevev®o.o®a .®vayrocvac+e~+•a "TWO aeeeaaann®e®eec ~ Zil J ''7f F m", ~rz6 a~^1ii u AT THE MATURITY HEREOF WILL PAY ISSUE DATE _ _ yl•~ B i - WHICH IS THE FIRST DAY OF _ Z05-03-0914 TOMB ANDREW DANISH BL i4 tt~t x`~~5__ (MONTHI (YEAR) 504 &RANOT AVE NEW CUMBERLAND PA 1 GTC= 4 L ' OR Pr~UVIUEN -E M UANISN bb 'l I{SYt FV~AOENT6 / DATING -AMP ~S f-1bto ~`r"i+• UMAN \ .x .Ox»rx...°ex.xEe.. K 5130 0 011 EE SERIES EE Da>.x THETF°r Ta.x. r 5, I T ue»r or THE r wws»mcrO Oj TRE- alanBa4l4Sn09flaan9.®B99nAfQn411a~AfnAa9n4®4Q89n8n4n4n4n4n4n4nanHn4a9.n4nvo4aPnfln4nfl4o v0.?®y®Vaa~Qn8n9nEfln f. Qj. y awvevsananafan4nanaaYn4 a eveya o °mvaa®vea•vovow~g mo®~~ eva .vg?nswnAnamn¢ovna a~~~y~,ri....SaA.,, t~l...an .~...s __°__--..f...-.--_- ."C`^-"''__".u,.•~ w+'E i"51/x„„ ~ y„}i1a*S++E4„+"s., ~1 I ~ .+a0b9a1a4^a9a®a1a1a®dea3aea~a Et~08ea,ae~o6aeaeb3a®a®aP86atnbea®dIb3a~,oaRxeea®e®eae®ea ,~'i~ v •..:aw r; ~~>-~~ISr~~ b>saeaed®na2paodm~ar4a®aad®a®aeeedea~a®a®bIC ° m ~ f e d44s~- ti>, ''AT THE MATURITY HEREOF WILL PAY ~ II 45# ~ Af ale y wHCSSIS THE UEFDA DE OF II, T"MRANURt.W sAi` IH 1-° ► t° c T.S'r5 n~\ J 504 bR NUT A Va... (MONTNI (VEARI_ NLW ll.{~)'I~t~'st(K 't #,A((eSiis 'h{ qt Vii( iyf ~ } L U "ge.3 i K j [S.L/iVL.Y$4 L- 11 {.!/'S ~'~.1 +.?.i e (,~~y/Ie I~/FVArv~-AGENT6 1 III DATING 6TAMP .~{'S'if r UM AN _ Txl9eorv~isie5uepxnq[x.~TxP 11111TI THE THE-R•xlnPep K51 220094 E E SERIES EE .npl,Arvae rTrv,x1T E00, THE BA" f O1rnx.MEITOI Ie rnAASOxr pt w. Irv ox SnnlaA S/IA~7 q F@44YpIl3pf4lp®4m9®9wp$~ppy4pIlp~i®4ov¢9a91PO9pIlq o0¢VflPmp6lpmo®pmgpOm P9POamo•ooowomo p CPpp@gfl40plO8floII4®0=~__@gpppq~ p_o o ~gypppoo¢pmgmvepogovwopg o®ogo I9 pt Bfl4®H®9~ f. s sa 11 d , 's: 116 Odd :1 1 ►YYI N : _ ' 0 0 `1 D 1,1 E EIP s}3~ I ^~m.. aoaogaeewmeea®m+aaibeeeslmeaaala0ae Ah~^~'M~w~~4~~' ~ , r` '`L•,•f..l:;y41•,#I. xs ~I, Iti/jD+1,{~y AT THE MATURITY HEREOF WILL PAY ISSUE DATE _a~'~1'~1!''~.~'~~°. v WHICH IS THE FIRST DAY OF Z05-03 TO M-K~ ANURLW UAWSH PLN APR iS185 b ANUT AV (MONTH) NEAR) f 50l• V ~P ~.7 e ♦ iii! Y UK PKU !ULNLL 14 LJ/'{N!1 >f i IIBBIhK1SA%ENTB :\x DATIyN iG, STAMP 1 {id iJ t F /'t b " i RU "A' rxis eoxo is issOeo Orvoce xO, elxrr eorvo nc,. ns.xenoco. SERIES EE ,xP.=~e,e..grxEr9 Pxxrxle.ex1x1o1 K47428066 E E .xerv,pe.xe.xe.A ~ A... x &.rt1aA e/IAe7 rA ' D9,. wns wcron glopp0pp8pp@gv8yi8mga9pq®oevggnpw°mgpp@g~wp4e4oogepggpgpgpP•4ep®pm9wa moePwa•opom4po@g@p14@VL49popps4®P98C4p4nB@4s2@4e4pPl¢pPePpePIl@4n41 O?L9p4@4@9pPp?@?P9@.4pP@4®Pp9pP®pl4pppym9®y0994ooeplPm4pomom~3ppopm919•o•gyp®9@p~gyp®Vla9 t ~1 ,i kv ~~y IR~y O 0 Id d ! D __~a = "-i~0 1. 0 D _a: `¢4 V5t119 ?1' I a ~ ~,2'~ a~a9a1a9a1ama1aaa2a9aoambmaaaea®a9a1t9a~a9a9omb9o~nema9aeaea~drleaaoebeaeaee®a®suede'aa®aea®ea~ntna®aoeloe~~¢po>ma~aeeea®e®m+rome®ameeaeaaa®,v eaa ~3 ~.~~~f 1 A r -fTtif' a`w m , r1n AT THE MATURITY HEREOF WILL PAY ' t ;roes 1~ ? 1 j Mi~ ISSUE DATE WHICH IS THE FIRST DAY OF 205-03-0914 To MK, ANUKEW UANISH et N AeK 5Fci•. y._RAq NUT AV IMONTHI _ IYEARI-- NLW LUMbizkLAi1 U B7k 1 7U It,4 4~~-5 Uk eRUV ILUCN`x: A I i 1 U yy j` M NH 01661Mtl1'l'A~ENT6 4Q 17/ DATING -1 oc l ~F2~ti ` A • PUMA a SERIES EE Pe..x .nxl,=Ve,l.xxx..E.ERM; i~ ,E.xESo. P K47 Q 067 EE rxwwiNv+c*OnxE M a/ IA. 7 .p O1. •pJ 4tiop8p94k4049opPp4VPfl4[44PPV_flp.@4fl2@8PL4@4@4@4p4@40omgmvo4®p®g®4•oeo®ao®o@Q@9@8fl8@8@p@ppg®Pooooao@owvsopolo@g@H@VflV®4®Pmowo•9slg@q@4@p@4089P@A@HpP@9@~@9p4@91904@4eopy®Pmomom4®p®4pP®4®4mgp9@ggpploflq@g@gv@g@glomoq ov@gp4~@o~y8p9@P~gp. r'~~~'~^iI~~u~z;; 1 '~A;~ar ' ~I 1 • I ~ ~ ~ ~ ~rrw ~ tea., ,E~~ ~s._. AT THE MATURITY HEREOF WILL PAV fA yyryry r, ISSUE DATE WHICH IS THE FIRST DAY OF 2.0~-G3-G~~14 To MK ANUKL eq UAw A )H NLN AVK 3~8--------- (YEAR) (MONTH) 1' - 504 BRANDT AVE N~L[W~ LUMBi~kLANL) VA17U`l{U 9 4,,1. Uk10 , rROVIUENCE M DA N1 ~4} 1 LA 1,• 1'' P}..l16~JI)I~~.GENT'6 rl~ ~ TTT DATING STAMP UMAN SERIES EE x AN_EUe,.TTOTx1TE o :E ONTHE-TD All"IED K47 4.28 190 EE DEIAITIFITOI TIE TREASURY w,ssxixcT0, .4fa~tlaJ ./IM 7 .A X02. ~q@90004popPOP®P®omo0Q1g0g@p&80p@g0aq_p4fl9®q®~9 1Q(Q➢9yQYQygjP;P p o0-1 ~Lp®4®GS4[Pi4i919@A041flC40A1B1Py419L91999.4YPID9Il41q~46-41404flPd~9p9.9o91P1a~41Il141P~10yg1B1Cm9mP®P®P®P®pmpp9m®Q1, i' Ii ~rj ~ Pa@a@a~aea@aflwaeaea@wa~ °ese°®ae - ~ ,,~JT~_ F 1~ ,x,~` ~ ae~a@asehasatiAnhwes~a@amaofemee~aas ~~~L~~1 II ~I 'q r AT THE MATURITY HEREOF WILL PAY ISSUE DATE WHICK4S THE FIRST DAY OF 205-03-0914 PEN JUL TO MR ANDREW DANISH -(MONTHI----_`(YEARI i 504 BRANDT AVE 4 yu( NEW CUMBERLAND PA 17070 L/DWv' 16~OK MGENTG ``r'I 4 OR PROVIDENCE M DANISH 7Xil/E5 J I OwTING STAMP HbG w f M • E E RUM I fll=..~n.En. rno .ounr~.. nr. ns•M nEn.or. K51455757 wic*ro rnn rn. ♦no~nErsunv M e/rAr S.QAr•rl ,pt SERIES EE ..rn E pt /tomm5ga :a AT THE MATURITY HEREOF WILL PAY ISSUE DATE ~r•w~~ WHICH IS THE FIRST DAY OF 205-03-0914 TO MR ANDREW DANISH PEN JUkba8-- -I YEARI - 504 BRANDT AVE NEW CUMBERLAND PA 17070 4150 OR PROVIDENCE M DANISH 13~3fGENTS\``t' ri► 26 ' DATING I~pN, STAMP t-tb~ v` ~F OMAN SERIES EE ..r.rrnnur'"~ _ °uE` .."`r ::EE° K 514 5 5 8 5 9 E E n Serrrrr~./rhr7 7 pt. 4@9 `vvvma~vgQ@a@Q@P@494@Q@QL'PIl9@Q@9@P~@?@Q@9@P@44➢m➢ ➢ @GBP@9@R Leo ➢AA@Bm4l➢➢IDflm9@91Q@0.avmcra"vwm➢mae a~vmgl9@g@ymyq®_v_@Q@Q@Q@v®q@~geveymomyq-@QmoaQ@Q@%@gmglQmgmVy%@om➢®➢oy®v®veq@pmg@p@Q@p@gm9mQm%mgO9m_vmvABHP1P@Pmfl@%mv®vmomaflymwy® gip? wI~mrla.:, wLU~uG~? < 0 ~0 U M : ! 0 1T~ _ - - ° 0 = -0 `0 D A ,~k al~gailr a{ qu °ti ar':fi %MUM r. ~ ~ s E~e@see~oacsaeo®a@aaeeoem9aea~aee~saaameeaPaearacaro~a~a~a~rae ` a e eaaoa~a~ama~eeA '~3 ~ _ AT THE MATURITY HEREOF WILL PAY ti nna- { ~a ISSUE DATE :~iV WHICH IS THE FIRST DAY OF 205-03-0914 MR A UREW UANISH P tai otky__ 4t (MONTHI (YEARI l 504 bKANUT AVE.. f NEW LuMGEgRLAf/ i., ~N/ l; 1.1 f~ iu p4' f.vC 63 IN U€' PKUFi.DLN1.E Iii ANI J>H I..t ifU ! `U ~'3'°iPENT•6 r1 I DATING 6TAMP "~41 R U M AN "S 11N' SERIES EE •no.,uv._.T-E,.n fl.r. 7E E oEn E.. K 4 T 4 2 8 5 3 3 EE nrM[ s.mr.ry./ rAr rf ^p} Q49mgflv v e4 9®vmgmP@Q@QmAigl9mq@9lPmIl ve voy®a a ®o Q@Q@Qmgmgso n'narorl a@4maaosama ev@Q@o. vagf4@QmV@QmQ@A@q@q®gm8m9mYlAmgave_9@gmGf%lq®V!fl@4m8mCmP4APmQm9lamo J h1 1 r.,.. 1 {l1 ! E 53 Y _ 0 D 1/ M :1 1 1N : • 0 ~I D D _ -ty udri ° 1 5 {1~~v 6.~~ ~ -c "asaaaea®a®a~aeaoau~aea®wavaeaea@aeaevnn~ a "wwa~aeaaomw 2 +Q Vas `.d`~~h t • Yh,t s4 °S AT THE MATURITY HEREOF WILL PAY rte- - 2 0M%. Bs~ ~l t~T►19~~ WHICSSUHEFDATDE OF 2U-U3-{l'14 To MR AtIUREW tJk iT:,t1 FLN MAY 1*,48 la~ ` 5U4 BRANDT AVL (MONTHI IYEARI = NEW LUMbLRLANU VA 17U7U 415U OR PROVIDENCE. M DANISH UD C 15 4GENT3 J 5/ IU/85 I DATING STAMP Huj IPUMAN SEhlEs no:. E aF~ K47 428 496 EE RAu EE DEr.,M.nr01TIE.n..,U..-E.l 0'- .,s".anon sr..rr.~arAr r.,L•o p t,: P@➢@o®v"0344@q¢%flq@q@Q@9A9ID3@?f9n4®4@v@Po!o%ov@pgvo¢~o.®amv®voa®ven4a®ma®gmam,Q@gm4@P@408®Il@Am%mfl9A@P v®vwvev v@vm°°°m°®veo~onal@R@P@Q@c@%@A@Q@Q@%@q!q@4@~v@.Q@v@q@a,@a~IltQ@~@o@8@9@%@E@?@%c~?@aHV@4@P@4@~➢p_➢@%@o@gmv@4@%iv®v®v®vm➢@4.mIl@@?@. ~O?, j e044\P'`rtb •.;.,r,\a01 ° " - 0 0 Fe r0 D Ifs' d~N 0 . i 0 )a 0 D=a * f i y Jr s - "1' s 1 ~ ~ ~b©0-0b60a°®06~6ja0p{tDbOL©A~ ©b~lrmoOGDO© moOn~bR'DUa'*n16oh7 d boo©o~^o©G6a0o6iRkShcEv~E~6Ztl 60bG6®6Sf60A$b®bmb$b~bua$666AQmAm89LALPAG6bd®bl9BlS&ADOHTbIIiFbi II @llF ~ ~ _-,°~'~'>r• a ~ AT THE MATURITY HEREOF WILL PAY E 11~f{•µ {'`~`14~' ISSUE DATE _ WHICH IS THE FIRST DAY OF T° 245-03-0914 k MR ANDREW DANISH PIN MAOVj9b-5 I 504 bRANUT AVE NEW LUMB ERLANU PA 17070 415ft k GENTS OR PROVIDENCE M DANISH UC+Fs766~;~. 999 YR~ ~ rx o. - SERIES EE Woi55V1Ue .111Iere oox.xe,. Ea. o, K47 428 675 EE rmexr ov rx GTO e mews Srrelary et rFe7 0 D} Py05dPQ4lD!?1963fl.04@4!~➢Opgl:.QQl4@ve3➢0_/OgQ®P®POPmOnonymy®4nomPOOY®P@ppplg@4091.4@9@P!ffiP@0,/9ggpq@P@P!D@Ql4HD~l9@4 vq;o_@glP.4v$?!4!0@Oq~vl2$P440P10$P 9!_ _ _@9@4$4@9@9 a al9$P1P~laP@?141.@PIDD.@P-@918C&4!a@a@P!?➢P@ffia~PlE6E@9!?!P!P!9@@?!"® ~!i ,19 011 !rs 0 0 M !1 i l D ~1 ` 0 1 D _h= 9 k ~w .{11 i - roba966a986amn6 686D9A9666.969tl.... AT THE MATURITY HEREOF WILL PAY - t~yf~ ISSUE DATE r ~ ~1~N~.~ WHICH IS THE FIRST DAY OF 2Q5-03-0914 TO MR ANUREW UANIZ'rH PN MAY__l 85 MO ( NTH I I -R) 504 b ANUT AVM NEW LUMBERLANu PA 17u iU,r 4,150 OR PROVIDENLE M UAN3 -I~t uui i6~U~p1.GENT'6 `li 3 O/ IV ~ TAMP f`{ J - i !~v i I4 f „a; aumAr SERIES EE x .xal„x~e rrarxer oaxrxE.W~axe-I aeor, D. K51 24.3 378 EE nerW a. wwsx~xcrox &mu7 .J Mr 9' 9 DOt 02 0.141g!➢mDYP@a@ylyfClyBpgp(pi„Plppglq® ®y oa 9 y P oe ao@q@q!Q!Q!Q!pl9lPno@y®y!vlOIWDOOnynanP®PnP r g0` i{ ' 04~ ~0 - 0 0 d M :1 0 R ' 0 0 `0 D " NYC\d i110t \ r : ~ 1 ~ a eessadeoelaoeca~eao~aeaeo~eee®onma®weeo®maaav~ r•b+aaa®a*ls~ae~ar.'eleeaes~eesae®_ ~3 r1. :r E`;;eG~'f3~} ~cxLl~IJ O',0thv„E;w f €.~i',';) `~4`^ :xy _ AT THE MATURITY HEREOF WILL PAY VOL- OP ~ D ~ - ISSUE DATE WHICH IS THE FIRST DAY OF 2.05-Oj-0'14 To Mk ANURLW UANISti PL.tt s(ttdvi_ (MONTH) NEAR) 504 bkANUT AVL 1. NLW LUMBERLANU PA 1.7G7U 4, 1 ~G OR PRU 1V4. N LE M UA( ISH V V~'.I I6VfGENT'G `i tui! 7r b!) D{A~.Ti IffNG 6TAMP `T RUMAN SERIES EE De..a ANHVpYxer. .EEE° K47 421-8 34.2 EE rxexr Oe 1.1 T.IM R,-- WMHlxnroH &..rWxl d IA 7 0 ! ~o$o@p!v$a!o@q!Y@q1.0.@Pl9lvA40v@4!v!g@Q$e@v@glpnow®veoe ooa® Ot: anD!@p!p!q@9!➢@4!7@4!?!4$494@9@P!4@4!9!4!V!4@gpglo@p 0.!p®flf4l4BQlIllQ@vfv~ci@4!R!Il!D!C!9@4!?!9!?04lopp~glplQlpOglylgm9q®~419191P141~4/D@9@o®P➢ElYQ4@9~@v11114IIC1. Tf h ! $t tl C 0 0 Id 1. t'1 0 1g' IAN t ~ _ 0 _ D ~ 0 `0 D x 7 01 8 ~.In . ~ F~ ;1 5, 3 y ,P7~•; ,s- 'a~4'N v11.•-%u6../{{[tf3if~✓ry3 ~R~~'I ~~IPI `r~'~''~g^+r, 3>Ilb®E68wb® yd~8086dPrElb®6l6l6Abmb®8!6986 bPS9AlWOID86LE f ~ ~ ~ AT THE MATURITY HEREOF WILL PAY ' - n-M A -11 D O OIA WHICH FDA DAEY OF 205-03-0914 TO MR ANDREW UANISH PiN JUN 1985 „ (MONTHI (YEARI_- •(tOa_$"\ 504 csRANC►T AVt NEW CUMBERLAND PA 17070 4k' EU OR PROVIDENCE M UANISH u u u I.LQ,,.A_NT'. 14/65 GATING STAMP rib V . PA f 11 MAN SERIES EE x Wxa,=.~~r.o.He.° oao~~.s.xEwEO.xoFn. K 47 42/1 8 9 14 E E DEIARTIEll 01 TIE °uav __DT" ~aeW S r.~~,Ilr r, 'p! O! P!9$4!elBlq~P@91Q1p10$g@4®y@P$q!q@g®D® rey@ P Pny Y PlYIYnOn n®P®y®ore06yo0®0®0 Y4ePn014i4®PM®nWOnonD9P®POCeUnOnynvoglplg90e0w➢0Y90lylglq@919Q4lylglq@91?94@419~flfl~0ClBag.9l4@4@Pl4Il91414!?9019!_llgl;yp9412@QQ4@9@RID,IIl@@4! „1 ,r . I1 i 1 y_ 0 0 1/ E! : A D ►f ~1 : _i 0 _ --0 0 D _ 1 a Si I!~ I '"A A!B!E!A!h!A!A!o DlnlSFAICIDFO~lG00la2b~Al~dlbIItl/5D6®E D ~y~.~~ . AT THE MATURITY HEREOF WILL PAY ~~~~~~~~~;r~/~~!,@y ~~p/~■~,~y'~■ e}~,~1g. {yp ISSUE DA T E _ ~1~Y • WHICH IS THE FIRST DAY OF 205-03--U914 To MR ANDREW DANISH FLN JAM- _1S_45 ~ 1e " (MONTH I _ _ _ - (YEAR l t _ 504 bRANUT AVE - NEW CUMBERLANf PA 17[0`7,0 4i5u s OR PROVIDENCE M DANISH DDS+16Y{4 ~iENT'6 `TIII .1 r 14V~.♦A LV ~'1 -INGG E-MP Nbt~: ~,t'A. J UMAN TA 'A ;``5°MENDE 1 K 5-1243 584 EE SERFS EE Axe", „E Sup.xET yam' wr.sxixmox &rnEq e/Mr7 ep P@QHQl9Y9➢4 e P Pe eP ev y fASAiA AT THE MATURITY H~E~REOF WILL PAY SSUE FDA DE WHICH OF 205-03-0914 To MR ANDREW DANISH PEty r. 504 bRANDT AVE. MONTH (YEAR) NEW CUMBERLAND PA 17070 4151 OR PROVIDENCE M DAMS ODE if166~`:~.ENT6 `II DATING 6TAMP UMAN SERI is EE x Axe.=xr,E~.VpYxE. T~ ESo K51 ~ 585 EE Ct wASxix... &rrr-.flhr7 4 DI =0 g =414 m -M. ull-c -E - - -"-4 3 EEdlb® dBEIRF+OIE®6 ~ ~fi,~~~ - ~ ~ IS III. F 0. N AT THE MATURITY HEREOF WILL, I ISSUE DATE _ f@ghl~ WHICH IS THE FIRST DAY OF 205-03-0914 To MR ANDREW DANISH t' N JUL__1-985 (MONTH) -RI rt, F 504 bRANDT AVE. ~i`150 NEW CUMBERLAND PA 17070 s OR PROVIDENCE M DANISH ~UItiT16~g~AENT6 ``III 'I1/5 J DATING STAMP RDNII N_ .x A-11..-TxTxE, ,..r. =%OEDI~x,Al x. K 51 ? 4 8 767 EE SERIES EE eEPA 5,.. nTwwwsoir~moH sx.Y &neErrt r/rAr 7 r,1 ~QQQgQ(ve°~gpQQQ~Qp9 Y P®P 9 2POPYPe9y_Il®P PaAU-_ PS a_, y _~__esswPgv~ P COD_._ 4®P uePlq(Q~,QpQlgl9yQ®Qty@$AOy®p®Q~164S9IIIl00wP!alOmP®P®4 46Qi9flAYP0P®PmP®40P~Py9@pigeQ®P0o!?pP®P ' d!A!6!E!O!A! P>A~lA! eAeaAAm § 11' ff '~✓I AT THE MATURITY HEREOF WILL PAY ISSUE DATE j!jl?jIl WHICH IS THE FIRST DAY OF 205-03-091 To MR ANDREW DANISH PtN JUL 1585 - (MONTHI _ IYEARI 504 BRANDT AVE NEW CUMBERLAND PA 170701 41~U ' OR PROVIDENCE M DANISH ODb~ IB~D~,aENT6 7~,19/€35 DATING -AMP ' H b U PA A. RUMS-R ix Ac..~s •MEx o. , ,ECT OT,ETC, _A~x-10F.lE K51455758 EE SERIES EE E eErAniHExTCFTIETxE 5- w.Pxxc, x A ~1~T~•~ Dt. ipt avevooe 0. yeveyef~v~vi94A®Q®Q08®Ai4~4i4®9YQYV v®vay®P!0_a•QlvH4&flQ4@Q®flA98fl4®AlvlgiffiQ➢EB.v9P®4iQY4®P@Qfll4®- Q@glDaevmaG4®v®P~nvooOPOOepgvwo_~Pq-{LP ~w 1l~. y„1 a:~"4rt?F e A 1/ k tai l !d : ~ ~ i yA ~ ~D_ `A D d'-~~ pv+l ~11~ ~+i~lrs•~ ~'i%. T ~ `~f o d!d!b!b!tl66 A6~80~b bID61060b9E®~696®EII6925®OS50 ^~1~f~.f' 0lbD3lbD80'Q®bTg66ET6®dfl6~®bEb A969 ~~~~~N~r AT~THE` MATURITY HEREOF WILL PAY ISSUE DATE WHICH IS THE FIRST DAY OF 205-03-0914 TO MR ANDREW DANISH PAN AUu 6_, 85 a 504 BRANDT AEI E. (HON (YEARI " NEW CUMBERLAND PA 17070 4,15U OR PROVIDENCE M DANISH bu/o/l i$I,II6C.AGENT'9 ` `/65STAMP DATING - NfrG• ~~?A~ RUM A ° SERIES EE xx° TER TA DDxrxE^A°.xE.E.1. K51455979 EE DEPARTMENT xnixc*oxnensUx. Senerq e/rhe 7 ry gpp~0 p@OflplplPO¢•P@P1p09@9. 4 p•¢w¢mpmpwP oopm•~qOglP•P•4•PAyOQ®4g:yg0alq$$lpeP pbpl¢fl,PAq D-4_.®9 p ➢9> P 0lA 9 0•ol¢0Il P P•pOPm¢lp®pl¢l4lOlp•omp•pmp®9~Og¢lplplO~alQOglPlp Pw •P•p0¢• P apt 1 1D Fs"a3 rp +l~ I ~f1 - e eudiil VC. 01 1 AT THE MATURITY HEREOF WILL PAY ` ISSUE DATE WHICH IS THE FIRST DAY OF 205-03-0914 lr-0 To MR ANDREW DANISH PEN AUL;__1.9-$.5 504 BRANDT AVE (MONTH I------ (YEAR) A NEW CUMBERLAND PA 17070 415E III OR PRUVIUENCE M DANISH uUq'j 1 (yp.AGENT'6 Et 5/65 J DATING GTAMP Ht~V~ ~.I'N• 111111 1111 UNDER AITNI -"Ty D RUMAN T" .xD is_ 'TD rxCr TA11111TI-ACR-1.1 ° K 4 C j fir . E E SE~~IES EE 4x=xm 6 - lJ . 'AA'_TDx &.,"./rh.1 -r •~02 Ot. lRmaRlQa9lRS^p~s ^C~•u.4l~vlR~l •4•¢a ¢•aampaaq a I m I`Ya l l @ A b EI : E D ►i ~d l1 i s_-~ .A ^ _.D `A~x 1tid y !Jv~llq s A~~V~'•-l~~~~~-"~"Yrj`, ~ P~nID6Hd®ba',-o'TdA6Pb-b®H®d®6®d~6ID0A6tlD15C9EmoAa9dF:EmA®bA'b'~e69~4b*b~P2AU®bIlEd'~6.59bF6A8®•dPb®6m'b'StlFb~ibRZ~AbDd®tlm6®b1556®b~d'fld!bd~6DA0 ,r . 3+st,NM w F o- p..r+(3 . r kd( / I p I>r AT THE MATURITY HEREOF WILL PAY 5 ~h s ;tea ( i~11t~ ISSUE DATE WHICH IS THE FIRST DAY OF ` To LCi d' -0914 Mk ANDREW l1ANi5t1 1'IL iii _ (YEAR) 504 L ANUT kVL NLW LU~~M'}dLRLANu (P~x~17pC{`! u' ~erT UR PROVIULN(AL Il0 UA1T{SH ViJ d' •16> IfJ6'GENTS - ~ ~ ~ ~ TS/[TINC3'~TAMP m a~ 111111 -0-0 A T AND=._TT., PI DDxrx.PADxxI^TDF 4 71;.2 4 271 EE SERIES EE f E,,.~5m,2 DEIAPTmw.sx~TIE TPI.Uav - Swrary o/IhrT ry Ot DI 444@4@4@4flam b4lvl4.4lP14148.@Il@P94l4lol4Q 4 0414x4®4@R3fl914fl414fl4lHpIlpflPIl4fl4@4l ~a14@4lflaR04®elof4p40v1¢®4fl4fl4/4lo@g0aflg1404!¢0olo/P041004T4041q@.@P@ofPl99P0914®4@P.OPS4@?fl4fl40oW99P941q@:.@Bfl4'i4@q9?@4@oCP990~9@~Ql99lolvlglalP@~IQP,Yfl@fl@. sfl'rrl l' f I\ u} e A Id M C A 0-dl : 0 .~~:r s~ aer~albe~a®dea~maea *~bes®sl*e*amdmd _ _ 0 _ E D E. :~..~III~ -,^a a~llita.~ a. c ( .aaa*,ee'elcnAdoagd.a• omac, ~ b~dabea~ae i t aL w_..,.u "s' . 4.4 AT THE MATURITY HEREOF WILL PAY9I ( 1~ w. I,rS$'•{li j\ = A P.•~ ~J~1 I m d`s ISSUE DATE 205-03-0914 WHICH IS THE FIRST DAY OF TOMR ANDREW DANISH PEN (MONTHI IYEARI 1t~_-E1 504 BRANDT AVE NEW CUMBERLAND PA 17070 - 41!> U . OR PROVIDENLE M DANISH DU t y;~.AGENT6\``` 1 823 Fi5 ~ I~TING STAMP [y f 1~} V ~ ~ Y A RUMAN ^Dx r. SERIES EE " T°.""`" K47 424 358 EE DEPARTMENT 01 TIE 1.EARU.1 pt xswx rox &rnr~ry e/lhT7 ry R00g0@gfl4@4!f@9®4!_OlVlgl4l9lP@4lqER^10099I~n@H@¢fl~➢340fl1C0vYglq@7fllRlAl ¢lPwp•a•ono•¢mplQlo@qlq@pl.¢lgm4.o•POV•r•vwv@gmglq~glq~g~ p~~lgl9 p o ,(11: ! m apl9l4lR@vP•P!¢@voflv o Plve2./Rlvl¢lv®Pl¢•P•o.o•oma»m..~.N„~,,..,.,.,..._,.,_ j ,•xl,d~P'stii ,~1l;'~rl l'P . f @ ~D le N ~E D _ br~M 0 D ~@ D ~ ~ xk,>°1o~s,. z}~y ~.JEr yiy d'eTibIIb®dPfbII dFu'96©bFbP9696^DTdT~b36~LFiM E682 dmi b@b~ d•EEb06FiGTiDEbEdEddb6bnb6bEFgID6 D66LrE9bIDB6dRdd' Ed•dlhe3o-ID6TdEBbbO-E-1206Eb3iEb9b®aII6n18©eID~d© bD ~ } s } I,i:~ X1 Ml ti W s ° S,5 M, F l ~ ;;r ,£!v,! P ^;S :f ~~iE at>„ix W. I "S Ix~ AT THE MATURITY HEREOF WILL PAY f: Lys ,'~~,'u`c r ~pY~~=(C ~~19~~ +yC ISSUE DATE WHICH IS THE FIRST DAY OF 205-U3-U914 MR ANDREW DANISH ELI ALP. T~,~~'~_ -IVE4R1 5U4 URANUT AVt J, NEW GUMBERLANL FA. 17U70 WjL!)u ~K VIA. F Ur ll/LiF.LL. 14 L1 F1 .41 •.ill LrfVV eIS Z.r ?v...6 BATINO 6 AMP / RUM, SERIES EE ___E, .T .E TEx K47 424 497 EE T.E x Aw ® wwsxwDTOx &.swq d fhr 7 0 P7 ¢P¢Q¢pjq~y pplfp~_®_0®ypPamm~•n•P¢P•0•P•P•P••PYOmn•P•P•0• nu 9•nq m_•I~PIq®Pm0• ~Y¢90419_ n~4~®n¢P➢Pfln¢n•D•nmP,pt°®p®ypPOO_PYV•n•O(sPOO®Pf0 Q . ~=~ey~ d~1f ~ {e~' 41,,,E ~ _ @ `0 IA M D , ~ , 4r /~Mr ~ . = e ~~0 0 `0 D ~J?~s _ 'fit` "~Pllh I+~l; ~ S41~i4.; R~~~ ~ ~ o emd©bT.fiIDbIDeIDd©~d0'dIIDEIDdIDdIDUIIBIDdID6IIb0obBIDG3F,oF.dIDb@+6ID6E5EdEODdII6®dTTARfdEO~"BIDdObIIabEbr.B®EdbDBOy@HEdIDB06®bEFiIDd®a0b9eIDBIlAD@dIDd®80D®AEd@16®dlrtb®B®d9B0DIDd~g ° - y ~l~ P ~ 1 ~E~iVINd%1 s~~n' s1f~ ` ~ :t°' .f;•. reM'I.;jSkikH xw~...,, t .4 ,.j*~ AT THE MATURITY HEREOF WILL PAV h::p r.+ ,3 • ISSUE DATE WHICH IS THE FIRST DAY OF• 205-03-0914 To MR`S ANDREW { DA(N)ISH PLN SLP 11 85 - 504 BRANDT AVE (MONTH) (YEAR) NEW CUMBERLAND PA 17070 5 A.; CS R PROVIDENCE M DANISH 4 S~LJ_~1GENT6 ` 0 D f,J T, V/, 13/85 ` DATING STAMP f'It3 l7 ! ~ ~ jj A . rRO I His hDN IS ~UeUE`DTU DDT HE LES p SERIES EE °rvp K47 424 724 EE DCPAPTIEIT M. ,HE T.EN°xx pt wwsi1 I, - SAr• ; 0P-RV4'-°44¢A¢49pd4¢p®¢4¢ylgppms¢44➢PHpov_0p¢A¢9•o• •a•n•P 0m =,;_~otiB v c__o~lgtgYy®v_flgCV~v ny n P ~4 lvnevvev~®n®P4pypmve_~pqQ@ydq¢g¢ylyP®409i14(ti6y¢v~vmp¢gavaanommm~•vw¢a®~¢p¢P~v®Qep@vyg ng}TgID4¢vy.voq,~ n~q 1D2 1 ~ t S ffl t ~t~ Jfd~ ~ . _ 0 0 II M :~D 1 1r~ : £ 0 : 1 0 D .at y ~ a. AiS~~• 4h d'v7 ~YS:....Eti 5'~• r' c-~~ x.. _,.~~::m~ - _ u"~ ~ Jf~StJ . I}~ I.iE t1..3~"'i. ~L~ es96EdIDJRdPbECAamb®beseC9aGBASPS5baS9gIDdebSase6ASaaee>~e x DIDbe6~dma'.FS•5Eao6®ae60de6ed 6®~l/-®5 ~ i ~s~ r~~. ,y'~T,:~.~ G1 • 1 / £~-:~/Y'~`~1 FTC-~'":. AT THE MATURITY HEREOF WILL PyAY~y~~ lly1a~1~Am iyA ISSUE DATE - WHICH IS THE FIRST DAY OF To 205-03-0914 MR ANDREW DANISH PEN -s E, NTi _TL &,'I_ MG IYEARI 504 bRANDT AVE E NEW CUMBERLAND PA 1707£ 4,15U OR PROVIDENLE M DANISH, UU1.j pe...TS DATING STAMP rib(, "-F-A-. "4 R I " SERIES EE AND•.D.,E_.TNETEx ~ rE~ EyoF~ ED. ~ K 4 7 4 2 4 7 2 5 E E DEx.nT¢ErvTOET,HE T.E. &rwfof .l fhr 7.°Lvp Ot wNS x ' P@p®_¢q®pflama•o•v~ •P¢y¢ns w•v®vP•o•n•P• •P P.o ,D1. - •v~_;,_® v oy~yApygma® P.uQoma.opetnlgmn•P.P u v~o yno.n®vP•Pmvnvo•vo•v.vvPyg`q®ypppP•aaam°~®p®p®p® MOM w4gffl~ AT THE MATURITY HEREOF WILL PAY IIS THE SSUE FDA DE WHICH OF 205-03-0914 To MR ANDREW 3ANISH PEN JAN I.V85 _ 50T Lr (Bi^ r-E; NDT t VE (MONTH) (YE4R1-- NcWlMEsF tRL~AjNU PA 170I0 5u OR PROVIDENCE M DANISH uu-,I IE (bAGENTS I 1/65 DATING STAMP HtsG .'~.I'lk.. UA N Nh.DN MOMS D,.,MEDrvNDEx.,E DTHD. xo..EoxoN.~„~KHEME01, ED K43 517 840 EE SERIES EE DEIA NTO TI TR ~wa.xE.wE~ 8ermq r/fAr 7 .rID •'~t vmvnann•P•Pnony.o.onPmP.P.o•o.P.P•P•P•P•Pw•P • was _ _ _ f7@C .Ot ht~ Iqa'✓ _ @ D IA E! :E D 4Y ~d M _@ D D D rv,,:rlt. Y S Pllk"s DS60D®6S5®ULD0b90®DDd95WS3mL®dbdbibb'Sb®oBpSibSDSDTLSbRipTIdLADm6STObydb u5*QFd, FDbdM1lS705SpSbd506d6dt9o,~mo~dS563SD®b0~196R,oSdSCSAD1d05PJdE6IIHmDl~iO"PfiSL790bTip©pPdl&dq ~..r' 1 # ri y Ir a - RI ' 2I D ►l 1 A V,~jjj~~I 1 t AT THE MATURITY L P n) I~•1A7F;33:w • ^t w'fl~{j~?'^#xl z _ ISSUE DATE ° •'~+'+~~~`/~l I ~~n. i_ WHICH IS THE FIRST DAY OF Tiilff: A7mUI is JA.1f"y F'Li` ' IMONTHI _ IYEARI d. N L Vi LU Mb I: 1 E o, I( i 7 4,1 U K P K U V I. D C. ! 1 l.. L. E~ H ;l~ 1 w i V lJ ISOM GENT6 `1~ DATING STAMP I LU . J'A UMA .AS SERIES EE x .xG,55Gn,5GTTGTxETE ono. ES. KNEa/!SSEOF K4-7 4 28 2 7 0 EE M1 p l : nirnw'swmGTON SUnv n[PA TT N A e/lAr~riN ®0@PQQ@q@p,@v@,q10@,~v(;m0@Q@P@9ALaH9@4@4®P94®PmP@G------- - glQ@p@q@q@g~0~g@v Pt. .@9@POa9@q@v@QlgpppypgiA@91P@HftBl9@4®~RIPLVmVmymq@q@v~@p@089@4@PC@449@S@~q@$@$oomow mamyO0m09amyivmamamamqpPOLP@OmamOmamamy®QmamamVm4s®y0 r jy a oue►:eD e_ o D eD a Lm A i bane iI g ~y• AT THE MATURITY HEREOF WILL PAY ISSUE DATE WHICH 15 THE FIRST DAY OF To 2U5-03-0914 MR ANDREW DANISH PLN S a "NTH NEAR,-- 504- bRAND7 AVE Y~ NEW CUMBERLAND PA 17010 4151. UDC PROVIDENCE M RANI H bub■""I tweENT•S - ~ATI~Nn6 L~6~AMP [yam Htsb.~_ F'A., . UMAN T"ll 11"111 ANG,55G _TG.MEE'Mn ooN ACCX. AS T REOFxwAG. K0:9 784 206 EE SERIES EE DEIARWE 411 SL wTE~.. 5 ,A &rRlq s/ IAr 7 Ke Nws"NG.Gx -O! - - @q ~ a y d , .Ii ~ ~e ~ •I @ Dud ► _ u _ _ ~ D = D o D - '~i ,ti ' 6lOlIIlBmAldll3>IA,~jLlE6~7~E~~edlSeG6Am&nd®d®b®A4lRd6eeaeAl~AeEld'@ AT THE MATURITY HEREOF WILL PAY ISSUE DATE WHICH IS THE FIRST DAY OF 205-03-0914 TOMB ANDREW DANISH ?L Ii Ei' x~a'85 y\ 504 BRANDT AVE MONTHI vE.RI r NEW CUMBERLAND PA 1770 4I~v.. OR PROVIDENCE M DAN1 oc H bUdT I"Q&AecNTs 7/Et DATING STAMP f"IfJ w~ ~kt w RUMAN SERIES EE GSPA 1„4554„EGTVgYxSTP .EES° K49 78L4 '0139 EE T 'M_GTOrTinEK Srmr~ Pl pr 7 F mQ@7ma@4®q@~m7@II®?ID9~PP@q@9\P@9@90R®Y^ao@q@9 moooe0noo0®®oao®o oao®o y c o ~ NS@q@A9➢@91'➢@e@glglqmgmomo owawglylplplglglglowow ooa@glyylp@glgm0eoq; f~waflq@qa4 ooa®a®aq,®_lppp@g,g®4lylgpv~wowv® owopgplgq 7 L i . Ip ii A of Jl AT THE MATURITY HEREOF WILL PAY ISSUE DATE WHICH IS THE FIRST DAY OF 2(0}5-0{?-0914 PEN OCT 1985 TD MR ANDREW DANISH -IMONTHI YEARI__ t 504 BRANDT AVE ~ l50 yJ( NEW) CUMBERLAND PA 17P70 D,i3B~ [DENTS / t UFl PROVIDENCE j9 l~AN15Fi 6VIN J _ 1C/ 4185 DATING STAMP HE G- PA. RUMAN T" wu[ciiGTIN coyR~ GoNaMxGncT.as.weNGeG, K49 7,84428 EE wxw is d euc G SEAlLs EE GEPAn ws",NGTGN Gn. d~ nTA~~Ay ~,A~ N &amlddr7 of ,OL ' awq wo Deo wa emgmgwD g Ot womcmvma r R 'lr..II~,Y I.'ilY. - _r_ a `B d d it 1 d _ 1 e B _ e E _ o rl. :ice I►al i. . ~~k.•" bmbm6mAlbmAmA2A.bm6®A bmbmbmbmb®0.~A®L®b.n ~ r. AT THE MATURITY HEREOF WILL PAY ► ~/~y ISSUE DATE -Il -i~ WHICH IS THE FIRST DAY OF 205-03-0914 To MR ANDREW DANISH pt 14 UCT 18,b5 504 BRANDT AVE MGNTHfl) YEAR)-- " NEW CUMBERLAND PA17Ci 0 pp ~yy {{Aq4'15CCU OR PROVIDENCE M DANISH LJ LJIU "~66 TN~mtENT6 ``II C~ DATING 6TAMP fib S- vi (`A• RU MAµ n _TOTHETEIR. oo~:~E,.EExEaEOF1oI K4 784 566 EE SERIES EE .[P. xr __To, s l fau ~ ,fit Ot: mVm9®?L~AL )lAL lA6AmPmPm9Lflm4mBLYmbm9mlm➢ A X11 4~ t ~ c ® BNd:~ll _ 3 ~A~aarm.~+rE v AT THE MATURITY HEREOF WILL PAY ~j ~1 1 f - ISSUE DATE WHICH IS THE FIRST DAY OF 205-03-0914 i TO MR ANDREW DANISH 504 BRANDT AVE PEN UC7GM~ygg_ rYE.al-- NEW CUMBERLANU PA 17070 OR PROVIDENCE M DANI")" 4,1 SO ~(j 1 Af U6 B 16t 1"GENT'6 I: U L` 5/ DATING 6T-l RUMI N UNDE, A"T"lle SERIFS EE rx An.l,.U-TI O-T .EE~E o.xo o K49 798 EE 4 ^~8~ P7 oer~ wuxinmon -r FN---.1m, omv87m4mAm4m➢LVmYfIlLO.pmppgLpmpmg®pm➢mCL9L4 o•o_.__~ o LCmGm9mymo om• o P mpmpLVmP .Pq__ ,vt DtEmblBmAmb dmAm619mRTA9Em AT THE MATURITY HEREOF WILL PAY q~ y~ 11 ~t ISSUE DATE WHICH IS THE FIRST DAY OF 205-03-0914 Ta MR ANDREW DANISH PtN OLT hi85 T~ 504 BRANDT AVE (MONTHI (YEaRI-- NEW CUMBERLAND PA 17070 04,150 t~~ 16~y rAGrAGENT6 r`II OR PROVIDENCE M UANISH L3 _ 1CXC5f65 DATING STAMP R U` M I N/PJrP SERIES EE oT.. Ano,=~.I.CTT.,., .E~ 10 EIDED, K111,9 7 8 4. 7 9 9 EE S ~..Imr a IAe 7~r link Gt. Gt m4mPmPL4m.PLAmIlm1L9LPmooom eoLVm9mBmY ➢LPmV a'xcrox P^Pm8m4mP . oxpLpmoeoa ao~pL[mpmq~pmo P.PmomanomPLfLP®oamxP Pmo®9®a a ePxPmpmP"gOLOB9 eo®Pwo®PxnmgLpww•Pm. e oud:iB u B o eB _ a k„ I VIC AT THE MATURITY HEREOF WIL WHICH ISSUE FDATE OF 2 05-03-0914 To MR ANDREW DANISH PEN B►L1i__~3t? K f~- (MONTHI IYEAR) z - 504 BRANOT AVE NEW CUMBERLAND Phi 17070 5 1 IIB OR PRUVIUENLE M DANISH UDI~y~166~ ~ENT6 ` 11 ✓ DATING DATING 6TAMP HbG: PA. .urxox ex.v eoxo ~K.nexFOinoP . -111- D 111 K40 UMAN o 7344 SEA .'ES EE .E.x xT TWFTA -RYxET 89 0 E E w.ml«~TM a ~-,au gam-, of o: a vmcmumvm amamvma -setaea5eleee~Yeasaaezaan~aasaaaavartscaaeaaaee_e!ec*s~ta~nae*a~oaaaeasav*reeaaeaaeaaecoaa~aeecramsaaeasaaamsaaaeaeace~aiaaeaee-',ro~~aa~eeasaa•eaatraasaasrcaaaaas s II 'ye`,I AT THE MATURITY HEREOF WILL PAY ISSUE DATE .m m~~p WHICH IS THE FIRST DAY OF ty► 205-03-0091~4 ltloNTl-IY YeARI_ To Mr. Andrew Danish PEN 504 Brandt Ave. oAGP+pM DEPOSIT _ New Cumberland, Pa. 17070 BASK $ rrzGST C0, 1 ISSUING AGENTS ; OR: Providence M. Danish N (j IAT -k ~J MARKSOumd, m b~ r "T1iFeR "RI E"DE°. EE 801n IS SE 7~ ~q1 M=,a"°, -lE°..°:. a[°r K9183634 ' Y<IEAJ EE ¢ErnaTME"+orrsne TnE.sunr° „-Q o ~i __'10" "E , Sr:r arya/rFr irmrvy 1 ts5f~::°a799E2rvPa4d2a9ap_oo9V¢PmP¢_a:A9sv.®4a3a4®P9A3P9PaaPaP¢Vfl➢S7&c2ff4rT¢a~➢flC9iPCVBPId➢IIPBV®➢®➢09Y9¢PmP9pLt~vIIS^s7aP~kQmP>a41?¢P~S3vy2Ap.9DY~s4a9ffDf:D9PaDH?Fl` agoffyt~¢PGp~fla9fm%i*t.al~Ytv~P¢4IDPaD¢P6-0.®~P@~91~LPc?E?ffp(V.`+~PW`8?5IlffPlplaP3Sa?a r3~ rs sA,.• - aseaaaae a sy~m % III r*-rr sl `i`- I!'~ •AT THE MATURITY HEREOF WILL PAY I 3 WHICH IS THE FIRST DAY OF 205-03-0914 MyR04 B A~~DRREtW~ DANISH PEN UV--1' t~5------- (MONTH) NEAR) z , NEW CUMBERLAND PA 17070 415U OR PROVIDLNCL M DANISH U 03Tes ~N~jAbENrs 11/2ulb5 DATING STAMP Htj(~. Pk. IRUMAN \ o - JOL- SERIES EE K 5 2 3 9 0 0 4 9 EE S mE.,, w.an~n°T°n °ar ~tlir..<~ !•sAr~..f r/O7offA®A@441v14¢4¢994fPa➢ pm v®vag pmve}o•_ompml ® mamosmgmogoaP®a oev pooPq®p p®ye~mye:~®veaeowa®aao®ompaoapeoeveo o ~4mamoapmamoea ~O?,1 'ie~ y'1 ?~~rl,~~~IS~ ~ z ' - `jam _ 0 D b N 1 ~ N : ~ ~ ~ ' 0 ~ 0 D D aura li1 Is ti. A a eaeaeaaaeeas~aaeeaeasa~eeasaaeaeee~ ,A,,, >S t~ Mumma ft It 1 ,,1'`I, Rel/1 ~1 Fr' y~j t"^-'"Tits AT THE MATURITY HEREOF WILL. AY ISSUE DATE WHICH IS THE FIRST DAY OF 205-03-0914 TO MR ANDREW DANISH PEN NCV__1Y$ 04 6RANUT AVE MONTHI VEAR1 5 - > NEW CUMBERLAND PA 1707U 4,150 JJJ~' OR PROVIDENCE M UANIS11 yllr~ 55~ A~ENTG \r`I . DATLNGA STAMP H6G C M . RUMAN SERIES EE •ND15Ve,E.,°TMETE °°MT"E$A_ERE°a. K52 390 048 EE mEr" ar rsROroM Sr.n1..T of rM 7 7 O t,. ~a¢fl¢P.P¢Pl4a9iP¢V04aPmompmpmampmam momq~9¢pmo eoepmomowowe w "i ¢g~gap'p~v.pmpmo~p®p p _ rr 11 I , .,.-~~1A 1, "~ilil •AT THE MATURITY HEREOF WILL PAY ISSUE DATE 1 - WHICH IS THE FIRST DAY OF ~ 20 I4 DEC 5-03-9 PEN 1 85 To MR ANDREW DANISH MONTHi YEARI 504 BRANDT AVE 4150 rc~ NEW CUMBERLAND PA 17070 DD6Tl6~11Y6.GENT6 \,V OR PROVIDENCE DANISH PROVIDENCE M D 12/ 6/85 I DATING STAMP 1 HC3C: PA. I °~."Ea•M E K52 390 288 EE RUMAN Twrs e^ oeus°ii osa r.u.noa oo~ir°ieu so'. TM;RT F THE iRE/suar [ i[ TF 41~ SIA[ o r.0 L °ErAR M,n T°n omp y wgep®piRafllplAa~P~PaRb9CGg~Pa~ SERI, :S EE - _ `~yf9BA.7a4ifl.4.9~114/P.9.Vf70P ,Ot ataly pey . ~ ~ e D U EI S~1 ► V _ _ " i _0 : o `D D ~.f-~~' ~ 4i~ Yl~,.s~ :IVY !i! ~ ~ -T" -5- a2ean>se~ueaea>Baln>geaeeeame>oaeeeseeaaaelaeaoeaae I f AT THE MATURITY HEREOF WILL PAY ISSUE DATE WHICH IS THE FIRST DAY OF 205-03-0914 To MR ANDREW DANISH PEN k7EG19$5_------- (MONT IVEARI c* 504 ERANDT AVE 4,150 NEW CUMBERLAND PA 170370 (f{J W T I3~IC1lG 1iGENTS . r OR PROVIDENCE M DANISH 12;f 6f85 DATING STAMP _ 1 tC.lV ~`.r ~ • 1 RDMAN ,x Eoxo:l1.s:~."ExEOI. ° K 5 2 3 9 0 287 EE EE .x°,s=~NE°..° ..x~x°.ox SERFS 1,r.nTM " suxv 1911o19po1 l9w 9s9 e oe4lgl9¢0_q4®a®ol9®9lY@9p809¢BIPJmP®~llfll9 as9fa,®9®9$4 ¢9^loaala o®9 9®0®Oao®o¢o®Q jD t. 'O!. Qfl9¢Qle®BIDQflS4l0.0.®.~4®P14/419619091o19f3¢8691 ~ - aeamallea~ aaeeeosseeeneaecemae _ ~ - ~ ~ !(6 Its q W, ti' _ AT THE MATURITY HEREOF WILL PAY 6 vim' ISSUE DATE 205-03-OS~14 WHICH IS THE FIRST DAY OF TO MR ANDREW DANISH F'C.N Cr_E.C 19E35 504 BRANDT AVE NEW -IYEARI__ NEW CUMBERLAND PA. 1707U A OR PROVIDENCE M DANISH _ v~~ ~6511WiIA~ENT6 ♦ DATING STAMP 1+ I` _ ~~I NfSG: FA. BUMAN SERIES EE xl saxv.m„°,x... o"o~ a E;. RxraE K52 390 523 EE nsr. wwsxixcrox sunv 3'..nle~.{rb7 Q¢o®gpCppa~Qgylq®p®.4®p¢yyp~l9l➢@4maa9moe9 gl$19n91ve9wul 19 9 ➢lp1P191919¢919®9 p 9 0V L ¢ m9 ,(1! aaelamelasalRPolala/elaleeelaeasa/elaealasalelalmalalameleeenolal ~"~-`,i . AT THE MATURITY HEREOF WILL PAY • rl M`I I~pl~ ISSUE DATE 1 WHICH IS THE FIRST DAY OF 205_03J M TEP T~ MR ANDREW DANISH PEN UEC 1985 504 BRANDT AVE -I o TH1 venril-- NEW LUMBERLANU FAA 17070 44 50 a OR PROVIDENCE M DANISH UUi 6S ~AeENT6 1 f 2. t J/65 DATING STAMP / Hb(~~. PA • J OMAN K52 390 522 EE SERIES EE ~_o ;.o,".. °°mx,x...°xx°x.oF. osrAxrMWxrH.1HTREAS°nv 5. ws i~t &mlel d fh.~..1 .OI Q)940QSOp~g®9ggl0,lp@4d91P14®407091O19m9¢9®IlO°®°e°a0®9o9mo®0 .°eBpQyy 0® e02 9 °@Q$Q@Q®Qe9®Pl°ea oeolG®°¢ylq®9¢9l9®OO9®o@ Q190°18919®9@?®9lq¢7@y@Q(Q190A0$®9lQlQ®Q®QylYipe li.il ~ 116 M .n~? ` li;~r~a~• --I.-~ p DUE! :~i ► - d ~5. z~- 1~7 DI • AT THE MATURITY HEREOF WILL PAY ISSUE D A T E WHICH, IS THE FIRST DAY OF 12 1985 PEN (MONTHI IYEAR 7,,2-05 -03-0914 1+ ^1 Mkt ANDREW DANISH 504 BRANDT AVE 4115 0 NEW CUMBERLAND PA 1770 DDDT iIC•AGENT6 OR Pj~OV IDENCI- P'1 DANISH i2/I,?7JA~5STAMP HBO.`. PA. ,,DERAUT.H.ooAL,1lftTy 90NO , OMAN .xm,E-:ITTO.H., °ON,x°,.°x...E°,. ° K52390611 EE SERIES EE Calculated Value of Your Paper Savings Bond(s) http://www.treasurydirect.govBC/SBCPrice Calculated Value of Your Paper Savings Bond(s) Calculator Results for Redemption Date 05/2012 Total Price Total Value Total Interest YTD Interest $1,987.50 $7,590.87 $5,603.37 $124.86 Bonds: 1-53 of 53 Issue Next Final Issue Interest Interest Value Note Serial # Series Denom Date Accrual Maturity Price Rate K63893031. EE $75:12/1986,06/2012 12/2016 $37.50 $90.09 4.00% $127.59 K63893271 EE $75 12/1986,06/2012 12/2016 $37.50 $90.09 4.00% $127.59: K51469572 EE $75.02/1986 08/2012 02/2016 $37.50 $110.13 4.00% $147.63 K63893520 EE $75,12/1986 06/2012 12/2016 $37.50 $90.09 4.00%, $127.59 k63893272 EE $75 12/1986 06/2012 12/2016 $37.50 $90.09 4.00% $127.59 k63892963 EE $75;12/1986 06/2012 12/2016 $37.50 $90.09 4.00%: $127.59 K63892843 EE $75 11/11986-11/2012 11/2016 $37.50 $92.64 4.00% $130.14 K63892604 EE $75 11/1986 11/2012 11/2016 $37.50 $92.64 4.00%: $130.14 K63892769; EE $75 11/1986 11/2012 11/2016 $37.50 $92.64 4.00% $130.14 K63892605 EE $75 11/1986 11/2012 11/2016 $37.50 $92.64 4.00% $130.14 K63892331 EE $7510/1986 10/2012 10/2016 $37.50. $107.25 4.00% $144.75 K63892403 EE $75 10/1986:10/2012, 10/2016 $37.50 $107.25 4.00% $144.75 K63892181 EE $75:10/1986,10/2012, 10/2016$37.50 $107.25 4.00% $144.75 K63891922 EE $75,10/1986 10/2012 10/2016 $37.50: $107.25 4.00% $144.75' K63891778 EE $75 10/1986 10/2012z 10/2016 $37.50. $107.25 4.00%: $144.75 K63892140 EE $75:09/1986 09/2012 09/2016` $37.50: $107.25 4.00% $144.75 K63891706 EE $75 09/1986 09/2012 09/2016 $37.50 $107.25 4.00%: $144.75 K63891634 EE $75 09/1986 09/2012 09/2016 $37.50 $107.25 4.00%. $144.75 K63891509 EE $75:09/1986 09/2012 09/2016 $37..50 $107.25 4.00% $144.75 K63891180 EE $75 08/1986 08/2012 08/2016 $37.50 $107.254.00%, $144.75 K63891274 EE $75 08/1986 08/2012 08/2016 $37.50. $107.25: 4.00% $144.75 K63891420 EE $75 08/19W08/2012 08/2016 $37.50 $107.25 4.00% $144.75 K63891181 EE $75 08/1986:08/2012 08/2016: $37.50 $107.25. 4.00% $144.75 K63890955 EE $75 08/1986 08/2012 08/2016,$37.50. $107.25 4.00% $144.75 K63890604 EE $75 07/1986:07/2012 07/2016 $37.50 $107.25. 4.00% $144.75 K63890815 EE $75,07/1986 07/2012 07/2016$37.50: $107.25 4.000/o: $144.75 K63890518 EE $75 07/1986 07/2012 07/2016 $37.50 $107.25 4.00% $144.75 K63890729 EE $75:07/1986 07/2012 07/2016 $37.50 $107.25 4.00% $144.75 K63889933 EE $75 06/1986 06/2012 06/2016 $37.50 $107.25 4.00% $144.75 K63890355 EE $75 06/1986 06/2012 06/2016 $37.50 $107.25 4.00% $144.75 K63889932 EE $7506/198606/2012.06/2016 $37.50 $107.25 4.00% $144.75, K63890354 EE $75 06/1986 06/2012:06/2016 $37.50 $107.25 4.00% $144.75 K63889421 EE $75:05/1986 11/2012 05/2016 $37.50 $110.13 4.00%. $147.63: K63889422' EE $751.1015/1986,1. 05/2016; $37.50` $110.13: 4.00% $147.63 K63889644 EE $75 05/1986 11/2012; 05/2016 $37.50. $110.13 4.00% $147.63. K63889643. EE $75' 05/1986 11/2012 05/2016 $37.50 $110.13: 4.00%; $147.63'. K63889788: EE $75 05/1986 11/2012,05/2016, $37.50 $110.13 4.00%: $147.63, K638898501 EE $75 05/1986; 11/201205/2016: $37.50.. $110.13' 4.00% $147.63' K63889222 EE $7504/1986 10/2012 04/2016 $37.50 $110.13 4.00% $147.63 K63889136 EE $75 04/1986 10/2012 04/2016 $37.50 $110.13 4.00% $147.63 1 of 2 2/1/2013 10:39 AM Calculated Value of Your Paper Savings Bond(s) http://www.treasurydirect.gov/BC/SBCPrice K6081552& EE $75' 04/1986 10/2012. 04/2016 $37.50 $110.13` 4.00% $147.63 _ K60815431 EE $75 03/1986 09/2012 03/2016 $37.50 $110.13 4.00% $147.63 K60815190 EE $75 03/1986 09/2012 03/2016 $37.50 $110.13 4.00% $147.63 K608.15301 EE $75 03/1986 09/20112.....0..3/21016 $37.50 $110.13 4.00% $147.63 K60815074 EE $75 03/1986 .09/2012 03/2016 $37.50 $110.13 4.00% $147.63 K60815075 EE $75 03/1986,09/2012 03/2016 $37.50 $110.13 „ 4.00% $147.63; K51469841 EE $71502/1986 08/2012 02/2016 $37.W $110.13 4.00% $147-63K51469840 . EE $75 02/1986.08/2012. 02/2016 $37.50 $110.13 4..00% $147.63 K51469571 EE $75 02/1986 08/2012 02/2016 $37.50 $110A.3 4.00% $147.63. K51469321 EE_ $75 01/1986 07/2012 01/2016 $37.50 $110.13. 4.00% _ ..$147.63 K.5239,08591. EE $75 01/1986 07/201201/2,016- $37.50 $110.13 4.00% $147.63 . K51469212 EE $75 01/1986 07/2012: 01/2016 $37.50 $110.13 4.00% $147.63 K52390773 EE $75 01/1986 07/2012, 01/2016 $37.50 $110.13 4.00% $147.63 Totals for 53 Bonds $1,987.50 $5,603.37 $7,590.87 Notes NI Not Issued NE Not eligible for payment P5 Includes 3 month interest penalty MA Matured and not earning interest 2 of 2 2/1/2013 10:39 AM a ouu:oo ►?aeu:; o oSd®$®d0bS1~d0~0/9~PREldIJ<dda6ltA®d9d06E$®b5906FEDdIDG687$®d@A®L~169- dPSA@8®~d®d66Wd®d®3~A®L®b®6660!®dW9 AT THE MATURITY HEREOF WILL PAY Y ISSUE DATE WHICH IS THE FIRST DAY OF TO 205-03-0914 - ~-~----1.9_E3~--- IMONTHI _ (EAR) 1 MR ANDREW DANISH PEN 514 BRANDT AVE 1 NEW CUMBERLAND PA 17070 : ss~hpF>tITs ~I DR PROVIDENCE M DANISH DDBT CO. ]HB-G-o PA: a , R u m I a 4/` a U.°°n an°,,,°urcrTlraErdR• TE° 0erM1..CnrAE M°, K52 390 773 EE SERIES EE °E..n =°n. p},A I wwnsOixc*orrinr^ s.-(-./,F 7 p pt rptv~l a vlvl lE4__ ~ P eoeo•nav P eaev 3i.....8.,~ e~Fwelstesei+eaeeeetfe~nad>QSe~P~a~aPaaaea®e ~-r~' ^f AT THE MATURITY HEREOF WILL PAY ISSUE DATE A T WHICH IS THE FIRST DAY OF 20 5-0- 3-0914 l 1986 TO MR ANDREW DANISH ~~N -IMONTHI- YEAftI-- 50 4 B RANI T AVE - = NEW CUMBERLAND PA 17~r7(% 4151, OR PROVIDENCE M OANISN 1/17/86; 4 PA.,I E V ieT H Z RUMPN rxIs so•o is iss°ro }N E,T"j Tvo oa rHS e.cn xdneov. o Aa°Idi°~d°.- K51 46 9 212 E E SERIES EE °,P, SLRr .c wAS n.°T°. xQL 4pglg®Plvl94g4p44444W44P.~4944444~P1Y04 4yeylP^mPIO 0_eYgnM;-a fl0 i4®Sl44FmlAAP1P®O~Rylda0e0lPa0®q®9$F®P~ Ploeo®F®90P9V0.9@4~91 a0e0•P~Pm_Q®9gigQV®P PIPS: aPR4l4@9®9]9iC AFLrl - ® ON~:~1 _ V _ _ 0 _ 0 0D _ gal i l~ %M Nam 90M @94AMM& AT THE MATURITY HEREOF WILL PAY ISSUE DATE WHICH IS THE FIRST DAY OF TO 205-03-0914 0-1 1986 (MONTHI IYEARI MR ANDREW RANI SH PEN 504 BRANDT AVE sslT'6 NEW CUMBERLAND PA 17070 DR PROVIDENCE M DANISH TDDTj Il U BT ]~C~/gD(. ' V6/ HOG. PA,; RUMAN rM Al 10 .1 ° K52 390 859 EE LTO SERIES EE nE.. T .n° or ~ rn .wv.°. ~pv°.r n IRA .~E.<E wash HGiOT si""~C l,A" z L. f ',41,. PeP•n P. y4P•eneP~•PePS?!9•?S3P_v.d®9YA®c19m899eIlaPdi9Y4 y y ?~!_l9 P oIVO; P~•P_~_ooy Pe olv°_ pt. ®4o➢B409Y¢e4Q4oolnm_Ploeaav_®v~®n Pw -P y y P P P~ P 7fiV~P ROdd404De64PtdEdP&~~cae~6ntl®amdmd®wse~~y~ AT THE MATURITY HEREOF WILL PAY ISSUE DATE tl WHICH IS THE FIRST DAY OF T° 205-03-0914 _ ADZ 1986 IMONTN 1 _ (YEAR) MR ANDREW DANISH PEN 504 BRANDT ',AVE E T'9 a NEW CUMBERLAND PA 17070 1 16s;U1 A d OR PROVIDENCE M DANISH 11 DDBT 'CO. 'HBG. P¢: pN P~ n °E°..°En.°..° d°o ;~E:. K E.EO°... K51 46 9 571 EE SERIES EE SUTE° a. 'E T 5 nnrnnwrsMxctonns~ 7 7~.419441fl4414P.4 .Oi pp~q•4 a„l7aP49494449494V!"-"-" 9 Plyl➢401q 1yP=P44®49P^PiA49L4fv41®90C1f/9@9@4l_vi4~4LY49QfloPS@@aQ4flP~9S9iP~41484i9Q90f0C@ 579449®H®e171a B@7i9®44C4i®1144A@91P4944144~4496Y y , ' ' 8 D Id W •1 1 , _ : ~ ' _ _ 0 ~I 0 D - T..i~~.~L.'..~*rI. ~y , ~s~~ + tt, st'~ - esemasam mesas . seesasemesxeeseseaaeoaaaeeaeae¢~.aeaeseaeeflaeeQaeaen~eeaaaaao .y~ttsrlltTd'xlv,~ "rY r AT THE MATURITY HEREOF WILL PAY ISSUE DATE _ 1\ WHICH. IS THE FIRST DAY OF IMONTHI (YEARI TO 205-03-0914 _ X31- 19 66--- MR ANDREW DANISH PEN 504 BRANDT AVE 65UOJA'6 NEW CUMBERLAND PA 17070 DDBT CO. ; t 0R PROVIDENCE M DANISH °IT7Y4Af8b,, HBG. RA: , L111 IINI *IT, UMAN T" A"0 EDDnTHEBADBNEBEDE. D. K51 46 9 321 EE SERIES EE DEEAA BY (S°-V wASHINCTON ./IA` ilk ,02. a?t _ _ s a•n•B•a•9Sa~~BP a-~--°=°-°°•°-•vs __u o_a n n v nva - vmv. a~ a 9fl4l4 M - 0 0 d d :•1 1 b : ` 0 = 0 `D D 'Bh+ ;i~I~~ ~~~;3 •"w"~~ ~ asameseee'0sea~eee~a~aea~aeeasaeaoa~aa+eeecseaesaeewam g~ 7 AT THE MATURITY HEREOF WILL PAY ISSUE DATE - - WHICH IS THE FIRST DAY OF = T° "D5-X13-091'r -(MOa t MR, ANDIDE' UANI Sii PEEN 111~~~'''...~~~~~~ 5114 BRAcli)T AVE ' NEW CUMBERLAND PA 17(70 69UIN4 ~GC5~1'ys ,7i; PF?.l)Vl-)LNCE M DANISH UDE3T CO DATING B))TA]MP p RUMAN TN ENEDE ° K51 46 9 840 EE SERIES EE OEEA ND155DUEDTSVRVHET BT•wwSlDi NGTONneA $em1Ar~ qM. 7 I^f VI: OL a a• •vovv v o• •vnvevvBV • flv v a voa®o•vafl9 Qe4G4YO9a6.'Plat"P®P34Y.aE9i34®o64oaY44AiIPY409®E M9AP _4_.~-~4 °°~YfP090POP0P0H®v®,4@4flflflAfl964@ nosa4.:- ®a-@a®PL444f4BaaaM~!°^°f➢141444fl "r is 'r3s A~.lia atl - 0 0 fd M :•D 1 = 1~ !~U : ~ _ ~ 0 ~ 1 0 D ~r~r ~ ~i 1 >I,F ss a~ 47 't~~' . ~ ' , ~esesesestsaeaeasemamesas _ AT THE MATURITY HEREOF WILL PAY ISSUE DATE WHICH. IS THE FIRST DAY OF , To z _ ~ 9A6-- L C), 5 3- J c) 1 IMONTFR _ _ _ (-R) MR AiNDPE`v4 DANISH PEN 5J4 I1R AADT AVE NEW CUMI)E_kLAND PA 1707'' SSUIMa yGE~I5 ! i'r; PROV IIEN(E it DANISH DL13T CO»; DATING STAMP hJ 'x.. ` L /2 1 j/[J , .CA),6 t ``~I`U~ • _TN • SERIES THIS BOND 151AUED UNDEN AUT"O EBTYBOno ACT.A5AINDED, UMAN a K51469 841 EE EE DEEAA ANDI ETUgUHET I :E E> p _ ' - - _ wASHlncton &nAq ./IA 7 - O! •Et9•aflP ^ flPr.~!aYPfl^flaSa®e• •,Ot ~ d I< rl r~ _ ~ e o u u :•i 1 = u : - _ ~ o = ~ : ~1 `e D ' ~ ,}li ~:M n d = Imo' ~ ~ emasesemasaeas f f eaa®aBemnoa~aeeeaeaflaeoeaeeeeemoe~B ease Demos AT THE MATURITY HEREOF WILL PAY IAs f " ~ P Iit WHICH FDA of OF T° 205-03-17914 02 1986 y MR ANDREW UANiSH PEN IMONTHI _ (YEAR) - 504 BRANDT-AVE _ NEW CUMBERLAND PA 17070 OR PROVIDENCE M DANISH DDBBT CO.. J 'HBO. PA RUMAF . ~I TNE.ACANEBEOH SERIES EE ANO I E.Ew EDDN T " K51469 572 EE H OF TIE TREMURY - DEIARTME, &nYlAp BjW 7 M ~Eat a ®Pfl?flPfl4'BVBVaa~vav ocaflQga~o4~➢fl9fPlPRenanasaea•onP fl4fl4mAt4G40flm41P➢Y®7®onaeoeBflo®o®aBPBnin69flgfl4~.~i4~®~P~aB&Y41~®9®i~ Ot. ~;,;,~j4~k~yr<:.~ sI'i J:~':~t~Y 1 1 V JN C11 __►r 4 1 t P 11 1 r ~l v.r •~rr~ S / 1 ik ,MEN ~~~~:~Vt NTO J - U. Y-11 kTqVIVJ-:0 ~?I11 . 4~ vit-` SERIES L F a AT THE MATUPUT~ZREOF WILL PAY E ` t 1203-03-09141 03 1986 MR ANDREW 04NI SH PEN ' Ti. 504 BRANDT AVE NEW CUMBERLAND' 'PA 17070 4150 OR PROV I OENC E' M DANISH 11 Dn° A-Cfl. 3 7/86 O /TI N* STAMP HBG, PAI , Kb08150~5EE 1:00009000 71:00 00608 L 50 7 SIII ~Q~yVA:PVC6V;4Gtw I ~ fiZ ' ua 91NAR1-0offlVr "i*m. MC SERIES EE ' 1 k AT THE MATURITYHEREOF WILL PAY 1205-433-A914' (31986 MR -AhDREW DANISH PEN T. 504, `BRANDT '.AVE " NEW CUMBERLAND. PA 17070, j 4150.`' OR PROVIDENCE; M •DANISH ;ID&BaT^°efl. / ]TAM //8 f 11FTINO P 6 HBG. PA., K608150~4EE 1:00009000 71:00 00608 L SO 74n' i +~N~+l r. 1 1 1 1/ u :•1 1 11 ~ 1 ~ 1 ~1 1 ~ 7~~1~ VI,~:. l r ra1:1~ T~Z\"s~• wo '4T1,0-19 ~wJalp-HA AS SERIES EE ,yL AT THE MATURITY HEREOF WILL PAY 1 20 5-0 3-0914 03, 1986,1 MR• ''ANDREW DANISH PEN 504 BRANDT `AVE - 4150 NEW CUMBERLAND,PA 47070 . OR PROVI DENGE wDANI SH DllBd~afl.'; ff t ~ : 3 l~ 21 / 8 b ; A NO 9T P H lW. AOk Kb0815801EE 51 00608 L 5 30 L►i' 1:0000900071:00 =r-q MAN" ~7 r •.y~1, I r. j to 11 V V 1 1 u. ' 1 1 1 1 t j w~~„\+\V/Py/ / I ~ ~`~~i~ ~~V/. SERIES E AT THE MATURITY HEREOF WILL PAY - J 03' 15186 ,205-03-0914, MR ANDREW DANISH PEN Try 504 BRANDT 'AVE 44 r ' 4150 NL-W CUMBERLAND. PA 1,7070 . OR PROVIDENCE M .DAN ISH 'D943 -T "GO IT 3/14/66 n INa sT P 1 Qom- Kb0815190EE t'rrnA,ry //A/ /rA ,r, 1:00009000 71:00 00608 L 5 L90ii' y~t=1~' aaa ~l a1 u N 4 7 - V10511-4#.~11~~~~~~MOOD* SERIES EE y AT THE MATURITY HEREOF WILL PAY r'~t~711 4 T ~Ssldyfl'3s,y'1~?f1T:1y1"7Ct 205-03-04141 03 1986 MR ANDREA DANISH PEN r = Tip 504 BRANDT AVE NEW CUMBERLAND PA 17070 4150 OR PROV I DENCE M DANISH DD&T^ . s, 3/28/86 HBG. PA.,' /n, Kb0S15431EE 00608 L 54 3 LIT' 1:0000 9000 71:00 MCI 11 F~ 7. iE'' I 1uV:i1 V[ e - 1 11 1 r~ Y - AT n+[MATURIT'HEREOF WILL PA AY SERIES EE 205-03-09141' i 04; 'x . ;1986 MR` ANDREW DANISH PEN "rte T.. 504 BRANDT `:AYE NEW CUMBERLAND. 'PA -17070 4150 ' OR PROVIDENCE' M =DAN I SH D&&TAe„Ca '4/':-4/86 A E(PA• 1 HOr O 91 -1.~ - -1 KbOESSHEE 000900071:00 00608 L 5 5 2611' I •T t r'~+I~~~ r'A me MATURITY HERE01 WIlL PAY SERIES EE it 205 03 0914 04 1986 5RR4ANDREWW DANISH _ NEW CUMBERLAND PA 17070 ' (U939~-4150 \ DATING STAMP r PEN HBG. PA.' ~O~ PROVIDENCE M., DANISH I .7~G171J s fg J ~ " N N ~ i - F^- ~ ~ to A 5 ~ n S%,rs yJIA.'imar,Iry rr 1:00.00900071:00 0063889 L3611' I euu:el u ~ _ e ei - ' o N 19 9 SERIES EE rHE MA RT HEREOF-1 PAV I ' tvY "M 04 1986 205 03 0914 77 J MR ANDREW DANISH : ► T~ 504 BRANDT AVE, ' r . ' 03-4150 V/ NEW CUMBERLAND. PA.1,7070 D&OTA°. CO.', 11 4/18/ 86 - I OATINO STAM' 4 HBG. PA,' r; ``pp PROVIDENCE DANISH ( . vi ".ta, t\63889222EE 1:00009000 71:00 006 388'9 2 2 211' inr ~R•F~`11 ` i°" jai iu~~w ~ A~ 1 I Y Y :1 1 _ Y : _ I -1 1 1 „a KEN` AT THE T~ RVaNF,REFW~LLMY y SERIES EE ;205 03 09i4~ 05 1986 f~ 5U4ANRANI7TDAV[SN NEW CUMBERLAND PA 17070 03-4150 ! 5/16/86 , PEN `.HBG. PA,r'` OR PROVIDENCE M UANXSH Kb3889643EE 1 .00009000 71.00 006 388964 3n' Mom t A SERIES EE . 5 ~ r THE MATUR TY HE.... WILL PAY n 205 03 0914 0 1986'. < 7i MR ANDREW DAVI SH 504 BRAND' A 03-4150 W CUMBERLAND PA. 17070 NE L DIDisri. - 5/:6186 'HBG. PA*' PEN PROVIDENCE M,, DANISH I~ - , W Kb3889644EE v:.Wn`1 .,11113 i _ ~ 3' q f' 7 0063889 r L. ' 1:00009000,71:60 i a W~F A1'5~9 9 -sj A'l•°.Luis FAR TT EMATURITY HERlWILL PAY SERIES EE ~a M ~ ''S'u'~s~i1-112j<lz~D 2 0 5- 03 0914 05 ~1986 _ . 1 ~ 7b MR ANDREW DANISH 504 BFANDT AVE r NEW CUMBERLAND. PA 117070 HOW. PF N. 1A8G. PA.' Kb3889422EE 1:00.00900071:00 006388942,211' AT THE MATU- H- WILL PAY IEs EE 05 ~ it 7ir ~ i Mk A1,10kEW 1AN.1s 504 r3PANDT AV E~ NEW NEW C'Ji4 LkLAN 11 '-PA 11707U e I ~ 1JI ~GliNL1 ' I \ 51T, G NAM ' d P (~i H3G. PA.' )F"NCB M -DAN I SId Kb38S9421.EE 1:0000900071:00 00 6 388 9 4' 2 1118 ` P ~j~ rji1~~C~~~:,.1 A r I ►1 UY :q1~1~~ ~ e Y : _ ~ 1 ,~~p ~ ~ 1 1 1 M ~i~'' ; T THE MATURITY HEREOF WILL PAY SERIES- E E (205 03 09141 06 1986 MR ANDR W UA SH 504 BRMMT -A y NEW CUMBERLAND PA I7Q4 Q 01i!] TrR~. ; 'i II ~ATINQ 4fllM P~ PEN 'HBG.` PA: OR PROVIDENCE. M, DANISH' KbS890SS4EE 1:00009000 71:00 006 3890 3 5 S . 3; SERIE7~E~Ej .~i.., AJffnql-c xyz ~11986 06 205 03 0914 MRABRM ITDA$H 7 504 ,03-4150 NEW CUMBERLAND `_A 1:7070 ~6J13/86 ,v ry 11 DATING STAMP ~ r '.HBG. PA..~ ":,PEN~ PROVIDENCE M~DANISH I! ~q a 6~ K63889932EE Y h F f u,vy. 1:00009000?x:00 006388993'2 V Y HO »v_ S- w4l A SERIES EE AT EMATUR,V HEPEGF I'll 'Al - 205 03 0914) I, 05 1986 , NN 504A8RAUTON15H /J NEW CUMBERLAND PA - 17070 "03~y-4~.1~5P't10~ D'DEw{~~L/ E A6EC() ~5/30/86; \ - - DATING STAMP PEN H$ PA. P ROV IDENCE. M = DANISH if K638898SOEE firnlrry N/FA lmcrr..V 1:0000900071:00 : 006 3889.8 50)p I Y. • Jz F 9- Null, I T . U-91 N M 99@94 I ~ CF7~~{ C F~ F~ HER- A111 IAI I(~~ TAT THE 'tuRn 1 S AT E 1205 03-U~)14! 05i 1986 MR ANDREW DANISH 504 BRANDT AVYE NEW CUMBERLANDI PA, 4,7070 03-4t50 DOBT CO. PENi ,I H13G. PA;' ` S' r OR1 PROVIDENCE F:MliDANISH' ~2 n 6I v. ga P+ fi"r-el\ ~ }/ynay~~ ~ 8B E E pi m Kb38899 1:00009000 71:00 006,3889 7$8►t' I ' SERIES EE ' AT tME MATUAITVMENEOF WILL tAY - 205 03 09141 07 1986 904A RAN TDAV H NEW CUMBERLAND PA ;17070 -'i0yE~3e~E-MC'4T150 ' M V i/ ! Aa ~ • ,1 7/18/86 1 DATING STAMP POR" PROVIDENCE a M DANISH HBG. PAr' y:rnluyd,Ar m.my 1:00009000 71:00 006 3890 7 290 h • 5 ' ~jp)19 iU ' rya ~ SERIES EE .J T THE MAtUR Tv HEEEOP W LL PAY i 120503 0914 0& 1986 N r gR ARR DANISH 5 El i, NEW CU BERLAND[ PA ,17070 D^ , PEN 'HBG. OR; PROVIDENC PA: • E r M~iDANI SH '-------1:00009000 71:00 006 3890 3 5 Sill 14-0-3B V_ Am MATURITY-ATUEW LLPAY SERIES EE AT THE _ 205 03 0914 ' i 07' 1986 MR ANNRA TDAY SH NEW CUMBERLAND" PA .1;7070 '03-4150 D fBTAcrD . 7/ 4/86 "'{E DATING STAMP PEN HBG. PAy' ORI PROVIDENCE,-M DANISH i 1:0000900071:00 006 31B 90 5 18u' • •T UPI It v ~ (wM91.9t_p_ k MA AT E UPIT .H[REOf WILL PAY S■T ERIES EE 1205 031, 0914 06 ;1986 pp WW NN F T~ 504ANRAhI~TDAVJSH 4:. NEW CUMBERLAND- A X17070 03-41~~5E•~'0 DD'8`I AGCO a 6/13/86 \ DATING STAMP PEN 'fiBG. PA./ OR! PROVIDENCE J4 ,DANISH i , h ,Kb388g9 EE 31 v r ~)'..nl.,y.flArnry 1:00009000 71:00 006 38899 3311' of I ~~rt y3t =i01Ijlt ~n l vry • p1~ 1/N : 1 1y~ N : _ _ (1 1 1 1 ~V!(. YIN 71 E LJ AT THE MATURITY HH EE'REOF W-LL PAY SERIES 1205 03 09141 ! 08, 1986 R ANDREW DA~yI$ - - 04"ORANDT AVE NEW CUMBERLAND PA 17070 03-4150 8/ 1/86 I DATING STAMP PEN ,HBG. PA,,' OR PROVIDENCE M DANISH Kb38909SSCE. 1:0000 9000 71:00 00 638 90 9 5 Sl+' AO&M ;2:031 d7 AT THE MATURITY: HEREOF WILL PAY SERIES EE 7 j19,36 205 03 09 l Ti. MR ANDREW DANISH 504 BRANDT _ AV E, - NEW CUMBERLAND 'PA 17070 j033-4150 7/25/86 DATING STAMP HBO. PA., PEN ,ORS " PROVIDENCE M DANISH 1:00009000 71:x00 006 38908 I S11' SERIES EE t T E MATURITY HCREOF W11 PAY ; I 1 S r 86 2!J 5 03 0914 08119 4 i. 7,9 MR ANDREW DANT Sti 504 BRANDT AVE,,, 4 50 "t NEW CUMBERLAND, PA 1,7070 03OD--41,50 CU. 8/15/86 H13G. PA,,' Q ~ nov ib NGE A «DANY S1 F b911KEE 1:00009000x71:00 006'389 1413 III' i sERIEs. EE 11TURTY E AT TIE 205 03 0914 07 19 86 4 MR ANDREy~ DA 5H 504 BROT A~~.,, p3--4150 11 NEW CUMBERLAN PA'!?070 J a;, D'©8T tea. , J 7/11/86,; DATING STAMP ~PEN NBG. PA.,' E DANISH II ZOEN ~ ~D PROY w: Kb 890bO4EE: $'.rnA.yd/F 1:00009000?~:00 006389060411' ac Zll k. j AT THE MATURITY HEREOF WILLfAY ' SERIES EE 105 03 0914) 09 1,986 I ~y 70 04AADTAN NEW CUMBERLANpA 117070 03-4150 flDSS If Ale 1] 9/ 5/86, DATING STAMP PEN ',HBO.` PA,,' R PROVL[Ik~NCE _Ml DANISH' Kb3891E09EE 1:00009000 71:00 006 389 150911' ~y / 1uV:11 Y ' 1 MITI t 13"'l 1 f + ~ d~ ? a - SERIES EE - - - 1205 03 0914 08, i~?86 %MR ANDREW DA ISN 504 BRANDT'A E - NEW CUMBERLAND, PA ,17070 BOW. hk HBG. PA, ;E~~ _ PRDVIpENCE *D40 5i I1 I I 1 j Kb38914E0EE {6+.A.yd 6., . 1:0000 9000 71:00 O:Q6 38 9 14 2011' Z IN UP NEMAT TVNCR,.-L .AY SERIES EE [205 03. 0914) 08 i 986 . s ! 70 MR AN DREy~ DA~y SN. 504 BRA NOT NEW C UMBERLANO PA 1;7070 "0 D ()IT 39-N{415 /0~ 8/22186 V ~.P Aj DATING STAMP p U'~VI PROVIDENCE JCA,JANtH 'I tIBG. PAS-' f _ 'JL3.Ja1 7rl`~' P P k~. KI ; F f "=t 1 ' P G v' - n ' - - Kb38912 4EE 1:0000900071:00 00638 9 12 7 411 LOW. j / SERIES EE •:VI T E MATUR TY NCREOf W LL AY I I 205 03 0914 08' 198+ MR ANDREW DAV I SH 504 BRANDT A E:,- NEW CUMBERLAND--PA 17070 0 _ VAT,k STj.06 `PEN HBC. PA: PROVI'D NCE ,M,DA"N~tSi~1 ~7 'M 93= K63891180EE 1:000,09000 71:00 00 6 313 9 1 X80.11' SERIES ' MATUA- HEPEO-11-AT 09 1986 205 03 0914 1' ,F-,- AtE %T~tVJSH /03-4150 904' b NEW CUMBERLAND PA 17070 'DIM A`CII. 9/12/86 ; I DATING STAMP M14. PEN 0 PROVIDENCE M , RANI SN Kb3891b34EE • 071:00 - ~ 006389 l634il' 1.0000900 Z' K v U., ~I lcl~~ SERIES EE AT LHI n I. _ 09 :1986 205 03 09141 ' 7a g04ARRAEDTDAVISN - NEW CUMBERLAND PA '17070 "0y3j-[415.0 LlIR~7A 9/19Y8b II DATING STAMP t PEN ,HBG. PA, ~Cl PROVIDENCE M DANISH 1:00009000 71:00 006 389 17060 ~ti t E t 'q..• +ei 1 1 Y Y :'l l V 1' 1 1 1' x I r f *SERIES EE AT THE "TILRI- HERFIF I'LL 'Al 205 03 09141 1 0911 1986 MR ANDREW DAV SH 504 BRANDT 'A NEW CUMBERLAND OA 17070 /03-4150 ~q DaffA.Cti 9/26/86 DATING STAMP P OR~ PROVIDENCE M OANISH t160. PA!," K6389214©EE 1:00.00900071:00 00638.9 2 1 40u' :5 FIIZ-3 M-213 =M 3 T r SERIES EE THE MA*un n HEaEO I.AV ~205 03 091.4 10 !1986 7~. MR A GREW DA SH 504 RANDT AN , NEW CUMBERLANfl PA L7070 , l n.. ATINGRM P" PEN - HBG. PA,; s RI PROVIDENCE 4.DANISII' Kb3891~~HE r .f.-»M1y.i Rr lmxuy 1:00009000 71:00 006`389 i 7 7811' R :°.+~~Y/;'' I / 1- s If 1,411 w ma omm 'Oft SERIES EE : AT THE MATURITY HEREOF WILL PAY 205 03 0914` 10 1986 -i MMR4ANNDDRE DAVI SH NEW :CUMBERLAND PA 7.7070 '03-41~5`0E~ I D~O~~'Ap ZATr/i 10/10/86 F DATINC STAMP PEN HBG. PA." OR PROVIDENCE. M DA,NISfi li aai,iti~` /yny Kb3891922EE //5 n1oyWIAr TtivrH.y 1:00009000 7,,:,o0 006 389 19 2 20 rt '1 u V :11 Y' , 1 1 11 OTHE ~~.rl NATURI ,HERE -••1`1~,~ SERIES EE e 1205 0.3 OS 141 10, 1986 MR ANDREW DANISH 504 BRANDT AVE NEW CUMBERLANUI PA X11070 03-4150~yg D i~'FslT A`CU. zr ~ 10/17/86 IG TMPAP PIS VIDENG' '~iBG. PA E M DAN1 SH A, 7, ►r /yny Kb38921 SlE ,//.Y'..n•IOry✓Nrr irnrrry 1:00009000 7:00 006 389 2 La Lill I till {Y'' 3 1 1 u w L• :d 1 V P E I i t 1 1 w,~ I MATUR EOEWILLPAY %Alm -1 :j 205 03 0914 I . 10 '1985 MR ANDREW DAN ii 5H 504 BRANDT AVE NEW CUMBERLAND.PA 1.7070 any:' 03--4150 1 DY1B'7 AG''ni 10/31l8b • P~AI. • - DATING STAMP "i D PROVI'DENCE-M,DAN'ISH 'HBG. PAw'~j. ry✓h ti 0 0 0 0 9 0 0'° - 389 2'~-0 3 EE 0?1:00 .-p 006389240311' 4 ' ?i: ~ 1 1 1/ 11 :1 I _ 11 _ 1 1 1 1 I AT THE -TUHRI~ NE EDf WILL rAY SERIES EE e „yr r ,vovim'getmR J - j2{}5 03 0914 11 19x86 MCI ANDJ EW DAN I SH 504 BR NOT AVE NEW CUM,BERLANto. PA 1.7070 -)63 41 5 f~0? r 11/ 14/66 II DATING STAMP -N JIBGS. PA.,/ GR PXGVIQL1NCE M; OANkSO i .r,r ~ s'T,.o,y✓Ar n....Hy 1:00009000 71:00 ~ 006 389 26'0.511' +ili „v~r 1 1uY:11 V:. 1 0: 1: 11 1 11.„„^~"~V►h ~I AT THE MATURITY HEREOF WILL PAY ~ SERIES EE 1205 03 0914 10 1986 MR ANDREW DANISH 50.4 BRANDT AVE NEW CUMBERLAND. PA 17070 '03-41~5}0(`<~.' 10/24/86 I DATING STAMP / PEN 'HBG. PA.r'J OR PROVIDENCE M DANISH Kb3893331EE .S'rrrviry✓IAr 7rmnrry 1:0000900071:00 006 389 2 3 3 1um A SERIES EE 1 T ,HE~,M*gTU~RI=TIF*NEREOf WyIL~L PyA~~ , I L1 ~198b 205 03 0914 lI - ~ % MR ANDREW DAN I SH 504 .BRANDT AVE NEW CUMBERLAND ,PA 1:70717 03-4150 , +H;AGSIry I 17 ~V~ l~♦ 1 11/21186 DATING STAMP v 'P EN, 'HBG. P A1,, R; PROVIDENCE M-0ANISH - Kb38921b~EE 1:00009000 71:00 006389 2 769ii' i AT T11 M RTYH-OFWLLPAY SERIES EE 205 03 0- 14 1986 I I J IT MR ANDREW DANISH 504 BRANDT AVE NEW CUMBERLAND .PA 1'707; '03-4150 -n]41150 A.r.10 IS t/1 ~tpATING STAMP MP I ~ '.PEN '.1-18c. PA.,, 10R, PROVIDENCE M DANY SIi gal Kb3892604EE S-1,., ,.ry 1:0000900071:00 006389 260Lill, - I ~ I p~}E-Wj-~~1~'SERIES EE MAT R~L %P14 A<'$qY UFNV1MREOF1iL Y C-1 _ 205 03 09141 11I 1986 < k f 7;, MR ANDREW DAN SH, 504 BRANDT AV~ NEW CUMBERLAND, PA 17070 03-41517 D D6 00. 11128/86 DATING STAMP PEN F 'HBG. PA.,'' LORI PROVIDENCE A, DANISH Kb3893843EE 1:0000900071:00 006.389284311' I i f SERIES EE ./T THE MAaTUr~PI.. ~PEPEOF WII'l }A,Y `~~1~~ ~Z U5 03 09 4 1 Z 198 w~ .'To MR ANDREW DAN SN,_ - 504 BRANDT AV E, '03-435{0`,'X+► NEW CUMBERLAND' PA `17070 DI9181f A0C 12! 5/{8~b . ; I DATIN4 STAMP PEN ',HBG. PA." OR PROVIDENCE ,1 DANISH K63892962EE. 1:00009000 7:00 006 389 296 3 Y AT TIE -EaEOpW.«.~AY SERIES EE Tr '!fit 1>~ I i ^ I 11 205 03 0914 ~11121986 { 7:~ MR ANOR DAN i SH. 504 6RAN T AVE.! NEW CUMBERLAND; PA; 17070 ~D~~~r~~T~. ~J . I JY ~ATISTRMP86 ,'PEN II HBG. PA: PROVIDENCE M:: OAN1 SH - - n.u.nv I 1:00009000 71:00 006.389 3 2 7 20 SERIES EE'. AT iM iYHEn pAy { Ss 1%7 3 m 1205 03 - 914 3 X1986 MR ANDR DA SH 504 BRUIT AU NEW CUMBERLAND PA L7070 D al r_ O. Z~a3/86 . PEN HBG. PA. `0RI PROVIDENCE M DANISH, li - Kb3893S20EE 5' iryrlh. $ntrirry 1:00009000 71:00 006'3893 5 20u■ mill SERIES E 205 03 0914 ANDREW DAN IStj NEW CtJMBERL ANDS PA 17070 DJ=~ T _ [ t Prey /TI STAMP6 ER, PR>CIV'1OENCE M .DANISH li 13G. PA,,' V Kb3893L2 I E E 1.0000900071:00 W-~ 006'893 27 Lu■ CD y CD ' CD O bm 2t~t O X.P. O t~ CICD Z OA~o : w yam, /npr 0 O z y,b 4,, m amti a p t~ f o _ .I w O' UQ O - O X43 Z~ t +tr ° LL) m W rr7 rTl <r Calculated Value of Your Paper Savings Bond(s) http://www.treasurydirect.govBC/SBCPrice Calculated Value of Your Paper Savings Bond(s) Calculator Results for Redemption Date 05/2012 Total Price Total Value Total Interest YTD Interest $1,950.00 $6,545.19 $4,595.19 $103.95 Bonds: 1-52 of 52 Issue Next Final Issue Interest Interest Value Note Serial # Series Denom Date Accrual Maturity Price Rate K67113061;. EE $75 04/198710/2012:04/2017 < $37.50 $90.09 4.00% $127.59: K73965395 EE $75;12/198706/2012 12/2017: $37.50 $85.14 4.00% $122.64;. K73965525; EE $75 12/1987 06/2012 12/2017 $37.50 $85.14 4.00% $122.64 K73965362 EE $75 12/198706/2012 12/2017 $37.50 $85.14 4.00% $122.,64 K67110778 EE $75 12/1987 06/2012 12/2017 $37.50 $85.14 4.00% $122.64 K67110644i EE $75;,12/1987 06/2012 12/2017 $37.50: $85.14: 4.00% $122.64 K67110514; EE $75 11/1987 11/2012 11/2017 $37.50 $87.60 4.00% $125.10. K67110450 EE $75 11/1987 11/2012' 11/2017 $37.50 $87.60 4.00% $125.10 K67110289! EE $75 11/1987 11/2012.11/2017: $37.50 $87.60 4.00% $125.10 K67110244 EE $75:11/1987 11/2012 11/2017$37.50 $87.60 4.00% $125.10. K67110151 EE $75.10/1987 10/2012110/2017 $37.50 $87.60 4.00% $125.10 K67110073: EE $7510/1987 10/2012 10/2017 $37.50 $87.60 4.00% $125.10 K67109904 EE $75 10/1987 10/2012 10/2017 $37.50 $87.60 4.00% $125.10, K67112760 EE $75 10/1987 10/2012 10/2017 $37.50 $87.60 4.00% $125.10K67112627 EE $75,09/1987 09/2012 09/2017 $37.50 $87.60 4.00% $125.10 K67112572'; EE $75.09/1987 09/2012 09/2017 $37.50 $87.60 4.00% $125.10 K67112571 EE $75 09/1987 09/2012 09/2017 $37.50 $87.60 4.00% $125.10 K67112214 EE $75 09/1987 09/2012; 09/2017 $37.50 $87.60 4.00% $125.10. K671120W EE $75,09/1987 09/2012 09/2017! $37.50 $87.60 4.00% $125.10: K67112024: EE $75:08/1987 08/2012; 08/2017 $37.50 $87.60 4.00%: $125.10. K67111882. EE $75 08/198708/2012 08/2017 $37.50 $87.60. 4.00%, $125.10. K67111803 EE $75 08/1987,08/2012; 08/2017 $37.50 $87.60. 4.00%; $125.10, K67111674 EE $75 08/1987 08/2012" 08/2017 $37.50 $87.60 4.00% $125.10 K67111583 EE $75 07/1987 07/2012; 07/2017 $37.50 $87.60 4.00% $125.10 K67111582 EE $75,07/1987 07/2012 07/2017 $37.50. $87.60 4.00% $125.10 K67111316' EE $75 07/1987 07/2012' 07/2017 $37.50 $87.60 4.00% $125.10 K67111263 EE $75 07/1987 07/201207/2017 $37.50 $87.60 4.00% $125.10 K67111169: EE $75 06/1987 06/2012.06/2017 $37.50 $87.60' 4.00% $125.10. K67113656 EE $75 06/198706/2012 06/2017 $37.50 $87.60 4.00% $125.10 K57111052 EE $75 06/1987 06/2012 06/2017 $37.50 $87.60 4.00% $125.10 K67113769 EE $75'06/198706/2012:06/2017 $37.50 $87.60 4.00% $125.10 K67111009 EE $75 06/1987 06/2012 06/2017 $37.50 $87.60 4.00% $125.10 K67113341 EE $75.05/1987 11/2012 05/2017: $37.50: $90.09 4.00% $127.59' K67113404 EE $75 05/1987 11/2012 05/2017: $37.50 $90.09 4.00% $127.59 K67113465 EE $75,05/1987 11/2012: 05/2017 $37.50 $90.09 4.00%: $127.59 K67113589 EE $75:05/1987 11/2012 05/2017 $37.50 $90.09 4.00% $127.59 K67112957 EE $75.04/1987 10/2012 ` 04/2017 $37.50 $90.09 4.00% $127.59 . . K67112958 EE $75',04/198710/2012 04/2017 $37.50; $90.09 4.00% $127.59 K67113019 EE $75 04/1987 10/2012 04/2017 $37.50 $90..09 4.00% $127.59 K63894909 EE $75:03/1987 ; 09/2012: 03/2017 $37.50 $90.09 4.00% $127.59 1 of 2 2/1/2013 11:08 AM Calculated Value of Your Paper Savings Bond(s) http://www.treasurydirect.gov/BC/SBCPrice K63894816 EE $75 03/1987 09/2012 03/2017 $37.50 $90.09 4.00%: $127.59 K63894910, EE $75:,93/1987 09/2012 03/2017 $37.50 $90.09 4.00% $127.59 K63894476 EE $75 03/1987 09/2012 03/2017 $37.50 $90.09 4.00% ..$127.59, K63894612 EE $75 03/1987 09/2012 03/2017 $37.50 $90.09 4.00% $127.59 ...$127.59 K6389415.3 . BE $75 02/1987 08/2012 02/2017 $37.50 $90.0914,910% K638.94152 . EE $75 02/198T08/20112 02/2017 $37.50 $90.09 4.00% $127.59 K63894257 EE $75 02/1987 08/2012 02/2017 $37.50 $90.09 4.00% .$127.59 K63894387 EE $75 02/1987 08/2012 02/2017 $37.50 $90.0914.00%' . $127.59 K63893588 EE $75 01/1987 07/2012 01/2017 $37.50 $90.09 4.00%: $127.59 K63893.8.19:. . EE $75 01/1987 07/2012 01/2017 _ $37.50 _ $90.09 4.00%;_.....$127.59 K63893820 EE $75 01/1987 07/2012: 01/2017 $37.50 $90.09 4.00%, $127.59 K63893947 EE $75 01/1987 07/2012. 01/2017 $37.50 $90.09 4.00%$127.59 Totals for 52 Bonds $1,950.M $4,595.19, 6 545.19 Notes NI Not Issued 11 NE Not eligible for payment P5 Includes 3 month interest penalty MA Matured and not earning interest 2 of 2 2/1/2013 11:08 AM i : SERIES EE i T THE MAtUP1TV NEPEGf WILL fAY n y 205 03 091-41 01 1987 To Ka ANDREW. DAMS 504 BRAN llT AVL NEW CUMBERLAND PA 1707) jj,4 p,.P97 ; 1aBG+ PA4' \ POK PROVIDENLE M DANIS1a Kb3893941EE 1:0000900071:00 006389394711 i , SE RIES EE Y I , 0I. ? 87 ~ 205 03E 09141 i MR ANDREW DANISH D?,-4150 504 BRANDT AVE,. 0-3-'P150' / NEW CUMBERLAND PA 17071 J/23JB7; J ~`GATING STAMP: HBG. PA,•1 GR PROVIDENCE DA N 1511-1 PEN OEE X67;7 1 ~ ~w.mry.Jh „.,.,y „:o ~ . ~ 006389 38 2011' :000090007~ ~0 E • _ • SERIES EPEGf WILL IAY I 19 87 j 2 75 0' 014 ~ T~MR ANDREW DANISH 504 "BRANDT AVE 03-4150 NEW CUMBERLAND PA ~1 i07i~ ~ t1fi~~TAEC~~ 1S/23lB7 GATING STAMP H$V. PA.', .PEN ,L~ PROVIDENCE M.DANI: H /J ; Kb38938i9EE .i" y9;1,1'a1J?'u19 e~S nfnry,ilh.u •y r' 1:00009000 71:00 006 389 38 011' SERIES EE c JYJ9i E MATUR ttHEREOF W I rAV 205 03,F 0914 ~ ~ 01 1987 ' 7K MR ANDREW DANISH 504 BRANDT AVNEW CUMBERLAND :PA 1,7070 03-4150 IN' 1/ 9187 • ; yam, ! DATING TAMP PEN, ',HBG. PA,, PROVIDENCE fit-,DANISH ; - - ~:,,aa~~ ► x, Kb3893S88E,E. 1:00009000 71:00 0 06389 3 S1313115 av v ' SERIES EE £ AT THE MATUPITMFPEOF WILLL II Y~ I205 03 0914 I ' ;0 2- 11987 12 MR ANDREW DANISH 504 BRANDT AV _ NEW CUt~3ERL AN Di PA 17070 ,/D1T8T ~`'C3. 2/Z7/87 DATIND STAMP \ PEN JiBG. PA./ 1R Ph 'R~3VIUE`E M DANISH, 'G~1C. - Kb38943UEE 1:00009000 71:00 006 3894 38 711' Y : I luV:11 V:~ E I 1 11 Aa~bfs 1lG.rAT tNE MATURIP NEPEOP wILi Av SERIES EE 1205 03 0914 1 I 02' 1987 ' ! L 7ir MR ANDREW DANISH - 504 BRANDT AVE.,,, N LW CUM BERL ANDi PA 17070 Das~~'°~~. 'I I` "U ATIFId STTM 7 PgN, LHBG.. PA.', PRA PROVIDENCE 'M =DANISH Kb389g2S~EE 1:00009000 71:00 0063894 2 5'7ii' i Yo w: 15 ' AT THE MAT- TYH p F I y SERIES LIE. F i ev~ `u me 6Tr~.,n An r _ 205 03 0914 02 1987 7< MR ANDREW DANISH 504 BRANDT AVE NEWCUMBERLAND, PA 17070 03-4150 2/13/87 DATING STAMP PEN ~'.HBG. P+.'r IOR PROVIDENCE,M,DANISH j I I K63894152EE; 1:00009000 71:00. 006 3894 L 5 t i' IT THE IIATUAI { ~ T_,► rY"EAEDF 1114 I'AY FAT 1~ SERIES EE 205 03 09141 0Z! 1987 L, SIR ANDREW DANISH 504 BRANDT AV E 1 ' NEW CUMBERLAND PA 1,7070 -'03-4150 DUBTAGC'a. 39 2/13/87 1 DATING STAMP PEN HBG. PA,,` XIR'l PROVIDENCE,M;,.DAN~ISH Kb389q1S3EE 1:00009000 71:00 006'3894 1 5 ass' Vg~~='~U,a 1 I 0. X.11 SERIES EE ~ lr `~I I I FT THE MATURITY HEREOF WILL MY 205 03 0914 t' PEN 04 , 1987 MR AND~RE~ DAN ISH 504 BRANDT AV E NEW CUMBERLAND PA :17070 DO& fl3-(~,4Ti5d AG . 4/24/87 \ GATING STAMP OR P]VIDENCE M DANISH HBG. PA., J ,hKb9112019EE SMr.r, y.lih nnu„ 1:0000900071:00 006 7 113 0 19 M 1VY:1I Y:. E 1 1 I1 r _ = "IRE qpp~ldlA!~ SERIES EE 'II HC MATURITY XEREOF WILL FAQ I ATT ~ , , s Ir. . I•F 1~EN21-2 ~ ~GTG 012 205 03- 09141 1 04 19971 594 ~R4HT AVISH + ` NEW CUMBERLAND ;PA 17070 d3u-'41E5E0 PEN 'HBG. PAS: OR PROV IDENCErM , DANISH 4i% i: ~ Kb~112958EE STn/.ydlhF lrnuuy 1:00.009000 71:00 006 7 1129 580 I ATTXE XPEOF SERIES EE c L MATU0.1 I Y E WiLLAY lid r ~i E E 14 _ 1987 2Z15 03 -09 0 4 MR AN D-REW D A S'F# ---5.04 8 ANOT A - NFW CUMBERLAND PA "17070 d~IN41~0 DOBT Co. , V1,17T/.187 , PEN; 'HBG. PA,.' QR? PRGV':IDENCE , M -DANISH Kb~1129S~EE 1:0000 9000 71:00 006 7 1 1 2 9 5 Wl r Es EE ~ SERI Hf MATURITY,XEREOF WI ERAY 205 03 0314 I s I'. 03 1987 Tr MR ANDREW DANIISH 504 BRANDT A11E.; + NEW CUMBERLAND PA 1;7070 -"03-4150 DQ'BT AGC 0. 3/31/87 ~ €TING STAMP PEN. HBG. PA", PRI PROVIDENCE M,,DAN I`SH r / LL 9 i 909EE 1:00009000 71:00 0,0 C3 3894909~~' J+'~'~"A(/~ile1g~j5jlf/ f VI i. Ir y ! / Y tPl 1 ~ Y ~ ~ / ~ 1 1 1R ~A f5 'n~ t EIL JN ` 5 \ AT THE MATURITY HEREOF WILL AV SERIES A.<E J.1fi 1`i145~5gl :'Y El '~d ~LEI~' c`f ,f- - ,LUG 03 OSljt PEN 05 187 t G4AMEW'TUANISH NE CUM8ERLANU PA 17U70 o.; ` Vl -5 I D T lAM H8G. PA.,' OR PROVIDENCE N DANI SEI Kb~1134bSEE Si.M,iry.r Ar tr.,uurY 1:00009000 711:00 006 7 1 1 346 5 E~r+~a,~~eruxaua!~~,~te I pro / 1 u Y 1 V 1 1 1 " 6.10 THE MATURITY HEREOF WILL IAY SERIES EE AATT7 S EE i205 031109ir! PEN 05 1987 j MR ANDREW DAN SH y 504 BRANDT AV NEW CUMBERLIAND P A J 7070 D~014`O. VA 50 7 ~ - I'HBG. Pit OR PROVIDENCE I A N ANISH ~ Kb~l13404EE 1.0000 9000 71.00 00 C. 7 1 13 40 41,° Al 1 111: gwgu 1a-»~NIMP 9_X SERIES EE` At THE MANRI' .11L IAI :205 03 0914, PEN ; 05; 1987 MR ANUR`EW DANISH 504 BRANDT'AVE NEW CUMBERLAND PA 1,7070 03-41.50 Dom, BAP A~C'C. 5/ 8/87 DATING STAMP JiBG. PA./ ORS PROVIDENCE ;M,.DANISH' ~I ~.,asi,»,~ Kb~113341EE 1.00009000 71.00 006 7 113 34°111 r~ 1 ali~l~}~'irt''i 1 MM Y 2 F SERIES EE IUAI REOF wiu PAY AT THE 17;Wa I D'fY7 205 03 09141 W I PEN 04' 1:19 A4 - - n :rat, fr MR ANDREW DANISH 5t~4' BRANDT '.AV NEW-CUMBERLAND PA 17070 ~'03-4150 DDB7AGC~. 4/30/87 DATING STAMP HBG. PA,/' PRA PROVIDENCE ML .,DANISH ~ r Kb~1130b1EE 1:0000900071:00 006 7 11306 Lit' riir ~R' nrrt sV rrr t~~~)',Ilgtf/''nb /Y 4 1 1 1/ 11:1 1 11w:_ ' 1 1 1 1 lllr'\~/It AT THE MATURITY HEREOF WILL PAY SERIES EE 205 03 09141 PEN 06' ,1`9871 MR ANDREW DAN SH 504 BRANDT AV NEW CUMBERLAND` PA 1;7070 00A5■0`, II '§ZA6(M871 IOk PROVIDENCE M DANISH }~BG• PAS; Kb7lll053EE 1:0000 9000 71:00 0067 1 L LOS 211a MEMO 11 X11 'F r~ SERIES EE pp_.II ' AT HE MATURITY HEREOF WILL PAY 205 03 0914 i n 6 1 I 1 PEN 0~ 1987 ► A MR ANDREW DANNIISH 504 BRANDT AL'S NEW CUMBERLAND SPA .17070 /03-4150 6/12/87 j I II DATING STAMP ;ORI PROVI~DENCE,~K,DANISH II' NBC• SPA,, \ I, Kb~113b5bEE ~ury JMr%n.vvry 1:00.009000 71:00 ~~~006 7 L l 3656111 f V-. v drr 1 1 u Y :1 1 V:_ 1 1 1 1. '`IVIF SERIES fA(e.~I T- AT THE MATURITY HEREOF WILL IAV E i 12.05 03 0914] PEN 061 1967 MR An~yy DR W D AN I SH 504 BRA DT,AVE NEW CUMBERLAND PA 17070 06 6/ /M 7 HBG. PA. ORi PROVIDENCE M` DANISH Kb~llllb9EE ice. ~..h.ryN)hr!'mvlMy 1:0000900071:00 0067 L'L'I i691e @ 9 A N m 91-f-d A I SERIES EE At THE MATURITY HEREOF WILL PAY sl 1205 03 09141, PEN j 01; 1987 ► _ 7 gR ANDREW DANISH 04 BRANDT AVE. NEW CUMBERLAND; PA 17070 b3~~p.-+6E41~y5ry~0}q 1~17JL~/J7 1+` DATING STAMP z NBC QRj PROVIDENCE ;M ,,DANISH . PA..f F i Kb~l11Eb3EE ' t..nA:ryJIA. S....ry 1:0.000 9000 71:00 00 6 7 14 12 6 311' A W1T~~3f ('h { qp~yEE4 q J PAY SERIES EEµ AT THE MATURITY HEREOF WILL PAY 1 205 03 0914 f PEN 07! 1.1987 1 4--- - M 50 R4ANDDREW DANISH NEW CUMBERLAND PA '17070 AO • 7/17/87 ; DATING STAMP f,HBG. PA..rr OR' PROVIDENCE-M, DANISH awl~~ Kb~1113ibEE 1:0000 9000 71:00 006 7 1113 &r.111 i uftgug gag @u mm. t SERIES EE A,TT THE MMAYUUR Y HEREOF WILL PPAAYY LL 4j/};lyaj T y 1 . _J • J,~' Civs1'f.=iE _/`fA-Maulusj I f ( f - 205 03 09,141 PEN ~ 071 ;1987 >F % MR4ANNDREWW DANISH NEW CUMBEtl~iNt~ PA 17070 0 0 r f DYy - ~Is.07 PkGVIDENCE-1 .,DANISt! ,HBG. PA,' nr R a Kb~11l58 2 EE 1:00009000 71:00 006 7 L L L 5$ 2um \V' 1Y~t •tEa~!'( ,I/' 1 1 u V :1 1_ V _ ' I 1 1 1 - a r'1M SERIES EE ( gg~~A~~T THE MATURITY HEREOF WILL PAY :205 03 0914 1 PEN 07; 1y87 MR ANDREW UAt~ I S:!i 504 BRANDT AV E,-, NEW CUMBE LANDi, PA 17070 o TI c AM fi8G• PA., ~i P{.UVb E C,t r,DANIZ fi - - Kb~111S83EE ,/~.lirv/•ry Nth marusg 1:0000900071:00 1 006.7 b L L 58 311' • - 1 - 1 Ii' 1 tow -10M V SERIES rEE "Al MATURITY HEREOF WILL MY 1 1 AL~i~ I THE 081 1987 1205 03 09.141 ~I. PEN ~ i AIR' X, - AIX AN,RpREW 'DAN I SH N04 R A - NEW CUMBERLAND PA .17070 8 7 {(]j v`~+'t U~INd 9T~MT 7 HBG. PA. OR` PROVIDENCE ; M,DANI SH ~ Kb~lllb~4EE . /'/5..+./ny NMr n.n ury 1:0000900071:00 ( 0067 L L LG 741" ~~i~ tit 'r;; 1 1 u V :•1 1_ V: 1 I 1 1 1 h e~gt ~ rr may SERIES EE / AT THE MATURITY HEREOF WILL FAY mw~ue r I j 205 03 0914, PAN % UPI! 1987 LSfi A MR ANDREW DAN NEW CUMBERLAN5I PA 17070 0(l~3ViS-W.Y415(My0+~, I I L/ 4f AGpVy. 11 Bl114/ 87 / HBG. PA,-' GR! PROVIDENCE : M -.D AN I S H Kb~1118O3EE 1:0000900071:00 006 7 1 L 1130 311' >Z Yi lhi'!r fir, ..1 1 u Y :1 1 V 1 1" i~ N! E. I 1 11 . t>p r = E SERIES EE AT THE MATURITY HEREOF WILL PAY ~l\r I I 2D5 03 09141 PEN 08, 11987 I Mid A DRE DA 5H NEW CUMBERLAN& PA 17070 HBG. PA.,` )3R:! PROV'IDENCE I M -DANISH' ~ Kb~M88EEE 1:0000900071:00 006711 ia8 gum i 'rte-'j~"`'~1 err , - • _ SERIES EE AT THE MATURITY HEREOF WILL FA -w 7 mom 'sId [gyp 1205_03 U9141 i PEN MR ANDRE DAN I Sd 504 BRAN T A E NEW :CUMBERI AND PA J7070 Dn)En] . I 5~1~ ST~M~~ I 'H8G PA. S11 DAN I . M CE ' EN VI D 0P11 PRO Kb`111202`4EE F, J, 1:00009000711:00 006`7 1120 24ii' j ~r,: ~,i~,~'rhrr`>n, • 1 U 11 C1 1 _ a 11 : 1 I : 1 11" SEEN j-k nmmuftL ~ SERIES EE 1205 03 0' 14 PEN U1)3 119137 t`. 7i MFR ANDREW DANISH 504 BRAND? AVE NEW CUMBERLAND PA U070 03-4150 i 0 `SIT AGCTJ • I 9ING<a /817 +ii3G PA I/ OR; PROVIDtNCE ;M DA'NISN I I K6 11E080EE ~l ryJl/Ir /rnu vy is0000900 _ 0 7:00 - 00,6 ?1 L 208011'_ _ ° 1 1 1 1 >r . 1vf r ~t~6 Ali i / i 1 1 u V :1 1 N _ = • " ` eats I:YVfY~I fir/ SERIES EE rl•~iiF',YA /!:l'=Y. _ MATUAITY HEREOF~W~ISI Y7Y1V)) I if 205 03 139141 PEN 04 IL9871 MR ANDREW DANISH 504 Bit ANllT AVE 03-415U NEW CUMBERLAND PA 17070 DID ay AGICf l0'♦] DATING STAMP v HBG PA.,,; } ;OR PROVIDENCE M DANISH - d~~~wale Kb~ 112214EE 1:0000 9000 71:00 00 6 7 L L 2 2 L 411' I MR, y - r SERIES EE +l " 1 AT THE MATURITY HEn~lV ~L1LL i W , i.. ~~J - I205 03 0914 PEN 09;1987 MR ANDREW -DANISH, - 504 BRANDT AVE NEW CUMBERLAND PA 17070 03-41 9 DOST 9/ 2G3/ 87 H3G. PA.,' DR 1, PROVIDENCE X,,.DANISti 1:0000 9000 71:00 00 6 7 L` L 2 5 7=&11' \X~ ,n lrr' ~ 1 rt 1 1 u Y •1 1 Y - . 1 1 1' ~ ,d i J L"AT THE MAi'URIxY HEPE6P WILL /AY SERIES EE Y , 1 1sA } ASH a Ylis, ~.1j- B _R~- I r i l n r r 1205 03 0914 PEN 091 11987 MR ABRANDTDA~JSH 04 " NEW CUMBERLAND, P,A 17070 0D Cl . 9/,?3~p7 'I. . O tl Si N v ORS . PROViIDENCE -M L-DAN.I SH ; ~ki$G. PAS" I Kb~112S~HE 1:0000 9000 71:00 00 6 7 L L 2 5 7 211' .v '1l_si rs~+'~~''!~ ' ~ 1 1 u u :•1 1 u : - = ' ' 1 ~ 1 , / 1 Mi ~ 4 :~Le.„ SERIES EE IT TURIIEIEOF A- PAY r - ~ -Y L Nors I 1205 03 0914' PEN 09 1937 FT~ MR ANDREW DAN ISH 504' BRANDT AV E" NEW CUABERLAN[3 PA ~17t370 03-4150 D9/30/P387 I3fl- ~oBG. PA,"' 4 OR, PRGVIDANCE.,N! D '~T 'i-I ❑ S - 1 t~ 1 y -.i. it {t 1 " Kb~112b2~EE 1:00009000 71:00` '006,7 L L 26 2711- I 'gin ~'~tij`~!~,rr w ~ 1 / u u 1 u : - _ 1' _ 1 1 i' ~ A, SERIES EE rY,•r~ e '1~~ ` AT T~~TURITY HEREOF WILL PAV ~11r I r 1 I) : - 1 114 J •Oa ail 'i. --'2-05 03 09141 PEN 10' 1987 - 7ir MR A DREW llA SH 504 RANDT A NEW UMBERLAND, PA 1117070 ° 1 WING911.07 r 1 Vey _ r HSG. PA. OR PROVIDENCE ,M DANISH . Kb~112~60EE 1:00009000 71:00 00 6 7 L L 2 7 6011' : SERIES EE Ar TXC MAruelri XEREOFwuL rAV = ; '.5 I 1 1 i r 1 12-05 03 0914 PEN 10 15+87 7b MR ANDREW DANISH 504 BRAND? AVE 03 41`50 NEW CUMBERLAND, PA 17070 D0B'1 V0 10/16/87 - DATING STAMP PAr/ "OR' PRO "Kb~109904EE 1:0000,900071:00 0067L0990411' r 4~ SERIES EE MATURITY HEREOF WILL PAV AT THE 4 PEN 10'' i987 1205 0:~ Jar 14 , OKI Tiii AiNb#E DANISH ?S-04 6RANUT AVE , NEW GUMBERLAN& PA 11070 D~S/"P~Q ~ 1 ATrNO 6TAhIP .l 1iBG. P A.rr upl. PkL;,v IO NLE 14 .IUANLH ~ Kb~1100`13EE 1:00009000 71:00 0.06 7 L L0.0 7311' i SERIES E s AT THE MATUR1IV XEREOF Wlll fAV r.. AF► a ` Q ~ ' i J ri~~- V PEN 101 1'987 12135 _03 0914 7~1 MR ANDREW DAV I SH 504 BRANUT A E' NEW CUMBERLAND, PA 117070 T I Q/TAQ40 H80. PA., _ ~lR) PROVIDENC f?MI`,uAN ISH ~i - Kb~1.10151EE 1:00009000 7.1:00 006 7 L LO IS Lill \V e' f !9 r b V!i r 11+~1' 1 1 1/ 11 : I 1 11 : . 1 1 1 1 • . •3\V/ NiN` j' 1 \VI' AT THEM YHEREOF WILL PAY SERIES EE 20.5 03 0914 PEN 11,, .1987 ~7b MR ANDREW DANISH 504 BRANDT AVE, NEW CUMBERLAND PA 17070 (0~'~~y}13r~~~yy'11-~~'~4.1q~5••C+~ D V V TAG V V i ,II pil 11/ 8/87; DATING STAMP FIBG. PA.' 0R PROVIDENCE M DANISH Kb~ 1l0E44EE 1:0000900071:00 0067 L LO 244ii' wax 1 1 1\Vq% • . Ali '3 = 1 1 u u :1 1 - u : _ 72.5 I=wAr~~Big m~ SERIES EE A THE MATURITY HEREOF WILL PAY 1205 03 09141 PEN 11; 11987 - r. MR ANDREW DANISH 504 BRANDT AVE NEW CUMBERLAND PA 17070 03-4150 DOIBTAGC1D. 11/13/87 I DATING STAMP ',iBG. PA.,' OR! PROVIDENCE M DANISH J gr1~J ~T"y1~ I _ I = Kb1110289EE Sri./.ryN/Ar /rnMPry 11:000091000711:00 006 7 L 10 289A' 1 \~ty e' \P~i*~' d 1 1 u 11 :1 1 u 1 1 1 1 Ai TNl MAT 1Y HEPEOF WILL PAv SERIES EE ` i , 13 3 ; , n , 1. d W, lIv!2 1~1 %21-1 t) N-11 -111-S Jr> s 205 03 0914, PEN 1i 1987 ? < 7~ MR ANDREW ;IAN S 504 8RANDT AVM; NEW CUMBERLAND PA 17070 ,'03-4150 YYV ~AOVV• 11/20!87; ya I \ _ DATING STAMP j Ofd PROVIDENCE M DANISH H6G. PA.' VJ/ ` Kb~1104SOEE 1:00009000 71:00 006 7 1 104SOil, \ Y=i4y'~1II > g; M T i ~'@dL ~b;~~~1 IP// 7, 1 1 u V :1 1 y ~ ~ 1 • pT ,~,,\Y/~~ A 1 I fir'\VYr ule'J'AL THEN TDRIT/NEREOFwL 1AV SERIES EE .I 12U5 03 09141 j PEN 111 119871 7~. !WR ANpRE SH ADAW NEW CUMBERLAND R:PA 17070 OS-4I50 _ D'[~~'1'" PTO. 'I 1lAl27J81 D PROVIDENCEi-,DANISH HBG. PA,i' Kb~110514EE 1:00009000 71:00 006 7 1 '10 5 1411' AT THE M T~URIN HEEO WILL P SERIES EE } 205 03 0914 PEN 121 11987 i, ASR ANDRE DAl~yy 5H 504 ' BRAUT AY NEW CUMBERLAND, PA 17070 irrD}~~1N~,~R ' `HBG. PA.; :OR PROVILiENCE-M DANISH Kb~I10b44EE 1:0000900071:00 00671 1064411' § i ors y\~1 ~',~~r!} ~ t ~ ~ 1 l u u '1 1 - u : _ ~ 1 _ 1 1 1 ~ „ . ~ • . SERIES EE AT TNf MATYRIT4 HEREOF WI[L PAY 205 03 09141 - I PEN [19871 5 0 4AS A DTlAVj5H r'fr ~ NEW CUMBERLAND PA 17070 415T~r0 5 03-6srco ~.A 12/1887 DATING STAMP ~HBG. PA.r, OR PR©VIDENCE,.,~„DANISH II .5'wM..ryJihYJ wry . m 18 :0000 9000 ?1:00 o0 6 7 L 10 7 7811 Wp) SERIES EE ` T THE sMATU.IT$ITY~i (EREO. WILL 'AY lJ ` I 09 14 PEN 12 ~98? '205 03 MR AgDRE i DAN SH Jjf 504 RANUT AV _y NEW CUMBERLAND PA 17070 fl~~~'j~T$.1 '1 1?vIf ST P87 HBG. PAi OR PROVIDENCE MI DANISH ~WOAID~~3 K~39b53b2EE . ~,ny.,!/hr Anrny 1:0000900071:00 00 7 3965 36 2ii' _ SERIES EE--- All.. IMTURI }1EAE0# WjLI,FAY _ r ;2:05 03 0914 PEN 05 19x87 ~7,9 PAR ANDREW DANISH 504 BRAND` AV E NEW CUMBERLAND -PA 1`7070 ,03-4150 VVV : 51219/87 GATING STAMP Ht3G* PA*" s r ,OANI511 _ I ~R; , PR OV.I D ~~i C,E _ , - - - - Kb~113589EE 1:0000-9000 71:00 006 7 L L 3 58911, i `~aby~=~~'y~~~dlRdl~Fr v~~„„s1Y r' • I u N •I I M_ 11,P,~ ~ • 1 11IN. .~~~`""„;,i~.. p Ik ~ ~~~~Ve THE MATURITY HEREOF WILL PAY SERIES EE 205 03 0914 PEN 06 1987 n. /o MR ANDREW DANISH 504 BRANDT AVE O..SIIr~~ NEW CUMBERLAND PA 17U70 ° E< H ''I^ \ l' ,i 11 "DATINGST~M~~ VBG. PA.,, UR PROVIDENCL' M DANISH - u, ass Kb~M009EE 1:0000900071:00 006 7 i L 10091i' \V '1'lp" 1'lfr'. - v 1 1 u V 1 - y _ _ 1 / 1~ ,v r I If I tl~~, AT THE MATURITOFP('(Y~~y ^E SERIES EE 205 03 09141 PEN 12 ,1987 I IA! P YtI. MR AN' REW DANISH 504` BANDT :AV NEW CUMBERLANa PA 1,7070 ,1{03-~}.~4150 .12/31/87 . DATING STAMP 1..' ;QRj PROVIDENCE M DANISH ',08G. PA K139bSS2SEE 1:0000900071:00 00739655 25ii' I i d l e A 1, 46 __ik~ XIT 9yY4 11 H 11 t 1 I 1 s k AltEMATURITY HEREOF WILL SERIES EE off"' 205 03 09141!IVl~ 03 1987; ' ''41 719 MR ANDREWTDANISH NEW CUMBERLAND-,PA 17070 (03-~4{A1~5T(0 5 l.I 1J {J 1 .GE W LJ i M- 3/13/87; DATING STAMP "PEN ~ HBC. PA:' iOR PROVIDENCE M_ DANISH Kb3894bl2EE -a" 1:00009000?1:00 00638946 L 2n' i S Ell SERIES EE AT TIE IA-RITY.-OF -L PAI is 20: 03 091`'+I 03; ]1987 . To MR ANDREW DANISH - 504 BRANDT AVE - 03-4150 NEW CUMBERLAND 'PA '17070 DID&T-C-®. :k 3/ 6/87 y\ " - DATING STAMP PEN HBG. PA, n PROV IflENCE M DANJ SH 3 S..nT.,yrFA.7F uy 1:00009000 71:00 006;3894Le 7-Gill JZI 1,172 2,0'j tit ~!'t .:,gip ai V : - 1, 1 1 1' .s \vi r 1 4:~ : „.\vr mill T THE MATURITY HEREOF WILL PAY SERIES EE n;& Nm 205 03 09141 03 1987 T,'r' MR ANDREW DANISH 504 BRANDT AV. NEW CUMBERLAND PA 17070 03-ftl5Dj~ i 1 DU~EE(EVNr AG f To 1 1 313118.7 L DATING ST MP POOR PROVIDENCE M DANISH HBG. PAP, Kb38949410EE 1:0000900071:00 fill 0063894910lie ' i\ Yj~• ~~~Y~E„~R >e. ~ / u V :•1 I Y : _ 1' - 1 1 ,,:~R~.:\~/~z ."i~~S~\VI' ~ AT THE MATURITY HEREOF WILL PAY SERIESEE jdAAa, l ~ i\ l T e-91X ~f ~AA- rr, i,y 205 03 0914 03 1987 R AN RED DAN - 504 B ANDT AV NEW CUMBERLANDI PA I7070 03p)I-M41(5,0 3I?7/87; IT DATIN STAMP PE. \J-1SC. PAO 0 PROVIDENCE 'M., DANISH', K638948lbEE 11:0000 9000 71:00 00 6 38 9 48 1611' I (YbY~f~ s Ir, 7m ~ R 1\..m~~~1' i~t `~~";\VI\M ' •'d~4 P'ri ~ l6l/' •'Y/! a rr~.. 1 1 u N "1 1 _ 11 : ~ _ 1 _ 1 1 1 ~ i~...w,\WI'r,;,,. {I{FE., %i~~~s(a SERIES EE q[ RI AT THE MATURITY HEREOF WILL PAY PEN 12 1987 12-0503 0914 _ 1 3 MR~ ANDREiN DANISH - 504 BRANDT AVE NEW CUM 8&RLANI) IPA ;170"70 OIAuiN3A~~Y DOBT C1. 11~1~4,~P~37 'H1iG. PAS o PROVIDENLE M DANISH - I I /yn{ = K~39bS395EE 1:00009000 71:00 00 7 396 5 39 sill I - i Yia. , 0~~~9''~' q/r`~ • 1 u V 1_ V_ / 1 1 1<\vi: ~j ''1~►~~ SERIES EE `JIB- T AT THE MATURITY HEREOFWILL PAY t 2 05 03 0914 ( 1. PEN 06, 1987 ~3R ~A OREW DA ISH 504 RANDT A E NEW CUMBERLAND PA 17070 tj~5UIN6 ~~FE DO/B11T Co. tn~ ~1fT117 ~M~ HBG. PAY' URI ,PRGV.IDENCL ~~A'i~DANTS~6~ i. Kb91139b9EE 1:0000900071:00 0 06'7 1`13 7 69 i' Calculated Value of Your Paper Savings Bond(s) http://www.treasurydirect.gov/BC/SBCPrice Calculated Value of Your Paper Savings Bond(s) Calculator Results for Redemption Date 05/2012 Total Price Total Value Total Interest YTD Interest $68.75 $267.68 $198.93 $2.76 Bonds: 1-2 of 2 Issue Next Final Issue Interest Serial # Series Denom Date Accrual Maturity Price Interest Rate Value Note C309230272 EE $100 01/1992 07/2012 01/2022 $50.00 $89.56 4.00%1$139.56 Q2159324329 E $25:,12/1965 12/1995$18.75. $109.37 $128.12 MA Totals for 2 Bonds $68.75 $198.93 $267.68 Notes NI Not Issued NE Not eligible for payment P5 Includes 3 month interest penalty MA Matured and not earning interest 1 of 1 2/1/2013 11:13 AM H&R Block ® H&R BLOCK ADVANTAGE Prepared For: Prepared By: For Year- round Service: SUSAN SPRACKLEN HRB TAX GROUP INC HRBTAXGROUPINC 5094 C Jonestown Rd Ste 12 Date Prepared: 717 Market St Harrisburg, PA 17112- 0000 Lemoyne, PA 17043- 0000 (717)901- 0786 02/04/2013 (717)901- 2744 1 appreciate your business and thank you for trusting me to be your tax partner. My business continues to grow through recommendations from clients like you and I'd be-honored to help anyone you recommend to me. Today's Savings In simple terms, the Marginal Tax Rate is the tax rate that you pay on your fast dollar of taxable income. It is the highest federal tax bracket that affects your tax calculation. The Effective Tax Rate is the percentage of your total income that you paid in taxes. For 2012, your Marginal Tax Rate is 0% and your Effective Tax Rate is 0%. Total Savings ..................................................................$0.00 Filing, Refund and Balance Due Information Refund / Tax Return efile (Balance Due) Summary Message Federal Yes $1,252.00 Refund $1,252.00 Based on IRS acceptance of yourtax return today, H&R Block Fees ($189.98) your IRS check for $1,252.00 should be mailed to you in 3 to 4 weeks. Pennsylvania Yes $0.00 Refund $0.00 Your tax return has been e- filed: no additional action is needed. 'The Department of Treasury Offset Program maytake an offset against yourtax refund to pay child support, state tax or other debt. You can contact the agency by calling 800- 304- 3107. Refund timing is based on the IRS Refund Cycle chart. Actual date may vary. Projected date based on normal processing and assumes your return does not req uire further review by the IRS. 'To check the status of your return 24 hours a day, log onto www.hrblock.com/myreturnstatus or call toll- free 1- 866- 761- 1040. Have the primary Social Security number and date of birth available. This H&R Block Advantage document provides information that could help you improve your tax and financial situation. Its contents should be considered in conjunction with information you receive from other sources that are familiar with your specific circumstances. Tax services offered through subsidiaries of H RB Tax Group, Inc. Advantage (2012) FDADVICE- 1V1.0 Form Software Copyright 1996- 2013 HRB Tax Group, Inc. REV-15og EX+ (oi-io) i pennsylvania SCHEDULE F - DEPARTMENT OF REVENUE INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Andrew T. Danish 21-12-0615 If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A• Andrew G. Danish 506 Terrace Drive, New Cumberland, PA 17070 Son B. C JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 06/01/82 PNC Bank - Checking Account 187,664.57 50%' 93,832.29 2. A. 03/09/89 PNC Bank - Savings Account 574.67 50% 287.34 3. A. Metro Bank - Savings Account 247.52 50% 123.76 TOTAL (Also enter on Line 6, Recapitulation) $ 94,243.39 If more space is needed, use additional sheets of paper of the same size. Total Banking Statement PNCBANK PNC Bank Primary account number: 51-4007-5584 Page 1 of 7 For the period 04/07/2012 to 05/07/2012 Number of enclosures: 0 000984 M For 24-hour banking, and transaction or ANDREW DANISH interest rate information, sign on to ANDREW G DANISH PNC Bank Online Banking at pnc.com. 504 BRANDT AVE $ For customer service call 1-888-PNC-BANK NEW CUMBERLND PA 17070-1834 Monday -Friday: 7AM-10 PM ET Saturday & Sunday: 8 AM - 5 PM ET Para servicio en espa Rol, 1-866-HOLA-PNC Moving? Please contact us at 1-888-PNC-BANK ® Write to: Customer Service PO Box 609 Pittsburgh PA 15230-9738 Visit us at pnc.com TDD terminal: 1-800-531-1648 For hearing impaired clients only Relationship Overview Bank Deposit Accounts Description Account Number Deposit Balance Interest Checking 51-4007-5584 574.67 Savings 51-3014-8401 187,664.57 Total Deposits 188 239.24 Enroll in online statements today through online banking, and have access to your checking and saving statements for up to 6 years. Enroll today by visiting the Customer Service Tab in online banking. Premium Plan Andrew Danish Interest Checking Account Summary Andrew G Danish Account number: 51-4007-5584 Overdraft Protection has not been established for this account. Please contact us if you would like to set up this service. Your account is currently Opted-Out of Overdraft Coverage. To learn more, visit us online at pnc.com/overdraftsolutions Balance Summary Beginning Deposits and Checks and other Ending balance other additions deductions balance 182.56 1,975.00 1,582.89 574.67 Average monthly Charges balance and fees 348.99 .00 Transaction Summary Checks paid/ Check Card POS Check Card/Bankcard withdrawals signed transactions POS PIN transactions 4 0 0 Total ATM PNC Bank Other Bank transactions ATM transactions ATM transactions 0 0 0 PN D M LT01-J O B89 366-140- N N N N N N-004-00318 2 Total Banking Statement PNCBANK For the period 04/07/2012 to 05/07/2012 ff~l For 24-hour information, sign on to PNC Bank Online Banking ANDREW DANISH on pnc.com. Primary account number: 51-4007-5584 Account number: 514007-5584 - continued Page 3 of 7 DID YOU KNOW... THE GREATER YOUR RELATIONSHIP, THE GREATER YOUR REWARD. 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PNC Bank, National Association (PNC Bank) is the creditor and issuer of the credit cards referenced above. Member FDIC CashBuilder, PNC points and PNC Flex are registered marks of The PNC Financial Services Group, Inc. Visa is a registered trademark of Visa International Service Association and used under license. Need to make a deposit? Try it on your SmartPhone. Using Mobile Deposit is easy. First download the Virtual Wallet App or PNC App, enter the amount and where you want the funds deposited, then take a picture of the front and back of the check. Third party message and data rates may apply. Use of the Mobile Deposit feature requires a supported camera-equipped device and you must download a PNC mobile banking app. Eligible PNC Bank account and PNC Bank Online Banking required. Certain other restrictions apply. Give Mom, Dad or Grad the gift they have always wanted The PNC Bank Visa® Gift Card is perfect for everyone on your gift list. PNC Bank Visa Gift Cards are easy to purchase at most of our branch locations. They come with a gift card carrier of your choice to highlight the special occasion. To learn more, visit your local PNC Bank branch or pnc.com/giftcard. Visa(R) is a registered trademark of _Visa USA. Inc. Premium Plan Andrew Danish Or Savings Account Summary Andrew Gerard Danish Account number: 51-3014-8401 Balance Summary Beginning Deposits and Checks and other Ending balance other additions deductions balance 187,899.66 5,039.91 5,275.00 187,664.57 Average monthly Charges balance and fees 186, 736.65 .00 PN DMLT01-J OB89366-140-N N N N N N-004-003183 - PENNSYLVANIA INHERITANCE TAX \B INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES ~ FILE NO. 21 PO Box 280601 DennS lvania AND HARRISBURG PA 17128-0601 ACN 12137773 DEPARTMENT OF REVENUE TAXPAYER RESPONSE DATE 06-25-2012 REV-1543 EX AFP (05-11) TYPE OF ACCOUNT EST. OF ANDREW T DANISH X❑ SAVINGS SSN 205-03-0914 R CHECKING DATE OF DEATH 05-09-2012 F-1 TRUST COUNTY CUMBERLAND CERTIF. REMIT PAYMENT AND FORMS TO: ANDREW G DANISH REGISTER OF WILLS 506 TERRACE DR 1 COURTHOUSE SQUARE NEW CUMBERLAND PA 17070-1562 CARLISLE PA 17013 PNC BANK NA provided the department with the information below, which was used in calculating the inheritance tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you are the spouse of the deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. Please call 717-787-8327 with questions. COMPLETE PART 1 BELOW x SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 5130148401 Date 06-01-1982 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of wills. Make check Account Balance $ 187,665.00 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $ 93,832.50 months of the decedent's date of death, Tax Rate X 045 deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due 4,222.46 nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT A. ❑ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or return this notice to the Register of Wills and C ONE an official assessment will be issued by the PA Department of Revenue. B LOCK B. The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return ONLY filed by the estate representative. C. The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 121 and/or PART M below. PART If indicating a different tax rate, please state OFFICIAL USE ONLY E AAF Fil relationship to decedent: 11-1 PA DEPARTMENT OF REVENUE TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date Established 1 1 2. Account Balance 2 $ 2 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ 6 5. Debts and Deductions 5 - 5 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X 7 8. Tax Due 8 $ 8 PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) 5 Under penalties of perjury, I declare that the facts I reported above are true, correct and complete to the best of my knowledge and belief. HOME C 17 ) 77" a 5 vt WORK C ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE PENNSYLVANIA INHERITANCE TAX BUREAU OF INDIVIDUAL TAXES INFORMATION NOTICE FILE NO. 21 PO Box 280601 ennS lvania AND HARRISBURG PA 17128-0601 ~ r ACN 1213]]]2 DEPARTMENT OF REVENUE TAXPAYER RESPONSE DATE 06-25-2012 REV-1543 E% AFP (05-11) TYPE OF ACCOUNT EST. OF ANDREW T DANISH ❑ SAVINGS SSN 205-03-0914 X❑ CHECKING DATE OF DEATH 05-09-2012 ❑ TRUST COUNTY CUMBERLAND ❑ CERTIF. REMIT PAYMENT AND FORMS TO: ANDREW G DANISH REGISTER OF WILLS 506 TERRACE DR 1 COURTHOUSE SQUARE NEW CUMBERLAND PA 17070-1562 CARLISLE PA 17013 PN C BANK NA provided the department with the information below, which was used in calculating the inheritance tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you are the spouse of the deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. Please call 717-787-8327 with questions. COMPLETE PART I BELOW x SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 5140075584 Date 03-09-2009 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 575.00 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $ 287.50 months of the decedent's date of death, Tax Rate X .045 deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due $ 12.94 nine months after the date of death. PART TAXPAYER RESPONSE F1 I FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT A. ❑ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. C 0 NE BLOCK B. 4 The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return ONLY filed by the estate representative. C. ❑ The above information is incorrect and/or debts and deductions were paid. Complete PART ❑2 and/or PART rq below. PART If indicating a different tax rate, please state OFFICIAL USE ONLY ❑ AAF relationship to decedent: PA DEPARTMENT OF REVENUE TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date Established 1 I 2. Account Balance 2 $ 2 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ G 5. Debts and Deductions 5 - 5 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X 7 8. Tax Due 8 $ 8 PART DEBTS AND DEDUCTIONS CLAIMED P] DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) 5 Under penalties of perjury, I declare that the facts I reported above are true, correct and complete to the best of my knowledge and belief. HOME ('71 ) _72L OS- YS-0" c. vf~ WORK C ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE M Metro Bank 3801 Paxton Street Harrisburg PA 17111-1418 1-888-937- ymetrroba000com BANK m >10763 7613995 001 092140 I NQ UJicLI0. W ANDREW DANISH Jo 1/1 7- W r1-1, 42 I'L-) _r'.114 n& "7 p7 DONNA M DANISH G--- Q o~~dL w.! /7a-,I-R- ~O ®-ST 'at Q ( 4 l~ 506 TERRACE DR NEW CUMBERLAND PA 17070 We're here 7 days a week, 24 hours a day at 1-888-937-0004. PIERS STATEMENT SAVINGS 0627046410 Statement Balance as of 03/31/12 $247.52 Plus Deposits and Other Credits $0.00 Less Checks and Other Debits $0.00 Plus Interest Paid $0.12 Statement Balance as of 06/30112 $247.64 Transactions By Date Date Description _ Debit Credit Balance 04/30112 INTEREST PAYMENT - $6.04 $247.30 05131/12 INTEREST PAYMENT $0.04 $247.60 06129112 ` INTEREST PAYMENT $0.04 $247.64 Interest Summary Beginning Interest Rate 0.20% Number of Days in this Statement Period 91 Interest Earned this Statement Period $0.12 Annual Percentage Yield Earned this Statement Period (APY); 0.20% Interest Paid Year to Date $0.24; 0 °Fees Summary e Total Overdraft Fees this Statement Period $0.00 00 Total Overdraft Fees Year to Date $0.00 00 Total Returned Item Fees this Statement Period $0.00 00 Total Returned Item Fees Year to Date $0.00 0 For your convenience, a summary of overdraft and returned item fees appears on your monthly statement. Please note that the overdraft fee U) summary includes non-sufficient funds fees, uncollected funds fees and unavailable funds fees. The summary does not reflect refunded or waived o items credited to your account. ~ Metro Bank is offering Home Equity Loans and Lines of Credit with AMAZING rates! Apply today for the cash you o need at your nearest Metro Bank store, online at mymetrobank.com or call Loan-by-Phone at 800.296.1015. Ask a representative for details on rates and terms. Interest may be tax deductible (consult your tax advisor). Equal Opportunity Lender. Looking for a credit card with an AMAZINGLY low interest rate, no late fees and no annual fee? Look no further than the Metro Bank Personal Visao Credit Card! It's easy to apply. Visit your nearest store, call 800.296.1015 or visit mymetrobank.com. See pricing and terms for details on fees. A foreign transaction fee of up to 1% of a foreign transaction amount will apply. This is a fee charged by Visa and is not directly assessed by Metro Bank. 35 Cycle Pagel of 2 NOTE : SEE REVERSE SIDE FOR IMPORTANT INFORMATION 92140 ROLL 07/11 Member FDIC REV-151.0 EXH- (08-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Andrew T. Danish 21-12-0615 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. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATFACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. Transamerica Life Insurance Company - Annuity No. 0200PBO9203 271,524.43 100 271,524.43 2 Metropolitan Life Insurance Company - IRA Contract No. 010179170 15,172.93 100 15,172.93 3 Fidelity Retirement Savings - 401(k) Account No. 205030914 37,089.46 100 37,089.46 TOTAL (Also enter on Line 7, Recapitulation) $ ` 323,786.82 If more space is needed, use additional sheets of paper of the same size. TRANsAmEmcA Administrative Office; 4333 Edgewood. Road NE a L I F E INSURANCE COMPANY Cedar Rapids, IA 52499 www.transamericaannuities.com June 8, 2012 ANDREW G DANISH 506 TERRACE DR NEW CUMBERLAND PA 17070 RE: Annuity Number(s) 0200PBO9203 Dear Claimant: We have received notification of the death of Andrew T Danish. We extend our sincere condolences to you for your loss. The information in this letter is being provided to assist you in submitting death claim paperwork. Our records reflect the following information regarding this annuity: Annuitant: Andrew T Danish Owner: Andrew T Danish Claimant: Andrew G Danish 1000 Annuity value: $271,524.43 as of 05/09/2012 Annuity type: Non-Qualified Tax Information This letter includes general tax information that should not be relied upon for personal tax planning. Transamerica Life Insurance Company does not give legal, tax, or accounting advice. You may want to consult your attorney, tax advisor, or accountant with questions regarding the direct tax consequences when selecting an option. General Information The financial professional of record will remain on this annuity unless we are notified of a change in writing. Please be advised automatic operations such as Systematic Payouts and Automatic Payments have been stopped. an AEGON company Metropolitan Life Insurance Company P.O.Box10342 Des Moines IA 50306-0342 October 27, 2012 ESTATE OF ANDREW DANISH 504 BRANDT AVE NEW CUMBERLAND, PA 17070 RE: METROPOLITAN LIFE INSURANCE COMPANY CONTRACT 010179170 DECEASED ANDREW DANISH Dear Executor: We are writing to provide you with important information regarding the above contract. The Internal Revenue Service requires we furnish the date of death value for Individual Retirement Annuities (IRA) on which a death claim has been filed in case this value is needed for income tax purposes. In most cases, the executor/administrator of the decedent's estate will not need the date of death fair market value for income tax purposes. The date of death valuation will only be necessary for income tax purposes if one or more of the decedent's IRAs contain nondeductible contributions and, in addition, the decedent received an IRA distribution in the year of death. This is to inform you that the value of the IRA contract as of the date of death, May 09, 2012, was $15,172.93. If you have any questions, please contact your representative or call our Customer Service Center at 1-800-638-7732 (Client Line) Monday through Friday between 9:00 a.m. and 6:00 p.m., ET. Sincerely, SA Sfwphe%d Seth Shepherd Annuity Representative - Post Issue Processing MetLife Annuity Operations and Services ADVANCE 401(k) PLAN Retirement Savings Statement May 8, 2012 - May 9, 2012 ENV#OP000018 OP 20925 D ANDREW DANISH For information: Call 1 (855) 238-4015 5 04 BR_kNDT AVE Internet Address: http://www.fidelity.com/atwork NEW CUM3ERLAND, PA 17070 Get Your Statements Online Online statements offer many advantages over paper statements. For instance, you can view and print up-to-date statements whenever you like, and you can retrieve statements for any date, month, quarter, or custom date range within the previous 24 months. To sign up for online statements, please visit us online, go to Mail Preferences under the Your Profile tab, and update your delivery preference for savings statements and other notices. You must also provide us with a valid e-mail address so that we can periodically remind you to view your statements and other notices online. Your Account Summary Your Asset Allocation Beginning Balance $37,231.45 Change in Account Value -141.96 Stocks 40% Ending Balance $37,089.49 Bonds 60% Additional Information Vested Balance $37,089.49 Your Personal Rate of Return This Period -0.4% Year to Date 3.7% Your Personal Rate of Return is calculated with a time-weighted formula, widely used by financial analysts to calculate investment earnings. It reflects the results of your investment selections as Your investments are currently allocated among the displayed well as any activity in the plan account(s) shown. There are other asset classes. Percentages and totals may not be exact due to Personal Rate of Return formulas used that may yield different rounding. results. Remember that past performance is no guarantee of future The Additional Fund Information section lists the allocation of results. your blended funds. Market Value of Your Account This section displays the value of your account for the period, in both shares and dollars. Shares on Shares on Price on Price on Market Value Market Value Investment 0510712012 0510912012 0510712012 0510912012 on 0510712012 on 0510912012 Blended Fund Investments" $37,231.45 $37,089.49 Target Retirement 3,549.233 3,549.233 $10.49 $10.45 37,231.45 37,089.49 Account Total $37.231.45 $37,089.49 Please read this statement carefully. Any error must be reported to Fidelity Investments within 90 days. 0018 OP000018 0001 20120810 OP4K Page 1 of 4 ADVANCE 401(k) PLAN Statement Period: 05/08/2012 to 05/09/2012 Your Account Activity Use this section as a summary of transactions that occurred in your account during the statement period. Employee Term Employer Activity Deferral 4 Total Beginning Balance $23,858.19 $13,373.26 $37,231.45 Change in Account Value -90.97 -50.99 -141.96 Ending Balance $23,767.22 $13,322.27 $37,089.49 Vested Percent 100.00 % 100.00 % Vested Balance $23,767.22 $13,322.27 $37,089.49 A message from Advance To make changes to your account or for questions about this statement, visit the website at hftp://www.fidelity.com/atwork or contact a Customer Service Representative at 1-855-238-4015. A Message from Fidelity Investments To access performance information on the investment options available in your Plan - log onto NetBenefits at www.fidelity.com/atwork or call your plan's toll-free number. Before investing in any investment option, please carefully consider the investment objectives, risks, charges and expenses. For this and other information, call or write Fidelity for a free mutual fund or variable annuity prospectus. Read it carefully before you invest. For more information on your vested account balance, please refer to your Summary Plan Description, Custodial Account Agreement, or other plan materials. Fidelity Brokerage Services LLC, Member NYSE, SIPC, 900 Salem Street, Smithfield, RI 02917. 459279;460035 Additional Fund Information Use this section to determine the asset allocation of your blended investments. Blended Investment Stocks Bonds Short-term Target Retirement 40% 60% 0% Blended Investments must invest in more than one asset class. The blended investment asset allocation above reflects the stated neutral mix or, if not available, the asset mix reported by Morningstar, Inc., for mutual funds or by investment managers for non-mutual funds. 0018 OP000018 0001 20120810 OP4K Page 3 of 4 pennsylvania DEPARTMENT OF REVENUE BUREAU OF INOIYIDUAI TAXES August 30, 2012 ANDREW DANISH 506 TERRACE DRIVE NEW CUMBERLAND PA 17070 Re: Estate of: Andrew T Danish Social Security Number: 205-03-0914 File Number: 2112-0615 Dear Sirs: The Department issues this waiver for the following security held in beneficiary format by the decedent. The security will be subject to Pennsylvania inheritance tax. The Department will not issue an information notice to the transferee of the potential Pennsylvanian inheritance tax due for this asset as the estate representative has informed the Department that the asset(s) will be reported on the REV-1500 filed by the estate representative. A copy of this waiver is to be used by you to notify the transfer agent that the reporting requirements of Section 6411 of the Probate Estates and Fiduciaries Code (Title 20, Chapter 64, Pennsylvania Consolidated Statutes), have been satisfied. Name of Company: FIDELITY Type of Account: Security Account ID Number(s) 205030914 Account Balance(s): $37,089.49 Sincerely, atu"Judy Watts Inheritance Tax Division REV-1511 EX+ (10-09) i Pennsylvania SCHEDULE H ' DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Andrew T. Danish 21-12-0615 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Parthemore Funeral Home & Cremation Services, Inc. 10,155.00 2. Rolling Green Cemetery Company 1,245.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: 3,000.00 2• Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City - - - - State ZIP Relationship of Claimant to Decedent 4• Probate Fees: 753.74 5. Accountant Fees: 6. Tax Return Preparer Fees: 189.98 7• West Shore Emergency Medical Services - ALS 977.50 8. Borough of New Cumberland 230.48 9. Pennsylvania American Water ($33.28 + $33.35 + $18.15) 84.78 10. Verizon 12.93 11. ` PP&L Electirc Utilities ($30.72 + $29.59 + $33.90 + $43.33) 137.54 (continued on attached page) 1,235.59 TOTAL (Also enter on Line 9, Recapitulation) 18,022.54 If more space is needed, use additional sheets of paper of the same size. SCHEDULE H - Funeral Expenses & Administrative Costs (continued - page 2) AT & T 20.44 Premium Mowing and Lawn Service 730.00 Penn National Insurance - Homeowners Insurance 123.00 Cropf Bros., Inc. 362.15 Total of Continued Page: $1,235.59 \ M, -L -rafftio:n Of r,~ IL _..LJ~_ S_J ~1*~ ~ 5.R 3/1.11 i T -rv'c~s~ Inc, Mr. Andrew G. Da 506 Terrace Drive 5/11/2012 New Cumberland, PA 17070 For the Service of Andrew T. Danish 1303 Badge S.reet We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way P. 0. Bo„ 431 we can. Please feel free to contact us if you have any questions in regard to this statement. The following flew Cumherl_and, P a 1707u is an itemized statement of the services, facilities, automotive equipment and merchandise that you selected when making the funeral arrangements. (717) 774-7721 (Fax) 774-5546 Terms Due Date Account # tivw,w.partlhernore.com Net 30 6/10/2012 2012034.0 Description Amount SERVICES & MERCHANDISE Traditional Funeral Service 6,395.00 Jesus of Nazareth Stationery Set 165.00 Gilbert Stainless Steel Casket, "Rockefeller" 2,895.00 ~1. PatThemore, Founder Total Services and Merchandise 9,455.00 Gilbert J. Parthemore, Supervisor CASH ADVANCE ITEMS Stephen K. Palthemore, Death Notice, Harrisburg Patriot (No Charge) 0.00 F 20 Certified Copies of Death Certificate 120.00 C` S Clergy Honorarium , 150.00 Organist Honorarium 125.00 Bruce R. Par themore, Soloist Honorarium 75.00 Pre-Aleed Coordinator, CPC Altar Servers 30.00 Flowers, Casket Spray 200.00 Total Cash Advances 700.00 Professional Memberships: NFDA_ - PFDA DCFDA a CCFDA The Rule You ~i6rom, The Peorle You Trust Tota 6 $10,155.00 Payments/Credits $-10,155.00 Balance Due $0.00 - C 77 y C ~ n 0 4 O N O f ❑ 4 • ~"3 ~ any 1a y y ro y z O p r 0 A IZ y a ~ x icy, n y • C~ z P` \ f y H SALES DRAFT H&R Block 36635 717 MARKET ST LEMOYNE, PA (717)901-2744 02/04/2013 16:59:01 CREDIT CARD VS xxxxxxxxxxxx2836 MERCHANT ID 904236635994 TERMINAL ID 0001 RECEIPT 2477333 INVOICE 03561133 AUTH. CODE 05784A ENTRY METHOD SWIPED SALE TOTAL $189.98 I agree to pay above total amount according to card issuer agreement (merchant agreement if credit voucher) X DANISH, ANDREW AFTER 5 DAYS FOLLOWING COMPLETION OF SERVICES, ALL PURCHASES ARE FINAL, NON-CANCELABLE AND NON-REFUNDABLE, EXCEPT AS SPECIFIED IN THE APPLICABLE RETURNS POLICY CUSTOMER COPY ALS EMERGENCY LEVEL 1 - A0999 1.0 967.62 967.62 EKG ELECTRODES (1) A0398 4.0 0.80 3.20 GLUCOSE BLOOD A0394 1.0 7.08 7.08 ~ I I i I - Total Charges 977,90 ---DES(~Ci9PTION OF PAYMENT I RECEIPT I PA5'MUIT DfTE I l~PR4eJf,1 T . Total Credits 0.00 $977.90 DANISH, ANDREW CALL r+u11nBER: 120780A AnnoUnlT P 1P1: 05/10/2012 RESPONSIBILITY. THESE SERVICES ARE NOT COVERED BY MEDICARE AND ARE YOUR . WEST SHORE EMS - ALS 205 GRANDVIEW AVE CAMP HILL, PA 17011-1708 '\J i \ I s -s 0 w I:i cn w O =~oU.i I T O > r 0= d) ~ LU T L-1 . d/4/LU I L DANijH,'ANDREW 504 BRANDT AVENUE NEW CUMBERLAND PA 17070 Your utility account for service at 504 BRANDT AVE is currently past due in the amount of $121.00. SEWER $80.47 TRASH $40.53 Please forward payment as soon as possible to bring your account up to date. If you have any questions or feel this amount is in error, please contact the Borough Office at (717) 774- 0404. Thank you, New Cumberland Borough 9 ~ BORO OF NEW CUM! N* w [=:rarnB~r I ~nc1 Bc_)rc)t-j V) 1120 MARKET ST P. O. Box 22( NEW CUMBERLAND, R RIEGE I V, Dabf : 6/11/2012 Steiun: 1 (,asluer: 1 PJame: DANISH ANDREW Trancode SY Invoice Account Amount UBPayment UB 122073 141190-- -$115 24 ' Total Due: $115.24 Tendered $115.24 Change $.00 Thank you for your uavoient! (Please keep this portion for your records) Account Number: 147190-147190 Billing Period Usage Units Service Address: 504 BRANDT AVE Sewer APR MAY JUN Customer Name: DANISH, ANDREW Trash JUL AUG SEP BILL DATE: 8/1/2012 DUE DATE: 9/1/2012 IF PAID ON OR BEFORE DUE DATE IF PAID AFTER DUE DATE BAL FWD $0.00 BAL FWD $0.00 Sewer 76.64 Sewer $80.47 Trash 38.60 Trash $40.53 TOTAL DUE $115.24 TOTAL DUE $121.00 Make check payable to: New Cumberland Borough 1120 Market Street, PO Box 220, New Cumberland PA 17070 Payment Drop Box: Located next to the main entrance of the Borough Office. Payments placed in the drop box after 4:30 PM will not be credited until the next business day. Sewer/Trash Payments: All payments are due by 4:30 PM on the due date. Payments received after that date are considered late and are subject to a 5 % penalty. This includes the drop box payments and U.S. Mail postmarked after the due date. Non-sufficient Funds: A fee of $20.00 will be charged for checks returned due to insufficient funds. Delinquent Charges: A civil claim will be filed and additional costs, fees and charges will be assessed if account is not paid within 90 days of due date. Questions: If you have any questions, please contact our office at (717) 774-0404. Our office hours are Monday through Friday, 8:30 AM to 4:30 PM. This office is closed on Saturday, Sunday and Holidays. E-mail: info@newcumberlandborough.com Special Messages: 1982 SEPT 22 APPLE FESTIVAL OCT 23 HALLOWEEN PARADE OCT 26 TRICK OR TREAT NIGHT New Ct.rrnbai 1 ~jnd Bar c~i_rl i RECEIPT-39802 Date: 812212012 Station: 1 Cashier: 1 Name: DANISH ANDREW Trancode Sys Invoice Account Amount UBPayment UB 125890 147190 $115.24 Total Due: $115.24 Tendered $115.24 Change $.00 Thank you for your payment! v0 =?RjM z co W -0 D -n M CD _ - = (D n O z' cn cn' - -zz O r- -0 co N w .x.. 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Thanks! -33.28 Filling Period & Meter Information Total prior balance, Jul 10, 2012 .00 Billing Date; Jul 10, 2012 ---------Current Water Charges---------- ) Service Charge 13.75 Billing Period: Jun 05 to Jul 05 30 days Next reading on/about: Aug 06 (2012 DSl - PAWC Charge 0.83% Total water charges, Jul 10, 2012 • 11 Rate Type: Residential 13.86 ----------Other Current Charges---------- Meter readings in current billing period: H20-Help To Others 1 .00 In Home Meter Number N044037967 is a 58-inch meter. Customer Protection Sewer Line 3 .99 Present-actual 79300 9.00 Last-actual Customer Protection Water Line 5.50 79300 Total other charges, Jul 10, 2012 Gallons used 0 19.49 ----------AMOUNT DUE $33.35 Water Usage Comparison 2 Monthly usage in hundred gallons. 2 J A S p .:N. ,.D. J F. M- A- M -J - J- 2 10 u o c o e a e a p a u u o 9 1 v c i b r r y n 1 1 . 2 a PRESORTED FIRST-CLASS MAIL! US POSTAGE PAID AMERICAN WATER ~ r1 J V Customer Account Information Billing Summary For Service To: A T Danish ----------Prior Balance------------------------ 504 Brandt Ave Prior Water Balance $17.55 Account Number: 24-0623738-4 Prior Balance Other $38.98 Premise Number: 24-0368764 Payments prior to Sep 14, 2012. Thanks! .00 Total prior balance, Sep 14, 2012 56.53 Billing Period & Meter Information ----------Adjustments---------- Billing Date: Sep 14, 2012 CPP Adjustment - water -5.50 Water Line Protect Adj -5.58 CPP Adjustment - sewer -9.00 Rate Type: Residential Sewer Line Protect Adj -10.31 In Home Line Protect Adj -4.00 CPP Adjustment - in home -3.99 Total adjustments, Sep 14, 2012 -38.38 ----------A M OU N T D U E--------------------- $18. 15 Water Usage Comparison Monthly usage in hundred gallons. 0 e 0 o eD J e a A M J J A S 2 1 p t v c n b r r y n u g p 1 2 Messages to you from Pennsylvania American Water Any portion of the water charges which is not paid as of 10109112 will be subject to a 1.50% penalty. " The due date pertains to current charges only. Any past due balance should be paid immediately. "Approximately 4.57 percent, or $0.00, of State taxes are included in your current bill. Effective July 1, 2012, the Distribution System Improvement Charge (DSIC) increased from 0.32% to 0.83%. This charge funds the replacement of water distribution facilities. "Have you recently changed your primary phone number? If you have, please update your account information onfin using My H2O Online at www.amwater.com/myh2o or call us at the number below so that we can update our records 001800/001800 NCEOSR TAT11 12 Customer Service & Emergencies 1-800-565-7292 (24 Hours) For Hearing Impaired Customers TDD 1-800-300-6202 (24 Hours) Visit us online at: www.pennsylvaniaamwater.com RAW 100AM8091 9397 Account Number Due Date Amount Due 717 774-1643 1145 171Y Upon Receipt 512.93 Account Information verizon.coin Scup 'Bill Pate`Account L'lrarnes Statement Date: 6/18/12 AutnPap P7pe,FterHill Repa7r IAR ANDREW DANISH On D-d/Pa} Fe-Uieu- "wrrxse lletad- Phone: 717-774-1643 ` GD green today - Go Paper Fro, ~g l~erlZOn crnWmyieri7on Account Summary ` Previous Balance $3101 No Payment Received - $.00 Don°t Move Without Verizon! Balance Forward $33.01 Call 1-888-416-9691 before you move. We'll help set up your Internet, TV and Phone for your new, new Charges address. You can be up and running in no time! DON'T WAIT! And be sure to ask if FiOS is available in your Current Activity _$14,77 area. Service availability varies. - - - - - - 3- Taxes, Fees and Other Charges -$5.31 We Want You to Stay With Ds Total New Charges _ 420.08 You are a valued customer & we want to deliver the very best service & value to you. Call us at Amount Due - Please Pay Now $12.93 1-877-875-8490 to find out about the new ways Verizon can save you money. We appreciate being Final Bill your provider, and we would like to keep you with us longer by improving your Verizon experience. Better Bundles That Save Call 1-888-363-3644 or visit verizon.com/supreme to make sure that you're getting the best Verizon services at the best value. From phone, Internet and TV bundles, to international plans and fun add-ons, together we'll find ways to save you more on Verizon's sr nerior services. Questions about your bill or service? Want Automatic Payment? View your bills in detail at venzon.com or call 1-800-VERIZON (1-800-837-4966). Enroll below or at Vedzon.com to authorize your financial Enter your ten digit number 717-774-1643. Use 145 if asked for your customer institution to deduct the amount of your monthly bill from identification number. Reach us by TTY at 1-800-974-6006, the account associated with your enclosed check and send payment directly to Verizon. To discontinue Automatic Payment, call Verizon. Please keep a copy of this authorization. Please return remit slip with payment. NOZIa3A 6408-EEL£E ldEmEIS21313d1S pied aear:oasn 6LOEE Y,090d ~~eyy ssep-ssn j par,osa,d ® Questions? Please Visit us online at Page 1 contact us by Jul 24. pplelectric.com pp, 1-800-DIAL-PPL .::f (1-800-342-5775) 68030-79009 Jul 24 2012 $30.72 -~L =1nTrr, u=,a„srs M-F: Sam to 5pm Your Electric Usage Profile Billing Summary (Billing details on back) Service to: Balance as of Jul 3, 2012 $98.00 ANDREW DANISH-ESTATE Charges: 504 BRANDT AVE Total PPL Electric Utilities Charges -$67.28 NEW CUMBERLAND, PA 17070 iVleter: 98929648 Total Charges $30.72 Your next meter reading is on or about Aug 2, 2012. Amount Due By Jul 24, 2012 $30.72 This section helps you understand your year-to-year Account Balance $30.72 electric use by month. Meter readings are actual unless PPL Electric Utilities' rice to compare for our rate is 7.993 cents er kWh otherwise noted. p y p effective 6/1/2012 to 8/31/2012. For a list of supplier offers, visit 2011 2012 papowerswitch.com or www.oca.state.pa.us. 90 75 Your Message Center 60 • Budget Settlement Summary after 12 months: We billed you $601.72 45 ( Including this bill, you used $601.72 30 t1b 15 0 I' F~ nn F1 Fi We have subtracted $91.30 from this bill to settle your Budget Billing Plan. J F M A M J J A 5 O N D • With paperless billing, you can receive and pay your ° Months PPL Electric Utilities bills online. The process is free, quick, convenient and secure. To learn more or sign up, visit pplelectric.com. 3 ' • " a' * • Save postage and late charges - sign up for Automated Jul 2012 29 135 5 72F Bill Payment. Ju12011 32 252 8 73F y ' :x Payrraea~t i~eth®ds Jul 3 Actual 78418 Online at: By phone: 1-800-342-5775 Jurt 4 Actual 78283 pplelectric.com or call BillMatrix (service fee applies) at 1-800-672-2413 to pay using Visa, 29 Days kWh Billed 135 MasterCard, Discover or debit card. + r+ , - ® By Mail: Correspondence should be sent to: 2012 7875 656 2 North 9th Street Customer Services CPC-GENN1 827 Hausman Road 0 All 2011 10561 8g entown, PA 18101-1175 Allentown, PA 18104-9392 2 727oio-juil Other important information on the back of this bill 4 C,- i OE 1 S2n07 4 RO A'EES SSEE OTV era ® Questions? Please ~ Visit us online at Page 1 - contact us by Aug 23. pplelectric.com 1-800-DIAL-PPL (1-800-342-5775) PPL VeettFr Utwtie!i M-F: 8am to 5pm 160 8030-79009 Aug 23, 2012 $29.59 Your Electric Usage Profile Billing Summary (Billing details on back) Service to: Balance as of Aug 2, 2012 $0.00 ANDREW DANISH-ESTATE Charges: 504 BRANDTAVE Total PPL Electric Utilities Charges NEW CUMBERLAND, PA 17070 $29.59 Meter: 98929648 Total Charges $29.59 Your next meter reading is on or about Aug 31, 2012. Amount Due By Aug 23, 2012 $29.59. This section helps you understand your year-to-year Account Balance $29.59 electric use by month. Meter readings are actual unless otherwise noted. PPL Electric Utilities' price to compare for your rate is 7.993 cents per kWh 2011 02012 effective 6/1/2012 to 8/31/2012. For a list of supplier offers, visit papowerswitch.com or www.oca-state.pa-us. 90 3 9s Your Message Center e0 • With paperless billing, you can receive and pay your as PPL Electric Utilities bills online. The process is free, a quick, convenient and secure. To learn more or sign up, m 30 visit pplelectric.com. > is • Information about appliance energy use and tips on 0 r " saving energy are available through the Energy Library on our Web site, pplelectric.com. J F M A M J J A S 0 N D N • Before digging around your home or property, you s Months should always call the state's One Call notification system to locate any underground utility lines. You can ,monthly Days Average Average~ kWh do this by simply dialing 811, which will connect you to omparison , , the One Call system. Be safe and call 811 before you C Billed ~ Tem.. Aug dig. 6 =78F 10 Payment Methods Aug 2 Actual 78602 Online at. _ By phone: 1-800-342-5775 Jul 3 Actual 78418 lJ ppIelectric.com or call BillMatrix (service fee applies) 30 Days kWh Billed 184 at 1-800-672-2413 to pay using Visa, MasterCard, Discover or debit card. - • - ® By Mail: Correspondence should be sent to: - 7Se 2011- Aug 2012 7760 647 2 North 9th Street Customer Services CPC-GENN1 827 Hausman Road 2010 - Aug 2011 10605 884 Allentown, PA 18101-1175 Allentown, PA 18104-9392 - Other important information on the back of this bill 4 N N C _ m ~ Tm 0 Sq -i C a~ 0 N > WCn G~ M v ma v Questions? Please Visit us online at Page 1 O contact us by Sep 21. pplelectric.com ; • 1-800-DIAL-PPL ' p (1-800-342-5775) 68030-79009 Sep 21, 2012 $33.90 PPL Mecvic Ublibes M-F: 8am to 5pm Your Electric Usage Profile Billing Summary (Billing details on back) Service to: Balance as of Aug 31, 2012 $0.00 ANDREW DANISH-ESTATE Charges: 504 BRANDTAVE Total PPL Electric Utilities Charges $33.90 NEW CUMBERLAND, PA 17070 Meter: 98929648 Total Charges $33.90 Your next meter reading is on or about Oct 3, 2012. Amount Due By Sep 21, 2012 $33,9701 This section helps you understand your year-to-year Account Balance $33.90 electric use by month. Meter readings are actual unless PPL Electric Utilities' price to compare for your rate is 7.993 cents per kWh otherwise noted. effective 6/1/2012 to 8/31/2012. For a list of supplier offers, visit 02011 ■ 2012 papowerswitch.com or www.oca.state.pa.us. L 70 Your Message Center Y • With paperless billing, you can receive and pay your so k PPL Electric Utilities bills online. The process is free, as quick, convenient and secure. To learn more or sign up, visit pplelectric.com. c 30 r Information about appliance energy use and tips on a is ? 1 saving energy are available through the Energy Library o - 0. Fim, on our Web site, pplelectric.com. N J F M A M J J A S 0 N D • Before digging around your home or property, you Months should always call the state's One Call notification system to locate any underground utility lines. You can Monthly . Average' do this by simply dialing 811, which will connect you to • • kWh/Day the One Call system. Be safe and call 811 before you ~,C Billed Temp. dig. Aug 2012 29 222 8 73F Aug 2011 29 237 8 73F - Period • Reading Payment Methods Aug 31 Actual 78824 Online at: © By phone: 1-800-342-5775 Aug 2 Actual 78602 _ U pplelectric.com or call BillMatrix (service fee applies) at 1-800-672-2413 to pay using Visa, _ 29 Days kWh Billed 222 MasterCard, Discover or debit card. . _ ® By Mail: Correspondence should be sent to: Sep 2011- Aug 2012 7745 645 2 North 9th Street Customer Services CPC-GENN1 827 Hausman Road Sep 2010 - Aug 2011 10623 885 Allentown, PA 18101-1175 Allentown, PA 18104-9392 Other important information on the back of this bill .r m cn N c~ N Z$ m ~o (7 M M T M v 'G fl 0 n ~ M o Cl) - O M~ M m v Questions? Please Visit us online at Final Bill Page 1 O contact us by Oct 1. pplelectric.com Bill:Acct. r ■ Amount Due P P~ 1-800-DIAL-PPL 777_7 ! T (1-800-342-5775) 68030-79009 Oct 1, 2012 $43.33 PPL Electric Utilities M-F: Sam to 5pm Your Electric Usage Profile Billing Summary (Billing details on back) Service to: Balance as of Sep 10, 2012 $33.90 ANDREW DANISH-ESTATE Charges: l 504 BRANDT AVE Total PPL Electric Utilities Charges $9.43 P~ NEW CUMBERLAND, PA 17070 Meter: 98929648 Total Charges $43.33 Amount Due By Oct 1, 2012 $43.33' This section helps you understand your year-to-year Account Balance $43.33 electric use by month. Meter readings are actual unless PPL Electric Utilities' price to compare for your rate is 7.907 cents per kWh otherwise noted. effective 9/1/2012 to 12/31/2012. For a list of supplier offers, visit ■ 2011 ■ 2012 papowerswitch.com or www.oca.state.pa.us. 90 r 75 Your Message Center 3 • With paperless billing, you can receive and pay your so PPL Electric Utilities bills online. The process is free, 45 quick, convenient and secure. To learn more or sign up, a 30 visit pplelectric.com. > • Information about appliance energy use and tips on 15 saving energy are available through the Energy Library 0 on our Web site, pplelectric.com. J F M A M J J A S o N D • Before digging around your home or property, you Months should always call the state's One Call notification system to locate any underground utility lines. You can Monthly ■ do this by simply dialing 811, which will connect you to Billed kWh ■ the One Call system. Be safe and call 811 before you Comparison dig. Sep 2012 10 58 6 74F Sep 2011 33 410 12 65F - Billing • • Type Reading Payment Methods _ Sep 10 Actual 78882 Online at: © By phone: 1-800-342-5775 Aug 31 Actual 78824 pplelectric.com or call BillMatrix (service fee applies) at 1-800-672-2413 to pay using Visa, 10 Days kWh Billed 58 MasterCard, Discover or debit card. Comparison Yearly _ I Use Avg. Monthly: ® By Mail: Correspondence should be sent to: Oct 2011- Sep 2012 7393 616 2 North 9th Street Customer Services CPC-GENN1 827 Hausman Road Oct 2010 - Sep 2011 10742 895 Allentown, PA 18101-1175 Allentown, PA 18104-9392 Other important information on the back of this bill 4 t (D Q 0 0 5 C N y ~ S o. CL „ 7 v r , m o m m ~ _ m z - a) cn a) 7U m. m m CD :3 :3 -4 c N o (o n m W D - > T ' - a E a ~DC7 y r Z ~ 0 m M ~ v (D mo _ o 0 m < 11-1 D O M D 0 O N O p W CD Ln S w O W v CD N N N CO O C =Y" A fA _ - W N p O W (J1 A A ' N A ~I N m m P'$ ~gco C my z CrJ x-10 -0 n O cn rD (D (D C N c O O (D (n (a N Ln'(n c rD Q ,j -U O CD O C 3 1 3 CD CO -0 ~jj 0 (D - CD O (n N k Q. N < N N O D --J,< Q O v JO rt (D go N N N -i 0-0 O 3 as (n 3-0 N O _ V N 4 (D (D (D p $ W co O (DE O C0 D. < O (a p f7 U7 N 'O N _ O N O A (Q 7 - 3 co w co =3 n. m co O \J C) CD II O c C In 0 c(D A z o a o d ui U H 0 a O. as m ~ w E ea • 3 o es -d* A a~ J M co 0 ' - ea :v a o. ti U fn co fl. U) O N p ~ L C1 C) M Y Ch r U) Cn W Z 2 Z a Cl A z 101' CD n H ~ o a - d m v a - y ' as d ~ iu E V) o p ~p 3: LO 0 a m l~ - C U N Y a) uj 4) 0 4 to . _ V M M Ri U) Z 2 ~ Z Q C1 -fte Mowing and Lawn Services 1330 Sheep Bridge Rd. • York, PA 17406 717-873-0501 NAME DATE: ADDRESS QUANTITY DESCRIPTION PRICE AMOUNT i i E TOTAL DUE: Make checks payable to James Payne. R...„vF C - ~ a w ' 'w C5 Z Q U j, (0) Q a V a N it N I Y 6i E 1 N N o • 3 N - J ~ Q r+ ~ J ~ `,mod', ~ d C 0)~ 0 m m ti a N .3 W V O •Lr ~ ~ .C (n V O Y co w r W W Z Z Q Premi Mowing and Lawn Services 1330 Sheep Bridge Rd. • York, PA 17406 717-654-1232 NAME DATE: ADDRESS QUANTITY DESCRIPTION PRICE AMOUNT TOTAL DUE: Make checks payable to James Payne. '~j 17-1 j t✓ 5 r 13~ u7~~ 219.:12 S}'. i X1///1 (1 m~ ,~,v,...,,,~. ,~~„x+wms.++`'} -.~~°•°'wsf O""-t~°~ YL i A 50 L ~ ijt;, ~ (,t s ! ~FI}11~}!!~I~i}7liiilllFlFF iiia?iilii!li}?7Ii I!i iiFltit!r(i ~7~ PENN NATIONAL INVOICE INSURANCE AGENT: GUNN-MOWERY LLC ® AGENT NUMBER: 12-1134 Pennsylvania National Mutual Casualty Insurance Company TELEPHONE: 717-761-4600 Penn National Security Insurance Company Founders Insurance Company ACCOUNT NUMBER: 3 7 5 5 1 7 4 0 7 5 001 0 0 0 0 1 P.O. Box 2257 • Harrisburg PA 17105 INVOICE DATE: 06/25/2012 DUE DATE: 07/ 12/2012 MAIL TO: ACCOUNT NAME: DANISH ANDREW T& P M DANISH ANDREW T& P M 504 BRANDT AVE 504 BRANDT AVE NEW CUMBERLAND PA 17070 NEW CUMBERLAND PA 17070 PREVIOUS 94LlkIU1~E PAYNIErv7S ;OTHER ACTIVITY. NIIAf aALAtVCE 1~[iNIIFiEIjI IIlE..;> ? $359.00 $123.00- $5.00 $241.o0 $123.00 TRANS E}ATE DSCRIPTIQIV ..POI E(i1' Nts1M.. POEICIf TYPE GO DEIAI DETAI`.>'" PREVIOUS BALANCE 359.00 04/06/2012 PAYMENT - THANK YOU 123.00- 06/25/2012 INSTALLMENT 5550174075 26 HOMEOWNERS 1 118.00 INSTALL SERVICE FEE 5.00 5.00 - TOTALS 241.00 123.00 S C H E D U L E O F F U T U R E I N S T A L L M E N T D U E D A T E S 10/12/2012 $118.00 EACH INSTALLMENT WILL BE CHARGED AN INSTALLMENT SERVICE FEE Y i SEE REVERSE SIDE FOR IMPORTANT CLAIM HISTORY INFORMATION Make a payment or inquire about the convenience of our no installment fee recurring payment plan. Click or call: www.PennNationalinsurance.com or 800-766-2245 Penn National Insurance P.O. Box 2257 Harrisburg PA 17105-2257 t ~ PENN NA-riONAL JNSUICE yr IMPORTAN7 INSURAMCE POLICY IMFORMATION: OPEN IMMEDIATELY INVOICE MAY BE ENCLOSED C PF BROS.I INC. Invoice q~ Invoice Number: P. O' ,BOA 243 14625 CAMP DILL' PA 17001 Invoice Date: Aug 20, 2012 Voice: 717/761-2124 Fax: 717/591-1239 Page: 1 Sold To: Work At: Danish, Mr. Andrew 504 Brandt Ave. 506 Terrace Drive New Cumberland New Cumberland, PA 17070 Customer ID Reference Payment Terms Danish 504 Brandt, NC Net 15 Days Sales Rep ID Work Done Job Date Due Date ti Misc. repairs 8/14/12 9/4/12 Quantity Description Unit Price Extension Replace disposal, Repair toilet & Repair faucet 1 ISE Badger V disposal 139.95 139.95 1 1-1/2" PVC "P" trap 11.90 11.90 1 Chrome nut & washer 3.90 3.90 1 Wicking 1.75 1.75 1 Crest flapper 9.85 9.85 1 Putty & teflon sealer 5.90 5.90 1 Rinse-quick head 12.90 12.90 1 Service call 35.00 35.00 1 Labor 141.00 141.00 TOTAL 362.15 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 Andrew T. Danish 21-12-0615 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. East Pennsboro Ambulance Service Inc. 851.80 2. Urology of Central PA 99.75 3. Thomas P. Kunkle, DO 105.00 4. PharMerica 4.43 5. Golden Living Centers 6,315.60 6. Holy Spirit Hospital 1,855.38 7.Pinnacle Health Cardiovascular Inst., Inc. 280.00 8. Kantor & Tkatch Assoc., P.C. 506.00 9. Camp Hill Emergency Physicians 780.00 TOTAL (Also enter on Line 10, Recapitulation) $ 10,797.96 If more space is needed, insert additional sheets of the same size. East Pennsboro Ambulance Service Inc Billing Office 12-143769 ' 9 6/18/2012 $851.80 PO Box 726 New Cumberland, PA 17070-0726 QU'=3730 S A DZ)1 -I-j. 7S 3I! L' Phone: 377-214-6013 Espanol: 86o-723-411=1 Fax: 717-214-5020 Lnnail: info@ambulancabillingoffiee.com Date of Service: 5/2/2012 02:02 Please visit our website to provide insurance or make payment, and Patient Name: DANISH, ANDREW for additional payment options and frequently asked questions: From: GOLDEN LIVING CENTER - WEST SHORE To: Holy Spirit Hospital ''J'jw•am buJ a ncebill in g off ice. corn "Please Please read -this bill is your responsibility. * *We have no insurance information on file for you. Please provide your inszrance information on the back of this bill or remit payment. Thank you. 5/02/12 BLS Emergency Transport A0429 1.0 800.00 800.00 5/02/12 Mileage A0425 0.2 9.00 1.80 5/02/12 Oxygen A0422 1.0 50.00 50.00 Total 851.80 0.00 0.00 DETACH AND RETURN BOTTOM PORTION WITH YOUR PAYMENT. Ambulance Billing Office P.O. Box 726 New Cumberland, PA 17070-0726 n .t L ADDRESS SERVICE REQUESTED r Please Pay -Amount Due From Patient Thank You. - PAY ON-LINE AT WWW.UROLOGYCP.COM/PAY.HTM Insurance Charges pending to Prv: 117.00 Ins Pay/Adj against Ins pending 56.58 -60.42 0.00 i 01/17/12 1 12 OFFICE VISIT NEW LEVEL 2 99202 599.0 118.00 01/26/12 Medicare Payment 0.00 04/04/12 Check-Personal Payment 118.00 0.00 i 02/15/12 1 12 Insert Of Temporary Indwe 51702 788.20 169.00 03/14/12 SELFPAY DISCOUNT Adj. -42.25 04/04/12 Check-Personal Payment 126.75 0.00 j 03/14/12 1 12 Insert Of Temporary Indwe 51702 788.20 169.00 03/19/12 SELFPAY DISCOUNT Adj. -42.25 04/04/12 Check-Personal Payment 27.00 99.75* I , DATE LAST P.A!C ANICU F 1 , y a - - rT 3 n 4 - . 04/04/12 271.75 0.00 99.75 0.00 0.00 I 0.00 0.00 I 0.00 99.75 ? Urology Of Central PA MA, c Ecx PO Box 458 E.a,!.a L T01, Camp Hill, PA 17001-0458 ~ 99.75'' Ph:(717)-724-4684 PAT# 1-ANDREW DANISH PRV# 12-DOWLING, KEITH J., M.D. Acct#: 103437 Date: 05/10/12 Page 1 of 1 Awl, I moo J u 1 THOMAS P KUNKLE, DO (717) 774-0300 500 BRANDT AVE NEW CUMBERLAND, PA 17010-1834 G Account Number Billing Date Paee Office Use Only Andrew Danish 4671 05/17/12 1 504 Brandt Ave New Cumberland, PA 17070 Service Date CPT4 Description Prov Units Mese. Charge Ins. Paid Adjustment Patient Paid Balance Due 04/07/12 99308 Skilled Nursing Facility K 1 105.00 105.00 Patient: Danish, Andrew - 4671 o Comments: Please Pay--> 105.00 Please pay within 30 days ...thank you Andrew Danish 4671 105.00 525.00 105.00 Account Number New Charges New Payments New Ins. Pmt. Current Due Past Due Finance Charge Scheduled Amount Since Last Bill Since Last Bill Since Last Bill / Billing Fee Thomas P. Kunkle DO • 500 Brandt Avenue • New Cumberland, PA 17070-1834 21 S P. KUNKLE, D.O. BRANDT AVENUE P.O. BOX 423 F ~•.r, IMBERLAND, PA 17070 PharMerka 1900 S. SUNSET UNIT 1-A • LONGMONT, CO 80501-6599 800-984-8363 • www.pharmerica.com/mybiII PAGE: 1 of 1 ANDREW DANISH ANDREW DANISH GL-WEST SHORE 506 TERRACE DRIVE NEW CUMBERLAND, PA 17070-1562 05/21/12 5702-48-51512 Balance Forward: 45.14 05/03/12 PAYMENT - THANK YOU -45.14 04/26/12 56 AMLODIPINE BESYLATE 5 MG 4.43 0 a 0 0 0 A 4.43 -45.14 4.43 FOR YOUR CONVENIENCE, PAYMENTS CAN BE MADE ONLINE AT WWW.PHARMERICA.COM/MYBILL L First Class Mai! PF FIRS' U.E EN r ~i -,1791844441 golden STATEMENT living centers QUESTIONS ABOUT YOUR BILL? (866) 325-5606 WEST SHORE STATEMENT DATE PATIENT NAME ACCOUNT NUMBER 08/01/2012 ANDREW DANISH 00285444410001 S BALANCE NEW CHARGES PAYMENTS ADJUSTMENTS NEW BALANCE 0.00 0.00 0.00 578.00 578.00 REPERUIC D COVERED ACCOUNTACTIVITY QTY/DAYS CHARGES PAYMENTS ADJUSTMENTS 01/20/12 CO-INSURANCE 1401/20/12 CO-INSURANCE -10 2,023.00 -1,445.00 When returning home, patients often require ongoing care that family members cannot easily provide. In these cases, AseraCare Home Health is an ideal solution, Visit homehealth.aseracare.com for more information. Thank you for choosing Golden LivingCenters. MAIL YOUR PAYMENT USING THE COUPON BELOW PAYMENT -OR DUE DATE 08/15/2012 PAY YOUR BILL ONLINE AT www.goldenliving.com PLEASE. AMOUNT $ /578.00 i ~ -nC -~N Cn r: 2 ° o _ 0: m in ;0 IIIIIIIIIIIIIIIIIIIIIIIIII~i~IIIIIIII~IIIIiIIIIIIIIIIIIIIII 1804544441 STATEMENT golden living centers QUESTIONS (866) 325-5606 WEST SHORE STATEMENT DATE PATIENT NAME ACCOUNT NUMBER 06/01/2012 AT1F T"; Dai1ItiH ( 002854444_0001 PREVIOUS BALANCE NEW CHARGES PAYMENTS ADJUSTMENTS NEW BALANCE 12,365.29 =,'27.69 0.00 0.00 5,7 .6J DATE/PERIOD COVERED ACCOUNT ACTIVITY WDAYS CHARGES PAYMENTS ADJUSTMENTS 04/22/12 04/30/12 WCR-DUODERM EXTRA THIN 7 22.82 05/01/12 05/02/12 ALPHA RELIEF-MATTRESS 2 24.00 05/01/12 05/01/12 OT THER CPT 97530 1 32.14 05/01/12 05/01/12 OT THER CPT 97112 1 30.62 05/01/12 05/01/12 OT THER CPT 97542 1 28.44 05/01/12 05/01/12 ST THER CPT 92526 1 80.29 05/01/12 05/01/12 ROOM CHARGE 1 228.20 05/01/12 05/31/12 REV LAST MO RC -31 -7,074.20 Please make sure that any automatic payment from your bank is updated with the current Remit To address shown on this statement. Thank you for choosing Golden LivingCenters. " PAYMENT' MAIL YOUR PAYMENT USING THE COUPON BELOW DUE DATE 06/15/2012 - OR- PAYYOUR BILL ONLINE AT www.goldenliving.com AMOUNT DUE 5,737.60 ..'•?3?l is riot={i?I???ii;'iiii3?~~3~i1?i{3?~+=fl°~?ili$??i?i??? f _ _ r! ~Qy ° ma y, i cy -3 P., 17 v;I.Je;soy 17 RECEIPT RECEIPT INS. PAT. DATE PATIENT DOCTOR CPT4 DESCRIPTION CHARGE FROM INS. FROM PAT. ADJ. BAL BAL 12/18/11 Andrew Patel 99223 INITIAL HOSPITAL CARE $289.00 $0.00 $245.65 $43.35 $0.00 $0.00 12/18/11 Andrew Patel 1123F ACP DISCUSS/DSCN MKR DOC' $0.00 $0.00 $0.00 12/19/11 Andrew Waheed 99232 SUBSEQUENT HOSPITAL CARE $103.00 $0.00 $87.55 $15.45 $0.00 $0.00 12/20/11 Andrew Waheed 99232 SUBSEQUENT HOSPITAL CARE $103.00 $0.00 $87.55 $15.45 $0.00 $0.00 12/21/11 Andrew Waheed 1123F ACP DISCUSS/DSCN MKR DOC' $0.00 $0.00 $0.00 12/21/11 Andrew Waheed 99232 SUBSEQUENT HOSPITAL CARE $103.00 $0.00 $87.55 $15.45 $0.00 $0.00 g 12/22/11 Andrew Waheed 99238 HOSPITAL DISCHARGE DAY $102.00 $0.00 $86.70 $15.30 $0.00 $0.00 0 05/02/12 Andrew Vahora 1123F ACP DISCUSS/DSCN MKR DOC' $0.00 $0.00 $0.00 $0.00 A 0 05/02/12 Andrew Vahora 99223 INITIAL HOSPITAL CARE $289.00 $0.00 $0.00 $289.00 D 05/03/12 Andrew Kahlenborn 99233 SUBSEQUENT HOSPITAL CARE $148.00 $0.00 $0.00 $148.00 05/04/12 Andrew Kahlenborn 99232 SUBSEQUENT HOSPITAL CARE $103.00 $0.00 $0.00 $103.00 05/05/12 Andrew Kahlenborn 99232 SUBSEQUENT HOSPITAL CARE $103.00 $0.00 $0.00 $103.00 05/06/12 Andrew Kahlenborn 99232 SUBSEQUENT HOSPITAL CARE $103.00 $0.00 $0.00 $103.00 05/07/12 Andrew Kahlenborn 1123F ACP DISCUSS/DSCN MKR DOC' $0.00 $0.00 $0.00 $0.00 05/07/12 Andrew Kahlenborn 99232 SUBSEQUENT HOSPITAL CARE $103.00 $0.00 $0.00 $103.00 05/08/12 Andrew Gupta 99232 SUBSEQUENT HOSPITAL CARE $103.00 $0.00 $0.00 $103.00 05/09/12 Andrew Gupta 99238 HOSPITAL DISCHARGE DAY $102.00 $0.00 $0.00 $102.00 Thank yo for your romp payment. CURRENT 30-60 DAYS 60-90 DAYS 90-120 DAYS OVER 120 DAYS TOTAL ACCOUNT BALANCE 11DUE FROM PATIENT $1,054.00 $0.00 $0.00 $0.00 $0.00 $1,054.00 $1,054.00 Thank You For Your Payment. For Billing Questions, Please Call: (717) 972-4490. l IIIIIIII IIII IIIII IIII 1111111 II IIIIIIII IIII IIIII IIII IIIII IIIII IIIII IIIII IIIII IIII IIII ,IaSS IVlaII EPRESORTED IL510 i i .l - 2. We have received the explanation of benefits -17 from your insurance company(s) and have applied whatever payments and/or adjustments are appropriate. Please make payment for the s P I T L balance due $37.20 OR take advantage of a The Spiric o I 15% prompt payment discount and remit $31.62 on or before 07120/2012. 41918327 Here are two convenient ways to make ANDREW DANISH payment: 770 POPLAR CHURCH RD 770 P HILL PA 1RCH 3 D 1. Cali Customer Service at 717-763-2138 to make payment by credit card. 2. !Mail tear-off coupon below with payment using the enclosed self-addressed envelope. :If Patient Name: Danish Andrew Previous Balance: $.00 Statement Date: 06/20/12 Total New Charges: $469.50 Service Date(s): 03/06/12 Payments/Adjustments: $432.30- Account Balance: $37.20 Account dumber: 41913327 P .4 ~11111 37.20 Medical Record Number 271638 ~ ppo f,.d T`i:1 tia -d Ai l O paid on o 07 'Ll, ware r. .a Ins. 1: 5?01 Please call Customer Service at 717-763-2138 Ins. 2: CHARITY CARE to add or make corrections to your insurance Ins. 3: information, or to make arrangements for a Ins. 4: payment plan. If you are unable to make payment, please contact the Financial W Counselor's Office at (717) 763-2885 to discuss Ah 4 financial assistance options. Ul Please !Vote: Your physicians will /sill separately for professional services. PRESORTED n y~ FIRST-CLASS MAIL I l U.S. POSTAGE PAID SIEMENS . ' 19355 f"7 D Previous Balance: ~3~,~i3fl.9S HOLY otai 14e,,i/Charges: ~21,3106.15 ter, ! Fa?,!!ilentJi'i~juStTi3en35. $S'D, 711 , 5U- ~Account Balance: La t 0 S P 1 T A I_ Please Pay This ,mount: ~9D~.SD 0IR TJ~e Spi-, of caybng 7s r- curted Am u it of S76B.76 if paid on or before 07.',012012 ORION= Trans. Date Description, Am, o nt 05114/12 MED C/A HOSP-1P M12 SM 20,184.15- OSY23/12 MED1 PYMT-HOSP IF M12 SM .0.0 05/23/12 MED1 CJA HDSP-1P X912 5M .00 06107112 MED1 PYMT-HOSP 10 M12 5M .00 06/07/12 MED1 PYMT-HOSP IF M12 SM 9,434.18- 061'87112 MED1 C/A HOSP-1P M12 SM - on 06/07/12 MED1 C/A HDSP-iP M12 SM 19,934.37- 96/13112 MED C/A HOSP-1P M12 53 20,134.15 06/19112 HSH CHARITY 1,132. Go 06!19112 HSH CHARITY 226,40- 06/19112 HSH CHARITY H2O PENDING CH,AR1 1,132.00- r r From: r,• PRE; a• FIRST-C It ai ,t- U.S. F a _ `F f, l SIE i 4 To: , f 7 r ^-~I aY9 ar w - - 1-. A_. Thank YOU for your prompt payment. Please call 717-731-8315 with any questions,.,.,.,.;.,.,.,.,.,•,,,,,,;;,,,;,;;,;,,,,,,,,,,;;;,;,,,,,•;:;:;;;:;:,.;:::;:,. 05/04/12 1 11 HOSPITAL IN.TIAL CARE 2 99222 427.31 190.00 0.00 190.00 06/04/12 Medicare Payment ,I I Lila? 1aViO UP1T~ 00/00/00 0.00 190.00 0.00 0.00 0.00 0.00 0.00 0.00 190.00 M~, PINNACLEHEALTH CARDIOVASCULAR INST, INC CHECK 1000 N FRONT ST (MOFFITT HEART & VASC) P''''`'BL`TO' WORMLEYSBURG, PA 17043-1034 190.00* Ph:(717)-731-0101 PAT# 1-ANDREW DANISH PRv# ll-BOKELMAN, TODD A, MD, FA Acct#: 221684 Date: 06/08/12 Page 1 of 1 i n n ro m tai (D z D [fin o t7 tY n y O :d n td m W O N C) Fa-- O E ro Hd morn t7 P r h] z _ y t3l r• H r 0 x H W U o x w r d txj ~ w N o n C: i 0 z n CD O ~ ~ D m CD O CD O cv rn C/) O w ~ w ~ W IVICJJHU CJ CAT LTIIY L'✓ 3LL'.1'!'/ Thank you for your prompt payment. Please call 717-731-8315 with any "4uestions. 111" 705/04/12 HOSPITAL L INITIAL CARE "2; 99222 427.31 190.00;; ; 06/04/12 Medicare Payment 0.00 06/19/12 Check-Personal Payment 190.00 0.00 05/05/12 1 11 HOSPITAL SUBSEQUENT CARE 99232 427.31 90.00 07/12/12 Medicare Payment 0.00 90.00^ DATE LAST PAID AMOUNT s - i _ - 06/19/12 190.00 90.00 0.00 0.00 0.00 0.00 0.00 I 0.00 90.00 MAKE PINNACLEHEALTH CARDIOVASCULAR INST, INC CHECK 1000 N FRONT ST (MOFFITT HEART & VASC) E±!a) PAVASLEro: WORMLEYSBURG, PA 17043-1034 PAT# 1-ANDREW DANISH PRV# 11-BOKELMAN, TODD A, MD, FA Acct#: 2216840101 Date: 07/20/12 Page 1 of 1 c M N a p --Cl) 'a 1 M M O m o V r- N D a < m (n d Patient: ANDREW DANISH Chart Number: DANAN001 Services Provided at: HOLY SPIRIT HOSPITAL- MC-BS Amount Paid by Paid By Dates Procedure Procedure Charge Insurance Guarantor Adjustments Remainder 05/02/12 99222 HOSP INIT INPT LEVEL 2 225.00 0.00 0.00 225.00 member responsibility. Medicare states patient does not have Part B coverage. 05/03/12 99232 HOSP SUB CARE LEVEL 2 106.00 0.00 0.00 106.00 Contact billing office with correct insurance information orto make payment arrangements. 05/04/12 99232 HOSP SUB CARE LEVEL 2 106.00 0.00 0.00 106.00 Account will be sent to collections without further notice. 05/07/12 99231 HOSP SUB CARE LEVEL 1 69.00 0.00 0.00 69.00 Member Responsibility. Please remit payment upon receipt of statement. 3 en':~ 9' / 2 PAYMENT EXPECTED UPON RECEIPT OF 1st STATEMENT BY STAMPED DUE DATE Past Due 30 Day Past Due 60 Days Past Due 90 Days Balance Due 0.00 0.00 0.00 506.00 IF PAYMENT HAS BEEN MADE RECENTLY, PLEASE DISREGARD THIS STATEMENT, THANK YOU "NOTICE: TO ALL CO PAY & SELF PAY PATIENTS" Chart Number: DANAN001 IF YOUR POLICY REQUIRES A CO-PAY AMOUNT & IT IS NOT PAID AT THE TIM E OF OFFICE V iSIT 31957 ONLY1-COURTESY STATEMENT WILL BE SENT FOR CO-PAY & SELF PAY PATIENTS. ACCOUNT VVILL BE SENT TO COLLECTION WITHOUT FURTHER NOTICE. **YOUR RECEIPT" Sake this bottom Portion as your Receipt for "End of Year Taxes" a fee will be charged for Requests at the End of the Year! Payment made to: Kantor & Tkatch Assoc., P.C. - Date: - 3' Amount: -S-oE, D 0 Z_ r w °o °o 00 W i Z0 (o c o °o m o Q c 2 10 « e^- M 1a am En >E } E U 20 W_ N CO m~ C o w z M 0 FOCC a) o °o - 04 CD LU ~e 2 z 2 U N a (0000 O O O O 1'aN~ =N t= d Q = N ON 64 604 tf? 604 fR ~ C C C E o v- V 61. Ld a- 4) Q -O a> o o ( a N O W o OC-5 CO`Ou > W~p as w_ LC O m. o (u c cc u. ti 0 Q' v O co `c 0 1- D7 x o w d w- W CL 7i > : O L i 0 m ees LLi I-m c c0~p~a Q am.. M as ° O y Q C v y G z 7 C C C C 2 z O L J~ G O L uj 2 Q u E O O~ F- a o -0 ? C m N c w Q O Q z hi ¢Q QaQm =a° CM L O a fn O Z m a_ 0 L) t~ Q'~ 3m~ w mdaM~ C _ v CL ow EL 0 ~ U- N V r.+ d~ rr- m'oN Q L O o0 00 0o w EL E J ITS O Q O ro v o 0 0 °ud 00~ co 0 3: 0 ° _o~ tC WC O C3 U) M Z c m O t4 -0 G1 Q m O 2 (n Tm EinpC1ss O U -C) C ~a 7 Q J °0.3 fIIy~cncm d U) = =0 0O rY ma': aLp C) r- ce) L O _ u7 ac') >u°iwuaouai¢ - * 1~ v= d M m F_T2=<: O y 1 Q c0~ =N M - S U-p V 0a ¢o ~xw cJ 4 1, 083 O O O a Gt c amaaaw m°c ~CLo 4 V c,5 U) 51 of u) f" z 0) - O 04 r ~>oyw>p Nom N N w O -zUQ O >0poZOy 0 `.'°v `c +:Oc~to ~ C7 Q o aQwa J y Go W co-, OQ-~ za~wauriaz 0= J-I O (D (A w E °rn O fQ O UJ rn= i-l~0W0= w°w:z ~°w hoc au Q. O a w y 2 o J co d _ u7zOCiaa RJ wQU)coT u-'o ru CD C) v 2 X W - 0~0°5Z°~Q a Mooooo=w `o""c R 7 Q 0q O#*kQI-- U rn Q m rcn Do g at N c~ C v a O a o ^ i L } N U IL N N N O N d Q E 2.0 0 0 o O Q y V In N N ~ U ~ ~ 0 0 o f~ m a a m JJ016169 . r FIRST-CLASS MAIL ~ PRESORTED USPOSTAGE PAID - - - - - _ PSC N N 1 (um -cr n 4 7 1;taHi....fH.;3 REV-1513 EX+ (01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Andrew T. Danish 21-12-0615 NUMBER NAME AND ADDRESS OF PERSONS RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2),] 1. Andrew G. Danish son 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS 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, l it j, j' AD LAST WILL AND TESTAMENT OF T. DANISH! I, ANDREW T. DANISH of l ~nns Cumberland County, Pe v 1- ylvs', izia, r, do make, publish and declare this to~ be my Last Will and Testament, hereby revoking all Wills and' i Codicils by me at any time made. I it ITEM I• I direct ~Ithat all inheritance and estate taxes becoming due b I y reason of my death, whether such taxes may be payable by my estate nor by any recipient of any property, shall be paid by the Execut!,lors out of the property passing under ITEM III of this Will, as an expense and cost of administration of my estate, it The Executors shall have no duty or obligation to obtain reimbursement for any tax so paid, even though on proceeds of insurance or other property not passing II under this Will. I ITEM II: I direct the Executors to pay the expenses of my last illness and funeral expenses from the ~i property passing under this Will as an expense and cost of administration of my estate. ITEM III: (a) I dev ise and bequeath all 11 the rest, residue and remainder of my estate of whatsoever nature I' and wherever situate, together with any insurance policies thereon, to my son, ANDREW G. DANISH. In',the event my son should predecease me, his share shall be paid tolihis•issue per stirpes. In the event my son dies without issue surviving, my estate shall be paid as follows: i (a) FIFTY PERCENT (500) to myi daughter-in-law, Donna Danish; Page 1 t I' j! . I ii (b) FIFTY PERCENT (500) to my brother-in-law ~ John Roselhi. I If either of the aforesaid persons should predecease me, the full estate shall be paid to the survivor of them. II III ITEM IV: In the settlement of my estate, my Executor shall posses, among others, the'followin g powers: (a) To retain investments I1Imay have at my death, as long as the Executor may deem it advii.sable to my estate to do so; it it ICI (b) To sell either at private or public sale and upon such terms and conditions as ~the Executor may deem advantageous to the estate, any or all real or personal property or interest therein owned by the estate; ill III (c) To pay all costs ill taxes,, expenses and charges in connection with the administration of my estate; (d) to compromise controversies,; and ii i (e) To do all other acts in ;;the Executor's judgment deemed necessary or desirable for the proper and advantageous management, investment and distribution ofithe estate. ~i ITEM V: Any personlI who shall have died at the same time as I shall have, or inn a common disaster with me, or under circumstances that the order of our deaths cannot be established by proof r or within thirty, (30) days of my death, shall be deemed to have predeceased me. I~ III i! jl IPage 2 , i ~I I it i~ ' I iI i i i ITEM VI' I hereby it Y I, nominate, constitute and appoint my son, ANDREW G. DANISH, j,lto be the Executor of my Estate. In the event m y said son cannot act or refuses to act as Executor for any reason, I nominatel, constitute and appoint my brother-in-law, John Roselli to act as Executor in his place. The Executor is specifically relieved from the duty or obligation I of filing any bond or other security. i I I IN WITNESS WHEREOF, I have hereunto set my. hand and seal this day of 1992, to this and the preceding two (2) pages, and I' have also placed my initials on each preceding page for better identification and greater security. I I (SEAL) NDREW T. DANISH We, the undersigned, hereby certify that the foregoing Will was signed, sealed, published and declared by the above-named Testator as and for his Last Will and Testament, in the presence of each other, have hereunto set our hands and seals the day and year first above written, and we certify that at the time of the execution thereof, the said Testator was of sound and disposing mind and memory. Residing at Residing at~~r~ Residing at / r ~-Gs ~ off ` ~ ;7a 70 i' l i Ii II I I Page 3 ii ~I I ii i i ACKNOWLEDGMENT ii li it COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND • i i j , I I, ANDREW T. DANISH, Testator, whose name is signed .to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament.; that I signed I' it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. i -(SEAL) NDREW T ! DANISH I Sworn to and subscribed i! I before me this ,1r?y~day of /F 1992. I NOTARY PUBLIC I I a) a-eal Badi7ra SumplF~-Suliivan. Notary Public New CLimbl3r1arxl 13oro, CumPrmanu County My Commission Expir S: Myt,utitit~i~5ion t_`•xpirt,s Oct. ,i, 1 J95 nii,, ylvtlrllet hccstigEyn e~f Ncta~ies (SEAL) II i I I. ii ii i. I! I I~ i I' ~i ~j I I' I j 'I I I; ii I ii Page 4 ~I j i~ ! I'. I~ it I it it • I i I AFFIDAVIT i; ~i COMMONWEALTH OF PENNSYLVANIA • iCOUNTY OF CUMBERLAND SS. ~i We, j,,- `'10'11c r and the Witnesses; whose names are signed to the attached or foregoing instrument, I . being duly qualified according to law, do depose and say that we:were present and saw Testator, ANDREW T. DANISH, sign and execute the instrument as his Last Will and Testament; that Testator signed willingly and that he executed said Will as his freehand voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Willias Witnesses; and that to the best of our knowledge the Testator_ was at that time I' eighteen (18) or more years of age, of sound mind and under it no constraint or undue influence. 'I Witness , I ; Witness i~ Witness ~I Sworn to and subscribed before me this ~~fl> day of ~ j 1992. 2 ' NOTARY PUBLIC My Commission Expires: fJ0lfrial tidal (SEAL) LNew tt~ara Nnla.ry puf_Aic 11 Ctui,urjl larrri (361"o. Cun t e.. Y r.~` frifrih,~,lafl I~Hpir~::, incf (;c~~nty 199~Membt r f~onn;a tt ttrilr; u Y n vN~Uyn of Notaries I ' it II i I i Page 5 it li