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02-13-13
J 1505611188 REV-1500 Exl°2-"„F° Pennsylvania OFFICIAL USE ONLY PA Department of Revenue oenenwrxra aEVa+oe County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN n I _ ' PO BOX 280601 p( _ I !~ /T- Harrisburg, PA 77128-0601 RESIDENT DECEDENT (--,/ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 05262012 12282022 Decedent's Last Name Suffix Decedent's First Name MI GREENE SR ROBERT S (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 BOXES BELOW © i. Original Return 0 2. Supplemental Return 0 3. Remainder Return (Date of Death Prior to 12-13-62) [] 4. Limited Estate 0 4a. Future Interest Compromise (tlate of 0 5. Federel Estate Tax Return Required death aRer 12-12-82) QX 6. Decedent Dled Testate Q 7. Decedent Maintained a Living Trust (] 8. Total Number of Safe Deposit Boxes (Attach Copy of Wiil) (Attach Copy of Trust) Q 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (Date of Death 0 11. Election to Tax under Sec. 9113(A) Between 12J7-81 and 14-95) (Attach Schedule O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number SUSAN SHENK 717649368Ix~; b REGISTER t7FWILL ONLY D~D~ m ~o v ~ N ~ ~ = n First Line of Address C7 _ r z ~ w ~ n 217 EVERGREEN ROAD z f': x o ~,, Second Line of Address t ~ ~ ~'i ' t' , g C t '-I DATE FILED ~ City or Post Office State ZIP Code ~, tV 'rl SHERMANSDALE PA 17090 Correspondent's e-mail address: Under penalties of perjury, l tleclare that I have examined this return, including acwmpanying schedules and statements, and to the best of my knowledge and belief, it Is true co ct and corn late. Declaration of re rer other than the ersonal ro resenta3ve is based on all IMormation orwhich re arer has an knowled e. SIGNATU OF PERSO ESPONSI FOR FI NG RETURN DATE n X1/31/13 ADDRESS SIGNATUR E F PREPARER p R H ~ ENTATIVE DATE I [-l~~ 01/30/13 ADDRESS' 610 LANSVALE STREET, MARYSVILLE, PA 17053 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505611180 15E5611180 J J 1505611280 REV-1500 EX (FI) Decedent's Social Security Number Decedent's Name: ROBERT S GREENS RECAPITULATION 1. Real Estate (Schedule A) ...... . ................................. . 1. N 0 N E z. stocks and Bonds (scnedule B> .................................... z. N 0 N E 3. Cfosety Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... 3. N 0 N E 4. Mortgages and Notes Receivable (Schedule D) ........................ 4. N 0 N E 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) ... . 5. 3 4 4 9 . 0 0 6. Jointly Owned Property (Schedule F) ®Separate Billing Requested ..... .. 6. 18 356.22 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested ..... .. 7. NONE 6. Total Gross Assets (total Lines t through 7) ..... 8 21805 22 9. Funeral Expenses and Administrative Costs (Schedule H) ............... . 9. 925 . DD 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I} ........... . 10. 2 70 4.00 11. Total Deductions (total Lines 9 and 10) ............................ . 11. 3629 . ~0 12. Net Value of Estate (Line 8 minus Line 11) .......................... . 12. 18176.22 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .................... .. 13. ~ . Q ~ 14. Net Value Subled to Tax (Line 12 minus Line 13) . .. 14 18176 22 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2)X.0 0 15, 0,00 16. Amount of Line 14 taxable at linealratex.o 45 18176.22 1s. 817.93 17. Amount of Line 14 taxable at sibling rate X # # # 17, ~ , ~ ~ 18. Amount of Line 14 taxable at collateral rate X # # N 18, 0.00 19. TAX DUE ...................................................... . 19. 817.9 3 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT d $IC1B Z L 1505611280 1505611280 J REV-1500 FJ((FI) Page 3 Decedent's Complete Address: Flle Number 184-16-0729 DECEDENTS NAME ROBERT S GREENE SR STREET ADDRESS CITY STATE ZIP Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount (f) 817.93 Total Credits (A + g) (2) 0.00 3. Interest (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line ZO to request a refund. (4) 5. If Line t + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Ditl decedent make a transfer and: Yes No a. retain the use or income of the property transferced ................................................................................. ...... ^ b. retain the right to designate who shall use the property transferred or its income .................................... ...... ^ c. retain a reversionary interest .................................................................................................................... ...... ^ d. receive the promise for life of either payments, benefits or care? ............................................................ ....... ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate conaideration? .................................................................................................... ...... ^ 3. Ditl decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? ...... ...... ^ 4. Ditl decedent own an individual retirement account, annuity or other non-probate property, which wntains a benefciary designation? .............................................................................................................. ...... ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YE3, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July t, 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 adoptlve 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)]. • Tha tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. LAST WILL AND TESTAMENT OF ROBERT 5. GREENE, a.k.a. ROBERT S. GREENE, SR. I, ROBERT S. GREENE, a.k.a., ROBERT S. GREENE, SR., umemanied widower, currently of 4815 Creekview Road, Mechanicsburg, Hampden Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills and Codicils by me at any time heretofore made. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. 1 give and bequeath my Classic Car, a 1949 Chrysler Windsor, five (5) passenger coupe to my grandson, RYAN GREENE outright and absolutely as a specific bequest. Any fees, commissions, death taxes or the like which would typically be assessed against its value are to be paid from the residue of my Estate and aze not to be personally assessed against my said grandson. In the event he predeceases me then I direct my Executor named hereinbelow to sell the said caz at a private or public sale as he deems best. The proceeds aze then to become part of the residue of my Estate. 3. All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, is to be divided equally among my children, oer stirpes, to wit: PATRICIA ANN ELLENBERGER; SUSAN CAROL SHENK; ROBERT S. GREENE, JR; RICHARD V. GREENE; RODNEY L. GREENE; and SHIRLEY M. ZEITERS. 4. [ nominate, constitute and appoint my son, ROBERT S. GREENE, JR., to be [he Executor of [his my Last Will and Testament. [n the event that he is unable or unwilling to act as Executor, I appoint my daughter, PATRICIA ANN ELLENBERGER, [o be Executrix in his place and stead. I further direct [hat [hey shall not be required to file bond or other security in [he Office of the Register of Wills for the purpose of administering my Estate. "IN'"WITNESS WHEREOF, I have hereunto set my hand and seal this ,~Q~ day of /µevtt{~,yyUt)Zt./ , A.D. 2008. ~ Q (y~Ai~ryrs~( t U1AgPA~~~ (SEAL) ROBERT S. REENE ~(g~y~ , (SEAL) ~~~ ~~~ a.k.a. ROBERT S. GREENE, SR REV-1508 EX+ (11-10) pennsylvania DEPARTMENT OF REVENUE INHERfiANCE 7AX RETURN ESTATE OF: SCHEDULE E CASH, BANK DEPOSITS, 8r, MISC. PERSONAL PROPERTY Include the proceeds of litigation and the date the proceeds were received by the estate, If more space is needed, use additional sheets of paper of the same size. REV-1509 EX+(01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEF JOINTLY-OWNED PROPERTY FILE NUMBER: 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. Susan Shenk 217 Evergreen Road, Shermansdale, PA 17090 daughter B. Patdcia Ellenberger 336 N 2nd Street, Wormleysburg, PA 17043 daughter C. JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANGAL INSTITUTION AND BANKACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECEDENT INTEREST DATE OF DEATH vALUE OF DECEDENTS INTEREST 1. A. a/1/ss M R T account 1292978 29,868.84 50.00% 14,934.42 /14/08 M 8 T Account 31003917889247 10 263 34 34% 33 421.80 3 2. A&B 11 . , . , 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 a.oo o.oo o.oo o.oo o.oo o.oo TOTAL (Also enter on Line 6, Recapitulation) I S 18,356.22 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+(10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDEM SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATNE COSTS Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Mary Conrad, Funeral Refreshments 476 8. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representadve(s) Street Address Ciry Year(s) Commission Paid: 2. I Attorney Fees: 3. Family EXemptlon: (If decedent's address is not the same as claimant's, attach explanation.) 4. 5. 6. 7. City State Reladonship of Claimant to Decedent Probate Fees: Acwuntant Fees: Tax Retum Preperer Fees: mev fees Stale ZIP ZIP 449 TOTAL (Also enter on Line 9, Re If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+(12-0a) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN RESIDENT DECEDENT MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Report debts Incurred by the decedent prior to death that remained unpaid at the dale of death, including unrelmbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Water Bill 127 2, Darren Barbacci DPM 35 3, American Home Patient 113 4, Pinnacle Health Cardio Inst 21 5, UGI 1pg 6, West Share Anethesia Assoc 2g 7, Pinnacle Health Hospital gg 8. PPL 211 9. JC Blair Memorial Hospital 65 10. Hampden Township 155 11. Internists of Central PA 20 12. Holy Spirit Hospital 507 13. 1-800- Got Junk 563 14. Mahantango Est 170 15. Orbisonia Rockhill EMS 150 16. Verizon 72 17. Firelnsurance 193 18. American Prog 100 TOTAL (Also enter on line 10, Recapitulation) I $ 2,704 If more space Is neede4 insert additional sheets of the same size. Th -~~ M&'.~ ~an~c ACCOUNT N0: ACCOUNT TYPE 12929'8 M6T SELECT WITH INTEREST 00 0 04342M NM I17 12671 ROBERT S GREENE SUSAN C SHENK 4815 CREEKVIEW RD MECHANICSBURG PA 17055-2113 INTEREST EARNED fOR STATEMENT PERIOD 0.24 INTEREST PAID VEO,R TO IIATE 1.46 A f`f`f111NT CIIMMARV STATEMENT :PERIOD PAGE MAY.10-JUN.08,2012 1 OF 3 [ARLISLE PIKE BEGINN NG -- BALANCE DEPOS S & tHER ADDITIONS .._ - - ~ CHECKS PAID DTHER SUBTRACTIONS "L4RR INTEREST PD ENG NG BALANCE _ ~ N0. AMOUNT N0. AMOUNT I N0. I AMOUNT I = 30,631.55 .T- 1 942 0~ 5 r 662.88 4 2,142.00 0.25 29,768.92 A f`f f111MT Af TTVTTV p0_T NG DATE S ': T2ANSACTION DESCRIPTION EPOSI S,IN.E EST S'OTHER ADDITIONS CH K ~Q!THE ---- SUBTRA TiONS AILY' BALANCE 05-10-12 __ BEGINNING BALD+NCE ~ 530,631.55 05-10-12 AMERICAN PROG TO PAYMENT 100,00 ` 05-10-12 CHECK NUMBER ;!060 -10.00 30,521.55 05-11-12 CHECK NUMBER 2059 ..59.76 30,461.79 05-14-12 CHECK NUMBER ~?061 ~, 26.69 30,435.10 05-15-12 CHECK NUMBER '.!062 ~, 500.00 29,935.10 05-23-12 CHECK. NUMBER ?063 ~ 66.43 29,868.67 06-01-12 US TREASURY 3L2 X%CIV SERV 1,351.00 06-01-12 US TREASURY 313 XXSOC SEC 591.00 31,810.67 06-06-12 REVERSE DIRECf DEPOSIT 1,351.00 \\ ` 06-06-12 REVERSE DIRECT DEPOSIT ~ , 2~'~" ~ a 06-06-12 AMERICAN PROG TO PAYMENT ~ 100.00 29,768.67 ~~` 06-08-12 INTEREST PAYMENT 0.25 'e9,768.92 ENDING BALANCE 529,768.92 ~- CHECKS PAID:SUMMARY 2059 05-11-12 59.76 2060 05-10-12 10.00 2061 05-14-12 26.69 2062 05-15-12 500.00 2063 05-23-12 66.43 ANNUAL PERCENTAGE YIELD EARNED = 0.00 SAVE YOUR CASH FOR WHEN YOU REALLY NEED IT. INSTEAD OF CARRYING E%TRA CASH OR FUMBLING KITH CHANGE, USE YOUR MBTCHECK CARD FOR ALL YOUR EVERYDAY PURCHASES - IT.S SAFER AND FASTER! NHETHER IT'S A BURGER AT LUNCH, GAS, GROCERIES, EVEN MOVIE RENTALS OR A CUP OF COFFEE - NO PURCHASE IS TOO SMALL FOR YOUR CARD! v t ~g ~ r s ~~ i.. & ~ 1f* a^a ~ ..3.~ Loden fero~l a f ~ ~ ~ ~~'~~ g~ * ~ , ... ` ~°..,~? ~ ~~ ! ~ ` ~ , _:. ._ saa .y3; t a=« ~ v' ~1 ~,y T '4 ©M~TBank ACCOUNT I~. PA6E 000000001292978 2 Of 3 AOBERT 8. GREENS, SR. . m-m~ ZUSJ SUSAN C. SNENK . w+s wEExvlEw Ro{P ¢. - ~ MECINNG9eURG,PA )N50 ` ? Ic~a1Ma~TIIank nsgSelecrt_ MFM¢ 40313029554 L292978:P 2059 - ~ j ^~ ,c ', a~F:~ s` . - s -. ll111' TU UGI Vlilitice 7~12U3 219955 290U7 Q Ab~m+ve o[E¢u~xsmnnM 3uurenweJ :,'~ "' `.~ N _ pl I 2v ia r _d ~ m i; 5 . .:> Paid :05/11/1011 =59.76 Check %1059 Pald :05/11/1011 559.76 Check %1059 ROBERY 6. GREENS, 6R. wee 2060 SUSAN C. SNENK r9a ov.n)-)aee t MEGHNIIC86U~. PA 11lAD - 1 (die ?Y~1 ~d'yri..i-- ~I~V\ L:OLLARS 8 ~~ 3 Ie51M&TDank ,(/~/J~//(~ C. f~~M 40313029554 L292978~•2060 Chock %7060 Pa1d :05/10/7017 510.00 P -"'-' ~¢O6p ~N oanF a3 18901 631000225280012'05:0914:92:2 i ' i as ,. ~,,, :91 -~ C t tfi' ~ E I `~ Check p1060 Paid :05/10/1011 y30.00 ROBERT E. OREENE SR. ~ ~ ZUBl SUSAN C. SNEk(C - PH fI)-T9-)9M A91e (%EFJOAEtiINMO - U.VCT`//~~~ 3 M£GWN16&IRE, PA ))75P ~ ~ ;~ E~ o ~ /° .TVA - ~ a i s .2~e- G 9_ I-~--dv ~ ~ /l~~~^^i - ~~~~1~~} ~ ooL1t4Al~~R]SC~1®~y~°~4.~ ~M~~~~~V} LIHSr~J 1f4 '.T ~C9 L. U~Y', LL i~J, "_ i 403 L30 X9554 L29297$n 20fii ~~~, ~_. - Geck %1061 Paid :05/19/7011 y16. 69 ROEIiRT R GREENS. ER m- ° maa - ZOB2 ~ l ' ~ SUSAN C. SMENK vm nPa79.+o9R NIS CREEIMEW HMD ¢3m~-IG ~~ ~ . MEEKMKGBURf., PA )ms9 i ~ 1 ~ i. . /~ wnil' aJ~.. Ti l ~ ~ ARi e ~C /lalMael'Bank - hudSeloc[_- 1 - M1 .. 4031302955. - - 1292978r 2062- - - - - - - - - Geck %1061 Pnld :05/15/1011 3500.00 ir ' ; [ f CVasOLIJ TN BV,IY >0119033{6 1E3013 50)3 ~., I f ,~ e9Re ¢P p)YORR os/la/)z .cf so. m , 6600 ]5 6PO]P ACP)ll)])60869)6 I ~ COP50410 RTR BONY >02190Y3{6 96]013)SOIS , 1 ~ , _ , , ~'~ Y.. '. ~ , i . 0 C f ~~ ~ ~ ~ .: 1 Check p1061 Paid :05/19/1011 316.fi9 a 3~a1 ,p 3 ( ) Zv > Ap - '+ i ~ ~~ q F) ~ 3 ~ , 3E 9 O , e s t 5• C r • t ,L Check p1061 Pald :05/15/1011 1500.00 ~ _ __ ~. (ACCOUNT N0. ACCDUNT TYPE 1292978 M8T SELECT WITH INTEREST 00 0 04342M N11 I17 000003835 FIDS1541G70107091207 01 000000 3835 ROBERT S GREENE SUSAN C SHENK 4815 CREEKVIEW RD MECHANICSBURG PA 17055-2113 STATE„ENT PERIOD PAGE JUN.09-JUL.09,2012 1 OF 5 INTEREST EARNED FOR S7A7EMEN7 PERIOD 0.24 CARLISLE PIKE INTEREST PAID YEAR TO DATE 1.71 ACCOl1N7 5l1MMARV 9ALANCE< i07HER ADOI7IDNS ~ CHECKS PAID ~UB'tRAGYB iS tNT R T PD Al:ANCP T NO, AMOUNT _ NO. AMOIRiT N0. AMOUNT 29,768.92 ~ ~ 0.00 8 .24 2 0.25 28,707.62 ACCf711NT ACTTVTTV R S U D LL O e R 6 8 !7 f~ .-~' .DATE 7RANSAC7rDN BBSC IP7ION s?.OTHER ADDIT R ~:I HAL~UIGE! 06-09-12 BEGINNING BALANCE 829,768.92 06-11-12 CHECK NUMBER 2066 ` 41.07 06-11-12 CHECK NUMBER 2068 10.28 29,717.57 Ob-12-12 CHECK NUMBER 2065 x,476.00 06-12-12 HARTFORD FIRE IN TEST 000000000002064 ~ 207.60 29,033.97 06-13-12 CHECK NUMBER 2067 ~ 35.00 28,998.97 06-14-12 CHECK NUMBER 2069 X15.61 28,983.36 06-15-12 VERIZON ARC CHECK PVMT OD0000000002071 x•27, 71 06-15-12 CHECK NUMBER 2072 x•25.76 06-15-12 CHECK NUMBER 2070 ~~19,39 28,910.50 06-26-22 CNECK NUMBER 2073 ~ 56.21 06-26-12 CHECK NUMBER 2074 +49.97 28,804.32 07-06-12 CNECK NUMBER 2075 ~ 65.00 07-06-12 CHECK NUMBER 2076 ~ 31.95 28,707.37 07-09-12 INTEREST PAYMENT 0.25 28,707.62 ENDING BALANCE 128,707.62 CHECKS PAID :SUMMARY 2065 06-12-12 476.00 2066 06-11-12 41.07 2067 06-13-12 35.00 2068 06-11-12 10.28 2069 Ob-14-12 15.61 2070 06-15-12 19.39 2072* 06-15-12 25.76 2073 06-26-12 56.21 2074 06-26-12 49.97 2075 07-06-12 65.00 2076 07-06-12 31.95 ANNUAL PERCENTAGE YIELD EARNED = 0.00 iaaencs ~ZI an c ';ACCOUNT NO. !~~ ACCOUNT TYPE 1292978 - MKT SELECT WITH INTEREST P .A1H A09 MA1L .0982012 2 OF 5 ROBERT S 6REENE ~` SU'_,AN C SHENK KEI?PING TABS ON YOUR CREDIT SCORE CAN ALERT YOU TO POSSIBLE IDENTITY THEFT OR BEHAVIORS AFFECTING YOUR CREDIT. FOR ONLY 62.99 PER MONTNi VZEN YOUR CREDIT SCORE PAGE ANYTIME YOU L06 ON TO M8T NEB BANKING. GET STARTED MEIN - LOG ON TO MiT NEB BANKING AND CLICK ON "CREDIT SCORE" UNDER THE °ACCOUNTS" TAB. CREDIT SCORE AND KEY FACTORS ARE PROVIDED BY E4UIFA%. MEMBER FDIC. ioaencs(s~izt a ~~ ~1CCGUfiT PAGE __ __.. 000000001292978 3 OF 5 00000815-OOt4080-Pepe 3 0!4-FlOStBlIG10107091107 ~{{~y'~y~`,~y u' ~ti vA 'tl ~'.03i3p2~5~~ .. 12929 °,~„ na 2086 g1TE~i~z~t~ 'i $~~~j7 ~ ~~vD 36` 2065 _~ ` Check p7ofi5 paid :08/11/1011 5476.00 IloneNrs.aaeeNE,sN. ~ UU 2066 8U8AN C. NIENK E - rn na-n>-.1am ~ ~ ~ ~~' . ONIBMew AOAD p ~~((/ !//p1 tne. IA 17RU - • Tl--~ 9 eermn6 aecaoE 1 - - ' J/ -. __~ $ 7~_ O~.-: -~-..e ~ A~ ~~LAeg 8 ~ ~V0319029554 ~ L292978~2066 Check p70fi6 pall :08/31/7017 p41. 07 X[1BlNT S. ON@ENE, SR. r~M'1'~sa 2067 BUeAN C. HNeNK PN. m-rnloea ~: "•ete CNeIXw6n WOAD Dnn MECHAN~DBEURD tAliO ~~~ q /ioar7 /~ PC~ J s 35 °~..: Oti/ ~ ^^°' LAAS ® E ~ awnb.QC7C t7 00(1 h (~- ~KP/V/~ :1:0313029554 3292978•`2067 Chsck p10fi7 paid :06/13/1011 p35.00 ~.. AO~Yffl.OHCW{{,,BN. - .. •.2p6$, .. ; ll~BW1 C..BHPNIC. ~ . _ , ne _ .- .lam-nnlus' ~ - •~..-- _-. me D9acAwex Naw. ..- - .. .. Nuneanwo, eA 1tDeo ~., .. ... :. .: w'df~`-i-"Y-'"`-[- _ Deese - -$i ~ Q b~,~ - . ` b7~ LLAZS 0 ~'fe ®M&TBank i - ~HaSebcG. s.:...•. iE:03i30~29~551: ~ ~~L~2929781. 2068 - ~. Check p1068 paid s0fi/]1/1011 p10. 18 ~ I 7 ~ ag ~ .eae_erwpf>m>C•laH..o.y.4~ _ ~~w. j !! 3 - r! :~ y y `Z e F fl i 4 ~E ~ E `; i Check p1065 I ______ g~~~ p1~ 12 1629E pp.••4i%e ~~ ~ C Y~^~ 4 ~l ]a ~.i Paid :06/11/7031 Deck p106fi Paid :06/13/7017 N { o w _J A ~ KI ~ v ~ a• N w ~' Z p476.00 i ~ e I : i I p41.07 r ., >0313D9i29< ^' ' :': {~ f i su 12iiIZNef1215.'00:]5 ~\ DOZ t1o a P sa ~ ot e43 ~ ~:?.031;~q~7134061220125U50002101002699130 ~ m = =r' : E i< '. ' I 2 :~ d $ .~ u~ac ~ ~ ~ rK L .. °~ . ~_..._.._ ~ m Chsck p10fi7 paid :06/13/1011 535.00 a_. ~ ri}~ d Q 7 ~a E ' ;Cr~ 1 I ~ ~ : :r S'S ~~ . ~ ~ 8 ~ ~ ~ $` ~ ~ i W I ` C ~ }DSP0609 ~~ ~ ~" ~ p y yl'6~p^CS(Ep .+'] - >033000913< PNC genk IT b" p :{E'3Y 4R ~ y~{;epR ~( DEP. TO CE. AEE:: OT END n PIYEE ~ ~ ' CTD ~ :g' , n S : ~ ; >033000063e ~NZ i k ~ ~$~ ~ ~ . _ 3 ~~ ,, ~' ;s I , ._ G1eck p10fie pald :06/33/]01] p10. 78 p Ma~sank ~ ROBfiRT S. OR6SN6, SR. ~ ., e~iM ' . 207 4 ' SUBRN G. SNENK PH. TIFif7-tOM ,ala cfEHNlEly GOAD - an /nom. .. M PA 1)6,D ~•~~~ I s uq_q."~o 97 .LAR9 8 ~~ a . M&T - 1 ..: i te '/ ~~0 _ 0~0~1 II--- I~~~,L._~~~. 11 ~` ~1:03i3029551: 1292978•'2074 Geck p707q P61d :06/7fi/7017 319.97 _ ROBERT S. OAEENE, SR. _--_ ~ALi -- 2075 SUSAN C. SNENK PH n>.rnnwe W MWC a /a Wl4 M,S CP[f.IME E MEGUNICSellfle. PA SHI50 L °nSD S ~ s ~~S ~l ~ ~h~ - 4 ". °^~ e • O a-J m6t14 ~ ~ j /,J -MmiSe)DRa I;0313029551: 12929781+2075 ,+0000006500+' Check #7075 Paid :07/06/7017 Sfi6. 00 ROBERT B. GREENS, SR. ~un 2076 amw+ c. Sk1ENK w,. nnrn-1m ,eu rxeflvaw nno ,4 ~. a t _ GpM(~J@~ PA ; ~OpO ' 5~ nAVronM f 1~ ~ 1 RLU4 LO/1 ~/~/a~. I $'J7 ~ qy°Q ~• 7amx • ~ o rto 9~ .~ °OLLAps B ~= .k11-IIIS°T3N-8 ~1.mn e i(~c- C03i30Z9551: 129 Z978a•2076 Cheek p7076 Said :07/06/7017 331.95 KC~tMMi?T pI,GE 000000001292978 ~ 5 OP 5 00003p75-0o14084•Pepe 4 e,4-FID6tS41G70707091207 ' ~ ua ~ r s[ ~~ 3 ~ m z 3 9 i ~ d' >~ 5 y ST ~Fg#E ~Y ~ Pin tlTi III R~ or.c.xR•~ I ~:,5 I I~~ 5 '^ M F ~ -, g ~ s 4'~1 S E~} S y~ a ~~ ~#L0j3 i1B n r b Y A aa ` ~~ a ~i3 ~4 ~` ! "~ ~ y y y ~i ~ F~' 9~ i Y~ # ~ ~ : Geck #7076 Pa1d :06/76/7017 39.97 - 5 _ - 4 m - sr = ~g ( 0 0 03 ~.O ~ ~ T p ro ' E~ ~ S%B L S S7B4912 P% ii- '' = :: ~ • JL ~ _iii_ _! L?~ J i K a #7075 Check E61d :07/06/7017 365.00 $$ ry~7~, ~~ h~ ' I 3 ~ S~ ~g IT ,I , x~9. "r,+' ~ R ) ~ _ P:323 l ~sASfpn 35094 oT061 009Q }-~~~'ILBNVn3~~r6bN' . `CRED T4YPRYEE ,39398 ~li # p p # ~a e y~EEa [g ~`;ye P y , 411 -I A ~ 9G~Jg3L%} ~_ ~ _ ~ ~ D R I -3D03~3Y~,tg12 ABji END6N ,77Qd8$2Q9q,~34 ,~: Are 1 Ii' , o~ ~~ I ~ (( * a --- - Cheek p707fi - Pa1d :07/06/7017 331.95 ~, ~ , ,_- . 'ACCOUNT N0. ACCOUNT TYPE J 1 129297 -! M8T _SELECT VITH INTEREST OD 0 114542" NM ]'.I. 000003805 FIDS^541G7'J10809'1208 01 000000 3805 ,.,., •'~` ROBERT S GREENE t SUSAN C SHENK 481!5 CREEKVIEW RD MECHANICSBURG PA 1,7055-211:; SrATEMI NTI'ERIOD dAGE` . IUL 10 fUG D7,b OIZ L OF 5 INTEREST EARNED FOR STATEMENT PERIOD 0.23 CARL:[SL'c P]:KE. INTEREST PAID YEAR TO DATE 1.95 ACCOUNT" SUMMARY • ! ! fi: BALANCE. D `~0•^'•'•^ :OTHER AD~DIt10NS ~ ~~ "~ NECKS PAiD ^TI'f~iE'i~"'` SUBTRACTIONS '~Ii~R'~'N~' INTJRE~T Pb k'L 116 •-.. BALANCE _ N0~ AMOUNT N0. A110UNT N0 AMOUNT _ 1 28,707.62 r l _ I r~ 9.95 - ~-1 40 ~4 _ ~ ? 211 3E1 - 0.24 ' 27,1 66 10 ACCOUNT ACTIVITY 0 i `e R v r ;DATE s IRAN ACT DN DE5CRIRTI N ; - flE o I S+: NT B.OTNER abDITTONS - -- ~CFT~fiS ~'l~E~ SU87RACTIQlC: .,,,,,..~.~.,......~'•~~i ]SAJ.ANCE 07-10-12 BEGINNING BALANCE ~ -' - -'--V•- _ _ -` 028„7CV.6 . 07-10-12 CHECK NUMBER 20'79 ~`~,10.00 28n6'i~7. 62: 07-11-12 CHECK NIMBER2078 ,`102.76 28,,594.8ii 07-13-12 CHECK NUMBER 20'77 '`•,155.05 28,r4::i9.81 07-24-12 VERIZON ARC CHECK PYMT 000000000002081 ,~ 11f, ~ 27.31 28,4:1.2.5!1 ,,~y , 'r" " 07-25-12 HARTFORD FIRE IM CHECKPYMT D00000000002082 ~;"' •..184.08 07-25-12 CHECK NUMBER 2080 \1.1. 48 07-25-12 CHECK NUMBER 2083 \J.1,46 28,205.48 07-27-12 CHECK NUMBER 2084 \40. 4T 28,1 55.01 07-30-12 CHECK NUMBER 2085 ~. ~~315 00 27,850.01 08-03-12 VERIZON VERIZON R~ ~` 9.95 08-03-12 CHECK NUMBER 2087 ~3] 12 27,828.84 08-06-12 CHECK NUMBER 2089 `x.56: 00 27,20b.84~ 08-09-12 INTEREST PAYMENT U.:24 27, 2~fi6.08~ ENDING BALANCE -~ -'---~--~-- _--~--'-- --.827,266_081 _.~. CNECItS PAID: SIInMARY . --__._.__ ____._-- -._.___, e-.-..i 2077 07-13-12 155.05 2078 07 ^a1.•12 102.76 2579 OP •30-12 l0.Oq~ 2080 07-25-12 11.48 2083 07-;25'12 11.46 20&i 0'•27-12 40.47 2085 07-30-12 315.00 20871' 08^03-12 31.12 2D8'9~ OU •05-12 5b?, ,,OAT ANNUAL PERCENTAA:E YIELD EARNED ~~ 0.00 i; moeacs tsnzl ,.,_ & an c iACCOUNT Ma. ACCOUNT TYPE 1292978 M8T SELECT HITH INTEREST STATEMENT PERIOD PAGE ~: JUL.10-AUG.09,2012 2 OF 5 i..~ ROBERT 5 GREENE .• ~< SUSAN C SHENK SAVE BI6 ON BACK TO SCHOOL BASICS NHEN YOU USE YOUR MST CHECK CARD OR MiT CREDIT CARD AT POPULAR RETAILERS IN STORES, ON THE MEB AND OVER THE PHONE. FOR FULL DETAILS AND TO START SAVING, VISIT MTId.COM/SXOPPING. FOR CUSTOMER SERVICE WESTIONS, PLEASE CALL 1-800-724-2440. caoeac, (en21 pB~ ACC53lINT - iAGE - 000000001292978 3 OF 5 00003905-001415&Pape 3 o14FID51541G70109091208 t i.'r - NOBEII'3 S. 6REENE, 8FL ~ ~a• ~ ~ 2077 ~- - -... sue~p/ e. sNEHtc ~ - - . .. ...'.. Mt. rrnmtae - . _ .- :ale CreBataw RDwD ~~ ~ wnl~ /,a - . ~ ~ ~ MCxw~ry1l1q rw~t •~.•.r~~t~.n'°~~/~~~1-_l,_l~Y_l~)l_H_J ./'d.~M~/~ft~•///l ~ ~ ~ I $S/~$5',~%d7:. _SILiGlLt ~LSRGPIL ~-~-~/.~LL.$Y"~~•oPw~as B m' ~ (s!a1M&TDank ~ . (J (/ l 1N~r~~~dS~el-~ a:03L302955t: ~ ~ g2929789.2047~ Chsck N1077 Pald :07/13/7011 5155.05 noaEwr B ~EEp~g 813. el~'i p° :207$ _ " ~-' 9UeAN C BHENK - _ ' _ __ rN 'nam tmn ._' _ _ __ -. N16®tEEkNEKRDwO~ _[ WN ~• •.• rwrrom. , T/A~ $. /~ '26'0 ; ~ ~ Ill ,~ ' /fu!"~,. ~_.~"'`7~ii,nRd~:®~~5~"' ~, ~ ~ ^~ 33 i .. ~ ~. ~'\C'11 . W1331~0?S53 TSJP Se9+E'R 'REU $ 06-"$1-94 F ~~ ,;-3 i i .2- ~\_. ~"% ~ ~ ~ t tF fa`i{i;2 i..~ g~ , 4~~4i3 i- t) y N ', , t-. ti.', ~~.. ., . J tl ~ ` r~ ~s; ~ I 1 ~e {' ~: :5i51°s L d 4?S~ 1 ! +-qty:; :f Nd If~~ `s ~ t _ i ~C . - Check M1077 Paid :07/13/1011 5155.05 ,3 c ~~ ~i ... ~ ~ ~~ ! I Q ~ 8 S .s .~y.., Aaiooteesy<; 111 - I _' :' i Q ~a ice. • ._. ~ y _. - Sl1P TO CR:~V ~ 4°{HL ~~ .. j1~i I >J J QS 4 C'i /! S~0H SSI'13g •_l•. ~S ~p S93k~~ l5 "I+Ha OI EWS, - ~~ oaloooosa<. CTD I T: ' _. Igg: . .~ 'I ' ' i , . Ne1/~S]/4'S]Y(/°/ '. yJUCy~4 ~ _ iJR1,P1~ _ ~d~ ~~ ~~b~ ~ ~ y ` ~~ ~~ -r I, i -15:09130293'~t: ~ - _.i 2929?84•'2048 ~ ~ ~ ~~ _~. - - I ~; ~~ '~ Chsck p1078 PHSd :07/11/1011 5101.76 Check N7078 Paid :07/11/1017 7101.74 POBERT B. OBEENE, Sfl. °*~en 2079 SU8i1N C. BNENK m. n]•r.D•t4ee 4sta SLIRF]fv1EW AD ~ a~wn • ~ -~•tLwAp 8 e`er- ~ (4~M8(THank M- 4033302955. i29z998a•2049 -~~ Geck N7079 Pa1d :07/10/7011 510.00 AOBlAT B. OFIBENE, SR . ~'• e¢ 2Q80 BUBAN 0. BNENK ~I s Iate C4mlVlf'A RWD 9 our J MEGHI NI CEW Pw ]OW . / ' MI/O b16 /~iC7. 2 LJ~J~~ 1 W /~ •//JU ~ ~ 2 ~~QQ~~ ` ~ e i .~/.wR9 8 5° /J•iM a1T _ M:a~~9ys.~Ia~OOr ~1:03i3029551: i292978r 2080 Chet( p1080 Pnid :07/15/1011 511.48 .~ ~~ €i_.. ~€: R N1 `~ y', : ~~ Int4pcryBank OJYYYgggppp18]8] 431 D255030 y112/07Np 1!?OB:~ Check M1079 P4id :07/10/10]7 510.00 lllfl' 1'U Util Utilities 21203 2194571~19Wp F ~' a~+ ~ Ahfanee n(Hn~,~~y4mer6 (' d Cut ~C`(~ ~ C 4.]C.1 ~• •1~: ii~8 13.i'r'. i.y1L ' k ~ - i-2 ~ .I ^ __ ~~ _ ~ Geck M10p0 Paid :07/15/1011 511.48 ©M&T&311k ACCtlIMl7 PAGE .< ... _.. _. 000000001292978 5 OF 5 00003805-OOt41a7•Papr 4 el4•FIDStLrIG70tOpO8t20B 910lEIifB.GREF71F. S8. ~ Oa eLD89 BWIW F BXENK nam-7mnopr utaen~avlewaOAO wa 11 LKCIUIaCY1180. M IlmO NaQ.~.C ~1/~w~r 1:03330 Z9551t 3292978r 2089 CAeek M1089 Paid :OB/Ofi/7017 9963.00 OBfD4201709:47PM PAZ3181081 {583.0090899]01151061745 D GeOk 717089 ~:. ~~ Pa1d :08/06/7017 9563.00 _, M&T Ban c ~i ACCOUNT N6. ACCOUNT TYPE. 1292978 MST SELECT WITH INTEREST 00 0 04342M NM I17 000002586 FIDS1541G70209071209 01 001000 12586 ROBERT S GREENE + SUSAN C SHENK 4815 CREEKVIEW RD MECHANICSBURG PA 17055-2113 INTEREST EARNED FOR STATEMENT PERIOD O. ZI INTEREST PAID YEAR TO DATE 2.16 ACCOUNT ~;UMMARY STATEMENT PERIOD PAGE AUG.10-SEP.07,2012 1 OF 2 CARLISLE PIKE B BALANCE s R OTHER :AUDr72OeIS ~ CHECKS PAID _ ~U ~TRACTI ! Sfli'E Y PD ~ N0. AMOUNT N0. AMOUNT N0. AMOUNT 27,266.08 2 298.6 4 40 8 0 .00 0.21 27,159.79 ACCOUNT ACTIVITY fW[iRV ;DATE ~:'tRAN ACT~GN bE5CkIpTION Yf'yyi [1i f; Wl~[MRYy[ Bi ~NE AIf(fI7IONS '::MyrNRy 'R:':Y [[[F^ :': 5117 iETIONS M^iYT;:: ~ BAt i1CL 08-10-12 BEGINNING BALANCE 027,266.08 08-10-12 CHECK NUMBER 2090 .. . ~"~ 169,50 27,096.58 08-14-12 _ DEPOSIT ` Z,r~S,.,r 100.00 27,196.58 08-15-12 CHECK MINBER 2091 ('G{v^~ ~ 6.52 27,186.06 08-30-12 CHECK NUMBER 2092 ~ 35.26 27,152.80 08-31-12 DEPOSIT ~~ pw~ ~ 198.68 f ~ 27,351.48 09-07-12 INTEREST PAYMENT ~ 0.21 "~~D' . 09-07-12 ~~y CHECK NUMBER 2095 'C' ~4~^1 `191,90 27,159.79 ENDING BALANCE 027 159.79 `o S a CHECKS PATASUMMARY !I 2090 08-10-12 169.50 2091 08-15-12 8.52 2092 08-30-12 35.26 20958 09-07-12 191.90 ANNUAL PERCENTAGE YIELD EARNED 0.00 DID YOU KNON THAT YOU CAN MANAGE VIRTUALLY ALL YOUR ACCOUNTS IN ONE PLACE AND DISCOVER NAYS 70 SAVE MONEY BY USING FINANCENORKS AVAILABLE IN MBT NEB BANKING? GET STARTED TODAY FOR ONLY 00.99 PER MONTH. LOG ON TO MBT NEB BANKING AND SELECT ••FINANCENORKS^ UNDER THE ACCOUNTS ^TAB••. LEARN MORE AT NTB.COM/FINANCENORKS. FINANCEYIORKS IS A REGISTERED TRADEMARK OF .TNTUIT,INC. MEMBER FDIC. LOOBAGS (6/12 a~~ ACCt3UNT - PkGE ~: 000000001292978 2 OF 2 00009498-0009869-P•pe R Pf _ _. R09/EpT 9, GNEENE,SS, °.+e 2090 HUSIW C. SH6HK PX, m-mfCHe ~' / ulacneeEVi9w woaD n,m {{{f MPtHAN1C9BUNO. Pa n9ao ~nPl IM ~//tJ• y~~ -e:03 i302955e: 129 2978~v 2090 Check 89090 Paid :08/10/7019 Sifi9.50 __. _ FSOSESTB.GNEENE,5fl. ]~] 2091 SUSAN C. SHPNK PN.41]dSl-llba anaCNEEE9NaVADM ~~~/~~,_ ~ MCCflWM.88UN8. PA 1]050 ~e:03i302955f: i292978~~'209i Check 89091 said :OB/ls/9017 49, s9 _ froscmL.GxEE99f:,se. ~-<rr.:- 2092~~ 7KIBAN C. tM6NK vr<n]-m-,oe9 fr w+ecNeNea9w ww ' _ ' -~ RW4MCPBUNai Pa 1]afia -~' Mn ~ ~ ,• ~ ~ ,... .- ~ ~ _. '. ~ / .W,,; 3d3~f0zooo`~ ._, Il,non °~.031302955f ~ 1292978r 2092. Z L; r ~ n S'E1.08EI~8u^^2228&88~>831312835< 88892812 ~ ~ - ~ a F; ~y '. • ~ ~y ^ .- .. - ~ ti -- O '~ ' . ~ ~ T JC` L-_-.. __ Chsek 89091 h ~~ 1 3 :~ dP .' $ ~~ .} ~ @~(Ps9~ €~ 4aSe~~E at , `~' ' a~ ;~~~ ' i "i ~:- t.. 43a-9fi Pa1d :08/10/7019 y~4~~1~69.50 llriY 1'U VU4.UW1gMitd7l~b.ei3e-aix 21PBSV1~.20DL J Ahecnw Df HndnnemcnS [keDmrcaed ~, I-. _ ~ ~!_z said :06/15/9019 I _~ + Check 89097 Paid :08/30/9019 436.9fi Cluck 89099 Paid :08/30/9017 ao~er4raraeeNe,4w. _°-•,a ~' =. 2095'- .. e418AN c. HIIFNK - vH ]4]-»]-lava _ aIaDRHFSN1eWNCND - '.wm q/5//a. _ MECNMa[YWHL, vAA HD9D • UOm.n95 8 PeY~" -C03i3029@51. - ~. i'292988a';2095-~- - 49.59 I~y I~ ~ o i~ rA ' 5~ T~~ ' < ~~~ ~ !"~ ~ Check 89095 Paid :09/0]/9019 4191.90 . _ I g ~~ F I O , f >' >2 ~ ; ~ ^ i_~ ^ '~ ve ;zalzD 9ov ~'^ m P ~ S! ' u :>031000053< ~ IFS ~ N . ar. r IE sY ~_ :PNC Beek. NBP. TD CG. .;0 W P1Y8E ~ ' ~ t f d •- X$ ~~ < IaeH, O! LND >D31DOD0 a3< M ~ GTD ~ - ~ 1 S h I . u . ~ ,Dim ~_ I:~ C r; a - _ Check 89095 Paid X09/07/1019 4191.90 R1 AA ~ ~ _ _ i ACCOUNT N0. ACCOUNT TYPE 1292978 M8T SELECT WITH INTEREST 00 0 04342M NM I17 000003782 FI051541G70110091210 01 000000 378:? ROBERT S GREENE SUSAN C SHENK 4815 CREEKVIEW RD MECHANICSBURG PA 17055-2113 INTEREST EARNED FOR STATEMENT PERIOD 0.23 INTEREST PAID YEAR TO DATE 2.40 A Cf'1711NT SUMMARY STATEMENT PERIOD PAGE SEP.OB-OCT.09~2012 1 OF 2 CARLISLE PIKE . d~~ ,, 6 '~~~~ Ifi~7P ': BAL NCE '~ S ~OTNER ADDITIONS ~ ~"- CNEL:KS PAID '! t SUBTRACT' ~ ~ TN P BA '~~ ND. AMOUNT N0. AMOUNT N0. AMOUNT 27,159.79 0 0.00 4 62.14 0 0.00 0.24 27097.89 A L:000N I AG I 1 V'f-1V-1C GAGVA TRYJGR CV7l - - r...c r. .--i.r• 8 09-13-12 CHECK NUMBER 2096 X18.42 27111.17 u 09-18-12 CHECK NUMBER 2097 ~ 8.52 uS'~ 09-18-12 CHECK NUMBER 2093 \" 5.00 27097.65 LL 10-09-12 INTEREST PAYMENT 0.24 27,097.89 m ENDING BALANCE i27~097.89 S n 3t CHECKS PAID 8tRMlARY 8 ~ 2093 09-18-12 5.00 2094 09-10-12 30.20 2096 09-13-12 18.42 2097 09-18-12 8.52 ANNUAL PERCENTAGE YIELD EARNED O.OD CUSTDMIZE YOUR NEN MST BANK ALERTS MST BANK ALERTS CAN HELP YOU: MONITOR YOUR BANK ACCOUNT FOR POSSIBLE FRAUDULENT ACTIVITY STAY ON TOP OF YOUR ACCOUNT BALANCES KEEP TRACK OF MST CHECK CARD SPENDING, AND KNON NHEN A LARGE DEPOSIT OR NITHDRANAL HAS BEEN MADE TO YOUR ACCOUNT. 6ET NOTIFIED BY TEXTS EMAIL OR MST APP. LEARN MORE A7 MTB.COM/ALERTS. MEMBER FDIC. LOOBACS (fi/121 Q n~TBank ~ccma;r fkce 000000001292978 2 Of 2 00003182-OOt~tefi-Page 2 el 2-FIDB1fi11G70it00B12t0-00003782 '*t ~_<~ ROBERT S.OREENE. BR ~-na .LQ 9.3 SUSAN Q SNFNK '.'. PiLT'I-'Tf.1pB _ 'A f ~M~ANC@BURD, PPA 1]eS~e ,w //~-~Ie"~_.-. t oo'n°n ' 1.1L! CLn / n.r u / A4e'.~Cl M FJi1C . 1 S: S a0 ~ : f 'K0313f129557: 3292978w 2093 ~ ~' Deck p7093 Paid :09/38/3D33 S9. DO pOSERT a. aREFJ1E, &i. _-~°--wt 294 SUSAN C.BHENK PM.nb»fdnp Lt M wnl°m. tPA~imo omc 9 /~-- PO~Y~l7--u~nr~iL(i_' L.~ ~ ~ aryO .. r aA M&T ank ~~~~ ~~-~ . x:0 3 130 2955i: 1 29 2978w 2094 Check p3099 Yaid :09/10/7013 ;30.70 ~, ~ ~ 6Y p_.l 33 ' s~ ' d C g ~ ~S " N~ -oorr 9 y # i ~i 3 ~~ ~ ~' ~ ~~ ''N p ~ R i( 3i ~ 1 ~$ _ 3_?~S R ;3 ~{ ~ ~ i ~ ,,t;=;. s f ~ ~~ k ~. } 3 :heck N7093 Paid :09/18/7013 ~_ - _ 5.9 ' .: QjR7027 703175?~~2~d 8P11'ME~,1-pld .. . ., 00024111893$7 PfT =: CRED TQ PAYEE ,w : < 184-BOp$(371412 ABS END GUA1i z x n ..: ~. ~. . Check p709p Paid :09/10/3013 ;30.30 ;9.00 ___ a 3 RQ®ERT l]BL'13Q-]$ Q13'/ee Be OP3~~ eU6AN C. QNENK 2096 PH. n1-mrnwe - ~ u+e alettwlew nDAD ~ ne,. / d//pj _ ' MEaHANICeBDPO, PA 110x0 j'_ i:1i +c: ° ~ / ~ $ / ~. 100 P f~O ~^`` yA6 B ~- 9 ~...~d. / A1EaSebc~ n„3,Z3~o- 000 n.C.~`~~ ~r:03L302955x: i292978w 2096 h > r~ y~~;. ~ $~ 6s %p^ }ip 2F3 .. ~'I. Y;; fid#gyC#g"x {~~xp{€ap9[ r ~ j~ ~; is ~~§e ~ n "a ''~~ t s ~~ 0 ~ ~ 'T xQ$t ~m~~ ~` ~ ~ u ~~ ~ Check p3096 Pdd :D9/13/3013 S38. i3 NOSE11T1OREEN[,tiR. e-°ea 2097 BUBAN QSNENK wx. nramtW _ 41x p1lEMNlW RDAD ~. ~wtt /p7 / MECNIHK9EUg3, PA 1)OSO _ _~~. Momma r ' ~ Bank _ /MeaSdBCt. : 4wti ~2j 9/59/a~oc~rc ~C`,..~ 2_03i3O 29554 129297Bw 2D97 ~~ Check p3097 Paid :09/18/7013 ;8.53 Check p3096 9a1d :09/33/1033 - _ ~ DRP TO iri.T [Ril iticn 71203 - = Ahecnee of Andnncmeert Cwerentcad ~~ - :. _ 6 4 t s Chsek p3097 Said :09/78/3013 518.43 21943~290(IR -~ ~~ ~~ 6£ a e m `~y i$ F' P ~~ _ ;8.63 & an c - L ACCOUNT N0, ACGOVNT TYPE: :.. 1292978 MYCHOICE PLUS CHECKING 00 0 04342M NN I17 000001595 FIDS1541G70211091211 02 000000 15569 ROBERT S GREENE SUSAN C SHENK 4815 CREEKVIEW RD MECHANICSBURG PA 17055-2113 INTEREST EARNED FOR STATEMENT PERIOD 0.01 INTEREST PAID YEAR TO DATE 2.41 1CCOIINT SLIM MARY STATEMENT PERI00 PAGE OCT.10-NOY.09,2012 1 OF 2 CARLISLE PIKE I 0< ~` BALANCE ': D DINER A~ftIOMS CHECKS PkID -- Sd)BTRACTIONS YefTEYE'ST PD RAi:~-Nra N0. A_MOUNi ND. AMOUNT N0. AMOUNT 27,097.89 1 7.6_ 0.00 0 0.00 0.01 ~ 26.955.57 a v N G 0 a ACCOUNT ACTIVITY DATE YRANSAC7IdN BESCR pTIQN 8. HER AdllYTIEXVS ~SUSYR tT E. 10-10-12 BEGINNING BALANCE ~ 027,097.89 10-10-12 CHECK NUMBER 2098 150.00 26,947.69 10-12-12 INTEREST PAYMENT ;~ 0.01 26,947.90 10-19-12 DEPOSIT 1.J~11i1 X7.67 26,955.57 ENDING BALANCE 026,955.57 exesKS PAID .sunNAR,v 2098 30-10-12 150.00 ANNUAL PERCENTAGE YIELD EARNED = 0.00 MOBILE TEXT BANKING- IT•S AS EASY AS TEXTING THE LETTER ••B•• TO MANDT (62638) TO RETRIEVE YOUR ACCOUNT BALANCE. NI7H MOBILE TEXT BANKING YOU CAN GET ACCOUNT INFORMATION AT YOUR FINGERTIPS AND RETRIEVE YOUR BALANCES AND RECENT TRANSACTIONS. NOH YOU CAN AL50 ENROLL TO RECEIVE TEXT ALERTS ON IMPORTANT ACCOUNT ACTIVITIES. MOBILE TEXT BANKING VIORKS ON VIRTUALLY EVERY MOBILE PHONE. YIEM OUR DEMO AND LEARN MORE TODAY AT MTB.f.OM/MOBILE. MEMBER FDIC. Loo6aCS (6/12) p MsrTBank ACCOUI9T PAGE 000000001292978 2 OF 2 OOOOt595-0905971-Cape 2 oft-FIDSt511G70tt7091ttt-OOOOSSfi9 ~~ . _~~~~^- eoeeKra aF~K69f9. ~°, eR 2098 8D3MNGlNIEIIK ~e+e enm~newn0.~o O ~ wroux9sew0. va rvw i re'r~m/gJn',m~ `~, d,~~/,(y~ ,p/~//J//I / ~ m S_ J s ~~,Q O/ y &SIMaF!'Henk _~~ „,„~~~ 378'95 .~r/~ _--_ COI 33302955-^_•C ~_~L292978u'2098 Cheek N9099 eald :10/10/7019 3150.Oo Cheek NpD99 Baia aoho/to19 g~~~ ~ °3m ~2~0 ~>~ fir%t° m~. ~~~ 31so. oo ). ', ~~ 7 B 3. ,~ ~~) a. -5 %v :~ b ~~ ~. 'y L., ~~ G c ~ U EE~S:~j~E S~~Ee~~aaa~~a~~~~T ~S~ex ~Sa~~g~EE55= E o"d~~tl5a'e1o ~'s 3'~~ 0~~1'"d~a~~~"d 6'~"d5v"~g'~ld~~a "6 ~~"dtlo~do '" GG GGGG GGGG CGvGCv vGGGGGG w GG GGvGGGGGG ~y~~ o ~ a ~ N ~ b; ~ z ~. ~ ~ S a . E a 9 8 $ F o v N ., ~ ~3 $ $ ~ 3 a 'R. "s R. ~ 4 m a Cg gp'gp 5 ~ G °sp ~ ~ w L ~ ~ ~ ~~ ~P Q~~ p '~ 6 ~ U =^^ ., a a ~. ~ s a c~ a ~ ~~ i- ~~ g ~ 8 ~ 3 x e ~ ~3~ ~~ ~ ~ § $ 8 ~; ] ; ~ s~ ~ e ~ :~~ 8 s - ~4:_. k ns "' 2 a W g, "a ~ e g e ~ a U, ~ ~ a ~ '" 9~ ,.g g~~ ?' a a a i. -<.; y a r~ Charles E. Shields, III 6 Clouser Road Mechanicsburg, Pennsylvania 17055 717/766-0209 • FAX 717/795-7473 Invoice su6milted ta. Ms. Patricia A. Ellenberger 336 North 2nd Street Wormleysburg PA 17043 Professional Services Rendered concerning the Estate o1'Robert S. Greene, Sr.: meeting $448.50 and discussions. See attached detailed timesheet. $195.00 ph x 2.3 hours ROBERT S. GREENE, SR. , SUSAN C. SHENK PH. 717-737.1066 4615 CREEKVIEW ROAD PAY TO I'EIE I~1M&TBanlc d~~~%w~ MEMO •~:03i3029554 Friday, December 7, 2012 313 4342 DATE I ~ O 2099 l ~./~/~~ ARS LI ....a.. ~+w ~ ~. \ ~ i 29 29781i' 2099 Total Amount Due: $448.50 Please make check payable to Chazles E. Shields, III. To ensure proper credit, please return a copy of the invoice. Net Payable: 30 Days Thank you for allowing me to be of assistance. For office use only: Date of Payment Check Number Amount Paid ~p~ INSURANCE BILL Auto & Home Insurance Program o-om PERSONAL AUTOMOBILE THE HANTFONO A A R.P INSURANCE PROGRAM PROPI_RTY AND CASUALTY INS. CO. OF HARTFORD 0740 GREENE ROBERT S Billing ID 81605624 4815 CREEKVIEW RD Customer Service 1-800-423-6789 MECHANICSBURG PA 17050 Statement Date 04/23/12 Policy Number 55 PHF597789 Policy Term 06/01 /12-06/01 /13 Balance $1,013.00 Your auto policy will expire on 06/01/12. YOUR POLICY WILL BE RENEWED IF WE RECEIVE YOUR PAYMENT BY THE DUE DATE. REMEMBER: Unless you renew your policy, you will not have any coverage from The Hartford on or after 06/01 /12. If we receive the minimum amount due by the due date, you will avoid a $12.00 late payment fee. a s FULL PAYMENT You may avoid future fees if we receive your balance of 5 by 'may; Or, you may choose one of the available payment opti ms shown below by paying one of the shaded amounts by the due date: TWO PAYMENTS DUE DATE~~q 7~, AMQUNT 11 /21 /12 $491:24* TWELVE PAYMENTS ' i Pay by °, ,. :With this. option you will be billed $86.04* on O6/01 /12, due 06/21 /12: Additional installments will be billed on the 1st of each month with payments due on the 21st. SIX PAYMENTS DUE DATE OUNT"" 07/21/12' -$-1 09/21/12 $167.08* 11/21/12 $167.08* 01/21/13 $167.08* 03/21/13 $167.08* ~~~~ ~U~ Customer Account Information For Service To: Robert S Greene 4815 Creekview Rd Account Number: 24.1 1 1 8939-8 Premise Number: 24-0582129 Billing Period & Meter Information Billing Date: May 25, 2012 Billing Period: Apr 24 to May 22(28 days) Next reading ontabout: Jun 22, 2012 Rate Type: Residential Meter readings in current billing period: Meter Number N084263867 is a 5/8-inch meter Present-actual 79500 Last-actual 78100 Gallons used 1400 Water Usage Comparison Monthly usage in hundred 'LV 1 1 p a u u u e~ o e e a a p a 1 y n I g p t v c n b r Y y 2. $29.31 $14.50 -43.81 .00 13.75 12.74 .08 26.57 9.00 5.50 1 0 $41. ~~ ~~~ ~~-kl );;~z+ '~.~..I IFS 1f. Messages to you from Pennsylvania American Water ' Any portion of the water charges whidr is not paid as of 6/19/12 will tie subject to a 1.50% penalty. Approximately 4.57 percent, or $1.21, of State taxes are included in your current bill. E active Aprit 1, 2012, the Distribution System Improvement Charge (1~SIC} increased from O.DD~° to D.32%. This charge funds the replacement of water distnbu6on /aalities. "Have you recently changed your primary phone number? I1 you have, please update your account information using My H2O Online at wwwamwater.com/myh2o or call us at the number bebw so that we can update our re Customer Service & Emergencies 1-800-565-7292 (24 Hours) For Hearing Impaired Customers TDD t-8D0-300-6202 (24 Hours) Visit us online at: www.pennsylvaniaamwater.com RAW100AM7871 Billing Summary ---------Prior Bal:mce------------------ Prior Water Balance Prior Balance Otl~er Payments prior tc May 25, 2012. Thanksl Total prior balance, May 25, 2012 ------Current Vlater Charges--------- Service Charge Water Volume ($.009101 x 1,400} DSl - PAWC Cha ge 0.32% Total water charges, May 25, 2012 ----------Other Current Charges------- CustomerProtadion Sewer Line Customer Protection Water Line Total other charges, May 25, 2012 ----------AMOUNT DUE 001815/001ti1b NI:V I lh IAVUti 13 A1M 13880 Patient: -ROBERT B.GREENE Chart Number: GRE:RO000 Case: 4/13/12 Pald by Paid By Dates Procedure Charge Primary Guarantor Adjustments Remainder 04/13/12 11721 46.00 -6.74 -2.26 35.00 ~,c ~C~~ ~, . ~k~ ~dl~ ~P~~1>Ii~ ~~ Amount Due 35.0 ~j~ AMERICAN HOMEPATIENT" P.O. 80X 827161 PHILADELPHIA PA 19182-7161 lll'I'lllllllllllllll'll'III'll'I"'llllllllll'lllllllllllll"11• ROBERT GREENE 4815 CREEKVIEW RD MECHANICSBURG PA 170502113 zsso Patient Name: ROBERT GREENE For Billing Questions, Call: 877-214-7913 Option 4 Account No.: 06571957844 Bill Date: 05/21/2012 Pay online with your credit card! Visit www.ahom.com anytime. Statement of Account as of 05/21/2012 03/13/2022 K081891 OXYGEN TANK WREGULATOR 03/13/2012 K081891 CONCENTRATOR E1390 K081891 Payments Received - Thank you $7.36 $44.02 ($41.1Oj /„~ r~I~ ~~ ~~ r f! d iyl insurance claims have alreatly been filed on your behalf. The balance on this statement is your portion. Please disregard this statement if you have already submitted payment. $1 you for trusting American Home Patient with your respiratory and This amount is payable upon receipt MESSAGES EXPLAINED BELOW *** Thank yoi for your prompt payment. Please call 717-731-8315 with any *** *** uestion>. *** it ~k it it*~ir 9CJY]Y ic~k 4i ':~~4~e>Y~'r>Y>k>k~4~4.k~k,kitie*~'e.4~4i.~k>k ~4a4aka4>Fa4aY~4icir~4~4,t~t ic~kir~tic i. ~r~tic,kit ~'rir'hic~k it is it>Yic~k4c it is itiritic~t~k is it Ac Insurance Charges pending to Prv; 440.00 Ins Pay/Adj against Ins pending 262.38 -177.62 04/26112 1 9 PROGRAM EVAL ICD, DUAL LE 93283 V45.02 175.00 05/15/12 TODAY'S OPTI Payment 62.43 05/15/12 Accept Assign Adl. -96.96 0.00 15.61* L-The 'PLEASE PAY' includes unpaid co-pay or co-ins. Please make payment. DATE LAST PAID AMOUNT • - ~ • - . ~ • - • ~ • ~ . . - . .. 00/00/00 0.00 15.61 0.00 0.00 0.00 0.00 0.00 0.00 15.b1 MAKE PINNACLE;fEALTH CARDIOVASCULAR INST, INC , ~ CHECK 1000 N FJtONT ST (MOFFITT HEART & VASC) PAVAeLE TO: WORMLEYSiSURG, PA 17043-1034 (~ ~ ~ 1~/,,~ 15.61* PAT~~ 1-ROBER" S GREENE SR PRV~~ 9-SMITH, MICHAEL F, MD, FA `~~~' c7Ph: (717) -731-0101 Acct~~: 53023 Date: 05/23/12 Page 1 of 1 H ..- BId fMY/Cr Bltlhl..~ Summary for Service to: ROBERT S GREENE 4815 CREEKVIEW RD MECNANICSBURG PA 17050 Rate Clasal0ca0on: Residential Heating gtlling Period: 05/01!2012 to06l01/2012 (31 days) Company Read OuesOonsT Call 800-276-2722 or mite to UGI at PO 80)(13009 Reading, PA 19612-3009 Your current UGI charges include State taxes totaling about $.0.62. Prnastk Illu forrmuUoa - l~l UUIIt 1 ~ 290 The ac~unt b~ ncpe oymentrof sf 6ill was . ... $ 59.76 2 94591 OS Your balance as of 06!0412012 .............................. i~~d Currant BIII Information -UGI Utility 8.55 e (11 CCF at $0.58818 ............. 6.47 es (FuSt 11 CCF at $0.0364) .. 4,44 barge .::.............................................. -007 gas -UGI uNlitv .............................'~S,'.~ sa owed thla hill ........................................................ (~~~~1~1:.., f~~•: Q ,~1~.~ Metsr Information -Next Read Dale June 29, 2012 5.20 Avsroge CCF Per Day Meter Number Previous Reading Prsaent Reading CCF Uead 4.68 1232400 9756 (company) 9767 (company) f t 4.16 3.64 Messages from UGI 3.12 'Your currant pdca to compare is $ 0.60244 /CCF. 2.60 'Your total annual usage is 599 CCF. Your average monthly usage is 49 CCF. 2.08 1.56 • We can make your energy costs easier on your budget with our 12 month Budget Billing 1.04 plan. Your monthly payment wouhl he approximately $ 69.00. Far more information about this plan pll UGI. 0.52 _ _ _. 0.001 1 ~ ~ ~ 1 ~ ~ ~ ~ ~ I 'Help prevent pipeline damage, accidents and service disruptions. Call 811 before you dig M J J A 8 0 N D J F M A M 'Save time. Save the planet Sign up to view and pay your UGI hills online at www.ugi.com. 2011 Months 2012 last This Average Year Year CCF/day 0.64 -0.35 Daily temperature 6 °F 67°F If you pay at a payment agent please take your entiro bill. Make check payable to UGI. Keep this part for your records. Important Information Ia on the back of this bill. a ~ Account Numher Due Date Amount Due \~/'/ 717737-1086 976 ISSY 6/28/12 $27.71 veriLn Special Offers Just For You Call 1-877-896-5144 or visit vertzon.com/giamdeal to learn more about these FiOS specials Today. When you do, we'll review your account and help you choose which exciting bundles and features best meet your needs. Call today and take advantage of this momh's hottest FiOS otters. FiOS Special Bonus Offer Get FiOS N Prime HD, 15/5 Mbps Internet and home phone for $99.99/mo. with a 2-yr. comract and gel a $200 Visa(r9 prepaid card. Limited time otter. Call 1-888-456-4481 or visit verizon.com/supremespeed today. Availability varies. Taxes, terms and tees apply. Special Offer - 579.99/mo. Order FiOS 15/6 Mhps Internet and home phone for only $79.99/mo. with 1-year PRICE GUARANTEE and NO TERM COMRACT REQUIRED. Limited-time offer. Call 1-888-642-7502 or visit verizon.comdhemosl for more value. Availability vades. Taxes, terms and tees apply. Actwunt Information Statement Date: 8/1/12 ROBERT GREENE Phone: 717-737-7086 Account Summary Previous Balance ._ Payment Received May 14 9alana Forward New Charges Current ActiviTy Taxes, Fees and Other Charges _._ Total New Charges due by Juna 29, 2012 Amount Due by June 28, 2012 $26.69 -$26.69 $.00 $17.36 $10.35 27.7 J l~ ~{ fC. dG~ Want Automatic Payment? Questions about your bill or service? Enroll below or at Verrzon.com to authorize your financial View your bills in detail at verizon.com or call 1-800-VERIZON (1-600-837-4966). Ender your ten digR number 717-737-1086. Use 976 R asked for your Customer iristitNion to deduct the amoutd 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 diaconlinue Automatic Payment, call Verizon. Please keep a copy of this autfpdzation. Please ret urn remit slip with paymerd. 25-76~NEELIMA PARIKH 503 N 21ST ST ~~~P Please Pay YOUR CLAIM HAS BEEN SUBMITTED TO YOUR INSURANCE COMPANY. THE WEST SHORE ANESTHESIA ASSOCIATES PO BOX 947 REMAINING BALANCE.IS YOUR RESPONSIBILITY. PAYMENT IS DUE CHAMBERSBURG, PA 17207-0947 WITHIN30 DAYS. (800)827-3458 X4950 MON-FRI 8AM-4PM STATEMENT SEE REVERSE SIDE FOR IMPORTANT BILLING INFORMATION 23259 sni oilo~ xns-air cm woiesos stow . e-nn 25. ~,7 ~~ PINNACLEHEALTH HOSPITALS ROBERT S GREENE SR 4815 CREEKVIEW RD MECHANICSBURG PA 17050-2113 Patient Name: Greene ,Robert Statement Date: OB/13/12 Service Date(s): 05/11/12 Account Number: 120348915 Primary Diagnosis Code: V72.83 YOUR ACCOUNT IS CURRENTLY DUE. Financial assistance is available for the uninsured or underinsured who apply and qualify. For more information, please call or see our website at wdvw.pinnaclehealth.org/billpay. For Account Information, Please Call (717) 230-3717 or 1-800-603-6064 for Out of Area Calls. See details on the back of this statement. If payment has been sent, please disregard. Pay online at: httpsa/billpay.p innaclehealth. org .- ~ Total Charges: 1266.00 Payments/Adjustments: 1254.54- ACCOUnt Balance: 111.46 Patient Balance: 111.46 Please Pay This Amt: 571.46 Ins. 1: TODAYS OPTION .00 For questions, call our Billing Help line at: Ins. 2: 717-230-3717 for local calls or Ins. 3: 1-800-803-8084 for Out of Area. ~ ~ Ins. 4: Customer Service Hours: Mon-Wed-Fri 7:00 AM to 4:00 PM j°~~ ~j Tues-Thurs 7:00 AM to 6:00 PM ~? ~y6~, s Please Note: Your physician will bill separately for professional services. ~' ~' ~~ P! NNACLEHEAi.TH HOSPITALS ROBERT S GREENE SR 4815 CREEKVIEW RD MECHANICSBURG PA 17050-2113 Patient Name: Greene ,Robert Statement Date: 06/11/12 Service Date(s): 05!10/12 Account Number. 120344271 Primary Diagnosis Code: 433.10 YOUR ACCOUNT IS CURRENTLY DUE. Financial assistance is available for the uninsured or underinsured who apply and qualify. For more information, please call or sea our website at www.pinnaclehealth.orglbillpay. For Account Information, Please Call (717) 230-3717 or 1-800.603-8084 for Out of Area Calls. See details on the back of this statement. If payment has been sent, please disregard. Pay online at: httpsalbillpay.p inna c lehealth. org Total Charges: PaymentslAdjustments Account Balance: Patient Balance: Please Pay This Amt: ~~ •ai2.no 0767.25- 544.75 044.75 544.75 / Ins. 1: TODAYS OPTION .00 For questions, call our Billing Help line at: ~`-~ Ins. 2: 717-230-3717 for local calls or ~~ Ins. 3: 1-800-803064 for Out of Area. d -x~ lns. 4: Customer Service Hours: ~'F~; Mon-Wed-Fri 7:00 AM to 4:00 PM , G ~~ ~~, Tues-Thurs 7:00 AM to 6:00 PM gyp] y~~ `7 %fi Please Note: Your physician wilt bill separafe/y for professional services. Questions? Please Visit us online at Page 1 ~'+° ®contact us by Jul 10. ~ pplelectric.com ~ ! II s _ 1-800-DIAL-PPL ~~~ (1-800342-5775) 32340-70004 1u1 SQ 2012 ~y~"!~l o~~~ '~* a,,. ~,~,a W,Nb• M-F: Sam to Spm Your Electric Usage Profile Service to: ROBERT S GREENE 4815 CREEKVIEW RD MECHANICSBURG, PA 17050 Meter: 50271351 Your next meter reading is on or about Jul 19, 2012 This section helps you understand your year-to-year electric use by month. Meter readings are actual unless otherwise noted. ^ 2oit ~ zorz 30 zs zo A is a a 30 a G 1 F M A M 1 J A S O N D Months Jun 2012 32 I~ 378 12 68F Jun 2011 32 338 11 71F ~u Jun 19 Actual 59467 May 18 Actual 59089 32 Days kWh Billed 378 Ju12011-Jun 2012 5683 ' i 474 Jul 2010-Jun 2011 5031 419 Billing Summary (Billing details on back) Balance as of Jun 19, 2012 50.00 Charges: Total PPL Electric Utilities Charges $49.97 Total Charges $49.97 Account Balance $44.97 PPL Electric Utilities' price to compare for your rate is 7.993 cents per kWh effective 6/1/2012 to 8/31/2012. For a list of supplier offers, visit papowerswitch.com or www.oca.state.pa.us. Your Message Center • With paperless billing, you can receive and pay your PPL Electric Utilities bills online. The process Is free, quick, convenient and secure. To learn more or sign up, visit pplelectric.com. • Information about appliance energy use and tips on saving energy are available through the Energy Library on our Web site, pplelectric.com. • Before digg(ng around your home or property, you should always call the state's One Call notification system to locate any underground utility lines. You can do this by simply dialing 811, which will connect you to the One Call system. Be safe and call 811 before you dig. Online at: ®By phone:1-800342-5775 pplelectric.com or call BtllMatrix (service fee applies) at 1-800672-2413 to pay using Visa, MasterCard, Discover or debit card. ®By Mail: Correspondence should be sent to: 2 North 9th Street Customer Services CPC-GENN1 827 Hausman Road Allentown, PA 18101-1175 Allentown, PA 181049342 Other importa nt information on the back of this bill (ACTIVITY DATE I DESCRIPTION I AMOUNT V 05/26/12 Admit/Service Date 06/01/12 BILL 844.OC 06/11/12 TODAYS OPTION OPT ADJ EY -33.2 06/11/12 TODAYS OPTION OPT ADJ EY; 65.00 COPAYMENT -535.3 06/11/12 TODAYS OPTIONS PAYMENT -39.7f 06/11/12 TODAYS OPTIONS PAYMENT -170.6: Charges to date: 894.0( Receipts to date: 210.9: Adjustments to date: 568.5! Estimated insurance due: 0.0( ~'d ~~~ C'.~/U~ Your insurance was billed but there is a balan ce due. If you dispute this balance, ple ase contact your ins urance company. O Please pay in full. For your convenience, we accept VISA, J J /~ MASTERCARD, DISCOVER, or AMERICAN EXPRESS. ~jo~ LAST NAME: PAY THIS AMOUNT A-G: (814}643-8844 _ ACCOUNT NUMBER H-O: (814) 643-8494 ~~----.-.-.-.-- 3 65.00 V00016153629 P-Z: (814) 643-8495 ~-- ~ FOR AN ITEMIZED BILL, CONTACT s~ ~ A BILLING REPRESENTATIVE `{~ ~ 33751'TJ20HXVA60000 55 ~ - Customer Account Information For Service To: Robert S Greene 4815 Dreekview Rd Account Number: 24-1 1 1 8939-B Premise Number: 24-0582129 Billing Period & Meter Information Billing Date: Jun 27, 2012 Billing Period: May 22 to Jun 22 (31 days} Next reading on/about: Jul 24, 2012 Rate Typa: Residential Meter readings in current Cilling period: Meter Number N084263867 is a 518-inch meter Present-actual 79900 Last-actual 79500 Gallons used 400 Water Usage Comparison Monthly usage in hundred gallons. c0 Billing Summary ..-_...._Prior Balance-------------------- Prior Water Balancs Prior Balance Other Payments prior to Jun 27; 2012. Thanks! Total prior balance, Jun 27, 2012 -----Current Water Charges------ Sertnce Charge Water Volume ($.009101 x 400) DSI - PAWC Charge 0.32°/ Total water charges, Jun 27, 2012 --------Other Current Charges-------- Customer Protection Sewer Line Customer Protection Water Line Total other charges, Jun 27, 2012 -°-•--•-AMOUNT DUE ^---------...---- 0 J J A S O N D J F M A M J 0 n r g p f v c n b e y n 2 $26.57 $14.50 -41.07 .00 13.75 3.64 .06 17.45 9.00 5.50 14.50 ~~d~~ ~~ ~~ . Messages to you from Pennsylvania Amertcan Water ' Any portion of the water charges which is not paid as of 7/23/12 will be subject [o a 1.50 % penalty. 'Approximately 4.57 peroent, or $.79, of State taxes are included in your current bill. 'E ecNve Apn 1, 2012, [he Distribution System Improvement Charge (DSIC) increased from 0.00% to 0.32%. This charge funds the replacement of water distribution facilities. ' Have you recently changed your primary phone number? !l you have, please update your account information using y H2O On me at www.amwater.com/myh2o or call us at the number below so that we can update our re Customer Service & Emergencies 1-800-565-7292 (24 Hours) For Hearing Impaired Customers TDI] 1-800-300-6202 (24 Hours) VisRVS online at; www.pennsyNaniaamwater.com apwrooAM7Tm 003328/003328 NCDVHF TAVOS 13 A1M 10827 ~~p~ ~? 6iiq-1~L~ ~ ~ ~, %Is~ .~/~ I $ ~~ a21 M7IA7laa2I0 SIR4 a.Lda ana 2I3 Lad arla LNnolud a Lda ana bfiUE£OILi01 ~07 000-600201 ~NJ SSaNQOd [J,2ladO'Jd 00'0 00'0 00'0 08'Ob SZ'bI I 00'Ebl- 00' Eb I wnoWd a'Iadvdnd ndMdaaHd.IM 1 Jaxua S id0 OE TlaYdd a'IfldAVd aONd'Id8 SSOT1O ZIOZ/10/LO zloz/iu2o Z IOZ/60/40 Zi 02/10/b0 NOI,idYYnSNOJ a.LVa bOZ4-I IOL[ Vd "17IHdNlVO .LS H.LOE S £S Nf za'Iannd H Sa'RIdHJ .LS321a,1.M A.I.'1dNad. .LN3W.LSnfad HSVN.L aaMas LN3NLidd aY1dM21Od aJNd'idH ~ncisN^:H-L •..=.?.'TdNadal,wl d aIOAV O.L N3QIl0 NI ZiOZ `T£ A'Illf Aa enu SI .LN3W [dd 'BdaT~iiIZdBS' A7nf NOd S3J8VH0 fiS{'N.UiI3A1HS S8TIf1'IJNI TIIH ;dlaoaa uodn a1ge~(ed s1 ;unouae slyl pue ~Go;ei~dsai ~no~f y;~n~;ua~aed awoH uea~iawd Bu-;sn~; ao~ no~f ~ueyl 9L'ZO 6$ ~~ QfL >' J ~ j p to luaw~(ed paulwgns ~(pea~le aney nog( JI luawalels slyl p~e6a~slp aseald •uol}~od ~no~( sl 3uawa3e3s sly3 uo aoueleq ayl iieuao ~no~( uo oam uaaa ~(oeane aneu swiea aoue~nsw 9£'LS 2i0SK'II1032IM >INKS. N'30xX0 69L60T}I ZTOZ/£T/SO ZO'b6S 06£T3 2IOSK2IS,N30N00 69L60T?I ZTOZ/£T/SO 9£'LS 2i0ZK'In932iM }INKS N30xX0 SZTS60?i ZTOZ/£T/b0 ZO'b6S 06£T3 230SK2IZN30N00 SZTS60?I ZTOZ/£T/60 Z60ZIZZI90;o se;unoood;o;uawa;e;g awl;~(ue woo~woye~MMM ~Isln Ip~eo ~Ipa~~ mop( y~IM au!luo ~(ed q uol;d0 E46L-bLZ-LL8 ZLOZIZZ/90 :a3ea 11!8 ~Ile~ `suol~sanp ti48LS6LLS90 :'oN;unooo~y fiu!II!g ~o~ 3N3321J 12139021 :aweN;ual;ed OSb £11Z040L1 `dd J21f18S~INb'H~3W 421 M31Ni3321~ 968b 3N33M~ 12138021 ~~rllr~~IPllll`n~~~lpl~~ull~llll~~hllquglhdllul~hl~ l9lL-Z8161 vd b'IHdl30HlIHd L9LLZ8 X09'O'd a1N311dd3WOH Nd~1~3Wb' ~T~ Z 3o Z a8ea ZT/TT/ Oi ~a~EQ `HS33H.LtllId `NtlHZdNdMSIA-ST ~~Alld L ,~ 'Q'H "J.T II3,L3d `iI3IHfi-I //ATId '21S 3H33TI0 S ZiI3fi02I-T ~{Zdd 99£T- -(LTL ~ud ~00'Oi £hOLT ia3xzs tld 3H]LOx3'I u3xzMOZ soT 0131: = ~ ,, ' tla zvx.IH3o do s,ISIHx3ixl OT'6 00.0 06'0- 00'0 00'0 00'0 00'0 00'Oi 00'Oi ZT/60/' • • • • • ~ • ~ • - • ~ - • 1NOOWV dltld 1Stl'I _ - ~ ~9.~ •;uamrCad aKEm aseaid •su?_oo so ~fEd_oo p?edun sapnTo u? ,xtld 3Stl3•Id, a~IZ ~00.OT ZL'6T- •Cpy u8?ssy ;daooy ZT/LT/ 8Z'S6 ;uaislCad I~aO~Sa,xtlQEZ ZI/LI/ 00'S 00'0£i O'8Z4 bIZ66 7 'I3A31 IS3 SISIAU30I3ao 'i T T ZT%h0% 00'0 00'OT ;ua~urfaa Teuosiaa_xoag0 ZT/60/ ZL'6T- •Cpy u8?ssy ; aooy Zi/LI/ 00'S6 ;aauuAed ;uauOuSadxyQBj Zi/£0/ .. ~ . . .~ . ~•I !f! Ill Y/i! Illingp Summary far 8ervlce to; )BEitT 5 GREENS 315 GREEKVIEW RD ECHANICSBURG PA 17050 eta ClaaNgeaOon: ssidanfial Heating Illing Psrlod; s/01l2012 to 06/28/2012 (27 days) Company Read uesgonst all 800-276-2722 or write to UGI at )gOK 13009 wading, PA 19612-3009 wr currant UGI charges include ate taxes totaling about S 0,37, 5.20 4.68 4.16 3.64 3.12 2.sD 2.08 1.56 1.04 0.52 0.00 JJASONDJFMAMJ 2011 Months 2012 Last This verage Year Y~r ;Flday 0.00 0.11 rily temperature 73°F 71°F Past BIII Informatlon -UGI UUIIty The account balance on your last hill was .............. $19.39 Thank you For your payment of ...........................__..:. -t9.39 219459129008 Your balance as of 07/03/2012 ................................. ~~d Currant BUI lnforma0on -UGI Utlllly Customer Charge ............................................................ 6.55 Commodity Charge (3 CCF at $0.58667) ............... 1.76 Distribution Charges (First 3 CCF at $0.40333) .,.. 1.21 PA State Tax Surcha e ....._ ......................................... - 4 Total Current Charg a-UGI Utilityy .,........___............ 1. UGI UOllly cbargea owed this blll .........._ .............:.._........_...._,._................ ................ 11.48 Total Amount Dus, Please Pay by Due Data (07/2412012) ..................... ..........~ $17.46, 7 ~k,~b a~~6 Mebr InPormaUOn - Nexl Read Dafe July 81, 2012 Meier Number Previous Readlna Present Readlna CCF Used Maseagss from UGf •Your current price to compare is $ 0.60244 /CCF. •Your total annual usage is 602 CCF. Your average monthly usage is 50 CCF. • We can make your energy costs easier on )our budget with our 12 month gadget Billing plan. Your monthly payment would be approximately $ 70.00. For mac information about this plan call UGI. ^ Help prevent pipeline damage, accidents and service disruptions. Call 811 before you dig. ^Save time. Save the planet Sign up to view and pay your UG{ bills online at www.ugi.com. If you pay at a payment agent please hke your entire hilt Make check payable to UGI. Keen Chia Hart for war records. Imoortant Information Is on the back of this bill. yy\ // r,.: ~,nml Numbrr Due Dale Amount Due ~ ~ 737--1066 ~i!,76 ~58Y 7/39/12 $27.31 ver~,Zon n urount Intonnation :~~:Armrmt hate: '/L72 Isa3E Ri GREENe f 1. xr:: 717-737-108f~ A:Gmm~t Surnnrlary Special Offers Just trot You Call 1-888-363-3655 or visit venzon.com/giantdeal to learn more about these FiOS specials lotlay. When you do, we'll review your account and help you choose which exciting bundles and features heat meet your treads. Cafl today and take advantage of this month's tallest FiOS otters. Great Triple Play Offer Get FiOS TV Prime H0, 15l3 Mbps Internet and fame ptrone for $99.99/mo. with a 2-yr. contract and get a $200 Visa® pmpaid cardlimited time otter. Cak 1-888-367-7439 or visit verizon.tam/supremespeed today. Availability varies. Taxes, terms and fees apply. Upgrade to FiOS - 579.99imo. Order FiOS 15/5 Mbps Imemet and home plane for only g79.99/mo. with a 1-year PRICE GUARANTEE and NO TERM CONiflACi REQUIRED. Limited-time oNer. Call 1-888-748-6756 or visit verizon.camdhemosl for more value. Availability varies. Taxes, terms and fees apply. Wam Automatic Payment? Fnmll bebw or et Verizon.com to aulhotize your tirencial tnetNMion to deduct the amount of yotm moMhty hill tmm Yne account asaocieted with your encbsed check and semi payment dlrectry to Verizon. To discoMirwa Automatic Payment, call Verizon. Please keep a copy of this aMtadzatbn. P ~~ ~ virus Balance $27.71 P,/Wont Received dun 14 _$27.71 B1r.m.a Ponuard __. _f-00 N,rn Chargr.. Cu. mllu:tivity -. $16.99 Tar; s, Fees and OlM~°Charges $10.32 TatrAew GMar9rs due by July 30, T012 ~-~ ~ - ~_7 Aun loot Due by .luly 30, 2012 ~ 527.3 i ~' ~~ 1 ~1 ~~~~ b /. ..! ~:~ k-. ~b-'F% ~' .~ ~- Duesllons about ymrr bill or service? View 7 ow bills in detail .d vedmn.cam or call 1-800-VERIZON I7-BO0-837-4966). Enter ! mien r&git nurti oar 717-737-1Q86. Use 976 it askedfor your customer ident I ~~~ anon number. Fl~;ach us by TTY at 1-800-974-6006. ~ Please return remit slit I ~ifh payment. To enlolllnAUtomatrc PeymeM (Sign and date beloa9 ~ - ~ - 1C000M IVUm,her. 717 737-1088 976 58Y ^ ;Flanges Due: ,1nloumDud: S.GO 080112 BYyYaeq aUwel wiry Nstltura reNexsa aaa Ple,no Bal DO NOT PAY acapeatrowiro ena ca,aroro at waxan.coMauageyeme mrwmrtmnc Eln PeYment 00000573 Ol AB 0.374 VPC21411 0003 XX 1~BERT GRFFNE 4815 CREEKVIEW RD MCHNCSBRG PA 17050-2113 Il~r~lnlnl~l'~I'111Iu~LJ66~~II'1111'd~IdIIIL'1i1~"1111 11771707371086976U0280217c'99i099100GIp0CIl]DOOODOOOOD0000000000 Your Default Su tier Contact Info. For questions regarding the generation and transmission portions of this bill, please contact your supplier at: ~ PPL Electric Utilities Phone: Customer Services ®1-800-342-5775 827 Hausman Rd (1-800-DIAL-PPL) Allentown, FAA 18104-9392 pplelectric.com Manage Your Account visit pplelectric.com for self-service options including: -v(ew your bill, payment, and usage history. -Make a payment, set up a payment agreement. -Start/stop service. -Enroll in paperless billing, automatic bill pay, budget billing. -Report an outage, check outage status, and more. View your rate schedule at ppieiectric.com/rates or tail i-800-342-5775 t0 request a copy. General Information Generation prices and charges are set by the electric generation supplier you have chosen. The Public Utility Commission regulates distribution rates and services. The Federal Energy Regulatory Commission regulates transmission prices and services. PPL Electric Utilities uses about $0.04 of this bill to pay state taxes and about $2.38 is used to pay the PA Gross Receipts Tax. Understanding Your Bill Billing Details Page Previous Balance 549.97 Payment Received Jun 26, 2012 -Thank Youl -$44.97 Balance as of Ju119, 2022 50. Chargges for •PPL Electric Utilities IlResidential Rate: RS for Jun 19 -Jul 19 oistribution Charge: Customer Charge 8.75 280 kWh at 3.359000001 per kWh PA Tax Adj Surcharge at -0.34500000% 9.41 -0.06 Transmission Charge: 280 kWh at 0.68700000c per kWh 1.92 PA Tax Adi Surcharge at -0.28400000% -0.01 ZSOjC1Nh at 7.~~900000t per kWh 20.52 PA Tax Adj Surcharge at -0.28400000% -0.06 PPL Electric Utilities Charges $40.4r Balance $40,47 Customer charge - Monthly basic distribution charge to cover Transmission Charge - Chang fvr moving high voltage costs for billing, meter reading, equipment, maintenance and electricity from d geheration~acllity to the distribution 11nes of advanced metering when in use. an electric distribution company. Distribution Charge -Charge for the use of local wires, 7y e(s} 4f Meter RCadings• transformers, substations and other equipment used to deliver Acfual -Reading dy distribution company. electricity to end-use consumers from the high voltage transmission lines. Generation Charge -Charge for the production of electricity. kWh (Kilowatt-hour] - -Fhe basic unit of electric enemy for which most customers are charged.. The amount of a ectrlcity used by ten 100-watt lights left on for 1 hour, Consumers are usually charged for electricity in cents per kilowatt-hour. Rate RS -Rate for service to a private home. State Tax Adjustment Surcharge -Charge or credit on electric rakes to reflect changes in various state taxes included In your bill. The surcharge may vary by bill component. ~ U n~ • _ ~'INNACLENEALTH I~t~Spi'TALS ROBERT S GREENE SR 4815 CREEKVIEW RD MECHANICSBURG PA 17050-2113 ~ ~ ~ ~ Patient Name: Greene ,Robert Statement Date: D7/11l72 Service Date(s): 05/11!12 Account Number: 120346915 Primary Diagnosis Code: V72.83 important Message YOUR ACCOUNT IS CURRENTLY DUE. YOUR PROMPT ATTENTION WOULD BE GRATEFULLY APPRECIATED. Financial assistance is available for the uninsured or underinsured who apply and qualify. For more information, please call or see our website at www.pinnaGeheafth.org/billpay. For Account Information, Please Call Customer Service (717)230-3717 or 1-800-803-8D64 for Out of Area Calls. See details on the back of this statement. If payment has been sentw please disregatti. Pay online at: http8://btllpay.pinna cleheaitlr. org ~ - Total Charges: 52bb.00 PaymentslAdjustmeMs: 5254.54- Account Balance: 411.46 Patient Balance: 511.46 Please Pay This Amt: Si1.46 ~~ ~ Ins.1: TODAYS OPT10N .00 For questions, call our Billing Help line at: Ins 2: 717-230-3717 for local calls or Ins. 3: 1-800-803-8064 for Out of Area. Ins. 4: Customer Service Hours: Mon-Wed-Fri 7:00 AM to 4:00 PM a Tues-Thurs 7:00 AM to 8:00 PM 0 n Please Note: Your physician will bill separately for professional services. . . «T ~ ~ 5 ~ ~ 1 ' 8Q0 GOT ~lU1~K? Job ID: ~ s ~-~~ `~ THE WORLD'S LARGEST JUMK REMOVAL SERVICE GS Madison LLC PO Box4705 Lancaster, PA 17604 Tel: 877-538-5665 „~ ~.. Name: i'a i ~' lC- Y ~x-r t~f-(iI' Company Name: CK V~c ~ 81S ~ Pickup Address k e c City: ~ ~ C ~ tate(Prov: ~~ Oate: ~z Team: ~~~~' ~^ ~ Route#: i ~ ~ Start Time: End Time: Moving: ^ DM: _ KHIfE fA%OFPLF YELLNVCO%CIIFNi Zin/PnstaL f 7~ -_ Home#: ~9~- y7~~" Cell#: ~yg- ~;~ '`' Fax #: Office #: Email: Bill hype Load ize ,. ascription 'ye a. C~ _,,. aill TYOe'.V-Volume,8-aedloed,5-Surcharge, SP-Standard lrem Price Other ~ ~ ~+ Y ~ HQt1U alb' ~ ~ a~?a?4a ~ ~ Subtotal Tax Total ~ Job Sign ^ Yes ^ No ^ Cash ^ Dis Check # t. ^ Voice Auth: ^M/C ^ VISA ^AMEX Approval Code: CC#:^^^^-^^^^-^^^^-^^^^ Signature: Exp Date: 'k!~I r `r~ ^Invoice Contact#: PO#: Name: Mailing Address: City: State/Prov: Zip/postal: Job Comple -o ~ Signature: n Date: ~ ~~~~~" TERMS: All eccoume sere due u0an receipt unlaaa credit has been eNablished. Overdue ec0ounte ere subject to imeren not higher Menthe maximum allowable imemsl rate as determined by law. As owner, agent, or tenant of the above location, I hereby agree Me work has been satisfactorily completed end understand [het I no longer own Me items Mat have been removed. if a check is returned far any reeeon, l egmr pay a $35 returned check fee. ~afjantango int., ,inc. USED TIRE REMOVAL & RECYCLING 2100 OLD TRAIL ROAD, PENNSYLVANIA 17045 (717) 444-3788 FAX (717) 444-7651 NAME ':JV~ _.. _. L~~~... . __ . , /~/) gyp(/ ~-( f SOLD BY CASH QO. D. CHARGE ON ACCT. MDSE. RETD: PAID OUT' QTY. DESGRIPTfON PRICE AMOUNT .Scrap The Disposal ,.. Rubber Chips __ ~~ , ._ Side Walls ~~ ~ Used Lres (Passenger) ...., ~ ~-y~ G /~ 7 ; 'S Used Tires CI'rucW Rubber Mulch Freight Charge ~ ~ ~. ~ _~ _ _. ,_ _.~ ~ _. _. __ , ~.. flEGEIVED BV TOTAL / (~ ; All claims and returned gcOds MUS'rbe accompanied 6y thls bill. Te R~~ae~ `Thank`~au 3 3 8 5 5 800- 25-5380 or nehs.cem Your Default Supplier Contact info. Billing Details - (enl Acct. 32340-7oooa) For questions regarding the generation and transmission portions of this bill, Please contact your supplier at: ® PPL Electric Utilities Phone: Customer Services ®1-800-342-5775 827 Hausman Rd (1-800-DIAL-PPLj Allentown, PA 18104-9392 pplelectric.com Manage Your Account visit pplelectric.comfnr self-service options including: -View your bill, payment, and usage history. -Make a payment, set up a payment agreement. -Start/stop service. -Enroll in paperless billing, automatic bill pay, budget billing. -Report an outage, check outage status, and more. View your rate schedule at ppletectric.com/rates or call 1-800-342-5775 to request a copy. General Information Generation prices and charges are set by the electric generation supplier you have chosen. The Public Utility Commission regulates distribution rates and services. The Federal Energy Regulatory Commission regulates transmission prices and services. PPL Electric Utilities uses about $0.02 of this 6111 to pay state taxes and about $1.08 is used to pay the PA Gross Receipts Tax. Understanding Your Bill Balance Received Aug 30, 2012 -Thank Youl as of Sep 4, 2D12 r -PPL Electric Utilities I Rate: RS for Aug 17 -Sep 1 n Charge: ier Charge ~h at 3.359000000 per kWh Adj Surcharge at -0.34500000% an Charge: 'h at 0.68700000< per kWh 124kWh at 7.323265000 per kWh PA Tax Adj Surcharge at -0.28400000% PPL Electric Utilities Charges Balance Pag $35.26 -$35.26 50 4.38 a. v -0.03 0.85 9.08 -0.03 ~° ( $18.• ,« }4a7~ -i~ $18.4 Customer Charge -Monthly basic distribution charge to cover Transmission Charge -Charge for moving high voltage costs for billing, meter reading, equipment, maintenance and electricity from a generation facility to the distribution lines of advanced metering when in use. an electric distribution company. Distribution Charge -Charge for the use of local wires, type(s) 9f Meter Readin s: transformers, substations and other equipment used to deliver Acfuai -Reading by dis~rlbution company. electricity, to end-use consumers from the high voltage transmission lines. Generation Charge -Charge for the production of electricity. kWh (Kilowatt-hour) -The basic unit of electric en2rggy for , which most customers are charged. The amount of electricity used by ten 100-watt lights left on for 1 hour. Consumers are usually charged for electricity In cents per kilowatt-hour. Rate RS -Rate for service to a private home. State lax Adjustment Surcharge - Charge or credit on electric rates to reflect changes in various state taxes Included in your bill. The surcharge may vary by bill component. Your Default Supplier Contact Info. For questions regarding the generation and transmission portions of this bltl, please contact your supplier at: ® PPL Electric Utilities Phone: Customer Services ®1-800-342-5775 827 Hausman Rd 1i-800-DIAL-PPL) Allentown, PA 181049392 ppiefedriacom Manage Yow Account Visit pplelectric.comfnr self-service options including: -View your bill, payment, and usage history. -Make a payment, set up a payment agreement. -Startjstop service. -Enroll in paperless billing, automatic bill pay, budget billing. -Report an outage, check outage status, and more. View your rate xhedule at pplelectric.com/rates or call 1-B00-30.2-5775 to request a copy. General Information Generation prices and charges are set by the electric generation supplier you have chosen. The Public Utility Commission regulates distribution rates and services. The Federal Energy Regulatory Commission regulates transmission prices and services. PPL Electric Utilities uses about $0.04 of this bill to pay state taxes and about $2.08 Is used to pay the PA Gross Receipts Tax. Understanding Your Bill Billing Details - (Bill ACCt. 32340-70004) Page Balance $40.47 t Received Jul 27, 2012 -Thank Youl -$40.47 as of Aug 17, 2011 $0.~ for -PPL Electric Utilties :lal Rate: RS for Jut 19 -Aug 17 :Ion Charge: Amer Charge h 3 0 0 kWh 0 8.75 7 86 :W at 3. 590 0 0 per . ax Adj Surcharge at -0.34500000% -0.06 >sion charge: cWh at 0.687000000 per kWh 1.61 234kWh at 7.~2900000C per kWh 17.15 PA Tax Adj Surcharge at -0.2840000096 -0.05 PPL Electric Utilities Charges 535.2- Balance r~~ /~ $35.2: ~~~~i ,,)~ ~ e ~~a a Customer Charge - Monthly basic distribution charge to cover Transmissbn Charge -Charge for moving hi88h voltage costs for billing, meter rea ing, equipment, maintenance and electricity from a generation facNity to the olstributlon lines of advanced metering when In use. an electric distribution company. Distribution Charge -Charge for the use of focal wir~s, Typels) Pf Meter R b dd(est ibution company. transformers, substations and other equipment use to deliver ua -Reading y st electricity to end-use consumers from the high voltage transmission lines. Generation Charge -Charge for the production of electricity. kWh (Kilowatt-hour) -The basic unit of electric en~r~y for , which most customers5 are charged. The amount o e ectriaty used bV ten 100-watt lights left on for 1 hour. Consumers are usually charged for electricity fn cents per kilowatt-hour. Rate RS -Rate for service to a private home. State Tax Adjustment Surcharge - Charge or credit on electric rates to reflect changes In various state taxes Included in your bill. The surcharge may vary by bill component. ~rhPJuP.G~~'1 ! - ~G(~ -,~ ~~_ ~:J~- ~;~r ~~ t~7~,c~<> ~~ ~. -) ~~~~~b~ .~~%~~ ~~,if Karns Quality Foods m G.,.~~.....~......, a.. wwwi.GiantFoodStoresecomt My goal is to ensure your satisfaction every time y°moreoI canhdos to improve is anything your expaveeRudy,pStore Manager write. Gi6560 CarlSsleaP#ke05 Mechanicsburg, PA 17050 Store Telephone: (717> 796-5555 Pharmacy Telephone: (7171 796-0444 THANK YOU 48006503288 gt83.99 7.98F MRZ RNCH 15.502 4 ® 1.89 7.56 F SUPER G ICE 00 TAX PAID 4_ ****TOTAL p CASH 4.46 CHANGE• TOTAL NUMBER OF ITEMS SOLO = 6 5/31/12 8:20 AM 6005 82 0031 `:72264 I mVouadCashieroPPeEASYrSCANaa,+ 4870 Carlisle Pike ' ' Mechanicsburg,PA Rich Brown Store Manager 901-6967 1~/id~fl ldrt . .. , Todd Keys Meat Manager 901-3667 Save rnoney.Liva bettor. Store:3 717 ) 691 - 3150 Cashier: Amanda MgNRGER STEVEN LAYERS 6520 CRRLISLE PIKE STE 560 05/30112 12:03:46 N R T 0 3 l 60 STfI 1886 O~N 000 8 Ei O6 R1t 08293 6 ® 1/ 2 69 FORKS 068113170217 2.68 X . 1G St' TEA IJNSWEETENE 16 14 FD GV CLERR CJP 068113192653 2.58 X . 1/2G HOMOGENIZE MILK 1 97 F GV CLERR CJP 068113192663 2.68 K . FORM CUPS 007874201449 0.96 X FORM CUP5 007871201419 0,95 K NAPKINS 003700031886 2.97 X GU SN PLRT. 007874204881 2.23 X GU SN PLRT. 007874204BB1 2.23 X DX MD PLRT.S 004200091b04 5.97 X GV SN PLRT= 007874204881 2.23 X SUBTOTAL 25.37 T9K 1 6.000 x 1.63 TOTRL 26.90 VISA TEND 2~Q ACCOUNT x rw~+E ^x~rr ~~r +r 2476 S RPPROVRL 0 01173G REF ! 2150)02b1891 TRANS IO - 0282150670261939 VRLIDRTION - S90J PRYMENT SE7VICE - E TERMINAL t 19001707 05/29/12 19:37:04 CHRNGE OUE 0.00 # ITEMS SOLD 10 TCi 6034 1273 1408 3042 4 184 I Ililm 11111 SIN IIIII IIII IIIIU W uUII WI ~I III~uI~NI ~l~l~~ uuu iuu u uiii im INa I ~~ art :':. Save maiE~ey. Live better. ` Self ~t_heckout .Fast; FEYn. Easy. 3805 FIARZOALE ORIVE CAMP ItllL: PFl .57-763-9560 Cash!er.2981d8 D5I29;I^ 72OZpN kkkYkk*Nikk kkkf ^'Ikk'k k*k%R kk **1liF%***'k **kiF *++w MEMBERSHIP I0. 02540212603 ^*^ »kk MEMBERSHIP F.XPIRE5 ON 04/13 ^*+' kkNkkYkkk klFk kkMXMM XM kkMMkkkk*kk***Cf *iFk* 90000016287 WF HAM )TOLL 16. 90 N 10 @ 1.69 333836G55r BABY i:ARRUTtt9 9. 79 N 91i8000pt7 IfT ZPC20REGUL 8. 97 Fl 3e299 ss3e9yoool~; NAr~TTNS X5(17 SaN ~ ~3 7,79 DM^* SUBTOTAI. 36 .24 ^**w TOTFlL 36 .29 1;kkkk kklMkkk~9 ~5 (?0TH 0°'9i9G ti 54yu +t ure N.rY Retiuir'eri~ Visa 36 24 CHRNGE 0 .00 TOTAL NUMBER OF ITE NS SOLO - t6 %'I Y~R'M1YM>kl%YYY%%/.Y1MYY.Y}yT 111*lt.il it All ~A iF Shank Yvu for Shoevlrre nt BJ's < 717 > 691 - 3150 MAIYAGETi STEVEN MYERS ..6520 ~IARLI',SLE PIKE STE 550 MEg9lWICSElI,RG PA 17050 ST# 1886 (WN 00009045 TE# 45 TR# 01292 Sf'LEk)A PK1'S 072277620002 F 3.78 0 F180 NFL Cfp 003304900014 F 2.50 N MAKNELLHOIJSE OOg3pOp02gg1 F 8.98 N TEA 007654500113 F 2.50 0 TEA 007Ei5450f)113 F 2.50 0 TE:A 007654500113 F 2.50 0 TEA 00765450011:1 F 2.50 0 TFjI 007654500113 F 2.50 0 StiBTOTAL 27.76 TOTAL 27.76 'PISA TEND 27.76 ACCOUNT # k9Cx* R'kRN .**: 2475 g APPRDYAL # 046726 REF # 215100431912 -•- $~ 9 g'" TRANS ID - 0162151617019486 . YALIDA7IOIW - KP4fE l~. 7 PAYMENT SE72'YICE - E; ~ TERMINAL # 24003r?88 051'30!12 13:08;23 CFIANGE DUE 0. DO # .ITEMS SQLD 8 TC# 9596 5]63 5584 9402 6520 NN ~~~u I u II~ I1 Newt Place your order at Nalniart.conl and Pay with cash at your store. 05/30/12 13:08:23 ***CUSTOME:R f,OPY*** C U d L > d = d o+- „~' ~ -i-.~ L .+ ~ C A L D ' ~ W W ' .h n H L t - o o a ~~ r w T C r q W n.e ~ ~ N J C L W W L L J2 a ~ '~ 1 ~ q q i ~ 3 U A O N d d +~ • ._ 6hr .-. VI ~ "~ C d 0 .,. w L d - s' N L T JN Y O d ~ ~ ? 6 V J W O O C C , T Y ~ a x L ; ~ II o X R T d C T C 9+ L 7 L d T i r. z a - `J 8 C O m d -- i N +- 9 O C o u. v ~ a ~ > > r!i 4n O C O d !~ •DY~ f -. d M 4 L da O N 1A .-~ Ql -. L aLD o up O LJ .1 LL U O +b L C to A L L x __ ~... ..._~.`._---- l.n< N roa•.M ~~N r, ti =, ~ooo.-. nic:n r,-,JiNV -, nc~a, :~mm. 4014 Kt OiN CV K- ""~T GIN Cd G^. O1 pl p•f4 V V ~•04pMQ~,: L'Y PTO LVN %k c '.4)O ~1 ~-.._.. ~.T C~P+c Cn :hN V._;..,- ti,~ -~~ OO ttl: •D W O M !•'1 ~ C= 4'• m C - `- N m P r # - v r -K ~: Y d x 1. C G ~ x ov sxxxxx a:M TL ~_,~,_r.i_~._ 6 a dy ] _~1WWw1L000:h V: !~'i v~CnNZZZ2ZZWti -~ y N N ? ~" yW W IJJJJJJ JIW W' .J ~IU V U..]JY W Jr-r J) Y £<~C 2 .~ 'S.. 0.'a: - 'XS-J+# _, d? 2 ¢~2C 2 -~~ VU JJ _JC i-¢05 r L U S 222 000»>`r T>SS£ £ 1-F-.J ..S C A 2 N N V` v N N'- F-^ F- W W W W W W 6¢¢ ¢¢ F- >k x V •'E F tir~r~+`-iHr-+N ViNNNN6¢¢YYYYYY r'-r 1r +KF- NL ~WJJJJHr-:~+~-+f+~+F-F-F-C'C O_'C'2'GY F-HI-L-F-F-~ 2 ~sZG 4 W W W W W iU 3 3 3 3 3 3 0 0 0~~~~ 0~ S_ S x S 2 5 • r¢ •a L PCiGOJ~NNNNNN.000~H~~~I-333333LL ~--iN d LL ~r2 O H ... +ur B' ,« Past BIII information -UGI Uliil The account balance on your last bill was ...._..„.... $ 0.52 219459129008 Blllinp Summarytor Service to: Thank you for your payment of ................................... -8.52 ROBERT 5 GREENE Your balance as of 08/3112012 ............................. ~~ 4815 CREEKVIEw RD '"' NECHANICSBURG PA 17050 Rate Classlflcatlon: Residential Heating Billing Period: Currant Blil 1nMrmaflon -UGI UUllty 07/31/2012 to 08/28/2012 (28 days) Customor Charge ............................................................ 8.55 Company Read PA5tateTaxSurcharge ............................._.................. -D.D3 pusallonsP Total Current Charges -UGI UUhty ..............._.........._--9TH Ca11 8 0 0-27 6-2 7 22 or write fD UGI at UGI UUllty charges owed this hill ....................____....___._...._..__. PO BOX 13009 TaMI Amount Due, Please Pay by Due Date (09/21/2072) .........- Reading, PA 19612-3009 Your current UGI charges include ~ ~i State taxes totaling aheut $ 0.27. C ~~Oq '1 Meier In/ormaUon -Next Rsed Dats September 28, 2072 Mster Number Previous Reading Present Reading CCF Uaed 1232400 9770 (company) 9770 (company) 0 Mesupss hom UGI ^YOUt aurreht price N compare is $ 0.60244 /CCF. Last This Average Year Yar CCF/day 0.00 0.00 Daily temperature 4°F 74°F 'Your total annual usage is 602 CCF. Your averega monthly usage is 50 CCF. • We can make your energy costs easier on your budget with our 12 month Budget Billing plan. Your monthly payment would be approximately $ 70.00. Far more information ahaut this plan call UGi. • Help prevent pipeline damage, accidents and service disruptions. Call 611 before YW dig. •Save time. Save the planet Sign up to view and pay your UGI hills online at www.ugLcom. H yoo-payaka paymentagent please take your entire bill. Make check payable to UGI. Keep this part for your records. Important Information Is on the back of this bill. 8 ASONDJFMAMJJA 2017 Months 2012 Customer Accounf Information For Service To: Robert S Greene 4815 Creekview Rd Account Number: 24-1118939-8 Premise Number: 24-0582129 Blllfng Period & Meter Information Billing Date: Aug 28, 2012 Billing Period: Jul 24 to Aug 23 (30 days) Next reading on/about: Sep 21, 2012 Rate Type: Residential Meter readings in current billing period: Meter Number N084263867 is a 5/8-inch meter Present actual 80400 Last-actual $0200 Gallons used 200 Water Usage Comparison AAnnlhly ucanw in hundrari nallnns 2 0 1 1 Billing Summary •---•-----Prior Balance--•-----•••-----•- Prior Water Balance Prior Balance Other Payments prior to Aug 28, 2012. Thanks/ Total prior balance, Aug 28, 2012 -----_--Current Water Charges------', Service Charye Water Volume ($.009101 x 200) DSI - PAWC Charge 0:83% Total water charges, Aug 28, 2012 -----•----Other Current Charges-----•-- Customer Protection Sewer Line Customer Protection Water Line Total other charges; Aug 28, 2012 --_---_•AMOUNT DUE -•---------"••--- $16,62 $la.so -31.12 .00 13.75 1.82 .13 15.70 9.00 5.50 50 $30 0 5~ I ~~J~ 0641.( Messages to you from Pennsylvania American Water 'Any portion o/the water charges which is not paid as of 9/24/12 will be subject to a 1.50% penalty. A,,rr~~roximately 4.57 percent, or $.71, o/State taxes are included in your current bill. " El/active July 1, 2012, the Distribution System Improvement Charge (DS1C) increased from 0,32/, to 0.83%, This charge funds the replacement o/ water distribution facilities. 'Have you recently changed your primary phone number? I/you have, please update your account information online using My H2O Online at www.amwater.corr/myh2o or call us at the number below so that we can update our records. `Did you know digging without callingg 811 /first increases the chances of knocking out a utility service /or you or your neighborhoods In fact, an underground line is damaged once every three minutes. Know what's below and be sure to call 811 be/ore you dig. To team more, visit PA One Call's website at www.pa811.org. Nen]a; ravna rn Customer Service 8 Emergencies 1-800-565-7292.(24 Hours) For Hearing Impaired Customers TDD 1-500-300-6202 (24 Hours) Visit us online at: www.pennsylvaniaamwater.com RAW100AM7721 A1M 80]9 u e O o e e y a A M J JU A 2 g p t v c n b r P y n I g ~ 2 i u~a i t ~r ~ uv~ i vK ~ CHAFtGt DESCRIPTION CHARGES INSURANCE oATlENT I ADJUST ~ BALANCE I SERVICE I NAME ', CODE I I I RECEIPT I RECEIPT (ACCOUNT NUMBER: 133428 /12 MAY 99219 0£FICE VISITESTMOD25 I 155.00 { 65.25 30.00 54.75 5.00 AMOUNT DUE $5.00 I17-591-7122 n B+4lin PhDne ~~ „ gg . CARDIOLOGY'PRACTICE INC , ~~~ &~3~~ ~~ Q / ~ 3 ', STATEMENT SEE REVERSE SIDE FOR IMPORTANT BILLING INFORMATION ~ III IIII III IIII I~ ~ ~~ ~ ~II ~~ ~~ ~ ~~ X714 ~ ie89343 ~~, Caring 42459248 ROBERT S GREENE 4815 CREEKVIEW RD MECHANICSBURG PA 17050-2113 Patient Name: Greene ,Robert S Statement Date: 08/28/12 Service Date(s): 05/18/12 Account Number. 42459248 Medical Record Number: 081133 ~. ~ ~ . u Ins. 1: AMERICAN PROG //11 Ins. 2: q V Ins. 3: ~~ ~,~ ~ - Ins.4: ~ ,. W `1 ~ 51~k ~G~o~ ~ 0 ~. ..- We have received the explanation of benefits from your insurance company(s) and have applied whatever payments and/or adjustments are appropriate. Please make payment for the balance due of $225.76 OR take advantage of a 15°~ prompt payment discount and remit $191.90 on or before 09/27/2012. Here are 3 convenient ways to pay: 1. Make payment online at www.hsh.org. 2. Mail tear-off coupon below with payment in the enclosed envelope. 3. Call Customer Service below to make payment by phone. Previous Balance: 4.00 Total New Charges: 418,754.60 Payments/Adjustmerits: 418 , 528.84- Account Balance: 4225.76 Please Pay This Amount; $225.76 OR Discounted Amount of $191.90 if paid on or before 09!27/2 12 ~: - Please call Customer Service at 717-783-2138 to add or make corrections to your insurance inforrnation, or to make arrangements fora payment plan. If you are unable to make payment, please contact the Patient Financial 9) /Q ~ jG Advocate's Office at (717) 763-2885 to discuss ~~-rr financial assistance options. / Q rc~ ,h~u ~~~ Please Note: Your physicians will bill separately for professional services. a ~ ~ e srsrrer Past Blli Information -UGI UtlNty The account balance on your last bill was .............. S 11.48 219459129008 Illlinoo Summa far Service to: Ey Thank y0U for your payment of ................................... -11.48 ABERT 5 GREEN 876 CREEKVIEw RD Your balance as of 08/0212012 ................................. 7ECHANICS6URG PA 17050 late ClassMcatisn: lesidantial Heating Iilling Perlod: Currant Bill Inlormallon -UGI UUlily 16128!2012 to 07/31/2012 (33 days) Customer Charge ......................................................__.. 8.55 Company Read PA State Tax Surcharge ............................._.,................ -0.03 tuesllonsY Total Current Charges -UGI Uhlrty ............................. ~~ ;all 800-276-2722 or write to UGI at UGI UBI cha es owed thlsblli ___„„„__ .............................._...,.............................. 8.52 '0 BOX 13009 Total Amount Dus, Pleas Pay by Oue Date (D6/2S/2012) ...............................~ 5.52 Leading, PA 19612-3009 lour current UGI charges include O f I'-`' '~ State taxes totaling about $ 0.27. ~~~~ ~ S/' 0 ! ~ , Meter Information -Next Rssd Dale August 29, 2012 Molar Number Previous Readlap Present Reading CCF Usetl Messages hom UGI 'Your current price to compare is $ 0.602441CCF. 'Your total annual usage is 602 CCF. Your average monffily usage is 50 CCF. We can make your energy costs easier on your budget with our 12 monUr Budget Billing plan. Your monthly paymenf would be appmximatety $ 70.00. For more information about this plan call UGh • Help prevent pipeline damage, accidents and service disruptions. Call 611 before you dig, •Sava Ume. Save the planet Sign up to view arnl pay your IIGI bills online at www.ugi.com. Last This Average Year Year CCF(tlay 0.00 0.00 Gaily temperature 79°~ If you payat a payment agent please take your entire bill. Make check payable to UGI. Kann this Dart far your rxords, Important Information Ia on the back of this bill. JASONDJFMAMJJ 2011 Moniha 2012 Customer Account tntormatlon For Service To: Robert S Greene 4815 Creekview Rd Account Number: 24-1 1 1 8939-8 Premise Number: 24-0582129 B1lling Period & Meter Information Billing Date: Ju127, 2012 Billing Period: Jun 22 to Jul 24 (32 days) Next reading on/about: Aug 23, 2012 Rate Type: Residential Meter readings in current billing period: Meter Number N084263867 is a 5/8-inch meter. Present-actual 80200 Last-actual 79900 Gallons used 300 Water Usage Cornparison Monthly usage in hundred 'L'rJ 1 eating Summary ----------Prior Balance-------------.-•---- Prior Water Balance Prior Balance Other Payments prior to Ju127, 2012. Thanks! Total prior balance, Jut 27, 2012 ---------Current Water Charges--------- Service Charge Water Volume ($.009101 x 300) DSI - PAWL Charge 0.83% Total water charges, Jul 27, 2012 ----------Other Current Charges-------- Gustomer Protection Sewer Line Customer Protection Water Line Total other charges, Jul 27, 2012 ----------AMOUNT DUE pp ~ u e~ o e a e a~ a u u o 1 g p t v c n h r y n I 2 $17.45 $14.50 -31.95 .00 13.75 2.73 .14 16.62 9.00 5.50 50 $31, 2 ~ il~~ ~~ ~~~~ Messages to you from Pennsylvania American Water "Any portion of [he water charges which rs no[ paid as o/ 8/21/12 wilt be subject to a 1.50% penalty. ' Apppppproximately 4.57 percent, or $.75, of Stare taxes are included in your current bill. ' EHectiva Juty 1, 2012, the Dis7i6u6on System Improvement Charge (DSIC) increased lrom 0,32% to 0.83%. This charge hinds the replacement o1 water distribution facilities. "Nave you recently changed your primary phone number? 1/you have, please update your account intormation or using My H2O Online at www.amwateccom/myh2o or call us at the number below so that we can update our reco "An annual water quality report (C.onsumer Confidence Report) was provided to you earlier this year. Copies can be obtained by contacting our Cusromer Service Center or by also visiting our website. Landlords /businesses / schools and other groups are asked fo share this water quality intormation with water users at their location who may not receive a bill and therefore did not receive a copy or thrs report directly. 001489/001d9>iiNCOXLU tAV0512 CustomerService & Emergencies 1-B00-565-7292 (24 Hours) I i For Hearing Impaired Customers TDD 1-800-300-6202 (24 Hours) Visit us online at: www.pennsylvaniaamwater.com PAW100AM7931 A1M 10149 Holy Spirit Hospital 503 North 21" Street • Camp Hill, PA 17011 • (800) 596-9997 July 17, 2Q12 Your Account With: Holy Spirit Hospital Account #: For: Admission Date: Total Due: 42018945 Robert Greene Sr $315.00 ~ ~)~a Dear Robert Greene Sr. ~ ~ e k ~°o~~ This letter is to follow up the above referenced visit to Holy Spirit Hospital. Our records indicate that there is an outstanding balance remaining on this account. Please remit payment in full upon receipt of this letter. It has always been the continuing goal of Holy Spirit Hospital to serve the community as a full service health care facility from the time of a patient's initial care through the account's final resolution, If you have any questions regazding this account, please feel free to call this office at 1-800-596-9997 and speak with one of our representatives. Thank you for choosing Holy Spirit Hospital and for resolving this outstanding balance promptly. To assure proper application of your payment, please attach the bottom portion of this letter to it. If you wish to pay by credit card, please complete the required information on the reverse side of this letter. If you have insurance that may pay all or a portion of this debt, please complete the information on the reverse side of this letter and return the entire letter. Payment can also be made online at www.hsh,or¢. Sincerely, Holy Spirit Hospital IONFIR110191 """Detach Lower Pmlion Md Refum With PaWnenl""" `~p® INSURANCE BILL Auto & Home Insurance Program ~,m PERSONAL AUTOMOBIIrE "r`°"~ A A R P INSURANCE PROGRAM PROPERTY AND CASUALTY INS. CO. OF HARTFORD 6643 GREENE ROBERT S Billing ID 81805624 4815 CREEKVIEW RD Customer Service 1-800-423-6789 MECHANICSBURG PA 17050 Statement Date 07/02/12 Policy Number 55 PHF5977t39 Policy Term 06/01/12-06/01/13 Balance $832.40 Thank you for your business. Please refer to the back of the bill for additional information. If we receive the minimum amount due by the due date, you will avoid a $12.00 late payment fee. FULL PAYMENT You may avoid future fees if we re~eixe your balance of ' by ' ... .. Or, you may choose one of the available payment options shown below by paying one of the sl the due date: TWO PAYMENTS DUE DATE AMOUNT ....: 01/21/13 $329.16* THREE PAYMENTS DUE DATE AMOUNT 6 . , '~. cv 11/21/12 ~~ $329.16* 03/21/13 $167.08* SIX P DUE DATE 09/21/12 11/21/12 01/21/f3 03/21/13 aded amounts by iAE p~ AMOUNT ~~~ ~is7:oa~'... ~ k/ $167.08* ~~ $167.08* TWELVE PAYMENTS Pay ., ,: by ,. .With this option you will be billed $86.04* on 08/01/12, due 08/21/12. Additional installments will be billed on the 1st of each month with payments due on the 21st. i, ~' uaJ BVi p® INSURANCE BILL Auto & Home Insurance '' Progrem eom PERSONAL AUTOMOBILE nee HARTFORD A A R P INSURANCE PROGRAM PROPERTY AND CASUALTY INS. CO. OF HARTFORD GREENE ROBERT S Billing ID 81605624 4815 CREEKVIEW RD Customer Service 1-800-423-6789 MECHANICSBURG PA 17050 Statement Date 06/08/12 Policy Number 55 PHF597789 Policy Term 06/01/12-06/01/13 Balance $1,025.00 We did not receive the required premium payment for your Automobile continuation policy. As a result, your policy has expired. If we receive the required payment by Q6/28/12, we will reinstate your policy. Otherwise, there will be no coverage under your Automobile policy. 2732 FULL PAYMENT You may avoid future fees if we receive your balance of ~1 by ~; Or, you may choose one of the available payment options shown below by paying one of the shaded which include past due and current due installments, by the due date: TWO PAYMENTS DUEDATE AMOUNT «.~ ..Y w 12/21/12 ~$410.20* TWELVE PAYMENTS ...,. . Pay by This amount includes past and current due mstallments. C/ . ~~~~~J SIX PAYMENTS ~ AMOUNT DUE DATE ~ dj i~; •~ >yan:~ t~k:; ~ 08/21/12 $167.08* c ~ 10/21/12 $167.08* ~ 12/21/12 $167.08* 02/21/13 $167.08* * ~, 04/21/13 $86.04 y ~,. * A service fee of $5.00 has already been included in the amount due.- _A late payment fee of $12.00 has been included in the amount due. =,-_ Please Tear AlgngPerforation And. Return Bottom Portion With_ A Chet:k Payable To The Hartford _ Greene Robert S Bilf Account # 55 81605624 The Hartford P 0 Box 660917 Dallas, TX 75266 - 0917 II~~~I~I~I~~,1~1~11„~II~~II,~~I~I~~~~~III~~~I~„III~„II~I~~I DUE. DATE: 06/28/12 AMOUNT ENCLOSED: 55816D5624504DD00000000000002246000305640062980001D2500610D6 Form PLIC-INS1 13329273 06/08/12 37 17050 81605624 NV5010UD 1 2006 Dodge Dakota Club Cab ST Pickup 2D 6 112 ft Trade In Values -Kelley Blue Book Page 1 of 3 y [+A CooE lypso ~ spn in;or s:e~ r~rl home ~ car values ( cars for sale ~ car reviews ~ kbn Lop picks ( resmarch tools Popular at Ka B.com fh=a0 mrya Czrsof 2013 rnwnne,,xnt trome > Car Vzlue. > Drxlge > paknta Club Calf > 2 W6 > Style > U;Rans > Sl Pickup 20 6 1/2 R Your Blue Book® Value Show Nsed ~r Fries, Grace Your Nen ~r 2006 Dodge Dakota Club Cab 11 ' style ST Wdcup 2D 61/1. ft etlit Wronsichange style Mileage: 120000 mange Uke tl9s car Trade-In Value Private Parry Value ' when kdaing In at a eeakvsnlp whan selling the <ar YW rsGa r~ ~ iNnnL Rty~or[ Excellent .. $3,549 Shop for your next car price a new car Very Good 53.449 Good Instant Trade-In Offer get the ol(er 53,099 Fair 52,324 Own it? LOVe It? Tell Us. write a review Verity Condition vows:valid unm Be the first to know opal/zols when values change louow mis car (ppGateE w~N1 _ .. Helpful resources from kbb.com W rite a Revfaw Check Spec Sell VOUr Car Oen it? Love it? Tell us. Kigw your <ar Ireide Use our Tlps & Tools. arrcf eut. Search Cars for Sale Get a Used Car Report near Mechanicsburg I r°~ Get [he IMOrma[ion You Need on This ' Dodge i~~ ~O~ ~~ 2006 Dodge Before You Buy search Cnft'r VfN (ryuwroafJ ......._ , go No V(N?Sw RObleml GUy an UNtIMRED repprC Luray artl run VlNS as yqi research. ~A~ChKk .ev.xn Dodge ~~; Dakota qub Cab ;- 2006 '.- e~ '~. ~$tlry~ #a8 ~r§~il,~~t ~ N.dt Cumlwrland Valley Motors Dodge 0440a~ ~ ~iY Cablxating __._~. __ a0« user. g/ Etcellence -Since 1977 Se na9,.., srra~aaar f. S' Snm~ a.r..yCC, rw^~sp etlJ¢rtlWmpnl W11y anif VL<enUY VieweO Cais i MV Savetl Gn ve ca. 5309W bii http://www.kbb.com/dodge/dakota-club-cab/2006-dodge-dakota-club-cab/st-pickup-2d-6-1-... 01/25/13 m~cnlummc wur obs+ COMMONWEALTH OF PENNSYLVANIA REGISTRATION CRE(}ENAAL `r~XPIRY: JAN 31, 2012 VALID: 12107/10 )( `. OPLATE: NR49394 REG i:: GROSS. NT: 06010 1 yb ~.t ,~s~~u rIpITLE: b3157252302 =;6R SIGNA~'uRE ~IN: 1dTHN48N26S6414b7 UNLADEM NETGHT: 04497 R/MAKE: 2006 BODGE CUSS: 02 I hereby ecknowletl9e Chic tlay that I have received i YPE: TK Code of the pmvieione M Section 3]09 0l the Vehkle ~1 ID: 10341 1022 000038-001 EMISSIONS INSPECTION REQUIRED/DIESEL VEHICLES EXEMPT COUNTY: CUMBERLAND ROBERT S GREENS 4815 CREEKVIEW RD MECHANICSBURG PA 17050 orerw......- -