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Home My WebLink About03-01-13 (3) 1505610105 IX (o~-ii) (Fn REV-1540 ~ OFFICIAL USE ONLY PA Department of Revenue pen~ylvama OEPARTMEtR OF REVENUE County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO Box 213o60i ~~ j/~ j~ - ~ /~ I RE Harrisbur , PA i i28-o6oi SIDENT DECEDENT / .- ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 11 /16/2012 01 /04/1923 Decedent's Last Name Suffix Decedent's First Name MI Case Mary L (If Applicable) Enter Surviving Spouse's Information Below ' Mt Spouse's Last Name s First Name Suffix Spouse Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW (~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) Litigation Proceeds Received O O 9 10. Spousal Poverty Credit (Date of Death r Sec. 9113(A) O 11 • . Between 12-31-91 and 1-1-95) Attach Schedule O ( ) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Bar L Case (717~j80-3149 ry ~ ~_ ~ ~ ~o t~ER OF tt111R~S U Nlgf a rn ~ n ~ Cn ~a First Line of Address 6310 Stephens Crossing Second Line of Address City or Post Office Mechanicsburg State ZIP Code PA 17050 ~ rn n ~ U3 ~? i~-- r :C7 ~ 4 ~ ~ ~ r ~,, DA ILED ~ Q'? '~ Correspondent's e-mail address: bcase645 comcast net -- Under penalties of perjury, t declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADS S SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY L 1505610105 Side 1 150561U1U5 J J 1505610205 REV 1500 EX (FI) Decedents Name: Mary L Case Decedent's Social Security Number RECAPITULATION 1 60,000.00 1. Real Estate (Schedule A) ............................................. . 2 91,782.02 2. Stocks and Bonds(Scheduie B) ....................................... . 3. Closely Held Corporation, Partnership wSole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 17,178.54 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 7 (Schedule G) O Separate Billing Requested........ . 8. Total Gross Assets (total Lines 1 through 7) ............................ . 8 168,960.56 9. Funeral Expenses and Administrative Costs (Sc~eciule H) ................... 9. 1,317.91 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............... 10. 11,453.02 11. Total Deductions (total Lines 9 and 10) ................................. 11. 12,770.93 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 156,189.63 13 Charitable and Governmental Bequests/Sec 9113 Trusts fw which . an election to tax has not been made (Schedule J) ........................ 13. 14. ......... . ... Net Value Subject to Tax (Line 12 minus Line 13) .......... . 14. 156,189.63 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 0.00 15. 0.00 (a)(1.2) X .0_ 16. Amount of Line 14 taxable 156,189.63 at lineal rate X .0 45 16. 7,028.53 17. Amount of Line 14 taxable 17 at sibling rate X .12 . 18. Amount of Line 14 taxable 18 at collateral rate X .15 . 19. TAX DUE .........................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610205 1505610205 7,028.53 O J REV 1500 EX (FI) Page 3 File Number Decedent's Complete Address: Mary L Case STREET ADDRESS 645 N 2nd St CITY STATE Wormleysburg Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. ZIP pq 17043 (1) 7,028.53 7,028.53 Total Credits (A + B) (2) (3) (4) (5) Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred .......................................................................................... ^ b. retain the right to designate who shall use the property transferred or its income ............................................ ^ c. retain a reversionary interest .............................................:..................................... ^ ........................................... 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 consideration? ••••••••••••••••••••••~•••~~•••••~••••••••~•••~~••••~••••~~•••~••••~•~••••••••~ ^ 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? .............. ^ 4. Did decedent own an individual retirement acxount, annuity or other non-probate property, which ^ ^ contains a beneficiary designation? ...................................................................................................................... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent (72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disdosure of assets and filing a tax return are still applicable even if the surviving spouse is the only benefiaary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a}(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal bef~efiaaries is 4.5 percent, except as noted in [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (12-12) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: Mary L Case SCHEDULE A REAL ESTATE FILE NUMBER: All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. _ _____.~_ ~~_.:_ __._u.._.......~..1 ...a6 an6t of euwivnrehin must 6e dISCIOSed on Schedule F. If more space Is neeoea, use auuuwnai ~~ica~a ~~ NaNc~ ~~ ~~~~ ~~•••~ ~•~~• REV-15o3 EX+ (8-12) ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Marv L Case FILE NUMBER su nroeertv inintlv owned with rii4ht of survivorship must be disclosed on Schedule F. If more space is needed, insert daaicionai sneers of u~c aanic ~~« REV-i5o8 EX+ (o8-i2) SCNEDt~LE E ~ enns Lvania DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Mary L Cas e Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. VALUE AT DATE ITEM R DESCRIPTION OF DEATH NUMBE 1, PNC Checking account 51-4000-9763; 11,747.72 2. Interest Income on checking 11130/2012 0.07 3. Prorated Real Estate taxes @ settlement 60.49 + 688.24 748.73 4. Prorated Sewer Bill @ settlement 49.04 Income from investments received after death -PNC Investments acct # 097-008055 310.93 5. Income from investments received after death -PNC Investments acct # 097-008055 182.73 g. 7. Soaal Security payment -Post death. Will be deducted by Federal Gov't 885.00 g. Life Insurance Proceeds 2,945.84 g. Highmark Health insurance premium recovery 303.09 10. Income from investments received after death -PNC Investments acct # 097-008055 5.39 TOTAL (Also enter on Line 5, Recapitulation) $ 17,178.54 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 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: ESTATE OF FILE NUMBER Maur L Case Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Church Luncheon 200.00 Minister 150.00 Musselman Funeral Home 150.99 Organist 125.00 Flowers for Church 151.80 B. 1. 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as daimant's, attach explanation.) ('laimant 4. 5. 6. 7. SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS Ctroct Arlrimcc City State Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Return Preparer Fees: State ZIP ZIP 540.12 TOTAL (Also enter on Line 9, Recapitulation) $ 1,317.91 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-12) ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS FILE NUMBER ESTATE OF Mary L Case _ _ ... ________, ~__ .~_ ~___~,._....:.,. ~., ae~tti t~~t ~amainatl oneaid at the date of death, including unreimbursed medical expenses. tt more space ~5 neeUeu, III~CII Ouu~uv~~a~ ,~~cc.w v. ~..~ w•••- -•__. REV-1513 EX+ (01-10) ~ pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Mary L Case RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY Do Not List Trustee(s) OF ESTATE I I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1.I 2. 3. 4. 5. 6. II Bonnie L Hoover 42 Victoria Way, Camp Hill, PA 17011 Judy A Reynolds 5352 90th Ave Circle East, Parrish, FL H. Mark Case 1611 Matthew Dr, Camp Hill, PA Teny J. Case 856 Erford Rd, Camp Hili, PA Barry L Case 6310 Stephens Crossing, PA Janice L Keys 492 Pine Ridge Circle, Lewisbeny, PA Daughter Daughter Son Son Son I, Daughter ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TATAI AC DADT n _ ~IUTGD T(1TA1 NIl1w TAYARI c t1TCTDTRI ITT(1NC (1N I iNF 1 ~ (1F RFV-1 Snn ('(1VFR SHFFT I ~ 149161.1 ~ 24860.19 24680.19 24860.18 24860.18 24860.18 24860.18 If more space is needed, use additional sheets of paper of the same size. vin ~ ~~ ~vr+ ~ ~. v~ n~~~o ~ ~.n yr rr~~~..~ CUMBERLAND COUNTY GRANT OF LETTERS PENNSY~.VANIA --.__ - ~_ __. r `- - - _ - -- - r - _ .. r- = ~- _ ___ ~- . No. 2012- 01215 PA No . 21- ~ 2- 1215 Estate Of : MARY LOUISE CASE lFirs~ Middle, Last1 Late Of : CURB BLAND COUNT OUGH Deceased WHEREAS, on the 20th day of November 2012 an instrument dated LINDA TED MARY L OUISE CASE (First, Middle, L.astl late of WORMLEYSBURG BOROUGH, CUMBERLAND County, who died on the 16th day of November 2 012 and WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Regi s ter ~ of Wi 11 s in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: BONNIE L HOOVER who has duly qualified as EXECUTOR(R/X) and has agreed to administer the estate according to law, all of which fully appears of record in my office a t CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VAN/A. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 20th day of November 2012. egisier of l s eputy * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) LAST VI~`ILL A''+iD TESTAR~IFNT_OF MARY L. CASE 1, Mary L. Case, of Cumberland Cou~~t}°, Pennsylvania !~eing of sound mind and memory, do make, publish and decla~•e this my Last Will and Testament, hereby revoking any and alt ~N ilis L-Fv me heretufore :Wade. f~ 1 RST: ;direct that my funeral be conducted in a manner corresponding with my estate and situation in life, and that 31( my just debts and funeral expenses be paid and s:aisfied b}j my Executrix her•einaftzr named, as soon as conveniently may be after my decease. `~~C'O?~D: 1 give, devise and bequeath all the rest, residue and remainder of my estate, real, ~~;;*.}.. I~r.c>nal and mixes:, ~~f whatsoever kind and wheresoever situate, which I may own c, have the right to dispose of at the time of my death, in equal shares to Bonnie I.. tJoover, Judy !~. Reynolds, I-Ierbert M. Case, Terry J. Case, Barr} L. Case and Janice L. Keys or their issue, per stirpes. '~~3~!I."fH: t~wreby nomi~~ate, cc~nstitu~~e and appoint my daughter, Bonnie L. I~ionver, Fx~;cutri ~ oi' th:s m}° Last Will and Testament. if Bonnie L. Hoover is unable u:• u=nwilling to serve as such, I then appoint Bam~ L. Case to so serve. I dire~~t that n:y personal represe;~taiive be excused from entering and/or filing any bond. to i~~sure the proper performance of her duties, in any jurisdiction where such bond would be required in the absence of this sentence. t~_ O V7 ~ ~ '~ ~~' N ~~ = t~ ` ~' _, _r_ © ! - ~ , Pare ~ of 3 ~...L.1 ~~ f ~ ~ ~ i ~ r'~.. ~-~ ~ y - .-=j U, ~~ c ~ . . . FIFTH: I direct that any and ail inheritance, estate and transfer taxes imposed upon my estate, passing under my Will or otherwise, shall be paid out of the principal of my estate before any distributions are made to any Beneficiaries set forth herein. I, Mary L. Case, the Testatrix whose name is signed to the foregoing instrument, having been duty qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. s~ '. ~ J - J Z/1. ~ ~ if ir" (Seal) • Mary L. Case COMMONWEALTH OF PENNSYLVANIA §§ COUNTY OF CUMBERLAND - Sworn to or affirmed and acknowledged before me by Mary L. Case, the Testatrix, this 24th day of February, 2011. CArlMONVVEAII~! OF PENNSYLVANIA Notarial seal Marisa Seeger, Nabry Pubic East Pera>stioro Twp., Cad County My Cortimission Expires Dec. 15.2413 Member, peRnsylvania A.~sedatia~ of Notaries ~j NOT RY P~1BLI My Commission Expires: We, Jeffrey N. Yoffe and Yvonne Dobson, the witnesses, whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were Page 2 of 3 M.L.c. present and saw the Testatrix sign and execute the instrument as her Last Will; that the Testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Will as a witness; and that to the best of our knowledge the Testatrix was at that time 18 years or more of age, of sound mind and under no constraint or undue influence. d~• ef~-ey N. Yoffie 214 Senate Avenue, Suite 404, Camp Hill, PA 17011 { Y ~' nne Dobson 127 South 18~' Street, Carnp Hill, PA 17011 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND §§ Sworn to or affirmed and subscribed to before me by Jeffrey N. Yoffe and Yvonne Dobson, witnesses this 24th day of February, 20I 1. . c~MMONwE~.TM o~ ~vNSnvarv~ Notarial 5ea1 Marisa Seeger, i Pubic _ i 1 East Pennsboro S~n-P~C ~~ ~~ l~! ~r~~~- ~V My Gommis~n Member, p~,yyi,rania ~- ~ '~ NOTA Y PUB~,IC My Commission Expires: Page 3 of 3 .. ~~ M.L.C. COMMONWEALTH OF PENNSYLVAN~© COUNTY OF CUMBERLAND estate of MARY LOUISE CASE SHORT CERTIFICATE I, GLENDA EARNER STRASBAUGH Register for the Probate of Wills and Granting Letters of Administration in and for CUMBERLAND County, do hereby certify that on the 20th day of November, Two Thousand and Twelve, Letters TESTAMENTARY in common form were granted by the Register of said County, on the late of WORML EYSBURG BOROUGH r~~ a,;da~ c~su in said county, deceased, to BONNIE L HOOVER r~•n, M;~ case and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and -affixed the seal of said office a t CARLISLE, PENNSYLVANIA, this 2 0th day of November Two Thousand and Twelve _ File No. 2012- 01215 PA File No. 21- 12- 1215 Date of Death 11/16/2012 NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL ~.r.~c 1 it Lx i iv~r yr ~~ ~ t it,~ uly.~.i~x rd. c~..t,. ~u~c ~.v~d~ . , Name of Deca Date of Death: " Date Letters G !b_ ~ a 1~- r^ File Number:. a'tQ I ~ -~ ~ !~.! s'~ 1~.~v ~o ~ a o ~l.z- - To the Register: i certify that htotice of Estate Administration required by Pa. O.C. Rule S.6(a} of the Qrphans' Court Rules was vn or~mailed to the following beneficiaries. of t~ above-captioned. estate on Name• ~U3dress: , ~g .~.at~ y- G~,~ b~fa ~~~ ~ ~ _ ~ -~: ~,~ /~ ~~ (I~'rnore space is needed attach separate sheet.} Notice leas now liven given to all persons. entitled thereto under Pa. O_C. Rule 5.6(a} except: ~i~.l r~ ~3 ~a l.3. ~~ Signat~ae ~'Pe~-ox fir uig this Forn~ _ Ca 'ty. ~erscmal Iteprese~iative ^ Cotmsel ~on~~-G ~ ~ ors r NameafPerson Fi~gdiu Form ~~. ~i ~ ~v ~, ,~ ~ ~~ 13 06 ~C~~U~ ~ Form RW-08 r-E-c Ia off t~Dn expen~s s~}et: ~ fin auarm aapen~s Tos ss ~a-v, ~ ar~w~ MARY L CASE 615 N. 7~5'[i!£ET ~ PA. 17943 E3pB6FS 0~.~~4 29i2 -~^ T~CaamsiraETiwsO~sHea~9112f16a.OD ~ (,~ ) P~iotllawsO~Mnllooe9j22~911~7~d.90 ~ 7 f•- F+I-C+o~wvtOOslIsl~9j]i if9.i9 f~taiotll.sOpwlioloe9l26M.,p r _ 2 f~ Gmrum(otlo~s f~M 19/3 21b.OD ~ /- ~ O ~ ' f ~ j L~/l~/~ ~ . ast tCa~liera0.00 r!J!~ Z34659Tda151~M ~ f pct }'~ /~ _~~„~ ~ ~~~ ~~~~ f ~L ;SOS,fS~oeDneToAstiowec ~ '" / "- ~~ ~ ~"~ ,s{!'/L~1..~' ®ID'1f RtiON AtlCi301933tlfp a9'J422•L ~~ f~ j J~ ~-*7 _ . i 813 era wn ~ e ROAD ~e+"r-"'.~..~ OIIMGMINON, PA 17024 MARYL CJl4E 6458 71~5IidgT ~ PlL 170{3 S~leOf Rrl EatMieOcOobefy 29f2 tii6,M0.M , .a~.oeas~ToAuo~a ~.. ~ ~,~~ !~ ~ (~ ~.> ~~u~ a93eEa.e...enoAu nts~o[R, P11.17929 7t7-96s~s399 ( of 1 11/27/201210:19 AM - r ~`: a U_ 5: D~PARTNEfYi' OF HONG and IJF~A14 ~Et:OPM ENT OMB No. 2502-0265 SETi'L9~M' STATE~MC- TNepro for W~da~s"' , L~SERTY LAt~t~3 TRANSFER, ANC, _. . _ B. TYPE OF LOAN • 4680 Trirldle Road, Suite 201 ~ t..~w- z.~- p a: co~w.~s. Ca[Ylp E"titt P/~ ~~~~ ~ ; 4. VA . S: CONV..11+1S. : S t=iLE 7_ LQAN NUY>BER .Phone: 717,87-9915 FAX: 71?-?83-746(1 ss3t3 ,~ ter: tn~: cAS~ No.: C: NOTE. This onn is 5rrnisf~il to giae you a staterrle+rt of acdtal ~ costs. Arnourds paid to and by the se8letne~ agent ena siwwn. : Hems 1i18F1C8d'{p.O.Gr wee paid OVt~ ~ Cbs~ they are ?af~Nll1 ilerB fiDt PmP~ affil 3N8 not @llf in th6 . ]. NAtY~ANQADDRESS OF 2 NAt~At+@ ADDRESS OF SELLER F_ NAME AND ADDRESS ~ LENDER ~' ~Iostaet Rarraani Fsta~a of t~Aary L Case . 3. PROPERTY LOCATION:. t~ SEiTtt~N'[ AGF~!'i : libeti~- E~td Tref i. SERLBiAENT t1~17E: i45 N. Zi1~3 S . tit 2Q 2Q42 Normleysbntg. PA 17045 N~ PLACE OF S~'T: 2 Drive, Suite t 00 : ~Y, PA Lerrwyme. PA 17043 J. StNNMARY t>F BORROWER"S TtANSACTIO N K.8tl~ARRY Oir SS.LER'S TRANSACTION. 00 t3ross /1rn~sd Dne sraaa Bocc~aaasr 400 Grabs Ama~urS Dna to 3~ :. Oi: Coni-act s2~fea prke 6Q.000.00 40t. fi sales price titi, 02: Parsot~at Pacp~ll • 442 Peraonai AnPertY 03. Seit~nenE Charges (6~e 1400) 194200 403. 04. _ _ _ 404:- ~- _ - 405:. AdjtrstiRre<-ts #a itemB pak! in advance by ice) A tbF items paid in advaerce by satier{s) ~ C~rRawn taz . - m 406. Cily/i'anf tau b . -OT, Co~tylCSy tax ; 11192412 fin 1?J3fi20'iZ 6045 407. C.aa- tax tilZSi20i2 b 12tStJ2tYt2 60. OS: AssessrrwMs . to 408. Assassrn~fs ~ 09. SdiootTax : 11/29/2012 to 6J30JZOf3 ~ 6'8824 409. SchoolTax f129rL012 to 613tafZOf3' i0 SawedTrash 11t29/Z412. do 12/312012 49.04 410 Se+wer/Frasii 111292412 ' b ` (?13112012 49.04 . 11. :. _ to - 411. ~ 12, tQ 412 _ to Z0. Qrvss Amormt Dus fi±wn Bocr~ower - (12.739.77 424. Gross Amotrnt`Doe ~ Seper ti4.T97. 00. Arriourrfs Paid 13j- Oran t3Ntalf Of Sorrawer - 500 Rorrslo Arfaourrf OueTa Seller 01. Depose or earnest money 8.000.00 501. t?~ooeas depot {see ~} S.OOQ 02. Pr;Ar:a of new ban{s3 502 Se~r~nt to se9er (5ne 1400} : _ 2,4fi5_ 03. ban(s) ~ - 503, Existing tosn(s}i~r subj~ ~ ~- _ 544.. Payoti'of FastRe tit - O5. 505. Paya# of Secorut loan ~ 506. irrlrer~e Tax Estuow 4.200. 07- .. _ 507_ 08. ~ 09. 509: tbt ilwrrs t by setter A~-fore i~ by sew - . ' f 0. C9ylfawn tax to 510_ CitydT own lax iD ! i. County/Cijr tart to . 5i 1: CountyrlC'4y tax - to 12 Amts to 512 A~ tD 13. School Tax to 5#3. ScFwol'Tax to . 14. tv 514.. m 15- ~ 515. _ #o 16. to . 516: iT. 517. i8. - 518. f 9. Sig: 2Q Total Paid. Borrnarsr 8,000.04 x20. Total R Amoturt Due 5elier 1 00 CASH AT S~ Fr+ori:/TaBORRE)MYlSft 600- CASH AT 8ETfi.EMENT TdFrom SELLER 01. Gross Amt dry firorrr- (lire 120) 62,739.77 601_ Groans Arrrountdue Seger (ire 424) 60>79T- 02. Less AmL paid by/lor borrower (8ne 220} $000.00 bat. tress tedrrt2io~r it AmLdra3 Seq~ (C~e-524} 14,665. 03. 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For tli>. period 1./'31 /2012 ~ 11/'29/2®12 000106 MARY L CASE DECD Cl0 BONNIE HOOVER 42 VICTORIA WAY CAMP HILL PA 17011-1732 Pnmary account numner. Page 1 of 5 Number of enclosures: 0 For 24-hour banking, and transaction or interest rate infornnatwn, sign on to PNC Bank Online Banking at pnc.com. a For customer service ca111-888-PNC-BANK Monday - Friday: 7 AM - 10 PM ET Saturday & Sunday: 8 AM - 5 PM ET Para servicio en espafiol,1-8S6-HOLA PNC C~~ - cH~e~aS D Dam D~ ,Os~~ __.~~ Lr ~~ 1 Mo~9~ Please contact us at 1-888-PNC-BANK. ® Write to: Customer Service PO Box 609 _ V isit us at pnc.com ® TDD terminal:1-800-531-1648 Far hearing anpaired clients only J ' vonsttip OYSrwaw ~nk AR:~n~' Deposit Balance Description Account Number 235.58 Interest Checking 50-0492-7498 2~r cg Total De 'ts /nvast ~ a PNC Bfokerage Account Number: Q004856584 Description . ~y t~ v~t.~ ~ • ]\o iE~r Caaraa Nlarlaet value on 11/26 91,647.80+ Mutual Funds 91,647.80+ Value 91,647.80+ Net Value Investment balances are provided for informational purposes only. For more details regarding these investernents, Please refer to your account statement from your investment providerts). This information ~s not intended to replace your regular brokerage account statemerrtls). Mary L Case Decd Senor Plreuwun Plan - -- Interest Ci~edan~ Account Snultar~ Aooouat manber: 5o-oast-7as8 O~rordratt Prot,~otiau has not been established for this account. Please contact us if you would like to set up this service. pYerdraft coyrrago-Your account is currentlypptod-Oat. You or your joint owner may revoke your opt-in or opt-out d~oioe at any time. To learn more about PNC Overdraft Solutions visit us online at pnc.corrUbverdraftsolutions. Call 1-877-588-3®05 visit any branch, or Sign on to PNC Oniine~ hkin9 f ~~~ ~Ye ~e s~ ~e~~ft Solutions` link under the Account Services section to mange y Protection settings. iR~lawt.a SuY Beginning balance 1,668.40 Deposits and Ctuecks and outer cther additions deductions - 10,185.07 11,617.89 Average monthly balance 9,419.76 Ending balance 235.58 Charges and fees .00 ~•ti .~ PNDMLT01-JO678344140-NNNNNN-003-000324 ~ on pnc.oom. v Primary account number. 50-0492-7498 Page 2 of 5 . e~r~.nn! number. 54-0492 7498 -continued Transaction Sut~nary Checks paid/ Check Card POS Check Card/Bankcard withdrawals signed transactions POS PIN transactions 1 0 ~ Total ATM PNC Bank Other Bank transactions ATM transactions ATM transactions 0 0 0 As of 11/29, a total of $.24 in interest was Interest Suzy paid this year. Annual Percentage Number of days Average collected Interest Paid Yield Earned (APYE; in interest period balance for APYE this period o.olr. 30 9,419.76 .07 A~cti~rit~1 Detail Deposits ~d Other pd~tions Date Amount Description fl 11/02 885.00 Direct Deposit - ~:soc Sec ~ ~.~ ~ US Treasury 303 ~;l~,~i1541D 11/05 9,300.00 Direct Deposit -Brokerage Pnci Ibp Sett .' , ' ' '~~1 11 /29 .07 Interest Payment There were 3 Deposits and Other Additions totaling $10,1H5A7. Checks and Substitute Decks Check Date Reference number Amount paid number 1036 60.00 11/16 ossa~~~ There is 7 check listed totaling $60A0. Deductions There were 4 Online or Electronic Banking Online and Electronic Banldn9 Deductions totaling $57.8s. Date Amount Description 11/(K 14.9fi Direct Payment - Payiuent PAWC 0642839 ~d ~ lI/16 19.74 D"u-ect Payment - Elec Svc Ppl Eu ' ' ' '~4017Ws ~~ 11/16 10.98 Direct Payment - Elec Svc Ppl Eu ?~~Y~4002Ws 11/91 12 91 Direct Payment -UGI UGI Utilities 7C~ti~' ' '1~i,17L0-1I There was 1 Other Deduction totaling Date Amount 11/28 11,500.00 Description Te104000041010062 Transfer To ~~1~11396 Daily Balance Debi Date Balance ~~ Balance 40 853 Date 11%Ifi Balance Date Balance 11 ~8 747.72 /~ 235.51 21 10/31 1,668.40 40 553 . 11/05 11, 838.44 11/06 11 11/21 , 11,735.51 11/29 235.58 . 11/02 2, , ,(~,gz/arc~c ~r~lv //, 7Y7. ~Z ,.~ .;~ FORIt9166R-0111 ~ on pnc.com. u Account number. 50-0492 7498 -continued Primary account number. 50-0492-7498 Page 2 of 5 Transaction Summary Checks paid/ Check Card P~ Check Cat+d/Bankcard withdrawals signed trar-s~tions POS PIN transactions 1 p U Total ATM PNC Bank Other Bank transactions ATM transactions ATM transactions p 0 U ~~~ ~y Annual Percentage Number of days Average collected Yield Earned (APYE) in interest period balance for APYE O.Ul% 30 9,419.76 Interest Paid this period .07 As of 11/29, a total of $.?4 in interest was paid this year. A~CtiYlty Detail Deposits and ~,~ inn There were 3 Deposits and Other Additions Date Amount Description ~ ~ totaling $10,155A7. 11 U2 885.00 Direct Deposit - Xxsoc Sec / ' ' ' f` ~ i , 1541D US Treasury 303 :s1. 11/05 9,300.00 Direct Deposit -Brokerage Pnci Ibp Sett ~~11i~5841 11/29 .07 Interest Payment Checks and Substitute Checks Check Date R~erence number Amount paid number 1036 60.00 11/16 osso~¢~~ " Online ~d ®ectronic Banking Deductions Date Amount Description 11/U6 14.96 Direct Payment -Payment PAWC 0642832 ~~ it/16 19.74 Dizect Payment - Elec Svc Ppl Eu .' ' 4017Ws ~~{ 11/16 10.98 Direct Payment - Elec Svc Ppl Eu ?i~`i~14002Ws 11/21 12 ~1 D'u-ect Payment -UGI UGI Utilities ~~~?t.' ' ' ' ' 0-11 There is 1 check listed totaling $i80A0. There were 4 Online or Electronic Banking Deductions totaling $57.58. There was 1 Other Deduction totaling ANesur Daducbiats -~~.,,_._ _.~. .- _-,,,_._ ~_,.~-- $~'~'00~0. Date Amount Description 11/28 11,500.00 Te104000(?4101 0062 Transfer To ~11~i11396 Daily Balance Detail Date Balance 668.40 10 31 1 Date Balance 11/05 11,853.40 Date 11/16 Balance Date Balance 11,747.72 11/28 235.51 58 5 , 1102 2,553.40 11/06 11,838.44 11/21 . 11,735.51 11/29 23 ~C/l F/Jfi~~ ~` ~~ ~~0~~~ L/NE Z ,.~ .;~ FORf~166R•Ot 71 ~. ~.~£~ 3 r' . " U. S. OEPAFtTMEH7 OF HOUSING end UFiI3ANl DEVELOPMENT Old No. ?502-0265 SETTLEMENT STATN~NT - Tiro ~. Windows"' LIBERTY LAND TRANSFER, ANC. - B. rrn~ of LOAN 4660 Trindle Road, Suite 201 Camp HI~1, PA 17019 ~. FHA p 2 FtWl1 p 3. coNV.t~aNS. 4: vA 5. CONV. ups. - .Phone:. 717-975-9915 FAX:-717-763-7460 ~ B. FILES 96393 7: t~t>,i l ~ AA(~T: INS. CASE NO.: G MOTE Tlds form s m giMe you a stacatr~rrt of actriai sew coals. Artiands paid b and bS- the agent are shown. - Hans rrar<lcea'~µaar ~ paid arrtaide ~e dosirrg< they are strowrr here for puposes and ire Hoc inchraed in the botats. - ]. NAirAE ANQII>]DRES'S OF ~ do,~aFa Rarr~ani E NAYEAI~D OF 1 FR' Estem.of Icy L Case F_ NA1YE AND ADDRESS ~ LENDER - a. PROPERTY LOCATION: 145 N. and Sf NotmisysDutg. PA 17043 H. SETTLEi~lT AGENT't Li~rly Lat1d Try _ L SETTLEMENT DATE Nov 2S 2012 Nomdeysbwg Borough Cll. PA PLACE OF SETTlEMFNT: 2 Drive, Suite 100 Lemoyne. PA 17043 J. SUMMARY OF BORR04YER'S TRANSACTIO N - K StAaIURY OF Sa.1.ER'S TRANSACTION 00. Grvaas Ar>totart Dos From l3orrvwar ~ Gloss AmounE Dud to SeUsr Oi. Corrtract sales price 6D.00000 40t; Contract sales price 80,000 AZ. Personal PEOPenY ~ Peisarrai Ptoperh 03. Sstflement Charges (bre 1400) 1.84200 403. - 04. µ}4, 05. ~ ~: ~ for ierrts ~ ir- ay setier(aj A~ for ierrrs p8id b ad~ranoe b~- ssbrta) 08. Cilylt owa ~ to 408. CilyfTown tax : to 07. gYtax tt292012 to t213t2012 80.49 407. Coung~y~c t1/29~0t2 !a tZf3lrl.Ott 8Q ~ Ass~r~s bo 406, gases~rfer#S Q9. SdwoiTax 11129/2032 to 6r30ROt3 10. SewerlTrash 111Z912Qt2 to 121342012 68824 48.04 4D9 SdiodTax -11292012 b 6I30i2013' 410: Sewer/1'rash 112912012 ' b 121312012 48. U. b 411. to 12 b 412. m 20. Grass Amount Dus from- Barrdwar BZ,T~ 77 42Q Geads Ansa~ Dus to Sailer 80,787. QO Araowrts Paid By Ot ti Behalf Of Borrower 500 Radu irr Amount Oue 7o Seller 01. Deposit or earnest money 8,00000 501. Excess deposit (see ions} 8,000. 02 PrirKapal M~ounE of new ban(s) 502.. Sect bo suer (Gne 1100) 2465. beM~ > ~ 503. Exis9rrg ban(s) laloen sutrject to ~- 504. PayalFof First iAorlgsge loan 05. 506. Payoif or Secard Mortgage Lean 08. 506. IMrer>tarK:e Tau. Escrow. 4,200. O7. 507_ O8. 506. 09. ~ - Adjustrrrerrfs for Hems by s~ Arrerrts for kerns unpaid hY setkr _ - . 10. City/Town ~c to 510 CitylTown tax- b 11. CouMylCihr tax to . 5t 1. Couniylt+ity tax to 12 Assessrrrerds to 532 ~ ~ 13. School Tax to 513. School Tax m - 14. to _ 534.: to 15, m 515. to 16. to 516. to 17. 517. 18. - 518. 19. 51& 20 T~ Paid B~IFos Borrosres 8,II005iD 00 CASH AT SETTLENItafl t=raNTo .BORROWER 520- TodCReductloaAato~sit Due Setter 600- CASH AT SETTLfttlEiilT To1From SELLER 01. Gross Aml due trvrrr borrower (Cris 120} 02 Leas Amt. paid bye borrower (line 220) 62,7.77 8,00000 601. Gross Amount due Setbr (fie 420} 602. Lase neductian b Arrrldue Seger (tire~520} ~.T97. 14,865. 03. can ®FROM p To . B«mwer 54,73977 603. castr ®TO p FROw Seller 46,1 ~~ ~~,~~ r - ~~:.: rDW ~ _ ° ~, ~ ~~ D ~~o~ won ~ z DNna 3<~N 3~~ ~~W N ~~ .~D~ =C ~ ZmZ~DD a ~ _~~_ N~ ~ = C ~ _'~Q° s~ °mmmm~m Z m r~?~ ~m~ w p ~~-~n x '-"~ ~ -i~ -t I `o a z ~w ~ bv~n ~' zc"aotnrn ~ D~~~ ~ Q ~ m ~ r @ 0 • ~ 4~p c ~ m ~~ - c ~z ~ _ x ~° ~ ~ ~ m my ~ ~ 5 D ~~ ° 000 m ° m v p _ ~ ~ N N N ~ to ~ ~ 1 D ~ n 0 0 0 'p m -i m ~ Z NN N am ~ ..~ ti m n O N o .~, j a . ~c Z p = o m ~ ~- A X ~ o ~ ~V ~~ ~ o~ N ~ p v ~ ( V "'1 O ~O ~ v -` ~ a ~ a a m ~ O C ~ ~ m C ~, rn ~ a p O ti ~ ~ W -~ ~ Upt ~ ~ ~ N ~ a rt ~ ~ is ~ v a` 0 0 CD N V W .~-. O N ~ ~ ~A fA N m ` -+ -~ N ~ ~D t71 V ~ N m O S ~ pp ~ W V N O W ~ N CND m r ~ ~ w ~ o°0 0 0 oND ~ ~ "' ~ ~ V m ~ A C) 7+G m !'t9 ~ to o a O • ~ ~ • m y oo ,s ° ~s ~ o ~ 1- c .. me T'Q~~ • ~ ~ N Z1~ ~ ~° n ~ ~ C! rn ~ O ~ _ ~ • - C D = 0 ~ m D N m » t ~m v m ~ ~ ,m A b ~ co ~ r ' i A o D r w~ o ai nO°i y o m 0 0 z z ADO ~ m03 ~ 1 ~~~ `• v ~ Q W O O C_ ~ ~ L ! _ S C D 0 Z N Z C Sc .r{ v m ~ -~-i (JI ~ .° n ~ ~ aD ~ ~ O ~ Z CD 3 n ~ ~ o -~ »oz 000 Z -- 0 A `i .i ~~a t O N w 0 w \~ n o ~ ~ ~ ~ ~ ~ ~ ~ ~ BOROUGH OF WORMLEYSBURG 20 MARKET STREET. WORMLEYSBURG, PA 17043 PHONE: (717) 763-4483 FAX: j717) 763-5701 er!`C1f iNT Nf) RIi f lAlf_ Hart , 40185-0 10/02/12 SERVICE LOCATION 645 N SECOND STREET SEWER UNITS TRASH UNITS l.oo I l.oo PREVIOUS BALANCE PENALTY/CHARGES 0.00 ~ - 0.00 CURRENT SEWER CURRENT TRASH 92.00 ` USAGE 49.00 • • • 17 ._ _ 141.00 ' BILLING PERIOD 10/Ol/12 IF PAID AFTER 11/02/12 12/31/12 i i ~ • • 155.10 ~,~`~rj~`( flt!l~~tttli~iltlF Procx=eds -From -Real -E~ate Trans~ons as r~equir~ed by the lntemal Revenue Service Section 6.045 {e) of Tt~ lntemal Revenue Code, as amended. by the Tax Refa~m Act of 1986, requires the reporting of certain _ on every r+~i estafie transaction. The information in the Substifdbe Fpm 1099-S below wii! be .famished to the 1 Sin oomplianoe with the tnter~ral .Revenue Cede. You -will be famished a copy of the form in compliance with the lntemal Revenue Code. You are required by law do provide. the Filer shown on the Substihtfie Form 1099-5 belov~r with your Taxpayer identiT'>cation number. ff you do not provide ifie Filer sl~wn' on the Substitutie Form 't099-S belaNV with your taxpayer identification number, you may be sub}ect #o cnril or criminal-penalties inltposed by raw. Transferors fixv+rardmg address: Transferor's, Taxpayer 1 Nutr>ber (S. S. ~ i Street Tr~sfervr's Signature City :State Tip Code Date Under penatties of p~uy, l certify that the number shown ~ this fomr is my cameo Taxpayer ident~tion Number: Type or machine print. D Con~ecfed LIBERTY LAND TRANSFER, iNC. {'rf checked) 4660 T~indMe Rd, .Sure 209 SuBSTtTUTE Camp Hitt, PA 9709 - F~R~t 79 7-975-999 5 ~ ~~ ~5 wuRe a~ Aoia>~ss of Fit. Estate of .Mary L. Case ,mss- ~~ ~~~ TR1-NSFERORS FQRWARnING ADDRESS . /~~cJ~ ~ ~~ ~1 CITY, STATE, T-#~ fi45 N. 2nd Street, Wormleysburg, PA 17043 ~rtoPEimrAD>D~ssott i.EC,A~ oESCRi - ~ ci~clc t+ene ~ the trar~era reoei~d or v~ recs3nne or service as pait of the conskieralior-. $fi0, 000.00 ~vss ~oce~s I Fi~scr~aw Nuiu~ ~ffi'~37L.5'88 ~'~~ .~.3 TAX PRORI4710N3 CREbit'$ Nav 29 2012 DATE of cu~aat~ THfS iS iMPQRTANT TAX. fIVFOE~MATtON and is Ming famished ~ ~ Fntemal Revenue Servioe.lf you are rnquired to file a return, a negligence penalty or other auction wt11 tie imposed on you if this item is requin3d to be reported and the IRS determines that it has n~# been reported. SUBSTITUTE 1 Owne~a Affidavit (indiridua~ ~,yz fs~~,~. ~~ flit ~. ~_ ~~~r ~ 3 ~v..- ~_ v_.o rT L'3 ~ ~ ,off, ~ ~ « "'L r ~ p ~+~' H vDi C'1 ~ ~ A 0 ~ A = _ ~~r~~ a~= ~ a ~' c~ ~ c~ ~r ~~~ ?~ Q ~ ~ fn ~~ ~ ~+. r P a ~ ~_ ~ ~ a y o s d ~ ~ ~ ~. 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W N (7 .. ~, Total Banlzing Statement ~~,~~~ PNC Bank ~/it/a< For t~ period 11130/Z•iZ 10 1?JZS/Z•1Z 000149 MARY L CASE DECD s' .- C/0 BONNIE HOOVER 42 VICTORIA WAY CAMP HILL PA 17011-1732 Visit us at pnc.com ® TDDte`minal:1-800-531-1648 Foe hating impaired clients only Relafioin~ip Overview _-- _ __ Bank Deposit Accounts Description Account Number Interest Checking 50-0492-7498 Total Deposits Deposit Balance 1,100.58 1,100.58 NOTICE OF EXPIRATION OF THE TEMPORARY FULL FDIC INSURANCE COVERAGE FOR NON-INTEREST BEARING TRANSACTION ACCOUNTS ' Unless there is a change in federal law, beginning January 1, 2013, funds deposited in anon-interest bearing transaction account {for example, a non-interest bearing checking account), including an Interest on Lawyer Tivst Account, no longer will receive unlimited deposit insurance coverage by the Federal Deposit Insurance Corporation (FDIC). Beginning January 1, 20I3, all of a depositor's accounts at an insured depository institution, including all non-interest bearing transaction accounts, will be insured by the FDIC up to the standard maximum deposit insurance amount (5250,000), for each deposit insurance ownership category. For more information about FDIC insurance coverage of non-interest bearing h~ansaction accounts, visit: www.fdic.gov/deposit/deposits!unlimited/expiration.html Seeior PreiriillNw Plsn Mary L case Decd Interest Chedong _~ccouw# Sui~altary - - - -_ - aao~bar: sa-04s2-74ss --- _ - 4rir+tlratt Prroteetioiw has not been established for this account. Please contact us if you would lilae to set up this service. ahrerdra>~ coverages-Your account is currentlyOpts~l-Oat. You or your joint owner may revoke your opt in or opt-out choice at arty time. To learn more about PNC Overdraft Solutions visk us online at pnc.compverdraftsolutions. Ca111-877-586-3605` visit any branch, or Sign on to PNC Online Banking , and seiect the "Overdraft Solutions" link under the Account Services sedan to manage both your Overdraft Cover~e and Overdraft Protection settings. ~f~ SiI~ Beginning Deposits and Checks and other balance other additions deductions 235.58 885.00 20.00 Average monthly balance 1,028.33 Ending balance 1,100.58 Charges and fees 20.00 ~,~ } PNCBANK Primary account number: 50-0492-7498 Page 1 of 3 Number of enclosures: 0 For 24hour banking, and transaction or interest rate information, sign on to PNC BankOr-tine Banking at pnc.com. 'a For customer service call 1-888-PNC-BANK Monday - Friday: 7 AM -10 PM ET Saturday & Sunday: 8 AM - 5 PM ET Para serviclo en espafiol,1-866-HOLA-PNC ^ooip? Please contact us at 1-888-PNC-BAN K ® Write to: Customer Servroe PO Box 609 _:.. v'Y ---Pittsburgh PA 152 - __ -T _ __ __ , .. Total Banlzing Statement For 24-hour information, sign on to PNC Bank Online Banking on pnc.oom. Account number. 50-0492 7498 -continued Interest Su~oary ..Annual Percentage Number of days Average collected Yield Earned ~APYE~ in interest period balance for APYE 0.00% 29 1,028.33 ActinitY De1td~~ Deposits and fhher Ad~tions ~~~~. ,~~ Date Amount Description ~` w err 12/03 885.00 Direct Deposit -~xsoc Sec US Treasury 303 XXXXX1541D ~~/ y~ Dlher Daduclioins Date _ Amount- Description __ . _ . 12/28 20.00 Calculated Service Charge Type Hd Daily Balance Detail Date Balance Date Balance 11/30 235.58 12/03. 1,12058 SENIOR PRENWM PLAN - Serrice Charge Explanation Account type Account number Balance type Interest Checking XX XXXX 7498 This Cycle Avg Balance For ~ porioa 11/3e/281Z 1~0 12/28/2012 MARY L CASE DECD Primary account number. 50-0492-7498 Page 2 of 3 As of 12/28, a total of $.24 in interest was paid this year. Interest Paid this period _~ ~~'Q~r~ ~~ There was 1 Deposit or Other Addition totaling ~885:A8. i~l' ~Q~r,''L There was 1 Other Deduction totaling I~®.~. Date Balance 12/28 1,100.58 As of Balance These accounts were reviewed to meet- 12/29 1,029.02 the balance requirements of your Senior Premium Plan Account. Since balance requirements were not met this month, a $20.00 fee. was deducted from this aoDOUnt. Stock Up on PNC Ba®k Visa® Gilt Cards this Holiday The PNC Bank Visas Gift Card is perfect for everyone on your gift list. PNC Bank Visa Gift Cards are easy to purchase at most of our branch locations. They come with a gift card carrier of your choice to highlight the special occasion. To learn more, visit your local PNC Bank branch or pnc.corn/giftcard. Visa® is a registered trademark of Visa USA, Inc. Free Checking Account PNC Bank Foir tpe pNioa 1?J13/~of2 ~ A1/1'f/2f9~3 OOt1.355 ~~ EST OF MARY L CASE DECD BONNIE L HOOVER EXTRX 42 VICTORIA wAY CAMP HILL PA 17011-1732 ~* ` PNCBATJK Primary aocountnumber: 51-1513-1396 Rage 1 of 3 Number of encbsures: 0 For 24hour banking, and transaction or interest rage information, sign on to PNC Bank Online Banking at pnc.com. 'j! For customer service tali 1-888-PNC-BANK Morxiay - Friday: 7 AM -10 PM ET Saturday & Sunday: 8 AM -.5 PM ET Para serviao en espafiol,1-866-HOLA-PNC Please corkacx us at 1-888-PNC-BANK ® Write to: Customer Service PO Box 609 Visit us at pncoom ® TDD terminat:1-800 531-1648 Fear hearing ioopaired clients only Free Chee~ng A~eeou~ ~~ary Estof Mary L case Decd Bonnie L t~loo~ver Fxtrx A~o-eort der: 51=1513-1396 O_ v~rd~aif~ Pir~ub~tio~ has not been established for #his xcount. Please oorrtact us if you would iiloe to set up this service. 4~rer~tlratt cowraye -Your account is currentiyOptod-tu. You or your joint owner may revoke your opt-in or opt-out choice at any time. To learn more about PNC Overdraft.Solutwns visit us online at p~.cotrt/bverdraftsoiutions. Call 177-586-3605x, visit any branch, or Sign on to PNC Online Banking ,and select the "Overdraft Solutions' (ink underthe Account Services section to manage both your Overdraft Coverage and Overdraft Protection settings. Beginning Deposits and Checks and other Ending balance other additions dedadiars balance 157,086.77 3,254.32 8,567 04 151,774.05 average monthly Charges balarxe and tees 152,456.13 .00 Transaction Siuelreary Checks paid/ withdrawals 5 Trial ATM transactions 0 Check Card P06 sigosd transactions 0 PNC Bank ATiN trarrsadions 0 Check CaN/Bankcard P05 PIN transactions 0 Other Bank ATirl transactions 0 Scf~f~0~e e E Deposits awd Ober /i~dalilions cafe Amount Description leg ; 2,845.84 Deposit Reference No. 520495541 Ol/11 303.09 -Deposit Reference No. 520748530 Ol/11 539 Direct Deposit. -Brokerage Pnci lbp Sett ~i~KX~0551 There were 3 Deposits and Other Additions totaling $~,Z54~,2. ~a~ fs ~~ ~~ /Z~ z W~ L N C .. ^^ co Vl ~ Z L m a r ~ ~ , \ O N r t 7 `~ W ~ M (/'~ "U ` ,~ V N .-= i ~~ C ~ 7 m oho C WO ~~ ° a w ~ ~ O o~ c -~Z ~ w~ ,M Z o y m Q v ~ ~ C7 r e w A C O .p v E ~ ~- N N L N ~ CJ N N ~--~ m U ~~ U c v c q ~u N r c~ rn O c rn of p 7 M M O 7 M th (]., o E ~ ~ ~° E ~ y ~ LL Q -- Q a 0 .~ o z i O ~ ~ 4+ ~ •3 '~' u w .~ 0 a ~ M ~ ?~ N ~ C to tm C [ N ~ 7 "• W ~ c) ° Q z a x ` `~ +,~ 0 +~ Q a m c ~ ~ c ^ _~ ~ A .. N A ~ z A o z Z H o o Q ~ ~ Q ~ ~ ~ o t J J d m m N w ~ o o p4 ~ _ ~ M O p Q U W 0 M n ~ ~ O m N o ~ Y ~ A. a Q~ Q F9' ~ a m ~ ~ ` (~~ ~ M 0 C!2 0 (n ~ y ~ u a -' ~ `/' C v ~ aWiU WU ~ _ o ~ J ~ 0 o A ~ J ~ - ~ p ~+ ~ « ~ ~ ,u ~ ~ o V ~ 'o N m ~ : a Q o~ A ,.. W 0 0 '7Qt- o -~ z = U A ~ - amp a ~ ~ o ~ .v U Nc.~ ~ O d ~ 0 ~ •~ Z A C ~ y M~ o ~ ~ A b ~ z ~-~i oQ g ~ A ~~.~ ~ ~ ~ ~g a ~~ :~ z ~ r ~ ~ .-~ w V ~ r~ • g ~ C • [~~ ~W/ ~ M M ~ M t~~ ..~ Z« lam- ~! O N ~ o o O Q~ b° ~ o [-~+ O .., ...,,. .......n on pnc.com. Account number: 51-1513-1396 - continuexf -Primary account number: 51-1513-.1396 Page 2 of 3 ~C~Y~Iy Deta~I )oPa-siEs and Other Additions -ate amours Description 1/28 11,500.00 Tel 04000041010062 Transfer From ~.1?~a?~i7498 2/04 54,152.39. Deposit.Reference No. 593094168 2/05 .99,275 68 Duect Deposit - Brole~age Pnci Ibp Sett. ~~~7s0551 -There were 3 Deposits and Outer Additions totaling $15T,908:08. :becks and Swbstib~te Checks :heck Date Reference Check Date Reference umber Amours paid number number amount paid number k u ~ c ' 1 200.00 12/03 0~1 V ~ ~ 14 91 19/12 0~7151oi /~ J n ~ S ~e r' 15.000 19/10 or~s7~5o2 , j~ ,~- c 14.03 12/12 08676163? ~ €-~ t / ~ j~ I5(L49- 64 ~ ~ 7 12/ 10 -- - - 12 11 - 5x+ s - _ ~~ ~ ~% _ 9.~6 _ -- 00 s X195 3 * ~ 12J 12. 12/11 _ _ o>367sic~,~s -_ _ os62i77i;i j j mod, c jn ~ 8 . / as s . ~~ ~~~ ~h ~ Sy ~ 70.00 19/19... orJss52~? Gap in check sequence There were 9 check listed totaling $82123. ~y sa~an~. late Balance 1/21 .00 Oate 12/03 Balance 11,300.00 Gate Balance Date 1,/05 157,708.00 19/11 Balance 157,194.87 1/98 11,500.00 12/04 65,432.39 12/10 157,407.01 12/19 157,086.77 -tock Up o® PNC Ba®k Visa®Gift Cards this Holiday 'he PI~C Bank Visa? Gift Card is perfect for everyone oa your gift list. PNC Bank Visa Gift Cards are easy to purchase at most of our branch xations. They come va-ith a ,gift card carrier of your choice to highlight the special occasioa. , To learn. caore, visit your local PAC Bank .ranch or pnc.com'giftcard. Jisa~ is a registered trademark of Visa USr~, lnc. ~cN~,o u~-~ !~ 3 `~ i ,., FORM166R-01 t 1 FUNERAL HOME & CREMATION SERVICES, INC. Bonnie Hoover - 42 Victoria Way Camp Hill, PA 17011 Funeral Expenses for Mary L. Case November 16, 2012 Professional Services Direct Cremation Cash Advance Items Deaxh Certificates 10 - $6.00-each, prepaid 20.00 Newspaper Notice -prepaid SO.flO Total. TOTAL DUE November 30, 2012 prepaid 40.00 110.99 150.99 _``',-`~ ~Vs~~ ~ Terms: Net due 30 days. A charge of 1.5% per month (18% per annum) for Unanticipated late payment will be charged on any amount unpaid after due date. We accept Mastercard and VISA ~~~~ ~ P.O. Box 137 •324 Hummel Avenq+e- • Lemoyne, PA 17043-0137 • (717) 763-7440 • Fax: 717-730-9798 Brian C. Musselman, Supervisor • www musselmanfunerai.com ~, t~aali ' ".,ter fk',Bel,ea:float, Sur.-iei ~. ~~' 23 . Fret'r" ~saY- t!y noel is to ensur every t i ~e yotr shop a your sat } s f•eC t i an is anything +~ore althdes,tQxf there ~~ur tXPerienCe ~ pan $i 11 M Please cal! t~prove . e-'-tin, Store Maneser wr j to . " tifant F 3301 and Story ~62f ~ ' Ce1+P Ni ! l nd~q Road • -- 17011 Sore Telephone:. PherAacy Telephone; 1717} 724_116b f717} 724-1170 THANK Ypu FLORAL 9$001551721 IA?( PAID ~~~. GO T e**eTOTA~ vF ca~DrT `~ *~~~ CARS 127.2 9F ?E 3F 9F~F9E~3E#xyf~if~t~fk ..,x.. ,c GIANT FOOD }`~ t .,~0 3301 TRINOLE RORO ~~v. . CAMP HILL. Pq 17p1;1 VISA PAYMENT P~y~nen f Card Xh'XX XX~;i~; AMt=unt S ~~~ ~ ,XKXX 36bG 1~7.~Q ~`z~!~l a _1 ~~?~~a_~ 1~7: ~~ ~€~~. ~4 ...- ~ • .... ~ '~ ~ ?E iE :r it° : ,~ ~ .,r is rt f, i if :t ~ iE ~S h 3 5~~~ ~~ ~,~~_ ~~- Visit us on the In+ernei wwW.GiantF~dStoreS.con, Fr+e~ ~~e~ Acca~ ~~a~~~~n~ , ~r tl~ period 1Z/i3/Z07Z to 07M1120i3 . EST OF MARY L CASE DECD For 24hour information, sign on to PNC BankOnline Banking primary acxountnumber: 51-1513-1396 on pnc.oom. Page 2 of 3 Account nuonber: 51-1513-1396 - contiinued L: aNfl ~~ ~~CkS Check Gate Reference Check Gate Reference Amousrt Paid number Amount paid number number number ),.,~t, u~ '`4 ty ~ 54U.12 12/21. 12J18 ossifiao~ 9999. * ¢d Y 151.8(} 41/03 oa~saso~ 19~]g 686251157 ~a k 1219 os64si~5 ~ la ~ ~ "-~ There were 5 checks fisted totaling * Gap in check sequence $g,567.A4. Daily Balance Det~l eaiance Balance Date Balance i?ate Date- ~ 01 03 151,65.57 , 12/13 157,086.77 Inf I9 15,,157.49 ~ Ol 11 151,7'7.05 1`218 I~9,410.66 19/91 151,617.37. ~ F~~~ ~ r.?~"i17tt'~i~' SOl~~ 3 i€D:~S~DE~~G?~t~13"'~~ ~E~]P YflTt`~R~Y OFF i~OtTR MOR'TGa~E, ~4UNER. r1 Ilome Equity Rapid Refinance Loan farom PNC can put you in control Pay off your first mortgage faster when you reduce the term at a currents lov~f rate that's fixed for the life of your loan. r'1ll with tower closing costs, fewer fees o reach Dupe o• lrsk than traditional mortgage Y et the more and control you need t y g loans. You can close in weeks instead of months, so you g Y To Learn more about Home Lending Options, speak with a PNC Loan Specialist in any I'AIC branch, call 1-877-Cr1LL-PNC (1-877 22~-762) or visit pnc.com/rapidrefinance Credit is sub' •t to a royal. PNC Bank, National Association. E ual Housin Lender ' e statemeutstoda throogb oetine baekiteg, and have access to your checking and- saving statements for up to 7 years.. Enroll m oeLn Y Enroll toda b visitin the Customer Service Tab in online banknn . Say so long to Ligh i®terest rate credit cards. - to balances to a new PNC Bank credit card with a low introductory .balance transfer rate and take ch targee f Y ~ eve Move your old high ra finances today. Whether you want faster rewards for your everyday purchases or simply an affordable card with flexibility y and eara rewards, PNC Bank has a credit card that s right for you. To apply or for more information, visit: pnc.com/creditcards. Credit is subject to approval. ,SCI~£D~~~ ~ ~~ L~~~.s ~~i:.r~ 1 ' .~ FAO~111 C•C.L711Y 11 S~~L~= ~~ Yoffie & Yoffie, P.C. ~~~~.,tl ~'~ /~~ F~ 2 Lemoyne Drive, Sine 100 ,~ Lemoyne, PA 17043 ~ y'3~ ss t ~ yl. ~'7 - Invoice submitted to: Estate of Mary L. Case December 11, 2012 in Reference To: Estate Of Mary L. Gase Invoke #10699 Professional Services 11/17/2012 Retum t~e_te~one cati~~~~ H~~~ fQ/1, ~o~ '` /YI Y iyto~TXt,L- 17iCEj~ ~~ E-malt to Holly Keller E-mail to Bonnie Hoover 11/21/2012 Unsuccessfully attempted to obtain an EIN Number 11/24/2012 Received a-mails from Holly Keifer and cepNed -E-mail to Mr. Ramzani 11 /27/2012 Drafted deed 11/28/2012 Received a-mail. from Bonnie Hoover a~ replied 11 /29/2012 Prepared for and attended real estate settlement For pro~ionai services rendered 11129/2012 Payment from Ubefiy Land Transfer, Inc. for deed preparation Total payments and adjustments Balance due Hrs/Rate Amount 0.63 126.56 200.OQmr f 0.12 24-~ 200.OOlhr 0.24 47-~ 2oo.oomr 0.12 24.83 ZOO.OOmr 0.19 38.00 2p0.00/hr 1.40 150.00 0.09 17.28 200.OO/tu 0.60 120.00 200.00Ihr 3.39 $548.55 ($150.00) ($'150.00) ----~. $398.55 Yoffie & ~toffe, P.C. 2 Lemoyne Drive, Suite 100 Lemoyne, PA 1-7043 Invoicesubmitted t°= Bonnie Hoover December 11, 2012 me Fps Owed By Bonnie Hoover In Her Capa~y As to Re#ecence To:-Total Alto Y Power of Attorney . Invoice #10698 Profiessior:al ~'~ .8122/2012 Te~ph~e call from Bonnie f-~ver _ ' to Ubetty t-a~'~d Transfer, Inc.: Tetept~one caii to Cindy 9/212012 Reviewed file E-mad Fenton 9/25/2012 Tetept~one call from Bonnie Hoover fi/2012 E mail to Cindy 1=errton -Reviewed documents 912 10/3/2012 Prepared documents for auction 10/412012 Lec,~ Research ` NO ~~ ~ ~{ .research Drafted .documents #or auction - Telepi'~one cal! to Bonnie Hoover 10/612012 Attended auction 10/8/2012 Teteph~e call-from. Bonnie Hoover E rrrail to Nfr. Ramzini a~ Cindy Fenton e..mait from Mr- ~rnzani ` p~ended conditions of 10110120'12 Received and reviewed E-mait to Bonnie Hoover safe - E-ma~ to Mr. Ramzant ` {717} 975-1838 ~~rci ~~~ Amount 0.24 48.72 200.OOfir 0.25 50.fi7 200.OO/hr 0.05 10.00 200.OOlhr 0.18 36.44 ZOO.OOihr Q22 43.28 2oo.oomr 0.31 N4 CHARGE 1.23 246.67 ZOO.OOfir ~.2~ 250.00 200.Ot)!hr 0~4 47.89 200.OOlhr 0.38 75.17 zoo.oolt-r 0.35 70.17 200.OOfir Bonnie Hoover 10/12/2012 Met with Mr_ Ramzani E mail to Bonnie Hoover 10/16/2x12 E-rnait to Mr. Ramzani 10f17l2012 Telephone call from Mr. Ramzani Return telephone salt to Bonnie Hoover 10/18/20'! 2 E-mail to Mr. Ramzani 11l1I2012 Received e-mail from Mr. Ramzani and replied 1112/2012 E-mail to Hotly Keller Telephone-call and e-mail #o Bonnie Hoover 11/9/2012 Telephone call from Mr. _Ramzani 11/14/20'!2 E mail to Holly Keller Received e-mail from-Hotly Keller and replied .For professional serveces rendered Additional Charges 9/17/2012 liberty Land Transfer, Inc. for current owner search .Tatar additional charges Total amount of this- bill. 8f29/2012 Payment -thank you 10/1712012 Payment -thank you- Page 2 HtsfRate Amount 0.08 16.61 200.OOfir 0.07 13.94 200.OOfir 0.04 7.78 200.00/hr 0.04 8.1 ~ 2QO.OOfir 0.04 7.56 200.OOfir 0.03 5.56 200.OOfhr 0.05 9.17 200.OOfir 0.21 42.50 200:OOfhr 0.08 16.22 200.OO/hr 0.02 4.22 200.00/hr 0.04 8.89 200.OOfir 0,04 7.78 200.OOfir 5.44 $1,027.35 60.00 $60.00 •~--- --- ~$sso.oo~ ($295.78) Total payments and adjustments Balance clue Page 3 Amount ~~~•~~ ~.-.,. $141.57 ~ on pnc.oom. v Accoamt number: 50-0492rfi498 -continued Primary account number. 50-0492-7498 Page 2 of 5 Transaction Sun~mar~i Checks paid! Check Card POS Check CaM/Bartkcard withdrawals signed transactions POS PIN transactions 1 O ~ Total ATM PNC Bank Other Bank transactions ATM transactions ATM transactions U 0 0 Interest Suzy Annual Percentage Number of days Average collected Yield Earned (APYE) in interest period balance for APYE 0.01'!. 30 9,419.76 ~~~~ ~~~~ Deposits and Othar pds Date Amount Description 11/02 885.00 Direct Deposit - Yxsoc Sec ~` E" US Treasury 303 ?~.lAhX1541D ~ f / 11/U5 9,300.00 Direct Deposit - Brokerage Pnci Ibp Sett ' ' ' ' ' 841 11/29 .07 Interest Payment r Checks and Substitute Checks Check Date Reference number Amount paid number 1036 60.00 11/16 osso~¢~~ " Online and ®ectronic Banlong Detections Date Amount Description 11/U6 14.96 Direct Payment - Payment PAWC 0642832 ~~ 11/16 19.74 Du-ect Payment - Elec Svc Ppl Eu ~' ' ' ' ' '4017W s ~,~ I1/16 10.98 Direct Payment - Elec Svc Ppl Eu ?ili`~t~i~i4002Ws 11/21 12 ~1 Direct Payment -UGI UGI Utilities ~~~li?~ ' ' ' ' ' 0-11 Interest Paid this period .07 ~~~ Dediu~ion~_ There was 1 Other Deduction totaling __.__ __ _ _-_____ ~ ~..-..~- - - -~--. ~ - --4s----_ _ - __ ~ Date Amourrt Description a ~'1"`~o+lf:-o~` 11/28 11,500.00 Te104000041010062 Transfer To ~~~t1396 Daily Balance Detail Date f3alance 10/31 1,668.40 11/02 2,553.40 Date Balance 11/05 11,853.40 1 i/06 11,838.44 ~c,~~ ,~~, ~,~ ~~~~ z Date Balance 11/16 11,747.72 11/21 11,735.51 ,~fCE,~evT As of 11/29, a total of $.Z4 in interest was paid this year. There were 3 Deposits and Other Additions totaling $1+>1.185A7. There is 1 check listed totaling ~6i9 ~9. There were 4 Online or Electronic Banking " Deductions totaling $57.89. Date Balance 11/28 235.51 11/29 235.58 ,., .;~ FORh71 S6R-01 i 1 link Summary ~ Service to: RY L CASE ! 80NNIE HOOVER i N 2ND 51` ~iMIEYSBUi~ PA 17043 to Ciassif~catian• sidentiat Heating-CC lire Period: /26/2012 to 10/25/2012 (29 days} Remote Davies Read sstionsY 11 800-276-2722 a~ write to UGt at SOX 13009 ading, PA 19612-3009 ~r current 1161 charges indude !te tames totaling about $ 0.3i. Currant BUI irrfermation - I~ Utility Custianer Charge _ 8.55 Distribution Charges (First 3 CCF at $0.34000} __ 1.02 PA State Tax Surcharge ,_..___...,....__.._....~.,._..__.._ -0.04 Total CurrentCharges - tlGl utility .........w..______ ' .. Uq Utility charges owed this bill $ ~.~ Past 8ii1 information - SHIPt_EY ENERGY The accatnt balance an yair last hilt was __......_.. $ 204 Thank you for your payment of ._____a.__________ -204 Your balance as of 10/31/2012 ._«...._....«__.«......._ . 0 Current Bill trMatlon - SHIPli:Y ENERGY Supplier Customer Charge . _.«._..__ 1.00 Commodity Charge (3 CCF at $0.56000} ~___YM~ ~,~6~8 S'tIIPLEY EI~RG Total Current Chars - SHIPLEY tl~RGY charges awed this biih~ _ $ 2.68° Total Mount Due by (11/21/20i2~._.:.._..~ ~._ ~_ __....__..__e_...._.. _ $12.21 Meter infnrmatiar -Next Read Date Novamber 28, 2012 0.40 9.36 8.32 Last This arage Year Year F/day 2.14 0.10 IY temperature 57°F 57°F °- ~~t stxricf Mier Number Previous Ruing Present Reading CCF Used 1123600 4080 (rrmmte} 4083 (remote) 3 General lniornsation ^ SHIPLEY ENERGY CON~APi1( 550 E. KM1G S3RC-ET P,0. BOX 946 YORK PA 17405 ar Phale 800-839-1849 ^ Commodity prices and drams are set hY the nahrral gas supplier you have chosen. The Public utility Commission regulates distribution prices and smvics3s. Important Mesaagea frar! UGt ^Yow current price to compare is $ 0.60244 /CCF. ^Your total annual usage is 1..089 CCF. Your average monthly usage is 90 CCF. ^ We can make your energy costs easier a! your budget with a!r 12 month Budget ~tling plan. Your monthly payment would be appraonrnab~y $ 40.00. Fee more information about this plan calf UGL Keep this part for your records. Important Intormatlon is on the back of this bill. tlGi Utilities, lnc. Customer Number Po ~ 15523 221601873011 Wilmington, DE 19886-5523 The amount due will be deducted from your 'checking account on November 21, 2012 221601873011112101000012210000150000000000000000000007 ~~~ ~ N r S yir~'~ ~ ONDJFMAMJJASO 2011 Montha 2012 ... ~-. ....« . .................., ...y...........................................y ~.... .... ........ ~ ..........~..... on pncoom. Prim2~ry acxount number: 51-1513-.1396 Account number: 51-1513-1396 -continued Page 2 of 3 ~ctivitg Detail )eposit~ and Olhor A~dd'itioas -ate Amount Description 1/28 11,500.00 Te104000041010069 Transfer From ~.1~~i.~7498 2/04 54,132.3. Deposit Reference No. 593094168 2/05 92,275.68 Duect Deposit - Brokerage Pnci Ibp Sett. ~1;~~0551 -There were 3 Deposits and Other Additions totaling 5157,908.®®. :hacks and Substitute I:hecks :heck Date Reference Gheck Gate Reference umber Amount< paid number number Amount paid number ~. u n c ~ 900.00 19j03 t~~~~ t1 ~ ~ 14 91 12/12 or~57~5101 /)') j ~ ~ She r 150.00 19 j10 Gtf367150~ ,~ ~- c 14d}3 19/12 OilEi761s37 ~ €-s t j -~i~ X50.99- ~ d 87:64 19/10 -_- .__ 12/11 - `'~_ 0,~~~ - - ~~ _v~c= 9.36 _ -_ 00 X195 3 * 19/12 19/11 _:- - :, _ -o857s1s3s - - - 085177$1 / j mo , c!r? -z ' . pF.. ~n/s ~ ~ -, 70.00 ~~h~s ~ 12 19 / 0$.5652457 Gap in check sequence There were 9 checks listed totaling $521.23. ~.,uy sa~~. ot~ gate Balance Date Balance Date Balance ate Balance 1/21 .00 19/03 11,300.00 19/05 157,708.00 12/11 157,194.37 1/28 11,500.00 12/04 65,432.39 12/10 157,407.01 19/19 157,086.77 -tock Up o® PNC Ba.k Visn®Gift Cards tkis Iiokday 'he Pi~C Bank Visa~l Gift Card is perfect for everyone oa your gift list. PNC Baak Visa -Gift Cards ar+e easy to purchase at most of our branch xations. They- come v~ith a .gift card carrier of your choice to highlight the special occasion. _,To learn more, visit your local PNC Bank .ranch or pnc.cotn,'giftcard. Iisa~ is a registered trademark of Visa USr~, lnc. SC/. cDvLL T ~ ~ic~~S `3, y~ s ~ h ~ 7 ,•, FORM166R-0111 -~CAI~ OF: BONNIE HOOVER 209 NORTH BEAVER STREET 42 VICTORIA WAY YORK, PA 17403 ~FM CAMP HILL, PA 17011 18 L '~ S A~ Store LIC# - 415001E # - 7 9028 854 7 e PH Stor Store DEA# - BB.4363672 Provider # - Birth Date - 01/04/1923 Pat. Sex - F Medical Record# - 3047 Social SecuritY# - 183-12-2831 DATE RX# DRIIG (ITEM} NAME QTY PRESCRIBER PRICE PR TYPE N/R NDC# MFG# D/S DEA# GEN IND . 10%29/12 07391123 TAB-A-VITE TABLE'T` 28 TAB ~ 5 1.56 GIC REFILL 00904-0530-80 MAJOR S 66164 28DAY DAW Ind - NO Policy# 309805976 ECS Auth # - 10/29/12 07391116 CHLD C:HEHT ASA $1MG 28 'rte BH 4.02 OTC~RIC REFILL 00904-4040-73 MAJOR 966164 28DAYS DAW Ind - NO Policy# 309805976 ECS Auth # - 7.0/29/12 07392115 ~~tANBERRY 45OMG TA 28 TAB HARTY, J. 4.75 OTC GENERIC REFILL 78765-1420-67 PDC 28DAYS BH5966164 DAW Ind - NO Policy# 309805976 ECS Auth # - 11/10/12 07396323 POLYETHYLENE GLYCO 527 GM HARTY, J. 2.00 COPAY GENERIC REFILL 51991-045?-57 BRECK 30DAYS BH5966164 ECS Auth # - 1231530523780849 DAW Ind 11/12/12 07421027 - NO Policy# 30980597.6 LIDODERM 5~ PATCHE 2 EA HARTY, J. 5.10 COPAY . ~W 63481-0687-06 ENDOP 1DAYS BH5966164 BRAND DAW Ind - NO Policy# 309805976 ECS Auth # - 1231723818060889 11/12/12 07403824 SAN'TYL OINTMENT 30 GM HARTY, J. 9.00 COPAY gEFTT.T. 00064-5010-30 HELTH 7DAYS $H5966164 BRAND DAW Ind - NO Policy# 309805976 ECS Auth # - 123176324533141.9 87.64 TOTAL sc,~~~« ~ ~~~ ~ ~'C:AR~ OF- . BONNIE HOOVER 209 NORTH BEAVER STREET 42 VICTORIA WAY YORK, PA 17403 CASEM . CAMP HILL, PA 17011 PI~[~~RMACIST - SERAPIGLIA, Store LIC# - 415003E Store PH # - ?17-854-9028 Store DEA# - BB4363672 - Provider # --- Birth Date - 01/04/1923 Pat. Sex -- F Social Security# - 183-12-2831 Medical Record# - 3047 ~****~***~**~******~***~***************~~** **t****-*~*********~** **~~************ DATE RX# DRUG (ITEM) NAME QTY PRESCRIBER PRICE PR TYPE N/R NDC# MFG# D/S DEA# GEN IND ***********~***~******~*****************~~* *********~********~** ~*************** 10/29/12 07417466 SENNA LAX TABLFtiT 56 TAB HARTY, J. 2.21 OTC NEW 00603-0282-32 QUALT 28DAXS BH5966164 GENERIC DAW Ind - NO Policy# ECS Auth # - 10/29/12 07403493 ZINC SULFATE 220 M 28 CAP HARTY, J. 9.11 Rx REFILL 00245-0080-11 17PSHE 28DAYS BH5966164 GENERIC DAW Ind - NO Policy# ECS Auth # - l0/29/12 07403492 VITAMIN C 250MG NA 56 TAB HARTY, J. 4.51 OTC REFILL ?4312-0015-30 NABOU 28DAYS BH5966164 GENERIC DAW Ind - NO Policy# ECS Auth # - . 10/29/12 07396322 LIDODSRM 5~ PATCHE 30 EA HARTY, J. 9.00 COPAY REFILL 63481-0687-06 ENDOP 15DAYS BH5966164 BRAND DAW Ind - NO Polic~# 309805976 ECS Auth # - 1231052519940559- 10/29/12 07392726 METOPROLOL TAR.TRAT 112 TAB HARTY, J. 2.00 COPAY . REFILL 5?664-0167-58 CARAC 28DAYS BH5966164 GENERIC DAW Ind - NO Policy# 309805976 ECS Auth # - 1231052560390719 10/29/12 07392725 SERTRALINE HCL 50 28 TAB- HARTY, J. 2.00 COPAY REFILL 59762-4900-05 GREEN 28DAYS BH5966164 GENERIC DAW Ind - Nfl Policy# 309805976 ECS Auth # - 1231052596800719 10/29/12 07392724 TRICOR 48 MG TABLE 28 TAB HAR.TY, J. 9.00 COPAY REFILL 00074-6122-90 ABBOT 28DAYS BH5966164 BRAND DAW Ind - NO Policy# 309805976 ECS Auth # - 1231052632320409 10/29/12 07392723 DILTIAZEM CD 120MG 28 CAP HARTY, J. 2.00 COPAY REF'TLL 00228-2588-09 PAR 28DAYS BH5966164 GENERIC DAW Ind - NO Policy# 309805976 ECS Auth # - 1231052666050559 10/29/12 07392722 LISINOPRIL 20 MG T 28 TAB HARTY, J_ 2.00 COPAY REFILL 00185-0102-10 SANDO 28DAYS BH5966164 GENERIC DAW Ind - NO Policy# 309805976 ECS Auth # - 1231052700770559 10 / 2 9 / 12 0 7 3 92 T 2 i `I'~~i~lytADOL HCL 5 0 MG 84 TAB HARTY, J . 2.0 0 COPAY REFILL 65162-0627-11 ~-MNEA 28DAYS BH5966164 GENERIC DAW Ind - NO Policy# 309805976 ECS Auth # - 1231052737650929 10/29/12 0?392720 LEVOTHYROXINE 75 M 28 TAB HARTY, J. 2.00 COPAY REFILL 00378-1805-10 N[YLAN 28DAYS BH5966164 GENERIC DAW Ind - Policy# 309805976 NO ~ ECS Auth # - 1231052781631419 10/29/12 07392719 _ PRAVASTATIN SODIUM 28 TAB HAR.TY, J. 2.00 COPAY REFILL 55111-0274-90 DR.RE 28DAYS BH5966164 GENERIC DAW Ind - NO Policy# 309805976 ECS Auth # - 1231052818730439 10/29/12 07392718 PANTOPRAZOLE SOD D 28 TAB HARTY, J. 6.00 COPAY REFILL 00378-6689-10 N[~tLAN 28DAYS BH5966164 GENERIC DAW Ind - NO Policy# 309805976 ECS Auth # - 10/29/12 07392717 Q,pPILK)GREL 75 MG 28 TAB HARTY, J. 2.00 COPAY REFILL 55111-0196-90 DR.RE 28DAYS BH5966164 BRAND DAW Ind - NO Policy# 309805976 ECS Auth # - 1231053031290439 10/29/12 07391130 OCL~VITE LUTEIN TAB 28 TAB HARTY, J. 5.38 OTC REFILL 24208-0387-62 BAUSC 28DAYS BH5966164 BRAND DAW Ind - NO Policy# 309805976 ECS Auth # - 6780 Lehigh Ave. Harrisburg, PA 17111 1-866-807-7161 (Toll Free) r ~ ~Yla~ ~us2 L J a~~5 ~__----- ~5~~.~= ~,NE y Die i Services Rendered _ _ _ I Fee o ~/o~ /~ 2 .~~~~-- ~.~ ~ l~ ~ p I j Z GI eu~+,n .,. YS ~K ~ s T i 70 ~ ~ l r~s sairie~ ll~rtgtnary ~' Service to 1 BONNIE HOOVER i N 2ND ST 1RMLEYSiOJRG PA 17043 ate C1as~flcatlon• sidentiat Heating-CC Ilirtg Period: /25/2012 to i 1129/2012 (35 days} Final Read iestiorts? II 800-276-2722 or write to UGi at -BOX#3009 ading. PA 19612-3009 ur current UGI d~arges indude ate taxes totaling about $ 0.33. n^1^ i i~ as.~.w~.~ usy~ p~yETi'@Iwtt 0~ ............. ~__. _=~ .~.._ .~_: u~ _ -~_ _ __. _ . .. Thank you for 221601873011 Your balance as of 12!0312012 ..._....__..........--_-- Currertt Biii IMonrtatiort - UGd UUIily 8.55 Customer Charge _...._ .... ....__ .._ ifistribution Charges (Fret 5 CCF at 50.34000) ~. p;04 PA State Tax Surd-arge UGi U _'____~.. Total Current Charges __________..._. S 10.21 UtN Utility charges owed this 11 _ _.,~.«~...-._ - - Past ~H Iniorrsati~ - SiRPLEY ENERGY The account balance on your last bill was ..~...-._ S X68 Thank you for your payment of __.__--.....-.._-.. 0 Your balance as x€12/03/2012 r___.._..„.._..__...... - Current Bill Irtierrea~ -SHIPLEY ENERGY 1.00 S~Piier Customer Charge .._......«._....-...-_.._--..-_-,. 3. 0 Ccxnnmodity Charge (5 CCF at 50.600El0 Total CurrentCharges - S't1tP~ ~i~blll __._ _ 3 4.~ SHIPLEY ENERGY charges ~.....-.-~-..---r-----_-°--_..-°--- Total Jimoset Due, Please PaY by Due Date (12124/20'12} ...._...._...._w.....a......._. ~ 14.21 Meter Reading lnior+n~atiort Average CCf ~ ~ Meter Nun~er Previous Reading Present Reading ~ '~ 10.40 9.36 1123600 4083 (tetnobs} 4088 (filial} 5 8.32 - __ Genera! irt~ ^ SHIPLEY ENERGY COMPANY 550 E. KING STREET P.O. BOX 946 YORK PA 17405 or Phone 800-839-1849 0.00 ^ Commodity prices and charges are set by the natural gas sup~ier you have dwsen. The Public Utility Commission regulates d"tstribution prices and services. Important Messages froea UGf ^Yotr current price to compare is $ 0.55048 JCCF. ^Your total annual usage is 1,089 CCF. Your average monthly usage is 90 CCF. ^Thank you for your business. You have maintained an s~ettent payment history with UGL Last This This bill may be used as a cxedit reference for obtaining future utility service. image Year Year ^ Help prevent pipeline damage. acddents and service disruptions. Cali 811 before you dig. CF/day 5.15 0.14 if yxu pay at a payment ag~t please take your entire bill. Make check payat>fe m UGI. oily temperature 46°F 42° Keep this part for your records. important inbrmation is on the back of this bill. ~is~~ ~ MDJ fMAMJ.f AEON 2011 Months 2012 ~ PO Box 371412 ` Pittsburgh, Pa. 15250-7412 For Service To: 645 N 2nd St -- It..~iil~il.i~~ii.li..llillt~l~.il~llllll.~..~..,.~l~r~u...~iili osssn ~ aro.37~ osnr~ssnrooosrr ~4s ~ nicES~e MARY L CASE C/O BONNIE L HOOVER 42 VICTORIA WAY CAMP HILL, PA 17011-1732 PENNSYLVANIA AMERICAN WATE PO BOX 371412 PITTSBURGH, PA. 15250-7412 I~~~I~~~...I•I....Ili..lll~~~~llf~~l~~l~~ll~~~l..l~~~~l~~lll~lll~ here to adid H2O_-Ne~1p13. -contrib~rtan Please cf~c =---- to-l~wr !-~t~tY bbl __ __ . _ , -_ or to c3iange your adun3ss a tetePhone rwrnber, and print information an reverse side_ Customer Account tnformatlon Bi/ling Summary For Service To: Mary L .Case Prior: Balanc 645 N 2nd St _ Prior Water Balance $14.96 Account Number: 24-0642832-2 Paytnettfs ptyor to Nov 14, 2D12 Thanks! -14.96 Premise Number: 24-0379967 Total prior balance, Nov 14, 2012 .00 ' -----Currenfi Water Charges------ BlNing Peried & A~eter Information service Charge 13.75 Billing Date: Nov 14, 2012 DS/ - PAWG Charge 2.05/ X28 Bi ling Period: Oct 11 to Nov 09 (29 days). Total water charges, Nov 14, 2012 14.03 Next reading on/about: Dec 1 i , 20i 2 _ Rate Type: Residential ------AMOUNT DUE -- $14.03 Meter readings in current billing period: Do rwt send payment Total Amount wi11 be deducted Meter Number N000506312 is a 5/8-inch meter. from your bantc account on Dec 04, 201 Present-.actual 1601000. Last-actual 1601000 Gallons used 0 ~cN~Ou~ ~ L~~c .~ -~. 4 .~ \:.,`' • •.-....~.~ •~v.•.vw . ~-r vv• vvv• ! VlAI fJ1iV! !laiA!lLZSt Nl7~i {iJ~ LU IL ------Current Water Charges-----_ Billing Period &: Meter infot'mation Service Charge Billing Date: Dec 03, 2012 DSt - PAWC Charge 2.051 Billing Peri©d: Nov U9 #a Nov 29 {20 days) Total water charges,' Dec 03, 212 Next reading on/about: Dee 11, 2012 Rate. Type: Residential -----~-AMOUNT DUE ----~----~ Meter readings in current billing period: Meter Number NOOO506312 is a 5/8-inch metes. Present-actual 1641000 Last-actual. 160 1004 Gailorts used 0 9.17 .19 9.36 ~ $9.3 ~_~ Messages to you from Pennsylvania American tiMater This is your Final Bill for. service, t has been a pleasure serving you and we hope we may again have the opppoortunity in the future. A roximate/y 4.57 percent or $.42, of Stage taxes are included in your current bill. * Effective October 1, 2012, the Disbrbution System improvement Charge (DS1C) increased from 0.8396 to 2.059'0 This charge funds the replacement of water distribution facilities. * Have you recently changed your primary phone number? tf you have, phase update your account information onlinE using My H2O Online at www.amwatercom/rnyh2o or call us at the number below so that we can update our records. 00~053/000D53NCE6GTTM~1 t23 Customer Service & Emergencies 1-800-565--7292 (24 Hours) For Hearing frnpaired Customers TDD 1-80t}-300-fi2U2 (24 Hours} Vis'rl us online at: www.permsytvaniaamwater.com W1WtOQNM8831AM8941 AiM 2129 _ _. t i ~~ c~~ i~~~ v c.~ L Z/N~ 7 \. Total Banlzing Statement For 24hour information, sign on to PNC Bank Online Banking on pncoom. Account nimaber: 50.0492-7498 - cones I~tterest San~ary Annual Percentage Number of days Avetaye oolletxed Yreld Fanned (APYE) in inbere4 period balance for APYE O.OOX 29 1,028.33 For dM peei~i 11/x/2012 ~0 12/28/'2012 tilfARY L CASE DECD Primary account number: 50-0492-7498 Page 2 of 3 As of 12/28. a total of $.24 in irrterest was Interest Maid paid this year. this period _ . 00 - - - -:: - . ~ ~~ Deposits aad Oll~r /~Idrtiolos Date Amourrt Description - 12/03 885.00 Direct Deposit - Xzs~oc Sec US Treasury 303 XXXXX1541D There was 10epos~ or Other Ardd~ion totaling ~tS6.+A®. Omer Deducliows pale _ Amount_ - 12/28 --_ -, _ _ - - - - -- .: -. .- - - - - -- Hd - -- - , ----- There was 1 Other Deduction totaling. $~:~N. _ - . _ - - ~Y Balaaoe Detai . _ Date Date Balance 11/30 235.58...... 12/03. Balance pate 1,12058 ~ 12/28 Balance 1,10058 __ SENIOR ~RE~M PLAIII - Serviee _.- barge E~eation Account type Acooueit number Balance-type AS of Balance These a°°°untswere reviewed to meet- Interest Checkin XX ' ' -7495 g ` Tbis C cie Av Balance- 12f29 Y g 1,029.02 the balance requirements of your Senior ; - _ _ Premium Plan ACUOUr~t. Since balance r~equiremerrts v~rere not met this month, a S20 00 flee was deducted from this .- _ . - aoaount. Stock Up oe PNC Bask Visa®Gitt Cards this Holiday The PNC Bank Visa~l Gift Card is perfect for everyone oa your gift list. PNC Bank Asa Gift Cards are easy to Purchase at most of our branch locations. They come with a gift card Gamier of your choice to highlight the special occasion. To learn more, visit your local PNC Bank branch or pnccomtgftcard. Visas is a registered trademark of V sa USrI, Iuc. Sc~ou ~ ~~~~ ~ Statement HOMELAND CENTER 1901 N FIFTH STREET HARRISBURG, PA 17102 Telephone: (717) 221-7900 ~~~ Statement Date: 12/01/2012 BONNIE HOOVER 42 VICTORIA WAY CAMP HILL, PA 17011 Re: MARY L CASE Account Nr: 3047 ------------------------------------------------- Date Description Days Rate Charges Payments Balance Quant ----------------------------------------------- BALANCE FORWARD 14,437.44 14,437.44 10/29/12 PHARMACY 1.00 965.87 965.87 15,403.31 10/31/12 AIR CHAIR RENTAL CR -1.00 279.00 -279.00 15,124.31 10/31/12 AIR CHAIR RENTAL 1.00 54.00 54.00 15,178.31 10/31/12 PHARMACY -1.00 2325.35 -2,325.35 12,852.96 10/31/12 PHARMACY -1.00 730.66 -730.66 12,122.30 10/31/12 MATTRESS CREDIT -1.00 232.50 -232.50 11,889.80 10/31/12 MATTRESS 1.00 45.00 45.00 11,934.80 11/01/12 PRIVATE ROOM 30 319.00 -9,570.00 2,364.80 11/02/I2 TRANSPORTATION 1.00 2.3.00 23.00 2,387.80 11/07/12 SET AND STYLE 1.00 15.00 15.00 2,402.80 11/14/12 OXYGEN 1.00 12.00 12.00 2,414.80 80 C2J 2 1 1/1 4 /12 SET p~?D S'"YLE 1.00 00 1 25.00. 37 107 15.00 107.37 ~ . , 2,537.17 11/15/12 11/15/12 MEDICAL SUPPLIES INCONTINENT PRODUCT . 1.00 . 71.61 71.61 2;60$.78 11/15/12 PERSONAL SUPPLIES 1.00 8.33 8.33 2,617.11 11 627 2 11/15/12 CABLE TV ~ 1.00 00 1 10.00 00 10 10.00 10.00 . , 2,637.11 11/15/12 11/16/12 TELEPHONE AIR CHAIR RENTAL . 1.00 . 144.00 144.00 2,781.11 11/16/12 MATTRESS 1.00 120.00 120.00 2,901.11 11/30/12 PRIVATE ROOM 14 319.00 4,466.00 ~~ 11/30/12 PRIVATE ROOM 1 309.00 309.00 7,676.11 - ..-. ~~.~f~uG~- `'G- C-/it/~ The Patriot-News Co. 202fl T _~ .~hnology Pkwy Suite 300 Mechanicsburg, PA 17050 Inquiries - 717-255-8213 HOOVER 42 VICTORfA WAY CAMP HILL PA 17011 c'~i~e~latriot News Now you know ei ~ r_Hd-RCrFS ARE NET TEMENT ___ STA ACCT # NAME AD ORDER # DATE EDITI N ADDTL INFO. TYPE OF CHARGE AMOUNT 239630 HOOVER 0002242445 12!28/12 METRO WEST BASIC AD CHARGE $23.29 239630 HOOVER 0002242445 01/01/13 METRO WEST BASIC AD CHARGE $23.29 239630 HOOVER 0002242445 01/08/13 METRO WEST BASIC AD CHARGE $23.29 AFFIDAVIT CHARGE $5.00 TOTAL: ~c~~£o~ ~ ~~~ r ~~~~~ / i"Gli~lS This is not an invoice. Please do not remit .payment from this Statement. An invoice will be generated at the end of the month. --Thank you. NOTE' This Statement replaces the Order Confirmation which we previously sent with Proofs of Publication -4~7 ~. u M-i=: Sam to 5pm ,,. Your Electric Usa a Profile Billing Summary {Bluing details on back) Service to: Balance as of Dec 7, 2012 ~•~ MARY CASE Charges: 645 N 2ND ST 2i=L ~ Total iDT Energy Charges $74.56 WORMLEYSBURG, PA 17043 ,~ Total APL Electric Utilifies Charges $40.15 Meter: 84576188 Total Charges $114.71 This section helps you understand your year-to-year electric use by month. Meter readings are actual unless otherwise noted. Za~~ 12012 v zo o ~ a 10 a 5 0 J F M A M J J A s O N D Mor~du .- -. •- ~~ .. Nov 29 Actual 6106 Oct 25 Actual 5235 35 Days kWh Billed 871 .. .. Dec 2011- Nov 2012 968 81 Dec 2010 -Nov 2011 1 0 Account Balance PPL Electric Utilities' price to compare for your rate is $0.07544 This changes the 1st of Mar, Jun, Sept, and Dec. Visit papowers~ or www.oca.state.pa.us for supplier offers. Your Message Center • Important biil_message: Your account has been suspended from our electronic bill payment plan. We will not deduct this bill from your bank account. Please pay the total amount due shown on this bill. • 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, pplekctric.com. Payment Methods Online at: PPlelectric.com ~ By phone:l-moo-342-5775 - E or call BiIlMatrix (service fee applies) at i-g00-672-2413 to pay using Visa, MasterCard, Discover or debit card. ® By Mail: Correspondence should be sent to: 2 North 9th Street Customer Services CPC-GENN1 827 Hausman Road Allentown, PA 18101-1175 Allentown, PA 18104x9392 ~.. Other importa nt information on the back of this bill -l s~•~o~~ . ~~~ ~ r //y; ~ r ` ~; `~ - `~ BiNing details on back) Your Electric Usage Prole Billing Summary Service to: BaMance as of Dec 7, 2012 ~-~ MARY CASE Charges: 645 N 2ND ST TOtai PPL Electric Utilities Charges $0.59 VVORMi.EYSBURG, PA 17043 Total IDT Energy Charges $0.00 Meter: 84576191 This section helps you understand your year-to-year electric use by month. Meter readings are actual unless otherwise noted. 2011 ~ 2012 5 a 0 ate. ~° 24 20 is iz 8 0 J F M A M J l A S O N D M ~ S - • Nov 2012 2 0 l~~ 4 1 r ~ 0 34F Nov 2011 30 249 8 41F ~. Nov 29 ! Actual `'.i 30806 Nov 27 Actual 30$06 2 Days. kWh Billed 0 Dec 2011-Nov 2012 i 1576 ~ - ~ 131 Dec 2010 -Nov 2011 3527 294 Total Charges Account Balance $9.43 PPL Electric Utilities' price to compare for your rate is $0. This changes the 1st of Mar, Jun, Sept, and Dec. Visit paps or www.ocastate.pa.usfnr supplier offers. Your Message Center ~' $9.43 perk • With paperiess biNing, you can- receive and pay your PPL Electric Ufilities 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 Ubrary ~ on our Web site, ppleiectric.com. • Before digging around your home or properly, you should always call the state's One Ca11 notification system to locate any underground utility lines. You can do this by simply dialing 811, which will connect you to the One Cali system. Be safe and call 811 before you dig. Payment. Methods Online at: `~ ~ By phone: 1-800-342-5775 ,.. pplelectric.com or call BiNMatrix (service fee applies} at i-800-fi72-2413 to pay using Asa, MasterCard, Discover or debit card. i By Mait: Correspondence should be sent to: 2 North 9th Street Customer Services CPC-GENN1 827 Hausman Road =.. Allentown, PA 18101-1175 Allentown, PA 18104^9392 -- Other 'smporta nt information on the back of this bill ~ -~ 4fi60 Trindle Road, Suite 201 p t. FHA z. FMHA ^ 3. coNV.uNINS. Camp Hiii, PA 17011 4. vA 5. CONY. tNS. 6. FILE NUMBER: T_ toAN N~ Pfzone: 717 975-9915 FAX: 717-763-7480 s~t5 >i MORT. INS. CASE NO.: NOTE: This form is famished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. ; ' . - {term marked "(P.a.a)"were pant outside the dosing: they are shown here for infomration Purposes end sre rwt krduded ~ the totals. ~. NAME.ANL1 AIIDRESS OF BORROYILER: ~ NAME AND ADDRESS QE SELLER: F. NAIVE AND ADDRESS OF LENDER lostafa Ramzani Estate of-Mary L. Case PROPERTY LOCATION: H. SE ft1EMENT AGENT: L~tty Larni Transfer 1. SETTLEMENT DATE: i . . Nov 29 ffit2 45 N. 2nd Stte~ Vortnleysburg, PA 17043 Thursday Normleysburg Borough PLACE OF SEI"TLEMENT: 2 per, Suite 100 ;umberland County, PA Lemoyne, PA 17043 J. St1MMARY OF BORROWER`S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION Q0. Gross Amount Dus Fsom Borrower 400. Gross Amount Du$ m Seller 000 60 . , Ot: Contract safes price 60.000.00 40t. Contract sates prise 02. Personal Property 4 02. Personal Property 03. Settlement Cfrarges pine 1400) 1.942.00 4 03. 04 ~. . 05 405. . .~.~,. Adjusblrents for iten'ts Paid ht advartce by seller(s)- Adjustrnerrts for items paid k- advance by seNer{s) to 406. CitylI own tax to O6. CitytTown tax 07. County/City tax 11/29/2012 to 12J312012 60.49 407. CounfyfCity tax t t2920t2 to t2J31/20t2 60. 08. Assessments to 11/29/2012 to 6/30/2013 686.24 408. Assessments to 409. School Tax 11292012 to 6130I20t3 668.24 08. School Tax 1129/2012 to 12/3112012 49.04 SewedTrash 11/292012 to 121318012 10 49.04 410. SeMrerlfrash 1 . to 11 491. to . ~ 12. 4t2 to 20. ~Groes Artwunt Due from Borrower 62,739.77 420. Gross Amount Due to Setter 80,797.77 Amourds Paid BY Or In Behalf Of Borrower 00 500. Reductions fn Amount Due 7o Seller . Ot . Deposit or earnest money 8.000.00 501. Excess deposit (see instructlcns) 8,000. 4 465 2 02 Principal Amount of now loan(s) 502. Settlement dtarges to sager pine 1400) . , 03. F.xis}ing. loan(s) taken subject to 503. Fadsting loan(s) taken subject to 504. Rayoffof FirstMottgage Loan 04. 505. Payoff of SerxMd Mortgage Loan 05. ~ 506. Inheritance Tax Escrow 4,200. . O7 507. . 08. ~. os. At~ustrneMs for items unpaid by seller ~~ Adjustrnet-ts for llama urgsaid tyy setbr lfown tax to Cit 10 510_ Cityr/Town tax to y . CourrtylCity tax to . 1 i 511. CountytCity tax to . 12. Assessments to 512. Assessments to 13. Sdrool Tax to 513. School Tax to 14. to 514, to 15. to 515. to 16. to 516. to 17 517. . 18 518. 19. 519. 20. TaRal Paid- ByltTor Borrower 8.000.00 520. Total Reduction Nnount Duo Seller 14, CASH AT SETTLEMENT Fromffo BORROYYER 00 tiE10. CASH AT SETTLEMENT To1From SELLER . due from borrower p~ 120) 62,739.77 Gross Amt 01 601. Gross Amount due Setter pine 420) 60,797.77 . . Less Amt. paid bylfor borrowver (Ikre 220? 8,000.00 OZ 602. Less reduction in Arnt.due Seller (6ne-520) 14,665. . 03. Cash ~ FROM ^ TO Borrower 54,739.77 603. Cash ®TO ^ FROM Seller 46,132.3 r Buyer or s S' . ~~ tLc.1r; ~ l~fu.Y G CaS~ t Setters Signature Htfp-1 ~~~~~~ ~~~ ~ .~~ f - ~ ~ Ht~ Y~a,a~y~~~.f~R/i~j~~y ~ ~7{G~W~j~wy i..... ...,,{ yy~ a/y~ t 1~01G •~~.~~'~ ~ !7W ~ ~ ~ Y~c fiW~ M •••7 ~ ~ YQ~i ~ W-a ~YYa 01Y ~N'~u ~ ~ ~'^. ~ tide ~ R y .by ~e h tlfis ~ i t~athet Y that 1 #~ars ~iaoeiued a copy a~ its HUat Sel~~'~- ~a ~-~ ~~ The tN1D-1 sed>e~nc,~ t PdNS propeted ~at~ andamaaNe aoooentafAis ~ tyre causca~v~,~e.tAe ~>Qb.u~ased in aoo~anos.rtr,ws o~ . ~~ gillle b laowtgly 11~e ~ 1D sUe llnied Stales aA this a any simibr bnn. t~nalde's upon oon~On can inducts a br snd leipdso~ennnt. Fa dafaYs sea TMIe 1~ t).S. bode Secpon 11101 and Section 1010. r?~G9•T~YI~aa~~~~~Rls~w~ww Jd~M9~w~~NWR1~~Mpi~~~~~'7WtR' ~~~ FROM: DEPARTl+1ENT OF THE TREASURY ELECTRONIC FUNDS TRANSFER FINANCIAL MANAGEMENT SERVICE FEDERAL RECURRING PAYMENTS PHILADELPHIA FINANCIAL CENTER POST OFFICE BOX 603 BENSALEM, PA 19020-9921 NOTICE Of RECLAMATION 8ss-868-o1s1 I ~ DATE: 01/14!13 TICKET #: 26022046 ~~i9ooi~otr~ RECIPIENTANDIOR BENEFICIARY NAME - - - -CLAIM NUMBER- DATE OF DEATH MARY L CASE _ Ending in 541D 11-16-12 AGENCY. DATE OF AND IOR TRACE TYPE OF DEPOSrrOR AMOUNT PAYMENT TYPE OF NUMBER ACCOUNT ACCOUNT NUMBER PAYMENT 12-03-12. RSI 03103603 2759779 C Ending in 7498 885.00 ~'~~ OUTSTANDING TOTAL 885.00 NOTICE TO ACCOUNT OWNERS FROM THE GOVERNMENT The Government has received information. that the person named on this notice is deceased. The purpose of this noticE is to inform you that by law entitlement to Government benefits for this person. ended at death. Therefore, the Government must recover all payments made after the date of death. Lf there has been an error and this person is not deceased, or if -the date of death is wrong, this notice- explains how to correct the mistake. If you do not understand this notice, please get help from either your financial institution or the Government agency that was making payments. PAYMENTS TO THIS PERSON HAVE BEEN STOPPED Your financial institution has been asked to .return the payments shown on this .notice. to the .Government because they were issued in error. The Government has asked your financial institution to send this. notice to you, the account owner. Your. financial. institution must notify you if it has. taken action to ,recover .these funds from the account. Contact .your financial institution immediately if you do not understand i#s actions. If the Government is unable to collect from -the financial institution the -full amount of the payments made after death, you may be contacted by the agency which made the: payments. IF THE P~.RSON IS NOT DECEASEQ - If the person is ,not deceased,. immediately .contact both.. your financial institution and -the. agency ,that made t payments to correct the error. The Government regrets any inconvenience this error may. cause. Your .fin u- tion can correct the collection .action if it is given satisfactory proof that the person is alive. NOTE: OU MUST~~~,~ i CONTACT THE AGENCY THAT MADE THE PAYMENTS BECAUSE THIS ERROR HAS STOPPED ~T~l~~'~a PAYMENTS.- ONLY THE AGENCY .CAN RESTART THE PAYMENTS.- - C ~ ~~ s~4 L