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HomeMy WebLinkAbout03-01-13 REV-1500 EX(w-t=)(FA 1505610105 Yi OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN I ' Ha BOX nj,PA 1 RESIDENT DECEDENT it �,g Harrisburg PA tyi28-o60i ENTER DECEDENT INFORMATION BELOW 09/12/2012 ( 02/15/1922 Decedent's Last Name Suffix Decedent's First Name MI Free Geraldine R _1111 (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI — Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE –� REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW CID 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) p 4.Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name _ Daytime Telephone Number VIRGINIA E MAIDL (717)939563 ----r REGI R OF WILLS ONLY QJ 'U � First Line of Address M S n CA _ �_ 11-_11 �7 A f^ ""{� 1385 Overlook Rd. rn I--� p Cl) Second Line of Address _ R GS C7 n _� -n C> � TE FILED'- �' City or Post Office State ZIP Code _ ......... 1111. I Middletown PA 17057 — - COO .......... . I , I I .__ ...._ Correspondent's e-mail address:GINN715 COmOast.net Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the personal representative Is based on all Information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE 2--2-5-13 ADDRESS 1385 OVERLOOK RD. MIDDLETOWN, PA 17057 R.-25-13 SIG F PREPAREgOTHE AN RIPRESENTATIVE AT GPA s 7 / 3 ADDR 7 AIN ST. SHIREMANSTOWN, PA 17011 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 J F ����� N��? ��� i 1505610205 REV-1500 EX(FI) RECAPITULATION .................................................................. ......................... 1. Real Estate(Schedule A). . ........................................... 1. 2. Stocks and Bonds(Schedule B) . ...................................... 2. 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. 4. Mortgages and Notes Receivable(Schedule D)........................... 4. 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 1 218.30 6. Jointly Owned Property(Schedule F) C= Separate Billing Requested ...... . 6.1 3,312.84 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) C=D Separate Billing Requested..... ... 7. 125,070.54 8. Total Gross Assets(total Lines 1 through 7)............................. 8. 128,601.68 9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 12,852.24 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. 11. Total Deductions(total Lines 9 and 10)................................. 11. 12,852.24 12. Not Value of Estate(Line 8 minus Line 11)...................... ........ 12. 115,749.44 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) ........................ 13. 14. Not Value Subject to Tax(Line 12 minus Line 13) ..................... ... 14. 115,749.44 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.0- 15.. 16. Amount of Line 14 taxable at lineal rate X.0 45 5,208.72 16.;' 5,208.72 17, Amount of Line 14 taxable at sibling rate X.12 1 17• 18. Amount of Line 14 taxable at collateral rate X.15 18. 19, TAX DUE ........................................ ................. 19. 5,208.72 .................... 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610205 1505610205 REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENTS NAME Geraldine R. Free STREET ADDRESS 20 HUMMEL AVENUE CITY STATE ZIP CAMP HILL PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 5,208.72 2. Credits/Payments A.Prior Payments 2,257.14 B.Discount 118.80 Total Credits(A+B) (2) 2,375.94 3. Interest (3) 4. If Line 2 is greater than Line 1+Line 3,enter the difference. This is the OVERPAYMENT. Fill In oval on Page 2,Line 20 to request a refund. (4) 5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 2.832.78 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.......................................................................................... ❑ M b. retain the right to designate who shall use the property transferred or its income............................................ ❑ 0 c. retain a reversionary interest.............................................................................................................................. ❑ ■ d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ 0 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?.............. E ❑ 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation? ........................................................................................................................ ❑ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE 0 AND FILE IT AS PART OF THE RETURN. For dales of death on or after July 1,1994,and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S. §9116(a)(1.3)].A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-%so8 Ex+{08-u} 10 pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS&MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: GERALDINE R. FREE Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with tight of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH f­ rirn 1, Prorated Real Estate Tax refunded 218.30 �:x��kYWwb nlEdtlreMi&�m5,veeuf atxb� :.. Au^-� ..._. ,.• iYN ,. ....-�, lwe � •. ,.v^.�< -e ,.�.. � .. W ,. nrv1n.. ��e '� +(E��'�a��yY!�ti'^�k6S!NSkK�2*Nk:%4W'�tc'�ArAB✓Y9iylµ�Y�gU�*I at4 t i 1'.m ... :.s :e .. ..iM r wr,J..,.. .mro.. it.... �:� ✓- ... 'u .. �.v E'.n< ,......4Y.i. . ..eau nN4..yA I���i1�WJ' �R'[MAr�dftH tvYSLNSrc§Qd4' .... :P 1 ��. .r . . .. z I } E4 F a ,kw, .. +s OM - ,..,.. .... i � r 45 ... ,Wow MsWI d.u.. ..,3e1.0 oxo .... .�„ �..... .... .... .=n. m..�.,,.. -.�.�., ,,.:.. ..,..�,.a_ a..�------ WRM af'3, ° "131; It +g z TOTAL(Also enter on Line 5 Recapitulation) $ 218.30- f.kiM!...swYM5:a au#3i5V4..s:, sw If more space is needed,use additional sheets of paper of the same size. REV-1509 EX+(oi-10) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE IOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER' GERALDINE R. FREE If an assot 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•VIRGINIA E.MAIDL 1385 OVERLOOK RD DAUGHTER MIDDLETOWN, PA 17057 E e'BEVERLY F.GALE 413 ARBOR COURT DAUGHTER !CELEBRATION, FL 34747 C. _... _._:... _�..:, .............. f JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % DATE OF DEATH ITEM FOR JOIWr MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMI M DATE OF DEATH DECEDENT'S VALUE OF NUMBER TENANT 7 NT IDENTIFYING NUMBER DEED FOR JOINTLY HELD REAL ESRATE VALUE OF ASSET INTEREST DECEDENT'S INTSEST I. A. 03117107 ` M&T BANK-CHECKING NO.9843039042 9.948 48 x E a 33� 1 .84 - yr�zrr%w,. ,.n;sewce;xmvaazaa�+g x ed. ,x5112, lARB&IP zasnr.6 4 w-6+vxiEV"}� 2 � . nca ..n id6CYa� j ••••• �Wn'" Y,.^w I'MA`IN4t�3CiY t 4RR - .... ..........�.m ..t 6v LAS ...-..-<..... '.if. ..... .... .... „..�... .... .._ .......... ......_.. .>.> ..... .. ,... �. .. r..".:n#ls.l .,mef✓L' t r .. ...MVL,x.xe::,i ..,„ niz a z.r ,>..,...w 8w.>,9 ,a i.41✓Lre ..._.. ..._ Gh¢,..,atW8R89iMCALEr S . ., ,..... ._..._.. w,.. -...,., .............. ,. ........ 2'£IM...., r ...w,. YZ.Rh38WYFe95Sx"M1R'Jx"9+"'.tPoC n` 33 E IE Y u� R gg x E; €� _'-.,�'• � -'}1^ .._..v..L..e.. d fYv - .-rvxm C®.'!.t.x.4SVN1 xpin` - x .I �(•l+i Mrftlw#e'h L1LYr8ll..I.'.� . __. . A... ....... ..... •y r � E TOTAL Also enter on Line 6,Recapitulation) 3,312.84 Y aar 6xihP` � 3�H&£x EftY?YM"!Ml;t It more spate is needed,use additional sheets of paper Of the same size. REV-1510 EX+(08-09) pennsylvania SCHEDULE G DEPARTMENT Of REVENUE INTER-VIVOS.TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER GERALDINE R. FREE This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 Is yes, TEEM DESCRIPTION OF PROPERTY txwbE n�NAME OF THE VA %REE,THEM PBA71MO TO DECEW AND DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE NUMBER _THE wTEOFinaaFTR.ATTACH ArnwOF THE DEED FOR REAL WTATE. VALUE OF ASSET INTEREST APPUCABLE VALUE 1. 20 HUMMEL AVENUE,CAMP HILL,PA 17011,JANUARY 2,2012 VIRGINIA E.MAIDL,DAUGHTER AND BEVERLY F GALE,DAUGHTER 'S 100 1 �'�� 2.. WELLS FARGO A[C#1172-7055 BANK DEPOSIT SWEEP 63,570.53; ; 50 31,785.27 '.VIRGINIA E.MAIDL,DAUGHTER 3 WELLS FARGO A/C#1172-7055 BANK DEPOSIT SWEEP 66,570.541 50< 33.28527 BEVERLY F.GALE DAUGHTER t i F �b •-,. •.•ry vsromm .,...,yi 1 1 3 jg •,`• c o a x uv}v�!ex't ...... ... ..� gwro ®e�.nuwmo.vk _- -----------t` �nxv="„n, 1.4':S,4L.t4Kxi."Ir�A4`fthips`ikSJFlYd6d�d2kiC45".:�5'- TOTAL(Also enter on Line 7,Recapitulation) 125,070 54 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER GERALDINE R. FREE Decedent's debts must be reported on Schedule L ITEM AMOUNT NUMBER DESCRIPTION A. FUNERAL EXPENSES 1. Musselman Funeral Home x 8,232.12 Pastor James Moss 250 00 3. Virginia Maidl-Flowers for funeral 53.00 ,.� $x0.i 9 1 <6 J `S"b4d9N56Y 3S6£6t' r i . ..i � � N- ICS h!vvY°1e✓d�'C F Stl a ... ... .__. ... .... .... _. ... ... _..._- ..... _..I � ,�u� •ra e=e, .«>e.ewe. B, ADMINISTRATIVE COSTS: ..&&"&.-.Y�natzRitllkiY4N:4:Mne S C".'. 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 5me ..:aentlac�e vaasaas�:w ec ox u�_ i 2. Attorney Fees: .....�caa. y�?u.r,�aaznwt<ar zw, atlrntlee u:suaa:,ror:i*:a�€ 3. Family Exemption:(If decedent's address is not the same as claimant's,attach explanation.) tl�, Claimant Street Address City State ZIP Relationship of Claimant to Decedent r 4. Probate Fees: we"t.SC'.�4Sii'iii .i"'fidPRIGIW�t S. Accountant Fees: 450.00 6. Tax Return Preparer Fees: . ,..,.,..,., ......_..�_ ••< i C'hT6tffi&i55rt NxAJ£ x P„m�m4APJ&kr�a.W�j 7• Hospice r 2,220.00 ^.._ ........_. .� .- i b1SRi&uKit' MH+1�1'iP Uk MTIMMYa"cF413`i1�4` _. •.• .,.. ........ ..... ....� ...... ..i �£ek Ai a�xeS£n6�NpHM;hmnJrb2iAVdSSaI,iA 8. Record of Deeds 62.00, 9 Prorated school taxes at settlement 70 65 10 Attorneys fees for settlement 450.00 11 Final sewer/trash and certification fees 38.42 _... ....... .. .... ... ,.... ..... __._. ........... .. _...._ .... x Qa w.2x...x.:<n.Sh xxSa6£iWiti....v �,.. �__. .... _......._ �...... ...... ................ ...... ........ x.sa.:'"..'WI A&hK&(uC fi?61..6 z 1z See Attached Schedule 1,026.05 F TOTAL(Also enter on Line 9,Recapitulation) # 12,852 24 If more space Is needed,use additional sheets of paper of the same size. Estate of Geraldine Free Schedule H Administrative Expenses Continued 12 Check#1988, Reimbursement of medical supplies $75.00 Check#1873 Essex-final nursing home payment 931.92 Check#1875 Verizon-final phone bill 19.13 Total $ 1,026.05 WILL AND TESTAMENT or GERALDINE R. FREE 1, GERALDINE. R. FREE, of Camp Hill, Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do make and publish this my last will and testament, hereby revoking and making void all former wills by me at any time heretofore made. And first, I direct that my funeral be conducted in manner corresponding with my estate and situation in life and that. all my just debts and funeral expenses be fully paid and satisfied as soon as conveniently may be after my decease. As to such estate as it hath pleased God to intrust me with, I dispose of the same as follows: I direct that all my succession, inheritance, and estate taxes that may be imposed shall be paid by my Executors as costs of administration. I give, devise and bequeath all of my property, real, personal and mixed, of whatsoever kind and whatsoever situated, to my beloved husband , Charles H. Free. If my beloved husband, Charles H. Free, shall predecease me or fail to survive me by thirty (30) days, then I give, devise and bequeath all my property, real, personal and mixed, of whatsoever kind or whatsoever situated, to my daughters, Virginia E. Hughes (Free) and Beverly J. Gale (Free) in equal shares to share and share alike. And I hereby nominate, constitute and appoint my husband, Charles, H. Free, as Executor of this my last will and testament. If he fails to survive me, then appoint Virginia E. Hughes as Executrix of this my last will and testament. In Witness Whereof, I GERALDINE R. FREE, the Testatrix, have to this, my will, written on o sheets of paper, set my hand and seal, thisp')6/Lay of A.D. One Thousand Nine Hundred and Ninety-Five (1995). Signed, sealed, published and declared by the above named Geraldine R. Free as and for her last will and testament, in the presence of us, who have hereunto subscribed our names at her request as witnesses thereto, in the presence of the said Testatrix and each other. (WITNESS (WITNESS) STATE OF PENNSYLVANIA ss COUNTY OF CUMBERLAND On this, N1 day of ,199s,--before me a Notary Public, personally apprea2 he above testatrix and witnesses known to me (or satisfactorily proven) to be the persons whose names are subscribed to within instrument, and knowledged that they executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and my seal. my Commission Expires: NOTARIAL SEAL. SUSAN E.PEFFLEY.Notary Pubilc Lower Paxton Twp,Dauphin County M Commission Ex 'es Sept.27.1997 &f->eAt-b I J C 2. FR t�E MMSTBank -ACCOUNT No ;,,:,; ;,ACCOUNT.,TYPE ,.... ..t.,:..SPATSMENT 9843039042 POWER CHECKING AUG.18-SEP.19,2012 I OF 1 00 0 06123M NM 017 i i 22693 T — GERALDINE R FREE VIRGINIA E MAIDL BEVERLY F GALE ESSEX HOUSE RM339 20 NORTH 12 ST LEMOYNE PA 17403 INTEREST EARNED FOR STATEMENT PERIOD 0.13 WEST SHORE PLAZA - INTEREST PAID YEAR TO DATE 0.96 - - ACCOUNT SUMMARY BWINNINO NO. R1601i1NT AMOUNT NO. AMOUNT 31 026.23 2 21 380.00 2 1 8, 2 .95 0.33 29,820-41 ACCOUNT ACTIVITY POSTING ...-.. .. .,.,.D ITS. T :CEIECR'S°4. ..: DRIET AbbzTlONA 08-18-12 BEGINNING BALANCE $11,026.23 08-21-12 PAWC PAYMENT 8.31 11,017,92 08-31-12 US TREASURY 303 XXSOC SEC 1,380.00 22,397.92 - 09-10-12 HOLIDAY RETIPM43 CHECKPAYMT 000000000001987 2,407.50 9,990.42 - 09-11-12 VERIZON ARC CHECK PYMT 000000000001989 42.14 09-14-12 DEPOSIT Tx p P", S Rvt#+b•S 20,000.00 29,948.28 - 09-17-12 CHECK NUMBER 3988 75.00 09-17-22 CHECK NUMBER 1990 53.00 29,020.28 09-19-12 INTEREST PAYMENT- 0.13 29,820.42 ENDING BALANCE - $29,820.41 _C •PAID.. 1988 09-17-12 75.00 1990• 09-17-12 53.00 ANNUAL PERCENTAGE YIELD EARNED - 0.00 t DID YOU KNOW THAT YOU CAN MANAGE VIRTUALLY ALL YOUR ACCOUNTS IN ONE PLACE AND DISCOVER WAYS TO SAVE MONEY BY USING FINANCEWORKS AVAILABLE IN M&T WEB BANKING? GET STARTED TODAY FOR ONLY $0.99 PER MONTH. LOG ON TO MCI WEB BANKING AND SELECT "FINANCEWORSS" UNDER THE ACCOUNTS "TAB". LEARN MORE AT MTB.CCMIFINANCEWORKS. FINANCEWORKS IS A REGISTERED TRADEMARK OF INTUIT,INC. MEMBER FDIC. - i i I Rktb t'i a NINE Sc��ou�r G /7km / 021 U97 SEARCHEDMI SATISFIED Parcel Number: 13-22-0536-037 THIS DEED THIS DEED made this lf') day of January, 2012 BETWEEN Geraldine R Free, widow, Grantor AND Beverly F Gale, an adult individual and Virginia E Maidl, an adult individual, as joint tenants with the right of survivorship and not as tenants in common, Grantees WITNESSETH, that in consideration of the sum of One ($1.00) Dollar, in hand paid, the receipt whereof is hereby acknowledged, the said Grantor does hereby grant and convey to the said Grantees, their heirs and assigns, ALL THAT CERTAIN piece or parcel of land situate in Lower Allen Township, Cumberland County, and State of Pennsylvania, bounded and described as follows, to wit: BEGINNING at a point on the northern line of Hummel Avenue, as laid down by the W. R. Gorgas Estate, which point Is three hundred fifteen (315) feet west of the western line or Milltown Road, at the division line between Lot No.18 and the property herein described; thence northwardly at right angles with Hummel Avenue one hundred nineteen (119) feet, more or less, to the southern line of a Public Road; thence westwardly along the southern line of said Public Road thirty-five (35) feet, more or less, to a point on the division line of Lot No. 22; thence southwardly along said division line and through the center, of a partition wall of this and adjoining property and beyond, one hundred nineteen (119) feet, more or less, to the northern line of Hummel Avenue and thence eastwardly along the northern line of said Hummel Avenue thirty-five (35)feet to a point; the place of BEGINNING. HAVING thereon erected a brick dwelling house, known and numbered as 20 l l in said Plan of Lots. l t It is expressly understood and agreed that no building or obstruction, other than an open porch shall be erected beyond the present building line of Hummel Avenue. The Plan of Lots as laid out constitute the Plan as follows: The street line being twelve (12) feet beyond the building line, then a grass plot three (3) feet S Ck+" u LLS in width, then a pavement five (5)feet wide, then a grass plot two (2) feet wide and then the curb, which makes the street forty (40) feet wide between curbs. Grantees to pay pro rata the cost of maintaining the cess pool at the end of the row, and make their own sewer connection to the main line running on the south side of Hummel Avenue, without any sewer tapping charge, if ever needed. it is hereby expressly understood and agree by and between the parties hereto, their heirs and assigns, that the land above described by reference to a certain plan is so described for convenience only; that the parties hereto are not to be bound by said plan except in so far as it refers to and determines the tract of land hereinbefore intended to be conveyed, and that the parties of the first part are not to be bound by reason of the reference to said plan herein to lay out any other parts of their lands according to said plan, or to open, use or dedicate any of the streets or alleys represented in said plan and the parties of the first part are not to be held or bound as having convenanted that the streets and alleys represented in said plan have been laid out or will at any time be laid out, as streets or alleys, but it is expressly understood and agreed between the parties hereunto that the said parties of the first part may at any time change the plan aforesaid or entirely revoke or repudiate it or substitute another plan. It is however expressly understood that the lot of ground hereby conveyed is bound on the north by the old State road, on the East by property No. 18, on the south by the new State Highway, as laid down in said plan and on the west by property No. 22. BEING THE SAME PREMISES which Albert W Case, Guardian of the Estate of Amanda F. Eby, incompetent person, granted and conveyed by deed dated July 24, 1956, unto Charles H Free, Jr, and Geraldine R Free, his wife, and recorded j on July 24, 1956, in the Office of the Recorder of Deeds Office in and for Cumberland County, Pennsylvania, in Deed Book H 17, Page 297. By operation of law, upon the death of Charles H Free, Jr, on October 9, 1996, title to the herein premises vested solely in Grantor, Geraldine R Free, the surviving spouse and Grantor herein. TOGETHER with all and singular the ways, waters, water-courses, rights, liberties, privileges, hereditaments and appurtenances whatsoever thereunto belonging, or in anywise appertaining, and the reversion and remainders, rents, issues and profits thereof; and all the estate, right, title, interest, use, trust, property, possession, claim and demand whatsoever in law, equity, or otherwise howsoever, of, in, to or out of the same. TO HAVE AND TO HOLD the said hereditaments and premises hereby granted, released, or mentioned, and intended so to be with the appurtenances, unto the said parties of the second part, their heirs and assigns, to and for the only proper use and behoof of said parties of the second part, their heirs or assigns forever. PZ- And the said party of the first part does covenant, promise and agree to and with the said Grantees, their heirs and Assigns, by these Presents, that Grantor has not done, committed or knowingly or willingly suffered to be done, committed any act, matter or thing whatsoever, whereby the premises hereby granted, or any part thereof, is, are, shall or may be impeached, charged or encumbered, in title, charge, estate or otherwise howsoever; and, the said Grantor shall and will Specially Warrant. THIS CONVEYANCE IS EXEMPT FROM THE PENNSYLVANIA REALTY TRANSFER TAX IN THAT IT IS A CONVEYANCE FROM MOTHER TO DAUGHTERS. IN WITNESS WHEREOF, said Grantor has hereunto set her hand and seal, the day and year first above-written. Sealed in the presence of: Witness Geraldine R Free Certificate of Residence I hereby certify that the precise residence of the Grantee herein is: e(100 ddl F-+ t-7 b,5'7 Agent for Gra e Sci-fi co. k G ITe 1 Commonwealth of Pennsylvania : . ss. County of Cumberland: On this r'A day of January, 2012, before me, a notary public, the undersigned officer, personally appeared Geraldine R Free, known to me (or satisfactorily proven) to be the person whose name she subscribed to the within instrument, and acknowledged that she executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and seal. Nota � I My Commission Expires: xs0"9' ° r 0 WA 00 R-. Frzez '5L H-Itp v e_cs ROBERT P. ZIEGLER RECORDER OF DEEDS CUMBERLAND COUNTY 1 COURTHOUSE SQUARE - CARLISLE, PA 17013 717-240-6370 i Instrument Number-201200712 Recorded On 1/9/2012 At 9:13:23 AM *Total Pages-5 •Instrument Type-DEED Invoice Number-99812 User ID-KW •Grantor-FREE,GERALDINE •Grantee-GALE,BEVERLY F •Customer-MILLER LIPSITT *FEES STATE WRIT TAX $0.50 Certification Page STATE JCS/ACCESS TO $23.50 JUSTICE DO NOT DETACH RECORDING FEES - $11.50 RECORDER OF DEEDS This page is now part PARCEL CERTIFICATION $10.00 FEES of this legal document. AFFORDABLE HOUSING $11.50 COUNTY ARCHIVES FEE $2.00 ROD ARCHIVES FEE $3.00 WEST SHORE SCHOOL $0.00 DISTRICT LOWER ALLEN TOWNSHIP $0.00 TOTAL PAID $62.00 I Certify this to be recorded in Cumberland County PA i RECORDER O D DS *-Information denoted by an asterisk may change during the verification process and may not be reflected on this page. 0 119 P_ t-2 OUS NO,250 l7Lra� / 5Lto u��, A U.S.DEPARTMENT OF HOUSING&URBAN DEVELOPMENT 1• FHA 2. FmHA 3. CONY.IJ 7. LOAN ER 5. CONY tNS. $. FILE NUMBER: 7. LOAN NUMBER: SETTLEMENT STATEMENT 8. MORTGAGE INS CASE NUMBER: C. NOTE: This/oral is fumlahad to give you a statement of actual Settlerrrortt costs. Amounts paid m and hY the seNtwwt ara shown. itamsmarked 7POCj'ware paid outside the dosing;they are shown here foriritormafibnalpurposes and arse trot In t rwwa. 1.0 318$ ffi_}A819.AWCAW 16tiR1 D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: D&F Realty Holdings,LP Beverly F.Gale and Centric Bank Virginia E.Maldl 4320 Llrglestown Road Harrisburg,PA 17112 G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 25-1824811 L SETTLEMENT DATE: 20 Hummel Avenue Stephen C.Nudel,PC Camp Hill,PA 17011 July25,2012 Cumberland County,Pennsylvania PLACE OF SETTLEMENT 219 Pine street Harrisburg,PA 17101{717)236.5OD0 rc !nO- GROSS AMOUNT ME FW= MW 101. Contract Sales Prioe 60 000.DD 401. Contract Saks P400 60 000.00 102. Personal pmpwv 7U.-Persoa Pmperty 103. Settlement Charm to Borrower We 1400 4,469.07 403. 104. 404, 105. 405. 106. CWTOM Taxes 07125112 to, 01101/13 218M 406.CWO%r Tani SOOMAMMETIM101 113 107. CountyTiaxes to 407.Cone Tawas to 1D8. School to 400,School 109. 409. 110, 410. 111. 411, 112. 412. 120. GROSSAMOUNTDUE FROM BORROWER 64.687.27 420. GROSS' NT DUE TO 60218.20 200. AMOUNTS PAID BY OR IN 201. Deposit or earnest money 10 000.00 501. Excess D Insaucnloes 202. Prindpal Amount of New Loans 48 ti00.00 5M. Saltlgmant Charges to Seller jUne 1 488.42 203. Existin loa s taken sub eot to 503. Extaft taken vubW to € 204. 504.Payoff offirstMorlilage i 205. 505.Payoff of second MoMme 206. 506. 207. 507.(Deposit disb.as proceeds 208. 506. 209. 5 i Adf-U&M-ents For s 08. 210. Cityfrown Taxes to 510,qtqTNM Taxes to 211. Countv Taxes to 511.County Taxes to 212. School 07/01/12 to 07/25112 70.65 512.Scholl 07101/12 to 07125112 70.65 213. 513. 214. 514, 215. 515. 216. 516, 217. 1 517. If 218. 1 5181 219. i 519. 220. TOTAL PALDBY/FORBORROWER 1 58,070.65 520. TOTAL REDUCTANAMOUNTDUESELLER 559.07 301. Gross Amount Due From Borrower Line 120 64 687.27 601. Gross Amount Due To SeBer Ling 4201 60 18.20 302, Less Amount paid B or Borrower ne 220 { 58,070.$5 602. Less Reduc>ions Due SeOgr Line 520 559.0 303. CASH X FROM TO BORROWER 6,616.62 [603, CASH X TO FROM SELLER 59 659.13 twa�16-ae} A,eaa2 L.SULLCMT CHARGES :700.TOTAL COMMISSION 80"on Price % PAW FROM PAW FROM DMslonofCommission 700 as Follows mowers sus 701.$ t0 FUNDS AT FUNDS AT 702.$ to sera WENT seTne A&U, 703.Commission Paid at Settlement 704. 801. on .5000 /o to enM Bank WOM 802.Loan Discount % to an Documentation Fee to Centric Bank 500.00 804.Wire Fee to Centric Bw* 805.Flood Certification Fee to Centric Bank 19 SOB.Morigme,Ins.App.Fee to 807.Assumption Fee to 806. 809. 810. 811. 1900.ITEMS REGMED BY LENDER TO REPAID JN MYAWF 9,01.Interest From 07/25/12 to 08/01/12 @ $ /day 7 days % 9102.Morkme Insurance Prem)umfor months to 9.03.Hazard Insurance Premium for 1.0 yam to 904. 1000.RESERVES DEPOSUM WM LENDER 905. 1001.Hazard Insurance months 0 $ per month 1002.Morkme Insurenoa months Q $ per month 1003.q /Town Taxes months 0 $ per month 1004.County Taxes months $ per month 1005.School per month 1008, months month 1007. months @ $ per month 100 .Aggregate ent morms month 1101.Satllement or Closing Fee to Stephen C.Nudes PC 150.00 1102.Abstract or Titre Search to 1103.Me Examination to 1104.Title Insurance Binder to 1105.Document eMparation to 1106.Notary Fees to 1107.Atiorneys Few to James A.Miller,Esquire 460.00 Includes above item numbers: 1108,Title Insurance to Acent for BMW Magmal Title Ins,Co. nclude above item numbersEND.100 300 900 710 1109.Lander's Cmoerage $ 48,000.00 1110.0wne's Cov $ 60,000.00 680.00 1111.Insured Closing Letter to Fidelity National Tice Insurance Company 75.00 1112. 1113. RNMENTRECOREHIMIAND Au aim= 1201.Reeerdi Fees: Deed $ 62.00;Mo $ 113.00; Releases $ 175.00 1202.q Coun Ta tam s:Deed 600.00•Mortgage 600,00 1203.State Tax/S s: Revenue Stains 600.00; 600.00 1204. 1 5. tCourianlmre to Cash 50,00 1301.Survey to 1302.Pest Inspection to 1303.2012-13 School Tax to Bonnie War Treasurer 20 Hummel 1074.54 1304.Sewerrrrash 7/1-OMIZ to Lower Allen Township Authority Tats$108.95 80.53 28.42 1305.Tau CeMcation to Cash 10.00 1400.TOTAL SETTLEMENT CHARGES on Lines 103 Section J and SM Sections 4t400,07 488.42 By signing page 1 of this statement,the signatories acknowledge receipt of a completed copy of pap 2 of this two page statement, t OwMed th be a true copy. Stephen C.Nudes,PC SettlementA®ent I (012-18411012-1041/22) ACKNOWLEDGMENT OF RECEIPT OF SETTLEMENT STATEMENT Borrower: D&F Realty Holdings,LP Seiler: Beverly F. Gale and Virginia E.Maidl Lender: Centric Bank Settlement Agent Stephen C.Nudes,PC {717}236-5000 Place of Settlement: 219 Pine Street Harrisburg, PA 17101 (717)236-5000 Settlement Date: July 25,2012 Property Location: 20 Hummel Avenue Camp Hill, PA 17011 Cumberland County,Pennsylvania I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and bel€ef,it Is a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further certify that I have received a copy of the HUDA Settlement Statement. D&F Realty Holdings,LP hPlell r,, by D&F GP,LLC Beverly F.G'ale' f BYc=cf L .� Vlrginia� Maidl i To the best of my knowledge,the HUD-1 Settlement Statement which I haw r a an rate account of the funds which were received and have been or will be disbursed by the as of etaement of this transaction. C S nt WARNING: It is a crime to knowingly make false statements to the United tes on this or any similar form. Penalties upon conviction can include a fine and Imprisonment. For details see: Title 18 U.S.Code Section 1001 and Section 1010. s E i , tpJGi(3.86)R68PA.F�43053 Lrt?QR�D�.J�% �. Ftze"C I Taon a MMOBank xac�oNT No. :;. ': �CE1FfHT �eE,.: , .. 150 M&T MARKET ADVANTAGE OCT.13-JAN.13r2012 1 OF 1 00 0 06123M NM 017 VIRGINIA E MAIDL BEVERLY F GALE 1385 OVERLOOK RD MIDDLETOWN PA 17057 INTEREST EARNED FOR STATEMENT PERIOD 173.47 WEST SHORE PLAZA INTEREST PAID YEAR TO DATE 84.00 ACCOUNT SUMMARY srmsx6 . .; ......REPO, .:.. ITS 6 .. .. . .. 'NO. AMOUNT . :.. No..:.,. AMOUNT 173.38 116 407.87 0.00 1 6 234. 9 0.00 ACCOUNT ACTIVITY POSTING-. 777777777T_-,,;,:: : . , ITBr<EWTBT; yr H2 T SD.00 10-13-11 BKGINNING BALANCE 48,663.96 10-14-11 DEPOSIT PZROGrNl1+ �cco�s c? �' �?4. 48,663.96 28.33 48,692.29 11-10-11 INTEREST PAYMENT 116,262.82 11-29-11 DEPOSIT 10,N T A^Q K O r �s. )"IL et 61.05 116,323.87 12-13-11 INTEREST PAYMENT 116,407.87 01-13-12 INTEREST PAYMENT 89.00 i $116 407.87 ENDING BALANCE f f ANNUAL PERCENTAGE YIELD EARNED 0.85 t 4 •* GROW YOUR SAVINGS THE EASY WAY EASY SAVE IS A CONVENIENT SERVICE THAT ALLOWS YOU TO SET UP AUTOMATIC TRANSFERS FROM YOUR M&T CHECKING ACCOUNT TO YOUR M&T SAVINGS ACCOUNT. y •� YOU CHOOSE THE AMOUNT AND FREQUENCY l ++ YOU CAN CHANGE OR STOP IT AT ANY TIME TO GET STARTED, LOG ON TO HIT WEB BANKING AND CLICK THE TRANSFERS TAB OR STOP BY { YOUR LOCAL M&T BRANCH. LEARN MORE AT MTB.COM/EASYSAVE. MEMBER FDIC. FOR CUSTOMER SERVICE QUESTIONS, PLEASE CALL (800) 724-2440 �4 ,o o o, oo) 'TUA fi Fim% To (s. Fa d CH�.c,c�.�p ti�� 9g43o3goVi NeT Y/twe (D y� Cz�.i2hLa r,•rtr R_ �sz� :PERI+OD; PAGE 150042 MIT MARKET ADVANTAGE APR.14-JUL.13,2012 1 OF 1 00 0 06123H NM 017 _ VIRGINIA E MAIDL BEVERLY F GALE 1395 OVERLOOK RD MIDDLETOWN PA 17057 INTEREST EARNED FOR STATEMENT PERIOD 42.67 NEST SHORE PLAZA . INTEREST PAID YEAR TO DATE 170.21 - ACCOUNT SUMMARY NO. AMOUNT I NO. AMOUNT . . 116 451.41 1 0 O.uo 1 21 41000 001 42.67 112 494.08 ACCOUNT ACTIVITY POSTING DEPOSrI r INTEREST W 4, .:. . .... .. .. .c,. - , 04-14-12 BEGINNING BALANCE 8116,451.41 04-26-12 In Branch Transfer/Withdrawal 2,000.00 114,451.41 05-11-12 INTEREST PAYMENT 13.27 114,464.68 06-13-12 INTEREST PAYMENT 15.53 114,480.21 06-15-12 TELLER MISCELLANEOUS UEBIT 2,000.00 112,480.21 07-13-12 INTEREST PAYMENT 13.87 112,494.08 ENDING BALANCE 8112 494.08 ANNUAL PERCENTAGE YIELD EARNED 0.15 t i KEEPING TABS ON YOUR CREDIT SCORE CAN ALERT YOU TO POSSIBLE IDENTITY THEFT OR BEHAVIORS AFFECTING YOUR CREDIT. FOR ONLY 82.99 PER MONTH, VIEW YOUR CREDIT SCORE PAGE ANYTIME YOU LOG ON TO MIT WEB BANKING. GET STARTED NOW - LOG ON TO MIT WEB BANKING AND CLICK ON "CREDIT SCORE" UNDER THE "ACCOUNTS- TAB. ! CREDIT SCORE AND KEY FACTORS ARE PROVIDED BY EOUIFAX. MEMBER FDIC. LrLRR�-D�n1 E R. FRS -m Al MbWBank t1NT No CCTY `..15004 POWER MONEY MARKET OCT.13-JAN.13,2012 EmEl 00 0 06123M NM 017 BEVERLY F GALE VIRGINIA E MAIDL 413 ARBOR CT CELEBRATION FL 34747-4682 INTEREST EARNED FOR STATEMENT PERIOD 269.50 WEST SHORE PLAZA INTEREST PAID YEAR TO DATE 129.75 ACCOUNT SUMMARY . .::BEG.: KING :rDE ITS;X::;: :•. ..' WT T 5 & OTB6R. N6 S ., p0. "AMOUNT W0• AMOUNT 269.29 116 718.83 Sir 0.00 2 120 5 0. 3 121.00 ACCOUNT ACTIVITY STING . ....•. . .. .. .. ,..:. . . ..:. TS•' , T' TO f $0.00 10-13-11 BEGINNING BALANCE 50,000.00 10-14-11 DEPOSIT ?a*T0,+Rt_ 146tx oc it., twA'k-e 50,O40.O0 44.19 50,044.19 11-10-11 INTEREST PAYMENT & F2�� 120,614.73 11-29-11 DEPOSIT J adr Acc T• m 1,500.00 119,114.73 12-05-11 CHECK NUMBER 0551 119,210.08 12-13-11 INTEREST PAYMENT 95.35 2,907.50 116,802.58 01-04-12 CHECK NUMBER 0552 213.50 116,589.08 01-05-12 CHECK NUMBER 553 116,718.83 01-13-12 INTEREST PAYMENT. 129.75 $116 718.83 ENDING BALANCE i j i ANNUAL PERCENTAGE YIELD EARNED 1.29 % I i ** GROW YOUR SAVINGS THE EASY WAY •* EASY SAVE IS A CONVENIENT SERVICE THAT ALLOWS YOU TO SET UP AUTOMATIC TRANSFERS FROM YOUR M&T CHECKING ACCOUNT TO YOUR MIT SAVINGS ACCOUNT. ! ** YOU CHOOSE THE AMOUNT AND FREQUENCY j *• YOU CAN CHANGE OR STOP IT AT ANY TIME TO GET STARTED, LOG ON TO MIT WEB BANKING AND CLICK THE TRANSFERS TAB OR STOP BY YOUR LOCAL M&T BRANCH. LEARN MORE AT MTB.COM/EASYSAVE. MEMBER FDIC. FOR CUSTOMER SERVICE QUESTIONS, PLEASE CALL (800) 724-2440 (4 ,000, OD) TA�s f,tas `ro cr, Fu•r e+te cltl.4(, A-)c_ • 484 3oa9o4i 1I � C- c_1zA(-D(A6 R - Pam NWBonk _. i� 590,p92 POWER MONEY MARKET AYR.19-JBL.I3,2012 1 OF 1 00 0 06123M NM 017 BEVERLY F GALE VIRGINIA E MAIDL 413 ARBOR CT CELEBRATION FL 34747-4682 INTEREST EARNED FOR STATEMENT PERIOD 77.08 WEST SHORE PLAZA INTEREST PAID YEAR TO DATE 293.79 ACCOUNT-SgMMARY - ,;NNING N0. AMOUNT NO. AISUUliT 116 183.91 y-OF 0.00 1 3 4 17. 0 77.OT 112 043.08 j f ACCOUNT ACTIVITY POSTING .,::•. INTEREST i.:i °;.-:'.' x { 04-14-12 BEGINNING BALANCE $116,183.91 { 05-01-12 In Branch Transfer/Withdrawal 2,000.00 114,183.91 05-04-12 CHECK NUMBER 0555 217.90 113,966.01 05-11-12 INTEREST PAYMENT 26.55 113,992.56 06-13-12 INTEREST PAYMENT 27.49 114,020.05 06-15-12 TELLER MISCELLANEOUS DEBIT 2,000.00 112,020.05 07-13-12 INTEREST PAYMENT 23.03 112,043.08 ENDING BALANCE S112,043.08 ANNUAL PERCENTAGE YIELD EARNED = 0.27 6 KEEPING TABS ON YOUR CREDIT SCORE CAN ALERT YOU TO POSSIBLE IDENTITY THEFT OR BEHAVIORS AFFECTING YOUR CREDIT. FOR ONLY $2.99 PER MONTH, VIEW YOUR CREDIT SCORE PAGE ANYTIME YOU LOG ON TO M&T WEB BANKING. GET STARTED NOW - LOG ON TO M&T WEB BANKING AND CLICK ON "CREDIT SCORE" UNDER THE "ACCOUNTS" TAB. CREDIT SCORE AND KEY FACTORS ARE PROVIDED BY EOUIFAX. MEMBER FDIC. V1, t9 � At �N t. k. M t 2 5c.He-DVz�l- ATCtrUWT.NO�,. '""ACCOUNT,TYPE ..;.� . .... , .STATEMENT:PER:TOD'` . •. ,; ,..; PAGE..;; :.:. POWER CHECKING APA.20-MAY.18e2422 1 DF 1 00 0 06123M NM 017 62691 GERALDINE R FREE VIRGINIA E MAIDL BEVERLY F GALE ESSEX HOUSE RM339 20 NORTH 12 ST LEMOYNE PA 17403 INTEREST EARNED FOR STATEMENT PERIOD 0.02 WEST SHORE PLAZA INTEREST PAID YEAR TO DATE 0.69 ACCOUNT SO MARY - ,,,;BEG;NNSNG ,. ., ,.,• . .DPa,,PO$STS.& ... �.., .:. . ....:. -.:..: :• :: ... .. 'N0. AMOUNT NO. AMOUNT NO. AMOUNT 1,370.63 3 5 380.00 1 4 1 57.54 5 2 1.04 0.02 2 832.07 ACCOUNT ACTIVITY POSTING .DEPO4ITS..INTFRES?i' .?... G2GS i•,OTBFtit r..? • Y 04-20-12 BEGINNING BALANCE $1,370.63 04-26-12 In Branch Transfer/Deposit 2,004.00 3,370.63 04-30-12 CHECK NUMBER 1964 668.40 04-30-12 CHECK NUMBER 1963 100.00 04-30-12 FZA CardServices CHECK PINT 000000000001965 55.78 2,546.45 05-01-12 In Branch Transfer/Deposit 2,000.00 05-01-12 CHECK NUMBER 1961 100.00 05-01-12 VERIZON ARC CHECK PYNT 000000000401966 44.21 4,402.24 05-02-12 CHECK NUMBER 1968 499.14 - 05-02-12 PANC PAYMENT 28.79 3,874.31 05-03-12 US TREASURY 303 XXSOC SEC 1,380.00 05-03-12 HOLIDAY RETIREME CHECKPAYNT 000000000001969 2,407.50 2,846.81 05-08-12 PPL EU ELEC SVC 14.76 2,832.05 05-18-12 INTEREST PAYMENT 0.02 2,832.07 ENDING BALANCE $2,832.07 1961 05-01-12 100.00 1963* 04-30-12 100.00 1964 04-30-12 668.40 1968" 05-02-12 499.14 ANNUAL PERCENTAGE YIELD EARNED 0.00 5 EFFECTIVE JULY 30, 2012, THE FEE FOR EACH DAY THAT THERE IS A TRANSFER FROM YOUR SAVINGS, MONEY MARKET, OR CHECKING ACCOUNT TO COVER ONE OR MORE OVERDRAFTS IN YOUR CHECKING ACCOUNT WILL BE $12.50. THIS FEE WILL BE CHARGED TO THE ACCOUNT FROM WHICH THE FUNDS WERE TRANSFERRED. THIS FEE DOES NOT APPLY TO A POWER CHECKING OR MYCROICE PREMIUM CHECKING ACCOUNT. MMOBank ACCOUN2.N0 9843039042 POWER CHECKING MAY.19-JUN.19,2012 k OF 2 00 0 06123M NM 017 23250 GERALDINE R FREE VIRGINIA E MAIQL BEVERLY F GALE ESSEX HOUSE RM339 20 NORTH 12 ST LEMOYNE PA 17403 INTEREST EARNED FOR STATEMENT PERIOD 0.02 WEST SHORE PLAZA - INTEREST PAID YEAR TO DATE 0.72 - ACCOUNT SUMMARY eEGINNING�.:.,.,.;, .:..;;,:.;i}$P08XT`5,.6.:::-:...:.. ... ...: ..::.:,..,:...:,::. .: .... : ;� ,.:..r:r•,.:..• :: •.,CORRBfi'T .. � - NO. AMOUNT i NO. i AMOUNT NO. AMOUNT .. 2,832.07 1 2 5,380.00 f 51 240.08 1 6 2,940.63 1 0.03 %,011-19 ACCOUNT ACTIVITY POSTING IT8,.2 A-OTHER ,.A .,..� 05-19-12 BEGINNING BALANCE $2,832.07 05-24-12 FIA CardServices CHECK PYMT 000000000001974 81.57 2,750.50 05-25-12 VERIZON ARC CHECK PYMT 000000000001971 31.02 2,719.48 05-29-12 STATE FARM RD 27 PYMT 000000000001970 377.81 05-29-12 CHECK NUMBER 1972 5.28 2,336.39 06-01-12 DS TREASURY 303 XXSOC SEC 1,380.00 - 06-01-12 PAWC PAYMENT 28.79 3,687.60 06-05-12 CHECK NUMBER 1812 100.00 06-05-12 HOLIDAY RETIREMB CHECKPAYMT 000000000001967 2,407.50 1,180.10 06-06-12 PPL EU ELEC SVC 13.94 1,166.16 06-14-12 CHECK NUMBER 1814 9.80 1,156.36 06-15-12 TELLER MISCELLANEOUS CREDIT 4,000.00 .5,156.36 06-18-12 CHECK NUMBER 1973 80.00 06-18-12 CHECK NUMBER 1975 45.00 5,031.36- - 06-19-12 INTEREST PAYMENT 0.03 5,031.39 _ ENDING BALANCE - $5,031.39 1812 06-05-12 100.00 1814* 06-14-12 9.60 1972+ 05-29-12 5.28 1973 06-18-12 80.00 1975" 06-18-12 45.00 ANNUAL PERCENTAGE YIELD EARNED 0.00 1 R. +-fit to ti 5Gt4mvt.ir 14 MUSS"ELMAN FUNERAL HOME & CREMEAUON SERVICES, INC. Virginia Maidl 1385 Overlook Road Middletown,PA 17057 September 18,2012 Funeral Expenses for Geraldine R. Free September 15,2012 Professional Services Professional Services,Facilities and Autos 5495.00 Classic Metal Casket 2150.00 Dress 150.00 Total 7795.00 Cash Advance Items Flowers 437.14 Newspaper Death Notice Patriot NO CHARGE Total 437.14 Total Due $$232.14 V00 ` 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. P.O.Box 137 • 324 Hummel Avenue+ Lemoyne,PA 17043-0137 • (717)763-7440 • Pax: 717-730-9798 Brian C. Musselman, Supervisor• www.musselmanfuneral.com U-e Qf4L D t.►(r � • H R� SeNaut N /TLmS 2 1Z M OB A :, STATEIENT PERIOD : gAt,�E . ::.:: 'AC 9843039042 POWER CHECKING 5EP.2D-aCT.19,2012 I {}F 1 _ 00 0 06223H NM 017 53938 GERALDINE R FREE VIRGINIA E MAIDL BEVERLY F GALE 1385 OVERLOOK RD MIDDLETOWN PA 17057 INTEREST EARNED FOR STATEMENT PERIOD 0.19 WEST SHORE PLAZA - INTEREST PAID YEAR TO DATE 1.15 ACCOUNT SUMMARY Tf BEGINNING. .:.. . .,_,,DEPOEZTSt.8 ... .,, :•. .:..:....,•':..>..:.:..;,_`•: .:. ;!aTSiER .'. EHD _ NO. I AMOUNT NO. AMOUNT NO, AMOUNT " 29 820.41 0 0.00 3 10 702.14 2 951.05 1 0.19, 1$ ib7.41 ACCOUNT A TIVITY POSTING PEPOSITSITNTERMST cam i DAILY: r 09-20-12 BEGINNING BALANCE 09-21-12 CHECK NUMBER 1871 PASTOR. Ja.n-% MUSS - ri.+naZ,4.L if Z 250.00 29,570.41- 10-02-12 CHECK NUMBER 1872 /MUSSLI- mA+J 8,232.14 10-02-12 HOLIDAY RETIREME CHECKPAYMT 000000000001873 C15 4ax-•OC1.,,4} pMr t$ 931.92 20,406.35 10-16-12 CHECK NUMBER 1874 Ye9-i?L 0 4 -r-1^4L, 81 t-(- 2,220.00 10-16-12 VERIZON ARC CHECK PYMT 000000000001875 tf IZ 19.13 18,167.22 10-19-12 INTEREST PAYMENT 0.19 18,167.41 ENDING BALANCE $18,167.41 1871 09-21-12 250.00 1872 10-02-12 8,232.14 1874+ 10-16-12 2,220.00 ANNUAL PERCENTAGE YIELD EARNED - 0.00 CUSTOMIZE YOUR NEW MbT BANK ALERTS M&T 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 KNOW WHEN A LARGE DEPOSIT OR WITHDRAWAL HAS BEEN MADE TO YOUR ACCOUNT. GET NOTIFIED BY TEXT, EMAIL, OR M&T APP. LEARN MORE AT MTB.COM/ALERTS. MEMBER FDIC, i l SCke"o�� t-/ Hospice of Central Pennsylvania Invoice 1320 Linglestown Road Harrisburg, PA 17110 Invoice Number: 4549 Invoice Date: Voice: via � Fax: 717-234-0384F � 9/30/12 Page: 1 Resident: Geraldine Free C/o Virginia Maidl 1385 Overlook Rd Middletown, PA 17057 '° Resident ID: FreeGeraldine Payment Terms Due Date Net 15 Days 10/15/12 Description Amount Residential Care - September 7-12, 2012 2,220.00 Please note our new office address -- 1328 Linglestown Road, Rarrisbur PA 1'7118 Total Invoice Amoun 2,220.00 Check/Credit Memo No Payment/Credit Applies TOTAL 2,220.00 Thank you for choosing Hospice of Central Pennsylvania. s .F i Qe! � 7 " ' "LSF 'LERK Gr ORPf{q 4S. COURT UMb E RLANO CO A4 - h p CL "V 1 zz `�w r 1 # ~ :. . m , � n .. > ■ e ° ®® � ^ \ - . � � , Q. ; �\y �\�m © � �m.y> 22� a i . �»s. , �/�9««( \� . \7\��« r ° � « \ \, : / - � ® / r �\ . � � , � / �� i - � � | �\\ \ � � ; ��\\� ���� 4 ~\ . . : � :