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Home My WebLink About05-21-13 � 1505610105 REV-1500EX�°'_"„F° � enn ballia OFFICIAL USE ONLY PA DepaRment of Revenue P r SY , County Code Year File Number Bureau of IndividuatTaxes INHERI7ANCE TAX RETURN , ( , PO BOX z8o6oi ^ HarnsburgPA1y1z8-o601 RESIDENrDECEDENT �� `�`x ilJ.`7I ENTER DECEDENT INFORMATlON BELOW Social Security Number DatG of Death MMD�YYYY Da(e of Birth MM�DYYYY 09/19/2012 02/06/1943 DecedeM's Last Nama Su(flx DecedenYS First Name MI Bradshaw Mr John F (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffx Spouse's First Name MI Spouse's Social Secunty Number THIS RETURN MUST BE FILEO IN DUPLICATE WITH THE REGISTER OF WIL�S FILL IN APPROPRIATE OVALS BELOW (� 1. Onginal Return O 2.Supplemental RaNm O 3. Remainder Retum(Date of Death Prior to 12-13-82) p 4. Llmited Estate O 4a.Future lnterest Compromise(date of O 5. Federal Estate Tax Re[urn Required death aRer 12-12-82) � 6.Decedant�ied Testata O 7.Decedent Maintained a Llving Trust 0 e. Total Number o(Sate Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9.Litigation Proceeds Raceryed O 10.Spousal Poverty Cradlt(Da[e of�eath O 11. Election to Tax under Sea 9113(A) Belween 7231-91 and i-1-95) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALl CORRESPONDENCE ANO CONFIDENTIA4 TAX INFORMATION SHOULD BE DIRECTEU T0: Name Daytime Telephone Number Kimberly Weindorf (631)4�,8�6-2430 .. 4± -i:Y rn R�I R OF WILt9>USE,QI�IL j�U. CJ ' " _t �� - - ' i-_; First Line of Address — � �' ' '�� .. �"..� 11 Alma Lane , c. SecondLineo(Address _'�.i ��i e - fA', �_. ��YF City of POSf offlCe Sfafe ZIP COtle "7 � ' �ATE FILEO �� - ,....a �'1 East Northport NY 11731 corresponaenrs a-maii address:jweindorf�o weindorfcpas.com Under penalties o( jury, e Ihal I have ezaminetl ihis retum,including accompanying scheCUles antl statements,anG to the best of my knowledge and belief, it is ime,corr d co lete.De ation of preparer othar than the personal representative is based on all in(ormation of which preparer has any knowleage. SIGNAT F P ON PO LE F I RN /� OATE� A ORE � � / / SIGNATURE F PREPARER OT ER THA REPRESE ?ATI E DATE ADORESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 � Cl(�, �.: � 1505610205 REV-1500 EX(FI) DecedenYs Social Secunty Number ,_ . ._ ..._ _ . . . . . _ . . . . . . . .. . ... �aoada�es Nama: John F. BfadsheW ' RECAPITULATION ._ ._ ... ._. ... _. ... _.. .. ... . .... 1. Real Estate(Schedule A). . .�. ... . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . t �. 23S�O�OAO i � ._._. _ ._... _._.____. ._. ._.... .._i 2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. � �8,503.�4 �'� . . ._. ...._.__. _.. .. .. .... . .. ...._._� 3. Closely Held Corporation, Partnership or Sole-Propnetorship(Schedule C) . . . . . 3. � 4. Mortgages and Notes Receivable(Schedule D) . . . . . . . . . . . . . . . . . . . . . . . .. . 4. ' �� . .. __.__._, 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . . . 5. 242,456A0 ,� 6. Jointly Owned Property(Schedule F) O Separate Billing Requested . . . . .. . Q , '� 7, Inter-Vivos Transfers$Miscellaneous Non-Probate Property � �� "� �"�� (Schedule G) O Separate Billing Requested.. . . . . . . 7. 1,111,490.0 ! , ..... . ....._. . ,.....__ _., 8. Total GrossAsseta(total Lines 1 through 7). . . . . . . . . . . . . . . . . . . . . . . . . . .. . 8. � 1,667,449.0 ! 9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . .. . . . . . 9. 43,823.00 ; .. .. .. ... . ... ..... _.... ._.... .._.; 10. Debts of Decedenl, Mortgage liabilities and Liens(Schedule I). . . . . . . .. . . . . . . 10. �. 6,86F).00 ; , . _ ._.._.... . _...,_. . ..._.__._,. 11. Total Deductions(total Lines 9 and 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. � 50,689.00 i .. ,_ .. ....,... _..._.. ....._.._,. 12. Net Valua of EsWte(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . 12. ' 1,616,760.0 ' 13. Chantable and Govemmental Bequests/Sec 9N3 Trusts for which ��"�"�- ""'��'"`�" "�"�� ' �°�`��'��°�' an election to tax has not been made(Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. � 0.00 i 14. Net Value Subject to Tax(Line 12 miws Line 13) . . .. . . . . . . .. . . . . . .. . . . . . 14. � 1.616,760.0 ' TA7C CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount o(Line 14 taxable at the spousal tax rate,or transfers under Sec. 9116 .. . ... ... . . . . . . . .. . ... . . .. . .� . . . . ... .. . . -. . - .... . . ... . (al(12)X .0_ ��., , 15. . . 16. AmountofLinel4taxable ._.._. ..._. .... _.. ..._; ' . ._., . ._.... ..._ .. . . .. .._., �. at�inealratex.D45 1,616,760.0 ! �s. ' 72,754.20 ', _ _ __ _ __ � ._.._ _ _ 17. Amount of Line 14 taxable �-"�, � �� at sibling rale X.12 , �7, ' 18. Amount of Line 14 taxable ... .. ... . .... .. . . ... . ....... . . ...: � .. ... ..... .. . .. . ... . .. ..... . � at collateral rate X.15 �� ' �g, '� 19. TA7(DUE . . . . . . . . . . . . . . . . . . _ . . . . . . . . . .. _ . . . . . . . . . . . _ . . . . . . . . . . . 19. . 72,754.20... 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Side 2 � 15056102�5 15056102a5 J REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: 2„�>-o,os� DECEDENT'S NAME John F. Bradshaw -- - --- ----- _- ------ ------ -- -- - - - ------ STREETADDRESS __-- -- ---- — 2738 S.Rosegarden Blvd -- —._____—_____--------- --------�----�-- ------ --rSTATE �--�--- ----� CITV - I�ZIP - —�---�--- -- Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tae Due(Page 2, Line 19) (1) 72,75420 2. CreditslPayments A.Prior Payments _________.___ 71,000.00 B.Discount 3,637.71 - -- ------ ----- Total Credits(A+e) (2) 74,637.71 3. Interest (3) 0.00 4. If Line 2 is greater than Line 1 +Line 3,enter the difference, This is the OVERPAYMENT. Fili in oval on Page 2,Line 20 to request a refund. (4) 1,883.51 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. �5) Make check payable to: REGISTER OF WILLS,AGENT. 4 k� �ryp 8" 1U$�'� V� ils�e p �'µ� �(� jq� ,r�( �{'� ttt ♦� �.�V �,`�/f�y{� e,� � { � £1rM �\��i�tl'�iN1Y'.N.�GY��IY��ir�i'SIAY�v%Ylfl#��¢�I�iVS�li.yf:'Eei�ke�rrv�9n'li.��ll�f}'i�e.i4ii..t[��Mif#�I�fF�^�+� ,t��Clilv'Y� XY'�!' �i Se'�""v��L..�i*S}.F .C�/'.i:� 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.......................................................................................... ❑ � 6. retain the right to designate who shall use ihe propeAy 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 hansfer property wifhin one year of death without receiving adequate consideration?.............................................................................................................. ❑ � 3. Did decedent own an"in tmst for'or payable-upon-death 6ank account or security at his or her death?.............. ❑ � 4. Did decedeM own an individual retirement account,annuiry or other non-probate pmpedy,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. � . .^� s y. , w.yG +f,y��p�ry:�p GC� a* ; ��s . ,�i ..,. � . ,_..gtiiti.�.Gk�X13ct4.€s...i.ax .a.,,,��A.G., �„�c�:k��,. ��i��kr ,� �. Je�%._., 4e�:>��,.�i�� x� ...5�,�'..",Eirv.i��v � ,✓� . , � .t�,, , . For dates ot death on or after July 1, 1994,and before Jan. 1, 1995,the tax rate imposed on the net value of transiers to or for the use oT 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 percenf [72 P.S.§9116(a)(1,1)(ii)].The slatute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and fling a fax return are still applicable even ii the surviving spouse is the onty benefciary. 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 fax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficianes is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)]. . The tax rafe imposed on the net value of transfers to or for the use of the decedenPs siblings is 12 percent[72 P.S. §9116(a)(1.3)].A sibling is defned, under Section 9102. as an individual who has at least one parent in common with the decedent,whether by blood or adoption. g =;� � r .,_ rf;e � � � m � $ `1 q a � ° � � � � � � � . N o � � o � � \ 'S 0 3 � O � „, o � a a �, �� Q , _. mz � � � � � LL� N � V � ^' _ ' °�3S a � � a LLWtt u Om�� £ `p T 1�� E `u Q � I Wl7.�W a.'� �. � do LL � RE`✓-1502 EX+ (12-121 �pennsylvania SCHEDULE A DEPAR7MENfOFftEVENUE �NnearrnNCe r,vc aEruwu REAL ESTATE RESIDENT OECE�ENT ESTATE OF: FILE NUMBER: John F. Bradshaw 2112-01051 All real property owned solely or as a tenant in common must he reported at fair market value.Fair market value is deFlned as the price at which pmperty would 6e exchanqed between a willing buyer and a willing seller, nei[her being mmpelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorehip must he disclosed on Schedule F. Attach a copy of the settlement shee[if the property has been sold. [TEM [ndude a copy of the deed showing deceden['s interes[if owned as[enant in common. VAWE AT DATE NUMBER OF�EATH DESCRIPTION 1 2738 S Rosegarden Blvd, Mechanicsburg, PA 17055 235,000.00 TOTAL(Also enter on Line 1, Recapitulation.) ; 235,000.00 If more space is needed, use addi[ional sheets of paper oF the same size. ' OMB ADP�oval No.2502-0265 �`•��•� A. SettlementStatement(HUD-1) ��IIIIIIII' �_�- h. �FHA 2.�RHS 3. QConv.Unins. 6.c�Nqumo.�. �.�w�NUmce� a.w�yaagemsu�a�cecauNOmcer. I,,4. QVA 5.❑GOnv.lns. M55309] 57015I3710 IC.NOtp: 11�'¢IOimafumsle4bgrvepuaflakmeMOlacWalu0lemanlm[h.Amou�ASD�roa�E�yMeutlk�rcMaqen�a2i�ovm.IbmsmaMM'IPoc�'wemvai0ou15Cemechiing�.t�eyart I slqim IsRb��mkmidl9nel pury>ae antl art ro�ndWM In Me b�uls. D.Name 6 AtlEreu N Bo�mxer. E.Name BAEEre55 M Selkr. F.Name 8 FCEress ol LenGer. CNUttESwNnoHUmatveR�vwuxrarv ESTATEOFJOHNF.BRNDSHAW FULTONBANK,NA ��LLA� 277BROSEGARDENBLVD.S ONEPENNSOtIARE CeERxvNilL,eJOBOP MECHANICSBURG,PA17055 SUITE304 avnN N.*FU�orv LANCASTER,PA 1]60P 2oa S�,wMRL RoM LNERRYNILLNJ OBOA G.PmpeM��p�' H.SetlkmeniFqenl �OISONSEiiLEMENTSERVICESCARl15LE. I.SeNertreni�aie I �ISEUrsamenl0a�e lLC P738ROSEGARDENBLVO.S 595.Pm5rnEer,GRUSLE,Pntml3ptn 2I71/2017 I 1/222017 MECHANICSBURG,PA 17055 (CUMBERLAN�j Z�>�� (E231-2157-787) ' q�q�memem� 59S.PITTSTREET,CARUSLE,PA 17073 100.Grosa AmouM Uua Fnm Bortower /00.Groas AmouM Du�To SNler 101.Coniractsak5 rice 8235,40000 401.ConVacisalespnce $775.00OAO 101.PersanalProparh 40P.PersonalP 7W.SetllemenlCha estoBortower Iine74�0 58,65201 403. 704. 404. 105. 405. Adus nb Por ilxm ai0 NIIN i�iGvi�G AE uftmenb kr ihm� aiE b xllx in a0wnn 706.Ci flown tazes 406.L' Itam WKce 1 W.Counry traes 407.Caunty�zxa 700.SUad Taz7271L017 ro fi13012017 2651661Vear 59JJ.16 408.Schod Tae 1/21/2013 to 6I30I2013 2653.66/Year 8939.16 109. 1122I2013to3/772013 $iiP.00l�uarter &16.56 d09. 1/271P013to9/311Z013 E712.00louaner Edfi.56 710. 470. iti. 417. 112. 412. 130.GronAmountOU�Fmm6ortaxar S2N,63177 610.GmnAmountDUaTOSeller =2D5,979]2 IW.AmouMSPtlOB OrInBMaHOfBOmwar WO.Reductlon�InAmouM�u�ToSeller 201.�epnsilorEamatMo E7,500.00 501.ExcessEe� i�seeinsWctlons 202PtlncipalamaMMnc+rban E188,000.00 502.Se111eman�C� esNSellerline1E00) 516.817.00 203.Existin ban bken sub' to 503.Existi loan takm sub'ecl to 204, 504.P XWfrs�mo elaan 205. 505.PayoX M secm0 magage losn 206.SeIlerASSbtance $2,500.00 SO6.SeeACtlmdum506 E2,500.00 7(17. 507.DisEUrseda9pm�.eeGS 51,50000) 20B. 508. Zp9. 509. AEfYfhlllllbblllllll�Yllpildby6lllN NOYfUM�tltOlMlIISYOpi100 feIIB� 270.Ci ttpm ta�a 510.Ci flown tazrs 211.Gwnrytme5111(1017M7/2712017�5790.<YYear 8112.61 511.Coun Was111R0731o2R7/2�13 $]90<7/Year 811181 212.Assasmenb 512.Assessmen�s 273. 513. 214 514 275. 515. 21fi 516. 29. 51]. 218. 518. 219 519. 7LO.TOtaIPaiEBylFOrBOrtwnr {7g7,7�2,67 SIO.TObIRMuctlanAmounl0us5tller y19,6ri.67 ]00.Cu�A[SattlameM FmmTO Bortowar 600.Cah Ft Settlmwn�TolFrom Seller 307.GrmsAmauntDueFromBOrtarM IlneiYfl 5144,fi31.73 601.GrmsNmaniDuaTOSeller Iine420 5235,979]7 30P.LrssAman6PaiE ffaBOrtower(Iine220) E19P,112.61 601.Le5s0educ6oninAmt.DueToSetlerline520 E19,949.61 J07.Cah �✓From �TOBartower E52,519.1P fiO3.Caah �✓Ta ❑FnmSSller 8216,SSO.fl PreviousetlXionsareobsole�¢ Page 7 0l 4 OtiY11201311<9AM HUD�1 t0U.7ohl RaH E�tab Broku Fan � paip Fmm PaiO Frqn Division M Canmissim Iine 700 az ldloxs: Bonvxefs Sellefs 701.SG,915 OO lo Coltlwell Banker Hanesteatl Group FunGS at FunOS al 702. �o ERA NftT SeNaman� SeNement 703.Canmission aiEatSettlemant ' 813,950.00 701.Braker Fce to ERA NRT $195.00 705.Tramaction.Fee�o CWtlwell Banker MomrsteaE Grou 8100.00 .WnbV WNInConMetlonWlNlAan .. . . . . . 801.OuronginaYOnUaryeSG95,W � (irqnGFEk1) 802.Your cre0i�a cna e(poinLS M Ne specifk interes�rate chmen (irpn GFE#2) 803.YOUreOjuste0 ' ina6onc�a � (irqnGFEA) 5695.00 804.A aisal fee to Premier A 2isals irom GFE#3 SJ]0.00 BOS.CretlilRepdtWCreEStar (iromGFEtt3) E24.34 846.Tu service�o FuIWn Bank,NA (irwn GFE tt3) BW.FIOOE CeNfication to C ic FIooG Services irpn GFE#3 811.50 a.lqm. u�nas tenarTOe.rawmnanna . . . 901.Dail intermt c� es ham 7/27fL(113 N L112073 18.0474/Ea to Fullon Bank,NA irom GFE p10) 8126.19 9a2.M e Insu2nce Premium from GFE kJ 903.Haneawireh insu2nca for 12.00 monlhs lo Stale Faim(POCB 8702 00) Qrom GFE p71) .�OO.RaMVpMW�YMWWI.�otl✓ �. . . . . . . 1001.tnNal Eep�i�la your escrox accan� Qmm GFE k9) 52.540.98 1 W2.Homacwnefs insurence 3 monttu $58.50 per monN 5175.50 1003.Mo�t e insurance 0 00 months per monU i WC.P taKes 13 mon�hs $8fifi.09 monN$859.17 � 1005.SUOd Taa 9 mqMS�SZ3574 prt month 52.111 fifi 1007. ateAAusMenl(Efi15.35) NOO.iItl�C � a �- . . . � . . � 1107.Tl�e servicm anG IenEefs IiYe insu2Ma (iran GFE k4) 87,993.00 1102.SeNement or dosi /ee ro MaEisan SaWemenl Sernces-CaAisle,LLC 1103.Oanefs 6Ye imu2nce lo MaOism Setllement Smicas-Cxiisle,LLC iran GFE#5 8235.00 1104.LeMefstitleimuanceloMaCisonSeNmnenlServkas-Cartisle,LLC $1725.00 1705.LBMerStiUapoliCylimit E188.000.00 ' itOfi.Ownehtitlepoli limi� §235,000.00 �� 1107. enCS 'on M Ua total Utle ireu2nce remium to MaEZan SeNement Services-Carlisle,LLC 51,666.00 itOB.UndenlfilefspoNOndNeWWtiYe1n5u2ncepremWmbOMRepublicNatlonalTilleln5u2nceCanpany $294.00 7109.CPL Fce to Oltl Republic Na�imal Title Insu2nce Cqnpan E75.00 1200.GOwnmmtMardin antlTtmWrC � ,:...- . .. :. . , . 7201.GwmnmantrxdE' chazgsa (tromGFE#7). .521100 1202.DeeO 57000 Ma e E104.00 Releaaes S t207.Trarts/ertaces iranGFE#8 82.J50.00 E2.35�.00 1204.CitylCaunrytaxlstamp5 DeeES2,350.00 Mo�gage8 1205.State terhtamps DceE E2,350.00 M e S 120fi.Recortlin M POA W MaEisan Carlisle Remrdi Accoun� .U7.00 17W.AEtlNonYSWlrnmlth r - � . . 1307.Requiretl services ihat cen s�a0�a�� (from GFE Y6) 130P.Suna 130J.Pest Inspeciian 1305.Taz Cerl to A7adism Settlement Services-Cazlisle,LLC 810�0 1306.Fina15CwxJaNFBNMarChWUD rAllenTams�ip $�� 1707.DeeGPfe bGuartlianT2nsterC aatian . $775W 1708.Atlomey Feas W Won,Zulli&Seibert $�� ii , i . i $8,fi57.01 Si6,B11.00 Previou5etli�ionsareoUSOle�e Page 2 0l 4 07121/20131149AM HU�4 �ConpuhonWGoatlE��EtCmW.(GFEju,MHU0.t.Chvpw� .�. �� . GooEFailhES6mate HUD�t Chaqp T�at Cannot Incna�e MI10.1 Lins Number ��,OuroriginaUOnc�arge #gpt $695.W 869500 ��vw�aeEM1 or c�arga(poin6)tor Ne spacifrc in�ere�t 2�e chmrn k W2 '��.Youratljustedonginafioncharyes p 80J %95.00 569500 �Transferlaras q1203 $4,350.00 $2,35000 Chargp ThA in Tolal Gnnodncrena Mon T��n 10% :Gopp FaiN Estlmate � MU�4 Govemmenirecor4ingNargm #1201 $15850 5211.00 AppraisalFaeWPremierAppaisals f1804 $950.00 87]0.00 CreEit0.epotlloGretlstar #805 $E0.00 $24.34 ,FIOOECeNfca�ionmCOrelogicFlooCServices pgp7 $71.50 51150 — # tl � — � 85fi0.00 $516.84 � -8aJ.16 a fi.53939% ��,CharyaThatpnC�ongs .:� GooOFaMEStimffie . HUD-1 InitialCepttiifwyourescrowaccoum #1001 $4,300.00 82,540.98 i Dailyinteresitharyes N 907 518.0274/OaY &50477 St26.19 ;Hamar+mefs insuance %903 8750.00 S1�P.W i7itleservicrsanClenOe�stitleinsurance %N07 g7,99000 5189100 Oanels Iitle insuraMe to NaEisan SeNement Services-Carlisle,LLC p 110J $275D0 5275.40 0 I Loan Terms Yar initial loan aman�is S 188,000.00 Your ban Ixm a 30.00 years Your initial interest rate is 35% VariniWlmw�lyaznan�w�eU(apfincipal,inlerest,andany $ 84420 i�ludes mongageinsurancais i- QPnncipal � �✓Inleresl '�� ❑MOiigage Insuranca �Can yw�interasl a�e nse? ONO. �Ves,d can nse lo a mazimum ol %.TAe lirst change will be , on antl can charge again every atler � .Every cliange tlate,your interest ate can inuease w aecrease oy '�, %.P2r Ne lile W Ne loan,your interesl rate is gua2n�eea�o never Ue lower IAan '� . %orngnerman %. Even if you make paymenb m time,fan yar loan halance nse7 QNO.�Yrs,it wn nse to a m�imum oi E - IEvan X you make paymems on time,pn your manNly anwunt �✓No. �Yes,Ne frs�inuease wn oe on antl me monthly amaum ,u�eC M pnncipal,in�eres4 anE moM1qage insurance nse? p�.�ap�n rise lo S �' 7ne macimum it ran ever rise to is 8 . Ooes your loan�ave a prepayment penaltf� �✓No.�Ya,your marimum prepayment penalry is$ � �ces your loan have a hd�bon payment7 �✓No. �Ves,you have a Ealloon payment W$ aue in years on .Total mmNly amoun�ave0 inGuEirg rscrav accoun�paymmis �YOU Ea not�ave a monNly esctav Daymenl for ilems.such az properry ' tazes and homeawnefs insurance.You must pay t�we i�ems EirxOy yoursell. � Q✓You�ave an aGaiGonal monlhly esciwv paymenl ol S 3fi0.33 �I IM-iresulL-inatMai-mi5almom.lyamwnmweaW: i,20iS3 .T�islncwCes pnnupol,inler4t,any mwigage insurance an0 any items checkM below. � �✓PropeM laees ❑✓Homeownets insurance �Floodinsurance �SChaolTazes ❑ ❑ Note�.If ya�ave any quesfions about Ue$etllemen�C�arges antl Loan Terms IisteE an Nis lomi,please contacl your IenOer. PreviouseCitronsareo05olele Page 3 W 4 0712L20131149AM MU�-1 Suppiemental Page HUD-1 Settlement Statement naaenaumsrorvayai A o � naa�a�m sas a.Eamest money re�ained b�CWMreII Banker HanesteaG Group $�00 b.Seller Assistance g�5�� ToGI: f7,500.00 ��m fsMUlly mlawE Ne HUDi 5elbmen15�adment anE W Ne bst olmy WwbEqe aN[elgl A'¢We anE axuqb sNpmenlol al AttiD�anE E6Wrs¢m¢nls mMe on my Xmunlor0y ire in I��S vanSxLnn. I IuMeruNFy Ual l nm rtuiapp awOYalN¢HUDi AIIkmBnISYMrtanL BORROWE0.5 SELLE0.S t �� i��2�ti.�� i i�lu.�r�ti/i 1��,'-,L c� z�-� CHA�[f TRUXfON �~� 2� J NimbetlyA.WeinCad,ErxuNx > � � . BEVERLY TRUXTON � "� i RVA/N/N � /ON+,�� /�� y�/—/[`�' z�z� �� iAe11tl415el1b nTel$�¢menlefirJilnmortoaMisaweaMaa2baaauntolNlsVansaclq ewseCOrlmllrwuNalurds aisEUrseElnaccoNanuvnNN¢staument. $eW Bnl 01 p„0 -. 1127I2013 � PreviaseCitionsareaESdele Paga E d 4 042Z2013fl:49AM HUD4 RF/-iso3 EX�(8-11) ,�. pennsylvan9a SCHEDULE B �„'+,7 DEPAPTMFNfOFREYENUE MHERiTANCETAXRETUflN STOCKS & BONDS RESIDENTDECEDENT ESTATE OF FILE NUMBER John F. Bradshaw 2112-01051 _ All property jointly owned with right of survivorship must 6e disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCR1PiI0N OF DEATH 1 57 Shares of Prudential Financial Acct#C0000795593 3,280.00 2 PNC InvestmentsAcct#004-375055 1,203.649 Shares fo MFS Municipal PA Bonds �Z,g19.00 3 MorganStanleySmithBameyAcct#617-099613-039SeeAttached 55,624.00 4 Columbia ManagementAcct#00590134795 3,396.00 5 ColumbiaManagementAcct#00210031624 3,384.00 707AL (Also enter on Line 2, Recapitulation) ; 78,503.00 IF more space is needed, inrert addioonal sheets of the same size �omputershare Computershare Investor Serviees 250 Royall Street Canton Massachusetts 02021 www.computershare.[om KIMBERLY A WEINDORF 11 ALMA LANE EAST NORTHPORT NY 11731 October 26, 2012 Company: PRUDENTIAL FINANCIAL INC Registration: ]OHN F BRADSHAW Holder Account Number: C0000795593 Document I.D.: 12297WF00165979 Our Reference: PRU/0011814801/8/ Dear Sir/Madam: Thank you for contacting Computershare, Prudential's transfer agent. We appreciate the opportunity to be of service to you. �On September 19, Z012, account number C0000795593 held 57 shares. On that date, the closing price was ;,�57.54 per share. The following list provides the information you requested for account number C0000795593, as of the close of business on September 17, 2012: • Date investment established: December 18, 2001 • Share balance: 57 (j� �7 �,i„a� • Value per share: $58.07 ��1 • Total doilar value of account: $3,309.09 � � , �� • Dividend rate per share for 2011: $.145 • Dividend rate per share for 2010: $1.15 �� -�� • Dividend rate per share for 2009: $0.70 �"7 � • Dividend rate per share for 2008: $0.58 ��.�_.--__ Dividend rate per share for 2007: $1.15 ----- � - " ' • Dividend rate per share for 2006: $0.95 • Dividend rate per share for 2005: $0.78 • Dividend rate per share for 2004: $0.63 • Dividend rete per share for 2003: $0.50 • Dividend rate per share for 2002: $0.40 • Dividend payment cycle: Annual October 17, 2012 Donna Pollock donna.nollock��nc.com RE: 004375055/John F & Karen A Bredshaw (Joint With Rights of Survivorship) The value of the above-referenced account on September 19, 2012 is as follows: �� '' �>- , t ; j u �' �_ m6o � �: CGIE�� ': „ Rccrue� �, � dnwun� .' � ' �u� or�=� ��.� ' � �us► ,,- ��t�r�c«� �Ot�E�vawex;i:.�nter��`.;� _ 0.010 Federated Prime Mana ement Obli ations pPSSo $ 1.00 $ 0.01 1,203.649 MFS Municipal Pennsylvania Bond MFPAX $10.65 $12,818.86 -- $12,818.87 $ - __ __�_ Grand Total(Market Value+Accrued Interest $12,818.87 If you have any questions, please contact our Estate Resolution Desk at 800-622-7086. Sincerely, PNC Investments, LLC. Estate Resolution Desk JEO The summaries, prices, quotes and/or statistics contained herein have been obtained from sources believed to be rellahle but are not necessarily complete and cannot be guaranteed.They are provided for informational purposes only. Past performance does not guarantee future results. Page I of 5 � JOHN F BMOSMAW 8 Xanc l�t))881-9M! illR SYMrE �CCT Bll�09BlAOJ9 FAUWry 5�rvica NAqEN A B(UD91MW JT TEN !wp FuM BOP! 3]]lR09EGAROENBLVOSOUTM MeW4:�ltl)l14JlM MECMANICSBU0.0V�1)OS}5]p! 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Avon ProEUCts Inc � �5.000 �� 09H92012 18.01 560.35 A SBO.JS 601 85 0t]0 long adj 2012 . . .. . .09�2t � BankOlAmenwCary 5.000 . 09/192012 9.36 <8.80 A 4R.80 4].58 OJd Ionga4�20�Z � 09-]1 25.000 � 09/19/2012 . 9.36 � 2J0.00 A 29a.00 2J1.91 J.91 lon9 aCJ 2012 � . � �. . .09-Y1 . 30.000 09H911052 9.38 480.80 A 180.80 285.49 . 6.h9 long atl�20R �, -09-21 � 5.000 09119/2012 9.38 � 46.80 A 46.8U 475g OSB Irn�gadjY012 �'. . ' . . � .0&21 � � 45000 � 09/1W2012 9.]B 236.00 A � 2J4.00 � 23191 3.41 longad2012 0421 � 15000 OWt9/2012 . 936 �'. 140.40 A � 1d0.40 � 142]4 1.J1 IonqaaJ2012 � 0421 � SubTOtal 105.000 f9.I! fBl3.B0 f9E2l0 y899.20 S1lAO , � � 6ankOlNxwVnrkMailon 30.000 �, 09/1&2012 ]JB2 . ]OB80 A � 108.60 . ]a2.4p �5]II Iongaajp012 �. Corp �. ' �� 0&2t � BbBTCwp '� Z0.000 09/t9/Y0f2 ]9,40 B68J0 A . 608]0 . 8]5.03 G3! � IangaCjlOtY � - . .. �. � 09-21 ' Boston 5<IenM1Rc Cory 75000 09/iW1012 . 5.81 d353B A , 4J5.]8 �. 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SuOTOtaI 190.000 SS.l1 f1,OM.91 51,04t.91 S1,ON.00 30.91 � Bnggs A Slretlon Cp Wisc 40.000 09/19/2012 19.]7 �. �9080 A ��. ]90.BU 784�0 b.80 long atl�2012 . . � .. � . . .09-21 .. � CM1esapeake Eneyy Cory 5000 09/19/2012 �. 19.9d � 99.68 A 99.68 � 96.15 -3.53 long aEj P012 . .. �. . , -0421 �5.000 0&1W2012 19.9C � 299.03 A � 299.03 � 28B.65 -0OSB Iongadj3012 �� 0421 , 5.000 �9/192012 19.9C 99fi8 A 99.68 °R.15 �]S:) longatlj]012 ; 0921 5.000 09/19I2012 19.9d 9988 A 99.68 � 96.15 �. �J 53 long atl�1012 09-21 5.000 W/1W2012 � 13.96 9988 A 99.69 �� 96.15 -J.53 iongaE�T012 � �� -03-21 ��. 15.000 09/1912012 19.96 � 299.09 A 299.0� IB8A5 -1098 iongaEj2012 0421 C5.000 09/19R012 19.94 89].OB A 891.08 065.35 JtT] Iorgadj40i2 0421 SubTelel 95.000 519.9� 1�,87l.9E S1,B9I.8! si.ese.es sezoi C�evmn Corp 5.0�0 09/19I2012 116.51 SB2.53 P 582.53 589.Y5 5�;1 Iong a0j 20R 09-21 CumSY9lnc 30.000 09/t92012 19.08 A2.00 A 5]2C0 56820 .d10 Iangatl1�012 ��. 09-21 J5.000 09/19I20R 19A8 661.80 A 5fiZ90 fi62.90 A91) IongatllZ012 0421 SupTOhl 65.U00 519A! $1,2I0.]0 31,2�030 51,371d0 �f9d0 CitigmupincNew 3.LW 09Ii9120�1 3021 1�2.6� A 102.6] i05.81 3.,9 �ongaEj101P 09-2� t0000 (]91i9ROR 3621 Ji211 A ld'2.11 J51J0 ID'i9 �nngay40�1 �. 0&21 http://ideas.msdwis.wm/Site/Secure/GainandLoss/ExoonFortnaso: �� Page 2 of 5 � SubTOtal u.000 sa�.zi saa.v� saa4.�� Ease.si sia.n ComwslCOrpCiASpaciai IS.WO 09/19I2012 3C19 BSG6J A BSa.83 tl9250 L�i3) inngacf12012 Nrw -09 11 �00(IO 0 911 9/2 01 2 :34J9 J4t.85 N 311.85 39.00 i51'i Iongntl�2012 -09Q1 i0.000 09It92012 ]4.19 3J1.85 A J61,05 J5Z00 i515 Iangatlj2012 09d1 SuETO�aI GS.000 S]t.19 f1,5383] 51,538.J3 51.808.50 569.1] Comvarso Tec�noiogy Inc ROD00 U9H9/Y012 0 da 5152� q 51621 SOP-(10 -]Z] iong atlj 2012 09 21 Comin9lnc a0.000 09119/2012 13.06 522a0 A 522J0 5]320 10.pp iunga�j2012 0&2� 25.fh�0 09It4i2012 11.06 J19.W A J26.50 JJ125 :i)5 Ion9 art YUt2 09-Lt 5.�00 09I19�2012 DA6 G530 A 65.90 fi6.E5 !.35 long adj 2012 49-21 20A00 05I1W2012 13.06 26120 A 26120 26fi.60 S.aO IcnqatllZ012 �9.Y1 SubTOlal 90.000 51108 ft.t]5.40 f1,i13A0 51.199J0 E3L]0 UowCbomiralCo 25.000 p9It9I2012 31A4 !]5.A8 A �]5.tl8 ]3I.0� -1NP9 Iongadj2012 09-21 10000 09I19l2012 31D4 3ID.35 A 91035 . 294.80 -t5.55 Iongetl�2012 �9-21 SubTOlal 33.000 E]1.0/ f1,OB8.2] 51,088.]3 51,OJ1.80 �SS/.�� Eli liiry 9 Co 500� p911912011 Sfi99 13J.N5 A 2J3 Fi5 24090 v_.v lon9 aaj 10t1 -0421 5.000 09Ii9/2012 4893 294.65 A 2J485 24090 0'S longae�2�t2 09-21 10.000 09H9I2012 a6.93 469.30 A a69.90 J8190 i)50 Ionga4�2012 09-11 SubTotal 20.000 S�fi.9] 5938.6U f938.80 5963.60 S]3.00 FiIIb 3RCI Banmrp D�lo 15400 p9119/2012 t5.u5 23i]5 A 29415 239.93 5 :tl Iunq atlj 2012 09-21 15.000 09I19I2012 15_85 Y34]5 A 234]5 2JB9J 5.18 iongatlj1012 (19-21 SubTOtel �0.000 f15.65 5069.50 fd68.50 y4]9.85 f10.35 Fle.rtranirs intl Lttl 30.000 09I19I2012 B31 189.15 A iB915 �N3.15 �G.00 bnq adf 20t2 09-21 55.000 09I19I2012 fi.J1 366]8 A 348]B ]95]0 �11 01 long acf�2012 -0&21 . 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Page 3 of 5 smrom� as.000 sat.ao ft,ws.ao f1,035.00 51,068.]S f11.f5 HcymryNew 50.000 OA119/2012 8.59 46950 A n49.50 460]5 .p]5 IongaAj2012 09-11 Kroq�rCO 90.000 09/19/2012 23.08 11iB8 A ]15.8fl 115]8 .p13 Inngatl12012 . 09-21 5.000 09I15/2012 23.fi8 119.31 A 1i9.J1 11929 +J02 Iongad2012 09-11 10.000 09/�9i20tt P].86 2l8.63 A 238.63 2J959 -0Ci5 bnga�j'tpt2 09-21 5000 09/19I2012 2J.86 11931 q 119.31 1t�J29 -OJ2 Ionqa412012 09-21 � 5.040 09I19I4012 2J.B8 t19-Ji A 119.31 11929 q.U2 Iongad2012 �. Sub Tolal 55.000 ��9�� SR0.88 S1,Jif.M 51,31]A! S1.11I.3f .f0.03 Leer Corp 10000 09/19I2012 dp.81 JOB.85 A 408.65 JOB 90 __.� Iong a4�2012 09-21 10_000 09119/2012 4U.6) J06.65 A 408.65 408-90 2.25 iong adl 2012 aazi SubTOlal 30.000 f�0.61 5811.30 f81].30 S81).80 5�.50 Mnrs�BMCiennanCOSinr. 5.(100 09I19I1Ot1 ;14.tl] 1]3.J3 A 1]y33 1]Jefi U;i3 Innqad�'20�2 09-21 IDD00 09I19/2012 �a.6) J66.fi5 A 3J6.G5 d4]]2 1-0' Ionq atl�2012 W.21 20A00 J9I19/1012 k.61 693.3� A 89J.3� 595.4d 1..+A iong atl�2012 09-21 SuETOteI ]5.000 fJ4.6] 51.31J.28 y1,11128 31,31].02 S]94 M11asm Carp 25A00 09/19/2012 15.85 ]98.13 A ]96.0 60525 J 1[ long aoj 2012 -09-21 25D00 09119I2012 15.85 195.t] A 395.13 405.25 9.:2 inn9atl�2012 f19�11 20_pp0 09H9I2012 15.85 � 918.90 A 916.90 � 32420 1�0 lonyatl�2012 � -0&21 SubTOlal �0.000 f15.05 51.109.1E N,108A8 51,136]0 fZ5.5C hlamk&COincNewCom 25000 09I19I2012 a4d0 1,110.88 A i,tlpfi8 1,i5J]5 i38] Iangatlj2012 �. 09-11 MidwoftCOrp 25.000 09/19I2012 31.12 ]]].08 A 1]].89 �JB]5 �29.13 Ionqad20tt 09-21 YOD00 09It92012 91.12 622.J0 A 622.J0 599.�0 -?J.]0 Ion�ad20i2 n�-n 10.000 091191"2012 31.11 311.15 A 31 L15 299-50 -1 i fi5 Iong ad11012 W-21 10000 09/19I2012 31.12 311.15 A 311.15 29950 -1 i f5 lang aaj pp�p 09-21 5.000 09I19/2012 . 3t12 155.58 q �� i55.5B iM14]5 -S.HO Iongatlj2012 09-21 SubTOlal ]0.000 f31.12 #,VB.OE SI.i18.08 51,096.50 -581.56 MolsonCoarsB�ewingCUCI 1500� 091i9/2012 45.84 � 6W.59 A 6BZ53 6�1]0 -Li➢3 Ianqadj20t2 B 09-21 15.000 03I19I2012 a5.86 68153 A fi9).53 6]1l0 -13 T9 iong atlj 2012 � -09-11 SubTotel 30.000 5�5.8! St.])S.OE f1,3]5.08 51,313.60 .EN.66 News Corp Lta CI A Del 20000 09I19/2012 2J]4 J96.80 A J9480 50tl20 �i a0 long aU�Y012 09-25 25 000 03119/2012 24.l4 818 50 A 918.50 632]5 t a_5 bny atlj 2012 -09-21 t0U00 09R9I2012 24.%4 26]60 A 24]40 259.i0 SIO iongad�2012 09-25 SubTdal 55.000 SY6.]I f1,360]0 f1,]Bp.]0 51,392.05 S]1J5 OItlReOubliclntiCp 30000 p9/19I2012 9.38 280B5 A 280.65 291.J0 m.n5 kniga4�2012 ae-zi 30.000 O9H9/2012 9.98 200.G5 A 280.fi5 29130 iJ.59 Iongadj2012 09-2t 20-WO 09119/2012 9_3fi 1B].10 A 18Z10 �9420 ��J Ionged2012 09-21 SuGTatal BO.00U 5938 5168A0 S�aeao 5]]8.80 f�840 Orecle Coro 26.040 04I19I2012 3282 820.50 A 820.60 1Bfi]5 -33J5 long a0�2012 09.21 Owens Illinols Cam New 35 000 10/0�2012 18.9� 66J92 669.92 )1120 nl"IJ cport PA�O�a'sUnitetlFinancial �0.000 09/19/2012 12.12 OB4,80 A J9J_00 49J20 I�JU bngadj2012 InC 09-21 VepsicalncNC 5.000 a9/t9l'2012 ]0.83 95J20 A J6420 856A0 i5p Ian9�tljL0�2 u�v s000 a9rivzoiz �oea 3s�za n 3sazo aseoo ��eo i,��,g,a�sorz i�-zi http://ideas.msdwis.com/Site/Secure/GainandLoss/ExportForm.aspx 10/5/ZO l2 Page 4 of 5 5.00o 09/19I2012 IOBi 9%10 A �5J20 356D0 i 0J ionq a�j 2012 OY41 1�.000 09It912012 ]0.04 ]OB40 A 1U8,40 ]11D0 3(�0 Iongaa�2011 � 0&21 5000 09I21r2012 ]0.51 J5251 35251 J5800 343 sAOrt � Su�TOlal J0.000 S]0.I9 S],1I).5] 53,13151 St,1]6.00 f12.13 Pfzerinc 2J.W0 09It912�12 2410 SBQ60 P 580.00 G1196 J11f. lonqa�j2�12 0421 35.000 09I19/2012 2J2� H41-0p q 96].00 891 a4 .Ki a4 lon9 r�j lOt1 '. U9 21 5.000 p911912012 2120 121A0 A 121A0 1P.J9 u49 Iongatlj2012 09-Y1 SuCTOIaI 6�.000 S3<.30 51,548.Bp 51.5/8.60 51,6J1.90 58�.10 Pnr.FinlSvcsGp 1.00(I p9/i9I2012 85.98 G59B A fi5.q8 fi52P �0]2 longatlj'tOt2 U9-21 3.�00 09119/20f2 G59B 26392 A 263.92 261A4 -2.BB Ionqadj2012 -09-21 1 000 p9119/2�12 55-98 85.9B A fi598 6528 -0�2 long ad 2012 04'21 SuETotal 8.000 f85.98 S]95.88 f�95.B8 f391.58 �f4.JZ Procter9Gamble t0000 09119I20t2 � G9.]0 693.00 A 693.00 098.85 JUS Ianqatlj2012 09-21 5D00 09I1912012 69.30 046.50 A 3J8.50 Y19A9 1.99 long atl�2012 0421 SubTOtal 15.000 569.]0 y1,0395� 51,039.50 51,WSSB j5.98 Pabllc Servke Enlerpdse Gp 5 000 09I19/2012 31.5] 16LB9 A 15Z83 18260 a)/ long atlj 2012 09-21 15D00 09/1912012 9L5� � J�340 A 4]3.48 48].BO 1M132 IongatllZ012 09-21 SA00 O9I1W20�1 31.9 15LH9 A t9-83 162.G0 1]] IongatllZ012 09 21 tOD00 09/19I2012 31.5] 315fi5 A 915.65 325.20 955 icngatlj2012 -0&21 Su�TOtal �5000 531.5] 51,1WJ9 N,10�18 §1,1]B.YO EJ3A1 � Pul�aGmupinc 19A00 09I19/2012 1g.34 31046 A 910d6 32148 tt!)l iongatlj20R ae-zi i5.000 09I19I2012 1G.36 ]]530 A P35.J0 ]6tA0 tB.tO IongaEj2012 09-21 Su�TOtal B1000 516A1 E1,0l5.]8 3�,0�5]8 N.082.BB 591d2 � Rrgions Financial Gory Now 35 000 09/19/2012 �50 282.3] A 262.33 26495 lB2 Inng atll 2012 09-21 Saleway Inc Com New 15.000 p9I1912012 16 39 2JS.I8 A 245]B 261.95 -3.BJ long adj 2012 � 09-21 � 30.000 O9I192012 16.99 09L55 A 491.55 48390 -].h5 long a�j 2012 0421 �0.000 p9/19I2012 1639 iR3.86 4 163.85 1P130 �1.55 Iongedf201P U9-21 SubTmal 55-000 51899 5901.18 f901.18 5881.15 y14.0] S�anley 81ack&Decker lnc 12.000 09�19i20tt P592 910.98 A �10.98 891.84 -IJ.14 Ionq aJ 2012 �. 09-21 S4�P�eslnc C0.(lU0 09ItHR012 12.04 4d1A0 A 181.40 a66.d0 -1G.fi!) bn9atljl�R u421 StateSnee�COrp 15000 09/i912012 4J.6] E55.09 A u5509 63214 -22.65 Ionga�j2012 09-21 SupArvalu Inr. 10A00 09I19I2012 2A1 2<AS N 20_OS 2J 00 -1A5 long»tl�2012 -09-21 11.000 09/1912012 261 YO.B9 � 40.89 J9.10 ±.]9 iongad2012 09-21 20000 �9It92012 � 2.11 4tl.10 A atl.10 APAO .2Jt1 lon9atl)20t� -0Y-21 00.000 091�91'2012 2.Jt 96.20 A 9R20 9200 .a.�U Innge4110t2 09-21 Su�TOtal 8].000 fY.41 {I093C fY09.3� RWdO �59.1I SymenlecCorp P,5000 OBI19/2012 t898 n]M150 A 4�4.50 n5n25 �^p�5 onga0j1012 042t G5000 09/�9I2012 1fl98 85d.10 q tl54.10 9t).55 -D665 langetlj'tl)�2 0¢21 SuETotal t0.000 T18.98 ff,]38.80 51,328.60 St,O]1.90 �SS6.i0 Taxasinso-umenx 20A00 09/t9/2012 2�.60 5]1.60 A 5]1b0 568.60 -500 ionga0iZ0�2 . 0&21 tl)00� 09/19I20f2 Y8.!i8 28580 A 285.90 28�30 -LV0 IongaAj'1012 ��2t SubTolai J0.000 SI8.58 585]Ad 585]AO S8dB.90 -SI90 http://ideas.msdwis.com/Site/Sewre/GainandLoss/ExportFortn.aspx 10/5/2012 _ . Page 5 of 5 TravalereCOmpanleslnc 5.p00 09/1912012 68.5Y JS26B A �d2,6B 1J8.00 3'i` Ion9aaj20t2 Com -0A-21 SDUO 09/14/2012 6tl.54 341.tiB A :IA2.fi8 J4tlOf1 S.s2 Iongatlj40t1 0421 SubTalal 10.000 568.5! 58B5.38 f685.]E 589E.00 510.8� Trwqwomouvel+oltliny 15-WO 09/19/2012 i].10 106,a3 q ]o6AJ ]�8]5 d'2.:�2 IonpaU20�2 . c;,�� o3zt Tyson�ootlsmcClA 45D00 09/9fl�2012 i6.0a n9.99 ]1999 1i980 tUNt s�on VainroE�ergyGp�elaNOw 3111IDa 09It92012 31,q0 955.tl5 A 968.tl5 9B9]0 J785 longatl�24i1 0421 WaiMatlSmreslnc t0UV0 09I19I20t2 ]191 �43.10 A 163.10 ]5192 362 iongatl�2012 U9-21 Wells Fargo 3 Go New ].000 09119/2012 J5.56 26B]2 A Y;8-]8 I52A2 3b�1 long ad�1012 09-11 2&000 09/19�2p12 ff5.56 BBB50 q 888.50 90150 i)00 bng atlj 2012 oy-zi 5.000 09/19i2012 �5 54 1]]]0 A V]"!p ip0.30 2 GO lonq aUj 2012 04-21 SubTO�al 31.000 SdS,S� f1,JU.9B 31,]U.9B 51,30/.22 E19.1� Western Digltal Grnporatlon 25A00 09I19I2012 3913 BBO G! � 9tl0.63 95'2�0 �28.13 long atl�2012 -09-21 5.000 09/19@012 �429 198-13 A 196.13 I90.50 -55d Iong atlj 2012 � 09-2i SubTOta� )p.000 539.Y] 51,116.]9 N.1]6.18 51,163.OU -E11.16 xom�COrp 30000 09I19I1014 Z10 13o95 A 230-BS 21].PO �1dA5 Iongadj2012 . 09-21 15000 09It9/2�12 1.]0 115.03 A 11543 1p8.90 -fi.SJ Ionqadj201Y 09-)I B5.000 � (19/i92012 I.�O 500AP A W0.18 a]1.90 -�0.J8 Ianga4120i2 os-zi SubTOtal 110.000 5�.�0 5848A8 f818A6 f�98.80 -NI.BE Total5leckaOptlone f55,598.)] 555,S98J] 'ESS,Bf0.1] 525.d0 Totel Unrealizetl GaiNLms E55,59B.11 555,59E.11�. 555,82C.V S45A0 I]isclaimer A�Fricetl Assets calcmation inciud�s ali assets evcluefing CasM1,MMF 8 Deposits.Thls aggregato numhar is not�uplicaletl in inlal AcCpwJ-Vaue calr.ulation. P-Yuu M1ave piovitletl I�e Irada hislory for Ihls Vansatlioq it was nol available thmuyh Morpan Stanley SmitM1 Bamey L�C records. "fM1n gain ana loss iniormation Is pro�i0od br informatianal pmposes only,is nol a subsliWte 1�99 bmi(or any nl�erapP�opriato laa farm�,anA s�oultl not bo use�for tax preparatlon. Ume.alizeA gain antl loss valurzs arA�stimat�s anC sM1OUId be intlepentlenliy verdiod Wn mcommend tM1at you contact your tax ativisorto Ootermine me nOP�oprinfA u.se o(Ihls inlonnation.Past performance tloes not quarantee IuWre relums. Gain znd loss inlom�afon is calculaled basetl u0on uniform stantlartls antl Does nol acrounl(or eacM1 indiviUUal clienfs patlicular circumslancee such as the eristence ol M1xtl�in9 Iransanions or cnnsVUCCive sales.Ailhoug�we makn wory eHOn to aElust roe cost basis for ser.uri�oi wpi�al cl�anges,we tlo nat atljusl the cost basis lor ail events.Conlact your inancial Advisor lor quidance m�partiwlar pueslions. Por acwunls wilh ChoiA 5elecl pncing,Ne�omnrssions paitl on your eliqible equity and opuon purohases antl salas a�e appliPtl to Iha Tolal Cwl on a mont�ly basis. Wlth raspea to esXmatetl gelns and losms for lislaq equity optlons,vm havo taken mto aowunt o0��on promlums pel�or racelvAe antl.m rospoc�lo multipie purchasos antllor selos, cnlr.uleted co,vt usinq on averega und pdce fo.all like posibons. \Ne are nm responsible lor any qain anE loss informalion provideE by you or anot�er llnancial instiW6oq you are responsiCle for ensunng Pie accurary ol such informalion.Whel�er providetl by you,anot�Ar fnxncial insliWllon or MSSB,II is your res0o�sibilily to engure Ne attimacy of all ol Ne Eslimalee Gain antl Loss in(ormation. For dienls wishing lo mako vorsus purohasa sales IM1at in�orma[lon noetls[o be comeyftl al lhe fim¢of��e sale.UnIe55 you tell us olhe.hNSe,we uso frstin frsl out�FIFO) ecmunllny. http://ideas.msdwis.com/Site/Secure/GainandLoss/ExportFortn.aspx 10/5/2012 ColumbiaManagement �� Th�a check �a drawn on the account oe � KIMBERLY A WEINOORF EXEC ESTATE OF JOHN F BRADSHAW october 10, 2012 11ALMALN E NORTHPORT NY 11731-3708 ]]]013 F001 65 10Z 1H— 6� ESTATE OF JOHN f BRA�SHAW 11 FLMA LN E NORTHPORI NY 11731-3708 Thia check hae been eent [o you at the requeat of [he ehareholder or an authorized fiduciary. CHECK AMOUNT j6,780.96 � E A T A T B, . L A A H . �, J L,:< � ' 005875706 REDEMPTION �. . . � � . �.. DAFE�.. � � '� . � . . . . . . . . tio ��. PAY TO THE ORDER OF �10/10/12 � � � � � � � AMOUNT � ESTATE OF JOHN F BRAD9NAW `� E6,780.46 11 ALMA LN E NORTHPORT Nt 11�31�770e qCCOUNT NUMBER 0227�0227o0ozo52 PAVABLE AT Sfate Sheet 8ank&7rust ✓/}, J 1 / 11��I��I I� I� ��III Baston MA 02171 r�� •- AUTHORIZEO SIGNqTURE u'00 58 7 5 704��' �:0 1 i0000 28�: 990 5 70 2 8i�• � ColumbiaManagement �,� � Year-End Statemern Pags 1 of 4 StatemeM Period January t,2012-Decem6ar 31,2012 Contact Your F�ancial Professional BRIAN S EAGON MORGAN 5TANLEY SMITH BAANEY LLC AT q1 028182 934758 92 B"3DGT 1 PPG PL STE 1300 PfTTSBURGH PA 15222-5401 Co�act US JOHN F BRADSHAW& �P�M KP.REN A BRADSHAW JTWROS 800.345.6611 11 ALMA LN E NORTHPORT NY 11731-3708 On the I�ernet ��J��d��ll'll��l�6��'�'��I�I��I��d��l'�IU�1��6��L colUm6iarnanagemerrt.can By Mail Cdumbia Management Irnestrnerrt Services Corp.(Ager�q P.O.Box 8081 Boston, MA 02266-8081 e & £ Value of Your Portfolio 50.00 Portfolio Overview Beginning Valw 56,084.42 + Investrnents +a0.00 + Earnings +$101.64 - Rademptions -$6,780.46 - +/-Change In Value +$614.40 Ending Valw 50.00 rranaers are hcluded'm Invesn��en6 u Nedenpilonc.vwr cnage in vaqre k me mcrea�udecrea�inlhevalceafyarsharesPh�stliaiu.tWfec(dsakscharges - a ather fees. AccouM Summary Beginning�alue Changes Ending Yalue on January 1,2012 + Inves�bnenls + Eamings - Redempfions +!- in Value .as o/Oecembei 3i,20i2 Nql-NBh�IBllt — ----...--- --- -- Accowrt Number:00590134795 COLUMBIA DIVIDEND INCOME FUND-A Fund Number:0227 JOHN F BRADSHAW 8 KAREN A BRADSHAW JTVVROS S.i,007.96 +50.00 +557.20 -53.396.30 +5331.14 50.00 AcxouM Number:OQ210D37624 COLUMBIA CAPTL ALLOC MOD AGGRESSIVE PORTFOLIO-A Fund Number: 0592 JOHN F BRADSFWW 8 KAREN A BRADSHAW JTWROS 53,056.46 +50.00 t544.44 -53,384.16 +5283.26 50.00 NOT FUIC INSURED May Lcce Value No Bank Guarantea RB/a5o8 EX+(o8-i�) �' pennsylvania SCNEDULE E �„�� OEPAfiTMENTOFREVENl1E CASH, BANK DEPOSITS & MISC. �Nnea�TaNCerr�aeruaN PERSONAL PROPERTY Resioerrr oeceoenr ESTATE OF: FILE NUMBER: John F. Bradshaw 2112-01051 Include the praeeds oF li[igation and the date the proceeds were received by the estate. /UI property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION Of DEATH � PNC Bank Acct#50-0598-4654 31,008.00 2 PNC Bank Acct#50-0613-1784 13,522.00 3 PNC BankAcct#51-1199-4848 18,753.00 4 Members 1st FCU#26t756-0000 105.00 5 Members 1st FCU#261756-0005 8,230.00 6 Members ist FCU#261756-0041 19,142.00 � Michael Baker Jr. FCU#1439-Savings 115,691.00 $ Michael Baker Jr. FCU#1439-Christrnas Club 1,705.00 9 2012 Buick Vehicle ID#5GAKVCED1CJ209786 34,000.00 TOTAL(Also enter on Line 5, Retapitulation) ; 242,456.00 If more space is needed, use additional shee[s of paper of[he same size. � �.� P1VC � �r.�E��r�t�war October 29. �012 Kimberlv A w"iendorf 11 A1ma Lane East tionhport. ?�I" 117=I RE: John F Bradshaw DOD: 09-19-ZOL-' Dear ?vls. Vv iendorf: In response to vour request for Date of Death (DOD) balances for tbe custoruer noted above, our records sho� the followin�: Checl:ing Account Account r �0059846�4, Establisbed: 0�-02-2011 ,/ JOHI`' F BR�,DSH.AVJ DOD balance: $ �1.007.67 + 0.02 accrued interest � Interest paid Ol-01?012 thru 09-19-20L $ 1.59 YTD Savings Accounf Account # �006li 1784, Established: 12-10?O10 JOI� F BRADSFL��' DOD balance: � 13.821.71 '- 0.09 accrued interest Interest paid O1-01-20L' thru 09-19-?O12 $ 1�.63 I'TD Account r �I I I 994848 - Established: OS-2?-3011 „�� JOHN F BRADSH.AW' DOD balance: $ 18.,'�3.�7 '- 0.10 accrued int�rest Interestpaid 01-01-?OL th,-u 09-19=?012 $ 1.18 YT`D Investment Account The decedent maintained Investment Account� 437�0�� . For further information. vou ma� call 1�e Brokerane Department at 1-800-763-61;I. Pa=e 1 of� Please note that this office provides date of death balances for deposit accounts (IRAs, CDs, Checkino and Sa�in�s). VVe do not process an} financial transactions or provide statements. If you need assistance with an}� of these icems, please call I-888-PI�IC-B.S.'�T{ (1-888-76^_-'_36�) or stop b}�your local PNC Banfi brancn office. Sincerel�. Ivational Financial Sen�ices Center P'vC Bacil�. ?�..4. ?�4emher FDIC 77iis messa�e is intended for the use of the indiridual or entin� to r+�hich it is addressed and mm� contain injornzation that is privileged, confidential and esempt 7rom disclosure under appllcable larr. If che reader o{this message is not the intended recipi.ent or the emploi�ee or agent responsible.for deli»erir.g this nzessage to the intended recinierat; vou are hereh��notified that am� dissemination. disn�ibution or copying of this communications is sflzetty prohibited. 1(you have received this communicution in error. please notifi� me immediatel�° bi�reply�or br telephone at b'DO-'6'-1�-� and immediatel}� destroy chis faxed document Pa�=e '_ oI= St � MEMBERS 1" FEDERAL CREDIT UNION October 19, 2012 To Whom It May Concern: This letter is to verify decedents John and Kareiz Bradshaw's account ending balances. As of ihe dates 9-17-12 and 9-]9-12 the account holders' regular savings, moncy management, and certificate accoLmt obtained the balances as shown below. Regular Savings: $ 10�23 � Money Management: $ 8,229.89 f Ccrtificate of Deposit# 0041: $ 79,142.09 If you have any questions, please feel free to contact me at(717) 697-1834. Thank you, �`��`�,'� �1�ui1��- U ,� Ashley Zimmennan Member Service Representati��e Members 1'� FCU Market Plaza Branch 717-697-1884 �nnU Loui;r I)ri��r • I?C). l3us �lU • Mcchauicsburg, Pcm�st'I��ani� 170:ii • (Sllflj ?g;-?;�g • ��v.m�mbcrslst.nrg �� MICHAEL BAKER JR. FEDERAL CREDIT UNION � Airside Business Park 100 Airside Drive Moon Township, PA 15108 KimberlyA. Weindorf 11 Alma Lane [iast Northport, NY 11731 Cctouer 12, 2012 RE: Estate of John F. Bradshaw EIN 46-6268726 Estate of Karen A. Bradshaw Dear Kimberly, The value of the PCU account as of 9 j17/2012 was $117,395.82 total. The regular savings account had $115,¢91.19 and the Christmas Club account had $1,7�63. ,r `Che vatue of the PCU account as of 9J19/2012 was $117,395.82 totaL The regular savings account had $17 5,69119 and the Christmas Clu6 account had$1,704.63. 'Phere was no activity on the regular savings account from 7/31/2012 until the dividends posted on 9J30/2012. 'Phe Christmas Club had no activ'rty from 5J18J2012 untit the dividends posted o❑ 6/30/2012 and 9/30/2012. Allaciieu is a staie�naul Prurn Glj D1J2G12 until lOj 12�2G1Z, whici� shuuvs aicouncactivity and balances. lf you have any additionat questions, feel free to contact me. Sincerely, �� j/� �i��t�i7 �� , Debra J. Milligan Michael Baker Jr. Federal Credit Union CreditUnion Manager MICHAEL BAKER JR FCU 1G0 AIRSIDE DRIVE AIRSIDE BUSINESS PARK MOON TOWNSHIP PA 15108 FGR INQUIRIES 412 -269-2525 1/Ol/12 10/12/12 1439 1 OR. FAX US AT: 412 -375-3976 JOHN F BRADSHAW 11 ALMA LANE EAST NORTPORT NY 11731-0530 DATE SFX DESCRIPTION PRINCIPAL INTEREST AMOUNT BALANCE 1J01 1 SEGINNING BALANCE-SVGS 109, 893 . 04 1/13 1 SHAI2E DEPOSIT-PAYROLL 800 . 00 110 , 693 . 04 1J2'7 1 SHARE DEPOSIT-PAYROLL 800 . 00 111 , 493 . 04 2/10 1 SHARE DEPOSIT-PAYROLL 800 . 00 112 , 293 . Q4 2/24 1 SHARE DEPOSIT-PAYROLL 800 . 00 113 , 093 . 04 2/2'7 1 SHARE WITHDRAWAL - CHE 1 , 000 . 00- 112 , 093 . 04 3/09 1 SHARE DEPOSIT-PAYROLL 800 . 00 112 , 893 . 04 3J23 1 SHARE DEPOSIT-PAYROLL 800 . 00 113 , 693 . 04 3/31 1 DIVIDEND 153 . 37 113 , 846 . 41 4/OF 1 SHARE DEPOSIT-PAYROLL 800 . 00 114 , 646 . 41 4/20 1 SHARE DEPOSIT-PAYROLL 80� . 00 115, 446 . 41 5/04 1 SHARE DEPOSIT-PAYROLL 800 . 00 116 , 246 . 41 SflE3 1 SHARE DEPOSIT-PAYROLL 800 . 00 117 , 046 . 41 6/30 1 DIVIDEND 144 . 78 117 , 191 . 19 7J37. 1 SHARE WITHDRAWAL - CHE 1 , 500 . 00- 115, 691 . 19` 9/30 1 DIVIDEND 117 . 15 115 , 808 . 34 10/Ol 1 SHARE DEPOSIT 1 , 706 . 78 117, 515 . 12 - - - - - - - - -- - - - - - - - - - - - - --- - - - -- -- - - - - - - - - -- - - - - -- - - - - - - - - - - - - - - - - 1/O1. 9 BEGINNING BALANCE-XMAS 700 . 64 1/l� 9 SHARE DEPOSIT-PAYROLL- 100 . 00 800 . 64 1/27 9 SHARE DEPOSIT-PAYROLL- 100 . 00 900 . 64 2/1G 9 SHARE DEPOSIT-PAYROLL- 100 . 00 1 , 000 . 64 2/24 9 SHARE DEPOSIT-PAYROLL- 100 . 00 1, 100 . 64 3/09 9 SHARE DEPOSIT-PAYROLL- 100 . 00 1 , 200 . 64 3f23 9 SHARE DEPOSIT-PAYROLL- 100 . 00 1 , 300 . 64 3/31 9 DIVIDEND-XMAS 1 . 61 1 , 302 . 25 4/06 9 SHARE DEPOSIT-PAYROLL- 100 . 00 1 , 402 . 25 4/20 9 SHARE DEPOSIT-PAYROLL- 100 . 00 1 , 502 . 25 S/04 9 SHARE DEPOSIT-PAYROLL- 100 . 00 1 , 602 . 25 S/18 9 SHARE DEPOSIT-PAYROLL- 100 , 00 1 , 702 . 25 6/30 9 DIVIDEND-XMAS 2 . 38 1 , 704 . 63�� 9/30 9 DIVSDEND-XMAS 2 . 15 1 , 706 . 78 10/Ol 9 CHRISTMAS DISBURSEMENT 1 , 706 . 78- 0 . 00 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - �� .�� : � , � � . � ' ' � :`�xs ..._ ? _ ..�,..�.,�. �Cl� `-"-"�""^� �� 720 E. Maln Street • Pelmyra, PA 17078 (717) 838-13b3 or 1-800422-1973 tv CHEVROLE7 * 6UICK �k DONTIAC �F * CHEVYTRUCKS �t . �� /,� .�✓.�s'C-w% ��%�''` �%L�A"ifJ� ,�.✓ -��.� � G�ir,� v�i� �.�,e �'�-/.�✓�, ,�i'�'� �,�cm� � �,� ��-- T'>�� ,�y v.�,� ,.�./�.�,� /;�'�ri/f!�%� ,��1� G�/,•�,e ,��,�, 4'r.i� �� .�.�'- ��'d�e� �tJl� dS,r✓� �it/ �' �'�l��G�/C1✓"��'��" � 4d� C�✓.Qer-"; �� "'"' �y ��•�i7� �'�.s/r �'J r`�� /a fh/ /yl�- .� � g�� y�� lc''D.3.S��. KLICK LEW1S...G01Np& QROWINa WITH Yt7Uf 1 1 � � • � � I CERTIFICATE:OFTITL�:FOf�A VEHICLE &9 S , i. 'LT►3L+E3�kQQEII�d547t EIQ7it I . t � _. .,- F , lS�AkYCCp�C�t2CF4'7Bf=: 2'fl1� }r 8t1TUG �Qa1CF'Z'496Q1 :.9f� .; VEHMAFIDQIiiFlG1T10NNUMMA ,. . ) YCAF, 1 . MN001��YCL[ .• � ';,. TRIENUMBER .. . I I��°.90O��TYP6 . � ��:�:W� I� .9EATCM � PRIORTRIlHfAT�` 1'�', OOO�APROGG�IE�� OGOIl1YlEd��`.• '��: OOOY4T�TUB�:': . .• I (��f�� ..��.:uL��M��M �. .�.� .. ,�:,Fw �,�, � ,�:: . , L . , �ATlP�TLLEO U�lEOF198UF UTAAOENWLUIff � t0VW11 OCWA I �� TIILEBR�W�l•. ? � OOCNffP114l�i11B I . � a.�cNN.1,rUac . . . �. 1�MlG9l E'RLLlM MC N[CMMIIOK Y . .. �4f{. . . . . 0.XOlTNICNK 1tG0� - " .. J.MltMbC1WLWAa6aupollN� . -°y�P � - .. TNlf.pq VlMl�u� . JOINT OWNERSHIP WIT� RYIYORSHI ''°�""°'0D°"�""°°""` .nr.asrerreo ovmEn�sl - � ime ewp �� •.�xnwN vo�xaa r�. e.aner¢mxne. KAREM ANN 8 JOHN ' °"°"""°"'°""` � . . P.qROiWlNT1Y.. BRADSHAY °-°""""`""°°`°""°""' qliiXMl110N 2738 I ROSEGARDEN B �' - �=�� 11ECHANICSBURG PA 17QS5 � �=�"��`�`� e.meer xoo t.A(owerim�rr ven�aa � + v.v�cu mrturN�iewm vw . � w.noao vri«cie ,FlP6fIlENFAWHOF' � ' .�IIFNPAVGtOfl!. . %•IBM�M�TAMI • I � M. rs`ab w1�M rw�w�e.m.rmn w mr mn n.�,..u. nm� . . �.�� M�etli m�16.bniW YW TIY b tlw�9uw d IAUa VNi4Jti�wM tlM�.� 'MST L1O!RElEABED �NYeOM law 1Y M►.. . . . WTE �' : C BY � 9ECCfa LIEN R6FABEp , , � �011qPIgOPEPNE9FNGTNl� . . . '.J.�.:. ,_} :f .... � WTE �AWl11M�OONEB! . . . � �.� . . . �T �URqMZE�PEPRE9EM�TIVE KAREN ANN & JOHI�t F � BRADSHAIi 2738 S ROSEGARDEM BLYD , ; HECHANICSBURG PA 17055 p@nnS�/�V811�8 � � . OEPAqTMENTOFTNANSPOPT�TION I • ��i�.rcy ..a m.a.a u.., w rna+ �.A.s a w w�..�wr+rawr��-� : � BARRY� J • SCHOCH+ R• E• y�.T��nT��rMw tlut tlw MnuN�l w tdnprX n�riM Iw�n N Cr IM�onrr: . . a n..ra w�.w . . � . . - �f«'h+�� 1 1 • 1 I ' 1 � 9ueecniem u�o svron» � � n�mn�err onnr uan r��r I�n.ra ena rw w.in uN uw eo io eewne r.e hs ihrd ar�VaYCTrrnb�Wie�Podx-a 9iwlwnnW lon deem a w:- I. . � � ' .ew�W:tltI�WwlafwNMOV�wiCNEC%HEREQOtl�a�wiM.IMtltl�� ,wW.0►1w�w0.sTe�wib In Camnan'(On dseN d an�awnn.Nl�mt d �ro � M�stl�d�vwrt b MNwr Min a Msb). II �iRnot!eK�.artacL}��isnia�w¢rr�vvsanuncauineol YE9ONOO � ° � �aruEtHduxtu+u�cwMafmrt+oxHN,eEw � I � ' .18FLIQMCOfM1UMk" ' . , ..� 9TPE�('.;�. � a . � fJIV n.i 9T�TE DP � i/� � IFNp➢NDt1FRQ1[CN�191FM9AN6Tt�IfYE9.FlNREWIRED�YE90N0� \.JJ iM uY�VM �nM .'mvw WeM b CM� tl Pw b Y�rWY 4�N�. � ,w....qoea..4.,e......e..i.,+m.�.re.,,.. mouus�anEnrw�NCU�wemuriaNruMeEn: � 9q 4F1Y�01MR N�IAl� . wuvrure or wnswr an wnqa�aqrM� N s'"� � "J dTV sr�r¢ nv � 516WNPEOiCG/JRIf fltrtLEC'.WIICMII09qMF11 iiev-isio ex+ �os-os� �, pennsytvania SCHEDULE G �y oePeArnen.or Aevenue INTER-VIVOS TRANSFERS AND INHEIUTANCETAXNETU0.N MISC. NON—PROBATE PROPERTY 0.ESIOENT DECEDEN! ESTATE OF FILE NUNBER John F. Bradshaw 2112-01051 _ This schedule must be mmple[ed and fled if the answer to any o(questions 1 Mrough 4 on page three of the REV4500 is yes. �M DESCRIPTION OF PROPERTY rvnuoernenui[prTMemµyrn�,txEiauunonsnin.00[t�xruw DATEOFDEATH %OFDECDS EXCLUSION TAXABLE NUMBER iFE0.11E0fTUX5iE0. Artb1AroVY0FTHE�EEOFORPFIIEST�TE. VALUEOFASSET INTEREST ;ir�ovu VALUE i Morgan Stanley TraditionatlRollover IRA Acct#617-099618-039 1p8,623.00 100 108,623.00 2 TIAA-Traditional Acct#C4053405 6,628.00 100 6,628.00 3 TIAA-CREF Acct#U4053403 12,g71.00 100 12,971.00 4 Morgan Shanley Rolbver IRA Acct#617-119315-039 970,955.00 100 970,955.00 5 Baker 401 k Plan with T.Rowe Price 12,3t3 00 100 12,313.00 � � TOTAL(Alsa enter on Line 7, Re[apiNlation) ; 1,111,490.00 ❑more space is needed,use additional sheets of paper of the same size. � Page l of2 �,�� /� MSSB C/F q��;(ry�)691-9618 iIER: SunJaN BCCT 91]-099810.pJ9 TRAK FunJ Solwon IRA HAREN A BM�SNAW '2]]BROSEGARDENBlVD50l1TH Mo011c�]t>)]0]-])BS 3rnpFUMBOPS � MECWINICSBURGPNI)055�5]OS Bu�ln�u:pt]�934955f ieraamaw�a��e�mon nei Unrealized Gain/LOSS for Vear 2012 SECUflITV ♦ OIIqNTlV ppIEACpUWEO IINITC09T�5) IO�pLCOST�3� ppJ115TE0C09Ti5) MAFNEiVRLUE�S� G/�qMOUNTp) MO�DINOPERI00 7MUIIIALFVNO9 Mar\NVaiu�'.510063].10 Am�rlcan8tlPo0(A�narica ]]2405 09I19/2012 1290 9,95454 A 9,9BdSd t0.018G1 St.pJ Iongad�2012 F1 05-21 I_ipiviCAntlReinves�mont 18J.503 09/t"//Zpl2 1T.90 2,122.10 A 2,122.10 T.t9J56 1i:In InngatljY0t2 09-21 FunJTotul 9�9.9A8 129� 12.08684 12.OBG6J t2.152A] =itSJ MkLValueva.TOlal 599W.5{ 31I,153.1) Purchaeas NatValuelncreaael $2,181.6J (DecreaeapY Amr�rican Gr Po O�4menca f).661 03;1]I2012 J420 GIM.01 A 61MA1 600.�tl il�/ iong�tl�2012 FI 09-21 38B.JfiJ 0911]2012 9J20 tJ,2B569 A U285.J3 1328932 l0) Ionr�adj2012 -0941 TotalPUrthanaESharas 406dY/ 53d.20 511,889M Sl],BB9.N 513,09].50 4.Ofi LTDivttlen�Reinvestmant 4G]13 09I1)I?01'1 }420 t,5"e3.3) A 1,6533] 1,563_tl6 i).t4 iongatlf2012 09-21 PuntlTotal 051.03� Ja2� 15,452.01 15,U52.81 15p5/38 150 MhcValueve.TOtal f1J,BB8.01 f15,051.08 Purchasee Net Value Increaeal 31,581.9Y (Oecmaae�N Oevis New York Vmrnwre A dP3]0 09I1L2012 3�A� 15.816.96 A 15,81�96 15,�31 J9 -95 G] Iunq adj 4012 09-21 l.T�ivia�nORO�nws�mont 40.961 09I1]/2012 3L01 i,516.96 A 1,51696 1,50]]B -d.18 iongatlj2012 U9.21 FundTotal 488_331 3].01 1�,93252 1],33292 1].29921 _op.�5 MMI.Valae va.Tolal 515,818.98 511,1J9.]1 Purchasee NelValualncreasal St.d2].J1 �Oacrease�N LaeartlEmergingMarke�s 1fi8.520 p911%R012 20A3 3,394.9G A 3,39692 3,31]a6 �iB.HFi longeAf21)11 oVen -09-21 LTDIViOentlRe.lnvestmanl 952]] 9911]/2012 20.13 1,91].94 A 1.91]96 �.900.60 .9.54 Ionged12012 09-21 PondToml 263.89] 20_1J 6,3122fi 5,3122F 5.285tl6 �pr�,W Mkt.Value va.Total f�,�9l.13 S5,]85.88 Pu¢�asee NelValuelncrease/ 51,891.50 (�ecreaseW Mxna9ersCadanaeM�Cp 1]Q005 09I�1/ZOt2 2636 1,1P�3 A ],iV.J3 9.996.83 -t2�.5�) Ionga�j20i2 A -09-21 3±9659 09I1U2012 2fi36 B.J26.10 A B.d'28.18 8,20296 -iJ38d Iongadj1012 . 09-21 To�alPUrchasetlSharea SB9.663 528.J8 515.541.51 515,N1.51 515,2]BdT 465J< L�OivitlentlRnimr,slment p)89 O9/i12012 29.JR PO.tlO A 2�80 tOnA {i�{6 Iongad2012 03-2t Fundtoml 590362 2636 15.5643t 15,56A31 15,29B.ti1 .255I0 Mk1.Value va.Tolal E15,5f3.51 515,298.81 PIlfC�1d9l9 NeNalue increasel i2i�.90 (DacreaeeFY RsPaeners� 2202fi5 09/t]20t2 93.49 l,3]0.01 A ],3I0.0] 1.003Jt 1i01 Iongad�2012 09 21 i.T Dlvidentl Re6rvns6nent 58]41 09/tP12012 03.M16 1,898-5] A �,p9B.9 I 90101 A SO Icng aQ 20t2 09d1 Fun�rolal 2�]pOfi ;{;).a6 9,269.50 9,2fi86a 9,911J�A u.3.t MMt Vama va.Tolal S1,310.01 59,310.10 PurcM1aaee NelValuelncreasel 51,9<0.11 �Dacreaee�M inorMUrgmtlVaiucq G19.230 09It]12p11 Zfi]0 11.9]524 � 1�,9]52q 1�]59.E1 .LiS.ld iongatl�2012 {19-21 ;.i Dlvitleo�f Reimes�ment 6130 09I112012 25]0 112 9d A 11294 1 t I 59 ��95 lon9 ad�2012 0¢21 STDrn��rntlRcinv�3tmen� 1921 f9/2{i201? Zd65 SO.yI 50Ui S�If.P .�'J sport http://ideas.msdwis.com/Site/Sewre/GainandLoss/ExportForm.aspx l0/5/2012 Page 2 of 2 PonOTolal 619.981 26]0 18,13B.99 IB.138.99 1]922.08 -2+591 MMI.Va�u�vs.Totnl f11.915.10 f11,93I.08 Purchas� Nel Value Inc2esu/ (Uacroa�ap -f5048 Vinus Muitl 9aa SM Trm 64 t]99.B8I 09It1/Y012 G.9B B.B]3.3A A 8.8733J 9.691.]J 13 00 iong atl�201I A -0&21 � L i Oivi�eM Reim�stmnnl 4/8.19] OY111/2f112 4.93 2,39A] A 2,35].C7 2,36Y22 �l;5 inng adl Z012 09.21 FundTo�ai 22�8.056 4.93 11,230.81 11,230.81 1t263.59 12]5 MFI.Valu�ve.Tolal f8,891.]. y11,]53.56 � Purc�raas Na1 VaW�Inaaane/ (oecmasep 52.J8023 VIrWSRealEvta�eSxcA 105.152 09I1]I2012 35.92 9]]ZO6 4 3,]]1A6 3,596.10 -:9295 Iunqadj2012 �9-21 LTOmi�enaftr��ostrtwnt 326]3 09/il1Y012 J6.92 1,15fi4J A 1,i66A] 1,10991 �5A.52 Ion9atlIZ012 ne zi PunCTO�ai q16Y5 3G.92 0,94948 4,94JC9 4]pq01 -LJk)19 MNI.Value ve.Totel S3,Tl1.08 50.]O101 � Purchasea Nel Value InoeanN 59]8.95 �oecreaseNl TotalMUWalFUntla 5109,J30.8'/ 5109,J30.B9 �51�3.10 -)0�.�] To�alUnreaiizetlGainlLOas f�09,310.81 f1W,]00.89 , NOl,83].10 -S�Oi.'i] Uisclaime� A-Prired Assets calcula�ion includes all assels erclu�ing Cash,MMF 8 Oeposits This aggreqale numper is not duplicaleE In Tolal�cmunt Value calculalion. tt-Net Value IncreasrJ(�ecrease)wmpares your Total Purchases(excludinq DiviOend ReinvesMeno�wiN��e Markel Value ol all s�ares you holtl o(Ihe lund.TM1IS calculation is lor Informatinwl purposAS nnly,tloes nm m0ecf your lotal unreallzed gain or loss antl sM1OUItl no[Do usAOlor tax purposes. T�a gain and loss Infortna[ion is pmvitleC for inlorma�ianal purposes only,is not a substiNta 1099 form(or any ot�er appropriate lar lorml.ana sboultl nol be usetl for taz preparation. Unraalized 9ain antl�oss values are estimates arM shoultl pe intle0entlently varife�.We recommantl Ihat you r,onpct your tax advisor to tletermine Ihe appropriate use o1 Uis info�mation.Past peAortnanco Eocs not guarnntee fulure retums. Cain antl loss Inlormalion Is calculated besetl upan vnilorm stantlarOS antl tloes not account lor eacM1 in0ivitlual clienCS particular circumstances such as Ihe existence ul hetlqing transactlons orconsUUCtive salee.Al�hough we make evary aflort to adjust�e wst basis lor securities'ca0��l chanBes,we do no�adjust the cosl�asis lo�all avenls.Conlacl your Financial ACvisor lor quidance on patlicuiar questions. For accounts with Choice Selecl Dricing,t�e commissions paiE on your eligible equity antl optlon purthases and sales are aVPlietl lo Ne Total Casf on a monlhty basis. Wil�respnct to eslimatetl gains and losses�or lisletl epuity op6ons,wa have laken into accounl opM1On premiums paid or received and,in respect lo multiple purchases andlor sales. camulate�nst using an avnr�e unil pnce lor all iika pasitions. Wo arn not responsible lor any gain and loss Informa�ion pmvidetl by you or another fnancial'mstiWGart,ynu are responsible lor onsuring IM1O ar.mrar.y of such iNrnmation.Whmher pmvi�ed by you,anolM1erTnaieial instiWtion or MSSB,It is your responxibility to ensure the accura<y of all ol tFe Estimated Gain antl Loss inlormatbn. Por cliFlnLS wi5hing ro make vo5us purc�ase sales Vial intormation noetls lo be coroeyod al tM1e fimo of I�e sale.Unlass you lell us otherwise,we uso�irsl ln Ilrst ou�(FIFO) accounting_ http://ideas.msdwis.com/Site/Secare/GainandLoss/ExportForm.aspx 10/5/2012 TIAA + CREF FlNANCIAL SEIMCES OCtObCC I$, 2OI2 Pti p$NIXIJN Estate ofJohn Bradshaw C/O Kimberly Weindorf I 1 Alma Lane East Northport NY 1 1731 Rc: Karcn A Bradshaw TIAA Contract - C4053405 1H5354B0 � CREF Ccrtificate- U4053403 � Dear Kimbcrly Wcindorf: � We recently received notification of dea[h for Karen A Bradshaw and are now contacting you sincc Estate = of John Bradshaw is a named beneficiary for the above-listed TIAA-CREF retirement accounts. � � The survivor benefit that Es[ate of John Bradshaw is entitled to receive is listed below. Any balances in the � TIAA Traditional Annuity will continue to earn interest, and balances in the variable antmity accounts � and/or mutual fu�ds will fluctuate based on investment performance. In addition, this value can be subject = ro change duc to special spouse provisions or State Statutes. � s Account Value as of 09/17/2012 = TIAA Traditional $6,628.46� CREF �12,971.40 Total $19,599.86 For your convenicncc, wc havc listcd the materials the au[horized representative, gusrdian, execu[or or au[horized power of atromey, as applicable, will need to provide to reccive the benetits: ❑ New York: Allows for elcetive withholding. If you wish ro elect s[ate wi[hholding, please indicatc thc amounts on your application. ❑ SURVIVOR BENEFITS DISTRIBUTION Request Form ❑ Proceeds Plus Supplemental Contract-if payee opHon selected, this needs to be signed and returned in order to complete your request. � A statement signed by thc executor(s) or admi�istrator(s)of thc Estate confirming [hat the Will has beeo presented for probate and providing thc name(s) of thc qualificd trustec(s). • After n Loved One Pa.rses Ativav booklet . The booklet TAK/NG THE NEXT STEP describes thc annuity income options availablc to yo� and contains instructions ro complcte your fortn. . Single St�m Pntments...At n Glmzce which provides answers to frequently asked questions about your paymcnt. TIAMCRfiF Individual & Instimtiunul Scrvices, LLC Member FINRA, SIPC. BENEBUND- GC• Headyuarters: 730 Third Avenuc,Ncw York 100173206 Tel: ?12-490A000 Page 1 of 2 l/�1�, ��5 MSSBGF rypm�;��p�891-98,8 TIER: Reaavep5aletl RCLT81]419315039 C�oiuSalWlRrl JOHN F BMOSHAW 2)JBftOSEGNRDENBLVO50UTH MahIN:O1)7810.JBBB Sw�pFUM8DP5 �� MECN�NICSBURGP,11]055-5]05 8�� jor.aan.w�3�rerizm ne� UnreallzeA Galn/LOSS forVear 2012 SECORIR' ♦ pULNiITY pptE4COUWEO IINRC09T�3� iOfPLC09i�3� AOJUSiE�<O$Tlf� M1qNfTVALUE�f� GLLAMOUNiIi� MOLOIN�PEPIOO 1�SIOCbIOp�inn� Mm4elValu��.{60.ID.93 AmerkanElecMCPaverCo �OOWO 09I19R01P 4J.65 13095.00 A 13,095.00 13.33200 2,q�)U iongadj2012 09-21 9larkror.k Oebl Svat Ftl lnr. "2,M1OQ(NJO �9I192012 d32 i0,359 o0 A t0,956.00 10.91J.84 55]Pd Iong atlj 10iP 09 21 Flretena�qyGOrp 250.000 09/19I2012 03J1 10,85250 A 10,85250 11,21288 3fi0.d9 Ionga��2�1Y 09-21 Plmm Corporele 8lnmme t.800.000 09I19IY012 iB.19 32.�39A0 A 32.]J3.00 33.95520 1 31:'�.'.p iong atlj 2012 Shal .09.Y1 To1e151«kn Optlons EB],UJ8.50 56],0�8.50 E89,l2].9Y 52,J8IA2 �� OCOflYOfl�TEfl%EOINCOME MnK�IWlucftl9A8lAG . Ba<Cap Tr Iv S l�0 5-0333 N60.000 09I19I2012 2Y H9 21 601.10 P 21,501.ID 21,801 00 150.50 iong atlj ?.�12-09-25 CillgmupCapXviti35012- tlU0(100 091191'1012 252fi 20,204A0 P 202(Id.00 20p58A0 -tl'100 longotlj 31-b6 2012-0425 Gmac Lic)1IJ 2-0]3] 8A0 000 09I19/2012 24 tiA 20,69]60 P 20,h9L60 20,Bfi5.60 1]f 30 lonq atlj 201249-25 Moigan 5U n V Cum 5 3l4] 800D00 09/19/2012 24.tl8 i�J,904A0 P 19,904_00 19,93fi.00 -8 00 long ac¶ 45-39 2012�09�25 ahoenixCOS].450i-15-32 �60000 PleasePmvide 20,929,89 � SlmCOry3.6613-i5-1� lG0.000 09i1912012 2396 B,ti18A0 P 8.618A0 B.6]6,00 5]ti0 lonqatlj 2012-49-25 Slm Corp Ei-(�00 12-15A3 Ja0.000 09I19I2012 24 tY 8.20590 P 8,405.90 8.18]YO �;1910 long atlj soiz-uy-zs NfiO(i00 09I19I20�2 � 24.tq 2U,158.ID P 20,]56.10 LO]OB-PO -9H.g0 longaa) L012�09-25 . SubTOlal 1,200.000 f1{.1/ fY8,96t.00 53B,98&00 S�B,B96.00 51�8.00 � SImCpVariable4]011-06- �60A00 O�JI19I2012 23AJ BA9300 P 8,4J3.00 8,53200 +qp4 longatlj 1B zniz-oo-zs TolalCorpombFlKeE 5120,2I0.10 f138,220d0 51�9,688.49 5183.51 Income � �MUTU�L FUNDb MarMel Velus:f<6B,)]!-0B � BlarkrockGibDNltlentllnc ].840.506 09I1912012 t0.36 81,22�.64 A 81,22].84 81,384A5 t%B� ionBatl�2012 . C 09-11 FunCTOtai ].9Y0-SOG 10.38 81,Y21.G4 N1121.84 tl1,3d405 1GnA� MM�.Valueve.TOtal SB1,22).fi{ f81,384.45 Purchaeee � N�I Value Incnaee/ 5158.91 �� (oecnase�N PiEel Adv Floating Rt Hi lnc I,ti46914 09I19I2012 9-96 ]6,163 2fi 4 . 'IB.1B326 ]d,1832E 0.00 Ionq a4j 20�2 C 09-21 FundToial ],609914 996 ]B,16328 ]6,16J28 ]8,16326 U.00 � MkLValuevs.TOtal f�8,160.26 El6,ifillfi Purchana� � NalValv�inc�aaael � (OecmaaeFY FrankiinlncomeC 58433.962 09I19I2012 228 . 13J229.d3 A 133,229.43 1J2,06015 -L.1G9fi� IongaUj2012 09-21 Huntlloial 58.433.962 � 2.20 19J,219.43 �33,229.0.9 t92,060.]5 -1.159bA MML Value vs Tatal E13J,239.J3 y132,060]5 Purchasea � NetValuelncreaeal .51,168.68 �Decroane�l Loomis5aylesS�eat'neC 090A518 09I19I2012 1555 tt9.1914J A 129.19]d4 120.61586 .5qiS8 iangaoj2012 09-Yi FunCTOtaI 8.3110.51N t555 t29,tW.04 i29,t9)4; 116fi15B6 �htlt5& MkL Value ve.To�al it29,19>.44 512e,615.88 Vurc�asee NelValuelncraaae/ �S5B1.58 ��acreasept PrincipalHighvldC 6J93.tl08 09/142012 ]99 50J68.82 A SO.I6892 50,5110] -155]5 langrA�1(1�1 -09-21 fim�talal fi,393.806 ]94 507eG.e2 50]6fi.e2 50,5�t.�1 -2%]5 Mht Vaiue vs.TOtal y50,�68.e3 550,511.O1 � Purchasea http://ideas.msdwiscom/Site/Secure/GainandLoss/ExportFocm.aspx 10/5/2012 Page 2 of 2 Nat Valus Increaael �525�.)S (Dacraaea�fl TaWlMUlualFunde EU0.581.59 S<10,581.59�5�88,1]5.39 �1809.20 Tolal UnreallioG Gainllou 5685,BN.19 38B5,8tl.19t L`5801,845.]9 5�21]8 �.:r oisr.iaimor P�You M1ava pmviCeA�be Vade�islory for t�ie transactioq il was nol available Rnouqh Morqan Stanley Smil�Bamey LLC racoNS. q-Pnced Assels calcu�alion indu0es ail asseb eaclu0ing CasR MMF 8 Daposits.T�is aqqregate num�er is nd�u0lka�ed in Total Acco�m6VMiie calcuialion. k-Net Velue IncreaealfDecrease)comperas your ToUi Purc�axes(eMr.luding DWiOentl Reimesrcnenls)wi1M1 Ue Markat VaWe o�all snarea you�old ol��a Wn�.Tliis ceir,ulation Is for Infurmational0uryosas only,does not reilecl yourlotal unrealizeE Gain or loss anC s�ould nol be used ior iax pur0osea. Tno gain antl loss inlortnation is prwitletl lor inlormalional purposos only,is no�a subsiiW[e 1099 fortn(or any ot�er apPropriate tax Irnm�,antl s�ould not be usea fnr lax preparation. Unreaiiaetl 3ain and loss values ara es�imalas ard shoultl ba inaepentlen0y verilled.We remmmend Ihat you ronlact your tax aMisor lo determine Ihe aOP�opnaie use of�his Information.Pasl paNO�mance aoas not quarantae IuNre reWrns. sd111 dll(�IpSS 1II�Of111`1�011 IS Cdlf.11�dlfld�aSC�U(IOfI Illll/OIR15Ii1lldd/d5 a114 t10P5110L i1CCp1111�(O!22l.�1 IIl(�IVldlld�f�1E11��5�ldl�1Cllld!LIICIII�I4�AlMP.9 VUf.h d9�I1P.B4151PI1f.B 0�IIP.1191I19 IIT115]CGOlIS Of fA1151lIlClIVB Sd�AS.AI1�1011]h W9 T]MP AVClY C��Ol�IO i141�SI��O f,OSI bdAi9�OI SCCIIII�IC9 CdPlldl Chdf1904�WB�Q IIOI rld�U5ll�lp f.OSI bi1515�Of 311 BVGfIL9.C011ldf.l Y011! Financial Advisor lor guidance on particular queslions. Por accoun�s wi��C�oice Solnr.�D�cinq,t�o commissions paA on your oligible oquily and op4on purchases antl sales are aOPlied to No Total Cost on a monihly�asis. Wlth rnapqct la AstlmatAa gains ona lassos for list5a equity option3,we hav5 taken inlo acrounl optlon premiums paitl or recoived anq In respect lo multiple purchasos antllnr sales. calculeled mst using an avaraqe unit pdce for ell like posltlona. We are nol responsible for any gain and losa Inlormatlon pmvided�y you or anm�erfinancial institu6on:you a�e responsible lor ensuring Me acwraq of suc�in(ormalion.WM1et�er provirietl by you,anot�nr tlnanr,i�i instihnion m MSSB.It is your res�mnsibility lo ensure Ne accuracy ol all o(tha EstimaleA Gain an�loss ininrmalbn. For cllenh wi,�ing�o makx vertus purr.hasn salAS ihal infortnatlan neeES to ba r.anv�yv�i at the timn ol tM1e sale.llnless you lell us nt�nrwise,wo uso fvs�in first oW�RFO) uccaunting. �� A S?, �'�S , � r, � � s ��,`?; � /�.�v�'t� C� � 3� _/��._ ��-�v,_�SY' S"`� <d �_______..-----_.__ __ http://ideas.msdwis.com/Site/Secure/GainandLoss/ExportFoem.aspx l0/5/2012 Jason Weindorf From: Rodgers, Anna K <Anna.K.Rodgers@morganstanley.com> Sent: Wednesday, October 10, 2012 1220 PM To: Jason Weindorf Subject: RE: Bradshaw Date of Death Values HiJason, .-., t � ✓ V�liie ot the an�tuity was:+283,108.75. I'hank vuu, .i1n n a. 1Zodp7e rs [2egistered Client Service Associate Morgan Stanley Wealth Management One PPC Place, Suite 1300 I'ittsbtvgh, Pr�15222 Phone:472-434-8024 @-Pax:412-291-7513 anna.kcodgers«��morganstanley.com Investments�nd Services are offered Nirough blorgan Stanley Smith f3arney LLC, member S(PC Movz money where��ou want it, when you need it with online trailsfers. Ask me how or encoll tod,iy at www.mor�;anstanley.com/online. __ . __ _. _._ _.. _._ _ From: Jason Weindorf[mailto:JWeindorf@weindorfcpas.com] Sent: Wednesday, October 10, 2012 10:06 AM To: Rodgers, Anna K (Wealth Mgmt MS) Subjed: RE: Bradshaw Date of Death Values Anna, Thank you for the statements of value for both lohn and Karen. I wili also need a value for the annuity in lohns IRA and the values for the 529 plans. Thanks, Jason Weindorf Weindorf, Wightman. & Co. CPAs LLP 6080 Jericho "Curnpike, Sui[e 306 Co��unack, NY l 1735 63L-670-77?0 631-670-7721 (fax) www.weindorfcpas.com From: Rodgers, Anna K [mailto:Anna.K.RodgersCalmoraanstanley com] Sent: Wednesday, Odober 10, 2012 9;07 AM i Kimberly Weindorf From: Kimberiy Weindort<jkweindort�optonline.net> Sent: Tuesday, October 23, 2012 10:44 AM To: kweindorf(�weindoHcpas.com SubJect: Fwd: Daily Balance Sentfrom myiPhone Begin forwarded message: From: "Hoadley, Alicia" <AHoadlevC�mbakercoro mm> Date:October 23, 2012, 10:25:25 AM EDT To: "jkweindorfCa�ootonline com" <jkweindorfRaootonline net> Subject: FW: Daily Balance Hi Kimberly, Please see below for the balance as of the dates you requested. If you require anything further, please let me know. Thank you, Alicia Alicia Hoadley HR Specialist Michael Baker Corporation P 412.269.4675 � F 412.375.3987 � ahoadievC�mbakercorq com _ _ ___ __ __ _._ _.__ _ From: Atkins, Carol Sent: Tuesday, October 09, 2012 10:53 AM To: Hoadley, Alicia Subject: RE: Daily Balance Hi Alicia, blc. [3radsha�v's market value was as follo�vs: • SeptembeT 17,2012 = �12,324.74 • Septembex 19, 2012 = 12,313.10 � If you have any orher qucstions or need additional information, please let me kno�v. "Chanks, t�:�rol .itkinn ,(ac6sou 12clircmi�nf Nlan ticnicc.) C�lient Administration i. f7o�:a�'n..r i �. ' i� '�t_� � �:I '�, I�li 1 O�binqs^4i115, h�liJ 71 I I7 From: Hoadiey, Alicia fmailto:AHoadleyCa�mbakercorp coml Sent: Tuesday, October 09, 2012 10:15 AM To: Atkins, Carol Subject: Daily Balance Hi Carol, One of our former participants has passed and his beneficiary needs his balance as of 9/17/2012 and 9/19/2012. The participant isJohn F. Bradshaw—xxxxx7721. Thank you, Alicia Alicia Hoadley HR Specialist Michael Baker Corporation P 412.269.4675 � F 412.375.3987 � ahoadlev(�mbakercoro.com T . Rowe Price (including T. Rowe Price Group, Inc . and its affiliates) and its associates do not provide legal or tax advice. Any tax-related discussion contained in this e-mail, including any attachments, is not intended or written to be used, and cannot be used, for the purpose of (i) avoiding any tax penalties or (ii) promoting, marketing, or recommending to any other party any transaction or matter addressed herein. Please consult your independent legal counsel and/or professional tax advisor regarding any legal or tax issues raised in this e-mail . The contents of this e-mail and any attachments are intended solely for the use of the named addressee(s) and may contain confidential and/or privileged information. Any unauthorized use, copying, disclosure, or distribution of the contents of this e-mail is strictly prohibited by the sender and may be unlawful . If you are not the intended recipient, please notify the sender immediately and delete this e-mail . z BAKER 401(K) PLAN �ohn F Bradshaw �io i Rowe P�ice ao eoz n3as Retirement Account Summary Baltimore MD 21297-13A9 July 1, 2012 to September 30, 2012 Contact Us--rps.troweprice.com ar Mo6ile--www.troweprice.mobi 1-800-922-9945(M-F 7 a.m.-10 p.m Eastern Time) ao-oiozrse-naa Ending Balanee � �0.00 John F Bradshaw Changein Balance -$11,743.16 2738 Rosegrdn Bivd S Mechanicsburg PA 17055 1 � � 1 1 Your ending account balance is zero for this siatement peried. BeginningBalance Ei1,743.16 Therefore,yourAssetAllocationcouldnotbecalculated. Formore - Withdrawals7Dehits $1?,16t59 information, seethelnvestmentActiviNsectionoithisstatementorca!l - Fees $0.00 1-800-922-9945andrequestadetailstatement. + Gainftoss $418.43 Ending Balance 50.00 Vested Balance $0.00 � � 1 1 1 � � Your ending account balance is zero for this statement period. Your ending account balance is zero for this statement period. � The�efore,your Market Return&RiskAnatysis could not be The�efore,your Estimated Monthty lncome at Retirement could not be � calculated calculated, � � � � � � _ � � — — ---- -—'— .. Retire with conf�cence� T��ICQ ___ ____� __ _ . _�._ _ INVEST WITM CONf�OEN[E iaS90/+Hl02FW-121 W9 Page 1 oF 3 lohn F Bradshaw Retirement Account Summary July 1,2012 to September 30,2012 �ivarsitieatian To help achieve lonq-term reiirement securiry,you should give carefui consideration m the benelits ola weil-balanced and diversilied investment portlolio. Spieading youi assets among dilferent rype5 olinVestments can help you achieve a lavorable rafe olrefum, While minimizing youi overall nsk o//osing money This�s because market or other economic conditions that cause one category of asseis.or one patlicWar securiry,to pertorm very weli oRen cause another asset category,oi anofherparticular securiry,to peAorm pooily. I!you invest more than 20%olyour retiiement savings in any one company or industry,your savings may not be propedy diversified. Although diversdicafiort is not a guarenfee against loss,it is an eBective svategy to help yau manage investment risk. In deciding how m invest your retiremem savi�gs, you should take in(o accounf all ol yourassets,including any ietirement savings outside olthe Plan. No single approach is righf lor everyone because,among ofher lactors,individuals have dillerent(nancial goals,di(lerent 6me horimns/or meefing the(r goals,and diflerent tolerances loi risk. it rs also important to periodically review your investmen�porttolio,your investment objectives,and�he invesfinenf options under the Plan m help ensure that your retirement savings will meet your refirement goala Por moie inlormalian on individual investing and diversification,vrsit the�epartment o/Labor website:httpllwww doi.govlebsa/investing.html. Vesting Vour vested account balance may con(ain mulhple contribufion sources with dillerent vesting schedules. Vested balance relers to the amoun(olyouraccount balance that you are entitled m receive when you terminate employmenL You are always 700°!o vested in the portion of your accounl lrom any contributions you make(for exampie: contribufions out o!your paycheck or rollovers lrom previous plans),plus or minus any associated earnings orlosses. Vou become vested in all company matching oi other employer contributiorts and any associated eamings or losses based on years of service. Please reler to your summary A�an description for more information about you�vesting schedule and details on how to calculafe yow vested balance. 'VourAccounf Remm represents an estimate olynur poMolio remm based on available account data usmg the tlme-weighted dairy vaivation calculation widely used by linancial anatysts. The remm rellecfs the resWts of yourinvestment selections as well as account activity. All remms over one yearare annualized. Other retum formulas mayyielddifferentresults. Pas[per(ormanceisnoguaranteeo(futuraresults. Please review yourstafement and report any errors to T Rowe Price wifhin 60 days. � s s � � s � � s � � � s s � � � h'.ebre wiih confidence�— - - 1-1�17�'1'Ci 1�� iNVEST WITM CONFIOENCE IDs9o��000z84-tzloos Page 3 of 3 REV-i5ll EX+ (10-09) `� � pennsylvania SCHEDULE H OEP�pTMENTOFNEVENUE FUNERAL EXPENSES AND wnearnweevixa�rurw ADMINISTRATIVE COSTS RESIDENT�KEOENT ESTATE OF PILE NUMBER John F. Bradshaw 2112-Ot051 Decedent's debts must be repoHed on Schedule I. [TEM NUMBER DESCRIPTION AMOUNT A. FUNERALEXPENSES: 1' Partherrrore Funeral Home&Cremadon Services, Inc. 11,161.00 2. JLN Monuments-Head Stone 4,075.00 3. Royer's Flowers 8 Gifts 616.00 4. SlateHillCemetary-Gravepurchase 1,125.00 s. Pastors Ron Berrus&Jesse Eaton-fee tor religious sennces 300.00 6. Grave opening-Slate Hill Cemefary 1,690.00 �. See attached Schedule 194.00 8. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) ____.___ ______ ______ ___ Street Address Ciry— ._..__--- ---.___... ---- -�-------._----�State.___.—ZIP.... Year(s)Commission Vaid: z� At[orney Fees: 1,939.00 3. Family Exemp[ion: Qf decedenPs address is not the same as daimant's,a[tach explanation.) Claimant Street Address City__ _ ______— — __.__._ ___-- .__._State____ZfP__._._ —_ Relationship of Claimant to Decedent 4. Proba[e Fees: 559.00 5. Accountant Fees: 6. Tax Return Preparer Fees: �. Closing Costs on Sale of 2738 Rosegarden Blvd S. Mechanicsburg, PA 18,450.00 8 Mileage-Travel to take care of esfate 4 Vips(482 miles roundtrip)@.$.55 per mile 1,060.00 9 Packing Supplies 175.00 �o. Postage 22.00 it Ufilities 1,105.00 i2. Home Maintenance 1,352.00 TOTAL(Also enter on Line 9, Recapitulation) ; 43,823.00 If more space is needed, use additional sheets of paper of[he same size. ��, , I ,,/j .�� A Family Tradition Of Caring� _� :`� ��, PARTHEMORE Funeral Home & Cremation Services, Inc. Mrs.Kimberly A.Weindod 9/20/2012 I 1 Alma Lane East Northpoct,NY !1731 For the Secvice of John F.8radshaw 1303 BriJge Street We sinttrely appreciate the confidence you have placed in us and will continue to assist you in every way P.O. E3ox 431 we can. Pleaze feel free ro contact us if you have any questions in regard to this starement. The following New Cumberland, PA U070 is an itemized statement of the services,facilities,automotive equipment and merchandise that you selected (717) 774-7721 �'+hen making the funeral arrangements. (Fax) 774-5546 Terms Due Date Account# www.parthemore.com Net 30 10/20/2012 2012078.0 Description Amount SERVICES 8c MERCHANDISE Traditional Funeral Secvice 6,395.00 ' Dove Stationery Set 165.00 Gilbert W. Parthemore, l8 Gauge Steel Casket,Bronze 2,650.00 Founder 12 Gauge Galvanized Steel Vault 1,345.00 To[al Services and Metchandise 10,555.00 Gilbert J. Parthemore, Supervisor CASH ADVANCE ITEMS Stephen K. Parthemore, CFSP Death Notice,Harrisburg Patriot 485.52 20 Certified Copies of Death Certificate 120.00 Bruce R. Parthemore, Total Cash Advances 605.52 Pre-Need Coordinator, CPC � Professional Memberships: NFDA • PFDA DCFD,1• CC:FDA G �,.��w c,��Q �� !h.•R�dr >nu A)ru�r. ihr Pr,�ple l�u I u..i I Total S 11,!60.52 Payments/Credits so.00 � - � �,4 � �Balance Due s<<,�bo sz � ._ - � - �"-�"a�-�,-�__ = �J '' — --- — t�,� � _ �Aa� � �n �n , ��/iZ� �'`/ n .TLN IIONU�ILV'l'S 93 BEECHWOOD STREET FARMINGDALE, NY 11735 516 810-8023 CELL 631 420-1740 FAX JIMNEUBURGER@AOL.COM EMAIL May 13, 2013 Mrs. Kimberly Weindorf 11 Alma Lane East Northport, NY 11731 Dear Mrs. Weindorf, Per our prior conversations, I am advising of the quote to add a memorial monument to your parenYs gravesite at Slate Hill Cemetery in Camp Hill, Pa. The monument will be 3'6" x 1'6" x 0'10"with a polished face, smooth back, balance rock pitch with rounded corners. The color will be "Carnelian". It will sit upon a base which will be 4'4" x 1'2" x 0'6" with a polished top, balance rock pitch also in "Carnelian". I have spoken with the person from Slate Hill who digs the gravesites and he will pour the foundation which will be 56" x 18"wide and 4'0" deep. He strongly recommends that the foundation be at that depth to prevent"heaving" caused by the frost line. I do not know how the other monument company was able to quote you a foundation fee of$400.00 but can only assume that it was going to be dug only 2'0 or 2 '/�' deep which I strongly urge against. The cost of the monument is: Marker and Base...$3325.00 inscribed per sketch, shipped and installed at cemetery Foundation...$750.00 Total cost...$4075.00 I would require a deposit of$1125.00 PLUS the cemetery foundation fee of$750.00, a total of $1875.00 in order to the granite and begin this work. The second payment($1100.00)would be due at the time I forward a final sketch to you for your approval and the final payment($1100.00)would be due when I am ready to ship the stone to Pennsylvania for installation in the cemetery. Please review and call me if you have any questions or if you would like me to send along the necessary paperwork. Thank you. Sincerely, Jim Neuburger JLN Monuments . Estate of John F. Bradshaw Schedule H Flowers Royer's Florist 243.80 Royer's Florist 90.10 Royer's Florist 28.09 Royer's Florist 10.60 Royer's Florist 243.80 Total Flowers 616.39 : _..._.. - _ _ �_ - - - - Order: $QQ$9 Clerk: 11 Sale Date: 09/19/2012 Time: 13:33 De�ivery Date: 09/24/2012 ooW: MON Store: 30 Del Date: 09/24/2012 �oW� MON De1 Code: LOC... Delivery Code: LOCAL First Loc o�de�: 84489 A=�e No: First Loc ro: JOHN BRADSHAW oe��erya,dd�ess: JOHN BRADSHAW BIBLE BAPTIST BIBLE BAPTIST 201 W MAIN ST 201 W MAIN ST SHIREMANSTOWN, PA 17011 SHIREMANSTOWN, PA 17011 Store Fhone: 717-730-4090 �oc: CAMP HILL BETWEEN 8:30 AND 9 FOR DELIVERY II I I I I I(I I ( I 'I BETWEEN 8:30 AND 9 FOR DELIVERY wire: This order is filled!! PN �ty. Description Designer Amount ._.._....._.._............................................_.._____.._.___.._.-. 22 1 CASKET SPRAY �220.00 , S12-4465, AS SHOWN °-----°-------------------------------------°-------------°--°-------------•------------------ 82 1 RIBBON ADD-ON $10.00 ----- -----------------------------------------------------------------•-- ----------- -------- 2 TAILS, WHITE BANNER, ONE TAIL Amount $230.00 "TO JOHN" OTHER TAIL"LOVE, Phone $0.00 KAREN" 09/24 Delivery $0.00 SubTotal $230.00 Coupon $0.00 DiStount $�.�� 7ax $13.80 tv °•�i�.OYERS'I�owers� gijts Occasion: � RegisterSeq: ToWI $243.80 �� C A R D Customer. g_C_ KIMBERLY WEINDORF 30 STATUS: 6 11 ALMA LN EAST NORTHPORT, NY 11731 Ph (631)871-2108 Wk III I II I II I ' I II ""„"'•"421610l13 Auth: 72982P _ Order: $4568 C�erk: 76 Sa�e Date: 09/20/2012 7ime: 13:33 - - - �- - - - -- - - Delivery Date: OJI24IYO�Y DOW: MON Store: 3� Del Date: Q9l24l2012 DOW: M�rj �e�Code: LOC... Delivery Code: LOCAL First Loc o�aer: $4568 A��Np� First Lec ro: JOHN BRADSHAW �eitve�y ndd�ess: �OHN BRADSHAW BIBLE BAPTIST BIBLE BAPTIST 201 W MAIN ST ST 201 W MAfN ST ST SHIREMANSTOWN, PA 17011 Ph (717)... SHIREMANSTOWN, PA 17011 Ph (717)761-6040 Store Phone: 717-730-4090 �oc: CAMP HILL PLEASE DELIVER AFTER 8:15, PREFERABLY BEFORE 9 � II I I III�) I I II I II PLEASE DE�IVER AFTER 8:15, PREFERABLY BEFORE 9 wire: This order is/illed!! PN �tY. Description Designer Amount -___-_..._-_..__..._._...___..__.____....__._....'._...__......_.___. e^3 1 FUNERAL ARRANG $75.00 FTD ADORNMENT WREATH---HANGS OFF THE CORNER OF THE CASKET ON THE OUTSIDE--INCLUDE SOME RED ROSES WITH THE U�.VENDAR FLOWERS- 111 LOVlllg MBfilOry, -----------------•------------------------------------------------------ -------------------- Caf01 82 1 RIBBON ADD-ON $10.00 °----------------•------�------------------------------------------• ---••--------- ----- WHITE BANNER TO READ "LOVING Amount $85.00 BROTHER" —RED RIBBON TO HANG Phone $0.00 09/24 Delivery $0.00 SubTOWI $$5.00 Coupon $0.00 Discount $0.00 Tax $5.10 t�i �i�OYERS'I�owers�'y gijts Occasion: � RegisterSeq: ToWI $9�.1fl V � In Loving Memory, Carol � A R D CuStomer: B.C, KIMBERLY WEINDORF 30 STATUS: 6 11 ALMA LN EAST NORTHPORT, NY 11731 Ph (631)8'4216�10/13 Auth: 99303P llil I llil i il II I II Order: $¢4J� c�erk: 11 Saie oate: 09119/2012 7ime: 13:33 �:/ Delivery Date: O9IZ4IZO�2 oow: MON Store: 30 oel Date: pg(24/2012 oOw: MON Del Code: LQC. Delivery Code: LOCAL First Loc o.de�: $4491 Acct No: FI�St LO� ro: JOHN BRADSHAW oerve�y nddress: JOHN BRADSHAW BIBLE BAPTIST BIBLE BAPTIST 201 W MAIN ST 201 W MAIN ST SHIREMANSTOWN, PA 17011 SHIREMANSTOWN, PA 17011 store Pnone: 717-730-4090 �oc: CAMP HILL BETWEEN 8:30 AND 9 FOR DELIVERY II I 1 I I I I I I II I II BETWEEN 8:30 AND 9 FOR DELIVERY wire: This o�der is filled!! PN �ry. Description Designer Amount _._...___....._...._....__-_..._.......__......_-_._...__......._..__... 75 10 ROSES-LOOSE $2.65 10 WHITE ROSES, IN WATER TUBES WRAPPED IN PLASTIC. NOT PRESENTATION Amount $26.50 09/24 Phone $p.pp Delivery $0.�0 SubToWl $26.50 Coupo� $0.00 oiscount $0.00 iax $1.59 gY'rA Occasion: � Register Seq: Total �r'�`OYERS'j�owerr Fy gifts $28.09 � G A R D Customer: g.C. KIMBERLY WEINDORF 30 STATUS: 6 11 ALMA LN EAST NORTHPORT, NY 11731 Ph (631)871-2108 Wk III 1l IIIIII (I I II •""„`"„'421610/13 Auth. 31�42P l II order: 84490 Clerk: 11 Sale oate: 09/19/2012 rime: 13:33 V ' Delivery Date: O9IZ4IZO'IZ DOW: MON Store: 30 oel Date: pg/2q/2p�2 DoW: MON Del Code: LOC... Delivery Code: �OCAL First Loc order: $QQJQ n��c No: First Loc To: JOHN BRADSHAW oa�i�erynddress: ,10HN BRADSHAW BIBLE BAPTIST BIBLE BAPTIST 201 W MAIN ST 201 W MAIN ST SHIREMANSTOWN, PA 17011 SHIREMANSTOWN, PA 17011 Store Phone: 7�7-730-4090 Loc: CAMP HILL BETWEEN 8:30 AND 9 FOR DELIVERY II I I (I I I I I II II BETVUEEN 8:30 AND 9 FOR DELIVERY wire: This o�deris filledrr PN pry. Description Designer Amount ------�----------�------------------�----�-- . 3 1 LOOSE FLOWERS $10.00 , 1 BAG WHITE ROSE PETALS Amount $10.00 09/24 Phone $p.p0 Delivery $0.00 SubTotal $10.00 Coupon $p.00 Discount $0.00 7ax $0.60 i�i °�i�OYERS',(dawers �gifts Occasion: � RegisterSeq: Total $�Q.60 \_l C A R D Customer: g C KIMBERLY WEINDORF 30 STATUS: 6 11 ALMA LN EAST NORTHPORT, NY 11731 Ph (631)8`4216�10/13 Auth: 94027P III I II III I II II Order. H44HS Clerk: 11 Sa1e Date: 09/19/2012 Time: 13:33 -- - - -- - `�J -- ---- Delivery Date: O9IZ4IZO'I? oOw: MON Store: 3Q Del Date: 09/24/2012 ��W� MON Del Code: LOC... Delivery Code: LOCAL First Loc ome�: 84485 Acct No: FIrSt LOC ro: KAREN BRADSHAW oerverynddress: KAREN BRADSHAW BBLE BAPTIST BIBLE BAPTIST 201 W MAIN ST 201 W MAIN ST SHIREMANSTOWN, PA 17011 SHIREMANSTOWN, PA 17011 Store Phone: 7�7_730.4090 �oc: CAMP HILL BETWEEN 8:30 AND 9 FOR DELIVERY III II III IIIIN�III II BETVVEEN 8:30 AND 9 FOR DELIVERY w�re: This order is filled!! PN Qty. Description Designer Amount -------------�---.. --.-......._.._._..... 22 1 CASKET SPRAY $220.00 S12-4465, AS SHOWN ----------------------------------------------------------------------------°--------------------- 82 1 RIBBON ADD-ON $10.00 -----°-------°------------------------------------------------------------- --°---•----- ------ 2 TAILS, WHITE BANNER, ONE TAIL Amount $230.00 "TO KAREN"OTHER TAIL"LOVE, Phone $0.00 JOHN" 09/24 Delivery $0.00 SubTotal $230.00 Coupon $0.00 Discount $0.00 Tax $13.80 Iy Occasion: � RegisterSeq: Total $Zq3.gp '��ERS'.��owers�jgifts C A R D Customer: B C KIMBERLY WEINDORF 30 STATUS: 6 11 ALMA �N EAST NORTHPORT, NY 11731 Ph (63+)871-2108 Wk III I III III II I II 421610/13 Auth: 52382P STATEMENT 9 �� DATE / _ �—/� TO Kim ��in�or� II / II�q r�� TERA �dsf �o�-� o�f /v-l- ��7�3/ IN ACCOUNT W1IZi� / S 1 �°��4 /3 �'� S/Q� i��//,t�q! � ;// �°�4 ��/ � �� /p 'X D ' ur:a o //� .>� /'� ,� o f 2 � rnl��s /sF-2- 7� � rr 9' Ql�rr ra s �r /�in r1 n1 �037 {�9rves f,J� . �e a-rt,'c s u / l7 ..� /2, � � D �� em.m zseiz Klm- I cailed the Funeral Home Just to make sure that the payments weren't pald. . . I had spoken wlth them as we were making the plens and thought they were going to make the payments. . .anyway,when I checked wBh them today,they sald that they had noted that the famlty would take care of the payments. So we are ail on the same page-ylppeell Here are the namea for you: � Planist-Becky Flaymond ��/ Pasrors-Ron 8ertus✓ '��D �� Je�Eata, ✓� $I DD — '� AudloNideo-DanFranGs '� $�D .dM1I4934 SST os JoF�I F BR]wBN�►W DSCD DATE � `7 _ 60-1273/373 RIMBBRLY A WBINDORI� SSTR7C PAY TO THE ORDER OF � $ D� " DOLLARS PNC Baak, National Aesociatioa Central PA MORRI9 PLAINS 0 9TOP & 9HOB018Z ,/ /} Non-Negotiabie Customer Copy MEMO�/L�J� (�—, �/�JnI�//G�/ !�L/�,�p -Tr �or—�t"�""\ oozoo-o2�z - PAPER FOR GL TICKETS AND CONVENIENCE CHECKS �1� 1�j `�; :�; STATEMENT DATE /�- y - �o�= TD �� ei��q�Or � // �/�� `� � TERMS ��s ol-f" or f V /l 73/ IN ACCOUNT WI H � /3�"� S/,� , ' �P . h��/ �°� i��ir O in ?- ��o.f ir o i� jq s f� �7�,� �kq��, h'. ��/.s - �, �. y 6 0 — ,�r� i�.� _ (. — �ia�- – -_— ---_o�r/ 69� '� ade�rv 258,Z Estate of John F. Bradshaw File no. 2112-01051 Schedule H, Funeral Expenses Descrtiption Amount Pianist for funeral services-Becky Raymond 50.00 Sound booth technician for funeral services-Dan Francis 50.00 Refreshments for out of town guests-Jo Jo's Restaurant 85.00 Photos for funeral -Walgreens 9.00 194.00 ��ire�l�/1. There's a wayTM #02630 555 LARKFIELD RD �o �o;s Pizza 8 Pasta EAST NORTHPORT NY 11731 107 West Main Street � 631-288-�093 MechanicsburB, Pa 11055 415 2439 0071 09/19/2012 12:30 PM (717) 755-8292 INTERNET PHOTO 427728 A 8.38 SUBTOTAL 8.36 Date/Time: 2012-09-23 06:41 PM SALES TAX A=8,625% 0.72 Order Number: 5d342 Account Type: CREDIT M 3TERCARD ACCT 4216 9.08 EDC Tran ID: 9283oe333 CHANGE .00 Server: Admin ---------------- ------- — iHANK YOU FOR SHuPPING AT WALGREENS PURCHASE DID YOU KNOW THAT YOU CAN EARN POINTS APPROVAL ON HUNDREDS OF ITEMS IN-STORE AND ONLINE? SEE OUR WEEKLY AD fOR MORE Entry Made: Swiped INfORMATION. RESTRICTIONS APPLY, SEE Card Number: XXXXXXXXXZXX421fi PROGRAM RULES FOR OETAILS, r,�rd ENpire: XX/zX . RFN# 0283-0712-4392-1209-1903 Card Type: Mastercard IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII ApDro�valeCotleme: lfi 4NPWEiNUOkr Reference Number: 9645 � balance� I'QWarCjS pUP.LHASE: $84.90 How a re we do 1 ng? Gratuity: Enter our monthly sweepstakes for $3 , 000 casf-i iutal: �jSit ,",.i',hnP,��ln�� drkllUWli��PK, I'ELL'1PI UF www . wAGCARES . caM -��*#***#****#*#**** eoodsdnd/uiae; ei� ;, n..� amniint or Cell t011 ft'eB ' the rotal shown herw� dnd ac��er.� 1 -800-658- 1584 � perloim �hr. oblia�tions set fwth witMn 72 hours to take a short �„ �, ,Imr.ou,�� 's aareement with issuer survey about this Walgreens visit SURVEY# 0263-0712-439 ,,,,,,,,� ,� __ ... __ PASSWORD 2120-9190-321 Far contest rules see stare or WWW.WAGCA�ES,COM w ~�� . . LAwOFFlCE9 � ,�'� � �� P.0.80x1137 FLauuBURG,PA 17108-1131 109 LocUS'r Srncer DAVID A.WION HAMAISBUaG,PA 17101 l{3 E.MAM STAEET Frt.�HC�s A.Zu�u HuMn+e�sroww,pA 17036 IEAN D.$EIBEAT (717)236-930I SHELLYI.KUNKEL ��232_�488 (717)566-2501 F,Ut(717)2;6-6100 EMAIL WZSQa MINDSPAING.COM October 1, 2012 Estates of Karen A. Bradshaw and John F. Bradshaw c/o Kimberly A. Weindorf 11 Alma Lane E. Northport, NY 1173 S FOR PROFESSIONAL SERVICES RENDERED Fees: 9-10-12 TC from Jason Weindorf - spoke re: Karen's terminal cancer, (:20) N/C John cardiac hospitalizarion; discussed lookback, possible assets transfers, referral to Marielle Hazen for emergency planning 9-11-12 TC from Kimberly Weindorf- spoke again re: asset transfers; (:45) N1C life expectancy for Karen,effect of disinheritance of John; review asset transfer issues w/DAW;TC per KW request to Jason Weindorf- discussed same in further detail 9-13-12 TC from KW - discussed additional account transfers,elecfive (:20)N/C share of estate should they transfer funds from Karen to daughters bypassing John 9-19-12 TC's from KW - discussed death of both Karen and John 1;15 Bradshaw; possible probate, funeral payments, interment fees; TC to Gib Parthemore - spoke re: death certificate availability, SS notificaHon;TC to KW - obtain dob and SSN info for both Karen and John;obtain deed from Ionni 9-20-1 Z TC from/to KW - discussed fees for estate administration :10 9-23-12 Confirzn Cumberland County assessment values on RE;TC to :35 Diane Jenkins re: possible lisring, riming/availability to meet w/ clients 9-25- 12 Draft estate info sheets, petition for grant of letters;online 1:30 application for EIN'contact Computershare - confirm Pnidential stock owned by John Bradshaw �� 9-25-12 Drive to Carlisle to meet Kimberly and Jason Weindorf to probate 1:40 both estates; discussion about bonding; issuance of shorts; review Prudenrial stock;pull copy of Grace Bradshaw estate file to review TOD stocks, obtain copies of all; review asset quesrions w/KW 9-26-12 Email from/to KW re: listing of RE for sale :10 9-27-12 Checklists for both estates;TC to Morgan Stanley - spoke w/Anna 2:10 Rogers re: DCL requests;draft authorizarion L;TC to Michael Baker FCU - left msg; return TC from Deb at MBFCU - spoke re: DCL requests;con�rm Prudenrial Financial stock value as of 9-19-12; download and complete transfer pkg from Computershare; engagement L; 10-1-I Z 'I1vo TC's from Jason Weindorf re: representation - spoke (:20) N/C re: engagement L,calculation of fee, request to provide all short certificates Time spent - 7:00 @ $200.00 per hour = 51,400.00 Costs incurred listed on separate bill: $ 983.00 TOTAL BALANCBDUE .t2,383.00 Thankyou. \ �'`]/7- � s.�xd � �q 9 --_ 7NISISA BILL FORSERVICESR�'NDERED PLEASESEND PA}'MBNT TO OURNAXXISBURG OFFlCE . � �/' GWOfFlCES , �'�%�u//v `�S� `�5M/ �C�007�6 tl P.O.Box 112t H�qAISeVRO,PA 17108-1111 l09IACU4TStRLBT DAVIDA.WION ��BUItO,PA17I01 Fp.v+c�s A.Zu�u 1 13 E.M�rta Srrteer JEAN�.$EIBERT (71'p 236-9301 F3UMMELSTOWN�pA 170�6 SHELLY 1.KUNKEL (7I�232-1488 ��)5664501 FaX(7l7)236-6100 EMAII:WZSQMQJDSPRMG.COM September 28, 2012 Estates of Karen A. 8radshaw and John F. Bradshaw c/o Kimberly A. Weindorf 11 Alma Lane E. Northport, NY 11731 FOR PROFESSIONAL SERVICES RENDERED Costs incurred: Register of Wills - probate fees (Karen A. Bradshaw Estate) $89.50 (John F. Bradshaw Estate) 443.50 Advertising - Cumberland Law Journal (for both estates) 150.00 Central Penn Business Journal (for both estates) 300.00 TOTAL BALANCEDUE $983.00 Thankyou. SJK/kd THIS ISA BILL FOR SERVJCESRENDERED PLEASES�'NDPAYMENT TO OUKHARRISBURG OFf7CE - _� EFORM124934 ssx or oo� F BRAD3HAW DBCD DATE �� 60-1273/313 KIMHBRLY A WEINDORF EXTRX PAY TO THE �/0� /7 /LU � �`�� ORDER OF �� .��i/ D r DOLLARS PNC Bank, Natioaal Aeeociation . Ceatral PA MORRI3 pLAIN3 @ 9TOP 6 SHOB0182 Non-Negotiable Customer C�py MEMO I�I�/I� /✓��DI� >aozoo-o21z PAPER FOR GL TICKETS AND CONVENIENCE CHECKS I ' ' 1 ............................................................................................................. .... _ . . "� 09J21 09)21 U-HAUL MOVING 6 STORAG HUNTINGTON ST NY $142.67� ..................................................................................................................................... ................ .........._.........................PHONE NUMBER:8005280463.................................................... ........ � Come check us out. NAME:NO NAME PROVIDED R i Join tn the conversation. .....................................PICKUP:09/21(12.................................---.......................................... ...................................................................................................................................................... I RETURN:HUNTINGTON STA NY 09/22/12 .....................................AGREEMENT NUMBER:00284945........................................................ � Find us on�acebook ....................................................................................................................................................... 09/22 09/22 GIANT 6120 MECHANICSBURG PA $49.05 I wwrahabook.ean/dtllank .._...................................................._......._..._..._.__.....................................--.............---........_.. ��`��'z�:�� Ninc�u CfrB�i�'il/ I I�q:�ioi�i PIII;4-11 _ `.IIYA� '�RCu L i ':;' 9l''. ��i:�l <'�i '�IM11_ Ili� � �iNIItH�I��N HY Ill�lr, ... . 14�� i �.,k. �.. I�-J�"11 b�-ib ca.-.. M,i[��illt-9119�1FJ1-lGIf.9 ! �� I��ii�l�� I�� t r�� tti�. r�t[,a .nx,. �*��_ ��,�i�it i�i�i�i f iF Ut tNllli 1� 9:ti�1(K.�)N 57: I.u. 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Stop 8 Stap Card Savings -0.71 = Price with your card 0.68 GTR COOL BLUE 1.59 =T Siop 8 Shop Card Savings -0.71 x Price with your card 0.88 PF NNTKT CHO CHK 3.49 * PF SFT OT RSN CK 3.49 * Stop 8 SFwp Card Savings -0.50 * Price wlth your card 2.99 POL SPRNG WATER 3.99 * TOSTITO SAL MILD 3.29 x TOSTS REST STYLE 3.99 * � Stop 8 Shop Card Savings -0.65 * Price with your card 3.34 NATIIRAL FOODS DRMOC ALM CHN 3.49 • ORG LS VEGGIE 3.99 * Total before savings $33.20 Yar Total Savings 52.57 Total after savings $30.63 Tax paid $0.12 Total $30.75 Credlt $30.75 Change $0.00 1 l 1 � , 'r St�nps.SPoop� STi)P 8 SHO� N893 MQkRIS PLACNS, td� 683-0170 - H'dW.STOPANO"aHOP.COM WELWME( ''M IlAVINDR 11:14am 1U107l12 Tran 21324 Te�minal 6 Cashier 00118 f,ustomer Card Number 1201016270 *i1EFT'F-CItr'CFl°;35Btl9:"... .. °+.°a T fifAB�TAtti-YrSt�tKr---^°�"""'�`8-�9 T �9ub`otaY" ' ._ _ $16.58 Tax Pai�:! $1.79 Totnl�.. .,�— —S3E.17. Credit $1£.71 � Chan9e $0.00 THANN YOU FOR SHOPPING AT S'fOP & EHUP. WE'VE ENJO'!EO >ERVING +'Ol:, AND WE LOOK FORMARD TJ SERVIN; ALL YOUF; FUiURE SHOPP:N3 NEEDS. Postaae US Post Office 1.33 US Past Office 6.18 US Post Office 0.43 US Post Office 4.30 US Post Office 6.60 US Post Office 1.44 US Post Office 1,gg Total Postage 2�,97 I �/' I ----------COMMACK P.O,--------------- ______________________________________ COMMACK, New York � COMMACK P,O. 117253636 COMMACK, New York 3548330725-0097 117253636 10/04/2012 (631)543-3647 03;01:01 PM 3548330725-0096 � ______________________________________ 10/18/2ui2_(631)543_3647 02_54_29_PM__ i Sales Receipt — Product Sale Unit Final = Sales Receipt Description Oty Price Price Product Sale Unit Fina� i ° Description Qty Price Pri�e COMMACK NY 11125 $5.20 = Zone-0 Priority Mail CAMP HILL PA 17011 g�,30 13.20 oz. Zone-2 First-Class Customer Postage -$5.20 Large Env Subtotal: $0.00 3.00 oz. ______== _ _______= Issue PVI; $0.00 Issue PVI: $1 .30 1c Tiffany 3 $0,01 $0,03 PHILADELPHIA PA - $0.45 Lamp PSA _ 19101 Zane-2 20c Georee 2 $0.20 $0.40 First-Class Letter Washington 0.30 az, � PSA Customer Postage J _$p,42 NEW CUMBERLAND PA $0.45 _______= 17070 Zone-2 Iss4e PVI: $0.03 First-Class Letter 0,60 oz. Total : °--- Expected Delivery: Sat 10/O6/12 81.33 Return Rcpt (Green $2.35 Paid by: Card) Cash , Certified $2•95 $1 .33 i Label �: 70110110000155222123 +*t�**********:*�**�*****:tts*�****** ________ �*�*******�s��***#****�***#****r*�** Issue PVI: $5.75 BRIGHTEN SOMtDNE'S MAILBOX. Greeting j cards a��ailati�e f�� purchase at =________° select Post Offices. Total: $6.18 $$#�$$##$$#$##��$*�*Y?ff't###�##$$�$* ' **�**�r+*�++******�a.*#***:#**�s=�.ik � Paid by; i VISA $6.18 Account p: XXXXXXXXXXXX4925 Order stamps at usps.com/shop or Approval tl; 031387 call 1-800-Stamp24, Go to � Transaction #: 653 ,�:nc rn�n.'r, :.:�-,..�,:,� ,,, ,,..... � 23903190486 +��******�*t***�**�***r**�***vt*s*** s***t**:#*********#�********s****** RRtGHTEN SOMEONE'S MAILBOX. Greeting j -------------------------- -------- ---------------------------- --------- -------------------------------------- Ep� ��ORTNPORT P.O. -------------------------------------- COMMACK P.O. EAST NORTHPORT, New York COMMACK, New York 117312449 117253636 3548330731-��95 3548330725-0096 10/24/2�12 (800)275-8777 04;01:48 PM 1�122l2012 (631)543-3647 03:09:52 PM =__-________`___=______'=_`_=_=______ __°_______=_ . . , � ' '• � °_=__=_-_:_:=__:.�______________________ � �lL �xq� p/ � snrrHrnwN MPo SMIiHiOWN, New Vork 117873743 ____=__ '� 3548330787-0097 EAST NORIHPORT P.O.====________ " 09/14/2012 (800)275-8777 02:57:24 PM EAST NORTHPORT, New York � =_______==____________________________ 117312449 � Sales Receipt 3548330731-0098 Nroduct Sale Unit 09/13/2012 (800)275-8771 04:34;23 PM �escription Qty Price F�nal _______________°====____________°°___= — — Price Sales Receipt i► CHARLOTiE NC 28201 _ '-" Product Sale Unit Final jone-4 first-Class $�•30 Description Oty Price Price Large Env � ; 2.80 oz. LITTLETON NH 03561 $1.95 Expected Delivery; Tue 09/18/12 Zone-3 first-Class Return P,cpt (Green Parcel ' Card) 82.35 1 .80 oz. Certified Expected Delivery; Sat 09/15/12 Label �; 701216400002518563055 "" Insurance $2.35 Insurance Amount : 570.00 Issue PpI; =__==_== � Lahel q: 13103060000026929181 $6.60 _==_'=== �� Issue PVI: $4.30 iotal: _==______= $6.60 _________= Paid bY: Total : $4.30 VISA Account M; XXXXXXXJ(XXXX492660 Paid by: , APProval �: 016470 Cash 820.30 Transar.tion q; 5z� Chanee Due: -$16,00 � 23903190874 ***********�*��**********�*t***t**�* �*******�**e*#**�*r********* I ###########*####i################### k##i####t#�k##########*############ BRIGHTEN SOMEONE'S MAILBOX, Greeting dRIGHTEN SOMEONE'S MAILBOX, Greeting � i cards available for purchase at cards available for purchase select Post Offices. select Pnst Of � at � kk#########k#**##########*t######### I t####*##########t#k###########*###t# �I #*########*###*##############*##**## k*##**#**#i#####�t*k#####�######### . � I I COMMACK P,O. COMMACK, New York 117253636 3548330725-0097 11/19/2012 (631)543-3647 03:17;40 PM -------------Sales ReceiPt=====_______ Product Sale Unit final Description Qty Price Price r�ary ramtiy PSA Bklt/20 �-- lOc 13 $0.10 $1.30 American Clock PSA 3c Silver 13 $0,03 $0.39 Coffeepot PSA �i �� _=---=°__= T"�'�' QAC FA Utilities P PL 154.00 York Waste Disposal 38.85 United Water PA 17.09 PPL 154.00 UpperAllen Township 112.00 United Water PA 11.18 United Water PA 11.18 PPL Electric 137.32 York Waste Disposal 39.03 UpperAllenTownship 112.00 PPL Electric 178.99 United Water PA 11.18 United Water PA 11.45 United Water PA 17.33 PPL Electric 99.62 Total Utilities 1,105.22 „ , Questlons2 Please Visit us online at Page 1 �'�""P' ” � contad us by Oct 3. pplelectric.com II 1-804DIAL-PPL ' PP� ':'�, (1-800-342-5775) 5709476009 Oct 3,2012 . $3$�.p(►} ' ,va¢.er�eu..r.. M-F:BamtoSpm Your Electric Usage Profile Billing Summary (Billing details on back) Service to: Balance as of Sep 12,2012 $0.00 JOHN F BRADSHAW Charges: 2738 S ROSEGARDEN BLVD Total PPL Elec[ric Utilltles Charges $154.00 MECHANICSBUR�, PA 17055 Meter:82485738 TotalCharges $154.00 Your neM meter reading is on or about Oc[ 11, 2012. p�pp�ByOtt 3,2012 $154•00 Thls sectlon helps you understand your year-to-year Account Balance y $154.00 eledric use by month. Meter readings are ac[uai unless pp�Elec[ric Utilities' price to compare for your rate Is 7.907 ce�kWh otherwise noted. effedlve 9/1/2012 to 12/31/2012. For a Iist of suppller offers,vlst�C � p�� p�2 papowerswkch.com or www.oca.state.pa.us. 1� Your Messa e Center � • eud�et Summary: � g 100 We billed you 52,038.00 �s Including this blll,you used SZ.027.03 � so After this payment,your budget Is ahead $10.97 � a 25 • With paperless bllling,you can receive and pay your - ° PPL Electric Utllitles bills online.The process Is free, � � F M A M i i n s o N o quick,convenient and secure.To learn more or sign up, nnonens vlsit ppleledric.com. I � I • Information about appliance energy use and tlps on saving energy are available through the Energy Library on our Web site,ppleledric.com. Sep 2012 32 914 29 72F Sep 2011 32 1088 34 70F - Payment Methods ° Sep il Adual 96667 ./� Online at: �By phone: 1-804342-5775 ` Aug SO Actual 95753 V PP�electric.com or cail BIIIMatrix(service fee applles) � at 1-800�672-2413 to pay using Vlsa, = 32 Days kWh Billed 914 MasterCard, Discover or debit card. - � By Mail: Correspondence should be sent to: _ Oct 2011-Sep 2012 19587 1632 Z North 9th Street Customer Servlces ; CPC-GENNS 827 Hausman Road - Oct 2010-Sep 2011 21273 1773 Allentown, PA 18301-1175 Allentown, PA 18104-9392 = Other important infarmation on the back of this bill � �y:1STE DI�SPOSAL JOHN BRADSHAW Involce <r",�� aeg.� a s J770 9�nA�urtt Drtv� YoA,PA 77�06 PaymenblAdJustments Dab Dncriotlon Refere�s Amou OBl30 Payment-Thank You 579 -E38.85 � AecouM NumMr 3-0611.12tN7! Curront Involce Charges Invole�We� 9eptamMr 16,2014 John Brad�haw 27�8 S RosegaMen Blvd (L1) Involu NumMr Oett-001071576 ��Gburg,PA P�evbus Balanu saa.es Psym�ntalAdjuslmsnb 37l.l6 COMnct:961702D(C4) Unp�W Balanc� f0.00 � _Trash CaR(96/9!Gallon) Sehsduled Sarvic� (37) -� Cumnl Invoka Chsrge� sae.es Dab Ds�cAotlon Rafaranca ua Unk Prle� AmouM 09/15 ResldanNalService 70/01/12-12137112 538.85 538.85 CurreM Imoice Chsrges f3B.88 • ass.as Due By: 10/05H2 . . • . . � Customar Ssrvlca (71�846-1667 /v/ Custaner Senles (B00)270.9875 � . � . . FOR VOUR CONVENIENCE TWO AL7ER WITIVE METHOOS TO PAY:W W W.DISPOSAL.COM OR PAV BV PHONE�877�eB2-W29 BOTH METHODS HAVE NO PROCESSING FEE.PAVMEMS POSTEO ONLINE OR THRU THE PAY BV PHONE SVSiEM WILI APPEAR ON VOUR BANK/CREDIT . CARD STATEMEM AS:REPUBIIC SERVICES/ALLIED WAS7E PHOENIX AZ 78.86 0.00 0.00 0.00 To pay on-Iine or sign up for convenient auto pay, go to: e A • w.n our w.e�ro.,www.Al�poul.eom to mak�your p�ymnR slectronkally www.dlaposal.com crM�Ign up lor our wmenNnt�u[omatic paym�nt plan. • Pbaw�N nv�n�sid�tor brms uM condltlon� . A{y�-b +it}�c qv�6,��5`d"�h7�s�f� ��1.�r� �ya«�r�� x.�.+a �f� � �+� �{� '��4, '�. �L� as,�m`� 'r"4 '�r.,' °� '�rl��Z asy�+}( . ° 4d 4 6�1� :� s K�i r'��' S.t� Yy:.. �� k �$� A��/�x �, s� r3 � �U(ry'H�0��Y�� Y� .: �'E6�a�rst�,'��+�s�'� ��'�r� r � .� oc. �� l!��,�� ;;�M1I1�'A��, ,�' � "'d �`�'� e)PRN� e#7T'�. 4•36¢�"��,��,�� d��'�° �.� ;�p. � � e . ,y, r Ti-,.�.��? . � 3�°ra` •X vv,s, �..�1:.,`,a�±"� ��.`N 9a•� 4. �.,.1 *'+',3 � �' ' . W.UO Ci2�Lfl YA �b �o�. t,"x".. , �fau,�' a�SSti',„^a� w,a�-st.. USAGE HISTORY Billing Date: 09/28/12 Monthly usage in Thousands of Gallons Account Number: 00203448520000 8 6 6 �, Previous Balance 558.92 ° � : I � payments Through 09/28/12 TMAHKYOU $58.92CR � , I; I Balance forward $0.00 ` � Curre}n..yt�Charkpes Due 10/1�84/2012y�� 517.09 j I 1�f1M�� e"��'M� •�.yT'v^a��wfr*q'�� ti:�. �'Yt..,: w' y i p.. 0 a wo s.v r.a, o.� �n rw. ro. '+w �� m +w zn . Next meter reading date�on ar about 10/31/2012 'PAY BY 10/Z4/2012 TO AVOID A 1.5%LATE PAYMENT CHARGE SEHVICE TO: 70HN F BRADSHAW SERVICE AODRE55: 2738 ROSEGAROEN BIVD MECHANICSBURG VA �+ £11��n�9„'�i�s` �l'td "�t "�d��p� S"a,M -- � �•�� — � r �� ,;:� �� •�.. � k'"�4,. r +�°"�P,tr,w�Pd � '.�. 'Xl "��. ,.£ 66673310 08/3l/12 09/28/12 28 0396 0397 1 MGL � ACTUAI W�7 EOUIVAIENT TO 1,000 GALLONS SERVICE CHARGES Sl'1.00 STATE TAX AD7USTMENT SURCHARGE $0.01 WATER CHARGES 55.91 TOTAI CURRENT CHARGES $17.09 DISTRIBUTION SVSTEM IMPROVEMEN 50.17 SEEREVERSESIDEFORIMPORTANTACCOUNTINFONMATION � s "'" �w ;: r 'v"`lh�d{`^:`�5dj �p�r. � e .%�` .fi ,�""�v p�+3�;��n:. ct^ a.a-. � ''• ��,y,�.a,cr ?? 'A4 i .�*$4"a s�w"' �<�i� , ��'�i,�c �-R:��±ml � .. ,� s` �/'�17G�: �� ,n��P��,#�,,. $ ,�"wvn F�.� 3 .. t�aa Your consumption is based on an actual reading of your water meter. Save a stamp an4 go pnperless today! log on to www.umtedwater.com or call Customer Service to find out more information and to enroll in eBilling. Effective luly 1, 2012 UWPA's Distnbution System Improvement Charge(DSIC)surcharge increased from 0.77%to 1.02%. Appraximate state tax included on this bill $0.68. �//�/ � n�I/.'/7 �111 ' 0 > � �i" '/ � �, �Ni� � ►J�l �ic� �a�d ��/�J�z��(� .� • � � Questlons?Please ,/� Vlsit us onilne at Page 1 '''°"•'•" contad us by Nov 2. - �1 pplelectrfacom 1-80aDIAL-PPL � PP' ��° (1-804342_5��5) 5709o-76009 Nov 2,2012 a ' :$1:I�.fi�"�" : a�e,,c�,,,u,,,,�.. M-F:8amto5pm Your Electric Usage Profile Billing Summary (Bllling details on back) Servlce to: Balance as of Oct 12,2012 50.00 JOHN F BRADSHAW Charges: 2738 S ROSEGARDEN BLVD Total PPL Electric Utilitles Charges $154.00 ,L�II MECHANICSBURG, PA 17055 �y •� MMer:82485738 Total Charges - $154.00 �j��j Your neM meter reading is on or about Nov 9, 2012. uM Dtld Byt Nov'2,2Q12 $ Thls sectlon helps you understand your year-to-year Attount Balance 5154.00 elec[ric use by month. Meter readings are actual unless ppL Electric Utllities'price to compare for your rate Is 7.907 cents per kWh otherwise noted. effec[Ive 9/1/2012 to 31/30/2012. For a Ilst of suppller offers,visit � p» �p�2 papowerswkch.com or www.oca.state.pa.us. �so Your Message Center p izs • gud�et Summary: � 100 We billed you 52,192.00 $ �s Including th�s bill,you used 52.082.95 a ' After this payment,your budget Is ahead 5109.05 so � a 25 • With paperless bllling,You can recelve and pay your " ° PPL Electric Utilitfes bills online.The process Is free, � i F M A M i i n s o N D quick,convenlent and secure. To learn more or sign up, r�no„ms visit pplelectric.com. ' � • Informatlon about appllance energy use and tips on saving energy are available through the Energy Library on our Web slte, pplelearic.com. Oct2012 30 461 15 63F Oct2011 30 930 31 61F Payment Methods Oct 11 Actual 97128 � Online at: �By phone: 1-80a342-5775 Sep 11 Adual 96667 PPlelearic.com or call BIIIMatrix(service fee applies) : at 1-800-672-2413 to pay using Visa, 30 Days kWh 8illed 461 MasterCard, Discover or deblt card. !i � By Mail: Correspondence should be sent to: _ Nov 2011-Od 2012 19118 1593 Z North 9th Street Customer Services CPC-GENN3 827 Hausman Road - Nov 2010-Oc[2011 21394 1783 Allentown, PA 18101-1175 Allentown, PA 18104-9392 ` Other important information on the back of this bill � / . or JOHl7 F eanDSaow nscn DATE � 60-12731373 .tMHSRLY A WSINDORF BXTRX PAY TO THE , /1�/ _ $ ORDER OF LYy�' db DOLLARS Pt7C Bank, Natioaal Aseociation Ceatral PA MORRIS PLAZN$ @ 3TOY & SHOBO181 Non-Negotiabie Customer Copy MEMO I� �?�yy (1�� zoo2oo-a2�2 PAPER FOR GL TICKETS AND CONVENIENCE CHECKS � ti � e E A , . -- . . .� . � .,� � L� �,`/C/(„�/ Your Supplier Contact Information Billing Details - (eiu Ac�t. 57o9o-7soo9) rage z For questlons regarding the generetlon and transmisslon prevlous 8alance 5154.00 portlons of thfs blll,please coMaR your supplier at: payment Recelved Oct 8, 2012-Thank You I -$154.00 � Dominlon Ener`y Servlces Phone: Customer Services � i-888-216-3721 Balonce as ojOct 12,1011 $0.00 P 0 80X 298 PI7TSBURGH, PA 15230 Char�es for-Dominion Ener`y Services Generatlon/Transmi sslon DOMPPL for Sep 11-OR 11 Electrlc Chg:461 KWH � $0.06890 31.76 Manage Your Account STATE SALES TAX 0.00 GROSS RECEIPTS TAl($1.92 Visit ppietectric.com for self-service optlons Total Dominlon Energy Services Charges 531.76 including: Charses for-PPL E►ectrk UUlkles -Vlew your bill, payment,and usage hlstory. Resldential Rate:RS for Sep 11-Oct li -Make a payment,set up a payment agreement. Distrlbutlon Charge: -Start/stop service. Customer Charge 8.75 -Enroll In paperless billing,automatic biil pay, q51 kWh at 3.35900000t per kWh 15.49 budget billing. PA Tax Ad)Surcharge at-0.34500000% -0.08 -Report an outage,check outage status,and more. Total PPL Electrlc Utllities Charges 524.16 Vlew your rate schedule at pplelectric.com/rates or Your Budget Plan Amount 5154.00 call 1-80a342-5775 to request a copy. Mqu D�1E�MOk"2i 2d22. $YS�1.00 Gene�l Infom'18tion Account ealance 5154.00 Generatlon prlces and charges are set bY the electric generotlon supplier you have chosen. The Public Utility Commisslon regulates distribution rates and services. The federal Energy Regulatory Commisslon regulates transmisslon prfces and services. PVL Electric Utllities uses about$0.18 of this blll to pay state taxes and about$9.08 is used to pay the PA Gross Recelpts Tax. Understanding Your Blll Bud�et BIIIin�-Plan that provides for equal monthly State Tax AdJustment Surchar�e-Charge or credit on electric payments. ra�es to refle changes In varlo s state taxes Included in your Custome �har`e-MonthlY 6asic dis[ributlon charge to cover bill. The surc�arge may vary by�lll component. costs for�IIlfng,meter reatling,equlpment,maintenance and Type s)0f Meter R�adin�s• advanced metering when In use. A�ual-Reading oy distributton company. Dlstribution Char�e-Charge for the use of local wires, transformers,substations and other equIpment used to deliver electricity to end-use consumers from the high voltage transmisslon Ilnes. kWh(Kilowatt-hour►-The basic unit f elec[ric energy for � which most customer are charged. T�e amouM of electriciry used b ten 100-wat�l�l8hts left on for 1 hour. Consumers are usuallyYcharged for electricity in cents per kilowatt-hour. 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J }� ...1� �J J � . } � r � }, Y Y.. :}�••�'_j•T �� .J}" / ir ��}1Y:I..i . .�r..�.y'l�://.a,i r/��i.T�S.-'/i-r.�. .�r .,Tr �/i:A'. ��r .}J . �i.� .: .>>r. ��2.`r. . . . d.r.-. , g y��, .,:. , � . i i; " ' .: a„ �451ARfE(5@N�C2�ElIt2f QI'1�G, � .. ,i�, � r� 41r�;°.�: mg��y � UNITED WATER' 8,es�4m9a��e. ; , �` '°Hurrymelstown PA-�17036 •..-� ° � - g r , � Teleqh6pes71�•564366Z�� r�:[ .� ��`� � � � ' �www:unite water.com ` �, USAGE HISTORY Billing Date: 09/28/12 Montnly usage in Thousands of Gollons Account Number: 00203448520000 . 8 � 6 ` ` ` Previous Balance $58.92 ' ' , payments Through 09/28/12 n,nnrrou 558.92CR I � ' � Balance forward $0.00 z � I 'II i � Current Char es Due 10/'18/20i 2 517 09 �i � � , T07AlAM0UNT OU�: -: ! ;: �'�T.O�`' � a 0 wu so w., w� r.> n> ro, ne. i�. ,m ..a s.. Next mete�reading date:nn ar about 7 0/3 7 2012 'PAY BY 10/24/2012 TO AVOID A 1.5%IATE PAYMENT CHARGE SERVICE T0; JOHN F BRADSHAW SERVICE AOORE55: 2T3B qO5E6AR0EN 8W0 MECHANICSBURG PA IEyteuFNambea, �saMca ooysoPe� �..°.MSttrResaln4r�a � cr��."*� unttof '`� � , =,`� , .�,::" � + „ ' frorvi" . ,.. ta=° ` '� Seryt`cr:« Pre'viauta� t`Vresen�`,` `,�.,��saylj*�eosurer ''�,��: ReaMnq�l'vP�' .r..�' . Rau6 ::� 66673310 08/31/'12 09/28/'12 28 0396 0397 1 MGL � ACTUAL W07 EQUIVALENTTO 1,000 GALtONS SERVICE CHARGES S11.00 STATE TAX AD7USTMENT SURCHARGE 50.01 wATER CHARGES 55.91 TOTAI CURRENT CHARGES $17.09 DISTRIBUTION SYSTEM IMPROVEMEN $0.'17 SEEkEVERSESIDEfORIMPORTANTACCOUNTINfORMATION IT - I�IP6it1`AIVl"NtESS�iGE�`r � j "� wb `� Your consumptlon is based�on an actuol reading of your water metec � Save a stamp and go pnperless today! log on to www.unitedwater.com or call Customer Service to find out more information and to enroll in eBilling. Effecti�e luly 1, 2012 UWPA's Oistribution 5ystem Improvement Charge(DSIC)surcharge increased from 0.77%to 1.02%. Approximate state tax included on this bill $0.68. - - . _ _..-'_.:_.�`` `_-�� K�YI� _ -. _., � e�� I� �'ll, r � � 1�,�„� � V � ►Jo� �icL ��\ �`� ��D �l/�JI z�.soLP � ,,. � . � - � __,.___- --- - ---- -- -- ------ �ni� WaeMceC�ieivaMc s� °�� UNITED WATERr ��m��st�°Pa,7a36 •Tel6phone:7lf-564•3662, www.unftedwater.com usAGe HiSTOaY Billing Date: ' 11/30/12 Monthly usage in Thousands of Gallons Account Number: 00203448520000 6 - ` ` , Pre�ious Balance $11.18 ' ' PaymentsThroughll/30/1Zrw,Hrvou $1�.18CR � _ _'; � � Balance Ponuard $0.00 � Current Char es Due 12/20/2012 $11.18 � , TOTALAMOUNTOUE � ; $11,18`: 0 0 0 .w o. r.s na K. nw m. a� +w sm m w. Nert meter reading date:on or about 12/3t/2012 'PAV BY 12/26/2012 TO AVOID A 1.5%LATE PAVMENT CNARGE SERVICE 70: JUFlN F BRAOSHAW SERVICE ADDRE55: 2738 ROSEGANDEN BLVD MECHANICSBURG PA .� _._ �_.— , ._� MetetNumber �. SeMC[ Day4of �. Mlte�Readip9 .� L�� T.Meosue . . Read�n47ype +.� Note° �..��. � From '�' To .� SeMee� ` preulous-' Fleserit� 66673310 10/3l/12 11/30/12 30 039T 039T 0 MGl ACTUAL WO7 EQU/VACEMTO OGACCONS SERVICE CHARGES 511.00 OISTRIBUTION SYSTEM IMPROVEMEN $0.17 STATETAXA07USTMENTSURCHARGE 50.01 TOTAL CURRENT CHARGES $'11.18 SEEAEVEFSESIDEFORIMPOHTANTACCOUNTINFORMATION 1M PbRTANT ME55AGE5 Your consumption is base4 on an actual reading of your water meter. � Effective October 1,2012 the Distribution System Improvement Charge(DSIC)was increased from 1.02%to 1.52%. This charge funds the replacement of water distribution facilities in Pennsyl�ania. Save a stamp and go papertess today! Log on to www.umtedwater.com or call Customer Service to find out more infarmatlon and to enroll in eBilling. � Approximate state tax included on this bill 50.44. ` VlIIIGGGYMFNTINTHGPFI'IIRN"""Iq;�F Oq(1VI^.Ffl n.+ ,,�.; ;',- � Questlons?Ptease ,/c� Visit us online at . Page 2 contad us by Jan 2. - U pplelectric.com � , i � Pp�•••:.,: (1_�DI42-5775) 5709a76009 �an 2, 2013 $337:32 ,.��„tl„e.. M-F:8am to Spm Your Electric Usage Proflle Billing Summary (8��ng details on back) Service to: Balance as of Dec 12, 1012 SO•00 JOHN F BAADSHAW Charges � 2738 S ROSEGARDEN BLVD Total PPL Elec[ric Utiiitles Charges 5137.32 �� MECHANICSBURG, PA 17055 \� r�� Meter:82485738 Total Charges 5137.32 �Q Your next meter reading Is on or about Jan 11, 2013. pmount Due By lan 2,2013 5137.32 This sedlon helps you understand your year-to-year Account Balance $137.32 electric use by month. Meter readings are aRUal unless PPL Elec[ric Utllitles' prlce to compare for your rate Is$0.07544 per kWh. otherwise noted. Thls changes the ist of Mar,Jun, Sept, and Dec.Vlsit papowerswkch.com � 2ot� �20�2 or www.oca,state.pa.us for suppller offers. i� Your Message Center � • Budget Summary: > 100 We billed you 5179.00 B �5 Including this bill,you used 5112.32 d After this payment,your budget is ahead 566.68 so � a ZS • With paperless billing,you can recelve and pay your � ° PPL Etectric Utllities bilis online. The process is free, i F M A nn i i n s o N D quick, convenient and secure.To learn more or sign up, � �„� vlsit pplelectric.com. � • Information about appliance energy use and tips on +I saving energy are avallable through the Energy Library 1 0�our Web site, pplelectric.com. Dec2012 32 1012 32 40F Dec2011 3Z 1966 61 45F = � Payment Methods . Dec 11 Adual 98713 � Online at: �By phone: i-80a342-5775 ° Nov 9 Actual 97701 pP��ectric.com or call BIIIMatrix(service fee applies) _ at 1-800-672-2413 to pay using Visa, 32 Days kWh Bllled 1012 MasterCard, Discover or dehit card. = � By Mail: Correspondence should be sent to: Jan 2012-Dec 2012 17375 1448 Z North 9th Streei Customer Services _ CPC-GENNl 827 Hausman Road Jan 2011-Dec 2011 21705 1809 Allentown, PA 18101-1175 A)lentown, PA 18104-9392 _ Other important information on the back of this bill � YUNk-- w,1S"fEt)ISYOS.3t, JOHN BRADSHAW �nvotce ;;,a R��ua Pap�1 of 4 J770 9�ntlhwri Drlvs York,PA 1740f PaymentslAdjustments _ �` Date DqerlDNon Referenee Amoun[ t0109 Payment-ThankYOU 5555555 -538.85 • Aeeount NumMr •3� 1t-1221Q7! Current Invoiee Cha es Involea Da4 December 73,2012 �ohn Bndshaw 2738 S Rosegarden Blvd (L1� /_,i Inrole�NumWr 0811-OONa9aJD Meehanieaburg,PA l/i�j P�evlous 8alanco 578.BS paym�nhlAd�ustmenb -578.80 Contract:9811028(C2) /2 � Unpeld Bala�ce SO.oO � _Trash Cart(96198 Gallon) Seheduled Sarvlea (St) ��^� CunsM Invoke Charges f�9•07 �L D� DeserloUon Referenca uant Unit Prke Amcunt 12115 Residential Service O1IOtl13-03131113 1.0000 839.03 539.03 Current Involce Chargas f39.03 • 539.03 Due By: 0110M73 � . . . Customer Senice p17)846-1567 CusYOmer Servlce (800)210-9876 . . • • FOR VOUR CONVENIENCE 7W0 ALTEkNATIVE METHODS TO PAV:NMNVDISPOSAI.COM OR PAV BV PNONE�877-892-972980TH METHODS HAVE NO PROCESSING FEE.PAVMENTS . POSTED ONLINE OR THRU THE PAV 8Y PHONE SYSTEM WILL APPEAR ON YOUR BANK/CREDIT CARO STATEMENI AS:REPUBLIC SERVICES/ALLIED WASTE PHOENIX AZ 39.03 0.00 0.00 0.00 To pay on-line or sign up for convenlent auto pay, go to: e n • w.n o�.w.e.ia,www.tllspoal.com ta mak�your peymerrt aleetronicaly WWW.fJIS sal.com orWsignupfarourcanvania�tsuWmrileprymantplan. � . Pl�aa�aN nven�sW�for termf anA conditlons . . � � , : , � : � . . . - . . - . • . . . .- -.- �- . . - • - � � - . , . .- � �� . -- .. � � � . � _ . . , . , . - - •- - � � - . . . - .. . - •- �� - - - � � '- - . . . •- J � lr . l }� // . . J . y l� '. .�r ?� . , � ' Y ' � . .!- � ' �/r .�./Y. l� r.- J� . uy_ l,. . J :Yr �r , �J JY Ir J i. jY /r r �ti'J �.}! ,. /� ;; y . r �- ti M . � .t� ,,.�r � � Y}� - .y a �Y�. .yr � � 7 M� � r] . r�/,_d9 .`9r' Jr�Ir �J� '}Jr. /r.r� �.1� . J}'fi,- � � ir. b..,., � ��,. :.✓r lr � . �� .}Ir l� .y�� .J .� �r >.rl� ' J . ,r..J� . .J lT'. l� �J J�- / -J lY l� J � :}J // � },J . 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M-F: Sam to Spm You� Electric Usage Profile Billing Summary (BIIIing details on back) Service to: Balance as of !an 14,2013 50.00 JOHN F BRADSHAW-ESTATE Charges: 2738 S ROSEGARDEN BLVD Total PPL Electric Utilities Charges $178.99 MECHANICSBURG, PA 17055 Meter:82485738 Total Charges $178.99 Your oeM meter reading Is on or about Feb 11, 2013. uM DUe By Feb 4,2013 5378.99 This sectlon heips you understand your year-to-year Aaount Balance $178.99 elec[ric use by month. Meter readings are actual unless ppL Electric Utillties' prlce to compare for your rate Is$0.07544 per kWh. otherwise noted. This changes the lst of Mar,Jun,Sept,and Dec.Visit papowerswkch.com � 20�2 �2013 or www.ow.state.pa.us for supplier offers. 150 Your Message Center � 125 y 1� • Bud;et Summary: We billed you $358.00 � 8 �5 Including this blll,you used 5271.37 � so After this payment,your budget is ahead 586.63 � a ZS • With paperless billing,you can recelve and pay your - ° PPL Electric Utillties bilis online.The process is free, � i F nn n nn � i n s o N D quick,convenlent and secure.To learn more or sign up, nnornns visit ppleledric.com. • Information about appliance energy use and tlps on � � saving energy are available through the Energy Library I, � - � on our Web site, pplelectric.com. Jan 2013 31 1460 4> 34F Jan2012 31 2741 88 36F — � � , : Payment Methods = Jan 11 Adual 173 ✓� Online at: �By phone:l-SOa342-5775 = Dec 11 Actual 98713 v PD�elettrfc.com or call BIIIMatrix(servlce fee applles) _ at i-804672-2413 to pay using Visa, — . 31 Days kWh Bliled 1460 MasterCard, Discover or debit card. - � � � '�'� � � ' � 2 North 9th Street CusYOmer Services �uld be sent to: _ Feb 2012-Jan 2013 16094 1341 CPC-GENN1 827 Hausman Road = Feh 2011-Jan 2012 20871 1739 Allentown, PA 18101-1175 Allentown,PA 18104-9392 _ Other important information on the back of this bill-� �4 � ��, �� e, �, a� ��.a �' �" :��j' '� ��;�'CU�stcmq�S�v'1o�C�n+�nl�u9n9C,g q� r � ��a�,, ;. ``� *��.ri�+ � ��4��iA�G��+ � a.� 818'��A plriSDACik.s a r.�i�� , . : & � �H�HUm u�sco a�i�'o36� ` � �� .� ��` •+�r �°Tgl6pho�4a�T� 564^366C- �r ,, � �I> �' �'3.w k u 4R r x .�'i USAGE HISTORY Billing Date: 12/31/12 Monthly usage in Thousands of Gallons Account Number: 00203448520000 e B 6 4 6 ', previaus Balance $17.18 6 + : paymentsThroughl2/31/l2 n+nNKVOU $�1.18CR � Balance Forward $0:00 ° , Current Char es Due 01/22/2013 $11.18 = ro7a�,A�iouNT` ue , t,�� .:� 5'fi��" � , . � . �. . . , � . � 0 o a 0 va. o. rm rw, +e. wu ��• �•� wa sm n� ww v«. Next meter reading dare�on or about 07/37/2073 'PAY BY Ol/28/2013 TO AVOID A l.5%LATE PAYMENT CHARGE SERVICE TO: ]OHN F BRADSHAW SERUICE ADDRESS: 2738 ROSEGARDEN BWD MECHANICSBURG PA t ' Y�� -a ,�SM11�Gfr�� G�Q � '� MRW'RQOdI17 sa"�g-^z &+ 2� a :UI�ICORf ' �, � �a�*2Ns°,-�5'�95uz$'°�..i �^"'9 i . , . � i . �`. �, ja x =, ��,r� � � �'6, �� ` ,� �USd� r� �;,M.af41'iUj= 4,�� h�diNd{��ls+ ,*c f ' r` �0�4;? t 6fi673370 71/30/12 12/31/12 31 0397 0397 0 MGl � AC7UAl WO7 EQUIVALENTTT7 OGALCONS SERVICE CHARGES 511,00 DISTRIBUTION SYSTEM IMPROVEMEN S0.'17 STA7E TAX AD)USTMENT SURCHARGE 50.0'I TOTAL CURRENT CHARGES 511.18 SEEREVERSESIDEFORIMGORTANTACCOUNTINfORMATION o "r s �� ;'¢° �`r� �s�� , xi2""a'.� w.c.�,��s°' �", ,�`e� �.17 .< �47S�VG S�a. 1'v cT3 w r+r?�, ¢ :t �,�,�,'.`fl`7.��'S3 ".°,3 'k��'i°';^ '! iwun;v�r. .5�m.:4 Your consumpdon is based on an actual reading of your water metec � �f �y „ � . � � Effective)anuary 1, 2013 the Distribution System Improvement Charges(DSIC)increased from 1.52%ta 2.45%.This charge funds the replacement of water distribution facilities in Pennsyl�ania. Sa�e o stamp and go DaPerless today! Log on to www.umtedwater.com or call Customer Seruice to find out more information and to enrotl in eBilling. Approzimate state tax included on this bill $0.44. , ' �,� _ �e . _ . ,PLEASE.OETACH HERE FNO RETORN THE_BOTTOM PORTION WITH VOUR VqYMENT IN TME RETURN ENVELOPE PROVIDED . . . . . . . . an; n te ater ennsy van a Customer SeMee Ce�ter 3� '�� U�IITEC� WaTE�: 81�g�amsArtue Hummdstowrr PR17o36 Telephone:71�•564-3662 www.unitedtuater.com ' USAGE HISTORY Billing Date: 01/31/13 Monthly usage in Thousands of Gallons Account Number: 00203448520000 e 6 � � Previous Balance $11.18 � � � : Payments Through 01/31/13 �(oy5 50.00 Balance Forward - PqST DUE \ 511:18 � Current Char es Due 02/20/20'13 "1�.5 � $11.45 : TOTAC AMOUNT pUE $22.63- o a o I� o 0 � rn na w nw m� mi n�a s.. n� rvw o. �o. Past Due Balance may be subjec[ta late charges, callection and/or Nezt meter reading date�.an or about 02/28/2013 +pqY BY d2/Z6/Z013 TO AVOID A 1 5%IATE PAYMENT CHARGE SERVICE TO: ]OHN f 9NADSHAW SERVtCE AO�RE55: 2738 ROSEGARDEN BLVD MECNANICSBUNG PA I MecerNum6e��. Servix Ooycof'� M4tarReadln4, '- .. .;��Unitof :. � .. �. from�� Ta �� Setvlee'� prevlous FrcsenC. Us�9t Meesurc Readfh�TBW" "�Netr s.� 66673310 12/31/12 Q7/31/'i3 31 0397 0397 0 MGl ACTUAI W4� EQUIVAIENTTO 0 WLLONS SERVICE CHARGES 511.00 WATER LATE PENALTY CHARGE 50.17 DISTRIBUTION SYSTEM IMPROVEMEN 50.27 TOTAL CURRENT CHARGES 511.45 STATE TAX AD7USTMENT 5URCNARGE 50.01 SEE REVERSE SIDE FOR IMPORTANT ACCOUNT INFORMATION ��_ � 1MFORTANT M�551XGE� � Your consumption is based on an actual reading of your water meter. Effective lanuary 1, 2013 the Distribution System ImDrovement Charges(DSIC)increased from 1.52%to 2.45%.This charge funds the replacement of water distribution faci]ities in Pennsyluanio. Saue a stqmp and go PaPerless today!Log on to www.unrtedwater.com or call Customer Service to find out more information and to enroil in eBilling. Approximate state tax included on this bill$0.45. 0 o ae n.ar� ,PLEASE OETACM HERE FNO RETURN THE BOl'fOM PORTION WITH VOUR PAVMENT IN THE RETURN ENVELOGE PROVIOED. am UnitedWaterPe�hrisylUanla; . � � s i,° k»3 r� H�y m9mels bwn PA 17035 �, � , � . ` . . �„�..�'' � F UNkT�D,�1N�1T'ER � . � � . , .,.. Teleppone:T1�•564•�66� . . USAGE HISTOaY Billing Date: 03/01/13 Monthly usoge in Thousands of Gallons Account Number: 00}03448520000 a ' �/.�/d— �A�I��S 6 d a ' Previous Balance id�,[�— �/�� $22.63 + � paymenis Through 03/01/13 rHaNx rou ' S22.63CR ' Balance Forward 50.00 � � i CurrentChargesDue03/21/2013 $17.33 � TOTALAMOUNTDUB., 517.33 - 0 0 o a ' � FINAL BILL � 0 ieY Mo� Mr iyy Iun lul uy Sry IX� Nw Crt )on Nor Next meter reading date:on or abaut 03/29R013 'PAY BV 03/27/2013 TO AV010 A 1.5%LATE PAYMENT CHARGE SERVICE TD� ]OHN F BPADSHAW SERVICE AODqE55: 2738 ROSEGARDEN BLVD MECHANICSBURG PA .M50ecMimbea�. Se9vtM' � . Oaysotr� . ,�ik[kcReadiq f.� �.. Unital �. � � � - k6m� , O�,�a' a� SeniiC� ,. preulobs',=. �. Prd5M1}^� , . :r l(�a9e Mea4ur4 , Readfny T9G@: � . Rota �. 66673310 O1/31/13 02R6/73 26 0397 0398 1 MGL ACTUAI W07 EpUIVAIENTTO 7,OOOGALLONS SERVICE CHARGES $11.00 S7ATE TAX AD7USTMENT SURCHARGE �/ 50.01 WATER CHARGES 55.91 TOTAI CURRENT CHARGES ��-{ S17.33 DISTRIBUTION SYSTEM IMPROVEMEN 50.41 �'/�/�� SEEREVERSESIDEFORIMPORTANTACCOUNTINFORMATION ,; : IMPQIk�'ANt;M�SSAGES. , Your consumption is based on an actual reading of your water meter. Effective]anuary 1, 2013 the Distributlon System Improvement Charges(DSIC)increased from 1.52%to 2.45%.This charge funds the replacement of water distribudon facilities in Pennsylvania. Sa�e a stamp and go paperless today! Log on[o www.umtedwater.com or call Customer Service to find out more information and to enroll in eBilling. Appro�mate state tax included on this bill $0.68. ' ��VELOFE PROVIDED. . . . . . . ao,z .. ._ . .. . . .. . . . . _ Questlons7 Please �/� Vlsit us online at Final Bill Page 1 ' .. I � 1-n80p-OfAL-pP ar 19. - �J pplelectric.com , Pp�•••'' (1-804342-5775) 570947Ei009 Mar 19,2013 '$94.6I� vK e�wo w„m.. � � M-F:Sam to Spm Your Electric Usage Profile _ Billing Summary (Bilting details on back) Service to: Balance as of Feb 26,2013 $178.99 JOHN F BRADSHAW-E57ATE Charges: 2738 S ROSEGARDEN BIVD Total PPL Etectric Utilitles Charges . 7 ��l�/� MECHANICSBURG, PA 17055 / Meter:82485738 Tota{Charges S99•62 ,��/� uM Due By Mar 19,2013 S94•62 This sectlon helps you understand your year-to-year Account Balance $99.62 electric use hy month. Meter readings are actual unless ppL Electrlc Utilities' price to compare for your rate is$0.07544 per kWh. otherwise noted. This changes the lst of Mar,Jun,SeF�t,and Dec. Visit papowerswkch.com �p�2 �p�3 or www.ow.state.pa.ut for suppller offers. �so Your Messa e Center � l�s . Bud et Se�ttlement Summa `J 100 We billed you n�fter 12 months: $457.65 a �s — Including this blll, you used $457.65 � ° so � a 25 • We have subtracted$134.08 from this bitl to settle your � ° Budget Billi�g Plan. � F M A M i i n s o N o . yy�th paperless billing,you can recelve and pay your ` naonens pPL Electric Uiilitles bflls anlinH.The process is free, quick,convenlent and secure.l�o leam more or sign up, visit pplelectric.com. Feb 2Q13 12 qgg 41 32F Feb 2012 32 2670 83 40F � Payment Methods Feb 23 Actual 1832 ✓� Online at: ��By phone: 1-800�342-5775 - Feb 11 Actual 1343 v PD�elearic.com or call BIIIMatrix(service fee applies) at 1-900�672-2413 to pay using Visa, - 12 Days kWh Billed 489 MasterCard, Discover or dehit card. _ � By Mail: Correspondence should be sent to: _ Mar 2032-Feb 2013 12156 1013 Z North 9th Street Customer Services _ CPGGENNl 827 Hausman Road ' Mar 2011-feb 2012 20719 1727 Allentow�,PA 18101-1175 Allentown, PA 18104-9392 - pther important information on the back of this bill � Estate ofJohn F. Bradshaw Expenses Home Maintenance Loren Anderson-Lawn 25.00 Ron Gabriel-Lawn 100.00 Packaging Materials 38.64 Rental for Packing House Contents 83.10 Dumpster Rental 405.00 BassAirQuality-Radon Mitigation System 700.00 Total Home Maintenance 1,351.7A � i �� ,. � �� , `�/yk,;�,r� �?�,��/''�',,�,�, Panera Bread %(" Cafe 4659 =_=°____=�__'___=-____-_'___'_'��, Syosset, NY 11791 Phone: (51fi)677-5380 � BRICCO 31 S Third St.eet II/3012p1y Harr�sburFt� Pfi 17101 5:32:t3 PM (717)724-0222 Check Numter: 118536 Cashier: SoM a 1 Smkhouse Turkey Panlni GIfT CERT'iFICRTE 1 0/S MUST ALE 7 29 1 No Meal Upgrade ID # HNNNNNNN0866 i K*.CHIPS 1 Asian Sesame Chfck Salad Card Trae Diaitai D�nina Gift Carc� 1 No Meal U � 69 pgrade 1 •*aCHIP$ iransacticm Issue 1 BOkL CRM TOM flmount 100.00 1 No Meal 4'99 �P9rade 1 xxwBAG/ROLL Baiance 100.0� k ?aCf�C�V�d`�'�`-+r�r.`�.-••'�1'rE)� SubTotal Data 11/29/2012 44.97 - Tax 1,7P Time 6�32'38 PN Total q6.69 Master Ca�d 46.69 flcti�atim� Date 11/23/2012 Acct:NffN1fKXXX4216 AuthCode:51673P Exp nation Date N/fl TransN;5077 Vlew Your Account at www,mypanera.cor� Raarovai k 183?.42 MYPanera Member: xxxxxxxxxxxxOfi776 Reference # MyPanera Offers Earned: Oeta�ie� None Frae Coffee, Hot iea or Soda: 1 [Exp Date: O1/29/13] _________"__'_____�._=_____�=__�=_"__ 7ELL US HOW W� ARE DOING Transaction: --------------------- -----------'--- ANO YOU MAY WIN $2000 Oate Time flmaunt Balance GO i0 NNk.PANERALISTENS.COM -"�-' -"'--"`-"--�-"'--� ------------ OR CALL ]-BQO-699-0130 11/23/12 18:32 +100.00 )00.00 WITHIN 48 HOURS/ MONIHLY DRAMING --------------- - RlAES AT WNM,PANERpLISTENS.COM HERE Your Order Num6er Is: 136 CusYOmer / pyaer: K�m � Custnmer Copy . \ �+ � y : r \. � � I that wes easy � ow prices. Every item. Every day �85�Gar ts e i e echanics urg, ,� SALE ��, 1580627 1 001 25409 ' � 0643 01;07 13 10:09 e ##*####� Y'kk#k#w#�� #i##i###�t t# #�k# �k# #*##t a e� YOUR OPIV[ON CUUNTS AND'W[,` VIEWE� 13Y fHIS STORE'S M�INAGER! Pleas ke a short sw•ve� ' �� entere i n �." e for a $5 On Staples gt car NO PURCHASE N' " v a�esCares.com � r 11 -80�-881—i12;)— � Yaur surve�� code: 010 �tY343-6625 Sa�stnra fnr_��a�iog �' Su vey r.ode expires-0I/14,�2073. �«+Tome nuastra encuesta en Espanol en la pagina de Internet r,� par telefono. Cons ga las reglas en la tienda.*** R# . k�. #### # �F�#R##*i#!t . r . OTY SKU � � PRICE 2 STAPLtS 13UABL WRAP - 11 .790ea 23.56 3 . � �� G � �� i 12.87 SUBTOTAL 38.45 I _�— I S! dard-Fa� . . 2 19 ' T L � fi38.64 I � Cash \ •� 40.00 , Cash Chand : 1.36 TCITAL iTEMS 5 -- __ _ _ _ _ _ _ - � ��iBudget. _ _ PCr�TriL rweEEMENT: �uCftl P,��_on;1 � r.toSf�� 0i �9 Ut39:ss RM i �ubr. 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I c.11 I�RP�a 46��L±42 and �enr�U� ceu�on rodc �L`�' or I I FF3'�GfC � .• ••••.•••• .•• •• � � =it �� ,t bu.ig��rr�,icl.cos a�1 en[er pro�otior: c,�tle F/iL`�? I ,Moviny Si:<<plie-� Ret��i��; ..... . �j.L`�I � � � ii�� i LeA�r.f�er ... . ..... � 14 I ��, tii� end �oi�J��n �, qo to wah.bn�iqPtl.ruce.a��!kA15e I I �f,t�l Chyryr , .. .. Bi. lk1 I #R�i<_ di�cnurt due rnt �p�l� tc Le�=. �e�o it!fro:�oi fey��Fnt�_ I ,.o��r�� al a ��r,��nt . ,� ��;nl,��cted ra!�,. 4 O.DP - � � H�cn�it Ma N�.i�ine� .......... ... 9;. 11�! _ . ___ .. . _ . . . �. . �. . .. . .. -- --�--- �� IPa �ents �� ruvzi ' 1�� iFr�.ar.a�r�'i�,�y V'99(7Ll 2 °.3, 12 i . Any a trucM :iqe the one you �n.t tr,ed. Fur �are in►or�atian risit us at budgettruck.co�/buytru�As or call us at 1-8Pa-95'c-3�97. For aay ot6er inquir�es� please call our cus{o�er servic2 d!pt at 1$77-460-4863. ----------�----- � ------ u;r;[,! Hg>nt: [41TEflt Disfo�er S�qr��tm�e:✓�� . � - - �,. '_y`—�---�-----. _.-------- i.,�, �,ec�i"��--�F.�i�. TT.�_._----- —�--------�-- ----..---------- Ti.�.� .. ._., , .:..,,.,..«,.. ._.m ,....a. ..n...�� .. ,:;^5 x N7 ..�. "}"y��, . ... a.rtl.aw�.G'4 �.�ui.Yl§d.v.daa.c�fi�,�'�' � ! .,.�J'�'r"�?..�'� Si iR�' . . " . . . , iZead Messagr: Page 1 of 2 Read Meaaage i Vrevious � Next Move To $el �� _ From: wmonline�wm.com<wmonline�wm.com> , [add to To: tim(dmontgomerybakehouse.com Cc: Date: Monday,January 07, 2013 11:19 am Subject: Your Payment For Has Been Processed Attachmenb: ❑Teut version of this message. (28) WM.com ( My AccouM� Customer Sei ��. IM��f M1W1r�M�1YT Hello TIMOTHY SCHENK, A payment fo�$405.00 for your moat recent Waste Managemerrt invoice was A��t Number processed on 07-JAN-13.This payment will 6e reflected ort tha payment method on 00000-00000-20078 file for your account CREDIT MC 9202. Note that payments are normally reflected on • your Waste Management accouM wkhin three business days. Pleaae think about the For questions regarding the payment process,please contact the Waste environment betore you Management Service Center at 86�834-2080 and select the opGOn fa WM ezPay. P�^t this email. Please have this conflrtnation number-69775430160-available when speaking with the customer service representative. For service or billing issues,please contact yaur local Wasfe Management office at the number provided on your invaice. Thank you, Waste ManagemeM Service Center Use of WM ezPay constitutes acceptance of Waste ManagemenYs WM ezPay Tertns and Conditions,which may be reviewed at www.wm.com - PrCVi0u5 Since all homea have some level of Radon Gas,Ihe following is pro�ided as a frame ofrefercnce ro help you wderstand the results ofyour Iesl: L .4 reported rcsWl ofless than 4.OpCi/L is bclow�he prcsrnt marimwn recommended levels by S1ale and U.S.Federal Authorities and Colbw-up measuremenls are pmbably no[needed. 2. A resWt ofgea�er than 0.0pCi/1 is above Ihe present recommended level and the aliachmem,"Interyrclation of Screrning Aieasuremenis,"will provide you wilh ihe follow-up action plan. Ow Radon Meuuremrnl Company cannnt accepl responsibility for financial or health consequences oFsubscqurn[ac�ion or inaclion by the cliem or its represenlalives based upon�he above resWts. 'I'his Radon�est onty providee Ihe msWts for the penod covered during[he measuremen�. 6you have any questioq Please do wt hesita[e m contact our Radon Specialist a[ihe above addmss. 't'hank you for allowing us lo be ofservice to you. NOTICE TO CLIENTS The Radon Cun6caEOn Ac[ryuv<s Net anyoM who provides any radon-relate�urvice rn p`oduct to�Ae gererel Wblic must be cnEfied by @e Pamsylvviia De�erpnerit o(EnvimmnenW Pmimnon Yw aze en[itle�to evidence of certificaEOnfiunenyFersoriwlnprwid¢ssuchurvicnorproducGS. Yoivarealsoentitledroapricelislforsemres �T A��d off d. All rzdon meaauerreN data will b¢svn m tl+e Departlrent az reqwred in the Act aM will be kept cmfidentel. I(you heve arry ques�ons,corturents(or complainLS concaeurig pesoris w�p prwide radon-relehd servica,please ronlac[the Ue�ertrr�t at IM Bivaiu of ftadienon ProtecpoR D partlnerit of F.nvuoeunental Pm[ection,P OBm�SAb9,Henub�¢g,Pa I 1105-6d69,('119pe3359d rn B00)23�-P366 � � Air Quality Systems The Best Air System Solufion for your ltome 30 SONSET DRNE,CARLISLE,PA 17013 PHONE 717-226-7I79 E MAIL jooikro(r�comcastnet, INVOICE rznn��,y�,zo�3 Dear, i'hz total charge for the radon mitigation at 2738 S.Rosegnrden Blvd.Mochnnicsburg,PA I7050 is$700.00. Nlease make check payable[o BASS A(R QU.\LITY SYST8M5 'llim�k you for the oppartunity to ba ofservicz. � RaspectfullY, � �i� � ./ 7ooik Ro �� /Y � . _ . _ . .. . _ _ _ . _ REV4512 EX+ (12-12) ,�i pennsylvania SCHEDULE I � �EPAHiMENTOFREVENUE DEBTS OP DECEDENT� ,NNearrnNCevvca�rvwv MORTGAGE LIABILITIES & LIENS RESIDENT DECE�ENT ESTATE OF FILE NUMBER John F. Bradshaw 2112-01051 Report dabts incurred 6y the decedeat pdar to death that remained unpaid at the date of death,including unreimbursed medical expenses. REM VALUE AT DATE NUMBER DESCRIPfION OF DEATH 1 Hospice oi Central Pennsylvan+a 5,180.00 2. Discover Credit Card Payment 22.00 3. American Home Medical 38.Otl 4. Holy Spirit Hospital 170.00 5. Digestive Disease Inst 200.00 6. Pinnacle Health 20.00 7 Highmaric Blue Shield Health Insurance 93.00 9. Highmark Blue Shield Health Insurance 83.00 9. United Water PA 59.00 10. Mystic Stamps 18.00 �t Aodrews&Patel Oncologists 427.00 12. Verizon 171.00 �3. Hershey Medical Center 200.00 14. Susquehanna Township-Ambulance 100.00 15. Holy Spirit Hospital 85.00 TOTAL (Also en[er on Line 10, Recap�tulation) � 6,866.OD If more space is needed, insert adtlitional sheets of the same size. Hospice of Central Penneylvania lnvoice 1320 Linglestown Road Hazx'isburg, PA 17110 InvoiceNumber: 4553 Voice: �1�-�32-iaoa Invoice Date FaX: '717-234-0384 �� 9/30/12 Page: IiY 1:11.Y�M1:PR.YVBYLV.WLt . 1 Resident: � � Karen Bradshaw ��, C/O Kimberly Weindorf POA 11 Alma Lane � East Northport, NY 11731 � � Resident ID: sraasnawx Payment Terms Due Date I Net 15 Days 10/15/12 Description Amount ed Ha1d - September 1-6. 2012 1, 110.00 esidential Care - SeptembeY 7-17, 2012 4, 070.00 � � I ' I 'i �� I �_ _ i Please note our new office address -- 1320 Linglestown Koad, Harrisbur PA 17110 TotalInvoice.Amoun s, ieo.00 ChecWCredit Memo No PaymentlCreclit Appliei 'TOTAL s, ieo . 00 Thank you for choosing Hospice of Central Pennsytvania. _ _ _ Opening Daro: August I 1, 2012- Closing DaM: SepMmbsr 10,2012 � � � Discover More Card Accoun�Summary Paymen� Informafion � Cardmember since 2004 New Balance � Minimum PaymeM Dus � Accounf num6er andin9 in 7125 payma�}Due Dafe � Prsvious Balance s75.03 �ti p��Wamng:If we do nd �� Payments And Credih - 75.03 � paymsM by ths dats lisled abovs,y� ,= Purcha»a + 21.60 (�oF up fo 535.00 and your purch � Balan<e TransFers + 0.00 APRs(or new hanwc�ions may bs ir � Cash Advances + 0.00 APR of 14.99%wriable. � Fess Charged � O.pp —��-- Infxesf Charged + 0.00 � � Nsw Balancs 21.60 Manags Your Accounf On1irM � See Inferosf Charge Calculalion sxfion following Saurely xcess stafemenb and 6 � hanwcfions for defailed APR in(ormafion online and hack and view all hrn '�'7 Crodlt L•ne � 510,000.00 M�ke�our munery worNi muie�h — Credit llne Available f9,978.00 and redesm cash rewords � � Caah Advance Credit Line s5,000.00 NEWI Acceu your ac<ounf secu � Cash Advance Cradif Line Available 55,000.00 mobils phone �? You may be able lo avoid Interest Charges,ses Addifionol 3 Easy Ways to Contacf U: � Impodanf InFormation for defoils. 1. Ameu your occouM securely al� 2. Coll 1-800.DISCOVER(1-800.3� Pleox hava your Dixova�mrd Cashback 8onus• Anniversary Monih 3 Sah'Loke City,UT 841 JN d c March Fa paymeMs,pleax xnd M addrsa Opening Cashback Bonus Balance S 64.1 7 Dixover,PO Hox 6103,Carol$heo New Cash6ack Bonus This Pariod + p,p� For TDD(Telecommunicaliona Devia Cashb«k Bawt Balanc. S �q,�b assistance,pleaxcalll-804347-7. io leorn more,log in a�www.Di�cover.com 0 � Transactions T.�,. von �� N oa+. ua. 'o Paymenls and Gsdih Aug 22 Aug 22 PAYMENT-THANK YOU Msrchandis� Aug 10 Aug 11 PUZZLEWAREHOUSE ST.LOUIS MO F�� TOTAL fEES FOR iH15 PERpD Inlsrost Chargsd TOTAL INTEREST fOR iH15 PERIOD 2012 Totals Year-�o-Dnte TOTALFEES CHARGEDIN 2012 TOTALINTERE5T CHARGEDIN 2012 NOTICE:.SEE REVERSE SIDE fOR IMPOR7ANT INfORMATION ' M p N OD � � mo m � D O � Z -n �m b � � r s � g� "Tj , � � 5� � � � >. � � z � q � I � � � � ' � � , z � � �. � `° . ; o � -� � _ w � � r o � � � :,. � _ � w I � .: � � ` 3 �/ a � `� r � r ` $ _ . p �5 � � t : m .� � J _ . o . � � m � \ � C� 1 , � a � f � � � � � � N I� � o o � � i a � c>p z �� .+� n p va ;m (A � 4 � �'. z � � N� �i0 � �� °P p ( ..m y �7 , 2 ii i�� m d American Name Medical Summary Statem Equipment Company, LLC 2300 A Ofd Gettysburg Rd DATE: Friday, October O5, 2t Camp Hiil, PA 17011-7303 BRADSHAW, JOHN F Make Payment To: 2738 S ROSE GARDEN BLVD America� Home Medical E ui MECHANICSBURG, PA 17D55 q Pment Company, llC 2300 A Old Gettysburg Rd Camp Hili, PA ll011-7303 (7ll) 761-9124 Date o Invoice Qty Item Descriptlon Charges �Credits Item Customer Service Number Balance Balance 6/1$/2012 $1�5 1 CPAP MACHINE $112.(JO $104.07 $7.93 $7.93 6/18J2012 BS005 1 H�A7E0 HuMi�t�[ER $30.Q0 $25.26 $4.74 $4.74 7/1$/2�12 91923 1 CPAP MACHINE �112.� $304.�7 $7.93 $7.93 7J18(2012 91923 1 HEATED HUMID1ftER $30.00 $25.2b $4.74 $4.74 Payments on Account $O.QO $0.00 $O.QO $0.00 Customer qalance ;25.34 Commenis: 0 � � g .�? � celCIlc(,'2t� Ana tvewkam �L tal Home Medica! EquipmentCompany phone: 717.731.5384 All4eim atM+erican F�mxaro Suppy Co. Faa: 717.761.9127 Aida for daily �iving ^ 1,�. �!��Ks 23t�A Old fmttysburg Road /�� A ,' �� Seated Walk<rc Camp Nill, PA 17(I71 �C.'�" �'� n ._Il-� � �. Whee�chai.s n y' .�.}� Nirwd prts�ure Moniior5 Nours:Moa,-Fr48:)OS 4� n �j'fu' � �� `T � a 5, 3 �+ =#� r-suMSr-ieieo � �..,_ �--, 1 � _g _ . AMERICAN HOME MEDICAL Summary Statement EQUIP CO 2300 A OLD GEiTYSBURG ROAD DATE; Thursday, October 04, 2012 fJ1MP HILL, PA 17011-7303 BRADSHAW, ]OHN F Make Payment To: 2738 S ROSEGARDEN BLVD AMERICAN hIOME MEDICAL E MECHANICSBURG, PA 17055 QUIP CO Date of Invoice Qty Item Descriptlon Charges Credits Item Customer Service Number 8/18/2012 5811 1 CPAP MACHINE ��a�� ance $112.00 yk9933 $12.67 $12.67 8/18/2012 5811 1 H�TED HUMIDIRER $30.00 �29.64 $036 $0.36 Payments on Acmunt $0.00 $0.00 $0.00 $0.00 Customer Balance ;13.03 Comments: THANK YOU FOR YOUR PAYMENT. ANY QUESTIONS PLEASE CALL 71i-761-9124 ��g- � � �� 8 � f3 , �3 d,--, l o -� -l a- BT-SUM5T-10163 � � . . . . . Q We have received the explanation ot benefits �Ly from your Insurance company(s) and have applied whatever payments and/or adjustmeMs are appropriate. Please make paymer�t for the A balance due of 5200.00 OR take advar�tage of a Thr Sp�,;c of Cn,�nt 15% prompt paymerrt discouM and remit 3170.00 on or befor� 10/78/2012. 43121227 Nere aro 3 convanient ways to pay: KAREN A Bi2ADSHAW �• ��PeYmeM onOna at www.hsh.org. 2738 S ROSEGARDEN BLVD �. Mail tear-of/coupon below with paymant MECHANICSBURG PA 170555305 in ttie enclosad anvelope. 3. Call Customsr 3wvies bslow to maks payment by phons. ��l�d r . , 9��z . . Patlerrt Name: Bradshaw,Karen A Previous Balance: 941,526.25 Statement Date: 09/18N2 Total New Charges: t,oa Service Date(s): 08/11/12-U8l24/12 Payments/AdjustmeM:s: ;41,326.25- AccourH Balance; t200.00 Account Number. 4i127227 p�asa pey Thjs pmaunt: S200.00 OR Medical Record Number. 081909 Discounted Amount of;770.00 if paid on or before 10H8/2012 . � . . • . Please call Customer Service at 717-7832138 fns. 7: HiGHMARK SECU to add or make cortections to your insurance Ins. 2: infartnetion,or to make artangemertts for a ins. 3: payment plan. If you ere unable to make Ins. 4: paymeM, please comact tfie PatieM Financial Advocate's Office at(71� 783-2885 to dlscuss � financial assistance opRions. N r Please Note: Your physiciar�s will bill sep�atety Ior pro/essronal services. _ _ � . . . 0 OLY Total New Charges: 941,526.25 _.o0 Payments/Adjustments: 941,326.25- Account Balance: —�. 9200.00 S P I T A L PleaSe Pa ThiS un The $pirit o(Caring y 5200.00 OR Discounted Amoun of 5770.00 if paid on or before 10H 8/T012 . - . � Trans. Date DescriMion Amount 09/12/12 FREEDOM BLUE IP PYMT B06 HIGHMARK SECU 11,065.82- 09/12/12 FREEDOM BLUE C/A IP B06 HIGHMARK SECU 30,260.43- DIG ESTI VE DI SEASE I NST �F PAYNO BY y7M pp yiy7�pp�qy pJ�sE�p�y 899 POPLAR CHURCH ROAD �� h=1� ,_ ❑,M,re„�� • CAMP HILL PA 17011-2206 °'°'° "'°" ��rA MU511NCWUE]OGII RETURN SERVICE REQUESTED sE°°"'"v"'F'�'' ELY:N UF CAPO 9TATEMENT OATE�.�' PAY TN18 AMOUM ACCOUNT NO. JOHN F BRADSHAW Billing Phone: 717-763-0430 ext 319 10/OS/2012 $200.00 t29736 BillingFax: 717-763-9854 CNpRGE54NOCREDIT5MR0EAFfENSTqTEMENT SHOWAMOUNT � Billing Email: brendar@pagiconsultants.com DATEVYILLAGPEAqONNE%TSiAIEMENi. PA�DHERE Web Address: www.pagiconsultants.com Stmt ID#: 206211000 �MAKE CHECKS PAYABLE/REMIT TO:� h�li�lr�,i.i�i,.uinl„q�n,i�ii,,.�i„qrd��lird��ilhh a��.,, � JOHN F BRADSHAW DIGESTIVE DISEASE INST 11 ALMA LN 899 POPLAR CHURCH RD m EAST NORTHPORT NY 11731-3708 CAMP HILL PA 17011-2206 I��III��III��II��II��I�I��I�III��II,�I�I��I�I��I�II � Please check box ii above adtlress is inconect or insurance PLEASE DETACM ANO HETUFN TOP POflTION WITH in(ormation has changeQ an0 indicate c�ang�ys)on reverse sida. YOUF PRVMENi IN ENCIOSEU ENVELOPE Please Note:If a'1'appears in this eotumm,we have filed wHh your primary cartier. I(a'2'appears, — we have alw filed with your secondary eartier. Our records show your insunnce as follows: 1: NOVITAS SOLUTIONS INC 2: HIGHMARK BS MC SUPPL 378 Pro- Artaunt Your Date ider ICDB Rehrence Descri 'on ol Serviees Cha ed Pa ments Insurance Balance OB/15/12 LPL 530.89 93235 EGD 895.00 100.00 1 OB/29/12 HIGHMARK FREEDOM BLUE ASC 232.62 OB/29/12 HI6HMARK EB ASC ADJ 562.38 OB/16/12 LPL 537.89 43298 EGD W/DIL GUIDE WIRE 1195.00 100.00 1 08/29/12 HIGHMl�RK FREEDOM BLUE ASC 395.50 08/29/12 HIGHMARK FB ASC ADJ 799.50 An endoa opic pro ure may pxoduce mvltiple ills with tlhia acet N. ne for P aiciaa, aneatheaia and fac ty. If you 'sagree w thia billinq state�ent c 1 your insuranc cazrier asA about your out of p cket bene i�ta Account Current Over 30 Over 60 Over 90 Over 120 Due From Balance ealance Patient DUE FROM PATIENT $200.00 $0.00 $200.00 $0.00 $0.0 $0.00 $200.00 $200.00 Providers: LOUIS P LEITE DO, Make Checks Payable To: DIGESTIVE DISEASE INST STATEMENT IIIIIIIIIIIIIIIIIIIIIIIIIIII�I�II�IIIIIIIIIIIIIIIIIIIIIIIIII SEE REVERSE SIDE FOR IMPORTANT BILLING INFORMA'iION .��s<as+ _ _ _ eaaae-n Pleaw Nob:If s'T appears in this column,ws havs fllad wkh your prhnary carrler. If a'2'appear;� — wa Aav�alw Bled with your secondary carria. Our racords show your Insura�e as lollows,; '1: HIGHMHRK FREEDOM BLUE (ME 2: ° Pro- AmouM� Your Date ICUB Referene� Dexrl on of Sarvkes Char ad Pa nts Insuranes BaWncs OB/15/12 LPL 530.89 93235 EGD . 895.00 100.00 1 OB/29/12 HIGHMARK FAEEDOM BLVE ASC 232.62 08/29/12 HIGtIIdARH FB ASC ADJ 562.38 08/15/12 LPL 530.89 G8918 PATIENT WITFIOUT PAEOPERAT 0.00 0.00 1 08/16/12 LPL 537.89 93298 EGD W/DZL GUIDE WIRE 1195.00 100.00 1 08/29/12 HIGHMAAIC FREBDOM- BLUH �ASC 395.50 08/29/12 HIG}RTARK FB ASC AOJ 799.50 08/16/12 LPL 537.89 93239� EGD WITH BIOPSY- 1195.00 0_00 1 08/29/12 � HIGHMARH FB RSC MJ � 972.25 �08/29/12 HIGHM}1.RK FREEDOM BLUE ASC 222.75 08/16/12 LPL 537.89 G8918 PATIENT WITHOUT PREOPERA'C 0.00 0.00 1 Aa endoa opio pro e may produca multipla i]1e with 1:Lis. acct N. ne for B sician, aneatheeia and Pac lity. Account Current p�er 30 Over 80 Over 80 Wer 120 Due rom ealance ealance PatieM DUE FROM PATIENT 5200.0o S2oo.00 $0.00 $0.00 $o.o $0.00 5200.00 $200.00 Pttivider�:.� ., a ,. . . . ,. LOUIS RLEITE�E� , �� 1 � .a,>.�4 em c^c ; MakeCheckspayabftrTa; " ,� ±„�-,,., �. . , DIGEST 14E DI3EA$E INS7 { �. . , ._ .. . . . �� . _ _. . . . . .--- n` d I IIIInIIIIIIIIi�IIIIIIIIIIIIIIIIIIIIIII!IhIIIIIlIIIIIII SEE REVERSE SIDE F RTMPOR ANT BILLING INFORMATION 938�� _,�7z EFORM144934 asx oF JOHN P siunstuw Dscn DATE /D,/7 � 60-1273I313 RIAIDBRLY A WSINDORP S]CTRX PAY TO THE ✓� ORDEROF �C�J � --t��'� $ Di �� --� DOLLARS PNC Bank, Natioaal Aaeociation � Central PA MORRI9 PLAZN3 � 3TOP & SHOB0182 Non-Negotiable Customer Copy MEMO �29�3Lp �002oo-o2iz PAPER FOR GL TICKETS AND CONVENIENCE CHECKS � �/ � � �tii � PI N NACI.EHEALTH YOUR ACCOUNT IS CURRENTLY DUE. HOSPTTALS Financial assistance is available for the uninsured � or underinsured who �apply and qualify. For more information, please c;311 or see our website at www.pinnaGeheatth.cirg/bil I pay. KAREN A BRADSHAW �1 ��1�� 2738 S ROSEGARDEN BLVD e For AccouM Informatdon, MECHANICSBURG PA 77055- 05 Please Call (77� 23a3717 or �� 7-800-603-8084 for Out of Area Calis. � � �See details on the bac:k of this statement. �j/If payment has been s�ent, please disregard. Pay online at: �■ httPs-1lbillpay.pinnutel�ealth.org . � Patient Name: Bradshaw ,Karen Total Charges:. • 5357.00 Statement Date: 09/11/12 Payments/Adjustments: 5337.00- service Date(s): 08/o7/7z �D/� Account Balance: !20.o0 Account Number. 770176836 r'"�� Patient Balance: 920.OD Primary Diagnosis Code: 729.81 Please pay This Amt s20.00 . • � Ins. 1: HIGHMARK FREE .00 For questions, call our Biiling Help line at: ins. 2: 717-230-3717 forlocalcalls or Ins. 3: 7-800-603-6064 for Out of Area. Ins. 4: Customer Service Hours: ~ Mon-Wed-Fri 7:00 AM to 4:00 PM 0 q Tues=Thurs 7:00 AM to 6:00 PM � m P/ease Note: Your physician will bill separate/y for pro/essional senrices. _ 000874 0001 0001 000 P)8570.00L0 IGHMNtK.� P O Box 38;?702 Pitlsbi rgh PA 15250-8702 �"��'"�D Invoice P.O. Box 382102~Pi@sburgh PA 15250.8102 __D�ate ! Group 09/05/12 06605561 Company Code Billing ID i)1 900481887 � � � JOHN E BRADSHAW 0 2738 5 ROSEGARDEN BLVD °o MECHANICSBURG PA 17055 � Member Covera e Period Account Status ` � ID Number Be innin Endin Previous Balance 14'�. 00 100515105001A 09101/12 10131112 Payments Received u. 00 Adjustments u .o0 Product: MedigapBlue - Plan F prior Balance Due 147 . o0 Individual Coverage Period P�remiurr 147 . o0 Total Balance Due 294 . o0 Highmark Blue Shield has filed with the Pennsylvania lnsurance Department for a ra adjustment in your MedigapBlue plan tor 2013. We will inform you of any rate chang as � soon as it is approved. � � '/� �d�� % To ensure proper credit to your account, always include your Billing ID on yow payment. See reverse side for important information. --------------------- Detach Here and Return Bottom Portiun �Vith Your Payment --------------------- �G-�-{�RK,� Date Company Code Billing ID _&��_�,w4_ 09/05/12� 01V _�900481887 I�III��III�II��I��I��I��II��I��IIIIII��I��IIII��'��'�I'lll� Make Check or Highmark Blue Shield Money Order P.O. Box 382102 payableto: Pittsburgh PA 15250-8102 Nigt�mark Blue Shield Member Covera e Period Due Before Amount [)ue� Ilmount Paid ID Number Be innin Endin 10/01/12 $ 294 . 00 100515105001 A 09/01 N 2 10/31/12 ___ _ JOHN F BRA�SHAW � CHECK HERE FOR ADDRESS CHANGE -PRiNT CORREC710NS ON REVERSE SIDE �19�048181�7nnnnn�94nn7 . 0008�5 000,000,000 1 u-��Ap�/ �{ iaes�o-ooi-o 1G1 uv V Y�^.� �n /) P.O. Box 382102 Pittsburgh PA 15250-8102 �SH�Lp '`��l�,L I►�voice __,,...,_._...».__ P.O. Box 382102 Pitlsburgh PA 15250.8102 Q Date Group 09Y05N 2 06605561 Company Code Billing ID 01 900481890 � � x�K A sx�►nsxaw 0 2738 S ROSEGARDEN BLVD °o MECHANICSBURG PA 17055 � � Member Cpvera e Period Accoun�t Status ID Number Be innin Endin Previous Balance 147. 00 118581266001B 09/U1/12 10l31l12 Payments Received 0.00 Adjustments o. o0 Product: MedigapBlue - Plan F prior Balance Dus 147 . Oo Individuai Coverage Period IPremium 14� . o0 Total Balance Due 294 . 00 Highmark Blue Shield has filed with the P nns ania lnsurance Department for a rate adjustment in your MedigapBlue plan fo 2013 iU inform you of any rate change as soon as it is approved. � � 1 �p/ y �� v/,� c� To ensure proper credit to your account, always inclu illing I1D on your payment. See reverse side for important information. --------------------- Detach Hcre anJ Return Bottom Portion With Your Payment -------------------- �GHM/�RK+� Date Company Code Billing ID [3UJE SHELD 09105112 01 900481890 I�III��lll�ll��l��l��l��ll��l��lllll��l��i�llll��'��'�I'lll� Make Check or Hiqhmark Blue Shield Money Order P.O. Hox 382102 payableto: Pittsburgh PA 15250-8102 Highmark Blue Shield Member Covera e Period Due Before Amount Due Amount Paid ID Number Be innin Endin 10/01/12 $ 294 . o0 1185812660016 09/01H2 10/31/12 KAREN A BRADSHAW �_� CHECK HERE FOR ADDRESS CHANGE -PRiNT CORRECTIONS ON REVERSE SIDE _ 0190048189D�0000294�01 i +,..4* �3v'� k ° z r �.�'ei�x s+�.� ,�°13g tr�t. r'i`a n�U('ITt�� 4�f�P P@ I151J11KCD�Q. %�"; �,�,� L� � � �s� � llNIT�D VIIATER ,� � � �qmm;sow"f4�A;�o3�ti� �� , , f' ��9naamsor� : ; '�;°: - E ., . � . . ,,� ' ,��. , , � �� . ; '� , TNbP,honebtl7-565�36b2 ' �.� f : � � �e � y = .,, _ .unit dwn .co � . °�° ,,. � USAGE HISTORY Biiling Date: 08/3'I/12 MonthlyusageinThousandsofGollons AccountNumber: 00203448520000 ,z — , _ Preuious Balance $46.97 � PoymentsThrough0fi/31/12 rna�KVau $46.97CR a « s Baiance Forward $0.00 fi , , ' ' Current Char es Due Q9/20/2012 $58.92 3 ' TOTALl�MOUNT DU�.,,"; > s, SS�.��; < 0 Iul .Wp in rvw Drt iN Mv Pp Mey lun lul Mp Next metei reading aate:an or about 09/28/2012 'PA'�BY 0926/2012 TO AVOID A 1.5%IATE PAYMENT CHARGE SERVICE TO: IOHN F BRAOSHAW SERVICEAODRE55: 2738 HOSEGARDEN BLVO MECHANICSBURG PA .([10L N »€y5� '`�4$t 4� n `` yf �t� s . �-0tlYQ RRIdfyA�yyy g� 3. ;" q c��yiym�t�p.�.d rv^' c� ' ��}�yq; y�� '• L 'py'�"' '4Y4 ,b�.'�� Tk v5d�' E Y+�� 5��`fP ,"�F " �..'� �TI6ii1! y �� 1'1[PfO�f.rM' A�.- Y �EA`�T'iryYF" Y > "4"� 6, fli`P{F�{'�� 66673310 07/31/12 OB/31/12 31 0388 �0396 8 MGL ACTUAI W07 EQU/VALENTTO B.00OGqLLONS SERVICECHARGES 511.00 STATE?AXAD]USTMENTSUFtCHARGE 50.04 wATER CHARGES 547.29 TOTAI CURRENT CHARGE'.5 $58.92 DISTRIBUTION SYSTEM IMPROVEMEN 50.59 SEE REVERSE SIDE FON IMPOPTANT ACCOUNT INfORMATION %�� "�A �x �� r A r�{"�� rc` , �..- 3ta �'1�' 1f1 1 A'�W7Ml7CA ,� n? � q"'n` � Your consumptlon is based on an actual reading of your water meter. � � ' " � " "� " � - � �. , ��°. _ Saue a stamp and go paPerless today! Log on to www.umtedwater.com or call Custumer Service to tind out more informaiion and to enroll in eBiDing. Effective]uly 1, 2012 UWPA's Distributian 5ystem Impro�ement Charge(DSIC)surr.harge increased from 0.77%to 1.02%. Approximafe state tax included on this bill$233. �k1�3.� �I�Ir�- ., � , o. ..... niCnccnRerul+coceMnocinau*uFOt�ein4nnrT1(�MMnil�vnunnpv4cnlT�uTUCOCT�nIJtenK�nnc ooTimcn .... HBRITAGB AMSRICAN FIRBT LADIE9 MYSTIC STAMP COMPANY grancee cleveland 9700 MILL STREET 1 Miat stamp REPLY FORM 1 Mint Souveair 8heet 07/30/12 CAM DEN, NEW YORK13316 Colorzied Preaidential Dollar Payment upon receipt y-�, i � DESCRIP'I'ION is npprecfated. 'I111 ti�� SHZPMENT #23 17055BRD5273 170 23 UK JOHN F BRADSHAW 2738 S ROSEGARDEN HLVD SELECTION 2[ticE MECHANICSHURG PA 17055-5305 14 . 95 . SHIPPIN3 ANp FWNpLING 2.55 � NEW YpAK STATE SALES TAX I�I�I�Ji��llil�l�l��ll�l��lql�ll��l�l�l'll'�I��Ili�l�' xoxw NON DIIE 17.50 Please make any corrections to your name 6 address ��,/j � ,/� /� �L ��3�v PLEASE KEEP THIS PORTION FOR YOUR RECORDS ql 0��/'^ Friend/y Reminder Just a reminder that we have not received yout report on the last selection Mystic sent to yau. Perhaps you have already mailed in your paymenT. or your last shipmeoG In that case, your letter and tiris note may have crossed in the: mail. If so, please disregard this! For your convenience, the description above lists what was sent, al.ong with the original invoice date. If you havcn't made your report, please take a few moments to do so today. T6is will bring your account up-to-date. If you c600se �to return the product please use the convenient return em+elope that was sent with your shipment. All of us at Mystic appieciate your business and enjoy helping your collecbon grow. Please call us at 1-800.433-7811 if there is a problem with your acc�unt Cordially, \��- ��U.�, Connie Borden Mysfic Stamp Compan.y DATE OF THIS NOTICE 09/10/12 MR342 �R mit payment to: Patrent Statement drews and Patel Associates PC Frlda �„s�3�, so�s �3912 Trindle Road . . • . , Camp Hill, PA 17011-4246 baz�.o (717) 761-8740 Paymen e: �Check � �Visa � Mastercard ❑Disi:over � Other ❑Unknown Karen A Bradshaw � A�o��,�# 2738 S Rosegarden Bivd � � Mechanicsburg, PA 17055 Expiration Date_/_/ Signature Date__/_/ �D.tacn mtl nmlt vnM aym�nq Reflar.b transacUons po�tetl through 8/�1/2012 fo�16813 � Karen A Bredaha�254b8)/A Andrews MD'WES001117 Location:Andrews and Petal Assoclate�PC 06/1 s/2012 OKce or other outpatient visit for the evafuation and management of an $730.00 1.00 $130.Oo go.00 established patient, which requires at least 2 of these 3 key components: A detailed history;A detailed examination; Medical decision making of moderate complexity. Counseling and/o 06/19i20t2 Collection of venous blood by venipuncture $8.00 1.00 $8.00 $0.00 Os/19/2012 Blood count; complete(CBC), automated(Hgb, Hct, RBC, WBC and $79.00 1.00 $1g.00 $0.00 platelet count)and automated differential WBC count 06/19/2012 Injection, irinotecan, 20 mg $460.00 77.00 57,820.00 $0.00 os/19i20t2 Injection, bevacizumab, 10 mg 820ZOO 40.00 S8,2a0.00 So.oO 06i19/2012 Injection,,dexamethasone sodium phosphate, 1 mg� � � $7.00 12.00 512.00 SO.00 06/19/2ot2 fn�ection, atropine sulfate,0.01,mg . � - � - .� $2.C�o 40.00 $80.00 50.00 O6/'19I2012 Injection, palonosetron HCI, 25mcg � � EtOS.00 70.00 $1,080.00 $0.00 o6/19/2012 Chemotherapy administration, intravenous infusion technique; up to 'I $250.00 1.00 $250.00 80.00 hour, single or initial substance/drug 06i1s/2012 Chemotherapy administration, intravenous iniusion technique; each $125.00 2.00 $250.00 $0.00 additional hour(List separately in addition to code for primary procedure) 06/79/2072 Chemotherapy administretion, intravenous infusion technique; each $125.00 1.00 $125.00 $O.Oo additional sequential infusion(different substance/drug), up to 1 hour(List separately in addition to code for primary procedure) o6n9i20i2 Therapeutic, prophylactic, or diagnostic injection(specify substance or 3s7A0 3.00 S2o7.0o So.00 � drug); each additional sequential intravenous push of a new substance/drug(List separately in addition to code for primary procedure) 06/19/2072 Infusion, normal saline solution, sterile(500 m1=1 unit) 515.00 7.00 $15.00 SO.00 06i19/2012 Infusion, normal saline solution, 250 cc 517.00 t.00 817.00 $O.Oo O6/19/2012 Copaymant Payment from Bredshaw, Karan A(25458) 576 $0.00 -525.00 Thank you for paying your copayment at time of service. 07/10/2012 Disallowed Adjustment trom HIGHMARK BLUE SHIELD 0992863 $0.00 $0.00 07/10/2012 Payment from HIGHMARK BLUE SHIELD 0992863� $0.00 $0.00 08/01/2012 Disallowed Adjustment from HIGHMARK BLUE SHIELD 0992938 -$14,820.84 $0.00 OB/01/2012 Payment from HIGHMARK BLUE SHIELD 0992938 -$2,985.50 $0.00 08/01/2012 Transferfrominsuranca 0992938 -$480.66 5480.66 This balance is the patienPS responsibility per the insurence carriec This could include coinsurance,copay,or deductible. OB/17/2012 Payment from Bradshaw, Karen A 80.00 -$3at.33 ' E0.00 5114.33 . Karen A Brodshav�2S458)/Kathryn A PeroutkaNVES002162 � Location:Andraws and Gatel Assoclatas PC 07/10/2012 Office or other outpatient visit for the evaluation and management of an 5130.00 1.00 $90.00 Sa0.0o established patient,which requires at least 2 of lhese 3 key componerats: A detailed history;A detaiied examination; Medical decision making of moderate complexity. Counseling and/o 07/i0i2012 Collection of venous blood by venipuncWre� � SB.oa �.o0 38.00 So.00 o7i10no�2 Blood count; complete(CBC), automated (Hgb, Hct, RBC, WBC and S19AO �.00 579.00 80.00 platelet count) and automated differential WBC count 07/18/2072 Disallowed Adjustment from HIGHMARK BLUE SHIELD 0992908 -$42.73 $0.00 \ // Ar.count Number Due Date Amount Due ;� �� n19000 �850600823q In Upon qeceiP� 5171.33 ve��n � i y�s�ve►izon•corNmgvarizon Account Iniormation �'/VA'Pq•Aupeay ; statwneneom: tvtenz Ap�y��,q�, . JOfINFB1IADSWIW I �'l�7GP:p'lrf�.Y/MYDIfiVs' . Cu51arc�AccanL BSOB009�234 Ge phn bAry,Gs ipr Fm Account Summary ' � .. �. . � � .. �. Previous Balance S46fi.24 YBflm�NBWS No F'ayment Reccived 5.00 � -- � -�� - -- - -- Adjus7mentsandCredils --.__._._ . Call Us Before You Move -szao.00 �, ealanc.Ferw,ra sxs.2l Call 1-888-416-9691 and we'll help set up your In�emet,N and Phorie lor yro�c new address.You can br,up and rurxrrg in ro time!DON'i WAIT!And 6e N��+rpa . sure to ask il FiOS is available jn your area.Service Cunent Ac�ivity availaDility ranes. -576.48 Taxes,Gavernmental5urcharg:s aM Fees -$5.34 We Value Our Customers Verizun Surcharges antl Other Charges 8 Credi�s We apprecia�e your busness 8 waM lo deliver�M very -513.09 best en�ehainment to you.Call us al T0�N�'�+9� _�91 1-888-805-7111 to lind oul aboN the new v,2ys Venton can save you morey.We enjoy beirg your ArtloUllt DUe-PIBaSe p'ay NOW s171.33 provider,and we would like to keep you wilh us lorger by improvirg your Venzon experience. �j0i`A J Get More,Save More ,/�� i I I �/„.�� Call 1-888-818-734410 ermlre you're getting the v� � �KS hesl Verizon services at a great value-Irom phone, �/� Internet and N,to money saving bundles,intematioral �r /)...1/1 i I /""u'/�� plar�s,and�un add-o�.Together we'll IiM ways to ��M save you even more. - questlons about your blll oK service? View your bills in detail at verizon�.com m call i-B00-VEHIZON(t-800-837-q966), When asked ior your account number,please enler 8508008234.Customers with disdbilities call 1-800-974-600fi 17Y. Please retum remil slip wilh payment. � PENNSTA'TE HERSHEY 1 st Statement �Milton S. Hetshey Pa e� of 2 Medical Center PO Box 843T91 This bill represents the portion remaining after your Pittsburgh,PA 1528d3297 insurance company has processed your claim. Please send yaur payme�t for ttie full amount due. If you have any questions concerning how your insurance company processed your claim, please cali them. JOHN BRADSHAW 11 ALMA LN �voz,as C/O KIMBERLEY WINDORF EAST NORTHPORT NY 11731-37D8 n�qlwn�u�uml��dlmnh�114hII,��dP�hPd�pp�p, Patient Name BRADSHAW JOHN F DATE DESCRIPTION AMOUNT Statement Date 04/17/13 Service Date(s) 08/20/12-09/01/12 09/11/12 "&4LANCE PORNJARD" 92074.15 Typ6 af Seivica INPATIENT 08/20/12 VENTILATOR DAY'INITIAL -1202.00 OB/20/12 INTUBATE,ENDOTRACH,EMERG 632.00 Account Number 1775716 p8120/72 VENIPUNCTt1RE 25.00 New Chafges/Adj $0.00 08/20172 12 LEAD EKG-TRP�CING ONLY 198.00 New Payments/Adj $0.00 OB/20712 NONINVAS PULSE':OX,MULTI 147.00 Account Balance $200.00 08/20/12 EMERGENCY ViSIT, LEVEL 1063.00 Amount Pending fnsurance $0.00 08/29/12 GLUCOSE BEDSIL�E MONITORIN 42.00 Amount You Owe $200.00��I� a Continued on next page... �-I�IR�I This new statement has been specially designed For billing questions or in<.;urance changes: with you in mind. Let uS know what other Para preguntas acerca de su facmra o cambios de seguro contarnos con improvements we should make. representantes disponibles para e�sistir a Ia comunidad hispana Phone: (i 17)531-5069 or(800)254-2619 Please e-mail your ideas to: Available Hours:Monday,Tuesday&Wednesday 8:00 am w 5:30 pm Statementide�S�hmC.DSU.edu Thursday&Firiday 8:00 am to 4:30 pm or write to us at: Written Correspondence: ' Penn State Milton S. Hershey Medical Center Penn State Milton S. H'ershey Medical Center Statement Ideas, PO Box 854, MC A410 Patient Financial Services Department Hershey, PA 17033 PO Box 854,MC A4I0 Hershey,PA 17033-08:i4 P/ease Note: Ynur physicians wi/1 bi[I separately for their projesskonal services. „ERS�evsT o, , __ __ _ _ _ _ _ _. _ _ _ ____ _ _ __ S T A T E M E N T SUSQUEHANNA TOWNSHIP EMS PREPARED April 16, 2013 P.O. BOX 98 ACCOTJNT #: 9806 ENOLA, PA 17025-0098 PATIENT : KAREN BRADSHAW 717-728-9223 PATIENT BALANCE: 100 . 00 KAREN BRADSHAW ' 11 ALMA LN EAST NORTHPORT NY 11731-3708 Amount Enclosed ��D �� yr� '�'`S'v PAYMENTS MADE ONE WEEK PRIOR TO STATEMENT DATE MAY N�OT BE REFLECTED /� - - ----- --- --- --------- --------- ------ --------- ---- --- ---------- —— ---- ---- - -- - PAYMENTS INSURANCE PATIENT DATE CODE # DESCRIPTION CHARGES CREDITS BALANCE BALANCE - - -- -- — - -- ---- - -----— ------ ------------ - - ----- ---- -- - -- ---- ------- - - -- - - -- - — 08-31-12 A0427 ALS1 EMERGENCY TRANS 750 . 00 650 . 00 100 . 00 (2) CP - THIS IS YOUR COPAY AMGUNT 09-07-12 A0428 BLS NE TRANSPORT 375 . 00 169 . 56 205 . 44 � (1) A0425 AMBULANCE MILEAGE 117 . 00 7 . 33 109 . 67 (1) Payments received in last 30 days : 04-16-13 ALSI PCR 1204206 417 . 99 . \ TOTALS 315 . 11 100 . 00 - -- - - ---- ------ --- - -- ------ - - - ---- - - -- --------- AGING: Current � 30 Day I 60 Day � 90 Day � 120 Day � T O T A L -- - - -- - -- --- - -- - --- - -- - - - ---- - - - --- --- - -— -- — - -- - - - - - - -- - - - - Insurance 31.5 . 11 315 . 11 Patient 100 . 00 100 . 00 - -- - - - -- - — - - ---- - - - -- -- - - - - ------ - - -- ----- - - - - -- - - - -- - - - - - - - - - - - - (1) - This item has been filed to your insurance (2) - This item is the patients respons:ibility FOR QUESTIONS OR TO PROVIDE INSURANCE INFO CALL 717-728-9223 MAKE CHECKS PAYABLE TO: SUSQUEHANNA TOWNSHIP EMS PLEASE MAIL PAYMENTS TO: P.O. BOX 98 , ENOLA PA 17025 CIQ�m ✓Qp roce 1�� by �i5hra�c��!% �r��larn��l�� - -- - - - - - - - - - - -- - - - - PLEASE PAY P��TIENT BALANCE -> 100 . 00 � 0 LY We have received tpe e anatlon of benefits from your insurance com�any(s)and have applied whatever payments and/or adjustments are appropriate. Please make pay S P 1 T A L balance due of§t 00�.00 OR take age a The Spint af Caring 15% prompt paymerK discouM an mit a85.0 on or before 04/20/2013. 42899124 Here ara 3 eonvenient ways to pay: KAREN A BRADSHAW 1• Make payment onlin•at wwrW,�h,ary_ 2738 S ROSEGARDEN BLVD 2. Mail tear-off eoupon below with payment MECHANICSBURG PA 17055-5305 in the enclosed$nvelope. 3. Call Customer Serviee below to make payment by phone. - � � . - Patient Name: Bradshaw ,Karen A Previous Balance: StatemeM Date: 03/21/13 Total New Cha es: �•00 r9 t8,780.60 Service Date(s): pg��g�12 Payments/Adjustments: 98,680.60- Aecount Number. 42699124 A�unt Balance: A100.00 Medical Recorcl Number: 081908 P�� Pey rn�$�ount: =100.00 OR Discounted Amou�t of=85.00 if paid on or � before 04l20/2013 ��: - - � � s . . �� , Please call Customer Service at 7�7_7g�y�gg � r Ins. 1: HIGHMARK SECU to add or make cort+ecijons to your insurance f// Ins. 2: information, or to make airangements for a /� Ins. 4� payment plan. If you are unable to make `� payment, please corKact the Patient Financial � Advocate's Office at (I1� 763-2g85 to discuss m financial assistance options. e Please Note: Yow physicians will biN separately for piufessional services. LAST WILL AND TESTAMENT OF JOHN F. BRAD.SHAW I, JOHN F. BRADSHAW, of 2738 S. Rosegazden Boulevazd, Upper Allen Township, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do make, pub]ish and declare this to be my Last Will and revoke any Wills and c:odicils previously made by me. ARTICLE ONE �ecific Bepuest of Taneible Personal Pronerh+ I give and bequeath all of'my tangible personal pxoperty, includin�g, but not limited to, all my automobiles, furniture, fixmishings, books, pictures, jewelry, china, linen, silver, clothing, household effects and personal effects, and other tangible personal properiy of like nature (not including cash, securities and other property used for the production of income), together with any existing insurance thereon to my spouse, KAREN A. BRADSHAW (hereinafter my "Spouse"), if my Spouse survives me by thir[y f,30) days. In the event that my Spouse predeceases me or does not survive me by thirty (30) days, my tangible personal pxoperty shall be divided by my executor into as nearly equal shares as practical giving due reg��rd for their personal preferences and distributed among my children, HIMBERLY A.WEINDORF and HE��THER L. SCHENK, who so survive me,per stirpes. ARTICLE TWO Residuarv Estate I give, devise and bequeath all of the rest, residue and remainder of my estate, of whatever nature and wherever situated, to my Spouse, KAREN A. BILADSHAW (hereinafter my"Spouse"), if my Spouse survives me by thirty (30) days; or, if my Spouse predeceases me or does not so survive me, in equal shares to my children, HIMBERLY A. WEINDOR.F and HEATHER L. SCHENK, who so survive me,per stirpes. G�ION7U/,LI&SEIBERT LAST 6VIL,L & TESTA�LlENT �� Puge / oj70 ��H •��HN F' BR�I DSNAW ARTICLE THRE:E Grandchildren's Trust In the event that my spouse and children have predeceased me: or not survived me by thirty (30) days and one or more of my beneficiaries is a grandchild who has not attained the age of twenty-five (25) yeazs at the time of my death, the shares of my residuary estate payable to those grandchildren shall instead be payable to my Trustee, hereinafrer named, in trust nevertheless, to be divided into equal separate shares so that there is one share representing each grandchild who survives me and who is under the age of twenty-five (25). Each such separate share shall be retained by my tnistee, in trust nevertheless, as a separate trust estate to be held, managed, administered and distributed for the benefit of that grandchild as set forth herein. During the term of any Trust created pursuant to this Paragraph, rny Trustee is authorized to expend and apply, from time to time, so much of the net income and principal of said trust as my Trustee, in his sole discretion, shall consider, advisable far the healtti, maintenance, support, and education (including college education, undergraduate and graduate) of my said grandchild until the attairunei�t of twenty-five (25) years oF age, or until all such amounts are paid out of the Crust It is my intention that the expenditures to be made on behalf of my said beneficiaries will vary as the needs of the respective grandchildren change. At or upon a grandchild attaining eighteen (18) years of age, the Trustee shall distribute up to 1/3 of the principal and accumulated income to or far the benefit of and upon request of the said grandchild; 1/2 of the then remaining principal and accumulated income at or afrer my grandchild attains twenty-one (21) years of age; and the then remaining ��alance of principal and accumulated income upon my grandchild's attainment of twenty-five (25) years of age, whereupon any Trust created hereunder shall be terminated. If a grandchild should die; before final distribution of the trust assets, I direct that the affected Trust shall terminate and any remaining Trust assets shall be redistributed in accordance with the priority of beneficiaries I have established for m;y residuary estate which is set forth in ARTICLE TWO hereinabove. ARTICLE FOUR Pavment of Taxes and Administrative Exoenses I direct that all estate, inheritance and other death taxes (other than generation-skipping transfer taxes), and all interest and penalties thereon imposed by reason of my death with respect to property subject to such taxes by reason of my death, whether such property passes through my probate estate or outside of my probate estate, and payable to any federal, state or foreign taxing WION7,ULL1&SEIBF,RT L.iST GvILL � TESTAti(ENT �� 01%JOHNP. BRADSfIAGi� �� - Pnge?oj10 �� authority, whether payable by my estate or by any recipient of such property, and all estate administration expenses, shall be paid to the extent possible out of my residuary estate passing under ARTICLE TWO hereinabove. ARTICLE FIVE; Protective Provisions The principal of my estate and the income therefrom, so long as the same are held by my Executor, shall not be subject to anticipation, assignment, pledge, sale or transfer in any manner, nor shall any beneficiary have power in any manner to charge or encumber his/her interest in my estate, nor shall the said interest of any beneficiary be liable or subject in any manner while in the possession of my Executor for any liability of said beneficiary, whether such liability arises from said beneficiary's debts, contracts, torts, or other engagements of any type. ARTICLE SIX Powers of Fiduciaries In addition to and without limiting the powers conferred by case law, by statute, and by other provisions hereof, my Executor and any Trustee or other fiduciary appointed hereunder shall have the following rights and powers exercisable without the need for court approval: (A) Accent and Retain Investments. To accept and retain any form of real or personal property received by transfer, devise, bequest or otherwise without being required to diversify and without being limited to the types of investments in which fiduciaries are authorized by law to invest. This autharity shall specifia�lly include the authority to accept and retain any stock of a corporate fiduciary hereunder, or in any corporation which controls ar is controlled by it, or any other corporation in which it holds any ownership interest, together with a�ry stock dividends received thereon, or any stock acquired in the exercise of subscription rights, or received by xeason of any consolidation, merger or reorganization, without liability for such retention. (B) Invest. To invest and reinvest in any form of real or personal property without limitation by any law applicable to investments by fiduciaries. (C) Votine Ri�hts. To vote a security in person or by proxy, to participaYe in or consent to any merger, reorganization, dissolution, ]iquidation, voting trust plan, or other action affecting any securities held hereunder, and; to exercise conversion, subscription, and otl�er rights of whatever nature. WLON ZUGLI& SELBERT LAST GVILL & TESTi1MENT OFJOHNF. BR.IDSNAW �� Page 3 oJ�l0 (D) Title To Propertv. To register or hol� securities andlor other property in the name of a nominee or nominees, including that of a clearing corporation, a depository, in book entry form, or to retain securities and/or other property unregistered �or in a form permitting transfer by delivery. (E) Sale, Lease and Other Dealings with Prapertv. To sell, from time to time, at public or private sale, exchange, lease, encumber, opti.on or otherwise dispose of all or any portion of assets held hereunder; to make, execute and deliver deeds, mortgages, leases, assignments and other documents necessary to carry out any of the powers granted hereunder, which shall specifically include the authority to grant leases which ex:tend beyond the period authorized by law, and; to partition, subdivide, improve and impose any restrictions on real estate held hereunder and enter into agreements concerning the partition, subdivision, improvement, zoning or management of any such real estate. (F) Borrow. To borrow money from any person or institution and pledge property as security for repayment of funds. (G) Distributions in Kind. To make distributions in cash or in kind, or partly in each, and; to allot different kinds of property to differenl: shares without regard to differences in the income tax basis of such property. Any such designar.ion, division, a]',location, apportionment or valuation of property shall be binding and conclusive on all parties. (H) Power to Distribute Outrieht. In any instance wh�ere property would be immediately distributable to a beneficiary of a trust, distribution may be made directly to such beneficiary without funding such trust. The receipt of any such distribution by any such beneficiary shall be a full acquittance of the fiduciary maJ:ing such distribution as to any amounts so distributed. (I) Settle Claims. To institute, prosecute arid defend any and all legal proceedings; and compromise, release, adjust and/or settle any debt or r,laim. (J) Emplovment of A�ents. To employ agerits including attorneys, accountants, and others to perform administrative duties. (K) Disclaimer. To disclaim any interest in property which would devolve to me or to my estate by whatever means, including but not I.imited to the following means: as a beneficiary under a will, as an appointee under the exercise of a power of appointment, as a person entitled to take by intestacy, as a donee/benefriciary of an inl:er vivos transfer, as a beneficiary under any insurance policy, as a beneficiary wider an individuial retirement account or annuity, and as a beneficiary under any qualified or non-qualified retiremE:nt plan. (L) Property Distributable to Minors and Persans Under a Disabili . Any property (whether income or principal) distributable to a beneficivy of my estate who is under a disability may be paid directly to such beneficiary, to the parent or guardian of such beneficiary, to a GVION7.ULLl& SE/L3E2T L�1ST GVILL & TESTAMENT OFJONN/-. BRr1DSHAW �� Page 4 of l0 l . _ custodian selected by my Executor (other than my Executor) under tlie Pennsylvania Uniform Transfers to Minors Act or under a similaz act of any other state, or to persons caring for or having custody of such beneficiary (other than my ]Executor), or may be applied for such beneficiary's benefit by payment to such other persons, organizations or institutions (other than my Executor) as my Executor may select, and the receipt of any such payee shall be a full release therefor. The receipt of any such payments by any such person shall be a full acquittance of my Executor as to any amounts so paid. Any beneficiary hereunder shall be considered to be under a disability while under the age of'twenty-one (21) years or at any time w]'sen, in the opinion of my Executor, such beneficiary is incapacitated in any way so as to be unable to properly manage his/her affairs. (M) Closelv Held Business Interests. 4Vith respect to any interest in a sole proprietorship or closely held businesses, including but not limited to cotporations, partnerships and limited liability companies (any such sole proprd.etorship or clasely held businesses is hereinafter called a "Business"), my Executor shall huve the following rights and powers in addition to and without limitinb the powers conferred by case law, by statute, and by other provisions hereof, exercisable without the need far court approval: (1) To retain and eontinue to operate a Business for such period as my Executor may deem advisable without regard to the general fiduciary principle of investment diversification. (2) To acquire interests (including minority interests) in a Business either for cash or with borrowed funds and to retain all or part of any such investment in a Business for such period as my Lxecutor may deem advisable withoui' regard to the general fiduciary principle of investment diversification. (3) To control, direct and manage a Business. In this connection, my Fxecutor shall determine the manner and extent of their active participation in the operation and supervision, and my Executor may delegate all or;any part of their power to supervise and operate, to sttch person or persons as they may select, including any associate, partner, officer or employee of a Business. (4) To hire and discharge officers and employees, fix their compensation and define their duties; and similazly to employ, compensate and discharge agents, attorneys, consultants, accountants and such other representatives as my Executor may deem appropriate; including the right to employ any beneficiary or Trustee in any of the foregoing aapacities. (5) To take any action required to change or to partici��ate in the organization of a Business to a corporation, limited liability company or p;�rtnership, partnership, limited partnership, or other organizational form. GVIO�V 7.UI.LI& SEIBERT l,�iST WILL & '1'EST.9,LIENT OF JOFIN F. 6RADSflAGf' �� Page 5 oJlO (6) To elect �r consent to the election to be taxed in accordance with the provisions of Subchapter K or S of the Code. (7) To execute or consent to the execution of shazeliolder, joint venture and partnership agreements and amendments thereto and to participate in the recapitalization, merger, consolidation, reorganization, liquidation or dissolution of a Business. (8) To treat a Business as an entity sepazate from any trust hereunder. In their accountings to the court (if any are made) and to any beneficiaries, my Executor shall only be required to report the earnings and condition of a Business in accordance with standard accounting practice. (9) To retain in a Business such a�ount of the net earnings for working capital and other purposes of the Business for working capital and other purposes of the Business as my Executor may deem advisable. (10) To diminish, enlarge ar change the: scope or nature of a Business. (11) To purchase, process and sell merchandise of eve;ry kind and description; and to purchase and sell machinery and equipment, furniture and� fixtures and supplies of all kinds. (12) To sell or liquidate all or any part of a Business at such time and price and upon such terms and conditions (including credit) as my Executor may deem advisable. (13) To exercise any of the rights and powers herein ronferred in conjunction with another or others. ARTICLE SEVEN Fiduciaries (A) Appointment of Executor. I appoint my spouse, KARI:N A. BRADSHAW, as Executor of this Will (my said Executor and any successor Executor or co-Executors shall be referred to herein as my "Executors" or "Executor"). Upon the death, renunciation or resignation of my spouse, I appoint my daughter, HIMBERLY A. WEINDORF, as successor Executor. (B) Appointment of Trustees. In the eve:nt that my daughter, Kimberly A. Weindorf, predeceases me or does not survive me by thirty (30) days amd leaves minor issue to inherit a share of my estate by representation, I nominate:, constitute, and appoint her spouse and my son-in-law, JASON J. WEIIVDORF, of East Northport, New York:, as Trustee of any trust created liereunder for the benefit of those minor grandchildren who are children of Kimberly A. Weindor£ Alternately, in the event that my daughter, Heather L. Schenk, predeceases me or does not sun ive me by thirty (30) days and leaves minor issue to inherit a share of my estate by representation, I nominate, constitute, and appoint her spouse and my son-in-law, TIMOTHY WION LULLL& SE/BERT L�4ST wILL & 'IESTAMENT OFJOFlNF. BR,9D.SKAW �—�� • Page6oj10 M. SCHENK, of Montgomery, Texas, as Trustee of any trust created he�reunder for the benefit of those minor grandchildren who aze children of Heather L. Schenk. I�n the event of the death, resignation, refusal or inability of either JASON J. WEdNDORF or TID�IOTHY M. SCHENK to serve as my Trustees, I nominate, constitute and appoint JOHN CAFFI7.EY, of Hauppauge, New York, to fill such vacancy and to serve as my successor. Trustee for tha, affected trust only. The last acting Trustee as named above in this Will shall have the power to designate his successor which shall take effect in the event of the death, resigna�ion, refusal or inability of the last acting Trustee to so serve. (C) Miscellaneous. Any successor Exec.utor or Trustee; named hereunder shall succeed to the capacity of its predecessor without re-conva;yance or transfer of property and have all of the rights, powers, authorities and discretion conferred upon the original fiduciary. No successor Executor or Trustee shall be obligated to examine the accounts, records, or acts of a previous Executor, as the case may be, nor shall any such successor Executor ar Trustee in any way or manner be responsible for any act or omission to act on tk�e part of any such previous fiduciary, as the case may be. No Executor or Trustee serving hereunder at any time shall be required to file any bond ar enter security in any Court or jurisdiction in which such fiducia�y may be called upon to act. ARTICLE EIGHT Internretation (A) Child Children. Grandchild Grandchildren and Issue. Whenever the terms "child," "children," "grandchild," "grandchildren" and "issue" are used herein, such terms shall be interpreted to include adopted persons as well as natural persons, provided in each instance that the adoptee is under the age of eighteen (18) years at the time of adoption. Such terms aze also intended to include persons in gestation at any pertinent time under this Will, provided such persons survive birth by thirty (3�) days. In applying any provision of my Will wtiich refers to a person's "issue, per stirpes", the children of such person are heads of their respective stocks of issue, whether or not any child of such person is then livirig. (B) Survival Clauses. If any beneficiary hereunder should die within thirty (30) days after my death or within thirty (30) days afrer any other perso❑ the survival of whom determines such beneficiary's rights hereunder, then such beneficiary s;hall be deemed to have predeceased me or such other person, as the case may be, for all purposes hereunder. (C) Governine Law. This Will shall be construed and governed in all respects by and in accordance with the laws of the Commonwealth of Pennsylvania. 6�lON ZULLI& SEIBERT LAST�[�ILL& TESTAMENT � C)F'JOHN R BRADSHAW , ,y�j Page 7 oj!0 �; � '�%/ (D1 Gender and Number. Where appropriate except whe�re the context otherwise requires, whenever used herein, the singular includes and plural, the plural the singular and words of any gender shall be applicable to all genders. (E) Headines/Captions. The headings/captions of Articles, Sections and Paragraphs used herein are for convenience of reference only and shall have no significance in the construction or interpretation of this Will. IN WITNESS WHEREOF, I have hereunto set my hand and seal and caused this my Last Will and Testament, consisting of ten (10) typewritten pages, includi.ng this attestation clause and the followin Acknowledgment and Affidavit, to be executed, declazed and published this 2 7__day of_��-iJ c,�/{�52012, at Harrisburg, Pennsylvania. 7 -T7 � cUCG+T J---- / OHN F. BRA SHAW On this a h day of , 2012, JOHN F. BRADSHAW declazed to us, the undersigned, that the fo going ins nzment was his Last Will, and he requested us to act as witnesses to the same and to his signature thereon. He tha;reupon signed said Will in our presence, we being present at the same time. We now, at his request, in his presence, and in the presence of each of us, hereby subscribe our names as witnesses thereto. By so doing; each of us declares that he or she believes this Testator to be of sound mind and memory. Wi ses: Address: ��— �`t"''1��I��, , Witness �2.�, �f� /7//O _��/ �d/d cS l�i�� Witness > ��(rc..�`�s n):��,c9 �'�3�� 6VION "LULLI& SEIl3ERI' LAST WILL & TESTA�LfENT OF JOHN F. BRADSHA 6f� i��i�� Page 3 oj l0 l%/ V ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA . . SS: COUNTY OF DAUPHIN I, JOHN F. BRADSHAW, the Testator, whose na�ne is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein expressed. � ��dE�� J N F. BRA—� DSFIAW S�vom or affirmed and acknowledged before me b;y JOHN F. BI2ADSHAW, the 'I'estator this��ay of_(��r'ilLc,c.�i� 2012. : � �' �sEal.� No�a Public My Commission Expires: COMMONWEALTH OF PENNSYLVANIA �� NOiARIAL SEAL I IEA�!b �� I�Cf�T Nctary Public iG �c�ri rns�urg,�auphin County— 11�4 l '. FqPil"a3l�,lyl;St��,2��4 LVIO,V ZIILLI& SEI6ERT G�IST WILG & TF.STANIENT OFJOfNF. BR,9DSHAW Page 9 of IO �� , . AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA . . SS: COUNTY OF DAUPHIN . We, �hGZ(y �'. l�-�k-�_ and �-Ll[[G�/�1 �. ��lL�`�1�v�GE� , the witnesses, whose names aze signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw JOHN F. BRADSHAW, sign and execute the instrument as the Testator's free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the 'I'estator signed ihe Will as witnesses; and that to the best of our knowledge, the Testator was at the time twenty-one (21) or more years of age, of sound mind and under no constraint or undue influence. _=�-- Witness �"��<�? Witxiess Sworn or affirmed to and acknowledged before me by �-�"'°-U� �. ,�w�t and �GZ�G�f/, � /�/�/s�• 1/�l�y , the witnesses, 'thisD?`� day of �isuc�it� , 2012. , -� � _ � _ :�.��/ �� (SEAL) Not " ublic 6MMON ntxHOr-r�sn,vntrtw My Commission Expires: NOTARIAL SFAL JEAN D,5c".IL'sERT,I�otary FuL•Iic City of Harris6urg,�auphin County My Commission Expires August 17,T014 6�ION ZUGLL& SF,76ERT LAST WILL & TESTAMEN7' OFJOH�V F. f3R9DSHAW �� Page 10 oJ[0 � ,� ,. 6 �1 �� o�2 ¢K �2dtJ'C.COt111.8pp.GoFetlEx 1.8004633339 FZ � ;o pJ ;�. c�p f'� �� N ,.� sl¢ ,.�� b �3�p � g � � �3" c� �1 {`'..' ��'� �n � a 'b '3v �o tl (`1 � x � �� 3 �` ��t � P m i � .,. *. W }t h 1 � � � ! � �� s - � . � � � � � "� � i us. 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