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HomeMy WebLinkAbout06-21-13 (2) -- —— __._ _ _ ___ __ �If'� � � 1505610105 REV-1500�`�02��=,�FI, .: OFFICIAL USE ONLY PA Department of Revenue pennsyLvaMa County Code Year File Number xwnrnex,or�[vcnut Bureau o�IndividualTaxes INHERITANCE TAX RETURN � � �2 /y� �j� Po BOx:8o6oi RESIDENT DECEDENT {f) J IJT� ' Harrisbur� PA i�i28-o6oi EN7ER DECEDEN7 fNFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 04/01/2013 ' 05/07/1929 _ _ DecedenYs Last Name Suffix DecedenYs First Name MI Spenard Lionel J '', _ __ (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Su�x Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE O'JALS BELOW � 1.Original Retum � O 2.Supplemental Return O 3. Remainder Retum(Date of Death Priorto 12-13-82) p 4.Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust ^ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.} O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Oate of Death O 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Kathleen Misturak-Gingrich (717) 591-1755 -._� _ _ �� _ �, _ ,.-.. REGI�I�F WILLS ONlifky � � � � � Z t1? �'t s n � First Line of Address � D �-- N �� : . 'S006 E. Trindle Road 2 � � ~ a Second Line of Address � C'7 �, —� T � �-j C7 -�;, � .e.� Suite 203 �a � ' � �== .. City or Post Office State ZIP Code � TE FILEDC� � "O �.,., (f1 O Mechanicsburg PA ; 17050 � ' � � _ CorrespondenYs e-maii address:�ingrich@pjrlaw.com Under penalties of perjury,I dedare that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct a�d complete.Declaration of preparer other than the personal representative is based on all infoRnation of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FlLING RETURN DATE �--,�.,_ (3 . 9�J c.l�a_— co -�� -�3 ADDRESS �.5� Sa.r��cz [32toG� c.�� .csc� �. paf � u U SIGNAT F�O�PRE_ PARER OTHER T AN REPRES T �DATE� � [4c(-ti.(.�,�- /°7 _ 10 f ADDRESS �00(o E . (r��c.t.� ���. l�-c1�-�-�s�a,.<-•, • �� 0,.� PLEASE USE ORIGINAL FO ONLY Side 1 � 1505610105 15D5610105 � �(� '�- U ��. _ __._ __ _ ___._ . . _.._. ��1� . J 1505610205 REV-1500 EX(FI) DecedenYs Social Securiry Number DecedenYs Name: Lionel J. Spenard ' RECAPITULATION 1. Real Estate(Schedule A). ............................................ 1. 185,000.00 I 2. Stocks and Bonds(Schedule B) ....................................... 2. 1,430.32 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. ' 4. Mortgages and Notes Receivable(Schedule D)........................... 4. 5. Cash,Bank Deposits and Misceilaneous Personal Property(Schedule E)....... 5. 307,008.35 ', 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property ' (Schedule G) O Separate Billing Requested........ 7. ' 8. Total Gross Assets(total Lines 1 through 7)............................. 8. 493,438.67 ' 9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 37,857.88 ; 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............... 10. 6,634.39 ' 11. Total Deductions(total Lines 9 and 10)....................... .......... 1L 44,492.27 ' 12. Net Value of Estate(Line 8 minus Line 11) .............................. 12. 448,946.40 ' 13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which : an election to tax has not been made(Schedule J) .................... .... 13. ' 14. Net Value Subject to Tax(Line 12 minus Line 13) ........................ 14. 448,946.40 ' TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 �a)(1.2)X A- 15. ', _ 16. Amount of Line 14 taxable __ _ , _ ' at lineal rate X.0_ �6 ' 17. Amount of Line 14 taxabie __ __ at sibling rate X.12 �� ', 18. Amount of Line 14 taxable _ _ _ at co��atera�rate X.15 448,946.40 ' 18. ' 67,341.96 ' 19. TAX DUE ......................................................... 19. ' 87,341.96 i 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0 Side 2 � 15�5610205 1505610205 J __ _ _ '�,� REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENTS NAME Lionel J. Spenard - - -- - . - — STREETADDRESS -- — — 9 South Locust Lane _____- ---- ---- CITY STATE l Z�p Mechanicsburg PA ' 17050 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 67,341.96� 2. CreditslPayments A.Prior Payments B.Discount __ 3,367.10 Total Credits(A+B) (2) 3,367.1�, 3. Interest 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENt (3) Fill in oval on Page 2,Line 20 to request a refund. �q� 5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 63,974.86! ' Make check payable to: REGISTER OF WILLS,AGENT. ... , , _. _ �.- , � : ,.. � t, . �� ,. ,; _� - . � : �.. ��� ..: � !� PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred.......................................................................................... ❑ � b. retain the right to designate who shall use the property transferred or its income ............................................ � � c. retain a reversionary interest.............................................................................................................................. ❑ � d. receive the promise for life of either payments,benefits or care?....................................................... ............... o ■ 2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death without receiving adequate consideration?........................................................... ................................................... ❑ � 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ � 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation? ................................................................................................ ........................ � ❑ IF TNE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ' ����� � � � � , �°�• ; ���� . � ��; . � ;' ��� For dates of death on or after July 1,1994,and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the sunriving 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 statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and' filing a tax retum are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: . The tax rate imposed on the npt value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)). . The tax rate imposed on the net value of transfers to or for the use of the decedenYs lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)].' • The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. __ _ — �,�� REV-1507 EX+(12-12) � pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE [NHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Lionel J. Spenard All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be exchanged 6etween a willing buyer and a willing seller,neither being compelied to buy or sell,both having reasonable knowledge of the relevant facts. Reaf property that is jointfy-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been soid. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCR[PTION 1• 9 South Locust Lane 185,000.00 TOTAL(Also enter on Line 1, Recapitulation.) $ 185,000.00 If more space is needed,use additional sheets of paper of the same size. �i.., ___ __ __ . �1�� ' Mark Heckman Real Estale Appraisers 1309&idge Stceet, New Cumberland,PA 17070 Pae No.9SLocust APPRAISAL OF 'Ht���'��j�2 Sy,. :.S., y e'+=� � � �^e �� �t��; r"' i. !w�s. , r: Single Family Residential Properiy LOCATED AT: 9 S.Locust Lane Mechanicsburg,PA 17050 CUENT: Kathryn Gates 259 Sampie Bridge Road Mechanicsburg,PA 17050 AS OF: May 9,2013 BY: Gina Distefano,State Certified Residential Appraiser RL13899t PH(717)774-7202 FAX(717)774-0383 EMAIL heckmanappraisers@comcast.net �i�_----- �,��_ _ - Summary Residential Appraisai Report F�7eNo.9SLOCUSI , Thep�aposedthisappaisatrcpxtisropovidetheciedvrithacred�ieopG�ondlhedefinedvaWeoithewbjalproperty,givenlheintendeduseotlheapprotsal. C�emNamdinenaeaUsa Kalh n Gates E-maticscbu verizon.net � c�aaaress 259 Sam e Brid e Road c' Mechanicsbur s�a�e PA z 17050 • Aa�iana�i�uenaea s Estate of Lionet naM and his ass ns � m�enaed use Fair market value for olential sale Pr Addras 9 S.Locust Lane Mechanicsbur swce PA z 17050 ownaotwatcRaaaLionel J.S nard Cumberland � Deed Book: Pa e Number Assessor s Parcd/ 38-14-0847-054 Tax Year 2012 RE.Taxes S 2 029.00 N Nam� Ma Retererxe 38-14-0847-054 Cenws Traa 0118.01 ai�tl X Fee Lesuhdd OUier dew�be research �d �1 na reveal br sales or vansfas of Ihe sub far Ihe Ihree to the eNecuve date M Ws a raisal. PrhrSeldCram[v: Oate Price Sarcc s MalysisofpdorsabaUan9ahtstaryoftliewbJeclproperty(anACOmparaGesates,ifappticade) A raisers anai sts shows no transfers for lhe su ect ro e in the ast three ears. . ottatngs.oqiananacarracuasw�nedrectivedatear�neappraisat NoneKnown .,�,._ .Y.�� :.. , _ , _- ;:,. ,r .1 ...;,. ..r.s �,�'..:t,r.�r�1�lk.Ighborlworl,ChrraeterhGes_ � � t�,.=J,,�..:. ��.�...:`One:UnftH6ifsing7rands�r-,.i:v....3,..ttF....v.0??�UNtFlousieg,��._�.:',K.Q�asentl:and,UseW�:�.;', • Locatlon r�lbban SWurban Rittal Pro Values k�aasi X Stede ' PRICE AGE One�Unfl 81% ' BWt X Ovu 75X 25•75% UMer 2596 e tn Belance Over Su 000 2•4 Wdt 2% GrowM Ra Steble Sbw Market Time Under3mNS X 3•6mths Over6mUn 40 Low 0 MulB•F 2% � Netg�aornoodEou�aries See Attached Addendum 615 100 Commerdal 5� 310 Pma. 50 �u�Vacant 10 96 ; Neg�ahooa Dewiqton This suburban nei hborhood has relativel eas access to em lo ment and services and Is com titive wilh other " nei hborhoods in the neral area. Most have similar amenities. Mancei Cana�aions pncwang wppan ia me aoove conuusto� While housin rices on a nationat basis are said to be declinin the CenVai PA market area in eneral has not seen th(s e of de reaation. Howeve�,the market in lhis area has slowed in lhat residenUai dwellin s are 6ei marketed(or ton er eriods ot time cal less lhan 180 da s. A raisers have also encountered more sellers concesslons/assisfance than in recent ears. oimaswns See Piat Ma area 1.19 sne e irre ular wexr Above Avera e 5 z c�rxsmn R-1 Residential Zone 1 z De � Aliows for current use as a sin te(amil detached resldential dwellin . nce l Nanconf Grandfathered Use No 2ad I 1 descn'be Is thc htghat aM bat use of tAe wbjeu prapenyas improved(a as proposed per plans and spedficatio�u)Ihe present use? Yes No If No,descr�be. Ulilhles Pu01k Other describe) Publle Other douNbe) Off•sitelm rovements--T e Publle Prlvate E � X 200 AMPS wa�er Well sveet As halt X cas None seni sewer Se tic au None ' St�e CanmeMS Site has avera e slte im rovemenls avera e landsca in and ical malntenance.The site im rovemenls and services to the site are ad uate and acce lable in this market.There are no a arent adverse easemeMs encroachments or other adverse conditions on this site. � �,,.�..............__.. .._ � .. ._ . ,.____...._. . ,, . ......., .,GENERAI!DESCRIP.DON+�. ., ,�_ :...,..;,: ...FOUNDATION.., .. .;_;: EXTERIORDESCRIRTION.. .;m`atenals,..,::_.; INiER1UR�:s, _` .:mat'enals :s:. unRs X one Onew/accair Caae�es�an aawl ce vwnaauanwaas ConcretelGd flaors �n UCerTil/Gd I M Staies 1 X Fuu 8asemem Pania�easement Ex�aior Wans BricklGd Waus D aIl/Gd T X Det nd. 5•DeUErMUna BasememArea 1232.0000 .h Raorsurrace ArchitShin lelGd TrimlFanish Wood/Gd UnderCons�. easeme�Fa�sn Ox Gunersaoown sAluminum/Good eamFwor CerTile/Gd ►Ranch X anstaeE a wnavaT DoublelnsuUGd BamWainsca CefiilelGd YearBWt 1999 StamSashA�ula�ed Y6s/Gd Car5lwa e None ENecuve e rs 10 Sueens Yes/Gd X Drivexia f of Caa 2 AWc None Hea' X FWA HW RadaM Amendies X WoodSwve s►1 DiNewa Sw(ace ConClete Stair staes Om� Fue�GeoHP Fte ace s r 0 Fence None X Gar e �orcars 1 Fba X Sanne C X Cenual Atr Cond'qton X PaudDeck Side Pacn None Ca l o�Cars 0 Firished Heated Intl'rvidual ONer Poa None Olhc NOrte Aa. X Oel. Bud�-in P Rel' ma Ra Dishwasher Oi Miaowave P Washer r Other descri6e � F4lshed area a6ove adx coniaina: 5 Rooms 3 8edrooms 1 B s 1 232 re Feet ol Gross LM Area Above Grade ' ad�aona�Feames Geothermal electric heat um . Custom kitchen cabinets with custom inseAs. Solid su�face counters Master bedroom with tar e walk in Goset and se arate cbset with custom closet inseAs.Air cieaner on HP. Electric u raded in 2011. Oversize detached ara e with workshu a�d level two stora e heat air and water.3rd bedroom is currenU bein used as laund room. Cammen�sonitee u�prwemems These im rovements are of ood uali frame desi n and re(lect ood maintenance. There are some items . that have et lo be done to the ro � includin some trim�both baseboards and 800r no interior doors are hun no downs outs or utters li ht fixtures need to be installed and some d all. A tunctional uGii ad'ustment is Dei made on the sa{es rid. y__��M nmtmwnno�edmmd,:,nw,.aoa�nm� rmlmnwppqie2aosamo�vll�c��,aa�aupas�spaa'ea�l�f oy�totio . (l��j ad��o��rwvz-«c�+�.��.�c� wnrt��oste�a�o _i i,... ��! Summary � Residential Appraisal Report FtleNo.9SLoCUSt FEATURE SUBJECT COMPARABLE SAI.E N0.1 • CUMPARABIE SAIE N0.2 COMPARABLE SAIE K0.3 ' 9 S.Locust Lane 227 Hempt Road 6342 Concord Road 1311 Scenery Drive adaess Mechanicsbur Mechanicsbur Mechanicsbu Mechanicsbur ro5 .t.s ': �%`% 3.61 miles SSW 1.79 miles ESE 1.66 miles SE SalePrice 5 ..�a..t.x ".j�_< S 199 000 s ;. ' .;� S Z�B OOO :%:�R�g:,:.,1.�....,�; S 182 000 SakPAadC',rassuv.Area S 0.00 h S 89.80 h.r�"..:.`:...cr .`::`��5 142.57. n.�"�...>}?..�_';_.5::r S 153.07 h.'... . � , oara s ��:�:�:`„;>�"'it" �"'� MlS/Tax Records MLS/Tax Recwds MLS/fax Records ven�ceuonsare s �Y���`�;:��F��'::�:�'�;:r; TaxRecords TaxRecords TaxRecords VALUE ADIUSTMENTS DESCRIPTION UESCRIPTlON �•s DESCRIPiION . s DESCRIPiION .(•)s i Sa�eorFinanang a��,��;,?,r,_::i:{ Conventional FHA Conventional cancessbns r....?.,.��`5,.:,:.,.�_,:;::'i Ctosin Costs -3 385 Cbsin Costs -2 000 Closin Costs -2 730 Dt1eMSa�dfime .,.,,'.?�::: __., ;;`; 08/31/2012 �4l18/2013 09/28/2912 I.oauon Suburban Suburban Suburban Suburban �easeiawiFee Fee Sim le Fee Sim le Fee 5im le Fee Sim le 5iu 1,2 Acre .71 Ac�e 3 920 .42 Acre 6 240 .61 Acre 4 720 wew Above Avera e Abwe Avera e Above Avera e Above Avera e Rartch Ranch . Ranch Ranch � qu dComwaton Above Avera e Above Avera e Above Avera e Above Avera e Aca� 14+/-Years 55+/- +�0 000 21+/-Years 0 40+/_Years +10 000 � conmbn Good Avera e +�0 000 Good Good , � flhOVBCifed2 Tmi 86ms Bshs Tqal BMms Batle TaW 8„AS TWI Bdms Bsl�s RoanCoia�� 5 3 1 8 4 2 -6 000 5 3 2 •6 000 6 3 1.1 -3 000 Gtos I4ei20.00 1 232 .f� 2 216 .h. -19 700 1 515 .tt. -5,700 1 189 .h. O � BasemenlEFinished Full Basement Full Basement Full Basement Full Basemenl � RoansBeawcxaae Unfinished Unfinished RecJ.5 Bath -8 000 Rec Room -5 000 Funaionai Less than Ave Avera e -5 000 Avera e -5 OUO Avera e -5 000 Hea GeoHP/C/Air Oi1HWlC/Air EIecHP/C/Air EIecHP/C/Air . . E�edea kems T Icai ArealA e T ca{Area/A e T icai Area/A e T ipl ArealA e Ga 1 Car Det Gara e 1 Car Att Gar -2 000 2 Car Aft Gar -7 000 1 Car Att Gar -2 0�0 � ParcNPaiwoeck Patio Deck Deck Deck Other 1 W/S 2 F!P -2,000 1 F!P None +2 000 Other None None None None Other None None None None Net t aa h:d�����r?,�.:=:=�=�ii_�::±„":{, , X- S 14165 . X- 5 27 460 . X- 5 1 010 A�uStedSalePrice ' ':>r. r; NetAdj. -7.196 NetAg. -12.7% MMAdJ. -0.69G ut ua4ks '._ :�:_::........�..:;.' Gross 31.296 5 184 835 Gmss 18.596 S 188 540 Gross 18.9% S 180 990 Sim�me asa�es Com risan cn See Attached Addendum . �,....b,.-<...,,,,,....... � ,- ; � , , .COSLAPPROACHTOVALVE -.. '! ��. � .. . - " ' . ' - .� s' S r ,i _..... ....... .. .. .. ...�. _ . ., �.,_,.,:.... ...,_... .>, 4. Site Value Commenls , �, . . . ..,.,-_. ,� ,.-.: ., ... :_:, ESTIMATED REPR�OUCTlON OR REPIACEMENT COSi NEW OPIt�ION OF SRE VALUE........................................•5 �e��#� Dwel6n 1232 .F��+S .............S 0 � Ou trom cost service Ef(edive date af wst data Bsml:1232 S .FL 5.F��s ............-S 0 � Comments on Cost h ss ' atea wkWatiaM. ' .�c � In view of the a e of these im rovements the Cost A roach cara dca Fc e s ............a s • can�ot be considered an accurate indiptor oi value. 7aai E�ima�e aCosaNew ............=5 0 less al Funcponal Exlemai De edatton =5 0 eciatedCostoflm meMS.................................S 0 'As•is'Valueot5ite ................................=S INOICATEO VALUE BY COST APPROACH...................... =S 0 r........:.:... ...-.. . . �INCOMEAP.P.ROACHJO.VALUE:��i�; ... .;�:�: . ..�:.:�... ..:,�:5.. . ���.�..�i .. :�,;:-��,. �, .- . .• .,.• .., . �x EsUnwud Maiket Re�u S X Gross Rent 6k1' ier •5 Indicaied Vatue lacome , , h ' summaryonnco�eappraacn@nca,angwpponrurma,iceire�xandGRNn The Income A roach is ina ro riate because the ical bu er of a ro e similar to the sub'ect in s le,condition,and a eal would be an owner occu ant. Indiea[edValueb. SalosCam arisonA roach5185��� Cost oach i[devel d)S 0 IncomeA oaeh(Ifdcrelo ed S See Attached Addendum • . This appiaisal is made 'as is: • wbjttt to compMtion per plain and spealtalians on the basis ot a hypothetkal tondition that�he fmptovements have been complMed, ❑wOjecl lo Ihe fdlawing repairs or alteraGans on the basis d a hypqhelical cond6on that Ihe tepa'as or aqeraUons have been canpleted ❑wbject lo the(oltawing: . Based on thC scope of work,assumpNons,limiting conditlons and appraiser's certllleatlon,my(our)opinton of the defined value of the real property . thatlslhesubJectolthlsreportls5 185,000 asof OS/09/2013 ,whtchlstheeffectivedateofthtsappraisaL � �. �par� �,����:N.,r,�.�� ,M��.e�.�ro������.K.�� :n, A.,o�,p�,�w w cvna �o io a^=•N�w�^^Frm�+��Rv� Mark Heckman Real Estate Appraisers � ii,, .�,�r _ _ ___ Summary � Residentiaf Appraisal Report ��eo.ss�ocust Scope of Work,Assumptions and Limiting Conditions • ScopeotworktsdeRnedlntheUniformStandardsMProTessionalApproisalPracticeas"thetypeandextentotresearchandanalysesinan assignmant"In sltort,scape of work ts simply what lhe approlser did and did not do during the course of the assignment.I[inaludes,but Is�ot Itmitedto:theaxeeMtowhiehiheproperty{sMentitiedandlnspecled,Ihetypeandextentofdataresearched,therypeandextentofanalysesapplied �� wsrfveatopiniomsorcanclusions. The scope of this sppralssl and ensu�ng dlscussion in ehis report are specilic to lhe needs of the c0en4 aher ldenUfied intended use�s and to the intended use ofthe repoR This repwtwas prepared fw the sole and exclusive use of the clientand other WenGlied Intended users tor the ldentified intended use and Its use by arry other parties is prohtDited.The appraiser is noc responsible for unauthwized use of the report. The a�ralsers eerU(icatfon appeuing in tl�is appralsal report is subJect to the following condfUons and to sueh other speeifb eondiUons as are selforth by the appralser in tlu report.All exVaordtnary assumpUons and hypotheGcal condltions are stated in the report and mtght have atfected the � assignmeM rasutts. t.The appratur aswmes no�espons�ifly(or maaers d a kgal�aaure alleai�g the propeny appatsed a ti1le lherelo,iwr doa 1he appraiser render a�ryopSnron as to ihe 1'�tle,wldch is assumed to be good md marketade.The propeny is appraised as tl�agh under responside ownershfp. 2.My skelch in Uds repon�wy slaw approMimaro Qunemims and ts inGWed only to assist Ihe reader in vis�wflzing the poperty.The appraher has made ra swey ol the prapeny. 3.The appaisec ts rot�equ�ed a give tesUmonyar appeaz h coun because d hav6g madethe appraisatwilh rdererxe to q�e propaty in quesilon,uNess arcargements have been Peutaisty rwde U�ereto. 4.Neqher ap,nor arry pan W the coMent d Urs repon,capy a olher media thered(uKkM'ug conclusbns as to the propenyvalue.Ne qenUryd Ihe appraiser,profasbnal tlesignalions. a we rrm wan wnrcn me a�ra�ser is�nneaeo►.sl�atl be used fa a�ry purposes by a�ryone but lhe cNent and alha�ta�ded usas as ideMifred in tlis repat,iwr sliall d Ee corneyed by airya�e ro the pubYc lMaugh sdvemsing,public rela6ons.news,saks.a olher media.wiU�out lhe vxitten conseM of the appraiser. � S.The appraiser wit�at dndose the cadtnts otll�s appraisal repart uriess required Oy appGwde Ww or as spedfied�the Unifam StamWrds of Professional Approfsal Pracdce. � 6.InfamaUan,es�imates,and optntons fwnished to ihe appro�.and wrttatned in 1he cepat were o0tained kan s�tc¢s considered reGabte and be6eved 10 6e we and carec� However.�a resporoiWi�y for aaurary W wch ilems hrcnhhed ro the appraiser is aswmed by�he appraiser. 7.The appraiser aswmes Uwt Nere are m hidden or unapparerx cor�ntons W Ihe propeny,wbsa7,a swchres,which wauld rerMer k mae a less vatuaMe.The appraiser assumes no respo�ily far wch condMions,a for engineerin�j a 1e56ng,whicb mfgM Ue reeWired b diuover wch fauas.This appraisal is na an emriranmental assessment nl the propeny and shaJd na be considaed as wch 8.The appwtsec speaaizes h the va�a�n o[rea!propeny and is irot a hane 6specror.building wNrecta.suucwral enginea.a simiar expen,uNess oU�e�wise noted.The appraiser 4dnotcontluuiheinmsNetypeolfieldobservatlonsolqiek(ndkrtendedaseekand6scoverpropaydefeqs.Theviewingofihepropenyandanyimpravernemsislar�xxpoxsol de�elopinganopiniono(ttied�nedval�eotNepopary.gire�ftheintwdedusedthisassignmen.S�atemenKrega[dngcondAtonareGasedanwrtazeobservalionsady.The appaisa claims m 5pedal expenise regarding fssres Gidud'ug.but not 6maed ta foundatton settlement:basemem motsdre prodems.wood destroyirg(a aher)1Mecls.pest infes�aUon. , �adat gaz,kad hased pain6 moW a envi�onnuntat issues.Wdess ofiawiseirWkated,mecirorucal syslems were na acGvated or Iested. Tids appraisal report sMWd nM be used b d'isrJose the condtlon at lhe pmpeny as it relales m Ihe pcesencelab�eaue d detects.The cl'i¢nt is Invited a�mcaxaged w empby qua6fied aperts ro inspect and address areas dconcem.If negMive cond�lions arediscovered,lhe opnion of vaNe may be alfeded. UMess otherwhe noted,tfie appraiser assumes the eomponenes lhat constttute Ihe subJect properly�mprovement(s)are fundamenW Ily sound and in � working order. Myvie�xiigMtheprapatybytheappreiserwasGmYedtoreatlilyoMervableareas.Unlessathr�wisenoted,atticsanduavASpaceareaswerenotaccessed.Theapprofserd'idndmowe Umltu&floor coverings ar oMa items that may tesUitllheviewi�g d Ihe pmpetty. _ 9.Appraisak irvdving�ypoNetical condRiom rdaled W rnmpleUon ol new cansuuctlon,repairs a allera6on are based on Ihe aswmption Ihat such completion,akerazion or repairs vnll he competenUy ppt«mCd. � 10.Untess the incended use N this appraisal speciNcally inrludes Iswes dpropeny k�surance covaage,ihh appraisal shwid not be used Iar wch purposes.Reproducfion w Repacemerx cost fgures used In Ihe cost approaN are fa vahudan purposes o�tly,given the hNended use of the assigronent The Oefmition al Value used in tha assignment is unGkety to he conststentwYh the deA�d Inswable VaWe(or propeny i�urancecmrerageluse. 11.The ACI General Purpose Appraisal Report(GPAR'"")fs not Intended for use in transaeGons that requtre a Faante Mae 7004IFreddie Mac 70 form, � also known as the Untform Resldentlol Apprelsal Report(URAR). � Add(tional Comments Related To Scope Of Work,ASSUmptfons and Llmiting Conditions gparw vroa�ewqnu�eeoan�.un.�...,o.�m,� lnsbmCqyq[°AOS�Af0A0Umsmd150pi�nSwuaYrc.NW�NeoKLL �ia� �rut-lccnea�v�oseAVac'vn°�roRO`�.4"a�m pmeMP�wxrof��rcpor. i1.... ���! , Summary Residential Appraisal Report FIeNa ss�ocust ' Appraiser'sCertification The appraiser(s)cenitles that,to the 6est of the appraiser's knowtedge and betlef: 1.The statemenis W lact coMained In this report are we and corteu. 2.The reponed analyses,opiniais,and caxAisions are�mited oNy 6y Ibe reported assumpNor�s and IimUing condqionsand are thc appraisers persanal.impanial,and unDiased ' protessional analyses,opLdons,aM canclusions. 3.Ucdess dhe�wi�stated,the ap{uaiser has ro pteseM a prospec9ve iMerest k�the propary that is the su6Jat of tfik repon and has no personal interest wdh respeU to Ihe panies involved. 4.The approiser bas rw bias w�lh respecl ta 1he aopaty ihat is the subjat of Ihis report a to lhe pantes invaNM with Ihis assignment. 5.TheappmiseisengagmnpNintlusassignmemvrasnolwnUngemupandevetopingarepoNigpredele�minedrew0.5. 6.Theappraiserscampensatlonfacanpktinglhisa5siguneMismtcandngenluportthedevelopmertarepaWgdapcedetemdnedveWead'rectbnhvakreNalfavasihecauseW Ihe clien4 Ne amount d Ihe vaWe opirion,lhe attainm¢nt ota sdpulated rewll a the occurtence of a wbsequenl event drectlyrelated to Ihe MMeMed use d this appraisaL 1.The appraiser s analyses.apinions,and conclusions vrere devebped,and Ihis repon has been prepared in conlamfrywilh Ne Unifam Swndards of Prdessbnal Appreisal Pranke. 8.Udess olhdwise rpled.�e appraiser has made a pcaona�htspeclion d tl�e Prape�lY tl�at h the w6Jed af ih4srepM. 9.Udess naed below,no one provided sign'dicant�eal property appreisai assistance ro the appraisvl signmg this ceitificaUon.Sigrifrcant real popeiry appraisa�asstuance provided by: AdMtlonal Certifteatlons: � DeMitionofValue: �MarketVal�e ❑O[herVatue: SarccorDermitlac USPAP2010 The most probable price which a property should bring tn a competitive and open market under ali condiUons requfsite to a fair sale, lhe buyer and seiler each acting prudently ar►d icnowledgeab{y,and assuming the price is not affected by undue stimulus. ADORESS OF THE PROPERTY APPRJIISED: 9 S.Locust Lane Mechanicsbura.PA 17050 EFFECTIVE DATE OF THE APPRAISAL:OS/09/2013 APPRAISEO VAIUE OF THE SUBIECT PROPERTY 5 185�000 APPRAISER SUPERVISORY APPRAISER Signalure: C'���}/�T, � Sfgnature: aame: Gina ist'6 efano,Slate Certified sidential Appraiser wame: Slate Cenificauon I RL138991 Stare CerifxaUOn t a LiceMe f or Lkeree J a Oiher(desuibeC ' State t: ' Sute: ' State:PA � � Expira6on Date of CenificaGon w Lkense: � � Expiatlai Oate oI Cer61ita6on w Lkense: 06/30/2013 Date ol5ignalure: Date ol5tgnature arM Repon: OS/21/2013 Oate a1 Propeny Vfewing: Date d Proprny Yiewirg: 05/09l2013 Oegree d propenyviewing: ���p���Y'^��9� ❑Interiora�dExlerior QEx�eria0nly ❑Didnotpersonallyview Olnterior an0 Ex�erim ❑Ex�aior Onty ❑Did not p�sonally view noa�oawy�a�eeoo.:.uem.M.+sv.mm,� insa.�q.emos�nionaa�duoa�ss�K.Nay..weawe rage�ai laP�"lcaas�wpamnp���wio aM�w�=x�P�•���hr�: Mark Heckman Real Estate Appraisers �i,„ —__ _ _ ___ _ ��� ADDENDUM ' CIIenC Ka1MVn Gaks FNe No.:9SLausl Pronertv Address:8 S.Locusl Lane Case No.: • CIty: Mechanicsburg Slale: PA Zip: 17050 Neighborhood Boundaries The subject properly is located in Silver Spring Township. Silver Spring Township is bounded by Rye Township to the noAh; Hampden Township to the east;Route 641 to Ihe south and Middlesex Township to the west. � Comments on Sales Comparison A thorough search for comparable sales has been made to find sales which b�acket the final value¢stimate.AI{three comparabfe sales are located in the same market area as the subject would be constdered by the same prospective purchaser if aU were on the market at the same time as the subject.After a thorough search of a11 avaiiable maricet data,the three sales used are considered to be the best indicators ot value.Appropriate adjustments have been made for all differences.Comparable sales used are dosed sales.I�suf(cient sales in cbse proximity to the subject propeAy required the appraiser to extend search parameters.It is appropriate for appratsers to adJust a portion of seller's wncessions. Actual seilers concessions are:Comparable#1:$6770,Comparable#2:54000 and Comparable#3:$5460.It is noted that the gross adjusfinent for Comparable Sale No.1 exceeds 25%. This adjustmenl is large�tha�normal,but sates chosen are considered the best available.Other comparables analyzed would have required less desirable adjustments and were not used for that reason. There are some iEems that have yet to be done to the properly including some trim(both baseboards and floor),no interio� doors are hung,no downspouts or gutters,light fixlures need to be instalied,and some drywall repaired. A functional utility adjustmenl is being made on the sales grid. Flnal Reconciliation APPRAISER HEREBY CERTIFIES THAT THIS REPORT HAS BEEN PREPARED IN COMPLIANCE WiTHIN THE UNIFORM STANDARDS OF PROFESSIONAL APPRAISAL PRACTICE(USPAP),THAT THE APPRAISER IS A DISINTERESTEO PARN AN4 THAT THE VALUE STATED IN THIS REPORl'IS ACCURATE TO 7HE BEST OF THE APPRAISER'S ABILITY,AND THIS VALUE HAS NOT BEEN PREDETERMINED. � The subject property was vacant at the time of the i�spection;however,utilities were on and mechanicals were functioaing. � ln ihe view of the age of these improvements,the Cost Approach cannot be considered an accurate indicator of value.The appraiser has wnsidered the income approach in this assignment. The subjed is a single-family dwelting,and there is insufficient�ental data for similar homes in this maiicet area to produce a reliable estimate of market rent for ihe subject,and a GRM.Because it could rtot be reliably deveioped,She income approach has been omitted in this appraisal. See attached appraiser's certification and Slatemenl ot Limiting CondiGons.The appraiser considered only those items that were permanently attached to the properly as really. Any items not so aHixed such as refrigerators,washers,dryers,a6ove ground swimming pools,etc.,were not included in the estimate of market value. The opinlon of value stated in this appraisal is based upon market conditions present as of lhe effective date.This appraisal assumes a reasonabie marketing period for the suhject propeAy of 180 days and a reasonable exposure time oF 180 days. This appralsal is based o�readily observable conditfons and is not to be considered as a thorough home inspection to anaiyze a�warta�t the subject ptoperly and/or fts mechanicai systems.This appraisal report has been prepared with the property in"as is"condition. ndde�a.n P�o i a� ' i i, :—__ ___ r�aA _ SUBJECT PROPERTY PH070 ADDENDUM Client: KalhNn Gates File No.: 9SLocust 'Pr�erty Address:9 S.Locust Lane Case No.: Gt.Mechanicsbu State:PA Zi :17050 `i. s ``�� y'' FRONT VIEW OF w'='�'s'"` SUBJECT PROPERTY �;� : . : .,,t. .,-, ., >y. Appraised Date:May 9,2013 Appraised Value:S 1 ss,000 REAR VIEW OF SUBJECTPROPERTY 'i���� ;�r. .� . �r W y� �' STREETSCENE �'1.. - �� u'�� �• " �f.r ..1. _ . si.;� _a '"i r :�,.r:�� - F„ �i�_.___ _ ���I Glient: Kathrvn Gates File No.: 9SLocust Propertv Address:9 S.Locust Lane Case No.: , Cil:Mechanicsbu Slate:PA Zi :17050 Dining Area r, r�� zh x- .`c 3" — -,'7a. Living Room :? ;y � I ` � Kitchen ` '; , ' -` � • :J, Aa0[WVUgAOfGm3C�0.171Dit/�wa,xrammn qlf]101l1010 �I,�—_ r�� Client: Kathrvn Gates File No• 9SLocust Properly AddteSS:9 S.Locust Lane Case No� Ca:Mechanicsbur State:PA Zi :17050 � Sathroom r,:� � r}y��f�., �1 � � ' � • Laundry :: �. ¢'� ., ; ;' � �_• T; �. : t i. :'::�':%: ,.c B�[OORI � •Z;+" , �'.`i. .fj�;, . .(��5 M t �� ;T ` _ . ���e � :.�1`�i �4�'' �� � . AeACMwigAUSdMa¢lOO.illp2)ewwaGVap.mp RIIIfO1W10 i l .: ��� Clienl: Kathrvn Gates File No.: 9SLocust � . , PropertY Add�ess:9 S.Locust Lane Case No: Cil:Mechanicsbur Slate:PA Zi :17050 Bedroom r,^ I ���• `���� ,. -f , : Updated elecUic s*'r �:., '. ti���• x ;.`r':i;: � . � 3� '� �: ' r f. �:? �R , � �� Detached Garage nm�ca�:yna,��eoors�e�:r,�,�.�.ao.m� Rlf]101W10 i i.._.. • ••• • • � r� � • , , ��, ,�� , . , � � � e�� � �. !: y „ '�^.y`-� +����.�•,�?� '� ���'�_ 1 �< < : ti.?�r,as,�� '���%c��O � ! -�,`"��:.� l �: l��..t` � ��6 y� � � Y�"_ti_.` � i ��j 1-..,. } ��`O��11���f L�r� �� � � . `� ���', �� \``tJ(* �irJ\ �}k�Y��Cy���.' ` . ' 1_t_. ��„`�? f.� �� `,�tA� �lj�;��l��?��r1.�/� ` ���.1%?��'f�� ` i �� Y , � � , ���t,.-�.�, i � . ���r� � ; ���,,� c .�� , , � � ,f,. t�i� �� �� �. ��: � ��`�ni�T�� '-." �� !,�����r»�ir��4x�� ^���� a.i • ��� �ti �,`����ja"`�`�Yya_y'�S-.e+. i i_l s � �r�_ �-�T; 4 ..������ '��"i� w�i,� :�� _ �;�T .= — �- ��., _ ._ _ . yy.� �-� �f�� �t � � _. li.!� .(_!�'f ��,�.- �r._ T .�-� _ }a "� , , �- �;- 1� z���'�' �} _ F . � ^'y--r�_' .�.,�� '� . r .:� j ��i' i<.1.1,�Z+C..b(��j`.�Tc.�i Sy..�. �- -.�.-,..*,z.s•- �' .` .1 r ����."�z�"'?, .,�-„ ��,r — {�-: r' : sj'f,^H rn :� � ��.� 7 rv . ' _Y`3 �.. : ._ .:. . .. : yq^p"'^ j. .aT� 'L. ... ���./ M T' Q{�y?i r�,+ :. '� _ . � 4� YV� � "'� 1 � °"��1"" •m« �P-z3 "µ �'";� ��' s� ;�' ' ' �� = „�:-r .�.....••��� ".r»� ._{.�i+�c � �•'"�'7 ^ .�,w.: .�X���t v..iv ��,� �.w� i. :��_ ....r.��.� �.`+�;'�i��� ,, � `�'� �� C r Q����i r ��s ��r�S,��sj������J � r� i ti\� � t��F J ;viS - ; �J y^ �'�.�t�q;}T�'G��,�t �tij�tii.� _ c.uyv\. • i: ..:a: . � � l�����..:..-.�..-�•..., ..- ._r� �,? .vi-��:. , . �_ 1 , ' _ . ,, - .. �.. , . . . . - .1..,.:. ..._ _ � �,.~ . . 111 . ,. . . ._,. _.,_ _, ... ' - ' _ t • � -_�. . , - , -.� ._-• .�. ._ . .IC���...._... ,.�.. . � E� : la� � � � _ It� � � � N;� 5�'_ I, u '• ��` +� . �—__ '�;��'I��I{��,�iillil��lll�11111�, ' �� - }.� �` , �:_�, ..^ : I� .. ' ..... P �.�_ , �'i. ,ti . Z Z� � "� ��p'f `.4. ': . � T. � �:' '�� �`�}. f� ���., _ � �( � ��'��, !.: '(!C���r'� ' �� • �� .:` .. _ :'�rti� -� L +� . . { - ��r � - . . , � �. 5 - : .i�/�� " .,^��S r� ?ti . '� . � �t -TJ 1; 'Nn - � .. � f..:� � ..I+ .,P ��.x .�: \1 v}1� t'�I {,. .!� 1'l�jY'J�:f 3�,�1GrE'�� '� . � �-.� . . .., il � . ��'d,� .�.` . �s . "_ � �tr ��;y��� . ^ . 1. �• � �., , y �co ti t' -`,t�!�.=.r i�!y�� o� ��� �.+.] `1 l .�� � T..� � f� T�`v �"�� "ll �� � . . ...� Lr ...�: ,� a �� 7 ' ? ��a. -�. r� ,�'s�- '` _ir� ,A � r�r; �, �,,,.� , ,� '. �: �sJ ��fL r �� .���T���_ .����r � �t�jf !�t,.�� � � � ` � ,..�. � .i {Fy . . f.�',�..c_�C r: 3�nt i l ' � .. {'2 �,y_ �� f .. _ . i � �r4�� �'�..'' ..,r?`, .. �,�r'�, �==! _ � . ���'`34i �i ' . 1 `�"o�:. .�,� . FLOORPLAN SKETCH ClienL KathrYn Gates File No.: 9SLocust , ProDerty Addtess:9 S.Locust Lane Case No.: Cit.Mechanicsbu Sta[e:PA Zi :17050 u. ay. eedroom Bath p����9 Kitchen � (aeens123m2 R� � ° First Ftoor �3 (l4ea:1?32 fl'� Bedroom �undry �v�g . �k' 4!' . . . ��—t . FiotFiaor 123211•Ff,nt Ftoor. �� , x 1.00.12J2 fl �j!�._...� ,28 x�: ; 44 x -�^ i'��050 "-.:.6J6Q? ��� 1232rt A � 28'x �� 44'x " � 0.50 .........� 615rt' _ i i��.... _.. _ ��'� DIMENSION LISTADDENDUM Clienl: Kathnm Gates File No.: 9SLocust Propertv Address:s S.Locust Lane Case No.: • Cil:Mechanicsbur State:PA Zi :17050 GROSS BUILDIIVG AREA(GBA) 2.464 GROSS LIVING AREA(GLA) 1.232 11rea(s) Area 96 of GLA %at GBA Living 1.232 50.00 Levelt 1,232 100.00 50.00 Leve12 0 0.00 0.00 Level3 0 0.00 0.00 Other 0 0.00 0.00 GBA Basement ❑ 1.232 Garage ❑ D Area Measurements Area Type Measureme�ts Factor Total Levell Level2 level3 Other Bsmt. Garage �.zsz.00 x �.00 x 1_�0__0 = �.2a2,00 O � D O OO O �.232.00 X �.00 , �.00 . ,.2s2.00 OO D O O D O x x _. _ ❑ ❑ ❑ ❑ ❑ ❑ � x x • ❑ ❑ ❑ � � ❑ x x _ x x � � ❑ ❑ ❑ ❑ ❑ ❑ x x — _ ❑ ❑ ❑ ❑ ❑ ❑ x x � _ x = —. = O O D O O O X x _ = O � O O D O x x _ = p O O D D O x x _. = O O D O O O x x _ _ ❑ � ❑ ❑ 0 ❑ x x _ _ ❑ ❑ ❑ ❑ ❑ � x x _ _ ❑ � ❑ ❑ ❑ ❑ x x _ • � ❑ ❑ ❑ ❑ � X x _ . o 0 0 0 0 0 z x _ n ❑ ❑ ❑ ❑ ❑ ❑ x x _ • ❑ ❑ ❑ ❑ � ❑ X X _ . O O O D D O x x _ = ❑ D O O O O x X _ - D D O D O O x z —. _ ❑ ❑ ❑ ❑ ❑ � x x —. _ ❑ ❑ ❑ ❑ ❑ ❑ x x _ _ ❑ ❑ ❑ ❑ ❑ ❑ x x _ _ ❑ ❑ ❑ � ❑ ❑ x x — = ❑ ❑ ❑ ❑ ❑ ❑ x x _ = Q ❑ ❑ � ❑ � x x _ _ x x — • ❑ ❑ ❑ ❑ ❑ ❑ x x _ _ ❑ ❑ ❑ ❑ ❑ ❑ x x — _ ❑ ❑ � ❑ � 0 x x , _ x x , _ ❑ ❑ � ❑ ❑ � x x � � ❑ ❑ ❑ ❑ ❑ ❑ x x ,. _ � � ❑ ❑ ❑ ❑ x x _ _ x x — � ❑ � ❑ ❑ ❑ ❑ x x _ • ❑ ❑ ❑ ❑ ❑ ❑ x x _ _ ❑ ❑ � ❑ 0 ❑ x x _ _ x x _ _ ❑ ❑ ❑ ❑ ❑ ❑ x x — _ � � ❑ ❑ ❑ ❑ x x _ _ x x _ _ ❑ ❑ ❑ ❑ ❑ ❑ x x — _ ❑ ❑ ❑ ❑ ❑ ❑ = x — = Q O O O D D x = — = o 0 0 0 o a . . x x - _ ❑ � ❑ ❑ ❑ � ' x x _ _ x x - _ ❑ ❑ ❑ ❑ ❑ ❑ x x ^ = O D O O O O X x _ = O O O O D D Aonomwqnaweg�emiuet:r..«�«e� ommasiaw � i1�...�„ _. • � • ��- �„ � . , , � � � � . 0.� � �::� �' � .i�- a r�S� — N�� � - ' � - Z .3 ``( � : �t�. `�ti` t '�)"� �. '�-� t ' . 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ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1' MetLife Account C0051747887 38 shares at$37.64 1,430.32 TOTAL(Also enter on Line 2,Recapitulation) $ 1,430.32 If more space is needed,insert additional sheets of the same size _ _ _ "�"� B9d you knov��?Most shareholders can manage their hoidings online with free �omputershare access to Computershare's Investor CentreT"'website. Use this simple tool to quickly and easily update account information, sign up for electronic delivery of documents and more. Enroll FREE today at www.computershare.com/investor. Computershare tnvestor Services 250 Royall Street Canton Massachusetts 02'021 www.co mputershare.com LAW OFFICES OF PETER J RUSSO PC ATfN KATHLEEN MISTURAK-GINGRICH 5006 EAST TRINDLE RD STE 203 MECHANICSBURG PA 17050 May 21, 2013 Company: MEfLIFE INC . Registration: LIONEL J SPENARD Holder Account Number: C0051747887 . Document I.D.: 13136WF00598583 Our Reference: METL/0021402970/6/ Dear Sir/Madam: Thank you for contacting Computershare regarding the above referenced MetLife account. Below is the account balance information you requested as of 01 April 2013 for the above account. Shares Held by Agent: 38 � Shares tield in Certificate Form by Holder: 0 Total Shares: 38 Closing Price Per Share: $37.64 If you have any additional questions or concerns, please call our Customer Service Center at 1-800-649- ' . 3593 or 1-201-680-6578. You may also access your MetLife stock account on the Internet at www.computershare.com/investor. Our mailing address is Computershare, P.O. Box 43078, Providence, RI 02940-3078. . Sincerely, .. • Service Representative . _ . Enclosure: None _ _ _ _ _ _ _ . ,�,,._ _ ��� REV-15o8 EX+(o&�) � pennsylvania SCNEDIILE E DEPARTMENT OF NEVENUE CASH, BANK DEPOSITS & MISC. INMEItITANCE TAX RENRN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FIIE NUMBER: Lionel J. Spenard 2�13-00410 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly owned wtth right of survivorship must be disclosed an Schedule F. • ITEM VALUE AT DATE ' NUMBER DESCRIPTI�N OF DEATN 1. Members 1st Fedaral Credit Union Acct 107197-00 1,853.25 2 Members 1st Federal Credit Union Acct 107197-05 39,397.83 ' 3 Members 1st Federal Credit Union Acct 107197-11 743.41 ' 4 Members 1st Federal Credit Union Acct 107197-42 114,340.64 ' 5 Members 1st Federal Credit Union Acct 107197-45 31,334.94 ' g Members 1st Federal Credit Union Acct 107197-06 91,368.38 ' 7 West Shore A.L.S. 1,008.90 g MetLife Dividend C0051747887 5.06 ' g 7996 Ford F150 2,500.OU 10 1999 Lincoln Continental 5,850.00 11 Household Items,television 300.00 �2 Miscellaneous tools 366.00 13 Two Chairs,small cabinet,footstoll 250.00 14 Coins 922.00 15 Miscellaneous Tools 350.00 16 Verizon Refund 12.97 �7 Nationwide Insurance Refund 157.70 18 AARP Refund 13.03 �g Refund-Readers Digest 24.51 2p The Washington Spectator Refund from Subscription 38.50 2� Cash/Coins 160.00 22 Cash 1,021.89 23 Interest 0.13 24 Neill Funeral Home(Prepaid Funeral Costs) 13,742.85 25. Auto Club Membership Refund 79.00 TOTAL(Also enter on Line 5, Recapitulation) $ 305,840.99 If more space is needed,use additional sheets of paper of the same size. ;i,_: — __ _ _ __ _ ____ __ _r�� REV-15o8 EX+(o8-u) � � pennsylvania SCNEDULE E DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC. INHERRANCE TAX RENRN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Lionel J. Spenard 2013-00410 Include the praeeds of litigation and the date the proceeds were received by the estate. AIi property jointly owned with right of survlvorship must be dtsclosed on Schedule F. 1TEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ' 1. Northwestern Mutual Policy 19827300 256.24 2 Northwestern Mu�ual Policy 19827299 877.63 3 Northwestern Mutual Policy 19827298 33.58 ' t TOTAL(Also enter on Line 5, Recapitulation) $ 1,167.36 ' If more space is needed,use additional sheets of paper of the same size. ----- —– ,1 .;.. ��� � �� 4 7' � MEMBERS 1'� F&DBRALCREDIf t]NION REGULAR SAVINGS ACCOUNT: Account Number/Suffix 107197-00 � Date Account Estabiished 03/14/1989 - Principal Balance at Date of Death $1,853.25 Accrued Interest to Date of Death $0.00 Totai Principal and Accrued Interest $1,853.25 Name of Joint Owner None INVESTMENT SAVINGS ACCOUNT: Account Number/Suffix � 107197-05 Date Account Estabiished 03/14/1989 Principal Balance at Date of Death $39,397.83 � Accrued Interest to Date of Death $0.00 Totai Principal and Accrued Interest $39,397.83 Name of Joint Owner None CHECKING ACCOUNT: Account Number/Su�x 107197-91 Date Account Established 02/20/2007 Principal Balance at Date of Death $743.41 Accrued interest to Date of Death $0.00 . Total Principal and Accrued Interest $743.41 Name of Joint Owner None CERTIFICATE OF DEPOSIT: Account Number/Suffix 107197-42* 107197-45** Date Account Established 02/08/2012 � 09/27/2012 Principal Balance at Date of Death $114,340.64 $31,334.94 Accrued Interest to Date of Death $0.00 $0.00 Total Principal and Accrued Interest $114,340.64 $31,334.94 Name of Joint Owner None None • '"Rollover from CD 107197-49 opened 11/04/2010 **Roliover from CD 107197-43 opened 02/28/2012 CERTIFICATE OF DEPOSIT: Account NumbeNSu�x 107197-46* Date Account Established 03/05/2013 Principal Balance at Date of Death $91,368.38 Accrued Interest to Date of Death $0.00 Total Principal and Accrued Interest $91,368.38 Name of Joint Owner None � *Rollover from CD 107197-41 opened 03/06/2009 MEMBERS 1Sr FEDERAL CREDIT UNION . ���� Tessa L Klugh Lending Insurance Support Specialist May 10,2013 . Estate of: LIONEL J SPENARD Date of Death: 04/01/2013 Social Security Number: 056-20-6Q12 5000 Louise Drive � P.O.Box 40 • Mechanicsburg,Pennsylvania 17055 • (800) 283-2328 • wwav.membetslstosg _ ___ _ --- — ._ ,� . __ _ __.. �1�t� :::>:;z:r:><;:>::::::<�•;:•,;:v.::,••, :z:::�._..:.;:;;::. G r i a i .r.,'.�.At'/,�i.;v�i•i'++.4i�+i'•Y":v .�..5:.}• ..iSYn:::�:;$:i•ii:.r.. ::::��::.;.�::•:::•.::::.�•U..�IVU�Q.f�`:NA11�1�::;�:?:.•..:•::::.::;;:::;�::::<3>:G�lE�1�:1S1,1]!::<:}CIiECK��.:� . �.�.{•n:.:nw..•.v.v:xM�v1vxr.1v:x:n+x.v.v.vx:.w.v?w:r:•:.vv•:. •x:hv�4y?•\v.{a.•x::rhv::-:•:4i:i�:�•}:A"•:?:�•:� Wesf Shore A.L.S. 999048063 LIONEL J SPENARD. .. 29325 05/24/13 503 North 21st Street Camp Hill, Pa. 1701'1-2204 Page 01 of 01 r:•. ,:........:. ........:....•.�:.,•,.:•:::,:.,�:.,.N, ...... •.,.•.v ,..,, :...;.,.:.:...:. ....,:..:. s.;'v,y:i:;:'�...� . . ... i{nY..xv"•::':'. . .. .{4..}�}•S.�•�.,i.y�fi; . .. :x}•i •.vn..........:.:..�.�.r...n ..'+ �. . .. Ke:i , .v. � �r� ..... .. •::::............... , x. . .r. r. hvv .'i- .ryik=�:?.� �. .. . .:::';.}�: ............:.:w:-.• . .,�;.::N.<kW.,:'.:.�I ltb1C ' UIVIBEi�:�:;<c:::;� rr..<::;:<:•,::cr•:s•::>{:.::..D1�1.7E. ,�1iVA10E�A O •�'"'3:D SCOU ., p :..;:i:';:;r`�'' ' ��:zz;:`'>'. ........A.........�.........�................,.....,....,.s.....n.,.........:.......:.......;�.,..a�,.t:�:.���I..:......:.....:..:�...��`C:.:::>::;::::.:�:..i.....:..:..!�TANI..UNT::;;::.::.,.::.::�.�'i`:aiNAoiiNT.:..,.�., REFUND OS/20/13 1008.90 0.00 1008.90 � � � I tOTAL $1,008.90 ' . . . � . .t �hti:�.r+.;,a'nl:s'h r . PNC BANK ����GK�NtJMBEF}� ' West Shore A.L.S. 'PNGBANKN.A.040 60-7�73 .X"�r`s''c'��..�`<�.�Cfi:'�°cx,E.:' 503 North 21st Street 29325 ` Camp Hill„Pa. 1701'1-2204 -. , . . . '. .- : _: . � . .. . _ . .. . t+. u�_ ........... .... �.t __},, � �� . : . . � . . . "� . . �. . � .: �\I�e��a { ,,>.•� < �r �,r,�-� Q�-��. .e�i-.s.3c.vs•,>s:c.,Y::,f�.�,.... } �.z >���'�'Y'x.«..��.�,s"'3�.� ...»x . OS/24/13 .��►a'$1,008:90 . VOID AFTER:90'DAYS.� PAY . . One thousand eight and:90/IOO Dollars � ':TOTHE . ,ORDER . OF.:': . LIONEC J SPENARD `9.S LOCUST Li4ND '. '. : MEGHANICSBURG PA 17050 °. � : I _ � :':_ �n�. 8 SECURITY FEATURES INCLUDED.�ETAILS ON BACK �t i�'029325ii' �:03L3L2738�: 5000 7494 5 2ii' _ _. :� _ ��� . � . �omputershare °�° . _ Computershare � �0 9ox 43006 = Providence,RI 02940-3006 = . Within USA,US teRitories&Canada 800 649 3593 = Oufside USA,US�teRitories 8 Canada 201 680 6578 - 2 6 8 4 6 0 Hearing Impaired RDD� 201 680 6611 � � � � 1 I �i I� �I I � � �� I I I � I ��I I I�� � � �•computershare.com�nvestor — I i� li I i i II i ilil� i u hll li i � ! I nli ili = LIONEL J SPENARD - 9 S LOCUST LN — MECHANICSBURG PA 17050-1620 Holder Account Number = - C005�1747887 I N D ._ � = � I I � Your account is not tax cedified.Please contact us via Record Date 06 Feb 2013 � web ar phone as shown above to avoid tax withhold(ng Check Number 0003008146 on sales proceeds andlor�vidend payments. • . .. . .. .. .... . _ .. ... - 001(SOOOSDomME7L�(31.ME]L.135327 51602/26846012684�1� . ._ raia� . . . .. . . . . . . _ .. , . • .. .. . .. . �,T�« .... Metlife P.olicyholder Trust ;Dividend Distribution. Enroll Now for Direct Deposit! . Effective in 2013,Metlife will now pay common stock dividends quarterly rather than annually.In addition,you can now receive your fund$i immediately and convenient(y by having your dividends directly deposited into your bank account.Just complete the enrollmenf form on�e 6ack of this statement and retum it in the envelope enclosed,You can also enroll by logging into www.comnutershare.com or by calling t +�ree at 800•649-3593. � Holder Account Number C00517�d1887 Dividend Summary Record Payable Security Total Trust Dividend Current Tax Net Total Stock Price i s of Deduction Date I Date I Description interesis Rate I Distribution I AmouM($) I Dividend(�)I Market Value Record�, ate O6 Feb 2013 13 Mar 2013 TRUST INTERESTS 38 $0.18500 7.03 1.97 5.06 1,427.66 37.$�000 Year-To•Date Paid 7.03 1.9T • � 1 UDC M E T L "�` . 003SSP0010/R OOHXDA-PP ' � WARMNG:IEUL7IPLE SRFETY FEATURES.iHE FACE OF THIS CXECK HAS A B:UE BACKGROUND AND RUORESCEHf INK(NOLD U�DEtt B'.ACKUGHT TO VIEYI�.REFER TO 5°_CURRY EKDO(iSEAtEAT BACKER FOR iRUE WA7ERMARKAND RGDIiIONAL FERTUR�S. � � ���� Bank of America �-� Atlanta,Dekaib County,Georgia 61 A , .. .•._- _ . . . .. ... _ . .._ . _. . . _ .._ . ;` :- ` PLEASE DEPOSIT TtiIS CHECK,PROMPTLY:VOID SIX MONTHS FROM CHECK DATE. . Pay : $'*"FNE DOLLARS AND SIX CENTS"***�' ' Check Number..`0003008146 � � , ,. . :., : .�Pay to the"� LIONEL J SPENARD ,� .`: `: - ,_. �. _ :. .'.: . . 05 M r a 2013 order of 9 S LOCUST LK : . . . .-.---.. ___.._....._.......-- --.--.�.___�. **** ***� MECHANICSBURG PA 17050-1620 " � � = ':_ : ` :. : .;:� >-:;: : ' . . ' $ 5.06 :... : : =:: ;: ; _ . .. ___, :, -�: � _ _ . .:. ..., , :-.. : - - - - - . . . . _ . _.. .; .. . . _ .. - - - . .___. ,_. . - .. :. . ._ .. , .. . . - . .: :. : . ,. ._ ,.. ` '.: aumonzed otficer: .. : , ._ �: :__ : ` ` - .: • -- `. ` ' .. .;. -:; . .: :,.. . .. .: _.. E, - �. ::.. ..: _.. ,'.,- :. .._, ,. �-•. ,:. .: .. ,: ,:_ : �.. . : . . ,.. :.:, ?. .,, :; :.,.:. �:..:, :.:t .,:. ... ?Senior Vlce Pres�denl8 Treasurer ,... . . . . .... .. :.., . ..:= . _. .. . ... ., . . .. , .....:. ...... ..... .. .,::.. ,... - �. , .,. . . �.,__ �.-.:. .:.- ` ' _ __ ,.. . .: . . , ` Dividends an MetLife,lnc common stock� ; - ` - M�� � .. . '. � r.ORiPU�@fSh8f8$h8f80WDB�SBN�CCS��C.:�.' �:seevnryFeamrtsOetallsonBiek �/�p�0�28dS(g08lUfC(S) ,. . ,: ;. ., � . 4801Nashington Blvd,Jersey City;NJ 07310` ` . - " ' - u�000 3008 146u■ �:06 L 1 L 2 788�: 3 3 5 98 7 09 3 Lii� _ _ _ __ ���r May 3, 2013 I purchased a 1996 Ford F 1 S 0 �rom the estate of Lionel Spenard for $2500. S ignature Printed Name l �G,� J � ���-S � � S� ��' �,�' n� 1 �� S -- ���� �`�,, b� ���� �n . ���� �� _ _ __ _ ___ ___ _ _ _ __ <<� ,. __ _ _ _ _ May 4, 2013 I purchased a 1999 Lincoln Continental from the estate of Lionel Spenard for $S 8 5 0. S ignature o� Printed Name ,L�� � �. a� . S'� `�� �� C� �'� -� � �� � �� ��. � �� ��� � � ` . ,�1r� 51 __ . __ _ _ __ . �`_ ��� _ May 8, 2013 Miscellaneous household items were sold to Melissa Jamison for $150.00. She also purchased a television for $150.00 (as priced by the appraiser). The total is $300.00, as is, where is, for all items. Buyer signature ���1 . 1 ��t,.D � � . t Printed name rn�7,��S�� c�-,�i'�'� �.�� 11° ��u � � ��� ��lt 1 � �� � � . � �� - -- --- ,�. _ . _ . _ �� May 9, 2013 Miscellaneous tools were sold to Tom Gates, as is, where is, for the $366.00. � Bu er si ature ������ �� Y � Printed name /!,.,,,,� .E 6�/-}��.,5 �t' �' . ;N . ��� `!�u �^ `,v _� �1 � �� . � � \L � __ ,�.� - __ _ AA� May 13, 2013 . Two chairs, a small cabinet and a footstool were sold to Kathy and Jim Gates for the $250.00, as is, where is. They were priced by the appraiser. � Bu er si ature c - �--�'�� Y � � � ����p . � Printed name k.A,�r��r� � r�-, �s � � � i � n l ,� 5l ' ' � 5 �� � �� ��� _ __ _ __ .� _ _ __ ___ e�� May 24, 2013 � ; , Coins from the estate of Lionel Spenard were purchased by wt�,��.� �, Chris 1�I��e�: The purchase price was $ 92� Buyer signature �� Printed name , �;��,,�- /���� _ __ _ . ___ --- --- _ - - - _ ,�._._ . _. _ _ _ I�1�1� May 28, 2013 Miscellaneous tools from the estate of Lionel Spenard were purchased by Jim Gates, as is, where is, for $3 5 0.00. Buyer signature �� i . _ ,.- <� C � Printed name I� ,��� , , � � �� � ��� ` � � � v� �o , � � � � psl l 3 � �� I�9 � � ! --_ - -- -- _ __---- <<<__ __ _ ___ _ . __ i �e"�— Account Number_ Due Date Amount Due . 717 766-0968I535�85Y $.00 ver��on �',��'i '�"25;.�:vi�y 3dt,;S;::�,�5;:.:R:�ui4�iLF'�.;:;'�•�•,: :��s�•;. �r � ��„��,-�;,,.,fy Account Information �r'����� •��t�. ^y ' fl��,�� Statement Date: 4/19/13 �d�������'.>iS�j �p � `s'??�r"�x�=� LIONEL J SPENARD �t�� �q�'N"al:. ' fi1Y. '3r' S,.'A?:} !15 � � .•�"�D� Ph0I1B: 717-766-0968 r�� �t��6r�i'a,�.i� �.�'�v�jsy - • ''. � �i �-R�'� -, ; • � - •, • : �������s� Account Summary ---- --�- ._.._..__ _ . - �'t�y .. " • . ' 9 . %'G 5; ' ,,� , Z '�'�1+.� �. t,''�r,� �..�� _.......... . . . _--•-� ....... .._...__ .._...... . c�•Gcn s.'se�i:�°t+�:�'x�nu.-��.'��'���+�•'::.r�'��t1.:t�ta•��f�ia: Previous8alance ---- - -._.....----- ---•-- .......__...-- ------._.__.. ... �54.46 Payment Received Apr 1 - .___ f .u.t�':.: s r °I�iCi�� r •��rata:F{I�}•'F!':ji�r{:ft. !�.�.i( .'...' __....___ .."'._"_'_.' __'_"'. "'_'.'_...____ _"_' _'_'____..'_'_. " 4 t-1���1�+���7���ixk�iti��:���1$1.7��II��QWSt.tFi:fi:�ii;�Y:t.��t.#:�1�'s.i BalanceForward 5.00 Before You Move... Call 1-888-416-9691 and we'll help set up your New Cfiarges --.._..--� -- ---.... _---.......•---...._..---• ------------� --. .—._.._ Intemet,N and Phane tor your new address.You can Current Activiiy -$8.55 ' be up and running in no time!DON'T WAIT!And be ---...---• _--- — ._...__ .. ....__ ----.-.-� -----..—.--..------ ---.- sure to ask if FiOS is avaiiable in your area.Service Taxes,Govemmental Surcharges and Fees -$.63 . __.... _.._.. ...-•--• •-----.... -----__ ------- _�......---....--•--._...._._. avaiiahility varies. Verizon Surcharges and Other Charges&Credts -�.79 We Value Our Custamers Total New Charg�s�-•-----•------�-- -- -•-- --- 1�� We appreciate your business&waM to deliver lhe very Total Amount -$�2•97 besl entertainment to you.Call us at 1-888-747-578110 tind oul about the new ways Your account has been disconnected.My other eharges or credits 'I Verizon can save you money.We enjoy being your an your next 6iIL provider,and we would like to keep you with us longer _ 6y improving yourVerizon expedence. This aedit may be applied to any balance you owe Verizon.lf you don't have a Get More,Save More balance,you wili be retunded the amount Call 1-868-747-5783 to ensure you're getting the besl Verizon services at a great value-irom phone, Internet and N,to money saving bundles,intematiorral ' plans,and tun add-ons.Together we'!1 flnd ways to ' save you even mare. Questions about your bill or service? �ew your bills in detai)at verizon.com or call 1-800-VERIZON(1-800-837-4966). Enter your ten digil number 717-766-0968.Use 535 ii asked for your customer (dentitication cade.Customers with dsabilities call 1-800-974-6006 TiY. Accounl Number. 717 766-0966 535 85Y - Charges Due: Amount Due: $.00 0 41913 Memo Bill OD NOT PAY 00021646 01 AV 0.360 VPC11211 0073 XX UONEL J SPENARD 259 SAMPLE BRIOGE RD MECHANICSBURG PA 17050-1630 �I��I�I���I�����1��1111�'I�������IIII�II��I��'i�l�l����ll����ll�� 1177170766096853530280216299999100000000�000000OOO�D0�00�00 . � -- - - _ _ ___ ---- 1�._� __ __ __ ._ _ r��I IIIII��IIIII�IIIII�II�IIIIIIIIIII� , 00457 , LIONEL SPENARD LtONEL SPENARD . 9 S LOCUST LN 9 S LOCUST LN MECHANICSBUR6 MECHANICSBURG PA 17050-1620 PA 17050-1620 n . � �� R . � • a � � 5837E 309883 ' 58011706 � Policy Number: ����57.�o Check Number: 05-t 5-2o t 3 n Refund Amount: $ . . Check Issued: � � � c This refund was issued for the foliowing reason(s): � Your policy,has been cancelled. This check is to refund you what . � we owe. � _ � � � � � � � . � � � . � � � � If you have any questions, please conta�t your Nationwide representative. � ' � Agent Name: JT MOR I TZ � Agent Phone Number: 717-697-9469 � � Agent Number. 0007s92 Detach Stub Before Cashing And.Keep For Your Record �•zaoz• c anoi2� a � o • e o 0 0 0 � NATIONWIDE AFFINITY INSUAANCE COMPANY OF AMERICA: `NattOilWltJe'-. . � . . � � • P 0 eox 8379,Canton OH '' � , 58071706 aa���=as�s � 000451 � Insurance Gheck No: �a-� rz � . : ., . . � _ , .;. . . , :. . >,. ,, .Policy. Number. `.583 309883. 15::. 7 E 72 ' .° PAY **ONE HUNDRED FIFTY SEVEN AND Z0./'IOd.DOLLARS******************.*******�*******.*******************+►***�r***,** .;EXACTI:Y ` . . , . . . ... . ,= ` ���r�i��.������f��i.���i�ir���������n���n����i������,�i����� `� . . _ ._ :. � , . ; � L I ONEL. SPENARD: : .. , . _ . . �:9 S LOCUST LN PaY �. : MECHAN:I'CSBURG. . �.�:�157.70. :To The�: • �'. � PA� 17050-9620 .. .' '. . � .� :;::Order ,: _ . Of ' . Vald Ii Nof Cashad Wllhin eO:Day ;Thls Is full paymant aniees othervut�e� _ . . _ . ` � '.'_ .`.. . ' :...:" :....�� ,..�s. ..::` ��' -'•�r. , ' Indlcated on stub. . .,. : . : . .. ,_ . . :.JPMorgan.ChasrBank N13: r.: :. : '. - �uearoam Mi- - . > Autho�zed:3lgneluro ` -�i• 580L1706u' �;0724L2927�: L15826i�' ___ ,� _ _ _ _ _ _ . _ '►�� NO. �' C T yP--413711 i�E.ML��Fi�H IF' RE�UND - 8�c50�24 . �79�OQ DECEAS�D �iEM��F� �'A ID TD: L..xONEL 5F'E�lAF:D TC)TAL D ISTB. ��������79.fl0 . `� �jl� . . Q��� Refund issued due to overpayment of your „���`AARP membership dues.Your membership is in °ATE �ECK NO. 6d1 E.Street, N.W. goad standing.For additional questions cali 04/17/13 1418279 Washington, D.C. 20049. us at 1-88�687-2277 Vendor No.: 20025�7 . SPU Code: DATE INVOICE/CREDIT MEMO TYPE DESCRIPTION GROSS DISCOUNT {�1� 04/12/13 4095791697 04h2N3 1.201 -Member Refu d 13.03 13.03 � ;id_-- __ _. _ . ���I _ � � � j��/�/J�11 S` � ,�.�G-�°J'7� � a � � r- � �: � = n� � p � _. . =D � rnp � _ Z � Nqp _ ���� �r�� � � _ � � � � 7� Q W � � � � �. � . D W �` _ � � ���� _. ' � 1� � � � a � � � � � � = � r� ''S F- n = . o �j .t� -xA' ; p -- J � - � � J � � \ O � ` �\� •1i� -�- � .' a �� � � �►� � — � � � * _ � � � N W ti Vt � •'- _ __ !-� - � .. __. __ -_. - - ---- ---- ._--- -- -- --_.__ �1��4�_... _____ �� The 6�9r'�Sffi11TGr'PIDN � THE WASHINGTON SPECTATOR ��������. ; PO BOX 241 OREGON, IL 61061 � — ���''°,�-� ��'� c�� RENEWAL NOTICE �� �� � ; ' �—� � — `�'J� �r���:�.-'� , Mr.Lionel Spenard �'`��� Do n't M i ss a n I ss u e : 9 S Locust Ln Mechanicsburg,PA 17050-1620 I��I���II�I����n�n�'��Il��lll��nl����l'I��I'��'I'I�I�'I��II��� d���isG �i!�G�/�i� ' L��rr.!%%� Dear Mr. Spenard, � One of your fellow subscribers to The Washin�ton Spectator wrote me: � . _� _ "Every member of Congress,the Administration and the bureaucracy should be required to read your newsletter;study it, and have if available for reference at all - times." And that brought to mind Marilyn Monroe. Why?Because Ms. Monroe was so annoyed at the arrogance and ignorance of the Congress of her day that she bought every member a subscription to I.F. Ston�e's Weeklv, i the now-legendary newsletter that specialized in raking the Washington establishment over the coals. Unfortunately,Marilyn,Izzy Stone and his newsletter have all passed on. But The : Washin on Spectator contmues to be inspired by the same determination that they had to tell the truth to the people. Every member of the current Congress gets The Washin on S ectator,and I want to make sure you continue to as well. That's why I've sent this note--to encourage you to renew your subscription now, using the attached form,so you don't miss an issue. . Cordially, �—='c���... Lou Dubose Editor IR V�7 P1Gaeq [4atat�h lna-ar mrf-inr, anA ra1-iirn -r=t1� rnnc�aral ns�nnrant in-tl.c �v.a}:.�.n ..�iA .n....r.�......_. yy . 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I !pC * � ? • I �� � . �:7 �Jt r.� 7�C 7QC t{! �;�„ ' � `a , ■ + O O IO O . i . t � — --- '�-1---- - . _ _ ___ _ _ _ _ �� _ ■ . ���Northwestern Mutual' M�°�kee�Wl 532o2Venue LIFE BENEFITS DIVISION ��r� STATEMENT BY 1NSURER - DEATH OF PAYEE I Treasury Department Form T92 Not Applicable I fNSURED(ANNUITAN7') DECEASED PAYEE � � LIONEL J SPENARD LIONEL J SPENARD 'I POUCY(CONTRAC�NO. PAYEE'S DATE OF DEATH(MM/DD/YWY) 19827300 04/�1/2013 ' . I POLICY(CONTRACT) INFORMATION I � death of Insured on ' DATE(MM/OD/YYY`� �� 1. Policy originaily payable`by reason of — maturity on ', DATE(MM/DD/YYY1� ', � surrender on 06/04/1993 ' DATE(MMIDD/YYY1� ' 2. Setflement Option (Description): . ', SINGLE LIFE '� � Elected by LIONEL SPENARD Date 06/04/1993 ' �MNwomnr� ' 3. Value of any remaining t�enefits$ 256.24 I 4. Successor payee designated by Date ' (MNUDO/YYY1� 5. The deceased payee did have the right fo change or revoke the successor payee. ' IMMEDIATE ANNUITY tNFORMATiON ' 1. Annuity applied for by Date ' (MM/DD/YYYI� , 2. Type of annuity(Description): ', . ,� 3. Value of any remaining benefits$ ', 4. Successor payee desigriated by DaQe � (MNUDD/YYYI� 5. The deceased payee did have the right to change or revoke the successor payee. ', . REMARKS: � The undersigned officer of The Northwestem Mutual Life Insurance Company hereby certifies that this statement sets ' forth correct and true information. ' Date of (� �I Certification May 16,2013 Signature �.c��'�t'Q .�S.G�^ � � (MMIDD/YYY1� DIRECTOR OF—UFE BENEFffS,LOAN&SURRENDER,BENEFICIARY&T(TTLE ' 15-0163(1203) ' � WORD e-LS _ __ __ _ . ��� ��Northwestern Mutual' 720EastWisconsinAvenue LIFE BENEFITS DIVISION Milwaukee,WI 53202 STATEMENT BY INSURER-DEATH OF PAYEE Treasury Department Form T92 Not Applicable � INSURED(ANNUITAN'� DECEASED PAYEE � LIONEL.J SPENARD LIONEL J SPENARD POUCY(CONTRAC�NO. PAYEE'S DATE OF DEATH(MMlDD/YYYI� 19827299 04/0112013 POLICY(CONTRACT)INFORMATION death of Insured on � DATE(MMIDD/YWI� '� 1. Policy originally payable�by reason of — maturity on ' DATE(MM/DD/YYYY) surrender on 06/04/1993 . DATE(MM/DDlYYYI� 2. Settlement Option(Description): SINGLE LIFE Elected by LIONEL SPENARD Date 06104l1983 (MAA/D�/YYYY) . 3. Value of any remaining benefits$ 877.63 4. Successor payee designated by Date (MAA/DDlYYY1� 5. The deceased payee did have the right to change or revoke the successor payee. IMMEDIATE ANNUITY INFORMATION 1. Annuity applied for by Date (MM/OD/YYY1� : 2. Type of annuity(Description): 3. Value of any remaining benefits$ �4. Successor payee designated by Date (MMIOD/YYl^!) 5. The deceased payee did have the right to change or revoke the successor payee. � REMARKS: � The undersigned o�cer of The Northwestern Mutual Life insurance Company hereby certifies that this statement sets forth correct and true information. Date of Q : Certification May 16,2013 Signature ����a -�4G� (MM/DD/YYYI� DIRECTOR OF—LIFE BENEFITS,LOAN 8 SURRENOER,BENEFICIARY&TI'fTLE 15-0163(1203) � WORD 8-LS - _ _ __ _ _i I..,. _ _ _ _ _"�"1i �Northwestern Mutual' 720EastWlsconslnAvenue LIFE BENEFiTS DIVISION Milwaukee,WI 53202 STATEMENT BY fNSURER- DEATH OF PAYEE Treasury Department Form 792 Not Applicable . INSURED(ANNUITANn DECEASED PAYEE LIONEL J SPENARD LIONEL J SPENARD POLICY(CONTRACT)NO. PAYEE'S DATE OF DEATH(MM/DD/YYYI� 99827298 04/01/2013 � POLICY(CONTRACTj INFORMATION death of Insured on DATE(MMIDD/YYY1� 1. Policy originaily payable�by reason of — maturity on DATE(MMfDDlYYY1� surrender on 06/04/1993 DATE(MM/DD/YYY1� 2. Settiement Option (Description): ' SINGLE LIFE � Elected by LIONEL SPENARD Date 06/04/1993 (MMIDO/YYYI� � 3. Value of any remaining benefits$ 33.58 � 4. Successor payee designated by Date (MNVDD/YYY1� 5. The deceased payee did have the right to change or revoke the successor payee. . iMMEDIATE ANNUITY INFORMATION 1. . Annuity appiied for by Date �� (MMlDD/YYY� 2. Type of annuity(Description): 3. Value of any remaining benefits$ ' 4. Successor payee designated by Date �muonrmrv� 5. The deceased payee did have the right to change or revoke the successor payee. REMARKS: The undersigned officer of The Northwestern Mutual Life Insurance Company hereby certifies that this statement sets � forth correct and true informafion. ' Date of Y �.c��Q �C�_' Certification Ma 16,.2013 Signature (MM/DDlYYY`n DIRECTOR OF—LIFE BENEFITS,LOAN&SURRENDER,BENEFiCIARY&TITTLE 15-0163(1203) • WORD&LS - — _ . _ _ _ ��. -- _ _ ��� ��Northwestern Mutual' ^ 720 East Wisconsin Avenue POLICY�WNER$ERVICES �EPARTMENT Mi�waukee,wi 53202 �.IFE BENEFITS �tVISION � � KATHLEEN MISTURAK-GINGRICH � LAW OFFICES OF PETER J RUSSO 5006 EAST T�INDLE RD SUITE 203 � MECHANICSBURG�PA 17050 � ' DATE(MMIDD/YYWj INSURED(ANNUITANn ' May 16,2013 UONEL J SPENARD POUCY(CONTRAC'n NOS. COPY TO 19827298,19827299,19827300 ABOVE � � , ❑ 1. Completed Treasury Department Form 712 is enclosed. � 2. Statement by Insurer-Death of payee is enclosed. (Treasury Department Form 712 is � not applicable.) NOTE: You may wish to give consideration to factors or arrangements which may exclude the proceeds from the estate of the deceased for federal estate tax purposes. Your tax advisor or atforney can provide additional information. 15-0162(0412) WORD 8-LS _ -- _ _ -- ��.. _ _ _- — . .�,� _ REV-1511 EX+(Ip-09) � � � SCHEDULE H � ���� pennsylvania OEPARTMENTOFREVENUE FUNERAL EXPENSES AND INHERRANCE TAX RETURN ADMINISTRATIVE COSTS RES[DENT DECEDENT ESTATE OF FILE NUMBER Lionel J. Spenard 2013-00410 Decedent's de6ts must be reporked on Schedule I. - ITEM NUMBER DESCRIPTION AMOUNT A. fUNERAI EXPENSES: 1. Neill Funeral H�me 13,742.85 '' B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 17,475.15 ' Name(s)of Personal Representative(s) Street Adc�ress City State ZIP Year(s)Ccmmission Paid: Z. Attomey Fees: 5,850.60 3. Family Exemption:(If decedenYs address is not the same as claimant's,attach explanation.) � Claimant Street Address ���Y— State ZIP Relationship of Claimant to Decedent 4• Probate Fees: 789 28 5• Accountant Fees: 6• Tax Retum PreparerFees: 7. TOTAL(Also enter on Line 9, Recapitulation) $ 37,857.88 If more space is needed,use additional sheets of paper of the same size. _ _ _ _ . � � __ .. ., ._ �. Neill Funerai Home,Inc. � 3401 Market Street Camp Hill,PA 170114428 (717)737-8726 Supervisor:Kevin J.Shillabeer 1 � The following is a detailed b(II tor the professionai servioes and/or merchandise arranged for ' Llonel J.Spenard Date of Servioe:April 08,2013 Kathryn Gates Statement Date May 29,2013 259 Sample Bridge Rd Contract Number 741101000401 Mechanicsburg,PA 17050-1630 Arraneer Name Kevin J Shillabeer � Initlal Selection Flnal Seledion Dtfference I . Padcage Of6erings I Forwarding Remalns to Another Funeral Home $3,495.00 $3,495.00 — Transfer of Remains to Funeral Home Incl incl , , Transfer to or From Airport Incl Incl � i Basic Professionat Service Fee Incl incl — Embalming Incl Incl — Total Padcage Offedngs $3,495.00 $3,495.00 — Use of Fadlwes and Related Services Chapei Funeral Ceremony $395.00 $395.00 — Use of Facilities and Staff for Viewing $395.00 $395.00 — Total Use of Faalities and Related Services $790.00 $790.00 — I I Other Goods and Services Flowers $250.00 $250.00 � Totat Other Goods and Servlces $250.00 $250.00 — I Merchandtse 148247 Imperial Mahogany Wood Veivet $5,695.00 $5,695.00 — , Std Graveliner Concrete $995.00 $995.00 __ Total Mer�chandise $6,690.00 $6,690.00 _ Cash Advanoe Certified Copies of the Death Certificate $90.00 $90.00 � � Newspaper Notice $38.00 $38.00 � Public Transp�rtation $550.00 $402.85 ($147.15) i� . �I � --- __ „� _ _ _ .�,� _ .. . ,. IniUal Selec�ion Final Selectlon Difference ' Priest in New York $50.00 $50.00 — Engrave stone $175.00 $175.00 — ' Outside Funeral Director Expense $1,125.00 $1,262.00 $137.00 � Cemetery $500.00 $500.00 — Total Cash Advance $2,528.00 $2,517.85 ($10.i� ' Total Services,Merchandise and Cash Advance $13,753.00 $13,742.85 ($10.15) � Total Charges(Total Services+/-Allowances+Taxes) $13,753.00 $13,742.85 ($10.15) , Less Cash Received ($13,742.8� Unpaid Balance Due $Q.00 f . � /� P Page 2 qf 2 _ ��. _ _. .�+� `J�� '�� ti���i�� �-� G�� � � • � � � �� • ��' 11579222 148247 QA27303 • This LimiEed Warranty("Warranty")gives you specific legal rights,and you may aIso have other rights which vary from sEate to state. ' BATFSVII.,LE CASKET COMPANY,INC.,Batesville, which are hereb� exp�•essl� disclaimed. Some states do I�diana('Batesville")hereby warrants,to the Authorized not allow the exclusion or limitations of incidental or and Licensed Funeral Director (defined as a licensed consequential damages, or exclnsions or limitations funeral home and licensed funeral director who on implied warranties or how long they last, so the purchases caskets from Batesville),and to any purchaser above limitations may not apply to you.In such cases, who initially purchases this Batesville Hazdwood Casket any implied warranty of inerchantability or fiiness for ("CaskeY') from the Authorized and Licensed Funeral a particular purpose will be limited to the duration of Director for interment: • this limited Warranty. The purchase�s remedy will be � That tIus Casket is free from defects in material strictly limited to replacement of this Casket as stated and workmanship. That Batesville will, witiva ten (10) above. days of receipt of this notice to it, ieplace this Casket This Warranty will be void if this Casket is with one of equal or greater value if, at any time prior purchased from other than an Authorized and Licensed to�the placement of this Casket in an initial place of Funeral Director, if it is purchased for purposes other interment, it is found to be defective in materials or than interment or entombment or if the integrity of workmanship;provided that this Casket was purchased this Caskers structure is damaged or compromised &om and interred or entombed under the supervision through improper handling, transportation, accident, of an Authorized and Licensed Funeral Director, and neglect,or force majeure or other Acts of God,including, fiuther provided that an opporh�nity is afforded for without limitation, IIood or earthquake. No person, examination of this Casket by Batesville representatives including Batesville employees or representatives, is and/or impartial experts designated by it Notice must authorized to change this Warranty in any way or be made in writing during the warranty period to the grant any other wananty,and any statements made by address listed below. any persons or such representatives or in any sales or Disclaimer: BatesviIle makes no clnim thnt this CaskeE advertising materials are superseded in their entirety by or�an� of its caskets wiIl prese�ve remains. No brcriai tivs Warranty, which constitutes the entire agreement prod:rct prevents the decomposition of remsins.BaEesoille between the parties as to tivs subject matter. will not be responsi'ble for nny consequentinl, emoEional,� i�icicle�ttal, special and/or indirect dnmages rrrising out of �� �I��` zny breach of thrs express Warranty or for anJ warrattties implied b� l�w, induding without limitntio�t mi� implieci �gerly K Dennis,President warranfij of ine�rhmitabilihj or fzhTess for a pnrticular purpose, Batesville Casket Company,Inc l�l�hl �CrY� �P ���C��� Ff JNERAL HONI����� ��/ I NAME OF DE � � � � � �0 J� `�'�`''��� DATE OF PURCHASE For warranty daims,please contact: $atesville Casket Company,Inc i579-W(REV.6-11) 1 Batesville Blvd.,Batesville,IN 47006 �2008 Batesville Casket Company,Ina 1-800-622-8373 _ _ _ _ _ _ .�v� _ RECEIPT FOR PAYMENT ' ------------------- GLENDA FARNER STRASBAUGH Receipt Date : 5/03/2013 Cumberland County - Register Of Wills Receipt Time: 15 -22 :50 One Courthouse Square Receipt No. : 1074074 . Carlisle, PA 17613 SPENARD LIONEL J Estate File No. : 2013-00410 Paid By Remarks : KATHRYN GATES CJ ------------------------ Receipt Distribution ----------------- ------_ Fee/Tax Description Payment Amount Payee Name SHORT CERTIFICATE 10 . 00 CUMBERLAND COUNTY GENER.AL FUN' ---------------- Check# 104 $10 . 00 Total Received. . . . . . . . . $10 . 00 _ _ _ _ ;1�.. . � RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Receipt Date: 4/11/2013 Cumberland County - Register Of Wills Receipt Time: 1 1 :21 :56 One Courthouse Square Receipt No. : 1073773 Carlisle, PA 17�13 SPENARD LIONEL J Estate File No. : 2013-00410 Paid By Remarks : MBHRYN B GATES ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 410 . 00 CUMBERLAND COUNTY GENERAL F WILL 15 . 00 CUMBERT_;AND COUNTY GENER.AI� F SHORT CERTIFICATE 10 . 00 CUMBERLAND COUNTY GENERAI� F INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL F INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENER.AL F JCS FEE 23 .50 BUREAU OF RECEIPTS & CNTR M.p' AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FLT�'' ---------------- Check# 1234 � $493 . 50 Total Received. . . . . . . . . $493 .50 - _ _ - - --- ----- - --__ __ -- _ ,,u _ �R� H'l�l� �'C��eI PETER J.RUSSO,ESQUIRE AD NUMBER PAGE NO. w w w.c u m 6 e r 1 i n k.c o m 5406 EAST TRINDLE ROAD 420563 1 Of 1 �� SUITE 203 � MECHANICSBURG,PA 17050-4327 B1LL DATE SALESPERSON G.Qi]StE src�er,s�.� ��zrca,�am 717-591-1755 05i17i13 Wolfc START DATE STOP DATE 05l03h 3 05/17/13 AD NUMBER AD DESCRIPTION CLASS LINES A20563 EXECUTRIX'S NOTICE LETTERS OF TEST 16 PUBUC NOTICES 38 * 2 cols '' Publication Insertions Rate Net Amount Gross Amount I!' 3 THE SENTINEL-LEGAL 3 LGL $201.78 TOTAI AD CHARGE $201 78 3 PROOF OF PUBL{CATiON 01PRF $7.00 3 MOBILE SITE MOB2 $2.00 Purchaseorder Est.L.J.Spenard PAY THIS AMOUNT $210.78 $252.94* '', "AFTER 06/11l13 ', THE SENTINEL Thank you for advertising with The Sentinel! Deadline for c/o LEE NEWSPAPERS in-column legal ads is 4:00 p.m.two business days prior to PO BOX 540 date of insertion. For questions,call(717)240-7130. WATERLOO IA 50704-0540 Retum thls porNon wlth yourpayment �@g81 THE 5ENTINEL ❑ Check# �Credtt Card Ad Number 420563 ; c/o LEE NEWSPAPERS ❑ � ❑ v�sR' ❑ � ❑ Bifling Date Ob/17113 PO BOX 540 ' WATERLOO IA 50704-0540 Acct#: Amount Due $ 210.78 Exp.Date:m m ' �; �'�� T` = lAtllOUllt Name on credit card �.� '; $ „ �. Epclo,�$e'�d� Signature ��j`""* '�'h�� ?':�.'.u�:r''<3�. � Please make checks payable to: THE SENTINEL ' °°°�6o THE SENTINEL • PETER J.RUSSO,ESQUIRE c/o LEE NEWSPAPERS 5008 EASl'TRINDL�ROAD PO BOX 742548 SUITE 203 CINCINNATI OH 45274-2548 . MECHANICSBURG,PA 17050-4327 '�{��1�'�I���I�'I111'�'��'"I�'''�I„'11"",,,'1,�,,,''I11r" 2154020DOOOOD42�563000Q00000000�0025294000�027,0788 ��_ - __ r�� ��``���OG �� ti� ! . `�e�ssoc+Pr�� CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARUSLE, PA 17013 Tele: (717)249-3166 Fax:(717)249-2663 May 31, 2013 � Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Caurt of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Kathleen Mistuark-Gingrich, Esquire RE: Lionel J. Spenard Estate Legal advertisements must be received by Friday Noon. All legal advertising � must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on the following dates: May 17, May 24, and May 31, 2013 � Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 0 .00 Total Amount Due $ 75.00 Payment received by _ _ �a. __ _ �R� REV-1512 EX+(12-12) � pennsylvania SCHEDULE I DEPARTMENTOFREVCNUE DEBTS OF DECEDENT, INHERITANCETAXRETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FI4E NUMBER Lionel J.Spenard 2013-00410 Report debts incurred by the decedent prior to death that remained unpaid at the date af death,i�cluding unreimbursed medtcal expenses. ITEM VALUE AT DATE � NUMBER DESCRIPTION OF DEATH 1• PPL Electric Utilities 209.86 2 Consumer Ceilular 19.67 3 West Shore EMS 1,008.90 4 Spirit Physcians 38.86 5 Northwestern Mut�aal 488.20 6 Kathy Gates(Executor Reimbursement, Post Office,Target,Walma�t) 225.33 7 Emie Mader(C1e�:n out house,basement,garage and garage attic) 300.00 8 Tom Gates(Clean out house,basement,garage and garage attic) 48�.00 9 Mark Heckman Real Estate Appraise�s 400.00 10 Gates Building and Remodeling 270.52 11 US Post O�ce 18.87 12 PPL Electric Utitlies 79.53 13 US Post Office 10.20 14 Gates Building and Remodeling 985.00 15 Kathy Gates(Reimbursment of initial Trash Bill;dumpster) 495.00 ! 16 Tiger Trash 495.00 17 Jim Gates(Clean out house,basement,garage and garage attic) 600.00 18 Kathy Gates(Reimbursement of Post Office and Walmart) 57.81 19 Kathy Gates(Reirabursement of Mileage per IRS Reimbursement) 211.64 20 John Potteiger(lauvn mowing) 240.00 ' TOTAL(Also enter on Line 10,Recapitulation) $ 6,634.39 If more space is needed,insert additional sheets of the same size. i i. _ __ . _ _ _ _ - _ .�,� , , - :. . 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Page 1 ;O40�i y,V, . . . ., • . . � o�;_ contact us by May 1. pplelectric.com ' �� `:�: 1-800-DIAL-PPL ' ` ' ='�• (1-800-342-5775) 8 5 2 6 0-7 2 0 0 4 M a y 1,2 0 2 3 ;:;'�s.:.$�0 9"$,,,.'�,��_:. pa��eew�uuuuae � M-F:8am to 5pm Your Etectric Usage Profile Biiling Summary (eiuing details oni back) Service to: Balance as of Apr 10,2013 � $0.00 � LIONEL SPENARD Charges: 9 LOCUST LN Totai PPL Electric Utilities Charges $73.64 MECHANICSBURG, PA 17050 Total PPL EnergyPlus, LLC PA Charges $136.22 ' Meter:10065702 Your next meter reading is on or about May 8,2013. Total Charges $209.86 This section hei s ou understand our ear-to- ear moui��'�Dii ;B�ICAay�1,;�UZ����+'�`�����°�'���'`��``�� a�}� ��r�'��-'�` �`� p Y , Y Y Y �,.»y.x..,..,�. ..,.�.,:.�. . �� a,..���..�?�r����}z�'€t�',�r�-��:`.��__.�.:u�s�-�.��3.��Si���� . •$�� electric use by month. Meter readings are actual unless Account Balance $ 9,86 otherwise noted. �20�2 �2013 PPL Electric Utilities'price to compare for your rate is$0.07237 per k This changes the 1st of Mar,Jun,Sept,and Dec.Visit papowerswitch.�m 90 or www.oca.state.pa.us for supplier offers. L '75 3 60 Your Message Center � 45 � • rNith paperless billing,you can receive and pay your ' „ PPL Electric Utilities bills oniine.The process is free, m 3o quick,convenient and secure.To learn more or sign up, a visit pplelectric.com. ss o • Information about appliance energy use and tips on � saving energy are avatlable through the Energy Library � J F M A M � � a s o N u on our Web site,pplelectric.com. �� ��;,%� o Months . Before dlgging around your home or property,you ���i� should always call the state's One Call notification ' system to locate any underground utility lines. You can � � � do this by simply dialing 811,which will connect you to �a!� Apr 2013 32 1892 59 40F the One Call system. Be safe and cal!811 before you �� ', / � dig. 2�p1 /� Apr2012 32 1009 32 52F ' ' Payment Methods . ° Apr 8 Actual 30094 � Online at: Q By phone•1-800-342-5775 �� = Mar 7 Actual 2g2p2 ppielectric.com or call BiIlMatrix(service fee ap ��es) _ at 1-800-672-24i3 to pay using sa, = 3Z Days kWh Biiled 1892 MasterCard,Discover or debit c ktl. = •. . . . � By Mail: Correspondence should be sent tb: - May 2012-Apr 2013 13073 . 1089 2 North 9th Street Customer Services ' = CPGGENNI 827 Hausman Road = May 2011-Apr 2012 10353 863 Allentown,PA 18101-1175 Allentown, PA 18104-9392 - Other important information on the back of this biyil� _ _ _ _ - - - _ _ - - ,_;,. _ _ _ _. ■ � . BlueCross m ► � � BlueShield m Ex lanation of Benefits Federal Employee Program � � 351 www.fepbtue.org THIS IS NOT A BILL Camp Hill,Pennsylvania 17089 FEDERAL EMPLOYEE PROGRAM f � PO HOX 890035 CAMP HILL PA 17089-0035 � i MEDICAL QUESTIONS CALL 1-800-779-6945, I DENTAL QUESTIONS CALL 1-800-746-5687, .y.�.� TTY QUESTIONS CALL 1-800-345-3848 a" LIONEL J SPENARD 9 S LOCUST LN ', MECHANICSBURG PA 17050-1620 � � EXPLANATION OF BENEEITS AT A GLANCE � I � ' � � ID Number: R03079498 I � Claim Number: 20401492575 �Patient Name: LIONEL � � � Claim Received On: 04/03/2013 �Dates of Service• 03/19/2013 - 03/19/2013 � Claim Processed On: 04/12/2013 ', Provider: WESTSHOREALS Dates of Service: 03/19/2013 - 03/19/2013 ' Type: NON-PARTICIPATING PROVIDER Type of Service � Submitted � Plan �Remark� DeducC�Coinsurance� Medicare/ ( What �You Owe the ' � I Charaes I Allowance � Codes� I Or Copav �Other Ins J We Paid � Prov��e� ' ', AMBULANCE SERVICES I 1 008 901 I 165 „ TOTALS: I 1 .008.901 I I � � � � 1 008 90 � EXPLANATION OF REMARK CODES ' 165--BENEEITS ARE NOT PROVIDED FOR SERVICES/SUPPLIES LISTED IN THE GENERAL ' - EXCLUSIONS SECTION OF THE BLUE CROSS BLUE SHIELD SERVICE BENEFIT PLAN ' BROCHURE. YOU ARE RESPONSIBLE FOR THESE CHARGES EVEN IF TNE ' SERVICES/SUPPLIES WERE ORDERED BY A PROVIDER, EXCEPT WHEN ANOTHER CARRIER HAS ' PAID FOR THE SERVICE(S) IN FULL. ' ' " � Health Tips � � Complete your Blue Health Assessment and receive a $35 health debit card to use for qualified medical � � expenses. Limit of two $35 cards When two adult members complete the BHA. Visit www.fepblue.orq � ' � today. � If you had used a Preferred Provider for this care, your out-of-pocket expenses would have been less. I ' ��o locate a Preferred ProvidQ+- ;� vour area check out the online provider directorv on www fp+�blue ora � If you have questions, please call a customer service representative at your local Blue Cross and Blue ' Shield Plan. You may also request the diagnosis codes, the treatment codes, and the corresponding meaninqs of the codes for your claim. If you disagree with the decision on your claims or request for services, and wish to have the decision reconsidered, you must noti£y your Plan in wriLing within 6 months from the date of this decision, i.e. 10/12/2013. You may request copies, free of charge, of any relevant materials and ' Plan documents relating to your claim. Your Plan will not accept unauthorized reconsiderations from providers. See the Disputed Claims section of your Service 8enefit Plan Brochure. wnni4�y ._ ... _.. .. _. _.. ... . _. __. .... ... . ... ... .. _ �JI,,.. _ __ __ .�� '� . I� , �� WEST SHORE EMS - ALS . 205 GRANDVIEW AVE SUITE 211 CAMP HILL, PA 17011 LIONEL J. SPENARD Date of Service: 03/19/2013 . 9 S LOCUST LN Origin: HOME/RESIDENCE MECHANICSBURG, PA 17050 Destination: HOLY SPIRIT HOSPITAL Invoice Number: 1304783AA1 Billing Total: $ 4008.90 As a member of our subscription program,we have submitted this claim for the above services to your insurance carrier. Payment may be made directly to you because we are not a participating provider. Upon receipt, please remit payment or rejection to WEST SHORE EMS-ALS along with a copy of your expianation of benefits. Please verify all insurance information below. If you find any errors, please contact our billing office immediately.You can reach our billing staff at(800)367-0512. Insurance Carrier: FEP(NO CONTRACT) Identification Number: R03079498 �� . u� j 3 Group Number: � � y Insured: LIONEL J.SPENARD � 1 � 3 , � ��' ��� � �� �� ��� � = �'� ��'�� � �� ��:�, � , ,� G� �,�--' ' � � � ��� ����� _ - - - _ _ _ -- -- _ _ - -- ,�r _ _ _ _ _ _ � � %�� � B1ueCross� BlueShieldm Explanation of Bene�ts Federal Employee Program THIS IS NOT A BILL 520� www.fepblue.org Camp Hill,Pennsylvania 17089 FEDERAL EMPLOYEE PROGRAM PO BOX 890035 CAMP HILL PA 17089-0035 MEDICAL QUESTIONS CALL 1-800-779-6945, DENTAL QllESTIONS CALL 1-800-746-5687, TTY QUESTIONS CALL 1-800-345-3848 � LIONEL L SPENARD 9 S LOCUST LN MECHANICSBURG PA 17050-1620 � � � EXPLANATION OF HENEEITS AT A GLANCE �. � I � � . �We Sent Check To: WEST SHORE ALS � ID Number: R03079498 I � C1aim Number: 20401492575Z ��atient Name: LIONEL SPENARD � Claim Paid On: 05/15/2013 I � Claim Received On: 04/08/2013 (Q�tes of Service: 03/19/2013 - 03/19/2013 � Claim Processed On: OS/OS/2013 I � Patient Acct No: 1304783AA �You Owe the Provider: 50.00 � ' Provider: WESTSHOREALS Dates of Service: 03/19/2013 - 03/19/2013 Type: NON-PARTICIPATING PROVIDER . Type of Service ( Submitted � Plan (Remark� Deduct�Coinsurance� Medicare/ � What �You Owe the I Charaes I Allowance � Codes� J Or Copav �Other Ins � We Paid � Provider AMBULANCE SERVICES I 1 .008.901 1.008.901 I � � � 1 008 90� �ALS: I 1,008.901 1 .008.901 � 0 00� 0 00� 0 001 1 008 90� 0 00 I Health Tips � ' � Complete your Blue Health Assessment and receive a $35 health debit card to use for qualified medical � � expenses. Limit of two 535 cards when two adult members complete the BHA. Visit www.fepblue.org � itoday. � ' � If you had used a Preferred Provider for this care, your out-of-pocket expenses would have been less. � � To locate a Preferred Provider �n �our area check out the online nrovider directorv on www fPgblu ora � �_ Summarv of Out-of-Pocket Exuenses for 2013 � � Your Out-of-Pocket Expenses � � � � Catastrophic Protection � � On This Claim I �Calendar Year� Preferred � Non-Preferred/ � �Calendar Year Deductible $0.00� � � Deductible � � Preferred Total� �Per Admission Copay $0.00� �What You Have Paid � I I � �Coinsurance $0.00� � Individual � 50.00� 5162� $162� �Copayment 50.00� ' � Family � $0.00� 50� S0� �Non-covered Charges $0.00� �Annual Maximum � � I � �Precertification Penalty $0.00� � � Individual � $0.00� S5,000� S7,000� � � Familv I SO 00� S01 S0� �TOTAL: SO 00� If you have questions, please call a customer service representative at your local Blue Cross and Blue Shield Plan. You may also request the diaqnosis codes, the treatment codes, and the corresponding meanings of the codes for your claim. If you disaqree with the decision on your claims or request for services, and wish to have the decision reconsidered, you must notify your Plan in writinq within 6 months from the date of this decision, i.e. 11/15/2013. You may request copies, free of charqe, of any relevant materials and Plan documents relating to your claim. Your Plan will not accept unauthorized reconsiderations from providers. See the Disputed Claims section of your Service Benefit Plan Brochure. ' 003�O1 - -- - _ 0001 _ _ . _ "R� � � m � H a m y. � W � o° . a � Zm "' . O� � �� s � ' w� � .t� � ° o � r�� . o � d . . � � � �.. � a a . .• . . � � � c�'i � �`-� ''� m �. � � �i � � . LL = � � Z v : .0 � � ' W � � 4 W p � a � � � .. . O � W o F" ^ ' � q . . Q n Q - Z � 0 V .. _ N0 � (� F.� • e- p ' N . � � W �A � �. � U � � 0 a ,.. . O W . � � . V� Vj �.. a H a a V a 0 0 ' � o � Ca . N �o ��y H i v H . � . � � C ` � ' ','�. Z H • N � � � � m N Ll O �O � U rn p p L . � � � _ O.. :. , . � � � d ' � N ' .. . . � � � � .. , �" lQ G o 0 O = ` Z � m °� � ' W �-+ . O L F- � M a ° LL a a � � i _ W � W .a�o � �� , f- o . ' � 00 Y ��� � G � • . V � � L � F 000005I50-A . _ _. _ . ___. __ _ I 1.... __._ . . _ _ _ _�r�,� ��North.w�stern Mutual� _. _____ .__ _ . _ JAMIE LEVERENCE . ............_ ....._........ .._. . ._._ . ._.._...... . ......_... .. _. .._. ..... . .. � . .Cife�Benefits�Sr:Analysf _ _..._ Ufe Benefds Divlsfon April ]5,2013 Policyowner Senrices oepartment , 800-635-8855 • Fax:(414)825-9000 ' Kathryn. Gates '' 259 Sample Bridge Road ' Mechanicsburg, �A 17050 ' Re: Lionel J. Spenard ', 19327298; 19827299, 19E?7300 ', Dear Ms. Gates: ' We were sorry to !earn of the death of Lionel J.Spenard;please extend Northwestern MutuaCs ' sympathy�o the far.=.ily. All of us at Northwestern Mutual will do our part to assist in any way we can. Uur records indicate that Ms. Cynthia Glinski is the contingent beneficiary. , The beneficiary must survive each payment date in order to receive the benefit of the payment. ' Proceeds from payment dated Apri(4,2013 totaling$488.20 were sent after the death of Lionel J. ' Spenard�r�accounts 19827298, 19827299, 19827300. Since the funds were not due,we have contacted the bank for reimbursemen� If we cannot recover the funds,personal reimbursement will ' be required. � ' To understand the settlement choices,please review the enclosed Settlement and Tax Information sfieet. � ', In order to process the claim,we need the following: ' ➢ Death Certificate—A copy of a certified death certificate,which provides the cause and ' manner c•�death. lfthere u:e multiple beneficiaries or policies, only one death certificate is ' required. ' ➢ Bene��iary C:�:�ns Statement-It is very important that the beneficiary's Social Security ' Number is provided on this form. ' �Income Ptan Direct Deposit Form-Please complete this portion of the form if you ' ' would like your payment directly deposited into your checking or savings account. ' Attach a voided check to deposit future payments into a checking account. ' . �;�� ��Y� _ ��� � S��` Natice Letler-Page I of Z ' - - - _ _ -- - - u�_. _ _ _ . .�� Kathryn Gates April 15,2013 " Page 2 You may send th�is information in the following manner: • mail to Liie�Benefits Division,Northwestern Mutual,PO Box 2972,Milwaukee,WI 53201 • fax to 414=525-9000 • email to LIFE$ENEFITS@northwesternmutual.com - After all reyuirements have been received,we will promptly process the claim. Please do not return the original policy. It can be destroyed after settlement. . __. Once again,we offer our coridolences to the family. If I can help in any way,please let me know. Our toll-free number is $00-635-8855. � Sincerely, � � �a�sie .L�ea�ieaue ' Jamie Leverence . � � Notice Letter-Page 2 of 2 - - - - - _ !�„ . _ __ ■�r� c'� �,� Q � � c�`�� �� .�- l � °SP- �' . 3 h G v1 0o M O O N M . ' v? v? '-+ •--; M O: O N 00 l� M M �--� �D l� \O M OO . N b9 O � �-. � b9 � 64 59 � C� 69 n t/l� N bA cd � . b�A � � � � `d • N � �,., C� � � O w O ►�-. �3 � �� y � � �O � y � 'G �1, N a� � .� ° w `� � a' .� a . o � y +r °��' � a � �+ y � .� E+ � � 0 � 0 U 0 U ^d y � � � � � � . . � � ,a ; ; � 00 � � o � � � `� o o � � ac� HH3a, a3 � � M M c�1 M M M M .--1 �--� .-r H .-ti .-�� .-•� . � � � � 0 � 0 � M N N N N N N N '�" C d\' \ O O � O O N � ~ a �' � N N � � � O x �f' d' d' d' � d � W � _ . - - __ - __ ___ _ _ . __ i i. . _ - .�� - I � - (D � a w :, � � cn � tQ v D m .� n D W s; i y n N O a � 1 O +N�- C� " .� � ' � � ��� d > > I '� L� � �mi1 3 O G� � m ` �c �Y.v�i m r . � � � � t....��y cZ. C fD c°� �x `. � 3 ' � m y t . 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SUBTOTAL �, '' 9.10 �y T = PA TAX 6.00OOFS on $19.98 20 ~ W ~ -L ' l� ('�� TOTAL �.30 a • d Z ��� x9723 VISA CHARGE $�Ip.30 PS Form , Receipt for Registered Mail' copy r-c�smme� May 2007 (7530-02-000-9051) (see Inlormatton on Reverse) .� INDICATES SAVINGS _ For domestic delivery information,visit our website at www.usps.com� ' TOTAL SAVINGS THIS TRIP ' $10.53 ' -------------------------------��-- Target Pharmacy We're here to h�p'p! 9am - 9pm M-F ' 9am - 6pm Sat 9am - 6pm Sun ' REr,#2-3110-2202-0080-8013-1 vCD#754�$50-045 IVIONTFILY . PLUS B'I ', S7S00 � � InatantI ' ' GIFTCAR� winners�'�, TELL US ABOUT YOUR VISIT WITHIN 72 �,NInURS • ON OUR NEW SHORTER SURVEY: ' User�WID�6��88 9�9 991 ' Password: 919 869 For a monthly chance to win: ' . One $1,500 TGT GiftCard national swee�}stakes ---PLUS--- Six $25 instant TGT GiftCard winnersj/!state EN UN PLAZO DE 72 HORAS ' CU�NTENOS SOBRE SU VISITA USAND�i NUESTRA NUEVA Y CORTA ENCUESTA:', www.informtarget.com Tenga la oportunidad mensual de ga' �r: Una tarjeta TGT GifitCard de $1,500 �n un sorteo nacional Y Seis ganadores por estado al instan�e de � una tarjeta TGT GiftCard de $25� 18+ TO ENTER, TARGET TEAM AND FAMILY NOT ELIGIB FOR COMPLETE RULES, SEE GUEST SERV��E OR WWW.INFORMTARGET.COM _ _ _ _ _ _ . _ . _._ . _ _ �� v ...._v _. . .... ._ . _ ._ .��� ._ �Y C 'ct ���, .^J N N E9 69 Ef? ��. Q] N � � a 4.7('�Z 0 p O = w 1 � �. ��� � • t� a . Y O �^ F—O O G � � � V � . E E - � y W/R J � t! N CD y f^�� � � � � p O O � � U �✓ � Cp �� C� _�r> m � d • p N rQn � � d' m � i O 0 O L � �- � y <v V, Q� � � " � +' `� -�`" ° a " '- � N O � � ^ � a� _ � � �<o a � ¢ N N c�N d � F-¢- N -O � �.7 � . O � � c0 y 'p r � � ¢ N 11 l� O O ~ � � � � � � . � � � � `�. � U � � � Y t!7 V X t[J � � 0 . 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ENCE TODAY fiT WAL-MART. ��,..r� � � NEW KINGSTOWN PO ! � �f comPlete a survea about NEW KINGSTOWN, Pennsylvania lfl s store visl.t at: 170729988 I � � 413q870072 -0099 , NEW KINGSTOWN PO /www.survea,waln�art.com 04/30/2013 (8001275-8777 11:58:16 AM NEW KINGSTOWN, Pennsylvania i i 170729998 ll. need to Emter the � �� 4134870072 -0099 �lns online: Shces Receipt 04/04/2013 (800>275-8777 09:a5 54 AM Product Sale Unit Final .�,� 7FP7W6NF6F�C Description oty Price Price ; ;,'�'"' Sales Receipt � (Forever) 1 $q6.00 $46.00 Prod'uct Sale Unit ', inal 'URN FOR YOUF! TIME YOU CUULD Description Qty Price �� ' � rice �E ONE OF FTUE f1000 Four Flags !�, , ;T SHOPPING CARQS Coil/100 Oanada - First-Class I $1.10 Canada - Priority Mail $53.95 Ma1�1 Int'1 Letter ie 18 or oldc�r and a lesal LBrge Flat Rate BoX � 0.60 oz. I mt of the U:i, DC, or PR to 15 lb. 8.4 oz. Re�turn Raceipt , ' $3.50 No purchase necessary to Subject to content limitations, rRe�istered ' 12.95 or win. To fmter aithout postage on this article inctudes up iInsured �Value : $0.00 '' �se� and for c:omPlete official to $111.76 in coverage for loss or prt,iele Value : $0.00 vistt damage. � Label #: RE779918723U$ �try.survey.�ialmart.com. stakes Perincl ends on the date Customs Form #: CW041376q14US ' fi °°°°°" in the offir.lal rules. Survey _______„ 'Issue PVI: � ' 17.55 �e taken wltFiin TWO weeks Issue PVT: $53.95 � �8y. ' '. _ Canada - Priority Mail $53.95 � Total : ; 17.55 :ncuesta tambl�n se encuentra Lat' e Flet Rate Box �anol en la F�Sslna del lnternet � paid py; �� ' ------ 12 b. 10.6 oz. Cash 20.00 YDU _________ Sub�ect to content limitations, Change pue: $2,4g i ------- -- postage on this article includes up "� { � to $102.34 in coverage for loss or �' � -1{}y1Q�� �����1 ��'I� ' Order stamps at usps.com/shop or ca 1 damage. � 1-800-Stamp24. Go to usps.com clickm ip ' • �r r Customs Form #: CW041376q28US � to'print shipping labels wit 'posta� . For �IIJ'alnn��rt =_______. ; oth�;r lnformation call 1-800- 'SK-US . .w � ����������������������������� ����� ��� iave rnoney.Live better. � Issue PVI: $53.95 ,���,�������������������������� �����: �� Ge�t, your mai 1 when and where ��ou w�ri i t ( 717 )�691 - 3150 Total : $153.90 ' Wj .lp, a seoure Post Office Box. Si h..� for MANAGER .�TEVEN MYERS ,. a �ox online at usps.com/poboxes� ; 6520 CARLIS�E PIKE STE 550 'y ** �*******��������������������* �,� r� Paid by: �� x�r�x�rrcrc�xx�e�rr��x�r�r�r�r�rr��rrc�rx�r�r�r�r���r�r�� x�x MECHANICSpURG PA 1T060 Cash $153.90 ;; � 886 OP# 00007987 TE# 11 TR# 09131 � i CNTRCT 007325700985 12.97 X � , � BAGS 001370086061 12.47 X Order stamps at usps.com/shop or call ! please visit www.usps.com(R) to co� ' te 5UBTOTAL 25.44 1-800-Stamp24. Go to usps.com/clicknship �� m. 7AK 1 fi.000 % 1 .53 rto print shlpping labels with postage. For i Int�rnational Mail customs form onl� e TOTAL 26.97 other information call 1-800-ASK-USpS. and� to ship packages from your� omej� CfISH TEND 50.00 **�******�********�***�**�************** ' off�ice using Click-N-Ship(R> e1^v1Cd.; . CFIANGE DUE 23.03 **************************************** , gj����l#1: 10U0100833689 Get your mail when and where you want it , i } Tr ' with a seoure Post Office Box. Sign up for ' Clerk: 04 f� 1 1 E M 5� S 0 L D 2 a box online at usps.com/poboxes. pll sales final on stam s a'nd o ' e C#.2 9 0 2 2 1 0 2 2 3 2 9 1 7 8 6 2 2 9 8 '�'�'�'�'�'�'�'�'��"�'�'�'��"��`�`�"�'�'�'��`�"��"�'��"��"�*�"�'��`�`�` I Re fun ds for uaranteed ps 'rvi ces� 1� IIIIIIIIIIIIIIIIII�IIIIIIII�II�IIII�II�IIIIIIIIIIIIIIIIIIIIIIII�IIIIII ���������������������������x������������ g v Thsnk you for your b�slness ' i ��r,��r����r�r�r*�r��x����r�r��r���r��r�F�������6� ;�� ��'���������������������������r��������� W� � Pharmacy Sal.es Assoclate how you Please visit www.usps.com(R> to compiete ` �'�": HELP US SERVE YOU BETTER ' � save n�oney an Pet �nedlcationsR International Mail customs forms online Oq/30/13 11:28:55 and to ship packages from your home or 'i j Go; to: https://postalexperi+ence.co" Pos office using Click-N-Ship(R) service. , � � �' 1'ELL US ABOUT YOUR RECENT ' Bill#: 100010085�230 }, POSTAL ExPERIENCE I Clerk: 06 ' �j YOUR OPINION COUMTS Al1 sales final on stamps and postage ������������������������������������* �� Refunds for guaranteed services only �,�,���,������������������*�������*����* ,�� Thank you for your business �a �r�r�r:r�rrcrc�r�rx�rx�c�rx�rrc�r:�xxr��x�c*rcx�r��r�r��r�c�r�e�r�crcrc � ��r�rxrcxrcr�xrc�xxx�r�r�r�crr���rx��rc��r�r�r�rirrcrcrcrerc�crc�rc �' I HELP US SERVE YOU BETTER ' ;; . Customer Copy � Go to: https://postalexperience.cpm/Pos + I 1'ELL US ABOUT YOUR RECENT II POSTAL EXPERIENCE ' YOUR OPINION COUNTS I� �����������������������������x���������� ��r�r:��rx�r��tx�c�c�t�r�cx�crcrc��t�t�r�cx�c�r�r�r�r��tx�rr�ic��x�t� �I _ __ - i i1.,. _ _ _ __ _ _ _ _ ,�� _ _ Ernie Mader was hired to help clean out Lionel Spenard's house, basement, garage and garage attic. He worked for 15 hours at a rate of @$20.00 per hour, for a total of $300.00. Mr. Mader's SSN is 208-38-6887 He was paid with check #105. - _ - - ___ �,� _ � �� Tom Gates was hired to help clean out Lionel Spenaxd's house, basement, garage and garage attic. He worked for 24 hours at a rate of @$20.00 per hour, for a total of $480.00. Tom's S SN is 121-50-522 He was paid with check #106. -- _ _ ��� _ _ _ _ �"�� � Mark Heckman Real Estate Appraisers , 1309 Bridge Street, New Cumbedand,PA 17070 ' fae No.9SLoCUSt '•`•"••`INVOICE"•'•••'• File Pfumber:9SLocust o5/20/2013 Kathryn Gates,Exe 258 Samp►e Bridge Road Mechanicsburg,PA 17050 Irnoice#: 9SLocust . Order Date: 05/07/2013 . , ReferencelCase#: PO Number: 9 S.Locust Lane Mechanicsburg,PA 17050 Single Family Appraisal Report S 400.00 S Invoice Total S . 400.00 - State Sales Tax @ 5 0.00 Deposit (S 400.00 ) Deposit (5 ) ' Amount Due 5 0.00 Terms: Thank you for your payment • Please Make Check Payable Ta Mark Heckman Real Estate Appraisers 1309 Bridge Street � New Cumberland,PA 17070 ' Fed.I.D.#: PH(717)774-7202 FAX(717}774-0383 EMAIL heckmanappraisers@comcast.net _ i l, ,, _ _ . _ _ _ _ . ,� Gates Building and Remodeling � 259 Sample Bridge Road � Mechanicsburg, PA 17050 � � 717-697-6425 , . I Statement ' � , . Submitted to: The Estate of Lionel Spenazd , I!, , Installation of new locks sets at 9 South Locust St Mechanicsburg PA 17050 ' I � Install four new keyed lock sets at the above property � • Redrill the garage entry door to except the lock . � I , � Materials cost: $95.52 '', . i Labor cost: $175.00 �I � � . Balance Due: $270.52 ' Check Payable to: James Gates I, Thank you for your business II�, , � � � �l I'�� r� 4� �3 � � � � �� � � I � � � � � °� ' ��L ����� , . , � _ _ _ - - _ -- _ _ _ _. _ _ . . "�'� _ ..-'�.,�. 0 L� E� _ w � 1���v�i� � � LOYE'S HOME CEN1'EAS, INC. 5500 CARLISI.E PII;E MECHANICSBUR6, PA 1705(I (►17) 610-92pb - SALL` -� SALESN: S2223IW1 1580098 TRANSt; 2080351 OqH04-13 � 287039 K4IIKSET PB ENTRY L'ANERAN 87.2� � 22.91 DISCOUNT EACH -1.1$' � 4 � 21.82 SUBiOTAI.: 87.�26 TAY: 5.Q4 ` INUOICE 02469 TOTAL: 92.5� � LCG: 92.�2 TOTAL DISCOUNT: 4-160 LCC:XXXXXX%X%XXX5512 ANOUNT:92.!'i2 AUTHCD:0p�737 SNIPED REFID:080357222302 04/04/13 08:59E�'7 LBA/P0: N .� C�--��.. SiORE: 2223 TERMINAL: 0�! 0�!/04/13 08:5�1:25 # OF ITEMS PURCHA�SED: ..' '' 4 EXCLUDES fEES, SERVICES AND SPEI:IAL ORDER I EMS I����'������pA��l� '�9����� �� � TNANK YOU FOR SHOf'PINfi LOUE'S. ' SEE REVERSE SIDE FOR RETUHN POLICY. STOAE MANAGER: JI11 DUNISELBERQEfl ' ' 4�E HAUE THE LOaEST PRICES, QUARANTEEDRI, IF YOU FIND A LO�ER PRICE, kIE klII.L BEAi IT 91� 10$. SEE STORE FOR DETA:ILS. ' • **�****�*�***�*�*******��*******�**t��****��*��#���*��**� * YOUR OPINIONS COUfii! * * RE6ISTEH TO YIN A i5.000 LOYG'S 6IFT CA��! * * iRE6ISTRESE PARA GANAA UNA TARJETA DE REBALOIt�DWE'S! * * � * REGISTER BY COMPLETING A 6UF.ST SOTISFACiION',�URVEY * * aITHIN ONE bEEK AT: wu�i.lnai.s.com/suru�r� � * � Y 0 U R I D # 0.!469 ;223 094 * * * * NO PURCHASE NECESSARY TO ENiER OR 61INa ', * * UOID kIHERE PROHIBITED. MUSi pE 18 OR OLDER TQ�iE�ITER. * � OFFICI1iL RULES E �INNERS AT: wwa.loHes.co�/��ruey * *��**************�***��***�**��**����***���*�**�I�k��***** STORE: 2223 TERMINAL: 02 0�{/04/13 08:��;25 __ _ - — - - - — - - — __ _ __ - - -- - _ �I,, � � _ � .. .. il �' ;� rNi ° i°rn ;� � o~o aro � � � U � ii ,-+ r+ CJ N !i r dQ 0� '. r+ C.� r+ u fH H3 (A+-+ .i ,rr .-� T� , N �d � li '� ii � � �. Q u U) O O cB � 00� C � � ��Q > ^ O ?. �O O-t' U 0�p t-� �" C O h N C t- •-� ! � Z C GO � I"� U�d � � '. �!4/a3 O� m � �� Od�N � CC � Q � . �--- OSI`�-!n . � � tn N O t� N r >. t[) y pG � C7Zt�ON m t6+� O 1 Z�O I�r. tn d � N t�C � � :J HOI�COO R y YN�,�� tn .. •' L�t]Z '�v �V NJ � �7 �/ U �i-� •- � .. . Z Y a �m L i°i (y,'- m S» _ j `� �. W �"�`' (/� i-+ U Lf..�N 0. � ++IV� m"LS @ iG a. ai6 C O C+' Gf.-- ,, .. � I� �L ¢� m0 7 i�7H0 3 N��@ � � 'a y �. �--� 'a V T df afC'? N �'�r�m C L t�6 N i'' L ��.. ' l f L NN W O�N H V�.-���HdC_1 �"'� 10- �� �. p dp �N�1 ..__.__._. ._____. . .. . _.. . . ���. 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P Be 1 �`+°"°`"•:��" O contact us by May 31. `� pplelectric.com 1-800-DIAL-PPL ' � • ' ' �� °:�-; (1-800-342-5775) 85260-72004 Ma 31 2013 '-``` � rp��e��uuouo6 M-F:8amto5pm y ' -' ?$�g'5',:�' ':�;n'° Your Electric Usage Profile Billing Summary (Bining details on qack) Seroice to: Balance as of May 10,2013 $0.00 LIONEL SPENARD Charges: � 9.LOCUST LN Total PPL Electric Utilities Charges $34.03 MECHANICSBURG,PA 17050 Total PPL EnergyPlus, LLC PA Charges $45.50 Meter:10065702 Your next meter reading is on or aboutJun 7,2013. Total Charges $79.53 .}�".�rr-3+nr �3.{t%�""p;^- t"w a v � �'ia`k�'h �"�(d�c` �7'�'yf�'r t,'�YYS+ht y^�rx��.,�`� i Thfs section hel s ou understand our ear to- ear ..,. rr�o D e B�r`II`�'a�j�i 2 � "' ,, ,�s"��" „ •-' P Y Y Y Y w:.�,,.�!�a,.4!�.�t9.,,.;t„,�.,.,.-.,-..,•�;�.01���s�h.���.fi4,:��� �'-��'a,.:..',;��:y����.���"-� �.�� electric use by month. Meter readings are actual unless qccount Balance 9.53 otherwise noted. �20�2 �2013 PPL Electric Utitities'price to compare for your rate is$0.07237 per kU�. This changesthe 1st of Mar,Jun,Sept,and Dec.Visit papowerswitch.d¢�n 90 or www.oca.state.pa.us for supplier offe�s. r� 75 Y 6o Your Message Center � as • With�aperless b'illing,you can receive and pay your � � a PPL E ectric Utilitles bflls online.The process is free, m ao quick,convenient and secure.To leam more or sign up, ��' '_ ¢ 15 � r visit pplelectric.com. ^ o � � � � � • Information about appliance energy use and tips on ��/�,e,��� � saving energy are available through the Energy Library � � F M A nn � � a s o N D on our Web site,pplelectric.com. � �d � o Months • Before digging around your home or property,you � should always call the state's One Call notification �)�'�',�13 system to locate any underground utility lines. You can t � �- _ � • do this by simply dialing 811,which will connect you to May 2013 30 632 21 56F the One Call 5ystem. Be safe and call 811 before you dig. May 2012 29 769� 27 55F ' ' � • • Payment Methods °_ May 8 Actual 30726 '"� - � Online at: Q By phone:l-800-342-5775 = Apr 8 Actual 30094 PP�electric.com or call BiIlMatrix{service fee ap' �ies) _ at 1-800-672-2413 to pay using �a, = � 30 Days � kWh Billed 632 MasterCard, Discover or debit c� ' . _ . . . . � By Mail: Co�respondence should be sent�tp: _ Jun.2012-May 2013 12936 1078 2 North 9th Street Customer Services = CPGGENNi 827 Hausman Road _ Jun 2011-May 2012 10206 851. 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I i,��,-_.... _ _ _ r�a�— Gates Building and Remodeling 259 Sample Bridge Road ' Mechanicsburg, PA 17050 717-697-6425 � Statement ' Submitted to: The Esta.te of Lionel Spenard May 28,2013 ' � Completion of the installation to the rear patio door and the kitchen window located at 9 South Locust Lane Mechanicsburg,PA 17050 � • Saw cut the brick course at the patio door to make room for the brick door sill. , • Install one course of wall brick and one course of sill brick. Saw cut the sill bricks to accommodate the installation. � Frame the exterior of the door opening with wood trim. Cover the same with ' white aluminum to match the existing house. • Install the kitchen window sill. Saw cut the sill brick to accommodate the installation. • Provide all materials and labor to complete the above items. ' • Clean up all debris and provide a final job clean up. Tota1 Job Cost: $985.00 I Check Payable to: James Gates �13 �� Thank you for your business / � ', � 1�� � r�� � ��� C�L � � � _ _ _ _ _ _ - - _ -- - - _ _ ��, _ _. _ _ ._ � � ___ ����� ,�, � R � A , S , H Tiger Tr.ash P.O-Box 2444 �::• r`"' York,'PA 17405-2444 _ ; � 35395 - _ _ .. }.. . � Gates Building & Remoldeling voice aa , 259 Sample Bridge Rd ' Mechanicsburg, PA 17050 , 4 TIGER TRASH - . . ' : ' ` . .._, _., _:..... ,. ..,_ :;: :. ..:: ,_.. ...:,- , P.O.Box 2444'�York�PA 17405-2444. .... .. _.. _ _ .. _. __ ...... � - -•--..�_._. . - .,_ .__. (717)699-1111 •FAX(717)699-0309 35395 S/15/13 144721 1�, www.Uge�trash.com 1.00 PC Pull Charge 260.00 26'� .00 3.00 TCC Disposal Fee per Ton 70.00 21' .00 1.00 DEL Delivery Charge 25.00 2' .00 I , ;: : ,_, , :. , � ; _ ; . . ,,: :... .. . . ::. :.:-., ' - _. _ - _ � - , . , ,, i . �� ', ._ . . ' _ ._ . _ ,. . II - . . .. _.- ,::.:.._ , ... � r � l/ y I _ � { �� I . . . Lv � I�� . . , � l�'� I : _ � Tiqer also offers Portalile Toilets! Please call our office�for pricina 717-699-1111 , Senrice Address• ' 9 S. Locust Lane Subtotal 4�S.00 30U4-E6 ; Mechancsburg Sales Tax . : . -: � .: . . , ,� < .:. .. .:_. . ue a e > Totai Amo t: : �, � : � -- -- -- ;�i ___ _ � � ���acn �nr�on _ P.O.Box 2444•York�PA 17405-2444 <._�_ -: ._ :. ,::. .. .,:; , : - . _:..: ,:, _,...�:__. . _:..:...... . . (7J 7)699-1111•FAX(717)699-0309 3 5 3 9 5 5/15/13 14 4 721 www.tfgertrash.com 1 , .. _ , ; :. .. , � , .,::; _ .. . � 1.00 PC Pull Charge 260.00 26'p.00 3.00 TCC Disposal Fee per Ton 70.00 210.00 1.00 DEL Delivery Charge 25.00 �'5.00 •;:.. � , � � Tiqer also offers Portable Toilets!�Please call�our office for pricinq 717-699-1111 Service Address: � 9 S. Locust Lane Subtotal 4I95.00 3004-E6 Mechancsburg Sales Tax . __ , .:� . - . e a e Total Amo �t , _ - -_ _ - -- - _ �1� _ __ _ __ ��� TI��I� r • a • a • s • H Tiger Trash P.O. Box 2444 �'" York, PA i7405•2444 35395 Gates Building & Remo[deling 259 S�mpie Bridge Rd Mechanicsbur�, PA 17050 � otal Invo�ce S 4 95.o0 T1GER 1'RASN _ - ice----• - .. _ _ _._.Pa e�-7'-- -- P.O.Box 2444•Yotk.PA 17405-2444 ' ' (71?)699�t111•FAXpt�699•0309 35395 517/13 1A4492 1' www.t(gertrash.com 1.40 PC pull Charge 260.00 26q�OD 3.00 TCC Disposal Fee per �on 70.00 21qa00 1.00 DEL Delivery Charge 25.00 2�;OQ PREPAY�lENT 995.04 .14M1� • �.�`'��-♦ �. ' ��';• >•' Tlcter atso offers Portabte Tofletsl Ptease catt our office for Pricinq 717-699-1111 Service Address: 9 S. Locast Lane Subtotal 4��.01 3004-E6 Sales Tax Mechancsburg aar l _ ■�� - . 'i ' , '� ' , � ' �I Jim Gates was hired to help clean out Lionel Spenard's house, basement, garage and gaxage attic. He worked for 3 0 hours at a rate of @$20.00 per hour, for a total of $600.00. Jim's SSN is 178-20-9208. He was paid with check #115. . _ . . ,��_ _ _ _ . ��� __ �' � ����G�l�' � `3� �/ . �� � Cl��� 1���°� �� � 1�i �l,s ���/J c�� �' 51`D Gl� -S� 1�a s7/�L �-e�v1C� �"���a C ��. � � ���� �� �' S�� < � r /�� � � /'L-���-� � 5����,� G/�, !`7 _ - - - - --- _ _ � � .__ _ _ _ _ _ __ _ _ "�'�r I � "n �a m <'' r' ❑ � ❑N � -' .f�_,.-.:.�j 4..,.v ..D ao�.< � n D W j-' 6f S y ,:\ 6 N O `G C. N `� -- � � �fp' 1mt� 3 O � � ',' c�o {�' � f?$ k:. 'm �� m � '�,.,,. I 3 �y.-Z � � n � n � a S a N N • N tl1 .,r N .�' � C! C � � �p 7• � � ...A'1 y -� f/1 , �� v m �m n a � O p,., � � .�.... 3 a 3 � vD S.�fD d N N i y � �i� �`.' N f�D v c �� � � �. �,� 1 J � I�'\� On'C � r �. 5'._ N ...�� y � a`G � � N � N ^fD+ �,�.,_ `�G . �m� ❑ ❑ ❑ � k:.�y ..., � y '�,�,- � �C ..d.� � O m 7 � -�.� �\ m -�. .�� � ��'. m 3 c m ��m �,m li �� �w ' � m m � r:;a - 'm0,,,� I ���''',,� N O ? Z y�<� Oi � � ��.'�.,... � . � �I .1""'.�;� �n v c o 0 O � M�.� . 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O.� �� � N O �1 '.�7-� C i < m W � fD• 3 � m 3 � � 7 � m y ya 3 � � N y w .,� Q�/ m . i . __.� � 0 fD m • � c .�'G Q � y � � fD � � N R � a m � o v+ �''a x o' � � � rt U. _ �rY .. ?� a � � � � o v � � � °� m -. � <n 3'C � }� � mj� d j � o � �ZU N �; C7 �'•��5�"i ' y n T�� � � �. �i d '�,_,.�►- � %j` � � ��t y �m � .7�t i �/ �'"� m a�2 m ..4� p� � ` ��v � N� n ��N "O.^G , N l/� O 3 ` ��n i�P �(`C� '.;:,•�n ,'�'�' n i C . - _ --_ _ _ __ _ - _ f I�d,.`-- __ _ �R� . ' WE VALUE YOUR OPINIOW! WE WANT TO KNOM ABOUi YOUR SHOPPING EXPERI�WCE TODAY AT YlAL-MART. Please complete a survey about NEW KINGSTOWN PO ' today's store visit .at: NEW KINGSTOWN, Pennsylvania http:/1www.survey.walmart.com 170729998 4134870072 -0099 You will need to ent�er the 05/10/2013 (800>275-8777 03:37:03 PM following oniine: Sales Receipt '_ ID #: 7FPJO�NF2V9 Product Sale Un1t Finai IN RETURN FOR YOUR TIME YOU COULD ' ' Oescription Qty Price Price RECEIVE ONE OF FIVE �$1000 NfALMAR't SHOPPING CARDS Canada - Priority Mail $44.70 Must be 18 or older and a legal Int'1 resident of the US, DC, or PR to 7 lb. 0.2 oz, enter. No pt.e�chase necessary to Sub,�ect to content limitations, enter or win. To enter without postage an this article includes up purcha�se and for cotn�plete official ', ' to $86.6q in coverage for loss or rules visit damage. www.en�try.survey.walmart.com. ' Sweeps�takes period ends on the dat Customs Form #: CW0q1376493US shown in the officlal rules. Surve�, _______-• must b� taken withln TMO weeks Issue PVI: $qq.70 of today. ' Total : — Esta encuesta ta�ebi,n se encuentra� ''� $44.70 en espanol en la p gina del lntern�� � Paid by: THANK YOU fi VISA $44.70 ----------------------------------�y-- Account #: XXXXXXXXXKXX9723 i Approval #: 010312 ♦ /I i Transaction #: 974 ����'a r t � '+r� „ 23 903111615 � • ' Save maney. Live better. , < Order stamps at usps.com/shop or call Self CI'lE?CI<OUt � 1-800-Stamp24. Go to usps.com/clicknship to print shipping labels with postage. For Fast Fun.Easy. ' , other information call 1-800-ASK-USPS. �rzxx�rx�rr��r�rzxx*rcr�rc�r�rxx�r��rrcxxrr�rr�rcrrx*xxxrcxrc ( 717 ) 691 — 3150 ' �c�rx�rxxrc�r�r�erc�z��r*�rr��rx�r�r�rrr��r�rx�r�r�r���r�rrc�r�rrcx MANAGER STEYEN MYERS Get your mail when and where you want it 652U CARLISLE PIKE STE 550 ' MECHAMCSBUR�G PA 17050 with a secure Post Office Box. Sign up for r a box online at usps.com/poboxes. ST# 1886 OP# 00009045 TE# 45 TR� 0 � ,�*,�,�,��,�,�*,;,��,���,�,�,����*,�*���,�,�,���,��*,���** TC 3018 24/7 �D07023010734 6. X � ����������y�y�������y��������,��*����,������� TC 30LB 24/7 007023010734 6. X ?� SUBTOTAL 12. ,. TAX 1 6.000 �! 0. � Please visit www.usps.com(R) to complete TOTAL 13. � VISA TEND 13. Internatianal Meil customs forms online ACCOUNf � **** **** **** 972 i S ` and to ship packages from your home or APPROVAL f{ 008477 r office using Click-N-Ship(R> servlce. �F � 312800476672 - Bill#: 10Q0100861599 TRANS IO - 0083128544464215 Clerk: 04 . VALIDA�iION - VXDN PAYt�ff SERVICE - E Al1 sales final on stamps and postage TERMINAL N 24003888 ' Refunds for guaranteed services only � 05/08/13 11:07:27 ' CHANGE DUE O.d� Thank you for your business # ITE:MS SC�LD 2 ���������������������������������������� *x�t�rx*�c�t�rre�crr��rxx�tx�r�r�c:�x:t�txxx�c�rc�cx�rxx�r�c�r�r TC# 6003 5150 2573 0609 036 '� HELP US SERVE YOU BETTER Go to: https://postalexperience.com/Pos TELL US ABOUT YOUR RECENT POSTAL EXPERIENCE Ask a Pharmacy Sales Associate how �ou can save money on pet medicationslil YOUR OPINION COUNTS � 05/08/13 11:07:27 �c�r��r�xx�r�rx�rrcx�r�rrrzrc�r�rxrc�rx�r�r�r�r�r�rycrcrc�rrc:rx�r�cr��r **xCUSTOMER COPYxx* ��r�xx�r�tzxrcrc�rxrc�r�r�rx�rxz�r�c�rrcx�rxx�r�r�e�r�r�rx�r�c�r�r Customer Copy - — �i, _ _ _ _ _ ��� � � � � _ Date Amount � 4/1/2013 $ 10.48 5/1/2013 $ 2.53 I 4/2/2013 $ 5.11 $ 1.27 ` 4/3/2013 $ 6.24 $ 6.45 � (� ��1 4/5/2013 $ 8.69 $ 6.27 . 4/8/2013 $ 2.54 $ 5.55 L I 4 �� ( 4/11/2013 $ 14.55 S/2/2013 $ 1.27 � �) ` �� $ 5.55 5/3/2013 $ 2.53 � $ 1.27 $ 19.10 $ 5.55 $ 1.27 4/12/2013 $ 1.27 5/4/2013 $ 2.53 4/19/2013 $ 10.48 $ 9.18 4/20/2013 $ 1.27 5/5/2013 $ 1.27 $ 1.27 S/6/2013 $ 1.27 $ 1.27 5/7/2013 $ 1.27 $ 5.55 5/8/2013 $ 1.27 4/21/2013 $ 1.27 $ 1.27 f '� $ 10.64 5/9/2013 $ 1.27 � Q , $ 1.27 $ 1.27 � 4/26/2013 $ 1.27 5/11/2013 $ 1.27 � $ 5.55 5/13/2013 $ 1.27 � � ' 4/28/2013 $ 1.27 5/14/2013 $ 6.26 ,l � l 4/29/2013 $ 1Z7 5/15/2013 $ 6.24 � �Cy $ 5.55 5/21/2013 $ 1.27 �l $ 6.23 5/23/2013 $ 4.64 4/30/2013 $ 6.23 $ 3.76 • $ 2.53 5/24/2013 $ 4.65 . 5/28/2013 $ 1.27 ' _ ;_ _ - _ __ _ . � ,� 1 d � O��o � � w N � O O O O O O r--� � r-� �--� �--� r--� W W W W W W � �1 G o � ^ `-: G � kh t7 r r' � n o � d �C � 0 'd C 7�C' �. � � C �* � C � N UR� � .�.� � O R' CD v �! 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N N -P 64 � 69 � �, w � v � � O� � - - -- _ -- _ __ _ _ �i�� __ _ __ . _ . r � andard Mileage Kates to.r"l"S'3 http://www.�rs.gov/uac/"LU13-5tandard-Mileage-lZates-Up-1-Ce t-per-... ��IIR� News Essentials Standard Mileage Rates for 2013 - • WhaYs Hot R-2012-95,Nou 21,2012 • News Releases • IRS-The Basics 1N/�SHINGTON—The Intemal Revenue Service today issued the 2013 optionat standard mileage • IRS Guidance rates used to calculate the deductibie costs of operating an automobile for business,charitable, • Media Contacts medical or moving purposes. • Facts&Fqures • Problem Alerts Beginning on Jan.1,2013,the standard miteage rates for the use of a car(aiso vans,pickups or • Around the Nation panel trucks)will be: • e-News Subscriotions . 56.5 cents per mile for busfness miies driven. The Newsroom Topics • 24 cents per mile driven for medicai or moving purposes. • 14 cents per mile driven in service af charitable organizations. • Muttimedia Center • Noticias en Es�anol The rate for business miles driven during 2013 increases 1 cent from the 2012 rate.The medical and • Radio PSAs moving rate is aiso up 1 cent per mile from the 20i2 rate. • Tax Scams � The Tax Ga� The standard mileage rate for business is based on an annual study of the fixed and variable costs • 2013 Fact Sheets of operating an automobile.The rate for medical and moving purposes is based an the variabie • 2013 Tax Ti�s �S�• • Armed Forces Taxpayers always have the option of calculating the actual costs of usin their vehicle rather than • Latest News Home 9 using the standard mileage rates. A taxpayer may not use the business standard mileage rate for a vehiGe after using any depreciation method under the Modified Accelerated Cost Recovery System(MACRS)or after claiming a Sectian 179 deduction for that vehicle.In addition,the business standard mileage rate cannot be used for more than four vehicles used simuitaneously. � These and other requirements for a taxpayer to use a standard mileage rate to calculate the amount of a deducGble business,moving,medical,or charitable expense are in Rev.Proc.2010-51.Notice 2012-72 contains the standard mileage rates,lhe amount a taxpayer must use in calculating reductions to basis far depreciation taken under the business slanda�d mileage rate,and the maximum standard automobile cost that a taxpayer may use in computing the allowance under a fixed and variable rate plan. Follow the IRS on New Media Subscribe to IRS Newswire Page Last Reviewed or Updated:13-Dec-2012 � of 1 Si����n�z »��n p�a _ _ _ _ _ _ _ _ _ � � _ _ � � � JOHN POTfEtGER � 76 Silver Crovim Drive Me�chanicsburg,Pa.17050 (717�571 7640 1 r ���/�f` G��-s � � S, �ocus,� L��= �� 1026 ���������gv�� �� � i, RETURN THIS UPPER PORTION WITH YOUR REMITTANCE �j` I STATEMENT '�RMS oa� .�= 3d`� I DATE DESCRIPTION AMOUNT I � PAEVIOUS BALANCE • I .�/ ��� (a o; c�� . S=/� (�c1; oa ,-5-',2� (�� � �� ' � S-�o (� o . a� . I I _ �� I PREVIOUS BAL. CHARGES PAYMEMS NEW BALANCE � I � C�.O� I JOHN POTTEIGER � '� � I �I I I � . � � . � � _ _ _ _ ,�i,, _ _ ._ _ — „�� - REV-1513 EX+(O1-10) ' �� a� � �� pennsylvania SCHEDULE ] ' '�, ; DEPARTMENT OF REVENUE � BENEFICIARTES INHEAITANCE TAX AETt7RN RESIOENT DECEDENT ESTATE OF: FILE NUMBER: � Lionel J. Spenard U56-20-601 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBfR NAME NIdD ADDRESS OF PERSON(S)RECEMNG PROPERTY Do Not List Trustee(5) OF ESTATE 1 TAXABIE DISTRIBUT[ONS[Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] 1• Johanne Spenard cousin 100°!0 ' � ENTER DOLLAR AMOIINTS FOR DISTR[BUTIONS SHOWN ABOVE ON LINES 15 TNROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SEGTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II—ENTER T07A1 NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size. _i i�::_ --