HomeMy WebLinkAbout08-02-13 � BURFAU OF INDIVIDIIAL TAXES {7 �1�g pennsylvania � �
PO BOX 280601 Pennsylvania lnheritance Tax ��
HpRRISBURG PA 17128-Ob01 Information Notice DEPARTMENTOFREVENUE
vcv-�w ex wmcc ueaa
And Taxpayer Response FILE NO. 2113-0698 � I, I 2_ O /„a�(
RECO ,��� 0��1�4 f�t ACN13139238 J ly IO
R � '"�� -- �,.�; � � DATE07-19-2013
iU13 f,�U � �'(�} j "I TypeofAccount
C�t�K �; Estate of MARY E HUSER Savings
� SSN Checking
���'�.���S� G 0 S tt- Date of Death 06-17-2013 Trust
PHYLLIS E SMITH CUMBERL�,�t7 C';,, p,�ountyCUMBERLAND Certificate
12 SPRINGERS LN
NEW CUMBERLAND PA 17070-2455
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nerRO BANK provided the department with the information below indicating that at the death of the
above-named decedent you were a joint owner or beneficiary of the account identified.
Account No.626562185 Hemit Payment and Forms to:
Date Established 04-07-2005 REGISTER OF WILLS
Account Balance $g,777.77 1 COURTHOUSE S�UARE
Percent Taxable X 50 CARLISLE PA 17013
Amount Subject to Tax $4,388.89
Tax Rate X 0.150
Po[ential Tax Due $658.33 NOTE`: If[ax payments are made within three mon[hs ot the
decedenYs date of death, deduct a 5 percen[discount on the tax
With 5%Discount(Tax x 0.95) $(see NOTE') due. Any inheritance tax due will become delinquent nine months
after the date of death.
PAR7 Step 1 : Please check the appropriate boxes below.
1
A �No tax is due. 1 am the spouse of the deceased or I am the parent of a decedent who was
21 years old or younger at date of death.
Proceed to Step 2 on�everse. Do not check any othe�boxes and disregard the amount
shown above as Potential Tax Due.
� g �TFie information is - ' The above information is correct, no deductions are being taken, and payment will be sent
correct. with my response.
P/�ceed to Step 2 on�everse. Do not check any other 6oxes.
� �The tax rate is incorrect. p� � 4.5% I am a lineal beneticiary (parent,child,grendchild, etc.)of the deceased.
(Select correct tax rate at �—��. �
right, and complete Part �� ip=�, I am a sibling of the deceased.
3 on reverse.)
� 15% All other relationships (including none).
p �Changes or deductions, The information above is incorrect andlor debts and deductions were paid.
listed. Complete Part 2 and part 3 as appropriate on the back ol this form.
E �Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA tnheritance Tax
inheritance tax form Retum filed by the estate representative.
REV-1500. Proceed fo Step 2 on reverse. Do not check any other boxes.
Please sign and date the back of the form when finished. �
, ,
PART Debts and Deductions
2
Allowable debts and deductions must meet both of the following criteria:
A. The decedent was legally responsible for payment,and the estate is insufficient to pay the deductible items.
B. You paid the debts after the death of the decedent and can furnish proof of payment i(requested by the department.
(If additional space is required,you may attach 8 1/2"x 11"sheets of paper.)
Date Paid Payee Description Amount Paid
Total Enter on Line 5 of Tax Calculation $
PART Tax Calculation
3 If you are making a correction to the establishment date(Line 7 j account balance(Line 2), or percent taxable(Line 3),
- � please obtain a wririen correction from the financial institution and attach it to this form.
1. Enter the date the account was established or titled as it existed at the dale of death.
2. Enter the total balance of the account including any interest accrued at the date of death.
3. Enterthe percentage otthe accountthatistaxableto you.
a. First,determine ihe percentage owned by the decedent.
i. Accounts that are held"in trusl for"another or others were 100%owned by the decedenl.
ii. For joint accounts established more than one year prior to the date of death,the perceniage taxable is 700%divided
by the total number of owners including the decedent. (For example:2 owners=50%,3 owners=33.33%,4 owners
=25qo,etc.)
b. NeM,divide the decedent's percentage owned by the number of surviving owners or beneficiaries.
4. The amount subject to tax is determined by multiplying the account balance by the percent taxable.
5. Enter the total of any debts and deductions claimed from Part 2.
6. The amount taxable is determined by subtrac[ing the debts and deduclions from the amount subject to tax.
7. Enter the appropriate tax rate from Slep 1 based on your relationship to the decedent.
If indicating a diflerent tax rate,please state i
your relationship to ihe decedeni: I OffiCi81 US0 Ot11y �AAF �
PA Department of Revenue �
1. Date Established 1
2. Account Balance 2 S PA�
3. PercentTaxable 3 x '� d
2 'i
4. Amount Subject to Tax 4 $ 3 i
5. Debts and Deductions 5 - 4
6. Amount Taxable 6 $ 5
7. Tax Rate 7 X 6 f
8. Tax Due S $ $ -�.
9. With 5% Discount (Tax x .95) 9 X i
St2p 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form,
along with a check for any payment you are making. Checks must be made payable to"Register of Wills,Agent" Do not send
payment directly to the Department of Revenue.
Under penalty ot perjury, I declare that the tacts I have reported above are true,correci and complete io[he best of my knowledge and
beli .
Work ' � — ��XD
Hom d
T yer Si nature Telephone Number Date � ��
YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT O REVENUE
ISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR
TAXPAYERS W(TH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-302a
Estate of Mary E. Huber �
Record of expenses as of the date of her death,lune 17th, 2013
Recorded by, Phyllis Smith, Executrix (daughter)
Flowers $400.00 Royers Flowers 06/18/2013 (cash)
Church 300.00 First Church of God, Enola luncheon donation 06/21/2013 (cash)
PastorJensen 100.00 Pastor ponation 06/21/2013 (cash)
Keith Parrish 20.00 DVD's made for memorial service (check q 4833) 06/23/2013
Giant 6.34 Cardsforthe church and the pastor(cash) 06/20/2013
PAW� 50.19 Water bill (check#4834) 06/24/2013
PP&� 100.70 Eiectric bill (check#4835)06/25/2013
Mailbox 19.81 Postage (cash)06/29/2013
US Post Office 3.16 Postage (cash) 06/29/2013
Taxes 1825.26 Propertytaxes(cash) 07/02/2013
Pharmacy 34.37 Harrisburg Pharmacy(check#4836) 07/OS/2013
Kinkora Pythian 450.00 Nursing Home co-pay(check k4837) 07/08/2013
Gingrich Mem. . 165.00 Headstone Engraving(check#4838)07/09/2013
$3474.83
Phyllis E Smith
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INSCRI ^^� ; DEf1 FORM
• , No. 12- ��:�:�`��
ingrzc
MEMORIALS Since 1921
5243 Simpson Ferry Road, Mechanicsburg, PA 17050
(717) 766-5622 • Fax (717) 766-8007 • www.gingrichmemorials.com
CEMETERY �--,^'r� �r_1.;���,�_ r .-.�, j j
LOCATION i��±� C=i..
NAMEOFDECEASED �t „ : C , �;,,'r� �-
LETTERING REQUIRED:
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LOCATION: DRAW A PRECISE MAP ��� ,� ( (Use back of work order if necessary)
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BILLTO: ��'l,,,��I�� �;..��;i-. DATEOFORDER �1 ' ' ' �(? �=,
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1�. �Ori,�i .. 1 'v� , ORDEREDBY �GiY;I �.
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UPON EXAMINING THE ABOVE INSCRIPTIONS, I/WE THE UNDERSIGNED, FIND THE SPELLING AND DATES TO BE
CORRECT. THE WORK WILL BE COMPLETED AS IT IS ACCUMULATED. NO SPECIFIC COMPLETION DATE IS
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1 `;i� JSIGNED L(1+ � � SIGNED
`�/ � / �/J /r//lJ � �a�D ,;,.,;i, -"r: c,�
//�� PRICE $ 1�S= '�'
(�'U`'v �/�1-.� , DEPOSIT $
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BALANCE DUE $
Kinkora Pythian Home
. JUIy 3, 2013 � . 25 CovE Ro.� •DUNCANNON,PA S�O2O•(717)8344887�Fnx 834-6622 .
Mary E. Huber
Phyllis Smith
12 Springer's Lane
New Cumberland, PA 17070
Dear Phyllis/Mary:
Enclosed is a remittance advice from Capital Blue Cross for Mary's stay at Kinkore Pythian Home during .
the month of May 2013, showing a $450.00 copayment that is curre�tly due to our facility.We had
L-i!!ed Capital � s for iv1ary's st�y with us du,ing N1ay, and they had paid us$5,402.00, but tne
6alance o 450.00 is till due. PleaSe remit payment upon receipt of this notice. If you have any ;
questions, - ree to caN me at 717-83A-4887. , i
" Sincerely; �
3 li�c�lsCG'l��'( � '
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Barry Schlosman �f/�' �
Business Office Manager ?� I
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�OPRAMIDE 5 1 4.00 .00 4.00c
� 'ACID SUSPEN 1 3 .49 � . .,00 �� �.� 3.48
�DYL EC 5 MG 01 4.00 - .00 � 4.00
�N-A EYE DRO O1 1�.89 ' '-.00 10.89
ZOLE DR 20 O1 12.00 - .00 12.00c
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DEBBIE LUPOLD,7REASURER PRESORTID
98 S.ENOLA DRIVE,ROOM 101 PIRST CLASS nmzr.
ENOLA PA 77025-27�4 v.s. rosTrca rxm =
PERMST NO 303 =
TEf11P-R2�11ff1 SEfVICB R2Qu25(2d ESE:ISHURG PA 15931 ��
SCHOOL REAL ESTATE TAX STATEMENT ENCLOSED �—
""""""""`AUTO"5-DIGIT 17025 2926 7 AV 0.360 0�=
HUBER MARY E W�,—
&ROB�RT DALE GOTTSHALL
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3 PATRICIA DR o�
ENOIA PA 17025-1931 ��
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Control No:009-�03034
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resesaed Land Impzovemene Mineral Tocal
OEBBIELUPOLD,TREASUREA °eiuea ea,soo �ao.600 o ie3,soo
98 S. ENOLA DRIVE, ROOM 101 � EAST PENNSBORO AflEA 5.0. Disceunt Face Penal
ENOLA PA 77025-2704
Rates .0108]950 .01082950 14 30 Y
sc: ASSESS.NO-9003054 SCNOOL R E ' 1,967.<7 1,98'/.7} 7,185.93
MAP N0: 09-14-0836-181.
3 PATRICIA DRIVE �
ACRES 390 DEED267 /4037 TAXAMOUNTDUE----> $1,825.26 $1,862.51 $2,048.76
S MAGARO ROAD ��� � �
SHERWOOD PARK if raid on or Aftez �/oi/aoi3 v/oil�ois iiloi(xoia
LOT 9 SEC 7 PB 72 PG 29 x€ aaifl Oa or eeEOre e 3i xai3 io �i zoi3 iz ai xoia
RESIDENTIAL 1 FAMILY RETURN ONE COPY WIiH PAYMENT•••IF TAXES ARE ESCROWED FOflWApD
JUL 0 2 2013 TO MORTGAGE CO.""51.00 PEE FOH EACH ADD'L COPY OA pECEIpT
z HUBER MARYE 'IFNOTPDBY77/31/13THISBILLWILLBEqETUHNEDTOTA7(ClM
xeq & ROB�RT DALE GOTTSHAL BUREAU FOR COLLECTION 8 FlLING OF A LIEN AGNST YOUH PROPER'iY
3 PATRICIA DR DEBBIE LUPOLD $ �$GO•00 C�[it1��.
ENOLA PA 17025-1931 �STPENNSBORO'fWP �
TREASURER a 5•a4 ��
NOTICE OF PROPERTY TAX RELIEF
� MONDAY-THURSDAY 9:OOAM-4:OOPM Your enclosed tax bill includes a taz reduction for your homestead andlor tarmstead
uns: CLOSED FRIDAYS&HOLIDAYS property. As an eligible homestead and/or farmstead property owner,you have received
ta�c relief ihrough a homestead and/or larmstead exclusion which has been provided
PHONE(777)907-9392 under the Pennsylvania Taxpayer Reliet Act,a faw passed by the Pennsylvania General
Assembly designed to reduce your property taxes.
If paying in instafVments use the coupons below to submtt payments.If paying in full use ONLY ihe 1ST coupon below to submH payment.
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NEH CUMBERLAN� P� � NEN CUMBERLAP76 PO
NEFt CUMBERLAND, Pennsylvania NEN CUMBERLAND, Pennsylvania
170709998 1707�9998
4134870070 -0096 4134870070 -0098
6/29/2013 (800)275-8777 09:51:00 AM 6/29/2013 (800>275-8777 09:51:00 AM
Sales Receipt ' � Sales Recelpt �
Product Sale Unit Final � � Product Sale Unit Final I
Description Oty Price Price ; Descriptian Oty Price Price I
AUSTIN TX 78704 Zone-6 $1.32 � AUSTIN TX 78704 Zone-6 $1.32 `
First-Class Large Env � First-Class Large Env �
� 2.60 oz. � � 2.60 oz.
Issue PVI: '- PVI: $1 32 '
• CATAWISSA PA 17820 [SSA PA 17820 $p,9z �
Zone-1 First-Class � C��'!�'�/'✓, �Envrst-Class �
Large Env i
0.90 r.z. oz.
Issue PVI: � 3 PVI: --$0.92 �
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�ccount k: XXXH' ount N: HxXXXXXXXXXX
=.pproval q: ,0095U� roval q: ,�09505
�ransaction N: 549 Transactlon N: 549 I
:�3 903110146 �� � 23 9031101q6
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HELP US SERVE YOU BETTER HELP US SERVE YOU BETTER j
Go to: https://postalexperience.com/Pos Go to: https://postalexperience.com/Pos I
TELL US ABOUT YOUR RECENT � 1ELL US ABOUT YOUR RECENT �
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MAIL ROOM ETC �
1200 MARKET ST � MAIL ROOM ETC
, LEMOYNE, PA 11043 1200 MARKET ST i
717-975-9991(PHONE) � LEMOYNE, PA 11043
717-975-9993 (FAX) l 717-975-9991(PIiONE)
�J 717-975-9993 (FAX)
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�ment-------------------- i
�JSPS Priority Mail Shipment----------------- �
ShiD To: USPS Priority Mail i
DIANNA FETTERMAN Ship To: �
3 BILLMAN RD U DIANNA FETTERMAN
• CATAWISSA, PA 17820-8447 3 BILLMAN RD
PackaBe ID: 918 10.06 � � CATAWISSA,.PA 11820-8447
Trackins A: 9405510200793I329506B7 � PackaSe ]0: 918 10.06
Delivery Confirmation [$0.007 � Trackins A: 9405510200793732950687
PackaSe ID: 919 . 7.63 Detivery Confirmation [$0.007
Trackins �: 9405510200830867489733 Packase ID: 919 7.63
Delivery Confirmation [g0.00] Trackins q: 9405510200830867489733
Packing Materials 2.00 TX � Delivery Confirmation [$O.00j
� Packin8 Materials 2.00 TX �
SUBTOTAL 19.69 � i
TAX SUBTOTAL 19.69
State Tax on 2.00 0.12 I TAX
TOTAL State Tax on 2.00 0.12 I
TEND Visa 19.81 � TOTAL �
� TENO Visa 19.81 �
PHYLLIS SMITH � I
W611 _ _ 9/4oPM � � PHYLLIS SMITH g�2013 I
. � � �617 � < 02:54 PM I
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`�����g Gods Donation Request Form "�g Goa.
`' Enola First Church of God
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9 Sherwood Drive � �"
� Enola, PA 17025
��"a�;rs,�„�«�ot 717-732-4253 `��,, �'
www.enolacoa.com ���'�h"`�°`
Requesting
Donation From: The Family of Mary Huber
For Event: Funeral Luncheon - 6/21/2013
Donations are Requested for�
Cost of food items for luncheon $ 57.00
*Additional Voluntarv Donations Are Appreciated for
Use of Fellowship Hall $ 50.00
Donation to Women's Ministry for food preparation $ 193.00
TOTAL (Please total all items): $ 300.00
PA/D W1TH CASH DONAT/ON - THANK YOU!!
CHURCH COPY DONOR COPY
06/21/2013 .
Donation to Pastor Jensen for$300.00 nola Church of God)for the Services of my mother who passed
away on June 17, 2013
Donation wasinadein cashto PastorJensen.
Submitted by,
Phyllis Smith, Executrix for Mary E Huber( mother)
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� ° D OYERSm 3015 GETTYS RD �
, CAMP HILL, PA
f�°�'°,°�s�Ir' i (717)730-4090 I
3015 GETTYS RD Clerk#: 350 NANCY I
CAMP HILL, PA ' ! O6/78/2013
(777)730-4090 Transaction: 31472 REG #2 9:59am
CASKET SPRAY p22 '
Clerk�: 350 NANCY O6/18/2013 265.00 I
:tion: 31472 REG q2 , Validated order: 11759
4ase Arrangement tt4 95.00
• SPRAY ri22 265.00 Validated order: �1782 �
dated order: 11759
rangement tl4 95.00 Tax:
dated .order: 11762 Total : 381:60
Cash Tender.
Tax: Change: 18.40
Total: 381;60 Thank-You For Your Patronage
Cas ender:
Change: 18.40 www.royers.com i
�hank-You For Your Patronage Order Number; 11759
ww��.royers.com Delivery Date: O6/21/2013
Recipient; HUBER
:�mber: 11759 Address; 51 N ENOLA DR . I
Date: O6/21/2013 City/State: ENOLA PA
t: HUBER � '
. 51 N ENOLA OR � Order Number: 11762 �
City/State: ENOLA PA ; Delivery Date: O6/21/2073 �
Recipient: HUBER
Order Number: 11762 � Address: 51 N ENOLA DR
Delivery Oate: O6/21/2013 I City/State: ENOLA PA
Recipient: HUBER ,
Address: 51 N ENOLA DR I . I
City/State: ENOLA PA
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; -- 1-$00-DIAL-PPL � • - �. • � � �
(1-800-342-5775) 2133a72001 Auto Pay •
�oeaN�um�u.. M-F:8am to Spm
Your Electric Usage Profile Biiling Summary (Billing details on back)
Service to: Balance as of Jun 18, 2013 50.00
MARY E HUBER Charges:
3 PATRICIA DR Total PPL Electric Utilities Charges $94.19
ENOLA, PA 17025
Meter:84571215 Total Charges $94.19
Your neM meter reading is on or about 1ul 18, 2013. Automatic Bili Payment on lul 9;2913 . ' $
This section helps you understand your year-to-year Account Balance $gq,lg
eleciric use by month. Meter readings are actual unless pp�Electric UUlities' price to com are for our rate is$0.08227 er . �
otherwis2 noted. p y p
This changes the lst of Mar,Jun,Sept,and Dec.Visit papowersOw�t�om �
� 2o�Z �20�3 or www.oca.state.pa.us for supplier offers.
=4 � z� z
3 4s Your Messa e Center
� 36 � � ' pp�L Elecptrelcl Utilbiflesnbills�onliner TheVe ocess Is freef ' ' '
° 27 quick,convenient and sewre.To learn more or sign up,
d 18 visit pplelectric.com. �O
� 9 ? � ' �� • Information about appliance energy use and tips on
� ;; saving energy are availabie through the Energy Libra y O� _
� . � on our Web site,pplelectric.com. °
� F nn n M � � n ,s o N o . Before digging around your home or property,you \D o
rnonms should always call the state's One Call notification
system to locate any underground utility lines. You
• .- do this by simply dialing 811,which will conned you to
, ,. , .� �. . I � � the One Call system. Be safe and call 811 before you
dig.
Jun 2013 32 743 23 68F ,, �� p
1un2012 33 765 23 68F �/ii�'L/W�' � —
� " � ' Pa m ntMethods =
Jun 18 . Adual 93320 Online at: ���8y phone: 1-800-342-5775 =
May 17 Actual gz577 � pPlelectric.com , or call BiIlMatrix(service fee applies) -
at 1-804672-2413 to paY using Visa,
32 Days kWh BNled 743 � � � MasterCard, Discover or debit card. _
� . . . . � By Mall: Correspondence shoufd be sent to: -
Jul 2012,1un 2013 8138 67g Z North 9th Street � Customer Services =
CPC-GENNl 827 Hausman Road -
)u12011-Jun 2012 8059 672 Allentown, PA 18101-1175 Allent�wn, PA 18104-9392 °
Other important inform�tion on the back of this bill–�
_ .
...................... ... . . --- - .
, Customer Account Informatlon Billing Summary
For Service To: Mary E Huber �._.____prior Balance---------------•--
3 Patricia Dr Prior Water Balance $30.35
AccountNumber:24-1 647 7 50-2 PaymentspriortoJun19,20i3. Thanksl -30.35
Premise Number: 24-0603244 7otal prior balance,Jun 19,2013 .00
-------•-Current Water Charges-----
Billing Period& Meter Informafion Service Charge 13.75
Billing Oate: Jun 19,2013 Water Va�ume($.009101 x 3,800) 34.58
Billing Period: May 16 to Jun 14 (29 days) STAS PAWC Water - .07
Next reading on/about: Jul 16,2013 DSI-PAWC Charge 3.99% 1 .93
Rate Type: Residential Total water charges,,lun 19,2D13
Meter readings in current 6illing period: ---•----qMOUNT DUE----------------- $50.19
Meter Number N087701472 is a 5/8-inch meter.
Presentactual 196000
Last-actual 19 2 2 00
Gallons used 3800
l,// '.�'` � ° :
�°
���� .
� ���
Water Usage Comparison � /�l� ,
8 5 Monthly usage in hundred gallons. IY_1 .J
V �
68
51
34 _
17 -
0
. 2 J J A S O N D J F M A M J 2
0 u u u e c o e a e a � a u 0
Z n I g p t v c n b r Y n 3 . . .
Messages to you from Pennsylvania American Water
'Any portion o!the water charges which is not paid as ol 7/75/13 will be subject to a 1.50%penalry.
App�oximately 4.57 pe�cent, or$2.29, o/State taxes are induded in your cunent bill.
`El(ective Apni 1, 2013, the Distribution System Improvement Charge(DSIC)increased lrom 3.48%to 3.99%.
This charge/unds the replacement ol water distnbution lacilities.
'Have you recenf/y changed your primary phone number?N you have,p�ease update your account inlormation online
using My H20 Online at www.amwater.com/myh2o or call us at the number be/ow so that we can update our records.
-------°------°--°-----------------------------------------------------------------
---------------°----------------------------------------------------------------°
""IMPOR7ANT WA7ER QUALITY INFORMATION:
Your annual Water Quality Report can be viewed eleclronically at www.amwater.com/ccr/mechanicsburg.pol
lf you pre%r a paper copy to be sent to you,please contact our Customer Service Center at 800-565-7292.
----------------------------------------------------------------------------------------
---°--°-------------------------------------------------------------------------�---
� 07.tt�62N03462NCEN98TAV031
Customer Service& Emergencies 1-50�-565-7292{24 Hours)
For Hearing Impaired Customers TDD 1-800-300-6202 (24 Hours)
Visit us online at:www.pennsylvaniaamwater.com
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Kmart<kmart@value.kmart.com> Sat, Jun 22, 2013 at 2:28 PM
Reply-To: Kmart<reply@value.kmart.com>
To: KEIl}iD1ANE.PARRISH@gmail.com
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�����, electronics for the home bed 8 bath clothing rtusic,mov'tes&garting jewelry&watches
Dear Diane, BONUS MEMBER
TI72�lIC j/OU for shopping at our Enola store,and forleffing me assistyou rnemberu:
with yvurpurchase. 7oa1313seasa7zo7
This eReceipt is a convenience exclusive to Shop Your Way RewardsSM Base Points eamea:
Nlembers!Please keep it on file for your reference.If you'd like to view details 332 _v _+`_�_"_�
on your order, or to retum or eYChange an item,vtsit the Order Center. points Balance:
332
Rwas mypieasure serving you. Hopeto se you b ckin ourstore soon! -------.—.-.—.
i Expiring Value:
Since�ely, ���� "' 332
Pngela -' . __.____ ��_.__
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