HomeMy WebLinkAbout08-08-13 r *�i
� 1505610105
—" REV-1500EX'°�_"„�, a
� OFFIqAL OSE ONLY
PA Department of Revenue Pennsyivama
i8ureau of individua�Taxes ��"`�"`" "`�`"�` County ode Year File Number
aoe0xz8o5oa INHERITANCETAXRETURN �� /�� 0���
Harrisburg,PA19128-0601 RESIDENTDECEDENT
ENTER DECEDENT INFORMATION BELOW. -
Social SecuriN Nurriber � � � Date bf Death .MMDDYYYY Date of.8irth MMDDriYY
01/30/2013 11/07/1927
DecedenPS Last Name SuKx DecedenPs First Name MI
EARLEY ° DOROTHY �
(If Applicabte)Enter Surviving Spouse's Information�Below .
Spouse's last Name Suffix Spouse's First Name MI
Spouse's Soual Securiry Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH 7HE
REGISTER OF WILLS
FlLL IN APPROPRIATE OVALS BELOW' . �
� 1. Original Retum O 2.Supplemental Retum O 3. Remainder Retum(Date of DeaN
. Prior to 12-13-821
p 4. Limited Estate O 4a.�FUture Interest Compmmise(date of O 5. Federal Estate Tax Retum Required
tleath aRer12-72-82F
. m 6. Decedent Died Testale O 7. Decedent Maintained a Living Trust _ 8. Tofal Number of Safe Deposit Boxes
(Attach Copy of Wiil) (Attach Copy of TrusL)
O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 71. Election to Tax under Sec.9173(A)
Belween 1231-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT- THIS SEC710N MU57 BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name � Daytime T�,ohone Numbeb �
VICKIE R. DUNN (717) 3�-�01' � r� �
c�
I RE 7E[;OF.WILL�USE ONLN-�I
�
. . . I b f"' � ri fTi
First Line of Address Z � � � � �'
x G) O
977 RIDGE ROAD � �-�', c � „ �
oc +- __
Second Line of Address . �7 �_� ��.. ��
-.a �,.,., ryl
� �.: (n o
�
� DATE FIL'Efl � I
City or Post Offce State ZIP Code
SHIPPENSBURG PA 17257
correspondenrs e•maii address:trickles@centurylink.net
Under penalties of perjury,I declare�hal I have ezaminetl this retum,incWaing accompanying sc�edules and statements,and to Ihe best of my knowiedge ana behef,
it's true.cortect and mplele.Declaration of p2parer other Ihan lhe personal representative is basetl on all information of which preparerhas any knowl dge. �
S NA RE F PE SON-RESP SIB E OR FI G RETURN DAT
5 /
ADDRESS
977 RIDGE ROAD, SHIPPENSBURG, PA 17013
SI ATUR O PARER OT ER A REPRE TATIVE DAT
� /
r� � Pr5 A- OU
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1505610105 1505610105 �
`� '� .�
_ , ..,1 ,
� 15�5610205
��
REV-7500 EX(FI�
OecedenPs Social Security Number
oe�eaenrs Narne DOROTHY J. EARLEY
RECAPITULATION
1. Real Estate(Schedule A). ... ... .. ............. .......... . _........... i. 0.0�
2. Stocks and Bonds(Schedule 6) . ....... ... .... ... .......... .. .. ... .... 2, 0.00
3. Closety Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ... .. 3. D.00
4. Mortgages and Notes Receivable(Schedule D)........ ... ................ 4. 0.0�
5. Cash,Bank�eposits and Miscellaneous Personal Property(Schedule E),...... 5. 11,010.82
6. JoinUy Owned Property(Schedule F) O Separate Hilling Requested ... ,.. . 6. 0.00
7. Inteo-Vivos Transfers R Miscellaneous Non-Rm6ate Property
(Schedule G) � Separate Billing Requested........ 7.
8. TMaI Gross Assets lrotal Lines 1 through 7)....... ... .... ............. .. 8. 11,0�0.82 �
9. Funeral Expenses and Administrative Costs(Schedule H)..... ..... ... .... .. 9. 2,$��,g7
16. Debts ot Decedent,Mortgage Liabililies and liens(Schedule I)...... ......... 10. 923.17
� 11. Total 6eductions(toiai Unes 9 and 10)................ .... ... ... ..... .. 71. 3,735.74
12. Net Value of Estate(Line 8 minus Line 11� . .. ._.. ... .. .. ...... .. ..... .. 12. 7,275.68
13. Charitable antl Governmental BequeslslSec 9173 Trusts for which
an efection to tax has not been made(Schedule d) ..... ....... ....... ..... 13. 1 Q,321.75
14. Net Value S�bject to Tax(Line 12 minus Line 13) .... .... ... ... .......... 14. -3,�46.07
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 caxable
af the spousat tax rate,or
transfers under Sec.9116
(a)(12)X A_ t5.
i6. Amount of Line 14 tazable
et lineal 2te X.�_ 16.
�J. Amount o(Line 14 taxable
at siblino rate x.i2 tz. -3,046.07
�8. Amount of Line 14 taxable
at collaferal rate X.15 qg,
19. TAX DUE....... . ....... ... ... ..... ... ............... .. ........ ... 19. 0.00
20. FILL IN THE OVAL IF YOU ARE REQUESTWG A R2EFUND OFAN OVERPAYMENT � �
Side 2
� 15�56102�5 15�56102�5 �
�
�REV-1T�00 EX(FI) Page 3 Flie Number
Decedent's Complete Address:
DECEDEN7"S NAME
DOROTHYJ. EARLEY
STREETADDRESS �
977 RIDGE ROAD
� cm - i sTn� zia
SHIPPENSBURG � PA I ��25� �
Tax Payments and Credits:
t. Tax Due(Page 2,Line 19) (1) 0.00
2. Credits�Pavments
A.Prior Paymenis _ 123.50 .
B.Discount �
Tota1 Credits(A+g) (p) 123.50
3. inierest
�??
4. If Line 2 is grealer ihan Line 7 +Line 3,enier the diHerence. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4)
5. If Line 1 +Line 3 is greater Nan Line 2,enter the diffe2nce.This is lhe TAX DUE. (5) 0.00
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS
1. Did decedent make a t2nsfer and: Yes No
a. retain the use or inoome of the ProPedY transferted.......................................................................................... ❑ �
b. retain the right lo designate who shall use Me property lronsferted or its income............................................ ❑ �
c. retaln a reversionary interest.............................................................................................................................. ❑ �
d. receive the promise for life of either payments,benefts or care?...................................................................... ❑ �
2. If deaih occurred after Dec. 12.1982,did decedent Vans(er p�operry within one year of dealh
wifhout receNing adequate mnsideration?.............................................................................................................. ❑ ��
3. Did decedent own an"in trust foP or payable-uporrdealh bank aaount or security al his or her deathl.............. ❑ �
4. Did decedent own an individual�etirement accounl,anauity or olher non-probate property,which
con�ains a beneficiary designafronT ........................................................................................................................ � ❑
If THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1,1994,and before Jan. 1,1995,fhe tax rate imposed on ihe net value of lransfers to or for Ihe use of the surviving spouse
�5 3 Percem�z Ps.gs��s(a�(�.�)(>l.
Por dates of death on or aRer Jan. 1, 1995, the tax rete imposed on the net value of transfers to or tor the use of the surviving spause is 0 percent
(72 P.S.§9116(a)(1.1)(ii)].The statule does not exempl a transfer to a surviving spouse from taz,and lhe statutory requirements for disdosure of assels and
filing a tax retum are still applicable even if the surviving spouse is tfie only 6enalciary.
For dates ot death on or after July 1,2000:
. The taz rate imposed on the net value of transfers from a deceased child 21 years of age or younger at deaih to or for the use of a natural parent,an
adoplive parent or a stepparen�af the child is 0 perceN p2 P.S.§9116(a�(1.2�].
• The taz rate imposed on fhe net value of transfers to or for fhe use o(Ihe decedenYs lineal benefidaries is 4.5 percent,ezcept as noted in[/2 P.S.§9116(a)(1)].
. The tax rate imposed on the net value ot trans(ers to or for the use of the decedenfs siblings is 12 percent(72 P.S.§9116(a)(1.3)].A sibling is defined,
under Secfion 9102,as an individual who has at least one parent in common with lhe decedent,whether by blood or adopUon.
R�•�508 E%+(o8-u)
� SCNEDULE E
� pennsy(vania
� DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INMERRANCETq%RENRN PERSONAL PROPERTY
RESIOEM DECEDEM
ESTA7E OF: FILE NUMBER:
EARLEY, DOROTHY J. 21-13-0144
Indude the praeeds of Iitigation and the date the proceeds were received by Yhe estate.
All property Jointly owned with Hght of survivorship must be disclosed on Schedule F.
�M VALUE AT DATE
NUMBER DESCRIPTION
OF DEATH
�. M&T BANK-ESTATE ACCOUNT#9858862999 2,510.82
2, Satum VUE,200I,Gifted to Gilbert E.Earley,Jr. 8,500.00
TOTAL(Also enter on Line 5, Recapitulation) $ 11,010.82 -
If more space is needed,use additional sheetr of paper of the same size. ,
,
. C . - :
���ACCOUNT f10. .-. .. . ..._. - - �
. � 3iGC0UNT TYBE�!. .: :� � .. . .
� � - '� - STATEMENi PEkEOD '� PACE�
_.,. . . . _.... ..
JI1N.07-JUL.05�201i �� 1 OF 1
9858862999 FREE CHECKING �
00 0 04342M NM O17
000003497 FIOS1549D01707051307 OS 001000 43484
�� ESTATE OF DOROTHY J EARLEY
VICKIE R DUNN, EXEC
GILBERT E EARLEY JR, EXEC
9�7 RIDGE RD
SHIPPENSBURG PA 1�25�-9722
INTEREST EARNEO FOR STATEMENT PERIOD 0.00 CAflLISLE PIKE
ACCOUNT SUMMARY
�B�GI �. � ...::: DE SiTS-s �::: �� .. . :;�,oTH�R ��: �: CURR N7 : . ..ENOINC; �:.:
�.� ALAHCE :�... . �: OTNER :ADDEIID 5 . -CHPEI(S PAID ���-� SUBTRAC7YON5:� ZN EREST PD " � ��
i'BACANCE :
N0. ANOUNT N0. AMOUNT N0. AMOUNT
2,510.82 0 D.DO 0 D.00 0 D.DO 0.00 2�510.82
ACCOUNT ACTIVITY
:POSTING ::. .• � : . . . DE . S TS:INTEREST !CHE KS� ;�ATH ft :-: DAILY .- ::�
a "�-�DATE :�� . . <TRANSACTIONiDESCRIPTZON ii. �. C�'02HER ADDITIDNS i�'$UBiRACTIONS '�BALANCE:::: �'i�
a
R 06-07-13 BE6INNING BALANCE 52�510.82
ENDING BALANCE - 52�530.82 �
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� C�n_CHECK HERE IP APPLiCATION FOR DEAIER TITLE AND COMPLETE SECTION D,TRLING FEES S _�
I-_:-::_ — � ___—
� pennsylvania SCHEDULE G
oeaaArMeNraFaeveNUe INTER—VIVOS TRANSFERS AND
mHenirnnceraxneTUaN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
E5TATE OF FILE NUMBER
DOROTHY J. EARLEY 21-13-�144
This schedule must be mmpleted antl fled if the answer to any of questions 1 through 4 on page three of the REVd500 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEAiH %OF DECD'S EXCWSION TAXABLE
INCIU�E THF NAME OF TNE PUNSfEREF,iHE1R REfAilONSHIP i0�ECEDfM FN�
NUMBER meoareorlanxsrea. nnacrv.coevorrxeoeeoraaaeuestare. VALUEOFASSET INTE0.EST prncaucae�ei VALUE
1. EE PaViot Bond,Tina Dunn,Grand Daughter,February 10,2013,21 Red 630.a0 100 630.a0
Shed Road,Shippensburg,PA 17257
Z EE Patriot Bonds,lna King,Grand Daughter,Pebruary 10,2013,104 Wertz �,040.16 100 t,040.16
Avenue,Mechanicsburg 17055
3 EE Patnot Bonds,Gilbert Eadey,Grandson,February 10,2013, 165 �,040.�6 100 1,04o.16
Bemheisel 6ndge Road,Cadisle,PA 17015
4 EE Patriot Bonds,Susanna Eadey,Grand Daughter,February 10,2013, 165 y,040.t6 100 t,0ao.16
Bemheisel Bridge Road,Cadisle,PA 17015
5 EE Patriot 8onds,Eric Earley,Grandson,February 10,2073,904 Cedar 1,040.16 100 1,040.16
Road,Lewisberry,PA 17339
6 EE Patriot Bonds,Amanda Eadey,Grand Daughter,February 10,2013,904 q,pq0.16 100 9,Oa0.16
Cedar Road,Levdsberty,PA 17339
� EE Patnot Bonds,Mike Eadey,Grandson,Fe6ruary 10,2013,687 �,pq0.t6 100 �,040.16
Old Mill Road,Newville,PA 17241
8 EE Patriot Bonds,Gordie Evert,Great Grandson,February 10,2013, 1,040.16 100 1,040.16
141 Tall Pine Drive,Fayetteville,GA 30214
9 EE Patnot Bonds,Evert,Tyler,Great Grandson, February 10,2013, 189.12 10Q 189.12
285 Applewood Circle,Newnan,GA 30263
�� EE Patriot Bonds,Lacy Eveh,Great Grand Daughter,February 10,2013, �57.60 100 757.60
265 Applewood Circle,Newnan,GA 30263
>> EE Pafiot Bonds,Kyle Evert,Great Grandson, February 10,2013, 630.40 100 630.40
425 Burburg qose,Fayetteville,GA 30215
12 EE Patnot Bonds,Ashlsy Evert,Great Grand Daughter,Pebruary 10,2013, 63o.4� 100 630.40
425 Burburg Close,fayetteville,GA 30215
13. EE Patriot Bonds,Jaden Reed,Step Great Grandson,February 1Q 2013, �57.60 100 t57.60
904 Cedar Road,ewisberry,PA 17339
14 EE Patriot Bonds,Lesley Edwards, Step Great Grand Daughter, 1,040.16 100 1,040.16
February 10,2013,204 GoH CIu6 Drive,Nicholasville,KY 40356
15 EE Patriot Bonds,Whitney Fadey, Step C,reat Grand Daughter, 1,040.16 100 1,040.16
February 10,2013,2313 Mulundy Way,Lexington,KY 40511
16 EE Patriot Bond,Byron Patterson, Step Great Grand Son Removed �p6.08 100 126.08
February 10,2013,350 Darren Drive,Fayetteville,GA 30215
TOTAL(Also en[er on Line 7, Recapitulation) $ 11,883.04
If more space is needed,use additional sheets of paper of the same size.
.. _ . . .. . . . - _. .. . ... . .. . . .
�Fl7-l5tl EX*(t6-�Y! .
� pennsylvania SCHEDULE H
OEV,INTMENTOiHEVEf1UE FUNERAL EXPENSES AND
INMESU7ANCETAXRENAN i ADMINISTRATIVE COSTS � �
RESIDEHT DECEDEM
ESTATE OF FILE NUMBER -
EARLEY, DOROTHY J. 21-13-0144
Decedent's debts must 6e reported on Schedule I,
REM !
NUMBER I DESCRIPTION AMOUNT
A. 1 FUNERALEXPENSES: ' 1
" I HOFFMAN-ROTH FUNERAL HOME AND CREAMATORY.CARLISLE.PA 17013 I 1.990.00
1 �� �PCfASE'NOIE FUNERAL EXPENSES AND ADMINISTRATIVE COSTS WERE PAID IN FULL BY
� VICK4E R.6UNN,REPRESENTASIVE,977 RIDGE ROAD,SHIPPENSBURG,PA 17257 �
� NO REIMBURSEMENT HAS BEEN MADE ON THIS DEBT YET.($2,811.97) j
� POSTAGE&DUPLICATING FOR ESTATE MATTERS , 25.00
1 . i
8. J ADMiiJiSTRATIVE COSTS: 1
1. IPersonal ReDresentative Commissions: 1 0.00
( Namefs)ot Personal Reoresentative(s� VICKIE R. DUNN �
Street Address 977 RIDGE ROAD
I CiN SHIPPENSBURG S[ate_P?ZIP »?57 I
i 'iearjsj iommission'rai6:
I � 0.00
Z. j A[iomey Fees:
1
3 � Famfiy ExemMion: pf deceAenPs adGress Is not the same as daimanPS,attach ezplanation.) {
I O:imant �
i scree:aaaress. ,:j
QW _.�5`o:z ._,u'r I
� RelationshiD atqaimant to Decedent '
j _'__� I
i
?. I Probate Fees: � '1"t3.50
5. I Acwuntant Fees: � I 0.00
o. � Taz Retum Preaarer Fees: � I �.00
� 1 MEMORIAL FOLDERS I 25.00
e. ,� DEATH CERTIFICATES(19) 114.00
9. � CORONERS FEE ; 30.00
�o. 1 CARLISLE SENTINEL-MEMORIAL NOTICE I 286.68
». I CARLISIE SENTINEL•LEGAL NOTICE 1 115.20
t z. I PATRIOT NEWS-LEGAL NOTICE I 102.59
I �
TOTAL(Also enter on Line 9, Recaoitulationl�5 2�81��97
ir more soace is neeued,use atidiiional sheets of uaoer af the same size.
i pennsylvania SCHEDULE I
� DEPAflTMEMOFREVENUE DEBTS OF DECEDEN7,
INHERtTANCETA%RENRN MORTGAGE LIABILITIES & LIEtVS
RESIDEM DECEDEM
ESTATE OF FILE NUMBER
EARLEY, DOROTHY J. 21-13-0144
Report debts incurred by the decedent prior to death that remained unpaid at the date ot death,including unreimbursed medical expenses.
�M � I. VALUE AT DATE
NUMBER � DESCRIPTION I OF DEATN
1• �Comcast(TVIPhone) � g4.31
t �
2. PP&L(Electric) 199.42
3. Kohls'Department Store(Charge Aocount) 137.64
4. Don&Adele Birx(Landlord)Wffier/Sewer Bill 135.80
5. Spirit Physicians(Dr.Malzoni)January 17,2013 101.15
6. Ohio Casualry(Car Insurance) 51.50
7. Capftal Cardio Associates,January 7,2013 45.85
8. PAW(Water) 60.50
9. Siiver Spring Township Authority(Sewer) f 107.00
1
jf
f
'
�
� .
II
1
F
F
I
TOTAL(Also enter on Line 10, Recapitulation� �$ 923.17
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(0I-10)
ji1 pennsylvania SCHEDULE ]
fy OEO�piMEniOFqEVErvUE BENEFICIARIES
INME0.RANCE TAX RENRN
0.ESIOENT DECEDEM �
ESiATE OF: FILE NUMBER:
EARLEY, DOROTHY J. 21-13-0144
REIAlI�NSNIP TO DECEDENT AMOUN�OR SMARE
NUMBER NAME AND ADDRE55 OF PERSON(5)RECEMNG PROPERTY Do Not List Trustee(s) OF ESTATE
I TA%ABLE DISTRIBUTIONS[Indude ouMght spousal disMbutlons and Itansfers under .
Sec.9116(a)(1.2).] .
1• Connie J.EveA,145 Ta11 Pine Orive,Fayetteviile,GA 30214 Daughter 1/5
2. Vickie R.Dunn,977 Ridge Road,Shippensburg,PA Daughter 1/5
3. Gilbert E.Eadey,Jr.,165 Bembeisel Bridge Road,Cadisle,PA 17015 Son 1/5
4. Rodger L.EaAey,P.O.Box 211,Plainfield,PA 17081 Son 1/5
5. . Keith D.Eadey,904 Cedar Road,lewisberty,PA 17339 Son 1l5
Please note nane of the persons above received any properry.They are
ail listed as benefidaries on the Will.
ENTER DOLIAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON L1NE5 IS THROUGH 18 OF REV-I500 COVER SHEET,15 APPROPRIATE.
i� NONdAXABLE DISTRIBUTIONS �,
A. SPOUSAL D]STRIBUT10N5 UNDER SECTION 9113 FOR WHICH AN ELECfION TO TAl(IS NOT TAKEN:
1.
B. CHARRABLE AND GOVERNMENTAL D[SfAIBUfI0N5: �
1.
PINK HANDS OF HOPE,MECHANICSBURG,PA -H011SEHOLD CONTENTS,CLOTHING 9,971.75
2. TRINITY UNITED METHODIST CHURCH,NEW KINGSTOWN,PA 17072-PANTRY CONTENTS 350.00
TO7AL OF VART II-ENTER TOTAL NON-TAXABIf DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SNEEL § 10,321.75
If mure space is needed,use additionai sheets of paper of the same size.
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REGISTER OF WILLS _ CERTIFICATE OF
�UMBERLAND COUNTY „�,� s� GRANT OF LETTERS
PENNSYLVANIA
;
' No. 2013- 00144 PA No. 21- 13- O 144
Estate Of: DOROTHYJEARLEV
' . lFiin,MiCC)q Lasp
a/k/a : DORT EARLEY DOT EARLEY
La te Of: SlL VER SPRING TOWNSHIP
CUMBERLAND COUNTY
Deceased
Social Security No:
WHEREAS, on the 5th day of February 2013 an instrument dated
UNDATED
DOROTHY J EARLfY
lFirsl.Midtl1C Lesq
a/k/a DORT EARLEY DOT EARLfY
Iate of SILVER SPRlNG TOWNSHlP, CUMBERLAND County,
who died on the 30th day of January 2013 and,
wHEREAS, a true copy of the will as probated is annexed heretc.
THEREFORE, I, GLENDA FARNER STRASBAUGH , Reaister of Wills in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby �
certify that I have this day granted Letters TESTAMENTARV to: ��
GILBERT E EARLEV JR and VICKIE R DUNN
who have duly qualified as EXECUTOR(R/X)
and have agreed to administer the estate according to Iaw, a11 of which
fu11y appe�rs cf record in my office at CUMBERLAND COUNTY COURT HOUSE,
CARUSLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 5th day of February 2013. Gi���.�
`-��'U . ' ;��, lil �'�/1'��r�l. ')� U'1'
� ; =I egister o s �
it ( � '
I:��!(�� '�;; � ;l �.:k�� `,^9�c,�
-� ��y
� . � � � ► - � 3 - o �y�J
f, Dorothy J. Earley, of Mechanicsburg, Pennsylvania, declare that this is my Last Wili
and Testament and revoke all prior Wills and codicils.
ARTICLE ONL-
D�CLARATIONS CONCERNING FAMILY AND PROPERTY
I.l Family. I have five living children. They are Connie J. Evert, Vickie R. Dunn, Gilbert
E. Earley, Jr., Rodger L. Earley and Keith D. Earley.
1.2 Personal Wishes. It is my desire that my co-executors foilow any written directions
left with this Will regarding my memorial service. I would like to be cremated and my
chi Idren lrnow what my wishes are in regards to my remaia�.
r1RT1CLE TWO
GIFTS OF PROPERTY
2.1 TANGIBLE Personal Property. I give and bequeath unto my living children the
tvticies of fumiture, furnishings and other tangible personal property and a11 my real
proper[y wluch I have previously expressed in oral declarations to them. ( direct my co-
executors to distribute the above property. I may also leave a non-testamentarv]etter
addressed to my co-executors requesring that certain of my personal possessions be
delivered to named individuals. Although such letter shall not be interpreted as a
testamentary writing, I request that my co-executors carry out the requests made iri the
letter. All remaining personal property shall be sold by my co-executors and the proceeds
added to my residuary estate.
2.2 Residue of Estate. I ]eave the residue of my estate to my living children by right of
representation. I direct my co-executors to sell at either public or private sale all of my
real property and to add the proceeds thereof to my residuary escate.
ARTICLE THREE
APPOINTMENT OF FIDUCIARIES
3.1 Co-executors. I nominate my daughter,Vickie R. Dunn, and son. Gilbert E. Earley,
Jr., to serve as co-executors ofthis Will. No bond shall be reyuired of any executors
under this Will.
:r:
o �
� ; � rn
3.2 Executors's Authority. 1n addirion to any powers and elective r�confer�d b� o
statute or federai ]aw or by other provisions of ttus Will; I grant m}�o��ut P1 th� �
aut6ority to administer my estate under any procedure for informal���j"iper�ed � n
administration, or any other available procedure for avoidance of ac�ams�'ation or o 0
reduction of its burdens. o � o -� T �
� p T� 3
o c ..,� c�
IN WITNESS WHEREOF, I have hereunto set my hand and seal this�nday�'o
June, 2009. n � -.�
(SEAL)
Dorothy J. Eazley
� � � � af -� 3 � ►�y
This document(consisting of two pages including this one)was signed and declazed to be
tier Last Will and Testame�t by Dorothy J. Eazley in our.joint preseuce. At her request, in
her presence, and in the presence of each other, we hereby sien as wimess to tne
execution of this Will, believing that she is of sound mind and under no undue influence.
Each of us obsen�ed the signing of this Will by Dorothy J. �arley and each other
subscribing witness and knows that each signature is the true signature of the person
w�hose name was signcd. Bach of us is now more than eighteen years of age and a
competent wimess:
We declare under penalty of perjury that the foregoine is true and correct and that this
declaration was executed on
(witness signature) (date)
(witness signature) (date)
,j . _
} ,---._____ ___- - ---- -- --
/�q5`, i Account Number 09547 25619502-0
� Billing Date 02/14/13
� Unpaid Balance $133.71 -Due Now
,� � ' New Charges �133.71 -Due 03/07/13
� Total Amount Due 5267.42
Contact us: C�, www.comcast.com� 1-88&931-1379 '� Page 1 of 2
1
� DOROTHYEARLEY �iu�•�t��� .^Sr_�ra,��a•� .,.nmir� . " -- � '.
Previous Balance 133.71
For service at: Payments - received by 02/14/73 0.00
17 NOTTfNGHAM DR
MECHANICSBURG PA 17050-2646 Unpaid Balance -Due Now 133.71
New Charges - Due by03/07/13 133.71
News from Comcast seebelowformoreinformation
Total Amount Due $267.42
Questions? Call 1-800-XFINITY(1-800-934-6489)
Ourrecordsindicateyouraccountispastdue. ifyour `•�"�' �' �.�^E�� �!�����!r�" " '1
_ account is not paid in the next seven(7)days, a$7.95 `i XFINITY N 66.65 �
late fee will be assessed. If payment has already been �
made, please disregard this notice. � XFINITY Voice 56.75 m
s
For your convenience, we now accept regular and Additional Products &Services 3.95
�b�matic monthly credi[card payments and direct Taxes, Surcharges 8�Fees 6.96
HearinglSpeech Impaired Cail 71� Total New Charges $133.�1 °
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� Detach and enciose this croupon wi17i your payment.Ptease wri[e your accounl number on your dmck or money ortler.�o not sentl cash. ^ '
Comcast, Account Number 09547 256195-02-0
Payment Due by Due fVow
PO BOX 985
TOlE00 OH 43697-0985 Total Amount Due $267.42
nv oi o�asa� 846946 64 A••SDGT Amount Enclosed S_
luullll��llllir�lilill�lq4lil���i�l�lll�l��r�r������ldl�� MakecheckspayahietoComcast
DOROTHY EARLE"
77 NOTTINGHAN DR
NECHANICS811RG PA 17050-2646 (III'llll�ll'II�'I'I�I�I�II�III�III"1111"IIIIII���I�����IIII��I
COMCAST CABLE
P 0 BOX 3006
SOUTHEASTERN PA 19398-3006
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,.�-^ .;.;j;:"; Q Questions7Please ,f� Vi5ltusonlineat F��aI6il1 � .� �`--L{ (� � � .,pagel
t]�]`'':=' contaa us by Mar 15. lJ pplelectric.com
.`:: 1-800�DIAL-PPL . . • s. . • , . .
��� , �3-80o-342-5775) 49760-71033 Mar 15, 20J3 $149.42
tx�i Etcctxc uaimo: , M-F:$0rn t0 Spin
Your �lectric Usaqe Profile Siiling Summary (Bflling detai{s on back) ,
5ervice to: Balance as of Fe6 22,2013 $113.96 �/
DOROTHYJEApLEY Charges:
17 NOtTINGHAM DR Totaf PPL Electric Utllit�es Charges �$85:4
MECHANICSBURG,PA 17050 ��
Meter:10347928 Total Charges $199.42
mount Due 8y Mar 15,2013 , 5199.42
This section helps you unders[and your year-to-year A��ount 8alance 5199.42
0lectric use by month. Meter readings are ac[ual unless pp�Electric Utflities' nce to com are for our rete is 50.07544 er kWh.
otherwise rtoted. This changesthe 1st of Mar,lun,Sept,andy�ec. Visit papowerswitch.com
�207z []2073 �Estimated or www.ow.state.pa.us for supplier otfers.
;5 Your Message Center
� � • Budgei Settlement Summary after 12 months: �
We billed you $1,386.04
8 45 � � Including this bili,you used $1,386.04
0
� 30
¢ � � � � _ .
o ( � G C � • We have subtrac[ed 5152.57 from this hiU to settle your '
i F M A M � � p s o N o 8udget Billing Plan. �
• With�aperless 6111ing,�ou can receive and pay your °
MontM PpL E ectric Utilitles btl s online.The p�acess is free,
� � qulck, convenient and secure.To learn more or sign up,
i � � � I '� i '�'��'- visitpplelectric.com.
. 4 �. �. � � � �.A
Feb 2013 .29 2130 73 29F �i7�P't
<�f� � �
Feb 2012 28 1442 52 36F _
��
� '' •• � ' ' PaymentMethods =
Feh 20 Actuaf 14389 Online at: �By phon2:1-800-342-5775 �
Jan 22 Ac[u21 12259 � PP�ele[tric.com or call BillMatrix(service fee appiles} _
at 1-800-672-2413 to pay using Visa, '
29 Days kWh BiAed 2130 MasterCard, Discover or debii card. �:
-. . . � . . . � By Mail: Correspondence should be s2nt to: °
Mar 2012-Feb 2013 13155 . 1096 z tJOrth 9th Street Customer 5ervices —
CPC-GENNS 827 Hausman Road -
Mar 201]-Feb 2012 12498 1042 Allentown, PA 18301-1175 Allentown, PA 181049392 =
Other important informatlon on the back af this bil! -� .
�. J.C. Christensen
C 8T Associates Inc. �s �9
P.O. BOX 519,SAUK RAPIDS,MN 56379 � I
TOLL FREE#:866-826-2pg6 .���i �
www.JCCSecurePa�com
,,.:�,.,�1 . .�
� . `(1.i:. L�. �:,:v.l. '
ACCOUNT#: 14332283
CREDITOR(S) REGARDING AMOUNT OWED
CAPITAL ONE, N.A. XXXXXXXX5452 RE: KOHL'S $183.53
DEPARTMENT STORES, INC.
TOTAL DUE: $183.53
03/06/13
Dear Executor:
We understand the person below has passed away. We are sorry for your loss and want to help resaive this
outstanding balance.
Establishing contact with our office will assist you in clarifying your estate matters and payment obligations. At this
time, there is a balance of$183.53 due for CAPITAL ONE, N.A.. /�
Piease send all payments and correspondence to the addres�listed be�ow.
To pay this acCOUnt related to the estate, please visit us at \ .�JCCS�ecurePay.com. �� �U
If you have any questions, please cali our office at 8 =826-2096: ` � � 1
Sincerely, v ./
. i
Anthony Trunk • '
Probate Department �
Unless you notify this office within 30 days after receivinglth' tice that you dispute the validity of this debt or
any portion thereof, this o�ce will assume this debt is valid if you notify this office in writing within 30 days from
receiving this notice that you dispute the validity of this^d t or any portion thereof, this office wili obtain
verification of the debt or obtain a copy of a judgment arid mail you a copy of such judgment or verification. If you
request this o�ce in writing within 30 days aft@r r�Eiding'this notice this office will provide you with the name and
address of the original creditor,�if differer�t from the�current c��ditor.
` � � \ V
\. \ �
� \
This communication is from a debt collector. This is an attempt to collect a debt and any information obtained will
be used for that purpose.
�� JCC receives incoming caiis Gentrai Time ivionday-Tuesday oanr5p�n,'vVeclnea�ay-Fric;ay oam-Spm, Saiurday Sarrh�i,t,;;,_
PLEASE DETACH AND RETURN THIS PORTION WITH YOUR PAYMENT KP�A
PO Box 1952 I authorize the following amount to be charged to m credit
Southgate, MI 48195-0952 card shown O � U �' U � ❑ �
illllll�lll'IIIIIIIIfiIIII�IIIWI���ll�llllllll�lllllll�lllll Cardholder name: Exp. Date:
Account#: ❑❑❑❑ ❑Q❑❑ ❑❑�❑ D❑❑❑
Q3/06113 Amount S: Signature:
Account#: �4332283 Balance Due: 5'183.53
Client Account XXXXXXXX5452
224t05400531 a934/Oo02520 1 001 3 pLEASE SEND ALL CORRESPONDENCE T0:
�lihliu�il�l�dh�dhlr4�u�i�����llnrndll�pyu��pu,
The Executor of: Dorothy Earley . J.C. CHRISTENSEN AND ASSOCIATES, INC.
977 Ridge Rd P.O. BOX 519
Shippensburg, PA 17257-9722 SAUK RAPIDS, MN 56379
I�I�I��II����II�I���II�I��II����I�I����ill�l���l�l�l
,
IF PAyING BY f.1A5TERCAFD,DISCOVEfl Ofl VISA.FILL OOT BEIOW,
'" � MAKE CHECKS PAYABLE TO: cHecK cn�o usi.c�Kca Panaerr - _
. " � IRIT PHYSICI L� �s;rnr.n�r. ��cw=_P "W' ,G�,
CARP Wte:�N 5'^tlA'UPE CCG:
ASQtViC'iOFHOLY5P1lti1' �7}�SySm,{
205 GRANDVIEW AVE `"'''"i0�" rxoca��
� SUITE 210 3838•MHSH
CAMP HILL, PA 17011-1708 STATEi�5EN70ATE PAYTHISAEdOUNT ACCT.@
oxc,<0,02
02/28/13 5101.15 ts217
SHOW APAOUNT
PAGE: 2 PAID FiERE �
.:0.7>
h�nh�Ihl�u�14�P�lll�l�rll��u�i4��ll�llnpqi�npq�q Idqlli��nlnPli�������r�npiull�idm�rih�ud�liuul�
DOROTHY J EARLEY SPIRIT PHYSICIANS SERVICES INC
977 RID6E RD 205 GRANDVIEW AVE
SHIPPENSBUR6, PA 17257-9722 SUITE210
CAMP HILL, PA 17011-1708
3838-MHSH•5�70 VJ2J W E000150
nPleese cheak hox if eddress is incorrect or I�urence STATEMENT p�EqSE DETACH AND RETURN TOP PoRTION WITH YOUR PAYMENT
U information hes chefged,and IMkete change(s)on reverse side.
�
RECEIPT RECEIPT INS. PAT.
DATE PATIENT DOCTOR CPT4 DESCRIPTION CHARGE FROM INS. FROM PAT. ADJ. BAL BAL
0_/03/.3 Doro.hy Napzor.i 992i9 OFFIC?/0:;7?nTIE!7i VISZT, 5137.00 50.00 535.84 80.00 510115
0:/03/:3 Doro:hy N.atzwd 3G9'_i tiOJTis= VnNi205CTUR= 57.00 53.00 b<•00 50.00 50.00
0-/iLi3 o�coihy ,atzor.! 992_? OFFIC'o/OJT?ATiEA1' JIS11', 592.00 466.80 513.20 g0.00 90.00
0:/:7/33 D�cochy Y.ntzOnS 205:0 D�AIV/I::TCS, JO:Ni/Bt135A $95.00 557.61 $37.39 80.00 §0.00
0:/17/i3 Dorothy N.a[zon`_ T_OAO F:eGhyl?redaigplor.c eo N.G 512.00 55.60 $6.d0 50.00 $0.00
6
pm ,
b
CURRENT 30-60 DAYS 60-90 DAYS 90•120 DAYS OVEH 120 DAYS TOTAL ACCOUNT BALANCE
DUE FROM PATIENT �
$101.15 $0.00 $0.00 $0.00 S0.00 $707.15 $101.15
Thank You For Your Payment. For Billing Questions, Please Cell: (777) 972-4490.
��2EJl4lUM NOTICE y _ �;` `"� q� ?;.� �Ohio
ACCOUNTNUMBER: p�py��7�g�z Casualtv.
,��.sa�,au�.,:.u����mr,m
Agent: TELEPHONE (717)-249-2812 Account of:
J RODNEY FICKEL INS AGENCY IN DOROTHY J EARLEY
PO BOX#1 977 RIDGE RD
CARLISLE PA 17013 � SHIPPENSBURG PA 17257 9722
G ��
Notice issued to: Insurer:
DOROTHY J EARI.EY pEERLESS INDEMNITY INSURANCE
977 RIDGE RD
SHIPPENSBURG PA 17257 9722 9450 SEWARD ROAD
FAIRFIELD, OH 450145456
W W W.OH IOCASUALTY-INS.COMlBI LLING
SEE REVERSE SIDE FOR INFORMATION ON: FUTURE PAYMENT SCHEDULE, SERVICE FEES, 24HOUR STATUS
� HOTLINE, ADDRESS CHANGE REQUE5T5 AND OTHER IMPORTANT
NOTICES.
Co: 02 Loan Number: Agent 3202486 Payment Pian: MONTHLY Invoice Date:03721f2013
Policy Number Trans. Description of Transactfons Charges/ Policy Minimum
Date Credits Balance Due
PLP W771812 OIRECT BILL CANCELLATION MEMO y��
�320l2013 THE PERSONAL PROTECTOR �VW� r
PRO-RATA CANCELLATION �� t �
EFFEC7IVE 03I082013 � � �
-� J � Cr ,
PRIOR BAIANCE DUE % �� 1,113 .00 ,' �
CANCEIIAPON C -379.00
PRIOR PAYMENTS �; :} \� -682.SO 51.50 51.50 �
�,, � ' ,�c, �
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�,
., ('� . —�\
Payment Due Date: UPON RECEIPT Account Balance: $ 51.so Minimum Amount Due: g Si.So 4
Policy Type: pERSONAL PROTECTOR Future Payment Schedule: Please See Reverse j
:.apital CardiovascularAssociates r���AnNOBYVI31NA8fEACApDOfi q6COYEp,qLLqJf8EL01P
PO Box 1292 �Vi�.= ❑unem+w,n w�.� ❑msooven, ��''
Ce�Ilp Hill, PA 17001-1292 m°'re °°'"'
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RETURN SERVICE REQUESTED �«u`�"1O1
STATEMENT DATE PAY THIS AMOUNT ACCOUNT NO.
Billing Phone: 717-7246462
Billing Fax: 717-724-6461 03f04/2013 545.85 2285D5
Oftice Hours: Monday-Friday B;OOam-4:O�pm _�. „ . ,.. ..
�_. . �.:;rsrn=��•�°-•:r SHOWAMOUNTQ
. .•.r. :•�i..r:�:�;�u���.:,r_r::r�..,....v PAIDHERE W
Stm11D#:281086624 ��MAKE CHECKS PAYABLE/REMIT TO:�
�•�u.qdl��li�wi6��ii�pihuiu.��q�qlll��ll�rvl�llnq a,�,<.�o
DQRQTHY EARLEY
a 977 RIDGE RD Capital Cardiovascular Associates
� SHIPPENSBURG PA 17257-9722 PO BOX 1292
CAMP HILL PA 17001-1292
IIIIII'111'IIIIII'IIIIIIIIIIIII11�11111111111"1'llll'illlllll
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� Nease check box H aCme eCdress I5 inwnect a inw2nce Ptf1.5E DETACH AND NE7UNY TOP PORTION 1'ATN
IMOrmatbn nas UungSd,andltAitete��y�y�on reverse sb?. YDUIi PAYAIENT tti ENLLOSfD E�7VELOPE
DATE OP 00[.TOR CF173tfiE IN8[RtAt�CE PATIETiT
SERVICE N7S� CODE DSSCRIPTION C[iAROE9 RECEIPT RECEIPT ADN6T HALAtICE
O1/07/13 RALI 93280 PACEFW(Q:R EVAL DUAL LEAD 125.00 8.90 .00 70.25 45.85
"""""'_""__"_""""'_"'___"__"'___"_"_"""'_"""""_""'_""'_'
PLPA38 BAY THIB AT[OUNT: 45.85
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Billing Phone: 717-724-8482 AMOUNT DUE
45.85
STATFMFNT
_ �- 000241675102B000000000001� 0857Q17
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�� PennsylvaniaAmerican Water ` �,S�`'_�;�� 24-1675102-8
. PO Box 371412
Pittsburgh, Pa. 15250-7412 AMOUNT DliE �.� � 57
ForService To: 17 NOTTINGHAM DR DElE SI::C� 20, 2013
_ A090UtdT PAlD
mu.hqa.�,.luiqPl�hl�llril,qi,i,���in�,.nq.,,idld
�� 0220151 AVO.Si 20I5'22015bpZp15 Oe2 1 NC50.N.. — a 1 �;� , ��f
_ DONALD BIRX � .•:� :� : � . : :..�-; ,• , `
`_ 208 TEXACO RD
MECHANICSBURG PA t7050-2628 PENNSYLVANIA AMERICAN WATEF
PO BOX 371412
PITiS6URGH, PA. 15250-7412
�!�h�ihii,i,ldll�iu�rli44ihP�u�..11n�l��hh�l�u�s��i
❑ PfaesediecYhsrefontldH2O�HelaloO�henconnfWrtienloyou�man!hyGM a '
a fo fhmqe yom address or 7elap/rrne numCM,and ptin!infomtE(!rn on reVerse Sk1e.
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Customer Account lnformation Bflltng Summary
for Service To: Donald Birx •------Prior Balance----•••---------.--
5 i NO iTiNGHRIJ� DR P�ior V✓ater Balance $33.Ol
AccountNUmber:2t_�675102-B PriorBalanceOther $5.50
Premise Number: 25-0382GP° Payments prior to Feb28,2013. Thanksl .00 �
Total prior halance,feb 28,2013 38.51 _,9 q
BIIOng Period& l�eter lnformatlon ------.current Water charges--- ���
Billing Date: Feb 28.2013 Service Cha�ge 13.75
Billing Peiiod: Jan 23 to Feb 25{33 days) Water Voluma($.009101 x 5,300) 48.24 / � /
Next reading on(about: hdar 25.20i 3 STAS PAWC Wafer � ,pg l/ /�
Rate Type: Residential • (; �
DSI-PAWC Charge 3.48/a 2,1 � �
Total water charges, Feb 28,2013 �.06
Meter readings in current billing period; Oiher CurreM Charges-----.- �
Meter Number N090652091 is a 5/8-inch meter. Customer Pratectien Wafer Line 5.50
Presenhactual 45800 Late Paymenf Charge .50 i
Last-actual 40500 Total other charges,Feb 28 2013 6.00
Gallonsus_d 5300 � � >� � ✓�
••-----•AtMOUNT DUE---------••---. $108.5 � � �
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Water Usage Comparison
_ Mon�iiy uszge in hundred gallons. ~'•�.�
::� ..—. .__ —_. ----' �—�--��-- �
��
4� _�.._�_—....� — ---�� ��
,.,
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`'- ��, --�Silver Spring Township Authority `
� ��
� �'� Silver Spring Townsh(p Authority Please review �
rr1-� 5 Willow Mill Park Rd.,Suite#3 by 01/28/13, D
, � ` �`� \✓ Mechanicsburg,Pa 17050
�� �\ `. 7f7-591-1370----"------:,� ACH paymentsnte�
' �11 ' � �'" � -'� � will be
S.tatement�}f Acc�ount for Sewer Services �1
Account Number: � � �,�` ,, _� / withdrawn on
'� ,�� t, . Du Date Before D"ue Date 02l04/13.
f 1497-1504 � � �,,�� 0211 9/2 01 3.__.T..___�-'$107.00
, -. . f
Service Address: �.G-� <^' !' Aker Due Date
i � �':; ci t /
17 Nottingham Dr �'y '+ �� �117.70 ��yy��(\
Office will be closed: HOLIDqYS: Mon`�ay�' Feb�uary 18, 2013(Presidents' Day)and Friday, March 29, 20�3(Govd Friday) (� �� � \
" ,�, � \ lJ
� 8'illing period �J,���`� Previous Balance: ' ($0.01) ' \G
' '� �i'� �� Current Char i_ $107.00 'i �7 �� � )
Fram 70/01/2012 L< ge:
To: 12/31/2012 ' �/� � f'� Other Charges: IY
Y
i -_-- -- C l� fG�' ,, Meter Crwdits: j- - - u0A0 � .
4 ��� � Pay this amount before due date:
ToWI Usage: 6500 �l/ � $107.00 W,�
-- — ___ Pay this amount aker due date: 117.70
Piease review by 01/28/13, ACH payments will be withdrawn on 02/04/13. �
Hours; Normal business hours are/rom B:OOAM-0;OOPM;however,an answenng machine is availabie for after hour questions �U4
regarding your sewer bilis. �
ti
Payments Paymenis are due at the Silver Spring Authority office on or before the due date and are subject to a 10%penalty after ihe due\� �
1nFo.: date has past. Return checks will be subject to a$40.00 NSF charge. Payments can be made by check,money order or �
credit cards(call for conveNence fee rates). Bring your payment along with the retun stub to the Silver Spring Authority offi �"'
during regular business hours or you may mail your paymenl to:5 Willow Mill Park Rd., Suite#3,Mechanicsburg,Pa t?050.
We do have a drop•box for your convenience at the sidewalk entrance. ���
Idotice: The Silver Spring Authority had directed lhe waiver for sewer rental fees for±emporarify vacated propertieis be terminated. p
The fixed costs of operating the sewer system are continuaily ongoing and are paid with funds collected from the base sewer (1.J`}
rental fee each quarter•year billing period. The sewer system stands ready to serve each connected property on a perpetual \1
Rates: The rate schedule as of 01l01l13 for Silver Spring Township Authority is as foliows: 'Commercial Metered Customers-
Minimum charge of S72.8S for your first 3,000 gallons of consump6on (per unit, per month). `Commercial Non-Meter•Gharge
of$789,75(per unit,per month).'Residential-Minimum charge of$107.00 for your frst 9,�00 gallons of cynsump on(per unit, r
per quarter).•AddiHOnal gallons charged are 56.75 per 1,000 gallons after your frst 3,000(COmmerei�nd 9,000(�identia . ����C
�
- - •: � � �.
Please c��t below nd return with a Y t: " ��` �
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Silver Spring Township Authonty � � Make Che Payable: Silver�rfng Township Autharity �
/�,�( / � � �'
5 Willow Mill Park Rd., SUlte#3 ��v Mail To: 5 W'lI6w�Mil! --Park Road,Suite#3 r
Mechanicsburg, Pa 17050 `� `�l cnanicsburg,Pa 17050 :/
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1� c I "1�J�'��� ', � �', �'
p�� (((111 ��% Account#: 7497-1504 �
, ', I �� �\ Invoice#: 474680
�� �J �
Donald 8 Adele Birx
v \ Due Date: 02/19/2013
208 Texaco Road � U Amount Before Due Date: $107.00
(��\ \ �� Amount After Due Date: $71770
Mechanicsbura.Pa 17050 1 ` \v'A l\�'� IIII�I�IIIIIIIIIIIflI!�flIll�lulll��I��IIIlllll
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� PennsylvaniaAmericanWater (,�o-0 3=:- 107�_02-g�
P� Box 371412 � t; °
'ittsburgh, Pa. 15250J412 I A[4�OUNT DUE I $3� � 51 �,
LFor Service To: 17 NOTTINGHAM DR �UE DATE ��eb 19, 2�13 � �
IAMOUNTpQ�D ELECTRONIC
��I��II��,'�l.��l�i��l���l�'�I��i���l��l���"�II�II��IIIIIII��I�� PAYMENT
r_ . _ ��5��1 P� �
ors�e�avnanaass=eess�c�w��, �a� � .Cenuo g� f /`��'e � �''�s oini o�, ii�hi f�9��1
DONALD BIRX � ��i�� a ��L�r_ooP�-F.r1��li����M
17 NOTTINGHAM DR
MECHANICSBURG PA 17050-2646 PENNSYIVANIA AMERICAN WATER
�� PO BOX 371412
-� y-: .,,,,`, ( . PITTSBURGH, PA. 15250-7412
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P;_=nan c:�cck h?,e tc add N2GH[;o!o Other,ccn!ri6uticr r�yc;h..�nonlfi;y t?!
er!o,:ha;:�'%�ur�dd�e�s cr!cicPhcra nmrher,erd print in(crn;-4:n c�;reverse�ie-:�
__..... ..............__.__.._.'._..'_'...__.____'____. .. ..._..
Customer.4ccount Informaffon ... - ----� - _ ;. - ---- --- - ---
. _,J. _. __ .. . .. _ _ ___.
........
_
B l�.,g�um r
For Service To: Oonald Birx , � ��
-•--- • P�rBala e--'-. .-
17 NOTINGHaA4 CF Pcior`%'a,e Eala:;ce '� j '1 $35.39
Account Number.24-io"75102-A \ l�rior a;ar, OtH=r �
Premise Number: 24-0352090 $5.50
nts p�`r tc�a� 2°. 2013r Thar,ks��) -40.89
� Total ior b Vanc�e. Jan 28, 2013 � U ,pp
Sflling Period� Meter Informafion ��.
Billing Date: Jan 28, 2013 •\ (`, '"'"""' urr t�Y�ater Charge ��•—�.l ;
Billing Period: Dec 27 to Jan 23 (,33 s� `` Servic 'r el � � 13. 75 �
Next reading on/about: Feb 2 , 3 y `�� w�ter lu e;' .009701 x . 18. 20
' STAS PA C Water' � �
Rate Type: Residential - .OS
, CSI-PAN Charae 3.49;� � 1. 11
fYeter readings in current billi a � ; ��ate c arges.Jan 2 , 2013 33.O1
p °d� •�------Othe rreni`�h.arges------••-
Meter Number N090652091 is a i8-inch mater. ustomer Prot c,on W'ater Line
Preseni-actual u pp 5.50
Last-actual Total mher cha s,Jan 28,2013 5.50
3$�00
Gailons used 2000 • AM DUE-----------..__�___
--------• $38.51
i
�
Do not end payment Total Amount Due�will be detlucted � I
from y' r bank account on Feb 19,2013� i
� � - �" � I
° 0�02416751028000000000DD04089015
1
i '
� �.
Pennsylvania American Water � � • 24- 1675102-8
PO Box 371412 .
; Pittsburgh, Pa. 15250J412 � �� AMOUNT DUE� 540,89
For Servlce To: 17 NOTTINGHAM DR �t n / DUE OATE {t-�-2�
�1"��U 4;,�� AMOUNT p�p �ELECTR ic �
„�y"h,�u�i�Irq��.,1rrm�Il�I��iIlq��llh�I�Iliii4rH �' d� NT
011928 f AV 0.&7�92g11187A'003y2g p5y I NCE84a 1� �
DONALD BIRX • �� - • •�� - �- �
17 NOTTiNGHAM DR t
MECHANICSBURG PA 17050-2646 P�NNSYLVANIA AMERICAN WATE
PO BdX 371412
! PITTSBURGH, PA. 15250-7412
L�..L- �-7. `":�, . t� �� � �r-.., ��}s�j� �rh�ru��hllh��d��rll�ll�lldyn�„�,,i,�,i,iml,r,.,,(
` .
�
D %ease check here(o add H2O�NOW fo Ofhers conUllwlion to ya�r nwnlhty biA
a to change your edd2ss or telep,hona num6er,nM print informatbn on reverse slda.
.............. .'_"........ ............."'_""'...."'.-"__"'......_..._......'_""............_......._..'.."._"-"'•"'.'......W.....'•""'......__"_._..............___.'__'_"'
Customer Account Mformatlon Bllling Summary
For Service To: Donald Birx -----prior Belance-------�.-
17 NOTTINGHAM DR Prior Water Balance $33.53
AcCOUntNumber:2d-1675102-8 PnorBalanceOther $5.50
Premise Number: 24-0392098 Payments prior to Oec 28, 20f2. Thanksl -39.03
Totaf prior bafance, Dec 26,2012 .00
B!UlAg PB/fOd& MBtBf IttfO�RtBtlOA ----.--Curreni Water Charges------
Billing Date: Dec 28,2012 Servica Charga 13.75
Billing Period: Nov 21 to Dec 21 (30 days) Watar Volume($.009101 x 2,300J 20.93
Next reading on/about: Jan 23,2013 � OSl-PAWC Charge 2.05"/0 ,71
Rate Type: Residential Total water charges, Dec 28,2012 35.39
---Other Current Charges---
Meter reatlings in current bllling period: CustamerProt�ction WaterLine 5.50
Meter Number N090652091 is a SIB-inch meter. Toial other charges,Dec 28,2072 S.50
Present•actual 3B500
Last-actual 36200 ----qMOUNT DUE-----•--»---- $40.89
Gailons used 2300
Uo not send paymant.Total Amount Due will be deducted
,(� 6 v 1 � _ irom your bank account on Jan 17,207J
Y l OS
�.E..z._. a � -
Water Usage Comparison
�� Monihly usaga In hundred gallons.
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