HomeMy WebLinkAbout08-16-13 � 1505610140
REV-1500 EX �°,_,°>
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes �NHERITANCE TAX RETURN County Code Year File Number
Po sox 2aoso� 2 1 1 1 0 8 3 2
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
2 0 6 3 2 1 5 0 6 D 7 1 7 2 0 1 1 0 5 1 5 1 9 4 1
DecedenYs Last Name Suffix DecedenYs First Name MI
F A R L L I N G J 0 A N L
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1.Original Retum � 2.Supplemental Return � 3.Remainder Return(date of death
priorto 12-13-82)
� 4.Limited Estate � 4a.Future Interest Compromise(date of � 5.Federal Estate Tax Return Required
death after 12-12-82)
QX 6.Decedent Died Testate � 7.Decedent Maintained a Living Trust 8.Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
� 9.Litigation Proceeds Received � 10.Spousal Poverty Credit(date of death � 11.Election to tax under Sec.9113(A)
between 12-31-91 and 1-1-95) (Attach Sch.0)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
R 0 G E R B • I R W I N , E S Q U I R E 7 1 ? 2 4 9 2 3 5 3 '
_- :�
GREGISTER OF'WILLS U5��„�LY
'�"" . _ � i'1
�J.� `I,�' .....�
First line of address rn .' J
:�7 t� F—° ,
( ' :J) ..tl
I R W I N & M c K N I G H T , P . C . t�� �,; . . �
Second line of address -- '' �
, .., .
_:� . ,,
6 0 W E S T P 0 M F R E T S T R E E T "� � �J �
City or Post Office State ZIP Code � DATE FILED ��
� � .,� -;�
C A R L I S L E P A 1 7 0 1 3
CorrespondenYs e-mail address:
Under penalties of pery'ury,I declare that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIG TURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
-ao�
A RESS
1D12 HARRISBURG PIKE CARLISLE PA 17013
SIGNATUR OF PREPARER OTHER T�,,R�EPRESENTATIVE D �E
�j, ���C`1GG..r S
ADDR S
60 WEST PO FRET STREET CARLISLE PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1505610140 1505610140 �
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
JOAN L. FARLLING 21 11 0832
DecedenYs Name Page 2 File Number
Correspondents
Name Daytime Telephone Number
R O G E R B . I R W I N , E S Q U I R E 7 1 7 2 4 9 2 3 5 3
First line of address
I R W I N & M c K N I G H T , P . C .
Second line of address
6 0 W E S T P O M F R E T S T R E E T
City or Post Office State ZIP Code
C A R L I S L E P A 1 7 0 1 3
CorrespondenYs e-mail address:
Under penaltles of perjury,I declare that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is hue,correct and complete.Declaration of prepa�er other than the personal representative is based on all information of which preparer has any knowledge.
SIGN /l'1�RE O PERSON RESP NSI�FILING RETURN �T�_ �
" � 3
__ _ ---_ - -- __ --
ADORESS
3633 MACEDONIA ROAD SPRING HOPE NC 27882
J 150561D240
REV-1500 EX
DecedenYs Social Security Number
oecedent's Name: J 0 A N L• F A R L L I N G 2 0 6 3 2 1 5 0 6
RECAPiTULATION
1. Real Estate(Schedule A) . . . . . . . . .. . . . . . . .. . . . . . . . . . . . .. . . . . . . . . . . . . 1. 1 1 6 9 2 3 . 0 0
2. Stocks and Bonds(Schedule B) . . . . .. . . . . . . . ... . . . . . . . . . . .. .. .. . . . . . . 2• •
3. Closely Hetd Corporation,Partnership or Sole-Proprietorship(Schedule C) .. . . . 3. •
4. Mortgages and Notes Receivable(Schedule D) .. .. . . . . . . . . . . .. . .. . . . . . . . 4. •
5. Cash,Bank Deposits and Miscellaneous Personai PropeRy(Schedule E). . ... . . 5. 3 5 3 � . 1 7
6. J�intly Owned Property(Schedule F) ❑ Separate Billing Requested .. . . .. . 6. •
7. Inter-Vivos Transfers 8�Miscellaneous Non-Probate Property
(Schedule G) � Separate Billing Requested . . . . . . . 7. 2 3 6 6 3 , 7 8
8. Total Gross Assets(totai Lines 1 through 7) .. . . .. . . . . . . . . . . . .. . . . . . . . . 8. 1 4 4 1 1 6 . 9 5
9. Funeral Expenses and Administrative Costs(Schedule H) .. . . . . . . . . . . .. . . . . 9• 3 7 1 8 6 . � 5
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) . . . .. . . . . . . . . 10. 4 8 5 4 . 4 3
��. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . .. . . . . . . .. . . . . . .. . . . 11. 4 2 0 4 0 . 4 8
12. Net Value of Estate(Line 8 minus Line 11) . . . . .. . . . . . . . . .. . . . . . . . . . . . . 12• 1 0 2 � 7 6 . 4 7
13. Charitable and Governmental BequestslSec 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. 1 � 2 � 7 6 . 4 7
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X.0 _ 0 . � O 15. O . 0 Q
16. Amount of Line 14 taxable
at lineal rate X.045 1 0 2 0 7 6 . 4 7 �6. 4 5 9 3 . 4 4
17. Amount of Line 14 taxable
at sibling rate X.12 ❑ . � � 17. � . � 0
18. Amount of Line 14 taxable
at collateral rate X.15 0 • � 0 18. � • � 0
19. TAX DUE . .. . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .. . . . . . . . . . . . . .. . . 19. 4 5 9 3 . 4 4
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
Side 2
� 1505610240 1505610240 �
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 2� 11 os32
DECEDENTS NAME
JOAN L. FARLLING
STREET ADDRESS
1402 PHEASANT DRIVE SOUTH
CITY STATE ZIP
CARLISLE PA 17013
Tax Payments and Credits:
1• Tax Due(Page 2,Line 19) (1) 4,593.44
2. Credits/Payments
A.Prior Payments 4,500.00
B.Discount 0.00
Total Credits(A+B) (2) 4,500.00
3. Interest
(3)
4. If Line 2 is greater than Line 1+Line 3,enter the difference.This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 93.44
Make check payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; .......�............................................................... ❑ ❑X
b. retain the right to designate who shall use the property transferred or its income; ............................... ❑ X❑
c. retain a�eversionary interest;or ................................................................................................ ❑ �
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ X❑
2. If death occurred after December 12,1982,did decedent transfer propeRy within one year of death
without receiving adequate consideration? ....................................................................................... ❑ 0
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ......... ❑ X❑
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation?.................................................................................................. X❑ ❑
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,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is
3 percent[72 P.S.§9116(a)(1.1)(i)).
For dates of death on or after Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax retum are sfill applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an
adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)�.
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in
72 P.S.§9116(1.2)[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-1502 EX+(12-12)
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
JOAN L. FARLLING 21 11 0832
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 between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts.
Real property that is jointly-owned with right of survivo�ship must be disclosed on Schedule F.
Attach a copy of the settiement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedenYs interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1. 1402 PHEASANT DRIVE SOUTH, CARLISLE, PENNSYLVANIA 116,923.00
SOLD-SETTLEMENT SHEET ATTACHED
TOTAL(Also enter on Line 1,Recapitulation.) $ 116 923.00
If more space is needed,use additional sheels of paper of the same size.
REV-1508 EX+(OB-12)
pennsylvania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS 8� MISC.
INHERITANCE TAX RETURN
RESIDENTDECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
JOAN L. FARLLING 21 11 0832
Include the proceeds of litigation and the date the proceeds were received by the estate.
All properly jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. M&T BANK-CHECKING ACCOUNT 2,617.17
2. PERSONAL PROPERTY-APPRAISAL ATTACHED 913.00
TOTAL(Also enter on Line 5,Recapitulation) $ 3 530.17
If more space is needed,use additionai sheets of paper of the same size.
REV-1510 EX+(08-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCETAXRETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FIIE NUMBER
JOAN L. FARLLING 21 11 0832
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDETHENAMEOFTHETRANSFEREE,THEIRREUITIONSHIPTODECEDENTAND DATEOFDEATH %OFDECD�S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER.ATfACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE� VALUE
1. NATIONWIDE FINANCIAL 23,663.78 100.00 23,663.78
ANNUITY#01-5336067
BENEFICIARIES:
CRISTINE KELLER
LESLEE J. NACE
TOTAL (Also enter on Line 7,Recapitulation) $ 23 663.78
If more space is needed,use additlonal sheets of paper of the same size.
REV-1511 EX+(10-09)
pennsyivania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JOAN l. FARLLING 21 11 0832
DecedenYs debts must be reported on Schedule l.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. EWING BROTHERS FUNERAL HOME 6,093.05
2. CARLISLE MEMORIAL SERVICE, INC. 1,676.00
3. GEORGE'S FLOWERS 109.18
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
2. Attomey Fees: IRWIN &McKNIGHT, P.C. 6,800.00
3, Family Exemption:(If decedenYs address is not the same as claimanYs,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. ProbateFees: REGISTER OF WILLS 303.50
5 AccountantFees:
6. Tax Retum Preparer Fees: PATRICIA A. ROSENDALE, CPA 375.00
FINAL FIDUCIARY TAX RETURN
7. REGISTER OF WILLS- FILING FEE 30.00
8. CLOSING COSTS FROM SALE OF REAL ESTATE 18,387.86
9. CUMBERLAND LAW JOURNAL- ESTATE NOTICE 75.00
10. THE SENTINEL-ESTATE NOTICE 200.16
11. ROY D. GOTTSHALL-APPRAISAL ON PERSONAL PROPERTY 65.00
12. REGISTER OF WILLS-SHORT CERTIFICATE 4.00
13. LESLEE J. NACE-REIMBURSEMENT OF REPAIRS TO REAL ESTATE 274.65
14. GORDON ELECTRIC SUPPLY-CIRCUIT BOX& BREAKERS 204.40
15. POSTAGE 7.20
16. NOTARY FEES 6.00
17. NORTH MIDDLETON AUTHORITY-ANTIFREEZE TO WINTERIZE SINK/TOILET 91.42
18. CARLISLE ELECTRONICS-STOVE, HOOD& PAINT 339.20
TOTAL(Also enter on Line 9,Recapitulation) $ 37 186.05
If more space is needed,use additional sheets of paper of the same size.
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
JOAN L. FARLLING 21 11 0832
DecedenYs Name Page 1 File Number
Schedule H -Funeral Expenses 8 Administrative Costs-B7.
ITEM
NUMBER DESCRIPTION AMOUNT
19. MATERIALS FOR REPAIRS-REAL ESTATE 636.82
20. MULCH, GAS, FLOWERS 90.00
21. MRD-AC MAINTENANCE 940.00
22. ELECTRIC REPAIRS(LABOR) 125.00
23. TUCKEY MECHANICAL SERVICES, INC. -SERVICE HEAT PUMP 352.61
SUBTOTAL SCHEDULE H-B7 2,144.43
REV-1512 EX+(12-12)
pennsyivania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT�
INHERITANCETAXRETURN MORTGAGE LIABILITIES 8 LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JOAN L. FARLLING 21 11 0832
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. NORTH MIDDLETON AUTHORITY-WATER/SEWER 826.08
2. ROBIN K. SOLLENBERGER, TAX COLLECTOR-REAL ESTATE TAXES (PRORATED) 1,483.65
3. ROBIN K. SOLLENBERGER, TAX COLLECTOR-REAL ESTATE TAXES (PRORATED) 140.30
4. YORK WASTE-TRASH 42.00
5. HARTFORD INSURANCE COMPANY- HOMEOWNERS INSURANCE 1,116.84
6. PP&L- ELECTRIC 1,245.56
TOTAL(Also enter on Line 10,Recapitulation) $ 4 854.43
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(Ot-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
JOAN L. FARLLING 21 11 0832
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. CRISTINE KELLER Lineal 51,038.24
3633 MACEDONIA ROAD 1/2 REMAINDER
SPRING HOPE, NC 27882
2. LESLEE J. NACE Lineal 51,038.23
1012 HARRISBURG PIKE 1/2 REMAINDER
CARLISLE, PA 17013
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS: '
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
L
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART ll-ENTER TOTAL 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.
,-;''�� OMB Appraval No.2502-0265 .
�,:������� A. Settlement Statement {HUD-�1�
. ..
1.Q FHA 2,Q RHS 3.�Conv.Unins. 6.Fite Number: 7.l�oan Number: 8.Mortgage Insurance Case Number:
13083 1373273
4.Q VA 5.Q Conv.ins.
C.Note:This form is furnished to give you a statement af adual settlement costs.Amounts paid ta and by the settlement agents are shawn.Items marked
"(p.o.c)"were paid autside the closing;they are shown here for informational purposes and are not included in the totals.
D.Name&Address of Borrower: E.Name 8 Address af Seiier. F.Name&Address af tender:
Brandi L.Newland Estate of Jpan Louise Fadling Susquehanna Bank
845 East 4range Street,Apartment 1,Lancaster,PA 1402 Pheasant Drive South,Cariisie,PA 17013 3507 Concord Road,York,Pa 17402
17fi02
G.Property�ocatian: H.Settiemen#Agen1: 1.Settlement Date:06I0�2413
i402 Pheasant Drive South Keystone Land Transfer,Ltd Oisbursement Date:06/05/2013
Carlisle,PA 17q13 3421 Market Sireet Camp Hill,PA 17011
North Middletan Township
7elephone:717-731-4200 Fax:717-731-1799
Place af Settiement: TitieExpress
3421 Markef Street,Camp NH},PA t70i 1 printed 66J0512013 at 127 pm
by KS
f i• i i • •
100. Gross Amount Due from Borrower 400. Gross Amount Due to Seller
149. Contract sales price 11$.923.Q0 401. Contrad seles p�ice 116,923.00
102. Personaf ro rt d02. Personat ro
103. Settlement charges to borrower(line 1400) 7,067.92 403.
404. 4Q4.
105. 405.
Ad'ustme�ls for items aid b seller in advance Ad'astments for items aid b seller in advance
1�. Cifyliaam taxes fa 446. Cityftocm taxes fa
107. County ta�ces O6/05I2013 to 12/31I2013 228.68 407. County ta�ces O610512013 to 12I31I2013 228,66
148. Schooi Tax fl6(45t2013 to 46/30i2013 tOQ.54 408. Schoai Tax 46l05120�3 to O6l3012413 900,54
1Q9. AD9.
110. 410.
111. 411.
112. 412.
�2�• Gross Amount Due from Borrower 124,320.14 420. Gross Amount Due to Seller 117,252.22
20Q. Amaunts Pald ar In Belralf ot$arrower �. Reduct3ans In Amourrt Dus to Selier
201. peposit or earnest money 1,OOO.IX1 501, Excess deposit(sea instructions)
202. Principal amount of new ioan{s) 113,415.00 502. Settlement charges to seller(line 1400) 13,887.86
203. Existin ioa s taken su ' to 503. Exisfi toa s taken sn ' to
204. 504. Pa oif of first mort a e loan
205. 505. Pa aff o#second mod loan
206. 506.
207. Seller Assist 4,500.W 507. Seller Assisl 4,500.Op
248. 508.
209. 509.
Ad ustments(or items un aid b seller Ad'ustments For itema un aid b seller
2'!4. Cityftown taxes to 510. GtyRown ta�tes fo
211. Gauntytaxes to 5i1. Countyta�ces io
212. School Ta�c to 512. School Ta�c to
213. 513.
214. 514,
2t5. 515.
216. 518.
217. 517.
21$. 518.
219. 519.
z20• Total Paid b Ifor Borrawer 118,915.00 520. Total Reduction Amount Due Seller 18,387.86
3�. Cash at Settiement fromfto Borrow� B�. Cash at Setdement toi6'am Seli�
301. Gross amount due 6om borrower(line 120} 124,320.14 601. Gross amount due to seiler(tina 42�j 117,252.22
3p2, Less amounts paid byHor borrower(line 220) 1 i8,915.00 602. Less reductions in amount due seller(line 520) �g,387,gg
303. Cash �X from �Ta Borrower 5,AQ5.44 gp3. Casir XQ Ta ❑ Frorn Se1I� 98.864.36
this Iwm unbss q ai 5 a C4tteMl�eli0 OM91wrtlrol number.No mn(MlnlfelX u 1°P°'^0 may n m ion, yo rcqui mm s
splay y v y is essured ItIi50istbsure h maMriary.7116 is EsSiqMetl 10 qovi0e Ille�NIIin lo e REBpA wvereE IrBncepion wil�InluYmtlbn Ourinp ihe selllsmenl
proeess.
See attached addendum far additional informetion �
Previous editions ere obsotete Page 2 of 4 HUD-S
700. ToWI Real Estate Broker Fees S 5,846.15 Paid From Paid From
Divisionofcommission Iine700 asfotlows: Borrower'S Seller'S
7�� $2,810.58 to Howard Hanna FundS at FundS at
70z. $3,035.57 to Howard Hanna Company Settlement Settlement
703. Commission paid at settlement 4,846.15
704. Eamest Money Deposit to Howard Hanna Company $1,000.00 P.O.C.B' ���•�a
705. Broker Fee to Howard Hanna Company 225.00
500. Rems Pa able in Connection with Loan
801. Our origination charge (Includes Origination Point 0.000%or$0.00) $895.00 (from GFE#1)
802. Your credit or charge(points)for the specific interest rate chosen $ (from GFE#2)
803. Your adjusted origination charges (from GFE A) 895.00
804. Appraisal fee to ALS,Inc1A raisal Lo istic Solutions,Inc. (from GFE#3) 460.00
805. Credit report to CoreLo ic Credco (from GFE#3) 28.00
806. Tax service to First American Real Estate Tax Serice (from GFE#3) 93.00
807. Flood certification to CoreLo ic Flood Services (from GFE#3) 12.50
808. ta
900. Rems R uired b Lenderto be Paid in Advance
901. Daily interest charges from from 0 6/0 512 0 1 3 to 07I0112013 @$11.42031day (from GFE#10) 296.93
902. Mort a e insurance remium months to from GFE#3
903. Homeowner's insurance for ears to Libert Mutual (from GFE#11) 691.00
gpq. months io from GFE#11
1000.Reserves De osited with Lender
1001. Initial deposit for your escrow account (from GFE#9) 1,61976
1002.Homeowner's insurance 4 months $ 57.58Imonth $230.32
1003. MoA a e insurance months $ Imonth
1004.Property taxes months $ 0.00/month S
1005.Countytaxes 5 months $ 33.12Imonth $165.60
1006.School Tax 13 months $ 717.62Imonih $1,529.06
1007.Aggregate Adjustment $-305.22
1100.Tkle Cha es
1101. Title services and lender's title insurance from GFE iJ4 1,302.00
1102. Settlement or closing fee tp S
1103.Owner's title insurance-First American Title Insurance Company from GFE#5 1t3•�
1104. Lenders title insurance-First American Title Insurance Company $1,195.00
1105.Lender's title policy limit$113,415.00 Lender's Policy
1106.Owner's title policy limit$116,923.00 Owner's Policy
1107.AgenYs po�tion of the total title insurance premium $1,048.47
to Ke stone Land Transfer,Ltd
1108. Underwriters poRion of the total title insurance premium $260.03
ro Firs(American Title Insurance Com an
1109.
1110. Notary Fee to Kristen D.Shive 14��
1111. Tax Certification Fee to Ke stone Land Transfer,Ltc 5.00
1200.Govemment Recordin and Transfer Cha es
1201.Govemment recording charges $ (from GFE#7) 162.00
12�2. Deed$67.00 Morl a e$95.00 Release$
1203.Transfer taxes $ (from GFE#8) 1,169.23
1204. CitylCounty taxlstamps Deed$1,16923 Mort a e$
1205. State Taxlstamps Deed$1,16923 MoR a e$ 1,169.23
1206. Deed$ Mort a e$
1300.Addkional Settlement Cha es
1301.Required services that you can shop for (from GFE�6)
1302. to
1303. to
1304. to
1305. to
1306. Sewer to NoRh Middleton Sewer Authori �•4
1307. Home Warranty to Home Securit Of America,Inc. 479•�
1308. Inheritance Tax Escrow to Ke stone Land Transfer,Ltd 6,312.00
,�� . . . .• • . i • . . � � • . 7,067.92 13,887.86
'Paid outside of closing by(B)orrower,(S)eller,(L)ender,(I)nvestor,Bro(K)er."Credit by lender shown on page 1."'Credit by seller shown on page 1.
See attached addendum for additional information
Previous editions are obsolete Page 2 of 4 HUD-1
Com arison of Good Faith EsGmate�PE and HU4-1 Cha es Gaod Fatki�Eatimate HUD-t
Cha That Cannot Increase HU6-1 Lina Number ..�.
Our origination charge p 801 � 895.00 y 895.00
Your credit or charge{po+nis)for the specific interest rate chosen p 802 0.00 �� 0.00
Yaur adjusted ariginalion charges # $d3 $g5.pp gg5,�
Transfertaxes q 1203 1,169.23 t,16923
Cha es That in Totai Cannot increase More Than 1�6 Good FaiM Estimate� HUD-1
Government recording charges # 1201 160,00 �'� 162.00
Appraisalfee # 804 460.00 � .� 4fi000
Credit report #805 28.� -.�. 28.�
Tax service # 806 93.00 93,00
Flood certification p 807 12.50 12.50
#
#
#
753.50 755,54
� $ 2•�1 or 02654%
Cha es Thaf Gan Chan e Good Faith Estim�e� HUD-1
Initial deposit for yaur escrow account # 1001 1,992.96 � 1,61976
Daiiy interest charges from #9Q1 $11.42431da � 1713Q —�.. 296 93
Homeawner's insurance g 903 360 4Q . 691 dd
Titie services and lenders titie insurance # 1101 1,476.00 1,302.00
Qwner's tiUe insufarace-First Rmerican Title insurance Campany # 1193 15.OQ 113.5Q
#
#
Laan Terms
Your initial loan amount is $113,415.00
Your Ioan term is 30.years
Your initial interest rate is 3.6250°k
Your inifial monthiy amount awed for principal,interes#,and any rtror#gage $5t7.23 includes
insurance is QX Principal
❑X Interesf
❑Mortgage Insurance
Ca�your interest rake rise? QX No. ❑Yes,it can rise ko a manimum ot �. The 6rst change
wili be on 1 1 and can change again every years afler ! l Evety change
date,your interest rate can increase or decrease by °h. Over the I'rfe of the loan,your
i�terest rate is guaranteed ia never be lottirer than %or highe�'than %.
Even if you make payments on Gme,ran your toa�baiance rise? QX No. ❑Yes,it can rise to a maximum of$
Even if you make paymenis on time,can your monthly amount owed for XQ No. ❑Yes,the first increase can be on I / and the monthly
principal,interest,and morigege insuranCe rise? amount owed can rise to$
The ma�timum it can ever rise fo is$
Does your loan have a prepaymeM penalty? X❑No. ❑Yes,your maximum prepayment penalty is$
d4es your Ioan have a baitaon paymen#? QX No. ❑Yes,you have a ballaon paymenf af$ due in
years on I I .
Total montE�Iy amount owed inciudirtg escrow accou�t payments ❑You do riaf have a monthly escrow payment for items,such as pso�#y f�es
and homeowner's insurance. You must pay these items directly yourseif.
QX You have an additional moMhly escrow payment of$208.32
that resuifs in a tat�ini6al rrwnNly amount o�ved af$129.55, This indudes principa�interesf,any
mortgage insurance and any items checked below:
QX Property taxes „�X Homeowner's insurance
�fiood insurance QX Schooi Tax
❑ ❑
Note: if yau have any questions abaut the Settiement Charges and laan Terms iisted�#his form,please contact yonr Iender.
See attached addendum for additianal infarmation
Previous editions are ohSOlete Page 3 of 4 HUD-1
• HUD CERTIFICATION OF BUYER AND SELLER
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief,it is a true and accurate statement of all receipts and
disbursements made on my account or by me in this transactiort I further certify that 1 have received a copy of the HUD1 Settlement Statement.
Bra nd
�:v�, �t.a.�.1�,�� �.��r,��„�,�
"� r �
Estate of Joan ouise Farlling
The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transadion.I have caused or will cause the funds to be
disbursed in accordance with this statement.
�o%`�
SETTLE AGENT DATE T
WARNING:IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM.PENALTIES UPON
CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT.FOR DETAIIS SEE TITLE 18:U.S.CODE SECTION 1001 AND SECTION 1010.
See attached addendum for additional information
Previous editions are obsolete Page 4 of 4 HUD-1
• • • •. • � • �-
Name of Borrower: Name of Seller: File Number:
Brandi L.Newland Estate of Joan Louise Farlling 13083
Prepared 0610512013 at 127 pm
Note:This page displays an itemization of the adjusted origination charges shown in section 800 of the HUD-1 Settlement Statemen
This page accompanies but is not a part of the HUD-1 Settlement Statement.if a discrepancy exists,the information on the HUD-1
Settlement Statement applies.
Your Loan Origination Charges Borrower Seller
801. Our origination charge (Includes Origination Point 0.000°h or$0.00)
Origination fee to Sus uehanna Bank $ 895.00
802. Your credit or charge(points)for the spec�c interest rate chosen
to $ 0.00
803. Your adjusted origination charges 895.00 0.00
. . �
Name of Borrower: Name oi Seller: File Number:
Brandi L.Newland Estate of Joan Louise Farlling 13083
Prepared 06105I2013 at 127 pm
Note:This page displays an itemization of the charges shown on line 1101 of the HUD-1 Settlement Statement.This page
accompanies but is not a part of the HUD-1 Settlement Statement.If a discrepancy exists,the information on the HUD-1 Settlement
Statement applies.
1700.Title Charges Total Charge Bonower Seller
��p�,Title services and lender's title insurance to
Ovemight Delivery Fee-Package to Ke stone Land Transfer,Ltd $ 25.00 25.00
EmaillDoc Copy Fee to Ke stone Land Transfer,Ltd $ 35.00 35.00
Wire In Fee to Ke stone Land Transfer,Ltd $ 12.00 12.00
Notary Fee to Kristen D.Shive $ 35.00 35.00
1102.Settlement or ciosing fee to $ ��
1104.Lender's title insurance-First American Titto First American Title insurance C�$ 1,195.00 1,195.00
ToWis: S 1,302.00 0.00 1,302.00 0.0
SelledLender credits shown on a e 1 POC=Paid Outside Closin CR=Lender Credit
See attached addendum for additional information
Previous editions are obsolete Page 1 of 1 HUD-1
� ����
499 Mitchell Road,Millsboro,DE 19966 Adjustment Services
Phone 888-502-4349
F ax (302)934-2955
August 5,2011
Irwin and McKnight PC
60 West Pomfret Street ���+�ivE�
Carlisle,PA 17013-3222 ��
auG o s 20��
�RWIN&McKIdIGHT
Re: Estate of Joan L Farllin� �.AW pfFICES
Social Security: 206-32-1506
Date of Death: July 17, 2011
Dear Sir or Madam:
Per your inquiry on August 1,2011,please be advised that at the time of death,the above-named decedent had
on deposit with this bank the following:
1. Type of Account Checking Account
Account Number 581968
Ownership(Names o,fl Joan L Farlling
Opening Date 06/02/08
Balance on Date of Death $2,617.17
Accrued Interest $ •�
- --------------------------
Total $2,617.17
For any additional information on the above accounffi,including ownership and any changes,closures and/or reimbursement of funds,
please call the Stonehedge O�ce at#717-2A0�52A.
We were unable to locate any safe deposit box for We above-mentioned decedent
This letter does not indude any accounts in which the deceased may have been listed as Power of Attorney,C�stodian of Uniform Transfers,
Representative Payee,or 1�vstee under a Written.A�eement
Sincerely,
Tammy Spencer
Adjustment Services
1
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Nationwide�
• On Your Side
��������
September 22, 2011
SEP 3 C� ?.����
Irwin & McKnight, P.C.
West Pomfret Professional Building ��v�i��s n�cK�v��Hs
60 West Pomfret St '-�ti"�`������-5
Carlisle PA 17013-3222
RE: Contract Number: 01-5336067
Insured: Joan L Farling
Dear Mr. Roger Irwin:
Per your correspondence dated August 23, 2011, please find enclosed the
requested information for the above contract:
1) Owner: Joan L Farling
2) Account was established 10/13/1999
3) Date of death value was $23,663.78
We're here to help. tf you require any further assistance, please contact us within
the next 60 days at 1-800-848-6331, Monday through Friday 8:30 a.m. to 8:00
p.m. Eastern Time. Our annuity service center specialists will be happy to assist
you.
Sincerely,
Nationwide Financial
Enclosure
Annuities and life insurance products are issued by Nationwide Life Insurance Company or
Nationwide Life and Annuity Insurance Company, Columbus, Ohio. The general distributor for
variable insurance products is Nationwide Investment Services Corporation, member FINRA. In
MI only: Nationwide Investment Svcs. Corporation.
, Ewing Brothers Funeral Home, Inc.
630 South Hanover Street
� Carlisle, PA 17013-
, ' (717)243-2421
July 23,201:ti
Leslee J.Nace
1012 Harrisburg Pike
Carlisle, PA 17013
The Funeral Service for Joan L. Farlling
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES,FACILITIES,AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
1. PROFESSIONAL SEItvICES
Services of Funeral Director/Staff , , , , , , , , , , , , , , , , , , , $.1840.00
Casketing , , , , , , , , , , , , , , , , , , , , , , , , , , $75.00
2. FACILITIES AND SERVICES
One Day Private Event , , , , , , , , , , , , , , , , , , , , , , $700.00
3. AUTOMOTIVE EQUIPMENT
Hearse(Casket Coach) , , , , , , , , , , , , , , , , , , , , , , $275.00
Lead car/Clergy , , , , , , , , , , , , , , , , , , , , , , , , $125.00
Director service fee in MD , , , , , , , , , , , , , , , , , , , , , $350.00
C. SPECIAL CHARGES
Refrigeration 5 Days, , , , , , , , , , , , , , , , , , , , , , , $250.00
FUNERAL HOME SERVICE CHARGES . . . . . . , . . . . . $3615.00
SELECTED MERCHANDISE:
The Lonkay poplar/veneer , , , , , , , , , , , , , , , , , , , , , $850.00
Guardian Sealed OBC , , , , , , , , , , , , , , , , , , , , , , $1295.00
Memorial folders , , , , , , , , , , , , , , , , , , , , , , , , $75.00
THE COST OF OUR SERVICES,EQUIPMENT,AND MERCHANDISE
THAT YOU HAVE SELECTED . . . . . . . . . . . . . . . $5835.00
Cash Advances
Certified Copies of the Death Certificate , , , , , , , , , , , , , , , , , $200.00
The Sentinel Obit, , , , , , , , , , , , , , , , , , , , , , , , $58.05
TOTAL CASH ADVANCES AND SPECIAL CHARGES . . . . . . . . $258.05
Total
Total Cost , , , , , , , , , , , , , , , , , , , , , , , , , $6093.05
. ��P,� f�� P��
6 SUB-TOTAL $6093.05 /��J
INITIAL PAYMENT/DISCOtJNT/CREDITS 1218.48 °�/ZZ)7011 /V I � �
" � TOTAL AMOLJNT DUE $4874.57 L 112�
The unpaid balance i�ver 30 days is subjected to a 1.50%service charge per month-18.0000%per annum.
, _
��:
�: :
� ` : C�r�isle. Memorial Service, Inc. Pr'°e
DESIGNERS AND BUILDERS OF
� ,�. : Cemetery Memorials - � ���Z�'' � � �t �ca
�'•° ��, ` 41 South Bedford St � � � ��
,
Carlisle, PA 170 'U�'�
b ." ^ Telephone (717) 3-5480 �- � { �� �.: �
�� �
�,. . ,�'jC�,,p�'�� � �' of rice .��� �''�
. �. �� � �� �
Please design and build the following memorial '`��
- ���\\2�. Date �° � °° "'�, .�' ,�.�
For � .�. ,��,�da � �.'_ � • .
�
Address ,�� f �;.�- ��`��"��'� � � �-°C � �v� ��t_�t. � �'� � �/ ��'
�r t.'` d a„
Design No�''� "'���.: 1,�� �ca �1�.��
��5; �Material �,��� �,�°"�.'� � t ��.�, �,��"��� ,��'� t��:��:�S� L��� � � � ,'
�
' � as'��: � �! '����.�� �4� .
. Die _ q�� - �r� ��'��
BaSe��,��/k..e�'" Q� �'��r i��_ Uv��i!-�!)�"f�¢,E l � �'� � i��`'' � • 1 �� Y�'`9 �3�' G,,. e� ��
Markers �
Posts �L��r�� �p, �-�� Pa �.�- ,�� �
Vases
Price r � � ���� Tax
Deposit c`a���3`'''�" Q�`i � !����
Balance Due �����
Style of Letters
Foundation to be furnished by �-� �f
Material to be best selected monumental grade and to be free from imperfections and first class in every way.Work to be finished in a workmanlike
manner.
This memorial to be erected in � ��°'� Cemetery in or near
during the month of '�~!�r e'�.��. unless unavoidably delayed by labor
troubles and other contingencies beyond our control and then as soon as possible:Additional lettering and other work on this memorial in the future is
not included in the Contract Price.
Title and right of possession and removal of said stone,monument or appurtenances shall remain for all purposes in Carlisle Memorial Service,Inc.
until work and materials ordered are fully paid by purchaser or purchasers.In consideration of the acceptance by Carlisle Memorial Service,Inc.of this
4 {�.`�
order,the undersigned(hereinafter known as the purchaser)agrees to pay Carlisle Memorial Service,Inc. �.S �- � '
Dollars on or before the 15th day following
the billing of the work or job upon completion thereof by Carlisle Memorial Service,Inc.Thirty(30)days from date of invoice a 1-1/2°r6 finance charge
will be added to the unpaid balance. Said billing to be notice of completion thereof, this order shall become a contract between the purchaser and
Carlisle Memorial Service,Inc.upon acceptance thereof in the space below by a duly authorized representative of said Carlisle Memorial Service,Inc.It
being understood that this instrument upon such acceptance covers all of the agreement between the purchaser and Carlisle Memorial Service,Inc.and
that no agent or representative of Carlisle Memorial Service,Inc.has made any statements or agreements,verbal or written,modified or adding to the
terms and conditions herein set forth. ,
It is further understood that upon the acceptance of this order the contract so made cannot be cancelled,altered,or modified by the purchaser or
by any agent of Carlisle Memorial Service,Inc.in any manner except by agreement in writing between the purchaser and Carlisle Memorial Service,Inc.
and it is hereby understood and agreed by all parties involved that in case of default by purchaser or purchasers,twenty-five per cent of the total original
cost of the work or work and materials ordered,as the case may be,shall be a specified correct sum as liquidated damages which purchaser shall owe
Carlisle Memorial Service,Inc.less any payment on account made prior to such default,this specification of damages to be due regardless of removal
and taking possession of stone,monument or materials from purchaser or purchasers by Carlisle Memorial Service, Inc.upon following such default.
P , (SEAL)
;�r.��J_.� b'�'�'�' �'. 20� (SEAL)
� r�� � � ,n,,�
Carlisle MemoY�l Service, Inc:Approval By ���� z,. �.._ , d�.��.�' i ` �.^,a -b,�-"' (SEAL)
-�y �� ,_�",� � y� � � White:Office Copy,C,�a�;ary:Customer Copy;Pink: �le man Copy;Gold:Deposit Copy
� '• .
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iJtliti�ery (.;ttar7es: �; :3,Uii :' � '
>ales l�a;: $ f�. lu
1s_�ia3 hri„�ur3t ()ila; $ ii;i�1.f� Total: $?.2�
C;ash TNrclerci:l; $ ?09. 1��
i:F���i�,�{: �rt�e: � �i.�3i; Patd bYs �7.25
Cash
Change que: -$0.05
if7a;e{: You Fc;r t�7;�r� F�i�;ir?t�ss! Order stamps at USPS.caa�lshap or cali
1-B00-Stamp24. Go ta USPS.com/clicknship
to print shippin9 ]abels with pustase.
!'`rirt f)atr: ("J7/�;;�i))I For ather irfarmatidn cal] 1-800-ASK-USPS,
********,�*«*****«�******�**,�************
Pria�t Time: 1�:.�i:�),� t�� �w,rW*WVe,k*w****,tw+rk***,k,r,�+r*rk*,r*+�,v**fi*,r,h*vr
Get your �ail whan and �rhere ��u want it
with a secure Post Office Box. �ign up for
a box oniine at usps.coaalpoboxes.
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8111#: 10002Q4647175
Cterk: 09
All sales final an stamws and pustage
Rafunds far guarantzecl s�rvices only
Thank you for ��ur #�usiness
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HEtP lIS SER�IE VpU BETTfft
6o to: httpstllPQS��1exPei'�ence,com/Pos
TELL U� ABOUT YOUR RECENT
POSTAL EXPERIENCE
YOUR OPINION COUNT5
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Customer Co�Y
Leslie Ivace Acct#:662618 �,r ,.
1902 Pheasant Drive So. (717)245-2479 � � � �
Carlisle, PA 17013
[Qty�item/Products- ___ ___ __ L,_Service �.Price__� LOWE'S HOME CENiERS, INC.
1 1 Area ���� 850 EAST HI6H SiREET
ST $115.00 CARLISLE, PA 17013 (717) 258-7700
1 1 Area Clean $10.00
SH
- 10.00� OFF MILIiARF= PERSONAL USE DISCOUNT SALE -
� SALE -
SubTotal: $125.� SALES #: 51710EA1 1265938 OB-05-11
Tax(6%): $7,50
PAYMENT(5); Total: $132.50 336443 FRIG 30 PINT ESTAR DEHUM 134.10
Check#1309 $132.50 149.00 DISCOUNT EACH -14.90
Balance �p,pp
SUBTOTAL: 130.10
iAX: 9.05
INUOICE 09026 iOTAL: 14?.15
DEBIT: 142.15
T[?TAL DISCOUNT: � _90
WARNING: Customer ackrwwledg-r.s being informed and
understands thai carpet is darn��duriny and after cleaniny and that DEBIT:XKXXtXXXSXXX5064 AMOUNT:142.15 AUTHC�:aU� �2
care should be taken in steppiny onto non-carpeted surfaces to SUIIPED REFID:803910205 08/05/11 10:21:22
avuid sli�ping and hereby releases Stnnley Steemer from any and all TRACE:00950646
(iability for ii�juries which miyht ue sustained as a iesult thereof. PURCHASE CHSH BRCK TOTAL DEBIT
_ _ _ _ _- -- - 142.15 0.00 142.15
-- - _ __._..
_._.__ ._ __ _-------- -- -_
STORE: 1710 iERMINAL: 09 08/05/11 10:21:24
� OF ITEMS PURCHASED: 1
EKCLUDES FEES, SERVICES AND SPECIAL ORDER ITEMS
LMC. II I I I
�IIN�N���I���IN�I�I�INN��I�N��I��I��I�N�I��I��
,. .:_ �_: _�__ .TNANK YOU FOR SHOPPING LOWE'S.
_-.
(LeTe Nace� _._. ._ ___ ._-,—._.,_
SEE REVERSE SIDE FOR REiURN POLICY.
STORE MANAGER: RICH TROSS
Carpets luose at seairn or aluny walls or cuncrete Floors,or that have been
incunectly or defectively installed,are .r.leaneil at custumerk risk.Carpets that have HAVE A COMMENT OR FEEDBACK? LET US KNOW AT:
been exposed to pets mey sumetimes not be able to deuJaiize effectively,Any WWW,LOWES.COM/FEEDBACK
questiuns reyardiny our workmanship nju�t be iepurted within 10 days after STOI�E CODE: 17100-80511-09028
completion�f work or will be subject to a service charge at aur option. .
WE HAVE THE LOWEST PRICES, GUARANTEED!
CUSTOMER INSTRUCTIONS IF 40U FIND A LOWER PRICE, WE WILL BEAT IT BY 108.
Leave protective coasters and blucks in place far 3 days.
SEE STORE FOR DETAILS.
I HAVE AUTHURILEU-I�1E SERVICES UUTLINED ABOVE AND ����**������������������*���*�****������*******������*M*
UNDERS TANU l HE CHARGES fHEREFOR ARE UUE UPON THE * YOUR OPINIONS OUNT! *
COMPLETION OF WORK � RE6ISTER TO iIIN R i5 0 OYE'S 6IFT C . �
_. ,, _ __.. . _ _ _ . * iREGISiRESE PARR NRR U iR JETR DE R 0 LOWE'S! *
_..... . _--
_._ _._.__._---
* *
* REGISTER BY COMPL I GUEST SA SFRCiION SURVEY �
* HIN ONE AT: uiaw.l es.cam/surveY *
� * Y R I D � 09 8 1710 217 �
� *
� U SE NECES RY i0 ENTER OR WIN. *
jC iel�ce) --J --- -"-""� -- - ` �� -- - ��---`------ � VOI VlHE OHIBITEQ. UST BE 18 Ofl OLDER TO ENTER. *
* OFFICIRL ULES 8 WI ERS RT: www.lawes.com/surueY *
***************��*�* �*******�*****�*��*****�***�******
SiORE: 1710 ERMINAL: 09 08/05/11 10:21:24
Free carpet care Gp�,order produc�&servires online at
www.StanleySteemer.com
THE FOLLOIJING ITEMS � . •• �:�C��
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AAA.com
1911 WESTTRINDLE RD SUITE 1
CARUSLE, PA, 17013
Tel: 717 243-1846
_ _ _ _ _ _ _ _ _ _ _ _
26 JUL 2011 09:45 AAA CENTRAL PENN
Receipt : 03CR-4047-6/KB3 RECEIPT
LESLEE NACE 438 195 873383101 0 BA
1012 HARRISBURG PIKE Mem Since: 2007
CARLISLE, PA 717 245-2479
17013-1615
Reference Description Amount Domestic
----------------- ------------------------------------ ------ --------
1. SUN 1271631 NOTARY FEES (NF)
3 Q 2.00 US 6.00
Total 6.00
C Payment 6.00
--------------------
1. SUN NOTARY FEES
DON'T MISS OUT! Join the 1, 000 's of inembers who have saved hundred's
of dollars on their Auto & Home Insurance. Call or visit your local
AAA Central Penn Office for a free quote.
--------------------
Do you Show your Membership Card at the following locations:
Tanger Outlets, New York & Co. , Payless Shoes, Lenscrafters,
NAPA, Reebok Outlet Stores
If you do, your savings will be 10� or more.
Go to AAA.com for a complete listing.
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Carlisle Electronics and Appliaace Center
CARLISLE ELECTRONICS 1060 Harrisburq Pike
1060 HARRISBURG PIKE
CAR(ISLE,PA 17 Carlisle Penna.17013
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02J15/2013 11;47,39 Phone: 117-24 9-7822
Merthant ID; OOOQ00001988161
Termin�al ID: D2964645 �NVOiCE#
601103007446105 U822715-2-15
CREDIT CARD [ANDI SE SALF: ir�vnA�: 2/15/2 013
DISCUR SALE
CARD# Xf0U0(XX)0(XXX6532 DELIVDATE:
INYOICE 0001
B��h#; OD0589 DELIVERYI+�N: BMD � pHONE: 2 4 5 2 4 7 9
l�proval Code; 01531P IxE
TIMESCDL: WK PHONE:
Entry Metl�od; Swiped ?A 17 013
�e; ���e IPECIAL INSTItUCTIONS: sLM: JAM
iALE AMOUNT $339,20
CUSTOMER COPY �
L�DEL $ERIAL MERCHANDI$E ITEM CO3T
N N R $275.00
BROAN N N HOOD $45.00
LIlVIITED WARRANTY INFORMATION
❑1 year limited warranty:Covers major electricaU mechanical componets,labor to repair TOTAL: $32 0.0 0
up to 1 year from the invoice date.Eacludes ice makers,knobs,hinges,cabinet I,p,BpR• $0.0 0
components,trim,finis6,customer abuse,floods,fire,electrical supply problems,or acts �
of God.We reserve the right to refund or egchange the product for one of equal value. In SERVCALL: $0.0 0
home service calls on major appliances ooly,limited to 15 miles from store. DELIVERY• $0.0 0
❑90 day limited warranty:Covers major electricaUmechanical componets,labor to repair up �IGHT: $0.00
to 90 days from the invoice date.Eacludes ice makers,Imobs,6inges,cabinet components,
trim,finish,customer abuse,floods,fire,electrical supply problems,or acts of God.We anr.Fg TAX• $19.20
reserve the right to refund or eachange the product for one of equal value. In 6ome �
service calls on major appliances only,limited to 15 miles from store. TOTAL: $3 3 9.2 0
0 30 day limited warranty:Covers Iabor only to repair up to 30 days from t6e invoice date DEPOSIT: $0.0 0 N
above.Escludes,customer sbuse,floods,fire,electrical supply problems,or acts of God.
Parts or ice m�kers are not covered.In home service calls on roajor appliances only,
limited to 15 miles from store. HALANCE: $33 9 .Z�
� %Credit on new purchase of equivalent product up to. mo from invoice date. ��,�� ��� �,
❑No warranty: Product sold as is without any warranty of any kind.
I understand t6e warranty I am receiving SIGNED (
I
� ����'`� 140 Stover Drive• Carlisle, PA 17015 ►nvoice Number
REMIT TO: P.O. Box 9 + Carlisle, PA 17013 ; _- <<: , -` r�
(717)249-1535 Phone Cust. ID# Cust. P.O. Number
��'�`�t�`"�` rM (717)249-4062 Fax
Mechanical Services Inc. f� r7/
Sili To � Date Emergency Service PMP
3 Service
L �� I ;� �_::f� i'a •,�, . , z o
Billing Address � Job Address
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City � � State Zip Code City State Zip Code
r, :r'� >�-�
Home Phone Work Phone Tech
;�, ,,�.� � Code � Complete � Incomplete
Ti�chnician's R� c�rt
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P�r���ntive M�int�r�ar��+�'��r�ic+e Re art
AIR CONDITIONING � OIL � PLUMBING � GAS � HEAT PUMP � OTHER �
�. Clean or replaced air filters 0 Check controls/thermostat 0 Clean or replace oil filter
� Clean and check cordensate drains � Check voitages � Check gas valve
0 Check and adjust fan belts Q Amp draws 0 Check flue
Q Lube motor and bearings � Tighten all electrical connections � Check ignition
0 Ambient temperature Q Check safety controls 0 Combustion text
� Supply temperature 0 Vacuum Clean Unit �
� Return temperature � Examine comb.chamber 0
� Head pressure 0 Examine heat exchanger �
� Suction pressure � Clean jet line � 'Special notes-see Tech.Rept.
_ _ _,
t'��t�► M�t�r��l Used ' Tt3C �mQUn# !; � ' �i��ing Sumrm�ry
'�"r c ,1 ���'� ,., , Show-up Charge
�. ,� ; 1- �
� Total Hours
Material Used
Reclaiming Equipment
Preventive Maintenance
Program/Contract
Sales Tax
All installed parts are guaranteed against normal service failure for a period of 15 days or in ' T����,,, ��.
� �
accordance with manufactures or other specific warranties,whichever applies.All labor is ' �
guaranteed for a period of 30 days with limitations:Many defects which seem identical can
be caused by one or many parts or circuits,therefore,no responsibility`will be assumed for `'
any portion of equipment(parts or circuits)on which Tuckey's has not perfnrmed service.
This is your invoice. __..---_,___._.___. ._.......__ j�+
_.X '� Please Pay from This Invoice
The above work is authorized �� `...._--____.._._.._.--
and approved. -^+"'`^Y�
.__...___ -----°f-='... ..1
� SERVICE TICKET / PREVENTIVE- MAINTENANCE PROGRAM / CONTRACT FORM
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LOYE'S HOME CENTERS. INC. �����'N�
B50 EAST HIBH SiREET LOYE'S HOME CENTERS, INC.
CAALISLE, PA 17013 (717i 258-7700 850 EAST HI6H STREET
CAALISLE, PA 11013 (117) 258-7100 �
- 10.008 OFF MILITARY-PERSONAL USE DISCOUNT SALE-
— SRLE — — SALE —
SALEStl: 51710J62 1212900 iRAHSt: 10002064 11-15-12 SALESA: 51710CC1 1138143 TAANSN: 9081736 11-16-12
31625 3PK 15A 125U IVORY fiFCI 53.9fi 39293 2G MIDSIZE DECO TP126ICC1 1.56
29.98 DISCOUNi EACH -3.00
2 @ 26.98 SUBTO(AL: 1.56
122064 IU YAINKLE PRINCESS 2T066 2.68 TAX: 0.09
1.49 DISCOUNT EACH -0.15 INl�OICE 0975A TOTAIe 1.65
2 @ 1.34 CASH : 1.65
119631 IVORY WRINKLE S1D 6FI 3.18
0.59 DISCOUNT EACH -0.06 STOBE: 1710 TERMINAL: 09 11/16/12 11:02:25
6� 0.53 it OF ITEMS PURCHASED: 1
EXCLUDES FEES, SERUICES AND SPECIBL OADER ITEMS
INUOICE 10797UBTOTAL. 63.41 I��������������'�����������
DEBIT: 63.41 THANK YOU FOA SHOPPIN6 LOYE'S.
T OTAL D I SCO UNT: 6.6 6 SEE�REUERSE SIDE FOR RETURN POLICY.
STORE MANAGEA; AICH TROSS
DEBIT:%Xl(RX%XXXRX%5064 AMOUNT:63.41 AUTHCD:568836
SYIPED AEFID:002096171010 11/15/12 12:54:56 @E'HAVE THE LOYEST PAICES. 6UAAANTEED!
TAACE:00512986 IF YOU FIND A LOYER PRICE. WE WILL BEAT IT BY 108.
PURCHpSE CASH BpCK TOTAL DEBIi SEE STORE FOA DETBILS.
63.41 0.00 63.41
STORE: 1710 TERMINAL: 10 11/15/12 12:54:58 �*#Y*x:*:r�rx��:*:+�s***::�t*#**��r�r*+:�*rxs�*�x:x+�a�
# OF ITEMS PURCHASEO: 1 O ,� YOUR OPINIONS COUNT! �
EXCLUDES FEES. SERVICES qND SPECIRL ORUER IiEMS . 1�6ISTER TO YIN R f5.000 LOYE'S 6IFT CARD! *
Iil��lillll�����I��I���I�� * �REGISTRESE PARA 6ANAA UNA TARJETA DE REGALO LOUE'S! �
•
* AEGISTEA BY COMPLETING R OUEST SATISFACTION SURUEY *
TNANK YOU fOR SHOPPIN6 LOWE'S. x IIITHIN ONE MEEK AT: wau.laues.cow/suruev *
SEE REUEASE SIDE fOR RETURN POLICY. � Y 0 U A I D t 09754 I710 321 *
STOAE MANA6EA: RICH TAOSS * *
* NO PUACHASE NECESSARY TO ENTER OA WIN. *
YE HAUE THE LOYEST PRICES. 6UARANiEED! *UOIU YHERE PROHIBITED. pUST BE 16 OR OLDER TO ENTER. �
IF YOU FINU A LOYEA PAICE, YE YILL BEAT IT BY 108. * OFFICIAL RULES S WINNEAS AT: auu.loaes.coelsurvev •
SEE STORE FOA DEiAILS. x**e*a**x****�xs*��x:�***:sax::xs�raxx���a+a***r+x.r***+
STORE: 1710 TERNINAL: 09 11/16/12 11:02:25
*::*:#sc*x#xx**a*sx******:*sx*#►*��r�r�x►#*x►r�x►���
* YOUR OPIRIONS COUNT! ►
* REBISTER i0 YIN R t5.000 LOYE'S fiIFT CNRD! s
� iRE6ISTAESE PARA fiANAR UNA TARJFTA DE RE6AL0 LOtlE'S! *
: �
* REfiISiER BY COMPLEiIN6 A GUESi SAiISFACTION SURVEY �
* YIiNIN ONE YEEK Ai: aWW.luaes.can/surver #
* Y 0 U R I D f 10787 1710 320 x
* *
* NO PUACHASE NECESSARY TO ENTER OR WIN. ►
*UOID WHEAE PAOHIBIiED. MUSi BE 18 OA OLDEA i0 ENiER. a
* OFFICINL RULES d WINNERS AT: wma.lames.coe/surueY •
*�x****s*s*ss**t+***s�ttssrxx��a#�*#���#�xx#�ax��**x#x�*
STORE: 1710 iERNINAL: 10 11/15/12 12:5�:56
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Nl�r$ �avirrg. L04E'S HUME CENTERS, IAG.
• �l,��'�,' ��Yn�.� 850 EAST NiBH STREET ����������`
CpALISCE, PA i10i9 (717) 258-770D y
CARLISLE PR 17013 LQYE'S NOME CENTEAS
STORE MANAGER MARG Ct�h#2AN 717 249-1771 _ 10.048 4FF kIkITAAY-PERSONpt USE DISCOUNT SAIf -
850 EAST NI6H STI
GASHIE�GAN��s1�+IW4218 f 11J13 10:11 AM - SpLE - CARLISLE, PA 17013 (�i;
SALESt: Sl71QLF1 745796 TRANSN: 2417310 43-Q4-13
051421057Q15 FIHCMBQCON 'A> <M> 10.20 , - SALE •
FLX Glk�O CO1�9 3!$"-1/2" KO PK25 23971 3/AIN%iOFT SAO PUWIPE VL 1.86 SALESY: S171QMG1 67970 TRANSA:
MAX REFt� VALkJE $9,18
7837$6371907 90LT <A> <M> 2.18 OISCpUNT EACN -0.22
2-1lQA4tG CPPR qUAL RATED SPLIT BOLT 330A23 JONH2-RIN6 MAR BASKEi (24 1.33 Z4628 1-1/2 X 12 SINK TAILPI
�3�9� il'9� 1.48 DISCOUNT EACH -0.15 24621 1-1f2 X t-112 NUT 5LIF
MAX REFUNp VALUE'�$10.75/3
0000-641-98$ 2-2-2 ALSEUI <A> <M> 23856 3/4"SCH40 ADAPTEA 436007 0.33 2� p,q�
2-2-2 3E AL SEU�i^ 6 6� 0.31 pISCOUNT fACH -0,04 25016 1-1/2 COUPLINB TEE YNi
5�1.32 � 23595 PIPE Ji CNPN BP.OZ' 101 1.41 30524 1-i12 ROLYItASHfR BEUEtt
MpX REFIAVD VALUE�5.34/5
---10% off MilitarY Discount-------- 1.57 DISCOUNT EACN -Q.16 2� o.9E
28.74 10% off M�litery�Discount -2.$7 3614A5�tp 1-ii2"PUC PIPE;CUTTE 15.82 �
MUST RETURN ALL,I7EMS,FQR A FUC.L REFUND �7,58 OISCOUNT EACH -1.76
______ °SUBi4TAt;
SUBTOTAL 25.87 30524 1-iJ2 POLYIlBSHER BEUELED 2.64 iAX:
SALES TAX 1.56 0.98 DISCOUNT EpCN -0.70 INUOICE 0449@ TQFflE:
TOTAL $27.43 3 0 0.88 DEBiT;
XXXXHHXX7000 S?ORE CREDIT 5�6� 2q313 i-1l4 CNROME FOP UP ASSEN 7.21
CARD BALANCE �•� TA e.Oi DISCOUNT EBCN -0.80 UEBIT:XR%XXXR!!%XX85064 AMQUN�:13.:
ltxx7(XXKKRXXH9009 DfBIT 21.74 23868 3!4"SCH40 ELBOY 406007 0.27 Sk�iPED RfFID:42800�i]1004 03JOi
a�� � �f2� 0.30 DISC�lINT EACH -0.�3 TRpCE;OQ578342
PURCHBSE CBSH BRCK TQT
�Mt> = Mi 1 i tary Appreci SUBTOTRI: 30.97 13.34 0.00
��� t���� S� ��1��i���������Nt rax:
A24� 0� ��9�3l11 � iNWICE 027�8 T4ipt: 32.8 STOpE: 171Q FERMINpE: QA QR)
GEBIT: 62.68 ti QF ITEFtS PURCHAS
CHAN6E: 50.00 EXCLUDES FEES, SERVICES 8ND SPECIf
RETt�2N FOLICY QEFINITIONS TOTAL DISCOUNT_ 3.46 �������������������
POLICY ID dAYS POIICY EXPIRE5 ON
p 1 90 06J0912013
T t10� taEPOT RESERVES TFIE RIGHl 70 DE6IT:XXXX%XX7!%XXX5064 pROUNT.62.83 AUTNCA:51396�
LI / DENY RETt#tP15. PLEASE SEE THE SMIPED AEFIDt417360171002 03lOA113 12:i6:OQ THANK YOU FOR SMOPPIN6 LO
RE M POI.ICY SIGN IN STORES FOR FRACE:0�69255b
EIETAIl.S. SEE BEUERSE SIOE F4R flETURN
PURCNpSE CASN B�CK TOTAL DEBIT STORE KRNA6ER: RICH TA
BUY 4PkI1� PICK-t�' IN S70RE 32.83 3p.op 62.63
AYAIL NOM 4N IiOt�DEP4T,GOM.
G4NUENIENT. EASY ANq M4ST �?QERS STURE: 17tD TERNINRI: 02 0311�it13 72:i6:Ot 8!E HAUE TNE LOMESi PRIGES, SAi
READY IN LESS THAN 2 110URS! # OF ITEMS PURCHASEO: 70 If YOU fIND A LOYER pRICE, YE kILL i
xxx�exxxxxexrcxxx�rx*xxxrrxxx�xxxxr�r��r*xxx*x EXCLUDES FEES, SERUICES HNO SPECIAL 4NpER ITENS
SEE Si9RE fOR DETAILS.
EN7EF2 FOF2 A G!-1ANGE I��������������w����������
TO W2N A $5,000 '� *��*�:�*x�r*�**�xxx**z�s:xx**�**�**:�*rr
HC)h1E DE�P�p! GIFT
■ YOUR OPINIONS COUNT!
5hare Your Opinion Wi'th Us! Complate THANK YdU FOA SHOPPING EOYE'S. * 1�6I5iER T0 Ynl p t5,000 LOYE•S
the bHef survey a6out Your store vis�t SEE NEUEASE SIDE FDR RETURN POLICY. * iRE6SSTRESE PRRa 6pNpR UNa TpRdETp DE
and enter for a ahance to win at: STQRE MANR6ER: RICH TRUSS *
* NEGISTER 9Y COXPLETINB 8 6UEST S8TI5f
www.homedepot.comlopi ni on NE NAUE TNE LONEST PRICES, 6UARANTEE4'. * YIiNIM DNE UEEK Q�: Ypy,toues.ec
COMPARTA Sl.l UP2M1IZOhI EN IF Y9U PIND A LpYEB PRIGE. ME NILL BEAT IT 8Y 10$. a Y D U R I D+i d4438 1710
11NR BFtEVE SEE StDBE FDR DETNIIS. *
EhICUESTle► PARA L_A OPrJF2T
UN�DAD CIE GflNRR. � NO PURCHpSE MECESSRRY TO ENTER
USCet"' XC7- #���*�**�*'�r�*�***���***t*trt*��**��*�+r�*+�*#*r�**�**** �UOI6�HERE FRONI$ITED. MUST 8E 18 OR 0
ry62gq 721'`-j2 * YaUR OPINIONS CDUMT! * * OFFICIAL BUIES S MINNERS qT: uaw.laµe
+ t1E6I8TER TO YIN p i5.000 LOYE'S 6IF1'CRND! * **xxxxx*xe+xa**x�**x*s**rx**s*ar**rs�xr*:
1��,'�.�����,�.rJ * iREBISTRESE PNRA 6pNAR UN8 TARJETA DE REBALD LOYE'S! * ST�IE; 17t0 TERNIBflL• 09 p3JW/
* *
Entries must be entered bY 04110l2013. x REBISTEA BY CONPIETTNe q fiOEST.SpTISfACTIOH SURVEY *
Entr^ants must be 18 or older to enter. * yITHIN ONE 4EEK AT: aMw.loues.ca�lsurvev *
See oomplete rules on websita. No
purchase neoessary. * Y 0 U R i D i 02�08 i71d 063 *
* *
a NO PURCHHSE NECESSpRV TO EHTER OR YIN. *
*UOID YNERE PRpNISFTEO. NUST 6E 18 OR OLDER TO ENiER. *
* OFFICIAL HULES 6 41iNNEAS AT: uwr,luMas.co�lsurveY +�
*���*��*r�***t**#*e�*�t****t�:��*�t#s***�»�**x�*��*�r�
SiORE: 1710 TERMINAL:02 0314i/19 12:i4:Ot
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""�'°"�° PLUMBING•HVAC•WATER SYSTEMS•NARDWARE•LIGHTiNG
efo-zts-ir5s
&Ilimoro Werq
di6�T2&1133
N������� '� x�u�,Mn 8323 Puiaski Highway•Baltimore,MD 21237
$ias�� 410-574-0010•Fa�c 410-574-33f5•www.nprtheasfem.com
BnMwood,Mo 24 HOUR EMERGEMCY SERVECE:i-$77-NE-24ffQUR(1-$77-632-4d6$
LOiIE'S I�iE CENTERS. INC. �''T7�s°°
„o-r�za,se "CUSTII'MER DI�I/VEAI„
854 EAST HI6N STBEfi �.n�c
CARLISLE. PA 51013 (717) 258-7700 Icoc�Eao n ,�Mn
a�o-et�-ss�o
- 10.Q08 OFf MIlItARY-PERSONqL USE DISCOUNT SALE- ��aM���M�
<�o-�ssa000 �
aia�e�•r� �
— SflLE — eMan,up //�
SAIESt: Si710KJt 13 iRANSt: 18504Q48 03-05-f3 4°�3���' � G�-
xapramm.MU
301-T39-7474 .
24313 1-1/4 CHAOME POP UP ASSEN 14,42 aoi�Peo-oiio
8.01 OISCOUNi EpCH -O,gp ¢t°�'�' /) �
LeoWNMWn,MD
Q� 7.�� 301-475•282b / t.�
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- INSURANCE BILL
Auto&Home Insurance�
Program�m HOMEOWNERS
THE
`/� HAitTFORD A A R P INSURA�VCE PROGRAM
HARTFORD INSURANCE CO. OF THE MIDWEST
1113 �������
FARLLING JOAN L Billing ID 80330676
1402 PHEASANT DR S bl�� 0 4 201Z Customer Service 1-800-423-6789
CARLISLE PA 17013 �RWIN�McKi�GN� Statement Date 07/27/12
LAW OFFICES Policy Number 55 RBA825719
Policy Term 12/27/11-12/27/12
Balance $191.88
Thank you for your business. Please refer to the back of the bill for additional information.
If we receive the minimum amount due by the due date, you will avoid a$12.00 late payment
fee.
FULL PAYMENT
Q You may avoid future fees if we receive
,� . your baiance ofi ���. by `� ' x
,....... .....:. .;. ..
. . .
, . . , -.�:<
^ . . .. . .. : ::.
o ,::....:.......... ..:...:;.:....::.....
�
� Or, you may choose one of the available payment options shown below by paying one of the shaded amounts by
� the due date:
N TWO PAYMENTS THREE PAYMENTS SIX PAYMENTS
'� DUE DATE AMOUNT DUE DATE AMOUNT DUE DATE AMOUNT
y �s ��v;:4;::w;,e;r���>;,k:::;s:::.. ��,�.
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� AT THIS TIME AT THIS TIME 10/17/12 $98.44*
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� TWELVE PAYMENTS
� Pay �;;...� by ��:�',�. With this option you will be billed $51.72* on 08/27/12, due
� 09/16/12. Additional installments will be billed on the 27th of each month with payments due on
�
� the 16th.
�
�
� *A service fee of$5.00 has already been included in the amount due.
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- • INSURANCE BILL
Auto&Home Insurance�
Progra �� HOMEOWNERS
HARTFORD q A R P INSURANGE PROGRAM �
HARTFORD INSURANCE CO. OF THE MIDWEST
1436
FARLLING JOAN L Billing ID 80330676
1402 PHEASANT DR S Customer Service 1-800-423-6789
CARLISLE PA 17013 Statement Date 03/27/12
Policy Number 55 RBA825719
Policy Term 12/27/11-12/27/12
Balance $378.76
Thank you for your business. Please refer to the back of the bill for additional information.
If we receive the minimum amount due by the due date, you will avoid a$12.00 late payment
fee.
FULL PAYMENT -
You may avoid future fees if we receive
� ...: ... ... . ..
o your balance of ��:�* by Q;��'�.�:'���
�
�
� Or, you may choose one of the available payment options shown below by paying one of the shaded amounts by
� the due date:
�, TWO PAYMENTS THREE PAYMENTS SIX PAYMENTS
DUE DATE AMOUNT DUE DATE DUE DATE AMOUNT
::.�:.,...::.......:;,...:>;::-::.;::::.:r:.:::<.>..;,..;,..:..:..:.,.:.:::::...,.....:.:.:: ..:.....,.�.,..:...:.::.......::.:::::: ::.:.::.:..:.:.:::::.:.:.::.:.:.:..::
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� 10/17/12 $98.44* 08/16/12 191.88* 06/16/12 $98.44*
� 08/16/12 $98.44*
�
= 10/17/12 $98.44*
�
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� TWELVE PAYMENTS
� Pay �'�:�'� by Q�.�'�����. With this option you will be billed $51.72* on 04/27/12, due
� 05/17/12. Additional installments will be billed on the 27th of each month with payments due on
� the 17th.
�
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� *A service fee of$5.00 has already been included in the amount due.
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-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------
INSURANCE BILL
,��I �g,�m°,�"°InsuranTM�p HOMEOWNERS
� �� A A R P INSURANCE PROGRAM
HARTFORD INSURANCE CO. OF THE MIDWEST
Billing ID 80330676
FARLLING JOAN L � Customer Service 1-800-423-6789
1402 PHEASAN�S Statement Date 11/17/11
CARLISLE PA 17013 Policy Number 55 RBA825719
Policy Term 12/27/11 - 12/27/12
Balance $584.00
Thank you for your business. Please refer to the back of the bill for additional information.
If we receive the minimum amount due by the due date, you will avoid a$12.00 late payment fee.
FULL PAYMENT
You may avoid future fees if we receive
. .......
your balance of �8?��;:�::;;�:����{��
Or, you may choose one of the available payment options shown below by paying one of the shaded
amounts by the due date:
TWO PAYMENTS THREE PAYMENTS SIX PAYMENTS
DUE AMOUNT DUE AMOUNT DUE AMOUNT
DATE DUE DATE DATE DUE
_ .:._:::�:>��y�x>::>�:::::::;:: :;:>:::: Y _ �t
::>::::>::;,""<:'"�"'';':<»�{'>'::>::>::;::z:::>;::::::::>:?':::�.>::�> ....::::,;,,'.:":":",:':�?'�:::::v�+:<_:>::>::>::::::>:':::;�...;..�::::>�":�'�r`:�>�;<:»:: >::>::;:s:�'':>,,,`'::;",:':>:;.;:.:::::i:;::>:::>':::<::z::«:>::.;::<;•:••>;�;;,'"°:'.'';<::::>::::::>:
>:>;»:.:;:.'.>::.:::..»>:.>::a>::::>:.:_:: '. ; ...:: . .::»>.>;::::: :::::::... . ::.:.:.::::..:.:�:::::::: ::�.:'.: . �1.F.::� :»::.: �::::::::.... .::.f.:.:�::.:_:::.::::::::::: :: .>.�::. :.:::::::::._.
:_:::>::.��:..�;:.:.I:.:>;::�::_.>:>;:�>:.:;�. ...:�r:�A:.;;s:,;s>o-;:.; .;:.::.:;.;��:.�:'t:�:o:;».. ....::.::: .. .. .....:... :.;;:>:;.�:�:..�:�::�;>:>:::.:.:;;:::r::o. �;��:..A.�;:.;c::.;x:�
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06/16/12 $285.32* 04/16/12 91.88* 02/16/12 $98.44*
_ _ ._ .. . 08/1fi/12 - $191.88* 04/16/12 ... $98.44*
06/16/12 $98.44*
08/16/12 $98.44*
10/17/12 $98.44*
TWELVE PAYMENTS
�k'�::>�`��:�>:�''::::'I:��:��?::�::1��:<<�>':»::<::::<;?::::«;:: With this o tion ou will be billed on the 27th of
;:.::.:.:�.;�:.;:<.;:.;:.:;:.;:.:;.>:.:;;::�`::.:;.;:.;:.�.;;�:.>;;:.:�;:.;:.;;:.;:.;:.:.;;;:.;:.:;;::. P Y
each month with payments of$51.72*, due on the 16th.
*A service fee of$5.00 has already been included in the amo�tnt due:
THE RESIDENCE PREMISES COVERED BY THIS POLICY IS LOCATED AT:
1402 PHEASANT DR S
CARLISLE PA 17013
----------------------------------------------------------------
RATING INFORMATION:
1 FAMILY ALUM OR PLASTIC DWELLING BUILT IN 1980
STATE 37 TERR. 00024 PROTECTION CLASS 5
FIRE PROTECTION PROVIDER NORTH MIDDLETON TS
WITHIN 1000 FEET OF A FIRE HYDRANT AND WITHIN 2 MILES OF A FIRE STATION
INSIDE CITY LIMITS PREMIUM GROUP 1 .00
COUNTERSIGNED BY �' AUTHORIZED AGENT
----CONTINUED ON PAGE 2-
�ncne u_c�c rain�� n R 7 Z�
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- � INSURANCE BILL
Auto&Home Insurance
Program�m HOMEOWNERS
n�e
HARTFORD A A R P INSURANCE PROGRAM
HARTFORD INSURANCE CO. OF THE MIDWEST
1177
FARLLING JOAN L Biiling ID 80330676
1402 PHEASANT DR S Customer Service 1-800-423-6789
CARLISLE PA 17013 Statement Date 09/27/12
Policy Number 55 RBA825719
Policy Term .. a-. -1 7/12
Balance $98.44 1 ,�
Thank you for your business. Please refer to the back of the bill for additional inform ion. O 1.�1�,
If we receive the minimum amount due by the due date, you will avoid a$12.00 late payment ` �' ,rL,
fee. �l��,/
FULL PAYMENT
� You may avoid future fees if we receive
o your balance of �$:� by �:Q�<�:'���
�
�
�`° Or, you may choose one of the available payment options shown below by paying one of the shaded amounts by
the due date:
� TWO PAYMENTS THREE PAYMENTS SIX PAYMENTS
$ DUE DATE AMOUNT DUE DATE AMOUNT DUE DATE AMOUNT
.'.:. .: �.. . : .: �. � �� .��...
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° AT THIS TIME AT THIS TIME AT THIS TIME
�
�
_
�
— TWELVE PAYMENTS
= Pay :.�s..'�:�'?�* by '�:##�?�:�`���. With this option you will be billed $51.72* on 10/27/12, due
� 11/16/12. Additional installments will be billed on the 27th of each month with payments due on
= the 16th.
— *A service fee of$5.00 has already been included in the amount due.
�
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,
u . ,. ,.
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� PREMIUM STATEMENT
.
Auto&Home Insurance �MEOWNERS
Program�m A A R P INSURANCE PROGRAM
nie
� HARTFORD HARTFORD INSURANCE CO. OF THE MIDWEST
0684
FARLLING JOAN L Billing ID 80330676
1402 PHEASANT DR S
CARLISLE, PA 17013 Customer Service 1-800-423-6789
Statement Date 01/03/1
Policy Number BA82571
Policy Term 12/27/12-12/2 /13
�
Balance $599.00
� PLEASE SEE IMPORTANT INFORMATION ABOUT YOUR POLICY ON TH NEXT PAGF�-�'��Jf �
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MINIMUM AMOUNT DUE
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Pay 71.10* by 02/08/13 to reinstate our policy.
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= v�. �
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SEE OTHER SIDE FOR IMPORTANT INFORMATION
Form ACC-7022-3 Printed in U.S.A.
����� PREMIUM STATEMENT
Aato&Home lnsurance HOME�WNERS
�ragram�,m A A R P INSURANCE PROGRAM
��
HARTiORD HARTFQRD INSURANGE CQ. OF THE MIQWEST
0662
FAR��ING JflAN L g�I�ing ID 80330676
1402 PHEASANT DR S Customer Service "1-$Od-423-6789
CAR�IS�E, PA 17013
Statement Date tJ3/27113
Policy Number 5S RBA825719
Policy Term 12/27/12-12/27/13
�
Balance $559.9p
�
� P�EASE SEE IMPtaRTANT INFORMATItJN ABOUT YQUR PUI�ICY C?N THE NEXT PAGE.
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...-----------•----•--------------------------•----------------__.----------------------------------------------------�_-_---------------------------------_----------------_-----------------------------------------------------------�
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� INSURANCE BILL
' Auto&Home Insurance�
Program from
HOMEOWNERS
HARTFOHD A A R P INSURANCE PROGRAM �
HARTFORD INSURANCE CO. OF THE MIDWEST
6461
FARLLING JOAN L Billing ID 80330676
1402 PHEASANT DR S Customer Service 1-800-423-6789
CARLISLE PA 17013 Statement Date 08/29/11
Policy Number 55 RBA825719
Policy Term 12/27/10-12/27/11
Balance $39.00
Thank you for your business. Please refer to the back of the bill for additional information.
If we receive the minimum amount due by the due date, you will avoid a$12.00 late payment
fee.
FULL PAYMENT
You may avoid future fees if we receive
� your bala�ce of ��QE:3 by E?;9��:$�=�T'�:�
�
�
� Or, you may choose one of the available payment options shown below by paying one of the shaded amounts by
the due date:
�
�, TWO PAYMENTS THREE PAYMENTS SIX PAYMENTS
DUE DATE AMOUNT DUE DATE AMOUNT DUE DATE AMOUNT
...: . :;�::.: .::-:;:. :. ....:� :::::::..::::.:::�::.;.:..:;:.::>::>�:<:�::;>;>:;;:::>::>:<;:::;::;:::_..::..;..:::::...:.:.::><::::>
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� AT THIS TIME AT THIS TIME 11/16/11 $18.00*
�
�
— TWELVE PAYMENTS
= Pay �;�3��* by E19��t�:�:'�'. With this option you will be billed $18.00* on 09/27/11, due
= 10%17/11. Additional installments will be billed on the 27th of each month with payments due on
� the 17th.
�
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�
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38815-30251
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Electric Summary Page i
Service �
Balance as oi 5ep 1,2011 $0.00 �
For: Chat es:
70AN L FART.i.rnrG Tot�PL Elect�ic Utilities Charges $28.53 �
1402 PI�EA5ANT DR 5 LTNTT 40 i
CARLI5LEPA 17013 Total Charges $28.53 �
, :..:�:.:.::. �
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Account Balance $2g_53 �
Quesfions about �
this bill? Please New look comin soon �
contact us b �22 g I
at i-S00-34�57'J5 In October,we'll debut a new bill design based on feedback rovided by '
(1-800-DIAL-PPL) out customers. The new bill will make it easier to find the in�ortnation
you need. Please check out Co�nect,the monthly newsletter included in I
.. or write to: your bill, for mare inforrnation.
Customer 5ervice
827 Hausmau Rd_ i
Alleirtown,PA
18104-9392
www.pplelectric.com
. I
Meter Reading Information I
Electric KWH-Average Pet Day
USQ � Meter#44771105 i
Sep 1 Actual 70291 �
50 Aug 3 Actual 70127 ;
This gaph shows 29 Da s KWH Billed 164 i
your electric use �
� �e last 13 Average-Sep 2010 2011 � �
30 Tempetaiure 75F 73F � o
Types of KWH Per Day 21 6 ; �
Meter Readings: 20
Yearly Use: Tota1 Average ', �
Actual - 10 Oct 2009-Sep 2010 7543 Mont6hly ', m
9
Adjusted p Oct 2010-Sep 2011 8763 730 ', �
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��t� � SONDJ FMAMJ JAS I; �
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Other important information on back � : �
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With pa�perless billing,you can receive and pay your PPL Electric Utilities 4
bills onrme. The process is free, quick,convement and secure. To learn r' '
more or sigtt up,visit www.pplelectric.com.
Dish washers use about 13 allons of hot water per load That's less than
washing dishes by hand�ways use full loa.ds on the shortest cycle. When
washing dishes by hand, don't let the hot water run continuously.
Save postage and late charges-sign up for Automated Bill Payment.
Infonnation about ap liance energy use and tips on saving energy are
available through the�nergy Library ou our Web site,
www.pplelectnc.com.
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