HomeMy WebLinkAbout10-11-13 _ ___ _ __
1505610101
REV-1500 °`�°°�°°> 'd�
OFFICIAL USE ONLY
PA Department of Revenue PennsylvaMa
Bureau of IndiWdual Taxes ^ "`"�""` County Code Year Pile Number
PO soX zsa6oi INHERITANCE TAX RETURN t
Harrisbu PA i �z8-o6oi RESIDENT DECEDENT
E TER DECEDENT tNFORMATION BELOW
cial Securky Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
2o3zo y ol oy jr � � a oyo ? lYz',�
ecedanYs last Name Sufix DecedenYs First Name MI
eFavRG i�1Rs Vq �� �
( Applicabls)Enter Survlving Spouse's Informatlon Below
pouse's Last Name Su�x Spouse's First Name Mt
� rm-r-��r.�� ❑
S use's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
F LL IN APPROPRIATE OVALS BELOW
1.Original Return O 2. Supplemental Return O 3. Remainder ReBim(date of death
priorM 12-73-82)
4. Limited Esfate O 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Retum Required
death aRer 12-12-82)
6. Decedent Died Testate O 7. Decedent Maintained a Living Trust �_ 8. Total Number oi Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received O 10.Spousal Poverty Credit(date of death O 11. Election to tax under Sec.9113(A)
belween 1231-91 and 1-1-95) (Attach Sch.O)
C RESPONDENT- THIS SEC710N MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SNOULD BE DIRECTED T0:
me Daytime Telephone Number �.
N e, e� 1- e. e V 9 ) � ' � � �
� GISTER 41EWILLBZS�jONLV
CSJ =� �� � �7
m _;,, �� —a � o
F rst line of address �� �,:. r- �'' �Tr rn
r ,;- r'n � � G
RL. N � � �� �;� o0
�=, r; , , � -n �;
d line of address �..� �,, .�„ � �
O O e-, c.:. �, — n
,: a �_. � rn
C or Post Otfice State ZIP Code
"U �a D/QEIFILEH� �
C C V j ) ( � � � 8�
c rresporw�nt's e-meu address: I¢��/R2.. 'C�e V RC.� h14� � � G o m
U der penalfies of perjury,I dedaie that I have erzamined ihis retum,inGW ing accompanylrg schedules and sWtements,and to the best of my krrowledge and belief,
it i true,cortect arW complale.DeGa�ation of preparer other than the personel represen is based on all in/ormation of which preparer has any knrnNetlge.
. ATURE OF PERSON RES ONSIBLE FOR FILING ET N � DATE
4N - a - a
n oRess
Q,e c1' }� I 6 &'
SI NATURE OF PREPARER OTHER THA REPRESENTATIVE DATE
A DRESS
PLEASE USE OR161NAL FORM ONLY
Side 1
1505610101 1505610101 J
� ��
� 1505610105
REV-1500 EX
DecedenYs Social Security Number
�,�t �� �s � �� � �� �
�§ ��/
DecedenYs Name: �* �' �� ���� �c�_��` i �
RECAPITULATION
�r�a=� �, .,� �� ,;.° �iN��:-�-�. ,� �'��'_""�
�
. . .. . .. .. .. .... .. .. ... .. .. . .. ...... . 1 � � �� a��� � � ����
1. Real Estate(Schedule A). .. .. ... � �f
.�,x ����� r���
, � �
1 f� �
2. Stocks and Bonds(Schedule B) .... .. . .. ..... ... ....... .. ... .. .. ...... 2. � ,� � �5� � ��� I ����.< ���
��x������'�°°'� "- �� _;
3. Closely Held Corporation,Partnership or Sole-Propnetorship(Schedule C) . .. . 3 � � °
,��,r-;r�e"�. � :,�"��s:°"���°'�` �.,.,a�"'���'. :.:;�..
ti � � �
4. Mortgages and Notes Receivable(Schedule D) ...... .. . .. .. . .... .. .. .. .. 4 � � � � � � y� � � _ �
�� �������� �_ � ������ � `
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).. .. .. 5 � � �� =fo � ������ � �
� � z� .2 � .. .
6. Jointly Owned Property(Schedule F) p Separate Billing Requested ..... . 6 � � � � � � �
7. inter-Vivos Transfers&Miscellaneous Non-Probate Property ��'��� ���� �� �` ����� � � ��
(Schedule G) p Separate Billing Requested.. ... .. 7 � t � � � � � � � � �
� ,�
���e ���,��"�������� ���'� �� " � ��
8. Total Gross Assets total Lines 1 throu h 7 .. .. ....... . 8. � �� � � x � ��� � �_� �
( 9 ).. .. .. . .... .. .. . . , b « ; ,� �� ��
� � .
9. Funeral Expenses and Administrative Costs(Schedule H). ... .. .. .. ... .. .. . 9 � � � �� ���Q 3����`� � ����
���,.����������;�.. � , �° ��
; �o ��
10. Debts of Decedent, Mortgage�iabilities,and Liens(Schedule I) .... .. .. .. .. . 10 � � � � �`�� ���� Q �����
�x�� ,"�` �s+�'°�"; �''' �
a �
11. Total Deductions(totai Lines 9 and 10). . .. . . . . . . . .. . . .. . . . .. .. . . .. . . .. 11 � � t �� � A �� Q ��p , � ���
m�, � p.�� .� � ��
12. Net Vaiue of Estate(Line 8 minus Line 11) . . .. . 12 � � � � `�� � � � U � � �
. . . . . . . .. . . . . . . . . .. .. . . . � �
13. Charitable and Govemmentai Bequests/Sec 9113 Trusts for which ���'��`"��t��"���� *"��-�'�� ��� ����
an election to tax has not been made(Schedule J) .. . . . . . . . .. . . . .. .. . . .. . 13 * ' � � � .�
. �rc" F....���-a+d4a���� ��r ��i�� .. �'�
14. Net Value Subject to Tax(Line 12 minus Line 13) . .. .. .. .. . . . . . . . . . . .. . . 14. � � �p��� ��� �g��� � / �
�., * �,���� �, � ,r,�,���a,.�
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 - � ° � �" � '�"�°`� � ����� �"°`��� `�"'� ���°
's ' - � K 3 ,� � g � :,.�
�a)�1.2)X A— � ,r � � 15.� � � F� � �
� } '' ��� ��� � '���r�������� �� ° ;t �?'
16. Amount of Line 14 taxable � y` � ' ���� � � �� _ � � '�" `� f �
at lineal rate X.0� �j�� � � �8 M� � ��� 16. ' � � � � � � � ����
"'� " '�,� � e tr'��"����„^��`
17. Amount of Line 14 taxable �
at sibling rate X.12 � � � ��•� � � � �� � �
i ^� p .�
�; � � � ��� � �� �
18. Amount of Line 14 taxable ` � �� � � � ,
at collateral rate X.15 � � �� � � �8 � � � � � _
19. TAXDUE . . . .. .. .. .... . . .... ..�. . . .. .. .... . . .. .. .�ui�.. .. .���. .. . . . 9 �r ��� � � � ����/��,� O ��
�
� � 5 �
l�� . �� ���� .��,�� ��� � �
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
Side 2
� 15056107,05 1505610105 J
REV-1500 EX P 3 Fik Numbar a I) a � � (P �/
Decedent s Compls�s Address:
��V �u`r�e� �.e, �e�/R,e-
���E 3 0 (�1 e�,�'z v; 11�. ��D
� �N� f� �A,� pf� � l�o�s
Tax Pa and Credits:
�. T�a,e x,u��s� t�) a 9 �S• o �
z.
A Prior
B.Discoun � � �./
— Taml Credts(A*B l (2) .I, � /5. �.3�
3. I�est i �
�s� -8'
4. If Lirre 2 is tl�line i+�3,en8x Me�. This is�e OYBNMYYENT. h ,�y
F1A M ovN on Pape 2,tk�e 30 to nqwat a�etirM. (4) d� 3�. 7.D
5. H Line t r ' 3 is grealer tl�en Line 2,er�r ihe�.This is tl�e TAX DUE. (5)
Make checic payable to: REGISTER OF WILLS, AGENT.
P E ANSYVER THE Fa.L01MNG WJESTIONS BY PIACING AN "X"IN THE APPROPRIATE BLOCKS
1. Did decedent make a transtar and: ....... ...... Yes No
a. ietain tl�e use w incwrae of tlie propeAytransferted:...................................................................... ❑ �
I b. retan the right to desig�ate who sheb use tFre property translerted a its income:............................................ ❑ �
c. re9am a reversionazy ir�est�or.......................................................................................................................... ❑
d. receive thB pqnise for p'Re of either paymerts�barrefits Or care?...................................................................... ❑
2. If death occurted after Dec.12, 1�2,did decedent transier property wittxn one year d death �
wid�ait receiving adequak oaisideration7.............................................................................................................. ❑
3. Did decedent own an"in Wsl fot'or payabie-upon-0�th bank accant a security at lus a her death?.............. ❑
4. Did decedent own an individual refiremeM acmunt,annuity or other non-probate property,which �
caitains a benefiaary designation? ........................................................................................................................ ❑
�THE TO IUIV OP T11E ABOVE QUESi101�iS YES,YOU MUST COYPLETE SCHEOUIE G A!�FlLE R AS RART OF TIIE RENRN.
For�� on or af6e�July 1, 1994�ar�belwe Jan. 1, 1995,ihe tax rate imposed on lhe net vaNre of transfe�s to a for tlie use of tl�e survivirg spouse is
3 pe�ent[72 .S.§9116(a)(1.1)()1•
For � of ai a a�er ,1an. 1, 1995, tlie tax ra� imposed on tl� net v�ue d transfers to or for the use of the surviveg � is 0 pe�cent
[72 P.S.§911 ;a���.�f(x)l.rne sm�e does�at e�ce�a tran�oo a sur�vin��,ouse tr«n ta�, and ure�,wry�ey�ren,e�s ra a�su�e or a�.s ana
filaig a iax are sh'N appf�able ev+en if tfie survivirg spouse's the wdy ben�ary.
For ds�s af on w afEer July 1,2000:
• The tax imposed on tl�e oet waqie of transfers from a dac�d duld 21 years of age or yamger at death�or Ea Uie use of a naWrel pa�t, an
aaapmve «a s�a�or n�e cnaa�s o perce��z P.s.�S��s�aH�z��.
• The tax on the net vakie of tra�ters to or for the use � the decedenfs I� berrefidaries is 4.5 PBrceM. @xcept es no�ed in
72 P.S.§9 76(1.2 [72 P.S.§911G(ax1)].
. Ttre tau imposed on Me nel value of ttar�s to a fa ttie use�the�nPs�is 12 pe�ent(72 P.S.§9118(a�(1.3)].A s�ling is defined,under
Section 91 2,as an i�ual who has at least aie parent in comrtwn with tl�e dacedank wh�r bY WOOd or adoPtron.
�
�v-iso��+�ir-os}
penn.sylvania SCHEDULE A
o��,�„�oR�N,�
�„�,�, �a�. �s�a�
��
esr�re oF�,.dtk �u.�te,� �.e. ev R e� ��a
�11� — o G�'Y
AN PIO�NMLy OINMA MIM�Of M N�IR ODIIINOII IMI�M/yp���IIIM'I�q�W.f�!1I181I!!R ViW!IS ElflIMl�M M!�f�CQ i[WhICII pfOpol�'
be excharged between a wBNng Euyer and a w4Nn9 seNer,neitl�er AdnA canpelled b buy a sNl,boM haNng r�e�tonahle knowkdAe d tl�e rckvaM facts.
Red prapoty Nit k�pintlriawmd nIM rNM d sir+Ma�MiE wurt M d4cfo�ed on 9da�le P.
� Att�a c�y of#t�e settlement s�.t ff Gu property tras bes�sdd. �
NU BE0. 1"d�de m�SWy of tlie deed showing deaedent8 inberest H owned as hnant in canmon. VAQF DEA7H�
� DESCRtPTtON -
i• �{�� oa-}'zv; 1 ti 7�� Na1A� f� t?d �5 3�1000
I
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�
I
I
I
I
i
I
i
I
• (
ro��c���,u��,�,., : 3a o od
If mMC spoa is needed.MsM addXiaial sAeels of tlrc ser�c size.
i
_ __ . — __
�.�a.�,
SCHEDULE B
TMac�va�u, STQCKS 8� BONDS
x�uru�rNCr�rura
Z� Le, �vRe� �a�- o �8'y
M Jolntly�oveNd wM rbld of turNasMp m�pt 6s dMdoad w�SdN4d�F.
ITEM VALUE AT DATE
NUMBER DESCRIPTI�I OF DEATH
1. '��t� WC$'rc.Rh� uNiO� CO�k pq�Jy Gom vno N S'�Oi.k
C� � � S�,qrQ,eS C,wS i !I' / 9�98o a i o 9
f
va,�. oN y-a?-i� M�:aN ia�, y� �Sl,��, �g o a6 . 9 �
�}�,4 �tu� ou �-�� -�a �s.�� tmW e,� y-�.�-�� �s. �6 �
R ��.d +� -so��k P. k�.,R� � � ��.,�� t�.FL.,R� -xr ra
� l,�b�ud, �'��1, Y. d�e� o�fi. a� iY99
. F' R3 1 i..�70. CeiR�C1R4"�",O1J �T�I` Sh.aR2S ^�3, I v H-�a
Ual�. o,� �-a9-�a �3y� � s��'
Go�s� � ew�" v�alv.� dk.r. 3'o a co�x�a+� rn�QR
R,�.�s�'�a� -Fo �stp1► Q 1..e,Fav►v,� 8� .s 5a,�x_.�cFw,ee. 3''►'Tw
flea I.�ba..d, �'os.�pl, P t.e�e,�ae d;e�l Od"• 'otl� 194`j
�,����.��z,�� :.�'�� � � v, �a
cN����a,�..�«��.an���� .
_- --L-- _. ____—_
���.�i
� scH�au� �
,„�,�,.�,�, c,a�, e�►rr�c c�aos�rs,�r�ssc.
"'�T"�"�'"" PERSONAL PROPERIY
Esr�„ea� Vf� �"uu�- �e.`�.�.,r Re� a,""�.--. o��'�'
mdude c�osaaharl�MCnenderderhrpioeeehwisnaweaqrf�.we.�up�yJpMMlra�aww�r.rl�Mat.arNawrlpaw�ewdlwb.anasaudW.F.
ITEAf ' YAi�AT t�0.TE
FN)MBER �PTKfFi OF DEATtt
t C"�o,g�, aN ar� � ) a"'� 1• a.,3
�, I ,��-� c��.�os;�i- ,5o ?C tt�}U.2 o-�- e.or.fknl�-s i8'1.5'S"
� 1 q 8 7 l�he.v,� 7I���.�k — xo+ R,,.,�N�� (se� e,��al�-�;eN �oo -o a
! '�N eNc-�ase�t 1e'�.
<f �NSa+Ra-rrce.. �o�;cy or� 7'a,�,rnr LtfRU,e.e c,o.s F�l � W �� 1'� t- m 2.5
, .
�. �e.R,5a n�� �� ��R'`�"� : 1 311
IY'(jkSC.��� d�s Q� �lA.'P��firih��js o�� �.S�r
� � �d �-�;.�+e. e��s J �-1Pes? f�`'�s j��a ,d O
�eu��e.p. C S 6, �o
��1<s �. �xes
No pa;,��:��s a�c1 nto av..� �� 6� f�s
-�
. }3�k.. ���s='�s o �� 1 b''y. �3
R o Il e �e.e. �„1 Y►1� '1� ,Qan�� �atA�-� � , 6.i
i t�tl��� �m Ps�.� ��,k- d��- 3, `� /
�ad;-�;BN�.1 ���k �.��5 �~� �ded a� sGo • �`y
'}'�".s Re�iRe-Saa3'�S ct�a�.; �"�drJa� c2�p vs;'�"+ a'� ��
�5�. 83�, 8o r�„Nks -�ds -�.�.� �. RQ��o
? • �111�f!��5 �m ;us�rr.a,ue�
�1s�,.y�e��, :,�ul,,.�+: • 6�. � �
�e r:�y a� �7''ah,�,, 1.�.���� l,�f� QS Nu� � .�i��k
� . Q,�a� -���a� �m �-�t .���� ��- -�
a�s �� - �`�� g ,an.
i ��s� 6� �-���F�d�-!�k l��`,�1 s�+aa. y� �y
� �lso ��
���, � '�.0 � �NSwRdN� �'xl�L�! dN 'Y�
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�ece.�lenr�' �.r,�.i�,,..�r�.. s�.-����r� ����t�,g'� ��sf�.
aad: '�'�e� D an1 7— w � �
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,�x����.s,�, : JG ��3.s5
���.��.�.�.��,�,��,
.,,��.�.-- . _ . _____ __
� pennsylvania SCHEDULE H
' ���NT��� FUNERAL EXPENSES AND
, ua�eur,w�nuc nEninN ADMINISTRATIVE COSTS
n�r oct�arr
ESTATE F ���
-- '� �vA 5,���, L�.FtvRe� a �ia—o� ��'
�
�.�������. - —
NUM DESCRIPiION AMWNf
A. RINERAL IXPENSES:
i. r►'�0.R�E.('Z I 7 00•00
Re-FR�s�, h,e�u�s 196. �o
e. ADMIN[STRATIVE COSfS: --8-' �`
i. Personal Repre�riUqve CommiS5i0n5:
Name(s)at Msmal R�ve(sJ
Street Address
aN SbOe_LP
Year(s)Commissia�Paid:
z. �„K,,�: y 9? y• ��
3. Family Exanpypr.(If�address is not fhe same as daimarR's,attach e�taretlon.)
ClaimaM � �,e,,F� V R P , '� /3y.3d
�eetAddress-�� Lt�2R't'Z U, �$1-i
�Y G�A fj _.. _ _Sb6e�IIP I�eaS
Relatlmship af ClafmaM tn DecedeiR St�A� -
,. ��: 3��,so
s. �naM rea: --�.-.
6. Tax Reh�m Prepa�Fees: . --��
�. R Pl°Ra s s0.1 1'ree. ,�a.S,o0
skoR+ cr���c�te.�s+ ao �o�
a�'eCk �RaNB�EIe. 7'eC.S oZ.l�e00
R�' s+�.� �,a. � � I .�a. oc
So��}y de�os��" �+oX QR;��i'N�, �Ne kay� ISO•o0
,��p �(eRS Cornm i Ss;onl
�� 109, 60
c�+ m�r r►..0.;�r-� pR.p�a.t�a Pv� o� ���al f�;�� 9566
�S'a�'e�t'y d��•.p�fi�' b�keN9a�-UNi:1 J f' Co�W lkda�lle,� o (00•00
Sih� d�+d 1�cal Feal�' tRanAS�e.�-{a�.zes �Na�+e 1►'/atkeR �o&��� •0--
,�uc,����9.�> : 10 38'�� 1� -
; tf����,,�����,����.
-- - _ _ �— -- ----
. _ _
_ _ .
- I�� �yy��� SCHEDULE I
���«,E o�s oF o�Nr,
�*�*�� �e�u►surr�s a�a�s
��
Esr� oF � �/� ��Ne� �.�f��/R,P� ��I�O �aB�'
�«e a.u�s m�w,aa er me a.o.a«a vrw�c�ae.m wc n�n.e w�wa u eha au a a«n�,�um.�n�ersw�.aw�.
VALUE AT DATE
mx�� oacarvnoH oF oeaTn
1 pal0al�"me�1' of wbl tc W�-�uR� c,lass .5, I Gia; rY/ ;j�j � 8'4 , 8'/
�us�' �e,NNS�iRU ���Ns 1,;� .�.��,�./7'Ras1, 30 3 , 60
�ast �eNn�s�oRO Cow�r� /Local Tax �d ,a Cs�Oar��)
� � '�i 9 , a5
�asf' �eN,vs�oRO �S�h.fio� ��X �� � a.. � 1 S�� ��Z
CZW�e,R��ots Gas Ta,�k Re,v-�� a�R; � 0°�11 ' � a`l � /a
c{ �a;. � �o I a,
rwra.cn��o�u�io.�) s a Y 3 � o.ao
, �����,��������.
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fiEV-1513 O�+{9-00}�
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i ni aF r�snwwu BEN�FICUJt�S
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A�er�rc oECEOa+r
I �a,� .�,�R �4�►�- L���vR� ��i � a —o �sy
RELATIO}ISHIPTODEC�ENf AMOUNT�ORSNAFE
tU11+IBER W1ME AHDl�pDRFSB#PERSUN(S)RECEIVING PROPERT! Oo Nnt UM7taiNys) OF ESTATE
I TAXABLE[MSTRIBUIIONS IMM�ude pu�ipM apo�eN��aM Ver�eta�s uWar t
Sec.97t8{si t1�^?i iu!W cw� 3w?.
�. 'Sos;p1�. �' �,� �e,YRe� �oa wwa��;�k.R�D 5B�,t Wtatr�:�ie R.01��+j�'�
�rol.a- �A !?a�.s ��hi<-�. �a °lo dF �esi-- �e�' i
2 J�iw\�i1e. 5. Le.F�✓Re� 3N Wc�IMtG1'ST- 1+e.tie. I
R�da,,.�1� �h �'tasy �
�. T�,�,r � ���LJ�. s�, �,.� s8 � �a�� � �s�-y ,�t ;
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B. CMARITABLE AlID Ca0V6RNMENTAI DISTRIBU�IONS
TOTAL OF PAAT II—ENTER TOTAI.NON-TAXAHLE[NSTRIBUTIONS ON LINE 73 QF REW150q COVER SHEEf S
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LABT iiILL
I, iVA JoNE I.wFEVRE, of East Pennsboro Township,
Cumberland County, Pennsylvania, declare this to be my Last
Wi12, hereby revoking all prior Wills and Codicils.
FIRST: I direct that the expenses of my last illness
and funeral be paid out of my estate as soon after my death
as is convenient and expeditious in the judgment of my Co-
Executors, hereinafter named.
SECOND: I give and devise my homestead residence
�ituate at 302 Wertzviile Road, Enola� Cumberland County,
Pennsylvania to my son, Joseph J. LeFevre.
THIRD: I give, devise and bequeath all the rest,
residue and remainder of my estate, be it real, personal or
mixed, of whatsoever nature and wheresoever situate to my
five (5) children, Paulette LeFevre, Terry LeFevre, Debrah
Roschel, Loretta McNaughton and Tammy Champagne, in five (5)
equal shares, share and share alike.
FOURTH: All estate, inheritance and other death taxes,
together with any interest and penalties payable with respect
to property or interests therein subject to taxa�ion by
reason of my death and whether passing under my ill or any
codicil thereto, or otherwise including jointly eld and
other non-testamentary property shall be paid ou of the
principal of my residuary estate without apporti nment.
FIFTH: I hereby nominate, constitute and a point my
son, Joseph J. LeFevre and Paulette LeFevre, Co- xecutors of
this my Last Will. I further direct that they s all not be
required to post any bond to secure the faithful performance
of their duties in the Commonwealth of Pennsylva ia or in any
other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
to this my Last Will, which consists of one (1) sheet of
paper, dated this olf/�� day of febr�d•� , 2012 .
R800RTQNIBt
6.�rlrMllBl '�Yi�tPZ"t� EAL)
P.O.�at 13Y
��1� Iva • Lelev
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The writing contained on the one tl) preceding paqe was
signed and sealed by ivs .TUae LeBwrw, and by her published
and declared as her Last Will, in the presence of us, who
have hereunto subscribed our names as witnesses at her
request, in her presence, and in the presence of each other.
/
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COMMONWEALTH OF PEIdDISYLVANIA)
)SS
COUNTY OF PERRY )
I, ina JUae IwD'svrs, testatrix, whose name is signed to
the attached or foregoing instrument, having been duly
qualified according to law, do hereby acknowledge that I
signed and executed the instrument as my Last Will; that I
signed it willingly; and that I signed it as my free and
voluntary act or the purposes therein expressed.
�� . ��
- Ivs I.�Ssv e
SWORN or affirmed to and
acknowledged before me by
iva Jtiae Lelevre, testatrix,
this a�ti/i day of F�g�,�, 2012
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COMMONWEALTH OF PENNSYLVANIA)
)
COUNTY OF PERRY )
We ��zd�(_".@�4/AO�K _ and �/oS'�1 �- C�Al2�G/I
the witnesses whose names are signed to the attached or
foregoing instrument, being duly qualified according to law,
do depose and say that we were present and saw testatrix sign
and execute the instrument as her Last Will; that Iva Juae
TwP�vrw signed willingly and that she executed it as her free_
and voluntary act for the purposes therein expressed; that
each of us in the hearing and sight of the testatrix signed
the will as witnesses; and that to the best of our knowledge
the testatrix was at the time 18 or more years of age, of
sound mind and under no constraint or undue influence.
�
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SWORN or affirmed to and aub cribed
to be ore me by � ��1'fH?G.!'✓
and �ob'Gd/� LU- �rCA'�»7�11�✓, witnesses,
this���day of �. /�/IJ,- , 2012 .
•Gf� n q�_�
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P.0.la 7S1
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PO 80 53
Reed 'ile, PA 17084
Septe ber 28,2013
,
PA De rtment of Revenue
Burea of lndividual 7axes
PO Bo 28t�U2
iHarris urg, PA 17128-0601
� Dear ' or Madame:
1 a ae for tfie lateness af these far�t�s. The attorney we are using asked us to handle liquidating the
as�urd pay(ng#he bills. t.tnfarwnat�Y,mY mother�#t everytl�i�t�my fatfier's�ame,instead of
cha ic to hers,when he died o�October 21, 1999. 1 had to get things ir►to my rtwther's name befo�e i
cauld then get them 3Mo my name,in order to sell them. 1 also had to prove to the insurance campany that
not a 1y was my father dead,IwL that a wiil had not t�t probated when he di�d and that my mother did
inh everything when he died. They wanted proof that non�of his siblings ar other relatives had a clalm (
to an ing that was!eft€n his name. it requhed a!ot of extra ttme ta acmmpNsh. And,also,we could�ot I
find a key to the safety deposit box. it took a whi�before we gave np and#i�aHyr had it dr�ed apen. Erren �
then, here was nolt much in the box The stadc certificates and 'mwrance policies were not found untit we I
were gotag through thi�in the house this year.
This tter is to help darify the values that are listed for fumiture and personal property that belnnged ta
my er. 3he was not in her hame for much o#the lask feve years af t�e�ilfe. Tfre fiwuse was empty and
beca owerrun by mke. They did damage to mcuh of the firmiture,tiothing,and other fiousehoid items.
Md, ' p�es in the ceiling leaked water into the home. The last time was in the winter of 2009 when I
foun water gushing fram pipes In Lhe kitchen ceiilrqy. I do not know hoar long the water was runnir�aut
befo i found it. The water damage atso caused moid and rusk. The furnkure,even the wooden stands
and binets have mold on the botDams and backs of them. And,my mother had an incantinence problem
that used much of her fumiture ta tFa�re uriae on it. So,much of it has to be discarded. T#�e same
resuhed in clathing that needs to be thrown ouL In addition to tF►e probicrns at her hame that
da her dothing and other personal items,she last things due to actions of ihe hnmes she was In.
Duri g her last tllness,sfie was at Stanebridge home ln Duncannon. 'ihey threw eway all her cbthing and
pers nal ikems when she was trensported to the hospRal from that facility. A woman had died there the
sam day and they thought my mother also dled. 1 searched ttirbugh the trash Lo recaver my maRher's
gl ,whkh�nera in the dead wroman's purse,but!ciid not wan#to try ta ftnd other ftems in#he waste,
since I did not know what had killed the other woman,or wF�at other germs cauld be an them. When my
r ieft the hospitai a�gain,she went to Galden I.tving in Camp Hill. She had to keep gaog from Golden
tivin ta Noly Spirit Hospit�at and baCk again. During one af her h�spital stays,even#hwFgh tfiey were to be
savin hew room at Golden Uving,they decided to move her to another room. They IosC most of her
c!o and at#rer tbings. But,by the time she retumed,she was slying and did not really m+ss her things.
Si she had E[)if,durirtg some of fie�fiospitat time,we would have thraam her clothing and personal
item away,to avoid the danger of contaminaRion ftam them ff they had not been lost.
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On t of all Mis,when my brother moved irrto my mother's home in 2010,he threw a�eat deal of my
moth rs things away to make room for him. She was happy that he was going to Inre there, because she
could eave Manor Care in Camp HiA,where she was residing at the time. In order to move his thMgs in, he
threw away what was in the gar�e and the basement.. And, he also discarded much of what was on the
secon floor,since he wanted to Iive there. He brought In trudcs from work and just threw things out
with even looking in the boxes to see what they contafned,accordtng to my sister. My mother and
father had boxed up most of their personal things and stored them on second floor to make repairs to the
down tairs.They left them there because my mother could no longer go upstairs to the bedroom and they
had t have r�m to sleep downstairs. As I said, my brother asked my mother if he could move in and just
to out most of her things to make room for his. He did that before she came home from Manor Care in
2010. My mother wuld not walk to go upstairs or in the garage,so she did not know what he had
disca ed. My one sister had been there and tried to stop him,but she never told us. However, my mother
war►te out of Manor Care and badc home so much,that 1 think she wouid have told him to throw away
anythi g he wanted to toss, in order to get him to move in with her. She could not live alone any longer. .
I list the kems that remain and valued them. I spend a lat of time at thrift shops,yard sales, websltes
with its�s,�tf at auc[ions. I know the value of used Mings. Marry af the items at my mothers home
I ove lued. They should be thrown away due to the mold, rodent damage, and rodent droppings on
them,but since they have sentimental value they wiil be kept. The►e are no valuable antiques because my
moth r preferred new things. There are no paintings or valuable jewelry because my parents did not have
mone to purchase them..We 6uried her with her wedding rings. .
There is a 1987 Ford Truck that belonged to my father. It had 111,000 miles on it when he bougF►t it.. R has
not ru in years and is sitting in my brother's yard. The tires were new,but they are rotten now. Someone
stole arts from under the truck. I doubt that it wfll ever run,but my brother wants to try to fix it. The title
could t be found but we found it in the safety deposit box. 1 tried to get a value ftom KeNy Blue Book but
it is t old. I then went to Regester Chevrolet in Thompsontown wfth the title,since 1 cannot take the
truck. Bill, a 72 year old salesman,who has worked there for over forty years,told me that it would be
worth$70 to$200. He then took me to the finance person,who values the cars for them,and he said that
it was probably only worth its weight or about$300• I used ihe highest value aF$300 for the truck value.
I hfre a certiffed appraiser to value the property. The house is nat worth much at aN and vrould probably
be to down by anyone who bought the property. The lot is large, but unfortunately,there is a stream
that ns the entire length of the property and causes the flat area to be designated as"wetlands"so it
cann be used to buiid. The rest of the property is a very steep hill directly behind the house. The steep
hill is ot dpa�e�q�cut. For those reasons,the property is not worth very much.
I hav done my best Xn complete the forms correctly. I am including the documents I think I am to supply. I
can reached�t the address above, at my email address ��e��vRR.•����R�1 ,or at 717-275-
3722. `4 t ' �p yy�
�
Since ely,
� � p[R��/�1.�_� -�1 C�CJ '
Paule e 1. LeFevre,executor for the estate of Iva June LeFevre.
�
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LOCATED AT:
302 WeitrvYle Rd
Enda,PA 17025
Cumberland County InstrumerR Number
FOR:
Estate of Iva J Lefevre �
302 WertrviNe Rd
Enola,PA 17025
AS OF:
o�ra�no�z
BY:
Robert Ensminger �
Fortn GA2 LT—"WinTOTAL"appraisal sottware by a la made,inc.—1-800�AWYqDE
__ _ _ _ . _ _____
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Rabert Et�minpEr Approiaers
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'; �` . AppraiSal RepOrt
�= � .: . ,,..
� � � 302 Wertzville Rd
�- �- �. �
Enola, PA 17025
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� �� � � � f � `• RobeTrt E'mAdyqter ApPraiaers
— j 4K ' �e. - ` I �]p�{,I �1/J 6sfl�111
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+ . ��° = Appra�ed Value as of: 7/31/2012
�.�.wc '�„",�--
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# 32,000
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�. . .
Style/Design: 2 Story Lot Size: A�cres
Living Area(Sq.Ft.): 954 Neighbarhood: Enda
T�I Bedroams: 4 Total Baths: 1
Year Built: 1930 Effective Age: 30
Condition: Fair Date of Report: 09/06f201Z
Cliecrt: Eatate of Na J Letevre
Address: 302 Wer�ville Rd.
City: Enola State: PA Zip: 17025
Phone: 275-3723 Fax:
E-mail: piefevre.lefevre�gmail.com
Name: Robsrt Ensminger
Desi�nation: PA Certilisd Res.R.E.Appraiser
Certification or License#: RL0�952L
Expirafion Date: 6130i2011 ST: PA
Appraise�"s sig�amre E-mail: robert�ensmingers.net
Client File#: None Appraiser File#: None
TM vdw a�rwwd alwvs is mty vaYd In eayunetlm wXh IM tlhched ropal.7hls wNw aplMc^
A�tru�b and�to MypuMstlW Ca$mmaa����numptlaa �In tlie 6ody d IM rpat
� . . CapyrlpMO 2W7 by a W mode,Mic.Thic Iam may be reproducetl unmaUpbO xdlhwt wrN[en paimissWn,hmxever,a h moOe,inc.�st he aclmowhEped and uedpeG.
SF Form GPCSF_LT—"WmTOTAL'appraisal sollware by a la mode,inc.—1-80aALAMODE ���
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' RESIDENTIAL APPRAISAL SUMMARY REPORT
', SUBJECT PROPERTY IDENTIFICATION
PfOblrty AddrBSS: 302 Wertzvdle Rd City: Enola
tate: pA Lp COde: 17025 Counly: Cumbedand
L el DeacriptlOn of Rey Property: Cumberland Couniy Instrument Number
T ASSeasOrs PefCBI#`: 09-1408-34-258 R.E.Taxes:$ 0.00 Tax Year: 2010
pecial AssessmerRS:S None Known Current Owner of Recard: Le�evre,Joseph P and Iva J
Oc upancy: � Owner ❑ Tenant ❑ Vacant CurreM Occupant(if occupied): Lefevre,Joseph P and Iva J
Pro�ct Type(it applkabk): ❑ Planned Unit Developmem ❑ Condominium ❑ Caoperative ❑
ome Owners'Associatlon Membership Fees('rf applicaWe): $ ❑ per year ❑ per momh
M et Aroa Name: Enola Map Reference: 25420 Census Tract: 42641A102.04
ASSIGNMENT
Th puryosa o}this appraisal is W develop a Curront opinlon M Market Value(as deflned elsewhere in ihla report).
Pro RiqMa Appreised: � Fee Simqe ❑ Leasehold ❑ Leased Fee ❑ Olher(descri6e)
hrt ded Use: Estata purposes
lirt ded User(s)(by name or rype): Estate of Iva J Lefevre
CII nt: Estate of Na J Lefevre Address: 302 Wer�viAe Rd.,Erwla,PA 17025
A felaer: Robert Ensmirger Address: 3557 ElmeMn Ave.,Harrisburg,PA 17109-1132
MARF�T AREADESCRIPTION
Lo rtbn: ❑ Urban � Subuiban ❑ Rural Bulft Up: � Over 75% ❑ 25-75%
❑ Under 25%
Gro Rate: ❑ Rapid � Stable ❑ Slow Pro�rerty Values: ❑ Increasing � Stable ❑ UecFning
De nNSupply: ❑ Shortage � In Balance ❑ Over Supply MaAcetlnp Time: ❑ Under 3 Mos. � 3-6 Mos. ❑ Over 6 Mos.
T I One-Ihdt Price:(S) Low 15,000 High 150,000 Predominam 100,000
ou�p Haiqes: ppe:(yrs.) Low 5 High 150 P2darMnant 60
eM Land Use: One-Untt: 100% 2-0 Unfl: % Mu�i-Untt: % Camm'I: % %
Ch iqe In La�Use: � NM Likely ❑ Likely* ❑ Is Changing" •To:
M Aroe Commenta:
sublect is located in East Pennsboro Township. ft is bcated abng a busy road. All amanities are available within a shoA
ommutirg distance.
SAL.E!TRANSFER I IISTING HISTORY OF SUBJECT PROPERTY
My esearCh: ❑ Did �Did not reveal airy prior sales or transfers of the subject property Por the three years prior to ihe Ettec6ve Date M this
praisal. Data Source(s): Daed,Cumberland CouMy Tax Records
1 st Prlor Sale/Transler 2nd Prlor Sale/Tranater 3nd Prbr Sale/Trans(er
ffie M Prior Sale/Transfer. 12/29/1960
'ce M Prior Sale/Transfer: 4,800
urce(s)oi Prior Sale/Transfer Data: Deed
A a ot sab/transler hiatory,any currem aqroements of sale w Ilstlnp,and Iiatlnp history�f rolevaM):
here are no krrown recerd sales or NsGnps of the subled property.
Clle t: Estate of Iva J Lefevre CIIeM FNe No.: None AppreISE�Flle No.: None
. . CC Copynpht0 2007 6y a W irode.inc.TAis lam mry be reprod�ced unmodNed wNhout wrNh.n pertnicsim,hoxrerer,a h mode,nc.muat he�ImvMedged and aMAed.
J� form GPCSF_LT—'�nTOTAL"appraisal software by a la mode,inc.—i-800ALAMODE iN2007
�
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II
I RESIDENTIAL APPRAISAL SUMMARY REPORT
I srre oescwPrioN
Dl�enalons: 175 x zso x 226 x 190 Sfte Area: t 15 Acres
ZO NIp CI8561flCetl0�: R-1 ZONtIp DESC�IptlO�: Residential Single Famiy
Zo np Cotnpliance: � Legal ❑ Legal Non-Conforming(Grandlathered) ❑ Illepal ❑ No Zoninp Hegulalians
De RestrlcUons: Are Cavenants,Condi�ons,8 ResVicUOns(CC&R5)apqicable? ❑ Ves ❑ No � Unlmawn
ave the documarRS been reviewed? ❑ Yes ❑ No � N/A Ground ReM(tl applicable) S /
ommems:
NI eat 6 Beat Uae,as improved,is the: �Present use,or ❑ Other use(e�lain)
Ch cte�istles: Topopraphy: Sbpe above grade Size: Average for the aroa
Shape: Irregular Drainage: Averege for the area
View: Average for the area LandSCaping: Aversge for the area
er features: � Inside Lat ❑ Comer Lot ❑ Cul de Sac ❑ Underground U61Xies ❑
Itlea: Public Other ProviderlDescriptlon Olf-site ImprovemeMS: Type Pubhc Private
eiecmc�ty: � ❑ PPBL streer. n4unen � ❑
Gas: � ❑ UGI Curt(Gut[er Norre ❑ ❑
ater: ❑ � Private Sidewalk None ❑ ❑
Sanftary Sewer: � ❑ East Pennsboro Twp. Alley: None ❑ ❑
Is propxty or the ImprovemeMS located in a FEMA Special Flood Hazerd Area7 ❑ Yes � No
FEMA Rood Zor�e: X FEMA Map# 42041 C0115E FEMA Map Date: 03/16Y1009
S ConxmMe:
There are ra apparem easemeMs or encroachmeirts,The property has a steep sbpe up from the street. A tqle search,wluch is
beyo�d the scope of this appreisal,has not been conducted to discover easements of record. .
DESCFUPTION OF THE IMPROVEMENTS
s er�Deec�lptbn: #of units: 1 ❑ +Accessory unn #ot SYories: z oesiqn(Style): z story
Type: � Detached ❑ Attached ❑ StaWS: � Existing ❑ Praposed ❑ UnderConstruction
Actual Age(ye�s): 82 Eifective Age(years): 30 Year Buftt: 1930
ar Descd�on:
Founda6an: Cor�crete Bbck Exterior Walls: Aluminum
RaoT SuAace: Fiberglas Shingles Gutters 8 Downspouts: Numinum
Window Type(s): Double Hunp � Storm/Screens: Stortnslscreens
H np System: Hot water CoolN�p Systam: None
c r staeoe: ❑ None � caraae ❑ caroort ❑ o��reway (Surtace: p,gpry�tt ) rotai#m cars: z
area above prede coMains: 6 Rooms, 4 Bedroams, 1 Bath(s),and 954 Sq.Ft.of GLA
D cribe Additfonal Features and ImprovemeMS:
Side patio;2 car garage. Property is in below averege condkion with many repairs needed.
CI aM: Estate of Iva J Lefevre Client Hle No.: None Appralaer File No.: None
� � . . . CopyrlpMm 2007 hy a la mo0e,iu.This fam maY�e�epio0uud unnp9lbO wXhwl vrt�n parmissbn,hawerer,a la moM.hc.rtwst be ulmmvladped antl aeUihC.
SF form GPCSF_LT—"WinTOTAC appraisal saflware by a la mode,inc.—1-80QALAMOOE ���
i
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II
I RESIDENTIAL APPRAISAL SUMMARY REPORT
' SALES COMPARISON APPROACH TO VALUE
For e Sales Companson Appraach,tl�e appraiser selects canparable sales that ihey consider the best mffiches to dre sObject in terms af physical
cha sdes,plrysical pro�imity,and tlma of sale. The appraiser then makes ad�ustmerRS to the known sale pACa of each comparable sale ta accourrt for
d' nces that are recoWdmd by the market. For exampe,i1 the sublect has a single bathroom but a comparable has 2,the comparaMe's sale price wauld be
red ced by the athibut�le value pMen to lhe extra bathroom basad on the markeYs reaction. Likewfse,H a comparade s�e has a sm�ler square footage than
the ubject,its sale price would be ad�usted upward in the same manner. By weigMing and reconciling these adJusted sales prices together,an opinbn af
valu tar the subject can be datertnlned.
FEATURE SUBJECT COMPARABLE SALE#1 COMPARABLE SALE#2 COMPARABLE SALE#3
A ress 302 Werhvab Rd 1449 2nd St 404 High St 200 4th St
Erwla,PA 17025 Errola,PA 17025 Summerdale,PA 17093 Summardale,PA 17093
Pro ' ity ta Subject 1.16 miles SE 1.56 mAes N 1.39 miles NE
S Price E N/A $ 19,900 $ 30,100 S 30,175
Sa Price/GLA S /Sq.FtS 15.57/Sq.Ft. $ 33.90/Sq.Ft. S 26.65/Sq.R.
D SourCe(S) Inspection MLS MLS . MLS
A USTMENT REMS DESCRIPTION DESCRIPTION +(-)S Ad�ust. DESCRIPTION +(-)S Ad�ust. DESCRIPTION +(-)E Adjust.
S s or Fnancing Cash or Equiv. Cash Cash Cash
C cessions 67 DOM 5 DOM 79 DOM
Offi of Sale/Tima As of 7/31/2012 05/22/2012 03/15/2012 11/10I2011
Riq Appraised Fee Simple Fee Simple Fee Simple Fee Simple
Lo ation Subwban/Avg. Similar Similar =1
S� 1.15 Aaes 0.2 Acres +3,500 0.17 Acres +3,500 0.22 Acres +3,500
�e Avera9e Avera9e Avera9e Avera9e
De Ip�(Sryle) 2 Story 2 Story Ranch Ranch
�u otCansWctlon Averape Averege Averepe Averege
AB 82 150 +1,500 72 70
C dtlon Fair Fair BelowAverege -2,500 BebwAverage -2,500
ve Grade Total Bdrtns Baths Taal Bdrtns Baths Tofal Bdrtns Balhs Taql Bdmx Batl�s
R m Count 6 4 1 5 2 1.5 -500 4 1 1 8 2 1
Gr ss LiNnp Area g54 Sq.Ft. 1,278 Sq.Ft. -t,600 888 Sq.R. +300 1,124 Sq.Ft. -900
. Ba enlTalal Mea FuH BasemeM Fuq Basement Partial Bsmt +Spp None +�,000
B ent Flnish Area Unfinished UMinished Unfinfshed UMkiished
Fu onal UtlNly Fair Fair Averege -2,500 Averege -2,500
He ng/Caoling HW/None OFWAMone OFWA/CA -2,000 GFWAINone
En Eifldeirtltems Startns Storms Starms Storms
G ge(Caryort Z Car Detached None +p,000 None +p,pp0 Norre +p,000
Po h/Patio/Deck Patio Porch Porch Poroh
Rr aces None None None None
Oth Features
Otli Fealures
Net Ad�uStrnent(i01a1) �+ ❑- $ 4,800 ❑+ �- S -700 �+ ❑- S B00
Adj sbd Sale Pdce Net 24.6% Net 2.3% Net 2.0%
of amparaMes Gross 45.7%5 24,800 Gross 442%S 29,400 Gross 41.1%E 30,775
Co ents on tlro SNes Camparison Approach:
ales were seleded because of their cond'Rbn arW bcation. The adl�tment for functional utikty is de to the bcatbn ot the bathroom
MJ the wa&Mrough bedrooms. DOM=days on the market at the bwest listed price. The comparables irxficete the rarge of value for
he aublect proDerty.
Appralaer's Indcated Value by tlro Sales Comparlsan Approach: S 29,000
CA : Estate of Iva J Lefevre CIIeM Nle No.: None Appralser File No.: None
. . . . .. ..CC�oPY�m 20W M a h maEe,6x.TMs fam may he reqoGUCeE wmodYkd Mlhaut vuiten permiesiaq Awrerer,a k mode�Nc.must be aclmovAeOped anA creEM�.
�� Form GPCSF_LT—M4nTOTAL"appraisal software by a la made,lnc.—1-800�ALAMO� 1���
il
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!, RESIDENTIAL APPRAISAL SUMMARY REPORT
RECONCILWTION
H RxonelNatlon of the Approaches to Value:
iAll approeches to value ware considered. The cost apD�oach and the income approach were deemed not to be appropriate in
estabFshing the value of the subJect property and were not utilizsd in the preparetbn of this report. Even if other approaches to value
are used,the Sales Comparison Approach is the best indicator of market value. �
T appreisal is made � "as Is"; ❑ sub�ect to completlon per plans and spxMcatlons an the basis of a Hypothetical
Co �tlan tl�at the Irtp�rovemeMs have been completed; ❑ sub�ect to the folbwinq repoirs or alterrtbne on the hesls of a
H al Conditlon Viat the repalre ar alteradons have been completed; ❑ sub�ect to the fdlowinp requirod inspectlon(s)
ba ed on the ExtraorWnery Asaumptlon that the follawinp conditlon ar deflclency does not requlre atter�tlon or repalr:
This appraisal is made in as is condition.
❑ This report Is Neo sub�ect ta olher Hypothetical Con�tlons or Extraordinary Assumpdans as apeclAed elaewhere in tMs repmt.
ATTACHIIIENTS
A e and camplete copy M this roport conhins 25 papes, InclWinp �I exhlbite wMch are conaWered an hdepral part of the
rL Thts appr�sal roport may not be property underotood wiMout reference to the IMormatlon coMalirod In the camplete report.
A E#�Ita:
Scape of Work � Limitlng Cond✓Certificatlons ❑ Narrative Addendum � Photoqraph Addenda
Sketch Addendum � Map Addenda � Additlonal Sales ❑ Cost Addendum
Flood Addendum ❑ Manul.House Addendum ❑ Hypothetical Conditions ❑ EMraordinary Assumptions
❑ ❑ ❑
OPINION OF VALUE
OplMon of VNue may be s�dJect to other Hypothetical Conditlons and / or 6c��Eh�ry Assumpllons, H go Indlcri� above.
8 on the d� of I�ecUon of the auaect properry as Indlc�ted below; ,the deAned Sc�e of Work for thle appralsal
�nt; the �teched StetemeM of Asaumptlais and Limitlnp Co�tlons; and tM attached Appr�ser's Certllkatlona, my (our)
Cu eM OqMOn of the Marl�t_Value (or value ranpe), as deNned elsewhere In this report, W the_real_propeny that is the_subect
of 1h18 roport Is: 't 32,000 ,as of: 07/3 V2D12 � ,
wh ch Is both tha Inspectlon Date and the Ettective Date W this appraisal. _
SIGNATURES
AP AISER SUPERVISORY APPRAISER(if requfred)
or CO-APPRAISER(H applicable)
SuperWsory or
A 'ser Name: Robert Erreminger Co-Appraiser Name:
Co pany: RobertEnsmingerAppraisers Campany:
Ph e: (717)6523111 F�c: (717)370-5557 Phone: Fan:
E- �L robert�ensmingers.rret E•mail:
Dffi ot Repat(Sipnature): 09/06/2012 , Dffie of Report(Sipn�ure):
Uc se or Certiflcation#: RL000952L State: PA License or Certification#: State:
De ignatlon: PA Cartified Res.R.E.Appraiser Designatlon:
ion Date ot License or Certltkatlon: 6/3 012 01 1 Expiratlon Date of License or CeAificatbn:
Ins on of SubJect: � Interiw 8 Exterior ❑ Exterbr Only ❑ None Inspectlon of Sub�ect � Imerior 6 EMerior ❑ EMeriar Only ❑ None
D M Inspedion: 7/31/2012 Date M Inspection:
CII nt: Estate of Iva J Lafevre Cllad flIB NO.: None Appralser Flb NO.: None
� . SC Capyriphlo 2007 6y a la moAe,Nic.Thla Imm may be reprotluced unmotlf�eE xitliait v�iqen pe�mission,Amveva,�h mo0e,hc.must be ximoxietlpeG anA creAkA.
� Form GPCSF_LT—°WinTOTAL•appraisal soMeare by a la mode,irc.—1-BOo-ALAMODE iN2001
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�� ADDITIONAL COMPARABLE SALES
' SALES CON�ARISON APPROACH TO VALUE
�Aj�� SU&IECT COMPARABLE SALE N 4 COMPARABLE SALE#5 COMPARABLE SALE#6
A�dress 3pz W ertzviYe Rd 210 Susquehanne Ave 516 3rd St
Enola,PA 17025 Enola, PA 17025 Enola, Pq 17p25
P �dmity to SubjCCt 0.56 miles NE 1.16 miles SE
e Price $ N/A $ 34,g00 S � 29,000 §
Sa e Prica/GLA a /Sq.Ft.$ 35.25/Sq.Ft. S 2227/Sq.R. $ /Sq.ft
D Sou�ce(s) Inspection MLS InsPection
STMENT fTEMS DESCRIPTION DESCRIPTION +(-)=AdJust DESCRIPTION +(-)t Adjust DESCRIPTION +(-)S Ad�usf.
S s or Fnaricing Cash or Equiv. Cash Cash
Co essions 73 DOM 308 DOM
D e ot Sale/Time P,s of 7/31/2012 2/28/2012 11/14l2012
Ri hts Appra(sed Fce Simpk Fee Simple Fee Simple
Lo �tian Suburban/Avg. Similar SuburbanlAvg.
Sit 1.15 A�xes 0.16 Acres +3,500 0.07 Acres +4,000
Ye Avera9e Avera9e Avere9e
D I�(Style) 2 Story 2 Story 2 Story .
�uAtyMConstrucUonAverage Averege Averege
a9 82 92 92
Co di�on Fair Bebwqverage -2,500 BebwAverege -2,500
A ve Grade Total Bdrtns BaNs TMaI BOrtns Ba�hs Total Bdrms Batl�s Topl Bdrms Baths
Ro m COUrrt 6 4 1 5 2 1.5 -500 6 3 2 ��,5pp
Gro s Living Area 954 Sq.Ft. 990 Sq.H. -200 1,302 Sq.Ft -7,70o Sq.ff.
Bas meMTatal Area FuA Basemerrt Full BasemeM Futl Basement
Bas m�t fMfsh Area UMMishad Ur�inished Urfinished
Fu� Utlllty Fair Averepa -2,500 Averepe -2,500
He o9/Coolln9 HW/None GFWAICA -2�000 HW/None
Ene gy Efficle�d Items Storms Srorms Storms
6ar ge/Carpmt 2 Car Detached None +2,000 None +p,000
Por h/Palio/Deck patio Porch Porch
R aces None None None
Features
OMi FeaWres
Net dJustrneM(fot�) ❑+ �- S -2,200 ❑+ �- S -z,zoo ❑+ ❑- g
AdJu ed Sale Price Net 6.3% Net 7.6% � g,
oi C mparables GrOSS 37.8%E 32,700 6ro55 49.0%$ 26,800 Gross %S
Com errts:
CYe Estate of Iva J Lafevre Cllerrt Flle No.: None Appwieer flk No.: Narre
• : �� . . .��.Cr�oPY�qh�m 21107 by a h mo0e,inc.mis fam mey be re0mducd unmo6Hed wNnM vmp�Vemdssion,Aov,arer�e a imde�Inc.murt be aclmowkEpeA ana croGtled.
N Farm GPCSF_LT.(AC)—'WIniOTAL•appraisa�sWlware by a la mode,Inc.—1-BOaALAAHIOE tq/2007
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ASSUMPTIONS & �IMITING CCtNQfTlt'�NS
sue.►ecT�o�rr
,plrty AddflSS: 302 W etlxviNe Rd CiP/: Erro�a
6tate PA Zip Gar�: 17425 CttUMy: Cumberland �
S ATEI�NT OF A58UMPTIONB 8 UAMTiNG COqDRIOPIS
The a�raiser • :,ot 6e restansi6le fa matters of a�gal nature that affect dttu�the P�I�Y�9 aAi�aaisal or ihe tltie ta it The
ap aiser assna inat fhe fitle iS paod and marketaMe an6,therefare,wfli not render any opinians about the tiHe.The properiy is appraised
on the basi& of [u�ng under respansible ownership.
—The appraiser may have provided a sketCh in the appraisat rep�t to show apprmcimafe dirnensions of the improv�ne�s,and any such
sk is inciu�d only to assist the reader of t�e rc�tort in visoa8zi�g ihe praDertY and ande�s#�ding the appraiser's det�mina�on ot its size.
U ess othawise indicated,a Land Survey was not perfortned.
—If so indcated,the apprais�has examinetl the available flaod maps that are provided by the Fetleral Emergenby Managdnem Agency(ar
er data sources!a�l has notad in the appraisat repat wt�ther the subject Site is located in ao kle�fled Speci�fiood Har2rd Area.
B use�aRpraisar is n�a sur�eya,he or she makes no guardn#ees,exprass or imqiad,regardinp this deEermina�tion.
—The appraiser wifl not pive tes6mony ar apqear in caurt because he or she made an appraisai of the property in question,unless speCific
arr ngemems to do so have been made beforehand.
—The apC�aiser has noted in the atwraisal repmt anY adverse con�tiais{includinp,twt not llmit�#a,needed ret�s,deDreclatl�,ihe
p ce of hazardous wastes,tadc suCstances,�c.)observed during the inspecfima of the subiect property,or that he ar she became aware
of urinp the nortnal reseaxh involved in perttKminp ihe appraisal. Unless otherwise stffied in ihe apDraisal report,the apprais�has no
kn wledge of any hidden or unapparem condftions ot the properry,or adverse environmenta!Conditions(including,but not limited[o,ihe
p �ce ot hazard�s wast�,to�c substancas,etc.}ihat�M make Ne t��tY more or i�ss valuaae,and t�as assurned ttaat Urere are no
su h caidit+ons and makes no guarar�tees or warramies,express a impiied,regaMing the condi�on of the property.The appraiser will not be
r siWe fa any such cond'Nons thffi do euist or for any engineering or testinp that mipM be required to discaver whethw sush canditions
exi . Because tlie appraiser is not an expert in the field of environmemai hanrds,ihe appraisai r�art must not be ca�sidered as an
� ' menCal assessm�d�the
—The appraiser ohtained the i�ormatlan,estlmates, and opinions that were expressed in tl�e appraisal report from sources that he or she
co siders to be r�iaMe and believes them tq be tnie antl sorrect. The apprafser does not assume respansibiifry for the accuracy of such items
tha were tumishad by other parties.
— e api�se,r wiN not Gisdose the cant�ts of the appraisal repat�eept as proaided ta in the Uniform Standards af Professionai
Ap raisal Practice,and any applicable federal, state or local laws.
—M this apqraisal is indicated as sublect to satisfactory comple�an,r�airs,or aKeratians,the appraiser has based his or her appraisal report
an Yalua�an con�asbn on ihe assumptian that compi��f ffie Imp�av�nents+�II be perfamed in a w�kinan�ke manne�.
— a apt�aiser's c88M is the party{or parAes}who engape an apprdiser in a spec'�'ic assigrnnent.My oiher partV 8�u'Mng this repat from
the cliem does not become a party to the appraiser-dient rdatianship,Any persons receivittg ihis appraisal rrpart berause of disclosure
rea irements aODUcable to the appraiser's client do not became inteoded users o#this repod unless spec'rfia�y iderrGked bV the c�t at!he
URt Of�118 aSSI�ItiiC(d.
— e appraiser's w+�ten caisem and appravai must be obtained b�ore this appraisal repart can be canveved bV anyare to the pubiic,
thr ugh advertising,puWic relations, news, sales,a by means of any other medla,or by its inclusion in a private or pubNc database.
— appralsaE ot real property is n�a'hane inspec��'aod shouid not be consVued as suCh.As part of the valuatim�Drocess,the
raiser p�fams a non�m+asive visual inva�tory ttrat is n�Pntentf�l to reueai deiect�or deGimental can6Uons fhat are n�t read�y zpparent.
Th presense of such conditlons ar defects could adversely affect the appraiser's opinian at value.Clients with concems about such potentlal
ne tive tactas are encauraged W enAage the appropriats type of e�t to invesdgate.
— d�oph�g tlds�p�Na�,tlae apprNeer tm N�caPOrrhd a�+l the Sabe Com�femt appreech.Tha r�preNer hr�d ttre Gost
Incane approache�.The�xaisx hes detamined thetthis apprdsai procaes is rrot eo t�that Nro r�a Mdre ncignm�t are no
lon credibk.
( CII : Esiste of Iva J Lefevre CtIeM flie No.: None AppniserFllB No.: Norre
� re
. :C=Cqy�qMm 2007 hy a Ip motle,hc.Tids Po�m msY be rlpmEUCeG unmwWbE vAhoul wkm pemusslm,however.a q mndB�hc.muet 6t xlmnwNd9ed antl GedW.
X Fwm IX'GSFAtS_LT—'4Y�rTOTAI'a�x�sai soRware bY a la mor�,�c.-1-�-Pa.A6�DE �1 W 3 i4+2007
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DEFINiT{t'3NS & SGOPE OF WORK
' sua►�cr��rr
Mty Ad�'e68: 302 WertzvYle Rd Gity: Et�
I St2te: PA Lp Cpde: 17025 County; Cumberland
OF MARKET YALUE*:
M rket vaiue means the most probable price which a property shouid brinq in a competitive and open market under aU camdibons requisfte
ta a fair safe,the buyer and seHer each acting prudently and knowledi#eaMy,and assur��the Drice is n�a(f��d bY u�due sUmulus.
t pflcit in this de�nfian is the consummatlon of a sale as of a specHied date and the passing ot tide from sdler to buyer under sondi�ons
fEby:
1.Buyer and seNer are rypiCally motivaked;
2.8otl€patt�s are r�!infamed a wdi advised ar�d actin��what theY ct�sider their own best i�erests:
3.A reasonade tlme Is aliowed tor expnsure in the apen market;
A.f�ymerrt is made In ieams o�cash 1n U.S.ddiars a in terms of�nanciai arzanp�n�#s comparabte thereto;and
5.The price reptesents the normel consideratlon for the property sold unaffected by spectal or creative financing a sales coneessions
Med by anyare associffied with tMe sale.
* 's definitla�is from repuiaUOns pubiished bV faderai repulatory aqencies Dursua�t to T�fe Xi ot the Flnanciai InstiWtions
R orm,flecav�y,and EMorcernem Act{FlRREA}of 1969 6etween July 5,1990,�d August 24,1990,by U�e�tler�Reserve Syst�n
g},Natlonai Credit Unian Administradon �NCUA),federai Depasit insurance Caporatlon (FDIC),the OiAce af Thrift Supervislan (OTSI,
an the 4ffice of CortWtrdl�of tt+e Gu�rencY!(IGG�.IEris d�'��i�is also referenced in regu�ti�s l��Y R��ished bY ihe�C,075,
FR , and FDIC on June 7,1994,and in the I�erapencY Appraisai and Evaluatian Guidelines,datetl October 27, 1994.
m�d Wark is Ihe tYM+nd ezteM d reseerch and�DeMorm�d k�ui epP►+Mad wyrx�nt d�t k►awind to pradua crodibk
n�,9�ihe n#tna at the apP�Orobkm,#��pecific requhemerts of tla inl�d�et(s)�kt tl�t NiNnded u�r cf the
r10or1,INNlnce uPO�lhle►apor�,►eprdka�f Iww+�c9uir+sd,bll anY Pr'l�f a for enir aa,alher tlam tlro��P�dlbd(n thb►eport
bY �PP�►,i�prohlbiNd.TheOaniaiofYaluetlndietheeoncluaionoftldrrpwrtbcradA�MoniYriitl�iniheao�totdroScapeof
EfN01M DM0.d1e Ewb oi ReDOtt,the Inbnded UM�(s�,the IMendMt Uae4 the�ed Man�tkn�e�d LM�tM19 C�r�dbkiub rtY
Con�ttaa andlor ExtreordinxY�sumPdonR etW iheTYDe of Yalue,ae deM�d Maein.Tfie�ppr�`�e0p'�1&m�md
OMIMta�wnMenoo6N9rdon,�IehNilY,aaccou�ria611itY,anQwiN not berespa�sl6Nta�utmmulhori�d tn�e�tlde npbrta�
onei Conxnenis(Scope d Wak,ExtraoMinary Aswmptions,Hypotheticel CondiGons,eic.);
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. Estate of Iva J Lefevre G�ent F�e Ma.; None APPr�iser F�e Nu.: t�ane
. . . t�±CaPf�t020NbYap�mde.Mic.TMalammey6s�ua6icedunmallkErAtlwutv�enpemYSeb+.haeeru.ekmod4i+c.amgt6e�w+,itl�da�aetlptl.
�� Fmm GPCSFAD LT—"rMnTOTAL�appraisai soRware by a la mode,Mc.—1•8�-ALAMO� . �AQ 2�� �4�2007
�._
CERTIFiCATIONS
SUBJECT PR�ERTY
P Addresa: 342 Wertr+,�le Rd — Giry Erwie _-----�
I $ta[e: PA Zfp Cpde: 17025 Courrty: Cumberlsnd
R'S CERTIFICATION
t tlrt,to tlro bad oi mY k�owkd9e and heileC:
The stat�nems of tact eo�ained in this report a�e Erue and car�t.
The C�bi�fly of this r�aort,br the stated use by the stated user(s), of the reported anatyses, opininns,and conclusions are limiked only
b the repwted assumAUons and limfdn�caiGftlons,and are my p�s�ai,impartial,and�biased professim�a!an�VSes,oRfrriafs,and
c ctusians.
I 6ave no preseaat or pros�Uve int�est In ihe pr�ty that is the sahi�t of this�epat and no pwsonat rerEerest wAh respec#to the parHes
in oNed.
1 have no bias xdm rest�t to the prov�ty tha#Is the snbiect af this r�fort or ta the parti�invotved with#his assignmem.
My�tgagemem in tlds assignment was noi contingEa+t upa�davdoping ar reporting predetermined resutts.
Mv compensa#tUa�for campletlnp tt�s assipr+ment is not cor�inpent upon the devetopment ar reportlng of a predetermined va(ue ar direcBan
in value that favnrs the causa oi the clieM,the amaum of the valus opinian,the attainment of a sUpulated resuli,or Ne aceurr�ce of a
bsequ�t evartt directN retated to the h�tended use of this appraisaL
My analyses,apinians,and cnndusiais were devdoped,and this summary reGart has been pt�ar�i,v�co�orm�r witt�G�e Uni(orm
S ndards of Professlonai A�raisat Pra�ice ihat were in eifect at the fime this report was prepared.
!did not ba&e,eith�paartiiaYy tu canpletdy,my analySis andta the oRinion of ualue in h�e appraisai repat an the race,color,r�ig�,
S ,handiC2p,hdmil121 StatuS,or nafiona�oripin af eith�the praspective owners or occuDams of the su6�ct propeity,ar of the present
o ers or accupants of the ' In tl�e aid�lty of the sub�t pr�rty.
i have made a pe�smial inspectlon of the propmlV that is the subiect ot this repoR.
Na a�e�rnided s�ticant reai p�opertY�sai assistance to the D�sontsy sti9ni�this certificaBon.
Gert}B�xBoru:
I c rti(y that I have pertarmed no serviaes repardinp tl�e subjeat proqerty wfthin khe pria three years,as an apprais�or U any other capacity.
I
ISiGNATURE5
5ER SUPEAVISORY APPRAISEFi(If roqplred}
or CO-APPRAISER(If app�ceble}
Supervisary or
'ser Narne: Robart EnsmMgar Co-Appralser Name:
Go . Robert E�sminger Rppraisers Cnmparry:
Ph e: (717?852-4111 F�: {717}370-5557 Phane: f�:
E-m iI: robertt�ansmingers.net E•mail:
a of Report{Sl�n�ure}: Ogt�t2012 Da#e o(Report(Si�ure):
Lice se or Cartlfiet�on�: RL000952L State: PA License ar CerGf'�catlon#: Stffie:
�ion: PA Certified Res.R.E.Appraiser Oesipna6on:
Ezq ' n Oate at I.k�or CeN�CCatbn: 9t3012071 E�tp�ttnn Date of t�.mse or Certlllcation:
insp ctlon af Sub(ect: � Imerla&Exteriar � EMerior Only ❑ None Inspection of Subject: 0 Intedor 8 Extedar ❑ E�erior Only ❑ None
Daf of N�sp�tion: 7131t?012 Date ot Inspectlon:
� Estate of!va J Lefavrs C�t Hi6 No.: Narie FRe l�.: Nw�e
�DY�tm2GO7Maamoda,he.ThiePonnmayhar�eedwmoddad+�wtvsi��.Mvrerer.ak�.YU.m�t6e a�srodAtG.
� Fmm�PCSFAp,_tT—NYin70TpL"appraisai soilware by a la mode,Mc.—1-800.ALAMODE Page 3 N 3 1 D/2007
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Su lemsntal Addendum File No.None
aa er
lWdte55 302 WeAZWNe Rd
C' Erala Cou Cumberland Slate pA L Code 17025
L er 6mit
�I Fam TADO_LT—•Y�nTOTAL'appraisal soRwara by a la mode,inc.—1-804ALAMODE
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' Supplsmsntal Addendum File Na.None
�
Addtess 3p2 WertzvAle Rd
C Enola Cai Cumberland State pA Code 17025
L m/Clier&
!i Form TADD_LT—^WInTOTAC appraisal soltware by a la mode,inc.—1-804ALAMpDE
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�I' Su Ismental Add n
Pp e dum F�eNo.None
B
R AddreSS 302 Wertzville Rd
C' Enole Cou Cumberland State PA � Cade 17025
L eNCIieM
li Form TMD_LT—1MnTOTAL"appraisal soRware by a la mode,inc.—1-80aALAMODE
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���o.n�
AddrBSS 302 WertXVtlle Rd
C Enola Cou Cumbedand State PA L COde 17025
Lerder �&
A MiSAL AN� REPORT iDENTifICATiON
TMa Hepwt is at�cf u�e idbw�p types:
Self CarNdned (A wrilten report prepared under StanCards Ruk 2-2(a) ,pursuaMM tlie Scope M NWrk,as discbsed elsevA�zre in this repoRj
Sumrwry (A wrilten repart prapared un�r Standards Ruls 2-2(b) ,pursuaMto tlw Scopa of Wak as dlscbsed elseNAtee M tlds rePat)
Restr�ctad tk9 (A v��t t�er Sta�Mards t� 2-2{c} ,putsuantW tl�e Scape ot Watk,as�sclosad alsevArere�tlMS repwS,
resOlcMd to the slated irrt�ded use bytlre�ecNi�cNeM a�tended user.)
C �ats on $tandards Ruis 2-S
I ce thaF,to the best a!my Wwwledge and b�d:
— �fact a�G�s repat�e tr�and c�nect.
reported anaryses,aqnimis,and conciusians are Nmi[ed ony by tlie rpo�ted assur�tlons and Iim11Mq sakiUans and are rtry persan�,irt�arlial,and uibiased
p�ot sbnal anayaes,oqdams,and conclusions.
—U s�wisa i�dfcated.t nave na�esdd w prasPer�ve i�erost in tl+e property ttrut is the suGjaCt of ttis repat and na Dassd�z3+s�rest w0h�espeet to tre partles
—U s otlknwise Nidicatad,I have perloimed no services,as an appraiser w in any�her capaeity,regarding tlre properly that ie tlie su6�ect M mis repat wiThin If�tlues�yea�
paia lmmeQial�v prwading acceptance ot this assiqnnbnt.
—i m i�as wi�resped�11�pr�eity 1h�is ihe suhje�t of tlas repat m it�part�s ttwNved w�h 9i&assi�rma�A.
— er�errror#�tNS assi�m�a was rrot co�kg�t won aevd�Me m re�Unp predemn,�nea resuks.
— carpensatlan for eomipletlnp ttds as&fAmnent ia nM carNrpeM upon tlia Cevebpmad or repatdnp of a predeMmined value ar drectiai in ralue tl�at invas tlie cause of the
cYeM,the amaxR M tlie value npiniai,tl�c aGain�n[M a stlPuqted result,or ttm acurtence of a s�senuwd eveit dkectly�d m ffie NdaMed�e d tliis appralsal.
° �n�yses,�ion8�arx!��slm�s w�e �1t#r�t has�t ,Gt COrA'�rdtY v�r 1he IknEam Standards�PM�sianal Appr3i8al R2AICe U�t
were etlect at dia lime ihis report wa&prepare8.
—U less otl�wise indicated,I have made a personal Inspocbmi of the prapeAy th2t I�me suhject oi 1Hs ro�rL
ath�Mss indkatad,rw ane P�fl+dded sigidlica�t real P�oR�1Y�P�sal assistance to tha Persun(s)si9nin9 tlYS c�tiflcatla�N il�re are a�septWns,the nazne of each
�ng '�ficazd real property assis�e is st�ed�ewhers in iHs r�t}.
C �nts on Ap�aiisai and Report tdentMCatlon
ar�y USPAP roieded iasuas re9���0 tHscbsure a�any SYate mandated req�rom�ts:
. Co-Apprsissr.
Signa re: SignaWre:
Na Robart EnamGx�ar Mame:
PA Cer�Od Res.R.E.Aooraiser �iG�fl�Bn:
Qak ignetl: 08/06/2012 Dffie Siqned:
State atlfinaUon k: RL000952L State Ce�tlflcatian M;
Ot LkdiSC i�: ot S19�B Lic&ISe#:
ShdtC: PA St2IB:
E�ira' Date M CerUticatlon a Lkense: 6/30/2011 Ezpiradon Date ot Certlfication or License:
I�P 'an ai 5uOject I�sDec�dun ot Sub]ecl:
❑ rae r� itddiar � F�Seria � t�ce ❑ kddia ❑ Ektaim
Date Inspection 7/31/2012 Date at InspecGOn
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Addrass 302 WertzviYe Rd
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Sub�ect Front
302 WerhvYe Rd
Sales Price N/A
Gross Livinp Area 954
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� E^�� Cou Cumberlend State PA L Code 17025
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Comparable Photo Page
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Address 3p2 WerfzviMe Rd
� E"O� Cou CumbeAand SMe Pq Zf Code 17025
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. 210 Susquehanna Ave
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ap����s.zoTS Shar�owner Services
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St. Paul, MN 551840874
www.shareowneronline.com
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PN P LEFEVRE 8
t JU IEFEVItE JT TEN
3d2 R6
@N PA 170ZS2028
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Re: �inenCiat Confirrnation
Dear Shareawner.
nt Numl�er. 4i1OQ6284U8
Regi : JOSEPH P LEFENRE 8
1 JUNE LEFEYRE JT TEN
302 4YERTNILI.E RD
ENOI.A PA 1742�2Q28
M Cr'e�ion DaWr: 1/2?l1996
iss Name of Stac�c: First Oata C.orparetisrn
Total Shere Balance on M18/2013: 976.000
Gertlflca#e Sheres: 488.�4
DRS/Book-Entry Shares: 488.000
OivWend Reinvsstrnent Plar+Shares: .WO
D' ' nd Amount Paid YTD: 5.00 �;��.ao �e,+t s�a.�-d«o � ��""'�
Cbsi Price per Share on 4/18/2013: N/A � ��U P"'"��`'��� ��.,,�,�y,Q, a p�,�� �s�-`�
'S'icit SymbW f�#�e Company is: XXXX V
St Exchange: NYSE
P r�th�as a�er�ge�,u�e�e n�dkectly connected to the smck market.The�ova pri�is ghren as ary
esti te and is not a guararrtee af a spedfc prk:e.
If have any quesNons.piease ceN our olfiae WII--free at 1-90a46B-9718.Our ShareaMrtrer Relatlons SpecialiNsts are
avaii to assiet}�M�day thraugh Friday.from 7 AM ia 7 PM Centrai Tuna.You may�so s�u!ars�to�by
sel 'ng'Contact Us"at any time while ontine et www.shsreowneronline.com.
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Well Fargd Shaneowner S�rvices
1������������������ `ZFNC0109�11711�VlYYIY' � (
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www.shareowneronline.com
s
PH P LEFEVRE 6
1 JUN LEFEVf�JT TEN
902 RO
EN PA 77Nt5-2028
Re: inancial Confirtnatan
Dear Shareowner.
_ _
nt Number. 4000B28408
Regi tradon: JOSEPH P IEFEVRE 8
I JUNE LEFEVRE JT TEN
302 WERTZVILLE RD
ENOLA PA 170252028
nt Creation Date: 1/22H996
Issu Name of StoGc: The Westem Union Compeny
Total Share Balance on M18l2013: 978.000
Certificate Shares: .000
DRSBook-EMry Shares: 976.000
Dividend Reinvestrrrent Plan Shares: .000
Amount Paid YTD: 5122.00
Clos Price per Share on 4/18/2013: 514.51000
Tick r Symboi fw the Compemy is: WU
St Exchange: NYSE
note that aa a trar�afer agent�we are not dkecUy conneded to tlie stodc market The above pri�is given as an
estl ate and is not a guerantee of a specific price.
If y have any questlons,please cell our office toll-free at 1-@00-488-8716. Our ShareoMrtier Relations Speaalists are
avail e to assist you Monday through Friday.from 7 AM to 7 PM CeMral Time.You mey also send an email to us by
se ng'Confact Us'ffi any time while online at www.shareoMrt�eronline.com.
Sin y,
Well Fargo Shareowner Services
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'�� Warwick, RI 02887-0321
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'i 00167
' EST OF IVA J LEFEVRE'DECEASED
, JOSEPH & PAULETTE LEFEVRE EXECS.
, PO BOX 53
'i REEDSVILLE, PA 17084
I
_ Re: Check Number._ _006108559 _–-- _ _
Amount: S5,830:41
I Date of Check: 04/09/13
I Type: TIC-IB Life
According to our records the above referenced check was issued and sent to you on the
date in�cated.
- Thia letter is intended to verify that the transaction has been completed to your
satisfaction. It will also serve as a reminder to negotiate the check if you have not
already done so.
In order to complete our records, your cooperation is needed in completing one of the
statements and returning this entire letter to the addresa below.
I Respectfully,
MetLife Life Administration
P O Box 321
���r•; Warwick, R/028$7-0321 __ _ _
�
( 1 This check was received and cashed or deposited on approximately
( 1 This check was not received/lost. Please send me a replacemeM check.
( 1 This check was received but not cashed. �Please Explain►:
Comments:
Signature:
Date:
(Please return the entire letter.)
__ �_ _ __ _ __
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IM�t�1'�e� ,
aoo�,
�METLIFE INSURANCfi COMPANy OF CONNHCPICSPl
(Pt? Box 321
iKarnrick RZ p2887-8321
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PAUL�$1TPs LSFPiVRE
PO BOX 53
34 41ALN0'P ST
R&SDSVILLE PA 17084
1
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POLiCY NUMBEI2 : 82GF76847
CFIECR NUMHER : 890L 060031069
CliECIC AMOt7NP . **:***:*$1,141_25
INu^ITRSD : TAMMY LE FE:VRE
you requeeted, a surrender has been proceesed on the referenced
ontract. The a�rrender was calculated as fallovs:
ash Value $ 1233.28
lua Llnearnefl Interest $ 5.76
lus Refund Premium $ 34.31 1
ss 4ctstanding Loan $ 132.10 ^ �'� � h� �'��
" ederal Tax Withholding $ 0.00 `�" `�'I�
tate Tax Wikhholding $ 0.00
urrender Proceeds $ 1141.25
he release of pa23cy valuss as a result of this transaction may
fect the guaranteed eiements, nonguaraztteed elemexite, faoe amaunt
r surrender value of the policy fran which the values are released.
f you have any qixeations, please contact your representative or aall
ur Customer 8ervice Center at 2-SOQ-334-429$ i�nday through Friday �
tween 9 a.m. and 6 p.m. , ST.
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,
I) Sharcowner Servlces
� � PO Eaz 64854
. ( St Paul,A4Y 35164-0854
www:shareownerorrt ine.com
! May l0,2013 Rtgasat#190121 p3
i
� FAULETTE d I.EFEVRE
I 34 WALNUT ST
PO BOX S3
�� REEDSVILLE PA 170&1
IRE: Corq�y: F'vst T�ala Caparatian naw eacctuagcabk fa�a cash paymeni
I Cenkificate(s): S 003I47 far 244 shanes and OQ7726 for 244 shere.s taraling 488 shares
Re�ishation: loseph P Lefevre&I lune Lefevre J2 Ten
-Dear Paulotte I[.eFevre: ,
Tliattk you f�t�ifying us thst the adt'rfic��te(s} li�ed above ane tosk or stotati. A sMp Vmisf�ot�det 1�as been
placed agaiast the ccrti5cate(s). if ihe cutificate(s)are locaud before bein6�P�P�natify us in writing sa
that wc may removo the stop trsnsfer order.
Here's what you neai w do w replace ifit ceRificat�s}:
• We wiii requ've an indemnity bond.The baad is roquiued to indemnify Weils Fargo Bsnk,N.A. aa transfer
agw�t and tl� issuiag against:sny!i�'IIry which may az� by-ntasw� of the issuance af the
raplacement certificate.See below fa fivther infom�etioq on the iudemnity lwnd qitiona.
Pleesc choase dne of We aptia�listed below fw pravid'wg.us with the indemniry bond.
QPtion I-amo�,y for dse indcmnitv band thr uo $�
App1y for tlie indemnity baid BuaeBh us bl'comP�e��n8 the tmciosed affulavit of Ioss mx!ic�ity egreemem from
Tnvckrs esausuy ana s�dy rAm�ny of nmaica. nny fieWs aoc co�pleua mry aolay the re�l�a�,esc proccss.
(ease comptrxe tiu fallow3ng i�on the affxlarir.
• List tht Shareowr�'s name, du �Ys nsrne (the iudividuat suthorized w act on behalf of the
regisoered owmr),md then wriW Ihe deponenYs capaciry(titie).
� For s�campk:Jans Doe EsanWr af ths John Aoe Estata
i • Number t should be compieted by the deponent in its entirery. Please complete the information as
req�•
INote:We eaanot accept a P.O.Bo:as the addras of raidence.
I • Nutnber 2, indicate approximately when the stcurity was acqtnired, when you determined that tho shares �
wero lost,azui thc circumstanco af the i�s ta ibe beat af yaur Imowladge. I
INate:�Unkaowa"and"N/A"are aat acceQmbk rerponees ar the Afridavit of l,oss. I
• Number 3,�dicauie if tMe back of the c�ti�satc{s)�a segxraEe aksck powa was signed.
INata�Unknown"aed°N/A"sre oot aeaepqbk raponsa on the Aftidavit of L,ose.
I • Number 5:enter the deponent(s)capacity(ritle)and then enter the Sheceowner's name.
� • Tha deprrnent(s)must sign the Affidavit of I,oss in tfiair capacity iu the prosenco of a Nokary Public.The
deponont(s}must an�r#fiexiate they signed�Aftidavit an#6e�iae ae�ter t�ev sign�ture.'�'�c N�sry
� I PubGc must mber t6e date they signed on thc line below tlieir signawrc.TLe d�tha depoe�t{s}sigis the
, Affidsvit af Loss mnst match the dete of the Notmy Public.Pkaiae eanpkte ttie intarmatfoa ae
,, FCI��Cd. . . - ...
For e:amplc:Jane Doe Esecutor of the John llroe Eatat+e. Tog�th�.we71 gd far
� �+ .
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Pleasc submii s ahcck fcu fhe f Z 16.�g��,�eheek shautd be madt�ysblc to Strareawner Services,
. and must be preprinted with tlld� � owner s nfw�roazion. V✓e cannot accept staRcr or counter checks.The
j fee attravnt combt'nes the 5166.00 Swety Premium and a SSO.OtY se�vice fee.
' �...`x
', OP'('ION 2-�rovide an indemniN�n &om��reliebM suretv cornnenv:
i
IYou may ekct W}NOridc us wiih an int�nniiy baad$am anotl�sr ratisbk suretS`�mP�X `�s�Y�#�Y
I must also be rated A or better by A.M. Best&Companp. A.M. Best dt CampsnY provides a roview and assigns a
I ratmg which mats standazd,c f� q�ntitstive and qnalitaave snalysis af the Campany's financisi condition m�d
Ioperaating perfarmance. Compenies wfth a lower rating are more wlnerable and potentially rnay not meet fuwre
� insurance obligations.
II if you chpose W fiunish this type ai"bond.there may be a fx invaived based on tlieir compeny requiremeMs. This
bond must be an open penalty indemnity botid and presented m us in duplicate. The b�d must ind�nnify the
Ifollowing:
� • Pirst L�ata Corporation
I • Wells Fargo Bank,N.A.
ITherc is a service fee of 550.00 for processing bontls&nm othu swety compaaies. P►east maka the ehxk�yabk
to Shareo�vner Servicp.Piease mail the indemniry bond and ihe check for the replaccment fce to us st the address
listed above.
I
The a�ond step ln t6e process is to repbce and trqnater the a6ares out at tha decedent�'aamea. In order to
ea�pleta t�e rephetmtat,wt a�ill reqeEre oat otthe foitowisg:
I} Medsltion Gnanetet:
� . The Affidavit of Loss compietai and signed by the sppointad legel r�presao�utive of the sxond
daceaw,M shareowner's estate with tl�ir sigoauues guatanteed'u2 fI�Me�iti�formst by an
eligible guarantor instihNion.T6+e Medallbe sfamp mnst not be dated or aobed iu uy manper.
�I 2) F'.a[atiC Leg�l Dacume�ts:
� . An updsted coiut certitied copy of the 4euers of Appoimonent namiag tht execator.administretor,
or personat tcpresemstive far the estatc,datcd within 66 days ofihe date the sWCk is presented for
transfer. ••Mease ooie: the preHoasly wbeittM Skort CsrtlBes�te wn dated T�ebrasry 25,
I20I3 and b ont of data The S6art CerNflate MII need In be reartitied aed dated w�it6ie 60
i �y�'
I
• A copy of dte deattt ctrtif�far b�h deeedsnts.
IWe wfll alao raqaire t6e foilowlog W rnmpkte the trrosfer; �
I • The enctoud Lettar of Transmittat signeA by the mc�utor,edministrat�,or p�sanai n�6ve of
the estate in Box A with du signatwe gusrantaed in tbe Medsllion format by an elig�ble guarantor
iavtitutian in Box F. Tikr Me�dalilsu�aaqt Aeep�t be dr�ar�hr s�ey mmmer.
I . Inshuctions for die ixsuanez of the shares.ia Bmc C of�e LeEter of Transmidal. Please inel�ifse
camplcte name(s),address,and social security nwnbrar in Box Gi for the ntw ngistration. �
iI . Tlre original stock certificate S 003149 for 244 ahacea to be exchanged. We mcommead sending d�em
by registered,insured mail for 2%of the current market vaiae. �
�leas�e retum your ariginsl request when responding to this Idt�a�d e�l�a!t raquired documa�ts. �
I
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�: _ _ _
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. . If you have any questions abou�:i�Cbe prepedwes, P�eau ca11 our office at ]-800-4b8-9716 or 651-450-4064 to
�� speak with a Sharoowner Itepro�t�ive.qw Shareown�Itelations Specialists ara available to assist you Monday
I through Friday from 7 AM to 7 PM Cemral Time.Thank you.
i
I Sincerely,
I L.ost Securities Department
(MO)
For intemal uye only:
RETURNED DOCUMENTS:
All pepers XP93698
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PE ONAL fTEMS FOR IVA JUNE LEFEVRE ESTATE ESTIMATED MARKEf VALUE
Des Chair $ 35.00
Tr k $ 50.00
5 rockingchair $ 45.00
Ma tel dodc-wind up(dces not work+missing a decorativP P�) $ 50.00
Ce mk pitcher and bowl made by Mom $ 25.00
Cer mic pitcher and bowl made by Mom(chipped) $ 15.00
Cer mic tree(small)with bfrd lights made by Mom $ 15.00
Rad o cabinet g 40 Qp
La e Old Dresser with mirrot $ 35.00
Sm ightstand with drower in badc BR $ 10.00
Pen y wall hangin8 $ 5.�
Wa erfatl dresser $ 35.00
Tall Id dresser with door on it inside back BR $ 2S,pp
Old mall Freezer $ 30,pp
She Debbie got Dad behind front door $ 6.00
N I 'ng room $ qp,pp
Biac four pronged stand beside couch Mom used for water $ 10.00
Clot es Tree $ 10.00
Thr floor lamps(taking as set) $ 35.00
Kitc en Aid m�Cer $ gp,pp
La "Christrnas Tree stand"in the comer of LR S 5.00
Wa Stand Distressed in her old BR S 25.00
Ugh over DR table S 5.00
sma I green vase on the entertainmeM ccr $ g,pp
Arm tel Boat Wate $ 6_00
, 1Nas stand in back BR $ 15.�
Ak itiorrer(very old) $ 20.00
Naf musk water gbbe $ Z,pp
Chi 's roll top desk $ 10.00
Floo redio in lR(1950s) $ 15.00
Dou le metal cabinet in M&D 8R $ 5,pp
N s anding trays in LR(wobbly) $ 5,00
Ra it with arrot Mom made S 2.00
Cast iron skillets $ 10.00
Gun rack $ g,pp
Larg cake dish with lid in china cabinet $ S.pp
sma I round hobnail bowl or dish $ 3,pp
' Litti hob nai)saucer $ Z,pp
Gri le $ 7.00
sak el�ars(61 S 2.00
il dish in middk of top shelf $ 4.00
Cere it Mouse&Cheese dish $ l.pp
Filin Wbinet $ 25.00
Pa it glasses $ Z,pp
Sma I round hobnaii dish $ Z,pp
"Egg Plate"(Holds deviled eg�) $ 3.00
i
f�a�egg beacer S a.00
R e glass piate $ Z,pp
Ro nd deep crodt bowl S 2.0t7
la twM►ail cake t�ate $ 5.00
Gla saiad bowis sei S S.W
Gla double serving dish $ 3.00
5 II rec#angular cut gla�s tNsh $ 1.00
Sm tl giass dish 5 1.00
Ey bowl $ 1.OQ
5e2 of smali crystal bud vases $ 4.40
Old Salad 6owl wkh fork&spoon $ 6.Q0
Ca ng knffe&fork $ 5.40
Gta s bawi 5 4.00
Cry al glass $ 1.50
Ve smai!glass dish $ 1,00
Tail glass"cete�yr'holder $ 2.4Q
Gla Jelly jar for canning $ 0.25
Di with goFd trim $ 1.44
Sm II pedestal pmival gtats dessert dishes{2) $ 1.SQ
Sm 11 pink dish tn use as barrette tray on dresser $ O.Sp
GI suga�bowi $ 0.5tt
� Pin "ceiery dish" $ 1.Of3
II glass salad bawl $ O.Sq
Set giasses{6}Piaire giass $ 3.Od
oid ugar bowi $ 0.50
MU glass dessert pedestal cups(2► $ 1.00
t piate $ 1.00
pie tate 5 S.Op
pie late $ 1.00
Bowi Set S 3.00
Ste k knives S 3.00
ta plasfk container $ 1,00 �
Sq re brnt s��t $ 2.UC! (
Me t pletter(only ane rat cracked) $ 2.00
Pi pple pnnG�g jar $ 0.54
Sr�u i piastic cor�tait�er on wheeis $ 3.00
Lar �er Mom made wFth a turkey on it $ 2.00
GR Mug $ 1.Q0
Arm t Mom disfi $ 5.00
Ccxnmonwcatth tup $ 5.00
t Ti�y erra)dish $ i.0t}
{ Rou biscotti Jar $ 1.Sp
Sma I chicken covered glass candy dish S 1.50
Th d hoider $ 2.OQ
Prin ess house smai)giau dish $ 2.00
Cup $ 0.50
Sma I ramd�sh with metaf tegs $ l.�'}
�� _ i
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fo due set $ 3.�
ye�low glass plate $ 1.�
va S 2.�
tal dish $ 0.75
Ch tree dish $ 1.00
while chipped meat piatter $ 0.25
Ro e plate with creck 5 0.25
S all Christmas dish $ 0.25
Ba tender figurine $ 0.75
M at platter chipped $ 0.50
B� froB $ 1.00
Lr basket 5 1.00
Ro Is basket S 1.00
W ite glass grape vine dish 5 1.�
B r stefn glass $ 1�
dfs with four holes S 1.�
ch ap tin can for stora�e $ 0.10
Co 'er hen basket $ 2.00
Sm II liquor bottle set(2 bottles to hold ifquor) $ 1.50
Ste med glass $ OJS
Gr vy boat $ 1.00
sti ed dish S 1.00
�� �p��� $ 1.50
ste med goblet $ 1.00
mu hroom trivet $ 0.75
C I dish $ 1�
Sm II camival glass bowl $ Z�
Oil le 5 0.50
5 11 princess egg shaped jar $ ��
�a � S 1.00
sm II wuvenir spoon S 1�
sm If white horse knicknac $ 0.75
s 11 mother's basket $ 1�
����2) $ 1.00
Se 'ng basket 5 0.75
s II souvenir spoon $ 1.�
� $ 0.50
Cfii en's dish set 5 1.�
Bird vase $ 1�
Bird night Iight $ 1.�
bl vase S 1.00
si r child's fork $ 1.00
Sm II quik easy ktt fw child to make $ l,pp
sma I wuvenir spoon $ 1�
Biu i Jar S iJ5
sma I glass toothpidc holder $ 1.00
art dish 5 2.QQ
___. _ _ _i
� __ T _ __ _ __ __
Sma�l pheasar►t plate $ 1.�
Sma I WV hillbilly knickknack $ 0.50
Glas s(3 small juice) S 1•�
Emp�ty Penn State soda bottle $ 0.50
Me I napkin holder S 0.50
Sm I wooden raptain knidcknadc $ OZS
Poc et knife $ 1.00
Tab saw not used fm 16 yrs. $ 50.00
Ta saw not used for i6 yrs. $ ���
5 117001 box with hand tools $ 35.00
M I hand saw $ 5•�
m (3) $ 6.00
sma I yellow vase $ 3•�
sma I white vase witfi rose $ 2.50
C I egg dish $ 2.�
Ch I dish S 3.00
sma I tabletop propane grill $ 8.00
co 'uter desk S 7.�
Dou le bed $ �•�
ce mit rab�t flgurines(5) 5 15.00
me hanical banks repainted $ ���
5 I banks(not mechardcail(S) $ 30.00
ce mic jackolaMem lamp $ 15.00
cer mit lephracan lamp $ 15.00
cer mic chess set S 25.00
Fla off Dad's casket $ 15.00
Box of aluminum and stafnless pans $ �•�
Box of aluminum baking pans S ZZ•00
Box of dishes 5 45.00
Box of woking utensils S 25.00
, Box of auorted nafis $ 50.00
Box of plastic ware S 5.�
2 b s of cheap plastk Christmas omaments and tkcorations 5 20.00
VC tapes $ 15.00
Rs ds 331/3 $ 165.00
DV $ 15.00
Wh elchair manual(srt�ll) S �5•�
alu inum clothes radcs(2) 5 16.00
cer mic mexiwn boy statue $ 5.�
ce mic chidcen S 6.�
ker sene heater(22 yrs.old) S �•�
ker sene container $ 1.50
gas conWiner S 1.50
I kftchen sWnd with three shelves(rusted) S 5.00
she ves above tdlet 25 years old) $ 5•�
el ic oii heater(about 15 years dd) S 5.�
ap ns(4 very used made by Mom) S �•�
� r � -
sm II 50"'anniversary plate $ l,pp
Du k windchime(small ceremic) $ 0.75
gla flower holder S 0.75
II ca�dyJa� $ 1.00
pf basket&smali basket $ 1.00
� ��(�) S 10.00
Tw Ceremic Grecian Girl statues(set) S 6.pp
Ent rtainment CeMer $ 25.00
Lov Seat $ 25.00
Sc House dock $ g,pp
Twi �eds and mattresses $ 20.00
Th in LR $ 3.00
' La e Boat har�ing 5 5.00
two boxfans and a revolving pedestal fan S 15.00
Co puter system(very otd) $ Zp.pp
DV $ 10.00
VC $ 5.00
ea I(in bad shaPe) $ 2.00
; Sm II end tabk type stand upstairs In froM of badc BR door $ 3.00
Lar e Biscotti Jar(Gear glass on DR qble) $ 1.00
FI $ 4.00
pot older hange� $ 1.00
Bee Stein S l.pp
w saiad eowis S 2.00
2 s all grecian Erns-tourist pieces $ 3.00
Oil I mP S 4.00
Clo n bpe holder Mom made S l.pp
Gla mug $ l.pp
m�B $ 0.50
Nut ish $ 0.75
Fyin pan decoration $ 0.50
Chri tmas ball jar $ 1.50
Nut holder and utensils(Has mouse dirt in R) $ 0.50
Nut ish $ 0.50
T dish $ l,pp
Tri $ 0.50
Thr e D puzzle $ 1.50
Gla mug $ 1.00
Glas mug S 1.00
sh glass $ 0.50
Tiny pia►ic UWe sait�pepper S 1.00
Me I aluminum pedestal dish $ 0.75
Sho glass $ 0.50
Whi tle while you drink mug $ 1.00
Half fast bartender mug $ 1.00
US 00"'anniversary cup $ 1.50
._ _ _ _
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, _ �- - - _ _
_ ,_ _ _ .
Sm'all rabbk dish $ 0.50
tin plastic sak shakers $ 0.25
L blue tNvet $ l,pp
II glass bird in pBe $ 1.00
It glass Christmas candle hoiders $ 1.00
s 11 wooden dish $ l,pp
ca dle sniffer 5 Z,pp
ho seshoe curve souvenir shot glan $ 0.50
E size rebbit in beaded e�Mom made $ 0.50
1el bean jar $ 0.50
5 II Halloween decoration $ 0.50
2 u saucen 5 0.50
Ar etel Dad cup $ 5,pp
Lrg plain glau mug $ i,pp
gla s mug Mom made 5 i.pp
gla shlp m�from Mcponaid's $ l.pp
gla mug wtth bartender sayir�g $ 1.00
ship mug from McDonald's $ 1.00
mi iature shot glass mug $ p,75
sh t glass $ D.SO
Ch istmas tree glass $ l,pp
Cle r glau mug with Washington sayir�on it $ l,pp
B�� $ 0.50
Ea Penn cerrtennial B��B $ 2.00
Shi mug from McDonald's $ l,pp
tin green al lamp $ 1.pp
M' halob plastic mug S OJS
Wil souvenir mug $ i.pp
Un Christian oil lamp $ l,pp
GI mug $ 1.00
gla s cup S 0.50
sm II chereb decorat(ons $ l,pp
tin Christian otl lamp $ l.pp
tin glau pipe ash tray $ 0.50
old glass creamer $ 0.75
pla k carwas toilet paper cover Mom made S 0.50
tin white bear knickKnadc with broken ear $ 0.25
tin mushroom knickknack $ 0.25
2 0l meat piatterstrocked $ 1.50
2 s II leaf sized leaf d�hes $ l.pp
k n apple tlmer(it was broken) $ 0.50
cbe p tin an for storage $ 0.30
Nia ch stick cross(made at camp or school] S 0.25
sm il sewing basket—(mouse dirded) S 035
sm II robbit decoretion $ 0.75
cle glass vase from flwist $ 0.50
sm II plastic plate holders(2) $ 0.25
. - — - --'---- ---
__�___ _ ___
2 II framed boat prints on wood S 8.00
Tro bk light $ 5,pp
Bo of Hand Tools $ 45.00
Phc}tographer's picture of Mom a�d Dad framed on wall $ 25.00
Tot�l balue $ 2,15430
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I, � DE►AIRM[NT pf PUtIIC NELfAp!
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� A11�U5C 2r 2012 j � E{ �� � ����;ti
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� IERRY A PHILPOTT ATTORNEY AT LAW ;(�I;: AUG 1 ZO�I2 ;.i` if i i
i flt�ANHON PA 17020-01i6 `� �� €�;
�, . . �
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I _ - Re: Iva Lahavre
_ CIS ;�; 4502�37279
i SSPi: ##�-##-46p1
, _ �e or neen,: oa�x�/zoiz
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Oeaa�Atborr�y�iipott:
F'leas�it 6e advl�ed that tl�e bepari�ent Of Pub!!c VifNfare mafrrtains a c{sFm in the
aEr�ot�rtt af�i�,',�sQetnst dfe abpMe-��tloned astate. TMS daitn !s far nu�db�on of
tnMdfcaf a�pEsnoe yrarKed wt bahalf af the du��ddent fiar whkh khe ProbirGe � is now
re�bk bo nNmburge the CieparbtteM acaonding M Act 49, B2 P.S. 1412,efhscrdve
AUQtIS� 15i 1994r�!1(11BAdad by Att 2V-95r!#'flCtN!.IRlite 30+ 1995. EtIC1o3ld iS t}�
I DepsrtmeM"s ItemEzed statemerK of daim.
� A portbrt of ii�s medical expe�e, narrlely�was ihCUrrrd durinp Yfie Lt�t sht
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( GL��A FARNER STRASBAUGH ReCeipt Date: 5 28f2013
Cu rland County - Register Of Wille Re eipt Nom�� �1074319
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LEFEVRE IVA JUA7E
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C rland County - Register Of Wills Receipt Time: 12 : 4 :02
O e Caurthouse Square Receipt Na. : 1473300
C rliBle, PA 17(T13
LEFEVRE IVA JUNE
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Dear C�Stomer:
Yair fmal bill with PPL Hedric Utilit�es is overdue far the amount shown sbove. We �
�m�d it is easy to furget a fmal bill when moving or cbanging servicx. Far�is naeun,PPL
Elochic Uhlifies offera variavs metLods of bill payment such as credit card psyment,speoci PaN
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If yarc acaamt ramains overdue,we may ref�your balmce to one of our collection agcncies a
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To avoW colectlo�actioa,Pkue co�tsct a�wMiia rie rest 1.days. O�¢talopho�e numbe� �
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Attn:CP�GEIINI,2 N.9th Sk,AIlentoam,P�i I$78T: _ _. __
Rcvenue Coll�s Supervisor
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