HomeMy WebLinkAbout10-16-13 (2) __ I� __._. .. .. __
J 1505610140
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ro eo�c�t
PA 17128-OBOt RE8IDENT DECEDENT
�rret o�t slFOnw►noN e�ow
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07112013 � 227i 925
Dsad�nPs Wt Name SWllx DscedsnCs F � iN�me MI
G U T S H A L L K A T R Y N M
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THIB RETtJRN IW8T BE FIIFJ DUPLICATE YVITH THE
RE�i1STER OF LtS
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� 7.O�Ipinal RNum � 2.S�plemsntal Retum 3.Rsm�hWsr Rstum(deM of ds�lh
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� 4.LimlNd EqaEe � �a.Fudwe Ir�tsrest Cornprombs(dab of �.., 5.Fsd�ral Estats Trx Rstum Requiisd
ds�M MMr 12-14-82)
❑ 8.D�o�d�M DMd TwhES � 7.DeadMh IA�k�d a LAri�ng Tnmt 8.Tohl Numbmr of 3ds DepotR 8oxes
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bslw�sn 12-91�1 and 7-1-9b) (Atl�ch Sch.O)
fAN1EaP0lABIT-TNIB SECf10N MISf BE l�IIFLET�.ALL CORRE�AND TAX�IFOI�i1DN 111011LD BE ONECT�T0:
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C A R L I T L E P A 1 7 0 ]i 3
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UMx psrtlss otperjuy�1 tlxiw tlrt I Mie suminsd tli Mum�fndudYq amom�yNq Wrdulw xM uM b IM Wd al my luawletlpe mtl DNkf,
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TURE OF P�i � FOR F RN DATE
)0-1(o-Zo 13
22�2 NEYVILLE ROAD CARLISLE PA 17015
SIONA OF PREPARER OTH REPRESENTATNE 7E
/0 I6 /3
60 WE OfiFRET STREET CARLISLE PA 17013
PLEABE USE ORIf�INAL FORM Ot�Y
Sids 1 I
L 1505610140 � 15�5610140 J \
(1"
J 1505610240
REV-10W IX �,�����
��.: KATHRYN M• 6U7SHALL
�rru.,anoN
1. Rw1ENw(Sdwduk A) ... ... .. . .. . . .. ... . ... ..... ... .. .. ..... . .. . 1. •
2. Stoda and BorMS(&chaduls B) .. . . . . . ... ... ...... ... .. ..... .... . .. . . 2. •
3. Clophr Hmk Corpontlai�P�rBMnhiP«�P�P(8duduN C1 .. ... 3. •
4. Mortp�pu arM Notss RaosWabls(Sdisduk D) .. . . .. ... ... . . .. ... .. .. . .. 4. •
9. cwn�e.ruc oapa.w.uid 1�aNYnwu.venon.�Praa�b tsd�wu�s e).. .. .. . s. 3 1 8 4 0 . 6 7
8. Jokdhr OwrNft Prop�r�(Si,d�Isfl �, ., .�,�p�d .. .. .. . 8. •
7. IrN�VNw TnxrNn d M�17�NOUa ` � .
(sohw�n.o) a� rt.qu.a.a .. .. .. . �. 6 4 1 6 . 9 6
b. Taataa�a#wMs�4un..t aNV�pn� ........ ..... ..... ......... a. 3 8 2 5 7 . 6 3
9. FunNal E�nw md AdmN�Mtradw CoMs(SdwduN H) ... . ..... ....... .. 9. 1 4 5 4 4 . 8 6
�o. oasa a�eosd.m,�.u.pwuas,ww u.na�sax.am.i> .... .. .. . .. .. �o. 2 U 0 . � 0
t�. Tad D�duelbn�(w�N t.irws 9 and to) .... .. .. ... ... .. ...... .. .. ... .. t t. 1 4 7 4 4 . 8 6
iz. �vw�r serwr#ua.e minus une�i> . .... .. . .. . ..... .. ..... ... .. �s. 2 3 5 1 2 . 7 7
73. ChMIabN�nd Oo�Mmawiplt B11qWlMAB�e 9113 TnW for whida
an Ni�tlon'!o Lx!w noFbyn nS�d�(SrffNd6M.q .... . ....... .. .. . .. ... 13. .
14. tift{�MM-�M�ItIC�t:N.�12rtIkyNLIM13) ...... ... ....... ..... . 14. 2 3 5 1 2 . 7 7
U1X CALCULAI'ION-!Ht�1O71dfi F6p�Il�DkICA�Ld RA7Ea
t s. aiawd a L4�s 14 tcuble
at ths lpa�l quc r�tb,or
tru�es uniNr Sec.9118
(axt.2)X.0_ 0 . 0 0 �5. 0 . 0 0
18. AmouM oi Wis 14 pwbN
at pnal nro x.o� 2 3 5 1 2 . 7 7 �6, 1 0 5 8 . 0 7
17. ArtNWrtafl.Yisl4taiabb
et ae,t�p rue X.12 0 . 0 0 17. 0 . 0 0
18. AmouM of Lha 14 htr�ls
M txl�nl r�te X.15 � • 0 �0 tg, � • � �
79. TAX DUE .. .......... ... .... ..... . ... .... .. ...... ..... .... . .. .. 19. 1 0 5 8 . � 7
20. F�L IN TNE i1AlAL IF YG4i�l�1Mt�A�1�YlMF�01°MF ❑
81tl�2
� 1���4a Lsa�f�ao �
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REV•7500 E7( Pape 3 FIN Num �
Decedent's Complete Address: 2� �� os�s
DECEDENTSNAME
KATHRYN M. GUTSNALL
STREETADDRESS
2282 NEVWILLE ROAD
CITY STAT ZIP
CARLISLE PA ; 17015
Tax Paymanb and Credits:
t. TauDue(Pape2,Li�19) (t) 1,058.07
2. CredltslPayments
A.Prior Payments 1.005.17
B.Diacount 52.90 Totat Credits k +8) (2) 1,058.07
3. Interest �
� (3)
4. If Line 2 is grea�than Li�1 +�3,enter the�erence.Thia is the OVERPAI'MENf.
FNI in ovN on Pps 2.Lkis 20 to rsquat a Mund. � (4) 0.00
5. H Line 1 +une 3 is greataz ihan Lirre 2,enter the d'Aference.This is the TAX WE. �' (5) 0.00
Make check payable to: REGISTER OF WILL , AGENT
PLEASE ANSWER THE FOLLOIMNG QUESTIONS BY PLACING AN "X" THE APPROPRIATE BLOCKS
t. Did decedent make a hanafer end: Yes No
a. retaNi the use or income of the DroPei1Y transferred� ............................................... ..................... ❑ �
b. ietain the right to designate who ahall use the propeiiy transierred a its inoortre: ........ .....................
c. reNdn a�eve�aionary interest w ......................................................................... . . ❑ �
f .. ..... ............
d. receive Ihe pranise fa life of eitfier payments�benefits ar care9 ................................' ..................... ❑ �
2. IF dealh ocarted after Oecember 12,1982,did deoedent tr�sfer propeAy within one year of
wiMait receiving adequ�conaidera�tlon7 ................................................................ .... ............ ❑ �
3. Did decedenl awn an'in truat for a payable-upon-0eaM bank accaunt a eecurily ffi his a h ? ......... ❑
4. Did decedent am an individu�retirement account,annufty a other non{�robale property,whi
contains a beneflciary designatlon7........................................................................... ..................... � ❑
IF THE ANSINER TO ANY OF TNE ABOVE QUESTIONS IS YES,YOU MUBT COMPLETE SCHEDU G AND FILE R AS PART Of THE RETURN.
For da6es of tkath on or after July 1,1994,and before Jan. 1,1995,the tax rate imposed on ihe net valu of transfers to or for ihe use of ihe surviving sEause is
3 percent[72 P.S.§9118(a)(1.1)(i)1•
For dabs of�on or after Jan. 1, 1995,fhe tax rate impo�d on the net value of bansfers to a for th se of ihe aurviving spouae is 0 percent
(/2 P.S.§9116(a)(1.1)(ii)j.The statute doea not ex�npt a tranafer to a sunriving spouse from tan,and slalutory requirements for disdosure of assets and
filin8 a te�c relum are stl�applicable even ff the surviving spouse is the only benefiaary.
For dabs of death on or afte�July 1,2000:
• The tax reee imponed on Ihe net v�ue of transFers irom a deceased child 21 years of age or younger death W or iw the use of a natural parent,an
adoptive perent or a alepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)].
• The tax ra�e impoaed on the net v�ue of tranafers to or for ihe use of the decedenPs lineal benefidari is 4.5 percent,except as noted in
72 P.S.§9116(1.2)[72 P.S.§9116(a)(t)1•
• The tax rate imposed on ihe net value of transfers to or for ihe use M ihe decedenYs siWings is 12 pe t[72 P.S.§9116(a)(1.3)].A sibling is defined,under
Sectlon 9102,as�ir�ividual who has at least one parent in common with the decedent,whether by or adoption.
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R�-,��.�o�,z�
pennsylvania SCHEDULE E
DEPARTAENT OF REVENUE CASH, BANK DEPOSITS 8 MISC.
��sioEiir��er�irT�� PER80NAL PROPERTY
ESTATE OF: iFILE pUAMER:
KATHRYN M. GUTSHALL ' 1 13 0916
Include the proceeds of IRipatbn and tM date tM pioceeds were rece �. by the eWle.
All Prop�rly Joirrtly ownW wNh rlpht of suMvonhip mwt b�dlad �� on ScMduN F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. MB�T BANK-CHECKING ACCOUNT#8892442180 28,835.60
2. M&T BANK-CERTIFICATE OF DEPOSIT#31003915942683 3,005.07
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TOTAL(Aleo eMx I Jne 5�RecaqtWetlai) { 31 840.67
If mas space b nesdsd,uw aaaroo�wi snseu a�sr a ms ms aize.
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REV-7510 EX+(OB-08)
pennsyivania SCHEDULE G
DEPAR7MENTOFREVENUE INTER•VIVOSTRANSFERSAND
INHERITANCETAXRETURN MISC.NON-PROBATE PROPERTY
RE91DENf OECEDEM
ESTATE OF 'FLE N111�R
KATHRYN M. GUTSHALL �21 13 0918
Thb achedula must be canpleYd and Aled IFthe anawwm arry of queatlons 1 mmugh 4 on p6ge� 'ree dlhe REV-1500 b yes.
DESCRIPTION OF PROPERTY
ITEM �������q�,�q�,Tqr�s�ppropE�me�rpNp DATEOFDEATH I %OFDECD'S EXCLUSION TAXABIE
NUtY6ER n+ewreoFm�.�n�a+�covroFn+¢o�waxSUESrn�. VALUEOFASSET � ��. IMEREST acrm,c.aa VAU�
t. AMERICAN GENERAL LIFE INSURANCE CO. 6,416. 100.00 6,416.96
ANNUITY#XP223299
BENEFICIARY: MONICA GUTSHALL
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TOTAL Also en�er an Li 7, letbn ; 6 416.96
H mae apnce is needed,uae additlond sl�eeb d PaPx oi Ihe aema �
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REV-7517 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENfOECEDENT
EBTATE OF PILE NUMBER
KATHRYN M. GUTSHALL ' ' 21 13 0916
MexMM's dsbb mu�t M npaUd on 8e1�MuN L
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. EWING BROTHERS FUNERAL HOME 7,906.82
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B. ADMINISTRATIVE COSTS �
1. Peraonal Repreeenta�ve Commiasions:
Nemaa)d Persaial Reprexntetive�s)
SVeetAddreas
City Sfa6e
Yea�(s)Comn�eabn PaM: I ...
p, n�nerFeea: IRWIN 8 McKNIGHT, P.C. � 2,250.00
3. Femiy Ezemptlon:pt deceeerds addreas is rrot the mme as daknem's,anadi exqeneuon•1 i 3,500.00
�by,b„� MONICA K. GUTSHALL
sma,tndareas 2262 NEWVILLE ROAD
cxy CARLISLE sm�e PA 17015
Remnonenpac�neMrooeoeaent DAUGHTER
4. probe�pees: REGISTER OF WILLS 123.50
5. Acrou�t Fees:
6. razRauanPreparerFees: PATRICIAA. ROSENDALE, CPA I 500.00
INCOME AND FINAL FIDUCIARY TAX RETURN
Z CUMBERLAND LAW JOURNAL-ESTATE NOTICE 75.00
8. THE SENTINEL-ESTATE NOTICE 189.54
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TOTAL(Also eMer 'Une 9�RecepNulellon) S 14 544.88
n mae a�e b neeeea,we aeatl�d aneea a p�ame eeme
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REVas�z ex.��z-�z�
pennsylvania SCHEDULE I
DEPMTMEM�REVENUE DEBTS OF DECEDENT,
INF�WTANCETAXRETURN MORTGAGE LIABILITIES 8 LIENS
RES�DEM DECEDENT
ESTATE OF 'FKE NUMBER
KATHRYN M. GUTSHALL 21 13 0916
F�poR d�bb hicuurnd by tM dendart prbrto daM tlat nmdn�d unpNd at the d�b of M�Ih.I IudMp unnNMwn�d nNdial sxp�ntes.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. NEVWILLE COMM AMBULANCE-AMBULANCE 200.00
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TOTAL(Also enter on ine 10,Recepftula6on) S ���
If more apace is needed,inaert edditbnal sheeb of the same .
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REV-1513 EX+(01-10)
pennsylvania SCHEDULE J ��
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENTDECEOENT
EBTATE OF: ' � FRE NI�ER:
KATHRYN M. GUTSHALL ' 21 13 0916
RELATIONS P TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not ft Tn���) OF ESTATE
I TAXABLE DISTRIBUTIONS pndude oW�pM dbtrldtlbna and trairetera wMer
Sec.91i6�a (1.2).]
1. MONICA K. GUTSHALL Lineal 23,512.77
2262 NEWVILLE ROAD
CARLISLE, PA 17015
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ENTER DOLUR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 REV-1500 CAVER SHEET,AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS N TAKEN:
1.
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B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
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TOTAL OF PART II-ENTER TOTAL NON-TAXABIE DISTRIBUTIONS ON LJNE 13 OF REV-1 ICOVER SHEET. S
If mae spece ia needed,use additlonal aheels of paper of Ihe size.
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499 Mitchell Roed,Millsboro.DE 199G6 Adjushnent Servias �
Plane 888•302-4349
F ex (302j 934-2955
August 28,2013
Law Offkea
Irwin& McKnight,P.0
60 R'est Pomfret 3treet ; '
Csrliele,PA 17013-3222 ' �
I ' AU6 31 2013
a�z Mowaext
Re: Estate of Kathrvn M.Guthshall ��
Social Security: 201-16-6662
Date of Death: Julv 11.2013
Dear Sir or Madam:
Per your inquiry on August 23,2013,plesse be advised thet at tt�e time of d�e above-named decadent t�ed
on deposit with this bank tl�e following
1. TypeofAccotwt C��Acoow� I '
Accow�t Number 8892441180
Owriership(Namcs on KatMyn GrmhaU
Mauca K GutslwU(POA)
Openirg IMte 03/ZO/1001
Ba7mrae on Date ofDeath 31$835.43
Accnred Irrtere.st $ .17
_�_----.._._.....------ ...— -__._....__. .i_..................
Total S 28,835.60
2. Type ofAccrnmt Ca7iftc�ue ofDepasit
Account Number 31003915942683
Owreershrp(Nmnes oJJ Kad�ym Garshall
Monica K Gutslw![(POA)
OpenygDate 1a30/2007
BaJm�ae ort Date ofDeath $3,004.50
Accruedlnterest S .57
_---------------------------------- '-------------
Total $3,005.07
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For uy�ddltlood idor�aqoo 0o tYe�bove acwaab,�ecluding ownenYlp nd�ny eYaeQa,elal ' �ed/or rdmbaneseet ot fuadh
plwe n6 MeE�90'eet Cu1Ye�t717-1A0�/516.
Wc werc ae�bk M beate any aR depodt bo:[oc the�bovo-menHoncd deeedenG �
'1�lellv doe aot Iedade�aawete�n whk6 Ne deenecd m�y�ve buo Wlcd u Power d ,. , ,GL�a d Udkr-Tnmkn.
pepve�htive Rya+�TraM[e 0der�WAMrn Apeeoent
$InCRIC�, .
V8�8[7C MCICt7'
.eld�U9�[[IC[It$ONICCS
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� Arr�ican 6eneral
� Life Companies
September 10, zoi3 RECEIYED
SEP 16 2013
j ix�nN i M�anc�r
I tnw o�s
IRWIN&MCKI�TIGHT, P.C.
AT'I'N: ROGER B.IRWIN
6U W POMFRET ST I
CARLISLE PA 17013-3222 i
Re: Annuity Contract XP223299
Deceased KATHRYN GIJTSHALL i
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Deaz Mr. Irwin:
Thank you for your recent inquiry regarding the above referenced ity contract. We would
like to take this opportunity to respond to your request.
The accumulated value of ttris contract as of July 11, 2013,the date Ideath, is$6,416.96. The
owner was Kathryn C Gutshall and the account was opened 6/1/2006 7'he accrued interest for
2013 up to the date of death was $99.00. Reseach shows no other ac �urts found for Kathryn
Gutshall.
Mr. Irwin, we appreciate the opportunity to assist you. Should you h � e any questions,please
contact our Client Caze Center at 1-800-424-4990.
Sincerely, `
����
Mary Crrice
Annuity Claims Deparlment
{, ,x,_ ,. I
Amsrican G�neral Lih Inwranc�Compan '
P.O. Box 871 •Amarillo,TX•79105-0871
LH-AGL
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/ Ewing Brothers Funeral Home, Inc.
630 South Hanover Strxt
Carlisle,PA 17013
(71�243-2421
July 17,2013
Monica K.Gutshall
2262 Newville Rd.
Carlisle, PA 17015
Ka n M.Gutshall �
The Funeral Service for �'Y
We sincerely appreciate the confidence you have placed in us and will continue to st you in every way we can. Please
feel frce to contact us if you have any queations in regard to tlus statement.
�� �THE FOLLOWIN(}�IS AN Y['6MIZED STATEMENT OF'I'f�SERVICES.FACQ.ITIES.AVfOM � 6QUIPMEIVI',
AND MERCHANDISE THAT YOU SELECIED WHEN MAKING TFffi FUNERAL ARRANGEM � S. � �
Profeesional Services
Basic Services of PA L.F.D. 1,300.00
Bathing and Embalming 895.00
Other Prepscation of Deceased 295.00
Basic Use of Fecility 200.00
Documentadon Prep/Recording 325.00
FD/StaffSupervision ViewNisiUSmia 375.00
Facility/Equip ViewNisiUSavice 375.00
FD/StaffSupecvision ViewNisiUService 375.00
Facility/Equip ViewNisiUService 375.d0
FD/Stafffor Interrttent Service 125•00
Total Profeasional Services ------_�d�__
Eqaipment
Trensfer Deceased to Funeral Home 295.00
Hearse Usage 295•00
Safery/Lead Vehicle 135.00
Utility Vehicle 135.00
Total Eqnipment -------866:Q�--
Merehandise
18G White from Batesville 1,900.00
Regista Book 40.00
Memorial Folders 1�•�
Thank you cazds 10.00
ToW t Merc6andiu Selechd -°---------�OSUU�—�
AT THE TIME FUNERAL ARRANGEMENTS WERE MADE,WE ADVANCED CERTAIN�,AYMENTS TO
OTHERS AS AN ACCOMMODATION. TE�FOLLOW(NG iS AN ACCOUNTING FOR E CHARGES.
Cash Advaoces
The Sentinel Obituary w.photo 290•8z
Valley Times Star 60.00
p�ath Certificates 30.00
Professional Hair Styling 40.00
Total Caa6 Advanea '���.'- ��y
SALES TAX I 0.00
SUB-TOTAL '�, 7,970.82 \
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NEVWILLE COMM. AMBULANCE C/O PROMED SERVICES, IN .
4 W. MAIN STREET
SHIREMANSTOWN, PA 17011
1-866-678-6855
/ Patient Bill
Page: 1
Pdrned: OB/30/13 11:55
KATHRYN C GUTSHALL ID: Neww2975
2262 NEVWILLE RD
Cartisie, PA 17015
DOB: 02/27/1925
PadeM: KATHRYN C GUTSHALL ID: 2875 OB:02/27M825
Claim Number: 4713055�i8gnosis 1) 707.23
Ins: 1)MC/Aapn 20118B862A 2)CBX/Aagn YWM80030183300/00900001001
03 08/27-OBl17/13 010 A0888RH 1 A 300.00 20 300.00 , 0.00 100.00 200.00 200.00
Procedure: BLS ADDITIONAL MILES �
Date firet WNed: OB/23H 3 i
MEMBER REDUCED RATE
PatleM Tohls: 500.00 800.00 0.00 ' 0.00 100.00 200.00 200.00
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Total Amount Due B i uarantor. 200.00
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www DETACH HERE vwwv i
--- --- ---- �
PLEASE MAKE CHECKS PAYABLE TO NENNILLE COMM AMBULANCE '
Prov Codea:01U�MIle Ambulance
-- To Yrunprap�r andlt.Plw�c1ip and mNl the bottom ssctlon for aach pip���.d Includ�wRh p�ymsM --------- �
Guer.KATHRYN C 6UT8HAlL N:NeWV-2975 Clma:47130552
!'% . Pepe t � Totel Due(all peges):200.00
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