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10-25-13 (2)
� 15056�4b114 REV-1500�t�> �,,:,,,��,,.Y PADl�rKdi20vanua Cqmt}rCpd6YUV FYtlkqnh�r �"`"D��tli"�T"°` iNHERITANCETAXRETURN �HpTkWuO,PA 17128�OE01 RESIDENT DECEDENT �� �� bCabb ��`. EM7ER GI�+CfDENT if�ORMAT�t BEIOfAt Sodet Secutky 1Vumber Dste of Death Date of BiRh 01132012 11261926 DecadsM's I.�t N�m SuHbc ESecedenPa F�at N�me t� SMITH ROYCE E tHl�ikabiel E�Swvkvinp Spous�'s MtomWticn BNow Spouae'a i.ast Name SuH6t Sp0ue6'8 Fint NW1M Mi Spouse's Socis!Saa�ItY Number THI$RETURN MUBT BE FILED IN DUPIICATE 1MTH THE R�Ci1STEIt OF WILLS FlLL�i/�PPRQPIiIA1'E OYJU.B BEIQW � 1.OHpk�N Md�m 0 2.SuPPb���keWm � 3.Wm�YqK RM�n(NM N drM � prbr b 14-1'9-02) �] 4,lJnYkd EtAae � Ia.FW�u'a hNiwl ComP��(AW W � S.FaAxY EMM�Ta Rs6fm FSquq�d � de�tt Mier t&S2•82} p s:os�»a.moiaataub- p 7.OnpMeMl�etlal.lvinpTruN _ B.TqhINUN�dSNeDepaNtBOCee (�ca+coar a� Ntmcn coar a rrucp (� s.uupst�onP'ooesusrtacNVea p to.sva�wPOVerbicroax(a�aaam p tt.tlecmnnmcu+aers�c.`6lt3� . . . . bM`vam,ts.at�9t w,a Lt-a5} (Atl�a�sela.0} G�OIIOEIff.—iiMA BECTION MUBT BE COMPtETED.ALL(�RRESP4tIC�NCE AND Q01&MENTUU.TAX BFqRMAl10NliqULD��UI�C7�T0: ... Name D�ytkns TeYpNom Number ANN OPDYKE DEELEY, EA 717-901-33� � � Firm Name(N App6cpbh) �qe o ,ry ,�y Fi&R BT,OCK PREMZIIM m -�a � vt � firat Iine M addrosa � a r rv pr, m . rZm � � ,� 4821 JON£STOwN RD, ST$ 125 x u.' � o 0 Sewntl Uns of atldrosa `,°y Q o � � � .3 G � n , � r�'`,,,, m CHy�ar Poet Otflce St�e ZIF Code � � . � HARR25BURG PA 17109 Cmrsa�Ci a+nW�s: ANNOPDYKE.DEELEY@TAX.HR$LOCK.COM romm, my . m,e.mm�,�lcaaxi.o«sW.bnanna�nranrwwnscereawna�»bneraanr�b�ear�� prrMe.«r�l�aweme. � 'l.1�_ �,,��r�t�t.� l t� � { f� -'� 01 `j ApDRESS . �� � � 160 C RCH RD SHERMANSDALE, PA 17090 _.__ . � , .�� . .�tYT,F1�R ttEPRES6,NTATNE . .: .76.. •, . : p 4$11 30NESTQ RD STE 125 HARRISBORG, PA 17109 ��us�awc�rtu FattM or�v Sk10 1 � 18p56041b14 15056041114 � � 15�56042115 c�ut5oq�c DpoetlenY6$acJaii$scurity Nut�ar caeoeusnrsrmme: ROYCE E 3MITH R�CArt71►urw�t t.'� ..Reateptate{SchsdubA>... .. .. .... .. ..... .. .. ..................... t. NON$ � � �' � . . . 2. stodcs ana eo�ult{Schettub 8)....... ............................... 2. NONE 3. Ckeey Nek!Cory�tion�Partetirship ar Sde-Prqrrrf�tonhtp(Scheduls G).. ... 3. NONE a. i�wrtgagee 3 rui�s Recen+aab(seneaub a}......._................... 4. NONE 5. Casn,8a�k tJehaks 3 MbceNsneous Peroonai Properly(scheduk E)........ 5. 9 69 2 5.0 0 6. Jopuly oNmed P+cPeAY(sdiaduie F� OSeperoM+Ba4nst Rerwesdad........ 8. NONE 7. Imsr-VIvM Tramfera b FAb�lteneoua Non-Probats Propsrty (Schetlub G} �Separate 8iping Requeeted......,. 7 p30NE a. ra�t aro.s�t�tr trou�unes�-�}.............. ........... ......... a. 3 6416. 0 Q 9. Pensra�E�ensea 3 AdmmhtraNve Coeta(Schedule H).. . ... .... .......... 9. 5 918. 0 0 to. Debn ot oeceAerd,rutortpaye u�bs,a t.kna tsc�isd�,b�)............... to. 2 7 7 8 5. 0 0 �f. Toatasducna�a(mwuneaeato}........ ... ... ................... �a. 33703.00 �z. ra.tv.ru.a�saa(uneamm�xuur�ett). .... ... .. ...................�z. 27I3.d0 ts. ,cn.rMaWe and Govemme�nta�asqw.ro�Sec at ta rru.a rw wn�n am elscRbn W t�has not been mada(Schadub J).. .. .. .. ............... t3. 0.0 0 14. tMtVMueBUbMetEOTrpr(tJnsl2mMu,cLMisi3}....................... t4. - 2713. 0d � T1tX COMPUTATION-SEE Ni6TftUCTWNB FOR APPLICA9LE RATEB i5. �M of Lkro 14 tezpbb at � the sppusal Rez raa�,w - hanstln under Sec.9118 (ax1.2?X.Q .Q__-_. 15. Q.00 18. AmouM of line 14 taxable . . ae�r,�+x.o 45 2713.00 is. 122.00 17, AmouM of LN�s 14 taxan+s a tivanp rate X . 12 17. 0.0 0 � ta. I4na,nt�l:Me�t4t�ab�e - � at coae�a rate X . 1� 18. 0. 00 te. Tutnue.:::. :.:............................... ...... .. .. ...... tS. 122 . 00 20. FILL IN TNE OYAL iF YOU ARE REQUE$YNi6 A ItEFW�D OF AN BVEId�AYMENT �] -- i �-- ti�... I Sldi 2 �,�.,� 15[156�42115 150560V2I15 � � i � REV-isooEU Papaa - 197-20-47$1 Fxs►�,mp„ C31bC9dQ8t'a CWllpilt8 Addt+l�S: 21-12-0088 DECEDENTS NAME _ 13ECEDENT'S SOCW.SECURRY NUMBER OYCE E SM1T S7REETADDRESS 3t BRANDY LANE ` ClTV gTA� �p ECHANfCSBURG PA 1 Taac Payments and Credits: �. rax o�(aaae z�,e tsy t�) tz2.00 2. credn.maymenm A.Spousai Poverty C�edU � B.Ptbr Paymei�t8.. C.DiecouM � � Total C�Ilts(A+8+e) (p} q.pQ 3. intereaf/PanaMy H applkabb D.irksrest 37.00 E.PanrXy TctW InpbnbetlPenaky(D+E} (3j $7.OQ 4. H LMe 2 b gtsNer ihur l�e i+Lina 3,�ths dMeienae.'flNS b thb tiVERPAYMENT. PNl in w�al on P�pi Z�Lkie ZO to nqupt e retund. (4j 0.4t} 5. lt Line 1 +f-kro 9 k greMer than LMx6 2,antbr ttro dfRerence.Thh b tl�e T/U(OUE. (6} 159.00 A.EMx tl�9 Mterest on tlrs tau due. (5A? B.ErNer tha MUI of Line 5+5A.Thls b ths BihLANCE DUE. (5E� t59.W Make Check Payabte fa: REQtSTER Ctf WtLL.3, AU4E'NT PLEASE ANSYYER THE FOLlBWiNG QUESTIONS BY Pl�4C1NG AN "X" I1V THE APPl�OP'RtA'fE BLOCKS t. tNd.deosdAnt m,ake a hane/ar end: Y No � e. r�ain tM we a income of ii�s P��N trrneAerrod:..................... ......... ... ...... � �X •. b. ratain Me ripM M ds�ignets who shaH we tl�e propsrty frans�terred w ks inoane:................ ❑ QX c.-�rotMn a rovsabnary iMereett or................... ................. .................. ❑ �X . d, reoeive the prombe tu IHe of elGf�r pey�t�ents,benMfts ar cero9. ............................ � �X 2. tf dsdh oxvrrod aAer Deamber 12.1982,did decsdent trenefer property wiFhin one ysuW dwM �s vM!l+out receNhrp adequaro ooneidsratbn4...................... .. .... ......... .. .......... � ❑X . , 3, Dkl decxdsnt orm an 9�Wet for"or pryabls t�on death Mnk accouM or ucurity at hN or her ds�th7.. ❑ ❑X 4. Did dacetlent owm an IndNWusl Rstiromerd AccouM,annuRy,a oMier nonyxobaM prapaAy whkh I cantakis a bsnefidary tlesipnatbn?........... ... ..... ............... .................... � OX � IF THE AtlS�R TQ Ji�IY dF TFIE A84YE QUE8TIOM3 IS YE8�YW MU�T COMPLETE SCt�DULE ti AIrQ F14E!T A4i P/iRT OF TiiE RET[1RFi. I I ' Far detas at death on w afker JWy 1, 1884 and betara January 1� 19�'r�tAe t�rate impo�d on the net vaitis of transfxs to�for i � Hte uae 4f tt�e sunrMlnp spquse ie three(3}perceM(72 P.S.§9118(a)(1.1)()J• Fdr datea of daqih on o'r aftet Jantiary 1. 1995.Nfe tax r8t8 impoeed on the nef vstue of transfers ta w for U»usC of th!swvfving spouea is zero(0)percxmt(72 P.S.§9718(a}(1.1)p)l.Tria statute does not exemot s trensfar ta s surviving spouse f�an tau,and dw�tahrtory reqairet»e�ts far discbsure of aa8ets snd$iing a tau ratum ske still appliCadle even if tlie surviving apouee ia die only 6e�flciaty. . ___ Gor dates af death on ar eRer July 1,200Q: fhe ta�c rete&npoeed an the net vaiue of transfera from a deceased dNki t�vennty-one yearo of age or youngx at deatf+�r oi far , he use M a'neturaf peiant,an adoptive parent,or a stepperont M the chiW is zera t0)percent[72 P.S.§9118(a)(1:2}j. ; :.� 7re tsnc rate impoeed on ihe net val�af frens�rs to ar for the use W tlre decedeM`s iineai benefNdarles is fau arui one-haN , ;__.... 4.5)permnt,+�cept es rwted in 72 P.S.§8118{1.2)(72 P.S.§9118(a)(1)l• re tmc rste�ry�sed on.uia net va�e or aerisrers ta or�or me use of u�e aecedenrta s�s ta tw�ve(t2}percent[�2 P.s:§'ai ts(aX�.3yj.A sin�q :-- :dafined�wdet Sectlai 9102�as�in�vldual who has at Nast one p�ent k�oomrtwn ari�tha decedent,whetheT by Wood or adopUan: �_ - _ _. _ z,� REV-1508 EX�(&YB) . . . . . SCWEDULE E �a�a,we,urno��,�„�,��,WU CASH, BANK DEPOSIT3, 8, MISC. �NMERRN/CE TA%hEfUIiN �roc PERSONAL PROPERTY ESTATE OF � �� . ROYCE E SMiTH .. . FILE NUMBEq . . �. �I"d��Wooseds of ptlp�tbn and the date ths Prooeads wen ncsivetl by IM e�f�Op, . 21-12.pp@g' . . . . NU�ER . � . 'O��� ht ot sunWoishl must p�dklp��� � � . F. DESCRIPTION VALUE AL DqTE � WELLS FARGO BANK 1010021782905 �DEAT}{ Z 1995 CHAN H$4T MOBILE HOME VIN JACFL1562gq "�416 25�000 „ � . � . � - . � � i_ � TOTAL(Also enter on Nne 5, RecapHu�ali�� _ (If more epace is needed.insert eddNfonal eame aize) �.418 � shssta of Ihe �... � REV-1ditEX+{i0-06) � SCHEDULE H� ac�r.«�ru oF r�renvnnu FUMERAI EXPEMSES& "�`ic�r�rr Ta� ADMNi18TRATIVE COSTS E9TMTE OF fILE NUII�6R ROYCE�SMtTH 21-12-0086 D�bb ot d�cedatr mwt 6s an Sch�ctuN t. i M U R CRiPTION AhtQ(!M` A. FUNERAL EXPENSES: e. HETRiCK FUNERAL HOME 3,p� 2. PROSPEGT HILL CEMETARY �,g4g B. DMIIWSTRATNE C43TS: i. Pww�WR�pae�qw'�C,omnN�e�aro . . . tMma d Pawroi R�ew�hYvete} . . 54eMAtltlrus � . . CNY 9fa4e Zp �. � Year(sj CanmYpiai PaM: � . , � 2. ALLarribyFws �. � 3. FamNY E�p�n:(Mdeadxd's addms k nW 9is wms a daxnaM'e.�rod�d�lrrpon) . . . ClpinaM � ,,, . ... StrestAdtlrw� , CKy Shb Zp� � .. RaatlwiNdp d CktmaM ps Oecadent � c 4. Peaba�fees 5. AomumanCs Faes 4d6 8. Tax Re9im.Prepara's Feee 88 �. 20N IRS 9AlANCE DUE 448 � � � TOTAL Aiso eMet on�ne 9 S 6 918 ;.._._. � . . . . (Nmas apace ks aeeded,Meb+t additiatisi shseis oitta wns Nsw) t._. 2tt REV-t518 E7C+(p-0p} � SGHEDUI.E J ca�TH a aErn+awt.vt,�w gENEPIGUIRlBS �NiTANCE TAX RETURN NT ESTATE OF � F�NUMBER . ROYCE E SMlTH 21-12-0OH8 . . PEUTIOi�MPT00Et'EOENT AMOUNTOR$HARE � NU�IBER WWIEANDADDl�63pP tiECEMN6PROPER'tY OcM7tLMlTnMW(p OFES7A7E I. TAXABLE INSTRIBUTIbNS�ouAipM�Paroal�uNan,antl tlanefMS wtdmr . Sac.Bi 78(q f t.�l DE9RA BREWBAKER DAUGHTER 100% ; ENTER qd.LARA6/OUNT'3 FOR AISTR18ttf1Ul1$SfM7MM A80VE ON lNlFS 15 TNRWlWi 14!�APPROPRN7E.di REV•1b00 COVER 8HEET I!. HON-TAXABiElNSTR18U71QNS: �A. S�ISAI DISTR�ti7N3N3 UNOER�SECTION Yi 13 fOR WHIGH AN ELECTIOM TO TAX IS N4T BEMIG MADE ��. ; � B. CHARRA&.E AND GOVERiA�AENTAL DISTRIBUTIONS . � � _ � . .. . .. . . � . . . � F. . . . . . . . . i_._. : TOTAL9F►ARTq=ENTERT4TALtI41MTp7(ABLEDi3TRIBUTI0N30NUNE790FREV-1bWC04ER8FfE'ET f O t"' (It mntr�b neetl�tl,YaeR aOdKorW th�sb W Ifw wrr Nnt) . - �'_- _ . _ _ __ . __ EST�4TE OF ROYCE E SI`/IITH 21 - 12-0466 F LAST WILL AND TESTAMENT � . � � � REGISTER OF W#LCS CERTIFICATE OF CUMBERIAND COUNTY GRANT OF LE7'TERS PENNSYLVANtA No. 2012- 00066 PA No. 21- 12- 0066 &state Of: RQYCEESMlTH /fM,MMdie,tast7 La te Of: MECHANlCSBURG BORDU6H CUMBERLANQ COUN7'Y Deceased Social Security No: WXEREAS, on the 25th day of Jenuary 2022 an instrurnent deCed Noveinlaer 8th 2oD7 was admitted to probate as the Zast wi12 of ROYCE 6 SMITH' rrvr�.x�w�r..c.,o Zate of MECNANICSBURG BOROUGH, CUMBERLAND County, who died on the 13th day of January 20i2 and, WHEREAS, a true copy of the wi21 as prabated is annexed hereto. THEREFORE, I, GLENpA FARNER STRASBAUCrH , Regiater of Wills in and for CUMBSRLAND Caunty, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Let�ers TESTAMENTARYto: DE9RA BflEWBAKEti who hae dul,y qualified as EXECUTOR(RIXJ and hae agreed to administer Che eatate accordfng tcr Iaw, aII of whioh fuZZy appears of record in my office at GilMBERLAIVDCOUNTYCDURTHOUSE, CARLl3LE, PENNSYLVANlA. IN TESTIMONY WHEREOF, I have hereunta set my hand and affixect the seal af my office on the 25th day of January 2012. ��.�����.��, ee,�a,o I �n.�.� 6 � 1� ��,,tor�c�r, ��t� I � ' ' **NOTE** ALL N�MES AHOVE AFPEAR (FIRST. MILILILE. 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' Li4KE H�4M MOCK VTLL�4GE ACT.IVL�55+COMMUNfI'Y .... .......... ...........».__.... ..,_...�....._...__......................_. ..........._................................._... ....._... ........ ... . .. .... . 3FilOb CT.S.Iiip,hwny 27 • Iiainae C:ity,rlorlde�.'SN44 •T.ocal(RR3)421.59C�L •'I'oll l�roc(Hli6)797=123� SUN R�ST SALES CORPORATIO�V SELLER5 CLQSING STATEMENT Date: June 26, 2013 Seller: Debra Brewbaker (Royce E. Smith) Address: 14 Silver Crest Drive, Haines City, FL 33844 Purchase Price: $ 25,OD0.00 Less: Listing Fee (� 8% $ 2,000.00 Sub Total: $ 23,000.00 �Itlonal Charaes Less: 201Z Ad Valorem Tax $ 312.35 Lot Rent (see attached) $ 3,974.70 NET T� SELLER: $ 18,7].2.95 s+o..�...]..�L�tl��r..� • Sell�r— q� -- ueon alrs iq �snt8 Wro . i I7 '(TE7FTrT R/ C/ T7b C�4 RqFi�TRTA V'1l1T�1FiV 'JVpT CT•C/1 CTnv•TO•FnV 1Y lln YW�mIS dptafl�yw�O/�1y�tlYalarNMOlr.NM IUid��0.7Wr�,R�IN-0Np � � T� 76l6l100� � B* 7SU67 • I"�„`-z.10ur�w�w�lsss�mv�� T�wria�. �w.w�.rw�e�aiso�i � � � I � � �� . �at� o! bsw 07/7U]OS� u.iiwr� YW W 6MEraMevMYd��INnb/nMrC . - �71 LOVIR i1Ol� g�, � 160 C�� 1D 7w� �� alL�• P11 17090-t71� � � � mORlAR �OMQSRO� � 1. 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A +�� � �,�� � <:= 4 " i� � o , �,h <�i' ,,`�, , � . ;; ,� � "'c. � ,r �L v'r .�� \ i�+�,n�, '�„` $. .; �y� �,� .. � ��'� � , � e: •.�, � �..d? �� c vrvr ne'•� sue� nrrw ����'L5���'�fiF�T�l7��I�I r� 763632004 5 4 AM( 3708 ��R�, STATE OF PLORIDA � 75a862 110865283 ApPLICAT'ION FDR VEHICLF/VESSEL �' 17993407 CERTIFICATE OF TITLE TIRE NUMBER VEHICLENE$$EL IDEMiHCA7pN t VR.MFKE �E� �V VEHICLE COLOp VJT�LENp7N OVW/LOC MANUFACiURER TYPE 67041904 IACFL13629A 1995 � � L—�J 47 � DATEOFI38UE TR�NB yp��UBE �V- PRpP{J�pN FUEL ��� WATER f{µJMgEp AUfH MO. DAV YEAfl CODE IMTENW. TYPE �E6TRIHTION 07 24 13 1RT PRIVATE BIRfHGA7E RE8IDFM CM'Y SIX MO. DAV VFAR V N ALIEN flF$.� App�n60wn�f�Nr�r 8 AtldM� ' �� DEBRt1IAULSE BREWBAI�R F 02 08 57 I X I I I 5❑ 160 CHURCH RD � L—L_J_J ,'� � CO/AGY 5 /4 TM 76363T274 � FLORIDA MOBII.E HOME REGISTRATION B" '� DECAI. 18668447 Expires NNdnl�ht Tue 12�31JZ013 YRMIIC 7996(�FI�N BODY HS COLOR IN11C Reg.Tu . 26.35 Cleee Cade 51 VB�1 JACRI�2BA 1TfLE 87041904 Init.Reg. Tex Monthe 6 LEN(TIH 4T IACA170N 5 48 CowtY Fee 3.00 Bodc Tu Moe Mail Pee Ctcdit Clmt Sska Tu CYcdh Mmths Date leaxd 7/211Z019 Vo���+�Y� (�and Tdel 29.35 � IldPORTANf IIdPDRMATTON o�u►wu�� i. Yo��mm�m�n��a.ceamya«��w.aa�w•r��a.y,ormw�. 7B0 q#N1CF1 RD 2 Regimation rmewals are tl�e mpmeibtl3ry of�he�i+trmt m!�ocx�rc dieing SFEFtlNi11�CALE.PA 17080�6714 the 30�Y Pnlod�w drc exphation date ahmw on tltia reg�huia� Rmewd natias aa provided ss a courteaY ud are na rxp'ued for renewV puc�osa. _ _ _ C 5 r 4' • AM< 3706 �I�'�^���+^r'�r+r�■ �+'+„�+y �III T+ 763632004 STATE OF F�l.ORIDA � 754862 �« 110865283 ApPLICATION FOR VEHICLPJVESSEL �'" 17993407 CERTfFICATE OF T1TLE rme ran.�een veriwt.�vessa oemr�,��raN• vra.wuce wu�a eoor ve�w�caon wrnFrwni ovwn.oc MANUFAC7UIiEfl TYPE _ 67041904 JA(�L15629A 1995 CfiAN � � 47' � DATEOFIBffilE TRANB VEHICLEUSE �- PROMSION FUEL VEBBEL WATEA RM/MBER AUfH MO. DAV YEAfl CODE AU7EFiLLL TVPE DEB�RUCf10N 07 ?A 13 TRT PRIVATE BIWIFIDATE RESDEM CMY � SIX MO. DAY YEM V N ALIFN REBd �ypbWOw�f�Dl�r S A06w � DEBRA IAUISE BREWBAI�R F 02 08 57 � � 160 CHURCH RD SHERMANSDALE,PA 17090-8714 �aovm�Rwn�o� znaovmEnr�aROa F.EI.U.� UNR♦ � � VOLUfiTAftY COMfR�UT10N6 . �� TRLEFEE &LLESTA% OflANDTOTAL 8.2$ 77.50 0.00 55.�$ l�etioa xpu��t�E� TRANSPEk1TIIE araad�� PREV.BTAiE DA7EAWU%IED NEW U9ED OOOMETEp/VE89ELM�NUPACNIffR OpOMEfEp DEGAqATK)N CEpTIFICA710N �. �/Z�013 �{ ❑ LIENIIVFORMAITON oa�oFUe� r�c�wre FEID�OR0./DLNA9IXMDDA7EOFBIfiTH o►weccourrr• nurE oF r-wsr uaaioineR: AODRESS 8RLVAOETYPE SELLER INPORMATION wu�oF s�rt aa+en oeuFn,on on�n�evaus ov�n AODqE98 DEALHiLIC@18E110. - . CONBIAIER OR EALEBTIIX E77�IIP1'ION� SALES TAX AND USE REPORT �ATETOTAL°�0i"��Nq1-�0"'^' s �sit ar rsrta ❑ avaceasn aos.vs vium unr�uo ewwcE a�eEU.e�,wac on m�ns I8 i�@T lAC�I i�l@RIOIf C�TI�IQTi NDK)ATEBi1LE'Bqit�ETA7tDUEA9PROVDEDBVCFUPfER i 0.00 1AO1I� 81L'/ �t ❑ VaIQi / �V1/fII. 1RLL Si 212�ROIiWBfAMEB D� Tu 7'Ml 4� II/m �LCLII8I111L= 1011 �'��. 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Invoice � 3125 Watnuf Street "''" Harrisburg PA 17109 Date Invoice# J Ittb12012 3069 - Phone# 7i7-545-3774 ;i ��� + Bill To � � Debra Brewbaker 260 Church Rd. � Shercnans Dala,PA 17090 Tenns Ihte Dotp Clfent COD St161&!Z� Royce Smith . @�j� Description Ra#e Amount I1ir�ect Cremution 2,4SO.OU 2,430.00 Cremation Gontainer 96.00 98.p0 Tan Color McKenzie Urn 2Q0.00 20tl.00 IQ ZYeath Certifscates &.00 �.00 Coroner Fee 2b.00 25.00 Obxtuary in Patri.ot Netua 160.87 160.87 9Ee �s a pfeaeure u�rar�r�yar�l Tot81 sz,99o.�� .:'Fs {: ' ' "`4 PmylFt9nts/ClYdits $-2,990.97 ` _ B812il1C@ DU� so.oa HSYNE% tAiN17LY St'hE2:13. #40\S£S Date: October 7, 2013 Wells Fargo PhotoCopy Page 1 of 1 Request Rejerence;IOOOSS3589952:1000553588952:1000533570951 aovice�.sMrrH 1891 0.p1BR�NCYUINELOT87 � t0100p17�f�iG6 MECHANIC9BURO.PA 11060 � '1 - 1�- � PaY to�he -_..__...... l om���r \J o�� ,r� I $��p55,D 0 • O b� ` � � a � MMM/p�r4MA � �■��� . . � . ; � � . . �,���� .,�� �:031D00503�: 10100 2 L ?62905u'0 L89 i �u�o a��ra �~� N � �� . Fi� K p7 � .. ; p � n R/T Numbsr 03100050 Processing Date 20120118 Sequeetce Number 8229374332 Amo�mt 3055.00 AccouM Number 01010021762905 Check Number 1891 Date:Aug�ust 12, 2013 Wells Farga PhataCopy Page 2 of 5 Request Reference:1000521028821:l000521018811:]ODpS21012821 Q� ., t ,,, ', �r� ai1W101Y! _ �, _��r���� � � �.w; � � � ' MM�� � y1 y � • � � ... a ��..����,,,� � , _ � �� �,��..�.� �.D33000503i: 3CI64526530w CI0098 �-r ���.�`»�:.� � 'Y�� � � - � _ �¢ F � l • � ♦ RIf Number 03100050 Processing Date 20120206 3equanca Nur�►k�r 3487026015 Amourrt 1949.q0 Acconnt Mumbar 306452&530 Ghedc IVumber 98 i � � .. '� Royce E Smith c/o Debra L Brewbaker Invoice Date : 04/25/2012 160 Church Road Shermans Dale, PA 17090 7our 7011 eax r�GUra wu pr�par�d by Jam�� g gN• CDa. Daacri tioa of Cha ea Price Hedaral aad 8upplamental goz�¢� Form 1040 -U.3. Individual Incana Tax Return 1040 Line Itsm Chargee $ sa.00 3ocial 3ecurity -SOCial 8ecurity Benefite 3tndrd Deduction-3tnndard Deduction 6.00 Farm 8879 -E-File Signature Authorization �1.00 Form 1040V -Payment Voucher F011t1 3099-R -DiBtL�ibUtiotl9 fran peneione 1.00 Compnriaon -Tax Year Comparieon 3heet � 1.00 Wkeht SSB -SOCial Security Benefita Workeheet 1099-R Lietin -Lietin of All 1099-Re 1.00 Total I�osme e 7 z.00 Forme Subtotal $ 66.00 Total Halaace Due $ 66.00 � � �„ 8$79 IRS ++�r--file Slgnap�r8 Author�atlon a,��.,�r. p.v�ati,.rnruy r oo eoe.rna ro eh.�NS.Thi.b ea.wc rNUm. 201� xw�nrn«w»erwo. r K..p ihh Mrm tur YW►ncad..S�.�frudlons. �8�6�0"���"�B"��� � 00-238374-023262 Ta,qNyranw,. 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SpawYWO�Mw. ► � � ► Practitloner P!N Mekhod Retums Qnly - c�ntinue below � - h � �Rdr lFIWlIN.F.rMx your sbc-dlplt EFlM kAOwed by your flve-dlplt asM•ealeatad PIN. 2 3 83 74-17?64 � io.a�rrMa�a i certMyl�et U»above rxxrerf¢ar�ry Is my PIN.whfctf!e my sianetws�t tl�e Wc year�ti e�ra�caly fied hoarne�c+stum�r tlts hxp�y�r(eI YKYCebd e6ova.1 arnflrtn M'ist I em w4nddhtp tliM rahrrt In ea�rdance wqh the reqWre�tiente of tlw ProctlUona'PIN afatltod atM Pe�69polen 13+�,Ftndbook�r t�orked IR3 e-�e F'rwklere�k�f Moam Tsx Fi6Wms. �'•�a�+ s �7AMES H FIESS CPA ou+ ► 04-25-2012 i�Ause rn Farm -s.�s Do Not Submit Tl�IS Fam�tM �iS Uniars �d To f�So R'a Pywrwort n.Menon Aa Ndl�e.�s«.yaMr me r.wm hatrualens. � wrm u» (2a1+) _ _ �t1VO1C@ �oi��no�s FROM: H8R BLOCK PREMIUM 4817 JONESTOYVN RD STE 125 HARRISBURCa, PA 17109 BILL TO: ESTATE OF ROYCE E SMITH 160 CHURCH RD SHERMANSDALE, PA 17090 Shbm�M ot Charaa Tax retum preparation fee 400.00 TOTAL 100.00 FortNScheEule ESTATE OF ROYCE E SMITH 21 - 12-0066 � � SCHEDULE I � � �. � � , Bs"k°fAmerka � C3_1631 LNHIST 15012 6424@012 lN�� P.O.Box 5f70 Shd Veley,CA 93pBp-5170 00OO8�h00013A )]1396 Ol0{P ��I'�I���I'I'�'I"�III"11i�1��1�II��1�'�I�II�I��II���II����I��� ��Ce Date: 03/14/2013 ESTATE OF ROYCE E SMITH Loan No.: 873701883 180 CHURCH RD SHERMANS DALE,Pq 77080 Property Address: 14 SILVERCREST DR HAINES CITY, FL 33844 IMP014TANT MESBAGE ABOUT YOUR HOME LOAN Endosed is the loan history statement you requested that provides a detailed outline of transactions for the above-referenced toan number. This statement provides a hlstory or infortnation on�� We have received from you, serviqng expenses we have paid to third parties, tax ana-insuran'ce payments paid on y'ouFT'iehalf, and any late charges assessed and pald. THANK YOU If you have any questions, piease cail us at 1-800-669-6607, AAonday-Friday 7a.m. - 7p,rr�, Local Time. We apprecfate the opportunity to serve your home loan needs. 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Smith) Address: 14 Silver Crest Drive, Haines Clty, FL 33844 Purchase Price: $ 25,000.00 Less: Listing �ee (� 8% $ 2,000.00 Sub Total: $ 23,000.00 Adsilttonal Charaes Less: 201Z Ad Valorem Tax $ 312.35 Lot Rent (see attached) $ 3,974.70 NET TO SELLER; $ 18,7i.2.95 s.ea�sa'�.a,.�a.�ti,� ' � u��' w� ap psnt 81 iro /9 • . :7�]Hr7 p/ C/ T7b COA RF1i1TRTA V'll1WGiHT7 57�7{.+rr CT]C/1 CTl19•T9•Rr1W �_._ ._ _..___ _.. ._ ._.. _ _... .. /I Transaction �isting ��� � � � �� ��� � �� � 02N1/06 Rent Charge 338.x6 33E.26 ff2110� 1311 Payin�ntRaasNad.ThinkYW (3'J8.28) B.Oa o3Jptro9 Rent Charos 33e.zs 336.26 Q3N� . t3Z8 Paym�nt i�swMd-Thank Yai ' (33d.2b} 0.00 04lQ1N6 R�nt Chaf� 338.26 336.25 W1�100 . 1944 P�yrt�tft RsaNad-fiarrk You {986,28} O.GO 05N1roD Rerk Cherpe 338.25 33C.26 G� 130R P�Yment Raodv�d-Ttf�nk Yar f3�•28} 0.00 08apv0➢ MnlChr►�s 3383Q 396.26 Oet08�]9 i37$ Fayrt�nt R�oeived-TTMaMt Yaa (336.2b1 8.00 07/01/09 R��t Ch�� 336.26 338.28 airo� 19�l► �ymer�Mcav.a-rn•�ra� t3�e,xs) a.aa 08/Q1/OO RehtClierCe 336.25 338.26 08I05t0$ 141� Payment RaetlNsd-That1k Y6U (33d.26} 4.Od 09�01/09 R�nt ChArp� 338.28 33E.28 QYAD9/0i t+C� PtYtrant R�cihnd-'tftank YoU t99A,26) 0.06 10K11/09 RentCharae 338.25 336.25 10101f09 '1�3 Psym�tttReaiNed•ThltttkYCti (338,2b� B.OG 11/b1/00 R�ntCharpa 936.23 336.25 11t40� 1483 Payrt�ntRecaiwd-TlunkYeu (33e.2$) 0.80 72/01/09 R�ntCharyo 336.28 336.26 iZ�?7� t�84 Paymartt RiolN�d-Thntk Yat i�0.2Ej 8,00 Ot/01/10 Rent Chwrpe 363.08 363.06 09161Jt4 169A PaylrrentR�ori++ed-ThankYa� (3S:i.0iS) 8.00 O�R11/10 R�ntCh�lrp� 363.09 383.OE 0?,187118 i6i4 Paymsnt R�oWtrod-11SImit You (39�4.Od} 0.00 03�01H0 RentCherpe 3b3.0�Y 863.49 QEIQ$!!0 1lSS7 t+�y�mnt IimoNwd•Th�nic Yoli {0d8.D8) O.OQ 04J01H0 RenlChsrae 363.06 883.OB arov�o isr3 P.y�,ran�¢.o.rv.a-rn�vat ��.oe7 o.oa 06/01/10 R�nt Chqrya 363.p9 368.06 0�104t10 16i$ P�yrnint R�o�iwd�7Funk Y8u (963.003 0.08 OE/C71/10 RetkCh�rge 363,08 383.08 pOdp1t16 i� Paymsnt PFiplivtld-Thatik YoU i338.00) 0.00 07AD1/10 R�ttt Ch�rpe 363.06 363.04 07A6s1t4 1426 Pay�nt RsoMved-TheMc Yau, . (353.W!) 0.00 aB/qti10 Rent Chrrye 363,08 353.Og oarO�MO 9�4 PiymMtMO�fwd-ThuN�Yau (�b3.diy o.00 OW01/10 R�ntChaq� 353.p8 383.U8 06t03t10 ify48 PpytrHnt ReeNvaC•TheMt You (363.08} 6.00 10/D1I1D RsMChwps 853.09 3fi3.08 t410111� • 1� 'P�Ymsn#lNWiwd-th�nkYaa (363.08) 0,60 a�rov�o R.mcnar�e 3ss.� �.oa 1 tl06t90 1876 F�aymsnt Rswlwd•Thank YoU 1363,06) D,OD 12MiM0 RernCh�lrpe 863.Ob 3B3,Qf'e 1�10 . !8� FaymrMFtaaived-?1faNcYau (953.OE} O.Op 01/01/11 RentCh[irp9 370.77 3TQ.71 QilDA111 1708 Paymmt Rfa�iwd-'iNrmk You {�T8.71j 8.00 02/0'IH 1 Rerd Charp� . 370.T1 970.77 Q2184/i t 172lS P�ymsnt Rsaiwd-Thank Yar (3T0.71j 0.00 03K11H 1 R�M ChMrp� 370.�1 27d.71 OJip4J11 - 971G Piytnsntlt�div�d-ThankYou t�1d.71; 0,00 � 04/01N1 RsrYtCAU�pe 370.71 370.T1 ' p410lS14 t 17StC Psymint IR�nd-Tts�nk You (878.7i 1 O.GO 03l01/11 Ron4 Ch�rp� 370.71 . 3T0.77 trsns+wYlat patlitp dH8/i31q:02em Aepb!0l2 rontmaitape�oom•prope�ty tnene�ment gysfoma rev.3427 ( /£ `39Eid $L6L T26 £98 39Y't'IIA )2'JOI�lh'H 3�i'I bt�60 £TD7"CZ'Bn� ow e.r�na.r a.aMonon cumm.�n nmou�t B.rm. 06/0!/11 17E! Puym�nf R�o�N�d-Thank YOU (870.71) 0.00 OEN1/11 R@MChYI'p0 370,71 570.71 OB/08N 1 1781 P�ymMt ReaMwd-Thenk You (370.71) D.00 07/Dt/11 R�ntCherpe � 370.71 870,71 OT/06/41 1707 Paymsnt ReaNwd-Thenk You (370.71). 0.00 oB/01 N 1 Rent Charpe 370.71 370.71 0910EN1 1911 P�ymatklUaHed-1T�McYou (870.71) 0,00 09/07/11 ReM Ch�rps 370.71 370.71 Q8I00/11 182e PaY�M��-7hankYou (870.71) . 0.00 t0101/11 R�nt Ch�rpe 370.71 370.71 10A9/11 1a0i MtymoM ROOSiwd•TMnk You (370.71) o.CO 11I01/71 Rant Char� 370,71 370.71 a�roa�� �ea+ P.rrn�,easoen�.a•rn.n�vou ts�o.»> o.00 12/07l11 Rmt Cherpa 370.71 3�0.71 12/02H 1 , 1808 P�yment R�oNv�d-ThaMc You (370.71) 0.00 01/O1H2 RsntChsrpe 386.84 385.54 01/00/12 1983 P�ymmt R�alwd•Thenk You (396.04) (0,30) 02/O1N2 RentCheige 365.54 386.2A 03/Ot/12 Rsnt Charps 385.5a 770.78 03l01/12 096 Peyment R�whnd•TA�nk YOU (:l06.sa) 386.24 04/01N4 IWntChalpe 306�64 770.7� 04/01/12 066 Pmyment Rewiwd-ThrMc You (386.64) 3BS.24 OBI01H2 RsMChnps 988.s4 770,78 os/04H 2 OE P�ymont ReaNsd-1'h�nk Vou (386.54) 395.24 06/pt/12 R�nt Charge J8B.64 770.78 06/26/12 0007 Paymrnt Reoelwd-Thank You (386.64) 386,24 07/01f12 RMtCMrp� 3E5.S4 770,78 07/11H2 Lele Ch�rgo 10.00 7E0.78 OB/01/12 R�M Ch�rge 386.64 1,188.92 08HM12 Lab Ch�rpe . 70.00 1,176.32 oe��ut2 a2e P�ym�+tR�oMwd-Th�McYou caes.s�> >eo.�e 09I01/12 Rent ChAty� 386.54 1,178.32 Oif24H2 d40 Peyn1M1 R�oNVed-ThNdt YoU (�86.46) 790.67 10/01l12 Rmnt Cherge 366.84 1,178.41 11Pot/12 Rant Charp� 386.64 1,681.95 1 t11M12 I.�te Chary! 10.00 1,671.% 12/04/12 Mrd Ch� 386,64 1,9S7.10 12/17N2 L.s�Cherpe 10.00 1,967.49 01/01N8 R�MCh�� � 3�7.1t 2,384.00 OtY16/13 Lab Chafpe 10.OD 2,374,80 01/26H3 9301 P�ymer�tR�oNved-TMnkYou (986,A6) 1,G89.76 02/Otn3 Rent Chug� 3�7.11 2,386.26 03/01/13 RN1t Ch�rp� 307.71 2,783.37 Oa/01113 R�M Ch�rpe 387.11 3,1 B0.4E 05/01/13 R�at Chupa 397.11 3,677.68 OBPo1/13 Rmt Cherye 3G7,11 3,974,70 TYa/fNdbn Istip QHAM!to:O�eM � PpN$d2 I6rlhnAnapsr.Cbm-pYOpIAYmdntlpBlllBflt Sy�bmx I'6v.3�27 6 /b '3�4'd SLEL TZ6 E98 39K'IZIA x�ONII+lYH 3?I`t'I qt:60 £TOZ'i2'bn� ._._.____—.,. I��I � . ___._._.. � ISunarwtBdesCorpontlon °�'a�'"'�0' . YG6TO�i ;:� � 7a0¢ M�,suir�i , :.:: : Actl�Rtt�T 'i: ;� �+w pM�ic PI.�l633 ' . r•.. rt��e+ze�a ,,4., . , .. � T/"J0, I�D13 �;�. �-.•. eoo _ . . ,+ee i. r � j�� � Debra�}�rba�cer , �. ,- ..Y .... . .$18,811 , �.: ;. :,,'. � .25 �-: < :: ;., .:.., ' ; �,;. .. . ._. �'�;s f:f.. .r4 t4. . . . ...�. ,. . :' ry:... `:`.t,'fr .. : + '� ' v'Jt ':Irv.... '�..r• � . . , , •'."� . :'t�y'f.��Y"lf;•:tirif`�t � a• (]�yO�j�L-- /f� •_�n' �f:•a .� 5i� "�f`f.f'.' /Yt/� � i�Y:. � ^�'�'{i��q,�.�'�(.•� ��p � w!��wrt�F..jF..�"�e��.��['w�rr��'�:��".'."� ./��l.r � S� .1A0.!CLUnrh `,. ..'1� •: .. `;. .f�;'��±fr� � . ,�f _ a, -::+¢ . ;.v ? .. 'a.�fyf ei+y'k`'C�::•'I,��j� �(F r�p'��%.: :n� •� _ � ' N F�f�{�� . .:If �i� ��3�!'Y!'T7��� � � � ��~ Y'r ,-�� �,: ..b:'*n'�'d..,.Fi_'+je:Er`';�v'r:;t���i tff s;9JJr. ���:;..?j��i,ry:: ^�:'i f.r:�i,.'y+3� 's - n�r.. �'} ��� i �'e . � � r�{ y�i�. �y��y, ��li �I.'}4j!�5.,:. *' ..:,..:: , . .,x' r ���� :ti. j\};:+ .i: . �:r'�tvYl.:',�lil."'J%.:.:�S"�'FJ'2.4��"!/,r,.}�'1��V��N1 EFN�fif.Y�i�1rY.:�:?pf� ' . � v� S i� ��{ �I _ •,x. �,,',..� h'. .C:+}" r: . .:,"+i� ."�`�,1}� J�': . .}ir...,� .a. .J • Y. �, .x; + :� � -- �:.: ,,� , , ,�r::,.: _.,' .S w9057QSM i:463000044�: 898008 5 50 28 5r � 'u� 1� \\'� k.c -Q v -e {� I � l � l � � a � � �.1,. �e .,� �- a � t�. � G a � . � wt,. -�-^� !� •ti� vt �.` nnc� 36106 US H�hway 27 Haines City, Fiorida 33844 (863)A21-5764 (868)741-1239 fax: {863}421-73?$ Email: neeCdlia ehammock.com July 29, 2013 Debra Brewbaker ibQ Chut�ch Roac! Shermansdale, PA 17090 RE: 14 Silver Crest Drtve—E.�ke Ffatnmt�dc Vfllage Hi Deb, I have endosed the lien satiisfaction from Bi7A and their FedE�c labeis as well as copies from the State of Fla�ida/Polk County Tag OfFice. Induded in t��ese copies are: • Certlficate of TiNe for or�gtnaE �des (Smfth} —Charge uf;g5.75 each sfde = $17L50 • Certiflcate af Title for transFer ta Debra Brewbaker — Charge of $85.75 each side = $171.50 • GOp#ES Qf D85C8 BI'2WE7r3I{8C 11U@S • 20i3 RegEstration for [�hra Brewbaker and • 2013 Registratlpn Stkkers—Charge . side = $58J0 Jan thru ]uly 2013 • Copies of Receipt far above pay — $901.74 , Nopefully }rou have aiready receh�d your check frtun tk�e cor{�arate affi� of Suncrest Saies. If you have not wlth receipt of these papers, piea� iet me know. I ur�rsta�J you hacl a dEfFicuit t�me wltfi �A {sti11 are) re,}ardl� the t[t� ta the home but I do want to reiterate that i# was nok Lake Hammock Vfllage, Suna�est Sates, or I that delayed the transfer process of t#�e tttles to the new owners and or the disbursement of your - w w ■ crlrrr 4vt �t 3 O8 � ��'�' ����R° ��'"-' `������ ry 963633678 STATE OF FLt)RIDA B'' 75a862 FI. ��T+� 1�os652&t AppLICAT70N FOR VEHICLt7JVESSEL � 179938tb CER'TIFTCATE OF TffLE mtEr�raeER vFr�ci�rvessametar�ECnt�+x va� thacEOr e�r vencx.eceioR wrn.�e+einr c;vr�aoc AiANUFACNRER TYPH 67041905 � JACF+I.15629B �� 1995 CHAN HS � 47' � r�a o,t�v t� c� v�rncieuae �tiu�ia� aaoPUt.�a+ w� V� wn�n Rr�� c��aucrwr� 07 24 13 TRT PkIVATE . BIRTH6ATE REB�EM CNTi' SIX M6. DAY YEAfl Y N ALtEFt RE$.N App1a�MDrRwe Nme 8 Aaanee DEBRA LOUISH BREWBAKER P p2 OS 57 X 5 160 CF![1ftCH RD SFffiiMANSDALE,PA 17Q90-8724 �a°wr�ERt�mu'°R z�'°°vm�nrva.ron F.E.t.a.� warr,, � �� YOtttNTAflY CONTAIBttTf4tlS F�EEE� irtLEFEE SALEBTAx CiRAND70TAL 825 7?.50 O.OQ 85.?5 a.etioa a�¢u��t�d� TRANSPER717LE arand�: PflEY.$TATE OAtEACOItiFiEO NEW U8� 40DMEfERtVE88El�MMN1PACNRER OQOMEfER DECLAM710�1 CERTIFICATqN FT., 07/24t2013 3IX ❑ LtBNINFQFtMATiQN wreoFU� AECEnhooA� �a�aar��o�,wasocxaoa�aFSrcmr a,�vaccaurrrs IUME OF FNiBT LIENMOIDER: AWREfiB 9FiYAQE7YPE SELLER IIVFORMATION NAME qF 9ELLER,Fl.QRIUA DEALER,OR OiHEIi PREVpUB bWNER ADbRF.S9 DEAI.�q LICEN6E N0. CONSUMER�i 8,H.ESTAX EXEMPripN N SAL.BS TAX AND USE REPORT '"�"�T°T^�wmause°w�,'r�cu�w°'n"v s a�rra or �rxrrs ❑ soxc� eozoe vu.xa �PAIDd�VA�M.ELIl�BELLEH,BANCOR07HER8 2$ E'�pQR liQl[ �@?S�/ C�SlIGT! M#71CA7E8N.£90RUBETAXDUEABPFiOVNfED6YCHAPi'ER 5 Q.OQ aLf�tCVi !AL#i � ❑ 4i9ZCLE ! �YBiL 1PZLL 8� stRFtOt�A8tXn1iE& V/! 4'At 1O91 T� OYm m[CL082V'iLY 70A R1�P11T. 1ti�YdN(8) Cl�Q� � O'Pl�l, IlVHE�k.CCANCE ❑ BiLL=#'Ni P7tICi 'VVnttIlYSD ]1PiLiC,iiT1' '�./IN!'I!Z@�4'IAiT N1tM1�YC/N�MTYITMV01114lIMltl.TO rTRIDMMiNOf!pMpIRpIRON71�WRLCIbNM'IMMURwIWAYlIfM1M�lTMb I C�11lY11111T711�ARlqRi�CP lfll!I�lfJi�q11�f�OMlO�. t EetilY TiRf 71M Y7 W II VNON7�R YYI{I�O4lOM OflfLT fM}i!{'i M'fMelf NO NlIQW ii r!MMMION. 1'wa i�l/Il�SIlYttYttMl!�MMMa.Y OM Ai MCI!CNL1�/U W N�lN�16.Mo YMi N�tJ�ONlOR'lllti/i.el M MI161�Op�tN711Q IN�A'8!Yl17MNT SloE s lYV WORIMO'/i1RRIt�IMH�l1-1f11Yp.VNOMYaCLlNlMl.E60CIlW MOIAMOItO�VLOf10lLS1�ON/iNOYl.YMlNlfll1110/�1DC@loillTR[AWlIETALLCNiL IIr11M1 PB/M.11O M FOLMNV.I OMH,AIL TMT I INVq ICIDT!lMICOOpO Gi00N�Mf AM TIAT 1K MCI7 6TA'1[p N R/K 71NML SyMlub d Ap�rr 8¢/itlue d� HSMVB$MIREVIBEb0YA6 �&CANCODE �'�' . BATCH NUM 754862 BATCH DATE 07/24/2013 HATCH HOLDER NAME SMITH, ROYCE � TOT NUM OF TRANS 6 BATCH AMT 401.70 NUM OF PAID TRANS 0 PREV PAID AMT 0.00 NC7M OF SELECT. TRANS 6 � AMOUNT DUE 401.70 � RECEIVED AMOUNT 0.00 : AMOUNT REMAINING 401.70 PAYMENT TYPE CHBCK NUM. PAYI�NT AMR' Caehier Batch Dieplay Traneactions � JOE G.' TEDDER - � TAX COLLBCfOR Date: 07/2C/2013 Time: 14:31:33 Location: 605 . � Clerk: RJH Transaction 06d3868 . , Miecellaneous Account PRV . RecelDt 0642868.0001 85.75 Miecellaneous Account PRV Receipt 0642868.0002 85.75 � Miecelleneous Account FAV Receipt 06d2868.0003 85.75 ' Miecellaneoue Account FRV - Receipt 0642868.0004 29.35 Mlecellaneoue � � Account FRV . Receipt 0642868.0005 85.75 , Hiscellaneous � . Account FRV Receipt 0642868.0006 29.35 - TOTAL PAID 401.70 . TOTAL TffidDSRED 412.00 CASH 412.00 . LE9S CHANpE 10.30 Paid By: emith r,,,,�_,_ � '2�22,��g AN�'TICeAIR ��b c�'�`� 9� ,�� SERVIC ORDER - Winter Haven, FL 33881 I 5�,,v�'A`� 1>°� I1�IVOICE 863-291-8201 _ __ a�«,� ..,��i�'"Q......�.���l.�,�,�.� _._ .�'/„���cr>.aab:��y .. tMe worw iam ee --'� O C.O.D. ,O CHARGE ❑ NO CHARGE _....:__................_......_.__._...._D_............................._.......__.......................... _._. _.............................:......__.. �E � ........ . ...... ?�� s� 3 ��y p _......_...__._..._..._....................._..........._.._......._..........._....................... ..........._........_._........_...._......_......_..... �`%�� G;o.3c000 � � 6NKMMYl11 eEwLNWlFA ""'"e . .e�j' C 7 6 � O r`r c�/'l9/ . . 9TPF�/ pATE� �.t� -� S� � wr !' 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TOTAL MATERIALS ,p p "'�m� . � _ ._{.!'�.�„��l.� .�,�...�Q �._ eitcr.xrn. c�aiavea q GJ n�.�uwc cuuao .- �. � p(•+�� �t ""'.5•�7,^'?i+`_. _.._.._ . /— y� �.o,�� � � � yy.� ���_ .. ......_.... _._... _ _ .. ._. .._""""_'_"' '""""_ PeMI11FOWIM � PUMPI81� . .I.'___"__ '_____f'_ '�...�..ft�'/�1"L.� � ..___"_______.. ,� ���zr � � t J.� ;��� ,��, o�o � r G� .. ._. ._1�.��_....�.��"_"'... ... _,.._!__....._._..�._.._. .__. _......�._ " __ i"_'"' ..� _ '""' "".. ..... ........ .�.... � � � . . �[quMG: R1Bi8 D aiuleb �� O n'n.�eeo m.���w TOTAL LABOR � LIMITED WARIiAN7Y: All �matodals; parts � and equipment are warremed by the 7ERMS manufecturero' or auppliera' writlen wemMy� � /� onty.Ad labor parfortnad by Me�.dwve nert�d� � SOTkL. � � � /� //� � �� � company le warrented for 30 deye or ea MATERIALS � � - � , �2�� dtll9iWlee Ind�Fa�W In W11tInp.TMlbGV9nerMA�� .TOTIIL �.. . . � � compe�ry rt�ekee no�othar wartantba. expraee . �LABOR . �n.,.nsanM a aa.r wrre.�w. �:�...6:.�'erwwh m�arrs��.a�wi � w.Implied, and tte epeM6 or-�teehnk9ane are -� . s.w�r+.w.e � n.�++ra�.r��r wr���w��nw�w+��m�.a. � rwt auMorizad lo� make srry�auch wertanlies � �/�;;_ I c.1 ..p.m.wr u��w..0.�r�.ww�s.wn.m.�...Mr�w�r�xxw na��� on beAaM of above namad compeny. we n�or ww nd e.ar nAa.nar a sa.r. . � CH ROE �� . / � 1 .. . ❑ REflULAR :.. ❑ WARRANTY . �-� � ❑ SERVICE CONTRACT- � � � T� -I l�G ��X�� . . . . 1� .e..ue ma �Ren��ew TOTAL' 'YG�` �"� ann,u�.R�w.�aa� s48 te0 CMUR�FI 110�1D DFU�tAta SMERMJWS DAi.E.PA t70Y4 � �� i^�� � a j �y tO t.i18 f� ��� � �j �� � ''"� p' �QFt18C O� � L.r.� y�, ��;'c�r�"'-��� pC� � .J�� ( � V �_��`�.�� ��- �- j'��'� B ;�. � '�,.8�knf t.a+ehsb�g 6Mnn�na DrN,PA 17�OY0 For ` �? �.,��,,�j. - a.,4�a�s�e t:� 3i3i2i� 23�: 3 ? 3383� i�' OG48 , �� _ .,,,." . • - • l�I�`t,.ORI�Cradi`t Untarr� �v{' Branch NWHA 08/t�l�t143 O:s�tf3Z Teiter# 31� � . BAFD >263179804< tr�! 80917:��OQ �_�r . Not'th 1liatsr RatveA Acco�rtt! #�Wi �" ' 2G13-0 —OS -> 263l793Q4 <- �a�is�s�i�s , . i�� � _ _ ���� IN$URANCE OROUP ovt7cE�oonaes r�aaNO�oweees 5800 BEECH TREE LANE P.O.BOX 9399 CALEDONN,MI4991&0050 GRAND RAPIDS,MI4B601•9333 February 8,2013 � � � ROYCE SMITH C/O DEBRA BREWBAKER °��j , �- C�r 160 CH[JRCH RD �- SHERMANS DALE PA 17090 RE: Foremost Insurance Company Grand Rapids,Michigan Policy Number: 103 0660021294 12 Insured Name: Royce Smith Dear Royce Smith: This letter provides the history of payments we have received for the above-listed policy. These payments have been applied to the 03/21/2012 to 03/21/2013 term. AcHvity Date Billed Rceeived REGiJLAR BILL 04/10/2012 186.09 CASH ON POLICY TRAN 04/11/2012 186.09 REGiILAB_BIL 04/25/2012 80.26 �_...._v..._, �D-IItECT REMITTANCE OS/20/2012 �'86Zb�� AR BII.L OS/28/2012 80.26 REMITTANCE 06/18/2012 80.26 ?' 06/24/2012 80.26 –' RE (�AN['�E � 07/17/2012 80,26 7 AR B 07/24/2012 80.26 „ �'�'�EC MITTANCE 08/16/2012 80.26 `-R GUL�AR BI�L 08/23/2012 80.26 -- CE 10/02/2012 80.26 �WTff�RAWAL OF CANCEL NOTICE 10/02/2012 80.26 CANCELED,EARNED AMOiJNTS 11/12/2012 638.03 CANC 11/26/2012 50.64 ��IRECT RE'�ANCE� 11/27/2012 50.64. ��_��— 12/03h012 18614 �L3IKECT CE 12/04/2012 29. �-�D CT RE 12/26/2012 . D ECIAL BILL IIDIL]E AYMENT I2/26/2012 80.26 SP � IItECT REMITTANCE \ Ol/20/2013 80.26 -----� Ol/20/2013 80.26 DIItECT REMITTANCE 02/07/2013 80.26 ���. � � •ea.�w•wm.•r•bw r.�d+..e u.e.nrba rcw uc.aem ea.ei tt..�.n..cwmu.�w�wm.wvrc.ao�w•m.me.ram.rrme.x.nano.cmuo��mr�rawm saame�xwrw.aroup. 729217 OYI08 ' ��� � p� � � �� i I �p .' . 5.,. 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W HtM�L�NICfBURO,PA1TCfC y�M'�TOlLLtt.01�MCIITI6D p�h07/27/72 . ti ro��CITICARDS $ 1p3,93 �' Qne Hundred Three Dollars end 1�400 ' ' dH92d27tS3D8070572 �VIlE11ri0 � Authoriaed by yrour Liepoaitar 01 t2TJ12 �:03i0D0503�: 3064526530��' 224,i,2, ,,��',QC�Q.Q�I}��.i,�,,., .,......�. . _ . ..... ... �.v. .. --,.—. . :� '" :" ' .._ , . .. _ . � � -. : ' i . . _, . . � . . .. �TS"'i: . . Y' u 3t.dk 3..�.3p ;.�•--'< . _ . `w�a�ti��a:-�`�: . . .. . ., , , i :��u� � -r; �s--( . _ • S . . �;s�' ` i ' �e'Q� ��,a !`-• � . . . �. .:_ _. . . . j '. . ���:Q �' y 3=$ � `=' .:-=='• � ForUepesitOltly: ,• ., � : .. ii 4� r� i �,Q$ 1 Qdt13f�847 d1272072- PECd CITiBANIC NA. _ _ �.: ; �� k � 2a7'4 286 8�'!0 . '�COttJRABUS OH � ; �. � � 1 7.'f2� tf2= :: . >122401710< _ = . � - � ��� . . .. - . #�.:- � ., e� � n a � ' . ' • �. � . : • _ ' - � .. , .. � ..• � . . .�. ��,.�......�..—. .—.u.�.� . . . . ... . . �. .� . . . . .. . . . � � . • r. .. .. . . topyrght C�7 2002-06 WeNS Far4o&ComPa�Y.AA rights�eserved. f � � i:- c � {_. https:!loibsecvices.wellsfargo.comlOIBlControllerServiet 'n"'"'"," �� � � STATEMENT OF ELECTRIC SERVICE FEBRUARY 2012 ��� �� � 28632 70224 FOR CUSTOMER SERVICE OR DEBRA BREWBAKER DUE DATE TOTAL AMOUNT DUE PAYMENT LOCATIONS CALL: MAR 08 2012 33.75 1•800•700-8744 160 qiuicH RD SFERMANSDALE PA 17090 NEXT READ DEPOSIT AMOUNT WEB SITE:www.progroaranerpy.com DATE ON OR ON ACCOUNT •--•••••••-•••••••••••••••..••-•••..................... SERVICE ADDRESS ABOUT TO REPORT A POWER OUTAGE: 14 sbvEx ctrEST oR MAR 19 2012 NONE 7-800-228-8485 HAIIES CITY FL 33844 ELECTRIC SQtVICE COMECTION CHAR6'E 28.00 PIN: 773995010 RS-1 001 RESIDENTIAL SERVICE BILLaiG PERIOD..O1-31-12 TO 02-15-12 15 DAYS (PRORRTED) METER READINGS ��TO� �"'� ��+^r�� 4.ae ENERGY CHARGE I£7ER N0. OOS86SS60 FIRST 1000 KWH 4 KWH � 6.275000 .25 � PRESENT (MCNAL) 004348 �� 1000 KWH 0 KWH a 7.366000 .00 PREVIOUS (ACNALI 004344 F� ��� DIFFERENCE � 000004 F�T 1000 KWH 4 KNH 8 4.860000 .19 TOTAL KYAi 4 �� 1000 KNH 0 KFM1 a 5.860004 ,00 ■TOTAL ELECTRIC COST — q,82 GROSS RECEIPTS TAX .12 MIMICIPAL FRANCHISE FEE .30 MUNICIPAL UTILITY TAX .51 TOTAL CURRENT BILL ;3,�5 TOTAL DUE THIS STATEMENT }�3 ',� ��� C� � � �� , � �� aa �� � � � � � � c� �re ayment o your pr w to t a e ue ate w avo a late payment charge of f5.00 or 1.5°/a, whichever is greaMr. It is our pleasure to welcome you as a customer at this Iacallon. We value your buclness and look fw�ward to eerving you. Remove the gueeawork from your billa by joining the Budget Billing plan. Budget Billing eliminafea peak billing perioda. Contact ue todayl �� � �� C� ENERGY USE DAILY AVG. USE - 0 KWX/DAY � USE OIE YEAFt ACO - 0 KYM/DAY ■DAILY AVC. 0.ECTRIC COST - �.32 OETACN AND REfURN THIS SECTION Maka cMcks payable to: Progreaa Enargy FlorWa, Inc. ACCOUNT NUMBER - Y6632 70224 MqR pg 2072 P.O. BOX 33788 000001533t O1 MB 0.40 sT. PETERSeURC, �� ���������i���l������������������'���������������������������II�II . FL 33733B19B DEBRA BREVYBAKER �.TS 180 CHURCH RD SHERMANS DALE PA 77090 • 8714 iLEABE FNTER �rouxr rao 2863270224100000�033753DOOOOOOOOODOOOOOOOD33753010000DOD0009 _ . A A A A U t�\A U pq O� pq V \ \ p�p lO [� ia �-, � � � � C � ? C � � ` � � ° ii+f � � N N N N N N N N N N N N N N y O � N > �21 P n v � � J i � � � � m � � � # m � R m n^G +�i � ',~i � w X � � � � � � � � � � �� � � � � � N � • w m m m G `n � `n � m n o�i � � s •b 7� ? .7 n � A "� lS � � < < [�i C � � a n m tii � m ^ m ° m e C � � � M Rf Q 0 m ? v � $ m � o n Y o * � � • C75 � � � � � {� {/� tltl A N N �N A M J H a Y Np 0p0 Up U pU O �p r.�+ O O O r O J U O �Op / o � ro O o v � � B � � Y � ^ � � � �� � � � � � �' o � � � 6 �� � aA �1 H H N N � B O N N w . V O�e y�i V V r y r � N `� A A W Y ♦ M n N � CO J p A A O w l. H H f1 J p�p � � O �+ J � � C ' N b A � A C � P � 7 � n �A � � s � b O N � * � � � � rA � � � � � � I� � � � :: o o � o �p ... .. � S O N � P(Qt'�+eSS EjtBlgy Progress Energy Florida, lnc. St. Petersburg, Florida January 4, 2013 Debra 8rewbaker 1607 CHURCH RD SHERMANS DALE PA 17Q90 Re: Account number 92687-fid3d2 Dear Debra Brewbaker. Progress Energy Floride is committed to providing you with reliable power and outskanding oustomer service. We wauld like to thank you for your recsnt payment of$20.p0 made on January 4, 2q13, with the assiskance of one of our associates on tlre phone. Based on your verbel authorization, this payment wfii be debited frarrr your bank accaunt within three businsss days. In addi6orr to tfie payment to Progress Energy, a convenience fee of$4.95 will be paid ta Siebel Systems and alsa wiil appear on your bank statement. To learn about aihsr convenient payment services, induding e-bill, piease visit us online at www.progress-energy.cam. You also may reach us between 7 a.m. and 9 p.m. Monday through Friday at 8Q0-TOQ-8744. Sincerely, Progress Ener9Y Pro�ess Energy. Looking at Pawer In a New tlght. ouzo - I �I 1� � V/ Progress Energy Florida, lnc. St. Petersburg, Flarida February 1,.2013 debra Brewbaker 1601 GHURCH RD SHERMANS DALE PA 17Q90 Re: Ac�oun#number 92687-84342 Dear Debra Brewbakee. Progress Energy Florida is c.rommitted to providing you with reliable power and outstanding customer service. We vvr.�uld like ta thank yau for yaur recent payment of$25.00 made on February 01, 2013, with the assistance of one of our assaciates fln the phone. 8ased an your verba!authorizatian, this paymenk wiA be debited from your bank account within M�tee business days. En addition ta tha payment to Progress Energy, a convenience fee of$4.95 will be paid to 5iebel Systems and alsa wilt appear on your bank statement. 30 learn about ather convenient payment services, induding e-bill, please visit us online at www.progress-energy.com. You also may reach us belween 7 a.m. and 9 p.m. Monday through Friday at 800-70a-$744. `'�,.. Sincerely, �.�..,, ^ Pra,�ress Energy ----- -�'t �? � / L� � � � � �� � `� �� � �?C � �r r � � �° � � t � c --�_.. F'ro�esa Energy. Laoictng at Pow�er in a Mew Light. nozo _. 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