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11-12-13
1505611184 REV-1500 Ex(02.11)(FI)'sJ!j OFFICIAL USE ONLY PA Department of Revenue pennsytvania Bureau of Individual Taxes DEFT-ENT OFp ENUE County Code Year File Number PO BOX 28o6o1 INHERITANCE TAX RETURN Harrisburg,PA 17128-o6o1 RESIDENT DECEDENT 2) ZO 3 (J Sg ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 182-22-9653 02092013 11141929 Decedent's Last Name Suffix Decedent's First Name MI CREE SHIRLEY R (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1.Original Return Q 2. Supplemental Return Q 3. Remainder Return(date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) Q 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) Q 9. Litigation Proceeds Received O 10.Spousal Poverty Credit(date of death O 11. Election to tax under Sec.9113(A) between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number. FRANK H KELLY, EA 717 .�74 . 753&z; rn c� R S*@R OF WI USE M S —I X* r'— }—' frS m First line of address a r\3 C) 400 BRIDGE STREET, SUITE #4 ° n �a Second line of address G"3 • � Iv r-- rr1 r-° —i C7 City or Post Office State ZIP Code DATE FI<}.F�.D Cf) � NEW CUMBERLAND PA 17070 Correspondent's e-mail address:FRANKKELLY @KELLYTAX.COM Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATI RE OF PERSON RE,SPONSI Lf FOR FILING RETURN DATE A�RESS 375 STON GE LANE, MECHANICSBURG, PA 17055 .SI E THERTHAN REPRESENTATIVE rDAJ e AD 00 BRIDGE STREET, SUITE #4, NEW CUMBERLAND, PA 17070 PLEASE USE ORIGINAL FORM ONLY Side 1 1505611184 1505611184 1505611284 REV-1500 EX(Fl) Decedent's Social Security Number Decedent's Name:SHIRLEY R CREE 182-22-9653 RECAPITULATION 1. Real Estate(Schedule A). . . .... .. ..... .. ... .. ..... ... .. ... .. .... .. .. . 1. 275, 000.00 2. Stocks and Bonds(Schedule B) .. .. . . ... .. ... .. ... .. ..... .. . . ... .. .. . . 2. 64, 188.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . ... . 3. 4. Mortgages and Notes Receivable(Schedule D) ..... . .. ..... .. . .. .. .. .. ... 4. • 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). . .. ... 5. 80, 438.00 6. Jointly Owned Property(Schedule F) O Separate Billing Requested . .. .. .. 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested.. .... .. 7. 628, 123.00 8. Total Gross Assets(total Lines 1 through 7).. .. ..... .. . .. ... .. .. . . ... . .. 8. 1, 047, 7 4 9.0 0 9. Funeral Expenses and Administrative Costs(Schedule H).. ..... .. ..... ..... 9. 77, 5 7 6.0 0 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) .. .. ..... .. .. . 10. 226.00 11. Total Deductions(total Lines 9 and 10).. .. .. .. . .. .. .. . .. ... .. .. . . .. . . .. 11. 77, 8 0 2.0 0 12. Net Value of Estate(Line 8 minus Line 11) . .... .. .. ... .. ... .. ... .. .. .. .. 12. 969, 9 4 7.0 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) . .. .. . . . ..... .. . . ... . . .. 13. 14. Net Value Subject to Tax(Line 12 minus Line 13) .. ... .. .. . .. .... . .. .. . . . 14. 969, 947.00 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec. 9116 (a)(1.2)x.o45 969, 947. 15. 43, 647 . 62 16. Amount of Line 14 taxable at lineal rate X.0 . 16. 17. Amount of Line 14 taxable at sibling rate X.12 . 17. 18. Amount of Line 14 taxable at collateral rate X.15 • 18. • 19. TAX DUE .. .. .... .. . .. . .. . . ... ... .... . . ... .. .. ... .. .. . .. .. .. ... . .. 19. 43, 647 . 62 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505611284 1505611284 J REV-1500 EX(FI) Page 3 File Number 2113.0189 Decedent's Complete Address: DECEDENT'S NAME Shirley R Cree STREETADDRESS 328 Lamp Post Lane (Decedents address at date of death) (Mailing address - c/o Susan E Greene, 375 Stonehed e Lane, Mechanicsburg_, PA 17055) CITY STATE ZIP lCamp Hill P 1701117055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 43, 64 7. 6 2. Credits/Payments A.Prior Payments 42, 000.00 B.Discount 2, 181 Total Credits(A+B) (2) 44, 181. 0( 3. Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 533.3£ 5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... ❑ b. retain the right to designate who shall use the property transferred or its income;............................................ ❑ FKI c. retain a reversionary interest .......................................................................................................................... ❑ d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ FKI 2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................................. ❑ FKI 3. Did decedent own an"in trust for'or payable-upon-death bank account or security at his or her death?.............. ❑ X❑ 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation? ........................................................................................................................ ® ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spous( is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percen [72 P.S. §9116(a) (1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets anc filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, ar adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)J. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)J. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S. §9116(a)(1.3)].A sibling is define( under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-1502 EX+(01-10) pennsylvania SCHEDULE A A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER Shirley R. Cree 2113.0189 All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1. House — 328 Lamp Post Lane, Camp Hill, PA 17011 — see attached appraisal 275, 000.00 TOTAL(Also enter on Line 1, Recapitulation.) $ 275,000.00 If more space is needed,insert additional sheets of the same size. REV-1503 EX+(8-12) pennsytvania SCHEDULE B VQDEPARTMENT OF REVENUE INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER Shirley R. Cree 2113.0189 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH t• Oppenheimer PA Tax Free Fund 1253.775 SHares at 11.57 p/s 14, 506 2. Tyco International 202 shares at 30.76 per share 6, 214 3. Covidien 200 shares at 63.28 per share 12, 656 4. Pentair 48 shares at 51.05 per share 2, 450 5. ADT Corp 101 shares at 47.67 per share 4, 815 6. H D Vest Money Market Account 35 7. Blackrock College Adv 13-16 626.658 shares at 11.86 p/s 7, 432 8. Blackrock College Adv 17 Plus 134 .491 shares at 11.32 p/s 1, 522 9. Blackrock College Adv 13-16 612.413 shares at 11.86 p/s 7, 263 10. Blackrock College Adv 13-16 615.064 shares at 11.86 p/s 7,295 TOTAL(Also enter on line 2,Recapitulation) $ 64, 188.00 If more space is needed,insert additional sheets of the same size REV-1504 EX+(6-98) SCHEDULE C CLOSELY-HELD CORPORATION, COMMONWEALTH OF PENNSYLVANIA PARTNERSHIP OR INHERITANCE TAX RETURN RESIDENT DECEDENT SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER Shirley R. Cree 2113.0189 Schedule C-1 or C-2(including all supporting information)must be attached for each closely-held corporation/partnership interest of the decedent,other than a sole-proprietorship.See instructions for the supporting information to be submitted for sole-proprietorships. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. None TOTAL(Also enter online 3,Recapitulation) $ (If more space is needed,insert additional sheets of the same size) REV-1505 EX+(11-11) pennsylvania SCHEDULE C-1 .. � DEPARTMENT OF REVENUE CLOSELY-HELD CORPORATE INHERITANCE TAX RETURN STOCK INFORMATION REPORT RESIDENT DECEDENT ESTATE OF FILE NUMBER Shirley R. Cree 2113.0189 1. Name of Corporation None State of Incorporation Address Date of Incorporation City State ZIP Code Total Number of Shareholders 2. Federal Employer ID Number Business Reporting Year 3. Type of Business Product/Service 4. TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE STOCK Voting/Non-Voting SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENT'S STOCK Common $ Preferred $ Provide all rights and restrictions pertaining to each class of stock. 5. Was the decedent employed by the corporation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑Yes ❑No If yes, Position Annual Salary $ Time Devoted to Business 6. Was the corporation indebted to the decedent? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑Yes ❑No If yes, provide amount of indebtedness$ 7. Was there life insurance payable to the corporation upon the death of the decedent? . . . . . ❑Yes ❑ No If yes, Cash Surrender Value$ Net proceeds payable$ Owner of the policy 8. Did the decedent sell or transfer stock in this company within one year prior to death or within two years if the date of death was prior to 12-31-82? ❑Yes ❑No If yes, ❑Transfer ❑Sale Number of Shares Transferee or Purchaser Consideration$ Date Attach a separate sheet for additional transfers and/or sales. 9. Was there a written shareholder's agreement in effect at the time of the decedent's death? .... ❑Yes ❑ No If yes, provide a copy of the agreement. 10.Was the decedent's stock sold? ....... ...... ........ ............... . ... ..... . ....... ❑Yes ❑No If yes,provide a copy of the agreement of sale,etc. 11. Was the corporation dissolved or liquidated after the decedent's death? .. ........ ...... . . .. ❑Yes ❑No If yes,provide a breakdown of distributions received by the estate,including dates and amounts received. 12.Did the corporation have an interest in other corporations or partnerships? . . . . . . . . . . . . . ❑Yes ❑ No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. THE FOLLOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE A. Detailed calculations used in the valuation of the decedent's stock. B. Complete copies of financial statements or federal corporate income tax returns(Form 1120)for the year of death and four preceding years. C. If the corporation owned real estate,submit a list showing the complete address/es and estimated fair market value/s.If real estate appraisals have been secured,attach copies. D. List of principal stockholders at the date of death,number of shares held and their relationships to the decedent. E. List of officers,their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. (If more space is needed,insert additional sheets of the same size.) REV-1506 EX+(12-11) pennsylvania SCHEDULE C-2 DEPARTMENT OF REVENUE PARTNERSHIP INHERITANCE TAX RETURN INFORMATION REPORT RESIDENT DECEDENT ESTATE OF FILE NUMBER Shirley R. Cree 2113.0189 1. Name of Partnership None Date Business Commenced Address Business Reporting Year City State ZIP Code 2. Federal Employer ID Number 3. Type of Business Product/Service 4. Decedent was a ❑General ❑Limited partner. If decedent was a limited partner, provide initial investment$ 5. PARTNER NAME PERCENT PERCENT BALANCE OF OF INCOME OF OWNERSHIP CAPITAL ACCOUNT A. B. C. D. 6. Value of the decedent's interest$ 7. Was the partnership indebted to the decedent? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑Yes ❑No If yes, provide amount of indebtedness$ 8. Was there life insurance payable to the partnership upon the death of the decedent? ..... . ❑Yes ❑ No If yes, Cash Surrender Value$ Net proceeds payable$ Owner of the policy 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-82? ❑Yes ❑No If yes, ❑Transfer ❑Sale Percentage transferred/sold Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 10.Was there a written partnership agreement in effect at the time of the decedent's death? ...... ❑Yes ❑ No If yes, provide a copy of the agreement. 11. Was the decedent's partnership interest sold? ........ ................ .... ............ . ❑Yes ❑No If yes,provide a copy of the agreement of sale,etc. 12.Was the partnership dissolved or liquidated after the decedent's death? . ........ ........ ... ❑Yes ❑No If yes,provide a breakdown of distributions received by the estate, including dates and amounts received. 13.Was the decedent related to any of the partners? ....... .... ................. . . .... . ... ❑Yes ❑No If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? .. ........ .... . ❑Yes ❑No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. THE FOLLOWING INFORMATION A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or federal partnership income tax returns(Form 1065)for the year of death and four preceding years. C. If the partnership owned real estate,submit a list showing the complete address/es and estimated fair market value/s.If real estate appraisals have been secured,attach copies. D. Any other information relating to the valuation of the decedent's partnership interest. REV-1507 EX+(6-98) SCHEDULE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER Shirley R. Cree 2113.0189 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH None TOTAL(Also enter online 4,Recapitulation) $ (If more space is needed,insert additional sheets of the same size) REV-1508 EX+(08-12) w pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Shirley R. Cree 2113.0189 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Metro Bank 16, 517 2• Citizens Bank - Checking 22, 597 3. Citizens Bank - Savings 40, 474 4. Household items - list attached 850 TOTAL(Also enter on Line 5, Recapitulation) $ 80, 438.00 If more space is needed, use additional sheets of paper of the same size. REV-1509 EX+(01-10) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE -- INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Shirley R. Cree 2113.0189 If an asset was madejoint within one year of the decedent's date of death,it must be reported on Schedule G. SURVIVING JOINTTENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT A. None B. C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANKACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. TOTAL(Also enter on line 6,Recapitulation) $ (If more space is needed,insert additional sheets of the same size) REV-1510 EX+(08-09) SCHEDULE G pennsylvania UQ DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS & INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Shirley R. Cree 2113.0189 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDETHE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OFDECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER.ATTACH ACOPY OF THE DEED FOR REAL ESTATE. VALUEOFASSET INTEREST (IF APPLICABLE) VALUE 1. Citizens Bank IRA 24 100 24.00 2• Commonwealth Annuity CB10015820 263, 400 100 263, 400.00 3. Hartford Putnam Capital Manager 711069259 94, 981 100 94, 981.00 4 . MFS Sun Life Regatta 95.9500.096238 269, 718 100 269,718.00 TOTAL(Also enter on line 7,Recapitulation) $ 628, 123.00 (if more space is needed,insert additional sheets of the same size) REV-1511 EX+(10-09) SCHEDULE H pennsylvania FUNERAL EXPENSES & i DEPARTMENT OF REVENUE INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Shirley R. Cree 2113.0189 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Myers Harner Funeral Home, Camp Hill PA 3, 885 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 52, 387 Name of Personal Representative(s)Susan E. Greene StreetAddress 375 Stonehedge Lane CityMechanicsburg State PA ZIP17055 Year(s)Commission Paid:2 013 2. Attorney Fees 3. Family Exemption:(If decedent's address is not the same as claimant's,attach explanation) 3, 500 Claimant Susan E. Greene (Daughter Moved in October 2013) StreetAddress375 Stonehedge Lane (was 328 Lamp Post Ln, Camp Hi 1) CityMechanicsburg State PA ZIP17011 Relationship of Claimant to Decedent Daughter 4. Probate Fees 738 5. Accountant's Fees 15, 716 6. Tax Return Preparer's Fees 650 7. Susan Greene — Wake Expenses 350 8. Capital Property Appraisers — house appraisal 350 TOTAL(Also enter on line 9,Recapitulation) $ 77, 576.00 (If more space is needed,insert additional sheets of the same size) REV-1512 EX+(12-08) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Shirley R. Cree 2113.0189 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PPL 78 2. UGI 148 TOTAL(Also enter on Line 10, Recapitulation) $ 226.00 If more space is needed,insert additional sheets of the same size. REV-1513 EX+(01-10) pennsyLvania SCHEDULE k DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Shirle R. Cree 2113.0189 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS(Include outright spousal distributions and transfers under Sec. 9116(a)(1.2).] 1. Michael B. Cree Son .25 107 Beagle Club Road Carlisle, PA 17013 2. Susan E. Greene Daughter .25 375 Stonehedge Lane Mechanicsubrg, PA 17055 3. Thomas B. Cree Son .25 10 Union Church Road Dillsburg, PA 17019 4. John K. Cree Son .25 6339 Stephens Crossing Road Mechanicsburg, PA 17050 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed, use additional sheets of paper of the same size. REV•1514EX+(4.09) SCHEDULE K pennsylvania DEPARTMENT OF REVENUE LIFE ESTATE,ANNUITY Bureau OflndividualTaxes &TERM CERTAIN PO Box 28o6oi Harrisburg PA 17128-0601 (CHECK BOX 4 ON REV-1500 COVER SHEET) ESTATE OF FILE NUMBER Shirley R. Cree 2113.0189 This schedule should be used for all single-life,joint or successive life estate and term-certain calculations. For dates of death prior to 5-1-89, actuarial factors for single-life calculations can be obtained from the Department of Revenue. Actuarial factors can be found in IRS Publication 1457,Actuarial Values,Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate below the type of instrument that created the future interest and attach a copy of it to the tax return. ❑ Will ❑ Intervivos Deed of Trust ❑ Other CALCULATION LIFE ESTATE INTEREST NAME OF LIFE TENANT DATE OF BIRTH NEAREST AGE AT TERM OF YEARS DATE OF DEATH LIFE ESTATE IS PAYABLE ❑ Life or ❑Term of Years ❑ Life or ❑Term of Years ❑Life or ❑Term of Years ❑Life or ❑Term of Years Cl Life or ❑Term of Years 1. Value of fund from which life estate is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .$ 2. Actuarial factor per appropriate table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . Interest table rate-❑3.5% ❑6% ❑ 10% ❑Variable Rate % 3. Value of life estate(Line 1 multiplied by Line 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ CALCULATION ANNUITY INTEREST NAME OF LIFE ANNUITANT DATE OF BIRTH NEAREST AGE AT TERM OF YEARS DATE OF DEATH ANNUITY IS PAYABLE ❑Life or ❑Term of Years ❑Life or ❑Term of Years ❑Life or ❑Term of Years ❑Life or ❑Term of Years 1. Value of fund from which annuity is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .$ 2. Check appropriate block below and enter corresponding number . . . . . . . . . . . . . . . . . Frequency of payout-❑ Weekly(52) ❑ Bi-weekly (26) ❑ Monthly(12) ❑ Quarterly(4) ❑ Semi-annually(2) ❑ Annually (1) ❑Other( ) 3. Amount of payout per period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .$ 4. Aggregate annual payment, Line 2 multiplied by Line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. Annuity Factor(see instructions) Interest table rate-❑3.5% [36% ❑ 10% ❑Variable Rate % 6. Adjustment Factor(See instructions.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. Value of annuity-If using 3.5, 6, or 10%,or if variable rate and period payout is at end of period, calculation is Line 4 x Line 5 x Line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . .$ If using variable rate and period payout is at beginning of period, calculation is (Line 4 x Line 5 x Line 6) + Line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ NOTE; The values of the funds that create the above future interests must be reported as part of the estate assets on Schedules A through G of the tax return.The resulting life or annuity interest should be reported at the appropriate tax rate on Lines 13 and 15 through 18 of the return. If more space is needed, use additional sheets of the same size. REV-1644 EX+(01-10) pennsylvania INHERITANCE TAX • - DEPARTMENT OF REVENUE SCHEDULE L INHERITANCE TAX RETURN REMAINDER PREPAYMENT RESIDENT DECEDENT OR INVASION OF TRUST CORPUS I. ESTATE OF FILE NUMBER Shirley R. Cree 2113.0189 This schedule is appropriate only for estates of decedents dying on or before Dec. 12, 1982. This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust corpus (principal). II. REMAINDER PREPAYMENT: A. Election to Prepay Filed with the Register of Wills on (Date) B. Name(s) of Life Tenant(s) Date of Birth Age on Date Term of Years Income or Annuitant(s) of Election or Annuity is Payable C. Assets: Complete Schedule L-1 1. Real Estate . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 2. Stocks and Bonds . . . . . . . . . . . . . . . . . . . . . .$ 3. Closely Held Stock/Partnership . . . . . . . . . . . . .$ 4. Mortgages and Notes . . . . . . . . . . . . . . . . . . . .$ 5. Cash/Misc. Personal Property . . . . . . . . . . . . . .$ 6. Total from Schedule L-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ D. Credits: Complete Schedule L-2 1. Unpaid Liabilities . . . . . . . . . . . . . . . . . . . . . . .$ 2. Unpaid Bequests . . . . . . . . . . . . . . . . . . . . . . .$ 3. Value of Non Includable Assets . . . . . . . . . . . . .$ 4. Total from Schedule L-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ E. Total Value of Trust Assets (Line C-6 minus Line D-4) . . . . . . . . . . . . . . . . . . . . . . . . . . .$ F. Remainder Factor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G. Taxable Remainder Value (Multiply Line E by Line F) . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ (Also enter on Line 7, Recapitulation) III. INVASION OF CORPUS: A. Invasion of Corpus (Month, Day, Year) B. Name(s) of Life Tenant(s) Date of Birth Age on Date Term of Years Income or Annuitant(s) Corpus or Annuity is Payable Consumed C. Corpus Consumed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ D. Remainder Factor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E. Taxable Value of Corpus Consumed (Multiply Line C by Line D) . . . . . . . . . . . . . . . . . . . .$ (Also enter on Line 7, Recapitulation) REV-1645 EX+(11-09) INHERITANCE TAX m pennsylvania ,j' DEPARTMENT OF REVENUE SCHEDULE L-1 INHERITANCE TAX RETURN REMAINDER PREPAYMENT ELECTION RESIDENT DECEDENT -ASSETS- I. ESTATE OF FILE NUMBER Shirley R. Cree 2113.0189 II. ITEM NO. DESCRIPTION VALUE A. Real Estate (Please describe.) Total Value of Real Estate $ (Include on Section II, Line C-1 on Schedule L.) B. Stocks and Bonds (Please list.) Total Value of Stocks and Bonds $ (Include on Section II, Line C-2 on Schedule L.) C. Closely Held Stock/Partnership - Please list. (Attach Schedule C-1 and/or C-2.) Total Value of Closely Held/Partnership $ (Include on Section II, Line C-3 on Schedule L.) D. Mortgages and Notes (Please list.) Total Value of Mortgages and Notes $ (Include on Section II, Line C-4 on Schedule L.) E. Cash and Miscellaneous Personal Property (Please list.) Total Value of Cash/Miscellaneous Personal Property $ (Include on Section II, Line C-5 on Schedule L.) III. TOTAL (Also enter on Section II, Line C-6 on Schedule L.) $ If more space is needed, attach additional sheets of paper of the same size. REV-1646 EX+(11-09) pennsylvania INHERITANCE TAX DEPARTMENT OF REVENUE SCHEDULE L-2 INHERITANCE TAX RETURN REMAINDER PREPAYMENT ELECTION RESIDENT DECEDENT -CREDITS- I. ESTATE OF FILE NUMBER Shirley R. Cree 2113.0189 II. ITEM NO. DESCRIPTION AMOUNT A. Unpaid Liabilities Claimed against Original Estate and Payable from Assets Reported on Schedule L-1 (please list) Total Unpaid Liabilities $ (include on Section II, Line D-1 on Schedule L) B. Unpaid Bequests Payable from Assets Reported on Schedule L-1 (please list) Total Unpaid Bequests $ (include on Section II, Line D-2 on Schedule L) C. Value of Assets Reported on Schedule L-1 (other than unpaid bequests listed under"B" above) that are Not Included for Tax Purposes or that Do Not Form a Part of the Trust. Calculation as follows: Total Non Includable Assets $ (include on Section II, Line D-3 on Schedule L) III. TOTAL (Also enter on Section II, Line D-4 on Schedule L) $ If more space is needed, attach additional sheets of paper of the same size. REV-1647 Ex+(02-10) pennsylvania SCHEDULE M DEPARTMENT OF REVENUE FUTURE INTEREST COMPROMISE INHERITANCE TAX RETURN RESIDENT DECEDENT (Check Box 4a on REV-1500) ESTATE OF FILE NUMBER Shirley R. Cree 2113.0189 This schedule is appropriate only for estates of decedents who died after Dec. 12, 1982. This schedule is to be used for all future.interests where the rate of tax that will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument that created the future interest and attach a copy to the tax return. ❑ Will ❑ Trust ❑ Other I. Beneficiaries NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO NEAREST BIRTHDAY 1. 2. 3. 4. S. II. For decedents who died on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within nine months of the decedent's death, check the appropriate box below and attach a copy of the document in which the surviving spouse exercises such withdrawal right. ❑ Unlimited right of withdrawal ❑ Limited right of withdrawal III. Explanation of Compromise Offer: IV. Summary of Compromise Offer: 1. Amount of future interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . $ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (Also include as part of total shown on Line 13 of REV-1500.) . . . . . . . . $ 3. Value of Line 1 passing to spouse at appropriate tax rate Check one. ❑ 6%, ❑ 3%, ❑ 0% . . . . . . . . . . . . . . . . . . . . $ (Also include as part of total shown on Line 15 of REV-1500.) 4. Value of Line 1 taxable at lineal rate Check one. ❑ 6%, ❑ 4.5% . . . . . . . . . . . . . . . . . . . . . . . . . . $ (Also include as part of total shown on Line 16 of REV-1500.) 5. Value of Line 1 taxable at sibling rate(12%) (Also include as part of total shown on Line 17 of REV-1500.) . . . . . . . . $ 6. Value of Line 1 taxable at collateral rate (15%) (Also include as part of total shown on Line 18 of REV-1500.) . . . . . . . . $ 7. Total value of future interest(sum of Lines 2 thru 6 must equal Line 1) . . . . . . . . . . . . . . . . . . . . . . . $ If more space is needed, use additional sheets of paper of the same size. REV-1648 EX(02-09) SCHEDULE N pennsylvania �� DEPARTMENT OF REVENUE SPOUSAL POVERTY CREDIT Bureau of Individual Taxes PO BOX28o6oi FOR DATES OF DEATH 01/01/92 TO 12/31/94 Hardsburg PA 17128 ESTATE OF FILE NUMBER Shirley R. Cree 2113.0189 This schedule must be completed and filed if you checked the spousal poverty credit box on the cover sheet. CALCULATION OF • • 1 . Taxable assets total from Line 8(cover sheet) . . . . . . . . . . . . . . . . .. . . . . . . . . . . .. . . . . . . . .. . . . . . . 1 . 2. Insurance proceeds on life of decedent .. . . . . . . . . . . .. . . . . . . . . . .. . . . . . . . . . . . .. . . . . .. . . . . . . 2. 3. Retirement benefits . . . . . . .. . . . . . . . . .. . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. 4. Joint assets with spouse ... . . . . .. . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . 4, 5. PA Lottery winnings . .. . . . . . . . . . . . . . . . . . . .. . . . . . .. .. 5. . . . . . . . . . . . .. . . .. . . .. .. . . . . . . . . . . 6a. Other nontaxable assets: List and attach schedule if necessary . . 6a. 6b. 6c. 6d. 6. SUBTOTAL(Lines 6a, b,c,d) . . .. . . . . . . . . . . . . . .. . . .. . . . . . . . .. . . .. . . . . . . . . . . . . . . . . . . . . . . 6. 7. Total gross assets(Add Lines 1 thru 6) . . . . . . . . . . . . . . . . . .. . . .. . . . . . . . . . .. . . . . . . . . .. . . . . . . . 7. 8. Total actual liabilities .. . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . .. . . . . . . . . . . . . . 8. 9. Net value of estate(Subtract Line 8 from Line 7) . .. . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. If Line 9 is greater than$2001000-STOP. The estate is not eligible to claim the credit.If not continue to Part 11. CALCULATION PART II - OF • • INCOME for decedent and spouse. Income: 1. TAX YEAR: 19 2. TAX YEAR: 19 3. TAX YEAR: 19 a. Spouse . . . . . .. . . . .. la. 2a. 3a. b. Decedent . . . . .. . . . . . 1b. 2b. 3b. c. Joint . . . . .. ... . .. . lc. 2c. 3ci d. Tax-exempt income . . . . Id. 2d. 3d. e Other income not listed above . . .. . .. . . le. 2e. 3e. f. Total . . . .. .. . . . . . . . if. 2f. 3f. 4. Average joint exemption income calculation 4a. Add joint exemption income from above: (if) + (2f) + (3f) _ (-3) 4b. Average joint exemption income . . .. . . . . . . . . . .. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . _ If line 4(b)is greater than$40,000-STOP. The estate is not eligible to claim the credit. If not, continue to Part III, PART III -CALCULATION OF SPOUSAL POVERTY CREDIT FOR RESIDENT AND NONRESIDENT ESTATES 1. Insert amount of taxable transfers to spouse or$100,000,whichever is less . . . .. . . . . . . . . . . . . . . . . . . . 1. 2. Multiply by credit percentage(see instructions) . . . . . . .. . . . . . . .. . . .. . . . . . . . . . . . . . . . . . .. . . . . . 2. 3. This is the amount of the Resident Spousal Poverty Credit. Include this figure in the calculation of total credits on Line 18 of the cover sheet. . . . .. . . . . . . . . . . . . . . . . . . . . . . . .. . . . 3. 4. For nonresidents,enter the ratio of the decedent's gross estate in PA to the value of the decedent's gross estate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. 5. Multiply Line 3 by Line 4 and enter the total here.This is the amount of the Nonresident Spousal 5 Poverty Credit. Include this figure in the calculation of total credits on Line 18 of the cover sheet. . . . . . . . . . . REV-1649 EX+(6-98) SCHEDULE O COMMONWEALTH OF PENNSYLVANIA ELECTION UNDER SEC. 9113(A) INHERITANCE TAX RETURN (SPOUSAL DISTRIBUTIONS) RESIDENT DECEDENT ESTATE OF FILE NUMBER Shirley R. Cree 2113.0189 Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A)of the Inheritance&Estate Tax Act. If the election applies to more than one trust or similar arrangement,a separate form must be filed for each trust. This election applies to the Trust(marital,residual A,B,By-pass,Unified Credit,etc.). If a trust or similar arrangement meets the requirements of Section 9113(A),and: a. The trust or similar arrangement is listed on Schedule 0,and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0, then the transferor's personal representative may specifically identify the trust(all or a fractional portion or percentage)to be included in the election to have such trust or similar property treated as a taxable transfer in this estate.If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0,the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement.The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule 0.The denominator is equal to the total value of the trust or similar arrangement. Part A: Enter the description and value of all interests,both taxable and non-taxable,regardless of location,which pass to the decedent's surviving spouse under a Section 9113(A)trust or similar arrangement. Description Value Part A Total $ Part B: Enter the description and value of all interests included in Part A for which the Section 9113(A)election to tax is being made. Description Value Part B Total $ (If more space is needed,insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA SHORT CERTIFICATE COUNTY OF CUMBERLAND I, GLENDA FARNER STRASBAUGH Register for the Probate of Wills and Granting Letters of Administration in and for CUMBERLAND County, do hereby certify that on the 15th day of February, Two Thousand and Thirteen, Letters TESTAMENTARY in common form were granted by the Register of said County, on the estate of SHIRLEYR CREE late of HAMPDEN TOWNSHIP (First,Middle,LoW in said county, deceased, to SUSAN ELAINE GREENE Oro,Middle,Lost) and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this 15th day of February Two Thousand and Thirteen. Fi 1 e No. 2013- 00189 PA Fi 1 e No. 21- 13- 0189 Date of Death 210912013 S.S. # 182-22-9653 _ egister t epury NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records in accordance with Act 66, P.L. 304, approved by the General Assembly,June 29, 1953. WARNING: It Is Illegal to duplicate this copy by photostat or photograph. UP P Robert erman,Jr., MPH S ate Charles Hardester Secretary of Health State Registrar Military Status 1839025 ��r,�FNZ AUG 2 2 2001 No. Date HIO&T.3R&,.207 COMMONWEALTH Of PENNSYLVANIA•DEPARTMENT OF HEALTH•VITAL RECORDS 066912 TYPIENORNIT CERTIFICATE OF DEATH PERMANENT NAVE C;r sex ISOCIAL SECUPTY NUMBER DoE an ' Male 209 —20 —3548 4.1. trFe.-q,.2cD) AGE It-9-1" UNDER I YEAR UNN"DIE IN I DAY ONE OF BIRTH 8WWLAC6'C-h,Andi PLACE OF OE1aH(Cht* Wnn o0•ii,a(MI .Morn.O*V.4-. HOSPW.: TIMER 7 g' Othe'' 2 Y, 4-17-29 T. -;;T� -mom-0 ODA ❑ Rhademe 0 -Va."❑ TY0FOKAR4 CRY.$ORO.h"OF DEATH WA RACE-AeanoIh YwfW..Blem White.W. Cithen, rosom Maxeclat.potato Rkan.e4c. White L Cumberland E. Pennsboro DL� PI P-Ir 0S F I T DECEOENT'SUSUAL OCCUPARO" IUNOOF RUS04 7 "T EVER"'I mCmmmrsroucam SUW.To"Oo SPOUSE US.ARMENORCES' taft, 'I.. M.® hat 0 it. Mktg. McIr. It. AMP, -�I�nc MARRIED L Shirley Waters 011CIEDEARs"A"J"O A00"Ess(S-..Lc*^—se"' DECEDENT'S Pennsylvania Did en 328 Lamp Post Lane S. -- I Camp Hill, PA 17011 r5a.— Iftc,-gEt3t�iand FMNWS MAW real.Made.LAIR Blair D. Cree MOTHER'S NAME(Fvt Mottle Maiden S-nanal Violet Lloyd te. 0040FWAANrS NAME(Type" Shirley Cree *WOFWMT'3 MAIIANIG ADDRESS Orate,Coolown,S.N.rV Coded ;&3A,M,Pbst Lane, CmV Hill, PA 17011 MVIROMOF DISPOSMON OFOISPOWTCN 1 IL -Cdv(ROwrI.&MN,apcoft ❑ Chmadeam "ahmeathwaslet.0 Oft"IN't twomeoplat. ❑ 0'W-rSpaoeA_ ❑ E. Harrisburg Cemetery Harrisburg, PA �7 SIGNAZURE OF FUNERAL;n;ZMTdeQ AS SUCH iLrEWANUMWR I"MIANDADO*3SOFWAI" — m, 012755-L jAyers-Hamer FH, 1903 Mkt St, CaM Hill, PA 17011 the bean of niY ki—tedge.death=wrd at Ift him.Mot And place stood. LICENSE NUMBER DATE SIGNED ptlyYeWlr not I oft weal i�;=c fo"m Beth.Tw-=6+nunWrnrnptaga R''1' t)F DEATH WGEP 6 DEAD VAS CASE REFERRED TO MEDICAL EXMAtkEPXOF4W.R? U-6 if we 91 FD N.0 27.1ARri: Atioex,hane— LOONVenti—oneachfine. 0 PART NT Do- IaA WA— ti— BimnbPARTL NAkWOWICAUUCF,uI anMababth —D dean— IZ- 'AWE Oq, ,WNSEO =AJ - ASACpf,�EOVENCE Oft y 5C —41 L Z)/5&W S ..11OPSYF... MAMNEIRCF.A1H DATE OF INJURY 1RIAEOFOLIURY IK#URYaWOA" JOESCNBE NOINUMURYOCCURIA1110 PEPFCNWM07 AMULABLE PRIOR M COMK17MN C11'CAUSE ❑ (Mont".on eate) OF OEAn0 "01. Homicide 0 CK " . Acledent 0 pandevionn"filinkin ❑ YIN ❑ me❑ 'NM 301111. 0 No❑ Y-❑ me 0 soeoid. 0 C-4d—W d--..d ❑ PLACE OF INJURY-At Want.tam,time.fackwy.offita a buidaiz—So—A 20& 30.. ILCC '0"IS 7/7"a" AND TFTIE OF CER HER A. ............................... .......... ❑0 31b.L ," NUM ORE WIND off} 'PRONOUNCING AND CEBTIFYING1 PHYSICIAN(Phneas,both im,'irig of—MI L o2 a-of-.. natty.........raj To the II-N 0"kiiii-led".death a-W-1 At the a—,dtil.� 3. S /0 EXAMBRIFIFUCOIRCHER M—271 00 ON,Battle of tia'"'Ination and/or Investigation.10 my opinion,death oceunr9d at the time,date,and place:and due 10 the C-500)Bred ❑ 7- 7-- Va.an—ta.061ital........11,............... ....... ..........I...... .............. .... .................. 32. It REGISTRAR'S t3REGISTRAR'S REGISTR 'S SIGNATURE OaY.am, A TRU£COPY,FROM RECORD In TAStimony"eiof,,I hereunto ,,set any hand-and the a" ,it SOW Court at•Cafte.PA Last Will T +�n► �� Of aa+Eaorm� CUMWOW SHIRLEY R. CREE I, SHIRLEY R. CREE, the Testatrix, a resident of Cumberland County, Pennsylvania, declare that this is my Last Will. I hereby revoke all my previous wills and codicils. Article One t.: Introductory Provisions rn rn n 00 rn O rn ' c= Z; --a rl Section 1. Marital Status I was married to BOYD H.CREE who died on June 29, 2001. Section 2. Children All references to "my children", subject to the exclusion of any child under subsequent provisions of this Section 2, are to all of the children so identified in this Section 2, but only to those children and any children born to or adopted by me subsequent to the execution of this, my Last Will. a. My Children The names and birth dates of my children are: Name Birth Date MICHAEL BOYD CREE May 16, 1955 SUSAN ELAINE.CREE GREENE May 06, 1958 THOMAS BLAIR CREE August 01, 1962 JOHN KIRBY CREE October 29, 1963 I Article Two Appointment of My Personal Representatives Section 1. Nomination of My Personal Representatives I appoint the following to be my Personal Representative(s) in the order of priority in which their names appear: SUSAN ELAINE CREE GREENE;THEN JOHN KIRBY CREE If, for any reason, the Personal Representative(s) named above are unable or unwilling to serve, the next successor Personal Representative(s) shall serve in the order of priority listed until the list has been exhausted. Unless otherwise specified, if Co-Personal Representatives are serving, the next named successor Personal Representative shall serve only after all of the Co-Personal. Representatives cease to act as Personal Representatives. Section 2. Waiver of Bond No bond or undertaking shall be required of any Personal Representative nominated in this Last Will. Section 3. General Powers My Personal Representative shall have full authority to administer my estate under the laws of the Commonwealth of Pennsylvania relating to the powers of fiduciaries. My Personal Representative shall have the power to administer my estate under the Pennsylvania Probate,Estates and Fiduciaries Code. Article Three Disposition of My Property Section 1. Estate Planning Letter or Memorandum To the extent permitted by state law and not necessary to fully utilize my Unused Applicable Credit Equivalent, my Personal Representative shall distribute such of my personal or household items to such persons as I may direct by a written instrument signed by me and delivered to my Personal Representative. Section 2. Distribution to My Revocable Living Trust I give all the rest, residue and remainder of my property of whatever nature and kind and wherever located to the then acting Trustee(s) of my revocable living trust of which I am a Trustor known as the: SHIRLEY R CREE LIVING TRUST, Dated March 9, 2000, and any amendments thereto. I executed said revocable living trust prior to the execution of this Last Will. Section 3. Alternate Disposition If my revocable living trust is not in effect for any reason, I give all of my property to my Personal Representative under this will as Trustee who shall hold, administer and distribute my property as a testamentary trust the provisions of which are identical to those of my revocable living trust on the date of execution of this Last Will, or as thereafter amended. Article Four Death Taxes Section 1. Definition of Death Taxes The term "death taxes," as used in this will, shall mean all inheritance, estate, succession, and other similar taxes that are payable by any person on account of that person's interest in the estate of the decedent or by reason of the decedent's death, including penalties and interest, but excluding the following: a. Any additional to the federal estate tax for any "excess retirement accumulation" under Internal Revenue Code Section 4980A. b. Any additional tax that may be assessed under Internal Revenue Code Section 2032A or 2057; and C. Any federal or state tax imposed on a Generation Skipping Transfer, as that term is defined in the federal tax laws, unless the applicable tax statutes provide that the Generation Skipping Transfer Tax is payable directly out of the assets of my gross estate. Section 2. Payment of Death Taxes Pursuant to the terms of my revocable living trust, all death taxes whether or not attributable to property inventoried in my probate estate shall be paid by the Trustee from my Trust. However, if my Trust does not exist at the time of my death or if the assets of my Trust are insufficient to pay the death taxes in full, I direct my Personal Representative to pay any death taxes that cannot be paid by my Trustee from the assets of my probate estate by equitably prorating and apportioning those taxes among the beneficiaries of this will. Unless specifically provided otherwise in my Trust, all death taxes incurred by reason of assets being transferred outside of my Trust or probate estate shall be assessed against those persons receiving such property. Section 3. Waiver of Right of Reimbursement Under Code Section 2207A I hereby waive my estate's right of reimbursement under Code Section 2207A. Article Five General Provisions Section 1. No Contest Clause If any person or entity singularly or in conjunction with any other person or entity, directly or indirectly, contests in any court the validity of this Last Will including any codicils thereto, then the right of that person or entity to take any interest in my estate shall cease and the demise of that person (and his or her descendants)or entity shall be deemed to have occurred prior to mine. Section 2. Captions The captions of Articles, Sections and Paragraphs used in this Last Will are for convenience of reference only and shall have no significance in the construction or interpretation of this Last Will. Section 3. Severability Should any of the provisions of this Last Will be for any reason declared invalid, such invalidity shall not affect any of the other provisions of this will and all invalid provisions shall be wholly disregarded in interpreting this Last Will. Section 4. Governing Law This Last Will shall be construed, regulated and governed by and in accordance with the laws of the Commonwealth of Pennsylvania. I signed this, my Last Will, on "ISHMIRLEY .CREE ATTESTATION CLAUSE On this/3 �'ly �0' Zov/, SHIRLEY R. CREE, Testatrix, personally Published and Declared the foregoing instrument, as and for her Last Will and Testament, in the presence of each of us and all of us together,who, at her request, in her presence, and in the presence of each other, also signed the said instrument as witnesses. We further state that each of us believes that at the time she executed the foregoing instrument she was of sound mind and memory, of lawful age, and did so execute it as her own free act and deed and not under the constraint or undue influence of any person. t Witness s i , Street Addr s, City, State, Zip Witness 5750 \,JC4 Z� : Its Street Address � nA l7 A.. X 70 City, State, Zip COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN We, SHIRLEY R. CREE, 69�%�' �' ���-C and the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument,being duly first sworn, do hereby declare to the undersigned authority that we were present and saw the Testatrix sign and execute the foregoing instrument as her Last Will; that the Testatrix signed it willingly, or directed another to sign it for the Testatrix, that it was executed as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the presence and hearing of the Testatrix signed the Last Will as a witness; and that to the best of our knowledge the Testatrix was at the time of sound mind and memory,of lawful age, and under no constraint or undue influence. X1. S EY R CREE Witness id y Witness SUBSCRIBED, SWORN TO and ACKNOWLEDGED before me, a notary public, by SHIF�LEY R. CREE, the Testatrix, and,/447,iy�iy and <%/5�61G�✓ �'` 1/'✓444ige 4' the witnesses on this NckalyVu lam' sod (SEAL) "VA Not"PW* My COmmisslon ExkeQ s SOpt 6C 20 '4 Me4 F'enrsyh nis kssn;ia!+�;. .,,,,,:,•_ FLauwemer INVOICE faun, CapkW Ply Appraisers 8280 Wkhors Cast HarMbtxp,PA 17111 Tobom Nlan .717-514-1580 Fn Rx.ft 717-852-8404 08/22/2013 TO: tnwrwaiderr. tandraesr. ClwicFkada ttiarrt4tr/oeform CreaLamppod ahw Fla/enknm Tdgherx►Num u. FIX Miler Fadard Tax W. Attemdo f w*W. E-Malt E R&W IM Please make checks payable to CaDMI Properb Apmeban Thank you Lender Susan Green C0wt Estate d SMrley Cree Purdww/Borows.WA Propwq Addmw 328 Lamp Post lace Cky:Camp HE Couw..CUM"N I rd SI M:PA ap: 17011 Lqd DMOr"m DOW book 00258 Pape 01044 350.00 SUBTOTAL 350.00 ChsokA DoW Daaat W:Paid 8/22/2013 -350.00 Check#. Ogg Dssaom, Check A DW Ossor"on: SUBTOTAL I 350.00 TOTAL DUE $ 0 Form NN5—M1nTOTAL'appraisal software by a is mok kv.—1-80D.&MOOS Caol PmpwW Appraiaere(717W-1088 [Main Re No.CradzmPoid Paos 01 APPRAISAL OF REAL PROPERTY LOCATED AT: 328 Lamp Post Lars DOW book 00288 Paps 01844 Camp Hi,PA 17011 FOR: susen Green 328 Lamp Post Lana AS OF: 08/22/2013 BY: Lauri warner Form GM—VhTOTAL•apprab+l software by a la mode,irc.—1-MALAMODE Capital Property Appraisers 8288 Wlwn Court HwrWxwp,PA 17111 07/21/2013 Swan Green 328 Lamp Post Lane Re: Property: 328 Lamp Post Lane Camp Hill,PA 17011 Borrower: WA Fro No.: In ecoordence with your request,we have appraised the above referenced property. The report of that appraisal Is attached. The purpose of thts appraial Is to estimate the market valw of the property described in this appraisal report,as Improved,in unencurnberod fee simple title of ownership. This report Is based on a physical analysis of the site and improvements,a Imc On anaysle of the nslphboAaod and city.and an economic analysis of the market for properties such as the Maect. The appraisal waa developed and ft report was prepared In accordance with the U.don, Standards of Professional Appraisal Practice. The value conclusions reported we as of the effective date slated in it*body Of the report and oontinpent upon the eertllicalion and I mbig oondYbrn attached. It has been a pleasure to assist you. Please do not hesitate to contact me or any d my stall If we can be d addttkxal service to Yom Sirtcerey �����✓ LMA WWW Conrad ResldaMfal Appralar Main Re No.Crml- SUMMARY Of SALIENT FEATURES Subject Address 328 Lamp Pal Lane Leal Dsscrlptlon Dead book 00258 Pape 01844 City Camp HI Cw* Cumbsrlarrd Sbb PA Dp Code 17011 Cow Tract 0113.05 Map Reform 10201848038 SW Pike $ Dab of Sale WA Bonower/Clam WA Lender Susan Green Size"ems 1.593 Pike per Square Foot S 172.83 Location Creek FrorM/Gd Ap 44 Conddar Averape Total Rooms e Bedmon s 3 Bathe 2 Appraiser Lauri Wemer Dab of Appraised Value 08/22f2013 Fbd Esbmde of Value $275.000 Form SSD—WmTOTAL'appraisal software by a Is mode,k c.—1-8O4ALAMOOE Capbl P►wV Appraim(71702.100 Man Me No.C UNIFORM RESIDENTIAL APPRAISAL REPORT Ns, "rooLwppoot Address 328 Lamp Post Lana CRY Cwnp Hi Slate PA Do Code 17011 legWDewfullon Deed book 00258 Parge 01844 CoAft Came 10201846039 Tu Year 2013 RE Texas S 2,490 0 Borrow WA Cumvi Daw Estate of Sinirlev Crw M Foe S HOA 8 0 Naldboillood at Rolect Mims Pinebrook Hwnpden T 10201848039 Constis Trod 0113.06 Swe ft;0 III Dab of$6 WA Descriollon wW I mod of k9n in be cold by Wier bt Swan Green Address 328 Lamp Post Lane kwww Lain Warmer Aftus 6288 WkMrs CauR PA 17111 Location Urban Suburban Rule fhadesaNnt Prssar w4m% Laduse Built up Over 75% 25.75% Under 25% e0smp One fv* 82 ®Not ikey]Likey Groelh rile ❑Rapid Stable ❑Slow ❑Owner 200 Low 0 24 W* ❑In process Proo VVsk" ❑Increasing Stable ❑Declining ❑Tod 400 80 Multi-family To: DemmNauppy SW" In balance ❑Over Soppy ❑Vacat(45%) Commercial Teo 40 1lacar" 18 Neese knee sad Ira halal ass p III of tea ofthiss bad as sell a/p ftd Oastara Neighborhood bourderW and cMacIlrlsila: Pirabrook Flarnioden Townsiltip,To On north is Route 81 to the east Is Route 11/15,to the"Is CanWo Pike and to the wet Is Good Road. FwW IM affect to Rwke0lbiiy of do properties in fa neighbortnood(pmdr*to mVbymad and amedtles,anpbymad sbbilty,appeal b market,et): The Kabled Is located in a residential reiahborhood.MaW route of travel are Wedod within a resswobls dM wm of the ubject Enniplownnot for the area to r@W e clood.MWor wplloyawa M the Cannip HE Amor kndude Ww maruftchming coomparries and many smafw swvim com .S and demand ovum in bWwm for the hboAaod. Makd cordNbns in fa waeet neiplttorhood(Indudirg support for to above cmcbio s related loft bend of pro"values,denrrrnllsuppy,and marketing fine —each is data on cmp ftn propartles for sale In the ndghbarfaod,descdpdm of da prevalence of Was and financing concessions,dc.): Markat conditlom *dive for ft fine of yew.Than we vwkm ken amorrams awNable Mrouch both oanenfon and artai rams and rMw rwdw from 4%ARM pmwwm to 5.0%Nod rata wooname.Mast fans for reasonable Priced housina Is wOn 3 to 6 sale owmessiorwo,ddwuah evident In some trweeftns. P"d Irlaeslbnfor PIDs(n applicable)--Is the devdDWAnddar In conYd of to Home Oscan'Aseoddm(Ift)7 Lj Yes No ApproAulis trial number of mb In ft subject project Appmrdns0e trial renber of udb for sale in the subject project Dimensions Sae L -Not Attadod. Topography Leval Sb acs .42 se Comer Lot❑Yes ®No Size .42 Ac Specific MM chuftatlon and dsedptbn Resider furl Shape Redanouler zwng campince ®Legat Legel nanrwdarMng(Gradtfmared use)❑Wesel ❑No zerig Drakage Averaoe New Raskiwtlal IN�es Public oft 08-Oflapovesrrds Type Pubic PnMb Landseaft Avenoe 9etfd4r ® Sleet Awhok ® ❑ DnMeway SurIece Paved AsWM Gas Csiygndler Yes ® ❑ Apparent asamerh Nora Known► Ikhllr I Sidewafn Ye ® ❑ FEMA Special RoW Hazard Mee Yes Z No tiafnbry Serra Strd W b Ye ® ❑ Ft91A Dome Zone X Map Dab 03/16!2009 None 420360 Cmnnwb(Apparad adverse easanab,craw nets,special asseaanaib,side Mae,60 or legal nmcadamig Zorig us,eb.): Then wen no noted apipanyt advere or uriavorsbie ewmente or ercmadrnanb nosed.Sea ettadnd swoWnentral scidandum for comments. GENOK DESCRIPTION EXTERIOR DESCRIPIM FMWTION aASEMI NT INSULATION No.of Udb 1 Fou ddon BlocWAocr Slab No Area Sq.Ft 11.073 Roof ❑ Na of Storks 1 EdeHo Web BrickVInWAya CruA Space No %Malted 80 Calling Type(Dat1AIL) Ddeded Roof Surfas Cam A%9asanent Fat Calling Finished Web Design(Sgie) Ranh GUM 1i Dwmpb.AIurrJAvcr Sump Pump Ye Wale FirriW Floor Bdsfn11"Dwed EA@ft Window Type VkwKWnWAy Dampness None Flea Firtslesd Nona ❑ Age(Yrs.) 44 SbrMSaeens 69mon"m Sealene t Nora Outride Fyiy Ye Urmlmowf_❑ Effective 20 Nam No I I None ROOMS R. X 1 1 1,593 X 1 1 1 3 2 1,593 FhWW am above 8 3 T 1593 k im I*of Gross LMna Area INFERIOR Materier(CordMon HEATING MWN EOWP. ATTIC AMBNRES CAR STORAGE: 2 RM WdCpi~Awo Type BB Rehtg.W ® Non ❑ Fimph (s)• 1 ® Nona ❑ Web DrywaYAwn Rol Gras Raw/oven ® Stab ❑ Patio Raw ® Gangs 0 of an TrkWMsh WoodfAw Cowillon Olsposd ® Drop Stir ❑ Deck ❑ Abdned 2 Bath Floor VInTWAycr CDOUw DJsWmW M Scdtle ® Poch Covered ® Detdned Bath Wainscot FlIbercilawtsTWAvis Centel X FaNHoad ❑ Flea ❑ Fence ❑ Bohlen Door PwWA Otw MIMowevs ® Healed ❑ Pod ❑ Carport No- Common Addglonai feakes(special energy efficient items,e!.): Thsrrnonidowe and doors. Condition of fa improvaies deprwidm oW*W,functional,and ob md),repairs needed,gwfy ot con*ucdm rmmddrKVaddkkm*b Then we no hndbnal obsolescarroe indicated from the subled pnopedy ftoecdorL The bvrw krvel Is finished wMi a frarnbrwrn.bath and bedroom. Adverse aNNireormadel comMons(such s,but not smiled to,hazardous waste,bate substnces,etc.)present In the knprovernade,on the sib,or in to immediate weinty of to subject pro".: Freddie Ma:Forth 70 6W PAGE 1 OF 2 Fannie Mae Form 1004 6W Form UA2—"ftTOTAL'appraisal software by a Is mode,Inc.—1. O-R AMODE [Main Fits N&CruLarwPosd Pegs#31 UNIFORM RESIDENTIAL APPRAISAL REPORT so ft creaLamppost EMTM SITE VALUE.............................................. Cmmwb on Cod Approach{each a,was of cost edtr^3ft"J^ ESTIMATED REPRODUCTION COSPIEW-OF WRMOM: sqm fad coicuiftm and for HUD,VA and Fff*K Me aftod renuhN Dwdq_Sq.PL $ ecarraric If$of to pworm: Sq,ft 011 r The softated Mnlinft a=="ft of the subled Is rated 40 Years ft"Itcaw—sq.R @$ Total Ed NJCNN#w............................. LOU ftsical I I Nrdonsi Eve s Dww _ — - Ww — Dwsclad Vakn of Irsprowsraft ..... .....--.........--$ Asir Vdw of Sits IWWWWU...................................ri N"rIYCW ........................... I SU&M I =w9wLE a I COMPARABLE N0.2 COWAPME RD.3 328 Lamp Pod Lim 406 Lamp Pod Low 202 Lamp Poo Lane 314 Lamp Pod Low a Como hiI PA 17011 Camp HM,PA 17011 Camp HIL PA 17011 Camp H1,PA 17011 ft tg Subied 0.11 NW 0.43 min SE 0.13 min SE 240.000 327.500 fte(Sms Uft Am S 172.83 8 161.73 ON 8 172.33 Qt 149.68 t I Dab and/or Cw**PennALS Contrai Pam Mu ki UstDOM 58 Car"Pam WA Ust;DOM 6 Centraf Perm%A UstDOM 72 V1rftdM6o1M C Cumbedand Co Pubic Records CwnbwWW Co Pubic Records Cumberianci Co.Pubic Recwft VALUE AUXTMBn DESCRIPTION DESCRIPTION +(-)$Adlud DESCRIPM +(-)$A" DESCRIM +(-)$A" SaW or Rnamirig Cash 0 Comwftnof 0 Conventions! 0 CbsingCosNalip 0 C110sincCositift 0 CJos1noCWs04ft -6,876 s06/13•q06/13 0 s03f13•c02/13 0 owl 0 Locdon Creak FronUt3d Creek FrcrWGd 0 Frontf0d I Crook Front 0 Crook 0 Lumbdiffs Skook Fat m Fee Simpis 0 Fee simob 0 Fee Sim cie 0 .42 as .34 ac: 0 M so 0 .33 me 0 YM ResMenUSI Redder 0 Re@kWM 0 Reskientlei 0 Dialm and Again! Ruch Ranch 0 Ranch 0111, sp*4-" 0 QWft of C=Wft BddWkM &WAkv*w 0 slownurniru" 0 BricidAiuminum 0 Am 44 47 0 49 0 0 47 coffillon Averago 0 GoodiUpw*dW -20,000, Average 0 ; sib Abon Grads Tw:00=; iia =i Bft TgW:Nrra: Bdv; TOW iodm1s, NO Room CoW 6 : 3 : 2 6 3 : 2 0 6 : 3 2 0 7 4 : 3 -3.000 Mg Livion Am 1,593 St FL 14484 k FL: +Z700 2.118 So.FL: -13,100 2,186&R, -14.900 Bagnst&FWdW FmRmSdRm13th FmRml3dRmBth 0 FmRmBdRmB1h 0 FmRrnOdRmft 0 Room Below We 100%/80% lW%180% 0 100%/80% 0 100%/75% 0 r:WgMj LIft Average &%"a 0 Averew 0 &v—anm 0 G981Cw*W GBOrge" 0 GeEwcer" 0 GOBfCer*W.. 0 0 Thermo Wkwho 0 ThwmoWrdw 0 ThemnoWinctw NV N Thwnxkxkm$ 2 Ca 2 C Gwmo 0 2 Car gant M 01 2CWGwaw 0 forch,Pak DKK Paib,CovPach Pa6oPondL 0 Dedc;ovparch 0 PadoDw* 0 Firephyce 0 2 Fhnftoss -1.000 Fkapiece 0 ftmL PA dL Nona Nam 0 None 0 Sun Room -2,000 Nd Ad.bw 2.700 M+ M-4 -34,1001n+ M-:9 -28,776 A4us%d Sabo Price of cwnow" Is 24Z700 1 330 900 300124 Ca wm*on Win Coraperism(Irdift I tow,fic.y. The tows were chosen after a thorouch search for sews in to&*jw nwtat area and we the bod-swalaft for comparison to the subject based on moot Wee d simlar propWa boated in does wwftnft to the sublea Grosser Mai&wax piated ard cornglgft 1.2.3.4 aid 5 because May Wcated in the NNW neighborhood. The sdumadvakararve d the wsiottecicomparebials$211400 and S2215W, The subied Is In averaw coralon wW ouppofte value the mid poomd the rm estabi1shaci from the own parablessies, The a"withaWyatmerft aftioNshe ram d valve far ft ea No adiusynerg were made for am because the sublect and to comeggft have simia 006*40 saw my SIMM COMPARABLE ND.1 COMPARABLE NO.2 COMPARABLE N0.3 Dote,Price and Dab Source,for prior miss Year of apo*g Cumbsem%0*4 Cum beflard—CattrPubkRew CumbwkrdQr&wPub11cRqq CumbwhmdCntAhA*Aoc: M*ds of any cement gunat of s*opbn,or WN of 9AW pq"and analysis of my prior Wes of su*d and corMarsbin whin one year of the d&of appraisal: 11111DICAND VALUE BYWAUCOWARMAPPMW.......... ........................................................ ..................... $ 275,000 Wum VALUE V WMEWO&Andc") EdmiWMv*jLBjL_I /Mo-XGMjJ&vtMw0ww This app tWismode *u Is" I lsubject tftrepahWbraftmkmpodmorcmtftmidWbobw LjwWbc=*Jm per pkm&spKftdons. Cgwe"at AW*t This sops"Is not vaW wWW al of the aftchad addenties. See stWdW addendum for commoft Rai RworciWorc AN weight In this ansiy*Is p!KW_on the ad=gomparlson signech,which bet refticts the ttL*ft and behavior d the bvicai buyer The Cost Approach was not c"Wered spokabia due to the overd we of the subject which makes qgtIft§N?Mg4ft specui*A.The income approach Is not consiciered apokabis due to Insufficient rants!data.Most propw-ft—a Ike the subject are owrw The Wpm of#6 appraisal Is to sdnb ft ffwW vto at the real property to Is to subOd of#6 ropott MW on to above cord win and to cad utin corftert aW kftq ow bm and ffwMvA*d0ficalot as*Min to attached%W Mac Form 43vw form 10016 0466 — jpMEn"Tj THE 0MWvWkmWWAoF THE RMPRMff WITHEWMWOFIX111111MM.A8010 08r=13 MMO DATE OF q*ANDr&vFww DATE oFTwRmqTon $ 275,000 APPM ,-W. , , : GLWERV4WAPPRAW(0111LYFR10AM� El Did F�Did NO SkrahnEsff��, Signakiro Rare Law Warner Name Inspect Propsly M Rapt Sb* September 03 2013 D*R"SkPW SO C**Aft*RL139096 Stab Pal sto palific"# SW Or State Licerse# State Or SW Liceras*- stab Fertile Mat Fan 70 W PAGE 2 OF 2 Fancis Mae Form 1001 6-93 Rm UA2—IWTOTAV appraisal subw by a Is mode,m—1-MALAMODE Main Re No.CmLmw—PaW-P-w—q jQ UNIFORM RESIDENTIAL APPRAISAL REPORT MARKET DATA ANALYSIS rtes a � e a s pipet % ° po Pa 'WT u ore orr tlm the°aub ect Z m +1ad is made N Incnusl tln indkated v m1tlie°wbbct 5 a sip aM �e ° le o,a bu ITEM SUBJECT COMPARABLE NO. 4 COWARABLE NO. 5 COMPARABLE ND. 8 328 lamp Post Lan 539 Lamp Post Lair 422 Lamp Post Lary 4923 Shasta Way Addrm Comp HN PA 17011 Camp Hi PA 17011 Camp HN PA 17011 Machericabura,PA 17050 0.79 mNa N 0.25 mass NW 0.88 miss W 1900 269900 275.000 172.63 122.57 0 137.70 0 154.08 0 Dab&War CentrePsmAAL.S Central Pam WE Ust;DOM 14 Central Perm MLN Ust DOM 24 Central Peron MuIB List;DOM 75 CML Cumberland Co.Pubic Records Cumberland Co.PubBe Records Cumbarhm Co.Pubk Records VALUE AUNTMOM DESCRPTI011 DESCRIPlM +- DESCIWMN I +- DESCRPRON +- Sabs or AnmckV Cornarrtbnst 0 Corrvardorw 0 ConvaMbnel 0 0 qbwngg2gtL4lP.,i -8,097, Closirm Cwt 0 ode of sawDro W7/12•cO5/12 0 s01/13:01/12 0 *02113:01/13 0 Locam Creak Frork/Gd Creek FfoWGd 0 Creek FfoNGd 1 0 Subraben/A +20,000 Fee Skn pie Few Simple 0 FN Simple 0 Fee Simple 0 42 so .8840 -1,300, .29 so 0 .29 ac 0 4AvwawAvww@ RasidwdW 0 Resklantlel 0 Reakfantlel 0 Ranch 0 Coioltel 0 Ranch 0 Brk* A 0 Brick A 0 B 0 An 20 0 43 0 37 0 coffift 0 A 0 Good/U reeled -20 000 Abon GrWe T Room Count 8 3 2.0 0 6 3 2.5 -3,000 7 3 20 0 2,202 -15,200 1,960 -9,200 1,785 -4.800 Baamat 8 Ads w FmRmBdRmBM UrkHehed 0 Urdhdw 0 FarrdyRoom 0 100%/80% 100%/0% +10000 100%/0% +10,000 100%/80% +3,000 gal"Uft Average Average 0 Average 0 Average 0 GBB/Csrrtral HPumplCartrai 0 GFHA C r&W 0 HtPumplCardral 0 Eway MIN b= Thw=W ndrwe T?wmoWtrndows 0 Thw=WhWme 0 ThermaWndws 0 2 Car Garage 2 Car Garage 0 2 Car Garaige 0 2 Car Garage 0 Pads,Pd o,Deck, PWo,CovPadr PabWorch 0 PorchPdo 0 PatloPodn 0 finobco(l),It Preplece 1 0 1 Fl O Firsolece 0 Few PA ft Nora 0 1 Nora 0 Nora 0 8 500 - S -10,2971 -1.800 Aqusbd Sake Wks 263400 259 803 273 200 Dde,fte ad Dab sun for prior vein Ctnbw%rWCrtvF Cum Cum Cumbw%ndC ec Conn rb: An ad ustmant waa made to comparables 2 end 6 far condition because Vw have recsft updateWupwaded Idtchew. Markel Dam Arkdysis 6-93 Form UA2(AC)—"%bTOTAV appraisd soRwue by a la mode,im.—1-8ON AMODE [Midn He No.CiEiigaiim Supplemental Addendum File Crool-ornpPoo Barrows Chit NIA Address 328 Lamp Post Lane Cq Camp HE C Cumbedwid Stets PA Zip Code 17011 Lender Susan Green Every effort hea been made to conform to U.S.P.A.P.and In most cases even stricter interpretations found common on to most Investors In the secondary market. Since every property can't compare to'Ideor comparable sales,the appraiser must chose the bast avellable Sales for comparison available from the market search that meets Investors underwriting standards and guidelines established by the professional appraisal association that this appraiser Is affiliated with. The first part of the addendum is designed to clarify items common to all appraisal repots. The second part of the addendum Is designed to simplify the reporting of comments most typically required by landem to dandy aspects of the appraisal process. The presence of UREA-FORMALDEHYDE FOAM INSULATION or RADON GAS has not been determined. it UFFI or RADON GAS Is present,the appraised market value may,be adversely affected. Exact"R"value Insulation factom could not be determined. Any information slated on the appraisal was provkted by the inspection where the Insulation was visible,or by lire owner or agent of On owner where the insulation was concealed. All of the sales are dosed transactions unless otherwise noted. The settlement dais is to be considered the date of the sale U0 and Sri Is shown on the market grid data section. U stands for under contract and S stands for settled date. This is done to We the reader more complete Information on the considered comparable set". Source of Infonns on of the sales generally list the appraisers Data Bank. The Daft Bank contains Information from the following sources: CENTRAL PENN MULTI-UST,MONTHLY STEB REPORTS,COURTHOUSE RECORDS,ASSESSMENTS RECORDS,EXTERIOR INSPECTION OF THE SUBJECT PROPERTY,TELEPHONE INTERVIEWS WITH REAL ESTATE AGENTS,OWNERS,AND BUYERS,OR PRIVATE SALES REPORTING AGENCIES. Intbmratlon is always verified by two(2) sources,and most usually by three(3)ommes. When the sours is listed as"INSPECTION"your appraiser has personally Inspected the property. Heating systems abbreviations used In this report are as folkiws: The first letter denotes the fuel used-0■011,G a Gas,E■ Electric,C■Coal,W■Wood,and 0 a Dual Fuel. The next series indicated the type of heat BS■So rd,FWA■Forced Warm Air,HWBS a Hot Water Baseboard,CIS a Cast Iron Baseboard,STM■Steam(radiator or convector),HW■Hot Water(Radiator or Convector),RAO■Radiant(heating alsmanb concealed in the ceiling or Boom). Air Condition: CENT■Central Air,Wall■Built in wall units. Occasionally,the subject or comparable haw special,higher affidency heating systems: HEAT PUMP■a for warm air heating system with a conventional backup heeling system (usually electric,could be dl or gas)and central air conditioning. GEO.HEAT PUMP a Geothermal Hoot Pump uses constant temperature ground water for heating and cooling. This system requires two welts and is extremely efficiant. SESS■Supplemental Electric Storage System. This system hoots large quantities of water during off-peak hours and uses On hooted water during peak hours. Subtler, I savings result from reduced electric:rates from the local eledrfc company. Sonde of the sales may show photographs with sew signs.Salsa are not now under contract or being offered unless specifically indicated within the apprahal report.For convisnce and speed,seise photographs are taken from my existing data base for sales In the arse.All of tie sales Indicated have been externally and or Interiorally view by the appraiser as required by the approlsem guidelines for performing appraisals. Subject Pholos am original photos taken at the time of the subject property viewing and have not been altered. The use of the toms Supedorflnfertor Is considered as amid lie range between the more stsrdard Good,Average,Fair,ata, eta When applicable within the appraisal report it is assumed,unless noted In the report,that the roof,plumbing,heating,electrical and air conditioning system,wells,septic tanks or cesspool are in satisfactory operating condition,that the building is stnraturally sound and free of tai mits Infestetfon and free of termite damage.The appraiser suggests that buyers,lenders and other interested parties obtain ceMflcatkim from properly guaYfied professionals for their protection. Comparable photos may show listing signs or weather conditions di femnt then the subject photos.Photos may be taken from the appraisers date base.All of the sales have been viewed by the appraiser as generally requested by the appralsem dients. There has rat been a title search or survey completed on the subject property that would confirm or deny any encroachments, easements or dead restrictions on or against the subject property. At the time of the Inspection of the subject unless rated in considering the items not present or having no effect on the overall typical use of the subject as valued In this report If any of these Items are present,the Fair Market Value as determined by this report may be adversely alfeded. APPRAISAL COMMENTS The digital signature is an original signature and Is password protected. Digital signatures are accepted In the industry. It is noted that one or all of the sales are older than the desired six.,iond range. The sales chosen were done so after s thorough search for"lee that conform better to the desired guidelines. The sales dasen are considered representative of the subject market and offer the best data available for the subject. It is noted that tie price per square toot of gross living area for 1 or all seise varies by more than$10.00 per square foot compared to the subject. The sates chosen are the best available. Under current market condttlens,the reasonable exposure time for the subject property is approximately three to six months. This Is based on the analyses of current market bands In the general area and takes into account the size,condition and price range of the subject property and surrounding arse.It presupposes that the listed price would be at or new the appraised value. It also assume*aggressive professional marketing by reputable local real estate offices. I have not performed services,as an appraiser or in any other capacity,regarding the property that is the subject of this report Form TADO—MMTOTAV appraisal software by a la made,Inc.—1400•ALAMODE Imwn R@ No-CNeLOMPOSH Pace Supplemental Addendum His No.Cr„L,rm ost Bomer lIs t WA AddrM 328 Lamp Post Lana city camp M Courtj Cumberland State PA Lp Code 17011 Lender Swan Grow within the thresojear period Immedlately preceding acceptance of this assignment. The suNed's bedroom count varies from that of the comparable*used. Thera was a lads of sales with comparable with the same bedroom count. Tha dlfleronce In the bedroom count does not effect the marketability of the subject nor the comparables. No adjustments necessary. Additions to the Scope of Wok:This Is a Summary Appraisal report.My visual inspection included the main living areas of tit home.No mechanical systems wars thoroughly inspected.The appraiser Is not a home Inspector nor an expert in construction technique*.Oats sources that the appraiser has used Include,but are not limited to,local multiple listing services,public records,local reettos,developers and sometime*previous appraisal Ille*.This Summary Appraisal report is intended for use by tit lender/dlwd and/or their assigns only and not for any others.All others are considered unintended users and the judgment and conclusions that form the bash of the appraisers valuation may not necessarily pertain to other functions that required an estimate of value for the subject property. The scope of work to complete this report used the Sales Comparison Approach to value to estimate the market value heroin. The Cost Approach was not developed.The Income Approach Is included only If the property is an Investment property and there is sufticlent rental and expense data.The Sales Conparlson Approach is the most applicable approach and was used to reconcile the final estimate of value. The Intended User of this appraisal report Is the Client. Forth TADD—"ftTOTAV appraisal software by a la mode,Ina—1.800-M MODE Main FH@ No.CrakarmoPosir-&-a-0-4 Subject Photo Borrows lent WA Prooft Address 328 Larnp Post Lane CHY Camp He C Cumberland Shia PA D Code 17011 Lends Susan Groan Subject Front 328 Lamp Post Lane Saba No Gross UftAm 1,503 ToW R TOW Bah ms 3 ToW Bdn ma 2 Latalion Croak FronUGd View Reskhandat r Sh .42 ac "r OulY Brwuvkm Age 44 Subject Rear Subject Street t Form PICPDLSR—'WUTOTAL'appraisal software by a la mode,ine.—14ONAMODE Main Me No.Crekarwftsfi EVe#101 Subject Photo Pape Borrower Clem WA Addreee 328 Lomp Post Lana CHY Camp H8 counly Ctanbedand Slate PA 4 Code 17011 Lender Swan Green Subject Street 328 Lamp Pod Lone Saba Prbs Groan Livhq Ares 1,583 ToW Roams 8 TOW Bedrooms 3 TOW Barrooms 2 Locdon Crook FvonHGd vow Rsakk fal Sib .42 ac Ape 44 Subject Side Subject rear Form WJ30.SR—'MnrOTAV appraisal wftm by le mode,im.—1.800-ALAM OE Subject Photo Papa Bommff b t NA Propertl Addml 328 Lwnp Post Lana CKY Camp HO Cwq Cumbsdand Stab PA ZIPCOdO 17011 Lender Suns Green Subject stairs 328 Lamp Post Lana swu Pros Grote Living Ares 1,593 ToW Roam 8 TOW BOOM 3 ToW Battanonn 2 Loeatlon Croak FmrWGd View ResidentW Sib .42 me We* BrWWhM Age M Subject view Subject Kitchen Fam PICPO(.SR—'ftTOTAV aWalsal software by a la mode,im.—1-SWALAWM Subject Photo Page BormwerlClat WA Roporly Mdmse 328 Lomp Pod Lana Cly Camp He C Cumbodwid SUb PA zo Code 17011 Lender Swan(item Subject I Itchen 328 Lamp Pod Lary Saba Price Gmss Uft Area 1,583 TOW Roars 8 Tof l Bedrocrra 3 ToW Bsthoorm 2 Locsdm Creek FrorWGd Yrew Reeldenftal Sffe .42 ac Dually Bftk/VN Ap 44 Subject Dining room Subject bedroom a 't form PMSR—MMnTOTAL•appraisal software by a la mode,lw.—1-804&WOE [Main Fie No.CmLwmPoA Paw 013 Subject Photo Page Borrower Yens WA Addras 328 Lwnp Pod Lana CRY Camp HI C Cumbed&W Sfam PA ZoCods 17011 Lander Swan Omen Subject Ihingroom 328 Lamp Pod Lane Salsa lake - Gross Lift Area 1,593 r. ToW Roans 8 ToWBedrooms 3 15 Total Bdnoms 2 Location Creek FroWGd Vlee Rasklentisi Sib .42 so OAft Bftmnyi AOe 44 � n Subject bedroom � a f i � f► a Subject bath Form PIMSR—"ftTUTAL•appraisal wftm by a is made,ins.—14OD-ALAMODE Subject Photo Pays BWMN font WA PrMdl Aditl 328 Larno Post Lane Clw Camp He C CumberWW Stab PA BP Code 17011 Lade► Swan careen Subject bedroom f ,. 328 Lamp Post Lane Sake Prke a Ores Uft Aren 1,583 1 : ToW Rooms 8 ToW Bedrocme 3 Told Badeooma 2 Lacdke Crook Front/Od View Redder!N Sib .42 as Wft Bdduvk yI Ape 44 Subject bath Subject bath Cont. Form PICPDf.SR—"NfnTOTAI'appraisal sof m by a k mode,k c.—1 d10 XAMOM Main Re No.CrnLrm PM#15 Subject Photo Papa Boaower Bent NA Addroas 328 Lamp Past Lane CRY Camp FBI Cumberland Stab PA ZIPCods 17011 Lender Susan Groan Subject family room 328 Lamp Post Lane Sets Price Gross Uvft Aron 1,583 ToW Roam 8 TOW Bedroarro 3 ToW Baft ms 2 Locdm Creek FronUGd View RoWderdW Site .42 ac DA* Brk*Mnyi Ape 44 Subject familymm a P r Subject laundry room `i Form PMd.SR—"ftTOTAV appraisal soHwre by a b mode,kc.—1.900-&&ODE Subject Photo Page Borrower Clem WA PmPft Aftus 328 Lamp Post Lam CRY Camp He C CumbsAand Sbb PA ZO Code 17011 Lender Susan Green Subject 1.0 Bathroom 328 Lamp Post Lane Saba Prlce Gmaa LMM Area 1,543 TaW Roorm 8 TOW WOO= 3 TOW Satbrooma 2 LOcdbn Creek FronUGd View Reaidsrdw Sib .42 ac DAy BrfttVkM AOs 44 Subject LL Bedroom Form WPKSR—'MnTOTAL'appraisal software by a b mode,inc.—1-800 M AMOOE Comparable Photo Papa Borrower kt WA 328 Lamp Pod Lana CKV Camp HM C Cumbedwid SM PA 3D CA 17011 Lender Swan Ones a Comparable 1 408 Lamp Pod Lane Rox b Subject 0.11 miles NW Saba Prig 240,000 Gross Lift Ares 1,484 ToW Rooms 8 TOW Bedrocma 3 TOW Salhcoon 2 {w Loubm Crook FmnUOd View ReskMrd al Silo .34 ac s Ous* BAck/Aksnh" Ape 47 _ Comparable 2 202 Lamp Pod Lana Prox b SubOd 0.43 mbs SE Saba Rte 385,000 Grow U*V Ares 2,118 TOW Roan 8 TOW Bedroomm 3 ToW Mimi 2 LOCdlon Crock Frort/Od Vbw Reatdertfal Site .48 ac Qjft StonWAksmh" Ape 40 Comparable 8 314 Lamp Pod Larw Pmx b SW*d 0.13 mfln SE Saba No 327,500 Groan Uvkig Area 2,188 ToW Rooms 7 TOW Bedrooms 4 ToW Batlroara 3 Locadon Creek FronUOd View Reskis M Sib .33 ac Ouefigr BrkidAksninum Ape 47 Form MMCR— tTOTAV appraisal wftm by a la mode,ft.—1.8O0 M AWN Comparable Photo Pape Borrower lent WA 32a Lamp Pod Lem ch Camp FYI Coft CumbaAand M PA N CoM 17011 Lender Swan Groan Comparable 4 539 Lamp Poet Lam Prox b Subject 0.79 mYa N Sales Prke 289,900 Grose U q Area 2,202 Tats)Roam 8 ToW Bedoam 3 TOW BdnM 2.0 LOcdM Croak FroriVGd View Redderft Site .88 ac Ou" BrftVinWAvp Age 28 Comparable S 422 Lamp Pod Lane Prox b Su*d 0.28 mks NW Saba Rte 289,900 Gross UftArse 1,980 ToW Ro" 8 rr; ToW Badroam 3 TOW BdTWM 2.5 LocdM Creak FrcWGd Vbw RedderMW Sib .29 ac t{- Ouslly Srk*VinWAvg 4 Age 43 Comparable 6 4923 Shade Way Prox b Subod 0.88 min W i Sales Pdcs 275,000 Gmss Lift Area 1,785 TOW Roam 7 TOW Bedroam 3 TOW Bdvwme 2.0 LOc#dM SWxmb&VAvp Prow ResklanU Site .29 ac Ouaity eftwvkv Age 37 Form PICPDLCR—"MTOTAL`appraisal SORware by a la mode,inc.—1.MMAMODE ' S Sri•. ,..�.- �. �s CA Como He Cw* Cumbohm Sbb-PA AP COdl 17011 i•' �Q��ay"s� 1, a i-,• 1,� t•: ,:.11.•, 1:,. ,41 t• I �' -^4��Y:')[s aa �r� •"%�• ./i .;Y�'y��I}}'2Y�^-! 1"7+*+..-���•+• (! /'.+�' '�.'.,r✓r/�'',i .'�� ''-.{r-`S^t('�/� ���i'.` �a,t',�^`.�'';p r, �' � .•�y ,� Tii{ �tl 1.�`• �-!�.i��� ��} �' j(F�,~r�'((�t •�_Y� itf./.r.' �1 ��. ,`}{sr�`t/ I 1•a'_•,. �{{4r•'' �,�"..!' 1(�t i77 � � +.l .-r`V" S _'V .%� '.�'+1. 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Oppenheimer PA Municipal A(OPATX) Add to Portfolio 10.11 :0.01(0.10%) Nov4 Historical Prices Gat Histerioal Prices for:�� GO Set Date Range O Daily Start Date: Feb V! 2013 Eg.Jan 1,2010 0W.,skly End Date: Feb v r9 013 O Momhly O Dividends Only Get Prieea First Prevous I Next Last I----__._...._..___....-- ----...__..._..._..-----....._.._....._..................._...._................_..._......__......--— Prices !t _I Date Open High Low Close Volume Adj Close* Feb 8,2013 11.57 11.57 11.57 11.57 0 11.16 Close price adjusted for dividends and splits. First I Previous Next Last MIDownload to Spreadsheet Currency in LISD. ai-_ of-4 Ad Topics That Might Interest You... 1.Penny Stocks to Watch 6.Best CD Rates 2.Dividend Income Funds 6.Beat Stocks of 2013 3.Stock Trading Lessons 7.High Interest Savings 4.Good Stocks to Invest 8.Stocks to Buy Now Feedback ads http://fmance.yahoo.com/q/hp?s=OPATX&a=01&b=9&c=2013&d=01&e=9& 2013&g=d 11/5/2013 OPATX Historical Prices I Oppenheimer Pennsylvania Munici Stock - Yahoo! 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Fundamental company data provided by Capital IQ Historic at chart date and daily ufxtauts provided by Commodity Systems.Inc.(C'SI) International historical chad data;daily updates,fund s.unmary.fund performance,dividend data and Morningstar Index data provided by Morningstar.eic, http://finance.yahoo.com/q/hp?s=OPATX&a=01&b=9&c=2013&d=01&e=9& 2013&g=d 11/5/2013 i 09"000 0990008 I���I���I�I�I��I��IIII�'I�I�II���IIII II�II I�III IIII�'�I ,,...• NN � ffi O N CI �. c9 O N ~ . G i u N CL x` p 4 LL 9 0 H Ge cc Z9 N LU I OZ y�jLr U g� g I 1 F. F. LL LLJ a4� W �� z = Cie 4 L� � 0 0� I- o a8.� � �� � � �'�V -12.81 s3 0 x= m S Co CL Ir LL ru Ln ru 8888 ~ C = A C C N C Q p C .q/ 000111 W � C g; W <M N Z N �C Cpl C �F y <O W a 52 oLE£n{z g '�i f C Lix 7 W Y iv p X a ffi to N p J J It m flf Ill I E 1. .Q N � � � C � � L .. •. 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Set Date Range OBAMA REDUCES co Dally AMOUNT Start Date: Feb ii.F9 7 013 Eg.Jan 1,2010 Weekly HOMEOWNERS End Date:fFFRF-7,. 2013 O Monthly O Dividends Only OWE Get Prices If you On 5625;000 on your First I Previous I Next I Last home,use Obama's Prices Refi Program.You'll be' Date Open High Low Close Volume Adj Close• shocked when you.. Feb 8,2013 30.52 30.84 30.48 30.78 1,976,500 30.33 see;. ow much you Can Save. Close price adjusted for dividends and splits. First I Previous I Next I Last Ii1Download to Spreadsheet 18-25 Over 6 Currency in USD. \CLICK YOUR AGE: 26-45 4 -65 CALCULATE NEW HOUSE PAYMENT Ad Topics That Might Interest You... 1.Penny Stocks to Watch 6.Performing Mutual Funds 2.10 Best Mutual Funds 6.E-mini Trading Strategies ...... ....... ..... ...... ....... _... _.. _.... 3.Best Penny Stocks 7,Research Stocks Online ..... ...... ..... ...... .... 4.High Yield Investments S.Free Stock Trading Feedback ads http://finance.yahoo.com/q/hp?s=TYC&a=01&b=9&c=2013&d=01&e=9& 2013&g=d 11/5/2013 TYC Historical Prices I Tyco International, Ltd. (Switz Stock- Yahoo! Finance Page 2 of 2 Cnpyrl ( 173 Yal uric.all iN18"xervedc"Policy F'ft J1' rr Ada t }§(i{ T,nrvicx f nine r ,g FeecN(;M, l$f10bi•i3.�Mews hktWork Mnbile I More Quotas are reaWme for NASUAO,NYSE,and NYSE MKT.See also delay Imes for other exoh rages. , n omia on p se as�s' or yr urrn flonal',urprr3es only no1ltuF�ndcau far tr Nag uu posos or adv ce.Neither Yah)o nor any gf indepondent pravidars Is liable for any infgnnat1, alb d6lnClpiE:Aef�lf Ov.,.,gr$At)Clb &thny coons taken in relic , inrmation.... fined hort)ln.By accasslrig the Ysho of site,you agree not to redistribute the information found theiein.' �lablta through our premium seivitQ You may Turn streaming quotes on or off. Fundamental company data provided by Capital IQ Historical chid data and daily utxlates provided by Commod ty Systems.Inc.iCSili Inlematlonal historical chart data daily updates,Lund summary fund performance,dividend data and Momingstar Index data provided by Morningstar,Inc. http://finance.yahoo.com/q/hp?s=TYC&a=01&b=9&c=2013&d=01&e=9&1=2013&g=d 11/5/2013 Aa+saa j N co 42 � 8 v 3 U° C R r 0 E p 9 1 a V� LL Fes- 2 C •�" Y 'LL� L o W CL � ea IL Ali �s u C cu 0 ,�• A: o i CL `� e IL _ V Z (� Z = W $ a is O = V COV Historical Prices Covidien p1c. Ordinary Shares ( Stock- Yahoo! Finance Page I of 2 Home Mail News Spoils Finance Weather Games Groups Answers Screen Flickr Mobile I More Search Finance Search Web I Sign In Mail HOME INVESTING NEWS PERSONAL FINANCE MY P EXCLUSIVES Enter Symbol FZO'0"k Tue,Nov 5.2013,9.33MA EST US Markets close in,-a Iva and 27rn,m Dow 40.520/6 Nasdaq 40.41% 6-00 TAEND .................................................- MOO cov -iV, U-2 PRIM M, M. Covidlen pic(COV)-NYSE Add to Portfolio Like .17': J 64.24 4i 0.41(0.63%) 9:33AM EST-Nasdaq Real Time Price Historical Prices GO Historical Prices for: GO Set Date Range Daily Start Dd.: Eg.Jon 1,2010 Weekly C-,,I"otjQ 1 End Daft: Feb Y 9 2013 0 Monthly 0 Dividends Only variety Got Prices First I Previous I Next I Last search for ............ .................................................... ........................................ ............- ........................................................................................................................11........................ Prices income? Date Open High Low Close Volume Adj Close* Feb 8,2013 62.71 63.34 62.71 63.28 1,996.100 55.35 Close price adjusted for dividends and splits. First I Previous I Next I Last i4i Download to Spreadsheet Currency in USD. 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Finance Page 2 of 2 CUpyr~13 Yatlftitilc.alt r)4 Ak9serveU, ,�Policy F{�y j&lr Ada. jEer�gce MlI(�P y rd Peeygq�tl5pt1•'Ighrxa! 1y,�vews )efork Mobile I More f)trias are realdlmo for NASDAQ,NYSE,and NYSE MKT.Selo al o delay bras far Hiner exch nAes. ut rnmat n p Ued'as is or rr,orrn liana)purprr�es onlye fL I,(ended far bt��n purposes or advice.Neither Yahoo!nor any of independent providers is iioblo for any infomraHO at S S6RGIfiFxH x •,ar 861f/CIbNS(9tl�ny Ctions to in reRartttlr�lhtonnation +S rtNinod herein By accessing U the Yaharl olto,you agree not to redlstdnuta the tound therein. table through rx,r prernium service You may turn streaming quotas on or oft. Fundamental company data provided by Capital tQ Historical chart date and daily updates provided by Commodity Systems,Inc..(CSI) International historical char data,daily updotes,fund summary.fund perfomrance.dividend data and Morningstar Index data provided by Morningstar.Inc. http://finance.yahoo.com/q/hp?s=COV&a=01&b=9&c=2013&d=01&e=9& 2013&g=d 111512013 Pentair Ltd. Pentair Common Stock Account Information Current Dividend Summary Total Dividends Year-to-Date ' Account Number 3550008588 Gross Dividend' $10.56 Gross Dividends $10.58 `Retrord Date. 10/26/12 Federal Tan Withheld $0.00 Federal Tax Withheld $0.00 4..... .": Payable pate 11109/12 NRA Tape Withheld $0.00 NRA Tax Withheld, $0.00. Rate Per Share $0.2200000 State Tax Withheld• $0.00 State.Tax Withheld $0.00' Redord-Datt?i°Shares •=48:000•' Net Dividend $10.56 Net Dividends $10.56 ms ry;,„.,. For online account Information,please visit www.shareownerohline.corn If you have any questions,please call Shareowner Services: Toil-free:866-854-1361 ?' Local:651-4504064 ire' ReWn for tax purposes N.;• is�� r ��u� � �e �l 1� �f Pentair Ltd. F Common Stock Direct Deposit of Dividends 1 Wells Fargo Sharsowner Services (WFSS) is authorized to deposit my dividend payment by electronic funds transfer in the United States financial institution account Indicated below. This will be effective for all companies that offer Direct Deposit, for which I am a registered shareholder and WFSS acts as Disbursing Agent. WFSS is authorized to initiate cornactions to any amourd ireresferred in error, and arty claim against WFSS or the financial institution involved Is valved with respect to the operation of this service. This authorization will remain in effect until WFSS receives notice to terminate or revise ft. WFSS and the financial institution reserve the right to terminate this service at any time.ft is the sharehokises responsibility to notify WFSS of changes In financial institution information. Change address as indicated on reverse- Checking ❑ Savings all registered owners must sign below. ;(A voided check (A deposit slip Account Number 35500065813 MUST be included.) MUST be Included.) ABA/Routing Number(9 digits starting with 0,1.2,or 3) Issue Number PNR1 SHIRLEY R CREE Bank Account Number 326 LAMP POST LANE All Regisbred Owners MUST Sign (direct deposit or address change). For direct deposit,if the names)on your Dank account drRer from your shareholder account your signatures)must CAMP HILL PA 17011-1460 be guaranteed by a member of a Medallion Stamp Program.(See rrredapion rmprint area on(he back d the fcxm.) x at 110812 �I��� ���1'I������� •ZPNR1 C06j3022j1 j1 jYjYJY(Y” PNR Historical Prices I Pentair, Ltd. Registered Share Stock- Yahoo! Finance Page 1 of 2 SM&WiI News Sports Finance Weather Games Groups An ens Screen Flickr Mobile I More "MMA Investing News Persons'Fine my PC "As F)ll",-sh4& Enter Symbd Fri,Nov 8,2013,9:54AM EST-US Markets dose in 8 hrs and 6 mins Dow 40.08%Nasdaq 40.46% ti>'wytartitAsMfi� • r ' upb2gOtiNlladM ®AosalrMs a Trade Pentair Ltd.(PNR)-NYSE _................_..._.. _ Add to Portfolio uke t ti 12 66.54 4 0.20(0.30%) 9:53AM EST-Nasdaq Real Time Price Historical Prices Get Historical Prices for: null Set Date Range __ Dally Start Dab: Feb 8 ;2013 Eg.Jan 1,2010 Weekly Ford Dab: Feb -9 2013 Monthly fit$Dividends Only First Previous I Next l Last DID YOU KNOW: Prices K Your Car Is Date Open High Low Close Volume Adj Close* Over S Years Old, You M tilsi110 Feb 8,2013 50.59 51.35 50.59 51.05 1,708,500 50.42 Ripped Og By Not Close price adjusted for dividends and splits. 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Fundamental company data provided by Capital IQ.Historical chart data and daily updates provided by Commodity Systems,Inc.(CSI).International historical chart data,daily updates,fund summary,fund performance,dividend data and Morningstar Index data provided by Morningstar,Inc. http://finance.yahoo.com/q/hp?s=PNR&a=01&b=9&c=2013&d=01&e=9& 2013&g=d 11/8/2013 i i v5 � o Q�i �p8p8ppp8pg z tt�� � v NMNNN (, C 8 8 8 a o TM cm} - �dH U.�� - Fm Tn m g 8 8 8 8 — 02 N N : $ g _ E AAA al E .C. Z _ d a m 0U.zU)z a N a acv E C cc q19 j a Eui a v) C r 599 ;' v . a Uoaa �.� A a � . N IL a M. it If ir CC 1L ADT Historical Prices ADT Corporation Common Stock Stock- Yahoo! Finance Page 1 of 2 Home Mail News Sports Finance Weather Games Groups Answers Screen F'lickr Mobile ( More Search Finance Search Web Sign In Mail HOME INVESTING NEWS PERSONAL FINANCE MY PORTFOLIOS EXCLUSIVES Enter Symbol : Look lJp Lie,Nov 5.2013,9.31 AM EST-US Markets dose in 3 hrs and 23 min, Dow 40.446.Nasdaq 40.34% s i>AY tTt�NO' ■ r ; ADT D . t � .. � .•'..'� .; �AMIaltibelre O ' The ADT Corporation(ADT)••NYSE Add to Portfolio Like 1...5... 42.98 40.20(0.46%) 9:WAM EST-Nasdaq Real Time Price Historical Prices riot Historical Prices for:1 - GO ............-.............................. ... ............ .... : Set Date Range Q Daily Start Dab: Feb:?, 9� 013 Eq.Jan 1,2010 ()Weekly 1 End Dab: Feb w 9 013 0 Monthly �- �- get a bundle O Dividends Only that won't Get Prices break f First Previous Next j Last the bank ..................................................... .. ..................... .... .................................. ... .... Prices Date Open High Low Close Volume Adj Close' Feb 8,2013 48.05 48.25 47.45 47.67 1,368,300 47.39 Close price adjusted for dividends and splits. First Previous l Next Last +b OSDownioad to Spreadsheet Currency in USD. ; Ad Topics That Might Interest You... .. ........ ......... ........... 1.ADT Stock Predictions 5.Best Stocks to Buy 2.ADT Stock History S.Top S Income Funds ..... ........ ....... ..... ....... ....... 3.Buy ADT Stock 7.Fixed Income Funds .. ........ ....... ... ...... ....... ..... ...... ....- 4.Top 10 Stock Picks for 2013 S.Hot Penny Stock Picks Feedback ads http://fmance.yahoo.com/q/hp?s=ADT&a=01&b=9&c=2013&d=01&e=9&f=2013&g=d 11/5/2013 ADT Historical Prices ADT Corporation Common Stock Stock- Yahoo! Finance Page 2 of 2 copyp ,}gt3YalVr..All,pWgfgsnrvearuur,�F{}gjivann• �nnncep� nvirp ,dFeeygpt�yy�rghoo! yllewsty rk Mobile I More Quotas ate roof-time for NASDAQ.NYSE.and NYSE.-.MKT.Soo aloo dal ay Mmes for other ex" noels. information p c as s' r r urrn lionai purposes onty�oj I�[r ndetl tur b u'n purposes or advice.Neither Yahoo'nor any of independant providers is iiablo for any infnmrario a1 tivaf1F♦Rl4 Ie, ,dr B�gCI1�V'dmthnd r coons taY,an in f^lia formation mw herpin By accesshrg the Yahoo!site you agree not to redistribute the mformatlon faun l thamin. labia through our prernium service You may tum streaming quotas on or off. Fundamental company data provided by Capita!10.Historical chart data and daily ufxtatas provided by Commodity Systems.Inc,!(:SI) International historical ctlart oafs,daily updates,fund summary.fund performance.dividend data and Morningstar index data provided by Morningstar,Inc. http://fmance.yahoo.com/q/hp?s=ADT&a=41&b=9&c=2013&d=01&e=9& 2013&g=d 111512013 BLACKRocic C01wqeAdyc-mtaqe g I 5 9 Savings Plan Transaction Confirmation Confirm Date: December 6, 2012 Account Numbur: 51291591757 Account Type: Coilege Sav ngs Pian Account Representative: Mr. FrdnK t-t•Kelly H D VEST INVESTMENT SECURITIES Sharer,ctder: I;LK CoRegeAdvantage S29 Pian (OHI 400 BRIDGE ST STE 4 S-hirley R Crae FBO Sarnuet R Cree NE" CUMBERLAND PA 17070-1936 3328 Lamp PuM I n Camp Hill IAA 17011-7460 BLACKROCK COLLEGEADVANTAGE INFORMATION ® Websilu: www.c.ackrock.COrn/collegeadvsc-tage ® Account Ae.sistdrr_e: 1-ebb-c.:4-8582 8am -6 pn!ES I Mon Fri See Reverse_:icje I-u( Addit,c•rwt Information A MESSAGE FROM BLACKROCK COLLEGEADVANTAGE V Sit WY:Yi.glaCkfG:K.:Cm/CUIi.:..eddV;inl.tge,the tir--t,ne home for yuur .,huge savings needs.While ont.ne,you Can access your account -furm.dtiun,:-het:k the perfurm;nce of the Btackko-:k CullegeAdvaritage 529 investment options,download forms and utilize collei�.a savings :_A,uhiturs•dii to help you wor k with y':ur Finar.aat Advisor in determ;mnq your investment needs.Visit today or call [8661529-8582 for more ••.turn.�tci,. TRANSACTION DETAIL BY FUND _ Investment CUSIP Registration Investment Option Option No: No: i.-.K COLLE"LAUVANTAGE Kv PLAN(3-Ij bk MOD 13-16 AGE iiA iED Uf�TIUN-A 2547 1�452P529 -tIR1 F y R Ci.EE b0 SAMUcL k CREE Trade Transaction Unit Number of Units Total Number Date Transaction $Amount Price This Transaction of Units 2/06/12 BEGINNING BALANCI 628.833 1 ! 5/1t MAINTf:NANCL : EE $25.00 $11.47 2.160 62,6.650 - 12/06/12 ENDING BALANCE $7,200.30 $11.49 626.658 C.L.may aigiLle fcr ureakc,:,,a discounts based on the s,ze of your purchase,Current holdings or future purchasao.T he sates-rarge you paid may dater soghtty frurn the Program Description d sclusea rate due to rounding calculdtiuno.f'tease refer to the Program Description or contact ycur finar',•_at advisor lur furtl:,i mformat:un. Blanch Ccpy BLACKRocic Collew�4) nMtage tlan Transaction Confirmation Confirm Date: December 6,2012 Account Number: 5291591781 Account Type: Cullege Savings Plan, Account Rupresentativ,:: Mr.Frank H.Kelly H D VEST INVESTMENT SECURITIES Shareholder: LLK CotlegeAdvantage 529 Plan(OH) 400 BRIDGE ST STE 4 r hit Wy R Cree BO Chelsea L Gordon NEVI CUMBERLAND PA 17070.1936 :33 Lamp Post Ln Camp Hill PA 17011-1460 BLACKROCK COLLEGEADVANTAGE INFORMATION ® Website: www.btackrock.:cm/collegeadvantage ® Account Assistar:cu: 1-866-529-8582 Barn-6pm EST Mon-Fri See Reverse Sio2 For Aom;,onal Infcrr-,.euon A MESSAGE FROM BLACKROCK COLL EG EADVANTAG E V sit www.blackrock.com/cottegeadvantaye,the untine hume for your college savings needs.Wh.te online,you can access your aA-ount nforrndtion.check the perfurrnance of lire BtackRo:k CollegeAdvantage 529 investment option,,d,wntoad for and utilize college savings :alculator.,,all to help you work with your Financial Advisor in determining your investment need:,.Visit today or call(8661529-8582 for m--re nfurmatiL•,,. TRANSACTION DETAIL BY FUND Investment CUSIP Registration Investment Option Option No: No: ELK COL_=GEADVAN PAGE 5-9 PLAN(OHI BR MOD 17*AGE-BASED OPTION -A 2549 19452P495 SHIRLEY n CREE i bO CHEc.:.t.A L GORDON Trade Transaction Unit Number of Units Total Number — Date Transaction $Amount Price This Transaction of Units 12/06/12 BEGINNING BALANCE 136.762 12/05/1: MAINTENANCE FEE $25.:0 $11.01 -2.271 134.491 12/06/12 ENDING BALANCE $1,482.09 $11.02 134.491 You may l._ubgible for breakpoint dis,_,,ants based on the size of your purchase,current holding,or future p, rchases.The sales charge you paid -nay differ s,ightty from the Program Description di.clueed rate duu to rounding calculations.Plea:,e refer to the Program Description or contact � your financial advisor for further information. ; Branch Cut) BLACKRoac ColleaeAdywitaae 5 9 g Transaction Confirmation Confirm Dale: Cecember 6,2012 Account Number: 5.,91591799 Account Type: Caleye Savings Plan Account Representative: Mr.{-rank H.Kelly H D VEST INVESTMENT SECURITIES Shareholder: BLK CollegeAdvantage 529 Plar,'•OHI Shirley R( r 100 BRIDGE ST STE 4 ::e F BO Nicholas B Cree NEW CUMBERLAND PA 17070-1936 328 Lamp Post Ln Camp Hill PA 17011-1460 BLACKROCK COLLEGEADVANTAGE INFORMATION Webs te: www.b,ackrock.com/collegeadva:uage ® Account A:,r,istunce: 1-866-C>9.85ii2 Sam -6pm EST Mon-Fri See Reverse Side Fur Additional lniurmat.on A MESSAGE FROM BLACKROCK COLLEGEADVANTAGE _ V>a WN.NJ.Cla.kroCk.cum/collegeadvar:;age,the online hume tot your college savings needs.While online,yo..can access your account 'urm,arun,check the perfurrwnce of Wv blackkock CollegeAdvar•tage 529 investment options,download forms and utilize college sav^gs _a._uletcr,,ati to heir•you worx with your Frnam:i;t Advitur in daterrnining your investment needs.Visit today ur call(8661 529-8532 for rr,�re TRANSACTION DETAIL BY FUND Investment CUSIP —� Registration Investment Option Option No: No: K(; i I i C;ADVAN IAGE 6..,I'L.AN r if L✓�,MUD l i-16 AGE-EASED OPT,ON-A 2547 1-,4;i2P5219 :.0 Trade Transaction Unit Number of Units Total Number Date Transaction $Amount Price This Transaction of Units ::10611:: HLGINNtNG bAL.ANCL 614.593 210h1 is MAINP:NANCE.FCE $2!:.00 $11.47 -2.180 512.413 12/06/12 ENDING BALANCE $7,036.63 $11.49 612.413 `.Cu may La e,,)rble fa breakrioriI bated rm the size of your Purchase,current holdings or future pur..hases.The sales charge yc.: paid '- ay di;rar:i cinlly from lhr:F r:,,lram Got.c;iplum d�,c;used rate due to rounding calculations.Please refer to the Program Description or cc ntact y.:.,r hr.-,n•_i,i sdv our tor furtt ::! lilkwin6oull. a Branch Cop; BLACKRocic Collew,�2,dvantage 9 Transaction Confirmation Confirm Date: December 6,2012 Account Number: 5291591807 Account Type: College Savings Plan Account Representative: Mr.Frank H.Kelly H D VEST INVESTMENT SECURITIES Shareholder: E!LK CollegeAdvantage 529 Plan,IOHI Shirley R Cree 400 BRIDGE ST STE 4 1'130 Madeline S Cree NEW CUMBERLAND PA 17070-1936 28 Lamp Post Ln Gimp Hill PA 170 11-1460 BLACKROCK COLLEGEADVANTAGE INFORMATION Website: www.bLackrock.com/cotlegeadvantage ® Account Assist;„ ce: 1-866-529-8582 Sam -6pm EST Mon- Fri See Reverse Side For Additional Information w A MESSAGE FROM BLACKROCK COLLEGEADVANTAGE _ Visit www.clackrock.com/cotlegeadvantage,the online home for your college savings needs.Wh l„online,you can access your account informatio-. check the performance of the Bluckkock CollegeAdvantage 529 investment options,download forms and utilize college savings calcutator, all to help you work with your Financial Advisor in deter mnung your investment need Visit today or call(8661529-8582 for more ,nformatu.c. TRANSACTION DETAIL BY FUND _ Investment CUSIP Registration Investment Option Option No: No: BLKCOLLi-:,LADVANIAGE PLANlGHI BR MOD 13-16AGI- FiASCDOPT ION-A 2547 1?452~529 .,WRLFI r,,RFE =EC MACE_iNE S CFEE Trade Transaction Unit Number of Units Total Number — Date Transaction $Amount Price This Transaction of Units 12/06/12 BEGINNING BALANCE 617.244 12/DS/12 MAINTENANCE FEE $25.,;0 $11.47 -2.180 615.064 12/06/12 ENDING BALANCE $7,067.09 $11.49 615.064 You may ca�lrgibte for breakpoint discs—nts based on the size of yu,,r purchase,current holdings„r future p.rchases. l he sales charge you paid = may differ s,.ghtly from the Program L'escnptrun dr closed rate due to rounding calculauuns.Ptvo a refer to the Program Description or contact your frnan.:.at advisor for further information. Branch Cop r+ E T RO metro Bank 3801 Paxton Street BANK Harrisburg PA 17111-1418 1-888-937-0004 mymetrobank.00m >23720 31996io8 001 092140 SHIRLEY R CREE 328 LAMP POST LN CAMP HILL PA 17011 WeYe two 7 days a week,24 hours a day at 14188.937.0M. PERS PREMIER SAVINGS 0616278068 IL psij ..k C� t.,����y'�b Rl►7RR'��7f'l�' , �y-.3�,y .,.. i \..{Y+�-.k .F � J ytu C���r; 4 J '� v1 ✓ ! ,� y S � f� ��� s���p �_+��� � + �i�'=is°'i?b�lx4` �4fi''Lny,` �.#9Y�S d'� t.r` 'r `` �w F. ,��'• ' a th r '`ry�r a s +r � t "� . y 'f+• d 0.# f v � x ,� U5 c r' s i � «t� � �s y k",W, •x xe°'1 ay f s .-,. •n° k a { Na `'.. * �' �f�' s "s.. ; 2 =.>r .w fa ._,.rx.,�'L�.�>i,_.,.ks_.�,lsn...,....,`.��._�_s rm.1W,:w,a.c...s''-,.��a�..�,....,..,y.s r_�..•ir��._ ,..,,. �dm.._,_�,_'u., ,_x.,e.,.�. '1 III Transactions By Date Date Description Debit n Credit Balance ,6. is" tT+::vd..�:•' .,.u:.,r ,t°,iL'* '�.....��,.�r��.r,e.�4.tis,�.�:�e�icu✓.��'i' �xil<s_ ri''� �*�'rr ,..r_.;�.'s�'r_t.�_'vX,,."s� _,�e:.....�:1:�f.1.����.f xr.:t '•:a 01/31N3 • CYCLE SERVICE CHARGE, 12 00 116,516 57 s Interest Summary Y���i�p�7■y p y,�y,//FF c .� r � ` r .i e 4 fi ' �ti 4 � �,� �v S n � `�+ j ,'. : '. a;�������^�lr+l�� � 1 Y� �A < < G '' �y a a u' �t�P7'�f i -yv si'• � du5 i �` ��a Fees Summary - Total Overdraft Fees Year to Data 90.00 tnlil ffied `Total Returned Item Fees Year to Date $0.00 For your convenience,a summary of overdraft and returned item fees appears on your monthly statement. Please note that the overdraft fee summary includes non-sufficient funds fees,uncollected funds fees and unavailable funds fees. The summary does not reflect refunded or waived items credited to your account. Metro Bank Makes home Mortgages easiez Our Mortgage Customers enjoy AMAZING service,competitive rates and fast approval.A variety of terms are available to suit your needs. For Information or to schedule a convenient appointment,call a Metro Bank Mortgage Representative at 800.975.0619. Stay connected to Metro Bank on Twitter and Facebooki Twitter-Follow us @My_MetroBank Facebook-Like us at facebook.com/mymetrobank 35 Cycle Page 1 of 2 92140 RML C M, ETRO 888.937.0004 • B A N K mymetrobank.com Deposits may not be available for Immediate w ftnewel.For deposits made before 8:00 PM,that business day will be considered the day of your deposit. Funds from your cash and check deposits will be available to you on the first business day,after the day we rec"your deposit. 75 12:18 2/15/2013 0310 A""8068 TirSvWdClose $ 16.5.18:57 HAMPDEN CENTRE STORE103 S-16 3MM 1/121NT Citizens Bank , Customer Receipt Picric be sure to enter this transaction in your records. Transaction Date Amount Description Account Number ow 29iJ021742 X63 02/15/13 12:31 CK CK 00 IOQQ()0(7114 $16,516.57 Funds from your deposit may not be available for immediate withdrawal.All transactions are subject to 22089-BUNKER 8/08 WPK verification as outlined in the rules and regulations of the Bank. Member FDIC 3-888-910-4100 Checking Account .1 UtIzens tsank RO P450 7000 0 CaU Citltem(Phonellank anytime for �f account information,current rates and Statement Pnoaiderice,RI 02940 answers to your Questions. O OF 2 Beginning February 06, 2013 through March 05, 2013 AT 01 051868 234448174 A••3DGT rrllrhlirirliiinnuirurllillrrllilhl11iehirrlilirilillil SHIRLEY R CREE 328 LAMP POST LN CAMP HILL PA 17011-1460 Checking < US002 SUMMARY SHIRLEY R CREE Balance calculation Balance Personal Money Market Previous Balance 40,473.60 Averse Daily Balance XXXXXXX290-4 9 � 16,793.05 Checks .00 - Withdrawals Interest 40,483.60 - Deposits&Additions 398.83 + Current Interest Rate .01% ` Interest Paid .00 + Annual Percentage Yield Earned .00% Cunerit B�cu 388 83 a Number of Days Interest tamed 22 Interest Earned Q0 = Interest Paid this Year 2,04 You can waive the monthly maintenance fee of$10.00 by maintaining a minimum daily balance in your account of$2,500. Your minimum daily balance used to qualify,this statement period is: $ Previous talana TRANSACTION DETAILS 40,473.60 Withdrawals Other Withdrawals Date Amount Daxription 02/15 40,473.60 Withdrawal 03/05 10.00 Monthly Maintenance Fee n Total WNUdri vals Deposits&Additlons 40,483.60 Date Amount DesalieWn 02121 398.83 The Hartford Iad Swp 130221 711069259 n Total Deposits 8 AddiHous 398.83 (raa l Cumrd Balarroa Daily Balance 388.83 Date Balance Date Balance Date Balance 02/15 .00 02121 398.83 03/05 388.83 MEMO --If you have paid Overdraft or Insufficient Available Funds Fees,your account statement includes a table that shows Total Overdraft Fees and Total Returned Item Fees, less any rebates,you paid for the statement period and for the calendar year to date.Transaction descriptions for fees paid in Total Overdraft Fees include"Overdraft Fee"and "Sustained MW*W FMC ib E*WIlc„ tender U t I ze n sJ a n i( 1-800.773-7373 Circle Gold P.O.Box 7000 ROP450 CaU Citizens'special,dedicated Gold Customer service tine any time for account Account Statement PrOVIdenCe,RI 02940 information,current rates,and answers to your questions. OF 3 Beginning February 06, 2013 through March 05, 2013 AT 01 051866 234448174 A"3DGT ��u1Jl'Ilhlnl�irl�l�lls�llsslllr�ylsln�llllll��l�n�sllssl� Contents SHIRLEY R CREE 328 LAMP POST LN Summary Page 1 CAMP HILL PA 17011-1460 Checking Page 2 Circle Gold Summary U5002 Account ALDDUnt Number Bob" salaam SHIRLEY R CREE o Lad Statement This Statement DEPOSIT BALANCE Circle Gold Checking w/Inter ed Checking XXXXXXX395-1 Circle Gold Checking w/Interest XVMM395-1 22,597.12 2,867.82 Personal Money Market XXXXXXX290-4 40,473,60 388.83 Retirement Variable Rate Savings IRA XXXXXXX6587 23.66 .00 ME Total Deposit talcum 3,256.65 (s l TOW Roudoo ft Balance 3,256.65 On WE— M-*-FMC The Salvation Army Family Stores: Donation Value Guide Page 1 of 4 tt= I About The Selvallon Army ARC City,ST or Zip Code' G_o'� DONATE GOODS I DONATION VALUE GUIDE I FAMILY STORES I REHABILITATION PROGRAM GET RECEIPT DONATION VALUE GUIDE DONATION VALUE GUIDE APPLIANCE DONATIONS ApnliancesDonation Appliance Donations Low High Automobile Donation Air Conditioner $20.00 $90.00 Children's Clothing Donation Dryer $45.00 $90.00 Furniture Donation Electric Stove $75.00 $150.00 Household Goods Donation Gas Stove j $50.00 $125.00 '; Men's Clothing Donation Miscellaneous Donation Heater $7.50 $22.00 Women's Clothing Donation Microwave $10.00 $50.00 Refrigerator(working) ' $75.00 $250.00 T.V.(color,working) $75.00 $225.00 Washing Machine 4 $40.00 $150.00 LVL CHILDREN'S CLOTHING DONATION Children's Clothing Donation Low High Blouse $2.00 $8.00 Boots $3.00 $20.00 Coat $4.50 $20.00 Dress $3.50 $12.00 Jacket $3.00 $25.00 Jeans $3.50 $12.00 Pants $2.50 $12.00 Shirt $2.00 $6.00 Shoes $2.50 $8.75 Skirt $1.50 $6.00 Slacks $2.00 $8.00 Snowsuit $4.00 $19.00 Socks $0.50 $1.50 Sweater $2.50 $8.00 Underwear $1.00 $3.50 FURNITURE DONATION 0 Furniture Donation Low High HOUSEHOLD GOODS DONATION Household Goods Donation Low High Bakeware $1.00 $3.00 Bedspread/Quilt $3.00 $24.00 Blanket $3.00 $15.00 http://satruck.org/donation-value-guide 11/8/2013 The Salvation Army Family Stores: Donation Value Guide Page 2 of 4 Household Goods Donation Low High Chair/Sofa Cover $15.00 $35.00 Coffeemaker $4.00 $15.00 Curtains $1.50 $12.00 Drapes $6.50 $40.00 Fireplace Set $20.00 $90.00 Floor Lamp $6.00 $50.00 Glass/Cup $0.50 $1.50 Griddle $4.00 $12.00 Kitchen Utensils $0.50 $1.50 Lamp $5.00 $75.00 Mixer/Blender $5.00 $20.00 Picture/Painting $5.00 $200.00 Pillow $2.00 $8.00 Plate $0.50 $3.00 Pov?an $1.00 $3.00 Sheets $2.00 $8.00 Throw Rug $1.50 $12.00 Towels $0.50 $4.00 MEN'S CLOTHING DONATION tA: sr 14 i,R pbj I T;„ns Men's Clothing Donation Low High Jacket $7.50 $25.00 Overcoat $15.00 $60.00 Pajamas $2.00 $8.00 Raincoat $5.00 $20.00 Shirt $2.50 $12.00 Shoes $3.50 $25.00 Shorts $3.50 $10.00 Slacks $5.00 $12.00 Suit $15.00 $60.00 Sweater $2.50 $12.00 Swim Trunks $2.50 $8.00 Tuxedo $10.00 $60.00 Undershirt $1.00 $3.00 Undershort $1.00 53.00 MISCELLANEOUS ITEM DONATION Miscellaneous Item Donation Low High Answering Machine $10.00 $30.00 Bicycle $5.00 $80.00 Board Game $1.00 $3.00 Book(hardback) $1.00 $3.00 Book(paperback) $0.75 $1.50 http://satruck.org/d_onation-value-guide 11/8/2013 The Salvation Army Family Stores: Donation Value Guide Page 3 of 4 Miscellaneous Item Donation Low High CD $2.00 $5.00 Computer Monitor $5.00 $50.00 Computer Printer $5.00 $150.00 Computer System $100.00 $400.00 Copier $40.00 $200.00 DVD $2.00 $5.00 DVD PlayerNCR $8.00 $15.00 Edger $5.00 $25.00 Golf Clubs $2.00 $25.00 Ice Skates $3.00 $15.00 Luggage $5.00 $15.00 Mower $25.00 $100.00 Mower(riding) $100.00 $300.00 Radio $7.50 $50.00 Roller Blades $3.00 $15.00 Sewing Machine $15.00 $85.00 Stereo $15.00 $75.00 Stuffed Animal $0.50 $1.00 Tennis Racket $2.00 $5.00 Typewriter $5.00 $25.00 Umbrella $2.00 $6.00 Vacuum Cleaner $15.00 $65.00 WOMEN'S CLOTHING DONATION Women's Clothing Donation Low High Bathing Suit $4.00 $12.00 Bathrobe ! $2.50 $12.00 Blouse 7 $2.50 $12.00 Boots J $2.00 $5.00 Bra $1.00 $3.00 Coat $10.00 $40.00 Dress $4.00 $20.00 Evening Dress $10.00 $60.00 Foundation Garment $3.00 $8.00 Fur Coat $25.00 $400.00 Fur Hat $7.00 $15.00 Handbag Y $2.00 $20.00 Hat $1.00 $8.00 Jacket $4.00 $12.00 Nightgown $4.00 $12.00 Pants Suit $6.50 $25.00 Shoes $2.00 $25.00 http://satruck.org/donation-value-guide 11/8/2013 The Salvation Army Family Stores: Donation Value Guide Page 4 of 4 Women's Clothing Donation Low High Skirt $3.00 $8.00 Slacks $3.50 $12.00 Slip $1.00 $6.00 Socks $0.50 $1.25 Suit $6.00 $25.00 Sweater $3.75 $15.00 All donations of appliances,electronics and equipment assumed to be working,and all clothing and furniture donations in good condition. Pi UCY Policy I Sita Mm Copyright C 2013 The Salvation Amy,All Rights Reserved http://satruck.org/donation-value-guide 11/8/2013 The Salvation Army Family Stores: Donate Furniture Page 1 of 2 ' tlftma I AOeul TTe Setvetton Amry ARC ay.sf or Zip Code t33 DONATE GOODS I DONATION VALUE GUIDE ( FAMILY STORES I REHABILITATION PROGRAM I GET RECEIPT FURNITURE DONATION DONATION VALUE GUIDE The Donation Value Guide below helps you determine the approximate tax-deductible value of some of Apnliences Ibmtion the more commonly donatod items.It includes low and high estimates.Please choose a value within this Automobile Donation range that reflects your item's relative age and quality. Children's Clothirs:Donation The Salvation Army does not set a valuation on your donation.It's up to you to assign a value'to your item.For professional advice,please consult your tax advisor. Furniture Donation PLEASE NOTE:This list is not ail-inclusive,and not all items are accepted at every location.If you have Household Goods Donation questions about your donation,your local Salvation Army Family Store will be happy to help you. Men's Ciothina Donation DROP OFF OR PICK UP? Miscellaneous Donation It helps us even more if you can drop off your items.But,if you need us to,we can pick them up for you Women's Clothing Donation In either case,simply call 1-SWSA-TRUCK or find your nearest dtonffloration here. FURNITURE DONATION Furniture Donation Low High privacy pout. Site MW Copyright O 2013 The Salvation.Army.All Rights Reserved . Z 13,60 n.wM 66 Z�. oV 70, c1V _D1 /tovv http://satruck.org/donation-value-guide/furniture 11/8/2013 The Salvation Army Family Stores: Donate Furniture Page 2 of 2 http://satruck.org/donation-value-guide/furniture 11/8/2013 Myers-Harner Funeral Home,Inc. mnInTvin + 1903 MARKET STREET SIN 'E�1 I CAMP HILL,PENNSYLVANIA 17011 _.G± •.. -+. Robert H.Harner,Supervisor Phone:(717)737-9961 Dustin R.Baker,Funeral Director STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED Charges are only for those items that you selected or that are required. If we are required by law,by a cemetery,or by a crematory to use any items,we will explain in wri below. If you selected a fun"that may require embalming,such as a Ameral with viewing,you may have to pay for embalming. You do not have to pay for embalming did not approve if you selected arrangements such as a direct cremation or immediate burial. If we charged for embalming,we will explain why below. For the Service o Date of Des Charge to: a? Nam Address City State Z A. CHARGE FOR FUNERAL SERVICES SELECTED: I. PROFESSIONAL SERVICES Um VanIL..............................................5 Services of Funeral Director/Sts$....;/!? Acknowledgement Cruder......................s Embalming.......................................S Register Book........................................S Other Preparation of the Body.........S Mere Folds (Drassing,Cosmetology,stc.) mY R't�ds..............S, SPECIAL CARE Burial Cl othing......................................S Autopsied...................................s (Dampttm> .Non-Embalmed...... s SUB-TOTAL OF PROFESSIONAL SERVICES.„...S SUB-TOTAL OF MERCHANDISE.......................„.„„.S�p C. CASH ADVANCED ITEMS: 2. USE OF FACILITIES,STAFF&EQUIPMENT Newspaper Notices: (Coups Bahnsw) For Visitation or Viewing................S Patriot Newa....................................s Wv_'V For Funeral Ceremony.....................S s For Memorial Service.....�..............l s For Graveside Service/,joo)........S�t� Grave Opening and Closing....................S OTHER USE OF FACLMES Airfare......:..............................................s Office Area.......fAfte' e.........VVV'C Clergy/h4aua'04ll ring..............................�l� Preparation Room. . $ Organist................................................... .9W AJ. s a Alta Servers...........................................s SUB-TOTAL OF FACHdTIFS,STAFF ds EQUIP...S Vault Service Charge..............................s Flowers....................................................$ 3. AUTOMOTIVE EQUIPMF.(VT Certified lea of the Certificate 's, Transfer of remains to F. /.4-'.S #�as T�dd eeh...S 4�6 Hearse(Casket Coach).....................S Coroner Processing Fee...........................S Flower Car........................ .........$ Additional Mileage # at S each...S Lead/Clergy/Firand Carr �fd/GL..S' H .. Limousine Rental....................................5 SUB-TOTAL OF AUTOMOTIVE EQUIPMENT.....5 Honor Guard...........................................S s 4. SPECIAL CHARGES s / Forwarding of remains to $ SUB-TOTAL OF CASH ADVANCED ITEMS--.--.-3y (Funeral Hams) We charge you for our service in obtaining: Receiving of remains from tmv«ltY era tl...er Wsr.,.—W.W) S (Funwal Ham) SUMMARY OF CHARGES Immediate Burial..............................S A. Funeral Services,Use of Facilities, Direct Cremation.............:................� Automotive Equipment,and PACKAGE PRICING: Special Charges...............................S A r- B. Merchandise....................................5 SUB-TOTAL OF SPECIAL CHARGES....................S C. Cash Advanced Items...................... 5 c2 v TOTAL OF FUNERAL SERVICES,USE OF TOTAL OF ALL SECTIONS....„.„.........„„..„„„....„..„...._$ FACILITIES,AUTOMOTIVE EQUIPMENT, ����� Amount paid at time of arrangemen ..................... ts .... AND SPECIAL CHARGES .........„.„..„..„..„..„.„..„.....�i!'�l(1.(6� BalanceDue:........................................................... B. CHARGE FOR MERCHANDISE SELECTED: Casket...............................................S If any law,cemetery,or crematory requirements have required the purchase of any the items Bated above the law or requirement is explained below. Outer Burial Container......................S Other Receptacle...............................$_T The undersigned represents the surviving legal neat of kin or is legal representative the decedeK and as such,have paramount right to authorize the fi meral home, Cremation Container.........................s� ,L� employees,or hired agents,to cam for,prepare,and embalm the body of the deced and hereby acknowledge my granting of permission to embalm. Um.r.Ga.t/�rfl........................ (�(f REASON FOR EMBALMING: I agree that I have examined the items of goods and a xvices selected above and found them to be correct and according to the arrangements I have requested I aeimowl receipt of a copy of this Statement of Funeral Goads and Service Selected as well as a copy for retention of the General Price list. I resort that I have sufficient f available for payment of the cash prim for the goods and services selected. I also agree to make payment of S within r days I agra m be jc and severely liab a with anyone else who gigs below. A late charge of %per month amounting to Z %per year will be applied to the unpaid bal beginning days from the dam of this agreemeaL I will also pay 16 the Funeral Director all reasonable coats paid by the Funeral Director to collect amounts I under this agreement Those mats may include attorney's fees,court coats and other meta. Any additional services or merchandise ordered or requested alter the date or agreement will be considered part of this agreement and the coat thereof will be reflected on the final bill or statement. .-- � (Pumhasm) ) Y COMMONLL�� Amdq s9ddml wa.wr ChoCk Datr. Aad 19,2013 C Num: 0032 13873 LR i CONTRACT NO CB10015820 REFERENCE NO. OWNER SHIRLEY R CREN ANNUITANT SHIRLEY R CREE PAYEE MICHAEL B CREE PARTIAL DEATH CLAIK - DEATH PROCESS DATE 04/18/3013 CHECK AMOUNT $ 65,850.00 i ' I E I i i , COMMO TY � od sumcumw Chwk D rll 19,2013 Check Nu'm: 0032413974 LR CONTRACT NO CS10d15810 REFERENCE NO. ONNER SHIRLEY R CRSS ANNUITANT SHIRLEY R CREE PAYER JOHN J CRES PARTIAL DEATH CLAIM - DEATH PROCESS DATE 04/18/7013 1 CHECK AMOUNT $ 65,850.00 I r i I i j COMMON .arr.a�rn�r. C hock On* Acd 19,2013 Chock Nu 0032413971 Lq CONTRACT NO CB10015820 REFERENCE NO. OWNER SHIRLEY R CREE ANNUITANT SHIRLEY R CRES PAYEE THOMAS 8 CRSE PARTIAL DEATH CLAIM - DEATH- PROCESS DATE 04/18/2013 CHSCX AMOUNT $ 65,850.00 - I i COMMON2a,TH. Check Mb: A x019 2013 Check Num• 0032413972 LR CONTRACT NO CB10015820 REFERENCE No. OWNER SHIRLEY R CREE ANNUITANT SHIRLEY R CREE PAYER SUSAN E GREENE PARTIAL DEATH CLAIM - DEATH PROCESS DATE 04/18/2013 CHECK AMOUNT $ 65,850.00 i i i i I I r; -Sun Life Financial' 0193696 SP 0104 C2041000004 SHIRLEY R CREE 328 LAMP POST LN Contract number 95-9500-096238 CAMP HILL PA 170111460 Product Regatta Choice Variable Annuity owner(s) SHIRLEY R CREE Annuitants) SHIRLEY R CREE Plan type Non-Qualified Summary of values This quarter Issue date October 9,2001 Account activitp Beginning Account Value $238,309.85 Earnings(gain/loss) $7,464.59 Ending Account Value........................................................................................$245,774.44 Surrender Value $245,774.44 Personal rate of return 3.13% Benefkiary protection Death benefit value...........................................................................................$269,718.05 I I When reviewing this statement,plea"keep in mind that the values are current as of the statement date and may fluctuate. Plea"refer to the current prospectus for more detailed information. ° Issued by Sun Life Assurance Company of Canada(U.S.),P.O.Box 9133,Wellesley Hills,MA 02481-9133. Sun Life Assurance Company of Canada(U.S.)(Sun Life)is a member of the Sun Life Financial group of companies. Sun Life provides this confirmation on behalf of the broker/dealer listed in the"Contact information"section, who is acting as an agent of Sun Life. www.sunlife.com �ev 24-hour automated service 800-752-7218 Customer Service 800-752-7216 M—F 8:30 a.m.-6 p.m.ET 1 of 4 Kelly Financial Services, Inc. Invoice 400 Bridge Street, Ste 4 Date Invoice# New Cumberland, PA 17070 717.774.7536/717.774.4802 (fax) 11/8/2013 10436 EIN 23.2874776 Bill To Estate of Shirley Cree c/o Susan E Green 375 Stonehedge Lane Mechanicsburg,PA 17055 Description Amount Preparation of Pennsylvania Inheritance Tax Return 15,716.00 Preparation of U S Individual Income Tax Return 275.00 Preparation of U S Estate/Fiduciary Income Tax Return for Estate of Shirley Cree 375.00 I Total $16,366.00 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX01-98) BUREAU DEPARTMENT INDIVIDUAL REVENUE CLIEWs CO BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 1 7 1 28-0801 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 017552 GREENE SUSAN ELAINE 328 LAMP POST LANE CAMP HILL, PA 17011 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- ,ob 101 $421000.00 ESTATE INFORMATION: SSN: 182-22-9653 FILE NUMBER: 2113-0189 DECEDENT NAME: CREE SHIRLEY R DATE OF PAYMENT: 05/06/2013 I POSTMARK DATE: 05/06/2013 i COUNTY: CUMBERLAND DATE OF DEATH: 02/09/2013 TOTAL AMOUNT PAID: $42,000.00 REMARKS: CHECK#528 INITIALS: HEA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS TAXPAYER siw GOFMN amem"No . 629 M LAMP Pte'ue CAW NIL.PA IMI-140 10"TO TFW OR06p GF 'J'aAs •� / ,e IM Cttlsens Bank• 41:0360?& 150I. 0528 RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Receipt Date: 2/15/2013 Cumberland County - Register Of Wills Receipt Time: 10 :28 :01 One Courthouse S uare Receipt No. : 1073092 Carlisle, PA 1713 CREE SHIRLEY R Estate File No. : 2013-00189 - Paid By Remarks : SUSAN E GREENE EA ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 610 . 00 CUMBERLAND COUNTY GENERAL FUN WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 50 . 00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN INH TAX RETURN 15. 00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 1222 $733 . 50 Total Received. . . . . . . . . $733 . 50 RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Receipt Date: 2/15/2013 Cumberland County - Register Of Wills Receipt Time: 10 :29 : 15 One Courthouse Square Receipt No. : 1073093 Carlisle, PA 17013 'CREE SHIRLEY R Estate File No. : 2013-00189 Paid By Remarks : SUUSSAN E GREENE ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name CERT COPIES 5 . 00 CUMBERLAND COUNTY GENERAL FUN ---------------- Cash $5 . 00 Total Received. . . . . . . . . 5 . 00 Page 1 of 1 My Account View Payment History Details on more than two dozen of your latest payments are at your fingertips Account Number:47463-12572 Account owner SIRLEY CREE Service Address328 LAMP POST LN, CAMP HILL, PA 17011 Rate type RSO Payment History Payment Date Amount Method Status 10/30/2013 $133.00 Electronic payment Customer issued PAID 09/16/2013 $197.20 Electronic payment Customer issued PAID 07/30/2013 $98.00 Electronic payment Customer issued PAID 07/01/2013 $73.00 Electronic payment Customer issued PAID 06/03/2013 $73.00 Electronic payment Customer issued PAID 04/29/2013 $78.12 Electronic payment Customer issued PAID 04/01/2013 $78.10 Electronic payment Customer issued PAID ,03/04/20'13" $78.10 Electronic payment Customer issued PAID 01/30/2013 $78.10 Electronic payment Customer issued PAID 12/31/2012 $65.00 Electronic payment Customer issued PAID 123 ©2013 PPL Electric Utilities Corporation.All rights reserved. https://www.pplelectric.com/my-account/billing-and-payments/view-payment-history.aspx 11/5/2013 Customer Care Self Serve-Bill History Page 1 of 1 SIRLEY CREE Address: Account#:4746312572 328 LAMP POST LN,CAMP HILL,PA 17011 Account:4746312572 UAW Odw ChErg- 00 Deb tam lMetft*l Else ft (!) Tam charyaa Umd(kWh) chary- 1!1 I!! 1 1 353 $56.23 52.00 $58.23 9/11/2013 912 4719.13 5320 $122.33 &12 1,835 $199.01 42.00 $201.01 7112/2013 1,544 $186.79 $2.00 $188.79 1 01 ... .715 $90.38 $2.00. ..$92.38 5/1312013 429 $58.69 $2.00 $60.69 4111 12013 442 $60.05 $7.12 $67.17 3/12/2013 480 $64.90 $710 $72.00 ..... ........ ...... .......,............, .._.............,........ .._...,....,..«...._ .._................. $7.16 $94.01. 1/11/2013 511 $65.95 $7.10 $73.05 t 7 71201 520 566.60 52.00 $68.60 11/0912012 421 $56.10 $2.00 $58.10 10/11/2012 426 . $58.67 $2.00 $58.67 https://www.energyguide.com/customercare/BillHistoryRes.aspx 11/5/2013 0 Past Bill labrmatbn-UGI Utilitlr HThe account balance on your last 'll was ....._ ._..._. $148.00 &= AS l sAYI L f Thank you for your payment of.................................to 48 213535163023 Blll)pp Summary for Service b: Your balance as of 02/01/2013 ._.__........_........_..._... SHIRLEY CREE 328 LAMP POST LN CAMP HILL PA 17011 Current Bill Information-UGI Utility Rob Claufficatbn: Customer Charge.......................................................... 8.55 Residential Heating Commodity Charge(296 CCF at$0.53736) ....... 159.06 Billing Period: Distribution Charges First 50 CCF at$0.41380)...-. 20.69 ! 12/3112012 to 01/29/2013(29 days) Distribution Charges(Next 246 CCF at$0.34931).... 85.93 Remote Device Read PA State Tax Surcharge..................................._............._, 23 Questions?mote Total Current Charges-UGI Utility............................ Call 800-276-2722 or write to UGI at Budget Billing Amount........._...._..._..._.......................... 148.00 Ca BOX -276- UGI Utility charges owed this bill_...._..._..._..._........._..._..._...._..._........_...._..._..._.... $148.00 Reading,PA 19612-3009 Total Amount Due,Please Pay by Due Dab(02/22/2013).................................... $141LW Your current UGI charges include State taxes totaling about$8.79. Meter Information-Next Read Dab March 1,2015 13.0 Average CCF Per Day Meter Number Previous Reading Present Reading CCF Used 11.7 1077373 2929(remote) 3225(remote) 296 10.4 9.1 Messages from UGI 7 8 ■Your current price to compare is$0.55048/CCF. 6.5 •Your total annual usage is 1,501 CCF. Your average monthly usage is 125 CCF. 5.2 3.9 ■Your annual budget year began with September 2012- 2 6 To date you have been billed $888.00 To date you have used $874.84 1.3 0.0 0 1 Al Help prevent pipeline damage,accidents and service disruptions.Call 811 before you dig. JFMAMJJASONDJ 2012 Months 2013 Last This Average Year Year CCF/day 9.4 10.2 Daily temperature 351 32°F it you pay at a payment agent please take your entire bill. Make check payable to UGI. Keep this part for your records. Important Information Is on the back of this bill. UGI Utilities,Inc. Customer Number Please pay by the due date PO Box 15523 213535163023 to avid the late charge Wilmington.DE 19886-5523 Please payment _ LAA Lf IY/L! RH February 22, 2013 h I SHIRLEY CREE $ 148.00 328 LAMP POST LN CAMP HILL PA 1.7011 $ 149.85 280 213535163023022201000148000001850000000000000000000003 Paw 01 of fit• ;, �•�.• _ •zs;;.�:r_-:: ,.ir:_ ;.�_�r� ._ „_�. .ce+..+,•� -•::;, .. '. ti � � 4=� tea}.; .��N +:z^,�;�r:.__.,,.. :.,,?_ �£+.��.,•_•:,. . ..;f�'� ..���+:s:rr* -*F__. �,.,, '�_ r_..4_„+�__i,,++���'_ ;; .r. 5• s +•-. �j•:. y :r.• "'fir s�:=a .� ��: �,.�;�',�+;.'_,�r. �..:?'r".- x;p:.� : t ,r•+•.:��_ GA,r� ,' + *:r p. irr- . '�; ;tf�.+: �:�' �.. � �-_'-.`x� a:r�:.7•� ��;r;�!• �,l�I ,�,:r�;: :��+t.:1�k,h, •p� : ...'�7!i,rr�:'�fi8�:'^.-,ft5n�'�-'ti:F ..�r'F:�+'=.1:' }rig :,'e:�..�}• _ t - •:,. :.�y, - 1. a 4r7y: t• 1 .,.�-_._.L �sari.+.:jF"�r 78H•'i}:. '. :,. ,• _.:fir .,y,�,., �:_r. +-.• .`kr�` y ii' �''•`•',�•�'t+,_ ±+,-,?�:,'':�1;,-;.;r:< r.•�];�s-° �': ,.��_..t T �=s CUSTOMER SERVICE INFORMATION Your Medicare Number. XXX-XX-3548D SHIRLEY cREE HHH If you have questions, call 1-800-Medicare 328 LAMP POST LN (1-877-220-6289) (#15004) CAMP HILL PA 17011-1460 m Ask for Hospital Services h TTY for Hearing Impaired: 1-855-294-9889 3 BE INFORMED: Read your Medicare Summary Appeals Address: Please see the General Information Section Notice. This is a summary of claims processed on 03/12/2013. PART A - HOSPICE FACILITY CLAIMS Dates Now Deductible You See Of Amount Covered and May Be Notes Service Services Provided Charged Charges Coinsurance Billed Section Control number 21306501018107PAR Horne For The Friendless a 2300 Vartan way 115 Harrisburg,PA 17114-9794 Referred by: Jonathon Tocks Md 02/03/13-02/09/13 7 Hospice/Rin Home $1,048.74 $0.00 $0.00 $0.00 4 Skilled Nurs/visit b 1 Med Soc Servs/Visit b Claim Total 51,048.74 $4.00 $0.04 Si101 Notes Section: a The amount Medicare paid the provider for this claim is $1,048.76. b Payment for this hospice service is included in the payment for the hospice daily level of care; therefore, you should not be billed for this service, THIS IS NOT A BILL - Keep this notice for your records. p�hs��)tIf/1Q) I