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HomeMy WebLinkAbout03-31-14 (2) 1so561o1as REV-1500 Fir(n'�"'(R) PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes County Cods Year File Number PO BOX 280601 �INHERITANCE TAX RETURN Harrisburg PA 17128-o6ot RESIDENT DECEDENT �� ENTER DECEDENT INFORMATION BELOW o7/isf ur3 talaa�i9z Decedent's Last Name Suf x, Decedent's First Name _ MI (if Applicable)Enter Surviving Spouse's Information Below - Spouse's Last Name Suffix Spouse's First Name M7 Ott 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 C-') 2.Supplemental Return q 3. Remainder Return(Date of Death Prior to 12-13-82) C=) 4.Limited Estate O 4a.Future Interest Compromisa(date of C=) 5. Federal Estate Tax Rehm Required death after 12-12-82) 6. Decedent Died Testate 7.Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Wiii) (Attach Copy of Trust) O 9.Litigation Proceeds Received C=> 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 0) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIALTAX INFORMATION St )ULO BE DIRECTED TO: Name Daytime Telephone Number 1117- 7 '/- QS� a,' REGISTEFW�Wi USE QTY Cy First Line of Address ,�— - f / 31 1l�f�Ksnrt T}'�t. CD - ;;N Q _. _. - . .. . . . h p r 6 Second Line Of Address � ,T,i `r > City or Post Office r State ZIP Code J�DATE FILED Correspondent's e•mafi address; Under penalties of�uM I declare that I have examined this return,inciuding accompanying schedules on all and to the best of my knowledge and belief, It is true,correct and complete.Dedamtlon of re rer other than the personal re ramntative is ormation of which preparer has any knowedge SIGNATURE OF P PONS{gLE Fn FOR FILING RETURN DATE ADDRESS Z49 L S , r>{ c l l Litt SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 �,,�, 15OS61O105 1505610105 J 1505610205 REV-1500 EX(FI) 1. Real Estate(Schedule A). ......................... .............. ..... ,. -- ry 2. Stocks and Bonds(Schedule B) ....................................... 2. 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3, 4. Mortgages and Notes Receivable(Schedule D)........................... 4. _ - _.._._._..._' .. . _ ..___. ... . S. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. " 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Pro perty !'7, 0 0 (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets(total Lines 1 through 7)..... ........................ 8. 9. Funeral Expenses and Administrative Costs(Schedule H)................... 9: 7. a96, ea 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............... 10. 11. Total Deductions(total Lines 9 and 10)................................. 11. 12. Net Value of Estate(Line 8 minus Line 11).......... ,z. 13. Charitable and Governments]Bequests/See 9113 Trusts for which ----�--`-- - an election to tax has not been made(Schedule J) ........................ 13. 0 14. Net Value Subject to Tax(Line 12 minus Line 13) ......... ............... 14. crib TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 - ___- . .... . (a)(1.2)X.0_ 15 16. Amount of Line 14 taxable -"" - ---- ------- . at lineal rate X.Ogs- 1s a u8y GS 17. Amount of Line 14 taxable - '"" "' - - -- - at sibling rate X.12 17 18. Amount of Line 14 taxable I at collateral rate X.15 _ 18. 19. TAX DUE ......................................................... 19. oZU�I GS-' 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O L Side 2 1505610205 1505610205 REV-1500 EX(FI) Page 3 FRO Number Decedent's Complete Address: ao,3 • ato37 DECEDENTS NAME /-��, 1/e BVdA STREETADDRESS 443 14U'rmn 1 vc-. City STATE ZIP e M o y,,e- f 1.76 `{3 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (i) a a de -r 2. Credits/Payments A.Prior Payments 8.Viscount Total Credits(A+B) (2) 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) 5. If Line 1+Line 3 is greater than line 2,enter the difference.This is the TAX DUE. (5) Make check payable la: 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.................................. -..............,..................................... ❑ IR b. retain the right to designate who shag use the property transferred or its income................_.......................... ❑ R c. retain a reversionary interest_...........................................................................................................--............. ❑ d. receive the promise for I'de of either payments,benefits or care?........................ .........:.................................... ❑ 9 2. If death occurred after Dec.12,1962,did decedent transfer property within one year of death without receiving adequate consideration?.._.........................._....................................._..........................._.......... 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?,............ ❑ 4. Did decedent own an individual retirement account,annuity or other non-probate properly,which contains a beneficiary designation? .........................................................................................._........................... ❑ Q IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994,and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent]72 P.S,§9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent ]72 P.S.§9116(a)(11)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax 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,an adoptive parent or a stepparent of the child is 0 percent(72 P.S. • 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)]. • 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 defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-1502 Ex+(12-12) i pennsylvania SCHEDULE A �� DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: 1 FILE NUMBER: L UL1l'e. SVdA a013 - c/o3'7 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 to DESCRIPTION 1. r�esrdeNr-c- 9Y3 11o.«r c) / )gee wue. Ltmoywer 1914 17043 77000, 00 TOTAL(Also enter on Line 1, Recapitulation.) $ -71.60o X00 If more space is needed,use additional sheets of paper of the same size. REV-a508 EX+(08-U) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHEWANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: five., lie. Budd ?o 1,3. 0143 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. REM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1_ f7}i T e(�r Yti — c�o K,�fr _ W?Cc y M 98S-93.x4 71 1 TOTAL(Also enter on Line 5, Recapitulation) ; S.j'ot P If more space is needed,use additional sheets of paper of the same size. REV-LSo9 EX+(oi-f o) npennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF. FILE NUMBER: Ile- BVJ/4 e7o/3� o/o.37 If an asset became jointly owned within one year of the decedents date of death,It must be reported on Schedule G. SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. Ro,vA l d 8vd A aoo i PA,,c ray A/ Is+, NAQA�tS 6u� y A /7/// SO Al B. C. JOINTLY OWNED PROPERTY. LETTER DATE DESCRIPTION OF PROPERTY % DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INS TTURON AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENTS VALUE OF NUMBER TENANT JOINT ID£NFIMNG NUMBER.ATTACH DEED MR MIMMY HELD REAL ESTATE VALUE OF ASSET INTEREST DECEDENTS MERRIEST 1. A. a00`1 M-0- ,,64,jK. CheF-krA4f //c..F' dSb6po7I /A33 _Sv � r 7 C1-kti 3Dl TOTAL(Also enter on Line 6,Recapitulation) $ to/`7 do 0.80 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(08-13) pennsytvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF �j FILE NUMBER Lv�ll1c syc7A 0 1 6 37 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. r p P� r '�l,cn-1 0rc, /� hv.v�rAl /Nornc... St. / trC r � �1G CR Vr (V, B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Gcorc-� 4,iear�- Street Address /-31 7314oK3n+,44 fe*o .1 city i'A—,o /l, I/ , State A ZIP /701J Year(s)Commission Paid: ao/3 2. Attorney Fees: + G/err✓t,✓ CEX II /}'� IL� a9o,f' 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: p 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. TOTAL(Also enter on Line 9, Recapitulation) $ % ';2 9� If more space is needed,use additional sheets of paper of the same size. REV-IS12 EX+(12.12) pennsytvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES&UENS RESIDENT DECEDENT ESTATE OF FILE NUMBER LUaf !le. 934A o?013 ^ 0/637 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 4100 e--F /.'urfr - y43 lJri..pnfc f >7rGZ L.e o7.rc. � t'r/i'o7 it (&41,, Ltg�3 ,rfn4c IrkK f — Sr.1flc,nu.�" Slce."C' CI'X11 x/, 1605 3 .� /✓1-.7' 8A'K• 11c,4 Ike qqg6x-e. WY9 PAyoff �3t3gs- / ( yt l � / � t�uyq,14st L�Sr\J�S. Y . 7nak tf/a tSnacY G. t+f�S TiA f'C. 1i4�SVf/7 r�C C. ' ll4 MGOrJN4fS .4NS(IONN4 @. 4�x'+ J/ (. �t� 7. l�A JIa H�>wNtr f5'oe f lc 6Arfc. �a'ba> ION ffineeJGAn/ 144/C.- '71?7r,r1C4,J �J/l-tcr Clrxh S� ....3. 1ot, HCAlf4 !- -'v1 fa /'r C C-i b� 3 0 y, v HCAf� ( r os a7 �a it `E i% 1 /t 5/d0.eJ 171/. az% 1/ I Crr7.6 At Er tt ls', I-AM, ly sl ctA.,� /'�ss6Gtn �o.r /� 4 ) G .S.3 J�- 1 a �.ly t yT srcta /jssactA �rs t t 1, 12) pS t7 d✓/tost/ �_6Znrc{t�� tJ['MSJ � �x� l3) a-a Id Js Dlo r rASI NAu1i,V f- /6' IV +N, C- /ss ua cC�? S'44 r.v e e / J'l aW t N 6,p C./r." 17) of GGUr 6.G LA1prt t1 Rl/'l burSC MG�✓"l- ` l'x� TOTAL(Also enter on Line 10, Recapitulation) $ a j,Sfo,a s OM If more space is needed,insert additional sheets of the same size. REV-1513 Ex+(01-10) Ilk pennsytvania SCHEDULE 7 l DEPARTMENT OF REVENUE mHERrrANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: r've.rjje- &JA 4013. 0/6,?7 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSONS)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS(include outright speusai distributions and transfers under Set.4116(a)(1.2).) 1. L. 1c L- 8vdq Li iw& T".✓s4 (V4'644819}) t14 i'�ZON41cl 13u8 /60 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: i. TOTAL OF PART U—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ONLINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size. OMB NO.2502-0265 it A. B. TYPE OF LOAN: U.S.DEPARTMENT OF HOUSING&URBAN DEVELOPMENT 1.QfHA 2. FMHA 3.QCONV.UNINS. 4. VA 5.QCONV.INS. 6. FILE NUMBER: 7. LOAN NUMBER: SETTLEMENT STATEMENT 8. MORTGAGE INS CASE NUMBER: C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the seftlement agent are shown. Items marked"[POC]"were paid outside the closhV;they are shown here for informational purposes and are not miuded in the totals. D. NAME AND ADDRESS OF BUYER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: DONALD KLAIBER LUCILLE L BUDA REVOCABLE LIVING TRUST CASH 312 BLACKSMITH ROAD 1011 MUMMA RD CAMP HILL,PA 17011 LEMOYNE,PA 17043 G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 1. SETTLEMENT DATE: 443 HUMMEL AVENUE LEON HALLER ESC AGENT FIRSTAMERICAN LEMOYNE,PA 17043 August 16,2013 CUMBERLAND County,Pennsylvania PLACE OFSETREMENT 1719 N.FRONT ST./717-234-4178 HARRISBURG,PA 17102 J.SUMMARY OF BUYER'S RASJ ACTION K SUMMARY OF SELLER'S TRANSACTION ROSS AMOUNT DUE FROM BUYER, G&QSSAMOUNT DUE TO SELLEFL _ 101. Contract Sates Price 7500.00 401._Contract Sales Price 77,000.00 102. Personal Property 402. Personal Property 103. Settlement. C 0 __ 1,611.50 403. 104. 404. 405. 405. e c a Her 106. City/Town Taxes 08/17/13 to 01/01/14 213.00 406. CityrTown Taxes 08117/13 to 01/01/14 213.00 107. School Taxes 08/17!13 to 07/01/14 947.13 407. School Taxes 08/17113 to 07101/14 947.13 108. TRASH 08/17/13 to 10/01/13 2128 408.TRASH 08/17113 to 10/01/13 21.28 109. 409. 110. 410. 111. 411. 112, 412. 120. GROSS AMOUNT DUE FROM BUYER 79,792.91 420. GROSS AMOUNT DUE TO SELLER 78,181 Al 200. AMOUNTS PAID BY OR IN BEHALF OF BUYER: 500.REDUCTIONS IN AMOUNT DUE TO SELLER: 201. Deposit oreamest money 500.00 501. Excess Deposit See Instructions 202. Principal Amount of New Loans 502, Settlement Char es to Seller Line 1400 1,92275 203. Existing loan(s)taken subject to 503. Existing bans taken subject to 204, 504. Payoff of first Mortgage to M&T BANK/1204446567849 23,34476 205. 505. Payoff of second Mortgage 206. 506. De osit retained b seller 500.00 2G7. 507• 208. 508. 209, 509. A us ens r ems n a 8 /er A ustmens For ltems Urroad By Seller 210. Cityrrown Taxes to 510.City/Town Taxes to 211. School Taxes to 511. School Taxes to 212. TRASH to 512.TRASH to 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219, 519. 220. TOTAL PAID BYIFOR BUYER 500.00 520. TOTAL REDUCT70NAMOUNTDUE SELLER 25,767.51 300. CASH AT SETTLEMENT PROM(TO BUYER: 600. CASH AT SETTLEMENT TOIFROM SELLER: 301. Gross Amount Due From Buyer Une 120 79,792.91 601. Gross Amount Due To Seller Line 420 78,181.41 302. Less Amount Paid (For Buyer Line 220) ( 500.00) 602. Less Reductions Due Seller(Li ne 520) ( 25,767.51 301 CASH( X FROM)( TO)BUYER 79292.91 603. CASH(X TO ( FROM) SELLER 52,413.90 The undersigned hereby acknowledge re�ipt f ipjpte, copy of pages 1&2 of this statement&any attachments referred to herein. Buyer "ar LUCILLE L BUDA REVOCABLE LIVING TRUST DONAL IBER BY: GEORGE LAPORE,SOLE TRUSTEEx h ) HUn-t(3-86)RE4FA.He43D52 � PaM z L.SETTLEMENT CHARGES 700.TOTAL COMMISSION Based on Price ° PAIDFROM PAID FROM Division OfrAmmissron 1%ne 700 as F01/OWs: BUYERS SELLER'S 701.$ t0 FUNDS AT FUNDS AT 702.$ to SETTLEMENT SETTLEMENT 703.Commission Paid at Settlement 704. to 800.ITEMS PAYABLE IN CONNECTI WITH LOAN 801.Loan Ori ination Fee ON% to 802. Loan Discount % to 803. Appraisal Fee to 804. Credit Report to 805. Lenders Inspection Fee to 806. Mortgage Ins.App.Fee to 807. Assumption Fee to 808. 809. 810. 811. 900.ITEMS REQUIRED SY LENDERTO BE PAID IN ADVANCE 901. Interest From to @ $ /day ( days %) 902. Mortgage Insurance Premium for months to 903.Hazard Insurance Premium for yea rs to 904. 905. 1000.RESERVES DEPOSITED WITH LENDER 1001.Hazard Insurance @ per 1002.Mortgage Insurance @ $ per 1003. City/Town Taxes 2 $ per 1004. School Taxes $ per 1005.TRASH @ $ per 1006. @ $ per 1007. @ $ per 1008. @ $ per 1100.TITLE CHARGES 1101. Settlement or Closing Fee to 1102. Abstract orTitle Search to 1103. Title Examination to 1104. Tdle Insurance Binder to 1105. Document Preparation to 1106. Notary Fees to 1107.Attorneys Fees to includes above item numbers: 1108.Title Insurance to FIRST AMERICAN TITLE INSURANCE COMPANY 773.50 includes above item numbers: 1109.Lenders Coverage $ 1110.Owners Coverage $ 77,000.00 773.50 1111. 1112. 1113. 1200.GOVERNMENT RECORDING AND TRANSFER CHARGES 1201.Recording Fees: Deed $ 68.00;Mortgage $ Releases $ 68.00 1202.Ci /Coun Tax/Stam s:Deed Mortgage 770.00 1203.State Tax/Stamps: Deed ;Mortgage 770.00 1204. 1205. 1300.ADDITIONAL SETTLEMENT CHARGES 1301. Sumey to 1302. Pest Inspection to 1303. 1304. 1305. See addit'l disb.exhibit to 1,152.75 1400.TOTAL SETTLEMENT CHARGES Enter on Lines 103,Section J and 502,Section K 1,611.50 1,922.75 By signing page 1 of this statement,the signatories acknowledge receipt of a completed copy of page 2 of this two page statement. LEON HALLER ESC AGENT FIRSTAMERICAN Settlement Agent (lKLAIBER44 (13)/9) ADDITIONAL DISBURSEMENTS EXHIBIT Buyer: DONALD KLAIBER Seller: LUCILLE L. BUDA REVOCABLE LIVING TRUST Lender: CASH Settlement Agent: LEON HALLER ESC AGENT FIRST AMERICAN (717)234-4178 Place of Settlement 1719 N. FRONT ST./717-234-4178 HARRISBURG, PA 17102 Settlement Date: August 16, 2013 Property Location: 443 HUMMEL AVENUE LEMOYNE, PA 17043 CUMBERLAND County, Pennsylvania PAYEE/DESCRIPTION NOTE/REF NO BUYER SELLER BOROUGH OF LEMOYNE TAX COLLECTOR 1,087.11 2013 SCHOOL TAX 12-21-0265-231 LEMOYNE BOROUGH 50.64 SEWER PU RCELL KRUG HALLER 15.00 TAX CERT REIMB Total Additional Disbursements shown on Line 1305 $ 0.00 $ 1,15215 (KLAIBER443(13).PFD/KLAIBER443(13)19) ACKNOWLEDGMENT OF RECEIPT OF SETTLEMENT STATEMENT Buyer: DONALD KLAIBER Seller: LUCILLE L. BUDA REVOCABLE LIVING TRUST Lender: CASH Settlement Agent: LEON HALLER ESC AGENT FIRST AMERICAN (717)234-4178 Place of Settlement 1719 N. FRONT ST./717-234-4178 HARRISBURG, PA 17102 Settlement Date: August 16, 2013 Property Location: 443 HUMMEL AVENUE LEMOYNE, PA 17043 CUMBERLAND County, Pennsylvania I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement. LUCILLE L. BUDA REVOCABLE LIVING TRUST DONALD KLAIBER BY: GEORGE LAPORE, SOLE TRUSTEE WARNING: It is a crime to knowingly make false statements to the United States on this or any similar form. Penalties upon conviction can include a fine and imprisonment For details see: Title 18 U.S.Code Section 1001 and Section 1010. (KLAIBER443(13).PFD/KLAIBER443(13)/9) M&TBank P.O. Box 619063 Home Equity Line of Credit Dallas, TX 75261-9063 PAGE 1 of 2 Contact Us 9 General Customer Service: 1-800-724-6444 1-770-17084.0009697-002-000-110-000.000 =4 LUCILLE L BUDA Correspondence Mailing Address: LUCILLE L BUDA P.O. Box 900, Millsboro,DE 19966-0900 443 HUMMEL AVE LEMOYNE PA 17043-1955 Payment Mailing Address: P.O. Box 62146,Baltimore,MD 212642146 O www.mtb.com Statement Period:06/14113-07114113 Days in Billing Cyde: 31 Account Number 120444.6567178-4998 ACCOUNT DUE DATE 08108113 Property Address 443 HUMMEL AVE Payment Breakdown LEMOYNE PA 17043 Principal +$103.97 Annual Percentage Rate 4.1682% interest *$81.33 Credit Life Insurance $0.00 Total Line of Credit ` •�� Late Charge +ggpp.00 Current Principal Balance A $23,330.39 MISCBIIaneoua Fee(a) +$0 00 Available Credit $26,669.61 Amount Billed This Statement ----TTAuw Draw Period Expiration Date February 02,2D22 Past Due Amount +$0.00 Over Credit Limit Amount +50.00 2013 Finance Charges Paid Year-to-Data $565.41 Unpaid Charge(s) +$0.00 A This is NOT a payoff amount.To obtain the amount required to pay yourline of credit TOTAL AMOUNT DUE 08108/13 $185.30 in full,please call 1-800-724.6444. If received after 08/23/13 (includes late charges) $189.00 Balance and Finance Charge Summary Line of Credit Total p Bess Amount - w Previous Balance $23,513.38 $23,51338 i Payments!Credits - $18299 - $182.99 LL A Advances! Debits + $0.00 + $0.00 _C _Finance Charges + $81.33 + $81.33 Cietlit Llie Insurance—'—'__._. _.. ; x.00 ♦ - $6.00 Late Charges + $0.00 + $0.00 Other Fees + $0.00 + $0.00 Ending Balance —ST3,4' m —6T3 4 T77 Principal Balance $23,330.39 $23,33039 Dally Periodic Rate 0.0112054% Corresponding APR 4.090%(r) Average Daily Balance 'S23A14.23 - $23,414.23 Number of Payments - Payments Remaining Fined Tenn Loan Payment Amount See additional footno0e httormatlon on back Melatemem. Important information about your Account Options If you would like to lockan a balance of your outstanding principal or future advance into a fixed rata Iran,the following rates are cwnenily available until your next billing cycle: Term Option Current Rate Available 12. 60 449%APR 61-120 4.49%APR 121-180 4.74%APR 181-240 4.84%APR 241-300 6.04%APR PO8Drehsumnce Company WAllstate. P0aor35a9 Akmn 0H 443o9.3589 You're in good hands. 'I'lllllll�'llllial�rl�li"1111�II'III"I"I�I�iIiIIlllil�dulr Information as of August 19,2013 LUCILLE L Policyholder Page i of 2 BUDA GEROGE LAPORE TRUSTE Lucille L 133 BLACKSMITH RD Buda Geroge LaporeTruste CAMP HILL PA 17011_8417 Cancelled olicy number 098 756 524 Property 449 HUMMEL AVENUE LEMOYNE PA 17043 Amount due Your Allstate agency is $774 Timothy Fritz Payment due upon receipt 124 East Main St Palmyra,PA 17078 (717)838-8712__._._. Important Information Your insurance has been terminated.An outstanding balance of$7.74 is due for coverage provided prior to the time your policy terminated.If you obtained insurance with another carrier or there were changes to your policy prior to the termination of this policy,please send proof of new insurance in the envelope provided as well as the tear off portion of this notice.Upon receipt,the appropriate credit if any will be applied. Terms of agreement for One-Time Electronic Withdrawal If you choose to make a payment using your checking account information,you may be asked to provide the following code 56524,By using this code you authorize Allstate and its affiliates to initiate a one-time electronic withdrawal from your checking account in the amount you specify.Future payments you initiate using the same checking account will be sent to your bank as an electronic withdrawal for the amount you specify.The withdrawal may be made from your checking account as early as the next business day. To make a payment by Credit/Debit Card or Check By Phone,please call 1-866-835-8631 or visit www.alistate.com to pay by Credit/Debit (conum" &h 3 Detach bottom portion here v Customer Account Information Billing Summary For Service To: Lucille Buda --.----Prior Balance---- —-----. 443 Hummel Ave Prior Water Balance $17.15 Account Number:24-0627803.2 Prior Balance Other $18.99 Premise Number:24-0370979 Payments prior to Aug 21,2013. Thanksl .00 Total prior balance,Aug 21,2013 36.14 Billing Period& Meter Information -»----Current Water Charges-»-------- Billing Date: Aug 21,2013 Service Charge 5.04 Billing Period: Aug 08 to Aug 19{11 days} STAS PA WC Water -.Ol Neat reading on/about: Sep 09,2013 OSI-PAWC Charge 4.20% .21 Rate Type: Residential Total water charges,Aug 21,2013 5.24 Other Current Charges----- Meter readings in current bitting period: Customer Protection In Home 3.99 Meter Number N091361739 is a 5/8-inch moter. Customer Protection Sewer Line 9.50 Present-actual 33500 Customer Protection Water Line 5.50 Last-actuat 33500 Total other charges,Aug 21,2013 18.99 Gallons used 0 AMOUNT DUE -------- $60.37 Water Usage Comparison 30--- Monthly usage in hundred gallons. 24 - — - 18 12 b - 2 A S O N 0 J F M A M J Ju A r2 9 P i v c n n r y n 1 9 36 Messages to you from Pennsylvania American Water This is your Final Bill for service. ft has been a pleasure serving you and we hope we may again have the oppnrtunityin the future. 'The due date pertains to current charges only. Any past due balance should be paid immediately. ANproximately 4.57 percent, or$.23, of State taxes are included in your current bill. fl ii E active July t,2013. the Distribution System Improvement Charge(DSIC)increased from 3.99%to 4.20%. This charge funds the replacement of water distribution facilities. Pennsylvania American Water is now offering paperless bilfrng. It's a convenient, environmentally friendly and secure way to receive your water and/orwastewater•bilG' sers must enroll online. To get started, visit www.amwateroom/myh2o. Go to Account Detail and click on the green Paperless Billing button- FaIlaw the steps,press subm t and youie enrdltedt l a ve yyou racenNy changed your primary phone number?If you have,please update your account information online using My H2O Online at www_am wa r�mrmyh2o or call us at the number below so that we can update our records. IMPORTANT WATER QUALITY 1NFORMATtOtd Your annual Water Quality Report clan be v awed electronically at www.amwater..com1=1mechanicsburg.pdf !f you prefer a paper copy fo be sent to you,please contact our Customer Service Center at 800-565.7292. Customer Service& Emergencies 1-800-565-7282{24 Hours} 002dOUW24 NNCESVU TAVOB 12 For Hearing Impaired Customers TDD 1-800-300-6202{24 Hours} Visit us on the INTERNET:www.pennsylvaniaamwater.com <Urh•e4 6ff 00024062780320000000000003614018 Pennsylvania American Water ; 24-0627803-2 PO Box 371412 Pittsburgh, Pa. 15250-7412 AMOUNT DUE $36, 14 For Service To: 443 Hummel Ave DUE DATE Sep 03, 2013 AMOUNT PAID u°rIII'Iy1u1111P1'rll6lrl'16•h°lulhlhll°•11.11111 02M I AT 0.381 1288292C8=12m Opt 1 NCES82 Please return this portion with check LUCILLE & RONALD BUDA V Payable tothe address below PENNSYLVANIA AMERICAN WATEF 133 BLACKSMITH RD PO BOX 371412 CAMP HILL PA 17011-13417 PITTSBURGH, PA. 15250-7412 II"1111111"I IIIhill lllll-if'I"I1111111111,11.1111'llll'li'II QPlease check here to add H2O-Help to Others contriblaim to your monthly bill or to change your address or telephone number,and print information on reverse side. .....�.......__.._._. ._ .__......__ ......... Customer Account Information Billing Summary For Service To: Lucille& Ronald Buda ------Prior Balance----- 443 Hummel Ave Prior Water Balance $34.19 Account Number:24-0627803.2 Prior Balance C h $18 99 Premise Number: 24-0370979 Payments prior Au i3, 2013. Thanks 53. 18 Total prior balance,Aug 13,2013 Billing Period& Meter Information -----Current Water Charges------ Billing Date: Aug 13,2013 Service Charge 13.75 Billing Period: Jul 09 to Aug 08(30 days) Water Volume($.009101 x 300) 2.73 Next reading on/about: Sep 09,2013 STAS PAWC Water - ,02 Rate Type: Residential DSI-PAWC Charge 4.20% .69 Total water charges,Aug 13,2013 17.15 Meter readings in current billing period: ---:-Other Current Charges- Meter Number N091361739 is a 5/8-inch meter. Customer Protection In Home 3.99 Present-actual 33500 Customer Protection Sewer Line 9.50 Last-actual 33200 Customer Protection Water Line 5.50 Gallons used 300 Total other charges,Aug 13,2013 18.99 ---AMOUNT DUE-- •-- $36.14 CxNS rR* Do not send correspondence to this address. iw(- l�' a7 30 3 O S ONAMSY01 Wixom MI 4 Box 148 8393-1022 PINNACLEHEALTH Wa ADDRESS SERVICE REQUESTED Hospitals (717)221-1294 August 30,2013 (888)467-2563 Representatives Available: Mon—Thu 8:00 AM—8:00 PM 55261063-1000 @ @@ 124469133 Fri 8:00 AM—5:00 PM II�Iu�L����l�lll'I�IIII�III'll'�'Illull���lnll"'�'ll�'�I�I�I Lucille Buda 443 Hummel Ave Lemoyne PA 17043-1955 Bill#: 130462965 Patient Name: Lucille Buda Date of Service: 06/19113 Location of Service: Pinnacle Health Balance Due: $3064.11 Our records indicate the balance on your account is now due in full. Please pay this immediately using the enclosed envelope. You may also pay by credit card by using the form below. If you need to make payment arrangements, please call us as soon as possible. Financial assistance is available for the uninsured or underinsured who apply and qualify. For more information, please call or see our website at www.Dinnaclehealth.org/billoay. You may also pay online at https.//bilipay.ninnaclehealth.orp Sincerely, Pinnacle Health Hospitals Patient Accounts Department SEE REVERSE S'ID � � STATEMENT The amount shown below represents To discuss payment, call: your financial obligation to: PINNACLEHEALTH Pinnacle Health Hospitals Hospitals (717) 221-1294 (888)467-2563 For all other inquiries: PO Box 2353 Harrisburg, PA 17105 (717)221-1294 MESSAGE: Thank you for choosing Pinnacle Health Hospitals.The balance on your account is due. If you need assistance or have insurance coverage,please call our customer service department. If you need to make arrangements for payment,we have representatives available to assist you. Financial assistance is available for the uninsured or underinsured who apply and qualify. For more information, please call or see our website at www.oinnadeheafth.oro/billoay. You may also pay online at httos://billaay.oinnaclehealth.om HOSPITAL SERVICE DATE PATIENT NAME BILL NUMBER 07/15/13 LUCILLE BUDA 130496926 FOR YOUR HOSPITAL SERVICES: Room/Bed $22500.00 Supply Pharmaceutical $5435.44 Lab/Blood $5435.00 X-ray/Nucmed $2300.00 Med Resp $2757.00 MISC $2900.00 Clinic $877.00 Oriqinal Billed Amount $42204.44 Total Payments and Adjustments $-40454.44 Patient Responsibility $1750.00 a .$ $1750.00 7'� EXh 7 8050NAMSV011001 V PLEASE DETACH AND RETURN LOWER PORTION WITH YOUR PAYMENT 1 GC 6�-t O, t3 Igo Pagel Questions? ease Visit us online at " ''•° " ® contact us by Jul 30. - U pplelectric.com Bill Accl. No Due Date Amount Due 1-B00-DIAL-PPL (1-800-342-5775) 06650-82002 1 Ju130,2013 $174. Fft BlMrle umnt•r M-F:8am to 5pm Your Electric Usage Profile Billing Summary (Billing details on back) Service to: Balance as of Jul 9,2013 $0.00 LUCILLE BUDA Charges: 443 HUMMEL AVE Total PPL Electric Utilities Charges $174.00 LEMOYNE, PA 17043 Meter:94211464 Total Charges $174.00 Your next meter reading is on or about Aug 6,2013. mount Due By Ju130;2013, $174:00 This section helps you understand your year-to-year Account Balance $174.00 electric use by month. Meter readings are actual unless PPL Electric Utilities'price to compare for your rate is$0.08227 per kWh. otherwise noted. This changes the 1st of Mar,Jun,Sept,and Dec.Visit papowerswitch.com 122012 0 2013 or www.oca.state.pa.us for supplier offers. 90 Your Message Center Z 75 • Budget Summary: so We billed you $1,062.00 0 45 including this bill,you used 51.313.00 d 30 After this payment,your budget is behind $251.00 eu 15 • With paperless billing,you can receive and pay your 0 " PPL Electric Utilities bills online.The process Is free, J r M A M J J A S 0 N D quick,convenient and secure.To learn more or sign up, Months visit pplelectric.com. • Information about appliance energy use and tips on Monthly Days Average Average saving energy are available through the Energy Library kWh Day Temp. Comparison Billed kWh/ on our Web site,pplelectric.com. E11013 32 703 22 73F Ju12012 30 809 27 Billing Period Type Reading Payment Methods Jul 8 1 Actual 52981 Online at: ®By phone:i-800.342-5775 Jun 6 Actual 52278 U pplelectric.com at or 1a1800-672-2413sto fee Visa,) 32 Days kWh Billed 703 MasterCard, Discover or debit card. Comparison - _ ® By Mail: Correspondence should be sent to: 'Yearly Aug 2012-Jul 2013 15797 1316 2 North 9th Street Customer Services CPC-GENN1 827 Hausman Road Aug 2011-Jul 2012 15098 1258 Allentown,PA 18101-1175 Allentown, PA 181049392 Other important information on the back of this bill 1 ;',• ® Questions?Please /� Visit us online at Final BIII Page 1 contact pplelectric-com ppj'= 1-80D-DIAL-PPL Bill Acct. No. Due Dite AM01111 < (1-800-342-5775) wae.�=umm•• M-F:Sam to Spm 06650.82002 Sep 30•2013 Your Electric Usage Profile Billing Summary (Billing details on back) Service to: Balance as of Aug 20,2013 $28627 LUCILLE BUDA-ESTATE Charges: 443 HUMMEL AVE Total IDT Energy Charges LEMOYNE, PA 17043 Total PPL Electric Utilities Charges $6.39 Meter:94211464 Total Charges $296.60 This section helps you understand your year-to-year., 00-10 ie By Seji`•Y0;201;xz ;; + d,a=4?> .yam ,r Q sta$296tfi0 electric use by month. Meter readings are actual unless Account Balance $296.60 otherwise noted. 02012 02013 PPL Electric Utilitles'price to compare for your rate Is$0.08227 per kWh. This changes the 1st of Mar,Jun,Sept,and Dec.Visit papowerswitch.com _ 90 or www.ocastate.pa.us for supplier offers. 75 so Your Message Center > 45 • With pa erless billing,you can'recelve and pay your, PPL Electtric Utilities bills online.The process is free, 30 quick,convenient and secure.To learn more or sign up, visit pplelectriccom. 0 • Information about appliance energy use and tips on 0 saving energy are available through the Energy Library i F M A M i i A s o N o on our web site,pplelectriccom. Months • Before digging around your home or property,you monthly Days 1 should always call the state's One Call notification T = system to locate any underground utility lines. You can Comparison • do this by simply dialing 811,which will.connect you to Aug 2013 11 38 3 71F the One Call system. Be safe and call 811 before you dig. Aug 2012 30 803 27 73F - Reading,Billin-g Period Type Payment Methods, Aug 17 Actual 53173 Online at: ®By phone:1-800-342-5775 = Aug 6. Actual 53135 lJ pplelectric.com or call BillMatrix(service fee applies) c at 1-800.672-2413 to pay using Visa, 11 Days kWh Billed 38 MasterCard, Discover or debit card. Avg. Monthly ® By Mail: Correspondence should be sent to: Sep 2012-Aug 2013 14278 1190 2 North 9th Street Customer Services CPC-GENN1 827 Hausman Road Sep 2011-Aug 2012 15157 1263 Allentown,PA 18101-1175 Allentown, PA 18104-9392 9 Other important information on the back of this bill-� I ' t s,r.:�^.qbl jjj . 1 . � 1 A, Family Tradition of Car$n y° .......... PARTHEMORE Funeral Home & Cremation Services, Inc. August 2, 2013 1303 Bridge Street P.O.Box 431 Mr. George Lapore New Cumberland,PA 17070 133 Blacksmith Road PH:(717) 774-7721 Camp Hill,PA 17011 FX:(717)774-5546 www.parthemore.com Dear Mr. Lapore; The following items were either not funded or not guaranteed in the pre- F T arrangements for Lucille L. Buda: Actual Cost As Funded Gilbert W.Parthemore Death Notice,Harrisburg Patriot $ 133.67 $ —0— Founder Certified Death Certificates 90.00 30.00 Gilbert J.Parthemore Hairdresser 45.00 30.00 Supervisor Tent& Cemetery Equipment 200.00 75.00 Clergy Honorarium 150.00 150.00 Stephen K.Parthemore Organist Honorarium 125.00 100.00 President,CFSP Soloist Honorarium 75.00 75.00 Altar Servers 30.00 —0— Bruce R.Parthemore Grave Opening 1085.00 600.00 Pre-Need Coordinator,CPC Flowers, Casket Spray 212.00 175.00 Subtotals: $ 2145.67 $ 1235.00 Professional Memberships: Difference: $ 910.67 . ' Total Due: $ 910.67 ® Pennsylvania Funeral Please call if you have any questions. Thank you. Directors Association 1 \ a p U p P Order of the Golden Rule Cipriani & Werner, P.C. 650 Washington Road Suite 700 Pittsburgh,PA 15228 EIN#:25-1779527 PHONE:(412)563-2500 George Lapore 133 Blacksmith Road Camp Hill,PA 17011 October 25,2013 # 177461 In reference to: CLAIM NO: OUR FILE: 8101-35043H Estate of Lucille Buda Hours Amount 9117/2013 ERG Department of Treasury letter regarding no lost property 0.10 25.00 9/30/2013 ERG Receipt and review of time stamed copy of Pennsylvania 0.10 25.00 Inhertiance Tax and iinformation notice and taxpayer response 10/7/2013 ERG Calculate prelimnary inhertancetax 1.00 250.00 10/10/2013 ERG E-mail to client regarding making preliminary inheritance tax 0.20 50.00 payment 10/11/2013 ERG Phone conference with client regarding option of paying taxes 0.30 75.00 and calculation of taxes;emailsto and from client regarding payment of taxes For professional services rendered 1.70 425.00 Attorney Rate Summary Attorney Hours Rate Amount E.Ralph Godfrey 1.70 250.00 425.00 Payments 10/4/2013 Payment 2,480.00 Sub-total Payments: 2,480.00 Zx1 /S s Cipriani & Werner, P.C. 650 Washington Road Suite 700 Pittsburgh,PA 15228 EIN#:25-1779527 . y PHONE:(412)563-2500 Georgel-apore 133 Blacksmith Road Camp Hill,PA 17011 September 23,2013 # 175353 } , In reference to: CLAIM NO: OURFILE:, .8101-35093H, . Estate of Lucille Buda Hours Amount 71181201 ERG Meeting withclient regarding handling estate and trust(no 1.50 NoCharge charge) " 7119/2013'• ERG Draft trust certificate;draft SS-4,meet with client;apply for 1.00 250.00 EIN 7/2212013 ERG Meeting with client regarding Certificate of Trust and EIN 0.20 50.00` 712412013' ERG E-mail to and from client regarrding'information for sale of 0:20 50.00 house and settlement agent 7/2412013 ERG E-mail from client regarding beneficiary addresses,i 0.10 , 25.00 4 r , 712612013 ERG, Draft Notice of trustAdministration to all beneficiaries 0.30, 75.00 7/28/2013 ERG E-mail from client regarding agreement of sale for,property .. . 0.10 25.00 7/30/2013 ERG Review claim sheets for Computershare,life insurance policy 0.50 125.00 and authorizations 8/112013 ERG. Correspondence toMBTbank regarding credit card debt 0.20 50.00 81212013 ERG Meet with client regarding review of documents 0.40 100.00 815!2013 ' ERG . Correspondence to client regarding Prudential stock being 0.20 50.00 cashed 81612013 ERG Correspondence to DPW regarding medicare lien 0.20 50.00 certification for settlement on real estate 8/6/2013 ERG CorrespondenceioM&T regarding date of death balances 0.20 50.00 8/7/2013 ERG Draft deed for sale of property 1.00 250A0 8/8/2013 ERG Phone conference with buyer's attorney regarding deed and 0.20 50.00 1 11x1, t� i S :egsq .�^-.�l,vsnraUlf$fnslsgiQ Jan!to efsotaifhso 00 Oa OS.O elnernmob"mete lsepnibisgeinnuGofeonebnogasnoa afi3 CrOS\818 OOM 02.0 !nems0tcaiolbeebw,ivsR OYa chow% 00.0M 08.0 atn9me fsteDoysgpnibispetgnsdUMc,wriGbnogaerLO OM UOMA8 oonwelriao enodq,ynsgrnoo fremsUlea tmol b:is of a€isms efrlaolce inoJnerneltluapnttnsps,lneibr Nv 00.02 OS,O QUH lol asel pr ib7sge't nnuQ moil bne of alism-3 e r> E€OS M\8 QO.ZS 01.0 smitgniaoi3gnibeap:n!naHOoffism-3 D543 UOS1%fl8 OU"Tr OC.O ;fnemslitsaefsfaef ssipnibispe,nnuCJ moil,bnsofaiisrt3 OFF Eta Me M8 xsl;fnetrreplezgnib�speiJneEomoi Jisme;isfteilloV,sgwsive5 QUH gnitmgm insi€ool lisme;Yoysq gnibisom nm tQ of 4UHwDimn OO.c'S 011.0 t sl talneilonWgCilowswo,.bnriq`rsasR asa £t ova Me OO cS U 1.0 beaiwen pribnee bns bssb nselo pr,iblr,pe7 nnuo of i em-3 --0 39 VOSY M tliAf CU.ZS 01.0 pmbn?ffe ton gnib,sgeiinsilo(mv),11M,9onsreinaoenodq @S3 EtOS18f18 tnsmo!vee (10.0Z 02.0 1-QUHbeeivoilowe€veibnsfgi",YR 3Fr3 £tOS1 M (JJ?T€ 0[.O fnemeMseonambn>rno.!bnsofievsiT OM Et"M8 t?O.dS ar.O 9 ciertofnsmeMeegnivulinibt,peinnuO moil fiem-3 -.)M EPOS18Ms OG.'cS Oh.O noRnosonaw ani01pniLncpsilrteliomoillism-3 @M crWI ii8 OO.�a V O fisma:)b ariol nems lneaqugn+Aaiggnibisgudneiloof€ism-3 ar13 r'Me1ta Aosdo Ito bsggoyb ybssils mnibtepw nnu4;mol rfitJ£ Ot.O ebnceapniv63bnswnsivar diisoenolgeleT Ptl £tOSt M 01.0 abawmq eonsiuem slit pnibiapsi lneilo mo)l firm-3 OM E MSM 01.0 Ansd TWA rooAieffelrhasbtoefsblo•xsiveibn=lgisasfl aRa £€OS1sSls (XVS 01.0 JnsmsidaA nadfauguspnib•tspe-fneito moil lism-3 @fU ctwrm 0O.W OS.O Afsum:letslaenianoifo sans ltbinoe-Jreme;u+alinsd,,veivsfi EM U010£1s lnsmst,ua 00.0e, M.0 al eal aanego0 been bnsarmoleonewanieli;vrsivsP OM EhoSlalp JO.O? as.0 iol faw bns stelae qu gmnego pnibisggi Jnwib of lism-3 r3;9 £t ake pniamevbs 00.c'S Ot.O TAM moOacidonsonsfiterfnilow',AveibneJgleasn a"8 VOa'"1s\p 00.4 or 0 093 £tOS1s npie nofi pnivsn bns tnu(ms ined 0(}.OFN,S Jb.ti baiebne+.eso;visaisnoiaaolorgx+a Cipriani&Werner,P.C. Page: 3 Attorney Rate Summary Attorney Hours Rate Amount E.Ralph Godfrey 1.50 0.00 0.00 E.Ralph Godfrey 9.80 250.00 2,450.00 David H.Radcliff 0.10 300.00 30.00 Total Current Billing: 2,480.00 Previous Balance Due: 0.00 Total Now Due: 2,480.00 kxl, r � 19•e� 7 S(• l ?Ai11�•'�10 — sec sec. SyOa Lk1 z8 h s CD ¢ I' '�o _ o m C77 ?r Cm') ci- co Z n I S S r Y i ¢ X O X N G H s <�M6 N U tl) #t INI J C(,n VJO M i c:3O � N ,� H #C C7 O4 0.- J C7C N I L� mNLI IVl] O ~ G [l7 •• wK'- mm r " CJ CJw <YH YO .~^, d3= �KS A m Q Lf) O LO CC V) W H Q x V) U It '. --- — -- H rn o00 o II — m it Lri ai m v LL ¢ ¢ I W ~ f A C I 1 X m H D 1x- m fr uN7 X co ¢ W m M 1 m L CLUCV zm i Q ¢ F mN Em w �_ O C CL WW ti = —1-I i ~ O ¢ X ¢ m CCW CO QO I rn X O S Q [r LC CL i L� fn X u0-1 m H S m XCD ffi ' W Ix w Y d N u7 0 co w 1— W W I J •• - O ti? 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ACG011NIT fiYPE°' .. STATEMENT PERIOD PAGE .. 9859324676 MAT CLASSIC CHECKING N/INTEREST .NlN.22-JUL.22,2013 1 OF 2 00 0 06223H NM 017 000004554 FIDS1549DO1707221307 02 001000 14221 THE LUCILLE L BUDA REVOCABLE LIVING TRUST U/A DTD 2-25-1999 LUCILLE L BUDA, TRUSTEE 443 HUMMEL AVE LEMOYNE PA 17043-1955 INTEREST EARNED FOR STATEMENT PERIOD 0.02 NEST SNORE PLAZA INTEREST PAID YEAR TO DATE 0.09 ACCOUNT SUMMARY EG DEPOSITS i NG' ":-BALANCE,:.. OTHER ADDITIONS CKS PAID :-- ..SUBTRACTIONS T ER ST PDHALANC NO. AMOUNT NO. AMOUNT I N0. ANOtK9T 1 125.34 ,824. 5 14 1,815.1V 1 4 108.80 I 0.03 5,827.93 ACCOUNT ACTIVITY DEPOSITS,INTEREST 'CHECKS 8 OTHER DAIL DATE -�TRA ACTION DESCRIPTION i TN R:ADDITI AmrRAC IONS BALANCE 06-22-13 BEGINNING BALANCE 01,125.34 9 06-24-13 CHECK NUMBER 0640 J 23.00 .-- 1,102.34 06-25-13 CHECK NUMBER 062.5 -- f � - - - 45.00 8 06-25-13 CHECK NUMBER 0645 200.08 8S7.34 07-01-13 IRON WORKERS PENSION _ 453.00 1,310.34 ¢° 07-02-13 CHECK NUMBER 0646 48.00 07-02-13 CHECK NUMBER 0648 15.00 07-02-13 CHECK NUMBER 0649 200.00 1,047.34 g 07-03-13 SSA TREAS 310 XXSOC SEC 1,164.00 2,211.34 07-05-13 RITE AID 00418 PURCHASE 651 NEWC PA 3.95 2,207.39 07-09-13 CHECK !UMBER 0652 134.60 07-09-13 CHECK NUMBER 0653 26.00 07-89-13 Allstate Ins Co CHECKPAYNT 000000000000655 46.99 07-09-13 CHECK NUMBER 0656 162.99 07-09-13 CHECK NUMBER 0658 10.00 07-09-13 CHECK NUMBER 0659 40.00 1,766.81 07-18-13 CHECK NUMBER 0647 23.00 87-10-13 ADT SECURITY SER CHECKPYMNT 000000000000657 32.95 1,710.86 07-11-13 PNMEDSVCSPROFBIL 7172318960 24.91 11685.95 07-12-13 DEPOSIT - 7-r1..'kI {r.... Snvr:VC-s tlm^!'. 3,907.55 5,593.50 07-17-13 CHECK NUMBER 0661 -c k 004u 71+9 46.00 5,547.50 07-18-13 CHECK NUMBER 0660 C K An it 7 La/r3 19.60 5,527.900 07-22-13 DEPOSIT 300.00 07-22-13 INTEREST PAYMENT 0.03 5,627.93 ENDING BALANCE 05,827.93 CHECKS PAID SUMMARY - 62S 06-25-13 45.00 We 06-24-13 23.00 64Se 06-25-13 200.00 646 07-02-13 46.00 647 07-10-13 23.00 648 07-02-13 15.00 k008QJFYi !' + .n w MsTBank _ S'A`ATY.[dM�`t3T SIUO:'. ::fkG£ JUN.22-JUL 22 2013 1 OF 3 00 0 06113M NM 017 17703 —" LUCILLE BUDA OR RONALD S BUDA 406 HILLSIDE RD NEW CUMBERLAND PA 17070 S�LECTEI�<ACCOUNT SC�I4RY ACCOUNT ACCOUNT INTEREST EARNED MATURITY ENDING TYPE NUMBER YEAR-TO-DATE DATE BALANCE M&T DIRECT CHECKING 000000028860071 0.00 933.35 M&T CLASSIC CHECKING W/INTEREST 000000098028952 0.16 0.00 TOTAL DEPOSITS 933.35 ::ItGEO T:: LUCILLE BUDA MST DIMT CHE IN Lo—NALD S BUDA ACCOUNT NO. 28860071 HIGHLAND PARK INTEREST EARNED FOR STATEMENT PERIOD 0.00 ACCOUNT SUMMARY HER AnnItl6ks NO. AMOUNT NO. AMOUNT NO, AMOUNT 726.35 2 1,655.00 1 51 1,148.00 1 1 1 300.00 0.00 I 933.35 ACCOUNT ACTIVITY ft. :AAI3.Y : 06-22-13 BEGINNING BALANCE $726.35 06-26-13 CHECK NUMBER 4828 100.00 626.35 07-01-13 PA TREASURY DEPT REVENUE 500.00 1,126.35 07-03-13 SSA TREAS 310 XXSOC SEC 1,155.00 2,281.35 07-09-13 CHECK NUMBER 4829 300,00 07-09-13 CHECK NUMBER 4830 225.00 11756.35 07-10-13 CHECK NUMBER 4827 23.00 1,733.35 07-15-13 CHECK NUMBER 4831 500.00 1.,233.35 07-17-13 M&T ATM CASH WITHDRAWAL ON 07/17 300.00 344 SOUTH TENTH STREET, LEMOYNE, PA 17043 933.35 ENDING BALANCE $933.35 4827 07-10-13 23.00 4828 06-26-13 100.00 4829 07-09-13 300.00 IMMOBank _ JUN 22 JUL 22 2613 2 OF 3 LUCILLE BUDA OR RONALD S BUDA 777 7 777.7 77 4830 07-09-13 225.00 4831 07-15-13 500.00 OVERDRAFT AND NSF FEE SUMMARY TO',XATi pR H,_S . ::,A EQR C;ATi DA11 TOT ;F PRI47 _: • S'Ct��ENBNx CY�LE -':YGAR Tp PATE. ,'�NpAR TOTAL INSUFFICIENT FUNDS (NSF) FEES $.00 $.00 $.00 TOTAL OVERDRAFT FEES $.00 $.00 $115.50 Total Insufficient Funds (NSF) Fees include per item fees charged when we return an item unpaid because there are not sufficient funds in the account to cover the item. Total Overdraft Fees include per item fees charged when we pay an item that overdraws the account as well as any Extended Overdraft Fees charged to the account. OVERDRAFT AND NSF FEE WAIVERS REVERSALS AND REFUNDS SUMMARY TOTA1.>;EOR GtitEN£!RR fiQTAL Fi7R RFC:LOR '; YEA4i fiQ 17ARf't :�AT.'ENbAtc OVERDRAFT & NSF FEE WAIVERS, REVERSALS & REFUNDS $.00 $ 00 TOTAL OVERDRAFT & NSF FEES LESS ANY WAIVERS, REVERSALS & REFUNDS $.00 $115.50 Note: Fee Waivers, Reversals & Refunds may include waivers, reversals or refunds applied to your account this year for fees assessed in the prior year. A COQN2 :_ LUCILLE L BUDA 1ST CLASSIC cmEcts mr, w/iNTMMST RONALD S BUDA ACCOUNT NO. 98028952 HIGHLAND PARK INTEREST EARNED FOR STATEMENT PERIOD 0.02 ACCOUNT SUMMARY i::BEGIIiNING. AEPOSST� 8 ' ?CiTHEA �Ui#�€NT �: ENDING ' .�:: >"n s NO. AMOUNT NO. AMOUNT I NO. I AMOUNT 4,107.53 1 ul 0.00 I of 0.00 1 2 1 4,107.56d 0,02 0.00 Fvl ryil - MffBank sraxEra�W� csctsr �a�E JUN 22-JUL 22 2013 3 OF 3 LUCILLE BUDA OR RONALD S BUDA ACCOUNT ACTIVITY P.0 STI 4' -;i; 'ii .fi. .;;i .:S PD5 TSi 1NTERGST CHk.CiSS, fr Q..,,.k . -:j IYASLY 06-22-13 BEGINNING BALANCE $4,107.53 06-26-13 M&T ATM CASH WITHDRAWAL ON 06/28 200.00 344 SOUTH TENTH STREET, LEMOYNE, PA 17043 3,907.53 07-12-13 INTEREST PAYMENT 0.02 07-12-13 CLOSEOUT 3,907.55 0.00 ENDING BALANCE $0,00 ANNUAL PERCENTAGE YIELD EARNED - 0.00 9 ** END OF STATEMENT ** _ 0 � x rn r^ C6 �l C6 C3i o °� ro a ty z y 1 ea G�9 IS cn m s o crn-a ao � � T .a REV-1500 EX(004r)(FI'J 1505610105 PA Department of Revenue pennsylvanla OFFICIAL USE ONLY Bureau of Indivfduat Taxes County Code Year Rle Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg,PA 17128-o6oi RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Binh MMODYYYY X79- /6 �SLB o7/is /aor3 ralaP�r9a�,.. Decedent's Last Name Suffix Decedent's First Name MI S, a c u C, Ile- - L (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name suffix Spouse's First Name MI N1� _ 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 Ca 2.Supplemental Return C= 3. Remainder Return(Date of Death Prior to 12-13-82) C7 4.Limited Estate GT 4a.Future interest Compromise(date of Cf 6. Federal Estate Tax Return Required death after 12-12-82) ® 6. Decedent Died Testate C:! 7.Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) C=I, 9.Litigation Proceeds Received C= 10.Spousal Poverty Credit(Date of Death C'3 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 Gle0VeC-e. Lyore. `7 )7- 741- f1Sa6 REGISTER OF WILLS USE ONLY First Line of Address Second Line of Address City or Post Office .. .. --- State ZIP Code DATE FILED CArnP N% 11 !"�J� �7dr! Correspondents eanall address: _ CeZl L4 {A A • )I y Under penalties of perjury,I declare that I have examined this retum,induding 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. SIGNATURE O SON PONSIBLE FOR FILING RETURN DATE ADDRESS / 1 70/t SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE t" DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 �,� 1505610105 1505610105 1505610205 REV-1500 EX(Fl) Decedent's Social Security Number Decedent's Name: RECAPITULATION 1. Real Estate(Schedule A). ....... .......... ........................... 1. 2. Stocks and Bonds(Schedule B) ....................................... 2. 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. 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. 8. Total Gross Assets(total Lines 1 through 7)............................. 8. ., 9. Funeral Expenses and Administrative Costs(Schedule H)................. .. 9: 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. °�C� 90, a .7, 11. Total Deductions(total Lines 9 and 10)................................. 11. 12. Net Value of Estate(Line 8 minus Line 11) .............................. 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which - an election to tax has not been made(Schedule J) ..................... ... 13. 0 14. Net Value Subject to Tax(Line 12 minus Line 13) ................. ....... 14. TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.0_ 15. 16. Amount of Line 14 taxable at lineal rate X.0Jr 16. a u�y. L.f ._.._.,._._... ....-_.__...__._. ._....._..__....v__ .....,__._-.....,,__._r....___.,__..____.-_..___.._ 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. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Side 2 1505610205 1505610205 REV-1500 EX(Fl) Page 3 File Number Decedent's Complete Address: as r3 • 01,03-7 DECEDENTS NAME /-. ce, u� B,dA STREETADDRESS 44y3 (cum nc / vc-. CITY STATE 23P /7a 443 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) 2. Credits/Payments A.Prior Payments B.Discount Total Credits(A+B) (2) 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) 5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) o fit. GS' Make check payable to: REGISTER OF WILLS,AGENT, PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS 1. old 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........_......_........._............._ ❑ 2 c. retain a reversionary interest........................................................_................................................----.......... ❑ d. receive the promise for life of either payments,benefits or c are?...................................................................... ❑ Q 1 If death occurred after Dec.12,1982,did decedent transfer property within one year of death without receiving adequate consideration?...................._.................._................................................................... ❑ 1 Did decedent own an"in trust for'or payable-upon-death bank account or security at his or her death?.............. ❑ 0 4. Did decedent own an individual retirement account,annuity or other non-prubate property,which contains a beneficiary designation? ....................................................................................................................... ❑ 52 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETURN, For dates of death on or after July 1,1994,and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(11)(i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(Ii)].The statute does not exempt a transfar to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are add applicable even if the surviving spouse is the only beneficiary. For dates of death on or after duly 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent or a stepparent of the child is 0 percent 172 P.S.§9116(x)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in V2 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedents siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by Wood or adoption. REV-1502 EX+(12-12) pennsytvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: 1 �pp FILE NUMBER: L �tl llE. SVJA oZ0/ 3 • 0/037 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, �CSIQ eNLG yy3 NVM/�C Vep NVe/ Lt. oywel PA 17643 77000. 00 TOTAL(Also enter on Line 1, Recapitulation.) $ 71.000 -G--Be If more space is needed,use additional sheets of paper of the same size. REV-1508 EX+(08-1z) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: LVt. Ile Bud re =?v/3. 0)437 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. I1EM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. mi T 3n k - C�o�Kr�c _ t7c. r 985-4�a �lG7L (x� r9l Sr��. TOTAL(Also enter on Line 5, Recapitulation) $ SS.`ld P If more space is needed,use additional sheets of paper of the same size. w REV-1509 EX+(D1.10) pennsylvania SCHEDULE F 4� INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: L„CIlle. /34�1a 0701,3� 016.37 If an asset became jointly owned within one year of the decedent's date of deathf it must be reported on schedule G. SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. FoAtA /d 8�dn 606,E PgX7"bA/ IP4. fla�kis 6v 1 14 /7/// a. C. JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY °k OF DATE OF DEATH nEM FOR MINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENTS VALUE OF NUMBER TENANT 301NT IDENTIFYING NUMBER.ATTACH DEED FOR 30INTLY HELD REAL ESTATE VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A. aoOy ()i4 7' 454.✓K. Chtc.�L'T^f4f 11"4" ?kkg 00-7 f /a33 .Yd /o 61 -7 Ckxl,a� TOTAL(Also enter on Line 6, Recapitulation) $ (0 j 7 4° 9 @9 If more space Is needed,use additional sheets of paper of the same size. REV-1511 IX+ (08.13) IffIM pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT , . ESTATE OF _ FILE NUMBER LV6/ 11G 431c/a 0/ 037 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EX1PENSES: / p 1. A/ I4he More Si. T brLJN , CAI.//c `Ch �1 < I�e aho 300 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: ` - o3oou Name(s)of Personal Representative(s) :Gcurc-e.. 1r+4!o.a Street Address /31 14 Rood City I" q— a 14, p , ' State I"R ZIP 1701) Years)Commission Paid: ao 13 2. Attomey Fees: (-,,o�tAN; i W erNLr C Exit /r� /C) 079o.I� - i 3. Family Exemption: (If decedent's address is not the same as daimant's,attach explanation.) Caimant Street Address _ city _ state_ZIP Relationship of Claimant to Decedent 4. Probate Fees: /�p 5. Accountant Fees: - 6. Tax Return Preparer Fees: 7. TOTAL(Also`enter on Line 9, Recapitulation) $ 71 f 6 If more space is needed,use additional sheets of paper of the same size. w 70303130 90 2T9W 8M31.1 ig ZMIJIGAIJ 3DADT910M F T3staiMlAlirvau Memv.RJR qO 3TATE3 ann"xa Ubsm b5mldAnmflu ptwbld rUs5b to mb iAl iL bir4ou tjri6,mq,.Is M Mesa cj,;oiiq!rnbr ,:b t4j yd bnvwrml ahmIlaps r.Ila-1 A 2 Llj A v min KVILM 90 AD al UqU;:0 JVA ol 'T NA r'j t to rl- NA .c t f.notl61ul� sDoA O.t -mJ no iaJ.n o2lA)JATOT 7 5-16Q?—s"Om tl REV-1513 EX+(01-10) �pennsylvania SCHEDULE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: L ,c-rl/e, l3 vdN X013. 6/037 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(5)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE i TAXABLE DISTRIBUTIONS(Include outright spousal distributions and transfers under Sec.9116(a)(1.2).) I. LU, Je, L- a.dAa Li i ,& r. sf r n (Y(' 6ijklf-A) '7 c.,.e.il try+a7 f�o.�n ld /3ud � Son/ /60 `7a ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH IS 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 n-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper Of the same size. OMB NO.2502-0265 A - - - - B. TYPE OF LOAN: U.S.DEPARTMENT OF HOUSING&URBAN DEVELOPMENT 1.QFHA 2.[JFmHA 3.QCONV UNINS. &N� A 5. CONV INS, 6. FILE NUMBER: 7. LOAN NUMBER: SETTLEMENT STATEMENT 8. MORTGAGE INS CASE NUMBER: C. NOTE: This form is furnished to give you a statement of actual settlement costs Amounts paid to and by the settlement agent era shown. Items marked"(POC)"were paid outside the closing;they are shown here for infannatbnaipurposas and are not mc/uded In the totals _ D. NAME AND ADDRESS OF BUYER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: DONALD KLAIBER LUCILLE iL-BUOA REVOCABLE LIVING TRUST CASH _ 312 BLACKSMITH ROAD 1011 MUMMA RD CAMP HILL,PA 17011 LEMOYNE,PA 17043 G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 1. SETTLEMENT DATE: , 443 HUMMEL AVENUE LEON HALLER ESC AGENT RRSTAMERICAN LEMOYNE,PA 17043 August 16,2013 CUMBERLAND County,Pennsylvania PLACE OF SETTLEMENT - - -' 1719 N.FRONT ST,f717-2344178 HARRISBURG,PA 17102 - { J.SUMMARY OF BUYER'S TRANSACTION K SUMMARY OF SELLER'S TRANSACTION 1 ,$i$ST ,p�T DSIF TO RELER- 101. Contract Sales Price _ .77,000AO 401, Contract Sales Price- 77,000.00 , 102. Personal Property 402, Personal Property-._ -- ` 103. Settlement Charges to B r Line 1400 1,611.50 403. 104. 404. 105. 405. 106. Cilyrrown Taxes 08117/13 to 01/01114 213.00 406•CityfTown Taxes 08/17/13 to 01101/14 2150 107. Schaal Taxes 08117/13 to 07/01/14 947.13 407.School Taxes 08/17/13 to 07/01/14 947.13 108. TRASH 08/17/13 to 10101113 21.28 408.TRASH 08117113 to 10101/13 21.28 109. 409. _ 110. ---- 410. 111. 411, 112. 412, 120. GROSS AMOUNT DUE FROM BUYER ' 79,792.91 420, GROSS AMOUNTDUE TO SELLER 78,181 At 200. AMOUNTS PAID BY OR IN BEHALF OF BUYER: 500.REDUCTIONS IN AMOUNT DUE TO SELLER: 201, Deposit or earnest money 500.00 501. Excess Deposit See instructions 202. Print al Amount of New Loans 502. Settlement Charqes to Seller Line 1400 1,922.75 203. Exist' towns taken Subject to 501 Existing loans taken subject to 204. 504. Payoff of first Mortgage to M&T BANK/1204446567849 23,344.76 205. - 505- Payoff of second Mortgage 206. - 506. Deposit retained by seller 500.00 207. 507. 208. 508. 209. 509. Adjustments r Items Unpaid By Iter A s ns r ms n a BvSjW 210. Cityfrown Taxes to - 510. Cityfrown Taxes to 211. School Taxes to - 511. School Taxes - -to 212. TRASH - to 512. TRASH - - to 213. 513. 214, 514, 215. 515. 216. 516. 217, 517. - - -- 218. 518. - 219. 519. - 220. TOTAL PAID BWFOR BUYER 500.00 520. TOTAL REDUCTION AMOUNTDUE SELLER 25,76731 300, CASH AT SETTLEMENT FROMI OBUYER: 600. CASH AT SETTLEMENT TOIFROM SELLER: 301. Gross Amount Due From Buyer Une 120 79 792.91 601. Gmss Amount Due To Seller Line 420 78 181.41 302. Less Amount Paid By/For Buyer Une 220) ( 500.007 602. Less Reductions Due Seger Une 520) { 25,767.51 303. CASH(X FROM)( TO)BUYER 79 292.91 603. CASH(X TO)( .FROM)SELLER $2,413.90 The undersigned hereby acknowledge ipt f �plate{S11 copy of pages 1&2 of this statement&any attachments referred to herein. Buyer w^•"�' SeAer LUCILLE L BUDA REVOCABLE LIVING TRUST DON BER BY: GEORGE LAPORE,SOLE TRUSTEE Ex)+ 1 " Kira-rt3-eaS RESaA H5a3a52 �/ iQJ P,!vLl401TJ')"k,(jl M1,3) C-1 "U)qmLz aA 103 r04NGfj YO asrlfUy`5;?�$?r�; ytbl Owl'i lveletv.3 joe C, top santmwil I HOMW91' ZOO; Mori boot 'tort t3 tldA Sort. 10§�Mmqzg elf r 01 rid9bir4F —n m q pun;037 Dt •I in-frWago zeat t mto , awR tiMalm Aot t -,MW 3,)MRU8i4l-iff IT 0.-VJlF,3MA Ta9l I wrswmt d ebu v;7,vlm-J8,1 DnqjRolf CZ.C', 00'(01,1T rrTr Vft a4ORAH:) 331 01,4A asawlsq :00$3 2_1l3q wipmw+9`?J sus, �•_. ,__,�..�M���.�___..._.._..._.,,� �.___�...�__..._,_...—_...._._._...,.»__T_.___.....-.—___._.._�_.,_. .cost `, 140sr ---me—1VEL SAE r —ME r —Lwt 2309- AHO fmsw-llmB aATOT.Clpbr, Jrmirstup.spaq rv4 ildl to pp2q I*Mo bolsfqmoo s 1.)Imam rAt,locnwitter imlo t egtm gr.!VIZ ys KADIFUMA TG R#3 I L19CIA 3 3 qDJ i VCI Z-, ADDITIONAL DISBURSEMENTS EXHIBIT Buyer: DONALD KLAIBER Seller: LUCILLE L. BUDA REVOCABLE LIVING TRUST Lender: CASH Settlement Agent: LEON HALLER ESC AGENT FIRST AMERICAN (717)234-4178 Place of Settlement 1719 N. FRONT ST.1717-234-4178 HARRISBURG, PA 17102 Settlement Date: August 16, 2013 Property Location: 443 HUM ME L AVEN UE LEMOYNE, PA 17043 CUMBERLAND County, Pennsylvania PAYEEIDESCRIPTION NOTE/REF NO BUYER SELLER BOROUGH OF LEMOYNE TAX COLLECTOR 1,087.11 2013 SCHOOL TAX 12-21-0265-231 LEMOYNE BOROUGH 50.64 SEWER PURCELL KRUG HALLER 15.00 TAX CERT REIMS Total Additional Disbursements shown on Line 1305 $ 0.00 $ 1,152.75 (KLAIBE R443(13).PF D/KLAI BE R443(13)/9) ACKNOWLEDGMENT OF RECEIPT OF SETTLEMENT STATEMENT Buyer: DONALD KLAIBER Seller. LUCILLE L. BUDA REVOCABLE LIVING TRUST Lender: CASH Settlement Agent: LEON HALLER ESC AGENT FIRST AMERICAN (717)234-4178 Place of Settlement: 1719 N. FRONT ST1717-234-4178 HARRISBURG, PA 17102 Settlement Date: August 16, 2013 Property Location: 443 HUMMEL AVENUE LEMOYNE, PA 17043 CUMBERLAND County, Pennsylvania I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement. LUCILLE L. BUDA REVOCABLE LIVING TRUST DONALD KLAIBER BY: GEORGE LAPORE, SOLE TRUSTEE WARNING: it is a crime to knovringiy make false statements to the United States on this or any simitarform. Penalties upon conviction can include a fine and imprisonment For details see: Tdle 18 U.S.Code Section 1001 and Section 1010. (KLAI$ER443(13).PFDMLAlBe R443(13)!9) M&TBank P.O. B0x619063 Dallas,TX 75261-9063 Home Equity Line of Credit F Contact Us PAGE 1 of 2 General Customer Service: 1.600-724-6444 1-770.17084.0009697-002-000-110.000-000 F04 LUCILLE L BUDA Correspondence Mailing Address: LUCILLE L BUDA P.O. Box 900, Millsboro,DE 19966-0900 443HUMMELAVE LEMOYNE PA 17043-1955 Payment Mailing Address: P.O. Box 62146,Baltimore,MD 212642146 % www.mtb.com Statement Period:06(14113-07114113 Days in Billing Cycle: 31 Account • ! Account Number 12WM4-6567178-0998 ACCOUNT DUE DATE 08108113 Property Address 443 HUMMEL AVE Payment Breakdown LEMOYNE PA 17043 indntsr 1 +$18197 Annual Percentage Rate 4.1682% CXedB Lge insurance ++81.00 Total Una of Credit 0,000AD Late Charge +$11.00 Currant Principal Balance" $23,330.39 Miscellaneous Feats) +$0.00 Available Credt $26,669.61 Amount Billed This Statement .r.3 Draw Period Expiration Date February 02,20V Past Due Amount +18.. D 0 Over Credit UmttAmmmt 00 2013 Finance Charges Paid Year4o-Date $565.41 Unpaid Charii +$0.00 A This is NOTs payoffamount.To obtain the amount required to pay yourfere of credif TOTAL AMOUNT DUE 08148/13 $185.30 in full,please call 1.800724.6444. If mceived after 08123113 (Includes late charges) $189.00 Batance and Finance Cha�ge Summary Una of Credit Total p Base Amount . w Previous Balance $23,513.38 $23,513.38 Paymentslonadits $182.99 - $162.99 ,LLy Advances 1 Debits + $0.00 + $0.00 , +_ Finance Charges—�. _�- + $81.33 + $81.33 Credit Life Msuanca �-�"a $0.00 s $0.06 $ Late Charges + $0,00 + $0.00 Other Pass + $0.00 + $6.00 n ng a ante ---Ur4TM Tm Principal Balance $23,330.39 $23,330.39 Daily Periodic Rate 0.0112054% Corresponding APR 4.090%i-) _ Average Daily Balance $23,414.23 $2381423 Number of Payments -- --- Payments Remaining Fixed Term Loan PaymentAmount -- see addwnal foowaa hdmmatim an back of statement Important Information about your Account Options _ If you would tike to Udr4n a balance of your outstanding principal or future advance into a fixed ram loan,the following rates are cunantly available until your next Willing cycle: Tenn Option Current Rate Available V. 60 x'39 61-120 449%APR 121-180 4.74%APR 1811-240 4.84%APR 241.300 5.04%APR ■�V\trY Y■ yM\V\YttMtttb VYtMttrY - ABxta fnwranctCompany p0 Box x 3589 You're in good hands. Akm4 OH 443093589 information as of August 19,2013 '1'illilll�'IIIIIu1�d�i�ullil�llgll"I'9�i��i�lilli�l�'i"I' Policyholder Page 1of2 LUCILLE L Lucille L BUDA GEROGE LAPORE TRUSTE Buda Geroge Lapore Trusts 133 BLACKSMITH RD Cancelled oiic number CAMP HILL PA 17011-8417 098756524 Property 443 HUMMEL AVENUE LEMOYNE PA 17043 Your Allstate agency is Timothy Amount due $7.74 24 Fast Main St Payment due upon receipt Palmyra,PA 17076 Important Information Your insurance has been terminated.An outstanding balance of$7.74 is due for coverage provided prior to the time your policy terminated.If you obtained insurance with another carrier or there were changes to your policy prior to the termination of this policy,please send proof of new insurance in the envelope provided as well as the tear off portion of this notice.Upon receipt,the appropriate credit if any will be applied. Terns of agreement for One-Time Electronic Withdrawal If you choose to make a payment using your checking account information,you may be asked to provide the following code 56524.By using this code you authorize Allstate and its affiliates to initiate a one-time electronic withdrawal from your checking account in the amount you specify.Future payments you initiate using the same checking account will be sent to your bank as an electronic withdrawal for the amount you specify.The withdrawal may be made from your checking account as early as the next business day. To make a payment by Credit/Debit Card or Check By Phone,please call 1-866-835-8631 or visit www.alistate.com to pay by Credit/Debit Lx h 3 lcontim" Detach bottom portion here• Customer Account Information Billing Summary For Service To: Lucille Buda Prior Balance-------• 443 Hummel Ave Prior Water Balance $17.15 Account Number:24-0627803-2 Prior Balance Other $18.99 Premise Number: 24-0370979 Payments prior to Aug 21,2013. Thanksl .00 Total prior balance,Aug 21,2013 36.14 Billing Period& Meter Information Current Water Charges---------- Billing Date: Aug 21,2013 Service Charge 5.04 Billing Period: Aug 08 to Aug 19(11 days) STAS PAWC Water - .01 Next reading on/about: Sep 09,2013 DSI-PAWC Charge 4.20% .21 Rate Type: Residential Total water charges,Aug 21,2013 5.24 Other Current Charges--------- Meter readings in current billing period: Customer Protection In Home 3 .99 Meter Number N091361739 is a 5/8-inch meter. Customer Protection Sewer Line 9.50 Present-actual 33500 Customer Protection Water Line 5.50 Last-actual 33500 Total other charges,Aug 21,2013 18.99 Gallons used 0 -----AMOUNT DUE $60.37 Water Usage Comparison 30 Monthly usage in hundred gallons. 24 - -- 16 - — 12 b 0 - - 2 A S O N 0 J F M A M J J A 2 0 u e c o e a g a D a u r u U 1 g p i v c 1 y n g 1 a 2 9 Messages to you from Pennsylvania American Water This is your Final Bill for service. It has been a pleasure serving you and we hope we may again have the opportunity in the future. The due date pertains to current charges only. Any past due balance should be paid immediately. Approximately 4.57 percent,or$.23, of State taxes are included in your current bill. Effective July 1,2013, the Distribution System Improvement Charge(DSIC)increased from 3.99%to 4.20%. This charge funds the replacement of water distribution facilities. .Pennsylvania American Water is now offering paperless billing. Its a convenient,environmentally lriendly and secure way to receive your water and/or wastewater bill:-Users must enroll online. To get started, visit www.amwater.com/myt12o. Go to Account Detail and click on the green Paperless Billing button. Follow the steps,press submit and you're enrolled/ Have you recently changed your primary phone number?If you have,please update your account information online using My H2O Online at www.amwatercomrmyh2o or callus at the number below so that we can update our records. ---------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------- "IMPORTANT WATER QUALITY INFORMATION: Your annual Water Quality Report can be viewed electronically at www.amwater.com/cd/mechanicsburg.pdf If you prefer a paper copy to be sent to you,please contact our Customer Service Canter at 800-565-7292. ---------------------------------------------------------------- ----------------------- ---------------------------------------------------------------------------------------- L x1 q 002495=495 NOESVU TAV0912 Customer Service& Emergencies 1-800-565-7292 (24 Hours) For Hearing Impaired Customers TDD 1-800-300-6202 (24 Hours) Visit us on the INTERNET:www.pennsylvaniaamwater.com RAWI00AM0271 AIM 16254 G -��' 00024062780320000000000003614018 Page 2 of �UrheQ gf/bll3 Pennsylvania American Water , 24-0627803-2 PO Box 371412 Pittsburgh, Pa. 15250-7412 AMOUNT DUE $36. 14 For Service To: 443 Hummel Ave DUE DATE Sep 03, 2013 AMOUNT PAID u°rill'Iy1u911P1'rl9drl'Ih'h°INIhIIdPI'il'Ihll _ 079268 1 AT 0.391 1258=681001208 092 1 NCESBZ LUCILLE & RONALD BUDA • ' ••• ' PENNSYLVANIA AMERICAN WATEF 133 BLACKSMITH RD PO BOX 371412 CAMP HILL PA 17011-8417 PITTSBURGH, PA. 15250-7412 II"1111111"I111111111111I'I I'I"I IIIIIIIIII"II.IIII.1111'II'II EPlease check here to add H2aHe/p to Others contribution to your monthly bill or to charge your address a tole one number,and print information on reverse side. --- --–- ...----------------- - -- -- --.....---- - --- ------... ......_ – ---- - ..._..—. _ Customer Account Information Billing Summary For Service To: Lucille& Ronald Buda --Prior Balance-- 443 Hummel Ave Prior Water Balance $34.19 Account Number:24-0627803.2 Prior Balance Oth $18 99 Premise Number: 24-0370979 Payments prior Au 13, 2013. Thanks 53.18 Total prior balance,Aug 13,2 13 Billing Period& Meter Information Current Water Charges Billing Date: Aug 13,2013 Service Charge 13.75 Billing Period: Jul 09 to Aug 08(30 days) Water Volume($.00910.1 x 300) 2.73 Next reading on/about: Sep 09,2013 STAS PA WC Water - .02 Rate Type: Residential DSI-PA WC Charge 4.20% .69 Total water charges,Aug 13,2013 17.15 Meter readings in current billing period: ----Other Current Charges-- Meter Number N091361739 is a 5/8-inch meter. Customer Protection In Home 3.99 Present-actual 33500 -Customer Protection Sewer Line 9.50 Last-actual 33200 Customer Protection Water Line 5.50 Gallons used 300 Total other charges,Aug 13,2013 18.99 --AMOUNT DUE—----••-- $36.14 ExH S https:Hsal.www4.irs.gov/irfof-efp/getEfp.do 3/4/2014 Do not send correspondence to this address. Ej ONAMSY01 Po Box 1022 PINNACLEH�LTH Wixom MI 48393-1022 ADDRESS SERVICE REQUESTED Hospitals (717)221-1294 (888)467-2563 August 30,2013 Representatives Available: Mon—Thu 8:00 AM—8:00 PM 55261063-1000 @ @@ 124489133 Fri 8:00 AM—5:00 PM III"�h����I�IILI�IIII�IIIgh�gllnll���l"II"'�'II�'�I�I�I Lucille Buda 443 Hummel Ave Lemoyne PA 17043-1955 Bill t 130462965 Patient Name: Lucille Buda Date of Service: 06/19/13 Location of Service: Pinnacle Health Balance Due: $3064.11 Our records indicate the balance on your account is now due in full. Please pay this immediately using the enclosed envelope. You may also pay by credit card by using the form below. If you need to make payment arrangements, please call us as soon as possible. Financial assistance is available for the uninsured or underinsured who apply and qualify. For more information, please call or see our website at www.pinnaciehealth.ora/bilipay. Iloay. You may also pay online at https:/Poillpay.pinnaclehealth.orp Sincerely, Pinnacle Health Hospitals Patient Accounts Department .x SEE REVER5H STATEMENT The amount shown below represents To discuss payment, call: your financial obligation to: t� PINNACLEHEALTH Pinnacle Health Hospitals Hospitals (717)221-1294 (888)467-2563 For all other inquiries: PO Box 2353 (717) 221-1294 Harrisburg, PA 17105 MESSAGE: Thank you for choosing Pinnacle Health Hospitals.The balance on your account is due. If you need assistance or have insurance coverage, please call our customer service department. If you need to make arrangements for payment,we have representatives available to assist you. Financial assistance is available for the uninsured or underinsured who apply and qualify. For more information, please call or see our website at www.Dinnaclehealth.ora/billoay. You may also pay online at httns://billnay.ninnaclehealth.ora HOSPITAL SERVICE DATE PATIENT NAME BILL NUMBER 07/15/13 LUCILLE BUDA 130496926 FOR YOUR HOSPITAL SERVICES: Room/Bed $22500.00 Supply Pharmaceutical $5435.44 Lab/Blood $5435.00 X-ray/Nucmed $2300.00 Med Resp $2757.00 MISC $2900.00 Clinic $877.00 Oriqinal Billed Amount $42204.44 Total Payments and Adjustments $-40454.44 Patient Responsibility $1750.00 `✓'`J, 0 $ $17SO.00 Cdua�a 1L0 �) ydl� Exh 7 805ONAMSY011001 ♦PLEASE DETACH AND RETURN LOWER PORTION WITH YOUR PAYMENT V --fu rA-e d G t �� s3 ° . ^, ® Questions?1� ease ,/� Visit us online at Page 1 contact us by Jul 30. U pplelectric.com Bill Acct. No. i • s • •Amount f 1-800-DIAL-PPL PP ' . (1-800-342-5775) 06650-82002 Jul 30,2013 $174,04 PM zf• o VOW" M-F:Sam to Spm Your Electric Usage Profile Billing Summary (Billing details on back) Service to: Balance as of Jul 9,2013 $0.00 LUCILLE BUDA Charges: 443 HUMMEL AVE Total PPL Electric Utilities Charges $174.00 LEMOYNE, PA 17043 Meter:94211464 Total Charges $174.00 Your next meter reading is on or about Aug 6,2013. mount Oue 8 v Jut This section helps you understand your year-to-year Account Balance $174.00 electric use by month. Meter readings are actual unless PPL Electric Utilities'price to compare for your rate is$0.08227 per kWh. otherwise noted. This changes the 1st of Mar,Jun,Sept,and Dec.Visit papowerswitch.com N 2012 02013 or www.oca.state.pa.us for supplier offers. 75 Your Message Center • Budget Summary: 60 We billed you $1,062.00 0 45 ----- Including this bill,you used so After this payment,your budget is behind $251.00 161 1 0 • With a erless billing,o p p g,you can receive and pay your � J F M A M J J A 5 D N D PPL Electric Utilities bills online.The process Is free, quick,convenient and secure.To learn more or sign up, Months visit ppielectric.com. • Information about appliance energy use and tips on Monthly Days kWh Average Average saving energy are available through the Energy Library Comparison Billed kWh/Day Temp. on our Web site, pplelectric.com. JIM013 32 1 703 1 22 73F Ju12012 30 1 809 27 74F Billing p Period Payment Methods Jul 8 Actual 52981 Online at: ®By phone:1-800-342-5775 Jun 6 Actual 52278 lJ pplelectric.com or call BiIlMatrix(service fee applies) at 1-800-672-2413 to pay using Visa, 32 Days kWh Billed 703 MasterCard, Discover or debit card. Yearly Comparison Total _ Monthly ® By Mail: Correspondence should be sent to: Aug 2012-Jul 2013 15797 1316 2 North 9th Street Customer Services CPC-GENN3 827 Hausman Road Aug 2011-Jui 2012 15098 1258 Allentown, PA 18101-1175 Allentown, PA 181049392 Other important information on the back of this bill Questions?Please Visit us online at Final Bill Page 1 contact us by Sep 10. U pplelectric.com III�Bill 80 1- 0-DIAL-PPL �1W'�W�1 Due PPS (1-800-342-5775) 06650-82002 Sep 10,2013 $296.60 nx ebeMe uwm.. M-F:Sam to 5pm Your Electric Usage Profile Billing Summary (Billing details on back) Service to: Balance as of Aug 20,2013 $286.27 LUCILLE BUDA-ESTATE Charges: 443 HUMMEL AVE Total IDT Energy Charges $3.94 LEMOYNE, PA 17043 Total PPL Electric Utilities Charges $6.39 Meter:94211464 Total Charges $296.60 This section helps you understand your year-to-year ount flue By Sep 10,,2013'`' $286:60 electric use by month. Meter readings are actual unless Account Balance $296.60 otherwise noted. ®2012 2013 PPL Electric Utilities'price to compare for your rate is$0.08227 per kWh. This changes the 1st of Mar,Jun,Sept,and Dec.Visit papowerswitch.cwm 90 or www.oca.state.pa.us for supplier offers. soYour Message Center • With paperless billing,you can receive and pay your PPL Electric Utilities bills online.The process is free, a 30 quick,convenient and secure.To learn more or sign up, visit pplelectric com. a is • Information about appliance energy use and tips on g 0 saving energy are available through the Energy Library 1 r M A M i 1 A s D N D on our Web site,pplelectric.com. E Months • Before digging around your home or property,you should always call the state's One Call notification monthly °I system to locate any underground utility lines. You can kWh kWh/Day Comparison Billed do this by simply dialing 811,which will connect you to Aug 2013 it 38 3 71F the One Cali system. Be safe and call 811 before you dig. Aug 2012 30 803 27 73F Period Billing Payment Methods Aug 17 1 Actual _ 531 Online at: ©By phone: 1-800-342-5775 Aug 6 Actual 53135 �J pplelectric.com or call BillMatrix(service fee applies) at i-800.672-2413 to pay using Visa, 11 Days kWh Billed 38 MasterCard,Discover or debit card. Avg. ® By Mail: Correspondence should be sent to: Yearly Comparison Total Use Sep 2012-Aug 013 14278 1190 2 North 9th Street Customer Services B CPC-GENN3 827 Hausman Road Sep 2011-Aug 2012 15157 ( 1263 I Allentown,PA 18101-1175 Allentown, PA 181049392 L Y Ai 6,-f- 9 Other important information on the back of this bill 4 f Account Number Due Date Amount Due 717737-2695 j359;52Y Upon Receipt $49.73 MrVon y Account Information ' Statement Data: 8/1/113 EUC01E BUDA Phone. 717-737-2695 t 'y' iD1etlliUdpy��e3lliteK�klyd 1 Account Summary Previous Balance $55.86 No Payment Received $.00 a Zdll�telYSa E?: -- ---- . _ ._..... . VMt Balance forward $55.88 Before You Move... Call 1-888-416-9691 and we'll help set up your Now Charges Internet.TV and Phone for your new address.You can be up and running in no time!DONT WAIT!And be Current Activity sure to ask d FiOS is available In your area.Service Taxes,Governmental Surcharges and Fees —$.18 availability vadea ----------.—.. Venzon Surcharges and Other Charges&Credits —$1.59 We Value Our Customers Total New charges —$6.13 We appreciate your business&warn to deliver the very best entertainment to you.Call us at Amount Due—Please Pay Now $49.73 1-888-649-8090 to find out about the new ways Your account has been disconnected.Any other charges or credits wDl appear Vedzon can save you money.We enjoy being your ar,your next bUl. provider,and we would like to keep you with us longer by improving your Verizon expedence. Get More,Save More Call 1-688-668-0301 to ensure you're getting the best Vedzon services at a great nine—from phone, Internet and TV to money saving bundles,international plans and fun add—ors.Together we'll find ways to save you even more. Questions about your bill or service? View your bills in detail at verizon.com or call 1-800-VERIZON 11-800-837-4966). Enter your ten digit number 717-737-2695.Use 359 it asked for your customer Identification rode.Customers with disabilities call 1-800-974-6006 TTY. Please return remit slip with payment. FAMILY PHYSICIAN ASSOCIATES, INC NEW CUMBERLAND, PA 17070-1127 1900 BRIDGE STREET (717) 774-7041 Page 1 * VISA, MASTERCARD & DISCOVER PAYMENTS CAN 8E TAKEN OVER THE TELEPHONE*"* "THE PRACTICE IS NOW ACCEPTING, NEW PATIENTS To: LUCILLE L BUDA Statement Date 443 HUMMEL AVENUE 10/10/13 Lemoyne PA 17043 Account Number 1753 Date D sonpt7 n o 1rari;acitun. C13` es t,*00410 Balance 05/29/13 LUCILLE 99213 OFFIC/OUTPT E&M ESTAB 80.00 .00 Check Payment from Ins MCARE 47.93 HUMANA GOLD ADJ 10.15 2% FEDERAL SEQ RED 97 Transfer From Ins MCARE to Patien .00 Check Payment from Patient 20.95 07/01/13 LUCILLE 99213 OFFIC/OUTPT E&M ESTAB 80.00 6.93 Check Payment from Patient 15.00 Check Payment from Ins MCARE 47.92 HUMANA GOLD ADJ 10.15 Transfer From Ins MCARE t0 Patien 00 DUE TO THE RISING COST OF MAILING PATIENT STATEMENTS AND OUR DESIRE TO AVOID A REPROCESSING FEE ALL COPAYS AND PATIENT DUE BALANCES MUST BE COLLECTED AT THE TIME OF VISIT Currently Due 31 - 60 Days 61 - 90 Days 91 - 120 Days Over 120 Days 6.93 .00 .00 .00 .00 FAMILY PHYSICIAN ASSOCIATES, INC NEW CUMBERLAND, PA 17070-1127 1900 BRIDGE STREET (717) 774-7041 Page 1 —VISA, MASTERCARD& DISCOVER PAYMENTS CAN BE TAKEN OVER THE TELEPHONE- " THE PRACTICE IS NOW ACCEPTING NEW PATIENTS "* To: LUCILLE L BUDA Statement Date 443 HUMMEL AVENUE 07/19/13 Lemoyne PA 17043 Account Number 1753 F f� .^F' sk" 7' 'l lw rllnxs s<r' K47c Cr y: l is a_r.,is sy9.E Sc YR sf,&-, s�S r i 3x �l:< 9 �, a5:isz :5lts.o`YR9 Tm .1�xa 5°at as♦ > P � s�s..r .x 3�iw:�"� `�s.;.3s;°va'''x � sa a$4�,�i "X;•�� s r r < r �ibr„'�f xtatt�e a��.._:�.,iza �• _ :�u A . �. '� 'Oha�rges �.,,._ Cred€i$�k< �:8alanc@ x 05/29/13 LUCILLE 99213 OFFIC/OUTPT E&M ESTAB 80.00 20.95 Check Payment from Ins MCARE 47.93 HUMANA GOLD ADJ 10.15 2% FEDERAL SEO RED ,97 Transfer From Ins MCARE to Patlen .00 DUE TO THE RISING COST OF MAILING PATIENT STATEMENTS AND OUR DESIRE TO AVOID A REPROCESSING FEE ALL COPAYS AND PATIENT DUE BALANCES MUST BE COLLECTED AT THE TIME OF VISIT Currently Due 31 - 60 Days 61 - 90 Days 91 - 120 Days Over 120 Days 20.95 .00 .00 .00 .00 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - TearHere - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - « ” * Please return bottom half with payment « " « 07/19/13 Acct # 1753 h�=c l aS �!.'aa't x sx� `! r�s � r r �� 3.t��a3's i•aa £ x�y3`x;>z_l lyi'.E M�1 68.88 47.93 20.95 t3"ran "Pi: ir� a: 186.72 q¢ as 1�`�1+4' yrc•xis 'g': tU @s..t t$ks�<1!�t{sift z 20.95 3F g. s ('(� (:x� yWS x 'yc /j > s �7,4{� �2V:. NSif , .2 N�r llr �y$140 !YF 20.95 / .00 .00 .00 .00 �( h f 4j, 12 "` Payment Due Upon Receipt`Thank You BLS EMERGENCY BASE RATE A0429 1.0 907.21 907.21 BLS MILEAGE A0425 2.3 13.73 31.58 DESCRIPTION OF PAYMENT RECEIPT PAYMENT DATE AMOUNT Medicare Assignment Adjustment 07/30/2013 595.10 Payment-Medicare HMO 0002117539 07/30/2013 193.69 Total Credits 788.78 PLEASE PAY THIS AMOUNT—INVOICE DUE UPON RECEIPT --o- RETURNED CHECK FEE-$31.00 $150.00 PATIENT NAME: BUDA,LUCILLE CALL NUMBER: 1311 061 B AMOUNT PAID: - 08/01/2013 !I is Is fte amoun Ue a Lov your nsurance arner s payment. �f A Family Tradition of Caring' PARTHEMORE Funeral Home & Cremation Services, Inc. August 2, 2013 1303 Bridge Street P.O.Box 431 Mr. George Lapore New Cumberland,PA 17070 133 Blacksmith Road PH:(717) 774-7721 Camp Hill, PA 17011 FX:(717)774-5546 www.parthemore.com Dear Mr. Lapore; The following items were either not funded or not guaranteed in the pre- arrangements for Lucille L. Buda: Actual Cost As Funded Gilbert W.Parthemore Death Notice,Harrisburg Patriot $ 133.67 $ —0— Founder Certified Death Certificates 90.00 30.00 Gilbert J.Parthemore Hairdresser 45.00 30.00 Supervisor Tent& Cemetery Equipment 200.00 75.00 Clergy Honorarium 150.00 150.00 Stephen K.Parthemore Organist Honorarium 125.00 100.00 President,CFSP Soloist Honorarium 75.00 75.00 Altar Servers 30.00 —0— Bruce R.Parthemore Grave Opening 1085.00 600.00 Pre-Need Coordinator,CPC Flowers, Casket Spray 212.00 175.00 Subtotals: $ 2145.67 $ 1235.00 Professional Memberships: Difference: $ 910.67 • Total Due: $ 910.67 Pennsylvania Ftnetar Please call if you have any questions. Thank you. Directors Association ai i v C i a Order of the Golden Rtile . . .. � Vii_ �. . is ..�.'{: ` } : q L. f J i � 1.) " 1( '..r. f .. 1 . ,. il� r . . . - . . .. _. .. .M1 r y .. ��I e. )�� .. ..� . � e. ... 1 Cipriani & Werner, P.C. 650 Washington Road Suite 700 Pittsburgh,PA 15228 EIN#:25-1779527 PHONE:(412)563-2500 George Lapore 133 Blacksmith Road Camp Hill,PA 17011 October25,2013 # 177461 In reference to: CLAIM NO: OUR FILE: 8101-35043H Estate of Lucille Buda Hours Amount 9/1712013 ERG Department of Treasury letter regarding no lost property 0.10 25.00 9130/2013 ERG Receipt and review of time stamed copy of Pennsylvania 0.10 25.00 Inhertiance Tax and iinformation notice and tax payer response 1 0/712 01 3 ERG Calculate prelimnary inhertance tax 1.00 250.00 1 0/1 012 01 3 ERG E-mail to client regarding making preliminary inheritance tax 0.20 50.00 payment 10/11/2013 ERG Phone conference with client regarding option of paying taxes 0.30 75.00 and calculation of taxes;emails to and from client regarding payment of taxes For professional services rendered 1.70 425.00 Attorney Rate Summary Attorney Hours Rate Amount E.Ralph Godfrey 1.70 250.00 425.00 Payments 10/412013 Payment 2,480.00 Sub-total Payments: 2,480.00 LxJ lS . .:).� s•;+ •i 'S;s :t2•. 'v.S`..;t` . ;^n_{��.^•..., _'•+J "f::`:5�:::@?!i.�ll;!�e;`.i: i.�7'is 1, ..:S�.�:" A In oira ^.f ltj(('. _ 3 �. f tr_) ..�C!�`,z(t.-dS' 1(`tf• E+ 4!i .. 5!55G ��,n•t +*�1C^,, t. .tr^r'.•.. .. .'=4E1(1!):„i*9. 1): t..�'x i t��4t'. .'F fpm(..rj f-':+J t;'i;'. -° __irv: 'T=p':` l�.'-ltit. .":.-�'a°�-.):•.S4,:) G.. - ..Fd�S.. '�' f, t Ks.• ai....a� .,..,::iZ._.r. -}::3t6�" _.e`+a._ ^,',�. .n•'-^... , f+Z'. :�' � .,"4'� .. , Cipriani&Wemer,P.C. Page: 2 certificate of trust 8/8/2013 ERG Correspondence to Dunn regarding settlement documents 0.20 50.00 8/9/2013 ERG Reviewdeed for settlement 0.20 50.00 8/13/2013 ERG Correspondence toM&T bank regarding payoff statements, 0.80 200.00 emails to and form settlement company,Phone conference with client regarding settlement on real estate 8/14/2013 ERG Emaiis to and from Dunn regarding fees for HUD 0.20 50.00 8/15/2013 ERG E-mail to Client regarding Closing time 0.10 25.00 8/15/2013 ERG Emails to and from Dunn regarding real estate settlement; 0.70 175.00 review payoff letter;email from client regarding settlement;fax to Dunn regarding payoff;email to client regarding HUD; reviewHUD 8/15/2013 ERG Receipt and review of DPW no lien letter 0.10 25.00 8/16/2013 ERG E-mail to Dunn regarding clean deed and sending revised 0.10 25.00 HUD 8/16/2013 ERG Phone conference with(vm)client regarding not attending 0.10 25.00 settlement 8/16/2013 ERG Receipt and review of revised HUD-1 0.20 50.00 8/16/2013 ERG Travel to and from and attend settlement 0.70 175.00 8/16/2013 ERG E-mail from Dunn regarding having settlement check 0.10 25.00 8/17/2013 ERG E-mail from client regarding life insurance on Ron 0.10 25.00 8/19/2013 ERG E-mail to client regarding picking upsettiementcheck;email 0.20 50.00 form Dunn regarding already dropped off check 8/19/2013 DR Telephone call Insurance and Savings Bonds 0.10 30.00 8/22/2013 ERG E-mail from client regarding life insurance proceeds 0.10 25.00 8/28/2013 ERG Receipt and review of date of death letterfromM&T bank 0.10 25.00 8131/2013 ERG E-mail from client regarding august bank statement 0.10 25.00 8/31/2013 ERG Review bank statement record transactions in estate fi rm bank 0.20 50.00 statement 9/5/2013 ERG Review I ife insurance form s and need to open estate 0.20 50.00 9/6/2013 ERG E-mail to client regarding opening up estate and cost for 0.20 50.00 advertising 9/6/2013 ERG Receipt and review of i nheritance notice from M&T 0.10 25.00 9/6/2013 ERG Correspondence to client regarding revenue notice onM&T 0.20 50.00 bank account and having Ron sign For professional services rendered 11.40 2,480.00 X/ r4 Cipriani&Wemer,P.C. Page: 3 Attorney Rate Summary Attorney Hours Rate Amount E.Ralph Godfrey 1.50 0.00 0.00 E.Ralph Godfrey 9.80 250.00 2,450.00 David H.Radcliff 0.10 300.00 30.00 Total Current Billing: 2,480.00 Previous Balance Due: 0.00 Total Now Due: 2,480.00 k+3 _, � Z-� y AEGE ttl�YLwYiRrer /q.n '7 i17'� � pcEowwar� �y..3o 7-2f 5;c u 7°z4 otF� .. 4tivtA ?- • � ?AA.u.�NO — Sew S�� S�00 -� Z U 1 AA, IL 190 9 � X61. 9 i _ 1 1 t tk1 I8 E2 ~ EE CL ' O J m X W 3. I .- .� O C/J r= IO- LOL C) „ T f~> c7 cc; X N ! Y d Z i tNa Z 0¢Sj C`J }; ER W N C N 4 iE [tiD N _a -� n M �v co ti A J NO L Z' h- �,. 1 L1'J <O,L .O-- JN ¢ ¢ # OOyu -1 J OL w W N ' ~ mNM 1J0 FO-- ME U7 � UF- Cr LJ ' CO Lu04 0 ]C CC/)) CW ~ ' L f4 W <FH m x +' CL m co H I O n O co II .- mm m V m 22 m ] 9G O rz m X r # O U FO- Z n d LL Q Q' Cr I r to m X yO,7 co 1-•i t C3 Ckt } LLry � z m i xm as cQ» Cr)Qx atH^> v i p N N E_-- W W i _J J •. N O N W Z U Q t n CC M CL 4 O N W ~ � N Q - f c.> mw rQ co M1- i lii cHe c=ra H 1 s} m CJ M 11 W P J I CC T W <L Q 1 W Kf X (CJ ¢ x x M C o X CO 1 w M M I # •,• m M M a a m dUN Z' t0 I KC4F_ m 2_ W � O VJ S J H 1 W U CL] ]•' xe CCw ED ¢ cz m i `= x um'J n ZZE .r O CJ r T m X FN N V> W 'S 1 >; Co T W N p_M a[ 1 >G m ttJ jE <C W Z M I m >' tD U w 6 3_ 0 LLl LLJ CJ H 1 ^b � Ha M1- Q E- x 1 N •• r.l m a- -. — # t� w CJ Cc M I w ¢ se o N-• a z U Q U) O N > OC uj ML--> LU I\- V K Yna 0MZ II M t7 CJ Va V) m H tC 7c VJ U II rMO �Q u; r.[)Om O M c}C M fA N w o M E w a 0 E �O O. U w' a°ai : ''io nv- n �n nLw3E 3 ED �M O Q t_ d _� W ME Ip i w o o - ru m o +• c .� as r ter` Elf >- - � w O S .--• O a0 fU L >� 61 O • V) CL.... O r0 J M QI O .O N E fA u> ffi ti r,L sF _ 4> i y r]i ul U i CO, A to h 3 + WED Q wwo wa —_ N N C ^ 6I CL ^ LC1N:Dm0 if •u�f't J G C`Jr.� 4 '2 �:7tOlfI4(] N - 2'Vl�i1 322 ••�f7 % 9 C �•2'—O �(7F- UILf'�6_ W W W:.JO if !�E 2 Z6_J O£ �-£6•• N L ++C�+- 1 = - 60017 X66 r-�6.-.¢2 VJ CJ OVJ II: ¢ ,Jt 1y CL fu rl aj ` e Lo +s �r. LL m LL m m (n (n c000tln * X W F v � O 3_ -- Z w '- ro � N � !- •- Pk � C O :k � Y R ! C H Q N N N U 7 lY. C W U W AAA.com 3433 TRINDLE ROAD CAMP HILL, PA,17011 Tel:717 761-8347 23 JUL 2013 15:12 AAA CENTRAL PENN Receipt 02WS-4706-70/CG2 RECEIPT RONALD S BUDA 717 761-0526 443 HUMMEL AVE LEMOYNE, PA 17043 Reference Description Amount Domestic ----------------- ------------------------------------ ------ -------- 1. SUN 1514798 NOTARY FEES (NF) 1 @ 5.00 US 5.00 Total 5.00 C Payment 20.00 Change Given 15.00 -------------------- 1. SUN NOTARY FEES DON'T MISS OUT! Join the 1, 000's of members who have saved hundred's of dollars on their Auto & Home Insurance. Call or visit your local AAA Central Penn Office for a free quote. -------------------- Do you Show your Membership Card at the following locations: Tanger Outlets, New York & Co. , Payless Shoes, Lenscrafters, NAPA, Reebok Outlet Stores If you do, your savings will be 108 or more. Go to AAA.com for a complete listing. -: .ACCOUNT- NO. `..ACCOUNT TYPE" STATEMENT PERIOD PAGE 9859324676 MiT CLASSIC CHECKING N/INTEREST JUN.22-JUL.22,2013 I OF 2 00 0 86123H MM 017 000004554 FUDS1546DO1707221307 02 001000 14221 THE LUCILLE L BUDA REVOCABLE LIVING TRUST U/A DTD 2-25-1999 LUCILLE L BUDA, TRUSTEE 443 HUMMEL AVE LEMOYNE PA 17043-1955 INTEREST EARNED FOR STATEMENT PERIOD 0.02 NEST SHORE PLAZA INTEREST PAID YEAR TO DATE 0.09 ACCOUNT SUMMARY E OEPOSITS i - OTHER BALANCE OTHER OTHER ADDITIONS CNEC1 5 PAI SUBTRACTS INTEREST PD - BA E . NO. 1 AMOUNT I M. I AMOUNT M. AMOUNT 1,125.34 4 ,8-f4-.55 141 1,013.19 1 4 1 108.80 0.03 5,827.93 ACCOUNT ACTIVITY POSTI - - 7463.00 dC i OTHER DAILY .. DATE TRANSACT I DESCRIPTION - SUBTRACTI NMS AL E 06-22-13 BEGINNING BALANCE 01,125.34 06-24-13 CHECK NU BER 0640 23.00 1,102.34 6 06-25-13 CNECK liAtBER 0625 45.00 06-25-13 CHECK NUMBER 0645 200.00 657.34 07-01-13 IRON WORKERS PENSION 1,310.34 07-02-13 CHECK NUMBER 0646 48.00 0 07-02-13 CHECK NUMBER 0648 15.00 07-02-13 CHECK NUMBER 0649 200.00 1,047.34 y 07-03-13 SSA TREAS 310 XXSOC SEC 1,164.00 2,211.34 R' 07-05-13 RITE AID 00418 PURCHASE 651 NEWC PA 3.95 2,207.39 07-09-13 CHECK NUMBER 0652 134.60 07-69-13 CHECK NUMBER 0653 26.00 07-09-13 Allstate Ins CO CHECKPAYMT 000000000000655 46.99 07-09-13 CHECK NUMBER 0656 182.99 07-09-13 CHECK NUMBER 0658 10.00 07-09-13 CHECK NUMBER 0659 40.00 1,766.81 07-10-13 CHECK NUMBER 0647 23.00 07-10-13 ADT SECURITY SER CHECKPYNNT 000000000000657 32.95 1,710.86 07-11-13 P4MEDSVCSPROFBIL 7172318960 24.91 11685.95 07-12-13 DEPOSIT - 7-,A-rc- f,- Sloe- 'S /1..�t, 3,907.55 5,593.50 07-17-13 CHECK NUMBER 0661 -t k 044c 7 19 46.00 5,547.SO 07-18-13 CHECK NUMBER 0660 CA D^la 7 l h3 19.60 5,527.900 07-22-13 DEPOSIT 300.00 07-22-13 INTEREST PAYMENT 0.03 5,827.93 ENDING BALANCE 05,827.93 " _ 5 CHECKS PAID SUMMARY 625 06-25-13 45.00 640* 06-24-13 23.00 645* 06-25-13 200.00 646 87-82-13 48.00 647 07-10-13 2340 648 07-02-13 15.00 LOBO(W12) 1' .n MsrTBank &TATP.68'+N� Y�`iRS(�t1_ � .PdGE JUN.22-,JUL 22 2013 1 OF 3 00 0 06113M NM 017 -�-�- 17703 —" LUCILLE BUDA OR RONALD S BUDA 406 HILLSIDE RD NEW CUMBERLAND PA 17070 _: E�,ECT�A "ACCC3t71�T .S.[TA3C�kRY ` ACCOUNT ACCOUNT INTEREST EARNED MATURITY ENDING TYPE NUMBER YEAR-TO-DATE DATE BALANCE M&T DIRECT CHECKING 000000028860071 0.00 933.35 M&T CLASSIC CHECKING W{INTEREST 000000098028952 0.16 0.00 TOTAL DEPOSITS 933.35 :::::ftiCCOUtF2:i>�: LUCILLE BUDA T DIRECT CHECKING o RONALD S BUDA ACCOUNT NO. 28860071 HIGHLAND PARK INTEREST EARNED FOR STATEMENT PERIOD 0.00 ACCOUNT SUMMARY BEGLtiN3 G ,DEE�ISIT& & -:<?i3THER CURRENT ENDING:. _ .: NO. AMOUNT NO. I AMOUNT I NO. I AMOUNT 726.35 1 21 1'655.00 1 51 1,148.00 1 1 1 300.00 1 0.00 933.35 ACCOUNT ACTIVITY Jig ioNs .;;POSTING ATE 06-22-13 BEGINNING BALANCE $726.35 06-26-13 CHECK NUMBER 4828 100.00 626.35 07-01-13 PA TREASURY DEPT REVENUE 500.00 1,126.35 07-03-13 SSA TREAS 310 XXSOC SEC 11155.00 2,281.35 07-09-13 CHECK NUMBER 4829 300.00 07-09-13 CHECK NUMBER 4830 225.00 1,756.35 07-10-13 CHECK NUMBER 4827 23.00 1,733.35 07-15-13 CHECK NUM13ER 4831 500.00 1,233.35 07-17-13 M&T ATM CASH WITHDRAWAL ON 07117 300.00 344 SOUTH TENTH STREET, LEMOYNE, PA 17043 933.35 ENDING BALANCE $933.35 4827 07-10-13 - 23.00 4828 06-26-13 100.00 4829 07-09-13 300.00 ®WrBank _ JUN 22—JUL 22 2013 2 OF 3 �"— LUCILLE BUDA —T OR RONALD S BUDA rGHLE6GkfS PAiA::SF7i$SARY. 7 7-771 4830 07-09-13 225.00 4831 07-15-13 500.00 OVERDRAFT AND NSF FEE SUMMARY &?.`R'I'E{'1EL40-'-CXGLC YE7aR 'l0 DMTE CR3rF•NtiA1� TOTAL INSUFFICIENT FUNDS (NSF) FEES $AO $.00 $.00 TOTAL OVERDRAFT FEES $.00 $.00 $115.50 Total Insufficient funds (NSF) Fees include per item fees charged when we return an item unpaid because there are not sufficient funds in the account to cover the item. Total Overdraft Fees include per item fees charged when we pay an item that overdraws the account as well as any Extended Overdraft Fees charged to the account. OVERDRAFT AND NSF FEE WAIVERS REVERSALS AND REFUNDS SUMMARY - TLPT.etL FQR - kAR TQ1AL FOR ERTOIII :: YeAR T{hT XkT& EATENAAR`: YEAR :: OVERDRAFT 6 NSF FEE WAIVERS, REVERSALS & REFUNDS $.00 TOTAL OVERDRAFT S NSF FEES LESS ANY WAIVERS, REVERSALS & REFUNDS $.00 $115.50 Note: Fee Waivers, Reversals & Refunds may include waivers, reversals or refunds applied to your account this year for fees assessed in the prior year. ACCtfEF LUCILLE L BUDA A46 SIC CHECKING W INTE ST N D u DA ACCOUNT NO. 98028952 HIGHLAND PARK INTEREST EARNED FOR STATEMENT PERIOD 0.02 ACCOUNT SUMMARY HEGTNN3NG DEPOSITS & '::s OTHF,R :CURRENT ENDING.- .,.:.:. 9:: NO. AMOUNT NO. AMOUNT NO. 1 AMOUNT 4,107.53 0 0.00 0 0.00 2 4 107.55 if 0.02 1 0.00 duG n0 0MTBank S1�ATEMP, .NT PPR.IaO ::. k+AGP. dUN.22-,IUL 12,2013 3 OF 3,:, LUCILLE BUDA OR RONALD S BUDA ACCOUNT ACTIVITY 'DATE %BRAN CT ONE. DEkZ3S2�S,2NTEAEST CU�CISS SDTHER C ta21S:: 06-22-13 BEGINNING BALANCE 06-28-13 M&T ATM CASH WITHDRAWAL ON 06128 $4,107.53 344 SOUTH TENTH STREET, LEMOYNE, PA 17043 200.00 07-12-13 INTEREST PAYMENT 3,907.53 07-12-13 CLOSEOUT 0.02 0.00 ENDING BALANCE 3,907.55 $0.00 ANNUAL PERCENTAGE YIELD EARNED - 0.00 $ ** END OF STATEMENT ** W fS � CC ]C Z O � m y V O CO C7 Lw Cq S 2 ;E f. Lcm r Y e Z y Y C=2 C a. Q . W W 0 ' » I C CZ w W W Z V O S C d d