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Home My WebLink About06-05-14 (3) yau�oyuy�u _"� REV-1500 °`�'�'°' ��.Y PA DepaM�ent oi Re�snue �y� y� �Number ewsau af��tdua ra�ass ny��p�,�CE TAX RETURN Po aox 28oeoa 2 1 � 2 1 3 5 2 PA 17128-0601 RESIDENT DECEDENT ENTER DECEDEM INFORMATION BELONt Socie[Securily Numbsr (�be of Death I�ADDYYYY Da�e aF BiRh tueiADDYYYY 1 1 0 2 3 2 Q 1 2 0 5 2 8 1 9 3 U DeoedanCs Last Plame S� �� GRONI (dGER MiAR I AN �- (M AppOcablel Enbr 8urvivinp 8pou�e's IrdorntWon Belaw MI Spo�e's Laet Name Sufflx Spouss's First Neme Spouse'a Social Securlty Number THIS RETURN MU3T BE FILED lN DUPUCATE IMTH THE REGISTER OF WIILS FlLL IN APPROPRU7E OYA1.8 BELOW � 1.Ortginal Retum � 2.3upplemer�tal Retum � 3.l�mainder F�tum(dete of death priorta 12-13-82) (� 4.l.�nni�ed Fstetie � 4a.Future I�erost Corrq�romise(ciebe of [] 5.Federal Eatate Tax Retum Fte4uirod deeth aRer 12-12-62} � 6.DecsdaM Died Tes�te � T.Dsoedent AAaintai�ed a t.ivin8 Trust ! e.Total Number of Safs Dep�it Bozes {Attach Copy of W il� (Attach Copy af 7rost} � 9.L�s�ion Proceeds Received � t 0.Spousal PoveRY Cred�(date of death ❑ 11.Eledbn to tax under Sec.8113(A} tislween 12-31-A1 a�9-1-95) {Attach Sc��.O) CORRESPONOEM'T-'IkIS SECTpN I�IST BE COMPLETED.ALL C�CE A�lD COa1FIDENTIAL TAX MFORIIATION SNOtILD�D�Q?W TO: Daytime Telephon�lumber s :� m Name p rrt � MATTHEW A . McKNIGHT 717 2 � � 2 �' ��' 4 ,.7.1 �., Z ;,� :�a _r _,, �:a 1�t3tSTER�M�S ,$��Y '�'� �� ._ �„ ,i Y C.3 . ` .. , , .� � �� ,,p '":1 Flf9t 1�115 Of 8�1�8 ,�-7 L,� -� � �.� I R GI I N 8 M c K N I G H T , P • C • .`' � o ��= r i Seoond iine of add�ess � c�� p _ s 6 0 W E S T P 0 P9 F R E T S T R E E T C�r or Post OfRoe � Z�P� DATE FILED C A R L I S L E P A 1 7 D 1 3 cor�spo�Ys.-nat��dcNwa: Under ps�reMies af psrjury.i ds�Nus q�at i have examkied�ts�s�um�Indu�p acoomPp�ryi^0�d�s and staEement�.and b the bert d n'N kno�d�e and beNet rt is true,correct ana oompble.us�on a ptea�aC�r than�e pa�or�l�ep��°d m al�1Manna�on awt�c�►preparer has emr�� SI TURE OF P iBLE_FOR �1G R � �w 304 BATTLESHIP CV STAFFORD VA 22554 SIG T OTHERTNAN REPRESENTATIVE ��/ ADDRE 60 WE PONlFRET STREET CARLIS�E PA 17�13 Stde 1 3�50561014a 150561014D ,J � � __ _ _ _ _ � 150561024� REV-1500 EX DecedenYs Social Security Number DecedenYsName: MARIAN L• GRONINGER RECAPITULATION 1. Real Estate(Schedule A) . . . .. .. .. . .... ... . .. . ... . .... . . . .. . ... . . .. . 1• 183oao . 00 2. Stocks and Bonds(Schedule B) ... . . ... . ... .. . . .. . . . . . . . . . .. . . .. .. ... 2• 1 2 9 7 8 5 . 8 1 3. Closely Held Corporation,PaRnership or Sole-Proprietorship(Schedule C) ... . . 3. • 4. MoRgages and Notes Receivable(Schedule D) . . .. .... . . . .. . . .. .. . . ... . . 4. • 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E).. . . . . . 5. 8 8 1 2 . 3 7 6. Jointiy Owned Property(Schedule F) ❑ Separate Billing Requested .. . . .. . 6. 1 6 7 1 2 . � 0 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property 5 9 0 6 7 . 4 6 (Schedule G) � Separate Billing Requested .. . . .. . 7. 8. Total Gross Assets(total Lines 1 through 7) .. . .. . . . ..... .. . .. . ... .. .. . 8. 3 9 7 3 7 7 . 6 4 9. Funeral Expenses and Administrative Costs(Schedule H) 9. 7 2 1 1 1 . 8 8 .. . .. . . .. . . . . .... . 10. Debts of Decedent,Mort a e Liabilities,and Liens Schedule I 10. 1 8 2 5 0 . 7 5 9 9 ( ) .. . . . .. . .. .. . ��. Total Ged�ctions(total Lines 9 and 10) .. . ... . . . . .. .... .. . . ... . . . . .. . . 11. 9 0 3 6 2 . 6 3 12. Net Value of Estate(Line 8 minus Line 11) . .. . . . . . . . . . . .. . . .. . . . . . . .. . 12• 3 � 7 � 1 5 . 0 1 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) .. .. . .. .. . . .. . . . . . .. . . 13• • 14. Net Value Subject to Tax(Line 12 minus Line 13) .. . . . .. .. . . . . . .. . . . ... 14. 3 0 7 0 1 5 . � 1 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 _ � . 0 � 15. 0 . 0 � 16. Amount of Line 14 taxable at�inea�rate x.oa5 3 0 7 0 1 5 . 0 1 �s. 1 3 8 1 5 . 6 8 17. Amount of Line 14 taxable at sibling rate x.a 2 0 . D 0 ��. 0 . 0 0 18. Amount of Line 14 taxable Q . O � at collateral rate X.15 0 • � � 18� 19. TAX DUE . .. ... . . . .. . . . . ... . . . ... . . . .. . . . . . . . . . . . . . . . . . . . . . . . . .. 19. 1 3 8 1 5 • 6 8 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 � 150561024� 1505610240 J REV-1500 EX Page 3 File Number Decedent's Complete Address: 2� �2 1152 DECEDENT'S NAME MARIAN L. GRONINGER STREET ADDRESS 1041 WEST SOUTH STREET CITY STATE ZIP CARLISLE PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 13,815.68 2. CreditslPayments A.Prior Payments 13,000.00 B.Discount 650.00 Total Credits(A+B) (2) 13,650.00 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) 0.00 5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 165.68 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred: ...................................................................... ❑ � b. retain the right to designate who shall use the property transferred or its income; ............................... ❑ X❑ c. retain a reversionary interest;or ................................................................................................ ❑ X❑ d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ � 2. If death occurred after December 12,1982,did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ❑ X❑ 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ......... ❑ X❑ 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation?.................................................................................................. 0 ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE tT 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)J. 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 transfer to a suNiving 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.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedenYs lineal beneficiaries is 4.5 percent,except as noted in 72 P.S.§9116(1.2)[72 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedenYs 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+(01-10) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHEPoTANCE TAX RETURN RESIDEM DECEDENT ESTATE OF: FILE NUMBER: MARIAN L. GRONINGER 21 12 1152 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 belween 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 jointty-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 decedenYs interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1. 1041 WEST SOUTH STREET, CARLISLE, PENNSYLVANIA 183,000.00 APPRAISAL ATTACHED TOTAL(Also enter on Line 1,Recapitulation.) $ 183 000.00 If more space is needed,use additional sheets of paper of the same size. REV-1503 EX+(6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER MARIAN L. GRONINGER 21 12 1152 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. WELLS FARGO ADVISORS 129,785.81 ACCOUNT#3878-3212 DATE OF DEATH VALUATION ATTACHED TOTAL(Also enter on line 2,Recapitulation) $ 129 785.81 (If more space is needed,insert additional sheets of the same size) REV-1508 EX+(11-10) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS, 8� MISC. INHERITANCE TAX RETURN RESIDENTDECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: MARIAN L. GRONINGER 21 12 1152 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PERSONAL PROPERTY 5,456.00 APPRAISAL ATTACHED 2. COINS-APPRAISAL ATTACHED 3,356.37 TOTAL(Also enter on Line 5,Recapitulation) $ 8 812.37 If more space is needed,inseR additional sheets of paper of the same size . _ REV-1509 EX+(01-10) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE �OINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: MARIAN L. GRONINGER 21 12 1152 If an asset was made jointly owned within one year of the decedent's date of death,it must be reported on Schedule G. SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. LYNNE G. BEISWANGER 304 BATTLESHIP COVE DAUGHTER STAFFORD, VA 22554 B. c. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. M&T BANK 15,499.63 50. 7,749.82 CHECKING ACCOUNT#38839121 2. A. M&T BANK 17,924.35 50. 8,962.18 SAVINGS ACCOUNT#15004212519423 TOTAL(Also enter on Line 6,Recapitulation) $ 16 712.00 If more space is needed,use additional sheets of paper of the same size. REV-1510 EX+(OB-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER MARIAN L. GRONINGER 21 12 1152 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY ITEM INCLUDETHENAMEOFTHETRANSFEREE,THEIRRELATIONSHIPTODECEDENTAND DATEOFDEATH %OFDECD'S EXCLUSION TAXABLE NUMBER THE DATE OFTRANSFER.ATfACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST pF nPPUCnBL� VALUE 1. NATIONWIDE INSURANCE 59,067.46 100.00 59,067.46 ANNUITY CONTRACT#01-5950116 BENEFICIARIES: LYNNE G. BEISWANGER JOAN GRONINGER TOTAL (Also enter on Line 7,Recapitulation) $ 59 067.46 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(10-08) pennsylvania SCHEDULE H DEPARTMENTOFREVENUE FUNERAL EXPENSES AND INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER MARIAN L. GRONINGER 21 12 1152 DecedenYs debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A, FUNERAL EXPENSES: 1. EWING BROTHERS FUNERAL HOME, INC. 8,135.12 2. ROLLING GREEN CEMETERY COMPANY 4,049.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) LYNNE G. BEISWANGER 12,700.00 StreetAddress 304 BATTLESHIP COVE City STAFFORD State VA z�p 22554 Year(s)Commission Paid: p. AttomeyFees: IRWIN & MCKNIGHT, P.C. 14,500.00 3, Family Exemption:(If decedenYs address is not the same as claimanYs,attach explanation.) 3,500.00 Claimant JOAN GRONINGER StreetAddress 1041 W. SOUTH STREET City CARLISLE State PA z�P 17013 Relationship of Claimant to Decedent 4. ProbateFees: REGISTER OF WILLS 419.50 5 Accountant Fees: 6. Tax Retum Preparer Fees: PATRICIA A. ROSENDALE, CPA 475.00 INCOME TAX RETURN & FINAL FIDUCIARY TAX RETURN 7, REGISTER OF WILLS-FILING FEE 30.00 8. DIVERSIFIED APPRAISAL SERVICE-APPRAISAL ON REAL ESTATE 350.00 9. ROY D. GOTTSHALL-APPRAISAL ON PERSONAL PROPERTY 80.00 10. CUMBERLAND LAW JOURNAL- ESTATE NOTICE 75.00 11. THE SENTINEL- ESTATE NOTICE 189•� 12. GILBERT'S LANDSCAPING, LLC-LAWN CARE 1,402.48 13. HOFFMAN'S CUSTOM CONTRACTING, INC. -CARPET&PAINTING 10,715.00 14. HOFFMAN'S CUSTOM CONTRACTING, INC. -TOTAL CLEAN OUT 397.50 15. IBIS APPRAISAL SERVICES-APPRAISAL ON COINS 525.00 16. REGISTER OF WILLS-SHORT CERTIFICATES 15.00 17. SERVICE LINE WARRANTIES-EXTERNAL WATER LINE WARRANTY 39.00 18. SHANE BOUDER-TRASH REMOVAL 500.00 TOTAL(Also enter on Line 9,Recapitulation) $ 72 111.88 If more space is needed,use additional sheets of paper of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent MARIAN L.GRONtNGER 21 12 1152 DecedenYs Name Page 1 File Number Schedule H-Funeral Expenses�Administrative Costs-B7. ITEM NUMBER DESCRIPTION AMOUNT 19. TOM RODGERS-REPAIRS 85.00 20. CLOSING COSTS ON SALE OF REAL ESTATE 13,929.74 SUBTOTAL SCHEDULE H-67 14,014.74 REV-1512 EX+(12-08) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT� INHERITANCETAXRETURN MORTGAGE LIABILITIES,�LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER MARIAN L. GRONINGER 21 12 1152 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. CENTURYLINK-TELEPHONE 425.82 2. CARLISLE PETROLEUM, INC. -UTILITY 3,721.62 3. THE SENTINEL-NEWSPAPER 23.30 4. REAL ESTATE TAXES 2012 &2013 4,765.68 5. CUMBERLAND GOODWILL FIRE RESCUE-AMBULANCE 84.15 6. CARLISLE REGIOIVAL MEDICAL CENTER-MEDICAL 65.00 7. M&T BANK-REIMBURSEMENT OF SOCtAL SECURITY 1,240.00 8. PP&L-ELECTRIC 816.97 9. BOROUGH OF CARLISLE-WATER/SEWER 752.82 10. CARE CREDIT-CREDIT CARD 5,954.89 11. DONEGAL INSURANCE GROUP- INSURANCE 400.50 TOTAL(Also enter on Line 10,Recapitulation) $ 18 250.75 If more space is needed,insert addibonal sheets of the same size. REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: MARIAN L. GRONINGER 21 12 1152 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include out n'qht spousal distributions and transfers under Sec.91'�6(a)(12).] 1. LYNNE G. BEISWANGER Lineal 153,507.51 304 BATTLESHIP COVE 1/2 REMAINDER STAFFORD,VA 22554 2. JOAN GRONINGER Lineal 153,507.50 1041 W. SOUTH STREET 1/2 REMAINDER CARLISLE, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size, i .- ; . , . . ry LAST �ILL AND TLSTAMENT OF MARIAN L. GROI�iINQFR � I, Marian L. Groninger, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this to be my last Will and Testament and revoke all Wi].ls and Codicils previously made by me. ITEM I: I direct that my legally enforceable debts and funeral expenses, together with the expenses of the administration of my estate, shall be paid from my residuary estate as soon as practicable after my decease, as a part of the expense of the administration of my estate. ITEM II : I devise and bequeath all of my estate of every nature and wherever situate in equal shares unto my two daughters, Lynne G. Beiswanger and Joan D. Hall, provided, however, that the share of either of my said daughters who shall predecease me or die on or before the thirtieth day following my death shall be distributed to her issue, per stirpes, living on the thirty-first day following my death and in default of such then living issue, such share shall be added to the share for my other daughter, if then living, or to the shares of her then � living issue, per stirpes, if she is also then deceased. ITEM III : I appoint my daughter, Lynne G. Beiswanger, Executrix of this my Last Will and Testament. Should my said daughter, Lynne G. Beiswanger, fail to qualify or cease to act as . � . �I',�(tiQ'+it � . _ _ _ _ _ • � a � Executrix, I appoint my daughter, Joan D. Hall, Executrix of this my Last Will and Testament. ITEM IV: I direct that my personal representatives, as well as their successors, shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal, this �_ day of January, 2000. � . ��-� � [SEAL] Marian L. Groning F The preceding instrument, consisting of this and one (1) other typewritten page, each identified by the signature of the Testatrix, was on the date thereof, signed, published and declared by Marian L. Groninger, the Testatrix therein named, as and for her last Will, in the presence of us, who, at her request, in her presence and in the presence of each other, have subscribed our names as witnesses hereto. � / / � •. - . .. • � , . ,� P COMMONWEALTH OF P£NNSYLVANIA COUNTY OF CUMBERLAND We, Marian L. Groninger, Dale F. Shughart, Jr. and Heather A. Barbour, the Testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her last Will and that she had signed willingly, and that she - executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of his/her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under ; no constraint or undue influence. � .. c � Testatrix � r � Witness � � Witnes Subscribed, sworn to and acknowledged before me by Marian L. Groninger the Testatrix, and subscribed and sworn to before me by Dale F. �Shughart, Jr. , and Heather A. Barbour, S witnesses, this ro �r day of January, 2000. ,� � � �pw, Notary P lic �1.00Mta,Mo�r�y wetic �Ip 0'CAlIL111l,pN1�6M.ANO COUNTv M��lJ�1li0CT�ER 17 Z002 ' ara�`"E"'�'y OMB Approval No.2502-0265 d` '�m_ ' R ' � A. Settlement Statement (HUD-1) � _ . � �,4= 4��RN oe�Eb� B. Type oT Loan 1.�FHA 2.Q RHS 3.�X Conv.Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number: 4.�VA 5.�Conv.Ins. 15642.1 MOSES 6800771136 C. Note: This form rs/umished to give you a statement of actua/seft/ement costs. Amounts paid to and by the setNement agent are shown. /tems marked"(p.o.c.)"were paid outside the closing;they are shown here(or in(ormafional purposes and are not inc/uded in fhe tota/s. D. Name and Address of Borrower: E. Name and Address of Seller: F. Name and Address of Lender: Andrew J.Moses and Estate of Marian L.Groninger Members tst FCU Samantha Moses 1041 West South Street 5000 Louise Drive 438 West Penn Street Carlisle,PA 17013 Mechanicsburg,PA 17055 Carlisle,PA 17013 G. Property Location: H. Settlement/{qent: I. Settlement Date: 1041 West South Street Martson Deardorif Williams Otto Gilroy&Faller Carlisle,PA 17013 10 East High Street May 12,2014 Cumberland County,Pennsyivania Carlisle,PA 17013 Ph. (717)243-3341 Place of Settlement: 10 East High Street Carlisle,PA 17013 J. Summary of Borrowers transaction K. Summary of Sellers transaction 100. Gross Amount Due from Borrower: 400. Gross Amount Due to Seller: 101. Contrect sales rice 183,000.00 401. Contrect sales rice 183,000.00 102. Personal ro e 402. Personal ro e 103. Settlement Char es to Borrower Line 1400 7,857.53 403. 104. 404. 105. 405. Ad'ustments for items aid b Seller in advance Ad ustments for items aid b Seller in advance 106. Coun !fw .Taxes 05/13/14 to 01/01/15 727•22 406:Coun /fw .Taxes 05/13/14 to 01/01/15 727.22 707. SchoolTaxes 05/13/14 to 07/01/14 326.26 407.SchoolTaxes 05/13/14 to 07/01/14 326.28 108. Assessments to 408.Assessments to 109. 409. 110. 410. 111. 411. 112. 412. 120. Gross Amount Due from Borrower 191,911.03 420.Gross Amount Due to Seller 184,053.50 200. Amounts Paid b or in Behalf of Borrower 500. Reductions in Amount Due Seller. 201. De asit or earnest mone 2,000.00 501. F�ccess de osit see instructions 202. Princi al amount of new loan s 128,000.00 502. Settlement char es to Seller Line 1400 12,229.74 203. Existin loan s taken sub'ect to 503. Existin loan s taken sub'ect to 204. raisal Fee Credit 425.00 504.Payoff First Mo�tgage 205. 505.Pa off Second Mort a e 206. 506. 207. 507. De ositdisb.as roceeds 208. 508. 209. Seller Credit for Re airs 1,700.00 509. Seller Credit for Re airs 1,700.00 Ad ustments for items un aid b Seller Ad'ustments for items un afd 6 Seller 210. Coun !fw .Taxes to 510.Coun /Tw .Taxes to 211. Schoal Taxes to 511. School Taxes to 212. Assessments to 512.Assessments to 273. 513. 274. 514. 215. 515. 216. 516. 217. 517. 278. 518. 279. 519. 220. Total Paid b/for Borrower 132,125.00 520. Total Reduction Amount Due Seller 13,929.74 300. Cash at Settlement fromlto Borrower 600. Cash at settlement to/from Seller 301. Gross amaunt due from Borrower line 120 191,911.03 601. Grass amount due to Seller line 420 184,053.50 302. Less amount aid by/for Borrower(line 220) ( 132,725.00) 602. Less reductions due Seller(line 520) ( 13,929.74 303. Cash X❑From � To Borrower 59,786.03 603. Cash �To � From Seller 170,123.76 •Paltl ouWtle of Uoaing by Eartower(B),selier(S),lentlar(L),or thirtl-party(T) The undersigned hereby acV owledge recei t of a completed copy of this statement 8 any attachments referred to herein Borrower i �, Seiler Estate of Marian L. r inger rew J.Moses L By� �� eG_ Lynne G.Be' anger,Exe utrix p Sam nthaMoses �j�[i,{w�� The Public ReporGng Burtlen lor t�is wllec6on of informaUOn is asCmated at 35 minutes par response for wllecung,reviewing,and reporting tl�a tlala.This agency may nat collect Mis informatian,antl yau are not requlred to eomplete Nis form,unless it displays a wrrently valid OMB control num6ec No canfidentlaliry I s assured:llils ElsGOSUre is mantlalary.This is tleslgned to proviEe tl�e paroes ro a RESPAaovereC transacfion wilh informedan Euring Ne seltlement Orocess. Page 1 of 3 HUD-1 (15642.1 MOSES/15642.1 MOSESl42) - ' L.Settlement Char es 700.Total Real Estate Broker Fees S 9,150.00 Paid Fmm Paid Fmm Division of commission(lirre 700)as follows: Borrowets 5eners ��01.$4,575.00 to Wolfe&Com an Realtors Funds at Funds at 702.$4,575.00 to George L.Ebener&Associates Senlement Settlement 703.Commission aid at settlement 9 150.00 704. 705. 800.Items Payable In.Connectfon wtth L'oan _ . 801.Our ori ination char e $ 595.00 from GFE#1 802.Your credit ar char e oints for the s ecific interest rate chosen 32D.00 ftom GFE#2 803.Your ad'usted ori ination char es from GFE#A 915.00 804. raisal fee to Members 1st FCU from GFE#3 425.00 805.Credit Re ort to from GFE#3 806.Tax service to from GFE#3 807.Flood certification to from GFE#3 808. from GFE#3 809. from GFE#3 810. from GFE#3 811. (from G FE#3) 900.kems Requi�ed by Lenderto BePaid in Advance ` > 901.Dail interest char es ftom 05/12/14 to O6/01/14 20 $14.904100/da from GFE#10 298.08 902.Mortgage insurance premium for months to (from GFE#3) 903.Homeowner's insurance for years to Erie Insurance (ftom GFE#11) POC$548.00 904. (from GFE#11) 905. (from GFE#11) 1000.Reserves De osited wkh lender - 1001.Initial deposit for your escrow account (ftom GFE#9) 2,430.45 1002.Homeowner's insurance 3.000 months @ $ 45.67 per month $ 137.01 1003.Mort a e insurance months $ er month $ 1004.Pro e taxes S Coun /iw .Taxes months $ er month School Taxes months � $ per month 1005.Ciry/Counry Property Tax $ 379.72 Ci /Coun Pro e Tax 4.000 months 94.93 er month 1006. months @ $ per month $ 1007. School Properly Taxes 12.000 months Q $ 202.54 per month $ 2,430.48 1008. $ 7009.AggregateAdjustment $ -516.76 1100.Title Charges 7101. Title services and lender's title insurance (from GFE#4) 1,486.50 7102. Settlement or closin fee S 1103. Owner's title insurance to Old Republic National Title Insurence Company (from GFE#5) 302.50 1104. lender's title insurance to Old Republic National Title Insurance Company $ 1,321.50 1105. Lender's title policy limit $ 128,000.00 1106. Owner's title policy limit $ 183,000.00 1707. Agenfs portion of the total title insurance premium to Martson Deardorff Williams Otto Gilroy 8 Fai $ 1,380.39 1108. Underwriter's portion of the total title insurance premium to Old Republic National Title Insurance Comp: $ 243.61 1109. Closing Service Letter Old Republic National Title Insurance Corr�ny 75.00 1110. $ 1111. $ 1112. $ 1113. $ 1200.Govemment.Reco[din and TransferCharges 1201.Government recordin char es to Recarder of Deeds from GFE#7 770.00 1202.Deed $ 67.00 Mort a e S 103.00 Releases $ Other $ 1203.Trensfer taxes to Recorder oi Deeds (fram GFE#8) 1,830.00 1204.Ci /Coun tawstam s $ 1,830.00 5 1205.Statetaxlstam s $ 1,830.00 $ 1,830.00 1206. 1207. 1300.Additional Settlement Cha►ges ' 1301.Required services that you can shop for (from GFE�16) 1302.2014 Local Taxes to Charles Holtry,Tax Coliector $ 04-21-0324001 1,162.45 1303. Final Sewer 8 Water to Borough of Carlisle $ Acct#013068 87.29 1304. $ 1305. $ 1400:Total Settlement Charges(enter on Iines 103,Secfion J and 502,Section K) ' 7,857.53 12,229.74 •PaiO outsitle olUOSing Cy borrower(B).sellet(S),IenOer(L),or Ihirtl-party(T) ��DDD Bysigningpagato/IhisstatementihasignatoriesacknowlatlgereceiplofacompleteOCOpyolpage283o1Mi raep g arqanl � � //� Martson Deardorff Williams Otto Gilroy&Faller,SettiementAgent Page 2 of 3 HUD-1 (15642.1 MOSES/15642.1 MOSES/42) ' Comparison of Good Faith Estimate(GFE)and HUD-1 Charges Good Fakh Estimate HUD-1 Charges That Ca�not Increase HUD-1 Line Number �Our origination charge #801 595.00 595.00 Your credit or charge(points)far the specific rate chosen #802 320.00 320.00 Youradjusted origination charges #803 915.00 915.00 Transfer taxes #1203 1,830.00 1,830.00 Charges That in Total Cannot Inerease More than 10h Good Faith Estimate HUD-1 Government recording charges #1201 238.00 170.00 Appraisal fee # 804 425.00 425.00 Total 663.00 595.00 Increase between GFE and HUD-1 Charges $ -68.00 or -1026°/ Charges That Can Change Good Faith Estimate HUD-1 Initial deposit for your escrow account #1001 2,600.00 2,430.45 Dailyinterestcharges # 901 $ 14.904100/day 298.08 298.08 Homeowner's insurance #903 600.00 0.00 Title services and lender's title insurance #1101 1,773.75 1,486.50 Owner's title insurence to Old Republic National Title Insurence #7103 275.00 302.50 Loan Tertns Your Initlal loan amount is $128,000.00 Your loan term is 30.00 years Your initial interest rate is 42500% Your initial monthly amount owed for principal,inlerest and $629.69 includes any moRgage insurance is Q Principai � Interesi � Mortgagelnsurance Can your interest rete rise7 QX No � Yes,it can rise to a mabmum of °h. The first change will be on and can change again every_months after . Every change date,yourinterestrate canincrease ordecrease by °h. Over the life of the loan,your inlerest rate is guaranteed to never be lower than %or higher than %. Even if you make payments on time,can your loan balance rise? �X No � Yes,it can rise to a ma�dmum of$ Even if you make payments on time,can your monthly �X No � Yes,the first increase can be on and the monthly amount owed for principal,interest,and mortgage insurence risel amount owed can rise to$ The maximum it can ever rise to is$ Does your loan have a prepayment penaity7 QX No � Yes,your maximum prepayment penalry is$ Does your loan have a balloon payment7 QX No � Yes,you have a balloon payment of$ due in_years on Total monthly amount owed including escrow account payments ❑ You do not have a monthly escrow payment for items,such as property taxes and homeowner's insurance. You must pay these items directly yourseli. �X You have an additional monthly escrow payment of$343.14 that results in a total initial monthly amount owed of$972.83. This includes principal,interest,any mortgage insurance and any items checked below: �X Propertytaxes �X Homeowner's insurance � Floodinsurance � QX School Taxes ❑ Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form,please contact your lender. Page 3 of 3 HUD-1 (15642.1 MOSES/15642.1 MOSES/42) HUD-1 Attachment Borrower(s):Andrew J.Moses and Samantha Moses Se11eKs): Estate of Marian L.Groninger 438 West Penn Street 1041 West South Street Carlisle,PA 17013 Carlisle, PA 17013 Lender:Members 1st FCU Settlement Agent:Martson Deardorff Williams Otto Gilroy&Faller (717)243-3341 Place of Settlement:10 East High Street Carlisle, PA 17013 Settlement Date:May 12,2014 Properly Location:1041 West South Street Carlisle,PA 17013 Cumberland County, Pennsylvania Adjusted Origination Charge Details Origination Charge Origination Fee 595.00 to Members 1st FCU Total $ 595.00 Origination CrediUCharge(points)for the specific interest rate chosen Charge for 4.25 interest rate 320.00 to Members 1st FCU Total $ 320.00 Adjusted Origination Charges $ 915.00 Reserves Deposited with Lender Homeowner's Insurance 137.01 3.000 at 45.67 per month City/County Property Tax 3�9•72 4.000 at 94.93 per month School Property Taxes 2,430.48 12.000 at 202.54 per month Aggregate Adjustment -516.76 Total $ 2,430.45 Title Services and Lender's Title Insurance Details BORROWER SELLER Closing Service Letter 75.00 to Old Republic National Title Insurance Company Electronic Document Production 50.00 to Martson Deardortf Williams Otto Gilroy&Faller Overnight Mail Fee 20.00 to Martson Deardorff Williams Otto Gilroy&Faller Incoming Wire Fee 20.00 to Martson Deardortf Williams Otto Gilroy&Faller Lender's titie insurance 1,321.50 to Oid Republic National Titie insurance Company Total $ 1,486.50 $ 0.00 WARNING: It is a crime to knowingly make false statements to the United States on this or any similar fortn. Penalties upon conviction can inelude a fine and imprisonment. For details see: Title 18 U.S.Code Section 7001 and Section 1010. (15642.1 MOSES/15642.1 MOSES/42) _ _ _ _ _ . � HUD-1 Attachment- Continued Owner's Title Insurance BORROWER SELLER Owner's Policy Premium 302.50 to Old Republic National Title Insurance Company Total $ 302.50 $ 0.00 Lender's Title Insurance BORROWER SELLER •fees also shown above in Title Services and Lenders Title Insurence Details Lender's Policy Premium 1,040.00 to Old Republic National Title Insurance Company Lender's Endorsement Charges 281.50 Endorsement Endorsement Charge Endorsement PA 100(No Apparent Violation of 50.00 Restrictions) Endorsement PA 300(Survey Exception) 50.00 Endorsement PA900(Environmental Protection Lien) 50.00 Endorsement PA 1030(Special Risks) 131.50 Total $ 1,321.50 $ 0.00 WARNING: It is a crime to knowingly make faise statements to the United States on this or any simiiarfortn. Penalties upon conviction can include a fine and imprisonment. For details see: Title 18 U.S.Code Section 700'I and Section 1010. (15642.1 MOSES/15642.1 MOSES/42) _ _ _ Buehler Wealth Management Group Te1717-761-7344 of Wells Fargo Advisors Fax 717-975-8426 800-468-8685 ' � • � Wells Fargo Advisors,LLC 3 Lemoyne Drive 3Lemoyne,PA 17043 Member FINRNSIPC November 19, 2012 �� Irwin& McKnight, P.C. '�i � � �� Attorney Mattliew A. McKnight �� West Pomfret Professional Building ��`��q�c�(�;GN-t 60 W. Pomfret Street e�p��F�ICE� Carlisle, PA 17013-3222 Re: Tlie �state of Marian L. Groninger Date of Deatti: Uctober 23, 2012 Social Security#177-24-6763 Dear Attorney McKnight: Listed below is ttie date of deat�i values for account#3878-3212. At ttie time of Mrs.Groninger's deat�i, slie tield a single account wit�i Wells Fargo Advisors, LLC registered in �ier name. Tlie referenced account was opened Janua�ry 25, 2002. Quanrity Security Name Market Price Value 400 �nron Cap Res 9�Pfd $ - $ - 62 AT&T $ 35.00 $ 2,169.99 253 Alcatel-Lucent ADR $ 1.U7 $ 270.70 400 Baiik of'America $ 9.36 $ 3,744.00 3 DUSA Pliarmaceuticals $ 621 $ 18.63 200 General Electric $ 21.28 $ 4,256.00 7 LSI $ 6.45 $ 470.85 1000 Pengrowtti Energy $ 6.20 $ 6,200.00 17 Pordaiid Geiieral Electric $ 27.44 $ 466.48 33 Thoniburg Mortgage $ - $ - 76.754 Hartford Capital Appreciatioii Fuiid-A $ 32.61 $ 2,502.93 1021.400 Loomis Sayles Iiiv Grade Boiid Fuiid-C $ 12.69 $ 12,961.51 1067.456 Pimco Total Retuni Fuiid-C $ 11.57 $ 12,350.40 411808 Templetoii Global Boiid Fuiid-C $ 13.49 $ 5,555.27 838.202 Wells Fargo Asset Alloc.atioii Fuiid-C $ 12.30 $ 10,309.85 Jennifer L.Buehler,MBA E.Thomas MeKee,MBA,CRPC� Senior Vice President-Investments Financial Consultant Financial Advisor tom.mckee@wellsfargoadvisors.com jennifer.buehler@wellsfargoadvisors.com Lynda K.Neff Kendra Meyer Tricia Mankosld Senior Client Associate Registered Client Associate Registered Client Associate lynda.neff@wellsfargoadvisors.com kendra.meyer@wellsfargoadvisors.com tricia.mankoski@wellsfargoadvisors.com Buehler Wealth Management Group Te1717-761-7344 of Wells Fazgo Advisors Fax 717-975-8426 � 800=468-8685 � � � Wells Fazgo Advisors,LLC 3 Lemoyne Drive .Lemoyne,PA 17043 e Member FINRA/SIPC 15,000 8Enrou Corp 9.875ryo 6/15/2013 $ - $ - 1622 FI'UTILS SLCT PRT 17 C $ 10.13 $ 15,516.70 50,000 FNR 06-22 YB 5.5gb 2/25/2036 $ 100.64 $ 50,319.00 10 PENNA IMIT 99 M � $ 123.17 $ 1,231.70 10 PA IMIT 2.26 M $ 144.18 $ 1,441.80 Please do not liesit��te to contact t�ie office wit�i any questions. Sincerely, -�,��1��-- � � Iti �,` Kendra A. Meyer Registered Client Associate This report is not the official record of your account. However, it has been prepared to assist you with your investment planning and is for informational purposes only. Your Wells Fargo Advisors Client Statement is the official record of your account. Therefore, if there are any discrepancies between this report and your Client Statement, you�should rely on the Client Statement and call your local Branch Manager with any questions. Cost data and acquisition dates provided by you are not verified by Wells Fargo Advisors. Transactions requiring tax consideration should be reviewed carefully with your accountant or tax advisor. Unless otherwise indicated, market prices/values are the most recent closing prices available at the time of this report, and are subject to change. Prices may not reflect the value at which securities could be sold. Past performance does not guarantee future results. Jennifer L.Buehler,MBA E.Thomas MeKee,MBA,CRPC° Senior Vice President-Investments Financial Consultant Financial Advisor tom.mckee@wellsfargoadvisors.com jennifer.buehler@wellsfargoadvisors.com Lynda K.Neff Kendra Meyer Tricia Mankosld Senior Client Associate Registered Ciient Associate Registered Client Associate lynda.neff@wellsfargoadvisors.com kendra.meyer@wellsfargoadvisors.com tricia.mankosld@wellsfargoadvisors.com -- ._ _ _ _ :;,. . ;.,.,.. _ _ _______ .__ ____ _ _ _ - .. . ,... _ _ _ _—�-.��__-___, r. � . .�._ � '�� , �� : �y � APPRAISAL SUMMARY � ;"� z � - � 9��; It is in my opinion, that as of the d.o.d. October 23, 2012 and reported on May 15, 2013,the Fair � ' Market Value of the Estate Personal Property of Marian Groninger, deceased: Total Part I &Part II (Three Thousand Three Hundred Fifty Six Dollars and ThiRy Seven Cents ($3,356.37) Part I.•Items Recorded&Inventoried on April 10, 2013 (One Thousand Nine Hundred Ninety Two Dollars and Forty Four Cents) ($1,992.44) Part II.•Items Recorded&Inventoried on May 09, 2013 (OAe Thousand Three Hundred Sixty Three Dollars and Ninety Three Cents) ($1,363.93) I�is A��Yaisa� Serv�ices ACyssa . ney, ISA AJI�t lnirector The report must be read in its entiretu The Appraisal Summarv ONLY is not the appraisal repor� �6is/-�P�raisa� �jervices Page 5 of 21 � �� 499 Mitchell Road,Milisboro,DE 19966 Adjustrnent Services Phone 888-502-4349 F ax (302)934-2955 November 14,2012 Irwin& McKnight,P.C. West Pomfret Professional Building 60 West Pomfret Street �� Carlisle,PA 17013-3222 �ov � o ?a�� tfiWii��iCitMiGFl3� Re: Estate of Ivlarian L.Gronin�er - �,�� Social Securitv: 177-24-6763 Date of Death: October 23,2012 Dear Sir or Madam: Per your inquiry on November 5,2012,please be advised that at the time of death,the above-named decedent had on deposit with this bank the following: 1. Type ofAccount CheckingAccourrt Account Number 38839121 Ownership(Names o� Lynn g.Beinswanger Marian L. Groninger Joan Hall(POA) Opening Date 08/28/1967 Balance on Date ofDeath $15,499.56 Accrued Interest $ .07 __......__......._..._.__..._..._...._..__.........................._........___._...__..........._............ Total $15,499.63 2. TypeofAccount SavingsAccount Account Number 15004212519423 Ownership(Names o� Joan Hall(POA) Lynne G.Beiswanger Marian L. Groninger Opening Date 12/01/2005 Balance on Date ofDeath $17,924.03 Accrued Interest $ .32 _...._...__.__................_...................._...._..._..........._..........................._.................. Tota! $17,924.35 6 .— . '� �, .�; . . " f r T�ra�'�action Confirrnation . . � m T��o �o�i� - Nat�onwnCle � � �$� � ' On Yv�ir Side� �` ` � � s , £ � � n �an°f��c .� 01-5950'I 16�_ ,� � ` ` � - 1 C�S N 3e C =. k t �- k . ` 4� ' 4 : ' r Wa�rr�,,b��rn�uity Portfolio II ` z I S �. ,f a '. ', ' t ... � r. .,i.� ..' �..,� �.,.' \ � ,4.h.,.*.e��:i�„x,.�1J.w..', .... ,......��...� ...... '�,._� , ,:•,... Y_x_,. �' ' - j ... " _.. :-c '��.....�.... .. . .... , r...� i.. .". � . .-:� . ........ ... . �� t ,S, . . . . .. :. . � . . '.� �.. _ r_. -' . . ... t. ., s.-.. ..S .. , `a_t_, .. . .. e_ �- � .. , vtr.-��.. = 'z. J:� ��' MARIAN B GRONINGER How to Contact us: 1041 W SOUTH ST CARLISLE PA 17013-2718 www.nationwide.com Your Investment Professional Na6onwide Lffe Insurance Company P.O.Box 182021 SHAWNEE E SMITH Columbus oH 43218-2027 M TSECURITIES Custome�Service:l-B00-848-6331 1 W HIGH ST Hearing Impaired:7-800-2383035 24 hr.Automated Information Line:1-800-321-9332 CARLISLE PA 17013-2951 Contract Issu�date: 10/05/2006 Plan type:IRA Owner: MARIAN B GRONING�R Annuitant: MARIAN B GRONINGER � Your Account Summary � � .�n�� _.� �� f}4�� Beginning Balance on 01/01/2012 $60,517.11 n lJl, v`, � Contributions $0.00 � ,/ � Withdrawals/Charges ($4,705:27) � � ��--� �� + �� 'Change in Value �2,827•87 � Current Value as of 11105/2012 $58,639.71 � � ,J� �This is the net amount of investment gains or losses during each period. The change in value includes the deduction of charges as outlined in your prospectus. � Please read your confirmation carefully and no6fy us within 30 days if you \� discover any potential errors by calling 1-800-848-6331. We recommend Q�, �1 keeping this confirmation with your other important financial documents. �\� Thank you for choosing Nationwidem. 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Please feel free to contact us if you have any questions in regard to this statement. � THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES,FACILITIES,AUTOMOTIVE EQUIPMENT, � I AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. 1. PROFESSIONAL SERVICES Basic Services ofFuneral DirectodStaff . . . . . . . . . . . . . . . . . $1200.00 � Bathing&Embalming . . . . . . . . . . . . . . . . . . . . . $895.00 ( Dressing,Casketing,Cosmotology etc. . . . . . . . . . . . . . . . . . $295.00 i 2. FACILITIES/SERVICES/STAFF/EQUIPMENT Basic Use of Facility. . . . . . . . . . . . . . . . . . . . . . . $200.00 � Document Prep/Permanent Recording. . . . . . . . . . . . . . . . . . $325.00 � Facility Usage for Viewing/Visitation. . . . . . . . . . . . . . . . . . $375.00 S StaffUsage for Viewing/Visitation. . . . . . . . . . . . . . . . . . . $375.00 � Staff for Graveside/Interment . . . . . . . . . . . . . . . . . . . . $125.00 � 3. AUTOMOTIVE EQUIPMENT Vehicle to transfer remains to Funeral Home. . . . . . . . . . . . . . . . $295.00 Hearse(Casket Coach) . . . . . . . . . . . . . . . . . . . . . . $295.00 Safety Lead/Clergy Caz . . . . . . . . . . . . . . . . . . . . . . $135.00 Utility Car. . . . . . . . . . . . . . . . . . . . . . . . . . $135.00 s Family Car. . . . . . . . . . . . . . . . . . . . . . . . . . $250.00 FUNERAL HOME SERVICE CHARGES . . . • • • • • • • • • $4900.00 SELECTED MERCHANDISE: 20G Spartan Coral Gasketed Casket . . . . . . . . . . . . . . . . . . $1350.00 #12 Guardian OBC in copper paint. . . . . . . . . . . . . . . . . . . $1395.00 Acknowledgement cazds. . . . . . . . . . . . . . . . . . . . . . $10.00 i Register Baok(s) . . . . . . . . . . . . . . . . . . . . . . . . $40.00 , Memorial folders . . . . . . . . . . . . . . . . . . . . . . . . $8�.00 i THE COST OF OUR SERVICES,EQUIPMENT,AND MERCHANDISE THAT YOU HAVE SELECTED . . . . . . . . . . . . . . . $7780.00 Cash Adv�nces � SentinelObituaryw/Photo . . . . . . . . . . . . . . . . . . . . . $Z��•�Z Certified Copies of Death Certificate . . . . . . . . . . . . . . . . . . $60.00 Clergy Honorarium . . . . . . . . . . . . . . . . . . . . . . . $125.00 TOTAL CASH ADVANCES AND SPECIAL CHARGES . • . . . . . . $455.12 Total Total Cost . . . . . . . . . . . . . . . . . . . . . . . . . . $8235.12 QVC►�.��e� �� " SUB-TOTAL $8235.12 ,.`�' INIT[AL PAYMENT/DISCOUNT/CREDITS 100.00 � Cu�y C��v�� TOTAL AMOLMT DUE $8135.t2 ��,p�� / � To 6e I��£PtiJCd The unpaid balance over 30 days is subjectcd to a I.50%service charge per month-18.0000%per annum. I EWING BRUTHERS 63�i S. HANOVER ST CARLISLE. PA 171�15 i Merchant ID: 00006�3a01243335 Terni ID: 01825076 23522603�999 Sale 19C XXXKXXXXXXxX2176 Entr� Method; Swiped � Rpprud. Online Batcy�; ��EdSi 14�2��12 i2;51;10 I�u �; O��01 �PPr Codr; ��iP�1 iotal; # 8�13�,12 Custoiner COPY R��Ll�S� �� '�� `� 9�'i 9��Li9LE ROi� ° GilMP NILi„i�A 17091 " (747)3B�-406� �;�, �1��2� Contract File Folder Name/Number CEMETERY INTERMENT RIGHTS,MERCHANDISE,AND SERVICES PURCHASE/SECURITY AGREEMENT THIS AGREEMENT PROVIDES FOR PERPETUAL/ENDOWMENT CARE. The undecsigned,referred to as`Purchaser',hereby agtees to purchase the Idtermeat Rights,Machandise and Services described herefn,subject to acceptence snd epproval of j the above named cemetery,hereaFter roferred to as`Seller'. Purchaser:Lusc Name:'� �� N�(�.Z I I I I I I I � I F1t5�: L�! 1��PU iE i I I I I I I I I Middie: � I I I I I I Telephone:�� g�—b_�� SSN: _ DOB: � � Email: Address:-� l�}.I I �3fl7f�"L��-!1 I U I I I I I Ci�y: ,li If/f}��7�.1J I I I I I state: '� I 2'p' ��y Co-Purchnser:I,ust Nnme: I I I I I I I I I I I I I I I I I I First: I I I I I I I I I I I I � � Middle: � I I I I I I Telephone:�_� . _ SSN: _ _ DOB: _1 � Email: Address: I I I I I I I I I I I I I I I I I I I I I I I I I I C'�y` I I I I 1 I I I I I I I � Stnte: �� Zip: Deceased:Lnsc Name: (�.f�,7 n�(N � `��"��R I I I I I I I � � Firsc: � � � � � � � I I I I I I � Middle: I I I I I I I I DOB: � /�_/ I(�3o DOD: Ia /a:z /�(� Burial Dnte: �� Veleren: ❑ JescripHon af Inte:ment Rights to be used: ,3�� .,, ��._ G�� _Memorie!ization Rights: Issue Certificute of Interment Rights to: B Address: City: State: Zip: INTERMENT MERCHANDISE&SERVICES • Interment Rights $ ' • Urn — (Includes Perpetual/Endowment Care of$ ) � Supplier • Interment and Recording Fees l�i�'�.� Type/Color • Outer Burial Container Design/Size Supplier • Admin/ProcessingFee �ab ,u� � Model/Design • Other �i- - ��-+'n-��' _ - 1�-C•�l� j MateriallColor • Other I • Other � � • Outer Burial Container Installation °" � MEMORIALIZATION • Other T I • Memorial�c�,tThr?n ��.C�11 • Other Supplie� b'"1 �!-LnI,JS _ • Other l Type/Color �� TOTALS, ALLOWANCES&TAXES Des�gnlSize� �! ` • 4."r.j�01 11 c�e�nA c�c ln • Interment Rights............................................................... ( - ) I • Memorial Base ��G�.�A 12 �C4�.� Reason � `` c�-� cM �.�� _ � Supplier . p � MerchandiselService........................................................ ( . ) 1 I � Type/Color C.-{�-�� Reason � �" nncion/c;�<� _'7 G v • '� • '' APP�Y�0 ! i ° • Menhandise/Service........................................................ ( " ) i �a, ��;� � Zc�a,l�l Reason � I .�ao:: �p �~� 0� } � Apply�O I } m� M�s �t G. — SubTotal .�C��l.� I w ^ m ( "'am � N =~_ � f�.1 — Total Taxable " �&� X `" a `. ' sw° X y�j ` • Sales Tax(if applicable)................................................... � W�� X � TOTAL CASH PRICE $�F�4� �Ul� °1O`�= X �, O �� X �" � Less: Down Payment��f�� M� X mti J � Other I c°e X m�— a t� 1'r,f'.p �/�n �z XW°xm — Total Down Payment ( �-r��%) � xc XJ��m � �� Xa"�'" r Unpaid Balance of Total Cash Price $ —�� r'� `iz�Nmo�°++ i - ucauie._- - - A c v ! � � , � . � _ _ ._ ._ �d �n , a �. �' r � � y � . H C� � � b i � v . m , � � �a ,.. 0 � � O Z 0 C7 a . � � � � m iY � 0 . - . , � . � N _ 3 � � ,�. � 3 , � � � � : � � ^ O U v " ° � � _ . . C a . �D � � ; y o 3 � o » _ ys � ' .., j � t�ii O � - o tn U O o U � O O � ' .. . ......._.._. _ ... . ..�. . .,' . ..:..� ..�_ . . . ._ . . . . ._.._._ i � I _ . ' � i � I . � `_ f � a � � � ; �.� � � �' 7 I � � � oa � O �, °u- � � . v , y � � � .�► O � , � � i ' � Z O � � G � � N � � O , __ � � � � � � 3 " . � b 3 � � � �° c'y ' - �, � � � o � v � o � . : �:. -c a c� �« � a D � o �. c � � � � N 64 N - . �. . N lr �l O J O O O O � � Invoice Date Invoice# "5/2/2013 3194 0� �� L.L.C. 456 Burnt House Road Carlisle PA 1709 5 717-218-0223 Bill To Marian Groninger io4i W.South Street Carlisle,PA i�oi3 P.O.No. Terms Project , Due on receipt Quantity Description Rate Amount i clean up ad mow i2,5.00 i�.00T PA Sales Tax 6.00% 7•50 1 . ��/'G��"""" ��/ • TOt� $i32•5o Payments/Credits $o.00 Balance Due $132.So 4� Invoice Date Invoice# . 7/9/2013 3343 ��• L.L.C. 4S6 Burnt House Road Carlisle PA 97015 T17-218-0223 Bill To Marian Groninger io4i W.South Street Carlisle,PA i�oi3 P.O.No. Terms Project Due on receipt Quantity Description Rate Amount 4 6/5 6/i2 6/i9 6/25 Weekly Mowing 45•5o i82.00T PA Sales Tax 6.00% io.92 � � � � � Total $192•92 Payments/Credits $o.00 Balance Due $i92•92 J ' S.' y t., � - �x rv .��r . .. . ., � . . . . �A�� :: �,�,,� �,+,u. .�,�,�, ,µ�,� � �� Statement . , d p 4:J,.. s �.., .... �. � _ .. � _ � � . � ' Date , .. .._ ;. , � ,....Nll�.b:. . � G�WN�A17�1s �„�,..� ; �` , _ . � 3 3C�3 ,�2s�zo�s � �r � �- * ,., To.�_ ��..�... ; __� , , ��`�EIV�� , ._ : , � �� E Manan Groiunger . � C � �� io4i W:South Street ; ; SC� `� � 2�� "� i:Carl�sle,�PA i�oi3°. `° � t ' IRWIN&NlcKNIGHi' �' ' (A��CES � � ;:.�, �; - � S , . : , � '. , ' s , 3 �. �...�._�..._____....___.��_ _��_ ,._..� _ : . . : : _ : Ai110llIIY Dll2 Amnnnt�no_ - -_ ._.__ _ --- - - $96.46 _ _ ; Date i Transaction Amount Balance . 06/o2/2oig ;INV#3274.Due o6/o2/2oi3.Orig.Amount$q6.46. 9b•4b 96•46 ---Weekly Mowing,2 C�$45•50=91.00 ---Tax:PA Sales Tax @ 6.0%=5.46 Please in�lude invoice numbers;o be pard on yoru ' c6eck. This wi!/he/p to make sure your payment is posted correctly. Thank You! � �/l:J � J� � . ' • .� �� /WJ ./�n J�' � ` CILJ�eJ1,�c.�-Q.. � , �"""^''"� , J� CURRENT 1-3o DAYS PAST 3i-6o DAYS PAST 6i-90 DAYS PAST OVER 90 DAYS PAST �ount Due DUE DUE DUE DUE o.00 o.o0 96.46 0.00 0•00 $96•46 ,: . Invoice � Date Invoice# r � . 8/i/2oi3 3399 �� t.L.C. 456 Buret Houso Road Carlisle PA 17a1 S T1��1s-d223 � Bill To . ':Marian Groninger _ ; ;io4i W.South Street ; ;Carlisle,FA i�oi3 ; _. __ _._ .._ __. __ ._, : _ _ _Y.O.No. Terms Yroject Due on receipt Quantity Description Rate Amount 4 j�/2-io-i9-3i Weekly Mowing 45•0o i80.00T PA Sales Tax 6.00% io.8o � �/�� Please indude invoice numbers to be paid on your c6eck.Tbis wi!lheJp to make sure yourpayment is posted comecdy. T6ank You! Total $i9o.so Payments/Credits � $o.00 Balance Due �190.80 �_; . yr +`�'}?+ r y �.� }r� ' > 44x . � . - � ��4 tY � ��l� .�.r.y.� '''.3`k�'�1 s � . .. �- , �,�� : a l� : . Invoice Date Invoice# .* `. �-- 9/3/2oi3 3458 I� �� . L.I.:C. 456 8at»t Na�so 1'to�d. C�itl�sh�PA 1'�b1�v, : ,. � '?"�?-1''Ma-OZ23 � ' Btll To � ,S �' � __ ..�._..». . ......_. � t l j� Nianan Gronmger:', ; � io4i� South Street ; Car,lisle,PA:i�o1g . � � � � � � ,_ , .; . , , -, ... �, __. . � ' P.O.No. Terms � Project t , I._..._,.=-_._.___ . ._... -- -.__ ._ . _ �: ' ' Due on receipt _. .. _.__ _ _ __ i Quantity � Description Rate Amount . 2�August 9-2i Weekly Mowing 45.00 9o.00T , ;PASalesTax 6.00% 5•40 � / �� ' Total $95•40 Payments/Credits $o.00 . ' Balance Due $95•40 '. ;� �:; �:._;-,, _ _ _ _ =;�,� _ _- :I _ Invoice t.. _ Date Invoice# _ ii/ii/2oi3 3590 � � O L.L.C. 456 Bure►t Ha�s�Road Carlisla PA 77095 717-�18-p2�3 Bill To Marian Groninger 3194 C/O Irwin&McKnight 6o W Pomfret St Carlisle PA i�oio3 " P.O.No. Terms Projzct , Due on receipt Quantity Description Rate Amount fall leaf clean up i75.00 i�S.00T PA Sales Tax 6.00% io.5o Total $1H5•5o Payments/Credits $o.00 Balance Due $18550 � :, , , �. . �� ..�'._-_.T .-..'�'�' L ;: . �. - . � . . .�.� ' �; �_.- _ _- - - _ _ Invoice _ L Date Invoice# io/i/2oi3 3520 � � L.L.C. 45G Barnt Hoas�Raad Carlisle PA 77d75 717'-218-0223 Bill To Marian Groninger 3194 C/O Irwin&McKnight 6o W Pomfret St Carlisle PA i�oio3 P.O.No. Terms Project , Due on receipt Quantity Description Rate Amount 2 9/4, 9/18 Weekly Mowing 45.00 9o.00T PA Sales Tax 6.00% 5.40 Total $95•40 Payments/Credits $o.00 Balance Due $95•40 -:::>, HOFFMAN' ' • CONTRACTING� �N�i. 35 Chelsea Lane • Carlisle, PA 17015 • PhonelFax: (717)245-9259 www.hoffmanscc.com September 12, 2013 Lynne Beiswanger 1041 W. South St�eet Carlisle, PA 17013 CONTRACT • All carpeting including spraying urine be gone on all floors to get rid of smell $5,610.00 • Paint entire interior including walls/ceilings and all trim/doors white $5,105.00 TOTAL PRICE: $10,715.00 PAYMENT SCHEDULE: 50% Deposit on carpet $ 2,805.00 Upon completion of paint $ 5,105.00 Remainder of 50%of carpet installation $ 2,805.00 � � Z � Timot D. Hoffman, President Date Hoffman's Custom Contracting, Inc. PA 008224 R-I-18349-09-02545 Lynne Beiswanger Date � �UILD@IVG �A►RLISLE'S FIiVEST �USTOM �OIVIES � INVOICE BILL TO DATE INVOICE # Lynne Beiswanger 1/17/2014 2853 1041 W. South Street Carlisle, PA 17013 TERMS Net 10, 1 1/2% after 10 days DESCRIPTION AMOUNT Total clean out including windows, bathrooms, back porch, 397.50 kitchen, all floors etc. Please remit payment to: TOTAL $397.50 Hoffman's Custom Contracting, Inc. 35 Chelsea Lane Carlisle, PA 17015 ......�n w.__. 16is Appraisal Ser�ices, .�.�C 717 43-3474 1�'.O. �o.x 24 � ACyssa@i6isa�raisals.com 14S9V: �fanoverSt. w�rcv.ibi.sappraisaGr.com CarCrsCe, �A 17013 STATEMEI�TT May 15,2013 � Roger B. Irwin,Esq. Irwin&McKnight 60 West Pomfret St. Carlisle, PA 17013 RE:Part II Groninger Estate Personal Property Appraisal Dear Atty. Irwin: � Please find enclosed three hard copies and three digital copies of Part II of the Marian Groninger Estate personal property appraisal report. I ha.ve combined Part I and Part II into this one report. Should you need any more items appraised or have any questions and comments, please do not hesitate to contact me at Alyssa@ibisappraisals.com or (717) 243-3474. I can also provide extra copies if needed. APPRAISAL FEE: $300.00 PERSONAL PROPERTY.• $75.00/hour x 4 hours = $300.00 PERSONAL PROPERTY: Ibis Appraisal Services has reseazched, consulted, and appraised the personal property of Marian Crroninger, deceased (date of death October 23, 2012). The final report was completed and produced on May 15,2013. Thank you! Yours faithfully, Ibis ppraisa� r�ices Atyssa L. !. o�ey, SA A�t l�h'rectrn' ALL/all Enclosures � .: � , �: ; � Id�s :� ra�sal Serv�ces, ��C . � : ;- - pp � . �1 r)243-3474 P O. Box24 hlussa@i6isa��raisals com 145� �anover St ww�w.id rsappraisals.com . CarC�sle, P.�k 1 T013 STATEMENT .Apri1.16, 2013 Roger B. Irwin, Esq. Irwin&MeKnight _ 60 West Pomfret St. Carlisle,PA 17013 RE:Marian.Groninger Estate Personal Property Appraisal Dear Atty. Irwin: Please find enclosed three hard copies and three digital copies of the Marian Groninger Estate personal property appraisal report. Should you need any more items appraised or have any questions and comments, please do not hesitate to contact me at Alyssa@ibisappraisals.com or (717) 243-3474. I can also.provide extra copies if needed. APPRAISAL FEE: $225.00 PERS0IVAL PROPER7'Y.• $75.00/hour x 3 hours = $225.00 PERSONAL PROPERTY: Ibis Appraisal Services has researched, consulted, and appraised the personal property of Marian Groninger, deceased (date of death October 23, 2012). The final report was completed and , ,produced on April 16, ZO 13. ' Thank you! Yours faithfully, Ibis A��raisa� erz�:ices - � ACyssa L. . 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O O u�e � � y. m °' � : � � o N � ., , . � •, ro `� ~A � � � o°' � , s S. ;. b � a°, w � y9 yg � ° � o � � W � � w � � N :r � \ � fD �D O O �O O ,�p N .-. i i r,' � `'� d� O O O O O �l W F� � � A � �♦ � � �~ �`� 2022-1110F o,� Rd ��.�s � �20975 �� ,�.�,e � r�-e�' 6� Y DATE c, • CUSTOMER'S ORDFA N0. �� ' yoZ / — NAME _ ,,,� ' � � � �� ADDRESS CITV,STATE,ZIP � �. a ,�p�,�� MD� `�,� �PA1401�T�. . `� '� ��Q4D � �'� �\�, �� .1��rS ��'�� `��3�c�a � a� '� ��'� �r .' ; . �� a �.�.� a � u. �� ,� ?. ��e�. �� ♦ � �� `�� i� \.a ,g z�� ``*�c � �� .. ��'� �\ �. ��\\� �- ti*�\� �� a 4`' � ,�r�i�.a�i �'�� '`y� ` �\�� `C � � �\: �� .��.� E� � �R\.�� ,��`,?:�°l�"� � �\;v � F. � �. t :,'j . . �?�� .� �� .V�� :� �'�.�"`..; �',•PRIC� _ :.N��,UNT. -�.p�1�1'�1.�f�� ' - „3�,-:�:� .,�- � - ^1 � ' c�� p • � (.�� i n b �l� 0 � 3 s 4 � 5 ` �- '�'e 1� {' (��L' ti s L� � � 7 bS s 8 9 � � ,o �r °,cs,�o� » o S' �Jc�-�� c�o rvt . i t2 s . 13 74 -s= '� 15 U j 16 17 n OjMC�!1 1e ,j' r 1 L� � ��'i�► \ -,-� �=�.� . � �� E�P 8��x:�r � ;�` � �� , � �; �,, � �i� �� i*\l ` �. .�a:.�..�i..�.a.�:,�;� .�'.,. \ �.. �''' �. ,.,,.. . ., _a............... .:: ¢,�,�, KEEP THIS SLIP FOR REFERENCE � f� � P.O.Box 4650 "" � ' ACH/EDI Services Buffa�o,NY 14240-9975 *** This is an Advice *** (800)724-2240 Date: Thursday,November 08,2012 MARIAN L GRONINGER LYNNE G BEIS WANGER 1041 W SOUTH ST CARLISLE PA 17013-2718 Subject: No±ifc�tion of Death/Reclamation Case Number: 45899 Funds Deposited to Account: , ******9121 Funds Deducted from Account(s): ******9121 $1,240.00 This is to advise you that on 11/8/2012 we deducted from the account(s)shown above the amount of$1240 for the SSA Direct Deposit of 11/2/2012. Due to the fact that 1�ZARIAN L GRONINGER has passed away prior to the issuance of the credit,the Treasury of the United States is requesting reimbursement. In accordance with Federal Regulations, any subsequent post- death benefit payrnents should be returned immediatly,by ACH,to the Government Disbursing Office. If the number of the'account deducted from'is different from the account into which the funds were originally deposited,the deduction is authorized under the bank's rules for right of offset because one or more of the owners on both accounts are the same. Should you have any further questions about this charge,please call and refer to the case number above. This advice is provided to facilitate the reconcilement of your monthly account statement. Respectfully, ACH/EDI Services M&T Cardholder Name: MARIAN L GRONINGER I � CARECREDIT/GECRB Account Number: 8019 1830 8029 2642 - ' Statement Closing Date: 12/16/2012 ; GE Capitai taEt Bank : � .�. . . . 7 . . . .. .� �n aa� ;�" � �x p ��N ,��. . �r r,'G.,� t�A,��-+-3'F}�i`�{s 1y`�y �`iLrj?;,y -��. i � �.....� �. ^?,��n`• aty�'�4x n.. �1�1',.R�SF�a<:.;�'a.....15*::a� y �.r.�.,t�` � ; . �,uvs. s,:� ..� : _ -�� kt;,,� . : .. . ...�.. _ ., as,ssa.es� �� ' Previous Balance $5,784.65 New Balance ' + New I�urchases $0.00 Minimum Payment This Period $220.00 � , - Paym�nts $0.00 Amount Past Due $385.00 ; +/- Credits,Fees&A ustments(net) $35.00 Total Minimum Payment Due $616.00 �� +/- Interest Gharge net) $125.24 Payment Due Date 0110812013 � New BalaY�ce $5,954.69 pAYMENT DUE BY 5 P.M.EASTERN ON THE DUE DATE. We may convert your payment into an electronic debit. See Credit Limit $10,500.00 reverse side. Available Credit $4,545.00 DaYs in Billing Period 31 Late Payment Warning: If we do not receive your Total ; Pay online For free at:gogecapital.com Minimum Payment Due by the Payment Due Date listed above, �� ' For GE C�pital Retail Bank customec service or to report you may have to pay a late fee up to$35.00. your card lost or stolen,call 1-866-893-7864. Minimum Payment Warning: Making only the Total Minimum ' Best times�to call are Wednesday-Friday. Payment Due wili increase the amount of interestyou pay and the time it takes to repay your balance. For example: '�'��;�w,T�C��I�y��'�h*��j`+Fi� �> 5,a t�E� ; �Fl��v 1��{�' � }��i�if��l'�e[��'r,��a, �v�,,c� ��1Kf`��Ith� flldtE(� �.0 1a �S �'I�,�( � ��#i y n�t�kr`�f�,�(��`i ,� i � N 4�E7�'t��(F/��ys�k"t� ��,'s,,£��✓t!� y*i ; � � u i � 3 i� '�C�:� �i��- �M�� r �+,� ..."`'�k'�4��as"P`1j`'�a, �'�'` , il i :hr�Rst��<si.5'll� i��n15 i�r'ti�", x,.azrY.�. 'f .f;�r t�,)X°^�.�..��.„��v?..� ..i a�.a.w Only the minimum 18 years $75,OU1.00 i ' payment � if you would like information about credit counseling services, Call 1-877-302-8797. �[�h.y ...,��43�'y�.�y y� �` 4.} �-' i�, 'S��1�y M¢ n i ...,� . .,1. � r�'r i`�"c'£'C �""k_� if#v54�V�x��4��.:. .>..��.. r.L<t, i��. ..� � ` y: r . .... .., ...:.._i.. �._. ...._ ...>:, ,k.:_ , ,..�.__.. ..�:^ ..i .. ,.��,.. . , . Tran Date Post Date Reference Number Description Amount FEES 12/08/20i2 12/OS/2012 LATE FEE $35.00 ` � TOTAL FEES FOR THIS PERIOD 335.00 INTEREST CHARGED 12/16/20i2 12/16/2012 INTEREST GHARGE ON PURGHASES $�25•24 TOTAL INTEREST FOR THIS PERIOD 3725.24 �, � t eS� � F�d '��'{'�-��O�dr��1�'��t�.�s r�'t ' �`�rr. �ti 4.'��cafi�lu�,� 7 �av.�'l..�L_Y F srxv�..� 4A"a...��,3A...�`!...�y? , es�'1r'F'rl �,•.h�'o�... Total Fees Charged in 2012 $140.0 Total interest Charged in 2012 $5,031.8 Total Interest Paid in 2012 $1,390.00 i �I i� . x :a �t qF. t . S� t�� a4 !. a ��.,r �� -a r cn .t�//��■x +�� 1..F^"„n :-s a.� � y� � . .+ -s % ��..��s��Y��i��47Y1a��1�r� C 4..ri��..., :n..'�2,� LC �,.� ,...1., i.> � °�t�;I.. :'.7r.t��.��tP@.f{�u'�„�, 7 ,x7.�l.?�ar�ri>�:.��. ..,..:n ..�,� . . .�. .. ,..-`:;. � ,....<., ..,..3r .x.�e ,..r. J,.,M,. ..._., . , ,.�. .. �. . .. . . Expiradon Date Annual Balance Subject to Interest Charge Type of Balance Percentage Interest Rate � Rate(APR) CUrrent Transactions Purchases NA 29.99% $177.18 $4.52 Transactions on or before 09M512011 RegularTransactions NA 24•99% $5'68�'89 $�20.�2 "NOTICE: See reverse side and additional pages(if any)for important information concerning your account. 5302 0003 UFH 1 7 13 121216 0 PAGE 1 of 3 9072 3000 XE35 OlEJ5302 80733 �II — 5302 9072 3000 8000 C1RTC 3015 FN00028373