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Home My WebLink About07-03-14 REV-9500 °`(°'-t0' OFACIAL USE ONLY m PA Department of Revenue County Cod* Year FllaNurlbar ' M PO BO 2806 idualTaxes INHERITANCE TAX RETURN L0 PO sox 28o5ot 2 1 L 3 0 4 6 9 Harrisburg,PA 17128-0601 RESIDENT DECEDENT Social Security Number Date of Bath MMDDYYYY Date of Birth NIMDDYYYY r 0 3 1 9 2 0 1 3 ❑ 9 2 2 1 9 3 1 Decedent's Last Name Suffer Decedent's First Name MI H O O V E R A N N A M OfAppflcab te)FnterSurvTvingSpouse` InromiatfonBelow Spouse's Last Name Su1Rx Spouse'sF-ustName MI Spouses Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE tRWSTRK FILL IN APPROPRIATE OVALS BELOW Q 1.Original Return Q 2.Supplemental Return 3.Remainder Return(date of death priorto 12-1382) 4.Limited Estate 43.Future Interest Compromise(data of 5.Federal Estate Tax Return Required death after 12-12.82) ® 5.Decedent Died Testate 7.Decedent Maintained a Living Trust &Total Number of Safe Deposit Boxes (Rdaeh'C�syvi'�'CS)' (AaaetrCoprofiyasq 9.Lrtigatton Proceeds Received ❑ 10.Spousal Poverty Credit(date of death El 11.Election to tax under Sam 9113(A) between 12-31.91 and 1-1-95) (Attach Sch.O) CORRESPONDENT-THIS SECTION MUSTBECOhPLETED.ALL CORRFSPONDENCEAND CONFIDENftAI.TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number M A R C U S A N C K N I G H T , I I I 7 1 7 2 4 4 2 3 5 3 N C REGISTER Vcl, SUSE rn Y Pct O ro First line of address n y c^i r" •° .) r I R W I N & M c K N I G H T , P C '_ ?* r w ITS &000ndFnaot.adlr..ss p cy ' ' —a ii 'rT 6 0 W E S T P 0 M F R E T S T R E E T ° �p�p G 3 ChyorPostof5oa State ZIP Code pATEt&EO 7V p m C A R L I S L E P A 1. 7 0 1 3 Correspondents a-mail address; Underpenaktea pedvry.t dsdarethat l hava examihedthls return,irxluding=mnmrft schedules and staWwts,and lathe bestofmyknowiedge and belie( ill$ complete.DedaT62gMpreparorotharthanth,personal representovefs basedmap lnfonnatbnoWich preparerhasarry k=wWga. SHiNATURE F SON RFS N�tB OR FI NO RETURN DATE ^L' ADDRESS 8837 .PEDERFALES TRA L FORT WORTH TX 76118 SIGNATUREOFPR RER CrZRT REPHESENTATIVE ATE ADDRESS 60 WEST POMFRET ST ET CARLISLE PA 7013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610140 1505610140 J 1505610240 a u� REV 1500 EX Decedent's Social Security Number ,fG M aeeedenrsName: ANNA M- HOOVER U) RECAPITULATION r1. Real Estate(Schedule A) ................ ............ 0- 0 2. Stocks and Bonds(Schedule B) ............................. 2. 2 1 4 3 8 . 5 5 3. Closely Hold 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)....... S. 7 6 7 8 8. 2 3 6. Joiritly Owned Property(Schedule F) ❑ Separate Billing Requested......, 6. 1 4 4 2 2 3 . 3 4 7. Inter-Vlvos Transfers&Miscellaneous N -Probate Property (Schedule G) ri Separate Billing Requested ..... 7. 5 1 8 2 1. 6 9 8, Total Gross Assets(total Lines 1 through 7) ........................... 8. 2 9 4 2 7 1. 8 1 S. Funeral Expenses and Administrative Costs(Schedule H) .............. .. 9. 2 5 3 2 4 . 7 1 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) ............. 10. 7 6 3 4 . 1 3 it. Total Deductions(total Lines 9 and 10) ...............................11, 3 2 9 5 8. 8 4 12. Net Valuo of Estate(Line 8 minus Line 11) ............................12. 2 6 1 3 1 2 . 9 7 11 Charitable and Governmental BequestsfSec 9113 Trusts for which an election to tax has not been made(Schedule J) .............:....... 14. Net Value Subject to Tax(Line 12 minus Line 13) .......................14. 2 6 1 3 1 2 . 9 7 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sea 9116 (a)(1.2)X.0_ 0 . 0 0 is. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X.0 0 . 0 0 16. 0 . 0 0 17. Amount of Line 14 taxable at sibling rate x 12 11 . 0 0 17, 0. 0 0 16. Amount of Line 14 taxable atcoilateralrate X.15 2 6 2. 3 1 2 . 9 7 i8, 3 9 3 4 6 . 9 5 19. TAXDUE ...................................................... i9. 3 9 3 4 6 . 9 5 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Q Side 2 1505610240 1505610240 REVA500 EX Page ReNumber Decedents Complete Address: 21 13 0469 D DENTS NAME AGA M. HOOVER TlgETADCRESS 219gSTONEHOUSE ROAD In M CALISLE PAS 17013 r Tax Payments and Credits: t. TaxDuo(Page2,Unei9J (1) 39,346.95 2. Credits/Payments 55,000.00 A.Priorpayments 6.oiscount 1,967.35 TotalCtedds(A+g) (2) 56.967.35 3. Interest (3) 4. 11 Una 2 I greater than Una 1+tine 3,enter the difference.This is the OVERPAYMENT. Fill in oval on Page 2,Une20 to request a refund. (4) 17,620.40 S. If Una 1+Une 3 I greater than Une 2,enter the difference.This Is the TAX DUE (5) 0.00 Make check payable to:REGISTER OF WILLS,AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN"X" IN THE APPROPRIATE BLOCKS i. Did decedentmake a transferand: Yes No a. retain the use or income of the property transferred. ...................................................................... ❑ ED b, retain the right to designate who shall use the property transferred or Its Income; ............................... El MR c.retain a revers unary interesttor ................................................................................................ ❑ 0 d, receive the promisefrrifeof either payments,benefiitsorcaw? ....................................................... MX 2 If death occurred after December 12,1962,did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ❑ 3. Did decedent own an`in bust foe or payreVe-upondeath bank account or security all s orher death? _....... Q 4. bid decedent own an Individual retirement accouriL annuity orothernon-probatepropedy,which contains a beneficiary designation?.............................................................................:....................I� 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)(1.1)(ri)).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 V2 P.S.§9116(a)(1.2)]. • The tax rate Imposed on the net value of transfers to or for the use of iha decedents lineal beneficiaries is 4.5 percent,except as noted in 72 P.S.§9116(1.2)172 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 parentin common with the decedent,whether by blood or adoption. REV-ISM EX•(8.12) pennsylvania SCHEDULE B .+ 0EPARAE1ff0FRMWM o INHERITRNCETA%RErlm STOCKS & BONDS_ RODWI)ECEDW ES EOF FILE NUMBER ANA M. HOOVER 21 13 0469 C) All property Jointly owned with right of sumlvorshlp must be disclosed on Schedule F.: VALUE AT DATE N ER DESCRIPTION OF DEATH 1. 666.829 SHARES OF EXELON STOCK 21,438.55 566.829 X$32.15=$21,438.55 ( i 5 TOTAL(Also enter on line 2,Recapitulation) $ 21 438.55 if more space is needed,insert additional sheets of the same size REV-1509 EX+(0612) .. . rn pennsytvania SCHEDULE E ap mmARtnTirroFrstvsrvuE CASH, BANK DEPOSITS & MISC, INHMA IM TAX RMWI; c Rtsmarrtn2cEOeer PERSONAL PROPERTY ES�11TEOF., FILE NUMBER; At�dlA M. HOOVER 21 13 0469 0 Include the proceeds of fitigaGon and the date the proceeds were received by the estate. to All property Jointly owned wIth right of survivorship must be disclosed on Schedule F. **B�EEM N9MAER DESCW VALUE AT DATE PTION OF DEATH 1. MEMBERS 1ST FEDERAL CREDIT UNION-SAVINGS ACCOUNT#272471-00 21,376.63 2. MEMBERS 1ST FEDERAL CREDIT UNION-CHECKING ACCOUNT#272471-1.1 19,626.41 3. MEMBERS 1ST FEDERAL CREDIT UNION INVESTMENT SAVINGS#272471-05 13,747.09 4. MEMBERS 1ST FEDERAL CREDIT UNION=CERTIFICATE OF DEPOSIT#27247144 2,523.41 5. MEMBERS 1 ST FEDERAL CREDIT UNION-CERTIFICATE OF DEPOSIT#27247145 5,541.44 6. 1987 DODGE RAM 800.00 TITLE NUMBER 40174954302 7. PERSONAL PROPERTY-SETTLEMENT STATEMENT ATTACHED 13,27125 TOTAL(AlsoenteronUneS,Recapitulal'ron) 5 76788.23 If more space is needed,use additional sheets of paper of the same size. REV4509 EXa(01-10) Y eD pennsMama SCHEDULE F m DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANOEETAXRETURN O RESNENTOEtEDENT E$%7E OF: FILE NUMBER: ANNA M. HOOVER 21 13 0469 If an assetwas made jolRHy owned wtthfn ono yearof tho decedenYS date of death,It musthe reported on Schedule G. r SURVIVING JOINT TENANTM NAMES) ADDRESS RELATIONSHIP TO DECEDENT A,THOMAS W.TAYLOR 8837 PEDERNALES TRAIL FRIEND FT.WORTH,TX 76118 B,DENISE A.TAYLOR 8837 PEDERNALES TRAIL FRIEND FT.WORTH,TX 76118 C.ESTATE OF DOROTHY J.TAYLOR 60 WEST POMFRET STREET FRIEND CARLISLE, PA 17013 JOINTLY-OWNED PROPERTYi. LETTER DATE DESMPTIONOFPROPERTY %OF DATE OF DEATH ITEM FORJOINT MADE i mAUMHAMEOFNtWICtAI.tNSPMONANDDANKACCWtfrNUNBERORSOF LAR DATEOFDEATH DECEDENTS VALUE OF NUMBER TEtWIT I JOINT IDENnFYtNG NUM M ATTACH U$EDFORJOINTLY-HELD REAL ESTATE VALUEOFASSET INTEREST DECEDENTS INTEREST 1. A. 0312008 ACNB BANK-ACCOUNT#2187736 2,607.91 33:3 868.43 2. C. 0611971 14.5 ACRES,OLD STONEHOUSE ROAD,CARLISLE 113,000.00 50. 56,500.00 SOLD-SETTLEMENT SHEET ATTACHED 3. C. 1011972 216 STONEHOUSE ROAD,CARLISLE 168,000.00 50. 84,000.00 SIDECIFICIALLY DEVISED 4. D MEMBERS 1ST INVESTMENT SERVICES 5,709.81 50. 2,854.91 ACCOUNT NUMBER: SZV-400873 i TOTAL(Also entaron Une 6,Recapitulation) $ 144223 34 If more$pace is needed,use additional sheets of paper of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent ANkAM.HOOVER 21 13 0469 DBcUebfs Name Page 1 FlIa Number 4 SC%duce F-1 -Jointfy Owned Property C7 rn SURVMNG 40INTTENANT(S)NAMES) ADDRESS REWONSHiP TO DECEDENT D.VICTORIA L. SPESSARD FRIEND REV-1510 EX+(09-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER•VIVOS TRANSFERS AND DnMCTAXRMRN MISC. NON-PROBATE PROPERTY a IN C EST fE OF FILE NUMBER ANNA M. HOOVER 21 13 0469 W — m This schedule must he completed and filed if the answer to any of questions l through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY ITEM MBE INCLIIDEiHENM1EOFTHETRPNSFMERTHE IRRMIIONSKPTODECEDEMAA DATE OF DEATH OA OF DECD'S EXCLUSION TAXABLE NUMBER THEDATEOFTRANSFFR ATTACHACOP YOFTHEDEEDFORREALESTATE VALUE OF ASSET I INTEREST OFAPAJP VALUE 1. ALLSTATE LIFE INSURANCE COMPANY 40,692.39 100.00 40,692,39 ANNUITY#GA19259703 BENEFICIARY. THOMAS W. TAYLOR 2. MEMBERS 1ST INVESTMENT SERVICES 11,129.30100.00 11,129.30 ACCOUNT#52V 405708 BENEFICIARY. THOMAS W. TAYLOR TOTAL Also enter on Line 7,Recapltulagon) S 51 821.69 U more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(10-09) 0 pennsytvania SCHEDULE H p OEPARitAFNreFREVENUE FUNERAL EXPENSES AND U) IN11 MUIXETAXRETIM a RES@Eifr0ECEOfNr ADMINISTRATIVE COSTS ES TEOF FILE NUMBER AQA M. HOOVER 21 13 0469 >n m DocedenYs debts mustha reported on Schedule t. EM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: i. B. ADMINISTRATIVE COSTS: i. Personal Representative Commissions: Name(s)ofPsmonalReprasentathe(s) THOMAS W.TAYLOR 4,900.00 stmotAddrzas 8837 PEDERNALES TRAIL city FT.WORTH Sate TX ZIP 76118 Year(s)Comm sslon Paid: p, AttomeyFees: IRWIN&MCKNIGHT, P.C. 12,000.00 1 Fan*Exemption:(Ndecedears address is not the same as dalmonfs,attach explanation.) Cla'unant Sheet Address City State ZIP Retadonshipoigaimaotto Decedent 4, Probate Fees:REGISTER OF WILLS 463.50 6 Accountani Pees: 6. TaxRetumPreparerFees: PATRICIA A. ROSENDALE,CPA 500.00 FINAL FIDUCIARY TAX RETURN AND INCOME TAX RETURNS 7. CUMBERLAND LAW JOURNAL ESTATE NOTICE 75.00 8. THE SENTINEL-ESTATE NOTICE 189,54 9. CLOSING COSTS FROM SALE OF 14.5 ACRES(112 INTEREST) 585.00 10. KEVIN M.WICKARD-PUBLIC SALE COMMISSION 5,319.67 ii. BASSETT APPRAISAL SERVICES-APPRAISALS ON REAL ESTATE(2) 700.00 12. VITAL RECORDS'-DEATH CERTIFICATE 45.00 13. RTCAREY TRUCKING, LLC-TRASH CONTAINER 500.00 14. RECORDER OF DEEDS-RECORD DEED 67.00 TOTAL(Aiso enteron Line 9,Recapittda6an) 5 25 324.71 If more space is needed,use additional sheets of paperof the same sae. REV-1612 Ex.(12-12)- pennsytvania SCHEDULE I °_' °EPN`4FREVENUE DEBTS OF DECEDENT, u QaiEFdrr,NCETAxRMFol MORTGAGE LIABILITIES&LIENS O RMD0I.F0ECWFNF O ESTATE OF FILE NUMBER ANWA M. HOOVER 21 13 0469 V) r Report debts Incurred by the decadent prior to death that remained unpaid at the date of death,including unreimbumed medical expenses. ['ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH L ERIE INSURANCE HOMEOWNERS INSURANCE 435.00 2. CENTURYLINK-TELEPHONE 161.24 3. AT&T-TELEPHONE 42.27 4. PP&L-ELECTRIC 534.65 S. MSHMC-MEDICAL 70.07 6, QUANTUM IMAGING AND THERAPEUTIC-MEDICAL 9.76 7. CARLISLE REGIONAL MEDICAL CENTER-MEDICAL 648.61 8. CAROLYN R. McQUILLEN,TAX COLLECTOR-REAL ESTATE TAXES 4,667.12 t 9. CARLISLE HMA PHYSICIAN MANAGEMENT-MEDICAL 38.86 10. CARLISLE PHYSICIAN SERVICES-MEDICAL 42.91 11. CARLISLE PROPANE-UTILITY 463.66 12. ADVANCED DISPOSAL SERVICES-TRASH 94.34 13. AEGIS SECURITY INSURANCE-INSURANCE 126.50 14. CUMBERLAND GOODWILL FIRE RESCUE-AMBULANCE 187.52 t 15. HOSPITALISTS OF CENTRAL PENNSYLVANIA-MEDICAL 15.01 TOTAL(Also enter on Una 10,Recapitulation) S 7,634.13 If more space is needed.Insert additional sheets of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent ANY M.HOOVER 21 13 0469 De enrs Name Page 2 File Number 0 0 v SoRdule I-Debts of Decedent,Mortgage Liabilities,&Liens CM REM NQBER DESCRIPTION AMOUNT T6. GENOPTIX MEDICAL LABORATORY- MEDICAL 14.06 17, PA DEPARTMENT OF REVENUE-INCOME TAX 53.00 18. PUBLIC SCHOOL EMPLOYEES'RETIREMENT SYSTEM-REIMBURSEMENT OF 29.55 PENSION SUBTOTALSCHEDULEI 96.61 GRAND TOTAL SCHEDULER S 7,634.13 PEVA513 E3(�(ef•f0y Pennsylvania SCHEDULE J DEPARTMEM OF REVENUE BENEFICIARIES tW 1NHEmTANMTAXRE(UFN O RES1DUTOECEOM ES TEOF: FILENUMBER: AURA M. HOOVER 21 13 0469 Ln RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NU ER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not fist Trustee(s) OF ESTATE I;j TAXABLE DISTRIBUTIONS pndudenalht usaWistdhutions and transfers under Sac Btf6(a (12).1 1. GOURNEY WICKARD Collateral 500.00 2. BROOKE WICKARD Collateral 500.00 3. THOMAS W.TAYLOR Collateral 50%REMAINDER 4. ROBERT MARKLEY Collateral 20%REMAINDER 5. RICHARD W.TAYLOR Collateral 30%REMAINDER 6. ROBERT W.FAILOR,JR.AND KAYE N. FAILOR Collateral 210 STONEHOUSE ROAD 216 STONEHOUSE RD CARLISLE, PA 17013 ENTER DOLLARAMOUNTS 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 0113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: i. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART it-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. S It more space is needed,use additional sheets of paper of the same size. T IM I� OVWW �1/VW 1�VWYW//W/W L IM T- I, ANNA M. HOOVER, of Dickinson Township, Cumberland Couaiy, Pennsaijania, c o �.> eQ m M t> being of sound mind, disposing memory and full legal age, do hereby make,jgbsh�andclar`�9 this to be my Last Will and Testament, hereby revoking all Wills and Codici>i$r ofore made by me. 4> o -� q � c =z — `✓� --, Cn Ctl A ONE. I direct my Executor to pay all of my debts,funeral and administrative expenses as soon as convenient after my decease. Furthermore, I direct that all state, inheritance, succession and other death taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property composing of my gross estate for death tax purposes,whether or not such property passes under this will,shall be paid by the Executor of my estate, T WO. My Executor may, at his discretion, compromise claims, borrow money, retain property for such length of time as he may deem proper; lease and sell property for such prices, on such terms, at public or private sales, as he may deem proper; and invest estate property and income without restriction to legal investments unless otherwise provided hereunder. I authorize and empower my Executor to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor,in fee simple,as I could do if living. My Executor is authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said Executor. T W) 0 in in Cl) U) THREE. I specifically give,devise and bequeath the following: C) r A. To my great-niece,COURTNEY WICKARD.......$500.00 B. To my great-niece,BROOKE WICKARD...........$500.00 FOUR. All the rest,residue and remainder of my estate wherever situate I give,devise and bequeath as follows: A. To THOMAS W.TAYLOR.............................50% B.. To ROBERT MARKLEY................................20% C. To RICHARD W.TAYLOR............................30% If any of the above-named persons have predeceased me with living issue who survive them, then the share of said person will be equally divided by the 'issue of the one who has predeceased me. If any of the above-named persons have predeceased me without living issue, said share shall be distributed to those who are still living in equal shares. It is expressly understood that the term"living issue"does not include any stepchildren. FIVE. I hereby nominate and appoint THOMAS W.TAYLOR, to be the Executor of this my'Last Will and"Testament. If- lie is unable to serve or fails to survive me, I hereby nominate and appoint RICHARD W.TAYLOR as Substitute Executor of this my Last Will and Testament. SIX. No person(s) shall benefit hereunder unless such beneficiary shall survive me by thirty(30)days.. 2 a 0 0 LQ v r" M 5 U) rn r r SEVEN. No Executor or Substitute-Executor acting hereunder shall be required to post bond or enter security in this or any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this j(_' "day of February 201 L ��(SEAL) ANNA M.HOOVER Signed, sealed,published and declared by the above-named person as and for a Last Will and Testament, in our presence,who at said person's request,in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses. 3 Q h b O Q' C? ACKNOWLEDGMENT AND AFFIDAVIT a ' r WE, ANNA M. HOOVER, SHARON L. SCHWALM, and TRACI D. SMITH, the testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly swom, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her bast Will and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as a witness and that to the best of their knowledge the testatrix was, at that time,eighteen years of age or older, of sound mind and under no constraint or undue influence. A4N,N�A' M HOOVE,Rn / S7RON L. HWAL OD CI D.S TH COMMONWEALTH OF PENNSYLVANIA : SS: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by ANN .HOOVER,the testator herein, and subscribed and sworn to before me by SHARON . SCH Aland TRACI D. SMITH,witnesses,this 11th day of February 2011. COP,FMONMALTHOFMNNSYLVANIA Notapf Pubt Natarial3oai M.n @a L Nod,Noi;ry FUWC �CsARy RoNo Csunter2rd County Jhy Cnnmission Fapi.'as 9ap213,2097 "i�nbof:'ennaVY£hlu psscdaEan of Nd.3rizs o to0 o m . !� �v Ph7 Exelon Corporation r Exelon, Common Stock o o .o m Account Information Current Dividend Summary 2012 Total Dividends Year-to-Date Account Number 3402769003 Gross Dividend $350.09 Gross Dividends $1,400.35 Record Date 11!15!12 Federal Tax Withheld $0.00 Federal Tax Withheld $0.00 Payable Date 12/10112 NRATaxWithheld $0.00 NRATaxWdhheld $0.00 Rate Per Share $0.5250000 State Tax Withheld $0,00 State Tax Withhold $0.00 `r Record-Date Shares 666.829 Net Dividend $350.09 Net Dividends $1,400.35 r For online account information,please visit www.shareowneroniine.com If you have any questions,please call Shareowner Services: Toll-free:800.52643729 Local:6524504064 Refain rortax purposes YEAR: 2012 DIVIDENDS AND DISTRIBUTIONS OMB No.1545.8110 FORM-1099.OIV New your tax documents,and morewhlle signed into your account at shareowneronline.com. Exelon Corporation Common Stock WELLS FARGO BANK,NA . New users:enroll by selecting Sign Up Nowt Select Authentication ID,and P.O.BOX 64n54 then check I do not have myAuthenticahon ID. 23.2990196 EXC1 . ST.PAUL MN 55164-0854 . Tax Information is also available on our automated phone system at ,.A�l 800.626.8729 3402769003 203-24.8531 . Investment Plan Participants:Total dividends reported may Include ,5 O t ai company paid brokerage commission and/or discounts on purchases. $1,400.35 $1,400.35 ANNA M HOOVER TOO THOMAS W TAYLOR SUBJECT TO STA TOD $0.00 $0.00 RULES 26STONEHOUSEROAD CARLISLE PA 17015.9429. $0.00 $0.00 � Copy S For Recipient:This is Important tax information and is being furnished to the Internal $0.00 $0.00 Revenue Service.If you are required to fits a return,a negligeaeo penally or other sanction may ' e- be Imposed on you If this Income Is table and the IRS detemhines that it has not been reported. $0.00 NIA Confidential „ta12 II(/III(/III(Illllllllllllfll(IQIII(IIIIIilllll(I(VIII(i(IIIIIIIII(IIIIIIII(Illlllllil(I -ZEXC1U2911960611 I i IYIYIYIY- EXC Historical Prices(Exelon Corporation Common Stock Stock-Ya..., http://Snance.yahoo.comlq/hp?s=EXC&a=02&b=19&c-2013&d=02..: .� Home Mao News Sports Fire= vrpauter Games Groups AMY= Screen Flicks Mobile I More s— CD Us C m Finance Horne My Portfolio Market Data Business It Finance Personal Finance Yahoo Originals CNBC �•"'® Tut Mar 1%2011 e.40AM EDT-US NVkebdM In 6M mid 20mn3 Let Dow+0,27%Nasdaq+0.41% d' T ..Fderr2lr ", p � 7raee Exclon Corporation(EXC) -NYSE * roliow Got the big Picture on all your lnvostments. 31.01 *0.01(0.03%) 0s9M1EDT-Nasdaq Rcal Time Prloe Sync your Yahoo portfolio now Historical Prices Gee Historical Prices ran. ;TiP, Set Data Range C,DFty salt Date: Mar 19 ( 013 pEp.Jmt,3010 0Meky Four Date•.FlAor j 19 t .013 0 McnUdy t,Dividends only ,¢e[Pikos.� Flat I Previous I Next I last 1 Prices ogle open 149h Low Om 14Mno Close* Mm 19,2013 3330 3335 332$ 33,47 7,021400 32.15 •Cos,pdco ad}dlea for audendsand q%tL Ron I Previous I Nasal Lest ADownloed to Spreadsheet cononcy In USD. i X66 r ��9 Sbo Ad Topics That Might Interest You... 1.Buy EXC Stock S.Best Penny Stocks to Buy 2.Buy Healthcare Stocks 6.Stocks to Buy Now ` 3.Free Health Insurance 7.Penny Stocks to Own 4.Discount Dental Instrumonts S.Top Stocks to Imest In Feedback ads play-r wrat.7o a, .roFeaow.YahDol-ABC News Network 1 of2 3/18/2014 9:40 AM 0 764o. 15a I e $13, a 70, ' 5 FINAL SETTLEMENT / SELLEgNAME n a �j �`u dbq-er F s+a of DATE OF SALE u , a—44 201 ADDf�SS � JTOnQh0Uge Pd. PHONE v ZIP LOCATION OP SALE S CI M Q T 6 Ve AUCTIONEER I�e�/i n �, ' Vu l'C.PQ rd PHONE. '7I I —CRY/537 .r,.+n'ati •xg.i r�.,..i".,.�7'irnF:tnT�";.*,a stl:�' 1 'S4t yam„., 'r. J+' g P �.. ..,..v...._..�S.s:^x`..a`a+t_.2�s�..&"ws t� � L.a:,t3�•,n. ','a;? '^Et�r��.."i4t�� S" �".a."�y}��.. k �SMtfttXPMS—ES0 roIMM;12L•CEIMOR ,' } EE 10 L AUCTIONEER $ .�! (' "E J�6 w CASH $ F T /t O t"(, �I ' ?a CLERK J16 $ CHECKS $� 5 IR' CASHIER $ OTHER RECEIPTS OTHER EXPENSES $ fj Y $ y $ I & of 4 $ 1 36, 6 $ �, ! 13. 06©. �-6 mw1(\ ad— $ -r,6e0 6 TOTAL RECEIPTS $ 13 a73. d $ x LESS TOTAL EXPENSES '• 6 ' t4�� ititiYdL�i� c i z�^Y Y?i. "'•.)4 si*'•� aF 13 d$•t`i'f s.y .c .^-f k " mEEDS�`r A .tiS•>v k fs% �P {,, �,$A�IEf©SELEIYzn �k,, TA d+"3a• ar"�' ws sa Sf r "s.a M _ - 3'�L+y s yx r..t1 a ,�� :.>: � s w >R ''X,t P,Y��' �J�r!� "F i-�•.'n a.. ,'�4F1 ,..<.. -_... ... . . ._.. . .-.. c ....>-. i..,. .1..1 k•v.•x..uv..,..{,Fgu`.., .. .�>r.._�',r#�.`-^.X ..v<y ��:mM„vtr¢s.trs.:ti^�...'�v.�-?�as�.. I (or we),the seller, accept this settlement and acknowledge receipt of the above specified net proceeds from the auction of my goods and property sold on the abov date. 1 accept all ons bihy for providing merchantable title to all goods,and pro pery sold,and for ry of title to the urc aser. Auctioneer or Cashiers Signature (Sell s Signature SC'.Z4- /3 Date Date (Sellers Signature) pd r, �of .a,.. k yeju, sELLERscaPV St r O N O lq m O AD EMSIULBE V[ P uUi REGULAR SAVINGS ACCOUNT: Account Number/Suffix 272471-00 Date Account Established 10/03/2005 T- Principal Balance at Date of Death $21,374.52 Accrued Interest to Date of Death $2.11 Total Principal and Accrued Interest $21,376.63 Total Interest 1/1/2013 to 3/19/2013 $9.02 Name of Joint Owner None CHECKING ACCOUNT: Account Number/Suffix 272471.11 Date Account Established 10/03/2005 Principal Balance at Date of Death $19,525.93 Accrued Interest to Date of Death $0.48 Total Principal and Accrued Interest $19,526.41 Total Interest 1/1/2013 to 3/19/2013 $1.96 Name of Joint Owner None INVESTMENT SAVINGS ACCOUNT: Account Number/Suffix 272471-05 Date Account Established 10/03/2005 Principal Balance at Date of Death $13,745.73 Accrued Interest to Date of Death $1.36 Total Principal and Accrued Interest $13,747.09 Total Interest 1/1/2013 to 311 912 01 3 $5.80 Name of Joint Owner None CERTIFICATE OF DEPOSIT: Account Number/Suffix 272¢71-44 272471.45 Date Account Established 09/02/2008 09/0212008 Principal Balance at Date of Death $2,522.91 $5,540.35 Accrued Interest to Date of Death' $0.50 $1.09 Total Principal and Accrued Interest $2,523.41 $5,541.44 Total Interest 1/1/2013 to 3119/2013 $2.13 $4.67 Name of Joint Owner None None VISA CREDIT CARD ACCOUNT Account Number 4672090000260489 Date Account Established 08/18/2005 Balance at Date of Death $0.00 Joint Cardholder None MEMBERS 1sT FEDERAL CREDIT UNION Tessa L Klugh Lending Insurance Support Specialist v May 6,2013 Estate of:ANNA M HOOVER Date of Death: 0311912013 Social Security Number: 5000 Louise Drive P.O.Box 40 • Mechanicsburg,Pennsylvania 17055 (800)283-2328 • wwwmemberslscoig ' A. Settlement Statement (HUD-1) OMB Approval No.2502-0265 0 U) 1.❑FF1A 2.Q RHS 3.Q Comr.Unins. '.Fi'fiMAN'N10.13 7.Loan NUmOer, B.MOdgaga Insurance Case Number. C 4,0VA 5.QCOrN.lns. C,Neta;TNsram BNmahadrogrxyoua stmortleM OfadualsaWement xosq.A=Wtspaldtoandaytheaettlementagamsarosha Itemamarked pj '(p.ocrvmM Paid oulsfde the dosing;they are shovm hem forlMormatbnatpurposas and am nm lndeded in the basis. (5 D.Nam&Address ofBorrewer. E.Name&Address of Seller. F.Name&Address of Lender. to WAYNE R HALTEWA ELPIICEE.HALTFJJAH ANNA M.HOOVER DOROTHY J.TAYLOR ANABAPTIST FINANCIAL r 46 HICKORY MfM NEWVIU PA 17241 124501dRoutelS,HewCdumbla,PA 17856 V r O.Property Location H.SettlementAgenb I.Seldement Date:101182013 14.5 ACRES,OLD STONE HOUSE ROAD MM REAL ESTATE SERVICES,LLC Disbursement Date:1DII2013 Cadlsle,PA 17015 West Panft4 R*sOmd Brig,60 West PoWmt&ML OWnson Township CarWe,PA 17013 Telephone:717449 Za35.T Fac 717.249,6354 Place of SeWement: TideEvrass West Pomlretpmfessbnd Bldg,60 West Partial Street PdnteEE1011712013at 2:58Pm Calisle.PA 17013 bYJMR 100. Gross Amount Dee horn8ormwer 400..'Gros Amount Oueto Seller 101. Conm4ctades price 11 MDD 40. Contract 8a as prim 113,000. 102 Pewd Property 402 Pammal 1D3. SetOemaittFagesiobaraerr(Gne 7400) 2,127A0 403, 104. 404. 105. 405. ustments for items paid by sderin advanra Adjustments for Renes paid b seller In advance 105. C1yAmmimms to 40& C9ptean taxes to 1D7. Corny tm 101182013tolMI2013 7926 407. Cownylakes t0M82013tol21J712J13 79M 103. ShcociTam; f011820131o0fJ=14 1,44629 408. SdmolTams 1N1S20131o060M4 1,44629 109, 40A 110. 410. 711. 411. 112. 412. 120. Glass Amount Duo from Borrower 116,65255 420. Gross Amount Due to Seller 110.52555 280. Amaunte P4M orld Behallolsorrower - 500. Reddetlene hAmouhtDU416Sella 1. Deposaaemne Monal 12,ODOAO W1. EXZWdeP.asit(WiaAlu 5DAS) 12, 00 202 Pdnddpalmrountanewuan(s) ID3,79021 502 Settlement dwrgestoseter(roe 14M 1,130.00 203 s mken ed to 603. Fit s takmsu'taro 204, 5M. PW of IW motage lam, 206. SOS. "ofsecondimilpeeloon 20. 506. 207, 507. pg, 508. 209. 509. Ad'uslments for Dems unpaid b seller *50-u stmenbfor Kemslm id seller 210. C'.AOem terns b COl' faxes to 211. Cary taxes 10 511. County tares to 212 Sd'W Takes to 512. SOW Taxes to 2tl 513. 214. 514. 215, 515, 2ts. 51& 217. 517. 218. 518. 219. 519. 210. To6l Paidb or6ortovrer 115,790.81 520. Told Reduction Amount Due Seller 13,110.00 300. Cuh atSehlementfromho Borrower -600. Cash at Settl2atentld8rom.SeBeY 311, Grossanconldueh antorl aerryna120) 118,65255 501. GrossamomaduetoselaOroe420) 119,525.56 377, Lass amamtspdO byAaborraxrer(INe220) 115,790.87 602 Lessrod aimsln amounldue se0er(Gne 520) 17,730.00 103. Cash QK From []Tosomxser 861.74 603, Cash ©To ❑From seller 101,395.55 46 WgYN9.YNP.tl,tl''4Mb P10 ftlY.YIW.bMATaICMMSM Wtl1M4tlN14'r•nbtl..aVMebP<.tl•MOYY,tli R11A 0.nKNNCb tfatlM4M]MPIMtl 4�4( Prevous editions are obsolete Page 10 4 xuo-1 400: To61Red EstrteBmirerikes Paid From Palo From Dhiswlafomrnksian aaipD asiabax Borrower's Seller's o 5om tD I Funds at Funds at 1V Sem io I Settlement Settlement U) TD3. atSelGmtpm O 800. eumP MN CoeaecBanY4A lnsn 1. OmagNatimdwge (NWSkS0dgna0mlPantDA00XtY S (eomGFEPt) B02. Yarueat FEW.i +- V.-y"4jSWWW=UOW GFEA} to O WC Appralsaffee m !r=GFE >b5. Cnsfu to fim1GFE Vim• am. Tmserft M GFEe3 'T M 19soddm$hation m amnGFE1f3 M 10 100. imms hMW Undff beRldin Adrmm 1, OzTyWftgGIaWfmn fmienUM1310111010130SODWay ( GFE11 ) 971. YAd bmaxe mmAS10 GFE 933, ie"SN mmASto hmnGFE$ii 9}f. mmAStd BmtGFEW OA Res Deposited%Mj N 1001.InitieidePaSif lmyomesaavaa:wm (..IMMGFEA9) i00t i{mxvnnaSNsrarm trmAS S hnmA 1003.f t� mmft S Moth IOD4,RDPEq LUIS mmm $ hWA t005.Cmngmxm mmBis S 32.14hnmai $ to t00&$dbd Taxes omits S 171mftA*A $ to iD07.AggmgateAd1o50nmf $ A 1100.Ta1eCA m ilDt.iNeseMcesoMimam'sado NlUmnW GFE94 639.00 ttD2.SMmeilmdosmgiee to $ tt03.o+natsBteNsmaua GFE 4114.lenders9ttahswance $ 1103.teMers$0e1oUT0r61$tD3,,7W.8f t i D6.OwndS ft Pdity rOA S113A0000 ' S10T.Agsd's Px0mof0rtlataifiGOJ,r6vm*n $ 5500.tx>zmm�terS�acnctUetaa150eNSmatmpmium $ 1103.AWMFae AIRWINBMCMl0Hr P.0 SS25AD 7110.Notary to $14.00 titt. b $ 4200,GavemmetdRaw andiYaashrCha 12M7 GOmmml mvdigeopm $ OWGFE91) 14300 12Y2.0eedSN1.00 mciftmmoo Rdems fo Remdefgf0eeds 12n Lmtsferimm $ #=CFEA6) 1.130.00 12W,G5T11Cmx4tVjMW s MOSi MAI S mRKaftotDeeds 1105.'IUDTadsmmp3 OmdS113010 a3 fo RemsdmolDeais 1.13DA0 1246. Deeds Lkilme$ 10 t3D0.Addt$onaiSNBsmenSTdi as t f.FiEAucedsmMcesmatyaeoanstoPfa {frmnGFES6} 15. 1302 to 1303 to 13374.W1refee fo$ANTANDER $15.00 i3DS. to t Mm MOM Y,i .00 t,13DAD Padaadda ctaoSfrg 6y(Bk+mn'e.',($1mer 4)mdar.(rynresa.Bm(K)+r•"Ged4 Mkndmsta+mm Pie 1.^•Credtby SftSh"on Page 1. pmlous editions are omfete Page of 4 Hao-i fh�N'adsan of Good Fab Esdm de GFE and HUD.1 GhsMes Good Fab UUm de�� HUD-1. _ as,TkutCannotMcrxase HUM ilnelbmtber. Or ..tad�ar e n for ft sp—mraI. .._ #Sol 0.00 .. 0.00 Yam s a tntereslrateclasen "#B02 0.00 0.00 YarorpH s foal lw ,ry ted odg"maaon # lA3 0. 0.00 T oma # 0.00 1,13Odp C esThatMTaW Cenrtattocreas6 MOmThaniO%., CioDdFatth&Omrta MlDM1 Gorenmlalt mcadngcnages � # O.OD 143.00 M flus swim aid Wa sODO #Inn 0.00 .00 (� Osaals - #11W 0.00 O.00 U') Ytaefae #lW4 15.00 T # v e Om 997" chams7batcAnclmn e - GoodfntthEsumate HUM .... ,.. .., �#.i 1 U.W 0A0 dN+OSdfayouostrdx Ga➢Y npr:stchagas�min # .PYSilwwrance d!%� .0 0.00 # # Loan Tons YaaWfwl batamouMk s Yombantstmts yaam YowesdatMtemslmtels % Yourw(wilordhyannmloxed forpwPat,fnwm%and anymodgage S Stdudes krswaacats DF ©wmst Q NggagelnsumMa Canyrowkdaestratedsafi �Ha ❑Yel Rcendsetoama»xasnat %.Thefvstchange udlbeon d i aslcmdmPa0hem yeom Au t t .E" dlangedate,yrominteratmteaal r lt>CmasomdeGaaseby %.Gvaamrifed Ut bAynmMle mstmmisgusmn!eeitorwwbeloworlhan %ahtgher ft 14. Eren#}amdkepap+neMSOn6tw,can}aubanbxau#dsol [X, tb. [[YSS,dcandseroamadnnsadi Eml you make psy WIs onfime,canyow oixiWy aiMmtowedfor ©No. ❑YOSthe Fmtlnoeasecanbeon I I ad Um moNhly pinipal,MteA and mgtgagelns COOSe4 amountoxedcandseto$ Tho maMUm U cat ara dse W u 5 Doesyvwkathaveapmpaynamttxna'p7 �Ma. ❑Yes,yammadnmmtxaRiymantpartN7us Gxsyvwloatlla+ealsaW+ay paprenf7 [ElM. ❑Ye%yoohaveaballampaymentofs doe In yearson I I Tol�maittdyamwMaradhxiudm9asa+nvaozuntPsls QYCUdanmhavoamonritye saoxPaYmat�rhars.a+�haspro;e+tJtasss and Mrtleoamelstnsuraltce.Yoomtpay01ese1loms&e*r=r. YOU to"wauf w wm es<mx mwao of Owrewls b a tow Wild Aulhlyam towedOfs -ThhlncliMespdnripallntamsl, eaystwlW W0"ancoaldal7Umnsdmdmd6(et�w W ©fmpedyWS HOme rs MSum" Flood lnwrm a Note:Uyo06are anygOesUmts aiwOtihs Sotuatienicnatges andt omyiemtsr atodon Udstdmr.please wntayouf tomks. Previous editions are 00"tem Page of 4 HUD-1 HUD CERTIFICATION OF DUYERAND SELLER IhaveoarefuayravfaHadfheHUD4 Settlement Statement and to the best afmyMVMtdga=4 begat IbaIma and accurate statamom ofa#feceptts am AdaWmmemsmade on my accouMorby me In this Wnsadion.I fUMWCodity that I here MoWnd a Copy dOla HUD•1 Seblament Statement N t.7 LO V) WAYNERH4LLT EUNICE E,HALIBM N QS V' T" ANHkM.N00YER DOROTHYITAYWR nM4A5WTAYL0R,wCUT "T THOMASW.TA MI T0R The HUD-1 Sealement Matementubich I havaprepamdisatwe and e¢urateacmat of M bansaction i havetxusMmxiucamothe fimdambe dRWlmea in aemldanCO WM lhn SlaWMnL SEI'D.EM"eNTA ENT DASTE��' J� WARNING:ITIS ACRIMETO KNOWINGLYMAIIE FALSE STATEMENTSTO THE UNTTEO STATES ON THIS ORANY SIMILAR FORM.PENALTIES UPON CONYICIDONCAN INCLUDEA FINEAND IMPRISONMENT.FOR DETAILS SEE T el&U.S.CODE SECTION 1001 AND SECTION 10IM P2 WW eoiUonS are obwlete Page 4 of HUD-1 Itemization of Section 200 Credits Ndned Balaarer: NameotseeeC FileNUmber. A RV Prepared 1M772013 91288 pn to A A Note:ThFa page displays an Itemization of the credits shown lnsection200efthe HU04 Set11ementStatomenf.This page accompanies butts not a part of the HUD-1 Settlement Statement Ila discrepancy exists,the information on the HIRM Settlement M Statement applies G to 41 Credits Credit V' T' a Nzme of Brrooer: Namedsor. Fb Number: WAYNERRALTEMAN ANNAM.HOOVER HALTEMANW10.13 EUNICE E,WILTEMAN OOROTHYJ.TAYLOR Prepared 1M771013 M Mire Note:This page displays an itemization of the adjusted origination charges shown In section 800 of the HUD-1 Settlement Statemen This page accompanies but is not part of the HUMl Settlement Statement if a discrepancy exists,the Information on the HUD-1 Settlement Statement applies YourLohrOdglnallon Charges Borrow Seller 801, Oura01wMdwge (eldudes(Mostial Pdnt0. or10,00) to $ 0.00 802 Ymcre2acharge(pobts)forlhespedkinlerestr4edxmn to S 0.08 883. YouralNSledaginallon charges 0.00 0100 Name d Boovxa: Rameo(Wer. File Number: WAYNSR,HALTEMAN ANNAM.HOOVER HALTE6M 1043 EUNICE E HALTEMAN DOROTHYJ.TAYLOR 10/J720t3at Mom Note:This page displays an Itemization of the charges shown online 1101 of the HUMI SattlementStatement This page accompanies but is nota part ofthe HUD4 SatUament Statomont if a discrepancy exists,the Information an the HU0.1 Settlement Statementapplies. 1100.Tide Charges Total Charge Solmver Seiler t10i.Mesemces ardlarowstNe NSUrarire to t102Set9awtordosingfee to $ 0.00 1104.Lerderstlelmmrce to 5 0.00 1109.Attomey Fee to RVONSMCI000IIT,P.C. $ 825.00 825A 1110.Notary to $ 14,00 14,00 1111. to S 000 Totals: $ 839.00 000 839,00 0.00 SelledLenderendilsshovmnn a el POC-Paid Outside Closing CR=Lender Credit Previous editions are obsolete Page I of I HUD-1 BASSETT APPRAISAL SERVICES n O 17e No.13.144 an O O C M_ IA W r APPRAISAL OF a - Umited Appraisal Reperl LOCATEOAT:. 216 Storehouse Road Carlisle,PA 170159429 l� FOR: C a Karen Noel 60 West Pomfret Street Carlisle,PA 17013. BORROWER: NIA AS OF:: June 25,2013 BY:. Wiriam A.Bassett PA General Certified Appraiser/PA•GA001618L BASSETT APPRAISAL SERVICES 0 0 0 tae tlo.13144 to O O M m M_ fn in !n r V' r July 17.2013 Karen Noel 60 West Pomfret Street Carlisle,PA 17013 Fie Number: 13144 Deer Mr.Dixon: In accordance with your request,I have appraised she real property at:. 216 Stonehouse Road Carlisle,PA 1701&9429 - The purpose of this appraisal is to develop an opinion of the market value of the subject property,as improved. The property rights appraised are the fee simple Interest In the site and Improvements. In my opinion,the market value of the property as of June 25,2013 is: $169,000 One Hundred SixtyEghlThOUSand Dollars The attached report contains the description,analysis and supportive data for the conclusions, final opinion of value,descriptive photographs,limiting conditions and appropriate certifications. Sincerely yours, William A.Bassett PA General Certified AppraserIPA-GA0016161- SASSETT APPRAISAL SERVICES m Uniform Residential Appraisal Report Fetrw 13.144 NTrie purpose of(his su"tq eppraiml repm is to Ormns,the ltndwid,anwhh In aaaxm6 eM a0 utm su raSa Inion drft,.,,etvsW arttrc sub"ea p.al. CY Adkm216 Storehouse Road co Carlisle swe PA Code17015-9429 p ll m WA On dhNCltaad FstatelAnna Hoover tmq Cumberland 100' Deed Book 24W 272 AssnswsPxatt Tax46.08-0626-021 T.Yw2013 RE.Tadsd 3598.00 CO Name Dickinson Tosvnshi Abwow Ma 08.0 eamnT-0127.01 OrarA Twrc X vaad Axtssrett3 WA PW 110AS ar mdth Fee L Ora dlsaae Cr; Alf atT RuhatTrmvdm Rdn.rce TrensKam lima d-wa Valuatlonforan Estate tads Karen Noel Adaess60 West Pomfret Street Cetrsle PA 17013 r hme dfendkrsekaMSt OeenoKa¢dbsdemmehamx nxdre mtleMedivedektlmis ahM I lyes Rlpal dm snxKs)u W,arehg pbe0),am dmNd• 1 U&I d4 rrtamtyrotlataam fasakbdN wbj¢dWdaaebensxdart dpbhAeresdutllheangthtldlledam fataleaveyee areryYS wasnapedamm. Ca I`AmSN/A DakdCaam WA IsNp seWaroaertl Itm42 i Jyfti No Dmasynew hewe uYes UNO KYes2pMdlewmdVaamueaNdesabetMlammbepnid. fbr.Paceentlawnckl mdd.erw tedgedeeeroi lectors %`,iTrerynecihw`aCforidedstln a:".."'ks'{::S�i'cy'+a5r:a. -�IiNiuiFPYreiiBs,s:^i�`^'RVf,'� *"d'ir'Oi,it'au '",>:` S;iPwnit'an'df aNa%:2.% larmhn Ltten Jxlsbeba.WAXO Veber satle ME AGE 10wft 60ak% BAAV OM7sx IX 12S.75% I.. 11 a25% x Metlare Oar 24Ort 016% Golan N s,eh Sba Tme UNa]rtaM Sbr4a Orr 5r 60taa 201 0°,6% ftw t w Cwnwr, Legislative Route I Ito the north,Bumthmse Road to the can 250 90 1 Canaadm G%% Legislative Route 174 to the south Centerville road to the west 156 40 Om lace 1. I n- % H6$bor:oodDMV6m Subject Pro Is located In DldeNSen Townshi a mat 6 milesfrom the Borough of Carlisle. Carlisle is the roaloremployment and Population center for the westem section of Cumberland County. Tholocalnelabborhoodisprimarly residential ands rlculaturat land. Naha fbd[ms(,CtaarlsggrArmestaaaaa4sbm) Pro vaiuesare curverntly stable to sUghtly increasing. Imerestratesran ebetween 3.6 toy per cem forcanventional FHA end VA fireancing within the locel market area. The 1=1 market conditions a eartoshowe steady How of sales within the stlh"month Dhwar See Legal Descai tion /✓ea 7.642 acres She m Me ular IAW Avers e c f]eatieaeor A dcuXurel i Low DerESi Residential and a ritulatuml. 7 axe L 1 use fm desame blhetgltstand0estweddtsupjm Peparyampmed(aesPmposed Paplamendspadre�ean)mepmeauseT tWyftUNO KNadewme '. aa1dM A,Wk atMf deaalha PWk lima albs OrMe emmW- Purina elwk X wma On Site Well mm Ago haN G. Li I i UnbMsew On Sde Septic My None fEhaS fbadHaaard/um Yes X Na fEMAftsddlaX FaaN t 42041CO220E FENANe Dme03/1MW9 ArodeuDaes en0 dsste famemmtxant Yes No Y desatx. AePeee'eaaaseAeaNa'v6at.Umilfma5(eaiamaf.a4oxlanaC.trNMmatNOOrAbrts.lanu5es.acJT Yet No LYmdwa Therelsal6 fool ri ht at way that extends from Stonehouse road to Use site. ,'.. . `.`LENEPAkbfSWA`fi NL + -.':; `-f06t�71TI0,YS.w _°.�.' FXiEh16iFO1!SC - •Y Y1f"+dCm`'t4fFP1FOE!4'%`7.f,`.';ma?e5ay/m"n{t'nn. UAS Orc OrcvsA lhd CaertmaM Ord Fmfttoft a SWA Floor Hdw/Cer/Fair tdsi d Two IJRABasa as LJPm Ba Estaidwafs Vin VA waft Maro91e/PanIFeir r Dec An. SDdM-dUN 9aea 592 a Nad&dm Metat/Fair TintF't2A Wood/Fair Undafaxt aesanatF.:u10 % Gaasa Alumfnium/Avq BemFka Vin I/Fair Two Story O W.d<sv Thermo OH/A asmwewm Mamlhe/Fair Ytaeol1976 Esidenced Mesaaon samsmvom+wed NoKes Grsn Nom Eff d .25 s semened Saari ves ideas 0 Aft X N. JFWAIJ Nw88 O FU a Sri SSraakms e Odw Rm Av, v dSlms t srta"Gmvel/S tn Fm Pro ne 41 Frce Ga tdca 0 nalO X Patin Front/Sid X tdc r 3 fi i Nmkd I J(nd4itrr4 ILJw.w Pod I joz r X Ae. X am adr� , % Rd ewer D'dw,$Iw win I AC'.m I jw lima dettRe f1lbhMeaa eeeve demaehir 7R. 48taaam 1.5 ere NO 2,167 ,fora Gem Lm,Meer A Dade Adzmsf a (Veealaerg/erwdXmeta See Attached Addendum. OCSaBemeov6rkaldda rAUf neededr daraerPnrmmatasremadetryem,} The subject property is In poor to fairconditon. Thereis Poith ,pain. ma plaster rwater leakage taster r walls missing b the upper level of the Mme,Water Stains located on the callings thro hoot the seoondtevel. AYmaeagPh/s'o1 MRiCMksaadRneM3baramaaCetae Wla87.haYdnttSa3uuNnllrteGnydtM pmpma? Yes WN. KYeldwtO OaesaaPapbrJgMadtdPWaRmCN neyamdgW(hndimmmTAy,trftaM[atustmrtMAdialtCClT Yes Una uftdtsoie irti5luermeAwabri rm�+,vs v+ P�IId Im...ewmn rmeua rawl(W aY BASSETTAPPRAISAL SERVICES o Uniform Residential Appraisal Report Fm Na 13.144 N Them N/A tre oaaNfaaaehNe F 2 bt C TAIXfm WA URE aaesaks NAM rat:ntlb heMmaaasra bob tramf mS to FEAT SUBJECT COMPARABtESnERO.1 COMPARABLE SAVE No.2 COMPAWLESALEN0.3 C 216 Stonehouse Road 9 cadide Road 9 Kimberly Lane 107 Mceirater Church Road -v Ad*m Carlisle PA 17065 Neww'tle PA 17241 Carltale PA 17015 Carlisle PA 17015 pm m IXr 5. 2m as NNW 398 miles SE 3.38 miles NNE SaeNa s 225 000 i :: t 154,000 •eiSabFtcM3vssrM.An s 0.00 n 3 AA75mftl S 10712 2. S 12145 .h to : .x.. ..: W Dau s Imilidwow CPMUCt.HS.Ree CPMUC.HS.Reo CPML/CLHs.Rec r• Vexurm s Ct.Hs.Rec Ct.Hs.Rec Ct.Hs.Rec VALUEAOJUSTMEWS 1 OESCPoPTION OESCMPMN f OESCrd MN I .08 DESCRIPTION tDA4, T' Sabal'Judoi; J,,UK " :None None None tormsbu .: DOM 1 DOM 113 DOM 103 BabaSahentro 062512013,.:. ' 12013 102012 072012 tocafm Suburban Suburban Suburban Suburban lessabhYFee a Fee Sim to Fee Slm le Fee Simple Fee Simple Ste 7.642 acres 3.00 acres 13,926 6.08 acres -6,300 1.89 acres 17,256 Vb Averse Avers a Averse Avers e bu Two Sto TWO Sto Two Sto rib dCounCm Vin au/AV BrWAV •7 00 8&WVhVA •5000 Fmme/Wood Adal 37M-Years 92 vasm 1211 vears -51100130 rs faraAan Fair Aver o -20000 Avem a •20000 Awry a •20000 AaweGada rem ae. $be Tau coins e•ra To eva rau as•• m• PaanCant 7 4 1.5 86 54 2.5 •2000 111 31 3.0 •2000 6 3 1 Goa A'o, 20 2,157 h 3,572 IL -28,300 2,225 ia.A •1 360 1,268 h 17,780 BasercdSFhhrea 592 Sq.FL Full Bsmt Full Bsmt Full Bsmt NDani Bamv Cade Unfinished Unfinished Perli Finished •5000 Unfinished F tft Typical Typical Typical Typical GHWBBNone HPICA 5,000 EBB/CA •5000 HP/CA •5000 EGSbrvans Typical Tlvplml Typical Typical Eery 3CarCarport None 2000 3Car Gars a -0500 Scar am a Ji600 Pb ffidlmd Fr CovemdPCh Fr1Rf orch Sun Room 1 •5000 FORT Porch Other Shed/MObHome None 000 None 3,000 Detached Shad 43 874 -17F. Is 56,160 Is F.536 • Aqudd Sob Pdte Nd Act -20.2% NKAq. -2S.0% ua AVJ. 16%% d Oms 37.745. s 173126 —m276-Al, S 168 B40 Ciao 41.9°r9L S 159536 I as 4dnclraseaRANesabataWn KeaydtleaW'FdpepalT WCOMY are SAM Brottob resKna Cd ddtdlereat sa!Haeabbridtlb IoreY Brea bbeeRMedaed Vasa atsd Oman M ad ddmmada alnmfasddb aeesarilaVb blMdeledtdaddd desaln om dmrea�ladMrearMAaMe dine sob arrada ' ddb BIM deaeka ada'Wr vbian 9. REM SUBJECT COMPARABVESNENDA COUPARABLE SALE NO.2 CONPARABLES4ENO.3 DMedPiaAbRran4IX AbadPfbr Sddrramra Dabsa,ce s Ct.Hse RecoNls CLHse Rrxoms CLHse Records CLHse Records Fdadrve OaedDwSarces I 06252013 062512013 061252013 06252013 AnatJSNdpnorsaeavanraHMaraumshyeapppegandwmpara6a sobs The Subject property has not sold or been listed within the past 3 years. The cam arables sales have not sold or been listed Me year prior to the crurenl sale. Se'rmayaSeki CdrPa'uatApptWrh The subject property and mm ambles are located within the Carlisle Market area. jbeSubjectPToPertV Is in Fair tondtioh with with vadous Cosme5e and interior Improvements needed.All the coin ambles have been remodeled within the Past 10 yea rs therefore they are superior as to condtion.All the dam arables are verified sales and am the best available. r ad wVatb Sdta S 163,000 At teevaK . sefKCrcn :stn $169,000 e Apppth(VdWael 0 IncemeA a aae.do s Market Analysis consistenuy SUTW0dS my estimated market value. GRM and Cost Analysis was found Inapoopriate for this anal is. Greatest weight isa tied to the Marltet Veto Analysis. S rth file information substantiates these estimates. • TlEaapP>adhmade X 'asis.' MA,'enbrargkrenpap`ansanVSpeorCaddlsmlleeaSSdahspolkWrtnMaondatele PopuemMSruveeaacanperea . QagedbtlbfaonvyrepaisaaSaaummdbbs9sdelrypal le4W Cabfanwtaereprrsaalasliorts nnebemrmplenaa QswjedwNercrosy«pveV . iRpfamaaseam meaxanaarwynsanT.daluatNetzl�itnaxrckrc7 does ralegheatcarmarePaF. The subect property was appraised in AS IS Cond'&n and is Valued for mortgage purposes only • a•efa On/CemplMevrieahlnfp•c11Mef[MNallar•na.al•der N•aiefta.coatKtmeDt[ty.dMmet<°D•erwpY.flatMl•n[olattumptle nf.na llmNI11P conaNOns,enaappraber'a eenlmoeon.my(our)oplNan oflN•meaetwfue.aseerbnC olNe rearptepenyNn lslh•soOJKterellfrcponrs2 166,906 of June25 2013 vNNbth•abdb cmm•WlMedediveaaleermba •Mr• rnmautcro-erovmma Inena.p.bruemhamr...rareem a.blaeromhbl u.o,mas vpesaa IfaADAp Bassett Appraisal SeMmes BASSETT APPRAISAL SERVICES Uniform Residential Appraisal Report nett 13-1" r SCOPE OF APPRAISAL AND MAR SPECIAL LIMITING CONDITIONS: 0 0 -This apsnalsal is not a Mme Impedfor,and the alpmiw is not acrim as a Mme Inspectwr when preparing the .When 10 verf=km the Inspectim of this pmperty,the appraiser visually observed areas that were reaft accessible.The appraiSer Is not required to disturb or move anything that obstruct access or%isthifitty.Theinspection In not technically exhaustive.The InspectIon,does Q not offer warranties or cuaranties of anY kind. m .m Sce a of Appraisal and URAR:Supplemental Certifeations: 1 certify that to W Thfs COMPLETE APPRAISAL-SUMMARY APPRAISAL REPORT s prepared William Bassett for the exclusive use of Irwin ,r and Mcknf ht PC for use In estimalfing market value.Estimated market value Is the most probable price in terms of rash or In terms of fmandal arrangements equivalent to cash.Irwin and McknlriK PC,is considered to be my dent.The information and r opinions contained In this appraisal set forth the appraisers best ladnernent In gold of the infomation available at the time of the preparation of this re d.ft use of this apffaJisal by any other person or entity,a any reliance or dedslons based on this appraisal am the sole res onv'b➢i antl al the sole dsk of the tNM .1 acce t no re sponsibirity for damages strifiererik any third party,as a result of reliance on or decisions made erections taken based on this repoit In nW opinion,the reasonable exposure Ome finked to the vakie opinion Is up to 100 dm. I fudher certify that to the best of my knmvledcre and belief, -The statements oiled contained In this report are true and WMCL -TM reported analyses,o Intone and conclusions amrimited onty by the reported assumptions and lhn]Unq conditions and are m personal,Impartial and unbiased pralesslonal analyses.opinions and concluslons -1 have no present or prospectlyt Interest In the Property that is the sub of this report orto the parlin lmroNed with the assignment. • -My en a ement In this assignment was not oantin ent upon dewel0ping or reporom predetennined results -My compensation for completing this assignment is cwt contingent ppon the develo ment Or repartinrl Of predelemined value or direction In value that favors the cause of the client the amount of the value opinion,the attainment of a sti elated result or the ocwrmnce of a subsequent event directly related to the intended use of this appmMi. -My analyses, inions and mndustons were daVeloped,and this Myort has been pnepared,in confamille with the Uniform Standard of Professional Appraisal Pmclice. .1 have made a pemml ins edfor,of the pr rty that Is the subject of IN re -NO one provided signikant prolasslonal assistance to the signer of this report. .Mat A.Bassett prepared this report. j: :.?: '" :' ,'i.'iCOSfAAPROACHTOYACUE -•..•• "filir� Pamela tdie»'i n, :'r;^_•. �i t;L'ca.'g Rofde IehbNNha kfaroleMo/dedb edeadaroWf etdmlzMba. s,ypmbmeopnmdstevtle0u+mar/dmnPrake mm saesadnacenam faes6neagsmwbd ES ATED REPROOUC M(A JREPI, E Ewcosr NEW OFWmNOF51TEVMUE........................................t . Saemdmadaa D,91h4 2,157 SMOS .............S 0 r fmaea9 smite cff a OfuwS Bsmt:582 R®S .............S 0 Cmaedrm COS Awa ereareW edadaiea:. FIPPomh The Cost A roach wal generally resvltinanexcellemestImateof Gu ttOS .......,.....s • vakue 0 the building is new or reasonably new,and the TddES edCOAlrear .............s 0 Im ahements reflect the highest and best use of the land. tm 50 t WYtinal Ealemal However,when items of physical de redalfon must be estimatedan s 0 an area of judgement is kmlved which is sub"ed to error.The pwedwc cfl .................................i 0 Cost roach was not utilized due to the age of the sub' -AWVOMdste maeds.................................t E4nas�Re:na" Ecormictfe aadVA 25 Years RMMTE0VA1oESYC0STAPPR0A CN...................... .S 0 ._ .•.. , ._. .,.: ;-it MCOMEApP.RUACHTOVAIL.E ,,.._ .""-""'.Kamro6fae)%} "' .' ••• £samaM Vaaa RMi XCroSRMI WA •S D hdr edV"byaAXMMb SumurydkwmeAq.xm(rcmdagsupponkrmrmrecaemGpq Ouelo the sub'ed being asingle fanalyresidence, and the lack of rental data the lnooma Approach was considered Inappropdate,and NEAR.h,oe r inearoddaelbamnaeSAt.so.d.d'nn i Ue OharMa iasdkA. pre.HaVro ifmmalimbPaD50.ftV1aw MdderhYscaaodaeeOAaMMe henmxME N.eI uN. toted ' Tcoln d TadaarL afu Teaem0erdWSStd 7aalsrmaedwasrmted TdNaimaerdWSlvsea oaa sartts camtie vents Veranmowdme si=2PUOt I lye$I In. yr deed m ve . OaesrM mrsaha nsaed uNSt Yes No Oasasar s NQdeats.wrcmnekmaB WnamCOntadoMOalµeMt Yes ..N. Vlb.daabeNesaWSdmnFdas. AMU mmalebratskasNNatride Nenaorrtias'ASSOdaliMt YO Ne EYes.deslbe MreXdiecaarooP'am. DesaeecmmoneemeasaMreoeaaaW rages. NIA rIMLYC(OSA WAND MfN)IOM•..aAalVLwaSdOet firiNM(Oelil Vlela6 rgaadl aM,ORt11 {met a n w°t�wa�mt Fmm.kt x 19M. `�( A teT W) A O ` l C HARE THE z"a tr. ' dw^f October in the year . U5 of our Lord ons thousand nine hundred seventy-two. m r- }`t BETWEEN CALVIN S. S. ZINN and LEONA R. ZINN, husband and wife, of Dickinson Township, (R. D. # 4, CarlisIe), Cumberland County, Pennsylvania, parties of the first part, Grantors, and ANNA M. HOOVER and DOROTHY J. TAYLOR, as equal tenants in common, of 4 Lilac Drive, Hatfield, Pennsylvania 19440, parties of the second part, Grantees WITNMET8,that in aonsideWim of One Dollar -----------------------------------------------------------Dollars, in hand paid,the receipt whereof is hereby acknowledged,the aid rmn " do hereby,grant and convey to the said grantee s,their heirs and assigns, as equal tenants in common, ALL those two certain tracts of land situate in Dickinson Township, Cumberland County, Pennsylvania, bounded and described in accordance with surveys made by Thomas Alvin Neff, Registered Surveyor, on July 26, 1972 and September 6, 1972, drafts of said surveys being attached hereto and incorporated herein by reference, as follows: TRACT NO. 1: BEGINNING at an iron pin in the Southern line of land now or formerly of Clarence Collier at the Northwestern corner of other land of Anna M. Hoover, at al, which was conveyed to Anna M. Hoover, at al, by deed of Calvin.S. S. Zinn and wife dated June 24, 1971 and recorded in the hereinafter mentioned Recorder's Office in Deed Book"D", Vol. 24, page 821; thence from said iroii•pin lWt'he place of beginning,4ang'the'Southern line of said land now or formerly of Clarence Collier and along the Southern line of lands now or formerly of Lee M. Goodman, South 87 degrees 30 minutes East, a distance of One Thousand Fifty-one and Seven Hundredths (1,051.07)feet to a point in line of land now or formerly of Oren Lay; thence along the Western line of said land now or formerly of Oren Lay, South I degree 42 minutes 50 seconds West, a distance of Three Hundred Fifty-two and Fifteen Hundredths (352. I5)feet to a stake in line of'land retained by Calvin S. S. Zinn; thence along said line of land retained by.Calvin S. S. Zinn, North 87 degrees 20 minutes 10 seconds West, a distance of One Thousand Forty-eight and Seventy-six Hundredths (1,048.76) feet to an iron pin at the Southeastern corner of said land of Anna M. Hoover, at al; thence along the Eastern line of said land of Anna M. Hoover, at al, North 1 degree 19 minutes 50 seconds East, a distance of Three Hundred Fifty (350)feet to an iron pin, the place of BEGINNING. CONTAINING 8.460 Acres. ( Qlfa TRACT NO. 2: BEGINNING at a spike in the center line of Legislative Route 21064 at corner of land now or formerly of Harry Pallor; thence along the center line of said Legislative Route 21064; South 4 degrees 40 minutes 40 seconds East, a distance of Two Hundred Forty-three and Fifty-six Hundredths (243.56)feet to a spike; thence along the Northern line of land now or formerly of Marion S. Zinn, South 88 degrees 28 minutes 20 seconds West, a distance of Three Hundred Thirty- seven and Twenty-one Hundredths (337.21) feet to a stake; thence along the Western line of said land now or formerly of Marion S. Zinn, South 3 degrees ii minutes 40 sedonds East, a distance of One Hundred Seventy-four and Thtrty-five Hundredths (174.35)feet to a stake in line of land re'tained'bgg Calvin S. S. Zinn; thence along • ae,r'[�W.,.>ab a)na.8bort!•trey dct a! 1ro1. 0 CM t�0 MADE TOO �' day of June in the year of oar Lord one thousand nine hundredseventy-one. m T BETWEEN CALVIN S. S. ZINN and LEONA R. ZINN, husband and wife, of Dickinson Township, (R. D. g 4, Carlisle), Cumberland County, Pennsylvania, parties of the first part, Grantors, and ANNA M. HOOVER and DOROTHY J. TAYLOR, as equal tenants in common, of.4 Lilac Drive, Hatfield, Pennsylvania I9440, parties of the second part, Grantees WITNESSETH,that in consideration of Two Thousand ($2,000.00)-------------------------------------------------------Dotlars, in hand paid,the receipt whereof is hereby acknowtedged,the said grantor s do hereby grant and convey to the said grantees, their heirs and assigns, as equal tenants in common, ALL that certain tract of land situate in Dickinson Township, Cumberland County, Pennsylvania, bounded and described in accordance with survey made by Thomas Alvin Neff, Registered Surveyor, oa March 9, 1971, a draft of said survey being attached hereto and incorporated herein by reference, as follows: BEGINNING at a spike In the center line of Legislative Route No. 21064 locally;mown as Stone House Road, at corner of land now or formerly of Clarence Coller; thence from said spike at the place of beginning along the Southern line of said land now or formerly of Clarence Coller, South 87 degrees 30 minutes East, a distance of Seven Hundred Seventy-fine and Eighty-eight Hundredths (775.88) feet to an ash tree at corner of land retained by Calvin S. S. Zinn; thence along said line of land retained by Calvin-S. S. Zinn, South 01 degree i9 minutes 50 seconds West, a distance of Three Hundred Fifty (350)feet to a stake; thence still along line of land retained by Calvin S. S. Zinn, North 87 degrees 20 minutes 10 seconds West, a distance of Seven Hundred Forty-three and Eighty-nine Hundredths (743.89)feet to a spike in the center line of said Legislative Route No. 21064; thence along the center line of said Legislative Route No. 21064, North 03 degrees 55 minutes 10 seconds West, a distance of Three Hundred Fifty (350) feet to a spike, the place of BEGINNING. i CONTAINING 6.085 Acres. 4,42/kMG+� a BEING a portion of the premises which Harvey M. Deck and wife, by deed dated August 8, 1944, and recorded in the Office of the Recorder of Deeds in and ' for Cumberland County at Carlisle, Pennsylvania, in Deed Book "V", Vol. 12, page 433, granted and conveyed to Calvin S. S. Zinn and Laura M. Zinn, husband and wife. The said Laura M. Zinn having died November 28, 1960, title to the abolve described premises remained vested by operation of law solely in her surviving spouse, Calvin S. S. Zinn, one of the Grantors herein. The said Calvin S. S. Zinn subsequently married Leona R. Zinn who joins with him in this conveyance asdhe Grantors herein. BOB24fALE 821 said line of Sand retained by Calvin S. S. Zinn, North 89 degrees 45 minutes West, a distance of Three Hundred Four and Thirty-five Hundredths (304.35) feet to a stake in line of land now or formerly of-Lewis Fink; thence along said line of f f land now or formerly of Lewis Fink, North 1 degree 44 minutes 40 seconds East, Aa distance of Nine Hundred One and Eight Hundredths (901,08) feet to a post in Q line•of land now or formerly of Clarence Collier; thence along said line of land now or formerly of Clarence Collier, South 85 degrees 46 minutes East, a+- M distance of Two Hundred Forty-three and Thirty-f;ye Hundredths (243.35)feet 'a to a stake at corner of land now or formerly of Harry Failor; thence along the to Western line of said land now or formerly of Harry Failor, South-4 degree's t30 0) minutes 30 seconds East, a distance of Four Hundred Thirty-six and Eighty-seven Y`t Hundredths (436.87) feet to a stake; thence along the Southern line of said land now or formerly of Harry Pallor, South 85 degrees 46 minutes 40 seconds East, a distance of Three Hundred Eight and Twenty-five Hundredths (308.25) feet to a spike in the center line of-Legislative Route 21064, the place.of BEGINNING. THE above'two tracts of land are portions of the premises which Harvey M. Deck and wife, by deed dated Avgust 8, 1944, and recorded in the Office of the Recorder of Deeds in and for Cumberland County at Carlisle, Pennsylvania, in Deed Book "V", Vol. 12, page 433; granted and conveyed to Calvin S. S. Zinn and Laura M. Zinn, husband and wife. The said Laura M. Zinn having died November 28, 17960, title to the above described premises remained vested by operation of law solely in her surviving spouse, Calvin S.S. Zinn, one of the Grantors herein. The said Calvin S. S. Zinn subsequently married Leona R. Zinn who joins with him in this conveyance and is the Grantors herein. i o a O epe ^ bin z ry Nr90 \ K� OT t0 rsa^ O ry m noxyJ24W 273 AN� f RECEIVED: �r 'r May 10,2013 MAY 16 2013 IRW(N&Mc1lNIGHI Irwin&McKnight PC LAW OFFICES Attn: Marcus A McKnight III 60 W Pomfret St Carlisle PA 17013 RE: Estate of Anna M Hoover Dear Mr.,McKnight:. The following information is being provided as per your request: Acct.Type Account No. Balance at Accrued Ownership Date D.O.D. Interest to Opened/Joint D.O.D. Esteem 2187736 $2,607.91 S.08 Jt w/Thomas W Taylor or 3/25/08 Checking Denice A Taylor Account Inquiries concerning ACNB Corporation stock information should be directed to the Registrar and Transfer Compan at 1-800-368-5948. If you need any additional information,please contact me at(717)339-5122. Sincerely, 11 Barbara J Wame ACN13 Bank Deposit Services Representative I1 m•acnbbusiness.com•P.O.Box 3129,Gettysburg,PA 17325•Phone 717.334.3161•Toll Free 1.888334,ACNB(2262) T» 1•l r A � 'rY ja to Ems' ? !'}' f 1 { Y r5 t Y t k [ � [ 1 j ' � ' • I%� t , f ' � � � . � jlt � 111 Y � t � � ( it 1 ! ITS ^ x c 131c fl t i t w � +g�� , •T , E[�ti�j��N L r i Y ��, y f I � { � (t, I � , I � , i - % . y • i 41 i S ye i , f� i y i I ! 1 Jill r� >L I�Nq -�' $`i OH , � . YtS.°z� t � , . i . ! is • 1Fif ' tN .6M:a 11 i i , , ;� O LO , t Lm � ! 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'•y .• Beginning Account Balance 10/06/11 $38,985.94 Interest Earned l0/06111thru10/06/12 ..... ::..;^:,,,:.:.--. .: : . ,. .:;. :,;. :..:. .,=...-. .r..:. $1,169.58 Ending Account Balance 10/06/12 . ... .....:.. .. . .... . . . - $40,155.52 Nef Cash Surrender Value 10106112 :..,,. . ... .. :. . .:. .. ...:... ....: .. .. . . ........ . .,:,, , . .. $40,155.52 Net Cash Surrender Valui 10/08/11 .. .. . . . . . . ...::. ::.. . ... ... ,.. ..: .. . •,:•. $37,582.45 Total Purchase Payments Paid Since Issue . . . .: . .,. . ... .. .: . .. ..:..:.<.,,.. . ... . . $32,348.04 You cannot add additional funds to this contract if the total Purchase Payments made since this contract was issued total$1,000,000 or greater. .�r. . Syr-^•.�- _. r r 1 8141TA1 K.N01 oxn .. ti N to O A? w . 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N. .� C•� OOrT mi C I gd S.i � pq �l•Y• ,„g� m. f �+ p € o.-mc�0° rj j(✓7yQ6 $ � G. m CCi'T - fm'o�S O. jlQ -;,5; • Z�M-6 - N.E tttttt6�� i N o.uY m , f a E po n gill x c l!icd o�5 I Eli 03 - M, L r., g"g-c'.Q�v ig. m $!� a. dd 4'E f40i �i O Y mAm It' aO; m Gcum lrg al$ }`$ ya�i c -7 �� u=i'�23 : m a.c I o' 9 � ijl < t l `t ' W- 4 €i i6 V •�! I ' m, 'N { n2 ' o �, `. s . �s� �y� OS1� slPs,c°Ym,NR ,� miV U) jo jo vS +n 0 WHO W I tr IZ A E. is 1 't mi !rz 57 I'ig " ilk.! .0 i IV in qu -Ro y ilk . I I 1 49 i 49 Iff i IC C) 9- 1 1 , Kill �l I p C?i 2 RECEIPT FOR PAYMENT ry U) U) GLENDA FARNER STRASBAUGH Receipt Date: 4 24/2013 °v Cumberland County - Register Of Wills Receipt Time: 55:12:49 m One Courthouse Square Receipt No: :, 1073942 Carlisle, PA 17013 0 m T !' HOOVER ANNA M Estate .File No. : 2013-00469 --- Paid By Remarks: IRWIN & KCMNIGHT DMB ------------------------ Receipt Distribution -------°---------------- Fee/Tak Description Payment Amount. Payee Name PETITION LTRS TEST 360.00 CUMBERLAND COUNTY GENERAL FUN WILL 15.00 CUMBERLAND COUNTY GENERAL FUN CODICIL 15.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 15.00 CUMBERLAND COUNTY GENERAL FUN INVENTORY 15.00 CUMBERLAND COUNTY GENERAL FUN INH TAX RETURN 15.00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 23 .50 BUREAU OF .RECEIPTS & CNTR M.D AUTOMATION FEE 5,.00 CUMBERLAND COUNTY GENERAL FUN --- ----------- Check# 7977 5463.50 Total Received. . . . . . . ., , 463 . 50 t BASSETT APPRAISAL SERVICES .N C Re Na 13-144 Lo AD {J tq �r •"""'•INVOICE""""' File Number:13144 July 17.2013 Karen Noel 60 West Pomfret Street Carlisle,PA 17013 Bomovrer: WA Invoice 9: Order Dale: ' Reference/Case S: PO Number: 216 Storehouse Road Carlisle,PA 17015.9429 Appraisal Report $ 400.00 S Invoice Total $ 400.00 State Sales Tax@ E 0.00 Deposit (S I Deposit Amount Due S 400.00 Terms: Upon Receipt Please Make Check Payable To: BASSETT APPRAISAL SERVICES 716 West North Street Carlisle,PA 17013 Fed.I.D.1:45-4800385 Thank You For Your Business BASSM7 APPRAISAL SERVFICES �1 F�Na 13.145 AD 4J O Ir A3 C7 5 In 0) •'•""•"INVOICE"'•""' r File Number.13-145 Jury 17,2013 Karen Noel,Irvin and McWgght.PC 60 West Pomfret Street Carlisle,PA 17013 Borrower: NIA Invoice 1: Order Date: ReferencelUset: PO Number: 216 Slonebouse Road Cargsle,PA 17015.9429 Land Appraisal Report S 300.00 f Invoke Total f 300.OD Stale Sales Tax O f 0.00 Deposit (Y Deposit ............... Amount Due f 300.00 Terms: Upon Receipt Please Make Check Payable To: BASSETT APPRAISAL SERVICES 716 West North Street Carlisle,PA 17013 Fed.I.D.R:454600385 Thank You For Your Business RT Carey Trucking,LLC ■ cn DBA are ' Dumpster Service N ■ • ' ! ■V O Q V c 61 etsers Lane Carlisle,PA 17015 Invoice Date 7!22/2013 m 717-258-1400 Invoice# 6509 careysdumpsters@centurytinknet - to m Billing Address Service Address rr Anna Hoover 216 Stone House C/O Marcus McKnight Carlisle 60 W.Pomfret St Carlisle Pa 17013 P.O.No. Terms Due Date Due on receipt 7/22/2013 Date Description Quantity Rate Amount 7/12/2013 30yd Container Delivery(Includes 3 tons of 500.00 500.00 disposal) 40—ECR ED IJUL 2 4 2W !RVllfi�?ActttJtGN7 UVI OFEIfFs Thanks for choosing Carey's-your local,family-owned Subtotal $500.00 trucking and dumpster service! Sales Tax (6.0°l0) $0,00 it's been pleasure working with you! Payments/Credits $0.00 Please call ifyou have any questions regarding this invoice,we can be reached at 717.258.1400. SaIaOC@ QU2 $500.00 Want to receive your invoices by email? Drop us a note at careysdumpsters @centurylink.net to go paperless! M ��Ne cOo ti o A Q m A T CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tete: (717)2493166 Fax:(717)244-2663 May 31, 2013 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. T0: Marcus A. McKnight, III, Esquire RE: Anna M., Hoover Estate Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on following dates:. May 17, May 24, and May 31, 2013 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 75.00 Total Amount Due $�^0.00 Becky H. Morgenthal, Executive Director The S�iknel IRWIN&MCKNIGHT AD NUMBER PAGE NO. i B 60 WEST POMFRET STREET 420784 1 of 1 H ww w.cum orlln k.com ,.gyp CARLISLE,PA 17013 BILL DATE SALESPERSON ,0 717-248.2353 05/23/13 wolfs , Q unmF sacNSeuc roexcvran START 0 E S E 1 911305 23113 AD NUMER I ADDESCRIPTION CLASS LINES 420784 NOTICE LETTERS TESTAMENTARY HAVE 10 PUBLIC NOTICES 34 • 2 soh r Publication Insertions Rate Net Amount Gross Amourt 3 THE SENTINEL-LEGAL 3 LGL $180.54 TOTAL AD CHARGE 518054 3 PROOF OF PUSUCAT16N 01PRF $7.00 ' 3MOBILE SITE MOR2 $2.00 t i Purchase Order EsLAnna Hoover PAY THI§AMOUNT $189.54 $227.4 •AFTER 06117!' THE SENTINEL Thank you for advertising with The Sentinell Deadline for c/o LEE NEWSPAPERS in-column legal ads is 4,00 p.m.two business days prior to PO BOX 540 WATERLOO IA 50704-0541 date of insertion. For questions,call(717)240-7130.: 1 BASSETT APPRAISAL SERVICES tv 0 N A Fie Nn.13-212 m rn PAST D Ue ' } .s �*INVOICE A ,.46C November 21, 2011& o"Am v � - File Number: 13-212 October 3,2013 Karen Noel 60 West Pomfret Street Carlisle,PA 17013 Borrower: NIA Invoice#: Order Date: Reference/Case# PO Number: 216A Stonehouse Road Carlisle,PA 17015.9429 Appraisal Report $ 350.00 Invoice Total $ 350.00 State Sales Tax @ $ 0.00 Deposit ($ ) Deposit ($ ) Amount Due $ 350.00 Terms: Upon Receipt Please Make Check Payable To: BASSETT APPRAISAL SERVICES 716 West North Street Carlisle,PA 17013 Fed,I.D.M 45.4800385 BASSETT APPRAISAL SERVICES rile No.13-211 rb , ST DUE r INVOICE **'*** November 21, 2013 File Number:13-211 October 3,2013 Karen Noel 60 West Pomfret Street Carlisle,PA 17013 Borrower: N/A Invoice# Order Date: Reference/Case# PO Number: 216 Stonehouse Road Carlisle,PA 17015-9429 Appraisal Report $ 300.00 Invoice Total $ 300.00 State Sales Tax Q $ 0.00 Deposit ($ ) Deposit ($ ) Amount Due $ 300.00 Terms: upon Receipt Please Make Check Payable Tv BASSETT APPRAISAL SERVICES 746 West North Street Carlisle,PA 17013 Fed.I.D.#: 45-4800385 Thank You For Your Business RECEIPT FOR PAYMENT 0 )LISA M. GRAYSON ESQ: Receipt Date: 5f02J2014 VCummbberland County - Register Of Wills Receipt Time: 15:29:19 riOne Courthouse Square Receipt, No. : 1077887 5Carlisle, PA 17013 » v r HOOVER ANNA M Estate File No. : 2013-00469 Paid By Remarks: IRRWIN & MCKNIGHT ------------------------ Receipt Distribution --------------- ------ Fee/Tax Description Payment Amount Payee Name SHORT CERTIFICATE ,5.00 CUMBERLAND COUNTY GENERAL FUN -----------=---- Check# 35623 $5._00 Total Received. . . . . . . . . $5.40 U) RECEIPT FOR PAYMENT 0 u� °o GLENDA FARMER STRASBAUGH Receipt Date: 9/27/2013 v Cumberland County - Register Of Wills Receipt Time: 15:41:19 m One Courthouse Square Receipt No. : 1075734 Carlisle, PA 17013 m r r TAYLOR DOROTHY J Estate File No. : 2003-00838 Paid By Remarks:_ IRWWIN & MCKNIGHT DMB ----=------------------- Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name BOND 15.00 C174BERLAND COUNTY GENERAL FUN Check# 034664 $15.00 Total Received. . . . . . : . . $15.00 Insured Copy Erie Insurance VExchange Mail Date: 05/21/2013 9 fier•Ede lnrur eGroup to lnt.K•FAO.PA 16530 V Premium invoice $$lamed Insured ;&NNA M HOOVER Policyholder: ANNA M HOOVER 216'STONE HOUSE ROAD Policy Number: Q541107414 CARLISLE PA 17015-9429 Policy Type: Home Protector Policy Period: 06/11/2013-06/11/2014 34819213 AA7371 Previous Minimum Due $0.00 Payment: $0.00 Net Adjustments: $0.00 Past Due Amount: $0.00 Current Installment: $435.00 ERIE Agent Billing Fees Due:. $0.00 Agent Number AA7371 To pay in full $435.00 D X, W; ,sri&y r`taE�MI FETROW INSURANCE ASSOCIATES LLC DPe 14300 3" P"-` e r 5299 E TRINDLE RD D I MECHANICSBURG,PA 17050-3511 (717)766-3200 Thank you for choosing Erie Insurance for your Insurance needsl Want to pay this bill online?Go to www.erleinsurance.com, Pay My Bill and make a convenient,secure online payment. Other bill paying options are also available on our Web site.Contact your Agent with questions or coverage changes. Fees will be added for any returned payments and included on future invoices. Keep top portion for your records/Return bottom portion with your payment Detach here PCOOei Delaehhere PC0004 Page 3 o13 lr�:CenturyUnk- o / P.O.Box tte,NC a Charlotte,NC 28201-1319 C3 1 AccgQ��.rfit Name: ANNA M HOOVER Page: 1 of 5 Ace6unt Number: 313226938 Bill Date:.Apr.25,2013 Coritac[tVii'rn[iers .'Currekbiiardes.Suriimary lieteli page Product,Services and Bilrmg 1-600.201-4099 ® CenturyUnk Local Services '3 34.60 Repair Servlco 1-800.7883600 a ConturyUnk Long Distance Services 5 5.00 Payment or Account balance 24/7 Lats Fees 0.50 1-800.2014099 ' HighSpecd.IntemotTech Support 2417 Total Current Charges 40.30 1.800.7883600 Dial-up lntemei 24/7 T&h Support 1-88"727313 Flnanetal ServiceslPayment Arrangemonts 1.888.6464)004 Visit us online www.cenM)ry ink.com "Previous Balarici) Payments Ads Past Due Current Charges _ Amount Due Date,Due 40.30 I 0.00 I 40.30 40.36 I 80.60 May 20,2013 Just a friendly reminder that your account is past due. If you have already mado yopr paymont;thank you for bringing-your eacount up to date. 6 The DUO Date On This 61 71 Applies to Current Charges only Local §ervices Detail Local Service from APR 25 to MAY 24 Recurring Charges 1 Pty Residence Una 18.00 Caller ID Number Only o.0o Federal Subscriber Une 8 Access Recovery Charge 4.60 Total Local Exchange Services 22.80 '• Inside Wim Maintenance 6.95 '• Mon-Telecom Services Surcharge 1.65 Total Optional Features/Services 8.50 Total Recurring Charges 31.30 Total Current Charges For 717-245-0408 31 .30 Taxes,Fees and Surcharges CUMBERLAND County 911 Surcharge 1.25 Federal Excise Tax 0.71 I` CenturyLink- o P.O.Box 1319 o Charlotte,NO 28201-0319 v m V) Account Name: ANNA M HOOVER Page: 1 of 5 15 Account Number: 313226938 Bill Date:, Jun.25,2013 N m Contact Numbers Current Charges SummarV Detail Page Product,Servicesand Billing 1.800.201-4099 ® CenturyUnk Local Services 3 34.80 Re�7883600 © CenturyUnk Long Distance Services 5 5.00 Payment or Account Balance 2417 Total Current Charges 39.80 1.600.201-0099 High Speed Internet Tech Support 2417 1.800-7885600 Dial-up Internet 240 Tech Support 1-888-872-7313 Financial SemIceslPayment Arrangements 1-888-646-0004 Visit us online www,centurylinkcom Previous Balance Payments&Ads Balance Fonvard Current Charges Amount Due Date Due 40.84 I 40.84 CR ` 0,00 I 39..80 I 39.80 I Jut.19,2013 Thu Due Date On This Sill.Applies to Current Charges Only s Caller ID Number Only - O.OD '.1 Federal Subscriber Line 8 Access Recovery Charge 4.60 Total Local Exchange Services 22.60 Inside Wire Maintenance 6.95 •• Non-TetecomServices Surcharge 1.55 Tots!Optional Features/Services 8.50 Total Recurring Charges 31.30 Total Current Charges For 717-245-0408 31 .30 Taxes,Fees and Surcharges CUMBERLAND County 911 Surcharge 1.25 Federal Excise Tax 6.71. PENNSYLVANIA Sales Tax 0,71 PENNSYLVANIA State Surcharge 0.08 ` ® CenturyLinkn P.O.Box 1319 o Charlotte,NC 28201-1 31 9 0 v ,m Account Name:"ANNA M HOOVER Page: 1 of 5 Account Number: 313226938 Bill Date: May P5,2013 Cdhtdd1'Nurhb6tS ,.' CLrrrentChargeS'Sutni6ar.w: . e ' r Product,Services and Billing 1-600.201-4099 ® Comuryun%Local Services 3 34.e0 RepalrSorvlco 1.800.7883600 Cemuryllnk Long Distance Services 5 6.04 Payment or Account Balanco 24M Total Current Charges 40.84 I-BOD•201-0099 High Speed Internet Tech.Support 2417 . 1.800-7883600 Dial-up Internet 24?Tech Support 1-888-8727313 ' Financial SorviceslPayment Arrangements 1.889-646-0004 ( Visit us online www.eenturyenkcom 1 Previous Balance Payments&Ads Balance Forward CurrentCharges Amount Due .Date Due 80.60 I 80.60 CR I 0.00 I 40.84 � 40.84 I Jun.21,2013 f Tho Duo Date On This Bi11 As lies to Current Charges Only 6 Local Service,from MAY 25 to JUN 24 Recurring Charges 1 Ply Residence Lana 18.00 Caller ID Number Only 0,00 Federal Subscriber Una&Access Recovery Charge 4,80 ` Total Local Exchange Services 22,80 Inside Wire Maintenance 6.95 •' Non-Telecom Services Surcharge 1.55 Total Optional Features/Services 8,50 Total Recurring Charges 31.30 Total Current Charges For 717-245-0408 31 .30 Taxes,Fees and Surcharges CUMBERLAND County 911 Surcharge 1,25 Federal Excise Tax 0.71 PENNSYLVANIA Sales Tar 0.71 Other Charges and Credits Service Page Total ,_. , One-Time Charges Date Descrip;Ion c A Account Charges 1. 5558 . 1. 04/14 Late Payment Charge Wireless SOX, Surcharges and Other Fees ;W 717'609-6395 so.00 I 2. State Gross Receipts Surcharge r M ' —U Total New Charges S558 Government Fees and Taxes m 3. PA State Sates Tax C r 'r" Total Other Charges & Credits 5. Total Account Charges 5. 717 609-6ER ANNA HOOVER Senior Nation 200- Includes 200 Anytime Minutes, Nationwide Long Distance&Roaming,Unlimited Mobile to Mobile calling to/from other AT&T Mobiles,.500 Night How to Contact Us: (9pm-6am)&Weekend Minutes, call Forward Feature,Caller For questions about your account:1800 331-0500 ID,_Call Wait,Conference Call Feature, Mobile Purchases & or 611 from your.cetl'ph6ne Downloads Detail, Basic Voice Mail Feature, (Additional For Deaf/Hard of hearing*Y:.1 866 241=6567 Minutes 50,45 each). Visit us online at www.att.com For Important Information about your bill, please r see the News You Can Use section (Page 2). ys�o i ck�l r o S4 khv = ftelos SUNce;nro,,100 q'AT&T Mot,41rr,U t. a pos.,t ' .o w �� .... .. _ - Rimed on Recycrablei t n it . f ESTATE 7RUSj t{OOER AN 64077088401 42 27,'. fiedr'3er.•'TSS'softwareTdrpo2Uon yy332136a0 Ts�a�� -. ^^ter, .. .. . . .. .,. .. .. ,. a .. .. ANNA HOOVER Page: 1 of 2 .i. .�. t 216 STONEHOUSE RD Bill Cycle Date: 02/15/13-03/14/13 CARLISLE,PA 17015-9429 Account: 464077088401 u�i Visit us online at www.att.com m r ?7 Wireless Statement O PreYlous Balance'•; 56;69 Stay connected OCl-the-go PoyrYfelit x03/b5 ;.•Thank Youi; 536 69CR `; - AT&T is the place to find Adjustments $bj00k your new tablet. Balance'. Obq Add a tablet today! New Charges 536;69 „ Cale1-855-More4you(1-855-667-3496) CI e Totat Amount Due $36.69 Vis it an AT&T st ore grfioQdt;DUe)n FuUby • , A,�r 09 �0�'3 .ANNA.HOOVER �4 _:... ... ....,<_.__ _ Senior Nation 200-Includes 200 Anytime Minutes, Service, _. . ..., .,Page ,:T,Otal •,;,.._ Nationwide Long Distance&Roaming,Unlimited Mobile to Mobile calling to/from other AT&T Mobiles,.500 Night Wireless " 536:69._ (9pm-6am)&Weekend Minutes,Calt Forward Feature,Caller 71T6i19-S39$ 536.64 a ID,Call Wait,Conference Call Feature,Mobile Purchases& Downloads Detail,Basic Voice Mail Feature,(Additional Total New Charges 536;6,9 Minutes$0.45 each). " International Roaming-Standard Includes Enables International roaming outside the U.S.,including calls placed within the roamed country and back to U.S,_at standard,pay-per-use international rates. See rates at www.att.com/glabaL raD.�n 7357.14.704.184351 1 AT 0.3946y If I ePay Enrollment 1 enroll In AutoPay,l authorize AT&T to pay my hill Iiillllllll{��'iIII�III�I�h��('�['��Il�r!�Irrjp�{IrI�y11Jl��l monthly by electronically deducting money from my bank account.I can cancel authorization by notifying AT&T at ANNA HOOVER www.attcom or by calling the customer care number 216STONEHOUSE RD listed on my bill. CARUSLE PA 170159429 Bank Account Holder Signature: Date: ' Questions?Please /�,' Visit us online at Page 1 �r Q��°�•A� © 80 .ct PP Lay 18. U pplolectric com .' . c a'�' •','' '(1-800-342-5715) 67180-80003 May 16,2013 nt Due rmL e�enc Utl woo M-F:Sam to Spm YojE Electric Usage Edrofiie Billing Summary (Billing details on back) Ser*e to: Balance as of Apr 25,2013 $122.10 ANN�+�ilOOVER Charges: 216 ONE HOUSE RD Total PPL Electric Utilities Charges $40.10 CARLISLE,PA 17015 Total VERDE Energy USA Charges $62.94 Meter:94573366 Your next meter"reading Is on or about May 24,2013. Total Charges $225.14 This section helps you understand your year-to-year X52 s' electric use by month. Meter readings are actual unless Account Balance $225.14 otherwise noted. Me 2012 2013 This Electric Utilitles'price to compare for your rate is$0.07237 per kWh. This changes the 19 of Mar,Jun,Sept,and Dec.Visit papowerswitch.com 42 or www.ota.state.pa.us for supplier offers. 28 M Your Message Center o + This bill Includes a previous balance. If you have paid b 14 this amount,please accept our thanks and payonlythe m >a current charges. A 7 • VERDE ENERGY USA RATE$0.08101KWH D 4 With paperiess billing,you can receive and pay your 1 F M A M 1 J A S 0 N U PPL Electric Utllltles bills online.The process isfree, Months quick,convenient and secure.To learn more or sign up, visit pplelectriccohl. id kWh/Day Temp. o information about appliance energy use and tips on saving energy are available through the Energy Library "2012 0 777 26 49F on our Web site,ppletectriccont. 0 709 24 52F 'Billinip6riod' I Type Reading Payment Miathotts Apr 24 Actual 24939 ✓( Online at, ©By phone:1-800-342-5775 Mar 25 Actual 24162 v ppieldctric.cdm or call BIIIMatrix(service fee applies) at 1.800.672-2413 to pay using"Visa, _ 30 Days kWh Billed 777 MasterCard,Discover or debit card. -_ B Y Mail: Correspondence should be sent to: May 2012-Apr 2013 8823 735 2 North 9th Street Customer Services CPC-GENN1 827 Hausman Road — May 2011-Apr 2012 8043 670 Allentown,PA 18101-1175 Allentown,PA 18104-9392 Other Important information on the back of this bill 4 '6'Q°•;: ® Return this part in the envelope _ l Pp, J.-Z provided with a check payabte ! " - ' m i .LM�c thaftio's to PPL Electric Utilities. 67180-80003 Apr 16, 2013 1. $122.10 Amount Enclosed: IH Of 007447 3I-I[I 26 C"6DGT ❑❑ ❑ 1❑❑ llh4"1dEll'191IdrlGhl f"6hnrl4'I('P'I'gd'nlu,� ANN HOOVER 216 STONE HOUSE RD PPL ELECTRIC UTILITIES CARLISLE,PA 17015-9429 2 NORTH 9TH STREET CPC-GENN1 ALLENTOWN, PA 18101-1175 hlHllill '111.1'l Jill 11 fill Ill."lit III1L 1 5700001221070000122104 6718080003 ' ,,, Illlllllllllllllllllllfll�lllQll�flllllll ' O o m ' o'y c gE NN N= O4 �ww O.O 7 M.yeYO Nd1�gN A t,o c NQo dK `/ �u�OO oc e' Q �cQ G '> Em ti�LO avwi'8181 o `. 1> ay` cc ��tt,,m c � c c moE ww �'o w--Y� a°�S� HEmo —°. � oo` �aE �-5 =0 L—oy�{0�1 w r. w 1 pCw �w� `m as?v>- sR. U oNN= E . m0 uUW< d m °^Ra "�` ��IS T�ccC n ti .c. 0 a > c �a o� A>°OUmL'l a t: ¢ mm + o.p 1 1E m N o s . �° u � w,°s V (T7 �cW roan ��uc3 ,�. p ¢ O Fo. �E c w «rIw C w — o�('+ yc�°a °c8111E +c' V" L�Zc CL CY G ^ O YN w �_�U— 10`J� V�pp� VlW3 o� '.(� �" a 1 '81 m Imo N fi�uY �co $Eacm C cm goy$ (.. y•ri 1 > a `m . . m Y"icx w c. ��, .Q>1 ��ywe d c8 Tza?i 7� w uim t '; C w.mcS ? 0.0'} C '�i0 �Q v�.aCUT E om mN UQ Y; ziR G �o p _ugg m to u F- y 1:• m o o w� n rri `m Z •io m w ' u1i10., a D.savi p In w a 7 ww Ot,32 w lD Y (7 3 ei.~.. �+ m •p m ^ Q t�D ta0r1 i'.. © O w G�G S .a00 h •.iiiii4� V NN CI v y O N u lM fNfl • N N F• :o wo-4 en Cr z m o�wa d%r o�v Z w 3 y e! r6 UM � a w C V YSr r N n 0 W 'OZzl�/1 h Q N U G} F w O (gm>I),tea jad'dntl UI06910U �IIII II I it 1 1 1 lfl�l l l 1111 l ll MIN[Jill Nom.. • a - - .vm u .n.>m •' _ 0 IT sp N.O d N•-q O Y O W O U Oqy� u 2,,:mR -E mV0o •G '. �+:'d p•J by� 2jxa u`"i mu°ti « 3} • N- m ms cad °c� cmw OPg�:v vvai`c°°• o U Iba ui=Wm o'',E„c c om roxE m omou aEmo ° 3 �.`m m.m_ �apc 1a°ro °L° ��^, Yana, E 1' m° Omm mOro� VVCO3 w o O E N w md�' aOiH CEO �d G w m m oy" o �•�ro w� °u b w © 1i -CS E d N G �y um�5 mp{t'n e Y le W M a 1Q/I ql mV� .d±. CN WC m m>�ro =yd tj n p m iD aoA V- } Haa� �.o.°'.�.c�5 p .a .°°� r o=. v n d a+ N C W M lyQQ C�.O db T �. V yj O r cv E. fl 0 .'7Tn w m'Fi°= my�j 2Ev t3`S &iZ 3: C� J O J C tao O�'^m w ddUd 'O°m m� w �.. S W u'alU N' O WY'd ECj E�LO •u ON Ora U) 'R b > Om CO d K «J�a+ `p-O V!� d �y 2OU� + mi RL` w d7Tn w> O N m o•> E w o F3°a.,=. O a m Izv i.Ia `si a p A fs M ca u IL tC d 15 m T Z7 O. ON TFa N C'. dCOaOa u. d O 'W C W M �S1 i � y O 4 0 �� " � � '.In rmi•. -7m�7,, m •^-� Imo` °O° *S FD In In � .7 mp m O•C � '. Y m N s < w eWI °•• Qp •�' On�YO� La-Ed E- V w S Q m W =M O® y5 d >[�W}}a .eM��aaE++ a m a q 2zln� cd° ,•mot�..r >- v°'i Q N U G Y �Cl p INMH1 he0 aad'8ntl -, � a Q ' IIII011111111 Illligllill(IIIIIIIIIII i�l to se�eoa amp . „e a lG H h N 3 ifj u q0 'p a d ' V m K K 0. �V m 9 c O O.m U C. c m v > cya K O y dg0� N ... 0a S•NO Fpp' C� CQ (;i �i�.a oaE2 0 d_H in G �m x moE ma, com`°v f'Er'o,30, a w m mz. MOA CLE 5-5 c to 0 o 2 c�~ w E 8 rw 1O m' Eca 4ia 3O`o' ma` �c °• H `` m b 0 E d) ffi Or His 0- �w 3 �' T O C G' �+•C OI Z S,^i N p 0 Eaat y858aai w icCm mom$ ;. £.a;- m mR d w 'rsa�� 8-r- oE�Y @" d cy TZda MR ono O�S•'3 S Oa >a C1 mu 10 EWE a o jt m w Vn E ° a° m M1AC6Nh N b p tD NNN tD i •e.�6v E a amid ,r. t 2N d lL 0 1302w,L O m C W e a tOpOi N 3}.p, to , o O 4E� IL {{.� O L "R d a �- v-C N c`zi $r i m o (qmt aa,ad lAv `o Questions?Please Visit us online at Page 1 w' V contact us I Oct 16. pplelectric com 1-800-DIAL-PPL Due Dale -"Acri6vot'Diiii PPI •,, (1800.342-5775 z o 67180$0003 Oct 16,2013 ';�Gr�,L�1 .� ' PPL. o'nauuUGoa M-F:SamtoSpm Your Electric U age Profile WINS Summary (silting details on back) Se51ce to: Balance as of Sep 25,2M3 $0.00 A HOOVER Charges: 2 NE HOUSE RD Total PPL Electric Utilities Charges $1&53 CAMISLE,PA 17015 Total VERDE Energy USA Charges $12.94 Meter:84573360 Your next meter reading Is on or about Oct 24,2013. Total Charges $31.47 This section helps you understand your year-to-year . o y electric use by month. Meter readings are acaial unless Account Balance $31.47 otherwise noted. ®2o12 ®2a13 PPL Electric Utilities'price to compare for your rate is$0.08777 per kWh. This changes the 1st of Mar,Iun,Sept,and Dec..Visit papowerswitch.com 42 or www oca.state.pa.us for supplier offers. za _ Your Message Center g 21 • VERDE ENERGY USA RATE$0.0924/KWH 14 • Go Paperless,and receive a FREE LED at 7 pplelectriccom/gopaperless o + Informat#on about appliance energy use and tips on e F M A M a 1 A s o N o saving energy are available throw the Energy Library on our Web site,pplelectriccom e•power MQ _ + Before digging around your home or property,you should always call the state's One Call noclfication system to locate any underground utility lines. You can " ' do this by simply dialing 811,which will connect you to Sep 2013 3Y 140 4 6$F ree Call system.. Be safb and call 811 before you dig. Sep 2012,, , 32 463 14 69F " _Palymerit'Methods 5eR 24 Actual 25812 1 Online at: By phone:1-800.342-5775 Aug 23 Actual 25672 c1 pplelectric.com or call Bi€iMatrix(service fee applies) at 1-800.672-2413 to pay using Visa, 32 pays, kWh Billed 140 MasterCard,Discover or debit card. till M By Mail: Correspondence should be sentto; Oct 2012•Sep 2013 7286 607 2 North M Street Customer5ervices CPGGENNI 827 Hausman Road Oct 2011-Sep 2012 6098 675 Allentown,PA 18101-1175 Allentown,PA 18104-9392 Other Important information on the back of this bill 4 (1) Questions?Please j6 Visit us online at Page 1 s;^ l�1 contact us by YO 6. �J pplelectric com 1-800-D1A1-PPL (1-800.342-5775) 67180.80003 Dec 16,2013, v aanaummaa M-F:Sam toSpm ..-- Ytibur Electric Usage Profile $1111ng Summary (Billing details on back) S M,ce to: Balance as of Nov 25,2013 $0.00 A HOOVEfi Charges: C�STONE NdUSE RD Total PPL Electric Utilities Charges $18.18 ter.8 57 360 Total VERDE Energy USA Charges $12.49 Meter:84573360 Your next meter reading Is on or about Dec 26,2013. Total Charges $30.67 Thlssection helps you understand youryear-to-year -vim electric use by month. Meter readings are actual unless Account Balance $30.67 otherwise noted. M 2o12 ®2o13 PPL Electric Utilities'price to compare for your rate Is$0.08777 per kWh. This changes the.1st of Mar,Jun,Sept and Dec.Visit papowerswitch.com az or www.ecastate.pa.os for supplier offers. as 28 — m Your Message Center $' IN zt • VERDE ENERGY USA RATE$0.0999/KWN m 14 • Go Paperless,and receive a FREE LED at a 7 ppielectric com/gopaperiess o • Information about appliance energy use and tips on 4 J F M A M J J A s o N o saving energy are available through the Energy Library E on our Web site,pplelectric.com/e-power u s • Before digging around your home or property,you should always call the state's One Call notification system to locate any underground utility lines. You can Nov2013 125 4'• 1 h Ope Ca ysil sply dialing 811,which will connect you to dig ystem. Be safe and call 811 before you Nov 2012 33 1011 31 44F Pay[ltent Methods Nov 22 Actual 26026 / Online at: ©By phone:1-800-342-5775 Oct 24 Actual 259D1 tJ Ppieleetric.com or tali BillMatrix(service fee applies) at 1-500-672-2413 to pay using Visa, 29 Days kWh Billed 125 MasterCard,Discover or debit card. lEM=i7K-=- 1E ® By Mailr Correspondence should be sent to:.Road 490 2 North 9th Street Dec 2011-Nav 2012 8472 706 Allentown,PA 18101-1175 AI eHausman t 18104-9392 Other important information an the back of this bill 4 . _ naacan� Questions?Please Visit us online at Page 1 -' \V contact us by Nov 18: PRielectdc com , 1-BOG-DIAL•PPL Bill Acct.No.. Due Date Arnpun't o �M a;• (1-800-342-5775) 67180 8Q003 Nov 18,2013 s PCtFJ•w+o w• M-F.Bam to 5pm - - rgour Electric Usage Profile Billing Suminary (Billing detalls on back) rvice to: Balance as of Oct 28,2013 $0.00 N HOOVER Charges: 6 STONE HOUSE RD Totai PPL Electric Utilities Charges $17.07. LISLE,PA 17015 Total VERDE Energy USACharges $8.89 Meter:84573360 Your next meter reading is on or about Nov 22,2013. Total Charges $25.96 This section helps you understand your year-to-year n v' p2 1 v electric use by month. Meter readings are actual unless Account Balance $25.96 otherwise noted. PPL®2012 ®2013 This chctric Utilities'pricer, compare for your rate is$0.08777 per kWh. This cltangesthe 1st of Mar,fun,Sept,and Dec.Visit papowerswitch.com 42 or www.ocastate.pa.us for supplier offers. as 28 Your Message Center • A new price for the quarterly distribution system 21 improvement charge is effective from Oct 1,2013 S4 - through Dec.31,2013 7 • VERDE ENERGY USA RATE$0.0999/KWH ° • Go Paperless,and receive a FREE LED at J F M A M r a A s o N ° pplelectric.comJgopaperless Monti s • Information about appliance energy use and tips on r _ saving energy are available through the Energy Library on our Web site,Pplefectric com/i�power " '" • Keep light bulbs and fixtures clean.Dust and dirt absorb Ott2013 .' 30 89 3 66F lig)itand can reduce ilghtdutputbyas much ashalf, Oct 2012 30 615 21 -56F j Payment Methods Oct 24 Actual 25901 Online at: ©By phone:?800342-5775 Sep 24 Actual _ 25812 U pplelectriccom or call BillMatrix(service The applies) at i-SOD•672-2413 to pay using Visa, 30 Days kWh Billed 89 MasterCard,Discover or debit card. - ® By Mali: Correspondence should be sent to: 2 Nov 2012-Oct 2013 6760 563 2 North 9th Street Customer Services CPC-GENN1 827 Hausman Road Nov Zbii-Oct 2012 8163 680 Allentown,PA 18101-1175 Allentown,PA 18104-9392 2 Other important information on the back of this bill 4 1 Questions?Please /y Visit us online at Page 1 contatuAsLbby Jan 20. �J pplelectriecom ■p N Ate .{ Y �14 .+K r=•ar r tt4aua uFmxo4y M P Sam to 5pm� 67180 80003 Jan 20,2014 3 99 *ur Electric Usage Profile Billing Summary (Billing details en back) !5rvice to: Balance as of Dec 30,2013 $DAO 6 STONE .L HOUSE RD Ch ToMi PPL Electric Utilities Charges $19.91 LARUSLE PA 17015 Total VERDE Energy USA Charges $18.08 Meter:84573360 Your next meter reading is on or about.lan 24,2014., Total Charges $37.99 This section helps you understand your year-to-year 'tiD r2 4°• r A;-"�`n,'`3 IIIO S9 electric use by month. Meter readings are actual unless Account Balance $37.99 otherwise noted. ®2012 2013 PPL Electric Utilities'price to compare for your rate is$0.08754 per kWh. . This changes the 1st of Mar,Jun,Sept,and Dec.Visit papowerswitMitom _ a1 or www.dca.state.pa.us for supplier offers. as Your Message Center g • VERDE ENERGY USA RATE$0.0999/KWH 21 t4 . With paperless billing,you can receive and pay your 7 PPL Electric Utilities b31is online.The process Is free, e quids,convenient and secure..To learn more or sign up, visit pplelectriccom. J F M A M 1 3 A 5 0 it o • Information about appliance energy use and tips on Monuu saving energy are available through the Energy Ubrary I l t on our Web site,ppielectriccom/e-power NO + Brighten your holidays safety.Check light strings before usingg to make sure cords and plugs are intact Turnoff Dec 2013 34 181 5 33F insitle holiday lights before you go to bed. Dec 2012 30 931 31 39F Payment Methods Dec 26 Actual 26207 Online at, By phone:1-800-342-5775 ? Nov 22 Actual 26025 pplelectr(ccom or call BillMatrix(service fee applies) at 1-800-672-2413 to pay using Visa,. 34,Days kWh Billed 181 MasterCard,Discover or debit card.. By Mali: Correspondence should be sent to- 2 North Street Customer Services Jani�� Dec 26b 5124 427 Jan 2012-Dec 2012 8406 701 Allentown, 18101-1175 A lentown,PA 18104-9392 Other important information on the back of this bill 3 F i i i r fit en000 Iilllllllilllllllllllllllllll .Iililni •,s .o 3� amp V a i G t w N a G oC G ry N O a o• Om al .m C ,pN,1�6 Y! u1�>? Y.L Lin r<"t° N .�. =fir+ q!MO 7zm te, (�. w�m e m m ° cc� E°+3 `w a�ca w E- 2 M LL oa �a� -.9 am aF� cad„ v ''.�ha E CNF- O 61 y Qa� p' 0ca a j a N C GO GO a H� W G uyr LT+� to iH U t V-�i fn C 0,-,.* N MMO a N H u�N C W c�Eoaai°�' 0 b1YA .`'-'::oiay z °1u�a u�L d c 3 E m a w -0. rp R w E{si� ma3 toa9 lob - w Cu 3 o a z m ( n �,°' Eca a» $ a 7Aa s �a'to 2 w 3ta5c -r JA o ¢off E oa cac';Va a c y-'juE. L ~ ma Sa Cflmu t°- a ¢ o N r a~ v = N m. M o y N E . Np�N rah E tai Tm Q ,p, M 0 pr W �y t7u.yu� _ O m ea a '. oo m m c 7 CL © u�O m i a N N N OMf L'i d f N. N N 0� C) ee m e _ Oac ct N N@ 0 �0 3ya 0 0 N a 0, N 1. �xy Lq �-c 5t 0, w w �• O 2Z � N7 yl'ja :q LL lL ¢ a n } vaiQNt� fir° �d� (4hW)Aep jad'VAtl .. t: t 1 STATEMENT OF PHYSICIAN SERVICES 3ENNSTATE HERSHEY ANNA M HOOVER PAGE S of g ru 216 STONEHOUSE RD n ate.Hershey CARLISLE PA 170153429 u use Q4 2sf f1S Medlcal.Center ACCOUNT# 816030 __ =STArEAtEffT M tF QUESTIONS,PL UE CONLACT:MSHMC PATIENT FINANCIAL SERVICES FED TAX ID# 25185/035 r m gb r BALANCE 9 MM RESPWIBLE PARTY POLICY i TOTAL HEP NUMAS SOLUT104 DC 203248BIA* $ 503.00 RM BINANA 11486133CM4437602 S 2.21 ME .GUARANTOR RESPONSIBILITY $ 19.51 WORY07-PHASE MUCH At"REYURNOOYYORMITTION OP 8rafMjff}WTjt fj3UR ❑CHECKBOXANDT:NTERANYADDRESSORINSURANCECORREMONSONBACK STATEMENT OF PHYSICIAN SETRVICES U P O 'ENINSTATE HERSHEY ANNA M HOOVER 2012 218 STONEHOUSE ROAD STATEMENT U) llm IQ 1 S. Hershey CARLISLE PA i70T5 942D � E'. 06/03/13 m elcal Cwter ACCOUNT# 818030 — DAM 04129113 P: tp quESTTONS,PLEASE ROHTACT:MSHMG PATIENT FINANGIAL SERVICES FED TAX ID 251857035 V.1 rte ;' ONE* ! +In €- r R `- THIS STATEMENC. FOR PHYSICIAN SERVIC . ORDER TO KEEP YOUR ACCOUNT CURRENT,. OUR POLICY IS TO APPLY YOUR PAYMENT TO THE OLDEST OUISTANDINO BALANCE. YOU MAY ALSO RECEIVE A STATEMENT FOR HOSPITAL FEB. THAW YOU FOR USING MLSHMC PHYSICIANS GROUP FOR YOUR PHYSICIAN SERVICES. BALANCE SUMMARY RESPONSIBLE PARTY POLICY 3 TOTAL HUH H MANA. Ht865I330MPI4376CE 8 1.61 3" GIIARANMR RESPOILSIBILny S 50.56 IMPORTANT.PLEASE OETACN ANO RETURN BOTTOM POS710H OF STATEKENT WITH YOUR R PAYMENT PERFORMED BY: GERALD V NACCARELLI PH ELEC'THOPHYSIOLOGY 03lI9lI3 93010 427.89 ECG ELECTROCARD TTTTERP HUM 101.00 05!28!13 MEDICARE PAYMEtii3F 6.42- 03128113 MEDICARE CONTRACTUAL AM 92.97- BALANCE: AMA N HOOVER 550.56 INDICATES NEW FINANCIAL ACTIVITY SINCE LAST BILL. AS A COURTESY TO OUR PATIENTS: MSM16 PHYSICIANS GROUP WILL SUBMIT BILLABLE CHARGES TO 1T15URANCE COMPANIES. IF YOU HAVE QUESTIONS ABOUT THE AMOUNT YOUR INSURANCE COMPANY PAID, PLEASE CONTACT THEM DIRECTLY. FINANCIAL ASSISTANCE IS AVAILABLE TO PATIENTS MIAO CARW AFFORD TO PAY THEIR MEDICAL DILISAF YOU HAVE QUESTIONS REGARDING YOUR BILL PLEASE CALL. 800-254-2619 OR 717531 5069 OR VISIT US AT THE ACADEMIC SUPPORT BLDG., (OFF HOPE DRIVE), RDOM 2106. HOURS ARE MON 8AM-8PM, TUES & WED 8AM-5:30PM, THURS & FRI 8AM-4:30PM. ❑tHI{KBOXAND£NiFR ANYAt}ORESS OR iNSURANCEfAtiR£CITONS ON BACK Patlent:ANNA'M HOOVER co Account:631014 Services Rendered At:CAR N 'P Date ayments o Date Code Description Charge Ad ustments Balam Q 0 311812013 70450 T SCAN BRAIN W/O CONTRAST 996.00 E 0 4115!2013 PMT MEDICARE-NOVITAS SOLUTIONS 32.06 4/152013 CR Adjustment MEDICARE-NOVITAS SOLUTIONS 157.92 C.) 3/16/2013 71010 CHEST SINGLE VIEW FRONTAL 36.00 1 L7 4/172013 PMT MEDICARE-NOVITAS SOLUTIONS 6.94 a 41172013 CR Adjustment MEDICARE-NOVITAS SOLUTIONS 27.32 v r Current 31 .60 61 -90 91 -120 Over 120 BALANCE DUE $ 9.76 0.00 0.00 0.00 0.00 PAY BY Due Upon Ref For billing questions call: (717)932-5955 or., (877)932-5955 Fax:(717)932-4856 Office Hours:8:00 AM-4:30 PM 111—((ii iii �` 1i� 11 To pay your bill online and register for eStat R IMPORTANT please visit us at:www.gita.com SEE REVERSE SIDE FOR IMFORTANT HILLINta INFORMATION tes o till - 7 --039 Or C MAL LE M - ateo�en¢ cExrex r7 , of l� Patient Name Anna M Hoover Online at www.cartistermc.com * Account Number 1324735 (available 24/7) Date of Service March 04,2013 Service Type Outpatient BY phone-717-980-1fi80 Insurance Name Medicare Outpatient Name of Insured Anna M Hoover By credit card-complete section below and retur Policy Number 203248631A Amount Due From You $177.81 ®By check-return section below with check Amount due from you is 5177:83 as of 0713112013 for the charges listed below do_hof reflect the,discount t Outpatient perforriled on,(v arch'04,2013: YP6,,Shd' ur insurance company.received. Other.Procedure 2,325 Total Charges $20,00196 Lab 2;726 DiscounES/Adiustm$nfs Given $17,569:17 athology 14,. 1 Jnsutance Paymants'Rdcelved 7$9,234.98 70 TAL GHAi2GFa^ $26,Ub1 Ar"nountYduPaid x � 0 AUG 0 5 2013 Amount bue Fro,m You 5^177:81 Ii0S 1. HMASTh9T•1785399-1478848546-P:7671785.1-108 33528515-1:1 The arciburilshown brn,this statement'as outstanding at this time.Your prompt paymenf l be#aatiy app',rogiefed. .. 77=,.. .:..y ,v J. ..., w. a 5 LE t4YL Q aE mE4EM 7EA O V. M Pailerif Name ' Anna M Hoover 0 Online at www.carlisiermc.com Account Number 1328738 (available 2417) v Date of Service March 15,2013 r Service Type Outpatient By phone-717-960.1860 Insurance Name Medicare Outpatient Name of Insured Anna M Hoover CO By credit card-complete section below and return Policy Number 203248531A 7� Amount Due From You $149.82 By check-return section below with check SI Amount duofrorit you rs$199:82 as of 07131124'i3 for The charges tisted�betow do_nof refiect the discount-iha Ouf Pat ient pe'rfp6ried on'Marrh 15,2013. . you and:your•Jnsurance.company received. Lab 915.1 Tdtat Gila"rges $5,063.92 Tmatnient Room DiscounWAdJus menu Giveh -$4,309.80 P imiacy $.9 insurance Paymen}s Rebeived 4$894.31) Supplies. 897.9 Artio4ht You•P.afd. $0.00 Processing fee for blood 840:8 Pathology 835 2 TOTAL CHARGE$ RE WED $5;053.9 AUG Amount Due From Youe CiI13"�269HM 49:82 �.�- 2Q13 • IRWIN&McRNIGHT �wQfEfas Il& ASTMT-17853 99-14768485524';7671785-1.107;33528616.1;1 - Your ihsurance carrier has denied payment of your bd1 Therefore,the bill is nowyou responsitiiitty C,di)tact your'Insurance Barrier it'you have any.questions: '""""31eo'r1ip�"155S6rtW3fUT.'Otpmaiwn8 >wo�. gg•- r.,,-r r ^y - 40 74C Account Information u) IONAL E AL CENTER Account# 9548316 Patient Name: ANNA M HOOVER Date of Service: 03/18/13 0 M MAIAL NO17CE m Balance: $320.98 C7 05123/13 We are writing to inform you that your balance is past due and a payment in full has not been received or a suitable payment;arrangement established. This is a request for Immediate payment in full on or before ten days from the date of this letter. Pay your account in full by check,money order or credit card payment using this form and enclosed envelope. If we receive no response from you this account will be referred to a national collection agency. If you have already sent your payment please disregard this letter. You may also pay your bill online at www cariisiermc.com. Thank you. Carlisle Regional Medical Center QtJCStions7 Telephone: 855-843.0549. Selvicio en espanoi, por favor Herne: 1-866-301-0426. BSS ,,....-_PLEASE DETACH ANp RETURN 80170M PORTION WITH YOUR PAYMENT OR MAKE PAYMENT BY CREDIT CARD;,,.._. 1 11t1 � 3791 U1 itiI8�'If813At�lll�Iil{ID!#i�It1 I Cl MCA Cartl umber sm9ne lure Total Paid Carlisle Regional Medical Center ❑Disc Signature Expi at",Date 366 Alexander Spring Road I7 AMEX Carlisle,PA 17015 Statement Date P- SHOW AMOUNT PAID HERE aThsAtrintu, 05/03118 532D:981s�';- 5 Account#: 9548316 JONSI954831659 317046801435 3348106024616002 0 Mail all Correspondence to: Carlisle Regional Medical Center Anna M Hoover PO Box 281442 216 Stonehouse Rd Atlanta, GA 30384-1442 Carlisle, PA 17015-9429 000011954831600000032098ANNA fi HOOVER 8 W N 0 O p p d m r- T go F. I.n = t9lfl�M Q Tf N . T F m CCC� `I. a " Z mNms O IL r W LL � � Nx =O yyw m¢ J v k�l' Wy m o.-N a 5oa 3 me �'ZQ { yc ^ ^ m a3s o m Iai m OM ^ O N 1 W & 0 S o CC J U ue N r..'.• � Y, at c� Z N W Z W (5 O Q ED Ir Utz o ��,�� o r ct r LL- N Co a� c'v S2 C* CQ Cl too O gym® - .C9 5Sxig'• ' 2 LU o ZOO¢ 8 m° Z}Sd j2 mw = ^ ¢e Q w m m^ W m= m^ LU0 no ° >IOU) co IS ir coom< DZNJ 02 a5NU — 3�aN s° .. mU•-U Oa loom 162713''SACHEA >"Ei HOSPITAL CARE ,'' ';INV#aa'S,rs�`SH OVER,AR#k 13fi2l00 5-3' V) AMOUNT TO BE 1-AID9Y.,C4, I4EDICARE PAYMENT. •.', +„':3''-:;yi6't`.`.;• ' `t; —15$.42,»' OJ 052813. MEDICARE ADJIT3TidEN2�",. .r,'*:: 061313 65 SPEC MEDGAP `PA'YMENTir"'f'r E„{ ^"M •';� ' W %I 062413 BALANCE CORIiECTZ027,=AEI =::E.fr.r=;u't .-'', .w1 OOU j) r ..�,k<::.� 3 ,- •.:} ;arisurance Balaacs: 0.00' i:k .z y:Patient Balii Ice: ?;; 38. iy ..t1,,.',M.:d'1yaKN• s^j it :i''} ry it :.F qv All ' i ' �✓..:ivta`:t4r F, �Yi •t Vl •ni wi t '!Statement PLEASE INDICATE YOUR ACOOUNT NUMBER WHEN CALLING OUR OFFICE; h Date: 06J25Ji3 1021397 �i -::'s;'.`»r:.,..�.,_:..,f,.,.y r.'C.+;.”:^.y.,.,+:+:,�..,prp•,) rS'.5?rr;�a;y;n.,.. ,. PATIENT BA i current 31=60 flays 61-90 Days >90""D$ys• Total Ins'Pedding PAVTHISM 0.00 .000• 0.00 ` ; " 3;8';p61. 0.00 Iy"'.t.'.iT1nw(w xr�.�i�...f� !n?J..�✓.'+?'4'(v ...yr..,1r.,. ,:,R 4M irrvehT j.a✓. .....:...,.e.. — A' i Yx .4=. oh:"r. nY r A�A?;=�C'f:SS;tY h<F:'.>^ Jas)^n>;•Ii•+» "`Y {$ENt?.IN403EStPAY�7Y o ti'�'�e�.r'.'.+ �3 )i.=i : 'F!''•'.`sa� R '^.'Z%�' y „^”. ?jsPH TA \5rb,NKO F ap cs`.n '' tit a'i j_S"?°r7 . :„ �.i'r�.�n- .rtl` ''e�•f ? t CARLISLE]KMA,,B 9• CI'A#��dANAOEMfeayt��i.,� } r >.'Ef0]-0BOXel28 '6$9 �' `> ! ( 4��dtie� •``}S�'T�"�»�q,y"�,sgir�`��tf e.rv� Ni.'.�1�lb Fd '�i'� l� '"y' r. rt Ykxl�h ��V^��,�4K��,L )�S t,"�}'!.,'`1FC�'ff�f�r"�tY"�lF�h� ^' ) \ f•��Y TL'�ti'I'd'7�, GA'r✓"3r0$84362..9 err c.3t ,?'�`h'�.�.�r `:5,.'� :t gg"i3q'tz,)t;'Iw,4"rat !'r.'Ya'#�"�+,,gia,�~•�{�i Sri" ��{sr��'"d3i�rr',cil,r� �}r�a.�+.�,✓`x>dts ��j: � NOTE:Charges and paymonis not appearing on this statement%vM appear on next monthe statement 8 i r t YSL6B00000 \ U) ; I. O O Z O N N N O m m m C m x o 0 m rn Q y Ur N °' N mc N N N N O. . B o y c o m m r C a• m Q m m m ° < C7 3 ° co o Z m 00l o o m v a >i 03 CD w I il40 3. m m O Co z c m N b n ('v m :o. ❑ OC <n o v d ` Rto 1 N- � m °. G N 0) p C m � CD 3 � CD CD m 3a `D m m Jf� m r ° � ° Cn CD }1i m N T. m SV n N x� aF C Ii p' O °) "m0 N O G N N .{ ¢"i3"r n59 -x3"� ? yy .T -r O 7 �. .6 0 cr d r 3 CO c•. D w m e O o g m ' N f�9 f ✓ CO e V N O .d.. O d W CD t1 OJ m N = 2 D o CL 0 Co CD D m Z D < .n 3 =O c ° iii >; UZD °: co v -I 3 3 m c � gp m Y rnm O mo c -n m 22 T �.°. N� T N O �Y ¢ �� C D= =Ip WM '� 1'a Qm0 y - .O;'y � � .RI 'O� o. a ' '4 �'�e.,�. ct- � C7 �y N co y 61 ti 7 0 co 3 w m Ln 3 � D. m p m 7' W f N N to Lp 0) 3 N x' . W ca CD CD w m � N N 0 o m 5 W) m v DEC 0 4 'r.`,i,a ON&McMIGHt LAW OFFIM DEUYE6YADDRESSI"-- - A FOUNT P " ,CP X20 'TERtdS: PREVIOU$BACANCE G ra f !). #w� aQOVETF1NkNf1IF4� yS'6'49S7� 4S�'p04p08g WB' COD llS27O� 00 - - a^ 1D� 'zC `L23L1S..-•.>PA :1:7013 ...- 7119/13 --:•333NOQ- -�0 DEOB£E:4AYS 3UJU1�—, �+� z iwlc&iG #110thA BY'THE GALL 02 U5/19 128 10 Q OUl 257 8 URIV HOOV ER;: ANNA 12103/12 113 90...:0 Co Lu f� o O C� o 21 STONEHOU3E RDA ter-- -� �,* o _ o CARI,IS�I . '�}1. 17.013 t -: PRINTE9 .FC DATE CARUS(LE,; i`-- INSTRUCTIONS '�� .... iNIE CQMPAANY 11/26/13' N - 11!26/13 No,Delivery Notes P.O.B07t 577 .GALLONS -<PAICE AMOUNT 4®'S{ 1_..-r Q• . . CBRUSLErPA Bj 1®• LD C� ,. ', 77073 2_:599 Z,�j J1 o y ( a� �t' (797)2943992•. . t O 1 -, �S TAX 1 a N , ter{ l ' .. ;• Tig4t . 1071803 EwoJUSBAVwCE C3 NO. n cc DELD SUB TOTAL _—"'•�C flECENED BV .r PAVUISAMOUNT ~— DRIVER PAID 0 YES OffACCOONT ❑ PA. SY DUE ❑ NIA{" Ea rCL l.: i CARLISLE PROPANE COMPANY co M. visa &177)'149-3112 N :0 �MASTERbAA p . . Q D P W(V JSSALENG. CODE GALLONREADING.STARt tONs m r. ,�- tiYbUR¢ALENO. +.��- GALL��tJ REA 1NC.. ISHf • . ... 2 Hr U R�SRt i St,�. H ui i T3 a'I rlt -i. 'D ' �.Q m Fi a: ti rtY .03 In V i IV . 'Z U! 2• ❑ r ; ' m o rox a NII,yr c o t 1 V 9Oa D.. v� .j raotCn.0 ,-• r ,= .. t C OF w r�X ah" 9 m two D L .. g ds y U C7 Ol C7� rz • y<y < Z X- Z D 37 m c o z j D "� m m �C ut z N > �9 C ` t . .. 1....' `.. �.: 1..: Pay By Phone:1-877-720-1583 N Phone PIN:1220802890000 N ADVANCED DISPOSAL SERVICES Advanced HARRISBURG.LC �j 1AUGHN RD. Advanced Disposal is a company bringing fresh ideas and D� IPPENSBURG PA 17257 solutions to a dean environment. How can we further help M your business or home become greener and cleaner? rr � Visit us at www.AdvancedDisoosai.com. C�1 RETURN SERVICE REQUESTED If payment Is not received by due date you maybe V• 005356 000002253 assessed a service charge of at least$5.00 or 1.5%of fillnII1 1111��f111111�111I111 Jill 11 11111 111" the unpaid balance. +�.yI is ANNA M&DOROTHY J TAY HOOVER 218 STONEHOUSE 170 RD CARLISLE PA 17015-9429 m Account Information Previous Balance $88.62 Account Number LCO80209 07/10/13 CASH •$44.31 Site Number 0000 Payments and Adjustments -$44.31 Invoice Date September 30,2013 Invoice Number LC0003288041 ANNA M&DOROTHY J TAY HOOVER(0001) Account Summary 216 STONEHOUSE RD CARLISLE.PA Previous Balance $88.62 Payments/Adjustments -$44.31 Date Description Reference /(Qty Unit Price Amount Current Invoice Amount $44.31 1.00.0.50YD:RESID TRASH(002) 09/30/13 STANDARD TRASH:101011133-19131113 3.00 14.77 44.31 Amount Due $88.62 SITE TOTAL 4431 Due Date October 31,2013 Invoice Breakdown Current Charges $44.31 Current $44.31 Amount Due $88.62 30 days-past due $0.00 60days-pastdue $0.00 \ 90 days-past due $44.31 Ifs easy being Green-sign up for ebill and auto pay at -, http;/hwnv.AdvancedDisposal.com @fllpey Contact Us (800)338-8971 shippensburg @advanceddisp?ealxom L0130027,p01.tz1.10711-000DD2253 �VVVf�w BEAR VALUEDCUMME8; At Advarmed Oisposal,v a us eommiffed't6 pravidins the bast possible customer cam experience.Wa have Implemented mare thorough trai ft programs to improve Ourcustamr relation's and hive updzied gaitdephariasystem to brinE you the qualilyserviceycu deserve Part of our Communication lmpavemmt efforts hsiludes providilmyou with more wgsto reach}marAdvancedDisposel service team,NcluNnglilm local office number,ourtdl-hee service center and a cus(omet ca eema @,all grnated espedaVy for.ymL We knowymid find.these rmpraalments as belyfd 4$wadD.ShouNyousceed egyasslstance or imvequesUpns sbautynus saMa,ireie fiereta[xipend etyaur�spaset, Shcertt,YaurhdvanW DispasalTeam Toll-free Customer Core Con left 091338.8911 1 tocall)ffice;(814)265.1975 AdvanCW i poSW Customer Care Email;Cf rpCustomet5ervica�AdvatreadDlaposal.eom M N °o �� 00BOX6539r6 Important Messages ETROIT,MI48255.3916 m Effective August 1,2013 we are standardizing M" Advanced our Administrative Fee that may impact your W) Dispo.a1 Return Service Requested next invoice charges. ce v r 6334038570 PRESORT 185701 AV 0.360 PIC64<B> tlurld��uhh�llhd��rl�ptNlllllll�lllllrllhh��lll.III ANNA M&DOROTHY J TAY HOOVER [wx 216 STONEHOUSE RD FYaY CARLISLE PA 17015-9429 Involce bate Invoice Number Customer Number Service or Billing Address 61=20J3. 0003272921;_ 080289. ANNA M&DOROTHY J TAY HOOVER- 216 For Inquiries,Call CARLISLEE A017015.9429 Service:(717)423-5383 Statement Detail .-IWw •3.v2-,, SERVICE DATE CODE DESCRIPTION REFER ENC O",-% ANTITY AMOUNT Balance Forward,;,, 44.31 Payments ,,q,'.``•T <":.� 0.00 Adjustmeri�s-v..x' r'< 0.00 Invoices ="� ,�„ 0.00 (D001) 9Np.'A,jv1SD,OROTHY J TAY HOOVER , 1!Y161.y#T,;,M ROUSE RD CARLISLE,PAP 06130/13 11 F';,:.al"i'ANDARDTRASH T.� - 3:00 44,31 `lr7f1/2013-91301"2013 -,'F; �•', Site Total 44.31. TOTAL THIS INVOICE 44.31 PLEASE PAY THIS AMOUNT 68,62 Account Status CURRENT - -31-60 DAYS >,O�'61-90 DAYS OVER 90 DAYS 44.31 `-',,, 9.00 ; -,�;,� .�.'''. 0.00 44.31 Thank you for your buslnessl II you have questions raganfing your Invoice Remember to follow us on facebook. please give us a call and we all be happy to assist you (717)421.5383 v Jacebook.comladvancedtlisposal page t of 2 Keep this portion for your records-Please return lowerportion with your payment. 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D O r to GD 2 n m O cn cn v� N CT A z S 4:� (n m r vi D cr'r'a N O yri m r D A:.. 11 N ... 1�. r N r• O ➢ m w A A A A A W m � to A ixt �$5 yt 3vn� .I �waxrt;Y,. N m Cn w w w [,n�yM4a A C z•D co Qm m O 3 C.,✓a',y�, w w m CA) wwww o m v Q at r �'to '^ >v 2 m m °s ' � 33yyvm gj 3r m i G) (DY ��TO.S 4 d IIl 0 -C4, , { C-) i ° o tf c• CD CD D a -4 F° N 'NO �' k�a 0 Z CNT m N �gr��+�'' ` 6 rc (0 Ln V a yp i Y { ' to • o��.. � o �� ${ `�r Z 90ggif� O A i M z A R A c :z a A fay o j, O Y Cn .� Q' rt A ? t0 t7) ••,; o ----:v V C 0 v o K i N D. 3 0 DO ° €m yy.' r a fl of a ,tom s s in co, CO sVLSyS5 v61i v u ,pyyT G •C CO G CA 3 UI O ' � � A V V -1 ; Account r 1`E-1111, r r • YlW4Y 3 vX.R. , 7/2/201 $99.T9 GUnRftftd;G'06wMr1 "e 32424 13 PO Box 726 New Cumberland,PA 70-0726r�r w QUESTIONS ABOUT THIS BILL? Ptione:877-214-6018 Espa6ol:866-724-4114 Fax:717-214-6020 ema!l:Info @ambutancebl111ngofTico." Date of Service: 3/182013 20:00 Please visit our website to provide insurance or make payment, and Patient Name: HOOVER,ANNA for additional payment options and frequently asked questions; Prom Carlisle Regional Medical Center wwwambutancebillingoffice.com To: HERSHEY MEDICAL CENTER r-n•x4•c:,r, -erx,e;�,:. r,••"c,^' .w i3r�j'> 7e�°?,:r^hvz " .;�'tts ,e• !ti'r--w si'•v� ;yts `,y-> .rc�: '.:Mgdic�ai�elius pairl-tligtr:p'j`�o;�oS`i;b,f7�r�s� gest� rir3tanc,6}d ��r t,}�pur";`�,s�',t s�ilj? f y'6 aygpF��me7a�d isitrrpt`. "y.i',�' ' Ir '2S ' '.,mot h':.^4:t+'"ti*"�S "w�,�x:'m r�y�g::s+,�t,, i�7�.-'ti!"'' " s. �"' nc>aYt1' `tt�C t u�-•`-aka x '��'r'`•,G'� 4 ,, ";it�hrch;caversrlhisrco-f7�'a'j,amo�7n �leatg�$mple e'he backo a re r� c'�'C'o�a'O`ou>ybrttrn o �{�l'han�`otr�'� >� .!ti: ?:.^`."`=T-x'k1`Y::.v�R�.>; .,a.�c�a::Xw:J:��t5.`'k'x��«.mi��'�r'L:�'.'x'--`�`�::1:•�."��LN'��"'' rr-,`'rz�'.Atyr ia,y`}ir -^o��.1-G`•:`.�#:2. v».� 3118113 -AL$Non-Emergency Transport A0426 1.0 1,655.94 1,555.94 3/18/13 .Mileage A0425 34.9 . 13.40 467.66 3/18/13 Adjustment-Insurance -1,414.27 5/08/23 Adjustment-Insurance -113.39 5106113 Payment -198.: 5/08/13 Payment -197.! TOW 2.023,60 -1,527,66 -396; . DETACH AND RETURN BOTTOM PORTION WITH YOUR PAYMENT. Account #: 140321456 Please Pay: $15.0 ... . ..... ... . ... . . . . .. ......___.- — Due gate: 09113113 payments ,3 Date Description Amount Adjustments cy BALANCE RWARD LAST STATEMENT 0.00 rn 03/18/13 99214 OFFICE VISIT ESTABLISH PT 125.00 n 04/25/13 OTHE DENIED BY INS CO 0.00 45 06/20/13 MCCK MEDICARE CHECK -50.04 06/20/13 MCWO MEDICARE WRITE OFF -49.95 v 08/22/13 INNV INS NO LONGER VALID 0.00 i A Word About Your Account Y Total Now Due 15.01 Make Checks HOSPITALI.STS OF CENTRAL PENNSYLVANIA For Billing Questions Call Payable To: PO BOX 82722 (888) 610-8 322 t BALTIMORE,MD 212642722 n vaxvYx.xs PAGE 1 OF 1 This statement is for services rendered by Genoptix, Inc. You can find more information about o �p services by visiting our website at www.genoptix.com. If you have questions regarding this tp statement, please contact us at the phone number listed below or by email at: billing @genoptix.c N Please disregard this statement if you have recently mailed in a payment. .Lr) Para communicarce con un representante en espanol, porfavor de llamar al 1-800-755-0802. o Tofiike payments or view your account, please go to www.MyLabBill.com. C) 1v m InANNA HOOVER (717)295-0408 ;;{tz x' 0`3628 '� �, 07/02/13 d' T' 03/1`9/1 881871 g.LOSS CYI'ONETE�l, IN�TER�,,2 BM�4F2KER5#ARV,, 'l,0 ; ^ 77 DO''` 09/21/13 BAYMENT ^�MEDYCARE�S GALYFORNI7} PAA 0.4/3'1/13 • AD'JVTMENT 6:72 OS`/,03/13 'SERVICES BILLED TO.1-W' .. . •. - ' - 04/11/13 $14.06 APPLIED TO YOUR COPAY/COINSURANCE PER ME ICARE-S CALI 04/11/13 MEDICARE-S CALIFORNIA PART B FWDD TO HUHANA 07/02/13 ***Your insurance is requesting additional infoxmation from 9702/13 you to process your claim please contact our f to 07/02/13 assist us in.getting:your' claim processed",a It thi In �_t" rdj k - ` il, * . ; f i:s banA .07A2/13 ra a IE tie e o not iecive,a :rsponse , e : bi8y **: *+ ' e 7/02/13 y ponsi ' #RVEY. S_HOTC ER-!, 'i i f CURRENT DAYS 1-90 DAYS 91-120 DAYS OVER 120 DAYS 14.06 - 0.00 0.00 0.00 0.00 IB _ • 11 FOR QUESTIONS CALL: WRITE ACCOUNT NO. ON YOUR TOLL FREE: 1-800-755-0802 I CHECK AND MAKE PAYABLE TO:GENOPTIX MEDICAL LABORATORY HOURS: MON-FRI 7:O0AM-5;00PM PACIF FAX:. 760-516-6062 FOR ASSISTANCE VISIT www.MyLabBill.com using Access Code GK-403628 A SEE A8ICEASE SID EPAJMPOftTAtyz,BILL%G INFORMATION _ —^..w. e,nn7aoon ¢. ypvmrol .7?4f.•sans ,rov,� ; f COMMONWEALTH OF PENNSYLVANIA ' PUBLIC SCHOOL EMPLOYEES' RETIREMENT SYSTEM ® PSERS Toll-free. 1.888.773.7748(1.888.PSERS4U) 5 N 5th Street Local: 717.787.8540 Harrisburg PA 17101-1905 www.psers.state.pa.us m 0) June 28,2013 � d � IJUL 0 8 2013 KAREN S NOEL IRWINEMcKNIGH? IRWIN & MCKNIGHT ;.AWOFFICES W POMFRET PROFESSIONAL BLDG 60 W POMFRET ST CARLISLE, PA 17013-3222 RE: Anna Hoover SSN: Dear Ms. Noel: The Public School Employees' Retirement System (PSERS)is processing the benefit of Anna Hoover. PSERS issued the following monthly retirement benefit(s)prior to processing the death benefit: Check Month Check Amount March 2013 $ 80.52 Anna Hoover was untfrom March 1, 2013 to March 19,.2013 in the amount of 97. Therefore, please reimburse PSERS $29.55, which rep sents the total of the monthly benefit paymen and debts (if applicable) listed above, less the prorated amount. Please make your check or oney order payable to Public School Employ es' Retirement System and send it to the above dress within 30 days. Please retain this information for preparation of the member's final tax return. If you have any questions, please contact the PSERS Member Service Center by calling toll-free 1-888-773-7748 (1-888-PSERS4U). Harrisburg local callers, please use 717-787-8540. To contact PSERS by e-mail, use the following address: contactPSERS @pa.gov. For your convenience, the Member Service Center is staffed each business day from 8:00 a.m. to 5:00 p.m.: For more general information, you may visit PSERS online at: www.psers.state.pa.us. Sincerely,. Pa k& .5c6d $4&veea r ;Zetvaeos we .Scyafw Iillll[l III�Il IIIIIIIIIIIIIII��IIII�IIIIIIIIIIIIIIIQIII�lllllllllll[IIIIIIIIIII�II[IIIIII�II 1111I�IIIII�III�llllllllllllllll[II[IIIIIIIIII[IIIIIIIIIIIIIIIHI��IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIillllll NNNdSM»Ni>M�R f 1300113665 0 U) o °v PA-40-2013 Pennsylvania Income Tax Return t9 ENTER ONE LETTER OR NUMBER IN EACH BOX H 7 �— N Extension. N Amended Retum. R Residency status. HOOVER PA Ruident/NonresidentlPan-Year Resident from to ANNA M Occupation RETIRED D SingldMarried,Filing Jointly/Matrlcd, Fling Sepamtely/Final Return Occupation Y Deceased `( Taxpayer Date of Death 031913 N Spouse Date of Death 60 W POMFRET ST N Farmers. CARLISLE PA 17013 SchcolDlstrict Name CARLISLE AREA 21110 - la Gross Compensation.Do not include exempt income,such as combat zone pay and la 0 qualifying retirement benefits.See the instructions. lb Unreimbursed Employee Business Expenses, 1b 0 lc Net Compensation,Subtmct Line lb from Lino Ia. 1C D 2 Interest Income.Complete PA ScheduleA if mquired. 2 284 3 Dividend and Capital Gains Distributions Income.Complete PA Schedule B if required. 3 408 4 Net Income or Loss from the Operation of a Business,Profession or Farts. 4 0 5 Net Gain or Loss from the Sale,Exchange or Disposition of Property. 5 0 5 Net Income or Loss from Rents.,Royalties,Patents or Copyrights. 6 1035 7 Estate or Trust Income.Complete and submit PA Schedule J. 7 0 8 Gambling and Lottery Winnings.Complete and submit PA Schedule T. 8 0 9 Total PATaxable Income. Add only the positive income amounts from Lines lc,, 9 1727 2,3,4,5,6,7 and 8. DO NOTADD any losses reported on Lines 4,5 or 6. 10 Other Deductions. Enter the appropriate code-for the type of deduction. N 10 0 See the instructions for additional information. 11 Adjusted PA Taxable Income.Subtract Line 10 from Line 9. 11 1727 1555 REV OIWJ14 FRO EC Page t of 2 FC 1300113665 ® ® 1300113665 1 1300213671 ''- PA-40-20t3 O Social SeauityNumber ,• to ' O °v Names) ANNA M HOOVER to 'T12 PA Tax Liability.Multiply Line 11 by 3.07 percent(OA307). 12 53 T13 Total PA Tax Withheld.See the instructions. 13 0 14 Credit from your 2012 PA Income Tax return. 14 0 15 2013 Estimated Installment Payments. REV459B included. N 15 0 16 2013 Extension Payment. 16 0 17 Nonresident Tax Withheld from your PA Schedule(s)NRK-1.(Nonresidents only) 17 0 18 Total Estimated Payments and Credits.Add Lines 14,15,16 and 17. 18 0 Tax Forgiveness Credit. Submit PA Schedule SP. l9a FilingStatus: 01 Unmarried or Separated 02 Married 03 Deceased 19a 00 19b Dependents,Part B,Line 2,PA Schedule SP 19b 00 20 Total Eligibility Income from Part C,Line 11,PA Schedule SP. 20 Q 21 Tax Forgiveness Credit from Part D,Line 16,PA Schedule SP. 21 0 22 Resident Credit.Submit your PA-Schedule(s)G-R with your PA Schedule(s)G-S,G-L and/orRK-1. 22 0 23 Total Other Credits,Submit your PA Schedule OC. 23 0 24 TOTALPAYMENTS and CREDITS.Add Lines 13,_18,21,22 and 23. 24 0 25 USE TAX.Add amount.See instructions. 25 0 26 TAX DUE.If the total of Line 12 and Line 25 is more than line 24,enter the difference here. 26 53 27 Penalties and Interest'.See the instructions. Enter Code: 27 0 If including form REV-I630/REV-1630A,mark the box. N 28 TOTAL PAYMENT DUE.See the instructions. 28 53 29 OVERPAYMENT.If Line 24 is move than the total of Line 12,Line 25 and Line 27,enter 29 0 the difference here. The total of Lines 30 through 36 must equal Line 29. 30 Refund—Amount of Line 29 you want m a check mailed to you. Refund 3 Q Q 31 Credit—Amount of Line 29 you want as a credit to your 2014 estimated account. 31 0 32 Amount of Line 29 you want to donate to the PA Breast Camas Coalition's Breast 32 0 and Cervical Cancer Research Fund. 33 Amount of Line 29 you want to donate to the Wild Resource Conservation Fund. 33 0 34 Amount cfLine 29 you want to donate to the Military Family Relief AssistanceProgram. 34 0 M Amount of Line 29 you want to donate to the Governor Robert P.Casey Memorial Organ 95 0 and Tissue Donation Awareness Trust Fund. 36 Amount of Line 29 you want to donate to the Juvenile(Type 1)Diabetes Cure Research Fund. 36 0 Signature(s).Underpenalties of perjwyj(we)deetate nut i(we)have examined Otis rtum,including all accompanying schedules and sutements,and to the belt of my(our)belier,they are we,eortxt,and complete. YourS)gnawre'. Spouse's SignaNre,if filing jointly Preparer's Name and Telephone Number Date E•File Opt Out N PATRICIA A• ROSENDALE CPA, LLC 041314 7172433184 Firm FEIN 205334904 Preparer'sP rN P00099907 Page 2 of 2 1555 REV 07/OTHd PRO L 1300213671 1300213671 J NOISIAIO XV133NVII83HNI m Inr SMI lenplalpul jo neamg